Surat Permohonan Permintaan Obat

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO )
PUSKESMAS
PUSKESMAS : MEKARMUKTI DOKUMEN NOMOR

KECAMATAN : CIKARANG UTARA DINKES KAB/KOTA
KAB / KOTA :BEKASI PELAPORAN BULAN / PERIODE : FEBRUARI 2019 GFK KAB/KOTA
PROPINSI : JAWA BARAT PERMINTAAN BULAN / PERIODE : MARET 2019 PUSKESMAS
PENERIMAA PEMAKAI STOK STOK PERMINT PE MB E R IAN

NO. NAMA OBAT SATUAN STOK AWAL PERSEDIAAN
N AN AKHIR OPTIMAL AAN PKD/DPP ASKES APBD I APBD II PROGRAM
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1. OBAT
1 ALBENDAZOL TABLET 400 MG. 22,900 0 22900 16720 6180 440 -5740
2 ALOPURINOL TABLET 100 MG. - 1600 1600 532 1068 1540 472
3 AMBROXOL TABLET - 0 0 0 0 4400 4400
4 AMBROXOL SYRUP 15 MG/ML - 0 0 0 0 440 440
5 AMINOFILLIN INJEKSI 24 MG/ML-10ML - 0 0 0 0 0 0
6 AMINOFILLIN TABLET 200 MG. TABLET - 0 0 0 0 440 440
7 AMITRIPTILIN HCL TAB SALUT 25 MG 200 0 200 0 200 110 -90
8 AMLODIPIN TABLET 5MG 3,544 3000 6544 710 5834 4400 -1434
9 AMLODIPIN TABLET 10MG 420 3,000 3420 700 2720 6600 3880
10 AMOKSISILIN KAPSUL 250 MG 12,200 0 12200 540 11660 1100 -10560
11 AMOKSISILIN KAPLET 500 MG 26,172 0 26172 3302 22870 7700 -15170
12 AMOKSISILIN SYRUP KERING 125MG/5 ML 503 150 653 117 536 440 -96
13 AMOKSISILIN + ASAM KLAVULANAT 625MG TABLET - 0 0 0 0 0 0
14 AMOKSISILLIN INJEKSI 1000 MG - 0 0 0 0 0 0
15 AMPICILLLIN SERBUK INJEKSI 1G/VIAL - 0 0 0 0 0 0
16 ASETIL SISTEIN 200 MG KAP 1,730 2640 4370 2540 1830 5940 4110
17 ANTALGIN(METAMPIRON) TABLET 500 MG - 0 0 0 0 6600 6600
18 ANTALGIN ( METAMPIRON ) INJEKSI 250 MG/ML-2ML - 0 0 0 0 0 0
ANTASIDA DOEN TABLET, KOMBINASI :Mg.Hidroksida 200
19 mg+Al.Hidroksida 200 mg 2,230 3000 5230 1780 3450 7700 4250
20 ANTASIDA DOEN SUSPENSI 145 200 345 95 250 330 80
21 ANTI BAKTERI DOEN salep kombinasi : Basitrasin 500 IU/g+Polym 73 0 73 61 12 132 120
22 ANTI FUNGI DOEN (WHITE FIELD) KOMBINASI : Asam Benzoat 6 % 178 24 202 0 202 44 -158
23 ANTI HEMOROID DOEN KOMBINASI 60 80 140 25 115 110 -5
24 ANTIMIGREN DOEN kombinasi : Ergotamin Tartrat 1 mg + Kofein 800 0 800 0 800 880 80
25 AQUA PRO INJEKSI STERIL , bebas pirogen 110 0 110 0 110 11 -99
26 ASAM ASKORBAT ( Vit.C ) tablet 50 mg 1,531 7000 8531 3051 5480 6600 1120
27 ASAM ASKORBAT ( Vit.C ) tablet 250 mg - 0 0 0 0 0 0
28 ASAM FOLAT TABLET 1MG 230 5000 5230 1200 4030 5500 1470
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
29 ASAM MEFENAMAT KAPLET 500 MG 3,250 0 3250 1650 1600 5500 3900
30 ASIKLOVIR CREAM - 0 0 0 0 330 330
31 ASIKLOVIR TAB 200 1,707 400 2107 57 2050 1100 -950
32 ASIKLOVIR TAB 400MG 1,834 0 1834 244 1590 880 -710
33 AZITROMICIN 250MG KAPSUL - 0 0 0 0 0 0
34 BETAMETASON KRIM 0,1 % 244 0 244 8 236 110 -126
35 CALCIUM GLUCONAS 15 6 21 0 21 11 -10
36 CAPTOPRIL 12,5 MG 5,960 400 6360 300 6060 2200 -3860
37 CAPTOPRIL 25 MG 6,680 0 6680 130 6550 2200 -4350
38 CEFADROXIL 500 MG - 0 0 0 0 1100 1100
39 CEFADROXIL SYRUP KERING 125MG/ML 61 0 61 13 48 110 62
40 CETIRIZINE TAB 10MG 2,038 3100 5138 946 4192 3300 -892
41 CIPROFLOXACIN 500 MG 1,870 2000 3870 300 3570 2200 -1370
42 DEKSAMETASON INJEKSI 5 mg/ml - 1 ml 400 0 400 0 400 0 -400
43 DEKSAMETASON TABLET 0,5 MG. 3,833 8000 11833 5128 6705 7700 995
44 DEKSTROMETORFAN SYRUP 10 mg/5 ml - 0 0 0 0 110 110
45 DEKSTROMETORFAN TABLET 15 mg - 0 0 0 0 2200 2200
46 DIAZEPAM TABLET 2 MG. - 0 0 0 0 0 0
47 DIAZEPAM TABLET 5 MG. 244 0 244 0 244 22 -222
48 DIAZEPAM INJEKSI 5 MG/ML-2ML 5 0 5 0 5 0 -5
49 DIAZEPAM SUPPOSITORIA 5 0 5 0 5 8.8 3.8
50 DIFENHIDRAMIN INJEKSI 10 mg/ml - 1 ml - 0 0 0 0 11 11
51 DIGOKSIN TABLET 0,25 mg 420 0 420 0 420 88 -332
52 DOKSISIKLIN 100 MG 400 0 400 0 400 220 -180
53 DOMPERIDON Tablet 2,448 1000 3448 328 3120 2200 -920
54 DOMPERIDON SUSPENSI 279 0 279 16 263 110 -153
55 EFEDRIN HCL TABLET 25 MG - 0 0 0 0 0 0
56 EKSTRAK BELADON TABLET 10 MG - 0 0 0 0 0 0
57 EPINEFRINA HCL/BITARTRAT ( Epinefrina/Adrenalin ) Injeksi 0,1% - 0 0 0 0 0 0
58 ERITROMICYN KAPSUL 250 MG - 0 0 0 0 0 0
59 ERITROMICYN KAPSUL 500 MG 300 0 300 0 300 0 -300
60 ERITROMICYN SIRUP 200MG/ML - 0 0 0 0 0 0
61 ETAKRIDIN ( Rivanol ) LARUTAN 0,1 % 300ML 22 7 29 0 29 11 -18
62 ETAKRIDIN ( Rivanol ) LARUTAN 1000 ML ( 1 LITER) - 0 0 0 0 0 0
92 ETANOL 70 % 57 6 63 0 63 11 -52
63 FENOBARBITAL TABLET 30 MG 520 0 520 0 520 22 -498
64 FENOBARBITAL TABLET 100 MG - 0 0 0 0 0 0
65 FENOBARBITAL INJEKSI 50 MG/ML - 2 ML - 0 0 0 0 0 0
66 FENOKSIMETIL PENISILINA TABLET 500 MG - 0 0 0 0 0 0
67 FENOL GLISEROL TETES TELINGA 10 % 129 0 129 17 112 11 -101
68 FITOMENADION ( Vit.K ) INJEKSI 10 mg/ml - 1 ml 95 40 135 35 100 44 -56
69 FITOMENADION ( Vit.K ) TABLET SALUT GULA 10 Mg 2,195 600 2795 25 2770 660 -2110
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
70 FLUKONAZOL 150 MG TABLET 120 0 120 20 100 66 -34
71 FUROSEMID TABLET 40 mg 1,009 0 1009 29 980 220 -760
72 GARAM ORALIT 412 0 412 250 162 1100 938
73 GENTAMISIN INJEKSI 5 0 5 0 5 0 -5
74 GENTAMISIN SALEP MATA - 0 0 0 0 0 0
75 GENTAMISIN TETES MATA 0,3% - 0 0 0 0 0 0
76 GENTAMYCIN SALEP KULIT - 0 0 0 0 66 66
77 GENTIAN VIOLET LARUTAN 1 % - 0 0 0 0 22 22
78 GLIBENKLAMID TABLET 5 MG 870 0 870 280 590 2200 1610
79 GLISERIL GUAYA KOLAT TABLET 100 MG - 0 0 0 0 5500 5500
80 GLUKOSA LARUTAN INFUS 5% STERIL - 0 0 0 0 88 88
81 GRISEOFULVIN TABLET 125 MG, Micronized 210 300 510 50 460 220 -240
82 GRISEOFULVIN TABLET 500 MG, Micronized - 0 0 0 0 0 0
83 HIDROKORTISON krim 2,5 % 459 0 459 36 423 66 -357
84 HYDROKLOROTIAZID ( HCT ) TABLET 25 MG 370 0 370 0 370 110 -260
85 IBUPROFEN tablet 200 mg 2,110 0 2110 230 1880 1100 -780
86 IBUPROFEN tablet 400 mg 11,924 0 11924 2520 9404 4400 -5004
87 IBUPROFEN SUSPENSI 250 0 250 11 239 44 -195
88 ICHTIOL SALEP - 0 0 0 0 22 22
89 IRBESARTAN TAB 150 MG - 0 0 0 0 0 0
90 ISOSORBID DINITRAT Tablet sublingual 5 mg 630 0 630 0 630 440 -190
91 KALIUM DIKLOFENAK 25 mg Tablet 0 0 0 0 1100 1100
92 KALIUM DIKLOFENAK 50 mg Tablet - 0 0 0 5500 5500
93 KALSIUM LAKTAT ( Kalk ) Tablet 500 mg 12,993 3500 16493 3000 13493 8800 -4693
94 KETOKONAZOL TAB 200 MG - 1000 1000 100 900 2200 1300
95 KETOKONAZOL KRIM 2% 277 80 357 44 313 110 -203
96 KLARITROMISIN 500 MG TABLET - 0 0 0 0 0 0
97 KLINDAMISIN 300MG 2,070 0 2070 270 1800 1100 -700
98 KLORAMPENIKOL KAPSUL 250 MG. - 0 0 0 0 1100 1100
99 KLORAMPENIKOL SALEP MATA 1 % 216 96 312 37 275 110 -165
100 KLORAMPENIKOL SUSPENSI 98 0 98 0 98 66 -32
101 KLORAMPENIKOL TETES MATA - 0 0 0 0 66 66
102 KLORAMPENIKOL TETES TELINGA 3 % - 0 0 0 0 44 44
103 KLORFENIRAMIN MELEAT (CTM) TABLET 4 MG 13,480 2800 16280 3500 12780 6600 -6180
104 KLORPROMAZIN TABLET SALUT 25 MG - 0 0 0 0 0 0
105 KODEIN FOSFAT TABLET 10 MG - 0 0 0 0 44 44
106 KOTRIMOXAZOL SUSPENSI, Kombinasi : Sulfametoksazol 200 mg + 282 0 282 0 282 1100 818
107 KOTRIMOXAZOL TABLET PEDRIATIK, kombinasi : Sulfametoksazol - 0 0 0 0 0 0
108 KOTRIMOXAZOL TABLET,Kombinasi : Sulfametoksazol 400 mg + 530 0 530 0 530 0 -530
109 Trimetoprim 80 mg 500 MG
LEVOFLOKSASIN - 0 0 0 0 0 0
110 LIDOKAIN HCl INJEKSI 2% 200 0 200 100 100 0 -100
111 LIDOKAIN KOMP INJEKSI Kombinasi : Lidokain Hcl 2% + Epinefrin 270 0 270 0 270 110 -160
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
112 LISOL , mengandung Kresol tersabun 50 % 13 4 17 3 14 15.4 1.4
113 LOPERAMID 2MG TABLET - 0 0 0 0 440 440
114 LORATADIN TABLET 10MG - 0 0 0 0 0 0
115 LYNCOMISIN 500MG - 0 0 0 0 0 0
116 MAGNESIUM SULFAT INJEKSI ( IV ) 20%-25 ml 18 0 18 0 18 4.4 -13.6
117 MAGNESIUM SULFAT INJEKSI ( IV ) 40%-25 ml 12 0 12 0 12 4.4 -7.6
118 MELOXICAM TABLET 7.5 MG - 0 0 0 0 0 0
119 MELOXICAM TABLET 15MG - 0 0 0 0 0 0
120 METFORMIN 500MG TABLET 4,220 3000 7220 2060 5160 6600 1440
121 METILERGOMETRIN MALEAT ( Metilergometrin ) tablet salut 0,12 500 400 900 0 900 440 -460
122 METILERGOMETRIN MALEAT INJ 0,200 mg-1ml 100 0 100 0 100 22 -78
123 METOKLORPROPAMID INJEKSI - 0 0 0 0 0 0
124 METROCLOPRAMIDE 10MG TABLET 350 0 350 0 350 0 -350
125 METRONIDAZOL TABLET 250 mg 2,130 0 2130 85 2045 330 -1715
126 METRONIDAZOLE 500MG 3,050 0 3050 85 2965 440 -2525
127 MICONAZOLE CREAM - 0 0 0 0 0 0
128 NATRIUM BIKARBONAT TABLET 500 mg - 0 0 0 0 0 0
129 NATRIUM DIKLOFENAK TABLET 25MG 0 0 0 0 4400 4400
130 NATRIUM DIKLOFENAK TABLET 50MG - 0 0 0 0 5500 5500
131 NATRIUM KLORIDA Larutan Infus 0,9 % steril - 0 0 0 0 0 0
132 NIFEDIPIN 10 MG. - 0 0 0 0 1100 1100
133 NISTATIN TABLET SALUT 500.000 IU/g - 0 0 0 0 220 220
134 NISTATIN TABLET VAGINAL 100.000 IU/g 400 0 400 8 392 110 -282
135 OBAT ANTITUBERKULOSIS ANAK 10 13 23 2 21 17.6 -3.4
136 OBAT ANTITUBERKULOSIS KATEGORI 1 48 80 128 23 105 44 -61
137 OBAT ANTITUBERKULOSIS KATEGORI 2 4 10 14 5 9 11 2
138 OBAT ANTITUBERKULOSIS KATEGORI 3 - 0 0 0 0 0 0
139 OBAT ANTITUBERKULOSIS SISIPAN - 0 0 0 0 0 0
140 OBAT BATUK HITAM ( O.B.H ) CAIRAN - 0 0 0 0 0 0
141 OKSITETRASIKLIN SALEP KULIT 3% - 0 0 0 0 0 0
142 OKSITETRASIKLIN SALEP MATA 1% - 0 0 0 0 0 0
143 OKSITOSIN INJEKSI 10 IU/ML-1ML 200 0 200 0 200 44 -156
144 OMEPRAZOLE TABLET 20MG 1,836 300 2136 678 1458 2200 742
145 PARASETAMOL DROP 158 0 158 58 100 154 54
146 PARASETAMOL SUPPOSITORIA - 0 0 0 0 0 0
147 PARASETAMOL SYRUP 120 MG/5 ML 576 600 1176 394 782 660 -122
148 PARASETAMOL TABLET 500 MG. 10,718 16800 27518 7658 19860 15400 -4460
149 PARASETAMOL100 MG. TABLET - 0 0 0 0 0 0
150 PETHIDIN INJEKSI 50MG/ML - 0 0 0 0 0 0
151 PIRANTEL TABLET 125 MG. - 0 0 0 0 0 0
152 PIRIDOXIN HCL (VIT.B6) TABLET 10 MG. 14,165 0 14165 3455 10710 1540 -9170
153 PIROXICAM 10 MG TABLET - 0 0 0 0 0 0
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
