LEMBAR PEMAKAIAN & PERMINTAAN OBAT

PUSKESMAS NIMASI
POLINDES : OENENU SELATAN

BULAN : MARET
NO. NAMA OBAT SATUAN STOCK PENERI PENGE SISA PERMIN
KEMASAN AWAL MAAN LUARAN STOK TAAN
I. ANALGETIKA/ANTIPIRETIKA/ANTI INFLAMASI NONSTEROID/ANTIPIRAI
1 Antalgin/Metampiron 500 Mg Tablet Tablet 100 0 0 0 100
2 Allupurinol 100 Mg Tablet Tablet 0 0 0 0
3 Antalgin/metampiron Inj 250 Mg/Ml -2 Ml Ampul 0 0 0 0 0
4 Asam Mefenamad 500 Mg Caplet Caplet 100 100 60 40 0
7 Ibuprofen 200 Mg Tablet Tablet 100 100 70 30 100
8 Ibuprofen 400 Mg Tablet Tablet 100 0 0 0 0
9 Kalium Diklofenak 50 Mg Tablet Tablet 50 0 0 0 50
10 Natrium Diklofenak 50 Mg Tablet Tablet 50 0 0 0 0
11 Parasetamol 100 Mg Tablet Tablet 100 100 30 70 0
12 Parasetamol 500 Mg Tablet Tablet 100 100 70 30 100
13 Parasetamol Syrup 120 Mg/5Ml Btl/60 Ml 5 3 1 2 3
15 Piroxicam 10 Mg Capsul Capsul 100 100 60 40 50
II ANESTETIK
1 Ethyl Klorida Semprot Btl/100 Ml 0 0 0 0 0
2 Lidokain Injeksi Ampul 10 10 0 10 0
3 Xylocain Injeksi Vial 0 0 0 0 0
III ANTIALERGI &OBAT UNTUK ANAFILAKSIS
1 Dexamethason 0,5 Mg Tablet Tablet 100 100 30 70 0
2 Dexamethason injeksi 5Mg/Ml-1ml Ampul 0 0 0 0 0
3 Diphenhidramin HCl Inj.10Mg/Ml-1Ml Ampul 0 0 0 0 0
4 Epinefrine / Adrenalin Injeksi Ampul 0 0 0 0 0
5 Klorfeniramin Maleat (CTM) 4 Mg Tablet Tablet 0 0 0 0 0
6 Loratadin Tablet 10 Mg Tablet 100 0 0 0 100
V ANTIEPILEPSI
1 Diazepam 2 Mg Tablet Tablet 0 0 0 0 0
2 Diazepam 5Mg/Ml - 2Ml Injeksi Ampul 0 0 0 0 0
3 Fenobarbital Injeksi 50Mg /Ml-2Ml Ampul 0 0 0 0 0
VI ANTIBAKTERI
1 Amoxicilline 250 Mg Capsul Capsul 100 100 70 30 0
2 Amoxicilline 500 Mg Capsul Capsul 100 100 60 40 0
3 Amoxicilyn 125 Mg/5Ml Syrup Kering Btl/60Ml 5 3 0 3 0
4 Chloramphenicol 250 Mg Capsul Capsul 100 100 30 70 0
5 Ciprofloksacin 500 Mg Capsul ( sebagai HCl Capsul 100 100 20 80 0
6 Cotrimoksazole 120 Mg Tablet Tablet 100 100 20 80 0
7 Cotrimoksazole 480 Mg Tablet Tablet 0 0 0 0 0
8 Cotrimoksazole Suspensi Btl/60 ml 3 3 0 3 0
9 Doxycicline 100 Mg Tablet Tablet 0 0 0 0 0
 10 Erytromycin 500 Mg Capsul Capsul 0 0 0 0 0
11 Metronidasol 250 Mg Tablet Tablet 100 100 30 70 0
12 Oksitetrasikline HCl I.M.50Mg/Ml Injeksi Vial 0 0 0 0 0
13 Tetrasiklin 250 Mg Capsul Capsul 0 0 0 0 0
VII ANTHELMENTIKA
1 Albendazole 400 Mg Tablet Tablet 100 100 0 100 0
2 Pirantel Pamoat 125 Mg Tablet Tablet 0 0 0 0 0
3 Pirantel Pamoat syrup Botol 0 0 0 0 0
VIII ANTI TUBERKULOSIS
1 Obat TB FDC Kategori I + III Paket - 0 0 0 0
2 Obat TB FDC Kategori II Paket - 0 0 0 0
3 Obat TB Kategori Anak Paket - 0 0 0 0
IX ANTI FUNGI
