BERITA ACARA

STOK OPNAME OBAT DAN ALKES DI UPTD PUSKESMAS JATIBARANG

PER. 30 September 2014
NOMOR : 442 / 003 / Puskesmas

Pada hari ini …………. tanggal ………….. bulan …………….. Tahun Dua ribu empat belas ( ……………………. 2014 ), yang bertanda tangan dibawah ini :

1 dr. Uding Pramudya : Kepala UPTD Puskesmas Jatibarang

: NIP 19760722 200902 1 001
2 Idris : Petugas Pengelola Obat
: NIP 19600518 198503 1 007
3 Cucu sartiasih, AMG. : Petugas Pengelola Program Gizi
: NIP 19691021 198903 2 006
4 Tosin, S.Kep.Ns : Petugas Obat Program TB
: NIP 19791207 200801 1 004
5 Taudin : Petugas Obat Program Diare
: NIP 19770824 200701 1 007
6 Gosikin, Amd.Kep : Petugas Obat program Kusta
: NIP 19650421 198903 1 008
Telah melaksanakan Stok Opname terhadap Obat-obatan dan Alat Kesehatan pada UPTD Puskesmas Jatibarang Dinas Kesehatan Kab. Indramayu Triwulan …
sebesar Rp. ……..…………... dengan perincian sebagai berikut :
STOK AWAL 2014 PENERIMAAN
NO NAMA OBAT SATUAN
VOL JUMLAH VOL
1 Air Raksa Dental use botol - - -
2 Alat suntik sekali pakai 1 ml set - - -
3 Alat suntik sekali pakai 2,5 ml set - - 1,500
4 Alat suntik sekali pakai 5 ml set 400 415,200.00 200
5 Albendazol tablet 400 mg tablet 210 85,398.60 -
6 Allopurinol tablet 100 mg tablet 1,400 147,000.00 -
7 Aminofilin tablet 200 mg tablet 1,200 104,580.00 1,000
8 Aminofilin injeksi 24 mg/ml ampul - - -
9 Amitripilin tablet salut 25 mg (HCL) tablet 1,000 102,000.00 -
10 Amoksisillin kapsul 250 mg kapsul - - -
11 Amoksisillin kapsul 500 mg kapsul - - 10,500
12 Amoksisillin sirup kering 125 mg/ 5 mg botol 250 575,000.00 400
13 Ampisillin kapsul 500 mg kapsul - - -
14 Ampisillin sirup kering 125 mg/5 ml botol - - -
15 Antalgin tablet 500 mg tablet 23,200 2,881,904.00 -
16 Antalgin injeksi 250 mg/ml ampul - - -
Antasida DOEN I tablet kunyah, kombinasi :Aluminium 311,760.00
17 tablet 4,000 15,000
Hidroksida 200 mg + Magnesium Hidroksida 200 mg
 Antibakteri DOEN salep kombinasi : Basitrasin 500 IU/g + -
18 tube -
polimiksin 10.000 IU/g
Antihemoroid DOEN kombinasi : Bismut Subgalat 150 mg + 4,000.00
19 supp 20 -
Heksaklorofen 250 mg
20 Antifungi DOEN Kombinasi : Asam Benzoat 6% + Asam Salisilat pot 120 228,528.00 -
21 Antimigren : Ergotamin tartrat 1 mg + Kofein 50 mg tablet - - -
Antiparkinson DOEN tablet kombinasi : Karbidopa 25 mg + -
22 tablet - -
Levodopa 250 mg
23 Aqua Pro Injeksi Steril, bebas pirogen vial 60 300,000.00 -
24 Aquadest steril - 500 ml botol - - -
25 Asam Askorbat tablet 50 mg tablet 3,000 96,000.00 -
26 Asam Askorbat tablet 250 mg tablet - - -
27 Asam Klorida 0.1 N - 100 ml botol - - -
28 Asam Sulfosalisilat 20 % - 100 ml botol - - -
29 Asetosal tablet 100 mg tablet - - -
30 Asetosal tablet 500 mg tablet - - -
31 Atropin Sulfat tablet 0,5 mg tablet - - -
32 Atropin tetes mata 0,5% botol - - -
33 Atropin sulfat injeksi l.m/lv/s.k. 0,25 mg/mL - 1 mL ampul - - -
34 Benzatin Benzil Pen inj 1,2 jt IU/vial ampul - - -
35 Benzatin Benzil Pen inj 2,4 jt IU/vial ampul - - -
36 Besi sirup botol - - -
