LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

SUB UNIT : PUSTU BADANG PELAPORAN BULAN / PERIODE : OKTOBER

PUSKESMAS : PELABUHAN DAGANG PERMINTAAN BULAN / PERIODE : NOPEMBER
TAHUN : 2017 LB. 2
Hal. : 1
KODE NAMA OBAT KELAS SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
TERAPI AWAL MAAN DIAAN KAIAN STOK OPT TAAN INPRES ASKES APBD LAIN 2 JMLH KET
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16
Albendazol tablet 400 mg tablet 30 30 20 10
Albothyl botol 0 25 -25
Alopurinol tablet 100 mg tablet 100 200 300 69 231
Ambroxol sirup 15 mg/ml botol 10
Ambroxol tablet 30 mg tablet 19 200 219 49 170
Aminofilin injeksi 24 mg/ml ampul 5 5 10 2 8
Aminofilin tablet 150 mg tablet 23 25 48 11 37
Aminofilin tablet scored 200 mg tablet 200 0
Amlodipin tablet 10 mg tablet 100 0
Amlodipin tablet 5 mg tablet 500 500 1,000 400 600
Amoksisilin + As. Klavulanat 625 mg tablet tablet 24 24 7 17
Amoksisilin kapsul/kaplet/tablet scored 500 mg kaplet 200 400 600 300 300
Amoksisilin kapsul/kaplet 250 mg kapsul 400 0
Amoksisilin serbuk injeksi 1000 mg vial 1 50 51 18 33
Amoksisilin sirup kering 125 mg/ 5 ml botol 20 0
Ampisilin serbuk injeksi i.v. 1000 mg/vial vial 1 1 1 0
Ampisilin 500mg tablet 50 400 450 100 350
Ampisilin sirup kering botol 100 30 130 90 40
Antalgin
Anestetik(Metampiron)
lokal gigi DOEN Injeksi, komposisi : Tablet 150 300 450 100 350
lidokain HCL
Antasida DOEN 2%I tablet kunyah, kombinasi : vial 120 120 147 -27
epinefrin 1 : 80.000 tablet
Aluminium Hidroksida
Antasida DOEN 200kombinasi
II suspensi, mg : 10 200 210 1 209
kunyah
Magnesium
Aluminium Hidroksida
Hidroksida 200
200 mg
mg/5 ml botol 50 20 70 30 40
Anti Bakteri DOEN salep kombinasi:
Magnesium
Basitrasin Hidroksida
500 IU/g 200 mg/5 ml tube 25 25 24 1
Polimiksin 10.000
Antalgin Injeksi IU/g 2ml
250mg/ml ampul 5 5

