No Nama Obat Satuan Stock Awal Penerimaan Pengeluaran Sisa Stock Harga (Rp) Total Harga

1 2 3 4 5 6 7 8 9
223 Yodium Povidon larutan 10% 30 ml Btl 113 951 954 110 2,100.0 231,000
224 Yodium Povidon larutan 10% 300 ml Btl 129 33 144 18 15,225.0 274,050
225 Zink Tab 100 - 100 - -
TOTAL 190,866,202

Mengetahui, Manna, Januari 2012

Kepala Dinas Kesehatan Kepala Gudang farmasi
Kabupaten Bengkulu Selatan, Kab. Bengkulu Selatan

Drs. YULIAN FAUZI, M.AP Drs. H. EDIWAN, Apt

NIP.196207061982011003 NIP. 195907051989111001
No Nama Obat Satuan Stock Awal Penerimaan Pengeluaran Sisa Stock Harga (Rp) Total Harga
1 2 3 4 5 6 7 8 9
208 Yodium Povidon larutan 10% 30 ml Btl 110 72 2,100.0 151,200
209 Yodium Povidon larutan 10% 300 ml Btl 18 15 15,225.0 228,375
210 Zink Tab - - -
160,149,671

Mengetahui, Manna, Januari 2012

Kepala Dinas Kesehatan Kepala Gudang farmasi
Kabupaten Bengkulu Selatan, Kab. Bengkulu Selatan

Drs. YULIAN FAUZI, M.AP Drs. H. EDIWAN, Apt

NIP.196207061982011003 NIP. 195907051989111001
 Stock
No Nama Obat Satuan Penerimaan Pengeluaran Sisa Stock Harga (Rp) Total Harga
Awal
1 2 3 4 5 6 7 8 9
176 Tiamin HCl/Mononitrat (Vit B1) tablet 50 Tab 22,187 51,000 51,497 21,690 37.0 802,530
177 Triheksifenidil Hidroklorida tablet 2 mg Tab 6,584 4,500 8,257 2,827 42.8 120,996
178 Tramandol 50 mg Tab 2,610 12,600 12,085 3,125 346.5 1,082,813
179 Urin Bag Pcs 405 356 49 4,000.0 196,000
180 Vaksin Rabies Vero Set 103,000 103,000 - 420,000.0 -
181 Vitamin B Kompleks tablet Tab 38,262 103,000 117,832 23,430 23.3 545,919
182 Wings Set Buah 47 150 165 32 5,497.5 175,920
183 Yodium Povidon larutan 10% 30 ml Btl 110 837 850 97 2,100.0 203,700
184 Yodium Povidon larutan 10% 300 ml Btl 18 110 112 16 15,225.0 243,600
185 Zink Tab - - - -
171,964,458

Mengetahui, Manna, Januari 2013

Kepala Dinas Kesehatan Kepala Gudang farmasi
Kabupaten Bengkulu
Selatan, Kab. Bengkulu Selatan

Drs. YULIAN FAUZI, M.AP Drs. H. EDIWAN, Apt

NIP.196207061982011003 NIP. 195907051989111001
No Nama Obat Satuan Stock Awal Penerimaan Pengeluaran Sisa Stock

1 2 3 4 5 6 7
171 Temporary Stopping Fletcher Set 1 - - 1
172 Tetrasiklin HCl Kapsul 250 mg Kaps 28,329 20,000 30,884 17,445
173 Tetrasiklin HCl Kapsul 500 mg Kaps 20,200 15,540 4,660
174 Thiamfenikol Tab 500 mg Tab 4,678 3,400 3,598 4,480
175 Tiamin HCl (Vit B1) inj 50 mg/ml- 1ml Ampl 60 2,250 1,949 361
176 Tiamin HCl/Mononitrat (Vit B1) table Tab 22,187 51,000 51,497 21,690
177 Tramandol 50 mg Tab 2,610 12,600 12,085 3,125
178 Triheksifenidil Hidroklorida tablet 2 Tab 6,584 4,500 8,257 2,827
179 Urin Bag Pcs 405 356 49
180 Vaksin Rabies Vero Set 243 243 -
181 Vitamin B Kompleks tablet Tab 38,262 103,000 117,832 23,430
182 Wings Set Buah 47 150 165 32
183 Yodium Povidon larutan 10% 30 ml Btl 110 837 850 97
184 Yodium Povidon larutan 10% 300 ml Btl 18 110 112 16

