Lplpo 2017

Halaman 1
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

PUSKESMAS : SUELA NO. : TANGGAL :
KECAMATAN : SUELA PELAPORAN BULAN Desember
KABUPATEN / KODYA : LOMBOK TIMUR PERMINTAAN BULAN Januari
PROVINSI : NUSA TENGGARA BARAT TAHUN : 2017
SISA STOCK PEMBERIAN

KODE NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN KET.
STOK OPTM INPRES ASKES APBD LAIN" JML
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
101 Alat Suntik 10 ml set 0 300 300 100 200
103 Alat Suntik 2,5 ml set 200 500 700 400 300
105 Albendazol 400 mg tablet 0 0 0 0 0
106 Alloporinol 100 mg tablet 0 0 0 0 0
107 Aminophillin 200 mg tablet 0 0 0 0 0
108 Aminophillin Inj 24 mg/ml 10 ml ampul 30 0 30 0 30
109 Amitriptilina tab 25 mg tablet 100 0 100 0 100
110 Amoksisilina Syrup kering botol 0 360 360 264 96
111 Amoksisilina kaps 250 mg kapsul 0 0 0 0 0
112 Ampisilina Kaplet 500 mg kaplet 0 0 0 0 0
113 Ampisilina Syrupkerng 125 mg/5 ml botol 0 0 0 0 0
114 Antalgin tab 500 mg tablet 0 0 0 0 0
115 Antalgin Inj 250 mg/ml 2ml ampul 0 0 0 0 0
116 Antasida DOEN tab tablet 5,200 7,000 12,200 6,200 6,000
117 Anti Bakteri DOEN Salep kombinasi tube 0 0 0 0 0
118 Anti Haemoroid DOEN Kombinasi suppos 0 0 0 0 0
119 Anti Fungi DOEN Kombinasi pot 0 0 0 0 0
120 Anti Migrain DOEN Kombinasi tablet 0 0 0 0 0
121 Anti Parkinson DOEN tab Kombinasi tablet 0 0 0 0 0
123 Aqua Pro Injeksi Steril bebas pirogen ampul 0 0 0 0 0
124 Aquadest Steril botol 0 0 0 0 0
125 Asam Askorbat 250 mg tablet 0 0 0 0 0
Halaman 2

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
126 Asam Askorbat 50 mg tablet 0 5,000 5,000 2,000 3,000
127 Asam Klorida 0,1 N botol 0 0 0 0 0
128 Asam Sulfosalisilat 20 % 100 ml botol 0 0 0 0 0
129 Asetosal 100 mg tablet 0 0 0 0 0
130 Asetasal 500 mg tablet 0 0 0 0 0
131 Atropin Sulfat Injeksi 0,2 mg/ml 1ml ampul 0 0 0 0 0
132 Atropin Sulfat Tablet 0,5 mg tablet 0 0 0 0 0
133 Atropin tetes mata 0,5 % botol 0 0 0 0 0
201 Benzatin B Penisilin 1,2 jt IU/vial vial 0 0 0 0 0
202 Benzatin B Penisilin 2,4 jt IU/vial vial 0 0 0 0 0
203 Besi Syrup botol 0 0 0 0 0
204 Betametason cream tube 63 100 163 63 100
301 Catgut / Benang bedah sachet 0 0 0 0 0
401 Cefotaxime ampul 0 0 0 0 0
402 Deksametason Inj 5 mg/ml 1ml ampul 0 0 0 0 0
403 Deksametason tablet 0,5 mg tablet 0 0 0 0 0
404 Dekstran 70 Lar Infus 6 % steril botol 0 0 0 0 0
405 Dekstrometorphan HBR Syr10mg/5ml botol 0 0 0 0 0
406 Dekstrometorphan HBR Tab 15 mg tablet 0 0 0 0 0
407 Devitalisasi Pasta botol 0 0 0 0 0
408 Diazepam Inj 5 mg/ml 2ml ampul 16 0 16 1 15
409 Diazepam tablet 2 mg tablet 0 0 0 0 0
411 Dietil Karbamasin 100 mg tablet 0 0 0 0 0
412 Diphenhidramin Inj 10 mg/ml 1ml ampul 0 0 0 0 0
413 Digoksin tab 0,25 mg tablet 300 0 300 200 100
501 Epedrina HCL 25 mg tab tablet 0 0 0 0 0
502 Ekstrk Belladona tab 100 mg tablet 0 0 0 0 0
503 Epineprin Inj 0,1 % 1ml ampul 0 0 0 0 0
504 Etakridin (rivanol) Lar 0,1 % botol 0 0 0 0 0
505 Etambutol 250 mg tablet 0 0 0 0 0
506 Etanol 70 % botol 10 30 40 20 20
Halaman 3

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
507 Eter Anestesi botol 0 0 0 0 0
508 Etil Klorida semprot botol 0 0 0 0 0
509 Eugenol Cairan botol 0 0 0 0 0
601 Fenitoin Natrium Inj 50 mg/ml ampul 0 0 0 0 0
602 Fenitoin kaps 100 mg kapsul 0 0 0 0 0
603 Fenitoin Kaps 30 mg kapsul 0 0 0 0 0
604 Fenobarbital Inj 50 mg/ml 1ml ampul 23 30 53 23 30
605 Fenobarbital Tab 100 mg tablet 0 0 0 0 0
606 Fenobarbital tab 30 mg tablet 1,000 0 1,000 0 1,000
607 Fenoksimetil pen tab 250 mg tablet 0 0 0 0 0
608 Fenoksimetil pen tab 500 mg tablet 0 0 0 0 0
609 Fenol Gliserol TT 10 % botol 0 0 0 0 0
610 Fitomenadion Inj 10 mg/ml 1ml ampul 0 0 0 0 0
611 Fitomenadion tab 10 mg tablet 700 0 700 0 700
612 Fluor tab 0,5 mg tablet 0 0 0 0 0
613 Furosemida 40 mg tablet 400 0 400 100 300
701 Gameksan Emulsi botol 0 0 0 0 0
702 Garam Oralit 1000 ml sachet 0 0 0 0 0
704 Gentian violet Lar 1 % botol 0 0 0 0 0
705 Glass Ionomer Cemen (GCIX) set 0 0 0 0 0
706 Glibenclamid 5 mg tablet 0 0 0 0 0
707 Gliseril Guayacolat tab 100 mg tablet 0 0 0 0 0
708 Gliserin botol 0 0 0 0 0
709 Glukosa Infus 10 % botol 0 0 0 0 0
712 Griseofulfin tab 125 mg tablet 0 0 0 0 0
801 Haloperidol tab 0,5 mg tablet 0 0 0 0 0
802 Haloperidol tab 1,5 mg tablet 0 0 0 0 0
803 Hidroclortiazide (HCT) tab 25mg tablet 0 0 0 0 0
Hidrokortison cream tube 32 96 128 37 91
Halaman 4

