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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT DAK

( LPLPO ) DAK

UPT PKM : PEUREULAK BULAN : Januari


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

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


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 4 300 304 135 169 300

3 Acyclovir cream 5 % Tube 0 100 100 28 72 100

4 Albendazole 400 mg Tablet 0 0 0 0 0 0

5 Allopurinol 100 mg Tablet 0 0 0 0 0 0

6 Ambroxol Syr 60 ml Botol 0 100 100 92 8 150

7 Ambroxol tab 30 mg Tablet 0 1000 1000 769 231 3000

8 Aminopillin tab 200 mg Tablet 140 0 140 0 140 0

9 Amitriptiline 25 Tablet 300 0 300 0 300 0

10 Amlodipin 5 mg Tablet 0 0 0 0 0 0

11 Amlodipin 10 mg Tablet 0 0 0 0 0 0

12 Amoksisillina kapl 250mg Kapsul 0 0 0 0 0 0

13 Amoksisillina kapl 500mg Tablet 0 0 0 0 0 0

14 Amoksisillina sirker 250 mg / 5 ml Botol 0 0 0 0 0 0

15 Antasida Doen Tab Tablet 2185 0 2185 2185 0 10000

16 Antasida sir Botol 0 0 0 0 0 0

17 Asam Ascorbat ( Vit.C ) 50 mg Tablet 0 0 0 0 0 0

18 Asam Mefenamat 500 mg Tablet 0 0 0 0 0 0

19 Attapulgite 630 mg Tablet 0 0 0 0 0 0

20 Atropin Sulfat 0.5 mg Tablet 200 0 200 0 200 0

21 Besi II Sulfat Tablet 0 0 0 0 0 0

22 Betametason Krim Tube 0 0 0 0 0 0

23 Captopril 12.5 mg Tablet 0 0 0 0 0 0

24 Captopril 25 mg Tablet 0 0 0 0 0 0

25 Captopril 50 mg Tablet 0 0 0 0 0 0

26 Deksametason Inj Ampul 0 0 0 0 0 0

27 Deksametason 0,5 mg Tablet 0 0 0 0 0 0

28 Diazepam Tab 2 mg Tablet 0 0 0 0 0 0

29 Digoksin 0,25 mg Tablet 300 200 500 0 500 0

30 Diltiazem HCL 30mg Tablet 200 0 200 0 200 0

31 Dipenhidramin Inj Ampul 0 0 0 0 0 0

32 Domperidom Tablet 0 0 0 0 0 0

33 Efedrina HCL 25 mg Tablet 237 500 737 419 318 300


34 Erytromicin Syr Botol 0 0 0 0 0 0

35 Etakridine kom Botol 9 5 14 2 12 0

36 Etanol Botol 0 0 0 0 0 0

37 Fenobarbital tab 30 mg Tablet 284 0 284 205 79 1000

38 Fitomenadion Inj Ampul 0 0 0 0 0 0

39 Fitomenadion Tablet Tablet 0 0 0 0 0 0

40 Furrosemida tab Tablet 181 300 481 167 314 200

41 Furrosemida inj Ampul 3 0 3 0 0 0

42 Garam Oralit Tablet 0 0 0 0 0 0

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

43 Gentamicin SK 0,1 % Tube 0 50 50 28 22 50

44 Glibenklamida tab 5 mg Tablet 0 300 300 0 300 300

45 Glimepiride 2 mg Tablet 0 0 0 0 0 0

46 Glukosa Lar. Inf 5 % Botol 0 0 0 0 0 0

47 Griseofulvin tab 125 mg Tablet 0 0 0 0 0 0

48 Halloperidol 0.5 mg Tablet 0 0 0 0 0 0

49 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

50 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

51 Hidrokortison Krim Tube 0 0 0 0 0 0

52 Ibuprofen tab.200 mg Tablet 0 0 0 0 0 0

53 Kalium Permanganas 5 gr Botol 0 32 32 0 32 0

54 Kals Laktat tab.500 mg Tablet 698 3000 3698 2536 1162 2000

55 Ketokonazol tablet 200 mg Tablet 0 0 0 0 0 0

56 Ketokonazol cream Tube 0 0 0 0 0 0

57 Kloramfenikol salep mata Tube 0 0 0 0 0 0

58 Klorpromazine inj Ampul 0 0 0 0 0 0

59 Kodein HCL 10 mg Tablet 0 0 0 0 0 0

60 Kotrimoksazol Susp Botol 0 0 0 0 0 0

61 Kotrimoksazol 480mg Tab Tablet 0 0 0 0 0 0

62 Levofloxacin 500 mg Tablet 0 0 0 0 0 0

63 Loratadine Tablet 0 500 500 280 220 500

64 Metilergometrin Tab. Tablet 0 0 0 0 0 0

65 Metoclopramide 10 mg Tablet 0 0 0 0 0 0

66 Metronidazole 500 mg Tablet 0 0 0 0 0 0

67 Mikonazole Cream Tube 0 0 0 0 0 0

68 Natrium Bikarbonat Tablet 0 3000 3000 880 2120 300

69 Natrium Diklofenac 50 mg Tablet 0 1000 1000 1000 0 5000

70 Natrium Klorida 0.9 % Botol 0 0 0 0 0 0

71 Nifedipin 10 mg Tablet 0 0 0 0 0 0

72 Nistatin 500.000 IU/g Tablet 90 500 590 110 480 0


73 Obat Batuk hitam Botol 0 96 96 19 77 50

74 Oksitetrasiklin Salep Mata Tube 0 50 50 23 27 50

75 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 0 50

76 Omeprazole inj 40 mg/ 10 ml Vial 7 10 17 7 10 0

77 Omeprazole 20 mg Kapsul 0 0 0 0 0 0

78 Parasetamol Syrup 120 mg / 5 ml Botol 0 0 0 0 0 0

79 Parasetamol Tablet 500 mg Tablet 0 0 0 0 0 0

80 Pehacain Inj Ampul 0 60 60 47 13 100

81 Pirantel tab 125 mg Tablet 3 100 103 72 31 200

82 Propanolol tab 40 mg Tablet 0 0 0 0 0 0

83 Propiltiourasil 100 mg Tablet 0 200 200 40 160 0

84 Ranitidin Tablet 2301 0 2301 1901 400 5000

85 Ranitidin Inj Ampul 0 0 0 0 0 0

86 Ringer Lactat Infus Botol 0 0 0 0 0 0

87 Salbutamol 4 mg Tablet 0 0 0 0 0 0

88 Salep 2- 4 Tube 0 0 0 0 0 0

89 Salisil Bedak 2 % kotak 0 0 0 0 0 0

90 Sefadroksil Syr Botol 0 0 0 0 0 0

91 Setirizine tab Tablet 0 0 0 0 0 0

92 Simvastatin 20 mg Tablet 0 0 0 0 0 0

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

93 Serum Anti Bisa Ular ( ABU I ) Vial 0 0 0 0 0 0

94 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0 0

95 Tetrasiklin HCL 250 mg Kapsul 26 2000 2026 508 1518 0

96 Tiamin HCL ( Vit B1 ) 50 mg Tablet 0 4000 4000 3824 176 5000

97 Tramadol caps 50 mg Capsul 0 300 300 236 64 500

98 Vitamin B Complek Tablet 0 0 0 0 0 0

99 Yodium Povidon 30 ml Botol 0 0 0 0 0 0


100 Zink Syr Botol 17 50 67 50 17 33

101 Zink tab Tablet 0 0 0 0 0 0

OBAT GIGI

102 Curaspon Botol 0 1 1 0 1 0

103 Etil Klorida semprot Botol 0 2 2 2 0 5

104 Eugenol Cairan Botol 0 0 0 0 0 0

105 Glass ionomer cement ART Botol 0 1 1 0 1 0

106 Kalsium Hidroksida Pasta Set 0 1 1 0 1 0

ALAT KESEHATAN 0

107 Alat Suntik 5 cc Unit 0 5 5 5 0 10

108 Alat Suntik 10 cc Unit 0 10 10 5 5 20


109 Aquadest 1000 ml Botol 0 1 1 0 1 1

110 Blood Tranfusion Set Kantong 0 0 0 0 0 0

111 Catgut 2/0 Pcs 0 24 24 0 24 0

112 Catgut 3/0 Pcs 0 0 0 0 0 0

113 Hand Scun Set 0 0 0 0 0 0

114 Infusion set dewasa Kantong 0 0 0 0 0 0

115 I.V Cateter 18 G Buah 0 10 10 0 10 0

116 I.V Cateter 20 G Buah 0 0 0 0 0 0

117 I.V Cateter 22 G Buah 0 0 0 0 0 0

118 I.V Cateter 24 G Buah 0 0 0 0 0 0

119 Kasa Pembalut 4m x 15 cm Rol 0 0 0 0 0 0

120 Masker Pcs 2 50 52 36 16 100

121 Plester 5 yard x 2 inch Rol 0 10 10 5 5 10

122 Silk Pcs 0 0 0 0 0 0

123 Spiritus 500 ml Botol 0 1 1 0 1 0

124 Sianokobalamin inj Vial 12 0 12 0 12 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 ) DAK
BULAN JANUARI 2016
PUSKESMAS : PEUREULAK KOTA

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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 0 0 0

2 Acyclovir tab 400 mg 4 300 304 20 20 30 20 15

3 Acyclovir cream 5 % 0 100 100 5 2 3 3 4 5 3

4 Albendazole 400 mg 0 0 0

5 Allopurinol 100 mg 0 0 0

6 Ambroxol Syr 60 ml 0 100 100 8 5 3 3 4 15 5 4 5 5 5 5 4 4 7

7 Ambroxol tab 30 mg 0 1000 1000 30 30 20 20 30 50 40 45 108 30 95 95 60 20

8 Aminopillin tab 200 mg 140 0 140

9 Amitriptiline 25 300 0 300

10 Amlodipin 5 mg 0 0 0

11 Amlodipin 10 mg 0 0 0

12 Amoksisillina kapl 250mg 0 0 0

13 Amoksisillina kapl 500mg 0 0 0

14 Amoksisillina sirker 250 mg / 5 ml 0 0 0

15 Antasida Doen Tab 2185 0 2185 150 120 230 116 550 700 114 105 100

16 Antasida sir 0 0 0

17 Asam Ascorbat ( Vit.C ) 50 mg 0 0 0

18 Asam Mefenamat 500 mg 0 0 0

19 Attapulgite 630 mg 0 0 0

20 Atropin Sulfat 0.5 mg 200 0 200

21 Besi II Sulfat 0 0 0

22 Betametason Krim 0 0 0

23 Captopril 12.5 mg 0 0 0

24 Captopril 25 mg 0 0 0

25 Captopril 50 mg 0 0 0
No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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 Deksametason Inj 0 0 0

27 Deksametason 0,5 mg 0 0 0

28 Diazepam Tab 2 mg 0 0 0

29 Digoksin 0,25 mg 300 200 500

30 Diltiazem HCL 30mg 200 0 200

31 Dipenhidramin Inj 0 0 0

32 Domperidom 0 0 0

33 Efedrina HCL 25 mg 237 500 737 30 20 20 30 20 60 15 20 20 24 30 20 20 40

34 Erytromicin Syr 0 0 0

35 Etakridine kom 9 5 14 1 1

36 Etanol 0 0 0

37 Fenobarbital tab 30 mg 284 0 284 30 25 20 20 20 40 20 30

38 Fitomenadion Inj 0 0 0

39 Fitomenadion Tablet 0 0 0

40 Furrosemida tab 181 300 481 20 10 20 10 10 15 12 50 10

41 Furrosemida inj 3 0 3

42 Garam Oralit 0 0 0

43 Gentamicin SK 0,1 % 0 50 50 3 5 5 5 3 2 3

44 Glibenklamida tab 5 mg 0 300 300

45 Glimepiride 2 mg 0 0 0

46 Glukosa Lar. Inf 5 % 0 0 0

47 Griseofulvin tab 125 mg 0 0 0

48 Halloperidol 0.5 mg 0 0 0

49 Halloperidol 1.5 mg 0 0 0

50 Halloperidol 1.5 mg 0 0 0

51 Hidrokortison Krim 0 0 0

52 Ibuprofen tab.200 mg 0 0 0
53 Kalium Permanganas 5 gr 0 32 32

54 Kals Laktat tab.500 mg 698 3000 3698 100 90 64 70 86 290 350 562 60 90 76 76 100 70 100 86 62 68

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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

55 Ketokonazol tablet 200 mg 0 0 0

56 Ketokonazol cream 0 0 0

57 Kloramfenikol salep mata 0 0 0

58 Klorpromazine inj 0 0 0

59 Kodein HCL 10 mg 0 0 0

60 Kotrimoksazol Susp 0 0 0

61 Kotrimoksazol 480mg Tab 0 0 0

62 Levofloxacin 500 mg 0 0 0

63 Loratadine 0 500 500 34 30 35 30 30 20 20 25

64 Metilergometrin Tab. 0 0 0

65 Metoclopramide 10 mg 0 0 0

66 Metronidazole 500 mg 0 0 0

67 Mikonazole Cream 0 0 0

68 Natrium Bikarbonat 0 3000 3000 50 30 50 40 50 90 70 50 84 50 80 56 40

69 Natrium Diklofenac 50 mg 0 1000 1000 76 60 96 96 74 60 60 80 96 78 70

70 Natrium Klorida 0.9 % 0 0 0

71 Nifedipin 10 mg 0 0 0

72 Nistatin 500.000 IU/g 90 500 590 20 20 20 20 10

73 Obat Batuk hitam 0 96 96 3 3 2 5 2 2

74 Oksitetrasiklin Salep Mata 0 50 50 2 7 2 2 3 2

75 Oksitetrasiklin Salep Kulit 0 0 0

76 Omeprazole inj 40 mg/ 10 ml 7 10 17 4

77 Omeprazole 20 mg 0 0 0

78 Parasetamol Syrup 120 mg / 5 ml 0 0 0

79 Parasetamol Tablet 500 mg 0 0 0

80 Pehacain Inj 0 60 60 5 10 12 10
81 Pirantel tab 125 mg 3 100 103 10 10 10 10 12 10

82 Propiltiourasil 100 mg 0 0 0

83 Propanolol tab 40 mg 0 200 200 20 20

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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 Ranitidin 2301 0 2301 106 80 80 66 245 96 64 56 50 86 56 68 176 100 226 56 70 62

85 Ranitidin Inj 0 0 0

86 Ringer Lactat Infus 0 0 0

87 Salbutamol 4 mg 0 0 0

88 Salep 2- 4 0 0 0

89 Salisil Bedak 2 % 0 0 0

90 Sefadroksil Syr 0 0 0

91 Setirizine tab 0 0 0

92 Simvastatin 20 mg 0 0 0

93 Serum Anti Bisa Ular ( ABU I ) 0 0 0

94 Serum Anti Tetanus 1.500 UI / ml 0 0 0

95 Tetrasiklin HCL 250 mg 26 2000 2026 270 100 24 30 10 24 20 10

96 Tiamin HCL ( Vit B1 ) 50 mg 0 4000 4000 242 620 580 152 600 160 150 106 124 126 120 124 136 126 136

97 Tramadol caps 50 mg 0 300 300 26 20 120 20 20 10

98 Vitamin B Complek 0 0 0

99 Yodium Povidon 30 ml 0 0 0

100 Zink Syr 17 50 67 5 3 5 9 7 6 4 2 2 3 2

101 Zink tablet 0 0 0

OBAT GIGI

102 Curaspon 0 1 1

103 Etil Klorida semprot 0 2 2 1 1

104 Eugenol Cairan 0 0 0

105 Glass ionomer cement ART 0 1 1

106 Kalsium Hidroksida Pasta 0 1 1

ALAT KESEHATAN
107 Alat Suntik 5 cc 0 5 5 5

108 Alat Suntik 10 cc 0 10 10 5

109 Aquadest 1000 ml 0 1 1

110 Blood Tranfusion Set 0 0 0

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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

111 Catgut 2/0 0 24 24

112 Catgut 3/0 0 0 0

113 Hand Scun 0 0 0

114 Infusion set dewasa 0 0 0

115 I.V Cateter 18 G 0 10 10

116 I.V Cateter 20 G 0 0 0

117 I.V Cateter 22 G 0 0 0

118 I.V Cateter 24 G 0 0 0

119 Kasa Pembalut 4m x 15 cm 0 0 0

120 Masker 2 50 52 3 15 12 6

121 Plester 5 yard x 2 inch 0 10 10 1 1 1 1

122 Silk 0 0 0

123 Spiritus 500 ml 0 1 1

Mengetahui Pen
Kepala UPT.Puskesmas Peureulak
(MUHAMMAD JAMIL, SE) (M
Nip. 19671231 198803 1 345 Nip. 198
Pema Stok Ket

28 29 30 31 kaian Akhir

0 0

30 135 169

3 28 72

0 0

0 0

5 5 92 8

20 76 769 231

0 140

0 300

0 0

0 0

0 0

0 0

0 0

2185 0

0 0

0 0

0 0

0 0

0 200

0 0

0 0

0 0

0 0

0 0
Pema Stok Ket

28 29 30 31 kaian Akhir

0 0

0 0

0 0

0 500

0 200

0 0

0 0

20 30 419 318

0 0

2 12

0 0

205 79

0 0

0 0

10 167 314

0 3

0 0

2 28 22

0 300

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
0 32

80 56 2536 1162

Pema Stok Ket

28 29 30 31 kaian Akhir

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

28 28 280 220

0 0

0 0

0 0

0 0

70 70 880 2120

72 82 1000 0

0 0

0 0

20 110 480

2 19 77

5 23 27

0 0

3 7 10

0 0

0 0

0 0

10 47 13
10 72 31

0 0

40 160

Pema Stok Ket

28 29 30 31 kaian Akhir

60 98 1901 400

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

20 508 1518

150 172 3824 176

20 236 64

0 0

0 0

2 50 17

0 0

0 0

0 1

2 0

0 0

0 1

0 1

0 0
5 0

5 5

0 1

0 0

Pema Stok Ket

28 29 30 31 kaian Akhir

0 24

0 0

0 0

0 0

0 10

0 0

0 0

0 0

0 0

36 16

1 5 5

0 0

0 1

Pengelola Obat PKM


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

UPT PKM : PEUREULAK BULAN : Februari


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

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 0 100 100 0 100 100

2 Acyclovir tab 400 mg Tablet 169 0 169 83 86 100

3 Acyclovir cream 5 % Tube 72 0 72 18 54 50

4 Albendazole 400 mg Tablet 0 0 0 0 0 0

5 Allopurinol 100 mg Tablet 0 0 0 0 0 0

6 Ambroxol Syr 60 ml Botol 8 150 158 57 101 50

7 Ambroxol tab 30 mg Tablet 231 1000 1231 584 647 500

8 Aminopillin tab 200 mg Tablet 140 0 140 75 65 100

9 Amitriptiline 25 Tablet 300 0 300 0 300 0

10 Amlodipin 5 mg Tablet 0 0 0 0 0 0

11 Amlodipin 10 mg Tablet 0 0 0 0 0 0

12 Amoksisillina kapl 250mg Kapsul 0 0 0 0 0 0

13 Amoksisillina kapl 500mg Tablet 0 1000 1000 0 1000 5000

14 Amoksisillina sirker 250 mg / 5 ml Botol 0 0 0 0 0 0

15 Antasida Doen Tab Tablet 0 5000 5000 1425 3575 5000

16 Antasida sir Botol 0 0 0 0 0 0

17 Asam Ascorbat ( Vit.C ) 50 mg Tablet 0 0 0 0 0 0

18 Asam Mefenamat 500 mg Tablet 0 0 0 0 0 0

19 Attapulgite 630 mg Tablet 0 1000 1000 162 838 0

20 Atropin Sulfat 0.5 mg Tablet 200 0 200 0 200 0

21 Besi II Sulfat Tablet 0 600 600 0 600 0

22 Betametason Krim Tube 0 0 0 0 0 0

23 Captopril 12.5 mg Tablet 0 0 0 0 0 0

24 Captopril 25 mg Tablet 0 300 300 0 300 200

25 Captopril 50 mg Tablet 0 300 300 0 300 200

26 Deksametason Inj Ampul 0 0 0 0 0 0

27 Deksametason 0,5 mg Tablet 0 0 0 0 0 0

28 Diazepam Tab 2 mg Tablet 0 0 0 0 0 0

29 Digoksin 0,25 mg Tablet 500 0 500 0 500 0

30 Diltiazem HCL 30mg Tablet 200 0 200 0 200 0

31 Dipenhidramin Inj Ampul 0 0 0 0 0 0

32 Domperidom Tablet 0 1000 1000 65 935 500


33 Efedrina HCL 25 mg Tablet 318 250 568 287 281 500

34 Erytromicin Syr Botol 0 0 0 0 0 0

35 Etakridine kom Botol 12 0 12 2 10 0

36 Etanol Botol 0 0 0 0 0 0

37 Fenobarbital tab 30 mg Tablet 79 1000 1079 70 1009 0

38 Fitomenadion Inj Ampul 0 0 0 0 0 0

39 Fitomenadion Tablet Tablet 0 0 0 0 0 0

40 Furrosemida tab Tablet 314 0 314 276 38 300

41 Furrosemida inj Ampul 0 0 0 0 0 0

42 Garam Oralit Tablet 0 0 0 0 0 0

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

43 Gentamicin SK 0,1 % Tube 22 30 52 9 43 50

44 Glibenklamida tab 5 mg Tablet 300 0 300 198 102 500

45 Glimepiride 2 mg Tablet 0 0 0 0 0 0

46 Glukosa Lar. Inf 5 % Botol 0 0 0 0 0 0

47 Griseofulvin tab 125 mg Tablet 0 0 0 0 0 0

48 Halloperidol 0.5 mg Tablet 0 0 0 0 0 0

49 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

50 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

51 Hidrokortison Krim Tube 0 0 0 0 0 0

52 Ibuprofen tab.200 mg Tablet 0 0 0 0 0 0

53 Kalium Permanganas 5 gr Botol 32 0 32 0 32 0

54 Kals Laktat tab.500 mg Tablet 1162 2000 3162 1350 1812 3000

55 Ketokonazol tablet 200 mg Tablet 0 700 700 72 628 500

56 Ketokonazol cream Tube 0 12 12 0 12 24

57 Kloramfenikol salep mata Tube 0 0 0 0 0 0

58 Klorpromazine inj Ampul 0 0 0 0 0 0

59 Kodein HCL 10 mg Tablet 0 0 0 0 0 0

60 Kotrimoksazol Susp Botol 0 0 0 0 0 0

61 Kotrimoksazol 480mg Tab Tablet 0 0 0 0 0 0

62 Levofloxacin 500 mg Tablet 0 0 0 0 0 0

63 Loratadine Tablet 220 500 720 285 435 300

64 Metilergometrin Tab. Tablet 0 0 0 0 0 0

65 Metoclopramide 10 mg Tablet 0 0 0 0 0 0

66 Metronidazole 500 mg Tablet 0 0 0 0 0 0

67 Mikonazole Cream Tube 0 0 0 0 0 0

68 Natrium Bikarbonat Tablet 2120 0 2120 1588 532 3000

69 Natrium Diklofenac 50 mg Tablet 0 1500 1500 705 795 2000

70 Natrium Klorida 0.9 % Botol 0 0 0 0 0 0


71 Nifedipin 10 mg Tablet 0 0 0 0 0 0

72 Nistatin 500.000 IU/g Tablet 480 0 480 30 450 0

73 Obat Batuk hitam Botol 77 0 77 18 59 100

74 Oksitetrasiklin Salep Mata Tube 27 25 52 9 43 50

75 Oksitetrasiklin Salep Kulit Tube 0 50 50 2 48 50

76 Omeprazole inj 40 mg/ 10 ml Vial 10 10 20 0 20 0

77 Omeprazole 20 mg Kapsul 0 0 0 0 0 0

78 Parasetamol Syrup 120 mg / 5 ml Botol 0 0 0 0 0 0

79 Parasetamol Tablet 500 mg Tablet 0 0 0 0 0 0

80 Pehacain Inj Ampul 13 60 73 35 38 100

81 Pirantel tab 125 mg Tablet 31 200 231 63 168 0

82 Propanolol tab 40 mg Tablet 0 0 0 0 0 0

83 Propiltiourasil 100 mg Tablet 160 0 160 20 140 0

84 Ranitidin Tablet 400 2000 2400 606 1794 2000

85 Ranitidin Inj Ampul 0 0 0 0 0 0

86 Ringer Lactat Infus Botol 0 0 0 0 0 0

87 Salbutamol 4 mg Tablet 0 0 0 0 0 0

88 Salep 2- 4 Tube 0 48 48 0 48 0

89 Salisil Bedak 2 % kotak 0 100 100 38 62 100

90 Sefadroksil Syr Botol 0 0 0 0 0 0

91 Setirizine tab Tablet 0 0 0 0 0 0

92 Simvastatin 20 mg Tablet 0 200 200 0 200 500

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

93 Serum Anti Bisa Ular ( ABU I ) Vial 0 0 0 0 0 0

94 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0 0

95 Tetrasiklin HCL 250 mg Kapsul 1518 1000 2518 120 2398 0

96 Tiamin HCL ( Vit B1 ) 50 mg Tablet 176 4000 4176 1533 2643 5000

97 Tramadol caps 50 mg Capsul 64 500 564 302 262 300

98 Vitamin B Complek Tablet 0 0 0 0 0 0

99 Yodium Povidon 30 ml Botol 0 0 0 0 0 0


100 Zink Syr Botol 17 50 67 42 25 50

101 Zink tab Tablet 0 0 0 0 0 0

OBAT GIGI

102 Curaspon Botol 1 0 1 0 1 0

103 Etil Klorida semprot Botol 0 2 2 0 2 3

104 Eugenol Cairan Botol 0 0 0 0 0 0

105 Glass ionomer cement ART Botol 1 0 1 0 1 0

106 Kalsium Hidroksida Pasta Set 1 0 1 0 1 0

ALAT KESEHATAN
107 Alat Suntik 5 cc Unit 0 10 10 0 10 0

108 Alat Suntik 10 cc Unit 5 20 25 0 25 0

109 Aquadest 1000 ml Botol 1 0 1 0 1 0

110 Blood Tranfusion Set Kantong 0 0 0 0 0 0

111 Catgut 2/0 Pcs 24 0 24 0 24 0

112 Catgut 3/0 Pcs 0 0 0 0 0 0

113 Hand Scun Set 0 0 0 0 0 0

114 Infusion set dewasa Kantong 0 0 0 0 0 0

115 I.V Cateter 18 G Buah 10 0 10 0 10 0

116 I.V Cateter 20 G Buah 0 0 0 0 0 0

117 I.V Cateter 22 G Buah 0 0 0 0 0 0

118 I.V Cateter 24 G Buah 0 0 0 0 0 0

119 Kasa Pembalut 4m x 15 cm Rol 0 0 0 0 0 0

120 Masker Pcs 16 100 116 44 72 100

121 Plester 5 yard x 2 inch Rol 5 6 11 5 6 5

122 Silk Pcs 0 0 0 0 0 0

123 Spiritus 500 ml Botol 1 0 1 0 1 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 ) DAK
BULAN FEBRUARI 2016
PUSKESMAS :

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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 0 100 100

2 Acyclovir tab 400 mg 169 0 169 20 25 20 15

3 Acyclovir cream 5 % 72 0 72 2 3 2 2 1 5 2

4 Albendazole 400 mg 0 0 0

5 Allopurinol 100 mg 0 0 0

6 Ambroxol Syr 60 ml 8 150 158 5 3 2 5 20 4 4 1 3 1 1

7 Ambroxol tab 30 mg 231 1000 1231 55 30 34 20 70 22 102 28 30 50 10 20 9 29

8 Aminopillin tab 200 mg 140 0 140 53 17

9 Amitriptiline 25 300 0 300

10 Amlodipin 5 mg 0 0 0

11 Amlodipin 10 mg 0 0 0

12 Amoksisillina kapl 250mg 0 0 0

13 Amoksisillina kapl 500mg 0 1000 1000

14 Amoksisillina sirker 250 mg / 5 ml 0 0 0

15 Antasida Doen Tab 0 5000 5000 60 160 260 144 242 80 128 70 130

16 Antasida sir 0 0 0

17 Asam Ascorbat ( Vit.C ) 50 mg 0 0 0

18 Asam Mefenamat 500 mg 0 0 0

19 Attapulgite 630 mg 0 1000 1000 52 100 10

20 Atropin Sulfat 0.5 mg 200 0 200

21 Besi II Sulfat 0 600 600

22 Betametason Krim 0 0 0

23 Captopril 12.5 mg 0 0 0

24 Captopril 25 mg 0 300 300

25 Captopril 50 mg 0 300 300


No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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 Deksametason Inj 0 0 0

27 Deksametason 0,5 mg 0 0 0

28 Diazepam Tab 2 mg 0 0 0

29 Digoksin 0,25 mg 500 0 500

30 Diltiazem HCL 30mg 200 0 200

31 Dipenhidramin Inj 0 0 0

32 Domperidom 0 1000 1000 19 22

33 Efedrina HCL 25 mg 318 250 568 30 20 31 33 26 10 50 11 22 11 10 10 6 15

34 Erytromicin Syr 0 0 0

35 Etakridine kom 12 0 12 2

36 Etanol 0 0 0

37 Fenobarbital tab 30 mg 79 1000 1079 40 10 10 10

38 Fitomenadion Inj 0 0 0

39 Fitomenadion Tablet 0 0 0

40 Furrosemida tab 314 0 314 12 15 10 200 30 9

41 Furrosemida inj 0 0 0

42 Garam Oralit 0 0 0

43 Gentamicin SK 0,1 % 22 30 52 2 2 3 2

44 Glibenklamida tab 5 mg 300 0 300 32 20 24 15 21 12 18 12 9

45 Glimepiride 2 mg 0 0 0

46 Glukosa Lar. Inf 5 % 0 0 0

47 Griseofulvin tab 125 mg 0 0 0

48 Halloperidol 0.5 mg 0 0 0

49 Halloperidol 1.5 mg 0 0 0

50 Halloperidol 1.5 mg 0 0 0

51 Hidrokortison Krim 0 0 0

52 Ibuprofen tab.200 mg 0 0 0
53 Kalium Permanganas 5 gr 32 0 32

54 Kals Laktat tab.500 mg 1162 2000 3162 120 48 50 104 54 58 456 256 44 48 36 10 66

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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

55 Ketokonazol tablet 200 mg 0 700 700 18 11 19 3 4

56 Ketokonazol cream 0 12 12

57 Kloramfenikol salep mata 0 0 0

58 Klorpromazine inj 0 0 0 0

59 Kodein HCL 10 mg 0 0 0

60 Kotrimoksazol Susp 0 0 0

61 Kotrimoksazol 480mg Tab 0 0 0

62 Levofloxacin 500 mg 0 0 0

63 Loratadine 220 500 720 36 26 30 54 19 13 21 23 22 4

64 Metilergometrin Tab. 0 0 0

65 Metoclopramide 10 mg 0 0 0

66 Metronidazole 500 mg 0 0 0

67 Mikonazole Cream 0 0 0

68 Natrium Bikarbonat 2120 0 2120 142 36 50 150 59 40 492 232 26 42 100 10 60 31 6 70

69 Natrium Diklofenac 50 mg 0 1500 1500 122 116 78 141 52 24 28 18 56

70 Natrium Klorida 0.9 % 0 0 0

71 Nifedipin 10 mg 0 0 0

72 Nistatin 500.000 IU/g 480 0 480 20 10

73 Obat Batuk hitam 77 0 77 2 2 3 5 6

74 Oksitetrasiklin Salep Mata 27 25 52 1 1 2 2 2 1

75 Oksitetrasiklin Salep Kulit 0 50 50 2

76 Omeprazole inj 40 mg/ 10 ml 10 10 20

77 Omeprazole 20 mg 0 0 0

78 Parasetamol Syrup 120 mg / 5 ml 0 0 0

79 Parasetamol Tablet 500 mg 0 0 0

80 Pehacain Inj 13 60 73 13 5 12 5
81 Pirantel tab 125 mg 31 200 231 12 12 7 3 22 7

82 Propiltiourasil 100 mg 0 0 0

83 Propanolol tab 40 mg 160 0 160 20

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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 Ranitidin 400 2000 2400 58 66 50 44 76 30 76 48 64 26 18 16 12

