LAPORAN BULANAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LB -PLPO )

DokumeNomor Tanggal
PUSKESMAS : Lahei 1 UPPK
KECAMATAN : Lahei Puskesmas
KAB. / KOTA : Barito Utara Bulan
PROPINSI : Kalimantan Tengah Tahun Sep-12

PEMBERIAN
NO NAMA OBAT Kemasan STOK AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
SISA STOK
STOK OPT
PERMINTAAN KET.
APBN ASKES APBD LAIN JLH
1 2 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1 Alopurinol Tablet 100 mg 100 tablet/ 100 300 400 300 100 300
2 Albendazol 400 mg 30 tablet/k 200 0 200 0 200 0
3 Ambroxol tablet 30 mg 100 tablet/ - 200 200 100 100 300
4 Ambroxol 15mg/ml sirup 60 ml/botol 10 0 10 2 8 10
5 Aminofilin Injeksi 24 mg/ml-10 ml 30 ampul/k 7 0 7 5 2 10
6 Aminofilin HCL Tablet Salut 25 mg 100 tablet/ 200 0 200 100 100 200
7 Amitriptilin tablet salut 25 mg (HCL) 100 tablet/ - 0 - 0 - 0
8 Amoxsillin Sirup Kering 125 mg/5 ml 60 ml/botol 8 50 58 25 33 0
9 Amoxsillin Kapsul 250 mg 100 tablet/ - 0 - 0 - 0
10 Amoxsillin Kaplet 500 mg 100 tablet/ - 1000 1,000 600 400 1500
11 Ampisillin kaplet 500 mg 100 tablet/ 150 0 150 50 100 0
12 Ampisillin Sirup Kering 125 mg/5 ml 60 ml/botol 50 0 50 20 30 0
13 Antasida Doen Tablet, Kombinasi 100 tablet/ - 0 - 0 - 0
14 Antasida Doen Tablet, Kombinasi 1000 tablet 6,000 0 6,000 1000 5,000 0 4000 exp 8/2012
15 Antasida DOEN II Suspensi Kombinasi 60 ml/botol 15 25 40 30 10 20
16 Antifungi Doen Salep 24 pot/kot - 0 - 0 - 24
17 Antihemoroid suppositoria 10 supp/ko 20 0 20 0 20 0
18 Antimalaria DOEN kombinasi: Pirimetami 100 tablet/ 90 0 90 10 80 0
19 Aqua pro injeksi steril, bebas pirogen 10 vial/kot 16 0 16 0 16 0
20 Asam Askorbat ( Vit.C ) Tablet 50 mg 1000 tablet 2,000 2000 4,000 2000 2,000 5000
21 Asam Folat tablet 1 mg 100 tablet/ - 0 - 0 - 0
22 Asam Mefenamat kaplet 500 mg 100 tablet/ - 500 500 500 - 1000
23 asiklovir tablet 200 mg 50 tablet/k 250 100 350 50 300 0 300 tabexp juli 2012
24 asiklovir tablet 400mg 50 tablet/k - 200 200 100 100 0
25 asiklovir tablet 200 mg 100 tablet/ - 0 - 0 - 0
26 asiklovir tablet 400mg 100 tablet/ 100 0 100 0 100 0
27 asiklovir 5% krim 25 tube/ ko - 0 - 0 - 25
28 Atropin Sulfat Injeksi O,25 mg/ml- 1 ml 30 ampul/k 7 0 7 4 3 0
29 Atropin Sulfat Tablet O,5 mg 500 tablet/ - 0 - 0 - 0
30 Atropin Sulfat Tetes Mata O,5 % 30 ampul/k - 0 - 0 - 0
31 Basitrasin - polimixin B 25 tube/ ko 5 0 5 5 - 24 5 exp sept 2012
32 Besi II Sulfat+Asam Folat (tablet tambah 20 saset/k 300 0 300 300 - 0
33 Betahistin Mesilat tablet 6 mg 30 tablet/k 120 0 120 0 120 0
 Hal. 2
PEMBERIAN
No NAMA OBAT Kemasan
SATUAN
STOK AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
SISA STOK
STOK OPT
PERMINTAAN KET.
