NO NAMA TANGGAL NAMA OBAT JUMLAH RETUR OBAT HARGA SATUAN HARGA SATUAN SUB TOTAL
PELAKSANAAN OBAT TERJUAL UMUM DPK TOTAL
Rp. Rp. Rp. Rp.
1 Ny. Chairani 5/31/2016 Inf RL 2 2 11600 23,200
Inf Set makro 1 1 10600 10,600
Venflon 22 1 1 23186 23,186
Ondan 4 mg Inj 2 2 0 7288 -
Ranitidin Inj 2 2 0 3746 -
Sp 5 cc 2 2 2478 4,956
ulsidex Tab 10 7 3 1484 4,452
SUB TOTAL 66,394
TOTAL 18,423,345
NO NAMA TANGGAL NAMA OBAT JUMLAH RETUR OBAT HARGA SATUAN HARGA SATUAN SUB TOTAL
PELAKSANAAN OBAT TERJUAL UMUM DPK TOTAL
Rp. Rp. Rp. Rp.
1 An. Nayla 6/13/2016 Psiidi Syr 1 1 38955 38,955
Valisanbe Tab 2 2 364 728
TOTAL 39,683
TOTAL 10,915,364
NO NAMA TANGGAL NAMA OBAT JUMLAH RETUR OBAT HARGA SATUAN HARGA SATUAN SUB TOTAL
PELAKSANAAN OBAT TERJUAL UMUM DPK TOTAL
Rp. Rp. Rp. Rp.
1 Tn. Hery 6/19/2016 Inf Ns 3 3 11600 34,800
Inf Set Makro 1 1 10600 10,600
Venflon 20 1 1 23200 23,200
Venflon 22 1 1 23200 23,200
Ketorolac Inj 2 2 21900 43,800
Sp 3 cc 2 2 2000 4,000
Ranitidin Inj 1 1 4000 4,000
Eperison Tab 10 10 2100 21,000
Nuvamox Tab 10 10 1500 15,000
Bisturi 1 1 5000 5,000
TOTAL 184,600
TOTAL 11,355,547
NO NAMA TANGGAL NAMA OBAT JUMLAH RETUR OBAT HARGA SATUAN HARGA SATUAN SUB
PELAKSANAAN OBAT TERJUAL UMUM DPK TOTAL
Rp. Rp. Rp.
1 Tn. Hery 6/19/2016 Inf Ns 3 3 11600 34,800
Inf Set Makro 1 1 10600 10,600
Venflon 20 1 1 23200 23,200
Venflon 22 1 1 23200 23,200
Ketorolac Inj 2 2 21900 43,800
Sp 3 cc 2 2 2000 4,000
Ranitidin Inj 1 1 4000 4,000
Eperison Tab 10 10 2100 21,000
Nuvamox Tab 10 10 1500 15,000
Bisturi 1 1 5000 5,000
TOTAL
TOTAL
Sintang, Juli 2016
Bendahara Yanmasum Pembantu Bendahara
Yang Menerima Yang Menyerahkan
NO NAMA TANGGAL NAMA OBAT JUMLAH RETUR OBAT HARGA SATUAN HARGA SATUAN SUB
PELAKSANAAN OBAT TERJUAL UMUM DPK TOTAL
Rp. Rp. Rp.
TOTAL
NO NAMA TANGGAL NAMA OBAT JUMLAH RETUR OBAT HARGA SATUAN HARGA SATUAN SUB
PELAKSANAAN OBAT TERJUAL UMUM DPK TOTAL
Rp. Rp. Rp.
1 An. Kevin 7/12/2016 Oralit 3 3 928 2,784
TOTAL
TOTAL
Rp.
184,600
68,710
92,990
54,000
63,491
42,790
68,792
37,100
152,813
182,480
993,963
44,520
65,000
7,650
19,370
302,760
69,138
77,730
47,455
253,536
77,770
23,380
6,000
2,359
38,410
53,000
45,500
58,260
41,753
22,500
55,431
13,040
64,790
29,680
40,000
318,169
328,781
50,200
117,727
19,879
122,513
9,280
344,461
171,787
142,737
24,446
11,901
43,837
56,860
63,544
23,636
185,861
138,767
1,373,284
121,870
100,247
94,550
416,844
16,564
8,388
26,500
909,586
33,027
59,978
57,500
8,840
11,120
6,820
56,572
18,763
28,750
54,720
6,955
596,225
20,305
77,621
116,118
115,825
40,090
17,293
71,000
66,400
23,500
41,700
51,108
21,666
155,103
18,088
195,635
27,870
597,775
19,800
96,400
11,355,547
Sintang, Juli 2016
Pembantu Bendahara
Yang Menyerahkan
Warsidi
Serma NRP 580944
TOTAL
Rp.