85 Ranitidin Inj 0 0 0

86 Ringer Lactat Infus 0 0 0

87 Salbutamol 4 mg 0 0 0

88 Salep 2- 4 0 48 48

89 Salisil Bedak 2 % 0 100 100 3 6 5 8 6 2 1 4

90 Sefadroksil Syr 0 0 0

91 Setirizine tab 0 0 0

92 Simvastatin 20 mg 0 200 200

93 Serum Anti Bisa Ular ( ABU I ) 0 0 0

94 Serum Anti Tetanus 1.500 UI / ml 0 0 0

95 Tetrasiklin HCL 250 mg 1518 1000 2518 10 10 100

96 Tiamin HCL ( Vit B1 ) 50 mg 176 4000 4176 100 76 186 186 240 222 136 60 67 40 106

97 Tramadol caps 50 mg 64 500 564 12 20 30 30 100 10 100

98 Vitamin B Complek 0 0 0

99 Yodium Povidon 30 ml 0 0 0

100 Zink Syr 17 50 67 7 2 2 3 2 1 4 5 4 4 2 2 2 2

101 Zink tablet 0 0 0

OBAT GIGI

102 Curaspon 1 0 1

103 Etil Klorida semprot 0 2 2

104 Eugenol Cairan 0 0 0

105 Glass ionomer cement ART 1 0 1

106 Kalsium Hidroksida Pasta 1 0 1

ALAT KESEHATAN
107 Alat Suntik 5 cc 0 10 10

108 Alat Suntik 10 cc 5 20 25

109 Aquadest 1000 ml 1 0 1

110 Blood Tranfusion Set 0 0 0

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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

111 Catgut 2/0 24 0 24

112 Catgut 3/0 0 0 0

113 Hand Scun 0 0 0

114 Infusion set dewasa 0 0 0

115 I.V Cateter 18 G 10 0 10

116 I.V Cateter 20 G 0 0 0

117 I.V Cateter 22 G 0 0 0

118 I.V Cateter 24 G 0 0 0

119 Kasa Pembalut 4m x 15 cm 0 0 0

120 Masker 16 100 116 10 12 15 7

121 Plester 5 yard x 2 inch 5 6 11 2 1 1

122 Silk 0 0 0

123 Spiritus 500 ml 1 0 1

Mengetahui Peng
Kepala UPT.Puskesmas Peureulak

(MUKLIS, SKM, M. Kes) (M


Nip. 19720709 199303 1 003 Nip. 198
Pema Stok Ket

28 29 30 31 kaian Akhir

0 100

3 83 86

1 18 54

0 0

0 0

8 57 101

75 584 647

5 75 65

0 300

0 0

0 0

0 0

0 1000

0 0

151 1425 3575

0 0

0 0

0 0

162 838

0 200

0 600

0 0

0 0

0 300

0 300
Pema Stok Ket

28 29 30 31 kaian Akhir

0 0

0 0

0 0

0 500

0 200

0 0

24 65 935

2 287 281

0 0

2 10

0 0

70 1009

0 0

0 0

276 38

0 0

0 0

9 43

35 198 102

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
0 32

1350 1812

Pema Stok Ket

28 29 30 31 kaian Akhir

17 72 628

0 12

0 0

0 0

0 0

0 0

0 0

0 0

37 285 435

0 0

0 0

0 0

0 0

42 1588 532

70 705 795

0 0

0 0

30 450

18 59

9 43

2 48

0 20

0 0

0 0

0 0

35 38
63 168

0 0

20 140

Pema Stok Ket

28 29 30 31 kaian Akhir

22 606 1794

0 0

0 0

0 0

0 48

3 38 62

0 0

0 0

0 200

0 0

0 0

120 2398

114 1533 2643

302 262

0 0

0 0

42 25

0 0

0 0

0 1

0 2

0 0

0 1

0 1

0 0
0 10

0 25

0 1

0 0

Pema Stok Ket

28 29 30 31 kaian Akhir

0 24

0 0

0 0

0 0

0 10

0 0

0 0

0 0

0 0

44 72

1 5 6

0 0

0 1

Pengelola Obat PKM

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

BULAN
UPT PKM : Maret
:
KECAMATAN : TAHUN : 2016
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 100 100 200 0 200 300

2 Acyclovir tab 400 mg Tablet 86 100 186 109 77 300

3 Acyclovir cream 5 % Tube 54 0 54 54 0 100

4 Albendazole 400 mg Tablet 0 0 0 0 0 0

5 Allopurinol 100 mg Tablet 0 0 0 0 0 0

6 Ambroxol Syr 60 ml Botol 101 0 101 49 52 100

7 Ambroxol tab 30 mg Tablet 647 200 847 847 0 1000

8 Aminopillin tab 200 mg Tablet 65 0 65 0 65 100

9 Amitriptiline 25 Tablet 300 0 300 0 300 0

10 Amlodipin 5 mg Tablet 0 0 0 0 0 0

11 Amlodipin 10 mg Tablet 0 0 0 0 0 0

12 Amoksisillina kapl 250mg Kapsul 0 0 0 0 0 0

13 Amoksisillina kapl 500mg Tablet 1000 3000 4000 2206 1794 8000

14 Amoksisillina sirker 250 mg / 5 ml Botol 0 0 0 0 0 0

15 Antasida Doen Tab Tablet 3575 0 3575 3575 0 8000

16 Antasida sir Botol 0 0 0 0 0 0

17 Asam Ascorbat ( Vit.C ) 50 mg Tablet 0 0 0 0 0 0

18 Asam Mefenamat 500 mg Tablet 0 0 0 0 0 0

19 Attapulgite 630 mg Tablet 838 0 838 437 401 1000

20 Atropin Sulfat 0.5 mg Tablet 200 0 200 0 200 0

21 Besi II Sulfat Tablet 600 0 600 48 552 0

22 Betametason Krim Tube 0 0 0 0 0 0

23 Captopril 12.5 mg Tablet 0 0 0 0 0 0

24 Captopril 25 mg Tablet 300 0 300 0 300 0

25 Captopril 50 mg Tablet 300 0 300 0 300 0

26 Deksametason Inj Ampul 0 0 0 0 0 0

27 Deksametason 0,5 mg Tablet 0 0 0 0 0 0

28 Diazepam Tab 2 mg Tablet 0 1000 1000 0 1000 0

29 Digoksin 0,25 mg Tablet 500 0 500 0 500 0

30 Diltiazem HCL 30mg Tablet 200 0 200 0 200 0

31 Dipenhidramin Inj Ampul 0 0 0 0 0 0

32 Domperidom Tablet 935 0 935 376 559 1000


33 Efedrina HCL 25 mg Tablet 281 250 531 252 279 500

34 Erytromicin Syr Botol 0 0 0 0 0 0

35 Etakridine kom Botol 10 0 10 0 10 0

36 Etanol Botol 0 0 0 0 0 0

37 Fenobarbital tab 30 mg Tablet 1009 0 1009 110 899 0

38 Fitomenadion Inj Ampul 0 0 0 0 0 0

39 Fitomenadion Tablet Tablet 0 0 0 0 0 0

40 Furrosemida tab Tablet 38 300 338 49 289 0

41 Furrosemida inj Ampul 0 0 0 0 0 0

42 Garam Oralit Tablet 0 0 0 0 0 0

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

43 Gentamicin SK 0,1 % Tube 43 0 43 4 39 0

44 Glibenklamida tab 5 mg Tablet 102 300 402 146 256 500

45 Glimepiride 2 mg Tablet 0 0 0 0 0 0

46 Glukosa Lar. Inf 5 % Botol 0 0 0 0 0 0

47 Griseofulvin tab 125 mg Tablet 0 0 0 0 0 0

48 Halloperidol 0.5 mg Tablet 0 0 0 0 0 0

49 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

50 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

51 Hidrokortison Krim Tube 0 0 0 0 0 0

52 Ibuprofen tab.200 mg Tablet 0 1000 1000 0 1000 0

53 Kalium Permanganas 5 gr Botol 32 0 32 0 32 0

54 Kals Laktat tab.500 mg Tablet 1812 1000 2812 1432 1380 3000

55 Ketokonazol tablet 200 mg Tablet 628 0 628 136 492 500

56 Ketokonazol cream Tube 12 0 12 5 7 24

57 Kloramfenikol salep mata Tube 0 0 0 0 0 0

58 Klorpromazine inj Ampul 0 0 0 0 0 0

59 Kodein HCL 10 mg Tablet 0 0 0 0 0 0

60 Kotrimoksazol Susp Botol 0 0 0 0 0 0

61 Kotrimoksazol 480mg Tab Tablet 0 0 0 0 0 0

62 Levofloxacin 500 mg Tablet 0 0 0 0 0 0

63 Loratadine Tablet 435 0 435 435 0 800

64 Metilergometrin Tab. Tablet 0 0 0 0 0 0

65 Metoclopramide 10 mg Tablet 0 0 0 0 0 0

66 Metronidazole 500 mg Tablet 0 0 0 0 0 0

67 Mikonazole Cream Tube 0 0 0 0 0 0

68 Natrium Bikarbonat Tablet 532 2000 2532 1051 1481 3000

69 Natrium Diklofenac 50 mg Tablet 795 500 1295 974 321 3000

70 Natrium Klorida 0.9 % Botol 0 0 0 0 0 0


71 Nifedipin 10 mg Tablet 0 0 0 0 0 0

72 Nistatin 500.000 IU/g Tablet 450 0 450 40 410 0

73 Obat Batuk hitam Botol 59 0 59 27 32 50

74 Oksitetrasiklin Salep Mata Tube 43 0 43 10 33 24

75 Oksitetrasiklin Salep Kulit Tube 48 0 48 48 0 72


76 Omeprazole inj 40 mg/ 10 ml Vial 20 0 20 0 20 0
77 Omeprazole 20 mg Kapsul 0 0 0 0 0 0
78 Parasetamol Syrup 120 mg / 5 ml Botol 0 0 0 0 0 0
79 Parasetamol Tablet 500 mg Tablet 0 0 0 0 0 0
80 Pehacain Inj Ampul 38 40 78 66 12 100
81 Pirantel tab 125 mg Tablet 168 0 168 38 130 0
82 Propanolol tab 40 mg Tablet 0 0 0 0 0 0
83 Propiltiourasil 100 mg Tablet 140 0 140 0 140 0
84 Ranitidin Tablet 1794 0 1794 878 916 3000
85 Ranitidin Inj Ampul 0 0 0 0 0 0
86 Ringer Lactat Infus Botol 0 0 0 0 0 0
87 Salbutamol 4 mg Tablet 0 0 0 0 0 0
88 Salep 2- 4 Tube 48 0 48 0 48 0
89 Salisil Bedak 2 % kotak 62 0 62 62 0 100
90 Sefadroksil Syr Botol 0 0 0 0 0 0
91 Setirizine tab Tablet 0 1000 1000 400 600 1000
92 Simvastatin 20 mg Tablet 200 0 200 43 157 400

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

93 Serum Anti Bisa Ular ( ABU I ) Vial 0 2 2 2 0 0


94 Serum Anti Tetanus 1.500 UI / ml Ampul 0 2 2 2 0 0
95 Tetrasiklin HCL 250 mg Kapsul 2398 0 2398 400 1998 0
96 Tiamin HCL ( Vit B1 ) 50 mg Tablet 2643 0 2643 1899 744 3000
97 Tramadol caps 50 mg Capsul 262 200 462 140 322 0
98 Vitamin B Complek Tablet 0 0 0 0 0 0
99 Yodium Povidon 30 ml Botol 0 0 0 0 0 0
100 Zink Syr Botol 25 0 25 14 11 50

101 Zink tab Tablet 0 0 0 0 0 0

OBAT GIGI

102 Curaspon Botol 1 0 1 0 1 0


103 Etil Klorida semprot Botol 2 3 5 2 3 5
104 Eugenol Cairan Botol 0 0 0 0 0 0
105 Glass ionomer cement ART Botol 1 0 1 0 1 0
106 Kalsium Hidroksida Pasta Set 1 0 1 0 1 0
ALAT KESEHATAN
107 Alat Suntik 5 cc Unit 10 0 10 2 8 10
108 Alat Suntik 10 cc Unit 25 0 25 2 23 0
109 Aquadest 1000 ml Botol 1 0 1 0 1 0

110 Blood Tranfusion Set Kantong 0 0 0 0 0 0


111 Catgut 2/0 Pcs 24 0 24 10 14 24
112 Catgut 3/0 Pcs 0 0 0 0 0 0
113 Hand Scun Set 0 0 0 0 0 0
114 Infusion set dewasa Kantong 0 0 0 0 0 0
115 I.V Cateter 18 G Buah 10 0 10 0 10 0
116 I.V Cateter 20 G Buah 0 0 0 0 0 0
117 I.V Cateter 22 G Buah 0 0 0 0 0 0
118 I.V Cateter 24 G Buah 0 0 0 0 0 0
119 Kasa Pembalut 4m x 15 cm Rol 0 0 0 0 0 0
120 Masker Pcs 72 50 122 73 49 100

121 Plester 5 yard x 2 inch Rol 6 4 10 2 8 5


122 Silk Pcs 0 0 0 0 0 0
123 Spiritus 500 ml Botol 1 0 1 0 1 0

Mengetahui
Kepala Puskesmas Pengelola Obat PKM

MUKHLIS SKM M.kes ERLINA AMK


NIP: 19720709 199303 1 003 Nip.19771504 200604 2 010
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) DAK
BULAN MARET 2016
PUSKESMAS :

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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 100 100 200

2 Acyclovir tab 400 mg 86 100 186 109

3 Acyclovir cream 5 % 54 0 54 1 3 3 3 4 4 3 4 3 5 4 4

4 Albendazole 400 mg 0 0 0

5 Allopurinol 100 mg 0 0 0

6 Ambroxol Syr 60 ml 101 0 101 4 2 2 1 3 2 2 3 3 5 3 5 3 4

7 Ambroxol tab 30 mg 647 200 847 34 35 81 94 10 15 30 40 20 20 119 146 35 34 20 20 94

8 Aminopillin tab 200 mg 65 0 65

9 Amitriptiline 25 300 0 300

10 Amlodipin 5 mg 0 0 0

11 Amlodipin 10 mg 0 0 0

12 Amoksisillina kapl 250mg 0 0 0

13 Amoksisillina kapl 500mg 1000 3000 4000 336 100 105 156 200 150 110 160 255 180

14 Amoksisillina sirker 250 mg / 5 ml 0 0 0

15 Antasida Doen Tab 3575 0 3575 133 120 145 124 346 96 120 130 144 102 110 164 338 262 146 110 219 218

16 Antasida sir 0 0 0

17 Asam Ascorbat ( Vit.C ) 50 mg 0 0 0

18 Asam Mefenamat 500 mg 0 0 0

19 Attapulgite 630 mg 838 0 838 20 13 20 34 100 100 20 15 100 15

20 Atropin Sulfat 0.5 mg 200 0 200

21 Besi II Sulfat 600 0 600 22 26

22 Betametason Krim 0 0 0

23 Captopril 12.5 mg 0 0 0

24 Captopril 25 mg 300 0 300

25 Captopril 50 mg 300 0 300


No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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 Deksametason Inj 0 0 0

27 Deksametason 0,5 mg 0 0 0

28 Diazepam Tab 2 mg 0 1000 1000

29 Digoksin 0,25 mg 500 0 500

30 Diltiazem HCL 30mg 200 0 200

31 Dipenhidramin Inj 0 0 0

32 Domperidom 935 0 935 19 19 12 100 20 20 38 16 10 12 20 20 40

33 Efedrina HCL 25 mg 281 250 531 15 10 6 10 16 12 22 22 10 20 20 20

34 Erytromicin Syr 0 0 0

35 Etakridine kom 10 0 10

36 Etanol 0 0 0

37 Fenobarbital tab 30 mg 1009 0 1009 30 20 20

38 Fitomenadion Inj 0 0 0

39 Fitomenadion Tablet 0 0 0

40 Furrosemida tab 38 300 338 7 10 10 6 10 6

41 Furrosemida inj 0 0 0

42 Garam Oralit 0 0 0

43 Gentamicin SK 0,1 % 43 0 43 2 2

44 Glibenklamida tab 5 mg 102 300 402 18 9 6 19 12 12 20 9 25

45 Glimepiride 2 mg 0 0 0

46 Glukosa Lar. Inf 5 % 0 0 0

47 Griseofulvin tab 125 mg 0 0 0

48 Halloperidol 0.5 mg 0 0 0

49 Halloperidol 1.5 mg 0 0 0

50 Halloperidol 1.5 mg 0 0 0

51 Hidrokortison Krim 0 0 0

52 Ibuprofen tab.200 mg 0 1000 1000

53 Kalium Permanganas 5 gr 32 0 32

54 Kals Laktat tab.500 mg 1812 1000 2812 50 28 60 40 84 222 28 222 80 18 50 115 34 62 18 52 110
No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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

55 Ketokonazol tablet 200 mg 628 0 628 36 27 20 18 25

56 Ketokonazol cream 12 0 12 2 3

57 Kloramfenikol salep mata 0 0 0

58 Klorpromazine inj 0 0 0

59 Kodein HCL 10 mg 0 0 0

60 Kotrimoksazol Susp 0 0 0

61 Kotrimoksazol 480mg Tab 0 0 0

62 Levofloxacin 500 mg 0 0 0

63 Loratadine 435 0 435 6 18 21 30 87 40 32 23 25 23 20 23 34 15

64 Metilergometrin Tab. 0 0 0

65 Metoclopramide 10 mg 0 0 0

66 Metronidazole 500 mg 0 0 0

67 Mikonazole Cream 0 0 0

68 Natrium Bikarbonat 532 2000 2532 70 30 50 50 55 30 45 30 50 36 40 45 60 45 65 50 32 81

69 Natrium Diklofenac 50 mg 795 500 1295 52 42 56 30 74 48 48 24 78 48 48 42 46 38 48 24 90

70 Natrium Klorida 0.9 % 0 0 0

71 Nifedipin 10 mg 0 0 0

72 Nistatin 500.000 IU/g 450 0 450

73 Obat Batuk hitam 59 0 59 3 11 7 1 2 1

74 Oksitetrasiklin Salep Mata 43 0 43 2 2 4

75 Oksitetrasiklin Salep Kulit 48 0 48 3 2 3 2 3 3 2 4 3 2 4 3 2

76 Omeprazole inj 40 mg/ 10 ml 20 0 20

77 Omeprazole 20 mg 0 0 0

78 Parasetamol Syrup 120 mg / 5 ml 0 0 0

79 Parasetamol Tablet 500 mg 0 0 0

80 Pehacain Inj 38 40 78 5 10 5 11 5 10 10

81 Pirantel tab 125 mg 168 0 168 4 8 4 4 10 8

82 Propiltiourasil 100 mg 0 0 0
83 Propanolol tab 40 mg 140 0 140

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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 Ranitidin 1794 0 1794 21 22 54 62 139 30 20 26 222 25 69 18 36 18 62

85 Ranitidin Inj 0 0 0

86 Ringer Lactat Infus 0 0 0

87 Salbutamol 4 mg 0 0 0

88 Salep 2- 4 48 0 48

89 Salisil Bedak 2 % 62 0 62 3 10 6 3 11 8 8 13

90 Sefadroksil Syr 0 0 0

91 Setirizine tab 0 1000 1000 18 29 6 12 30 28 46 20 30 12 30 65

92 Simvastatin 20 mg 200 0 200 20

93 Serum Anti Bisa Ular ( ABU I ) 0 2 2 2

94 Serum Anti Tetanus 1.500 UI / ml 0 2 2 2

95 Tetrasiklin HCL 250 mg 2398 0 2398 300 100

96 Tiamin HCL ( Vit B1 ) 50 mg 2643 0 2643 100 60 104 150 78 10 84 40 308 104 176 82 128 164 80 46 55

97 Tramadol caps 50 mg 262 200 462 20 120

98 Vitamin B Complek 0 0 0

99 Yodium Povidon 30 ml 0 0 0

100 Zink Syr 25 0 25 3 2 2 2 2 3

101 Zink tablet 0 0 0

OBAT GIGI

102 Curaspon 1 0 1

103 Etil Klorida semprot 2 3 5 1 1

104 Eugenol Cairan 0 0 0

105 Glass ionomer cement ART 1 0 1

106 Kalsium Hidroksida Pasta 1 0 1

ALAT KESEHATAN

107 Alat Suntik 5 cc 10 0 10 2

108 Alat Suntik 10 cc 25 0 25 2


109 Aquadest 1000 ml 1 0 1

110 Blood Tranfusion Set 0 0 0

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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

111 Catgut 2/0 24 0 24 10

112 Catgut 3/0 0 0 0

113 Hand Scun 0 0 0

114 Infusion set dewasa 0 0 0

115 I.V Cateter 18 G 10 0 10

116 I.V Cateter 20 G 0 0 0

117 I.V Cateter 22 G 0 0 0

118 I.V Cateter 24 G 0 0 0

119 Kasa Pembalut 4m x 15 cm 0 0 0

120 Masker 72 50 122 10 10 10 5 4 16 1 10

121 Plester 5 yard x 2 inch 6 4 10 2

122 Silk 0 0 0

123 Spiritus 500 ml 1 0 1

Mengetahui Pe
Kepala UPT.Puskesmas Peureulak

MUKHLIS SKM M.kes


NIP;19720709 199303 1 003 NIP;19
Pema Stok Ket

29 30 31 kaian Akhir

0 200

109 77

5 3 5 54 0

0 0

0 0

2 3 2 49 52

847 0

0 65

0 300

0 0

0 0

0 0

169 145 140 2206 1794

0 0

150 148 250 3575 0

0 0

0 0

0 0

437 401

0 200

48 552

0 0

0 0

0 300

0 300
Pema Stok Ket

29 30 31 kaian Akhir

0 0

0 0

0 1000

0 500

0 200

0 0

10 20 376 559

30 20 19 252 279

0 0

0 10

0 0

20 20 110 899

0 0

0 0

49 289

0 0

0 0

4 39

16 146 256

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 1000

0 32

49 72 38 1432 1380
Pema Stok Ket

29 30 31 kaian Akhir

10 136 492

5 7

0 0

0 0

0 0

0 0

0 0

0 0

12 26 435 0

0 0

0 0

0 0

0 0

80 75 32 1051 1481

56 42 40 974 321

0 0

0 0

20 20 40 410

2 27 32

2 10 33

3 4 5 48 0

0 20

0 0

0 0

0 0

10 66 12

38 130

0 0
0 140

Pema Stok Ket

29 30 31 kaian Akhir

24 30 878 916

0 0

0 0

0 0

0 48

62 0

0 0

24 30 20 400 600

23 43 157

2 0

2 0

400 1998

20 50 60 1899 744

140 322

0 0

0 0

14 11

0 0

0 0

0 1

2 3

0 0

0 1

0 1

0 0

2 8

2 23
0 1

0 0

Pema Stok Ket

29 30 31 kaian Akhir

10 14

0 0

0 0

0 0

0 10

0 0

0 0

0 0

0 0

7 73 49

2 8

0 0

0 1

0 0

0 0

Pengelola Obat PKM

ERLINA AMK
NIP;19771504 200604 2 010
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT DAK
( LPLPO ) DAK

BULAN
UPT PKM : PEUREULAK April
:
KECAMATAN : PEUREULAK TAHUN : 2016
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 200 0 200 138 62 300

2 Acyclovir tab 400 mg Tablet 77 200 277 77 200 0

3 Acyclovir cream 5 % Tube 0 100 100 49 51 100

4 Albendazole 400 mg Tablet 0 0 0 0 0

5 Allopurinol 100 mg Tablet 0 0 0 0 0

6 Ambroxol Syr 60 ml Botol 52 50 102 96 6 150

7 Ambroxol tab 30 mg Tablet 0 1000 1000 1000 0 2000

8 Aminopillin tab 200 mg Tablet 65 0 65 10 55 0

9 Amitriptiline 25 Tablet 300 0 300 0 300 0

10 Amlodipin 5 mg Tablet 0 0 0 0 0 0

11 Amlodipin 10 mg Tablet 0 0 0 0 0 0

12 Amoksisillina kapl 250mg Kapsul 0 1200 1200 0 1200 0

13 Amoksisillina kapl 500mg Tablet 1794 3000 4794 4624 170 5000

14 Amoksisillina sirker 250 mg / 5 ml Botol 0 100 100 86 14 100

15 Antasida Doen Tab Tablet 0 4000 4000 2206 1794 2000

16 Antasida sir Botol 0 150 150 88 62 200

17 Asam Ascorbat ( Vit.C ) 50 mg Tablet 0 0 0 0 0 0

18 Asam Mefenamat 500 mg Tablet 0 0 0 0 0 0

19 Attapulgite 630 mg Tablet 401 500 901 580 321 1000

20 Atropin Sulfat 0.5 mg Tablet 200 0 200 0 200 0

21 Besi II Sulfat Tablet 552 0 552 149 403 0

22 Betametason Krim Tube 0 0 0 0 0 0

23 Captopril 12.5 mg Tablet 0 0 0 0 0 0

24 Captopril 25 mg Tablet 300 0 300 0 300 0

25 Captopril 50 mg Tablet 300 0 300 0 300 0

26 Deksametason Inj Ampul 0 0 0 0 0 0

27 Deksametason 0,5 mg Tablet 0 0 0 0 0 0

28 Diazepam Tab 2 mg Tablet 1000 0 1000 121 879 500

29 Digoksin 0,25 mg Tablet 500 0 500 0 500 0

30 Diltiazem HCL 30mg Tablet 200 0 200 0 200 0

31 Dipenhidramin Inj Ampul 0 0 0 0 0 0

32 Domperidom Tablet 559 300 859 506 353 500

33 Efedrina HCL 25 mg Tablet 279 250 529 63 466 0


34 Erytromicin Syr Botol 0 0 0 0 0 0

35 Etakridine kom Botol 10 0 10 0 10 0

36 Etanol Botol 0 0 0 0 0 0

37 Fenobarbital tab 30 mg Tablet 899 0 899 50 849 0

38 Fitomenadion Inj Ampul 0 0 0 0 0 0

39 Fitomenadion Tablet Tablet 0 0 0 0 0 0

40 Furrosemida tab Tablet 289 0 289 39 250 300

41 Furrosemida inj Ampul 0 0 0 0 0 0

42 Garam Oralit Tablet 0 0 0 0 0 0

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

43 Gentamicin SK 0,1 % Tube 39 0 39 19 20 30

44 Glibenklamida tab 5 mg Tablet 256 300 556 99 457 500

45 Glimepiride 2 mg Tablet 0 0 0 0 0 0

46 Glukosa Lar. Inf 5 % Botol 0 0 0 0 0 0

47 Griseofulvin tab 125 mg Tablet 0 0 0 0 0 0

48 Halloperidol 0.5 mg Tablet 0 0 0 0 0 0

49 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

50 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

51 Hidrokortison Krim Tube 0 0 0 0 0 0

52 Ibuprofen tab.200 mg Tablet 1000 0 1000 470 530 2000

53 Kalium Permanganas 5 gr Botol 32 0 32 0 32 0

54 Kals Laktat tab.500 mg Tablet 1380 1000 2380 1735 645 2000

55 Ketokonazol tablet 200 mg Tablet 492 0 492 64 428 500

56 Ketokonazol cream Tube 7 24 31 19 12 24

57 Kloramfenikol salep mata Tube 0 0 0 0 0 0

58 Klorpromazine inj Ampul 0 0 0 0 0 0

59 Kodein HCL 10 mg Tablet 0 0 0 0 0 0

60 Kotrimoksazol Susp Botol 0 0 0 0 0 0

61 Kotrimoksazol 480mg Tab Tablet 0 0 0 0 0 0

62 Levofloxacin 500 mg Tablet 0 0 0 0 0 0

63 Loratadine Tablet 0 800 800 226 574 800

64 Metilergometrin Tab. Tablet 0 0 0 0 0 0

65 Metoclopramide 10 mg Tablet 0 0 0 0 0 0

66 Metronidazole 500 mg Tablet 0 0 0 0 0 0

67 Mikonazole Cream Tube 0 0 0 0 0 0

68 Natrium Bikarbonat Tablet 1481 1000 2481 1521 960 2000

69 Natrium Diklofenac 50 mg Tablet 321 1000 1321 1221 100 2000

70 Natrium Klorida 0.9 % Botol 0 0 0 0 0 0

71 Nifedipin 10 mg Tablet 0 0 0 0 0 0

72 Nistatin 500.000 IU/g Tablet 410 0 410 61 349 0


73 Obat Batuk hitam Botol 32 24 56 35 21 100

74 Oksitetrasiklin Salep Mata Tube 33 0 33 3 30 50

75 Oksitetrasiklin Salep Kulit Tube 0 50 50 12 38 50


76 Omeprazole inj 40 mg/ 10 ml Vial 20 0 20 0 20 0
77 Omeprazole 20 mg Kapsul 0 0 0 0 0 0
78 Parasetamol Syrup 120 mg / 5 ml Botol 0 0 0 0 0 0
79 Parasetamol Tablet 500 mg Tablet 0 0 0 0 0 0
80 Pehacain Inj Ampul 12 60 72 8 64 50
81 Pirantel tab 125 mg Tablet 130 0 130 0 130 0
82 Propanolol tab 40 mg Tablet 0 0 0 0 0 0
83 Propiltiourasil 100 mg Tablet 140 0 140 0 140 0
84 Ranitidin Tablet 916 500 1416 1079 337 1000
85 Ranitidin Inj Ampul 0 0 0 0 0 0
86 Ringer Lactat Infus Botol 0 0 0 0 0 0
87 Salbutamol 4 mg Tablet 0 0 0 0 0 0
88 Salep 2- 4 Tube 48 0 48 1 47 0
89 Salisil Bedak 2 % kotak 0 50 50 50 0 200
90 Sefadroksil Syr Botol 0 0 0 0 0 0
91 Setirizine tab Tablet 600 200 800 443 357 800
92 Simvastatin 20 mg Tablet 157 0 157 10 147 1000

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

93 Serum Anti Bisa Ular ( ABU I ) Vial 0 0 0 0 0 0


94 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0 0
95 Tetrasiklin HCL 250 mg Kapsul 1998 0 1998 300 1698 0
96 Tiamin HCL ( Vit B1 ) 50 mg Tablet 744 2000 2744 2171 573 5000

97 Tramadol caps 50 mg Capsul 322 0 322 32 290 500


98 Vitamin B Complek Tablet 0 0 0 0 0 0
99 Yodium Povidon 30 ml Botol 0 0 0 0 0 0
100 Zink Syr Botol 11 0 11 11 0 50

101 Zink tab Tablet 0 0 0 0 0 0

OBAT GIGI 0

102 Curaspon Botol 1 0 1 0 1 0


103 Etil Klorida semprot Botol 3 2 5 2 3 5
104 Eugenol Cairan Botol 0 0 0 0 0 0
105 Glass ionomer cement ART Botol 1 0 1 0 1 0
106 Kalsium Hidroksida Pasta Set 1 0 1 0 1 0
ALAT KESEHATAN 0

107 Alat Suntik 5 cc Unit 8 10 18 0 18 0


108 Alat Suntik 10 cc Unit 23 0 23 0 23 0
109 Aquadest 1000 ml Botol 1 0 1 0 1 0
110 Blood Tranfusion Set Kantong 0 0 0 0 0 0
111 Catgut 2/0 Pcs 14 24 38 5 33 50

112 Catgut 3/0 Pcs 0 0 0 0 0 0


113 Hand Scun Set 0 0 0 0 0 0
114 Infusion set dewasa Kantong 0 0 0 0 0 0
115 I.V Cateter 18 G Buah 10 0 10 0 10 50
116 I.V Cateter 20 G Buah 0 0 0 0 0 0
117 I.V Cateter 22 G Buah 0 0 0 0 0 0
118 I.V Cateter 24 G Buah 0 0 0 0 0 0
119 Kasa Pembalut 4m x 15 cm Rol 0 0 0 0 0 0
120 Masker Pcs 49 100 149 65 84 100

