LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO )

PUSKESMAS

PUSKESMAS DOKUMEN NOMOR

KECAMATAN DINKES KAB/KOTA
KAB / KOTA PELAPORAN BULAN / PERIODE : Maret 2018 GFK KAB/KOTA
PROPINSI PERMINTAAN BULAN / PERIODE : April 2018 PUSKESMAS

STOK PEM BER IAN

STOK PENERI PERSE PEMAK STOK PERMI
NO. NAMA OBAT
SATUAN OPTIM
AWAL MAAN DIAAN AIAN AKHIR NTAAN PKD/DPP ASKES APBD I APBD IIPROGRAM
AL

1 2 4 5 6 12 13 14 15
1. OBAT
1 ALBENDAZOL TAB 600 - 600 600 100 (500)
2 ALOPURINOL TAB ### - ### ### 0 ###
3 AMBROXOL TABL - - - - 1500 ###
4 AMBROXOL SYRU - - - - 300 300
5 AMINOFILLIN INJ - - - - 0 -
6 AMINOFILLIN TAB 200 - 200 200 100 (100)
7 AMITRIPTILIN HC 100 - 100 100 100 -
8 AMLODIPIN TABL - - - - 750 750
9 AMLODIPIN TABL ### - ### ### 1500 (300)
10 AMOKSISILIN KA - ### ### ### 1500 (500)
11 AMOKSISILIN KA - ### ### ### 9000 ###
AMOKS
ISILIN
SYRUP
KERIN
G
12 125MG/ 500 - 500 500 350 (150)
5 ML
AMOKS
ISILIN +
ASAM
KLAVUL
ANAT
13 625MG - - - - 0 -
TABLET
14 AMOKSISILLIN IN - - - - 0 -
15 AMPICILLLIN SER - - - - 0 -
16 AMPISILLIN KAPL - - - - 0 -
ANTAL
GIN(ME
TAMPIR
ON)
TABLET
17 500 MG
ANTAL - 2000 ### ### 8000 ###
GIN
( META
MPIRO
N)
INJEKSI
250
18 MG/ML- - - - - 0 -
2ML
 DA
DOEN
TABLET
,
KOMBI
NASI
:Mg.Hid
roksida
200
mg+Al.
Hidroksi
19 da 200
- ### ### ### 6500 -
20 ANTASIDA DOEN 500 - 500 500 300 (200)
ANTI
BAKTE
RI
DOEN
salep
kombin
asi :
Basitras
in 500
IU/g+Po
lymixin
1000
21 IU/g 225 0 225 225 125 (100)
ANTI
FUNGI
DOEN
(WHITE
FIELD)
KOMBI
NASI :
Asam
Benzoat
6%+
Asam
22 Salisilat 24 - 24 24 0 (24)
3%
23 ANTI HEMOROID 40 - 40 40 100 60
GREN
DOEN
kombin
asi :
Ergota
min
Tartrat 1
mg +
24 Kofein 500 - 500 500 150 (350)
25 AQUA PRO INJEKSI 20 0 20 20 10 (10)
26 ASAM ASKORBAT ( - 0 - - 7000 ###
27 ASAM ASKORBAT ( - - - - 5000 ###
28 ASAM FOLAT TAB - - - - 300 300
29 ASAM MEFENAMA - 5000 ### ### 5000 -
30 ASIKLOVIR CRE - - - - 125 125
31 ASIKLOVIR TAB 2 500 0 500 500 500 -
32 ASIKLOVIR TAB 900 0 900 900 500 (400)
33 AZITROMICIN 25 - - - - 0 -
34 BETAMETASON KR - 75 75 75 75 -
35 CALCIUM GLUCO - - - - 5 5
36 CAPTOPRIL 12,5 ### - ### ### 500 ###
37 CAPTOPRIL 25 M ### - ### ### 500 ###
38 CEFADROXIL 500 - - - - 300 300
 CEFAD
ROXIL
SYRUP
KERIN
39 G - 300 300 300 150 (150)
40 CETIRIZINE TAB - - - - 1000 ###
41 CIPROFLOXACIN 500 200 700 700 700 -
DEKSA
METAS
ON
INJEKSI
42 5 mg/ml 100 0 100 100 50 (50)
43 DEKSAMETASON T ### - ### ### 10000 -
44 DEKSTROMETORFA - - - - 0 -
45 DEKSTROMETORF - - - - 0 -
46 DIAZEPAM TABLE - - - - 50 50
47 DIAZEPAM TABLE 160 - 160 160 50 (110)
48 DIAZEPAM INJEK - - - - 5 5
49 DIAZEPAM SUPP - - - - 0 -
50 DIFENHIDRAMIN IN 60 - 60 60 10 (50)
51 DIGOKSIN TABLET 300 - 300 300 0 (300)
52 DOKSISIKLIN 100 400 - 400 400 100 (300)
53 DOMPERIDON Tab 200 2000 ### ### 1500 (700)
54 DOMPERIDON SU - - - - 200 200
55 EFEDRIN HCL TA - - - 0 -
56 EKSTRAK BELADO - - - 200 200
57 EPINEFRINA HCL/BI 53 53 53 10 (43)
58 ERITROMICYN K - - - 0 -
59 ERITROMICYN K - - - 0 -
60 ERITROMICYN SI 70 70 70 50 (20)
ETAKRI
DIN
( Rivano
l)
LARUT
61 AN 0,1 23 23 23 0 (23)
%
ETAKRI
DIN
( Rivano
l)
LARUT
62 AN - - - 0 -
1000
63 ETANOL 70 % 1 Li - 5 5 5 5 -
64 FENOBARBITAL T 400 - 400 400 0 (400)
65 FENOBARBITAL - - - - 0 -
FENOBARBITAL IN - - - - 0 -
66
FENOK
SIMETI
L
PENISI
LINA
67 TABLET - - - - 0 -
500 MGGLISEROL
FENOL
68 - - - - 24 24
FITOMENADION ( V 40 0 40 40 30 (10)
69
FITOMENADION ( - - - - 0 -
70
71 FLUKONAZOL 15 100 - 100 100 0 (100)
72 FUROSEMID TABL - - - - 0 -
73 GARAM ORALIT 500 1000 ### ### 700 500
74 GENTAMISIN INJ 85 - 85 85 0 (85)
75 GENTAMISIN SAL - - - - 96 96
76 GENTAMISIN TET - - - - 125 125
77 GENTAMYCIN SAL - - - - 125 125
78 GENTIAN VIOLET - - - - 24 24
79 GLIBENKLAMID T - - - - 600 ###
GLISERIL GUAYA - - - - 7000 ###
80
81 GLUKOSA LARUTA 175 0 175 175 100 (75)
GRISEOFULVIN TA 500 - 500 500 100 (400)
82
GRISEOFULVIN TA - - - - 0 -
83
84 HIDROKORTISON - 96 96 96 100 4
HYDROKLOROTIAZ 200 - 200 200 5 (195)
85
86 IBUPROFEN table - 0 - - 6000 ###
87 IBUPROFEN table - ### ### ### 8000 -
88 IBUPROFEN SUS - 100 100 100 50 (50)
89 ICHTIOL SALEP - - - - 6 6
90 IRBESARTAN TAB - - - - 100 100
ISOSORBID DINITR - - - - 0 -
91
92 KALIUM DIKLOFEN - - - - 0 -
93 KALIUM DIKLOFEN - - - - 3000 ###
KALSIUM LAKTAT ( - 8000 ### ### 8000 -
94
KETOK
ONAZO
L TAB
95 200 MG - 200 200 200 200 -
KETOK
ONAZO
L KRIM
96 2% 39 60 99 99 100 1
KLARIT
ROMISI
N 500
MG
97 TABLET - - - - 0 -
98 KLINDAMISIN 30 - ### ### ### 2000 -
99 KLORAMPENIKOL 200 - 200 200 500 300
100 KLORAMPENIKOL - 48 48 48 48 -
101 KLORAMPENIKOL 200 - 200 200 0 (200)
102 KLORAMPENIKOL - 80 80 80 75 (5)
103 KLORAMPENIKOL - - - - 20 20
KLORFENIRAMIN ### 0 ### ### 8000 ###
104
KLORPROMAZIN - - - - 50 50
105
106 KODEIN FOSFAT - - - - 0 -
 MOXAZ
OL
SUSPE
NSI,
Kombin
asi :
Sulfame
toksazol
200 mg
+
Trimeto
107 prim 40 200 - 200 200 75 (125)
mg / 5
MOXAZ
OL
TABLET
PEDRIA
TIK,
kombin
asi :
