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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT JKN

( LPLPO ) JKN
UPT PKM : PEUREULAK KOTA BULAN : JANUARI
KECAMATAN : PEUREULAK KOTA TAHUN : 2016
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 753 753 345 408 300


2 Acyclovir tab 400 mg Tablet 0 0 0 0 0
3 Allopurinol 100 mg Tablet 6256 6256 1772 4484 0
4 Aminofillin tab 200 mg Tablet 0 0 0 0 0
5 Amitriptillin 25 mg Tablet 0 0 0 0 0
6 Amlodipin 5 mg Tablet 5573 5573 697 4876 0
7 Amlodipin 10 mg Tablet 5797 5797 145 5652 0
8 Amoksisillina kapl 250mg Tablet 1760 1760 184 1576 0
9 Amoksisillina kapl 500mg Tablet 14253 14253 6393 7860 5000
10 Amoksisillina sirker 250 mg / 5 ml Botol 1203 1203 393 810 0
11 Ampisillin serbuk Inj 1000 mg/5 ml Ampul 0 0 0 0
12 Antasida Doen Tab Tablet 0 0 0 0 0
13 Antasida sir Botol 1256 1256 639 617 0
14 Asam Ascorbat ( Vit.C ) 50 mg Tablet 28489 28489 5233 23256 0
15 Asam Mefenamat 500 mg Tablet 25618 25618 4034 21584 0
16 Attapulgite 630 mg Tablet 1140 1140 696 444 0
17 Atropin Inj 0,25 mg/ml Ampul 0 0 0 0 0
18 Betametason Krim Tube 827 827 140 687 0
19 Bedak Salisil 2% serbuk Kotak 140 140 125 15 100
20 Carbamazepin 200 mg Tablet 380 380 160 220 500
21 Deksametason 0,5 mg Tablet 45054 45054 6427 38627 0
22 Deksametason Inj 5 mg/ml Ampul 141 141 35 106 0
23 Diazepam Tab 2 mg Tablet 1139 1139 452 687 0
24 Digoksin 0,25 mg Tablet 150 150 0 150 0
25 Dipenhidramin Inj Ampul 120 120 25 95 0
26 Domperidone Tablet 1379 1379 893 486 1000
27 Erytromicin Syr Botol 731 731 72 659 0
28 Etanol 70 % cairan 100 ml Botol 213 213 27 186 0
29 Ferro Sulfat 300 mg Tablet 0 0 0 0 200
30 Fitomenadion Inj Ampul 307 307 0 307 0
31 Fitomenadion Tablet Tablet 9520 9520 830 8690 0
32 Furrosemida tab Tablet 0 0 0 0 0
33 Garam Oralit Pcs 868 868 244 624 0
34 Gentamisin Tetes Mata Botol 0 0 0 0 0
35 Glibenklamida tab 5 mg Tablet 327 327 327 0 0
36 Glimepiride 2 mg Tablet 1610 1610 50 1560 0
37 Glukosa Lar. Inf 5 % Botol 198 198 0 198 0
38 Griseofulvin tab 125 mg Tablet 2309 2309 468 1841 0
39 Hidrokortison Krim Tube 571 571 144 427 0
40 Ibuprofen tab.200 mg Tablet 3721 3721 1462 2259 0
41 Kaptopril 12.5 mg Tablet 3616 3616 502 3114 0
42 Kaptopril 25 mg Tablet 197 197 40 157 500
43 Kaptopril 50 mg Tablet 80 80 80 0 500
44 Kals Laktat tab.500 mg Tablet 0 0 0 0 0
45 Klorfeniramine Maleat (CTM) Tablet 0 0 0 0 0
46 Ketokonazol tablet 200 mg Tablet 606 606 542 64 1000
47 Ketokonazol cream Tube 13 13 5 8 50

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

48 Kloramfenikol salep mata 1% Tube 718 718 104 614 0


49 Klorpromazine inj 5 mg/ml Ampul 0 0 0 0 0
50 Kodein HCL 10 mg Tablet 690 690 262 428 0
51 Kotrimoksazol Susp Botol 1243 1243 298 945 0
52 Kotrimoksazol 480mg Tab Tablet 17696 17696 2268 15428 0
53 Levofloxacin 500 mg Tablet 1136 1136 126 1010 0
54 Lidokain HCl 2 %+ Epinefrin Ampul 0 0 0 0 0
55 Loperamide 2 mg Tab Tablet 0 0 0 0 0
56 Loratadine Tablet 248 248 248 0 1000
57 Metilergometrin salut tab 0,125 mg Tablet 1624 1624 70 1554 0
58 Metoclopramide 10 mg Tablet 8444 8444 656 7788 0
59 Metronidazole 250 mg Tablet 2144 2144 716 1428 0
60 Metronidazole 500 mg Tablet 7076 7076 610 6466 0
61 Mikonazole Cream 2% Tube 1247 1247 160 1087 0
62 Natrium Diklofenak 50 mg Tablet 630 630 630 0 0
63 Natrium Klorida 0.9 % Botol 294 294 20 274 0
64 Nifedipin 10 mg Tablet 2094 2094 330 1764 0
65 Nistatin 500.000 IU/gr Tablet 0 0 0 0 0
66 Omeprazole 20 mg Kapsul 7962 7962 2180 5782 0
67 Omeprazole Inj 40 mg/ 10 ml Ampul 0 0 0 0 0
68 Parasetamol Syrup 120 mg / 5 ml Botol 4683 4683 498 4185 0
69 Parasetamol Tablet 500 mg Tablet 100308 100308 7860 92448 0
70 Propanolol tab 40 mg Tablet 890 890 130 760 0
71 Pirantel Pamoat 125 mg Tablet 0 0 0 0 0
72 Ranitidin 150 mg tab Tablet 0 0 0 0 0
73 Ranitidin Inj Ampul 140 140 22 118 0
74 Ringer Lactat Infus Botol 2813 2813 101 2712 0
75 Resperidone tab Tablet 0 0 0 0 0
76 Salbutamol 4 mg Tablet 2300 2300 1004 1296 1000
77 Salep 2- 4 Pot 0 0 0 0 0
78 Sefadroksil tab Tablet 0 0 0 0 0
79 Sefadroksil Syr Botol 912 912 113 799 0
80 Setirizine tab Tablet 1145 1145 450 695 500
81 Simvastatin 20 mg Tablet 620 620 310 310 500
82 Tetrasiklin HCL 250 mg Tablet 0 0 0 0 0
83 Vitamin B Complek Tablet 49970 49970 5817 44153 0
84 Yodium Povidon 30 ml Botol 181 181 13 168 0
85 Zink Syr Botol 0 0 0 0 0
86 Zink tab Tablet 0 0 0 0 0

OBAT GIGI
87 Eugenol Cairan Botol 19 19 0 19 0
ALAT KESEHATAN
88 Alat Suntik 2,5 cc pcs 1416 1416 183 1233 0
89 Catgut 2/0 pcs 25 25 5 20 0
90 Catgut 3/0 pcs 420 420 41 379 0
91 Infusion set Anak pcs 0 0 0 0 0
92 Infusion set dewasa pcs 580 580 42 538 0
93 I.V Cateter 20 G pcs 500 500 12 488 0
94 I.V Cateter 22 G pcs 590 590 32 558 0
95 I.V Cateter 24 G pcs 490 490 0 490 0
96 Kapas 250 gr Bungkus 76 76 9 67 0
97 Kapas Berlemak 500 gr Bungkus 0 0 0 0 0
98 Kasa Pembalut 4m x 10 cm Roll 3028 3028 115 2913 0
99 Kasa Pembalut 4m x 15 cm Roll 2650 2650 185 2465 0

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

100 Saveglove ( Hand scun) pcs 1198 1198 139 1059 0


101 Silk pcs 108 108 20 88 0
102 Oksigen tabung kecil Tabung 0 0 0 0 0
103 Oksigen tabung sedang Tabung 0 0 0 0 0
104 Oksigen tabung besar Tabung 0 0 0 0 0
Mengetahui Pengelola Obat PKM
Kepala UPT.Puskesmas Peureulak

(MUHAMMAD JAMIL, SE) (MAY LINDA)


Nip. 19671231 198803 1 345 Nip. 19801004 200801 2 001
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) JKN
BULAN JANUARI 2016
PUSKESMAS : PEUREULAK KOTA

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian


No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
1 Acyclovir tab 200 mg 753 0 753 25 20 100 30 30 20 40 30 30
2 Acyclovir tab 400 mg 0 0 0
3 Allopurinol 100 mg 6256 0 6256 42 40 26 17 57 600 500 60 50 30 52 50 85 30 30 35
4 Aminofillin tab 200 mg 0 0 0
5 Amitriptillin 25 mg 0 0 0
6 Amlodipin 5 mg 5573 0 5573 40 20 24 20 20 160 50 20 24 40 24 20 36 20 40 30 24 20
7 Amlodipin 10 mg 5797 0 5797 15 20 20 15 15 30 10
8 Amoksisillina kapl 250mg 1760 0 1760 50 20 20 20
9 Amoksisillina kapl 500mg 14253 0 14253 152 372 130 106 1102 1134 1000 100 173 170 150 210 186 160 402 190 170 136
10 Amoksisillina sirker 250 mg / 1203 0 1203 10 29 10 12 51 48 45 12 10 27 11 12 14 15 12 21 10 13
11 Ampisillin serbuk Inj 1000 mg 0 0 0
12 Antasida Doen Tab 0 0 0
13 Antasida sir 1256 0 1256 18 18 19 132 42 53 35 18 20 20 20 22 25 20 80 20 19 20
14 Asam Ascorbat ( Vit.C ) 50 mg 28489 0 28489 105 490 134 76 830 822 850 92 100 150 96 160 142 120 394 140 100 130
15 Asam Mefenamat 500 mg 25618 0 25618 200 290 90 90 705 600 450 80 120 100 80 170 86 94 320 176 90 82
16 Attapulgite 630 mg 1140 0 1140 50 200 30 26 30 20 20 30 30 100 30 20 40
17 Atropin Inj 0,25 mg/ml 0 0 0
18 Betametason Krim 827 0 827 8 4 4 23 15 15 5 7 5 5 5 5 4 5 6 4 7
19 Bedak Salisil 2% serbuk 140 0 140 9 4 15 4 10 12 5 7 16 4 4 5 5 5 5 3 3 3
20 Carbamazepin 200 mg 380 0 380 30 30 20 50 30
21 Deksametason 0,5 mg 45054 0 45054 220 192 124 120 1251 1256 1000 142 300 170 104 210 102 180 260 160 190 140
22 Deksametason Inj 5 mg/ml 141 0 141 5 15 10
23 Diazepam Tab 2 mg 1139 0 1139 40 40 49 10 40 16 44 16 20 20 42 20 22
24 Digoksin 0,25 mg 150 0 150
25 Dipenhidramin Inj 120 0 120 15 10
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
26 Domperidone 1379 0 1379 34 26 12 240 145 20 20 20 22 50 20 145 40 26
27 Erytromicin Syr 731 0 731 4 4 11 25 3 3 3 2 3 3 3 3
28 Etanol 70 % cairan 100 ml 213 0 213 3 5 3 4 6 3
29 Ferro Sulfat 300 mg 0 0 0
30 Fitomenadion Inj 307 0 307
31 Fitomenadion Tablet 9520 0 9520 100 310 300 30 10 20 20 20 10
32 Furrosemida tab 0 0 0
33 Garam Oralit 868 0 868 15 12 60 40 20 12 10 10 15 15 5 20
34 Gentamisin Tetes Mata 0 0 0
35 Glibenklamida tab 5 mg 327 0 327 40 40 20 36 24 26 19 20 20 24 18
36 Glimepiride 2 mg 1610 0 1610 20 10
37 Glukosa Lar. Inf 5 % 198 0 198
38 Griseofulvin tab 125 mg 2309 0 2309 20 20 20 20 220 20 30 36 24 20
39 Hidrokortison Krim 571 0 571 5 4 5 4 15 8 15 8 8 5 7 5 8 7 12 6 5 5
40 Ibuprofen tab.200 mg 3721 0 3721 46 30 36 20 300 340 350 56 24 40 30 20 20 30 30 20
41 Kaptopril 12.5 mg 3616 0 3616 30 20 24 20 180 16 24 18 24 20 16 30 20
42 Kaptopril 25 mg 197 0 197 20 20
43 Kaptopril 50 mg 80 0 80 80
44 Kals Laktat tab.500 mg 0 0 0
45 Klorfeniramine Maleat (CTM) 0 0 0
46 Ketokonazol tablet 200 mg 606 0 606 50 30 30 220 15 24 48 20 30 30 20
47 Ketokonazol cream 13 0 13 5
48 Kloramfenikol salep mata 1% 718 0 718 5 3 3 20 10 10 3 5 4 3 3 5 6 3 4 4
49 Klorpromazine inj 5 mg/ml 0 0 0
50 Kodein HCL 10 mg 690 0 690 20 10 10 10 10 10 10 20 16 20 10 20 20 20 16
51 Kotrimoksazol Susp 1243 0 1243 13 14 7 8 58 50 36 8 7 8 9 7 6 10 9 6 14 14
52 Kotrimoksazol 480mg Tab 17696 0 17696 90 42 36 120 670 430 350 30 30 92 30 32 30 26 52 36 32 38
53 Levofloxacin 500 mg 1136 0 1136 10 10 26 20 30 10

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian


No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
54 Lidokain HCl 2 %+ Epinefrin 0 0 0
55 Loperamide 2 mg Tab 0 0 0
56 Loratadine 248 0 248 30 25 20 40 20 20 60 33
57 Metilergometrin salut tab 0,12 1624 0 1624 20 10 20
58 Metoclopramide 5 mg 8444 0 8444 20 50 30 280 30 30 36 20 30 20 20
59 Metronidazole 250 mg 2144 0 2144 40 30 220 130 30 20 20 30 20 20 56 30 20
60 Metronidazole 500 mg 7076 0 7076 30 30 40 140 30 24 30 30 24 24 32 24 32 20 30 30
61 Mikonazole Cream 2% 1247 0 1247 8 8 7 9 15 7 7 9 10 6 7 7 8 7 8 8 7 8
62 Natrium Diklofenak 50 mg 630 0 630 90 78 72 102 102 96 90
63 Natrium Klorida 0.9 % 294 0 294 20
64 Nifedipin 10 mg 2094 0 2094 220 20 40 20
65 Nistatin 500.000 IU/gr 0 0 0
66 Omeprazole 20 mg 7962 0 7962 138 84 76 68 120 252 80 82 112 150 76 92 92 86 206 106 86 76
67 Omeprazole Inj 40 mg/ 10 ml 0 0 0
68 Parasetamol Syrup 120 mg / 5 4683 0 4683 18 19 13 14 41 72 60 24 17 31 14 19 12 13 20 20 21 23
69 Parasetamol Tablet 500 mg 100308 0 100308 360 494 200 227 1100 1247 1050 172 300 260 180 220 210 130 470 250 240 230
70 Propanolol tab 40 mg 890 0 890 30 20 20 20 20
71 Pirantel Pamoat 125 mg 0 0 0
72 Ranitidin 150 mg tab 0 0 0
73 Ranitidin Inj 140 0 140 5 12
74 Ringer Lactat Infus 2813 0 2813 20 21 4 6 40
75 Resperidone tab 0 0 0
76 Salbutamol 4 mg 2300 0 2300 30 120 30 20 60 120 200 30 30 24 30 20 20 130 30 30 30
77 Salep 2- 4 0 0 0
78 Sefadroksil tab 0 0 0
79 Sefadroksil Syr 912 0 912 5 6 6 6 9 3 3 7 12 3 5 3 4 5 7 5 6 10
80 Setirizine tab 1145 0 1145 24 20 20 50 20 30 30 30 50 20 24 26 36 20
81 Simvastatin 20 mg 620 0 620 40 20 30 40 30 40 30 20 20 20
82 Tetrasiklin HCL 250 mg 0 0 0
83 Vitamin B Complek 49970 0 49970 480 390 150 186 790 570 550 108 200 200 120 288 220 120 410 210 240 130

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian


No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
84 Yodium Povidon 30 ml 181 0 181 3 5 5
85 Zink Syr 0 0 0
86 Zink tab 0 0 0
OBAT GIGI
87 Eugenol Cairan 19 0 19
ALAT KESEHATAN
88 Alat Suntik 2,5 cc 1416 0 1416 20 25 20 18 50
89 Catgut 2/0 25 0 25 5
90 Catgut 3/0 420 0 420 7 5 5 24
91 Infusion set Anak 0 0 0
92 Infusion set dewasa 580 0 580 10 10 10 12
93 I.V Cateter 20 G 500 0 500 12
94 I.V Cateter 22 G 590 0 590 12
95 I.V Cateter 24 G 490 0 490
96 Kapas 250 gr 76 0 76 3 2 2
97 Kapas Berlemak 500 gr 0 0 0
98 Kasa Pembalut 4m x 10 cm 3028 0 3028 20 25 20 30
99 Kasa Pembalut 4m x 15 cm 2650 0 2650 20 20 10 30 20 60
100 Saveglove ( Hand scun) 1198 0 1198 12 10 25 10 15 12 20 10 10
101 Silk 108 0 108 10 10
102 Oksigen tabung kecil 0 0 0
103 Oksigen tabung sedang 0 0 0
104 Oksigen tabung besar 0 0 0

Mengetahui P
Kepala UPT.Puskesmas Peureulak
(MUHAMMAD JAMIL, SE)
Nip. 19671231 198803 1 345 Nip. 1
Pema Stok Ket
28 29 30 31 kaian Akhir
20 345 408
0 0
30 38 1772 4484
0 0
0 0
25 40 697 4876
10 10 145 5652
24 50 184 1576
220 130 6393 7860
15 16 393 810
0 0
0 0
18 20 639 617
200 102 5233 23256
145 66 4034 21584
70 696 444
0 0
6 7 140 687
3 3 125 15
160 220
150 156 6427 38627
5 35 106
20 53 452 687
0 150
25 95
Pema Stok Ket
28 29 30 31 kaian Akhir
20 53 893 486
2 3 72 659
3 27 186
0 0
0 307
10 830 8690
0 0
10 244 624
0 0
20 20 327 0
20 50 1560
0 198
16 22 468 1841
5 7 144 427
40 30 1462 2259
34 26 502 3114
40 157
80 0
0 0
0 0
25 542 64
5 8
4 9 104 614
0 0
20 20 262 428
7 7 298 945
72 30 2268 15428
20 126 1010

Pema Stok Ket


28 29 30 31 kaian Akhir
0 0
0 0
248 0
20 70 1554
60 30 656 7788
20 30 716 1428
20 20 610 6466
6 8 160 1087
630 0
20 274
30 330 1764
0 0
94 104 2180 5782
0 0
23 24 498 4185
260 260 7860 92448
20 130 760
0 0
0 0
5 22 118
10 101 2712
0 0
30 20 1004 1296
0 0
0 0
3 5 113 799
20 30 450 695
20 310 310
0 0
176 279 5817 44153

Pema Stok Ket


28 29 30 31 kaian Akhir
13 168
0 0
0 0

0 19

50 183 1233
5 20
41 379
0 0
42 538
12 488
20 32 558
0 490
2 9 67
0 0
20 115 2913
25 185 2465
15 139 1059
20 88
0 0
0 0
0 0

Pengelola Obat PKM


(MAY LINDA)
Nip. 19801004 200801 2 001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT JKN
( LPLPO ) JKN

UPT PKM : PEUREULAK BULAN : FEBRUARI


KECAMATAN : PEUREULAK TAHUN : 2016
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH
STOK PENERI PERSE PEMA STOK PERMIN
NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 408 0 408 241 167 300


2 Acyclovir tab 400 mg Tablet 0 0 0 0 0 0
3 Allopurinol 100 mg Tablet 4484 0 4484 937 3547 0
4 Aminofillin tab 200 mg Tablet 0 0 0 0 0 0
5 Amitriptillin 25 mg Tablet 0 0 0 0 0 0
6 Amlodipin 5 mg Tablet 4876 0 4876 456 4420 0
7 Amlodipin 10 mg Tablet 5652 0 5652 61 5591 0
8 Amoksisillina kapl 250mg Tablet 1576 0 1576 134 1442 0
9 Amoksisillina kapl 500mg Tablet 7860 0 7860 5542 2318 0
10 Amoksisillina sirker 250 mg / 5 m Botol 810 0 810 260 550 0
11 Ampisillin serbuk Inj 1000 mg/5 m Ampul 0 0 0 0 0 0
12 Antasida Doen Tab Tablet 0 0 0 0 0 0
13 Antasida sir Botol 617 0 617 269 348 0
14 Asam Ascorbat ( Vit.C ) 50 mg Tablet 23256 0 23256 3851 19405 0
15 Asam Mefenamat 500 mg Tablet 21584 0 21584 3091 18493 0
16 Attapulgite 630 mg Tablet 444 0 444 444 0 0
17 Atropin Inj 0,25 mg/ml Ampul 0 0 0 0 0 0
18 Betametason Krim Tube 687 0 687 90 597 0
19 Bedak Salisil 2% serbuk Kotak 15 0 15 15 0 0
20 Carbamazepin 200 mg Tablet 220 0 220 70 150 500
21 Deksametason 0,5 mg Tablet 38627 0 38627 4375 34252 0
22 Deksametason Inj 5 mg/ml Ampul 106 0 106 0 106 0
23 Diazepam Tab 2 mg Tablet 687 0 687 368 319 1000
24 Digoksin 0,25 mg Tablet 150 0 150 0 150 0
25 Dipenhidramin Inj Ampul 95 0 95 0 95 0
26 Domperidone Tablet 486 0 486 486 0 0
27 Erytromicin Syr Botol 659 0 659 30 629 0
28 Etanol 70 % cairan 100 ml Botol 186 0 186 9 177 0
29 Ferro Sulfat 300 mg Tablet 0 0 0 0 0 0
30 Fitomenadion Inj Ampul 307 0 307 0 307 0
31 Fitomenadion Tablet Tablet 8690 0 8690 338 8352 0
32 Furrosemida tab Tablet 0 0 0 0 0 0
33 Garam Oralit Pcs 624 0 624 154 470 0
34 Gentamisin Tetes Mata Botol 0 0 0 0 0 0
35 Glibenklamida tab 5 mg Tablet 0 0 0 0 0 0
36 Glimepiride 2 mg Tablet 1560 0 1560 20 1540 0
37 Glukosa Lar. Inf 5 % Botol 198 0 198 0 198 0
38 Griseofulvin tab 125 mg Tablet 1841 0 1841 230 1611 0
39 Hidrokortison Krim Tube 427 0 427 65 362 0
40 Ibuprofen tab.200 mg Tablet 2259 0 2259 1454 805 1000
41 Kaptopril 12.5 mg Tablet 3114 0 3114 1191 1923 0
42 Kaptopril 25 mg Tablet 157 0 157 116 41 500
43 Kaptopril 50 mg Tablet 0 0 0 0 0 0
44 Kals Laktat tab.500 mg Tablet 0 0 0 0 0 0
45 Klorfeniramine Maleat (CTM) Tablet 0 0 0 0 0 0
46 Ketokonazol tablet 200 mg Tablet 64 0 64 64 0 0
47 Ketokonazol cream Tube 8 0 8 7 1 0

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10
48 Kloramfenikol salep mata 1% Tube 614 0 614 68 546 0
49 Klorpromazine inj 5 mg/ml Ampul 0 0 0 0 0 0
50 Kodein HCL 10 mg Tablet 428 0 428 109 319 0
51 Kotrimoksazol Susp Botol 945 0 945 176 769 0
52 Kotrimoksazol 480mg Tab Tablet 15428 0 15428 1795 13633 0
53 Levofloxacin 500 mg Tablet 1010 0 1010 90 920 0
54 Lidokain HCl 2 %+ Epinefrin Ampul 0 0 0 0 0 0
55 Loperamide 2 mg Tab Tablet 0 0 0 0 0 0
56 Loratadine Tablet 0 0 0 0 0 0
57 Metilergometrin salut tab 0,125 m Tablet 1554 0 1554 30 1524 0
58 Metoclopramide 10 mg Tablet 7788 0 7788 550 7238 0
59 Metronidazole 250 mg Tablet 1428 0 1428 191 1237 0
60 Metronidazole 500 mg Tablet 6466 0 6466 1431 5035 0
61 Mikonazole Cream 2% Tube 1087 0 1087 107 980 0
62 Natrium Diklofenak 50 mg Tablet 0 0 0 0 0 0
63 Natrium Klorida 0.9 % Botol 274 0 274 0 274 0
64 Nifedipin 10 mg Tablet 1764 0 1764 36 1728 0
65 Nistatin 500.000 IU/gr Tablet 0 0 0 0 0 0
66 Omeprazole 20 mg Kapsul 5782 0 5782 1736 4046 0
67 Omeprazole Inj 40 mg/ 10 ml Ampul 0 0 0 0 0 0
68 Parasetamol Syrup 120 mg / 5 ml Botol 4185 0 4185 386 3799 0
69 Parasetamol Tablet 500 mg Tablet 92448 0 92448 8564 83884 0
70 Propanolol tab 40 mg Tablet 760 0 760 80 680 0
71 Pirantel Pamoat 125 mg Tablet 0 0 0 0 0 0
72 Ranitidin 150 mg tab Tablet 0 0 0 0 0 0
73 Ranitidin Inj Ampul 118 0 118 0 118 0
74 Ringer Lactat Infus Botol 2712 0 2712 55 2657 0
75 Resperidone tab Tablet 0 0 0 0 0 0
76 Salbutamol 4 mg Tablet 1296 0 1296 320 976 0
77 Salep 2- 4 Pot 0 0 0 0 0 0
78 Sefadroksil tab Tablet 0 0 0 0 0 0
79 Sefadroksil Syr Botol 799 0 799 74 725 0
80 Setirizine tab Tablet 695 0 695 664 31 1000
81 Simvastatin 20 mg Tablet 310 0 310 138 172 300
82 Tetrasiklin HCL 250 mg Tablet 0 0 0 0 0 0
83 Vitamin B Complek Tablet 44153 0 44153 4983 39170 0
84 Yodium Povidon 30 ml Botol 168 0 168 12 156 0
85 Zink Syr Botol 0 0 0 0 0 0
86 Zink tab Tablet 0 0 0 0 0 0
OBAT GIGI
87 Eugenol Cairan Botol 19 0 19 2 17 0
ALAT KESEHATAN
88 Alat Suntik 2,5 cc pcs 1233 0 1233 65 1168 0
89 Catgut 2/0 pcs 20 0 20 18 2 0
90 Catgut 3/0 pcs 379 0 379 18 361 0
91 Infusion set Anak pcs 0 0 0 0 0 0
92 Infusion set dewasa pcs 538 0 538 45 493 0
93 I.V Cateter 20 G pcs 488 0 488 10 478 0
94 I.V Cateter 22 G pcs 558 0 558 35 523 0
95 I.V Cateter 24 G pcs 490 0 490 10 480 0
96 Kapas 250 gr Bungkus 67 0 67 3 64 0
97 Kapas Berlemak 500 gr Bungkus 0 0 0 0 0 0
98 Kasa Pembalut 4m x 10 cm Roll 2913 0 2913 65 2848 0
99 Kasa Pembalut 4m x 15 cm Roll 2465 0 2465 105 2360 0

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

100 Saveglove ( Hand scun) pcs 1059 0 1059 99 960 0


101 Silk pcs 88 0 88 0 88 0
102 Oksigen tabung kecil Tabung 0 0 0 0 0 0
103 Oksigen tabung sedang Tabung 0 0 0 0 0 0
104 Oksigen tabung besar Tabung 0 0 0 0 0 0
Mengetahui Pengelola Obat PKM
Kepala UPT.Puskesmas Peureulak

(MUKLIS, SKM, M. Kes) (MAY LINDA)


Nip. 19720709 199303 1 003 Nip. 19801004 200801 2 001
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) JKN
BULAN FEBRUARI 2016
PUSKESMAS : PEUREULAK
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian
No Nama Obat
AwalTerima
Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

