Anda di halaman 1dari 104

NO KODE OBAT & BHP

FARMASI BADUNG 27 DES 2016


N0 NAMA OBAT SAT Kode Obat Kode grup nama grup
1 Acyclovir 400 mg Tab A02 01 OBAT
2 Acyclovir salep kulit 5 % tube A03 01 OBAT
3 Albendazol 400 mg Tab A04 01 OBAT
4 Alopurinol 100 mg Tab A05 01 OBAT
5 Ambroxol syr 5 mg / 5 ml Btl A06 01 OBAT
6 Ambroxol tab 30 mg tab A07 01 OBAT
7 Aminofilina tablet 200 mg Tab A08 01 OBAT
8 Amlodipin 5 mg Tab A09 01 OBAT
Amoxsisilina kap 500 mg
9 Tab A10 01 OBAT
10 Amoxsisilina kap 250 mg Kap A11 01 OBAT
11 Amoxsisilina sirup kering 125 mg/5ml Btl A12 01 OBAT
12 Amoxsisilina drop 100 mg/ml Btl A13 01 OBAT
13 As.Salicylsat 2% + Belerang 4 % (2-4) salep pot A14 01 OBAT
14 Astaxanthin 4 mg Tab A15 01 OBAT
15 Antalgin ( metampiron ) Tab A16 01 OBAT
16 Alletrol Tetes Mata btl A17 01 OBAT
17 Antasid syr btl A18 01 OBAT
18 Antasida doen tablet, Tab A19 01 OBAT
19 Anti hemmoroid supp supp A20 01 OBAT
20 Antimigren ( Ergotamin ,caffein ) tab A21 01 OBAT
21 Antiscabies / gamexan salp Tube A22 01 OBAT
22 Asam Ascorbat ( vit c ) tab 50 mg Tab A23 01 OBAT
23 Asam Folat 400 mcg Tab A24 01 OBAT
24 As. Mefenamat 500 mg Tab A25 01 OBAT
25 Acetosal 100 mg Tab A26 01 OBAT
26 Attapulgite active 600 mg Tab A27 01 OBAT
27 Azetromicyn tab 500 mg Tab A28 01 OBAT
28 Bacitracin - Poly SK Tube B01 01 OBAT
29 Benzatin Bensil Penisillin inj vial B02 01 OBAT
30 Besi II sulfat ( tablet tambah darah ) Tab B03 01 OBAT
31 Betahistin tab 6 mg Tab B04 01 OBAT
32 Betamethason krim 0,1 % Tube B05 01 OBAT
33 Bisacodyl supp 10 mg sup B06 01 OBAT
34 Borax Glycerin 5 % Btl B07 01 OBAT
35 Balsem kaki 3 Btl B08 01 OBAT
36 Captopril 12,5 mg Tab C01 01 OBAT
37 Captopril 25 mg Tab C02 01 OBAT
38 Ceterizine 10 mg tab C03 01 OBAT
39 Counterpaint cr tube C04 01 OBAT
40 Clobazam 40 mg Tab C05 01 OBAT
41 Clorpromazina hcl tab ( CPZ ) 100 mg Tab C06 01 OBAT
42 Clorpromazin HCl tab ( CPZ) 25 mg Tab C07 01 OBAT
43 Dexamethason inj 5 mg/ml-1 ml Amp D01 01 OBAT
44 Dexamethason 0,5 mg Tab D02 01 OBAT
45 Desoksimetason tube D03 01 OBAT
46 Dextrose 40 % steril Btl D04 01 OBAT
47 Diazepam 2 mg Tab D05 01 OBAT
48 Diazepam inj 5mg/ml Ampul D06 01 OBAT
49 Diazepam rectal 5 mg/2,5 ml Tube D07 01 OBAT
50 Diphenhidramin hcl inj 10 mg/1 ml Amp D08 01 OBAT
51 Digoxin tab 0.25 mg Tab D09 01 OBAT
52 Doxysyclin 100 mg tab D10 01 OBAT
53 Domperidon drop btl D11 01 OBAT
54 Domperidon syr 5 mg / 5 ml btl D12 01 OBAT
55 Efedrin hcl tab 25 mg Tab E01 01 OBAT
56 Epineprin hcl ( adrenalina ) inj 0.1%-1 ml Amp E02 01 OBAT
57 Erytromicin 500 mg Tab E03 01 OBAT
58 Erytromicin syr 200mg/5ml Btl E04 01 OBAT
59 Furossemid tab 40 mg Tab F01 01 OBAT
60 Fluconazole 150 mg tab F02 01 OBAT
61 Fitominadion (Vit K) inj 2 mg/1ml Amp F03 01 OBAT
62 Fenobarbital tab 30 mg Tab F04 01 OBAT
63 Fenol gliseron Tts Telinga Btl F05 01 OBAT
64 Fitominadion ( vit k1) inj 10 mg/ml-1ml Amp F06 01 OBAT
65 Fitominadion ( vit k1) tab salut 10 mg Tab F07 01 OBAT
66 Garam Oralit 200 ml air Sach G01 01 OBAT
67 Gentamisin sulfat TM 0,3 % Btl G02 01 OBAT
68 Gentamicin salep kulit Tube G03 01 OBAT
69 Gentian Violet larutan 1 % Btl G04 01 OBAT
70 Glibenklamid tab 5 mg Tab G05 01 OBAT
71 Glimepiride 1mg tab G06 01 OBAT
72 Glimepiride 2 mg tab G07 01 OBAT
73 Gliseril guaiakolat tab 100 mg Tab G08 01 OBAT
74 Glukosa larutan infus 10 % steril Btl G09 01 OBAT
75 Glukosa larutan infus 5 % steril Btl G10 01 OBAT
76 Griseofulvin tab 125 mg Tab G11 01 OBAT
77 Haloperidol 0,5 mg Tab H01 01 OBAT
78 Haloperidol 1,5 mg Tab H02 01 OBAT
79 Haloperidol tablet 5 mg Tab H03 01 OBAT
80 Hidroklorotiazida (hct) tab 25 mg Tab H04 01 OBAT
81 Hidrokortison krim 2.5 % Tube H05 01 OBAT
82 Hyocine-N-butilbr / Scopma tab 10 mg Tab H06 01 OBAT
83 Hyoscine-N-B Inj /Buscopan inj 20mg/ml Amp H07 01 OBAT
84 Ibuprofen tab 200 mg Tab I01 01 OBAT
85 Ibuprofen tab 400 mg Tab I02 01 OBAT
86 Ibuprofen Syr Btl I03 01 OBAT
87 Isosorbid dinitrat 5 mg tab I04 01 OBAT
88 IZONIASIDA ( INH) 100 MG Tab I05 01 OBAT
89 Kalium permanganat (PK) Pot K01 01 OBAT
90 Kalium Diklopenak 50 mg tab K02 01 OBAT
91 Kalsium laktat ( kalk ) tab 500 mg Tab K03 01 OBAT
92 Kalsium Glukonas10 % inj Vial K04 01 OBAT
93 Ketokenazol krim 2 % tube K05 01 OBAT
94 Ketokenazol tab 200 mg tab K06 01 OBAT
95 Ketorolac inj 30 mg Amp K07 01 OBAT
96 Klindamicin 150 mg tab K08 01 OBAT
97 Klindamisin 300 mg Tab K09 01 OBAT
98 Karbamazepin tablet 200 mg Tab K10 01 OBAT
99 Kloramfenicol salp mata 1 % tube K11 01 OBAT
100 Kloramphenikol Tetes Mata 0,5 % Btl K12 01 OBAT
101 Kloramfenikol tts Telinga 3 % Btl K13 01 OBAT
102 Klorfeniramini maleat (ctm) tab 4 mg Tab K14 01 OBAT
103 Kotrimoksazol kombinasi 480 mg Tab K15 01 OBAT
104 Kotrimoksazol suspensi Btl K16 01 OBAT
105 KB Suntik 1 bln Vial K17 01 OBAT
106 KB IUD bh K18 01 OBAT
107 KB PIL stp K19 01 OBAT
108 KB SUSUK / inflan infl K20 01 OBAT
109 Lidokain inj 2 % Amp L01 01 OBAT
110 Lidokain com inj 2% Amp L02 01 OBAT
111 Loveramid tab 2 mg tab L03 01 OBAT
112 Loratadin tab10 mg tab L04 01 OBAT
113 Mg SO4 40 % ( 25 ml ) Vial M01 01 OBAT
114 MgSO4 injeksi 20% Vial M02 01 OBAT
115 Meloksikam 7,5 mg Tab M03 01 OBAT
116 Meloksikam 15 mg Tab M04 01 OBAT
117 Metformin tab 500 mg Tab M05 01 OBAT
118 Metil ergometrina maleat inj 0.200 mg/ml-1ml Amp M06 01 OBAT
119 Metil ergometrina maleat tab salut 0.125 mg tab M07 01 OBAT
120 Methyl Prednisolon 4 mg tab M08 01 OBAT
121 Metoklopramid Hcl 5 mg tab M09 01 OBAT
122 Metoklopramid Hcl syr 5 mg/5ml btl M10 01 OBAT
123 Metoklopramid inj 5mg/2ml Amp M11 01 OBAT
124 Metronidazol 500 mg Tab M12 01 OBAT
125 Metronidazol supp ( flagyl ) 0.5 gr sup M13 01 OBAT
126 Miconazol crm 2 % tube M14 01 OBAT
127 MDT Combi ( obat kusta ) paket M15 01 OBAT
128 Multivitamin syr / Procuma btl M16 01 OBAT
129 Multivitamin tab tab M17 01 OBAT
130 Narium Tiroksin tab N01 01 OBAT
131 Natrium klorida larutan infus 0.9 % steril Btl N02 01 OBAT
132 Na Diklopenac 25 mg tab N03 01 OBAT
133 Na Diklofenac 50 mg Tab N04 01 OBAT
134 Nipedipin tab N05 01 OBAT
135 Nistatin 100.000 Iu/g/tab vaginal tab N06 01 OBAT
136 NB Salp Tube N07 01 OBAT
137 Obat Batuk Hitam Btl O01 01 OBAT
138 Obat batuk kering btl O02 01 OBAT
139 Obat Flu sirup btl O03 01 OBAT
140 Obat Flu tablet Tab O04 01 OBAT
141 Oksitetrasiklin hc salep 3 % Tube O05 01 OBAT
142 Oksitetrasiklin hcl salep mata 1 % Tube O06 01 OBAT
143 Oksitosin inj 10 iU ( 1 ml ) Amp O07 01 OBAT
144 Omeprazol 20 mg Tab O09 01 OBAT
145 Osedantron inj Amp O10 01 OBAT
146 Osedantron tab 8 mg Tab O11 01 OBAT
147 Oseltamivir 75 mg Tab O12 01 OBAT
148 Papverin tab Tab P01 01 OBAT
149 Parasetamol sirup 120 mg/ 5 ml Btl P02 01 OBAT
150 Parasetamol tab 500 mg Tab P03 01 OBAT
151 Paracetamol drop 100 mg/ ml Btl P04 01 OBAT
152 Paracetamol rectal 125 mg Tube P05 01 OBAT
153 Perak sulfadiazin 1 % / Burnazin cr Tube P06 01 OBAT
154 Pyrantel syr btl P08 01 OBAT
155 Piridoxin hcl (vit b6) tab 10 mg Tab P09 01 OBAT
156 Piroxicam 20 mg cap P10 01 OBAT
157 Piroxicam 10 mg cap P11 01 OBAT
158 Polycresulen / Albothyl/ Aptil Btl P12 01 OBAT
159 Prednison tab 5 mg Tab P13 01 OBAT
160 Ranitidin 150 mg Tab R02 01 OBAT
161 Ranitidin inj 25 mg/2 ml Vial R03 01 OBAT
162 Retinol ( vit A ) kaps lunak 100.000 Iu Kap R04 01 OBAT
163 Retinol ( vit A ) kaps lunak 200.000 Iu Kap R05 01 OBAT
164 Ringer laktat lrt inf steril ( RL ) Btl R06 01 OBAT
165 Resperidon 2 tab tab R07 01 OBAT
166 salbutamol 4 mg tab S01 01 OBAT
167 salbutamol 2 mg tab S02 01 OBAT
168 salbutamol nebulizer 2.5 mg Amp S03 01 OBAT
169 Salbutamol inhaler btl S04 01 OBAT
170 Salisil bedak 2 % Sak S05 01 OBAT
171 Sefadroxyl 500 mg tab S06 01 OBAT
172 Sefadroxyl syr kering 250 mg/5ml btl S07 01 OBAT
173 Sefiksim 100 mg tab S08 01 OBAT
174 Serum Anti Bisa Ular ( ABU ) vial S09 01 OBAT
175 Serum anti tetanus(tetagam) 250 IU / ml Amp S10 01 OBAT
176 Sianokobalamina (vit B12 ) inj Amp S11 01 OBAT
177 Simetidin 200 mg Tab S12 01 OBAT
178 Sinvastatin tab 10 mg tab S13 01 OBAT
179 Siproploxacin 500 mg Tab S14 01 OBAT
180 Sucralfate 500 mg /Mucogard tab Tab S15 01 OBAT
181 Sucralfat suspensi ( Mucogard susp ) btl S16 01 OBAT
182 Sulfasetamid Tetes mata 15 % Btl S17 01 OBAT
183 Salep perawatan luka (bioplacenton) tube S18 01 OBAT
184 Tetrasiklina hcl kapsul 500 mg Kap T01 01 OBAT
185 Triflouperazin ( Stelazin ) 5 mg Tab T02 01 OBAT
186 Thiamin hcl inj 100 mg/ml - 1 ml Amp T03 01 OBAT
187 Thiamin hcl ( vit B1)tab 50 mg Tab T04 01 OBAT
188 Thiamfenicol 500 mg Tab T05 01 OBAT
189 Trihexipenidil 2 mg Tab T06 01 OBAT
190 Vitamin B complek tab Tab V01 01 OBAT
191 Vit Neurotrofic tablet 5000 mg tab V02 01 OBAT
192 Vit Neurotrofic inj 5000 mg Amp V03 01 OBAT
193 Vitamin imunitas (Imunogard ) tab V04 01 OBAT
194 Zink tab 20 mg Tab Z01 01 OBAT
195 Zink drop 10 mg/ml btl Z02 01 OBAT
196 Zink syr ( Zirkum ) btl Z03 01 OBAT
VAKSIN
197 HB Uniject vial VAK01 02 Vaksin
198 BCG vial VAK02 02 Vaksin
199 CAMPAK vial VAK03 02 Vaksin
200 POLIO vial VAK05 02 Vaksin
201 Pentabio vial VAK06 02 Vaksin
202 DT vial VAK07 02 Vaksin
203 TT vial VAK08 02 Vaksin
204 TD vial VAK09 02 Vaksin
205 IPV vial VAK10 02 Vaksin
206 VAKSIN Anti Rabies ( VAR ) vial VAK11 02 Vaksin
OBAT PROGRAM TBC
207 Anti TBC Anak paket TB1 03 Obat TBC
208 Anti TBC I / FDC paket TB2 03 Obat TBC
209 Anti TBC II / FDC paket TB3 03 Obat TBC
210 kombipak katagori I paket TB4 03 Obat TBC
OBAT PROGRAM ARV
211 ALUVIA ( Liponavir 200mg + ritonavir 50 mg) tab ARV01 04 obat ARV
212 DUVIRAL( Lamifudin150 mg+zidofudin 300 mg) tab ARV02 04 obat ARV
213 Efavirenz 600 mg tab ARV03 04 obat ARV
FDC ( Tenofovir 300mg+lamivudin 300 mg +
214 efavirenz 600 mg) tab ARV04 04 obat ARV
215 Lamivudine ( Hiviral ) 150 mg tab ARV05 04 obat ARV
216 Nevirapine ( Neviral ) 200 mg tab ARV06 04 obat ARV
217 Tenofovir Disoproxil Fumarate (TDF) 300 mg tab ARV07 04 obat ARV
218 Abacavir tab ARV08 04 obat ARV
219 Triplepediatrik tab ARV09 04 obat ARV
GIGI
220 Bonding Btl GB01 05 BHP GIGI
221 Bur Gigi ( Longseng Bur ) bh GB02 05 BHP GIGI
222 Bur Gigi ( Fisure Bur ) bh GB03 05 BHP GIGI
223 Bur Gigi (Round Bur ) bh GB04 05 BHP GIGI
224 Bur Gigi ( Inverted Bur ) bh GB05 05 BHP GIGI
225 CHKM (Sterilisasi Akar) Btl GC01 05 BHP GIGI
226 Cresopate ( Munifying pasta) Btl GC02 05 BHP GIGI
227 Devitalisasi pasta (non arsen ) Btl GD01 05 BHP GIGI
228 Eugenol cairan Btl GE01 05 BHP GIGI
229 Endomethason N ( Munifying pasta ) Btl GE02 05 BHP GIGI
230 Etsa Btl GE03 05 BHP GIGI
231 Fuji /Glas Ionomer / ketak molar Btl GF01 05 BHP GIGI
232 Iodoform pasta / calplus syringe GI01 05 BHP GIGI
233 Semen seng fosf. Serbuk & cairan Btl GS01 05 BHP GIGI
234 Rocle (Sterilisasi Akar) Btl GR01 05 BHP GIGI
235 Tumpatan sementara ( Cavit) Btl GT01 05 BHP GIGI
236 Tumpatan permanen / Composit Btl GT02 05 BHP GIGI
237 Temporary stopping Fletcher Btl GT03 05 BHP GIGI
238 TKF (Sterilisasi Akar) Btl GT04 05 BHP GIGI
239 Tumpatan permanen / Composit A3 Btl GT05 05 BHP GIGI
240 Tincture pidofilin 80-90 % Btl GT06 05 BHP GIGI
LABORATORIUM
241 Asam acetat 100 ml Btl LA01 06 BHP LAB
242 Cover glass bh LC01 06 BHP LAB
243 Control N 2,5 ml bh LC02 06 BHP LAB
244 Eosin Btl LE01 06 BHP LAB
245 Giemza Btl LG01 06 BHP LAB
246 Jarum stik gula / Blood lounchet bh LJ01 06 BHP LAB
247 Jarum Vacumtainer ( needle 22 G ) bh LJ02 06 BHP LAB
248 Jarum CD 4 bh LJ03 06 BHP LAB
249 Kaca Slide /slide forstead box LK01 06 BHP LAB
250 Kertas lakmus ( Test paper ) pak LK02 06 BHP LAB
251 KOH 100 ml Btl LK04 06 BHP LAB
252 Kertas Ph vagina 0.2 box LK05 06 BHP LAB
253 M emersi btl LM01 06 BHP LAB
254 Menthanol btl LM02 06 BHP LAB
255 Methylen blue btl LM03 06 BHP LAB
256 Natrium klorida btl 500 ml Btl LN01 06 BHP LAB
257 Pot dahak bh LP01 06 BHP LAB
258 Pipet Tip Yellow pcs LP02 06 BHP LAB
259 Plesterin box LP03 06 BHP LAB
260 Reagen Widal test set LR01 06 BHP LAB
261 Reagen gol darah A & B Btl LR02 06 BHP LAB
262 Reagen ZN / BTA set LR03 06 BHP LAB
263 Reagen HIV I pcs LR04 06 BHP LAB
264 Reagen HIV II pcs LR05 06 BHP LAB
265 Reagen HIV III pcs LR06 06 BHP LAB
266 Reagen kimia darah pcs LR07 06 BHP LAB
267 RPR set LR08 06 BHP LAB
268 Reagen CD4 set LR09 06 BHP LAB
269 Reagen Erma set LR010 06 BHP LAB
270 Reagen Control mynthic set LR011 06 BHP LAB
271 Reagen SFR I set LR012 06 BHP LAB
272 Stik asam urat bh LS01 06 BHP LAB
273 Stik Kolesterol bh LS02 06 BHP LAB
274 Stik Gula darah bh LS03 06 BHP LAB
275 Stik urine 11( Pemriksaan urine lengkap ) bh LS04 06 BHP LAB
276 Stik Rapid test untuk sipilis stik LS05 06 BHP LAB
277 Stik test kehamilan /PP. test stik LS06 06 BHP LAB
278 SD Bioline Sphylis ( TPHA) set LS07 06 BHP LAB
279 Tissue kaca slide/ tisu lensa box LT01 06 BHP LAB
280 Thermal peper 30 mtr roll LT02 06 BHP LAB
281 Tabung reaksi 3 ml disposible box LT03 06 BHP LAB
282 Tabung vacum tutup ungu ( EDTA ) bh LT04 06 BHP LAB
283 Tabung serum( tutup merah) bh LT05 06 BHP LAB
284 Tabung Serum dg gel (tutup kuning) bh LT06 06 BHP LAB
285 Tabung glukosa ( tutup abu-abu) bh LT07 06 BHP LAB
286 Tincture pidofilin 80-90 % btl LT08 06 BHP LAB
BAHAN HABIS PAKAI
287 Abocat 18 ( Iv Catheter 18 ) bh UA01 07 BHP Umum
288 Abocat 20 ( Iv Catheter 20 ) bh UA02 07 BHP Umum
289 Abocat 22 ( Iv Catheter 22 ) bh UA03 07 BHP Umum
290 Abocat 24 ( Iv Catheter 24 ) bh UA04 07 BHP Umum
291 Aqua pro injeksi vial UA05 07 BHP Umum
292 Alat suntik 0,5 cc bh UA06 07 BHP Umum
293 Alat suntik 0,05 cc bh UA07 07 BHP Umum
294 Alat suntik 1 cc bh UA08 07 BHP Umum
295 Alat suntik 3 cc bh UA09 07 BHP Umum
296 Alat suntik 5 cc bh UA10 07 BHP Umum
297 Alat suntik 10 cc bh UA11 07 BHP Umum
298 Benang bedah / Cat gut -3/0 zak UB01 07 BHP Umum
299 Benang bedah sutra / Silk -3/0 zak UB02 07 BHP Umum
300 Benang ethicon / Prolene 5/0 zak UB03 07 BHP Umum
301 Etanol 70 % Btl UE02 07 BHP Umum
302 Ethanol 70 % 100 ml btl UE03 07 BHP Umum
303 Etil Klorida semprot btl UE04 07 BHP Umum
304 Film X ray 24x 30 box UF01 07 BHP Umum
305 Film X ray 40x 30 box UF02 07 BHP Umum
306 Film X ray 35 x 35 box UF03 07 BHP Umum
307 Foley catheter bh UF04 07 BHP Umum
308 Hand scund S / M psg UH01 07 BHP Umum
309 Infusion set anak Set UI01 07 BHP Umum
310 Infusion set dewasa Set UI02 07 BHP Umum
311 Jarum Heating otot 1/2 lingkaran Biji UJ01 07 BHP Umum
312 Jarum Heating otot 12,13.14 Biji UJ02 07 BHP Umum
313 Jarum Heating kulit 12,13.14 Biji UJ03 07 BHP Umum
314 Jelly unt doppler ( Doppler Jell 0 btl UJ04 07 BHP Umum
315 Kapas Alkohol /Alkohol sweeb lbr UK01 07 BHP Umum
316 Kapas pembalut 250 mg roll UK02 07 BHP Umum
317 Kasa pembalut 40 x 40 steril roll UK03 07 BHP Umum
318 Kasa pembalut 2 x 80 cm roll UK04 07 BHP Umum
319 Kasa pmbalt hidrfil 4m x 15 cm roll UK05 07 BHP Umum
320 Kasa pembalut 4 m x 3 cm roll UK06 07 BHP Umum
321 Kasa hidrofil 16/16 steril box UK07 07 BHP Umum
322 kassa gulungan 40 yard x 80 cm roll UK08 07 BHP Umum
323 Kertas Puyer SCI Lbr UK09 07 BHP Umum
324 Kondum gros UK10 07 BHP Umum
325 Klip Obat K Lbr UK11 07 BHP Umum
326 Klip Obat B Lbr UK12 07 BHP Umum
327 Klip Obat T Lbr UK13 07 BHP Umum
328 Lisol Btl UL01 07 BHP Umum
329 Masker tali karet / tali biasa bh UM01 07 BHP Umum
330 masker N 95 bh UM02 07 BHP Umum
331 Nurse cup (Disposible head cup ) box UN01 07 BHP Umum
332 Oksigen gas dalam tabung Tabung UO01 07 BHP Umum
333 Oksigen kalengan klg UO02 07 BHP Umum
334 Pembalut Ibu Bersalin buah UP01 07 BHP Umum
335 Perhidrol / H2O2 Btl UP02 07 BHP Umum
336 Plester 5 yards x 2 inch roll UP03 07 BHP Umum
337 Plester Ultravix 5 cm x 5 mm bh UP04 07 BHP Umum
338 Pisau Bedah no 10, 11 ,12 pcs UP05 07 BHP Umum
339 Reagen Developer box UR01 07 BHP Umum
340 Reagen Fixer box UR02 07 BHP Umum
341 Sopratul Lbr US01 07 BHP Umum
342 Sarung tangan Obgyn pcs US02 07 BHP Umum
343 safety box bh US03 07 BHP Umum
344 Tranfusi set bh UT01 07 BHP Umum
345 Tensocrip roll UT02 07 BHP Umum
346 Urine Bag buah UU01 07 BHP Umum
347 Umbilikor / klem tali pusat buah UU02 07 BHP Umum
348 Underpad box UU03 07 BHP Umum
349 wing Needle 25 G buah UW01 07 BHP Umum
350 Yodium povidon larutan 10 % 300 ml Btl UY01 07 BHP Umum
351 Yodium povidon larutan 10% 30ml Btl UY02 07 BHP Umum
OBAT JKN
352 Ambroxol syr Btl JKNA01 08 OBAT JKN
353 Ambroxol tab tab JKNA02 08 OBAT JKN
354 Antalgin ( metampiron ) Tab JKNA03 08 OBAT JKN
355 Antasid syr btl JKNA04 08 OBAT JKN
356 Anti hemmoroid supp supp JKNA05 08 OBAT JKN
357 Asam Folat Tab JKNA06 08 OBAT JKN
358 Attapulgite / New Diatab Tab JKNA07 08 OBAT JKN
359 Betahistin tab Tab JKNB01 08 OBAT JKN
360 Dexamethason inj 5 mg/ml-1 ml Amp JKND01 08 OBAT JKN
361 Epineprin hcl ( adrenalina ) inj 0.1%-1 ml Amp JKNE02 08 OBAT JKN
362 Fitominadion ( vit k1) inj 10 mg/ml-1ml Amp JKNF02 08 OBAT JKN
363 Fitominadion (Vit K) inj 2 mg Amp JKNF03 08 OBAT JKN
364 Gentamisin sulfat TM 0,3 % Btl JKNG01 08 OBAT JKN
365 Gliseril guaiakolat tab 100 mg Tab JKNG02 08 OBAT JKN
366 Glukosa larutan infus 10 % steril Btl JKNG03 08 OBAT JKN
367 Glukosa larutan infus 5 % steril Btl JKNG04 08 OBAT JKN
368 Hidroklorotiazida (hct) tab 25 mg Tab JKNH01 08 OBAT JKN
369 Hidrokortison krim 1 % Tube JKNH02 08 OBAT JKN
370 Kalsium laktat ( kalk ) tab 500 mg Tab JKNK01 08 OBAT JKN
371 Ketorolac inj 30 mg Amp JKNK03 08 OBAT JKN
372 Kloramphenikol Tetes Mata Btl JKNK04 08 OBAT JKN
373 Meloksikam 7,5 mg Tab JKNM02 08 OBAT JKN
374 Multivitamin tab/Nutrifar tab JKNM01 08 OBAT JKN
375 Obat Batuk Hitam Btl JKNO01 08 OBAT JKN
376 Oksitetrasiklin hc salep 3 % Tube JKNO02 08 OBAT JKN
377 Oksitetrasiklin hcl salep mata 1 % Tube JKNO03 08 OBAT JKN
378 Papverin tab Tab JKNP01 08 OBAT JKN
379 Ranitidin inj 25 mg/2 ml Vial JKNA01 08 OBAT JKN
380 Ringer laktat lrt inf steril ( RL ) Btl JKNR02 08 OBAT JKN
381 Sefadroxyl 500 mg tab JKNS01 08 OBAT JKN
382 Sinvastatin tab tab JKNS02 08 OBAT JKN
383 Vitamin Neurotrofic /Siobion 5000 tab JKNV01 08 OBAT JKN
BHP JKN
384 Bonding Btl JKNGB01 09 BHP GIGI JKN
385 Bur Gigi ( Longseng Bur ) bh JKNGB02 09 BHP GIGI JKN
386 Bur Gigi ( Fisure Bur ) bh JKNGB03 09 BHP GIGI JKN
387 Bur Gigi (Round Bur ) bh JKNGB04 09 BHP GIGI JKN
388 Bur Gigi ( Inverted Bur ) bh JKNGB05 09 BHP GIGI JKN
389 Brush bh JKNGB06 09 BHP GIGI JKN
390 Biostun bh JKNGB07 09 BHP GIGI JKN
391 Cresopat Btl JKNGC01 09 BHP GIGI JKN
392 CHKM (Sterilisasi Akar) Btl JKNGC02 09 BHP GIGI JKN
393 Devitalisasi pasta Btl JKNGD01 09 BHP GIGI JKN
394 Etsa Btl JKNGE01 09 BHP GIGI JKN
395 Elite cemen Btl JKNGE02 09 BHP GIGI JKN
396 Fuji /Glas Ionomer / ketak molar Btl JKNGF01 09 BHP GIGI JKN
397 Hydeal bh JKNGH01 09 BHP GIGI JKN
398 Polibib / lap dada Box JKNGP01 09 BHP GIGI JKN
399 Rocle (Sterilisasi Akar) Btl JKNGR01 09 BHP GIGI JKN
400 Ruber Cup Btl JKNGR02 09 BHP GIGI JKN
401 Silicon ruber Btl JKNGS01 09 BHP GIGI JKN
402 Selifa ejector bh JKNGS02 10 BHP GIGI JKN
403 Tumpatan sementara ( Cavit) Btl JKNGT01 09 BHP GIGI JKN
404 Tumpatan permanen / Composit Btl JKNGT02 09 BHP GIGI JKN
405 Tip Scaler gold Btl JKNGT03 09 BHP GIGI JKN
406 Stik asam urat bh JKNLS01 10 BHP lab JKN
407 Stik Kolesterol bh JKNLS02 10 BHP lab JKN
408 Stik Gula darah bh JKNLS03 10 BHP lab JKN
409 Stik HB Family DR stik JKNLS08 10 BHP lab JKN
410 Reagen golongan Darah A,B paket JKNLR01 10 BHP lab JKN
411 Aqua pro injeksi vial JKNUA01 11 BHP JKN
412 Benang bedah / Cat gut -3/0 zak JKNUB01 11 BHP JKN
413 Benang ethicon / Prolene 5/0 zak JKNUB02 11 BHP JKN
414 Hand scund S / M psg JKNUH01 11 BHP JKN
415 Jarum Heating otot 1/2 lingkaran Biji JKNUJ01 11 BHP JKN
416 Jarum Heating otot 12,13.14 Biji JKNUJ02 11 BHP JKN
417 Jarum Heating kulit 12,13.14 Biji JKNUJ03 11 BHP JKN
418 Jelly unt doppler ( Doppler Jell 0 btl JKNUJ04 11 BHP JKN
419 Masker tali karet / tali biasa bh JKNUM01 11 BHP JKN
420 Tranfusi set bh JKNUT01 11 BHP JKN
421 Yodium povidon larutan 10 %300 ML ml Btl JKNUY01 11 BHP JKN
422 Methadon liquid 10 mg/ ml ml Mtd 01 12 obat MTD
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
HP GIGI JKN
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
SUB - UNIT PELAYANAN
SUB UNIT : APOTEK
UPT PUSKESMAS : KUTA I DOKUMENNO TGL
KECAMATAN : KUTA PELAPORAN BULAN : Nopember 2016 PUSKESMAS
KABUPATEN : BADUNG PERMINTAAN BULAN : Desember 2016 sub unit
Periode : 26 oktober s/d 25 Nopember 2016
SATU STOK PENERI PEMA SISA PERMIN PEMBE KET
NO N A M A OBAT
AN AWAL MAAN KAIAN STOK TAAN RIAN
1 Acyclovir 400 mg Tab
2 Acyclovir salep kulit 5 % tube
3 Albendazol 400 mg Tab
4 Alopurinol 100 mg Tab
5 Ambroxol syr 5 mg / 5 ml Btl
6 Ambroxol tab 30 mg tab
7 Aminofilina tablet 200 mg Tab
8 Amlodipin 5 mg Tab
9 Amoxsisilina kap 500 mg Tab
10 Amoxsisilina kap 250 mg Kap
11 Amoxsisilina sirup kering 125 Btl
12 Amoxsisilina drop 100 mg/ml Btl
As.Salicylsat 2% + Belerang 4 %
(2-4) salep
13 pot
14 Astaxanthin 4 mg Tab
15 Antalgin ( metampiron ) Tab
16 Alletrol Tetes Mata btl
17 Antasid syr btl
18 Antasida doen tablet, Tab
19 Anti hemmoroid supp supp
20 Antimigren ( Ergotamin ,caffein ) tab
21 Antiscabies / gamexan salp Tube
22 Asam Ascorbat ( vit c ) tab 50 Tab
23 Asam Folat 400 mcg Tab
24 As. Mefenamat 500 mg Tab
25 Acetosal 100 mg Tab
26 Attapulgite active 600 mg Tab
27 Azetromicyn tab 500 mg Tab
28 Bacitracin - Poly SK Tube
29 Benzatin Bensil Penisillin inj vial
30 Besi II sulfat ( tablet tambah dara Tab
31 Betahistin tab 6 mg Tab
32 Betamethason krim 0,1 % Tube
33 Bisacodyl supp 10 mg sup
34 Borax Glycerin 5 % Btl
35 Balsem kaki 3 Btl
36 Captopril 12,5 mg Tab
37 Captopril 25 mg Tab
38 Ceterizine 10 mg tab
39 Counterpaint cr tube
40 Clobazam 40 mg Tab
41 Clorpromazina hcl tab ( CPZ ) 100 mg Tab
42 Clorpromazin HCl tab ( CPZ) 25 mg Tab
43 Dexamethason inj 5 mg/ml-1 ml Amp
44 Dexamethason 0,5 mg Tab
45 Desoksimetason tube
46 Dextrose 40 % steril Btl
47 Diazepam 2 mg Tab
48 Diazepam inj 5mg/ml Ampul
49 Diazepam rectal 5 mg/2,5 ml Tube
50 Diphenhidramin hcl inj 10 mg/1 Amp
51 Digoxin tab 0.25 mg Tab
52 Doxysyclin 100 mg tab
53 Domperidon drop btl
54 Domperidon syr 5 mg / 5 ml btl
55 Efedrin hcl tab 25 mg Tab
56 Epineprin hcl ( adrenalina ) inj 0.1%-1 mlAmp
57 Erytromicin 500 mg Tab
58 Erytromicin syr 200mg/5ml Btl
59 Furossemid tab 40 mg Tab
60 Fluconazole 150 mg tab
61 Fitominadion (Vit K) inj 2 mg/1ml Amp
62 Fenobarbital tab 30 mg Tab
63 Fenol gliseron Tts Telinga Btl
64 Fitominadion ( vit k1) inj 10 mg/ml-1mlAmp
65 Fitominadion ( vit k1) tab salut Tab
66 Garam Oralit 200 ml air Sach
67 Gentamisin sulfat TM 0,3 % Btl
68 Gentamicin salep kulit Tube
69 Gentian Violet larutan 1 % Btl
70 Glibenklamid tab 5 mg Tab
71 Glimepiride 1mg tab
72 Glimepiride 2 mg tab
73 Gliseril guaiakolat tab 100 mg Tab
74 Glukosa larutan infus 10 % steril Btl
75 Glukosa larutan infus 5 % steril Btl
76 Griseofulvin tab 125 mg Tab
77 Haloperidol 0,5 mg Tab
78 Haloperidol 1,5 mg Tab
79 Haloperidol tablet 5 mg Tab
80 Hidroklorotiazida (hct) tab 25 mg Tab
81 Hidrokortison krim 2.5 % Tube
82 Hyocine-N-butilbr / Scopma tab Tab
83 Hyoscine-N-B Inj /Buscopan inj 2 Amp
84 Ibuprofen tab 200 mg Tab
85 Ibuprofen tab 400 mg Tab
86 Ibuprofen Syr Btl
87 Isosorbid dinitrat 5 mg tab
88 IZONIASIDA ( INH) 100 MG Tab
89 Kalium permanganat (PK) Pot
90 Kalium Diklopenak 50 mg tab
91 Kalsium laktat ( kalk ) tab 500 mg Tab
92 Kalsium Glukonas10 % inj Vial
93 Ketokenazol krim 2 % tube
94 Ketokenazol tab 200 mg tab
95 Ketorolac inj 30 mg Amp
96 Klindamicin 150 mg tab
97 Klindamisin 300 mg Tab
98 Karbamazepin tablet 200 mg Tab
99 Kloramfenicol salp mata 1 % tube
100 Kloramphenikol Tetes Mata 0,5 % Btl
101 Kloramfenikol tts Telinga 3 % Btl
102 Klorfeniramini maleat (ctm) tab Tab
103 Kotrimoksazol kombinasi 480 mg Tab
104 Kotrimoksazol suspensi Btl
105 KB Suntik 1 bln Vial
106 KB IUD bh
107 KB PIL stp
108 KB SUSUK / inflan infl
109 Lidokain inj 2 % Amp
110 Lidokain com inj 2% Amp
111 Loveramid tab 2 mg tab
112 Loratadin tab10 mg tab
113 Mg SO4 40 % ( 25 ml ) Vial
114 MgSO4 injeksi 20% Vial
115 Meloksikam 7,5 mg Tab
116 Meloksikam 15 mg Tab
117 Metformin tab 500 mg Tab
118 Metil ergometrina maleat inj 0.200 mg/ml Amp
119 Metil ergometrina maleat tab salut 0.125 tab
120 Methyl Prednisolon 4 mg tab
121 Metoklopramid Hcl 5 mg tab
122 Metoklopramid Hcl syr 5 mg/5m btl
123 Metoklopramid inj 5mg/2ml Amp
124 Metronidazol 500 mg Tab
125 Metronidazol supp ( flagyl ) 0.5 g sup
126 Miconazol crm 2 % tube
127 MDT Combi ( obat kusta ) paket
128 Multivitamin syr / Procuma btl
129 Multivitamin tab tab
130 Narium Tiroksin tab
131 Natrium klorida larutan infus 0.9 % sterilBtl
132 Na Diklopenac 25 mg tab
133 Na Diklofenac 50 mg Tab
134 Nipedipin tab
135 Nistatin 100.000 Iu/g/tab vaginal tab
136 NB Salp Tube
137 Obat Batuk Hitam Btl
138 Obat batuk kering btl
139 Obat Flu sirup btl
140 Obat Flu tablet Tab
141 Oksitetrasiklin hc salep 3 % Tube
142 Oksitetrasiklin hcl salep mata 1 % Tube
143 Oksitosin inj 10 iU ( 1 ml ) Amp
144 Omeprazol 20 mg Tab
145 Osedantron inj Amp
146 Osedantron tab 8 mg Tab
147 Oseltamivir 75 mg Tab
148 Papverin tab Tab
149 Parasetamol sirup 120 mg/ 5 ml Btl
150 Parasetamol tab 500 mg Tab
151 Paracetamol drop 100 mg/ ml Btl
152 Paracetamol rectal 125 mg Tube
153 Perak sulfadiazin 1 % / Burnazin cr Tube
154 Pyrantel syr btl
155 Piridoxin hcl (vit b6) tab 10 mg Tab
156 Piroxicam 20 mg cap
157 Piroxicam 10 mg cap
158 Polycresulen / Albothyl/ Aptil Btl
159 Prednison tab 5 mg Tab
160 Ranitidin 150 mg Tab
161 Ranitidin inj 25 mg/2 ml Vial
162 Retinol ( vit A ) kaps lunak 100.00 Kap
163 Retinol ( vit A ) kaps lunak 200.00 Kap
164 Ringer laktat lrt inf steril ( RL ) Btl
165 Resperidon 2 tab tab
166 salbutamol 4 mg tab
167 salbutamol 2 mg tab
168 salbutamol nebulizer 2.5 mg Amp
169 Salbutamol inhaler btl
170 Salisil bedak 2 % Sak
171 Sefadroxyl 500 mg tab
172 Sefadroxyl syr kering 250 mg/5ml btl
173 Sefiksim 100 mg tab
174 Serum Anti Bisa Ular ( ABU ) vial
175 Serum anti tetanus(tetagam) 250 Amp
176 Sianokobalamina (vit B12 ) inj Amp
177 Simetidin 200 mg Tab
178 Sinvastatin tab 10 mg tab
179 Siproploxacin 500 mg Tab
180 Sucralfate 500 mg /Mucogard tab Tab
181 Sucralfat suspensi ( Mucogard sus btl
182 Sulfasetamid Tetes mata 15 % Btl
183 Salep perawatan luka (bioplacent tube
184 Tetrasiklina hcl kapsul 500 mg Kap
185 Triflouperazin ( Stelazin ) 5 mg Tab
186 Thiamin hcl inj 100 mg/ml - 1 ml Amp
187 Thiamin hcl ( vit B1)tab 50 mg Tab
188 Thiamfenicol 500 mg Tab
189 Trihexipenidil 2 mg Tab
190 Vitamin B complek tab Tab
191 Vit Neurotrofic tablet 5000 mg tab
192 Vit Neurotrofic inj 5000 mg Amp
193 Vitamin imunitas (Imunogard ) tab
194 Zink tab 20 mg Tab
195 Zink drop 10 mg/ml btl
196 Zink syr ( Zirkum ) btl
VAKSIN
197 HB Uniject vial
198 BCG vial
199 CAMPAK vial
200 POLIO vial
201 Pentabio vial
202 DT vial
203 TT vial
204 TD vial
205 IPV vial
206 VAKSIN Anti Rabies ( VAR ) vial
OBAT PROGRAM TBC
207 Anti TBC Anak paket
208 Anti TBC I / FDC paket
209 Anti TBC II / FDC paket
210 kombipak katagori I paket
OBAT PROGRAM ARV
211 ALUVIA ( Liponavir 200mg + riton tab
212 DUVIRAL( Lamifudin150 mg+zidofud tab
Efavirenz 600 mg
213 tab

