LAPORAN PEMAKAIAN DAN LEMBAR PERMINTA

POSKESDES BENGKEL SAR

PUSKESMAS : SELEMADEG BARAT

KECAMATAN : SELEMADEG BARAT PELAPORAN BULAN/PERIO
KABUPATEN : TABANAN PERMINTAAN BULAN/PER

KODE NO NAMA BAHAN MEDIS HABIS PAKAI Satuan Stok Awal

1 2 3 4
B1 1 Alat suntik sekali pakai 2,5 ml Pcs -
B2 2 Alat suntik sekali pakai 5 ml Pcs -
B3 3 Catgut / benang bedah no 2/0 chromic Sachet -
B4 4 Catgut / benang bedah no 3/0 chromic Sachet -
B5 5 Catgut / benang bedah no 2/0 plain Sachet -
B6 6 Catgut / benang bedah no 3/0 plain Sachet -
B7 7 Kapas pembalut / absorben 250 gram Roll -
B8 8 Kasa gulung Roll -
B9 9 Kasa pembalut hidrofil 4 m x 15 cm Roll
B10 10 Silk (benang bedah sutera) no.3/0 Pcs -
B11 11 Folley catheter Pcs -
B12 12 IV Catheter 24 Pcs -
B13 13 IV Catheter 20 Pcs -
B14 14 Sarung Tangan M Pasang
B15 15 Sarung Tangan S Pasang -
B16 16 Sarung Tangan L pasang -
B17 17 Urinebag Set -
B18 18 Jarum Injeksi Pcs -
B19 19 Sarung Tangan Steril M Pcs -
B20 20 Jarum Otot Kulit Set -
B21 21 Bisturi 11 Pcs -
B22 22 Bisturi 21 Pcs -
B23 23 Bisturi 20 Pcs -
B24 24 Jelly Tube -
B25 25 Perkamen Pak -
B26 26 Klip Plastik 10x7 Pak -
B27 27 Klip Plastik 13x8,7 Pak -
B28 28 Daryantul Lembar -
B29 29 Hypafix Pak -
B30 30 Alkohol 70 % 1 liter Brataco btl -
B31 31 IV cath no .22 Pcs -
B32 32 IV cath no .18 Pcs -
B33 33 Lisol Botol -
B34 34 H2O2 Onemed Botol -
B35 35 Alat suntik sekali pakai 3cc TOP pcs 78
B36 36 Alat suntik sekali pakai 5cc TOP pcs -
B37 37 Kasa pembalut 2 x 80 Bunda Biru Bungkus -
B38 38 Kasa gulung anugrah Roll -
B39 39 Kasa hidrofil 4 x 10 Bunda Biru pcs -
B40 40 Kasa hidrofil 18 x 22 anugrah pack -
B41 41 Sarung tangan nitril L Pasang -
B42 42 Sarung tangan nitril M Pasang -
B43 43 Silk no.3/0 pcs 1
B44 44 Masker Jeva pcs
B45 45 Jarum Otot Kulit Onemed set 1
B46 46 Jelly ultrasonic tube -
B47 47 Klip plastik obat 10 x 7 pack -
B48 48 Klip plastik obat 13 x 8,7 pack -
B49 49 Daryantule (Vaseline Swab) lembar -
B50 50 Hypafix 5 x 5 roll -
B51 51 Infuset dewasa pcs -
B52 52 Blood Set OM pcs -
B53 53 Jarum injeksi needle 23 OM pcs -
B54 54 Kasa Gulung 4 x 15 m bunda biru roll 3
B55 55 Nitrile Gloves White M Supercare Pasang -
B56 56 Nitrile Glove White L Supercare pasang 18
B57 57 Strip Glucose Supersensor @ 50 GlucoDR box -
B58 58 Golda Anti A Monoclonal 10 ml J.Mitra vial -
B59 59 Golda Anti B Monoclonal 10 ml J.Mitra vial -
B60 60 Strip Cholesterol Benecheck @10 pcs box -
B61 61 Strip Asam Urat Benecheck box -
B62 62 Strip Hemoglobin Mission Plus box -
B63 63 Tes Kehamilan Onemed box -
B64 64 Hypapix 15cm X 5m BSN Roll -
B65 65 Strip Glucose Active @50 Accu Check box -
B66 66 Selang Oxygen Anak GEA pcs -
