LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

(L P L P O)
Kode Puskesmas : 19011304
Puskesmas : Lameuru
Kecamatan : Ranomeeto Barat
Kabupaten : Konawe Selatan
Provinsi : Sulawesi Tenggara

Kelas Stok Harga

No. Nama Obat Satuan Penerimaan Persediaan Pemakaian Sisa Stok Total Harga
Terapi Awal Satuan

1 2 3 4 5 6 7 = 5+6 8 = 7-9 9 10 11 = 9 x 10
1 Abate btl1 kg 0 0 0 0 0 4,144 -
2 Albendazole suspensi 200 mg/ 5 ml btl 5 ml 0 0 0 0 0 4234 -
3 Albendazole tablet 400 mg tab 116 0 116 8 108 363 39,204
4 Alkohol 70% btl 1 liter 3 0 3 1 2 27950 55,900
5 Allylestrenol tablet 5 mg (Pregnolin) tab 0 0 0 0 0 4,299 -
6 Alopurinol tablet 100 mg tab 0 0 0 0 0 274 -
7 Ambroxol sirup 15 mg/ml btl 60 ml 0 0 0 0 0 2,722 -
8 Ambroxol tablet 30 mg tab 0 0 0 0 0 89 -
9 Aminofilin injeksi 24 mg/ml ampul 0 0 0 0 0 3,315 -
10 Aminofilin tablet /kapsul/kaplet 150 mg tab 0 0 0 0 0 86 -
11 Aminofilin tablet 200 mg tab 0 0 0 0 0 86 -
12 Amitriptilin tablet salut 25 mg (HCl) tab 0 0 0 0 0 123 -
13 Amoksisilin kaplet 500 mg kaplet 2200 0 2200 1000 1200 279 334,800
14 Amoksisilin sirup kering 125 mg/ 5 ml btl 60 ml 149 0 149 26 123 2,560 314,880
15 Amoksisilin sirup kering 250 mg/ 5 ml btl 60 ml 17 0 17 17 0 4730 -
16 Ampisilin serbuk inj. 1000 mg vial 0 0 0 0 0 4,700 -
17 Antalgin inj. 250 mg - 2 ml ampul 30 0 30 0 30 1,500 45,000
18 Antasida DOEN I tablet kunyah tab 1650 0 1650 600 1050 78 81,900
19 Antasida DOEN II suspensi btl 60 ml 27 0 27 13 14 2,213 30,982
20 Antifungi DOEN salep kombinasi pot 0 0 0 0 0 1,891 -
21 Antihemoroid (Superhoid) supp 27 0 27 0 27 3,350 90,450
22 Antimigren tablet tab 0 0 0 0 0 135 -