121 Plester 5 yard x 2 inch Rol 8 5 13 7 6 20


122 Silk Pcs 0 0 0 0 0 0
123 Spiritus 500 ml Botol 1 0 1 0 1 0

Mengetahui
Kepala Puskesmas Pengelola Obat PKM

MUKHLIS SKM M.kes ERLINA AMK


NIP: 19720709 199303 1 003 Nip.19771504 200604 2 010
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) DAK
BULAN APRIL 2016
PUSKESMAS : PEUREULAK

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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 200 0 200 21 7 10 2 38 12 36 12

2 Acyclovir tab 400 mg 77 200 277 26 20 31

3 Acyclovir cream 5 % 0 100 100 2 4 3 8 2 3 6 5 4 3 4 2 2

4 Albendazole 400 mg 0 0 0

5 Allopurinol 100 mg 0 0 0

6 Ambroxol Syr 60 ml 52 50 102 3 3 3 5 6 12 6 7 8 24 4 1 1 4 4 2 1 2

7 Ambroxol tab 30 mg 0 1000 1000 40 80 60 94 133 70 170 120 85 26 40 27 55

8 Aminopillin tab 200 mg 65 0 65 10

9 Amitriptiline 25 300 0 300

10 Amlodipin 5 mg 0 0 0

11 Amlodipin 10 mg 0 0 0

12 Amoksisillina kapl 250mg 0 1200 1200

13 Amoksisillina kapl 500mg 1794 3000 4794 330 150 80 40 70 224 210 180 446 605 380 347 224 240 210 430 208 250

14 Amoksisillina sirker 250 mg / 5 ml 0 100 100 13 5 16 12 8 13 9

15 Antasida Doen Tab 0 4000 4000 120 104 239 385 219 212 293 64 143 120 110 60 69

16 Antasida sir 0 150 150 20 3 15 5 6 8 5 12 6

17 Asam Ascorbat ( Vit.C ) 50 mg 0 0 0

18 Asam Mefenamat 500 mg 0 0 0

19 Attapulgite 630 mg 401 500 901 120 10 100 200 20 100 10 20

20 Atropin Sulfat 0.5 mg 200 0 200

21 Besi II Sulfat 552 0 552 20 25 10 3 9 26 40 16

22 Betametason Krim 0 0 0

23 Captopril 12.5 mg 0 0 0

24 Captopril 25 mg 300 0 300

25 Captopril 50 mg 300 0 300


No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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 Deksametason Inj 0 0 0

27 Deksametason 0,5 mg 0 0 0

28 Diazepam Tab 2 mg 1000 0 1000 12 23 6 20 10 10 20

29 Digoksin 0,25 mg 500 0 500

30 Diltiazem HCL 30mg 200 0 200

31 Dipenhidramin Inj 0 0 0

32 Domperidom 559 300 859 30 20 15 70 18 10 10 36 165 6 12 6 48 60

33 Efedrina HCL 25 mg 279 250 529 8 6 4 8 4 6 3 8 6 3 4

34 Erytromicin Syr 0 0 0

35 Etakridine kom 10 0 10

36 Etanol 0 0 0

37 Fenobarbital tab 30 mg 899 0 899 20 30

38 Fitomenadion Inj 0 0 0

39 Fitomenadion Tablet 0 0 0

40 Furrosemida tab 289 0 289 6 3 9 3 6 3 3 6

41 Furrosemida inj 0 0 0

42 Garam Oralit 0 0 0

43 Gentamicin SK 0,1 % 39 0 39 3 3 2 2 1 4 4

44 Glibenklamida tab 5 mg 256 300 556 18 12 12 6 28 6 10 7

45 Glimepiride 2 mg 0 0 0

46 Glukosa Lar. Inf 5 % 0 0 0

47 Griseofulvin tab 125 mg 0 0 0

48 Halloperidol 0.5 mg 0 0 0

49 Halloperidol 1.5 mg 0 0 0

50 Halloperidol 1.5 mg 0 0 0

51 Hidrokortison Krim 0 0 0

52 Ibuprofen tab.200 mg 1000 0 1000 88 116 18 160 20 10 28 10

53 Kalium Permanganas 5 gr 32 0 32

54 Kals Laktat tab.500 mg 1380 1000 2380 65 64 84 86 50 58 232 36 171 122 192 65 240 50 72 48 20 38 10
No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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

55 Ketokonazol tablet 200 mg 492 0 492 15 15 34

56 Ketokonazol cream 7 24 31 5 1 4 2 1 3 1

57 Kloramfenikol salep mata 0 0 0

58 Klorpromazine inj 0 0 0

59 Kodein HCL 10 mg 0 0 0

60 Kotrimoksazol Susp 0 0 0

61 Kotrimoksazol 480mg Tab 0 0 0

62 Levofloxacin 500 mg 0 0 0

63 Loratadine 0 800 800 37 10 3 3 36 3 12 8 26 8 28 6 28

64 Metilergometrin Tab. 0 0 0

65 Metoclopramide 10 mg 0 0 0

66 Metronidazole 500 mg 0 0 0

67 Mikonazole Cream 0 0 0

68 Natrium Bikarbonat 1481 1000 2481 156 74 100 43 50 50 44 6 246 310 174 10 100 30 22 22 32 10

69 Natrium Diklofenac 50 mg 321 1000 1321 76 72 72 54 47 172 32 64 30 160 98 66 64 40 50 24 64 12

70 Natrium Klorida 0.9 % 0 0 0

71 Nifedipin 10 mg 0 0 0

72 Nistatin 500.000 IU/g 410 0 410 20 4 3 6 3 4 15 6

73 Obat Batuk hitam 32 24 56 3 2 3 5 7 5 3 3 2

74 Oksitetrasiklin Salep Mata 33 0 33 3

75 Oksitetrasiklin Salep Kulit 0 50 50 2 3 2 3 2

76 Omeprazole inj 40 mg/ 10 ml 20 0 20

77 Omeprazole 20 mg 0 0 0

78 Parasetamol Syrup 120 mg / 5 ml 0 0 0

79 Parasetamol Tablet 500 mg 0 0 0

80 Pehacain Inj 12 60 72 5 3

81 Pirantel tab 125 mg 130 0 130

82 Propiltiourasil 100 mg 0 0 0
83 Propanolol tab 40 mg 140 0 140

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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 Ranitidin 916 500 1416 58 18 67 70 24 216 59 49 73 76 59 64 45 57 24 52

85 Ranitidin Inj 0 0 0

86 Ringer Lactat Infus 0 0 0

87 Salbutamol 4 mg 0 0 0

88 Salep 2- 4 48 0 48 1

89 Salisil Bedak 2 % 0 50 50 8 20 6 2 11 1 2

90 Sefadroksil Syr 0 0 0

91 Setirizine tab 600 200 800 30 67 52 33 48 41 42 22 44 46 6

92 Simvastatin 20 mg 157 0 157 10

93 Serum Anti Bisa Ular ( ABU I ) 0 0 0

94 Serum Anti Tetanus 1.500 UI / ml 0 0 0

95 Tetrasiklin HCL 250 mg 1998 0 1998 200 100

96 Tiamin HCL ( Vit B1 ) 50 mg 744 2000 2744 46 40 110 60 98 86 82 68 111 42 142 168 222 222 48 50 200 120 46

97 Tramadol caps 50 mg 322 0 322 10 22

98 Vitamin B Complek 0 0 0

99 Yodium Povidon 30 ml 0 0 0

100 Zink Syr 11 0 11 5 5 1

101 Zink tablet 0 0 0

OBAT GIGI

102 Curaspon 1 0 1

103 Etil Klorida semprot 3 2 5 1 1

104 Eugenol Cairan 0 0 0

105 Glass ionomer cement ART 1 0 1

106 Kalsium Hidroksida Pasta 1 0 1

ALAT KESEHATAN

107 Alat Suntik 5 cc 8 10 18

108 Alat Suntik 10 cc 23 0 23


109 Aquadest 1000 ml 1 0 1

110 Blood Tranfusion Set 0 0 0

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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

111 Catgut 2/0 14 24 38 5

112 Catgut 3/0 0 0 0

113 Hand Scun 0 0 0

114 Infusion set dewasa 0 0 0

115 I.V Cateter 18 G 10 0 10

116 I.V Cateter 20 G 0 0 0

117 I.V Cateter 22 G 0 0 0

118 I.V Cateter 24 G 0 0 0

119 Kasa Pembalut 4m x 15 cm 0 0 0

120 Masker 49 100 149 10 25 10 10 10

121 Plester 5 yard x 2 inch 8 5 13 2 1 1 1 1 1

122 Silk 0 0 0

123 Spiritus 500 ml 1 0 1

Mengetahui Peng
Kepala UPT.Puskesmas Peureulak

E
MUKHLIS SKM M.kes Nip.1977
NIP: 19720709 199303 1 003
Pema Stok Ket

29 30 31 kaian Akhir

138 62

77 200

1 49 51

0 0

0 0

96 6

1000 0

10 55

0 300

0 0

0 0

0 1200

4624 170

10 86 14

68 2206 1794

8 88 62

0 0

0 0

580 321

0 200

149 403

0 0

0 0

0 300

0 300
Pema Stok Ket

29 30 31 kaian Akhir

0 0

0 0

20 121 879

0 500

0 200

0 0

506 353

3 63 466

0 0

0 10

0 0

50 849

0 0

0 0

39 250

0 0

0 0

19 20

99 457

0 0

0 0

0 0

0 0

0 0

0 0

0 0

20 470 530

0 32

32 1735 645
Pema Stok Ket

29 30 31 kaian Akhir

64 428

2 19 12

0 0

0 0

0 0

0 0

0 0

0 0

18 226 574

0 0

0 0

0 0

0 0

42 1521 960

24 1221 100

0 0

0 0

61 349

2 35 21

3 30

12 38

0 20

0 0

0 0

0 0

8 64

0 130

0 0
0 140

Pema Stok Ket

29 30 31 kaian Akhir

68 1079 337

0 0

0 0

0 0

1 47

50 0

0 0

12 443 357

10 147

0 0

0 0

300 1698

210 2171 573

32 290

0 0

0 0

11 0

0 0

0 0

0 1

2 3

0 0

0 1

0 1

0 0

0 18

0 23
0 1

0 0

Pema Stok Ket

29 30 31 kaian Akhir

5 33

0 0

0 0

0 0

0 10

0 0

0 0

0 0

0 0

65 84

7 6

0 0

0 1

0 0

0 0

0 0

Pengelola Obat PKM

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

BULAN
UPT PKM : PEUREULAK Mai
:
KECAMATAN : PEUREULAK TAHUN : 2016
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 62 300 362 99 263 200

2 Acyclovir tab 400 mg Tablet 200 0 200 16 184 0

3 Acyclovir cream 5 % Tube 51 50 101 15 86 50

4 Albendazole 400 mg Tablet 0 0 0 0 0 0

5 Allopurinol 100 mg Tablet 0 0 0 0 0 0

6 Ambroxol Syr 60 ml Botol 6 150 156 54 102 200

7 Ambroxol tab 30 mg Tablet 0 2000 2000 1484 516 2000

8 Aminopillin tab 200 mg Tablet 55 0 55 0 55 0

9 Amitriptiline 25 Tablet 300 0 300 0 300 0

10 Amlodipin 5 mg Tablet 0 0 0 0 0 0

11 Amlodipin 10 mg Tablet 0 0 0 0 0 0

12 Amoksisillina kapl 250mg Kapsul 1200 1200 2400 0 2400 0

13 Amoksisillina kapl 500mg Tablet 170 4500 4670 3098 1572 5000

14 Amoksisillina sirker 250 mg / 5 ml Botol 14 100 114 114 0 200

15 Antasida Doen Tab Tablet 1794 0 1794 1794 0 5000

16 Antasida sir Botol 62 200 262 235 27 200

17 Asam Ascorbat ( Vit.C ) 50 mg Tablet 0 0 0 0 0 0

18 Asam Mefenamat 500 mg Tablet 0 0 0 0 0 0

19 Attapulgite 630 mg Tablet 321 1000 1321 370 951 500

20 Atropin Sulfat 0.5 mg Tablet 200 0 200 0 200 0

21 Besi II Sulfat Tablet 403 0 403 40 363 0

22 Betametason Krim Tube 0 0 0 0 0 0

23 Captopril 12.5 mg Tablet 0 0 0 0 0 0

24 Captopril 25 mg Tablet 300 0 300 0 300 0

25 Captopril 50 mg Tablet 300 0 300 0 300 0

26 Deksametason Inj Ampul 0 0 0 0 0 0

27 Deksametason 0,5 mg Tablet 0 0 0 0 0 0

28 Diazepam Tab 2 mg Tablet 879 500 1379 365 1014 0

29 Digoksin 0,25 mg Tablet 500 0 500 0 500 0

30 Diltiazem HCL 30mg Tablet 200 0 200 0 200 0

31 Dipenhidramin Inj Ampul 0 0 0 0 0 0

32 Domperidom Tablet 353 0 353 200 153 1000

33 Efedrina HCL 25 mg Tablet 466 0 466 70 396 0


34 Erytromicin Syr Botol 0 0 0 0 0 0

35 Etakridine kom Botol 10 0 10 0 10 0

36 Etanol Botol 0 0 0 0 0 0

37 Fenobarbital tab 30 mg Tablet 849 0 849 0 849 0

38 Fitomenadion Inj Ampul 0 0 0 0 0 0

39 Fitomenadion Tablet Tablet 0 0 0 0 0 0

40 Furrosemida tab Tablet 250 0 250 123 127 0

41 Furrosemida inj Ampul 0 0 0 0 0 0

42 Garam Oralit Tablet 0 0 0 0 0 0

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 30 6 7 8 9 10

43 Gentamicin SK 0,1 % Tube 20 0 20 0 20 0

44 Glibenklamida tab 5 mg Tablet 457 0 457 135 322 500

45 Glimepiride 2 mg Tablet 0 0 0 0 0 0

46 Glukosa Lar. Inf 5 % Botol 0 0 0 0 0 0

47 Griseofulvin tab 125 mg Tablet 0 0 0 0 0 0

48 Halloperidol 0.5 mg Tablet 0 0 0 0 0 0

49 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

50 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

51 Hidrokortison Krim Tube 0 0 0 0 0 0

52 Ibuprofen tab.200 mg Tablet 530 1000 1530 600 930 1000

53 Kalium Permanganas 5 gr Botol 32 0 32 0 32 0

54 Kals Laktat tab.500 mg Tablet 645 2000 2645 892 1753 2000

55 Ketokonazol tablet 200 mg Tablet 428 24 452 46 406 500

56 Ketokonazol cream Tube 12 0 12 0 12 50

57 Kloramfenikol salep mata Tube 0 0 0 0 0 0

58 Klorpromazine inj Ampul 0 0 0 0 0 0

59 Kodein HCL 10 mg Tablet 0 0 0 0 0 0

60 Kotrimoksazol Susp Botol 0 0 0 0 0 0

61 Kotrimoksazol 480mg Tab Tablet 0 0 0 0 0 0

62 Levofloxacin 500 mg Tablet 0 0 0 0 0 0

63 Loratadine Tablet 574 0 574 85 489 500

64 Metilergometrin Tab. Tablet 0 0 0 0 0 0

65 Metoclopramide 10 mg Tablet 0 0 0 0 0 0

66 Metronidazole 500 mg Tablet 0 0 0 0 0 0

67 Mikonazole Cream Tube 0 0 0 0 0 0

68 Natrium Bikarbonat Tablet 960 2000 2960 761 2199 1000

69 Natrium Diklofenac 50 mg Tablet 100 1500 1600 1228 372 2000

70 Natrium Klorida 0.9 % Botol 0 0 0 0 0 0

71 Nifedipin 10 mg Tablet 0 0 0 0 0 0

72 Nistatin 500.000 IU/g Tablet 349 0 349 0 349 0

73 Obat Batuk hitam Botol 21 60 81 18 63 50


74 Oksitetrasiklin Salep Mata Tube 30 25 55 3 52 0

75 Oksitetrasiklin Salep Kulit Tube 38 25 63 34 29 100

76 Omeprazole inj 40 mg/ 10 ml Vial 20 0 20 0 20 0

77 Omeprazole 20 mg Kapsul 0 0 0 0 0 0

78 Parasetamol Syrup 120 mg / 5 ml Botol 0 0 0 0 0 0

79 Parasetamol Tablet 500 mg Tablet 0 0 0 0 0 0

80 Pehacain Inj Ampul 64 0 64 59 5 100

81 Pirantel tab 125 mg Tablet 130 0 130 18 112 0

82 Propanolol tab 40 mg Tablet 0 0 0 0 0 0

83 Propiltiourasil 100 mg Tablet 140 0 140 0 140 0

84 Ranitidin Tablet 337 0 337 337 0 2000

85 Ranitidin Inj Ampul 0 0 0 0 0 0

86 Ringer Lactat Infus Botol 0 0 0 0 0 0

87 Salbutamol 4 mg Tablet 0 0 0 0 0 0

88 Salep 2- 4 Tube 47 0 47 0 47 0

89 Salisil Bedak 2 % kotak 0 0 0 0 0 100

90 Sefadroksil Syr Botol 0 0 0 0 0 0

91 Setirizine tab Tablet 357 400 757 486 271 1000

92 Simvastatin 20 mg Tablet 147 0 147 147 0 500

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

93 Serum Anti Bisa Ular ( ABU I ) Vial 0 0 0 0 0 0

94 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0 0

95 Tetrasiklin HCL 250 mg Kapsul 1698 0 1698 0 1698 0

96 Tiamin HCL ( Vit B1 ) 50 mg Tablet 573 4000 4573 1616 2957 5000

97 Tramadol caps 50 mg Capsul 290 200 490 100 390 0

98 Vitamin B Complek Tablet 0 0 0 0 0 0

99 Yodium Povidon 30 ml Botol 0 0 0 0 0 0


100 Zink Syr Botol 0 0 0 0 0 0

101 Zink tab Tablet 0 0 0 0 0 0

OBAT GIGI

102 Curaspon Botol 1 0 1 0 1 0

103 Etil Klorida semprot Botol 3 0 3 2 1 5

104 Eugenol Cairan Botol 0 0 0 0 0 0

105 Glass ionomer cement ART Botol 1 0 1 0 1 0

106 Kalsium Hidroksida Pasta Set 1 0 1 0 1 0

ALAT KESEHATAN

107 Alat Suntik 5 cc Unit 18 0 18 0 18 0

108 Alat Suntik 10 cc Unit 23 0 23 0 23 0

109 Aquadest 1000 ml Botol 1 0 1 0 1 0

110 Blood Tranfusion Set Kantong 0 0 0 0 0 0


111 Catgut 2/0 Pcs 33 0 33 12 21 0

112 Catgut 3/0 Pcs 0 0 0 0 0 0

113 Hand Scun Set 0 0 0 0 0 0

114 Infusion set dewasa Kantong 0 0 0 0 0 0

115 I.V Cateter 18 G Buah 10 0 10 0 10 0

116 I.V Cateter 20 G Buah 0 0 0 0 0 0

117 I.V Cateter 22 G Buah 0 0 0 0 0 0

118 I.V Cateter 24 G Buah 0 0 0 0 0 0

119 Kasa Pembalut 4m x 15 cm Rol 0 0 0 0 0 0

120 Masker Pcs 84 50 134 102 32 0

121 Plester 5 yard x 2 inch Rol 6 5 11 5 6 0

122 Silk Pcs 0 0 0 0 0 0

123 Spiritus 500 ml Botol 1 0 1 0 1 0

Mengetahui
Kepala Puskesmas Pengelola Obat PKM

MUKHLIS SKM M.kes ERLINA AMK


NIP: 19720709 199303 1 003 Nip.19771504 200604 2 010
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) DAK
BULAN MAI 2016
PUSKESMAS : PEUREULAK

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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 62 300 362 6 9 9 3 14 8 3 4 8 12 6 9

2 Acyclovir tab 400 mg 200 0 200 10 6

3 Acyclovir cream 5 % 51 50 101 4 8 2 1

4 Albendazole 400 mg 0 0 0

5 Allopurinol 100 mg 0 0 0

6 Ambroxol Syr 60 ml 6 150 156 4 2 7 6 4 1 3 3 2 1 5 4 2 2 3

7 Ambroxol tab 30 mg 0 2000 2000 103 81 105 145 71 15 55 40 86 240 108 68 126

8 Aminopillin tab 200 mg 55 0 55

9 Amitriptiline 25 300 0 300

10 Amlodipin 5 mg 0 0 0

11 Amlodipin 10 mg 0 0 0

12 Amoksisillina kapl 250mg 1200 1200 2400

13 Amoksisillina kapl 500mg 170 4500 4670 85 90 213 128 180 1320 86 90 80 120 180 98 104 104 220

14 Amoksisillina sirker 250 mg / 5 ml 14 100 114 2 6 6 13 12 75

15 Antasida Doen Tab 1794 0 1794 178 138 187 100 221 68 161 181 232 90 154 84

16 Antasida sir 62 200 262 5 11 6 5 5 8 11 6 55 23 15 5 11 12 9 14 13 10

17 Asam Ascorbat ( Vit.C ) 50 mg 0 0 0

18 Asam Mefenamat 500 mg 0 0 0

19 Attapulgite 630 mg 321 1000 1321 10 46 6 36 12 10 210 16 5 5 8 6

20 Atropin Sulfat 0.5 mg 200 0 200

21 Besi II Sulfat 403 0 403 20 10 10

22 Betametason Krim 0 0 0

23 Captopril 12.5 mg 0 0 0

24 Captopril 25 mg 300 0 300

25 Captopril 50 mg 300 0 300


No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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 Deksametason Inj 0 0 0

27 Deksametason 0,5 mg 0 0 0

28 Diazepam Tab 2 mg 879 500 1379 12 24 24 26 12 36 8 18 16 21 4 3 17 36 46 8 12 18

29 Digoksin 0,25 mg 500 0 500

30 Diltiazem HCL 30mg 200 0 200

31 Dipenhidramin Inj 0 0 0

32 Domperidom 353 0 353 40 10 10 10 20 30 10 10 12 12 8 20

33 Efedrina HCL 25 mg 466 0 466 8 8 24 9 6 7 8

34 Erytromicin Syr 0 0 0

35 Etakridine kom 10 0 10

36 Etanol 0 0 0

37 Fenobarbital tab 30 mg 849 0 849

38 Fitomenadion Inj 0 0 0

39 Fitomenadion Tablet 0 0 0

40 Furrosemida tab 250 0 250 6 3 8 100 6

41 Furrosemida inj 0 0 0

42 Garam Oralit 0 0 0

43 Gentamicin SK 0,1 % 20 0 20

44 Glibenklamida tab 5 mg 457 0 457 10 3 103 6 3 10

45 Glimepiride 2 mg 0 0 0

46 Glukosa Lar. Inf 5 % 0 0 0

47 Griseofulvin tab 125 mg 0 0 0

48 Halloperidol 0.5 mg 0 0 0

49 Halloperidol 1.5 mg 0 0 0

50 Halloperidol 1.5 mg 0 0 0

51 Hidrokortison Krim 0 0 0

52 Ibuprofen tab.200 mg 530 1000 1530 10 30 120 20 300 10 46 28 26

53 Kalium Permanganas 5 gr 32 0 32
54 Kals Laktat tab.500 mg 645 2000 2645 32 32 62 88 18 46 20 32 200 12 58 22 34 10 40 62 34 68

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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

55 Ketokonazol tablet 200 mg 428 24 452 15 6 3 13 9

56 Ketokonazol cream 12 0 12

57 Kloramfenikol salep mata 0 0 0

58 Klorpromazine inj 0 0 0

59 Kodein HCL 10 mg 0 0 0

60 Kotrimoksazol Susp 0 0 0

61 Kotrimoksazol 480mg Tab 0 0 0

62 Levofloxacin 500 mg 0 0 0

63 Loratadine 574 0 574 22 19 3 4 14 4 7 12

64 Metilergometrin Tab. 0 0 0

65 Metoclopramide 10 mg 0 0 0

66 Metronidazole 500 mg 0 0 0

67 Mikonazole Cream 0 0 0

68 Natrium Bikarbonat 960 2000 2960 40 40 25 38 10 20 22 420 30 52 10 4 10 10 20

69 Natrium Diklofenac 50 mg 100 1500 1600 30 30 20 20 120 100 94 106 62 86 24 86 76 86 40 120 46

70 Natrium Klorida 0.9 % 0 0 0

71 Nifedipin 10 mg 0 0 0

72 Nistatin 500.000 IU/g 349 0 349

73 Obat Batuk hitam 21 60 81 1 17

74 Oksitetrasiklin Salep Mata 30 25 55 3

75 Oksitetrasiklin Salep Kulit 38 25 63 4 3 5 2 4 2 2 5 2 2 1

76 Omeprazole inj 40 mg/ 10 ml 20 0 20

77 Omeprazole 20 mg 0 0 0

78 Parasetamol Syrup 120 mg / 5 ml 0 0 0

79 Parasetamol Tablet 500 mg 0 0 0

80 Pehacain Inj 64 0 64 10 10 10 10 5 4 10

81 Pirantel tab 125 mg 130 0 130 16 2


82 Propiltiourasil 100 mg 0 0 0
83 Propanolol tab 40 mg 140 0 140

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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 Ranitidin 337 0 337 6 78 21 88 38 20 32 48 6

85 Ranitidin Inj 0 0 0

86 Ringer Lactat Infus 0 0 0

87 Salbutamol 4 mg 0 0 0

88 Salep 2- 4 47 0 47

89 Salisil Bedak 2 % 0 0 0

90 Sefadroksil Syr 0 0 0

91 Setirizine tab 357 400 757 47 10 12 46 81 28 20 16 48 84 42 12 20

92 Simvastatin 20 mg 147 0 147 20 62 10 40 15

93 Serum Anti Bisa Ular ( ABU I ) 0 0 0

94 Serum Anti Tetanus 1.500 UI / ml 0 0 0

95 Tetrasiklin HCL 250 mg 1698 0 1698

96 Tiamin HCL ( Vit B1 ) 50 mg 573 4000 4573 110 95 40 30 86 60 86 182 62 64 42 40 88 68 128 231 78

97 Tramadol caps 50 mg 290 200 490 100

98 Vitamin B Complek 0 0 0

99 Yodium Povidon 30 ml 0 0 0

100 Zink Syr 0 0 0

101 Zink tablet 0 0 0

OBAT GIGI

102 Curaspon 1 0 1

103 Etil Klorida semprot 3 0 3 1 1

104 Eugenol Cairan 0 0 0

105 Glass ionomer cement ART 1 0 1

106 Kalsium Hidroksida Pasta 1 0 1

ALAT KESEHATAN

107 Alat Suntik 5 cc 18 0 18


108 Alat Suntik 10 cc 23 0 23

109 Aquadest 1000 ml 1 0 1

110 Blood Tranfusion Set 0 0 0

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian

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

111 Catgut 2/0 33 0 33 12

112 Catgut 3/0 0 0 0

113 Hand Scun 0 0 0

114 Infusion set dewasa 0 0 0

115 I.V Cateter 18 G 10 0 10

116 I.V Cateter 20 G 0 0 0

117 I.V Cateter 22 G 0 0 0

118 I.V Cateter 24 G 0 0 0

119 Kasa Pembalut 4m x 15 cm 0 0 0

120 Masker 84 50 134 7 10 10 50 25

121 Plester 5 yard x 2 inch 6 5 11 3 2

122 Silk 0 0 0

123 Spiritus 500 ml 1 0 1

Mengetahui Peng
Kepala UPT.Puskesmas Peureulak

ER
MUKHLIS SKM M.kes Nip.1977
Pema Stok Ket

29 30 31 kaian Akhir

8 99 263

16 184

15 86

0 0

0 0

5 54 102

241 1484 516

0 55

0 300

0 0

0 0

0 2400

3098 1572

114 0

1794 0

11 235 27

0 0

0 0

370 951

0 200

40 363

0 0

0 0

0 300

0 300
Pema Stok Ket

29 30 31 kaian Akhir

0 0

0 0

24 365 1014

0 500

0 200

0 0

8 200 153

70 396

0 0

0 10

0 0

0 849

0 0

0 0

123 127

0 0

0 0

0 20

135 322

0 0

0 0

0 0

0 0

0 0

0 0

0 0

10 600 930

0 32
22 892 1753

Pema Stok Ket

29 30 31 kaian Akhir

46 406

0 12

0 0

0 0

0 0

0 0

0 0

0 0

85 489

0 0

0 0

0 0

0 0

10 761 2199

82 1228 372

0 0

0 0

0 349

18 63

3 52

2 34 29

0 20

0 0

0 0

0 0

59 5

18 112
0 0
0 140

Pema Stok Ket

29 30 31 kaian Akhir

337 0

0 0

0 0

0 0

0 47

0 0

0 0

20 486 271

147 0

0 0

0 0

0 1698

126 1616 2957

100 390

0 0

0 0

0 0

0 0

0 0

0 1

2 1

0 0

0 1

0 1

0 0

0 18
0 23

0 1

0 0

Pema Stok Ket

29 30 31 kaian Akhir

12 21

0 0

0 0

0 0

0 10

0 0

0 0

0 0

0 0

102 32

5 6

0 0

0 1

Pengelola Obat PKM

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

BULAN
UPT PKM : PEUREULAK Juni
:
KECAMATAN : PEUREULAK TAHUN : 2016
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 263 0 263 161 102 200

