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 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS
PUSKESMAS : campakamulya
KECAMATAN : campakamulya
KABUPATEN : CIANJUR
PELAPORAN BULAN : November 2018
PERMINTAAN BULAN : Desember 2018

Jumlah Stok Stok

NO NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan akhir Optimum

1 2 3 4 5 6 7 8 9
1 Acyclovir tab 200mg TABLET 0 0 0 0
2 Acyclovir tab 400mg TABLET 0 200 200 200 0
3 Air Raksa Dental Use BOTOL 0 0 0 0
4 Alat Suntik Sekali Pakai 1 ml SET 0 100 100 50 50
5 Alat Suntik Sekali Pakai 10 ml SET 0 0 0 0
6 Alat Suntik Sekali Pakai 3 ml SET 0 200 200 200 0
7 Alat Suntik Sekali Pakai 5 ml SET 0 100 100 100 0
8 Albendazol tab TABLET 6030 0 6030 5830 200
9 Alkohol Swab KOTAK 0 0 0 0
10 Alopurinol Tablet 100 mg TABLET 0 200 200 200 0
11 Ambroxol syrup 15mg/5ml BOTOL 0 15 15 15 0
12 Ambroxol tab 30 mg TABLET 0 0 0 0
13 Aminofilin Injeksi 24 mg/ ml AMPUL 8 0 8 4 4
14 Aminofilin Tablet 200 mg TABLET 0 0 0 0
15 Amitriptilin HCL 25 mg TABLET 0 0 0 0
16 Amlodipin Tablet 10 mg TABLET 0 300 300 300 0
17 Amlodipin Tablet 5 mg TABLET 0 300 300 300 0
18 Amoksisilin 250 mg KAPSUL 0 0 0 0
19 Amoksisilin 500 mg TABLET 200 1500 1700 1700 0
20 Amoksisilin + Asam Klavulanat TABLET 0 0 0 0
21 Amoksisilin Syrup 125 mg/ 5 ml BOTOL 0 180 180 180 0
22 Ampisilin Kaplet 500 mg Kaplet 0 0 0 0
23 Ampisillin Serbuk 1.000 mg injeksi VIAL 0 0 0 0
24 Antalgin Injeksi 250 mg/ ml AMPUL 0 0 0 0
25 Antalgin tab (Metampiron) 500 mg TABLET 0 0 0 0
26 Antasida DOEN I tablet kunyah TABLET 300 3000 3300 2300 1000
27 Antasida DOEN II suspensi, Botol 0 100 100 100 0
28 Anti Bakteri DOEN salep kombinasi TUBE 0 25 25 24 1
29 Anti fungi DOEN Kombinasi POT 0 24 24 24 0
30 Anti Hemoroid Doen Kombinasi SUP 0 0 0 0
31 Antihemoroid Kapsul Kapsul 0 0 0 0
32 Antimigren tablet: Ergotamin Tartrat 1 mg TABLET 0 0 0 0
33 Aqua Proinjeksi Steril VIAL 0 0 0 0
34 Asam Asetil Salisilat Tablet 100mg TABLET 0 0 0 0
35 Asam Askorbat 50 mg TABLET 0 0 0 0
36 Asam Mefenamat 500 mg TABLET 0 1000 1000 1000 0
37 Asam Traneksamat injeksi 100 mg/ml Ampul 0 0 0 0
38 Atropin Sulfat Injeksi 0,25 mg AMPUL 5 0 5 5 0
39 Bekarbon TABLET 0 0 0 0
40 Benzatin B. P. Injek 2,4 juta UI VIAL 0 0 0 0
41 Betametason Krim 0,1 %- 5 mg TUBE 0 25 25 25 0
42 Bisakodil Suppositoria 10 mg Supp 6 0 6 6 0
43 Bisakodil Suppositoria 5 mg Supp 6 0 6 6
44 Bisaprolol tab 5mg TABLET 0 0 0 0