Sulfame
toksazol
100 mg
+
Trimeto
108 prim 20
KOTRI - - - - 0 -
MOXAZ
OL
TABLET
,Kombin
asi :
Sulfame
toksazol
400 mg
+
Trimeto
109 prim 80 ### - ### ### 400 ###
mg
110 LEVOFLOKSASIN - - - - 0 -
LIDOKAIN HCl IN 100 - 100 100 30 (70)
111 LIDOKA
IN
KOMP
INJEKSI
Kombin
asi :
Lidokain
Hcl 2%
+
Epinefri
n
112 1:80.00 240 - 240 240 0 (240)
0-2ml
LISOL , mengandu
113 - 8 8 8 8 -
114 LOPERAMID 2MG 200 400 600 600 600 -
115 LORATADIN TABL - - - - 1000 ###
116 LYNCOMISIN 50 - - - - 500 500
MAGNESIUM SULFA - - - - 0 -
117
MAGNESIUM SULFA - - - - 0 -
118
119 MELOXICAM TABL - - - - 300 300
120 MELOXICAM TAB - - - - 300 300
121 METFORMIN 500 - 1500 ### ### 1500 -
RGOME
TRIN
MALEA
T
( Metiler
gometri
n)
tablet
122 salut - - - - 100 100
0,125
METILERGOMETRI 356 - 356 356 0 (356)
123
124 METOKLORPROPA - - - - 50 50
125 METROCLOPRAMI 500 - 500 500 0 (500)
126 METRONIDAZOL T ### 0 ### ### 1000 ###
127 METRONIDAZOLE ### - ### ### 700 ###
128 MICONAZOLE C - - - - 0 -
129 NATRIUM BIKARB - - - - 1000 ###
130 NATRIUM DIKLO - - - - 0 -
131 NATRIUM DIKLO - 1000 ### ### 500 (500)
NATRIUM KLORIDA L
100 - 100 100 0 (100)
132
133 NIFEDIPIN 10 MG 300 - 300 300 0 (300)
134 NISTATIN TABLET 20 100 120 120 100 (20)
135 NISTATIN TABLET 50 - 50 50 0 (50)
136 OBAT ANTITUBE - - - - 0 -
137 OBAT ANTITUBER - - - - 0 -
138 OBAT ANTITUBER - - - - 0 -
139 OBAT ANTITUBER - - - - 0 -
140 OBAT ANTITUBER - - - - 0 -
141 OBAT BATUK HITA - - - - 200 200
142 OKSITETRASIKLI - - - - 75 75
143 OKSITETRASIKLI - - - - 0 -
144 OKSITOSIN INJEK 50 0 50 50 30 (20)
145 OMEPRAZOLE TA - 600 600 600 200 (400)
146 PARASETAMOL - 0 - - 225 225
147 PARASETAMOL S - - - - 15 15
148 PARASETAMOL SY - 450 450 450 350 (100)
149 PARASETAMOL TA ### 16800 ### ### 10000 ###
150 PARASETAMOL10 - - - - 0 -
151 PETHIDIN INJEK - - - - 0 -
152 PIRANTEL TABLE 100 - 100 100 0 (100)
153 PIRIDOXIN HCL ( ### - ### ### 4000 ###
154 PIROXICAM 10 M - - - - 300 ###
155 PIROXICAM 20 MG - - - - 300 ###
POLIKR
ESULE
N
( KOND
ENSASI
METAK
RESOL
SULFO
NAT
DAN
METAN
156 AL) 360 80 - 80 80 0 (80)
MG/G
157 POVIDON YODIDA - - - - 12 12
158 POVIDON YODIDA - - - - 0 -
159 POVIDON YODIDA 17 - 17 17 0 (17)
160 PREDNISON TABL ### - ### ### 5000 ###
161 PROPANOLOL HCL - - - - 0 -
162 PROPILTIOURASI - - - - 0 -
163 PYRAZINAMIDE 5 - - - - 0 -
164 RANITIDIN INJEKS 50 - 50 50 50 -
165 RANITIDIN TABLE - ### ### ### 1500 ###
166 RESERPIN TABLET - - - - 0 -
167 RETINOL (VIT.A) 850 - 850 850 0 (850)
168 RETINOL (VIT.A) ### - ### ### 0 ###
169 RIFAMPISIN 300 - - - - 0 -
170 RIFAMPISIN 450 - - - - 0 -
171 RIFAMPISIN 600 - - - - 0 -
172 RINGER LAKTAT 190 - 190 190 100 (90)
173 SALBUTAMOL TA - 800 800 800 300 (500)
174 SALBUTAMOL TAB - 800 800 800 800 -
175 SALBUTAMOL NEB - - - - 20 20
SALEP
2-4,
KOMBI
NASI:
ASAM
SALISIL
AT 2%
+BELE
176 RANG 24 - 24 24 0 (24)
177 SALISIL BEDAK 140 - 140 140 100 (40)
178 SEFIKSIM 100MG - - - - 0 -
179 SEFIKSIM SIRUP - - - - 0 -
180 SEFOTAKSIM INJ - - - - 0 -
181 SEFTRIAKSON IN - - - - 0 -
SERUM
ANTI
BISA
ULAR
POLIVA
REN
182 INJEKSI - - - - 1 1
5 ML.
SERUM ANTI TETA - - - - 2 2
183
SIANOK
OBALA
MIN
INJEKSI
(VIT.B1
2) INJ.
500
MCG/M
184 L-1ML - - - - 5 5
185 SIMVASTATIN 10 - ### ### ### 1000 ###
SULFASETAMIDA - - - - 0 -
186
TABLET
TAMBA
H
DARAH
KOMBI
NASI:B
ESI 2
SULFAT
200
MG+AS
AM
187 FOLAT ### 5600 ### ### 13000 ###
0,25
188 TETRASIKLIN HCL - - - - 0 -
189 TETRASIKLIN HC 600 - 600 600 0 (600)
190 TIAMFENICOL KA - - - - 500 500
TIAMIN HCL (VIT - - - - 0 -
191
TIAMIN
HCL /
MONO
NITRAT
(VIT.B1)
TABLET
192 50 MG. ### - ### ### 5000 ###
193 TRAMADOL 50 M - - - - 0 -
194 TRAMADOL INJEK - - - - 0 -
TRIHEKSIPENIDI - - - - 0 -
195
196 VIT. B KOMPLEK - ### ### ### 8000 ###
197 ZINC TABLET 20 500 500 ### ### 600 (400)
198 ZINC SYRUP - 100 100 100 0 (100)
199 MDT MB DEWAS - - - - 0 -
200 MDT PB ANAK - - - - 0 -
201 MDT MB ANAK - - - 0 -
- - - 0 -
2. BAHAN HA -
202 ALAT SUNTIK SEK 300 200 500 500 400 200
203 ALAT SUNTIK SEK ### ### ### ### 1000 ###
204 ALAT SUNTIK SEK 600 300 900 900 300 (600)
205 ALAT SUNTIK SEK - 5 5 5 5 -
206 AUTOMATIC DISA - - - - 0 -
207 ALKOHOL SWAB 400 - 400 400 300 (100)
208 BISTURI 50 - 50 50 0 (50)
209 CAIRAN ANTISEP - - - - 10 10
CATGU
T/BENA
NG
BEDAH
No.2/0 -
3/0
dengan
Jarum
210 Bedah - - - - 35 35
211 FOLLEY CATHETE 8 - 8 8 0 (8)
212 GAUSE SWAB STE - - - - 0 -
213 INFUS SET ANAK 80 - 80 80 50 (30)
214 INFUS SET DEW 150 - 150 150 100 (50)
215 IV CATETHER 200 - 200 200 150 (50)
JARUM
JAHIT
(BEDAH
) NO.9
s/d 14
KULIT/
216 OTOT - - - - 5 5
217 KAPAS Berlemak - - - - 0 -
218 KAPAS Pembalut/ - 0 - - 12 12
219 KASA Kompres 40 X 50 - 50 50 0 (50)
220 KASA Pembalut 70 - 70 70 0 (70)
221 KASA Pembalut 2 40 - 40 40 0 (40)
222 KASA PEMBALUT - - - - 5 5
223 KASA PEMBALUT - - - - 0 -
224 KASA PEMBALUT H 25 - 25 25 0 (25)
225 KASA PEMBALUT 73 - 73 73 0 (73)
226 MASKER DISPOS 600 1000 ### ### 700 ###