2 Acyclovir tab 400 mg Tablet 184 0 184 55 129 200

3 Acyclovir cream 5 % Tube 86 0 86 86 0 100

4 Albendazole 400 mg Tablet 0 0 0 0 0 0

5 Allopurinol 100 mg Tablet 0 0 0 0 0 0

6 Ambroxol Syr 60 ml Botol 102 100 202 126 76 100

7 Ambroxol tab 30 mg Tablet 516 2000 2516 1224 1292 2000

8 Aminopillin tab 200 mg Tablet 55 0 55 20 35 0

9 Amitriptiline 25 Tablet 300 0 300 0 300 0

10 Amlodipin 5 mg Tablet 0 0 0 0 0 0

11 Amlodipin 10 mg Tablet 0 0 0 0 0 0

12 Amoksisillina kapl 250mg Kapsul 2400 4800 7200 5151 2049 1000

13 Amoksisillina kapl 500mg Tablet 1572 0 1572 1572 0 10000

14 Amoksisillina sirker 250 mg / 5 ml Botol 0 300 300 300 0 300

15 Antasida Doen Tab Tablet 0 0 0 0 0 1000

16 Antasida sir Botol 427 400 827 447 380 400

17 Asam Ascorbat ( Vit.C ) 50 mg Tablet 0 1000 1000 0 1000 0

18 Asam Mefenamat 500 mg Tablet 0 0 0 0 0 0

19 Attapulgite 630 mg Tablet 951 0 951 630 321 500

20 Atropin Sulfat 0.5 mg Tablet 200 0 200 0 200 0

21 Besi II Sulfat Tablet 363 300 663 177 663 0

22 Betametason Krim Tube 0 50 50 0 50 0

23 Captopril 12.5 mg Tablet 0 0 0 0 0 0

24 Captopril 25 mg Tablet 300 0 300 97 203 0

25 Captopril 50 mg Tablet 300 0 300 18 282 0

26 Deksametason Inj Ampul 0 0 0 0 0 0

27 Deksametason 0,5 mg Tablet 0 0 0 0 0 0

28 Diazepam Tab 2 mg Tablet 1014 0 1014 240 774 500

29 Digoksin 0,25 mg Tablet 500 0 500 0 500 0

30 Diltiazem HCL 30mg Tablet 200 0 200 0 200 0

31 Dipenhidramin Inj Ampul 0 0 0 0 0 0

32 Domperidom Tablet 153 0 153 153 0 500

33 Efedrina HCL 25 mg Tablet 396 0 396 85 311 0

34 Erytromicin Syr Botol 0 0 0 0 0 0

35 Etakridine kom Botol 10 0 10 0 10 0

36 Etanol Botol 0 0 0 0 0 0

37 Fenobarbital tab 30 mg Tablet 849 0 849 0 849 0

38 Fitomenadion Inj Ampul 0 0 0 0 0 0

39 Fitomenadion Tablet Tablet 0 0 0 0 0 0

40 Furrosemida tab Tablet 127 0 127 67 60 0

41 Furrosemida inj Ampul 0 0 0 0 0 0

42 Garam Oralit Tablet 0 0 0 0 0 0


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

43 Gentamicin SK 0,1 % Tube 20 0 20 7 13 50

44 Glibenklamida tab 5 mg Tablet 322 500 822 98 724 0

45 Glimepiride 2 mg Tablet 0 0 0 0 0 0

46 Glukosa Lar. Inf 5 % Botol 0 0 0 0 0 0

47 Griseofulvin tab 125 mg Tablet 0 0 0 0 0 0

48 Halloperidol 0.5 mg Tablet 0 0 0 0 0 0

49 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

50 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

51 Hidrokortison Krim Tube 0 120 120 80 40 100

52 Ibuprofen tab.200 mg Tablet 930 1000 1930 691 1239 0

53 Kalium Permanganas 5 gr Botol 32 0 32 0 32 0

54 Kals Laktat tab.500 mg Tablet 1753 0 1753 1211 542 1000

55 Ketokonazol tablet 200 mg Tablet 406 0 406 139 267 500

56 Ketokonazol cream Tube 12 48 60 11 49 0

57 Kloramfenikol salep mata Tube 0 0 0 0 0 0

58 Klorpromazine inj Ampul 0 0 0 0 0 0

59 Kodein HCL 10 mg Tablet 0 100 100 0 100 0

60 Kotrimoksazol Susp Botol 0 200 200 0 200 0

61 Kotrimoksazol 480mg Tab Tablet 0 0 0 0 0 0

62 Levofloxacin 500 mg Tablet 0 0 0 0 0 0

63 Loratadine Tablet 489 0 489 214 275 500

64 Metilergometrin Tab. Tablet 0 0 0 0 0 0

65 Metoclopramide 10 mg Tablet 0 0 0 0 0 0

66 Metronidazole 500 mg Tablet 0 0 0 0 0 0

67 Mikonazole Cream Tube 0 0 0 0 0 0

68 Natrium Bikarbonat Tablet 2199 1000 3199 1573 1626 1000

69 Natrium Diklofenac 50 mg Tablet 372 1000 1372 1312 60 1500

70 Natrium Klorida 0.9 % Botol 0 100 100 0 100 0

71 Nifedipin 10 mg Tablet 0 0 0 0 0 0

72 Nistatin 500.000 IU/g Tablet 349 0 349 0 349 0

73 Obat Batuk hitam Botol 63 24 87 30 57 0

74 Oksitetrasiklin Salep Mata Tube 52 0 52 1 51 0

75 Oksitetrasiklin Salep Kulit Tube 29 50 79 53 26 50


76 Omeprazole inj 40 mg/ 10 ml Vial 20 0 20 0 20 0
77 Omeprazole 20 mg Kapsul 0 1500 1500 1500 0 2500
78 Parasetamol Syrup 120 mg / 5 ml Botol 0 0 0 0 0 0
79 Parasetamol Tablet 500 mg Tablet 0 0 0 0 0 0
80 Pehacain Inj Ampul 5 80 85 45 40 100
81 Pirantel tab 125 mg Tablet 112 0 112 1 111 0
82 Propanolol tab 40 mg Tablet 0 0 0 0 0 500
83 Propiltiourasil 100 mg Tablet 140 0 140 26 114 500
84 Ranitidin Tablet 0 0 0 0 0 2000
85 Ranitidin Inj Ampul 0 0 0 0 0 0
86 Ringer Lactat Infus Botol 0 0 0 0 0 0
87 Salbutamol 4 mg Tablet 0 500 500 170 330 300
88 Salep 2- 4 Tube 47 0 47 1 46 0
89 Salisil Bedak 2 % kotak 0 0 0 0 0 100
90 Sefadroksil Syr Botol 0 0 0 0 0 0
91 Setirizine tab Tablet 271 500 771 440 331 1000
92 Simvastatin 20 mg Tablet 0 300 300 169 131 500
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

93 Serum Anti Bisa Ular ( ABU I ) Vial 0 0 0 0 0 0


94 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0 0
95 Tetrasiklin HCL 250 mg Kapsul 1698 0 1698 1698 0 0 EXP
96 Tiamin HCL ( Vit B1 ) 50 mg Tablet 2957 1000 3957 2772 1185 2000
97 Tramadol caps 50 mg Capsul 390 0 390 50 340 0
98 Vitamin B Complek Tablet 0 3000 3000 0 3000 0
99 Yodium Povidon 30 ml Botol 0 0 0 0 0 0
100 Zink Syr Botol 0 0 0 0 0 0

101 Zink tab Tablet 0 0 0 0 0 5000

OBAT GIGI

102 Curaspon Botol 1 0 1 0 1 0


103 Etil Klorida semprot Botol 1 5 6 3 3 5
104 Eugenol Cairan Botol 0 0 0 0 0 0
105 Glass ionomer cement ART Botol 1 0 1 0 1 0
106 Kalsium Hidroksida Pasta Set 1 0 1 0 1 0
ALAT KESEHATAN

107 Alat Suntik 5 cc Unit 18 0 18 0 18 0


108 Alat Suntik 10 cc Unit 23 0 23 0 23 0
109 Aquadest 1000 ml Botol 1 0 1 0 1 0

110 Blood Tranfusion Set Kantong 0 0 0 0 0 0


111 Catgut 2/0 Pcs 21 0 21 0 21 0
112 Catgut 3/0 Pcs 0 0 0 0 0 0
113 Hand Scun Set 0 0 0 0 0 0
114 Infusion set dewasa Kantong 0 0 0 0 0 0

115 I.V Cateter 18 G Buah 10 0 10 0 10 0


116 I.V Cateter 20 G Buah 0 0 0 0 0 0
117 I.V Cateter 22 G Buah 0 0 0 0 0 0
118 I.V Cateter 24 G Buah 0 0 0 0 0 0
119 Kasa Pembalut 4m x 15 cm Rol 0 0 0 0 0 0
120 Masker Pcs 32 0 32 32 0 0

121 Plester 5 yard x 2 inch Rol 6 10 16 6 10 5


122 Silk Pcs 0 0 0 0 0 0
123 Spiritus 500 ml Botol 1 0 1 0 1 0

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 ) DAK
BULAN JUNI 2016
PUSKESMAS PEUREULAK

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 102 0 263 20 20 20 4 27 7 3 7 3 10 28 12 161 102

2 Acyclovir tab 400 mg 129 0 184 4 27 4 10 10 55 129

3 Acyclovir cream 5 % 0 0 86 8 3 2 3 3 2 4 12 7 6 2 6 3 6 1 7 3 4 2 2 86 0

4 Albendazole 400 mg 0 0 0 0 0

5 Allopurinol 100 mg 0 0 0 0 0

6 Ambroxol Syr 60 ml 76 100 202 24 3 2 8 6 3 5 24 3 2 2 4 5 6 4 3 2 4 6 3 3 4 126 76

7 Ambroxol tab 30 mg 1292 2000 2516 255 95 20 73 60 91 58 123 6 30 10 16 62 89 20 30 47 3 30 30 40 36 1224 1292

8 Aminopillin tab 200 mg 35 0 55 20 20 35

9 Amitriptiline 25 300 0 300 0 300

10 Amlodipin 5 mg 0 0 0 0 0

11 Amlodipin 10 mg 0 0 0 0 0

12 Amoksisillina kapl 250mg 2049 4800 7200 10 641 386 120 398 232 396 560 280 231 225 398 368 324 168 414 5151 2049

13 Amoksisillina kapl 500mg 0 0 1572 339 210 140 144 98 105 94 182 176 84 1572 0

14 Amoksisillina sirker 250 mg / 5 ml 0 300 300 27 9 9 6 11 11 13 93 17 9 13 10 5 10 9 12 3 4 10 8 11 300 0

15 Antasida Doen Tab 0 0 0 0 0

16 Antasida sir 380 400 827 25 19 23 33 16 18 23 82 25 13 11 34 7 20 8 13 12 10 16 9 22 8 447 380

17 Asam Ascorbat ( Vit.C ) 50 mg 0 1000 1000 0 1000

18 Asam Mefenamat 500 mg 0 0 0 0 0

19 Attapulgite 630 mg 321 0 951 10 20 45 10 10 210 20 20 50 100 30 10 20 15 20 10 30 630 321

20 Atropin Sulfat 0.5 mg 200 0 200 0 200

21 Besi II Sulfat 663 300 663 10 6 10 20 16 60 33 10 12 177 486

22 Betametason Krim 50 50 50 0 50

23 Captopril 12.5 mg 0 0 0 0 0

24 Captopril 25 mg 203 0 300 6 12 12 12 27 10 18 97 203

25 Captopril 50 mg 282 0 300 18 18 282


No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 Deksametason Inj 0 0 0 0 0

27 Deksametason 0,5 mg 0 0 0 0 0

28 Diazepam Tab 2 mg 1014 0 1014 18 6 12 3 12 9 42 9 6 12 23 19 12 3 7 9 18 8 12 240 774

29 Digoksin 0,25 mg 500 0 500 0 500

30 Diltiazem HCL 30mg 200 0 200 0 200

31 Dipenhidramin Inj 0 0 0 0 0

32 Domperidom 153 0 153 70 5 5 25 10 20 6 12 153 0

33 Efedrina HCL 25 mg 311 0 396 4 6 9 16 10 6 12 7 15 85 311

34 Erytromicin Syr 0 0 0 0 0

35 Etakridine kom 10 0 10 0 10

36 Etanol 0 0 0 0 0

37 Fenobarbital tab 30 mg 849 0 849 0 849

38 Fitomenadion Inj 0 0 0 0 0

39 Fitomenadion Tablet 0 0 0 0 0

40 Furrosemida tab 60 0 127 3 10 6 6 9 3 3 3 6 6 6 3 3 67 60

41 Furrosemida inj 0 0 0 0 0

42 Garam Oralit 0 0 0 0 0

43 Gentamicin SK 0,1 % 20 0 20 5 1 1 7 13

44 Glibenklamida tab 5 mg 322 500 822 11 18 12 21 8 6 6 10 6 98 724

45 Glimepiride 2 mg 0 0 0 0 0

46 Glukosa Lar. Inf 5 % 0 0 0 0 0

47 Griseofulvin tab 125 mg 0 0 0 0 0

48 Halloperidol 0.5 mg 0 0 0 0 0

49 Halloperidol 1.5 mg 0 0 0 0 0

50 Halloperidol 1.5 mg 0 0 0 0 0

51 Hidrokortison Krim 0 120 120 3 3 4 7 34 1 5 7 9 1 1 5 80 40

52 Ibuprofen tab.200 mg 930 1000 1930 30 10 40 20 410 20 10 6 20 20 10 5 20 30 40 691 1239

53 Kalium Permanganas 5 gr 32 0 32 0 32
54 Kals Laktat tab.500 mg 1753 0 1753 238 40 56 16 44 18 92 458 32 16 23 6 35 19 43 10 10 55 1211 542

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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

55 Ketokonazol tablet 200 mg 406 0 406 53 26 7 6 37 10 139 267

56 Ketokonazol cream 12 48 60 2 4 2 2 1 11 49

57 Kloramfenikol salep mata 0 0 0 0 0

58 Klorpromazine inj 0 0 0 0 0

59 Kodein HCL 10 mg 0 100 100 0 100

60 Kotrimoksazol Susp 0 200 200 0 200

61 Kotrimoksazol 480mg Tab 0 0 0 0 0

62 Levofloxacin 500 mg 0 0 0 0 0

63 Loratadine 489 0 489 49 33 3 18 14 28 9 15 20 3 6 6 10 214 275

64 Metilergometrin Tab. 0 0 0 0 0

65 Metoclopramide 10 mg 0 0 0 0 0

66 Metronidazole 500 mg 0 0 0 0 0

67 Mikonazole Cream 0 0 0 0 0

68 Natrium Bikarbonat 2199 1000 3199 60 30 52 48 16 10 85 355 60 50 24 229 36 36 26 98 45 80 56 86 51 40 1573 1626

69 Natrium Diklofenac 50 mg 372 1000 1372 277 30 132 12 68 42 98 64 180 36 24 42 50 75 24 54 22 12 32 18 20 1312 60

70 Natrium Klorida 0.9 % 0 100 100 0 100

71 Nifedipin 10 mg 0 0 0 0 0

72 Nistatin 500.000 IU/g 349 0 349 0 349

73 Obat Batuk hitam 63 24 87 1 3 16 1 2 1 1 1 1 3 30 57

74 Oksitetrasiklin Salep Mata 52 0 52 1 1 51

75 Oksitetrasiklin Salep Kulit 29 50 79 2 2 3 3 1 4 3 2 1 5 2 2 5 3 6 5 4 53 26

76 Omeprazole inj 40 mg/ 10 ml 20 0 20 0 20

77 Omeprazole 20 mg 0 1500 1500 80 110 132 120 60 30 81 42 26 20 47 32 20 165 120 36 56 96 82 89 56 1500 0

78 Parasetamol Syrup 120 mg / 5 ml 0 0 0 0 0

79 Parasetamol Tablet 500 mg 0 0 0 0 0

80 Pehacain Inj 5 80 85 10 10 25 45 40
81 Pirantel tab 125 mg 112 0 112 1 1 111

82 Propiltiourasil 100 mg 0 0 0 0 0

83 Propanolol tab 40 mg 140 0 140 6 20 26 114

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 Ranitidin 0 0 0 0 0

85 Ranitidin Inj 0 0 0 0 0

86 Ringer Lactat Infus 0 0 0 0 0

87 Salbutamol 4 mg 0 500 500 8 20 100 6 20 10 6 170 330

88 Salep 2- 4 47 0 47 1 1 46

89 Salisil Bedak 2 % 0 0 0 0 0

90 Sefadroksil Syr 0 0 0 0 0

91 Setirizine tab 271 500 771 26 6 9 6 3 46 33 8 9 12 20 42 12 16 65 30 28 28 21 20 440 331

92 Simvastatin 20 mg 0 300 300 6 24 12 30 8 14 3 16 3 30 8 3 12 169 131

93 Serum Anti Bisa Ular ( ABU I ) 0 0 0 0 0

94 Serum Anti Tetanus 1.500 UI / ml 0 0 0 0 0

95 Tetrasiklin HCL 250 mg 1698 0 1698 0 1698

96 Tiamin HCL ( Vit B1 ) 50 mg 2957 1000 3957 160 140 172 150 76 56 110 466 100 64 36 286 200 271 81 88 20 86 20 64 40 86 2772 1185

97 Tramadol caps 50 mg 390 0 390 50 50 340

98 Vitamin B Complek 0 3000 3000 0 3000

99 Yodium Povidon 30 ml 0 0 0 0 0

100 Zink Syr 0 0 0 0 0

101 Zink tablet 0 0 0 0 0

OBAT GIGI 0 0

102 Curaspon 1 0 1 0 1

103 Etil Klorida semprot 1 5 6 1 1 1 3 3

104 Eugenol Cairan 0 0 0 0 0

105 Glass ionomer cement ART 1 0 1 0 1

106 Kalsium Hidroksida Pasta 1 0 1 0 1


ALAT KESEHATAN 0 0

107 Alat Suntik 5 cc 18 0 18 0 18

108 Alat Suntik 10 cc 23 0 23 0 23

109 Aquadest 1000 ml 1 0 1 0 1

110 Blood Tranfusion Set 0 0 0 0 0

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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

111 Catgut 2/0 21 0 21 0 21

112 Catgut 3/0 0 0 0 0 0

113 Hand Scun 0 0 0 0 0

114 Infusion set dewasa 0 0 0 0 0

115 I.V Cateter 18 G 10 0 10 0 10

116 I.V Cateter 20 G 0 0 0 0 0

117 I.V Cateter 22 G 0 0 0 0 0

118 I.V Cateter 24 G 0 0 0 0 0

119 Kasa Pembalut 4m x 15 cm 0 0 0 0 0

120 Masker 32 0 32 15 10 7 32 0

121 Plester 5 yard x 2 inch 6 10 16 2 1 3 6 10

122 Silk 0 0 0 0 0

123 Spiritus 500 ml 1 0 1 0 1

0 0

0 0

0 0

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 PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT DAK
( LPLPO ) DAK

BULAN
UPT PKM : PEUREULAK Juli
:
KECAMATAN : PEUREULAK TAHUN : 2016
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 102 200 302 69 233 200

2 Acyclovir tab 400 mg Tablet 129 0 129 0 129 200

3 Acyclovir cream 5 % Tube 0 100 100 0 100 0

4 Albendazole 400 mg Tablet 0 0 0 0 0 0

5 Allopurinol 100 mg Tablet 0 0 0 0 0 0

6 Ambroxol Syr 60 ml Botol 76 100 176 71 105 100

7 Ambroxol tab 30 mg Tablet 1292 1500 2792 730 2062 500

8 Aminopillin tab 200 mg Tablet 35 0 35 0 35 0

9 Amitriptiline 25 Tablet 300 0 300 0 300 0

10 Amlodipin 5 mg Tablet 0 0 0 0 0 0

11 Amlodipin 10 mg Tablet 0 0 0 0 0 0

12 Amoksisillina kapl 250mg Kapsul 2049 2400 4449 3976 473 4000

13 Amoksisillina kapl 500mg Tablet 0 0 0 0 0 10000

14 Amoksisillina sirker 250 mg / 5 ml Botol 0 300 300 205 95 3000

15 Antasida Doen Tab Tablet 0 0 0 0 0 10000

16 Antasida sir Botol 380 200 580 376 204 200

17 Asam Ascorbat ( Vit.C ) 50 mg Tablet 1000 0 1000 1000 0 10000

18 Asam Mefenamat 500 mg Tablet 0 0 0 0 0 0

19 Attapulgite 630 mg Tablet 321 500 821 350 471 500

20 Atropin Sulfat 0.5 mg Tablet 200 0 200 0 200 0

21 Besi II Sulfat Tablet 663 0 663 184 479 0

22 Betametason Krim Tube 50 0 50 0 50 100

23 Captopril 12.5 mg Tablet 0 0 0 0 0 0

24 Captopril 25 mg Tablet 203 0 203 92 111 500

25 Captopril 50 mg Tablet 282 0 282 0 282 200

26 Deksametason Inj Ampul 0 0 0 0 0 0

27 Deksametason 0,5 mg Tablet 0 0 0 0 0 0

28 Diazepam Tab 2 mg Tablet 774 0 774 252 522 200

29 Digoksin 0,25 mg Tablet 500 0 500 0 500 0

30 Diltiazem HCL 30mg Tablet 200 0 200 0 200 0

31 Dipenhidramin Inj Ampul 0 0 0 0 0 0

32 Domperidom Tablet 0 0 0 0 0 500

33 Efedrina HCL 25 mg Tablet 311 0 311 245 66 500

34 Erytromicin Syr Botol 0 0 0 0 0 0

35 Etakridine kom Botol 10 0 10 0 10 0

36 Etanol Botol 0 0 0 0 0 0

37 Fenobarbital tab 30 mg Tablet 849 0 849 0 849 0

38 Fitomenadion Inj Ampul 0 0 0 0 0 0

39 Fitomenadion Tablet Tablet 0 0 0 0 0 0

40 Furrosemida tab Tablet 60 0 60 15 45 0

41 Furrosemida inj Ampul 0 0 0 0 0 0

42 Garam Oralit Tablet 0 0 0 0 0 1000


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

43 Gentamicin SK 0,1 % Tube 13 30 43 0 43 50

44 Glibenklamida tab 5 mg Tablet 724 0 724 189 535 200

45 Glimepiride 2 mg Tablet 0 0 0 0 0 0

46 Glukosa Lar. Inf 5 % Botol 0 0 0 0 0 0

47 Griseofulvin tab 125 mg Tablet 0 0 0 0 0 0

48 Halloperidol 0.5 mg Tablet 0 0 0 0 0 0

49 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

50 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

51 Hidrokortison Krim Tube 40 72 112 70 42 50

52 Ibuprofen tab.200 mg Tablet 1239 0 1239 590 649 1000

53 Kalium Permanganas 5 gr Botol 32 0 32 0 32 0

54 Kals Laktat tab.500 mg Tablet 542 1000 1542 1275 267 1000

55 Ketokonazol tablet 200 mg Tablet 267 200 467 80 387 500

56 Ketokonazol cream Tube 49 0 49 6 43 50

57 Kloramfenikol salep mata Tube 0 0 0 0 0 0

58 Klorpromazine inj Ampul 0 0 0 0 0 0

59 Kodein HCL 10 mg Tablet 100 0 100 20 80 500

60 Kotrimoksazol Susp Botol 200 0 200 20 180 200

61 Kotrimoksazol 480mg Tab Tablet 0 0 0 0 0 0

62 Levofloxacin 500 mg Tablet 0 0 0 0 0 0

63 Loratadine Tablet 275 200 475 177 298 500

64 Metilergometrin Tab. Tablet 0 0 0 0 0 0

65 Metoclopramide 10 mg Tablet 0 0 0 0 0 0

66 Metronidazole 500 mg Tablet 0 0 0 0 0 0

67 Mikonazole Cream Tube 0 0 0 0 0 0

68 Natrium Bikarbonat Tablet 1626 1000 2626 1674 952 2000

69 Natrium Diklofenac 50 mg Tablet 60 500 560 334 226 1000

70 Natrium Klorida 0.9 % Botol 100 0 100 0 100 0

71 Nifedipin 10 mg Tablet 0 0 0 0 0 0

72 Nistatin 500.000 IU/g Tablet 349 0 349 0 349 0

73 Obat Batuk hitam Botol 57 0 57 16 41 50

74 Oksitetrasiklin Salep Mata Tube 51 50 101 10 91 0

75 Oksitetrasiklin Salep Kulit Tube 26 0 26 26 0 0


76 Omeprazole inj 40 mg/ 10 ml Vial 20 0 20 0 20 0
77 Omeprazole 20 mg Kapsul 0 0 0 0 0 2000
78 Parasetamol Syrup 120 mg / 5 ml Botol 0 0 0 0 0 0
79 Parasetamol Tablet 500 mg Tablet 0 0 0 0 0 0
80 Pehacain Inj Ampul 40 0 40 15 25 200
81 Pirantel tab 125 mg Tablet 111 0 111 0 111 0
82 Propanolol tab 40 mg Tablet 0 0 0 0 0 0
83 Propiltiourasil 100 mg Tablet 114 0 114 10 104 0
84 Ranitidin Tablet 0 0 0 0 0 2000
85 Ranitidin Inj Ampul 0 0 0 0 0 100
86 Ringer Lactat Infus Botol 0 0 0 0 0 0
87 Salbutamol 4 mg Tablet 330 300 630 186 444 200
88 Salep 2- 4 Tube 46 0 46 0 46 0
89 Salisil Bedak 2 % kotak 0 0 0 0 0 0
90 Sefadroksil Syr Botol 0 0 0 0 0 0
91 Setirizine tab Tablet 331 500 831 151 680 0
92 Simvastatin 20 mg Tablet 131 200 331 64 267 500
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

93 Serum Anti Bisa Ular ( ABU I ) Vial 0 0 0 0 0 0


94 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0 0
95 Tetrasiklin HCL 250 mg Kapsul 0 0 0 0 0 0
96 Tiamin HCL ( Vit B1 ) 50 mg Tablet 1185 3000 4185 2544 1641 2000
97 Tramadol caps 50 mg Capsul 340 0 340 50 290 0
98 Vitamin B Complek Tablet 3000 0 3000 0 3000 0
99 Yodium Povidon 30 ml Botol 0 0 0 0 0 0
100 Zink Syr Botol 0 0 0 0 0 0

101 Zink tab Tablet 0 0 0 0 0 0

OBAT GIGI 0

102 Curaspon Botol 1 0 1 0 1 1


103 Etil Klorida semprot Botol 3 3 6 2 4 5
104 Eugenol Cairan Botol 0 0 0 0 0 0
105 Glass ionomer cement ART Botol 1 0 1 0 1 1
106 Kalsium Hidroksida Pasta Set 1 0 1 0 1 1
ALAT KESEHATAN 0

107 Alat Suntik 5 cc Unit 18 0 18 0 18 18


108 Alat Suntik 10 cc Unit 23 0 23 0 23 23
109 Aquadest 1000 ml Botol 1 0 1 0 1 1

110 Blood Tranfusion Set Kantong 0 0 0 0 0 0


111 Catgut 2/0 Pcs 21 0 21 14 7 7
112 Catgut 3/0 Pcs 0 0 0 0 0 0
113 Hand Scun Set 0 0 0 0 0 0
114 Infusion set dewasa Kantong 0 0 0 0 0 0
115 I.V Cateter 18 G Buah 10 0 10 0 10 10
116 I.V Cateter 20 G Buah 0 0 0 0 0 0
117 I.V Cateter 22 G Buah 0 0 0 0 0 0
118 I.V Cateter 24 G Buah 0 0 0 0 0 0
119 Kasa Pembalut 4m x 15 cm Rol 0 0 0 0 0 0
120 Masker Pcs 0 0 0 0 0 0

121 Plester 5 yard x 2 inch Rol 10 5 15 0 15 15


122 Silk Pcs 0 0 0 0 0 0
123 Spiritus 500 ml Botol 1 0 1 0 1 1

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 ) DAK
BULAN JULI 2016
PUSKESMAS :

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 102 200 302 18 4 12 8 7 20 69 233

2 Acyclovir tab 400 mg 129 0 129 0 129

3 Acyclovir cream 5 % 0 100 100 0 100

4 Albendazole 400 mg 0 0 0 0 0

5 Allopurinol 100 mg 0 0 0 0 0

6 Ambroxol Syr 60 ml 76 100 176 8 6 4 3 4 2 4 8 11 3 6 5 2 3 2 71 105

7 Ambroxol tab 30 mg 1292 1500 2792 46 126 68 58 64 24 18 48 26 85 60 20 87 730 2062

8 Aminopillin tab 200 mg 35 0 35 0 35

9 Amitriptiline 25 300 0 300 0 300

10 Amlodipin 5 mg 0 0 0 0 0

11 Amlodipin 10 mg 0 0 0 0 0

12 Amoksisillina kapl 250mg 2049 2400 4449 235 468 346 262 168 186 180 160 218 270 298 388 186 278 168 165 3976 473

13 Amoksisillina kapl 500mg 0 0 0 0 0

14 Amoksisillina sirker 250 mg / 5 ml 0 300 300 18 16 21 20 16 79 21 14 205 95

15 Antasida Doen Tab 0 0 0 0 0

16 Antasida sir 380 200 580 18 36 26 23 23 16 27 17 27 13 19 22 29 47 22 11 376 204

17 Asam Ascorbat ( Vit.C ) 50 mg 1000 0 1000 60 176 122 138 84 98 216 106 1000 0

18 Asam Mefenamat 500 mg 0 0 0 0 0

19 Attapulgite 630 mg 321 500 821 50 50 20 20 10 20 170 10 350 471

20 Atropin Sulfat 0.5 mg 200 0 200 0 200

21 Besi II Sulfat 663 0 663 30 28 20 6 30 20 30 20 184 479

22 Betametason Krim 50 0 50 0 50

23 Captopril 12.5 mg 0 0 0 0 0

24 Captopril 25 mg 203 0 203 12 10 40 30 92 111

25 Captopril 50 mg 282 0 282 0 282


No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 Deksametason Inj 0 0 0 0 0

27 Deksametason 0,5 mg 0 0 0 0 0

28 Diazepam Tab 2 mg 774 0 774 24 24 8 12 8 18 39 26 29 18 8 9 29 252 522

29 Digoksin 0,25 mg 500 0 500 0 500

30 Diltiazem HCL 30mg 200 0 200 0 200

31 Dipenhidramin Inj 0 0 0 0 0

32 Domperidom 0 0 0 0 0

33 Efedrina HCL 25 mg 311 0 311 20 26 18 26 18 12 10 16 26 8 18 12 5 30 245 66

34 Erytromicin Syr 0 0 0 0 0

35 Etakridine kom 10 0 10 0 10

36 Etanol 0 0 0 0 0

37 Fenobarbital tab 30 mg 849 0 849 0 849

38 Fitomenadion Inj 0 0 0 0 0

39 Fitomenadion Tablet 0 0 0 0 0

40 Furrosemida tab 60 0 60 3 6 3 3 15 45

41 Furrosemida inj 0 0 0 0 0

42 Garam Oralit 0 0 0 0 0

43 Gentamicin SK 0,1 % 13 30 43 0 43

44 Glibenklamida tab 5 mg 724 0 724 26 15 12 9 16 23 12 10 20 26 20 189 535

45 Glimepiride 2 mg 0 0 0 0 0

46 Glukosa Lar. Inf 5 % 0 0 0 0 0

47 Griseofulvin tab 125 mg 0 0 0 0 0

48 Halloperidol 0.5 mg 0 0 0 0 0

49 Halloperidol 1.5 mg 0 0 0 0 0

50 Halloperidol 1.5 mg 0 0 0 0 0

51 Hidrokortison Krim 40 72 112 6 4 4 5 4 2 8 12 3 22 70 42

52 Ibuprofen tab.200 mg 1239 0 1239 30 40 40 20 60 110 40 200 20 30 590 649


53 Kalium Permanganas 5 gr 32 0 32 0 32

54 Kals Laktat tab.500 mg 542 1000 1542 86 24 46 18 58 43 36 128 124 62 126 278 110 136 1275 267

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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

55 Ketokonazol tablet 200 mg 267 200 467 17 33 20 10 80 387

56 Ketokonazol cream 49 0 49 2 1 3 6 43

57 Kloramfenikol salep mata 0 0 0 0 0

58 Klorpromazine inj 0 0 0 0 0

59 Kodein HCL 10 mg 100 0 100 20 20 80

60 Kotrimoksazol Susp 200 0 200 20 20 180

61 Kotrimoksazol 480mg Tab 0 0 0 0 0

62 Levofloxacin 500 mg 0 0 0 0 0

63 Loratadine 275 200 475 12 9 48 9 18 17 15 9 12 18 10 177 298

64 Metilergometrin Tab. 0 0 0 0 0

65 Metoclopramide 10 mg 0 0 0 0 0

66 Metronidazole 500 mg 0 0 0 0 0

67 Mikonazole Cream 0 0 0 0 0

68 Natrium Bikarbonat 1626 1000 2626 86 132 128 126 90 230 64 62 140 160 110 80 140 20 60 46 1674 952

69 Natrium Diklofenac 50 mg 60 500 560 20 40 46 62 48 32 86 334 226

70 Natrium Klorida 0.9 % 100 0 100 0 100

71 Nifedipin 10 mg 0 0 0 0 0

72 Nistatin 500.000 IU/g 349 0 349 0 349

73 Obat Batuk hitam 57 0 57 16 16 41

74 Oksitetrasiklin Salep Mata 51 50 101 3 4 3 10 91

75 Oksitetrasiklin Salep Kulit 26 0 26 4 2 3 3 3 5 2 4 26 0

76 Omeprazole inj 40 mg/ 10 ml 20 0 20 0 20

77 Omeprazole 20 mg 0 0 0 0 0

78 Parasetamol Syrup 120 mg / 5 ml 0 0 0 0 0

79 Parasetamol Tablet 500 mg 0 0 0 0 0


80 Pehacain Inj 40 0 40 5 10 15 25

81 Pirantel tab 125 mg 111 0 111 0 111

82 Propiltiourasil 100 mg 0 0 0 0 0

83 Propanolol tab 40 mg 114 0 114 10 10 104


No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 Ranitidin 0 0 0 0 0

85 Ranitidin Inj 0 0 0 0 0

86 Ringer Lactat Infus 0 0 0 0 0

87 Salbutamol 4 mg 330 300 630 28 16 20 30 10 12 26 12 20 12 186 444

88 Salep 2- 4 46 0 46 0 46

89 Salisil Bedak 2 % 0 0 0 0 0

90 Sefadroksil Syr 0 0 0 0 0

91 Setirizine tab 331 500 831 35 38 19 24 12 23 151 680

92 Simvastatin 20 mg 131 200 331 20 20 6 18 64 267

93 Serum Anti Bisa Ular ( ABU I ) 0 0 0 0 0

94 Serum Anti Tetanus 1.500 UI / ml 0 0 0 0 0

95 Tetrasiklin HCL 250 mg 0 0 0 0 0

96 Tiamin HCL ( Vit B1 ) 50 mg 1185 3000 4185 68 170 44 68 126 86 130 132 160 198 120 86 110 786 120 140 2544 1641

97 Tramadol caps 50 mg 340 0 340 50 50 290

98 Vitamin B Complek 3000 0 3000 0 3000

99 Yodium Povidon 30 ml 0 0 0 0 0

100 Zink Syr 0 0 0 0 0

101 Zink tablet 0 0 0 0 0

OBAT GIGI 0 0

102 Curaspon 1 0 1 0 1

103 Etil Klorida semprot 3 3 6 1 1 2 4

104 Eugenol Cairan 0 0 0 0 0

105 Glass ionomer cement ART 1 0 1 0 1

106 Kalsium Hidroksida Pasta 1 0 1 0 1

ALAT KESEHATAN 0 0

107 Alat Suntik 5 cc 18 0 18 0 18

108 Alat Suntik 10 cc 23 0 23 0 23

109 Aquadest 1000 ml 1 0 1 0 1


110 Blood Tranfusion Set 0 0 0 0 0

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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

