LPLPO Pustu Plalangan 2017

LPLPO PUSTU PLALANGAN
31 Januari 2016
( Laporan Pemakaian dan Lembar Permintaan Obat )
Stok Peneri Pema Stok Permin-

No Nama Obat SAT Ket
Awal maan kaian Akhir taan
A OBAT - OBATAN
1 Air untuk injeksi ampul 25 ml btl - - - -
2 Albendazol suspensi 200 mg/5 ml btl - - - -
3 Albendazol tablet 400 mg Tab - - - -
4 Alopurinol tablet 100 mg Tab - - - -
5 Alopurinol tablet 300 mg tab - - - -
6 Alprazolam tablet 0,25 mg tab - - - -
8 Alprazolam tablet 1 mg tab - - - -
9 Ambroxol sirup 15 mg/ml btl - - - -
11 Ambroxol tablet 30 mg Tab - - - -
12 Aminofilin injeksi 24 mg/ml Amp - - - -
13 Aminofilin tablet 150 mg tab - - - -
14 Aminofilin tablet 200 mg Tab - - - -
15 Amitriptilin tablet salut 25 mg (HCl) Tab - - - -
16 Amlodipin tablet 10 mg tab - - - -
18 Amoksisilin + As. Klavulanat 625 mg tablet tab - - - -
19 Amoksisilin kapsul/kaplet 250 mg Kaps - - - -
20 Amoksisilin kapsul/kaplet 500 mg Tab 30 200 200 30
21 Amoksisilin serbuk injeksi 1000 mg vial - - - -
22 Amoksisilin sirup kering 125 mg/ 5 ml Btl 50 - 20 30
23 Amoxsan tab 500 mg tab - - - -
24 Ampisilin serbuk injeksi i.m./i.v. 1000 mg/vial vial - - - -
Antasida DOEN I tablet kunyah, kombinasi :
Aluminium Hidroksida 200 mg Magnesium Hidroksida
27 200 mg Tab 10 - 10 -
Antasida DOEN II suspensi, kombi : Aluminium

Hidroksida 200 mg/5 ml Magnesium Hidroksida 200
28 mg/5 ml Btl - - - -
Anti Bakteri DOEN salep kombinasi: Basitrasin 500
29 IU/g + Polimiksin 10.000 IU/g Tube - 10 10 -
Antifungi DOEN Kombinasi: Asam Benzoat 6% +
30 Asam Salisilat 3% pot - - - -
Antihemoroid DOEN kombinasi : Bismut subgalat 150
31 mg Heksaklorofen 2,5 mg Supp - - - -
Antimalaria DOEN kombinasi : Pirimetamin tablet 25
32 mg Sulfadoksin tablet 500 mg tab - - - -
Antimigren tablet: Ergotamin Tartrat 1 mg + Kofein 50
33 mg Tab - - - -
34 Antrain inj amp - - - -
35 Aqua pro Injeksi steril, bebas pirogen Amp - - - -
36 Artemether injeksi 80 mg/ml amp - - - -
37 Artesunate injeksi, vial 60 mg vial - - - -
38 Asam Asetilsalisilat tablet 100 mg (Asetosal) tab - - - -
39 Asam Asetilsalisilat tablet 500 mg (Asetosal) Tab - - - -
40 Asam Askorbat (Vitamin C) tablet 50 mg Tab 90 - 50 40
41 Asam Askorbat (Vitamin C) tablet 100 mg tab - - - -
43 Asam Folat tablet 1 mg tab - - - -
44 Asam Mefenamat kapsul/kaplet 250 mg tab - - - -
45 Asam Mefenamat kapsul/kaplet 500 mg Tab - - - -
47 Asiklovir krim 5% Tube - - - -
48 Asiklovir tablet 200 mg Tab - - - -
49 Asiklovir tablet 400 mg tab - - - -
51 Atapulgit tablet 600 mg tab - - - -
52 Atenolol tablet 100 mg tab - - - -
54 Atropin injeksi i.m./i.v./s.k. 0,25 mg/ml (Sulfat) amp - - - -
55 Atropin Sulfat tablet 0,5 mg tab - - - -
56 Benzatin Benzil Penisilin 1,2 juta IU/ vial vial - - - -
57 Benzatin Benzil Penisilin 2,4 juta IU/vial vial - - - -
Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet
58 (tablet tambah darah kombinasi ) tab - - - -
59 Betahistin Mesilat tablet 6 mg tab - - - -
60 Betametason krim 0,1 % (sebagai Valerat) Tube - 2 2 -
61 Bioplacenton tube - - - -
62 Bisakodil suppositoria 10 mg supp - - - -
63 Bisoprolol tablet 5 mg tab - - - -
64 Bromheksin tablet 8 mg tab - - - -
65 Buscopan inj amp - - - -
66 Cetirizin sirup 5 mg/5 ml btl - - - -
67 Cetirizine tablet 10 mg tab - - - -
68 Clobazam tablet 10 mg tab - - - -
69 Clobetasol krim 0,05% tube - - - -
70 Dapson tablet 100 mg tab - - - -
71 Deksametason injeksi i.v. 5 mg/ml Amp - 100 10 90
72 Deksametason injeksi i.v. 5 mg/ml amp - - - -
73 Deksametason tablet 0,5 mg Tab 100 200 200 100
74 Dekstran 70 - larutan infus 6% steril btl - - - -
75 Dekstrometorfan sirup 10 mg/5 ml (HBr) btl - - - -
76 Dekstrometorfan tablet 15 mg (HBr) tab - - - -
78 Diazepam injeksi 5 mg/ml Amp - - - -
79 Diazepam tablet 2 mg Tab - - - -
81 Dietilkarbamazin Sitrat tablet 100 mg tab - - - -
82 Difenhidramin injeksi i.m. 10 mg/ml (HCl) Amp 20 30 30 20
83 Digoksin tablet 0,25 mg Tab - - - -
84 Diltiazem HCl tablet 30 mg tab - - - -
85 Dimenhidrinat tablet 50 mg tab - - - -
86 Doksisiklin kapsul/kaplet 100 mg kaps - - - -
87 Domperidon suspensi 5 mg/5 ml btl - - - -
88 Domperidon tablet 10 mg Tab - - - -
89 Efedrin tablet 25 mg (HCl) tab - - - -
90 Ekstraks Belladona tablet 10 mg Tab - - - -
91 Epinefrin (Adrenalin) injeksi 0,1 % (sebagai HCl) Amp - - - -
92 Eritromisin kapsul/kaplet 250 mg kaps - - - -
94 Eritromisin sirup 200 mg/ 5 ml Btl - - - -
95 Etakridin larutan 0,1% (Rivanol) Btl - - - -
96 Etambutol tablet 250 mg (HCl) tab - - - -
97 Etambutol tablet salut 500 mg (HCl) tab - - - -
98 Etanol 70% cairan ( 30 ml ) btl - - - -
99 Famotidine tablet 20 mg tab - - - -
101 Fenilbutason tablet 200 mg tab - - - -
102 Fenitoin kapsul/kaplet 100 mg kaps - - - -
103 Fenitoin Natrium injeksi 50 mg/ml amp - - - -
104 Fenitoin Natrium kapsul/kaplet 30 mg kaps - - - -
105 Fenobarbital injeksi i.m./i.v. 50 mg/ml Amp - - - -
106 Fenobarbital tablet 100 mg tab - - - -
108 Fenoksimetil Penisilin tablet 250 mg tab - - - -
110 Fenol Gliserol tetes telinga 10% Btl - - - -
111 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tab - - - -
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml Amp 5 - 5 -
113 Flukonazol tablet 150 mg tab - - - -
114 Furosemid injeksi i.v./i.m. 10 mg/ml amp - - - -
115 Furosemid tablet 40 mg Tab - 200 20 180
116 Garam Oralit I serbuk Sac - - - -
117 Gemfibrozil kapsul/kaplet 300 mg kaps - - - -
118 Gemfibrozil tablet 600 mg tab - - - -
119 Gentamisin injeksi 40 mg/ ml amp - - - -
120 Gentamisin salep kulit 0.1% tube - - - -
121 Gentamisin Sulfat tetes mata 0,3 % btl - - - -
122 Gentian Violet larutan 1 % Btl - - - -
123 Glibenklamida tablet 5 mg Tab - - - -
124 Glimepiride tablet 1 mg tab - - - -
129 Gliquidon tablet 30 mg tab - - - -
130 Gliseril Gualakolat tablet 100 mg (GG) Tab - - - -
131 Gliserin btl - - - -
132 Glukosa larutan infus 10 % steril Btl - - - -
135 Griseofulvin tablet 125 mg Tab - - - -
136 Haloperidol inj 50 mg/mL amp - - - -
137 Haloperidol tablet 0,5 mg tab - - - -
139 Haloperidol tablet 5 mg tab - - - -
140 HCT 25 mg (Hidroklortiazid) Tab - - - -
141 Hidrokortison krim 1% tube - - - -
142 Hidrokortison krim 2,5 % Tube - 24 24 -
143 Hyoscine -N-Butilbromide tablet 10 mg tab - - - -
144 Ibuprofen suspensi 100 mg/5 ml btl - - - -
146 Ibuprofen tablet 200 mg Tab 100 200 200 100
147 Ibuprofen tablet 200 mg tab - - - -
148 Ibuprofen tablet 400 mg Tab - - - -
150 Iodiol kapsul lunak kaps - - - -
151 Isoniazid tablet 100 mg Tab - - - -
152 Isoniazid tablet 300 mg tab - - - -
153 Isosorbid Dinitrat tablet sublingual 5 mg Tab - - - -
154 Itrakonazol kapsul/kaplet 100 mg kaps - - - -
155 Kalium Diklofenak tablet 25 mg tab - - - -
157 Kalsium Laktat (Kalk) tablet 500 mg Tab - 2,000 350 1,650
158 Kaptopril tablet 12,5 mg Tab - - - -
159 Kaptopril tablet 25 mg Tab 70 200 170 100
160 Kaptopril tablet 50 mg tab - - - -
161 Karbamazepin tablet 200 mg Tab - - - -
162 Ketokonazol krim 2% tube - 10 5 5
163 Ketokonazol tablet 200 mg Tab - 100 50 50
164 Ketoprofen injeksi 100 mg amp - - - -
165 Ketoprofen tablet 100 mg tab - - - -
166 Ketorolac injeksi 10 mg amp - - - -
168 Klindamisin kapsul/kaplet 150 mg kaps - - - -
170 Klomifen tablet 50 mg tab - - - -
171 Klonidin tablet 0,15 mg tab - - - -
173 Kloramfenikol kapsul/kaplet 250 mg Kaps - - - -
174 Kloramfenikol salep mata 1 % Tube - - - -
175 Kloramfenikol suspensi 125 mg/ 5 ml Btl - - - -
176 Kloramfenikol suspensi 125 mg/ 5 ml btl - - - -
177 Kloramfenicol tetes mata 0,5% Btl - - - -
178 Kloramfenikol tetes telinga 3 % btl - 3 3 -
179 Klorfeniramina Maleat (CTM) tablet 4 mg Tab 200 1,000 200 1,000
180 Klorokuin tablet 250 mg tab - - - -
181 Klorpromazin injeksi i.m 5 mg/ml - 2 ml (HCl) amp - - - -
182 Klorpromazin injeksi i.m. 25 mg/ml (HCl) amp - - - -
183 Klorpromazin tablet salut 100 mg (HCl) tab - - - -
184 Klorpromazin tablet salut 25 mg (HCl) Tab - - - -
185 Kodein tablet 10 mg tab - - - -
Kotrimoksazol DOEN I (dewasa) kombinasi :
188 Sulfametoksazol 400 mg , Trimetoprim 80 mg Tab 70 300 200 170
Kotrimoksazol DOEN II (pediatrik) kombinasi :
189 Sulfametoksazol 100 mg Trimetoprim 20 mg Tab 800 - 400 400
Kotrimoksazol Suspensi komb: Sulfametoksazol 200
190 mg + Trimetoprim 40 mg / 5 ml Btl 30 - 15 15
191 Kuinin (Kina) tablet 200 mg tab - - - -
192 Kuinin Dihidroklorida injeksi 25% - 2 ml amp - - - -
193 Kuinin injeksi i.v. 25% (sebagai 2 HCl) amp - - - -
194 Lacto B sase - - - -
195 Lamivudine tablet 150 mg tab - - - -
Larutan mengandung Elektrolit (Na 130 mEq, Cl 109
196 mEq, Ca 3 mEq, Asetat 28 mEq) (ASERING) btl - - - -
Larutan mengandung Elektrolit (NaCl 1.125 gr,
197 Dekstrosa 18.75 gr) (KAEN 1B) btl - - - -
Larutan mengandung Karbohidrat + Elektrolit (Nacl