37 Betametason krim 0,1 % tube 25 38,000.00 100
38 Catgut / Benang Bedah No. 2/0 - 3/0 kotak - - 3
39 Dapson tablet 100 mg tablet - - -
40 Deksametason Injeksi I.v. 5 mg/ml ampul 200 280,000.00 -
41 Deksametason tablet 0,5 mg tablet 14,500 762,410.00 -
42 Dekstran 70-larutan infus 6% steril botol - - -
43 Dekstrometorfan sirup 10 mg/5 ml (HBr) botol 325 448,126.25 -
44 Dekstrometorfan tablet 15 mg (HBr) tablet - - -
45 Devitalisai Pasta (Non Arsen) botol - - -
46 Diazepam Injeksi 5mg/ml ampul - - -
47 Diazepam tablet 2 mg tablet - - -
48 Diazepam tablet 5 mg tablet - - -
49 Dietilkarbamazin Sitrat tablet 100 mg tablet - - -
50 Difenhidramin injeksi I.M. 10 mg/ml (HCL) ampul 30 28,800.00 -
51 Digoksin tablet 0,25 mg tablet 100 9,100.00 2,000
52 Efedrin tablet 25 mg (HCL) tablet - - -
53 Ekstrak Belladona tablet 10 mg tablet - - -
54 Epinefrin (Adrenalin) injeksi 0,1% (sebagai HCL) ampul 250 375,000.00 -
55 Etakridin larutan 0,1% botol 3 6,636.48 -
56 Etambutol HCl tablet 250 mg tablet - - -
57 Etanol 70% botol 12 179,506.80 -
58 Eter Anestetik botol - - -
59 Etil Klorida botol - - 25
60 Eugenol cairan botol - - 5
61 Fenitoin Natrium Injeksi 50 mg/ml ampul - - -
62 Fenitoin Natrium kapsul 100 mg kapsul - - -
63 Fenitoin Natrium Injeksi 30 mg ampul - - -
64 Fenobarbital injeksi I.m/I.v 50 mg/ml ampul - - -
65 Fenobarbital tablet 100 mg tablet - - -
66 Fenobarbital tablet 30 mg tablet - - -
67 Fenoksimetil Pen tablet 250 mg tablet - - -
68 Fenoksimetil Pen tablet 500 mg tablet - - -
69 Fenol Gliserol tetes telinga 10% botol - - -
70 Fitomenadion injeksi 10 mg/ml ampul 120 187,920.00 600
71 Fitomenadion tablet salut 10 mg tablet 1,000 579,000.00 -
72 Fluor tablet 0,5 mg tablet - - -
73 Furosemid tablet 40 mg tablet - - -
74 Ferinokresol botol - - -
75 Gameksan lotion 1 % botol - - -
76 Garam Oralit 200 ml air kantong 11,500 3,358,000.00 -
77 Garam Oralit 1000 ml air kantong - - -
78 Gentian Violet Larutan 1 % botol 72 64,440.00 -
79 Glass Ionomer Cement (GC IX) set - - 12
80 Glibenklamida tablet 5 mg tablet 1,300 70,200.00 -
81 Gliseril Guayakolat tablet 100 mg tablet - - -
82 Gliserin botol - - -
83 Glukosa larutan infus 5% botol 40 212,520.00 -
84 Glukosa larutan infus 10% botol - - -
85 Glukosa larutan infus 40% steril botol - - -
86 Griseofulvin tablet 125 mg tablet 1,600 364,800.00 -
87 Gutta Percha Points stik - - -
88 Haloperidol tablet 0,5 mg tablet - - -
89 Haloperidol tablet 1,5 mg tablet 1,000 60,470.00 -
90 Hidroklortiazida tablet 25 mg tablet - - 8,000
91 Hidrokortison krim 2,5% tube - - 120
92 Ibuprofen tablet 200 mg tablet 1,300 120,341.00 -
93 Ibuprofen tablet 400 mg tablet - - -
94 Infusion set anak set 15 60,000.00 -
95 Infusion set dewasa set - - 130
96 Insulin Reguler injeksi 40 IU/ml vial - - -
97 Idiol Kapsul Lunak kapsul - - -
98 Ipeka 0,14 % syr botol - - -
99 Isoniazid tablet 300 mg tablet - - -
100 Isosorbid Dinitrat tab subl 5 mg tablet - - -
101 Jarum jahit (Bedah No. 9 s/d 14) biji - - 10
102 Kalium Permanganat serbuk - 5 mg set - - -