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
901 Ibuprofen tab 200 mg tablet 0 0 0 0 0
902 Ibuprofen tab 400 mg tablet 0 5,000 5,000 2,600 2,400
903 Infusion set anak set 0 0 0 0 0
904 Infusion set dewasa set 100 400 500 350 150
905 Insulin reguler Inj 40 IU/ml 10 ml vial 0 0 0 0 0
906 Iodiol Kaps lunak kapsul 0 0 0 0 0
907 Ipeka Syrup botol 0 0 0 0 0
908 INH 300 mg tablet 0 0 0 0 0
909 Isosorbid Dinitrat tab 5 mg tablet 100 0 100 0 100
1,001 Jarum Bedah no 9 s/d 14 biji 0 0 0 0 0
1,002 Kalium Permanganat Serbuk botol 0 0 0 0 0
1,003 Kalsium Hidroksida Pasta tube 0 0 0 0 0
1,004 Kalsium Laktat tablet 0 0 0 0 0
1,005 Kapas berlemak 500 gram bungkus 0 0 0 0 0
1,006 Kapas Pembalut 250 gram bungkus 0 0 0 0 0
1,007 Karbamazepin tab 200 mg tablet 300 500 800 400 400
1,008 Kasa Kompres 40 x 40 rol 0 0 0 0 0
1,009 Kasa Pembalut 2x80 rol 0 0 0 0 0
1,012 Ketamin Inj 10 mg/ml vial 0 0 0 0 0
1,013 Klofazimin kaps 100 mg kapsul 0 0 0 0 0
1,014 Klorampenikol kaps 250 mg kapsul 0 0 0 0 0
1,015 Klorampenikol sm 1 % tube 48 0 48 0 48
1,016 Klorampeicol TT 3 % botol 0 0 0 0 0
1,017 Klorfeniramin maleat (CTM) 4 mg tablet 400 1,000 1,400 1,400 0 3000
1,018 Klorokuin tab 150 mg tablet 0 0 0 0 0
1,019 Klorpromazina Inj 25 mg/ml 1ml ampul 0 0 0 0 0
1,020 Klorpromazina Inj 5 mg/ml 2ml ampul 0 0 0 0 0
1,021 Klorpromazina tab 100 mg tablet 670 0 670 0 670
1,023 Klorpropamida 100 mg tab tablet 0 0 0 0 0
Halaman 5

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,024 Kodeina tab 10 mg tablet 0 0 0 0 0
1,025 Komb pirimetamin 25 mg+Sulfadoksin 500 mg tablet 0 0 0 0 0
1,026 Kotrimoksasol ped tab tablet 0 0 0 0 0
1,027 Kotrimoksasol Suspensi botol 0 300 300 100 200
1,028 Kotrimoxsasol tab Dewasa tablet 500 5,000 5,500 2,500 3,000
1,029 Kuinin Dihidroksida Inj 25 % 2 ml ampul 0 0 0 0 0
1,030 Kuinin sulfat tab 222 mg tablet 0 0 0 0 0
1,101 Larutan Benedict botol 0 0 0 0 0
1,102 Larutan Eosin 2 % botol 0 0 0 0 0
1,103 Larutan Etanol Asam botol 0 0 0 0 0
1,104 Larutan Giemsa Stain botol 0 0 0 0 0
Larutan Karbol Fuksin botol 0 0 0 0 0
1,106 Larutan Metilen biru botol 0 0 0 0 0
1,107 Larutan Turk botol 0 0 0 0 0
1,108 Lidokain Kompositum Inj ampul 75 100 175 19 156
1,109 Lisol botol 0 0 0 0 0
1,201 Magnesium Sulfat Inj(IV) 20 % 25 ml vial 0 0 0 0 0
1,203 Mebendazol Syrup100 mg/5 ml botol 0 0 0 0 0
1,204 Mebendazol Tab 100 mg tablet 0 0 0 0 0
1,205 Metanol botol 0 0 0 0 0
1,206 Metilergometrin maleat tab 0,125mg tablet 0 0 0 0 0
1,207 Metilergometrin maleat Inj 0,2 mg /ml ampul 116 0 116 0 116
1,208 Metronidazol tab 250 mg tablet 0 0 0 0 0
1,209 Monoklor Kamfermentol cairan botol 0 0 0 0 0
1,210 Mummifyng Pasta botol 0 0 0 0 0
1,301 Natrium Bicarbonat Tab 500 mg tablet 0 0 0 0 0
1,302 Natrium Fluoresein TM 2 % botol 0 0 0 0 0
1,303 Natrium klorida infus 0,9 % botol 40 0 40 20 20
1,304 Natium Tiosulfat Inj 25 % 10 ml ampul 0 0 0 0 0
1,305 Nistatin 100.000 IU Tab Vaginal tablet 0 0 0 0 0
1,306 Nistatin 500.000 IU Tab Vaginal tablet 0 0 0 0 0
Halaman 6

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,307 OAT FDC I paket 10 0 10 0 10
1,308 Oat FDC II paket 0 0 0 0 0
1,309 OBH Cairan botol 0 0 0 0 0
1,310 Oksigen gas dalam tabung tabung 0 0 0 0 0
1,311 Oksitetrasiklin HCl Inj 50 mg/ml 10 ml tube 37 0 37 0 37
1,312 Oksitetrasilin SK 3 % tube 100 0 100 0 100
1,313 Oksitetrasikli SM 1 % tube 0 0 0 0 0
1,314 Oksitosin Inj ampul 60 0 60 35 25 100
1,401 Paraformaldehida Tablet tablet 0 0 0 0 0
1,402 Parasetamol Syrup 125 mg/5 ml botol 168 300 468 200 268
1,403 Parasetamol tab 100 mg tablet 0 0 0 0 0
1,404 Parasetamol Tab 500 mg tablet 100 10,000 10,100 5,100 5,000 5000
1,405 Pembalut Gips rol 0 0 0 0 0
1,406 Perfenazine 16 mg tab tablet 0 0 0 0 0
1,407 Perfenazine 4 mg tab tablet 0 0 0 0 0
1,408 Pethidin Inj ampul 0 0 0 0 0
1,409 Pilokarpin HCl TM 2 % botol 0 0 0 0 0
1,410 Pirantel Pamoat tab 125 mg tablet 0 0 0 0 0
1,411 Piridoksin HCl Tab 10 mg tablet 0 3,000 3,000 500 2,500
1,412 Plester 5 yard x2 Inchi rol 0 0 0 0 0
1,413 Polikresulen rol 0 0 0 0 0
1,414 Polipeptida DOEN Infus botol 0 0 0 0 0
1,415 Prazikuantel Tab 600 mg tablet 0 0 0 0 0
1,416 Prednison Tab 5 mg tablet 0 0 0 0 0
1,417 Primkina tab 15 mg tablet 80 0 80 0 80
1,418 Prokain Benzil Penisilin Inj 3 Juta IU/vial vial 30 0 30 0 30
1,419 Propil tiourasil tab 100 mg tablet 0 300 300 0 300
1,420 Propanolol tab 40 mg tablet 0 300 300 0 300
1,501 Rabies Immune globulin 150 IU/ml vial 0 0 0 0 0
1,502 Reserpina Tab 0,1 mg tablet 0 0 0 0 0
1,503 Reserpina Tab 0,25 mg tablet 0 0 0 0 0
1,504 Retinol (vit A) Kaps 200.000 IU kapsul 0 0 0 0 0
Halaman 7

