LAPORAN PEMAKAIAN DAN LEMBAR P

PUSKESMAS : KARANGAN PELAPORAN BULAN

KECAMATAN : KARANGAN PERMINTAAN BULA
KABUPATEN : KUTAI TIMUR

STOK
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN
AWAL

1 2 3 4 5 6
JENIS TABLET /KAPSUL/KAPLET
1 Allilestrenol 5 mg Tablet 0
2 Allopurinol 100 mg Tablet 0
3 Allopurinol 300 mg Tablet 0
4 Ambroksol 30 mg Tablet 3600 3600
5 Aminofilin 150 mg Tablet 0
6 Aminofilin 200 mg Tablet 0
7 Amitriphyllin 25 mg Tablet 0
8 Amlodipin 10 mg Tablet 1290 1290
9 Amlodipin 5 mg Tablet 600 600
10 Amoksisilin 250 mg Tablet 0
11 Amoksisilin 500 mg Tablet 2800 2800
12 Antasida Tablet 0
13 Artemether-Lumafantrin (Kombinasi) Tablet 0
14 Asam asetil salisilat (asetosal) 100 mg Tablet 0
15 Asam asetil salisilat (asetosal) 80 mg Tablet 0
16 Asam askorbat (vitamin C) 250 mg Tablet 0
17 Asam askorbat (vitamin C) 50 mg Tablet 3000 3000
18 Asam folat 0,4 mg Tablet 0
19 Asam folat 1 mg Tablet 600 600
20 Asam folat 5 mg Tablet 0
21 Asam Mefenamat 250 mg Capsul 0
22 Asam Mefenamat 500 mg Tablet 300 300
23 Asam traneksamat 500 mg Tablet 0
24 Asam ursodeoksikolat 250 mg Kapsul 0
25 Asiklovir 200 mg Tablet 1200 1200
26 Asiklovir 400 mg Tablet 0
27 Atapulgit Tablet 0
28 Atenolol 50 mg Tablet 0
29 Atorvastatin 20 mg Tablet 0
30 Atropin sulfat 0,5 mg Tablet 0
31 Benserazid-levodopa (kombinasi) Tablet 0
32 Betahistin 24 mg Tablet 0
33 Betahistin 6 mg Tablet 870 870
34 Bisakodil 5 mg Tablet 0
35 Bisoprolol 5 mg Tablet 0
36 Bromheksin 8 mg tablet 0
37 Dapson 100 mg Tablet 0
38 Deksametason 0,5 mg Tablet 1900 1900
39 Dekstromenorfan 15 mg Tablet 0

