Format Perawatan

PEMAKAIAN DAN PERMINTAAN OBAT PUSKESMAS bulan : juli
STOCK
PUSKESMAS SATUAN PENERIMAAN SK
AWAL
1 AIR RAKSA DENTAL Botol 60
2 ALAT SUNTIK SEKALI PAKAI 1 ML Set 0 0
3 ALAT SUNTIK SEKALI PAKAI 2,5 ML Set 0 3079
4 AlAT SUNTIK SEKALI PAKAI 5 ML Set 0
5 ALBENDAZOL TABLET 400 MG Tablet 400 368
6 ALOPURINOL TABLET 00 MG Tablet 200
7 AMINOFILIN TABLET 200 MG Tablet 940 3032
8 AMINOFILIN INJEKSI 24MG / ML - 10 ML Ampul 34
9 AMITRIPILIN Hcl TABLET SALUT 25 MG Tablet 0 123
10 AMOKSILIN KAPSUL 250 MG Kapsul 0
11 AMOKSILIN KAPLET 500 MG Kaplet 0
12 AMOKSILIN SIRUP KERING 125 MG/5ML Botol 0
13 AMPISILIN KAPLET 500 MG Kaplet 0
14 AMPISILIN SIRUP KERING 125 MG/5 ML Botol 0
15 ANTALGIN (METAMPIRON)TABLET 500 MG Tablet 1561
16 ANTALGIN INJEKSI 250 MG/ML-2 ML Ampul 0
ANTASIDA DOEN,tablet Kombinasi Magnesium

17 Hidroksida 200mg+Aluminium Hidroksida 200mg Tablet 2000 5000
ANTI BAKTERI DOEN SALEP KOMBINASI :
18 BASITRASIN 500 IU/g + POLIMIKSIN 1000 IU/g Tube 50
19 ANTI HIMOROID DOEN KOMBINASI Supp 0
ANTIFUNGI DOEN KOMBINASI : ASAM BENZOAT 6%
20 + ASAM SALISILAT 3 % Pot 0
ANTIMIGREN DOEN KOMBINASI : ERGOTAMIN
21 TARTRAT 1 MG + KOFEIN 50 MG Tablet 100
ANTIPARKINSON DOEN TABLET KOMBINASI :
22 KARBIDOPA 25 MG + LEVODOPA 250 MG Tablet 0
23 AQUA PRO INJEKSI STERIL,BEBAS PIROGEN - 20 ML Vial 0

24 AQUADEST STERIL - 500 ML Botol 0
25 ASAM ASKORBAT (VIT C) TABLET 50 MG Tablet 2000
26 ASAM ASKORBAT (VIT C) TABLET 250 MG Tablet 0
27 ASAM KLORIDA 0,1N - 100 MG Botol 26
28 ASAM SULFOSALISILAT 20% - 100 ML Botol 0
29 ASETOSAL TABLET 100 MG Tablet 0
30 ASETOSAL TABLET 500 MG Tablet 0
31 ATROPIN SULFAT INJEKSI 0,25 MG/ML - 1 ML Ampul 30
32 ATROPIN SULFAT TABLET 0,5 MG Tablet 500
33 BETAMETASON KRIM 0,1% - 5 G Tube 75
34 catgut/benang bedah no.2/0-3/0 (plain&cromic) Sachet 0

35 DEKSAMETASON INJEKSI 5MG/ML - 1 ML Ampul 170
36 DEKSAMETASON TABLET 0,5 MG Tablet 2838
37 DEKSTROMETORFAN HBR SIRUP 10MG/5ML-60ML Botol 54

38 DEKSTROMETORFAN HBR TABLET 15 MG Tablet 1134
39 DEVITALISASI PASTA (NON ARSEN) Botol 0
40 DIAZEPAM INJEKSI 5MG/ML - 2ML Ampul 8
41 DIAZEPAM TABLET 2 MG Tablet 1100
42 DIAZEPAM TABLET 5 MG Tablet 0
43 DIETILKARBAMAZIN SITRAT TABLET 100 MG Tablet 0
44 DIFENHIDRAMIN HCL INJEKSI 10ML/ML - ML Ampul 34
45 DIGOKSIN TABLET 0,25 MG Tablet 100
46 EFEDRIN HCL TABLET 25 MG Tablet 0
47 EKSTARK BELLADON TABLET 10 MG Tablet 0
EFINEPRINA HCL/BARBITAL
48 (EFINEPRINA/ADRENALINA) INJEKSI 0,1 % - 1 ML Ampul 100
49 ETAKRIDIN (RIVANOL)LARUTAN 0,1 % - 3000 ML Botol 0
50 ETAMBUTOL HCL TABLET 250 MG Tablet 0
51 ETANOL 70% - 1000 ML Botol 4
52 ETER ANESTETIK - 140 ML Botol 0
53 ETIL KLORIDA SEMPROT - 100 ML Botol 0
54 EUGENOL CAIRAN - 10 ML Botol 0
55 FENITOIN NATRIUM INJEKSI 50MG/ML Ampul 0
56 FENITOIN NATRIUM KAPSUL 100 MG Kapsul 0
57 FENITOIN NATRIUM KAPSUL 30 MG Kapsul 0
58 FENOBARBITAL INJEKSI 50MG/ML - 2ML Ampul 0
59 FENOBARBITAL TABLET 100 MG Tablet 0
60 FENOBARBITAL TABLET 30 MG Tablet 400
61 FENOKSIMETIL PENISILINA TABLET 250 MG Tablet 0
62 FENOKSIMETIL PENISILINA TABLET 500 MG Tablet 0
63 FENOL GLISEROL TETES TELINGA 10% - 5ML Botol 0
64 FITOMENADION (VIT K1)INJEKSI 10 MG/ML - 1ML Ampul 32
65 FITOMENADION (VIT K1)TABLET SALUT 10MG Tablet 0
66 FUROSEMID TABLET 40MG Tablet 1000
67 FORINOKRESOL (PENGGANTI TKF)10ML Botol 0
68 GAMEKSAN EMULSI 1% - 100ML Botol 0
69 GARAM ORALIT 200 ML AIR Kantong 200
70 GENTIAN VIOLET LARUTAN 1% - 10ML Botol 0
71 GLASS LONOMER CEMENT(GC IX) Set 0
72 GLIBENKLAMID TABLET 5 MG Tablet 90
73 GLISERIL GUAYAKOLAT TABLET 100 MG Tablet 2000
74 GLISERIN - 100ML Botol 0
75 GLUKOSA LARUTAN INFUS 5% STERIL - 500 ML Botol 20
78 GRISEUFULVIN TABLET 125 MG,MICRONIZED Tablet 116
79 HALOPERIDOL 0,5 MG TABLET Tablet 0
80 HALOPERIDOL 1,5 MG TABLET Tablet 0
81 HIDROKLOROTIAZID (HCT) TABLET 25 MG Tablet 468
82 HIDROKORTISON KRIM 2,5% Tube 153
83 IBUPROFEN TABLET 200 MG Tablet 0
84 IBUPROFEN TABLET 400 MG Tablet 0
85 INFUSION SET ANAK Set 13
86 INFUSION SET DEWASA Set 0
87 ISOSORBID DINITRAT 5 MG TABLET SUBLINGUAL Tablet 100

88 JARUM JAHIT (BEDAH) NO.9 S/D 14 Biji 0
89 KALIUM PERMANGANAT SERBUK - 5 MG Tablet 0
90 KALSIUM HIDROKSIDA PASTA Kotak 0
91 KALSIUM LAKTAT (KALK) TABLET 500 MG Tablet 2419
92 KAPAS PEMBALUT/ABSORBEN 250 MG Bungkus 4
93 KASA KOMPRES 40/40 STERIL Bungkus 40
94 KASA PEMBALUT 2 m x 80 cm Rol 0
95 KASA PEMBALUT HIDROFIL 4 cm x 3 cm Rol 0
96 KASA PEMBALUT HIDROFIL 4 cm x 15 cm Rol 15
97 KLORAMFENIKOL KAPSUL 250 MG Kapsul 1239
98 KLORAMFENIKOL SALEP MATA 1% - 3,5 ML Tube 0
99 KLORAMFENIKOL TETES TELINGA 3% - 5ML Botol 60
100 KLORFENIRAMIN MALEAT (CTM)TABLET 4 MG Tablet 2054
KLOROQUIN FOSFAT TBALET 250 MG (SETARA
101 DENGAN 150 MG KLOROQUIN BASA) Tablet 0
102 KLORPROMAZIN HCL INJEKSI 25MG/ML - 1ML Ampul 0
103 KLORPROMAZIN HCL INJEKSI 5MG/ML - 1ML Ampul 0
104 KLORPROMAZIN HCL TABLET SALUT 25MG Tablet 0
105 KLORPROMAZIN HCL TABLET SALUT 100MG Tablet 0
106 KODEIN HCL TABLET 100MG Tablet 0
KOTRIMOKSAZOL PEDIATRIK TABLET,KOMBINASI :

107 SULFAMETIKSAZOL 100MG + TRIMETROPIM Tablet 0
KOTRIMOKSAZOL SUSPENSI KOMBINASI :
SULFAMETOKSZOL 200MG + TRIMETROPIM
108 40MG/5ML Botol 0
KOTRIMOKSAZOL TABLET,KOMBINASI :
109 SULFAMETOKSAZOL 400MG + TRIMETROPIM 80MG Tablet 0
110 LARUTAN BENEDIK - 100ML Botol 0
111 LARUTAN EOIS 2% - 100ML Botol 0
112 LARUTAN ETANOL ASAM - 100ML Botol 0
113 LARUTAN GEBBET -100ML Botol 0
114 LARUTAN GIEMSA STAIN - 100ML Botol 0
115 LARUTAN KARBOL FUKSIN - 100ML Botol 0
116 LARUTAN KINYOUN - 100 ML Botol 0
117 LARUTAN METILEN BIRU - 100 ML Botol 0
118 LARUTAN TURK - 100 ML Botol 0
LIDOKAIN KOMP INJEKSI KOMBINASI :LIDOKAIN HCL
119 2% + EPINEPRIN 1:80000 - 2ML Ampul 22
LISOL,MENGANDUNG KRESOL TERSABUN 50% -
120 1000ML Botol 2
121 MEBENDAZOL SIRUP 100MG/5ML - 30ML Botol 0
122 MEBENDAZOL TABLET 100MG Tablet 0
123 METANOL - 100ML Botol 0
METILERGOMETRIN
MALEAT(METILERGOMTETRIN)TABLET SALUT 0,125
124 gram Tablet 350
METILERGOMETRIN MALEAT INJEKSI 0,200MG - 1
125 ML Ampul 30
126 METRONIDAZOL TABLET 250 MG Tablet 0
127 MONOKLORKAMPER MENTOL CAIRAN Botol 0
128 MUMMIFYING PASTA Botol 0
129 NATRIUM BIKARBONAT TABLET 500MG Tablet 0
NATRIUM KLORIDA LARUTAN INFUS 0,9% STERIL -
130 500ML Botol 0
131 NATRIUM TIOSULFAT INJEKSI 25% -10ML Ampul 0
132 NISTATIN 100.000 IU/gram TABLET VAGINAL Tablet 0
133 NISTATIN 500.000 IU/gram TABLET SALUT Tablet 0
134 OBAT ANTI TUBERKULOSIS (FDC) Paket 0
135 OBAT ANTI TUBERKULOSIS KATEGORI ANAK Paket 0
136 OBAT BATUK HITAM (OBH)CAIRAN - 100ML Botol 0
137 OKSIGEN GAS DALAM TABUNG M3 0
138 OKSITETRASIKLIN HCL INJEKSI IM 50MG/ML - 10 ML Ampul 12
139 OKSITETRASIKLIN HCL SALEP MATA 1% - 3,5 garm Tube 0

140 OKSITETRASIKLIN HCL SALEP 3% - 5g Tube 75
141 OKSITOKSIN INJEKSI 10 IU/ML - 1ML Ampul 0
142 PARAFORMALDEHIDA TABLET I gram Tablet 0
143 PARASETAMOL SIRUP 125MG/5ML - 5ML Botol 50
144 PARASETAMOL TABLET 100MG Tablet 0
145 PARASETAMOL TABLET 500MG Tablet 2499
PIRANTEL PAMOAT 365MG(SETARA DENGAN 125MG
146 BASA) Tablet 202
147 PIRIDOKSIN HCL(VIT B6) TABLET 10MG Tablet 1000
148 PLESTER 5 YARD X 2 INCH Rol 4
POLIKRESULEN (PONDENSASI METAKRESOL
149 SULFONAT DAN METANAL) 360MG/G - 10ML Botol 0
150 POVIDON LODIDA 10% - 300ML Botol 50
151 POVIDON LODIDA 10% - 1000ML Botol 5
152 PREDNISON TABLET 5 MG Tablet 3229
153 PRIMAKUIN TABLET 15MG Tablet 0
154 PROPRANOLOL HCL TABLET 40MG Tablet 0
155 RESERPIN TABLET 0,25 MG Tablet 0
156 RETINOL(VIT A) 100.00 0IU KAPSUL Kapsul 0
157 RETINOL(VIT A) 200.000 IU KAPSUL Kapsul 0
158 RINGER LAKTAT LARUTAN INFUS STERIL - 500ML Botol 20

159 SALBUTAMOL TABLET 2MG Tablet 0
SALEP 2X4 KOMBINASI: ASAM SALISILAT 2%
160 BELARANG ENDAP 4% - 30 gram Pot 2
161 SALISIL BEDAK 2% - 30 gram Kotak 0
162 SEMEN SENG FOSTAT SERBUK DAN CAIRAN Botol 0
SERUM ANTI BISA ULAR POLIVALEN INJEKSI
163 5ML(ABU) Vial 2
164 50ML(ABU) Vial 0
165 SERUM ANTI RABIES Vial 0
166 SERUM ANTI TETANUS INJEKSI 1.500IU/AMPUL(ATS) Ampul 8
167 SERUM ANTI TETANUS INJEKSI 20.000 IU/VIAL (ATS) Vial 0

SIANOKOBALAMIN (VIT B 12) INJEKSI 500 mog/ml -
168 1ml Ampul 33
169 SILK (BENANG BEDAH SUTERA)NO.3/0 Sachet 0
TABLET TAMBAH DARAH KOMBINASI : BESI II
170 SULFAT 200MG + ASAM FOLAT 0,25 MG Tablet 0
171 TETRASIKLIN HCL KAPSUL 250 MG Kapsul 1890
172 TETRASIKLIN HCL KAPSUL 500MG Kapsul 600
173 TIAMIN HCL (VIT B1) INJEKSI 100MG/ML - 1ML Ampul 0
174 TIAMIN HCL /MONONITRAT(VIT B1) TABLET 50 MG Tablet 2758

175 TRIKRESOL FORMALIN (TKF) CAIRAN - 10 ML Botol 0
176 VITAMIN B KOMPLEK TABLET Tablet 0
177 ASAM MEFENAMAT KAPSUL 250 MG Kapsul 0
178 ASAM MEFENAMAT KAPSUL 500 MG Kapsul 0
179 BETASON N CREAMJ Tube 0
180 DASABION Tablet 400
181 NEURODIAL Tablet 0
182 NEUROVIT E Tablet 0
183 EXTRA FLU Tablet 0
184 MULVITAMIN DEWASA Tablet 0
185 NOVAKID ANAK Botol 0
186 PIROKSIKAM Tablet 0
187 BIKARBON Tablet 0
188 RANITIDIN Tablet 0
189 KOORAMPEKOR H Tube 0
190 HOLIDRIL SYRUP Botol 53
191 BRONIFAR Tablet 100
192 SUFRATUL Lembar 0
193 ABOCATH 0
194 AKITA Tablet 0
195 CAPTOPRIL Tablet 0
196 METOKLORPRAMID Tablet 0
197 KLORAMFENIKOL SUSPENSI Botol 31
198 FOLLEY CATHETER 5
199 URINE BAG 10
200 GENALTEN CREM Tube 20
201 CIPROFLOXAXIN Tablet 0
PEMAKAIAN STOCK AKHIR STOCK OPTIMUM PERMINTAAN
200 200 71 0
0 0.2 0
1670 980 3633.42 0
0 0 0.2 0
1292 0 434.44 0
0 0 0.2 0
9750 1250 3577.96 0
0 0 0.2 0
0 0 145.34 0
39100 0 0.2 0
91 6 0.2 0
0 0 0.2 0
0 100 0.2 0
0 0 0.2 0
9206 3994 0.2 0
8040 0 0.2 0
5900.2 0
0 0 0.2 0
0 0 0.2 0
5 30 0.2 0
142 8 0.2 0
62 172 0.2 0
21352 -2 0.2 0
0 0 0.2 0
427 42 0.2 0
707 1993 0.2 0
3 23 0.2 0
6515 985 0.2 0
0 0 0.2 0
80 48 0.2 0
100 100 0.2 0
0 0 0.2 0
1895 1255 0.2 0
788 213 0.2 0

0 100 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
13 2 0.2 0
0 0 0.2 0
8 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
203 1597 0.2 0
0 0 0.2 0
0 37 0.2 0
77 -27 0.2 0
247 3 0.2 0
0 0 0.2 0
962 357 0.2 0
0 0 0.2 0
460 0 0.2 0
16007 -7 0.2 0
0 0 0.2 0
40 0 0.2 0
0 0 0.2 0
0 0 0.2 0
3500 0 0.2 0
300 -300 0.2 0
1773 2227 0.2 0
717 0 0.2 0
2630 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 200 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
4800 0 0.2 0
330 0 0.2 0
0 0 0.2 0
0 0 0.2 0
3040 460 0.2 0
0 0 0.2 0
142 50 0.2 0
35845 655 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
734 6 0.2 0
0 0 0.2 0
5200 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
180 0 0.2 0
0 0 0.2 0
0 0 0.2 0
20 40 0.2 0
60 440 0.2 0
0 0 0.2 0
750 0 0.2 0
0 0 0.2 0
0 0 0.2 0
2104 -4 0.2 0
0 0 0.2 0
0 0 0.2 0
320 0 0.2 0
0 0 0.2 0
100 0 0.2 0
40 10 0.2 0
0 0 0.2 0
0 0 0.2 0
750 0 0.2 0
50400 0 0.2 0
0 0 0.2 0
0 0 0.2 0
9300 1880 0.2 0
1504 -4 0.2 0
0 10 0.2 0
3 -3 0.2 0
2 -2 0.2 0
19500 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 100 0.2 0
4471 1779 0.2 0

0 0 0.2 0
299 61 0.2 0
3500 0 0.2 0
5 -5 0.2 0
130 -5 0.2 0
0 5 0.2 0
0 0 0.2 0
70 162 0.2 0
0 0 0.2 0
0 0 0.2 0
5760 1490 0.2 0
0 0 0.2 0
0 0 0.2 0
13990 1910 0.2 0

0 0 0.2 0
0 0 0.2 0
17396 2804 0.2 0
396 404 0.2 0
377 23 0.2 0
8870 630 0.2 0
1700 0 0.2 0
7840 0 0.2 0
740 0 0.2 0
2817 413 0.2 0

105 60 0.2 0
213 0 0.2 0
5000 0 0.2 0
1285 195 0.2 0
1000 0 0.2 0
105 87 0.2 0
2900 600 0.2 0
4200 0 0.2 0
360 0 0.2 0
2520 0 0.2 0
100 140 0.2 0

0 20 0.2 0
1595 -295 0.2 0
832 68 0.2 0
1002 -2 0.2 0
9101 -1 0.2 0
960 0 0.2 0
256 44 0.2 0
0 20 0.2 0
0 300 0.2 0
1120 880 0.2 0
0 0 0.2 0
0 48 0.2 0
0 0 0.2 0
90 40 0.2 0
4 2 0.2 0
0 250 0.2 0
30 30 0.2 0
0 0 0.2 0
0 50 0.2 0
11 15 0.2 0
0 36 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
15 10 0.2 0
0 25 0.2 0
0 0 0.2 0
0 0 0.2 0
0 0 0.2 0
200 -200 0.2 0
0 0 0.2 0
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO) FORM:LPLPO
PUSKESMAS
PUSKESMAS : . DOKUMEN NOMOR TANGGAL

KECAMATAN : . DINKES KAB/KOTA
KAB / KOTA : . PELAPORAN BULAN / PERIODE : .. GFK KAB/KOTA
PROVINSI : .. PERMINTAAN BULAN / PERIODE : PUSKESMAS
NO NAMA OBAT SATUAN STOCK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOCK AKHIR STOCK OPTIMUM PERMINTAAN
1 AIR RAKSA DENTAL Botol 0 0 0 0 0 0
2 ALAT SUNTIK SEKALI PAKAI 1 ML Set 0 0 0 0 0 100
3 ALAT SUNTIK SEKALI PAKAI 2,5 ML Set 0 700 700 0 700 700
4 AlAT SUNTIK SEKALI PAKAI 5 ML Set 0 0 0 0 0 0
5 ALBENDAZOL TABLET 400 MG Tablet 400 0 400 0 400 0
6 ALOPURINOL TABLET 00 MG Tablet 200 0 200 20 180 0
7 AMINOFILIN TABLET 200 MG Tablet 940 0 940 709 231 1000
8 AMINOFILIN INJEKSI 24MG / ML - 10 ML Ampul 34 0 34 0 34 0
9 AMITRIPILIN Hcl TABLET SALUT 25 MG Tablet 0 0 0 0 0 0
10 AMOKSILIN KAPSUL 250 MG Kapsul 0 960 960 960 0 960
11 AMOKSILIN KAPLET 500 MG Kaplet 0 6000 6000 6000 0 6000
12 AMOKSILIN SIRUP KERING 125 MG/5ML Botol 0 400 400 400 0 500
13 AMPISILIN KAPLET 500 MG Kaplet 0 0 0 0 0 0
14 AMPISILIN SIRUP KERING 125 MG/5 ML Botol 0 0 0 0 0 0
15 ANTALGIN (METAMPIRON)TABLET 500 MG Tablet 1561 6000 7561 5316 2245 4000
16 ANTALGIN INJEKSI 250 MG/ML-2 ML Ampul 0 0 0 0 0 0
ANTASIDA DOEN,tablet Kombinasi Magnesium

17 Hidroksida 200mg+Aluminium Hidroksida 200mg Tablet 2000 13000 15000 11200 3800 10000
18 BASITRASIN 500 IU/g + POLIMIKSIN 1000 IU/g Tube 50 200 250 186 64 200
19 ANTI HIMOROID DOEN KOMBINASI Supp 0 0 0 0 0 0
ANTIFUNGI DOEN KOMBINASI : ASAM
20 BENZOAT 6% + ASAM SALISILAT 3 % Pot 0 48 48 35 13 48
ANTIMIGREN DOEN KOMBINASI : ERGOTAMIN
21 TARTRAT 1 MG + KOFEIN 50 MG Tablet 100 0 100 0 100 0
ANTIPARKINSON DOEN TABLET KOMBINASI :
22 KARBIDOPA 25 MG + LEVODOPA 250 MG Tablet 0 0 0 0 0 0
AQUA PRO INJEKSI STERIL,BEBAS PIROGEN -
23 20 ML Vial 0 0 0 0 0 0
24 AQUADEST STERIL - 500 ML Botol 0 0 0 0 0 0
25 ASAM ASKORBAT (VIT C) TABLET 50 MG Tablet 2000 2000 4000 4000 0 5000
27 ASAM KLORIDA 0,1N - 100 MG Botol 0 0 0 0 0 0
28 ASAM SULFOSALISILAT 20% - 100 ML Botol 0 0 0 0 0 0
29 ASETOSAL TABLET 100 MG Tablet 0 0 0 0 0 0
31 ATROPIN SULFAT INJEKSI 0,25 MG/ML - 1 ML Ampul 30 0 30 0 30 0
32 ATROPIN SULFAT TABLET 0,5 MG Tablet 500 0 500 0 500 0
33 BETAMETASON KRIM 0,1% - 5 G Tube 75 0 75 25 50 0
34 catgut/benang bedah no.2/0-3/0 (plain&cromic) Sachet 0 24 24 24 0 24

35 DEKSAMETASON INJEKSI 5MG/ML - 1 ML Ampul 170 0 170 20 150 0
36 DEKSAMETASON TABLET 0,5 MG Tablet 2838 6000 8838 8838 0 10000
DEKSTROMETORFAN HBR SIRUP 10MG/5ML-
37 60ML Botol 54 200 254 113 141 0
38 DEKSTROMETORFAN HBR TABLET 15 MG Tablet 1134 0 1134 513 621 0
39 DEVITALISASI PASTA (NON ARSEN) Botol 0 0 0 0 0 0
40 DIAZEPAM INJEKSI 5MG/ML - 2ML Ampul 8 0 8 8 0 0
41 DIAZEPAM TABLET 2 MG Tablet 1100 1000 2100 2100 0 2000
43 DIETILKARBAMAZIN SITRAT TABLET 100 MG Tablet 0 0 0 0 0 0
44 DIFENHIDRAMIN HCL INJEKSI 10ML/ML - ML Ampul 34 0 34 30 4 60
45 DIGOKSIN TABLET 0,25 MG Tablet 100 0 100 0 100 0
46 EFEDRIN HCL TABLET 25 MG Tablet 0 1000 1000 875 125 2000
47 EKSTARK BELLADON TABLET 10 MG Tablet 0 1000 1000 1000 0 2000
(EFINEPRINA/ADRENALINA) INJEKSI 0,1 % - 1
48 ML Ampul 100 0 100 0 100 0
49 ETAKRIDIN (RIVANOL)LARUTAN 0,1 % - 3000 ML Botol 0 5 5 0 5 5

50 ETAMBUTOL HCL TABLET 250 MG Tablet 0 0 0 0 0 0
51 ETANOL 70% - 1000 ML Botol 4 0 4 4 0 5
52 ETER ANESTETIK - 140 ML Botol 0 0 0 0 0 0
53 ETIL KLORIDA SEMPROT - 100 ML Botol 0 2 2 2 0 2
54 EUGENOL CAIRAN - 10 ML Botol 0 2 2 2 0 2
55 FENITOIN NATRIUM INJEKSI 50MG/ML Ampul 0 0 0 0 0 0
56 FENITOIN NATRIUM KAPSUL 100 MG Kapsul 0 0 0 0 0 0
58 FENOBARBITAL INJEKSI 50MG/ML - 2ML Ampul 0 0 0 0 0 0
59 FENOBARBITAL TABLET 100 MG Tablet 0 0 0 0 0 0
61 FENOKSIMETIL PENISILINA TABLET 250 MG Tablet 0 0 0 0 0 0
63 FENOL GLISEROL TETES TELINGA 10% - 5ML Botol 0 0 0 0 0 0
FITOMENADION (VIT K1)INJEKSI 10 MG/ML -
64 1ML Ampul 32 0 32 0 32 0
65 FITOMENADION (VIT K1)TABLET SALUT 10MG Tablet 0 400 400 177 223 0
66 FUROSEMID TABLET 40MG Tablet 1000 0 1000 300 700 0
67 FORINOKRESOL (PENGGANTI TKF)10ML Botol 0 0 0 0 0 0
68 GAMEKSAN EMULSI 1% - 100ML Botol 0 0 0 0 0 0
69 GARAM ORALIT 200 ML AIR Kantong 200 400 600 600 0 1000
70 GENTIAN VIOLET LARUTAN 1% - 10ML Botol 0 0 0 0 0 0
71 GLASS LONOMER CEMENT(GC IX) Set 0 0 0 0 0 0
72 GLIBENKLAMID TABLET 5 MG Tablet 90 200 290 140 150 0
73 GLISERIL GUAYAKOLAT TABLET 100 MG Tablet 2000 8000 10000 6996 3004 5000
74 GLISERIN - 100ML Botol 0 0 0 0 0 0
75 GLUKOSA LARUTAN INFUS 5% STERIL - 500 ML Botol 20 20 40 20 20 40

GLUKOSA LARUTAN INFUS 10% STERIL - 500
76 ML Botol 0 0 0 0 0 0
77 GLUKOSA LARUTAN INFUS 40% STERIL - 25 ML Botol 0 0 0 0 0 0