23 Antiparkison DOEN tablet kombinasi : Benserazid

25 mg, Levodopa 100 mg (Levopar)
tab 0 0 0 0 0 1650 -
24 Aqua pro injeksi vial 0 0 0 0 0 6,050 -
25 Asam Askorbat (Vit. C) tablet 250 mg tab 0 0 0 0 0 167 -
26 Asam askorbat (Vit. C) tablet 50 mg tab 2900 0 2900 500 2400 35 84,480
27 Asam Folat tablet / kapsul / kaplet o,4 mg tab 0 0 0 0 0 104 -
28 Asam mefenamat tablet 500 mg tab 577 0 577 277 300 127 38,100
29 Asam traneksamat Injeksi 500 mg/ 5 ml ampul 7 0 7 0 7 6,300 44,099
30 Asiklovir tablet /kapsul/kaplet 200 mg tab 0 0 0 0 0 251 -
31 Asiklovir tablet 400 mg tab 0 0 0 0 0 362 -
32 Atenolol tab 0 0 0 0 0 387 -
33 Atropin Sulfat tablet 0,5 mg tab 0 0 0 0 0 81 -
34 Attapulgit (Purulex) tablet 630 mg tab 0 0 0 0 0 220 -
35 Benzatin Penisilin inj. 1,2 juta U/ml (i.m) vial 0 0 0 0 0 10780 -
36 Benzatin Penisilin inj. 1,2 juta U/ml (i.m) vial 0 0 0 0 0 14740 -
37 Betahistin Mesilat tablet 6 mg tab 0 0 0 0 0 1,016 -
38 Betametason krim 0,1 % tube 50 0 50 25 25 1,596 39,900
39 Betametason tetes mata 1 mg/ml btl 0 0 0 0 0 25106 -
40 Bioneuron injeksi ampul 10 0 10 0 10 4,340 43,402
41 Bisakodil sup 10 mg supp 12 0 12 0 12 6045 72,540
42 Captopril tablet 12,5 mg tab 350 0 350 250 100 69 6,900
43 Captopril tablet 25 mg tab 610 0 610 160 450 97 43,650
44 Ciprofloksasin tablet 500 mg (sebagai HCl) tab 0 0 0 0 0 253 -
45 Ciprofloxazin tablet 500 mg tab 1100 0 1100 200 900 286 257,400
46 Deksametason inj. 5 mg/ml - 1 ml ampul 45 0 45 0 45 1,738 78,210
47 Deksametason tablet 0,5 mg tab 2500 0 2500 630 1870 68 127,160
48 Diazepam inj. 5 mg/ml - 2 ml ampul 0 0 0 0 0 2,605 -
49 Diazepam rectal tube 10 mg/2,5 ml (Stesolid) tube 0 0 0 0 0 46,332 -
50 Diazepam rectal tube 5 mg/2,5 ml (Stesolid) tube 0 0 0 0 0 25,080 -
51 Diazepam tablet 2 mg tab 300 0 300 0 300 35 10,527
52 Dietilkarbamazine tablet 100 mg tab 0 0 0 0 0 107 -
53 Difenhidramin injeksi i.m. 10 mg/ml (HCl) ampul 48 0 48 18 30 1,160 34,800
54 Digoksin tablet 0,25 mg tab 100 0 100 0 100 103 10,300
55 Diltiazem HCl tablet 30 mg tab 0 0 0 0 0 129 -
56 Dimenhidrinat tablet 50 mg tab 0 0 0 0 0 109 -
57 Doksisiklin kapsul 100 mg kapsul 100 0 100 0 100 298 29,800
58 Domperidon suspensi 5 mg/5 ml btl 60 ml 0 0 0 0 0 3,766 -
59 Domperidon tablet 10 mg tab 200 0 200 0 200 174 34,800
60 Efedrin HCl tablet 25 mg tab 0 0 0 0 0 47 -
61 Ekstrak Belladona tab 10 mg tab 0 0 0 0 0 35 -
62 Epinefrin (adrenalin) inj. 0,1 % - 1 ml ampul 0 0 0 0 0 1,137 -
63 Eritromisin 250 mg kapsul 500 0 500 0 500 522 261,000
64 Eritromisin 500 mg kapsul 0 0 0 0 0 1,023 -
65 Eritromisin sirup kering 200 mg / 5 ml btl 60 ml 10 0 10 0 10 8090 80,900