227 NELATON CATET - - - - 0 -
228 OKSIGEN REFILL - - - - 0 -
229 PARAFFIN GAUZ - - - - 0 -
230 PEMBALUT ELAS - - - - 0 -
231 PEMBALUT GIPS - - - - 0 -
232 PLESTER 5 YARD - - - - 0 -
233 POT SPUTUM - - - 500 500
234 POT URIN STERI - - - - 0 -
235 SABUN CUCI TAN 28 - 28 28 10 (18)
236 SARUNG TANGA - - - - 10 10
237 SARUNG TANGAN - 1000 ### ### 500 (500)
238 SARUNG TANGAN - - - - 50 50
SILK
(BENAN
G
BEDAH
SUTER
A)
NO.3/0
DENGA
N
239 JARUM 14 12 26 26 24 (2)
240 UMBILICAL KLEM 100 0 100 100 50 (50)
241 URINE BAG - - - - 0 -
242 USG JELLY 15 - 15 15 15 -
243 AUTOMATIC DISA ### - ### ### 0 ###
244 ALAT SUNTIK SEK - - - - 0 -
245 ALAT SUNTIK SEK - - - - 0 -
246 FOLLEY CATHETE 3 - 3 3 0 (3)
- - -
3. OBAT GIG - - -
247 AIR RAKSA DENT - - - - 0 -
BONDI
NG
(BUAT
TAMBA
248 LAN) - - - - 0 -
249 DEVITALISASI PAS - - - - 0 -
Dexame
thasone
0,125 g,
Phenol
36,7 g,
Formald
ehyde
32,4 g,
Gaiacol
24,46 g,
Excipie
nt qs ad
250 100 g - - - - 0 -
ETCHIN
251 G - - - - 0 -
252 ETIL KLORIDA S - - - - 0 -
253 EUGENOL CAIRA 10 - 10 10 0 (10)
254 GLASSIONOMER C - - - - 0 -
GLASSI
ONOME
R
FILLIN
G
MATERI
255
AL ART
- - - - 0 -
Hydroco
rtison
Acetate
1, 0 g,
Excipie
nt :
thymol
iodide,
Barium
Sulfate,
Zink
Okside,
Mg
Stearat
e qs ad - - - - 0 -
256
100 g
KACA
257 MULUT - - - - 0 -
258 KALSIUM HIDROX - - - - 0 -
M
HIDRO
XIDA
DENGA
259 N - - - - 0 -
MATA
IODOF
BOR
(HIGH
SPEED/
BULAT,
PISUR,
260 INVERT - - - - 0 -
)
261 MONOKLOR KAMP - - - - 0 -
262 MUMMIFYING PA - - - - 0 -
263 SEMEN SENG FO - - - - 0 -
264 SILVER AMALGA - - - - 0 -
265 SPONS GELATIN - - - - 0 -
266 SULFA CONUS K - - - - 0 -
267 SYNTHETIC FILL - - - - 0 -
RARY
FILLIN
G
268 MATERI - - - - 0 -
TEMPO
RARY
STOPPI
NG
FLETC
HER(FL
ETCHE
R)
SERBU
269 K DAN - - - - 0 -
270 TRIKRESOL FORM - - - - 0 -
- - - -
4. REAGEN - - - -
271 ALKOHOL ASAM - - - - 0 -
272 AMONIUM OKSAL - - - - 0 -
273 ANISOL - - - - 0 -
274 AQUA BIDESTILA - - - - 0 -
ASAM KLORIDA 0,1 - - - - 0 -
275
276 ASAM SULFO SAL - - - - 0 -
277 BIOCHEMISTRY - - - - 0 -
278 BLOOD LANCET A - - - - 0 -
279 CHOLESTEROL L - 0 - - 0 -
280 DRUBKIN ( HAEM - - - - 0 -
281 EDTA 10% 100 M - - - - 0 -
282 EOSIN 2% - - - - 0 -
283 GIEMSA STAIN - - - - 0 -
284 GLUKOSA LIQ - 0 - 0 -
285 GOLONGAN DARA - - - - 0 -
286 GRAM PEWARNA - - - - 0 -
287 HAYEM - - - - 0 -
288 HBSAB STRIP - - - - 0 -
289 HBSAG STRIP - - - - 0 -
290 HCG TEST KEHA - - - - 0 -
291 IMERSION OIL - - - - 0 -
292 IODINE TEST - - - - 0 -
293 KARBOL FUCHSI - - - - 0 -
294 NARKOBA AMP - - - - 0 -
295 NARKOBA MOP - - - - 0 -
296 NARKOBA THC - - - - 0 -
297 NATRIUM SITRAT - - - - 0 -
298 POCH D - - - - 0 -
299 POCH L - - - - 0 -
300 CELL CLEAN - - - - 0 -
301 8-CHECK HEMAT - - - - 0 -
302 REES ECKER - - - - 0 -
303 SERUM KONTRO - - - - 0 -
304 STICK ASAM URA - - - - 0 -
305 STICK CHOLESTE - - - - 0 -
306 STICK GLUKOSA - - - - 0 -
307 STICK GLUKOSA - 0 - - 0 -
308 STICK HB METER - - - - 0 -
309 STICK URINE 3 - - - - 0 -
310 STICK URINE 10 - - - - 0 -
311 TABUNG WESTE - - - - 0 -
312 TRIGLISERIDA - - - - 0 -
313 TURK - - - - 0 -
314 URIC ACID LIQUI - 0 - - 0 -
315 VAKUTEINER EDT - 0 - - 0 -
316 WIDAL - - - - 0 -
317 XYLOL - - - - 0 -
318 ZIEHL NIELSON 10 - 10 10 0 (10)
319 WHITE TIP - - - 0 -
320 KARTU GOLONG - - - - 0 -
321 STICK ASAM URAT - - - - 0 -
322 STICK CHOLESTE - - - - 0 -
323 Vacutainer EDTA 3 - - - - 0 -
324 YELLOW TIP - - - - 0 -
325 URINE TESTLABS - - - - 0 -
- - - 0 -
5. OBAT TA - - - 0 -
326 BURNAZINE CRE - - - 0 -
327 CAIRAN ANTISEP - - - 10 10
328 FG THROCHES - - - 0 -
329 MOLAKRIM 30GR - - - 24 24
330 NEO KAOMINAL - - - 100 100
RIN
HCL 30
MG,
ANTAL
GIN 500
MG,
EXTRA
K
BELLA
DON 5
MG
(SPASM
331 AL) - - - 300 300
332 PARAFFIN GAUZ - - - 0 -
333 PULAREX - - - 1000 ###
334 SALBUTAMOL NEB - - - 20 20
335 SANMAG SUSPEN - - - 0 -
336 ZAM BUK OINT - - - 0 -
337 ZINKID SYRUP - - - 96 96
ETAKRI
DIN
(RIVAN
OL)LAR
UTAN
0,1 %
338 BOTOL 20 20 20 0 (20)
300ML
339 SURGICAL TAPE 24 24 24 12 (12)
340 FILM RONTGEN U - - - 0 -
341 FILM RONTGEN U - - - 0 -
342 FILM RONTGEN U - - - 0 -
343 CAIRAN DEVELO - - - 0 -
344 CAIRAN FIXER B - - - 0 -
345 STESOLID RECT - - - 0 -
346 ADALAT 20 MG - - - 0 -
347 CETIRIZIN SYRP 360 - 360 360 200 (160)
348 ILLADIN - - - 0 -
349 ALKOHOL 70% 1 - - - 5 5
PARAFFIN GAUZE - - - 10 10
350
 351 MDT DEWASA - - - 0 -
352 PB DEWASA - - - 0 -
353 POVIDON IODIN - - - 0 -
354 SURGICAL TAPE RO - - - 0 -
355 IV CATETHER 24 100 - 100 100 50 (50)
SARUN
G
TANGA
N NON
STERIL
356 PCS S - - - 300 300
357 KERTAS PUYER ### - ### ### 0 ###
TRU CAL U - - - 0 -
REAGEN SGOT - - - 0 -
REAGEN SGPT - - - 0 -
LARUTAN BENEDI - - - 0 -
MB DEWASA - - - 0 -
MB ANAK - - - 0 -
TRULAB N - - - 0 -
STIK GULA BEN - - - 0 -
AXIMED SWEB 2- - -
SILK
(BENAN
G
BEDAH
SUTER
A)
NO.3/0
DENGA
N
239 JARUM 20 12 32 32 24 (8)
* TIDAK BOLEH MENAMBAHKAN "ROW" YG BARU, KLO ADA NAMA OBAT YG BARU/TDK ADA NAMA OBATNYA TAMBAHKAN DIBAWAHNY