1.75 gr, KCl 1.5 gr, Na Lactat 2.24 gr, Dekstrosa 27
198 gr) (KAEN 3B) btl - - - -
2.34 gr, Na Laktat 2.24 gr, KCL 0.75 gr Dekstrosa 27
199 gr) (KAEN 3A) btl - - - -
200 Lanzoprazol kapsul/kaplet 30 mg tab - - - -
201 Levofloksasin tablet 500 mg tab - - - -
203 Lidokain injeksi 2% amp - - - -
Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml
205 ( Lidokain Comp. Inj ) Amp - 30 10 20
206 Lidokain jeli 2% pot - - - -
207 Linkomisin kapsul/kaplet 500 mg kaps - - - -
208 Lisinopril tablet 10 mg tab - - - -
210 Loperamid tablet 2 mg tab - - - -
211 Loratadin tablet 10 mg tab - - - -
212 Lorazepam tablet 2 mg tab - - - -
213 Lytacur btl - - - -
214 Magnesium Sulfat inj (IV) 20% - 25 ml Vial - - - -
215 Magnesium Sulfat inj (IV) 40% - 25 ml amp - - - -
216 Mebendazol sirup 100 mg / 5 ml btl - - - -
217 Mebendazol tablet 100 mg tab - - - -
218 Meloksikam suppositoria supp - - - -
219 Meloksikam tablet 15 mg tab - - - -
220 Meloksikam tablet 7,5 mg tab - - - -
221 Menadion (Vitamin K3) injeksi 10 mg/ml amp - - - -
222 Metampiron injeksi 250 mg (Antalgin) Amp - - - -
223 Metampiron injeksi 250 mg amp - - - -
224 Metampiron tablet 500 mg (Antalgin) Tab - 200 100 100
225 Metampiron tablet 500 mg tab - - - -
226 Metformin HCl tablet 500 mg tab - - - -
228 Metilergometrin Maleat injeksi 0,200 mg -1 ml Amp - - - -
Metilergometrin Maleat (Metilergometrin) tablet salut Tab
229 0,125 mg 50 - 20 30
230 Metilprednisolon injeksi 500 mg amp - - - -
231 Metilprednisolon tablet 16 mg tab - - - -
234 Metoklopramide injeksi 5 mg/ml amp - - - -
235 Metoklopramide sirup 5 mg/ 5 ml btl - - - -
236 Metoklopramide tablet 10 mg Tab - 100 100 -
237 Metoklopramide tablet 5 mg tab - - - -
238 Metronidazol infus 500 mg/100 ml btl - - - -
239 Metronidazol tablet 250 mg Tab - - - -
240 Metronidazol tablet 500 mg Tab - 100 100 -
241 Metronidazol tablet 500 mg tab - - - -
242 Mikonazol krim/salep 2 % (Nitrat) tube - - - -
243 Mineral Mix, kombinasi sase - - - -
244 Momethason krim 0,1 % tube - - - -
246 Morfin injeksi 10 mg/ml amp - - - -
247 Morfin tablet 10 mg tab - - - -
248 Natrium Diklofenak tablet 25 mg Tab - - - -
249 Natrium Diklofenak tablet 50 mg Tab - 100 100 -
250 Natrium Klorida larutan infus 0,9 % (NaCl) Btl 3 - - 3
251 Neurobion 5000 injeksi amp - - - -
252 Nevirapin tablet 200 mg tab - - - -
253 Nifedipin tablet 10 mg tab - - - -
254 Nistatin tablet salut 500.000 IU/ g Tab - - - -
255 Nistatin vaginal tablet 100.000 IU/ g supp - - - -
256 Norages inj amp - - - -
257 Obat Antituberkulosis FDC Kategori 1 pak - - - -
259 Obat Antituberkulosis FDC Kategori Anak pak - - - -
260 Obat Antituberkulosis FDC Sisipan pak - - - -
261 Obat Antituberkulosis Kategori 1 dewasa pak - - - -
262 Obat Antituberkulosis Kategori anak pak - - - -
263 Obat Batuk Hitam ( O.B.H. ) cairan Btl - 60 10 50
264 Obat Batuk Hitam ( O.B.H. ) cairan btl - - - -
265 Ofloxacin tablet 200 mg tab - - - -
267 Oksitetrasiklin injeksi I.m. 50 mg/ml-10 ml amp - - - -
268 Oksitetrasiklin HCl salep mata 1 % Tube - - - -
269 Oksitetrasiklin salep kulit 3% Tube - 25 15 10
270 Oksitosin injeksi 10 IU/ml - 1 ml Amp 30 - 10 20
271 Omeprazol kapsul/kaplet 20 mg kaps - - - -
272 Oseltamivir kapsul/kaplet 75 mg kaps - - - -
273 Papaverin injeksi 40 mg/ml amp - - - -
274 Papaverin tablet 40 mg Tab 200 200 200 200
275 Parasetamol drops btl - 10 5 5
276 Parasetamol sirup 120 mg / 5 ml Btl 80 - 30 50
277 Parasetamol tablet 100 mg Tab - - - -
278 Parasetamol tablet 500 mg Tab 120 1,000 300 820
279 Perfenazin tablet 4 mg (HCl) tab - - - -
280 Permetrin krim 5% tube - - - -
281 Petidin injeksi 50 mg/ml amp - - - -
282 Piracetam injeksi 1 g/5 ml amp - - - -
285 Piracetam tablet 1200 mg tab - - - -
288 Pirantel sirup 125 mg/5 ml btl - - - -
289 Pirantel tablet score (base) 125 mg Tab - - - -
290 Pirazinamid tablet 500 mg tab - - - -
291 Piridoksin (Vitamin B6) tablet 10 mg (HCL) Tab - - - -
292 Piroksikam kapsul/kaplet/tablet 10 mg kaps - - - -
293 Piroksikam kapsul/kaplet/tablet 20 mg kaps 30 100 100 30
294 Povidon Iodida larutan 10% btl - - - -
295 Povidon Iodida larutan 10% 30mL Btl - - - -
296 Povidon Iodida larutan 10% 300 mL Btl - - - -
298 Pravastatin tablet 20 mg tab - - - -
299 Prednison tablet 5 mg Tab - 500 100 400
300 Primakuin tablet 15 mg tab - - - -
301 Primperan inj amp - - - -
302 Prokain Benzil Penisilin G. injeksi 3 jt IU/vial vial - - - -
303 Propanolol tablet 10 mg ( HCl ) tab - - - -
304 Propanolol tablet 40 mg (HCl) tab - - - -
305 Propiltiourasil tablet 100 mg (PTU) Tab - - - -
306 Ramipril tablet 2,5 mg tab - - - -
307 Ramipril tablet 5 mg tab - - - -
308 Ranitidin injeksi 25 mg/2 ml amp - - - -
309 Ranitidin tablet 150 mg Tab 40 100 100 40
310 Ranitidin tablet 150 mg tab - - - -
311 Reserpin tablet 0,10 mg tab - - - -
313 Retinol (Vitamin A) 100.000 IU kapsul lunak kaps - - - -
315 Rifampisin kapsul/kaplet 300 mg kapl - - - -
317 Rifampisin tablet salut 450 mg kapl - - - -
318 Ringer Laktat larutan infus (RL) Btl - - - -
319 Risperidon tablet 1 mg tab - - - -
322 SABU I Vial - - - -
323 Salbutamol tablet 2 mg (sebagai Sulfat) Tab - - - -
324 Salbutamol tablet 4 mg (sebagai Sulfat) Tab 30 100 100 30
Salep 2-4 , Kombinasi: Asam Salisilat 2% + Belerang
325 endap 4% Pot - 10 10 -
326 Salisil Bedak 2 % Ktk - 10 10 -
327 Salisil Bedak 2 % ktk - - - -
328 Sanmol syr btl - - - -
329 Sanmol tab tab - - - -
330 Sefadroksil kapsul/kaplet 250 mg kaps - - - -
331 Sefadroksil kapsul/kaplet 500 mg tab - - - -
333 Sefadroksil sirup kering 125 mg/5ml btl - - - -
334 Sefaleksin kapsul/kaplet 250 mg kaps - - - -
336 Sefazolin injeksi 1 g amp - - - -
337 Sefiksim 400 mg + Azitromisin 1000 mg tab - - - -
338 Sefiksim kapsul/kaplet 100 mg kaps - - - -
339 Sefiksim sirup kering 100 mg/ 5 ml btl - - - -
340 Sefotaksim injeksi 0,5 g amp - - - -
341 Sefotaksim injeksi 1 g vial - - - -
342 Seftazidim injeksi 1 g amp - - - -
343 Seftriakson injeksi 1 g vial - - - -
344 Seftriakson injeksi 1 g amp - - - -
345 Serum A.T.S injeksi 1.500 UI/amp (i.m.) Amp - - - -
346 Sianokobalamin (vitamin B12) injeksi 500 mcg Amp - 100 25 75
347 Sianokobalamin (vitamin B12) tablet 50 mcg tab - - - -
348 Simetidin tablet 200 mg Tab - - - -
349 Simvastatin tablet 10 mg Tab - - - -
350 Simvastatin tablet 20 mg tab - - - -
352 Siprofloksasin infus 2% btl - - - -
353 Siprofloksasin tablet 250 mg (sebagai HCl) tab - - - -
354 Siprofloksasin tablet 500 mg (sebagai HCl) Tab - 200 200 -
355 Spasminal tab tab - - - -
356 Spiramisin tablet 500 mg tab - - - -
357 Spironolakton tablet 100 mg tab - - - -
359 Stavudin tablet 30 mg tab - - - -
360 Streptomisin serbuk injeksi i.v 1000 mg/ml btl - - - -
361 Sulfasalazin tablet 500 mg tab - - - -
362 Sulfasetamida Natrium tetes mata 15 % Btl - - - -
363 Syntosinon inj amp - - - -
364 Tamoksifen tablet 20 mg tab - - - -
365 Tetrakain HCl tetes mata 0,5% btl - - - -
366 Tetrasiklin kapsul/kaplet 250 mg Kaps - - - -
368 Tiamfenikol kapsul/kaplet 250 mg kaps - - - -
370 Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) Tab 20 - 20 -
371 Tiamin (Vitamin B1) 100 mg tablet tab - - - -
372 Tiamin (Vitamin B1) injeksi 100 mg/ml Amp - - - -
373 Tiamin (Vitamin B1) injeksi 100 mg/ml amp - - - -
374 Tramadol injeksi 50 mg/ml amp - - - -
375 Tramadol kapsul/kaplet/tablet 50 mg kaps - - - -
377 Transamin tab tab - - - -
378 Trifluoperazin tablet 5 mg tab - - - -
379 Triheksifenidil tablet 2 mg Tab - - - -
380 Ulsikur inj amp - - - -
381 Valdimex Injeksi 5mg/ml (i.v.) amp - - - -
382 Valdimex tablet 5 mg tab - - - -
383 Verapamil tablet 80 mg (HCl) tab - - - -
384 Vicillin 1gr inj vial - - - -
385 Vitamin B Kompleks tablet Tab 900 - 150 750
386 Zidovudin tablet 100 mg tab - - - -
387 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg tab - - - -