103 Kalsium Hidroksida Pasta kotak - - 8
104 Kalsium Laktat tablet 500 mg tablet - - 31,000
105 Kapas Berlemak 500 gram roll - - 8
106 Kapas Pembalut/Absorben 250 g roll - - 22
107 Karbamazepin tablet 200 mg tablet - - -
108 Kasa Kompres 40/40 steril roll - - -
109 Kasa Pembalut 2 m x 80 cm roll - - -
110 Kasa Pemb Hidrofil 4 m x 5 cm elastic roll 50 27,500.00 150
111 Kasa Pemb Hidrofil 4 m x 15 cm elastic roll - - -
112 Ketamin Injeksi 10 mg/ml vial - - -
113 Klofazimin kapsul 100 mg microzine kapsul - - -
114 Kloramfenikol kapsul 250 mg kapsul 6,500 1,560,000.00 -
115 Kloramfenikol salep mata 1% tube 96 149,952.00 240
116 Kloramfenikol tetes telinga 3 % botol 24 38,376.00 -
117 Klorfeniramin maleat (CTM) tab 4 mg tablet 19,500 507,000.00 10,000
118 Kloroquin Fosfat tablet 250 mg tablet - - -
119 Klorpromazin injeksi i.m 25 mg/ml-2ml (HCL) ampul - - -
120 Klorpromazin injeksi i.m 5 mg/ml (HCL) ampul - - -
121 Klorpromazin tablet salut 25 mg (HCL) tablet 4,000 180,000.00 -
122 Klorpromazin tablet salut 100 mg (HCl) tablet - - -
123 Klorpropamid tablet 100 mg tablet - - -
124 Kodein HCl tablet 10 mg tablet - - -
125 Kombinasi Pirimetamin 25 mg + Sulfadoksin 500 mg tablet - - -
126 Kotrimoksazol pedia tablet 120 mg tablet 1,000 76,000.00 -
127 Kotrimoksazol suspensi 240 mg botol 375 965,250.00 -
128 Kotrimoksazol tablet 480 mg tablet 6,000 888,000.00 -
129 Kuinin Di HCl injeksi 25%-2 ml ampul - - -
130 Kuinin (kina) tablet 200 mg tablet - - -
131 Larutan Benedict botol - - -
132 Larutan Eosin 2% botol - - -
133 Larutan Etanol Asam botol - - -
134 Larutan Gabbet botol - - -
135 Larutan Giemsa Stain botol - - -
136 Larutan Karbol Fuksin botol - - -
137 Larutan Kinyoun botol - - -
138 Larutan Metilen Biru botol - - -
139 Larutan Turk botol - - -
140 Lidokain comp injeksi 2% (HCL) + Epinefrin 1 : 80.000-2 ml ampul 150 194,250.00 120
141 Lisol botol 2 82,770.60 -
142 Magnesium Sulfat inj (IV) 20%-25 ml vial - - 350
143 Magnesium Sulfat inj (IV) 40%-25 ml vial 140 368,060.00 350
144 Magnesium Sulfat serbuk 30 gram kotak - - -
145 Mebendazol sirup 100 mg / 5 ml botol - - -
146 Mebendazol tablet 100 mg tablet - - -
147 Metanol botol - - -
148 Metilergometrin Maleat tablet salut 0,125 mg tablet 1,200 168,000.00 -
149 Metilergometrin Maleat injeksi 0,200 mg -1 ml ampul 180 268,200.00 -
150 Metronidazol tablet 250 mg tablet 3,000 368,400.00 -
151 Monoklor Kamfer Menthol ( CHKM ) botol - - 5
152 Mummifying Pasta kotak - - 5
153 Natrium Bikarbonat tablet 500 mg tablet - - -
154 Natrium Fluoresein tetes mata 2 % botol - - -
155 Natrium Klorida larutan infus 0,9 % botol - - -
156 Natrium Thiosulfat injeksi I.v. 25 % ampul - - -
157 Nistatin tablet salut 500.000 IU/g tablet - - -
158 Nistatin Vaginal tablet salut 100.000 IU/g tablet 100 40,700.00 -
159 OAT Katagori 1 dewasa paket - - 7
160 OAT Katagori 2 dewasa paket - - -
161 OAT Katagori 3 dewasa paket - - -
162 OAT Sisipan dewasa paket - - -
163 OAT Katagori anak paket - - 2