66 Etakridin (Rivanol) larutan 0,1% btl 0 0 0 0 0 5,170 -
67 Etanol 70 % larutan btl 100 ml 24 0 24 5 19 2,625 49,875
68 Etil klorida spray btl 2 0 2 0 2 250,000 500,000
69 Fenitoin inj. 50 mg/ml ampul 0 0 0 0 0 20,857 -
70 Fenobarbital inj. 50 mg/ml - 2 ml ampul 0 0 0 0 0 1,980 -
71 Fenobarbital tablet 30 mg tab 0 0 0 0 0 34 -
72 Fenoksimetil Penisilin (Penisilin V) tablet 250 mg vial 0 0 0 0 0 319 -
73 Fenol gliserol (Karbogliserin) tetes telinga 10% btl 4 0 4 2 2 2,246 4,492
74 Fitomenadion (Vit. K) injeksi i.m 2 mg/ml ampul 0 0 0 0 0 3754 -
75 Fitomenadion (Vit.K1) tablet 10 mg tab 150 0 150 0 150 698 104,700
76 Fitomenadion (Vitamin K1) injeksi 10 mg/ml ampul 60 0 60 50 10 1,723 17,230
77 Furosemid inj. 10 mg/ml ampul 0 0 0 0 0 2,012 -
78 Furosemid tablet 40 mg tab 150 0 150 0 150 84 12,600
79 Gentamisin injeksi 40 mg/ml - 2 ml ampul 0 0 0 0 0 3,415 -
80 Gentamisin salep kulit 0,1% tube 0 0 0 0 0 2,021 -
81 Gentamisin Sulfat tetes mata 0,3 % btl 4 0 4 4 0 3,194 -
82 Gentian violet larutan 1 % btl 0 0 0 0 0 495 -
 83 Glibenklamida tablet 5 mg tab 80 0 80 80 0 61 -
84 Glimeperide tablet 1 mg tab 0 0 0 0 0 278 -
85 Glimeperide tablet 2 mg tab 0 0 0 0 0 458 -
86 Gliseril guaiakolat tablet 100 mg tab 0 0 0 0 0 31 -
87 Gliserin lautan 50% btl 0 0 0 0 0 5,967 -
88 Glukosa larutan infus 10 % steril btl 0 0 0 0 0 6270 -
89 Glukosa larutan infus 40 % steril vial 0 0 0 0 0 15,976 -
90 Glukosa larutan infus 5 % steril btl 42 0 42 0 42 5,720 240,240
91 Griseofulvin tablet 125 mg tab 200 0 200 70 130 230 29,900
92 Haloperidol tablet 0,5 mg tab 0 0 0 0 0 62 -
93 Haloperidol tablet 1,5 mg tab 0 0 0 0 0 76 -
94 Haloperidol tablet 2 mg tab 0 0 0 0 0 134 -
95 Hidroklorotiazid (HCT) tablet 25 mg tab 0 0 0 0 0 40 -
96 Hidrokortison krim 2,5 % tube 40 0 40 0 40 2,938 117,520
97 Ibuprofen Suspensi 100 mg/ 5 ml btl 45 0 45 6 39 3849 150,111
98 Ibuprofen tablet 200 mg tab 0 0 0 0 0 121 -
99 Ibuprofen tablet 400 mg tab 500 0 500 400 100 157 15,700
100 Isosorbit dinitrat tab sublingual 5 mg tab 0 0 0 0 0 107 -
101 Kalsium glukonat 100 mg/ml vial 0 0 0 0 0 7,800 -
102 Kaporit btl 1 kg 0 0 0 0 0 25,667 -
103 Karbamazepin tablet 200 mg tab 0 0 0 0 0 271 -
104 Karbogliserin tetes teliga 10% btl 0 0 0 0 0 2246 -
105 Ketokonazol tablet 200 mg tab 495 0 495 45 450 280 126,000
106 Ketorolac injeksi 10 mg ampul 22 0 22 7 15 2,665 39,975
107 Kloramfenikol kapsul 250 mg kapsul 250 0 250 0 250 254 63,525
108 Kloramfenikol kapsul 250 mg kapsul 0 0 0 0 0 275 -
109 Kloramfenikol salep kulit 2% (Bufacetin) tube 4 0 4 0 4 4138 16,552
110 Kloramfenikol salep mata 0,5 % tube 25 0 25 0 25 1680 42,000
