Format Lplpo 2018

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS KLAREYAN
PUSKESMAS : KLAREYAN PELAPORAN BULAN/PERIODE : JANUARI 2018 DOKUMEN NOMOR TANGGAL

KECAMATAN : PETARUKAN PERMINTAAN BULAN/PERIODE : DKK
diisi tiap ada permintaan
KABUPATEN : PEMALANG Cara ngisi: Cara Cara ngisi : obat PUSKESMAS
Di isi tiap awal bulan ngisi: Di isi tiap pemakaian obat (2 bln sekali)
Di isi
tiap STOK PENERI PERSE PEMA KELUAR SISA PERMIN PEMBERIAN :
NO NAMA OBAT SATUAN
terima KET
AWAL MAAN DIAAN KAIAN RUSAK/ED STOK TAAN DAK PKD BS LAIN2 JUMLAH
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT FORNAS
1 ALBENDAZOL TABLET 400 MG TABLET
2 ALLOPURINOL TABLET 100 MG TABLET 768 768 210 558

3 AMINOFILLIN INJEKSI 24 MG/ML AMPUL
4 AMINOFILLIN TABLET 200 MG TABLET 190 190 190

5 AMITRIPTILLIN HCL TABLET SALUT 25 MG TABLET
6 AMOKSISILLIN KAPLET 500 MG KAPLET 231,190 231,190 13,870 217,320 JKN
7 AMOKSISILLIN SIRUP KERING 125 MG/ML BTL 60 ML 484 484 182 302
8 ANTALGIN ( METAMPIRON ) TABLET 500 MG TABLET 12,932 12,932 4,190 8,742
9 ANTASIDA DOEN I SIRUP KOMBINASI BTL 60 ML 297 297 46 251
10 ANTASIDA DOEN I TABLET KOMBINASI TABLET 9,628 9,628 4,998 4,630
11 ANTIBAKTERI DOEN KOMB SK TUBE 161 161 59 102
12 ANTIFUNGI DOEN KOMB SK POT
13 ANTIHEMOROID KOMBINASI SUPPOSITORIA BIJI 83 83 83

14 ANTIMIGREN (ERGOTAMIN TARTRAT 1 MG+KOFEIN 50 MG) TABLET 200 200 200
15 AQUA PRO INJEKSI STERIL 20 ML VIAL 68 68 17 51
16 ASAM ASKORBAT ( VIT C ) TABLET 50 MG TABLET 59,388 59,388 2,178 57,210 JKN 50000
17 ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET 258 258 258

18 ASAM MEFENAMAT KAPLET 500 MG KAPLET 108,237 108,237 3,095 105,142 JKN
19 ASIKLOVIR TABLET 200 MG TABLET 269 269 10 259

20 ASIKLOVIR TABLET 400 MG TABLET 1,134 1,134 123 1,011
21 ATROPIN SULFAT INJEKSI 0.25 MG/ML - 1 ML AMPUL 10 10 10
22 ATTAPULGIT TABLET 600 MG (MOLAGIT/PULAREX) TABLET 6,564 6,564 739 5,825
23 BESI ( II ) SULFAT TABLET SALUT 300 MG TABLET 117,725 117,725 11,446 106,279
24 BETAMETASON KRIM 0.1 % TUBE 254 254 109 145
Cara ngisi: Cara Cara ngisi : obat
Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
25 DEKSAMETASON INJEKSI 5 MG/ML - 1 ML AMPUL 16 16 7 9

26 DEKSAMETASON TABLET 0.5 MG TABLET 107,272 107,272 5,231 102,041 JKN 80000
27 DIAZEPAM INJEKSI 5 MG/ML - 2 ML AMPUL
28 DIAZEPAM TABLET 2 MG TABLET
30 DIFENHIDRAMIN HCL INJ 10 MG/ML - 1 ML AMPUL 10 10 10

31 DIGOKSIN TABLET 0.25 MG TABLET
32 DIMENHIDRINAT TABLET 50 MG TABLET
33 DOKSISIKLIN KAPSUL 100 MG KAPSUL 200 200 200

34 DOMPERIDON TABLET 10 MG TABLET 368 368 65 303
35 EFEDRIN HCL TABLET 25 MG TABLET
36 EPINEFRIN HCL ( ADRENALIN ) INJEKSI 0.1 % - 1 ML AMPUL 24 24 2 22

37 ERITROMISIN SIRUP KERING 200 MG/ML BTL 60 ML
38 ETANOL 70 % BTL 1 LITER 12 12 4 8

39 ETANOL 70 % BTL 100 ML 48 48 48
40 FENITOIN KAPSUL 30 MG TABLET
41 FENOBARBITAL INJEKSI 50 MG/ML - 1 ML AMPUL
42 FENOBARBITAL TABLET 30 MG TABLET 233 233 3 230

43 FITOMENADION ( VIT K1 ) INJEKSI I.M. 2 MG/ML - 1 ML AMPUL 605 605 62 543
44 FITOMENADION ( VIT K1 ) TABLET SALUT GULA 10 MG TABLET 1,440 1,440 45 1,395
45 FUROSEMID TABLET 40 MG TABLET 162 162 12 150
46 GARAM ORALIT SERBUK UNTUK 200 ML AIR SACHET 6,006 6,006 450 5,556
47 GLIBENKLAMID TABLET 5 MG TABLET 6,129 6,129 412 5,717
48 GLUKOSA LARUTAN INFUS 5 % STERIL BTL.500 ML 19 19 1 18
49 GLUKOSA LARUTAN INFUS 10 % STERIL BTL.500 ML
50 GRISEOFULVIN TABLET 125 MG TABLET 980 980 980

51 HALOPERIDOL TABLET 1.5 MG TABLET 340 340 150 190
52 HALOPERIDOL TABLET 5 MG TABLET 720 720 720
53 HIDROKLOROTIAZID ( HCT ) TABLET 25 MG TABLET 99 99 40 59
54 HIDROKORTISON KRIM 2.5 % TUBE 195 195 59 136
55 HYOSIN N BUTILBROMID TABLET 10 MG TABLET
Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
56 IBUPROFEN TABLET 200 MG TABLET 16,000 16,000 608 15,392 JKN 14000
57 IBUPROFEN TABLET 400 MG TABLET
58 ISONIAZID TABLET 100 MG TABLET
59 ISOSORBID DINITRAT TABLET SUBLINGUAL 5 MG TABLET 50 50 50

60 KALSIUM GLUKONAS INJEKSI AMPUL 18 18 3 15
61 KALSIUM LAKTAT ( KALK ) TABLET 500 MG TABLET 68,462 68,462 6,353 62,109 JKN 62000
62 KAOLIN + PECTIN TABLET (OMEGDIAR) TABLET
63 KAPTOPRIL TABLET 25 MG TABLET 17,636 17,636 892 16,744 JKN
64 KARBAMAZEPIN TABLET 200 MG TABLET
65 KETOKONAZOL TABLET 200 MG TABLET 554 554 125 429

66 KLORAMFENIKOL KAPSUL 250 MG KAPSUL
67 KLORAMFENIKOL SALEP MATA TUBE 517 517 43 474

68 KLORAMFENIKOL SUSPENSI 125 MG / 5 ML BTL60 ML 13 13 2 11
69 KLORAMFENIKOL TETES MATA BTL 10 ML
70 KLORAMFENIKOL TETES TELINGA BTL 10 ML
71 KLORFENIRAMIN MALEAT ( CTM ) TABLET 4 MG TABLET 141,795 141,795 6,307 135,488 JKN
72 KLORPROMAZIN HCL TABLET SALUT 100 MG TABLET 761 761 60 701

73 KLORPROMAZIN HCL TABLET SALUT 25 MG TABLET 340 340 340
74 KOTRIMOKSAZOL SUSPENSI BTL 60 ML 160 160 89 71
75 KOTRIMOKSAZOL TABLET KOMB TABLET 17,999 17,999 643 17,356 JKN 17000
76 KUININ TABLET 222 MG TABLET
77 LIDOKAIN 2 % INJEKSI AMPUL
78 LIDOKAIN KOMB INJEKSI (LIDOKAIN HCL 2%+ EPINEFRIN 1:80.000) AMPUL
79 LISOL 50 % 1 LITER BOTOL 20 20 20

80 LORATADIN TABLET 10 MG TABLET 388 388 388
81 MAGNESIUM SULFAT INJEKSI ( IV ) 20 % - 25 ML VIAL 13 13 5 8
82 MAGNESIUM SULFAT INJEKSI ( IV ) 40 % - 25 ML VIAL
83 METFORMIN TABLET 500 MG TABLET
84 METILERGOMETRIN MALEAT INJ 0.200 MG/ML - 1 ML AMPUL 373 373 10 363

85 METILERGOMETRIN MALEAT TABLET SALUT 0.125 MG TABLET
86 METOKLOPRAMID TABLET 10 MG TABLET 854 854 854

Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
87 METRONIDAZOL SIRUP 125MG/ 5 ML BTL 60 ML 9 9 9

88 METRONIDAZOL TABLET 250 MG TABLET 380 380 380
89 METRONIDAZOL TABLET 500 MG TABLET 1,767 1,767 160 1,607
90 MIKONAZOL KRIM 2 % TUBE
91 NATRIUM BIKARBONAT TABLET 500 MG TABLET
92 NATRIUM DIKLOFENAK TABLET 50 MG TABLET
93 NATRIUM KLORIDA LARUTAN INFUS 0.9 % BTL500 ML 25 25 25

94 NIFEDIPIN TABLET 10 MG TABLET 88 88 30 58
95 NISTATIN DROPS 100.000 IU (CAZETIN) BOTOL
96 NISTATIN TABLET SALUT GULA 500.000 IU TABLET 570 570 570

97 NISTATIN TABLET VAGINA 100.000 IU TABLET 182 182 29 153
98 OAT ANAK PAKET 3 3 3
99 OAT KATEGORI I PAKET 32 32 32
100 OAT KATEGORI II PAKET
101 OAT KOMBIPAK KATEGORI I PAKET
102 OAT SISIPAN PAKET
103 OBAT BATUK HITAM ( OBH ) CAIRAN BTL 100 ML 3,078 3,078 141 2,937 JKN
104 OKSITETRASIKLIN HCL SALEP MATA 1 % TUBE
105 OKSITOSIN INJEKSI 10 IU/ML - 1 ML AMPUL 254 254 90 164

106 PARASETAMOL DROPS BOTOL 21 21 8 13
107 PARASETAMOL SIRUP 120 MG/5 ML BTL 60 ML 963 963 820 143
108 PARASETAMOL TABLET 100 MG TABLET
109 PARASETAMOL TABLET 500 MG TABLET 17,492 17,492 13,936 3,556

110 PIRANTEL TABLET 125 MG TABLET
111 PIRIDOKSIN HCL ( VIT B6 ) TABLET 10 MG TABLET 47,304 47,304 2,345 44,959 JKN
112 POLIKRESULEN ( ALBOTHYL CONC ) BTL 10 ML
113 POVIDON IODIDA LAR 10 % BTL 30 ML 132 132 92 40

114 POVIDON IODIDA LAR 10 % BTL 60 ML
115 POVIDON IODIDA LAR 10 % BTL 300 ML 10 10 10

116 PREDNISON TABLET 5 MG TABLET 15,775 15,775 1,385 14,390
117 PRIMAKUIN TABLET 15 MG TABLET
Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
118 PROPANOLOL HCL TABLET 40 MG TABLET
119 RANITIDINE TABLET 150 MG TABLET 1,630 1,630 675 955