164 Obat Batuk Hitam ( O.B.H.) botol - - -
165 Oksigen Gas dalam tabung tabung - - -
166 Oksitetrasiklin injeksi I.m. 50 mg/ml-10 ml vial - - -
167 Oksitetrasiklin HCL salep mata 1 % tube - - -
168 Oksitetrasiklin HCL salep kulit 3 % tube 250 382,250.00 100
169 Oksitosin injeksi 10 UI/ml-1 ml ampul - - 120
170 Paraformaldehid tablet 1 g tablet - - -
171 Parasetamol sirup 120 mg / 5 ml botol - - -
172 Parasetamol tablet 100 mg tablet - -
173 Parasetamol tablet 500 mg tablet 44,000 3,692,920.00 -
174 Pembalut Gips roll - - -
175 Perfenazin tablet 4 mg tablet - - -
176 Perfenazin tablet 16 mg tablet - - -
177 Petidin HCl injeksi 50 mgml - 2 ml ampul - - -
178 Pilokarpin tetes mata 2 % (HCL/Nitrat) botol - - -
179 Piperazin sirup 20 % botol - - -
180 Piperazin tablet 500 mg tablet - - -
181 Pirantel tab score (base) 125 mg tablet - - -
182 Piridoksin tablet 10 mg (HCl) tablet 6,000 104,400.00 -
183 Plester 5 yards x 2 inch roll - - 30
184 Polikresulen botol - - -
185 Polipeptida kombinasi DOEN Lar infus botol - - -
186 Povidon Iodida lar 10 % - 10 ml botol - - -
187 Povidon Iodida lar 10 % - 30 ml botol 5 10,000.00 -
188 Povidon Iodida lar 10 % - 300 ml botol 4 56,000.00 -
189 Povidon Iodida lar 10 % - 1000 ml botol - - -
190 Prazikuantel tablet 600 mg tablet - - -
191 Prednison tablet 5 mg tablet 6,000 312,000.00 -
192 Primakuin tablet 15 mg tablet - - -
193 Prokain Benzil Pen 3 jt IU / vial inj vial - - -
194 Propanolol tablet 40 mg (HCL) tablet - - -
195 Propiltiourasil tablet 100 mg tablet - - -
196 Rabies Immune Globulin (Human) 150 IU/ml vial - - -
197 Reserpin tablet 0,10 mg tablet - - -
198 Reserpin tablet 0,25 mg tablet - - -
199 Retinol (Vit. A) 100.000 IU kapsul kapsul - - -
200 Retinol (Vit. A) 200.000 IU kapsul kapsul - - 2,750
201 Rifampisin kapsul 300 mg tablet - - -
202 Rifampisin kapsul 450 mg tablet - - -
203 Rifampisin kapsul 600 mg tablet - - -
204 Ringer Laktat larutan infus botol 40 208,000.00 40
205 Salbutamol tab 2 mg tablet 1,500 89,730.00 -
206 Salep 2-4, kombinasi: Asam Salisilat 2% + Belerang endap 4% pot 72 59,394.24 -
207 Salisil bedak 2% kotak 150 168,000.00 -
208 Salisil Spritus 10% botol - - -
209 Semen Seng Fosfat serbuk dan cairan kotak - - 6
210 Serum ABU I polivalen inj 5 ml vial - -
211 Serum ABU II Polivalen inj 50 ml vial - -
212 Serum Anti Rabies Injeksi vial - -
213 Serum Anti Tetanus Inj 1.500 IU/ampul (A.T.S.) ampul - - 20
214 Serum Anti Tetanus Inj 20.000 IU/vial vial - - 12
215 Sianokobalamin injeksi 500 mcg ampul 100 91,600.00
216 Silk (Benang Bedah Sutera) No. 3/0 dengan jarum bedah kotak - - 5
217 Silver Amalgam serbuk set - -
218 Spons Gelatin cubicles set - -
219 Streptomisin Sulfat serbuk injeksi 1000 mg vial - -
220 Streptomisin Sulfat serbuk injeksi 1500 mg vial - -
221 Sulfa Conus Kerucut (preparat) set - -
222 Sulfadimidin tablet 500 mg tablet - -
223 Sulfasetamida Natrium tetes mata 15 % botol - - 227
224 Suspensi Seng Insulin injeksi 40 IU/ml vial - -
225 Syntetic Filling Material set - -