1 Acyclovir tab 200 mg 408 0 408 25 20 20 16 112 20 8 20

2 Acyclovir tab 400 mg 0 0 0

3 Allopurinol 100 mg 4484 0 4484 52 30 26 47 70 42 25 74 15 422 18 15 25 39 19

4 Aminofillin tab 200 mg 0 0 0

5 Amitriptillin 25 mg 0 0 0

6 Amlodipin 5 mg 4876 0 4876 20 21 25 26 30 20 16 23 100 9 20 16 100 18 6 6

7 Amlodipin 10 mg 5652 0 5652 10 12 12 15 9 3

8 Amoksisillina kapl 250mg 1576 0 1576 26 12 40 20 20 16

9 Amoksisillina kapl 500mg 7860 0 7860 235 215 120 200 150 120 170 120 700 1071 120 60 445 90 795 185 105 110 350

10 Amoksisillina sirker 250 mg 810 0 810 18 6 8 12 14 6 9 14 26 35 15 10 16 11 16 3 5 9 13

11 Ampisillin serbuk Inj 1000 m 0 0 0

12 Antasida Doen Tab 0 0 0

13 Antasida sir 617 0 617 30 21 15 25 15 10 13 15 28 37 15 7 18 5 2 4 1 8

14 Asam Ascorbat ( Vit.C ) 50 m 23256 0 23256 120 177 72 224 90 200 76 116 578 694 73 90 330 140 129 100 73 81 363

15 Asam Mefenamat 500 mg 21584 0 21584 205 200 76 180 70 70 70 90 450 670 55 50 280 50 190 55 110 160

16 Attapulgite 630 mg 444 0 444 20 20 20 20 40 200 26 20 78

17 Atropin Inj 0,25 mg/ml 0 0 0

18 Betametason Krim 687 0 687 5 3 5 7 5 5 3 3 16 19 2 5 4 1 5

19 Bedak Salisil 2% serbuk 15 0 15 3 2 3 3 2 2

20 Carbamazepin 200 mg 220 0 220 30 20 20

21 Deksametason 0,5 mg 38627 0 38627 191 164 120 116 152 110 140 130 740 944 138 135 354 173 365 35 69 82 137

22 Deksametason Inj 5 mg/ml 106 0 106

23 Diazepam Tab 2 mg 687 0 687 20 25 24 30 22 13 14 26 9 62 15 9 10 24 6 3 9

24 Digoksin 0,25 mg 150 0 150

25 Dipenhidramin Inj 95 0 95
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian
No Nama Obat
AwalTerima
Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

26 Domperidone 486 0 486 26 22 32 28 24 22 25 46 15 22 158 28 35 3

27 Erytromicin Syr 659 0 659 2 3 3 2 2 2 7 2 2 1 2 1

28 Etanol 70 % cairan 100 ml 186 0 186 2 3 2 2

29 Ferro Sulfat 300 mg 0 0 0

30 Fitomenadion Inj 307 0 307

31 Fitomenadion Tablet 8690 0 8690 10 16 12 100 200

32 Furrosemida tab 0 0 0

33 Garam Oralit 624 0 624 15 15 14 10 15 10 15 30 5 20 5

34 Gentamisin Tetes Mata 0 0 0

35 Glibenklamida tab 5 mg 0 0 0

36 Glimepiride 2 mg 1560 0 1560 10 10

37 Glukosa Lar. Inf 5 % 198 0 198

38 Griseofulvin tab 125 mg 1841 0 1841 20 20 10 20 35 100 5 20

39 Hidrokortison Krim 427 0 427 2 4 5 4 5 5 4 14 15 5 2

40 Ibuprofen tab.200 mg 2259 0 2259 40 20 20 44 20 4 30 30 400 400 20 10 130 40 200 16

41 Kaptopril 12.5 mg 3114 0 3114 32 18 36 28 30 12 18 12 312 512 18 112 24 15 3 3 6

42 Kaptopril 25 mg 157 0 157 16 100

43 Kaptopril 50 mg 0 0 0

44 Kals Laktat tab.500 mg 0 0 0

45 Klorfeniramine Maleat (CTM) 0 0 0

46 Ketokonazol tablet 200 mg 64 0 64 22 20 20 2

47 Ketokonazol cream 8 0 8 1 1 1 2 2

48 Kloramfenikol salep mata 1 614 0 614 3 3 3 3 4 2 3 20 15 7 5

49 Klorpromazine inj 5 mg/ml 0 0 0

50 Kodein HCL 10 mg 428 0 428 15 14 20 20 10 20 10

51 Kotrimoksazol Susp 945 0 945 13 9 8 5 5 6 4 3 41 35 10 5 16 5 5 2 4

52 Kotrimoksazol 480mg Tab 15428 0 15428 66 78 28 24 30 42 56 41 215 530 70 42 120 18 291 58 18 14


53 Levofloxacin 500 mg 1010 0 1010 14 10 10 10 10 30 6

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian


No Nama Obat
AwalTerima
Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
54 Lidokain HCl 2 %+ Epinefrin 0 0 0
55 Loperamide 2 mg Tab 0 0 0
56 Loratadine 0 0 0
57 Metilergometrin salut tab 0, 1554 0 1554 10 20
58 Metoclopramide 10 mg 7788 0 7788 40 20 20 30 20 33 78 18 200 30 10 10 16 5
59 Metronidazole 250 mg 1428 0 1428 25 10 40 10 30 20 20 20
60 Metronidazole 500 mg 6466 0 6466 520 20 30 10 15 20 600 40 100 30 26 10 10
61 Mikonazole Cream 2% 1087 0 1087 7 6 4 5 6 6 5 4 6 4 15 10 4 2 1 6 2 1 8
62 Natrium Diklofenak 50 mg 0 0 0
63 Natrium Klorida 0.9 % 274 0 274
64 Nifedipin 10 mg 1764 0 1764 20 16
65 Nistatin 500.000 IU/gr 0 0 0
66 Omeprazole 20 mg 5782 0 5782 76 56 64 110 120 64 76 104 200 180 100 64 78 166 22 76 26 54
67 Omeprazole Inj 40 mg/ 10 m 0 0 0
68 Parasetamol Syrup 120 mg / 4185 0 4185 31 7 15 11 17 11 12 15 49 51 15 15 25 17 23 3 10 15 23
69 Parasetamol Tablet 500 mg 92448 0 92448 342 230 125 495 235 240 260 215 1510 1780 221 210 745 270 576 100 170 80 374
70 Propanolol tab 40 mg 760 0 760 10 10 20 10 20 10
71 Pirantel Pamoat 125 mg 0 0 0
72 Ranitidin 150 mg tab 0 0 0
73 Ranitidin Inj 118 0 118
74 Ringer Lactat Infus 2712 0 2712 20 2 9 2 2 20
75 Resperidone tab 0 0 0
76 Salbutamol 4 mg 1296 0 1296 18 21 20 18 18 15 20 40 112 12 26
77 Salep 2- 4 0 0 0
78 Sefadroksil tab 0 0 0
79 Sefadroksil Syr 799 0 799 7 3 3 4 3 2 6 6 5 1 3 5 3 3 1 4 4 9
80 Setirizine tab 695 0 695 23 18 20 30 46 32 15 60 52 25 37 92 67 38 12 30 21 46
81 Simvastatin 20 mg 310 0 310 10 20 20 10 20 20 18 20
82 Tetrasiklin HCL 250 mg 0 0 0
83 Vitamin B Complek 44153 0 44153 300 380 158 160 260 150 200 160 766 600 205 159 183 194 429 85 97 100 180

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian


No Nama Obat
AwalTerima
Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

84 Yodium Povidon 30 ml 168 0 168 4 4 2 2

85 Zink Syr 0 0 0

86 Zink tab 0 0 0
OBAT GIGI

87 Eugenol Cairan 19 0 19
ALAT KESEHATAN

88 Alat Suntik 2,5 cc 1233 0 1233 15 10 15 15 10

89 Catgut 2/0 20 0 20 15 3

90 Catgut 3/0 379 0 379 15 3

91 Infusion set Anak 0 0 0

92 Infusion set dewasa 538 0 538 25 5 15

93 I.V Cateter 20 G 488 0 488 10

94 I.V Cateter 22 G 558 0 558 15 10 10

95 I.V Cateter 24 G 490 0 490 10

96 Kapas 250 gr 67 0 67 2 1

97 Kapas Berlemak 500 gr 0 0 0

98 Kasa Pembalut 4m x 10 cm 2913 0 2913 20 30 10 5

99 Kasa Pembalut 4m x 15 cm 2465 0 2465 20 30 20 5 5 20

100 Saveglove ( Hand scun) 1059 0 1059 10 10 7 35 8 2 7 5 15

101 Silk 88 0 88

102 Oksigen tabung kecil 0 0 0

103 Oksigen tabung sedang 0 0 0

104 Oksigen tabung besar 0 0 0

Mengetahui
Kepala UPT.Puskesmas Peureulak
(MUKLIS, SKM, M. Kes)
Nip. 19720709 199303 1 003
Pema Stok Ket
27 28 29 30 31 kaian Akhir

241 167

0 0

18 937 3547

0 0

0 0

456 4420

61 5591

134 1442

181 5542 2318

14 260 550

0 0

0 0

269 348

125 3851 19405

60 3091 18493

444 0

0 0

2 90 597

15 0

70 150

80 4375 34252

0 106

47 368 319

0 150

0 95
Pema Stok Ket
27 28 29 30 31 kaian Akhir

486 0

1 30 629

9 177

0 0

0 307

338 8352

0 0

154 470

0 0

0 0

20 1540

0 198

230 1611

65 362

30 1454 805

1191 1923

116 41

0 0

0 0

0 0

64 0

7 1

68 546

0 0

109 319

176 769

54 1795 13633
90 920

Pema Stok Ket


27 28 29 30 31 kaian Akhir
0 0
0 0
0 0
30 1524
20 550 7238
16 191 1237
1431 5035
5 107 980
0 0
0 274
36 1728
0 0
100 1736 4046
0 0
21 386 3799
386 8564 83884
80 680
0 0
0 0
0 118
55 2657
0 0
320 976
0 0
0 0
2 74 725
664 31
138 172
0 0
217 4983 39170

Pema Stok Ket


27 28 29 30 31 kaian Akhir

12 156

0 0

0 0

2 2 17 E.D 7

65 1168

18 2

18 361

0 0

45 493

10 478

35 523

10 480

3 64

0 0

65 2848

5 105 2360

99 960

0 88

0 0

0 0

0 0

Pengelola Obat PKM


(MAY LINDA)
Nip. 19801004 200801 2 001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT JKN
( LPLPO ) JKN

UPT PKM : PEUREULAK BULAN : MARET


KECAMATAN : PEUREULAK TAHUN : 2016
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH AC

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10
1 Acyclovir tab 200 mg Tablet 167 0 167 145 22 0
2 Acyclovir tab 400 mg Tablet 0 0 0 0 0 0
3 Allopurinol 100 mg Tablet 3547 0 3547 851 2696 0
4 Aminofillin tab 200 mg Tablet 0 0 0 0 0 0
5 Amitriptillin 25 mg Tablet 0 0 0 0 0 0
6 Amlodipin 5 mg Tablet 4420 0 4420 310 4110 0
7 Amlodipin 10 mg Tablet 5591 0 5591 92 5499 0
8 Amoksisillina kapl 250mg Tablet 1442 0 1442 220 1222 0
9 Amoksisillina kapl 500mg Tablet 2318 0 2318 2318 0 0
10 Amoksisillina sirker 250 mg / 5 ml Botol 550 0 550 311 239 0
11 Ampisillin serbuk Inj 1000 mg/5 ml Ampul 0 0 0 0 0 0
12 Antasida Doen Tab Tablet 0 0 0 0 0 0
13 Antasida sir Botol 348 0 348 239 109 150
14 Asam Ascorbat ( Vit.C ) 50 mg Tablet 19405 0 19405 3501 15904 0
15 Asam Mefenamat 500 mg Tablet 18493 0 18493 2690 15803 0
16 Attapulgite 630 mg Tablet 0 0 0 0 0 0
17 Atropin Inj 0,25 mg/ml Ampul 0 0 0 0 0 0
18 Betametason Krim Tube 597 0 597 97 500 0
19 Bedak Salisil 2% serbuk Kotak 0 0 0 0 0 0
20 Carbamazepin 200 mg Tablet 150 0 150 100 50 300
21 Deksametason 0,5 mg Tablet 34252 0 34252 3636 30616 0
22 Deksametason Inj 5 mg/ml Ampul 106 0 106 5 101 0
23 Diazepam Tab 2 mg Tablet 319 0 319 219 100 500
24 Digoksin 0,25 mg Tablet 150 0 150 0 150 0
25 Dipenhidramin Inj Ampul 95 0 95 0 95 0
26 Domperidone Tablet 0 0 0 0 0 0
27 Erytromicin Syr Botol 629 0 629 22 607 0
28 Etanol 70 % cairan 100 ml Botol 177 0 177 19 158 0
29 Ferro Sulfat 300 mg Tablet 0 0 0 0 0 0
30 Fitomenadion Inj Ampul 307 0 307 10 297 0
31 Fitomenadion Tablet Tablet 8352 0 8352 210 8142 0
32 Furrosemida tab Tablet 0 0 0 0 0 0
33 Garam Oralit Pcs 470 0 470 152 318 0
34 Gentamisin Tetes Mata Botol 0 0 0 0 0 0
35 Glibenklamida tab 5 mg Tablet 0 0 0 0 0 0
36 Glimepiride 2 mg Tablet 1540 0 1540 300 1240 0
37 Glukosa Lar. Inf 5 % Botol 198 0 198 0 198 0
38 Griseofulvin tab 125 mg Tablet 1611 0 1611 146 1465 0
39 Hidrokortison Krim Tube 362 0 362 65 297 0
40 Ibuprofen tab.200 mg Tablet 805 0 805 542 263 1000
41 Kaptopril 12.5 mg Tablet 1923 0 1923 327 1596 0
42 Kaptopril 25 mg Tablet 41 0 41 0 41 300
43 Kaptopril 50 mg Tablet 0 0 0 0 0 0
44 Kals Laktat tab.500 mg Tablet 0 0 0 0 0 0
45 Klorfeniramine Maleat (CTM) Tablet 0 0 0 0 0 0
46 Ketokonazol tablet 200 mg Tablet 0 0 0 0 0 0
47 Ketokonazol cream Tube 1 0 1 1 0 0

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10
48 Kloramfenikol salep mata 1% Tube 546 0 546 57 489 0
49 Klorpromazine inj 5 mg/ml Ampul 0 0 0 0 0 0
50 Kodein HCL 10 mg Tablet 319 0 319 29 290 100
51 Kotrimoksazol Susp Botol 769 0 769 156 613 0
52 Kotrimoksazol 480mg Tab Tablet 13633 0 13633 1640 11993 0
53 Levofloxacin 500 mg Tablet 920 0 920 61 859 0
54 Lidokain HCl 2 %+ Epinefrin Ampul 0 0 0 0 0 0
55 Loperamide 2 mg Tab Tablet 0 0 0 0 0 0
56 Loratadine Tablet 0 0 0 0 0 0
57 Metilergometrin salut tab 0,125 mg Tablet 1524 0 1524 100 1424 0
58 Metoclopramide 10 mg Tablet 7238 0 7238 101 7137 0
59 Metronidazole 250 mg Tablet 1237 0 1237 100 1137 0
60 Metronidazole 500 mg Tablet 5035 0 5035 1306 3729 0
61 Mikonazole Cream 2% Tube 980 0 980 71 909 0
62 Natrium Diklofenak 50 mg Tablet 0 0 0 0 0 0
63 Natrium Klorida 0.9 % Botol 274 0 274 40 234 0
64 Nifedipin 10 mg Tablet 1728 0 1728 0 1728 0
65 Nistatin 500.000 IU/gr Tablet 0 0 0 0 0 0
66 Omeprazole 20 mg Kapsul 4046 0 4046 1496 2550 0
67 Omeprazole Inj 40 mg/ 10 ml Ampul 0 0 0 0 0 0
68 Parasetamol Syrup 120 mg / 5 ml Botol 3799 0 3799 430 3369 0
69 Parasetamol Tablet 500 mg Tablet 83884 0 83884 7751 76133 0
70 Propanolol tab 40 mg Tablet 680 0 680 62 618 0
71 Pirantel Pamoat 125 mg Tablet 0 0 0 0 0 0
72 Ranitidin 150 mg tab Tablet 0 0 0 0 0 0
73 Ranitidin Inj Ampul 118 0 118 0 118 0
74 Ringer Lactat Infus Botol 2657 0 2657 94 2563 0
75 Resperidone tab Tablet 0 0 0 0 0 0
76 Salbutamol 4 mg Tablet 976 0 976 360 616 200
77 Salep 2- 4 Pot 0 0 0 0 0 0
78 Sefadroksil tab Tablet 0 0 0 0 0 0
79 Sefadroksil Syr Botol 725 0 725 86 639 0
80 Setirizine tab Tablet 31 0 31 31 0 0
81 Simvastatin 20 mg Tablet 172 0 172 50 122 200
82 Tetrasiklin HCL 250 mg Tablet 0 0 0 0 0 0
83 Vitamin B Complek Tablet 39170 0 39170 4068 35102 0
84 Yodium Povidon 30 ml Botol 156 0 156 14 142 0
85 Zink Syr Botol 0 0 0 0 0 0
86 Zink tab Tablet 0 0 0 0 0 0

OBAT GIGI
87 Eugenol Cairan Botol 17 0 17 2 15 0
ALAT KESEHATAN
88 Alat Suntik 2,5 cc pcs 1168 0 1168 30 1138 0
89 Catgut 2/0 pcs 2 0 2 2 0 0
90 Catgut 3/0 pcs 361 0 361 22 339 0
91 Infusion set Anak pcs 0 0 0 0 0 0
92 Infusion set dewasa pcs 493 0 493 53 440 0
93 I.V Cateter 20 G pcs 478 0 478 5 473 0
94 I.V Cateter 22 G pcs 523 0 523 20 503 0
95 I.V Cateter 24 G pcs 480 0 480 5 475 0
96 Kapas 250 gr Bungkus 64 0 64 5 59 0
97 Kapas Berlemak 500 gr Bungkus 0 0 0 0 0 0
98 Kasa Pembalut 4m x 10 cm Roll 2848 0 2848 136 2712 0
99 Kasa Pembalut 4m x 15 cm Roll 2360 0 2360 17 2343 0

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10
100 Saveglove ( Hand scun) pcs 960 0 960 107 853 0
101 Silk pcs 88 0 88 10 78 0
102 Oksigen tabung kecil Tabung 0 0 0 0 0 0
103 Oksigen tabung sedang Tabung 0 0 0 0 0 0
104 Oksigen tabung besar Tabung 0 0 0 0 0 0

Mengetahui Pengelola Obat PKM


Kepala Puskesmas

ERLINA AMK
MUKHLIS SKM M.kes Nip.19771504 200604 2 010
NIP: 19720709 199303 1 003
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) JKN
BULAN MARET 2016
PUSKESMAS : PEUREULAK

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian


No Nama Obat
Awal Terima
Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

1 Acyclovir tab 200 mg 167 0 167 6 10 4 14 4 20 19 6 7

2 Acyclovir tab 400 mg 0 0 0

3 Allopurinol 100 mg 3547 0 3547 12 12 8 213 10 418 10 17 56 17 10 13

4 Aminofillin tab 200 mg 0 0 0

5 Amitriptillin 25 mg 0 0 0

6 Amlodipin 5 mg 4420 0 4420 18 6 6 100 9 12 12 6 14 38

7 Amlodipin 10 mg 5591 0 5591 6 6 10 12 12 12

8 Amoksisillina kapl 250mg 1442 0 1442 20 20 20

9 Amoksisillina kapl 500mg 2318 0 2318 200 85 90 260 195 85 980 174 249

10 Amoksisillina sirker 250 mg / 5 550 0 550 10 5 6 9 10 2 84 11 48 16 8 12 17 13 6 10

11 Ampisillin serbuk Inj 1000 mg/ 0 0 0

12 Antasida Doen Tab 0 0 0

13 Antasida sir 348 0 348 11 3 7 3 5 9 77 7 33 11 5 4 5 8 8 7

14 Asam Ascorbat ( Vit.C ) 50 mg 19405 0 19405 70 ###### 147 158 47 837 84 523 ### 40 ### ###### 49 ###

15 Asam Mefenamat 500 mg 18493 0 18493 80 60 ### 170 120 36 656 100 236 90 66 ### ### 70 56 ###

16 Attapulgite 630 mg 0 0 0

17 Atropin Inj 0,25 mg/ml 0 0 0

18 Betametason Krim 597 0 597 3 2 2 2 23 6 16 24 2 2 2 4

19 Bedak Salisil 2% serbuk 0 0 0

20 Carbamazepin 200 mg 150 0 150 30 20 30 20

21 Deksametason 0,5 mg 34252 0 34252 124 82 ### 138 280 42 905 104 357 ### 89 ### ### 93 ###

22 Deksametason Inj 5 mg/ml 106 0 106 5

23 Diazepam Tab 2 mg 319 0 319 15 7 6 12 29 9 6 12 15 19 9 9 17

24 Digoksin 0,25 mg 150 0 150

25 Dipenhidramin Inj 95 0 95
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian
No Nama Obat
Awal TerimaJumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

26 Domperidone 0 0 0

27 Erytromicin Syr 629 0 629 3 3 2 2 10 2

28 Etanol 70 % cairan 100 ml 177 0 177 6 2 3 3 2 3

29 Ferro Sulfat 300 mg 0 0 0

30 Fitomenadion Inj 307 0 307 10

31 Fitomenadion Tablet 8352 0 8352 210

32 Furrosemida tab 0 0 0

33 Garam Oralit 470 0 470 12 19 35 29 12 10

34 Gentamisin Tetes Mata 0 0 0

35 Glibenklamida tab 5 mg 0 0 0

36 Glimepiride 2 mg 1540 0 1540 300

37 Glukosa Lar. Inf 5 % 198 0 198

38 Griseofulvin tab 125 mg 1611 0 1611 6 100 20 20

39 Hidrokortison Krim 362 0 362 4 3 28 14 2 2 12

40 Ibuprofen tab.200 mg 805 0 805 10 16 10 310 16 100 10 10 20 10 20

41 Kaptopril 12.5 mg 1923 0 1923 3 12 212 12 12 12 12 12

42 Kaptopril 25 mg 41 0 41

43 Kaptopril 50 mg 0 0 0

44 Kals Laktat tab.500 mg 0 0 0

45 Klorfeniramine Maleat (CTM) 0 0 0

46 Ketokonazol tablet 200 mg 0 0 0

47 Ketokonazol cream 1 0 1

48 Kloramfenikol salep mata 1% 546 0 546 3 28 14 3 2

49 Klorpromazine inj 5 mg/ml 0 0 0

50 Kodein HCL 10 mg 319 0 319 3 6 20

51 Kotrimoksazol Susp 769 0 769 8 4 2 3 3 2 78 6 14 3 3 5 8

52 Kotrimoksazol 480mg Tab 13633 0 13633 22 10 20 6 118 88 806 41 232 18 20 16 81 6 72

53 Levofloxacin 500 mg 920 0 920 3 10 12 13


Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

54 Lidokain HCl 2 %+ Epinefrin 0 0 0

55 Loperamide 2 mg Tab 0 0 0

56 Loratadine 0 0 0

57 Metilergometrin salut tab 0,125 1524 0 1524 100

58 Metoclopramide 10 mg 7238 0 7238 10 13 16 20 9 13 20

59 Metronidazole 250 mg 1237 0 1237 20 10 20 10

60 Metronidazole 500 mg 5035 0 5035 30 10 10 36 110 20 210 30 210 20 20 ###

61 Mikonazole Cream 2% 980 0 980 5 2 3 3 4 12 2 4 4 5 3 9

62 Natrium Diklofenak 50 mg 0 0 0

63 Natrium Klorida 0.9 % 274 0 274 20 20

64 Nifedipin 10 mg 1728 0 1728

65 Nistatin 500.000 IU/gr 0 0 0

66 Omeprazole 20 mg 4046 0 4046 75 72 58 100 78 34 120 34 202 68 30 ### 66 78 40

67 Omeprazole Inj 40 mg/ 10 ml 0 0 0

68 Parasetamol Syrup 120 mg / 5 3799 0 3799 18 9 25 11 24 3 87 17 45 20 9 26 24 22 16

69 Parasetamol Tablet 500 mg 83884 0 83884 184 ###### 301 315 ### 2185 263 1334 ######### ### ######

70 Propanolol tab 40 mg 680 0 680 12 12 16

71 Pirantel Pamoat 125 mg 0 0 0

72 Ranitidin 150 mg tab 0 0 0

73 Ranitidin Inj 118 0 118

74 Ringer Lactat Infus 2657 0 2657 14 20 20 20 20

75 Resperidone tab 0 0 0

76 Salbutamol 4 mg 976 0 976 6 200 100 14 20 20

77 Salep 2- 4 0 0 0

78 Sefadroksil tab 0 0 0

79 Sefadroksil Syr 725 0 725 2 3 7 2 6 8 3 4 3 4 9 5 7 5

80 Setirizine tab 31 0 31 31

81 Simvastatin 20 mg 172 0 172 10 20 20


82 Tetrasiklin HCL 250 mg 0 0 0

83 Vitamin B Complek 39170 0 39170 137 ###### 204 284 80 794 57 535 ######### ### 98 ###

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian


No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

84 Yodium Povidon 30 ml 156 0 156 2 3 1 1 4 1 2

85 Zink Syr 0 0 0

86 Zink tab 0 0 0

OBAT GIGI

87 Eugenol Cairan 17 0 17 2

ALAT KESEHATAN

88 Alat Suntik 2,5 cc 1168 0 1168 20 10

89 Catgut 2/0 2 0 2 2

90 Catgut 3/0 361 0 361 10 10 2

91 Infusion set Anak 0 0 0

92 Infusion set dewasa 493 0 493 10 25 5 3 10

93 I.V Cateter 20 G 478 0 478 5

94 I.V Cateter 22 G 523 0 523 10 10

95 I.V Cateter 24 G 480 0 480 5

96 Kapas 250 gr 64 0 64 2 1 2

97 Kapas Berlemak 500 gr 0 0 0

98 Kasa Pembalut 4m x 10 cm 2848 0 2848 10 20 10 25 5 6 15 25 20

99 Kasa Pembalut 4m x 15 cm 2360 0 2360 17

100 Saveglove ( Hand scun) 960 0 960 5 13 16 8 4 17 7 10 10

101 Silk 88 0 88 10

102 Oksigen tabung kecil 0 0 0

103 Oksigen tabung sedang 0 0 0

104 Oksigen tabung besar 0 0 0

Mengetahui
Kepala UPT.Puskesmas Peureulak
MUKHLIS SKM M.kes
NIP: 19720709 199303 1 003 Nip
Pema Stok
Ket
28 29 30 31 kaian Akhir
25 10 20 145 22

0 0

30 15 10 851 2696

0 0

0 0

56 12 6 15 310 4110

34 92 5499

60 40 20 40 220 1222

2318 0

15 13 10 6 311 239

0 0

0 0

12 6 10 8 239 109

###### 60 89 3501 15904

40 40 40 ### 2690 15803

0 0

0 0

2 2 2 3 97 500

0 0

100 50

###### 60 ### 3636 30616

5 101

17 37 219 100

0 150

0 95
Pema Stok
Ket
28 29 30 31 kaian Akhir

0 0

22 607

19 158

0 0

10 297

210 8142

0 0

21 14 152 318

0 0

0 0

300 1240

0 198

146 1465

65 297

10 542 263

20 6 6 8 327 1596

0 41

0 0

0 0

0 0

0 0

1 1 0

7 57 489

0 0

29 290

4 2 4 7 156 613

18 48 18 1640 11993

23 61 859
Pema Stok
Ket
28 29 30 31 kaian Akhir

0 0

0 0

0 0

100 1424

101 7137

20 20 100 1137

20 40 20 20 1306 3729

6 5 4 71 909

0 0

40 234

0 1728

0 0

### 54 ### 50 1496 2550

0 0

21 15 16 22 430 3369

############ 7751 76133

16 6 62 618

0 0

0 0

0 118

94 2563

0 0

360 616

0 0

0 0

6 4 8 86 639

31 0

50 122
0 0

############ 4068 35102

Pema Stok
Ket
28 29 30 31 kaian Akhir

14 142

0 0

0 0

2 15

30 1138

2 0

22 339

0 0

53 440

5 473

20 503

5 475

5 59

0 0

136 2712

17 2343

10 7 107 853

10 78

0 0

0 0

0 0

Pengelola Obat PKM


ERLINA AMK
Nip.19771504 200604 2 010
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT JKN
( LPLPO ) JKN

UPT PKM : BULAN :