40 Dekstrometorfan-Gliseril guaikolat-PPA- Tablet 0

CTM kombinasi
41 Diazepam 2 mg Tablet 0
42 Diazepam 5 mg Tablet 0
43 Digoksin 0,25 mg Tablet 1400 1400
44 diltiazem 30 mg Tablet 0
45 Dimenhidrinat 50 mg Tablet 400 400
46 Domperidon 10 mg Tablet 700 700
47 Efedrin 25 mg Tablet 0
48 Ekstrak graptofili-sitrus bioflavonoid kapsul 0
49 Ekstrak kurkuma 20 mg tablet 0
50 Ergokalsiferol (Vit D2) 50 mg Tablet 0
51 Ergotamin 1 mg Tablet 0
52 Ergotamin-Kafein (kombinasi) Tablet 0
53 Eritromisin 250 mg Capsul 0
54 Eritromisin 500 mg tablet 200 200
55 Etambutol 250 mg Tablet 0
56 Etambutol 400 mg Tablet 0
57 famotidin 20 mg Tablet 0
58 Fenitoin 100 mg Kapsul 0
59 Fenitoin 30 mg Kapsul 0
60 Fenobarbital 100 mg Tablet 0
61 Fenobarbital 30 mg Tablet 0
62 Fenoksimetil penisilin (Penisilin V) 250 mg Tablet 0
63 Fenoksimetil penisilin (Penisilin V) 500 mg Tablet 0
64 Ferro fumarat 300 mg kapsul 0
Ferro glukonat-Vit C-asam folat-vit B12-
65 Kupri sulfat-Mangan sulfat-sorbitol Tablet 0
kombinasi
66 Ferro sulfat-asam folat (kombinasi) Tablet 1900 1900
67 Fitomenadion (Vit K1) 10 mg Tablet 0
68 Fluoksetin 10 mg Kapsul 0
69 Fluoksetin 20 mg Kapsul 0
70 Furosemid 40 mg Tablet 600 600
71 Gabapentin 300 mg Tablet 0
72 Glibenklamid 2,5 mg Tablet 0
73 Glibenklamid 5 mg Tablet 900 900
74 Glimipiride 1 mg Tablet 0
 75 Glimipiride 2 mg Tablet 0
76 Glipizid 5mg Tablet 0
77 Gliseril guaikolat 100 mg Tablet 1000 1000
78 Gliseril trinitrat 0,5 mg Tablet 0
79 Griseofulvin 125 mg Tablet 1000 1000
80 Griseofulvin 250 mg Tablet 0
81 Griseofulvin 500 mg Tablet 0
82 Haloperidol 1,5 mg Tablet 970 970
83 Haloperidol 2 mg Tablet 0
84 Haloperidol 5 mg Tablet 0
85 Hidroklortiazid 25 mg Tablet 100 100
86 Hiosin butilbromida 10 mg Tablet 0
87 Hiosin butilbromida-parasetamol komb Tablet 0
88 Ibuprofen 200 mg Tablet 1300 1300
89 Ibuprofen 400 mg Tablet 0
90 Irbesartan 300 mg Tablet 0
91 Isoksuprin 20 mg Tablet 0
92 Isoniazid 100 mg Tablet 0
93 Isoniazid 300 mg Tablet 0
94 Isosorbid Dinitrat 5 mg Tablet 1200 1200
95 Kalium diklofenak 50 mg Tablet 0
96 Kalium klorida 600 mg Tablet 0
97 Kalsium karbonat 500 mg Tablet 0
98 Kalsium Laktat (Kalk) 500 mg Tablet 2400 2400
99 Kaolin-pektin komb Tablet 0
100 Kaptopril 12,5 mg Tablet 0
101 Kaptopril 25 mg Tablet 2000 2000
102 Kaptopril 50 mg Tablet 0
103 Karbamazepin 100 mg Tablet 0
104 Karbamazepin 200 mg Tablet 0
105 Karbon aktif 0,5 mg Tablet 0
106 Ketokonazol 200 mg Tablet 900 900
107 Ketoprofen 50 mg Tablet 0
108 Klindamisin 150 mg Kapsul 0
109 Klindamisin 300 mg Kapsul 500 500
110 Klofazimin 100 mg Kapsul 0
111 Klofazimin 50 mg Kapsul 0
112 Klopidogrel 75 mg Tablet 30 30
113 Kloramfenikol 250 mg kapsul 0
114 Kloramfenikol 500 mg Kapsul 0
115 Klorfeniramin 4 mg Tablet 1500 1500
116 Klorpromazin 100 mg Tablet 200 200
117 Klorpromazin 25 mg Tablet 0
118 Klortalidon 50 mg Tablet 0
119 Klozapin 100 mg Tablet 0
120 Klozapin 25 mg Tablet 0
121 Kodein 10 mg Tablet 150 150
122 Kodein HCL 10 mg Tablet 0
123 Kodein HCL 20 mg Tablet 0
124 Kolkisin 500 mcg Tablet 0
125 Kotrimoksazol 480 mg Tablet 400 400
126 Kotrimoksazol forte 960 mg tablet 0

127 Laktobasilus-bifidobakterium longun- sachet 0

streptokokus serbuk kombinasi
128 Lansoprazole 30 mg Kapsul 0
129 Levofloksasin sal selaput 500 mg Tablet 100 100
130 Lisonopril 10 mg Tablet 0
131 Loperamid 2 mg Tablet 100 500 600
132 Loratadin 10 mg Tablet 850 850
133 Lorazepam 0,5 mg Tablet 0
134 Lorazepam 1 mg Tablet 0
135 Lorazepam 2 mg Tablet 0
136 Mebendazol 100 mg Tablet 0
137 Mebendazol 500 mg Tablet 0
138 Mebhidrolin napadisilat 50 mg tablet 0
139 Meloksikam 15 mg Tablet 0
140 Meloksikam 7,5 mg Tablet 500 500
141 Metenamin mandelat sal enterik 500 mg Tablet 0
142 Metformin 500 mg Kaplet 800 800
143 Metformin 850 mg Tablet 0
144 Methysoprinol 500 mg Tablet 0
145 Metil Ergometrin 0,125 mg Tablet 200 200
146 Metildopa 250 mg Tablet 0
147 Metilprednisolon 16 mg Tablet 0
148 Metilprednisolon 4 mg Tablet 1000 1000
149 Metilprednisolon 8 mg Tablet 0
150 Metoklopramid 10 mg Tablet 400 400
151 Metoklopramid 5 mg Tablet 2500 2500
152 Metronidazol 250 mg Tablet 400 400
153 Metronidazol 500 mg Tablet 1000 1000
154 Misoprostol 200 mcg tablet 0
155 n-Asetil sistein 200 mg kapsul 0
156 Natrium bikarbonat 500 mg Tablet 0
157 Natrium Diclofenat 25 mg Tablet 3000 3000
158 Natrium Diclofenat 50 mg Tablet 0
159 Nifedipin 10 mg Tablet 200 200 400
160 Nistatin sal gula 500.000 IU Tablet 0
161 Nitrofurantoin 50 mg Tablet 0
162 Omeprazole 20 mg Kapsul 270 270
163 Ondansetron 8 mg Tablet 0
164 Papaverin 40 mg Tablet 0
165 Parasetamol 500 mg Tablet 3700 3700