388 Zinc drop 10 mg/mL btl - 5 - 5
389 Zinc tablet 20 mg tab - 200 10 190
- - -
B PERBEKALAN KESEHATAN - - -
1 Alat suntik sekali pakai 1 ml set - - - -
2 Alat suntik sekali pakai 2,5 ml set 20 100 100 20
5 Catgut/benang bedah no.2/0 dengan jarum bedah set - - - -
7 Infusion set anak Set - - - -
8 Infusion set dewasa Set - - - -
9 IV Catheter No. 20 G Set - - - -
12 Kapas Berlemak 500 gram Bks - - - -
13 Kapas Pembalut / Absorben 250 gram Bks - 1 1 -
14 Kasa Hidrofil uk. 16 x 16 (isi 16 lembar) / kotak ktk - - - -
15 Kasa Hidrofil uk. 36 m x 80 cm rol - - - -
17 Kasa Pembalut Hidrofil 4 m x 5 Rol - 10 10 -
18 Kasa Pembalut Hidrofil 4 m x 10 cm Rol - - - -
19 Kasa Pembalut Elastic 3 inchi (medicrepe) rol - - - -
20 Kasa Pembalut Elastic 4 inchi rol - - - -
21 Kasa Pembalut Elastic 7,5 cm x 4,5m rol - - - -
22 Kasa Pembalut Elastic 10 cm x 4,5m rol - - - -
23 Pembalut Gips 3 ichi Rol - - - -
24 Plester 5 yards x 2 inch / 5 cm x 4,5 m Rol - - - -
Silk (Benang Bedah Sutera) No. 3/0 dengan jarum
25 bedah Sac 10 - 1 9
26 Ultrafix 5x5 rol - - - -
27 Urine Bag Set - - - -
28 Foley Catheter / Urocare set - - - -
29 Handscoon (Sarung Tangan Steril) Set - - - -
30 Masker set - - - -
- - -
C OBAT & PERBEKALAN KESEHATAN TAMBAHAN - - -
- - - -
1 Alkohol 70% 1 liter btl - 1 1 -
2 Alkohol 70 % 100 ml btl - - - -
3 Zinc sirup 20 mg/5 mL btl - - - -
4 - - - -
5 - - - -
6 - - - -
7 - - - -
8 - - - -
9 - - - -
10 - - - -
6,837
JUMLAH KUNJUNGAN BAYAR GRATIS JUMLAH

RESEP
- - -
Kepala UPTD Pkm Sumbermalang Pengelola Obat Puskesmas Pelapor
AMROZI, S.Kep.Ns. JONI HARDIANTO ___________________

NIP. 19641008 198503 1 004 NIP. 19820610 200604 1 016
Penanggung Jawab Pustu/Ponkesdes
______________________
YG 300 KEMBALI KE GUDANG OBAT
____
29 Pebruari 2016

A OBAT - OBATAN 1
20 Amoksisilin kapsul/kaplet 500 mg Tab 30 1,000 330 700
27 200 mg Tab - 1,000 300 700
28 mg/5 ml Btl - 60 10 50
29 IU/g + Polimiksin 10.000 IU/g Tube - - - -
33 mg Tab - - - -
60 Betametason krim 0,1 % (sebagai Valerat) Tube - - - -
71 Deksametason injeksi i.v. 5 mg/ml Amp 90 - 90 -
73 Deksametason tablet 0,5 mg Tab 100 - 100 -
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml Amp - - - -
115 Furosemid tablet 40 mg Tab 180 - 30 150
116 Garam Oralit I serbuk Sac - - - -
130 Gliseril Gualakolat tablet 100 mg Tab - - - -
142 Hidrokortison krim 2,5 % Tube - - - -
146 Ibuprofen tablet 200 mg Tab 100 - 100 -
148 Ibuprofen tablet 400 mg Tab - 200 200 -
157 Kalsium Laktat (Kalk) tablet 500 mg Tab 1,650 - 400 1,250
162 Ketokonazol krim 2% tube 5 - 5 -
163 Ketokonazol tablet 200 mg Tab 50 - 30 20
178 Kloramfenikol tetes telinga 3 % btl - - - -
179 Klorfeniramina Maleat (CTM) tablet 4 mg Tab 1,000 - 300 700