120 RETINOL ( VIT A ) KAPSUL LUNAK 100.000 IU KAPSUL 2,700 2,700 2,700
122 RINGER LAKTAT LARUTAN INFUS STERIL BTL 500 ML 272 272 87 185
123 SALBUTAMOL TABLET 2 MG TABLET
124 SALEP 2-4 KOMB POT 106 106 21 85

125 SALISIL BEDAK SERBUK 2 % BIJI 285 285 91 194
126 SERUM ANTI BISA ULAR POLIVALEN ( ABU I ) INJEKSI 5 ML VIAL 25 25 4 21
127 SERUM ANTI TETANUS ( ATS ) INJEKSI 1.500 IU - 1 ML AMPUL 60 60 2 58
128 SIANOKOBALAMIN ( VIT B12 ) INJEKSI 500 MCG/ML - 1 ML AMPUL
129 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET
130 SIMVASTATIN TABLET 10 MG TABLET 305 305 213 92

131 SIPROFLOKSASIN TABLET 500 MG TABLET 2,527 2,527 412 2,115
132 SPIRONOLACTONE TABLET 25 MG TABLET
133 TETRASIKLIN HCL KAPSUL 250 MG KAPSUL 352 352 20 332

134 TETRASIKLIN HCL KAPSUL 500 MG KAPSUL 2,053 2,053 60 1,993
135 TIAMIN HCL ( VIT B1 ) INJEKSI 100 MG/ML - 1 ML AMPUL
136 TIAMIN HCL ( VIT B1 ) TABLET 50 MG TABLET 60,609 60,609 2,564 58,045 JKN 50000
137 TRIHEXIFENIDIL TABLET 2 MG TABLET 370 370 30 340

138 VITAMIN B KOMPLEKS TABLET TABLET 77,636 77,636 3,819 73,817 JKN 75000
139 ZINC TABLET DISPERSIBLE 20 MG TABLET 1,477 1,477 334 1,143
PERBEKALAN KESEHATAN
1 ALAT SUNTIK 0.05 ML BIJI 234 234 84 150
2 ALAT SUNTIK 0.5 ML BIJI
3 ALAT SUNTIK 1 ML BIJI 373 373 94 279

4 ALAT SUNTIK 3 ML BIJI 1,197 1,197 306 891
6 ALAT SUNTIK 10 ML BIJI 100 100 100
Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
8 ALAT SUNTIK 50 ML BIJI
9 BLOOD TRANSFUSION SET SET 221 221 41 180 JKN
10 CATGUT CHROMIC / BENANG BEDAH NO.2/0 BIJI
11 CATGUT CHROMIC / BENANG BEDAH NO.3/0 BIJI 137 137 43 94

12 CATGUT CHROMIC / BENANG BEDAH NO.3/0 ROL 100 M ROL
13 CATGUT PLAIN / BENANG BEDAH NO.2/0 BIJI
15 CATGUT PLAIN / BENANG BEDAH NO.3/0 ROL 100 M ROL
16 FOLLEY CATHETER NO. 14 BIJI
18 FOLLEY CATHETER NO. 18 BIJI 29 29 6 23

19 HIPAFIX 5 CM X 0.5 M (PHARMAFIX) ROL 2 2 2
20 HIPAFIX 10 CM X 0.5 M (PHARMAFIX) ROL
21 HIPAFIX 15 CM X 0.5 M (PHARMAFIX) ROLL 10 10 10

22 INFUSION SET ANAK SET 16 16 16
23 INFUSION SET DEWASA SET 143 143 20 123
24 IV CATHETER NO. 16 BIJI
25 IV CATHETER NO. 18 BIJI 200 200 100 100

29 IV CATHETER NO. 26 BIJI 57 57 57
30 JARUM JAHIT KULIT ( BEDAH ) NO. 12 SAK 12'S
32 JARUM JAHIT KULIT NO. 32 SAK 12'S
35 JARUM JAHIT OTOT BESAR NO. 8 SAK 12'S
36 JARUM JAHIT OTOT KECIL NO. 15 SAK 12'S
37 KAPAS PEMBALUT 250 GR BUNGKUS 18 18 1 17

38 KAPAS PEMBALUT 500 GR BUNGKUS
39 KASA PEMBALUT 2 M X 80 CM ROL

Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
40 KASA PEMBALUT 4 M X 15 CM ROL 58 58 48 10

41 KASA STERIL 16/16 KOTAK 389 389 62 327
42 KASA STERIL 40/40 BIJI
43 KASA VERBAN GULUNG 80 CM ROL 3 3 3

44 LEUKOPLAST HOSPITAL 2.5 CM X 4.5 CM ROLL
45 LEUKOPLAST HOSPITAL 7.5 CM X 4.5 M ROLL
46 MASKER EAR LOOP (KARET) BIJI 350 350 100 250

47 MASKER TIE ON (TALI) BIJI 571 571 571
48 NEEDLE 23 G X 5/8 SET
51 ONEMED ULTRA ONE TEST HAMIL PCS 950 950 950

52 SARUNG TANGAN GYNECOLOG NO. 6.5 PAIR
53 SARUNG TANGAN GYNECOLOG NO. 7 PAIR 28 28 28

54 SARUNG TANGAN GYNECOLOG NO. 7.5 PAIR 120 120 36 84
55 SARUNG TANGAN NO. 6 PSC 0
56 SARUNG TANGAN NO. 6,5 PASANG 172 172 172
57 SARUNG TANGAN NO. 7 PSG 194 194 162 32
58 SARUNG TANGAN NO. 7.5 PSG 200 200 200
60 SARUNG TANGAN SIZE M PASANG 4,100 4,100 1,200 2,900
61 SARUNG TANGAN SIZE S PASANG 400 400 400
62 SELANG OKSIGEN ANAK PCS 55 55 2 53 JKN 50
63 SELANG OKSIGEN DEWASA PCS 103 103 2 101 JKN 100
64 SILK ( BENANG BEDAH ) NO. 2/0 BIJI
65 SILK ( BENANG BEDAH ) NO. 3/0 BIJI 8 8 7 1

66 SILK ( BENANG BEDAH ) NO. 3/0 ROL (ZEIDE) ROL
67 SLIM SECHER BAYI BIJI 977 977 9 968

68 UMBILICAL CORD KLEM STERIL NYLON BIJI 310 310 25 285 JKN
69 UNDER PAD STERIL 60 X 90 CM PCS 1,280 1,280 94 1,186 JKN
70 URINE BAG BIJI 66 66 7 59

71 WING NEEDLE NO. 21 SET
Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
73 WING NEEDLE NO. 25 SET 51 51 51 JKN
OBAT GIGI
1 ETIL KLORIDA SEMPROT BOTOL 14 14 1 13 JKN
2 EUGENOL CAIRAN BOTOL 1 1 1 JKN
OBAT TAMBAHAN
1 ALKOHOL HAND RUB (PENCUCI TANGAN TANPA BILAS) BOTOL 22 22 22
2 ALKOHOL SWAB SACHET 2,950 2,950 250 2,700 JKN
3 ALLETROL TETES MATA BTL 5 ML 35 35 12 23

4 ALOPURINOL TABLET 300 MG TABLET 1,000 1,000 18 982
5 ALPRAZOLAM TABLET 0.5 MG TABLET
6 AMBROKSOL SIRUP BOTOL 1,989 1,989 53 1,936 JKN
7 AMBROKSOL TABLET 30 MG TABLET 28,377 28,377 1,538 26,839 JKN
8 AMLODIPIN TABLET 5 MG TABLET 290 290 87 203

9 AMLODIPIN TABLET 10 MG TABLET
10 AMOKSISILIN SERBUK INJEKSI 1000 MG VIAL
11 AMOKSISILIN+ASAM KLAVUL. SUSP BTL
12 AMOKSISILLIN 500 MG + ASAM KLAVULANAT 125 MG TABLET TABLET
13 AMPISILLIN SERBUK INJ 1000MG/ ML VIAL
14 ANTASIDA + SIMETIKON SIRUP (NUVAMAG) BTL 60 ML 16 16 2 14

15 ANTASIDA + SIMETIKON TAB (ATMACID) TABLET
16 AQUADESTILATA STERIL BTL 500 ML
17 ASAM FOLAT TABLET 0,4 MG TABLET 1,990 1,990 1,990

18 ASAM TRANEKSAMAT INJEKSI 50 MG/ML AMPUL
19 ASETOSAL TABLET 100 MG TABLET
21 ASETOSAL TABLET 80 MG (MINIASPI) TABLET
22 ASIKLOVIR KRIM 5 % TUBE 132 132 18 114

Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
23 BATUGIN ELIKSIR BTL 120 ML
24 BERODUAL SOL BOTOL
25 BERODUAL SPRAY BOTOL
26 BETAHISTIN MESILAT TAB 6 MG (HISTIGO) TABLET 1,110 1,110 30 1,080

27 BETAMETHASON PLUS SK (ERLADERM) TUBE 70 70 7 63
28 BISAKODIL TABLET (BICOLAX) TABLET 437 437 39 398
29 BISAKODIL SUPPO 5 MG BIJI 72 72 72
30 BISAKODIL SUPPO 10 MG BIJI
31 BISOPROLOL TABLET
32 BROMHEXINE HCL SYRUP BTL 60 ML
33 BROMHEXINE HCL TAB 4 MG TABLET 2,000 2,000 2,000

34 CIMETIDINE INJEKSI AMPUL
35 CIMETIDINE TABLET 200 MG TABLET
36 DEXTEEM PLUS TABLET TABLET 2,600 2,600 273 2,327

37 DIAZEPAM LAR RECTAL 5 MG/2,5 ML (STESOLID RECTAL) TUBE 31 31 1 30
38 DILTIAZEM HCL TABLET 30 MG TABLET
39 DOKSAZOSIN TABLET (CARDURA) TABLET
40 DOMPERIDON SIRUP BOTOL 16 16 16

41 DUTASTERID (AVODART) TABLET
42 EFAVIRENS TABLET SALUT 600 MG TABLET
43 EKSTRAK BELLADON TABLET 10 MG TABLET
44 EKSTRAK PLACENTA + NEOMYCIN JELLY (NEOCENTA JEL) TUBE 50 50 2 48

45 ENKASARI LIQUID BTL 120 ML
46 ENZYMFORT TABLET SALUT ENTERIK TABLET
47 ERITROMISIN KAPLET SALUT SELAPUT 500 MG KAPLET
48 ERYTHROMYCIN 250 MG KAPSUL
49 ETAKRIDIN ( RIVANOL ) LAR 1 % BTL 100 ML
50 ETAKRIDIN ( RIVANOL ) LAR 1 % BTL 300 ML 89 89 17 72

51 FENOTEROL HBR AEROSOL 100 MCG/DOSIS (BEROTEC MDI) BOTOL
52 FLU KOMBINASI + BATUK SIRUP BOTOL 207 207 79 128

53 FLU KOMBINASI + BATUK TABLET (HUSTAB) TABLET
Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
54 FLU KOMBINASI SIRUP (MOLEXFLU) BOTOL 92 92 52 40

55 FLU KOMBINASI TABLET (AFLUCAPS) KAPLET
56 FRAMISETIN SULFAT 1 % (BIOPLACENTON TULLE/LOMATUEL) LEMBAR 29 29 9 20

57 GEMFIBROZIL KAPSUL 300 MG KAPSUL 416 416 108 308
58 GENTAMISIN INJEKSI 40 MG/ ML AMPUL
59 GENTAMISIN SALEP KULIT (GENTALEX) TUBE
60 GENTAMISIN SALEP MATA 0,3% TUBE 96 96 96