166 Parasetamol-gliseril gualikolat-PPA-CTM tablet 0

kombinasi
167 Piracetam 800 mg Tablet 0
168 Pirantel Pamoat 125 mg Tablet 0
169 Pirantel Pamoat 250 mg Tablet 0
170 Piridoksin (Vit B6) 10 mg Tablet 1600 1600
171 Piridoksin (Vit B6) 25 mg Tablet 0
172 Piroksikam 10 mg Capsul 0
173 Piroksikam 20 mg Capsul 0
174 Prazikuantel 600 mg Tablet 0
175 Probenesid 500 mg Tablet 0
176 Propanolol 10 mg Tablet 0
177 Propiltiourasil 100 mg Tablet 0
178 Pseudoefedrin 30 mg tablet 0
179 Ranitidin 150 mg Tablet 900 900
180 Rifampisin 300 mg Kapsul 0
181 Risperidon 1 mg Tablet 0
182 Risperidon 2 mg Tablet 0
183 Salbutamol 2 mg Tablet 0
184 Salbutamol 4 mg Tablet 1600 1600
185 Sefadroksil 250 mg Kapsul 0
186 Sefadroksil 500 mg Kapsul 2000 2000
187 Sefiksim sal selaput 100 mg Tablet 0
188 Sefiksim sal selaput 200 mg Tablet 200 200
189 Setirizin tab 10 mg Tablet 500 500
190 Sianokobalamin (vit B12) 50 mcg Tablet 3000 3000
191 Simetidin 200 mg Tablet 0
192 Simvastatin 10 mg Tablet 1860 1860
193 Simvastatin 20 mg Tablet 1700 1700
194 Simvastatin 40 mg Tablet 0
195 Siprofloksasin sal selaput 500 mg Tablet 1300 1300
196 Sitikolin 500 mg Tablet 0
197 Spironolakton 100 mg Tablet 0
198 Spironolakton 25 mg Tablet 0
199 Sukralfat 500 mg Tablet 500 500
200 Teofilin 100 mg Tablet 600 600
201 Tetrasiklin 250 mg kapsul 0
202 Tetrasiklin 500 mg Kapsul 100 100
203 Tiamfenikol 500 mg Tablet 350 350
204 Tiamin (Vit B1) 50 mg Tablet 1500 1500
205 Tramadol tab 50 mg tablet 300 300
206 Triheksifenidil 2 mg Tablet 0
207 Valproat lepas lambat 250 mg Tablet 0
208 Valproat lepas lambat 500 mg Tablet 0
209 Valproat sal enterik 250 mg Tablet 0
210 Valsiklovir 500 mg Tablet 0

Vit A-vit D-vit B1-vit B2-Vit B6-Vit B12-

nikotinamid-vit C-vit E-Kalsium
211 pantotenat-Biotin-asamfilat-Ferro tablet 0
fumarat-asam glutamat-Zink-Mangan-
Fluor-Iodium kombinasi
212 Vit B1 100 mg-Vit B6 200 mg-Vit B12 200 tablet 1200 1200
mcg kombinasi
213 Vitamin B Kompleks Tablet 2400 2400
OBAT JENIS SYRUP
1 Ambroksol drop 15 mg/ml botol 7 7
2 Ambroksol sy 15 mg/5 ml Botol 182 182
3 Amoksisilin drops 100 mg/ml Botol 0
4 Amoksisilin Syrup Kering 125 mg/5ml Botol 90 90
5 Amoksisilin Syrup Kering 250 mg/5ml Botol 10 10
6 Antasida Suspensi Botol 180 180
7 Domperidon drop 5 mg/ml botol 0
8 Domperidon Syrup 5 mg/5ml Botol 95 95
9 Ergokalsiferol (vit D2) susp 10.000 IU/ml botol 0
10 Eritromisin Sy kering 200 mg / 5 ml Botol 0
11 Ferro sulfat sy 150 mg/5ml botol 0
12 Haloperidol drop 2 mg/ml botol 0
13 Ibuprofen syrup 100mg/5 ml Botol 94 94
14 Ibuprofen syrup 200mg/5ml Botol 0
15 Kaolin-pektin kombinasi sirup botol 0
16 Karbamazepin sy 100 mg/ 5 ml Botol 0
17 Kloramfenikol Suspensi 125 mg/5 ml Botol 39 39
18 Kotrimoksazol Suspensi 240 mg/ 5 ml Botol 206 206
19 laktulosa sy 3,335 gr/5 ml botol 0
20 Lugol larutan botol 0
21 Mebendazol sy 100 mg /5 ml Botol 0
22 Metadon sy 50 mg/5ml botol 0
23 Methysoprinol sy 250 mg/5 ml botol 0
24 Metoklopramid sy 5 mg/5 ml Botol 60 60
25 Metoklopramid drop 2 mg/ml Botol 15 15
26 Metronidazol suspensi 125 mg / 5 ml botol 0
27 Nistatin susp 100.000 IU/ml botol 0
28 Obat Batuk Hitam Sy Botol 100 100
29 Parasetamol 120 mg / 5 ml Syrup Botol 100 100
30 Parasetamol Drops 100 mg/ml Botol 0