198 gr) (KAEN 3B) btl - - - -
199 gr) (KAEN 3A) btl - - - -
205 ( Lidokain Comp. Inj ) Amp 20 - 10 10
224 Metampiron tablet 500 mg (Antalgin) Tab 100 1,000 250 850
229 0,125 mg 30 - 10 20
236 Metoklopramide tablet 10 mg Tab - 100 30 70
240 Metronidazol tablet 500 mg Tab - 1,000 300 700
249 Natrium Diklofenak tablet 50 mg Tab - 200 100 100
250 Natrium Klorida larutan infus 0,9 % (NaCl) Btl 3 - 1 2
253 Nifedipin tablet 10 mg tab - - - -
263 Obat Batuk Hitam ( O.B.H. ) cairan Btl 50 - 30 20
269 Oksitetrasiklin salep kulit 3% Tube 10 - 2 8
274 Papaverin tablet 40 mg Tab 200 - 100 100
275 Parasetamol drops btl 5 - 1 4
278 Parasetamol tablet 500 mg Tab 820 - 400 420
299 Prednison tablet 5 mg Tab 400 - 100 300
309 Ranitidin tablet 150 mg Tab 40 - 20 20
322 SABU I Vial - - - -
324 Salbutamol tablet 4 mg (sebagai Sulfat) Tab 30 - 20 10
325 endap 4% Pot - - - -
326 Salisil Bedak 2 % Ktk - - - -
346 Sianokobalamin (vitamin B12) injeksi 500 mcg Amp 75 - 20 55
370 Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) Tab - - - -

388 Zinc drop 10 mg/mL btl 5 - 1 4
389 Zinc tablet 20 mg tab 190 - 10 180
B PERBEKALAN KESEHATAN 1
17 Kasa Pembalut Hidrofil 4 m x 5 Rol - - - -
25 bedah Sac 9 - 3 6
C OBAT & PERBEKALAN KESEHATAN TAMBAHAN 1

- - - -
1 Alkohol 70 % 100 ml btl - - - -
2 Alkohol 70 % 100 ml btl - 2 1 1
3 - - - -
4 - - - -
5 - - - -
6 - - - -
7 - - - -
8 - - - -
9 - - - -
10 - - - -
7,991

NIP. 19641008 198503 1 004 NIP. 19820610 200604 1 016
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0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 1 1 1 3
0 - 0 0 0
0 - 0 0 0
0 1 1 1 3
0 1 1 1 3
0 - 0 0 0
0 - 1 0 1
0 - 0 0 0
1 1 1 1 4
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
1 1 0 0 2
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 1 1 1 3
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 1 0 1
0 - 0 0 0
0 - 0 0 0
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0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
___
31 Maret 2016

A OBAT - OBATAN
4 Alopurinol tablet 100 mg Tab - 300 100 200
11 Ambroxol tablet 30 mg Tab - 200 100 100
27 200 mg Tab 700 - 200 500

28 mg/5 ml Btl 50 - 20 30
33 mg Tab - - - -
40 Asam Askorbat (Vitamin C) tablet 50 mg Tab 10 - 10 -
71 Deksametason injeksi i.v. 5 mg/ml Amp - 100 30 70
73 Deksametason tablet 0,5 mg Tab - 1,000 200 800
116 Garam Oralit I serbuk Sac - 500 20 480
142 Hidrokortison krim 2,5 % Tube - 24 10 14
148 Ibuprofen tablet 400 mg Tab - 200 100 100
162 Ketokonazol krim 2% tube - - - -
163 Ketokonazol tablet 200 mg Tab 20 - 20 -
179 Klorfeniramina Maleat (CTM) tablet 4 mg Tab 700 4,000 200 4,500
190 mg + Trimetoprim 40 mg / 5 ml Btl 5 - 5 -

198 gr) (KAEN 3B) btl - - - -
199 gr) (KAEN 3A) btl - - - -
205 ( Lidokain Comp. Inj ) Amp 10 - 10 -
210 Loperamid tablet 2 mg tab - 100 100 -
224 Metampiron tablet 500 mg (Antalgin) Tab 850 - 150 700
229 0,125 mg 20 - - 20
236 Metoklopramide tablet 10 mg Tab 70 - 50 20
240 Metronidazol tablet 500 mg Tab 700 200 100 800
249 Natrium Diklofenak tablet 50 mg Tab 100 - 50 50
250 Natrium Klorida larutan infus 0,9 % (NaCl) Btl 2 - - 2
253 Nifedipin tablet 10 mg tab - 100 20 80
263 Obat Batuk Hitam ( O.B.H. ) cairan Btl 20 60 10 70
269 Oksitetrasiklin salep kulit 3% Tube 8 - 8 -
270 Oksitosin injeksi 10 IU/ml - 1 ml Amp 18 - - 18
275 Parasetamol drops btl 4 - 4 -
293 Piroksikam kapsul/kaplet/tablet 20 mg kaps 80 - 20 60
299 Prednison tablet 5 mg Tab 300 1,000 100 1,200
322 SABU I Vial - - - -
324 Salbutamol tablet 4 mg (sebagai Sulfat) Tab 10 - 10 -
325 endap 4% Pot - - - -
327 Salisil Bedak 2 % ktk - 20 5 15
333 Sefadroksil sirup kering 125 mg/5ml btl - 10 2 8

388 Zinc drop 10 mg/mL btl 4 - 4 -
1
13 Kapas Pembalut / Absorben 250 gram Bks - - - -
17 Kasa Pembalut Hidrofil 4 m x 5 Rol - - - -
1
C OBAT & PERBEKALAN KESEHATAN TAMBAHAN 1
- - - -
1 Alkohol 70 % 1000 ml btl - - - -
2 Alkohol 70 % 100 ml btl 1 - 1 -
3 - - - -
4 - - - -
5 - - - -
6 - - - -
7 - - - -
8 - - - -
9 - - - -
10 - - - -
14,436

RESEP
- - -

NIP. 19641008 198503 1 004 NIP. 19820610 200604 1 016
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1 1 1 1 4
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1 1 1 1 4
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1 1 1 1 4
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0 1 0 1 2
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1 1 1 1 4
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0 1 1 1 3
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0 1 1 1 3
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
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1 1 1 1 4
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
1 1 1 1 4
0 - 0 0 0
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0 - 0 0 0
0 - 0 0 0
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0 - 0 0 0
0 - 0 0 0
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0 1 0 1 2
0 - 0 0 0
0 - 0 0 0
1 1 1 0 3
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
1 1 1 0 3
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
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0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 1 1 1 3
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
1 1 0 0 2
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 1 1 1 3
0 - 0 0 0
0 - 0 0 0
0 1 0 1 2
0 1 1 1 3
0 - 0 1 1
0 - 0 1 1
0 - 0 0 0
1 1 1 1 4
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 1 1 1 3
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 1 1
0 - 0 1 1
0 - 0 0 0
0 - 0 0 0
0 1 0 1 2
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
____
30 April 2016

A OBAT - OBATAN
4 Alopurinol tablet 100 mg Tab 200 - 200 -
11 Ambroxol tablet 30 mg Tab 100 - 100 -
20 Amoksisilin kapsul/kaplet 500 mg Tab 800 - 400 400
22 Amoksisilin sirup kering 125 mg/ 5 ml Btl 5 - 5 -
27 200 mg Tab 500 - 300 200

28 mg/5 ml Btl 30 - 20 10
33 mg Tab - - - -
40 Asam Askorbat (Vitamin C) tablet 50 mg Tab - - - -
71 Deksametason injeksi i.v. 5 mg/ml Amp 70 - 50 20
73 Deksametason tablet 0,5 mg Tab 800 - 300 500
82 Difenhidramin injeksi i.m. 10 mg/ml (HCl) Amp 30 - 20 10
116 Garam Oralit I serbuk Sac 480 - 40 440
142 Hidrokortison krim 2,5 % Tube 14 - 10 4
159 Kaptopril tablet 25 mg Tab 280 - 20 260
163 Ketokonazol tablet 200 mg Tab - - - -
179 Klorfeniramina Maleat (CTM) tablet 4 mg Tab 4,500 - 200 4,300
188 Sulfametoksazol 400 mg , Trimetoprim 80 mg Tab 400 - 100 300
189 Sulfametoksazol 100 mg Trimetoprim 20 mg Tab 100 300 100 300
190 mg + Trimetoprim 40 mg / 5 ml Btl - - - -

198 gr) (KAEN 3B) btl - - - -
199 gr) (KAEN 3A) btl - - - -
205 ( Lidokain Comp. Inj ) Amp - - - -
229 0,125 mg 20 - 10 10
236 Metoklopramide tablet 10 mg Tab 20 - 20 -
240 Metronidazol tablet 500 mg Tab 800 - 300 500
250 Natrium Klorida larutan infus 0,9 % (NaCl) Btl 2 - 2 -
253 Nifedipin tablet 10 mg tab 80 - 30 50
269 Oksitetrasiklin salep kulit 3% Tube - - - -
275 Parasetamol drops btl - - - -
276 Parasetamol sirup 120 mg / 5 ml Btl 20 - 20 -
299 Prednison tablet 5 mg Tab 1,200 - 100 1,100
322 SABU I Vial - - - -
325 endap 4% Pot - - - -
327 Salisil Bedak 2 % ktk 15 - 15 -
333 Sefadroksil sirup kering 125 mg/5ml btl 8 - 8 -
354 Siprofloksasin tablet 500 mg (sebagai HCl) Tab - - - -

388 Zinc drop 10 mg/mL btl - - - -
389 Zinc tablet 20 mg tab 100 - 100 -
1
2 Alat suntik sekali pakai 2,5 ml set 320 - 120 200
13 Kapas Pembalut / Absorben 250 gram Bks - - - -
17 Kasa Pembalut Hidrofil 4 m x 5 Rol - 20 - 20
18 Kasa Pembalut Hidrofil 4 m x 10 cm Rol - 10 - 10
C OBAT & PERBEKALAN KESEHATAN TAMBAHAN

- - - -
1 Alkohol 70 % 1000 ml btl - - - -
2 Alkohol 70 % 100 ml btl - - - -
3 - - - -
4 - - - -
5 - - - -
6 - - - -
7 - - - -
8 - - - -
9 - - - -
10 - - - -
11,111
RESEP
- - -