111 Catgut 2/0 21 0 21 10 4 14 7

112 Catgut 3/0 0 0 0 0 0

113 Hand Scun 0 0 0 0 0

114 Infusion set dewasa 0 0 0 0 0

115 I.V Cateter 18 G 10 0 10 0 10

116 I.V Cateter 20 G 0 0 0 0 0

117 I.V Cateter 22 G 0 0 0 0 0

118 I.V Cateter 24 G 0 0 0 0 0

119 Kasa Pembalut 4m x 15 cm 0 0 0 0 0

120 Masker 0 0 0 0 0

121 Plester 5 yard x 2 inch 10 5 15 0 15

122 Silk 0 0 0 0 0

123 Spiritus 500 ml 1 0 1 0 1

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 PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT DAK
( LPLPO ) DAK

BULAN
UPT PKM : PEUREULAK Agustus
:
KECAMATAN : PEUREULAK TAHUN : 2016
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 233 0 233 141 92 300

2 Acyclovir tab 400 mg Tablet 129 0 129 129 0 300

3 Acyclovir cream 5 % Tube 100 0 100 81 19 100

4 Albendazole 400 mg Tablet 0 0 0 0 0 0

5 Allopurinol 100 mg Tablet 0 0 0 0 0 5000

6 Ambroxol Syr 60 ml Botol 105 100 205 177 28 200

7 Ambroxol tab 30 mg Tablet 2062 0 2062 1507 555 3000

8 Aminopillin tab 200 mg Tablet 35 0 35 0 35 0

9 Amitriptiline 25 Tablet 300 0 300 0 300 0

10 Amlodipin 5 mg Tablet 0 0 0 0 0 0

11 Amlodipin 10 mg Tablet 0 0 0 0 0 0

12 Amoksisillina kapl 250mg Kapsul 473 1200 1673 1673 0 3000

13 Amoksisillina kapl 500mg Tablet 0 0 0 0 0 30000

14 Amoksisillina sirker 250 mg / 5 ml Botol 95 100 195 155 40 150

15 Antasida Doen Tab Tablet 0 5000 5000 4515 485 10000

16 Antasida sir Botol 204 50 254 204 50 300

17 Asam Ascorbat ( Vit.C ) 50 mg Tablet 0 700 700 700 0 0

18 Asam Mefenamat 500 mg Tablet 0 0 0 0 0 30000

19 Attapulgite 630 mg Tablet 471 500 971 550 421 500

20 Atropin Sulfat 0.5 mg Tablet 200 0 200 0 200 0

21 Besi II Sulfat Tablet 479 0 479 479 0 1000

22 Betametason Krim Tube 50 0 50 14 36 100

23 Captopril 12.5 mg Tablet 0 0 0 0 0 0

24 Captopril 25 mg Tablet 111 0 111 111 0 500

25 Captopril 50 mg Tablet 282 200 482 392 90 500

26 Deksametason Inj Ampul 0 0 0 0 0 0

27 Deksametason 0,5 mg Tablet 0 0 0 0 0 0

28 Diazepam Tab 2 mg Tablet 522 200 722 255 467 400

29 Digoksin 0,25 mg Tablet 500 0 500 0 500 0

30 Diltiazem HCL 30mg Tablet 200 0 200 0 200 0

31 Dipenhidramin Inj Ampul 0 0 0 0 0 0

32 Domperidom Tablet 0 0 0 0 0 500

33 Efedrina HCL 25 mg Tablet 66 500 566 336 230 500

34 Erytromicin Syr Botol 0 0 0 0 0 0

35 Etakridine kom Botol 10 0 10 0 10 0

36 Etanol Botol 0 0 0 0 0 0

37 Fenobarbital tab 30 mg Tablet 849 0 849 0 849 0

38 Fitomenadion Inj Ampul 0 0 0 0 0 0

39 Fitomenadion Tablet Tablet 0 0 0 0 0 0

40 Furrosemida tab Tablet 45 0 45 3 42 100

41 Furrosemida inj Ampul 0 0 0 0 0 0

42 Garam Oralit Tablet 0 300 300 185 115 200


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

43 Gentamicin SK 0,1 % Tube 43 0 43 2 41 50

44 Glibenklamida tab 5 mg Tablet 535 0 535 501 34 500

45 Glimepiride 2 mg Tablet 0 0 0 0 0 0

46 Glukosa Lar. Inf 5 % Botol 0 0 0 0 0 0

47 Griseofulvin tab 125 mg Tablet 0 0 0 0 0 0

48 Halloperidol 0.5 mg Tablet 0 0 0 0 0 0

49 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

50 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

51 Hidrokortison Krim Tube 42 0 42 42 0 0

52 Ibuprofen tab.200 mg Tablet 649 500 1149 449 700 0

53 Kalium Permanganas 5 gr Botol 32 0 32 0 32 0

54 Kals Laktat tab.500 mg Tablet 267 1000 1267 1267 0 5000

55 Ketokonazol tablet 200 mg Tablet 387 0 387 293 94 0

56 Ketokonazol cream Tube 43 0 43 32 11 0

57 Kloramfenikol salep mata Tube 0 0 0 0 0 0

58 Klorpromazine inj Ampul 0 0 0 0 0 0

59 Kodein HCL 10 mg Tablet 80 0 80 45 35 300

60 Kotrimoksazol Susp Botol 180 0 180 98 82 0

61 Kotrimoksazol 480mg Tab Tablet 0 0 0 0 0 0

62 Levofloxacin 500 mg Tablet 0 0 0 0 0 0

63 Loratadine Tablet 298 100 398 324 74 500

64 Metilergometrin Tab. Tablet 0 0 0 0 0 0

65 Metoclopramide 10 mg Tablet 0 0 0 0 0 0

66 Metronidazole 500 mg Tablet 0 0 0 0 0 2000

67 Mikonazole Cream Tube 0 0 0 0 0 2000

68 Natrium Bikarbonat Tablet 952 2000 2952 1901 1051 5000

69 Natrium Diklofenac 50 mg Tablet 226 0 226 226 0 2000

70 Natrium Klorida 0.9 % Botol 100 0 100 0 100 0

71 Nifedipin 10 mg Tablet 0 0 0 0 0 0

72 Nistatin 500.000 IU/g Tablet 349 0 349 0 349 0

73 Obat Batuk hitam Botol 41 24 65 48 17 50

74 Oksitetrasiklin Salep Mata Tube 91 0 91 34 57 50

75 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 0 100


76 Omeprazole inj 40 mg/ 10 ml Vial 20 0 20 0 20 0
77 Omeprazole 20 mg Kapsul 0 1500 1500 724 776 2000
78 Parasetamol Syrup 120 mg / 5 ml Botol 0 0 0 0 0 0
79 Parasetamol Tablet 500 mg Tablet 0 0 0 0 0 0
80 Pehacain Inj Ampul 25 0 25 25 0 80
81 Pirantel tab 125 mg Tablet 111 0 111 34 77 200
82 Propanolol tab 40 mg Tablet 0 0 0 0 0 500
83 Propiltiourasil 100 mg Tablet 104 0 104 104 0 500
84 Ranitidin Tablet 0 0 0 0 0 0
85 Ranitidin Inj Ampul 0 0 0 0 0 0
86 Ringer Lactat Infus Botol 0 0 0 0 0 0
87 Salbutamol 4 mg Tablet 444 200 644 262 382 500
88 Salep 2- 4 Tube 46 0 46 5 41 0
89 Salisil Bedak 2 % kotak 0 0 0 0 0 0
90 Sefadroksil Syr Botol 0 0 0 0 0 100
91 Setirizine tab Tablet 680 0 680 492 188 500
92 Simvastatin 20 mg Tablet 267 0 267 159 108 0
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

93 Serum Anti Bisa Ular ( ABU I ) Vial 0 0 0 0 0 0


94 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0 0
95 Tetrasiklin HCL 250 mg Kapsul 0 0 0 0 0 0
96 Tiamin HCL ( Vit B1 ) 50 mg Tablet 1641 2000 3641 2013 1628 3000
97 Tramadol caps 50 mg Capsul 290 0 290 30 260 0
98 Vitamin B Complek Tablet 3000 0 3000 0 3000 0
99 Yodium Povidon 30 ml Botol 0 0 0 0 0 0
100 Zink Syr Botol 0 0 0 0 0 0

101 Zink tab Tablet 0 0 0 0 0 0

OBAT GIGI

102 Curaspon Botol 1 0 1 0 1 0


103 Etil Klorida semprot Botol 4 0 4 2 2 10
104 Eugenol Cairan Botol 0 0 0 0 0 0
105 Glass ionomer cement ART Botol 1 0 1 0 1 0
106 Kalsium Hidroksida Pasta Set 1 0 1 0 1 0
ALAT KESEHATAN

107 Alat Suntik 5 cc Unit 18 0 18 0 18 0


108 Alat Suntik 10 cc Unit 23 0 23 0 23 0
109 Aquadest 1000 ml Botol 1 0 1 0 1 0
110 Blood Tranfusion Set Kantong 0 0 0 0 0 0
111 Catgut 2/0 Pcs 7 0 7 0 7 0
112 Catgut 3/0 Pcs 0 0 0 0 0 0
113 Hand Scun Set 0 0 0 0 0 0
114 Infusion set dewasa Kantong 0 0 0 0 0 0

115 I.V Cateter 18 G Buah 10 0 10 0 10 0


116 I.V Cateter 20 G Buah 0 0 0 0 0 0
117 I.V Cateter 22 G Buah 0 0 0 0 0 0
118 I.V Cateter 24 G Buah 0 0 0 0 0 0
119 Kasa Pembalut 4m x 15 cm Rol 0 0 0 0 0
120 Masker Pcs 0 0 0 0 0

121 Plester 5 yard x 2 inch Rol 15 0 15 9 6 20


122 Silk Pcs 0 0 0 0 0 0
123 Spiritus 500 ml Botol 1 0 1 0 1 0

Mengetahui
Kepala Puskesmas Pengelola Obat PKM

( ) ( Erlina,Amk
Nip. Nip.
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) DAK
BULAN AGUSTUS 2016
PUSKESMAS :

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 233 0 233 2 4 8 3 11 3 5 9 7 12 16 5 28 8 20 141 92

2 Acyclovir tab 400 mg 129 0 129 12 7 16 8 14 18 28 6 20 129 0

3 Acyclovir cream 5 % 100 0 100 1 5 2 2 4 3 8 3 11 9 6 6 5 3 3 6 4 81 19

4 Albendazole 400 mg 0 0 0 0 0

5 Allopurinol 100 mg 0 0 0 0 0

6 Ambroxol Syr 60 ml 105 100 205 4 7 3 15 4 11 6 11 9 7 10 8 13 6 6 8 37 5 3 4 177 28

7 Ambroxol tab 30 mg 2062 0 2062 35 30 60 80 120 68 111 40 38 32 120 16 700 15 27 15 1507 555

8 Aminopillin tab 200 mg 35 0 35 0 35

9 Amitriptiline 25 300 0 300 0 300

10 Amlodipin 5 mg 0 0 0 0 0

11 Amlodipin 10 mg 0 0 0 0 0

12 Amoksisillina kapl 250mg 473 1200 1673 289 184 146 189 158 120 148 132 151 156 1673 0

13 Amoksisillina kapl 500mg 0 0 0 0 0

14 Amoksisillina sirker 250 mg / 5 ml 95 100 195 21 9 11 16 9 14 15 10 25 25 155 40

15 Antasida Doen Tab 0 5000 5000 240 158 412 243 312 250 311 244 900 486 421 320 218 4515 485

16 Antasida sir 204 50 254 22 18 24 14 18 12 17 21 14 9 32 3 204 50

17 Asam Ascorbat ( Vit.C ) 50 mg 0 700 700 59 123 110 90 120 132 66 700 0

18 Asam Mefenamat 500 mg 0 0 0 0 0

19 Attapulgite 630 mg 471 500 971 30 30 10 20 30 10 20 50 10 60 10 250 10 10 550 421

20 Atropin Sulfat 0.5 mg 200 0 200 0 200

21 Besi II Sulfat 479 0 479 20 30 10 60 20 40 120 51 20 108 479 0

22 Betametason Krim 50 0 50 2 3 5 4 14 36

23 Captopril 12.5 mg 0 0 0 0 0

24 Captopril 25 mg 111 0 111 16 18 10 18 12 8 10 19 111 0

25 Captopril 50 mg 282 200 482 28 17 6 20 10 20 20 10 5 15 241 392 90


No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 Deksametason Inj 0 0 0 0 0

27 Deksametason 0,5 mg 0 0 0 0 0

28 Diazepam Tab 2 mg 522 200 722 26 9 16 6 9 16 12 20 16 6 18 9 36 10 10 3 6 9 3 12 3 255 467

29 Digoksin 0,25 mg 500 0 500 0 500

30 Diltiazem HCL 30mg 200 0 200 0 200

31 Dipenhidramin Inj 0 0 0 0 0

32 Domperidom 0 0 0 0 0

33 Efedrina HCL 25 mg 66 500 566 20 10 4 12 10 18 12 10 15 20 30 18 64 18 15 17 10 6 18 9 336 230

34 Erytromicin Syr 0 0 0 0 0

35 Etakridine kom 10 0 10 0 10

36 Etanol 0 0 0 0 0

37 Fenobarbital tab 30 mg 849 0 849 0 849

38 Fitomenadion Inj 0 0 0 0 0

39 Fitomenadion Tablet 0 0 0 0 0

40 Furrosemida tab 45 0 45 3 3 42

41 Furrosemida inj 0 0 0 0 0

42 Garam Oralit 0 300 300 5 15 10 25 15 5 20 5 45 25 5 10 185 115

43 Gentamicin SK 0,1 % 43 0 43 2 2 41

44 Glibenklamida tab 5 mg 535 0 535 20 18 8 6 12 16 32 16 28 28 18 40 18 25 168 14 12 6 16 501 34

45 Glimepiride 2 mg 0 0 0 0 0

46 Glukosa Lar. Inf 5 % 0 0 0 0 0

47 Griseofulvin tab 125 mg 0 0 0 0 0

48 Halloperidol 0.5 mg 0 0 0 0 0

49 Halloperidol 1.5 mg 0 0 0 0 0

50 Halloperidol 1.5 mg 0 0 0 0 0

51 Hidrokortison Krim 42 0 42 3 2 5 3 4 2 4 5 3 2 6 3 42 0

52 Ibuprofen tab.200 mg 649 500 1149 30 50 20 29 40 10 80 20 90 50 30 449 700

53 Kalium Permanganas 5 gr 32 0 32 0 32

54 Kals Laktat tab.500 mg 267 1000 1267 120 42 46 30 30 138 111 89 92 132 186 40 18 63 48 16 26 40 1267 0
No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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

55 Ketokonazol tablet 200 mg 387 0 387 30 12 6 3 9 12 18 30 12 18 3 113 3 9 12 3 293 94

56 Ketokonazol cream 43 0 43 2 1 2 1 3 5 1 3 2 2 4 4 2 32 11

57 Kloramfenikol salep mata 0 0 0 0 0

58 Klorpromazine inj 0 0 0 0 0

59 Kodein HCL 10 mg 80 0 80 10 20 5 10 45 35

60 Kotrimoksazol Susp 180 0 180 9 7 3 5 7 8 4 11 6 3 9 18 5 3 98 82

61 Kotrimoksazol 480mg Tab 0 0 0 0 0

62 Levofloxacin 500 mg 0 0 0 0 0

63 Loratadine 298 100 398 16 25 18 16 12 27 13 9 18 16 12 18 12 9 12 21 29 16 25 324 74

64 Metilergometrin Tab. 0 0 0 0 0

65 Metoclopramide 10 mg 0 0 0 0 0

66 Metronidazole 500 mg 0 0 0 0 0

67 Mikonazole Cream 0 0 0 0 0

68 Natrium Bikarbonat 952 2000 2952 93 90 40 58 60 40 20 246 18 27 48 167 24 216 20 634 20 24 32 24 1901 1051

69 Natrium Diklofenac 50 mg 226 0 226 72 18 42 18 18 24 34 226 0

70 Natrium Klorida 0.9 % 100 0 100 0 100

71 Nifedipin 10 mg 0 0 0 0 0

72 Nistatin 500.000 IU/g 349 0 349 0 349

73 Obat Batuk hitam 41 24 65 2 2 1 1 1 3 2 1 2 12 21 48 17

74 Oksitetrasiklin Salep Mata 91 0 91 2 3 1 5 1 2 3 5 3 1 3 4 1 34 57

75 Oksitetrasiklin Salep Kulit 0 0 0 0 0

76 Omeprazole inj 40 mg/ 10 ml 20 0 20 0 20

77 Omeprazole 20 mg 0 1500 1500 20 68 42 28 54 62 42 34 46 82 68 92 86 724 776

78 Parasetamol Syrup 120 mg / 5 ml 0 0 0 0 0

79 Parasetamol Tablet 500 mg 0 0 0 0 0

80 Pehacain Inj 25 0 25 10 10 5 25 0

81 Pirantel tab 125 mg 111 0 111 10 24 34 77

82 Propiltiourasil 100 mg 0 0 0 0 0

83 Propanolol tab 40 mg 104 0 104 20 30 20 34 104 0


No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 Ranitidin 0 0 0 0 0

85 Ranitidin Inj 0 0 0 0 0

86 Ringer Lactat Infus 0 0 0 0 0

87 Salbutamol 4 mg 444 200 644 30 10 10 5 12 18 10 20 25 10 20 30 25 37 262 382

88 Salep 2- 4 46 0 46 2 1 1 1 5 41

89 Salisil Bedak 2 % 0 0 0 0 0

90 Sefadroksil Syr 0 0 0 0 0

91 Setirizine tab 680 0 680 33 24 18 13 19 33 42 18 24 9 18 18 21 18 42 12 24 30 36 28 12 492 188

92 Simvastatin 20 mg 267 0 267 13 20 10 23 20 10 5 18 12 28 159 108

93 Serum Anti Bisa Ular ( ABU I ) 0 0 0 0 0

94 Serum Anti Tetanus 1.500 UI / ml 0 0 0 0 0

95 Tetrasiklin HCL 250 mg 0 0 0 0 0

96 Tiamin HCL ( Vit B1 ) 50 mg 1641 2000 3641 40 32 78 60 84 36 29 62 39 49 46 118 28 218 200 110 534 36 48 89 77 2013 1628

97 Tramadol caps 50 mg 290 0 290 10 10 10 30 260

98 Vitamin B Complek 3000 0 3000 0 3000

99 Yodium Povidon 30 ml 0 0 0 0 0

100 Zink Syr 0 0 0 0 0

101 Zink tablet 0 0 0 0 0

OBAT GIGI 0 0

102 Curaspon 1 0 1 0 1

103 Etil Klorida semprot 4 0 4 1 1 2 2

104 Eugenol Cairan 0 0 0 0 0

105 Glass ionomer cement ART 1 0 1 0 1

106 Kalsium Hidroksida Pasta 1 0 1 0 1

ALAT KESEHATAN 0 0

107 Alat Suntik 5 cc 18 0 18 0 18

108 Alat Suntik 10 cc 23 0 23 0 23

109 Aquadest 1000 ml 1 0 1 0 1


110 Blood Tranfusion Set 0 0 0 0 0

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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

111 Catgut 2/0 7 0 7 0 7

112 Catgut 3/0 0 0 0 0 0

113 Hand Scun 0 0 0 0 0

114 Infusion set dewasa 0 0 0 0 0

115 I.V Cateter 18 G 10 0 10 0 10

116 I.V Cateter 20 G 0 0 0 0 0

117 I.V Cateter 22 G 0 0 0 0 0

118 I.V Cateter 24 G 0 0 0 0 0

119 Kasa Pembalut 4m x 15 cm 0 0 0 0 0

120 Masker 0 0 0 0 0

121 Plester 5 yard x 2 inch 15 0 15 1 1 1 1 1 3 1 9 6

122 Silk 0 0 0 0 0

123 Spiritus 500 ml 1 0 1 0 1

0 0

0 0

0 0

Mengetahui
Kepala Puskesmas Pengelola Obat PKM

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

BULAN
UPT PKM : September
:
KECAMATAN : TAHUN : 2016
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 92 300 392 230 162 300

2 Acyclovir tab 400 mg Tablet 0 300 300 83 217 200

3 Acyclovir cream 5 % Tube 19 100 119 43 76 100

4 Albendazole 400 mg Tablet 0 0 0 0 0 0

5 Allopurinol 100 mg Tablet 0 0 0 0 0 0

6 Ambroxol Syr 60 ml Botol 28 150 178 139 39 200

7 Ambroxol tab 30 mg Tablet 555 2000 2555 1026 1529 1000

8 Aminopillin tab 200 mg Tablet 35 0 35 0 35 0

9 Amitriptiline 25 Tablet 300 200 500 0 500 0

10 Amlodipin 5 mg Tablet 0 0 0 0 0 0

11 Amlodipin 10 mg Tablet 0 0 0 0 0 0

12 Amoksisillina kapl 250mg Kapsul 0 3000 3000 3000 0 4000

13 Amoksisillina kapl 500mg Tablet 0 0 0 0 0 4000

14 Amoksisillina sirker 250 mg / 5 ml Botol 40 0 40 0 40 0

15 Antasida Doen Tab Tablet 485 5000 5485 4968 517 5000

16 Antasida sir Botol 50 0 50 0 50 0

17 Asam Ascorbat ( Vit.C ) 50 mg Tablet 0 0 0 0 0 0

18 Asam Mefenamat 500 mg Tablet 0 3000 3000 1805 1195 3000

19 Attapulgite 630 mg Tablet 421 0 421 281 140 500

20 Atropin Sulfat 0.5 mg Tablet 200 0 200 0 200 0

21 Besi II Sulfat Tablet 0 600 600 475 125 500

22 Betametason Krim Tube 36 0 36 0 36 0

23 Captopril 12.5 mg Tablet 0 0 0 0 0 0

24 Captopril 25 mg Tablet 0 200 200 58 142 200

25 Captopril 50 mg Tablet 90 500 590 363 227 300

26 Deksametason Inj Ampul 0 0 0 0 0 0

27 Deksametason 0,5 mg Tablet 0 0 0 0 0 1000

28 Diazepam Tab 2 mg Tablet 467 200 667 228 439 300

29 Digoksin 0,25 mg Tablet 500 0 500 0 500 0

30 Diltiazem HCL 30mg Tablet 200 200 400 0 400 0

31 Dipenhidramin Inj Ampul 0 0 0 0 0 0

32 Domperidom Tablet 0 0 0 0 0 500

33 Efedrina HCL 25 mg Tablet 230 500 730 284 446 200

34 Erytromicin Syr Botol 0 0 0 0 0 0

35 Etakridine kom Botol 10 0 10 0 10 0

36 Etanol Botol 0 0 0 0 0 0

37 Fenobarbital tab 30 mg Tablet 849 0 849 45 804 0

38 Fitomenadion Inj Ampul 0 0 0 0 0 0

39 Fitomenadion Tablet Tablet 0 0 0 0 0 0

40 Furrosemida tab Tablet 42 0 42 27 15 200

41 Furrosemida inj Ampul 0 0 0 0 0 0

42 Garam Oralit Tablet 115 200 315 225 90 200


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

43 Gentamicin SK 0,1 % Tube 41 0 41 20 21 50

44 Glibenklamida tab 5 mg Tablet 34 500 534 129 405 200

45 Glimepiride 2 mg Tablet 0 0 0 0 0 0

46 Glukosa Lar. Inf 5 % Botol 0 0 0 0 0 0

47 Griseofulvin tab 125 mg Tablet 0 0 0 0 0 0

48 Halloperidol 0.5 mg Tablet 0 0 0 0 0 0

49 Halloperidol 1.5 mg Tablet 0 1000 1000 670 330 1000

50 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

51 Hidrokortison Krim Tube 0 0 0 0 0 100

52 Ibuprofen tab.200 mg Tablet 700 0 700 0 700 0

53 Kalium Permanganas 5 gr Botol 32 0 32 0 32 0

54 Kals Laktat tab.500 mg Tablet 0 3000 3000 1940 1060 3000

55 Ketokonazol tablet 200 mg Tablet 94 0 94 0 94 0

56 Ketokonazol cream Tube 11 0 11 0 11 0

57 Kloramfenikol salep mata Tube 0 0 0 0 0 0

58 Klorpromazine inj Ampul 0 0 0 0 0 0

59 Kodein HCL 10 mg Tablet 35 200 235 70 165 200

60 Kotrimoksazol Susp Botol 82 0 82 0 82 0

61 Kotrimoksazol 480mg Tab Tablet 0 0 0 0 0 0

62 Levofloxacin 500 mg Tablet 0 0 0 0 0 0

63 Loratadine Tablet 74 0 74 74 0 500

64 Metilergometrin Tab. Tablet 0 0 0 0 0 300

65 Metoclopramide 10 mg Tablet 0 0 0 0 0 0

66 Metronidazole 500 mg Tablet 0 1000 1000 880 120 1000

67 Mikonazole Cream Tube 0 0 0 0 0 0

68 Natrium Bikarbonat Tablet 1051 3000 4051 2153 1898 2000

69 Natrium Diklofenac 50 mg Tablet 0 500 500 500 0 1000

70 Natrium Klorida 0.9 % Botol 100 0 100 0 100 0

71 Nifedipin 10 mg Tablet 0 0 0 0 0 0

72 Nistatin 500.000 IU/g Tablet 349 0 349 0 349 0

73 Obat Batuk hitam Botol 17 48 65 29 36 0

74 Oksitetrasiklin Salep Mata Tube 57 0 57 18 39 50

75 Oksitetrasiklin Salep Kulit Tube 0 100 100 44 56 100

76 Omeprazole inj 40 mg/ 10 ml Vial 20 0 20 0 20 0


77 Omeprazole 20 mg Kapsul 776 900 1676 1079 597 1000
78 Parasetamol Syrup 120 mg / 5 ml Botol 0 0 0 0 0 0
79 Parasetamol Tablet 500 mg Tablet 0 0 0 0 0 0
80 Pehacain Inj Ampul 0 0 0 0 0 60
81 Pirantel tab 125 mg Tablet 77 0 77 31 46 200
82 Propanolol tab 40 mg Tablet 0 0 0 0 0 0
83 Propiltiourasil 100 mg Tablet 0 0 0 0 0 0
84 Ranitidin Tablet 0 0 0 0 0 0
85 Ranitidin Inj Ampul 0 0 0 0 0 0
86 Ringer Lactat Infus Botol 0 0 0 0 0 0
87 Salbutamol 4 mg Tablet 382 300 682 407 275 300
88 Salep 2- 4 Tube 41 0 41 10 31 0

89 Salisil Bedak 2 % kotak 0 0 0 0 0 0


90 Sefadroksil Syr Botol 0 0 0 0 0 200
91 Setirizine tab Tablet 188 500 688 644 44 500

92 Simvastatin 20 mg Tablet 108 0 108 108 0 0


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

93 Serum Anti Bisa Ular ( ABU I ) Vial 0 0 0 0 0 0


94 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0 0
95 Tetrasiklin HCL 250 mg Kapsul 0 0 0 0 0 0
96 Tiamin HCL ( Vit B1 ) 50 mg Tablet 1628 3000 4628 2024 2604 3000
97 Tramadol caps 50 mg Capsul 260 0 260 0 260 500
98 Vitamin B Complek Tablet 3000 0 3000 2460 540 0
99 Yodium Povidon 30 ml Botol 0 0 0 0 0 0
100 Zink Syr Botol 0 0 0 0 0 0

101 Zink tab Tablet 0 0 0 0 0 0

OBAT GIGI

102 Curaspon Botol 1 2 3 0 3 0


103 Etil Klorida semprot Botol 2 2 4 1 3 5

104 Eugenol Cairan Botol 0 2 2 0 2 0


105 Glass ionomer cement ART Botol 1 2 3 0 3 0
106 Kalsium Hidroksida Pasta Set 1 2 3 0 3 0

ALAT KESEHATAN

107 Alat Suntik 5 cc Unit 18 0 18 0 18 0


108 Alat Suntik 10 cc Unit 23 0 23 0 23 0
109 Aquadest 1000 ml Botol 1 0 1 0 1 0

110 Blood Tranfusion Set Kantong 0 0 0 0 0 0


111 Catgut 2/0 Pcs 7 0 7 0 7 0
112 Catgut 3/0 Pcs 0 0 0 0 0 0
113 Hand Scun Set 0 0 0 0 0 0
114 Infusion set dewasa Kantong 0 0 0 0 0 0
115 I.V Cateter 18 G Buah 10 0 10 0 10 0

116 I.V Cateter 20 G Buah 0 0 0 0 0 0


117 I.V Cateter 22 G Buah 0 0 0 0 0 0
118 I.V Cateter 24 G Buah 0 0 0 0 0 0

119 Kasa Pembalut 4m x 15 cm Rol 0 0 0 0 0 0


120 Masker Pcs 0 0 0 0 0 0

121 Plester 5 yard x 2 inch Rol 6 10 16 7 9 10

122 Silk Pcs 0 0 0 0 0 0


123 Spiritus 500 ml Botol 1 0 1 0 1 3
124 Ciprofloxacin 500mg Tablet 0 1000 1000 150 850 0

Mengetahui
Kepala Puskesmas Pengelola Obat PKM

( ) ( )
Nip. Nip.
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) DAK
BULAN SEPTEMBER 2016
PUSSKESMAS:PEUREULAK

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 92 300 392 12 9 18 3 5 26 7 5 106 18 6 12 3 230 162

2 Acyclovir tab 400 mg 0 300 300 15 15 4 10 15 10 4 10 83 217

3 Acyclovir cream 5 % 19 100 119 4 2 1 3 1 4 3 3 1 1 1 4 2 3 1 1 2 1 5 43 76

4 Albendazole 400 mg 0 0 0 0 0

5 Allopurinol 100 mg 0 0 0 0 0

6 Ambroxol Syr 60 ml 28 150 178 6 7 8 3 4 10 7 5 2 6 8 9 5 27 6 4 7 3 2 4 6 139 39

7 Ambroxol tab 30 mg 555 2000 2555 15 38 102 47 42 28 24 18 36 10 17 426 27 18 38 34 68 12 26 1026 1529

8 Aminopillin tab 200 mg 35 0 35 0 35

9 Amitriptiline 25 300 200 500 0 500

10 Amlodipin 5 mg 0 0 0 0 0

11 Amlodipin 10 mg 0 0 0 0 0

12 Amoksisillina kapl 250mg 0 3000 3000 80 246 324 270 360 144 396 270 538 102 270 3000 0

13 Amoksisillina kapl 500mg 0 0 0 0 0

14 Amoksisillina sirker 250 mg / 5 ml 40 0 40 0 40

15 Antasida Doen Tab 485 5000 5485 50 184 106 86 59 124 326 136 214 273 427 315 153 732 328 168 321 306 281 197 182 4968 517

