LEMBAR PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO) PUSKESMAS

PUSKESMAS : BETOAMBARI PELAPORAN BULAN : SEPTEMBER DOKUMEN Nomor

KECAMATAN : MURHUM PERMINTAAN BULAN : OKTOBER DINKES KOTA
KOTA : BAUBAU PUSKESMAS
PROPINSI : SULAWESI TENGGARA

Pemberian
STOK Peneri- Perse- Pema- Stok Stok Permin-
NO NAMA BARANG OBAT Satuan Prog-
AWAL maan diaan kaian Akhir Optimal taan PKD Lain-Lain PKD
ram
1 2 3 4 5 6 7 8 9 10 11 12 13 14
1 Abbocath No. 18 Pcs 0 0 0 0 0
2 Abbocath No. 20 Buah 0 20 20 0 20
3 Abbocath No. 22 Buah 4 0 4 0 4
4 Abbocath No. 24 Buah 0 0 0
5 Acyclofir 200 mg Tablet 0 0 0 0 0
6 Acyclofir 400 mg Tablet 0 0 0 0 0
7 Acyclofir Cream Tube 35 0 35 0 35
8 Alat suntik sekali pakai 1 ml Set 0 100 100 0 100
9 Alat suntik sekali pakai 2,5 ml Set 50 0 50 0 50
10 Alat suntik sekali pakai 3 ml Set 50 0 50 0 50
11 Alat suntik sekali pakai 5 ml Set 0 0 0 0 0
12 Albendazole tablet 400 mg Tablet 120 0 120 0 120
13 Albendazole suspensi 200 mg/5 ml Botol 2 0 2 0 2
14 Allopurinol tablet 100 mg Tablet 600 600 200 400
15 Ambroksol tablet 30 mg Tablet 400 0 400 300 100 500
16 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 0 0 0
17 Aminofilin tablet 200 mg Tablet 100 0 100 0 100
18 Amitriptilin HCL tablet salut 25 mg Tablet 200 0 200 10 190
19 Amlodipin Tab 10 mg Tablet 30 0 30 30 0
20 Amlodipin Tab 5 mg Tablet 0 150 150 0 150
21 Amoksisilin Tablet 250 mg Tablet 120 0 120 120 0 240
22 Amoksisilin kaplet 500 mg Tablet 400 2000 2400 1300 1100 1000
23 Amoksisilin sirup kering 125 mg/5 ml Botol 22 30 52 52 0 100
24 Ampicillin 500 mg tablet Tablet 0 0 0 0 0
25 Ampicillin Sirup Kering 125mg/5ml Botol 0 0 0 0
26 Ampicillin 500 mg tablet Injeksi Vial 0 0 0
27 Antalgin (Metampiron) tablet 500 mg Tablet 0 0 0
28 Antalgin injeksi 250 mg/ml - 2 ml Ampul 0 0 0
29 Antasida DOEN tablet Tablet 1000 0 1000 500 500
30 Antasida DOEN suspensi Botol 5 80 85 35 50
31 Antibakteri DOEN II Tube 50 0 50 0 50
32 Antifungi DOEN kombinasi Pot 20 0 20 0 20
33 Anti Hemoroid DOEN kombinasi Suppo 20 20 10 10 30
34 Antimigren : Ergotamin tatrat + kofein Tablet 200 0 200 0 200
35 Aquades Botol 0 0 0
36 Aqua pro Injeksi steril, bebas pirogen Vial 30 30 30 0
37 Artesunate Tablet Tablet 0 0 0
38 Artesunate Injeksi Vial 0 0 0
39 Asam Folat tablet 1 mg Tablet 300 0 300 100 200 0
40 Asam Askorbat (Vit C) tablet 50 mg Tablet 1300 0 1300 500 800 500
41 Asam Askorbat (Vit C) tablet 250 mg Tablet 50 0 50 0 50
42 Asam mefenamat tab 500 mg Tablet 1000 0 1000 300 700
43 Asetosal tablet 100 mg Tablet 100 0 100 0 100
44 Asetosal tablet 500 mg Tablet 200 0 200 200 0
45 Asetosal 500 mg Tablet 0 0 0 0 0
46 Auto Disible Syringe (ADS)0,5 ml DPT-BD Pcs 0 0 0 0 0
47 Auto Disible Syringe (ADS)0,05 ml Pcs 300 0 300 0 300