APBN ASKES APBD LAIN JLH
1 2 4 ### 5 6 7 8 9 10 11 12 13 14 15 16 17
34 Betametason Krim O,1 % 25 tube/ko Vial 0 25 25 15 10 50
35 Bisoprolol tablet 5 mg 100 tablet Btl. 100 0 100 0 100 0
36 Ceterizine tablet 10 mg 50 tablet/kTube 0 0 0 0 0 0
37 Cloroquine 150 mg tablet 1000 tableSak 510 0 510 0 510 0
38 Cimetidin 200 mg tablet 100 tablet Tab. 200 200 400 300 100 300
39 Codein hidrocloryda 10 mg tablet 250 tablet Amp. 0 0 0 0 0 250
40 Codein hidrocloryda 15 mg tablet 250 tablet/Tab. 0 0 0 0 0 0
41 Deksametason Injeksi 5 mg/ml-1 ml 100 ampul/Btl. 25 30 55 25 30 0
42 Deksametason Tablet O,5 mg 1000 tableBtl. 0 2000 2000 1000 1000 3000
43 Dexstran 70 Larutan Inpus 6 % Stril 500 ml/botTab. 0 0 0 0 0 0
44 Dexstrometorfan Hbr Sirup 10 mg/5 ml 60 ml/botoBtl. 1 0 1 1 0 20
45 Dexstrometorfan Hbr Tablet 15 mg 1000 tableAmp.500 0 500 100 400 0
46 Diazepam Injeksi 5 mg/ml- 2 ml 30 ampul/kTab. 22 0 22 0 22 0
47 Digok
Diazepam Tablet 2 mg T
1000 tableTab. 0 0 0 0 0 1000
48 sin
Diazepam Tablet 5 mg 30 a
250 tablet/Tab. 0 0 0 0 0 0
49 Tablet
Diazepam tablet 5 mg ampul/kot b
500 tablet/Amp. 0 0 0 0 0 0
50 O,25
Difenhidramin HCL Injeksi 10 mg/ml- 1 mak . 6 0 6 2 4 0
51 mg 100 tablet Tab. 0 0 0 0 0 0
52 Doksisiklin kapsul 100 mg 100 tablet Tab. 200 0 200 0 200 0 200 ca exp sep 2012
53 Domperidon tablet 10 mg 50 tablet/kAmp. 50 100 150 70 80 200
54 Efedrin HCL Tablet 25 mg 1000 tableBtl. 0 0 0 0 0 3000
55 Epinephrine Injeksi 1mg/ ml 100 ampul/Tab. 18 0 18 0 18 20
56 Erytromycin 250 mg kapsul 100 tablet Btl. 80 0 80 20 60 0
57 Erytromycin 500 mg kapsul 50 kapsul/ Btl. 50 0 50 0 50 0
58 Erytromycin 200 mg/5 ml sirup 60 ml/botoBtl. 13 0 13 2 11 0
59 Ethambutol 250 mg tablet 100 tablet Btl. 0 0 0 0 0 0
60 Etakridin larutan 0,1 % (Rivanol) 300 ml/botAmp. 13 0 13 4 9 0
61 Etanol 70 % 100 ml 100 ml/botKaps. 0 0 0 0 0 0
62 Etanol 70 % 1000 ml 1000 ml/boKaps. 1 2 3 1 2 0
63 Famotidin tablet 50 tablet/kAmp.100 0 100 50 50 0
64 Fenilbutazon tablet 200 mg 1000 tableTab. 500 0 500 200 300 0
65 Fenoksimetil penisilin tablet 250 mg 100 tablet Tab. 0 0 0 0 0 0
66 Furosemid injeksi iv/im 10 mg/ml 25 ampul/kTab. 0 0 0 0 0 0
67 Furosemid Tablet 40 mg 200 tablet Tab. 200 0 200 100 100 300
68 Gentamisin injeksi 80 mg/2ml 5 ampul/koBtl. 0 0 0 0 0 0
69 Gentamisin Salep kulit 0,1% 10 tube/ko Amp. 25 0 25 10 15 0
70 Gentamisin sulfat tetes mata 0,3 % 5 ml/botol Tab. 0 10 10 2 8 0
71 Gentian violet lar. 1 % 10 ml/botoTab. 3 0 3 2 1 20
 72 Glibenklamida tablet 5 mg 100 tablet Tab. 100 300 400 300 100 500
73 Glimepiride tablet 1 mg 50 tablet/kBtl. 0 0 0 0 0 0
74 Gliseril Guayakolat Tablet 100 mg 100 tablet Sak 3000 0 3000 1000 2000 2000