KECAMATAN :
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

STOK PENERI PERSE PEMA


NO NAMA OBAT SATUAN
AWAL MAAN DIAAN KAIAN
1 2 3 4 5 6 7

1 Acyclovir tab 200 mg Tablet 22 22 22


2 Acyclovir tab 400 mg Tablet 0 0 0
3 Allopurinol 100 mg Tablet 2696 2696 542
4 Aminofillin tab 200 mg Tablet 0 0 0
5 Amitriptillin 25 mg Tablet 0 0 0
6 Amlodipin 5 mg Tablet 4110 4110 595
7 Amlodipin 10 mg Tablet 5499 5499 30
8 Amoksisillina kapl 250mg Tablet 1222 1222 680
9 Amoksisillina kapl 500mg Tablet 0 0 0
10 Amoksisillina sirker 250 mg / 5 ml Botol 239 239 239
11 Ampisillin serbuk Inj 1000 mg/5 ml Ampul 0 0 0
12 Antasida Doen Tab Tablet 0 0 0
13 Antasida sir Botol 109 109 109
14 Asam Ascorbat ( Vit.C ) 50 mg Tablet 15904 15904 7385
15 Asam Mefenamat 500 mg Tablet 15803 15803 3216
16 Attapulgite 630 mg Tablet 0 0 0
17 Atropin Inj 0,25 mg/ml Ampul 0 0 0
18 Betametason Krim Tube 500 500 217
19 Bedak Salisil 2% serbuk Kotak 0 0 0
20 Carbamazepin 200 mg Tablet 50 50 50
21 Deksametason 0,5 mg Tablet 30616 30616 4449
22 Deksametason Inj 5 mg/ml Ampul 101 101 5
23 Diazepam Tab 2 mg Tablet 100 100 100
24 Digoksin 0,25 mg Tablet 150 150 0
25 Dipenhidramin Inj Ampul 95 95 30
26 Domperidone Tablet 0 0 0
27 Erytromicin Syr Botol 607 607 8
28 Etanol 70 % cairan 100 ml Botol 158 158 47
29 Ferro Sulfat 300 mg Tablet 0 0 0
30 Fitomenadion Inj Ampul 297 297 26
31 Fitomenadion Tablet Tablet 8142 8142 1236
32 Furrosemida tab Tablet 0 0 0
33 Garam Oralit Pcs 318 318 185
34 Gentamisin Tetes Mata Botol 0 0 0
35 Glibenklamida tab 5 mg Tablet 0 0 0
36 Glimepiride 2 mg Tablet 1240 1240 250
37 Glukosa Lar. Inf 5 % Botol 198 198 0
38 Griseofulvin tab 125 mg Tablet 1465 1465 289
39 Hidrokortison Krim Tube 297 297 200
40 Ibuprofen tab.200 mg Tablet 263 263 263
41 Kaptopril 12.5 mg Tablet 1596 1596 635
42 Kaptopril 25 mg Tablet 41 41 0
43 Kaptopril 50 mg Tablet 0 0 0
44 Kals Laktat tab.500 mg Tablet 0 0 0
45 Klorfeniramine Maleat (CTM) Tablet 0 0 0
46 Ketokonazol tablet 200 mg Tablet 0 0 0
47 Ketokonazol cream Tube 0 0 0

STOK PENERI PERSE PEMA


NO NAMA OBAT SATUAN
AWAL MAAN DIAAN KAIAN
1 2 3 4 5 6 7

48 Kloramfenikol salep mata 1% Tube 489 489 134


49 Klorpromazine inj 5 mg/ml Ampul 0 0 0
50 Kodein HCL 10 mg Tablet 290 290 160
51 Kotrimoksazol Susp Botol 613 613 159
52 Kotrimoksazol 480mg Tab Tablet 11993 11993 2271
53 Levofloxacin 500 mg Tablet 859 859 183
54 Lidokain HCl 2 %+ Epinefrin Ampul 0 0 0
55 Loperamide 2 mg Tab Tablet 0 0 0
56 Loratadine Tablet 0 0 0
57 Metilergometrin salut tab 0,125 mg Tablet 1424 1424 502
58 Metoclopramide 10 mg Tablet 7137 7137 984
59 Metronidazole 250 mg Tablet 1137 1137 440
60 Metronidazole 500 mg Tablet 3729 3729 421
61 Mikonazole Cream 2% Tube 909 909 255
62 Natrium Diklofenak 50 mg Tablet 0 0 0
63 Natrium Klorida 0.9 % Botol 234 234 20
64 Nifedipin 10 mg Tablet 1728 1728 100
65 Nistatin 500.000 IU/gr Tablet 0 0 0
66 Omeprazole 20 mg Kapsul 2550 2550 1483
67 Omeprazole Inj 40 mg/ 10 ml Ampul 0 0 0
68 Parasetamol Syrup 120 mg / 5 ml Botol 3369 3369 410
69 Parasetamol Tablet 500 mg Tablet 76133 76133 6996
70 Propanolol tab 40 mg Tablet 618 618 0
71 Pirantel Pamoat 125 mg Tablet 0 0 0
72 Ranitidin 150 mg tab Tablet 0 0 0
73 Ranitidin Inj Ampul 118 118 23
74 Ringer Lactat Infus Botol 2563 2563 34
75 Resperidone tab Tablet 0 0 0
76 Salbutamol 4 mg Tablet 616 616 358
77 Salep 2- 4 Pot 0 0 0
78 Sefadroksil tab Tablet 0 0 0
79 Sefadroksil Syr Botol 639 639 73
80 Setirizine tab Tablet 0 0 0
81 Simvastatin 20 mg Tablet 122 122 122
82 Tetrasiklin HCL 250 mg Tablet 0 0 0
83 Vitamin B Complek Tablet 35102 35102 8987
84 Yodium Povidon 30 ml Botol 142 142 13
85 Zink Syr Botol 0 0 0
86 Zink tab Tablet 0 0 0

OBAT GIGI
87 Eugenol Cairan Botol 15 15 0
ALAT KESEHATAN
88 Alat Suntik 2,5 cc pcs 1138 1138 75
89 Catgut 2/0 pcs 0 0 0
90 Catgut 3/0 pcs 339 339 89
91 Infusion set Anak pcs 0 0 0
92 Infusion set dewasa pcs 440 440 124
93 I.V Cateter 20 G pcs 473 473 25
94 I.V Cateter 22 G pcs 503 503 5
95 I.V Cateter 24 G pcs 475 475 0
96 Kapas 250 gr Bungkus 59 59 4
97 Kapas Berlemak 500 gr Bungkus 0 0 0
98 Kasa Pembalut 4m x 10 cm Roll 2712 2712 110
99 Kasa Pembalut 4m x 15 cm Roll 2343 2343 65

STOK PENERI PERSE PEMA


NO NAMA OBAT SATUAN
AWAL MAAN DIAAN KAIAN
1 2 3 4 5 6 7

100 Saveglove ( Hand scun) pcs 853 853 52


101 Silk pcs 78 78 0
102 Oksigen tabung kecil Tabung 0 0 0
103 Oksigen tabung sedang Tabung 0 0 0
104 Oksigen tabung besar Tabung 0 0 0

Mengetahui Pengelola Obat PKM


Kepala Puskesmas
ERLINA AMK
MUKHLIS SKM M.kes Nip.19771504 200604 2 010
NIP: 19720709 199303 1 003
AN OBAT JKN

BULAN : APRIL
TAHUN : 2016

STOK PERMIN
KET
AKHIR TAAN
8 9 10

0
0
2154
0
0
3515
5469
542
0
0
0
0
0
8519
12587
0
0
283
0
0
26167
96
0
150
65
0
599
111
0
271
6906
0
133
0
0
990
198
1176
97
0
961
41
0
0
0
0
0

STOK PERMIN
KET
AKHIR TAAN
8 9 10

355
0
130
454
9722
676
0
0
0
922
6153
697
3308
654
0
214
1628
0
1067
0
2959
69137
618
0
0
95
2529
0
258
0
0
566
0
0
0
26115
129
0
0

15

1063
0
250
0
316
448
498
475
55
0
2602
2278

STOK PERMIN
KET
AKHIR TAAN
8 9 10

801
78
0
0
0

Pengelola Obat PKM


ERLINA AMK
Nip.19771504 200604 2 010
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) JKN
BULAN APRIL 2016
PUSKESMAS : PEUREULAK

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian


No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

1 Acyclovir tab 200 mg 22 0 22 10 8 4

2 Acyclovir tab 400 mg 0 0 0


3 Allopurinol 100 mg 2696 0 2696 15 16 16 10 26 40 242 20 100 20 22 3

4 Aminofillin tab 200 mg 0 0 0


5 Amitriptillin 25 mg 0 0 0
6 Amlodipin 5 mg 4110 0 4110 22 24 22 27 15 6 6 20 108 150 21 44 66 4 12 5 6 19 6

7 Amlodipin 10 mg 5499 0 5499 30

8 Amoksisillina kapl 250mg 1222 0 1222 10 10 240 240 30 10 120 20

9 Amoksisillina kapl 500mg 0 0 0


10 Amoksisillina sirker 250 mg / 5 ml 239 0 239 16 14 12 8 10 12 10 6 29 37 39 33 10 3

11 Ampisillin serbuk Inj 1000 mg/5 ml 0 0 0


12 Antasida Doen Tab 0 0 0
13 Antasida sir 109 0 109 4 12 12 10 19 5 9 35 3

14 Asam Ascorbat ( Vit.C ) 50 mg 15904 0 15904 480 340 236 320 340 238 256 320 235 680 870 420 289 427 234 286 340 206 326 321

15 Asam Mefenamat 500 mg 15803 0 15803 100 64 60 40 40 30 100 350 40 430 750 430 188 290 46 50 20 50 52 40

16 Attapulgite 630 mg 0 0 0
17 Atropin Inj 0,25 mg/ml 0 0 0
18 Betametason Krim 500 0 500 9 8 5 5 3 12 18 3 5 12 15 21 13 9 15 12 12 11 8 9

19 Bedak Salisil 2% serbuk 0 0 0


20 Carbamazepin 200 mg 50 0 50 30 20

21 Deksametason 0,5 mg 30616 0 30616 234 139 145 122 90 86 153 39 161 716 703 340 65 283 213 157 172 231 158 60

22 Deksametason Inj 5 mg/ml 101 0 101 5

23 Diazepam Tab 2 mg 100 0 100 9 12 13 10 23 10 12 11

24 Digoksin 0,25 mg 150 0 150


25 Dipenhidramin Inj 95 0 95 20 10
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

26 Domperidone 0 0 0
27 Erytromicin Syr 607 0 607 3 5

28 Etanol 70 % cairan 100 ml 158 0 158 2 2 3 5 4 4 1 2 2 6 2 2 5 1 2 3

29 Ferro Sulfat 300 mg 0 0 0


30 Fitomenadion Inj 297 0 297 2 2 10 2 10

31 Fitomenadion Tablet 8142 0 8142 20 36 20 26 6 21 308 28 8 330 25 100 200 28 20 24 21 9

32 Furrosemida tab 0 0 0
33 Garam Oralit 318 0 318 10 15 10 45 25 20 10 12 4 6 4

34 Gentamisin Tetes Mata 0 0 0


35 Glibenklamida tab 5 mg 0 0 0
36 Glimepiride 2 mg 1240 0 1240 50 100 50 50

37 Glukosa Lar. Inf 5 % 198 0 198


38 Griseofulvin tab 125 mg 1465 0 1465 10 20 20 10 100 119 10

39 Hidrokortison Krim 297 0 297 8 9 12 4 4 11 19 11 8 14 12 12 18 5 4 3 9 9 8 9

40 Ibuprofen tab.200 mg 263 0 263 20 20 20 20 40 110 33

41 Kaptopril 12.5 mg 1596 0 1596 30 15 12 100 100 103 100 31 106 12 6 12

42 Kaptopril 25 mg 41 0 41
43 Kaptopril 50 mg 0 0 0
44 Kals Laktat tab.500 mg 0 0 0
45 Klorfeniramine Maleat (CTM) 0 0 0
46 Ketokonazol tablet 200 mg 0 0 0
47 Ketokonazol cream 0 0 0
48 Kloramfenikol salep mata 1% 489 0 489 8 6 2 4 8 18 1 12 15 5 13 2 3 4 4 12 5 8 2

49 Klorpromazine inj 5 mg/ml 0 0 0


50 Kodein HCL 10 mg 290 0 290 8 12 20 10 30 4 8 8 18 20 10 12

51 Kotrimoksazol Susp 613 0 613 3 8 5 5 4 1 7 3 7 26 32 21 4 17 4 3 3 3 1

52 Kotrimoksazol 480mg Tab 11993 0 11993 236 28 24 18 39 36 36 16 6 509 518 306 227 212 12 12 12 18
53 Levofloxacin 500 mg 859 0 859 12 6 50 54 50 3

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian


No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
54 Lidokain HCl 2 %+ Epinefrin 0 0 0
55 Loperamide 2 mg Tab 0 0 0
56 Loratadine 0 0 0
57 Metilergometrin salut tab 0,125 mg 1424 0 1424 100 300 102

58 Metoclopramide 10 mg 7137 0 7137 40 40 30 30 30 110 135 128 211 87 43

59 Metronidazole 250 mg 1137 0 1137 100 20 20 100 100 100

60 Metronidazole 500 mg 3729 0 3729 60 70 50 50 40 30 5 10 26 40 40

61 Mikonazole Cream 2% 909 0 909 4 8 12 4 16 10 24 10 10 6 8 14 18 20 15 16 12 4 12 21

62 Natrium Diklofenak 50 mg 0 0 0
63 Natrium Klorida 0.9 % 234 0 234 20

64 Nifedipin 10 mg 1728 0 1728 100

65 Nistatin 500.000 IU/gr 0 0 0


66 Omeprazole 20 mg 2550 0 2550 108 158 52 56 60 72 84 98 68 69 144 60 48 90 24 58 64 96 30 18

67 Omeprazole Inj 40 mg/ 10 ml 0 0 0


68 Parasetamol Syrup 120 mg / 5 ml 3369 0 3369 19 30 13 20 16 12 24 11 25 20 42 37 16 30 11 27 6 9 16 12

69 Parasetamol Tablet 500 mg 76133 0 76133 470 235 188 190 200 219 325 360 255 630 950 637 114 659 220 270 228 250 262 150

70 Propanolol tab 40 mg 618 0 618


71 Pirantel Pamoat 125 mg 0 0 0
72 Ranitidin 150 mg tab 0 0 0
73 Ranitidin Inj 118 0 118 5 4 12 2

74 Ringer Lactat Infus 2563 0 2563 20 5 5 2 2

75 Resperidone tab 0 0 0
76 Salbutamol 4 mg 616 0 616 100 20 12 18 20 10 10 4 110 12 20 10 6

77 Salep 2- 4 0 0 0
78 Sefadroksil tab 0 0 0
79 Sefadroksil Syr 639 0 639 7 5 6 4 1 8 4 1 6 4 3 3 6 2 2 5 5

80 Setirizine tab 0 0 0
81 Simvastatin 20 mg 122 0 122 20 7 10 12 8 10 4 12 3 10 20

82 Tetrasiklin HCL 250 mg 0 0 0


83 Vitamin B Complek 35102 0 35102 320 220 230 305 310 208 480 250 209 980 308 860 1020 640 448 230 530 340 480 389

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian


No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

84 Yodium Povidon 30 ml 142 0 142 2 1 2 6 2

85 Zink Syr 0 0 0
86 Zink tab 0 0 0
OBAT GIGI
87 Eugenol Cairan 15 0 15
ALAT KESEHATAN
88 Alat Suntik 2,5 cc 1138 0 1138 20 5 20 15 5 10

89 Catgut 2/0 0 0 0
90 Catgut 3/0 339 0 339 5 5 8 12 5 5 5 5 12 5 12 5

91 Infusion set Anak 0 0 0


92 Infusion set dewasa 440 0 440 5 12 5 2 20 5 5 12 8 20 18

93 I.V Cateter 20 G 473 0 473 5 20

94 I.V Cateter 22 G 503 0 503 5

95 I.V Cateter 24 G 475 0 475


96 Kapas 250 gr 59 0 59 1 1 1 1

97 Kapas Berlemak 500 gr 0 0 0


98 Kasa Pembalut 4m x 10 cm 2712 0 2712 30 5 10 10 10 30 5 10

99 Kasa Pembalut 4m x 15 cm 2343 0 2343 50 15

100 Saveglove ( Hand scun) 853 0 853 13 10 10 9 10

101 Silk 78 0 78
102 Oksigen tabung kecil 0 0 0
103 Oksigen tabung sedang 0 0 0
104 Oksigen tabung besar 0 0 0

Mengetahui Pengelola
Kepala UPT.Puskesmas Peureulak
MUKHLIS,SKM,M.Kes ERLI
Nip.19720709 199303 1 003 Nip.1977041
Pema Stok Ket
29 30 31 kaian Akhir
22 0
0 0
12 542 2154
0 0
0 0
12 595 3515
30 5469
680 542
0 0
239 0
0 0
0 0
109 0
221 7385 8519
46 3216 12587
0 0
0 0
12 217 283
0 0
50 0
182 4449 26167
5 96
100 0
0 150
30 65
Pema Stok Ket
29 30 31 kaian Akhir
0 0
8 599
1 47 111
0 0
26 271
6 1236 6906
0 0
24 185 133
0 0
0 0
250 990
0 198
289 1176
11 200 97
263 0
8 635 961
0 41
0 0
0 0
0 0
0 0
0 0
2 134 355
0 0
160 130
2 159 454
6 2271 9722
8 183 676

Pema Stok Ket


29 30 31 kaian Akhir
0 0
0 0
0 0
502 922
100 984 6153
440 697
421 3308
11 255 654
0 0
20 214
100 1628
0 0
26 1483 1067
0 0
14 410 2959
184 6996 69137
0 618
0 0
0 0
23 95
34 2529
0 0
6 358 258
0 0
0 0
1 73 566
0 0
6 122 0
0 0
230 8987 26115

Pema Stok Ket


29 30 31 kaian Akhir
13 129
0 0
0 0

0 15

75 1063
0 0
5 89 250
0 0
12 124 316
25 448
5 498
0 475
4 55
0 0
110 2602
65 2278
52 801
0 78
0 0
0 0
0 0

Pengelola Obat PKM


ERLINA,AMK
ip.19770415 200604 2 010
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT JKN
( LPLPO ) JKN

UPT PKM : PEUREULAK BULAN : MEI


KECAMATAN : PEUREULAK TAHUN : 2016
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 0 0 0 0 0


2 Acyclovir tab 400 mg Tablet 0 0 0 0 0
3 Allopurinol 100 mg Tablet 2154 0 2154 535 1619
4 Aminofillin tab 200 mg Tablet 0 0 0 0 0
5 Amitriptillin 25 mg Tablet 0 0 0 0 0
6 Amlodipin 5 mg Tablet 3515 0 3515 944 2571
7 Amlodipin 10 mg Tablet 5469 0 5469 312 5157
8 Amoksisillina kapl 250mg Tablet 542 0 542 352 190
9 Amoksisillina kapl 500mg Tablet 0 0 0 0 0
10 Amoksisillina sirker 250 mg / 5 ml Botol 0 0 0 0 0
11 Ampisillin serbuk Inj 1000 mg/5 ml Ampul 0 0 0 0 0
12 Antasida Doen Tab Tablet 0 0 0 0 0
13 Antasida sir Botol 0 0 0 0 0
14 Asam Ascorbat ( Vit.C ) 50 mg Tablet 8519 0 8519 3946 4573
15 Asam Mefenamat 500 mg Tablet 12587 0 12587 2535 10052
16 Attapulgite 630 mg Tablet 0 0 0 0 0
17 Atropin Inj 0,25 mg/ml Ampul 0 0 0 0 0
18 Betametason Krim Tube 283 0 283 123 160
19 Bedak Salisil 2% serbuk Kotak 0 0 0 0 0
20 Carbamazepin 200 mg Tablet 0 0 0 0 0
21 Deksametason 0,5 mg Tablet 26167 0 26167 5621 20546
22 Deksametason Inj 5 mg/ml Ampul 96 0 96 5 91
23 Diazepam Tab 2 mg Tablet 0 0 0 0 0
24 Digoksin 0,25 mg Tablet 150 0 150 0 150
25 Dipenhidramin Inj Ampul 65 0 65 0 65
26 Domperidone Tablet 0 0 0 0 0
27 Erytromicin Syr Botol 599 0 599 127 472
28 Etanol 70 % cairan 100 ml Botol 111 0 111 11 100
29 Ferro Sulfat 300 mg Tablet 0 0 0 0 0
30 Fitomenadion Inj Ampul 271 0 271 60 211
31 Fitomenadion Tablet Tablet 6906 0 6906 1250 5656
32 Furrosemida tab Tablet 0 0 0 0 0
33 Garam Oralit Pcs 133 0 133 80 53
34 Gentamisin Tetes Mata Botol 0 0 0 0 0
35 Glibenklamida tab 5 mg Tablet 0 0 0 0 0
36 Glimepiride 2 mg Tablet 990 0 990 226 764
37 Glukosa Lar. Inf 5 % Botol 198 0 198 60 138
38 Griseofulvin tab 125 mg Tablet 1176 0 1176 130 1046
39 Hidrokortison Krim Tube 97 0 97 94 3
40 Ibuprofen tab.200 mg Tablet 0 0 0 0 0
41 Kaptopril 12.5 mg Tablet 961 0 961 286 675
42 Kaptopril 25 mg Tablet 41 0 41 36 5
43 Kaptopril 50 mg Tablet 0 0 0 0 0
44 Kals Laktat tab.500 mg Tablet 0 0 0 0 0
45 Klorfeniramine Maleat (CTM) Tablet 0 0 0 0 0
46 Ketokonazol tablet 200 mg Tablet 0 0 0 0 0
47 Ketokonazol cream Tube 0 0 0 0 0

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 6 7 8 9 10

48 Kloramfenikol salep mata 1% Tube 355 0 355 94 261


49 Klorpromazine inj 5 mg/ml Ampul 0 0 0 0 0
50 Kodein HCL 10 mg Tablet 130 0 130 73 57
51 Kotrimoksazol Susp Botol 454 0 454 220 234
52 Kotrimoksazol 480mg Tab Tablet 9722 0 9722 1029 8693
53 Levofloxacin 500 mg Tablet 676 0 676 129 547
54 Lidokain HCl 2 %+ Epinefrin Ampul 0 0 0 0 0
55 Loperamide 2 mg Tab Tablet 0 0 0 0 0
56 Loratadine Tablet 0 0 0 0 0
57 Metilergometrin salut tab 0,125 mg Tablet 922 0 922 200 722
58 Metoclopramide 10 mg Tablet 6153 0 6153 719 5434
59 Metronidazole 250 mg Tablet 697 0 697 304 393
60 Metronidazole 500 mg Tablet 3308 0 3308 135 3173
61 Mikonazole Cream 2% Tube 654 0 654 121 533
62 Natrium Diklofenak 50 mg Tablet 0 0 0 0 0
63 Natrium Klorida 0.9 % Botol 214 0 214 60 154
64 Nifedipin 10 mg Tablet 1628 0 1628 316 1312
65 Nistatin 500.000 IU/gr Tablet 0 0 0 0 0
66 Omeprazole 20 mg Kapsul 1067 0 1067 1067 0
67 Omeprazole Inj 40 mg/ 10 ml Ampul 0 0 0 0 0
68 Parasetamol Syrup 120 mg / 5 ml Botol 2959 0 2959 509 2450
69 Parasetamol Tablet 500 mg Tablet 69137 0 69137 16821 52316
70 Propanolol tab 40 mg Tablet 618 0 618 21 597
71 Pirantel Pamoat 125 mg Tablet 0 0 0 0 0
72 Ranitidin 150 mg tab Tablet 0 0 0 0 0
73 Ranitidin Inj Ampul 95 0 95 10 85
74 Ringer Lactat Infus Botol 2529 0 2529 167 2362
75 Resperidone tab Tablet 0 0 0 0 0
76 Salbutamol 4 mg Tablet 258 0 258 230 28
77 Salep 2- 4 Pot 0 0 0 0 0
78 Sefadroksil tab Tablet 0 0 0 0 0
79 Sefadroksil Syr Botol 566 0 566 30 536
80 Setirizine tab Tablet 0 0 0 0 0
81 Simvastatin 20 mg Tablet 0 0 0 0 0
82 Tetrasiklin HCL 250 mg Tablet 0 0 0 0 0
83 Vitamin B Complek Tablet 26115 0 26115 10157 15958
84 Yodium Povidon 30 ml Botol 129 0 129 31 98
85 Zink Syr Botol 0 0 0 0 0
86 Zink tab Tablet 0 0 0 0 0
0
OBAT GIGI
87 Eugenol Cairan Botol 15 0 15 0 15
ALAT KESEHATAN
88 Alat Suntik 2,5 cc pcs 1063 0 1063 171 892
89 Catgut 2/0 pcs 0 0 0 0 0
90 Catgut 3/0 pcs 250 0 250 64 186
91 Infusion set Anak pcs 0 0 0 0 0
92 Infusion set dewasa pcs 316 0 316 80 236
93 I.V Cateter 20 G pcs 448 0 448 65 383
94 I.V Cateter 22 G pcs 498 0 498 87 411
95 I.V Cateter 24 G pcs 475 0 475 50 425
96 Kapas 250 gr Bungkus 55 0 55 9 46
97 Kapas Berlemak 500 gr Bungkus 0 0 0 0 0
98 Kasa Pembalut 4m x 10 cm Roll 2602 0 2602 260 2342
99 Kasa Pembalut 4m x 15 cm Roll 2278 0 2278 220 2058

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

100 Saveglove ( Hand scun) pcs 801 0 801 171 630


101 Silk pcs 78 0 78 0 78
102 Oksigen tabung kecil Tabung 0 0 0 0 0
103 Oksigen tabung sedang Tabung 0 0 0 0 0
104 Oksigen tabung besar Tabung 0 0 0 0 0

Mengetahui Pengelola Obat PKM


Kepala Puskesmas

ERLINA AMK
MUKHLIS SKM M.kes Nip.19770415 200604 2 010
NIP: 19720709 199303 1 003
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) JKN
BULAN MEI 2016
PUSKESMAS : PEUREULAK

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian


No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

1 Acyclovir tab 200 mg 0 0 0


2 Acyclovir tab 400 mg 0 0 0
3 Allopurinol 100 mg 2154 0 2154 21 6 10 6 6 422 7 15 24 6 12

4 Aminofillin tab 200 mg 0 0 0


5 Amitriptillin 25 mg 0 0 0
6 Amlodipin 5 mg 3515 0 3515 12 16 9 42 27 23 300 3 3 6 462 9 3 23 6

7 Amlodipin 10 mg 5469 0 5469 3 300 3 6

8 Amoksisillina kapl 250mg 542 0 542 10 60 120 132 20 10

9 Amoksisillina kapl 500mg 0 0 0


10 Amoksisillina sirker 250 mg / 5 ml 0 0 0
11 Ampisillin serbuk Inj 1000 mg/5 ml 0 0 0
12 Antasida Doen Tab 0 0 0
13 Antasida sir 0 0 0
14 Asam Ascorbat ( Vit.C ) 50 mg 8519 0 8519 99 152 105 148 36 30 87 120 1291 313 97 59 130 123 588 123 231 87 127

15 Asam Mefenamat 500 mg 12587 0 12587 40 82 20 130 10 80 230 880 45 50 170 100 530 88 60 20

16 Attapulgite 630 mg 0 0 0
17 Atropin Inj 0,25 mg/ml 0 0 0
18 Betametason Krim 283 0 283 3 2 58 1 5 50 4

19 Bedak Salisil 2% serbuk 0 0 0


20 Carbamazepin 200 mg 0 0 0
21 Deksametason 0,5 mg 26167 0 26167 114 445 93 163 24 14 66 84 1145 85 101 110 288 132 2110 341 98 110 98

22 Deksametason Inj 5 mg/ml 96 0 96 5

23 Diazepam Tab 2 mg 0 0 0
24 Digoksin 0,25 mg 150 0 150
25 Dipenhidramin Inj 65 0 65
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

26 Domperidone 0 0 0
27 Erytromicin Syr 599 0 599 5 120 2

28 Etanol 70 % cairan 100 ml 111 0 111 1 1 2 3 4

29 Ferro Sulfat 300 mg 0 0 0


30 Fitomenadion Inj 271 0 271 30 30

31 Fitomenadion Tablet 6906 0 6906 200 10 1000 20 10 10

32 Furrosemida tab 0 0 0
33 Garam Oralit 133 0 133 5 14 6 40 5 10

34 Gentamisin Tetes Mata 0 0 0


35 Glibenklamida tab 5 mg 0 0 0
36 Glimepiride 2 mg 990 0 990 200 20 6

37 Glukosa Lar. Inf 5 % 198 0 198 60

38 Griseofulvin tab 125 mg 1176 0 1176 10 100 17 3

39 Hidrokortison Krim 97 0 97 1 2 3 35 2 3 48

40 Ibuprofen tab.200 mg 0 0 0
41 Kaptopril 12.5 mg 961 0 961 30 9 9 6 130 36 6 12 24 6 12 6

42 Kaptopril 25 mg 41 0 41 6 6 3 12 6 3

43 Kaptopril 50 mg 0 0 0
44 Kals Laktat tab.500 mg 0 0 0
45 Klorfeniramine Maleat (CTM) 0 0 0
46 Ketokonazol tablet 200 mg 0 0 0
47 Ketokonazol cream 0 0 0
48 Kloramfenikol salep mata 1% 355 0 355 40 1 5 48