48 Betametason krim 0,1 % Tube 48 0 48 0 48
49 Bisturi Buah 4 0 4 0 4
50 Captopril tablet 12,5 mg Tablet 0 500 500 0 500
51 Captopril tablet 25 mg Tablet 100 500 600 0 600
52 Cat Gut No. 2/0 Sase 0 5 5 0 5
53 Cat Gut No. 3/0 Sase 0 5 5 0 5
54 Cefotaxime inj 1 g Vial 0 0 0
55 Cetirizine 10 mg Tablet 200 200 400 300 100 300
56 Cimetidine tablet 200 mg Tablet 100 100 200 100 100
57 Devitalisasi pasta (non arsen) Botol/ktk 0 0 0
58 Deksametason injeksi 5 mg/ ml - 1 ml Ampul 5 0 5 0 5
59 Deksametason tablet 0,5 mg Tablet 700 1500 2200 1100 1100 1000
60 Diazepam injeksi 5 mg/ ml - 2 ml Ampul 0 0 0 0 0
61 Diazepam tablet 2 mg Tablet 0 0 0 0 100
62 Dietilkarbamazin sitrat 100 mg Tablet 0 0 0 0 0
63 Digoksin tablet 0,25 mg Tablet 0 0 0 0 0
64 Difenhidramin HCl inj 10 mg/ml - 1 ml Ampul 0 0 0 0 0
65 Domperidon Tab 10 mg Tablet 100 0 100 0 100
66 Domperidon suspensi 5 mg / 5 ml Botol 5 0 5 0 5
67 Doxyciclin 100 mg Tablet 200 0 200 0 200
68 Efedrin HCl tablet 25 mg Tablet 1000 0 1000 0 1000
69 Ekstrak Belladona Tablet 400 0 400 0 400
70 Epinefrina / Adrenalina injeksi 0,1 % Ampul 0 0 0
71 Erytromisin 250 Kapsul Tablet 240 0 240 0 240
72 Erytromisin 500 Kapsul Tablet 0 0 0
73 Erytromisin Sirup Kering 200 mg Botol 0 0 0 0 0
74 Etakridin (rivanol) larutan 0,1 % Botol 5 0 5 0 5
75 Etambutol HCl tablet 250 mg Tablet 0 0 0
76 Etambutol tablet 500 mg Tablet 0 0 0
77 Etanol 70% botol 1000 ml 0 0 0 0 0 0
78 Etanol 70% botol 100 ml 5 10 15 1 14
79 Etil klorida semprot Botol 3 0 3 0 3
80 Eugenol Botol 0 0 0 0 0
81 Foley Catheter 16 G Pcs 0 0
82 Foley Catheter 18 G Pcs 0 0
83 Foley Catheter 20 G Pcs 0 0
84 Foley Catheter 22 G Pcs 0 0
85 Fenobarbital injeksi 50 mg/ml - 1 ml Ampul 10 0 10 10 0
86 Fenobarbital tablet 30 mg Tablet 100 0 100 0 100 0
87 Fenol Gliserol tetes telinga 10% Botol 10 0 10 10 0
88 Fenitoin Natrium Kapsul 30 mg Kapsul 0 0
89 Fitomenadion(Vit.K1) injeksi 10mg/ml-1ml Ampul 10 10 0 10
90 Fitomenadion(Vit.K1) tab salut gula 10 mg Tablet 100 0 100 0 100
91 Flouride 1 mg tablet Tablet 0 0
92 Furosemid tablet 40 mg Tablet 200 0 200 0 200
93 Furosemid inj I.V/I.M 10 mg/ ml Ampul 0 0
94 Garam Oralit untuk 200 ml air Sase 0 200 200 0 200
95 Gentamicin salep kulit 0,1 % Tube 37 0 37 17 20
96 Gentamicin inj 40 mg/ml Ampul 0 0
97 Gentian Violet larutan 1 % Botol 8 8 8
98 Glass Ionomer Set 0 0
99 Glibenklamid tablet 5 mg Tablet 500 0 500 0 500
100 Gliseril Guaiacolat tablet 100 mg Tablet 0 2000 2000 1000 1000 1000
101 Gliserin Botol 0 0
102 Glukosa larutan infus 5% steril Botol 500 ml 20 0 20 0 20
103 Griseofulvin tablet 125 mg, micronized Tablet 300 0 300 0 300
104 Haloperidol tablet 0,5 mg Tablet 0 0
105 Haloperidol tablet 1,5 mg Tablet 0 0 0 0 0 100