FDC ( Tenofovir 300mg+lamivudin


300 mg + efavirenz 600 mg)
214 tab
215 Lamivudine ( Hiviral ) 150 mg tab
216 Nevirapine ( Neviral ) 200 mg tab
217 Tenofovir Disoproxil Fumarate (TDF tab
218 Abacavir tab
219 Triplepediatrik tab
GIGI
220 Bonding Btl
221 Bur Gigi ( Longseng Bur ) bh
222 Bur Gigi ( Fisure Bur ) bh
223 Bur Gigi (Round Bur ) bh
224 Bur Gigi ( Inverted Bur ) bh
225 CHKM (Sterilisasi Akar) Btl
226 Cresopate ( Munifying pasta) Btl
227 Devitalisasi pasta (non arsen ) Btl
228 Eugenol cairan Btl
229 Endomethason N ( Munifying past Btl
230 Etsa Btl
231 Fuji /Glas Ionomer / ketak molar Btl
232 Iodoform pasta / calplus syringe
233 Semen seng fosf. Serbuk & cairan Btl
234 Rocle (Sterilisasi Akar) Btl
235 Tumpatan sementara ( Cavit) Btl
236 Tumpatan permanen / Composit Btl
237 Temporary stopping Fletcher Btl
238 TKF (Sterilisasi Akar) Btl
239 Tumpatan permanen / Composit Btl
240 Tincture pidofilin 80-90 % Btl
LABORATORIUM
241 Asam acetat 100 ml Btl
242 Cover glass bh
243 Control N 2,5 ml bh
244 Eosin Btl
245 Giemza Btl
246 Jarum stik gula / Blood lounchet bh
247 Jarum Vacumtainer ( needle 22 G bh
248 Jarum CD 4 bh
249 Kaca Slide /slide forstead box
250 Kertas lakmus ( Test paper ) pak
251 KOH 100 ml Btl
252 Kertas Ph vagina 0.2 box
253 M emersi btl
254 Menthanol btl
255 Methylen blue btl
256 Natrium klorida btl 500 ml Btl
257 Pot dahak bh
258 Pipet Tip Yellow pcs
259 Plesterin box
260 Reagen Widal test set
261 Reagen gol darah A & B Btl
262 Reagen ZN / BTA set
263 Reagen HIV I pcs
264 Reagen HIV II pcs
265 Reagen HIV III pcs
266 Reagen kimia darah pcs
267 RPR set
268 Reagen CD4 set
269 Reagen Erma set
270 Reagen Control mynthic set
271 Reagen SFR I set
272 Stik asam urat bh
273 Stik Kolesterol bh
274 Stik Gula darah bh
275 Stik urine 11( Pemriksaan urine lengkap ) bh
276 Stik Rapid test untuk sipilis stik
277 Stik test kehamilan /PP. test stik
278 SD Bioline Sphylis ( TPHA) set
279 Tissue kaca slide/ tisu lensa box
280 Thermal peper 30 mtr roll
281 Tabung reaksi 3 ml disposible box
282 Tabung vacum tutup ungu ( EDTA bh
283 Tabung serum( tutup merah) bh
284 Tabung Serum dg gel (tutup kuni bh
285 Tabung glukosa ( tutup abu-abu) bh
286 Tincture pidofilin 80-90 % btl
BAHAN HABIS PAKAI
287 Abocat 18 ( Iv Catheter 18 ) bh
288 Abocat 20 ( Iv Catheter 20 ) bh
289 Abocat 22 ( Iv Catheter 22 ) bh
290 Abocat 24 ( Iv Catheter 24 ) bh
291 Aqua pro injeksi vial
292 Alat suntik 0,5 cc bh
293 Alat suntik 0,05 cc bh
294 Alat suntik 1 cc bh
295 Alat suntik 3 cc bh
296 Alat suntik 5 cc bh
297 Alat suntik 10 cc bh
298 Benang bedah / Cat gut -3/0 zak
299 Benang bedah sutra / Silk -3/0 zak
300 Benang ethicon / Prolene 5/0 zak
301 Etanol 70 % Btl
302 Ethanol 70 % 100 ml btl
303 Etil Klorida semprot btl
304 Film X ray 24x 30 box
305 Film X ray 40x 30 box
306 Film X ray 35 x 35 box
307 Foley catheter bh
308 Hand scund S / M psg
309 Infusion set anak Set
310 Infusion set dewasa Set
311 Jarum Heating otot 1/2 lingkaran Biji
312 Jarum Heating otot 12,13.14 Biji
313 Jarum Heating kulit 12,13.14 Biji
314 Jelly unt doppler ( Doppler Jell 0 btl
315 Kapas Alkohol /Alkohol sweeb lbr
316 Kapas pembalut 250 mg roll
317 Kasa pembalut 40 x 40 steril roll
318 Kasa pembalut 2 x 80 cm roll
319 Kasa pmbalt hidrfil 4m x 15 cm roll
320 Kasa pembalut 4 m x 3 cm roll
321 Kasa hidrofil 16/16 steril box
322 kassa gulungan 40 yard x 80 cm roll
323 Kertas Puyer SCI Lbr
324 Kondum gros
325 Klip Obat K Lbr
326 Klip Obat B Lbr
327 Klip Obat T Lbr
328 Lisol Btl
329 Masker tali karet / tali biasa bh
330 masker N 95 bh
331 Nurse cup (Disposible head cup ) box
332 Oksigen gas dalam tabung Tabung
333 Oksigen kalengan klg
334 Pembalut Ibu Bersalin buah
335 Perhidrol / H2O2 Btl
336 Plester 5 yards x 2 inch roll
337 Plester Ultravix 5 cm x 5 mm bh
338 Pisau Bedah no 10, 11 ,12 pcs
339 Reagen Developer box
340 Reagen Fixer box
341 Sopratul Lbr
342 Sarung tangan Obgyn pcs
343 safety box bh
344 Tranfusi set bh
345 Tensocrip roll
346 Urine Bag buah
347 Umbilikor / klem tali pusat buah
348 Underpad box
349 wing Needle 25 G buah
350 Yodium povidon larutan 10 % 30 Btl
351 Yodium povidon larutan 10% 30m Btl
OBAT JKN
352 Ambroxol syr Btl
353 Ambroxol tab tab
354 Antalgin ( metampiron ) Tab
355 Antasid syr btl
356 Anti hemmoroid supp supp
357 Asam Folat Tab
358 Attapulgite / New Diatab Tab
359 Betahistin tab Tab
360 Dexamethason inj 5 mg/ml-1 ml Amp
361 Epineprin hcl ( adrenalina ) inj 0.1%-1 mlAmp
362 Fitominadion ( vit k1) inj 10 mg/ml-1mlAmp
363 Fitominadion (Vit K) inj 2 mg Amp
364 Gentamisin sulfat TM 0,3 % Btl
365 Gliseril guaiakolat tab 100 mg Tab
366 Glukosa larutan infus 10 % steril Btl
367 Glukosa larutan infus 5 % steril Btl
368 Hidroklorotiazida (hct) tab 25 mg Tab
369 Hidrokortison krim 1 % Tube
370 Kalsium laktat ( kalk ) tab 500 mg Tab
371 Ketorolac inj 30 mg Amp
372 Kloramphenikol Tetes Mata Btl
373 Meloksikam 7,5 mg Tab
374 Multivitamin tab/Nutrifar tab
375 Obat Batuk Hitam Btl
376 Oksitetrasiklin hc salep 3 % Tube
377 Oksitetrasiklin hcl salep mata 1 % Tube
378 Papverin tab Tab
379 Ranitidin inj 25 mg/2 ml Vial
380 Ringer laktat lrt inf steril ( RL ) Btl
381 Sefadroxyl 500 mg tab
382 Sinvastatin tab tab
383 Vitamin Neurotrofic /Siobion 50 tab
BHP JKN
384 Bonding Btl
385 Bur Gigi ( Longseng Bur ) bh
386 Bur Gigi ( Fisure Bur ) bh
387 Bur Gigi (Round Bur ) bh
388 Bur Gigi ( Inverted Bur ) bh
389 Brush bh
390 Biostun bh
391 Cresopat Btl
392 CHKM (Sterilisasi Akar) Btl
393 Devitalisasi pasta Btl
394 Etsa Btl
395 Elite cemen Btl
396 Fuji /Glas Ionomer / ketak molar Btl
397 Hydeal bh
398 Polibib / lap dada Box
399 Rocle (Sterilisasi Akar) Btl
400 Ruber Cup Btl
401 Silicon ruber Btl
402 Selifa ejector bh
403 Tumpatan sementara ( Cavit) Btl
404 Tumpatan permanen / Composit Btl
405 Tip Scaler gold Btl
406 Stik asam urat bh
407 Stik Kolesterol bh
408 Stik Gula darah bh
409 Stik HB Family DR stik
410 Reagen golongan Darah A,B paket
411 Aqua pro injeksi vial
412 Benang bedah / Cat gut -3/0 zak
413 Benang ethicon / Prolene 5/0 zak
414 Hand scund S / M psg
415 Jarum Heating otot 1/2 lingkaran Biji
416 Jarum Heating otot 12,13.14 Biji
417 Jarum Heating kulit 12,13.14 Biji
418 Jelly unt doppler ( Doppler Jell 0 btl
419 Masker tali karet / tali biasa bh
420 Tranfusi set bh
421 Yodium povidon larutan 10 %300 Btl
422 Methadon liquid 10 mg/ ml ml

UMUM
ASKES JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR

Mengetahui / menyetujui Yang menyerahkan Yang Meminta/Pelapor


Kepala unit Farmasi Petugas Gudang UPT Pusk. Kuta I
drg. GA.. Ajeng Kencana W ( Ni Made Arni ) ( Ni Made Adi Yastini )
NIP : 196803072006 04 2009 NIP :19691231 200312 2 035 Nip.196404211987032019
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
SUB - UNIT PELAYANAN
SUB UNIT : GUDANG
UPT PUSKESMAS : MENGWI III
KECAMATAN : MENGWI PELAPORAN BULAN : Januari 2017
KABUPATEN : BADUNG PERMINTAAN BULAN : Pebruari 2017

SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE


NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
1 Acyclovir 400 mg Tab 300 0 300 0 300
2 Acyclovir salep kulit 5 % tube 25 0 25 0 25
3 Albendazol 400 mg Tab 0 0 0 0
4 Alopurinol 100 mg Tab 500 500 0 500
5 Ambroxol syr 5 mg / 5 ml Btl 7 7 7
6 Ambroxol tab 30 mg tab 5000 5000 4800 200
7 Aminofilina tablet 200 mg Tab 0 0 0
8 Amlodipin 5 mg Tab 3600 3600 900 2700
9 Amoxsisilina kap 500 mg Tab 9100 9100 4600 4500
10 Amoxsisilina kap 250 mg Kap 0 0 0
11 Amoxsisilina sirup kering 125 Btl 120 120 15 105
12 Amoxsisilina drop 100 mg/ml Btl 27 27 27 0
As.Salicylsat 2% + Belerang 4 % (2-4)
13 salep pot 0 0 0
14 Astaxanthin 4 mg Tab 850 850 300 550
15 Antalgin ( metampiron ) Tab 0 0 0
16 Alletrol Tetes Mata btl 0 0 0
17 Antasid syr btl 50 50 50 0
18 Antasida doen tablet, Tab 3100 3100 1600 1500
19 Anti hemmoroid supp supp 120 120 30 90
20 Antimigren ( Ergotamin ,caffein ) tab 100 100 0 100
21 Antiscabies / gamexan salp Tube 0 0 0
22 Asam Ascorbat ( vit c ) tab 50 Tab 400 7000 7400 400 7000
23 Asam Folat 400 mcg Tab 0 0 0
24 As. Mefenamat 500 mg Tab 2200 2200 300 1900
25 Acetosal 100 mg Tab 0 0 0
26 Attapulgite active 600 mg Tab 0 0 0
27 Azetromicyn tab 500 mg Tab 0 0 0
28 Bacitracin - Poly SK Tube 25 25 0 25
29 Benzatin Bensil Penisillin inj vial 0 0 0
30 Besi II sulfat ( tablet tambah dara Tab 0 0 0
31 Betahistin tab 6 mg Tab 180 180 0 180
32 Betamethason krim 0,1 % Tube 25 25 25 0
33 Bisacodyl supp 10 mg sup 0 0 0
34 Borax Glycerin 5 % Btl 0 0 0
35 Balsem kaki 3 Btl 0 0 0
36 Captopril 12,5 mg Tab 0 0 0
37 Captopril 25 mg Tab 1300 1300 1300 0
38 Ceterizine 10 mg tab 0 0 0
39 Counterpaint cr tube 0 0 0
40 Clobazam 40 mg Tab 0 0 0
41 Clorpromazina hcl tab ( CPZ ) 100 mg Tab 0 0 0
42 Clorpromazin HCl tab ( CPZ) 25 mg Tab 0 0 0
43 Dexamethason inj 5 mg/ml-1 ml Amp 0 0 0
44 Dexamethason 0,5 mg Tab 1200 1200 1200 0
45 Desoksimetason tube 0 0 0
46 Dextrose 40 % steril Btl 0 0 0
47 Diazepam 2 mg Tab 700 700 0 700
48 Diazepam inj 5mg/ml Ampul 5 5 0 5
49 Diazepam rectal 5 mg/2,5 ml Tube 0 0 0
SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE
NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
50 Diphenhidramin hcl inj 10 mg/1 Amp 18 18 0 18
51 Digoxin tab 0.25 mg Tab 0 0 0
52 Doxysyclin 100 mg tab 0 0 0
53 Domperidon drop btl 0 0 0
54 Domperidon syr 5 mg / 5 ml btl 0 0 0
55 Efedrin hcl tab 25 mg Tab 0 0 0
56 Epineprin hcl ( adrenalina ) inj 0.1%-1 mlAmp 0 0 0
57 Erytromicin 500 mg Tab 0 0 0
58 Erytromicin syr 200mg/5ml Btl 0 0 0
59 Furossemid tab 40 mg Tab 0 0 0
60 Fluconazole 150 mg tab 0 0 0
61 Fitominadion (Vit K) inj 2 mg/1ml Amp 0 0 0
62 Fenobarbital tab 30 mg Tab 0 0 0
63 Fenol gliseron Tts Telinga Btl 0 0 0
64 Fitominadion ( vit k1) inj 10 mg/ml-1mlAmp 30 30 0 30
65 Fitominadion ( vit k1) tab salut Tab 0 0 0
66 Garam Oralit 200 ml air Sach 600 600 200 400
67 Gentamisin sulfat TM 0,3 % Btl 0 0 0
68 Gentamicin salep kulit Tube 0 0 0
69 Gentian Violet larutan 1 % Btl 0 0 0
70 Glibenklamid tab 5 mg Tab 1500 1500 600 900
71 Glimepiride 1mg tab 0 0 0
72 Glimepiride 2 mg tab 0 0 0
73 Gliseril guaiakolat tab 100 mg Tab 0 0 0
74 Glukosa larutan infus 10 % steril Btl 0 0 0
75 Glukosa larutan infus 5 % steril Btl 0 0 0
76 Griseofulvin tab 125 mg Tab 200 200 0 200
77 Haloperidol 0,5 mg Tab 0 0 0
78 Haloperidol 1,5 mg Tab 0 0 0
79 Haloperidol tablet 5 mg Tab 0 0 0
80 Hidroklorotiazida (hct) tab 25 mg Tab 0 0 0
81 Hidrokortison krim 2.5 % Tube 111 111 48 63
82 Hyocine-N-butilbr / Scopma tab Tab 0 0 0
83 Hyoscine-N-B Inj /Buscopan inj 2 Amp 0 0 0
84 Ibuprofen tab 200 mg Tab 0 0 0
85 Ibuprofen tab 400 mg Tab 6800 6800 500 6300
86 Ibuprofen Syr Btl 0 0 0
87 Isosorbid dinitrat 5 mg tab 0 0 0
88 IZONIASIDA ( INH) 100 MG Tab 0 0 0
89 Kalium permanganat (PK) Pot 0 0 0
90 Kalium Diklopenak 50 mg tab 0 0 0
91 Kalsium laktat ( kalk ) tab 500 mg Tab 0 0 0
92 Kalsium Glukonas10 % inj Vial 7 7 0 7
93 Ketokenazol krim 2 % tube 0 0 0
94 Ketokenazol tab 200 mg tab 250 250 0 250
95 Ketorolac inj 30 mg Amp 0 0 0
96 Klindamicin 150 mg tab 0 0 0
97 Klindamisin 300 mg Tab 0 0 0
98 Karbamazepin tablet 200 mg Tab 0 0 0
99 Kloramfenicol salp mata 1 % tube 0 0 0
100 Kloramphenikol Tetes Mata 0,5 % Btl 0 0 0
101 Kloramfenikol tts Telinga 3 % Btl 14 14 14 0
102 Klorfeniramini maleat (ctm) tab Tab 4600 4600 2400 2200
103 Kotrimoksazol kombinasi 480 mg Tab 600 600 100 500
104 Kotrimoksazol suspensi Btl 15 15 15 0
105 KB Suntik 1 bln Vial 0 0 0
106 KB IUD bh 0 0 0
107 KB PIL stp 0 0 0
SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE
NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
108 KB SUSUK / inflan infl 0 0 0
109 Lidokain inj 2 % Amp 115 115 115 0
110 Lidokain com inj 2% Amp 240 240 40 200
111 Loveramid tab 2 mg tab 300 300 300 0
112 Loratadin tab10 mg tab 450 450 0 450
113 Mg SO4 40 % ( 25 ml ) Vial 13 13 0 13
114 MgSO4 injeksi 20% Vial 5 5 0 5
115 Meloksikam 7,5 mg Tab 500 500 500 0
116 Meloksikam 15 mg Tab 500 500 0 500
117 Metformin tab 500 mg Tab 0 0 0
118 Metil ergometrina maleat inj 0.200 mg/ml Amp 0 0 0
119 Metil ergometrina maleat tab salut 0.125 tab 0 0 0
120 Methyl Prednisolon 4 mg tab 2500 2500 500 2000
121 Metoklopramid Hcl 5 mg tab 0 0 0
122 Metoklopramid Hcl syr 5 mg/5m btl 20 20 0 20
123 Metoklopramid inj 5mg/2ml Amp 0 0 0
124 Metronidazol 500 mg Tab 500 500 0 500
125 Metronidazol supp ( flagyl ) 0.5 g sup 0 0 0
126 Miconazol crm 2 % tube 24 24 0 24
127 MDT Combi ( obat kusta ) paket 0 0 0
128 Multivitamin syr / Procuma btl 60 60 20 40
129 Multivitamin tab(vitacaps) tab 3000 3000 1400 1600
130 Narium Tiroksin tab 0 0 0
131 Natrium klorida larutan infus 0.9 % sterilBtl 10 10 1 9
132 Na Diklopenac 25 mg tab 0 0 0
133 Na Diklofenac 50 mg Tab 1600 1600 500 1100
134 Nipedipin tab 0 0 0
135 Nistatin 100.000 Iu/g/tab vaginal tab 0 0 0
136 NB Salp Tube 0 0 0
137 Obat Batuk Hitam Btl 120 120 0 120
138 Obat batuk kering/dextrofen btl 200 200 50 150
139 Obat Flu sirup/erpaflu btl 48 48 24 24
140 Obat Flu tablet/coparcetin Tab 1000 1000 1000 0
141 Oksitetrasiklin hc salep 3 % Tube 0 0 0
142 Oksitetrasiklin hcl salep mata 1 % Tube 0 0 0
143 Oksitosin inj 10 iU ( 1 ml ) Amp 0 0 0
144 Omeprazol 20 mg Tab 1200 1200 0 1200
145 Osedantron inj Amp 0 0 0
146 Osedantron tab 8 mg Tab 0 0 0
147 Oseltamivir 75 mg Tab 0 0 0
148 Papverin tab Tab 0 0 0
149 Parasetamol sirup 120 mg/ 5 ml Btl 188 188 85 103
150 Parasetamol tab 500 mg Tab 7500 7500 4300 3200
151 Paracetamol drop 100 mg/ ml Btl 0 0 0
152 Paracetamol rectal 125 mg Tube 10 10 5 5
153 Perak sulfadiazin 1 % / Burnazin cr Tube 3 3 0 3
154 Pyrantel syr btl 0 0 0
155 Piridoxin hcl (vit b6) tab 10 mg Tab 0 0 0
156 Piroxicam 20 mg cap 0 0 0
157 Piroxicam 10 mg cap 0 0 0
158 Polycresulen / Albothyl/ Aptil Btl 4 4 1 3
159 Prednison tab 5 mg Tab 6500 6500 500 6000
160 Ranitidin 150 mg Tab 1000 1000 500 500
161 Ranitidin inj 25 mg/2 ml Vial 0 0 0
162 Retinol ( vit A ) kaps lunak 100.00 Kap 800 800 0 800
163 Retinol ( vit A ) kaps lunak 200.00 Kap 4500 4500 0 4500
164 Ringer laktat lrt inf steril ( RL ) Btl 20 20 3 17
165 Resperidon 2 tab tab 0 0 0
SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE
NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
166 salbutamol 4 mg tab 2000 2000 500 1500
167 salbutamol 2 mg tab 0 0 0
168 salbutamol nebulizer 2.5 mg Amp 20 20 0 20
169 Salbutamol inhaler btl 0 0 0
170 Salisil bedak 2 % Sak 189 189 12 177
171 Sefadroxyl 500 mg tab 0 0 0
172 Sefadroxyl syr kering 250 mg/5ml btl 0 0 0
173 Sefiksim 100 mg tab 0 0 0
174 Serum Anti Bisa Ular ( ABU ) vial 0 0 0
175 Serum anti tetanus(tetagam) 250 Amp 15 15 15 0
176 Sianokobalamina (vit B12 ) inj Amp 0 0 0
177 Simetidin 200 mg Tab 0 0 0
178 Sinvastatin tab 10 mg tab 0 0 0
179 Siproploxacin 500 mg Tab 600 600 200 400
180 Sucralfate 500 mg /Mucogard tab Tab 0 0 0
181 Sucralfat suspensi ( Mucogard sus btl 0 0 0
182 Sulfasetamid Tetes mata 15 % Btl 0 0 0
183 Salep perawatan luka (bioplacent tube 10 10 10 0
184 Tetrasiklina hcl kapsul 500 mg Kap 0 0 0
185 Triflouperazin ( Stelazin ) 5 mg Tab 0 0 0
186 Thiamin hcl inj 100 mg/ml - 1 ml Amp 0 0 0
187 Thiamin hcl ( vit B1)tab 50 mg Tab 7100 7100 2200 4900
188 Thiamfenicol 500 mg Tab 0 0 0
189 Trihexipenidil 2 mg Tab 0 0 0
190 Vitamin B complek tab Tab 3800 6800 10600 3800 6800
191 Vit Neurotrofic tablet 5000 mg (so tab 1000 1000 800 200
192 Vit Neurotrofic inj 5000 mg Amp 0 0 0
193 Vitamin imunitas (Imunogard ) tab 540 540 300 240
194 Zink tab 20 mg Tab 500 500 300 200
195 Zink drop 10 mg/ml btl 0 0 0
196 Zink syr ( Zirkum ) btl 0 0 0
Bisacodyl tab tab 200 200 0 200
VAKSIN 0 0 0
197 HB Uniject vial 0 0 0
198 BCG vial 0 0 0
199 CAMPAK vial 0 0 0
200 POLIO vial 0 0 0
201 Pentabio vial 0 0 0
202 DT vial 0 0 0
203 TT vial 0 0 0
204 TD vial 0 0 0
205 IPV vial 0 0 0
206 VAKSIN Anti Rabies ( VAR ) vial 0 0 0
OBAT PROGRAM TBC 0 0 0
207 Anti TBC Anak paket 0 0 0
208 Anti TBC I / FDC paket 0 0 0
209 Anti TBC II / FDC paket 0 0 0
210 kombipak katagori I paket 0 0 0
OBAT PROGRAM ARV 0 0 0
211 ALUVIA ( Liponavir 200mg + riton tab 0 0 0
212 DUVIRAL( Lamifudin150 mg+zidofud tab 0 0 0

Efavirenz 600 mg
213 tab 0 0 0

FDC ( Tenofovir 300mg+lamivudin


300 mg + efavirenz 600 mg)
214 tab 0 0 0
215 Lamivudine ( Hiviral ) 150 mg tab 0 0 0
216 Nevirapine ( Neviral ) 200 mg tab 0 0 0
SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE
NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
217 Tenofovir Disoproxil Fumarate (TDF tab 0 0 0
218 Abacavir tab 0 0 0
219 Triplepediatrik tab 0 0 0
GIGI 0 0 0
220 Bonding Btl 0 0 0
221 Bur Gigi ( Longseng Bur ) bh 0 0 0
222 Bur Gigi ( Fisure Bur ) bh 0 0 0
223 Bur Gigi (Round Bur ) bh 0 0 0
224 Bur Gigi ( Inverted Bur ) bh 0 0 0
225 CHKM (Sterilisasi Akar) Btl 0 0 0
226 Cresopate ( Munifying pasta) Btl 0 0 0
227 Devitalisasi pasta (non arsen ) Btl 0 0 0
228 Eugenol cairan Btl 3 3 0 3
229 Endomethason N ( Munifying past Btl 0 0 0
230 Etsa Btl 0 0 0
231 Fuji /Glas Ionomer / ketak molar Btl 0 0 0
232 Iodoform pasta / calplus syringe 0 0 0
233 Semen seng fosf. Serbuk & cairan Btl 0 0 0
234 Rocle (Sterilisasi Akar) Btl 0 0 0
235 Tumpatan sementara ( Cavit) Btl 0 0 0
236 Tumpatan permanen / Composit Btl 0 0 0
237 Temporary stopping Fletcher Btl 0 0 0
238 TKF (Sterilisasi Akar) Btl 0 0 0
239 Tumpatan permanen / Composit Btl 0 0 0
240 Tincture pidofilin 80-90 % Btl 0 0 0
LABORATORIUM 0 0 0
241 Asam acetat 100 ml Btl 0 0 0
242 Cover glass bh 0 0 0
243 Control N 2,5 ml bh 0 0 0
244 Eosin Btl 0 0 0
245 Giemza Btl 0 0 0
246 Jarum stik gula / Blood lounchet bh 0 0 0
247 Jarum Vacumtainer ( needle 22 G bh 0 0 0
248 Jarum CD 4 bh 0 0 0
249 Kaca Slide /slide forstead box 0 0 0
250 Kertas lakmus ( Test paper ) pak 0 0 0
251 KOH 100 ml Btl 0 0 0
252 Kertas Ph vagina 0.2 box 0 0 0
253 M emersi btl 0 0 0
254 Menthanol btl 0 0 0
255 Methylen blue btl 0 0 0
256 Natrium klorida btl 500 ml Btl 0 0 0
257 Pot dahak bh 0 0 0
258 Pipet Tip Yellow pcs 0 0 0
259 Plesterin box 0 0 0
260 Reagen Widal test set 0 0 0
261 Reagen gol darah A & B Btl 0 0 0
262 Reagen ZN / BTA set 0 0 0
263 Reagen HIV I pcs 0 0 0
264 Reagen HIV II pcs 0 0 0
265 Reagen HIV III pcs 0 0 0
266 Reagen kimia darah pcs 0 0 0
267 RPR set 0 0 0
268 Reagen CD4 set 0 0 0
269 Reagen Erma set 0 0 0
270 Reagen Control mynthic set 0 0 0
271 Reagen SFR I set 0 0 0
272 Stik asam urat bh 0 0 0
SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE
NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
273 Stik Kolesterol bh 0 0 0
274 Stik Gula darah bh 0 0 0
275 Stik urine 11( Pemriksaan urine lengkap ) bh 0 0 0
276 Stik Rapid test untuk sipilis stik 0 0 0
277 Stik test kehamilan /PP. test stik 0 0 0
278 SD Bioline Sphylis ( TPHA) set 0 0 0
279 Tissue kaca slide/ tisu lensa box 0 0 0
280 Thermal peper 30 mtr roll 0 0 0
281 Tabung reaksi 3 ml disposible box 0 0 0
282 Tabung vacum tutup ungu ( EDTA bh 0 0 0
283 Tabung serum( tutup merah) bh 0 0 0
284 Tabung Serum dg gel (tutup kuni bh 0 0 0
285 Tabung glukosa ( tutup abu-abu) bh 0 0 0
286 Tincture pidofilin 80-90 % btl 0 0 0
Rapid tes Dengue Nsi Ag 150 150 150 0
Rapid tes Dengue Duo 125 125 125 0
0
BAHAN HABIS PAKAI 0 0 0
287 Abocat 18 ( Iv Catheter 18 ) bh 0 0 0
288 Abocat 20 ( Iv Catheter 20 ) bh 0 0 0
289 Abocat 22 ( Iv Catheter 22 ) bh 0 0 0
290 Abocat 24 ( Iv Catheter 24 ) bh 0 0 0
291 Aqua pro injeksi vial 0 0 0
292 Alat suntik 0,5 cc bh 0 0 0
293 Alat suntik 0,05 cc bh 0 0 0
294 Alat suntik 1 cc bh 0 0 0
295 Alat suntik 3 cc box 10 20 30 0 30
296 Alat suntik 5 cc bh 0 0 0
297 Alat suntik 10 cc bh 0 0 0
298 Benang bedah / Cat gut -3/0 zak 0 0 0
299 Benang bedah sutra / Silk -3/0 zak 0 0 0
300 Benang ethicon / Prolene 5/0 zak 0 0 0
301 Etanol 70 % Btl 0 0 0
302 Ethanol 70 % 100 ml btl 100 100 21 79
303 Etil Klorida semprot btl 8 8 0 8
304 Film X ray 24x 30 box 0 0 0
305 Film X ray 40x 30 box 0 0 0
306 Film X ray 35 x 35 box 0 0 0
307 Foley catheter bh 0 0 0
308 Hand scund S / M bok 84 84 11 73
309 Infusion set anak Set 10 10 1 9
310 Infusion set dewasa Set 0 0 0
311 Jarum Heating otot 1/2 lingkaran Biji 0 0 0
312 Jarum Heating otot 12,13.14 Biji 0 0 0
313 Jarum Heating kulit 12,13.14 Biji 0 0 0
314 Jelly unt doppler ( Doppler Jell 0 btl 0 0 0
315 Kapas Alkohol /Alkohol sweeb box 20 20 5 15
316 Kapas pembalut 250 mg roll 4 4 2 2
317 Kasa pembalut 40 x 40 steril roll 0 0 0
318 Kasa pembalut 2 x 80 cm roll 0 0 0
319 Kasa pmbalt hidrfil 4m x 15 cm roll 30 30 5 25
320 Kasa pembalut 4 m x 3 cm roll 12 12 12 0
321 Kasa hidrofil 16/16 steril box 0 0 0
322 kassa gulungan 40 yard x 80 cm roll 5 5 0 5
323 Kertas Puyer SCI Lbr 0 0 0
324 Kondum gros 0 0 0
325 Klip Obat K pak 400 400 0 400
326 Klip Obat B Lbr 0 0 0
SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE
NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
327 Klip Obat T pak 182 182 0 182
328 Lisol Btl 4 4 0 4
329 Masker tali karet / tali biasa box 37 37 8 29
330 masker N 95 bh 0 0 0
331 Nurse cup (Disposible head cup ) box 0 0 0
332 Oksigen gas dalam tabung Tabung 0 0 0
333 Oksigen kalengan klg 0 0 0
334 Pembalut Ibu Bersalin buah 0 0 0
335 Perhidrol / H2O2 Btl 0 0 0
336 Plester 5 yards x 2 inch roll 6 6 1 5
337 Plester Ultravix 5 cm x 5 mm bh 15 15 5 10
338 Pisau Bedah no 10, 11 ,12 pcs 0 0 0
339 Reagen Developer box 0 0 0
340 Reagen Fixer box 0 0 0
341 Sopratul box 3 10 13 4 9
342 Sarung tangan Obgyn pcs 50 50 50 0
343 safety box bh 0 0 0
344 Tranfusi set bh 0 0 0
345 Tensocrip roll 14 14 0 14
346 Urine Bag buah 0 0 0
347 Umbilikor / klem tali pusat buah 0 0 0
348 Underpad box 0 0 0
349 wing Needle 25 G buah 4 4 0 4
350 Yodium povidon larutan 10 % 30 Btl 1 5 6 2 4
351 Yodium povidon larutan 10% 30m Btl 0 0 0

JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR PHB

Mengetahui / menyetujui
Pimpinan Puskesmas Mengwi III Petugas Gudang Puskesmas

(dr.Komang Widia Asmawan,S.Ked) (Kd.Suryaning Ayu)


NIP : 19791202 200501 1 010 NIP.19820708 200604 2016
SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE
NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
KET
KET

..
KET
KET
KET
KET
KET

OBAT JKN
352 Ambroxol syr Btl
353 Ambroxol tab tab
354 Antalgin ( metampiron ) Tab
355 Antasid syr btl
356 Anti hemmoroid supp supp
357 Asam Folat Tab
358 Attapulgite / New Diatab Tab
359 Betahistin tab Tab
360 Dexamethason inj 5 mg/ml-1 m Amp
361 Epineprin hcl ( adrenalina ) inj 0.1%-1Amp
ml
362 Fitominadion ( vit k1) inj 10 mg/ml-1mlAmp
363 Fitominadion (Vit K) inj 2 mg Amp
364 Gentamisin sulfat TM 0,3 % Btl
365 Gliseril guaiakolat tab 100 mg Tab
366 Glukosa larutan infus 10 % steri Btl
367 Glukosa larutan infus 5 % steril Btl
368 Hidroklorotiazida (hct) tab 25 Tab
369 Hidrokortison krim 1 % Tube
370 Kalsium laktat ( kalk ) tab 500 Tab
371 Ketorolac inj 30 mg Amp
372 Kloramphenikol Tetes Mata Btl
373 Meloksikam 7,5 mg Tab
374 Multivitamin tab/Nutrifar tab
375 Obat Batuk Hitam Btl
376 Oksitetrasiklin hc salep 3 % Tube
377 Oksitetrasiklin hcl salep mata Tube
378 Papverin tab Tab
379 Ranitidin inj 25 mg/2 ml Vial
380 Ringer laktat lrt inf steril ( RL ) Btl
381 Sefadroxyl 500 mg tab
382 Sinvastatin tab tab
KET

383 Vitamin Neurotrofic /Siobion tab


BHP JKN
384 Bonding Btl
385 Bur Gigi ( Longseng Bur ) bh
386 Bur Gigi ( Fisure Bur ) bh
387 Bur Gigi (Round Bur ) bh
388 Bur Gigi ( Inverted Bur ) bh
389 Brush bh
390 Biostun bh
391 Cresopat Btl
392 CHKM (Sterilisasi Akar) Btl
393 Devitalisasi pasta Btl
394 Etsa Btl
395 Elite cemen Btl
396 Fuji /Glas Ionomer / ketak mol Btl
397 Hydeal bh
398 Polibib / lap dada Box
399 Rocle (Sterilisasi Akar) Btl
400 Ruber Cup Btl
401 Silicon ruber Btl
402 Selifa ejector bh
403 Tumpatan sementara ( Cavit) Btl
404 Tumpatan permanen / Compos Btl
405 Tip Scaler gold Btl
406 Stik asam urat bh
407 Stik Kolesterol bh
408 Stik Gula darah bh
409 Stik HB Family DR stik
410 Reagen golongan Darah A,B paket
411 Aqua pro injeksi vial
412 Benang bedah / Cat gut -3/0 zak
413 Benang ethicon / Prolene 5/0 zak
414 Hand scund S / M psg
415 Jarum Heating otot 1/2 lingkaran Biji
416 Jarum Heating otot 12,13.14 Biji
417 Jarum Heating kulit 12,13.14 Biji
418 Jelly unt doppler ( Doppler Jell 0 btl
419 Masker tali karet / tali biasa bh
420 Tranfusi set bh
421 Yodium povidon larutan 10 %3 Btl
422 Methadon liquid 10 mg/ ml ml
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
SUB - UNIT PELAYANAN
SUB UNIT : APOTEK
UPT PUSKESMAS : MENGWI III DOKUMENNO
KECAMATAN : MENGWI PELAPORAN BULAN : Januari 2017 PUSKESMAS
KABUPATEN : BADUNG PERMINTAAN BULAN : Pebruari 2017 sub unit

SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE


NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
1 Acyclovir 400 mg Tab 319 319 120 199
2 Acyclovir salep kulit 5 % tube 31 31 3 28
3 Albendazol 400 mg Tab 1666 1666 0 1666
4 Alopurinol 100 mg Tab 210 210 100 110
5 Ambroxol syr 5 mg / 5 ml Btl 0 0
6 Ambroxol tab 30 mg tab 1500 1500 104 1396
7 Aminofilina tablet 200 mg Tab 0 0
8 Amlodipin 5 mg Tab 900 900 0 900
9 Amoxsisilina kap 500 mg Tab 459 2000 2459 1397 1062
10 Amoxsisilina kap 250 mg Kap 0 0
11 Amoxsisilina sirup kering 125 Btl 91 91 9 82
12 Amoxsisilina drop 100 mg/ml Btl 27 27 27 0
As.Salicylsat 2% + Belerang 4 % (2-4)
13 salep pot 0 0
14 Astaxanthin 4 mg Tab 300 300 0 300
15 Antalgin ( metampiron ) Tab 0 0
16 Alletrol Tetes Mata btl 0 0
17 Antasid syr btl 50 50 3 47
18 Antasida doen tablet, Tab 378 500 878 330 548
19 Anti hemmoroid supp supp 15 15 0 15
20 Antimigren ( Ergotamin ,caffein ) tab 65 65 30 35
21 Antiscabies / gamexan salp Tube 0 0
22 Asam Ascorbat ( vit c ) tab 50 Tab 1221 1221 136 1085
23 Asam Folat 400 mcg Tab 0 0
24 As. Mefenamat 500 mg Tab 4698 4698 947 3751
25 Acetosal 100 mg Tab 0 0
26 Attapulgite active 600 mg Tab 0 0
27 Azetromicyn tab 500 mg Tab 0 0
28 Bacitracin - Poly SK Tube 32 32 19 13
29 Benzatin Bensil Penisillin inj vial 0 0
30 Besi II sulfat ( tablet tambah dara Tab 0 0
31 Betahistin tab 6 mg Tab 241 241 26 215
32 Betamethason krim 0,1 % Tube 14 25 39 28 11
33 Bisacodyl supp 10 mg sup 0 0
34 Borax Glycerin 5 % Btl 0 0
35 Balsem kaki 3 Btl 0 0
36 Captopril 12,5 mg Tab 0 0
37 Captopril 25 mg Tab 1060 800 1860 992 868
38 Ceterizine 10 mg tab 0 0
39 Counterpaint cr tube 0 0
40 Clobazam 40 mg Tab 0 0
41 Clorpromazina hcl tab ( CPZ ) 100 mg Tab 0 0
42 Clorpromazin HCl tab ( CPZ) 25 mg Tab 0 0
43 Dexamethason inj 5 mg/ml-1 ml Amp 0 0
44 Dexamethason 0,5 mg Tab 776 776 321 455
45 Desoksimetason tube 0 0
46 Dextrose 40 % steril Btl 0 0
47 Diazepam 2 mg Tab 138 138 14 124
48 Diazepam inj 5mg/ml Ampul 0 0
49 Diazepam rectal 5 mg/2,5 ml Tube 0 0
SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE
NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
50 Diphenhidramin hcl inj 10 mg/1 Amp 0 0
51 Digoxin tab 0.25 mg Tab 0 0
52 Doxysyclin 100 mg tab 0 0
53 Domperidon drop btl 0 0
54 Domperidon syr 5 mg / 5 ml btl 0 0
55 Efedrin hcl tab 25 mg Tab 0 0
56 Epineprin hcl ( adrenalina ) inj 0.1%-1 mlAmp 0 0
57 Erytromicin 500 mg Tab 0 0
58 Erytromicin syr 200mg/5ml Btl 0 0
59 Furossemid tab 40 mg Tab 0 0
60 Fluconazole 150 mg tab 0 0
61 Fitominadion (Vit K) inj 2 mg/1ml Amp 0 0
62 Fenobarbital tab 30 mg Tab 0 0
63 Fenol gliseron Tts Telinga Btl 0 0
64 Fitominadion ( vit k1) inj 10 mg/ml-1mlAmp 0 0
65 Fitominadion ( vit k1) tab salut Tab 0 0
66 Garam Oralit 200 ml air Sach 99 100 199 88 111
67 Gentamisin sulfat TM 0,3 % Btl 0 0
68 Gentamicin salep kulit Tube 0 0
69 Gentian Violet larutan 1 % Btl 0 0
70 Glibenklamid tab 5 mg Tab 547 500 1047 440 607
71 Glimepiride 1mg tab 0 0
72 Glimepiride 2 mg tab 0 0
73 Gliseril guaiakolat tab 100 mg Tab 0 0
74 Glukosa larutan infus 10 % steril Btl 0 0
75 Glukosa larutan infus 5 % steril Btl 0 0
76 Griseofulvin tab 125 mg Tab 0 0
77 Haloperidol 0,5 mg Tab 0 0
78 Haloperidol 1,5 mg Tab 0 0
79 Haloperidol tablet 5 mg Tab 0 0
80 Hidroklorotiazida (hct) tab 25 mg Tab 0 0
81 Hidrokortison krim 2.5 % Tube 73 73 1 72
82 Hyocine-N-butilbr / Scopma tab Tab 0 0
83 Hyoscine-N-B Inj /Buscopan inj 2 Amp 0 0
84 Ibuprofen tab 200 mg Tab 0 0
85 Ibuprofen tab 400 mg Tab 703 703 335 368
86 Ibuprofen Syr Btl 0 0
87 Isosorbid dinitrat 5 mg tab 0 0
88 IZONIASIDA ( INH) 100 MG Tab 0 0
89 Kalium permanganat (PK) Pot 0 0
90 Kalium Diklopenak 50 mg tab 0 0
91 Kalsium laktat ( kalk ) tab 500 mg Tab 0 0
92 Kalsium Glukonas10 % inj Vial 0 0
93 Ketokenazol krim 2 % tube 9 9 9 0
94 Ketokenazol tab 200 mg tab 260 260 0 260
95 Ketorolac inj 30 mg Amp 0 0
96 Klindamicin 150 mg tab 0 0
97 Klindamisin 300 mg Tab 0 0
98 Karbamazepin tablet 200 mg Tab 0 0
99 Kloramfenicol salp mata 1 % tube 53 53 24 29
100 Kloramphenikol Tetes Mata 0,5 % Btl 0 0
101 Kloramfenikol tts Telinga 3 % Btl 20 20 4 16
102 Klorfeniramini maleat (ctm) tab Tab 1402 2000 3402 988 2414
103 Kotrimoksazol kombinasi 480 mg Tab 240 240 10 230
104 Kotrimoksazol suspensi Btl 7 7 7
105 KB Suntik 1 bln Vial 0 0
106 KB IUD bh 0 0
107 KB PIL stp 0 0
SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE
NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
108 KB SUSUK / inflan infl 0 0
109 Lidokain inj 2 % Amp 100 100 100 0
110 Lidokain com inj 2% Amp 40 40 40 0
111 Loveramid tab 2 mg tab 170 300 470 102 368
112 Loratadin tab10 mg tab 312 312 67 245
113 Mg SO4 40 % ( 25 ml ) Vial 0 0
114 MgSO4 injeksi 20% Vial 0 0
115 Meloksikam 7,5 mg Tab 500 500 66 434
116 Meloksikam 15 mg Tab 0 0
117 Metformin tab 500 mg Tab 1485 1485 1020 465
118 Metil ergometrina maleat inj 0.200 mg/ml Amp 0 0
119 Metil ergometrina maleat tab salut 0.125 tab 0 0
120 Methyl Prednisolon 4 mg tab 532 500 1032 481 551
121 Metoklopramid Hcl 5 mg tab 0 0
122 Metoklopramid Hcl syr 5 mg/5m btl 0 0
123 Metoklopramid inj 5mg/2ml Amp 0 0
124 Metronidazol 500 mg Tab 229 229 37 192
125 Metronidazol supp ( flagyl ) 0.5 g sup 0 0
126 Miconazol crm 2 % tube 41 41 1 40
127 MDT Combi ( obat kusta ) paket 0 0
128 Multivitamin syr / Procuma btl 12 20 32 13 19
129 Multivitamin tab(vitacaps) tab 500 500 45 455
130 Narium Tiroksin tab 0 0
131 Natrium klorida larutan infus 0.9 % sterilBtl 0 0
132 Na Diklopenac 25 mg tab 0 0
133 Na Diklofenac 50 mg Tab 254 300 554 234 320
134 Nipedipin tab 0 0
135 Nistatin 100.000 Iu/g/tab vaginal tab 85 85 85
136 NB Salp Tube 0 0
137 Obat Batuk Hitam Btl 0 0
138 Obat batuk kering/dextrofen btl 50 50 0 50
139 Obat Flu sirup/erpaflu btl 24 24 2 22
140 Obat Flu tablet/coparcetin Tab 600 600 184 416
141 Oksitetrasiklin hc salep 3 % Tube 0 0
142 Oksitetrasiklin hcl salep mata 1 % Tube 0 0
143 Oksitosin inj 10 iU ( 1 ml ) Amp 0 0
144 Omeprazol 20 mg Tab 369 369 326 43
145 Osedantron inj Amp 0 0
146 Osedantron tab 8 mg Tab 0 0
147 Oseltamivir 75 mg Tab 0 0
148 Papverin tab Tab 0 0
149 Parasetamol sirup 120 mg/ 5 ml Btl 128 128 37 91
150 Parasetamol tab 500 mg Tab 1553 2000 3553 2054 1499
151 Paracetamol drop 100 mg/ ml Btl 92 92 73 19
152 Paracetamol rectal 125 mg Tube 5 5 5
153 Perak sulfadiazin 1 % / Burnazin cr Tube 0 0
154 Pyrantel syr btl 0 0
155 Piridoxin hcl (vit b6) tab 10 mg Tab 763 763 331 432
156 Piroxicam 20 mg cap 0 0
157 Piroxicam 10 mg cap 0 0
158 Polycresulen / Albothyl/ Aptil Btl 1 1 1 0
159 Prednison tab 5 mg Tab 480 480 480
160 Ranitidin 150 mg Tab 500 500 500
161 Ranitidin inj 25 mg/2 ml Vial 0 0
162 Retinol ( vit A ) kaps lunak 100.00 Kap 0 0
163 Retinol ( vit A ) kaps lunak 200.00 Kap 0 0
164 Ringer laktat lrt inf steril ( RL ) Btl 2 2 2 0
165 Resperidon 2 tab tab 0 0
SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE
NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
166 salbutamol 4 mg tab 500 500 40 460
167 salbutamol 2 mg tab 198 198 142 56
168 salbutamol nebulizer 2.5 mg Amp 10 10 10
169 Salbutamol inhaler btl 0 0
170 Salisil bedak 2 % Sak 62 62 8 54
171 Sefadroxyl 500 mg tab 0 0
172 Sefadroxyl syr kering 250 mg/5ml btl 0 0
173 Sefiksim 100 mg tab 0 0
174 Serum Anti Bisa Ular ( ABU ) vial 0 0
175 Serum anti tetanus(tetagam) 250 Amp 15 15 9 6
176 Sianokobalamina (vit B12 ) inj Amp 0 0
177 Simetidin 200 mg Tab 0 0
178 Sinvastatin tab 10 mg tab 0 0
179 Siproploxacin 500 mg Tab 64 200 264 160 104
180 Sucralfate 500 mg /Mucogard tab Tab 0 0
181 Sucralfat suspensi ( Mucogard sus btl 0 0
182 Sulfasetamid Tetes mata 15 % Btl 0 0
183 Salep perawatan luka (bioplacent tube 10 10 0 10
184 Tetrasiklina hcl kapsul 500 mg Kap 0 0
185 Triflouperazin ( Stelazin ) 5 mg Tab 0 0
186 Thiamin hcl inj 100 mg/ml - 1 ml Amp 0 0
187 Thiamin hcl ( vit B1)tab 50 mg Tab 502 502 20 482
188 Thiamfenicol 500 mg Tab 0 0
189 Trihexipenidil 2 mg Tab 0 0
190 Vitamin B complek tab Tab 1624 1700 3324 2435 889
191 Vit Neurotrofic tablet 5000 mg (so tab 500 500 0 500
192 Vit Neurotrofic inj 5000 mg Amp 0 0
193 Vitamin imunitas (Imunogard ) tab 300 300 18 282
194 Zink tab 20 mg Tab 300 300 50 250
195 Zink drop 10 mg/ml btl 0 0
196 Zink syr ( Zirkum ) btl 0 0
Bisacodyl tab tab 15 15 0 15
VAKSIN 0 0
197 HB Uniject vial 35 19 54 32 22
198 BCG vial 32 20 52 12 40
199 CAMPAK vial 40 10 50 24 26
200 POLIO vial 56 0 56 43 13
201 Pentabio vial 29 50 79 56 23
202 DT vial 0 0
203 TT vial 32 20 52 12 40
204 TD vial 0 0
205 IPV vial 12 5 17 7 10
206 VAKSIN Anti Rabies ( VAR ) vial 0 0
OBAT PROGRAM TBC 0 0
207 Anti TBC Anak paket 0 0
208 Anti TBC I / FDC paket 0 0
209 Anti TBC II / FDC paket 0 0
210 kombipak katagori I paket 0 0
OBAT PROGRAM ARV 0 0
211 ALUVIA ( Liponavir 200mg + riton tab 0 0
212 DUVIRAL( Lamifudin150 mg+zidofud tab 0 0