154 PIROXICAM 20 MG. TAB. - 0 0 0 0 0 0
155 POLIKRESULEN ( KONDENSASI METAKRESOL SULFONAT DAN 80 0 80 0 80 0 -80
156 POVIDON YODIDA 10 % 30 ML. 28 0 28 0 28 0 -28
157 POVIDON YODIDA 10 % 60 ML. 55 0 55 0 55 44 -11
158 POVIDON YODIDA 10 % 300 ML. - 0 0 0 0 0 0
159 PREDNISON TABLET 5 MG. 398 2000 2398 430 1968 2200 232
160 PROPANOLOL HCL TABLET 40 MG. - 0 0 0 0 0 0
161 PROPILTIOURASIL TABLET 100 MG. - 0 0 0 0 0 0
162 PYRAZINAMIDE 500 MG. TABLET - 0 0 0 0 0 0
163 RANITIDIN INJEKSI 40 0 40 0 40 11 -29
164 RANITIDIN TABLET 150 MG 6,126 1000 7126 1810 5316 5500 184
165 RESERPIN TABLET 0,25 MG - 0 0 0 0 0 0
166 RETINOL (VIT.A) KAPSUL 100.000 IU - 0 0 0 0 0 0
167 RETINOL (VIT.A) KAPSUL 200.000 IU - 0 0 0 0 0 0
168 RIFAMPISIN 300 MG. KAPLET - 0 0 0 0 0 0
171 RINGER LAKTAT LARUTAN INFUS STERIL - 200 200 74 126 220 94
172 SALBUTAMOL TABLET 2 MG 699 400 1099 433 666 110 -556
173 SALBUTAMOL TABLET 4 MG. 570 0 570 204 366 220 -146
174 SALBUTAMOL NEBULIZER 2,5ML - 0 0 0 0 0 0
175 SALEP 2-4, KOMBINASI: ASAM SALISILAT 2%+BELERANG END 111 48 159 15 144 22 -122
176 SALISIL BEDAK 2% 205 100 305 53 252 154 -98
177 SEFIKSIM 100MG TAB /KAPSUL 1,500 0 1500 300 1200 1100 -100
178 SEFIKSIM SIRUP KERING 100MG/5ML 13 40 53 13 40 44 4
179 SEFOTAKSIM INJEKSI 1GRAM - 50 50 0 50 0 -50
180 SEFTRIAKSON INJEKSI 1GRAM - 0 0 0 0 0 0
181 SERUM ANTI BISA ULAR POLIVAREN INJEKSI 5 ML.(ABU 1) 2 0 2 0 2 0 -2
182 SERUM ANTI TETANUS INJ. 1500 IU AMPUL(ATS) 2 0 2 0 2 0 -2
183 SALBUTAMOL SRY 2 MG - 98 98 0 98 0 -98
184 SIMVASTATIN 10 MG TABLET SALUT - 3000 3000 230 2770 3300 530
185 SULFASETAMIDA NATRIUM TETES MATA 15% - 0 0 0 0 0 0
186 TABLET TAMBAH DARAH KOMBINASI:BESI 2 SULFAT 200 MG+A 192,270 0 192270 23810 168460 11000 -157460
187 TETRASIKLIN HCL KAPSUL 250 MG. - 0 0 0 0 0 0
188 TETRASIKLIN HCL KAPSUL 500 MG. 240 0 240 0 240 0 -240
189 TIAMFENICOL KAPSUL 500 MG - 0 0 0 0 660 660
190 TIAMIN HCL (VIT.B1) INJEKSI 100 MG/ML-1ML - 0 0 0 0 0 0
191 TIAMIN HCL / MONONITRAT (VIT.B1) TABLET 50 MG. 9,830 0 9830 1200 8630 6600 -2030
192 TRAMADOL 50 MG/KAMADOL - 0 0 0 0 0 0
193 TRAMADOL INJEKSI - 0 0 0 0 0 0
194 TRIHEKSIPENIDIL HIDROKLORIDA TABLET 2 MG. - 0 0 0 0 0 0
195 VIT. B KOMPLEK TABLET 1,966 6000 7966 3287 4679 7700 3021
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
196 ZINC TABLET 20MG 1,050 1000 2050 379 1671 2200 529
197 ZINC SYRUP 384 180 564 67 497 330 -167
- 0
- 0 0
- 0 0
2. BAHAN HABIS PAKAI {BHP} - 0 0
1 ALAT SUNTIK SEKALI PAKAI 1 ML. 450 400 850 50 800 440 -360
2 ALAT SUNTIK SEKALI PAKAI 2,5 ML - 0 0 0 0 3300 3300
3 ALAT SUNTIK SEKALI PAKAI 5 ML 938 0 938 14 924 550 -374
4 ALAT SUNTIK SEKALI PAKAI 10 ML 64 0 64 8 56 110 54
5 ALAT SUNTIK 3 ML - 500 500 0 500 0 -500
6 ALKOHOL SWAB 200 2400 2600 300 2300 3300 1000
7 BISTURI 100 0 100 0 100 22 -78
8 CAIRAN ANTISEPTIK SOFTAMAN - 0 0 0 0 22 22
9 CATGUT/BENANG BEDAH No.2/0 - 3/0 dengan Jarum Bedah - 36 36 0 36 22 -14
10 FOLLEY CATHETER NO.18, 20, 22 13 0 13 0 13 4.4 -8.6
11 SUGICAL TAPE 1 INC ROLL12 - 12 12 0 12 0 -12
12 INFUS SET ANAK - 0 0 0 0 44 44
13 INFUS SET DEWASA 800 0 800 100 700 220 -480
14 IV CATETHER no 20 60 50 110 30 80 220 140
15 JARUM JAHIT (BEDAH) NO.9 s/d 14 KULIT/OTOT - 0 0 0 0 22 22
16 KAPAS Berlemak 500 gram - 0 0 0 0 0 0
17 KAPAS Pembalut/Absorben 250 gram 16 12 28 0 28 6.6 -21.4
18 KASA Kompres 40 X 40 steril 203 0 203 40 163 110 -53
19 KASA Pembalut 16CM X 16CM 66 0 66 10 56 143 87
20 KASA Pembalut 2 m X 80 cm 77 0 77 12 65 132 67
21 KASA PEMBALUT 40CM X 80CM 15 40 55 5 50 11 -39
22 KASA PEMBALUT 4M X 4CM - 0 0 0 0 11 11
23 KASA PEMBALUT HIDRIFIL 4 M x 3 CM - 0 0 0 0 44 44
24 KASA PEMBALUT HIDROFIL 4 M x 15 CM 65 0 65 10 55 22 -33
25 MASKER DISPOSIBLE 3,200 0 3200 500 2700 1320 -1380
26 NELATON CATETHER - 0 0 0 0 0 0
27 OKSIGEN REFILL - 0 0 0 0 11 11
28 PARAFFIN GAUZE DRESSING - 0 0 0 0 0 0
29 PEMBALUT ELASTIS - 0 0 0 0 0 0
30 PEMBALUT GIPS - 0 0 0 0 0 0
31 PLESTER 5 YARDS X 2 INCH - 12 12 2 10 22 12
32 POT SPUTUM 500 400 900 200 700 660 -40
33 POT URIN STERIL - 0 0 0 0 660 660
34 SABUN CUCI TANGAN 46 24 70 5 65 15.4 -49.6
35 SARUNG TANGAN GYNEKOLOG 5 8 13 0 13 13.2 0.2
36 SARUNG TANGAN NON STERIL 700 500 1200 400 800 13.2 -786.8
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
37 SARUNG TANGAN STERIL - 10 10 0 10 11 1
38 SILK (BENANG BEDAH SUTERA) NO.3/8 DENGAN JARUM BED - 36 36 0 36 0 -36
39 UMBILICAL KLEM NYLON 50 0 50 0 50 44 -6
40 URINE BAG 20 0 20 0 20 0 -20
41 USG JELLY 65 0 65 3 62 6.6 -55.4
43 -
3. OBAT GIGI -
1 AIR RAKSA DENTAL USE - 0 0 0 0 0 0
2 BONDING (BUAT TAMBALAN) - 0 0 0 0 0
3 DEVITALISASI PASTA ( Non Arsen ) - 0 0 0 0 0 0
Dexamethasone 0,125 g, Phenol 36,7 g, Formaldehyde 32,4 g,
4 Gaiacol 24,46 g, Excipient qs ad 100 g - 0 0 0 0 0 0
5 ETCHING - 0 0 0 0 0 0
6 ETIL KLORIDA SEMPROT - 0 0 0 0 0 0
7 EUGENOL CAIRAN 17 0 17 0 17 0 -17
8 GLASSIONOMER CEMENT ( GC IX ) - 0 0 0 0 0 0
9 GLASSIONOMER FILLING MATERIAL ART - 0 0 0 0 0 0
Hydrocortison Acetate 1, 0 g, Excipient : thymol iodide, Barium
10 Sulfate, Zink Okside, Mg Stearate qs ad 100 g - 0 0 0 0 0 0
11 KACA MULUT - 0 0 0 0 0 0
12 KALSIUM HIDROXIDA PASTA - 0 0 0 0 0 0
13 KALSIUM HIDROXIDA DENGAN IODOFORM - 0 0 0 0 0 0
14 MATA BOR (HIGH SPEED/BULAT, PISUR, INVERT) - 0 0 0 0 0 0
15 MONOKLOR KAMPER MENTHOL CAIRAN - 0 0 0 0 0 0
16 MUMMIFYING PASTA - 0 0 0 0 0 0
17 SEMEN SENG FOSPAT SERBUK DAN CAIRAN - 0 0 0 0 0 0
18 SILVER AMALGAM SERBUK 65-75% - 0 0 0 0 0 0
19 SPONS GELATIN CUBICLRS 1X1X1 CM - 0 0 0 0 0 0
20 SULFA CONUS KERUCUT PREFARAT - 0 0 0 0 0 0
21 SYNTHETIC FILLING MATERIAL - 0 0 0 0 0 0
22 TEMPORARY FILLING MATERIAL - 0 0 0 0 0 0
23 TEMPORARY STOPPING FLETCHER(FLETCHER) SERBUK DAN - 0 0 0 0 0 0
24 TRIKRESOL FORMALIN (TKF) CAIRAN - 0 0 0 0 0 0
25 - 0 0
26 - 0 0
4. REAGEN - 0
1 ALKOHOL ASAM - 0 0 0 0 0 0
2 AMONIUM OKSALAT - 0 0 0 0 0 0
3 ANISOL - 0 0 0 0 0 0
4 AQUA BIDESTILATA - 0 0 0 0 0 0
5 ASAM KLORIDA 0,1 N-100ML. ( HCl 0.1N ) - 0 0 0 0 0 0
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
6 ASAM SULFO SALISILAT 20%-100ML. - 0 0 0 0 0 0
8 BIOCHEMISTRY 9 SAMSUNG - 0 0 0 0 0 0
9 BLOOD LANCET ACCU-CHECK '200 10 5 15 1 14 11 -3
10 CHOLESTEROL LIQ - 0 0 0 0 0 0
11 DRUBKIN ( HAEMOGLOBIN C )100 ML - 0 0 0 0 0 0
12 EDTA 10% 100 ML - 0 0 0 0 4.4 4.4
13 EOSIN 2% - 0 0 0 0 2.2 2.2
14 GIEMSA STAIN 1 0 1 0 1 0 -1
15 GLUKOSA LIQ - 0 0 0 0 2.2 2.2
16 GOLONGAN DARAH + KARTU - 0 0 0 0 660 660
17 GRAM PEWARNA 2 0 2 0 2 8.8 6.8
18 HAYEM - 0 0 0 0 0 0
19 HBSAB STRIP - 0 0 0 0 0 0
20 HBSAG STRIP 32 150 182 45 137 176 39
21 HCG TEST KEHAMILAN 60 200 260 50 210 110 -100
22 IMERSION OIL 10 0 10 0 10 0 -10
23 IODINE TEST - 0 0 0 0 0 0
24 KARBOL FUCHSIN - 0 0 0 0 0 0
25 NARKOBA AMP - 0 0 0 0 0 0
26 NARKOBA MOP - 0 0 0 0 0 0
27 NARKOBA THC - 0 0 0 0 0 0
28 NATRIUM SITRAT 3.8% 1 0 1 0 1 0 -1
29 POCH D - 0 0 0 0 33 33
30 POCH L - 0 0 0 0 2.2 2.2
31 CELL CLEAN - 0 0 0 0 2.2 2.2
32 8-CHECK - 0 0 0 0 0 0
34 REES ECKER - 0 0 0 0 0 0
35 SERUM KONTROL - 0 0 0 0 2.2 2.2
36 STICK ASAM URAT 3 22 25 10 15 22 7
37 STICK CHOLESTEROL 4 10 14 3 11 44 33
38 STICK GLUKOSA ACCU-CHECK '25 - 0 0 0 0 0
39 STICK GLUKOSA ACCU-CHECK '50 - 20 20 0 20 22 2
40 STICK HB METER - 5 5 0 5 0 -5
41 STICK URINE 3 PM - 0 0 0 0 0 0
42 STICK URINE 10 PM - 0 0 0 0 4.4 4.4
43 TABUNG WESTERGEN - 0 0 0 0 0 0
44 TRIGLISERIDA - 0 0 0 0 0 0
45 TURK 1 0 1 0 1 2.2 1.2
46 URIC ACID LIQUID - 0 0 0 0 0 0
47 VAKUTEINER EDTA 3ML - 0 0 0 0 660 660
48 WIDAL 5 2 7 2 5 4.4 -0.6
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
49 XYLOL 1 0 1 1 0 2.2 2.2
50 ZIEHL NIELSON - 0 0 0 0 0 0
51 YELLOW TIP 200 0 0 100 0 440 440
52 URINE TESTLABSTIP U11 PLUS TUBE 150 STRIP 1 0 0 0 0 0 0
5. OBAT TAMBAHAN - 0
1 BURNAZINE CREAM 10MG 3 5 8 0 8 4.4 -3.6
2 CAIRAN ANTISEPTIK SOFTAMAN - 0 0 0 0 0 0
3 FG THROCHES - 0 0 0 0 0 0
4 MOLAKRIM 30GRAM - 0 0 0 0 66 66
5 NEO KAOMINAL - 0 0 0 0 0 0
PAPAVERIN HCL 30 MG, ANTALGIN 500 MG, EXTRAK
6 BELLADON 5 MG (SPASMAL) - 0 0 0 0 0 0
7 PARAFFIN GAUZE DRESSING - 0 0 0 0 0 0
8 PULAREX - 0 0 0 0 0 0
9 SALBUTAMOL NEBULIZER 2,5ML - 0 0 0 0 0 0
10 SANMAG SUSPENSI - 0 0 0 0 0 0
11 ZAM BUK OINT - 0 0 0 0 0 0
12 ZINKID SYRUP - 0 0 0 0 0 0
13 NYSTATIN DROP 100.000 UI BOTOL 15 ML 85 0 85 7 78 22 -56
14 FRAMISETIN SULFAT TULLE 1 % PCS 5 0 5 0 5 0 -5
SURGICAL TAPE ROLL 1 - 12 12 2 10 6.6 -3.4
CETRIZINE SYR - 0 0 0 0 220 220
PB DEWASA BLISTER '6 1 0 1 1 0 4.4 4.4
SURGICAL TAPE ROLL 1/2 inchi pcs'24 12 0 12 0 12 0 -12
IV CATETHER 24 50 0 50 0 50 110 60
SARUNG TANGAN NON STERIL PCS S 300 0 300 200 100 8.8 -91.2
KERTAS PUYER PCS 32,300 0 32300 4000 28300 4400 -23900
MB DEWASA BLISTER '6 48 0 48 2 46 0 -46
ILIADIN DROP BOTOL 10 0 10 0 10 8.8 -1.2
CATGUT CHROMIC 2/0 SACCHET 24 24 8 16 22 6
* TIDAK BOLEH MENAMBAHKAN "ROW" YG BARU, KLO ADA NAMA OBAT YG BARU/TDK ADA NAMA OBATNYA TAMBAHKAN DIBAWAHNYA SAJA.
UMUM
TIDAK ASKES JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR
BAYAR
0 1477 1359 2836
Kepala Dinas Kesehatan Kab. Bekasi Kepala GFK Kepala Puskesmas Petugas Puskesmas
hal.1
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
dr.Hj.Sri Enny Mainiarti, SKM Eva Yanti Hermansyah, S.Farm.Apt H.Firman, SKM Sanih Susilawati, AM.Keb
NIP.19700525 200003 2 004 NIP.19780918 200902 2 001 NIP. 19730201 199903 1 005 NIP.19740426 200604 2 008
KETERANGAN :
Lembar 1 ( Putih ) : Puskesmas
Lembar 2 ( Merah ) : Dinkes Kab. Bekasi
Lembar 3 ( Biru ) : GFK kab. Bekasi
Lembar 4 ( kuning ) : PT. Askes
hal.1
FORM : LPLPO
SO = SK + SWK + SWT +SP
TANGGAL SO : STOK OPTIMUM