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,505 Rifampisina tab 600 mg tablet 0 0 0 0 0
1,506 Rifampisina tab 300 mg tablet 0 0 0 0 0
1,507 Rifampisina kaps 450 mg kapsul 0 0 0 0 0
1,508 Ringer Laktat Lar Infus botol 170 1,200 1,370 620 750
1,601 Salbutamol Tab 2 mg tablet 0 0 0 0 0
1,602 Salep 24 kombinasi pot 0 0 0 0 0
1,603 Salisil Bedak 2 % kotak 0 0 0 0 0
1,604 Salisil Spritus 10 % botol 0 0 0 0 0
1,605 Semen seng pospat set 0 0 0 0 0
1,606 Sabu polivalen 5 ml (ABU I) vial 1 0 1 1 0
1,607 Sabu polivalen 50 ml (ABUII) vial 0 0 0 0 0
1,608 Serum anti Dufteri 20.000IU/vial vial 0 0 0 0 0
1,609 Serum ATS 1500 IU / Ampul vial 0 0 0 0 0
1,610 Serum Anti Tetanus Inj 20000 IU/vl vial 0 0 0 0 0
1,611 Sianokobalamin Inj 500 mcg/ml ampul 142 200 342 242 100
1,612 Silk ( Benang Bedah ) sak 0 0 0 0 0
1,613 Silver Amalgam botol 0 0 0 0 0
1,614 Spon Gelatin tabung 0 0 0 0 0
1,615 Streptomisin Sulfat Inj 1000 mg vial 0 0 0 0 0
1,616 Streptomisin Sulfat Inj 1500 Mg vial 0 0 0 0 0
1,617 Sulfadimidin Tab 500 mg tablet 0 0 0 0 0
1,618 Sulfacetamide TM 15 % botol 0 0 0 0 0
1,619 Suspensi Seng Insulin 40 IU/ml 10 ml set 0 0 0 0 0
1,701 Besi Sulfat tablet salut 300 mg tablet 0 0 0 0 0
1,702 Temporary Stopping Fletcher serbuk set 0 0 0 0 0
1,703 Tetrakain Hcl TM 0,5 % botol 0 0 0 0 0
1,704 Tetrasiklin Kaps 250 mg kapsul 0 0 0 0 0
1,705 Tetrasiklin Kaps 500 mg kapsul 0 0 0 0 0
1,706 Thiamin Hcl (vit B1) Inj 100 mg/ml vial 0 0 0 0 0
1,707 Thiamin Hcl (vit B1) tab 50 mg tablet 0 1,000 1,000 500 500
1,708 Tiopental Natrium serbuk inj 1000 mg/amp ampul 0 0 0 0 0
1,709 Triheksipenidil Hcl 2mg/tab tablet 0 0 0 0 0
Halaman 8

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,710 Trikresolformalin (TKF) cairan botol 0 0 0 0 0
1,801 Vaksin Rabies Vero set 0 0 0 0 0
1,802 Vitamin B-Komplek Tablet tablet 2,000 8,000 10,000 6,000 4,000
1,901 Yodium Povidon Larutan 10 % 30ml botol 0 0 0 0 0
1,902 Yodium Povidon Larutan 10 % 300ml botol 30 0 30 0 30
TAMBAHAN 0 0 0 0 0
T-01 Ambroxol 30 mg tablet 0 2,000 2,000 1,900 100 3000
T-02 Amoksisilin 500 mg tablet 4,900 6,000 10,900 5,300 5,600 5000
T-03 Salbutamol Tab 4 mg tablet 0 0 0 0 0
T-04 Bisacodyl 10 mg supp suppos 0 0 0 0 0
T-05 Diazepam Rectal tube tube 0 0 0 0 0
T-06 Paracetamol drop 60 mg / 0,6 ml Lembar 0 0 0 0 0
T-07 IV Catheter set 0 0 0 0 0 200
T-08 Jarum Suntik pcs 0 0 0 0 0
T-09 Kalsium Gluconat Inj 100 mg vial 0 0 0 0 0
T-10 Mikonazol Salep tube 5 24 29 5 24
T-11 Klorampenicol botol 0 0 0 0 0
T-12 OAT Kat III paket 0 0 0 0 0
T-13 OAT Sisipan paket 0 0 0 0 0
T-14 Metoklorpramid tab 5 mg tablet 0 0 0 0 0
T-15 Metoklorpramid Inj 5 mg/ml ampul 0 0 0 0 0
T-16 Amlodipin tablet 0 900 900 0 900
T-17 Ventolin vial 0 20 20 10 10
T-18 Ranitidin 150 mg botol 0 0 0 0 0 2000
T-19 Ranitidin Inj 25 mg/ ml ampul 0 0 0 0 0
T-20 Fitomenadion 1 mg/ml ampul 0 0 0 0 0
T-21 Retinol (vit A)tablet salut 100,000 IU kapsul 0 0 0 0 0
T-22 Zinc sirup pot 0 0 0 0 0
T-23 Paracetamol rectal kotak 0 0 0 0 0
T-24 Antasida Syrup botol 0 100 100 50 50
T-25 Antapulgit tab 600 mg tablet 0 500 500 500 0
T-26 Kasa 40x80 cm rol 0 0 0 0 0
Halaman 9

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
T-27 Papaverin Tablet tablet 0 0 0 0 0
T-28 Masker box 0 300 300 100 200
T-29 Pehacain vial 0 40 40 0 40
T-30 Sarung tangan non steril pcs 300 500 800 400 400
T-31 Sarung tangan steril Pasang 0 200 200 0 200
T-32 OAT Katagori anak paket 0 0 0 0 0
T-33 Asam Mefenamat 500 mg tablet 0 5,000 5,000 2,000 3,000
T-34 Ambroxol syrup botol 0 48 48 0 48
T-35 Nipedipin tablet 300 500 800 200 600
T-36 Kaptopril 12.5 mg tablet 0 0 0 0 0
T-37 Kaptopril 25 mg tablet 3,000 1,000 4,000 2,000 2,000
T-38 Kloramphenicol inj vial 0 0 0 0 0
T-39 Ampisilin inj. 1 gr vial 0 0 0 0 0
T-40 Plester transparan rol 0 0 0 0 0
T-41 Plester non transparan rol 5 10 15 10 5 10
T-42 Gentamicin inj ampul 0 0 0 0 0
T-43 Artemeter Inj ampul 0 0 0 0 0
T-44 Artesunate Inj ampul 0 0 0 0 0
T-45 Doksisiklin 100 mg kapsul 0 0 0 0 0
T-46 Haloperidol 5 mg tablet 300 500 800 400 400
T-47 Piroxicam 10 mg tablet 0 3,000 3,000 1,000 2,000
T-48 Siprofloxasin 500 mg tablet 0 0 0 0 0
T-49 Etabion tablet 50,300 0 50,300 0 50,300
T-50 Zinc tablet 20 mg tablet 0 0 0 0 0
T-51 Ibuprofen Sirup botol 0 100 100 50 50
T-52 Kloram salep mata tube 0 0 0 0 0
T-53 Fondazen botol 0 21,600 21,600 4,300 17,300
T-54 Asiklovir 400 mg tablet 0 0 0 0 0
T-55 Asiklovir cream tube 0 25 25 0 25
T-56 Metronidazol tab 500 mg tablet 0 0 0 0 0
T-57 Natrium diklofenak 50 mg tablet 500 500 1,000 300 700
T-58 Kaptopril 50 mg tablet 3,650 0 3,650 0 3,650
Halaman 10

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
T-59 Ketokonazole 200 mg tablet 150 500 650 50 600
T-60 Famotidin 40 mg tablet 900 500 1,400 1,300 100
T-61 Ketoprofen Inj tablet 0 0 0 0 0
T-62 Metoklorpramid syrup 5 mg/ ml botol 0 0 0 0 0
T-63 Asam asetil salisilat 100 mg tablet 100 0 100 0 100
T-64 Lexavit tablet 0 0 0 0 0
T-65 OAT Kategori I ( Kombipak ) Paket 0 0 0 0 0
T-66 Arterakine Tablet 45 0 45 0 45
Halaman 11
UMUM BPJS JML HARI RAWAT PERKIRAAN KET

JUMLAH JML PERSALINAN PERSALINAN
JUMLAH KUNJUNGAN RWT INAP RWT JALAN RWT INAP RWT JALAN UMUM BPJS
RESEP
103 415 67 1,481 2,066 309 201 45 50
MENGETAHUI : Yang Menyerahkan Yang Menerima / Melapor Yang Menerima