61 GENTAMISIN TETES MATA 0,3% (GENOINT) BOTOL 282 282 109 173
62 GENTIAN VIOLET LAR 1 % BTL 10 ML
63 GLIMEPIRIDE TABLET 1 MG TABLET
65 GLIMEPIRIDE TABLET 4 MG TABLET 145 145 20 125

66 HALOPERIDOL TABLET 0,5 MG TABLET
67 HARNAL OCAS (TAMSULOSIN HCL 0.4 MG) TABLET
68 HEMOROGARD KAPSUL KAPSUL
69 HEPAGARD KAPSUL KAPSUL
70 HEPARIN 20.000 IU (HICO JEL) TUBE
71 HYOSIN N BUTILBROMID INJEKSI (SPASHI) AMPUL
72 HYOSIN N BUTILBROMID TABLET PLUS TABLET 328 328 20 308

73 IBUPROFEN SUSPENSI 100 MG/ 5 ML BOTOL 100 100 100
74 IMULAN KAPSUL KAPSUL
75 IMULAN SIRUP BOTOL
77 ITRAKONAZOL KAPSUL KAPSUL
78 KALIUM ASPARTAT TABLET 300 MG (ASPAR-K/KALIPAR) TABLET 100 100 100

79 KALIUM DIKLOFENAK TABLET 50 MG TABLET
80 KAOLIN + PECTIN SIRUP (OMEGDIAR) BOTOL 138 138 13 125

81 KAPTOPRIL TABLET 12.5 MG TABLET
82 KARBO ABSORBEN TABLET TABLET
83 KETOKONAZOL KRIM 2 % TUBE 93 93 16 77

84 KLINDAMISIN KAPSUL/KAPLET 150 MG KAPSUL
Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
86 KLONIDIN TABLET 0.15 MG TABLET
87 KLORAMFENIKOL INJEKSI I.V. 100 MG VIAL
88 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 135 135 40 95

89 KLORAMFENIKOL SALEP KULIT 2% TUBE
90 KLOZAPIN 25 MG TABLET TABLET 950 950 90 860

91 KLOZAPIN 100 MG TABLET TABLET 470 470 470
92 KODEIN TABLET 10 MG TABLET 1,110 1,110 110 1,000
93 KOTRIMOKSAZOL FORTE TABLET TABLET 578 578 578
94 LAMIVUDINE (3TC) 150 MG TABLET
95 LEVOTIROKSIN TABLET/KAPSUL 100 MCG TABLET
96 LIDOKAIN HCL 20 MG/G JEL (XYLOCAINE JELLY 2%) BIJI 2 2 2

97 LIDOKAIN SPRAY BOTOL 8 8 3 5
98 LINKOMISIN KAPSUL 500 MG KAPSUL
99 LISINOPRIL TABLET 5 MG TABLET
101 LOPERAMID TABLET 2 MG (NOVADIUM) TABLET
102 MDT MB ANAK BLISTER
103 MDT MB DEWASA BLISTER 29 29 3 26

104 MDT PB ANAK BLISTER
105 MDT PB DEWASA BLISTER
106 MELOXICAM TABLET 15 MG TABLET
107 METILDOPA TABLET 250 MG (DOPAMET) TABLET 86 86 86

108 METILPREDNISOLON TABLET 4 MG TABLET 2,060 2,060 10 2,050
109 METILPREDNISOLON TABLET 8 MG TABLET
110 METOKLOPRAMID DROP 10 ML (GAVISTAL) BOTOL
111 METOKLOPRAMID SIRUP 5 MG/ 5 ML (LEXAPRAM) BOTOL 5 5 5

112 METOKLOPRAMID TABLET 5 MG TABLET
113 METRONIDAZOL INFUS 5 MG/ ML BOTOL
114 METRONIDAZOL OVULA 500 MG BIJI 100 100 100

115 MINERAL MIX SACHET
Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
116 MINYAK KAYU PUTIH 30 ML BOTOL
118 MINYAK TELON 30 ML BOTOL
120 MISOPROSTOL TABLET 200 MCG (GASTRUL) TABLET
121 MOLAKRIM TUBE 5 5 5

122 MULTIVITAMIN DROPS (CAVIPLEX/VITACHILD) BOTOL
123 MULTIVITAMIN SIRUP (PACDIN VITCUR,RECOVIT,DLL) BOTOL 108 108 44 64

124 MULTIVITAMIN TAB (VITALAMIN) TABLET 4,637 4,637 1,494 3,143
125 N-ASETIL SISTEIN TABLET/KAPSUL 200 MG KAPSUL 40,741 40,741 2,474 38,267
126 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 3,702 3,702 1,230 2,472
127 NEUROTROPIC KAPLET (IFIBION) KAPLET 4,784 4,784 1,513 3,271
128 NEUROTROPIK 5000 (NUTRALIX 5000) KAPLET
129 NEUROTROPIK PLUS TABLET (PRITAGESIC) KAPLET 90 90 90

130 NEVIRAPIN 200 MG TABLET
131 NIFEDIPIN TABLET 30 MG (ADALAT OROS) TABLET
132 OCUGARD KAPSUL KAPSUL 90 90 17 73

133 OFLOXACIN TABLET 200 MG TABLET
134 OKSITETRASIKLIN SALEP KULIT TUBE
135 OMEPRAZOL INJEKSI 40 MG/ 10 ML VIAL
136 OMEPRAZOLE KAPSUL 20 MG TABLET 979 979 84 895

137 ONDANSETRON INJEKSI AMPUL
138 ONDANSETRON TABLET/KAPSUL 4 MG TABLET 1,387 1,387 157 1,230

139 PANVITON KAPSUL KAPSUL 605 605 102 503
140 PEHACAIN INJEKSI AMPUL 80 80 23 57
141 PERMETRIN KRIM 5 % (SCABIMITE CREAM 10) TUBE 20 20 9 11
142 PETIDIN INJEKSI 50 MG/ML AMPUL
143 PIRACETAM TABLET TABLET
144 PIROXICAM TABLET 20 MG TABLET 1,478 1,478 516 962

145 PROKAIN BENZIL PENISILIN INJEKSI VIAL

Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
147 PROPILTIOURASIL TABLET 100 MG TABLET
148 PROTECAL SOLID EFF TABLET
149 RAPID 1 HIV (INTEC/SD) TEST 100 100 100

150 RAPID 2 HIV (BIOMERIK VIKIA) TEST
151 RAPID 3 HIV (ONCOPROBE) TEST
152 RAPID SYPHILLIS (CARD) TEST
153 RDT MALARIA TEST
154 REAGEN SHIPILIS (VDRL) TEST
155 RISPERIDON TABLET 1 MG TABLET
156 RISPERIDONE TABLET 2 MG TABLET
158 SEFADROKSIL KAPSUL 500 MG KAPSUL 601 601 60 541

159 SEFADROKSIL SIRUP KERING 125 MG/5 ML BOTOL 299 299 2 297
160 SEFADROKSIL SIRUP KERING 250 MG/5 ML BOTOL 47 47 47
161 SEFIKSIM 400 MG + AZITROMISIN 1000 MG PAKET
162 SEFIKSIM KAPSUL 100 MG KAPSUL
163 SEFIKSIM SIRUP KERING 100 MG/5 ML BOTOL 42 42 42

164 SEFOTAKSIM INJEKSI 1 GR VIAL
165 SEFTRIAKSON INJEKSI 1 GR VIAL
166 SETIRIZIN KAPSUL 10 MG KAPSUL 530 530 54 476

167 SETIRIZINE SIRUP 5 MG / 5 ML BOTOL 48 48 48
168 SIPROFLOKSASIN INFUS BOTOL
169 SPIRAMYCIN TABLET 500 MG TABLET
170 SULFASETAMID NATRIUM TETES MATA 15 % BTL 5 ML 190 190 6 184

171 TABLET TAMBAH DARAH PATEN (NOVABION/SAMCOBION) TABLET
172 TABURIA SACHET
173 TENOFOVIR (TDF) 300 MG TABLET
174 TENSIGARD KAPSUL KAPSUL
175 TEOFILIN TABLET SR 300 MG (RETHAPYL) TABLET
176 THIAMFENIKOL KAPSUL 500 MG KAPSUL 225 225 15 210

177 THIAMFENIKOL SIRUP BOTOL
Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
178 TRAMADOL INJEKSI 50 MG/ML AMPUL
179 TRAMADOL KAPSUL 50 MG KAPSUL
180 TRIFLUOPERAZINE TABLET 5 MG TABLET
181 VALVED SIRUP (TRIPOLIDIN) BTL 60 ML 19 19 1 18

182 VALVED TABLET (TRIPROLIDIN - QUANTIDEX) TABLET 244 244 6 238
183 VENTOLIN INHALER BOTOL
184 ZIDOVUDIN 300 MG + LAMIVUDINE 150 MG TABLET
185 ZINC SIR 20 MG/ 5 ML BOTOL 41 41 41

186 KARBO GLISERIN T.TELINGA BOTOL 36 36 36
187 USG GEL 250 ML BOTOL 42 42 3 39 JKN
188 ASEPTIK/ALKOHOL GEL 500 ML BOTOL 148 148 148 JKN
189 SARUNG TANGAN OBGYN PCS 955 955 955 JKN
190 SELANG OKSIGEN BAYI PCS 200 200 200 JKN
191 IV CATHETER WITH INJECTION PORT NO.22 PCS 200 200 200 JKN
192 CHLORHEXIDINE 4% 500 ML BOTOL 10 10 10 JKN
OBAT GIGI
193 BAHAN TUMPATAN TETAP (FUJI IX ) SET 1 1 1 JKN
194 BAHAN TUMPATAN SEMENTARA ( CAVITON WHITE GC ) BOTOL 1 1 1 JKN
195 BAHAN TUMPATAN SEMENTARA ( ORAFIL PLUS ) BOTOL 1 1 1 JKN
196 JARUM CITO JEK PCS 45 45 45

197 OBJECT GLASS BIJI 72 72 55 17
198 FLU BATUK TABLET WICOLD TABLET 3,607 3,607 1,827 1,780
199 FLU BATUK TABLET BRONCHIFAR TABLET 2,750 2,750 552 2,198
200 LOSMAN WASIR KAPSUL 528 528 58 470
BPJS NON
BAYAR BPJS PBI JAMKESDA GRATIS JUMLAH GENERIK TOTAL
JUMLAH KUNJUNGAN RESEP PBI JUMLAH R/
1916 2801 330 24 5071 11239 12471
Mengetahui / menyetujui,
Kepala Dinas Kesehatan Yang menyerahkan, Yang Meminta, Yang Menerima,
Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
KABUPATEN PEMALANG KEPALA BIDANG PELAYANAN DAN SDK KEPALA UPT PUSKESMAS UPT PUSKESMAS KLAREYAN
dr. ERNA NURAINI, M.Hlth.,Sc. AKHMAD SARIFUDIN, S.KM, MM. dr.WENDY NURYANTI TRI LESTIYORINI
NIP. 19630329 198903 2 007 NIP. 19660204 199103 1 004 NIP.19800123 200604 2 010 NIP.19860906 200501 2 003
PUSKESMAS KLAREYAN
PUSKESMAS : KLAREYAN PELAPORAN BULAN/PERIODE : FEBRUARI 2018 DOKUMEN NOMOR TANGGAL