Hal. 3
PEMBERIAN
KODE NAMA OBAT Kemasan
SATUAN
STOK AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
SISA STOK
STOK OPT
PERMINTAAN KET.
APBN ASKES APBD LAIN JLH
1 2 4 ### 5 6 7 8 9 10 11 12 13 14 15 16 17
75 Gliserin botol S
Sak 0 0 0 0 0 0
76 Glukosa Larutan Infus 10 % Steril 500 ml/botBtl.
e 18 0 18 2 16 0
77 Glukosa Larutan Infus 5 % Stril ml/botol t 25 0 25 10 15 0
78 Haloperidol Tablet O,5 mg 100 tablet Tab. 0 0 0 0 0 0
79 Haloperidol Tablet 1,5 mg 100 tablet Tab. 0 0 0 0 0 0
80 Haloperidol tablet 5mg 100 tablet Btl. 0 0 0 0 0 0
81 Hidroklorotiazid (HCT) Tablet 25 mg 1000 tableBtl. 4000 0 4000 600 3400 0
82 Hidrokortison Krim 2,5 % 24 tube/ko Btl. 48 0 48 24 24 0
83 Ibuprofen Tablet 200 mg 100 tablet Btl. 0 0 0 0 0 500
84 Ibuprofen Tablet 400 mg 100 tablet Tab. 30 0 30 30 0 1000
85 Isoniazid Tablet 300 mg 1000 tableTab. 0 0 0 0 0 0
86 Isosorbid Dinitrat Tablet Sublungual 5 mg100 tablet Tab. 100 0 100 50 50 200
87 Kalium Parmnganat Serbuk pot Tab. 6 0 6 2 4 0
88 Kalium Diklofenak tablet 50 mg 50 tablet/kTube 50 0 50 50 0 0
89 Kalsium Laktat (Kalk) Tablet 500 mg 1000 tableTab.8000 0 8000 2000 6000 3000 6000 taexp sept 2012
90 kaptopril tablet 12,5 mg 100 tablet Tab. 600 0 600 400 200 500
91 kaptopril tablet 25 mg 100 tablet Set 1050 0 1050 200 850 0
92 kaptoprol tablet 50 mg 100 tablet Set 0 0 0 0 0 0
93 Ketokonazol krim 2% 12 tube/ko Vial 2 24 26 10 16 24
94 Ketokonazol tablet 200 mg 50 tablet/kKaps.180 0 180 80 100 0
95 Ketoprofen tablet 50 mg 100 tablet Btl. 200 0 200 0 200 0
96 Ketoprofen tablet 100 mg 100 tablet Tab. 0 0 0 0 0 0
97 ketorolac injeksi 10 mg 6 ampul/koTab. 0 0 0 0 0 0
98 ketorolac injeksi 30 mg 6 ampul/koBiji 10 0 10 0 10 0
99 Klindamycin kapsul 150 mg 50 kapsul/ Btl. 50 0 50 0 50 0
100 Klindamycin kapsul 300 mg 50 kapsul/ Tube 50 0 50 0 50 0
101 Kloramfenikol Kapsul 250 mg 250 kapsulTab. 500 0 500 250 250 0
102 Kloramfenikol Kapsul 250 mg 1000 tableBks. 600 0 600 500 100 0
103 Kloramfenikol Salep Mata 1 % 24 tube/ko Bks. 24 0 24 12 12 0
104 Kloramfenikol Suspensi 125 mg/5ml 60 ml/botoTab. 55 0 55 15 40 0
105 Klorfeniramin Maleat (CTM) Tablet 4 mg 1000 tableRol 6000 0 6000 3000 3000 0
106 Klorpromazin HCL Tablet Salut 100 mg 1000 tableRol 666 0 666 10 656 0
107 Klorpromazin HCL Tablet Salut 25 mg 1000 tableRol 0 0 0 0 0 0
108 Kotrimoksazol DOEN I Dewasa 100 tablet Rol 640 0 640 100 540 0
109 Kotrimoksazol DOEN II Pediatrik 100 tablet/Vial 300 0 300 0 300 0
110 Kotrimoksazol suspensi 60 ml/botoKaps. 38 0 38 30 8 20
111 Kuinin Sulfat Tablet 222 mg ( 7h20) 60 tablet/kKaps. 40 0 40 0 40 0
112 Kuinin Sulfat Tablet 222 mg ( 7h20) 1000 tableTube 0 0 0 0 0 0
113 Lansoprazol kapsul 30 mg 20 tablet/kBtl. 20 0 20 20 0 60
114 Levofloxacin 500 mg tablet 50 tablet/kTab. 120 0 120 100 20 0
115 Lidocain Injeksi (pure) 100 ampul/Tab. 21 0 21 15 6 0