45 Bromhexin Syrup Botol 0 0 0 0
46 Bromhexin Tablet 8 mg TABLET 0 0 0 0
47 Ca-Glukonas injeksi IV 10% Ampul 9 0 9 9
48 Captopril Tablet 25 mg TABLET 0 1000 1000 1000 0
49 Catgut Chromic No.2/0 Sachet 0 0 0 0
50 Catgut Chromic No.3/0 Sachet 0 0 0 0
51 Catgut plain No.2/0 Sachet 0 0 0 0
52 Catgut Plain No.3/0 Sachet 0 0 0 0
53 Cefadroxil Kapsul 500 mg KAPSUL 0 400 400 400 0
54 Cetirizin Tablet 10mg TABLET 20 120 140 140 0
55 Cimetidine Tablet 200 mg TABLET 0 0 0 0
56 Clindamycin Kapsul 150mg KAPSUL 0 300 300 100 200
57 Clindamycin Kapsul 300mg KAPSUL 0 300 300 200 100
58 Clobazam Tablet 10 mg TABLET 0 0 0 0
59 Clozapin 25 mg TABLET 0 0 0 0
60 Codein 20 mg TABLET 0 0 0 0
61 Cyprofloxacin Tablet 500 mg TABLET 0 600 600 600 0
62 Deksametason Injeksi 5 mg/ ml AMPUL 0 30 30 30 0
63 Deksametason Tablet 0,5 mg TABLET 200 800 1000 1000 0
64 Devitalisasi Pasa Non Arsen BOTOL 0 0 0 0
65 Dextran 6% BOTOL 0 0 0 0
66 Diazepam Injeksi 5 mg/ ml- 2 ml AMPUL 30 0 30 30
67 Diazepam Rectal Tube 5mg Tube 5 0 5 5
68 Diazepam Tablet 2 mg TABLET 0 0 0 0
69 Diazepam Tablet 5 mg TABLET 180 0 180 180
70 Difenhidramin HCL Injeksi AMPUL 0 30 30 30 0
71 Digoxin 0,25 mg TABLET 100 0 100 100
72 Domperidon Syrup Botol 0 10 10 10 0
73 Domperidon Tablet 10mg TABLET 0 100 100 100 0
74 Doxycilkin 100 mg kapsul KAPSUL 0 0 0 0
75 Efedrin HCL 25 mg TABLET 0 0 0 0
76 Ekstrak Belladone 10 mg TABLET 100 0 100 100 0
77 Epinefrin (Adrenalin) injeksi 0,1 % AMPUL 5 0 5 5
78 Eritromisin sirup 200 mg/ 5 ml BOTOL 0 0 0 0
79 Erythromicin 250 mg KAPSUL 0 0 0 0
80 Erythromicin 500 mg KAPSUL 0 100 100 100 0
81 Etakridine ( Rivanol ) 0,1 % BOTOL 0 0 0 0
82 Etambutol 500 mg TABLET 0 0 0 0
83 Etanol 70 % 100 ml BOTOL 0 0 0 2 -2
84 Etanol 70 % 1000 ml BOTOL 0 2 2 2 0
85 Etil Klorida Semprot BOTOL 0 0 0 0
86 Eugenol Cairan BOTOL 0 0 0 0
87 Extrak Plasenta dan Neomisin Jeli tuBE 0 10 10 10 0
88 Fenilbutazone Tablet 200 mg TABLET 0 0 0 0
89 Fenobarbital Injeksi 50 mg/ ml AMPUL 10 0 10 10
90 Fenobarbital Tablet 30 mg TABLET 100 0 100 100
91 Fenoksimetil Penisilina 250 mg TABLET 0 0 0 0
92 Fenoksimetil Penisilina 500 mg TABLET 200 0 200 100 100
93 Fenolgliserol TT 10 % 5 ml BOTOL 0 24 24 24 0
94 Fitomenadion Injeksi 10 mg/ ml AMPUL 0 0 0 0
95 Fitomenadion Injeksi 2 mg/ ml AMPUL 120 0 120 120 0
96 Fitomenadion Salut Gula 10 mg TABLET 0 200 200 200 0
97 Fluoksetin 10 mg TABLET 0 0 0 0
98 Folley Catheter No. 18 Buah 2 0 2 2