78 GRISEUFULVIN TABLET 125 MG,MICRONIZED Tablet 116 800 916 672 244 1000
79 HALOPERIDOL 0,5 MG TABLET Tablet 0 0 0 0 0 0
81 HIDROKLOROTIAZID (HCT) TABLET 25 MG Tablet 468 2000 2468 711 1757 0
82 HIDROKORTISON KRIM 2,5% Tube 153 144 297 229 68 216
83 IBUPROFEN TABLET 200 MG Tablet 0 1000 1000 1000 0 1500
85 INFUSION SET ANAK Set 13 0 13 13 0 50
86 INFUSION SET DEWASA Set 0 50 50 50 0 100
ISOSORBID DINITRAT 5 MG TABLET
87 SUBLINGUAL Tablet 100 0 100 0 100 0
88 JARUM JAHIT (BEDAH) NO.9 S/D 14 Biji 0 0 0 0 0 0
89 KALIUM PERMANGANAT SERBUK - 5 MG Tablet 0 0 0 0 0 0
90 KALSIUM HIDROKSIDA PASTA Kotak 0 0 0 0 0 0
91 KALSIUM LAKTAT (KALK) TABLET 500 MG Tablet 2419 1000 3419 1693 1726 1000
92 KAPAS PEMBALUT/ABSORBEN 250 MG Bungkus 4 0 4 2 2 0
93 KASA KOMPRES 40/40 STERIL Bungkus 40 150 190 140 50 0
94 KASA PEMBALUT 2 m x 80 cm Rol 0 0 0 0 0 50
95 KASA PEMBALUT HIDROFIL 4 cm x 3 cm Rol 0 0 0 0 0 0
97 KLORAMFENIKOL KAPSUL 250 MG Kapsul 1239 0 1239 1039 200 1000
98 KLORAMFENIKOL SALEP MATA 1% - 3,5 ML Tube 0 24 24 0 24 48
99 KLORAMFENIKOL TETES TELINGA 3% - 5ML Botol 60 48 108 41 67 24
100 KLORFENIRAMIN MALEAT (CTM)TABLET 4 MG Tablet 2054 10000 12054 12054 0 15000
KLOROQUIN FOSFAT TBALET 250 MG (SETARA

101 DENGAN 150 MG KLOROQUIN BASA) Tablet 0 0 0 0 0 0
102 KLORPROMAZIN HCL INJEKSI 25MG/ML - 1ML Ampul 0 0 0 0 0 0
103 KLORPROMAZIN HCL INJEKSI 5MG/ML - 1ML Ampul 0 0 0 0 0 0
104 KLORPROMAZIN HCL TABLET SALUT 25MG Tablet 0 0 0 0 0 0
106 KODEIN HCL TABLET 100MG Tablet 0 0 0 0 0 0
KOTRIMOKSAZOL PEDIATRIK
TABLET,KOMBINASI : SULFAMETIKSAZOL
107 100MG + TRIMETROPIM Tablet 0 0 0 0 0 0

SULFAMETOKSZOL 200MG + TRIMETROPIM
108 40MG/5ML Botol 0 250 250 250 0 300
SULFAMETOKSAZOL 400MG + TRIMETROPIM
109 80MG Tablet 0 1200 1200 1200 0 1500
110 LARUTAN BENEDIK - 100ML Botol 0 0 0 0 0 0
111 LARUTAN EOIS 2% - 100ML Botol 0 0 0 0 0 0
112 LARUTAN ETANOL ASAM - 100ML Botol 0 0 0 0 0 0
113 LARUTAN GEBBET -100ML Botol 0 0 0 0 0 0
114 LARUTAN GIEMSA STAIN - 100ML Botol 0 0 0 0 0 0
115 LARUTAN KARBOL FUKSIN - 100ML Botol 0 0 0 0 0 0
116 LARUTAN KINYOUN - 100 ML Botol 0 0 0 0 0 0
117 LARUTAN METILEN BIRU - 100 ML Botol 0 0 0 0 0 0
118 LARUTAN TURK - 100 ML Botol 0 0 0 0 0 0
LIDOKAIN KOMP INJEKSI KOMBINASI

119 :LIDOKAIN HCL 2% + EPINEPRIN 1:80000 - 2ML Ampul 22 90 112 112 0 90
LISOL,MENGANDUNG KRESOL TERSABUN 50%
120 - 1000ML Botol 2 0 2 0 2 0
121 MEBENDAZOL SIRUP 100MG/5ML - 30ML Botol 0 0 0 0 0 0
122 MEBENDAZOL TABLET 100MG Tablet 0 0 0 0 0 0
123 METANOL - 100ML Botol 0 0 0 0 0 0
METILERGOMETRIN
MALEAT(METILERGOMTETRIN)TABLET SALUT
124 0,125 gram Tablet 350 0 350 70 280 0
METILERGOMETRIN MALEAT INJEKSI 0,200MG
125 - 1 ML Ampul 30 0 30 30 0 30
126 METRONIDAZOL TABLET 250 MG Tablet 0 0 0 0 0 0
127 MONOKLORKAMPER MENTOL CAIRAN Botol 0 0 0 0 0 0
128 MUMMIFYING PASTA Botol 0 0 0 0 0 0
129 NATRIUM BIKARBONAT TABLET 500MG Tablet 0 1000 1000 1000 0 2000
NATRIUM KLORIDA LARUTAN INFUS 0,9%
130 STERIL - 500ML Botol 0 0 0 0 20 0
131 NATRIUM TIOSULFAT INJEKSI 25% -10ML Ampul 0 0 0 0 0 0
132 NISTATIN 100.000 IU/gram TABLET VAGINAL Tablet 0 0 0 0 0 0
133 NISTATIN 500.000 IU/gram TABLET SALUT Tablet 0 0 0 0 0 0
134 OBAT ANTI TUBERKULOSIS (FDC) Paket 0 16 16 16 0 0
135 OBAT ANTI TUBERKULOSIS KATEGORI ANAK Paket 0 0 0 0 0 0
136 OBAT BATUK HITAM (OBH)CAIRAN - 100ML Botol 0 120 120 120 0 120
137 OKSIGEN GAS DALAM TABUNG M3 0 0 0 0 0 0
OKSITETRASIKLIN HCL INJEKSI IM 50MG/ML -
138 10 ML Ampul 12 0 12 0 12 0
OKSITETRASIKLIN HCL SALEP MATA 1% - 3,5
139 garm Tube 0 0 0 0 0 0
140 OKSITETRASIKLIN HCL SALEP 3% - 5g Tube 75 0 75 25 50 0
141 OKSITOKSIN INJEKSI 10 IU/ML - 1ML Ampul 0 60 60 60 0 60
142 PARAFORMALDEHIDA TABLET I gram Tablet 0 0 0 0 0 0
143 PARASETAMOL SIRUP 125MG/5ML - 5ML Botol 50 400 450 417 33 500
144 PARASETAMOL TABLET 100MG Tablet 0 0 0 0 0 0
PIRANTEL PAMOAT 365MG(SETARA DENGAN
146 125MG BASA) Tablet 202 0 202 70 132 0
147 PIRIDOKSIN HCL(VIT B6) TABLET 10MG Tablet 1000 2000 3000 3000 0 4000
148 PLESTER 5 YARD X 2 INCH Rol 4 4 8 5 3 5
POLIKRESULEN (PONDENSASI METAKRESOL
149 SULFONAT DAN METANAL) 360MG/G - 10ML Botol 0 0 0 0 0 0
150 POVIDON LODIDA 10% - 300ML Botol 50 0 50 10 40 0
152 PREDNISON TABLET 5 MG Tablet 3229 2000 5229 4029 1200 5000
153 PRIMAKUIN TABLET 15MG Tablet 0 0 0 0 0 0
154 PROPRANOLOL HCL TABLET 40MG Tablet 0 0 0 0 0 0
155 RESERPIN TABLET 0,25 MG Tablet 0 0 0 0 0 3000
156 RETINOL(VIT A) 100.00 0IU KAPSUL Kapsul 0 400 400 0 400 0
157 RETINOL(VIT A) 200.000 IU KAPSUL Kapsul 0 4700 4700 0 4700 0
RINGER LAKTAT LARUTAN INFUS STERIL -
158 500ML Botol 20 100 120 120 0 200
159 SALBUTAMOL TABLET 2MG Tablet 0 1200 1200 1100 100 1200
SALEP 2X4 KOMBINASI: ASAM SALISILAT 2%
160 BELARANG ENDAP 4% - 30 gram Pot 2 48 50 28 22 48
161 SALISIL BEDAK 2% - 30 gram Kotak 0 50 50 47 3 50
162 SEMEN SENG FOSTAT SERBUK DAN CAIRAN Botol 0 0 0 0 0 0
163 5ML(ABU) Vial 2 0 2 1 1 5
164 50ML(ABU) Vial 0 0 0 0 0 0
165 SERUM ANTI RABIES Vial 0 0 0 0 0 0
SERUM ANTI TETANUS INJEKSI
166 1.500IU/AMPUL(ATS) Ampul 8 0 8 0 8 0
SERUM ANTI TETANUS INJEKSI 20.000 IU/VIAL
167 (ATS) Vial 0 0 0 0 0 0
SIANOKOBALAMIN (VIT B 12) INJEKSI 500
168 mog/ml - 1ml Ampul 33 0 33 0 33 100
169 SILK (BENANG BEDAH SUTERA)NO.3/0 Sachet 0 24 24 24 0 24
TABLET TAMBAH DARAH KOMBINASI : BESI II
170 SULFAT 200MG + ASAM FOLAT 0,25 MG Tablet 0 6000 6000 6000 0 6000
171 TETRASIKLIN HCL KAPSUL 250 MG Kapsul 1890 0 1890 680 1210 2000
172 TETRASIKLIN HCL KAPSUL 500MG Kapsul 600 500 1100 600 500 500
173 TIAMIN HCL (VIT B1) INJEKSI 100MG/ML - 1ML Ampul 0 60 60 0 60 0
TIAMIN HCL /MONONITRAT(VIT B1) TABLET 50
174 MG Tablet 2758 5000 7758 5143 2615 4000
175 TRIKRESOL FORMALIN (TKF) CAIRAN - 10 ML Botol 0 0 0 0 0 0
176 VITAMIN B KOMPLEK TABLET Tablet 0 7000 7000 5000 2000 6000
177 ASAM MEFENAMAT KAPSUL 250 MG Kapsul 0 0 0 0 0 0
179 BETASON N CREAMJ Tube 0 0 0 0 0 0
180 DASABION Tablet 400 2000 2400 1400 1000 1000
181 NEURODIAL Tablet 0 500 500 0 500 0
182 NEUROVIT E Tablet 0 0 0 0 0 600
183 EXTRA FLU Tablet 0 0 0 0 0 0
184 MULVITAMIN DEWASA Tablet 0 3000 3000 3000 0 3720
185 NOVAKID ANAK Botol 0 0 0 0 0 250
186 PIROKSIKAM Tablet 0 0 0 0 0 0
187 BIKARBON Tablet 0 0 0 0 0 0
188 RANITIDIN Tablet 0 500 500 400 100 500
189 KOORAMPEKOR H Tube 0 0 0 0 0 0
190 HOLIDRIL SYRUP Botol 53 300 353 353 0 300
191 BRONIFAR Tablet 100 0 100 0 100 0
192 SUFRATUL Lembar 0 0 0 0 0 0
193 ABOCATH 0 25 25 25 0 50
194 AKITA Tablet 0 1500 1500 1500 0 2000
195 CAPTOPRIL Tablet 0 1500 1500 1500 0 2000
196 METOKLORPRAMID Tablet 0 0 0 0 0 500
197 KLORAMFENIKOL SUSPENSI Botol 31 0 31 31 0 0
198 FOLLEY CATHETER 5 0 5 0 5 0
199 URINE BAG 10 0 10 0 10 0
200 GENALTEN CREM Tube 20 0 20 10 10 0
201 CIPROFLOXAXIN Tablet 0 1000 1000 112 888 0
202 FARIZOL Tablet 0 500 500 300 200 500
203 IKAMICETIN SALEP MATA Tube 0 100 100 100 0 0
204 SULFASETAMID TETES MATA Botol 24 48 72 43 29 48
205 VICALCIM SIRUP Botol 0 96 96 96 0 0
206 TRIKORTIN SALEP KULIT Tube 0 10 10 0 10 0
207 YUSIMOX DRY SIRUP Botol 0 100 100 100 0 100
157549 35276
UMUM
BAYAR TIDAK BAYAR ASKES JUMLAH
JUMLAH KUNJUNGAN RESEP 2717 1756 237 4710
Mengetahui / Menyetujui : Yang Menyerahkan: Yang Menerima: Yang Meminta:

Kepala Dinas Kesehatan Kab./Kota Kepala DFK, Kepala Puskesmas, Petugas Puskesmas,
PUSKESMAS
DOKUMEN NOMOR TANGGAL
DINKES KAB/KOTA
PUSKESMAS : . GFK KAB/KOTA
KECAMATAN : . PUSKESMAS
KAB / KOTA : . PELAPORAN BULAN / PERIODE :Desember
PROVINSI : .. PERMINTAAN BULAN / PERIODE : Januari
STOCK PEMBERIAAN
STOCK PENERIMA PERSEDIA PEMAKAI STOCK PERMINTA
NO NAMA OBAT SATUAN OPTIM LAIN- JUMLAH
AWAL AN AN AN AKHIR AN PKD/DAU ASKES PROG PDPSE
UM LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
ANTASIDA DOEN,tablet Kombinasi

17
Magnesium Hidroksida 200mg+Aluminium
Hidroksida 200mg Tablet 2000 13000 15000 12600 2400 15000
18 BASITRASIN 500 IU/g + POLIMIKSIN 1000
IU/g Tube 100 100 200 150 50 200
STOCK PEMBERIAAN
UM LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
20 ANTIFUNGI DOEN KOMBINASI : ASAM

BENZOAT 6% + ASAM SALISILAT 3 % Pot 0 72 72 24 48 72
ANTIMIGREN DOEN KOMBINASI :
21 ERGOTAMIN TARTRAT 1 MG + KOFEIN 50
MG Tablet 100 0 100 0 100 0
ANTIPARKINSON DOEN TABLET

22 KOMBINASI : KARBIDOPA 25 MG +
LEVODOPA 250 MG Tablet 0 0 0 0 0 0
23 AQUA PRO INJEKSI STERIL,BEBAS

PIROGEN - 20 ML Vial 0 0 0 0 0 0
31 ATROPIN SULFAT INJEKSI 0,25 MG/ML - 1
ML Ampul 30 0 30 0 30 0
34
catgut/benang bedah no.2/0-3/0 (plain&cromic) Sachet 25 24 49 1 48 0
37 DEKSTROMETORFAN HBR SIRUP

10MG/5ML-60ML Botol 50 300 350 100 250 100
38
DEKSTROMETORFAN HBR TABLET 15 MG Tablet 0 2000 2000 1500 500 2000
STOCK PEMBERIAAN
UM LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
43 DIETILKARBAMAZIN SITRAT TABLET 100

MG Tablet 0 0 0 0 0 0
44 DIFENHIDRAMIN HCL INJEKSI 10ML/ML -
ML Ampul 0 0 0 0 120
48 (EFINEPRINA/ADRENALINA) INJEKSI 0,1 %
- 1 ML Ampul 100 0 100 0 100 0
ETAKRIDIN (RIVANOL)LARUTAN 0,1 % -
49
3000 ML Botol 2 5 7 2 5 3
51 ETANOL 70% - 1000 ML Botol 0 3 3 3 0 3
63 FENOL GLISEROL TETES TELINGA 10% -
5ML Botol 0 0 0 0 0 0
64 FITOMENADION (VIT K1)INJEKSI 10 MG/ML

- 1ML Ampul 32 0 32 0 32 0
STOCK PEMBERIAAN
UM LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
65 FITOMENADION (VIT K1)TABLET SALUT

10MG 250 0 250 150 100 0
75 GLUKOSA LARUTAN INFUS 5% STERIL- 500

ML Botol 20 40 60 0 60 0
76 GLUKOSA LARUTAN INFUS10% STERIL-500

ML Botol 0 0 0 0 0 0
77 GLUKOSA LARUTAN INFUS 40% STERIL-25

ML
GRISEUFULVIN TABLET 125 Botol 0 0 0 0 0 0
78 MG,MICRONIZED Tablet 300 1000 1300 1300 0 2000
87 ISOSORBID DINITRAT 5 MG TABLET

SUBLINGUAL Tablet 100 0 100 0 100 0
STOCK PEMBERIAAN
UM LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
92
KAPAS PEMBALUT/ABSORBEN 250 MG Bungkus 0 2 2 0 2 2
98 KLORAMFENIKOL TETES
SALEP TELINGA
MATA 1% 3%
- 3,5- ML Tube 0 0 0 0 0 0
99 5ML Botol 0 72 72 24 48 48
100 KLORFENIRAMIN MALEAT (CTM)TABLET 4

MG Tablet 1000 10000 11000 11000 0 13000
KLOROQUIN FOSFAT TBALET 250 MG
101 (SETARA DENGAN 150 MG KLOROQUIN
BASA) Tablet 0 0 0 0 0 0
102 KLORPROMAZIN HCL INJEKSI 25MG/ML -

1ML Ampul 0 0 0 0 0 0
103 KLORPROMAZIN HCL INJEKSI 5MG/ML -

1ML Ampul 0 0 0 0 0 0
104
KLORPROMAZIN HCL TABLET SALUT 25MG Tablet 0 0 0 0 0 0
105 KLORPROMAZIN HCL TABLET SALUT

100MG Tablet 0 0 0 0 0 0
KOTRIMOKSAZOL PEDIATRIK
107 TABLET,KOMBINASI : SULFAMETIKSAZOL
100MG + TRIMETROPIM Tablet 0 0 0 0 0 0
108 SULFAMETOKSZOL 200MG +
TRIMETROPIM 40MG/5ML Botol 250 200 450 400 50 400
STOCK PEMBERIAAN
UM LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
109 SULFAMETOKSAZOL 400MG +
TRIMETROPIM 80MG Tablet 300 2000 2300 1400 900 1500
LIDOKAIN KOMP INJEKSI KOMBINASI
119 :LIDOKAIN HCL 2% + EPINEPRIN 1:80000 -
2ML Ampul 20 30 50 0 50 0
LISOL,MENGANDUNG KRESOL TERSABUN
120
50% - 1000ML Botol 2 0 2 0 2 0
123 METANOL - 100ML Botol 0 0 0 0 0 0
METILERGOMETRIN
124 MALEAT(METILERGOMTETRIN)TABLET
SALUT 0,125 gram Tablet 100 200 300 200 100 200
125 METILERGOMETRIN MALEAT INJEKSI

0,200MG - 1 ML Ampul 0 0 0 0 0 30
NATRIUM KLORIDA LARUTAN INFUS 0,9%
130
STERIL - 500ML Botol 20 20 40 0 40 0
STOCK PEMBERIAAN
UM LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
135 OBAT ANTI TUBERKULOSIS KATEGORI

ANAK Paket 0 0 0 0 0 0
136
OBAT BATUK HITAM (OBH)CAIRAN - 100ML Botol 0 50 50 50 0 240
138 OKSITETRASIKLIN HCL INJEKSI IM
50MG/ML - 10 ML Ampul 12 0 12 0 12 0
139 OKSITETRASIKLIN HCL SALEP MATA 1% -

3,5 garm Tube 0 0 0 0 0 0
146 PIRANTEL PAMOAT 365MG(SETARA

DENGAN 125MG BASA) Tablet 0 0 0 0 0 100
148 PLESTER 5 YARD(PONDENSASI
POLIKRESULEN X 2 INCH Rol 0 5 5 3 2 5
149 METAKRESOL SULFONAT DAN METANAL)
360MG/G - 10ML Botol 0 0 0 0 0 5
156 RETINOL(VIT A) 100.00 0IU KAPSUL Kapsul 0 0 0 400 -400 0
157 RETINOL(VIT A) 200.000 IU KAPSUL Kapsul 950 950 950 0 0
STOCK PEMBERIAAN
UM LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
RINGER LAKTAT LARUTAN INFUS STERIL -
158
500ML Botol 80 60 140 80 60 120
SALEP 2X4 KOMBINASI: ASAM SALISILAT
160
2% BELARANG ENDAP 4% - 30 gram Pot 98 0 98 24 74 50
162 SEMEN SENG FOSTAT SERBUK DAN

CAIRAN Botol 0 0 0 0 0 0
SERUM ANTI BISA ULAR POLIVALEN
163
INJEKSI 5ML(ABU) Vial 0 0 0 0 0 5
164 SERUM ANTI BISA ULAR POLIVALEN
INJEKSI 50ML(ABU) Vial 0 0 0 0 0 0
166 SERUM ANTI TETANUS INJEKSI

1.500IU/AMPUL(ATS) Ampul 8 0 8 0 8 0
167 SERUM ANTI TETANUS INJEKSI 20.000

IU/VIAL (ATS) Vial 0 0 0 0 0 0
168 SIANOKOBALAMIN (VIT B 12) INJEKSI 500

mog/ml - 1ml Ampul 183 0 183 30 153 0
170 TABLET TAMBAH DARAH KOMBINASI : BESI

II SULFAT 200MG + ASAM FOLAT 0,25 MG Tablet 0 6000 6000 6000 0 9000
173 TIAMIN HCL (VIT B1) INJEKSI 100MG/ML -
1ML Ampul 35 0 35 0 35 0
174 TIAMIN HCL /MONONITRAT(VIT B1) TABLET

50 MG Tablet 2000 5000 7000 7000 0 7000
175 TRIKRESOL FORMALIN (TKF) CAIRAN - 10

ML Botol 0 0 0 0 0 0
STOCK PEMBERIAAN
UM LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
179 BETASON N CREAM Tube 0 0 0 0 0 0
180 DASABION Tablet 1000 1000 2000 2000 0 2000
185 NOVAKID ANAK Botol 0 150 150 150 0 250
191 BRONIFAR Tablet 100 0 100 0 100 0
193 ABOCATH Buah 0 0 0 0 0 60
194 AKITA Tablet 0 0 0 0 0 2000
199 URINE BAG 10 0 10 0 10 0
202 FARIZOL Tablet 0 0 0 0 0 500
168433 40403
STOCK PEMBERIAAN
UM LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
UMUM
TIDAK ASKES JUMLAH
BAYAR
JUMLAH KUNJUNGAN RESEP BAYAR

PUSKESMAS
DINKES KAB/KOTA
PUSKESMAS CIMANUK GFK KAB/KOTA
KECAMATAN CIMANUK PUSKESMAS
KAB / KOTA PANDEGLANG PELAPORAN BULAN / PERIODE PEBRUARI 2010
PROVINSI BANTEN PERMINTAAN BULAN / PERIODE MARET 2010
NO NAMA OBAT SATUAN STOCK PENERIMAA PERSEDIAA PEMAKAIA STOCK STOCK PERMINTA PEMBERIAAN
AWAL N N N AKHIR OPTIMU AN PKD/DA ASKES PROG PDPSE
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
17 ANTASIDA DOEN,tablet Kombinasi Tablet 0 12000 12000 12000 0 16000
Hidroksida 200mg
18 ANTI BAKTERI DOEN SALEP KOMBINASI : Tube 0 75 75 75 0 300

BASITRASIN 500 IU/g + POLIMIKSIN 1000
IU/g

20 ANTIFUNGI DOEN KOMBINASI : ASAM Pot 0 0 0 0 0 96
BENZOAT 6% + ASAM SALISILAT 3 %
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
21 ANTIMIGREN DOEN KOMBINASI : Tablet 0 0 0 0 0 100
ERGOTAMIN TARTRAT 1 MG + KOFEIN 50
MG
22 ANTIPARKINSON DOEN TABLET Tablet 0 0 0 0 0 0

KOMBINASI : KARBIDOPA 25 MG +
LEVODOPA 250 MG
23 AQUA PRO INJEKSI STERIL,BEBAS Vial 0 0 0 0 0 0

PIROGEN - 20 ML

31 ATROPIN SULFAT INJEKSI 0,25 MG/ML - 1 Ampul 0 0 0 0 0 30
ML
34 catgut/benang bedah no.2/0-3/0 Sachet 24 24 48 30 18 24
(plain&cromic)
37 DEKSTROMETORFAN HBR SIRUP Botol 0 0 0 0 0 300
10MG/5ML-60ML

43 DIETILKARBAMAZIN SITRAT TABLET 100 Tablet 0 0 0 0 0 0
MG
44 DIFENHIDRAMIN HCL INJEKSI 10ML/ML - Ampul 20 60 80 80 0 90

ML
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
48 EFINEPRINA HCL/BARBITAL Ampul 0 0 0 0 0 0
(EFINEPRINA/ADRENALINA) INJEKSI 0,1 %
- 1 ML
49 ETAKRIDIN (RIVANOL)LARUTAN 0,1 % - Botol 0 0 0 0 0 5

3000 ML
51 ETANOL 70% - 1000 ML Botol 2 3 5 2 3 2

61 FENOKSIMETIL PENISILINA TABLET 250 Tablet 0 0 0 0 0 0
62 MG
FENOKSIMETIL PENISILINA TABLET 500 Tablet 0 0 0 0 0 0
63 MG
FENOL GLISEROL TETES TELINGA 10% - Botol 0 0 0 0 0 0
5ML
64 FITOMENADION (VIT K1)INJEKSI 10 MG/ML Ampul 0 0 0 0 0 30
- 1ML
65 FITOMENADION (VIT K1)TABLET SALUT 100 400 500 100 400 0
10MG

73 GLISERIL GUAYAKOLAT TABLET 100 MG TABLET 0 5000 500 5000 0 10000
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
75 GLUKOSA LARUTAN INFUS 5% STERIL- Botol 0 40 40 40 0 40
500 ML
76 GLUKOSA LARUTAN INFUS10% STERIL- Botol 0 0 0 0 0 0

500 ML
77 GLUKOSA LARUTAN INFUS 40% STERIL-25 Botol 0 0 0 0 0 0
ML
78 GRISEUFULVIN TABLET 125 Tablet 0 500 500 500 0 2000

79 MG,MICRONIZED
HALOPERIDOL 0,5 MG TABLET Tablet 0 0 0 0 0 0

87 ISOSORBID DINITRAT 5 MG TABLET Tablet 0 0 0 0 0 0
SUBLINGUAL



99 KLORAMFENIKOL TETES TELINGA 3% - Botol 0 72 72 72 0 96

5ML
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
100 KLORFENIRAMIN MALEAT (CTM)TABLET 4 Tablet 2000 15000 17000 12000 5000 13000
MG
101 KLOROQUIN FOSFAT TBALET 250 MG Tablet 0 0 0 0 0 0

(SETARA DENGAN 150 MG KLOROQUIN
BASA)
102 KLORPROMAZIN HCL INJEKSI 25MG/ML - Ampul 0 0 0 0 0 0

1ML
1ML
105 KLORPROMAZIN HCL TABLET SALUT Tablet 0 0 0 0 0 0

100MG
107 KOTRIMOKSAZOL PEDIATRIK Tablet 0 0 0 0 0 0
100MG + TRIMETROPIM
108 KOTRIMOKSAZOL SUSPENSI KOMBINASI : Botol 0 200 200 200 0 400

SULFAMETOKSZOL 200MG +
TRIMETROPIM 40MG/5ML
109 KOTRIMOKSAZOL TABLET,KOMBINASI : Tablet 1100 2000 3100 2100 1000 1500
SULFAMETOKSAZOL 400MG +
TRIMETROPIM 80MG

M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
119 LIDOKAIN KOMP INJEKSI KOMBINASI Ampul 60 60 120 90 30 90
:LIDOKAIN HCL 2% + EPINEPRIN 1:80000 -
2ML
120 LISOL,MENGANDUNG KRESOL TERSABUN Botol 0 0 0 0 0 0

50% - 1000ML

123 METANOL - 100ML Botol 0 0 0 0 0 0
124 METILERGOMETRIN Tablet 100 100 200 0 200 0
MALEAT(METILERGOMTETRIN)TABLET
SALUT 0,125 gram
125 METILERGOMETRIN MALEAT INJEKSI Ampul 0 0 0 0 0 0

0,200MG - 1 ML

130 NATRIUM KLORIDA LARUTAN INFUS 0,9% Botol 0 0 0 0 0 20
STERIL - 500ML

134 OBAT ANTI TUBERKULOSIS (FDC) Paket 0 23 32 32 0 19F
135 OBAT ANTI TUBERKULOSIS KATEGORI Paket 0 0 0 0 0 0
ANAK

138 OKSITETRASIKLIN HCL INJEKSI IM Ampul 0 0 0 0 0 0
50MG/ML - 10 ML
139 OKSITETRASIKLIN HCL SALEP MATA 1% - Tube 0 50 50 36 14 100