226 Tablet Tambah Darah tablet - - 9,240
227 Temporary Stopping Fletcher serbuk dan cairan set - - 4
228 Tetrakain HCl tetes mata 0,5% botol - -
229 Tetrasiklin kapsul 250 mg kapsul - -
230 Tetrasiklin kapsul 500 mg kapsul - - 5,000
231 Tiamin injeksi 100 mg/ml ampul - -
232 Tiamin tablet 50 mg (HCL/Nitrat) tablet - - 35,000
233 Tiopental Natrium serbuk injeksi 1000 mg/amp ampul - -
234 Triheksifenidil tablet 2 mg tablet - -
235 Trikresol Formalin (TKF) cairan set - -
236 Vaksin Rabies kering untuk manusia ampul - -
237 Vaksin Rabies Vero set - -
238 Vitamin B Kompleks tablet tablet - - 35,000
239 Alat Suntik 0,05 ml set - -
240 Asam Mefenamat 500 mg tablet - -
241 Asiclovir cream tube 275 591,800.00
242 Asiclovir tablet 200 mg tablet -
243 Captopril tablet 12.5 mg tablet 3,600 259,200.00
244 Captopril tablet 25 mg tablet 3,000 264,000.00
245 Cefadroxyl tablet 500 mg tablet - -
246 Cefixime 400 mg + Azithromicin 1000 mg paket - -
247 Ciprofloksasin tablet 500 mg tablet - -
248 Dimehydrinate 50 mg tablet tablet 500 47,500.00
249 Gentamicin Sulfat TM botol - -
250 H2O2 Larutan botol - -
251 IV Catheter No 20 G set 18 95,040.00 47
252 IV Catheter No 22 G set - -
253 IV Catheter No 24 G set - -
254 Kasa Hidrofil 36 m x 80 cm roll 6 331,200.00 5
255 Kasa Hidrofil Steril 18 cm x 22 cm roll 200 79,166.00
256 Kasa Pembalut Hidrofil 4 m x 10 cm roll - - 110
257 Kasa Pembalut Hidrofil 4 m x 5 cm roll - -
258 Klindamycin 150 mg tablet - -
259 Kloramfenicol susp 125 mg/5ml botol - -
260 Kloramfenicol TM botol - - 240
261 Kontrasepsi Implan KB II set - -
262 Larvasida galon - -
263 Multivit Anak Kurang Gizi botol - -
264 Multivit Gizi Buruk botol - -
265 Multivit Ibu Hamil kapsul - -
266 Ranitidin inj 25 mg/2ml ampul - -
267 Test Gula Urine strip - -
268 Test Gula, protein urine pcs - -
269 Test Kehamilan strip 150 429,000.00
270 Thiamfenicol kapsul 500 mg kapsul - -
271 Wing Needle No 21 G set - -
272 Wing Needle No 23 G set - -
273 Wing Needle No 25 G set - -
274 Wing Needle No 27 G set - -
275 Zink tab 20 mg tablet - -
276 Ambroxol tab 30 mg tablet - -
277 Amlodipin tab 5 mg tablet - -
278 Amoksisilin+As klavunalat 625mg tab tablet 6,900 3,036,000.00
279 Ampisillin serb inj 1000 mg/ml vial - -
280 Anti diare kapl kaplet - -
281 Anti infeksi TM botol - -
282 Dengue rapid test set - -
283 Fitomenadion inj infant 2 mg/ml ampul - -
284 Gentamicin inj 40 mg/1ml ampul - -
285 Haloperidol tab 5 mg tablet 1,000 88,230.00
286 Handscoon No 7-7,5 set - - 200
287 HIV Test paket - -
288 Insektisida Pengasapan/kabut galon - -
289 Iodina test pcs - -
290 Masker pcs - -
291 Metronadizol 500 mg infus botol - -
292 Nifedipin tab 10 mg tablet - -
293 Obat Batuk Anak syr botol - -
294 Polycatheter no. 18 pcs - -
295 Suplemen Balita gizi buruk pcs - -
296 Surgical Blade No. 10 pcs - -
297 Syifilis test paket - -
298 Transfusi set pcs - -
299 Urine Bag set - -
300 Fluconazole tab 150 mg tablet - -
301 Miconazole cream 2 % tube - -
JUMLAH 28,734,529.97

