LAPORAN PEMAKAIAN DAN LEMBAR P

PUSKESMAS
PUSKESMAS : CIKANCUNG
KECAMATAN : CIKANCUNG
KABUPATEN : BANDUNG
PROPINSI : JAWA BARAT

STOK
NO NAMA OBAT SATUAN PENERIMAAN
AWAL
1 2 3 4 5
OBAT
1 Alopurinol Tablet 100 mg Tablet 7,754 -
2 Ambroksol Sirup 15 mg/ 5 ml Botol 784 -
3 Ambroksol Tablet 30 mg Tablet 4,260 -
4 Amlodipin Tablet 10 mg Tablet - 3,000
5 Amlodipin Tablet 5 mg Tablet 2,490 7,200
6 Amoksisilin Injeksi 1000 mg/ml Ampul 20 -
7 Amoksisilin Kaplet 500 mg Kaplet 5,600 15,000
8 Amoksisilin Kapsul 250 mg Kapsul - -
9 Amoksisilin Sirup Kering 125 mg/5 ml Botol - 500
10 Amoksisilin Sirup Kering 250 mg/5 ml Botol 26 600
11 Antalgin Tablet 500 mg Tablet - -
12 Antasida Doen Suspensi Botol 327 300
13 Antasida Doen Tablet Kunyah Tablet 15,090 5,000
14 Antidiare Nonspesifik, Attalpulgit Tablet / Puralex / Alkita Tablet - -
15 Antifungi Doen Salep Kombinasi Tube 158 -
16 Antihemoroid Doen Suppositoria Suppo - 50
17 Aqua Pro Injeksi Steril Bebas Pirogen Ampul 40 -
18 Asam Asetilsalisilat Tablet 100 mg Tablet - -
19 Asam Askorbat (Vit. C) Tablet 50 mg Tablet 3,200 -
20 Asam Folat Tablet 1 mg Tablet 1,730 -
21 Asam Mefenamat Tablet 500 mg Tablet 1,640 9,600
22 Asiklovir Krim 5% Tube 506 -
23 Asiklovir Tablet 400 mg Tablet 790 -
24 Atropin Injeksi 0,25mg - 1ml Ampul - -
25 Besi (Fe) Kombinasi Asam Folat Tablet Sachet 20,670 -
26 Betametason Krim 0.1 % Tube 240 250
27 Bisakodil 10 ml / Sitolac Supp Suppo - -
28 Cefixim Kapsul 100 mg Kapsul - -
29 Deksametasone Injeksi 5 mg Ampul 100 -
30 Deksametasone Tablet 0,5 mg Tablet 5,286 5,000
31 Diazepam Injeksi 5 mg/ml Tablet -
32 Diazepam Rectal 5 mg Tablet -
33 Diazepam Tablet 2 mg Tablet -
34 Domperidon Tablet 10 mg Tablet -
35 Dopamet Tablet - -
 STOK
NO NAMA OBAT SATUAN PENERIMAAN
AWAL
1 2 3 4 5
OBAT
36 Doxycyclin 100 mg Tablet - -
37 Ekstrak Beladonna Tablet 10 mg Tablet - -
38 Epinefrin HCL Injeksi 0,1% - 1 ml Ampul 60 100
39 Eritromisin Kapsul 500 mg Tablet - 1,000
40 Eritromisin Sirup 200 mg/ 5 ml Botol - -
41 Etakridin (Rivanol) 0,1% Botol 372 -
42 Etanol (Alkohol) 70 % - 100 ml Botol - -
43 Fenilbutazon Tablet 200 mg Tablet - -
44 Fenobarbital Injeksi 50 mg/ml Ampul - -
45 Fenobarbital Tablet 30 mg Tablet 120 300
46 Fenol Gliserol Tetes Telinga 10% Botol - -
47 Fitomenadion ( Vit K) Injeksi 2 mg Ampul 30 300
48 Fitomenadion (Vit K) Injeksi 10 mg/ ml Ampul - -
49 Fitomenadion (Vit. K) Tablet 10 mg Tablet 1,995 -
50 Furosemid Injeksi 10 mg/ml-2 ml Ampul - -
51 Furosemida Tablet 40 mg Tablet 915 -
52 Garam Oralit II (200ml) Serbuk Sachet 3,107 -
53 Gentamisin Injeksi 80 mg/ 2,5 ml Ampul 20 50