Hal. 4
PEMBERIAN
KODE NAMA OBAT Kemasan
SATUAN
STOK AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
SISA STOK
STOK OPT
PERMINTAAN KET.
APBN ASKES APBD LAIN JLH
1 2 4 ### 5 6 7 8 9 10 11 12 13 14 15 16 17
116 Lidokain adrenalin cum injeksi (kombinas100 ampul/Amp. 25 0 25 5 20 0
117 Lisinopril 30 tablet/kAmp. 0 0 0 0 0 0
118 Lisol 1000 ml/boTab. 0 0 0 0 0 0
119 Loperamid Tablet 2 mg 100 tablet Tab. 0 0 0 0 0 0
120 Loratadin tablet 10 mg 100 tablet Tab. 170 0 170 70 100 0
121 Magnesium Sulfat Injeksi (iv) 20% - 25 m25 ml/botoTab. 7 0 7 1 6 0
122 Meloxicam tablet 7,5 mg 50 tablet/kTab. 100 0 100 50 50 300
123 Metampiron tablet 500 mg 1000 tableTab. 0 0 0 0 0 0
124 Metformin HCl tablet 500 mg 100 tablet Tab. 100 100 200 0 200 200
125 Metilprednisolon tablet 8 mg 100 tablet Tab. 50 0 50 25 25 0 25 tab juli 2012
126 Metilprednisolon tablet 4 mg 100 tablet Amp. 50 0 50 25 25 0 25 tab juli 2012
127 Metilergometrin Maleat Tablet Salut O,1 100 tablet Tab. 540 0 540 40 500 0
128 Metilergometrin Maleat Injeksi O,200 mg ampul/kotaBtl. 0 0 0 0 0 50
129 Metoklopramida tablet 1o mg 100 tablet Btl. 180 0 180 20 160 0
130 Metoklopramida sirup 5mg/5ml 60 ml/botoBtl. 8 5 13 2 11 5
131 Metronidazol infus 500 mg/100 ml 100 ml/botBtl. 4 0 4 2 2 2
132 Metronidazol Tablet 250 mg 100 tablet Btl. 200 200 400 200 200 100
133 Miconazole krim 2% 24 tube Btl. 2 24 26 6 20 24 20 exp agustus 2012
134 Natrium Bikarbonat Tablet 500 mg 1000 tableBtl. 1000 0 1000 0 0 1000
135 Natrium Diklofenak tablet 25 mg 50 tablet/kAmp. 0 0 0 0 0 0
136 Natrium diklofenak tablet 50 mg 50 tablet/kBtl. 100 0 100 0 100 0
137 Natrium Fluoresein Tetes Mata 2 % 24 botol/k Vial 0 0 0 0 0 0
138 Natrium Klorida Larutan Infus O.9 Steril 500 ml/botVial 6 0 6 3 3 10
139 Nifedipin 10 mg tablet 100 tablet Btl. 0 0 0 0 0 300
140 Nistatin 100.000 IU/g Tablet Vaginal 100 tablet Tab. 0 0 0 0 0 100
141 Nistatin 500.000 IU Tablet Salut 100 tablet Btl. 200 0 200 0 200 0
142 Obat Batuk Hitam ( OBH ) Cairan 100 ml/botTab. 6 0 6 4 2 20
143 Ofloxacin tablet 200 mg 50 tablet/kAmp. 0 0 0 0 0 0
144 Ofloxacin tablet 400 mg 50 tablet/kTab. 50 0 50 20 30 0
145 Oralit 100 saset/ Btl. 600 0 600 60 540 0
146 Oksitetrasiklin HCL Salep 3 % 25 tube/ko Btl. 0 0 0 0 0 0
147 Oksitetrasiklin HCL Salep Mata 25 tube/ko Tab. 35 0 35 10 25 0
148 Oksitosin Injeksi 10 IU/ml - 1 ml 10 ampol/kBtl. 15 10 25 7 18 30
149 Omeprazol 30 kapsul/ Btl. 60 0 60 50 10 60
150 Papaverin Injeksi 40 mg/ml 100 ampul/Amp. 0 0 0 0 0 0
151 Parasetamol Sirup 120 mg/5 ml 60 ml/botoTab. 15 50 65 35 30 0
152 Parasetamol Tablet 500 mg 1000 tableTab.5000 0 5000 2000 3000 0
153 Parasetamol Tablet 500 mg 100 tablet Pkt. 0 0 0 0 0 0
154 Piracetam tablet 400 mg 100 tablet Pkt. 0 0 0 0 0 0
155 Piracetam injeksi 3g/15 ml 4 ampul/koBtl. 0 0 0 0 0 0
156 Piracetam tablet 800 mg 60 tablet/kTbg. 60 0 60 0 60 0