1 Griseofulvin 125 Mg Tablet Tablet 100 100 50 50 0
2 Nistatin 500,000 IU/g Tablet Salut Tablet 100 100 20 80 0
3 Nistatin 100,000 IU/g Tablet Vaginal Tablet 0 0 0 0 0
4 Ketokonasol Cream Tube 5 5 3 2 3
5 Miconazole Cream Tube 10 Gr 5 5 1 4 0
6 Ketokonasol 200 Mg Tablet Tablet 0 0 0 0 0
X ANTI MALARIA
1 Primakuine 15 Mg Tablet Tablet 0 0 0 0 0
XI ANTITUSIVA / EXPEKTORAN
1 Ambroxol 30 Mg Tablet Tablet 100 100 30 70 0
2 Dextrometorphan 15 Mg Tablet/ Dextral Tablet 0 0 0 0 0
3 Gliseril Guayakolat 100 Mg Tablet Tablet 0 0 0 0 0
4 Obat Batuk Hitam ( OBH ) Cairan Btl/100 Ml 3 3 1 2 3
XII ANTI ASTHMA
1 Aminophyllin 200 Mg Tablet Tablet 0 0 0 0 0
2 Aminophyllin 24 Mg/Ml-10 Ml Injeksi Ampul 0 0 0 0 0
3 Efedrin HCl 25 Mg Tablet Tablet 0 0 0 0 0
4 Salbutamol 2 Mg Tablet Tablet 100 100 0 100 0
5 Ventolin Nabulizer Buah 0 0 0 0 0
XIII ANTASIDA / ANTI ULKUS
1 Antasida DOEN Tablet Tablet 100 100 20 80 0
2 Antasida Suspensi Btl/60 Ml 5 5 1 4 0
3 Omeprazol 20 Mg Capsul Capsul 30 30 0 0 30
4 Ranitidine 150 Mg Tablet Tablet 100 100 20 80 0
5 Ranitidine Injeksi 25 Mg/2 Ml Ampul 0 0 0 0 0
XIV OBAT KARDIOVASKULER
1 Amlodipin 10 Mg Tablet Tablet 0 0 0 0 0
2 Furosemide 40 Mg Tablet Tablet 0 0 0 0 0
3 Hidroklortiazida 25 Mg Tablet Tablet 0 0 0 0 0
4 Isosorbid Dinitrat 5 Mg Tablet Tablet 0 0 0 0 0
5 Kaptopril 25 Mg Tablet Tablet 100 100 30 70 0
6 Nifedipin 10 Mg Tablet Tablet 0 0 0 0 0
 7 Propranolol HCl 40 Mg Tablet Tablet 0 0 0 0 0
XVI LARUTAN ELEKTROLIT,NUTRISI, DLL
1 Aqua Pro Injeksi Steril Vial 1 1 0 0 0
2 Aquadest Steril Btl 500Ml 0 0 0 0 0
3 Garam Oralit 200Ml Sachet 0 0 0 0 0
4 Glukosa 10% Larutan Infus Flacon 3 3 0 0 0
5 Glukosa 5% Larutan Infus Flacon 3 3 0 0 0
6 Natrium Klorida Lar.Infus 0,9% Steril Btl 500Ml 2 2 0 0 0
7 Ringer Laktat Larutan Infus Steril Botol/500ml 3 3 0 0 0
XVII ANTIMIGRAIN
1 Anti Migrain DOEN Komb. Ergotamin Cofein Tablet 0 0 0 0 0
XVIII DISINFEKTAN & ANTISEPTIK
1 Etakridin (Rivanol) Larutan 0,1% Btl 300Ml 0 0 0 0 0
2 Ethanol 70 % Btl/1.000 Ml 0 0 0 0 0
3 Ethanol 70 % Btl/100 Ml 0 0 0 0 0
4 Kalium Permanganat Serbuk Pot 0 0 0 0 0
5 Lisol mengandung Kresol Tersabun 50% Btl 1000Ml 0 0 0 0 0
6 Paraformaldehid Tablet Tablet 0 0 0 0 0
7 Povidon Iodida 10 % Btl 300Ml 0 0 0 0 0
8 Povidon Iodida 10 % Btl/30 Ml 0 0 0 0 0
9 Povidon Iodida 10 % Btl/60 Ml 0 0 0 0 0
XIX OBAT TOPIKAL / KULIT
1 Anti Bakteri DOEN Salep Komb.(Basitrasin) Tube 0 0 0 0 0
2 Antifungi DOEN Komb.(Salep 3-6%) Pot 3 3 0 3 0
3 Betametason 0,1% Cream sebagai valerat Tube 3 3 1 2 0
4 Gentamycin Salep Kulit Tube 5 Gr 3 3 0 3 0