54 Gentamisin Salep Kulit 0,1 % Tube 399 -
55 Gentamisin Tetes Mata Botol - -
56 Gentian Violet Larutan 1% Botol 192 -
57 Glibenklamid Tablet 5 mg Tablet 1,750 -
58 Glimepirid Tablet 2 mg Tablet 5,630 -
59 Gliserin Larutan 100 ml Botol 46 -
60 Gluconas Kalsikus Injkesi 10% - 10 ml Vial 62 -
61 Glukosa Larutan Steril Infus 5% Botol - 100
62 Griseofulvin Tablet 125 mg Tablet 1,000 -
63 Griseril Guaiakolat Tablet 100 mg Tablet 16,000 -
64 Hidrochlortiazid (HCT) Tablet 25 mg Tablet 3,350 -
65 Hidrokortison Krim 2,5% Tube 137 192
66 Ibuprofen Suspensi 100 mg/5ml Botol 258 -
67 Ibuprofen Tablet 200 mg Tablet - -
68 Ibuprofen Tablet 400 mg Tablet - 3,700
69 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet - -
70 Kalsium Laktat (Kalk) Tablet 500 mg Tablet 10,510 3,000
71 Kaptopril Tablet 12.5 mg Tablet 6,180 -
72 Kaptopril Tablet 25 mg Tablet 15,240 -
73 Karbamazepine Tablet 200 mg Tablet - -
74 Ketokonazole Tablet 200 mg Tablet 2,620 -
75 Kloramfenicol Kapsul 250 mg Kapsul - -
76 Kloramfenicol Salep Kulit 2% Tube 612 -
77 Kloramfenicol Tetes Mata 0,5% Tube 201 -
78 Kloramfenikol Salep Mata 1 % Botol 651 -
79 Kloramfenikol Suspensi 60 ml Botol - -
 STOK
NO NAMA OBAT SATUAN PENERIMAAN
AWAL
1 2 3 4 5
OBAT
80 Kloramfenikol Tetes Telinga 3% Botol - -
81 Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 18,830 -
82 Kotrimoksazol Suspensi 60 ml Botol 806 -
83 Kotrimoxazol Tablet 120 mg Tablet - -
84 Kotrimoxazol Tablet 480 mg Tablet 4,590 -
85 KSR Tablet 860 -
86 Larutan Desinfektan Klorin Botol - -
87 Laxadine Botol - -
88 Lidocain Injeksi 2 % - ml Ampul 90 300
89 Lidokain Komb. Epinefrin Injeksi Ampul - -
90 Lisol Desinfektan C 1000 Botol 28 4
91 Lodecon Forte Tablet - -
92 Sofra-tulle Lbr 70 -
93 Magnesium Sulfat Injeksi 20% Vial 30 -
94 Magnesium Sulfat Injeksi 40% Vial - 20
95 Mebendazol Syrup 100 mg/5 ml-60 ml Botol - -
96 Albendazol 400 mg Tablet 30 -
97 Meloksikam Tablet 15 mg Tablet 5,750 -
98 Metformin Tablet 500 mg Tablet - 10,000
99 Metilergometrin Maleat Inj. 0,2 mg/ml Ampul - 200
100 Metilergometrin Maleat Tab. Sal. 0,125 mg Tablet 1,060 -
101 Metilprednisolon Tablet 4 mg Tablet - 3,000
102 Metilprednisolon Tablet 8 mg Tablet - -
103 Metoklorpramid Injek 5 mg / ml Ampul - -
104 Metoklorpramid Tablet 10 mg / Noristal Tablet 90 -
105 Metronidazole Tablet 500 mg Tablet 205 1,000
106 Mikonazol Krim 2% Salep Kulit Tube 294 -
107 Natrium Bikarbonat Tablet 500 mg / BICNAT Tablet 360 -
108 Natrium Diklofenak Tablet 50 mg Tablet - 8,400
109 Natrium Klorida Larutan Infus 0,9% Botol 80 -
110 Nifedipine Tablet 10 mg Tablet 183 -
111 Nistatin Tablet 500.000 IU Tablet 540 -