Manna, Januari 2013

Kepala Gudang farmasi
Kab. Bengkulu Selatan

Drs. H. EDIWAN, Apt

NIP. 195907051989111001
126 Miconazol Cream tub 10 g Tub 138 - 138 3,150.0 434,700
127 Mummifying Pasta Btl 16 - 1 15 176,000.0 2,640,000
128 Natrium Bikarbonat tablet 500 mg Tab - 50,000 - 50,000 15.0 750,000
129 Natrium diklofenak tablet 25 mg Tab 12,350 45,000 32,350 25,000 176.1 4,402,500
130 Natrium Klorida Lart Inf 0,9 % Btl 64 700 64 700 5,145.0 3,601,500
131 Nipedipin Tab - 4,300 - 4,300 135.4 582,220
132 Nistatin tablet vaginal 100.000 IU/g Tab 300 300 - 362.3 -
133 Nistatin tablet salut 500.000 IU Tab 300 300 - 577.5 -
134 Obat Batuk Hitam (OBH) cairan Btl 1,980 3,000 1,980 3,000 1,575.0 4,725,000
135 Oksitetrasiklin HCl inj im 50 mg/ml-10 ml Vial - 750 - 750 3,255.0 2,441,250
136 Oksitetrasiklin salep 3 % Tub 6,000 1,350 2,500 4,850 1,758.8 8,530,180
137 Oksitetrasilin HCl salep mata 1 % Tub 2,650 1,400 1,250 2,800 2,016.0 5,644,800
138 Oksitosin inj 10 IU/ml-1ml Ampl 4,450 1,500 1,870 4,080 1,874.3 7,647,144
139 Omeprazol 20 mg Kaps 1,260 - 1,260 428.7 540,162
140 Parasetamol sirup 120mg - 5 ml Btl 2,075 3,500 2,075 3,500 2,415.0 8,452,500
141 Parasetamol tablet 100 mg Tab 27,000 21,000 25,800 22,200 39.9 885,780
142 Parasetamol Tablet 500 mg Tab 346,000 300,000 204,500 441,500 110.3 48,697,450
143 Pirantel tab 365 mg Tab 10,000 - 4,100 5,900 304.5 1,796,550
144 Piridoksin HCl (Vit B6) tablet 10 mg Tab 271,000 36,000 44,000 263,000 15.0 3,945,000
145 Plester 5 yards x 2 inch Rol 247 400 244 403 23,625.0 9,520,875
146 Prednison tab 5 mg Tab 113,000 - 88,000 25,000 60.4 1,510,000
147 Primakuin tab 15 mg Tab - 75,000 - 75,000 106.9 8,017,500
148 Propiltiourasil tablet 100 mg Tab 18,200 18,500 12,200 24,500 314.6 7,707,700
149 Propranolol HCl tablet 40 mg Tab - 20,000 - 20,000 127.1 2,542,000
150 Ranitidin tablet 150 mg Tab 19,700 70,000 19,700 70,000 220.5 15,435,000
151 Reserpin tablet 0,1 mg TAb 79.0 -
152 Reserpin tablet 0,25 mg Tab 50,000 - 11,000 39,000 92.4 3,603,600
153 Retinol (Vitamin A) 200.000 IU Kaps 38,500 - 38,500 485.1 18,676,350
154 Retinol (Vitamin A) 100.000 IU 7,750 - 7,750 300.3 2,327,325
155 Ringer Laktat Lart Inf steril Btl - 970 232 738 5,460.0 4,029,480
156 Salbutamol tablet 2 mg Tab 57,000 - 29,800 27,200 88.2 2,399,040
157 Salep 2-4(As Salisilat2%+Blrng endap 4%) Pot 2,568 840 1,752 1,656 1,290.6 2,137,234
158 Salisil Bedak 2 % Ktk 1,190 1,000 999 1,191 1,155.0 1,375,605
159 Sefadroksil 500 Kaps - 40,000 - 40,000 882.0 35,280,000
160 Sefadroxyl Syr kering 125 mg/5 ml Btl 140 - 140 8,610.0 1,205,400
161 Sefiksim kapsul 100 mg Kaps - 12,500 - 12,500 2,514.3 31,428,750
162 Semen Seng Fosfat serbuk dan cair Set 19 10 4 25 93,500.0 2,337,500
163 Serum Anti Bisa Ular Polivalen inj 5 ml I Vial 100 60 100 60 229,000.0 13,740,000
164 Serum Anti Tetanus inj 1500 IU/amp ATS Ampl 270 100 120 250 50,000.0 12,500,000
165 Serum Anti Tetanus inj 20000 IU/Vial Vial 100 60 100 60 340,000.0 20,400,000
166 Sianokobalamin (VitB12) inj 500 mcg-ml Ampl 4,800 11,200 4,900 11,100 1,018.5 11,305,350
167 Silk (Benang Bedah Sutera) No. 3/0 Sak 6,304 612 611 6,305 6,983.3 44,029,707
168 Sulfasetamit Natrium tetes mata 15 % Btl 1,200 - 314 886 3,617.5 3,205,105
169 Simvastatin Tab 8,800 - 3,350 1,077.7 3,610,295
170 Tablet Tambah Darah kombinasi Tab 75,000 120,000 75,000 120,000 70.0 8,400,000
171 Temporary Stopping Fletcher Set - 30 - 30 34,000.0 1,020,000
172 Tetrasiklin HCl Kapsul 250 mg Kaps 79,000 105,000 20,000 164,000 159.6 26,174,400
173 Tetrasiklin HCl Kapsul 500 mg Kaps 50,000 20,000 20,200 49,800 262.5 13,072,500
174 Tiamfenikol Tab 3,400 12,500 3,400 12,500 609.0 7,612,500
175 Tiamin HCl (Vit B1) inj 50 mg/ml- 1ml Ampl 6,000 4,500 2,250 8,250 735.0 6,063,750
176 Tiamin HCl/Mononitrat (Vit B1) tablet 50 Tab 221,000 159,000 51,000 329,000 37.0 12,173,000
177 Tramadol tablet 50 mg Tab 10,500 10,000 4,500 16,000 346.5 5,544,000
178 Triheksifenidil Hidroklorida tablet 2 mg Tab 12,600 25,000 12,600 25,000 42.8 1,070,000
179 Urine Bag Pcs - 200 - 200 -
180 Vaksin Rabies Vero Ampl 243 700 243 700 420,000.0 294,000,000
181 Vitamin B Kompleks tablet Tab 265,000 150,000 103,000 312,000 23.3 7,269,600
182 Wing Set No. 25 Buah 120 480 150 450 5,497.5 2,473,875
183 Yodium Povidon larutan 10% 30 ml Btl 1,032 500 837 695 2,100.0 1,459,500
184 Yodium Povidon larutan 10% 300 ml Btl 203 150 110 243 15,225.0 3,699,675
JUMLAH 2,071,823,597