Efavirenz 600 mg
213 tab 0 0

FDC ( Tenofovir 300mg+lamivudin


300 mg + efavirenz 600 mg)
214 tab 0 0
215 Lamivudine ( Hiviral ) 150 mg tab 0 0
216 Nevirapine ( Neviral ) 200 mg tab 0 0
SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE
NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
217 Tenofovir Disoproxil Fumarate (TDF tab 0 0
218 Abacavir tab 0 0
219 Triplepediatrik tab 0 0
GIGI 0 0
220 Bonding Btl 0 0
221 Bur Gigi ( Longseng Bur ) bh 0 0
222 Bur Gigi ( Fisure Bur ) bh 0 0
223 Bur Gigi (Round Bur ) bh 0 0
224 Bur Gigi ( Inverted Bur ) bh 0 0
225 CHKM (Sterilisasi Akar) Btl 0 0
226 Cresopate ( Munifying pasta) Btl 0 0
227 Devitalisasi pasta (non arsen ) Btl 0 0
228 Eugenol cairan Btl 0 0
229 Endomethason N ( Munifying past Btl 0 0
230 Etsa Btl 0 0
231 Fuji /Glas Ionomer / ketak molar Btl 0 0
232 Iodoform pasta / calplus syringe 0 0
233 Semen seng fosf. Serbuk & cairan Btl 0 0
234 Rocle (Sterilisasi Akar) Btl 0 0
235 Tumpatan sementara ( Cavit) Btl 0 0
236 Tumpatan permanen / Composit Btl 0 0
237 Temporary stopping Fletcher Btl 0 0
238 TKF (Sterilisasi Akar) Btl 0 0
239 Tumpatan permanen / Composit Btl 0 0
240 Tincture pidofilin 80-90 % Btl 0 0
LABORATORIUM 0 0
241 Asam acetat 100 ml Btl 0 0
242 Cover glass bh 0 0
243 Control N 2,5 ml bh 0 0
244 Eosin Btl 0 0
245 Giemza Btl 0 0
246 Jarum stik gula / Blood lounchet bh 0 0
247 Jarum Vacumtainer ( needle 22 G bh 0 0
248 Jarum CD 4 bh 0 0
249 Kaca Slide /slide forstead box 0 0
250 Kertas lakmus ( Test paper ) pak 0 0
251 KOH 100 ml Btl 0 0
252 Kertas Ph vagina 0.2 box 0 0
253 M emersi btl 0 0
254 Menthanol btl 0 0
255 Methylen blue btl 0 0
256 Natrium klorida btl 500 ml Btl 0 0
257 Pot dahak bh 0 0
258 Pipet Tip Yellow pcs 0 0
259 Plesterin box 0 0
260 Reagen Widal test set 0 0
261 Reagen gol darah A & B Btl 0 0
262 Reagen ZN / BTA set 0 0
263 Reagen HIV I pcs 200 200 49 151
264 Reagen HIV II pcs 0 0
265 Reagen HIV III pcs 43 43 43
266 Reagen kimia darah pcs 0 0
267 RPR set 0 0
268 Reagen CD4 set 0 0
269 Reagen Erma set 0 0
270 Reagen Control mynthic set 0 0
271 Reagen SFR I set 0 0
272 Stik asam urat bh 0 0
SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE
NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
273 Stik Kolesterol bh 0 0
274 Stik Gula darah bh 0 0
275 Stik urine 11( Pemriksaan urine lengkap ) bh 0 0
276 Stik Rapid test untuk sipilis stik 0 0
277 Stik test kehamilan /PP. test stik 0 0
278 SD Bioline Sphylis ( TPHA) set 21 21 21
279 Tissue kaca slide/ tisu lensa box 0 0
280 Thermal peper 30 mtr roll 0 0
281 Tabung reaksi 3 ml disposible box 0 0
282 Tabung vacum tutup ungu ( EDTA bh 0 0
283 Tabung serum( tutup merah) bh 0 0
284 Tabung Serum dg gel (tutup kuni bh 0 0
285 Tabung glukosa ( tutup abu-abu) bh 0 0
286 Tincture pidofilin 80-90 % btl 0 0
Rapid tes Dengue Nsi Ag 150 150 150 0
Rapid tes Dengue Duo 125 125 125 0

BAHAN HABIS PAKAI 0 0


287 Abocat 18 ( Iv Catheter 18 ) bh 0 0
288 Abocat 20 ( Iv Catheter 20 ) bh 0 0
289 Abocat 22 ( Iv Catheter 22 ) bh 0 0
290 Abocat 24 ( Iv Catheter 24 ) bh 0 0
291 Aqua pro injeksi vial 0 0
292 Alat suntik 0,5 cc bh 0 0
293 Alat suntik 0,05 cc bh 0 0
294 Alat suntik 1 cc bh 0 0
295 Alat suntik 3 cc box 0 0
296 Alat suntik 5 cc bh 0 0
297 Alat suntik 10 cc bh 0 0
298 Benang bedah / Cat gut -3/0 zak 0 0
299 Benang bedah sutra / Silk -3/0 zak 0 0
300 Benang ethicon / Prolene 5/0 zak 0 0
301 Etanol 70 % Btl 0 0
302 Ethanol 70 % 100 ml btl 10 10 10 0
303 Etil Klorida semprot btl 0 0
304 Film X ray 24x 30 box 0 0
305 Film X ray 40x 30 box 0 0
306 Film X ray 35 x 35 box 0 0
307 Foley catheter bh 0 0
308 Hand scund S / M bok 10 10 10 0
309 Infusion set anak Set 0 0
310 Infusion set dewasa Set 0 0
311 Jarum Heating otot 1/2 lingkaran Biji 0 0
312 Jarum Heating otot 12,13.14 Biji 0 0
313 Jarum Heating kulit 12,13.14 Biji 0 0
314 Jelly unt doppler ( Doppler Jell 0 btl 0 0
315 Kapas Alkohol /Alkohol sweeb box 5 5 5 0
316 Kapas pembalut 250 mg roll 2 2 2 0
317 Kasa pembalut 40 x 40 steril roll 0 0
318 Kasa pembalut 2 x 80 cm roll 0 0
319 Kasa pmbalt hidrfil 4m x 15 cm roll 0 0
320 Kasa pembalut 4 m x 3 cm roll 0 0
321 Kasa hidrofil 16/16 steril box 0 0
322 kassa gulungan 40 yard x 80 cm roll 0 0
323 Kertas Puyer SCI Lbr 0 0
324 Kondum gros 0 0
325 Klip Obat K pak 0 0
326 Klip Obat B Lbr 0 0
SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE
NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
327 Klip Obat T pak 0 0
328 Lisol Btl 0 0
329 Masker tali karet / tali biasa box 3 3 3 0
330 masker N 95 bh 0 0
331 Nurse cup (Disposible head cup ) box 0 0
332 Oksigen gas dalam tabung Tabung 0 0
333 Oksigen kalengan klg 0 0
334 Pembalut Ibu Bersalin buah 0 0
335 Perhidrol / H2O2 Btl 0 0
336 Plester 5 yards x 2 inch roll 1 1 1 0
337 Plester Ultravix 5 cm x 5 mm bh 0 0
338 Pisau Bedah no 10, 11 ,12 pcs 0 0
339 Reagen Developer box 0 0
340 Reagen Fixer box 0 0
341 Sopratul box 3 3 3 0
342 Sarung tangan Obgyn pcs 50 50 50 0
343 safety box bh 0 0
344 Tranfusi set bh 0 0
345 Tensocrip roll 0 0
346 Urine Bag buah 0 0
347 Umbilikor / klem tali pusat buah 0 0
348 Underpad box 0 0
349 wing Needle 25 G buah 0 0
350 Yodium povidon larutan 10 % 30 Btl 1 1 1 0
351 Yodium povidon larutan 10% 30m Btl 0 0 0 0

JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR PHB
258 48 460 766

Mengetahui / menyetujui Yang Menyerahkan Yang Meminta/Pelapor


Pimpinan Puskesmas Mengwi III Petugas Gudang Puskesmas Petugas Apotek

(dr.Komang Widia Asmawan,S.Ked) (Kd.Suryaning Ayu) ( Ni Made Widhiastuti, S.Farm.,apt )


NIP : 19791202 200501 1 010 NIP.19820708 200604 2016 Nip.19840211 201001 2 025
SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE
NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
TGL

KET
KET

..
KET
KET
KET
KET
KET

OBAT JKN
352 Ambroxol syr Btl
353 Ambroxol tab tab
354 Antalgin ( metampiron ) Tab
355 Antasid syr btl
356 Anti hemmoroid supp supp
357 Asam Folat Tab
358 Attapulgite / New Diatab Tab
359 Betahistin tab Tab
360 Dexamethason inj 5 mg/ml-1 m Amp
361 Epineprin hcl ( adrenalina ) inj 0.1%-1Amp
ml
362 Fitominadion ( vit k1) inj 10 mg/ml-1mlAmp
363 Fitominadion (Vit K) inj 2 mg Amp
364 Gentamisin sulfat TM 0,3 % Btl
365 Gliseril guaiakolat tab 100 mg Tab
366 Glukosa larutan infus 10 % steri Btl
367 Glukosa larutan infus 5 % steril Btl
368 Hidroklorotiazida (hct) tab 25 Tab
369 Hidrokortison krim 1 % Tube
370 Kalsium laktat ( kalk ) tab 500 Tab
371 Ketorolac inj 30 mg Amp
372 Kloramphenikol Tetes Mata Btl
373 Meloksikam 7,5 mg Tab
374 Multivitamin tab/Nutrifar tab
375 Obat Batuk Hitam Btl
376 Oksitetrasiklin hc salep 3 % Tube
377 Oksitetrasiklin hcl salep mata Tube
378 Papverin tab Tab
379 Ranitidin inj 25 mg/2 ml Vial
380 Ringer laktat lrt inf steril ( RL ) Btl
381 Sefadroxyl 500 mg tab
382 Sinvastatin tab tab
KET

383 Vitamin Neurotrofic /Siobion tab


BHP JKN
384 Bonding Btl
385 Bur Gigi ( Longseng Bur ) bh
386 Bur Gigi ( Fisure Bur ) bh
387 Bur Gigi (Round Bur ) bh
388 Bur Gigi ( Inverted Bur ) bh
389 Brush bh
390 Biostun bh
391 Cresopat Btl
392 CHKM (Sterilisasi Akar) Btl
393 Devitalisasi pasta Btl
394 Etsa Btl
395 Elite cemen Btl
396 Fuji /Glas Ionomer / ketak mol Btl
397 Hydeal bh
398 Polibib / lap dada Box
399 Rocle (Sterilisasi Akar) Btl
400 Ruber Cup Btl
401 Silicon ruber Btl
402 Selifa ejector bh
403 Tumpatan sementara ( Cavit) Btl
404 Tumpatan permanen / Compos Btl
405 Tip Scaler gold Btl
406 Stik asam urat bh
407 Stik Kolesterol bh
408 Stik Gula darah bh
409 Stik HB Family DR stik
410 Reagen golongan Darah A,B paket
411 Aqua pro injeksi vial
412 Benang bedah / Cat gut -3/0 zak
413 Benang ethicon / Prolene 5/0 zak
414 Hand scund S / M psg
415 Jarum Heating otot 1/2 lingkaran Biji
416 Jarum Heating otot 12,13.14 Biji
417 Jarum Heating kulit 12,13.14 Biji
418 Jelly unt doppler ( Doppler Jell 0 btl
419 Masker tali karet / tali biasa bh
420 Tranfusi set bh
421 Yodium povidon larutan 10 %3 Btl
422 Methadon liquid 10 mg/ ml ml
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
SUB - UNIT PELAYANAN
SUB UNIT : AMBULAN KBS
UPT PUSKESMAS : MENGWI III DOKUMEN NO TGL
KECAMATAN : MENGWI PELAPORAN BULAN : Mei 2017 PUSKESMAS
KABUPATEN : BADUNG PERMINTAAN BULAN : Juni 2017 sub unit

SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE KET


NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
1 Acyclovir 400 mg Tab 0 0 0 0
2 Acyclovir salep kulit 5 % tube 0 0 0 0
3 Albendazol 400 mg Tab 0 0 0 0
4 Alopurinol 100 mg Tab 0 0 0 0
5 Ambroxol syr 5 mg / 5 ml Btl 0 0 0 0 0
6 Ambroxol tab 30 mg tab 0 0 0 0 0
7 Aminofilina tablet 200 mg Tab 0 0
8 Amlodipin 5 mg Tab 0 0 0 0
9 Amoxsisilina kap 500 mg Tab 0 0 0 0 0
10 Amoxsisilina kap 250 mg Kap 0 0
11 Amoxsisilina sirup kering 125 Btl 0 0 0 0 0
12 Amoxsisilina drop 100 mg/ml Btl 0 0 0 0
As.Salicylsat 2% + Belerang 4 % (2-4)
13 salep pot 0 0
14 Astaxanthin 4 mg Tab 0 0 0 0
15 Antalgin ( metampiron ) Tab 0 0
16 Alletrol Tetes Mata btl 0 0
17 Antasid syr btl 0 0 0 0 0
18 Antasida doen tablet, Tab 0 0 100 0 100
19 Anti hemmoroid supp supp 0 0 0 0 0
20 Antimigren ( Ergotamin ,caffein ) tab 0 0 0 0
21 Antiscabies / gamexan salp Tube 0 0
22 Asam Ascorbat ( vit c ) tab 50 m Tab 0 0 0 0 0
23 Asam Folat 400 mcg Tab 0 0 0
24 As. Mefenamat 500 mg Tab 0 0 0 0 0
25 Acetosal 100 mg Tab 0 0
26 Attapulgite active 600 mg Tab 0 0
27 Azetromicyn tab 500 mg Tab 0 0
28 Bacitracin - Poly SK Tube 0 0 0 0
29 Benzatin Bensil Penisillin inj vial 0 0
30 Besi II sulfat ( tablet tambah darah Tab 0 0 0
31 Betahistin tab 6 mg Tab 0 0 0 0
32 Betamethason krim 0,1 % Tube 0 0 0 0 0 0
33 Bisacodyl supp 10 mg sup 0 0
34 Borax Glycerin 5 % Btl 0 0
35 Balsem kaki 3 Btl 0 0
36 Captopril 12,5 mg Tab 0 0
37 Captopril 25 mg Tab 0 0 0 0 0 0
38 Ceterizine 10 mg tab 0 0
39 Counterpaint cr tube 0 0
40 Clobazam 40 mg Tab 0 0
41 Clorpromazina hcl tab ( CPZ ) 100 mg Tab 0 0
42 Clorpromazin HCl tab ( CPZ) 25 mg Tab 0 0
43 Dexamethason inj 5 mg/ml-1 ml Amp 0 0 0 0
44 Dexamethason 0,5 mg Tab 0 0 0 0 0 0
45 Desoksimetason tube 0 0
46 Dextrose 40 % steril Btl 0 0
47 Diazepam 2 mg Tab 0 0 0 0
48 Diazepam inj 5mg/ml Ampul 0 0
49 Diazepam rectal 5 mg/2,5 ml Tube 0 0
50 Diphenhidramin hcl inj 10 mg/1 m Amp 0 0 0 0
51 Digoxin tab 0.25 mg Tab 0 0
52 Doxysyclin 100 mg tab 0 0
53 Domperidon drop btl 0 0
54 Domperidon syr 5 mg / 5 ml btl 0 0
55 Efedrin hcl tab 25 mg Tab 0 0
56 Epineprin hcl ( adrenalina ) inj 0.1%-1 mlAmp 0 0 0 0
57 Erytromicin 500 mg Tab 0 0
58 Erytromicin syr 200mg/5ml Btl 0 0
59 Furossemid tab 40 mg Tab 0 0
60 Fluconazole 150 mg tab 0 0
61 Fitominadion (Vit K) inj 2 mg/1ml Amp 0 0
62 Fenobarbital tab 30 mg Tab 0 0
63 Fenol gliseron Tts Telinga Btl 0 0
64 Fitominadion ( vit k1) inj 10 mg/ml-1mlAmp 0 0
65 Fitominadion ( vit k1) tab salut 10 Tab 0 0
66 Garam Oralit 200 ml air Sach 0 0 0 0 0 0
67 Gentamisin sulfat TM 0,3 % Btl 0 0 0
68 Gentamicin salep kulit Tube 0 0
69 Gentian Violet larutan 1 % Btl 0 0
70 Glibenklamid tab 5 mg Tab 0 0 0 0 0
71 Glimepiride 1mg tab 0 0
72 Glimepiride 2 mg tab 0 0
73 Gliseril guaiakolat tab 100 mg Tab 0 0
74 Glukosa larutan infus 10 % steril Btl 0 0
75 Glukosa larutan infus 5 % steril Btl 0 0
76 Griseofulvin tab 125 mg Tab 0 0
77 Haloperidol 0,5 mg Tab 0 0
78 Haloperidol 1,5 mg Tab 0 0
79 Haloperidol tablet 5 mg Tab 0 0
80 Hidroklorotiazida (hct) tab 25 mg Tab 0 0
81 Hidrokortison krim 2.5 % Tube 0 0 0 0 0
82 Hyocine-N-butilbr / Scopma tab 1 Tab 0 0
83 Hyoscine-N-B Inj /Buscopan inj 20 Amp 0 0
84 Ibuprofen tab 200 mg Tab 0 0 0 0
85 Ibuprofen tab 400 mg Tab 0 0 0 0 0
86 Ibuprofen Syr Btl 0 0
87 Isosorbid dinitrat 5 mg tab 0 0
88 IZONIASIDA ( INH) 100 MG Tab 0 0
89 Kalium permanganat (PK) Pot 0 0
90 Kalium Diklopenak 50 mg tab 0 0
91 Kalsium laktat ( kalk ) tab 500 mg Tab 0 0
92 Kalsium Glukonas10 % inj Vial 0 0 0
93 Ketokenazol krim 2 % tube 0 0 0 0 ..
94 Ketokenazol tab 200 mg tab 0 0 0 0
95 Ketorolac inj 30 mg Amp 0 0
96 Klindamicin 150 mg tab 0 0
97 Klindamisin 300 mg Tab 0 0
98 Karbamazepin tablet 200 mg Tab 0 0
99 Kloramfenicol salp mata 1 % tube 0 0 0 0
100 Kloramphenikol Tetes Mata 0,5 % Btl 0 0
101 Kloramfenikol tts Telinga 3 % Btl 0 0 0 0 0
102 Klorfeniramini maleat (ctm) tab 4 Tab 0 0 0 0 0
103 Kotrimoksazol kombinasi 480 mg Tab 0 0 0 0 0
104 Kotrimoksazol suspensi Btl 0 0 0 0 0
105 KB Suntik 1 bln Vial 0 0
106 KB IUD bh 0 0
107 KB PIL stp 0 0
108 KB SUSUK / inflan infl 0 0
109 Lidokain inj 2 % Amp 0 0 0 0 0
110 Lidokain com inj 2% Amp 0 0 0 0
111 Loveramid tab 2 mg tab 0 0 0 0 0
112 Loratadin tab10 mg tab 0 0 0 0
113 Mg SO4 40 % ( 25 ml ) Vial 0 0 0
114 MgSO4 injeksi 20% Vial 0 0
115 Meloksikam 7,5 mg Tab 0 0 0 0
116 Meloksikam 15 mg Tab 0 0
117 Metformin tab 500 mg Tab 0 0 0 0
118 Metil ergometrina maleat inj 0.200 mg/ml- Amp 0 0
119 Metil ergometrina maleat tab salut 0.125 tab 0 0
120 Methyl Prednisolon 4 mg tab 0 0 0 0 0
121 Metoklopramid Hcl 5 mg tab 0 0
122 Metoklopramid Hcl syr 5 mg/5ml btl 0 0 0
123 Metoklopramid inj 5mg/2ml Amp 0 0
124 Metronidazol 500 mg Tab 0 0 0 0
125 Metronidazol supp ( flagyl ) 0.5 gr sup 0 0
126 Miconazol crm 2 % tube 0 0 0 0
127 MDT Combi ( obat kusta ) paket 0 0
128 Multivitamin syr / Procuma btl 0 0 0 0 0
129 Multivitamin tab(vitacaps) tab 0 0 0 0
130 Narium Tiroksin tab 0 0
131 Natrium klorida larutan infus 0.9 % sterilBtl 0 1 0 1
132 Na Diklopenac 25 mg tab 0 0
133 Na Diklofenac 50 mg Tab 0 0 0 0 0
134 Nipedipin tab 0 0
135 Nistatin 100.000 Iu/g/tab vaginal tab 0 0 0
136 NB Salp Tube 0 0
137 Obat Batuk Hitam Btl 0 0
138 Obat batuk kering/dextrofen btl 0 0 0 0
139 Obat Flu sirup/erpaflu btl 0 0 0 0
140 Obat Flu tablet/coparcetin Tab 0 0 0 0
141 Oksitetrasiklin hc salep 3 % Tube 0 0
142 Oksitetrasiklin hcl salep mata 1 % Tube 0 0
143 Oksitosin inj 10 iU ( 1 ml ) Amp 0 0 0 0
144 Omeprazol 20 mg Tab 0 0 0 0
145 Osedantron inj Amp 0 0
146 Osedantron tab 8 mg Tab 0 0
147 Oseltamivir 75 mg Tab 0 0
148 Papverin tab Tab 0 0
149 Parasetamol sirup 120 mg/ 5 ml Btl 0 0 5 0 5
150 Parasetamol tab 500 mg Tab 0 0 100 0 100
151 Paracetamol drop 100 mg/ ml Btl 0 0 0 0
152 Paracetamol rectal 125 mg Tube 0 5 5
153 Perak sulfadiazin 1 % / Burnazin cr Tube 0 0
154 Pyrantel syr btl 0 0
155 Piridoxin hcl (vit b6) tab 10 mg Tab 0 0 0 0
156 Piroxicam 20 mg cap 0 0 0
157 Piroxicam 10 mg cap 0 0
158 Polycresulen / Albothyl/ Aptil Btl 0 0 0 0
159 Prednison tab 5 mg Tab 0 0 0 0 0
160 Ranitidin 150 mg Tab 0 0 0
161 Ranitidin inj 25 mg/2 ml Vial 0 0
162 Retinol ( vit A ) kaps lunak 100.000 Kap 0 0
163 Retinol ( vit A ) kaps lunak 200.000 Kap 0 0
164 Ringer laktat lrt inf steril ( RL ) Btl 0 0 1 0 1
165 Resperidon 2 tab tab 0 0
166 salbutamol 4 mg tab 0 0 0 0
167 salbutamol 2 mg tab 0 0 0 0
168 salbutamol nebulizer 2.5 mg Amp 0 0 0
169 Salbutamol inhaler btl 0 0
170 Salisil bedak 2 % Sak 0 0 0 0 0
171 Sefadroxyl 500 mg tab 0 0
172 Sefadroxyl syr kering 250 mg/5ml btl 0 0
173 Sefiksim 100 mg tab 0 0
174 Serum Anti Bisa Ular ( ABU ) vial 0 0
175 Serum anti tetanus(tetagam) 250 I Amp 0 0 0 0
176 Sianokobalamina (vit B12 ) inj Amp 0 0
177 Simetidin 200 mg Tab 0 0
178 Sinvastatin tab 10 mg tab 0 0
179 Siproploxacin 500 mg Tab 0 0 0 0 0
180 Sucralfate 500 mg /Mucogard tab Tab 0 0
181 Sucralfat suspensi ( Mucogard susp btl 0 0
182 Sulfasetamid Tetes mata 15 % Btl 0 0
183 Salep perawatan luka (bioplacentotube 0 0 0 0
184 Tetrasiklina hcl kapsul 500 mg Kap 0 0
185 Triflouperazin ( Stelazin ) 5 mg Tab 0 0
186 Thiamin hcl inj 100 mg/ml - 1 ml Amp 0 0
187 Thiamin hcl ( vit B1)tab 50 mg Tab 0 0 0 0 0
188 Thiamfenicol 500 mg Tab 0 0
189 Trihexipenidil 2 mg Tab 0 0
190 Vitamin B complek tab Tab 0 0 0 0 0
191 Vit Neurotrofic tablet 5000 mg (soho tab 0 0 0 0
192 Vit Neurotrofic inj 5000 mg Amp 0 0
193 Vitamin imunitas (Imunogard ) tab 0 0 0 0
194 Zink tab 20 mg Tab 0 0 0 0 0
195 Zink drop 10 mg/ml btl 0 0
196 Zink syr ( Zirkum ) btl 0 0
Bisacodyl tab tab 0 0 0 0
VAKSIN 0 0
197 HB Uniject vial 0 0
198 BCG vial 0 0
199 CAMPAK vial 0 0
200 POLIO vial 0 0
201 Pentabio vial 0 0
202 DT vial 0 0
203 TT vial 0 0
204 TD vial 0 0
205 IPV vial 0 0
206 VAKSIN Anti Rabies ( VAR ) vial 0 0
OBAT PROGRAM TBC 0 0
207 Anti TBC Anak paket 0 0
208 Anti TBC I / FDC paket 0 0
209 Anti TBC II / FDC paket 0 0
210 kombipak katagori I paket 0 0
OBAT PROGRAM ARV 0 0
211 ALUVIA ( Liponavir 200mg + ritona tab 0 0
212 DUVIRAL( Lamifudin150 mg+zidofudi tab 0 0
213 Efavirenz 600 mg tab 0 0
FDC ( Tenofovir 300mg+lamivudin
214 300 mg + efavirenz 600 mg) tab 0 0
215 Lamivudine ( Hiviral ) 150 mg tab 0 0
216 Nevirapine ( Neviral ) 200 mg tab 0 0
217 Tenofovir Disoproxil Fumarate (TDF) tab 0 0
218 Abacavir tab 0 0
219 Triplepediatrik tab 0 0
GIGI 0 0
220 Bonding Btl 0 0
221 Bur Gigi ( Longseng Bur ) bh 0 0
222 Bur Gigi ( Fisure Bur ) bh 0 0
223 Bur Gigi (Round Bur ) bh 0 0
224 Bur Gigi ( Inverted Bur ) bh 0 0
225 CHKM (Sterilisasi Akar) Btl 0 0
226 Cresopate ( Munifying pasta) Btl 0 0
227 Devitalisasi pasta (non arsen ) Btl 0 0
228 Eugenol cairan Btl 0 0
229 Endomethason N ( Munifying pasta Btl 0 0
230 Etsa Btl 0 0
231 Fuji /Glas Ionomer / ketak molar Btl 0 0
232 Iodoform pasta / calplus syringe 0 0
233 Semen seng fosf. Serbuk & cairan Btl 0 0
234 Rocle (Sterilisasi Akar) Btl 0 0
235 Tumpatan sementara ( Cavit) Btl 0 0
236 Tumpatan permanen / Composit Btl 0 0
237 Temporary stopping Fletcher Btl 0 0
238 TKF (Sterilisasi Akar) Btl 0 0
239 Tumpatan permanen / Composit Btl 0 0
240 Tincture pidofilin 80-90 % Btl 0 0
LABORATORIUM 0 0
241 Asam acetat 100 ml Btl 0 0
242 Cover glass bh 0 0
243 Control N 2,5 ml bh 0 0
244 Eosin Btl 0 0
245 Giemza Btl 0 0
246 Jarum stik gula / Blood lounchet bh 0 0
247 Jarum Vacumtainer ( needle 22 G bh 0 0
248 Jarum CD 4 bh 0 0
249 Kaca Slide /slide forstead box 0 0
250 Kertas lakmus ( Test paper ) pak 0 0
251 KOH 100 ml Btl 0 0
252 Kertas Ph vagina 0.2 box 0 0
253 M emersi btl 0 0
254 Menthanol btl 0 0
255 Methylen blue btl 0 0
256 Natrium klorida btl 500 ml Btl 0 0
257 Pot dahak bh 0 0
258 Pipet Tip Yellow pcs 0 0
259 Plesterin box 0 0
260 Reagen Widal test set 0 0
261 Reagen gol darah A & B Btl 0 0
262 Reagen ZN / BTA set 0 0
263 Reagen HIV I pcs 0 0
264 Reagen HIV II pcs 0 0
265 Reagen HIV III pcs 0 0
266 Reagen kimia darah pcs 0 0
267 RPR set 0 0
268 Reagen CD4 set 0 0
269 Reagen Erma set 0 0
270 Reagen Control mynthic set 0 0
271 Reagen SFR I set 0 0
272 Stik asam urat bh 0 0
273 Stik Kolesterol bh 0 0
274 Stik Gula darah bh 0 0
275 Stik urine 11( Pemriksaan urine lengkap ) bh 0 0
276 Stik Rapid test untuk sipilis stik 0 0
277 Stik test kehamilan /PP. test stik 0 0
278 SD Bioline Sphylis ( TPHA) set 0 0
279 Tissue kaca slide/ tisu lensa box 0 0
280 Thermal peper 30 mtr roll 0 0
281 Tabung reaksi 3 ml disposible box 0 0
282 Tabung vacum tutup ungu ( EDTA ) bh 0 0
283 Tabung serum( tutup merah) bh 0 0
284 Tabung Serum dg gel (tutup kunin bh 0 0
285 Tabung glukosa ( tutup abu-abu) bh 0 0
286 Tincture pidofilin 80-90 % btl 0 0
Rapid tes Dengue Nsi Ag 0 0 0 0
Rapid tes Dengue Duo 0 0 0 0