49 Klorpromazine inj 5 mg/ml 0 0 0


50 Kodein HCL 10 mg 130 0 130 5 10 20 20 10 8

51 Kotrimoksazol Susp 454 0 454 2 1 4 8 2 1 9 62 2 2 1 4 106 3 6 2 5

52 Kotrimoksazol 480mg Tab 9722 0 9722 16 12 6 10 6 24 334 50 18 6 6 500 18 3 8 12

53 Levofloxacin 500 mg 676 0 676 106 3 6 5 3 6


Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
54 Lidokain HCl 2 %+ Epinefrin 0 0 0
55 Loperamide 2 mg Tab 0 0 0
56 Loratadine 0 0 0
57 Metilergometrin salut tab 0,125 mg 922 0 922 200

58 Metoclopramide 10 mg 6153 0 6153 6 3 10 141 25 10 500 24

59 Metronidazole 250 mg 697 0 697 4 300

60 Metronidazole 500 mg 3308 0 3308 20 30 20 40 20 5

61 Mikonazole Cream 2% 654 0 654 6 2 3 2 4 12 14 8 2 4 48 2 5 3 6

62 Natrium Diklofenak 50 mg 0 0 0
63 Natrium Klorida 0.9 % 214 0 214 60

64 Nifedipin 10 mg 1628 0 1628 100 10 200 6

65 Nistatin 500.000 IU/gr 0 0 0


66 Omeprazole 20 mg 1067 0 1067 130 54 78 54 26 18 30 84 134 82 78 92 120 87

67 Omeprazole Inj 40 mg/ 10 ml 0 0 0


68 Parasetamol Syrup 120 mg / 5 ml 2959 0 2959 24 14 19 30 2 6 13 17 91 22 26 8 18 162 11 12 18 16

69 Parasetamol Tablet 500 mg 69137 0 69137 340 162 209 324 100 102 150 430 2495 246 345 105 410 214 10233 286 240 310 120

70 Propanolol tab 40 mg 618 0 618 21

71 Pirantel Pamoat 125 mg 0 0 0


72 Ranitidin 150 mg tab 0 0 0
73 Ranitidin Inj 95 0 95 10

74 Ringer Lactat Infus 2529 0 2529 20 20 5 20 100 2

75 Resperidone tab 0 0 0
76 Salbutamol 4 mg 258 0 258 200 30

77 Salep 2- 4 0 0 0
78 Sefadroksil tab 0 0 0
79 Sefadroksil Syr 566 0 566 7 4 3 2 1 2 3 5 1 2

80 Setirizine tab 0 0 0
81 Simvastatin 20 mg 0 0 0
82 Tetrasiklin HCL 250 mg 0 0 0
83 Vitamin B Complek 26115 0 26115 86 248 211 262 81 17 147 112 1059 74 166 147 347 6843 102 64 86 105

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian


No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

84 Yodium Povidon 30 ml 129 0 129 3 1 3 4 20

85 Zink Syr 0 0 0
86 Zink tab 0 0 0
OBAT GIGI
87 Eugenol Cairan 15 0 15
ALAT KESEHATAN
88 Alat Suntik 2,5 cc 1063 0 1063 10 26 10 10 15 100

89 Catgut 2/0 0 0 0
90 Catgut 3/0 250 0 250 8 8 48

91 Infusion set Anak 0 0 0


92 Infusion set dewasa 316 0 316 10 10 50 10

93 I.V Cateter 20 G 448 0 448 10 50 5

94 I.V Cateter 22 G 498 0 498 10 17 50 10

95 I.V Cateter 24 G 475 0 475 50

96 Kapas 250 gr 55 0 55 1 1 7

97 Kapas Berlemak 500 gr 0 0 0


98 Kasa Pembalut 4m x 10 cm 2602 0 2602 3 10 22 5 5 15 200

99 Kasa Pembalut 4m x 15 cm 2278 0 2278 20 200

100 Saveglove ( Hand scun) 801 0 801 10 29 10 2 10 15 10 70 15

101 Silk 78 0 78
102 Oksigen tabung kecil 0 0 0
103 Oksigen tabung sedang 0 0 0
104 Oksigen tabung besar 0 0 0

Mengetahui Pengelola Obat PKM


Kepala UPT.Puskesmas Peureulak
MUKHLIS,SKM,M.Kes ERLINA,AMK
Nip.19720709 199303 1 003 Nip.19770415 200604
Pema Stok Ket
31 kaian Akhir
0 0
0 0
535 1619
0 0
0 0
944 2571
312 5157
352 190
0 0
0 0
0 0
0 0
0 0
3946 4573
2535 10052
0 0
0 0
123 160
0 0
0 0
5621 20546
5 91
0 0
0 150
0 65
Pema Stok Ket
31 kaian Akhir
0 0
127 472
11 100
0 0
60 211
1250 5656
0 0
80 53
0 0
0 0
226 764
60 138
130 1046
94 3
0 0
286 675
36 5
0 0
0 0
0 0
0 0
0 0
94 261
0 0
73 57
220 234
1029 8693
129 547
Pema Stok Ket
31 kaian Akhir
0 0
0 0
0 0
200 722
719 5434
304 393
135 3173
121 533
0 0
60 154
316 1312
0 0
1067 0
0 0
509 2450
16821 52316
21 597
0 0
0 0
10 85
167 2362
0 0
230 28
0 0
0 0
30 536
0 0
0 0
0 0
10157 15958

Pema Stok Ket


31 kaian Akhir
31 98
0 0
0 0

0 15

171 892
0 0
64 186
0 0
80 236
65 383
87 411
50 425
9 46
0 0
260 2342
220 2058
171 630
0 78
0 0
0 0
0 0

Obat PKM
NA,AMK
5 200604 2 010
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT JKN
( LPLPO ) JKN

UPT PKM : BULAN : JUNI


KECAMATAN : TAHUN : 2016
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 0 0 0 0 0


2 Acyclovir tab 400 mg Tablet 0 0 0 0 0
3 Allopurinol 100 mg Tablet 1619 0 1619 740 879
4 Aminofillin tab 200 mg Tablet 0 0 0 0 0
5 Amitriptillin 25 mg Tablet 0 0 0 0 0
6 Amlodipin 5 mg Tablet 2571 0 2571 396 2175
7 Amlodipin 10 mg Tablet 5157 0 5157 104 5053
8 Amoksisillina kapl 250mg Tablet 190 0 190 190 0
9 Amoksisillina kapl 500mg Tablet 0 0 0 0 0
10 Amoksisillina sirker 250 mg / 5 ml Botol 0 0 0 0 0
11 Ampisillin serbuk Inj 1000 mg/5 ml Ampul 0 0 0 0 0
12 Antasida Doen Tab Tablet 0 0 0 0 0
13 Antasida sir Botol 0 0 0 0 0
14 Asam Ascorbat ( Vit.C ) 50 mg Tablet 4573 0 4573 4567 6
15 Asam Mefenamat 500 mg Tablet 10052 0 10052 2934 7118
16 Attapulgite 630 mg Tablet 0 0 0 0 0
17 Atropin Inj 0,25 mg/ml Ampul 0 0 0 0 0
18 Betametason Krim Tube 160 0 160 91 69
19 Bedak Salisil 2% serbuk Kotak 0 0 0 0 0
20 Carbamazepin 200 mg Tablet 0 0 0 0 0
21 Deksametason 0,5 mg Tablet 20546 0 20546 4219 16327
22 Deksametason Inj 5 mg/ml Ampul 91 0 91 15 76
23 Diazepam Tab 2 mg Tablet 0 0 0 0 0
24 Digoksin 0,25 mg Tablet 150 0 150 0 150
25 Dipenhidramin Inj Ampul 65 0 65 0 65
26 Domperidone Tablet 0 0 0 0 0
27 Erytromicin Syr Botol 472 0 472 27 445
28 Etanol 70 % cairan 100 ml Botol 100 0 100 8 92
29 Ferro Sulfat 300 mg Tablet 0 0 0 0 0
30 Fitomenadion Inj Ampul 211 0 211 2 209
31 Fitomenadion Tablet Tablet 5656 0 5656 235 5421
32 Furrosemida tab Tablet 0 0 0 0 0
33 Garam Oralit Pcs 53 0 53 53 0
34 Gentamisin Tetes Mata Botol 0 0 0 0 0
35 Glibenklamida tab 5 mg Tablet 0 0 0 0 0
36 Glimepiride 2 mg Tablet 764 0 764 109 655
37 Glukosa Lar. Inf 5 % Botol 138 0 138 0 138
38 Griseofulvin tab 125 mg Tablet 1046 0 1046 205 841
39 Hidrokortison Krim Tube 3 0 3 3 0
40 Ibuprofen tab.200 mg Tablet 0 0 0 0 0
41 Kaptopril 12.5 mg Tablet 675 0 675 216 459
42 Kaptopril 25 mg Tablet 5 0 5 0 5
43 Kaptopril 50 mg Tablet 0 0 0 0 0
44 Kals Laktat tab.500 mg Tablet 0 0 0 0 0
45 Klorfeniramine Maleat (CTM) Tablet 0 0 0 0 0
46 Ketokonazol tablet 200 mg Tablet 0 0 0 0 0
47 Ketokonazol cream Tube 0 0 0 0 0
STOK PENERI PERSE PEMA STOK PERMIN
NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

48 Kloramfenikol salep mata 1% Tube 261 0 261 35 226


49 Klorpromazine inj 5 mg/ml Ampul 0 0 0 0 0
50 Kodein HCL 10 mg Tablet 57 0 57 57 0
51 Kotrimoksazol Susp Botol 234 0 234 155 79
52 Kotrimoksazol 480mg Tab Tablet 8693 0 8693 1449 7244
53 Levofloxacin 500 mg Tablet 547 0 547 19 528
54 Lidokain HCl 2 %+ Epinefrin Ampul 0 0 0 0 0
55 Loperamide 2 mg Tab Tablet 0 0 0 0 0
56 Loratadine Tablet 0 0 0 0 0
57 Metilergometrin salut tab 0,125 mg Tablet 722 0 722 100 622
58 Metoclopramide 10 mg Tablet 5434 0 5434 373 5061
59 Metronidazole 250 mg Tablet 393 0 393 0 393
60 Metronidazole 500 mg Tablet 3173 0 3173 672 2501
61 Mikonazole Cream 2% Tube 533 0 533 102 431
62 Natrium Diklofenak 50 mg Tablet 0 0 0 0 0
63 Natrium Klorida 0.9 % Botol 154 0 154 0 154
64 Nifedipin 10 mg Tablet 1312 0 1312 40 1272
65 Nistatin 500.000 IU/gr Tablet 0 0 0 0 0
66 Omeprazole 20 mg Kapsul 0 0 0 0 0
67 Omeprazole Inj 40 mg/ 10 ml Ampul 0 0 0 0 0
68 Parasetamol Syrup 120 mg / 5 ml Botol 2450 0 2450 494 1956
69 Parasetamol Tablet 500 mg Tablet 52316 0 52316 7041 45275
70 Propanolol tab 40 mg Tablet 597 0 597 9 588
71 Pirantel Pamoat 125 mg Tablet 0 0 0 0 0
72 Ranitidin 150 mg tab Tablet 0 0 0 0 0
73 Ranitidin Inj Ampul 85 0 85 10 75
74 Ringer Lactat Infus Botol 2362 0 2362 60 2302
75 Resperidone tab Tablet 0 0 0 0 0
76 Salbutamol 4 mg Tablet 28 0 28 28 0
77 Salep 2- 4 Pot 0 0 0 0 0
78 Sefadroksil tab Tablet 0 0 0 0 0
79 Sefadroksil Syr Botol 536 0 536 35 501
80 Setirizine tab Tablet 0 0 0 0 0
81 Simvastatin 20 mg Tablet 0 0 0 0 0
82 Tetrasiklin HCL 250 mg Tablet 0 0 0 0 0
83 Vitamin B Complek Tablet 15958 0 15958 4837 11121
84 Yodium Povidon 30 ml Botol 98 0 98 24 74
85 Zink Syr Botol 0 0 0 0 0
86 Zink tab Tablet 0 0 0 0 0
0
OBAT GIGI
87 Eugenol Cairan Botol 15 0 15 0 15
ALAT KESEHATAN
88 Alat Suntik 2,5 cc pcs 892 0 892 20 872
89 Catgut 2/0 pcs 0 0 0 0 0
90 Catgut 3/0 pcs 186 0 186 0 186
91 Infusion set Anak pcs 0 0 0 0 0
92 Infusion set dewasa pcs 236 600 836 20 816
93 I.V Cateter 20 G pcs 383 500 883 22 861
94 I.V Cateter 22 G pcs 411 1200 1611 0 1611
95 I.V Cateter 24 G pcs 425 700 1125 9 1116
96 Kapas 250 gr Bungkus 46 0 46 0 46
97 Kapas Berlemak 500 gr Bungkus 0 0 0 0 0
98 Kasa Pembalut 4m x 10 cm Roll 2342 0 2342 3 2339
99 Kasa Pembalut 4m x 15 cm Roll 2058 0 2058 114 1944
STOK PENERI PERSE PEMA STOK PERMIN
NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

100 Saveglove ( Hand scun) pcs 630 2000 2630 114 2516
101 Silk pcs 78 0 78 0 78
102 Oksigen tabung kecil Tabung 0 0 0 0 0
103 Oksigen tabung sedang Tabung 0 0 0 0 0
104 Oksigen tabung besar Tabung 0 0 0 0 0
105 Alat suntik 5 cc pcs 0 700 0 0 700
106 Hand scun steril pcs 0 700 0 0 700
107 Urine bag pcs 0 48 0 0 48
108 Foley catheter pediatric 2 way (8) pcs 0 5 0 0 5
109 Foley catheter pediatric 2 way (10) pcs 0 5 0 0 5
110 Foley catheter 2 way (16) pcs 0 5 0 0 5
111 Foley catheter 2 way (18) pcs 0 5 0 0 5
112 Masker pcs 0 1300 0 0 1300

Mengetahui
Kepala UPT.Puskesmas Peureulak Pengelola Obat PKM
Kabupaten Aceh Timur

( Mukhlis,SMK.M.Kes ) ( Erlina,AMK )
Nip.19720709 199303 1 003 Nip. 19770415 200604 2 010
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) JKN
BULAN JUNI 2016
PUSKESMAS :

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
1 Acyclovir tab 200 mg 0 0 0 0 0
2 Acyclovir tab 400 mg 0 0 0 0 0
3 Allopurinol 100 mg 1619 0 1619 20 32 18 6 16 25 115 12 3 104 24 26 9 6 13 303 8 740 879
4 Aminofillin tab 200 mg 0 0 0 0 0
5 Amitriptillin 25 mg 0 0 0 0 0
6 Amlodipin 5 mg 2571 0 2571 6 6 240 11 9 6 34 24 12 6 3 6 9 18 6 396 2175
7 Amlodipin 10 mg 5157 0 5157 6 6 60 20 12 104 5053
8 Amoksisillina kapl 250mg 190 0 190 10 30 150 190 0
9 Amoksisillina kapl 500mg 0 0 0 0 0
10 Amoksisillina sirker 250 mg / 5 ml 0 0 0 0 0
11 Ampisillin serbuk Inj 1000 mg/5 ml 0 0 0 0 0
12 Antasida Doen Tab 0 0 0 0 0
13 Antasida sir 0 0 0 0 0
14 Asam Ascorbat ( Vit.C ) 50 mg 4573 0 4573 356 179 99 61 241 169 257 1104 61 76 126 285 213 238 144 153 135 59 30 286 82 213 4567 6
15 Asam Mefenamat 500 mg 10052 0 10052 440 66 60 70 60 90 40 1098 23 60 16 35 166 40 80 20 85 55 30 260 80 60 2934 7118
16 Attapulgite 630 mg 0 0 0 0 0
17 Atropin Inj 0,25 mg/ml 0 0 0 0 0
18 Betametason Krim 160 0 160 2 2 52 2 2 15 4 1 1 5 2 3 91 69
19 Bedak Salisil 2% serbuk 0 0 0 0 0
20 Carbamazepin 200 mg 0 0 0 0 0
21 Deksametason 0,5 mg 20546 0 20546 405 181 107 120 103 110 213 888 68 114 96 369 324 150 98 81 95 21 67 363 136 110 4219 16327
22 Deksametason Inj 5 mg/ml 91 0 91 10 5 15 76
23 Diazepam Tab 2 mg 0 0 0 0 0
24 Digoksin 0,25 mg 150 0 150 0 150
25 Dipenhidramin Inj 65 0 65 0 65
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
26 Domperidone 0 0 0 0 0
27 Erytromicin Syr 472 0 472 20 1 4 2 27 445
28 Etanol 70 % cairan 100 ml 100 0 100 6 2 8 92
29 Ferro Sulfat 300 mg 0 0 0 0 0
30 Fitomenadion Inj 211 0 211 2 2 209
31 Fitomenadion Tablet 5656 0 5656 9 200 10 10 6 235 5421
32 Furrosemida tab 0 0 0 0 0
33 Garam Oralit 53 0 53 26 3 9 10 5 53 0
34 Gentamisin Tetes Mata 0 0 0 0 0
35 Glibenklamida tab 5 mg 0 0 0 0 0
36 Glimepiride 2 mg 764 0 764 109 109 655
37 Glukosa Lar. Inf 5 % 138 0 138 0 138
38 Griseofulvin tab 125 mg 1046 0 1046 6 17 13 21 14 3 100 28 3 205 841
39 Hidrokortison Krim 3 0 3 2 1 3 0
40 Ibuprofen tab.200 mg 0 0 0 0 0
41 Kaptopril 12.5 mg 675 0 675 6 18 21 6 12 18 9 24 12 6 26 6 10 6 8 28 216 459
42 Kaptopril 25 mg 5 0 5 0 5
43 Kaptopril 50 mg 0 0 0 0 0
44 Kals Laktat tab.500 mg 0 0 0 0 0
45 Klorfeniramine Maleat (CTM) 0 0 0 0 0
46 Ketokonazol tablet 200 mg 0 0 0 0 0
47 Ketokonazol cream 0 0 0 0 0
48 Kloramfenikol salep mata 1% 261 0 261 35 35 226
49 Klorpromazine inj 5 mg/ml 0 0 0 0 0
50 Kodein HCL 10 mg 57 0 57 10 20 10 10 7 57 0
51 Kotrimoksazol Susp 234 0 234 3 2 5 2 2 4 2 97 3 3 3 5 3 1 1 1 2 5 3 2 2 4 155 79
52 Kotrimoksazol 480mg Tab 8693 0 8693 30 50 50 12 32 6 10 900 48 12 28 28 12 38 10 9 6 112 20 36 1449 7244
53 Levofloxacin 500 mg 547 0 547 10 3 6 19 528
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
54 Lidokain HCl 2 %+ Epinefrin 0 0 0 0 0
55 Loperamide 2 mg Tab 0 0 0 0 0
56 Loratadine 0 0 0 0 0
57 Metilergometrin salut tab 0,125 mg 722 0 722 100 100 622
58 Metoclopramide 10 mg 5434 0 5434 30 5 6 10 102 30 30 70 30 10 40 10 373 5061
59 Metronidazole 250 mg 393 0 393 0 393
60 Metronidazole 500 mg 3173 0 3173 80 30 70 20 60 128 86 20 20 80 48 30 672 2501
61 Mikonazole Cream 2% 533 0 533 7 2 4 2 5 5 2 16 5 4 5 8 3 7 2 2 1 6 13 3 102 431
62 Natrium Diklofenak 50 mg 0 0 0 0 0
63 Natrium Klorida 0.9 % 154 0 154 0 154
64 Nifedipin 10 mg 1312 0 1312 10 10 20 40 1272
65 Nistatin 500.000 IU/gr 0 0 0 0 0
66 Omeprazole 20 mg 0 0 0 0 0
67 Omeprazole Inj 40 mg/ 10 ml 0 0 0 0 0
68 Parasetamol Syrup 120 mg / 5 ml 2450 0 2450 43 21 23 12 18 24 21 116 16 14 12 12 22 25 14 16 10 14 21 16 13 11 494 1956
69 Parasetamol Tablet 500 mg 52316 0 52316 541 169 220 105 105 125 290 2485 282 133 65 815 342 185 140 110 185 134 215 155 115 125 7041 45275
70 Propanolol tab 40 mg 597 0 597 6 3 9 588
71 Pirantel Pamoat 125 mg 0 0 0 0 0
72 Ranitidin 150 mg tab 0 0 0 0 0
73 Ranitidin Inj 85 0 85 10 10 75
74 Ringer Lactat Infus 2362 0 2362 20 20 20 60 2302
75 Resperidone tab 0 0 0 0 0
76 Salbutamol 4 mg 28 0 28 12 16 28 0
77 Salep 2- 4 0 0 0 0 0
78 Sefadroksil tab 0 0 0 0 0
79 Sefadroksil Syr 536 0 536 3 4 4 5 3 1 1 2 6 3 1 2 35 501
80 Setirizine tab 0 0 0 0 0
81 Simvastatin 20 mg 0 0 0 0 0
82 Tetrasiklin HCL 250 mg 0 0 0 0 0
83 Vitamin B Complek 15958 0 15958 482 175 159 234 180 151 243 1266 145 64 93 160 142 288 111 167 106 78 157 81 213 142 4837 11121
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
84 Yodium Povidon 30 ml 98 0 98 5 16 3 24 74
85 Zink Syr 0 0 0 0 0
86 Zink tab 0 0 0 0 0
OBAT GIGI
87 Eugenol Cairan 15 0 15 0 15
ALAT KESEHATAN
88 Alat Suntik 2,5 cc 892 0 892 35 65 10 30 30 170 722
89 Catgut 2/0 0 0 0 10 10 20 -20
90 Catgut 3/0 186 0 186 10 17 27 159
91 Infusion set Anak 0 0 0 0 0
92 Infusion set dewasa 236 0 236 25 25 10 10 70 166
93 I.V Cateter 20 G 383 600 983 15 5 20 963
94 I.V Cateter 22 G 411 500 911 2 15 5 22 889
95 I.V Cateter 24 G 425 1200 1625 0 1625
96 Kapas 250 gr 46 0 46 2 3 2 2 9 37
97 Kapas Berlemak 500 gr 0 0 0 0 0
98 Kasa Pembalut 4m x 10 cm 2342 0 2342 25 35 2 6 50 118 2224
99 Kasa Pembalut 4m x 15 cm 2058 0 2058 3 3 2055
100 Saveglove ( Hand scun) 630 2000 2630 13 9 12 5 55 5 10 5 114 2516
101 Silk 78 0 78 0 78
102 Oksigen tabung kecil 0 0 0 0 0
103 Oksigen tabung sedang 0 0 0 0 0
104 Oksigen tabung besar 0 0 0 0 0

Mengetahui
Kepala UPT.Puskesmas Peureulak Pengelola Obat PKM
Kabupaten Aceh Timur

( Erlina,AMK )
( Mukhlis,SMK.M.Kes ) Nip. 19770415 200604 2 010
Nip.19720709 199303 1 003
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT JKN
( LPLPO ) JKN

UPT PKM : BULAN : JULI


KECAMATAN : TAHUN : 2016
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 0 0 0 0


2 Acyclovir tab 400 mg Tablet 0 0 0 0
3 Allopurinol 100 mg Tablet 879 879 297 582
4 Aminofillin tab 200 mg Tablet 0 0 0 0
5 Amitriptillin 25 mg Tablet 0 0 0 0
6 Amlodipin 5 mg Tablet 2175 2175 365 1810
7 Amlodipin 10 mg Tablet 5053 5053 167 4886
8 Amoksisillina kapl 250mg Tablet 0 0 0 0
9 Amoksisillina kapl 500mg Tablet 0 0 0 0
10 Amoksisillina sirker 250 mg / 5 ml Botol 0 0 0 0
11 Ampisillin serbuk Inj 1000 mg/5 ml Ampul 0 0 0 0
12 Antasida Doen Tab Tablet 0 0 0 0
13 Antasida sir Botol 0 0 0 0
14 Asam Ascorbat ( Vit.C ) 50 mg Tablet 6 6 6 0
15 Asam Mefenamat 500 mg Tablet 7118 7118 3417 3701
16 Attapulgite 630 mg Tablet 0 0 0 0
17 Atropin Inj 0,25 mg/ml Ampul 0 0 0 0
18 Betametason Krim Tube 69 69 69 0
19 Bedak Salisil 2% serbuk Kotak 0 0 0 0
20 Carbamazepin 200 mg Tablet 0 0 0 0
21 Deksametason 0,5 mg Tablet 16327 16327 3294 13033
22 Deksametason Inj 5 mg/ml Ampul 76 76 0 76
23 Diazepam Tab 2 mg Tablet 0 0 0 0
24 Digoksin 0,25 mg Tablet 150 150 0 150
25 Dipenhidramin Inj Ampul 65 65 0 65
26 Domperidone Tablet 0 0 0 0
27 Erytromicin Syr Botol 445 445 12 433
28 Etanol 70 % cairan 100 ml Botol 92 92 2 90
29 Ferro Sulfat 300 mg Tablet 0 0 0 0
30 Fitomenadion Inj Ampul 209 209 0 209
31 Fitomenadion Tablet Tablet 5421 5421 400 5021
32 Furrosemida tab Tablet 0 0 0 0
33 Garam Oralit Pcs 0 0 0 0
34 Gentamisin Tetes Mata Botol 0 0 0 0
35 Glibenklamida tab 5 mg Tablet 0 0 0 0
36 Glimepiride 2 mg Tablet 655 655 0 655
37 Glukosa Lar. Inf 5 % Botol 138 138 0 138
38 Griseofulvin tab 125 mg Tablet 841 841 138 703
39 Hidrokortison Krim Tube 0 0 0 0
40 Ibuprofen tab.200 mg Tablet 0 0 0 0
41 Kaptopril 12.5 mg Tablet 459 459 438 21
42 Kaptopril 25 mg Tablet 5 5 0 5
43 Kaptopril 50 mg Tablet 0 0 0 0
44 Kals Laktat tab.500 mg Tablet 0 0 0 0
45 Klorfeniramine Maleat (CTM) Tablet 0 0 0 0
46 Ketokonazol tablet 200 mg Tablet 0 0 0 0
47 Ketokonazol cream Tube 0 0 0 0
STOK PENERI PERSE PEMA STOK PERMIN
NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

48 Kloramfenikol salep mata 1% Tube 226 226 23 203


49 Klorpromazine inj 5 mg/ml Ampul 0 0 0 0
50 Kodein HCL 10 mg Tablet 0 0 0 0
51 Kotrimoksazol Susp Botol 79 79 79 0
52 Kotrimoksazol 480mg Tab Tablet 7244 7244 1489 5755
53 Levofloxacin 500 mg Tablet 528 528 30 498
54 Lidokain HCl 2 %+ Epinefrin Ampul 0 0 0 0
55 Loperamide 2 mg Tab Tablet 0 0 0 0
56 Loratadine Tablet 0 0 0 0
57 Metilergometrin salut tab 0,125 mg Tablet 622 622 3 619
58 Metoclopramide 10 mg Tablet 5061 5061 402 4659
59 Metronidazole 250 mg Tablet 393 393 0 393
60 Metronidazole 500 mg Tablet 2501 2501 1854 647
61 Mikonazole Cream 2% Tube 431 431 68 363
62 Natrium Diklofenak 50 mg Tablet 0 0 0 0
63 Natrium Klorida 0.9 % Botol 154 154 15 139
64 Nifedipin 10 mg Tablet 1272 1272 20 1252
65 Nistatin 500.000 IU/gr Tablet 0 0 0 0
66 Omeprazole 20 mg Kapsul 0 0 0 0
67 Omeprazole Inj 40 mg/ 10 ml Ampul 0 0 0 0
68 Parasetamol Syrup 120 mg / 5 ml Botol 1956 1956 465 1491
69 Parasetamol Tablet 500 mg Tablet 45275 45275 7470 37805
70 Propanolol tab 40 mg Tablet 588 588 50 538
71 Pirantel Pamoat 125 mg Tablet 0 0 0 0
72 Ranitidin 150 mg tab Tablet 0 0 0 0
73 Ranitidin Inj Ampul 75 75 0 75
74 Ringer Lactat Infus Botol 2302 2302 20 2282
75 Resperidone tab Tablet 0 0 0 0
76 Salbutamol 4 mg Tablet 0 0 0 0
77 Salep 2- 4 Pot 0 0 0 0
78 Sefadroksil tab Tablet 0 0 0 0
79 Sefadroksil Syr Botol 501 501 97 404
80 Setirizine tab Tablet 0 0 0 0
81 Simvastatin 20 mg Tablet 0 0 0 0
82 Tetrasiklin HCL 250 mg Tablet 0 0 0 0
83 Vitamin B Complek Tablet 11121 11121 4246 6875
84 Yodium Povidon 30 ml Botol 74 74 6 68
85 Zink Syr Botol 0 0 0 0
86 Zink tab Tablet 0 0 0 0