5 Gentian Violet Larutan 1% Btl 10 Ml 3 3 1 2 0
6 Hidrokortison Cream 2,5% Tube 5 5 0 3 0
7 Icthyol Salep Pot 15 Gram 3 3 0 3 0
8 Levertran Salep Pot 15 Gram 0 0 0 0 0
9 Oxytetrasiklin HCl Salep Kulit 3% Tube 5 5 2 3 0
10 Salep 2 - 4 % Pot 2 2 0 2 0
11 Salicyl Spiritus 10 % Btl/30 Ml 0 0 0 0 0
12 Salicyl Talkum 2% Dos 3 3 1 2 0
XX OBAT MATA
1 Chloramfenikol Salep Mata 1% Tube/5 Gr 0 0 0 0 0
2 Chloramphenicol TM 1 % Botol 3 3 1 0 0
3 Oksitetrasikline HCl Salep Mata 1% Tube 0 0 0 0 0
4 Sulfacetamide TM Btl/5 Ml 0 0 0 0 0
XXI OBAT TELINGA
1 Chloramfenikol Tetes Telinga 3% Btl/10 Ml 1 1 0 1 0
2 Fenol Gliserol TT Botol 0 0 0 0 0
3 Karbogliserin Tetes Telinga 10 % Btl 0 0 0 0 0
XXII OKSITOSIK & RELAKSAN UTERUS
1 Methilergometrin Maleat Inj.0,200Mg-1Ml Ampul 0 0 0 0 0
 2 Methilergometrin Maleat Tab.Salut 0,125Mg Tablet 0 0 0 0 0
3 Oksitosin Injeksi Ampul 5 5 0 5 0
XXIII VITAMIN / OBAT ROBORANTIA
1 Asam Askorbat 50 Mg Tablet ( Vit. C ) Tablet 100 100 70 30 100
2 Besi II Sulfat + Asam Folat (SF/Tablet T Tablet 300 300 80 220 0
3 Fitomenadion 10Mg Tabl.Salut Gula ( Vit. K Tablet 0 0 0 0 0
4 Fitomenadion Inj.10Mg/Ml-1Ml ( Vit. K ) Ampul 0 0 0 0 0
5 Iodiol Capsul Lunak Capsul 0 0 0 0 0
6 Kalsium Laktate 500 Mg Tablet Tablet 100 0 0 0 100
7 Likurmin Syrup/Procurma Btl/100 Ml 0 0 0 0 0
8 Mineral Mix Sachet 0 0 0 0 0
9 Piridoksin HCl 10 Mg Tablet ( Vit. B 6 ) Tablet 0 0 0 0 0
10 Retinol 100,000 IU / Vit. A Capsul (Biru) Capsul 0 0 0 0 0
11 Retinol 200,000 IU / Vit. A Capsul (Merah) Capsul 0 0 0 0 0
12 Sianokobalamine 500mcg/ml-1ml Injeksi ( V Ampul 0 0 0 0 0
13 Thiamin HCl 100mg/ml-1ml Injeksi ( Vit. B Ampul 0 0 0 0 0
14 Thiamin HCl/Mononitrat 50 mg Tablet ( Vit. Tablet 0 0 0 0 0
15 Viferon Tablet/ Novabion Tablet 100 100 20 80 0
16 Vitamin B Complex Tablet Tablet 100 100 70 30 100
XXIV OBAT OBAT LAIN (PROG: KUSTA,KECACINGAN,KIA,DLL)
1 Magnesium Sulfat / MgSO4 ( IV ) 20 % - 25 Vial 0 0 0 0 0
2 Magnesium Sulfat / MgSO4 ( IV ) 40 % - 25 Vial 0 0 0 0 0
3 Magnesium Sulfat / MgSO4 Serbuk 30 gra Sachet 0 0 0 0 0
XXV OBAT ANTI DIARE, ANTIMUNTAH,ANTISPASMODIK,GGN SAL CERNA
1 Domperidon 10 Mg Tablet Tablet 0 0 0 0 0
2 Ekstrak Belladon 10 Mg Tablet Tablet 0 0 0 0 0
3 Karbo Adsorben ( Bekarbon ) Tablet Tablet 0 0 0 0 0
4 Loperamide 2 Mg Tablet Tablet 0 0 0 0 0
5 Metoclopropamide 10 Mg Tablet Tablet 0 0 0 0 0
6 Metoclopropamide Injeksi Ampul 0 0 0 0 0
7 Papaverine 40 Mg Tablet Tablet 0 0 0 0 0
8 Papaverine Injeksi Ampul 0 0 0 0 0
9 Zink 20 Mg/5 Ml Syrup Btl/60 Ml 0 0 0 0 0
10 Zink Dispersibel 20 Mg Tablet Tablet 100 100 20 80 100