MENGETAHUI
Kepala Dinas Kesehatan
Kabupaten Indramayu

dr. H. Dedi Rohendi, MARS.

Pembina Utama Muda
NIP 1960810 198911 1 001
 PUSKESMAS JATIBARANG
2014

nda tangan dibawah ini :

esehatan Kab. Indramayu Triwulan …... dan telah ditemukan saldo

HARGA-2013
PENERIMAAN PENGELUARAN STOK AKHIR 2014 -Trw.III SATUAN
JUMLAH VOL JUMLAH VOL JUMLAH
- - - - - 103,536.00
- - - - - 1,092.50
1,557,000.00 1,500 1,557,000.00 - - 1,038.00
207,600.00 300 311,400.00 300 311,400.00 1,038.00
- 210 85,398.60 - - 406.66
- 1,400 147,000.00 - - 105.00
87,150.00 900 78,435.00 1,300 113,295.00 87.15
- - - - - 3,240.00
- 100 10,200.00 900 91,800.00 102.00
- - - - - 288.75
3,885,000.00 10,500 3,885,000.00 - - 370.00
920,000.00 600 1,380,000.00 50 115,000.00 2,300.00
- - - -
- - - - -
- 18,800 2,335,336.00 4,400 546,568.00 124.22
- - - - - 1,200.00
1,169,100.00 14,000 1,091,160.00 5,000 389,700.00 77.94
 - - - - 2,491.00
- - - 20 4,000.00 200.00
- 48 91,411.20 72 137,116.80 1,904.40
- - - - 123.00
- - - - - 1,270.10
- - - 60 300,000.00 5,000.00
- - - - -
- 3,000 96,000.00 - - 32.00
- - - - -
- - - -
- - - - -
- - - - - 100.00
- - - - - 155.80
- - - - - 68.00
- - - - - 126.04
- - - - - 1,230.00
- - - - - 8,200.00
- - - - - 11,400.00
- - - - -
152,000.00 125 190,000.00 - - 1,520.00
1,920,000.00 3 1,920,000.00 - - 640,000.00
- - - - - 8.70
- - - 200 280,000.00 1,400.00
- 11,000 578,380.00 3,500 184,030.00 52.58
- - - - - 39,079.00
- 325 448,126.25 - - 1,378.85
- - - - - 90.00
- - - - - 390,000.00
- - - - - 2,344.00
- - - - - 35.00
- - - - - 56.00
- - - - - 97.50
- - - 30 28,800.00 960.00
182,000.00 200 18,200.00 1,900 172,900.00 91.00
- - - - - 51.26
- - - - 31.68
- - - 250 375,000.00 1,500.00
- 3 6,636.48 - - 2,212.16
- - - - - 398.06
- 12 179,506.80 - - 14,958.90
- - - - -
2,625,000.00 25 2,625,000.00 - - 105,000.00
229,166.65 5 229,166.65 - - 45,833.33
- - - - -
- - - - - 73.04
 - - - - - 121.00
- - - - - 1,716.00
- - - - - 144.00
- - - - - 61.00
- - - - - 262.00
- - - - - 464.80
- - - - - 1,008.00
939,600.00 150 234,900.00 570 892,620.00 1,566.00
- - - 1,000 579,000.00 579.00
- - - - -
- - - - - 78.00
- - - - -
- - - - -
- 1,000 292,000.00 10,500 3,066,000.00 292.00
- - - - -
- - - 72 64,440.00 895.00
4,740,000.00 12 4,740,000.00 - - 395,000.00
- 500 27,000.00 800 43,200.00 54.00
- - - - - 27.90
- - - - -
- 20 106,260.00 20 106,260.00 5,313.00
- - - - - 5,727.00
- - - - - 1,960.00
- 900 205,200.00 700 159,600.00 228.00
- - - - -
- - - - - 52.52
- 500 30,235.00 500 30,235.00 60.47