3,5 garm
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14

146 PIRANTEL PAMOAT 365MG(SETARA Tablet 0 0 0 0 0 0
DENGAN 125MG BASA)
149 POLIKRESULEN (PONDENSASI Botol 0 0 0 0 0 5
METAKRESOL SULFONAT DAN METANAL)
360MG/G - 10ML
158 RINGER LAKTAT LARUTAN INFUS STERIL - Botol 0 60 60 60 0 300
500ML

160 SALEP 2X4 KOMBINASI: ASAM SALISILAT Pot 0 0 0 0 0 96
2% BELARANG ENDAP 4% - 30 gram

162 SEMEN SENG FOSTAT SERBUK DAN Botol 0 0 0 0 0 0
CAIRAN
163 SERUM ANTI BISA ULAR POLIVALEN Vial 0 2 2 0 2 0
INJEKSI 5ML(ABU)

INJEKSI 50ML(ABU)
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
166 SERUM ANTI TETANUS INJEKSI Ampul 0 0 0 0 0 0
1.500IU/AMPUL(ATS)
167 SERUM ANTI TETANUS INJEKSI 20.000 Vial 0 0 0 0 0 5
IU/VIAL (ATS)
168 SIANOKOBALAMIN (VIT B 12) INJEKSI 500 Ampul 50 100 100 50 50 100
mog/ml - 1ml
170 TABLET TAMBAH DARAH KOMBINASI : Tablet 600 9000 9600 8400 1200 6000
BESI II SULFAT 200MG + ASAM FOLAT 0,25
MG
173 TIAMIN HCL (VIT B1) INJEKSI 100MG/ML - Ampul 0 0 0 0 0 0
1ML
174 TIAMIN HCL /MONONITRAT(VIT B1) TABLET Tablet 0 1000 1000 1000 0 7000
50 MG
175 TRIKRESOL FORMALIN (TKF) CAIRAN - 10 Botol 0 0 0 0 0 0

ML

180 DASABION Tablet 0 0 0 0 0 2000
185 MULTIVITAMIN ANAK Botol 0 144 144 144 0 240
191 BRONIFAR Tablet 0 0 0 0 0 0
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
193 ABOCATH Buah 0 0 0 0 0 50
194 AKITA Tablet 0 1000 1000 1000 0 2000
199 URINE BAG 0 0 0 0 0 10
205 NISAGON CREAM Botol 20 0 20 20 0 0
208 PEHACAIN Ampul 0 0 0 0 0 0
209 FASIPRIM SIRUP Botol 0 0 0 0 0 0
210 MOLASON CREAM Tube 0 0 0 0 0 0
220 MASKER Tablet 0 20 20 20 0 20
0 0 27048
UMUM
TIDAK ASKES JUMLAH
BAYAR

.. dr. Kodiat Juarsa, M.Kes Dia Juariah

M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Nip. 19680822.200003.1.002 Nip. 19690520.199103.2.012
M:LPLPO
TANGGAL
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
Yang Meminta:
tugas Puskesmas,
Dia Juariah
JML
LAIN-LAIN
15 16
690520.199103.2.012
PUSKESMAS
DINKES KAB/KOTA
KAB / KOTA PANDEGLANG PELAPORAN BULAN / PERIODE JANUARI 2010
PROVINSI BANTEN PERMINTAAN BULAN / PERIODE PEBRUARI 2010
NO NAMA OBAT SATUAN STOCK PENERIM PERSEDIAA PEMAKAIA STOCK STOCK PERMINTA PEMBERIAAN
AWAL AAN N N AKHIR OPTIMU AN PKD/DA ASKES PROG PDPSE
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Hidroksida 200mg

IU/g

M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
MG

LEVODOPA 250 MG

PIROGEN - 20 ML

ML
(plain&cromic)
10MG/5ML-60ML

MG

ML
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
- 1 ML

3000 ML
51 ETANOL 70% - 1000 ML Botol 0 5 5 3 2 3

62 MG
63 MG
5ML
- 1ML
10MG

M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
500 ML

500 ML
ML

79 MG,MICRONIZED

SUBLINGUAL




5ML
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
MG

BASA)

1ML
1ML

100MG
100MG + TRIMETROPIM

TRIMETROPIM 80MG

M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
2ML

50% - 1000ML

123 METANOL - 100ML Botol 0 0 0 0 0 0
SALUT 0,125 gram

0,200MG - 1 ML

STERIL - 500ML

ANAK

50MG/ML - 10 ML

3,5 garm
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14

DENGAN 125MG BASA)
360MG/G - 10ML
500ML


CAIRAN
INJEKSI 5ML(ABU)

INJEKSI 50ML(ABU)
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1.500IU/AMPUL(ATS)
IU/VIAL (ATS)
mog/ml - 1ml
MG
1ML
50 MG

ML

M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
193 ABOCATH Buah 0 0 0 0 0 50
194 AKITA Tablet 0 1000 1000 1000 0 2000
199 URINE BAG 0 0 0 0 0 10
205 NISAGON CREAM Botol 0 20 20 0 20 0
220 Zink Tablet 20 mg Tablet 0 0 0 0 0 0
0 0 26247
UMUM
TIDAK ASKES JUMLAH
BAYAR


M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Nip. 19680822.200003.1.002 Nip. 19690520.199103.2.012
M:LPLPO
TANGGAL
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
Yang Meminta:
tugas Puskesmas,
Dia Juariah
JML
LAIN-LAIN
15 16
690520.199103.2.012
PUSKESMAS
DINKES KAB/KOTA
KAB / KOTA PANDEGLANG PELAPORAN BULAN / PERIODE DESEMBER 2009
PROVINSI BANTEN PERMINTAAN BULAN / PERIODE JANUARI 2010
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Hidroksida 200mg

IU/g

M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
MG

LEVODOPA 250 MG

PIROGEN - 20 ML

ML
(plain&cromic)
10MG/5ML-60ML

MG

ML
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
- 1 ML

3000 ML
51 ETANOL 70% - 1000 ML Botol 0 0 0 2 -2 5

62 MG
63 MG
5ML
- 1ML
10MG

M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
500 ML

500 ML
ML

79 MG,MICRONIZED

SUBLINGUAL




5ML
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
MG

BASA)

1ML
1ML

100MG
100MG + TRIMETROPIM

TRIMETROPIM 80MG

M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
2ML

50% - 1000ML

123 METANOL - 100ML Botol 0 0 0 0 0 0
SALUT 0,125 gram

0,200MG - 1 ML

STERIL - 500ML

ANAK

50MG/ML - 10 ML

3,5 garm
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14

DENGAN 125MG BASA)

360MG/G - 10ML
500ML


CAIRAN
INJEKSI 5ML(ABU)

INJEKSI 50ML(ABU)
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1.500IU/AMPUL(ATS)
IU/VIAL (ATS)
mog/ml - 1ml
MG
1ML
50 MG

ML

M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
193 ABOCATH Buah 0 0 0 0 0 50
194 AKITA Tablet 0 1000 1000 1000 0 2000
199 URINE BAG 0 0 0 0 0 10
UMUM
TIDAK ASKES JUMLAH
BAYAR


M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Nip. 19680822.200003.1.002 Nip. 19690520.199103.2.012
M:LPLPO
TANGGAL
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
Yang Meminta:
tugas Puskesmas,
Dia Juariah
JML
LAIN-LAIN
15 16
690520.199103.2.012
PUSKESMAS
DINKES KAB/KOTA
KAB / KOTA PANDEGLANG PELAPORAN BULAN / PERIODE NOPEMBER 2009
PROVINSI BANTEN PERMINTAAN BULAN / PERIODE DESEMBER 2009
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Hidroksida 200mg

IU/g

M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
MG

LEVODOPA 250 MG

PIROGEN - 20 ML

ML
(plain&cromic)
10MG/5ML-60ML

MG

ML
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
- 1 ML

3000 ML
51 ETANOL 70% - 1000 ML Botol 1 1 2 2 0 5

62 MG
63 MG
5ML
- 1ML
10MG

M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
500 ML

500 ML
ML

79 MG,MICRONIZED

SUBLINGUAL




5ML
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
MG

BASA)

1ML
1ML

100MG
100MG + TRIMETROPIM

TRIMETROPIM 80MG

M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
2ML

50% - 1000ML

123 METANOL - 100ML Botol 0 0 0 0 0 0
SALUT 0,125 gram

0,200MG - 1 ML

STERIL - 500ML

ANAK

50MG/ML - 10 ML

3,5 garm
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14

DENGAN 125MG BASA)

360MG/G - 10ML
500ML


CAIRAN
INJEKSI 5ML(ABU)

INJEKSI 50ML(ABU)
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1.500IU/AMPUL(ATS)
IU/VIAL (ATS)
mog/ml - 1ml
MG
1ML
50 MG

ML

M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
193 ABOCATH Buah 0 0 0 0 0 50
194 AKITA Tablet 0 500 500 500 0 2000
199 URINE BAG 0 0 0 0 0 10
0 0 20803
UMUM
TIDAK ASKES JUMLAH
BAYAR


M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Nip. 19680822.200003.1.002 Nip. 19690520.199103.2.012
M:LPLPO
TANGGAL
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
Yang Meminta:
tugas Puskesmas,
Dia Juariah
JML
LAIN-LAIN
15 16
690520.199103.2.012
PUSKESMAS
DINKES KAB/KOTA
KAB / KOTA PANDEGLANG PELAPORAN BULAN / PERIODE OKTOBER 2009
PROVINSI BANTEN PERMINTAAN BULAN / PERIODE NOPEMBER 2009
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Hidroksida 200mg

IU/g

M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
MG

LEVODOPA 250 MG

PIROGEN - 20 ML

ML
(plain&cromic)
10MG/5ML-60ML

MG

ML
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
- 1 ML

3000 ML
51 ETANOL 70% - 1000 ML Botol 0 3 3 2 1 5

62 MG
63 MG
5ML
- 1ML
10MG

M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
500 ML

500 ML
ML

79 MG,MICRONIZED

SUBLINGUAL




5ML
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
MG

BASA)

1ML
1ML

100MG
100MG + TRIMETROPIM

TRIMETROPIM 80MG

M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
2ML

50% - 1000ML

123 METANOL - 100ML Botol 0 0 0 0 0 0
SALUT 0,125 gram

0,200MG - 1 ML
STERIL - 500ML

ANAK

50MG/ML - 10 ML

3,5 garm
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14

DENGAN 125MG BASA)

360MG/G - 10ML
500ML


CAIRAN
INJEKSI 5ML(ABU)

INJEKSI 50ML(ABU)
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1.500IU/AMPUL(ATS)
IU/VIAL (ATS)
mog/ml - 1ml
MG
1ML
50 MG

ML
180 DASABION Tablet 0 200 200 200 0 2000
M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
193 ABOCATH Buah 0 0 0 0 0 50
194 AKITA Tablet 0 1000 1000 1000 0 2000
199 URINE BAG 0 0 0 0 0 10
16871
UMUM
TIDAK ASKES JUMLAH
BAYAR


M U
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Nip. 19680822.200003.1.002 Nip. 19690520.199103.2.012
M:LPLPO
TANGGAL
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
JML
LAIN-LAIN
15 16
Yang Meminta:
tugas Puskesmas,
Dia Juariah
JML
LAIN-LAIN
15 16
690520.199103.2.012
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS
DOKUMEN NOMOR
DINKES KAB/KOTA
NO NAMA OBAT SATUAN STOCK AWAL PENERIMAAN PERSEDIAAN PEMAKAIA STOCK STOCK PERMINTA PEMBERIAAN
N AKHIR OPTIMU AN PKD/DA ASKES PROG
M U
1 2 3 4 5 6 7 8 9 10 11 12 13
Hidroksida 200mg
IU/g

M U
1 2 3 4 5 6 7 8 9 10 11 12 13
MG

LEVODOPA 250 MG

PIROGEN - 20 ML

ML
(plain&cromic)
10MG/5ML-60ML

MG

ML
M U
1 2 3 4 5 6 7 8 9 10 11 12 13
- 1 ML

3000 ML
51 ETANOL 70% - 1000 ML Botol 1 3 4 3 1 3

62 MG
63 MG
5ML
- 1ML
10MG

M U
1 2 3 4 5 6 7 8 9 10 11 12 13
500 ML

500 ML
ML

79 MG,MICRONIZED

SUBLINGUAL



5ML
M U
1 2 3 4 5 6 7 8 9 10 11 12 13
MG

BASA)

1ML
1ML

100MG
100MG + TRIMETROPIM

TRIMETROPIM 80MG

M U
1 2 3 4 5 6 7 8 9 10 11 12 13
2ML

50% - 1000ML

123 METANOL - 100ML Botol 0 0 0 0 0 0
SALUT 0,125 gram

0,200MG - 1 ML

STERIL - 500ML

ANAK

50MG/ML - 10 ML
3,5 garm
M U
1 2 3 4 5 6 7 8 9 10 11 12 13

DENGAN 125MG BASA)
360MG/G - 10ML
500ML


CAIRAN
INJEKSI 5ML(ABU)

INJEKSI 50ML(ABU)
M U
1 2 3 4 5 6 7 8 9 10 11 12 13
1.500IU/AMPUL(ATS)
IU/VIAL (ATS)
mog/ml - 1ml
MG
1ML
50 MG

ML

M U
1 2 3 4 5 6 7 8 9 10 11 12 13
193 ABOCATH Buah 0 50 50 50 0 50
194 AKITA Tablet 0 0 0 0 0 0
199 ASIKLOVIR SALP 5 0 5 0 5 0
200 SETRIASON INJEK 1 G Tube 2 10 12 5 7 0
202 SARUNG TANGAN Tablet 0 20 20 20 0 20
203 RANITIDIN INJ Tube 0 10 10 5 5 0
205 DONPERIDON Botol 26 0 26 10 16 0
206 MIKONASOL SALP Tube 0 24 24 10 14 0
207 PAPAVERIN Botol 300 1000 1300 300 1000 0
208 GENTAMISIN INJ Ampul 0 30 30 30 0 30
209 MASKER Botol 0 20 20 20 0 20
0 0 0 0 0 0
UMUM
ASKES JUMLAH
BAYAR TIDAK BAYAR
JUMLAH KUNJUNGAN RESEP


M U
1 2 3 4 5 6 7 8 9 10 11 12 13
Nip. 19680822.200003.1.002 Nip. 19690520.199103.2.012
FORM:LPLPO
TANGGAL
BERIAAN JML
PDPSE LAIN-LAIN
14 15 16
BERIAAN JML
PDPSE LAIN-LAIN
14 15 16
BERIAAN JML
PDPSE LAIN-LAIN
14 15 16
BERIAAN JML
PDPSE LAIN-LAIN
14 15 16
BERIAAN JML
PDPSE LAIN-LAIN
14 15 16
BERIAAN JML
PDPSE LAIN-LAIN
14 15 16
BERIAAN JML
PDPSE LAIN-LAIN
14 15 16
BERIAAN JML
PDPSE LAIN-LAIN
14 15 16
BERIAAN JML
PDPSE LAIN-LAIN
14 15 16
Yang Meminta:
Petugas Puskesmas,
Dia Juariah
BERIAAN JML
PDPSE LAIN-LAIN
14 15 16
Nip. 19690520.199103.2.012
PUSKESMAS
PUSKESMAS CIMANUK
KECAMATAN CIMANUK
PROVINSI BANTEN PERMINTAAN BULAN / PERIODE FEBRUARI 2011
NO NAMA OBAT SATUAN STOCK PENERIM PERSEDIAA PEMAKAIA
AWAL AAN N N
1 2 3 4 5 6 7
1 AIR RAKSA DENTAL Botol 0 0 0 0
2 ALAT SUNTIK SEKALI PAKAI 1 ML Set 0 100 100 82
3 ALAT SUNTIK SEKALI PAKAI 2,5 ML Set 281 300 581 400
4 AlAT SUNTIK SEKALI PAKAI 5 ML Set 0 0 0 0
5 ALBENDAZOL TABLET 400 MG Tablet 300 0 300 0
6 ALOPURINOL TABLET 00 MG Tablet 0 0 0 0
7 AMINOFILIN TABLET 200 MG Tablet 100 0 100 100
8 AMINOFILIN INJEKSI 24MG / ML - 10 ML Ampul 0 0 0 0
9 AMITRIPILIN Hcl TABLET SALUT 25 MG Tablet 0 0 0 0
10 AMOKSILIN KAPSUL 250 MG Kapsul 240 1680 1920 1920
11 AMOKSILIN KAPLET 500 MG Kaplet 1000 8000 9000 8000
12 AMOKSILIN SIRUP KERING 125 MG/5ML Botol 238 700 938 696
13 AMPISILIN KAPLET 500 MG Kaplet 0 0 0 0
14 AMPISILIN SIRUP KERING 125 MG/5 ML Botol 0 0 0 0
15 ANTALGIN (METAMPIRON)TABLET 500 MG Tablet 4800 2000 6800 800
16 ANTALGIN INJEKSI 250 MG/ML-2 ML Ampul 0 0 0 0
17 ANTASIDA DOEN,tablet Kombinasi Tablet 800 14000 14800 12746
Hidroksida 200mg
18 ANTI BAKTERI DOEN SALEP KOMBINASI : Tube 3 25 28 28

IU/g
19 ANTI HIMOROID DOEN KOMBINASI Supp 0 0 0 0

20 ANTIFUNGI DOEN KOMBINASI : ASAM Pot 0 0 0 0
21 ANTIMIGREN DOEN KOMBINASI : Tablet 0 0 0 0

MG
22 ANTIPARKINSON DOEN TABLET Tablet 0 0 0 0

LEVODOPA 250 MG
23 AQUA PRO INJEKSI STERIL,BEBAS Vial 0 0 0 0

PIROGEN - 20 ML
24 AQUADEST STERIL - 500 ML Botol 0 0 0 0

25 ASAM ASKORBAT (VIT C) TABLET 50 MG Tablet 2030 3000 5030 2980
26 ASAM ASKORBAT (VIT C) TABLET 250 MG Tablet 0 0 0 0
27 ASAM KLORIDA 0,1N - 100 MG Botol 0 0 0 0
28 ASAM SULFOSALISILAT 20% - 100 ML Botol 0 0 0 0
29 ASETOSAL TABLET 100 MG Tablet 0 0 0 0
30 ASETOSAL TABLET 500 MG Tablet 0 0 0 0
AWAL AAN N N
1 2 3 4 5 6 7
31 ATROPIN SULFAT INJEKSI 0,25 MG/ML - 1 Ampul 0 0 0 0
ML
32 ATROPIN SULFAT TABLET 0,5 MG Tablet 0 0 0 0
33 BETAMETASON KRIM 0,1% - 5 G Tube 0 100 100 85
34 catgut/benang bedah no.2/0-3/0 Sachet 48 0 48 0
(plain&cromic)
35 DEKSAMETASON INJEKSI 5MG/ML - 1 ML Ampul 0 0 0 0
36 DEKSAMETASON TABLET 0,5 MG Tablet 0 7000 7000 7000
37 DEKSTROMETORFAN HBR SIRUP Botol 20 100 120 76
10MG/5ML-60ML
38 DEKSTROMETORFAN HBR TABLET 15 MG Tablet 1000 0 1000 200
39 DEVITALISASI PASTA (NON ARSEN) Botol 0 0 0 0

40 DIAZEPAM INJEKSI 5MG/ML - 2ML Ampul 9 0 9 0
41 DIAZEPAM TABLET 2 MG Tablet 0 1000 1000 700
43 DIETILKARBAMAZIN SITRAT TABLET 100 Tablet 0 0 0 0
MG
44 DIFENHIDRAMIN HCL INJEKSI 10ML/ML - Ampul 60 0 60 60

ML
45 DIGOKSIN TABLET 0,25 MG Tablet 200 0 200 180
46 EFEDRIN HCL TABLET 25 MG Tablet 300 0 300 0
47 EKSTARK BELLADON TABLET 10 MG Tablet 0 0 0 0
48 EFINEPRINA HCL/BARBITAL Ampul 0 0 0 0
- 1 ML
49 ETAKRIDIN (RIVANOL)LARUTAN 0,1 % - Botol 0 0 0 0

3000 ML
50 ETAMBUTOL HCL TABLET 250 MG Tablet 0 0 0 0
51 ETANOL 70% - 1000 ML Botol 1 3 4 4
52 ETER ANESTETIK - 140 ML Botol 0 0 0 0
53 ETIL KLORIDA SEMPROT - 100 ML Botol 2 0 2 1
54 EUGENOL CAIRAN - 10 ML Botol 0 0 0 0
55 FENITOIN NATRIUM INJEKSI 50MG/ML Ampul 0 0 0 0
56 FENITOIN NATRIUM KAPSUL 100 MG Kapsul 0 0 0 0
57 FENITOIN NATRIUM KAPSUL 30 MG Kapsul 0 0 0 0
58 FENOBARBITAL INJEKSI 50MG/ML - 2ML Ampul 0 0 0 0
59 FENOBARBITAL TABLET 100 MG Tablet 0 0 0 0

61 FENOKSIMETIL PENISILINA TABLET 250 Tablet 0 0 0 0
62 MG
FENOKSIMETIL PENISILINA TABLET 500 Tablet 0 0 0 0
63 MG
FENOL GLISEROL TETES TELINGA 10% - Botol 0 0 0 0
5ML
64 FITOMENADION (VIT K1)INJEKSI 10 MG/ML Ampul 30 0 30 0
- 1ML
65 FITOMENADION (VIT K1)TABLET SALUT 200 1000 1200 200
10MG
66 FUROSEMID TABLET 40MG Tablet 0 0 0 0

AWAL AAN N N
1 2 3 4 5 6 7
67 FORINOKRESOL (PENGGANTI TKF)10ML Botol 0 0 0 0
68 GAMEKSAN EMULSI 1% - 100ML Botol 0 0 0 0
69 GARAM ORALIT 200 ML AIR Kantong 350 200 550 435
70 GENTIAN VIOLET LARUTAN 1% - 10ML Botol 0 0 0 0
71 GLASS LONOMER CEMENT(GC IX) Set 0 0 0 0
72 GLIBENKLAMID TABLET 5 MG Tablet 0 200 200 70
73 GLISERIL GUAYAKOLAT TABLET 100 MG Tablet 0 9000 9000 9000
74 GLISERIN - 100ML Botol 0 0 0 0

75 GLUKOSA LARUTAN INFUS 5% STERIL- Botol 20 0 20 0
500 ML
76 GLUKOSA LARUTAN INFUS10% STERIL- Botol 0 0 0 0

500 ML
77 GLUKOSA LARUTAN INFUS 40% STERIL-25 Botol 0 0 0 0
ML
78 GRISEUFULVIN TABLET 125 Tablet 0 200 200 200

79 MG,MICRONIZED
HALOPERIDOL 0,5 MG TABLET Tablet 0 0 0 0
80 HALOPERIDOL 1,5 MG TABLET Tablet 0 0 0 0
81 HIDROKLOROTIAZID (HCT) TABLET 25 MG Tablet 500 0 500 300
82 HIDROKORTISON KRIM 2,5% Tube 0 192 192 115

83 IBUPROFEN TABLET 200 MG Tablet 0 0 0 0
85 INFUSION SET ANAK Set 0 0 0 0
86 INFUSION SET DEWASA Set 75 0 75 50
87 ISOSORBID DINITRAT 5 MG TABLET Tablet 0 0 0 0
SUBLINGUAL
88 JARUM JAHIT (BEDAH) NO.9 S/D 14 Biji 0 0 0 0

89 KALIUM PERMANGANAT SERBUK - 5 MG Tablet 0 0 0 0
90 KALSIUM HIDROKSIDA PASTA Kotak 0 0 0 0

91 KALSIUM LAKTAT (KALK) TABLET 500 MG Tablet 0 2000 2000 1700
92 KAPAS PEMBALUT/ABSORBEN 250 MG Bungkus 5 0 5 3
93 KASA KOMPRES 40/40 STERIL Bungkus 100 0 100 100
94 KASA PEMBALUT 2 m x 80 cm Rol 20 30 50 50
95 KASA PEMBALUT HIDROFIL 4 cm x 3 cm Rol 0 0 0 0
96 KASA PEMBALUT HIDROFIL 4 cm x 15 cm Rol 10 50 60 60
97 KLORAMFENIKOL KAPSUL 250 MG Kapsul 800 250 1050 1050

98 KLORAMFENIKOL SALEP MATA 1% - 3,5 ML Tube 24 0 24 0
99 KLORAMFENIKOL TETES TELINGA 3% - Botol 2 72 74 56

5ML
100 KLORFENIRAMIN MALEAT (CTM)TABLET 4 Tablet 7150 8000 15150 11050
MG
101 KLOROQUIN FOSFAT TBALET 250 MG Tablet 0 0 0 0

BASA)
AWAL AAN N N
1 2 3 4 5 6 7
102 KLORPROMAZIN HCL INJEKSI 25MG/ML - Ampul 0 0 0 0
1ML
103 KLORPROMAZIN HCL INJEKSI 5MG/ML - Ampul 0 0 0 0
1ML
104 KLORPROMAZIN HCL TABLET SALUT 25MG Tablet 0 0 0 0
105 KLORPROMAZIN HCL TABLET SALUT Tablet 0 0 0 0

100MG
106 KODEIN HCL TABLET 100MG Tablet 0 0 0 0
107 KOTRIMOKSAZOL PEDIATRIK Tablet 0 0 0 0
100MG + TRIMETROPIM
108 KOTRIMOKSAZOL SUSPENSI KOMBINASI : Botol 0 200 200 123

109 KOTRIMOKSAZOL TABLET,KOMBINASI : Tablet 930 1000 1930 1330

TRIMETROPIM 80MG
110 LARUTAN BENEDIK - 100ML Botol 0 0 0 0

111 LARUTAN EOIS 2% - 100ML Botol 0 0 0 0
112 LARUTAN ETANOL ASAM - 100ML Botol 0 0 0 0
113 LARUTAN GEBBET -100ML Botol 0 0 0 0
114 LARUTAN GIEMSA STAIN - 100ML Botol 0 0 0 0
115 LARUTAN KARBOL FUKSIN - 100ML Botol 0 0 0 0
116 LARUTAN KINYOUN - 100 ML Botol 0 0 0 0
117 LARUTAN METILEN BIRU - 100 ML Botol 0 0 0 0
118 LARUTAN TURK - 100 ML Botol 0 0 0 0
119 LIDOKAIN KOMP INJEKSI KOMBINASI Ampul 60 0 60 0
2ML
120 LISOL,MENGANDUNG KRESOL TERSABUN Botol 0 0 0 0

50% - 1000ML
121 MEBENDAZOL SIRUP 100MG/5ML - 30ML Botol 0 0 0 0
122 MEBENDAZOL TABLET 100MG Tablet 0 0 0 0

123 METANOL - 100ML Botol 0 0 0 0
124 METILERGOMETRIN Tablet 100 0 100 0
SALUT 0,125 gram
125 METILERGOMETRIN MALEAT INJEKSI Ampul 10 0 10 0

0,200MG - 1 ML
126 METRONIDAZOL TABLET 250 MG Tablet 0 800 800 800

127 MONOKLORKAMPER MENTOL CAIRAN Botol 0 0 0 0
128 MUMMIFYING PASTA Botol 0 0 0 0
129 NATRIUM BIKARBONAT TABLET 500MG Tablet 200 1000 1200 1200
AWAL AAN N N
1 2 3 4 5 6 7
130 NATRIUM KLORIDA LARUTAN INFUS 0,9% Botol 0 20 20 20
STERIL - 500ML
131 NATRIUM TIOSULFAT INJEKSI 25% -10ML Ampul 0 0 0 0
132 NISTATIN 100.000 IU/gram TABLET VAGINAL Tablet 0 0 0 0

133 NISTATIN 500.000 IU/gram TABLET SALUT Tablet 0 0 0 0
134 OBAT ANTI TUBERKULOSIS (FDC) Paket 0 25 25 25
135 OBAT ANTI TUBERKULOSIS KATEGORI Paket 0 10 10 10
ANAK
136 OBAT BATUK HITAM (OBH)CAIRAN - 100ML Botol 20 90 110 110
137 OKSIGEN GAS DALAM TABUNG M3 0 0 0 0

138 OKSITETRASIKLIN HCL INJEKSI IM Ampul 0 0 0 0
50MG/ML - 10 ML
139 OKSITETRASIKLIN HCL SALEP MATA 1% - Tube 25 100 125 19

