LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

PUSKESMAS TAHUN 2016

DOKUMEN NOMOR
DINKES
PUSKESMAS LAPORAN TRIWULAN : I II III IV GFK
KECAMATAN PERMINTAAN TRIWULAN : I II III IV PUSKESMAS
KABUPATEN
PROVINSI

JUMLAH PEMBERIAN
STOK PENERIM PERSEDIA PEMAKAI SISA STOK PERMINT Buffer
NO NAMA OBAT SATUAN PROGRA
AWAL AAN AN AN STOK OPT AAN APBN APBD Stock
M
Kab
1 2 3 4 5 6 7 8 9 10 11 12 13 14

1 Alphamol Kaplet 600 mg Box 150 kaplet

Box, 10 strips @ 10
2 Alopurinol tablet/kapsul/kaplet 100 mg
tablets
3 Ambroksol syrup 15 mg/ml btl @ 60 ml

4 Ambroksol tablet 30 mg Dus, 10 Strip@10 Tablet

5 Aminofilin injeksi 24 mg/ml ktk 30 ampl x 10 ml

6 Aminofilin injeksi 24 mg/ml Dus @ 30 Ampul

7 Aminofilin tablet scored 200 mg Botol @100 Tablet

8 Amoksisilin + As. Klavulanat 625 mg tablDus, 5 Strip @ 6 Tablet

9 Amoksisilin tablet 500 mg Kotak @ 10 x 10 TAB

Amoksisilin kapsul/kaplet/tablet
10 KOTAK @ 10 x 10 TAB
scored 500 mg
11 Amoksisilin sirup kering 125 mg/ 5 ml btl @ 60 ml

12 Amoksisilin sirup kering forte 250 mg/5 Dus, Botol 60 ml

Ampisilin serbuk injeksi i.v. 1000
13 Dus, 10 vial @ 1 g
mg/vial
Antasida DOEN I tablet kunyah,
14 kombinasi : Aluminium Hidroksida 200 Dus, 10 Strip @ 10 Tablet
mg Magnesium
Antasida DOEN Hidroksida
II suspensi,200 mg
kombinasi :
15 Aluminium Hidroksida 200 mg/5 ml btl 60 ml
Magnesium
Antasida Hidroksida
DOEN 200 mg/5
II suspensi, ml :
kombinasi
16 Aluminium Hidroksida 200 mg/5 ml btl 60 ml
Magnesium Hidroksida 200 mg/5 ml
Asam Askorbat (Vitamin C) tablet 250
17 ktk 10x10 tablet
mg
18 Asam Mefenamat kapsul/kaplet 500 mg KTK 10 X 10
Dus, 10 blister @ 10
19 Asam Mefenamat tablet 500 mg
kaptab
Dus, 10 blister @ 10
20 Asam Mefenamat kapsul/kaplet 500 mg
kaptab ss
21 Asiklovir krim 5 % tube 5 gr

22 Asiklovir tablet/kapsul/kaplet 200 mg ktk 10x10 tablet

23 Asiklovir tablet/kapsul/kaplet 400 mg ktk 10x10 tablet

24 Bedak salisil serbuk 2% Dus @ 50 gram

Betametason krim 0,1% (sebagai
25 Tube 5 gr
Valerat)
26 CTM btl 1000 tablet

27 CTM Pot @ 1000 tablet

Deksametason injeksi i.v./i.m. 5
28 Dus, 100 ampul @ 1 ml
mg/ml
29 Deksametason tablet 0,5 mg Dus, 10 Strip@10 Tablet

30 Diazepam tablet 2 mg Btl 100 tablet

31 Difenhidramin injeksi i.m. 10 mg/ml (HCktk 30 ampl x 1 ml

 Difenhidramin injeksi i.v./i.m. 10
32 Dus @ 30 Ampul
mg/ml (HCl)
33 Digoksin tablet 0,25 mg 10 x 10 tab

34 Digoksin tablet 0,25 mg Box 10 X 10 Tab

35 Domperidon suspensi/sirup 5 mg/5 ml btl @ 60 ml

36 Domperidon tablet 10 mg dus 10 X 10'S

Epinefrin (Adrenalin) injeksi 0,1 %
37 ktk 30 amp x 1 ml
(sebagai HCl)
Epinefrin (Adrenalin) injeksi
38 Dus @ 30 Ampul
i.v/s.k./i.m 1 mg/ml
39 Etakridin larutan 0,1% Btl 300 ml

40 Etanol 70% cairan btl @ 100 ml

41 Famotidine tablet 40 mg Dus, 5 Strip @ 10 Tablet

Fitomenadion (Vit.K1) tablet salut gula
42 Dus @ 10 X 10 's
10 mg
Fitomenadion (Vitamin K1) injeksi i.m.
43 dus @ 30 ampul
2 mg/ml
44 Furosemid tablet 40 mg Dus, 10 strip @ 10 tablet