UMUM
TIDAK ASKES JUMLAH
JUMLAH KUNJUNGAN
BAYAR
RESEP
BAYAR

1301 1038 0 1038

Kepala Dinas Kesehatan Kab. Kepala

Bekasi GFK Kepala Puskesmas Petugas Puskesmas

dr.Hj. Sri Enny Mainarti,

Aam Komalasari.S.Si.,Apt
MKM H.Firman,Skm Agustiani,A.M.Kep
NIP. 19700525 200003
NIP.19790621
2 004 200212 2 004 NIP. 19730201 199903 1 003 NIP.19850830 201001 2 017

KETERANGAN :
Lembar 1 ( Putih ) : Puskesmas
Lembar 2 ( Merah ) : Dinkes Kab. Bekasi
Lembar 3 ( Biru ) : GFK kab. Bekasi
Lembar 4 ( kuning ) : PT. Askes
 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%)
JUMLA
IAN H
LAIN-LAIN

16 17 SK SK
SO (perbul (perhari SWK SWT SP
an) )

340 100 4 0 15 10
0 0 0 15 0
5100 1500 60 15 150
1020 300 12 15 30
0 0 0 0
340 100 4 15 10
340 100 4 15 10
2550 750 30 15 75
5100 1500 60 15 150
5100 1500 60 15 150
30600 9000 360 15 900

1610 350 14 30 35

0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

27200 8000 320 15 800

0 0 15 0
22100 6500 260 15 650
1020 300 12 15 30

425 125 7 15 12.5

0 0 15 0
340 100 4 15 10

510 150 6 15 15
34 10 0.4 15 1
23800 7000 280 15 700
17000 5000 200 15 500
1020 300 12 15 30
17000 5000 200 15 500
255 125 5 15 7.5
1700 500 20 15 50
1700 500 20 15 50
0 0 15 0
255 75 3 15 7.5
17 5 0.2 15 0.5
1020 500 20 15 30
1700 500 20 15 50
1020 300 12 15 30
 510 150 6 15 15
3400 1000 40 15 100
2380 700 28 15 70

170 50 2 15 5
34000 10000 400 15 1000
0 0 0
0 0 0
110 50 2 5
110 50 2 5
11 5 0.2 0.5
0 0 15 0
22 10 0.4 1
0 0 0 15 0
340 100 4 15 10
5100 1500 60 15 150
680 200 8 15 20
0 0 0
440 200 8 20
34 10 0.4 15 1
0 0 15 0
0 0 15 0
170 50 2 15 5

0 0 15 0

0 0 0
17 5 0.2 15 0.5
0 0 15 0
0 0 0
0 0 0

0 0 0
81.6 24 0.96 15 2.4
102 30 1.2 15 3
0 0 15 0
0 0 15 0
 0 0 15 0
2380 700 28 15 70
0 0 15 0
326.4 96 3.84 15 9.6
255 125 5 15 7.5
340 125 10 15 10
55.2 24 3 30 1.2
2040 600 24 15 60
32200 7000 280 30 700
340 100 4 15 10
340 100 4 15 10
0 0 15 0
340 100 4 15 10
0 5 0 15 0
20400 6000 240 15 600
27200 8000 320 15 800
170 50 2 15 5
0 6 2 15 0
220 100 4 10
0 0 15 0
0 0 15 0
6800 3000 80 15 200
27200 8000 320 15 800

680 200 8 15 20

340 100 4 15 10

0 0 0
3220 2000 20 30 70
2300 500 20 30 50
163.2 48 1.92 15 4.8
0 0 15 0
255 75 3 15 7.5
55.2 20 1 30 1.2
27200 8000 320 15 800
170 50 2 15 5
0 0 15 0
 255 75 3 15 7.5

0 0 0

1360 400 16 15 40
0 0 0 0
102 30 1.2 15 3

0 0 15 0
23.8 8 1 15 0.7
2040 600 24 15 60
3400 1000 40 15 100
2300 500 20 30 50
0 0 0 0
0 0 0 0
1380 300 6 30 30
1380 300 8 30 30
5100 1500 60 15 150

340 100 4 15 10
0 0 15 0
 170 50 2 15 5
0 0 15 0
3400 1000 40 15 100
2380 700 28 15 70
0 0 15 0
3400 1000 40 15 100
0 0 15 0
1700 500 20 15 50
0 0 15 0
0 0 15 0
340 100 4 15 10
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
680 200 8 15 20
255 75 3 15 7.5
0 0 15 0
102 30 1.2 15 3
4080 200 48 15 120
765 225 9 15 22.5
51 15 0.6 15 1.5
1190 350 14 15 35
30600 10000 360 15 900
0 0 15 0
0 0 15 0
0 0 15 0
13600 4000 160 15 400
1020 300 12 15 30
1020 300 12 15 30

0 0 15 0
40.8 12 0.48 15 1.2
0 0 15 0
0 0 15 0
17000 5000 200 15 500
0 0 15 0
0 0 15 0
 0 0 15 0
170 50 2 15 5
5100 1500 60 15 150
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
340 100 4 15 10
1020 300 12 15 30
2720 800 32 15 80
68 20 0.8 15 2

0 0 15 0
340 100 4 15 10
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0

3.4 1 0.04 15 0.1

6.8 2 0.08 15 0.2

17 5 0.2 15 0.5
3400 1000 40 15 100
0 0 15 0

44200 13000 520 15 1300

0 0 15 0
0 0 15 0
 1700 500 20 15 50
0 0 15 0

17000 5000 200 15 500

0 0 15 0
0 0 15 0
0 0 15 0
27200 8000 320 15 800
2040 600 24 15 60
0 0 15 0
0 0 0
0 0 0
0 0 0
0 0 0
###
1020 400 15 15 30
2720 1000 32 15 80
1020 300 12 15 30
17 5 0.2 15 0.5
0 0 15 0
1020 300 12 15 30
0 0 15 0
34 10 0.4 15 1

119 35 1.4 15 3.5

0 0 15 0
0 0 15 0
170 50 2 15 5
340 100 4 15 10
510 150 6 15 15

17 5 0.2 15 0.5
0 0 15 0
40.8 12 0.48 15 1.2
0 0 15 0
0 0 15 0
0 0 15 0
 17 5 0.2 15 0.5
0 0 15 0
0 0 15 0
0 0 15 0
2380 700 28 15 70
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
34 10 0.4 15 1
34 10 0.4 15 1
1700 500 20 15 50
170 50 2 15 5