B67 67 Selang Oxygen Dewasa GEA Pcs -
B68 68 Matabur Type Fissure High pcs -
B69 69 Komposit A3 (Estelite Quick) pcs -
B70 70 Bonding Te-Econom Bond botol -
B71 71 ETSA (Opal Etch) botol -
B72 72 Carviton (Cervitron White) botol -
B73 73 Urinalysis 10 SG 100 Test Insight Expert Acon pcs -
B74 74 Calsidor Dorident pcs -
B75 75 Matabor Mani Set 6 set -
B76 76 Matapex Metabiomed pcs -
B77 77 Multifix (Elite Cement) set -
B78 78 TKF (Cresoformalin) pcs -
B79 79 Calcium Hydroxit (Calcidor) pcs -
B80 80 Articulating Paper pcs -
B81 81 Ruwa Matrix Strip Camden pcs -
B82 82 Pipet 1 ml Plastik Biomedika pcs -
B83 83 Golda Anti B Monoclonal 10 ml J.Mitra vial -
B84 84 Infuset Dewasa Remidi pcs -
B85 85 Inflo IV Catheter No. 18 Onemed pcs -
B86 86 Inflo IV Catheter No. 20 Onemed pcs -
B87 87 Inflo IV Catheter No. 22 G Onemed pcs -
B88 88 Inflo IV Catheter No. 24 G Onemed pcs -
B89 89 Foley Catheter 2 Way FR 20 Remidi pcs -
B90 90 Foley Catheter 2 Way FR 16 GEA pcs -
B91 91 Glove Surgical Sterile No 7,5 Latex Powered Euroderm Pasang -
B92 92 Latex Glove L Supercare Pasang -
B93 93 Latex Glove M Supercare Pasang -
B94 94 Disposible Syring 3cc TP pcs -
B95 95 Masker 3 ply Karet Remidi pcs -
B96 96 Jarum Hecting Nald Combi Onemed set -
B97 97 Perhidrol 3 % Onemed botol 0
B98 98 Strip Glucose Active @50 Accu Check box 0
B99 99 Strip Glucose @25 easy touch box 0
B100 100 Alkohol Swab pack 0
B101 101 Underpad onemad pack 0
B102 102 Rivanol 0,1% 300ml onemed botol 0
B103 103 Vasofix IV G18X33 mm Green Bbraun pcs 0
B104 104 Vasofix IV G20X33 mm Green Bbraun pcs 0
B105 105 Vasofix IV G22X33 mm Green Bbraun pcs 0
B106 106 Mess no.11 @100 Aesculap Bbraun pack 0
B107 107 Stip HB Family Dr @25 box 0
B108 108 GC-Fuji IX 1-1 #Extra A2 buah 0
B109 109 GC-Fuji VII 1-1 White buah 0
B110 110 GC-Caviton Pink buah 0
B111 111 Biodinamica-Eugenol 20ml botol 0
B112 112 Devitec PD-Non Arsen botol 0
B113 113 Vitapex syringe 0
B114 114 Septodont-Rolde's botol : 13ml botol 0
B115 115 Svenska-saliva ejector : 100pcs Bungkus 0
B116 116 Folley catheter no 24 buah 0
B117 117 Onemed/GT9-Jarum Jahit Kulit No.9 pck : 12 pcs pack 0
B118 118 Onemed/GT10-Jarum Jahit Kulit No.10 pck : 12 pcs pack 0
B119 119 Onemed/GT11-Jarum Jahit Kulit No.11 pck : 12 pcs pack 0
B120 120 Onemed/GT12-Jarum Jahit Kulit No.12 pck : 12 pcs pack 0
B121 121 Onemed/GT13-Jarum Jahit Kulit No.13 pck : 12 pcs pack 0
B122 122 Onemed/GT14-Jarum Jahit Kulit No.14 pck : 12 pcs pack 0
B123 123 Onemed-Wing Needle No. 23 buah 0
B124 124 Onemed-Wing Needle No. 27 buah 0
B125 125 Bene Check - Strip Uric Acid box : 25's box 0
B126 126 Bene Check - Strip Cholesterol box : 10's box 0