111 Kloramfenikol suspensi 125 mg/5 ml btl 0 0 0 0 0 5500 -
112 Klorfeniramin maleat (CTM) tablet 4 mg tab 0 0 0 0 0 35 -
113 Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl) ampul 0 0 0 0 0 1,045 -
114 Klorpromazin tablet salut 100 mg (HCl) tab 0 0 0 0 0 292 -
115 Klorpromazin tablet salut 25 mg (HCl) tab 0 0 0 0 0 50 -
116 Kotrimoksazol suspensi btl 137 0 137 0 137 2,289 313,593
117 Kotrimoksazol tablet 480 mg tab 100 0 100 100 0 152 -
118 Kotrimoksazol tablet pediatrik tab 200 0 200 0 200 83 16,698
119 Kuinin (Kina) tablet 200 mg tab 0 0 0 0 0 737 -
120 Lidocaine comp. inj. 2% - 2 ml ampul 131 0 131 7 124 1,649 204,464
121 Lisol (Creolin) btl 1 liter 1 0 1 0 1 53,300 53,300
122 Loratadin tablet 10 mg tab 150 0 150 0 150 170 25,500
123 Lubricant Jely tube 1 1 2 1 1 38,488 38,488
124 Magnesium Sulfat inj. 20% vial 0 0 0 0 0 5,500 -
125 Magnesium Sulfat inj. 40% vial 22 0 22 0 22 2,629 57,838
126 Metformin tablet 500 mg tab 0 0 0 0 0 200 -
127 Metilergometrin maleat inj. 0,2 mg/ml - 1 ml ampul 0 0 0 0 0 2,175 -
128 Metilergometrin maleat tab. 0,125 mg tab 0 0 0 0 0 169 -
129 Metoklopramide tablet 10 mg tab 240 0 240 140 100 121 12,100
130 Metronidazol syrup 125 mg/5 ml (Farizol) btl 10 0 10 0 10 4350 43,500
131 Metronidazol tablet 250 mg tab 240 0 240 240 0 116 -
132 Metronidazol tablet 500 mg tab 300 0 300 300 0 196 -
133 Mikonazol krim/salep 2 % tube 24 0 24 0 24 3,150 75,600
134 NaCl larutan infus 0,9 % btl 42 0 42 5 37 5,170 191,290
135 Natrium Diklofenak tablet 25 mg tab 0 0 0 0 0 292 -
136 Natrium Diklofenak tablet 50 mg tab 500 0 500 50 450 193 86,850
137 Natrium levo-tiroksin tablet 100 ug (Euthyrox) tab 0 0 0 0 0 1,550 -
138 Nifedipin tablet 10 mg tab 340 0 340 340 0 142 -
139 Nistatin tablet salut 500.000 IU/ g tab 90 0 90 0 90 704 63,360
140 Nistatin vaginal tablet 100.000 IU/ g tab 32 0 32 0 32 407 13,024
141 Norepinefrin injeksi 1 mg/ml (Levosol inj) ampul 0 0 0 0 0 56595 -
142 OAT kategori anak FDC paket 0 0 0 0 0 189,200 -
143 OAT kategori I FDC paket 0 0 0 0 0 396,000 -
144 OAT kategori I kombipak paket 0 0 0 0 0 236,000 -
145 OAT kategori II FDC paket 0 0 0 0 0 1,320,000 -
146 OAT kategori sisipan FDC paket 0 0 0 0 0 160,000 -
147 Oksitetrasiklin HCl inj. 50 mg/ml vial 0 0 0 0 0 3,410 -
148 Oksitetrasiklin salep kulit 3% tube 23 0 23 23 0 1,816 -
149 Oksitosin inj. 10 IU/ml - 1 ml ampul 0 0 0 0 0 3,086 -
150 Omeprazol kapsul/kaplet 20 mg kapsul 0 0 0 0 0 221 -
151 Onemed Aseptan 500 cc + Dispenser btl 0 0 0 0 0 39,150 -
152 Oralit 200 sacet 0 0 0 0 0 418 -
153 Papaverin tablet 40 mg tab 200 0 200 0 200 128 25,600
154 Parasetamol drops btl 0 0 0 0 0 5,749 -