SK : STOK KERJA ( ADA HITUNGAN STOK PER BULAN DAN STOK PER HARI )
SWK : STOK WAKTU KEKOSONGAN
SWT : STOK WAKTU TUNGGU
SP : STOK PENYANGGA (10%)
JUMLAH
LAIN-LAIN
16 17 SK SK
SO SWK SWT SP
(perbulan) (perhari)
440 200 8 0 0 20
1540 700 28 70
4400 2000 80 200
440 200 8 20
0 0 0
440 200 8 20
110 50 2 5
4400 2000 80 200
6600 3000 120 300
1100 500 20 50
7700 3500 140 350
440 200 8 20
0 0 0
0 0 0
0 0 0
5940 2700 108 270
6600 3000 120 300
0 0 0
7700 3500 140 350

330 150 6 15
132 60 2.4 6
44 20 0.8 2
110 50 2 5
880 400 16 40
11 5 0.2 0.5
6600 3000 120 300
0 0 0
5500 2500 100 250
hal.1
16 17 SK SK
SO5500 2500 100 SWK SWT SP
250
330 150 6 15
1100 500 20 50
880 400 16 40
0 0 0
110 50 2 5
11 5 0.2 0.5
2200 1000 40 100
2200 1000 40 100
1100 500 20 50
110 50 2 5
3300 1500 60 150
2200 1000 40 100
0 0 0
7700 3500 140 350
110 50 2 5
2200 1000 40 100
0 0 0
22 10 0.4 1
0 0 0
8.8 4 0.16 0.4
11 5 0.2 0.5
88 40 1.6 4
220 100 4 10
2200 1000 40 100
110 50 2 5
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
11 5 0.2 0.5
0 0 0
11 5 0.2 0.5
22 10 0.4 1
0 0 0
0 0 0
0 0 0
11 5 0.2 0.5
44 20 0.8 2
660 300 12 30
hal.1
16 17 SK SK
SO 66 30 1.2 SWK SWT SP
3
220 100 4 10
1100 500 20 50
0 0 0
0 0 0
0 0 0
66 30 1.2 3
22 10 0.4 1
2200 1000 40 100
5500 2500 100 250
88 40 1.6 4
220 100 4 10
0 0 0
66 30 1.2 3
110 50 2 5
1100 500 20 50
4400 2000 80 200
44 20 0.8 2
22 10 0.4 1
0 0 0
440 200 8 20
1100 500 20 50
5500 2500 100 250
8800 4000 160 400
2200 1000 40 100
110 50 2 5
0 0 0
1100 500 20 50
1100 500 20 50
110 50 2 5
66 30 1.2 3
66 30 1.2 3
44 20 0.8 2
6600 3000 120 300
0 0 0
44 20 0.8 2
1100 500 20 50
0 0 0
0 0 0
0 0 0
0 0 0
110 50 2 5
hal.1
16 17 SK SK
SO15.4 SWK SWT SP
(perbulan)7 0.28
(perhari) 0.7
440 200 8 20
0 0 0
0 0 0
4.4 2 0.08 0.2
4.4 2 0.08 0.2
0 0 0
0 0 0
6600 3000 120 300
440 200 8 20
22 10 0.4 1
0 0 0
0 0 0
330 150 6 15
440 200 8 20
0 0 0
0 0 0
4400 2000 80 200
5500 2500 100 250
0 0 0
1100 500 20 50
220 100 4 10
110 50 2 5
17.6 8 0.32 0.8
44 20 0.8 2
11 5 0.2 0.5
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
44 20 0.8 2
2200 1000 40 100
154 70 2.8 7
0 0 0
660 300 12 30
15400 7000 280 700
0 0 0
0 0 0
0 0 0
1540 700 28 70
0 0 0
hal.1
16 17 SK SK
SO 0 SWK SWT SP
(perbulan) (perhari) 0 0
0 0 0
0 0 0
44 20 0.8 2
0 0 0
2200 1000 40 100
0 0 0
0 0 0
0 0 0
11 5 0.2 0.5
5500 2500 100 250
0 0 0
0 0 0 0
0 0 0 0
0 0 0
0 0 0
0 0 0
220 100 4 10
110 50 2 5
220 100 4 10
0 0 0
22 10 0.4 1
154 70 2.8 7
1100 500 20 50
44 20 0.8 2
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
3300 1500 60 150
0 0 0
11000 5000 200 500
0 0 0
0 0 0
660 300 12 30
0 0 0
6600 3000 120 300
0 0 0
0 0 0
0 0 0
7700 3500 140 350
hal.1
16 17 SK SK
SO2200 1000 SWK SWT SP
(perbulan) (perhari)40 100
330 150 6 15
0 0 0
0 0 0
0 0 0
0 0 0
440 200 8 20
3300 1500 60 150
550 250 10 25
110 50 2 5
0 0 0
3300 1500 60 150
22 10 0.4 1
22 10 0.4 1
22 10 0.4 1
4.4 2 0.08 0.2
0 0 0
44 20 0.8 2
220 100 4 10
220 100 4 10
22 10 0.4 1
0 0 0
6.6 3 0.12 0.3
110 50 2 5
143 65 2.6 6.5
132 60 2.4 6
11 5 0.2 0.5
11 5 0.2 0.5
44 20 0.8 2
22 10 0.4 1
1320 600 24 60
0 0 0
11 5 0.2 0.5
0 0 0
0 0 0
0 0 0
22 10 0.4 1
660 300 12 30
660 300 12 30
15.4 7 0.28 0.7
13.2 6 0.24 0.6
13.2 6 0.24 0.6
hal.1
16 17 SK SK
SO 11 SWK SWT SP
(perbulan)5 0.2
(perhari) 0.5
0 0 0
44 20 0.8 2
0 0 0
6.6 3 0.12 0.3
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 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 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
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
hal.1
16 17 SK SK
SO 0 SWK SWT SP
(perbulan) (perhari) 0 0
0 0 0
11 5 0.2 0.5
0 0 0
0 0 0
4.4 2 0.08 0.2
2.2 1 0.04 0.1
0 0 0
2.2 1 0.04 0.1
660 300 12 30
8.8 4 0.16 0.4
0 0 0
0 0 0
176 80 3.2 8
110 50 2 5
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
33 15 0.6 1.5
2.2 1 0.04 0.1
2.2 1 0.04 0.1
0 0 0
0 0 0
2.2 1 0.04 0.1
22 10 0.4 1
44 20 0.8 2
0 0 0
22 10 0.4 1
0 0 0
0 0 0
4.4 2 0.08 0.2
0 0 0
0 0 0
2.2 1 0.04 0.1
0 0 0
660 300 12 30
4.4 2 0.08 0.2
hal.1
16 17 SK SK
SO 2.2 SWK SWT SP
(perbulan)1 0.04
(perhari) 0.1
0 0 0
440 200 8 20
0 0 0
0 0 0
4.4 2 0.08 0.2
0 0 0
0 0 0
66 30 1.2 3
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
22 10 0.4 1
0 0 0
6.6 3 0.12 0.3
220 100 4 10
4.4 2 0.08 0.2
0 0 0
110 50 2 5
8.8 4 0.16 0.4
4400 2000 80 200
0 0 0
8.8 4 0.16 0.4
22 10 0.4 1
* catatan :
- kolom SK (per bulan ) untuk bln pertama kali (november) diisi manual dulu, untuk bln selanjutnya disamakan tdk perlu diisi lg (copy paste)
- kolom yg berwarna merah jgn diganti2/edit ( ada rumusnya)
- kolom yg berwarna merah bisa dipakai di bulan LPLPO bln berikutnya (tinggal copy paste aja)
- kolom yg berwarna putih di isi manual
- supaya tdk terjadi over stock atau kosong stok OBAT, pengisian harus benar dan pengambilan obat hrs disiplin TEPAT WAKTU
Petugas Puskesmas
hal.1
16 17 SK SK
SO SWK SWT SP
Sanih Susilawati, AM.Keb