OBAT GIGI
87 Eugenol Cairan Botol 15 15 0 15
ALAT KESEHATAN
88 Alat Suntik 2,5 cc pcs 872 872 20 852
89 Catgut 2/0 pcs 0 0 0 0
90 Catgut 3/0 pcs 186 186 21 165
91 Infusion set Anak pcs 0 0 0 0
92 Infusion set dewasa pcs 816 816 0 816
93 I.V Cateter 20 G pcs 861 861 15 846
94 I.V Cateter 22 G pcs 1611 1611 15 1596
95 I.V Cateter 24 G pcs 1116 1116 0 1116
96 Kapas 250 gr Bungkus 46 46 0 46
97 Kapas Berlemak 500 gr Bungkus 0 0 1 -1
98 Kasa Pembalut 4m x 10 cm Roll 2339 2339 0 2339
99 Kasa Pembalut 4m x 15 cm Roll 1944 1944 20 1924
STOK PENERI PERSE PEMA STOK PERMIN
NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

100 Saveglove ( Hand scun) pcs 2516 2516 30 2486


101 Silk pcs 78 78 0 78
102 Oksigen tabung kecil Tabung 0 0 0 0
103 Oksigen tabung sedang Tabung 0 0 0 0
104 Oksigen tabung besar Tabung 0 0 0 0
105 Alat suntik 5 cc pcs 0 700 0 0 700
106 Hand scun steril pcs 0 700 0 0 700
107 Urine bag pcs 0 48 0 0 48
108 Foley catheter pediatric 2 way (8) pcs 0 5 0 0 5
109 Foley catheter pediatric 2 way (10) pcs 0 5 0 0 5
110 Foley catheter 2 way (16) pcs 0 5 0 0 5
111 Foley catheter 2 way (18) pcs 0 5 0 0 5
112 Masker pcs 0 1300 0 0 1300

Mengetahui
Kepala Puskesmas.. Pengelola Obat PKM

Nip. Nip.
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) JKN
BULAN JULI 2016
PUSKESMAS :

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
1 Acyclovir tab 200 mg 0 0 0 0 0
2 Acyclovir tab 400 mg 0 0 0 0 0
3 Allopurinol 100 mg 879 0 879 3 20 50 8 16 21 18 3 118 40 297 582
4 Aminofillin tab 200 mg 0 0 0 0 0
5 Amitriptillin 25 mg 0 0 0 0 0
6 Amlodipin 5 mg 2175 0 2175 26 13 12 9 12 7 9 12 18 3 12 204 28 365 1810
7 Amlodipin 10 mg 5053 0 5053 6 3 18 10 10 120 167 4886
8 Amoksisillina kapl 250mg 0 0 0 0 0
9 Amoksisillina kapl 500mg 0 0 0 0 0
10 Amoksisillina sirker 250 mg / 5 ml 0 0 0 0 0
11 Ampisillin serbuk Inj 1000 mg/5 ml 0 0 0 0 0
12 Antasida Doen Tab 0 0 0 0 0
13 Antasida sir 0 0 0 0 0
14 Asam Ascorbat ( Vit.C ) 50 mg 6 0 6 6 6 0
15 Asam Mefenamat 500 mg 7118 0 7118 85 135 147 120 110 280 250 80 140 70 150 170 180 1200 160 140 3417 3701
16 Attapulgite 630 mg 0 0 0 0 0
17 Atropin Inj 0,25 mg/ml 0 0 0 0 0
18 Betametason Krim 69 0 69 7 7 6 2 6 3 2 3 4 3 7 3 2 14 69 0
19 Bedak Salisil 2% serbuk 0 0 0 0 0
20 Carbamazepin 200 mg 0 0 0 0 0
21 Deksametason 0,5 mg 16327 0 16327 240 120 134 136 256 102 154 142 138 236 218 160 898 126 234 3294 13033
22 Deksametason Inj 5 mg/ml 76 0 76 0 76
23 Diazepam Tab 2 mg 0 0 0 0 0
24 Digoksin 0,25 mg 150 0 150 0 150
25 Dipenhidramin Inj 65 0 65 0 65
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
26 Domperidone 0 0 0 0 0
27 Erytromicin Syr 445 0 445 4 5 3 12 433
28 Etanol 70 % cairan 100 ml 92 0 92 1 1 2 90
29 Ferro Sulfat 300 mg 0 0 0 0 0
30 Fitomenadion Inj 209 0 209 0 209
31 Fitomenadion Tablet 5421 0 5421 400 400 5021
32 Furrosemida tab 0 0 0 0 0
33 Garam Oralit 0 0 0 0 0
34 Gentamisin Tetes Mata 0 0 0 0 0
35 Glibenklamida tab 5 mg 0 0 0 0 0
36 Glimepiride 2 mg 655 0 655 0 655
37 Glukosa Lar. Inf 5 % 138 0 138 0 138
38 Griseofulvin tab 125 mg 841 0 841 10 8 100 20 138 703
39 Hidrokortison Krim 0 0 0 0 0
40 Ibuprofen tab.200 mg 0 0 0 0 0
41 Kaptopril 12.5 mg 459 0 459 18 95 28 40 30 42 34 16 45 22 28 18 10 12 438 21
42 Kaptopril 25 mg 5 0 5 0 5
43 Kaptopril 50 mg 0 0 0 0 0
44 Kals Laktat tab.500 mg 0 0 0 0 0
45 Klorfeniramine Maleat (CTM) 0 0 0 0 0
46 Ketokonazol tablet 200 mg 0 0 0 0 0
47 Ketokonazol cream 0 0 0 0 0
48 Kloramfenikol salep mata 1% 226 0 226 23 23 203
49 Klorpromazine inj 5 mg/ml 0 0 0 0 0
50 Kodein HCL 10 mg 0 0 0 0 0
51 Kotrimoksazol Susp 79 0 79 4 3 5 11 5 8 4 3 8 5 6 3 7 3 4 79 0
52 Kotrimoksazol 480mg Tab 7244 0 7244 24 64 49 134 28 68 16 26 18 12 34 36 24 860 58 38 1489 5755
53 Levofloxacin 500 mg 528 0 528 6 3 3 3 6 3 6 30 498
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
54 Lidokain HCl 2 %+ Epinefrin 0 0 0 0 0
55 Loperamide 2 mg Tab 0 0 0 0 0
56 Loratadine 0 0 0 0 0
57 Metilergometrin salut tab 0,125 mg 622 0 622 3 3 619
58 Metoclopramide 10 mg 5061 0 5061 20 26 31 60 20 50 10 40 135 10 402 4659
59 Metronidazole 250 mg 393 0 393 0 393
60 Metronidazole 500 mg 2501 0 2501 154 80 120 130 120 60 230 80 160 40 140 60 280 110 30 60 1854 647
61 Mikonazole Cream 2% 431 0 431 4 7 5 3 7 7 3 11 12 6 3 68 363
62 Natrium Diklofenak 50 mg 0 0 0 0 0
63 Natrium Klorida 0.9 % 154 0 154 15 15 139
64 Nifedipin 10 mg 1272 0 1272 20 20 1252
65 Nistatin 500.000 IU/gr 0 0 0 0 0
66 Omeprazole 20 mg 0 0 0 0 0
67 Omeprazole Inj 40 mg/ 10 ml 0 0 0 0 0
68 Parasetamol Syrup 120 mg / 5 ml 1956 0 1956 27 26 24 18 18 21 24 27 25 28 32 18 29 98 22 28 465 1491
69 Parasetamol Tablet 500 mg 45275 0 45275 312 256 308 388 321 240 354 215 326 312 371 320 283 2860 278 326 7470 37805
70 Propanolol tab 40 mg 588 0 588 30 20 50 538
71 Pirantel Pamoat 125 mg 0 0 0 0 0
72 Ranitidin 150 mg tab 0 0 0 0 0
73 Ranitidin Inj 75 0 75 0 75
74 Ringer Lactat Infus 2302 0 2302 14 6 20 2282
75 Resperidone tab 0 0 0 0 0
76 Salbutamol 4 mg 0 0 0 0 0
77 Salep 2- 4 0 0 0 0 0
78 Sefadroksil tab 0 0 0 0 0
79 Sefadroksil Syr 501 0 501 5 3 8 3 5 8 4 3 5 11 8 5 5 11 6 7 97 404
80 Setirizine tab 0 0 0 0 0
81 Simvastatin 20 mg 0 0 0 0 0
82 Tetrasiklin HCL 250 mg 0 0 0 0 0
83 Vitamin B Complek 11121 0 11121 286 264 280 135 148 124 178 146 240 311 322 226 326 838 187 235 4246 6875

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
84 Yodium Povidon 30 ml 74 0 74 5 1 6 68
85 Zink Syr 0 0 0 0 0
86 Zink tab 0 0 0 0 0
OBAT GIGI
87 Eugenol Cairan 15 0 15 0 15
ALAT KESEHATAN
88 Alat Suntik 2,5 cc 722 0 722 20 20 702
89 Catgut 2/0 0 0 0 0 0
90 Catgut 3/0 159 0 159 12 9 21 138
91 Infusion set Anak 0 0 0 0 0
92 Infusion set dewasa 166 0 166 0 166
93 I.V Cateter 20 G 963 0 963 15 15 948
94 I.V Cateter 22 G 889 0 889 15 15 874
95 I.V Cateter 24 G 1625 0 1625 0 1625
96 Kapas 250 gr 37 0 37 0 37
97 Kapas Berlemak 500 gr 0 0 0 1 1 -1
98 Kasa Pembalut 4m x 10 cm 2224 0 2224 0 2224
99 Kasa Pembalut 4m x 15 cm 2055 0 2055 20 20 2035
100 Saveglove ( Hand scun) 2516 0 2516 5 5 10 10 30 2486
101 Silk 78 0 78 0 78
102 Oksigen tabung kecil 0 0 0 0 0
103 Oksigen tabung sedang 0 0 0 0 0
104 Oksigen tabung besar 0 0 0 0 0
105 Alat suntik 5 cc 0 700 700 0 700
106 Hand scun steril 0 700 700 0 700
107 Urine bag 0 48 48 0 48
108 Foley catheter pediatric 2 way (8) 0 5 5 0 5
109 Foley catheter pediatric 2 way (10) 0 5 5 0 5
110 Foley catheter 2 way (16) 0 5 5 0 5
111 Foley catheter 2 way (18) 0 5 5 0 5
112 Masker 0 1300 1300 0 1300

Mengetahui
Kepala Puskesmas Pengelola Obat PKM

Nip. Nip.
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) JKN
BULAN AGUSTUS 2016
PUSKESMAS :

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
1 Acyclovir tab 200 mg 0 0 0 0 0
2 Acyclovir tab 400 mg 0 0 0 0 0
3 Allopurinol 100 mg 582 0 582 6 16 13 34 49 14 24 18 56 48 18 17 145 14 24 496 86
4 Aminofillin tab 200 mg 0 0 0 0 0
5 Amitriptillin 25 mg 0 0 0 0 0
6 Amlodipin 5 mg 1810 0 1810 6 16 18 3 6 15 18 28 14 18 90 324 12 10 578 1232
7 Amlodipin 10 mg 4886 0 4886 12 18 8 10 10 15 243 5 5 326 4560
8 Amoksisillina kapl 250mg 0 0 0 0 0
9 Amoksisillina kapl 500mg 0 0 0 0 0
10 Amoksisillina sirker 250 mg / 5 ml 0 6000 6000 7 12 79 14 16 21 8 157 5843
11 Ampisillin serbuk Inj 1000 mg/5 ml 0 0 0 0 0
12 Antasida Doen Tab 0 0 0 0 0
13 Antasida sir 0 3000 3000 7 17 58 6 9 11 9 117 2883
14 Asam Ascorbat ( Vit.C ) 50 mg 0 60000 60000 400 120 712 70 98 86 124 1610 58390
15 Asam Mefenamat 500 mg 3701 0 3701 90 100 70 120 160 120 60 350 121 80 140 60 120 50 200 30 900 140 60 80 60 3111 590
16 Attapulgite 630 mg 0 0 0 0 0
17 Atropin Inj 0,25 mg/ml 0 0 0 0 0
18 Betametason Krim 0 1000 1000 10 2 32 5 2 51 949
19 Bedak Salisil 2% serbuk 0 1700 1700 10 15 38 12 9 6 11 101 1599
20 Carbamazepin 200 mg 0 0 0 0 0
21 Deksametason 0,5 mg 13033 0 13033 171 134 139 158 122 278 132 423 178 148 150 179 98 321 423 132 1135 172 89 123 188 4893 8140
22 Deksametason Inj 5 mg/ml 76 0 76 5 5 5 15 30 46
23 Diazepam Tab 2 mg 0 0 0 0 0
24 Digoksin 0,25 mg 150 0 150 0 150
25 Dipenhidramin Inj 65 0 65 0 65
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
26 Domperidone 0 0 0 0 0
27 Erytromicin Syr 433 0 433 2 1 2 5 2 5 5 22 411
28 Etanol 70 % cairan 100 ml 90 0 90 3 1 2 6 1 13 77
29 Ferro Sulfat 300 mg 0 0 0 0 0
30 Fitomenadion Inj 209 0 209 16 16 193
31 Fitomenadion Tablet 5021 0 5021 6 10 10 20 35 25 100 123 421 10 14 774 4247
32 Furrosemida tab 0 0 0 0 0
33 Garam Oralit 0 0 0 0 0
34 Gentamisin Tetes Mata 0 0 0 0 0
35 Glibenklamida tab 5 mg 0 0 0 0 0
36 Glimepiride 2 mg 655 0 655 15 12 10 18 5 8 12 100 5 185 470
37 Glukosa Lar. Inf 5 % 138 200 338 20 10 30 308
38 Griseofulvin tab 125 mg 703 0 703 10 6 121 6 6 149 554
39 Hidrokortison Krim 0 0 0 0 0
40 Ibuprofen tab.200 mg 0 30000 30000 200 420 30 10 660 29340
41 Kaptopril 12.5 mg 21 0 21 16 5 21 0
42 Kaptopril 25 mg 5 0 5 5 5 0
43 Kaptopril 50 mg 0 0 0 0 0
44 Kals Laktat tab.500 mg 0 0 0 0 0
45 Klorfeniramine Maleat (CTM) 0 0 0 0 0
46 Ketokonazol tablet 200 mg 0 5000 5000 0 5000
47 Ketokonazol cream 0 488 488 7 3 2 1 13 475
48 Kloramfenikol salep mata 1% 203 0 203 3 6 10 1 1 21 182
49 Klorpromazine inj 5 mg/ml 0 0 0 0 0
50 Kodein HCL 10 mg 0 0 0 0 0
51 Kotrimoksazol Susp 0 4000 4000 10 6 46 11 7 11 6 97 3903
52 Kotrimoksazol 480mg Tab 5755 0 5755 36 34 12 20 18 6 24 32 34 12 6 24 345 50 18 12 683 5072
53 Levofloxacin 500 mg 498 0 498 3 3 6 492
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
54 Lidokain HCl 2 %+ Epinefrin 0 0 0 0 0
55 Loperamide 2 mg Tab 0 0 0 0 0
56 Loratadine 0 0 0 0 0
57 Metilergometrin salut tab 0,125 mg 619 0 619 0 619
58 Metoclopramide 10 mg 4659 500 5159 20 20 30 10 25 10 40 52 64 27 230 20 49 20 617 4542
59 Metronidazole 250 mg 393 0 393 40 60 30 20 60 60 60 30 33 393 0
60 Metronidazole 500 mg 647 0 647 30 30 40 60 40 60 20 67 300 647 0
61 Mikonazole Cream 2% 363 164 527 3 6 4 9 5 2 3 4 5 2 6 5 7 16 14 2 32 12 7 11 9 164 363
62 Natrium Diklofenak 50 mg 0 0 0 0 0
63 Natrium Klorida 0.9 % 139 400 539 20 20 40 80 459
64 Nifedipin 10 mg 1252 1500 2752 10 20 5 10 20 230 10 305 2447
65 Nistatin 500.000 IU/gr 0 0 0 0 0
66 Omeprazole 20 mg 0 0 0 0 0
67 Omeprazole Inj 40 mg/ 10 ml 0 0 0 0 0
68 Parasetamol Syrup 120 mg / 5 ml 1491 0 1491 34 19 15 21 14 21 15 10 19 22 27 11 18 24 15 11 86 11 12 15 13 433 1058
69 Parasetamol Tablet 500 mg 37805 0 37805 346 480 453 358 395 369 322 368 867 358 345 259 357 263 326 333 3670 397 480 312 456 11514 26291
70 Propanolol tab 40 mg 538 25 563 10 5 10 25 538
71 Pirantel Pamoat 125 mg 0 0 0 0 0
72 Ranitidin 150 mg tab 0 0 0 0 0
73 Ranitidin Inj 75 25 100 10 5 10 25 75
74 Ringer Lactat Infus 2282 90 2372 20 20 10 40 90 2282
75 Resperidone tab 0 0 0 0 0
76 Salbutamol 4 mg 0 0 0 0 0
77 Salep 2- 4 0 0 0 0 0
78 Sefadroksil tab 0 0 0 0 0
79 Sefadroksil Syr 404 0 404 15 14 17 12 15 17 14 12 15 11 16 19 11 16 18 8 38 7 11 7 5 298 106
80 Setirizine tab 0 0 0 0 0
81 Simvastatin 20 mg 0 0 0 0 0
82 Tetrasiklin HCL 250 mg 0 0 0 0 0
83 Vitamin B Complek 6875 0 6875 235 192 180 251 231 321 197 265 325 183 237 215 187 321 523 156 832 124 210 118 253 5556 1319
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
84 Yodium Povidon 30 ml 68 0 68 2 3 6 11 57
85 Zink Syr 0 0 0 0 0
86 Zink tab 0 0 0 0 0
OBAT GIGI
87 Eugenol Cairan 15 0 15 0 15
ALAT KESEHATAN
88 Alat Suntik 2,5 cc 702 1000 1702 50 20 20 80 170 1532
89 Catgut 2/0 0 600 600 5 5 10 590
90 Catgut 3/0 138 600 738 5 5 10 728
91 Infusion set Anak 0 200 200 0 200
92 Infusion set dewasa 166 700 866 15 10 25 10 20 5 85 781
93 I.V Cateter 20 G 948 600 1548 10 5 15 1533
94 I.V Cateter 22 G 874 0 874 15 15 859
95 I.V Cateter 24 G 1625 300 1925 10 5 15 1910
96 Kapas 250 gr 37 73 110 1 1 1 1 5 9 101
97 Kapas Berlemak 500 gr 0 0 0 0 0
98 Kasa Pembalut 4m x 10 cm 2224 1020 3244 25 10 5 30 5 75 3169
99 Kasa Pembalut 4m x 15 cm 2035 2000 4035 15 20 10 45 3990
100 Saveglove ( Hand scun) 2486 300 2786 10 5 9 10 5 10 49 2737
101 Silk 78 0 78 5 3 5 13 65
102 Oksigen tabung kecil 0 0 0 0 0
103 Oksigen tabung sedang 0 0 0 0 0
104 Oksigen tabung besar 0 0 0 0 0
105 Iodium pavidon 60 ml 0 100 100 3 1 4 96
105 Alat suntik 5 cc 700 800 1500 10 30 5 10 55 1445
106 Hand scun steril 700 0 700 0 700
107 Urine bag 48 43 91 0 91
108 Foley catheter pediatric 2 way (8) 5 25 30 0 30
109 Foley catheter pediatric 2 way (10) 5 25 30 0 30
110 Foley catheter 2 way (12) 0 5 5 0 5
111 Foley catheter 2 way (14) 0 5 5 0 5
112 Foley catheter 2 way (16) 5 15 20 0 20
113 Foley catheter 2 way (18) 5 25 30 0 30
114 Masker 1300 300 1600 0 1600
115 Magnesium Sulfat Inj 20 % 0 36 36 0 36
116 Magnesium Sulfat Inj 40 % 0 36 36 0 36
117 Metformin 500 mg 0 1800 1800 30 113 10 5 10 20 188 1612

Pengelola Obat PKM

Mengetahui
Kepala Puskesmas Erlina.Amk
Nip. 19770415 200604 2 010

Mukhlis,SKM,M,Kes
Nip.19720709 199303 1 003
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT JKN
( LPLPO ) JKN

UPT PKM : PEUREULAK BULAN : AGUSTUS

KECAMATAN : PEUREULAK TAHUN : 2016


KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 0 0 0 0 0


2 Acyclovir tab 400 mg Tablet 0 0 0 0 0
3 Allopurinol 100 mg Tablet 582 0 582 496 86
4 Aminofillin tab 200 mg Tablet 0 0 0 0 0
5 Amitriptillin 25 mg Tablet 0 0 0 0 0
6 Amlodipin 5 mg Tablet 1810 0 1810 578 1232
7 Amlodipin 10 mg Tablet 4886 0 4886 326 4560
8 Amoksisillina kapl 250mg Tablet 0 0 0 0 0
9 Amoksisillina kapl 500mg Tablet 0 0 0 0 0
10 Amoksisillina sirker 250 mg / 5 ml Botol 0 6000 6000 157 5843
11 Ampisillin serbuk Inj 1000 mg/5 ml Ampul 0 0 0 0 0
12 Antasida Doen Tab Tablet 0 0 0 0 0
13 Antasida sir Botol 0 3000 3000 117 2883
14 Asam Ascorbat ( Vit.C ) 50 mg Tablet 0 60000 60000 1610 58390
15 Asam Mefenamat 500 mg Tablet 3701 0 3701 3111 590
16 Attapulgite 630 mg Tablet 0 0 0 0 0
17 Atropin Inj 0,25 mg/ml Ampul 0 0 0 0 0
18 Betametason Krim Tube 0 1000 1000 51 949
19 Bedak Salisil 2% serbuk Kotak 0 1700 1700 101 1599
20 Carbamazepin 200 mg Tablet 0 0 0 0 0
21 Deksametason 0,5 mg Tablet 13033 0 13033 4893 8140
22 Deksametason Inj 5 mg/ml Ampul 76 0 76 30 46
23 Diazepam Tab 2 mg Tablet 0 0 0 0 0
24 Digoksin 0,25 mg Tablet 150 0 150 0 150
25 Dipenhidramin Inj Ampul 65 0 65 0 65
26 Domperidone Tablet 0 0 0 0 0
27 Erytromicin Syr Botol 433 0 433 22 411
28 Etanol 70 % cairan 100 ml Botol 90 0 90 13 77
29 Ferro Sulfat 300 mg Tablet 0 0 0 0 0
30 Fitomenadion Inj Ampul 209 0 209 16 193
31 Fitomenadion Tablet Tablet 5021 0 5021 774 4247
32 Furrosemida tab Tablet 0 0 0 0 0
33 Garam Oralit Pcs 0 0 0 0 0
34 Gentamisin Tetes Mata Botol 0 0 0 0 0
35 Glibenklamida tab 5 mg Tablet 0 0 0 0 0
36 Glimepiride 2 mg Tablet 655 0 655 185 470
37 Glukosa Lar. Inf 5 % Botol 138 200 338 30 308
38 Griseofulvin tab 125 mg Tablet 703 0 703 149 554
39 Hidrokortison Krim Tube 0 0 0 0 0
40 Ibuprofen tab.200 mg Tablet 0 30000 30000 660 29340
41 Kaptopril 12.5 mg Tablet 21 0 21 21 0
42 Kaptopril 25 mg Tablet 5 0 5 5 0
43 Kaptopril 50 mg Tablet 0 0 0 0 0
44 Kals Laktat tab.500 mg Tablet 0 0 0 0 0
45 Klorfeniramine Maleat (CTM) Tablet 0 0 0 0 0
46 Ketokonazol tablet 200 mg Tablet 0 5000 5000 0 5000
47 Ketokonazol cream Tube 0 488 488 13 475
STOK PENERI PERSE PEMA STOK PERMIN
NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

48 Kloramfenikol salep mata 1% Tube 203 0 203 21 182


49 Klorpromazine inj 5 mg/ml Ampul 0 0 0 0 0
50 Kodein HCL 10 mg Tablet 0 0 0 0 0
51 Kotrimoksazol Susp Botol 0 4000 4000 97 3903
52 Kotrimoksazol 480mg Tab Tablet 5755 0 5755 683 5072
53 Levofloxacin 500 mg Tablet 498 0 498 6 492
54 Lidokain HCl 2 %+ Epinefrin Ampul 0 0 0 0 0
55 Loperamide 2 mg Tab Tablet 0 0 0 0 0
56 Loratadine Tablet 0 0 0 0 0
57 Metilergometrin salut tab 0,125 mg Tablet 619 0 619 0 619
58 Metoclopramide 5 mg Tablet 4659 500 5159 617 4542
59 Metronidazole 250 mg Tablet 393 0 393 393 0
60 Metronidazole 500 mg Tablet 647 0 647 647 0
61 Mikonazole Cream 2% Tube 363 1200 1563 164 1399
62 Natrium Diklofenak 50 mg Tablet 0 0 0 0 0
63 Natrium Klorida 0.9 % Botol 139 400 539 80 459
64 Nifedipin 10 mg Tablet 1252 1500 2752 305 2447
65 Nistatin 500.000 IU/gr Tablet 0 1500 1500 0 1500
66 Omeprazole 20 mg Kapsul 0 0 0 0 0
67 Omeprazole Inj 40 mg/ 10 ml Ampul 0 0 0 0 0
68 Parasetamol Syrup 120 mg / 5 ml Botol 1491 0 1491 433 1058
69 Parasetamol Tablet 500 mg Tablet 37805 0 37805 11514 26291
70 Propanolol tab 40 mg Tablet 538 0 538 25 513
71 Pirantel Pamoat 125 mg Tablet 0 0 0 0 0
72 Ranitidin 150 mg tab Tablet 0 30000 30000 0 30000
73 Ranitidin Inj Ampul 75 0 75 25 50
74 Ringer Lactat Infus Botol 2282 400 2682 90 2592
75 Resperidone tab Tablet 0 0 0 0 0
76 Salbutamol 4 mg Tablet 0 0 0 0 0
77 Salep 2- 4 Pot 0 0 0 0 0
78 Sefadroksil tab Tablet 0 0 0 0 0
79 Sefadroksil Syr Botol 404 0 404 298 106
80 Setirizine tab Tablet 0 0 0 0 0
81 Simvastatin 20 mg Tablet 0 1000 1000 0 1000
82 Tetrasiklin HCL 250 mg Tablet 0 0 0 0 0
83 Vitamin B Complek Tablet 6875 0 6875 5556 1319
84 Yodium Povidon 30 ml Botol 68 0 68 11 57
85 Zink Syr Botol 0 0 0 0 0
86 Zink tab Tablet 0 0 0 0 0
OBAT GIGI
87 Eugenol Cairan Botol 15 0 15 0 15
ALAT KESEHATAN
88 Alat Suntik 2,5 cc pcs 852 1000 1852 170 1682
89 Catgut 2/0 pcs 0 600 600 10 590
90 Catgut 3/0 pcs 165 600 765 10 755
91 Infusion set Anak pcs 0 200 200 0 200
92 Infusion set dewasa pcs 816 700 1516 85 1431
93 I.V Cateter 20 G pcs 846 600 1446 15 1431
94 I.V Cateter 22 G pcs 1596 0 1596 15 1581
95 I.V Cateter 24 G pcs 1116 300 1416 15 1401
96 Kapas 250 gr Bungkus 46 73 119 9 110
97 Kapas Berlemak 500 gr Bungkus 0 0 0 0 0
98 Kasa Pembalut 4m x 10 cm Roll 2339 1020 3359 75 3284
99 Kasa Pembalut 4m x 15 cm Roll 1924 2000 3924 45 3879

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

100 Saveglove ( Hand scun) pcs 2486 300 2786 49 2737


101 Silk pcs 78 0 78 13 65
102 Oksigen tabung kecil Tabung 0 0 0 0 0
103 Oksigen tabung sedang Tabung 0 0 0 0 0
104 Oksigen tabung besar Tabung 0 0 0 0 0
105 Iodium povidon 60 ml Botol 0 100 100 4 96
106 Metformin 500 mg Tablet 0 1800 1800 188 1612
107 Masker Pcs 1300 300 1600 0 1600
108 Alat suntik 5 cc pcs 700 800 1500 0 1500
109 Hand scun steril pcs 700 0 700 0 700
110 Urine bag pcs 48 43 91 0 91
111 Foley catheter pediatric 2 way (8) pcs 5 25 30 0 30
112 Foley catheter pediatric 2 way (10) pcs 5 25 30 0 30
113 Foley catheter 2 way (12) pcs 0 5 5 0 5
114 Foley catheter 2 way (14) pcs 0 5 5 0 5
115 Foley catheter 2 way (16) pcs 5 15 20 0 20
116 Foley catheter 2 way (18) pcs 5 25 30 0 30
117 Magnesium Sulfat Inj 20 % Ampl 0 36 36 0 36
118 Magnesium Sulfat Inj 40 % Ampl 0 36 36 0 36
119 Hand scun non steril ukuran L pcs 0 1000 1000 0 1000
Mengetahui
Kepala Puskesmas.. Pengelola Obat PKM