81.6 24 0.96 15 2.4

170 50 2 15 5
0 0 15 0
51 15 0.6 15 1.5
0 0 0
0 0 0
0 0 0
0 0 0
0 0 15 0
0 0 15 0
0 0 15 0

0 0 15 0
0 0 15 0

0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0

0 0 15 0

0 0 15 0

0 0 15 0
0 0 15 0

0 0 15 0

0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0

0 0 15 0

0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
 0 0 15 0
0 0 15 0
0 0 15 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 15 0
20.4 10 1 15 0.6
0 0 15 0
81.6 24 0.96 15 2.4
255 100 3 15 7.5

1020 300 12 15 30
0 0 15 0
1700 1000 20 15 50
68 20 1 15 2
0 0 15 0
0 0 15 0
326.4 96 3.84 15 9.6

0 0 15 0
40.8 12 0.48 15 1.2
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
0 0 15 0
680 200 8 15 20
0 0 15 0
0 5 1 15 0
34 10 0.4 15 1
 0 0 15 0
0 0 15 0
0 0 15 0
0 0 0
110 50 2 5

660 300 12 30
0 0 0

81.6 24 0.96 15 2.4

BATNYA TAMBAHKAN DIBAWAHNYA SAJA.

* catatan :
- kolom SK (per bulan ) untuk bln pertama kali (november) diisi manual dulu, untuk bln selanjutnya disam
- 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

0 201001 2 017
TOK PER HARI )
 , untuk bln selanjutnya disamakan tdk perlu diisi lg (copy paste)

ggal copy paste aja)

nar dan pengambilan obat hrs disiplin TEPAT WAKTU

NO. NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN

1. OBAT
1 ALBENDAZOL TABLET 400 MG. 600 - 600

2 ALOPURINOL TABLET 100 MG. 1,100 - 1,100

3 AMBROXOL TABLET - - -

4 AMBROXOL SYRUP 15 MG/ML - - -

5 AMINOFILLIN INJEKSI 24 MG/ML-10ML - - -

6 AMINOFILLIN TABLET 200 MG. TABLET 200 - 200

7 AMITRIPTILIN HCL TAB SALUT 25 MG 100 - 100

8 AMLODIPIN TABLET 5MG - - -

9 AMLODIPIN TABLET 10MG 1,800 - 1,800

10 AMOKSISILIN KAPSUL 250 MG - 2,000 2,000

11 AMOKSISILIN KAPLET 500 MG - 10,000 10,000

AMOKSISILIN SYRUP KERING 125MG/5 ML
12 500 - 500
AMOKSISILIN + ASAM KLAVULANAT 625MG TABLET
13 - - -

14 AMOKSISILLIN INJEKSI 1000 MG - - -

15 AMPICILLLIN SERBUK INJEKSI 1G/VIAL - - -

16 AMPISILLIN KAPLET 500 MG. - - -

ANTALGIN(METAMPIRON) TABLET 500 MG
17 - 2000 2,000
ANTALGIN ( METAMPIRON ) INJEKSI 250 MG/ML-2ML
18 - - -
ANTASIDA DOEN TABLET, KOMBINASI :Mg.Hidroksida
19 200 mg+Al.Hidroksida 200 mg - 6,500 6,500

20 ANTASIDA DOEN SUSPENSI 500 - 500

ANTI BAKTERI DOEN salep kombinasi : Basitrasin 500
21 IU/g+Polymixin 1000 IU/g 225 0 225
ANTI FUNGI DOEN (WHITE FIELD) KOMBINASI : Asam
22 Benzoat 6 % + Asam Salisilat 3 % 24 - 24

23 ANTI HEMOROID DOEN KOMBINASI 40 - 40

ANTIMIGREN DOEN kombinasi : Ergotamin Tartrat 1 mg +
24 Kofein 50 mg 500 - 500

25 AQUA PRO INJEKSI STERIL , bebas pirogen 20 0 20

26 ASAM ASKORBAT ( Vit.C ) tablet 50 mg - 0 -

27 ASAM ASKORBAT ( Vit.C ) tablet 250 mg - - -

28 ASAM FOLAT TABLET 1MG - - -

29 ASAM MEFENAMAT KAPLET 500 MG - 5000 5,000

30 ASIKLOVIR CREAM - - -

31 ASIKLOVIR TAB 200 500 0 500

32 ASIKLOVIR TAB 400MG 900 0 900

33 AZITROMICIN 250MG KAPSUL - - -

34 BETAMETASON KRIM 0,1 % - 75 75

35 CALCIUM GLUCONAS - - -

36 CAPTOPRIL 12,5 MG 1,700 - 1,700

37 CAPTOPRIL 25 MG 2,200 - 2,200

38 CEFADROXIL 500 MG - - -
CEFADROXIL SYRUP KERING 125MG/ML
39 - 300 300

40 CETIRIZINE TAB 10MG - - -

41 CIPROFLOXACIN 500 MG 500 200 700

DEKSAMETASON INJEKSI 5 mg/ml - 1 ml
42 100 0 100

43 DEKSAMETASON TABLET 0,5 MG. 10,000 - 10,000

44 DEKSTROMETORFAN SYRUP 10 mg/5 ml - - -

45 DEKSTROMETORFAN TABLET 15 mg - - -

46 DIAZEPAM TABLET 2 MG. - - -

47 DIAZEPAM TABLET 5 MG. 160 - 160

48 DIAZEPAM INJEKSI 5 MG/ML-2ML - - -

49 DIAZEPAM SUPPOSITORIA - - -

50 DIFENHIDRAMIN INJEKSI 10 mg/ml - 1 ml 60 - 60

51 DIGOKSIN TABLET 0,25 mg 300 - 300

52 DOKSISIKLIN 100 MG 400 - 400

53 DOMPERIDON Tablet 200 2000 2,200

54 DOMPERIDON SUSPENSI - - -

55 EFEDRIN HCL TABLET 25 MG - -

56 EKSTRAK BELADON TABLET 10 MG - -

EPINEFRINA HCL/BITARTRAT ( Epinefrina/Adrenalin ) Injeksi 0,1%-1ml
57 53 53

58 ERITROMICYN KAPSUL 250 MG - -

59 ERITROMICYN KAPSUL 500 MG - -

60 ERITROMICYN SIRUP 200MG/ML 70 70

ETAKRIDIN ( Rivanol ) LARUTAN 0,1 % 100ML
61 23 23
 ETAKRIDIN ( Rivanol ) LARUTAN 1000 ML ( 1 LITER)
62 - -

63 ETANOL 70 % 1 Liter - 5 5

64 FENOBARBITAL TABLET 30 MG 400 - 400

65 FENOBARBITAL TABLET 100 MG - - -

FENOBARBITAL INJEKSI 50 MG/ML - 2 ML
66 - - -
FENOKSIMETIL PENISILINA TABLET 500 MG
67 - - -
FENOL GLISEROL TETES TELINGA 10 %
68 - - -
FITOMENADION ( Vit.K ) INJEKSI 10 mg/ml - 1 ml
69 40 0 40
FITOMENADION ( Vit.K ) TABLET SALUT GULA 10 Mg
70 - - -

71 FLUKONAZOL 150 MG TABLET 100 - 100

72 FUROSEMID TABLET 40 mg - - -

73 GARAM ORALIT 500 1000 1,500

74 GENTAMISIN INJEKSI 85 - 85

75 GENTAMISIN SALEP MATA - - -

76 GENTAMISIN TETES MATA 0,3% - - -

77 GENTAMYCIN SALEP KULIT - - -

78 GENTIAN VIOLET LARUTAN 1 % - - -

79 GLIBENKLAMID TABLET 5 MG - - -
GLISERIL GUAYA KOLAT TABLET 100 MG
80 - - -

81 GLUKOSA LARUTAN INFUS 5% STERIL 175 0 175

GRISEOFULVIN TABLET 125 MG, Micronized
82 500 - 500
GRISEOFULVIN TABLET 500 MG, Micronized
83 - - -