106 Haloperidol tablet 5 mg Tablet 40 0 40 30 10 100
107 Handscoon No. 7 Pcs 50 0 50 0 50
108 Handscoon No. 6,5 Pcs 0 0 50
109 Handscoon No. 8 Pcs 0 0
110 Handscoon Non Steril No. 7 Pcs 0 0 0 0 0 200
111 Hidroklorotiazid (HCT) tablet 25 mg Tablet 0 0 0 0 1000
112 Hidrokortison krim 2,5% Tube 24 48 72 24 48
113 Ibuprofen tablet 200 mg Tablet 100 0 100 0 100
114 Ibuprofen tablet 400 mg Tablet 0 700 700 0 700
115 Imersion Oil Botol 0 0
116 Infusion Set dewasa Pcs 20 0 20 0 20
117 Iodol kapsul lunak Kapsul 0 0
118 Isoniasid tab 300 mg Tablet 0 0
119 Isosorbit Dinitrat tab sublingual 5 mg Tablet 0 0
120 Jarum Jahit Bedah Lusin 0 0
121 Jarum Jahit Kulit Lusin 0 0
122 Jarum Jahit hect otot No. 9 Lusin 0 0
123 Jarum Jahit hect otot No. 10 Lusin 0 0
124 Jarum Jahit hect otot No. 11 Lusin 0 0
125 Jarum Jahit hect otot No. 12 Lusin 0 0
126 Jarum Jahit hect otot No. 13 Lusin 0 0
127 Kaca Slide Pcs 0 0
128 Kalsium Hidroksida pasta Ktk / 2 tube 0 0
129 Kalsium Laktat (Kalk) tablet 500 mg Tablet 0 1000 1000 0 1000
130 Kapas Pembalut 250 gr Bungkus 4 0 4 0 4
131 Karbamazepin tablet 200 mg Tablet 0 0
132 Kasa Pembalut Hidrofil 2m x 10 cm Rol 0 0
133 Kasa Pembalut Hidrofil 4 m x 3 cm elastis Rol 25 0 25 0 25
134 Kasa Pembalut Hidrofil 4 m x 15 cm Rol 100 0 100 0 100
135 Kasa Pembalut 2 m x 80 cm Rol 0 5 5 5
136 Ketorolac Injeksi 10 mg Ampul 0 0
137 Kloramfenikol kapsul 250 mg Kapsul 1000 0 1000 0 1000
138 Kloramfenikol tetes mata 0,5% Botol 0 0 0 0 0 25
139 Kloramfenikol tetes telinga 3 % Botol 24 0 24 0 24 0
140 Kloramfenikol salep mata 1 % Tube 30 0 30 0 30
141 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 1000 1000 2000 1400 600 2000
142 Klorfenol kamfer mentol (CHKM) Botol 0 0
143 Klorpromazin HCl tablet salut 100 mg Tablet 0 0 0 0 0 100
144 Kombinasi Primetamin + Sulfadoxin Tablet 0 0
145 Kotrimoksazol suspensi Botol 20 30 50 20 30
146 Kotrimoksazole tablet 480 mg Tablet 0 0 0 0 0 1000
147 Kotrimoksazole pediatrik 120 mg Tablet 0 300 300 0 300
148 Kuinin HCl 25% - 2 ml injeksi Ampul 0 0
149 Kuinin ( Kina) tablet 200 mg Tablet 0 0
150 Larutan EDTa Botol 0 0
151 Larutan Etanol Asam Botol 0 0
152 Larutan giemsa stein Botol 0 0
153 Laritan karbol fuksin Botol 0 0
154 Larutan metiln biru Botol 0 0
155 Levofloksasin 500 mg tablet Tablet 90 0 90 0 90
156 Lidokain injeksi 2 % Ampul 0 30 30 10 20 20
157 Lisol Larutan botol 1000 ml 1 0 1 0 1
158 Magnesium Sulfat inj (IV) 20% - 25 ml Vial 8 0 8 0 8
159 Magnesium Sulfat inj (IV) 40% - 25 ml Vial 8 0 8 0 8
160 Masker Pcs 30 0 30 30 0 30
161 Mebendazole sirup 100 mg / 5 ml Botol 0 0
162 Mebendazole tablet 100 mg Tablet 0 0
163 Meloksikam Tab 15 mg Tablet 0 0
164 Metilergometrin Maleat tab salut 0,125 mg Tablet 300 0 300 0 300