3,5 garm
140 OKSITETRASIKLIN HCL SALEP 3% - 5g Tube 0 75 75 75
141 OKSITOKSIN INJEKSI 10 IU/ML - 1ML Ampul 10 30 40 30
142 PARAFORMALDEHIDA TABLET I gram Tablet 0 0 0 0
143 PARASETAMOL SIRUP 125MG/5ML - 5ML Botol 305 100 405 189
144 PARASETAMOL TABLET 100MG Tablet 0 0 0 0

145 PARASETAMOL TABLET 500MG Tablet 2000 22000 24000 21600
146 PIRANTEL PAMOAT 365MG(SETARA Tablet 94 0 94 60
DENGAN 125MG BASA)
147 PIRIDOKSIN HCL(VIT B6) TABLET 10MG Tablet 0 3000 3000 3000
148 PLESTER 5 YARD X 2 INCH Rol 6 0 6 6
149 POLIKRESULEN (PONDENSASI Botol 0 0 0 0
360MG/G - 10ML
150 POVIDON LODIDA 10% - 300ML Botol 2 0 2 2
152 PREDNISON TABLET 5 MG Tablet 0 6000 6000 6000
153 PRIMAKUIN TABLET 15MG Tablet 0 0 0 0
154 PROPRANOLOL HCL TABLET 40MG Tablet 0 0 0 0
155 RESERPIN TABLET 0,25 MG Tablet 0 1000 1000 1000
156 RETINOL(VIT A) 100.00 0IU KAPSUL Kapsul 0 600 600 0
157 RETINOL(VIT A) 200.000 IU KAPSUL Kapsul 400 10000 10400 0
158 RINGER LAKTAT LARUTAN INFUS STERIL - Botol 120 160 280 125
500ML
159 SALBUTAMOL TABLET 2MG Tablet 0 400 400 400

160 SALEP 2X4 KOMBINASI: ASAM SALISILAT Pot 0 0 0 0
161 SALISIL BEDAK 2% - 30 gram Kotak 30 20 50 40

162 SEMEN SENG FOSTAT SERBUK DAN Botol 0 0 0 0
CAIRAN
AWAL AAN N N
1 2 3 4 5 6 7
163 SERUM ANTI BISA ULAR POLIVALEN Vial 2 0 2 2
INJEKSI 5ML(ABU)
164 SERUM ANTI BISA ULAR POLIVALEN Vial 0 0 0 0

INJEKSI 50ML(ABU)
165 SERUM ANTI RABIES Vial 0 0 0 0

166 S Ampul 5 0 5 0
167 SERUM ANTI TETANUS INJEKSI 20.000 Vial 0 0 0 0

IU/VIAL (ATS)
168 SIANOKOBALAMIN (VIT B 12) INJEKSI 500 Ampul 0 0 0 0
mog/ml - 1ml
169 SILK (BENANG BEDAH SUTERA)NO.3/0 Sachet 36 0 36 36
170 TABLET TAMBAH DARAH KOMBINASI : Tablet 2000 6000 8000 5200
MG
171 TETRASIKLIN HCL KAPSUL 250 MG Kapsul 1000 0 1000 0
172 TETRASIKLIN HCL KAPSUL 500MG Kapsul 100 0 100 0
173 TIAMIN HCL (VIT B1) INJEKSI 100MG/ML - Ampul 0 0 0 0
1ML
174 TIAMIN HCL /MONONITRAT(VIT B1) TABLET Tablet 0 4000 4000 4000
50 MG
175 TRIKRESOL FORMALIN (TKF) CAIRAN - 10 Botol 0 0 0 0

ML
176 VITAMIN B KOMPLEK TABLET Tablet 0 8000 8000 8000

177 ASAM MEFENAMAT KAPSUL 250 MG Kapsul 0 0 0 0
178 ASAM MEFENAMAT KAPSUL 500 MG Kapsul 0 1000 1000 1000
179 BETASON N CREAM Tube 0 0 0 0
180 DASABION Tablet 0 0 0 0
181 NEURODIAL Tablet 0 0 0 0
182 NEUROVIT E Tablet 0 800 800 800
183 EXTRA FLU Tablet 0 0 0 0
184 MULVITAMIN DEWASA Tablet 0 0 0 0
185 MULTIVITAMIN ANAK Botol 24 144 168 168
186 PIROKSIKAM Tablet 0 1000 1000 800
187 BIKARBON Tablet 0 0 0 0
188 RANITIDIN Tablet 0 1000 1000 1000
189 KOORAMPEKOR H Tube 0 0 0 0
190 HOLIDRIL SYRUP Botol 2 192 194 194
191 BRONIFAR Tablet 0 0 0 0
192 SUFRATUL Lembar 0 0 0 0
193 ABOCATH Buah 0 50 50 50
194 AKITA Tablet 0 0 0 0
195 CAPTOPRIL Tablet 0 600 600 600
196 METOKLORPRAMID Tablet 100 100 200 100
197 KLORAMFENIKOL SUSPENSI Botol 50 100 150 63
198 FOLLEY CATHETER 0 0 0 0
199 ASIKLOVIR 5 0 5 5
AWAL AAN N N
1 2 3 4 5 6 7
200 CEFTRIAKON INJ 1 G Tube 7 0 7 2
201 CIPROFLOXAXIN Tablet 700 500 1200 200
202 SARUNG TANGAN Tablet 0 20 20 20
203 RANITIDIN INJ Ampul 5 0 5 5
204 SULFASETAMID TETES MATA Botol 0 72 72 48
205 DONPERIDON Botol 16 0 16 5
206 MIKONAZOL SALP Tube 14 0 14 14
207 PAPAVERIN Botol 1000 0 1000 0
208 GENTAMISIN SALP Ampul 0 30 30 30
209 MASKER 0 20 20 20
210 ANTASID SIRUP Tube 0 50 50 43
211 Zink Tablet 20 mg Tablet 100 0 100 100
UMUM
TIDAK ASKES JUMLAH
BAYAR
Mengetahui / Menyetujui : Yang Menyerahkan:

Kepala Dinas Kesehatan Kab./Kota Kepala DFK,
..
FORM:LPLPO

DINKES KAB/KOTA
GFK KAB/KOTA
PUSKESMAS
STOCK STOCK PERMINTA PEMBERIAAN JML

AKHIR OPTIMU AN PKD/DA ASKES PROG PDPSE LAIN-LAIN
M U
8 9 10 11 12 13 14 15 16
0 0
18 100
181 400
0 0
300 0
0 0
0 500
0 0
0 0
0 1680
1000 8000
242 800
0 0
0 0
6000 0
0 0
2054 18000
0 300
0 0
0 0
0 0
0 0
0 0
0 0
2050 4000
0 0
0 0
0 0
0 0
0 0
M U
8 9 10 11 12 13 14 15 16
0 0
0 0
15 200
48 0
0 0
0 8000
44 200
800 0
0 0
9 0
300 1000
0 0
0 0
0 30
20 200
300 0
0 1000
0 0
0 10
0 0
0 5
0 0
1 2
0 0
0 0
0 0
0 0
0 0
0 0
200 0
0 0
0 0
0 0
30 0
1000 0
0 500
M U
8 9 10 11 12 13 14 15 16
0 0
0 0
115 600
0 0
0 0
130 100
0 10000
0 0
20 20
0 0
0 0
0 2000
0 0
0 0
200 0
77 288
0 1000
0 0
0 20
25 50
0 0
0 30
0 0
0 0
300 4000
2 0
0 50
0 50
0 0
0 50
0 2000
24 0
18 48
4100 15000
0 0
M U
8 9 10 11 12 13 14 15 16
0 0
0 0
0 0
0 0
0 0
0 0
77 300
600 2000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
60 0
0 0
0 0
0 0
0 0
100 0
10 0
0 800
0 0
0 0
0 2000
M U
8 9 10 11 12 13 14 15 16
0 20
0 0
0 0
0 0
0 20
0 10
0 240
0 0
0 0
106 0
0 200
10 60
0 0
216 200
0 0
2400 20000
34 0
0 5000
0 15
0 5
0 10
0 10
0 8000
0 0
0 0
0 2000
600 0
10400 0
155 100
0 2000
0 96
10 40
0 0
M U
8 9 10 11 12 13 14 15 16
0 3
0 0
0 0
5 0
0 5
0 0
0 36
2800 6000
1000 0
100 200
0 0
0 7000
0 0
0 10000
0 0
0 2000
0 0
0 0
0 1000
0 1200
0 1000
0 3000
0 250
200 1000
0 0
0 1000
0 72
0 300
0 0
0 0
0 50
0 2000
0 700
100 200
87 100
0 0
0 10
M U
8 9 10 11 12 13 14 15 16
5 0
1000 0
0 500
0 10
24 48
11 0
0 0
1000 0
0 50
0 50
7 100
0 1000
40733
Yang Menerima: Yang Meminta:

Kepala Puskesmas, Petugas Puskesmas,
dr. Kodiat Juarsa, M.Kes Dia Juariah

Nip. 19680822.200003.1.002 Nip. 19690520.199103.2.012
PUSKESMAS
PUSKESMAS CIMANUK
KECAMATAN CIMANUK
KAB / KOTA PANDEGLANG PELAPORAN BULAN / PERIODE JULI
PROVINSI BANTEN PERMINTAAN BULAN / PERIODE JULI
STOCK PENERIM PERSEDI
NO NAMA OBAT SATUAN
AWAL AAN AAN
1 2 3 4 5 6
1 AIR RAKSA DENTAL Botol 0 0 0
2 ALAT SUNTIK SEKALI PAKAI 1 ML Set 60 100 160
3 ALAT SUNTIK SEKALI PAKAI 2,5 ML Set 105 400 505
4 AlAT SUNTIK SEKALI PAKAI 5 ML Set 0 0 0
5 ALBENDAZOL TABLET 400 MG Tablet 400 0 400
6 ALOPURINOL TABLET 00 MG Tablet 200 0 200
7 AMINOFILIN TABLET 200 MG Tablet 0 100 100
8 AMINOFILIN INJEKSI 24MG / ML - 10 ML Ampul 0 0 0
9 AMITRIPILIN Hcl TABLET SALUT 25 MG Tablet 0 0 0
10 AMOKSILIN KAPSUL 250 MG Kapsul 120 1440 1560
11 AMOKSILIN KAPLET 500 MG Kaplet 1000 7000 8000
12 AMOKSILIN SIRUP KERING 125 MG/5ML Botol 0 700 700
13 AMPISILIN KAPLET 500 MG Kaplet 0 0 0
14 AMPISILIN SIRUP KERING 125 MG/5 ML Botol 0 0 0
15 ANTALGIN (METAMPIRON)TABLET 500 MG Tablet 150 1000 1150
16 ANTALGIN INJEKSI 250 MG/ML-2 ML Ampul 0 0 0
17 ANTASIDA DOEN,tablet Kombinasi Magnesium

Hidroksida 200mg+Aluminium
ANTI BAKTERI DOEN SALEP Hidroksida
KOMBINASI 200mg
: Tablet 0 13000 13000
18 BASITRASIN 500 IU/g + POLIMIKSIN 1000 IU/g Tube 0 50 50
19 ANTI HIMOROID
ANTIFUNGI DOENDOEN KOMBINASI
KOMBINASI : ASAM BENZOAT 6% + Supp 0 0 0
20 ASAM SALISILAT 3 %
ANTIMIGREN DOEN KOMBINASI : ERGOTAMIN Pot 0 0 0
21 TARTRAT 1 MG + KOFEIN
ANTIPARKINSON 50 MG KOMBINASI :
DOEN TABLET Tablet 0 0 0
22 KARBIDOPA 25 MG + LEVODOPA 250 MG Tablet 0 0 0
23 AQUA PRO INJEKSI STERIL,BEBAS PIROGEN - 20 ML Vial 0 0 0
24 AQUADEST STERIL - 500 ML Botol 0 0 0
25 ASAM ASKORBAT (VIT C) TABLET 50 MG Tablet 5000 2000 7000
26 ASAM ASKORBAT (VIT C) TABLET 250 MG Tablet 0 0 0
27 ASAM KLORIDA 0,1N - 100 MG Botol 0 0 0
28 ASAM SULFOSALISILAT 20% - 100 ML Botol 0 0 0
29 ASETOSAL TABLET 100 MG Tablet 0 0 0
30 ASETOSAL TABLET 500 MG Tablet 0 0 0
31 ATROPIN SULFAT INJEKSI 0,25 MG/ML - 1 ML Ampul 0 0 0
32 ATROPIN SULFAT TABLET 0,5 MG Tablet 0 0 0
33 BETAMETASON KRIM 0,1% - 5 G Tube 0 150 150
34 catgut/benang bedah no.2/0-3/0 (plain&cromic) Sachet 24 0 24
35 DEKSAMETASON INJEKSI 5MG/ML - 1 ML Ampul 0 0 0
36 DEKSAMETASON TABLET 0,5 MG Tablet 0 6000 6000
37 DEKSTROMETORFAN HBR SIRUP 10MG/5ML-60ML Botol 0 50 50
38 DEKSTROMETORFAN HBR TABLET 15 MG Tablet 0 0 0
39 DEVITALISASI PASTA (NON ARSEN) Botol 0 0 0
40 DIAZEPAM INJEKSI 5MG/ML - 2ML Ampul 19 0 19
41 DIAZEPAM TABLET 2 MG Tablet 0 400 400
42 DIAZEPAM TABLET 5 MG Tablet 0 0 0
43 DIETILKARBAMAZIN SITRAT TABLET 100 MG Tablet 0 0 0
44 DIFENHIDRAMIN HCL INJEKSI 10ML/ML - ML Ampul 60 0 60
45 DIGOKSIN TABLET 0,25 MG Tablet 40 0 40
46 EFEDRIN HCL TABLET 25 MG Tablet 200 0 200
47 EKSTARK BELLADON
EFINEPRINA TABLET 10 MG
HCL/BARBITAL Tablet 0 0 0
48 (EFINEPRINA/ADRENALINA) INJEKSI 0,1 % - 1 ML Ampul 0 0 0
49 ETAKRIDIN (RIVANOL)LARUTAN 0,1 % - 3000 ML Botol 0 0 0
50 ETAMBUTOL HCL TABLET 250 MG Tablet 0 0 0
51 ETANOL 70% - 1000 ML Botol 1 5 6
52 ETER ANESTETIK - 140 ML Botol 0 0 0
53 ETIL KLORIDA SEMPROT - 100 ML Botol 0 2 2
54 EUGENOL CAIRAN - 10 ML Botol 0 0 0
55 FENITOIN NATRIUM INJEKSI 50MG/ML Ampul 0 0 0
56 FENITOIN NATRIUM KAPSUL 100 MG Kapsul 0 0 0
57 FENITOIN NATRIUM KAPSUL 30 MG Kapsul 0 0 0
58 FENOBARBITAL INJEKSI 50MG/ML - 2ML Ampul 0 0 0
59 FENOBARBITAL TABLET 100 MG Tablet 0 0 0
60 FENOBARBITAL TABLET 30 MG Tablet 0 500 500
61 FENOKSIMETIL PENISILINA TABLET 250 MG Tablet 0 0 0
62 FENOKSIMETIL PENISILINA TABLET 500 MG Tablet 0 0 0
63 FENOL GLISEROL TETES TELINGA 10% - 5ML Botol 0 0 0
64 FITOMENADION (VIT K1)INJEKSI 10 MG/ML - 1ML Ampul 30 0 30
65 FITOMENADION (VIT K1)TABLET SALUT 10MG 100 200 300
66 FUROSEMID TABLET 40MG Tablet 250 250 500
67 FORINOKRESOL (PENGGANTI TKF)10ML Botol 0 0 0
68 GAMEKSAN EMULSI 1% - 100ML Botol 0 0 0
69 GARAM ORALIT 200 ML AIR Kantong 56 400 456
70 GENTIAN VIOLET LARUTAN 1% - 10ML Botol 0 0 0
71 GLASS LONOMER CEMENT(GC IX) Set 0 0 0
72 GLIBENKLAMID TABLET 5 MG Tablet 200 0 200
73 GLISERIL GUAYAKOLAT TABLET 100 MG Tablet 0 1000 1000
74 GLISERIN - 100ML Botol 0 0 0
75 GLUKOSA LARUTAN INFUS 5% STERIL- 500 ML Botol 0 20 20
76 GLUKOSA LARUTAN INFUS10% STERIL-500 ML Botol 0 0 0
77 GLUKOSA LARUTAN INFUS 40% STERIL-25 ML Botol 0 0 0
78 GRISEUFULVIN TABLET 125 MG,MICRONIZED Tablet 0 600 600
79 HALOPERIDOL 0,5 MG TABLET Tablet 0 0 0
80 HALOPERIDOL 1,5 MG TABLET Tablet 0 0 0
81 HIDROKLOROTIAZID (HCT) TABLET 25 MG Tablet 0 1000 1000
82 HIDROKORTISON KRIM 2,5% Tube 0 0 0
83 IBUPROFEN TABLET 200 MG Tablet 0 0 0
84 IBUPROFEN TABLET 400 MG Tablet 0 0 0
85 INFUSION SET ANAK Set 20 0 20
86 INFUSION SET DEWASA Set 0 75 75
87 ISOSORBID DINITRAT 5 MG TABLET SUBLINGUAL Tablet 0 0 0
88 JARUM JAHIT (BEDAH) NO.9 S/D 14 Biji 0 0 0
89 KALIUM PERMANGANAT SERBUK - 5 MG Tablet 0 0 0
90 KALSIUM HIDROKSIDA PASTA Kotak 0 0 0
91 KALSIUM LAKTAT (KALK) TABLET 500 MG Tablet 0 1000 1000
92 KAPAS PEMBALUT/ABSORBEN 250 MG Bungkus 1 3 4
93 KASA KOMPRES 40/40 STERIL Bungkus 0 100 100
94 KASA PEMBALUT 2 m x 80 cm Rol 0 30 30
95 KASA PEMBALUT HIDROFIL 4 cm x 3 cm Rol 0 0 0
96 KASA PEMBALUT HIDROFIL 4 cm x 15 cm Rol 0 50 50
97 KLORAMFENIKOL KAPSUL 250 MG Kapsul 0 0 0
98 KLORAMFENIKOL SALEP MATA 1% - 3,5 ML Tube 0 0 0
99 KLORAMFENIKOL TETES TELINGA 3% - 5ML Botol 0 0 0
100 KLORFENIRAMIN
KLOROQUIN FOSFATMALEAT (CTM)TABLET
TBALET 4 MG
250 MG (SETARA Tablet 2000 12000 14000
101 DENGAN 150 MG KLOROQUIN BASA) Tablet 0 0 0
102 KLORPROMAZIN HCL INJEKSI 25MG/ML - 1ML Ampul 0 0 0
103 KLORPROMAZIN HCL INJEKSI 5MG/ML - 1ML Ampul 0 0 0
104 KLORPROMAZIN HCL TABLET SALUT 25MG Tablet 0 0 0
105 KLORPROMAZIN HCL TABLET SALUT 100MG Tablet 0 0 0
106 KODEIN HCL TABLET
KOTRIMOKSAZOL 100MG TABLET,KOMBINASI :
PEDIATRIK Tablet 0 0 0
107 SULFAMETIKSAZOL 100MG ++ TRIMETROPIM
SULFAMETOKSZOL 200MG TRIMETROPIM Tablet 0 0 0
108 40MG/5ML
KOTRIMOKSAZOL TABLET,KOMBINASI : Botol 0 200 200
109 SULFAMETOKSAZOL 400MG + TRIMETROPIM 80MG Tablet 600 1500 2100
110 LARUTAN BENEDIK - 100ML Botol 0 0 0
111 LARUTAN EOIS 2% - 100ML Botol 0 0 0
112 LARUTAN ETANOL ASAM - 100ML Botol 0 0 0
113 LARUTAN GEBBET -100ML Botol 0 0 0
114 LARUTAN GIEMSA STAIN - 100ML Botol 0 0 0
115 LARUTAN KARBOL FUKSIN - 100ML Botol 0 0 0
116 LARUTAN KINYOUN - 100 ML Botol 0 0 0
117 LARUTAN METILEN BIRU - 100 ML Botol 0 0 0
118 LARUTAN
LIDOKAIN TURK
KOMP-INJEKSI
100 ML KOMBINASI :LIDOKAIN HCL Botol 0 0 0
119 2% + EPINEPRIN 1:80000
LISOL,MENGANDUNG - 2ML TERSABUN 50% -
KRESOL Ampul 90 0 90
120 1000ML Botol 0 0 0
121 MEBENDAZOL SIRUP 100MG/5ML - 30ML Botol 0 0 0
122 MEBENDAZOL TABLET 100MG Tablet 0 0 0
123 METANOL - 100ML
MALEAT(METILERGOMTETRIN)TABLET SALUT 0,125 Botol 0 0 0
124 gram Tablet 100 0 100
125 METILERGOMETRIN MALEAT INJEKSI 0,200MG - 1 ML Ampul 0 0 0
126 METRONIDAZOL TABLET 250 MG Tablet 0 300 300
127 MONOKLORKAMPER MENTOL CAIRAN Botol 0 0 0
128 MUMMIFYING PASTA Botol 0 0 0
129 NATRIUM
NATRIUM BIKARBONAT TABLET
KLORIDA LARUTAN 500MG
INFUS 0,9% STERIL - Tablet 800 1000 1800
130 500ML Botol 0 20 20
131 NATRIUM TIOSULFAT INJEKSI 25% -10ML Ampul 0 0 0
132 NISTATIN 100.000 IU/gram TABLET VAGINAL Tablet 0 0 0
133 NISTATIN 500.000 IU/gram TABLET SALUT Tablet 0 0 0
134 OBAT ANTI TUBERKULOSIS (FDC) Paket 0 15 15
135 OBAT ANTI TUBERKULOSIS KATEGORI ANAK Paket 0 0 0
136 OBAT BATUK HITAM (OBH)CAIRAN - 100ML Botol 29 60 89
137 OKSIGEN GAS DALAM TABUNG M3 0 0 0
138 OKSITETRASIKLIN HCL INJEKSI IM 50MG/ML - 10 ML Ampul 0 0 0
139 OKSITETRASIKLIN HCL SALEP MATA 1% - 3,5 garm Tube 0 50 50
140 OKSITETRASIKLIN HCL SALEP 3% - 5g Tube 0 0 0
141 OKSITOKSIN INJEKSI 10 IU/ML - 1ML Ampul 0 10 10
142 PARAFORMALDEHIDA TABLET I gram Tablet 0 0 0
143 PARASETAMOL SIRUP 125MG/5ML - 5ML Botol 260 250 510
144 PARASETAMOL TABLET 100MG Tablet 0 0 0
145 PARASETAMOL
PIRANTEL PAMOATTABLET 500MG
365MG(SETARA DENGAN 125MG Tablet 0 16000 16000
146 BASA) Tablet 0 0 0
147 PIRIDOKSIN HCL(VIT B6) TABLET 10MG Tablet 3000 3000 6000
148 PLESTER 5 YARD(PONDENSASI
POLIKRESULEN X 2 INCH METAKRESOL Rol 2 6 8
149 SULFONAT DAN METANAL) 360MG/G - 10ML Botol 0 0 0
150 POVIDON LODIDA 10% - 300ML Botol 2 5 7
151 POVIDON LODIDA 10% - 1000ML Botol 0 0 0
152 PREDNISON TABLET 5 MG Tablet 0 5000 5000
153 PRIMAKUIN TABLET 15MG Tablet 0 0 0
154 PROPRANOLOL HCL TABLET 40MG Tablet 0 0 0
155 RESERPIN TABLET 0,25 MG Tablet 0 500 500
156 RETINOL(VIT A) 100.00 0IU KAPSUL Kapsul 100 0 100
157 RETINOL(VIT A) 200.000 IU KAPSUL Kapsul 800 0 800
158 RINGER LAKTAT LARUTAN INFUS STERIL - 500ML Botol 0 200 200
159 SALBUTAMOL TABLET 2MG
SALEP 2X4 KOMBINASI: ASAM SALISILAT 2% Tablet 0 700 700
160 BELARANG ENDAP 4% - 30 gram Pot 0 0 0
161 SALISIL BEDAK 2% - 30 gram Kotak 0 50 50
162 SEMEN SENGBISA
SERUM ANTI FOSTAT
ULAR SERBUK DAN INJEKSI
POLIVALEN CAIRAN Botol 0 0 0
163 5ML(ABU)
SERUM ANTI BISA ULAR POLIVALEN INJEKSI Vial 2 0 2
164 50ML(ABU) Vial 0 0 0
165 SERUM ANTI RABIES Vial 0 0 0
166 SERUM ANTI TETANUS INJEKSI 1.500IU/AMPUL(ATS) Ampul 0 0 0
167 SERUM ANTI TETANUS INJEKSI 20.000 IU/VIAL (ATS) Vial 0 0 0
168 SIANOKOBALAMIN (VIT B 12) INJEKSI 500 mog/ml - 1ml Ampul 0 0 0
169 SILK (BENANG BEDAH SUTERA)NO.3/0 Sachet 24 0 24
TABLET TAMBAH DARAH KOMBINASI : BESI II SULFAT
170 200MG + ASAM FOLAT 0,25 MG Tablet 0 2400 2400
171 TETRASIKLIN HCL KAPSUL 250 MG Kapsul 1000 0 1000
172 TETRASIKLIN HCL KAPSUL 500MG Kapsul 300 0 300
173 TIAMIN HCL (VIT B1) INJEKSI 100MG/ML - 1ML Ampul 0 0 0
174 TIAMIN HCL /MONONITRAT(VIT B1) TABLET 50 MG Tablet 0 0 0
175 TRIKRESOL FORMALIN (TKF) CAIRAN - 10 ML Botol 0 0 0
176 VITAMIN B KOMPLEK TABLET Tablet 0 8000 8000
177 ASAM MEFENAMAT KAPSUL 250 MG Kapsul 0 0 0
178 ASAM MEFENAMAT KAPSUL 500 MG Kapsul 100 2000 2100
179 BETASON N CREAM Tube 0 0 0
180 DASABION Tablet 0 0 0
181 NEURODIAL Tablet 0 0 0
182 NEUROVIT E Tablet 0 1200 1200
183 EXTRAKPLU Tablet 0 0 0
184 MULVITAMIN DEWASA Tablet 0 0 0
185 MULTIVITAMIN ANAK Botol 12 0 12
186 PIROKSIKAM Tablet 0 300 300
187 SARUNG TANGAN Tablet 0 20 20
188 RANITIDIN Tablet 0 0 0
189 KOORAMPEKOR H Tube 0 24 24
190 HOLIDRIL SYRUP Botol 0 200 200
191 BRONIFAR Tablet 0 0 0
192 SUFRATUL Lembar 0 0 0
193 ABOCATH Buah 0 15 15
194 AKITA Tablet 0 1000 1000
195 CAPTOPRIL Tablet 0 200 200
196 METOKLORPRAMID Tablet 200 200 400
197 KLORAMFENIKOL SUSPENSI Botol 0 50 50
198 FOLLEY CATHETER 0 0 0
199 URINE BAG 0 0 0
200 GENALTEN CREM Tube 0 0 0
201 CIPROFLOXAXIN Tablet 500 700 1200
202 FARIZOL Tablet 0 0 0
203 IKAMICETIN SALEP MATA Tube 0 0 0
204 SULFASETAMID TETES MATA Botol 0 48 48
205 VICALCIM SIRUP Botol 0 0 0
206 TRIKORTIN SALEP KULIT Tube 0 0 0
207 GENTAMISIN SK Botol 0 40 40
208 PEHACAIN Ampul 0 0 0
209 MASKER Botol 0 20 20
0
Jumlah ibu hamil :0