XXVI OBAT ANTI VIRUS / HERPES
1 Acyclovir 400 Mg Tablet Tablet 0 0 0 0 0
2 Acyclovir Cream Tube 3 3 0 3 0
XXVII OBAT ANTI HEMOROID/WASIR
1 Anti Hemorroid DOEN Komb. Supp 0
XXVIII OBAT ANTI DEPRESAN,ANTIPSIKOSIS,PARKINSON,DIABETES MELITUS,HIPERTIROID,ANTIHIPOTIROID
1 Amitriptilin 25 Mg Tablet Tablet 0 0 0 0 0
2 Glibenklamide 5 Mg Tablet Tablet 0 0 0 0 0
3 Glimepiride 1 Mg Tablet Tablet 0 0 0 0 0
4 Glimepiride 2 Mg Tablet Tablet 0 0 0 0 0
5 Haloperidol 0,5 Mg Tablet Tablet 0 0 0 0 Dec-99
 7 Metformin HCl 500 Mg Tablet Tablet 0 0 0 0 0
8 Propiltiorasil 100 Mg Tablet Tablet 0 0 0 0 0
9 Triheksifenidil Hidroklorida 2Mg Tablet Tablet 0 0 0 0 0
XXIX BAHAN MEDIS HABIS PAKAI / PERBEKALAN KESEHATAN
1 Alat Suntik Sekali Pakai 0,05 Ml Buah 5 5 0 5 0
2 Alat Suntik Sekali Pakai 0,5 Ml Buah 5 5 0 5 0
3 Alat Suntik Sekali Pakai 1 Ml Buah 0 0 0 0 0
4 Alat Suntik Sekali Pakai 10 Ml Buah 5 5 0 5 0
5 Alat Suntik Sekali Pakai 2,5 Ml Buah 5 5 0 5 0
6 Alat Suntik Sekali Pakai 3 Ml Buah 0 0 0 0 0
7 Alat Suntik Sekali Pakai 5 Ml Buah 5 5 0 5 0
8 Blades FG 15 Buah 0 0 0 0 0
9 Blades FG 20 Buah 0 0 0 0 0
10 Cat Gut No.2/0 - 3/0 Sachet 0 0 0 0 0
11 Female Catheter FG 16 Pcs 0 0 0 0 0
12 Foley Catheter 2 Way 3 cc FG 10 Pcs 0 0 0 0 0
13 Foley Catheter 2 Way 3 cc FG 18 Pcs 0 0 0 0 0
14 Infus Set Anak Set 0 0 0 0 0
15 Infus Set Dewasa Set 5 5 0 5 0
16 IV Catheter No.18 G Pcs 0 0 0 0 0
17 IV Catheter No.20 G Pcs 2 2 0 2 0
18 IV Catheter No.22 G Pcs 0 0 0 0 0
19 IV Catheter No.24 G Pcs 0 0 0 0 0
20 Kapas Pembalut 250 Gram Bungkus 1 1 0 0 0
21 Kasa 2 M x 80 Cm Rol 1 1 0 0 0
22 Kasa 40 M x 80 Cm Roll 0 0 0 0 0
23 Kasa 16 M x 16 Cm Kotak 1 1 0 0 0
24 Kasa Kompres 40/40 Steril Bungkus 1 1 0 0 0
25 Masker Display 3 Play Set 0
26 Plester 5 yards x 2 inchi Rol 0 0 0 0 0
27 Sachet Obat Klips Buah 0 0 0 0 0
28 Silk/Benang Bedah Sutera No.3/0 Sachet 0 0 0 0 0
29 Surgical Glove Non Steril No.6 1/2/ M Pcs 0 0 0 0 0
30 Surgical Glove Non Steril No.7/ L Pcs 0 0 0 0 0
31 Surgical Glove Steril No. 7 1/2 Pcs 0 0 0 0 0
32 Surgical Glove Steril No.6 1/2 Pcs 0 0 0 0 0
33 Surgical Glove Steril No.7 Pcs 0 0 0 0 0
34 Surgical Glove Steril No.8 Pcs 0 0 0 0 0
35 Dipstik Sachet 0 0 0 0 0
36 HCG Test Set 10 0 0 0 10
37 Obyek Glass /Slide Dos/72 0 0 0 0 0
38 Sputum Pot Pot 0 0 0 0 0
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41 Jumlah kunjungan : 29
42 BPJS/KIS : 26
43 UMUM : 3
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Oenenu Selatan, 31 Maret 2019

Fransiska F F Atolan, SST.Keb

HIPOTIROID
Maret 2019

an, SST.Keb