155 Parasetamol sirup 120 mg/5ml btl 60 ml 174 0 174 133 41 1,535 62,935
156 Parasetamol tablet 500 mg tab 3950 0 3950 950 3000 88 264,000
157 Permetrin krim 5% tube 3 0 3 0 3 11475 34,425
158 Piracetam injeksi 1 g/5 ml ampul 0 0 0 0 0 2,021 -
159 Piracetam tablet 800 mg tab 0 0 0 0 0 16,850 -
160 Pirantel suspensi 125 mg/ml btl 25 0 25 0 25 9,100 227,500
161 Pirantel tablet score (base) 125 mg tab 50 0 50 40 10 352 3,520
162 Piridoksin HCl (Vit. B6) tablet 10 mg tab 1280 0 1280 280 1000 31 31,020
163 Piroksikam kapsul/kaplet/tablet 10 mg kapsul 0 0 0 0 0 68 -
164 Piroksikam kapsul/kaplet/tablet 20 mg kapsul 79 0 79 79 0 92 -
165 Polikresulen 10 ml (Albothyl Solution) btl 0 0 0 0 0 18,635 -
166 Povidon Iodida 10 % (30 ml) btl 12 0 12 1 11 2,344 25,784
167 Povidon Iodida 10 % (300 ml) btl 7 0 7 1 6 15,386 92,316
168 Prednison tablet 5 mg tab 750 0 750 250 500 127 63,250
169 Primakuin tablet 15 mg tab 0 0 0 0 0 205 -
170 Probenesid tablet 500 mg tab 0 0 0 0 0 1815 -
171 Prokain benzil penisilin serbuk inj. 3 jt IU vial 0 0 0 0 0 6,780 -
172 Propanolol tablet 10 mg (HCl) tab 0 0 0 0 0 80 -
173 Propanolol tablet 40 mg (HCl) tab 0 0 0 0 0 114 -
174 Propiltiourasil (PTU) tablet 100 mg tab 100 0 100 0 100 351 35,100
175 Ranitidin inj. 50 mg/2ml ampul 0 0 0 0 0 3,750 -
176 Ranitidin tablet 150 mg tab 650 0 650 400 200 128 25,600
177 Ringer Laktat larutan infus btl 28 0 28 18 10 5,720 57,200
178 Ripamfisin kapsul 300 mg kapsul 0 0 0 0 0 670 -
179 Rivanol 300 ml btl 0 0 0 0 0 3315 -
180 Salbutamol tablet 2 mg (sebagai Sulfat) tab 0 0 0 0 0 65 -
181 Salbutamol tablet 4 mg (sebagai Sulfat) tab 500 0 500 200 300 93 27,900
182 Salep 2-4 kombinasi pot 3 0 3 3 0 3,011 -
183 Salisil Bedak 2 % pot 19 0 19 7 12 1,350 16,200
184 Seftriakson injeksi 1 g vial 0 0 0 0 0 2,707 -
185 Setrizin syrup 5 mg/ 5 ml btl 60 ml 10 0 10 1 9 8799 79,191
186 Sianokobalamin (Vit. B12) inj. 500 mcg/ml ampul 0 0 0 0 0 21,340 -
187 Spironolakton tablet 25 mg tab 0 0 0 0 0 350 -
188 Tablet tambah darah kombinasi kaplet 2190 0 2190 990 1200 73 88,000
189 Tetrasiklin HCl kapsul 250 mg kapsul 0 0 0 0 0 162 -
190 Thiamin (Vit. B1) tablet 50 mg tab 3640 0 3640 0 3640 63 229,320
191 Tiamin (Vitamin B1) injeksi 100 mg/ml ampul 11 0 11 11 0 843 -
192 Vitamin A kapsul 100.000 IU kapsul 0 0 0 0 0 286 -
193 Vitamin A kapsul 200.000 IU kapsul 0 0 0 0 0 505 -
194 Vitamin B kompleks tab 3420 0 3420 1220 2200 112 246,400
195 Zinc sirup (Zirkum kid) btl 22 0 22 10 12 8,140 97,680
196 Zinc tablet 20 mg tab 200 0 200 200 0 521 -
JUMLAH 6,750,050
 PERBEKKES (BMHP)
1 Alat suntik sekali pakai 1 ml set 65 0 65 3 62 1,202 74,509