Jumlah ibu Nifas :0
UMUM
TIDAK ASKES JUMLAH
BAYAR BAYAR
0 0 0 0

..
AT (LPLPO) FORM:LPLPO

DINKES KAB/KOTA
GFK KAB/KOTA
PUSKESMAS
2010
2010
PEMAKAI STOCK STOCK PERMINT PEMBERIAAN
JML
AN AKHIR OPTIMUM AAN PKD/DAU ASKES PROG PDPSE LAIN-LAIN
7 8 9 10 11 12 13 14 15 16
0 0 0
70 90 0
405 100 500
0 0 0
0 400 0
0 200 0
100 0 500
0 0 0
0 0 0
1560 0 1560
8000 0 8000
700 0 800
0 0 0
0 0 0
1150 0 5000
0 0 0
13000 0 18000
50 0 250
0 0 0
0 0 48
0 0 0
0 0 0
0 0 0
0 0 0
5000 2000 5000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
150 0 200
24 0 48
0 0 0
6000 0 8000
50 0 200
0 0 1000
0 0 0
0 19 0
400 0 2000
0 0 0
0 0 0
60 0 60
40 0 0
200 0 200
0 0 3000
0 0 0
0 0 5
0 0 0
2 4 0
0 0 0
0 2 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
500 0 500
0 0 0
0 0 0
0 0 0
0 30 0
200 100 200
500 0 250
0 0 0
0 0 0
456 0 600
0 0 0
0 0 0
100 100 0
1000 0 12000
0 0 0
20 0 20
0 0 0
0 0 0
600 0 2000
0 0 0
0 0 0
1000 0 1000
0 0 288
0 0 1000
0 0 0
20 0 20
55 20 75
0 0 0
0 0 0
0 0 0
0 0 0
1000 0 4000
1 3 0
100 0 100
30 0 50
0 0 0
50 0 50
0 0 1000
0 0 100
0 0 72
12700 1300 15000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
200 0 400
1900 200 2000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
90 0 120
0 0 0
0 0 0
0 0 0
0 0 0
0 100 0
0 0 0
300 0 700
0 0 0
0 0 0
1300 500 2000
20 0 20
0 0 0
0 0 0
0 0 0
15 0 20
0 0 5
74 15 100
0 0 0
0 0 0
50 0 75
0 0 200
10 0 60
0 0 0
337 173 400
0 0 1000
16000 0 19000
0 0 0
2000 4000 3000
6 2 10
0 0 5
5 2 5
0 0 0
5000 0 10000
0 0 0
0 0 0
500 0 2000
0 100 350
200 600 2100
200 0 200
700 0 1000
0 0 0
50 0 50
0 0 0
2 0 2
0 0 0
0 0 0
0 0 10
0 0 0
0 0 100
10 14 24
2400 0 9000
0 1000 0
300 0 300
0 0 0
0 0 6000
0 0 0
8000 0 10000
0 0 0
2100 0 2000
0 0 0
0 0 2000
0 0 1000
1200 0 2400
0 0 1000
0 0 3000
12 0 144
300 0 1000
20 0 20
0 0 1000
24 0 72
170 30 300
0 0 0
0 0 0
15 0 50
1000 0 1500
200 0 600
100 300 200
50 0 100
0 0 10
0 0 10
0 0 20
600 600 1000
0 0 0
0 0 72
48 0 72
0 0 0
0 0 0
40 0 60
0 0 0
20 0 50
Dr, Kodiat Juarsa, M.Kes Dia Juariah

NIP. 19680822.200003.1.002 Nip. 1969052019910302012
PUSKESMAS
DOK
PUSKESMAS CIMANUK
KECAMATAN CIMANUK
STOCK PERSEDIAA PEMAKAI STOCK STOCK

NO NAMA OBAT SATUAN PENERIMAAN
AWAL N AN AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9
ALAT SUNTIK SEKALI PAKAI 1

1 Set 300 300 600 200 400 500
ML
ALAT SUNTIK SEKALI PAKAI 2,5

2 Set 200 400 600 300 300 900
ML
AMINOFILIN INJEKSI 24MG / ML -

5 Ampul 0 0
10 ML
6 AMOKSILIN KAPSUL 250 MG Kapsul 0 0 2000
AMOKSILIN SIRUP KERING 125

8 Botol 60 720 780 660 120 900
MG/5ML
ANTALGIN
9 Tablet 800 800 1600 1100 500 1900
(METAMPIRON)TABLET 500 MG

10 Magnesium Hidroksida Tablet 0 10000 10000 10000 0 11200
200mg+Aluminium Hidroksida 200mg
ANTI BAKTERI DOEN SALEP

11 KOMBINASI : BASITRASIN 500 Tube 0 0 100
IU/g + POLIMIKSIN 1000 IU/g
ANTIFUNGI DOEN KOMBINASI :

12 ASAM BENZOAT 6% + ASAM Pot 24 24 48 24 24 48
SALISILAT 3 %
ASAM ASKORBAT (VIT C) TABLET
13 Tablet 1000 3000 4000 3000 1000 4000
50 MG
catgut/benang bedah no.2/0-3/0

15 Sachet 48 48 0 48 60
(plain&cromic)
DEKSAMETASON INJEKSI
16 Ampul 80 80 -9 89
5MG/ML - 1 ML
DEKSTROMETORFAN HBR SIRUP

18 Botol 96 48 144 48 96 192
10MG/5ML-60ML
DEKSTROMETORFAN HBR
19 Tablet 600 300 900 500 400 700
TABLET 15 MG
DIAZEPAM INJEKSI 5MG/ML -

20 Ampul 33 33 0 33
2ML
21 DIAZEPAM TABLET 2 MG Tablet 100 200 300 200 100
DIFENHIDRAMIN HCL INJEKSI

22 Ampul 0 0
10ML/ML - ML
23 DIGOKSIN TABLET 0,25 MG Tablet 0 0 700
24 EFEDRIN HCL TABLET 25 MG Tablet 0 0
EKSTARK BELLADON TABLET 10

25 Tablet 2000 2000 0 2000
MG
26 (EFINEPRINA/ADRENALINA) Ampul 0 0
INJEKSI 0,1 % - 1 ML
27 ETANOL 70% - 1000 ML Botol 5 3 8 3 5 9

28 ETIL KLORIDA SEMPROT - 100 ML Botol 1 1 0 1 2
FITOMENADION (VIT K1)INJEKSI
31 Ampul 72 72 0 72
10 MG/ML - 1ML
FITOMENADION (VIT K1)TABLET
32 Tablet 500 500 300 200 400
SALUT 10MG
GLISERIL GUAYAKOLAT TABLET
35 Tablet 0 10000 10000 10000 0 12000
100 MG
GLUKOSA LARUTAN INFUS 5%
36 Botol 0 0
STERIL- 500 ML
GRISEOFULVIN TABLET 125

37 Tablet 0 300 300 300 0 500
MG,MICRONIZED
HIDROKLOROTIAZID (HCT)
38 Tablet 1000 1000 1000 0
TABLET 25 MG

ISOSORBID DINITRAT 5 MG
43 Tablet 0 0 0 0 300
TABLET SUBLINGUAL
KALSIUM LAKTAT (KALK)
44 Tablet 0 0 0 0 4000
TABLET 500 MG
KAPAS PEMBALUT/ABSORBEN
45 Bungkus 0 5 5 2 3 6
250 MG
46 KASA 16/16 STERIL Bungkus 16 10 26 16 10 50
KLORAMFENIKOL KAPSUL 250

48 Kapsul 1000 1500 2500 1500 1000 2000
MG
KLORAMFENIKOL SALEP MATA
49 Tube 72 48 120 72 48 96
1% - 3,5 ML
KLORAMFENIKOL TETES
50 Botol 0 0 0 0 96
TELINGA 3% - 5ML
KLORFENIRAMIN MALEAT
51 Tablet 0 0 0 0 17000
(CTM)TABLET 4 MG
KOTRIMOKSAZOL SUSPENSI
KOMBINASI : SULFAMETOKSZOL
52 Botol 100 150 250 150 100 250
200MG + TRIMETROPIM
40MG/5ML
KOTRIMOKSAZOL
TABLET,KOMBINASI :
53 Tablet 0 1000 1000 1000 0 1200
TRIMETROPIM 80MG
LIDOKAIN KOMP INJEKSI

54 KOMBINASI :LIDOKAIN HCL 2% Ampul 50 50 50 0 150
+ EPINEPRIN 1:80000 - 2ML
METILERGOMETRIN
55 MALEAT(METILERGOMTETRIN)T Tablet 0 0 300
ABLET SALUT 0,125 gram
METILERGOMETRIN MALEAT
56 Ampul 29 29 0 29 30
INJEKSI 0,200MG - 1 ML

58 Tablet 2000 2000 700 1300 2000
500MG
NATRIUM KLORIDA LARUTAN

59 Botol 20 20 0 20 20
INFUS 0,9% STERIL - 500ML
60 OBAT ANTI TUBERKULOSIS (FDC) Paket 6 20 26 20 6
OBAT ANTI TUBERKULOSIS

61 Paket 3 1 4 4 0 4
KATEGORI ANAK
62 ANTI TBC KATEGORI II Paket 0 0 0
OBAT BATUK HITAM
63 Botol 0 0 0 120
(OBH)CAIRAN - 100ML
OKSITETRASIKLIN HCL SALEP
64 Tube 100 100 25 75 75
MATA 1% - 3,5 garm

65 Tube 0 0 0 200
3% - 5g
OKSITOKSIN INJEKSI 10 IU/ML -

66 Ampul 0 0
1ML
PARASETAMOL SIRUP 125MG/5ML
67 Botol 50 250 300 200 100 300
- 5ML
PIRANTEL PAMOAT
70 365MG(SETARA DENGAN 125MG Tablet 500 500 100 400
BASA)
PIRIDOKSIN HCL(VIT B6) TABLET
71 Tablet 2000 3000 5000 2000 3000 6000
10MG
75 RESERPIN TABLET 0,25 MG Tablet 0 0 0 0 2000
RETINOL(VIT A)100.000 IU
76 Kapsul 50 50 0 50
KAPSUL
RETINOL(VIT A) 200.000 IU
77 Kapsul 2000 2000 0 2000
KAPSUL
RINGER LAKTAT LARUTAN INFUS
78 Botol 20 120 140 140 0 220
STERIL - 500ML
79 SALBUTAMOL TABLET Tablet 0 0 0 2000
SERUM ANTI BISA ULAR
81 Vial 18 18 17 1
POLIVALEN INJEKSI 5ML(ABU)
82 Ampul 2 2 0 2
1.500IU/AMPUL(ATS)
83 Vial 0 0
20.000 IU/VIAL (ATS)
SIANOKOBALAMIN (VIT B 12)
84 Ampul 0 0
INJEKSI 500 mog/ml - 1ml
SILK (BENANG BEDAH
85 Sachet 36 36 72 36 36
SUTERA)NO.3/0
TABLET TAMBAH DARAH
86 KOMBINASI : BESI II SULFAT Sachet 0 80 80 80 0 360
200MG + ASAM FOLAT 0,25 MG
TETRASIKLIN HCL KAPSUL 250
87 Kapsul 1000 1000 0 1000
MG
TETRASIKLIN HCL KAPSUL
88 Kapsul 0 0
500MG
TIAMIN HCL /MONONITRAT(VIT
89 Tablet 0 5000 5000 5000 0 8000
B1) TABLET 50 MG
90 VITAMIN B KOMPLEK TABLET Tablet 0 0 0 0 10000
ASAM MEFENAMAT KAPSUL 500
91 Kapsul 200 2000 2200 1800 400 2100
MG
AKITA/M
92 Tablet 300 1450 1750 1600 150 3000
OLAGIT
94 PIROKSIKAM Tablet 0 0 2500
95 SARUNG TANGAN Tablet 50 50 50 0 100
96 RANITIDIN Tablet 300 300 300 0 2000
97 HOLIDRIL SYRUP Botol 0 48 48 48 0
98 ABOCATH Buah 0 50 50 50 0
100 METOKLORPRAMID Tablet 100 100 0 100 300
101 KLORAMFENIKOL SUSPENSI Botol 100 100 0 100 150
102 FOLLEY CATHETER Buah 43 43 0 43
103 URINE BAG Buah 24 24 0 24
106 GENTAMISIN INJ. Botol 135 135 105 30
107 MASKER Biji 0 50 50 50 0
108 PAPAVERIN Tablet 0 0
109 RANITIDIN INJ. Ampul 10 10 0 10 30
110 ZINK Tablet 1000 1000 200 800 1000
111 ASIKLOVIR TAB.200 mg Tablet 0 0
112 ASIKLOVIR KRIM 5% Tube 0 0
113 ALLOPURINOL Tablet 0 0 0 500
114 LISOL 1000 ml Botol 1 1 0 1
115 POLIKRESULEN Botol 0 0
116 TIAMIN INJ. 1 ml Ampul 21 21 0 21
117 AMBROKSOL SIRUP Botol 50 50 100 50 50
118 CHLORPROMAZIN Tablet 1000 1000 0 1000
119 AMPISILIN INJ. Vial 90 90 0 90
120 FENILBUTASON Tablet 0 0
121 HALOPERIDOL Tablet 200 200 0 200
122 MAGNESIUM SULFAT Inj. Vial 10 10 0 10
123 PARASETAMOL DROPS Botol 0 0 0 0 112
124 TRIHEKSIFENIDIL Tablet 200 200 100 100
125 ANTASIDA SUSPENSI Botol 50 50 50 0 50
126 SEFTRIAKSON INJ. 1 g Ampul 0 0
127 ETAKRIDIN Botol 3 3 0 3
128 FUNDIFAR Tablet 0 0 1500
129 FUROSEMID Tablet 300 300 0 300 300
130 KALSIUM GLUKONAS INJ. Ampul 36 36 0 36
131 PROKAIN BENZIL PENISILIN Vial 90 90 0 90
132 DIETILKARBAMAZINE 57600 57600 0 57600

Tablet
UMUM
ASKES LAIN2 JUMLAH
JUMLAH KUNJUNGAN TIDAK
RESEP BAYAR
BAYAR
Yang Menyerahkan:
Mengetahui / Menyetujui : Yang Meneri
Kepala GFK,
Kepala Dinas Kesehatan Kab./Kota Kepala Puskes
..
dr.R.H.Daeng Su
NIP.19660729.1998
FORM:LPLPO

DINKES KAB/KOTA
GFK KAB/KOTA
PUSKESMAS
PERMINT PEMBERIAAN
JML
AAN
LAIN-
PKD/DAU ASKES PROG PDPSE
LAIN
10 11 12 13 14 15 16
300
400
100
1500
13000
800
800
12000
100
24
3000
200
10000
48
300
200
700
10
3
0
0
0
300
300
12000
20
500
300
500
25
50
300
2000
10
50
1500
48
96
150
1200
100
300
0
1000
20
0
120
200
50
250
1000
22000
3000
15
7
9000
2000
160
2000
50
0
36
320
100
6000
10000
2000
1500
96
2000
50
1500
96
60
3000
100
0
200
72
100
500
10
0
500
0
56
1500
0
dr.R.H.Daeng Suganjar Didi Evan Nugroho
NIP.19660729.199803.1.004 NIP. 198503212011011005

PUSKESMAS
DOK
PUSKESMAS CIMANUK
KECAMATAN CIMANUK
PROVINSI BANTEN PERMINTAAN BULAN / PERIODE FEBRUARI 2014

1 2 3 4 5 6 7 8 9

1 Set 400 200 600 200 400 500
ML

2 Set 300 300 600 200 400 900
ML
4 AMINOFILIN TABLET 200 MG Tablet 200 200 200 0 200

5 Ampul 0 0
10 ML
6 AMOKSILIN KAPSUL 250 MG Kapsul 1500 1500 1500 0 2000

8 Botol 120 720 840 760 80 900
MG/5ML
ANTALGIN
9 Tablet 500 800 1300 900 400 1900


11 KOMBINASI : BASITRASIN 500 Tube 100 100 100 0 100

SALISILAT 3 %
13 Tablet 1000 3000 4000 3000 1000 4000
50 MG
14 BETAMETASON KRIM 0,1% - 5 G Tube 200 200 200 0 200

15 Sachet 48 48 43 5 60
(plain&cromic)
16 Ampul 89 89 0 89
5MG/ML - 1 ML

18 Botol 96 48 144 144 0 192
10MG/5ML-60ML
DEKSTROMETORFAN HBR
19 Tablet 400 300 700 700 0 700
TABLET 15 MG

20 Ampul 33 33 0 33
2ML

22 Ampul 0 0
10ML/ML - ML
23 DIGOKSIN TABLET 0,25 MG Tablet 400 400 400 0 600
24 EFEDRIN HCL TABLET 25 MG Tablet 0 0

25 Tablet 2000 2000 0 2000
MG
26 (EFINEPRINA/ADRENALINA) Ampul 0 0
27 ETANOL 70% - 1000 ML Botol 5 2 7 2 5 9

31 Ampul 72 72 32 40
10 MG/ML - 1ML
32 Tablet 200 200 400 200 200 400
SALUT 10MG
33 GARAM ORALIT 200 ML AIR Kantong 400 400 200 200 300
34 GLIBENKLAMID TABLET 5 MG Tablet 700 700 400 300 500
35 Tablet 0 10000 10000 9000 1000 12000
100 MG
36 Botol 20 20 20 0
STERIL- 500 ML

37 Tablet 0 300 300 300 0 500
MG,MICRONIZED
38 Tablet 0 0 0 0
TABLET 25 MG

43 Tablet 0 100 100 100 0 300
TABLET SUBLINGUAL
44 Tablet 0 2000 2000 1700 300 4000
TABLET 500 MG
45 Bungkus 3 1 4 2 2 6
250 MG

48 Kapsul 1000 1000 2000 1500 500 2000
MG
49 Tube 48 24 72 48 24 96
1% - 3,5 ML
KLORAMFENIKOL TETES
50 Botol 0 72 72 52 20 96
TELINGA 3% - 5ML
51 Tablet 0 13000 13000 10000 3000 17000
(CTM)TABLET 4 MG
52 Botol 100 150 250 250 0 250
200MG + TRIMETROPIM
40MG/5ML
KOTRIMOKSAZOL
TABLET,KOMBINASI :
53 Tablet 0 1200 1200 1100 100 1200
TRIMETROPIM 80MG

54 KOMBINASI :LIDOKAIN HCL 2% Ampul 0 90 90 30 60 150
METILERGOMETRIN
55 MALEAT(METILERGOMTETRIN)T Tablet 0 0 300
56 Ampul 29 29 0 29 30
57 METRONIDAZOL TABLET 250 MG Tablet 2000 2000 500 1500 2000

58 Tablet 1300 1300 300 1000 2000
500MG

59 Botol 20 20 0 20 20

61 Paket 0 4 4 4 0 4
KATEGORI ANAK
62 ANTI TBC KATEGORI II Paket 0 0
OBAT BATUK HITAM
63 Botol 30 30 30 0 120
(OBH)CAIRAN - 100ML
64 Tube 75 75 25 50 75
MATA 1% - 3,5 garm

65 Tube 150 150 150 0 200
3% - 5g

66 Ampul 30 30 15 15
1ML
67 Botol 100 250 350 300 50 300
- 5ML
PIRANTEL PAMOAT
BASA)
71 Tablet 3000 1000 4000 3000 1000 6000
10MG
76 Kapsul 50 500 550 0 550
KAPSUL
77 Kapsul 2000 6050 8050 0 8050
KAPSUL
78 Botol 0 160 160 160 0 220
STERIL - 500ML
79 SALBUTAMOL TABLET Tablet 2000 2000 1700 300 2000
81 Vial 1 2 3 3 0
82 Ampul 2 2 0 2
1.500IU/AMPUL(ATS)
83 Vial 0 0
84 Ampul 0 0
SILK (BENANG BEDAH
85 Sachet 36 36 72 36 36
SUTERA)NO.3/0
TABLET TAMBAH DARAH
87 Kapsul 1000 1000 1000 0
MG
88 Kapsul 100 100 100 0
500MG
89 Tablet 0 5000 5000 4000 1000 8000
B1) TABLET 50 MG
91 Kapsul 400 2000 2400 1900 500 2100
MG
AKITA/M
92 Tablet 150 900 1050 1050 0 3000
OLAGIT
94 PIROKSIKAM Tablet 2000 2000 2000 0 2500
98 ABOCATH Buah 0 60 60 60 0
107 MASKER Biji 0 100 100 100 0
108 PAPAVERIN Tablet 0 0
110 ZINK Tablet 800 800 500 300 1000
111 ASIKLOVIR TAB.200 mg Tablet 0 0
112 ASIKLOVIR KRIM 5% Tube 20 20 0 20
113 ALLOPURINOL Tablet 300 300 200 100 500
114 LISOL 1000 ml Botol 1 1 0 1
115 POLIKRESULEN Botol 0 0
117 AMBROKSOL SIRUP Botol 50 50 10 40
120 FENILBUTASON Tablet 0 0
123 PARASETAMOL DROPS Botol 0 56 56 56 0 112
125 ANTASIDA SUSPENSI Botol 0 0 0 50
126 SEFTRIAKSON INJ. 1 g Ampul 0 0
128 FUNDIFAR/ MULTIVIT.DEWASA Tablet 500 500 500 0 1500

Tablet
UMUM
ASKES LAIN2 JUMLAH
RESEP BAYAR
BAYAR
Yang Menyerahkan:
Kepala GFK,
..
dr.R.H.Daeng Su
NIP.19660729.1998
FORM:LPLPO

DINKES KAB/KOTA
GFK KAB/KOTA
PUSKESMAS
PERMINT PEMBERIAAN
JML
AAN
LAIN-
LAIN
10 11 12 13 14 15 16
100
200
100
1500
13000
800
800
12000
100
24
3000
200
48
10000
144
500
200
500
10
2
2
0
0
200
200
300
12000
0
500
300
500
25
50
300
2000
10
50
1500
48
72
13000
250
1200
30
300
0
1000
20
2
120
25
200
10
250
1000
22000
3000
15
7
9000
2000
200
2000
50
3
36
340
100
5000
10000
2000
1500
96
2000
50
2000
96
60
3000
200
0
300
72
100
500
10
700
300
0
56
30
1500
100
NIP.19660729.199803.1.004 NIP. 198503212011011005

LAPORAN PEMAKAIAN DAN PERMINTAAN OBAT
SUB UNIT PELAYANAN
SUB UNIT :
PUSKESMAS : CIMANUK
KECAMATAN : CIMANUK PELAPORAN BULAN / PERIODE
KABUPATEN : PANDEGLANG PERMINTAAN BULAN / PERIODE
NO NAMA OBAT SATUAN STOCK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
1 ALAT SUNTIK SEKALI PAKAI 1 ML Set
2 ALAT SUNTIK SEKALI PAKAI 2,5 ML Set
3 ALBENDAZOL TABLET 400 MG Tablet

4 AMINOFILIN TABLET 200 MG Tablet
5 AMINOFILIN INJEKSI Ampul
6 AMOKSILIN KAPSUL 250 MG Kapsul
7 AMOKSILIN KAPLET 500 MG Kaplet

8 AMOKSILIN SIRUP KERING Botol
9 ANTALGIN (METAMPIRON) Tablet
10 ANTASIDA DOEN Tablet
11 ANTI BAKTERI salep ( BASITRASIN ) Tube
12 ANTIFUNGI DOEN Pot
13 ASAM ASKORBAT (VIT C) Tablet
14 BETAMETASON KRIM Tube
15 catgut/benang bedah Sachet

16 DEKSAMETASON INJEKSI Ampul
17 DEKSAMETASON TABLET 0,5 MG Tablet
18 DEKSTROMETORFAN HBR SIRUP Botol
19 DEKSTROMETORFAN HBR TABLET Tablet
20 DIAZEPAM INJEKSI Ampul

21 DIAZEPAM TABLET 2 MG Tablet
22 DIFENHIDRAMIN HCL INJEKSI Ampul
23 DIGOKSIN TABLET 0,25 MG Tablet
24 EFEDRIN HCL TABLET 25 MG Tablet
25 EKSTARK BELLADON Tablet
26 EFINEPRINA HCL INJEKSI Ampul

27 ETANOL 70% - 1000 ML Botol
28 ETIL KLORIDA SEMPROT - 100 ML Botol
29 EUGENOL CAIRAN - 10 ML Botol
30 FENOBARBITAL TABLET 30 MG Tablet
31 FITOMENADION (VIT K1) INJEKSI Ampul
32 FITOMENADION (VIT K1) TABLET Tablet
33 GARAM ORALIT 200 ML AIR Kantong
34 GLIBENKLAMID TABLET 5 MG Tablet
35 GLISERIL GUAYAKOLAT TABLET Tablet
36 GLUKOSA LARUTAN INFUS Botol
37 GRISEOFULVIN TABLET 125 MG Tablet
38 HIDROKLOROTIAZID (HCT) TABLET Tablet
39 HIDROKORTISON KRIM 2,5% Tube
40 IBUPROFEN TABLET 200 MG Tablet
41 INFUSION SET ANAK Set
42 INFUSION SET DEWASA Set
43 ISOSORBID DINITRAT 5 MG TABLET Tablet
44 KALSIUM LAKTAT (KALK) TABLET Tablet
45 KAPAS PEMBALUT/ABSORBEN Bungkus
46 KASA 16/16 STERIL Bungkus
47 KASA PEMBALUT 2 m x 80 cm Rol
48 KLORAMFENIKOL KAPSUL 250 MG Kapsul
49 KLORAMFENIKOL SALEP MATA Tube
50 KLORAMFENIKOL TETES TELINGA Botol

51 Tablet
(CTM)TABLET
52 KOTRIMOKSAZOL SUSPENSI Botol
53 KOTRIMOKSAZOL TABLET Tablet
54 LIDOKAIN KOMP INJEKSI Ampul
55 METILERGOMTETRIN Tablet
56 METILERGOMETRIN INJEKSI Ampul
57 METRONIDAZOL TABLET 250 MG Tablet

58 NATRIUM BIKARBONAT TABLET Tablet
59 NATRIUM KLORIDA LARUTAN INFUS Botol
60 OBAT ANTI TUBERKULOSIS (FDC) Paket

OBAT ANTI TUBERKULOSIS KATEGORI
61 Paket
ANAK
62 ANTI TBC KATEGORI II Paket
63 OBAT BATUK HITAM (OBH) Botol

64 OKSITETRASIKLIN SALEP MATA Tube
65 OKSITETRASIKLIN SALEP 3% Tube

66 OKSITOKSIN INJEKSI 10 IU/ML - 1ML Ampul
67 PARASETAMOL SIRUP Botol
68 PARASETAMOL TABLET 100MG Tablet
69 PARASETAMOL TABLET 500MG Tablet
70 PIRANTEL PAMOAT Tablet
71 PIRIDOKSIN HCL(VIT B6) Tablet
72 PLESTER 5 YARD X 2 INCH Rol
73 POVIDON LODIDA 10% - 300ML Botol
74 PREDNISON TABLET 5 MG Tablet
75 RESERPIN TABLET 0,25 MG Tablet
76 RETINOL(VIT A)100.000 IU KAPSUL Kapsul
77 RETINOL(VIT A) 200.000 IU KAPSUL Kapsul
78 RINGER LAKTAT LARUTAN INFUS Botol
79 SALBUTAMOL TABLET Tablet
80 SALISIL BEDAK 2% - 30 gram Kotak
SERUM ANTI BISA ULAR INJEKSI
81 Vial
5ML(ABU)
SERUM ANTI TETANUS INJEKSI 20.000
83 Vial
IU/VIAL (ATS)
84 SIANOKOBALAMIN (VIT B 12) Ampul
85 SILK (BENANG BEDAH SUTERA) Sachet
86 TABLET TAMBAH DARAH Sachet
87 TETRASIKLIN HCL KAPSUL 250 MG Kapsul
88 TETRASIKLIN HCL KAPSUL 500MG Kapsul
89 TIAMIN HCL (VIT B1) Tablet
90 VITAMIN B KOMPLEK TABLET Tablet
91 ASAM MEFENAMAT KAPSUL Kapsul
92 AKITA/MOLAGIT Tablet
93 MULTIVITAMIN ANAK Botol
94 PIROKSIKAM Tablet
95 SARUNG TANGAN Tablet
96 RANITIDIN Tablet
97 HOLIDRIL SYRUP Botol
98 ABOCATH Buah
99 CAPTOPRIL Tablet
100 METOKLORPRAMID Tablet
101 KLORAMFENIKOL SUSPENSI Botol
102 FOLLEY CATHETER Buah
103 URINE BAG Buah
104 CIPROFLOXAXIN Tablet
105 SULFASETAMID TETES MATA Botol
106 GENTAMISIN INJ. Botol
107 MASKER Biji
108 PAPAVERIN Tablet
109 RANITIDIN INJ. Ampul
110 ZINK Tablet
111 ASIKLOVIR TAB.200 mg Tablet
112 ASIKLOVIR KRIM 5% Tube
113 ALLOPURINOL Tablet
114 LISOL 1000 ml Botol
115 POLIKRESULEN Botol
116 TIAMIN INJ. 1 ml Ampul
117 AMBROKSOL SIRUP Botol
118 CHLORPROMAZIN Tablet
119 AMPISILIN INJ. Vial
120 FENILBUTASON Tablet
121 HALOPERIDOL Tablet
122 MAGNESIUM SULFAT Inj. Vial
123 PARASETAMOL DROPS Botol
124 TRIHEKSIFENIDIL Tablet
125 ANTASIDA SUSPENSI Botol
126 SEFTRIAKSON INJ. 1 g Ampul
127 ETAKRIDIN Botol
128 FUNDIFAR/ MULTIVIT.DEWASA Tablet
129 FUROSEMID Tablet
130 KALSIUM GLUKONAS INJ. Ampul
131 PROKAIN BENZIL PENISILIN Vial
132 DIETILKARBAMAZINE Tablet
Mengetahui:
Kepala Puskesmas Cimanuk Pengelola Obat
dr. Chaerudin Didi Evan N. S.Farm.,Apt

