LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

SUB-UNIT PELAYANAN TAHUN 2017

SUB UNIT : LANSIA

PUSKESMAS : GURAH
KECAMATAN : GURAH
KABUPATEN : KEDIRI
PELAPORAN BULAN/PERIODE : JANUARI 2017

STOK PENERIM PERSEDIA PEMAKAI

NO NAMA OBAT / NAMA PASIEN AWAL AAN AN AN
0101 Alopurinol Tablet 100 mg 141 100 241 208
0102 Alprazolam 0.5 mg 0 0 0
0103 Ambroxol sirup 15 mg/ml 0 0 0
0104 Ambroxol Tablet 30 mg 0 0 0
0105 Aminofilin Tablet 200 mg 80 100 180 116
0106 Amitriptilin HCL Tablet Salut 25 mg 37 100 137 47
0107 Amlodipin tablet 5 mg 24 60 84 37
0108 Amoksisilin Kapsul 500 mg 100 100 200 126
0109 Antalgin ( metampiron ) Tablet 500 mg 0 0 0
0110 Antasida DOEN Tablet Kombinasi : 53 300 353 274
0111 Antasida DOEN II suspensi,k 2 5 7 5
0112 Anti Bakteri DOEN, Salep Kombinasi 2 9 11 5
0113 Antifungi DOEN Kombinasi 0 5 5 2
0114 Antihemoroid DOEN Kombinasi 0 0 0
0115 Asam Askorbat ( Vit C ) Tablet 50 mg 94 94 37
0116 Asam Mefenamat Tablet 500 mg 11 300 311 212
0117 Asam Traneksamat 500 mg 0 0 0
0118 Asetosal Tablet 100 mg 0 100 100 0
0119 Asiklovir Tablet 400 mg 50 50 0
0120 Asiklovir Tablet 200 mg 0 0 0
0121 Asiklovir Krim 5 % 4 4 1
0122 Attapulgite Pektin 0 0 0
0123 Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet 0 6 6 6
0124 Betahistin Mesilat Tablet 6 mg 0 90 90 43
0125 Betametason Krim 0,1 % 5 5 5
0126 Bisacodyl 5 mg 0 0 0
0127 Bisoprolol tablet 5mg 0 0 0
0128 Bromheksin Tablet 8 mg 0 0 0
0129 Cetirizine tablet 10 mg 0 0 0
0130 Deksametason Tablet 0,5 mg 0 0 0
0131 Diazepam Tablet 2 mg 0 0 0
0132 Diazepam Tablet 5 mg 0 0 0
0133 Digoksin Tablet 0,25 mg 51 300 351 226
0134 Diltiazem HCl Tablet 30 mg 100 300 400 342
0135 Dimenhidrinat Tablet 16 200 216 123
0136 Doksisiklin Kapsul 100 mg 0 0 0
0137 Domperidon Tablet 10 mg 58 58 10
0138 Efedrin HCL Tablet 25 mg 16 16 0
0201 Eritromisin Tablet 500 mg 0 0 0
0202 Eritromisin Sirup 200 mg/5 mg 0 0 0
0203 Etakridin ( Rivanol ) Larutan 0,1 % 0 0 0
0204 Famotidin Tablet 20 mg 0 0 0
0205 Fenol Gliserol Tetes Telinga 10 % 0 0 0
0206 Fitomenadion ( Vit. K ) Tablet Salut 10 mg 0 4 4 4
0207 Furosemid Tablet 40 mg 20 300 320 128
0208 Gameksan Emulsi 1 % 0 0 0
0301 Garam Oralit 200 ml Air 44 44 26
0302 Gentamisin Salep Kulit 0,1 % 0 0 0
0401 Gentian Violet Larutan 1 % 0 0 0
0402 Glibenklamid Tablet 5 mg 208 100 308 204
0403 Glimepirid 1 mg 110 110 25
0404 Gliseril Guayakolat Tablet 100 mg 0 1000 1000 360
0405 Griseofulvin Tablet 125 mg, Micronized 48 100 148 48
0406 Haloperidol Tablet 0,5 mg 0 0 0
0407 Haloperidol Tablet 1,5 mg 0 0 0
0408 Haloperidol Tablet 2 mg 53 53 0
0409 Haloperidol Tablet 5 mg 0 0 0
0410 Hidroklorotiazid ( HCT ) Tablet 25 mg 49 100 149 39
0411 Hidrokortison Krim 2,5 % 5 5 2
0412 Hyoscine Butylbromide 10 mg Methampyronum 250 mg 0 0 0
0413 Ibuprofen Tablet 400 mg 48 200 248 181
0414 Isosorbid Dinitrat Tablet Sublingual 5 mg 10 10 10
0415 Kalium Diklofenak Tablet 50 mg 0 0 0
0416 Kalsium Laktat ( Kalk ) Tablet 500 mg 95 200 295 180
0417 Kaolin Pektin sirup 0 0 0
0418 Kaptopril Tablet 12,5 mg 36 300 336 246
0419 Kaptopril Tablet 25 mg 47 500 547 442
0420 Kaptopril Tablet 50 mg 0 0 0
0421 Karbamazepin Tablet 200 mg 0 7 7 7
0422 Ketokonazol Tablet 200 mg 0 0 0
0423 Ketokonazol Krim 2% 0 0 0
0424 Klindamisin Kapsul 300 mg 0 0 0
0425 Kloramfenikol Kapsul 250 mg 0 0 0
0426 Kloramfenikol Tetes Mata 0,5 % 0 0 0
0427 Kloramfenikol Salep Mata 1 % 0 0 0
0428 Kloramfenikol Tetes Telinga 3 % 0 0 0
0429 Klorfeniramin Maleat ( CTM ) Tablet 4 mg 155 200 355 265
0430 Klorpromazin HCL Tablet Salut 100 mg 40 40 0
0431 Kodein HCl Tablet 10 mg 0 0 0
0432 Kotrimoksasol Dewasa Tablet 64 64 14
0433 Lisinopril Tablet 5 mg 0 0 0
0434 Loratadin Tablet 10 mg 45 45 32
0435 Lorazepam 2 mg 0 0 0
0436 Loperamid Tablet 0 0 0
0437 Metilprednisolon Tablet 4 mg 38 38 0
0438 Metformin HCl Tablet 500 mg 0 0 0
0439 Metoklopramide Tablet 5 mg 0 0 0
0440 Metronidasol Tablet 500 mg 37 37 0
0441 Metronidazol Infus 500 mg/100 ml 0 0 0
0442 Mikonazol Krim/Salep 2 % 4 5 9 5
0443 Multivitamin tablet 95 95 0
0444 Natrium Diklofenak Tablet 50 mg 40 50 90 24
0445 Natrium Klorida Larutan Infus 0,9 % Steril 0 3 3 3
0446 Nifedipin Tablet 10 mg 10 50 60 60
0447 Obat Batuk Hitam ( O.B.H ) Cairan 0 0 0
0448 Obat Flu Kombinasi (Alpara) 0 0 0
0449 Ofloxacin tablet 200 mg 0 0 0
0450 Oksitetrasiklin HCL Injeksi I.M. 50 mg/ml - 10 ml 0 0 0
0451 Oksitetrasiklin HCL Salep 3 % 0 0 0
0452 Oksitetrasiklin HCL Salep Mata 1 1 1
0453 Omeprazol Kapsul 20 mg 34 34 0
0454 Papaverin Tablet 40 mg 84 84 10
0455 Parasetamol Tablet 500 mg 160 1000 1160 1090
0456 Piracetam Tablet 400 mg 0 0 0
0457 Piracetam Tablet 800 mg 0 0 0
0458 Piridoksin HCL Tablet 10 mg 100 300 400 278
0459 Piroksikam Kapsul 10 mg 100 100 200 160
0460 Prednison Tablet 5 mg 46 46 0
0461 Propanolol HCL Tablet 40 mg 112 200 312 154
0462 Ranitidin Tablet 150 mg 118 118 54
0463 Salbutamol Tablet 4 mg 125 125 98
0464 Salep 2 - 4 Kombinasi : 4 4 3
0465 Salisil Bedak 2 % 2 5 7 4
0466 Salisil Spiritus 10 % 0 0 0
0467 Sefadroxil Kapsul 250 mg 0 0 0
0468 Sefiksim Kapsul 100 mg 32 32 0
0469 Sianokobalamin (Vit.B12) Tablet 50 mcg 42 400 442 294
0470 Simetidin Tablet 200 mg 0 0 0
0471 Simvastatin Tablet 10 mg 35 100 135 27
0472 Siprofloksasin Tablet 500 mg 76 76 18
0473 Sulfasetamid Natrium Tetes Mata 15 % 0 0 0
0474 Terbutalin tablet 2,5 mg 80 80 0
0475 Tiamfenikol Kapsul 500 mg 0 0 0
0476 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 mg 200 200 124
0477 Triamcinolone Acetonide 1 mg 0 0 0
0478 Triheksifenidil Tablet 2 mg 0 0 0
0479 Vitamin B Komplek Tablet 60 400 460 304
0480 Zinc Tablet 20 mg 64 64 8