606,343
275,110
62,750
29,750
1,471,963
31,677
18,799
23,190
54,792
284,335
16,660
56,775
26,080
26,539
301,997
57,450
52,929
44,997
171,695
334,299
28,209
194,345
19,870
13,810
38,310
20,820
57,450
227,875
9,470
38,380
34,710
378,825
312,645
20,447
22,160
6,493
32,430
19,185
13,810
71,845
57,750
26,686
19,100
381,409
32,070
52,908
97,330
9,280
305,176
222,250
143,193
48,427
59,489
39,674
24,539
21,581
10,000
38,492
20,190
1,749
80,515
87,874
61,305
10,640
90,695
386,469
38,127
264,262
318,317
43,391
218,720
123,264
76,742
67,182
639,796
70,292
12,920
26,370
15,300
76,132
103,160
32,684
182,200
82,226
46,045
97,213
205,891
46,958
27,401
123,154
51,610
34,291
152,170
50,207
54,270
20,360
47,038
39,750
20,000
28,698
98,260
39,618
318,125
41,210
126,999
444,942
51,476
30,800
20,405
48,594
22,130
27,300
37,459
17,841
38,542
43,190
909,764
588,928
64,694
12,380
17,490
27,450
44,787
29,275
29,800
14,405,610 14,405,610
TOTAL
Rp.
2,784
47,570
369,207
14,850
61,832
46,500
28,730
122,560
194,945
29,180
70,490
137,402
353,858
34,935
367,464
422,826
43,480
37,490
238,810
330,760
17,490
24,445
88,740
28,513
254,036
85,310
29,680
8,400
95,310
118,350
78,832
8,640
67,692
27,450
706,662
20,000
30,204
64,982
28,780
56,082
43,130 4,838,401
311,166
195,060
267,085
5,960
158,210
5,960
38,110
38,686
23,640
48,100
60,740
138,896
153,006
316,194
80,414
875,233
40,545
81,213
25,140
10,205
89,975
881,639
65,411
31,220
214,572
421,752
204,189
809,673
19,310
64,341
54,520
13,810
80,162
53,686
30,870
37,138
10,686
10,496
47,700
44,250
214,036
15,518
27,450
23,612
288,425
158,750
49,120
11,600
115,920
42,100
53,292
30,820
23,230
11,951,237
11,951,237
LAPORAN UMUM BULAN AGUSTUS 2016
NO NAMA TANGGAL NAMA OBAT JML RETUR OBAT HARGA HARGA JUMLAH JUMLAH
PELAKSANAAN OBAT TERJUAL SATUAN SATUAN HARGA HARGA TOTAL
UMUM DPK
UMUM DPK UMUM DPK Rp.
Rp. Rp. Rp. Rp.
1 Tn. Jumari 7/19/2016 Lansoprazole Tab 10 10 1,855 18,550 -
Sanmagh Tab 10 10 1,020 10,200 -
Molagit Tab 10 10 636 6,360 -
Valesco Tab 10 10 11,660 116,600 -
SUB TOTAL 151,710 - 151,710
TOTAL
Kiki Indrawan
Serda NRP 21150228870193 Warsidi
Serma NRP 580944
LAPORAN UMUM BULAN AGUSTUS 2016
NO NAMA TANGGAL NAMA OBAT JML RETUR OBAT HARGA HARGA JUMLAH JUMLAH
PELAKSANAAN OBAT TERJUAL SATUAN SATUAN HARGA HARGA TOTAL
UMUM DPK
UMUM DPK UMUM DPK Rp.