99 Folley Catheter No. 20 Buah 0 0 0 0
100 Forinokresol (TKF) 10 ml BOTOL 0 0 0 0
101 Furosemid Tablet 40 mg TABLET 0 0 0 0
102 Garam Oralit 200 ml Air SASE 0 0 0 0
103 Gentamisin injeksi 40 mg/ ml AMPUL 25 0 25 25 0
104 Gentamisin Salep Kulit 0.1% TUBE 0 12 12 12 0
105 Gentian Violet Larutan 1 % 10 ml BOTOL 0 0 0 0
106 Glass Ionomer Cement ( Fuji GC IX ) BOTOL 0 0 0 0
107 Glibenklamid 5 mg TABLET 100 0 100 100
108 Gliseril Guayakolat 100 mg TABLET 0 0 0 0
109 Gliseril Guayakolat Syrup Botol 0 0 0 0
110 Gliserin lar. 50% BOTOL 0 0 0 0
111 Glukosa Larutan Infus 10% Steril BOTOL 0 0 0 0
112 Glukosa Larutan Infus 40% Steril VIAL 0 0 0 0
113 Glukosa Larutan Infus 5% Steril BOTOL 0 0 0 0
114 Griseofulvin 125 mg, micronized TABLET 0 0 0 0
115 Haloperidol 0,5mg TABLET 100 0 100 100
116 Haloperidol 1,5 mg TABLET 100 0 100 100
117 Haloperidol 5 mg TABLET 90 0 90 25 65
118 Haloperidol injeksi 5 mg/ml AMPUL 0 0 0 0
119 Haloperidol injeksi 50 mg/ml AMPUL 0 0 0 0
120 Hand Sanitizer Botol 0 0 0 0
121 Hidrogen Peroksida Lar. 3 % BOTOL 0 0 0 0
122 Hidroklorotiazid ( HCT ) 25 mg TABLET 100 0 100 100
123 Hidrokortison Krim 2,5 % TUBE 0 48 48 48 0
124 Hyoscine N Butilbromide 10 mg TABLET 0 200 200 200 0
125 Ibuprofen 200 mg TABLET 0 400 400 400 0
126 Ibuprofen 400 mg TABLET 0 0 0 0
127 Ibuprofen suspensi 200mg/5ml BOTOL 0 15 15 15 0
128 Infusion Set Anak SET 0 30 30 30 0
129 Infusion Set Dewasa SET 0 30 30 30 0
130 Isoniazid 300 mg TABLET 0 0 0 0
131 Isosorbid dinitrat 5 mg TABLET 100 0 100 10 90
132 IV Catheter/abocath No. 18 Buah 0 5 5 5 0
133 IV Catheter/abocath No. 20 Buah 0 20 20 20 0
134 IV Catheter/abocath No.22 Buah 0 15 15 15 0
135 IV Catheter/abocath No.24 Buah 0 10 10 10 0
136 Kalium Diklofenak 50 mg TABLET 0 0 0 0
137 Kalsium Hidroksida Pasta KOTAK 0 0 0 0
138 Kalsium Laktat 500 mg TABLET 0 700 700 700 0
139 Kapas Pembalut 250 mg ROL 0 0 0 0
140 Karbamazepin 200 mg TABLET 0 0 0 0
141 Kasa Kompres 16x16 steril KOTAK 0 10 10 10 0
142 Kasa Pembalut 36 mx 80 cm ROL 1 0 1 1
143 Kasa Pembalut Hidrofil 4 m x 10 cm ROL 0 0 0 0
144 Kasa Pembalut Hidrofil 4 m x 5 cm ROL 0 0 0 0
145 Ketokonazol 200 mg TABLET 0 0 0 0
146 Ketokonazol Krim 2 % Tube 15 g 0 25 25 25 0
147 Kloramfenikol 250 mg KAPSUL 100 0 100 100 0
148 Kloramfenikol SM TUBE 0 0 0 0
149 Kloramfenikol TM 0.5 % 5 ml BOTOL 0 0 0 0
150 Kloramfenikol TT 3 % 5 ml BOTOL 0 0 0 0
151 Klorfeniramin Maleat (CTM) 4 mg TABLET 0 1000 1000 1000 0