84 HIDROKORTISON krim 2,5 % - 96 96

HYDROKLOROTIAZID ( HCT ) TABLET 25 MG
85 200 - 200

86 IBUPROFEN tablet 200 mg - 0 -

87 IBUPROFEN tablet 400 mg - 8,000 8,000

88 IBUPROFEN SUSPENSI - 100 100

89 ICHTIOL SALEP - - -

90 IRBESARTAN TAB 150 MG - - -

ISOSORBID DINITRAT Tablet sublingual 5 mg
91 - - -

92 KALIUM DIKLOFENAK 25 mg Tablet - - -

93 KALIUM DIKLOFENAK 50 mg Tablet - - -

 KALSIUM LAKTAT ( Kalk ) Tablet 500 mg
94 - 8000 8,000
KETOKONAZOL TAB 200 MG
95 - 200 200
KETOKONAZOL KRIM 2%
96 39 60 99
KLARITROMISIN 500 MG TABLET
97 - - -

98 KLINDAMISIN 300MG - 2,000 2,000

99 KLORAMPENIKOL KAPSUL 250 MG. 200 - 200

100 KLORAMPENIKOL SALEP MATA 1 % - 48 48

101 KLORAMPENIKOL SUSPENSI 200 - 200

102 KLORAMPENIKOL TETES MATA - 80 80

103 KLORAMPENIKOL TETES TELINGA 3 % - - -

KLORFENIRAMIN MELEAT (CTM) TABLET 4 MG
104 15,570 0 15,570
KLORPROMAZIN TABLET SALUT 25 MG
105 - - -

106 KODEIN FOSFAT TABLET 10 MG - - -

KOTRIMOXAZOL SUSPENSI, Kombinasi :
107 Sulfametoksazol 200 mg + Trimetoprim 40 mg / 5 ml 200 - 200
KOTRIMOXAZOL TABLET PEDRIATIK, kombinasi :
108 Sulfametoksazol 100 mg + Trimetoprim 20 mg - - -
KOTRIMOXAZOL TABLET,Kombinasi : Sulfametoksazol
109 400 mg + Trimetoprim 80 mg 1,900 - 1,900

110 LEVOFLOKSASIN 500 MG - - -

LIDOKAIN HCl INJEKSI 2%
111 100 - 100
LIDOKAIN KOMP INJEKSI Kombinasi : Lidokain Hcl 2% +
112 Epinefrin 1:80.000-2ml 240 - 240
LISOL , mengandung Kresol tersabun 50 %
113 - 8 8

114 LOPERAMID 2MG TABLET 200 400 600

115 LORATADIN TABLET 10MG - - -

116 LYNCOMISIN 500MG - - -

MAGNESIUM SULFAT INJEKSI ( IV ) 20%-25 ml
117 - - -
MAGNESIUM SULFAT INJEKSI ( IV ) 40%-25 ml
118 - - -

119 MELOXICAM TABLET 7.5 MG - - -

120 MELOXICAM TABLET 15MG - - -

121 METFORMIN 500MG TABLET - 1500 1,500

METILERGOMETRIN MALEAT ( Metilergometrin ) tablet
122 salut 0,125 mg - - -
METILERGOMETRIN MALEAT INJ 0,200 mg-1ml
123 356 - 356

124 METOKLORPROPAMID INJEKSI - - -

125 METROCLOPRAMIDE 10MG TABLET 500 - 500

126 METRONIDAZOL TABLET 250 mg 3,500 0 3,500

127 METRONIDAZOLE 500MG 1,900 - 1,900

128 MICONAZOLE CREAM - - -

129 NATRIUM BIKARBONAT TABLET 500 mg - - -

130 NATRIUM DIKLOFENAK TABLET 25MG - - -

131 NATRIUM DIKLOFENAK TABLET 50MG - 1000 1,000

NATRIUM KLORIDA Larutan Infus 0,9 % steril
132 100 - 100

133 NIFEDIPIN 10 MG. 300 - 300

134 NISTATIN TABLET SALUT 500.000 IU/g 20 100 120

135 NISTATIN TABLET VAGINAL 100.000 IU/g 50 - 50

136 OBAT ANTITUBERKULOSIS ANAK - - -

137 OBAT ANTITUBERKULOSIS KATEGORI 1 - - -

138 OBAT ANTITUBERKULOSIS KATEGORI 2 - - -

139 OBAT ANTITUBERKULOSIS KATEGORI 3 - - -

140 OBAT ANTITUBERKULOSIS SISIPAN - - -

141 OBAT BATUK HITAM ( O.B.H ) CAIRAN - - -

142 OKSITETRASIKLIN SALEP KULIT 3% - - -

143 OKSITETRASIKLIN SALEP MATA 1% - - -

144 OKSITOSIN INJEKSI 10 IU/ML-1ML 50 0 50

145 OMEPRAZOLE TABLET 20MG - 600 600

146 PARASETAMOL DROP - 0 -

147 PARASETAMOL SUPPOSITORIA - - -

148 PARASETAMOL SYRUP 120 MG/5 ML - 450 450

149 PARASETAMOL TABLET 500 MG. 1,100 16800 17,900

150 PARASETAMOL100 MG. TABLET - - -

151 PETHIDIN INJEKSI 50MG/ML - - -

152 PIRANTEL TABLET 125 MG. 100 - 100

153 PIRIDOXIN HCL (VIT.B6) TABLET 10 MG. 8,000 - 8,000

154 PIROXICAM 10 MG TABLET - - -

155 PIROXICAM 20 MG. TAB. - - -

POLIKRESULEN ( KONDENSASI METAKRESOL
156 SULFONAT DAN METANAL) 360 MG/G 80 - 80

157 POVIDON YODIDA 10 % 30 ML. - - -

158 POVIDON YODIDA 10 % 60 ML. - - -

159 POVIDON YODIDA 10 % 300 ML. 17 - 17

160 PREDNISON TABLET 5 MG. 10,000 - 10,000

161 PROPANOLOL HCL TABLET 40 MG. - - -

162 PROPILTIOURASIL TABLET 100 MG. - - -

163 PYRAZINAMIDE 500 MG. TABLET - - -

164 RANITIDIN INJEKSI 50 - 50

165 RANITIDIN TABLET 150 MG - 3,000 3,000

166 RESERPIN TABLET 0,25 MG - - -

167 RETINOL (VIT.A) KAPSUL 100.000 IU 850 - 850

168 RETINOL (VIT.A) KAPSUL 200.000 IU 9,000 - 9,000

169 RIFAMPISIN 300 MG. KAPLET - - -

170 RIFAMPISIN 450 MG. KAPLET - - -

171 RIFAMPISIN 600 MG. KAPLET - - -

172 RINGER LAKTAT LARUTAN INFUS STERIL 190 - 190

173 SALBUTAMOL TABLET 2 MG - 800 800

174 SALBUTAMOL TABLET 4 MG. - 800 800

175 SALBUTAMOL NEBULIZER 2,5ML - - -

SALEP 2-4, KOMBINASI: ASAM SALISILAT 2%
176 +BELERANG ENDAP 4% 24 - 24

177 SALISIL BEDAK 2% 140 - 140

178 SEFIKSIM 100MG TAB /KAPSUL - - -

179 SEFIKSIM SIRUP KERING 100MG/5ML - - -

180 SEFOTAKSIM INJEKSI 1GRAM - - -

181 SEFTRIAKSON INJEKSI 1GRAM - - -

SERUM ANTI BISA ULAR POLIVAREN INJEKSI 5 ML.
182 (ABU 1) - - -
SERUM ANTI TETANUS INJ. 1500 IU AMPUL(ATS)
183 - - -
SIANOKOBALAMIN INJEKSI(VIT.B12) INJ. 500 MCG/ML-
184 1ML - - -

185 SIMVASTATIN 10 MG TABLET SALUT - 3,000 3,000

SULFASETAMIDA NATRIUM TETES MATA 15%
186 - - -
TABLET TAMBAH DARAH KOMBINASI:BESI 2 SULFAT
187 200 MG+ASAM FOLAT 0,25 MG. 10,000 5600 15,600