16 Antasida sir 50 0 50 0 50

17 Asam Ascorbat ( Vit.C ) 50 mg 0 0 0 0 0

18 Asam Mefenamat 500 mg 0 3000 3000 155 140 70 125 720 105 90 70 120 65 80 65 1805 1195

19 Attapulgite 630 mg 421 0 421 30 10 10 10 20 25 106 10 20 30 10 281 140

20 Atropin Sulfat 0.5 mg 200 0 200 0 200

21 Besi II Sulfat 0 600 600 20 80 30 40 85 10 120 30 10 20 20 10 475 125

22 Betametason Krim 36 0 36 0 36

23 Captopril 12.5 mg 0 0 0 0 0

24 Captopril 25 mg 0 200 200 18 10 15 5 10 58 142

25 Captopril 50 mg 90 500 590 3 18 3 24 3 18 250 12 20 6 6 363 227


No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 Deksametason Inj 0 0 0 0 0

27 Deksametason 0,5 mg 0 0 0 0 0

28 Diazepam Tab 2 mg 467 200 667 9 3 12 6 16 33 26 3 12 12 3 6 12 18 24 12 3 18 228 439

29 Digoksin 0,25 mg 500 0 500 0 500

30 Diltiazem HCL 30mg 200 200 400 0 400

31 Dipenhidramin Inj 0 0 0 0 0

32 Domperidom 0 0 0 0 0

33 Efedrina HCL 25 mg 230 500 730 20 14 10 20 36 3 16 5 24 12 6 18 24 32 12 26 6 284 446

34 Erytromicin Syr 0 0 0 0 0

35 Etakridine kom 10 0 10 0 10

36 Etanol 0 0 0 0 0

37 Fenobarbital tab 30 mg 849 0 849 10 5 15 10 5 45 804

38 Fitomenadion Inj 0 0 0 0 0

39 Fitomenadion Tablet 0 0 0 0 0

40 Furrosemida tab 42 0 42 3 3 3 6 12 27 15

41 Furrosemida inj 0 0 315 0 315

42 Garam Oralit 115 200 315 10 5 20 15 5 10 5 10 15 65 40 5 10 5 5 225 90

43 Gentamicin SK 0,1 % 41 0 41 2 5 1 2 1 3 1 1 2 1 1 20 21

44 Glibenklamida tab 5 mg 34 500 534 6 18 3 12 16 10 15 28 3 3 12 3 129 405

45 Glimepiride 2 mg 0 0 0 0 0

46 Glukosa Lar. Inf 5 % 0 0 0 0 0

47 Griseofulvin tab 125 mg 0 0 0 0 0

48 Halloperidol 0.5 mg 0 0 0 0 0

49 Halloperidol 1.5 mg 0 1000 1000 40 60 120 40 50 90 30 40 60 80 20 20 20 670 330

50 Halloperidol 1.5 mg 0 0 0 0 0

51 Hidrokortison Krim 0 0 0 0 0

52 Ibuprofen tab.200 mg 700 0 700 0 700

53 Kalium Permanganas 5 gr 32 0 32 0 32

54 Kals Laktat tab.500 mg 0 3000 3000 40 104 76 72 158 46 134 87 465 144 204 108 62 106 76 58 1940 1060
No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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

55 Ketokonazol tablet 200 mg 94 0 94 0 94

56 Ketokonazol cream 11 0 11 0 11

57 Kloramfenikol salep mata 0 0 0 0 0

58 Klorpromazine inj 0 0 0 0 0

59 Kodein HCL 10 mg 35 200 235 10 15 5 5 10 15 5 5 70 165

60 Kotrimoksazol Susp 82 0 82 0 82

61 Kotrimoksazol 480mg Tab 0 0 0 0 0

62 Levofloxacin 500 mg 0 0 0 0 0

63 Loratadine 74 0 74 6 9 12 5 6 9 9 6 12 74 0

64 Metilergometrin Tab. 0 0 0 0 0

65 Metoclopramide 10 mg 0 0 0 0 0

66 Metronidazole 500 mg 0 1000 1000 40 65 50 60 70 20 435 30 50 30 30 880 120

67 Mikonazole Cream 0 0 0 0 0

68 Natrium Bikarbonat 1051 3000 4051 68 120 46 102 68 32 98 108 62 57 86 842 26 88 148 86 52 64 2153 1898

69 Natrium Diklofenac 50 mg 0 500 500 45 65 72 37 24 107 105 45 500 0

70 Natrium Klorida 0.9 % 100 0 100 0 100

71 Nifedipin 10 mg 0 0 0 0 0

72 Nistatin 500.000 IU/g 349 0 349 0 349

73 Obat Batuk hitam 17 48 65 1 3 2 1 1 2 15 1 2 1 29 36

74 Oksitetrasiklin Salep Mata 57 0 57 2 1 3 1 2 2 1 2 1 3 18 39

75 Oksitetrasiklin Salep Kulit 0 100 100 2 5 3 2 6 5 1 4 3 5 2 2 4 44 56

76 Omeprazole inj 40 mg/ 10 ml 20 0 20 0 20

77 Omeprazole 20 mg 776 900 1676 36 87 104 39 21 27 89 146 22 16 62 32 24 30 16 69 87 59 32 24 57 1079 597

78 Parasetamol Syrup 120 mg / 5 ml 0 0 0 0 0

79 Parasetamol Tablet 500 mg 0 0 0 0 0

80 Pehacain Inj 0 0 0 0 0

81 Pirantel tab 125 mg 77 0 77 4 6 2 8 4 1 4 2 31 46

82 Propiltiourasil 100 mg 0 0 0 0 0

83 Propanolol tab 40 mg 0 0 0 0 0
No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 Ranitidin 0 0 0 0 0

85 Ranitidin Inj 0 0 0 0 0

86 Ringer Lactat Infus 0 0 0 0 0

87 Salbutamol 4 mg 382 300 682 10 25 15 10 24 10 5 24 15 214 10 20 15 10 407 275

88 Salep 2- 4 41 0 41 1 2 3 1 1 2 10 31

89 Salisil Bedak 2 % 0 0 0 0 0

90 Sefadroksil Syr 0 0 0 0 0

91 Setirizine tab 188 500 688 18 24 88 24 34 18 76 36 9 12 49 82 18 14 9 64 13 9 12 26 9 644 44

92 Simvastatin 20 mg 108 0 108 6 34 5 10 12 3 10 28 108 0

93 Serum Anti Bisa Ular ( ABU I ) 0 0 0 0 0

94 Serum Anti Tetanus 1.500 UI / ml 0 0 0 0 0

95 Tetrasiklin HCL 250 mg 0 0 0 0 0

96 Tiamin HCL ( Vit B1 ) 50 mg 1628 3000 4628 50 121 36 72 104 89 134 68 54 76 36 24 846 42 76 27 32 63 74 2024 2604

97 Tramadol caps 50 mg 260 0 260 0 260

98 Vitamin B Complek 3000 0 3000 82 105 198 205 146 721 179 201 186 96 102 132 107 2460 540

99 Yodium Povidon 30 ml 0 0 0 0 0

100 Zink Syr 0 0 0 0 0

101 Zink tablet 0 0 0 0 0

OBAT GIGI 0 0

102 Curaspon 1 2 3 0 3

103 Etil Klorida semprot 2 2 4 1 1 3

104 Eugenol Cairan 0 2 2 0 2

105 Glass ionomer cement ART 1 2 3 0 3

106 Kalsium Hidroksida Pasta 1 2 3 0 3

ALAT KESEHATAN 0 0

107 Alat Suntik 5 cc 18 0 18 0 18

108 Alat Suntik 10 cc 23 0 23 0 23

109 Aquadest 1000 ml 1 0 1 0 1


110 Blood Tranfusion Set 0 0 0 0 0

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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

111 Catgut 2/0 7 0 7 0 7

112 Catgut 3/0 0 0 0 0 0

113 Hand Scun 0 0 0 0 0

114 Infusion set dewasa 0 0 0 0 0

115 I.V Cateter 18 G 10 0 10 0 10

116 I.V Cateter 20 G 0 0 0 0 0

117 I.V Cateter 22 G 0 0 0 0 0

118 I.V Cateter 24 G 0 0 0 0 0

119 Kasa Pembalut 4m x 15 cm 0 0 0 0 0

120 Masker 0 0 0 0 0

121 Plester 5 yard x 2 inch 6 10 16 1 1 1 1 2 1 7 9

122 Silk 0 0 0 0 0

123 Spiritus 500 ml 1 0 1 0 1

124 Ciprofloxacin 500mg 0 1000 1000 12 6 18 18 24 6 12 6 18 18 12 150 850

Mengetahui
Kepala Puskesmas Pengelola Obat PKM

( ) ( Erlina.Amk )
Nip. Nip. 19770415 200604 2 010
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT DAK
( LPLPO ) DAK

BULAN
UPT PKM : PEUREULAK Oktober
:
KECAMATAN : PEUREULAK TAHUN : 2016
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 162 200 362 62 300 0

2 Acyclovir tab 400 mg Tablet 217 100 317 54 263 100

3 Acyclovir cream 5 % Tube 76 100 176 44 132 50

4 Albendazole 400 mg Tablet 0 0 0 0 0 0

5 Allopurinol 100 mg Tablet 0 0 0 0 0 0

6 Ambroxol Syr 60 ml Botol 39 200 239 60 179 100

7 Ambroxol tab 30 mg Tablet 1529 1000 2529 791 1738 0

8 Aminopillin tab 200 mg Tablet 35 0 35 0 35 0

9 Amitriptiline 25 Tablet 500 0 500 0 500 0

10 Amlodipin 5 mg Tablet 0 0 0 0 0 0

11 Amlodipin 10 mg Tablet 0 0 0 0 0 0

12 Amoksisillina kapl 250mg Kapsul 0 5000 5000 5000 0 7000

13 Amoksisillina kapl 500mg Tablet 0 0 0 0 0 7000

14 Amoksisillina sirker 250 mg / 5 ml Botol 40 0 40 40 0 0

15 Antasida Doen Tab Tablet 517 0 517 517 0 0

16 Antasida sir Botol 50 0 50 50 0 0

17 Asam Ascorbat ( Vit.C ) 50 mg Tablet 0 0 0 0 0 0

18 Asam Mefenamat 500 mg Tablet 1195 0 1195 1195 0 0

19 Attapulgite 630 mg Tablet 140 0 140 140 0 500

20 Atropin Sulfat 0.5 mg Tablet 200 0 200 0 200 0

21 Besi II Sulfat Tablet 125 300 425 425 0 0

22 Betametason Krim Tube 36 0 36 36 0 0

23 Captopril 12.5 mg Tablet 0 500 500 0 500 0

24 Captopril 25 mg Tablet 142 0 142 142 0 0

25 Captopril 50 mg Tablet 227 200 427 253 174 0

26 Deksametason Inj Ampul 0 50 50 0 50 0

27 Deksametason 0,5 mg Tablet 0 7000 7000 2745 4255 5000

28 Diazepam Tab 2 mg Tablet 439 200 639 121 518 100

29 Digoksin 0,25 mg Tablet 500 0 500 0 500 0

30 Diltiazem HCL 30mg Tablet 400 0 400 0 400 0

31 Dipenhidramin Inj Ampul 0 0 0 0 0 0

32 Domperidom Tablet 0 0 0 0 0 500

33 Efedrina HCL 25 mg Tablet 446 500 946 226 720 0

34 Erytromicin Syr Botol 0 50 50 50 0 0

35 Etakridine kom Botol 10 3 13 3 10 0

36 Etanol Botol 0 10 10 1 9 0

37 Fenobarbital tab 30 mg Tablet 804 2000 2804 0 2804 0

38 Fitomenadion Inj Ampul 0 30 30 0 30 0

39 Fitomenadion Tablet Tablet 0 0 0 0 0 0

40 Furrosemida tab Tablet 15 0 15 15 0 0

41 Furrosemida inj Ampul 0 25 25 5 20 0

42 Garam Oralit Tablet 90 300 390 183 207 100


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

43 Gentamicin SK 0,1 % Tube 21 30 51 28 23 30

44 Glibenklamida tab 5 mg Tablet 405 300 705 171 534 200

45 Glimepiride 2 mg Tablet 0 0 0 0 0 0

46 Glukosa Lar. Inf 5 % Botol 0 0 0 0 0 0

47 Griseofulvin tab 125 mg Tablet 0 0 0 0 0 500

48 Halloperidol 0.5 mg Tablet 0 0 0 0 0 0

49 Halloperidol 1.5 mg Tablet 330 1000 1330 890 440 1000

50 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

51 Hidrokortison Krim Tube 0 96 96 65 31 50

52 Ibuprofen tab.200 mg Tablet 700 0 700 240 460 0

53 Kalium Permanganas 5 gr Botol 32 48 80 0 80 0

54 Kals Laktat tab.500 mg Tablet 1060 1000 2060 908 1152 1000

55 Ketokonazol tablet 200 mg Tablet 94 0 94 94 0 500

56 Ketokonazol cream Tube 11 0 11 11 0

57 Kloramfenikol salep mata Tube 0 0 0 0 0

58 Klorpromazine inj Ampul 0 0 0 0 0

59 Kodein HCL 10 mg Tablet 165 0 165 70 95

60 Kotrimoksazol Susp Botol 82 0 82 82 0

61 Kotrimoksazol 480mg Tab Tablet 0 0 0 0 0 0

62 Levofloxacin 500 mg Tablet 0 0 0 0 0

63 Loratadine Tablet 0 0 0 0 0

64 Metilergometrin Tab. Tablet 0 0 0 0 0

65 Metoclopramide 10 mg Tablet 0 0 0 0 0

66 Metronidazole 500 mg Tablet 120 0 120 120 0

67 Mikonazole Cream Tube 0 0 0 0 0

68 Natrium Bikarbonat Tablet 1898 2000 3898 1494 2404

69 Natrium Diklofenac 50 mg Tablet 0 0 0 0 0

70 Natrium Klorida 0.9 % Botol 100 0 100 100 0

71 Nifedipin 10 mg Tablet 0 0 0 0 0

72 Nistatin 500.000 IU/g Tablet 349 0 349 0 349

73 Obat Batuk hitam Botol 36 0 36 25 11

74 Oksitetrasiklin Salep Mata Tube 39 50 89 18 71

75 Oksitetrasiklin Salep Kulit Tube 56 100 156 60 96

76 Omeprazole inj 40 mg/ 10 ml Vial 20 0 20 0 20

77 Omeprazole 20 mg Kapsul 597 0 597 597 0

78 Parasetamol Syrup 120 mg / 5 ml Botol 0 0 0 0 0

79 Parasetamol Tablet 500 mg Tablet 0 0 0 0 0

80 Pehacain Inj Ampul 0 0 0 0 0

81 Pirantel tab 125 mg Tablet 46 100 146 68 78

82 Propanolol tab 40 mg Tablet 0 100 100 0 100

83 Propiltiourasil 100 mg Tablet 0 0 0 0 0

84 Ranitidin Tablet 0 0 0 0 0

85 Ranitidin Inj Ampul 0 20 20 10 10

86 Ringer Lactat Infus Botol 0 0 0 0 0

87 Salbutamol 4 mg Tablet 275 200 475 260 215

88 Salep 2- 4 Tube 31 0 31 2 29

89 Salisil Bedak 2 % kotak 0 0 0 0 0

90 Sefadroksil Syr Botol 0 150 150 34 116

91 Setirizine tab Tablet 44 1000 1044 584 460

92 Simvastatin 20 mg Tablet 0 0 0 0 0
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

93 Serum Anti Bisa Ular ( ABU I ) Vial 0 0 0 0 0

94 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0

95 Tetrasiklin HCL 250 mg Kapsul 0 0 0 0 0

96 Tiamin HCL ( Vit B1 ) 50 mg Tablet 2604 3000 5604 3055 2549

97 Tramadol caps 50 mg Capsul 260 0 260 0 260

98 Vitamin B Complek Tablet 540 0 540 540 0

99 Yodium Povidon 30 ml Botol 0 0 0 0 0

100 Zink Syr Botol 0 0 0 0 0

101 Zink tab Tablet 0 0 0 0 0

OBAT GIGI

102 Curaspon Botol 3 0 3 0 3

103 Etil Klorida semprot Botol 3 3 6 1 5

104 Eugenol Cairan Botol 2 0 2 1 1

105 Glass ionomer cement ART Botol 3 0 3 0 3

106 Kalsium Hidroksida Pasta Set 3 0 3 0 3

ALAT KESEHATAN

107 Alat Suntik 5 cc Unit 18 0 18 18 0

108 Alat Suntik 10 cc Unit 23 0 23 23 0

109 Aquadest 1000 ml Botol 1 0 1 1 0

110 Blood Tranfusion Set Kantong 0 0 0 0 0

111 Catgut 2/0 Pcs 7 0 7 7 0

112 Catgut 3/0 Pcs 0 0 0 0 0

113 Hand Scun Set 0 0 0 0 0

114 Infusion set dewasa Kantong 0 0 0 0 0

115 I.V Cateter 18 G Buah 10 0 10 10 0

116 I.V Cateter 20 G Buah 0 0 0 0 0

117 I.V Cateter 22 G Buah 0 0 0 0 0

118 I.V Cateter 24 G Buah 0 0 0 0 0

119 Kasa Pembalut 4m x 15 cm Rol 0 0 0 0 0

120 Masker Pcs 0 0 0 0 0

121 Plester 5 yard x 2 inch Rol 9 5 14 3 11

122 Silk Pcs 0 0 0 0 0

123 Spiritus 500 ml Botol 1 5 6 0 6

124 Benecheck Glukose 50s Strip 0 50 50 6 44

125 Benecheck Total Chof 10s Strip 0 50 50 4 47

126 Benecheck Urid Acid 25s Strip 0 50 50 0 50

127 Blood Tranfusion Set Kantong 0 5 5 0 5

128 Infusion set Y Connector Kantong 0 10 10 0 10

129 Oksigen Masker Pcs 0 6 6 0 6

130 Siprofloxacin 500mg Tablet 850 0 850 138 712

Mengetahui
Kepala Puskesmas Pengelola Obat PKM

( MUKHLIS.SKM.M.Kes ) ( ERLINA.AMK )
Nip.19720709 199303 1 003 Nip.19770415 200604 2 010
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) DAK
BULAN OKTOBER 2016
PUSKESMAS :PEUREULAK
0
No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 162 200 362 3 15 3 10 10 15 4 2 62 300

2 Acyclovir tab 400 mg 217 100 317 15 5 15 2 2 15 54 263

3 Acyclovir cream 5 % 76 100 176 1 2 4 2 2 3 1 2 18 1 1 5 2 44 132

4 Albendazole 400 mg 0 0 0 0 0

5 Allopurinol 100 mg 0 0 0 0 0

6 Ambroxol Syr 60 ml 39 200 239 4 6 2 5 3 2 3 1 1 26 2 3 2 60 179

7 Ambroxol tab 30 mg 1529 1000 2529 67 64 35 98 30 24 10 18 35 3 15 25 328 4 25 10 791 1738

8 Aminopillin tab 200 mg 35 0 35 0 35

9 Amitriptiline 25 500 0 500 0 500

10 Amlodipin 5 mg 0 0 0 0 0

11 Amlodipin 10 mg 0 0 0 0 0

12 Amoksisillina kapl 250mg 0 5000 5000 89 283 341 397 380 185 265 360 386 914 358 243 368 431 5000 0

13 Amoksisillina kapl 500mg 0 0 0 0 0

14 Amoksisillina sirker 250 mg / 5 ml 40 0 40 13 15 7 5 40 0

15 Antasida Doen Tab 517 0 517 115 162 240 517 0

16 Antasida sir 50 0 50 18 5 9 11 7 50 0

17 Asam Ascorbat ( Vit.C ) 50 mg 0 0 0 0 0

18 Asam Mefenamat 500 mg 1195 0 1195 50 110 130 110 120 120 60 45 50 110 65 20 70 40 95 1195 0

19 Attapulgite 630 mg 140 0 140 20 10 15 20 10 25 20 20 140 0

20 Atropin Sulfat 0.5 mg 200 0 200 0 200

21 Besi II Sulfat 125 300 425 25 10 20 40 20 35 10 10 15 240 425 0

22 Betametason Krim 36 0 36 3 2 4 4 3 6 3 3 5 3 36 0

23 Captopril 12.5 mg 0 500 500 0 500

24 Captopril 25 mg 142 0 142 6 12 16 5 25 18 10 18 12 5 15 142 0

25 Captopril 50 mg 227 200 427 10 5 5 10 3 5 3 206 3 3 253 174


No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 Deksametason Inj 0 50 50 0 50

27 Deksametason 0,5 mg 0 7000 7000 1706 254 182 114 238 251 2745 4255

28 Diazepam Tab 2 mg 439 200 639 9 3 3 3 10 9 3 6 3 9 12 3 3 6 12 6 6 3 3 6 3 121 518

29 Digoksin 0,25 mg 500 0 500 0 500

30 Diltiazem HCL 30mg 400 0 400 0 400

31 Dipenhidramin Inj 0 0 0 0 0

32 Domperidom 0 0 0 0 0

33 Efedrina HCL 25 mg 446 500 946 20 4 24 18 12 10 34 5 10 18 26 5 18 19 3 226 720

34 Erytromicin Syr 0 50 50 1 3 2 1 2 3 3 2 30 1 2 50 0

35 Etakridine kom 10 3 13 3 3 10

36 Etanol 0 10 10 1 1 9

37 Fenobarbital tab 30 mg 804 2000 2804 0 2804

38 Fitomenadion Inj 0 30 30 0 30

39 Fitomenadion Tablet 0 0 0 0 0

40 Furrosemida tab 15 0 15 3 3 6 3 15 0

41 Furrosemida inj 0 25 25 5 5 20

42 Garam Oralit 90 300 390 15 5 10 15 16 5 15 25 5 10 42 5 10 5 183 207

43 Gentamicin SK 0,1 % 21 30 51 2 1 3 4 5 1 1 4 3 2 1 1 28 23

44 Glibenklamida tab 5 mg 405 300 705 5 16 18 24 6 3 13 9 12 18 26 9 12 171 534

45 Glimepiride 2 mg 0 0 0 0 0

46 Glukosa Lar. Inf 5 % 0 0 0 0 0

47 Griseofulvin tab 125 mg 0 0 0 0 0

48 Halloperidol 0.5 mg 0 0 0 0 0

49 Halloperidol 1.5 mg 330 1000 1330 60 40 40 80 110 60 40 60 140 20 20 80 40 60 40 890 440

50 Halloperidol 1.5 mg 0 0 0 0 0

51 Hidrokortison Krim 0 96 96 3 5 7 7 3 1 2 5 17 6 1 3 2 3 65 31

52 Ibuprofen tab.200 mg 700 0 700 25 10 40 30 10 40 45 20 20 240 460

53 Kalium Permanganas 5 gr 32 48 80 0 80

54 Kals Laktat tab.500 mg 1060 1000 2060 68 34 20 40 68 123 18 46 35 340 35 24 18 27 12 908 1152
No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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

55 Ketokonazol tablet 200 mg 94 0 94 30 29 20 15 94 0

56 Ketokonazol cream 11 0 11 2 1 1 2 2 1 2 11 0

57 Kloramfenikol salep mata 0 0 0 0 0

58 Klorpromazine inj 0 0 0 0 0

59 Kodein HCL 10 mg 165 0 165 10 10 5 10 25 10 70 95

60 Kotrimoksazol Susp 82 0 82 7 11 5 3 8 7 4 3 6 5 7 3 4 3 6 82 0

61 Kotrimoksazol 480mg Tab 0 0 0 0 0

62 Levofloxacin 500 mg 0 0 0 0 0

63 Loratadine 0 0 0 0 0

64 Metilergometrin Tab. 0 0 0 0 0

65 Metoclopramide 10 mg 0 0 0 0 0

66 Metronidazole 500 mg 120 0 120 40 10 30 40 120 0

67 Mikonazole Cream 0 0 0 0 0

68 Natrium Bikarbonat 1898 2000 3898 104 40 65 48 64 56 48 73 20 84 96 10 35 55 72 482 20 26 57 39 1494 2404

69 Natrium Diklofenac 50 mg 0 0 0 0 0

70 Natrium Klorida 0.9 % 100 0 100 20 20 20 40 100 0

71 Nifedipin 10 mg 0 0 0 0 0

72 Nistatin 500.000 IU/g 349 0 349 0 349

73 Obat Batuk hitam 36 0 36 3 1 1 4 1 15 25 11

74 Oksitetrasiklin Salep Mata 39 50 89 2 1 3 2 1 4 2 1 1 1 18 71

75 Oksitetrasiklin Salep Kulit 56 100 156 5 2 3 3 7 3 1 1 2 4 1 1 3 13 3 5 3 60 96

76 Omeprazole inj 40 mg/ 10 ml 20 0 20 0 20

77 Omeprazole 20 mg 597 0 597 212 86 122 90 87 597 0

78 Parasetamol Syrup 120 mg / 5 ml 0 0 0 0 0

79 Parasetamol Tablet 500 mg 0 0 0 0 0

80 Pehacain Inj 0 0 0 0 0

81 Pirantel tab 125 mg 46 100 146 4 2 8 2 8 4 10 8 2 4 12 4 68 78

82 Propiltiourasil 100 mg 0 100 100 0 100

83 Propanolol tab 40 mg 0 0 0 0 0
No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 Ranitidin 0 0 0 0 0

85 Ranitidin Inj 0 20 20 5 5 10 10

86 Ringer Lactat Infus 0 0 0 0 0

87 Salbutamol 4 mg 275 200 475 10 5 15 35 10 5 15 35 20 15 10 25 35 5 15 5 260 215

88 Salep 2- 4 31 0 31 2 2 29

89 Salisil Bedak 2 % 0 0 0 0 0

90 Sefadroksil Syr 0 150 150 2 1 3 3 1 2 6 3 4 3 1 3 2 34 116

91 Setirizine tab 44 1000 1044 30 14 18 12 25 45 35 18 9 9 25 225 12 9 15 36 47 584 460

92 Simvastatin 20 mg 0 0 0 0 0

93 Serum Anti Bisa Ular ( ABU I ) 0 0 0 0 0

94 Serum Anti Tetanus 1.500 UI / ml 0 0 0 0 0

95 Tetrasiklin HCL 250 mg 0 0 0 0 0

96 Tiamin HCL ( Vit B1 ) 50 mg 2604 3000 5604 112 86 108 86 104 144 64 68 43 164 186 31 22 47 122 1232 88 86 73 125 64 3055 2549

97 Tramadol caps 50 mg 260 0 260 0 260

98 Vitamin B Complek 540 0 540 142 175 98 125 540 0

99 Yodium Povidon 30 ml 0 0 0 0 0

100 Zink Syr 0 0 0 0 0

101 Zink tablet 0 0 0 0 0

OBAT GIGI 0 0

102 Curaspon 3 0 3 0 3

103 Etil Klorida semprot 3 3 6 1 1 5

104 Eugenol Cairan 2 0 2 1 1 1

105 Glass ionomer cement ART 3 0 3 0 3

106 Kalsium Hidroksida Pasta 3 0 3 0 3

ALAT KESEHATAN 0 0

107 Alat Suntik 5 cc 18 0 18 18 18 0

108 Alat Suntik 10 cc 23 0 23 23 23 0

109 Aquadest 1000 ml 1 0 1 1 1 0

110 Blood Tranfusion Set 0 0 0 0 0


No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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

111 Catgut 2/0 7 0 7 7 7 0

112 Catgut 3/0 0 0 0 0 0

113 Hand Scun 0 0 0 0 0

114 Infusion set dewasa 0 0 0 0 0

115 I.V Cateter 18 G 10 0 10 10 10 0

116 I.V Cateter 20 G 0 0 0 0 0

117 I.V Cateter 22 G 0 0 0 0 0

118 I.V Cateter 24 G 0 0 0 0 0

119 Kasa Pembalut 4m x 15 cm 0 0 0 0 0

120 Masker 0 0 0 0 0

121 Plester 5 yard x 2 inch 9 5 14 1 1 1 3 11

122 Silk 0 0 0 0 0

123 Spiritus 500 ml 1 5 6 0 6

124 Benecheck Glukose 50s 0 50 50 1 3 2 6 44

125 Benecheck Total Chof 10s 0 50 50 2 1 3 47

126 Benecheck Urid Acid 25s 0 50 50 0 50

127 Blood Tranfusion Set 0 5 5 0 5

128 Infusion set Y Connector 0 10 10 0 10

129 Oksigen Masker 0 6 6 5 1 6 0

130 Siprofloxacin 500mg 850 0 850 18 6 12 24 18 6 18 6 18 12 138 712

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 DAK
( LPLPO ) DAK

BULAN
UPT PKM : November
:
KECAMATAN : TAHUN : 2016
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK


AWAL MAAN DIAAN KAIAN AKHIR
1 2 3 4 5 6 7 8

1 Acyclovir tab 200 mg Tablet 300 0 300 160 140

2 Acyclovir tab 400 mg Tablet 263 100 363 129 234

3 Acyclovir cream 5 % Tube 132 0 132 46 86

4 Albendazole 400 mg Tablet 0 0 0 0 0

5 Allopurinol 100 mg Tablet 0 0 0 0 0

6 Ambroxol Syr 60 ml Botol 179 200 379 116 263

7 Ambroxol tab 30 mg Tablet 1738 0 1738 1565 173

8 Aminopillin tab 200 mg Tablet 35 0 35 0 35

9 Amitriptiline 25 Tablet 500 0 500 0 500

10 Amlodipin 5 mg Tablet 0 0 0 0 0

11 Amlodipin 10 mg Tablet 0 0 0 0 0

12 Amoksisillina kapl 250mg Kapsul 0 3000 3000 3000 0

13 Amoksisillina kapl 500mg Tablet 0 0 0 0 0

14 Amoksisillina sirker 250 mg / 5 ml Botol 0 0 0 0 0

15 Antasida Doen Tab Tablet 0 0 0 0 0

16 Antasida sir Botol 0 0 0 0 0

17 Asam Ascorbat ( Vit.C ) 50 mg Tablet 0 0 0 0 0

18 Asam Mefenamat 500 mg Tablet 0 0 0 0 0

19 Attapulgite 630 mg Tablet 0 0 0 0 0

20 Atropin Sulfat 0.5 mg Tablet 200 300 500 0 500

21 Besi II Sulfat Tablet 0 900 900 405 495

22 Betametason Krim Tube 0 0 0 0 0

23 Captopril 12.5 mg Tablet 500 0 500 101 399

24 Captopril 25 mg Tablet 0 0 0 0 0
25 Captopril 50 mg Tablet 174 0 174 46 128

26 Deksametason Inj Ampul 50 0 50 0 50

27 Deksametason 0,5 mg Tablet 4255 3000 7255 5744 1511

28 Diazepam Tab 2 mg Tablet 518 500 1018 275 743

29 Digoksin 0,25 mg Tablet 500 0 500 0 500

30 Diltiazem HCL 30mg Tablet 400 300 700 0 700

31 Dipenhidramin Inj Ampul 0 0 0 0 0

32 Domperidom Tablet 0 0 0 0 0

33 Efedrina HCL 25 mg Tablet 720 0 720 570 150

34 Erytromicin Syr Botol 0 100 100 0 100

35 Etakridine kom Botol 10 0 10 0 10

36 Etanol Botol 9 0 9 0 9

37 Fenobarbital tab 30 mg Tablet 2804 0 2804 110 2694

38 Fitomenadion Inj Ampul 30 0 30 0 30

39 Fitomenadion Tablet Tablet 0 0 0 0 0

40 Furrosemida tab Tablet 0 0 0 0 0

41 Furrosemida inj Ampul 20 10 30 0 30

42 Garam Oralit Tablet 207 100 307 175 132

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK


AWAL MAAN DIAAN KAIAN AKHIR
1 2 3 4 5 6 7 8

43 Gentamicin SK 0,1 % Tube 23 30 53 18 35

44 Glibenklamida tab 5 mg Tablet 534 500 1034 109 925

45 Glimepiride 2 mg Tablet 0 300 300 114 186

46 Glukosa Lar. Inf 5 % Botol 0 0 0 0 0

47 Griseofulvin tab 125 mg Tablet 0 0 0 0 0

48 Halloperidol 0.5 mg Tablet 0 0 0 0 0

49 Halloperidol 1.5 mg Tablet 440 0 440 440 0

50 Halloperidol 1.5 mg Tablet 0 0 0 0 0

51 Hidrokortison Krim Tube 31 0 31 31 0

52 Ibuprofen tab.200 mg Tablet 460 0 460 460 0

53 Kalium Permanganas 5 gr Botol 80 0 80 0 80

54 Kals Laktat tab.500 mg Tablet 1152 1000 2152 952 1200


55 Ketokonazol tablet 200 mg Tablet 0 0 0 0 0

56 Ketokonazol cream Tube 0 0 0 0 0

57 Kloramfenikol salep mata Tube 0 0 0 0 0

58 Klorpromazine inj Ampul 0 0 0 0 0

59 Kodein HCL 10 mg Tablet 95 0 95 70 25

60 Kotrimoksazol Susp Botol 0 0 0 0 0

61 Kotrimoksazol 480mg Tab Tablet 0 0 0 0 0

62 Levofloxacin 500 mg Tablet 0 500 500 39 461

63 Loratadine Tablet 0 0 0 0 0

64 Metilergometrin Tab. Tablet 0 200 200 40 160

65 Metoclopramide 10 mg Tablet 0 0 0 0 0

66 Metronidazole 500 mg Tablet 0 0 0 0 0

67 Mikonazole Cream Tube 0 0 0 0 0

68 Natrium Bikarbonat Tablet 2404 0 2404 1700 704

69 Natrium Diklofenac 50 mg Tablet 0 0 0 0 0

70 Natrium Klorida 0.9 % Botol 0 0 0 0 0

71 Nifedipin 10 mg Tablet 0 0 0 0 0

72 Nistatin 500.000 IU/g Tablet 349 0 349 0 349

73 Obat Batuk hitam Botol 11 120 131 13 118

74 Oksitetrasiklin Salep Mata Tube 71 0 71 0 71

75 Oksitetrasiklin Salep Kulit Tube 96 0 96 37 59

76 Omeprazole inj 40 mg/ 10 ml Vial 20 0 20 0 20

77 Omeprazole 20 mg Kapsul 0 0 0 0 0

78 Parasetamol Syrup 120 mg / 5 ml Botol 0 0 0 0 0

79 Parasetamol Tablet 500 mg Tablet 0 0 0 0 0

80 Pehacain Inj Ampul 0 60 60 25 35

81 Pirantel tab 125 mg Tablet 78 0 78 0 78

82 Propanolol tab 40 mg Tablet 100 0 100 100 0

83 Propiltiourasil 100 mg Tablet 0 0 0 0 0

84 Ranitidin Tablet 0 0 0 0 0

85 Ranitidin Inj Ampul 10 0 10 0 10

86 Ringer Lactat Infus Botol 0 0 0 0 0

87 Salbutamol 4 mg Tablet 215 0 215 215 0

88 Salep 2- 4 Tube 29 0 29 7 22

89 Salisil Bedak 2 % kotak 0 0 0 0 0


90 Sefadroksil Syr Botol 116 100 216 35 181

91 Setirizine tab Tablet 460 0 460 460 0

92 Simvastatin 20 mg Tablet 0 0 0 0 0

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK


AWAL MAAN DIAAN KAIAN AKHIR
1 2 3 4 5 6 7 8

93 Serum Anti Bisa Ular ( ABU I ) Vial 0 0 0 0 0

94 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0

95 Tetrasiklin HCL 250 mg Kapsul 0 0 0 0 0

96 Tiamin HCL ( Vit B1 ) 50 mg Tablet 2549 0 2549 2549 0

97 Tramadol caps 50 mg Capsul 260 0 260 260 0

98 Vitamin B Complek Tablet 0 0 0 0 0

99 Yodium Povidon 30 ml Botol 0 0 0 0 0

100 Zink Syr Botol 0 0 0 0 0

101 Zink tab Tablet 0 0 0 0 0

OBAT GIGI

102 Curaspon Botol 3 0 3 0 3

103 Etil Klorida semprot Botol 5 0 5 0 5

104 Eugenol Cairan Botol 1 0 1 1 0

105 Glass ionomer cement ART Botol 3 0 3 0 3

106 Kalsium Hidroksida Pasta Set 3 0 3 1 2

ALAT KESEHATAN

107 Alat Suntik 5 cc Unit 0 0 0 0 0

108 Alat Suntik 10 cc Unit 0 0 0 0 0

109 Aquadest 1000 ml Botol 0 0 0 0 0

110 Blood Tranfusion Set Kantong 0 0 0 0 0

111 Catgut 2/0 Pcs 0 0 0 0 0

112 Catgut 3/0 Pcs 0 0 0 0 0

113 Hand Scun Set 0 0 0 0 0

114 Infusion set dewasa Kantong 0 0 0 0 0

115 I.V Cateter 18 G Buah 0 0 0 0 0

116 I.V Cateter 20 G Buah 0 0 0 0 0

117 I.V Cateter 22 G Buah 0 0 0 0 0


118 I.V Cateter 24 G Buah 0 0 0 0 0

119 Kasa Pembalut 4m x 15 cm Rol 0 0 0 0 0

120 Masker Pcs 0 0 0 0 0

121 Plester 5 yard x 2 inch Rol 11 0 11 6 5

122 Silk Pcs 0 0 0 0 0

123 Spiritus 500 ml Botol 6 0 6 0 6

124 Benecheck Glukose 50s Strip 44 50 94 94 0

125 Benecheck Total Chof 10s Strip 47 0 47 13 34

126 Benecheck Urid Acid 25s Strip 50 0 50 17 33

127 Blood Tranfusion Set Kantong 5 0 5 0 5

128 Infusion set Y Connector Kantong 10 0 10 0 10

129 Oksigen Masker Pcs 6 0 6 0 6

130 Siprofloxacin 500mg Tablet 712 0 712 348 364

131 Test uji kehamilan 25 MU/ml Strip 50 0 50 6 44

Mengetahui
Kepala Puskesmas Pengelola Obat PKM

( ) ( )
Nip. Nip.
AT DAK

November

PERMIN
KET
TAAN
9 10

200

200

50

1500

3500

3000

500

0
0

5000

1000

500

200

PERMIN
KET
TAAN
9 10

200

1000

50

1000
0

1000

2000

100

50

1000

500

50

0
50

500

PERMIN
KET
TAAN
9 10

3500

500

0
0

0
0

100

25

25

500

gelola Obat PKM

)
LAPORAN PENGGUNAAN OBAT H
BULAN NOVEMBE
PUSKESMAS :Peureulak

No Nama Obat Persediaan Jumlah Jenis O

Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11

1 Acyclovir tab 200 mg 300 0 300 15 5 4 12

2 Acyclovir tab 400 mg 263 100 363 4 15

3 Acyclovir cream 5 % 132 0 132 12 2 2 1 2 1 1 2 2

4 Albendazole 400 mg 0 0 0

5 Allopurinol 100 mg 0 0 0

6 Ambroxol Syr 60 ml 179 200 379 3 5 12 9 2 1 7

7 Ambroxol tab 30 mg 1738 0 1738 86 42 40 102 114 62 25 47 92

8 Aminopillin tab 200 mg 35 0 35

9 Amitriptiline 25 500 0 500

10 Amlodipin 5 mg 0 0 0

11 Amlodipin 10 mg 0 0 0

12 Amoksisillina kapl 250mg 0 3000 3000 322

13 Amoksisillina kapl 500mg 0 0 0

14 Amoksisillina sirker 250 mg / 5 ml 0 0 0

15 Antasida Doen Tab 0 0 0

16 Antasida sir 0 0 0

17 Asam Ascorbat ( Vit.C ) 50 mg 0 0 0

18 Asam Mefenamat 500 mg 0 0 0

19 Attapulgite 630 mg 0 0 0

20 Atropin Sulfat 0.5 mg 200 300 500

21 Besi II Sulfat 0 900 900 30

22 Betametason Krim 0 0 0

23 Captopril 12.5 mg 500 0 500 3 12 10 6

24 Captopril 25 mg 0 0 0

25 Captopril 50 mg 174 0 174 3 3 6 3


No Nama Obat Persediaan Jumlah Jenis O

Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11

26 Deksametason Inj 50 0 50

27 Deksametason 0,5 mg 4255 3000 7255 423 234 148 269 364 120 108 236 276

28 Diazepam Tab 2 mg 518 500 1018 6 3 4 24 24 3 6 9 21

29 Digoksin 0,25 mg 500 0 500

30 Diltiazem HCL 30mg 400 300 700

31 Dipenhidramin Inj 0 0 0

32 Domperidom 0 0 0

33 Efedrina HCL 25 mg 720 0 720 20 15 20 45 38 12 27 13 30

34 Erytromicin Syr 0 100 100

35 Etakridine kom 10 0 10

36 Etanol 9 0 9

37 Fenobarbital tab 30 mg 2804 0 2804 20 20

38 Fitomenadion Inj 30 0 30

39 Fitomenadion Tablet 0 0 0

40 Furrosemida tab 0 0 0

41 Furrosemida inj 20 10 30

42 Garam Oralit 207 100 307 5 5 15 20 5 15

43 Gentamicin SK 0,1 % 23 30 53 1 2 4 1 2

44 Glibenklamida tab 5 mg 534 500 1034 3 12 6 3 10 5 9

45 Glimepiride 2 mg 0 300 300 12

46 Glukosa Lar. Inf 5 % 0 0 0

47 Griseofulvin tab 125 mg 0 0 0

48 Halloperidol 0.5 mg 0 0 0

49 Halloperidol 1.5 mg 440 0 440 40 60 80 40 60

50 Halloperidol 1.5 mg 0 0 0

51 Hidrokortison Krim 31 0 31 5 3 5 1 5

52 Ibuprofen tab.200 mg 460 0 460

53 Kalium Permanganas 5 gr 80 0 80

54 Kals Laktat tab.500 mg 1152 1000 2152 34 38 46 6 12 18 28


No Nama Obat Persediaan Jumlah Jenis O

Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11

55 Ketokonazol tablet 200 mg 0 0 0

56 Ketokonazol cream 0 0 0

57 Kloramfenikol salep mata 0 0 0

58 Klorpromazine inj 0 0 0

59 Kodein HCL 10 mg 95 0 95 20 10 5 20

60 Kotrimoksazol Susp 0 0 0

61 Kotrimoksazol 480mg Tab 0 0 0

62 Levofloxacin 500 mg 0 500 500 3

63 Loratadine 0 0 0

64 Metilergometrin Tab. 0 200 200

65 Metoclopramide 10 mg 0 0 0

66 Metronidazole 500 mg 0 0 0

67 Mikonazole Cream 0 0 0

68 Natrium Bikarbonat 2404 0 2404 600

69 Natrium Diklofenac 50 mg 0 0 0

70 Natrium Klorida 0.9 % 0 0 0

71 Nifedipin 10 mg 0 0 0

72 Nistatin 500.000 IU/g 349 0 349

73 Obat Batuk hitam 11 120 131 3

74 Oksitetrasiklin Salep Mata 71 0 71

75 Oksitetrasiklin Salep Kulit 96 0 96 5 5 5

76 Omeprazole inj 40 mg/ 10 ml 20 0 20

77 Omeprazole 20 mg 0 0 0

78 Parasetamol Syrup 120 mg / 5 ml 0 0 0

79 Parasetamol Tablet 500 mg 0 0 0

80 Pehacain Inj 0 60 60 10

81 Pirantel tab 125 mg 78 0 78

82 Propiltiourasil 100 mg 100 0 100 40 20 30

83 Propanolol tab 40 mg 0 0 0
No Nama Obat Persediaan Jumlah Jenis O

Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11

84 Ranitidin 0 0 0

85 Ranitidin Inj 10 0 10

86 Ringer Lactat Infus 0 0 0

87 Salbutamol 4 mg 215 0 215 35 10 28 42 32 18 25

88 Salep 2- 4 29 0 29 1 1 1

89 Salisil Bedak 2 % 0 0 0

90 Sefadroksil Syr 116 100 216 5 2 3 1 2 3

91 Setirizine tab 460 0 460 67 42 66 102 114 49 20

92 Simvastatin 20 mg 0 0 0

93 Serum Anti Bisa Ular ( ABU I ) 0 0 0

94 Serum Anti Tetanus 1.500 UI / ml 0 0 0

95 Tetrasiklin HCL 250 mg 0 0 0

96 Tiamin HCL ( Vit B1 ) 50 mg 2549 0 2549 121 47 108 78 115 56 34 37 86

97 Tramadol caps 50 mg 260 0 260 20 55 10 20

98 Vitamin B Complek 0 0 0

99 Yodium Povidon 30 ml 0 0 0

100 Zink Syr 0 0 0

101 Zink tablet 0 0 0

OBAT GIGI

102 Curaspon 3 0 3

103 Etil Klorida semprot 5 0 5

104 Eugenol Cairan 1 0 1

105 Glass ionomer cement ART 3 0 3

106 Kalsium Hidroksida Pasta 3 0 3

ALAT KESEHATAN

107 Alat Suntik 5 cc 0 0 0

108 Alat Suntik 10 cc 0 0 0

109 Aquadest 1000 ml 0 0 0

110 Blood Tranfusion Set 0 0 0


No Nama Obat Persediaan Jumlah Jenis O

Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11

111 Catgut 2/0 0 0 0

112 Catgut 3/0 0 0 0

113 Hand Scun 0 0 0

114 Infusion set dewasa 0 0 0

115 I.V Cateter 18 G 0 0 0

116 I.V Cateter 20 G 0 0 0

117 I.V Cateter 22 G 0 0 0

118 I.V Cateter 24 G 0 0 0

119 Kasa Pembalut 4m x 15 cm 0 0 0

120 Masker 0 0 0

121 Plester 5 yard x 2 inch 11 0 11 2 1

122 Silk 0 0 0

123 Spiritus 500 ml 6 0 6

124 Benecheck Glukose 50s 44 50 94 2 6 9 3 1 5 4 9

125 Benecheck Total Chof 10s 47 0 47 1 2 2 1

126 Benecheck Urid Acid 25s 50 0 50 1 2 2 1 1 3

127 Blood Tranfusion Set 5 0 5

128 Infusion set Y Connector 10 0 10

129 Oksigen Masker 6 0 6

130 Siprofloxacin 500mg 712 0 712 34 12 40 18 24 18

131 Test uji kehamilan 25 MU/ml 50 0 50 2 2

Mengetahui
Kepala Puskesmas

( MUKHLIS.SKM.M.Kes )
Nip.19720709 199303 1 003
UNAAN OBAT HARIAN ( LPOH ) DAK
LAN NOVEMBER 2016

Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok

12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir

28 5 20 10 16 25 20 160 140

10 100 129 234

6 1 1 2 1 3 5 2 46 86

0 0

0 0

15 2 5 9 11 1 1 4 8 11 3 7 116 263

201 86 55 30 84 102 70 26 122 111 40 28 1565 173

0 35

0 500

0 0

0 0

362 207 732 242 211 134 60 40 154 232 214 40 50 3000 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 500

60 18 60 50 45 35 5 5 56 20 3 18 405 495

0 0

10 28 10 12 10 101 399

0 0

10 3 3 3 3 3 6 46 128
Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok

12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir

0 50

330 165 989 210 276 297 169 140 154 172 276 150 238 5744 1511

23 3 6 4 20 12 10 15 25 16 26 3 12 275 743

0 500

0 700

0 0

0 0

45 15 20 5 25 60 30 40 60 15 35 570 150

0 100

0 10

0 9

60 10 110 2694

0 30

0 0

0 0

0 30

25 5 25 10 15 5 5 15 5 175 132

1 1 3 1 1 1 18 35

6 4 9 16 4 17 5 109 925

5 6 18 18 3 12 32 4 4 114 186

0 0

0 0

0 0

60 10 40 20 30 440 0

0 0

2 3 7 31 0

460 460 0

0 80

36 6 120 186 65 57 42 58 24 76 82 18 952 1200


Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok

12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir

0 0

0 0

0 0

0 0

10 5 70 25

0 0

0 0

3 9 3 6 12 3 39 461

0 0

20 10 10 40 160

0 0

0 0

0 0

600 200 200 100 1700 704

0 0

0 0

0 0

0 349

5 5 13 118

0 71

10 5 7 37 59

0 20

0 0

0 0

0 0

10 5 25 35

0 78

10 100 0

0 0
Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok

12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir

0 0

0 10

0 0

25 215 0

1 1 1 1 7 22

0 0

1 1 9 2 2 3 1 35 181

460 0

0 0

0 0

0 0

0 0

124 85 932 26 34 89 243 34 60 79 111 50 2549 0

35 10 60 20 10 20 260 0

0 0

0 0

0 0

0 0

0 0

0 3

0 5

1 1 0

0 3

1 1 2

0 0

0 0

0 0

0 0

0 0
Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok

12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

1 1 1 6 5

0 0

0 6

5 1 5 2 11 8 3 2 1 5 7 2 3 94 0

2 1 2 2 13 34

3 1 2 1 16 33

0 5

0 10

0 556

12 18 24 120 18 28 6 348 364

1 1 6 44

Pengelola Obat PKM

( ERLINA.AMK )
Nip.19770415 200604 2 010
Ket
Ket
Ket
Ket
Ket
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT DAK
( LPLPO ) DAK

BULAN
UPT PKM : PEUREULAK Desember
:
KECAMATAN : PEUREULAK TAHUN : 2016
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet 140 200 340 140 200 0

2 Acyclovir tab 400 mg Tablet 234 200 434 87 347 0

3 Acyclovir cream 5 % Tube 86 25 111 23 88 0

4 Albendazole 400 mg Tablet 0 0 0 0 0 0

5 Allopurinol 100 mg Tablet 0 0 0 0 0 0

6 Ambroxol Syr 60 ml Botol 263 100 363 65 298 0

7 Ambroxol tab 30 mg Tablet 173 1500 1673 714 959 0

8 Aminopillin tab 200 mg Tablet 35 0 35 0 35 0

9 Amitriptiline 25 Tablet 500 0 500 0 500 0

10 Amlodipin 5 mg Tablet 0 0 0 0 0 0

11 Amlodipin 10 mg Tablet 0 0 0 0 0 0

12 Amoksisillina kapl 250mg Kapsul 0 1000 1000 910 90 0

13 Amoksisillina kapl 500mg Tablet 0 0 0 0 0 0

14 Amoksisillina sirker 250 mg / 5 ml Botol 0 0 0 0 0 0

15 Antasida Doen Tab Tablet 0 0 0 0 0 0

16 Antasida sir Botol 0 0 0 0 0 0

17 Asam Ascorbat ( Vit.C ) 50 mg Tablet 0 0 0 0 0 0

18 Asam Mefenamat 500 mg Tablet 0 0 0 0 0 0

19 Attapulgite 630 mg Tablet 0 0 0 0 0 0

20 Atropin Sulfat 0.5 mg Tablet 500 0 500 0 500 0

21 Besi II Sulfat Tablet 495 900 1395 439 956 0

22 Betametason Krim Tube 0 0 0 0 0 0

23 Captopril 12.5 mg Tablet 399 0 399 104 295 0

24 Captopril 25 mg Tablet 0 0 0 0 0 0

25 Captopril 50 mg Tablet 128 1000 1128 403 725 0

26 Deksametason Inj Ampul 50 0 50 0 50 0

27 Deksametason 0,5 mg Tablet 1511 5000 6511 4522 1989 5000

28 Diazepam Tab 2 mg Tablet 743 0 743 182 561 0

29 Digoksin 0,25 mg Tablet 500 0 500 0 500 0

30 Diltiazem HCL 30mg Tablet 700 0 700 0 700 0

31 Dipenhidramin Inj Ampul 0 30 30 10 20 0

32 Domperidom Tablet 0 0 0 0 0 0

33 Efedrina HCL 25 mg Tablet 150 1000 1150 192 958 0

34 Erytromicin Syr Botol 100 120 220 17 203 0

35 Etakridine kom Botol 10 0 10 0 10 0

36 Etanol Botol 9 0 9 4 5 0

37 Fenobarbital tab 30 mg Tablet 2694 2000 4694 80 4614 0

38 Fitomenadion Inj Ampul 30 0 30 2 28 0

39 Fitomenadion Tablet Tablet 0 0 0 0 0 0

40 Furrosemida tab Tablet 0 500 500 74 426 0

41 Furrosemida inj Ampul 30 0 30 4 26 0

42 Garam Oralit Tablet 132 0 132 100 32 100


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

43 Gentamicin SK 0,1 % Tube 35 0 35 10 25 0

44 Glibenklamida tab 5 mg Tablet 925 0 925 154 771 0

45 Glimepiride 2 mg Tablet 186 0 186 12 174 0

46 Glukosa Lar. Inf 5 % Botol 0 100 100 0 100 0

47 Griseofulvin tab 125 mg Tablet 0 0 0 0 0 0

48 Halloperidol 0.5 mg Tablet 0 0 0 0 0 0

49 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

50 Halloperidol 1.5 mg Tablet 0 0 0 0 0 0

51 Hidrokortison Krim Tube 0 0 0 0 0 0

52 Ibuprofen tab.200 mg Tablet 0 0 0 0 0 0

53 Kalium Permanganas 5 gr Botol 80 0 80 0 80 0

54 Kals Laktat tab.500 mg Tablet 1200 1000 2200 1293 907 2000

55 Ketokonazol tablet 200 mg Tablet 0 0 0 0 0 0

56 Ketokonazol cream Tube 0 0 0 0 0 0

57 Kloramfenikol salep mata Tube 0 0 0 0 0 0

58 Klorpromazine inj Ampul 0 0 0 0 0 0

59 Kodein HCL 10 mg Tablet 25 0 25 25 0 0

60 Kotrimoksazol Susp Botol 0 0 0 0 0 0

61 Kotrimoksazol 480mg Tab Tablet 0 0 0 0 0 0

62 Levofloxacin 500 mg Tablet 461 1000 1461 30 1431 0

63 Loratadine Tablet 0 0 0 0 0 0

64 Metilergometrin Tab. Tablet 160 0 160 20 140 0

65 Metoclopramide 10 mg Tablet 0 0 0 0 0 0

66 Metronidazole 500 mg Tablet 0 0 0 0 0 0

67 Mikonazole Cream Tube 0 0 0 0 0 0

68 Natrium Bikarbonat Tablet 704 2000 2704 1117 1587 2000

69 Natrium Diklofenac 50 mg Tablet 0 0 0 0 0 0

70 Natrium Klorida 0.9 % Botol 0 0 0 0 0 0

71 Nifedipin 10 mg Tablet 0 0 0 0 0 0

72 Nistatin 500.000 IU/g Tablet 349 0 349 0 349 0

73 Obat Batuk hitam Botol 118 192 310 34 276 0

74 Oksitetrasiklin Salep Mata Tube 71 0 71 21 50 100

75 Oksitetrasiklin Salep Kulit Tube 59 100 159 103 56 50

76 Omeprazole inj 40 mg/ 10 ml Vial 20 0 20 0 20 0

77 Omeprazole 20 mg Kapsul 0 0 0 0 0 0

78 Parasetamol Syrup 120 mg / 5 ml Botol 0 0 0 0 0 0

79 Parasetamol Tablet 500 mg Tablet 0 0 0 0 0 0

80 Pehacain Inj Ampul 35 40 75 40 35 50

81 Pirantel tab 125 mg Tablet 78 0 78 20 58 0

82 Propanolol tab 40 mg Tablet 0 0 0 0 0 0

83 Propiltiourasil 100 mg Tablet 0 0 0 0 0 1000

84 Ranitidin Tablet 0 0 0 0 0 0

85 Ranitidin Inj Ampul 10 0 10 10 0 0

86 Ringer Lactat Infus Botol 0 0 0 0 0 0

87 Salbutamol 4 mg Tablet 0 500 500 205 295 500

88 Salep 2- 4 Tube 22 0 22 6 16 24

89 Salisil Bedak 2 % kotak 0 0 0 0 0 0

90 Sefadroksil Syr Botol 181 150 331 58 273 50

91 Setirizine tab Tablet 0 1000 1000 421 579 1000

92 Simvastatin 20 mg Tablet 0 0 0 0 0 0
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

93 Serum Anti Bisa Ular ( ABU I ) Vial 0 0 0 0 0 0

94 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0 0

95 Tetrasiklin HCL 250 mg Kapsul 0 0 0 0 0 0

96 Tiamin HCL ( Vit B1 ) 50 mg Tablet 0 4000 4000 1946 2054 2000

97 Tramadol caps 50 mg Capsul 0 0 0 0 0 0

98 Vitamin B Complek Tablet 0 0 0 0 0 0

99 Yodium Povidon 30 ml Botol 0 0 0 0 0 0


100 Zink Syr Botol 0 0 0 0 0 0

101 Zink tab Tablet 0 0 0 0 0 0

OBAT GIGI

102 Curaspon Botol 3 2 5 0 5 0

103 Etil Klorida semprot Botol 5 2 7 3 4 5

104 Eugenol Cairan Botol 0 12 12 0 12 0

105 Glass ionomer cement ART Botol 3 2 5 0 5 0

106 Kalsium Hidroksida Pasta Set 2 2 4 0 4 0

ALAT KESEHATAN

107 Alat Suntik 5 cc Unit 0 0 0 0 0 0

108 Alat Suntik 10 cc Unit 0 0 0 0 0 0

109 Aquadest 1000 ml Botol 0 0 0 0 0 0

110 Blood Tranfusion Set Kantong 0 0 0 0 0 0

111 Catgut 2/0 Pcs 0 0 0 0 0 0

112 Catgut 3/0 Pcs 0 0 0 0 0 0

113 Hand Scun Set 0 0 0 0 0 0

114 Infusion set dewasa Kantong 0 0 0 0 0 0

115 I.V Cateter 18 G Buah 0 0 0 0 0 0

116 I.V Cateter 20 G Buah 0 0 0 0 0 0

117 I.V Cateter 22 G Buah 0 0 0 0 0 0

118 I.V Cateter 24 G Buah 0 0 0 0 0 0

119 Kasa Pembalut 4m x 15 cm Rol 0 0 0 0 0 0

120 Masker Pcs 0 0 0 0 0 0

121 Plester 5 yard x 2 inch Rol 5 5 10 6 4 20

122 Silk Pcs 0 0 0 0 0 0

123 Spiritus 500 ml Botol 6 0 6 1 5 0

124 Benecheck Glukose 50s Strip 0 150 150 23 127 0

125 Benecheck Total Chof 10s Strip 34 30 64 7 57 0

126 Benecheck Urid Acid 25s Strip 33 25 58 6 52 0

127 Blood Tranfusion Set Kantong 5 0 5 0 5 0

128 Infusion set Y Connector Kantong 10 0 10 0 10 0

129 Oksigen Masker Pcs 6 0 6 3 3 0

130 Siprofloxacin 500mg Tablet 364 500 864 260 556 0

131 Test uji kehamilan 25 MU/ml Strip 44 0 44 6 38 0

132 Bahan Tumpatan Sementara Botol 0 2 2 0 2 0

133 CHKM Botol 0 2 2 0 2 0

134 Mumfying Pasta Botol 0 2 2 0 2 0

135 Semen Seng Fosfat Botol 0 2 2 0 2 0

136 Temporary Stopping Fletcer Botol 0 2 2 0 2 0

137 Nald 0,3 x 21 mm Pcs 0 100 100 9 91 0

138 Surginal Blade Steril Pcs 0 100 100 0 100 0

Mengetahui
Kepala Puskesmas Pengelola Obat PKM
( MUKHLIS.SKM.M.Kes ) ( ERLINA.AMK )
Nip.19720709 199303 1 003 Nip.19770415 200604 2 010
LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) DAK
BULAN DESEMBER 2016
PUSKESMAS :PEUREULAK

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 140 200 340 15 3 25 10 15 3 4 15 30 15 5 140 200 400

2 Acyclovir tab 400 mg 234 200 434 15 10 5 10 5 5 5 2 5 10 15 87 347

3 Acyclovir cream 5 % 86 25 111 2 1 2 1 1 3 2 2 1 1 2 1 1 2 1 23 88

4 Albendazole 400 mg 0 0 0 0 0

5 Allopurinol 100 mg 0 0 0 0 0

6 Ambroxol Syr 60 ml 263 100 363 2 5 7 2 3 5 25 1 3 6 1 2 3 65 298 s

7 Ambroxol tab 30 mg 173 1500 1673 5 30 10 20 14 72 10 368 47 15 24 5 62 10 22 714 959

8 Aminopillin tab 200 mg 35 0 35 0 35

9 Amitriptiline 25 500 0 500 0 500

10 Amlodipin 5 mg 0 0 0 0 0

11 Amlodipin 10 mg 0 0 0 0 0

12 Amoksisillina kapl 250mg 0 1000 1000 30 20 540 20 30 20 10 20 220 910 90

13 Amoksisillina kapl 500mg 0 0 0 0 0

14 Amoksisillina sirker 250 mg / 5 ml 0 0 0 0 0

15 Antasida Doen Tab 0 0 0 0 0

16 Antasida sir 0 0 0 0 0

17 Asam Ascorbat ( Vit.C ) 50 mg 0 0 0 0 0

18 Asam Mefenamat 500 mg 0 0 0 0 0

19 Attapulgite 630 mg 0 0 0 0 0

20 Atropin Sulfat 0.5 mg 500 0 500 0 500

21 Besi II Sulfat 495 900 1395 3 10 23 6 3 30 240 75 10 20 3 10 3 3 439 956 400

22 Betametason Krim 0 0 0 0 0

23 Captopril 12.5 mg 399 0 399 20 5 20 10 15 6 12 10 6 104 295

24 Captopril 25 mg 0 0 0 0 0

25 Captopril 50 mg 128 1000 1128 3 12 3 5 9 320 6 12 6 18 3 6 403 725


No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 Deksametason Inj 50 0 50 0 50

27 Deksametason 0,5 mg 1511 5000 6511 280 236 345 175 140 120 220 243 832 140 248 312 220 254 126 218 345 68 4522 1989

28 Diazepam Tab 2 mg 743 0 743 12 24 18 9 9 6 15 25 6 3 6 3 6 4 3 15 12 6 182 561

29 Digoksin 0,25 mg 500 0 500 0 500

30 Diltiazem HCL 30mg 700 0 700 0 700

31 Dipenhidramin Inj 0 30 30 5 3 2 10 20

32 Domperidom 0 0 0 0 0

33 Efedrina HCL 25 mg 150 1000 1150 6 12 10 42 10 12 9 5 20 10 26 20 10 192 958

34 Erytromicin Syr 100 120 220 2 1 3 2 1 2 3 3 17 203

35 Etakridine kom 10 0 10 0 10

36 Etanol 9 0 9 4 4 5

37 Fenobarbital tab 30 mg 2694 2000 4694 30 10 30 10 80 4614

38 Fitomenadion Inj 30 0 30 2 2 28

39 Fitomenadion Tablet 0 0 0 0 0

40 Furrosemida tab 0 500 500 3 6 50 3 3 3 6 74 426

41 Furrosemida inj 30 0 30 2 1 1 4 26

42 Garam Oralit 132 0 132 5 35 5 5 5 35 10 100 32 30

43 Gentamicin SK 0,1 % 35 0 35 2 3 1 1 1 2 10 25

44 Glibenklamida tab 5 mg 925 0 925 15 26 24 9 12 3 25 6 3 10 18 3 154 771

45 Glimepiride 2 mg 186 0 186 6 6 12 174

46 Glukosa Lar. Inf 5 % 0 100 100 0 100

47 Griseofulvin tab 125 mg 0 0 0 0 0

48 Halloperidol 0.5 mg 0 0 0 0 0

49 Halloperidol 1.5 mg 0 0 0 0 0

50 Halloperidol 1.5 mg 0 0 0 0 0

51 Hidrokortison Krim 0 0 0 0 0

52 Ibuprofen tab.200 mg 0 0 0 0 0

53 Kalium Permanganas 5 gr 80 0 80 0 80

54 Kals Laktat tab.500 mg 1200 1000 2200 70 43 140 110 80 62 45 135 250 20 65 52 20 35 30 43 71 22 1293 907 135
No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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