Mengetahui/Menyetujui Yang Meyerahkan

Kepala Puskesmas Selemadeg Barat

dr. Wayan Arya Putra Manuaba Ni Made Nuartini

NIP. 197211072005011008 NIP.1964123119900320
LEMBAR PERMINTAAN OBAT (LPLPO) BMHP
SDES BENGKEL SARI

PELAPORAN BULAN/PERIODE : FEBRUARI 2018

PERMINTAAN BULAN/PERIODE : MARET 2018

Penerimaan Persediaan Pemakaian Sisa Stok Stok Opt Permintaan Penerimaan Ket/Exp.

5 6=(4+5) 7 8 9 10=(9-8) 11
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Yang Meyerahkan Yang Meminta/Melapor

Petugas Pustu

Ni Made Nuartini Ni Putu Aristiadewi,A.Md.Keb

NIP.196412311990032079 NIP. 198807142017052006
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OB
POSKESDES BENGKEL SARI

PUSKESMAS : SELEMADEG BARAT

KECAMATAN : SELEMADEG BARAT PELAPORAN BULAN/PERIODE
KABUPATEN : TABANAN PERMINTAAN BULAN/PERIODE

KODE NO NAMA BAHAN MEDIS HABIS PAKAI Satuan Stok Awal Penerimaan

1 2 3 4 5
B1 1 Alat suntik sekali pakai 2,5 ml Pcs -
B2 2 Alat suntik sekali pakai 5 ml Pcs -
B3 3 Catgut / benang bedah no 2/0 chromic Sachet -
B4 4 Catgut / benang bedah no 3/0 chromic Sachet -
B5 5 Catgut / benang bedah no 2/0 plain Sachet -
B6 6 Catgut / benang bedah no 3/0 plain Sachet -
B7 7 Kapas pembalut / absorben 250 gram Roll - -
B8 8 Kasa gulung Roll -
B9 9 Kasa pembalut hidrofil 4 m x 15 cm Roll
B10 10 Silk (benang bedah sutera) no.3/0 Pcs -
B11 11 Folley catheter Pcs -
B12 12 IV Catheter 24 Pcs -
B13 13 IV Catheter 20 Pcs -
B14 14 Sarung Tangan M Pasang
B15 15 Sarung Tangan S Pasang -
B16 16 Sarung Tangan L pasang -
B17 17 Urinebag Set -
B18 18 Jarum Injeksi Pcs -
B19 19 Sarung Tangan Steril M Pcs -
B20 20 Jarum Otot Kulit Set -
B21 21 Bisturi 11 Pcs -
B22 22 Bisturi 21 Pcs -
B23 23 Bisturi 20 Pcs -
B24 24 Jelly Tube -
B25 25 Perkamen Pak -
B26 26 Klip Plastik 10x7 Pak -
B27 27 Klip Plastik 13x8,7 Pak -
B28 28 Daryantul Lembar 1 -
B29 29 Hypafix Pak -
B30 30 Alkohol 70 % 1 liter Brataco btl -
B31 31 IV cath no .22 Pcs -
B32 32 IV cath no .18 Pcs -
B33 33 Lisol Botol -
B34 34 H2O2 Onemed Botol -
B35 35 Alat suntik sekali pakai 3cc TOP pcs 83 -
B36 36 Alat suntik sekali pakai 5cc TOP pcs -
B37 37 Kasa pembalut 2 x 80 Bunda Biru Bungkus -
B38 38 Kasa gulung anugrah Roll -
B39 39 Kasa hidrofil 4 x 10 Bunda Biru pcs -
B40 40 Kasa hidrofil 18 x 22 anugrah pack - -
B41 41 Sarung tangan nitril L Pasang -
B42 42 Sarung tangan nitril M Pasang -
B43 43 Silk no.3/0 pcs 1
B44 44 Masker Jeva pcs
B45 45 Jarum Otot Kulit Onemed set 1
B46 46 Jelly ultrasonic tube -
B47 47 Klip plastik obat 10 x 7 pack -
B48 48 Klip plastik obat 13 x 8,7 pack -
B49 49 Daryantule (Vaseline Swab) lembar -
B50 50 Hypafix 5 x 5 roll -
B51 51 Infuset dewasa pcs -
B52 52 Blood Set OM pcs -
B53 53 Jarum injeksi needle 23 OM pcs -
B54 54 Kasa Gulung 4 x 15 m bunda biru roll 3
B55 55 Nitrile Gloves White M Supercare Pasang -
B56 56 Nitrile Glove White L Supercare pasang 28
B57 57 Strip Glucose Supersensor @ 50 GlucoDR box -
B58 58 Golda Anti A Monoclonal 10 ml J.Mitra vial -
B59 59 Golda Anti B Monoclonal 10 ml J.Mitra vial -
B60 60 Strip Cholesterol Benecheck @10 pcs box -
B61 61 Strip Asam Urat Benecheck box -
B62 62 Strip Hemoglobin Mission Plus box -
B63 63 Tes Kehamilan Onemed box -
B64 64 Hypapix 15cm X 5m BSN Roll - -
B65 65 Strip Glucose Active @50 Accu Check box -