NIP.19740426 200604 2 008
LAPORAN PEMAKAIAN DAN LEMBAR PERMIN
PUSKESMAS
PUSKESMAS : MEKARMUKTI
KECAMATAN : CIKARANG UTARA
KAB / KOTA :BEKASI PELAPORAN BULAN / PERIODE
PROPINSI : JAWA BARAT PERMINTAAN BULAN / PERIODE
PENERIMAA
N
1 2 3 4 5 6
1. OBAT
1 ALBENDAZOL TABLET 400 MG. 6,180 0 6180
2 ALOPURINOL TABLET 100 MG. 1,068 500 1568
3 AMBROXOL TABLET - 0 0
4 AMBROXOL SYRUP 15 MG/ML - 0 0
5 AMINOFILLIN INJEKSI 24 MG/ML-10ML - 0 0
6 AMINOFILLIN TABLET 200 MG. TABLET - 0 0
7 AMITRIPTILIN HCL TAB SALUT 25 MG 200 0 200
8 AMLODIPIN TABLET 5MG 5,834 0 5834
10 AMOKSISILIN KAPSUL 250 MG 11,660 0 11660
11 AMOKSISILIN KAPLET 500 MG 22,870 0 22870
12 AMOKSISILIN SYRUP KERING 125MG/5 ML 536 0 536
13 AMOKSISILIN + ASAM KLAVULANAT 625MG TABLET - 0 0
14 AMOKSISILLIN INJEKSI 1000 MG - 0 0
15 AMPICILLLIN SERBUK INJEKSI 1G/VIAL - 0 0
16 ASETIL SISTEIN 200 MG KAP 1,830 5280 7110
17 ANTALGIN(METAMPIRON) TABLET 500 MG - 0 0
18 ANTALGIN ( METAMPIRON ) INJEKSI 250 MG/ML-2ML - 0 0
19 mg+Al.Hidroksida 200 mg 3,450 5000 8450
20 ANTASIDA DOEN SUSPENSI 250 0 250
21 ANTI BAKTERI DOEN salep kombinasi : Basitrasin 500 IU/g+Polym 12 125 137
22 ANTI FUNGI DOEN (WHITE FIELD) KOMBINASI : Asam Benzoat 6 % 202 0 202
23 ANTI HEMOROID DOEN KOMBINASI 115 0 115
24 ANTIMIGREN DOEN kombinasi : Ergotamin Tartrat 1 mg + Kofein 800 0 800
25 AQUA PRO INJEKSI STERIL , bebas pirogen 110 0 110
26 ASAM ASKORBAT ( Vit.C ) tablet 50 mg 5,480 3600 9080
27 ASAM ASKORBAT ( Vit.C ) tablet 250 mg - 0 0
28 ASAM FOLAT TABLET 1MG 4,030 1500 5530
29 ASAM MEFENAMAT KAPLET 500 MG 1,600 5000 6600
30 ASIKLOVIR CREAM - 0 0
31 ASIKLOVIR TAB 200 2,050 0 2050
32 ASIKLOVIR TAB 400MG 1,590 0 1590
33 AZITROMICIN 250MG KAPSUL - 0 0
34 BETAMETASON KRIM 0,1 % 236 0 236
35 CALCIUM GLUCONAS 21 0 21
36 CAPTOPRIL 12,5 MG 6,060 0 6060
37 CAPTOPRIL 25 MG 6,550 0 6550
38 CEFADROXIL 500 MG - 0 0
39 CEFADROXIL SYRUP KERING 125MG/ML 48 50 98
40 CETIRIZINE TAB 10MG 4,192 0 4192
41 CIPROFLOXACIN 500 MG 3,570 0 3570
42 DEKSAMETASON INJEKSI 5 mg/ml - 1 ml 400 0 400
43 DEKSAMETASON TABLET 0,5 MG. 6,705 8000 14705
44 DEKSTROMETORFAN SYRUP 10 mg/5 ml - 0 0
45 DEKSTROMETORFAN TABLET 15 mg - 0 0
46 DIAZEPAM TABLET 2 MG. - 0 0
47 DIAZEPAM TABLET 5 MG. 244 0 244
48 DIAZEPAM INJEKSI 5 MG/ML-2ML 5 0 5
49 DIAZEPAM SUPPOSITORIA 5 0 5
50 DIFENHIDRAMIN INJEKSI 10 mg/ml - 1 ml - 20 20
51 DIGOKSIN TABLET 0,25 mg 520 0 520
52 DOKSISIKLIN 100 MG 545 0 545
53 DOMPERIDON Tablet 3,120 0 3120
54 DOMPERIDON SUSPENSI 263 0 263
55 EFEDRIN HCL TABLET 25 MG - 0 0
56 EKSTRAK BELADON TABLET 10 MG - 0 0
57 EPINEFRINA HCL/BITARTRAT ( Epinefrina/Adrenalin ) Injeksi 0,1 - 20 20
58 ERITROMICYN KAPSUL 250 MG 510 600 1110
59 ERITROMICYN KAPSUL 500 MG - 0 0
60 ERITROMICYN SIRUP 200MG/ML - 0 0
61 ETAKRIDIN ( Rivanol ) LARUTAN 0,1 % 300ML 33 0 33
62 ETAKRIDIN ( Rivanol ) LARUTAN 1000 ML ( 1 LITER) - 0 0
92 ETANOL 70 % 63 0 63
63 FENOBARBITAL TABLET 30 MG 520 0 520
64 FENOBARBITAL TABLET 100 MG - 0 0
65 FENOBARBITAL INJEKSI 50 MG/ML - 2 ML - 0 0
66 FENOKSIMETIL PENISILINA TABLET 500 MG - 0 0
67 FENOL GLISEROL TETES TELINGA 10 % 112 0 112
68 FITOMENADION ( Vit.K ) INJEKSI 10 mg/ml - 1 ml 100 0 100
69 FITOMENADION ( Vit.K ) TABLET SALUT GULA 10 Mg 2,770 0 2770
70 FLUKONAZOL 150 MG TABLET 100 0 100
71 FUROSEMID TABLET 40 mg 980 0 980
72 GARAM ORALIT 162 0 162
73 GENTAMISIN INJEKSI 5 0 5
74 GENTAMISIN SALEP MATA - 0 0
75 GENTAMISIN TETES MATA 0,3% - 0 0
76 GENTAMYCIN SALEP KULIT - 0 0
77 GENTIAN VIOLET LARUTAN 1 % - 0 0
78 GLIBENKLAMID TABLET 5 MG 590 1000 1590
79 GLISERIL GUAYA KOLAT TABLET 100 MG - 0 0
80 GLUKOSA LARUTAN INFUS 5% STERIL - 60 60
81 GRISEOFULVIN TABLET 125 MG, Micronized 460 0 460
82 GRISEOFULVIN TABLET 500 MG, Micronized - 0 0
83 HIDROKORTISON krim 2,5 % 423 0 423
84 HYDROKLOROTIAZID ( HCT ) TABLET 25 MG 1,957 0 1957
85 IBUPROFEN tablet 200 mg 1,880 0 1880
87 IBUPROFEN SUSPENSI 239 0 239
88 ICHTIOL SALEP - 0 0
89 IRBESARTAN TAB 150 MG - 0 0
90 ISOSORBID DINITRAT Tablet sublingual 5 mg 630 0 630
91 KALIUM DIKLOFENAK 25 mg Tablet - 0 0
93 KALSIUM LAKTAT ( Kalk ) Tablet 500 mg 13,493 0 13493
94 KETOKONAZOL TAB 200 MG 900 0 900
95 KETOKONAZOL KRIM 2% 313 0 313
96 KLARITROMISIN 500 MG TABLET - 0 0
97 KLINDAMISIN 300MG 1,800 0 1800
98 KLORAMPENIKOL KAPSUL 250 MG. - 0 0
99 KLORAMPENIKOL SALEP MATA 1 % 275 0 275
100 KLORAMPENIKOL SUSPENSI 98 0 98
101 KLORAMPENIKOL TETES MATA - 0 0
102 KLORAMPENIKOL TETES TELINGA 3 % - 0 0
103 KLORFENIRAMIN MELEAT (CTM) TABLET 4 MG 12,780 0 12780
104 KLORPROMAZIN TABLET SALUT 25 MG - 0 0
105 KODEIN FOSFAT TABLET 10 MG - 0 0
106 KOTRIMOXAZOL SUSPENSI, Kombinasi : Sulfametoksazol 200 mg + 282 0 282
107 KOTRIMOXAZOL TABLET PEDRIATIK, kombinasi : Sulfametoksazol - 0 0
108 KOTRIMOXAZOL TABLET,Kombinasi : Sulfametoksazol 400 mg + 830 0 830
LEVOFLOKSASIN - 0 0
110 LIDOKAIN HCl INJEKSI 2% 100 100 200
111 LIDOKAIN KOMP INJEKSI Kombinasi : Lidokain Hcl 2% + Epinefrin 270 0 270
112 LISOL , mengandung Kresol tersabun 50 % 14 0 14
113 LOPERAMID 2MG TABLET - 0 0
114 LORATADIN TABLET 10MG - 0 0
115 LYNCOMISIN 500MG - 0 0
116 MAGNESIUM SULFAT INJEKSI ( IV ) 20%-25 ml 18 0 18
118 MELOXICAM TABLET 7.5 MG - 0 0
119 MELOXICAM TABLET 15MG - 0 0
120 METFORMIN 500MG TABLET 5,160 1500 6660
121 METILERGOMETRIN MALEAT ( Metilergometrin ) tablet salut 0,12 900 0 900
122 METILERGOMETRIN MALEAT INJ 0,200 mg-1ml 100 0 100
123 METOKLORPROPAMID INJEKSI - 0 0
124 METROCLOPRAMIDE 10MG TABLET - 0 0
125 METRONIDAZOL TABLET 250 mg 2,045 0 2045
126 METRONIDAZOLE 500MG 3,814 0 3814
127 MICONAZOLE CREAM - 0 0
128 NATRIUM BIKARBONAT TABLET 500 mg - 0 0
129 NATRIUM DIKLOFENAK TABLET 25MG - 0 0
131 NATRIUM KLORIDA Larutan Infus 0,9 % steril 120 0 120
132 NIFEDIPIN 10 MG. - 0 0
133 NISTATIN TABLET SALUT 500.000 IU/g - 0 0
134 NISTATIN TABLET VAGINAL 100.000 IU/g 392 0 392
135 OBAT ANTITUBERKULOSIS ANAK 21 2 23
136 OBAT ANTITUBERKULOSIS KATEGORI 1 126 0 126
138 OBAT ANTITUBERKULOSIS KATEGORI 3 - 0 0
139 OBAT ANTITUBERKULOSIS SISIPAN - 0 0
140 OBAT BATUK HITAM ( O.B.H ) CAIRAN - 0 0
141 OKSITETRASIKLIN SALEP KULIT 3% - 0 0
142 OKSITETRASIKLIN SALEP MATA 1% - 0 0
143 OKSITOSIN INJEKSI 10 IU/ML-1ML 200 0 200
144 OMEPRAZOLE TABLET 20MG 1,458 690 2148
145 PARASETAMOL DROP 100 112 212
146 PARASETAMOL SUPPOSITORIA - 0 0
147 PARASETAMOL SYRUP 120 MG/5 ML 782 400 1182
148 PARASETAMOL TABLET 500 MG. 19,860 3000 22860
149 PARASETAMOL100 MG. TABLET - 0 0
150 PETHIDIN INJEKSI 50MG/ML - 0 0
151 PIRANTEL TABLET 125 MG. - 0 0
152 PIRIDOXIN HCL (VIT.B6) TABLET 10 MG. 10,710 0 10710
153 PIROXICAM 10 MG TABLET - 0 0
154 PIROXICAM 20 MG. TAB. - 0 0
155 POLIKRESULEN ( KONDENSASI METAKRESOL SULFONAT DAN - 0 0
156 POVIDON YODIDA 10 % 30 ML. - 0 0
157 POVIDON YODIDA 10 % 60 ML. 55 0 55
159 PREDNISON TABLET 5 MG. 1,968 500 2468
160 PROPANOLOL HCL TABLET 40 MG. - 0 0
161 PROPILTIOURASIL TABLET 100 MG. - 0 0
162 PYRAZINAMIDE 500 MG. TABLET - 0 0
163 RANITIDIN INJEKSI 40 0 40
164 RANITIDIN TABLET 150 MG 5,316 1000 6316
165 RESERPIN TABLET 0,25 MG - 0 0
166 RETINOL (VIT.A) KAPSUL 100.000 IU - 0 0
168 RIFAMPISIN 300 MG. KAPLET - 0 0
171 RINGER LAKTAT LARUTAN INFUS STERIL 126 140 266
172 SALBUTAMOL TABLET 2 MG 666 0 666
173 SALBUTAMOL TABLET 4 MG. 366 0 366
174 SALBUTAMOL NEBULIZER 2,5ML - 0 0
175 SALEP 2-4, KOMBINASI: ASAM SALISILAT 2%+BELERANG END 144 0 144
176 SALISIL BEDAK 2% 291 0 291
177 SEFIKSIM 100MG TAB /KAPSUL 160 0 160
178 SEFIKSIM SIRUP KERING 100MG/5ML 40 0 40
179 SEFOTAKSIM INJEKSI 1GRAM 50 0 50
180 SEFTRIAKSON INJEKSI 1GRAM - 0 0
181 SERUM ANTI BISA ULAR POLIVAREN INJEKSI 5 ML.(ABU 1) 2 0 2
182 SERUM ANTI TETANUS INJ. 1500 IU AMPUL(ATS) 2 0 2
183 SALBUTAMOL SRY 2 MG 98 0 98
184 SIMVASTATIN 10 MG TABLET SALUT 3,874 0 3874
185 SULFASETAMIDA NATRIUM TETES MATA 15% - 0 0
186 TABLET TAMBAH DARAH KOMBINASI:BESI 2 SULFAT 200 MG+A 168,460 0 168460
187 TETRASIKLIN HCL KAPSUL 250 MG. - 0 0
189 TIAMFENICOL KAPSUL 500 MG - 0 0
190 TIAMIN HCL (VIT.B1) INJEKSI 100 MG/ML-1ML - 0 0
191 TIAMIN HCL / MONONITRAT (VIT.B1) TABLET 50 MG. 8,630 0 8630
192 TRAMADOL 50 MG/KAMADOL - 0 0
193 TRAMADOL INJEKSI - 0 0
194 TRIHEKSIPENIDIL HIDROKLORIDA TABLET 2 MG. - 0 0
195 VIT. B KOMPLEK TABLET 4,679 5000 9679
196 ZINC TABLET 20MG 1,671 500 2171
197 ZINC SYRUP 497 0 497
-
- 0
- 0
2. BAHAN HABIS PAKAI {BHP} - 0
1 ALAT SUNTIK SEKALI PAKAI 1 ML. 800 0 800
2 ALAT SUNTIK SEKALI PAKAI 2,5 ML - 0 0
3 ALAT SUNTIK SEKALI PAKAI 5 ML 924 0 924
5 ALAT SUNTIK 3 ML 500 3600 4100
6 ALKOHOL SWAB 2,300 0 2300
7 BISTURI 100 0 100
8 CAIRAN ANTISEPTIK SOFTAMAN - 0 0
9 CATGUT/BENANG BEDAH No.2/0 - 3/0 dengan Jarum Bedah 36 0 36
10 FOLLEY CATHETER NO.18, 20, 22 13 0 13
11 SUGICAL TAPE 1 INC ROLL12 12 0 12
12 INFUS SET ANAK 350 50 400
13 INFUS SET DEWASA 700 0 700
14 IV CATETHER no 20 80 50 130
15 JARUM JAHIT (BEDAH) NO.9 s/d 14 KULIT/OTOT - 0 0
16 KAPAS Berlemak 500 gram - 0 0
17 KAPAS Pembalut/Absorben 250 gram 28 0 28
18 KASA Kompres 40 X 40 steril 163 0 163
19 KASA Pembalut 16CM X 16CM 128 0 128
20 KASA Pembalut 2 m X 80 cm 65 0 65
21 KASA PEMBALUT 40CM X 80CM 50 0 50
22 KASA PEMBALUT 4M X 4CM - 0 0
23 KASA PEMBALUT HIDRIFIL 4 M x 3 CM - 0 0
24 KASA PEMBALUT HIDROFIL 4 M x 15 CM 55 0 55
25 MASKER DISPOSIBLE 2,700 0 2700
26 NELATON CATETHER - 0 0
27 OKSIGEN REFILL - 0 0
28 PARAFFIN GAUZE DRESSING - 0 0
29 PEMBALUT ELASTIS - 0 0
30 PEMBALUT GIPS - 0 0
31 PLESTER 5 YARDS X 2 INCH - 0 0
32 POT SPUTUM 700 0 700
33 POT URIN STERIL - 0 0
34 SABUN CUCI TANGAN 156 0 156
35 SARUNG TANGAN GYNEKOLOG 13 0 13
36 SARUNG TANGAN NON STERIL 800 500 1300
37 SARUNG TANGAN STERIL 10 0 10
38 SILK (BENANG BEDAH SUTERA) NO.3/8 DENGAN JARUM BEDA 36 0 36
39 UMBILICAL KLEM NYLON 50 0 50
40 URINE BAG 9 0 9
41 USG JELLY 62 0 62
43 -
3. OBAT GIGI -
1 AIR RAKSA DENTAL USE - 0 0
2 BONDING (BUAT TAMBALAN) - 0 0
3 DEVITALISASI PASTA ( Non Arsen ) - 0 0
4 Gaiacol 24,46 g, Excipient qs ad 100 g - 0 0
5 ETCHING - 0 0
6 ETIL KLORIDA SEMPROT - 0 0
7 EUGENOL CAIRAN 17 0 17
8 GLASSIONOMER CEMENT ( GC IX ) - 0 0
9 GLASSIONOMER FILLING MATERIAL ART - 0 0
10 Sulfate, Zink Okside, Mg Stearate qs ad 100 g - 0 0
11 KACA MULUT - 0 0
12 KALSIUM HIDROXIDA PASTA - 0 0
13 KALSIUM HIDROXIDA DENGAN IODOFORM - 0 0
14 MATA BOR (HIGH SPEED/BULAT, PISUR, INVERT) - 0 0
15 MONOKLOR KAMPER MENTHOL CAIRAN - 0 0
16 MUMMIFYING PASTA - 0 0
17 SEMEN SENG FOSPAT SERBUK DAN CAIRAN - 0 0
18 SILVER AMALGAM SERBUK 65-75% - 0 0
19 SPONS GELATIN CUBICLRS 1X1X1 CM - 0 0
20 SULFA CONUS KERUCUT PREFARAT - 0 0
21 SYNTHETIC FILLING MATERIAL - 0 0
22 TEMPORARY FILLING MATERIAL - 0 0
23 TEMPORARY STOPPING FLETCHER(FLETCHER) SERBUK DAN - 0 0
24 TRIKRESOL FORMALIN (TKF) CAIRAN - 0 0
25 - 0
26 - 0
4. REAGEN -
1 ALKOHOL ASAM - 0 0
2 AMONIUM OKSALAT - 0 0
3 ANISOL - 0 0
4 AQUA BIDESTILATA - 0 0
5 ASAM KLORIDA 0,1 N-100ML. ( HCl 0.1N ) - 0 0
6 ASAM SULFO SALISILAT 20%-100ML. - 0 0
8 BIOCHEMISTRY 9 SAMSUNG - 0 0
9 BLOOD LANCET ACCU-CHECK '200 14 0 14
10 CHOLESTEROL LIQ - 0 0
11 DRUBKIN ( HAEMOGLOBIN C )100 ML - 0 0
12 EDTA 10% 100 ML - 5 5
13 EOSIN 2% - 0 0
14 GIEMSA STAIN 1 0 1
15 GLUKOSA LIQ - 0 0
16 GOLONGAN DARAH + KARTU - 0 0
17 GRAM PEWARNA 2 0 2
18 HAYEM - 0 0
19 HBSAB STRIP - 50 50
20 HBSAG STRIP 137 0 137
21 HCG TEST KEHAMILAN 500 0 500
22 IMERSION OIL 10 0 10
23 IODINE TEST - 0 0
24 KARBOL FUCHSIN - 0 0
25 NARKOBA AMP 1 0 1
26 NARKOBA MOP 1 0 1
27 NARKOBA THC 1 0 1
28 NATRIUM SITRAT 3.8% 1 0 1
29 POCH D - 0 0
30 POCH L - 0 0
31 CELL CLEAN - 0 0
32 8-CHECK - 0 0
34 REES ECKER - 0 0
35 SERUM KONTROL - 0 0
36 STICK ASAM URAT 15 7 22
37 STICK CHOLESTEROL 11 0 11
38 STICK GLUKOSA ACCU-CHECK '25 - 0 0
39 STICK GLUKOSA ACCU-CHECK '50 20 0 20
40 STICK HB METER 5 0 5
41 STICK URINE 3 PM - 0 0
43 TABUNG WESTERGEN - 0 0
44 TRIGLISERIDA - 0 0
45 TURK 1 0 1
46 URIC ACID LIQUID - 0 0
47 VAKUTEINER EDTA 3ML - 0 0
48 WIDAL 5 0 5
49 XYLOL - 0 0
50 ZIEHL NIELSON - 0 0
51 YELLOW TIP - 0 0
52 - 0 0
1 BURNAZINE CREAM 10MG 8 0 8
2 RAPID TEST HIV 1/2 SD TEST 100 - 300 300
3 RAPID TEST HIV KE-2 FOKUS TEST - 25 25
4 RAPID TEST HIV 1/2 BIOMERIC-/VIA TEST - 25 25
5 RAPID TEST SYPHILIS TEST - 40 40
6 BASIC DRESSING SET PACK - 10 10