KECAMATAN : PETARUKAN PERMINTAAN BULAN/PERIODE : APRIL 2018 DKK
KABUPATEN : PEMALANG Cara ngisi: Cara Cara ngisi : obat PUSKESMAS
Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT FORNAS
1 ALBENDAZOL TABLET 400 MG TABLET 15,000 15,000 15,000
2 ALLOPURINOL TABLET 100 MG TABLET 558 558 436 122 1,622
4 AMINOFILLIN TABLET 200 MG TABLET
7 AMOKSISILLIN SIRUP KERING 125 MG/ML BTL 60 ML 302 300 602 157 445 183
8 ANTALGIN ( METAMPIRON ) TABLET 500 MG TABLET 8,742 8,742 3,361 5,381 8,063
9 ANTASIDA DOEN I SIRUP KOMBINASI BTL 60 ML 251 251 51 200 200
10 ANTASIDA DOEN I TABLET KOMBINASI TABLET 4,630 5,500 10,130 4,958 5,172 14,660
11 ANTIBAKTERI DOEN KOMB SK TUBE 102 102 70 32 248

15 AQUA PRO INJEKSI STERIL 20 ML VIAL 51 51 13 38 14
17 ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET 258 258 40 218


20 ASIKLOVIR TABLET 400 MG TABLET 1,011 1,011 65 946
24 BETAMETASON KRIM 0.1 % TUBE 145 200 345 47 298
Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
25 DEKSAMETASON INJEKSI 5 MG/ML - 1 ML AMPUL 9 9 9


32 DIMENHIDRINAT TABLET 50 MG TABLET 500 500 20 480

33 DOKSISIKLIN KAPSUL 100 MG KAPSUL 200 200 10 190
36 EPINEFRIN HCL ( ADRENALIN ) INJEKSI 0.1 % - 1 ML AMPUL 22 22 22

38 ETANOL 70 % BTL 1 LITER 8 8 1 7

39 ETANOL 70 % BTL 100 ML 48 48 20 28 52

45 FUROSEMID TABLET 40 MG TABLET 150 150 150
46 GARAM ORALIT SERBUK UNTUK 200 ML AIR SACHET 5,556 5,556 434 5,122
48 GLUKOSA LARUTAN INFUS 5 % STERIL BTL.500 ML 18 18 18
50 GRISEOFULVIN TABLET 125 MG TABLET 980 980 100 880

51 HALOPERIDOL TABLET 1.5 MG TABLET 190 190 60 130 110
52 HALOPERIDOL TABLET 5 MG TABLET 720 720 90 630
53 HIDROKLOROTIAZID ( HCT ) TABLET 25 MG TABLET 59 200 259 8 251
54 HIDROKORTISON KRIM 2.5 % TUBE 136 136 40 96 64
Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
59 ISOSORBID DINITRAT TABLET SUBLINGUAL 5 MG TABLET 50 50 10 40

60 KALSIUM GLUKONAS INJEKSI AMPUL 15 15 15
61 KALSIUM LAKTAT ( KALK ) TABLET 500 MG TABLET 62,109 62,109 7,459 54,650 JKN 62000
63 KAPTOPRIL TABLET 25 MG TABLET 16,744 16,744 1,026 15,718 JKN
65 KETOKONAZOL TABLET 200 MG TABLET 429 429 103 326 200


68 KLORAMFENIKOL SUSPENSI 125 MG / 5 ML BTL60 ML 11 11 11
74 KOTRIMOKSAZOL SUSPENSI BTL 60 ML 71 300 371 88 283 200
75 KOTRIMOKSAZOL TABLET KOMB TABLET 17,356 17,356 629 16,727 JKN 17000
79 LISOL 50 % 1 LITER BOTOL 20 20 1 19

81 MAGNESIUM SULFAT INJEKSI ( IV ) 20 % - 25 ML VIAL 8 20 28 9 19


Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
87 METRONIDAZOL SIRUP 125MG/ 5 ML BTL 60 ML 9 9 2 7

88 METRONIDAZOL TABLET 250 MG TABLET 380 380 108 272
93 NATRIUM KLORIDA LARUTAN INFUS 0.9 % BTL500 ML 25 25 25

94 NIFEDIPIN TABLET 10 MG TABLET 58 58 30 28 200
96 NISTATIN TABLET SALUT GULA 500.000 IU TABLET 570 570 10 560

99 OAT KATEGORI I PAKET 32 32 2 30
105 OKSITOSIN INJEKSI 10 IU/ML - 1 ML AMPUL 164 164 58 106 126

106 PARASETAMOL DROPS BOTOL 13 13 4 9
107 PARASETAMOL SIRUP 120 MG/5 ML BTL 60 ML 143 2,100 2,243 806 1,437 1,787
109 PARASETAMOL TABLET 500 MG TABLET 3,556 30,000 33,556 12,126 21,430 27,074
110 PIRANTEL TABLET 125 MG TABLET 300 300 300
113 POVIDON IODIDA LAR 10 % BTL 30 ML 40 40 27 13 95


116 PREDNISON TABLET 5 MG TABLET 14,390 14,390 936 13,454
Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
119 RANITIDINE TABLET 150 MG TABLET 955 955 426 529 1,175
120 RETINOL ( VIT A ) KAPSUL LUNAK 100.000 IU KAPSUL 2,700 2,700 700 2,000
121 RETINOL ( VIT A ) KAPSUL LUNAK 200.000 IU KAPSUL 9,800 9,800 6,700 3,100
122 RINGER LAKTAT LARUTAN INFUS STERIL BTL 500 ML 185 185 47 138 100
124 SALEP 2-4 KOMB POT 85 85 22 63 50

125 SALISIL BEDAK SERBUK 2 % BIJI 194 194 63 131 121
126 SERUM ANTI BISA ULAR POLIVALEN ( ABU I ) INJEKSI 5 ML VIAL 21 21 21
130 SIMVASTATIN TABLET 10 MG TABLET 92 92 60 32 1,000

131 SIPROFLOKSASIN TABLET 500 MG TABLET 2,115 2,115 537 1,578 1,000
133 TETRASIKLIN HCL KAPSUL 250 MG KAPSUL 332 332 332

137 TRIHEXIFENIDIL TABLET 2 MG TABLET 340 300 640 60 580

138 VITAMIN B KOMPLEKS TABLET TABLET 73,817 73,817 3,624 70,193 JKN
139 ZINC TABLET DISPERSIBLE 20 MG TABLET 1,143 1,143 279 864 500
1 ALAT SUNTIK 0.05 ML BIJI 150 150 110 40


7 ALAT SUNTIK 20 ML BIJI 125 125 38 87 65
Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
9 BLOOD TRANSFUSION SET SET 180 200 380 2 378 JKN

18 FOLLEY CATHETER NO. 18 BIJI 23 23 12 11 37


25 IV CATHETER NO. 18 BIJI 100 100 72 28 260

37 KAPAS PEMBALUT 250 GR BUNGKUS 17 17 4 13 3


Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
40 KASA PEMBALUT 4 M X 15 CM ROL 10 200 210 17 193

41 KASA STERIL 16/16 KOTAK 327 100 427 19 408

45 LEUKOPLAST HOSPITAL 7.5 CM X 4.5 M ROLL 5 5 5

46 MASKER EAR LOOP (KARET) BIJI 250 250 100 150 250
47 MASKER TIE ON (TALI) BIJI 350 350 220 130 750

53 SARUNG TANGAN GYNECOLOG NO. 7 PAIR

55 SARUNG TANGAN NO. 6 PSC
56 SARUNG TANGAN NO. 6,5 PASANG 172 172 27 145 200

58 SARUNG TANGAN NO. 7.5 PSG 200 200 68 132 140
60 SARUNG TANGAN SIZE M PASANG 2,900 2,900 800 2,100 1,100
61 SARUNG TANGAN SIZE S PASANG
62 SELANG OKSIGEN ANAK PCS 53 53 53 JKN 50
63 SELANG OKSIGEN DEWASA PCS 101 101 6 95 JKN
65 SILK ( BENANG BEDAH ) NO. 3/0 BIJI 1 1 1

67 SLIM SECHER BAYI BIJI 968 968 968


Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT GIGI
2 EUGENOL CAIRAN BOTOL 1 1 1 JKN
OBAT TAMBAHAN
1 ALKOHOL HAND RUB (PENCUCI TANGAN TANPA BILAS) BOTOL 22 22 1 21

3 ALLETROL TETES MATA BTL 5 ML 23 23 7 16 24

4 ALOPURINOL TABLET 300 MG TABLET 982 982 86 896
8 AMLODIPIN TABLET 5 MG TABLET 203 203 44 159 200


15 ANTASIDA + SIMETIKON TAB (ATMACID) TABLET 3,000 3,000 82 2,918 3,000

22 ASIKLOVIR KRIM 5 % TUBE 114 100 214 11 203

Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
26 BETAHISTIN MESILAT TAB 6 MG (HISTIGO) TABLET 1,080 1,080 1,080

27 BETAMETHASON PLUS SK (ERLADERM) TUBE 63 30 93 5 88 200
33 BROMHEXINE HCL TAB 4 MG TABLET 2,000 2,000 3 1,997

35 CIMETIDINE TABLET 200 MG TABLET 2,000 2,000 56 1,944

37 DIAZEPAM LAR RECTAL 5 MG/2,5 ML (STESOLID RECTAL) TUBE 30 30 30


50 ETAKRIDIN ( RIVANOL ) LAR 1 % BTL 300 ML 72 100 172 6 166

52 FLU KOMBINASI + BATUK SIRUP BOTOL 128 128 39 89 200

Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
54 FLU KOMBINASI SIRUP (MOLEXFLU) BOTOL 40 180 220 26 194 200


57 GEMFIBROZIL KAPSUL 300 MG KAPSUL 308 308 84 224 112

61 GENTAMISIN TETES MATA 0,3% (GENOINT) BOTOL 173 173 99 74 322
65 GLIMEPIRIDE TABLET 4 MG TABLET 125 125 30 95 200


78 KALIUM ASPARTAT TABLET 300 MG (ASPAR-K/KALIPAR) TABLET 100 100 8 92

80 KAOLIN + PECTIN SIRUP (OMEGDIAR) BOTOL 125 96 221 19 202 100

83 KETOKONAZOL KRIM 2 % TUBE 77 77 18 59 50

Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
88 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 95 95 30 65 55


92 KODEIN TABLET 10 MG TABLET 1,000 1,000 80 920
93 KOTRIMOKSAZOL FORTE TABLET TABLET 578 578 578

97 LIDOKAIN SPRAY BOTOL 5 5 5




Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

123 MULTIVITAMIN SIRUP (PACDIN VITCUR,RECOVIT,DLL) BOTOL 64 120 184 38 146 100
124 MULTIVITAMIN TAB (VITALAMIN) TABLET 3,143 3,143 1,344 1,799 3,577
126 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 2,472 2,472 929 1,543 2,173
127 NEUROTROPIC KAPLET (IFIBION) KAPLET 3,271 3,271 1,050 2,221 1,979
129 NEUROTROPIK PLUS TABLET (PRITAGESIC) KAPLET



141 PERMETRIN KRIM 5 % (SCABIMITE CREAM 10) TUBE 11 11 4 7 50
144 PIROXICAM TABLET 20 MG TABLET 962 2,000 2,962 414 2,548


Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
149 RAPID 1 HIV (INTEC/SD) TEST