112 Nistatin Tablet Vaginal 100.000 IU Tablet 461 -
113 Obat Batuk Hitam Sirup 100 ml Botol - -
114 Ofloxacin 200 mg Tablet - -
115 Ofloxacin 400 mg Tablet - -
116 Oksitetrasiklin HCL Salep Kulit 3% Tube - -
117 Oksitetrasiklin HCL Salep Mata 1 % Botol - -
118 Oksitosin Injeksi 10 IU/ml Ampul - 200
119 Omeprazole Kapsul 20 mg Kapsul - -
120 Ondansetron Injeksi Ampul 45 -
121 Parasetamol Drop Tetes 60 mg/0,6 ml Botol 345 -
122 Parasetamol Sirup 120 mg/ 5 ml Botol 818 500
123 Parasetamol Tablet 100 mg Tablet - -
 STOK
NO NAMA OBAT SATUAN PENERIMAAN
AWAL
1 2 3 4 5
OBAT
124 Parasetamol Tablet 500 mg Tablet 14,920 16,800
125 Pirantel Pamoat Tablet 125 mg Tablet - -
126 Piridoxin HCL (Vit. B6) Tablet 10 mg Tablet 26,080 -
127 Piroxicam Kapsul 20 mg Kapsul 19,670 -
128 Povidon Iodida Larutan 10% 30 ml Botol - -
129 Povidon Iodida Larutan 10% 300 ml Botol 16 10
130 Prednisone Tablet 5 mg Tablet 5,876 -
131 Propanolol Tablet 10 mg Tablet 400 -
132 Ranitidin Injeksi 25 mg/ ml Ampul 75 -
133 Ranitidin Injeksi 25 mg/ ml Ampul - -
134 Ranitidine Tablet 150 mg Tablet 5,920 10,000
135 Retinol Kapsul Lunak 200.000 IU ( Vit. A ) Sotfcap 250 -
136 Ringer Laktat Larutan Infus 500 ml Botol - 260
137 Salbutamol Inhasi 100 Mcg Can - -
138 Salbutamol Nebulizer 1 mg/NaCl 2,5 ml Ampul - -
139 Salbutamol Plus Ipratonium Nebulizer Ampul - -
140 Salbutamol Tab 4 mg Tablet 1,240 -
141 Salbutamol Tablet 2 mg Tablet 5,620 -
142 Salep 2-4 Kombinasi Tube 95 -
143 Bioplasenton Gel Tube 10 -
144 Salisil Talk 2% - 50 Gram Kotak 31 200
145 Scabimite Salep Kulit Tube - -
146 Sefadroksil Kapsul 500 mg Kapsul - 20,000
147 Sefadroxil Syrup Kering 125 mg/ 5 ml Botol - -
148 Sefadroxil Syrup Kering 250 mg/ 5 ml Botol - -
149 Sianokobalamin Tablet 50 mcg (Vit. B.12) Tablet - -
150 Simvastatin Tablet 10 mg Tablet 2,060 1,680
151 Siprofloksasin Tablet 500 mg Tablet 2,430 -
152 Sodium Bicarbonat / Melon Injeksi Ampul - -
153 Sulfasetamid Natrium Tetes Mata 15% Botol - -
154 Tetrasiklin Kapsul 250 mg Kapsul - -
155 Tetrasiklin Kapsul 500 mg Kapsul 4,000 -
156 Tiamfenikol Kapsul 500 mg Kapsul - -
157 Tiamin HCL Tablet 50 mg ( Vit. B1 ) Tablet 4,810 -
158 Ventolin Nebu Botol - -
159 Vitamin B Komplek Tablet Tablet 30,710 -
160 Zink Sirup 20 mg/5 ml - 60 ml Botol - -
161 Zink Tablet 50 mg Dispersible Tablet 4,826 3,000
162 Genoint / Gentamicin Tetes Mata Botol - -
163 Sodium Tetraborate 5 % Botol 34 -
164 Retinol Kapsul Lunak 100.000 IU ( Vit. A ) Kapsul - -
165 Colfin Syrup Botol - -
166 New Chlorkol Syrup Botol - -
167 Kaotin Botol 101 -
 STOK
NO NAMA OBAT SATUAN PENERIMAAN
AWAL
1 2 3 4 5
OBAT