2 Alat suntik sekali pakai 2,5 ml set 108 0 108 46 62 1,142 70,792
3 Alat suntik sekali pakai 20 ml set 10 0 10 3 7 3,500 24,500
4 Alat suntik sekali pakai 5 ml set 12 0 12 12 0 1,142 -
5 Catgut/benang bedah No. 3/0 (plain) dgn jarum set 17 24 41 15 26 27,042 703,083
6 Feeding tube No.5 set 0 0 0 0 0 14,300 -
7 Foley catheter No. 12 set 0 0 0 0 0 9,435 -
8 Foley catheter No. 18 set 0 0 0 0 0 9,435 -
9 Hand schun Non-Steril ukuran (L) lembar 0 0 0 0 0 2,336 -
10 Hand schun Non-Steril ukuran (M) lembar 35 0 35 20 15 2,336 35,046
11 Hand schun Non-Steril ukuran (S) lembar 0 0 0 0 0 2,336 -
12 Hand schun Non-Steril ukuran (XL) lembar 0 0 0 0 0 2,336 -
13 Hand schun Steril 6.5 pasang 0 0 0 0 0 5633 -
14 Hand schun Steril 7 pasang 0 0 0 0 0 5633 -
15 Hand schun Steril 7.5 pasang 0 0 0 0 0 5620 -
16 I.V. Catheter No. 18 set 5 0 5 0 5 14,993 74,965
17 I.V. Catheter No. 20 set 18 0 18 7 11 7,788 85,668
18 I.V. Catheter No. 22 set 4 0 4 0 4 7,788 31,152
19 I.V. Catheter No. 24 set 11 0 11 7 4 7,788 31,152
20 I.V. Catheter No. 26 set 0 0 0 0 0 14,993 -
21 Infuset anak (60 drops/ml) set 10 0 10 0 10 4,400 44,000
22 Infuset dewasa (15 drops/ml) set 22 0 22 5 17 3,850 65,450
23 Kapas 500 gram roll 0 0 0 0 0 30008 -
24 Kapas absorben 250 gram roll 6 0 6 2 4 8,250 33,000
25 Kasa hidrofil 40 y (36 m) x 80 cm roll 1 0 1 0 1 60,720 60,720
26 Kasa pembalut elastis 4 inchi roll 5 0 5 0 5 11,000 55,000
27 Kasa pembalut hidrofil 2 m x 80 cm roll 5 0 5 0 5 12,000 60,000
28 Naso Gastrik Tube (NGT)/Stomach Tube No.18 set 0 0 0 0 0 17,600 -
29 Plester 5 yard x 2 inchi roll 5 0 5 1 4 25,982 103,928
30 Silk (Benang Bedah Sutera) No. 3/0 set 0 24 24 0 24 7,682 184,360
31 Suction catheter bayi set 2 0 2 2 0 19,998 -
32 Urine bag set 0 0 0 0 0 4,000 -
JUMLAH 1,737,324
 BAHAN/OBAT UNTUK GIGI
1 Composite solare set 0 0 450,000 -
2 Etching liquid btl 0 0 321,750 -
3 Dentorit (Caviton) btl 0 0 214,500 -
4 Eugenol cairan btl 0 0 18,333 -
5 Glass Ionomer Cement ART set 1 0 1 0 1 975,000 975,000
6 Kalsium hidroksi pasta (Hydcal) set 1 0 1 0 1 205,000 205,000
7 Klorfenol kamfer mentol (CHKM) btl 1 0 1 0 1 150,000 150,000
8 Kresol formalin (TKF) btl 0 0 84,920 -
9 Kresopen btl 0 0 743,600 -
10 Pasta devitalisasi (Pulp-X) pot 0 0 429,000 -
11 Pumish bks 0 0 47,300 -
12 Mummifying paste (Pasta Iodoform) pot 0 0 193,600 -
13 Silver amalgam (F 400 powder) btl 0 0 237,540 -
14 Stopping temporary (Fletcher) serbuk set 0 0 17,000 -
15 Stopping temporary (Fletcher) cairan set 0 0 45,000 -
16 Zinc cement liquid (Multifix) btl 0 0 114,400 -
17 Zinc cement powder (Multifix) pot 0 0 243,000 -
JUMLAH 1,330,000
TOTAL HARGA 9,817,374