Hal. 5
PEMBERIAN
KODE NAMA OBAT KemasanSATUAN
STOK AWALPENERIMAAN
PERSEDIAAN
PEMAKAIAN
SISA STOK
STOK OPT
PERMINTAAN KET.
APBN ASKES APBD LAIN JLH
1 2 4 ### 5 6 7 8 9 10 11 12 13 14 15 16 17
157 Pirantel Pamoat Tablet 365 mg 100 tablet Vial 350 0 350 100 250 200
158 Pirazinamid tablet 500 mg 100 tablet Tube 0 0 0 0 0 0
159 Piridoksin HCL (vitamin B6)Tablet 10 mg 1000 tableTube4000 1000 5000 2000 3000 2000
160 Piroxicam 100 tablet Amp.100 0 100 0 100 400
161 Povidon Iodida larutan 10% 60 ml/botoTab. 0 0 0 0 0 30
162 Povidon Iodida larutan 10% 300 ml/botBtl. 1 0 1 1 0 10
163 Prednison Tablet 5 mg 1000 tableTab.4000 0 4000 1000 3000 0
164 Propiltiourasil Tablet 100 mg 100 tablet Tab. 100 0 100 0 100 0
165 Phenobarbital 30 mg tablet 1000 tableRol 1317 0 1317 160 1157
166 Phenytoin 30 mg kapsul 100 tablet Tab. 0 0 0 0 0
167 Phytomenadion 10 mg tablet (Vit. K table100 tablet/Tab. 100 200 300 100 200 100
168 Phytomenadion injeksi (Vit. K injeksi) 30 ampul/kAmp. 9 0 9 1 8 0
169 Primakuin Tablet 15 mg 1000 tableBtl. 0 0 0 0 0 1000
170 Propranolol HCL Tablet 10 mg 100 tablet Tab. 0 0 0 0 0 0
171 Propranolol HCL Tablet 40 mg 100 tablet Tab.1900 0 1900 200 1700 0
172 Ranitidin injeksi 25mg/2ml 25 ampul/kRol 2 0 2 1 1 0
173 Ranitidin tablet 150 mg 100 tablet Btl. 70 0 70 50 20 500
174 Reserpin Tablet O,10 mg 250 tablet/Btl. 200 0 200 50 150 0
175 Reserpin Tablet O,25 mg 1000 tableTab.1000 0 1000 200 800 0
176 Rifampisin Kaplet 600 mg 100 tablet Tab. 0 0 0 0 0 0
177 Ringer Laktat Larutan Infus Steril 500 ml/kot Tab. 7 0 7 7 0 10
178 Risperidon tablet 2 mg 50 tablet/kVial 0 0 0 0 0 0
179 Salbutamol Tablet 2 mg 100 tablet Tab. 110 0 110 80 30 200
180 Salbutamol Tablet 4 mg 100 tablet Tab. 130 0 130 20 110 0
181 Salisil Bedak 2 % kotak/pot/ Vial 34 0 34 15 19 0
182 Sefadroksil kapsul 250 mg 100 tablet Tab. 70 0 70 30 40 0
183 Sefadroksil kapsul 500 mg 50 kapsul/ Tab. 10 200 210 100 110 300
184 Sefadroksil sirup kering 125mg/5ml 60 ml/botoKaps. 16 0 16 4 12 0
185 Sefiksim kapsul 100 mg 50 kapsul/ Kapl. 50 0 50 0 50 0
186 Sefotaksim injeksi 1 g 2 vial/kota Kaps. 0 0 0 0 0 0
187 Seftriakson injeksi 1 g 2 vial/kota Kaps. 4 0 4 1 3 2
188 Simvastatin tablet 10 mg 30 tablet/kBtl. 30 60 90 90 0 60
189 Siprofloksasin tablet 250 mg 50 tablet/kTab. 0 0 0 0 0
190 Siprofloksasin tablet 500 mg 50 tablet/kPot 10 0 10 10 0 300
191 Sianokobalamin ( Vit. B 12 ) Inj. 500 mcg 30 ampul/kKtk. 20 0 20 14 6 30
192 Sianokobalamin ( Vit. B 12 ) tablet 1000 tableBtl. 700 0 700 100 600 0
193 Tetrasiklin HCL Tetes Mata 24 botol/k Set 0 0 0 0 0 0
194 Tetrasiklin HCL Kapsul500mg 100 kapsulVial 200 0 200 0 200 0 200 cap Sep-12
195 Tiamfenikol kapsul 500 mg 100 tablet Vial 200 0 200 100 100 0
196 Tiamin HCL ( Vit.B 1 ) Inj. 100 mg/ml - 1 30 ampul/kVial 40 30 70 20 50 30
197 Tiamin HCL Monitrat ( Vit.B 1 ) Tablet 50 1000 tableAmp. 2500 0 2500 1000 1500 0