NIP. 19690213.200911.1.001 NIP. 19850321.201101.1.005
AN DAN PERMINTAAN OBAT
T PELAYANAN
PELAPORAN BULAN / PERIODE :

PERMINTAAN BULAN / PERIODE :
STOCK AKHIR PERMINTAAN PEMBERIAN
Pengelola Perawatan
..
Triwulan I
NO NAMA OBAT STOK
1 ALAT SUNTIK SEKALI PAKAI 1 ML 100
2 ALAT SUNTIK SEKALI PAKAI 2,5 ML 0
3 ALBENDAZOL TABLET 400 MG 1860
4 AMINOFILIN TABLET 200 MG 100
5 AMINOFILIN INJEKSI 24MG / ML - 10 ML 0
6 AMOKSILIN KAPSUL 250 MG 0
7 AMOKSILIN KAPLET 500 MG 0
8 AMOKSILIN SIRUP KERING 125 MG/5ML 150
9 ANTALGIN (METAMPIRON)TABLET 500 MG 600
ANTASIDA DOEN,tablet Kombinasi Magnesium Hidroksida
10 2000
11 ANTI BAKTERI DOEN SALEP KOMBINASI : BASITRASIN 500 0

ANTIFUNGI DOEN KOMBINASI : ASAM BENZOAT 6% + ASAM
12 48
SALISILAT 3 %
13 ASAM ASKORBAT (VIT C) TABLET 50 MG 2000
14 BETAMETASON KRIM 0,1% - 5 G 0
15 catgut/benang bedah no.2/0-3/0 (plain&cromic) 7
16 DEKSAMETASON INJEKSI 5MG/ML - 1 ML 0
17 DEKSAMETASON TABLET 0,5 MG 2000
18 DEKSTROMETORFAN HBR SIRUP 10MG/5ML-60ML 150
19 DEKSTROMETORFAN HBR TABLET 15 MG 400
20 DIAZEPAM INJEKSI 5MG/ML - 2ML 19
21 DIAZEPAM TABLET 2 MG 700
22 DIFENHIDRAMIN HCL INJEKSI 10ML/ML - ML 0
23 DIGOKSIN TABLET 0,25 MG 0
24 EFEDRIN HCL TABLET 25 MG 1150
25 EKSTARK BELLADON TABLET 10 MG 3000
26 EFINEPRINA HCL/BARBITAL (EFINEPRINA/ADRENALINA) 0
27 ETANOL 70% - 1000 ML 3
28 ETIL KLORIDA SEMPROT - 100 ML 4
29 EUGENOL CAIRAN - 10 ML 1
30 FENOBARBITAL TABLET 30 MG 1000
31 FITOMENADION (VIT K1)INJEKSI 10 MG/ML - 1ML 52
32 FITOMENADION (VIT K1)TABLET SALUT 10MG 200
33 GARAM ORALIT 200 ML AIR 0
34 GLIBENKLAMID TABLET 5 MG 400
35 GLISERIL GUAYAKOLAT TABLET 100 MG 0
36 GLUKOSA LARUTAN INFUS 5% STERIL- 500 ML 20
37 GRISEOFULVIN TABLET 125 MG,MICRONIZED 0
38 HIDROKLOROTIAZID (HCT) TABLET 25 MG 400
39 HIDROKORTISON KRIM 2,5% 0
40 IBUPROFEN TABLET 200 MG 0
41 INFUSION SET ANAK 15
42 INFUSION SET DEWASA 0
43 ISOSORBID DINITRAT 5 MG TABLET SUBLINGUAL 0
44 KALSIUM LAKTAT (KALK) TABLET 500 MG 500
45 KAPAS PEMBALUT/ABSORBEN 250 MG 3
46 KASA KOMPRES 40/40 STERIL 0
47 KASA PEMBALUT 2 m x 80 cm 0
48 KLORAMFENIKOL KAPSUL 250 MG 0
49 KLORAMFENIKOL SALEP MATA 1% - 3,5 ML 0
50 KLORAMFENIKOL TETES TELINGA 3% - 5ML 0
51 KLORFENIRAMIN MALEAT (CTM)TABLET 4 MG 6000
52 KOTRIMOKSAZOL SUSPENSI 50
53 100
SULFAMETOKSAZOL 400MG + TRIMETROPIM 80MG
LIDOKAIN KOMP INJEKSI KOMBINASI :LIDOKAIN HCL 2% +
54 0
EPINEPRIN 1:80000 - 2ML
METILERGOMETRIN MALEAT(METILERGOMTETRIN)TABLET
55 200
SALUT 0,125 gram
56 21
METILERGOMETRIN MALEAT INJEKSI 0,200MG - 1 ML
57 0
METRONIDAZOL TABLET 250 MG
58 NATRIUM BIKARBONAT TABLET 500MG 1000
59 NATRIUM KLORIDA LARUTAN INFUS 0,9% STERIL - 500ML 20
60 OBAT ANTI TUBERKULOSIS (FDC) 50
61 OBAT ANTI TUBERKULOSIS KATEGORI ANAK 0
62 ANTI TBC KATEGORI II 2
63 OBAT BATUK HITAM (OBH)CAIRAN - 100ML 120
64 OKSITETRASIKLIN HCL SALEP MATA 1% - 3,5 garm 125
65 OKSITETRASIKLIN HCL SALEP 3% - 5g 0
66 OKSITOKSIN INJEKSI 10 IU/ML - 1ML 180
67 PARASETAMOL SIRUP 125MG/5ML - 5ML 100
68 PARASETAMOL TABLET 100MG 100
70 PIRANTEL PAMOAT 100
71 PIRIDOKSIN HCL(VIT B6) TABLET 10MG 2000
72 PLESTER 5 YARD X 2 INCH 0
73 POVIDON LODIDA 10% - 300ML 0
74 PREDNISON TABLET 5 MG 0
75 RESERPIN TABLET 0,25 MG 0
76 RETINOL(VIT A)100.000 IU KAPSUL 600
77 RETINOL(VIT A) 200.000 IU KAPSUL 2000
78 RINGER LAKTAT LARUTAN INFUS STERIL - 500ML 40
79 SALBUTAMOL 100
80 SALISIL BEDAK 2% - 30 gram 0
81 SERUM ANTI BISA ULAR POLIVALEN INJEKSI 5ML(ABU) 3
82 SERUM ANTI TETANUS INJEKSI 1.500IU/AMPUL(ATS) 3
83 SERUM ANTI TETANUS INJEKSI 20.000 IU/VIAL (ATS) 0
84 SIANOKOBALAMIN (VIT B 12) INJEKSI 500 mog/ml - 1ml 0
85 SILK (BENANG BEDAH SUTERA)NO.3/0 0
86 TABLET TAMBAH DARAH 600
87 TETRASIKLIN HCL KAPSUL 250 MG 1000
88 TETRASIKLIN HCL KAPSUL 500MG 200
89 0
TIAMIN HCL /MONONITRAT(VIT B1) TABLET 50 MG
90 VITAMIN B KOMPLEK TABLET 0
91 ASAM MEFENAMAT KAPSUL 500 MG 100
92 AKITA 1000
93 MULTIVITAMIN ANAK 0
94 PIROKSIKAM 0
95 SARUNG TANGAN 0
96 RANITIDIN 0
97 HOLIDRIL SYRUP 0
98 ABOCATH 0
99 CAPTOPRIL 0
100 METOKLORPRAMID 200
101 KLORAMFENIKOL SUSPENSI 0
103 URINE BAG 27
104 CIPROFLOXAXIN 0
105 SULFASETAMID TETES MATA 0
106 GENTAMISIN INJ. 135
107 MASKER 0
108 PAPAVERIN 0
109 RANITIDIN INJ. 0
110 ZINK 1200
111 ASIKLOVIR TAB.200 mg 0
112 ASIKLOVIR KRIM 5% 0
113 ALLOPURINOL 200
114 LISOL 1000 ml 2
115 POLIKRESULEN 0
116 TIAMIN INJ. 1 ml 11
117 Neo-K INJ. 0
118 CHLORPROMAZIN 1000
119 AMPISILIN INJ. 60
120 FENILBUTASON 0
121 HALOPERIDOL 200
122 MAGNESIUM SULFAT Inj. 0
123 PARASETAMOL DROPS 112
124 TRIHEKSIFENIDIL 247
125 ANTASIDA SUSPENSI 35
126 SEFTRIAKSON INJ. 1 g 0
127 ETAKRIDIN / RIVANOL 13
128 FUNDIFAR 0
129 FUROSEMID 200
130 KALSIUM GLUKONAS INJ. 24
131 PROKAIN BENZIL PENISILIN 60
132 DIETILKARBAMAZINE 0
lan I
PENERIMAAN JUMLAH PENGELUARAN SALDO
800 900 800 100
1400 1400 1400 0
7560 9420 0 9420
300 400 300 100
0 0 0 0
4200 4200 4200 0
32000 32000 32000 0
1700 1850 1850 0
3400 4000 3200 800
37000 39000 39000 0
175 175 175 0
48 96 72 24
7000 9000 7000 2000
175 175 175 0
48 55 35 20
0 0 0 0
22000 24000 24000 0
288 438 414 24
900 1300 1100 200
30 49 16 33
1000 1700 1400 300
0 0 0 0
1200 1200 1000 200
0 1150 200 950
1000 4000 1000 3000
0 0 0 0
11 14 13 1
1 5 4 1
5 6 1 5
0 1000 1000 0
90 142 52 90
500 700 700 0
800 800 400 400
400 800 400 400
26000 26000 26000 0
20 40 20 20
900 900 900 0
1000 1400 400 1000
240 240 240 0
1000 1000 1000 0
25 40 25 15
125 125 100 25
200 200 100 100
6000 6500 5500 1000
5 8 6 2
300 300 300 0
150 150 150 0
2000 2000 2000 0
0 0 0 0
168 168 168 0
36000 42000 42000 0
550 600 600 0
2800 2900 2300 600
340 340 260 80
400 600 600 0
30 51 11 40
1100 1100 1100 0
3000 4000 2000 2000

20 40 20 20
42 92 60 32
4 4 4 0
8 10 6 4
360 480 480 0
200 325 200 125
175 175 175 0
50 230 160 70
800 900 900 0
3000 3100 2900 200
60000 65000 65000 0
100 200 168 32
9000 11000 9500 1500
33 33 31 2
17 17 16 1
22000 22000 18000 4000
2750 2750 2750 0
0 600 600 0
2000 4000 3400 600
640 680 520 160
2000 2100 1900 200
150 150 144 6
0 3 1 2
0 3 0 3
0 0 0 0
0 0 0 0
144 144 144 0
600 1200 -3000 4200
0 1000 0 1000
400 600 500 100
15000 15000 14000 1000
24000 24000 24000 0

4500 4600 4300 300
3000 4000 3100 900
288 288 288 0
4000 4000 4000 0
100 100 100 0
1500 1500 1500 0
192 192 192 0
180 180 180 0
2220 2220 2220 0
400 600 200 400
150 150 130 20
0 43 0 43
0 27 3 24
900 900 900 0
168 168 168 0
50 185 0 185
150 150 150 0
0 0 0 0
45 45 25 20
1000 2200 1600 600
120 120 120 0
0 0 0 0
800 1000 500 500
1 3 2 1
0 0 0 0
30 41 19 22
0 0 0 0
0 1000 0 1000
30 90 0 90
0 0 0 0
0 200 0 200
0 0 0 0
224 336 336 0
0 247 47 200
100 135 135 0
0 0 0 0
0 13 2 11
2000 2000 2000 0
900 1100 500 600
12 36 0 36
30 90 0 90
28800 28800 0 28800
,
PUSKESMAS
DOK
PUSKESMAS CIMANUK
KECAMATAN CIMANUK
KAB / KOTA PANDEGLANG PELAPORAN BULAN / PERIODE MARET 2013
PROVINSI BANTEN PERMINTAAN BULAN / PERIODE APRIL 2013
STOCK PENERIMAA PERSEDIAA PEMAKAI STOCK STOCK

NO NAMA OBAT SATUAN
AWAL N N AN AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9

1 Set 0 400 400 300 100
ML

2 Set 0 600 600 600 0
ML
3 ALBENDAZOL TABLET 400 MG Tablet 1860 7560 9420 0 9420

5 Ampul 0 0 0 0
10 ML
7 AMOKSILIN KAPLET 500 MG Kaplet 0 12000 12000 12000 0

8 Botol 0 700 700 700 0
MG/5ML
ANTALGIN
9 Tablet 900 1200 2100 1300 800

10 Magnesium Hidroksida Tablet 0 14000 14000 14000 0


12 ASAM BENZOAT 6% + ASAM Pot 24 24 48 24 24
SALISILAT 3 %
ASAM ASKORBAT (VIT C)
13 Tablet 2000 3000 5000 3000 2000
TABLET 50 MG

15 Sachet 0 24 24 4 20
(plain&cromic)
16 Ampul 0 0 0 0
5MG/ML - 1 ML
17 DEKSAMETASON TABLET 0,5 MG Tablet 0 10000 10000 10000 0

18 Botol 0 144 144 120 24
10MG/5ML-60ML
DEKSTROMETORFAN HBR
19 Tablet 500 200 700 500 200
TABLET 15 MG

20 Ampul 33 33 0 33
2ML

22 Ampul 0 0 0 0
10ML/ML - ML

25 Tablet 2000 1000 3000 0 3000
MG
26 (EFINEPRINA/ADRENALINA) Ampul 0 0 0 0
27 ETANOL 70% - 1000 ML Botol 2 5 7 6 1

ETIL KLORIDA SEMPROT - 100
28 Botol 1 1 2 1 1
ML
29 EUGENOL CAIRAN - 10 ML Botol 1 5 6 1 5
31 Ampul 99 99 9 90
10 MG/ML - 1ML
32 0 300 300 300 0
SALUT 10MG
35 Tablet 0 12000 12000 12000 0
100 MG
36 Botol 0 20 20 0 20
STERIL- 500 ML

37 Tablet 0 300 300 300 0
MG,MICRONIZED
38 Tablet 400 1000 1400 400 1000
TABLET 25 MG
39 HIDROKORTISON KRIM 2,5% Tube 0 96 96 96 0

40 IBUPROFEN TABLET 200 MG Tablet 0 500 500 500 0
42 INFUSION SET DEWASA Set 25 75 100 75 25
43 Tablet 0 200 200 100 100
TABLET SUBLINGUAL
44 Tablet 1000 2000 3000 2000 1000
TABLET 500 MG
45 Bungkus 2 2 4 2 2
250 MG
46 KASA KOMPRES 40/40 STERIL Bungkus 0 100 100 100 0
47 KASA PEMBALUT 2 m x 80 cm Rol 0 50 50 50 0

48 Kapsul 0 1000 1000 1000 0
MG
49 Tube 0 0 0 0
1% - 3,5 ML
KLORAMFENIKOL TETES
50 Botol 24 48 72 72 0
TELINGA 3% - 5ML
51 Tablet 0 14000 14000 14000 0
(CTM)TABLET 4 MG
52 Botol 50 200 250 250 0
200MG + TRIMETROPIM
40MG/5ML
KOTRIMOKSAZOL
TABLET,KOMBINASI :
53 Tablet 200 1200 1400 800 600
TRIMETROPIM 80MG

METILERGOMETRIN
55 MALEAT(METILERGOMTETRIN)T Tablet 0 0 0 0
56 Ampul 11 30 41 1 40

58 Tablet 1000 1000 2000 0 2000
500MG

59 Botol 20 20 40 20 20

60 Paket 48 16 64 32 32
(FDC)

61 Paket 0 0 0 0
KATEGORI ANAK
62 ANTI TBC KATEGORI II Paket 1 4 5 1 4
OBAT BATUK HITAM
63 Botol 0 180 180 180 0
(OBH)CAIRAN - 100ML
64 Tube 175 175 50 125
MATA 1% - 3,5 garm

65 Tube 0 75 75 75 0
3% - 5g

66 Ampul 100 100 30 70
1ML
PARASETAMOL SIRUP
67 Botol 0 400 400 400 0
125MG/5ML - 5ML
68 PARASETAMOL TABLET 100MG Tablet 300 1000 1300 1100 200

PIRANTEL PAMOAT
BASA)
71 Tablet 2000 4000 6000 4500 1500
10MG
72 PLESTER 5 YARD X 2 INCH Rol 0 15 15 13 2
73 POVIDON LODIDA 10% - 300ML Botol 3 5 8 7 1
74 PREDNISON TABLET 5 MG Tablet 4000 7000 11000 7000 4000
76 Kapsul 0 0 0 0
KAPSUL
77 Kapsul 600 600 0 600
KAPSUL
RINGER LAKTAT LARUTAN
78 Botol 60 220 280 120 160
INFUS STERIL - 500ML
80 SALISIL BEDAK 2% - 30 gram Kotak 10 50 60 54 6
81 Vial 2 2 0 2
82 Ampul 3 3 0 3
1.500IU/AMPUL(ATS)
83 Vial 0 0 0 0
84 Ampul 0 0 0 0
SILK (BENANG BEDAH
85 Sachet 0 72 72 72 0
SUTERA)NO.3/0
TABLET TAMBAH DARAH
86 KOMBINASI : BESI II SULFAT Tablet 600 6000 6600 2400 4200
87 Kapsul 1000 1000 0 1000
MG
88 Kapsul 100 200 300 200 100
500MG
89 Tablet 700 5000 5700 4700 1000
B1) TABLET 50 MG
91 Kapsul 100 1500 1600 1300 300
MG
92 AKITA Tablet 800 1500 2300 1400 900
93 MULTIVITAMIN ANAK Botol 0 96 96 96 0
95 SARUNG TANGAN Tablet 0 0 0 0
96 RANITIDIN Tablet 0 0 0 0
98 ABOCATH Buah 0 60 60 60 0
99 CAPTOPRIL Tablet 0 1200 1200 1200 0
104 CIPROFLOXAXIN Tablet 200 200 400 400 0
105 SULFASETAMID TETES MATA Botol 0 72 72 72 0
107 MASKER Botol 0 50 50 50 0
108 PAPAVERIN Tablet 0 0 0 0 0
110 ZINK Tablet 1100 1100 500 600
111 ASIKLOVIR TAB.200 mg Tablet 0 0 0 0
114 LISOL 1000 ml Botol 1 1 0 1
115 POLIKRESULEN Botol 0 0 0 0
117 Neo-K INJ. Ampul 0 0 0 0
120 FENILBUTASON Tablet 0 0 0 0
126 SEFTRIAKSON INJ. 1 g Ampul 0 0 0 0
128 FUNDIFAR Tablet 0 1000 1000 1000 0
132 DIETILKARBAMAZINE 0 28800 28800 0 28800

Tablet
UMUM
ASKES LAIN2 JUMLAH
RESEP BAYAR
BAYAR
Yang Menyerahkan:
Mengetahui / Menyetujui : Yang Menerim
Kepala GFK,
Kepala Dinas Kesehatan Kab./Kota Kepala Puskesm
..
dr.R.H.Daeng Sug
NIP.19660729.1998
FORM:LPLPO

DINKES KAB/KOTA
GFK KAB/KOTA
PUSKESMAS
PERMINT PEMBERIAAN
JML
AAN
LAIN-
LAIN
10 11 12 13 14 15 16
400
800
100
2500
12000
800
1200
14000
200
24
3000
200
24
10000
150
500
500
500
6
0
0
0
0
300
100
100
13000
0
500
200
500
25
75
200
1000
100
100
2000
100
72
14000
250
1200
100
300
0
2000
12
0
180
200
350
900
24000
100
4000
15
5
7000
2000
120
1000
50
0
0
72
6000
200
6000
12000
1500
1500
100
2500
50
3000
200
60
3000
100
100
0
0
500
96
0
100
1000
0
700
0
0
200
0
5
0
0
0
0
1000
0
0
112
0
100
0
0
1500
0
0
0
NIP.19660729.199803.1.004 NIP. 198503212011011005

PUSKESMAS
DOK
PUSKESMAS CIMANUK
KECAMATAN CIMANUK
KAB / KOTA PANDEGLANG PELAPORAN BULAN / PERIODE APRIL 2013
PROVINSI BANTEN PERMINTAAN BULAN / PERIODE MEI 2013

1 2 3 4 5 6 7 8 9

1 Set 100 400 500 300 200
ML

2 Set 0 700 700 700 0
ML

5 Ampul 0 0 0 0 0
10 ML

8 Botol 0 750 750 750 0
MG/5ML
ANTALGIN
9 Tablet 800 1200 2000 1200 800



SALISILAT 3 %
13 Tablet 2000 3000 5000 3000 2000
50 MG

15 Sachet 20 0 20 20 0
(plain&cromic)
16 Ampul 0 0 0 0 0
5MG/ML - 1 ML

18 Botol 24 150 174 126 48
10MG/5ML-60ML
DEKSTROMETORFAN HBR
19 Tablet 200 500 700 400 300
TABLET 15 MG

20 Ampul 33 0 33 0 33
2ML

22 Ampul 0 0 0 0 0
10ML/ML - ML
24 EFEDRIN HCL TABLET 25 MG Tablet 0 0 0 0 0

25 Tablet 3000 0 3000 0 3000
MG
26 (EFINEPRINA/ADRENALINA) Ampul 0 0 0 0 0
27 ETANOL 70% - 1000 ML Botol 1 6 7 4 3

30 FENOBARBITAL TABLET 30 MG Tablet 0 0 0 0 0
31 Ampul 90 0 90 0 90
10 MG/ML - 1ML
32 Tablet 0 300 300 100 200
SALUT 10MG
35 Tablet 0 13000 13000 12000 1000
100 MG
36 Botol 20 0 20 20 0
STERIL- 500 ML

37 Tablet 0 300 300 300 0
MG,MICRONIZED
38 Tablet 1000 1000 2000 0 2000
TABLET 25 MG

41 INFUSION SET ANAK Set 15 25 40 40 0
43 Tablet 100 200 300 200 100
TABLET SUBLINGUAL
44 Tablet 1000 1000 2000 1600 400
TABLET 500 MG
45 Bungkus 2 2 4 1 3
250 MG

48 Kapsul 0 1000 1000 1000 0
MG
49 Tube 0 48 48 24 24
1% - 3,5 ML
KLORAMFENIKOL TETES
50 Botol 0 72 72 72 0
TELINGA 3% - 5ML
51 Tablet 0 14000 14000 13000 1000
(CTM)TABLET 4 MG
52 Botol 0 250 250 200 50
200MG + TRIMETROPIM
40MG/5ML
KOTRIMOKSAZOL
TABLET,KOMBINASI :
53 Tablet 600 1000 1600 1000 600
TRIMETROPIM 80MG

METILERGOMETRIN
55 MALEAT(METILERGOMTETRIN)T Tablet 0 0 0 0 0
56 Ampul 40 0 40 10 30

58 Tablet 2000 0 2000 0 2000
500MG

59 Botol 20 0 20 0 20

61 Paket 0 0 0 0 0
KATEGORI ANAK
OBAT BATUK HITAM
63 Botol 0 48 48 48 0
(OBH)CAIRAN - 100ML
64 Tube 125 0 125 25 100
MATA 1% - 3,5 garm

65 Tube 0 75 75 75 0
3% - 5g

66 Ampul 70 0 70 0 70
1ML
67 Botol 0 350 350 300 50
- 5ML

PIRANTEL PAMOAT
70 365MG(SETARA DENGAN 125MG Tablet 32 100 132 64 68
BASA)
71 Tablet 1500 4000 5500 4000 1500
10MG
76 Kapsul 0 0 0 0 0
KAPSUL
77 Kapsul 600 0 600 100 500
KAPSUL
78 Botol 160 120 280 120 160
STERIL - 500ML
81 Vial 2 0 2 0 2
82 Ampul 3 0 3 1 2
1.500IU/AMPUL(ATS)
83 Vial 0 0 0 0 0
84 Ampul 0 0 0 0 0
SILK (BENANG BEDAH
85 Sachet 0 72 72 36 36
SUTERA)NO.3/0
TABLET TAMBAH DARAH
86 KOMBINASI : BESI II SULFAT Sachet 140 200 340 240 100
87 Kapsul 1000 0 1000 0 1000
MG
88 Kapsul 100 200 300 100 200
500MG
89 Tablet 1000 5000 6000 5000 1000
B1) TABLET 50 MG
91 Kapsul 300 2000 2300 1700 600
MG
92 AKITA Tablet 900 900 1800 1000 800
98 ABOCATH Buah 0 60 60 60 0
102 FOLLEY CATHETER Buah 43 0 43 0 43
103 URINE BAG Buah 24 0 24 0 24
106 GENTAMISIN INJ. Botol 185 0 185 0 185
107 MASKER Botol 0 50 50 50 0
110 ZINK Tablet 600 700 1300 400 900
111 ASIKLOVIR TAB.200 mg Tablet 0 0 0 0 0
112 ASIKLOVIR KRIM 5% Tube 0 0 0 0 0
114 LISOL 1000 ml Botol 1 1 2 1 1
115 POLIKRESULEN Botol 0 0 0 0 0
116 TIAMIN INJ. 1 ml Ampul 22 0 22 0 22
117 Neo-K INJ. Ampul 0 0 0 0 0
118 CHLORPROMAZIN Tablet 1000 0 1000 0 1000
119 AMPISILIN INJ. Vial 90 0 90 0 90
120 FENILBUTASON Tablet 0 0 0 0 0
121 HALOPERIDOL Tablet 200 0 200 0 200
122 MAGNESIUM SULFAT Inj. Vial 10 0 10 0 10
124 TRIHEKSIFENIDIL Tablet 200 0 200 0 200
126 SEFTRIAKSON INJ. 1 g Ampul 0 0 0 0 0
127 ETAKRIDIN Botol 11 0 11 0 11
128 FUNDIFAR Tablet 0 1500 1500 1500 0
130 KALSIUM GLUKONAS INJ. Ampul 36 0 36 0 36
131 PROKAIN BENZIL PENISILIN Vial 90 0 90 0 90

Tablet
UMUM
ASKES LAIN2 JUMLAH
RESEP BAYAR
BAYAR
Yang Menyerahkan:
Kepala GFK,
..
dr.R.H.Daeng Su
NIP.19660729.1998
FORM:LPLPO

DINKES KAB/KOTA
GFK KAB/KOTA
PUSKESMAS
PERMINT PEMBERIAAN
JML
AAN
LAIN-
LAIN
10 11 12 13 14 15 16
400
800
100
2500
12000
800
1100
14000
200
24
2000
200
24
10000
150
500
500
500
5
3
0
500
0
300
200
100
13000
20
500
200
500
50
40
100
3000
100
100
2000
48
72
14000
200
1100
90
300
20
2000
1000
12
0
180
25
200
300
900
24000
50
4000
15
5
7000
2000
100
2000
50
0
0
36
240
100
6000
10000
1500
1000
100
2500
50
2000
100
60
3000
100
100
0
0
300
96
0
50
1000
20
500
0
0
200
0
0
0
0
0
0
0
0
0
112
0
50
0
0
1500
0
0
0
NIP.19660729.199803.1.004 NIP. 198503212011011005

PUSKESMAS
DOK
PUSKESMAS CIMANUK
KECAMATAN CIMANUK
KAB / KOTA PANDEGLANG PELAPORAN BULAN / PERIODE MEI 2013
PROVINSI BANTEN PERMINTAAN BULAN / PERIODE JUNI 2013