172 TABURIA SACHET

Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16


186 KARBO GLISERIN T.TELINGA BOTOL 36 36 4 32
188 ASEPTIK/ALKOHOL GEL 500 ML BOTOL 148 148 1 147 JKN
OBAT GIGI
193 BAHAN TUMPATAN TETAP (FUJI IX ) SET 1 1 1 JKN
194 BAHAN TUMPATAN SEMENTARA ( CAVITON WHITE GC ) BOTOL 1 1 1 JKN
195 BAHAN TUMPATAN SEMENTARA ( ORAFIL PLUS ) BOTOL 1 1 1 JKN

198 FLU BATUK TABLET WICOLD TABLET 1,780 3,000 4,780 1,724 3,056 3,840
199 FLU BATUK TABLET BRONCHIFAR TABLET 2,198 3,000 5,198 728 4,470
200 LOSMAN WASIR KAPSUL 470 470 128 342 100
BPJS NON
JUMLAH KUNJUNGAN RESEP PBI JUMLAH R/
1755 2917 60 31 4763 10524 11726
Di isi
NO NAMA OBAT SATUAN
terima KET
obat
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
NIP. 19630329 198903 2 007 NIP. 19660204 199103 1 004 NIP.19800123 200604 2 010 NIP.19860906 200501 2 003
PUSKESMAS KLAREYAN
PUSKESMAS : KLAREYAN PELAPORAN BULAN/PERIODE : MARET 2018 DOKUMEN NOMOR TANGGAL

KABUPATEN : PEMALANG Cara ngisi: Cara ngisi: Cara ngisi : obat PUSKESMAS
Di isi dari sisa stok bln lalu Di isi tiap terima obat Di isi tiap pemakaian obat (2 bln sekali)
STOK PENERI PERSE PEMA KELUAR SISA PERMIN PEMBERIAN :

NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN RUSAK/ED STOK TAAN
PKD KAB PKD PROP PKPS LAIN-2 JUMLAH
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT FORNAS
2 ALLOPURINOL TABLET 100 MG TABLET 122 1,000 1,122 163 959
4 AMINOFILLIN TABLET 200 MG TABLET 300 300 300

10 ANTASIDA DOEN I TABLET KOMBINASI TABLET 5,172 5,172 5,172
13 ANTIHEMOROID KOMBINASI SUPPOSITORIA BIJI 83 83 3 80
15 AQUA PRO INJEKSI STERIL 20 ML VIAL 38 38 7 31
23 BESI ( II ) SULFAT TABLET SALUT 300 MG TABLET 94,226 112,320 206,546 10,542 196,004
Cara ngisi: Cara ngisi: Cara ngisi : obat

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
25 DEKSAMETASON INJEKSI 5 MG/ML - 1 ML AMPUL 9 9 2 7
39 ETANOL 70 % BTL 100 ML 28 28 28
46 GARAM ORALIT SERBUK UNTUK 200 ML AIR SACHET 5,122 5,122 3,845 1,277
50 GRISEOFULVIN TABLET 125 MG TABLET 880 880 880
53 HIDROKLOROTIAZID ( HCT ) TABLET 25 MG TABLET 251 251 111 140


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
61 KALSIUM LAKTAT ( KALK ) TABLET 500 MG TABLET 54,650 54,650 6,397 48,253 JKN

75 KOTRIMOKSAZOL TABLET KOMB TABLET 16,727 16,727 482 16,245 JKN


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
88 METRONIDAZOL TABLET 250 MG TABLET 272 272 272
93 NATRIUM KLORIDA LARUTAN INFUS 0.9 % BTL500 ML 25 25 2 23
106 PARASETAMOL DROPS BOTOL 9 9 9
107 PARASETAMOL SIRUP 120 MG/5 ML BTL 60 ML 1,437 900 2,337 949 1,388
110 PIRANTEL TABLET 125 MG TABLET 300 300 1 299


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
119 RANITIDINE TABLET 150 MG TABLET 529 529 288 241
124 SALEP 2-4 KOMB POT 63 63 25 38
127 SERUM ANTI TETANUS ( ATS ) INJEKSI 1.500 IU - 1 ML AMPUL 57 57 57
130 SIMVASTATIN TABLET 10 MG TABLET 32 32 32
131 SIPROFLOKSASIN TABLET 500 MG TABLET 1,578 1,578 461 1,117
133 TETRASIKLIN HCL KAPSUL 250 MG KAPSUL 332 332 332
139 ZINC TABLET DISPERSIBLE 20 MG TABLET 864 864 324 540
1 ALAT SUNTIK 0.05 ML BIJI 40 40 40


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

21 HIPAFIX 15 CM X 0.5 M (PHARMAFIX) ROLL 10 10 1 9
22 INFUSION SET ANAK SET 16 16 2 14


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
45 LEUKOPLAST HOSPITAL 7.5 CM X 4.5 M ROLL 5 5 1 4
47 MASKER TIE ON (TALI) BIJI 130 1,000 1,130 187 943
54 SARUNG TANGAN GYNECOLOG NO. 7.5 PAIR 77 77 77
56 SARUNG TANGAN NO. 6,5 PASANG 145 145 23 122
57 SARUNG TANGAN NO. 7 PSG
58 SARUNG TANGAN NO. 7.5 PSG 132 132 82 50
60 SARUNG TANGAN SIZE M PASANG 2,100 2,100 1,600 500
62 SELANG OKSIGEN ANAK PCS 53 53 2 51 JKN 50


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16


OBAT GIGI

2 EUGENOL CAIRAN BOTOL JKN
OBAT TAMBAHAN


14 ANTASIDA + SIMETIKON SIRUP (NUVAMAG) BTL 60 ML 214 214 214
15 ANTASIDA + SIMETIKON TAB (ATMACID) TABLET 2,918 2,918 72 2,846


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
27 BETAMETHASON PLUS SK (ERLADERM) TUBE 88 88 21 67
33 BROMHEXINE HCL TAB 4 MG TABLET 1,997 1,997 15 1,982
35 CIMETIDINE TABLET 200 MG TABLET 1,944 1,944 231 1,713


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
65 GLIMEPIRIDE TABLET 4 MG TABLET 95 95 95
78 KALIUM ASPARTAT TABLET 300 MG (ASPAR-K/KALIPAR) TABLET 92 92 92


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
92 KODEIN TABLET 10 MG TABLET 920 920 75 845
93 KOTRIMOKSAZOL FORTE TABLET TABLET 578 578 39 539
107 METILDOPA TABLET 250 MG (DOPAMET) TABLET 86 86 3 83


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
121 MOLAKRIM TUBE 5 5 2 3
124 MULTIVITAMIN TAB (VITALAMIN) TABLET 1,799 1,799 994 805
126 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 1,543 1,543 728 815
127 NEUROTROPIC KAPLET (IFIBION) KAPLET 2,221 2,221 1,439 782
132 OCUGARD KAPSUL KAPSUL 69 69 69
141 PERMETRIN KRIM 5 % (SCABIMITE CREAM 10) TUBE 7 7 7


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
144 PIROXICAM TABLET 20 MG TABLET 2,548 2,548 774 1,774
172 TABURIA SACHET


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
185 ZINC SIR 20 MG/ 5 ML BOTOL 41 41 1 40
187 USG GEL 250 ML BOTOL 36 36 36 JKN

190 SELANG OKSIGEN BAYI PCS 200 200 2 198 JKN
195 FLU BATUK TABLET WICOLD TABLET 3,056 3,056 3,056
196 FLU BATUK TABLET BRONCHIFAR TABLET 4,470 4,470 1,451 3,019
197 LOSMAN WASIR TABLET 342 342 86 256
198 DEXOCORT SALEP TUBE 50 50 50
BPJS NON
PBI
JUMLAH KUNJUNGAN RESEP JUMLAH R/
2018 2800 371 26 5215 11157 12485


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
NIP. 19630329 198903 2 007 NIP. 19660204 199103 1 004 NIP.19800123 200604 2 010 NIP.19860906 200501 2 003
PUSKESMAS KLAREYAN
PUSKESMAS : KLAREYAN PELAPORAN BULAN/PERIODE : APRIL 2018 DOKUMEN NOMOR TANGGAL

KECAMATAN : PETARUKAN PERMINTAAN BULAN/PERIODE : JUNI 2018 DKK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT FORNAS
2 ALLOPURINOL TABLET 100 MG TABLET 959 1,600 2,559 176 2,383

4 AMINOFILLIN TABLET 200 MG TABLET 1,000


7 AMOKSISILLIN SIRUP KERING 125 MG/ML BTL 60 ML 239 239 158 81 1,000
9 ANTASIDA DOEN I SIRUP KOMBINASI BTL 60 ML 117 200 317 20 297
10 ANTASIDA DOEN I TABLET KOMBINASI TABLET 14,600 14,600 267 14,333

15 AQUA PRO INJEKSI STERIL 20 ML VIAL 31 20 51 38 13 100

19 ASIKLOVIR TABLET 200 MG TABLET 183 183 81 102 222
22 ATTAPULGIT TABLET 600 MG (MOLAGIT/PULAREX) TABLET 4,711 2,000 6,711 641 6,070

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

28 DIAZEPAM TABLET 2 MG TABLET 300


31 DIGOKSIN TABLET 0.25 MG TABLET 100
33 DOKSISIKLIN KAPSUL 100 MG KAPSUL 190 190 2 188

38 ETANOL 70 % BTL 1 LITER 4 5 9 4 5 11

39 ETANOL 70 % BTL 100 ML 28 28 13 15 50

43 FITOMENADION ( VIT K1 ) INJEKSI I.M. 2 MG/ML - 1 ML AMPUL 431 431 431
44 FITOMENADION ( VIT K1 ) TABLET SALUT GULA 10 MG TABLET 1,216 1,216 220 996
46 GARAM ORALIT SERBUK UNTUK 200 ML AIR SACHET 1,277 1,277 1,277 2,000

51 HALOPERIDOL TABLET 1.5 MG TABLET 70 200 270 158 112 520
53 HIDROKLOROTIAZID ( HCT ) TABLET 25 MG TABLET 140 140 5 135 100

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
56 IBUPROFEN TABLET 200 MG TABLET 14,141 14,141 634 13,507 JKN


62 KAOLIN + PECTIN TABLET (OMEGDIAR) TABLET 1,000

66 KLORAMFENIKOL KAPSUL 250 MG KAPSUL 500
67 KLORAMFENIKOL SALEP MATA TUBE 298 298 101 197 207
69 KLORAMFENIKOL TETES MATA BTL 10 ML 200
70 KLORAMFENIKOL TETES TELINGA BTL 10 ML 200
73 KLORPROMAZIN HCL TABLET SALUT 25 MG TABLET 340 340 104 236 180
74 KOTRIMOKSAZOL SUSPENSI BTL 60 ML 168 200 368 104 264 300

80 LORATADIN TABLET 10 MG TABLET 388 388 36 352
81 MAGNESIUM SULFAT INJEKSI ( IV ) 20 % - 25 ML VIAL 16 16 10 6 34

85 METILERGOMETRIN MALEAT TABLET SALUT 0.125 MG TABLET 500

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

88 METRONIDAZOL TABLET 250 MG TABLET

90 MIKONAZOL KRIM 2 % TUBE 200
92 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 2,000


97 NISTATIN TABLET VAGINA 100.000 IU TABLET 122 122 30 92 100
105 OKSITOSIN INJEKSI 10 IU/ML - 1 ML AMPUL 177 200 377 127 250 258
106 PARASETAMOL DROPS BOTOL 20
107 PARASETAMOL SIRUP 120 MG/5 ML BTL 60 ML 1,388 1,800 3,188 451 2,737



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
119 RANITIDINE TABLET 150 MG TABLET 241 241 60 181 2,000