hal. 6
PEMBERIAN
KODE NAMA OBAT Kemasan
SATUAN
STOK AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
SISA STOK
STOK OPT
PERMINTAAN KET.
APBN ASKES APBD LAIN JLH
1 2 4 ### 5 6 7 8 9 10 11 12 13 14 15 16 17
198 Tramadol injeksi 50 mg/ml 5 ampul/koVial 0 0 0 0 0 0
199 Tramadol tablet 50 mg 50 tablet/kTube 50 0 50 50 0 0
200 Triheksifenidil tablet 2 mg 100 tablet Tube2300 0 2300 0 2300 0
201 Vitamin B kompleks tablet 1000 tableAmp. 0 0 0 0 0 8000
REAGENSIA
1 Larutan benedict 100 ml/botBtl. 0 0 0 0 0 0
2 Larutan eosin 2 % 100 ml/botTab. 0 0 0 0 0 0
3 Larutan giemsia stain 100 ml/botTab. 0 0 0 0 0 0
4 Larutan karbol fuksin 100 ml/botRol 0 0 0 0 0 0
5 Larutan metilen biru 100 ml/botTab. 0 0 0 0 0 0
6 Larutan asam asetat 100 ml/botTab. 0 0 0 0 0 0
7 larutan bufer pH 7,0 100 ml/botAmp. 0 0 0 0 0 0
8 Methanol 100 ml/botBtl. 0 0 0 0 0 0
9 Imersion oil-2 IEHL-nelson 1 100 ml/botTab. 0 0 0 0 0 0
10 Imersion oil-2 IEHL-nelson 2 100 ml/botTab. 0 0 0 0 0 0
11 Imersion oil-2 IEHL-nelson 3 100 ml/botRol 0 0 0 0 0 0
12 Larutan HCl 0,1 N 100 ml/botBtl. 0 0 0 0 0 0
BAHAN HABIS PAKAI/ALAT KESEHATAN Btl.
1 Alat suntik sekali pakai 1ml 100 set/ko Tab. 100 0 100 50 50 0
2 Alat suntik sekali pakai 2,5 ml 100 set/ko Tab. 200 0 200 100 100 0
3 Alat suntik sekali pakai 5 ml 100 set/ko Tab. 50 0 50 25 25 100
4 Catgut/Benang bedah No. 2/0 dengan ja paket Vial 0 0 0 0 0 0
5 Catgut/Benang bedah No. 3/0 dengan ja paket Tab. 8 0 8 4 4 5
6 Infusion set anak set Tab. 9 5 14 9 5 5
7 Infusion set dewasa set Vial 3 5 8 4 4 5
8 IV Catheter No. 20 G 50 set/kot Tab. 5 0 5 3 2 5
9 IV Catheter No. 21 G 50 set/kot Tab. 5 0 5 3 2 5
10 IV Catheter No. 22 G 50 set/kot Kaps. 0 0 0 0 0 0
11 IV Catheter No. 24 G 50 set/kot Kapl. 10 0 10 0 10 0
12 Kapas berkemak 500 gram 500 gram/ Kaps. 1 0 1 0 1 0
 13 kapas pembalut/ absorben 250 gram 250 gram/ Kaps. 0 0 0 0 0 0
14 kasa kompres 40/40 steril bungkus Btl. 1 0 1 1 0 20
15 Kasa pembalut 2 m x 80 cm bungkus Tab. 0 0 0 0 0 0
16 Kasa pembalut Hidrofil 4 m x 3 cm roll Pot 1 0 1 1 0 0
17 Kasa pembalut Hidrofil 4 m x 15 cm roll Ktk. 63 0 63 30 33 0
18 Kasa hidrofil roll Btl. 0 0 0 0 0 10
19 Pembalut gips 3 inchi roll Set 0 2 2 0 2 0
20 Pembalut gips 4 inchi roll Vial 0 2 2 0 2 0
21 Pembalut gips 6 inchi roll Vial 0 2 2 0 2 0
22 Plester 5 yards x 2 inchi roll Vial 0 3 3 1 2 5
23 Silk (benang bedah sutera) no, 3/0 deng paket Amp. 16 0 16 5 11 0