UMUM DPK
TOTAL
NO NAMA TANGGAL NAMA OBAT JML RETUR OBAT HARGA HARGA JUMLAH JUMLAH
PELAKSANAAN OBAT TERJUAL SATUAN SATUAN HARGA HARGA TOTAL
UMUM DPK
UMUM DPK UMUM DPK Rp.
Rp. Rp. Rp. Rp.
1 Nn. Trias 8/9/2016 Venflon 22 1 1 23,186 23,186 -
Inf Rl 3 3 8,700 26,100 -
Pantopain Inj 3 3 16,100 48,300 -
Pantomet Inj 2 2 92,625 185,250 -
Sp 3 cc 3 3 1895 5,685 -
Sp 5 cc 1 1 2478 2,478 -
Inf Set Makro 1 1 10600 10,600 -
Ranitidin Tab 10 10 321 3,210 -
SUB TOTAL 304,809 - 304,809
TOTAL
Kiki Indrawan
Serda NRP 21150228870193 Warsidi
Serma NRP 580944
Domperidon Tab
Sp 3 cc
Sp 5 cc
aquadest Inj GRAND TOTAL 50,000 1,728,485
1,678,485
SUB TOTAL - -
GRAND TOTAL -
151,710
28,131
40,114
20,643
107,937
123,230
133,108
23,780
8,000
241,470
429,430
7,288
436,718
48,098
86,250
40,000
239,296
166,314
16,700
422,310
26,789
226,152
10,205
132,237
42,798
23,186
5,390
439,968
22,130
18,380
36,040
22,130
64,792
18,480
4,700
257,563
342,413
1,020
600,996
187,831
7,288
26,100
221,219
22,136
103,480
19,310
133,108
47,366
13,243
27,761
6,000
227,478
3,000
49,450
160,463
135,500
5,513
8,745
149,758
30,610
42,858
21,948
34,050
9,342
9,341
21,112
28,115
18,480
101,965
9,800
56,988
143,950
96,850
87,870
164,550
90,656
37,630
292,836
35,892
74,250
145,288
20,700
5,960
94,896
148,183
124,380
33,723
16,231
17,560
70,940
59,105
100,748
5,226
105,974
9,960
120,863
172,876
27,518
66,044
266,438
36,450
142,853
78,265
176,714
32,207
106,524
5,960
542,523
59,230
85,071
25,603
54,980
27,450
31,235
6,000
26,235
27,450
115,655
81,386
108,451
305,492
7,706,375
12,902
73,196
32,336
89,536
103,483
79,248
304,603
1,820
72,520
27,450
33,125
119,468
87,384
74,473
281,325
62,160
200,075
49,160
58,490
115,567
117,230
128,590
207,850
37,518
223,790
87,704
244,720
71,333
61,480
88,465
117,719
88,234
93,430
765,381
164,112
97,392
78,158
339,662
21,010 10,927,503
148,450
68,141
7,492
75,633
254,950
31,482
3,060
34,291
32,476
69,230
460,510
72,345
106,831
107,325
3,000
27,778
30,000
274,934
138,020
174,442
46,372
64,846
104,539
528,219
13,600
78,305
40,440
36,872
101,342
186,672
6,000
129,416
114,014
11,300
447,402
122,271
95,026
217,297
13,741
104,915
16,105
16,231
311,245
76,050
346,197 kk li2s
10,200
210,956
152,294
62,735
782,382
275,780
134,538
23,186
238,257
4,370
119,097
795,228
40,000
15,305
17,490
13,810
177,190
139,015
22,550
240,477
193,948
200,050
109,937
53,795
267,718
65,588
1,131,513
28,750
16,160
27,976
30,686
29,442
18,004
114,860
36,772
203,110
21,050
123,744
117,921
39,107
68,061
322,578
42,201
589,868
180,140
80,470
70,088
72,116
80,903
136,094
53,302
22,731
55,456
109,462
51,625
42,201
954,588
51,476
19,767,597
HARGA
TOTAL
Rp.