UMUM BPJS TOTAL

JUMLAH KUNJUNGAN RESEP 36 177 213

Mengetahui/menyetujui Yang Melapor

Pimpinan Puskesmas Petugas Puskesmas

dr Rahma Sari Dewi Erni Setyowati,S.Farm. Apt

NIP. 19730621 200312 2 001 NIP. 19820305 200901 2 003
TAAN OBAT

DOKUMEN NO TGL
PUSKESMAS
SUB UNIT

SISA STOK PERMINT PEMBERI KET

AAN AN
33

64
90
47
74

79
2
6
3

57
99

100
50

47

125
58
 93

48
16

192

18

105
85
640
100

53

110
3

67

115

90
105

90
40
 50

13

38

37

4
95
66

34
74
70

122
40
46
158
64
27
1
3

32
148

108
58

80
156
56

Yang Menyerahkan
Petugas Gudang Puskesmas

Intan Paramitha
NIP. 19870628 201001 2 020
 mahmudi
supinah
legiyem

legiran
dayem
NO NAMA OBAT / NAMA PASIEN

sukadi

TOTAL
amari
yuni r

katun
lotari
0101 Alopurinol Tablet 100 mg 0
0102 Alprazolam 0.5 mg 0
0103 Ambroxol sirup 15 mg/ml 0
0104 Ambroxol Tablet 30 mg 0
0105 Aminofilin Tablet 200 mg 0
0106 Amitriptilin HCL Tablet Salut 25 mg 0
0107 Amlodipin tablet 5 mg 0
0108 Amoksisilin Kapsul 500 mg 0
0109 Antalgin ( metampiron ) Tablet 500 mg 0
0110 Antasida DOEN Tablet Kombinasi : 0
0111 Antasida DOEN II suspensi,k 0
0112 Anti Bakteri DOEN, Salep Kombinasi 0
0113 Antifungi DOEN Kombinasi 0
0114 Antihemoroid DOEN Kombinasi 0
0115 Asam Askorbat ( Vit C ) Tablet 50 mg 0
0116 Asam Mefenamat Tablet 500 mg 10 10 20
0117 Asam Traneksamat 500 mg 0
0118 Asetosal Tablet 100 mg 0
0119 Asiklovir Tablet 400 mg 0
0120 Asiklovir Tablet 200 mg 0
0121 Asiklovir Krim 5 % 0
0122 Attapulgite Pektin 0
0123 Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet 0
0124 Betahistin Mesilat Tablet 6 mg 0
0125 Betametason Krim 0,1 % 0
0126 Bisacodyl 5 mg 0
0127 Bisoprolol tablet 5mg 0
0128 Bromheksin Tablet 8 mg 0
0129 Cetirizine tablet 10 mg 0
0130 Deksametason Tablet 0,5 mg 0
0131 Diazepam Tablet 2 mg 0
0132 Diazepam Tablet 5 mg 0
0133 Digoksin Tablet 0,25 mg 15 15
0134 Diltiazem HCl Tablet 30 mg 10 10 10 30
0135 Dimenhidrinat Tablet 0
0136 Doksisiklin Kapsul 100 mg 0
0137 Domperidon Tablet 10 mg 0
0138 Efedrin HCL Tablet 25 mg 0
0201 Eritromisin Tablet 500 mg 0
0202 Eritromisin Sirup 200 mg/5 mg 0
0203 Etakridin ( Rivanol ) Larutan 0,1 % 0
0204 Famotidin Tablet 20 mg 0
0205 Fenol Gliserol Tetes Telinga 10 % 0
0206 Fitomenadion ( Vit. K ) Tablet Salut 10 mg 0
0207 Furosemid Tablet 40 mg 5 5
0208 Gameksan Emulsi 1 % 0
0301 Garam Oralit 200 ml Air 0
0302 Gentamisin Salep Kulit 0,1 % 0
0401 Gentian Violet Larutan 1 % 0
0402 Glibenklamid Tablet 5 mg 10 10
0403 Glimepirid 1 mg 10 10
0404 Gliseril Guayakolat Tablet 100 mg 10 10 15 35
0405 Griseofulvin Tablet 125 mg, Micronized 0
0406 Haloperidol Tablet 0,5 mg 0
0407 Haloperidol Tablet 1,5 mg 0
0408 Haloperidol Tablet 2 mg 0
0409 Haloperidol Tablet 5 mg 0
0410 Hidroklorotiazid ( HCT ) Tablet 25 mg 0
0411 Hidrokortison Krim 2,5 % 0
0412 Hyoscine Butylbromide 10 mg Methampyronum 250 mg 0
0413 Ibuprofen Tablet 400 mg 0
0414 Isosorbid Dinitrat Tablet Sublingual 5 mg 0
0415 Kalium Diklofenak Tablet 50 mg 0
0416 Kalsium Laktat ( Kalk ) Tablet 500 mg 5 5 10
0417 Kaolin Pektin sirup 0
0418 Kaptopril Tablet 12,5 mg 10 10 20
0419 Kaptopril Tablet 25 mg 10 10
0420 Kaptopril Tablet 50 mg 0
0421 Karbamazepin Tablet 200 mg 0
0422 Ketokonazol Tablet 200 mg 0
0423 Ketokonazol Krim 2% 0
0424 Klindamisin Kapsul 300 mg 0
0425 Kloramfenikol Kapsul 250 mg 0
0426 Kloramfenikol Tetes Mata 0,5 % 0
0427 Kloramfenikol Salep Mata 1 % 0
0428 Kloramfenikol Tetes Telinga 3 % 0
0429 Klorfeniramin Maleat ( CTM ) Tablet 4 mg 5 5
0430 Klorpromazin HCL Tablet Salut 100 mg 0
0431 Kodein HCl Tablet 10 mg 0
0432 Kotrimoksasol Dewasa Tablet 0
0433 Lisinopril Tablet 5 mg 0
0434 Loratadin Tablet 10 mg 5 5
0435 Lorazepam 2 mg 0
0436 Loperamid Tablet 0
0437 Metilprednisolon Tablet 4 mg 0
0438 Metformin HCl Tablet 500 mg 0
0439 Metoklopramide Tablet 5 mg 0
0440 Metronidasol Tablet 500 mg 0
0441 Metronidazol Infus 500 mg/100 ml 0
0442 Mikonazol Krim/Salep 2 % 0
0443 Multivitamin tablet 0
0444 Natrium Diklofenak Tablet 50 mg 0
0445 Natrium Klorida Larutan Infus 0,9 % Steril 0
0446 Nifedipin Tablet 10 mg 15 15
0447 Obat Batuk Hitam ( O.B.H ) Cairan 0
0448 Obat Flu Kombinasi (Alpara) 0
0449 Ofloxacin tablet 200 mg 0
0450 Oksitetrasiklin HCL Injeksi I.M. 50 mg/ml - 10 ml 0
0451 Oksitetrasiklin HCL Salep 3 % 0
0452 Oksitetrasiklin HCL Salep Mata 0
0453 Omeprazol Kapsul 20 mg 0
0454 Papaverin Tablet 40 mg 0
0455 Parasetamol Tablet 500 mg 10 10 10 10 10 10 10 10 15 95
0456 Piracetam Tablet 400 mg 0
0457 Piracetam Tablet 800 mg 0
0458 Piridoksin HCL Tablet 10 mg 10 10 10 30
0459 Piroksikam Kapsul 10 mg 0
0460 Prednison Tablet 5 mg 0
0461 Propanolol HCL Tablet 40 mg 0
0462 Ranitidin Tablet 150 mg 0
0463 Salbutamol Tablet 4 mg 15 15
0464 Salep 2 - 4 Kombinasi : 0
0465 Salisil Bedak 2 % 0
0466 Salisil Spiritus 10 % 0
0467 Sefadroxil Kapsul 250 mg 0
0468 Sefiksim Kapsul 100 mg 0
0469 Sianokobalamin (Vit.B12) Tablet 50 mcg 10 10
0470 Simetidin Tablet 200 mg 0
0471 Simvastatin Tablet 10 mg 0
0472 Siprofloksasin Tablet 500 mg 0
0473 Sulfasetamid Natrium Tetes Mata 15 % 0
0474 Terbutalin tablet 2,5 mg 0
0475 Tiamfenikol Kapsul 500 mg 0
0476 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 mg 0
0477 Triamcinolone Acetonide 1 mg 0
0478 Triheksifenidil Tablet 2 mg 0
0479 Vitamin B Komplek Tablet 10 10 10 30
0480 Zinc Tablet 20 mg 0
 mahmudi

mursidiq

slamet r

kosriadi
fatonah

sundari
katmini

imam g
m.toha
arliyah
NO NAMA OBAT / NAMA PASIEN

danuri
dul k
semi
siti a
0101 Alopurinol Tablet 100 mg
0102 Alprazolam 0.5 mg
0103 Ambroxol sirup 15 mg/ml
0104 Ambroxol Tablet 30 mg
0105 Aminofilin Tablet 200 mg
0106 Amitriptilin HCL Tablet Salut 25 mg 6 4
0107 Amlodipin tablet 5 mg
0108 Amoksisilin Kapsul 500 mg
0109 Antalgin ( metampiron ) Tablet 500 mg
0110 Antasida DOEN Tablet Kombinasi : 10
0111 Antasida DOEN II suspensi,k
0112 Anti Bakteri DOEN, Salep Kombinasi
0113 Antifungi DOEN Kombinasi
0114 Antihemoroid DOEN Kombinasi
0115 Asam Askorbat ( Vit C ) Tablet 50 mg
0116 Asam Mefenamat Tablet 500 mg 10 10
0117 Asam Traneksamat 500 mg
0118 Asetosal Tablet 100 mg
0119 Asiklovir Tablet 400 mg
0120 Asiklovir Tablet 200 mg
0121 Asiklovir Krim 5 %
0122 Attapulgite Pektin
0123 Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet
0124 Betahistin Mesilat Tablet 6 mg 6 6
0125 Betametason Krim 0,1 %
0126 Bisacodyl 5 mg
0127 Bisoprolol tablet 5mg
0128 Bromheksin Tablet 8 mg
0129 Cetirizine tablet 10 mg
0130 Deksametason Tablet 0,5 mg
0131 Diazepam Tablet 2 mg
0132 Diazepam Tablet 5 mg
0133 Digoksin Tablet 0,25 mg 7 10
0134 Diltiazem HCl Tablet 30 mg 14
0135 Dimenhidrinat Tablet
0136 Doksisiklin Kapsul 100 mg
0137 Domperidon Tablet 10 mg
0138 Efedrin HCL Tablet 25 mg
0201 Eritromisin Tablet 500 mg
0202 Eritromisin Sirup 200 mg/5 mg
0203 Etakridin ( Rivanol ) Larutan 0,1 %
0204 Famotidin Tablet 20 mg
0205 Fenol Gliserol Tetes Telinga 10 %
0206 Fitomenadion ( Vit. K ) Tablet Salut 10 mg
0207 Furosemid Tablet 40 mg 7
0208 Gameksan Emulsi 1 %
0301 Garam Oralit 200 ml Air
0302 Gentamisin Salep Kulit 0,1 %
0401 Gentian Violet Larutan 1 %
0402 Glibenklamid Tablet 5 mg
0403 Glimepirid 1 mg
0404 Gliseril Guayakolat Tablet 100 mg 8 10
0405 Griseofulvin Tablet 125 mg, Micronized
0406 Haloperidol Tablet 0,5 mg
0407 Haloperidol Tablet 1,5 mg
0408 Haloperidol Tablet 2 mg
0409 Haloperidol Tablet 5 mg
0410 Hidroklorotiazid ( HCT ) Tablet 25 mg 5
0411 Hidrokortison Krim 2,5 %
0412 Hyoscine Butylbromide 10 mg Methampyronum 250 mg
0413 Ibuprofen Tablet 400 mg 10
0414 Isosorbid Dinitrat Tablet Sublingual 5 mg
0415 Kalium Diklofenak Tablet 50 mg
0416 Kalsium Laktat ( Kalk ) Tablet 500 mg 3 6 7 7
0417 Kaolin Pektin sirup
0418 Kaptopril Tablet 12,5 mg
0419 Kaptopril Tablet 25 mg 14
0420 Kaptopril Tablet 50 mg
0421 Karbamazepin Tablet 200 mg
0422 Ketokonazol Tablet 200 mg
0423 Ketokonazol Krim 2%
0424 Klindamisin Kapsul 300 mg
0425 Kloramfenikol Kapsul 250 mg
0426 Kloramfenikol Tetes Mata 0,5 %
0427 Kloramfenikol Salep Mata 1 %
0428 Kloramfenikol Tetes Telinga 3 %
0429 Klorfeniramin Maleat ( CTM ) Tablet 4 mg 10 8
0430 Klorpromazin HCL Tablet Salut 100 mg
0431 Kodein HCl Tablet 10 mg
0432 Kotrimoksasol Dewasa Tablet
0433 Lisinopril Tablet 5 mg
0434 Loratadin Tablet 10 mg
0435 Lorazepam 2 mg
0436 Loperamid Tablet
0437 Metilprednisolon Tablet 4 mg
0438 Metformin HCl Tablet 500 mg
0439 Metoklopramide Tablet 5 mg
0440 Metronidasol Tablet 500 mg
0441 Metronidazol Infus 500 mg/100 ml
0442 Mikonazol Krim/Salep 2 %
0443 Multivitamin tablet
0444 Natrium Diklofenak Tablet 50 mg 10
0445 Natrium Klorida Larutan Infus 0,9 % Steril
0446 Nifedipin Tablet 10 mg 10 14
0447 Obat Batuk Hitam ( O.B.H ) Cairan
0448 Obat Flu Kombinasi (Alpara)
0449 Ofloxacin tablet 200 mg
0450 Oksitetrasiklin HCL Injeksi I.M. 50 mg/ml - 10 ml
0451 Oksitetrasiklin HCL Salep 3 %
0452 Oksitetrasiklin HCL Salep Mata
0453 Omeprazol Kapsul 20 mg
0454 Papaverin Tablet 40 mg
0455 Parasetamol Tablet 500 mg 10 10 10 10 10
0456 Piracetam Tablet 400 mg
0457 Piracetam Tablet 800 mg
0458 Piridoksin HCL Tablet 10 mg
0459 Piroksikam Kapsul 10 mg 10 10
0460 Prednison Tablet 5 mg
0461 Propanolol HCL Tablet 40 mg 7 7
0462 Ranitidin Tablet 150 mg
0463 Salbutamol Tablet 4 mg 7 7
0464 Salep 2 - 4 Kombinasi :
0465 Salisil Bedak 2 %
0466 Salisil Spiritus 10 %
0467 Sefadroxil Kapsul 250 mg
0468 Sefiksim Kapsul 100 mg
0469 Sianokobalamin (Vit.B12) Tablet 50 mcg 4
0470 Simetidin Tablet 200 mg
0471 Simvastatin Tablet 10 mg
0472 Siprofloksasin Tablet 500 mg
0473 Sulfasetamid Natrium Tetes Mata 15 %
0474 Terbutalin tablet 2,5 mg
0475 Tiamfenikol Kapsul 500 mg
0476 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 mg
0477 Triamcinolone Acetonide 1 mg
0478 Triheksifenidil Tablet 2 mg
0479 Vitamin B Komplek Tablet 14 10 14 14
0480 Zinc Tablet 20 mg
 semi