122 RINGER LAKTAT LARUTAN INFUS STERIL BTL 500 ML 71 100 171 86 85 259
123 SALBUTAMOL TABLET 2 MG TABLET 2,000
124 SALEP 2-4 KOMB POT 38 38 38 100
125 SALISIL BEDAK SERBUK 2 % BIJI 49 200 249 79 170 200
130 SIMVASTATIN TABLET 10 MG TABLET 2,000

131 SIPROFLOKSASIN TABLET 500 MG TABLET 1,117 1,117 266 851 2,000

137 TRIHEXIFENIDIL TABLET 2 MG TABLET 520 520 141 379 185

139 ZINC TABLET DISPERSIBLE 20 MG TABLET 540 500 1,040 177 863


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16


11 CATGUT CHROMIC / BENANG BEDAH NO.3/0 BIJI 47 120 167 61 106 138



23 INFUSION SET DEWASA SET 100 100 33 67 65



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
40 KASA PEMBALUT 4 M X 15 CM ROL 150 150 72 78 210


45 LEUKOPLAST HOSPITAL 7.5 CM X 4.5 M ROLL 4 4 2 2 6

46 MASKER EAR LOOP (KARET) BIJI 50 250 300 100 200 200
47 MASKER TIE ON (TALI) BIJI 943 750 1,693 434 1,259 477


55 SARUNG TANGAN NO. 6 PSC 100
56 SARUNG TANGAN NO. 6,5 PASANG 122 200 322 17 305 200
57 SARUNG TANGAN NO. 7 PSG 200 200 65 135 125
58 SARUNG TANGAN NO. 7.5 PSG 50 150 200 68 132 140
60 SARUNG TANGAN SIZE M PASANG 500 1,100 1,600 1,600 10,000

63 SELANG OKSIGEN DEWASA PCS 94 94 94 JKN

68 UMBILICAL CORD KLEM STERIL NYLON BIJI 86 86 79 7 309 JKN

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
69 UNDER PAD STERIL 60 X 90 CM PCS 1,066 1,066 143 923 JKN

70 URINE BAG BIJI 45 45 10 35 25

OBAT GIGI

2 EUGENOL CAIRAN BOTOL
OBAT TAMBAHAN

2 ALKOHOL SWAB SACHET 2,300 2,300 600 1,700 2,000 JKN
4 ALOPURINOL TABLET 300 MG TABLET 842 842 64 778 500


15 ANTASIDA + SIMETIKON TAB (ATMACID) TABLET 2,846 3,000 5,846 4,165 1,681 14,979
16 AQUADESTILATA STERIL BTL 500 ML 10


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
22 ASIKLOVIR KRIM 5 % TUBE 181 181 40 141 50

23 BATUGIN ELIKSIR BTL 120 ML 20

27 BETAMETHASON PLUS SK (ERLADERM) TUBE 67 67 52 15 300
32 BROMHEXINE HCL SYRUP BTL 60 ML 200

35 CIMETIDINE TABLET 200 MG TABLET 1,713 1,713 563 1,150 1,102

37 DIAZEPAM LAR RECTAL 5 MG/2,5 ML (STESOLID RECTAL) TUBE 30 30 5 25

43 EKSTRAK BELLADON TABLET 10 MG TABLET 200

44 EKSTRAK PLACENTA + NEOMYCIN JELLY (NEOCENTA JEL) TUBE 39 39 9 30 20
45 ENKASARI LIQUID BTL 120 ML 20
46 ENZYMFORT TABLET SALUT ENTERIK TABLET 2,000
47 ERITROMISIN KAPLET SALUT SELAPUT 500 MG KAPLET 200


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
52 FLU KOMBINASI + BATUK SIRUP BOTOL 79 79 11 68 200

53 FLU KOMBINASI + BATUK TABLET (HUSTAB) TABLET 10,000
54 FLU KOMBINASI SIRUP (MOLEXFLU) BOTOL 118 118 52 66 142
55 FLU KOMBINASI TABLET (AFLUCAPS) KAPLET 10,000
59 GENTAMISIN SALEP KULIT (GENTALEX) TUBE 200

62 GENTIAN VIOLET LAR 1 % BTL 10 ML 100
63 GLIMEPIRIDE TABLET 1 MG TABLET 200
65 GLIMEPIRIDE TABLET 4 MG TABLET 95 200 295 5 290

70 HEPARIN 20.000 IU (HICO JEL) TUBE 50

72 HYOSIN N BUTILBROMID TABLET PLUS TABLET 275 275 275

74 IMULAN KAPSUL KAPSUL 2,000
75 IMULAN SIRUP BOTOL 100
78 KALIUM ASPARTAT TABLET 300 MG (ASPAR-K/KALIPAR) TABLET
79 KALIUM DIKLOFENAK TABLET 50 MG TABLET 2,000

80 KAOLIN + PECTIN SIRUP (OMEGDIAR) BOTOL 177 96 273 11 262

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
82 KARBO ABSORBEN TABLET TABLET 500


89 KLORAMFENIKOL SALEP KULIT 2% TUBE 200
96 LIDOKAIN HCL 20 MG/G JEL (XYLOCAINE JELLY 2%) BIJI

99 LISINOPRIL TABLET 5 MG TABLET 200

100 LISINOPRIL TABLET 10 MG TABLET 200
103 MDT MB DEWASA BLISTER 8 8 2 6 2

106 MELOXICAM TABLET 15 MG TABLET 2,000



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

116 MINYAK KAYU PUTIH 30 ML BOTOL 50

118 MINYAK TELON 30 ML BOTOL 50

121 MOLAKRIM TUBE 3 3 3 30

122 MULTIVITAMIN DROPS (CAVIPLEX/VITACHILD) BOTOL 50
123 MULTIVITAMIN SIRUP (PACDIN VITCUR,RECOVIT,DLL) BOTOL 99 180 279 45 234 100
124 MULTIVITAMIN TAB (VITALAMIN) TABLET 805 3,500 4,305 761 3,544
126 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 815 815 274 541 3,000
127 NEUROTROPIC KAPLET (IFIBION) KAPLET 782 782 692 90 2,678
132 OCUGARD KAPSUL KAPSUL 69 69 12 57 300

134 OKSITETRASIKLIN SALEP KULIT TUBE 200


138 ONDANSETRON TABLET/KAPSUL 4 MG TABLET 1,089 1,089 103 986

141 PERMETRIN KRIM 5 % (SCABIMITE CREAM 10) TUBE 100


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
144 PIROXICAM TABLET 20 MG TABLET 1,774 1,774 1,198 576 4,216


157 SALBUTAMOL TABLET 4 MG TABLET 1,000


166 SETIRIZIN KAPSUL 10 MG KAPSUL 278 278 93 185 500

170 SULFASETAMID NATRIUM TETES MATA 15 % BTL 5 ML 95 95 79 16 300

171 TABLET TAMBAH DARAH PATEN (NOVABION/SAMCOBION) TABLET 20,000
172 TABURIA SACHET


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16


182 VALVED TABLET (TRIPROLIDIN - QUANTIDEX) TABLET 205 205 205
185 ZINC SIR 20 MG/ 5 ML BOTOL 40 40 5 35

193 JARUM CITO JEK PCS 45 45 4 41
194 OBJECT GLASS BIJI 12 12 12
195 FLU BATUK TABLET WICOLD TABLET 15,000
196 FLU BATUK TABLET BRONCHIFAR TABLET 3,019 3,019 1,855 1,164 6,256
197 LOSMAN WASIR TABLET 256 256 148 108 484
BPJS NON
PBI
1947 2654 316 19 4936 10833 12248

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
NIP. 19630329 198903 2 007 NIP. 19660204 199103 1 004 NIP.19800123 200604 2 010 NIP.19860906 200501 2 003
PUSKESMAS KLAREYAN
PUSKESMAS : KLAREYAN PELAPORAN BULAN/PERIODE : MEI 2018 DOKUMEN NOMOR TANGGAL


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT FORNAS
2 ALLOPURINOL TABLET 100 MG TABLET 2,383 2,383 214 2,169


7 AMOKSISILLIN SIRUP KERING 125 MG/ML BTL 60 ML 81 100 181 45 136
8 ANTALGIN ( METAMPIRON ) TABLET 500 MG TABLET

12 ANTIFUNGI DOEN KOMB SK POT 72 72 72
15 AQUA PRO INJEKSI STERIL 20 ML VIAL 13 13 13
17 ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET 25 25 25

19 ASIKLOVIR TABLET 200 MG TABLET 102 102 102

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16





39 ETANOL 70 % BTL 100 ML 15 15 10 5

44 FITOMENADION ( VIT K1 ) TABLET SALUT GULA 10 MG TABLET 996 996 65 931
46 GARAM ORALIT SERBUK UNTUK 200 ML AIR SACHET


51 HALOPERIDOL TABLET 1.5 MG TABLET 112 112 112
52 HALOPERIDOL TABLET 5 MG TABLET 529 529 529
53 HIDROKLOROTIAZID ( HCT ) TABLET 25 MG TABLET 135 135 135

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

59 ISOSORBID DINITRAT TABLET SUBLINGUAL 5 MG TABLET




72 KLORPROMAZIN HCL TABLET SALUT 100 MG TABLET

79 LISOL 50 % 1 LITER BOTOL 19 19 1 18



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16



94 NIFEDIPIN TABLET 10 MG TABLET 214 214 214

98 OAT ANAK PAKET


106 PARASETAMOL DROPS BOTOL




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
119 RANITIDINE TABLET 150 MG TABLET 181 181 66 115

124 SALEP 2-4 KOMB POT 72 72 29 43

130 SIMVASTATIN TABLET 10 MG TABLET
131 SIPROFLOKSASIN TABLET 500 MG TABLET 851 851 394 457




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16









1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16


45 LEUKOPLAST HOSPITAL 7.5 CM X 4.5 M ROLL 2 2 1 1

47 MASKER TIE ON (TALI) BIJI 1,259 1,259 425 834



60 SARUNG TANGAN SIZE M PASANG 1,000 1,000 500 500



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
69 UNDER PAD STERIL 60 X 90 CM PCS 923 923 69 854 JKN


OBAT GIGI

OBAT TAMBAHAN

3 ALLETROL TETES MATA BTL 5 ML



15 ANTASIDA + SIMETIKON TAB (ATMACID) TABLET 1,681 1,681 1,650 31



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16


27 BETAMETHASON PLUS SK (ERLADERM) TUBE 15 15 15

35 CIMETIDINE TABLET 200 MG TABLET 1,150 1,150 761 389





1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16


56 FRAMISETIN SULFAT 1 % (BIOPLACENTON TULLE/LOMATUEL) LEMBAR


61 GENTAMISIN TETES MATA 0,3% (GENOINT) BOTOL




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
83 KETOKONAZOL KRIM 2 % TUBE

97 LIDOKAIN SPRAY BOTOL
103 MDT MB DEWASA BLISTER 6 6 6 -


111 METOKLOPRAMID SIRUP 5 MG/ 5 ML (LEXAPRAM) BOTOL 5 5 1 4


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16



124 MULTIVITAMIN TAB (VITALAMIN) TABLET 3,544 3,544 809 2,735
126 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 541 541 224 317
127 NEUROTROPIC KAPLET (IFIBION) KAPLET 90 5,000 5,090 301 4,789


138 ONDANSETRON TABLET/KAPSUL 4 MG TABLET 986 986 50 936

141 PERMETRIN KRIM 5 % (SCABIMITE CREAM 10) TUBE


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
144 PIROXICAM TABLET 20 MG TABLET 576 1,000 1,576 642 934