168 Caviplex Drop Botol - -
169 Caviplex Kapsul Botol - -
170 Ailin Tetes Mata Botol 54 -
171 Pasaba Syrup Botol 59 -
172 Corsaneuron Tablet 9,100 -
173 Fervital Kapsul Kapsul 7,130 -
174 Novadryl Syrup 60 ml Botol 3 -
175 Neurotropik Injek Vial 30 -
176 Nocandis Drops Botol 50 -
177 Alletrol Compositum TM Botol - -
178 Betadine Salep Tube 51 -
179 Domperidon Syrup 5 mg / 5 ml Botol 151 -
180 Ketokonazol Cream Tube 590 -
181 Kalium Diklofenak 50 mg Tablet - -
182 Citirizine Tablet 4,910 -
183 Clindamicyn 150 mg Kapsul 40 -
184 Etanol 1 Liter Botol 7 40
185 Betason N Tube 500 -
186 Asam Traneksamat Injek Ampul 40 -
187 Larutan Klorin (Byclean) Botol - -
188 Gentamisin Salep Mata Tube 240 -
189 Grahabion Tablet 5,640 -
190 Teosal Tablet 9,910 -
191 Biovitan Botol 593 -
192 Flucadex Tablet 29 -
193 Citirizine Syrup Botol 9 -
194 Tropidryl Syrup Botol 674 1,848
195 Pramolta Botol 244 2,416
196 Corsagrip Tablet 26,970 -
197 New Diatab Tablet 4,360 -
BMHP
242 Alat Suntik Sekali Pakai 1 Ml Set 800 500
243 Alat Suntik Sekali Pakai 10 Ml Set - -
244 Alat Suntik Sekali Pakai 3 Ml Set 100 500
245 Alat Suntik Sekali Pakai 5 Ml Set - -
246 Bisturi Set - -
247 Catgut/Benang Bedah No.2/0 Set - -
248 Catgut/Benang Bedah No.3/0 Set - -
249 Foley Catheter 16 Set - -
250 Foley Catheter 18 Set - -
251 Foley Catheter 20 Set - -
252 Infusion Set Anak Set - -
253 Infusion Set Dewasa Set 460 -
254 IV. Catheter No. 18 Set 600 -
 STOK
NO NAMA OBAT SATUAN PENERIMAAN
AWAL
1 2 3 4 5
OBAT
255 IV. Catheter No. 20 Set 500 -
256 IV. Catheter No. 22 Set - -
257 IV. Catheter No. 24 Set - -
258 Kapas Pembalut/Absorben 250 Gram Roll 4 40
259 Kasa Gulung 36 M X 80 Cm Roll 9 5
260 Kasa Pembalut Hidrofil 4 M X 10 Cm Bks 495 -
261 Kasa Pembalut Hidrofil 4 M X 5 Cm Bks 500 -
262 Kasa Sterill 16 X 16 Cm Kotak 325 -
263 Kassa Steril Antibiotik Framisetin Lbr - -
264 Masker 3 Ply Lbr 1,300 500
265 Masker N 95 Lbr - -
266 Mucous Ekstraktor/Slem Seccher Dispos. Set - -
267 Plester 5 Yards X 2 Inch Roll 33 -
268 Sarung Tangan Non Steril Psg 20,580 1,000
269 Sarung Tangan Panjang (Obgyn) Psg - -
270 Sarung Tangan Steril Disposible Psg 150 -
271 Silk No. 3/0 Dengan Jarum Bedah Set 18 -
272 Slang/ Canula Oksigen Anak Set - -
273 Slang/ Canula Oksigen Dewasa Set - -
274 Tissu Gulung Roll - -
275 Umbilical Klem Set - -
276 Underpad (Non Woven) Steril 60 X 90 Set 240 -
277 Urine Bag Set 200 -
290 Alat Suntik Sekali Pakai 0.5 Ml Pcs 7,400 -
291 Alat Suntik Sekali Pakai 0.05 Ml Pcs - -
292 Medittol Hand Sanitizer Jrg 4 -
356 Polybag sampah/limbah warna hitam Lbr - 2
357 Polybag sampah/limbah warna kuning Lbr - -