7 OBJECK GLASS BOX - 5 5
8 GLIMEPIRIDE 1MG - 700 700
10 DUBESONIDE CAIRAN INH 0,5MG/2ML CAN 5 - 240 240
11 BETAHISTINE MESILATE 6 MG - 1000 1000
12 ZINKID SYRUP - 0 0
13 NYSTATIN DROP 100.000 UI BOTOL 15 ML 78 0 78
14 DUBESONIDE SERBUK INH 200 MCG/DOSIS CAN 100 5 8 13
SURGICAL TAPE ROLL 1 - 0 0
CETRIZINE SYR - 240 240
PB DEWASA BLISTER '6 - 0 0
SURGICAL TAPE ROLL 1/2 inchi pcs'24 12 0 12
IV CATETHER 24 50 0 50
- 0 0
KERTAS PUYER PCS 28,300 0 28300
MB DEWASA BLISTER '6 46 0 46
ILIADIN DROP BOTOL 10 0 10
CATGUT CHROMIC 2/0 SACCHET 16 0 16
* TIDAK BOLEH MENAMBAHKAN "ROW" YG BARU, KLO ADA NAMA OBAT YG BARU/TDK ADA NAMA OBATNYA TAMBAHKAN DIBAWAHNYA
UMUM
TIDAK ASKES JUMLAH
BAYAR
JUMLAH KUNJUNGAN RESEP
0 1787 1326 3113
Kepala Dinas Kesehatan Kab. Bekasi Kepala GFK
dr.Hj.Sri Enny Mainiarti, SKM Eva Yanti Hermansyah, S.Farm.Apt

NIP.19700525 200003 2 004 NIP.19780918 200902 2 001
KETERANGAN :
AN DAN LEMBAR PERMINTAAN OBAT ( LPLPO ) FORM : LPLPO
PUSKESMAS
DOKUMEN NOMOR TANGGAL

DINKES KAB/KOTA
: MARET 2019 GFK KAB/KOTA
: APRIL 2019 PUSKESMAS
PEMAKAI STOK STOK PERMINT PEM BER IAN

JUMLAH
AN AKHIR OPTIMAL AAN PKD/DPP ASKES APBD I APBD II PROGRAM LAIN-LAIN
7 8 9 10 11 12 13 14 15 16 17
0 6180 440 -5740

438 1130 1540 410
0 0 4400 4400
0 0 440 440
0 0 0 0
0 0 440 440
0 200 110 -90
1070 4764 4400 -364
1326 1394 6600 5206
1310 10350 1100 -9250
4160 18710 7700 -11010
129 407 440 33
0 0 0 0
0 0 0 0
0 0 0 0
2430 4680 5940 1260
0 0 6600 6600
0 0 0 0
6763 1687 7700 6013

33 217 330 113
23 114 132 18
2 200 44 -156
45 70 110 40
100 700 880 180
20 90 11 -79
4760 4320 6600 2280
0 0 0 0
166 5364 5500 136
1630 4970 5500 530
0 0 330 330
210 1840 1100 -740
80 1510 880 -630
0 0 0 0
41 195 110 -85
6 15 11 -4
520 5540 2200 -3340
130 6420 2200 -4220
0 0 1100 1100
19 79 110 31
2694 1498 3300 1802
1486 2084 2200 116
0 400 0 -400
8413 6292 8800 2508
0 0 110 110
0 0 2200 2200
0 0 0 0
30 214 22 -192
1 4 0 -4
5 0 8.8 8.8
0 20 11 -9
0 520 88 -432
20 525 220 -305
370 2750 2200 -550
81 182 110 -72
0 0 0 0
0 0 0 0
0 20 0 -20
10 1100 0 -1100
0 0 0 0
0 0 0 0
0 33 11 -22
0 0 0 0
1 62 11 -51
0 520 22 -498
0 0 0 0
0 0 0 0
0 0 0 0
16 96 11 -85
0 100 44 -56
118 2652 660 -1992
0 100 66 -34
29 951 220 -731
162 0 1100 1100
2 3 0 -3
0 0 0 0
0 0 0 0
0 0 66 66
0 0 22 22
240 1350 2200 850
0 0 5500 5500
0 60 88 28
20 440 220 -220
0 0 0 0
39 384 66 -318
0 1957 110 -1847
250 1630 1100 -530
1780 7624 4400 -3224
6 233 44 -189
0 0 22 22
0 0 0 0
0 630 440 -190
0 0 1100 1100
5600 5500 -100
3000 10493 8800 -1693
100 800 2200 1400
44 269 110 -159
0 0 0 0
270 1530 1100 -430
0 0 1100 1100
37 238 110 -128
0 98 66 -32
0 0 66 66
0 0 44 44
3500 9280 6600 -2680
0 0 0 0
0 0 44 44
0 282 1100 818
0 0 0 0
0 830 0 -830
0 0 0 0
100 100 0 -100
0 270 110 -160
3 11 15.4 4.4
0 0 440 440
0 0 0 0
0 0 0 0
0 18 4.4 -13.6
0 12 4.4 -7.6
0 0 0 0
0 0 0 0
2060 4600 6600 2000
0 900 440 -460
0 100 22 -78
0 0 0 0
0 0 0 0
85 1960 330 -1630
85 3729 440 -3289
0 0 0 0
0 0 0 0
0 0 4400 4400
0 0 5500 5500
0 120 0 -120
0 0 1100 1100
0 0 220 220
8 384 110 -274
2 21 17.6 -3.4
16 110 44 -66
2 19 11 -8
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 200 44 -156
678 1470 2200 730
58 154 154 0
0 0 0 0
394 788 660 -128
7658 15202 15400 198
0 0 0 0
0 0 0 0
0 0 0 0
3455 7255 1540 -5715
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 55 44 -11
0 0 0 0
430 2038 2200 162
0 0 0 0
0 0 0 0
0 0 0 0
0 40 11 -29
1810 4506 5500 994
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
74 192 220 28
433 233 110 -123
204 162 220 58
0 0 0 0
20 124 22 -102
39 252 154 -98
160 0 1100 1100
19 21 44 23
10 40 0 -40
0 0 0 0
0 2 0 -2
0 2 0 -2
3 95 0 -95
1650 2224 3300 1076
0 0 0 0
4485 163975 11000 -152975
0 0 0 0
0 0 0 0
0 0 660 660
0 0 0 0
2000 6630 6600 -30
0 0 0 0
0 0 0 0
0 0 0 0
3600 6079 7700 1621
140 2031 2200 169
50 447 330 -117
0
0
0
0
300 500 440 -60
0 0 3300 3300
100 824 550 -274
26 30 110 80
700 3400 0 -3400
2296 4 3300 3296
10 90 22 -68
0 0 22 22
0 36 22 -14
2 11 4.4 -6.6
12 0 55 55
50 350 44 -306
200 500 220 -280
10 120 220 100
0 0 22 22
0 0 0 0
1 27 6.6 -20.4
105 58 110 52
0 128 143 15
10 55 132 77
0 50 11 -39
0 0 11 11
0 0 44 44
0 55 22 -33
900 1800 1320 -480
0 0 0 0
0 0 11 11
0 0 0 0
0 0 0 0
0 0 0 0
0 0 22 22
700 0 660 660
0 0 660 660
5 151 15.4 -135.6
3 10 13.2 3.2
500 800 13.2 -786.8
10 0 11 11
0 36 0 -36
0 50 44 -6
0 9 0 -9
24 38 6.6 -31.4
0 0 0 0
0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 17 0 -17
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
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
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 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 14 11 -3
0 0 0 0
0 0 0 0
0 5 4.4 -0.6
0 0 2.2 2.2
0 1 0 -1
0 0 2.2 2.2
0 0 660 660
0 2 8.8 6.8
0 0 0 0
0 50 0 -50
135 2 176 174
250 250 110 -140
0 0 0
0 0 0 0
0 0 0 0
0 1 0 -1
0 1 0 -1
0 1 0 -1
0 1 0 -1
0 0 33 33
0 0 2.2 2.2
0 0 2.2 2.2
0 0 0 0
0 0 0 0
0 0 2.2 2.2
20 2 22 20
10 1 44 43
0 0 0 0
15 5 22 17
3 2 0 -2
0 0 0 0
0 0 4.4 4.4
0 0 0 0
0 0 0 0
0 1 2.2 1.2
0 0 0 0
0 0 660 660
5 0 4.4 4.4
0 0 2.2 2.2
0 0 0 0
0 0 440 440
0 0 0 0
7 1 11 10
200 100 440 340
0 25 0 -25
0 25 66 41
20 20 0 -20
3 7 0 -7
4 1 0 -1
0 700 0 -700
0 0 0 0
20 220 0 -220
0 1000 0 -1000
0 0 0 0
7 71 22 -49
0 13 0 -13
0 0 6.6 6.6
24 216 220 4
1 -1 4.4 5.4
12 0 55 55
20 30 110 80
0 0 8.8 8.8
4000 24300 4400 -19900
22 24 0 -24
0 10 8.8 -1.2
8 8 22 14
BATNYA TAMBAHKAN DIBAWAHNYA SAJA.
Kepala Puskesmas Petugas Puskesmas
H.Firman, SKM Sanih Susilawati, AM.Keb

NIP. 19730201 199903 1 005 NIP.19740426 200604 2 008
SO : STOK OPTIMUM
SK SK
SO SWK SWT
440 200 8 0 0
1540 700 28
4400 2000 80
440 200 8
0 0
440 200 8
110 50 2
4400 2000 80
6600 3000 120
1100 500 20
7700 3500 140
440 200 8
0 0
0 0
0 0
5940 2700 108
6600 3000 120
0 0
7700 3500 140