KEPALA DINAS KESEHATAN Kasi Kefarmasian dan Makmin Kepala Puskesmas Suela Petugas Puskesmas
KABUPATEN LOMBOK TIMUR
Drg. ASRUL SANI, M.Kes E bang Yuliastuti, S.Farm, Apt MUHAMMAD AZWARDI, S.Kep HERMAN SUBANDI, A.Md.Farm
NIP. 19750823 200112 1 002 NIP : 19860701 2001101 2 020 NIP : 19720501 199603 1 002 NIP : -
Halaman 12

KECAMATAN : SUELA PELAPORAN BULAN Januari
KABUPATEN / KODYA : LOMBOK TIMUR PERMINTAAN BULAN Februari

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
103 Alat Suntik 2,5 ml set 300 0 300 300 0 600
105 Albendazol 400 mg tablet 0 0 0 0
111 Amoksisilina kaps 250 mg kapsul 0 0 0 0
112 Ampisilina Kaplet 500 mg kaplet 0 0 0 0
113 Ampisilina Syrupkerng 125 mg/5 ml botol 0 0 0 0
114 Antalgin tab 500 mg tablet 0 0 0 0
115 Antalgin Inj 250 mg/ml 2ml ampul 0 0 0 0
116 Antasida DOEN tab tablet 6,000 0 6,000 5,000 1,000 15000
117 Anti Bakteri DOEN Salep kombinasi tube 0 0 0 0
118 Anti Haemoroid DOEN Kombinasi suppos 0 0 0 0
119 Anti Fungi DOEN Kombinasi pot 0 0 0 0
120 Anti Migrain DOEN Kombinasi tablet 0 0 0 0
121 Anti Parkinson DOEN tab Kombinasi tablet 0 0 0 0
123 Aqua Pro Injeksi Steril bebas pirogen ampul 0 0 0 0
124 Aquadest Steril botol 0 0 0 0
125 Asam Askorbat 250 mg tablet 0 0 0 0
Halaman 13

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
126 Asam Askorbat 50 mg tablet 3,000 0 3,000 2,300 700 8000
127 Asam Klorida 0,1 N botol 0 0 0 0
128 Asam Sulfosalisilat 20 % 100 ml botol 0 0 0 0
129 Asetosal 100 mg tablet 0 0 0 0
130 Asetasal 500 mg tablet 0 0 0 0
131 Atropin Sulfat Injeksi 0,2 mg/ml 1ml ampul 0 0 0 0
132 Atropin Sulfat Tablet 0,5 mg tablet 0 0 0 0
133 Atropin tetes mata 0,5 % botol 0 0 0 0
201 Benzatin B Penisilin 1,2 jt IU/vial vial 0 0 0 0
203 Besi Syrup botol 0 0 0 0
301 Catgut / Benang bedah sachet 0 0 0 0
401 Cefotaxime ampul 0 0 0 0
402 Deksametason Inj 5 mg/ml 1ml ampul 0 0 0 0
403 Deksametason tablet 0,5 mg tablet 0 0 0 0
404 Dekstran 70 Lar Infus 6 % steril botol 0 0 0 0
405 Dekstrometorphan HBR Syr10mg/5ml botol 0 0 0 0
406 Dekstrometorphan HBR Tab 15 mg tablet 0 0 0 0
407 Devitalisasi Pasta botol 0 0 0 0
410 Diazepam tablet 5 mg tablet 0 0 0 0
411 Dietil Karbamasin 100 mg tablet 0 0 0 0
501 Epedrina HCL 25 mg tab tablet 0 0 0 0
502 Ekstrk Belladona tab 100 mg tablet 0 0 0 0
503 Epineprin Inj 0,1 % 1ml ampul 0 0 0 0
504 Etakridin (rivanol) Lar 0,1 % botol 0 0 0 0
505 Etambutol 250 mg tablet 0 0 0 0
506 Etanol 70 % botol 20 0 20 14 6
Halaman 14

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
507 Eter Anestesi botol 0 0 0 0
508 Etil Klorida semprot botol 0 0 0 0
509 Eugenol Cairan botol 0 0 0 0
601 Fenitoin Natrium Inj 50 mg/ml ampul 0 0 0 0
602 Fenitoin kaps 100 mg kapsul 0 0 0 0
603 Fenitoin Kaps 30 mg kapsul 0 0 0 0
605 Fenobarbital Tab 100 mg tablet 0 0 0 0
606 Fenobarbital tab 30 mg tablet 1,000 0 1,000 0 1,000 exp
607 Fenoksimetil pen tab 250 mg tablet 0 0 0 0
609 Fenol Gliserol TT 10 % botol 0 0 0 0
610 Fitomenadion Inj 10 mg/ml 1ml ampul 0 0 0 0
612 Fluor tab 0,5 mg tablet 0 0 0 0
701 Gameksan Emulsi botol 0 0 0 0
702 Garam Oralit 1000 ml sachet 0 0 0 0
704 Gentian violet Lar 1 % botol 0 0 0 0
705 Glass Ionomer Cemen (GCIX) set 0 0 0 0
708 Gliserin botol 0 0 0 0
709 Glukosa Infus 10 % botol 0 0 0 0
711 Glukosa Infus 5 % botol 300 0 300 200 100 500
712 Griseofulfin tab 125 mg tablet 0 0 0 0
801 Haloperidol tab 0,5 mg tablet 0 0 0 0
803 Hidroclortiazide (HCT) tab 25mg tablet 0 0 0 0
804 Hidrokortison cream tube 91 0 91 31 60 96
Halaman 15

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
901 Ibuprofen tab 200 mg tablet 0 0 0 0
902 Ibuprofen tab 400 mg tablet 2,400 0 2,400 2,300 100
903 Infusion set anak set 0 0 0 0
905 Insulin reguler Inj 40 IU/ml 10 ml vial 0 0 0 0
906 Iodiol Kaps lunak kapsul 0 0 0 0
907 Ipeka Syrup botol 0 0 0 0
908 INH 300 mg tablet 0 0 0 0
1,001 Jarum Bedah no 9 s/d 14 biji 0 0 0 0
1,002 Kalium Permanganat Serbuk botol 0 0 0 0
1,003 Kalsium Hidroksida Pasta tube 0 0 0 0
1,004 Kalsium Laktat tablet 0 0 0 0
1,005 Kapas berlemak 500 gram bungkus 0 0 0 0
1,006 Kapas Pembalut 250 gram bungkus 0 0 0 0
1,007 Karbamazepin tab 200 mg tablet 400 0 400 100 300 300
1,008 Kasa Kompres 40 x 40 rol 0 0 0 0
1,009 Kasa Pembalut 2x80 rol 0 0 0 0
1,012 Ketamin Inj 10 mg/ml vial 0 0 0 0
1,013 Klofazimin kaps 100 mg kapsul 0 0 0 0
1,014 Klorampenikol kaps 250 mg kapsul 0 0 0 0
1,016 Klorampeicol TT 3 % botol 0 0 0 0
1,017 Klorfeniramin maleat (CTM) 4 mg tablet 0 3,000 3,000 700 2,300
1,018 Klorokuin tab 150 mg tablet 0 0 0 0
1,019 Klorpromazina Inj 25 mg/ml 1ml ampul 0 0 0 0
1,022 Klorpromazina tab 25 mg tablet 0 0 0 0
1,023 Klorpropamida 100 mg tab tablet 0 0 0 0
Halaman 16