Nip. Nip.
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT JKN
( LPLPO ) JKN

UPT PKM : PEUREULAK BULAN : SEPTEMBER

KECAMATAN : PEUREUAK TAHUN : 2016


KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 0 0 0 0 0 0


2 Acyclovir tab 400 mg Tablet 0 0 0 0 0 0
3 Allopurinol 100 mg Tablet 86 0 86 86 0 0
4 Aminofillin tab 200 mg Tablet 0 0 0 0 0 0
5 Amitriptillin 25 mg Tablet 0 0 0 0 0 0
6 Amlodipin 5 mg Tablet 1232 0 1232 321 911 0
7 Amlodipin 10 mg Tablet 4560 0 4560 480 4080 0
8 Amoksisillina kapl 250mg Tablet 0 0 0 0 0 0
9 Amoksisillina kapl 500mg Tablet 0 5000 5000 2895 2105 0
10 Amoksisillina sirker 250 mg / 5 ml Botol 5843 0 5843 393 5450 0
11 Ampisillin serbuk Inj 1000 mg/5 ml Ampul 0 0 0 0 0 0
12 Antasida Doen Tab Tablet 0 0 0 0 0 0
13 Antasida sir Botol 2883 0 2883 286 2597 0
14 Asam Ascorbat ( Vit.C ) 50 mg Tablet 58390 0 58390 3780 54610 0
15 Asam Mefenamat 500 mg Tablet 590 0 590 590 0 0
16 Attapulgite 630 mg Tablet 0 0 0 0 0 0
17 Atropin Inj 0,25 mg/ml Ampul 0 0 0 0 0 0
18 Betametason Krim Tube 949 0 949 83 866 0
19 Bedak Salisil 2% serbuk Kotak 1599 0 1599 115 1484 0
20 Carbamazepin 200 mg Tablet 0 0 0 0 0 0
21 Deksametason 0,5 mg Tablet 8140 0 8140 5613 2527 0
22 Deksametason Inj 5 mg/ml Ampul 46 0 46 11 35 0
23 Diazepam Tab 2 mg Tablet 0 0 0 0 0 0
24 Digoksin 0,25 mg Tablet 150 0 150 0 150 0
25 Dipenhidramin Inj Ampul 65 0 65 0 65 0
26 Domperidone Tablet 0 0 0 0 0 0
27 Erytromicin Syr Botol 411 0 411 34 377 0
28 Etanol 70 % cairan 100 ml Botol 77 0 77 18 59 0
29 Ferro Sulfat 300 mg Tablet 0 0 0 0 0 0
30 Fitomenadion Inj Ampul 193 0 193 9 184 0
31 Fitomenadion Tablet Tablet 4247 0 4247 956 3291 0
32 Furrosemida tab Tablet 0 0 0 0 0 0
33 Garam Oralit Pcs 0 0 0 0 0 0
34 Gentamisin Tetes Mata Botol 0 0 0 0 0 0
35 Glibenklamida tab 5 mg Tablet 0 0 0 0 0 0
36 Glimepiride 2 mg Tablet 470 0 470 130 340 0
37 Glukosa Lar. Inf 5 % Botol 308 0 308 10 298 0
38 Griseofulvin tab 125 mg Tablet 554 0 554 164 390 0
39 Hidrokortison Krim Tube 0 0 0 0 0 0
40 Ibuprofen tab.200 mg Tablet 29340 0 29340 1220 28120 0
41 Kaptopril 12.5 mg Tablet 0 0 0 0 0 0
42 Kaptopril 25 mg Tablet 0 0 0 0 0 0
43 Kaptopril 50 mg Tablet 0 0 0 0 0 0
44 Kals Laktat tab.500 mg Tablet 0 0 0 0 0 0
45 Klorfeniramine Maleat (CTM) Tablet 0 0 0 0 0 0
46 Ketokonazol tablet 200 mg Tablet 5000 0 5000 437 4563 0
47 Ketokonazol cream Tube 475 0 475 34 441 0
STOK PENERI PERSE PEMA STOK PERMIN
NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

48 Kloramfenikol salep mata 1% Tube 182 0 182 50 132 0


49 Klorpromazine inj 5 mg/ml Ampul 0 0 0 0 0 0
50 Kodein HCL 10 mg Tablet 0 0 0 0 0 0
51 Kotrimoksazol Susp Botol 3903 0 3903 178 3725 0
52 Kotrimoksazol 480mg Tab Tablet 5072 0 5072 1367 3705 0
53 Levofloxacin 500 mg Tablet 492 0 492 15 477 0
54 Lidokain HCl 2 %+ Epinefrin Ampul 0 0 0 0 0 0
55 Loperamide 2 mg Tab Tablet 0 0 0 0 0 0
56 Loratadine Tablet 0 0 0 0 0 0
57 Metilergometrin salut tab 0,125 mg Tablet 564 0 564 55 509 0
58 Metoclopramide 10 mg Tablet 4094 0 4094 448 3646 0
59 Metronidazole 250 mg Tablet 0 0 0 0 0 0
60 Metronidazole 500 mg Tablet 0 0 0 0 0 0
61 Mikonazole Cream 2% Tube 1399 0 1399 156 1243 0
62 Natrium Diklofenak 50 mg Tablet 0 0 0 0 0 0
63 Natrium Klorida 0.9 % Botol 459 0 459 38 421 0
64 Nifedipin 10 mg Tablet 2447 0 2447 33 2414 0
65 Nistatin 500.000 IU/gr Tablet 1500 0 1500 0 1500 0
66 Omeprazole 20 mg Kapsul 0 0 0 0 0 0
67 Omeprazole Inj 40 mg/ 10 ml Ampul 0 0 0 0 0 0
68 Parasetamol Syrup 120 mg / 5 ml Botol 1058 0 1058 300 758 0
69 Parasetamol Tablet 500 mg Tablet 26291 0 26291 7097 19194 0
70 Propanolol tab 40 mg Tablet 513 0 513 0 513 0
71 Pirantel Pamoat 125 mg Tablet 0 0 0 0 0 0
72 Ranitidin 150 mg tab Tablet 30000 0 30000 2664 27336 0
73 Ranitidin Inj Ampul 50 0 50 26 24 0
74 Ringer Lactat Infus Botol 2592 0 2592 130 2462 0
75 Resperidone tab Tablet 0 0 0 0 0 0
76 Salbutamol 4 mg Tablet 0 0 0 0 0 0
77 Salep 2- 4 Pot 0 0 0 0 0 0
78 Sefadroksil tab Tablet 0 0 0 0 0 0
79 Sefadroksil Syr Botol 106 0 106 106 0 0
80 Setirizine tab Tablet 0 0 0 0 0 0
81 Simvastatin 20 mg Tablet 1000 0 1000 75 925 0
82 Tetrasiklin HCL 250 mg Tablet 0 0 0 0 0 0
83 Vitamin B Complek Tablet 1319 0 1319 1319 0 0
84 Yodium Povidon 30 ml Botol 57 0 57 28 29 0
85 Zink Syr Botol 0 0 0 0 0 0
86 Zink tab Tablet 0 0 0 0 0 0
OBAT GIGI
87 Eugenol Cairan Botol 15 0 15 0 15 0
ALAT KESEHATAN
88 Alat Suntik 2,5 cc pcs 1682 0 1682 147 1535 0
89 Catgut 2/0 pcs 590 0 590 8 582 0
90 Catgut 3/0 pcs 755 0 755 6 749 0
91 Infusion set Anak pcs 200 0 200 5 195 0
92 Infusion set dewasa pcs 1431 0 1431 42 1389 0
93 I.V Cateter 20 G pcs 1431 0 1431 20 1411 0
94 I.V Cateter 22 G pcs 1581 0 1581 70 1511 0
95 I.V Cateter 24 G pcs 1401 0 1401 10 1391 0
96 Kapas 250 gr Bungkus 110 0 110 5 105 0
97 Kapas Berlemak 500 gr Bungkus 0 0 0 0 0 0
98 Kasa Pembalut 4m x 10 cm Roll 3284 0 3284 85 3199 0
99 Kasa Pembalut 4m x 15 cm Roll 3879 0 3879 75 3804 0

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

100 Saveglove ( Hand scun) pcs 2737 0 2737 25 2712 0


101 Silk pcs 65 0 65 0 65 0
102 Oksigen tabung kecil Tabung 0 0 0 0 0 0
103 Oksigen tabung sedang Tabung 0 0 0 0 0 0
104 Oksigen tabung besar Tabung 0 0 0 0 0 0
105 Iodium pavidon 60ml Botol 500 0 500 6 494 0
106 Metformin 500 mg Tablet 1612 0 1612 275 1337 0
107 Masker Pcs 1600 1600 50 1550 0
108 Alat suntik 5 cc pcs 1500 0 1500 5 1495 0
109 Hand scun steril pcs 700 0 700 20 680 0
110 Urine bag pcs 91 0 91 0 91 0
111 Foley catheter pediatric 2 way (8) pcs 30 0 30 0 30 0
112 Foley catheter pediatric 2 way (10) pcs 30 0 30 0 30 0
113 Foley catheter 2 way (12) pcs 5 0 5 0 5 0
114 Foley catheter 2 way (14) pcs 5 0 5 0 5 0
115 Foley catheter 2 way (16) pcs 20 0 20 0 20 0
116 Foley catheter 2 way (18) pcs 30 0 30 0 30 0
117 Magnesium Sulfat Inj 20 % Ampl 36 0 36 0 36 0
118 Magnesium Sulfat Inj 40 % Ampl 36 0 36 0 36 0
119 Hand scun non steril ukuran L pcs 1000 0 1000 25 972 0
120 Piroksikam Tablet 0 500 500 500 0 0
121 Oksitoksin inj 10ui/ml Ampl 0 30 30 0 30 0
122 Septoject 21 mm Botol 0 1 1 0 1 0
123 Klem pusat pcs 0 30 30 0 30 0
124 Spuit 1ml pcs 0 25 25 0 25 20
125 Phacain inj Ampl 0 40 40 0 40 100

Nip. Nip.
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) JKN
BULAN SEPTEMBER 2016
PUSKESMAS :

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
1 Acyclovir tab 200 mg 0 0 0 0 0
2 Acyclovir tab 400 mg 0 0 0 0 0
3 Allopurinol 100 mg 86 0 86 28 18 40 86 0
4 Aminofillin tab 200 mg 0 0 0 0 0
5 Amitriptillin 25 mg 0 0 0 0 0
6 Amlodipin 5 mg 1232 0 1232 15 10 34 5 25 5 10 62 125 5 15 10 321 911
7 Amlodipin 10 mg 4560 0 4560 5 25 60 6 5 5 18 330 3 12 3 8 480 4080
8 Amoksisillina kapl 250mg 0 0 0 0 0
9 Amoksisillina kapl 500mg 0 5000 5000 108 118 142 216 125 168 242 275 182 386 86 164 168 120 213 182 2895 2105
10 Amoksisillina sirker 250 mg / 5 ml 5843 0 5843 18 21 11 20 8 6 14 12 11 5 9 15 7 170 9 13 7 5 11 8 13 393 5450
11 Ampisillin serbuk Inj 1000 mg/5 ml 0 0 0 0 0
12 Antasida Doen Tab 0 0 0 0 0
13 Antasida sir 2883 0 2883 18 17 6 20 9 3 12 15 8 5 11 16 7 74 11 8 13 4 7 14 8 286 2597
14 Asam Ascorbat ( Vit.C ) 50 mg 58390 0 58390 175 144 325 135 89 102 147 184 164 78 126 121 86 1208 82 124 142 86 72 82 108 3780 54610
15 Asam Mefenamat 500 mg 590 0 590 130 80 40 70 50 40 70 60 50 590 0
16 Attapulgite 630 mg 0 0 0 0 0
17 Atropin Inj 0,25 mg/ml 0 0 0 0 0
18 Betametason Krim 949 0 949 3 5 5 10 3 5 2 4 7 5 11 2 7 8 2 1 3 83 866
19 Bedak Salisil 2% serbuk 1599 0 1599 9 7 7 2 5 4 11 6 3 5 9 6 6 11 9 5 3 3 4 115 1484
20 Carbamazepin 200 mg 0 0 0 0 0
21 Deksametason 0,5 mg 8140 0 8140 205 240 276 298 164 287 134 322 218 194 257 137 188 1200 203 217 364 275 133 133 168 5613 2527
22 Deksametason Inj 5 mg/ml 46 0 46 5 6 11 35
23 Diazepam Tab 2 mg 0 0 0 0 0
24 Digoksin 0,25 mg 150 0 150 0 150
25 Dipenhidramin Inj 65 0 65 0 65
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
26 Domperidone 0 0 0 0 0
27 Erytromicin Syr 411 0 411 2 3 1 3 20 5 34 377
28 Etanol 70 % cairan 100 ml 77 0 77 2 3 4 2 7 18 59
29 Ferro Sulfat 300 mg 0 0 0 0 0
30 Fitomenadion Inj 193 0 193 3 6 9 184
31 Fitomenadion Tablet 4247 0 4247 15 10 5 12 18 22 812 15 38 9 956 3291
32 Furrosemida tab 0 0 0 0 0
33 Garam Oralit 0 0 0 0 0
34 Gentamisin Tetes Mata 0 0 0 0 0
35 Glibenklamida tab 5 mg 0 0 0 0 0
36 Glimepiride 2 mg 470 0 470 3 6 12 100 9 130 340
37 Glukosa Lar. Inf 5 % 308 0 308 5 5 10 298
38 Griseofulvin tab 125 mg 554 0 554 10 15 18 25 10 47 15 24 164 390
39 Hidrokortison Krim 0 0 0 0 0
40 Ibuprofen tab.200 mg 29340 0 29340 30 50 100 18 20 22 30 58 812 10 40 20 10 1220 28120
41 Kaptopril 12.5 mg 0 0 0 0 0
42 Kaptopril 25 mg 0 0 0 0 0
43 Kaptopril 50 mg 0 0 0 0 0
44 Kals Laktat tab.500 mg 0 0 0 0 0
45 Klorfeniramine Maleat (CTM) 0 0 0 0 0
46 Ketokonazol tablet 200 mg 5000 0 5000 5 15 35 15 30 6 6 18 24 217 29 12 10 15 437 4563
47 Ketokonazol cream 475 0 475 2 1 2 4 1 20 3 1 34 441
48 Kloramfenikol salep mata 1% 182 0 182 4 10 12 3 15 3 1 2 50 132
49 Klorpromazine inj 5 mg/ml 0 0 0 0 0
50 Kodein HCL 10 mg 0 0 0 0 0
51 Kotrimoksazol Susp 3903 0 3903 9 11 5 3 11 9 6 3 7 13 6 63 7 6 8 4 7 178 3725
52 Kotrimoksazol 480mg Tab 5072 0 5072 112 89 34 104 24 18 24 6 12 806 12 68 34 6 18 1367 3705
53 Levofloxacin 500 mg 492 0 492 3 3 6 3 15 477
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
54 Lidokain HCl 2 %+ Epinefrin 0 0 0 0 0
55 Loperamide 2 mg Tab 0 0 0 0 0
56 Loratadine 0 0 0 0 0
57 Metilergometrin salut tab 0,125 mg 619 0 619 20 10 10 15 55 564
58 Metoclopramide 10 mg 4542 0 4542 26 25 10 20 18 20 18 219 14 46 10 22 448 4094
59 Metronidazole 250 mg 0 0 0 0 0
60 Metronidazole 500 mg 0 0 0 0 0
61 Mikonazole Cream 2% 1399 0 1399 5 3 13 10 7 2 9 11 8 3 7 9 3 27 6 5 11 4 3 3 7 156 1243
62 Natrium Diklofenak 50 mg 0 0 0 0 0
63 Natrium Klorida 0.9 % 459 0 459 10 5 20 3 38 421
64 Nifedipin 10 mg 2447 0 2447 6 18 9 33 2414
65 Nistatin 500.000 IU/gr 1500 0 1500 0 1500
66 Omeprazole 20 mg 0 0 0 0 0
67 Omeprazole Inj 40 mg/ 10 ml 0 0 0 0 0
68 Parasetamol Syrup 120 mg / 5 ml 1058 0 1058 18 18 15 20 6 9 16 16 12 8 9 12 9 58 8 11 13 6 9 15 12 300 758
69 Parasetamol Tablet 500 mg 26291 0 26291 280 386 342 943 245 205 287 332 241 216 452 361 230 2541 327 397 321 226 337 241 233 9143 17148
70 Propanolol tab 40 mg 538 0 538 0 538
71 Pirantel Pamoat 125 mg 0 0 0 0 0
72 Ranitidin 150 mg tab 30000 0 30000 86 124 154 68 85 138 103 140 102 66 86 148 64 636 74 120 86 62 94 142 86 2664 27336
73 Ranitidin Inj 75 0 75 5 10 5 6 26 49
74 Ringer Lactat Infus 2282 0 2282 20 20 20 65 5 130 2152
75 Resperidone tab 0 0 0 0 0
76 Salbutamol 4 mg 0 0 0 0 0
77 Salep 2- 4 0 0 0 0 0
78 Sefadroksil tab 0 0 0 0 0
79 Sefadroksil Syr 106 0 106 7 4 7 2 5 3 11 4 7 2 5 9 6 7 5 8 7 3 4 106 0
80 Setirizine tab 0 0 0 0 0
81 Simvastatin 20 mg 1000 0 1000 20 18 3 24 10 75 925
82 Tetrasiklin HCL 250 mg 0 0 0 0 0
83 Vitamin B Complek 1319 0 1319 155 213 232 126 108 98 126 166 95 1319 0
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
84 Yodium Povidon 30 ml 57 0 57 2 1 4 5 3 11 2 28 29
85 Zink Syr 0 0 0 0 0
86 Zink tab 0 0 0 0 0
OBAT GIGI
87 Eugenol Cairan 15 0 15 0 15
ALAT KESEHATAN
88 Alat Suntik 2,5 cc 682 0 682 20 10 2 25 65 25 147 535
89 Catgut 2/0 590 0 590 3 5 8 582
90 Catgut 3/0 728 0 728 3 3 6 722
91 Infusion set Anak 200 0 200 5 5 195
92 Infusion set dewasa 781 0 781 10 7 25 42 739
93 I.V Cateter 20 G 1533 0 1533 10 10 20 1513
94 I.V Cateter 22 G 859 0 859 50 10 10 70 789
95 I.V Cateter 24 G 1910 0 1910 5 5 10 1900
96 Kapas 250 gr 101 0 101 1 1 3 5 96
97 Kapas Berlemak 500 gr 0 0 0 0 0
98 Kasa Pembalut 4m x 10 cm 3169 0 3169 10 5 20 35 15 85 3084
99 Kasa Pembalut 4m x 15 cm 3990 0 3990 20 20 25 10 75 3915
100 Saveglove ( Hand scun) 2737 0 2737 13 12 25 2712
101 Silk 65 0 65 0 65
102 Oksigen tabung kecil 0 0 0 0 0
103 Oksigen tabung sedang 0 0 0 0 0
104 Oksigen tabung besar 0 0 0 0 0
105 Iodium pavidon 60ml 500 0 500 1 5 6 494
106 Metformin 500 mg 1612 0 1612 10 30 20 35 120 30 30 275 1337
107 Masker 1600 0 1600 10 10 20 5 5 50 1550
108 Alat suntik 5 cc 1500 0 1500 5 5 1495
109 Hand scun steril 700 0 700 10 10 20 680
110 Urine bag 91 0 91 0 91
111 Foley catheter pediatric 2 way (8) 30 0 30 0 30
112 Foley catheter pediatric 2 way (10) 30 0 30 0 30
113 Foley catheter 2 way (12) 5 0 5 0 5
114 Foley catheter 2 way (14) 5 0 5 0 5
115 Foley catheter 2 way (16) 20 0 20 0 20
116 Foley catheter 2 way (18) 30 0 30 0 30
117 Magnesium Sulfat Inj 20 % 36 0 36 0 36
118 Magnesium Sulfat Inj 40 % 36 0 36 0 36
119 Hand scun non steril ukuran L 1000 0 1000 10 10 5 25 975
120 Piroksikam 0 500 500 38 42 65 82 31 24 66 74 25 20 33 500 0
121 Oksitoksin inj 10ui/ml 0 30 30 0 30
122 Septoject 21 mm 0 1 1 0 1
123 Klem pusat 0 30 30 0 30
124 Spuit 1 ml 0 25 25 0 25
125 Phcain inj 0 80 80 10 15 14 10 13 13 5 80 0
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT JKN
( LPLPO ) JKN

UPT PKM : PEUREULAK BULAN : OKTOBER

KECAMATAN : PEUREULAK TAHUN : 2016


KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 0 0 0 0 0 0


2 Acyclovir tab 400 mg Tablet 0 0 0 0 0 0
3 Allopurinol 100 mg Tablet 0 15000 15000 5717 9283 0
4 Aminofillin tab 200 mg Tablet 0 0 0 0 0 0
5 Amitriptillin 25 mg Tablet 0 0 0 0 0 0
6 Amlodipin 5 mg Tablet 911 3000 3911 165 3746 0
7 Amlodipin 10 mg Tablet 4080 0 4080 1865 2215 0
8 Amoksisillina kapl 250mg Tablet 0 0 0 0 0 0
9 Amoksisillina kapl 500mg Tablet 2105 0 2105 2105 0 0
10 Amoksisillina sirker 250 mg / 5 ml Botol 5450 0 5450 212 5238 0
11 Ampisillin serbuk Inj 1000 mg/5 ml Ampul 0 0 0 0 0 0
12 Antasida Doen Tab Tablet 0 90000 90000 24796 65204 0
13 Antasida sir Botol 2597 0 2597 219 2378 0
14 Asam Ascorbat ( Vit.C ) 50 mg Tablet 54610 0 54610 5284 49326 0
15 Asam Mefenamat 500 mg Tablet 0 60000 60000 11615 48385 0
16 Attapulgite 630 mg Tablet 0 0 0 0 0 0
17 Atropin Inj 0,25 mg/ml Ampul 0 0 0 0 0 0
18 Betametason Krim Tube 866 500 1366 482 884 0
19 Bedak Salisil 2% serbuk Kotak 1484 1600 3084 910 2174 0
20 Carbamazepin 200 mg Tablet 0 0 0 0 0 0
21 Deksametason 0,5 mg Tablet 2527 0 2527 2527 0 0
22 Deksametason Inj 5 mg/ml Ampul 35 0 35 0 35 0
23 Diazepam Tab 2 mg Tablet 0 0 0 0 0 0
24 Digoksin 0,25 mg Tablet 150 0 150 0 150 0
25 Dipenhidramin Inj Ampul 65 0 65 0 65 0
26 Domperidone Tablet 0 0 0 0 0 0
27 Erytromicin Syr Botol 377 0 377 0 377 0
28 Etanol 70 % cairan 100 ml Botol 59 0 59 3 56 0
29 Ferro Sulfat 300 mg Tablet 0 0 0 0 0 0
30 Fitomenadion Inj Ampul 184 0 184 0 184 0
31 Fitomenadion Tablet Tablet 3291 0 3291 388 2903 0
32 Furrosemida tab Tablet 0 0 0 0 0 0
33 Garam Oralit Pcs 0 0 0 0 0 0
34 Gentamisin Tetes Mata Botol 0 0 0 0 0 0
35 Glibenklamida tab 5 mg Tablet 0 0 0 0 0 0
36 Glimepiride 2 mg Tablet 340 0 340 0 340 0
37 Glukosa Lar. Inf 5 % Botol 298 200 498 160 338 0
38 Griseofulvin tab 125 mg Tablet 390 0 390 239 151 0
39 Hidrokortison Krim Tube 0 0 0 0 0 0
40 Ibuprofen tab.200 mg Tablet 28120 19400 47520 14755 32765 0
41 Kaptopril 12.5 mg Tablet 0 0 0 0 0 0
42 Kaptopril 25 mg Tablet 0 6000 6000 1000 5000 0
43 Kaptopril 50 mg Tablet 0 0 0 0 0 0
44 Kals Laktat tab.500 mg Tablet 0 0 0 0 0 0
45 Klorfeniramine Maleat (CTM) Tablet 0 0 0 0 0 0
46 Ketokonazol tablet 200 mg Tablet 4563 0 4563 1600 2963 0
47 Ketokonazol cream Tube 441 0 441 151 290 0
STOK PENERI PERSE PEMA STOK PERMIN
NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

48 Kloramfenikol salep mata 1% Tube 132 0 132 28 104 0


49 Klorpromazine inj 5 mg/ml Ampul 0 0 0 0 0 0
50 Kodein HCL 10 mg Tablet 0 4000 4000 1000 3000 0
51 Kotrimoksazol Susp Botol 3725 0 3725 1285 2440 0
52 Kotrimoksazol 480mg Tab Tablet 3705 35000 38705 10590 28115 0
53 Levofloxacin 500 mg Tablet 477 0 477 30 447 0
54 Lidokain HCl 2 %+ Epinefrin Ampul 0 0 0 0 0 0
55 Loperamide 2 mg Tab Tablet 0 0 0 0 0 0
56 Loratadine Tablet 0 0 0 0 0 0
57 Metilergometrin salut tab 0,125 mg Tablet 509 0 509 0 509 0
58 Metoclopramide 10 mg Tablet 3646 0 3646 414 3232 0
59 Metronidazole 250 mg Tablet 0 0 0 0 0 0
60 Metronidazole 500 mg Tablet 0 16000 16000 4665 11335 0
61 Mikonazole Cream 2% Tube 1243 0 1243 463 780 0
62 Natrium Diklofenak 50 mg Tablet 0 35000 35000 5800 29200 0
63 Natrium Klorida 0.9 % Botol 421 300 721 242 479 0
64 Nifedipin 10 mg Tablet 2414 0 2414 500 1914 0
65 Nistatin 500.000 IU/gr Tablet 1500 0 1500 400 1100 0
66 Omeprazole 20 mg Kapsul 0 30000 30000 6200 23800 0
67 Omeprazole Inj 40 mg/ 10 ml Ampul 0 0 0 0 0 0
68 Parasetamol Syrup 120 mg / 5 ml Botol 758 4000 4758 848 3910 0
69 Parasetamol Tablet 500 mg Tablet 19194 0 19194 15159 4035 0
70 Propanolol tab 40 mg Tablet 513 900 1413 250 1163 0
71 Pirantel Pamoat 125 mg Tablet 0 800 800 200 600 0
72 Ranitidin 150 mg tab Tablet 27336 0 27336 10752 16584 0
73 Ranitidin Inj Ampul 24 0 24 0 24 0
74 Ringer Lactat Infus Botol 2462 300 2762 330 2432 0
75 Resperidone tab Tablet 0 2000 2000 300 1700 0
76 Salbutamol 4 mg Tablet 0 0 0 0 0 0
77 Salep 2- 4 Pot 0 0 0 0 0 0
78 Sefadroksil tab Tablet 0 1500 1500 424 1076 0
79 Sefadroksil Syr Botol 0 0 0 0 0 0
80 Setirizine tab Tablet 0 0 0 0 0 0
81 Simvastatin 20 mg Tablet 925 0 925 135 790 0
82 Tetrasiklin HCL 250 mg Tablet 0 0 0 0 0 0
83 Vitamin B Complek Tablet 0 80000 80000 21102 58898 0
84 Yodium Povidon 30 ml Botol 29 0 29 6 23 0
85 Zink Syr Botol 0 1000 1000 200 800 0
86 Zink tab Tablet 0 4000 4000 800 3200 0

OBAT GIGI
87 Eugenol Cairan Botol 15 0 15 0 15 0
ALAT KESEHATAN
88 Alat Suntik 2,5 cc pcs 1535 0 1535 327 1208 0
89 Catgut 2/0 pcs 582 0 582 204 378 0
90 Catgut 3/0 pcs 749 0 749 15 734 0
91 Infusion set Anak pcs 195 0 195 60 135 0
92 Infusion set dewasa pcs 1389 0 1389 55 1334 0
93 I.V Cateter 20 G pcs 1411 0 1411 330 1081 0
94 I.V Cateter 22 G pcs 1511 0 1511 435 1076 0
95 I.V Cateter 24 G pcs 1391 0 1391 315 1076 0
96 Kapas 250 gr Bungkus 105 0 105 29 76 0
97 Kapas Berlemak 500 gr Bungkus 0 0 0 0 0 0
98 Kasa Pembalut 4m x 10 cm Roll 3199 0 3199 346 2853 0
99 Kasa Pembalut 4m x 15 cm Roll 3804 0 3804 640 3164 0
STOK PENERI PERSE PEMA STOK PERMIN
NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