152 Klorfenol kamfer Mentol(CHKM) Cairan BOTOL 0 0 0 0
153 Klorin Cair Lar. 5% BOTOL 0 0 0 0
154 Klorpromazine tab 100mg TABLET 0 100 100 20 80
155 Klorpromazine tab 25mg TABLET 0 0 0 0
156 Komb : Pirimetamin+sulfadoxin TABLET 0 0 0 0
157 Komposit Resin Botol 10 ml 0 0 0 0
158 Kontrasepsi injek depo/ KB 3 bln vial 0 0 0 0
159 Kontrasepsi Oral (Pil KB) Blister 0 0 0 0
160 Kotrimoksazole Suspensi BOTOL 0 100 100 100 0
161 Kotrimoksazole Tablet Dewasa TABLET 200 0 200 200 0
162 Larutan Benedict 100 ml BOTOL 0 0 0 0
163 Larutan Eosin 2 % 100 ml BOTOL 0 0 0 0
164 Larutan Etanol asam 100 ml BOTOL 0 0 0 0
165 Larutan Giemsa stain 100 ml BOTOL 0 0 0 0
166 Larutan Iodine Test BOTOL 0 0 0 0
167 Larutan Karbol Fuksin 100 ml BOTOL 0 0 0 0
168 Larutan Metilen Biru BOTOL 0 0 0 0
169 Larutan Turk BOTOL 0 0 0 0
170 Laxadin Syrup Botol 0 0 0 0
171 Levertrans Salep POT 0 0 0 0
172 Lidokain Injeksi 2% AMPUL 0 50 50 50 0
173 Lidokain Jeli 2% Syringe 0 0 0 0
174 Lidokain Komp Injeksi AMPUL 30 0 30 30 0
175 Lisol BOTOL 1L 0 0 0 0
176 Loratadin tab 10mg TABLET 0 100 100 100 0
177 Lubricating Jeli (Aquagel) Tube 0 0 0 0
178 Magnesium Sulfat Injeksi 20 % VIAL 3 0 3 3
179 Magnesium Sulfat Injeksi 40 % VIAL 5 0 5 5
180 Masker 3 Fly earloop Buah 0 50 50 50 0
181 Masker N95 Single valve Buah 0 0 0 0
182 Mebendazol tablet 100mg TABLET 0 0 0 0
183 Meloxicam 15mg TABLET 0 0 0 0
184 Metformin HCl Tablet 500mg TABLET 0 0 0 0
185 Metil Prednisolon 4 mg TABLET 0 200 200 200 0
186 Metildopa tab sal 250 mg TABLET 0 0 0 0
187 Metilergometrin Maleat Inj. 0,200 AMPUL 60 0 60 10 50
188 Metilergometrin Maleat tab 0,125 mg TABLET 200 0 200 200
189 Metisoprinol TABLET 0 0 0 0
190 Metoklopramide 10 mg TABLET 300 0 300 100 200
191 Metoklopramide Drop 5mg/ml BOTOL 0 10 10 10 0
192 Metoklopramide injeksi 5mg/ml AMPUL 0 0 0 0
193 Metoklopramide syrup 5mg/ml BOTOL 0 10 10 10 0
194 Metronidazol Larutan infus 5mg/ml BOTOL 0 0 0 0
195 metronidazol ovula Ovula 30 0 30 10 20
196 Metronidazol suppositoria 500mg Supp 0 0 0 0
197 Metronidazole 250 mg TABLET 0 0 0 0
198 Metronidazole 500 mg TABLET 0 200 200 200 0
199 Mikonazol krim 2% TUBE 0 0 0 0
200 Mometason Furoat Krim 0.1% Tube 10g 0 10 10 10 0
201 Multivitamin Syrup Botol 0 0 0 0
202 Multivitamin tablet Caplet 0 200 200 200 0
203 Mummifying Fasta BOTOL 0 0 0 0
204 Narium Tiroksin 100 µg TABLET 0 0 0 0
205 Natrium Bikarbonat 500 mg TABLET 50 0 50 50