1 2 3 4 5 6 7 8 9

1 Set 200 400 600 450 150
ML

2 Set 0 700 700 600 100
ML

5 Ampul 0 0 0 0 0
10 ML

8 Botol 0 750 750 750 0
MG/5ML
ANTALGIN
9 Tablet 800 1200 2000 1200 800



SALISILAT 3 %
13 Tablet 2000 2000 4000 2000 2000
50 MG

15 Sachet 0 24 24 12 12
(plain&cromic)
16 Ampul 0 0 0 0 0
5MG/ML - 1 ML

18 Botol 48 144 192 96 96
10MG/5ML-60ML
DEKSTROMETORFAN HBR
19 Tablet 300 500 800 300 500
TABLET 15 MG

20 Ampul 33 0 33 0 33
2ML

22 Ampul 0 0 0 0 0
10ML/ML - ML

25 Tablet 3000 0 3000 0 3000
MG
27 ETANOL 70% - 1000 ML Botol 3 5 8 6 2

31 Ampul 90 0 90 0 90
10 MG/ML - 1ML
32 Tablet 200 300 500 300 200
SALUT 10MG
35 Tablet 1000 13000 14000 13000 1000
100 MG
36 Botol 0 20 20 0 20
STERIL- 500 ML

37 Tablet 0 500 500 500 0
MG,MICRONIZED
38 Tablet 2000 0 2000 0 2000
TABLET 25 MG

43 Tablet 100 100 200 0 200
TABLET SUBLINGUAL
44 Tablet 400 2000 2400 2400 0
TABLET 500 MG
45 Bungkus 3 2 5 4 1
250 MG

48 Kapsul 0 1000 1000 1000 0
MG
49 Tube 24 72 96 36 60
1% - 3,5 ML
KLORAMFENIKOL TETES
50 Botol 0 72 72 72 0
TELINGA 3% - 5ML
51 Tablet 1000 14000 15000 13500 1500
(CTM)TABLET 4 MG
52 Botol 50 200 250 200 50
200MG + TRIMETROPIM
40MG/5ML
KOTRIMOKSAZOL
TABLET,KOMBINASI :
53 Tablet 600 1100 1700 900 800
TRIMETROPIM 80MG

METILERGOMETRIN
56 Ampul 30 30 60 0 60

58 Tablet 2000 1000 3000 1000 2000
500MG

59 Botol 20 0 20 0 20

61 Paket 0 0 0 0 0
KATEGORI ANAK
OBAT BATUK HITAM
63 Botol 0 60 60 60 0
(OBH)CAIRAN - 100ML
64 Tube 100 0 100 75 25
MATA 1% - 3,5 garm

65 Tube 0 100 100 100 0
3% - 5g

66 Ampul 70 0 70 0 70
1ML
67 Botol 50 300 350 250 100
- 5ML

PIRANTEL PAMOAT
BASA)
71 Tablet 1500 4000 5500 3500 2000
10MG
76 Kapsul 0 0 0 0 0
KAPSUL
77 Kapsul 500 0 500 100 400
KAPSUL
78 Botol 160 100 260 220 40
STERIL - 500ML
81 Vial 2 0 2 2 0
82 Ampul 2 0 2 0 2
1.500IU/AMPUL(ATS)
83 Vial 0 0 0 0 0
84 Ampul 0 0 0 0 0
SILK (BENANG BEDAH
85 Sachet 36 36 72 42 30
SUTERA)NO.3/0
TABLET TAMBAH DARAH
86 KOMBINASI : BESI II SULFAT Sachet 100 240 340 260 80
87 Kapsul 1000 0 1000 0 1000
MG
88 Kapsul 200 100 300 100 200
500MG
89 Tablet 1000 6000 7000 6000 1000
B1) TABLET 50 MG
91 Kapsul 600 1500 2100 1500 600
MG
AKITA/M
92 Tablet 800 900 1700 1000 700
OLAGIT
98 ABOCATH Buah 0 60 60 60 0
103 URINE BAG Buah 24 0 24 0 24
107 MASKER Biji 0 50 50 50 0
110 ZINK Tablet 900 500 1400 600 800
114 LISOL 1000 ml Botol 1 0 1 1 0
117 Neo-K INJ. Ampul 0 0 0 0 0
128 FUNDIFAR Tablet 0 1500 1500 1500 0

Tablet
UMUM
ASKES LAIN2 JUMLAH
RESEP BAYAR
BAYAR
Yang Menyerahkan:
Kepala GFK,
..
dr.R.H.Daeng Sug
NIP.19660729.1998
FORM:LPLPO

DINKES KAB/KOTA
GFK KAB/KOTA
PUSKESMAS
PERMINT PEMBERIAAN
JML
AAN
LAIN-
LAIN
10 11 12 13 14 15 16
400
700
2500
12000
800
1100
14000
200
24
2000
200
24
30
10000
96
300
500
500
5
0
0
500
0
300
200
0
13000
0
500
200
200
0
100
3000
30
100
2000
72
72
14000
200
1000
60
300
0
2000
1000
12
0
180
50
200
250
900
24000
4000
15
6
7000
2000
200
2000
50
2
0
36
240
6000
10000
1500
1500
100
2500
50
2000
100
60
3000
0
50
0
0
300
96
0
50
1000
20
0
0
0
100
0
0
0
0
0
0
0
0
0
56
0
0
0
0
1500
0
0
0
NIP.19660729.199803.1.004 NIP. 198503212011011005

Triwulan II
NO NAMA OBAT STOK
10 0

12 24
SALISILAT 3 %
27 ETANOL 70% - 1000 ML 2
53 200
54 50
55 0
SALUT 0,125 gram
56 11
57 0
79 SALBUTAMOL 600
89 700
92 AKITA / MOLAGIT 800
94 PIROKSIKAM 0
95 SARUNG TANGAN 0
96 RANITIDIN 0
97 HOLIDRIL SYRUP 0
98 ABOCATH 0
99 CAPTOPRIL 0
103 URINE BAG 24
104 CIPROFLOXAXIN 200
107 MASKER 0
108 PAPAVERIN 0
110 ZINK 1100
113 ALLOPURINOL 400
114 LISOL 1000 ml 1
115 POLIKRESULEN 0
117 Neo-K INJ. 0
120 FENILBUTASON 0
121 HALOPERIDOL 200
128 FUNDIFAR 0
129 FUROSEMID 400
an II
1200 1200 1000 200
2100 2100 1900 200
15120 16980 0 16980
200 300 100 200
0 0 0 0
6200 6200 6000 200
37300 37300 36600 700
2280 2280 2160 120
3500 4400 3500 900
38700 38700 37500 1200
225 225 225 0
72 96 72 24
7000 9000 7000 2000
300 300 300 0
48 48 19 29
100 100 0 100
27000 27000 26200 800
290 290 194 96
1300 1800 1400 400
0 33 0 33
1500 2300 1500 800
0 0 0 0
1300 1500 1300 200
0 1000 1000 0
0 3000 0 3000
0 0 0 0
18 20 16 4
3 4 2 2
0 5 0 5
1000 1500 1000 500
0 99 26 73
900 900 600 300
600 1100 800 300
300 600 400 200
34000 34000 34000 0
20 20 0 20
1300 1300 1300 0
1000 2000 0 2000
660 660 636 24
1200 1200 1000 200
75 110 110 0
275 300 200 100
300 300 100 200
9000 10000 9000 1000
8 10 7 3
230 230 230 0
150 150 150 0
4000 4000 4000 0
192 192 96 96
216 240 216 24
44000 44000 39000 5000
650 700 650 50
2100 2300 2100 200
260 310 260 50
0 0 0 0
30 41 -9 50
1000 1000 1000 0
2000 3000 1000 2000

0 20 0 20
24 72 72 0
0 0 0 0
0 1 -3 4
108 108 108 0
0 175 155 20
325 325 325 0
0 100 30 70
900 900 800 100
2800 3100 2600 500
74000 74000 71000 3000
200 300 200 100
12000 14000 11000 3000
45 45 41 4
16 19 19 0
30000 34000 27000 7000
3000 3000 3000 0
500 500 0 500
6050 6650 200 6450
420 480 400 80
2000 2600 2600 0
150 160 153 7
1 3 1 2
0 3 1 2
0 0 0 0
0 0 0 0
144 144 114 30
680 1280 1260 20
1000 2000 1000 1000
300 400 300 100
11000 11700 11700 0
29000 29000 29000 0

5000 5100 4500 600
6600 7400 5900 1500
288 288 288 0
4570 4570 4570 0
200 200 150 50
4000 4000 4000 0
288 288 288 0
180 180 180 0
3600 3600 3600 0
200 400 100 300
250 300 200 100
0 43 0 43
0 24 0 24
1200 1400 1000 400
288 288 264 24
0 185 0 185
150 150 150 0
0 0 0 0
40 55 35 20
1200 2300 1800 500
0 0 0 0
0 0 0 0
500 900 400 500
0 1 1 0
0 0 0 0
0 22 0 22
0 0 0 0
0 1000 0 1000
0 90 0 90
0 0 0 0
0 200 0 200
0 10 0 10
280 280 224 56
0 200 0 200
150 150 120 30
0 0 0 0
0 11 2 9
4500 4500 4500 0
0 400 100 300
0 36 0 36
0 90 0 90
28800 57600 0 57600
,
PUSKESMAS
DOK
PUSKESMAS CIMANUK
KECAMATAN CIMANUK
KAB / KOTA PANDEGLANG PELAPORAN BULAN / PERIODE JUNI 2013
PROVINSI BANTEN PERMINTAAN BULAN / PERIODE JULI 2013

1 2 3 4 5 6 7 8 9

1 Set 150 400 550 350 200 500
ML

2 Set 100 700 800 600 200 900
ML

5 Ampul 0 0 0 0
10 ML

8 Botol 0 780 780 660 120 900
MG/5ML
ANTALGIN
9 Tablet 800 1100 1900 1000 900 1900


11 KOMBINASI : BASITRASIN 500 Tube 0 75 75 75 0 100

SALISILAT 3 %
13 Tablet 2000 2000 4000 2000 2000 4000
50 MG

15 Sachet 12 24 36 7 29 53
(plain&cromic)
16 Ampul 0 100 100 0 100
5MG/ML - 1 ML

18 Botol 96 96 192 96 96 192
10MG/5ML-60ML
DEKSTROMETORFAN HBR
19 Tablet 500 300 800 400 400 700
TABLET 15 MG

20 Ampul 33 33 0 33
2ML

22 Ampul 0 0 0 0
10ML/ML - ML

25 Tablet 3000 3000 0 3000
MG
27 ETANOL 70% - 1000 ML Botol 2 7 9 5 4 9

31 Ampul 90 90 17 73
10 MG/ML - 1ML
32 Tablet 200 300 500 200 300 400
SALUT 10MG
35 Tablet 1000 8000 9000 9000 0 12000
100 MG
36 Botol 20 20 0 20
STERIL- 500 ML

37 Tablet 0 500 500 500 0 500
MG,MICRONIZED
38 Tablet 2000 2000 0 2000
TABLET 25 MG

43 Tablet 200 200 0 200 200
TABLET SUBLINGUAL
44 Tablet 0 6000 6000 5000 1000 4000
TABLET 500 MG
45 Bungkus 1 4 5 2 3 6
250 MG

48 Kapsul 0 2000 2000 2000 0 2000
MG
49 Tube 60 72 132 36 96 96
1% - 3,5 ML
KLORAMFENIKOL TETES
50 Botol 0 72 72 48 24 96
TELINGA 3% - 5ML
51 Tablet 1500 16000 17500 12500 5000 17000
(CTM)TABLET 4 MG
52 Botol 50 200 250 200 50 250
200MG + TRIMETROPIM
40MG/5ML
KOTRIMOKSAZOL
TABLET,KOMBINASI :
53 Tablet 800 800 600 200 1000
TRIMETROPIM 80MG

METILERGOMETRIN
56 Ampul 60 60 10 50 50

58 Tablet 2000 1000 3000 1000 2000 2000
500MG

59 Botol 20 20 0 20 20

61 Paket 0 0 0 0 4
KATEGORI ANAK
62 ANTI TBC KATEGORI II Paket 4 4 0 4
OBAT BATUK HITAM
63 Botol 0 0 0 0 120
(OBH)CAIRAN - 100ML
64 Tube 25 25 5 20 45
MATA 1% - 3,5 garm

65 Tube 0 150 150 150 0 200
3% - 5g

66 Ampul 70 70 0 70
1ML
67 Botol 100 250 350 250 100 300
- 5ML
PIRANTEL PAMOAT
BASA)
71 Tablet 2000 4000 6000 3000 3000 6000
10MG
76 Kapsul 0 500 500 0 500
KAPSUL
77 Kapsul 400 6050 6450 0 6450
KAPSUL
78 Botol 40 200 240 160 80 220
STERIL - 500ML
79 SALBUTAMOL TABLET Tablet 0 1000 1000 1000 0 2000
81 Vial 1 1 2 0 2
82 Ampul 2 2 0 2
1.500IU/AMPUL(ATS)
83 Vial 0 0 0 0
84 Ampul 0 0 0 0
SILK (BENANG BEDAH
85 Sachet 30 36 66 36 30
SUTERA)NO.3/0
TABLET TAMBAH DARAH
87 Kapsul 1000 1000 0 1000
MG
88 Kapsul 200 200 100 100
500MG
89 Tablet 1000 1000 1000 0 7000
B1) TABLET 50 MG
91 Kapsul 600 1500 2100 1500 600 2100
MG
AKITA/M
92 Tablet 700 4800 5500 4000 1500 3000
OLAGIT
98 ABOCATH Buah 0 60 60 60 0
107 MASKER Biji 0 50 50 50 0
108 PAPAVERIN Tablet 0 0 0 0
109 RANITIDIN INJ. Ampul 12 20 32 12 20 30
110 ZINK Tablet 800 800 300 500 700
111 ASIKLOVIR TAB.200 mg Tablet 0 0 0 0
113 ALLOPURINOL Tablet 500 100 600 100 500 500
114 LISOL 1000 ml Botol 0 0 0 0
115 POLIKRESULEN Botol 0 0 0 0
117 Neo-K INJ. Ampul 0 0 0 0
120 FENILBUTASON Tablet 0 0 0 0
126 SEFTRIAKSON INJ. 1 g Ampul 0 0 0 0
128 FUNDIFAR Tablet 0 1500 1500 1500 0 1500

Tablet
UMUM
ASKES LAIN2 JUMLAH
RESEP BAYAR
BAYAR
Yang Menyerahkan:
Kepala GFK,
..
dr.R.H.Daeng Sug
NIP.19660729.1998
FORM:LPLPO

DINKES KAB/KOTA
GFK KAB/KOTA
PUSKESMAS
PERMINT PEMBERIAAN
JML
AAN
LAIN-
LAIN
10 11 12 13 14 15 16
300
700
1200
12000
780
1000
10000
100
24
2000
200
24
9200
96
300
500
5
0
0
0
0
100
0
200
12000
0
500
250
200
50
0
3000
30
50
2000
72
12000
200
800
100
200
0
2000
40
0
120
25
200
200
700
22000
3000
12
7
4000
2000
100
140
2000
50
0
0
36
340
7000
10000
1500
1500
100
2500
50
2000
100
60
3000
0
50
0
0
200
96
0
50
500
10
200
0
0
0
0
0
0
0
0
0
0
0
0
56
0
20
0
0
1500
0
0
0
NIP.19660729.199803.1.004 NIP. 198503212011011005

PUSKESMAS
DOK
PUSKESMAS CIMANUK
KECAMATAN CIMANUK
KAB / KOTA PANDEGLANG PELAPORAN BULAN / PERIODE JULI 2013
PROVINSI BANTEN PERMINTAAN BULAN / PERIODE AGUSTUS 2013

1 2 3 4 5 6 7 8 9

1 Set 200 300 500 300 200 500
ML

2 Set 200 700 900 600 300 900
ML

5 Ampul 0 0 0 0 0
10 ML

8 Botol 120 1560 1680 780 900 900
MG/5ML
ANTALGIN
9 Tablet 900 1000 1900 1200 700 1900


11 KOMBINASI : BASITRASIN 500 Tube 0 50 50 50 0 100

SALISILAT 3 %
13 Tablet 2000 2000 4000 2000 2000 4000
50 MG

15 Sachet 29 24 53 53 0 60
(plain&cromic)
16 Ampul 100 0 100 10 90
5MG/ML - 1 ML

18 Botol 96 192 288 96 192 192
10MG/5ML-60ML
DEKSTROMETORFAN HBR
19 Tablet 400 300 700 300 400 700
TABLET 15 MG

20 Ampul 33 0 33 0 33
2ML

22 Ampul 0 0 0 0 0
10ML/ML - ML

25 Tablet 3000 0 3000 0 3000
MG
27 ETANOL 70% - 1000 ML Botol 4 5 9 4 5 9

31 Ampul 73 100 173 100 73
10 MG/ML - 1ML
32 Tablet 300 100 400 100 300 400
SALUT 10MG
35 Tablet 0 8000 8000 8000 0 12000
100 MG
36 Botol 20 0 20 0 20
STERIL- 500 ML

37 Tablet 0 500 500 500 0 500
MG,MICRONIZED
38 Tablet 2000 0 2000 100 1900
TABLET 25 MG

43 Tablet 200 0 200 200 0 300
TABLET SUBLINGUAL
44 Tablet 1000 3000 4000 1000 3000 4000
TABLET 500 MG
45 Bungkus 3 2 5 1 4 6
250 MG

48 Kapsul 0 2000 2000 1750 250 2000
MG
49 Tube 96 0 96 24 72 96
1% - 3,5 ML
KLORAMFENIKOL TETES
50 Botol 24 48 72 48 24 96
TELINGA 3% - 5ML
51 Tablet 5000 12000 17000 12000 5000 17000
(CTM)TABLET 4 MG
52 Botol 50 400 450 200 250 250
200MG + TRIMETROPIM
40MG/5ML
KOTRIMOKSAZOL
TABLET,KOMBINASI :
53 Tablet 200 800 1000 600 400 1000
TRIMETROPIM 80MG

METILERGOMETRIN
55 MALEAT(METILERGOMTETRIN)T Tablet 0 0 0 0 0 300
56 Ampul 50 0 50 10 40 50

58 Tablet 2000 0 2000 0 2000 2000
500MG

59 Botol 20 0 20 0 20 20

61 Paket 0 4 4 3 1 4
KATEGORI ANAK
OBAT BATUK HITAM
63 Botol 0 0 0 0 0 120
(OBH)CAIRAN - 100ML
64 Tube 20 25 45 45 0 50
MATA 1% - 3,5 garm

65 Tube 0 50 50 50 0 200
3% - 5g

66 Ampul 70 0 70 0 70
1ML
67 Botol 100 612 712 312 400 300
- 5ML
PIRANTEL PAMOAT
BASA)
71 Tablet 3000 3000 6000 3000 3000 6000
10MG
76 Kapsul 500 100 600 455 145
KAPSUL
77 Kapsul 6450 0 6450 4250 2200
KAPSUL
78 Botol 80 360 440 220 220 220
STERIL - 500ML
79 SALBUTAMOL TABLET Tablet 0 1000 1000 1000 0 2000
81 Vial 2 0 2 1 1
82 Ampul 2 0 2 0 2
1.500IU/AMPUL(ATS)
83 Vial 0 0 0 0 0
84 Ampul 0 0 0 0 0
SILK (BENANG BEDAH
85 Sachet 30 36 66 36 30
SUTERA)NO.3/0
TABLET TAMBAH DARAH
87 Kapsul 1000 0 1000 0 1000
MG
88 Kapsul 100 0 100 100 0
500MG
89 Tablet 0 4000 4000 4000 0 8000
B1) TABLET 50 MG
91 Kapsul 600 1500 2100 1600 500 2100
MG
AKITA/M
92 Tablet 1500 1500 3000 2700 300 3000
OLAGIT
98 ABOCATH Buah 0 60 60 60 0
103 URINE BAG Buah 24 0 24 0 24
107 MASKER Biji 0 50 50 50 0
110 ZINK Tablet 500 200 700 500 200 1000
114 LISOL 1000 ml Botol 0 0 0 0 0
117 AMBROKSOL SIRUP Botol 0 50 50 3 47
125 ANTASIDA SUSPENSI Botol 30 100 130 80 50 50
128 FUNDIFAR Tablet 0 1500 1500 1000 500 1500
129 FUROSEMID Tablet 300 0 300 200 100 300

Tablet
UMUM
ASKES LAIN2 JUMLAH
RESEP BAYAR
BAYAR
Yang Menyerahkan:
Kepala GFK,
..
dr.R.H.Daeng Sug
NIP.19660729.1998
FORM:LPLPO

DINKES KAB/KOTA
GFK KAB/KOTA
PUSKESMAS
PERMINT PEMBERIAAN
JML
AAN
LAIN-
LAIN
10 11 12 13 14 15 16
300
600
1500
12000
1000
10000
100
2000
200
60
10000
700
4
1
15
100
300
12000
500
500
500
50
60
300
80
50
1750
24
72
12000
600
60
300
10
2000
32
120
50
200
900
22000
100
3000
12
7
6000
2000
2000
50
2
36
300
100
8000
10000
1500
2500
2000
50
2000
60
3000
100
300
96
100
500
20
800
100
2
1000
200
NIP.19660729.199803.1.004 NIP. 198503212011011005

PUSKESMAS
DOK
PUSKESMAS CIMANUK
KECAMATAN CIMANUK
KAB / KOTA PANDEGLANG PELAPORAN BULAN / PERIODE AGUSTUS 2013
PROVINSI BANTEN PERMINTAAN BULAN / PERIODE SEPTEMBER 2013

1 2 3 4 5 6 7 8 9

1 Set 200 200 200 0 500
ML

2 Set 300 600 900 600 300 900
ML

5 Ampul 0 0 0 0
10 ML

8 Botol 900 900 840 60 900
MG/5ML
ANTALGIN
9 Tablet 700 1000 1700 900 800 1900


11 KOMBINASI : BASITRASIN 500 Tube 0 0 0 100

SALISILAT 3 %
13 Tablet 2000 2000 4000 2000 2000 4000
50 MG

15 Sachet 0 48 48 24 24 60
(plain&cromic)
16 Ampul 90 90 0 90
5MG/ML - 1 ML

18 Botol 192 192 48 144 192
10MG/5ML-60ML
DEKSTROMETORFAN HBR
19 Tablet 400 400 200 200 700
TABLET 15 MG

20 Ampul 33 33 0 33
2ML

22 Ampul 0 0 0
10ML/ML - ML

25 Tablet 3000 3000 2000 1000
MG
26 (EFINEPRINA/ADRENALINA) Ampul 0 0 0
27 ETANOL 70% - 1000 ML Botol 5 4 9 4 5 9

31 Ampul 73 30 103 13 90
10 MG/ML - 1ML
32 Tablet 300 100 400 300 100 400
SALUT 10MG
35 Tablet 0 8000 8000 8000 0 12000
100 MG
36 Botol 20 20 20 0
STERIL- 500 ML

37 Tablet 0 500 500 500 0 500
MG,MICRONIZED
38 Tablet 1900 1900 900 1000
TABLET 25 MG

43 Tablet 0 300 300 200 100 300
TABLET SUBLINGUAL
44 Tablet 3000 3000 2000 1000 4000
TABLET 500 MG
45 Bungkus 4 1 5 1 4 6
250 MG
47 KASA PEMBALUT 2 m x 80 cm Rol 0 0 0 50

48 Kapsul 250 750 1000 1000 0 2000
MG
49 Tube 72 24 96 24 72 96
1% - 3,5 ML
KLORAMFENIKOL TETES
50 Botol 24 48 72 72 0 96
TELINGA 3% - 5ML
51 Tablet 5000 5000 10000 10000 0 17000
(CTM)TABLET 4 MG
52 Botol 250 250 200 50 250
200MG + TRIMETROPIM
40MG/5ML
KOTRIMOKSAZOL
TABLET,KOMBINASI :
53 Tablet 400 600 1000 600 400 1000
TRIMETROPIM 80MG

54 KOMBINASI :LIDOKAIN HCL 2% Ampul 0 0 0 150
METILERGOMETRIN
56 Ampul 40 10 50 50 50
57 METRONIDAZOL TABLET 250 MG Tablet 0 0 0 2000

58 Tablet 2000 2000 2000 2000
500MG

59 Botol 20 20 20 0 20

61 Paket 1 4 5 3 2 4
KATEGORI ANAK
OBAT BATUK HITAM
63 Botol 0 0 0 120
(OBH)CAIRAN - 100ML
64 Tube 0 50 50 25 25 50
MATA 1% - 3,5 garm

65 Tube 0 200 200 200 0 200
3% - 5g

66 Ampul 70 70 70
1ML
67 Botol 400 400 300 100 300
- 5ML
PIRANTEL PAMOAT
BASA)
71 Tablet 3000 3000 6000 3000 3000 6000
10MG
76 Kapsul 145 145 95 50
KAPSUL
77 Kapsul 2200 2200 100 2100
KAPSUL
78 Botol 220 220 120 100 220
STERIL - 500ML
81 Vial 1 1 2 2 0
82 Ampul 2 2 0 2
1.500IU/AMPUL(ATS)
83 Vial 0 0 0
84 Ampul 0 0 0
SILK (BENANG BEDAH
85 Sachet 30 36 66 30 36
SUTERA)NO.3/0
TABLET TAMBAH DARAH
87 Kapsul 1000 1000 0 1000
MG
88 Kapsul 0 0 0
500MG
89 Tablet 0 8000 8000 5000 3000 8000
B1) TABLET 50 MG
91 Kapsul 500 1500 2000 1700 300 2100
MG
AKITA/M
92 Tablet 300 3900 4200 3750 450 3000
OLAGIT
98 ABOCATH Buah 0 60 60 60 0
101 KLORAMFENIKOL SUSPENSI Botol 150 150 150 150
102 FOLLEY CATHETER Buah 43 43 43
103 URINE BAG Buah 24 24 24
104 CIPROFLOXAXIN Tablet 500 500 500 600
106 GENTAMISIN INJ. Botol 135 135 135
107 MASKER Biji 0 50 50 50 0
108 PAPAVERIN Tablet 0 0 0
110 ZINK Tablet 700 700 700 1000
111 ASIKLOVIR TAB.200 mg Tablet 0 0 0
114 LISOL 1000 ml Botol 0 2 2 2
115 POLIKRESULEN Botol 0 0 0
116 TIAMIN INJ. 1 ml Ampul 22 22 22
118 CHLORPROMAZIN Tablet 1000 1000 1000
119 AMPISILIN INJ. Vial 90 90 90
120 FENILBUTASON Tablet 0 0 0
121 HALOPERIDOL Tablet 200 200 200
122 MAGNESIUM SULFAT Inj. Vial 10 10 10
123 PARASETAMOL DROPS Botol 56 56 56 112
124 TRIHEKSIFENIDIL Tablet 200 200 200
125 ANTASIDA SUSPENSI Botol 50 50 50 50
126 SEFTRIAKSON INJ. 1 g Ampul 0 0 0
128 FUNDIFAR Tablet 500 1000 1500 800 700 1500
130 KALSIUM GLUKONAS INJ. Ampul 36 36 36
131 PROKAIN BENZIL PENISILIN Vial 90 90 90
132 DIETILKARBAMAZINE 57600 57600 57600

Tablet
UMUM
ASKES LAIN2 JUMLAH
RESEP BAYAR
BAYAR
Yang Menyerahkan:
Kepala GFK,
..
dr.R.H.Daeng Su
NIP.19660729.1998
FORM:LPLPO

DINKES KAB/KOTA
GFK KAB/KOTA
PUSKESMAS
PERMINT PEMBERIAAN
JML
AAN
LAIN-
LAIN
10 11 12 13 14 15 16
500
600
100
1500
13000
900
800
10000
100
24
2000
200
30
10000
48
500
500
700
5
2
100
0
300
300
12000
20
500
500
0
50
100
200
2000
70
50
1750
24
96
12000
250
700
100
300
0
2000
20
10
0
120
25
200
300
1000
22000
3000
12
7
6000
2000
120
2000
50
2
36
300
200
7000
10000
1500
2500
96
2000
50
2000
96
60
3000
0
0
0
72
100
500
15
200
100
0
1000
100
NIP.19660729.199803.1.004 NIP. 198503212011011005