62,160
252,550
95,925
53,340
331,561
86,824
22,731
15,304
52,556
77,440
48,875
13,037
316,767
62,798
178,150
7,420
155,453
70,208
66,970
292,631
124,265
6,270
90,010
20,342
74,942
35,700
307,003
43,841
8,860
359,704
273,240
69,182
60,510
57,370
86,245
142,644
79,926
49,728
13,037
371,580
38,710
271,989
103,738
364
47,683
48,345
429,960
208,995
1,111,074
56,293
48,356
86,553
161,761
492,641
740,955
30,084
156,913
234,847
421,844
193,556
6,000
99,198
37,860
336,614
96,935
96,170
438,875
94,315
26,410
200,210
215,600
73,135
25,110
118,610
196,780
35,040
27,410
46,640
46,640
46,640
177,385
111,507
151,819
39,458
139,985
48,587
209,466
34,280
912,487
46,640
53,959
63,064
26,500
95,700
21,333
224,486
171,653
110,720
506,859
91,226
124,948
129,048
315,253
28,570
89,769
562,640
221,831
28,992
7,884
41,825
47,232
347,764
17,490
94,150
51,990
96,493
73,306
22,960
6,415
58,300
151,010
42,666
169,184
113,715
163,130
446,029
236,249
51,647
87,000
374,896
7,680
15,762
14,360
109,965
13,810
42,666
23,976
74,598
195,905
103,793
52,940
88,356
143,232
52,224
57,661
153,210
406,327
130,902
36,335
104,320
9,960
65,852
65,852
56,246
51,994
4,638
55,947
110,972
43,367
30,608
5,641
78,308
268,896
157,076
14,954
172,030
15,023
185,910
75,697
16,078
99,800
183,400
79,245
55,053
9,502
14,575
26,684
41,658
1,012,500
24,486
1,824,588
195,230
34,980
6,360
29,831
14,020
88,060
26,474
13,700
27,165
73,255
75,370
26,410
73,678
16,720,862
HARGA
TOTAL
Rp.
304,809
29,720
217,565
93,003
242,065
887,162
120,674
39,260
61,374
102,026
71,923
59,268
64,390
78,502
19,910
457,393
174,441
174,178
29,018
198,430
20,700
41,770
20,750
19,446
105,745
263,216
34,291
40,492
125,000
462,999
285,252
198,681
207,964
691,897
152,230
59,257
17,944
23,380
21,333
149,106
99,223
533,542
256,183
85,947
1,124,001
30,624
76,605
63,999
31,511
5,300
32,595
137,918
17,490
16,192
171,600
45,486
294,865
12,755
186,291
96,899
545,870
1,136,680
152,375
53,405
155,736
132,550
56,330
139,336
44,393
1,908
12,396
99,550
297,583
231,100
50,525
6,236
228,720
172,750
689,331
83,440
86,300
95,250
160,990
15,890
52,643
32,210
66,582
24,650
58,177
45,567
256,494
4,081
17,490
278,065
240,394
38,990
279,384
47,260
34,750
46,640
22,130
44,561
46,640
46,640
46,640
46,640
87,910
40,603
147,831
81,834
9,794
129,029
116,468
337,125
112,829
42,572
91,064
64,793
311,258
94,875
40,909
93,650
264,200
149,921
50,600
464,721
152,490
46,640
54,976
25,859
2,799
46,349
15,416
15,787
161,186
134,735
11,260
71,810
39,750
46,640
354,081
205,076
23,186
182,784
149,430
106,100
1,020,657
80,210
48,455
48,356
95,798
79,090
73,050
23,958
262,631
258,945
44,144
106,264
162,242
45,115
1,055,439
59,551
39,749
57,945
63,100
143,140
55,580
101,110
28,520
5,000
46,640
46,640
21,884
225,338
46,640
46,640
176,363
15,442
20,799
28,750
241,354
280,760
77,194
29,220
46,640
2,332
28,990
239,267
45,777
87,630
403,996
102,687
532
136,895
86,495
190,640
94,819
27,371
39,864
61,465
127,305
41,476
392,300
192,244
94,911
287,155
117,322
147,679
11,300
13,960
75,526
147,279
106,450
144,000
34,862
125,000
303,862
195,165
73,278
5,960
274,403
25,000
5,990
131,860
14,170
85,950
189,312
119,819
160,990
470,121
28,315
17,918
223,971
15,170
239,141
62,024
137,620
157,013
54,192
165,692
27,825
18,543
70,555
282,615
176,930
160,000
20,777,060
1,287,080
20,643
12,000
10,500
LAPORAN UMUM BULAN SEPTEMBER 2016
NO NAMA TANGGAL NAMA OBAT JML RETUR OBAT HARGA HARGA JUMLAH JUMLAH
PELAKSANAAN OBAT TERJUAL SATUAN SATUAN HARGA HARGA TOTAL
UMUM DPK
UMUM DPK UMUM DPK Rp.