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Antifungi DOEN Salep, Kombinasi:
Asam Benzoat 6% pot
Antihemoroid
Asam SalisilatDOEN
3% kombinasi : Bismut subgalat 150 mg suppositor
Heksaklorofen 2,5 mg ia
Aqua pro injeksi, bebas pirogen vial
Asam Asetilsalisilat tablet 500 mg (Asetosal) tablet
Asam Askorbat (Vitamin C) tablet 250 mg tablet 200 500 700 174 526
Asam Askorbat (Vitamin C) tablet 100 mg tablet 23 23 12 11
Asam Askorbat (Vitamin C) tablet 50 mg tablet 38 500 538 156 382
Asam Folat tablet 0,5 mg tablet 0
Asam Folat tablet 1 mg tablet 33 300 333 178 155
Asam Folat tablet 5 mg tablet 10 10 4 6
Asam Mefenamat kapsul/kaplet 500 mg kaplet 100 400 500 200 300
Asam tranexamat 500 tablet 100 100 10 90
Asam salisilat salep 5% tube 30 50 80 36 44
Asiklovir krim 5% tube 0 100 100 9 91
Asiklovir tablet 200 mg tablet 200 0
Asiklovir tablet 400 mg tablet 33 400 433 8 425
Atapulgit tablet tablet 37 100 137 5 132
Bedak salisil serbuk 2% sachet 48 10 58 34 24
Betahistin Mesilat tablet 6 mg tablet 0 0
Betametason krim 0,1% (sebagai Valerat) tube 48 0 48 20 28
Betametason salep 0,1% tube 0
Betason N cream tube 0 0
Bismecon/bioplacenton tube 0
Bromheksin tablet 8 mg/Novahexin tablet 2 3 5 1 4
Bromheksin syrup (Hustab P) botol 10 5 15 10 5
Cetirizine tablet 10 mg tablet 200 100 300 100 200
Clydamicin tablet 100 100 0 100
Cimetidin 200mg tablet 100 100 3 97
Ciprofloxacin 500mg tube 100 100 0 100
Deksametason injeksi i.v./i.m. 5 mg/ml ampul 10 20 30 0 30
Deksametason tablet 0,5 mg tablet 200 300 500 0 500
Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) ampul 5 5 0 5
Doksisiklin kapsul/kaplet 100 mg kapsul 100 100 200 100 100
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Domperidon suspensi/sirup 5 mg/5 ml botol 10 10 20 619 -599
Domperidon tablet 10 mg tablet 100 100 200 2 198
Eritromisin kapsul/kaplet 500 mg tablet 300 400 700 540 160
Eritromisin kapsul/kaplet 250 mg kapsul 200 400 600 600
Eritromisin 200mg dry sirup 5% botol 10 20 30 90 -60
Etanol 70% cairan 1000ml botol 1 5 6 103 -97
EtakridinOralit
Garam larutan 0,1% kombinasi :
I serbuk, botol 2 2 0 2
Natrium
Etanol 70%klorida
cairan 100ml 0,52 g botol 20 500 520 155 365
kalium klorida 0,30 g sachet
Furosemid tabletdihidrat
Trinatrium sitrat 40 mg 0,58 g tablet 100 100 200 191 9
Glukosa Anhidrat 2,70 g 100 100 200 61 139
Gentamisin injeksi 40 mg/ ml ampul 50 50 40 10
Gentamisin salep mata 0,3% tube 10 10 0 10
Gentamisin tetes mata 0,3% botol 5 5 0 5
Gentamisin salep kulit 0.1% tube 5 5 10 0 10
Gentian Violet larutan 1 % botol 5 5 0 5
Glibenklamida tablet 5 mg tablet 100 500 600 0 600
Glimepirid 1mg Tablet 200 200 0 200
Glimepirid 2mg Tablet
Gliseril guaiakolat tablet 100 mg tablet 1000 1,000 0 1,000
Glukosa larutan infus 5 % steril botol 2 2 0 2
Griseofulvin tablet 125 mg tablet 100 200 300 0 300
Hemafort tablet 100 100 200 0 200
Hidrokortison krim 2,5 % tube 25 25 0 25
Hustab P syrup botol 10 10 0 10
Hyoscine -N-Butilbromide tablet 10 mg tablet
Hyoscine -N-Butilbromide Inj 20 mg/ml ampul
Ibuprofen sirup 100 mg/5 ml botol 10 20 30 0 30
Ibuprofen tablet 200 mg tablet 100 200 300 0 300
Ibuprofen tablet 400 mg tablet 100 200 300 0 300
Kalsium Laktat (Kalk) tablet 500 mg tablet 200 200 400 0 400
Kandistatin drop 100.000ui botol 4 3 7 0 7
Kaptopril tablet scored12,5 mg tablet 200 400 600 0 600
Kaptopril tablet scored 25 mg tablet 200 200 400 0 400

399505484.xls Page 3
Ketokonazol krim 2% tube 24 5 29 0 29
Ketokonazol tablet 200 mg tablet 100 100 200 0 200
Klorfeniramina Maleat (CTM) tablet 4 mg tablet 300 400 700 0 700

Kotrimoksazol DOEN I (dewasa) kombinasi :

Sulfametoksazol 400 mg tablet
Trimetoprim 80 mg 500 300 800 0 800

Kotrimoksazol DOEN II (pediatrik) kombinasi :

Sulfametoksazol 100 mg tablet
Trimetoprim 20 mg 200 200 0 200
Kotrimoksazol Suspensi komb:
botol
Sulfametoksazol 200 mg + Trimetoprim 40 mg / 5 ml 50 20 70 0 70
Lanzoprazol kapsul/kaplet 30 mg kapsul 100 100 0 100
Lidokain injeksi infiltrasi 2% ampul 10 10 0 10
Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml ampul
Loperamid tablet 2 mg tablet
Loratadin tablet 10 mg tablet 100 100 200 0 200
Lysmin Syrup botol
Magnesium Sulfat inj (IV) 20% - 25 ml vial 5 5 0 5
Magnesium Sulfat inj (IV) 40% - 25 ml vial 5 5 0 5
Metformin HCl tablet 500 mg tablet 100 100 0 100
Metformin HCl tablet 850 mg tablet
Metilergometrin Maleat (Metilergometrin) tablet salut 0,125 tablet 100 100 0 100
Metilergometrin Maleat injeksi 0,200 mg-1 ml ampul
Metilprednisolon tablet 4 mg tablet 100 100 0 100
Metoklopramide sirup 5 mg/ 5 ml botol 10 10 0 10
Metoklopramide tablet 10 mg tablet
Metoklopramide tablet 5 mg tablet
Metronidazol tablet 250 mg tablet
Metronidazol tablet 500 mg tablet 100 100 0 100
Mikonazol krim/salep 2 % (Nitrat) tube 24 24 0 24
Multivitamin (Pehavral tablet ) tube 100 100 0 100
Natrium Bikarbonat tablet 500 mg tablet 100 100 0 100
Natrium Diklofenak tablet 50 mg tablet 100 100 200 0 200
Natrium Diklofenak tablet 25 mg tablet 200 100 300 0 300