14
supartini
katijan

8
imam s

3
tumiran

10
7
seger

10 10 10
jawadi

7
ponirin

14
10
tamis l
tukiyem
mujiono

14 8
1
10 8
mahmud
TOTAL

15
60
31
12
10 60
35
4 17
10

0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
 0
0
0
0
7 14
0
0
0
0
7 18 25
0
8 26
0
0
0
0
0
5
0
0
10
8 8
0
10 10 43
0
14 14
14
0
0
0
0
0
0
0
0
0
7 6 31
0
0
14 14
0
0
0
0
0
 0
0
0
0
0
0
10
0
14 38
0
0
0
0
0
0
0
0
10 10 10 10 10 10 10 120
0
0
14 14
20
0
7 14 35
0
14
0
0
0
0
0
4
0
0
8 8
0
0
0
0
0
0
14 66
0
 musrikah

supinah
kosriadi
salimah
panirah
kaselan
imam g

djaitun
pirkani
NO NAMA OBAT / NAMA PASIEN

muji s
amari

pairin
lasini
siti a
0101 Alopurinol Tablet 100 mg 10
0102 Alprazolam 0.5 mg
0103 Ambroxol sirup 15 mg/ml
0104 Ambroxol Tablet 30 mg
0105 Aminofilin Tablet 200 mg 10
0106 Amitriptilin HCL Tablet Salut 25 mg
0107 Amlodipin tablet 5 mg
0108 Amoksisilin Kapsul 500 mg 10
0109 Antalgin ( metampiron ) Tablet 500 mg
0110 Antasida DOEN Tablet Kombinasi : 10 10 10
0111 Antasida DOEN II suspensi,k 1
0112 Anti Bakteri DOEN, Salep Kombinasi
0113 Antifungi DOEN Kombinasi
0114 Antihemoroid DOEN Kombinasi
0115 Asam Askorbat ( Vit C ) Tablet 50 mg
0116 Asam Mefenamat Tablet 500 mg
0117 Asam Traneksamat 500 mg
0118 Asetosal Tablet 100 mg
0119 Asiklovir Tablet 400 mg
0120 Asiklovir Tablet 200 mg
0121 Asiklovir Krim 5 %
0122 Attapulgite Pektin
0123 Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet
0124 Betahistin Mesilat Tablet 6 mg 10
0125 Betametason Krim 0,1 %
0126 Bisacodyl 5 mg
0127 Bisoprolol tablet 5mg
0128 Bromheksin Tablet 8 mg
0129 Cetirizine tablet 10 mg
0130 Deksametason Tablet 0,5 mg
0131 Diazepam Tablet 2 mg
0132 Diazepam Tablet 5 mg
0133 Digoksin Tablet 0,25 mg 10 14
0134 Diltiazem HCl Tablet 30 mg 15 10 10
0135 Dimenhidrinat Tablet 5 10 5 5
0136 Doksisiklin Kapsul 100 mg
0137 Domperidon Tablet 10 mg 10
0138 Efedrin HCL Tablet 25 mg
0201 Eritromisin Tablet 500 mg
0202 Eritromisin Sirup 200 mg/5 mg
0203 Etakridin ( Rivanol ) Larutan 0,1 %
0204 Famotidin Tablet 20 mg
0205 Fenol Gliserol Tetes Telinga 10 %
0206 Fitomenadion ( Vit. K ) Tablet Salut 10 mg
0207 Furosemid Tablet 40 mg 5 5
0208 Gameksan Emulsi 1 %
0301 Garam Oralit 200 ml Air 3
0302 Gentamisin Salep Kulit 0,1 %
0401 Gentian Violet Larutan 1 %
0402 Glibenklamid Tablet 5 mg
0403 Glimepirid 1 mg 10
0404 Gliseril Guayakolat Tablet 100 mg 10 10 14 10
0405 Griseofulvin Tablet 125 mg, Micronized
0406 Haloperidol Tablet 0,5 mg
0407 Haloperidol Tablet 1,5 mg
0408 Haloperidol Tablet 2 mg
0409 Haloperidol Tablet 5 mg
0410 Hidroklorotiazid ( HCT ) Tablet 25 mg
0411 Hidrokortison Krim 2,5 %
0412 Hyoscine Butylbromide 10 mg Methampyronum 250 mg
0413 Ibuprofen Tablet 400 mg
0414 Isosorbid Dinitrat Tablet Sublingual 5 mg
0415 Kalium Diklofenak Tablet 50 mg
0416 Kalsium Laktat ( Kalk ) Tablet 500 mg 5 5
0417 Kaolin Pektin sirup
0418 Kaptopril Tablet 12,5 mg 5
0419 Kaptopril Tablet 25 mg 10
0420 Kaptopril Tablet 50 mg
0421 Karbamazepin Tablet 200 mg
0422 Ketokonazol Tablet 200 mg
0423 Ketokonazol Krim 2%
0424 Klindamisin Kapsul 300 mg
0425 Kloramfenikol Kapsul 250 mg
0426 Kloramfenikol Tetes Mata 0,5 %
0427 Kloramfenikol Salep Mata 1 %
0428 Kloramfenikol Tetes Telinga 3 %
0429 Klorfeniramin Maleat ( CTM ) Tablet 4 mg 5 5 5 5 5
0430 Klorpromazin HCL Tablet Salut 100 mg
0431 Kodein HCl Tablet 10 mg
0432 Kotrimoksasol Dewasa Tablet
0433 Lisinopril Tablet 5 mg
0434 Loratadin Tablet 10 mg
0435 Lorazepam 2 mg
0436 Loperamid Tablet
0437 Metilprednisolon Tablet 4 mg
0438 Metformin HCl Tablet 500 mg
0439 Metoklopramide Tablet 5 mg
0440 Metronidasol Tablet 500 mg
0441 Metronidazol Infus 500 mg/100 ml
0442 Mikonazol Krim/Salep 2 % 1
0443 Multivitamin tablet
0444 Natrium Diklofenak Tablet 50 mg
0445 Natrium Klorida Larutan Infus 0,9 % Steril
0446 Nifedipin Tablet 10 mg
0447 Obat Batuk Hitam ( O.B.H ) Cairan
0448 Obat Flu Kombinasi (Alpara)
0449 Ofloxacin tablet 200 mg
0450 Oksitetrasiklin HCL Injeksi I.M. 50 mg/ml - 10 ml
0451 Oksitetrasiklin HCL Salep 3 %
0452 Oksitetrasiklin HCL Salep Mata
0453 Omeprazol Kapsul 20 mg
0454 Papaverin Tablet 40 mg
0455 Parasetamol Tablet 500 mg 10 10 10 10 10 10 10 10 10 10 10
0456 Piracetam Tablet 400 mg
0457 Piracetam Tablet 800 mg
0458 Piridoksin HCL Tablet 10 mg 10 10 10
0459 Piroksikam Kapsul 10 mg 10
0460 Prednison Tablet 5 mg
0461 Propanolol HCL Tablet 40 mg 5
0462 Ranitidin Tablet 150 mg
0463 Salbutamol Tablet 4 mg 14
0464 Salep 2 - 4 Kombinasi : 1
0465 Salisil Bedak 2 % 1
0466 Salisil Spiritus 10 %
0467 Sefadroxil Kapsul 250 mg
0468 Sefiksim Kapsul 100 mg
0469 Sianokobalamin (Vit.B12) Tablet 50 mcg 10
0470 Simetidin Tablet 200 mg
0471 Simvastatin Tablet 10 mg 5
0472 Siprofloksasin Tablet 500 mg
0473 Sulfasetamid Natrium Tetes Mata 15 %
0474 Terbutalin tablet 2,5 mg
0475 Tiamfenikol Kapsul 500 mg
0476 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 mg
0477 Triamcinolone Acetonide 1 mg
0478 Triheksifenidil Tablet 2 mg
0479 Vitamin B Komplek Tablet
0480 Zinc Tablet 20 mg
legiran
sukadi