206 Natrium bikarbonat injeksi VIAL 0 0 0 0

207 Natrium Diklofenak 50 mg TABLET 0 200 200 200 0

208 Natrium Fusidat Krim tube 0 0 0 0
209 Natrium Klorida Infus 0,9 % Steril BOTOL 17 0 17 7 10
210 Nipedifin 10 mg TABLET 0 0 0 0
211 Nistatin 100.000 IU/ Gram Vaginal TABLET 0 0 0 0
212 OAT FDC 1,3 PAKET 15 0 15 15
213 OAT Kategori 1 PAKET 0 0 0 0
214 OAT Kategori 2/FDC 2 PAKET 0 0 0 0
215 OAT Kategori 3 PAKET 0 0 0 0
216 OAT Kategori Anak PAKET 3 0 3 3
217 OAT Sisipan PAKET 0 0 0 0
218 Obat Batuk Hitam ( OBH ) 100 ml BOTOL 0 0 0 0
219 Obat Batuk Pilek Kombinasi Syrup BOTOL 0 0 0 10 -10
220 Obat Batuk Pilek Kombinasi Tablet TABLET 0 0 0 0
221 Obat Diare Syrup (Kombinasi Attapulgit 70 TABLET 0 0 0 0
222 Obat Diare Tablet TABLET 0 100 100 100 0
223 Obat Flu Kombinasi Tablet TABLET 0 0 0 0
224 Ofloxacin tab 400mg TABLET 0 0 0 0
225 Oksigen Kaleng Botol 0 0 0 0
226 Oksimetazolin Tetes Hidung 0,025% Botol 0 0 0 0
227 Oksitetrasiklin HCL Inj 1m 50 mg VIAL 0 0 0 0
228 Oksitetrasiklin HCL SK 1 % 3,5 Gr TUBE 0 0 0 0
229 Oksitetrasiklin HCL SM 1 % 3,5 Gr TUBE 0 25 25 25 0
230 Oksitosin Injeksi 10 IU/ ml AMPUL 100 0 100 100 0
231 Omeprazol injeksi 40 mg/ 10 ml AMPUL 0 0 0 0
232 Omeprazol Kapsul 20 mg KAPSUL 0 60 60 60 0
233 Ondansetron 4 mg TABLET 0 0 0 0
234 Ondansetron inj 4 mg/ 2 mL Ampul 0 0 0 0
235 Papaverin 40 mg/ ml injeksi AMPUL 0 0 0 0
236 Parasetamol Drops BOTOL 0 56 56 50 6
237 Parasetamol Syrup 120 mg/ ml BOTOL 0 100 100 100 0
238 Parasetamol tablet 100 mg TABLET 200 0 200 200 0
239 Parasetamol tablet 500 mg TABLET 0 3500 3500 3500 0
240 Pembalut Gips Rol 0 0 0 0
241 Permetrin Krim 5% (Scabimite) TUBE 0 10 10 10 0
242 Pirantel Pamoat 125 mg TABLET 0 0 0 0
243 Pirantel Suspensi 125mg/5ml BOTOL 50 0 50 50 0
244 Piridoksin HCL 10 mg TABLET 0 500 500 500 0
245 Piroxicam 20 mg KAPSUL 0 200 200 200
246 Plester 6 Yards x 2 Inch ROL 0 1 1 1 0
247 Polikresulen 360 mg 10 ml BOTOL 0 0 0 0
248 Povidon Iodida 10 % 30 ml BOTOL 0 5 5 5 0
249 Povidon Iodida 10 % 300 ml BOTOL 0 5 5 5 0
250 PP test Buah 50 0 50 50
251 Prednison 5 mg TABLET 0 500 500 500 0