31 Parasetamol-CTM-guaifenesin-PPA sirup botol 0

kombinasi
32 Pirantel pamoat susp 125 mg / 5 ml Botol 40 40
33 Pseudoefedrin drop 7,5 mg/0,8 ml botol 0
34 Pseudoefedrin sy 30 mg/5 ml botol 0
35 Salbutamol sy 2 mg/5 ml botol 30 30
36 Salbutamol-Guaifenesin kombinasi sy botol 0
37 sefadroksil syr kering 125 mg/5 ml Botol 127 127
38 sefadroksil syr kering 250 mg/5 ml Botol 0
39 Sefiksim sy 100 mg / 5 ml Botol 0
40 Setrizin Syrup 5 mg/5ml Botol 50 50
41 Sukralfat Susp 500 mg/5 ml Botol 0
42 Tiamfenikol sy 125 mg/5 ml botol 0
 43 Valproat sy 250 mg/ 5 ml Botol 0

vit A-vit D-vit B1-vit B2-Vit B6-Vit B12-

nikotinamid-vit C-vit E-Kalsium
44 pantotenat-Biotin-asamfilat-Ferro botol 0
fumarat-asam glutamat-Zink-Mangan-
Fluor-Iodium kombinasi syrup

45 Zink drop 10 mg/ml botol 0

46 zink syrup 10 mg/5 ml botol 0
BAHAN MEDIS HABIS PAKAI DAN BAHAN LABORATORIUM
1 Air untuk Injeksi 25 ml Botol 13 12 25
2 Alat Suntik sekali pakai 1 ml kotak 2 2
3 Alat suntik sekali pakai 10 ml kotak 2 2
4 Alat Suntik sekali pakai 2,5 ml kotak 0
5 Alat suntik sekali pakai 3 ml kotak 2 2
6 Alat suntik sekali pakai 5 ml kotak 2 2
7 alkohol swab kotak 0
8 Benang cat gut chromic 2/0 sachet 0
9 Benang cat gut plain 3/0 sachet 0
10 Benang Suture Silk 2/0 Pcs 0
11 Benang Suture Silk 3/0 Sachet 0
12 Benang suture silk 4/0 sachet 0
13 Blood lancet kotak 0
14 crepe/bandage 7,5 cm x 4,5 cm pcs 0
15 Etakridin laktat 0,1% botol 0
16 Etanol cairan 70% botol 1 1
17 Handschon ginekologi kotak 0
18 Handschon non steril kotak 4 2 6
19 Handschon steril kotak 0
20 Hidrogen peroksida cairan 3% botol 0
21 Imersi oil 100 cc botol 0
22 Infusion set Anak Set 95 95
23 Infusion set Dewasa Set 195 195
24 IV cath no 20 pcs 50 50
25 IV cath no 18 pcs 50 50
26 IV cath no 22 pcs 50 50
27 IV cath no 24 pcs 50 50
28 IV cath no 26 pcs 50 50
29 Jarum Bedah set 0
30 K.Y. Jelly tube 0
31 Kalsium hipoklorit serbuk botol 0
32 Kapas 250 mg Bungkus 0
33 Kapas 1000 gram Bungkus 3 3
34 Kapas Berlemak 500 mg Bungkus 0
35 Kapas Kompres 40/40 steril Kotak 0
36 Kasa gulung 40 x 80 cm Rol 0
37 Kasa Pembalut 2 M x 80 CM Rol 0
38 Kasa Pembalut Hidropil 4M x 15 CM Rol 0
39 Kasa Pembalut Hidropil 4M x 3 CM Rol 0
 40 Kasa steril 16x16 kotak 4 4
41 Klorheksidin lar 15% botol 0
42 Masker earloop kotak 0
43 Masker kerudung/hijab kotak 0
44 Masker N95 kotak 0
45 needle 24G x 25 mm kotak 0
46 needle 26G x 13 mm kotak 0
47 NGT no 16 pcs 0
48 NGT no 18 pcs 0
49 Nonwoven fixation 20 cm x 5 M roll 1 1
50 Oksigen ih tabung 0
53 Plester uk 5 cm roll 0
54 Povidon Iodin lar 100 mg/ml botol 0
55 PP Test kotak 0
56 selang oksigen anak pcs 4 4
57 selang oksigen dewasa pcs 4 4
58 selang oksigen neonatus pcs 3 3
59 Strip asam urat botol 0
60 Strip Glukosa botol 0
61 Strip kolesterol botol 0
62 surgical blade (bisturi) kotak 0
63 tongue spatel (kayu) kotak 0
64 urine bag pcs 10 10
65 urine cath no 18 pcs 15 15
66 urine cath no 16 pcs 0
OBAT SUNTIK / INJEKSI / INHALASI ( AMPUL / VIAL ) 0
1 Aminofilin Injeksi 24 mg/ml Ampul 0
2 ampisilin serbuk inj 1000 mg vial 0
3 ampisilin serbuk inj 250 mg vial 0
4 asam traneksamat 100 mg/ml Ampul 0
5 Asam traneksamat 50 mg/ml Ampul 0
6 Atropin Injeksi 0,25 mg/ml Ampul 5 5
7 Benzatin benzil penisilin 1,2 juta IU/ml Vial 0
8 Benzatin benzil penisilin 2,4 juta IU/ml Vial 0
9 Budesonid cairan ih 0,25 mg/ml Ampul 0
10 Budesonid cairan ih 0,5 mg/ml Ampul 0
11 Budesonid serb ih 100 mcg/dosis spray 0
12 Budesonid serb ih 200 mcg/dosis spray 0
13 D5 1/2 NS infus Botol 0
14 D5 1/4 NS infus Botol 0
15 Deksametason Injeksi 5 mg/ml Ampul 200 200