TOTAL
widi a

10
0
0
0
10
0
10 10 20
10
0
30
1
0
0
0
0
0
0
0
0
0
0
0
0
10 20
0
0
0
0
0
0
0
0
24
35
10 35
0
10
0
0
0
 0
0
0
0
10
0
3
0
0
10 10
10
44
0
0
0
0
0
0
0
0
0
0
0
10
0
10 15
10
0
0
0
0
0
0
0
0
0
25
0
0
0
0
0
0
0
0
 0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
10 10 130
0
0
30
10
0
5
0
14
1
1
0
0
0
10 10 30
0
5
0
0
0
0
0
0
0
0
0
 mahmudi
mashuri

suwardi
poniran

supiyah
SUMINI

suwarsi
katmini
ponirin

djaitun
dayem
katijan
NO NAMA OBAT / NAMA PASIEN

lotari
siti r
0101 Alopurinol Tablet 100 mg 10
0102 Alprazolam 0.5 mg
0103 Ambroxol sirup 15 mg/ml
0104 Ambroxol Tablet 30 mg
0105 Aminofilin Tablet 200 mg 10
0106 Amitriptilin HCL Tablet Salut 25 mg 4
0107 Amlodipin tablet 5 mg
0108 Amoksisilin Kapsul 500 mg
0109 Antalgin ( metampiron ) Tablet 500 mg
0110 Antasida DOEN Tablet Kombinasi : 8
0111 Antasida DOEN II suspensi,k
0112 Anti Bakteri DOEN, Salep Kombinasi 1 1
0113 Antifungi DOEN Kombinasi 1
0114 Antihemoroid DOEN Kombinasi
0115 Asam Askorbat ( Vit C ) Tablet 50 mg
0116 Asam Mefenamat Tablet 500 mg 10 10 10
0117 Asam Traneksamat 500 mg
0118 Asetosal Tablet 100 mg
0119 Asiklovir Tablet 400 mg
0120 Asiklovir Tablet 200 mg
0121 Asiklovir Krim 5 %
0122 Attapulgite Pektin
0123 Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet
0124 Betahistin Mesilat Tablet 6 mg
0125 Betametason Krim 0,1 %
0126 Bisacodyl 5 mg
0127 Bisoprolol tablet 5mg
0128 Bromheksin Tablet 8 mg
0129 Cetirizine tablet 10 mg
0130 Deksametason Tablet 0,5 mg
0131 Diazepam Tablet 2 mg
0132 Diazepam Tablet 5 mg
0133 Digoksin Tablet 0,25 mg 14
0134 Diltiazem HCl Tablet 30 mg 14 14
0135 Dimenhidrinat Tablet
0136 Doksisiklin Kapsul 100 mg
0137 Domperidon Tablet 10 mg
0138 Efedrin HCL Tablet 25 mg
0201 Eritromisin Tablet 500 mg
0202 Eritromisin Sirup 200 mg/5 mg
0203 Etakridin ( Rivanol ) Larutan 0,1 %
0204 Famotidin Tablet 20 mg
0205 Fenol Gliserol Tetes Telinga 10 %
0206 Fitomenadion ( Vit. K ) Tablet Salut 10 mg
0207 Furosemid Tablet 40 mg 7
0208 Gameksan Emulsi 1 %
0301 Garam Oralit 200 ml Air
0302 Gentamisin Salep Kulit 0,1 %
0401 Gentian Violet Larutan 1 %
0402 Glibenklamid Tablet 5 mg 6 14
0403 Glimepirid 1 mg
0404 Gliseril Guayakolat Tablet 100 mg 10
0405 Griseofulvin Tablet 125 mg, Micronized
0406 Haloperidol Tablet 0,5 mg
0407 Haloperidol Tablet 1,5 mg
0408 Haloperidol Tablet 2 mg
0409 Haloperidol Tablet 5 mg
0410 Hidroklorotiazid ( HCT ) Tablet 25 mg 7
0411 Hidrokortison Krim 2,5 %
0412 Hyoscine Butylbromide 10 mg Methampyronum 250 mg
0413 Ibuprofen Tablet 400 mg 10
0414 Isosorbid Dinitrat Tablet Sublingual 5 mg
0415 Kalium Diklofenak Tablet 50 mg
0416 Kalsium Laktat ( Kalk ) Tablet 500 mg 6 8 3
0417 Kaolin Pektin sirup
0418 Kaptopril Tablet 12,5 mg
0419 Kaptopril Tablet 25 mg 14 14 14
0420 Kaptopril Tablet 50 mg
0421 Karbamazepin Tablet 200 mg
0422 Ketokonazol Tablet 200 mg
0423 Ketokonazol Krim 2%
0424 Klindamisin Kapsul 300 mg
0425 Kloramfenikol Kapsul 250 mg
0426 Kloramfenikol Tetes Mata 0,5 %
0427 Kloramfenikol Salep Mata 1 %
0428 Kloramfenikol Tetes Telinga 3 %
0429 Klorfeniramin Maleat ( CTM ) Tablet 4 mg 6 10 10
0430 Klorpromazin HCL Tablet Salut 100 mg
0431 Kodein HCl Tablet 10 mg
0432 Kotrimoksasol Dewasa Tablet
0433 Lisinopril Tablet 5 mg
0434 Loratadin Tablet 10 mg
0435 Lorazepam 2 mg
0436 Loperamid Tablet
0437 Metilprednisolon Tablet 4 mg
0438 Metformin HCl Tablet 500 mg
0439 Metoklopramide Tablet 5 mg
0440 Metronidasol Tablet 500 mg
0441 Metronidazol Infus 500 mg/100 ml
0442 Mikonazol Krim/Salep 2 %
0443 Multivitamin tablet
0444 Natrium Diklofenak Tablet 50 mg
0445 Natrium Klorida Larutan Infus 0,9 % Steril
0446 Nifedipin Tablet 10 mg
0447 Obat Batuk Hitam ( O.B.H ) Cairan
0448 Obat Flu Kombinasi (Alpara)
0449 Ofloxacin tablet 200 mg
0450 Oksitetrasiklin HCL Injeksi I.M. 50 mg/ml - 10 ml
0451 Oksitetrasiklin HCL Salep 3 %
0452 Oksitetrasiklin HCL Salep Mata
0453 Omeprazol Kapsul 20 mg
0454 Papaverin Tablet 40 mg
0455 Parasetamol Tablet 500 mg 10 10 10 10 10 10
0456 Piracetam Tablet 400 mg
0457 Piracetam Tablet 800 mg
0458 Piridoksin HCL Tablet 10 mg 14 14 14
0459 Piroksikam Kapsul 10 mg 10
0460 Prednison Tablet 5 mg
0461 Propanolol HCL Tablet 40 mg
0462 Ranitidin Tablet 150 mg 8
0463 Salbutamol Tablet 4 mg
0464 Salep 2 - 4 Kombinasi :
0465 Salisil Bedak 2 %
0466 Salisil Spiritus 10 %
0467 Sefadroxil Kapsul 250 mg
0468 Sefiksim Kapsul 100 mg
0469 Sianokobalamin (Vit.B12) Tablet 50 mcg 14 14 14
0470 Simetidin Tablet 200 mg
0471 Simvastatin Tablet 10 mg
0472 Siprofloksasin Tablet 500 mg
0473 Sulfasetamid Natrium Tetes Mata 15 %
0474 Terbutalin tablet 2,5 mg
0475 Tiamfenikol Kapsul 500 mg
0476 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 mg 4
0477 Triamcinolone Acetonide 1 mg
0478 Triheksifenidil Tablet 2 mg
0479 Vitamin B Komplek Tablet 14
0480 Zinc Tablet 20 mg
 gemi
toha a

10
14
sundari
suwarsono

1
danuri

10
aminudin
tumiran

8
rubiyah
tami
suwaji

1
joyo s
TOTAL

0
0
0
0
0
8
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
3
1
8
0
0
0
4
0
0
0

28
7 5 36
10
44
10
10
 0
0
0
0
3 10
0
0
0
0
14 34
0
10 10 30
0
0
0
0
0
7
0
0
10 20
0
0
7 24
0
14 14
14 14 70
0
0
0
0
0
0
0
0
0
10 7 8 51
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 10 10 10 10 110
0
0
42
10
0
14 10 8 32
8
7 7
1 1
0
0
0
0
14 14 70
0
0
0
0
0
0
4
0
0
10 24
6 6
 mahmudi
SUKINEM

mardiyah

warsinah

legiran e
tukiyem

paiman

murtini
ponirin
arliyah
katijan
NO NAMA OBAT / NAMA PASIEN

jawadi
misti

siti n
0101 Alopurinol Tablet 100 mg
0102 Alprazolam 0.5 mg
0103 Ambroxol sirup 15 mg/ml
0104 Ambroxol Tablet 30 mg
0105 Aminofilin Tablet 200 mg 15
0106 Amitriptilin HCL Tablet Salut 25 mg 5 5
0107 Amlodipin tablet 5 mg
0108 Amoksisilin Kapsul 500 mg 10 10
0109 Antalgin ( metampiron ) Tablet 500 mg
0110 Antasida DOEN Tablet Kombinasi : 10
0111 Antasida DOEN II suspensi,k 1
0112 Anti Bakteri DOEN, Salep Kombinasi
0113 Antifungi DOEN Kombinasi
0114 Antihemoroid DOEN Kombinasi
0115 Asam Askorbat ( Vit C ) Tablet 50 mg
0116 Asam Mefenamat Tablet 500 mg
0117 Asam Traneksamat 500 mg
0118 Asetosal Tablet 100 mg
0119 Asiklovir Tablet 400 mg
0120 Asiklovir Tablet 200 mg
0121 Asiklovir Krim 5 %
0122 Attapulgite Pektin
0123 Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet
0124 Betahistin Mesilat Tablet 6 mg
0125 Betametason Krim 0,1 % 1
0126 Bisacodyl 5 mg
0127 Bisoprolol tablet 5mg
0128 Bromheksin Tablet 8 mg
0129 Cetirizine tablet 10 mg
0130 Deksametason Tablet 0,5 mg
0131 Diazepam Tablet 2 mg
0132 Diazepam Tablet 5 mg
0133 Digoksin Tablet 0,25 mg 10
0134 Diltiazem HCl Tablet 30 mg 10 6 5 10
0135 Dimenhidrinat Tablet 5 5 6 5
0136 Doksisiklin Kapsul 100 mg
0137 Domperidon Tablet 10 mg
0138 Efedrin HCL Tablet 25 mg
0201 Eritromisin Tablet 500 mg
0202 Eritromisin Sirup 200 mg/5 mg
0203 Etakridin ( Rivanol ) Larutan 0,1 %
0204 Famotidin Tablet 20 mg
0205 Fenol Gliserol Tetes Telinga 10 %
0206 Fitomenadion ( Vit. K ) Tablet Salut 10 mg
0207 Furosemid Tablet 40 mg 5
0208 Gameksan Emulsi 1 %
0301 Garam Oralit 200 ml Air
0302 Gentamisin Salep Kulit 0,1 %
0401 Gentian Violet Larutan 1 %
0402 Glibenklamid Tablet 5 mg 10
0403 Glimepirid 1 mg
0404 Gliseril Guayakolat Tablet 100 mg 10
0405 Griseofulvin Tablet 125 mg, Micronized 16
0406 Haloperidol Tablet 0,5 mg
0407 Haloperidol Tablet 1,5 mg
0408 Haloperidol Tablet 2 mg
0409 Haloperidol Tablet 5 mg
0410 Hidroklorotiazid ( HCT ) Tablet 25 mg 5
0411 Hidrokortison Krim 2,5 %
0412 Hyoscine Butylbromide 10 mg Methampyronum 250 mg
0413 Ibuprofen Tablet 400 mg 10
0414 Isosorbid Dinitrat Tablet Sublingual 5 mg
0415 Kalium Diklofenak Tablet 50 mg
0416 Kalsium Laktat ( Kalk ) Tablet 500 mg 5
0417 Kaolin Pektin sirup
0418 Kaptopril Tablet 12,5 mg
0419 Kaptopril Tablet 25 mg 10 10 15 10
0420 Kaptopril Tablet 50 mg
0421 Karbamazepin Tablet 200 mg
0422 Ketokonazol Tablet 200 mg
0423 Ketokonazol Krim 2%
0424 Klindamisin Kapsul 300 mg
0425 Kloramfenikol Kapsul 250 mg
0426 Kloramfenikol Tetes Mata 0,5 %
0427 Kloramfenikol Salep Mata 1 %
0428 Kloramfenikol Tetes Telinga 3 %
0429 Klorfeniramin Maleat ( CTM ) Tablet 4 mg 5 10 5 5
0430 Klorpromazin HCL Tablet Salut 100 mg
0431 Kodein HCl Tablet 10 mg
0432 Kotrimoksasol Dewasa Tablet
0433 Lisinopril Tablet 5 mg
0434 Loratadin Tablet 10 mg 5
0435 Lorazepam 2 mg
0436 Loperamid Tablet
0437 Metilprednisolon Tablet 4 mg
0438 Metformin HCl Tablet 500 mg
0439 Metoklopramide Tablet 5 mg
0440 Metronidasol Tablet 500 mg
0441 Metronidazol Infus 500 mg/100 ml
0442 Mikonazol Krim/Salep 2 % 1
0443 Multivitamin tablet
0444 Natrium Diklofenak Tablet 50 mg
0445 Natrium Klorida Larutan Infus 0,9 % Steril
0446 Nifedipin Tablet 10 mg
0447 Obat Batuk Hitam ( O.B.H ) Cairan
0448 Obat Flu Kombinasi (Alpara)
0449 Ofloxacin tablet 200 mg
0450 Oksitetrasiklin HCL Injeksi I.M. 50 mg/ml - 10 ml
0451 Oksitetrasiklin HCL Salep 3 %
0452 Oksitetrasiklin HCL Salep Mata
0453 Omeprazol Kapsul 20 mg
0454 Papaverin Tablet 40 mg
0455 Parasetamol Tablet 500 mg 10 10 10 10 10 10 10 10 10 10 10 10
0456 Piracetam Tablet 400 mg
0457 Piracetam Tablet 800 mg
0458 Piridoksin HCL Tablet 10 mg
0459 Piroksikam Kapsul 10 mg
0460 Prednison Tablet 5 mg
0461 Propanolol HCL Tablet 40 mg 14 10
0462 Ranitidin Tablet 150 mg 10
0463 Salbutamol Tablet 4 mg
0464 Salep 2 - 4 Kombinasi :
0465 Salisil Bedak 2 % 1
0466 Salisil Spiritus 10 %
0467 Sefadroxil Kapsul 250 mg
0468 Sefiksim Kapsul 100 mg
0469 Sianokobalamin (Vit.B12) Tablet 50 mcg
0470 Simetidin Tablet 200 mg
0471 Simvastatin Tablet 10 mg 5
0472 Siprofloksasin Tablet 500 mg
0473 Sulfasetamid Natrium Tetes Mata 15 %
0474 Terbutalin tablet 2,5 mg
0475 Tiamfenikol Kapsul 500 mg
0476 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 mg
0477 Triamcinolone Acetonide 1 mg
0478 Triheksifenidil Tablet 2 mg
0479 Vitamin B Komplek Tablet 10
0480 Zinc Tablet 20 mg
 kayah