252 Prokain Benzil Penisili 3 Jt IU VIAL 0 0 0 0
253 Propiltiourasil tablet 100mg TABLET 0 0 0 0
254 Propranolol HCL 40 mg TABLET 0 0 0 0
255 Pyrazinamide 500 mg TABLET 0 0 0 0
256 Ranitidin Injek Ampul 0 40 40 40 0
257 Ranitidin tablet 150mg TABLET 0 700 700 700 0
258 Reserpin 0,25 mg TABLET 0 0 0 0
259 Retinol (Vit. A) 100.000 IU KAPSUL 0 0 0 0
260 Retinol (Vit. A) 200.000 IU KAPSUL 0 0 0 0
261 Rifampisin 300 mg KAPSUL 0 0 0 0
262 Rifampisin 450 mg KAPSUL 0 0 0 0
263 Rifampisin 600 mg KAPSUL 0 0 0 0
264 Risperidon Tablet 2 mg TABLET 0 0 0 0
265 RL Larutan infus Steril 500ml BOTOL 0 120 120 120 0
266 Sacharum Lactis kaleng 0 0 0 0
267 Salbutamol 2 mg TABLET 0 100 100 100 0
268 Salbutamol 4 mg TABLET 0 100 100 100 0
269 Salbutamol Cairan inhalasi 0,1 % Botol plastik 10 0 10 5 5
270 Salbutamol Inhalasi /Aerosol 100 mcg/dosis Botol 0 0 0 0
271 Salep 2-4 Komb. POT 0 24 24 15 9
272 Salisil Bedak 2 % 50 Gram KOTAK 0 0 0 0
273 Sarung tangan Gynecology Pasang 0 0 0 0
274 Sarung tangan No. 6.5 Pasang 0 10 10 10 0
275 Sarung tangan No. 7 Pasang 0 10 10 10 0
276 Sarung tangan No. 7.5 Pasang 0 10 10 10 0
277 Sarung Tangan Periksa L Buah 0 100 100 100 0
278 Sarung Tangan Periksa M Buah 0 100 100 100 0
279 Sefiksim syrup kering 100mg/5ml BOTOL 0 10 10 10 0
280 Sefixime 100 mg TABLET 0 0 0 0
281 Semen Seng Fosfat Serbuk + Cair BOTOL 0 0 0 0
282 Serum ABU Injek. 5 ml (ABU I ) VIAL 5 ml 1 0 1 1
283 Serum ADS 20.000 iu VIAL 5 ml 0 0 0 0
284 Serum ATS Injek. 1.500 IU AMPUL 0 0 0 0
285 Serum ATS Injek. 20.000 IU VIAL 0 0 0 0
286 Sianokobalamin Injeksi 500mcg/ ml AMPUL 50 0 50 50 0
287 Silk No 3/0( Benang Bedah Sutera) SACHET 0 0 0 0
288 Silver Amalgam serbuk 65-75 % BOTOL 0 0 0 0
289 Simvastatin 10mg TABLET 0 60 60 60 0
290 Stomach Tube No. 12 Buah 0 0 0 0
291 Strip Test Asam Urat Pak 25 0 0 0 0
292 Strip Test Glukosa Pak 50 0 0 0 0
293 Strip Test Kolesterol Pak 10 0 0 0 0
294 Sulfasetamida Na. TM 15 % 5ml BOTOL 0 0 0 0
295 Tablet Tambah Darah Dewasa TABLET 0 17000 17000 17000
296 Tablet Tambah Darah Dewasa 2 (Hemafort TABLET 0 0 0 0
297 Temporary Stopping Fletcher SET 0 0 0 0