100 Saveglove ( Hand scun) pcs 2712 0 2712 34 2678 0


101 Silk pcs 65 0 65 0 65 0
102 Oksigen tabung kecil Tabung 0 0 0 0 0 0
103 Oksigen tabung sedang Tabung 0 0 0 0 0 0
104 Oksigen tabung besar Tabung 0 0 0 0 0 0
Iodium pavidon 60ml Botol
Metformin 500 mg Tablet
Masker Pcs
Alat suntik 5 cc pcs
Hand scun steril pcs
Urine bag pcs
Foley catheter pediatric 2 way (8) pcs
Foley catheter pediatric 2 way (10) pcs
Foley catheter 2 way (12) pcs
Foley catheter 2 way (14) pcs
Foley catheter 2 way (16) pcs
Foley catheter 2 way (18) pcs
Magnesium Sulfat Inj 20 % Ampl
105 Magnesium Sulfat Inj 40 % Ampl 0 20000 20000 3000 17000 0
106 Hand scun non steril ukuran L pcs 975 0 975 20 955 0
107 Piroksikam Tablet 0 900 900 0 900 0
108 Oksitoksin inj 10ui/ml Ampl 0 8000 8000 1500 6500 0
109 Septoject 21 mm Botol 0 2400 2400 300 2100 0
110 Klem pusat pcs 0 900 900 200 700 0
111 Spuit 1ml pcs 0 1800 1800 492 1308 0
112 Phacain inj Ampl 0 500 500 152 348 0

Mengetahui
Kepala Puskesmas Peureulak Pengelola Obat PKM

MUKHLIS.SKM.M.Kes ERLINA,AMK
Nip.19720709 199303 1 003 Nip.19770415 200604 2 010
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) JKN
BULAN OKTOBER 2016
PUSKESMAS :PEUREULAK

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
1 Acyclovir tab 200 mg 0 0 0 0 0
2 Acyclovir tab 400 mg 0 0 0 0 0
3 Allopurinol 100 mg 0 15000 15000 37 26 48 89 37 18 37 71 635 27 47 4562 52 31 5717 9283
4 Aminofillin tab 200 mg 0 0 0 0 0
5 Amitriptillin 25 mg 0 0 0 0 0
6 Amlodipin 5 mg 911 3000 3911 6 5 18 10 9 24 36 3 6 30 3 10 5 165 3746
7 Amlodipin 10 mg 4080 0 4080 24 900 12 10 5 12 15 3 3 6 240 632 3 1865 2215
8 Amoksisillina kapl 250mg 0 0 0 0 0
9 Amoksisillina kapl 500mg 2105 0 2105 264 186 142 164 264 275 182 628 2105 0
10 Amoksisillina sirker 250 mg / 5 ml 5450 0 5450 11 14 7 5 9 7 13 5 8 4 11 82 7 5 6 9 9 212 5238
11 Ampisillin serbuk Inj 1000 mg/5 ml 0 0 0 0 0
12 Antasida Doen Tab 0 90000 90000 321 1230 99 327 279 112 105 101 285 732 173 236 20255 301 240 24796 65204
13 Antasida sir 2597 0 2597 20 11 7 5 13 21 7 5 8 10 65 7 11 9 9 11 219 2378
14 Asam Ascorbat ( Vit.C ) 50 mg 54610 0 54610 130 1789 102 96 178 167 118 204 78 170 281 321 110 210 109 613 117 101 96 172 122 5284 49326
15 Asam Mefenamat 500 mg 0 60000 60000 20 360 40 90 110 70 40 60 95 470 50 30 10060 50 70 11615 48385
16 Attapulgite 630 mg 0 0 0 0 0
17 Atropin Inj 0,25 mg/ml 0 0 0 0 0
18 Betametason Krim 866 500 1366 300 7 3 34 1 3 125 6 3 482 884
19 Bedak Salisil 2% serbuk 1484 1600 3084 8 512 7 3 11 9 4 1 2 5 7 3 2 1 5 17 2 1 305 3 2 910 2174
20 Carbamazepin 200 mg 0 0 0 0 0
21 Deksametason 0,5 mg 2527 0 2527 165 146 216 150 168 282 99 105 89 108 210 107 86 101 231 264 2527 0
22 Deksametason Inj 5 mg/ml 35 0 35 0 35
23 Diazepam Tab 2 mg 0 0 0 0 0
24 Digoksin 0,25 mg 150 0 150 0 150
25 Dipenhidramin Inj 65 0 65 0 65
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
26 Domperidone 0 0 0 0 0
27 Erytromicin Syr 377 0 377 0 377
28 Etanol 70 % cairan 100 ml 59 0 59 1 2 3 56
29 Ferro Sulfat 300 mg 0 0 0 0 0
30 Fitomenadion Inj 184 0 184 0 184
31 Fitomenadion Tablet 3291 0 3291 15 20 12 6 45 20 5 235 15 10 5 388 2903
32 Furrosemida tab 0 0 0 0 0
33 Garam Oralit 0 0 0 0 0
34 Gentamisin Tetes Mata 0 0 0 0 0
35 Glibenklamida tab 5 mg 0 0 0 0 0
36 Glimepiride 2 mg 340 0 340 0 340
37 Glukosa Lar. Inf 5 % 298 200 498 60 20 20 60 160 338
38 Griseofulvin tab 125 mg 390 0 390 5 5 25 3 10 15 10 5 35 120 6 239 151
39 Hidrokortison Krim 0 0 0 0 0
40 Ibuprofen tab.200 mg 28120 19400 47520 9045 90 50 60 20 10 430 30 5020 14755 32765
41 Kaptopril 12.5 mg 0 0 0 0 0
42 Kaptopril 25 mg 0 6000 6000 1000 1000 5000
43 Kaptopril 50 mg 0 0 0 0 0
44 Kals Laktat tab.500 mg 0 0 0 0 0
45 Klorfeniramine Maleat (CTM) 0 0 0 0 0
46 Ketokonazol tablet 200 mg 4563 0 4563 1500 100 1600 2963
47 Ketokonazol cream 441 0 441 141 10 151 290
48 Kloramfenikol salep mata 1% 132 0 132 3 5 20 28 104
49 Klorpromazine inj 5 mg/ml 0 0 0 0 0
50 Kodein HCL 10 mg 0 4000 4000 1000 1000 3000
51 Kotrimoksazol Susp 3725 0 3725 1200 48 4 7 9 11 6 1285 2440
52 Kotrimoksazol 480mg Tab 3705 35000 38705 65 42 22 24 36 12 6 18 34 6 22 6 218 9 10038 20 12 10590 28115
53 Levofloxacin 500 mg 477 0 477 3 9 6 3 3 3 3 30 447
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
54 Lidokain HCl 2 %+ Epinefrin 0 0 0 0 0
55 Loperamide 2 mg Tab 0 0 0 0 0
56 Loratadine 0 0 0 0 0
57 Metilergometrin salut tab 0,125 mg 564 0 564 0 564
58 Metoclopramide 10 mg 4094 0 4094 200 10 20 40 5 10 100 9 10 10 414 3680
59 Metronidazole 250 mg 0 0 0 0 0
60 Metronidazole 500 mg 0 16000 16000 20 15 10 530 20 40 4000 30 4665 11335
61 Mikonazole Cream 2% 1243 0 1243 8 365 3 5 6 24 2 7 7 4 2 3 5 2 5 3 7 5 463 780
62 Natrium Diklofenak 50 mg 0 35000 35000 200 5600 5800 29200
63 Natrium Klorida 0.9 % 421 300 721 120 2 20 20 80 242 479
64 Nifedipin 10 mg 2414 0 2414 500 500 1914
65 Nistatin 500.000 IU/gr 1500 0 1500 400 400 1100
66 Omeprazole 20 mg 0 30000 30000 124 78 94 102 124 146 74 68 43 126 280 86 92 4598 102 63 6200 23800
67 Omeprazole Inj 40 mg/ 10 ml 0 0 0 0 0
68 Parasetamol Syrup 120 mg / 5 ml 758 4000 4758 16 18 16 13 22 17 11 5 9 17 14 11 7 9 14 85 12 7 511 21 13 848 3910
69 Parasetamol Tablet 500 mg 17148 0 17148 462 431 342 386 738 398 268 4020 399 342 446 328 263 489 353 3493 356 397 481 389 378 15159 1989
70 Propanolol tab 40 mg 538 900 1438 10 5 15 10 5 5 200 250 1188
71 Pirantel Pamoat 125 mg 0 800 800 200 200 600
72 Ranitidin 150 mg tab 27336 0 27336 242 9112 86 82 64 72 24 46 40 68 75 32 18 24 86 347 64 54 88 103 25 10752 16584
73 Ranitidin Inj 49 0 49 0 49
74 Ringer Lactat Infus 2152 300 2452 120 20 90 80 20 330 2122
75 Resperidone tab 0 2000 2000 300 300 1700
76 Salbutamol 4 mg 0 0 0 0 0
77 Salep 2- 4 0 0 0 0 0
78 Sefadroksil tab 0 1500 1500 6 18 24 12 6 34 6 6 300 6 6 424 1076
79 Sefadroksil Syr 0 0 0 0 0
80 Setirizine tab 0 0 0 0 0
81 Simvastatin 20 mg 925 0 925 3 15 25 10 15 3 15 25 3 9 12 135 790
82 Tetrasiklin HCL 250 mg 0 0 0 0 0
83 Vitamin B Complek 0 80000 80000 64 106 88 132 184 125 99 105 210 745 142 170 18721 109 102 21102 58898
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
84 Yodium Povidon 30 ml 29 0 29 2 4 6 23
85 Zink Syr 0 1000 1000 200 200 800
86 Zink tab 0 4000 4000 800 800 3200
OBAT GIGI
87 Eugenol Cairan 15 0 15 0 15
ALAT KESEHATAN
88 Alat Suntik 2,5 cc 535 0 535 300 27 327 208
89 Catgut 2/0 582 0 582 180 24 204 378
90 Catgut 3/0 722 0 722 12 3 15 707
91 Infusion set Anak 195 0 195 60 60 135
92 Infusion set dewasa 739 0 739 25 30 55 684
93 I.V Cateter 20 G 1513 0 1513 330 330 1183
94 I.V Cateter 22 G 789 0 789 360 25 50 435 354
95 I.V Cateter 24 G 1900 0 1900 300 15 315 1585
96 Kapas 250 gr 96 0 96 21 2 1 5 29 67
97 Kapas Berlemak 500 gr 0 0 0 0 0
98 Kasa Pembalut 4m x 10 cm 3084 0 3084 306 25 5 10 346 2738
99 Kasa Pembalut 4m x 15 cm 3915 0 3915 600 20 10 10 640 3275
100 Saveglove ( Hand scun) 2712 0 2712 5 10 5 14 34 2678
101 Silk 65 0 65 0 65
102 Oksigen tabung kecil 0 0 0 0 0
103 Oksigen tabung sedang 0 0 0 0 0
104 Oksigen tabung besar 30 0 30 0 30
105 Iodium pavidon 60ml 494 0 494 30 2 2 6 40 454
106 Metformin 500 mg 1337 0 1337 400 10 25 35 10 10 15 30 15 5 555 782
107 Masker 1550 0 1550 280 10 10 34 8 342 1208
108 Alat suntik 5 cc 1495 0 1495 450 15 20 5 490 1005
109 Hand scun steril 680 0 680 0 680
110 Urine bag 91 0 91 26 26 65
111 Foley catheter pediatric 2 way (8) 30 0 30 8 8 22
112 Foley catheter pediatric 2 way (10) 30 0 30 8 8 22
113 Foley catheter 2 way (12) 5 0 5 1 1 4
114 Foley catheter 2 way (14) 5 0 5 1 1 4
115 Foley catheter 2 way (16) 20 0 20 1 1 19
116 Foley catheter 2 way (18) 30 0 30 8 8 22
117 Magnesium Sulfat Inj 20 % 36 0 36 10 10 26
118 Magnesium Sulfat Inj 40 % 36 0 36 10 10 26
119 Hand scun Non steril L 975 0 975 368 368 607
120 Sianokobalamin(vit B12)50mcg 0 20000 20000 3000 3000 17000
121 Anti hemoroid supp 0 120 120 20 20 100
122 Hidroklorotiazid tab 25mg 0 900 900 900
123 Haloperidol 1,5mg 0 8000 8000 1500 1500 6500
124 Oksitosin inj 10 IU/ml 0 2400 2400 300 300 2100
125 Donsisiklin kaps 100mg 0 900 900 200 200 700
126 Loperamid tab 2mg 0 1800 1800 10 20 5 15 132 300 10 492 1308
127 Kloramfenikol susp 125mg/5ml 0 500 500 2 5 7 1 2 1 3 15 2 4 105 3 2 152 348

Mengetahui
Kepala Puskesmas Pengelola Obat PKM

MUKHLIS.SKM.M.Kes ERLINA.AMK
NIP:19720709 199303 1 003 Nip.19770415 200604 2 010
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT JKN
( LPLPO ) JKN

UPT PKM :Peureulak BULAN : NOVEMBER

KECAMATAN : Peureulak TAHUN : 2016


KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 0 0 0 0 0 0


2 Acyclovir tab 400 mg Tablet 0 0 0 0 0 0
3 Allopurinol 100 mg Tablet 9283 0 9283 1001 8282 0
4 Aminofillin tab 200 mg Tablet 0 0 0 0 0 0
5 Amitriptillin 25 mg Tablet 0 0 0 0 0 0
6 Amlodipin 5 mg Tablet 3746 0 3746 13 3733 0
7 Amlodipin 10 mg Tablet 2215 0 2215 374 1841 0
8 Amoksisillina kapl 250mg Tablet 0 0 0 0 0 0
9 Amoksisillina kapl 500mg Tablet 0 0 0 0 0 0
10 Amoksisillina sirker 250 mg / 5 ml Botol 5238 0 5238 265 4973 0
11 Ampisillin serbuk Inj 1000 mg/5 ml Ampul 0 0 0 0 0 0
12 Antasida Doen Tab Tablet 65204 30000 95204 5244 89960 0
13 Antasida sir Botol 2378 0 2378 291 2087 0
14 Asam Ascorbat ( Vit.C ) 50 mg Tablet 49326 50000 99326 6035 93291 0
15 Asam Mefenamat 500 mg Tablet 48385 50000 98385 2615 95770 0
16 Attapulgite 630 mg Tablet 0 0 0 0 0 0
17 Atropin Inj 0,25 mg/ml Ampul 0 0 0 0 0 0
18 Betametason Krim Tube 884 0 884 105 779 0
19 Bedak Salisil 2% serbuk Kotak 2174 0 2174 102 2072 0
20 Carbamazepin 200 mg Tablet 0 0 0 0 0 0
21 Deksametason 0,5 mg Tablet 0 0 0 0 0 0
22 Deksametason Inj 5 mg/ml Ampul 35 0 35 5 30 0
23 Diazepam Tab 2 mg Tablet 0 0 0 0 0 0
24 Digoksin 0,25 mg Tablet 150 0 150 0 150 0
25 Dipenhidramin Inj Ampul 65 0 65 5 60 0
26 Domperidone Tablet 0 8000 8000 240 7760 0
27 Erytromicin Syr Botol 377 0 377 0 377 0
28 Etanol 70 % cairan 100 ml Botol 56 0 56 15 41 0
29 Ferro Sulfat 300 mg Tablet 0 0 0 0 0 0
30 Fitomenadion Inj Ampul 184 0 184 0 184 0
31 Fitomenadion Tablet Tablet 2903 0 2903 546 2357 0
32 Furrosemida tab Tablet 0 0 0 0 0 0
33 Garam Oralit Pcs 0 0 0 0 0 0
34 Gentamisin Tetes Mata Botol 0 0 0 0 0 0
35 Glibenklamida tab 5 mg Tablet 0 0 0 0 0 0
36 Glimepiride 2 mg Tablet 340 0 340 50 290 0
37 Glukosa Lar. Inf 5 % Botol 338 0 338 0 338 0
38 Griseofulvin tab 125 mg Tablet 151 0 151 43 108 0
39 Hidrokortison Krim Tube 0 1200 1200 31 1169 0
40 Ibuprofen tab.200 mg Tablet 32765 0 32765 1365 31400 0
41 Kaptopril 12.5 mg Tablet 0 0 0 0 0 0
42 Kaptopril 25 mg Tablet 5000 4000 9000 749 8251 0
43 Kaptopril 50 mg Tablet 0 0 0 0 0 0
44 Kals Laktat tab.500 mg Tablet 0 0 0 0 0 0
45 Klorfeniramine Maleat (CTM) Tablet 0 0 0 0 0 0
46 Ketokonazol tablet 200 mg Tablet 2963 0 2963 354 2609 0
47 Ketokonazol cream Tube 290 0 290 8 282 0
STOK PENERI PERSE PEMA STOK PERMIN
NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

48 Kloramfenikol salep mata 1% Tube 104 0 104 52 52 0


49 Klorpromazine inj 5 mg/ml Ampul 0 0 0 0 0 0
50 Kodein HCL 10 mg Tablet 3000 0 3000 0 3000 0
51 Kotrimoksazol Susp Botol 2440 0 2440 153 2287 0
52 Kotrimoksazol 480mg Tab Tablet 28115 0 28115 1837 26278 0
53 Levofloxacin 500 mg Tablet 447 0 447 27 420 0
54 Lidokain HCl 2 %+ Epinefrin Ampul 0 0 0 0 0 0
55 Loperamide 2 mg Tab Tablet 0 0 0 0 0 0
56 Loratadine Tablet 0 0 0 0 0 0
57 Metilergometrin salut tab 0,125 mg Tablet 509 0 509 100 409 0
58 Metoclopramide 10 mg Tablet 3232 0 3232 300 2932 0
59 Metronidazole 250 mg Tablet 0 0 0 0 0 0
60 Metronidazole 500 mg Tablet 11335 0 11335 300 11035 0
61 Mikonazole Cream 2% Tube 780 600 1380 112 1268 0
62 Natrium Diklofenak 50 mg Tablet 29200 0 29200 1286 27914 0
63 Natrium Klorida 0.9 % Botol 479 0 479 40 439 0
64 Nifedipin 10 mg Tablet 1914 0 1914 50 1864 0
65 Nistatin 500.000 IU/gr Tablet 1100 0 1100 0 1100 0
66 Omeprazole 20 mg Kapsul 23800 15000 38800 1824 36976 0
67 Omeprazole Inj 40 mg/ 10 ml Ampul 0 30 30 4 26 0
68 Parasetamol Syrup 120 mg / 5 ml Botol 3910 2400 6310 400 5910 0
69 Parasetamol Tablet 500 mg Tablet 1989 818000 819989 6523 813466 0
70 Propanolol tab 40 mg Tablet 1163 0 1163 70 1093 0
71 Pirantel Pamoat 125 mg Tablet 600 0 600 85 515 0
72 Ranitidin 150 mg tab Tablet 16584 0 16584 1314 15270 0
73 Ranitidin Inj Ampul 24 0 24 30 -6 0
74 Ringer Lactat Infus Botol 2432 0 2432 170 2262 0
75 Resperidone tab Tablet 1700 1000 2700 60 2640 0
76 Salbutamol 4 mg Tablet 0 0 0 0 0 0
77 Salep 2- 4 Pot 0 0 0 0 0 0
78 Sefadroksil tab Tablet 1076 0 1076 613 463 0
79 Sefadroksil Syr Botol 0 0 0 0 0 0
80 Setirizine tab Tablet 0 5000 5000 855 4145 0
81 Simvastatin 20 mg Tablet 790 1000 1790 245 1545 0
82 Tetrasiklin HCL 250 mg Tablet 0 0 0 0 0 0
83 Vitamin B Complek Tablet 58898 0 58898 7272 51626 0
84 Yodium Povidon 30 ml Botol 23 0 23 14 9 0
85 Zink Syr Botol 800 0 800 56 744 0
86 Zink tab Tablet 3200 0 3200 0 3200 0

OBAT GIGI
87 Eugenol Cairan Botol 15 0 15 0 15 0
ALAT KESEHATAN
88 Alat Suntik 2,5 cc pcs 1208 0 1208 108 1100 0
89 Catgut 2/0 pcs 378 288 666 14 652 0
90 Catgut 3/0 pcs 734 96 830 35 795 0
91 Infusion set Anak pcs 135 200 335 0 335 0
92 Infusion set dewasa pcs 1334 0 1334 70 1264 0
93 I.V Cateter 20 G pcs 1081 0 1081 15 1066 0
94 I.V Cateter 22 G pcs 1076 0 1076 65 1011 0
95 I.V Cateter 24 G pcs 1076 0 1076 0 1076 0
96 Kapas 250 gr Bungkus 76 57 133 1 132 0
97 Kapas Berlemak 500 gr Bungkus 0 0 0 0 0 0
98 Kasa Pembalut 4m x 10 cm Roll 2853 6055 8908 60 8848 0
99 Kasa Pembalut 4m x 15 cm Roll 3164 570 3734 65 3669 0
STOK PENERI PERSE PEMA STOK PERMIN
NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

100 Saveglove ( Hand scun) pcs 2678 0 2678 62 2616 0


101 Silk pcs 65 0 65 0 65 0
102 Oksigen tabung kecil Tabung 0 0 0 0 0 0
103 Oksigen tabung sedang Tabung 0 0 0 0 0 0
104 Oksigen tabung besar Tabung 0 0 0 0 0 0
105 Iodium pavidon 60ml Botol 494 0 494 5 489 0
106 Masker Pcs 1550 0 1550 75 1475 0
107 Alat suntik 5 cc pcs 1495 0 1495 10 1485 0
108 Hand scun steril pcs 680 0 68 680 680 0
109 Urine bag pcs 91 0 91 0 91 0
110 Foley catheter pediatric 2 way (8) pcs 30 0 30 1 29 0
111 Foley catheter pediatric 2 way (10) pcs 30 0 30 1 29 0
112 Foley catheter 2 way (12) pcs 5 0 5 4 1 0
113 Foley catheter 2 way (14) pcs 5 0 5 4 1 0
114 Foley catheter 2 way (16) pcs 20 0 20 5 15 0
115 Foley catheter 2 way (18) pcs 30 0 30 5 25 0
116 Magnesium Sulfat Inj 20 % Ampl 26 0 26 0 26 0
117 Magnesium Sulfat Inj 40 % Ampl 26 0 26 0 26 0
118 Hand scun non steril ukuran L pcs 607 0 607 0 607 0
119 Hidroklorotiazid tab 25mg Tablet 0 900 900 0 900 0
120 Haloperidol 1,5mg Tablet 0 8000 8000 0 8000 0
121 Oksitosin inj 10 IU/ml Ampul 0 2400 2400 20 2380 0
122 Donssiklin kaps 100mg Kapsul 0 900 900 0 900 0
123 Loperamid tab 2mg Tablet 0 1800 1800 280 1520 0
124 Kloramfenikol susp 125mg/5ml Botol 348 500 848 124 724 0
125 Piridoksin(vit B6) tab 10 ml Tablet 0 15000 15000 0 15000 0
126 Metformin Tablet 1337 0 1337 605 732 0
127 Anti hemoroid Kapsul 0 120 120 12 108 0

Mengetahui
Kepala Puskesmas Peureulak Pengelola Obat PKM

MUKHLIS.SKM.M.Kes ERLINA,AMK
Nip.19720709 199303 1 003 Nip.19770415 200604 2 010
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) JKN
BULAN NOVEMBER 2016
PUSKESMAS : PEUREULAK

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian


No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

1 Acyclovir tab 200 mg 0 0 0


2 Acyclovir tab 400 mg 0 0 0
3 Allopurinol 100 mg 9283 0 9283 200 12 24 38 12 6 18 24 12 345 167 25 33 67 18

4 Aminofillin tab 200 mg 0 0 0


5 Amitriptillin 25 mg 0 0 0
6 Amlodipin 5 mg 3746 0 3746 5 3 5

7 Amlodipin 10 mg 2215 0 2215 10 3 12 6 6 126 120 47 12 32

8 Amoksisillina kapl 250mg 0 0 0


9 Amoksisillina kapl 500mg 0 0 0
10 Amoksisillina sirker 250 mg / 5 ml 5238 0 5238 40 5 120 50 50

11 Ampisillin serbuk Inj 1000 mg/5 ml 0 0 0


12 Antasida Doen Tab 65204 30000 95204 606 433 164 127 142 86 102 86 127 245 126 865 336 234 124 436 110 98 126 341 210

13 Antasida sir 2378 0 2378 30 2 3 5 2 1 3 2 4 6 2 63 55 8 12 56 8 9 11 3 1

14 Asam Ascorbat ( Vit.C ) 50 mg 49326 50000 99326 642 423 142 126 330 320 120 210 165 214 124 825 243 214 347 332 108 132 356 320 214

15 Asam Mefenamat 500 mg 48385 50000 98385 465 320 30 60 120 30 60 20 120 60 20 410 220 20 50 450 20 20 20 50 20

16 Attapulgite 630 mg 0 0 0
17 Atropin Inj 0,25 mg/ml 0 0 0
18 Betametason Krim 884 0 884 23 1 2 4 5 2 1 5 3 1 25 3 24 1 1 2 2

19 Bedak Salisil 2% serbuk 2174 0 2174 3 2 4 7 2 1 2 6 7 3 26 6 11 4 5 2 3 5 2

20 Carbamazepin 200 mg 0 0 0
21 Deksametason 0,5 mg 0 0 0
22 Deksametason Inj 5 mg/ml 35 0 35 5

23 Diazepam Tab 2 mg 0 0 0
24 Digoksin 0,25 mg 150 0 150
25 Dipenhidramin Inj 65 0 65 5
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

26 Domperidone 0 8000 8000 20 40 30 20 30 18 12 35 25

27 Erytromicin Syr 377 0 377


28 Etanol 70 % cairan 100 ml 56 0 56 4 2 4 5

29 Ferro Sulfat 300 mg 0 0 0


30 Fitomenadion Inj 184 0 184
31 Fitomenadion Tablet 2903 0 2903 10 12 26 20 15 5 303 126 16 10 3

32 Furrosemida tab 0 0 0
33 Garam Oralit 0 0 0
34 Gentamisin Tetes Mata 0 0 0
35 Glibenklamida tab 5 mg 0 0 0
36 Glimepiride 2 mg 340 0 340 20 10 5 15

37 Glukosa Lar. Inf 5 % 338 0 338


38 Griseofulvin tab 125 mg 151 0 151 10 15 3 15

39 Hidrokortison Krim 0 1200 1200 2 3 4 5 2 1 1 2 5 3 2

40 Ibuprofen tab.200 mg 32765 0 32765 400 100 10 20 540 20 30 200 10 35

41 Kaptopril 12.5 mg 0 0 0
42 Kaptopril 25 mg 5000 4000 9000 200 12 6 3 12 200 106 46 142 3 7

43 Kaptopril 50 mg 0 0 0
44 Kals Laktat tab.500 mg 0 0 0
45 Klorfeniramine Maleat (CTM) 0 0 0
46 Ketokonazol tablet 200 mg 2963 0 2963 100 24 18 3 15 30 5 15 3 126 3 12

47 Ketokonazol cream 290 0 290 1 2 1 1 1 2

48 Kloramfenikol salep mata 1% 104 0 104 10 5 1 1 5 2 10 10 2 2 2 1 1

49 Klorpromazine inj 5 mg/ml 0 0 0


50 Kodein HCL 10 mg 3000 0 3000
51 Kotrimoksazol Susp 2440 0 2440 35 2 3 5 5 1 2 3 2 1 1 40 2 5 3 25 4 2 5 3 1

52 Kotrimoksazol 480mg Tab 28115 0 28115 423 124 18 6 46 12 6 12 48 24 6 612 206 6 212 18 24 28

53 Levofloxacin 500 mg 447 0 447 9 6 3 6 3


Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

54 Lidokain HCl 2 %+ Epinefrin 0 0 0


55 Loperamide 2 mg Tab 0 0 0
56 Loratadine 0 0 0
57 Metilergometrin salut tab 0,125 mg 564 0 564 100

58 Metoclopramide 10 mg 3680 0 3680 20 20 10 30 120 30 30 20 10 10

59 Metronidazole 250 mg 0 0 0
60 Metronidazole 500 mg 11335 0 11335 200 100

61 Mikonazole Cream 2% 780 600 1380 10 5 2 7 12 3 2 2 11 3 2 21 3 2 5 7 1 2 4 5 2

62 Natrium Diklofenak 50 mg 29200 0 29200 24 30 18 28 46 30 20 32 88 126 36 328 34 86 88 43 24 28 46 68 27

63 Natrium Klorida 0.9 % 479 0 479 20 10 10

64 Nifedipin 10 mg 1914 0 1914 10 20 5 15

65 Nistatin 500.000 IU/gr 1100 0 1100


66 Omeprazole 20 mg 23800 15000 38800 64 174 60 74 126 46 34 26 86 120 64 240 168 58 126 72 40 34 88 46 26

67 Omeprazole Inj 40 mg/ 10 ml 0 30 30 2 2

68 Parasetamol Syrup 120 mg / 5 ml 3910 2400 6310 11 7 9 17 22 11 8 12 13 21 9 94 62 11 14 25 9 11 14 6 5

69 Parasetamol Tablet 500 mg 1989 818000 819989 310 721 278 293 312 75 124 322 241 201 732 287 291 923 265 114 344 321 204