10
ihanika

5
gemi
lotari

10
10
10
suparmi

5
semi
aminatus
dayem

10
supinah
sukari

10
slamet r

15
supiyah
tukiran

10
5

siti s
10

5
1
sukadi

15
1
karmiat
maini
10

lasini

10 5
amari

15
kartinem
5

yatemi
15 10

sumiati
sundari
kusmiati

10
10 10

1
kosriadi

5
ismadi
10 10 10

sukanti
TOTAL

41
86
35
40
75
20
10
20
35
10 15 45

0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
1
1
0
0
0
0
 0
0
0
0
5 5 5 20
0
5 5
0
0
15 10 35
0
15 10 35
16
0
0
0
0
10 15
0
0
10 10 30
0
0
5 5 5 5 25
0
10 5 15
15 15 20 10 15 10 10 ###
0
0
0
0
0
0
0
0
0
10 10 5 5 5 60
0
0
0
0
5 10
0
0
0
 0
0
0
0
1 2
0
15 15
1 1 2
0
0
0
0
0
0
0
0
10 10
10 10 10 10 10 10 10 ###
0
0
10 10 10 10 40
10 10 10 10 10 10 60
0
10 34
10 10 10 40
15 15
1 1
1
0
0
0
10 10 10 10 40
0
10 15
0
0
0
0
10 10
0
0
10 10 10 40
0
 aminudin

masrukin
supartini
sukinem

yusmiati
samsuri
tularsih

murtini
a.kadir
NO NAMA OBAT / NAMA PASIEN

tumidi
danuri

salam

jaitun
gisah
0101 Alopurinol Tablet 100 mg
0102 Alprazolam 0.5 mg
0103 Ambroxol sirup 15 mg/ml
0104 Ambroxol Tablet 30 mg
0105 Aminofilin Tablet 200 mg
0106 Amitriptilin HCL Tablet Salut 25 mg
0107 Amlodipin tablet 5 mg 7
0108 Amoksisilin Kapsul 500 mg 10 10
0109 Antalgin ( metampiron ) Tablet 500 mg
0110 Antasida DOEN Tablet Kombinasi : 10 10 10 10 10
0111 Antasida DOEN II suspensi,k
0112 Anti Bakteri DOEN, Salep Kombinasi
0113 Antifungi DOEN Kombinasi
0114 Antihemoroid DOEN Kombinasi
0115 Asam Askorbat ( Vit C ) Tablet 50 mg 6
0116 Asam Mefenamat Tablet 500 mg
0117 Asam Traneksamat 500 mg
0118 Asetosal Tablet 100 mg
0119 Asiklovir Tablet 400 mg
0120 Asiklovir Tablet 200 mg
0121 Asiklovir Krim 5 %
0122 Attapulgite Pektin
0123 Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet
0124 Betahistin Mesilat Tablet 6 mg
0125 Betametason Krim 0,1 %
0126 Bisacodyl 5 mg
0127 Bisoprolol tablet 5mg
0128 Bromheksin Tablet 8 mg
0129 Cetirizine tablet 10 mg
0130 Deksametason Tablet 0,5 mg
0131 Diazepam Tablet 2 mg
0132 Diazepam Tablet 5 mg
0133 Digoksin Tablet 0,25 mg 10
0134 Diltiazem HCl Tablet 30 mg
0135 Dimenhidrinat Tablet
0136 Doksisiklin Kapsul 100 mg
0137 Domperidon Tablet 10 mg
0138 Efedrin HCL Tablet 25 mg
0201 Eritromisin Tablet 500 mg
0202 Eritromisin Sirup 200 mg/5 mg
0203 Etakridin ( Rivanol ) Larutan 0,1 %
0204 Famotidin Tablet 20 mg
0205 Fenol Gliserol Tetes Telinga 10 %
0206 Fitomenadion ( Vit. K ) Tablet Salut 10 mg
0207 Furosemid Tablet 40 mg
0208 Gameksan Emulsi 1 %
0301 Garam Oralit 200 ml Air 5 6 6
0302 Gentamisin Salep Kulit 0,1 %
0401 Gentian Violet Larutan 1 %
0402 Glibenklamid Tablet 5 mg 5 5
0403 Glimepirid 1 mg
0404 Gliseril Guayakolat Tablet 100 mg 14 10
0405 Griseofulvin Tablet 125 mg, Micronized 28
0406 Haloperidol Tablet 0,5 mg
0407 Haloperidol Tablet 1,5 mg
0408 Haloperidol Tablet 2 mg
0409 Haloperidol Tablet 5 mg
0410 Hidroklorotiazid ( HCT ) Tablet 25 mg
0411 Hidrokortison Krim 2,5 %
0412 Hyoscine Butylbromide 10 mg Methampyronum 250 mg
0413 Ibuprofen Tablet 400 mg 10 10 10
0414 Isosorbid Dinitrat Tablet Sublingual 5 mg
0415 Kalium Diklofenak Tablet 50 mg
0416 Kalsium Laktat ( Kalk ) Tablet 500 mg 5
0417 Kaolin Pektin sirup
0418 Kaptopril Tablet 12,5 mg 14 5
0419 Kaptopril Tablet 25 mg 10
0420 Kaptopril Tablet 50 mg
0421 Karbamazepin Tablet 200 mg
0422 Ketokonazol Tablet 200 mg
0423 Ketokonazol Krim 2%
0424 Klindamisin Kapsul 300 mg
0425 Kloramfenikol Kapsul 250 mg
0426 Kloramfenikol Tetes Mata 0,5 %
0427 Kloramfenikol Salep Mata 1 %
0428 Kloramfenikol Tetes Telinga 3 %
0429 Klorfeniramin Maleat ( CTM ) Tablet 4 mg 5 14 10 6
0430 Klorpromazin HCL Tablet Salut 100 mg
0431 Kodein HCl Tablet 10 mg
0432 Kotrimoksasol Dewasa Tablet
0433 Lisinopril Tablet 5 mg
0434 Loratadin Tablet 10 mg 5
0435 Lorazepam 2 mg
0436 Loperamid Tablet
0437 Metilprednisolon Tablet 4 mg
0438 Metformin HCl Tablet 500 mg
0439 Metoklopramide Tablet 5 mg
0440 Metronidasol Tablet 500 mg
0441 Metronidazol Infus 500 mg/100 ml
0442 Mikonazol Krim/Salep 2 % 1
0443 Multivitamin tablet
0444 Natrium Diklofenak Tablet 50 mg
0445 Natrium Klorida Larutan Infus 0,9 % Steril
0446 Nifedipin Tablet 10 mg
0447 Obat Batuk Hitam ( O.B.H ) Cairan
0448 Obat Flu Kombinasi (Alpara)
0449 Ofloxacin tablet 200 mg
0450 Oksitetrasiklin HCL Injeksi I.M. 50 mg/ml - 10 ml
0451 Oksitetrasiklin HCL Salep 3 %
0452 Oksitetrasiklin HCL Salep Mata
0453 Omeprazol Kapsul 20 mg
0454 Papaverin Tablet 40 mg
0455 Parasetamol Tablet 500 mg 10 10 10
0456 Piracetam Tablet 400 mg
0457 Piracetam Tablet 800 mg
0458 Piridoksin HCL Tablet 10 mg 14 14
0459 Piroksikam Kapsul 10 mg 10
0460 Prednison Tablet 5 mg
0461 Propanolol HCL Tablet 40 mg
0462 Ranitidin Tablet 150 mg
0463 Salbutamol Tablet 4 mg 7
0464 Salep 2 - 4 Kombinasi :
0465 Salisil Bedak 2 %
0466 Salisil Spiritus 10 %
0467 Sefadroxil Kapsul 250 mg
0468 Sefiksim Kapsul 100 mg
0469 Sianokobalamin (Vit.B12) Tablet 50 mcg 14 14 10 10 10 10
0470 Simetidin Tablet 200 mg
0471 Simvastatin Tablet 10 mg
0472 Siprofloksasin Tablet 500 mg 10
0473 Sulfasetamid Natrium Tetes Mata 15 %
0474 Terbutalin tablet 2,5 mg
0475 Tiamfenikol Kapsul 500 mg
0476 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 mg 10
0477 Triamcinolone Acetonide 1 mg
0478 Triheksifenidil Tablet 2 mg
0479 Vitamin B Komplek Tablet 14
0480 Zinc Tablet 20 mg 5 5
kaslan
TOTAL