Manna, Januari 2013

Kepala Gudang farmasi
Kab. Bengkulu Selatan

Drs. H. EDIWAN, Apt

NIP. 195907051989111001
 LEMBAR PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
Kode Puskesmas LB 2
Nama Puskesmas : ANGGUT BULAN : Desember
Kecamatan : PINO TAHUN : 2017
Jumlah Puskesmas :
Kabupaten : BENGKULU SELATAN
Provinsi : BENGKULU
STOCK SISA PEMBERIAN
KODE NAMA OBAT KEMASAN SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN STOCK OPT PERMINTAAN KET
AWAL STOCK PKD ASKES LAIN JML
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
0001 Epineprine 1 ml ktk ampl
0002 dexametasone 5 mg/ml ktk tab

Anggut, 30 Desember 2017

Mengetahui, YANG MEMINTA/MELAPOR YANG MENERIMA LAPORAN
KEPALA PUSKESMAS ANGGUT POLIKLINIK GUDANG OBAT

RIDUWAN, M.K.M FEBDIARNI, SKM

NIP. 19790401 200212 1 005 NIP.19840229 201001 2 004
 STOCK SISA PEMBERIAN
KODE NAMA OBAT KEMASAN SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN STOCK OPT PERMINTAAN KET
AWAL STOCK PKD ASKES LAIN JML
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Mengetahui,
KEPALA DINAS KESEHATAN YANG MENYERAHKAN
KAB. BENGKULU SELATAN KEPALA GFK

(......................................................) (.............................................)
NIP. NIP.
 STOCK SISA PEMBERIAN
KODE NAMA OBAT KEMASAN SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN STOCK OPT PERMINTAAN KET
AWAL STOCK PKD ASKES LAIN JML
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Anggut, 03 september 2018

YANG MEMINTA/MELAPOR YANG MENERIMA
KEPALA PUSKESMAS PETUGAS PUSKESMAS

( RIDUWAN, M.KM) ( FEBDIARNI, S.KM)

NIP.197904012002121005 NIP.198429022010012004
Sisa Stock Kosong
S.O = SK+WT+WK+SP
Contoh:

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