165 Metilergometrin Maleat inj 0,200 mg - 1 ml Ampul 0 0
166 Metformin HCl tablet 500 mg Tablet 0 0 0 0 0 500
167 Metoklorpramid Syrup Botol 0 0 0 0 0
168 Metoklopramid 10 mg Tablet 400 0 400 300 100 300
169 Metoklopramid Injeksi Ampul 0 0
170 Metronidazole tablet 250 mg Tablet 0 300 300 0 300 0
171 Metronidazole tablet 500 mg Tablet 500 0 500 200 300 0
172 Metronidazole Infus 500 mg Botol 0 0
173 Miconazole krim 2 % Tube 0 24 24 24 0
174 Mummyflyng pasta Botol 0 0
175 Natrium bikarbonat 500 mg Botol 0 0
176 Natrium Diklofenat 25 mg Tablet 300 0 300 300 0 500
177 Natrium Diklofenat 50 mg Tablet 100 500 600 0 600
178 Natrium Klorida (NaCL) Larutan Infus Botol 500 ml 5 20 25 2 23
179 Nifedipin Tablet Tablet 100 0 100 0 100
180 Nistatin tablet salut 500.000 IU Tablet 100 0 100 0 100
181 Nistatin tablet vaginal 100.000 IU/g Tablet 80 0 80 0 80
182 Obat anti TB kategori anak (FDC) Paket 0 0
183 Obat anti TB kategori I (KOMBIPAK) Paket 0 0
184 Obat anti TB kategori I (FDC) Paket 0 0 0 0 0
185 Obat anti TB kategori II (FDC) Paket 0 0
186 Obat anti TB kategori sisipan Paket 0 0
187 Obat Batuk Hitam (OBH) cairan Botol 100 ml 17 0 17 0 17
188 Ofloksasin tablet 400 mg Tablet 0 0
189 Oksitetrasiklin HCl Injeksi Vial 0 0
190 Oksitetrasiklin HCl SK 3 % Tube 24 0 24 0 24
191 Oksitetrasiklin HCl salep mata 1% Tube 20 0 20 0 20
192 Oksitosin injeksi 10 IU / ml - 1 ml Ampul 30 0 30 30
193 Omeprazole kapsul 20 mg Tablet 0 0 0 0 0 100
194 Papaverin tablet Tablet 0 0 0 0
195 Parasetamol sirup 120 mg/5 ml Botol 60 ml 20 80 100 45 55
196 Parasetamol tablet 100 mg Tablet 200 0 200 200
197 Parasetamol tablet 500 mg Tablet 600 2000 2600 1000 1600
198 Pirantel Syrup Botol 60 ml 20 0 20 0 20 0
199 Pirantel Pamoat tab 125 mg Tablet 300 0 300 0 300
200 Piridoksin HCl (Vit. B6) tablet 10 mg Tablet 1800 0 1800 0 1800
201 Piroksikam tab 20 mg Tablet 500 0 500 500 0 500
202 Plester 5 Yard x 2 inci Rol 4 0 4 0 4
203 Prednison tablet 500 mg Tablet 2000 2000 1000 1000
204 Primakuin tablet 15 mg Tablet 0 0 0 0
205 Propiltiourasil tablet 100 mg Tablet 0 0
206 Propranolol HCl tablet 40 mg Tablet 0 0
207 Pyrazinamid 500 mg Tablet 0 0
208 Pot Dahak R-50 Buah 0 0
209 Ranitidin tab 15 mg Tablet 500 0 500 500 0 1000
210 Ranitidin injeksi Ampul 0 0
211 Reserpin 0,25 mg Tablet 0 0
212 Retinol (vitamin A) kaps 200.000 IU Kapsul 0 0 0 0 0
213 Retinol (Vitamin A) kaps 100.000 IU Kapsul 100 0 100 100 0
214 Rifampisin kaplet 450 mg Tablet 0 0
215 Ringer Laktat larutan infus steril Botol 500 ml 20 0 20 0 20
216 Risperidon tab 3 mg Tablet 0 0
217 Salbutamol tablet 2 mg Tablet 100 200 300 0 300
218 Salbutamol tablet 4 mg Tablet 0 300 300 200 100 300
219 Salep 2-4 Kombinasi Pot 23 0 23 23
220 Salisil Bedak 2 % Kotak 50 gram 10 0 10 10 0