NIP. 19641008 198503 1 004 NIP. 19820610 200604 1 016
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1 - 1 0 2
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____
31 Mei 2016

A OBAT - OBATAN
22 Amoksisilin sirup kering 125 mg/ 5 ml Btl - - - -
27 200 mg Tab 200 - 100 100

28 mg/5 ml Btl 10 - 10 -
33 mg Tab - - - -
71 Deksametason injeksi i.v. 5 mg/ml Amp 20 100 50 70
82 Difenhidramin injeksi i.m. 10 mg/ml (HCl) Amp 10 - 10 -
98 Etanol 70% cairan ( 30 ml ) btl - - -
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml Amp - 10 10 -
142 Hidrokortison krim 2,5 % Tube 4 - 4 -
144 Ibuprofen suspensi 100 mg/5 ml btl - 30 20 10
159 Kaptopril tablet 25 mg Tab 260 - 260 -
179 Klorfeniramina Maleat (CTM) tablet 4 mg Tab 4,300 - 2,200 2,100
189 Sulfametoksazol 100 mg Trimetoprim 20 mg Tab 300 - 300 -
190 mg + Trimetoprim 40 mg / 5 ml Btl - - - -

198 gr) (KAEN 3B) btl - - - -
199 gr) (KAEN 3A) btl - - - -
210 Loperamid tablet 2 mg tab - 100 100 -
229 0,125 mg 10 - 2 8
236 Metoklopramide tablet 10 mg Tab - - - -
249 Natrium Diklofenak tablet 50 mg Tab 30 200 150 80
250 Natrium Klorida larutan infus 0,9 % (NaCl) Btl - - - -
253 Nifedipin tablet 10 mg tab 50 - 50 -
263 Obat Batuk Hitam ( O.B.H. ) cairan Btl 40 - 40 -
269 Oksitetrasiklin salep kulit 3% Tube - 25 25 -
270 Oksitosin injeksi 10 IU/ml - 1 ml Amp 16 - 16 -
276 Parasetamol sirup 120 mg / 5 ml Btl - 84 40 44
278 Parasetamol tablet 500 mg Tab 200 - 200 -
299 Prednison tablet 5 mg Tab 1,100 - 400 700
309 Ranitidin tablet 150 mg Tab 100 - 100 -
322 SABU I Vial - - - -
325 endap 4% Pot - - - -
333 Sefadroksil sirup kering 125 mg/5ml btl - 10 10 -
346 Sianokobalamin (vitamin B12) injeksi 500 mcg Amp 20 - 20 -
348 Simetidin tablet 200 mg Tab - 100 50 50

389 Zinc tablet 20 mg tab - - - -
B PERBEKALAN KESEHATAN
5 Catgut/benang bedah no.2/0 dengan jarum bedah set - 4 2 2
17 Kasa Pembalut Hidrofil 4 m x 5 Rol 20 - 20 -
18 Kasa Pembalut Hidrofil 4 m x 10 cm Rol 10 - 10 -
25 bedah Sac 1 - 1 -

- - - -
1 Alkohol 70 % 1000 ml btl - - - -
2 Alkohol 70 % 100 ml btl - 2 2 -
3 - - - -
4 - - - -
5 - - - -
6 - - - -
7 - - - -
8 - - - -
9 - - - -
10 - - - -
6,649
AMROZI, S.Kep.Ns. JONI HARDIANTO DIAN A'YUNI

NIP. 19641008 198503 1 004 NIP. 19820610 200604 1 016
sers/pc/Ap
pData/Loc
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30 Juni 2016

A OBAT - OBATAN
3 Albendazol tablet 400 mg Tab - 60 - 60
4 Alopurinol tablet 100 mg Tab - 100 - 100
11 Ambroxol tablet 30 mg Tab 100 - 100 -
14 Aminofilin tablet 200 mg Tab - 300 - 300
22 Amoksisilin sirup kering 125 mg/ 5 ml Btl - 10 - 10
27 200 mg Tab 100 500 100 500

28 mg/5 ml Btl - 50 - 50
29 IU/g + Polimiksin 10.000 IU/g Tube - 25 - 25
33 mg Tab - - - -
82 Difenhidramin injeksi i.m. 10 mg/ml (HCl) Amp - 30 - 30
83 Digoksin tablet 0,25 mg Tab - 100 - 100
111 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tab - 100 - 100
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml Amp - 30 - 30
123 Glibenklamida tablet 5 mg Tab - 200 - 200
130 Gliseril Gualakolat tablet 100 mg Tab - 1,000 - 1,000
135 Griseofulvin tablet 125 mg Tab - 200 - 200
142 Hidrokortison krim 2,5 % Tube - 25 - 25
144 Ibuprofen suspensi 100 mg/5 ml btl 10 50 10 50
157 Kalsium Laktat (Kalk) tablet 500 mg Tab 1,000 - - 1,000
159 Kaptopril tablet 25 mg Tab - 100 - 100
162 Ketokonazol krim 2% tube 5 - 5 -
174 Kloramfenikol salep mata 1 % Tube - 10 - 10
177 Kloramfenicol tetes mata 0,5% Btl - 10 - 10
178 Kloramfenikol tetes telinga 3 % btl - 24 - 24
189 Sulfametoksazol 100 mg Trimetoprim 20 mg Tab - 1,000 - 1,000
190 mg + Trimetoprim 40 mg / 5 ml Btl - 50 - 50

198 gr) (KAEN 3B) btl - - - -
199 gr) (KAEN 3A) btl - - - -
211 Loratadin tablet 10 mg tab - 800 - 800
229 0,125 mg 8 - 5 3
249 Natrium Diklofenak tablet 50 mg Tab 80 200 50 230
253 Nifedipin tablet 10 mg tab - 200 20 180
263 Obat Batuk Hitam ( O.B.H. ) cairan Btl - 50 10 40
270 Oksitosin injeksi 10 IU/ml - 1 ml Amp - 10 - 10
275 Parasetamol drops btl - 10 - 10
276 Parasetamol sirup 120 mg / 5 ml Btl 44 84 28 100
278 Parasetamol tablet 500 mg Tab - 500 200 300
299 Prednison tablet 5 mg Tab 700 2,000 100 2,600
309 Ranitidin tablet 150 mg Tab - 400 - 400
322 SABU I Vial - - - -
324 Salbutamol tablet 4 mg (sebagai Sulfat) Tab - 300 - 300
325 endap 4% Pot - - - -
326 Salisil Bedak 2 % Ktk - 50 - 50
346 Sianokobalamin (vitamin B12) injeksi 500 mcg Amp - 100 - 100
348 Simetidin tablet 200 mg Tab 50 - 20 30
354 Siprofloksasin tablet 500 mg (sebagai HCl) Tab - 100 - 100
366 Tetrasiklin kapsul/kaplet 250 mg Kaps - 500 - 500
367 Tetrasiklin kapsul/kaplet 500 mg Kaps - 1,000 - 1,000
370 Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) Tab - 1,000 - 1,000
385 Vitamin B Kompleks tablet Tab 100 5,000 200 4,900

5 Catgut/benang bedah no.2/0 dengan jarum bedah set 2 3 2 3
13 Kapas Pembalut / Absorben 250 gram Bks - 1 1
17 Kasa Pembalut Hidrofil 4 m x 5 Rol - 20 2 18
18 Kasa Pembalut Hidrofil 4 m x 10 cm Rol - 10 5 5
25 bedah Sac - - - -

- - - -
1 Alkohol 70 % 1000 ml btl - - - -
2 Alkohol 70 % 100 ml btl - 1 - 1
3 - - - -
4 - - - -
5 - - - -
6 - - - -
7 - - - -
8 - - - -
9 - - - -
10 - - - -
22,125

RESEP
- - -

NIP. 19641008 198503 1 004 NIP. 19820610 200604 1 016
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1 1 1 1 4
0 - 0 0 0
1 - 1 0 2
0 - 0 0 0
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0 - 0 0 0
1 1 1 1 4
1 - 1 0 2
1 - 1 0 2
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0 - 0 0 0
0 - 0 0 0
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0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
1 - 1 0 2
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0 - 0 0 0
0 - 0 0 0
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0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
1 - 1 0 2
1 - 1 0 2
0 - 0 0 0
0 - 0 0 0
1 - 1 0 2
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
1 1 1 1 4
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
1 - 0 0 1
1 - 0 0 1
0 - 0 0 0
0 1 1 1 3
0 - 0 0 0
0 - 0 0 0
1 1 1 1 4
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
1 - 1 0 2
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
1 1 1 0 3
1 1 1 0 3
0 - 0 0 0
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0 - 0 0 0
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0 - 0 0 0
1 - 0 0 1
1 - 0 0 1
0 - 0 0 0
0 - 0 0 0
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0 - 0 0 0
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0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
31 Juli 2016

A OBAT - OBATAN
3 Albendazol tablet 400 mg Tab 60 - 10 50
4 Alopurinol tablet 100 mg Tab 100 200 100 200
14 Aminofilin tablet 200 mg Tab 300 - - 300
20 Amoksisilin kapsul/kaplet 500 mg Tab 200 - 200 -
22 Amoksisilin sirup kering 125 mg/ 5 ml Btl 10 10 20 -
27 200 mg Tab 500 - 150 350