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,024 Kodeina tab 10 mg tablet 0 0 0 0
1,025 Komb pirimetamin 25 mg+Sulfadoksin 500 mg tablet 0 0 0 0
1,026 Kotrimoksasol ped tab tablet 0 0 0 0
1,027 Kotrimoksasol Suspensi botol 200 0 200 100 100 300
1,028 Kotrimoxsasol tab Dewasa tablet 3,000 0 3,000 1,300 1,700 3000
1,029 Kuinin Dihidroksida Inj 25 % 2 ml ampul 0 0 0 0
1,030 Kuinin sulfat tab 222 mg tablet 0 0 0 0
1,101 Larutan Benedict botol 0 0 0 0
1,102 Larutan Eosin 2 % botol 0 0 0 0
1,103 Larutan Etanol Asam botol 0 0 0 0
1,104 Larutan Giemsa Stain botol 0 0 0 0
Larutan Karbol Fuksin botol 0 0 0 0
1,106 Larutan Metilen biru botol 0 0 0 0
1,107 Larutan Turk botol 0 0 0 0
1,109 Lisol botol 0 0 0 0
1,201 Magnesium Sulfat Inj(IV) 20 % 25 ml vial 0 0 0 0
1,203 Mebendazol Syrup100 mg/5 ml botol 0 0 0 0
1,204 Mebendazol Tab 100 mg tablet 0 0 0 0
1,205 Metanol botol 0 0 0 0
1,206 Metilergometrin maleat tab 0,125mg tablet 0 0 0 0
1,208 Metronidazol tab 250 mg tablet 0 0 0 0
1,209 Monoklor Kamfermentol cairan botol 0 0 0 0
1,210 Mummifyng Pasta botol 0 0 0 0
1,301 Natrium Bicarbonat Tab 500 mg tablet 0 0 0 0
1,302 Natrium Fluoresein TM 2 % botol 0 0 0 0
1,303 Natrium klorida infus 0,9 % botol 20 0 20 2 18 20
1,304 Natium Tiosulfat Inj 25 % 10 ml ampul 0 0 0 0
1,305 Nistatin 100.000 IU Tab Vaginal tablet 0 0 0 0
Halaman 17

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,307 OAT FDC I paket 10 0 10 1 9
1,308 Oat FDC II paket 0 0 0 0
1,309 OBH Cairan botol 0 0 0 0
1,310 Oksigen gas dalam tabung tabung 0 0 0 0
1,311 Oksitetrasiklin HCl Inj 50 mg/ml 10 ml tube 37 0 37 0 37 exp
1,313 Oksitetrasikli SM 1 % tube 0 0 0 0
1,401 Paraformaldehida Tablet tablet 0 0 0 0
1,403 Parasetamol tab 100 mg tablet 0 0 0 0
1,404 Parasetamol Tab 500 mg tablet 5,000 5,000 10,000 7,200 2,800 15000
1,405 Pembalut Gips rol 0 0 0 0
1,406 Perfenazine 16 mg tab tablet 0 0 0 0
1,408 Pethidin Inj ampul 0 0 0 0
1,409 Pilokarpin HCl TM 2 % botol 0 0 0 0
1,410 Pirantel Pamoat tab 125 mg tablet 0 0 0 0
1,411 Piridoksin HCl Tab 10 mg tablet 2,500 0 2,500 1,800 700 3000
1,412 Plester 5 yard x2 Inchi rol 0 0 0 0
1,413 Polikresulen rol 0 0 0 0
1,414 Polipeptida DOEN Infus botol 0 0 0 0
1,415 Prazikuantel Tab 600 mg tablet 0 0 0 0
1,416 Prednison Tab 5 mg tablet 0 0 0 0
1,501 Rabies Immune globulin 150 IU/ml vial 0 0 0 0
1,502 Reserpina Tab 0,1 mg tablet 0 0 0 0
1,504 Retinol (vit A) Kaps 200.000 IU kapsul 0 0 0 0 0 4850
Halaman 18

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,505 Rifampisina tab 600 mg tablet 0 0 0 0
1,507 Rifampisina kaps 450 mg kapsul 0 0 0 0
1,508 Ringer Laktat Lar Infus botol 750 0 750 570 180 400
1,601 Salbutamol Tab 2 mg tablet 0 0 0 0
1,602 Salep 24 kombinasi pot 0 0 0 0
1,603 Salisil Bedak 2 % kotak 0 0 0 0
1,604 Salisil Spritus 10 % botol 0 0 0 0
1,605 Semen seng pospat set 0 0 0 0
1,607 Sabu polivalen 50 ml (ABUII) vial 0 0 0 0
1,608 Serum anti Dufteri 20.000IU/vial vial 0 0 0 0
1,610 Serum Anti Tetanus Inj 20000 IU/vl vial 0 0 0 0
1,612 Silk ( Benang Bedah ) sak 0 0 0 0
1,613 Silver Amalgam botol 0 0 0 0
1,614 Spon Gelatin tabung 0 0 0 0
1,615 Streptomisin Sulfat Inj 1000 mg vial 0 0 0 0
1,616 Streptomisin Sulfat Inj 1500 Mg vial 0 0 0 0
1,617 Sulfadimidin Tab 500 mg tablet 0 0 0 0
1,618 Sulfacetamide TM 15 % botol 0 0 0 0
1,619 Suspensi Seng Insulin 40 IU/ml 10 ml set 0 0 0 0
1,701 Besi Sulfat tablet salut 300 mg tablet 0 0 0 0
1,702 Temporary Stopping Fletcher serbuk set 0 0 0 0
1,703 Tetrakain Hcl TM 0,5 % botol 0 0 0 0
1,704 Tetrasiklin Kaps 250 mg kapsul 0 0 0 0
1,707 Thiamin Hcl (vit B1) tab 50 mg tablet 500 0 500 0 500
1,708 Tiopental Natrium serbuk inj 1000 mg/amp ampul 0 0 0 0
Halaman 19

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,710 Trikresolformalin (TKF) cairan botol 0 0 0 0
1,801 Vaksin Rabies Vero set 0 0 0 0
1,802 Vitamin B-Komplek Tablet tablet 4,000 0 4,000 3,500 500 10000
1,901 Yodium Povidon Larutan 10 % 30ml botol 0 0 0 0
1,902 Yodium Povidon Larutan 10 % 300ml botol 30 0 30 0 30 exp
TAMBAHAN 0 0 0 0
T-01 Ambroxol 30 mg tablet 100 3,000 3,100 800 2,300 1000
T-02 Amoksisilin 500 mg tablet 5,600 5,000 10,600 7,000 3,600 15000
T-03 Salbutamol Tab 4 mg tablet 0 0 0 0
T-04 Bisacodyl 10 mg supp suppos 0 0 0 0
T-05 Diazepam Rectal tube tube 0 0 0 0
T-06 Paracetamol drop 60 mg / 0,6 ml Lembar 0 0 0 0
T-07 IV Catheter set 0 200 200 130 70
T-08 Jarum Suntik pcs 0 0 0 0
T-09 Kalsium Gluconat Inj 100 mg vial 0 0 0 0
T-10 Mikonazol Salep tube 24 0 24 24 0 48
T-11 Klorampenicol botol 0 0 0 0
T-12 OAT Kat III paket 0 0 0 0
T-13 OAT Sisipan paket 0 0 0 0
T-15 Metoklorpramid Inj 5 mg/ml ampul 0 0 0 0
T-18 Ranitidin 150 mg botol 0 2,000 2,000 1,700 300 3000
T-19 Ranitidin Inj 25 mg/ ml ampul 0 0 0 0
T-20 Fitomenadion 1 mg/ml ampul 0 0 0 0
T-21 Retinol (vit A)tablet salut 100,000 IU kapsul 0 0 0 0 0 750
T-22 Zinc sirup pot 0 0 0 0
T-23 Paracetamol rectal kotak 0 0 0 0
T-24 Antasida Syrup botol 50 0 50 10 40 50
T-26 Kasa 40x80 cm rol 0 0 0 0
Halaman 20