UMUM
BAYAR TIDAK BAYAR
JUMLAH KUNJUNGAN RESEP
JUMLAH RESEP 1,293 2,

Mengetahui / Menyetujui ;
Kepala Puskesmas Cikancung

drg. Mia Puspitawati

NIP. 19750107 200501 2 005
N LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKESMAS
PELAPORAN BULAN / PERIODE : AGUSTUS 2019
PERMINTAAN BULAN / PERIODE : -

STOK PEMBERIAN
PERSEDIAAN PEMAKAIAN STOK OPT. PERMINTAAN KET.
AKHIR BLUD DAK APBD 1 LAIN
6 7 8 9 10 11 12 13 14 15
OBAT
7,754 50 7,704 100 -
784 316 468 632 BLUD
4,260 780 3,480 1,560 -
3,000 540 2,460 1,080 -
9,690 3,640 6,050 7,280 -
20 - 20 - -
20,600 10,870 9,730 21,740 -
- - - - -
500 237 263 474 -
626 112 514 224 -
- - - - -
627 70 557 140 -
20,090 2,100 17,990 4,200 -
- - - - BLUD
158 - 158 - -
50 48 2 96 -
40 - 40 - -
- - - - -
3,200 2,960 240 5,920 -
1,730 260 1,470 520 -
11,240 6,440 4,800 12,880 -
506 29 477 58 -
790 140 650 280 -
- - - - -
20,670 5,190 15,480 10,380 -
490 114 376 228 -
- - - - -
- - - - -
100 - 100 - -
10,286 2,120 8,166 4,240 -
- - - - -
- - - - -
- - - - -
- - - - BLUD
- - - - -
 STOK PEMBERIAN
PERSEDIAAN PEMAKAIAN STOK OPT. PERMINTAAN KET.
AKHIR BLUD DAK APBD 1 LAIN
6 7 8 9 10 11 12 13 14 15
OBAT
- - - - -
- - - - -
160 - 160 - BLUD
1,000 - 1,000 - -
- - - - BLUD
372 - 372 - -
- - - - BLUD
- - - - -
- - - - -
420 210 210 420 -
- - - - -
330 30 300 60 -
- - - - -
1,995 60 1,935 120 -
- - - - -
915 140 775 280 -
3,107 345 2,762 690 -
70 - 70 - -
399 107 292 214 -
- - - - -
192 1 191 2 -
1,750 40 1,710 80 -
5,630 110 5,520 220 -
46 - 46 - -
62 - 62 - -
100 20 80 40 -
1,000 - 1,000 - -
16,000 1,540 14,460 3,080 -
3,350 20 3,330 40 -
329 55 274 110 -
258 18 240 36 -
- - - - -
3,700 750 2,950 1,500 -
- - - - -
13,510 3,640 9,870 7,280 -
6,180 320 5,860 640 -
15,240 30 15,210 60 -
- - - - -
2,620 40 2,580 80 -
- - - - BLUD
612 6 606 12 -
201 5 196 10 -
651 41 610 82 -
- - - - -
 STOK PEMBERIAN
PERSEDIAAN PEMAKAIAN STOK OPT. PERMINTAAN KET.
AKHIR BLUD DAK APBD 1 LAIN
6 7 8 9 10 11 12 13 14 15
OBAT
- - - - -
18,830 530 18,300 1,060 -
806 23 783 46 -
- - - - -
4,590 80 4,510 160 -
860 95 765 190 -
- - - - -
- - - - -
390 - 390 - -
- - - - -
32 - 32 - -
- - - - -
70 - 70 - -
30 - 30 - -
20 - 20 - -
- - - - -
30 - 30 - -
5,750 240 5,510 480 -
10,000 3,260 6,740 6,520 -
200 - 200 - -
1,060 20 1,040 40 -
3,000 30 2,970 60 -
- - - - -
- - - - -
90 - 90 - -
1,205 600 605 1,200 -
294 60 234 120 -