290,400.00 8,000 290,400.00 - - 36.30
304,920.00 120 304,920.00 - - 2,541.00
- 1,300 120,341.00 - - 92.57
- - - - - 145.00
- 10 40,000.00 5 20,000.00 4,000.00
4,719.00 115 (47,781.00) 15 52,500.00 3,500.00
- - - - -
- - - - -
- - - - -
- - - - -
- - - - - 92.00
15,000.00 10 15,000.00 - - 1,500.00
- - - - -
1,936,000.00 8 1,936,000.00 - - 242,000.00
1,612,000.00 31,000 1,612,000.00 - - 52.00
84,000.00 8 84,000.00 - - 10,500.00
165,000.00 22 165,000.00 - - 7,500.00
- - - - - 243.00
 - - - - - 1,386.00
- - - - - 5,500.00
82,500.00 170 93,500.00 30 16,500.00 550.00
- - - - - 2,200.00
- - - - -
- - - - -
- 500 120,000.00 6,000 1,440,000.00 240.00
132,000.00 336 281,952.00 - - 1,562.00
- 24 38,376.00 - - 1,599.00
260,000.00 21,000 546,000.00 8,500 221,000.00 26.00
- - - - -
- - - - - 1,021.00
- - - - - 950.00
- 2,000 90,000.00 2,000 90,000.00 45.00
- - - - -
- - - - -
- - - - - 470.00
- - - - -
- - - 1,000 76,000.00 76.00
- 275 707,850.00 100 257,400.00 2,574.00
- 2,000 296,000.00 4,000 592,000.00 148.00
- - - - -
- - - - -
- - - - - 27,445.00
- - - - - 105,035.70
- - - - - 29,216.00
- - - - - -
- - - - - 137,032.50
- - - - - 50,255.70
- - - - - -
- - - - - 21,579.80
- - - - - 20,749.30
155,400.00 270 349,650.00 - - 1,295.00
- 2 82,770.60 - - 41,385.30
727,300.00 120 249,360.00 230 477,940.00 2,078.00
7,552,930.00 140 7,000,840.00 350 920,150.00 2,629.00
- - - - -
- - - - -
- - - - -
- - - - -
- 500 70,000.00 700 98,000.00 140.00
- 150 223,500.00 30 44,700.00 1,490.00
- - - 3,000 368,400.00 122.80
220,000.00 5 220,000.00 - - 44,000.00
704,000.00 5 704,000.00 - - 140,800.00
 - - - - - 14.30
- - - - -
- - - - - 4,900.00
- - - - -
- - - - - 640.00
- - - 100 40,700.00 407.00
2,520,000.00 7 2,520,000.00 - - 360,000.00
- - - - - 1,200,000.00
- - - - -
- - - - - 160,000.00
430,000.00 2 430,000.00 - - 215,000.00
- - - - - 1,258.95
- - - - -
- - - - - 3,100.00
- - - - - 2,100.00
152,900.00 150 229,350.00 200 305,800.00 1,529.00
214,200.00 120 214,200.00 - - 1,785.00
- - - - -
- - - - - 1,318.90
- - - - - 32.23
- 30,500 2,559,865.00 13,500 1,133,055.00 83.93
- - - - -
- - - - -
- - - - -
- - - - - 13,191.00
- - - - -
- - - - -
- - - - -
- - - - - 311.00
- 6,000 104,400.00 - - 17.40
708,750.00 30 708,750.00 - - 23,625.00
- - - - -
- - - - -
- - - - -
- 5 10,000.00 - - 2,000.00
- 4 56,000.00 - - 14,000.00
- - - - -
- - - - -
- 4,000 208,000.00 2,000 104,000.00 52.00
- - - - - 109.00
- - - - - 6,100.00
- - - - - 108.00
- - - - -
- - - - -
- - - - -
 - - - - -