BAHAN HABIS PAKAI 0 0


287 Abocat 18 ( Iv Catheter 18 ) bh 0 0
288 Abocat 20 ( Iv Catheter 20 ) bh 0 0
289 Abocat 22 ( Iv Catheter 22 ) bh 0 0
290 Abocat 24 ( Iv Catheter 24 ) bh 0 0
291 Aqua pro injeksi vial 0 0
292 Alat suntik 0,5 cc bh 0 0
293 Alat suntik 0,05 cc bh 0 0
294 Alat suntik 1 cc bh 0 0
295 Alat suntik 3 cc box 0 0
296 Alat suntik 5 cc bh 0 0
297 Alat suntik 10 cc bh 0 0
298 Benang bedah / Cat gut -3/0 zak 0 0
299 Benang bedah sutra / Silk -3/0 zak 0 0
300 Benang ethicon / Prolene 5/0 zak 0 0
301 Etanol 70 % Btl 0 0
302 Ethanol 70 % 100 ml btl 0 0 1 0 1
303 Etil Klorida semprot btl 0 0 0 0
304 Film X ray 24x 30 box 0 0
305 Film X ray 40x 30 box 0 0
306 Film X ray 35 x 35 box 0 0
307 Foley catheter bh 0 0
308 Hand scund S / M bok 0 0 1 0 1
309 Infusion set anak Set 0 1 1
310 Infusion set dewasa Set 0 0
311 Jarum Heating otot 1/2 lingkaran Biji 0 0
312 Jarum Heating otot 12,13.14 Biji 0 0
313 Jarum Heating kulit 12,13.14 Biji 0 0
314 Jelly unt doppler ( Doppler Jell 0 btl 0 0
315 Kapas Alkohol /Alkohol sweeb box 0 0 0 0
316 Kapas pembalut 250 mg roll 0 0 0 0
317 Kasa pembalut 40 x 40 steril roll 0 0
318 Kasa pembalut 2 x 80 cm roll 0 0
319 Kasa pmbalt hidrfil 4m x 15 cm roll 0 5 5
320 Kasa pembalut 4 m x 3 cm roll 0 12 12
321 Kasa hidrofil 16/16 steril box 0 0
322 kassa gulungan 40 yard x 80 cm roll 0 0
323 Kertas Puyer SCI Lbr 0 0
324 Kondum gros 0 0
325 Klip Obat K pak 0 0
326 Klip Obat B Lbr 0 0
327 Klip Obat T pak 0 0
328 Lisol Btl 0 0
329 Masker tali karet / tali biasa box 0 1 0 1
330 masker N 95 bh 0 0
331 Nurse cup (Disposible head cup ) box 0 0
332 Oksigen gas dalam tabung Tabung 0 0
333 Oksigen kalengan klg 0 0
334 Pembalut Ibu Bersalin buah 0 0
335 Perhidrol / H2O2 Btl 0 0
336 Plester 5 yards x 2 inch roll 0 0 0 0 0
337 Plester Ultravix 5 cm x 5 mm bh 0 0 5 5
338 Pisau Bedah no 10, 11 ,12 pcs 0 0
339 Reagen Developer box 0 0
340 Reagen Fixer box 0 0
341 Sopratul box 0 0 1 0 1
342 Sarung tangan Obgyn pcs 0 0 0 0
343 safety box bh 0 0
344 Tranfusi set bh 0 0
345 Tensocrip roll 0 0
346 Urine Bag buah 0 0
347 Umbilikor / klem tali pusat buah 0 0
348 Underpad box 0 0
349 wing Needle 25 G buah 0 0
350 Yodium povidon larutan 10 % 300 Btl 0 0 0 0
351 Yodium povidon larutan 10% 30ml Btl 0 0 0 0

JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR PHB
0 0 0 0

Mengetahui / menyetujui Yang Menyerahkan Yang Meminta/Pelapor


Pimpinan Puskesmas Mengwi III Petugas Gudang Puskesmas Petugas Ambulan KBS

(dr.Komang Widia Asmawan,S.Ked) (Kd.Suryaning Ayu) ( I Putu Agus Sutresna)


NIP : 19791202 200501 1 010 NIP.19820708 200604 2016
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
SUB - UNIT PELAYANAN
SUB UNIT : P3K
UPT PUSKESMAS : MENGWI III DOKUMENNO TGL
KECAMATAN : MENGWI PELAPORAN BULAN : Januari 2017 PUSKESMAS
KABUPATEN : BADUNG PERMINTAAN BULAN : Pebruari 2017 sub unit

SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE KET


NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
1 Acyclovir 400 mg Tab 0 0 0 0
2 Acyclovir salep kulit 5 % tube 0 0 0 0
3 Albendazol 400 mg Tab 0 0 0 0
4 Alopurinol 100 mg Tab 0 0 0 0
5 Ambroxol syr 5 mg / 5 ml Btl 0 0 0 0 0
6 Ambroxol tab 30 mg tab 78 0 78 18 60
7 Aminofilina tablet 200 mg Tab 0 0
8 Amlodipin 5 mg Tab 0 0 0 0
9 Amoxsisilina kap 500 mg Tab 0 0 0 0 0
10 Amoxsisilina kap 250 mg Kap 0 0
11 Amoxsisilina sirup kering 125 m Btl 0 0 0 0 0
12 Amoxsisilina drop 100 mg/ml Btl 0 0 0 0
As.Salicylsat 2% + Belerang 4 % (2-4) salep
13 pot 0 0
14 Astaxanthin 4 mg Tab 0 0 0 0
15 Antalgin ( metampiron ) Tab 0 0
16 Alletrol Tetes Mata btl 0 0
17 Antasid syr btl 0 0 0 0 0
18 Antasida doen tablet, Tab 19 0 19 5 14
19 Anti hemmoroid supp supp 0 0 0 0 0
20 Antimigren ( Ergotamin ,caffein ) tab 0 0 0 0
21 Antiscabies / gamexan salp Tube 0 0
22 Asam Ascorbat ( vit c ) tab 50 mg Tab 0 0 0 0 0
23 Asam Folat 400 mcg Tab 0 0 0
24 As. Mefenamat 500 mg Tab 60 0 60 2 58
25 Acetosal 100 mg Tab 0 0
26 Attapulgite active 600 mg Tab 0 0
27 Azetromicyn tab 500 mg Tab 0 0
28 Bacitracin - Poly SK Tube 0 0 0 0
29 Benzatin Bensil Penisillin inj vial 0 0
30 Besi II sulfat ( tablet tambah darah ) Tab 0 0 0
31 Betahistin tab 6 mg Tab 0 0 0 0
32 Betamethason krim 0,1 % Tube 0 0 0 0 0 0
33 Bisacodyl supp 10 mg sup 0 0
34 Borax Glycerin 5 % Btl 0 0
35 Balsem kaki 3 Btl 0 0
36 Captopril 12,5 mg Tab 0 0
37 Captopril 25 mg Tab 0 0 0 0 0 0
38 Ceterizine 10 mg tab 0 0
39 Counterpaint cr tube 0 0
40 Clobazam 40 mg Tab 0 0
41 Clorpromazina hcl tab ( CPZ ) 100 mg Tab 0 0
42 Clorpromazin HCl tab ( CPZ) 25 mg Tab 0 0
43 Dexamethason inj 5 mg/ml-1 ml Amp 4 4 4 0
44 Dexamethason 0,5 mg Tab 0 0 0 0 0 0
45 Desoksimetason tube 0 0
46 Dextrose 40 % steril Btl 0 0
47 Diazepam 2 mg Tab 0 0 0 0
48 Diazepam inj 5mg/ml Ampul 0 0
49 Diazepam rectal 5 mg/2,5 ml Tube 0 0
50 Diphenhidramin hcl inj 10 mg/1 ml Amp 0 0 0 0
51 Digoxin tab 0.25 mg Tab 0 0
52 Doxysyclin 100 mg tab 0 0
53 Domperidon drop btl 0 0
54 Domperidon syr 5 mg / 5 ml btl 0 0
55 Efedrin hcl tab 25 mg Tab 0 0
56 Epineprin hcl ( adrenalina ) inj 0.1%-1 ml Amp 2 2 2 0
57 Erytromicin 500 mg Tab 0 0
58 Erytromicin syr 200mg/5ml Btl 0 0
59 Furossemid tab 40 mg Tab 0 0
60 Fluconazole 150 mg tab 0 0
61 Fitominadion (Vit K) inj 2 mg/1ml Amp 0 0
62 Fenobarbital tab 30 mg Tab 0 0
63 Fenol gliseron Tts Telinga Btl 0 0
64 Fitominadion ( vit k1) inj 10 mg/ml-1ml
Amp 0 0
65 Fitominadion ( vit k1) tab salut 10 Tab 0 0
66 Garam Oralit 200 ml air Sach 0 0 0 0 0 0
67 Gentamisin sulfat TM 0,3 % Btl 0 0 0
68 Gentamicin salep kulit Tube 0 0
69 Gentian Violet larutan 1 % Btl 0 0
70 Glibenklamid tab 5 mg Tab 0 0 0 0 0
71 Glimepiride 1mg tab 0 0
72 Glimepiride 2 mg tab 0 0
73 Gliseril guaiakolat tab 100 mg Tab 0 0
74 Glukosa larutan infus 10 % steril Btl 0 0
75 Glukosa larutan infus 5 % steril Btl 0 0
76 Griseofulvin tab 125 mg Tab 0 0
77 Haloperidol 0,5 mg Tab 0 0
78 Haloperidol 1,5 mg Tab 0 0
79 Haloperidol tablet 5 mg Tab 0 0
80 Hidroklorotiazida (hct) tab 25 mg Tab 0 0
81 Hidrokortison krim 2.5 % Tube 0 0 0 0 0
82 Hyocine-N-butilbr / Scopma tab 10 Tab 0 0
83 Hyoscine-N-B Inj /Buscopan inj 20mg Amp 0 0
84 Ibuprofen tab 200 mg Tab 0 0 0 0
85 Ibuprofen tab 400 mg Tab 0 0 0 0 0
86 Ibuprofen Syr Btl 0 0
87 Isosorbid dinitrat 5 mg tab 0 0
88 IZONIASIDA ( INH) 100 MG Tab 0 0
89 Kalium permanganat (PK) Pot 0 0
90 Kalium Diklopenak 50 mg tab 0 0
91 Kalsium laktat ( kalk ) tab 500 mg Tab 0 0
92 Kalsium Glukonas10 % inj Vial 0 0 0
93 Ketokenazol krim 2 % tube 0 0 0 0 ..
94 Ketokenazol tab 200 mg tab 0 0 0 0
95 Ketorolac inj 30 mg Amp 0 0
96 Klindamicin 150 mg tab 0 0
97 Klindamisin 300 mg Tab 0 0
98 Karbamazepin tablet 200 mg Tab 0 0
99 Kloramfenicol salp mata 1 % tube 0 0 0 0
100 Kloramphenikol Tetes Mata 0,5 % Btl 0 0
101 Kloramfenikol tts Telinga 3 % Btl 0 0 0 0 0
102 Klorfeniramini maleat (ctm) tab 4 m Tab 0 0 0 0 0
103 Kotrimoksazol kombinasi 480 mg Tab 0 0 0 0 0
104 Kotrimoksazol suspensi Btl 0 0 0 0 0
105 KB Suntik 1 bln Vial 0 0
106 KB IUD bh 0 0
107 KB PIL stp 0 0
108 KB SUSUK / inflan infl 0 0
109 Lidokain inj 2 % Amp 0 0 0 0 0
110 Lidokain com inj 2% Amp 0 0 0 0
111 Loveramid tab 2 mg tab 0 0 0 0 0
112 Loratadin tab10 mg tab 0 0 0 0
113 Mg SO4 40 % ( 25 ml ) Vial 0 0 0
114 MgSO4 injeksi 20% Vial 0 0
115 Meloksikam 7,5 mg Tab 0 0 0 0
116 Meloksikam 15 mg Tab 0 0
117 Metformin tab 500 mg Tab 0 0 0 0
118 Metil ergometrina maleat inj 0.200 mg/ml-1m Amp 0 0
119 Metil ergometrina maleat tab salut 0.125 mg tab 0 0
120 Methyl Prednisolon 4 mg tab 0 0 0 0 0
121 Metoklopramid Hcl 5 mg tab 0 0
122 Metoklopramid Hcl syr 5 mg/5ml btl 0 0 0
123 Metoklopramid inj 5mg/2ml Amp 0 0
124 Metronidazol 500 mg Tab 0 0 0 0
125 Metronidazol supp ( flagyl ) 0.5 gr sup 0 0
126 Miconazol crm 2 % tube 0 0 0 0
127 MDT Combi ( obat kusta ) paket 0 0
128 Multivitamin syr / Procuma btl 0 0 0 0 0
129 Multivitamin tab(vitacaps) tab 0 0 0 0
130 Narium Tiroksin tab 0 0
131 Natrium klorida larutan infus 0.9 % steril Btl 0 0 0 0
132 Na Diklopenac 25 mg tab 0 0
133 Na Diklofenac 50 mg Tab 0 0 0 0 0
134 Nipedipin tab 0 0
135 Nistatin 100.000 Iu/g/tab vaginal tab 0 0 0
136 NB Salp Tube 0 0
137 Obat Batuk Hitam Btl 0 0
138 Obat batuk kering/dextrofen btl 0 0 0 0
139 Obat Flu sirup/erpaflu btl 0 0 0 0
140 Obat Flu tablet/coparcetin Tab 0 0 0 0
141 Oksitetrasiklin hc salep 3 % Tube 0 0
142 Oksitetrasiklin hcl salep mata 1 % Tube 0 0
143 Oksitosin inj 10 iU ( 1 ml ) Amp 0 0 0 0
144 Omeprazol 20 mg Tab 0 0 0 0
145 Osedantron inj Amp 0 0
146 Osedantron tab 8 mg Tab 0 0
147 Oseltamivir 75 mg Tab 0 0
148 Papverin tab Tab 0 0
149 Parasetamol sirup 120 mg/ 5 ml Btl 0 0 0 0 0
150 Parasetamol tab 500 mg Tab 63 0 63 3 60
151 Paracetamol drop 100 mg/ ml Btl 0 0 0 0
152 Paracetamol rectal 125 mg Tube 0 0 0
153 Perak sulfadiazin 1 % / Burnazin cr Tube 0 0
154 Pyrantel syr btl 0 0
155 Piridoxin hcl (vit b6) tab 10 mg Tab 0 0 0 0
156 Piroxicam 20 mg cap 0 0 0
157 Piroxicam 10 mg cap 0 0
158 Polycresulen / Albothyl/ Aptil Btl 0 0 0 0
159 Prednison tab 5 mg Tab 0 0 0 0 0
160 Ranitidin 150 mg Tab 0 0 0
161 Ranitidin inj 25 mg/2 ml Vial 0 0
162 Retinol ( vit A ) kaps lunak 100.000 Kap 0 0
163 Retinol ( vit A ) kaps lunak 200.000 Kap 0 0
164 Ringer laktat lrt inf steril ( RL ) Btl 2 0 2 0 2
165 Resperidon 2 tab tab 0 0
166 salbutamol 4 mg tab 0 0 0 0
167 salbutamol 2 mg tab 0 0 0 0
168 salbutamol nebulizer 2.5 mg Amp 0 0 0
169 Salbutamol inhaler btl 0 0
170 Salisil bedak 2 % Sak 0 0 0 0 0
171 Sefadroxyl 500 mg tab 0 0
172 Sefadroxyl syr kering 250 mg/5ml btl 0 0
173 Sefiksim 100 mg tab 0 0
174 Serum Anti Bisa Ular ( ABU ) vial 0 0
175 Serum anti tetanus(tetagam) 250 IU Amp 0 0 0 0
176 Sianokobalamina (vit B12 ) inj Amp 0 0
177 Simetidin 200 mg Tab 0 0
178 Sinvastatin tab 10 mg tab 0 0
179 Siproploxacin 500 mg Tab 0 0 0 0 0
180 Sucralfate 500 mg /Mucogard tab Tab 0 0
181 Sucralfat suspensi ( Mucogard susp btl 0 0
182 Sulfasetamid Tetes mata 15 % Btl 0 0
183 Salep perawatan luka (bioplacenton tube 0 0 0 0
184 Tetrasiklina hcl kapsul 500 mg Kap 0 0
185 Triflouperazin ( Stelazin ) 5 mg Tab 0 0
186 Thiamin hcl inj 100 mg/ml - 1 ml Amp 0 0
187 Thiamin hcl ( vit B1)tab 50 mg Tab 0 0 0 0 0
188 Thiamfenicol 500 mg Tab 0 0
189 Trihexipenidil 2 mg Tab 0 0
190 Vitamin B complek tab Tab 84 0 84 14 70
191 Vit Neurotrofic tablet 5000 mg (sohob tab 0 0 0 0
192 Vit Neurotrofic inj 5000 mg Amp 0 0
193 Vitamin imunitas (Imunogard ) tab 0 0 0 0
194 Zink tab 20 mg Tab 0 0 0 0 0
195 Zink drop 10 mg/ml btl 0 0
196 Zink syr ( Zirkum ) btl 0 0
Bisacodyl tab tab 0 0 0 0
VAKSIN 0 0
197 HB Uniject vial 0 0
198 BCG vial 0 0
199 CAMPAK vial 0 0
200 POLIO vial 0 0
201 Pentabio vial 0 0
202 DT vial 0 0
203 TT vial 0 0
204 TD vial 0 0
205 IPV vial 0 0
206 VAKSIN Anti Rabies ( VAR ) vial 0 0
OBAT PROGRAM TBC 0 0
207 Anti TBC Anak paket 0 0
208 Anti TBC I / FDC paket 0 0
209 Anti TBC II / FDC paket 0 0
210 kombipak katagori I paket 0 0
OBAT PROGRAM ARV 0 0
211 ALUVIA ( Liponavir 200mg + ritonavi tab 0 0
212 DUVIRAL( Lamifudin150 mg+zidofudin tab 0 0
213 Efavirenz 600 mg tab 0 0
FDC ( Tenofovir 300mg+lamivudin
214 300 mg + efavirenz 600 mg) tab 0 0
215 Lamivudine ( Hiviral ) 150 mg tab 0 0
216 Nevirapine ( Neviral ) 200 mg tab 0 0
217 Tenofovir Disoproxil Fumarate (TDF) 3 tab 0 0
218 Abacavir tab 0 0
219 Triplepediatrik tab 0 0
GIGI 0 0
220 Bonding Btl 0 0
221 Bur Gigi ( Longseng Bur ) bh 0 0
222 Bur Gigi ( Fisure Bur ) bh 0 0
223 Bur Gigi (Round Bur ) bh 0 0
224 Bur Gigi ( Inverted Bur ) bh 0 0
225 CHKM (Sterilisasi Akar) Btl 0 0
226 Cresopate ( Munifying pasta) Btl 0 0
227 Devitalisasi pasta (non arsen ) Btl 0 0
228 Eugenol cairan Btl 0 0
229 Endomethason N ( Munifying pasta Btl 0 0
230 Etsa Btl 0 0
231 Fuji /Glas Ionomer / ketak molar Btl 0 0
232 Iodoform pasta / calplus syringe 0 0
233 Semen seng fosf. Serbuk & cairan Btl 0 0
234 Rocle (Sterilisasi Akar) Btl 0 0
235 Tumpatan sementara ( Cavit) Btl 0 0
236 Tumpatan permanen / Composit Btl 0 0
237 Temporary stopping Fletcher Btl 0 0
238 TKF (Sterilisasi Akar) Btl 0 0
239 Tumpatan permanen / Composit A3 Btl 0 0
240 Tincture pidofilin 80-90 % Btl 0 0
LABORATORIUM 0 0
241 Asam acetat 100 ml Btl 0 0
242 Cover glass bh 0 0
243 Control N 2,5 ml bh 0 0
244 Eosin Btl 0 0
245 Giemza Btl 0 0
246 Jarum stik gula / Blood lounchet bh 0 0
247 Jarum Vacumtainer ( needle 22 G ) bh 0 0
248 Jarum CD 4 bh 0 0
249 Kaca Slide /slide forstead box 0 0
250 Kertas lakmus ( Test paper ) pak 0 0
251 KOH 100 ml Btl 0 0
252 Kertas Ph vagina 0.2 box 0 0
253 M emersi btl 0 0
254 Menthanol btl 0 0
255 Methylen blue btl 0 0
256 Natrium klorida btl 500 ml Btl 0 0
257 Pot dahak bh 0 0
258 Pipet Tip Yellow pcs 0 0
259 Plesterin box 0 0
260 Reagen Widal test set 0 0
261 Reagen gol darah A & B Btl 0 0
262 Reagen ZN / BTA set 0 0
263 Reagen HIV I pcs 0 0
264 Reagen HIV II pcs 0 0
265 Reagen HIV III pcs 0 0
266 Reagen kimia darah pcs 0 0
267 RPR set 0 0
268 Reagen CD4 set 0 0
269 Reagen Erma set 0 0
270 Reagen Control mynthic set 0 0
271 Reagen SFR I set 0 0
272 Stik asam urat bh 0 0
273 Stik Kolesterol bh 0 0
274 Stik Gula darah bh 0 0
275 Stik urine 11( Pemriksaan urine lengkap ) bh 0 0
276 Stik Rapid test untuk sipilis stik 0 0
277 Stik test kehamilan /PP. test stik 0 0
278 SD Bioline Sphylis ( TPHA) set 0 0
279 Tissue kaca slide/ tisu lensa box 0 0
280 Thermal peper 30 mtr roll 0 0
281 Tabung reaksi 3 ml disposible box 0 0
282 Tabung vacum tutup ungu ( EDTA ) bh 0 0
283 Tabung serum( tutup merah) bh 0 0
284 Tabung Serum dg gel (tutup kuning) bh 0 0
285 Tabung glukosa ( tutup abu-abu) bh 0 0
286 Tincture pidofilin 80-90 % btl 0 0
Rapid tes Dengue Nsi Ag 0 0 0 0
Rapid tes Dengue Duo 0 0 0 0

BAHAN HABIS PAKAI 0 0


287 Abocat 18 ( Iv Catheter 18 ) bh 0 0
288 Abocat 20 ( Iv Catheter 20 ) bh 0 0
289 Abocat 22 ( Iv Catheter 22 ) bh 0 0
290 Abocat 24 ( Iv Catheter 24 ) bh 0 0
291 Aqua pro injeksi vial 0 0
292 Alat suntik 0,5 cc bh 0 0
293 Alat suntik 0,05 cc bh 0 0
294 Alat suntik 1 cc bh 0 0
295 Alat suntik 3 cc box 0 0
296 Alat suntik 5 cc bh 0 0
297 Alat suntik 10 cc bh 0 0
298 Benang bedah / Cat gut -3/0 zak 0 0
299 Benang bedah sutra / Silk -3/0 zak 0 0
300 Benang ethicon / Prolene 5/0 zak 0 0
301 Etanol 70 % Btl 0 0
302 Ethanol 70 % 100 ml btl 1 0 1 0 1
303 Etil Klorida semprot btl 3 3 1 2
304 Film X ray 24x 30 box 0 0
305 Film X ray 40x 30 box 0 0
306 Film X ray 35 x 35 box 0 0
307 Foley catheter bh 0 0
308 Hand scund S / M bok 0 0 0 0 0
309 Infusion set anak Set 0 0
310 Infusion set dewasa Set 0 0
311 Jarum Heating otot 1/2 lingkaran Biji 0 0
312 Jarum Heating otot 12,13.14 Biji 0 0
313 Jarum Heating kulit 12,13.14 Biji 0 0
314 Jelly unt doppler ( Doppler Jell 0 btl 0 0
315 Kapas Alkohol /Alkohol sweeb box 0 0 0 0
316 Kapas pembalut 250 mg roll 0 0 0 0
317 Kasa pembalut 40 x 40 steril roll 0 0
318 Kasa pembalut 2 x 80 cm roll 0 0
319 Kasa pmbalt hidrfil 4m x 15 cm roll 0 0
320 Kasa pembalut 4 m x 3 cm roll 0 0
321 Kasa hidrofil 16/16 steril box 0 0
322 kassa gulungan 40 yard x 80 cm roll 0 0
323 Kertas Puyer SCI Lbr 0 0
324 Kondum gros 0 0
325 Klip Obat K pak 0 0
326 Klip Obat B Lbr 0 0
327 Klip Obat T pak 0 0
328 Lisol Btl 0 0
329 Masker tali karet / tali biasa box 0 0 0 0
330 masker N 95 bh 0 0
331 Nurse cup (Disposible head cup ) box 0 0
332 Oksigen gas dalam tabung Tabung 0 0
333 Oksigen kalengan klg 0 0
334 Pembalut Ibu Bersalin buah 0 0
335 Perhidrol / H2O2 Btl 0 0
336 Plester 5 yards x 2 inch roll 0 0 0 0 0
337 Plester Ultravix 5 cm x 5 mm bh 0 0 0
338 Pisau Bedah no 10, 11 ,12 pcs 0 0
339 Reagen Developer box 0 0
340 Reagen Fixer box 0 0
341 Sopratul box 0 0 0 0 0
342 Sarung tangan Obgyn pcs 0 0 0 0
343 safety box bh 0 0
344 Tranfusi set bh 0 0
345 Tensocrip roll 0 0
346 Urine Bag buah 0 0
347 Umbilikor / klem tali pusat buah 0 0
348 Underpad box 0 0
349 wing Needle 25 G buah 0 0
350 Yodium povidon larutan 10 % 300 m Btl 0 0 0 0
351 Yodium povidon larutan 10% 30ml Btl 0 0 0 0

JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR PHB
0 7 0 7

Mengetahui / menyetujui Yang Menyerahkan Yang Meminta/Pelapor


Pimpinan Puskesmas Mengwi III Petugas Gudang Puskesmas Petugas Pusling

(dr.Komang Widia Asmawan,S.Ked) (Kd.Suryaning Ayu) (Desak Putu Indiati ,SKM)


NIP : 19791202 200501 1 010 NIP.19820708 200604 2016 NIP.19690622 199103 2010
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
SUB - UNIT PELAYANAN
SUB UNIT : PUSLING
UPT PUSKESMAS : MENGWI III DOKUMENNO TGL
KECAMATAN : MENGWI PELAPORAN BULAN : Januari 2017 PUSKESMAS
KABUPATEN : BADUNG PERMINTAAN BULAN : Pebruari 2017 sub unit

SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE KET


NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
1 Acyclovir 400 mg Tab 0 0 0 0
2 Acyclovir salep kulit 5 % tube 0 0 0 0
3 Albendazol 400 mg Tab 0 0 0 0
4 Alopurinol 100 mg Tab 130 130 0 130
5 Ambroxol syr 5 mg / 5 ml Btl 2 0 2 2 0
6 Ambroxol tab 30 mg tab 68 1000 1068 168 900
7 Aminofilina tablet 200 mg Tab 0 0
8 Amlodipin 5 mg Tab 0 0 0 0
9 Amoxsisilina kap 500 mg Tab 0 300 300 36 264
10 Amoxsisilina kap 250 mg Kap 0 0
11 Amoxsisilina sirup kering 125 Btl 0 0 0 0 0
12 Amoxsisilina drop 100 mg/ml Btl 0 0 0 0
As.Salicylsat 2% + Belerang 4 % (2-4)
13 salep pot 0 0
14 Astaxanthin 4 mg Tab 0 0 0 0
15 Antalgin ( metampiron ) Tab 0 0
16 Alletrol Tetes Mata btl 0 0
17 Antasid syr btl 0 0 0 0 0
18 Antasida doen tablet, Tab 442 100 542 152 390
19 Anti hemmoroid supp supp 0 0 0 0 0
20 Antimigren ( Ergotamin ,caffein ) tab 0 0 0 0
21 Antiscabies / gamexan salp Tube 0 0
22 Asam Ascorbat ( vit c ) tab 50 Tab 446 0 446 30 416
23 Asam Folat 400 mcg Tab 0 0 0
24 As. Mefenamat 500 mg Tab 813 0 813 271 542
25 Acetosal 100 mg Tab 0 0
26 Attapulgite active 600 mg Tab 0 0
27 Azetromicyn tab 500 mg Tab 0 0
28 Bacitracin - Poly SK Tube 2 2 0 2
29 Benzatin Bensil Penisillin inj vial 0 0
30 Besi II sulfat ( tablet tambah darah Tab 0 0 0
31 Betahistin tab 6 mg Tab 0 0 0 0
32 Betamethason krim 0,1 % Tube 29 0 29 4 25 0
33 Bisacodyl supp 10 mg sup 0 0
34 Borax Glycerin 5 % Btl 0 0
35 Balsem kaki 3 Btl 0 0
36 Captopril 12,5 mg Tab 0 0
37 Captopril 25 mg Tab 488 200 688 222 466 0
38 Ceterizine 10 mg tab 0 0
39 Counterpaint cr tube 0 0
40 Clobazam 40 mg Tab 0 0
41 Clorpromazina hcl tab ( CPZ ) 100 mg Tab 0 0
42 Clorpromazin HCl tab ( CPZ) 25 mg Tab 0 0
43 Dexamethason inj 5 mg/ml-1 ml Amp 0 0 0 0
44 Dexamethason 0,5 mg Tab 650 0 650 56 594 0
45 Desoksimetason tube 0 0
46 Dextrose 40 % steril Btl 0 0
47 Diazepam 2 mg Tab 0 0 0 0
48 Diazepam inj 5mg/ml Ampul 0 0
49 Diazepam rectal 5 mg/2,5 ml Tube 0 0
50 Diphenhidramin hcl inj 10 mg/1 m Amp 0 0 0 0
51 Digoxin tab 0.25 mg Tab 0 0
52 Doxysyclin 100 mg tab 0 0
53 Domperidon drop btl 0 0
54 Domperidon syr 5 mg / 5 ml btl 0 0
55 Efedrin hcl tab 25 mg Tab 0 0
56 Epineprin hcl ( adrenalina ) inj 0.1%-1 mlAmp 0 0 0 0
57 Erytromicin 500 mg Tab 0 0
58 Erytromicin syr 200mg/5ml Btl 0 0
59 Furossemid tab 40 mg Tab 0 0
60 Fluconazole 150 mg tab 0 0
61 Fitominadion (Vit K) inj 2 mg/1ml Amp 0 0
62 Fenobarbital tab 30 mg Tab 0 0
63 Fenol gliseron Tts Telinga Btl 0 0
64 Fitominadion ( vit k1) inj 10 mg/ml-1mlAmp 0 0
65 Fitominadion ( vit k1) tab salut 1 Tab 0 0
66 Garam Oralit 200 ml air Sach 197 0 197 0 197 0
67 Gentamisin sulfat TM 0,3 % Btl 0 0 0
68 Gentamicin salep kulit Tube 0 0
69 Gentian Violet larutan 1 % Btl 0 0
70 Glibenklamid tab 5 mg Tab 0 0 0 0 0
71 Glimepiride 1mg tab 0 0
72 Glimepiride 2 mg tab 0 0
73 Gliseril guaiakolat tab 100 mg Tab 0 0
74 Glukosa larutan infus 10 % steril Btl 0 0
75 Glukosa larutan infus 5 % steril Btl 0 0
76 Griseofulvin tab 125 mg Tab 0 0
77 Haloperidol 0,5 mg Tab 0 0
78 Haloperidol 1,5 mg Tab 0 0
79 Haloperidol tablet 5 mg Tab 0 0
80 Hidroklorotiazida (hct) tab 25 mg Tab 0 0
81 Hidrokortison krim 2.5 % Tube 25 0 25 4 21
82 Hyocine-N-butilbr / Scopma tab Tab 0 0
83 Hyoscine-N-B Inj /Buscopan inj 2 Amp 0 0
84 Ibuprofen tab 200 mg Tab 0 0 0 0
85 Ibuprofen tab 400 mg Tab 514 0 514 126 388
86 Ibuprofen Syr Btl 0 0
87 Isosorbid dinitrat 5 mg tab 0 0
88 IZONIASIDA ( INH) 100 MG Tab 0 0
89 Kalium permanganat (PK) Pot 0 0
90 Kalium Diklopenak 50 mg tab 0 0
91 Kalsium laktat ( kalk ) tab 500 mg Tab 0 0
92 Kalsium Glukonas10 % inj Vial 0 0 0
93 Ketokenazol krim 2 % tube 0 0 0 0 ..
94 Ketokenazol tab 200 mg tab 0 0 0 0
95 Ketorolac inj 30 mg Amp 0 0
96 Klindamicin 150 mg tab 0 0
97 Klindamisin 300 mg Tab 0 0
98 Karbamazepin tablet 200 mg Tab 0 0
99 Kloramfenicol salp mata 1 % tube 16 16 16 0
100 Kloramphenikol Tetes Mata 0,5 % Btl 0 0
101 Kloramfenikol tts Telinga 3 % Btl 9 0 9 0 9
102 Klorfeniramini maleat (ctm) tab 4 Tab 804 0 804 144 660
103 Kotrimoksazol kombinasi 480 mg Tab 100 0 100 0 100
104 Kotrimoksazol suspensi Btl 4 0 4 0 4
105 KB Suntik 1 bln Vial 0 0
106 KB IUD bh 0 0
107 KB PIL stp 0 0
108 KB SUSUK / inflan infl 0 0
109 Lidokain inj 2 % Amp 0 0 0 0 0
110 Lidokain com inj 2% Amp 0 0 0 0
111 Loveramid tab 2 mg tab 230 0 230 30 200
112 Loratadin tab10 mg tab 0 0 0 0
113 Mg SO4 40 % ( 25 ml ) Vial 0 0 0
114 MgSO4 injeksi 20% Vial 0 0
115 Meloksikam 7,5 mg Tab 0 0 0 0
116 Meloksikam 15 mg Tab 0 0
117 Metformin tab 500 mg Tab 0 0 0 0
118 Metil ergometrina maleat inj 0.200 mg/ml Amp 0 0
119 Metil ergometrina maleat tab salut 0.125 tab 0 0
120 Methyl Prednisolon 4 mg tab 0 0 0 0 0
121 Metoklopramid Hcl 5 mg tab 0 0
122 Metoklopramid Hcl syr 5 mg/5ml btl 0 0 0
123 Metoklopramid inj 5mg/2ml Amp 0 0
124 Metronidazol 500 mg Tab 0 0 0 0
125 Metronidazol supp ( flagyl ) 0.5 gr sup 0 0
126 Miconazol crm 2 % tube 0 0 0 0
127 MDT Combi ( obat kusta ) paket 0 0
128 Multivitamin syr / Procuma btl 0 0 0 0 0
129 Multivitamin tab(vitacaps) tab 300 300 0 300
130 Narium Tiroksin tab 0 0
131 Natrium klorida larutan infus 0.9 % sterilBtl 0 0 0 0
132 Na Diklopenac 25 mg tab 0 0
133 Na Diklofenac 50 mg Tab 500 0 500 140 360
134 Nipedipin tab 0 0
135 Nistatin 100.000 Iu/g/tab vaginal tab 0 0 0
136 NB Salp Tube 0 0
137 Obat Batuk Hitam Btl 0 0
138 Obat batuk kering/dextrofen btl 0 0 0 0
139 Obat Flu sirup/erpaflu btl 0 0 0 0
140 Obat Flu tablet/coparcetin Tab 300 300 0 300
141 Oksitetrasiklin hc salep 3 % Tube 0 0
142 Oksitetrasiklin hcl salep mata 1 % Tube 0 0
143 Oksitosin inj 10 iU ( 1 ml ) Amp 0 0 0 0
144 Omeprazol 20 mg Tab 280 280 0 280
145 Osedantron inj Amp 0 0
146 Osedantron tab 8 mg Tab 0 0
147 Oseltamivir 75 mg Tab 0 0
148 Papverin tab Tab 0 0
149 Parasetamol sirup 120 mg/ 5 ml Btl 0 0 0 0 0
150 Parasetamol tab 500 mg Tab 902 0 902 157 745
151 Paracetamol drop 100 mg/ ml Btl 0 0 0 0
152 Paracetamol rectal 125 mg Tube 0 0 0
153 Perak sulfadiazin 1 % / Burnazin cr Tube 0 0
154 Pyrantel syr btl 0 0
155 Piridoxin hcl (vit b6) tab 10 mg Tab 0 0 0 0
156 Piroxicam 20 mg cap 0 0 0
157 Piroxicam 10 mg cap 0 0
158 Polycresulen / Albothyl/ Aptil Btl 0 0 0 0
159 Prednison tab 5 mg Tab 0 0 0 0 0
160 Ranitidin 150 mg Tab 0 0 0
161 Ranitidin inj 25 mg/2 ml Vial 0 0
162 Retinol ( vit A ) kaps lunak 100.00 Kap 0 0
163 Retinol ( vit A ) kaps lunak 200.00 Kap 0 0
164 Ringer laktat lrt inf steril ( RL ) Btl 0 0 0 0 0
165 Resperidon 2 tab tab 0 0
166 salbutamol 4 mg tab 0 0 0 0
167 salbutamol 2 mg tab 193 193 70 123
168 salbutamol nebulizer 2.5 mg Amp 0 0 0
169 Salbutamol inhaler btl 0 0
170 Salisil bedak 2 % Sak 22 0 22 8 14
171 Sefadroxyl 500 mg tab 0 0
172 Sefadroxyl syr kering 250 mg/5ml btl 0 0
173 Sefiksim 100 mg tab 0 0
174 Serum Anti Bisa Ular ( ABU ) vial 0 0
175 Serum anti tetanus(tetagam) 250 Amp 0 0 0 0
176 Sianokobalamina (vit B12 ) inj Amp 0 0
177 Simetidin 200 mg Tab 0 0
178 Sinvastatin tab 10 mg tab 0 0
179 Siproploxacin 500 mg Tab 0 0 0 0 0
180 Sucralfate 500 mg /Mucogard tab Tab 0 0
181 Sucralfat suspensi ( Mucogard sus btl 0 0
182 Sulfasetamid Tetes mata 15 % Btl 0 0
183 Salep perawatan luka (bioplacent tube 0 0 0 0
184 Tetrasiklina hcl kapsul 500 mg Kap 0 0
185 Triflouperazin ( Stelazin ) 5 mg Tab 0 0
186 Thiamin hcl inj 100 mg/ml - 1 ml Amp 0 0
187 Thiamin hcl ( vit B1)tab 50 mg Tab 270 600 870 300 570
188 Thiamfenicol 500 mg Tab 0 0
189 Trihexipenidil 2 mg Tab 0 0
190 Vitamin B complek tab Tab 373 700 1073 463 610
191 Vit Neurotrofic tablet 5000 mg (soh tab 300 300 50 250
192 Vit Neurotrofic inj 5000 mg Amp 0 0
193 Vitamin imunitas (Imunogard ) tab 0 0 0 0
194 Zink tab 20 mg Tab 150 0 150 60 90
195 Zink drop 10 mg/ml btl 0 0
196 Zink syr ( Zirkum ) btl 0 0
Bisacodyl tab tab 0 0 0 0
VAKSIN 0 0
197 HB Uniject vial 0 0
198 BCG vial 0 0
199 CAMPAK vial 0 0
200 POLIO vial 0 0
201 Pentabio vial 0 0
202 DT vial 0 0
203 TT vial 0 0
204 TD vial 0 0
205 IPV vial 0 0
206 VAKSIN Anti Rabies ( VAR ) vial 0 0
OBAT PROGRAM TBC 0 0
207 Anti TBC Anak paket 0 0
208 Anti TBC I / FDC paket 0 0
209 Anti TBC II / FDC paket 0 0
210 kombipak katagori I paket 0 0
OBAT PROGRAM ARV 0 0
211 ALUVIA ( Liponavir 200mg + riton tab 0 0
212 DUVIRAL( Lamifudin150 mg+zidofudi tab 0 0
213 Efavirenz 600 mg tab 0 0
FDC ( Tenofovir 300mg+lamivudin
214 300 mg + efavirenz 600 mg) tab 0 0
215 Lamivudine ( Hiviral ) 150 mg tab 0 0
216 Nevirapine ( Neviral ) 200 mg tab 0 0
217 Tenofovir Disoproxil Fumarate (TDF) tab 0 0
218 Abacavir tab 0 0
219 Triplepediatrik tab 0 0
GIGI 0 0
220 Bonding Btl 0 0
221 Bur Gigi ( Longseng Bur ) bh 0 0
222 Bur Gigi ( Fisure Bur ) bh 0 0
223 Bur Gigi (Round Bur ) bh 0 0
224 Bur Gigi ( Inverted Bur ) bh 0 0
225 CHKM (Sterilisasi Akar) Btl 0 0
226 Cresopate ( Munifying pasta) Btl 0 0
227 Devitalisasi pasta (non arsen ) Btl 0 0
228 Eugenol cairan Btl 0 0
229 Endomethason N ( Munifying past Btl 0 0
230 Etsa Btl 0 0
231 Fuji /Glas Ionomer / ketak molar Btl 0 0
232 Iodoform pasta / calplus syringe 0 0
233 Semen seng fosf. Serbuk & cairan Btl 0 0
234 Rocle (Sterilisasi Akar) Btl 0 0
235 Tumpatan sementara ( Cavit) Btl 0 0
236 Tumpatan permanen / Composit Btl 0 0
237 Temporary stopping Fletcher Btl 0 0
238 TKF (Sterilisasi Akar) Btl 0 0
239 Tumpatan permanen / Composit Btl 0 0
240 Tincture pidofilin 80-90 % Btl 0 0
LABORATORIUM 0 0
241 Asam acetat 100 ml Btl 0 0
242 Cover glass bh 0 0
243 Control N 2,5 ml bh 0 0
244 Eosin Btl 0 0
245 Giemza Btl 0 0
246 Jarum stik gula / Blood lounchet bh 0 0
247 Jarum Vacumtainer ( needle 22 G bh 0 0
248 Jarum CD 4 bh 0 0
249 Kaca Slide /slide forstead box 0 0
250 Kertas lakmus ( Test paper ) pak 0 0
251 KOH 100 ml Btl 0 0
252 Kertas Ph vagina 0.2 box 0 0
253 M emersi btl 0 0
254 Menthanol btl 0 0
255 Methylen blue btl 0 0
256 Natrium klorida btl 500 ml Btl 0 0
257 Pot dahak bh 0 0
258 Pipet Tip Yellow pcs 0 0
259 Plesterin box 0 0
260 Reagen Widal test set 0 0
261 Reagen gol darah A & B Btl 0 0
262 Reagen ZN / BTA set 0 0
263 Reagen HIV I pcs 0 0
264 Reagen HIV II pcs 0 0
265 Reagen HIV III pcs 0 0
266 Reagen kimia darah pcs 0 0
267 RPR set 0 0
268 Reagen CD4 set 0 0
269 Reagen Erma set 0 0
270 Reagen Control mynthic set 0 0
271 Reagen SFR I set 0 0
272 Stik asam urat bh 0 0
273 Stik Kolesterol bh 0 0
274 Stik Gula darah bh 0 0
275 Stik urine 11( Pemriksaan urine lengkap ) bh 0 0
276 Stik Rapid test untuk sipilis stik 0 0
277 Stik test kehamilan /PP. test stik 0 0
278 SD Bioline Sphylis ( TPHA) set 0 0
279 Tissue kaca slide/ tisu lensa box 0 0
280 Thermal peper 30 mtr roll 0 0
281 Tabung reaksi 3 ml disposible box 0 0
282 Tabung vacum tutup ungu ( EDTA bh 0 0
283 Tabung serum( tutup merah) bh 0 0
284 Tabung Serum dg gel (tutup kunin bh 0 0
285 Tabung glukosa ( tutup abu-abu) bh 0 0
286 Tincture pidofilin 80-90 % btl 0 0
Rapid tes Dengue Nsi Ag 0 0 0 0
Rapid tes Dengue Duo 0 0 0 0

BAHAN HABIS PAKAI 0 0


287 Abocat 18 ( Iv Catheter 18 ) bh 0 0
288 Abocat 20 ( Iv Catheter 20 ) bh 0 0
289 Abocat 22 ( Iv Catheter 22 ) bh 0 0
290 Abocat 24 ( Iv Catheter 24 ) bh 0 0
291 Aqua pro injeksi vial 0 0
292 Alat suntik 0,5 cc bh 0 0
293 Alat suntik 0,05 cc bh 0 0
294 Alat suntik 1 cc bh 0 0
295 Alat suntik 3 cc box 0 0
296 Alat suntik 5 cc bh 0 0
297 Alat suntik 10 cc bh 0 0
298 Benang bedah / Cat gut -3/0 zak 0 0
299 Benang bedah sutra / Silk -3/0 zak 0 0
300 Benang ethicon / Prolene 5/0 zak 0 0
301 Etanol 70 % Btl 0 0
302 Ethanol 70 % 100 ml btl 0 0 0 0 0
303 Etil Klorida semprot btl 0 0
304 Film X ray 24x 30 box 0 0
305 Film X ray 40x 30 box 0 0
306 Film X ray 35 x 35 box 0 0
307 Foley catheter bh 0 0
308 Hand scund S / M bok 0 0 0 0 0
309 Infusion set anak Set 0 0
310 Infusion set dewasa Set 0 0
311 Jarum Heating otot 1/2 lingkaran Biji 0 0
312 Jarum Heating otot 12,13.14 Biji 0 0
313 Jarum Heating kulit 12,13.14 Biji 0 0
314 Jelly unt doppler ( Doppler Jell 0 btl 0 0
315 Kapas Alkohol /Alkohol sweeb box 0 0 0 0
316 Kapas pembalut 250 mg roll 0 0 0 0
317 Kasa pembalut 40 x 40 steril roll 0 0
318 Kasa pembalut 2 x 80 cm roll 0 0
319 Kasa pmbalt hidrfil 4m x 15 cm roll 0 0
320 Kasa pembalut 4 m x 3 cm roll 0 0
321 Kasa hidrofil 16/16 steril box 0 0
322 kassa gulungan 40 yard x 80 cm roll 0 0
323 Kertas Puyer SCI Lbr 0 0
324 Kondum gros 0 0
325 Klip Obat K pak 0 0
326 Klip Obat B Lbr 0 0
327 Klip Obat T pak 0 0
328 Lisol Btl 0 0
329 Masker tali karet / tali biasa box 0 0 0 0
330 masker N 95 bh 0 0
331 Nurse cup (Disposible head cup ) box 0 0
332 Oksigen gas dalam tabung Tabung 0 0
333 Oksigen kalengan klg 0 0
334 Pembalut Ibu Bersalin buah 0 0
335 Perhidrol / H2O2 Btl 0 0
336 Plester 5 yards x 2 inch roll 0 0 0 0 0
337 Plester Ultravix 5 cm x 5 mm bh 0 0 0
338 Pisau Bedah no 10, 11 ,12 pcs 0 0
339 Reagen Developer box 0 0
340 Reagen Fixer box 0 0
341 Sopratul box 0 0 0 0 0
342 Sarung tangan Obgyn pcs 0 0 0 0
343 safety box bh 0 0
344 Tranfusi set bh 0 0
345 Tensocrip roll 0 0
346 Urine Bag buah 0 0
347 Umbilikor / klem tali pusat buah 0 0
348 Underpad box 0 0
349 wing Needle 25 G buah 0 0
350 Yodium povidon larutan 10 % 300 Btl 0 0 0 0
351 Yodium povidon larutan 10% 30m Btl 0 0 0 0

JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR PHB
0 107 3 110

Mengetahui / menyetujui Yang Menyerahkan Yang Meminta/Pelapor


Pimpinan Puskesmas Mengwi III Petugas Gudang Puskesmas Petugas Pusling

(dr.Komang Widia Asmawan,S.Ked) (Kd.Suryaning Ayu) (Harfiah )


NIP : 19791202 200501 1 010 NIP.19820708 200604 2016 NIP.19720713 199301 2001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
SUB - UNIT PELAYANAN
SUB UNIT : PUSTU LUKLUK
UPT PUSKESMAS : MENGWI III DOKUME NO TGL
KECAMATAN : MENGWI PELAPORAN BULAN : Januari 2017 PUSKESMAS
KABUPATEN : BADUNG PERMINTAAN BULAN : Pebruari 2017 sub unit

SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE KET


NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
1 Acyclovir 400 mg Tab 0 0 0 0
2 Acyclovir salep kulit 5 % tube 0 0 0 0
3 Albendazol 400 mg Tab 0 0 0 0
4 Alopurinol 100 mg Tab 0 0 0 0
5 Ambroxol syr 5 mg / 5 ml Btl 5 0 5 5 0
6 Ambroxol tab 30 mg tab 300 300 0 300
7 Aminofilina tablet 200 mg Tab 0 0
8 Amlodipin 5 mg Tab 0 0 0 0
9 Amoxsisilina kap 500 mg Tab 0 300 300 40 260
10 Amoxsisilina kap 250 mg Kap 0 0
11 Amoxsisilina sirup kering 125 m Btl 10 0 10 2 8
12 Amoxsisilina drop 100 mg/ml Btl 0 0 0 0
As.Salicylsat 2% + Belerang 4 % (2-4)
13 salep pot 0 0
14 Astaxanthin 4 mg Tab 0 0 0 0
15 Antalgin ( metampiron ) Tab 0 0
16 Alletrol Tetes Mata btl 0 0
17 Antasid syr btl 4 0 4 0 4
18 Antasida doen tablet, Tab 124 0 124 32 92
19 Anti hemmoroid supp supp 0 10 10 0 10
20 Antimigren ( Ergotamin ,caffein ) tab 0 0 0 0
21 Antiscabies / gamexan salp Tube 0 0
22 Asam Ascorbat ( vit c ) tab 50 m Tab 180 0 180 0 180
23 Asam Folat 400 mcg Tab 0 0 0
24 As. Mefenamat 500 mg Tab 180 200 380 20 360
25 Acetosal 100 mg Tab 0 0
26 Attapulgite active 600 mg Tab 0 0
27 Azetromicyn tab 500 mg Tab 0 0
28 Bacitracin - Poly SK Tube 0 0 0 0
29 Benzatin Bensil Penisillin inj vial 0 0
30 Besi II sulfat ( tablet tambah darah Tab 0 0 0
31 Betahistin tab 6 mg Tab 0 0 0 0
32 Betamethason krim 0,1 % Tube 0 0 0 0 0 0
33 Bisacodyl supp 10 mg sup 0 0
34 Borax Glycerin 5 % Btl 0 0
35 Balsem kaki 3 Btl 0 0
36 Captopril 12,5 mg Tab 0 0
37 Captopril 25 mg Tab 104 0 104 10 94 0
38 Ceterizine 10 mg tab 0 0
39 Counterpaint cr tube 0 0
40 Clobazam 40 mg Tab 0 0
41 Clorpromazina hcl tab ( CPZ ) 100 mg Tab 0 0
42 Clorpromazin HCl tab ( CPZ) 25 mg Tab 0 0
43 Dexamethason inj 5 mg/ml-1 ml Amp 2 2 2 0
44 Dexamethason 0,5 mg Tab 0 100 100 0 100 0
45 Desoksimetason tube 0 0
46 Dextrose 40 % steril Btl 0 0
47 Diazepam 2 mg Tab 0 0 0 0
48 Diazepam inj 5mg/ml Ampul 0 0
49 Diazepam rectal 5 mg/2,5 ml Tube 0 0
50 Diphenhidramin hcl inj 10 mg/1 ml Amp 3 3 3 0
51 Digoxin tab 0.25 mg Tab 0 0
52 Doxysyclin 100 mg tab 0 0
53 Domperidon drop btl 0 0
54 Domperidon syr 5 mg / 5 ml btl 0 0
55 Efedrin hcl tab 25 mg Tab 0 0
56 Epineprin hcl ( adrenalina ) inj 0.1%-1 ml Amp 2 2 2 0
57 Erytromicin 500 mg Tab 0 0
58 Erytromicin syr 200mg/5ml Btl 0 0
59 Furossemid tab 40 mg Tab 0 0
60 Fluconazole 150 mg tab 0 0
61 Fitominadion (Vit K) inj 2 mg/1ml Amp 0 0
62 Fenobarbital tab 30 mg Tab 0 0
63 Fenol gliseron Tts Telinga Btl 0 0
64 Fitominadion ( vit k1) inj 10 mg/ml-1ml Amp 0 0
65 Fitominadion ( vit k1) tab salut 10 Tab 0 0
66 Garam Oralit 200 ml air Sach 0 100 100 0 100 0
67 Gentamisin sulfat TM 0,3 % Btl 7 7 7
68 Gentamicin salep kulit Tube 0 0
69 Gentian Violet larutan 1 % Btl 0 0
70 Glibenklamid tab 5 mg Tab 0 0 0 0 0
71 Glimepiride 1mg tab 0 0
72 Glimepiride 2 mg tab 0 0
73 Gliseril guaiakolat tab 100 mg Tab 0 0
74 Glukosa larutan infus 10 % steril Btl 0 0
75 Glukosa larutan infus 5 % steril Btl 0 0
76 Griseofulvin tab 125 mg Tab 0 0
77 Haloperidol 0,5 mg Tab 0 0
78 Haloperidol 1,5 mg Tab 0 0
79 Haloperidol tablet 5 mg Tab 0 0
80 Hidroklorotiazida (hct) tab 25 mg Tab 0 0
81 Hidrokortison krim 2.5 % Tube 6 0 6 0 6
82 Hyocine-N-butilbr / Scopma tab 10 Tab 0 0
83 Hyoscine-N-B Inj /Buscopan inj 20m Amp 0 0
84 Ibuprofen tab 200 mg Tab 60 60 20 40
85 Ibuprofen tab 400 mg Tab 0 0 0 0 0
86 Ibuprofen Syr Btl 0 0
87 Isosorbid dinitrat 5 mg tab 0 0
88 IZONIASIDA ( INH) 100 MG Tab 0 0
89 Kalium permanganat (PK) Pot 0 0
90 Kalium Diklopenak 50 mg tab 0 0
91 Kalsium laktat ( kalk ) tab 500 mg Tab 0 0
92 Kalsium Glukonas10 % inj Vial 5 5 5
93 Ketokenazol krim 2 % tube 0 0 0 0 ..
94 Ketokenazol tab 200 mg tab 0 0 0 0
95 Ketorolac inj 30 mg Amp 0 0
96 Klindamicin 150 mg tab 0 0
97 Klindamisin 300 mg Tab 0 0
98 Karbamazepin tablet 200 mg Tab 0 0
99 Kloramfenicol salp mata 1 % tube 18 18 1 17
100 Kloramphenikol Tetes Mata 0,5 % Btl 0 0
101 Kloramfenikol tts Telinga 3 % Btl 10 0 10 0 10
102 Klorfeniramini maleat (ctm) tab 4 Tab 350 0 350 43 307
103 Kotrimoksazol kombinasi 480 mg Tab 140 0 140 50 90
104 Kotrimoksazol suspensi Btl 16 0 16 0 16
105 KB Suntik 1 bln Vial 0 0
106 KB IUD bh 0 0
107 KB PIL stp 0 0
108 KB SUSUK / inflan infl 0 0
109 Lidokain inj 2 % Amp 15 0 15 0 15
110 Lidokain com inj 2% Amp 0 0 0 0
111 Loveramid tab 2 mg tab 0 0 0 0 0
112 Loratadin tab10 mg tab 0 0 0 0
113 Mg SO4 40 % ( 25 ml ) Vial 5 5 5
114 MgSO4 injeksi 20% Vial 0 0
115 Meloksikam 7,5 mg Tab 0 0 0 0
116 Meloksikam 15 mg Tab 0 0
117 Metformin tab 500 mg Tab 0 0 0 0
118 Metil ergometrina maleat inj 0.200 mg/ml-1 Amp 0 0
119 Metil ergometrina maleat tab salut 0.125 m tab 0 0
120 Methyl Prednisolon 4 mg tab 0 0 0 0 0
121 Metoklopramid Hcl 5 mg tab 0 0
122 Metoklopramid Hcl syr 5 mg/5ml btl 10 10 10
123 Metoklopramid inj 5mg/2ml Amp 0 0
124 Metronidazol 500 mg Tab 60 60 10 50
125 Metronidazol supp ( flagyl ) 0.5 gr sup 0 0
126 Miconazol crm 2 % tube 5 5 0 5
127 MDT Combi ( obat kusta ) paket 0 0
128 Multivitamin syr / Procuma btl 7 0 7 1 6
129 Multivitamin tab(vitacaps) tab 100 100 0 100
130 Narium Tiroksin tab 0 0
131 Natrium klorida larutan infus 0.9 % steril Btl 1 1 0 1
132 Na Diklopenac 25 mg tab 0 0
133 Na Diklofenac 50 mg Tab 0 0 0 0 0
134 Nipedipin tab 0 0
135 Nistatin 100.000 Iu/g/tab vaginal tab 7 7 7
136 NB Salp Tube 0 0
137 Obat Batuk Hitam Btl 0 0
138 Obat batuk kering/dextrofen btl 0 0 0 0
139 Obat Flu sirup/erpaflu btl 0 0 0 0
140 Obat Flu tablet/coparcetin Tab 100 100 0 100
141 Oksitetrasiklin hc salep 3 % Tube 0 0
142 Oksitetrasiklin hcl salep mata 1 % Tube 0 0
143 Oksitosin inj 10 iU ( 1 ml ) Amp 2 2 0 2
144 Omeprazol 20 mg Tab 0 0 0 0
145 Osedantron inj Amp 0 0
146 Osedantron tab 8 mg Tab 0 0
147 Oseltamivir 75 mg Tab 0 0
148 Papverin tab Tab 0 0
149 Parasetamol sirup 120 mg/ 5 ml Btl 9 10 19 7 12
150 Parasetamol tab 500 mg Tab 290 500 790 112 678
151 Paracetamol drop 100 mg/ ml Btl 0 0 0 0
152 Paracetamol rectal 125 mg Tube 0 0 0
153 Perak sulfadiazin 1 % / Burnazin cr Tube 0 0
154 Pyrantel syr btl 0 0
155 Piridoxin hcl (vit b6) tab 10 mg Tab 980 980 0 980
156 Piroxicam 20 mg cap 50 50 50
157 Piroxicam 10 mg cap 0 0
158 Polycresulen / Albothyl/ Aptil Btl 0 0 0 0
159 Prednison tab 5 mg Tab 864 0 864 73 791
160 Ranitidin 150 mg Tab 0 0 0
161 Ranitidin inj 25 mg/2 ml Vial 0 0
162 Retinol ( vit A ) kaps lunak 100.000 Kap 0 0
163 Retinol ( vit A ) kaps lunak 200.000 Kap 0 0
164 Ringer laktat lrt inf steril ( RL ) Btl 2 0 2 0 2
165 Resperidon 2 tab tab 0 0
166 salbutamol 4 mg tab 0 0 0 0
167 salbutamol 2 mg tab 0 0 0 0
168 salbutamol nebulizer 2.5 mg Amp 0 0 0
169 Salbutamol inhaler btl 0 0
170 Salisil bedak 2 % Sak 15 0 15 0 15
171 Sefadroxyl 500 mg tab 0 0
172 Sefadroxyl syr kering 250 mg/5ml btl 0 0
173 Sefiksim 100 mg tab 0 0
174 Serum Anti Bisa Ular ( ABU ) vial 0 0
175 Serum anti tetanus(tetagam) 250 IU Amp 0 0 0 0
176 Sianokobalamina (vit B12 ) inj Amp 0 0
177 Simetidin 200 mg Tab 0 0
178 Sinvastatin tab 10 mg tab 0 0
179 Siproploxacin 500 mg Tab 0 0 0 0 0
180 Sucralfate 500 mg /Mucogard tab Tab 0 0
181 Sucralfat suspensi ( Mucogard susp btl 0 0
182 Sulfasetamid Tetes mata 15 % Btl 0 0
183 Salep perawatan luka (bioplacento tube 0 0 0 0
184 Tetrasiklina hcl kapsul 500 mg Kap 0 0
185 Triflouperazin ( Stelazin ) 5 mg Tab 0 0
186 Thiamin hcl inj 100 mg/ml - 1 ml Amp 0 0
187 Thiamin hcl ( vit B1)tab 50 mg Tab 160 0 160 0 160
188 Thiamfenicol 500 mg Tab 0 0
189 Trihexipenidil 2 mg Tab 0 0
190 Vitamin B complek tab Tab 320 0 320 70 250
191 Vit Neurotrofic tablet 5000 mg (sohob tab 0 0 0 0
192 Vit Neurotrofic inj 5000 mg Amp 0 0
193 Vitamin imunitas (Imunogard ) tab 0 0 0 0
194 Zink tab 20 mg Tab 150 0 150 10 140
195 Zink drop 10 mg/ml btl 0 0
196 Zink syr ( Zirkum ) btl 0 0
Bisacodyl tab tab 0 0 0 0
VAKSIN 0 0
197 HB Uniject vial 0 0
198 BCG vial 0 0
199 CAMPAK vial 0 0
200 POLIO vial 0 0
201 Pentabio vial 0 0
202 DT vial 0 0
203 TT vial 0 0
204 TD vial 0 0
205 IPV vial 0 0
206 VAKSIN Anti Rabies ( VAR ) vial 0 0
OBAT PROGRAM TBC 0 0
207 Anti TBC Anak paket 0 0
208 Anti TBC I / FDC paket 0 0
209 Anti TBC II / FDC paket 0 0
210 kombipak katagori I paket 0 0
OBAT PROGRAM ARV 0 0
211 ALUVIA ( Liponavir 200mg + ritonav tab 0 0
212 DUVIRAL( Lamifudin150 mg+zidofudin tab 0 0
213 Efavirenz 600 mg tab 0 0
FDC ( Tenofovir 300mg+lamivudin
214 300 mg + efavirenz 600 mg) tab 0 0
215 Lamivudine ( Hiviral ) 150 mg tab 0 0
216 Nevirapine ( Neviral ) 200 mg tab 0 0
217 Tenofovir Disoproxil Fumarate (TDF) 3 tab 0 0
218 Abacavir tab 0 0
219 Triplepediatrik tab 0 0
GIGI 0 0
220 Bonding Btl 0 0
221 Bur Gigi ( Longseng Bur ) bh 0 0
222 Bur Gigi ( Fisure Bur ) bh 0 0
223 Bur Gigi (Round Bur ) bh 0 0
224 Bur Gigi ( Inverted Bur ) bh 0 0
225 CHKM (Sterilisasi Akar) Btl 0 0
226 Cresopate ( Munifying pasta) Btl 0 0
227 Devitalisasi pasta (non arsen ) Btl 0 0
228 Eugenol cairan Btl 0 0
229 Endomethason N ( Munifying pasta Btl 0 0
230 Etsa Btl 0 0
231 Fuji /Glas Ionomer / ketak molar Btl 0 0
232 Iodoform pasta / calplus syringe 0 0
233 Semen seng fosf. Serbuk & cairan Btl 0 0
234 Rocle (Sterilisasi Akar) Btl 0 0
235 Tumpatan sementara ( Cavit) Btl 0 0
236 Tumpatan permanen / Composit Btl 0 0
237 Temporary stopping Fletcher Btl 0 0
238 TKF (Sterilisasi Akar) Btl 0 0
239 Tumpatan permanen / Composit A Btl 0 0
240 Tincture pidofilin 80-90 % Btl 0 0
LABORATORIUM 0 0
241 Asam acetat 100 ml Btl 0 0
242 Cover glass bh 0 0
243 Control N 2,5 ml bh 0 0
244 Eosin Btl 0 0
245 Giemza Btl 0 0
246 Jarum stik gula / Blood lounchet bh 0 0
247 Jarum Vacumtainer ( needle 22 G ) bh 0 0
248 Jarum CD 4 bh 0 0
249 Kaca Slide /slide forstead box 0 0
250 Kertas lakmus ( Test paper ) pak 0 0
251 KOH 100 ml Btl 0 0
252 Kertas Ph vagina 0.2 box 0 0
253 M emersi btl 0 0
254 Menthanol btl 0 0
255 Methylen blue btl 0 0
256 Natrium klorida btl 500 ml Btl 0 0
257 Pot dahak bh 0 0
258 Pipet Tip Yellow pcs 0 0
259 Plesterin box 0 0
260 Reagen Widal test set 0 0
261 Reagen gol darah A & B Btl 0 0
262 Reagen ZN / BTA set 0 0
263 Reagen HIV I pcs 0 0
264 Reagen HIV II pcs 0 0
265 Reagen HIV III pcs 0 0
266 Reagen kimia darah pcs 0 0
267 RPR set 0 0
268 Reagen CD4 set 0 0
269 Reagen Erma set 0 0
270 Reagen Control mynthic set 0 0
271 Reagen SFR I set 0 0
272 Stik asam urat bh 0 0
273 Stik Kolesterol bh 0 0
274 Stik Gula darah bh 0 0
275 Stik urine 11( Pemriksaan urine lengkap ) bh 0 0
276 Stik Rapid test untuk sipilis stik 0 0
277 Stik test kehamilan /PP. test stik 0 0
278 SD Bioline Sphylis ( TPHA) set 0 0
279 Tissue kaca slide/ tisu lensa box 0 0
280 Thermal peper 30 mtr roll 0 0
281 Tabung reaksi 3 ml disposible box 0 0
282 Tabung vacum tutup ungu ( EDTA ) bh 0 0
283 Tabung serum( tutup merah) bh 0 0
284 Tabung Serum dg gel (tutup kuning bh 0 0
285 Tabung glukosa ( tutup abu-abu) bh 0 0
286 Tincture pidofilin 80-90 % btl 0 0
Rapid tes Dengue Nsi Ag 0 0 0 0
Rapid tes Dengue Duo 0 0 0 0

BAHAN HABIS PAKAI 0 0


287 Abocat 18 ( Iv Catheter 18 ) bh 0 0
288 Abocat 20 ( Iv Catheter 20 ) bh 0 0
289 Abocat 22 ( Iv Catheter 22 ) bh 0 0
290 Abocat 24 ( Iv Catheter 24 ) bh 0 0
291 Aqua pro injeksi vial 0 0
292 Alat suntik 0,5 cc bh 0 0
293 Alat suntik 0,05 cc bh 0 0
294 Alat suntik 1 cc bh 0 0
295 Alat suntik 3 cc box 0 0
296 Alat suntik 5 cc bh 0 0
297 Alat suntik 10 cc bh 0 0
298 Benang bedah / Cat gut -3/0 zak 0 0
299 Benang bedah sutra / Silk -3/0 zak 0 0
300 Benang ethicon / Prolene 5/0 zak 0 0
301 Etanol 70 % Btl 0 0
302 Ethanol 70 % 100 ml btl 8 0 8 2 6
303 Etil Klorida semprot btl 0 0
304 Film X ray 24x 30 box 0 0
305 Film X ray 40x 30 box 0 0
306 Film X ray 35 x 35 box 0 0
307 Foley catheter bh 0 0
308 Hand scund S / M bok 0 0 0 0 0
309 Infusion set anak Set 0 0
310 Infusion set dewasa Set 0 0
311 Jarum Heating otot 1/2 lingkaran Biji 0 0
312 Jarum Heating otot 12,13.14 Biji 0 0
313 Jarum Heating kulit 12,13.14 Biji 0 0
314 Jelly unt doppler ( Doppler Jell 0 btl 0 0
315 Kapas Alkohol /Alkohol sweeb box 0 0 0 0
316 Kapas pembalut 250 mg roll 0 0 0 0
317 Kasa pembalut 40 x 40 steril roll 0 0
318 Kasa pembalut 2 x 80 cm roll 0 0
319 Kasa pmbalt hidrfil 4m x 15 cm roll 0 0
320 Kasa pembalut 4 m x 3 cm roll 0 0
321 Kasa hidrofil 16/16 steril box 0 0
322 kassa gulungan 40 yard x 80 cm roll 0 0
323 Kertas Puyer SCI Lbr 0 0
324 Kondum gros 0 0
325 Klip Obat K pak 0 0
326 Klip Obat B Lbr 0 0
327 Klip Obat T pak 0 0
328 Lisol Btl 0 0
329 Masker tali karet / tali biasa box 1 1 0 1
330 masker N 95 bh 0 0
331 Nurse cup (Disposible head cup ) box 0 0
332 Oksigen gas dalam tabung Tabung 0 0
333 Oksigen kalengan klg 0 0
334 Pembalut Ibu Bersalin buah 0 0
335 Perhidrol / H2O2 Btl 0 0
336 Plester 5 yards x 2 inch roll 0 0 0 0 0
337 Plester Ultravix 5 cm x 5 mm bh 1 1 1
338 Pisau Bedah no 10, 11 ,12 pcs 0 0
339 Reagen Developer box 0 0
340 Reagen Fixer box 0 0
341 Sopratul box 0 0 0 0 0
342 Sarung tangan Obgyn pcs 0 0 0 0
343 safety box bh 0 0
344 Tranfusi set bh 0 0
345 Tensocrip roll 0 0
346 Urine Bag buah 0 0
347 Umbilikor / klem tali pusat buah 0 0
348 Underpad box 0 0
349 wing Needle 25 G buah 0 0
350 Yodium povidon larutan 10 % 300 Btl 0 0 0 0
351 Yodium povidon larutan 10% 30ml Btl 0 0 0 0

JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR PHB
11 41 3 55

Mengetahui / menyetujui Yang Menyerahkan Yang Meminta/Pelapor


Pimpinan Puskesmas Mengwi III Petugas Gudang Puskesmas Petugas Pustu

(dr.Komang Widia Asmawan,S.Ked) (Kd.Suryaning Ayu) (Ni.Ketut Suarnadi)


NIP : 19791202 200501 1 010 NIP.19820708 200604 2016
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
SUB - UNIT PELAYANAN
SUB UNIT : PUSTU PENARUNGAN
UPT PUSKESMAS : MENGWI III DOKUME NO TGL
KECAMATAN : MENGWI PELAPORAN BULAN : Januari 2017 PUSKESMAS
KABUPATEN : BADUNG PERMINTAAN BULAN : Pebruari 2017 sub unit

SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE KET


NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
1 Acyclovir 400 mg Tab 0 0 0 0
2 Acyclovir salep kulit 5 % tube 0 0 0 0
3 Albendazol 400 mg Tab 0 0 0 0
4 Alopurinol 100 mg Tab 0 0 0 0
5 Ambroxol syr 5 mg / 5 ml Btl 0 0 0 0
6 Ambroxol tab 30 mg tab 1000 1000 33 967
7 Aminofilina tablet 200 mg Tab 0 0
8 Amlodipin 5 mg Tab 0 0 0 0
9 Amoxsisilina kap 500 mg Tab 0 1000 1000 210 790
10 Amoxsisilina kap 250 mg Kap 0 0
11 Amoxsisilina sirup kering 125 mg Btl 5 15 20 4 16
12 Amoxsisilina drop 100 mg/ml Btl 0 0 0 0
As.Salicylsat 2% + Belerang 4 % (2-4) salep
13 pot 0 0
14 Astaxanthin 4 mg Tab 0 0 0 0
15 Antalgin ( metampiron ) Tab 0 0
16 Alletrol Tetes Mata btl 0 0
17 Antasid syr btl 0 0 0 0 0
18 Antasida doen tablet, Tab 120 400 520 100 420
19 Anti hemmoroid supp supp 0 10 10 0 10
20 Antimigren ( Ergotamin ,caffein ) tab 0 0 0 0
21 Antiscabies / gamexan salp Tube 0 0
22 Asam Ascorbat ( vit c ) tab 50 mg Tab 161 200 361 125 236
23 Asam Folat 400 mcg Tab 0 0
24 As. Mefenamat 500 mg Tab 0 0 0 0
25 Acetosal 100 mg Tab 0 0
26 Attapulgite active 600 mg Tab 0 0
27 Azetromicyn tab 500 mg Tab 0 0
28 Bacitracin - Poly SK Tube 0 0 0 0
29 Benzatin Bensil Penisillin inj vial 0 0
30 Besi II sulfat ( tablet tambah darah ) Tab 70 70 70
31 Betahistin tab 6 mg Tab 0 0 0 0
32 Betamethason krim 0,1 % Tube 0 0 0 0 0 0
33 Bisacodyl supp 10 mg sup 0 0
34 Borax Glycerin 5 % Btl 0 0
35 Balsem kaki 3 Btl 0 0
36 Captopril 12,5 mg Tab 0 0
37 Captopril 25 mg Tab 155 100 255 77 178 0
38 Ceterizine 10 mg tab 0 0
39 Counterpaint cr tube 0 0
40 Clobazam 40 mg Tab 0 0
41 Clorpromazina hcl tab ( CPZ ) 100 mg Tab 0 0
42 Clorpromazin HCl tab ( CPZ) 25 mg Tab 0 0
43 Dexamethason inj 5 mg/ml-1 ml Amp 0 0 0
44 Dexamethason 0,5 mg Tab 0 600 600 281 319 0
45 Desoksimetason tube 0 0
46 Dextrose 40 % steril Btl 0 0
47 Diazepam 2 mg Tab 0 0 0 0
48 Diazepam inj 5mg/ml Ampul 0 0
49 Diazepam rectal 5 mg/2,5 ml Tube 0 0
50 Diphenhidramin hcl inj 10 mg/1 ml Amp 0 0 0
51 Digoxin tab 0.25 mg Tab 0 0
52 Doxysyclin 100 mg tab 0 0
53 Domperidon drop btl 0 0
54 Domperidon syr 5 mg / 5 ml btl 0 0
55 Efedrin hcl tab 25 mg Tab 0 0
56 Epineprin hcl ( adrenalina ) inj 0.1%-1 ml Amp 0 0 0
57 Erytromicin 500 mg Tab 0 0
58 Erytromicin syr 200mg/5ml Btl 0 0
59 Furossemid tab 40 mg Tab 0 0
60 Fluconazole 150 mg tab 0 0
61 Fitominadion (Vit K) inj 2 mg/1ml Amp 0 0
62 Fenobarbital tab 30 mg Tab 0 0
63 Fenol gliseron Tts Telinga Btl 0 0
64 Fitominadion ( vit k1) inj 10 mg/ml-1ml
Amp 0 0
65 Fitominadion ( vit k1) tab salut 10 m Tab 0 0
66 Garam Oralit 200 ml air Sach 198 0 198 24 174 0
67 Gentamisin sulfat TM 0,3 % Btl 6 6 6
68 Gentamicin salep kulit Tube 0 0
69 Gentian Violet larutan 1 % Btl 0 0
70 Glibenklamid tab 5 mg Tab 0 0 0 0 0
71 Glimepiride 1mg tab 0 0
72 Glimepiride 2 mg tab 0 0
73 Gliseril guaiakolat tab 100 mg Tab 0 0
74 Glukosa larutan infus 10 % steril Btl 0 0
75 Glukosa larutan infus 5 % steril Btl 0 0
76 Griseofulvin tab 125 mg Tab 0 0
77 Haloperidol 0,5 mg Tab 0 0
78 Haloperidol 1,5 mg Tab 0 0
79 Haloperidol tablet 5 mg Tab 0 0
80 Hidroklorotiazida (hct) tab 25 mg Tab 0 0
81 Hidrokortison krim 2.5 % Tube 1 24 25 6 19
82 Hyocine-N-butilbr / Scopma tab 10 Tab 0 0
83 Hyoscine-N-B Inj /Buscopan inj 20mg Amp 0 0
84 Ibuprofen tab 200 mg Tab 0 0
85 Ibuprofen tab 400 mg Tab 200 0 200 0 200
86 Ibuprofen Syr Btl 0 0
87 Isosorbid dinitrat 5 mg tab 0 0
88 IZONIASIDA ( INH) 100 MG Tab 0 0
89 Kalium permanganat (PK) Pot 0 0
90 Kalium Diklopenak 50 mg tab 0 0
91 Kalsium laktat ( kalk ) tab 500 mg Tab 0 0
92 Kalsium Glukonas10 % inj Vial 5 5 5
93 Ketokenazol krim 2 % tube 0 0 0 0 ..
94 Ketokenazol tab 200 mg tab 0 0 0 0
95 Ketorolac inj 30 mg Amp 0 0
96 Klindamicin 150 mg tab 0 0
97 Klindamisin 300 mg Tab 0 0
98 Karbamazepin tablet 200 mg Tab 0 0
99 Kloramfenicol salp mata 1 % tube 17 17 5 12
100 Kloramphenikol Tetes Mata 0,5 % Btl 0 0
101 Kloramfenikol tts Telinga 3 % Btl 0 14 14 1 13
102 Klorfeniramini maleat (ctm) tab 4 m Tab 840 200 1040 188 852
103 Kotrimoksazol kombinasi 480 mg Tab 48 100 148 84 64
104 Kotrimoksazol suspensi Btl 8 10 18 4 14
105 KB Suntik 1 bln Vial 0 0
106 KB IUD bh 0 0
107 KB PIL stp 0 0
108 KB SUSUK / inflan infl 0 0
109 Lidokain inj 2 % Amp 5 0 5 0 5
110 Lidokain com inj 2% Amp 0 0 0 0
111 Loveramid tab 2 mg tab 0 0 0 0 0
112 Loratadin tab10 mg tab 0 0 0 0
113 Mg SO4 40 % ( 25 ml ) Vial 5 5 5
114 MgSO4 injeksi 20% Vial 0 0
115 Meloksikam 7,5 mg Tab 0 0 0 0
116 Meloksikam 15 mg Tab 0 0
117 Metformin tab 500 mg Tab 0 0 0 0
118 Metil ergometrina maleat inj 0.200 mg/ml-1ml Amp 0 0
119 Metil ergometrina maleat tab salut 0.125 mg tab 0 0
120 Methyl Prednisolon 4 mg tab 0 0 0 0 0
121 Metoklopramid Hcl 5 mg tab 0 0
122 Metoklopramid Hcl syr 5 mg/5ml btl 7 7 7
123 Metoklopramid inj 5mg/2ml Amp 0 0
124 Metronidazol 500 mg Tab 0 0 0 0
125 Metronidazol supp ( flagyl ) 0.5 gr sup 0 0
126 Miconazol crm 2 % tube 0 0 0 0
127 MDT Combi ( obat kusta ) paket 0 0
128 Multivitamin syr / Procuma btl 28 0 28 2 26
129 Multivitamin tab(vitacaps) tab 200 200 42 158
130 Narium Tiroksin tab 0 0
131 Natrium klorida larutan infus 0.9 % steril Btl 1 1 1 0
132 Na Diklopenac 25 mg tab 0 0
133 Na Diklofenac 50 mg Tab 0 0 0 0 0
134 Nipedipin tab 0 0
135 Nistatin 100.000 Iu/g/tab vaginal tab 7 7 7
136 NB Salp Tube 0 0
137 Obat Batuk Hitam Btl 0 0
138 Obat batuk kering/dextrofen btl 0 0 0 0
139 Obat Flu sirup/erpaflu btl 0 0 0 0
140 Obat Flu tablet/coparcetin Tab 0 0 0 0
141 Oksitetrasiklin hc salep 3 % Tube 0 0
142 Oksitetrasiklin hcl salep mata 1 % Tube 0 0
143 Oksitosin inj 10 iU ( 1 ml ) Amp 1 1 0 1
144 Omeprazol 20 mg Tab 0 0 0 0
145 Osedantron inj Amp 0 0
146 Osedantron tab 8 mg Tab 0 0
147 Oseltamivir 75 mg Tab 0 0
148 Papverin tab Tab 0 0
149 Parasetamol sirup 120 mg/ 5 ml Btl 1 30 31 12 19
150 Parasetamol tab 500 mg Tab 380 1500 1880 487 1393
151 Paracetamol drop 100 mg/ ml Btl 0 0 0 0
152 Paracetamol rectal 125 mg Tube 0 0 0
153 Perak sulfadiazin 1 % / Burnazin cr Tube 0 0
154 Pyrantel syr btl 0 0
155 Piridoxin hcl (vit b6) tab 10 mg Tab 630 630 70 560
156 Piroxicam 20 mg cap 100 100 100
157 Piroxicam 10 mg cap 0 0
158 Polycresulen / Albothyl/ Aptil Btl 0 0 0 0
159 Prednison tab 5 mg Tab 292 500 792 45 747
160 Ranitidin 150 mg Tab 0 0 0
161 Ranitidin inj 25 mg/2 ml Vial 0 0
162 Retinol ( vit A ) kaps lunak 100.000 I Kap 0 0
163 Retinol ( vit A ) kaps lunak 200.000 I Kap 0 0
164 Ringer laktat lrt inf steril ( RL ) Btl 2 0 2 0 2
165 Resperidon 2 tab tab 0 0
166 salbutamol 4 mg tab 0 0 0 0
167 salbutamol 2 mg tab 0 0 0 0
168 salbutamol nebulizer 2.5 mg Amp 0 0 0
169 Salbutamol inhaler btl 0 0
170 Salisil bedak 2 % Sak 8 12 20 6 14
171 Sefadroxyl 500 mg tab 0 0
172 Sefadroxyl syr kering 250 mg/5ml btl 0 0
173 Sefiksim 100 mg tab 0 0
174 Serum Anti Bisa Ular ( ABU ) vial 0 0
175 Serum anti tetanus(tetagam) 250 IU Amp 0 0 0 0
176 Sianokobalamina (vit B12 ) inj Amp 0 0
177 Simetidin 200 mg Tab 0 0
178 Sinvastatin tab 10 mg tab 0 0
179 Siproploxacin 500 mg Tab 0 0 0 0 0
180 Sucralfate 500 mg /Mucogard tab Tab 0 0
181 Sucralfat suspensi ( Mucogard susp ) btl 0 0
182 Sulfasetamid Tetes mata 15 % Btl 0 0
183 Salep perawatan luka (bioplacenton) tube 0 0 0 0
184 Tetrasiklina hcl kapsul 500 mg Kap 0 0
185 Triflouperazin ( Stelazin ) 5 mg Tab 0 0
186 Thiamin hcl inj 100 mg/ml - 1 ml Amp 0 0
187 Thiamin hcl ( vit B1)tab 50 mg Tab 210 1000 1210 170 1040
188 Thiamfenicol 500 mg Tab 0 0
189 Trihexipenidil 2 mg Tab 0 0
190 Vitamin B complek tab Tab 9 1200 1209 337 872
191 Vit Neurotrofic tablet 5000 mg (sohobi tab 0 0 0 0
192 Vit Neurotrofic inj 5000 mg Amp 0 0
193 Vitamin imunitas (Imunogard ) tab 0 0 0 0
194 Zink tab 20 mg Tab 120 0 120 0 120
195 Zink drop 10 mg/ml btl 0 0
196 Zink syr ( Zirkum ) btl 0 0
Bisacodyl tab tab 0 0 0 0
VAKSIN 0 0
197 HB Uniject vial 0 0
198 BCG vial 0 0
199 CAMPAK vial 0 0
200 POLIO vial 0 0
201 Pentabio vial 0 0
202 DT vial 0 0
203 TT vial 0 0
204 TD vial 0 0
205 IPV vial 0 0
206 VAKSIN Anti Rabies ( VAR ) vial 0 0
OBAT PROGRAM TBC 0 0
207 Anti TBC Anak paket 0 0
208 Anti TBC I / FDC paket 0 0
209 Anti TBC II / FDC paket 0 0
210 kombipak katagori I paket 0 0
OBAT PROGRAM ARV 0 0
211 ALUVIA ( Liponavir 200mg + ritonavi tab 0 0
212 DUVIRAL( Lamifudin150 mg+zidofudin tab 0 0
213 Efavirenz 600 mg tab 0 0
FDC ( Tenofovir 300mg+lamivudin 300
214 mg + efavirenz 600 mg) tab 0 0
215 Lamivudine ( Hiviral ) 150 mg tab 0 0
216 Nevirapine ( Neviral ) 200 mg tab 0 0
217 Tenofovir Disoproxil Fumarate (TDF) 30 tab 0 0
218 Abacavir tab 0 0
219 Triplepediatrik tab 0 0
GIGI 0 0
220 Bonding Btl 0 0
221 Bur Gigi ( Longseng Bur ) bh 0 0
222 Bur Gigi ( Fisure Bur ) bh 0 0
223 Bur Gigi (Round Bur ) bh 0 0
224 Bur Gigi ( Inverted Bur ) bh 0 0
225 CHKM (Sterilisasi Akar) Btl 0 0
226 Cresopate ( Munifying pasta) Btl 0 0
227 Devitalisasi pasta (non arsen ) Btl 0 0
228 Eugenol cairan Btl 0 0
229 Endomethason N ( Munifying pasta Btl 0 0
230 Etsa Btl 0 0
231 Fuji /Glas Ionomer / ketak molar Btl 0 0
232 Iodoform pasta / calplus syringe 0 0
233 Semen seng fosf. Serbuk & cairan Btl 0 0
234 Rocle (Sterilisasi Akar) Btl 0 0
235 Tumpatan sementara ( Cavit) Btl 0 0
236 Tumpatan permanen / Composit Btl 0 0
237 Temporary stopping Fletcher Btl 0 0
238 TKF (Sterilisasi Akar) Btl 0 0
239 Tumpatan permanen / Composit A3 Btl 0 0
240 Tincture pidofilin 80-90 % Btl 0 0
LABORATORIUM 0 0
241 Asam acetat 100 ml Btl 0 0
242 Cover glass bh 0 0
243 Control N 2,5 ml bh 0 0
244 Eosin Btl 0 0
245 Giemza Btl 0 0
246 Jarum stik gula / Blood lounchet bh 0 0
247 Jarum Vacumtainer ( needle 22 G ) bh 0 0
248 Jarum CD 4 bh 0 0
249 Kaca Slide /slide forstead box 0 0
250 Kertas lakmus ( Test paper ) pak 0 0
251 KOH 100 ml Btl 0 0
252 Kertas Ph vagina 0.2 box 0 0
253 M emersi btl 0 0
254 Menthanol btl 0 0
255 Methylen blue btl 0 0
256 Natrium klorida btl 500 ml Btl 0 0
257 Pot dahak bh 0 0
258 Pipet Tip Yellow pcs 0 0
259 Plesterin box 0 0
260 Reagen Widal test set 0 0
261 Reagen gol darah A & B Btl 0 0
262 Reagen ZN / BTA set 0 0
263 Reagen HIV I pcs 0 0
264 Reagen HIV II pcs 0 0
265 Reagen HIV III pcs 0 0
266 Reagen kimia darah pcs 0 0
267 RPR set 0 0
268 Reagen CD4 set 0 0
269 Reagen Erma set 0 0
270 Reagen Control mynthic set 0 0
271 Reagen SFR I set 0 0
272 Stik asam urat bh 0 0
273 Stik Kolesterol bh 0 0
274 Stik Gula darah bh 0 0
275 Stik urine 11( Pemriksaan urine lengkap ) bh 0 0
276 Stik Rapid test untuk sipilis stik 0 0
277 Stik test kehamilan /PP. test stik 0 0
278 SD Bioline Sphylis ( TPHA) set 0 0
279 Tissue kaca slide/ tisu lensa box 0 0
280 Thermal peper 30 mtr roll 0 0
281 Tabung reaksi 3 ml disposible box 0 0
282 Tabung vacum tutup ungu ( EDTA ) bh 0 0
283 Tabung serum( tutup merah) bh 0 0
284 Tabung Serum dg gel (tutup kuning) bh 0 0
285 Tabung glukosa ( tutup abu-abu) bh 0 0
286 Tincture pidofilin 80-90 % btl 0 0
Rapid tes Dengue Nsi Ag 0 0 0 0
Rapid tes Dengue Duo 0 0 0 0