157 SALBUTAMOL TABLET 4 MG TABLET 1,500 1,500 173 1,327

163 SEFIKSIM SIRUP KERING 100 MG/5 ML BOTOL 42 42 4 38


170 SULFASETAMID NATRIUM TETES MATA 15 % BTL 5 ML 16 192 208 53 155

172 TABURIA SACHET


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

181 VALVED SIRUP (TRIPOLIDIN) BTL 60 ML 12 12 12

182 VALVED TABLET (TRIPROLIDIN - QUANTIDEX) TABLET

191 IV CATHETER WITH INJECTION PORT NO.22 PCS 200 200 50 150 JKN
193 JARUM CITO JEK PCS 41 41 3 38
195 FLU BATUK TABLET WICOLD TABLET
196 FLU BATUK TABLET BRONCHIFAR TABLET 1,164 700 1,864 1,185 679
197 LOSMAN WASIR TABLET 108 108 108
BPJS NON
PBI
2331 2438 398 25 5192 9917 10889

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
NIP. 19630329 198903 2 007 NIP. 19660204 199103 1 004 NIP.19800123 200604 2 010 NIP.19860906 200501 2 003
PUSKESMAS KLAREYAN
PUSKESMAS : KLAREYAN PELAPORAN BULAN/PERIODE : JUNI 2018 DOKUMEN NOMOR TANGGAL

KECAMATAN : PETARUKAN PERMINTAAN BULAN/PERIODE : AGUSTUS 2018 DKK

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT FORNAS
5 AMITRIPTILLIN HCL TABLET SALUT 25 MG TABLET 400 400 400

7 AMOKSISILLIN SIRUP KERING 125 MG/ML BTL 60 ML 136 136 79 57 400
8 ANTALGIN ( METAMPIRON ) TABLET 500 MG TABLET 30,000
10 ANTASIDA DOEN I TABLET KOMBINASI TABLET 11,375 11,375 3,086 8,289 4,055
12 ANTIFUNGI DOEN KOMB SK POT 72 96 168 7 161
15 AQUA PRO INJEKSI STERIL 20 ML VIAL 13 13 7 6 100

16 ASAM ASKORBAT ( VIT C ) TABLET 50 MG TABLET 50,291 50,291 958 49,333 JKN
17 ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
24 BETAMETASON KRIM 0.1 % TUBE 53 300 353 84 269 200

25 DEKSAMETASON INJEKSI 5 MG/ML - 1 ML AMPUL 7 7 3 4 10
26 DEKSAMETASON TABLET 0.5 MG TABLET 81,551 81,551 3,817 77,734 JKN
27 DIAZEPAM INJEKSI 5 MG/ML - 2 ML AMPUL 5

28 DIAZEPAM TABLET 2 MG TABLET 500
30 DIFENHIDRAMIN HCL INJ 10 MG/ML - 1 ML AMPUL 10 10 3 7 10

31 DIGOKSIN TABLET 0.25 MG TABLET 100 100 100
36 EPINEFRIN HCL ( ADRENALIN ) INJEKSI 0.1 % - 1 ML AMPUL 22 22 3 19

39 ETANOL 70 % BTL 100 ML 5 5 5 20
41 FENOBARBITAL INJEKSI 50 MG/ML - 1 ML AMPUL 5

42 FENOBARBITAL TABLET 30 MG TABLET 204 204 204
46 GARAM ORALIT SERBUK UNTUK 200 ML AIR SACHET 2,000

49 GLUKOSA LARUTAN INFUS 10 % STERIL BTL.500 ML 5

51 HALOPERIDOL TABLET 1.5 MG TABLET 112 500 612 30 582


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16



67 KLORAMFENIKOL SALEP MATA TUBE 92 92 68 24 248

68 KLORAMFENIKOL SUSPENSI 125 MG / 5 ML BTL60 ML 7 7 3 4 10
73 KLORPROMAZIN HCL TABLET SALUT 25 MG TABLET 236 236 120 116 364
74 KOTRIMOKSAZOL SUSPENSI BTL 60 ML 163 300 463 59 404

81 MAGNESIUM SULFAT INJEKSI ( IV ) 20 % - 25 ML VIAL 2 34 36 8 28 4



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
87 METRONIDAZOL SIRUP 125MG/ 5 ML BTL 60 ML 4 4 1 3 10

89 METRONIDAZOL TABLET 500 MG TABLET 1,019 1,019 120 899
90 MIKONAZOL KRIM 2 % TUBE 200

92 NATRIUM DIKLOFENAK TABLET 50 MG TABLET 4,000

98 OAT ANAK PAKET
100 OAT KATEGORI II PAKET 1 1 1
104 OKSITETRASIKLIN HCL SALEP MATA 1 % TUBE 200
106 PARASETAMOL DROPS BOTOL 20



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
119 RANITIDINE TABLET 150 MG TABLET 115 115 115 2,000

124 SALEP 2-4 KOMB POT 43 96 139 18 121
125 SALISIL BEDAK SERBUK 2 % BIJI 108 200 308 34 274
130 SIMVASTATIN TABLET 10 MG TABLET 1,500

131 SIPROFLOKSASIN TABLET 500 MG TABLET 457 457 244 213 1,000
133 TETRASIKLIN HCL KAPSUL 250 MG KAPSUL 100

136 TIAMIN HCL ( VIT B1 ) TABLET 50 MG TABLET 49,072 49,072 1,381 47,691 JKN
137 TRIHEXIFENIDIL TABLET 2 MG TABLET 319 200 519 120 399 81



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

11 CATGUT CHROMIC / BENANG BEDAH NO.3/0 BIJI 84 120 204 56 148 76

17 FOLLEY CATHETER NO. 16 BIJI 100 100 100
18 FOLLEY CATHETER NO. 18 BIJI 20 20 8 12 20

22 INFUSION SET ANAK SET 14 14 3 11
23 INFUSION SET DEWASA SET 60 100 160 7 153


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
40 KASA PEMBALUT 4 M X 15 CM ROL 55 200 255 76 179 125

45 LEUKOPLAST HOSPITAL 7.5 CM X 4.5 M ROLL 1 10 11 2 9
46 MASKER EAR LOOP (KARET) BIJI 150 200 350 50 300
47 MASKER TIE ON (TALI) BIJI 834 500 1,334 405 929 691
55 SARUNG TANGAN NO. 6 PSC 100 100 100
56 SARUNG TANGAN NO. 6,5 PASANG 270 200 470 63 407
58 SARUNG TANGAN NO. 7.5 PSG 82 150 232 83 149 183

60 SARUNG TANGAN SIZE M PASANG 500 5,000 5,500 1,400 4,100 5,000
62 SELANG OKSIGEN ANAK PCS 51 51 2 49 JKN

65 SILK ( BENANG BEDAH ) NO. 3/0 BIJI 84 84 12 72

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

70 URINE BAG BIJI 29 25 54 7 47
73 WING NEEDLE NO. 25 SET 51 51 10 41 JKN

OBAT GIGI

OBAT TAMBAHAN
2 ALKOHOL SWAB SACHET 1,600 2,000 3,600 600 3,000 JKN

3 ALLETROL TETES MATA BTL 5 ML 100
4 ALOPURINOL TABLET 300 MG TABLET 702 500 1,202 17 1,185

7 AMBROKSOL TABLET 30 MG TABLET 21,462 21,462 825 20,637 JKN
15 ANTASIDA + SIMETIKON TAB (ATMACID) TABLET 31 8,000 8,031 104 7,927
16 AQUADESTILATA STERIL BTL 500 ML 10

17 ASAM FOLAT TABLET 0,4 MG TABLET 1,990 1,990 10 1,980


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
23 BATUGIN ELIKSIR BTL 120 ML 20

27 BETAMETHASON PLUS SK (ERLADERM) TUBE 200

28 BISAKODIL TABLET (BICOLAX) TABLET 265 265 63 202 100
32 BROMHEXINE HCL SYRUP BTL 60 ML 180 180 180
35 CIMETIDINE TABLET 200 MG TABLET 389 1,000 1,389 440 949 2,000
40 DOMPERIDON SIRUP BOTOL 16 16 1 15
44 EKSTRAK PLACENTA + NEOMYCIN JELLY (NEOCENTA JEL) TUBE 24 40 64 21 43 50

45 ENKASARI LIQUID BTL 120 ML 20
46 ENZYMFORT TABLET SALUT ENTERIK TABLET 2,000
47 ERITROMISIN KAPLET SALUT SELAPUT 500 MG KAPLET 200 200 200


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

53 FLU KOMBINASI + BATUK TABLET (HUSTAB) TABLET 10,000
55 FLU KOMBINASI TABLET (AFLUCAPS) KAPLET 10,000
56 FRAMISETIN SULFAT 1 % (BIOPLACENTON TULLE/LOMATUEL) LEMBAR 50
59 GENTAMISIN SALEP KULIT (GENTALEX) TUBE 200

60 GENTAMISIN SALEP MATA 0,3% TUBE 96 96 16 80 100
61 GENTAMISIN TETES MATA 0,3% (GENOINT) BOTOL 150
62 GENTIAN VIOLET LAR 1 % BTL 10 ML 50
70 HEPARIN 20.000 IU (HICO JEL) TUBE 20

73 IBUPROFEN SUSPENSI 100 MG/ 5 ML BOTOL 100 100 - 100
74 IMULAN KAPSUL KAPSUL 2,000

75 IMULAN SIRUP BOTOL 200


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
82 KARBO ABSORBEN TABLET TABLET 500

83 KETOKONAZOL KRIM 2 % TUBE 100
89 KLORAMFENIKOL SALEP KULIT 2% TUBE 200


111 METOKLOPRAMID SIRUP 5 MG/ 5 ML (LEXAPRAM) BOTOL 4 50 54 1 53


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

122 MULTIVITAMIN DROPS (CAVIPLEX/VITACHILD) BOTOL 50

123 MULTIVITAMIN SIRUP (PACDIN VITCUR,RECOVIT,DLL) BOTOL 172 120 292 27 265
126 NATRIUM DIKLOFENAK TABLET 25 MG TABLET 317 317 317

127 NEUROTROPIC KAPLET (IFIBION) KAPLET 4,789 3,000 7,789 512 7,277
132 OCUGARD KAPSUL KAPSUL 117 90 207 4 203
134 OKSITETRASIKLIN SALEP KULIT TUBE 200

140 PEHACAIN INJEKSI AMPUL 37 100 137 20 117
141 PERMETRIN KRIM 5 % (SCABIMITE CREAM 10) TUBE 100



1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
144 PIROXICAM TABLET 20 MG TABLET 934 934 320 614 2,000


157 SALBUTAMOL TABLET 4 MG TABLET 1,327 1,000 2,327 199 2,128
158 SEFADROKSIL KAPSUL 500 MG KAPSUL 347 347 126 221 283
166 SETIRIZIN KAPSUL 10 MG KAPSUL 115 500 615 52 563
170 SULFASETAMID NATRIUM TETES MATA 15 % BTL 5 ML 155 72 227 54 173 200
172 TABURIA SACHET


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
187 USG GEL 250 ML BOTOL 31 12 43 2 41 JKN

188 ASEPTIK/ALKOHOL GEL 500 ML BOTOL 147 147 2 145 JKN
195 FLU BATUK TABLET WICOLD TABLET 10,000

196 FLU BATUK TABLET BRONCHIFAR TABLET 679 679 474 205 10,000
197 LOSMAN WASIR TABLET 480 480 144 336 240
198 DEXOCORT SALEP TUBE 50 56 106 106
BPJS NON
PBI
1719 1700 302 21 3742 6398 6927