Hal. 7
PEMBERIAN
KODE NAMA OBAT Kemasan
SATUAN
STOK AWAL
PENERIMAAN
PERSEDIAAN
PEMAKAIAN
SISA STOK
STOK OPT
PERMINTAAN KET.
APBN ASKES APBD LAIN JLH
1 2 4 ### 5 6 7 8 9 10 11 12 13 14 15 16 17
24 Handscoon/ sarung tangan pasang Vial 12 10 22 7 15 0
OBAT GIGI Amp. 0 0 0 0 0 0
1 Etil klorida spray 100 ml/botSak 2 3 5 1 4 1 4 botol exp agustus 2012
2 Glass ionomer cement ART set/botol Btl. 0 0 0 0 0 0
3 Klorfenol kamfer menthol (CHKM) 10 ml/botoTbg. 0 0 0 0 0 0
4 Temporary Stopping Fietcher Serbuk dan botol Vial 0 0 0 0 0 0

Umum
Jumlah Kunjungan Resep Bayar Gratis ASKESJAMKESMASJumlah
287 3 47 387 724

Muara Teweh,……………………………………2012

Mengetahui Yang Menyerahkan Yang Meminta / Melapor Yang Menerima

Kepala UPTD. Perlengkapan dan PerbekalPetugas UPTD.Perlengkapan dan Perbeka Kepala Puskesmas Petugas Puskesmas/Pustu

…………………………………………………………………………………………………………… dr. Tiur Maida Asmah Wati, S.Far., Apt.

NIP. NIP. 19780324 200604 2 009 19860615 201101 2 013
 LAPORAN PEMAKAIAN OBAT - OBATAN BUFFER STOK DARI DEPARTEMEN K

KODE PUSTU :
PUSKESMAS/PUSTU :
KECAMATAN : Lahei
KAB. / KOTA : Barito Utara
PROPINSI : Kalimantan Tengah