UMUM
TOTAL
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR

Mengetahui Yang Menyerakan Mengetahui,

Kepala Dinas Kesehatan Kepala Instalasi Farmasi Kepala Puskesmas
Kab. Konawe Selatan Kab. Konawe Selatan
Drs. Madilaa Maryoto, S.Farm., Apt dr. Asmayanti Asrum
NIP. 19620105 198903 1 019 NIP. 19791215 200903 1 002 NIP. 19820921 201412 2 001
AN OBAT

Bulan : Juli
Tahun : 2016

Stok Pemberian KET

Permintaan
Optimum
INPRES ASKES APBD LAIN2 JUMLAH
12 13 14 15 16 17 18 19
Return
Return

Exp

expair juni 2016

Petugas Puskesmas
 Minarwati, AMF
201412 2 001 NIP. 19871014 201504 2 002
 LAPORAN PEMAKAIAN PSIKOTROPIKA

PUSKESMAS : LAMEURU BULAN : JULI

ALAMAT : TAHUN : 2016

No. Nama Obat Satuan Stok awal Penerimaan Persediaan Pengeluaran Sisa stok Keterangan
1 2 3 4 5 (6) = (4 + 5) 7 (8) = (6-7) 9

1 Carbamazepin tablet 200 mg

2 Chlorpromazin tablet 100 mg
3 Chlorpromazin tablet 25 mg
4 Diazepam tablet 2 mg Tab 300 0 300 0 300
5 Diazepam tablet 5 mg Tab
6 Diazepam rectal 5 mg/2,5 ml (STESOLID) Tube 0 0 0 0 0
7 Fenobarbital tablet 30 mg Tab 0 0 0 0 0
8 Fenobarbital tablet 100 mg
9 Fenobarbital Inj 50 mg/ml - 2 ml Amp
10 Haloperidol 0,5 mg
11 Haloperidol 1,5 mg
12 Haloperidol 5 mg
13 Aminoptylin 25 mg

Mengetahui,
Kepala Puskesmas Petugas Pengelola Obat,
Dr. Asmayanti Asrum Minarwati, AMF
NIP.19820921 201412 2 001 NIP. 19871014 201504 2 002
 FORMULIR KOMPILASI DATA PERESEPAN POR TINGKAT PUSKESMAS
DIAGNOSA PENYAKIT : (ISPA Non-Pneumonia (KODE : 1302)

Puskesmas : Lameuru Bulan : Juli

Pengolah Data : Minarwati, AMF Tahun : 2016

JUMLAH JUMLAH R/ ANTIBIOTIK INJEKSI JML GENERIK

UNIT NAMA PUSKESMAS/PUSTU
SAMPEL TOTAL @ TOTAL % TOTAL % TOTAL %
1 2 3 4 5 6 7 8 9 10 11
1 Puskesmas Lameuru 17 43 2.5294118 11 64,7% 0 0 43 100%
2 Pustu Laikandonga
3 Pustu Sindang Kasih 7 18 2.5714286 5 71,4% 0 0 18 100%
4 Pustu Amokuni
5 Puskesmas Keliling
6 UPT laikandonga
7 Poskesdes Opaasi
8 Pustu Boro2 Lameuru
9 Tunduno
10 Abeko
TOTAL 24 61 16 0 61
RATA-RATA R/ PUSKESMAS B/A

PROSENTASE AB PUSKESMAS C/A.100%

PROSENTASE INJ PUSKESMAS D/A.100%

PROSENTASE GENERIK E/B.100%

 FORMULIR KOMPILASI DATA PERESEPAN POR TINGKAT PUSKESMAS
DIAGNOSA PENYAKIT : MYALGIA (KODE : 21)