330 150 6
132 60 2.4
44 20 0.8
110 50 2
880 400 16
11 5 0.2
6600 3000 120
0 0
5500 2500 100
5500 2500 100
330 150 6
1100 500 20
880 400 16
0 0
110 50 2
11 5 0.2
2200 1000 40
2200 1000 40
1100 500 20
110 50 2
3300 1500 60
2200 1000 40
0 0
8800 4000 160
110 50 2
2200 1000 40
0 0
22 10 0.4
0 0
8.8 4 0.16
11 5 0.2
88 40 1.6
220 100 4
2200 1000 40
110 50 2
0 0
0 0
0 0
0 0
0 0
0 0
11 5 0.2
0 0
11 5 0.2
22 10 0.4
0 0
0 0
0 0
11 5 0.2
44 20 0.8
660 300 12
66 30 1.2
220 100 4
1100 500 20
0 0
0 0
0 0
66 30 1.2
22 10 0.4
2200 1000 40
5500 2500 100
88 40 1.6
220 100 4
0 0
66 30 1.2
110 50 2
1100 500 20
4400 2000 80
44 20 0.8
22 10 0.4
0 0
440 200 8
1100 500 20
5500 2500 100
8800 4000 160
2200 1000 40
110 50 2
0 0
1100 500 20
1100 500 20
110 50 2
66 30 1.2
66 30 1.2
44 20 0.8
6600 3000 120
0 0
44 20 0.8
1100 500 20
0 0
0 0
0 0
0 0
110 50 2
15.4 7 0.28
440 200 8
0 0
0 0
4.4 2 0.08
4.4 2 0.08
0 0
0 0
6600 3000 120
440 200 8
22 10 0.4
0 0
0 0
330 150 6
440 200 8
0 0
0 0
4400 2000 80
5500 2500 100
0 0
1100 500 20
220 100 4
110 50 2
17.6 8 0.32
44 20 0.8
11 5 0.2
0 0
0 0
0 0
0 0
0 0
44 20 0.8
2200 1000 40
154 70 2.8
0 0
660 300 12
15400 7000 280
0 0
0 0
0 0
1540 700 28
0 0
0 0
0 0
0 0
44 20 0.8
0 0
2200 1000 40
0 0
0 0
0 0
11 5 0.2
5500 2500 100
0 0
0 0 0
0 0 0
0 0
0 0
0 0
220 100 4
110 50 2
220 100 4
0 0
22 10 0.4
154 70 2.8
1100 500 20
44 20 0.8
0 0
0 0
0 0
0 0
0 0
3300 1500 60
0 0
11000 5000 200
0 0
0 0
660 300 12
0 0
6600 3000 120
0 0
0 0
0 0
7700 3500 140
2200 1000 40
330 150 6
0 0
0 0
0 0
0 0
440 200 8
3300 1500 60
550 250 10
110 50 2
0 0
3300 1500 60
22 10 0.4
22 10 0.4
22 10 0.4
4.4 2 0.08
55 25 1
44 20 0.8
220 100 4
220 100 4
22 10 0.4
0 0
6.6 3 0.12
110 50 2
143 65 2.6
132 60 2.4
11 5 0.2
11 5 0.2
44 20 0.8
22 10 0.4
1320 600 24
0 0
11 5 0.2
0 0
0 0
0 0
22 10 0.4
660 300 12
660 300 12
15.4 7 0.28
13.2 6 0.24
13.2 6 0.24
11 5 0.2
0 0
44 20 0.8
0 0
6.6 3 0.12
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
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
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
11 5 0.2
0 0
0 0
4.4 2 0.08
2.2 1 0.04
0 0
2.2 1 0.04
660 300 12
8.8 4 0.16
0 0
0 0
176 80 3.2
110 50 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
33 15 0.6
2.2 1 0.04
2.2 1 0.04
0 0
0 0
2.2 1 0.04
22 10 0.4
44 20 0.8
0 0
22 10 0.4
0 0
0 0
4.4 2 0.08
0 0
0 0
2.2 1 0.04
0 0
660 300 12
4.4 2 0.08
2.2 1 0.04
0 0
440 200 8
0 0
0 0
11 5 0.2
440 200 8
0 0
66 30 1.2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
22 10 0.4
0 0
6.6 3 0.12
220 100 4
4.4 2 0.08
55 25 1
110 50 2
8.8 4 0.16
4400 2000 80
0 0
8.8 4 0.16
22 10 0.4
* catatan :
- kolom SK (per bulan ) untuk bln pertama kali (november) diisi manual dulu, untuk bln selanjutnya disam
- supaya tdk terjadi over stock atau kosong stok OBAT, pengisian harus benar dan pengambilan obat hr
DAN STOK PER HARI )
SP
20
70
200
20
0
20
5
200
300
50
350
20
0
0
0
270
300
0
350
15
6
2
5
40
0.5
300
0
250
250
15
50
40
0
5
0.5
100
100
50
5
150
100
0
400
5
100
0
1
0
0.4
0.5
4
10
100
5
0
0
0
0
0
0
0.5
0
0.5
1
0
0
0
0.5
2
30
3
10
50
0
0
0
3
1
100
250
4
10
0
3
5
50
200
2
1
0
20
50
250
400
100
5
0
50
50
5
3
3
2
300
0
2
50
0
0
0
0
5
0.7
20
0
0
0.2
0.2
0
0
300
20
1
0
0
15
20
0
0
200
250
0
50
10
5
0.8
2
0.5
0
0
0
0
0
2
100
7
0
30
700
0
0
0
70
0
0
0
0
2
0
100
0
0
0
0.5
250
0
0
0
0
0
0
10
5
10
0
1
7
50
2
0
0
0
0
0
150
0
500
0
0
30
0
300
0
0
0
350
100
15
0
0
0
0
20
150
25
5
0
150
1
1
1
0.2
2.5
2
10
10
1
0
0.3
5
6.5
6
0.5
0.5
2
1
60
0
0.5
0
0
0
1
30
30
0.7
0.6
0.6
0.5
0
2
0
0.3
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
0
0
0
0
0
0
0
0
0.5
0
0
0.2
0.1
0
0.1
30
0.4
0
0
8
5
0
0
0
0
0
0
0
1.5
0.1
0.1
0
0
0.1
1
2
0
1
0
0
0.2
0
0
0.1
0
30
0.2
0.1
0
20
0
0
0.5
20
0
3
0
0
0
0
0
0
0
0
1
0
0.3
10
0.2
2.5
5
0.4
200
0
0.4
1
ulu, untuk bln selanjutnya disamakan tdk perlu diisi lg (copy paste)
inggal copy paste aja)
enar dan pengambilan obat hrs disiplin TEPAT WAKTU

LAPORAN PEMAKAIAN DAN LEMBAR PERMIN
PUSKESMAS
PENERIMAA
N
1 2 3 4 5 6
1. OBAT
2 ALOPURINOL TABLET 100 MG. 1,130 0 1130
3 AMBROXOL TABLET - 0 0
16 ASETIL SISTEIN 200 MG KAP 4,680 0 4680
19 mg+Al.Hidroksida 200 mg 1,687 0 1687
26 ASAM ASKORBAT ( Vit.C ) tablet 50 mg 4,320 0 4320
31 ASIKLOVIR TAB 200 1,840 0 1840
32 ASIKLOVIR TAB 400MG 1,510 0 1510
36 CAPTOPRIL 12,5 MG 5,540 0 5540
37 CAPTOPRIL 25 MG 6,420 0 6420
40 CETIRIZINE TAB 10MG 1,498 0 1498
43 DEKSAMETASON TABLET 0,5 MG. 6,292 0 6292
49 DIAZEPAM SUPPOSITORIA - 0 0
50 DIFENHIDRAMIN INJEKSI 10 mg/ml - 1 ml 20 0 20
57 EPINEFRINA HCL/BITARTRAT ( Epinefrina/Adrenalin ) Injeksi 0,1 20 0 20
58 ERITROMICYN KAPSUL 250 MG 1,100 0 1100
92 ETANOL 70 % 62 0 62
70 FLUKONAZOL 150 MG TABLET 100 0 100
72 GARAM ORALIT - 0 0
78 GLIBENKLAMID TABLET 5 MG 1,350 0 1350
80 GLUKOSA LARUTAN INFUS 5% STERIL 60 0 60
92 KALIUM DIKLOFENAK 50 mg Tablet 5,600 0 5600
93 KALSIUM LAKTAT ( Kalk ) Tablet 500 mg 10,493 0 10493
97 KLINDAMISIN 300MG 1,530 0 1530
LEVOFLOKSASIN - 0 0
139 OBAT ANTITUBERKULOSIS SISIPAN - 0 0
144 OMEPRAZOLE TABLET 20MG 1,470 0 1470
148 PARASETAMOL TABLET 500 MG. 15,202 0 15202
150 PETHIDIN INJEKSI 50MG/ML - 0 0
159 PREDNISON TABLET 5 MG. 2,038 0 2038
171 RINGER LAKTAT LARUTAN INFUS STERIL 192 0 192
173 SALBUTAMOL TABLET 4 MG. 162 0 162
177 SEFIKSIM 100MG TAB /KAPSUL - 0 0
195 VIT. B KOMPLEK TABLET 6,079 0 6079
196 ZINC TABLET 20MG 2,031 0 2031
197 ZINC SYRUP 447 0 447
-
- 0
- 0
5 ALAT SUNTIK 3 ML 3,400 0 3400
6 ALKOHOL SWAB 4 0 4
7 BISTURI 90 0 90
11 SUGICAL TAPE 1 INC ROLL12 - 0 0
25 MASKER DISPOSIBLE 1,800 0 1800
32 POT SPUTUM - 0 0
36 SARUNG TANGAN NON STERIL 800 0 800
37 SARUNG TANGAN STERIL - 0 0
40 URINE BAG 9 0 9
43 -
3. OBAT GIGI -
5 ETCHING - 0 0
7 EUGENOL CAIRAN 17 0 17
11 KACA MULUT - 0 0
25 - 0
26 - 0
4. REAGEN -
3 ANISOL - 0 0
12 EDTA 10% 100 ML 5 0 5
13 EOSIN 2% - 0 0
18 HAYEM - 0 0
19 HBSAB STRIP 50 0 50
20 HBSAG STRIP 2 0 2
21 HCG TEST KEHAMILAN 250 0 250
22 IMERSION OIL - 0 0
29 POCH D - 0 0
30 POCH L - 0 0
31 CELL CLEAN - 0 0
32 8-CHECK - 0 0
34 REES ECKER - 0 0
37 STICK CHOLESTEROL 1 0 1
45 TURK 1 0 1
48 WIDAL - 0 0
49 XYLOL - 0 0
51 YELLOW TIP - 0 0
52 - 0 0
1 BURNAZINE CREAM 10MG 1 0 1
2 RAPID TEST HIV 1/2 SD TEST 100 100 0 100
3 RAPID TEST HIV KE-2 FOKUS TEST 25 0 25
4 RAPID TEST HIV 1/2 BIOMERIC-/VIA TEST 25 0 25
5 RAPID TEST SYPHILIS TEST 20 0 20
6 BASIC DRESSING SET PACK 7 0 7

7 OBJECK GLASS BOX 1 0 1
8 GLIMEPIRIDE 1MG 700 0 700
10 DUBESONIDE CAIRAN INH 0,5MG/2ML CAN 5 220 0 220
11 BETAHISTINE MESILATE 6 MG 1,000 0 1000
CETRIZINE SYR 216 0 216
PB DEWASA BLISTER '6 (1) 0 -1
SURGICAL TAPE ROLL 1/2 inchi pcs'24 - 0 0
- 0 0
CATGUT CHROMIC 2/0 SACCHET 8 0 8
UMUM
TIDAK ASKES JUMLAH
BAYAR
0 1064 1212 2276

NIP.19700525 200003 2 004 NIP.19780918 200902 2 001
KETERANGAN :
AN DAN LEMBAR PERMINTAAN OBAT ( LPLPO ) FORM : LPLPO
PUSKESMAS

DINKES KAB/KOTA
APRIL 2019 GFK KAB/KOTA
: MEI 2019 PUSKESMAS
PEMAKAI STOK STOK PERMINT PEM BER IAN

JUMLAH
AN AKHIR OPTIMAL AAN PKD/DPP ASKES APBD I APBD II PROGRAM LAIN-LAIN
7 8 9 10 11 12 13 14 15 16 17
0 6180 440 -5740

400 730 1540 810
0 0 4400 4400
0 0 440 440
0 0 0 0
0 0 440 440
0 200 110 -90
1310 3454 4400 946
784 610 6600 5990
220 10130 1100 -9030
4340 14370 7700 -6670
110 297 440 143
0 0 0 0
0 0 0 0
0 0 0 0
4008 672 5940 5268
0 0 6600 6600
0 0 0 0
1687 0 7700 7700

124 93 330 237
100 14 132 118
36 164 44 -120
27 43 110 67
100 600 880 280
0 90 11 -79
4320 0 6600 6600
0 0 0 0
700 4664 5500 836
2640 2330 5500 3170
0 0 330 330
910 930 1100 170
420 1090 880 -210
0 0 0 0
48 147 110 -37
0 15 11 -4
620 4920 2200 -2720
540 5880 2200 -3680
0 0 1100 1100
19 60 110 50
1224 274 3300 3026
321 1763 2200 437
0 400 0 -400
6292 0 8800 8800
0 0 110 110
0 0 2200 2200
0 0 0 0
0 214 22 -192
0 4 0 -4
0 0 8.8 8.8
0 20 11 -9
0 520 88 -432
0 525 220 -305
350 2400 2200 -200
159 23 110 87
0 0 0 0
0 0 0 0
0 20 0 -20
0 1100 0 -1100
0 0 0 0
0 0 0 0
0 33 11 -22
0 0 0 0
1 61 11 -50
0 520 22 -498
0 0 0 0
0 0 0 0
0 0 0 0
37 59 11 -48
0 100 44 -56
52 2600 660 -1940
100 0 66 66
0 951 220 -731
0 0 1100 1100
0 3 0 -3
0 0 0 0
0 0 0 0
0 0 66 66
0 0 22 22
275 1075 2200 1125
0 0 5500 5500
40 20 88 68
203 237 220 -17
0 0 0 0
71 313 66 -247
0 1957 110 -1847
280 1350 1100 -250
1673 5951 4400 -1551
72 161 44 -117
0 0 22 22
0 0 0 0
0 630 440 -190
0 0 1100 1100
1828 3772 5500 1728
6523 3970 8800 4830
111 689 2200 1511
67 202 110 -92
0 0 0 0
510 1020 1100 80
0 0 1100 1100
87 151 110 -41
0 98 66 -32
0 0 66 66
0 0 44 44
4675 4605 6600 1995
0 0 0 0
0 0 44 44
2 280 1100 820
0 0 0 0
82 748 0 -748
0 0 0 0
0 100 0 -100
0 270 110 -160
0 11 15.4 4.4
0 0 440 440
0 0 0 0
0 0 0 0
6 12 4.4 -7.6
0 12 4.4 -7.6
0 0 0 0
0 0 0 0
2635 1965 6600 4635
0 900 440 -460
0 100 22 -78
0 0 0 0
0 0 0 0
133 1827 330 -1497
10 3719 440 -3279
0 0 0 0
0 0 0 0
0 0 4400 4400
0 0 5500 5500
0 120 0 -120
0 0 1100 1100
0 0 220 220
41 343 110 -233
2 19 17.6 -1.4
6 104 44 -60
1 18 11 -7
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 200 44 -156
990 480 2200 1720
73 81 154 73
0 0 0 0
425 363 660 297
6302 8900 15400 6500
0 0 0 0
0 0 0 0
0 0 0 0
4131 3124 1540 -1584
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 55 44 -11
0 0 0 0
2038 0 2200 2200
0 0 0 0
0 0 0 0
0 0 0 0
0 40 11 -29
3144 1362 5500 4138
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
192 0 330 330
221 12 440 428
162 0 330 330
0 0 0 0
28 96 22 -74
44 208 154 -54
0 0 1100 1100
13 8 44 36
0 40 0 -40
0 0 0 0
0 2 0 -2
0 2 0 -2
2 93 0 -93
968 1256 3300 2044
0 0 0 0
28705 135270 11000 -124270
0 0 0 0
0 0 0 0
0 0 660 660
0 0 0 0
1515 5115 6600 1485
0 0 0 0
0 0 0 0
0 0 0 0
4479 1600 7700 6100
2031 0 2200 2200
92 355 330 -25
0
0
0
0
200 300 440 140
0 0 3300 3300
0 824 550 -274
5 25 110 85
700 2700 0 -2700
4 0 3300 3300
0 90 22 -68
0 0 22 22
0 36 22 -14
0 11 4.4 -6.6
0 0 55 55
0 350 44 -306
100 400 220 -180
0 120 220 100
0 0 22 22
0 0 0 0
10 17 6.6 -10.4
0 58 110 52
23 105 143 38
0 55 132 77
0 50 11 -39
0 0 11 11
0 0 44 44
25 30 22 -8
1400 400 1320 920
0 0 0 0
0 0 11 11
0 0 0 0
0 0 0 0
0 0 0 0
0 0 22 22
0 0 660 660
0 0 660 660
1 150 15.4 -134.6
0 10 13.2 3.2
800 0 13.2 13.2
0 0 11 11
0 36 0 -36
0 50 44 -6
0 9 0 -9
0 38 6.6 -31.4
0 0 0 0
0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
17 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 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 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 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
4 10 11 1
0 0 0 0
0 0 0 0
0 5 4.4 -0.6
0 0 2.2 2.2
0 1 0 -1
0 0 2.2 2.2
0 0 660 660
0 2 8.8 6.8
0 0 0 0
0 50 0 -50
2 0 176 176
250 0 110 110
0 0 0
0 0 0 0
0 0 0 0
0 1 0 -1
0 1 0 -1
0 1 0 -1
0 1 0 -1
0 0 33 33
0 0 2.2 2.2
0 0 2.2 2.2
0 0 0 0
0 0 0 0
0 0 2.2 2.2
2 3 22 19
1 0 44 44
0 0 0 0
5 5 22 17
0 2 0 -2
0 0 0 0
0 0 4.4 4.4
0 0 0 0
0 0 0 0
0 1 2.2 1.2
0 0 0 0
0 0 660 660
5 -5 4.4 9.4
0 0 2.2 2.2
0 0 0 0
0 0 440 440
0 0 0 0
7 -6 11 17
200 -100 440 540
0 25 0 -25
0 25 66 41
20 0 0 0
3 4 0 -4
4 -3 0 3
0 700 0 -700
0 0 0 0
20 200 0 -200
0 1000 0 -1000
0 0 0 0
7 64 22 -42
0 21 0 -21
0 0 6.6 6.6
24 192 220 28
1 -2 4.4 6.4
12 -12 55 67
20 10 110 100
0 0 8.8 8.8
4000 20300 4400 -15900
19 5 15.4 10.4
0 10 8.8 -1.2
8 0 22 22