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
T-28 Masker box 200 0 200 0 200
T-32 OAT Katagori anak paket 0 0 0 0
T-33 Asam Mefenamat 500 mg tablet 3,000 0 3,000 2,000 1,000 10000
T-36 Kaptopril 12.5 mg tablet 0 0 0 0
T-37 Kaptopril 25 mg tablet 2,000 0 2,000 800 1,200
T-38 Kloramphenicol inj vial 0 0 0 0
T-39 Ampisilin inj. 1 gr vial 0 0 0 0
T-40 Plester transparan rol 0 0 0 0 0 10
T-41 Plester non transparan rol 5 10 15 12 3
T-42 Gentamicin inj ampul 0 0 0 0
T-43 Artemeter Inj ampul 0 0 0 0
T-44 Artesunate Inj ampul 0 0 0 0
T-45 Doksisiklin 100 mg kapsul 0 0 0 0
T-46 Haloperidol 5 mg tablet 400 0 400 0 400 500
T-47 Piroxicam 10 mg tablet 2,000 0 2,000 400 1,600 1000
T-48 Siprofloxasin 500 mg tablet 0 0 0 0
T-49 Etabion tablet 50,300 0 50,300 8,700 41,600
T-50 Zinc tablet 20 mg tablet 0 0 0 0
T-52 Kloram salep mata tube 0 0 0 0
T-53 Fondazen botol 17,300 0 17,300 13,800 3,500 21300
T-54 Asiklovir 400 mg tablet 0 0 0 0
T-56 Metronidazol tab 500 mg tablet 0 0 0 0
T-57 Natrium diklofenak 50 mg tablet 700 0 700 200 500
T-58 Kaptopril 50 mg tablet 3,650 0 3,650 0 3,650 exp
Halaman 21

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
T-59 Ketokonazole 200 mg tablet 600 0 600 500 100 1000
T-60 Famotidin 40 mg tablet 100 0 100 100 0 300
T-61 Ketoprofen Inj tablet 0 0 0 0
T-62 Metoklorpramid syrup 5 mg/ ml botol 0 0 0 0
T-64 Lexavit tablet 0 0 0 0
T-65 OAT Kategori I ( Kombipak ) Paket 0 0 0 0
Halaman 22

RESEP
100 438 110 1,447 2,095 300 330 58 65

NIP. 19750823 200112 1 002 NIP : 19860701 2001101 2 020 NIP : 19720501 199603 1 002 NIP : -
Halaman 23

KECAMATAN : SUELA PELAPORAN BULAN Februari
KABUPATEN / KODYA : LOMBOK TIMUR PERMINTAAN BULAN Maret

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
111 Amoksisilina kaps 250 mg kapsul 0 0 0 0
Halaman 24

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
126 Asam Askorbat 50 mg tablet 700 8,000 8,700 2,400 6,300
128 Asam Sulfosalisilat 20 % 100 ml botol 0 0 0
301 Catgut / Benang bedah sachet 0 0 0 0
403 Deksametason tablet 0,5 mg tablet 0 0 0 0
506 Etanol 70 % botol 6 0 6 6 0 5
Halaman 25

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
612 Fluor tab 0,5 mg tablet 0 0 0 0
804 Hidrokortison cream tube 60 96 156 51 105
Halaman 26

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
908 INH 300 mg tablet 0 0 0 0
1,017 Klorfeniramin maleat (CTM) 4 mg tablet 2,300 0 2,300 2,300 0 3000
Halaman 27

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,028 Kotrimoxsasol tab Dewasa tablet 1,700 3,000 4,700 1,200 3,500
Halaman 28

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,307 OAT FDC I paket 9 0 9 1 8
1,314 Oksitosin Inj ampul 74 100 174 74 100
1,404 Parasetamol Tab 500 mg tablet 2,800 15,000 17,800 1,100 16,700
1,504 Retinol (vit A) Kaps 200.000 IU kapsul 0 4,850 4,850 4,850 0
Halaman 29

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,612 Silk ( Benang Bedah ) sak 0 0 0 0
Halaman 30

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,802 Vitamin B-Komplek Tablet tablet 500 10,000 10,500 2,700 7,800
TAMBAHAN 0 0 0 0
T-01 Ambroxol 30 mg tablet 2,300 1,000 3,300 3,000 300 3000
T-02 Amoksisilin 500 mg tablet 3,600 15,000 18,600 1,300 17,300
T-07 IV Catheter set 70 0 70 70 0
T-17 Ventolin vial 0 0 0 0
T-18 Ranitidin 150 mg botol 300 3,000 3,300 800 2,500
T-26 Kasa 40x80 cm rol 0 0 0 0
Halaman 31

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
T-28 Masker box 200 0 200 200 0
T-33 Asam Mefenamat 500 mg tablet 1,000 10,000 11,000 1,200 9,800
T-37 Kaptopril 25 mg tablet 1,200 0 1,200 1,200 0
T-47 Piroxicam 10 mg tablet 1,600 1,000 2,600 1,400 1,200
T-49 Etabion tablet 41,600 0 41,600 0 41,600
T-53 Fondazen botol 3,500 21,300 24,800 7,300 17,500
Halaman 32

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
T-59 Ketokonazole 200 mg tablet 100 1,000 1,100 200 900
T-60 Famotidin 40 mg tablet 0 300 300 300 0
Halaman 33

RESEP
108 1,457 73 542 2,180 324 219 42 54

NIP. 19750823 200112 1 002 NIP : 19860701 2001101 2 020 NIP : 19720501 199603 1 002 NIP : -
Halaman 34

KECAMATAN : SUELA PELAPORAN BULAN Mret
KABUPATEN / KODYA : LOMBOK TIMUR PERMINTAAN BULAN April

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
103 Alat Suntik 2,5 ml set 400 0 400 300 100 200
116 Antasida DOEN tab tablet 13,200 0 13,200 8,200 5,000 10000
Halaman 35

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
126 Asam Askorbat 50 mg tablet 6,300 0 6,300 2,900 3,400 3000
128 Asam Sulfosalisilat 20 % 100 ml botol 0 0 0
204 Betametason cream tube 50 0 50 0 50 100
403 Deksametason tablet 0,5 mg tablet 0 0 0 0 10000
506 Etanol 70 % botol 0 5 5 1 4 10
Halaman 36

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
612 Furosemida inj ampul 0 0 0 0 25
703 Garam Oralit 200 ml sachet 400 0 400 200 200 1200
711 Glukosa Infus 5 % botol 260 0 260 60 200 300
Halaman 37

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
904 Infusion set dewasa set 0 0 0 0 0 500
908 INH 300 mg tablet 0 0 0 0
1,017 Klorfeniramin maleat (CTM) 4 mg tablet 0 3,000 3,000 2,000 1,000 5000
Halaman 38

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,027 Kotrimoksasol Suspensi botol 300 0 300 150 150 200
1,028 Kotrimoxsasol tab Dewasa tablet 3,500 0 3,500 2,300 1,200 6000
1,303 Natrium klorida infus 0,9 % botol 36 0 36 17 19 40
Halaman 39

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,307 OAT FDC I paket 8 0 8 2 6
1,404 Parasetamol Tab 500 mg tablet 16,700 0 16,700 4,400 12,300
1,411 Piridoksin HCl Tab 10 mg tablet 2,800 0 2,800 1,200 1,600
1,504 Retinol (vit A) Kaps 200.000 IU kapsul 0 0 0 0 0
Halaman 40