16 Diazepam Injeksi 5 mg/ml Ampul 10 10
17 Difenhidramin Injeksi 10 mg/ml Ampul 45 45
18 Diltiazem serb inj 50 mg vial 0
19 Dopamin inj 40 mg/ml Ampul 0
20 Epinefrin Injeksi 0,1 % ml Ampul 4 4
21 Esomeprazole serb inj 40 mg Ampul 0
22 fenitoin inj 50 mg/ml Ampul 0
23 Fitomenadion (Vit K1) Injeksi 10 mg/ml Ampul 0
24 Flufenazin inj 25 mg/ml Ampul 0
25 Furosemid inj 10 mg/ml Ampul 35 35
26 Glukosa 10 % Infus Botol 0
27 Glukosa 40 % Infus Botol 0
28 Glukosa 5 % Infus Botol 80 80
29 Haloperidol inj 5 mg/ml Ampul 0
30 Haloperidol inj 50 mg/ml Ampul 19 19
31 Hepatitis B Imunoglobulin Inj 150 IU/1,5 ml Ampul 0
32 Hepatitis B Imunoglobulin Inj 220 IU/ml Ampul 0
33 Hidrokortison serb inj 100 mg vial 0
34 Hiosin butilbromida inj 20 mg/ml Ampul 0
35 Human tetanus imunoglobulin inj 250 IU Ampul 0
36 Human tetanus imunoglobulin inj 500 IU Ampul 0
37 Ipratropium bromida aerosol 20 mcg/puf spray 0
38 Ipratropium bromida cairan ih 0,025% Ampul 0
39 Ipratropium bromida-salbutamol cairan ih Ampul 0
40 Isoksuprin 2 mg/10 ml Ampul 0
41 KA-EN 3A infus botol 0
42 KA-EN 3B infus botol 0
43 Kanamisin serb injeksi 1000 mg vial 0
44 Ketamin inj 100 mg/ml Ampul 0
45 Ketamin inj 50 mg/ml Ampul 0
46 Ketoprofen inj 25 mg/ml Ampul 0
47 Ketorolac inj 25 mg/ml Ampul 0
48 Klonidin inj 150 mcg/ml Ampul 0
49 Klorpromazin Injeksi 25 mg/ml Ampul 89 89
50 Klorpromazin Injeksi 5 mg/ml Ampul 0
51 Lidocain inj 2% Ampul 190 190
52 Lidokain 2% + epinefrin inj 2 ml Ampul 0
53 Magnesium Sulfat 20 % flakon 12 12
54 Metamizol inj 500 mg/ml Ampul 100 100
 55 Metoklopramid Inj 5 mg/ml Ampul 0
56 Nalokson inj 0,4 mg/ml Ampul 0
57 Natrium Klorida 0,9% infus Botol 200 200
58 Natrium Tiosulfat inj 25% Ampul 0
59 Omeprazole serb inj 40 mg Ampul 15 15
60 Ondansetron inj 2 mg/ml Ampul 180 180
61 Papaverin Injeksi Ampul 0
62 Parasetamol 1000 mg infus 100 ml botol 0
63 Petidin Injeksi 50 mg/2 ml Ampul 10 10
64 Piridoksin (vit B6) inj 50 mg/ml Ampul 0
65 Prokain benzil penisilin serb inj 3 juta IU vial 0
66 Ranitidin Injeksi 25 mg/ml Ampul 70 70
67 Ringer asetat infus botol 0
68 Ringer laktat infus Botol 60 240 300
69 Salbutamol cairan ih 1 mg/ml Ampul 0
70 Sefotaksim serb inj 1000 mg vial 16 16
71 Sefotaksim serb inj 500 mg Vial 0
72 Seftriakson serb inj 1000 mg vial 0
73 Serum Anti Bisa Ular I Injeksi 50 ml Ampul 1 1
74 Serum anti rabies inj 100 IU/ml Ampul 0
75 Serum anti rabies inj 200-400 IU/ml Ampul 9 9
76 Serum anti tetanus (ATS) inj 1.500 IU/ml Ampul 0
77 Serum anti tetanus (ATS) inj 10.000 IU/ml Ampul 0
78 Serum anti tetanus (ATS) inj 20.000 IU/ml Ampul 0
79 Serum anti tetanus (ATS) inj 5.000 IU/ml Ampul 0
80 sianokobalamin (vit B12) Inj 500 mcg/ml Ampul 0
81 Sitikolin inj 250 mg/2 ml Ampul 0
82 Streptomisin serb injeksi 1000 mg vial 0
83 Terbutalin cairan ih 2,5 mg/ml Ampul 0
84 Terbutalin inj 0,5 mg/ml Ampul 0
85 Tetanus toxoid inj Ampul 0
86 Tramadol inj 100 mg/2 ml Ampul 0
87 Triamsinolon asetonid inj 10 mg/ml Ampul 0
88 Tuberkulin serb inj 2 TU/0,1 ml Ampul 0
89 Vit B1 100 mg-Vit B6 100 mg-Vit B12 5000
mcg kombinasi injeksi Ampul 170
170
OBAT LUAR ( TUBE,POT DAN SUPPO ) 0
1 Asiklovir salep Kulit 5% Tube 100 100
Anti Bakteri Komb : Basitrasin+Polimiksin
2 tube 0
salep kulit
 Anti fungi komb : as benzoat+as salisilat
3 tube 0
salep kulit
4 Anti Hemoroid kombinasi Suppo 0
5 Asam asetat tetes telinga 2% botol 0
6 Asam salisilat lar 0,1% Botol 0
7 Asam salisilat salep kulit 10% tube 0
8 Asam salisilat salep kulit 2% tube 0
9 Asam salisilat salep kulit 5% tube 0
10 Atropin tetes mata 1% botol 0
11 Bedak Salisil serb 2% Botol 100 100