45 Furosemid tablet 40 mg Dus, 10 strip @ 10 tablet

46 Gentamisin injeksi 40 mg/ ml Dus, 5 ampul @ 2 ml

47 Gentamisin salep mata 0,3% Tube @ 3,5 gr

48 Gentamisin tetes mata 0,3% Dus, botol plastik 5 ml

Dus, 10 Blister @ 10
49 Glibenklamida tablet 5 mg
Tablet
Dus, 10 blister @ 10
50 Glibenklamid tablet 5 mg
kaptab
Dus, 10 blister @ 10
51 Glibenklamid tablet 5 mg
kaptab
52 Gliseril Guaiakolat tablet Pot @ 1000 tablet
53 Glukosa larutan infus 5 % steril botol @ 500 ml
Dus, 10 Blister @ 10
54 Griseofulvin tablet 125 mg
Tablet
Dus, 10 blister @ 10
55 Griseofulvin tablet 125 mg
tablet
Dus, 10 blister @ 10
56 Haloperidol tablet 0,5 mg
tablet
57 Hidrokortison krim 2,5 % Dus, 24 tube @ 5 g

58 Hidrokortison krim 2,5 % Tube 5 gr

59 Ibuprofen sirup 100 mg/5 ml Dus, botol 60 ml

60 Ibuprofen tablet 200 mg botol @ 100 tablet

61 Ibuprofen tablet 400 mg dus 10 X 10'S

Kalsium Laktat (Kalk)
62 Dus,10 Strip @ 10 tablet
tablet/kapsul/kaplet 500 mg
63 Kaptopril tablet 12,5 mg ktk 10 str x 10's

64 Kaptopril tablet scored12,5 mg Dus, 10 strip @ 10 tablet

65 Kaptopril tablet 25 mg Dus, 10 Strip @ 10 Tablet

66 Kaptopril tablet scored 25 mg Dus, 10 strip @10 tablet

67 Ketokonazol krim 2% tube 10 gr

Dus, 5 blister @ 10
68 Klindamisin kapsul/kaplet 150 mg
kapsul
Dus, 10 blister @ 10
69 Klindamisin kapsul/kaplet 150 mg
kapsul
70 Klindamisin kapsul/kaplet 300 mg Dus, 3 strip @ 10 kapsul
Dus, 10 Blister @ 12
71 Kloramfenikol kapsul/kaplet 250 mg
Kapsul
72 Kloramfenikol salep mata 1 % Tube 5 gr

73 Kloramfenikol suspensi 125 mg/ 5 ml Botol @ 60 ml

74 Kodein tablet 10 mg ktk 10x10 tablet
Kotrimosazol DOEN I (dewasa)
75 Kombinasi :Sulfametoksazol 400 mg + ktk 10 x 10 tablet
Trimetoprim 80DOEN
Kotrimoksazol mg I (dewasa)
76 kombinasi : Sulfametoksazol 400 mg Dus, 10 Strip@10 Tablet
Trimetoprim 80DOEN
Kotrimoksazol mg II (pediatrik)
77 kombinasi : Sulfametoksazol 100 mg ktk 10 str x 10's
Trimetoprim 20Suspensi
Kotrimoksazol mg komb:
78 Sulfametoksazol 200 mg + Trimetoprim Dus, botol @ 60 ml
40 mg / 5 ml Suspensi komb:
Kotrimoksazol
79 Sulfametoksazol 200 mg + Trimetoprim Dus, botol @ 60 ml
40 mg / 5 ml
80 Lanzoprazol kapsul/kaplet 30 mg Dus, 2 strip @ 10 kapsul
Lidokain injeksi 2% (HCl) + Epinefrin 1 :
81 Dus, 30 ampul @ 2 ml
80.000 - 2ml
Lidokain injeksi 2% (HCl) + Epinefrin 1 :
82 Dus, 20 ampul @ 2 ml
80.000 - 2ml
83 Loperamid tablet 2 mg Dus, 10 strip @ 10 tablet

84 Loratadin tablet 10 mg Dus, 5 strip @ 10 tablet

85 Meloksikam tab 15 mg ktk 50 tablet

86 Meloksikam tab 15 mg Dus, 5 X 10 Tablet

Metilergometrin Maleat injeksi 0,200
87 ampul @ 1 ml
mg-1 ml
Dus, 10 Blister @ 10
88 Metilprednisolon tablet 4 mg
Tablet
Dus, 10 Blister @ 10
89 Metilprednisolon tablet 4 mg
Tablet
90 Metronidazol tablet 500 mg 10 strip @ 10 tab