70 Propanolol tab 40 mg 1188 0 1188 20 10 20 10 10

71 Pirantel Pamoat 125 mg 600 0 600 20 3 8 12 18 8 8 4 2

72 Ranitidin 150 mg tab 16584 0 16584 86 120 64 123 165 26 30 18 52 34 12 320 54 68 20 18 12 62 24

73 Ranitidin Inj 49 0 49 20 10

74 Ringer Lactat Infus 2122 0 2122 10 20 20 40 20 40 20

75 Resperidone tab 1700 1000 2700 10 20 10 20

76 Salbutamol 4 mg 0 0 0
77 Salep 2- 4 0 0 0
78 Sefadroksil tab 1076 0 1076 24 43 6 52 120 12 6 24 30 6 248 6 12 18 6

79 Sefadroksil Syr 0 0 0
80 Setirizine tab 0 5000 5000 11 62 96 82 48 27 35 132 35 18 12 24 150 68 20

81 Simvastatin 20 mg 790 1000 1790 10 5 25 30 10 5 12 26 5 12 24 42 12 6 16 5

82 Tetrasiklin HCL 250 mg 0 0 0


83 Vitamin B Complek 58898 0 58898 634 324 215 354 423 216 189 243 322 354 231 993 423 127 243 326 181 221 320 332 421
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

84 Yodium Povidon 30 ml 23 0 23 5 4 5

85 Zink Syr 800 0 800 1 1 3 4 1 1 1 2 1 1 1 30 2 3 1

86 Zink tab 3200 0 3200


OBAT GIGI
87 Eugenol Cairan 15 0 15
ALAT KESEHATAN
88 Alat Suntik 2,5 cc 1208 0 1208 20 35 30 3 20

89 Catgut 2/0 378 288 666 14

90 Catgut 3/0 707 96 803 12 10 13

91 Infusion set Anak 135 200 335


92 Infusion set dewasa 684 0 684 20 25 25

93 I.V Cateter 20 G 1183 0 1183 15

94 I.V Cateter 22 G 354 0 354 50 5 10

95 I.V Cateter 24 G 1585 0 1585


96 Kapas 250 gr 67 57 124 1

97 Kapas Berlemak 500 gr 0 0 0


98 Kasa Pembalut 4m x 10 cm 2738 6055 8793 10 20 5 10 15

99 Kasa Pembalut 4m x 15 cm 3275 570 3845 20 20 20 5

100 Saveglove ( Hand scun) 2678 0 2678 50 2 10

101 Silk 65 0 65
102 Oksigen tabung kecil 0 0 0
103 Oksigen tabung sedang 0 0 0
104 Oksigen tabung besar 0 0 0
105 Iodium pavidon 60ml 494 0 494 2 1 2

106 Metformin 500 mg 1337 0 1337 20 10 30 20 10 5 40 20 10 60 30 320 10 20


Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
107 Masker 1550 0 1550 10 7 5 3 50

108 Alat suntik 5 cc 1495 0 1495 10

109 Hand scun steril 680 0 680


110 Urine bag 91 0 91
111 Foley catheter pediatric 2 way (8) 30 0 30 1

112 Foley catheter pediatric 2 way (10) 30 0 30 1

113 Foley catheter 2 way (12) 5 0 5 4

114 Foley catheter 2 way (14) 5 0 5 4

115 Foley catheter 2 way (16) 20 0 20 5

116 Foley catheter 2 way (18) 30 0 30 5

117 Magnesium Sulfat Inj 20 % 26 0 26


118 Magnesium Sulfat Inj 40 % 26 0 26
119 Hand scun Non steril L 607 0 607
120 Sianokobalamin(vit B12)50mcg 0 20000 20000
121 Anti hemoroid supp 0 120 120 2 3 5 2

122 Hidroklorotiazid tab 25mg 0 900 900


123 Haloperidol 1,5mg 0 8000 8000
124 Oksitoksin inj 10 IU/ml 0 2400 2400 5 15

125 Donsisiklin kaps 100mg 0 900 900


126 Loperamid tab 2mg 0 1800 1800 100 20 10 40 10 10 30 40 20

127 Kloramfenikol susp 125mg/5ml 348 500 848 2 5 68 1 3 7 1 23 3 5 4 2

Mengetahui
Kepala Puskesmas Pengelola Obat PK

MUKHLIS.SKM.M.Kes ERLINA.AMK
NIP:19720709 199303 1 003 Nip.19770415 200604 2 01
Pema Stok Ket
30 31 kaian Akhir
0 0
0 0
1001 8282
0 0
0 0
13 3733
374 1841
0 0
0 0
265 4973
0 0
120 5244 89960
5 291 2087
128 6035 93291
30 2615 95770
0 0
0 0
105 779
1 102 2072
0 0
0 0
5 30
0 0
0 150
5 60
Pema Stok Ket
30 31 kaian Akhir
10 240 7760
0 377
15 41
0 0
0 184
546 2357
0 0
0 0
0 0
0 0
50 290
0 338
43 108
1 31 1169
1365 31400
0 0
12 749 8251
0 0
0 0
0 0
354 2609
8 282
52 52
0 0
0 3000
3 153 2287
6 1837 26278
27 420
Pema Stok Ket
30 31 kaian Akhir
0 0
0 0
0 0
100 464
300 3380
0 0
300 11035
1 112 1268
36 1286 27914
40 439
50 1864
0 1100
52 1824 36976
4 26
9 400 5910
165 6523 813466
70 1118
2 85 515
6 1314 15270
30 19
170 1952
60 2640
0 0
0 0
613 463
0 0
35 855 4145
245 1545
0 0
180 7272 51626
Pema Stok Ket
30 31 kaian Akhir
14 9
3 56 744
0 3200

0 15

108 1100
14 652
35 768
0 335
70 614
15 1168
65 289
0 1585
1 123
0 0
60 8733
65 3780
62 2616
0 65
0 0
0 0
0 0
5 489
605 732
Pema Stok Ket
30 31 kaian Akhir
75 1475
10 1485
0 680
0 91
1 29
1 29
4 1
4 1
5 15
5 25
0 26
0 26
0 607
0 20000
12 108
0 900
0 8000
20 2380
0 900
280 220
124 724

ngelola Obat PKM

ERLINA.AMK
415 200604 2 010
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT JKN
( LPLPO ) JKN

UPT PKM : BULAN : DESEMBER

KECAMATAN : TAHUN : 2016


KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

STOK PENERI PERSE PEMA STOK PERMIN


NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 0 0 0 0 0 0


2 Acyclovir tab 400 mg Tablet 0 0 0 0 0 0
3 Allopurinol 100 mg Tablet 8282 0 8282 876 7406 0
4 Aminofillin tab 200 mg Tablet 0 0 0 0 0 0
5 Amitriptillin 25 mg Tablet 0 0 0 0 0 0
6 Amlodipin 5 mg Tablet 3733 0 3733 744 2989 0
7 Amlodipin 10 mg Tablet 1841 0 1841 229 1612 0
8 Amoksisillina kapl 250mg Tablet 0 0 0 0 0 0
9 Amoksisillina kapl 500mg Tablet 0 0 0 0 0 0
10 Amoksisillina sirker 250 mg / 5 ml Botol 4973 0 4973 332 4641 0
11 Ampisillin serbuk Inj 1000 mg/5 ml Ampul 0 0 0 0 0 0
12 Antasida Doen Tab Tablet 89960 0 89960 12239 77721 0
13 Antasida sir Botol 2087 0 2087 168 1919 0
14 Asam Ascorbat ( Vit.C ) 50 mg Tablet 93291 0 93291 14520 78771 0
15 Asam Mefenamat 500 mg Tablet 95770 0 95770 15280 80490 0
16 Attapulgite 630 mg Tablet 0 0 0 0 0 0
17 Atropin Inj 0,25 mg/ml Ampul 0 0 0 0 0 0
18 Betametason Krim Tube 779 0 779 89 690 0
19 Bedak Salisil 2% serbuk Kotak 2072 0 2072 81 1991 0
20 Carbamazepin 200 mg Tablet 0 0 0 0 0 0
21 Deksametason 0,5 mg Tablet 0 0 0 0 0 0
22 Deksametason Inj 5 mg/ml Ampul 30 0 30 5 25 0
23 Diazepam Tab 2 mg Tablet 0 0 0 0 0 0
24 Digoksin 0,25 mg Tablet 150 0 150 0 150 0
25 Dipenhidramin Inj Ampul 60 0 60 0 60 0
26 Domperidone Tablet 7760 0 7760 2328 5432 0
27 Erytromicin Syr Botol 377 0 377 41 336 0
28 Etanol 70 % cairan 100 ml Botol 41 0 41 2 39 0
29 Ferro Sulfat 300 mg Tablet 0 0 0 0 0 0
30 Fitomenadion Inj Ampul 184 0 184 0 184 0
31 Fitomenadion Tablet Tablet 2357 0 2357 405 1952 0
32 Furrosemida tab Tablet 0 0 0 0 0 0
33 Garam Oralit Pcs 0 0 0 0 0 0
34 Gentamisin Tetes Mata Botol 0 0 0 0 0 0
35 Glibenklamida tab 5 mg Tablet 0 0 0 0 0 0
36 Glimepiride 2 mg Tablet 290 0 290 0 290 0
37 Glukosa Lar. Inf 5 % Botol 338 0 338 20 318 0
38 Griseofulvin tab 125 mg Tablet 108 0 108 0 108 0
39 Hidrokortison Krim Tube 1169 0 1169 319 850 0
40 Ibuprofen tab.200 mg Tablet 31400 0 31400 1130 30270 0
41 Kaptopril 12.5 mg Tablet 0 0 0 0 0 0
42 Kaptopril 25 mg Tablet 8251 0 8251 1432 6819 0
43 Kaptopril 50 mg Tablet 0 0 0 0 0 0
44 Kals Laktat tab.500 mg Tablet 0 0 0 0 0 0
45 Klorfeniramine Maleat (CTM) Tablet 0 0 0 0 0 0
46 Ketokonazol tablet 200 mg Tablet 2609 0 2609 93 2516 0
47 Ketokonazol cream Tube 282 0 282 23 259 0
STOK PENERI PERSE PEMA STOK PERMIN
NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

48 Kloramfenikol salep mata 1% Tube 52 0 52 11 41 0


49 Klorpromazine inj 5 mg/ml Ampul 0 0 0 0 0 0
50 Kodein HCL 10 mg Tablet 3000 0 3000 20 2980 0
51 Kotrimoksazol Susp Botol 2287 0 2287 124 2163 0
52 Kotrimoksazol 480mg Tab Tablet 26278 0 26278 564 25714 0
53 Levofloxacin 500 mg Tablet 420 0 420 24 396 0
54 Lidokain HCl 2 %+ Epinefrin Ampul 0 0 0 0 0 0
55 Loperamide 2 mg Tab Tablet 0 0 0 0 0 0
56 Loratadine Tablet 0 0 0 0 0 0
57 Metilergometrin salut tab 0,125 mg Tablet 409 0 409 10 399 0
58 Metoclopramide 10 mg Tablet 2932 0 2932 490 2442 0
59 Metronidazole 250 mg Tablet 0 0 0 0 0 0
60 Metronidazole 500 mg Tablet 11035 0 11035 620 10415 0
61 Mikonazole Cream 2% Tube 1268 0 1268 245 1023 0
62 Natrium Diklofenak 50 mg Tablet 27914 0 27914 1716 26198 0
63 Natrium Klorida 0.9 % Botol 439 0 439 30 409 0
64 Nifedipin 10 mg Tablet 1864 0 1864 16 1848 0
65 Nistatin 500.000 IU/gr Tablet 1100 0 1100 0 1100 0
66 Omeprazole 20 mg Kapsul 36976 0 36976 5805 31171 0
67 Omeprazole Inj 40 mg/ 10 ml Ampul 26 0 26 10 16 0
68 Parasetamol Syrup 120 mg / 5 ml Botol 5910 0 5910 914 4996 0
69 Parasetamol Tablet 500 mg Tablet 813466 0 813466 21313 792153 0
70 Propanolol tab 40 mg Tablet 1093 0 1093 70 1023 0
71 Pirantel Pamoat 125 mg Tablet 515 0 515 10 505 0
72 Ranitidin 150 mg tab Tablet 15270 0 15270 1258 14012 0
73 Ranitidin Inj Ampul 19 0 19 5 14 0
74 Ringer Lactat Infus Botol 2262 0 2262 106 2156 0
75 Resperidone tab Tablet 2640 0 2640 340 2300 0
76 Salbutamol 4 mg Tablet 0 0 0 0 0 0
77 Salep 2- 4 Pot 0 0 0 0 0 0
78 Sefadroksil tab Tablet 463 0 463 164 299 0
79 Sefadroksil Syr Botol 0 0 0 0 0 0
80 Setirizine tab Tablet 4145 0 4145 1134 3011 0
81 Simvastatin 20 mg Tablet 1545 0 1545 272 1273 0
82 Tetrasiklin HCL 250 mg Tablet 0 0 0 0 0 0
83 Vitamin B Complek Tablet 51626 0 51626 4726 46900 0
84 Yodium Povidon 30 ml Botol 9 0 9 8 1 0
85 Zink Syr Botol 744 0 744 21 723 0
86 Zink tab Tablet 3200 0 3200 150 3050 0
0
OBAT GIGI
87 Eugenol Cairan Botol 15 0 15 0 15 0
ALAT KESEHATAN
88 Alat Suntik 2,5 cc pcs 1100 0 1100 99 1001 0
89 Catgut 2/0 pcs 652 0 652 87 565 0
90 Catgut 3/0 pcs 795 0 795 75 720 0
91 Infusion set Anak pcs 335 0 335 50 285 0
92 Infusion set dewasa pcs 1264 0 1264 59 1205 0
93 I.V Cateter 20 G pcs 1066 0 1066 45 1021 0
94 I.V Cateter 22 G pcs 1011 0 1011 35 976 0
95 I.V Cateter 24 G pcs 1076 0 1076 20 1056 0
96 Kapas 250 gr Bungkus 132 0 132 14 118 0
97 Kapas Berlemak 500 gr Bungkus 0 0 0 0 0 0
98 Kasa Pembalut 4m x 10 cm Roll 8848 0 8848 1527 7321 0
99 Kasa Pembalut 4m x 15 cm Roll 3669 0 3669 180 3489 0
STOK PENERI PERSE PEMA STOK PERMIN
NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

100 Saveglove ( Hand scun) pcs 2616 0 2616 83 2533 0


101 Silk pcs 65 0 65 0 65 0
102 Oksigen tabung kecil Tabung 0 0 0 0 0 0
103 Oksigen tabung sedang Tabung 0 0 0 0 0 0
104 Oksigen tabung besar Tabung 0 0 0 0 0 0
105 Iodium pavidon 60ml Botol 489 0 489 4 485 0
106 Masker Pcs 1475 0 1475 90 1385 0
107 Alat suntik 5 cc pcs 1485 0 1485 14 1471 0
108 Hand scun steril pcs 680 0 680 20 660 0
109 Urine bag pcs 91 0 91 0 91 0
110 Foley catheter pediatric 2 way (8) pcs 29 0 29 0 29 0
111 Foley catheter pediatric 2 way (10) pcs 29 0 29 0 29 0
112 Foley catheter 2 way (12) pcs 1 0 1 0 1 0
113 Foley catheter 2 way (14) pcs 1 0 1 0 1 0
114 Foley catheter 2 way (16) pcs 15 0 15 0 15 0
115 Foley catheter 2 way (18) pcs 25 0 25 0 25 0
116 Magnesium Sulfat Inj 20 % Ampl 26 0 26 2 24 0
117 Magnesium Sulfat Inj 40 % Ampl 26 0 26 0 26 0
118 Hand scun non steril ukuran L pcs 607 0 607 0 607 0
119 Hidroklorotiazid tab 25mg Tablet 900 0 900 15 885 0
120 Haloperidol 1,5mg Tablet 8000 0 8000 0 8000 0
121 Oksitosin inj 10 IU/ml Ampul 2380 0 2380 10 2370 0
122 Donssiklin kaps 100mg Kapsul 900 0 900 0 900 0
123 Loperamid tab 2mg Tablet 1520 0 1520 130 1390 0
124 Kloramfenikol susp 125mg/5ml Botol 724 0 724 82 642 0
125 Piridoksin(vit B6) tab 10 ml Tablet 15000 0 15000 3000 12000 0
126 Metformin Tablet 732 0 732 180 552 0
127 Anti hemoroid Kapsul 108 0 108 29 79 0

Nip. Nip.
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) JKN
BULAN DESEMBER 2016
PUSKESMAS : PEUREULAK

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
1 Acyclovir tab 200 mg 0 0 0 0 0
2 Acyclovir tab 400 mg 0 0 0 0 0
3 Allopurinol 100 mg 8282 0 8282 15 9 24 12 9 25 173 40 245 28 58 66 24 18 12 60 58 876 7406 50
4 Aminofillin tab 200 mg 0 0 0 0 0
5 Amitriptillin 25 mg 0 0 0 0 0
6 Amlodipin 5 mg 3733 0 3733 15 30 15 6 374 220 24 24 18 6 12 744 2989
7 Amlodipin 10 mg 1841 0 1841 10 15 12 3 15 5 163 3 3 229 1612 180
8 Amoksisillina kapl 250mg 0 0 0 0 0
9 Amoksisillina kapl 500mg 0 0 0 0 0
10 Amoksisillina sirker 250 mg / 5 ml 4973 0 4973 10 7 8 6 7 4 26 9 189 8 5 12 3 4 6 11 12 5 332 4641 59
11 Ampisillin serbuk Inj 1000 mg/5 ml 0 0 0 0 0
12 Antasida Doen Tab 89960 0 89960 130 180 353 170 184 210 227 421 1522 7240 282 286 134 132 210 252 254 52 12239 77721 198
13 Antasida sir 2087 0 2087 8 11 5 9 5 2 5 5 65 7 7 11 6 4 3 7 6 2 168 1919 68
14 Asam Ascorbat ( Vit.C ) 50 mg 93291 0 93291 130 180 270 110 160 165 321 175 1325 10210 240 223 130 152 119 325 235 50 14520 78771 636
15 Asam Mefenamat 500 mg 95770 0 95770 80 95 280 80 130 30 40 80 920 13050 65 245 10 30 50 45 50 15280 80490 290
16 Attapulgite 630 mg 0 0 0 0 0
17 Atropin Inj 0,25 mg/ml 0 0 0 0 0
18 Betametason Krim 779 0 779 2 3 5 2 1 2 16 5 36 3 2 3 1 2 2 4 89 690 14
19 Bedak Salisil 2% serbuk 2072 0 2072 5 2 3 2 5 3 17 3 19 3 4 3 2 1 2 4 3 81 1991
20 Carbamazepin 200 mg 0 0 0 0 0
21 Deksametason 0,5 mg 0 0 0 0 0
22 Deksametason Inj 5 mg/ml 30 0 30 5 5 25
23 Diazepam Tab 2 mg 0 0 0 0 0
24 Digoksin 0,25 mg 150 0 150 0 150
25 Dipenhidramin Inj 60 0 60 0 60
Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
26 Domperidone 7760 0 7760 20 18 40 20 18 28 65 55 24 1524 48 62 38 29 30 249 60 2328 5432
27 Erytromicin Syr 377 0 377 5 3 2 1 23 2 1 2 2 41 336 4
28 Etanol 70 % cairan 100 ml 41 0 41 1 1 2 39
29 Ferro Sulfat 300 mg 0 0 0 0 0
30 Fitomenadion Inj 184 0 184 0 184
31 Fitomenadion Tablet 2357 0 2357 10 20 10 5 300 20 30 10 405 1952 400

32 Furrosemida tab 0 0 0 0 0
33 Garam Oralit 0 0 0 0 0
34 Gentamisin Tetes Mata 0 0 0 0 0
35 Glibenklamida tab 5 mg 0 0 0 0 0
36 Glimepiride 2 mg 290 0 290 0 290
37 Glukosa Lar. Inf 5 % 338 0 338 20 20 318
38 Griseofulvin tab 125 mg 108 0 108 0 108
39 Hidrokortison Krim 1169 0 1169 6 4 5 4 7 3 7 6 4 245 6 4 1 3 2 7 5 319 850 1

40 Ibuprofen tab.200 mg 31400 0 31400 70 20 80 30 45 55 750 10 30 20 20 1130 30270 0

41 Kaptopril 12.5 mg 0 0 0 0 0
42 Kaptopril 25 mg 8251 0 8251 10 10 400 1000 12 1432 6819 310

43 Kaptopril 50 mg 0 0 0 0 0
44 Kals Laktat tab.500 mg 0 0 0 0 0
45 Klorfeniramine Maleat (CTM) 0 0 0 0 0
46 Ketokonazol tablet 200 mg 2609 0 2609 3 15 9 12 15 3 6 9 3 3 15 93 2516
47 Ketokonazol cream 282 0 282 1 1 14 1 3 2 1 23 259
48 Kloramfenikol salep mata 1% 52 0 52 1 3 1 5 1 11 41 27

49 Klorpromazine inj 5 mg/ml 0 0 0 0 0


50 Kodein HCL 10 mg 3000 0 3000 20 20 2980
51 Kotrimoksazol Susp 2287 0 2287 3 7 9 3 7 3 27 6 29 3 4 5 2 3 4 3 6 124 2163
52 Kotrimoksazol 480mg Tab 26278 0 26278 46 30 24 6 20 18 312 6 24 18 6 20 34 564 25714 67

53 Levofloxacin 500 mg 420 0 420 3 3 12 3 3 24 396 200


Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
54 Lidokain HCl 2 %+ Epinefrin 0 0 0 0 0
55 Loperamide 2 mg Tab 0 0 0 0 0
56 Loratadine 0 0 0 0 0
57 Metilergometrin salut tab 0,125 mg 464 0 464 10 10 454
58 Metoclopramide 10 mg 3380 0 3380 10 20 60 10 20 40 40 10 20 120 10 30 45 55 490 2890 100
59 Metronidazole 250 mg 0 0 0 0 0
60 Metronidazole 500 mg 11035 0 11035 20 20 40 20 420 10 40 30 20 620 10415 260
61 Mikonazole Cream 2% 1268 0 1268 4 7 5 4 3 5 8 12 7 152 6 8 3 4 5 5 7 245 1023
62 Natrium Diklofenak 50 mg 27914 0 27914 86 93 76 86 34 54 432 104 125 82 86 79 66 48 64 102 99 1716 26198
63 Natrium Klorida 0.9 % 439 0 439 7 3 20 30 409 10
64 Nifedipin 10 mg 1864 0 1864 10 6 16 1848
65 Nistatin 500.000 IU/gr 1100 0 1100 0 1100
66 Omeprazole 20 mg 36976 0 36976 130 154 130 87 66 57 88 92 241 4120 111 86 64 66 84 92 103 34 5805 31171 90
67 Omeprazole Inj 40 mg/ 10 ml 26 0 26 5 5 10 16
68 Parasetamol Syrup 120 mg / 5 ml 5910 0 5910 17 19 24 11 9 6 28 21 78 609 14 15 11 6 7 23 12 4 914 4996 79
69 Parasetamol Tablet 500 mg 813466 0 813466 210 285 350 290 230 230 335 437 1720 15340 139 420 180 264 236 324 276 47 21313 792153 224
70 Propanolol tab 40 mg 1118 0 1118 10 30 10 20 70 1048
71 Pirantel Pamoat 125 mg 515 0 515 10 10 505
72 Ranitidin 150 mg tab 15270 0 15270 60 78 76 40 39 42 176 79 267 48 72 168 25 12 28 42 6 1258 14012
73 Ranitidin Inj 19 0 19 5 5 14
74 Ringer Lactat Infus 1952 0 1952 20 44 2 20 20 106 1846 10
75 Resperidone tab 2640 0 2640 10 300 10 20 340 2300
76 Salbutamol 4 mg 0 0 0 0 0
77 Salep 2- 4 0 0 0 0 0
78 Sefadroksil tab 463 0 463 12 18 18 6 12 24 6 6 24 32 6 164 299
79 Sefadroksil Syr 0 0 0 0 0
80 Setirizine tab 4145 0 4145 18 24 30 24 38 1000 1134 3011
81 Simvastatin 20 mg 1545 0 1545 12 10 20 10 20 150 20 5 15 10 272 1273
82 Tetrasiklin HCL 250 mg 0 0 0 0 0
83 Vitamin B Complek 51626 0 51626 217 276 282 192 230 152 288 268 1027 132 273 324 246 130 186 224 239 40 4726 46900 420

Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket
No Nama Obat
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
84 Yodium Povidon 30 ml 9 0 9 1 2 1 4 8 1
85 Zink Syr 744 0 744 2 1 2 2 4 1 2 1 1 2 1 2 21 723
86 Zink tab 3200 0 3200 20 20 20 10 20 10 20 30 150 3050
OBAT GIGI 0 0
87 Eugenol Cairan 15 0 15 0 15
ALAT KESEHATAN 0 0
88 Alat Suntik 2,5 cc 1100 0 1100 17 52 20 10 99 1001 40
89 Catgut 2/0 652 0 652 15 72 87 565 17
90 Catgut 3/0 768 0 768 15 48 12 75 693 10
91 Infusion set Anak 335 0 335 50 50 285
92 Infusion set dewasa 614 0 614 25 3 31 59 555 46
93 I.V Cateter 20 G 1168 0 1168 20 15 10 45 1123
94 I.V Cateter 22 G 289 0 289 25 10 35 254
95 I.V Cateter 24 G 1585 0 1585 5 15 20 1565 10
96 Kapas 250 gr 123 0 123 2 12 14 109
97 Kapas Berlemak 500 gr 0 0 0 0 0
98 Kasa Pembalut 4m x 10 cm 8733 0 8733 1500 2 25 1527 7206 17
99 Kasa Pembalut 4m x 15 cm 3780 0 3780 25 15 100 40 180 3600
100 Saveglove ( Hand scun) 2616 0 2616 4 10 50 10 3 6 83 2533
101 Silk 65 0 65 0 65
102 Oksigen tabung kecil 0 0 0 0 0
103 Oksigen tabung sedang 0 0 0 0 0
104 Oksigen tabung besar 0 0 0 0 0
105 Iodium pavidon 60ml 489 0 489 3 1 4 485
106 Metformin 500 mg 732 0 732 20 40 20 40 20 10 30 180 552
107 Masker 1475 0 1475 10 5 5 50 10 10 90 1385
108 Alat suntik 5 cc 1485 0 1485 2 2 10 14 1471
109 Hand scun steril 680 0 680 10 10 20 660
110 Urine bag 91 0 91 0 91
111 Foley catheter pediatric 2 way (8) 29 0 29 0 29
112 Foley catheter pediatric 2 way (10 29 0 29 0 29
113 Foley catheter 2 way (12) 1 0 1 0 1
114 Foley catheter 2 way (14) 1 0 1 0 1
114 Foley catheter 2 way (16) 15 0 15 0 15
115 Foley catheter 2 way (18) 25 0 25 0 25
116 Magnesium Sulfat Inj 20 % 36 0 36 2 2 34
117 Magnesium Sulfat Inj 40 % 36 0 36 0 36
118 Hand scun Non steril L 607 0 607 0 607
119 Sianokobalamin(vit B12)50mcg 20000 0 20000 0 20000
120 Anti hemoroid supp 108 0 108 2 5 20 2 29 79
121 Hidroklorotiazid tab 25mg 900 0 900 3 6 3 3 15 885
122 Haloperidol 1,5mg 8000 0 8000 0 8000
123 Oksitoksin inj 10 IU/ml 2380 0 2380 5 5 10 2370
124 Donsisiklin kaps 100mg 900 0 900 0 900
125 Loperamid tab 2mg 220 0 220 10 20 30 60 10 130 90 45
126 Kloramfenikol susp 125mg/5ml 724 0 724 5 1 5 2 3 2 1 3 52 2 3 1 2 82 642
127 Piridoksin 10mg tab 15000 0 15000 3000 3000 12000

Mengetahui
Kepala Puskesmas Pengelola Obat PKM

Nip. Nip.