28 mg/5 ml Btl 50 - 20 30
29 IU/g + Polimiksin 10.000 IU/g Tube 25 - 5 20
33 mg Tab - - - -
82 Difenhidramin injeksi i.m. 10 mg/ml (HCl) Amp 30 - 15 15
83 Digoksin tablet 0,25 mg Tab 100 - - 100
111 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tab 100 - - 100
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml Amp 30 - - 30
123 Glibenklamida tablet 5 mg Tab 200 - 10 190
130 Gliseril Gualakolat tablet 100 mg Tab 1,000 - 200 800
135 Griseofulvin tablet 125 mg Tab 200 - 100 100
144 Ibuprofen suspensi 100 mg/5 ml btl 50 - 25 25
157 Kalsium Laktat (Kalk) tablet 500 mg Tab 1,000 - - 1,000
174 Kloramfenikol salep mata 1 % Tube 10 - 5 5
177 Kloramfenicol tetes mata 0,5% Btl 10 - 5 5
178 Kloramfenikol tetes telinga 3 % btl 24 - 15 9
189 Sulfametoksazol 100 mg Trimetoprim 20 mg Tab 1,000 - 100 900
198 gr) (KAEN 3B) btl - - - -
199 gr) (KAEN 3A) btl - - - -
203 Lidokain injeksi 2% amp - 25 5 20
210 Loperamid tablet 2 mg tab - 100 50 50
211 Loratadin tablet 10 mg tab 800 100 700
224 Metampiron tablet 500 mg (Antalgin) Tab 100 - - 100
229 0,125 mg 3 - - 3
322 SABU I Vial - - - -
325 endap 4% Pot - - - -
326 Salisil Bedak 2 % Ktk 50 - 20 30
354 Siprofloksasin tablet 500 mg (sebagai HCl) Tab 100 100 150 50
366 Tetrasiklin kapsul/kaplet 250 mg Kaps 500 - - 500
367 Tetrasiklin kapsul/kaplet 500 mg Kaps 1,000 - - 1,000
370 Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) Tab 1,000 - 100 900
385 Vitamin B Kompleks tablet Tab 4,900 - 100 4,800

5 Catgut/benang bedah no.2/0 dengan jarum bedah set 3 5 1 7
13 Kapas Pembalut / Absorben 250 gram Bks 1 - - 1
17 Kasa Pembalut Hidrofil 4 m x 5 Rol 18 - 3 15
18 Kasa Pembalut Hidrofil 4 m x 10 cm Rol 5 - 4 1

- - - -
1 Alkohol 70 % 1000 ml btl - - - -
2 Alkohol 70 % 100 ml btl 1 2 2 1
3 - - - -
4 - - - -
5 - - - -
6 - - - -
7 - - - -
8 - - - -
9 - - - -
10 - - - -
19,565

RESEP
- - -

NIP. 19641008 198503 1 004 NIP. 19820610 200604 1 016
0 - 0 0 0
0 - 0 0 0
0 1 1 1 3
1 1 1 1 4
0 - 0 0 0
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0 - 0 0 0
0 - 1 1 2
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0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
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0 1 0 1 2
0 - 0 0 0
1 1 0 1 3
0 - 0 0 0
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0 - 0 0 0
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0 1 1 1 3
0 1 1 1 3
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0 1 1 1 3
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0 1 1 1 3
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0 1 1 1 3
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0 1 1 1 3
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0 1 1 1 3
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0 1 1 1 3
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0 1 1 1 3
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0 1 1 1 3
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0 - 0 0 0
0 - 0 0 0
0 1 1 1 3
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0 - 0 0 0
0 1 1 1 3
0 - 0 0 0
0 1 1 1 3
0 - 0 0 0
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0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
1 1 1 0 3
0 - 0 0 0
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0 - 0 0 0
0 - 0 0 0
0 1 1 1 3
0 - 0 0 0
0 1 1 1 3
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
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0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 1 1 2
0 - 1 1 2
0 - 0 0 0
0 - 0 0 0
0 1 1 1 3
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 1 1 1 3
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
1 - 0 0 1
1 - 0 0 1
0 - 0 0 0
1 1 1 1 4
0 - 0 0 0
0 - 0 0 0
1 1 1 1 4
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 1 1 2
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 1 1 1 3
0 1 1 1 3
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
1 - 0 0 1
1 - 0 0 1
0 - 0 0 0
0 - 0 0 0
1 1 1 1 4
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
31 Agustus 2016

A OBAT - OBATAN
4 Alopurinol tablet 100 mg Tab 200 - 100 100
14 Aminofilin tablet 200 mg Tab 300 - 100 200
20 Amoksisilin kapsul/kaplet 500 mg Tab - 500 150 350
22 Amoksisilin sirup kering 125 mg/ 5 ml Btl - 5 5 -
27 200 mg Tab 350 - 30 320

28 mg/5 ml Btl 30 - 4 26
33 mg Tab - - - -
45 Asam Mefenamat kapsul/kaplet 500 mg Tab - 500 200 300
60 Betametason krim 0,1 % (sebagai Valerat) Tube - 25 15 10
73 Deksametason tablet 0,5 mg Tab 150 - 150 -
111 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tab 100 - 5 95
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml Amp 30 - 10 20
115 Furosemid tablet 40 mg Tab 20 200 20 200
130 Gliseril Gualakolat tablet 100 mg Tab 800 - 400 400
142 Hidrokortison krim 2,5 % Tube 15 25 15 25
144 Ibuprofen suspensi 100 mg/5 ml btl 25 - 15 10
148 Ibuprofen tablet 400 mg Tab 50 1,000 50 1,000
157 Kalsium Laktat (Kalk) tablet 500 mg Tab 1,000 - 200 800
163 Ketokonazol tablet 200 mg Tab - 100 50 50
174 Kloramfenikol salep mata 1 % Tube 5 - 5 -
177 Kloramfenicol tetes mata 0,5% Btl 5 - 5 -
198 gr) (KAEN 3B) btl - - - -

199 gr) (KAEN 3A) btl - - - -
203 Lidokain injeksi 2% amp 20 - 10 10
210 Loperamid tablet 2 mg tab 50 100 50 100
211 Loratadin tablet 10 mg tab 700 - 100 600
229 0,125 mg 3 100 3 100
250 Natrium Klorida larutan infus 0,9 % (NaCl) Btl - 100 - 100
269 Oksitetrasiklin salep kulit 3% Tube - 10 5 5
270 Oksitosin injeksi 10 IU/ml - 1 ml Amp 10 - 10 -
275 Parasetamol drops btl - 10 5 5
278 Parasetamol tablet 500 mg Tab 100 1,000 150 950
296 Povidon Iodida larutan 10% 300 mL Btl - 1 - 1
322 SABU I Vial - - - -
325 endap 4% Pot - - - -
333 Sefadroksil sirup kering 125 mg/5ml btl 3 - 3 -
366 Tetrasiklin kapsul/kaplet 250 mg Kaps 500 - 100 400
367 Tetrasiklin kapsul/kaplet 500 mg Kaps 1,000 - 200 800
370 Tiamin (vitamin B1) tablet 50 mg (HCL/Nitrat) Tab 900 - 200 700

5 Catgut/benang bedah no.2/0 dengan jarum bedah set 7 - 7 -
13 Kapas Pembalut / Absorben 250 gram Bks 1 1 1 1
18 Kasa Pembalut Hidrofil 4 m x 10 cm Rol 1 - 1 -

- - - -
1 Alkohol 70 % 1000 ml btl - - - -
2 Alkohol 70 % 100 ml btl 1 5 2 4
3 - - - -
4 - - - -
5 - - - -
6 - - - -
7 - - - -
8 - - - -
9 - - - -
10 - - - -
19,243

RESEP
- - -

NIP. 19641008 198503 1 004 NIP. 19820610 200604 1 016
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0 - 0 0 0
0 1 1 1 3
0 1 1 1 3
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0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 1 1 1 3
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
1 - 0 0 1
1 - 0 0 1
0 - 0 0 0
0 1 1 1 3
0 - 0 0 0
0 - 0 0 0
0 1 0 1 2
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
1 1 1 1 4
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 1 1 1 3
0 1 0 1 2
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
1 - 0 0 1
1 - 0 0 1
0 - 0 0 0
0 - 0 0 0
1 1 1 1 4
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
30 September 2016

A OBAT - OBATAN
4 Alopurinol tablet 100 mg Tab 100 - 30 70
11 Ambroxol tablet 30 mg Tab 80 - 40 40
22 Amoksisilin sirup kering 125 mg/ 5 ml Btl - 10 10 -

27 200 mg Tab 320 - 100 220
28 mg/5 ml Btl 26 - 26 -
33 mg Tab - - - -
45 Asam Mefenamat kapsul/kaplet 500 mg Tab 300 200 300 200
60 Betametason krim 0,1 % (sebagai Valerat) Tube 10 - 4 6
73 Deksametason tablet 0,5 mg Tab - 500 250 250
111 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tab 95 - - 95
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml Amp 20 - - 20
144 Ibuprofen suspensi 100 mg/5 ml btl 10 - 10 -
148 Ibuprofen tablet 400 mg Tab 1,000 - 200 800
157 Kalsium Laktat (Kalk) tablet 500 mg Tab 800 - 200 600
162 Ketokonazol krim 2% tube 10 - 5 5
163 Ketokonazol tablet 200 mg Tab 50 - 10 40
178 Kloramfenikol tetes telinga 3 % btl 5 - 5 -
189 Sulfametoksazol 100 mg Trimetoprim 20 mg Tab 800 - - 800
190 mg + Trimetoprim 40 mg / 5 ml Btl 20 - 20 -
198 gr) (KAEN 3B) btl - - - -
199 gr) (KAEN 3A) btl - - - -
210 Loperamid tablet 2 mg tab 100 - 30 70
224 Metampiron tablet 500 mg (Antalgin) Tab 50 - 50 -
229 0,125 mg 100 - - 100
236 Metoklopramide tablet 10 mg Tab - 100 100 -
263 Obat Batuk Hitam ( O.B.H. ) cairan Btl 20 - 20 -
269 Oksitetrasiklin salep kulit 3% Tube 5 - 5 -
270 Oksitosin injeksi 10 IU/ml - 1 ml Amp - - - -
296 Povidon Iodida larutan 10% 300 mL Btl 1 - 1 -
322 SABU I Vial - - - -
324 Salbutamol tablet 4 mg (sebagai Sulfat) Tab 100 - 100 -
325 endap 4% Pot - - - -
333 Sefadroksil sirup kering 125 mg/5ml btl - 5 5 -
348 Simetidin tablet 200 mg Tab 5 - 5 -