Rp. Rp. Rp. Rp.
1 An.Alfaro 8/19/2016 Apialys Drop 1 1 39,750 39,750 -
Thiamfenikol Syr 1 1 37,905 37,905 -
SUB TOTAL 77,655 77,655
77,655
19,035
88,317
47,980
47,640
31,822
18,210
34,148
66,250
43,035
238,013
121,060
10,600
206,316
23,186
100,524
Rp 699,699
37,300
115,918
35,686
188,904
363,820
497,956
30,805
177,613
2,592
32,704
32,704
193,908
439,521
49,155
138,089
21,618
-
41,455
201,162
84,934
201,374
38,915
30,462
270,751
45,320
43,940
22,560
139,750
221,937
286,880
44,386
331,266
4,000
15,890
24,866
374,752
229,003
50,390
654,145
165,149
83,874
249,023
14,000
25,045
32,940
4,320
82,750
99,545
44,467
67,443
28,268
86,073
325,796
28,753
21,948
36,366
123,930
34,291
28,753
7,831
82,150
49,149
37,390
205,040
16,618
31,140
29,840
369,265
186,035
53,782
101,718
39,355
25,078
372,347
153,880
1,301,460
144,350
71,814
35,000
34,080
1,590
38,560
385,930
22,724
47,670
99,300
200,280
197,572
14,750
212,322
47,842
352,632
158,169
58,363
569,164
77,850
30,475
106,829
32,065
82,424
221,318
49,449
472,543
144,834
24,380
133,575
3,384
75,432
163,313
77,577
38,444
779,216
1,912,698
109,310
32,920
15,300
231,813
186,446
12,124
205,796
32,890
669,069
37,020
259,623
31,838
138,464
30,609
117,330
319,504
34,318
34,146
67,686
455,654
11,250
21,035
11,190
250,433
208,405
383,256
55,792
342,965
64,250
208,405
16,192
4,000
20,000
1,232,326
41,126
437,250
300,000
455,400
156,700
450,924
34,550
65,246
43,000
59,560
76,697
4,000
49,070
107,200
117,940
40,940
20,343
139,958
270,707
240,922
11,759
25,300
24,936
102,026
71,923
59,268
64,390
78,502
19,910
420,955
MEN KESEHATAN WILAYAH 12 04 01 Sublampiran H
AH SAKIT TK.IV 12 07 02 SINTANG Lampiran Peraturan Kasad
Nomor Perkasad/24/IX/2012
Tanggal 26 September 2012
Rp 10,927,503
DETASEMEN KESEHATAN WILAYAH 12 04 01 Bukti kas No:
RUMAH SAKIT TK IV 12 07 02 SINTANG Bentuk : KU - 17
NO ADM. .................. Lembar : Kesatu
: Kedua
: Ketiga
: Keempat
KUITANSI
8/26/2016 rl 3 3 8700
metformin 850 2 2 530
ventolin nebu 2 2 12476
valesco 2 2 11660
18,290
159,990
22,000
SUB TOTAL 200,280 200,280 200,280
21,200
46,372
7,721
55,650
27,681
3,790
13,910
58,300
SUB TOTAL 234,624 234,624 234,624
14,750
SUB TOTAL 14,750 14,750 14,750
GRAND TOTAL 249,374
29,680
7,222
5,640
5,300
SUB TOTAL 47,842 47,842 47,842
8,700
23,186
10,600
66,250
37,563
152,375
3,286
2,478
1,895
5,698
3,312
2,186
4,638
14,575
15,890
SUB TOTAL 352,632 352,632 352,632
347,979
128,248
37,563
17,400
SUB TOTAL 531,190 531,190 531,190
15,890
1000 10,000
13,913
18,560
SUB TOTAL 34,450 23,913 34,450 34,450
GRAND TOTAL 918,272
17,880
15,300
44,670
SUB TOTAL 77,850 - 77,850 77,850
4,372