188 TETRASIKLIN HCL KAPSUL 250 MG. - - -

189 TETRASIKLIN HCL KAPSUL 500 MG. 600 - 600

190 TIAMFENICOL KAPSUL 500 MG - - -
TIAMIN HCL (VIT.B1) INJEKSI 100 MG/ML-1ML
191 - - -
TIAMIN HCL / MONONITRAT (VIT.B1) TABLET 50 MG.
192 16,000 - 16,000

193 TRAMADOL 50 MG/KAMADOL - - -

194 TRAMADOL INJEKSI - - -

TRIHEKSIPENIDIL HIDROKLORIDA TABLET 2 MG.
195 - - -

196 VIT. B KOMPLEK TABLET - 9,400 9,400

197 ZINC TABLET 20MG 500 500 1,000

198 ZINC SYRUP - 100 100

199 MDT MB DEWASA - - -

200 MDT PB ANAK - - -

201 MDT MB ANAK - -

- -
2. BAHAN HABIS PAKAI {BHP} -

202 ALAT SUNTIK SEKALI PAKAI 1 ML. 300 200 500

203 ALAT SUNTIK SEKALI PAKAI 2,5 ML 2,850 1,000 3,850

204 ALAT SUNTIK SEKALI PAKAI 5 ML 600 300 900

ALAT SUNTIK SEKALI PAKAI 10 ML
205 - 5 5

206 AUTOMATIC DISABLE SYRINGE 0.05ML - - -

207 ALKOHOL SWAB 400 - 400

208 BISTURI 50 - 50

209 CAIRAN ANTISEPTIK SOFTAMAN - - -

CATGUT/BENANG BEDAH No.2/0 - 3/0 dengan Jarum
210 Bedah - - -

211 FOLLEY CATHETER NO.18, 8 - 8

212 GAUSE SWAB STERILL - - -

213 INFUS SET ANAK 80 - 80

214 INFUS SET DEWASA 150 - 150

215 IV CATETHER 200 - 200

216 JARUM JAHIT (BEDAH) NO.9 s/d 14 KULIT/OTOT - - -

217 KAPAS Berlemak 500 gram - - -

218 KAPAS Pembalut/Absorben 250 gram - 0 -

219 KASA Kompres 40 X 40 steril 50 - 50

220 KASA Pembalut 16CM X 16CM 70 - 70

221 KASA Pembalut 2 m X 80 cm 40 - 40

222 KASA PEMBALUT 40CM X 80CM - - -

223 KASA PEMBALUT 4M X 4CM - - -

224 KASA PEMBALUT HIDRIFIL 4 M x 3 CM 25 - 25

225 KASA PEMBALUT HIDROFIL 4 M x 15 CM 73 - 73

226 MASKER DISPOSIBLE 600 1000 1,600

227 NELATON CATETHER - - -

228 OKSIGEN REFILL - - -

229 PARAFFIN GAUZE DRESSING - - -

230 PEMBALUT ELASTIS - - -

231 PEMBALUT GIPS - - -

232 PLESTER 5 YARDS X 2 INCH - - -

233 POT SPUTUM - -

234 POT URIN STERIL - - -

235 SABUN CUCI TANGAN 28 - 28

236 SARUNG TANGAN GYNEKOLOG - - -

237 SARUNG TANGAN NON STERIL PCS"100 - 1000 1,000

238 SARUNG TANGAN STERIL - - -

SILK (BENANG BEDAH SUTERA) NO.3/0 DENGAN
239 JARUM BEDAH 14 12 26

240 UMBILICAL KLEM NYLON 100 0 100

241 URINE BAG - - -

242 USG JELLY 15 - 15

243 AUTOMATIC DISABLE SYRINGE 0.5ML (ADS) 64,000 - 64,000

244 ALAT SUNTIK SEKALI PAKAI 5 ML (ADS) - - -

245 ALAT SUNTIK SEKALI PAKAI 5 ML (ADS) - - -

246 FOLLEY CATHETER NO.16 3 - 3

- -

3. OBAT GIGI - -

247 AIR RAKSA DENTAL USE - - -

BONDING (BUAT TAMBALAN)
248 - - -

249 DEVITALISASI PASTA ( Non Arsen ) - - -

 Dexamethasone 0,125 g, Phenol 36,7 g, Formaldehyde
250 32,4 g, Gaiacol 24,46 g, Excipient qs ad 100 g - - -
ETCHING
251 - - -

252 ETIL KLORIDA SEMPROT - - -

253 EUGENOL CAIRAN 10 - 10

254 GLASSIONOMER CEMENT ( GC IX ) - - -

GLASSIONOMER FILLING MATERIAL ART
255 - - -
Hydrocortison Acetate 1, 0 g, Excipient : thymol iodide,
256 Barium Sulfate, Zink Okside, Mg Stearate qs ad 100 g - - -
KACA MULUT
257 - - -

258 KALSIUM HIDROXIDA PASTA - - -

KALSIUM HIDROXIDA DENGAN IODOFORM
259 - - -
MATA BOR (HIGH SPEED/BULAT, PISUR, INVERT)
260 - - -

261 MONOKLOR KAMPER MENTHOL CAIRAN - - -

262 MUMMIFYING PASTA - - -

263 SEMEN SENG FOSPAT SERBUK DAN CAIRAN - - -

264 SILVER AMALGAM SERBUK 65-75% - - -

265 SPONS GELATIN CUBICLRS 1X1X1 CM - - -

266 SULFA CONUS KERUCUT PREFARAT - - -

267 SYNTHETIC FILLING MATERIAL - - -

TEMPORARY FILLING MATERIAL
268 - - -
TEMPORARY STOPPING FLETCHER(FLETCHER)
269 SERBUK DAN CAIRAN - - -

270 TRIKRESOL FORMALIN (TKF) CAIRAN - - -

- - -
4. REAGEN - - -

271 ALKOHOL ASAM - - -

272 AMONIUM OKSALAT - - -

273 ANISOL - - -

274 AQUA BIDESTILATA - - -

ASAM KLORIDA 0,1 N-100ML. ( HCl 0.1N )
275 - - -

276 ASAM SULFO SALISILAT 20%-100ML. - - -

BIOCHEMISTRY 9 SAMSUNG
277 - - -
BLOOD LANCET ACCU-CHECK '200
278 - - -

279 CHOLESTEROL LIQ - 0 -

280 DRUBKIN ( HAEMOGLOBIN C )100 ML - - -

281 EDTA 10% 100 ML - - -

282 EOSIN 2% - - -

283 GIEMSA STAIN - - -

284 GLUKOSA LIQ - 0 -

GOLONGAN DARAH + KARTU
285 - - -

286 GRAM PEWARNA - - -

287 HAYEM - - -

288 HBSAB STRIP - - -

HBSAG STRIP
289 - - -
HCG TEST KEHAMILAN
290 - - -

291 IMERSION OIL - - -

292 IODINE TEST - - -

293 KARBOL FUCHSIN - - -

294 NARKOBA AMP - - -

295 NARKOBA MOP - - -

296 NARKOBA THC - - -

297 NATRIUM SITRAT 3.8% - - -

298 POCH D - - -

299 POCH L - - -

300 CELL CLEAN - - -

301 8-CHECK HEMATOLOGI - - -

302 REES ECKER - - -

303 SERUM KONTROL - - -

STICK ASAM URAT Bene Check
304 - - -
STICK CHOLESTEROL Bene Check
305 - - -
STICK GLUKOSA ACCU-CHECK '25
306 - - -
STICK GLUKOSA ACCU-CHECK '100
307 - 0 -
STICK HB METER
308 - - -
STICK URINE 3 PM
309 - - -
STICK URINE 10 PM
310 - - -