- - - -
1 Alkohol 70 % 1000 ml btl - - - -
2 Alkohol 70 % 100 ml btl 4 - 1 3
3 - - - -
4 - - - -
5 - - - -
6 - - - -
7 - - - -
8 - - - -
9 - - - -
10 - - - -
19,243 1,745 4,797 16,191

RESEP
- - -
HARI SANTOSO, A.Md. Kep. JONI HARDIANTO DIAN A'YUNI

NIP. 19800510 200501 1 010 NIP. 19820610 200604 1 016
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0 - 1 1 2 400 -
0 - 1 1 2 800 -
0 - 0 0 0 0 -
0 - 0 0 0 0 -
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0 - 0 0 0 0 -
0 - 0 0 0 0 -
0 1 1 1 3 4100 -
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0 - 0 0 0 0 -
0 - 0 0 0 0 -
0 - 0 0 0 0 -
1 - 0 0 1 -
1 - 0 0 1 -
0 - 0 0 0 0 -
1 1 1 1 4 80 -
0 - 0 0 0 0 -
0 - 0 0 0 0 -
0 - 0 0 0 0 -
0 - 0 0 0 0 -
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0 - 0 0 0 0 -
0 - 1 1 2 1 -
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0 - 0 0 0 0 -
0 1 1 1 3 8 -
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1 - 0 0 1 -
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0 - 0 0 0 0 -
0 1 1 1 3 4 1
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0 - 0 0 0 0 -
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0 - 0 0 0 0 -
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16,600 409
31 Oktober 2016

A OBAT - OBATAN
3 Albendazol tablet 400 mg Tab 10 - 3 7 30
4 Alopurinol tablet 100 mg Tab 70 - 20 50 200
11 Ambroxol tablet 30 mg Tab 40 100 20 120
22 Amoksisilin sirup kering 125 mg/ 5 ml Btl - 25 20 5 50
27 200 mg Tab 220 500 100 620

28 mg/5 ml Btl - 60 10 50
29 IU/g + Polimiksin 10.000 IU/g Tube 12 25 10 27
33 mg Tab - - - -
40 Asam Askorbat (Vitamin C) tablet 50 mg Tab - 200 - 200
60 Betametason krim 0,1 % (sebagai Valerat) Tube 6 - 2 4 20
71 Deksametason injeksi i.v. 5 mg/ml Amp 30 - 10 20 100
83 Digoksin tablet 0,25 mg Tab 100 - 10 90
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml Amp 20 - 10 10 30
135 Griseofulvin tablet 125 mg Tab 30 - 10 20 100
142 Hidrokortison krim 2,5 % Tube 20 - 10 10 25
157 Kalsium Laktat (Kalk) tablet 500 mg Tab 600 2,000 20 2,580
162 Ketokonazol krim 2% tube 5 5 5 5 20
163 Ketokonazol tablet 200 mg Tab 40 - 20 20 100
174 Kloramfenikol salep mata 1 % Tube - 10 1 9
177 Kloramfenicol tetes mata 0,5% Btl - 10 2 8
178 Kloramfenikol tetes telinga 3 % btl - 10 2 8
190 mg + Trimetoprim 40 mg / 5 ml Btl - 50 10 40

198 gr) (KAEN 3B) btl - - - -
199 gr) (KAEN 3A) btl - - - -
203 Lidokain injeksi 2% amp 8 10 3 15
205 ( Lidokain Comp. Inj ) Amp - 30 2 28
210 Loperamid tablet 2 mg tab 70 - 50 20 100
224 Metampiron tablet 500 mg (Antalgin) Tab - - - -
229 0,125 mg 100 - - 100
236 Metoklopramide tablet 10 mg Tab - 200 50 150
249 Natrium Diklofenak tablet 50 mg Tab 70 200 250 20 200
253 Nifedipin tablet 10 mg tab 80 100 20 160
263 Obat Batuk Hitam ( O.B.H. ) cairan Btl - - - -
270 Oksitosin injeksi 10 IU/ml - 1 ml Amp - 10 2 8
322 SABU I Vial - - - -
324 Salbutamol tablet 4 mg (sebagai Sulfat) Tab - 300 20 280
325 endap 4% Pot - - - -
326 Salisil Bedak 2 % Ktk 5 25 10 20
333 Sefadroksil sirup kering 125 mg/5ml btl - 10 5 5 10
346 Sianokobalamin (vitamin B12) injeksi 500 mcg Amp 58 - 8 50 100

389 Zinc tablet 20 mg tab - 1,000 100 900
1 Alat suntik sekali pakai 1 ml set - 10 5 5
3 Alat suntik sekali pakai 3 ml set - 100 50 50
24 Plester 5 yards x 2 inch / 5 cm x 4,5 m Rol - 1 - 1

- - - -
1 Alkohol 70 % 1000 ml btl - - - -
2 Alkohol 70 % 100 ml btl 3 2 1 4
3 Zinc sirup 20 mg/5 mL btl - 5 - 5
4 - - - -
5 - - - -
6 - - - -
7 - - - -
8 - - - -
9 - - - -
10 - - - -
16,191 6,958 3,050 20,099

RESEP
- - -

NIP. 19800510 200501 1 010 NIP. 19820610 200604 1 016
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1 1 1 0 3
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1 1 1 1 4
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0 - 1 1 2
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0 - 0 0 0
0 1 1 1 3
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0 - 0 0 0
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0 - 0 0 0
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1 - 0 0 1
1 - 0 0 1
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1 1 1 1 4
1 1 1 0 3
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0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 1 1 2
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 1 1 1 3
0 - 0 0 0
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1 - 1 0 2
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0 - 0 0 0
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0 - 0 0 0
0 - 0 0 0
1 - 0 0 1
1 - 0 0 1
0 - 0 0 0
0 - 0 0 0
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1 - 1 0 2
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
30 Nopember 2016

A OBAT - OBATAN
3 Albendazol tablet 400 mg Tab 7 - 7 - 30
4 Alopurinol tablet 100 mg Tab 50 - 30 20 100
11 Ambroxol tablet 30 mg Tab 120 - 40 80
22 Amoksisilin sirup kering 125 mg/ 5 ml Btl 5 - 2 3 10
27 200 mg Tab 620 - 400 220

28 mg/5 ml Btl 50 - 20 30
33 mg Tab - - - -
45 Asam Mefenamat kapsul/kaplet 500 mg Tab 300 - 50 250
60 Betametason krim 0,1 % (sebagai Valerat) Tube 4 - 2 2 10
71 Deksametason injeksi i.v. 5 mg/ml Amp 20 - 14 6 100
82 Difenhidramin injeksi i.m. 10 mg/ml (HCl) Amp 60 - 40 20 30
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml Amp 10 - 2 8 30
142 Hidrokortison krim 2,5 % Tube 10 - 5 5 10
148 Ibuprofen tablet 400 mg Tab 900 - 400 500
162 Ketokonazol krim 2% tube 5 - 5 - 10
163 Ketokonazol tablet 200 mg Tab 20 - 10 10 100
174 Kloramfenikol salep mata 1 % Tube 9 - 2 7
177 Kloramfenicol tetes mata 0,5% Btl 8 - 4 4
188 Sulfametoksazol 400 mg , Trimetoprim 80 mg Tab 200 - 200 - 1,000

198 gr) (KAEN 3B) btl - 12 1 11
199 gr) (KAEN 3A) btl - - - -
205 ( Lidokain Comp. Inj ) Amp 28 - - 28
210 Loperamid tablet 2 mg tab 20 - 20 - 100
224 Metampiron tablet 500 mg (Antalgin) Tab - - - -
229 0,125 mg 100 - - 100
240 Metronidazol tablet 500 mg Tab 250 - 250 - 200
249 Natrium Diklofenak tablet 50 mg Tab 20 - 20 - 200
263 Obat Batuk Hitam ( O.B.H. ) cairan Btl - - - -
293 Piroksikam kapsul/kaplet/tablet 20 mg kaps 40 - 40 - 200
322 SABU I Vial - - - -
325 endap 4% Pot - - - -
333 Sefadroksil sirup kering 125 mg/5ml btl 5 - 5 - 10
354 Siprofloksasin tablet 500 mg (sebagai HCl) Tab 150 - 30 120
385 Vitamin B Kompleks tablet Tab 4,000 - 1,000 3,000

1 Alat suntik sekali pakai 1 ml set 5 - - 5
3 Alat suntik sekali pakai 3 ml set 50 - 40 10
13 Kapas Pembalut / Absorben 250 gram Bks 1 - 1 - 1
24 Plester 5 yards x 2 inch / 5 cm x 4,5 m Rol 1 - 1 - 2