NIP. 19730201 199903 1 005 NIP.19740426 200604 2 008
SO : STOK OPTIMUM
SK SK
SO SWK SWT
440 200 8 0 0
1540 700 28
4400 2000 80
440 200 8
0 0
440 200 8
110 50 2
4400 2000 80
6600 3000 120
1100 500 20
7700 3500 140
440 200 8
0 0
0 0
0 0
5940 2700 108
6600 3000 120
0 0
7700 3500 140

330 150 6
132 60 2.4
44 20 0.8
110 50 2
880 400 16
11 5 0.2
6600 3000 120
0 0
5500 2500 100
5500 2500 100
330 150 6
1100 500 20
880 400 16
0 0
110 50 2
11 5 0.2
2200 1000 40
2200 1000 40
1100 500 20
110 50 2
3300 1500 60
2200 1000 40
0 0
8800 4000 160
110 50 2
2200 1000 40
0 0
22 10 0.4
0 0
8.8 4 0.16
11 5 0.2
88 40 1.6
220 100 4
2200 1000 40
110 50 2
0 0
0 0
0 0
0 0
0 0
0 0
11 5 0.2
0 0
11 5 0.2
22 10 0.4
0 0
0 0
0 0
11 5 0.2
44 20 0.8
660 300 12
66 30 1.2
220 100 4
1100 500 20
0 0
0 0
0 0
66 30 1.2
22 10 0.4
2200 1000 40
5500 2500 100
88 40 1.6
220 100 4
0 0
66 30 1.2
110 50 2
1100 500 20
4400 2000 80
44 20 0.8
22 10 0.4
0 0
440 200 8
1100 500 20
5500 2500 100
8800 4000 160
2200 1000 40
110 50 2
0 0
1100 500 20
1100 500 20
110 50 2
66 30 1.2
66 30 1.2
44 20 0.8
6600 3000 120
0 0
44 20 0.8
1100 500 20
0 0
0 0
0 0
0 0
110 50 2
15.4 7 0.28
440 200 8
0 0
0 0
4.4 2 0.08
4.4 2 0.08
0 0
0 0
6600 3000 120
440 200 8
22 10 0.4
0 0
0 0
330 150 6
440 200 8
0 0
0 0
4400 2000 80
5500 2500 100
0 0
1100 500 20
220 100 4
110 50 2
17.6 8 0.32
44 20 0.8
11 5 0.2
0 0
0 0
0 0
0 0
0 0
44 20 0.8
2200 1000 40
154 70 2.8
0 0
660 300 12
15400 7000 280
0 0
0 0
0 0
1540 700 28
0 0
0 0
0 0
0 0
44 20 0.8
0 0
2200 1000 40
0 0
0 0
0 0
11 5 0.2
5500 2500 100
0 0
0 0 0
0 0 0
0 0
0 0
0 0
330 150 6
440 200 8
330 150 6
0 0
22 10 0.4
154 70 2.8
1100 500 20
44 20 0.8
0 0
0 0
0 0
0 0
0 0
3300 1500 60
0 0
11000 5000 200
0 0
0 0
660 300 12
0 0
6600 3000 120
0 0
0 0
0 0
7700 3500 140
2200 1000 40
330 150 6
0 0
0 0
0 0
0 0
440 200 8
3300 1500 60
550 250 10
110 50 2
0 0
3300 1500 60
22 10 0.4
22 10 0.4
22 10 0.4
4.4 2 0.08
55 25 1
44 20 0.8
220 100 4
220 100 4
22 10 0.4
0 0
6.6 3 0.12
110 50 2
143 65 2.6
132 60 2.4
11 5 0.2
11 5 0.2
44 20 0.8
22 10 0.4
1320 600 24
0 0
11 5 0.2
0 0
0 0
0 0
22 10 0.4
660 300 12
660 300 12
15.4 7 0.28
13.2 6 0.24
13.2 6 0.24
11 5 0.2
0 0
44 20 0.8
0 0
6.6 3 0.12
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
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
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
11 5 0.2
0 0
0 0
4.4 2 0.08
2.2 1 0.04
0 0
2.2 1 0.04
660 300 12
8.8 4 0.16
0 0
0 0
176 80 3.2
110 50 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
33 15 0.6
2.2 1 0.04
2.2 1 0.04
0 0
0 0
2.2 1 0.04
22 10 0.4
44 20 0.8
0 0
22 10 0.4
0 0
0 0
4.4 2 0.08
0 0
0 0
2.2 1 0.04
0 0
660 300 12
4.4 2 0.08
2.2 1 0.04
0 0
440 200 8
0 0
0 0
11 5 0.2
440 200 8
0 0
66 30 1.2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
22 10 0.4
0 0
6.6 3 0.12
220 100 4
4.4 2 0.08
55 25 1
110 50 2
8.8 4 0.16
4400 2000 80
15.4 7 0.28
8.8 4 0.16
22 10 0.4
* catatan :
- kolom SK (per bulan ) untuk bln pertama kali (november) diisi manual dulu, untuk bln selanjutnya disam
- supaya tdk terjadi over stock atau kosong stok OBAT, pengisian harus benar dan pengambilan obat hr
DAN STOK PER HARI )
SP
20
70
200
20
0
20
5
200
300
50
350
20
0
0
0
270
300
0
350
15
6
2
5
40
0.5
300
0
250
250
15
50
40
0
5
0.5
100
100
50
5
150
100
0
400
5
100
0
1
0
0.4
0.5
4
10
100
5
0
0
0
0
0
0
0.5
0
0.5
1
0
0
0
0.5
2
30
3
10
50
0
0
0
3
1
100
250
4
10
0
3
5
50
200
2
1
0
20
50
250
400
100
5
0
50
50
5
3
3
2
300
0
2
50
0
0
0
0
5
0.7
20
0
0
0.2
0.2
0
0
300
20
1
0
0
15
20
0
0
200
250
0
50
10
5
0.8
2
0.5
0
0
0
0
0
2
100
7
0
30
700
0
0
0
70
0
0
0
0
2
0
100
0
0
0
0.5
250
0
0
0
0
0
0
15
20
15
0
1
7
50
2
0
0
0
0
0
150
0
500
0
0
30
0
300
0
0
0
350
100
15
0
0
0
0
20
150
25
5
0
150
1
1
1
0.2
2.5
2
10
10
1
0
0.3
5
6.5
6
0.5
0.5
2
1
60
0
0.5
0
0
0
1
30
30
0.7
0.6
0.6
0.5
0
2
0
0.3
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
0
0
0
0
0
0
0
0
0.5
0
0
0.2
0.1
0
0.1
30
0.4
0
0
8
5
0
0
0
0
0
0
0
1.5
0.1
0.1
0
0
0.1
1
2
0
1
0
0
0.2
0
0
0.1
0
30
0.2
0.1
0
20
0
0
0.5
20
0
3
0
0
0
0
0
0
0
0
1
0
0.3
10
0.2
2.5
5
0.4
200
0.7
0.4
1
ulu, untuk bln selanjutnya disamakan tdk perlu diisi lg (copy paste)
inggal copy paste aja)
enar dan pengambilan obat hrs disiplin TEPAT WAKTU

LAPORAN PEMAKAIAN DAN LEMBAR PERM
PUSKESMAS
PENERIMAA
N
1 2 3 4 5 6
1. OBAT
2 ALOPURINOL TABLET 100 MG. 730 800 1530
3 ALUPURINOL 300 MG - 600 600
9 AMLODIPIN TABLET 10MG 610 2,100 2710
16 ASETIL SISTEIN 200 MG KAP 672 10,560 11232
19 mg+Al.Hidroksida 200 mg - 7,700 7700
31 ASIKLOVIR TAB 200 930 2000 2930
32 ASIKLOVIR TAB 400MG 1,090 200 1290
36 CAPTOPRIL 12,5 MG 4,920 0 4920
37 CAPTOPRIL 25 MG 5,880 0 5880
40 CETIRIZINE TAB 10MG 274 3100 3374
43 DEKSAMETASON TABLET 0,5 MG. - 10,000 10000
49 DIAZEPAM SUPPOSITORIA - 5 5
50 DIFENHIDRAMIN INJEKSI 10 mg/ml - 1 ml 20 0 20
57 EPINEFRINA HCL/BITARTRAT ( Epinefrina/Adrenalin ) Injeksi 0,1 20 0 20
58 ERITROMICYN KAPSUL 250 MG 1,100 0 1100
92 ETANOL 70 % 61 0 61
70 FLUKONAZOL 150 MG TABLET - 100 100
72 GARAM ORALIT - 0 0
78 GLIBENKLAMID TABLET 5 MG 1,075 500 1575
80 GLUKOSA LARUTAN INFUS 5% STERIL 20 0 20
92 KALIUM DIKLOFENAK 50 mg Tablet 0 0
93 KALSIUM LAKTAT ( Kalk ) Tablet 500 mg 3,970 10,000 13970
97 KLINDAMISIN 300MG 1,020 500 1520
LEVOFLOKSASIN - 0 0
130 NATRIUM DIKLOFENAK TABLET 50MG 6,329 5600 11929
139 OBAT ANTITUBERKULOSIS SISIPAN ( INH ) - 1000 1000
144 OMEPRAZOLE TABLET 20MG 480 2400 2880
148 PARASETAMOL TABLET 500 MG. 8,900 16,800 25700
150 PIRANTEL SYR - 100 100
159 PREDNISON TABLET 5 MG. - 4000 4000
171 RINGER LAKTAT LARUTAN INFUS STERIL - 340 340
173 SALBUTAMOL TABLET 4 MG. - 400 400
177 SEFIKSIM 100MG TAB /KAPSUL - 0 0
195 VIT. B KOMPLEK TABLET 1,600 10,000 11600
196 ZINC TABLET 20MG - 2000 2000
197 ZINC SYRUP 355 0 355
-
- 0
- 0
5 ALAT SUNTIK 3 ML 2,700 0 2700
6 ALKOHOL SWAB - 2400 2400
7 BISTURI 90 0 90
11 SUGICAL TAPE 1 INC ROLL12 - 24 24
25 MASKER DISPOSIBLE 400 1000 1400
32 POT SPUTUM - 600 600
36 SARUNG TANGAN NON STERIL - 2000 2000
37 SARUNG TANGAN STERIL - 20 20
40 URINE BAG 9 0 9
43 -
3. OBAT GIGI -
5 ETCHING - 0 0
7 EUGENOL CAIRAN - 0 0
11 KACA MULUT - 0 0
25 - 0
26 - 0
4. REAGEN -
3 ANISOL - 0 0
12 EDTA 10% 100 ML 5 0 5
13 EOSIN 2% - 0 0
18 HAYEM - 0 0
19 HBSAB STRIP 50 0 50
20 HBSAG STRIP - 0 0
21 HCG TEST KEHAMILAN - 100 100
22 IMERSION OIL - 0 0
29 POCH D - 0 0
30 POCH L - 0 0
31 CELL CLEAN - 0 0
32 8-CHECK - 0 0
34 REES ECKER - 0 0
37 STICK CHOLESTEROL - 0 0
45 TURK 1 0 1
48 WIDAL (5) 0 -5
49 XYLOL - 0 0
51 YELLOW TIP - 0 0
52 - 0 0
1 BURNAZINE CREAM 10MG (6) 0 -6
2 RAPID TEST HIV 1/2 SD TEST 100 (100) 0 -100
3 RAPID TEST HIV KE-2 FOKUS TEST 25 0 25
4 RAPID TEST HIV 1/2 BIOMERIC-/VIA TEST 25 0 25
5 RAPID TEST SYPHILIS TEST - 0 0
6 BASIC DRESSING SET PACK 4 0 4

7 OBJECK GLASS BOX (3) 0 -3
8 GLIMEPIRIDE 1MG 700 0 700
10 DUBESONIDE CAIRAN INH 0,5MG/2ML CAN 5 200 0 200
11 BETAHISTINE MESILATE 6 MG 1,000 0 1000
CETRIZINE SYR 192 0 192
PB DEWASA BLISTER '6 (2) 0 -2
SURGICAL TAPE ROLL 1/2 inchi pcs'24 (12) 0 -12
- 0 0
CATGUT CHROMIC 2/0 SACCHET - 0 0
UMUM
TIDAK ASKES JUMLAH
BAYAR
0 1064 1212 2276

NIP.19700525 200003 2 004 NIP.19780918 200902 2 001
KETERANGAN :
AIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO ) FORM : LPLPO
PUSKESMAS

DINKES KAB/KOTA
: MEI 2019 GFK KAB/KOTA
: PUSKESMAS
PEMAKAI STOK PERMINTAA PEM BER IAN

STOK AKHIR
AN OPTIMAL N PKD/DPP ASKES APBD I APBD II PROGRAM LAIN-LAIN
7 8 9 10 11 12 13 14 15 16
4010 2170 440 -1730

508 1022 1540 518
0 600 4400 3800
0 0 440 440
0 0 0 0
0 0 440 440
0 200 110 -90
1008 3346 4400 1054
810 1900 6600 4700
451 9679 1100 -8579
2639 11731 7700 -4031
198 99 440 341
0 0 0 0
0 0 0 0
0 0 0 0
2260 8972 5940 -3032
0 0 6600 6600
0 0 0 0
2890 4810 7700 2890