55 Ketokonazol tablet 200 mg 0 0 0 0 0

56 Ketokonazol cream 0 0 0 0 0

57 Kloramfenikol salep mata 0 0 0 0 0

58 Klorpromazine inj 0 0 0 0 0

59 Kodein HCL 10 mg 25 0 25 10 5 10 25 0

60 Kotrimoksazol Susp 0 0 0 0 0

61 Kotrimoksazol 480mg Tab 0 0 0 0 0

62 Levofloxacin 500 mg 461 1000 1461 6 6 3 6 3 3 3 30 1431

63 Loratadine 0 0 0 0 0

64 Metilergometrin Tab. 160 0 160 10 10 20 140

65 Metoclopramide 10 mg 0 0 0 0 0

66 Metronidazole 500 mg 0 0 0 0 0

67 Mikonazole Cream 0 0 0 0 0

68 Natrium Bikarbonat 704 2000 2704 60 83 70 45 30 50 340 120 65 20 36 70 110 18 1117 1587 357

69 Natrium Diklofenac 50 mg 0 0 0 0 0

70 Natrium Klorida 0.9 % 0 0 0 0 0

71 Nifedipin 10 mg 0 0 0 0 0

72 Nistatin 500.000 IU/g 349 0 349 0 349

73 Obat Batuk hitam 118 192 310 1 2 25 1 2 2 1 34 276 8

74 Oksitetrasiklin Salep Mata 71 0 71 2 4 2 1 2 1 3 3 1 1 1 21 50

75 Oksitetrasiklin Salep Kulit 59 100 159 2 5 6 3 4 7 7 35 2 15 2 3 7 3 2 103 56 5

76 Omeprazole inj 40 mg/ 10 ml 20 0 20 0 20

77 Omeprazole 20 mg 0 0 0 0 0

78 Parasetamol Syrup 120 mg / 5 ml 0 0 0 0 0

79 Parasetamol Tablet 500 mg 0 0 0 0 0

80 Pehacain Inj 35 40 75 10 10 10 5 5 40 35

81 Pirantel tab 125 mg 78 0 78 2 4 2 4 4 4 20 58 20

82 Propiltiourasil 100 mg 0 0 0 0 0

83 Propanolol tab 40 mg 0 0 0 0 0
No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 Ranitidin 0 0 0 0 0

85 Ranitidin Inj 10 0 10 10 10 0

86 Ringer Lactat Infus 0 0 0 0 0

87 Salbutamol 4 mg 0 500 500 20 55 10 10 20 30 10 20 30 205 295

88 Salep 2- 4 22 0 22 2 1 2 1 6 16

89 Salisil Bedak 2 % 0 0 0 0 0

90 Sefadroksil Syr 181 150 331 3 2 6 3 5 3 5 3 1 2 5 3 2 1 7 5 2 58 273

91 Setirizine tab 0 1000 1000 36 42 18 26 53 72 36 20 16 58 32 12 421 579

92 Simvastatin 20 mg 0 0 0 0 0

93 Serum Anti Bisa Ular ( ABU I ) 0 0 0 0 0

94 Serum Anti Tetanus 1.500 UI / ml 0 0 0 0 0

95 Tetrasiklin HCL 250 mg 0 0 0 0 0

96 Tiamin HCL ( Vit B1 ) 50 mg 0 4000 4000 30 210 100 450 101 95 154 62 120 68 204 220 132 1946 2054 440

97 Tramadol caps 50 mg 0 0 0 0 0

98 Vitamin B Complek 0 0 0 0 0

99 Yodium Povidon 30 ml 0 0 0 0 0

100 Zink Syr 0 0 0 0 0

101 Zink tablet 0 0 0 0 0

OBAT GIGI

102 Curaspon 3 2 5 0 5

103 Etil Klorida semprot 5 2 7 1 2 3 4

104 Eugenol Cairan 0 12 12 0 12

105 Glass ionomer cement ART 3 2 5 0 5

106 Kalsium Hidroksida Pasta 2 2 4 0 4

ALAT KESEHATAN

107 Alat Suntik 5 cc 0 0 0 0 0

108 Alat Suntik 10 cc 0 0 0 0 0

109 Aquadest 1000 ml 0 0 0 0 0

110 Blood Tranfusion Set 0 0 0 0 0


No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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

111 Catgut 2/0 0 0 0 0 0

112 Catgut 3/0 0 0 0 0 0

113 Hand Scun 0 0 0 0 0

114 Infusion set dewasa 0 0 0 0 0

115 I.V Cateter 18 G 0 0 0 0 0

116 I.V Cateter 20 G 0 0 0 0 0

117 I.V Cateter 22 G 0 0 0 0 0

118 I.V Cateter 24 G 0 0 0 0 0

119 Kasa Pembalut 4m x 15 cm 0 0 0 0 0

120 Masker 0 0 0 0 0

121 Plester 5 yard x 2 inch 5 5 10 1 3 2 6 4

122 Silk 0 0 0 0 0

123 Spiritus 500 ml 6 0 6 1 1 5

124 Benecheck Glukose 50s 0 150 150 5 3 1 2 5 2 3 2 23 127

125 Benecheck Total Chof 10s 34 30 64 2 1 2 2 7 57

126 Benecheck Urid Acid 25s 33 25 55 2 2 1 1 6 49

127 Blood Tranfusion Set 5 0 5 0 5

128 Infusion set Y Connector 10 0 10 0 10

129 Oksigen Masker 6 0 6 3 3 3

130 Siprofloxacin 500mg 364 500 864 20 10 10 20 50 10 20 10 10 100 260 556

131 Test uji kehamilan 25 MU/ml 44 0 44 1 2 1 1 1 6 38

132 Bahan Tumpatan Sementara 0 2 2 0 2

133 CHKM 0 2 2 0 2

134 Mumfying Pasta 0 2 2 0 2

135 Semen Seng Fosfat 0 2 2 0 2

136 Temporary Stopping Fletcer 0 2 2 0 2

137 Nald 0,3 x 21 mm 0 100 100 2 3 2 1 1 9 91

138 Surginal Blade Steril 0 100 100 0 100

Mengetahui Pengelola Obat PKM


Kepala Puskesmas

( ERLINA.AMK )
( MUKHLIS.SKM.M.Kes ) Nip.19770415 200604 2 010
Nip.19720709 199303 1 003
LAPORAN TAHUNAN PEMAKAIAN OBAT DAK
( LPLPO ) DAK

BULAN
UPT PKM : Desember
:
KECAMATAN : TAHUN : 2016
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK


AWAL MAAN DIAAN KAIAN AKHIR
1 2 3 4 5 6 7 8

1 Acyclovir tab 200 mg Tablet 0 0 0 0

2 Acyclovir tab 400 mg Tablet 234 234 0 234

3 Acyclovir cream 5 % Tube 86 86 0 86

4 Albendazole 400 mg Tablet 0 0 0 0

5 Allopurinol 100 mg Tablet 0 0 0 0

6 Ambroxol Syr 60 ml Botol 263 263 0 263

7 Ambroxol tab 30 mg Tablet 173 173 0 173

8 Aminopillin tab 200 mg Tablet 35 35 0 35

9 Amitriptiline 25 Tablet 500 500 0 500

10 Amlodipin 5 mg Tablet 0 0 0 0

11 Amlodipin 10 mg Tablet 0 0 0 0

12 Amoksisillina kapl 250mg Kapsul 0 0 0 0

13 Amoksisillina kapl 500mg Tablet 0 0 0 0

14 Amoksisillina sirker 250 mg / 5 ml Botol 0 0 0 0

15 Antasida Doen Tab Tablet 0 0 0 0

16 Antasida sir Botol 0 0 0 0

17 Asam Ascorbat ( Vit.C ) 50 mg Tablet 0 0 0 0

18 Asam Mefenamat 500 mg Tablet 0 0 0 0

19 Attapulgite 630 mg Tablet 0 0 0 0

20 Atropin Sulfat 0.5 mg Tablet 500 500 0 500

21 Besi II Sulfat Tablet 495 495 0 495

22 Betametason Krim Tube 0 0 0 0

23 Captopril 12.5 mg Tablet 399 399 0 399

24 Captopril 25 mg Tablet 0 0 0 0
25 Captopril 50 mg Tablet 128 128 0 128

26 Deksametason Inj Ampul 50 50 0 50

27 Deksametason 0,5 mg Tablet 1511 1511 4522 -3011

28 Diazepam Tab 2 mg Tablet 743 743 182 561

29 Digoksin 0,25 mg Tablet 500 500 0 500

30 Diltiazem HCL 30mg Tablet 700 700 0 700

31 Dipenhidramin Inj Ampul 0 0 10 -10

32 Domperidom Tablet 0 0 0 0

33 Efedrina HCL 25 mg Tablet 150 150 192 -42

34 Erytromicin Syr Botol 100 100 17 83

35 Etakridine kom Botol 10 10 0 10

36 Etanol Botol 9 9 4 5

37 Fenobarbital tab 30 mg Tablet 2694 2694 80 2614

38 Fitomenadion Inj Ampul 30 30 2 28

39 Fitomenadion Tablet Tablet 0 0 0 0

40 Furrosemida tab Tablet 0 0 74 -74

41 Furrosemida inj Ampul 30 30 4 26

42 Garam Oralit Tablet 132 132 100 32

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK


AWAL MAAN DIAAN KAIAN AKHIR
1 2 3 4 5 6 7 8

43 Gentamicin SK 0,1 % Tube 35 35 10 25

44 Glibenklamida tab 5 mg Tablet 925 925 154 771

45 Glimepiride 2 mg Tablet 186 186 12 174

46 Glukosa Lar. Inf 5 % Botol 0 0 0 0

47 Griseofulvin tab 125 mg Tablet 0 0 0 0

48 Halloperidol 0.5 mg Tablet 0 0 0 0

49 Halloperidol 1.5 mg Tablet 0 0 0 0

50 Halloperidol 1.5 mg Tablet 0 0 0 0

51 Hidrokortison Krim Tube 0 0 0 0

52 Ibuprofen tab.200 mg Tablet 0 0 0 0

53 Kalium Permanganas 5 gr Botol 80 80 0 80

54 Kals Laktat tab.500 mg Tablet 1200 1200 1293 -93


55 Ketokonazol tablet 200 mg Tablet 0 0 0 0

56 Ketokonazol cream Tube 0 0 0 0

57 Kloramfenikol salep mata Tube 0 0 0 0

58 Klorpromazine inj Ampul 0 0 0 0

59 Kodein HCL 10 mg Tablet 25 25 25 0

60 Kotrimoksazol Susp Botol 0 0 0 0

61 Kotrimoksazol 480mg Tab Tablet 0 0 0 0

62 Levofloxacin 500 mg Tablet 461 461 30 431

63 Loratadine Tablet 0 0 0 0

64 Metilergometrin Tab. Tablet 160 160 20 140

65 Metoclopramide 10 mg Tablet 0 0 0 0

66 Metronidazole 500 mg Tablet 0 0 0 0

67 Mikonazole Cream Tube 0 0 0 0

68 Natrium Bikarbonat Tablet 704 704 1117 -413

69 Natrium Diklofenac 50 mg Tablet 0 0 0 0

70 Natrium Klorida 0.9 % Botol 0 0 0 0

71 Nifedipin 10 mg Tablet 0 0 0 0

72 Nistatin 500.000 IU/g Tablet 349 349 0 349

73 Obat Batuk hitam Botol 118 118 34 84

74 Oksitetrasiklin Salep Mata Tube 71 71 21 50

75 Oksitetrasiklin Salep Kulit Tube 59 59 103 -44

76 Omeprazole inj 40 mg/ 10 ml Vial 20 20 0 20

77 Omeprazole 20 mg Kapsul 0 0 0 0

78 Parasetamol Syrup 120 mg / 5 ml Botol 0 0 0 0

79 Parasetamol Tablet 500 mg Tablet 0 0 0 0

80 Pehacain Inj Ampul 35 35 40 -5

81 Pirantel tab 125 mg Tablet 78 78 20 58

82 Propanolol tab 40 mg Tablet 0 0 0 0

83 Propiltiourasil 100 mg Tablet 0 0 0 0

84 Ranitidin Tablet 0 0 0 0

85 Ranitidin Inj Ampul 10 10 10 0

86 Ringer Lactat Infus Botol 0 0 0 0

87 Salbutamol 4 mg Tablet 0 0 205 -205

88 Salep 2- 4 Tube 22 22 6 16

89 Salisil Bedak 2 % kotak 0 0 0 0


90 Sefadroksil Syr Botol 181 181 58 123

91 Setirizine tab Tablet 0 0 421 -421

92 Simvastatin 20 mg Tablet 0 0 0 0

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK


AWAL MAAN DIAAN KAIAN AKHIR
1 2 3 4 5 6 7 8

93 Serum Anti Bisa Ular ( ABU I ) Vial 0 0 0 0

94 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0

95 Tetrasiklin HCL 250 mg Kapsul 0 0 0 0

96 Tiamin HCL ( Vit B1 ) 50 mg Tablet 0 0 1946 -1946

97 Tramadol caps 50 mg Capsul 0 0 0 0

98 Vitamin B Complek Tablet 0 0 0 0

99 Yodium Povidon 30 ml Botol 0 0 0 0

100 Zink Syr Botol 0 0 0 0

101 Zink tab Tablet 0 0 0 0

OBAT GIGI

102 Curaspon Botol 3 3 0 3

103 Etil Klorida semprot Botol 5 5 3 2

104 Eugenol Cairan Botol 0 0 0 0

105 Glass ionomer cement ART Botol 3 3 0 3

106 Kalsium Hidroksida Pasta Set 2 2 0 2

ALAT KESEHATAN

107 Alat Suntik 5 cc Unit 0 0 0 0

108 Alat Suntik 10 cc Unit 0 0 0 0

109 Aquadest 1000 ml Botol 0 0 0 0

110 Blood Tranfusion Set Kantong 0 0 0 0

111 Catgut 2/0 Pcs 0 0 0 0

112 Catgut 3/0 Pcs 0 0 0 0

113 Hand Scun Set 0 0 0 0

114 Infusion set dewasa Kantong 0 0 0 0

115 I.V Cateter 18 G Buah 0 0 0 0

116 I.V Cateter 20 G Buah 0 0 0 0

117 I.V Cateter 22 G Buah 0 0 0 0


118 I.V Cateter 24 G Buah 0 0 0 0

119 Kasa Pembalut 4m x 15 cm Rol 0 0 0 0

120 Masker Pcs 0 0 0 0

121 Plester 5 yard x 2 inch Rol 5 5 6 -1

122 Silk Pcs 0 0 0 0

123 Spiritus 500 ml Botol 6 6 1 5

Mengetahui
Kepala Puskesmas Pengelola Obat PKM

( ) ( )
Nip. Nip.
Desember

PERMIN
KET
TAAN
9 10
PERMIN
KET
TAAN
9 10
PERMIN
KET
TAAN
9 10
gelola Obat PKM

)
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT DAK
( LPLPO ) DAK

BULAN
UPT PKM :
:
KECAMATAN : TAHUN :
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN


KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir tab 200 mg Tablet

2 Acyclovir tab 400 mg Tablet

3 Acyclovir cream 5 % Tube

4 Albendazole 400 mg Tablet

5 Allopurinol 100 mg Tablet

6 Ambroxol Syr 60 ml Botol

7 Ambroxol tab 30 mg Tablet

8 Aminopillin tab 200 mg Tablet

9 Amitriptiline 25 Tablet

10 Amlodipin 5 mg Tablet

11 Amlodipin 10 mg Tablet

12 Amoksisillina kapl 250mg Kapsul

13 Amoksisillina kapl 500mg Tablet

14 Amoksisillina sirker 250 mg / 5 ml Botol

15 Antasida Doen Tab Tablet

16 Antasida sir Botol

17 Asam Ascorbat ( Vit.C ) 50 mg Tablet

18 Asam Mefenamat 500 mg Tablet

19 Attapulgite 630 mg Tablet

20 Atropin Sulfat 0.5 mg Tablet

21 Besi II Sulfat Tablet

22 Betametason Krim Tube

23 Captopril 12.5 mg Tablet

24 Captopril 25 mg Tablet

25 Captopril 50 mg Tablet

26 Deksametason Inj Ampul

27 Deksametason 0,5 mg Tablet

28 Diazepam Tab 2 mg Tablet

29 Digoksin 0,25 mg Tablet

30 Diltiazem HCL 30mg Tablet

31 Dipenhidramin Inj Ampul

32 Domperidom Tablet

33 Efedrina HCL 25 mg Tablet

34 Erytromicin Syr Botol

35 Etakridine kom Botol

36 Etanol Botol

37 Fenobarbital tab 30 mg Tablet

38 Fitomenadion Inj Ampul

39 Fitomenadion Tablet Tablet

40 Furrosemida tab Tablet

41 Furrosemida inj Ampul

42 Garam Oralit Tablet


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

43 Gentamicin SK 0,1 % Tube

44 Glibenklamida tab 5 mg Tablet

45 Glimepiride 2 mg Tablet

46 Glukosa Lar. Inf 5 % Botol

47 Griseofulvin tab 125 mg Tablet

48 Halloperidol 0.5 mg Tablet

49 Halloperidol 1.5 mg Tablet

50 Halloperidol 1.5 mg Tablet

51 Hidrokortison Krim Tube

52 Ibuprofen tab.200 mg Tablet

53 Kalium Permanganas 5 gr Botol

54 Kals Laktat tab.500 mg Tablet

55 Ketokonazol tablet 200 mg Tablet

56 Ketokonazol cream Tube

57 Kloramfenikol salep mata Tube

58 Klorpromazine inj Ampul

59 Kodein HCL 10 mg Tablet

60 Kotrimoksazol Susp Botol

61 Kotrimoksazol 480mg Tab Tablet

62 Levofloxacin 500 mg Tablet

63 Loratadine Tablet

64 Metilergometrin Tab. Tablet

65 Metoclopramide 10 mg Tablet

66 Metronidazole 500 mg Tablet

67 Mikonazole Cream Tube

68 Natrium Bikarbonat Tablet

69 Natrium Diklofenac 50 mg Tablet

70 Natrium Klorida 0.9 % Botol

71 Nifedipin 10 mg Tablet

72 Nistatin 500.000 IU/g Tablet

73 Obat Batuk hitam Botol

74 Oksitetrasiklin Salep Mata Tube

75 Oksitetrasiklin Salep Kulit Tube

76 Omeprazole inj 40 mg/ 10 ml Vial

77 Omeprazole 20 mg Kapsul

78 Parasetamol Syrup 120 mg / 5 ml Botol

79 Parasetamol Tablet 500 mg Tablet

80 Pehacain Inj Ampul

81 Pirantel tab 125 mg Tablet

82 Propanolol tab 40 mg Tablet

83 Propiltiourasil 100 mg Tablet

84 Ranitidin Tablet

85 Ranitidin Inj Ampul

86 Ringer Lactat Infus Botol

87 Salbutamol 4 mg Tablet

88 Salep 2- 4 Tube

89 Salisil Bedak 2 % kotak

90 Sefadroksil Syr Botol

91 Setirizine tab Tablet

92 Simvastatin 20 mg Tablet
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

93 Serum Anti Bisa Ular ( ABU I ) Vial

94 Serum Anti Tetanus 1.500 UI / ml Ampul

95 Tetrasiklin HCL 250 mg Kapsul

96 Tiamin HCL ( Vit B1 ) 50 mg Tablet

97 Tramadol caps 50 mg Capsul

98 Vitamin B Complek Tablet

99 Yodium Povidon 30 ml Botol

100 Zink Syr Botol

101 Zink tab Tablet

OBAT GIGI

102 Curaspon Botol

103 Etil Klorida semprot Botol

104 Eugenol Cairan Botol

105 Glass ionomer cement ART Botol

106 Kalsium Hidroksida Pasta Set

ALAT KESEHATAN

107 Alat Suntik 5 cc Unit

108 Alat Suntik 10 cc Unit

109 Aquadest 1000 ml Botol

110 Blood Tranfusion Set Kantong

111 Catgut 2/0 Pcs

112 Catgut 3/0 Pcs

113 Hand Scun Set

114 Infusion set dewasa Kantong

115 I.V Cateter 18 G Buah

116 I.V Cateter 20 G Buah

117 I.V Cateter 22 G Buah

118 I.V Cateter 24 G Buah

119 Kasa Pembalut 4m x 15 cm Rol

120 Masker Pcs

121 Plester 5 yard x 2 inch Rol

122 Silk Pcs

123 Spiritus 500 ml Botol

Mengetahui
Kepala Puskesmas Pengelola Obat PKM

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

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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

2 Acyclovir tab 400 mg

3 Acyclovir cream 5 %

4 Albendazole 400 mg

5 Allopurinol 100 mg

6 Ambroxol Syr 60 ml

7 Ambroxol tab 30 mg

8 Aminopillin tab 200 mg

9 Amitriptiline 25

10 Amlodipin 5 mg

11 Amlodipin 10 mg

12 Amoksisillina kapl 250mg

13 Amoksisillina kapl 500mg

14 Amoksisillina sirker 250 mg / 5 ml

15 Antasida Doen Tab

16 Antasida sir

17 Asam Ascorbat ( Vit.C ) 50 mg

18 Asam Mefenamat 500 mg

19 Attapulgite 630 mg

20 Atropin Sulfat 0.5 mg

21 Besi II Sulfat

22 Betametason Krim

23 Captopril 12.5 mg

24 Captopril 25 mg

25 Captopril 50 mg
No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 Deksametason Inj

27 Deksametason 0,5 mg

28 Diazepam Tab 2 mg

29 Digoksin 0,25 mg

30 Diltiazem HCL 30mg

31 Dipenhidramin Inj

32 Domperidom

33 Efedrina HCL 25 mg

34 Erytromicin Syr

35 Etakridine kom

36 Etanol

37 Fenobarbital tab 30 mg

38 Fitomenadion Inj

39 Fitomenadion Tablet

40 Furrosemida tab

41 Furrosemida inj

42 Garam Oralit

43 Gentamicin SK 0,1 %

44 Glibenklamida tab 5 mg

45 Glimepiride 2 mg

46 Glukosa Lar. Inf 5 %

47 Griseofulvin tab 125 mg

48 Halloperidol 0.5 mg

49 Halloperidol 1.5 mg

50 Halloperidol 1.5 mg

51 Hidrokortison Krim

52 Ibuprofen tab.200 mg
53 Kalium Permanganas 5 gr

54 Kals Laktat tab.500 mg

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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

55 Ketokonazol tablet 200 mg

56 Ketokonazol cream

57 Kloramfenikol salep mata

58 Klorpromazine inj

59 Kodein HCL 10 mg

60 Kotrimoksazol Susp 0 0

61 Kotrimoksazol 480mg Tab

62 Levofloxacin 500 mg

63 Loratadine

64 Metilergometrin Tab.

65 Metoclopramide 10 mg

66 Metronidazole 500 mg

67 Mikonazole Cream

68 Natrium Bikarbonat

69 Natrium Diklofenac 50 mg

70 Natrium Klorida 0.9 %

71 Nifedipin 10 mg

72 Nistatin 500.000 IU/g

73 Obat Batuk hitam

74 Oksitetrasiklin Salep Mata

75 Oksitetrasiklin Salep Kulit

76 Omeprazole inj 40 mg/ 10 ml

77 Omeprazole 20 mg

78 Parasetamol Syrup 120 mg / 5 ml

79 Parasetamol Tablet 500 mg


80 Pehacain Inj

81 Pirantel tab 125 mg

82 Propiltiourasil 100 mg

83 Propanolol tab 40 mg

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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 Ranitidin

85 Ranitidin Inj

86 Ringer Lactat Infus

87 Salbutamol 4 mg

88 Salep 2- 4

89 Salisil Bedak 2 %

90 Sefadroksil Syr

91 Setirizine tab

92 Simvastatin 20 mg

93 Serum Anti Bisa Ular ( ABU I )

94 Serum Anti Tetanus 1.500 UI / ml

95 Tetrasiklin HCL 250 mg

96 Tiamin HCL ( Vit B1 ) 50 mg

97 Tramadol caps 50 mg

98 Vitamin B Complek

99 Yodium Povidon 30 ml

100 Zink Syr

101 Zink tablet

OBAT GIGI

102 Curaspon

103 Etil Klorida semprot

104 Eugenol Cairan

105 Glass ionomer cement ART


106 Kalsium Hidroksida Pasta

ALAT KESEHATAN

107 Alat Suntik 5 cc

108 Alat Suntik 10 cc

109 Aquadest 1000 ml

110 Blood Tranfusion Set

No Nama Obat Persediaan Jumlah Jenis Obat Pada Tanggal Pemakaian Pema Stok Ket

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

111 Catgut 2/0

112 Catgut 3/0

113 Hand Scun

114 Infusion set dewasa

115 I.V Cateter 18 G

116 I.V Cateter 20 G

117 I.V Cateter 22 G

118 I.V Cateter 24 G

119 Kasa Pembalut 4m x 15 cm

120 Masker

121 Plester 5 yard x 2 inch

122 Silk

123 Spiritus 500 ml

Mengetahui
Kepala Puskesmas Pengelola Obat PKM
( ) ( )
Nip. Nip.
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT DAK
( LPLPO ) DAK

BULAN
UPT PKM :
:
KECAMATAN : TAHUN :
KABUPATEN : ACEH TIMUR
PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK


AWAL MAAN DIAAN KAIAN AKHIR
1 2 3 4 5 6 7 8

1 Acyclovir tab 200 mg Tablet

2 Acyclovir tab 400 mg Tablet

3 Acyclovir cream 5 % Tube

4 Albendazole 400 mg Tablet

5 Allopurinol 100 mg Tablet

6 Ambroxol Syr 60 ml Botol

7 Ambroxol tab 30 mg Tablet

8 Aminopillin tab 200 mg Tablet

9 Amitriptiline 25 Tablet

10 Amlodipin 5 mg Tablet

11 Amlodipin 10 mg Tablet

12 Amoksisillina kapl 250mg Kapsul

13 Amoksisillina kapl 500mg Tablet

14 Amoksisillina sirker 250 mg / 5 ml Botol

15 Antasida Doen Tab Tablet

16 Antasida sir Botol

17 Asam Ascorbat ( Vit.C ) 50 mg Tablet

18 Asam Mefenamat 500 mg Tablet

19 Attapulgite 630 mg Tablet

20 Atropin Sulfat 0.5 mg Tablet

21 Besi II Sulfat Tablet

22 Betametason Krim Tube

23 Captopril 12.5 mg Tablet

24 Captopril 25 mg Tablet
25 Captopril 50 mg Tablet

26 Deksametason Inj Ampul

27 Deksametason 0,5 mg Tablet

28 Diazepam Tab 2 mg Tablet

29 Digoksin 0,25 mg Tablet

30 Diltiazem HCL 30mg Tablet

31 Dipenhidramin Inj Ampul

32 Domperidom Tablet

33 Efedrina HCL 25 mg Tablet

34 Erytromicin Syr Botol

35 Etakridine kom Botol

36 Etanol Botol

37 Fenobarbital tab 30 mg Tablet

38 Fitomenadion Inj Ampul

39 Fitomenadion Tablet Tablet

40 Furrosemida tab Tablet

41 Furrosemida inj Ampul

42 Garam Oralit Tablet

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK


AWAL MAAN DIAAN KAIAN AKHIR
1 2 3 4 5 6 7 8

43 Gentamicin SK 0,1 % Tube

44 Glibenklamida tab 5 mg Tablet

45 Glimepiride 2 mg Tablet

46 Glukosa Lar. Inf 5 % Botol

47 Griseofulvin tab 125 mg Tablet

48 Halloperidol 0.5 mg Tablet

49 Halloperidol 1.5 mg Tablet

50 Halloperidol 1.5 mg Tablet

51 Hidrokortison Krim Tube

52 Ibuprofen tab.200 mg Tablet

53 Kalium Permanganas 5 gr Botol

54 Kals Laktat tab.500 mg Tablet


55 Ketokonazol tablet 200 mg Tablet

56 Ketokonazol cream Tube

57 Kloramfenikol salep mata Tube

58 Klorpromazine inj Ampul

59 Kodein HCL 10 mg Tablet

60 Kotrimoksazol Susp Botol

61 Kotrimoksazol 480mg Tab Tablet

62 Levofloxacin 500 mg Tablet

63 Loratadine Tablet

64 Metilergometrin Tab. Tablet

65 Metoclopramide 10 mg Tablet

66 Metronidazole 500 mg Tablet

67 Mikonazole Cream Tube

68 Natrium Bikarbonat Tablet

69 Natrium Diklofenac 50 mg Tablet

70 Natrium Klorida 0.9 % Botol

71 Nifedipin 10 mg Tablet

72 Nistatin 500.000 IU/g Tablet

73 Obat Batuk hitam Botol

74 Oksitetrasiklin Salep Mata Tube

75 Oksitetrasiklin Salep Kulit Tube

76 Omeprazole inj 40 mg/ 10 ml Vial

77 Omeprazole 20 mg Kapsul

78 Parasetamol Syrup 120 mg / 5 ml Botol

79 Parasetamol Tablet 500 mg Tablet

80 Pehacain Inj Ampul

81 Pirantel tab 125 mg Tablet

82 Propanolol tab 40 mg Tablet

83 Propiltiourasil 100 mg Tablet

84 Ranitidin Tablet

85 Ranitidin Inj Ampul

86 Ringer Lactat Infus Botol

87 Salbutamol 4 mg Tablet

88 Salep 2- 4 Tube

89 Salisil Bedak 2 % kotak


90 Sefadroksil Syr Botol

91 Setirizine tab Tablet

92 Simvastatin 20 mg Tablet

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK


AWAL MAAN DIAAN KAIAN AKHIR
1 2 3 4 5 6 7 8

93 Serum Anti Bisa Ular ( ABU I ) Vial

94 Serum Anti Tetanus 1.500 UI / ml Ampul

95 Tetrasiklin HCL 250 mg Kapsul

96 Tiamin HCL ( Vit B1 ) 50 mg Tablet

97 Tramadol caps 50 mg Capsul

98 Vitamin B Complek Tablet

99 Yodium Povidon 30 ml Botol

100 Zink Syr Botol

101 Zink tab Tablet

OBAT GIGI

102 Curaspon Botol

103 Etil Klorida semprot Botol

104 Eugenol Cairan Botol

105 Glass ionomer cement ART Botol

106 Kalsium Hidroksida Pasta Set

ALAT KESEHATAN

107 Alat Suntik 5 cc Unit

108 Alat Suntik 10 cc Unit

109 Aquadest 1000 ml Botol

110 Blood Tranfusion Set Kantong

111 Catgut 2/0 Pcs

112 Catgut 3/0 Pcs

113 Hand Scun Set

114 Infusion set dewasa Kantong

115 I.V Cateter 18 G Buah

116 I.V Cateter 20 G Buah

117 I.V Cateter 22 G Buah


118 I.V Cateter 24 G Buah

119 Kasa Pembalut 4m x 15 cm Rol

120 Masker Pcs

121 Plester 5 yard x 2 inch Rol

122 Silk Pcs

123 Spiritus 500 ml Botol

Mengetahui
Kepala Puskesmas Pengelola Obat PKM

( ) ( )
Nip. Nip.
AT DAK

PERMIN
KET
TAAN
9 10
PERMIN
KET
TAAN
9 10
PERMIN
KET
TAAN
9 10
gelola Obat PKM