STOK
NO. NAMA OBAT SATUAN
AWAL
1 2 3 4
OBAT - OBATAN :
1 Alopurinol Tablet 100 mg Tab.
2 Aminofilin Tablet 200 mg Tab.
3 Aminofilin Injeksi 24 mg/ml-10 ml Amp.
4 Amoxsillin Kapsul 250 mg Kaps.
5 Amoxsillin Kaplet 500 mg Kapl.
6 Antalgin ( Mentapiron ) Tablet 500 mg Tab.
7 Antalgin Injeksi 250 mg/ml-2 ml Amp.
8 Antihemoroid Doen Kombinasi Supp
9 Antifungi Doen Kombinasi :
Asam Benzoat 6 % + Asam Salisilat 3 % Pot
10 Asam Askorbat ( Vit.C ) Tablet 50 mg Tab.
11 Asetosal Tablet 100 mg Tab.
12 Atropin Sulfat tetes mata 0,5 % Btl.
13 Betametason Krim O,1 % Tube
14 Deksametason Injeksi 5 mg/ml-1 ml Amp.
15 Deksametason Tablet O,5 mg Tab.
16 Dexstrometorfan Hbr Tablet 15 mg Tab.
17 Difenhidramin HCL Inj. 10 mg/ml-1 ml Amp.
18 Efedrin HCL tablet 25 mg Tab.
19 Efedrin HCL/Barbiturat (Epinefirina + Adrenalin) Injeksi O,1 % -1 ml Amp.
20 Fenol Gliserol Tetes Telinga 10 % Btl.
21 Fitometadion (Vit.K1) Injeksi 10 mg/ml- 1 ml Amp.
22 Furosemid Tablet 40 mg Tab.
23 Gameksan Emulsi 1 % Btl.
24 Gantian Violet Larutan 1 % Btl.
25 Glibenklamid Tablet 5 mg Tab.
26 Gliseril Guayakolat Tablet 100 mg Tab.
27 Hidroklorotiazid (HCT) Tablet 25 mg Tab.
28 Hidrokortison Krim 2,5 % Tube
29 Ketamin Injeksi 10 mg /ml Vial
30 Kloramfenikol Kabsul 250 mg Kaps.
31 Klorfeniramin Maleat (CTM) Tablet 4 mg Tab.
32 Komb.Pirimetamin 25 mg + Sulfadoksin 500 mg ( Anti Malaria Doen ) Tab.
 STOK
NO. NAMA OBAT SATUAN
AWAL
1 2 3 4
33 Kontrimoksasol Tablet Kombinasi :
Sulfametoksazol 400 mg + Trimetroprim 80 mg. Tab.
34 Metilergometrin Maleat Tablet Salut O,125 mg Tab.
35 Metilergometrin Maleat Injeksi O,200 mg - 1 ml Amp.
36 Natrium Bikarbonat Tablet 500 mg Tab.
37 Nistatin Tablet Salut 500.000 IU Tab.
38 Nistatin Tablet Vaginal 100.000 IU/g Tab.
39 Obat Batuk Hitam ( OBH ) Cairan Btl.
40 Oksitetrasiklin HCL Salep Mata 1 % Tube
41 Oksitosin Injeksi 10 IU/ml - 1 ml Amp.
42 Parasetamol Sirup 120 mg/5 ml Btl.
43 Parasetamol Tablet 500 mg Tab.
44 Povidon Iodin 10 % 30 ml Btl.
45 Povidon Iodin 10 % 300 ml Btl.
46 Salisil Bedak 2 % Ktk.
47 Tetrasiklin HCL Kapsul 500 mg Kaps.
48 Tiamin HCL ( Vit.B 1 ) Inj. 100 mg/ml - 1 ml Amp.
49 Tiamin HCL/Monitrat ( Vit.B 1 ) Tablet 50 mg Tab.
50 Vitamin B Complex Tablet Tab.

ALAT KESEHATAN :
51 Alat suntik sekali pakai 1 ml Kotak
52 Catgut / Benang bedah sutra No. 2/0 dengan jarum bedah Kotak
53 Silk ( Benang Bedah Sutra ) No. 3/O dengan jarum bedah Kotak

OBAT GIGI :
54 Glass Ionomer Cement ART Kotak

Umum
Jumlah Kunjungan Resep Bayar Gratis

Menyetujui / Menyetujui : Yang Menyerahkan Yang Menerima,

Kepala Dinas Kesehatan Kepala GFP
NIP. NIP.
DEPARTEMEN KESEHATAN RI ( DEPKES RI )

BULAN : ..........................................................
TAHUN : ..........................................................

PENERI PERSED PEMAK SISA STOK

KET.
MAAN IAAN AIAN STOK OPT
5 6 7 8 9 10
 PENERI PERSED PEMAK SISA STOK
KET.
MAAN IAAN AIAN STOK OPT
5 6 7 8 9 10

Askes Askin Jlh

…………….……..., ………………..………………… 2008

Yang Menerima, Yang melaporkan
Kepala Puskesmas Pembantu
Petugas Puskesmas Pembantu
NIP. NIP.