B66 66 Selang Oxygen Anak GEA pcs -
B67 67 Selang Oxygen Dewasa GEA Pcs -
B68 68 Matabur Type Fissure High pcs -
B69 69 Komposit A3 (Estelite Quick) pcs -
B70 70 Bonding Te-Econom Bond botol -
B71 71 ETSA (Opal Etch) botol -
B72 72 Carviton (Cervitron White) botol -
B73 73 Urinalysis 10 SG 100 Test Insight Expert Acon pcs -
B74 74 Calsidor Dorident pcs -
B75 75 Matabor Mani Set 6 set -
B76 76 Matapex Metabiomed pcs -
B77 77 Multifix (Elite Cement) set -
B78 78 TKF (Cresoformalin) pcs -
B79 79 Calcium Hydroxit (Calcidor) pcs -
B80 80 Articulating Paper pcs -
B81 81 Ruwa Matrix Strip Camden pcs -
B82 82 Pipet 1 ml Plastik Biomedika pcs -
B83 83 Golda Anti B Monoclonal 10 ml J.Mitra vial -
B84 84 Infuset Dewasa Remidi pcs -
B85 85 Inflo IV Catheter No. 18 Onemed pcs -
B86 86 Inflo IV Catheter No. 20 Onemed pcs -
B87 87 Inflo IV Catheter No. 22 G Onemed pcs -
B88 88 Inflo IV Catheter No. 24 G Onemed pcs -
B89 89 Foley Catheter 2 Way FR 20 Remidi pcs -
B90 90 Foley Catheter 2 Way FR 16 GEA pcs -
B91 91 Glove Surgical Sterile No 7,5 Latex Powered Euroderm Pasang -
B92 92 Latex Glove L Supercare Pasang -
B93 93 Latex Glove M Supercare Pasang -
B94 94 Disposible Syring 3cc TP pcs -
B95 95 Masker 3 ply Karet Remidi pcs -
B96 96 Jarum Hecting Nald Combi Onemed set -
B97 97 Perhidrol 3 % Onemed botol 0
B98 98 Strip Glucose Active @50 Accu Check box 0
B99 99 Strip Glucose @25 easy touch box 0
B100 100 Alkohol Swab pack 0
B101 101 Underpad onemad pack 0
B102 102 Rivanol 0,1% 300ml onemed botol 0
B103 103 Vasofix IV G18X33 mm Green Bbraun pcs 0
B104 104 Vasofix IV G20X33 mm Green Bbraun pcs 0
B105 105 Vasofix IV G22X33 mm Green Bbraun pcs 0
B106 106 Mess no.11 @100 Aesculap Bbraun pack 0
B107 107 Stip HB Family Dr @25 box 0
B108 108 GC-Fuji IX 1-1 #Extra A2 buah 0
B109 109 GC-Fuji VII 1-1 White buah 0
B110 110 GC-Caviton Pink buah 0
B111 111 Biodinamica-Eugenol 20ml botol 0
B112 112 Devitec PD-Non Arsen botol 0
B113 113 Vitapex syringe 0
B114 114 Septodont-Rolde's botol : 13ml botol 0
B115 115 Svenska-saliva ejector : 100pcs Bungkus 0
B116 116 Folley catheter no 24 buah 0
B117 117 Onemed/GT9-Jarum Jahit Kulit No.9 pck : 12 pcs pack 0
B118 118 Onemed/GT10-Jarum Jahit Kulit No.10 pck : 12 pcs pack 0
B119 119 Onemed/GT11-Jarum Jahit Kulit No.11 pck : 12 pcs pack 0
B120 120 Onemed/GT12-Jarum Jahit Kulit No.12 pck : 12 pcs pack 0
B121 121 Onemed/GT13-Jarum Jahit Kulit No.13 pck : 12 pcs pack 0
B122 122 Onemed/GT14-Jarum Jahit Kulit No.14 pck : 12 pcs pack 0
B123 123 Onemed-Wing Needle No. 23 buah 0
B124 124 Onemed-Wing Needle No. 27 buah 0
B125 125 Bene Check - Strip Uric Acid box : 25's box 0
B126 126 Bene Check - Strip Cholesterol box : 10's box 0

Mengetahui/Menyetujui Yang Meyerahkan

Kepala Puskesmas Selemadeg Barat

dr. Wayan Arya Putra Manuaba Ni Made Nuartini

NIP. 197211072005011008 NIP.196412311990032079
PERMINTAAN OBAT (LPLPO) BMHP
NGKEL SARI

RAN BULAN/PERIODE : JANUARI 2018

TAAN BULAN/PERIODE : FEBRUARI 2018

PersediaanPemakaianSisa Stok Stok Opt Permintaan

PenerimaanKet/Exp.

6=(4+5) 7 8 9 10=(9-8) 11
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83 5 78 7
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ng Meyerahkan Yang Meminta/Melapor

Petugas Pustu

Made Nuartini Ni Putu Aristiadewi,A.Md.Keb

6412311990032079 NIP. 198807142017052006