173 220 330 110
64 150 132 -18
4 160 44 -116
44 59 110 51
0 600 880 280
0 90 11 -79
1360 5640 6600 960
0 0 0 0
1334 3330 5500 2170
1880 4950 5500 550
0 0 330 330
416 2514 1100 -1414
86 1204 880 -324
0 0 0 0
41 106 110 4
0 15 11 -4
80 4840 2200 -2640
90 5790 2200 -3590
0 0 1100 1100
0 60 110 50
1370 2004 3300 1296
727 1436 2200 764
400 0 0 0
3632 6368 8800 2432
0 0 110 110
0 0 2200 2200
0 0 0 0
0 214 22 -192
0 4 0 -4
3 2 8.8 6.8
0 20 11 -9
0 520 88 -432
0 525 220 -305
491 2389 2200 -189
17 306 110 -196
0 0 0 0
0 0 0 0
0 20 0 -20
20 1080 0 -1080
0 0 0 0
0 0 0 0
0 33 11 -22
0 0 0 0
23 38 11 -27
0 520 22 -498
0 0 0 0
0 0 0 0
0 0 0 0
12 119 11 -108
100 0 44 44
48 2552 660 -1892
0 100 66 -34
38 913 220 -693
0 0 1100 1100
0 3 0 -3
0 0 0 0
0 0 0 0
0 0 66 66
0 0 22 22
180 1395 2200 805
0 0 5500 5500
15 5 88 83
14 223 220 -3
0 0 0 0
45 268 66 -202
20 1937 110 -1827
150 1200 1100 -100
1154 4797 4400 -397
14 197 44 -153
0 0 22 22
0 0 0 0
0 630 440 -190
0 0 1100 1100
0 0 5500 5500
2595 11375 8800 -2575
19 670 2200 1530
24 178 110 -68
0 0 0 0
460 1060 1100 40
0 0 1100 1100
93 154 110 -44
98 0 66 66
0 0 66 66
0 0 44 44
3875 9730 6600 -3130
0 0 0 0
0 0 44 44
180 100 1100 1000
0 0 0 0
0 748 0 -748
0 0 0 0
0 100 0 -100
0 270 110 -160
2 9 15.4 6.4
0 0 440 440
0 0 0 0
0 0 0 0
6 6 4.4 -1.6
6 6 4.4 -1.6
0 0 0 0
0 0 0 0
1820 6145 6600 455
0 900 440 -460
0 100 22 -78
0 0 0 0
0 0 0 0
125 1702 330 -1372
120 3599 440 -3159
0 0 0 0
0 0 0 0
0 0 4400 4400
1929 10000 5500 -4500
20 100 0 -100
0 0 1100 1100
0 0 220 220
0 343 110 -233
1 18 17.6 -0.4
7 97 44 -53
1 17 11 -6
0 0 0 0
0 1000 0 -1000
0 0 0 0
0 0 0 0
0 0 0 0
0 200 44 -156
861 2019 2200 181
33 216 154 -62
0 0 0 0
182 1081 660 -421
8946 16754 15400 -1354
0 0 0 0
0 100 0 -100
0 0 0 0
2169 8404 1540 -6864
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 55 44 -11
0 0 0 0
775 3225 2200 -1025
0 0 0 0
0 0 0 0
0 0 0 0
0 40 11 -29
1682 8110 5500 -2610
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
180 160 330 170
130 282 440 158
215 185 330 145
0 0 0 0
96 0 22 22
54 154 154 0
0 0 1100 1100
5 3 44 41
0 40 0 -40
0 0 0 0
1 1 0 -1
2 0 0 0
9 84 0 -84
1374 1982 3300 1318
0 0 0 0
17910 272880 11000 -261880
0 0 0 0
0 0 0 0
0 0 660 660
0 0 0 0
725 5390 6600 1210
0 0 0 0
0 0 0 0
0 0 0 0
5360 6240 7700 1460
40 1960 2200 240
51 304 330 26
0
0
0
0
150 150 440 290
0 0 3300 3300
104 720 550 -170
20 74 110 36
2700 0 -2700
2400 3300 900
90 22 -68
0 22 22
36 22 -14
11 4.4 -6.6
24 55 31
350 44 -306
400 220 -180
120 220 100
0 22 22
0 0 0
27 6.6 -20.4
58 110 52
105 143 38
55 132 77
50 11 -39
0 11 11
0 44 44
30 22 -8
1400 1320 -80
0 0 0
0 11 11
0 0 0
0 0 0
0 0 0
0 22 22
600 660 60
0 660 660
150 15.4 -134.6
10 13.2 3.2
2000 13.2 -1986.8
20 11 -9
36 0 -36
50 44 -6
9 0 -9
38 6.6 -31.4
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 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 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
0 0 0
0 0 0
0 0 0
0 0 0
12 11 -1
0 0 0
0 0 0
5 4.4 -0.6
0 2.2 2.2
1 0 -1
0 2.2 2.2
0 660 660
2 8.8 6.8
0 0 0
50 0 -50
0 176 176
100 110 10
0 0
0 0 0
0 0 0
1 0 -1
1 0 -1
1 0 -1
1 0 -1
0 33 33
0 2.2 2.2
0 2.2 2.2
0 0 0
0 0 0
0 2.2 2.2
23 22 -1
0 44 44
0 0 0
25 22 -3
2 0 -2
0 0 0
0 4.4 4.4
0 0 0
0 0 0
1 2.2 1.2
0 0 0
0 660 660
-5 4.4 9.4
0 2.2 2.2
0 0 0
0 440 440
0 0 0
-6 11 17
-100 440 540
25 0 -25
25 66 41
0 0 0
4 0 -4
-3 0 3
700 0 -700
0 0 0
200 0 -200
1000 0 -1000
0 0 0
64 22 -42
29 0 -29
0 6.6 6.6
192 220 28
-2 4.4 6.4
-12 55 67
10 110 100
0 8.8 8.8
20300 4400 -15900
5 15.4 10.4
10 8.8 -1.2
0 22 22

NIP. 19730201 199903 1 005 NIP.19740426 200604 2 008
FORM : LPLPO
TANGGAL SO : STOK OPTIMUM

SK : STOK KERJA ( ADA HITUNGAN STOK PER BULAN DAN STOK PER HAR
JUMLAH
17 SK SK
SO SWK SWT
440 200 8 0 0
1540 700 28
4400 2000 80
440 200 8
0 0
440 200 8
110 50 2
4400 2000 80
6600 3000 120
1100 500 20
7700 3500 140
440 200 8
0 0
0 0
0 0
5940 2700 108
6600 3000 120
0 0
7700 3500 140

330 150 6
132 60 2.4
44 20 0.8
110 50 2
880 400 16
11 5 0.2
6600 3000 120
0 0
5500 2500 100
5500 2500 100
330 150 6
1100 500 20
880 400 16
0 0
110 50 2
11 5 0.2
2200 1000 40
2200 1000 40
1100 500 20
110 50 2
3300 1500 60
2200 1000 40
0 0
8800 4000 160
110 50 2
2200 1000 40
0 0
22 10 0.4
0 0
8.8 4 0.16
11 5 0.2
88 40 1.6
220 100 4
2200 1000 40
110 50 2
0 0
0 0
0 0
0 0
0 0
0 0
11 5 0.2
0 0
11 5 0.2
22 10 0.4
0 0
0 0
0 0
11 5 0.2
44 20 0.8
660 300 12
66 30 1.2
220 100 4
1100 500 20
0 0
0 0
0 0
66 30 1.2
22 10 0.4
2200 1000 40
5500 2500 100
88 40 1.6
220 100 4
0 0
66 30 1.2
110 50 2
1100 500 20
4400 2000 80
44 20 0.8
22 10 0.4
0 0
440 200 8
1100 500 20
5500 2500 100
8800 4000 160
2200 1000 40
110 50 2
0 0
1100 500 20
1100 500 20
110 50 2
66 30 1.2
66 30 1.2
44 20 0.8
6600 3000 120
0 0
44 20 0.8
1100 500 20
0 0
0 0
0 0
0 0
110 50 2
15.4 7 0.28
440 200 8
0 0
0 0
4.4 2 0.08
4.4 2 0.08
0 0
0 0
6600 3000 120
440 200 8
22 10 0.4
0 0
0 0
330 150 6
440 200 8
0 0
0 0
4400 2000 80
5500 2500 100
0 0
1100 500 20
220 100 4
110 50 2
17.6 8 0.32
44 20 0.8
11 5 0.2
0 0
0 0
0 0
0 0
0 0
44 20 0.8
2200 1000 40
154 70 2.8
0 0
660 300 12
15400 7000 280
0 0
0 0
0 0
1540 700 28
0 0
0 0
0 0
0 0
44 20 0.8
0 0
2200 1000 40
0 0
0 0
0 0
11 5 0.2
5500 2500 100
0 0
0 0 0
0 0 0
0 0
0 0
0 0
330 150 6
440 200 8
330 150 6
0 0
22 10 0.4
154 70 2.8
1100 500 20
44 20 0.8
0 0
0 0
0 0
0 0
0 0
3300 1500 60
0 0
11000 5000 200
0 0
0 0
660 300 12
0 0
6600 3000 120
0 0
0 0
0 0
7700 3500 140
2200 1000 40
330 150 6
0 0
0 0
0 0
0 0
440 200 8
3300 1500 60
550 250 10
110 50 2
0 0
3300 1500 60
22 10 0.4
22 10 0.4
22 10 0.4
4.4 2 0.08
55 25 1
44 20 0.8
220 100 4
220 100 4
22 10 0.4
0 0
6.6 3 0.12
110 50 2
143 65 2.6
132 60 2.4
11 5 0.2
11 5 0.2
44 20 0.8
22 10 0.4
1320 600 24
0 0
11 5 0.2
0 0
0 0
0 0
22 10 0.4
660 300 12
660 300 12
15.4 7 0.28
13.2 6 0.24
13.2 6 0.24
11 5 0.2
0 0
44 20 0.8
0 0
6.6 3 0.12
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
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
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
11 5 0.2
0 0
0 0
4.4 2 0.08
2.2 1 0.04
0 0
2.2 1 0.04
660 300 12
8.8 4 0.16
0 0
0 0
176 80 3.2
110 50 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
33 15 0.6
2.2 1 0.04
2.2 1 0.04
0 0
0 0
2.2 1 0.04
22 10 0.4
44 20 0.8
0 0
22 10 0.4
0 0
0 0
4.4 2 0.08
0 0
0 0
2.2 1 0.04
0 0
660 300 12
4.4 2 0.08
2.2 1 0.04
0 0
440 200 8
0 0
0 0
11 5 0.2
440 200 8
0 0
66 30 1.2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
22 10 0.4
0 0
6.6 3 0.12
220 100 4
4.4 2 0.08
55 25 1
110 50 2
8.8 4 0.16
4400 2000 80
15.4 7 0.28
8.8 4 0.16
22 10 0.4
* catatan :
- kolom SK (per bulan ) untuk bln pertama kali (november) diisi manual dulu, untuk bln selanju
- kolom yg berwarna merah bisa dipakai di bulan LPLPO bln berikutnya (tinggal copy paste aj
- supaya tdk terjadi over stock atau kosong stok OBAT, pengisian harus benar dan pengambil
ULAN DAN STOK PER HARI )
SP
20
70
200
20
0
20
5
200
300
50
350
20
0
0
0
270
300
0
350
15
6
2
5
40
0.5
300
0
250
250
15
50
40
0
5
0.5
100
100
50
5
150
100
0
400
5
100
0
1
0
0.4
0.5
4
10
100
5
0
0
0
0
0
0
0.5
0
0.5
1
0
0
0
0.5
2
30
3
10
50
0
0
0
3
1
100
250
4
10
0
3
5
50
200
2
1
0
20
50
250
400
100
5
0
50
50
5
3
3
2
300
0
2
50
0
0
0
0
5
0.7
20
0
0
0.2
0.2
0
0
300
20
1
0
0
15
20
0
0
200
250
0
50
10
5
0.8
2
0.5
0
0
0
0
0
2
100
7
0
30
700
0
0
0
70
0
0
0
0
2
0
100
0
0
0
0.5
250
0
0
0
0
0
0
15
20
15
0
1
7
50
2
0
0
0
0
0
150
0
500
0
0
30
0
300
0
0
0
350
100
15
0
0
0
0
20
150
25
5
0
150
1
1
1
0.2
2.5
2
10
10
1
0
0.3
5
6.5
6
0.5
0.5
2
1
60
0
0.5
0
0
0
1
30
30
0.7
0.6
0.6
0.5
0
2
0
0.3
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
0
0
0
0
0
0
0
0
0.5
0
0
0.2
0.1
0
0.1
30
0.4
0
0
8
5
0
0
0
0
0
0
0
1.5
0.1
0.1
0
0
0.1
1
2
0
1
0
0
0.2
0
0
0.1
0
30
0.2
0.1
0
20
0
0
0.5
20
0
3
0
0
0
0
0
0
0
0
1
0
0.3
10
0.2
2.5
5
0.4
200
0.7
0.4
1
anual dulu, untuk bln selanjutnya disamakan tdk perlu diisi lg (copy paste)
utnya (tinggal copy paste aja)
harus benar dan pengambilan obat hrs disiplin TEPAT WAKTU

Surat Permohonan Permintaan Obat

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PUSKESMAS : MEKARMUKTI DOKUMEN NOMOR

PENERIMAA PEMAKAI STOK STOK PERMINT PE MB E R IAN

0 1477 1359 2836

SO = SK + SWK + SWT +SP

TANGGAL SO : STOK OPTIMUM

7700 3500 140 350

Sanih Susilawati, AM.Keb

6 BASIC DRESSING SET PACK - 10 10

0 1787 1326 3113

Kepala Dinas Kesehatan Kab. Bekasi Kepala GFK

dr.Hj.Sri Enny Mainiarti, SKM Eva Yanti Hermansyah, S.Farm.Apt

DOKUMEN NOMOR TANGGAL

PEMAKAI STOK STOK PERMINT PEM BER IAN

0 6180 440 -5740

6763 1687 7700 6013

H.Firman, SKM Sanih Susilawati, AM.Keb

7700 3500 140

enar dan pengambilan obat hrs disiplin TEPAT WAKTU

6 BASIC DRESSING SET PACK 7 0 7

0 1064 1212 2276

Kepala Dinas Kesehatan Kab. Bekasi Kepala GFK

dr.Hj.Sri Enny Mainiarti, SKM Eva Yanti Hermansyah, S.Farm.Apt

DOKUMEN NOMOR TANGGAL

PEMAKAI STOK STOK PERMINT PEM BER IAN

0 6180 440 -5740

1687 0 7700 7700

H.Firman, SKM Sanih Susilawati, AM.Keb

7700 3500 140

enar dan pengambilan obat hrs disiplin TEPAT WAKTU

6 BASIC DRESSING SET PACK 4 0 4

0 1064 1212 2276

Kepala Dinas Kesehatan Kab. Bekasi Kepala GFK

dr.Hj.Sri Enny Mainiarti, SKM Eva Yanti Hermansyah, S.Farm.Apt

DOKUMEN NOMOR TANGGAL

PEMAKAI STOK PERMINTAA PEM BER IAN

4010 2170 440 -1730

2890 4810 7700 2890

H.Firman, SKM Sanih Susilawati, AM.Keb

SO = SK + SWK + SWT +SP

TANGGAL SO : STOK OPTIMUM

7700 3500 140

harus benar dan pengambilan obat hrs disiplin TEPAT WAKTU

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