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Natrium Klorida larutan 0,9% botol 5 5 0 5
Obat Batuk Hitam ( O.B.H. ) cairan 100 ml botol 20 20 40 0 40
Obat Batuk Hitam ( O.B.H. ) cairan 200 ml botol 20 20 0 20
Ondansetron tablet 8 mg tablet 20 20 0 20
Oksitetrasiklin salep kulit 3% tube 25 25 0 25
Omeprazol kapsul/kaplet 20 mg kapsul 100 100 0 100
Parasetamol tetes 60 mg/0,6 mL botol 10 5 15 0 15
Parasetamol sirup 120 mg / 5 ml botol 20 10 30 0 30
Parasetamol tablet 100 mg tablet 300 300 0 300
Parasetamol tablet 500 mg tablet 500 500 1,000 0 1,000
Pirantel suspensi 125 mg/5 ml botol 10 10 0 10
Pirantel tablet score (base) 125 mg tablet 100 100 0 100
Pirantel tablet scored 365 mg tablet
Piridoksin (Vitamin B6) tablet 10 mg (HCl) tablet 200 1000 1,200 0 1,200
Piridoksin (Vitamin B6) tablet 25 mg (HCl) tablet
Piroksikam kapsul/kaplet/tablet 10 mg kapsul 200 200 400 0 400
Piroksikam kapsul/kaplet/tablet 20 mg kapsul 200 200 0 200
Povidon Iodida larutan 10% 30 ml botol 10 10 0 10
Povidon Iodida larutan 10% 60 ml botol 20 5 25 0 25
Povidon Iodida larutan 10% 300 ml botol 5 5 0 5
Povidon Iodida larutan 10% 1000 ml botol
Prednison tablet 5 mg tablet 100 100 200 0 200
Ranitidin injeksi 25 mg/2 ml ampul 10 10 0 10
Ranitidin tablet 150 mg tablet 200 200 400 0 400
Ringer Laktat larutan infus botol 10 5 15 0 15
Salbutamol tablet 2 mg (sebagai Sulfat) tablet 100 200 300 0 300
Salbutamol tablet 4 mg (sebagai Sulfat) tablet 100 100 200 0 200
Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang end pot 10 5 15 0 15
Scabisid zalf tube 2 2 0 2
Sianokobalamin (vitamin B12) injeksi 500 mcg ampul 16 20 36 0 36
Simvastatin tablet 10 mg tablet 100 300 400 0 400
Simvastatin tablet 20 mg tablet 100 300 400 0 400
Teofilin tablet 150 mg tablet 100 100 0 100
Tetrasiklin kapsul/kaplet 250 mg kapsul 100 100 0 100

399505484.xls Page 5
Tetrasiklin kapsul/kaplet 500 mg kapsul 100 500 600 0 600
Tiamin (Vitamin B1) tablet 50 mg (HCl/ Nitrat) tablet 200 1000 1,200 0 1,200
Transamin 500mg/ Asam Tranexamat 500mg tablet 50 3000 3,050 0 3,050
Transamin inj ampul
Vitamin B Kompleks tablet tablet 200 200 0 200
Zinc Syrup 20mg/5ml (Zircum Syrup) botol 10 10 0 10
Zinc tablet dispersible20 mg tablet 300 300 0 300

399505484.xls Page 6
PERBEKALAN KESEHATAN
Alat suntik sekali pakai 1 ml Set 20 20 0 20
Alat suntik sekali pakai 2,5 ml Set 30 20 50 0 50
Alat suntik sekali pakai 5 ml Set 10 10 20 0 20
Catgut/Benang bedah no 2/0 ktk/24 set 1 1 0 1
Catgut/Benang bedah no 3/0 ktk/24 set 1 1 0 1
Elastis bandage rol 1 1 0 1
infuset anak Set 1 1 0 1
infuset Dewasa Set 2 5 7 0 7
Kapas berlemak 500mg bungkus 1 1 2 0 2
kapas pembalut/Absorben 250mg bungkus 1 1 0 1
Kassa hydrofil steril 16 x 16 cm ktk/16 lembar 5 5 0 5
Kassa Pembalut hydrofil 4m x 5 cm (bks isi 100 pcs) pcs 5 5 0 5
Kassa Pembalut hydrofil 4m x 10 cm (bks isi 50 pcs) pcs 5 5 0 5
Kassa Pembalut hydrofil 4m x 15 cm (4 Inc) bungkus 2 2 0 2
Jarum jahit (Bedah) no.9 s/d 14 Set
Lisol 50% (protector) botol 1 1 0 1
Masker Ktk 5 5 0 5
Perkamen/kertas obat rol 1 1 0 1
Pembalut Gips 4'' rol
Plester 5 yard x 2 inci rol 1 1 2 0 2
Silk (Benang Bedah sutra ) no 3/0 ktk/36 pcs 2 1 3 0 3
Steril prosedure glove no S (7,5) pasang 5 5 0 5
Venican IV cath G 20 Set 5 5 0 5
Venican IV cath G 22 Set 5 5 0 5
Venican IV cath G 24 Set
Urine Bag 2 L pcs

KEPALA PUSTU BADANG

DARIANTO, SKM
399505484.xls Page 7