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,709 Triheksipenidil Hcl 2mg/tab tablet 400 0 400 200 200 500
Halaman 41

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,802 Vitamin B-Komplek Tablet tablet 7,800 0 7,800 1,700 6,100
TAMBAHAN 0 0 0 0
T-01 Ambroxol 30 mg tablet 300 3,000 3,300 3,300 0
T-02 Amoksisilin 500 mg tablet 17,300 0 17,300 4,200 13,100
T-07 IV Catheter set 0 0 0 0 1980
T-18 Ranitidin 150 mg botol 2,500 0 2,500 2,500 0 5000
T-26 Kasa 40x80 cm rol 0 0 0 0
Halaman 42

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
T-28 Masker box 0 0 0 0
T-33 Asam Mefenamat 500 mg tablet 9,800 0 9,800 2,600 7,200 20000
T-37 Kaptopril 25 mg tablet 0 0 0 0 0
T-46 Haloperidol 5 mg tablet 400 0 400 200 200 500
T-47 Piroxicam 10 mg tablet 1,200 0 1,200 1,200 0 5000
T-49 Etabion tablet 41,600 0 41,600 11,600 30,000 21400
T-53 Fondazen botol 17,500 0 17,500 14,000 3,500
T-55 Asiklovir cream tube 20 0 20 15 5 25
T-57 Natrium diklofenak 50 mg tablet 100 0 100 100 0 500
Halaman 43

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
T-60 Famotidin 40 mg tablet 0 0 0 0 0
Halaman 44

RESEP
105 2,341 60 360 2,866 315 180 51 56

NIP. 19750823 200112 1 002 NIP : 19860701 2001101 2 020 NIP : 19720501 199603 1 002 NIP : -
Halaman 45

KECAMATAN : SUELA PELAPORAN BULAN April
KABUPATEN / KODYA : LOMBOK TIMUR PERMINTAAN BULAN Mei

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
102 Alat Suntik 1 ml set 0 0 0 0
106 Alloporinol 100 mg tablet 0 0 0 0
107 Aminophillin 200 mg tablet 0 0 0 0
108 Aminophillin Inj 24 mg/ml 10 ml ampul 30 0 30 0 30 ex
110 Amoksisilina Syrup kering botol 0 0 0 0
Halaman 46

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
126 Asam Askorbat 50 mg tablet 3,400 3,000 6,400 2,300 4,100
403 Deksametason tablet 0,5 mg tablet 0 10,000 10,000 0 10,000
412 Diphenhidramin Inj 10 mg/ml 1ml ampul 0 0 0 0
413 Digoksin tab 0,25 mg tablet 100 0 100 100 0 300
506 Etanol 70 % botol 4 10 14 5 9
Halaman 47

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
613 Furosemida 40 mg tablet 0 0 0 0
703 Garam Oralit 200 ml sachet 200 1,200 1,400 50 1,350
706 Glibenclamid 5 mg tablet 0 0 0 0
707 Gliseril Guayacolat tab 100 mg tablet 0 0 0 0
Halaman 48

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
908 INH 300 mg tablet 0 0 0 0
1,017 Klorfeniramin maleat (CTM) 4 mg tablet 1,000 5,000 6,000 1,200 4,800
Halaman 49

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,028 Kotrimoxsasol tab Dewasa tablet 1,200 6,000 7,200 0 7,200
Halaman 50

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,307 OAT FDC I paket 6 0 6 0 6
1,312 Oksitetrasilin SK 3 % tube 0 0 0 0
1,402 Parasetamol Syrup 125 mg/5 ml botol 0 0 0 0
1,404 Parasetamol Tab 500 mg tablet 12,300 0 12,300 11,100 1,200
1,411 Piridoksin HCl Tab 10 mg tablet 1,600 0 1,600 900 700
1,504 Retinol (vit A) Kaps 200.000 IU kapsul 0 0 0 0
Halaman 51

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,606 Sabu polivalen 5 ml (ABU I) vial 0 0 0 0
1,609 Serum ATS 1500 IU / Ampul vial 0 0 0 0
1,611 Sianokobalamin Inj 500 mcg/ml ampul 0 0 0 0
1,706 Thiamin Hcl (vit B1) Inj 100 mg/ml vial 0 0 0 0
Halaman 52

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,802 Vitamin B-Komplek Tablet tablet 6,100 0 6,100 6,100 0 3000
TAMBAHAN 0 0 0 0
T-01 Ambroxol 30 mg tablet 0 0 0 0
T-02 Amoksisilin 500 mg tablet 13,100 0 13,100 5,900 7,200
T-07 IV Catheter set 0 1,980 1,980 1,200 780
T-14 Metoklorpramid tab 5 mg tablet 0 0 0 0
T-18 Ranitidin 150 mg botol 0 5,000 5,000 1,000 4,000
T-21 Retinol (vit A)tablet salut 100,000 IU kapsul 0 0 0 0
T-25 Antapulgit tab 600 mg tablet 0 0 0 0
T-26 Kasa 40x80 cm rol 0 0 0 0
Halaman 53

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
T-27 Papaverin Tablet tablet 0 0 0 0
T-30 Sarung tangan non steril pcs 0 0 0 0
T-33 Asam Mefenamat 500 mg tablet 7,200 20,000 27,200 1,100 26,100
T-34 Ambroxol syrup botol 0 0 0 0
T-37 Kaptopril 25 mg tablet 0 0 0 0
T-41 Plester non transparan rol 0 0 0 0
T-47 Piroxicam 10 mg tablet 0 5,000 5,000 1,000 4,000
T-49 Etabion tablet 30,000 21,400 51,400 15,000 36,400
T-51 Ibuprofen Sirup botol 0 0 0 0
T-53 Fondazen botol 3,500 0 3,500 3,500 0
T-55 Asiklovir cream tube 5 25 30 30
Halaman 54

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
T-60 Famotidin 40 mg tablet 0 0 0 0
Halaman 55

RESEP
146 1,431 35 451 2,063 438 105 51 52

NIP. 19750823 200112 1 002 NIP : 19860701 2001101 2 020 NIP : 19720501 199603 1 002 NIP : -
Halaman 56

KECAMATAN : SUELA PELAPORAN BULAN Mei
KABUPATEN / KODYA : LOMBOK TIMUR PERMINTAAN BULAN Juni

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
102 Alat Suntik 1 ml set 0 0 0 0 500 900
103 Alat Suntik 2,5 ml set 180 0 180 180 0 1,200 600
104 Alat Suntik 5 ml set 100 0 100 0 100 500 200
116 Antasida DOEN tab tablet 11,300 0 11,300 3,100 8,200 10,000 2000
Halaman 57

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
126 Asam Askorbat 50 mg tablet 4,100 0 4,100 500 3,600 4,000 1000
204 Betametason cream tube 100 0 100 50 50 300 150
301 Catgut / Benang bedah sachet 70 0 70 58 12 150 144
403 Deksametason tablet 0,5 mg tablet 10,000 0 10,000 0 10,000
506 Etanol 70 % botol 9 0 9 5 4 30 10
Halaman 58

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
611 Fitomenadion tab 10 mg tablet 100 0 100 100 0 500 300
613 Furosemida 40 mg tablet 0 0 0 0 1,000
703 Garam Oralit 200 ml sachet 1,350 0 1,350 250 1,100
804 Hidrokortison cream tube 50 0 50 0 50 200 48
Halaman 59