12 Betametason 0,1%+Neomisin sulfat 0,5% tube 0

salep kulit kombinasi
13 Betametason krim 0,05 % Tube 0
14 Betametason krim 0,1 % tube 25 25
15 Betametason salep 0,1 % tube 0
16 Betametason tetes mata 1 mg/ml botol 0
17 Bisakodil 10 mg suppo 0
18 Bisakodil 5 mg Suppo 34 34
19 Boraks gliserin cairan botol 0
20 desoksimetason salp 0,25 % tube 20 20
21 Diazepam enema 10 mg/ 2,5 ml suppo 0
22 Diazepam enema 5 mg/ 2,5 ml suppo 0
23 Diklofenak dietilamin gel 10 mg/gr tube 0
24 Fenol Gliserol tetes telinga 10 % Botol 0
25 Fluoresein tts mata 2,5 mg/ml botol 0
26 Framisetin sulfat tulle 1% lembar 0
27 Gentamicin salep mata 0,3% tube 52 52
28 Gentamicin Tetes Mata 0,3% Tube 35 35
29 Gentamisin salep Kulit 0,1% Tube 0
30 Gentian Violet Larutan 1 % Botol 0
31 Gliserin cairan obat luar 100mg/ml botol 9 9
32 Heparin sodium gel 20.000 IU/100 gr tube 0
33 Hidrokortison 2,5 % Cream Tube 43 43
34 Ichtammolum salep kulit pot 0
35 Kalamin lotio Botol 0
36 Kalium Permagnat Serbuk Pot 0
37 Karbogliserin tetes telinga 10% botol 0
38 Ketokonazol 2 % Krim Tube 50 50
39 Ketokonazol scalp sol 2% botol 0
40 Ketoprofen 100 mg rectal Suppo 10 10
41 Kloramfenikol tetes telinga 0
42 Kloramphenicol Salap Mata 1% Tube 0
43 Kloramphenicol Salep kulit 2% tube 0
44 Kloramphenicol tetes mata 0,5% botol 0
45 Kloramphenicol tetes mata 1% botol 0
46 Klotrimazol tab vaginal 100 mg Tablet 0
47 Lidokain gel 2% tube 0
48 liquor carbonis detergens lar 5% botol 0
 49 Mentol-eugenol-metil salisilat krim tube 0