0
0
0
0
0
0
7
20
0
50
0
0
0
0
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
10 10
0
0
0
0
0
0
 0
0
0
0
0
0
17
0
0
10
0
24
28
0
0
0
0
0
0
0
30
0
0
5 10
0
19
10
0
0
0
0
0
0
0
0
0
35
0
0
0
0
5
0
0
0
 0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
30
0
0
28
10 20
0
0
0
7
0
0
0
0
0
68
0
0
10
0
0
0
10
0
0
14
10
 namgimah

muslimah

mardiyah
legiran e

djumino

mashuri
ponirin
ponirin

a.kadir
sumini
NO NAMA OBAT / NAMA PASIEN

gemi s

sriasih
seger
japar
0101 Alopurinol Tablet 100 mg 14
0102 Alprazolam 0.5 mg
0103 Ambroxol sirup 15 mg/ml
0104 Ambroxol Tablet 30 mg
0105 Aminofilin Tablet 200 mg 7 10 10
0106 Amitriptilin HCL Tablet Salut 25 mg
0107 Amlodipin tablet 5 mg
0108 Amoksisilin Kapsul 500 mg 10
0109 Antalgin ( metampiron ) Tablet 500 mg
0110 Antasida DOEN Tablet Kombinasi : 8
0111 Antasida DOEN II suspensi,k 1
0112 Anti Bakteri DOEN, Salep Kombinasi
0113 Antifungi DOEN Kombinasi
0114 Antihemoroid DOEN Kombinasi
0115 Asam Askorbat ( Vit C ) Tablet 50 mg 7 10
0116 Asam Mefenamat Tablet 500 mg 10
0117 Asam Traneksamat 500 mg
0118 Asetosal Tablet 100 mg
0119 Asiklovir Tablet 400 mg
0120 Asiklovir Tablet 200 mg
0121 Asiklovir Krim 5 %
0122 Attapulgite Pektin
0123 Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet 6
0124 Betahistin Mesilat Tablet 6 mg
0125 Betametason Krim 0,1 %
0126 Bisacodyl 5 mg
0127 Bisoprolol tablet 5mg
0128 Bromheksin Tablet 8 mg
0129 Cetirizine tablet 10 mg
0130 Deksametason Tablet 0,5 mg
0131 Diazepam Tablet 2 mg
0132 Diazepam Tablet 5 mg
0133 Digoksin Tablet 0,25 mg 7 14 14
0134 Diltiazem HCl Tablet 30 mg
0135 Dimenhidrinat Tablet 6
0136 Doksisiklin Kapsul 100 mg
0137 Domperidon Tablet 10 mg
0138 Efedrin HCL Tablet 25 mg
0201 Eritromisin Tablet 500 mg
0202 Eritromisin Sirup 200 mg/5 mg
0203 Etakridin ( Rivanol ) Larutan 0,1 %
0204 Famotidin Tablet 20 mg
0205 Fenol Gliserol Tetes Telinga 10 %
0206 Fitomenadion ( Vit. K ) Tablet Salut 10 mg
0207 Furosemid Tablet 40 mg
0208 Gameksan Emulsi 1 %
0301 Garam Oralit 200 ml Air
0302 Gentamisin Salep Kulit 0,1 %
0401 Gentian Violet Larutan 1 %
0402 Glibenklamid Tablet 5 mg 8 10 7
0403 Glimepirid 1 mg
0404 Gliseril Guayakolat Tablet 100 mg 10 10 10 10 10
0405 Griseofulvin Tablet 125 mg, Micronized
0406 Haloperidol Tablet 0,5 mg
0407 Haloperidol Tablet 1,5 mg
0408 Haloperidol Tablet 2 mg
0409 Haloperidol Tablet 5 mg
0410 Hidroklorotiazid ( HCT ) Tablet 25 mg 7 7
0411 Hidrokortison Krim 2,5 %
0412 Hyoscine Butylbromide 10 mg Methampyronum 250 mg
0413 Ibuprofen Tablet 400 mg 10
0414 Isosorbid Dinitrat Tablet Sublingual 5 mg
0415 Kalium Diklofenak Tablet 50 mg
0416 Kalsium Laktat ( Kalk ) Tablet 500 mg
0417 Kaolin Pektin sirup
0418 Kaptopril Tablet 12,5 mg
0419 Kaptopril Tablet 25 mg 8 14 14 8
0420 Kaptopril Tablet 50 mg
0421 Karbamazepin Tablet 200 mg 7
0422 Ketokonazol Tablet 200 mg
0423 Ketokonazol Krim 2%
0424 Klindamisin Kapsul 300 mg
0425 Kloramfenikol Kapsul 250 mg
0426 Kloramfenikol Tetes Mata 0,5 %
0427 Kloramfenikol Salep Mata 1 %
0428 Kloramfenikol Tetes Telinga 3 %
0429 Klorfeniramin Maleat ( CTM ) Tablet 4 mg
0430 Klorpromazin HCL Tablet Salut 100 mg
0431 Kodein HCl Tablet 10 mg
0432 Kotrimoksasol Dewasa Tablet
0433 Lisinopril Tablet 5 mg
0434 Loratadin Tablet 10 mg
0435 Lorazepam 2 mg
0436 Loperamid Tablet
0437 Metilprednisolon Tablet 4 mg
0438 Metformin HCl Tablet 500 mg
0439 Metoklopramide Tablet 5 mg
0440 Metronidasol Tablet 500 mg
0441 Metronidazol Infus 500 mg/100 ml
0442 Mikonazol Krim/Salep 2 %
0443 Multivitamin tablet
0444 Natrium Diklofenak Tablet 50 mg
0445 Natrium Klorida Larutan Infus 0,9 % Steril
0446 Nifedipin Tablet 10 mg
0447 Obat Batuk Hitam ( O.B.H ) Cairan
0448 Obat Flu Kombinasi (Alpara)
0449 Ofloxacin tablet 200 mg
0450 Oksitetrasiklin HCL Injeksi I.M. 50 mg/ml - 10 ml
0451 Oksitetrasiklin HCL Salep 3 %
0452 Oksitetrasiklin HCL Salep Mata
0453 Omeprazol Kapsul 20 mg
0454 Papaverin Tablet 40 mg
0455 Parasetamol Tablet 500 mg 10 10 10 10 10 10 10 10
0456 Piracetam Tablet 400 mg
0457 Piracetam Tablet 800 mg
0458 Piridoksin HCL Tablet 10 mg 10 10
0459 Piroksikam Kapsul 10 mg 10
0460 Prednison Tablet 5 mg
0461 Propanolol HCL Tablet 40 mg
0462 Ranitidin Tablet 150 mg
0463 Salbutamol Tablet 4 mg
0464 Salep 2 - 4 Kombinasi :
0465 Salisil Bedak 2 %
0466 Salisil Spiritus 10 %
0467 Sefadroxil Kapsul 250 mg
0468 Sefiksim Kapsul 100 mg
0469 Sianokobalamin (Vit.B12) Tablet 50 mcg
0470 Simetidin Tablet 200 mg
0471 Simvastatin Tablet 10 mg 7
0472 Siprofloksasin Tablet 500 mg
0473 Sulfasetamid Natrium Tetes Mata 15 %
0474 Terbutalin tablet 2,5 mg
0475 Tiamfenikol Kapsul 500 mg
0476 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 mg
0477 Triamcinolone Acetonide 1 mg
0478 Triheksifenidil Tablet 2 mg
0479 Vitamin B Komplek Tablet 10 14 14
0480 Zinc Tablet 20 mg
 lasini

10
mahmudi

4
samsuri

20
amari

14
sukadi
murtini

14
10
kasihani
kayah
poniran

10
kaslan
imam g

6
7
siti a
14

maini
10

dayem
14

supiyah
yasir

7
kosriadi

10
lotari

14
10

supiyah
8

amanah
mashadi
slamet r

14
hari s
10

dullah
katijan

6
tukiran
siti s
TOTAL

12
52
63
30
21
16
40
57
42

0
0
0
0
0
0
0
0
0
0
0
0
1
6
6
0
0
0
0
0
0
0
0
1 1
1
0
0
0
0
0
0
 0
0
0
4 4
7 7 7 7 7 35
0
0
0
0
7 7 7 20 66
0
14 10 8 8 10 100
0
0
0
0
0
7 21
0
0
10 10 10 10 50
0
0
3 7 4 7 21
0
8 10 8 26
14 14 14 10 96
0
7
0
0
0
0
0
0
0
10 6 6 6 7 35
0
0
0
0
0
0
0
0
 0
0
0
0
0
0
0
1 1
0
0
0
0
0
0
1 1
0
0
10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 250
0
0
10 30
10 20
0
14 7 7 28
0
14 14
0
1 1
0
0
0
0
0
7
0
0
0
0
0
0
0
10 10 14 14 86
0
NO NAMA OBAT / NAMA PASIEN