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
903 Infusion set anak set 0 100 100 100 0 500 400
904 Infusion set dewasa set 350 0 350 180 170 700 500
908 INH 300 mg tablet 0 0 0 0
1,007 Karbamazepin tab 200 mg tablet 300 0 300 100 200 500
1,010 Kasa Pembalut 4x15 rol 50 0 50 50 0 200 200
1,017 Klorfeniramin maleat (CTM) 4 mg tablet 4,800 0 4,800 3,600 1,200 15,000 10000
Halaman 60

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,027 Kotrimoksasol Suspensi botol 300 0 300 140 160 200 200
1,028 Kotrimoxsasol tab Dewasa tablet 7,200 0 7,200 500 6,700 3,000
1,108 Lidokain Kompositum Inj ampul 0 0 0 0 0 300 300
1,303 Natrium klorida infus 0,9 % botol 18 0 18 3 15 100 10
Halaman 61

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,307 OAT FDC I paket 6 0 6 1 5
1,314 Oksitosin Inj ampul 180 0 180 70 110 300 200
1,402 Parasetamol Syrup 125 mg/5 ml botol 0 0 0 0 500 500
1,404 Parasetamol Tab 500 mg tablet 1,200 0 1,200 1,200 0 10,000 5000
1,411 Piridoksin HCl Tab 10 mg tablet 700 0 700 700 0 2,000 2000
Halaman 62

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,508 Ringer Laktat Lar Infus botol 840 0 840 460 380 1,800 1000
1,602 Salep 24 kombinasi pot 0 0 0 0 48 48
1,612 Silk ( Benang Bedah ) sak 57 0 57 21 36 180 72
1,707 Thiamin Hcl (vit B1) tab 50 mg tablet 0 0 0 0 0 1000
1,709 Triheksipenidil Hcl 2mg/tab tablet 500 0 500 400 100 1,000 1000
Halaman 63

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,802 Vitamin B-Komplek Tablet tablet 0 3,000 3,000 3,000 0 15,000 8000
TAMBAHAN 0 0 0 0
T-02 Amoksisilin 500 mg tablet 7,200 0 7,200 7,200 0 10,000 10000
T-07 IV Catheter set 780 0 780 280 500 1,000 500
T-10 Mikonazol Salep tube 0 0 0 0 0 100 96
T-17 Ventolin vial 0 0 0 0 100 60
T-18 Ranitidin 150 mg botol 4,000 0 4,000 4,000 0
T-26 Kasa 40x80 cm rol 0 0 0 0
Halaman 64

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
T-29 Pehacain vial 20 0 20 20 0 100 60
T-30 Sarung tangan non steril pcs 0 0 0 0 2,000
T-31 Sarung tangan steril Pasang 0 50 50 30 20 500
T-33 Asam Mefenamat 500 mg tablet 26,100 0 26,100 1,400 24,700
T-46 Haloperidol 5 mg tablet 500 0 500 400 100 1,000 1000
T-47 Piroxicam 10 mg tablet 4,000 0 4,000 500 3,500 5,000 1000
T-49 Etabion tablet 36,400 0 36,400 6,400 30,000
T-53 Fondazen botol 0 0 0 0 0
T-58 Kaptopril 50 mg tablet 3,650 0 3,650 0 3,650 EX
Halaman 65

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
T-59 Ketokonazole 200 mg tablet 500 0 500 200 300 1,000 800
T-60 Famotidin 40 mg tablet 0 0 0 0 3,000
Halaman 66

RESEP
79 1,230 76 419 1,804 237 228 53 56

NIP. 19750823 200112 1 002 NIP : 19860701 2001101 2 020 NIP : 19720501 199603 1 002 NIP : -
Halaman 67

KECAMATAN : SUELA PELAPORAN BULAN Juni
KABUPATEN / KODYA : LOMBOK TIMUR PERMINTAAN BULAN Juli

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Halaman 68

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
126 Asam Askorbat 50 mg tablet 3,600 1,000 4,600 2,200 2,400
403 Deksametason tablet 0,5 mg tablet 10,000 0 10,000 2,000 8,000
506 Etanol 70 % botol 4 10 14 3 11
Halaman 69

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
613 Furosemida 40 mg tablet 0 0 0 0
703 Garam Oralit 200 ml sachet 1,100 0 1,100 300 800
Halaman 70

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
908 INH 300 mg tablet 0 0 0 0
1,017 Klorfeniramin maleat (CTM) 4 mg tablet 1,200 10,000 11,200 2,500 8,700
Halaman 71

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,028 Kotrimoxsasol tab Dewasa tablet 6,700 0 6,700 700 6,000
1,202 Magnesium Sulfat Inj(IV) 40 % 25 ml vial 33 0 33 2 31 exp
Halaman 72

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,307 OAT FDC I paket 5 0 5 0 5
1,404 Parasetamol Tab 500 mg tablet 0 5,000 5,000 500 4,500
Halaman 73

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,602 Salep 24 kombinasi pot 0 48 48 0 48
1,606 Sabu polivalen 5 ml (ABU I) vial 0 0 0 0
1,707 Thiamin Hcl (vit B1) tab 50 mg tablet 0 1,000 1,000 0 1,000
1,709 Triheksipenidil Hcl 2mg/tab tablet 100 1,000 1,100 200 900
Halaman 74

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1,802 Vitamin B-Komplek Tablet tablet 0 8,000 8,000 2,000 6,000
TAMBAHAN 0 0 0 0
T-02 Amoksisilin 500 mg tablet 0 10,000 10,000 500 9,500
T-07 IV Catheter set 500 500 1,000 250 750
T-18 Ranitidin 150 mg botol 0 0 0 0 0
T-26 Kasa 40x80 cm rol 0 0 0 0
Halaman 75

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
T-30 Sarung tangan non steril pcs 0 0 0 0
T-33 Asam Mefenamat 500 mg tablet 24,700 0 24,700 700 24,000
T-40 Plester transparan rol 1 0 1 1 0
T-46 Haloperidol 5 mg tablet 100 1,000 1,100 200 900
T-47 Piroxicam 10 mg tablet 3,500 1,000 4,500 1,500 3,000
T-49 Etabion tablet 30,000 0 30,000 5,000 25,000
T-53 Fondazen botol 0 0 0 0 0
T-58 Kaptopril 50 mg tablet 3,650 0 3,650 0 3,650 EX
Halaman 76

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
T-59 Ketokonazole 200 mg tablet 300 800 1,100 100 1,000
T-60 Famotidin 40 mg tablet 0 0 0 0
Halaman 77

RESEP
70 981 60 314 1,425 210 180 41 50

NIP. 19750823 200112 1 002 NIP : 19860701 2001101 2 020 NIP : 19720501 199603 1 002 NIP : -

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

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UMUM BPJS JML HARI RAWAT PERKIRAAN KET

MENGETAHUI : Yang Menyerahkan Yang Menerima / Melapor Yang Menerima

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

SISA STOCK PEMBERIAN

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SISA STOCK PEMBERIAN

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SISA STOCK PEMBERIAN

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SISA STOCK PEMBERIAN

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SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

UMUM BPJS JML HARI RAWAT PERKIRAAN KET

MENGETAHUI : Yang Menyerahkan Yang Menerima / Melapor Yang Menerima

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

UMUM BPJS JML HARI RAWAT PERKIRAAN KET

MENGETAHUI : Yang Menyerahkan Yang Menerima / Melapor Yang Menerima

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

UMUM BPJS JML HARI RAWAT PERKIRAAN KET

MENGETAHUI : Yang Menyerahkan Yang Menerima / Melapor Yang Menerima

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN

SISA STOCK PEMBERIAN