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
NIP. 19630329 198903 2 007 NIP. 19660204 199103 1 004 NIP.19800123 200604 2 010 NIP.19860906 200501 2 003
PUSKESMAS KLAREYAN
PUSKESMAS : KLAREYAN PELAPORAN BULAN/PERIODE : JULI 2018 DOKUMEN NOMOR TANGGAL


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT FORNAS
5 AMITRIPTILLIN HCL TABLET SALUT 25 MG TABLET 400 400 400

8 ANTALGIN ( METAMPIRON ) TABLET 500 MG TABLET
11 ANTIBAKTERI DOEN KOMB SK TUBE
12 ANTIFUNGI DOEN KOMB SK POT 161 161 23 138
15 AQUA PRO INJEKSI STERIL 20 ML VIAL 6 6 6

16 ASAM ASKORBAT ( VIT C ) TABLET 50 MG TABLET 49,333 49,333 941 48,392 JKN
17 ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

26 DEKSAMETASON TABLET 0.5 MG TABLET 77,734 77,734 4,196 73,538 JKN
31 DIGOKSIN TABLET 0.25 MG TABLET 100 100 100
38 ETANOL 70 % BTL 1 LITER
39 ETANOL 70 % BTL 100 ML
42 FENOBARBITAL TABLET 30 MG TABLET 204 204 204
46 GARAM ORALIT SERBUK UNTUK 200 ML AIR SACHET


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16


65 KETOKONAZOL TABLET 200 MG TABLET 56 56 56
67 KLORAMFENIKOL SALEP MATA TUBE 24 24 24




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
89 METRONIDAZOL TABLET 500 MG TABLET 899 899 91 808
97 NISTATIN TABLET VAGINA 100.000 IU TABLET 189 189 189
98 OAT ANAK PAKET
99 OAT KATEGORI I PAKET 10 10 10
100 OAT KATEGORI II PAKET 1 1 1
106 PARASETAMOL DROPS BOTOL
116 PREDNISON TABLET 5 MG TABLET 10,450 10,450 1,054 9,396


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
119 RANITIDINE TABLET 150 MG TABLET
124 SALEP 2-4 KOMB POT 121 121 13 108
127 SERUM ANTI TETANUS ( ATS ) INJEKSI 1.500 IU - 1 ML AMPUL 50 50 50
130 SIMVASTATIN TABLET 10 MG TABLET
131 SIPROFLOKSASIN TABLET 500 MG TABLET 213 213 213

133 TETRASIKLIN HCL KAPSUL 250 MG KAPSUL
136 TIAMIN HCL ( VIT B1 ) TABLET 50 MG TABLET 47,691 47,691 1,951 45,740 JKN


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

11 CATGUT CHROMIC / BENANG BEDAH NO.3/0 BIJI 148 148 148


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
40 KASA PEMBALUT 4 M X 15 CM ROL 179 179 179
45 LEUKOPLAST HOSPITAL 7.5 CM X 4.5 M ROLL 9 9 9
47 MASKER TIE ON (TALI) BIJI 929 929 550 379
55 SARUNG TANGAN NO. 6 PSC 100 100 100
60 SARUNG TANGAN SIZE M PASANG 4,100 4,100 1,900 2,200
62 SELANG OKSIGEN ANAK PCS 49 49 49 JKN


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16


OBAT GIGI

OBAT TAMBAHAN

3 ALLETROL TETES MATA BTL 5 ML
4 ALOPURINOL TABLET 300 MG TABLET 1,185 1,185 34 1,151

8 AMLODIPIN TABLET 5 MG TABLET 111 111 111
15 ANTASIDA + SIMETIKON TAB (ATMACID) TABLET 7,927 7,927 80 7,847
17 ASAM FOLAT TABLET 0,4 MG TABLET 1,980 1,980 10 1,970


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
27 BETAMETHASON PLUS SK (ERLADERM) TUBE
32 BROMHEXINE HCL SYRUP BTL 60 ML 180 180 180
35 CIMETIDINE TABLET 200 MG TABLET 949 949 520 429
47 ERITROMISIN KAPLET SALUT SELAPUT 500 MG KAPLET 200 200 200


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
52 FLU KOMBINASI + BATUK SIRUP BOTOL
54 FLU KOMBINASI SIRUP (MOLEXFLU) BOTOL
56 FRAMISETIN SULFAT 1 % (BIOPLACENTON TULLE/LOMATUEL) LEMBAR
57 GEMFIBROZIL KAPSUL 300 MG KAPSUL 6 6 6

60 GENTAMISIN SALEP MATA 0,3% TUBE 80 80 27 53
61 GENTAMISIN TETES MATA 0,3% (GENOINT) BOTOL
72 HYOSIN N BUTILBROMID TABLET PLUS TABLET 233 233 233


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
83 KETOKONAZOL KRIM 2 % TUBE
92 KODEIN TABLET 10 MG TABLET 490 490 490
103 MDT MB DEWASA BLISTER 6 6 6
107 METILDOPA TABLET 250 MG (DOPAMET) TABLET


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
127 NEUROTROPIC KAPLET (IFIBION) KAPLET 7,277 7,277 1,068 6,209
132 OCUGARD KAPSUL KAPSUL 203 203 203
136 OMEPRAZOLE KAPSUL 20 MG TABLET 588 588 588
141 PERMETRIN KRIM 5 % (SCABIMITE CREAM 10) TUBE


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
144 PIROXICAM TABLET 20 MG TABLET 614 614 374 240

157 SALBUTAMOL TABLET 4 MG TABLET 2,128 2,128 249 1,879

172 TABURIA SACHET


1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

195 FLU BATUK TABLET WICOLD TABLET
196 FLU BATUK TABLET BRONCHIFAR TABLET 205 205 205
197 LOSMAN WASIR TABLET 336 336 154 182
199 REAGEN HbsAg TEST 200 200 200
BPJS NON
PBI
1796 2479 477 16 4768 8753 9617

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
NIP. 19630329 198903 2 007 NIP. 19660204 199103 1 004 NIP.19800123 200604 2 010 NIP.19860906 200501 2 003

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

PUSKESMAS : KLAREYAN PELAPORAN BULAN/PERIODE : JANUARI 2018 DOKUMEN NOMOR TANGGAL

2 ALLOPURINOL TABLET 100 MG TABLET 768 768 210 558

4 AMINOFILLIN TABLET 200 MG TABLET 190 190 190

6 AMOKSISILLIN KAPLET 500 MG KAPLET 231,190 231,190 13,870 217,320 JKN

13 ANTIHEMOROID KOMBINASI SUPPOSITORIA BIJI 83 83 83

17 ASAM ASKORBAT ( VIT C ) TABLET 250 MG TABLET 258 258 258

19 ASIKLOVIR TABLET 200 MG TABLET 269 269 10 259

25 DEKSAMETASON INJEKSI 5 MG/ML - 1 ML AMPUL 16 16 7 9

27 DIAZEPAM INJEKSI 5 MG/ML - 2 ML AMPUL

28 DIAZEPAM TABLET 2 MG TABLET

29 DIAZEPAM TABLET 5 MG TABLET

30 DIFENHIDRAMIN HCL INJ 10 MG/ML - 1 ML AMPUL 10 10 10

32 DIMENHIDRINAT TABLET 50 MG TABLET

33 DOKSISIKLIN KAPSUL 100 MG KAPSUL 200 200 200

36 EPINEFRIN HCL ( ADRENALIN ) INJEKSI 0.1 % - 1 ML AMPUL 24 24 2 22

38 ETANOL 70 % BTL 1 LITER 12 12 4 8

41 FENOBARBITAL INJEKSI 50 MG/ML - 1 ML AMPUL

42 FENOBARBITAL TABLET 30 MG TABLET 233 233 3 230

50 GRISEOFULVIN TABLET 125 MG TABLET 980 980 980

57 IBUPROFEN TABLET 400 MG TABLET

58 ISONIAZID TABLET 100 MG TABLET

59 ISOSORBID DINITRAT TABLET SUBLINGUAL 5 MG TABLET 50 50 50

62 KAOLIN + PECTIN TABLET (OMEGDIAR) TABLET

63 KAPTOPRIL TABLET 25 MG TABLET 17,636 17,636 892 16,744 JKN

64 KARBAMAZEPIN TABLET 200 MG TABLET

65 KETOKONAZOL TABLET 200 MG TABLET 554 554 125 429

67 KLORAMFENIKOL SALEP MATA TUBE 517 517 43 474

70 KLORAMFENIKOL TETES TELINGA BTL 10 ML

72 KLORPROMAZIN HCL TABLET SALUT 100 MG TABLET 761 761 60 701

76 KUININ TABLET 222 MG TABLET

77 LIDOKAIN 2 % INJEKSI AMPUL

78 LIDOKAIN KOMB INJEKSI (LIDOKAIN HCL 2%+ EPINEFRIN 1:80.000) AMPUL

79 LISOL 50 % 1 LITER BOTOL 20 20 20

83 METFORMIN TABLET 500 MG TABLET

84 METILERGOMETRIN MALEAT INJ 0.200 MG/ML - 1 ML AMPUL 373 373 10 363

86 METOKLOPRAMID TABLET 10 MG TABLET 854 854 854

87 METRONIDAZOL SIRUP 125MG/ 5 ML BTL 60 ML 9 9 9

91 NATRIUM BIKARBONAT TABLET 500 MG TABLET

92 NATRIUM DIKLOFENAK TABLET 50 MG TABLET

93 NATRIUM KLORIDA LARUTAN INFUS 0.9 % BTL500 ML 25 25 25

96 NISTATIN TABLET SALUT GULA 500.000 IU TABLET 570 570 570

101 OAT KOMBIPAK KATEGORI I PAKET

102 OAT SISIPAN PAKET

104 OKSITETRASIKLIN HCL SALEP MATA 1 % TUBE

105 OKSITOSIN INJEKSI 10 IU/ML - 1 ML AMPUL 254 254 90 164

109 PARASETAMOL TABLET 500 MG TABLET 17,492 17,492 13,936 3,556

112 POLIKRESULEN ( ALBOTHYL CONC ) BTL 10 ML

113 POVIDON IODIDA LAR 10 % BTL 30 ML 132 132 92 40

115 POVIDON IODIDA LAR 10 % BTL 300 ML 10 10 10

118 PROPANOLOL HCL TABLET 40 MG TABLET

119 RANITIDINE TABLET 150 MG TABLET 1,630 1,630 675 955

124 SALEP 2-4 KOMB POT 106 106 21 85

129 SIANOKOBALAMIN ( VIT B12 ) TABLET 50 MCG TABLET

130 SIMVASTATIN TABLET 10 MG TABLET 305 305 213 92

133 TETRASIKLIN HCL KAPSUL 250 MG KAPSUL 352 352 20 332

137 TRIHEXIFENIDIL TABLET 2 MG TABLET 370 370 30 340

139 ZINC TABLET DISPERSIBLE 20 MG TABLET 1,477 1,477 334 1,143

3 ALAT SUNTIK 1 ML BIJI 373 373 94 279

8 ALAT SUNTIK 50 ML BIJI

9 BLOOD TRANSFUSION SET SET 221 221 41 180 JKN

10 CATGUT CHROMIC / BENANG BEDAH NO.2/0 BIJI

11 CATGUT CHROMIC / BENANG BEDAH NO.3/0 BIJI 137 137 43 94