0101 Alopurinol Tablet 100 mg

0102 Alprazolam 0.5 mg
0103 Ambroxol sirup 15 mg/ml
0104 Ambroxol Tablet 30 mg
0105 Aminofilin Tablet 200 mg
0106 Amitriptilin HCL Tablet Salut 25 mg
0107 Amlodipin tablet 5 mg
0108 Amoksisilin Kapsul 500 mg
0109 Antalgin ( metampiron ) Tablet 500 mg
0110 Antasida DOEN Tablet Kombinasi :
0111 Antasida DOEN II suspensi,k
0112 Anti Bakteri DOEN, Salep Kombinasi
0113 Antifungi DOEN Kombinasi
0114 Antihemoroid DOEN Kombinasi
0115 Asam Askorbat ( Vit C ) Tablet 50 mg
0116 Asam Mefenamat Tablet 500 mg
0117 Asam Traneksamat 500 mg
0118 Asetosal Tablet 100 mg
0119 Asiklovir Tablet 400 mg
0120 Asiklovir Tablet 200 mg
0121 Asiklovir Krim 5 %
0122 Attapulgite Pektin
0123 Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet
0124 Betahistin Mesilat Tablet 6 mg
0125 Betametason Krim 0,1 %
0126 Bisacodyl 5 mg
0127 Bisoprolol tablet 5mg
0128 Bromheksin Tablet 8 mg
0129 Cetirizine tablet 10 mg
0130 Deksametason Tablet 0,5 mg
0131 Diazepam Tablet 2 mg
0132 Diazepam Tablet 5 mg
0133 Digoksin Tablet 0,25 mg
0134 Diltiazem HCl Tablet 30 mg
0135 Dimenhidrinat Tablet
0136 Doksisiklin Kapsul 100 mg
0137 Domperidon Tablet 10 mg
0138 Efedrin HCL Tablet 25 mg
0201 Eritromisin Tablet 500 mg
0202 Eritromisin Sirup 200 mg/5 mg
0203 Etakridin ( Rivanol ) Larutan 0,1 %
0204 Famotidin Tablet 20 mg
0205 Fenol Gliserol Tetes Telinga 10 %
0206 Fitomenadion ( Vit. K ) Tablet Salut 10 mg
0207 Furosemid Tablet 40 mg
0208 Gameksan Emulsi 1 %
0301 Garam Oralit 200 ml Air
0302 Gentamisin Salep Kulit 0,1 %
0401 Gentian Violet Larutan 1 %
0402 Glibenklamid Tablet 5 mg
0403 Glimepirid 1 mg
0404 Gliseril Guayakolat Tablet 100 mg
0405 Griseofulvin Tablet 125 mg, Micronized
0406 Haloperidol Tablet 0,5 mg
0407 Haloperidol Tablet 1,5 mg
0408 Haloperidol Tablet 2 mg
0409 Haloperidol Tablet 5 mg
0410 Hidroklorotiazid ( HCT ) Tablet 25 mg
0411 Hidrokortison Krim 2,5 %
0412 Hyoscine Butylbromide 10 mg Methampyronum 250 mg
0413 Ibuprofen Tablet 400 mg
0414 Isosorbid Dinitrat Tablet Sublingual 5 mg
0415 Kalium Diklofenak Tablet 50 mg
0416 Kalsium Laktat ( Kalk ) Tablet 500 mg
0417 Kaolin Pektin sirup
0418 Kaptopril Tablet 12,5 mg
0419 Kaptopril Tablet 25 mg
0420 Kaptopril Tablet 50 mg
0421 Karbamazepin Tablet 200 mg
0422 Ketokonazol Tablet 200 mg
0423 Ketokonazol Krim 2%
0424 Klindamisin Kapsul 300 mg
0425 Kloramfenikol Kapsul 250 mg
0426 Kloramfenikol Tetes Mata 0,5 %
0427 Kloramfenikol Salep Mata 1 %
0428 Kloramfenikol Tetes Telinga 3 %
0429 Klorfeniramin Maleat ( CTM ) Tablet 4 mg
0430 Klorpromazin HCL Tablet Salut 100 mg
0431 Kodein HCl Tablet 10 mg
0432 Kotrimoksasol Dewasa Tablet
0433 Lisinopril Tablet 5 mg
0434 Loratadin Tablet 10 mg
0435 Lorazepam 2 mg
0436 Loperamid Tablet
0437 Metilprednisolon Tablet 4 mg
0438 Metformin HCl Tablet 500 mg
0439 Metoklopramide Tablet 5 mg
0440 Metronidasol Tablet 500 mg
0441 Metronidazol Infus 500 mg/100 ml
0442 Mikonazol Krim/Salep 2 %
0443 Multivitamin tablet
0444 Natrium Diklofenak Tablet 50 mg
0445 Natrium Klorida Larutan Infus 0,9 % Steril
0446 Nifedipin Tablet 10 mg
0447 Obat Batuk Hitam ( O.B.H ) Cairan
0448 Obat Flu Kombinasi (Alpara)
0449 Ofloxacin tablet 200 mg
0450 Oksitetrasiklin HCL Injeksi I.M. 50 mg/ml - 10 ml
0451 Oksitetrasiklin HCL Salep 3 %
0452 Oksitetrasiklin HCL Salep Mata
0453 Omeprazol Kapsul 20 mg
0454 Papaverin Tablet 40 mg
0455 Parasetamol Tablet 500 mg
0456 Piracetam Tablet 400 mg
0457 Piracetam Tablet 800 mg
0458 Piridoksin HCL Tablet 10 mg
0459 Piroksikam Kapsul 10 mg
0460 Prednison Tablet 5 mg
0461 Propanolol HCL Tablet 40 mg
0462 Ranitidin Tablet 150 mg
0463 Salbutamol Tablet 4 mg
0464 Salep 2 - 4 Kombinasi :
0465 Salisil Bedak 2 %
0466 Salisil Spiritus 10 %
0467 Sefadroxil Kapsul 250 mg
0468 Sefiksim Kapsul 100 mg
0469 Sianokobalamin (Vit.B12) Tablet 50 mcg
0470 Simetidin Tablet 200 mg
0471 Simvastatin Tablet 10 mg
0472 Siprofloksasin Tablet 500 mg
0473 Sulfasetamid Natrium Tetes Mata 15 %
0474 Terbutalin tablet 2,5 mg
0475 Tiamfenikol Kapsul 500 mg
0476 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 mg
0477 Triamcinolone Acetonide 1 mg
0478 Triheksifenidil Tablet 2 mg
0479 Vitamin B Komplek Tablet
0480 Zinc Tablet 20 mg
 suwarsono

mardiyah

nurwakid
mahmud

sumijani
kosriadi

puniran
fatonah
katmini

supiten

m.toha
legiran

adul w
NO NAMA OBAT / NAMA PASIEN

sriati
0101 Alopurinol Tablet 100 mg 14
0102 Alprazolam 0.5 mg
0103 Ambroxol sirup 15 mg/ml
0104 Ambroxol Tablet 30 mg
0105 Aminofilin Tablet 200 mg
0106 Amitriptilin HCL Tablet Salut 25 mg
0107 Amlodipin tablet 5 mg
0108 Amoksisilin Kapsul 500 mg
0109 Antalgin ( metampiron ) Tablet 500 mg
0110 Antasida DOEN Tablet Kombinasi : 10
0111 Antasida DOEN II suspensi,k 1
0112 Anti Bakteri DOEN, Salep Kombinasi
0113 Antifungi DOEN Kombinasi
0114 Antihemoroid DOEN Kombinasi
0115 Asam Askorbat ( Vit C ) Tablet 50 mg
0116 Asam Mefenamat Tablet 500 mg 10 10 10
0117 Asam Traneksamat 500 mg
0118 Asetosal Tablet 100 mg
0119 Asiklovir Tablet 400 mg
0120 Asiklovir Tablet 200 mg
0121 Asiklovir Krim 5 %
0122 Attapulgite Pektin
0123 Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet
0124 Betahistin Mesilat Tablet 6 mg 5
0125 Betametason Krim 0,1 %
0126 Bisacodyl 5 mg
0127 Bisoprolol tablet 5mg
0128 Bromheksin Tablet 8 mg
0129 Cetirizine tablet 10 mg
0130 Deksametason Tablet 0,5 mg
0131 Diazepam Tablet 2 mg
0132 Diazepam Tablet 5 mg
0133 Digoksin Tablet 0,25 mg
0134 Diltiazem HCl Tablet 30 mg 14
0135 Dimenhidrinat Tablet 6
0136 Doksisiklin Kapsul 100 mg
0137 Domperidon Tablet 10 mg
0138 Efedrin HCL Tablet 25 mg
0201 Eritromisin Tablet 500 mg
0202 Eritromisin Sirup 200 mg/5 mg
0203 Etakridin ( Rivanol ) Larutan 0,1 %
0204 Famotidin Tablet 20 mg
0205 Fenol Gliserol Tetes Telinga 10 %
0206 Fitomenadion ( Vit. K ) Tablet Salut 10 mg
0207 Furosemid Tablet 40 mg
0208 Gameksan Emulsi 1 %
0301 Garam Oralit 200 ml Air
0302 Gentamisin Salep Kulit 0,1 %
0401 Gentian Violet Larutan 1 %
0402 Glibenklamid Tablet 5 mg 7
0403 Glimepirid 1 mg
0404 Gliseril Guayakolat Tablet 100 mg 14 14
0405 Griseofulvin Tablet 125 mg, Micronized
0406 Haloperidol Tablet 0,5 mg
0407 Haloperidol Tablet 1,5 mg
0408 Haloperidol Tablet 2 mg
0409 Haloperidol Tablet 5 mg
0410 Hidroklorotiazid ( HCT ) Tablet 25 mg
0411 Hidrokortison Krim 2,5 % 1
0412 Hyoscine Butylbromide 10 mg Methampyronum 250 mg
0413 Ibuprofen Tablet 400 mg
0414 Isosorbid Dinitrat Tablet Sublingual 5 mg
0415 Kalium Diklofenak Tablet 50 mg
0416 Kalsium Laktat ( Kalk ) Tablet 500 mg 7
0417 Kaolin Pektin sirup
0418 Kaptopril Tablet 12,5 mg 14 14 14 14 14
0419 Kaptopril Tablet 25 mg 14 14
0420 Kaptopril Tablet 50 mg
0421 Karbamazepin Tablet 200 mg
0422 Ketokonazol Tablet 200 mg
0423 Ketokonazol Krim 2%
0424 Klindamisin Kapsul 300 mg
0425 Kloramfenikol Kapsul 250 mg
0426 Kloramfenikol Tetes Mata 0,5 %
0427 Kloramfenikol Salep Mata 1 %
0428 Kloramfenikol Tetes Telinga 3 %
0429 Klorfeniramin Maleat ( CTM ) Tablet 4 mg 10
0430 Klorpromazin HCL Tablet Salut 100 mg
0431 Kodein HCl Tablet 10 mg
0432 Kotrimoksasol Dewasa Tablet
0433 Lisinopril Tablet 5 mg
0434 Loratadin Tablet 10 mg 5 5
0435 Lorazepam 2 mg
0436 Loperamid Tablet
0437 Metilprednisolon Tablet 4 mg
0438 Metformin HCl Tablet 500 mg
0439 Metoklopramide Tablet 5 mg
0440 Metronidasol Tablet 500 mg
0441 Metronidazol Infus 500 mg/100 ml
0442 Mikonazol Krim/Salep 2 %
0443 Multivitamin tablet
0444 Natrium Diklofenak Tablet 50 mg
0445 Natrium Klorida Larutan Infus 0,9 % Steril
0446 Nifedipin Tablet 10 mg
0447 Obat Batuk Hitam ( O.B.H ) Cairan
0448 Obat Flu Kombinasi (Alpara)
0449 Ofloxacin tablet 200 mg
0450 Oksitetrasiklin HCL Injeksi I.M. 50 mg/ml - 10 ml
0451 Oksitetrasiklin HCL Salep 3 %
0452 Oksitetrasiklin HCL Salep Mata
0453 Omeprazol Kapsul 20 mg
0454 Papaverin Tablet 40 mg
0455 Parasetamol Tablet 500 mg 10 10 10 10 10 10 10
0456 Piracetam Tablet 400 mg
0457 Piracetam Tablet 800 mg
0458 Piridoksin HCL Tablet 10 mg 14 6
0459 Piroksikam Kapsul 10 mg 10
0460 Prednison Tablet 5 mg
0461 Propanolol HCL Tablet 40 mg 14
0462 Ranitidin Tablet 150 mg 6
0463 Salbutamol Tablet 4 mg
0464 Salep 2 - 4 Kombinasi : 1
0465 Salisil Bedak 2 %
0466 Salisil Spiritus 10 %
0467 Sefadroxil Kapsul 250 mg
0468 Sefiksim Kapsul 100 mg
0469 Sianokobalamin (Vit.B12) Tablet 50 mcg 14 10 10 14
0470 Simetidin Tablet 200 mg
0471 Simvastatin Tablet 10 mg
0472 Siprofloksasin Tablet 500 mg
0473 Sulfasetamid Natrium Tetes Mata 15 %
0474 Terbutalin tablet 2,5 mg
0475 Tiamfenikol Kapsul 500 mg
0476 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 mg 10 14 14
0477 Triamcinolone Acetonide 1 mg
0478 Triheksifenidil Tablet 2 mg
0479 Vitamin B Komplek Tablet 10 14 14
0480 Zinc Tablet 20 mg
 murtini
kasihani
ponirin