Puskesmas : Lameuru Bulan : Juli

Pengolah Data : Minarwati, AMF Tahun : 2016

JUMLAH JUMLAH R/ ANTIBIOTIK INJEKSI JML GENERIK

UNIT NAMA PUSKESMAS/PUSTU
SAMPEL
TOTAL @ TOTAL % TOTAL % TOTAL %

1 2 3 4 5 6 7 8 9 10 11

1 Puskesmas Lameuru 2 5 2.5 0 0 0 0 5 100%

2 Pustu Laikandonga

3 Pustu Sindang Kasih 3 6 2 0 0 0 0 6 100%

4 Pustu Amokuni

5 Puskesmas Keliling

6 UPT Laikandonga

7 Pustu Boro2 lameuru

8 Poskesdes Opaasi

9 Tunduno

10 Abeko

TOTAL 5 11 0 0 11

RATA-RATA R/ PUSKESMAS B/A

PROSENTASE AB PUSKESMAS C/A.100%

PROSENTASE INJ D/A.100%
PUSKESMAS
 PROSENTASE GENERIK E/B.100%

Mengetahui,
Kepala Puskesmas Petugas Pengelola Obat

Dr. Asmayanti Asrum Minarwati, AMF

NIP. 19820921 201412 2 001 NIP. 19871014 201504 2 002
 FORMULIR KOMPILASI DATA PERESEPAN POR TINGKAT PUSKESMAS
DIAGNOSA PENYAKIT : DIARE NON SPESIFIK (KODE : 0102)

Puskesmas : Lameuru Bulan : Juli

Pengolah Data : Minarwati, AMF Tahun : 2016

JUMLAH JUMLAH R/ ANTIBIOTIK INJEKSI JML GENERIK

UNIT NAMA PUSKESMAS/PUSTU
SAMPEL TOTAL @ TOTAL % TOTAL % TOTAL %
1 2 3 4 5 6 7 8 9 10 11
1 Puskesmas Lameuru 12 36 3 11 91,6% 0 0 36 100%
2 Pustu Laikandonga
3 Pustu Sindang Kasih 1 3 3 1 100% 0 0 3 100%
4 Pustu Amokuni
5 Puskesmas Keliling
6 UPT Laikandonga
7 Pustu Boro2 lameuru
8 Poskesdes Opaasi
9 Tunduno
10 Abeko
TOTAL 13 39 12 0 39
RATA-RATA R/ PUSKESMAS B/A

PROSENTASE AB PUSKESMAS C/A.100%

PROSENTASE INJ D/A.100%
PUSKESMAS
PROSENTASE GENERIK E/B.100%
 PEMERINTAH KABUPATEN KONAWE SELATAN
DINAS KESEHATAN
PUSKESMAS LAMEURU
JL. KAWASAN PEMERINTAHAN KECAMATAN RANOMEETO BARAT

LAPORAN BULANAN PELAYANAN KEFARMASIAN

Nama Puskesmas : LAMEURU

Kabupaten/ Kota : KONAWE SELATAN
Provinsi : SULAWESI TENGGARA
Bulan : JULI
Tahun : 2016

JENIS PELAYANAN RESEP

NO TANGGAL
RAWAT JALAN KONSELING
RAWAT INAP
R/ Lembar R/
1 2 3 4 5 6
1 1-Jul-16 9 4
2 2-Jul-16 32 11
3 3-Jul-16 0 0
4 4-Jul-16 30 12
5 5-Jul-16 10 3
6 6-Jul-16 0 0
7 7-Jul-16 5 2
8 8-Jul-16 0 0
9 9-Jul-16 7 3
10 10-Jul-16 0 0
11 11-Jul-16 74 30
12 12-Jul-16 34 12
13 13-Jul-16 25 9
14 14-Jul-16 71 27
15 15-Jul-16 39 14
16 16-Jul-16 21 7
17 17-Jul-16 0 0
18 18-Jul-16 73 22
19 19-Jul-16 51 17
20 20-Jul-16 53 14
21 21-Jul-16 35 12
22 22-Jul-16 32 10
23 23-Jul-16 42 14
24 24-Jul-16 0 0
25 25-Jul-16 24 8
26 26-Jul-16 36 11
27 27-Jul-16 85 26
28 28-Jul-16 45 12
29 29-Jul-16
30 30-Jul-16
31 31-Jul-16
TOTAL 833 280

Lameuru, 28 Juli 2016

Yang Melaporkan, Mengetahui,
Pengelola Obat Kepala Puskesmas Lameuru

Minarwati, AMF dr. Asmayanti Asrum

Nip. 19871014 201504 2 002 Nip. 19820921 201412 2 001
N

INFORMASI OBAT

7
u, 28 Juli 2016

Puskesmas Lameuru

ayanti Asrum
820921 201412 2 001