BAHAN HABIS PAKAI 0 0


287 Abocat 18 ( Iv Catheter 18 ) bh 0 0
288 Abocat 20 ( Iv Catheter 20 ) bh 0 0
289 Abocat 22 ( Iv Catheter 22 ) bh 0 0
290 Abocat 24 ( Iv Catheter 24 ) bh 0 0
291 Aqua pro injeksi vial 0 0
292 Alat suntik 0,5 cc bh 0 0
293 Alat suntik 0,05 cc bh 0 0
294 Alat suntik 1 cc bh 0 0
295 Alat suntik 3 cc box 0 0
296 Alat suntik 5 cc bh 0 0
297 Alat suntik 10 cc bh 0 0
298 Benang bedah / Cat gut -3/0 zak 0 0
299 Benang bedah sutra / Silk -3/0 zak 0 0
300 Benang ethicon / Prolene 5/0 zak 0 0
301 Etanol 70 % Btl 0 0
302 Ethanol 70 % 100 ml btl 1 10 11 4 7
303 Etil Klorida semprot btl 0 0
304 Film X ray 24x 30 box 0 0
305 Film X ray 40x 30 box 0 0
306 Film X ray 35 x 35 box 0 0
307 Foley catheter bh 0 0
308 Hand scund S / M bok 1 0 1 0 1
309 Infusion set anak Set 0 0
310 Infusion set dewasa Set 0 0
311 Jarum Heating otot 1/2 lingkaran Biji 0 0
312 Jarum Heating otot 12,13.14 Biji 0 0
313 Jarum Heating kulit 12,13.14 Biji 0 0
314 Jelly unt doppler ( Doppler Jell 0 btl 0 0
315 Kapas Alkohol /Alkohol sweeb box 0 0 0 0
316 Kapas pembalut 250 mg roll 0 0 0 0
317 Kasa pembalut 40 x 40 steril roll 0 0
318 Kasa pembalut 2 x 80 cm roll 0 0
319 Kasa pmbalt hidrfil 4m x 15 cm roll 0 0
320 Kasa pembalut 4 m x 3 cm roll 0 0
321 Kasa hidrofil 16/16 steril box 0 0
322 kassa gulungan 40 yard x 80 cm roll 0 0
323 Kertas Puyer SCI Lbr 0 0
324 Kondum gros 0 0
325 Klip Obat K pak 0 0
326 Klip Obat B Lbr 0 0
327 Klip Obat T pak 0 0
328 Lisol Btl 0 0
329 Masker tali karet / tali biasa box 0 0 0 0
330 masker N 95 bh 0 0
331 Nurse cup (Disposible head cup ) box 0 0
332 Oksigen gas dalam tabung Tabung 0 0
333 Oksigen kalengan klg 0 0
334 Pembalut Ibu Bersalin buah 0 0
335 Perhidrol / H2O2 Btl 0 0
336 Plester 5 yards x 2 inch roll 0 0 0 0 0
337 Plester Ultravix 5 cm x 5 mm bh 0 0 0
338 Pisau Bedah no 10, 11 ,12 pcs 0 0
339 Reagen Developer box 0 0
340 Reagen Fixer box 0 0
341 Sopratul box 1 0 1 0 1
342 Sarung tangan Obgyn pcs 0 0 0 0
343 safety box bh 0 0
344 Tranfusi set bh 0 0
345 Tensocrip roll 0 0
346 Urine Bag buah 0 0
347 Umbilikor / klem tali pusat buah 0 0
348 Underpad box 0 0
349 wing Needle 25 G buah 0 0
350 Yodium povidon larutan 10 % 300 m Btl 0 0 0 0
351 Yodium povidon larutan 10% 30ml Btl 0 0 0 0

JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR PHB
2 130 0 132

Mengetahui / menyetujui Yang Menyerahkan Yang Meminta/Pelapor


Pimpinan Puskesmas Mengwi III Petugas Gudang Puskesmas Petugas Pustu

(dr.Komang Widia Asmawan,S.Ked) (Kd.Suryaning Ayu) (Ni.Made Winten)


NIP : 19791202 200501 1 010 NIP.19820708 200604 2016 NIP.19611231 198210 2 026
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
SUB - UNIT PELAYANAN
SUB UNIT : PUSTU SADING
UPT PUSKESMAS : MENGWI III DOKUME NO TGL
KECAMATAN : MENGWI PELAPORAN BULAN : Januari 2017 PUSKESMAS
KABUPATEN : BADUNG PERMINTAAN BULAN : Pebruari 2017 sub unit

SATU STOK PENERI PERSE PEMA SISA PERMIN PEMBE KET


NO N A M A OBAT
AN AWAL MAAN DIAAN KAIAN STOK TAAN RIAN
1 Acyclovir 400 mg Tab 0 0 0 0
2 Acyclovir salep kulit 5 % tube 0 0 0 0
3 Albendazol 400 mg Tab 0 0 0 0
4 Alopurinol 100 mg Tab 0 0 0 0
5 Ambroxol syr 5 mg / 5 ml Btl 7 7 7 0
6 Ambroxol tab 30 mg tab 1000 1000 166 834
7 Aminofilina tablet 200 mg Tab 0 0
8 Amlodipin 5 mg Tab 0 0 0 0
9 Amoxsisilina kap 500 mg Tab 0 1000 1000 102 898
10 Amoxsisilina kap 250 mg Kap 0 0
11 Amoxsisilina sirup kering 125 mg/ Btl 21 21 6 15
12 Amoxsisilina drop 100 mg/ml Btl 0 0 0 0
As.Salicylsat 2% + Belerang 4 % (2-4) salep
13 pot 0 0
14 Astaxanthin 4 mg Tab 0 0 0 0
15 Antalgin ( metampiron ) Tab 0 0
16 Alletrol Tetes Mata btl 0 0
17 Antasid syr btl 6 0 6 0 6
18 Antasida doen tablet, Tab 315 500 815 240 575
19 Anti hemmoroid supp supp 0 10 10 0 10
20 Antimigren ( Ergotamin ,caffein ) tab 0 0 0 0
21 Antiscabies / gamexan salp Tube 0 0
22 Asam Ascorbat ( vit c ) tab 50 mg Tab 132 200 332 57 275
23 Asam Folat 400 mcg Tab 0 0
24 As. Mefenamat 500 mg Tab 600 600 400 200
25 Acetosal 100 mg Tab 0 0
26 Attapulgite active 600 mg Tab 0 0
27 Azetromicyn tab 500 mg Tab 0 0
28 Bacitracin - Poly SK Tube 6 6 2 4
29 Benzatin Bensil Penisillin inj vial 0 0
30 Besi II sulfat ( tablet tambah darah ) Tab 0 0
31 Betahistin tab 6 mg Tab 0 0 0 0
32 Betamethason krim 0,1 % Tube 0 0 0 0 0 0
33 Bisacodyl supp 10 mg sup 0 0
34 Borax Glycerin 5 % Btl 0 0
35 Balsem kaki 3 Btl 0 0
36 Captopril 12,5 mg Tab 0 0
37 Captopril 25 mg Tab 101 200 301 90 211 0
38 Ceterizine 10 mg tab 0 0
39 Counterpaint cr tube 0 0
40 Clobazam 40 mg Tab 0 0
41 Clorpromazina hcl tab ( CPZ ) 100 mg Tab 0 0
42 Clorpromazin HCl tab ( CPZ) 25 mg Tab 0 0
43 Dexamethason inj 5 mg/ml-1 ml Amp 0 0 0
44 Dexamethason 0,5 mg Tab 219 500 719 374 345 0
45 Desoksimetason tube 0 0
46 Dextrose 40 % steril Btl 0 0
47 Diazepam 2 mg Tab 0 0 0 0
48 Diazepam inj 5mg/ml Ampul 0 0
49 Diazepam rectal 5 mg/2,5 ml Tube 0 0
50 Diphenhidramin hcl inj 10 mg/1 ml Amp 0 0 0
51 Digoxin tab 0.25 mg Tab 0 0
52 Doxysyclin 100 mg tab 0 0
53 Domperidon drop btl 0 0
54 Domperidon syr 5 mg / 5 ml btl 0 0
55 Efedrin hcl tab 25 mg Tab 0 0
56 Epineprin hcl ( adrenalina ) inj 0.1%-1 ml Amp 0 0 0
57 Erytromicin 500 mg Tab 0 0
58 Erytromicin syr 200mg/5ml Btl 0 0
59 Furossemid tab 40 mg Tab 0 0
60 Fluconazole 150 mg tab 0 0
61 Fitominadion (Vit K) inj 2 mg/1ml Amp 0 0
62 Fenobarbital tab 30 mg Tab 0 0
63 Fenol gliseron Tts Telinga Btl 0 0
64 Fitominadion ( vit k1) inj 10 mg/ml-1mlAmp 0 0
65 Fitominadion ( vit k1) tab salut 10 mg Tab 0 0
66 Garam Oralit 200 ml air Sach 121 0 121 0 121 0
67 Gentamisin sulfat TM 0,3 % Btl 0 0
68 Gentamicin salep kulit Tube 0 0
69 Gentian Violet larutan 1 % Btl 0 0
70 Glibenklamid tab 5 mg Tab 20 100 120 10 110
71 Glimepiride 1mg tab 0 0
72 Glimepiride 2 mg tab 0 0
73 Gliseril guaiakolat tab 100 mg Tab 0 0
74 Glukosa larutan infus 10 % steril Btl 0 0
75 Glukosa larutan infus 5 % steril Btl 0 0
76 Griseofulvin tab 125 mg Tab 0 0
77 Haloperidol 0,5 mg Tab 0 0
78 Haloperidol 1,5 mg Tab 0 0
79 Haloperidol tablet 5 mg Tab 0 0
80 Hidroklorotiazida (hct) tab 25 mg Tab 0 0
81 Hidrokortison krim 2.5 % Tube 6 24 30 6 24
82 Hyocine-N-butilbr / Scopma tab 10 m Tab 0 0
83 Hyoscine-N-B Inj /Buscopan inj 20mg/m Amp 0 0
84 Ibuprofen tab 200 mg Tab 0 0
85 Ibuprofen tab 400 mg Tab 365 500 865 366 499
86 Ibuprofen Syr Btl 0 0
87 Isosorbid dinitrat 5 mg tab 0 0
88 IZONIASIDA ( INH) 100 MG Tab 0 0
89 Kalium permanganat (PK) Pot 0 0
90 Kalium Diklopenak 50 mg tab 0 0
91 Kalsium laktat ( kalk ) tab 500 mg Tab 0 0
92 Kalsium Glukonas10 % inj Vial 5 5 5
93 Ketokenazol krim 2 % tube 0 0 0 0 ..
94 Ketokenazol tab 200 mg tab 0 0 0 0
95 Ketorolac inj 30 mg Amp 0 0
96 Klindamicin 150 mg tab 0 0
97 Klindamisin 300 mg Tab 0 0
98 Karbamazepin tablet 200 mg Tab 0 0
99 Kloramfenicol salp mata 1 % tube 11 11 8 3
100 Kloramphenikol Tetes Mata 0,5 % Btl 0 0
101 Kloramfenikol tts Telinga 3 % Btl 11 11 2 9
102 Klorfeniramini maleat (ctm) tab 4 mg Tab 510 200 710 676 34
103 Kotrimoksazol kombinasi 480 mg Tab 392 392 10 382
104 Kotrimoksazol suspensi Btl 11 5 16 5 11
105 KB Suntik 1 bln Vial 0 0
106 KB IUD bh 0 0
107 KB PIL stp 0 0
108 KB SUSUK / inflan infl 0 0
109 Lidokain inj 2 % Amp 8 15 23 0 23
110 Lidokain com inj 2% Amp 0 0 0 0
111 Loveramid tab 2 mg tab 0 0 0 0 0
112 Loratadin tab10 mg tab 0 0 0 0
113 Mg SO4 40 % ( 25 ml ) Vial 5 5 5
114 MgSO4 injeksi 20% Vial 0 0
115 Meloksikam 7,5 mg Tab 0 0 0 0
116 Meloksikam 15 mg Tab 0 0
117 Metformin tab 500 mg Tab 0 0 0 0
118 Metil ergometrina maleat inj 0.200 mg/ml-1ml Amp 0 0
119 Metil ergometrina maleat tab salut 0.125 mg tab 0 0
120 Methyl Prednisolon 4 mg tab 0 0 0 0 0
121 Metoklopramid Hcl 5 mg tab 0 0
122 Metoklopramid Hcl syr 5 mg/5ml btl 8 8 8
123 Metoklopramid inj 5mg/2ml Amp 0 0
124 Metronidazol 500 mg Tab 160 160 10 150
125 Metronidazol supp ( flagyl ) 0.5 gr sup 0 0
126 Miconazol crm 2 % tube 4 4 1 3
127 MDT Combi ( obat kusta ) paket 0 0
128 Multivitamin syr / Procuma btl 18 0 18 4 14
129 Multivitamin tab(vitacaps) tab 300 300 65 235
130 Narium Tiroksin tab 0 0
131 Natrium klorida larutan infus 0.9 % steril Btl 1 1 1
132 Na Diklopenac 25 mg tab 0 0
133 Na Diklofenac 50 mg Tab 0 200 200 30 170
134 Nipedipin tab 0 0
135 Nistatin 100.000 Iu/g/tab vaginal tab 6 6 6
136 NB Salp Tube 0 0
137 Obat Batuk Hitam Btl 0 0
138 Obat batuk kering/dextrofen btl 0 0 0 0
139 Obat Flu sirup/erpaflu btl 0 0 0 0
140 Obat Flu tablet/coparcetin Tab 0 0 0 0
141 Oksitetrasiklin hc salep 3 % Tube 0 0
142 Oksitetrasiklin hcl salep mata 1 % Tube 0 0
143 Oksitosin inj 10 iU ( 1 ml ) Amp 2 2 2 0
144 Omeprazol 20 mg Tab 0 0 0 0
145 Osedantron inj Amp 0 0
146 Osedantron tab 8 mg Tab 0 0
147 Oseltamivir 75 mg Tab 0 0
148 Papverin tab Tab 0 0
149 Parasetamol sirup 120 mg/ 5 ml Btl 7 40 47 12 35
150 Parasetamol tab 500 mg Tab 756 200 956 422 534
151 Paracetamol drop 100 mg/ ml Btl 0 0 0 0
152 Paracetamol rectal 125 mg Tube 0 0 0
153 Perak sulfadiazin 1 % / Burnazin cr Tube 0 0
154 Pyrantel syr btl 0 0
155 Piridoxin hcl (vit b6) tab 10 mg Tab 514 514 74 440
156 Piroxicam 20 mg cap 0 0
157 Piroxicam 10 mg cap 0 0
158 Polycresulen / Albothyl/ Aptil Btl 0 0 0 0
159 Prednison tab 5 mg Tab 450 450 70 380
160 Ranitidin 150 mg Tab 0 0 0
161 Ranitidin inj 25 mg/2 ml Vial 0 0
162 Retinol ( vit A ) kaps lunak 100.000 Iu Kap 0 0
163 Retinol ( vit A ) kaps lunak 200.000 Iu Kap 0 0
164 Ringer laktat lrt inf steril ( RL ) Btl 0 0 0 0
165 Resperidon 2 tab tab 0 0
166 salbutamol 4 mg tab 0 0 0 0
167 salbutamol 2 mg tab 0 0 0 0
168 salbutamol nebulizer 2.5 mg Amp 0 0 0
169 Salbutamol inhaler btl 0 0
170 Salisil bedak 2 % Sak 20 20 3 17
171 Sefadroxyl 500 mg tab 0 0
172 Sefadroxyl syr kering 250 mg/5ml btl 0 0
173 Sefiksim 100 mg tab 0 0
174 Serum Anti Bisa Ular ( ABU ) vial 0 0
175 Serum anti tetanus(tetagam) 250 IU / Amp 0 0 0 0
176 Sianokobalamina (vit B12 ) inj Amp 0 0
177 Simetidin 200 mg Tab 0 0
178 Sinvastatin tab 10 mg tab 0 0
179 Siproploxacin 500 mg Tab 0 0 0 0 0
180 Sucralfate 500 mg /Mucogard tab Tab 0 0
181 Sucralfat suspensi ( Mucogard susp ) btl 0 0
182 Sulfasetamid Tetes mata 15 % Btl 0 0
183 Salep perawatan luka (bioplacenton) tube 0 0 0 0
184 Tetrasiklina hcl kapsul 500 mg Kap 0 0
185 Triflouperazin ( Stelazin ) 5 mg Tab 0 0
186 Thiamin hcl inj 100 mg/ml - 1 ml Amp 0 0
187 Thiamin hcl ( vit B1)tab 50 mg Tab 498 600 1098 230 868
188 Thiamfenicol 500 mg Tab 0 0
189 Trihexipenidil 2 mg Tab 0 0
190 Vitamin B complek tab Tab 724 200 924 300 624
191 Vit Neurotrofic tablet 5000 mg (sohobion tab 0 0 0 0
192 Vit Neurotrofic inj 5000 mg Amp 0 0
193 Vitamin imunitas (Imunogard ) tab 0 0 0 0
194 Zink tab 20 mg Tab 186 0 186 94 92
195 Zink drop 10 mg/ml btl 0 0
196 Zink syr ( Zirkum ) btl 0 0
Bisacodyl tab tab 0 0 0 0
VAKSIN 0 0
197 HB Uniject vial 0 0
198 BCG vial 0 0
199 CAMPAK vial 0 0
200 POLIO vial 0 0
201 Pentabio vial 0 0
202 DT vial 0 0
203 TT vial 0 0
204 TD vial 0 0
205 IPV vial 0 0
206 VAKSIN Anti Rabies ( VAR ) vial 0 0
OBAT PROGRAM TBC 0 0
207 Anti TBC Anak paket 0 0
208 Anti TBC I / FDC paket 0 0
209 Anti TBC II / FDC paket 0 0
210 kombipak katagori I paket 0 0
OBAT PROGRAM ARV 0 0
211 ALUVIA ( Liponavir 200mg + ritonavir tab 0 0
212 DUVIRAL( Lamifudin150 mg+zidofudin 30 tab 0 0
213 Efavirenz 600 mg tab 0 0
FDC ( Tenofovir 300mg+lamivudin 300
214 mg + efavirenz 600 mg) tab 0 0
215 Lamivudine ( Hiviral ) 150 mg tab 0 0
216 Nevirapine ( Neviral ) 200 mg tab 0 0
217 Tenofovir Disoproxil Fumarate (TDF) 300 tab 0 0
218 Abacavir tab 0 0
219 Triplepediatrik tab 0 0
GIGI 0 0
220 Bonding Btl 0 0
221 Bur Gigi ( Longseng Bur ) bh 0 0
222 Bur Gigi ( Fisure Bur ) bh 0 0
223 Bur Gigi (Round Bur ) bh 0 0
224 Bur Gigi ( Inverted Bur ) bh 0 0
225 CHKM (Sterilisasi Akar) Btl 0 0
226 Cresopate ( Munifying pasta) Btl 0 0
227 Devitalisasi pasta (non arsen ) Btl 0 0
228 Eugenol cairan Btl 0 0
229 Endomethason N ( Munifying pasta ) Btl 0 0
230 Etsa Btl 0 0
231 Fuji /Glas Ionomer / ketak molar Btl 0 0
232 Iodoform pasta / calplus syringe 0 0
233 Semen seng fosf. Serbuk & cairan Btl 0 0
234 Rocle (Sterilisasi Akar) Btl 0 0
235 Tumpatan sementara ( Cavit) Btl 0 0
236 Tumpatan permanen / Composit Btl 0 0
237 Temporary stopping Fletcher Btl 0 0
238 TKF (Sterilisasi Akar) Btl 0 0
239 Tumpatan permanen / Composit A3 Btl 0 0
240 Tincture pidofilin 80-90 % Btl 0 0
LABORATORIUM 0 0
241 Asam acetat 100 ml Btl 0 0
242 Cover glass bh 0 0
243 Control N 2,5 ml bh 0 0
244 Eosin Btl 0 0
245 Giemza Btl 0 0
246 Jarum stik gula / Blood lounchet bh 0 0
247 Jarum Vacumtainer ( needle 22 G ) bh 0 0
248 Jarum CD 4 bh 0 0
249 Kaca Slide /slide forstead box 0 0
250 Kertas lakmus ( Test paper ) pak 0 0
251 KOH 100 ml Btl 0 0
252 Kertas Ph vagina 0.2 box 0 0
253 M emersi btl 0 0
254 Menthanol btl 0 0
255 Methylen blue btl 0 0
256 Natrium klorida btl 500 ml Btl 0 0
257 Pot dahak bh 0 0
258 Pipet Tip Yellow pcs 0 0
259 Plesterin box 0 0
260 Reagen Widal test set 0 0
261 Reagen gol darah A & B Btl 0 0
262 Reagen ZN / BTA set 0 0
263 Reagen HIV I pcs 0 0
264 Reagen HIV II pcs 0 0
265 Reagen HIV III pcs 0 0
266 Reagen kimia darah pcs 0 0
267 RPR set 0 0
268 Reagen CD4 set 0 0
269 Reagen Erma set 0 0
270 Reagen Control mynthic set 0 0
271 Reagen SFR I set 0 0
272 Stik asam urat bh 0 0
273 Stik Kolesterol bh 0 0
274 Stik Gula darah bh 0 0
275 Stik urine 11( Pemriksaan urine lengkap ) bh 0 0
276 Stik Rapid test untuk sipilis stik 0 0
277 Stik test kehamilan /PP. test stik 0 0
278 SD Bioline Sphylis ( TPHA) set 0 0
279 Tissue kaca slide/ tisu lensa box 0 0
280 Thermal peper 30 mtr roll 0 0
281 Tabung reaksi 3 ml disposible box 0 0
282 Tabung vacum tutup ungu ( EDTA ) bh 0 0
283 Tabung serum( tutup merah) bh 0 0
284 Tabung Serum dg gel (tutup kuning) bh 0 0
285 Tabung glukosa ( tutup abu-abu) bh 0 0
286 Tincture pidofilin 80-90 % btl 0 0
Rapid tes Dengue Nsi Ag 0 0 0 0
Rapid tes Dengue Duo 0 0 0 0

BAHAN HABIS PAKAI 0 0


287 Abocat 18 ( Iv Catheter 18 ) bh 0 0
288 Abocat 20 ( Iv Catheter 20 ) bh 0 0
289 Abocat 22 ( Iv Catheter 22 ) bh 0 0
290 Abocat 24 ( Iv Catheter 24 ) bh 0 0
291 Aqua pro injeksi vial 0 0
292 Alat suntik 0,5 cc bh 0 0
293 Alat suntik 0,05 cc bh 0 0
294 Alat suntik 1 cc bh 0 0
295 Alat suntik 3 cc box 0 0
296 Alat suntik 5 cc bh 0 0
297 Alat suntik 10 cc bh 0 0
298 Benang bedah / Cat gut -3/0 zak 0 0
299 Benang bedah sutra / Silk -3/0 zak 0 0
300 Benang ethicon / Prolene 5/0 zak 0 0
301 Etanol 70 % Btl 0 0
302 Ethanol 70 % 100 ml btl 8 0 8 3 5
303 Etil Klorida semprot btl 0 0
304 Film X ray 24x 30 box 0 0
305 Film X ray 40x 30 box 0 0
306 Film X ray 35 x 35 box 0 0
307 Foley catheter bh 0 0
308 Hand scund S / M bok 1 0 1 1 0
309 Infusion set anak Set 0 0
310 Infusion set dewasa Set 0 0
311 Jarum Heating otot 1/2 lingkaran Biji 0 0
312 Jarum Heating otot 12,13.14 Biji 0 0
313 Jarum Heating kulit 12,13.14 Biji 0 0
314 Jelly unt doppler ( Doppler Jell 0 btl 0 0
315 Kapas Alkohol /Alkohol sweeb box 0 0 0 0
316 Kapas pembalut 250 mg roll 0 0 0 0
317 Kasa pembalut 40 x 40 steril roll 0 0
318 Kasa pembalut 2 x 80 cm roll 0 0
319 Kasa pmbalt hidrfil 4m x 15 cm roll 0 0
320 Kasa pembalut 4 m x 3 cm roll 0 0
321 Kasa hidrofil 16/16 steril box 0 0
322 kassa gulungan 40 yard x 80 cm roll 0 0
323 Kertas Puyer SCI Lbr 0 0
324 Kondum gros 0 0
325 Klip Obat K pak 0 0
326 Klip Obat B Lbr 0 0
327 Klip Obat T pak 0 0
328 Lisol Btl 0 0
329 Masker tali karet / tali biasa box 3 3 1 2
330 masker N 95 bh 0 0
331 Nurse cup (Disposible head cup ) box 0 0
332 Oksigen gas dalam tabung Tabung 0 0
333 Oksigen kalengan klg 0 0
334 Pembalut Ibu Bersalin buah 0 0
335 Perhidrol / H2O2 Btl 0 0
336 Plester 5 yards x 2 inch roll 3 0 3 0 3
337 Plester Ultravix 5 cm x 5 mm bh 2 2 2
338 Pisau Bedah no 10, 11 ,12 pcs 0 0
339 Reagen Developer box 0 0
340 Reagen Fixer box 0 0
341 Sopratul box 1 0 1 0 1
342 Sarung tangan Obgyn pcs 0 0 0 0
343 safety box bh 0 0
344 Tranfusi set bh 0 0
345 Tensocrip roll 0 0
346 Urine Bag buah 0 0
347 Umbilikor / klem tali pusat buah 0 0
348 Underpad box 0 0
349 wing Needle 25 G buah 0 0
350 Yodium povidon larutan 10 % 300 ml Btl 1 0 1 1
351 Yodium povidon larutan 10% 30ml Btl 0 0 0 0

JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR PHB
3 139 9 151

Mengetahui / menyetujui Yang Menyerahkan Yang Meminta/Pelapor


Pimpinan Puskesmas Mengwi III Petugas Gudang Puskesmas Petugas Pustu

(dr.Komang Widia Asmawan,S.Ked) (Kd.Suryaning Ayu) (Ni.Luh Rai Aryawati)


NIP : 19791202 200501 1 010 NIP.19820708 200604 2016 NIP.19760117 199603 2 003