50 Metronidazol 500 mg + Nistatin 100.000 suppo 0

IU kombinasi
51 Metronidazol ovula 500 mg ovula 0
52 Metronidazol sup 500 mg tube 0
53 Mikonazole Krim 2% Tube 43 43
54 Mikonazole serbuk 2% botol 0
55 Mometason furoat 0,1 % cream Tube 12 12
56 Natrium diklofenak tts mata 1 mg/ml botol 0
57 Natrium fusidat salep 2% tube 0

58 Natrium klorida-Kalium klorida tetes mata botol 0

kombinasi
59 Neomisin-Basitrasin powder botol 0
60 Nistatin tab vaginal 100.000 IU Tablet 0
61 Ofloksasin tetes telinga 3% botol 0
62 Oksimetazolin tetes hidung 0,025% botol 0
63 Oksimetazolin tetes hidung 0,05% botol 0
64 Olopatadin tetes mata 0,1% Botol 0
65 Parasetamol rectal 125 mg/2,5 ml suppo 0
66 Parasetamol rectal 250mg/2,5 ml suppo 0
67 Perak sulfadiazin krim 1% Tube 1 1
68 Permetrin krim 5% tube 0
69 Pilokarpin tetes mata 2% botol 0
70 Plasenta extract-Neomisin salep kulit Tube 0
71 Podofilin tingtur 25% botol 0

72 Polimiksin-Neomisin-deksametason tetes botol 0

mata kombinasi

73 Polimiksin-Neomisin-Fludrokortison- botol 10
Lidokain tetes telinga kombinasi 10
74 Povidon Iodin mouthwash 100 ml botol 0
75 Salep 2-4 Pot 2 2
76 Siprofloksasin tetes mata 3% botol 0
77 Tetrakain 0,5% tetes mata botol 0
78 Tetrasiklin salep kulit 3% tube 0

79 Thymol 10 mg, ol. methae 20 mg, botol 0

champora 60 mg tetes telinga
80 Timolol tetes mata 0,25% botol 0
81 Timolol tetes mata 0,5% botol 0
82 Triamsinolon asetonid 1 mg ointment kulit tube 0
83 Urea krim 10% tube 0
84 Urea krim 20% tube 0
OBAT PROGRAM ( PAKET,SET,BUNGKUS)
1 Albendazol susp 200 mg/ 5 ml Botol 30 30
2 Albendazol 400 mg Tablet 0 0
3 Ampisilin injeksi 1000 mg vial 0
4 Artesunat inj 60 mg Vial 0
5 ARV efavirenz 200 mg Tablet 0
6 ARV efavirenz 600 mg Tablet 0
7 ARV kombinasi FDC anak Tablet 0
8 ARV lamivudin150 mg Tablet 0
9 ARV lopinavir-ritonavir Tablet 0
10 ARV nefirapin 200 mg Kapsul 0
11 ARV tenofovir 300 mg Tablet 0
12 ARV tenofovir-emtrisitabin Tablet 0
13 ARV tenofovir-lamivudin-efavirenz Tablet 0
14 ARV zidofudin 100 Kapsul 0
15 ARV zidovudin-lamivudin Tablet 0
16 Azithromicyn 500 mg Tablet 120 120
17 DHP (Dihidroartemisin-piperakuin) komb Tablet 0
18 Dietil Karbamazin 100 mg Tablet 0
19 Doksisiklin 100 mg Kapsul 100 100
20 Fenobarbital Injeksi 50 mg/ml Ampul 30 30
21 Ferro Sulfat sal selaput 300 mg tablet 0
22 Fitomenadion (Vit K1) Injeksi 2 mg/ml Ampul 90 90
23 Garam Oralit Kombinasi serbuk Bungkus 400 400
24 Gentamisin inj 40 mg/ml Ampul 45 45
25 Kalsium glukonat inj 10% Ampul 0
26 Kontrasepsi AKDR Copper T set 0
27 Kontrasepsi AKDR IUD Cu T 380 A set 0
28 Kontrasepsi AKDR IUD levonorgestrel set 0
29 Kontrasepsi implan etonogestrel implan 0
30 Kontrasepsi implan levonogestrel implan 0
31 Kontrasepsi oral kombinasi Tablet 0
32 Kontrasepsi oral linestrenol 0,5 mg tablet 0