- - - -
1 Alkohol 70 % 1000 ml btl - - - -
2 Alkohol 70 % 100 ml btl 4 - 4 - 4
3 Zinc sirup 20 mg/5 mL btl 5 - 2 3
4 - - - -
5 - - - -
6 - - - -
7 - - - -
8 - - - -
9 - - - -
10 - - - -
14,948

RESEP
- - -

NIP. 19800510 200501 1 010 NIP. 19820610 200604 1 016
0 - 0 0 0
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0 1 1 1 3
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0 - 0 0 0
0 1 1 1 3
0 1 1 1 3
0 - 0 0 0
0 - 0 0 0
0 1 1 1 3
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 1 1 1 3
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 1 1 1 3
1 - 0 0 1
1 - 0 0 1
0 - 1 1 2
0 1 1 1 3
0 1 1 1 3
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 1 0 1 2
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 1 1 1 3
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 1 0 1 2
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
1 - 0 0 1
1 - 0 0 1
0 - 0 0 0
0 - 0 0 0
0 1 0 1 2
0 1 1 1 3
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
0 - 0 0 0
8-Dec
31 Desember 2016

A OBAT - OBATAN
4 Alopurinol tablet 100 mg Tab 20 200 100 120
11 Ambroxol tablet 30 mg Tab 80 100 10 170
22 Amoksisilin sirup kering 125 mg/ 5 ml Btl 3 10 13 -
27 200 mg Tab 220 500 20 700
28 mg/5 ml Btl 30 70 10 90
40 Asam Askorbat (Vitamin C) tablet 50 mg Tab 180 200 10 370
47 Asiklovir krim 5% Tube - 7 1 6
60 Betametason krim 0,1 % (sebagai Valerat) Tube 2 - 1 1
73 Deksametason tablet 0,5 mg Tab 180 500 100 580
112 Fitomenadion (Vitamin K1) injeksi 10 mg/ml Amp 8 - 2 6
122 Gentian Violet larutan 1 % Btl - 7 - 7
162 Ketokonazol krim 2% tube - 2 - 2
163 Ketokonazol tablet 200 mg Tab 10 50 - 60
174 Kloramfenikol salep mata 1 % Tube 7 5 2 10
176 Kloramfenikol suspensi 125 mg/ 5 ml btl - 50 10 40
177 Kloramfenicol tetes mata 0,5% Btl 4 5 9 -
178 Kloramfenikol tetes telinga 3 % btl 4 - - 4
179 Klorfeniramina Maleat (CTM) tablet 4 mg Tab 1,000 1,000 120 1,880
188 Sulfametoksazol 400 mg , Trimetoprim 80 mg Tab - 200 - 200
198 gr) (KAEN 3B) btl 11 - 1 10
205 ( Lidokain Comp. Inj ) Amp 28 - 2 26
210 Loperamid tablet 2 mg tab - 200 100 100
229 0,125 mg 100 - - 100
237 Metoklopramide tablet 5 mg tab - 200 - 200
240 Metronidazol tablet 500 mg Tab - 500 - 500
249 Natrium Diklofenak tablet 50 mg Tab - 100 10 90
253 Nifedipin tablet 10 mg tab 60 100 20 140
325 endap 4% Pot - 34 10 24
389 Zinc tablet 20 mg tab 800 2,000 - 2,800
1 Alat suntik sekali pakai 1 ml set 5 - - 5
3 Alat suntik sekali pakai 3 ml set 10 - 10 -

2 Alkohol 70 % 100 ml btl - 4 2 2
3 Zinc sirup 20 mg/5 mL btl 3 - - 3
21,095

RESEP
- - -

NIP. 19800510 200501 1 010 NIP. 19820610 200604 1 016
1 1 1 1 4
1 1 1 1 4
0 1 1 1 3
1 1 1 1 4
1 1 0 1 3
1 1 1 1 4
1 1 1 1 4
0 1 1 1 3
1 1 1 1 4
1 1 1 1 4
1 1 1 0 3
0 1 1 1 3
1 1 1 1 4
1 1 1 1 4
1 1 1 1 4
0 1 1 1 3
0 1 1 1 3
0 1 1 1 3
0 1 1 1 3
0 1 1 1 3
1 - 1 0 2
0 1 1 1 3
0 1 1 1 3
0 1 1 1 3
0 1 1 1 3
1 1 1 1 4
0 1 1 1 3
1 1 1 1 4
1 - 1 0 2
1 - 1 1 3
1 1 1 1 4
1 1 1 0 3
1 1 0 1 3
0 - 1 1 2
1 1 1 1 4
1 - 1 0 2
0 1 1 1 3
0 1 1 1 3
0 1 1 1 3
0 1 1 1 3
0 1 1 1 3
1 1 1 0 3
0 1 1 1 3
0 - 1 1 2
0 1 1 1 3
1 - 1 0 2
1 - 1 0 2
1 1 1 0 3
0 1 1 1 3
1 1 1 1 4
0 - 1 1 2
0 1 1 1 3
0 1 1 1 3
0 1 1 1 3
0 1 1 1 3
0 1 1 1 3
0 1 1 1 3
1 1 1 0 3
0 1 1 1 3
1 1 1 0 3
0 1 1 1 3
1 1 1 1 4
0 - 1 1 2
0 - 1 1 2
0 1 1 1 3
0 1 1 1 3
1 - 1 1 3
1 - 0 0 1
1 - 0 0 1
0 - 1 1 2
1 1 1 1 4
0 1 0 1 2
0 1 1 1 3
1 - 0 0 1
1 - 0 0 1
1 1 1 0 3
0 - 1 1 2

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LPLPO PUSTU PLALANGAN

Stok Peneri Pema Stok Permin-

Antasida DOEN II suspensi, kombi : Aluminium

Larutan mengandung Karbohidrat + Elektrolit (Nacl

387 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg tab - - - -

JUMLAH KUNJUNGAN BAYAR GRATIS JUMLAH

Kepala UPTD Pkm Sumbermalang Pengelola Obat Puskesmas Pelapor

AMROZI, S.Kep.Ns. JONI HARDIANTO ___________________

Penanggung Jawab Pustu/Ponkesdes

Stok Peneri Pema Stok Permin-

Larutan mengandung Karbohidrat + Elektrolit (Nacl

387 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg tab - - - -

C OBAT & PERBEKALAN KESEHATAN TAMBAHAN 1

Kepala UPTD Pkm Sumbermalang Pengelola Obat Puskesmas Pelapor

AMROZI, S.Kep.Ns. JONI HARDIANTO ___________________

Stok Peneri Pema Stok Permin-

Antasida DOEN II suspensi, kombi : Aluminium

Larutan mengandung Karbohidrat + Elektrolit (Nacl

387 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg tab - - - -

JUMLAH KUNJUNGAN BAYAR GRATIS JUMLAH

Kepala UPTD Pkm Sumbermalang Pengelola Obat Puskesmas Pelapor

AMROZI, S.Kep.Ns. JONI HARDIANTO ___________________

Stok Peneri Pema Stok Permin-

Antasida DOEN II suspensi, kombi : Aluminium

Larutan mengandung Karbohidrat + Elektrolit (Nacl

387 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg tab - - - -

C OBAT & PERBEKALAN KESEHATAN TAMBAHAN

Kepala UPTD Pkm Sumbermalang Pengelola Obat Puskesmas Pelapor

AMROZI, S.Kep.Ns. JONI HARDIANTO ___________________

Stok Peneri Pema Stok Permin-

Antasida DOEN II suspensi, kombi : Aluminium

Larutan mengandung Karbohidrat + Elektrolit (Nacl

387 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg tab - - - -

C OBAT & PERBEKALAN KESEHATAN TAMBAHAN

AMROZI, S.Kep.Ns. JONI HARDIANTO DIAN A'YUNI

Stok Peneri Pema Stok Permin-

Antasida DOEN II suspensi, kombi : Aluminium

Larutan mengandung Karbohidrat + Elektrolit (Nacl

387 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg tab - - - -

C OBAT & PERBEKALAN KESEHATAN TAMBAHAN

JUMLAH KUNJUNGAN BAYAR GRATIS JUMLAH

Kepala UPTD Pkm Sumbermalang Pengelola Obat Puskesmas Pelapor

AMROZI, S.Kep.Ns. JONI HARDIANTO DIAN A'YUNI

Stok Peneri Pema Stok Permin-

Antasida DOEN II suspensi, kombi : Aluminium

387 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg tab - - - -

C OBAT & PERBEKALAN KESEHATAN TAMBAHAN

JUMLAH KUNJUNGAN BAYAR GRATIS JUMLAH

Kepala UPTD Pkm Sumbermalang Pengelola Obat Puskesmas Pelapor

AMROZI, S.Kep.Ns. JONI HARDIANTO DIAN A'YUNI

Stok Peneri Pema Stok Permin-

Antasida DOEN II suspensi, kombi : Aluminium

Larutan mengandung Karbohidrat + Elektrolit (Nacl

387 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg tab - - - -

C OBAT & PERBEKALAN KESEHATAN TAMBAHAN

JUMLAH KUNJUNGAN BAYAR GRATIS JUMLAH

Kepala UPTD Pkm Sumbermalang Pengelola Obat Puskesmas Pelapor

AMROZI, S.Kep.Ns. JONI HARDIANTO DIAN A'YUNI

Stok Peneri Pema Stok Permin-

Antasida DOEN I tablet kunyah, kombinasi :

387 Zidovudin tablet 300 mg + Lamivudine tablet 150 mg tab - - - -

C OBAT & PERBEKALAN KESEHATAN TAMBAHAN

JUMLAH KUNJUNGAN BAYAR GRATIS JUMLAH

Kepala UPTD Pkm Sumbermalang Pengelola Obat Puskesmas Pelapor