Triwulan III
NO NAMA OBAT STOK
10 1200

12 24
SALISILAT 3 %
27 ETANOL 70% - 1000 ML 4
53 200
54 50
55 0
SALUT 0,125 gram
56 50
57 0
79 SALBUTAMOL 0
89 0
92 AKITA / MOLAGIT 1500
94 PIROKSIKAM 0
95 SARUNG TANGAN 50
96 RANITIDIN 0
97 HOLIDRIL SYRUP 0
98 ABOCATH 0
99 CAPTOPRIL 0
103 URINE BAG 24
104 CIPROFLOXAXIN 400
107 MASKER 0
108 PAPAVERIN 0
110 ZINK 500
113 ALLOPURINOL 500
114 LISOL 1000 ml 0
115 POLIKRESULEN 0
117 AMBROKSOL SYR. 0
120 FENILBUTASON 0
121 HALOPERIDOL 200
128 FUNDIFAR 0
129 FUROSEMID 300
an III
300 500 500 0
1900 2100 1800 300
0 16980 0 16980
100 300 200 100
0 0 0 0
3700 3900 3900 0
39600 40300 40300 0
2340 2460 2460 0
2800 3700 3000 700
30000 31200 31200 0
50 50 50 0
48 72 48 24
6000 8000 6000 2000
250 250 250 0
96 125 115 10
0 100 20 80
21000 21800 21800 0
240 336 240 96
800 1200 1000 200
0 33 0 33
100 900 800 100
0 0 0 0
300 500 500 0
0 0 0 0
0 3000 3000 0
0 0 0 0
14 18 13 5
3 5 4 1
0 5 0 5
1000 1500 500 1000
130 203 113 90
500 800 800 0
200 500 300 200
400 600 600 0
24000 24000 24000 0
20 40 20 20
1500 1500 1500 0
0 2000 1000 1000
916 940 940 0
1200 1400 1200 200
0 0 0 0
0 100 100 0
500 700 600 100
5000 6000 5000 1000
3 6 3 3
175 175 165 10
0 0 0 0
4500 4500 4250 250
48 144 72 72
96 120 120 0
27000 32000 32000 0
600 650 600 50
2100 2300 2100 200
100 150 130 20
0 0 0 0
10 60 10 50
2000 2000 1700 300
0 2000 1000 1000

20 40 20 20
82 82 62 20
12 12 10 2
0 4 3 1
0 0 0 0
100 120 120 0
350 350 350 0
0 70 20 50
862 962 912 50
2600 3100 2900 200
62000 65000 65000 0
100 200 128 72
9000 12000 10000 2000
23 27 27 0
8 8 8 0
19000 26000 26000 0
1750 1750 1750 0
100 600 550 50
0 6450 4350 2100
420 500 440 60
1000 1000 1000 0
150 157 144 13
1 3 3 0
0 2 0 2
0 0 0 0
0 0 0 0
108 138 102 36
900 920 840 80
0 1000 0 1000
0 100 100 0
16000 16000 15000 1000
11000 11000 11000 0

4500 5100 4900 200
6900 8400 7950 450
288 288 288 0
3300 3300 3300 0
200 250 200 50
5600 5600 5600 0
192 192 192 0
180 180 180 0
4700 4700 4700 0
100 400 300 100
100 200 150 50
0 43 0 43
0 24 0 24
0 400 200 200
264 288 240 48
0 135 0 135
150 150 150 0
0 0 0 0
45 65 55 10
400 900 700 200
0 0 0 0
12 12 12 0
100 600 500 100
2 2 0 2
0 0 0 0
0 22 0 22
50 50 20 30
0 1000 0 1000
0 90 0 90
0 0 0 0
0 200 0 200
0 10 0 10
0 56 56 0
0 200 0 200
100 130 100 30
0 0 0 0
0 9 1 8
2500 2500 2500 0
300 600 500 100
0 36 0 36
0 90 0 90
0 57600 0 57600
,
PUSKESMAS
DOK
PUSKESMAS CIMANUK
KECAMATAN CIMANUK
KAB / KOTA PANDEGLANG PELAPORAN BULAN / PERIODE SEPTEMBER 2013
PROVINSI BANTEN PERMINTAAN BULAN / PERIODE OKTOBER 2013

1 2 3 4 5 6 7 8 9

1 Set 0 0 0 0 500
ML

2 Set 300 600 900 600 300 900
ML

5 Ampul 0 0 0 0
10 ML

8 Botol 60 780 840 840 0 900
MG/5ML
ANTALGIN
9 Tablet 800 800 1600 900 700 1900



SALISILAT 3 %
13 Tablet 2000 2000 4000 2000 2000 4000
50 MG

15 Sachet 24 24 48 38 10 60
(plain&cromic)
16 Ampul 90 90 10 80
5MG/ML - 1 ML

18 Botol 144 48 192 96 96 192
10MG/5ML-60ML
DEKSTROMETORFAN HBR
19 Tablet 200 500 700 500 200 700
TABLET 15 MG

20 Ampul 33 33 0 33
2ML

22 Ampul 0 0 0 0
10ML/ML - ML

25 Tablet 1000 1000 1000 0
MG
27 ETANOL 70% - 1000 ML Botol 5 5 10 5 5 9

31 Ampul 90 90 0 90
10 MG/ML - 1ML
32 Tablet 100 300 400 400 0 400
SALUT 10MG
35 Tablet 0 8000 8000 8000 0 12000
100 MG
36 Botol 0 20 20 0 20
STERIL- 500 ML

37 Tablet 0 500 500 500 0 500
MG,MICRONIZED
38 Tablet 1000 1000 0 1000
TABLET 25 MG

43 Tablet 100 200 300 200 100 300
TABLET SUBLINGUAL
44 Tablet 1000 2000 3000 2000 1000 4000
TABLET 500 MG
45 Bungkus 4 4 1 3 6
250 MG

48 Kapsul 0 1750 1750 1500 250 2000
MG
49 Tube 72 24 96 24 72 96
1% - 3,5 ML
KLORAMFENIKOL TETES
50 Botol 0 0 0 0 96
TELINGA 3% - 5ML
51 Tablet 0 10000 10000 10000 0 17000
(CTM)TABLET 4 MG
52 Botol 50 200 250 200 50 250
200MG + TRIMETROPIM
40MG/5ML
KOTRIMOKSAZOL
TABLET,KOMBINASI :
53 Tablet 400 700 1100 900 200 1200
TRIMETROPIM 80MG

METILERGOMETRIN
56 Ampul 50 50 0 50 50

58 Tablet 2000 2000 1000 1000 2000
500MG

59 Botol 0 20 20 0 20 20

61 Paket 2 4 6 4 2 4
KATEGORI ANAK
OBAT BATUK HITAM
63 Botol 0 0 0 0 120
(OBH)CAIRAN - 100ML
64 Tube 25 25 50 50 0 75
MATA 1% - 3,5 garm

65 Tube 0 100 100 100 0 200
3% - 5g

66 Ampul 70 70 20 50
1ML
67 Botol 100 250 350 300 50 300
- 5ML

PIRANTEL PAMOAT
BASA)
71 Tablet 3000 3000 6000 4000 2000 6000
10MG
76 Kapsul 50 50 0 50
KAPSUL
77 Kapsul 2100 2100 0 2100
KAPSUL
78 Botol 100 60 160 100 60 220
STERIL - 500ML
81 Vial 0 0 0
82 Ampul 2 2 2
1.500IU/AMPUL(ATS)
83 Vial 0 0 0
84 Ampul 0 0 0
SILK (BENANG BEDAH
85 Sachet 36 36 72 36 36
SUTERA)NO.3/0
TABLET TAMBAH DARAH
87 Kapsul 1000 1000 0 1000
MG
88 Kapsul 0 0 0 0
500MG
89 Tablet 3000 4000 7000 6000 1000 8000
B1) TABLET 50 MG
91 Kapsul 300 1500 1800 1600 200 2100
MG
AKITA/M
92 Tablet 450 1500 1950 1500 450 3000
OLAGIT
98 ABOCATH Buah 0 60 60 60 0
107 MASKER Biji 0 50 50 50 0
110 ZINK Tablet 700 200 900 700 200 1000
112 ASIKLOVIR KRIM 5% Tube 0 0 0
114 LISOL 1000 ml Botol 2 2 0 2
128 FUNDIFAR Tablet 700 700 700 0 1500

Tablet
UMUM
ASKES LAIN2 JUMLAH
RESEP BAYAR
BAYAR
Yang Menyerahkan:
Kepala GFK,
..
dr.R.H.Daeng Su
NIP.19660729.1998
FORM:LPLPO

DINKES KAB/KOTA
GFK KAB/KOTA
PUSKESMAS
PERMINT PEMBERIAAN
JML
AAN
LAIN-
LAIN
10 11 12 13 14 15 16
500
600
100
1500
13000
900
800
12000
100
24
2000
200
48
10000
96
500
300
700
1000
5
1
0
0
400
200
500
12000
0
500
500
300
50
100
200
2000
20
50
1750
48
96
13000
200
1000
100
300
0
2000
2000
16
1
120
75
200
300
1000
22000
4000
15
7
10000
2000
120
2000
50
0
36
300
200
7000
10000
1500
1500
96
2000
50
2000
96
60
3000
200
100
300
72
100
500
15
800
400
0
1500
300
NIP.19660729.199803.1.004 NIP. 198503212011011005

PUSKESMAS
DOK
PUSKESMAS CIMANUK
KECAMATAN CIMANUK
KAB / KOTA PANDEGLANG PELAPORAN BULAN / PERIODE OKTOBER 2013
PROVINSI BANTEN PERMINTAAN BULAN / PERIODE NOVEMBER 2013

1 2 3 4 5 6 7 8 9

1 Set 0 400 400 200 200 500
ML

2 Set 300 600 900 600 300 900
ML

5 Ampul 0 0 0 0
10 ML

8 Botol 0 720 720 720 0 900
MG/5ML
ANTALGIN
9 Tablet 700 800 1500 600 900 1900



SALISILAT 3 %
13 Tablet 2000 2000 4000 3000 1000 4000
50 MG

15 Sachet 10 48 58 22 36 60
(plain&cromic)
16 Ampul 80 80 0 80
5MG/ML - 1 ML

18 Botol 96 96 192 96 96 192
10MG/5ML-60ML
DEKSTROMETORFAN HBR
19 Tablet 200 500 700 400 300 700
TABLET 15 MG

20 Ampul 33 33 0 33
2ML

22 Ampul 0 0 0 0
10ML/ML - ML

25 Tablet 0 1000 1000 0 1000
MG
27 ETANOL 70% - 1000 ML Botol 5 5 10 5 5 9

31 Ampul 90 90 18 72
10 MG/ML - 1ML
32 Tablet 0 400 400 200 200 400
SALUT 10MG
35 Tablet 0 10000 10000 10000 0 12000
100 MG
36 Botol 20 20 20 0
STERIL- 500 ML

37 Tablet 0 500 500 500 0 500
MG,MICRONIZED
38 Tablet 1000 1000 0 1000
TABLET 25 MG

43 Tablet 100 100 100 0 300
TABLET SUBLINGUAL
44 Tablet 1000 2000 3000 2200 800 4000
TABLET 500 MG
45 Bungkus 3 1 4 4 0 6
250 MG

48 Kapsul 250 1750 2000 1500 500 2000
MG
49 Tube 72 48 120 72 48 96
1% - 3,5 ML
KLORAMFENIKOL TETES
50 Botol 0 0 0 0 96
TELINGA 3% - 5ML
51 Tablet 0 13000 13000 12000 1000 17000
(CTM)TABLET 4 MG
52 Botol 50 200 250 200 50 250
200MG + TRIMETROPIM
40MG/5ML
KOTRIMOKSAZOL
TABLET,KOMBINASI :
53 Tablet 200 1000 1200 1100 100 1200
TRIMETROPIM 80MG

METILERGOMETRIN
56 Ampul 50 50 0 50 50

58 Tablet 1000 1000 0 1000 2000
500MG

59 Botol 20 20 20 0 20

61 Paket 2 4 6 3 3 4
KATEGORI ANAK
OBAT BATUK HITAM
63 Botol 0 0 0 0 120
(OBH)CAIRAN - 100ML
64 Tube 0 150 150 50 100 75
MATA 1% - 3,5 garm

65 Tube 0 150 150 150 0 200
3% - 5g

66 Ampul 50 50 50 0
1ML
67 Botol 50 300 350 250 100 300
- 5ML

PIRANTEL PAMOAT
BASA)
71 Tablet 2000 3000 5000 3000 2000 6000
10MG
76 Kapsul 50 50 0 50
KAPSUL
77 Kapsul 2100 2100 0 2100
KAPSUL
78 Botol 60 120 180 120 60 220
STERIL - 500ML
81 Vial 0 0 0
82 Ampul 2 2 0 2
1.500IU/AMPUL(ATS)
83 Vial 0 0 0
84 Ampul 0 0 0
SILK (BENANG BEDAH
85 Sachet 36 36 72 36 36
SUTERA)NO.3/0
TABLET TAMBAH DARAH
87 Kapsul 1000 1000 0 1000
MG
88 Kapsul 0 0 0 0
500MG
89 Tablet 1000 4000 5000 4000 1000 8000
B1) TABLET 50 MG
91 Kapsul 200 1500 1700 1700 0 2100
MG
AKITA/M
92 Tablet 450 1500 1950 1200 750 3000
OLAGIT
98 ABOCATH Buah 0 50 50 50 0
107 MASKER Biji 0 50 50 50 0
110 ZINK Tablet 200 800 1000 500 500 1000
114 LISOL 1000 ml Botol 2 2 1 1
128 FUNDIFAR Tablet 0 0 0 0 1500

Tablet
UMUM
ASKES LAIN2 JUMLAH
RESEP BAYAR
BAYAR
Yang Menyerahkan:
Kepala GFK,
..
dr.R.H.Daeng Su
NIP.19660729.1998
FORM:LPLPO

DINKES KAB/KOTA
GFK KAB/KOTA
PUSKESMAS
PERMINT PEMBERIAAN
JML
AAN
LAIN-
LAIN
10 11 12 13 14 15 16
400
500
1500
13000
800
800
12000
100
24
3000
200
48
10000
96
500
200
700
5
0
0
0
300
300
300
12000
20
500
500
300
25
75
300
2000
20
50
1500
48
96
13000
200
1100
100
300
0
1000
1000
20
20
4
120
75
200
50
250
1000
22000
50
3000
15
7
10000
2000
120
2000
50
0
36
180
200
6000
10000
2000
1300
96
2000
50
2000
96
60
3000
100
50
200
72
100
500
10
500
500
0
56
20
1500
0
NIP.19660729.199803.1.004 NIP. 198503212011011005

PUSKESMAS
DOK
PUSKESMAS CIMANUK
KECAMATAN CIMANUK
KAB / KOTA PANDEGLANG PELAPORAN BULAN / PERIODE NOVEMBER 2013
PROVINSI BANTEN PERMINTAAN BULAN / PERIODE DESEMBER 2013

1 2 3 4 5 6 7 8 9

1 Set 200 400 600 300 300 500
ML

2 Set 300 500 800 600 200 900
ML

5 Ampul 0 0 0
10 ML
6 AMOKSILIN KAPSUL 250 MG Kapsul 0 0 0 2000

8 Botol 0 720 720 660 60 900
MG/5ML
ANTALGIN
9 Tablet 900 800 1700 900 800 1900


11 KOMBINASI : BASITRASIN 500 Tube 0 0 0 100

SALISILAT 3 %
13 Tablet 1000 3000 4000 3000 1000 4000
50 MG

15 Sachet 36 48 84 36 48 60
(plain&cromic)
16 Ampul 80 80 0 80
5MG/ML - 1 ML

18 Botol 96 96 192 96 96 192
10MG/5ML-60ML
DEKSTROMETORFAN HBR
19 Tablet 300 500 800 200 600 700
TABLET 15 MG

20 Ampul 33 33 0 33
2ML

22 Ampul 0 0 0
10ML/ML - ML
23 DIGOKSIN TABLET 0,25 MG Tablet 0 0 0 700
24 EFEDRIN HCL TABLET 25 MG Tablet 0 0 0

25 Tablet 1000 1000 2000 0 2000
MG
26 (EFINEPRINA/ADRENALINA) Ampul 0 0 0
27 ETANOL 70% - 1000 ML Botol 5 5 10 5 5 9

31 Ampul 72 72 0 72
10 MG/ML - 1ML
32 Tablet 200 300 500 0 500 400
SALUT 10MG
35 Tablet 0 10000 10000 10000 0 12000
100 MG
36 Botol 0 0 0
STERIL- 500 ML

37 Tablet 0 500 500 500 0 500
MG,MICRONIZED
38 Tablet 1000 1000 0 1000
TABLET 25 MG

43 Tablet 0 0 0 0 300
TABLET SUBLINGUAL
44 Tablet 800 800 800 0 4000
TABLET 500 MG
45 Bungkus 0 3 3 3 0 6
250 MG

48 Kapsul 500 1500 2000 1000 1000 2000
MG
49 Tube 48 144 192 120 72 96
1% - 3,5 ML
KLORAMFENIKOL TETES
50 Botol 0 0 0 0 96
TELINGA 3% - 5ML
51 Tablet 1000 13000 14000 14000 0 17000
(CTM)TABLET 4 MG
52 Botol 50 200 250 150 100 250
200MG + TRIMETROPIM
40MG/5ML
KOTRIMOKSAZOL
TABLET,KOMBINASI :
53 Tablet 100 1000 1100 1100 0 1200
TRIMETROPIM 80MG

METILERGOMETRIN
56 Ampul 50 50 21 29 30

58 Tablet 1000 1000 2000 0 2000 2000
500MG

59 Botol 0 20 20 0 20 20

61 Paket 3 3 0 3 4
KATEGORI ANAK
OBAT BATUK HITAM
63 Botol 0 116 116 116 0 120
(OBH)CAIRAN - 100ML
64 Tube 100 75 175 75 100 75
MATA 1% - 3,5 garm

65 Tube 0 150 150 150 0 200
3% - 5g

66 Ampul 0 0 0
1ML
67 Botol 100 250 350 300 50 300
- 5ML

PIRANTEL PAMOAT
BASA)
71 Tablet 2000 3000 5000 3000 2000 6000
10MG
76 Kapsul 50 50 0 50
KAPSUL
77 Kapsul 2100 2100 100 2000
KAPSUL
78 Botol 60 120 180 160 20 220
STERIL - 500ML
81 Vial 0 0 0
82 Ampul 2 2 0 2
1.500IU/AMPUL(ATS)
83 Vial 0 0 0
84 Ampul 0 0 0
SILK (BENANG BEDAH
85 Sachet 36 36 72 36 36
SUTERA)NO.3/0
TABLET TAMBAH DARAH
87 Kapsul 1000 1000 0 1000
MG
88 Kapsul 0 0 0
500MG
89 Tablet 1000 4000 5000 5000 0 8000
B1) TABLET 50 MG
91 Kapsul 0 2000 2000 1800 200 2100
MG
AKITA/M
92 Tablet 750 1000 1750 1450 300 3000
OLAGIT
94 PIROKSIKAM Tablet 0 0 0 2500
98 ABOCATH Buah 0 50 50 50 0
107 MASKER Biji 0 50 50 50 0
110 ZINK Tablet 500 500 1000 0 1000 1000
114 LISOL 1000 ml Botol 1 1 0 1
125 ANTASIDA SUSPENSI Botol 0 100 100 50 50 50
128 FUNDIFAR Tablet 0 0 0 1500

Tablet
UMUM
ASKES LAIN2 JUMLAH
RESEP BAYAR
BAYAR
Yang Menyerahkan:
Kepala GFK,
..
dr.R.H.Daeng Su
NIP.19660729.1998
FORM:LPLPO

DINKES KAB/KOTA
GFK KAB/KOTA
PUSKESMAS
PERMINT PEMBERIAAN
JML
AAN
LAIN-
LAIN
10 11 12 13 14 15 16
300
400
100
1500
13000
800
800
12000
100
24
3000
200
10000
48
300
200
700
10
3
0
0
0
300
300
12000
20
500
300
500
25
50
300
2000
10
50
1500
48
96
150
1200
100
300
0
1000
20
0
120
200
50
250
1000
22000
3000
15
7
9000
2000
160
2000
50
0
36
320
100
6000
10000
2000
1500
96
2000
50
1500
96
60
3000
100
0
200
72
100
500
10
0
500
0
56
1500
0
NIP.19660729.199803.1.004 NIP. 198503212011011005

Triwulan IV
NO NAMA OBAT STOK
1 #REF! #REF!
2 #REF! #REF!
3 #REF! #REF!
4 #REF! #REF!
5 #REF! #REF!
6 #REF! #REF!
7 #REF! #REF!
8 #REF! #REF!
9 #REF! #REF!
10 #REF! #REF!
11 #REF! #REF!
12 #REF! #REF!
13 #REF! #REF!
14 #REF! #REF!
15 #REF! #REF!
16 #REF! #REF!
17 #REF! #REF!
18 #REF! #REF!
19 #REF! #REF!
20 #REF! #REF!
21 #REF! #REF!
22 #REF! #REF!
23 #REF! #REF!
24 #REF! #REF!
25 #REF! #REF!
26 #REF! #REF!
27 #REF! #REF!
28 #REF! #REF!
29 #REF! #REF!
30 #REF! #REF!
31 #REF! #REF!
32 #REF! #REF!
33 #REF! #REF!
34 #REF! #REF!
35 #REF! #REF!
36 #REF! #REF!
37 #REF! #REF!
38 #REF! #REF!
39 #REF! #REF!
40 #REF! #REF!
41 #REF! #REF!
42 #REF! #REF!
43 #REF! #REF!
44 #REF! #REF!
45 #REF! #REF!
46 #REF! #REF!
47 #REF! #REF!
48 #REF! #REF!
49 #REF! #REF!
50 #REF! #REF!
51 #REF! #REF!
52 #REF! #REF!
53 #REF! #REF!
54 #REF! #REF!
55 #REF! #REF!
56 #REF! #REF!
57 #REF! #REF!
58 #REF! #REF!
59 #REF! #REF!
60 #REF! #REF!
61 #REF! #REF!
62 #REF! #REF!
63 #REF! #REF!
64 #REF! #REF!
65 #REF! #REF!
66 #REF! #REF!
67 #REF! #REF!
68 #REF! #REF!
69 #REF! #REF!
70 #REF! #REF!
71 #REF! #REF!
72 #REF! #REF!
73 #REF! #REF!
74 #REF! #REF!
75 #REF! #REF!
76 #REF! #REF!
77 #REF! #REF!
78 #REF! #REF!
79 #REF! #REF!
80 #REF! #REF!
81 #REF! #REF!
82 #REF! #REF!
83 #REF! #REF!
84 #REF! #REF!
85 #REF! #REF!
86 #REF! #REF!
87 #REF! #REF!
88 #REF! #REF!
89 #REF! #REF!
90 #REF! #REF!
91 #REF! #REF!
92 #REF! #REF!
93 #REF! #REF!
94 #REF! #REF!
95 #REF! #REF!
96 #REF! #REF!
97 #REF! #REF!
98 #REF! #REF!
99 #REF! #REF!
100 #REF! #REF!
101 #REF! #REF!
102 #REF! #REF!
103 #REF! #REF!
104 #REF! #REF!
105 #REF! #REF!
106 #REF! #REF!
107 #REF! #REF!
108 #REF! #REF!
109 #REF! #REF!
110 #REF! #REF!
111 #REF! #REF!
112 #REF! #REF!
113 #REF! #REF!
114 #REF!
115 #REF!
116 #REF!
117 #REF!
118 #REF!
119 #REF!
120 #REF!
121 #REF!
122 #REF!
123 #REF!
UMUM
BAYAR
..
ulan IV
#REF! #REF! #REF! #REF!
#REF! #REF! #REF! #REF! #REF!
#REF! #REF! #REF! #REF! #REF!



UM
ASKES JUMLAH
TIDAK BAYAR
dr. Kartirini Didi Evan Nugroho

NIP. 197503082005012010 NIP. 198503212011011005
,

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PEMAKAIAN DAN PERMINTAAN OBAT PUSKESMAS bulan : juli

ANTASIDA DOEN,tablet Kombinasi Magnesium

23 AQUA PRO INJEKSI STERIL,BEBAS PIROGEN - 20 ML Vial 0

34 catgut/benang bedah no.2/0-3/0 (plain&cromic) Sachet 0

37 DEKSTROMETORFAN HBR SIRUP 10MG/5ML-60ML Botol 54

87 ISOSORBID DINITRAT 5 MG TABLET SUBLINGUAL Tablet 100

KOTRIMOKSAZOL PEDIATRIK TABLET,KOMBINASI :

138 OKSITETRASIKLIN HCL INJEKSI IM 50MG/ML - 10 ML Ampul 12

139 OKSITETRASIKLIN HCL SALEP MATA 1% - 3,5 garm Tube 0

158 RINGER LAKTAT LARUTAN INFUS STERIL - 500ML Botol 20

166 SERUM ANTI TETANUS INJEKSI 1.500IU/AMPUL(ATS) Ampul 8

167 SERUM ANTI TETANUS INJEKSI 20.000 IU/VIAL (ATS) Vial 0

174 TIAMIN HCL /MONONITRAT(VIT B1) TABLET 50 MG Tablet 2758

788 213 0.2 0

4471 1779 0.2 0

13990 1910 0.2 0

2817 413 0.2 0

100 140 0.2 0

PUSKESMAS : . DOKUMEN NOMOR TANGGAL

ANTASIDA DOEN,tablet Kombinasi Magnesium

34 catgut/benang bedah no.2/0-3/0 (plain&cromic) Sachet 0 24 24 24 0 24

49 ETAKRIDIN (RIVANOL)LARUTAN 0,1 % - 3000 ML Botol 0 5 5 0 5 5

75 GLUKOSA LARUTAN INFUS 5% STERIL - 500 ML Botol 20 20 40 20 20 40

77 GLUKOSA LARUTAN INFUS 40% STERIL - 25 ML Botol 0 0 0 0 0 0

KLOROQUIN FOSFAT TBALET 250 MG (SETARA

KOTRIMOKSAZOL SUSPENSI KOMBINASI :

LIDOKAIN KOMP INJEKSI KOMBINASI

JUMLAH KUNJUNGAN RESEP 2717 1756 237 4710

Mengetahui / Menyetujui : Yang Menyerahkan: Yang Menerima: Yang Meminta:

ANTASIDA DOEN,tablet Kombinasi

20 ANTIFUNGI DOEN KOMBINASI : ASAM

ANTIPARKINSON DOEN TABLET

23 AQUA PRO INJEKSI STERIL,BEBAS

37 DEKSTROMETORFAN HBR SIRUP

43 DIETILKARBAMAZIN SITRAT TABLET 100

64 FITOMENADION (VIT K1)INJEKSI 10 MG/ML

65 FITOMENADION (VIT K1)TABLET SALUT

75 GLUKOSA LARUTAN INFUS 5% STERIL- 500

76 GLUKOSA LARUTAN INFUS10% STERIL-500

77 GLUKOSA LARUTAN INFUS 40% STERIL-25

87 ISOSORBID DINITRAT 5 MG TABLET

100 KLORFENIRAMIN MALEAT (CTM)TABLET 4

102 KLORPROMAZIN HCL INJEKSI 25MG/ML -

103 KLORPROMAZIN HCL INJEKSI 5MG/ML -

105 KLORPROMAZIN HCL TABLET SALUT

125 METILERGOMETRIN MALEAT INJEKSI

135 OBAT ANTI TUBERKULOSIS KATEGORI

139 OKSITETRASIKLIN HCL SALEP MATA 1% -

146 PIRANTEL PAMOAT 365MG(SETARA

162 SEMEN SENG FOSTAT SERBUK DAN

166 SERUM ANTI TETANUS INJEKSI

167 SERUM ANTI TETANUS INJEKSI 20.000

168 SIANOKOBALAMIN (VIT B 12) INJEKSI 500

170 TABLET TAMBAH DARAH KOMBINASI : BESI

174 TIAMIN HCL /MONONITRAT(VIT B1) TABLET

175 TRIKRESOL FORMALIN (TKF) CAIRAN - 10

Mengetahui / Menyetujui : Yang Menyerahkan: Yang Menerima: Yang Meminta:

18 ANTI BAKTERI DOEN SALEP KOMBINASI : Tube 0 75 75 75 0 300

19 ANTI HIMOROID DOEN KOMBINASI Supp 0 0 0 0 0 0

22 ANTIPARKINSON DOEN TABLET Tablet 0 0 0 0 0 0

23 AQUA PRO INJEKSI STERIL,BEBAS Vial 0 0 0 0 0 0

24 AQUADEST STERIL - 500 ML Botol 0 0 0 0 0 0

38 DEKSTROMETORFAN HBR TABLET 15 MG Tablet 500 1000 1500 500 1000 0

39 DEVITALISASI PASTA (NON ARSEN) Botol 0 0 0 0 0 0