14
10
kayah
imam g
semi

14
siti a
kusmiati

10 10

7
yusuf

10
maini
14 14 14 14

gemi
dayem
14

supiyah
lotari

14
10

supinah
10
14

slamet r
tumini
amari
TOTAL

0
0
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
4
0
0
0

13
42
14 28
40
40
20
98
 0
0
0
0
7 7 14
0
0
0
0
7 14
0
14 10 14 66
0
0
0
0
0
0
1 2
0
10 10 10 10 40
0
0
7 7 7 28
0
14 14 98
14 20 14 14 14 ###
0
0
0
0
0
0
0
0
0
10 10 30
0
0
0
0
10
0
0
0
 0
0
0
0
1 1
0
0
0
0
0
0
0
0
0
0
0
0
10 10 10 10 10 10 10 10###
0
0
14 14 48
10 20
0
7 21
6
14 14
1
1 1
0
0
0
14 14 14 90
0
0
0
0
0
0
14 14 14 14 6 ###
0
0
38
0
NO NAMA OBAT / NAMA PASIEN 27 29 3 5
0101 Alopurinol Tablet 100 mg 0 0 10 10
0102 Alprazolam 0.5 mg 0 0 0 0
0103 Ambroxol sirup 15 mg/ml 0 0 0 0
0104 Ambroxol Tablet 30 mg 0 0 0 0
0105 Aminofilin Tablet 200 mg 0 10 10 10
0106 Amitriptilin HCL Tablet Salut 25 mg 0 17 0 4
0107 Amlodipin tablet 5 mg 0 0 20 0
0108 Amoksisilin Kapsul 500 mg 0 0 10 0
0109 Antalgin ( metampiron ) Tablet 500 mg 0 0 0 0
0110 Antasida DOEN Tablet Kombinasi : 0 35 30 8
0111 Antasida DOEN II suspensi,k 0 0 1 1
0112 Anti Bakteri DOEN, Salep Kombinasi 0 0 0 3
0113 Antifungi DOEN Kombinasi 0 0 0 1
0114 Antihemoroid DOEN Kombinasi 0 0 0 0
0115 Asam Askorbat ( Vit C ) Tablet 50 mg 0 0 0 0
0116 Asam Mefenamat Tablet 500 mg 20 60 0 44
0117 Asam Traneksamat 500 mg 0 0 0 0
0118 Asetosal Tablet 100 mg 0 0 0 0
0119 Asiklovir Tablet 400 mg 0 0 0 0
0120 Asiklovir Tablet 200 mg 0 0 0 0
0121 Asiklovir Krim 5 % 0 0 0 0
0122 Attapulgite Pektin 0 0 0 0
0123 Besi (II) Sulfat 200 mg + Asam Folat 0,25 mg tablet 0 0 0 0
0124 Betahistin Mesilat Tablet 6 mg 0 12 20 10
0125 Betametason Krim 0,1 % 0 1 0 0
0126 Bisacodyl 5 mg 0 0 0 0
0127 Bisoprolol tablet 5mg 0 0 0 0
0128 Bromheksin Tablet 8 mg 0 0 0 0
0129 Cetirizine tablet 10 mg 0 0 0 0
0130 Deksametason Tablet 0,5 mg 0 0 0 0
0131 Diazepam Tablet 2 mg 0 0 0 0
0132 Diazepam Tablet 5 mg 0 0 0 0
0133 Digoksin Tablet 0,25 mg 15 31 24 36
0134 Diltiazem HCl Tablet 30 mg 30 60 35 28
0135 Dimenhidrinat Tablet 0 15 35 8
0136 Doksisiklin Kapsul 100 mg 0 0 0 0
0137 Domperidon Tablet 10 mg 0 0 10 0
0138 Efedrin HCL Tablet 25 mg 0 0 0 0
0201 Eritromisin Tablet 500 mg 0 0 0 0
0202 Eritromisin Sirup 200 mg/5 mg 0 0 0 0
0203 Etakridin ( Rivanol ) Larutan 0,1 % 0 0 0 0
0204 Famotidin Tablet 20 mg 0 0 0 0
0205 Fenol Gliserol Tetes Telinga 10 % 0 0 0 0
0206 Fitomenadion ( Vit. K ) Tablet Salut 10 mg 0 0 0 0
0207 Furosemid Tablet 40 mg 5 14 10 10
0208 Gameksan Emulsi 1 % 0 0 0 0
0301 Garam Oralit 200 ml Air 0 0 3 0
0302 Gentamisin Salep Kulit 0,1 % 0 0 0 0
0401 Gentian Violet Larutan 1 % 0 0 0 0
0402 Glibenklamid Tablet 5 mg 10 25 10 34
0403 Glimepirid 1 mg 10 0 10 0
0404 Gliseril Guayakolat Tablet 100 mg 35 26 44 30
0405 Griseofulvin Tablet 125 mg, Micronized 0 0 0 0
0406 Haloperidol Tablet 0,5 mg 0 0 0 0
0407 Haloperidol Tablet 1,5 mg 0 0 0 0
0408 Haloperidol Tablet 2 mg 0 0 0 0
0409 Haloperidol Tablet 5 mg 0 0 0 0
0410 Hidroklorotiazid ( HCT ) Tablet 25 mg 0 5 0 7
0411 Hidrokortison Krim 2,5 % 0 0 0 0
0412 Hyoscine Butylbromide 10 mg Methampyronum 250 mg 0 0 0 0
0413 Ibuprofen Tablet 400 mg 0 10 0 20
0414 Isosorbid Dinitrat Tablet Sublingual 5 mg 0 8 0 0
0415 Kalium Diklofenak Tablet 50 mg 0 0 0 0
0416 Kalsium Laktat ( Kalk ) Tablet 500 mg 10 43 10 24
0417 Kaolin Pektin sirup 0 0 0 0
0418 Kaptopril Tablet 12,5 mg 20 14 15 14
0419 Kaptopril Tablet 25 mg 10 14 10 70
0420 Kaptopril Tablet 50 mg 0 0 0 0
0421 Karbamazepin Tablet 200 mg 0 0 0 0
0422 Ketokonazol Tablet 200 mg 0 0 0 0
0423 Ketokonazol Krim 2% 0 0 0 0
0424 Klindamisin Kapsul 300 mg 0 0 0 0
0425 Kloramfenikol Kapsul 250 mg 0 0 0 0
0426 Kloramfenikol Tetes Mata 0,5 % 0 0 0 0
0427 Kloramfenikol Salep Mata 1 % 0 0 0 0
0428 Kloramfenikol Tetes Telinga 3 % 0 0 0 0
0429 Klorfeniramin Maleat ( CTM ) Tablet 4 mg 5 31 25 51
0430 Klorpromazin HCL Tablet Salut 100 mg 0 0 0 0
0431 Kodein HCl Tablet 10 mg 0 0 0 0
0432 Kotrimoksasol Dewasa Tablet 0 14 0 0
0433 Lisinopril Tablet 5 mg 0 0 0 0
0434 Loratadin Tablet 10 mg 5 0 0 0
0435 Lorazepam 2 mg 0 0 0 0
0436 Loperamid Tablet 0 0 0 0
0437 Metilprednisolon Tablet 4 mg 0 0 0 0
0438 Metformin HCl Tablet 500 mg 0 0 0 0
0439 Metoklopramide Tablet 5 mg 0 0 0 0
0440 Metronidasol Tablet 500 mg 0 0 0 0
0441 Metronidazol Infus 500 mg/100 ml 0 0 0 0
0442 Mikonazol Krim/Salep 2 % 0 0 1 0
0443 Multivitamin tablet 0 0 0 0
0444 Natrium Diklofenak Tablet 50 mg 0 10 0 0
0445 Natrium Klorida Larutan Infus 0,9 % Steril 0 0 0 0
0446 Nifedipin Tablet 10 mg 15 38 0 0
0447 Obat Batuk Hitam ( O.B.H ) Cairan 0 0 0 0
0448 Obat Flu Kombinasi (Alpara) 0 0 0 0
0449 Ofloxacin tablet 200 mg 0 0 0 0
0450 Oksitetrasiklin HCL Injeksi I.M. 50 mg/ml - 10 ml 0 0 0 0
0451 Oksitetrasiklin HCL Salep 3 % 0 0 0 0
0452 Oksitetrasiklin HCL Salep Mata 0 0 0 0
0453 Omeprazol Kapsul 20 mg 0 0 0 0
0454 Papaverin Tablet 40 mg 0 0 0 0
0455 Parasetamol Tablet 500 mg 95 120 130 110
0456 Piracetam Tablet 400 mg 0 0 0 0
0457 Piracetam Tablet 800 mg 0 0 0 0
0458 Piridoksin HCL Tablet 10 mg 30 14 30 42
0459 Piroksikam Kapsul 10 mg 0 20 10 10
0460 Prednison Tablet 5 mg 0 0 0 0
0461 Propanolol HCL Tablet 40 mg 0 35 5 32
0462 Ranitidin Tablet 150 mg 0 0 0 8
0463 Salbutamol Tablet 4 mg 15 14 14 7
0464 Salep 2 - 4 Kombinasi : 0 0 1 1
0465 Salisil Bedak 2 % 0 0 1 0
0466 Salisil Spiritus 10 % 0 0 0 0
0467 Sefadroxil Kapsul 250 mg 0 0 0 0
0468 Sefiksim Kapsul 100 mg 0 0 0 0
0469 Sianokobalamin (Vit.B12) Tablet 50 mcg 10 4 30 70
0470 Simetidin Tablet 200 mg 0 0 0 0
0471 Simvastatin Tablet 10 mg 0 0 5 0
0472 Siprofloksasin Tablet 500 mg 0 8 0 0
0473 Sulfasetamid Natrium Tetes Mata 15 % 0 0 0 0
0474 Terbutalin tablet 2,5 mg 0 0 0 0
0475 Tiamfenikol Kapsul 500 mg 0 0 0 0
0476 Tiamin HCL Mononitrat ( Vit B 1 ) Tablet 50 mg 0 0 0 4
0477 Triamcinolone Acetonide 1 mg 0 0 0 0
0478 Triheksifenidil Tablet 2 mg 0 0 0 0
0479 Vitamin B Komplek Tablet 30 66 0 24
0480 Zinc Tablet 20 mg 0 0 0 6
9 12 16 19 23 TOTAL
45 0 42 98 205
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
35 0 57 20 142
20 0 0 4 45
10 7 0 0 37
20 20 40 0 90
0 0 0 0 0
75 50 16 40 254
1 0 1 1 5
1 0 1 0 5
0 0 0 0 1
0 0 0 0 0
0 6 21 0 27
40 0 30 40 234
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 6 0 6
0 0 6 5 53
3 0 1 0 5
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
35 10 63 28 242
86 10 52 42 343
41 0 12 13 124
0 0 0 0 0
0 0 0 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 4 0 4
20 0 35 14 108
0 0 0 0 0
5 17 0 0 25
0 0 0 0 0
0 0 0 0 0
35 10 66 14 204
0 0 0 0 20
35 24 100 66 360
16 28 0 0 44
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
15 0 21 0 48
0 0 0 2 2
0 0 0 0 0
30 30 50 40 180
0 0 0 0 8
0 0 0 0 0
25 10 21 28 171
0 0 0 0 0
15 19 26 98 221
140 10 96 104 454
0 0 0 0 0
0 0 7 0 7
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
60 35 35 30 272
0 0 0 0 0
0 0 0 0 0
0 0 0 0 14
0 0 0 0 0
10 5 0 10 30
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
2 1 0 1 5
0 0 0 0 0
 15 0 0 0 25
2 0 1 0 3
0 0 0 0 53
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 1 0 1
0 0 0 0 0
10 0 0 0 10
190 30 250 150 1075
0 0 0 0 0
0 0 0 0 0
40 28 30 48 262
60 20 20 20 160
0 0 0 0 0
34 0 28 21 155
40 0 0 6 54
15 7 14 14 100
1 0 0 1 4
1 0 1 1 4
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
40 68 0 90 312
0 0 0 0 0
15 0 7 0 27
0 10 0 0 18
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
10 10 0 100 124
0 0 0 0 0
0 0 0 0 0
40 14 86 38 298
0 10 0 0 16