221 Salisil Spritus 10 % Botol 10 ml 3 0 3 0 3
222 Sefadroksil Kapsul 500 mg Tablet 100 400 500 100 400
223 Sefadroksil Sirup Kering 125 mg / 5 ml Botol 60 ml 15 0 15 10 5 10
224 Semen seng fos. Serbuk / cair Botol 50 gram 0 0
225 Serum Anti Tetanus injeksi 1500 IU Ampul 1 ml 0 0
226 Serum Anti Tetanus injeksi 20.000 IU Vial 5 ml 0 0
227 Sianakobalamin (Vit. B12) Tab 500 mcg Tablet 1000 0 1000 0 1000 0
228 Sianakobalamin (Vit. B12) Injeksi 500 mcg Ampul 0 0 0 0 0 50
229 Silk (ben. Bedah sutra) no. 3/0 pcs 8 0 8 0 8
230 Silver amalgam ser. 55 - 75 % Botol 0 0
231 Simvastatin 10 mg Tablet 300 200 500 200 300 200
232 Siprofloksasin tablet 500 mg Tablet 400 0 400 0 400
233 Sulfacetamida nat 15% TM Botol 24 0 24 0 24
234 Sulfadimidin tablet 500 mg Tablet 0 0
235 Tablet tambah darah kombinasi (SF) Tablet 1050 1050 300 750
236 Tempor. Stopp.flet.serbuk. & cair Set 0 0
237 Tetrasiklin HCl kapsul 250 mg Kapsul 0 0 0 0 0
238 Tetrasiklin HCl kapsul 500 mg Kapsul 0 0
239 Thiamin HCl (Vit.B1) inj 100 mg/ml - 1ml Ampul 10 0 10 0 10
240 Thiamin HCl (Vit B1) tablet 50 mg Tablet 800 2000 2800 0 2800
241 Tramadol 50 mg Tablet 70 0 70 0 70
242 Tramadol inj 50 mg / ml Ampul 0 0
243 Triheksifenidil tablet 2 mg Tablet 120 0 120 30 90 100
244 Trikesol formalin (TKF) cairan Botol 0 0
245 Urin bag pcs 0 0
246 Vaksin Rabies Vero 1 kuur / set 0 0
247 Vitamin B Kompleks tablet Tablet 1400 1500 2900 2700 200 3000
248 Vitamin K3 Inj (Menadion Injeksi) Ampul 0 0
249 Wing Needle No. 21 G Pcs 0 0
250 Wing Needle No. 23 G Pcs 0 0
251 Wing Needle No. 25 G Pcs 0 0
252 Wing Needle No. 27 G Pcs 0 0
253 Yodium pov. Lar. 10% 30 ml Botol 0 10 10 0 10
254 Yodium pov. Lar. 10% 60 ml Botol 0 5 5 3 2
255 Yodium pov. Lar. 10% 300 ml Botol 0 2 2 0 2
256 Zinc tablet 20 mg Tablet 300 0 300 0 300
257 Nerofa Tablet 0 0 0 0 0 1000
258 Vastarel Tablet 0 0 0 0 0 1000
259 Rosidon Syrup Botol 10 0 10 0 10 20
260 Livron B - Plex Tablet Tablet 0 0 0 0 0 1000
261 Reagen Kotak 0 1 1 0 1
262 Plester Rol 0 0 0 0 0
263 Reagen HB
264 Reagen test gol. Darah
265 Paracetamol drops 100mg/ml Botol 15 ml 5 0 5 5 0

JUMLAH UMUM
ASKES JUMLAH
KUNJUNGAN BAYAR TIDAK BAYAR
RESEP

Mengatahui,
An. Kepala Dinas Kesehatan Kota Baubau Yang Menyerahkan, Yang Meminta, Yang Menerima
Kabid Kefarmasian dan Regdit Kasi Obat dan Perbekalan Kesehatan Kepala Puskesmas Betoambari Petugas Pengelola Obat

DJAINUDDIN ISHAK, S.Si, M.Si, Apt MUDRIAN S.Farm.,Apt D A H L A N. T NORA FERIE PANGARIBUAN, S.Si
NIP. 19800520 200502 1 007 NIP. 19860427 201001 1 012 NIP. 19591231 198412 1 023 NIP. 19830415 200904 2 001
Tanggal

KET

15
expired
expired

expired
 Yang Menerima
ugas Pengelola Obat

ERIE PANGARIBUAN, S.Si

9830415 200904 2 001