298 Test HIV I (Vikia) Buah 0 0 0 0
299 Test HIV II (intec) Buah 0 0 0 0
300 Test HIV III (Onco) Buah 0 0 0 0
301 Test Siphylis Buah 0 0 0 0
302 Tetrasiklin HCL 250 mg KAPSUL 0 0 0 0
303 Tetrasiklin HCL 500 mg KAPSUL 0 100 100 100 0
304 Thiamfenikol kap 500mg KAPSUL 0 100 100 100 0
305 Thiamfenikol Syrup BOTOL 0 10 10 10 0
306 Thiamin HCL (Vit. B1 ) Injek.100 mg AMPUL 0 30 30 30 0
307 Thiamin HCL (Vit. B1) 100 mg TABLET 0 0 0 0
308 Thiamin HCL (Vit. B1) 50 mg TABLET 0 0 0 0
309 Tramadol tablet 50mg TABLET 0 0 0 0
310 Trifluoferazin 5 mg TABLET 0 0 0 0
311 Trihexyphenidil HCL 2 mg KAPSUL 0 100 100 20 80
312 Umbilical cord klem Buah 50 0 50 30 20
313 Urea Krim 10 % (Soft U Derm) TUBE 0 0 0 0
314 Urine Bag BUAH 20 0 20 10 10
315 Vaksin Anti Rabies Vero KUUR 0 0 0 0
316 Vitamin B. Komplek TABLET 0 0 0 0
317 Vitamin B12 tablet 50mg TABLET 0 0 0 0
318 Vitamin Neurotropik TABLET 0 0 0 0
319 Wing Needle No.25,27 BUAH 0 0 0 0
320 Zink dispersibel tablet TABLET 0 500 500 500 0
321 Asetil Sistein Kapsul 200 mg Tablet 270 0 270 270 0
322 Betahistin Maesylate Tablet 0 0 0 0
323 Bioplasenton Tule 10x10 kotak 5 0 5 5
324 Bisturi No. 10,15, 20 buah 0 0 0 0
325 Cetirizin Syrup Botol 0 10 10 10 0
326 Dehidroartemisin +piperaquin TABLET 0 0 0 0
327 Gentamisin TM Botol 0 24 24 24 0
328 Hiosin N Butil Bromida injeksi AMPUL 0 0 0 0
329 Kaca Slide Buah 0 0 0 0
330 Kontrasepsi Suntik KB I bulan vial 0 20 20 20 0
331 Masker Tali Buah 0 50 50 50 0
332 Primakuin TABLET 0 0 0 0
333 Tabung EDTA Buah 0 0 0 0
334 Vaksin HB Uniject Vial 0 35 35 33 2
335 Vaksin DPT-HB/HIB Vial 3 50 53 47 6
336 Vaksin Polio (bOPV) Vial 0 50 50 50 0
337 Vaksin Polio IPV 5 Dosis Vial 0 5 5 5 0
338 Vaksin Campak Vial 0 0 0 0
339 Vaksin Td Vial 5 40 45 40 5
340 Pelarut Campak Vial 0 50 50 50 0
341 Dropper Polio Buah 15 0 15 15 0
342 Vaksin BCG Vial 20 10 30 30 0
343 Pelarut BCG Vial 20 10 30 30 0
344 Vaksin Polio IPV 10 Dosis Vial 0 0 0 0
345 Vaksin Campak MR Vial 0 0 0 0
346 Pelarut Campak MR Vial 0 0 0 0
347 Nistatin Suspensi Botol 0 0 0 0
348 Ichtiol Salep Pot 0 10 10 10 0