311 TABUNG WESTERGEN - - -

312 TRIGLISERIDA - - -

313 TURK - - -

314 URIC ACID LIQUID - 0 -

315 VAKUTEINER EDTA 3ML - 0 -

316 WIDAL - - -

317 XYLOL - - -

318 ZIEHL NIELSON 10 - 10

319 WHITE TIP - -

320 KARTU GOLONGAN DARAH - - -

STICK ASAM URAT Easy Touch
321 - - -
STICK CHOLESTEROL Easy Touch
322 - - -
Vacutainer EDTA 3 ml
323 - - -
YELLOW TIP
324 - - -

325 URINE TESTLABSTIP U11 PLUS TUBE 150 STRIP - - -

- -

5. OBAT TAMBAHAN - -

326 BURNAZINE CREAM 10MG - -

327 CAIRAN ANTISEPTIK SOFTAMAN - -

328 FG THROCHES - -

329 MOLAKRIM 30GRAM - -

330 NEO KAOMINAL - -

PAPAVERIN HCL 30 MG, ANTALGIN 500 MG, EXTRAK
331 BELLADON 5 MG (SPASMAL) - -

332 PARAFFIN GAUZE DRESSING - -

333 PULAREX - -

334 SALBUTAMOL NEBULIZER 2,5ML - -

335 SANMAG SUSPENSI - -

336 ZAM BUK OINT - -

337 ZINKID SYRUP - -

ETAKRIDIN (RIVANOL)LARUTAN 0,1 % BOTOL 300ML
338 20 20

339 SURGICAL TAPE ROLL 1 24 24

340 FILM RONTGEN UK 35 X 35 BOX - -

341 FILM RONTGEN UK 30 X 40 BOX - -

342 FILM RONTGEN UK 24 X 30 - -

343 CAIRAN DEVELOVER BOX - -

344 CAIRAN FIXER BOX - -

345 STESOLID RECTAL - -

346 ADALAT 20 MG - -

347 CETIRIZIN SYRP 360 - 360

348 ILLADIN - -

349 ALKOHOL 70% 100ML - -

PARAFFIN GAUZE DRESSING(DARYAN TULE)
350 - -

351 MDT DEWASA - -

352 PB DEWASA - -

353 POVIDON IODIN 10ML - -

354 SURGICAL TAPE ROLL 1/2 inchi pcs'24 - -

355 IV CATETHER 24 100 - 100

SARUNG TANGAN NON STERIL PCS S
356 - -

357 KERTAS PUYER PCS 60,000 - 60,000

TRU CAL U - -

REAGEN SGOT - -

REAGEN SGPT - -

LARUTAN BENEDIIC - -

MB DEWASA - -

MB ANAK - -

TRULAB N - -

STIK GULA BENECHECK - -

AXIMED SWEB 2-PLY DUS -

SILK (BENANG BEDAH SUTERA) NO.3/0 DENGAN
239 JARUM BEDAH 20 12 32
 STOK STOK
PEMAKAIAN PERMINTAAN
AKHIR OPTIMAL

600 100 (500)

1,100 0 (1,100)

- 1500 1,500

- 300 300

- 0 -

200 100 (100)

100 100 -

- 750 750

1,800 1500 (300)

2,000 1500 (500)

10,000 9000 (1,000)

500 350 (150)

- 0 -

- 0 -

- 0 -

- 0 -

2,000 8000 6,000

- 0 -

6,500 6500 -

500 300 (200)

225 125 (100)

24 0 (24)

40 100 60

500 150 (350)

20 10 (10)

- 7000 7,000

- 5000 5,000

- 300 300

5,000 5000 -
 - 125 125

500 500 -

900 500 (400)

- 0 -

75 75 -

- 5 5

1,700 500 (1,200)

2,200 500 (1,700)

- 300 300

300 150 (150)

- 1000 1,000

700 700 -

100 50 (50)

10,000 10000 -

- 0 -

- 0 -

- 50 50

160 50 (110)

- 5 5

- 0 -

60 10 (50)

300 0 (300)

400 100 (300)

2,200 1500 (700)

- 200 200

- 0 -

- 200 200

53 10 (43)

- 0 -

- 0 -

70 50 (20)

23 0 (23)
 - 0 -

5 5 -

400 0 (400)

- 0 -

- 0 -

- 0 -

- 24 24

40 30 (10)

- 0 -

100 0 (100)

- 0 -

1,500 700 500

85 0 (85)

- 96 96

- 125 125

- 125 125

- 24 24

- 600 1,400

- 7000 7,000

175 100 (75)

500 100 (400)

- 0 -

96 100 4

200 5 (195)

- 6000 6,000

8,000 8000 -

100 50 (50)

- 6 6

- 100 100

- 0 -

- 0 -

- 3000 3,000
 8,000 8000 -

200 200 -

99 100 1

- 0 -

2,000 2000 -

200 500 300

48 48 -

200 0 (200)

80 75 (5)

- 20 20

15,570 8000 (7,570)

- 50 50

- 0 -

200 75 (125)

- 0 -

1,900 400 (1,500)

- 0 -

100 30 (70)

240 0 (240)

8 8 -

600 600 -

- 1000 1,000

- 500 500

- 0 -

- 0 -

- 300 300

- 300 300

1,500 1500 -

- 100 100

356 0 (356)

- 50 50

500 0 (500)
 3,500 1000 (2,500)

1,900 700 (1,200)

- 0 -

- 1000 1,000

- 0 -

1,000 500 (500)

100 0 (100)

300 0 (300)

120 100 (20)

50 0 (50)

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 200 200

- 75 75

- 0 -

50 30 (20)

600 200 (400)

- 225 225

- 15 15

450 350 (100)

17,900 10000 (7,900)

- 0 -

- 0 -

100 0 (100)

8,000 4000 (4,000)

- 300 2,000

- 300 2,000

80 0 (80)

- 12 12
 - 0 -

17 0 (17)

10,000 5000 (5,000)

- 0 -

- 0 -

- 0 -

50 50 -

3,000 1500 (1,500)

- 0 -

850 0 (850)

9,000 0 (9,000)

- 0 -

- 0 -

- 0 -

190 100 (90)

800 300 (500)

800 800 -

- 20 20

24 0 (24)

140 100 (40)

- 0 -

- 0 -

- 0 -

- 0 -

- 1 1

- 2 2

- 5 5

3,000 1000 (2,000)

- 0 -

15,600 13000 (2,600)

- 0 -

600 0 (600)
 - 500 500

- 0 -

16,000 5000 (11,000)

- 0 -

- 0 -

- 0 -

9,400 8000 (1,400)

1,000 600 (400)

100 0 (100)

- 0 -

- 0 -

- 0 -

- 0 -

500 400 200

3,850 1000 (2,850)

900 300 (600)

5 5 -

- 0 -

400 300 (100)

50 0 (50)

- 10 10

- 35 35

8 0 (8)

- 0 -

80 50 (30)

150 100 (50)

200 150 (50)

- 5 5

- 0 -

- 12 12

50 0 (50)
 70 0 (70)

40 0 (40)

- 5 5

- 0 -

25 0 (25)

73 0 (73)

1,600 700 1,000

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 500 500

- 0 -

28 10 (18)

- 10 10

1,000 500 (500)

- 50 50

26 24 (2)

100 50 (50)

- 0 -

15 15 -

64,000 0 (64,000)

- 0 -

- 0 -

3 0 (3)

- 0 -

- 0 -

- 0 -
 - 0 -

- 0 -

- 0 -

10 0 (10)

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -
- 0 -

- 0 -

- 0 -

- 0 -

0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -
 - 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

10 0 (10)

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 10 10

- 0 -

- 24 24

- 100 100

- 300 300

- 0 -

- 1000 1,000

- 20 20

- 0 -

- 0 -

- 96 96

20 0 (20)

24 12 (12)

- 0 -

- 0 -
 - 0 -

- 0 -

- 0 -

- 0 -

- 0 -

360 200 (160)

- 0 -

- 5 5

- 10 10

- 0 -

- 0 -

- 0 -

- 0 -

100 50 (50)

- 300 300

60,000 0 (60,000)

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

- 0 -

32 24 (8)