5,698
20,405
SUB TOTAL 30,475 - 30,475 30,475
8,700
10,600
23,186
15,000
3,790
24,952
16,231
4,370
SUB TOTAL 106,829 - 106,829 106,829
17,490
14,575
SUB TOTAL 32,065 - 32,065 32,065
7,424
75,000
SUB TOTAL 82,424 - 82,424 82,424
GRAND TOTAL 221,318
9,810
2,189
4,638
17,490
6,625
8,700
SUB TOTAL 49,452 - 49,452 49,452
32,200
7,850
10,600
23,186
15,442
7,492
27825 27,825 27,825
58,300
25,510
SUB TOTAL 180,580 27,825 180,580 180,580
9,275
2,849
SUB TOTAL 12,124 - 12,124 12,124
25,000
26,100
23,186
46,372
10,600
22,500
3,790
3,286
37,428
14,575
204,050
6,624
1,092
1,590
43,728
2,622
SUB TOTAL 472,543 - 472,543 472,543
9,275
102,025
7,434
26,100
SUB TOTAL 144,834 - 144,834 144,834
1,060
23,320
SUB TOTAL 24,380 - 24,380 24,380
128,248
2,478
2,849
SUB TOTAL 133,575 - 133,575 133,575
3,384
SUB TOTAL 3,384 - 3,384 3,384
26,100
1,060
24,952
23,320
SUB TOTAL 75,432 75,432 75,432
14,600
21,834
9,280
92,750
SUB TOTAL 138,464 - 138,464 138,464
27,825
2,784
SUB TOTAL 30,609 - 30,609 30,609
1,748
5,832
3,712
6,000
100,038
SUB TOTAL 117,330 - 117,330 117,330
34,318
10,600
20,406
66,250
3,286
5,698
75,000
51,476
52,470
SUB TOTAL 319,504 - 319,504 319,504
34,318
SUB TOTAL 34,318 - 34,318 34,318
15,304
7,500
3,286
2,849
1,895
3,312
SUB TOTAL 34,146 - 34,146 34,146
67,686
SUB TOTAL 67,686 - 67,686 67,686
GRAND TOTAL 455,654
1,860
9,390
SUB TOTAL 11,250 - 11,250 11,250
6,000
2,186
2,849
10,000
SUB TOTAL 21,035 - 21,035 21,035
2,680
3,210
5,300
SUB TOTAL 11,190 - 11,190 11,190
8,700
7,492
SUB TOTAL 16,192 - 16,192 16,192
4,000
SUB TOTAL 4,000 - 4,000 4,000
20,000
43,500
14,750
6,000
SUB TOTAL 64,250 - 64,250 64,250
3,640
6,600
7,500
15,442
50,000
14,575
10,600
23,186
1,895
112,625
4,370
SUB TOTAL 250,433 - 250,433 250,433
8,700
46,372
10,600
165,625
6,572
3,790
2,849
25,000
14,575
SUB TOTAL 284,083 - 284,083 284,083
9,960
4,640
2,363
3,600
SUB TOTAL 20,563 - 20,563 41,126
218,625
SUB TOTAL 218,625 - 218,625 437,250
26,100
10,203
102,026
15,304
11,660
7,721
3,286
5,698
3,312
4,640
20,000
27,825
20,551
22,525
SUB TOTAL 280,851 - 280,851 280,851
145,750
SUB TOTAL 145,750 - 145,750 145,750
14,575
10,600
69,558
7,721
33,125
3,746
16,696
8,016
2,478
3,790
2,849
3,312
SUB TOTAL 176,466 176,466 176,466
109,310
SUB TOTAL 109,310 109,310 109,310
48,300
7,492
SUB TOTAL 55,792 55,792 55,792
27,681
7,492
83,475
66,250
3,498
17,400
SUB TOTAL 205,796 205,796 205,796
66,250
15,000
7,492
21,333
15,442
23,186
SUB TOTAL 148,703 148,703 148,703
34,318
SUB TOTAL 34,318 34,318 34,318
15,304
7,500
3,286
2,849
1,895
3,312
SUB TOTAL 34,146 34,318 34,318
14,600
21,834
9,280
92,750
SUB TOTAL 138,464 34,318 34,318