360 - 360 - -
8,400 1,408 6,992 2,816 -
80 - 80 - -
183 120 63 240 -
540 - 540 - -
461 20 441 40 -
- - - - -
- - - - -
- - - - BLUD
- - - - -
- - - - BLUD
200 - 200 - -
- - - - -
45 - 45 - -
345 26 319 52 -
1,318 245 1,073 490 -
- - - - -
 STOK PEMBERIAN
PERSEDIAAN PEMAKAIAN STOK OPT. PERMINTAAN KET.
AKHIR BLUD DAK APBD 1 LAIN
6 7 8 9 10 11 12 13 14 15
OBAT
31,720 6,110 25,610 12,220 -
- - - - -
26,080 2,170 23,910 4,340 -
19,670 2,300 17,370 4,600 -
- - - - -
26 2 24 4 -
5,876 1,530 4,346 3,060 -
400 200 200 400 -
75 - 75 - -
- - - - -
15,920 2,848 13,072 5,696 -
250 - 250 - -
260 40 220 80 -
- - - - BLUD
- - - - -
- - - - -
1,240 190 1,050 380 -
5,620 1,120 4,500 2,240 -
95 49 46 98 -
10 1 9 2 BLUD
231 40 191 80 -
- - - - BLUD
20,000 402 19,598 804 -
- - - - -
- - - - -
- - - - -
3,740 290 3,450 580 BLUD
2,430 78 2,352 156 BLUD
- - - - BLUD
- - - - BLUD
- - - - BLUD
4,000 - 4,000 - -
- - - - -
4,810 1,270 3,540 2,540 -
- - - - -
30,710 4,060 26,650 8,120 -
- - - - -
7,826 720 7,106 1,440 -
- - - - -
34 19 15 38 -
- - - - -
- - - - -
- - - - -
101 1 100 2 -
 STOK PEMBERIAN
PERSEDIAAN PEMAKAIAN STOK OPT. PERMINTAAN KET.
AKHIR BLUD DAK APBD 1 LAIN
6 7 8 9 10 11 12 13 14 15
OBAT
- - - - -
- - - - -
54 15 39 30 -
59 - 59 - -
9,100 815 8,285 1,630 -
7,130 2,740 4,390 5,480 BLUD
3 - 3 - -
30 - 30 - -
50 3 47 6 -
- - - - -
51 - 51 - -
151 11 140 22 -
590 18 572 36 -
- - - - -
4,910 1,655 3,255 3,310 -
40 - 40 - -
47 2 45 4 -
500 - 500 - -
40 - 40 - -
- - - - -
240 - 240 - -
5,640 130 5,510 260 -
9,910 - 9,910 - -
593 350 243 700 BLUD
29 - 29 - -
9 - 9 - -
2,522 142 2,380 284 -
2,660 578 2,082 1,156 BLUD
26,970 3,130 23,840 6,260 -
4,360 380 3,980 760 -
BMHP
1,300 100 1,200 200
- - - -
600 100 500 200
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
460 40 420 80
600 - 600 -
 STOK PEMBERIAN
PERSEDIAAN PEMAKAIAN STOK OPT. PERMINTAAN KET.
AKHIR BLUD DAK APBD 1 LAIN
6 7 8 9 10 11 12 13 14 15
OBAT
500 - 500 -
- - - -
- - - -
44 2 42 4
14 - 14 -
495 - 495 -
500 - 500 -
325 20 305 40
- - - -
1,800 150 1,650 300
- - - -
- - - -
33 2 31 4
21,580 1,101 20,479 2,202
- - - -
150 - 150 -
18 5 13 10
- - - -
- - - -
- - - -
- - - -
240 40 200 80
200 - 200 -
7,400 - 7,400 -
- - - -
4 - 4 -
2 - - -
- - - -

UM
JUMLAH
TIDAK BAYAR

2,551 3,844
Cikancung, Agustus 2019

Pengelola Obat

Husni Ahmad Khusaeri, S.Si., Apt.

NRP : 873.04.01.020