- - - - - 242.00
1,186,735.00 2,750 1,186,735.00 - - 431.54
- - - - -
- - - - -
- - - - -
208,000.00 60 312,000.00 20 104,000.00 5,200.00
- 600 35,892.00 900 53,838.00 59.82
- 72 59,394.24 - - 824.92
- 150 168,000.00 - - 1,120.00
- - - - -
570,000.00 6 570,000.00 - - 95,000.00
- - - - - 277,200.00
- - - - - -
- - - - - -
1,275,120.00 20 1,275,120.00 - - 63,756.00
2,292,000.00 12 2,292,000.00 - - 191,000.00
- - - 100 91,600.00 916.00
1,257,000.00 5 1,257,000.00 - - 251,400.00
- - - - -
- - - - - 370,982.00
- - - - -
- - - - -
- - - - -
- - - - -
782,071.75 227 782,071.75 - - 3,445.25
- - - - -
- - - - -
406,560.00 9,240 406,560.00 - - 44.00
136,000.00 4 136,000.00 - - 34,000.00
- - - - -
- - - - -
1,030,000.00 3,500 721,000.00 1,500 309,000.00 206.00
- - - - - 680.00
1,323,000.00 35,000 1,323,000.00 - - 37.80
- - - - -
- - - - - 40.00
- - - - - 21,818.00
- - - - -
- - - - -
777,000.00 35,000 777,000.00 - - 22.20
- - - - - 1,615.79
- - - - - 95.00
- 175 376,600.00 100 215,200.00 2,152.00
- - - - - 239.00
 - 3,400 244,800.00 200 14,400.00 72.00
- 3,000 264,000.00 - - 88.00
- - - - - 520.00
- - - - - 33,000.00
- - - - - 250.00
- 200 19,000.00 300 28,500.00 95.00
- - - - - 2,904.00
- - - - - 19,609.70
248,160.00 55 290,400.00 10 52,800.00 5,280.00
- - - - - 3,182.72
- - - - - 3,182.72
276,000.00 7 386,400.00 4 220,800.00 55,200.00
- 80 31,666.40 120 47,499.60 395.83
66,770.00 110 66,770.00 - - 607.00
- - - - - 303.50
- - - - - 382.00
- - - - - 3,700.00
1,056,000.00 240 1,056,000.00 - - 4,400.00
- - - - -
- - - - -
- - - - - 7,920.00
- - - - - 5,104.00
- - - - - 580.80
- - - - - 2,055.99
- - - - - 721.60
- - - - - 1,034.00
- 150 429,000.00 - - 2,860.00
- - - - - 431.00
- - - - - 5,770.00
- - - - - 5,770.00
- - - - - 5,770.00
- - - - - 5,497.50
- - - - - 455.00
- - - - - 95.00
- - - - -
- 6,900 3,036,000.00 - - 440.00
- - - - - 4,550.00
- - - - - 4,000.00
- - - - - 330.00
- - - - - 27,999.40
- - - - - 6,600.00
- - - - - 3,104.00
- 500 44,115.00 500 44,115.00 88.23
850,000.00 200 850,000.00 - - 4,250.00
- - - - -
 - - - - -
- - - - - 1,599.40
- - - - - 1,125.00
- - - - - 24,000.00
- - - - - 112.00
- - - - - 4,752.00
- - - - - 6,795.80
- - - - - 440.00
- - - - - 600.01
- - - - -
- - - - - 10,990.32
- - - - - 3,199.90
- - - - - 22,000.00
- - - - - 3,000.00
50,626,052.40 - 63,929,719.97 - 15,430,862.40

Jatibarang, 03 Oktober 2014

1 dr. Uding Pramudya 1.

2 Idris 2.

3 Cucu sartiasih, AMG. 3.

4 Tosin, S.Kep.Ns 4.

5 Taudin 5.

6 Gosikin, Amd.Kep 6.