Mengetahui/menyetujui, Yang menyerahkan, Yang meminta,

Kepala Dinas Kesehatan Kab. Cianjur Kepala Seksi Kefarmasian Kepala Puskesmas

…………………………………………. Meita Triwendyarti S.S.Apt.MH TB. Wahyu Rahayu, SKM

NIP. …………………………………… NIP. 19760505 200604 2 025 NIP. 19700504 199003 1 003
ERMINTAAN OBAT (LPLPO)

DOKUMEN NOMOR TANGGAL

PUSKESMAS
DINAS KESEHATAN
SIE. FARWASMAMIN 01/sbbk/XII/18 ###

Laporan Mutasi Obat JKN PKM

Permintaan
PEMBERIAN Bulan February 2017
DAU BPJS PROGRAM DAK Lain-lain Jumlah
Stok Awal Penerimaan Pemakaian
10 11 12 13 14 15 16
0 0
300 100 100 0
0 0
100 25 25 50
0 0
300 100 100 200
100 50 50 0
0 2370
0 20
300 200 200 0
100 30 30 0
500 200 200 1100
0 0
0 2800
0 0
300 300 300 0
300 300 300 0
0 160
3000 1500 1500 0
0 0
180 120 120 1320
0 0
0 0
0 0
0 0
2000 2000 2000 0
200 100 100 0
24 25 25 0
24 24 24 0
0 70
0 0
0 0
0 0
 0 0
0 0
1000 1000 1000 0
0 0
0 0
0 0
0 0
50 25 25 175
0 120
0 0
12 0 0
0 0
300 0 0
0 0
1000 1000 1000 0
0 0
0 0
0 0
0 0
1000 400 400 0
120 120 120 0
0 0
300 200 200 0
300 100 100 0
0 0
0 0
0 0
1000 500 500 0
50 30 30 0
800 800 800 0
0 0
0 0
0 0
0 0
0 0
0 0
60 60 60 220
0 0
50 30 30 0
200 200 200 0
0 0
0 0
0 0
0 0
67 67 67 0
 0 0
500 100 100 0
0 0
0 0
5 0 40
5 1 1 12
2 0 3
0 0
10 1 1 0
0 0
0 0
0 0
0 0
0 0
48 24 24 70
0 0
60 60 60 0
300 200 200 200
0 0
0 0
0 0
0 0
0 0
500 300 300 100
0 0
12 12 12 0
0 100
0 0
0 0
0 7220
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
72 48 48 0
 200 200 200 0
1000 400 400 0
1000 0 1050
100 30 30 0
30 30 30 0
50 30 30 0
0 0
0 0
30 5 5 0
30 20 20 0
30 20 20 0
30 20 20 0
0 0
0 0
700 700 700 0
0 0
0 0
30 10 10 1
0 1
30 10 10 20
30 10 10 15
0 0
25 25 25 0
0 0
25 24 24 0
50 0 0
48 0 0
1000 1000 1000 5700
0 0
0 8
300 0 0
0 0
0 0
0 0
0 0
0 0
200 100 100 0
0 10300
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 0 0
0 0
24 0 0
100 50 50 0
0 0
60 90 90 0
0 0
200 100 100 0
0 0
0 30
0 30
50 50 50 6
0 0
0 0
0 0
0 0
500 200 200 0
300 0 0
0 0
0 0
0 0
0 350
55 10 10 0
0 0
50 15 15 0
0 0
0 0
0 0
0 0
500 200 200 2800
0 270
10 10 10 0
50 0 0
300 200 200 0
0 0
0 0
0 100

0 0

300 200 200 0

0 0
0 5
500 0 0
0 0
0 0
 0 0
0 0
0 0
0 0
0 0
100 0 0
50 0 0
500 0 0
50 0 0
500 100 100 0
500 100 100 0
0 0
0 0
0 0
0 0
25 0 0
48 25 25 0
0 300
0 0
120 60 60 9000
0 0
0 0
0 0
50 56 56 0
300 100 100 0
0 0
3500 3500 3500 0
0 0
20 10 10 0
0 490
0 0
500 500 500 10750
500 200 200 8500
5 1 1 0
0 0
5 5 5 0
5 4 4 0
0 0
500 500 500 0
0 0
0 0
0 450
0 0
40 40 40 0
700 700 700 0
 0 0
0 0
0 0
0 0
0 0
0 0
0 0
120 100 100 0
0 0
300 100 100 0
300 100 100 0
0 0
0 0
48 24 24 26
50 0 15
0 0
30 10 10 15
30 10 10 30
30 10 10 15
100 100 100 0
100 100 100 0
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Yang meminta, Yang Menerima,

Kepala Puskesmas Petugas Puskesmas

TB. Wahyu Rahayu, SKM Ai Sri Yusnia, Amd.Keb

NIP. 19700504 199003 1 003 0
utasi Obat JKN PKM

Stok Akhir

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