91 Mikonazol krim/salep 2 % (Nitrat) ktk 24 tube @ 10 gram

92 Nacl 0,9% Botol 500 ml

93 Natrium Diklofenak tablet 25 mg Dus @ 5 X 10 's

94 Natrium Diklofenak tablet 50 mg Dus @ 5 X 10 's

 Dus, 10 Strip @ 10 tablet
95 Nifedipin tablet/kapsul 10 mg
salut selaput
96 Nistatin tablet salut 500.000 IU/ g Dus @ 10 X 10 's

97 Oksitetrasiklin salep kulit 3% Dus, 25 tube @ 5 g

98 Parasetamol sirup 120 mg / 5 ml botol 60 ml

Dus, 10 Strip@10 Kaplet
99 Parasetamol tablet 500 mg
Salut Selaput
100 Pehacain Injeksi 20 Ampul/box

101 Piridoksin tab (Vit B6) Pot @ 250 tablet

102 Povidon Iodida larutan 10% 30 ml botol @ 30 ml

103 Povidon Iodida larutan 10% 300 ml botol @ 300 ml

104 Prednison tablet 5 mg Ktk 10 strip @ 10 tablet

105 Prednison tablet 5 mg btl 1000 tablet

106 Prednison tablet Dus, 10 strip @ 10 tablet

107 Ranitidin injeksi 25 mg/2 ml Dus, 10 Ampul @ 2 ml

108 Ranitidin injeksi 25 mg/ml Dus, 10 Ampul @ 2 ml

Dus, 10 Strip @ 10 tablet
109 Ranitidin tablet 150 mg
salut selaput
110 Ringer Laktat larutan infus botol 500 ml

111 Salbutamol tablet 2 mg (sebagai Sulfat) strip @ 10 tablet

112 Salbutamol tablet 4 mg (sebagai Sulfat) ktk 10 x 10 tablet

Box, 10 strips @ 10
113 Setirizin tablet 10 mg
capsules
114 Sianokobalamin( Vit B12) inj 500 mg Ktk 100 ampul @1 ml

115 Sianokobalamin (vitamin B12) injeksi 50 Dus, 100 ampul @ 1 ml

 Sianokobalamin (vitamin B12) injeksi
116 100 ampul @ 1 ml
500 mcg
117 Sianokobalamin (vitamin B12) tablet 50 ktk 10x10 tablet
Sianokobalamin (vitamin B12)
118 Dus, 10 Strip @ 10 tablet
tablet/kapsul/kaplet 50 mcg
119 Simvastatin scored tablet 10 mg Box,3 strips @ 10 tablets
Siprofloksasin tablet 500 mg (sebagai Dus, 10 blister @ 10 tab
120
HCl) ss
Siprofloksasin tablet 500 mg (sebagai Dus, 10 blister @ 10 tab
121
HCl) ss
Tetrasiklin tablet/kapsul/kaplet 500 DUS,10 STRIP @ 10
122
mg KAPSUL
123 Tiamin (Vitamin B1) injeksi 100 mg/ml Kotak 30 ampul 1 ml

124 Vitamin B Kompleks tablet Dus 10 strip x 10 tab

125 Zinc sir 20 mg/5 Ml Dus, botol 60 ml

Dus, 10 strip @ 10 tablet
126 Zinc tablet dispersible20 mg
dispersible
BAHAN HABIS PAKAI
Alat suntik sekali pakai - 3 CC X 23 G X
127 box/100
1 1/4 "
128 Alkohol 70% 1 liter botol
Cut gat plain 2/0 +jarum 1/2 GT 35
129 box/24
mm
Cut gat plain 3/0 +jarum 1/2 GT 35
130 box/24
mm
131 Examination glove box/100

132 I.V Cateter No 22 g x 1 " pcs

133 Infusion set dewasa (20 drops/ml) pcs

134 Infusion set pediatric (60 drops/ml) pcs

135 Kapas pembalut / absorben 250 gr roll

136 Kasa kompres steril 40 x 40 pcs

137 Kasa pembalut hydrohil 4 m x 10 cm pcs

138 Lysol 1 liter botol

139 Safeglove surgical steril pre powder no. pasang

140 Silk 3/0 +jarum 1/2 GT 35 mm box/36

141 Surgical mask 3 ply earloop box/50

Diketahui: Diketahui: Yang Menyerahkan Diketahui :

Kepala Dinas Kesehatan Kabid Jamsarkes Kasie Farmasi Kepala Puskesmas
Kab. Labuhanbatu Utara

Burhanuddin Harahap, SKM. M. Kes Dr. Yulidawati Sury Astika S.Farm,Apt

Nip. 19620423 198603 1 004 Nip. 19701203 200604 2 002 Nip. 19830312 201001 2 016
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DII JLH KET

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