33 Kontrasepsi parenteral medroksi vial 0

progesteron asetat inj 150 mg/3 ml
34 Kontrasepsi parenteral siklofem vial 0
35 Kuinin 200 mg Tablet 0
36 Kuinin inj 25% Ampul 0
37 Levotiroksin 50 mcg tablet 0
38 Magnesium Sulfat 40% flakon 0
39 Metil Ergometrin 0,2 mg/ml Ampul 91 91
40 Metronidazol infus 5 mg/ml Botol 10 10
41 Mineral mix sachet 0
42 OAT anak 2KDT (FDC) Tablet 0
43 OAT anak 3KDT (FDC) Tablet 0
44 OAT anak Kombipak A paket 0
45 OAT anak Kombipak B paket 0
46 OAT dewasa 2KDT (FDC) Tablet 1176 1176
47 OAT dewasa 4KDT (FDC) Tablet 1176 1176
48 OAT dewasa Kombipak II paket 0
49 OAT dewasa Kombipak III paket 0
50 Oksitosin Injeksi 10 IU/ml Ampul 147 147
51 Prednison 5 mg Tablet 400 400
 52 Primakuin 15 mg Tablet 100 100
53 Retinol (Vit A) 100.000 IU kapsul 0
54 Retinol (Vit A) 200.000 IU kapsul 0
55 Tetrasiklin salep mata 1% tube 0
56 Vaksin BCG inj 0,75 mg/ml + pelarut Ampul 0
57 Vaksin bivalen OPV drop 10 dosis 0
58 Vaksin Campak inj + pelarut Ampul 0
59 Vaksin DT inj 40/15 If per ml Ampul 0
60 Vaksin hepatitis rekombinan 0,5 ml Uniject 0
61 Vaksin kombinasi DPT-HB-Hib Inj Ampul 0
62 Vaksin Measless Rubella Inj 0,5 ml Ampul 0
63 Vaksin polio IPV inj 0,5 ml Ampul 0
64 Vaksin rabies inj + booster Ampul 0
65 Vaksin rabies inj 2,5 IU Ampul 0
66 Vaksin Td Inj 15/4 lf per ml Ampul 0
67 Zink 20 mg Tablet 1200 1200
OBAT GIGI / PERAWATAN GIGI
1 articulating paper 0
2 Aquadest 500 ml botol 0
3 Bahan tumpatan sementara lar/serbuk 0
4 Etil Klorida Spray 100 ml botol 0
5 Eugenol Cairan 0
6 Ferrakrilum cairan 1% 0
7 Fluor topikal 0
8 formokresol cairan 0
9 Glass Ionomer ART serb/larutan 0
10 Gutta percha-paper points 15-40 mm 0
11 Gutta percha-paper points 45-80 mm 0
12 Kalsium Hidroksida Pasta 0
13 Klorfenol kamfer mentol (CHKM) cairan 0
14 Klorheksidin lar 0,2% 0

15 Kombinasi : deksametason asetat-thymol- 0

paraklorfenol-campor

16 Kombinasi : lidokain-medisinal creosote 0

phenol-eugenol-benzil alkohol

17 Kombinasi : tramsinolon asetonid - 0

dementilklortetrasiklin pasta
18 Komposit resin set 0
20 Lidokain salep 5% tube 0
21 Lidokain spray oral 10% botol 0
22 Natrium hipoklorit 5% 0
23 Pasta devitalisasi (non arsen) 0
24 Pasta pengisi saluran akar 0
25 surgical ginggival pack pasta 0
OBAT TIDAK ADA DI DAFTAR
1 Antalgin 500 mg Tablet 1000 1000
2 Betablok 50 mg Tablet 30 30
3 Becefort Tablet 500 500
4 Calporosis Tablet 1410 1410
5 Concor 1,25 mg Tablet 150 150
6 Concor 10 mg Tablet 60 60
7 Gemfibrozil Tablet 480 480
8 Hemorogard Tablet 60 60
9 Neo Diagon Tablet 500 500
10 Ofloksasin 200 mg Tablet 50 50
11 Ondansetron 4 mg Tablet 60 60
12 Nistatin vaginal 100.000 IU Ovula 105 105
13 Alletrol Botol 24 24
14 Bioplacenton Tube 18 18
15 Cendo Lyters Botol 15 15
16 Molakrim Tube 2 2
17 Ottopaint Tetes Telinga Botol 10 10
18 Soft U-derm Tube 28 28
19 Febrinex Botol 50 50
20 Laxadin Botol 29 29
21 Nifudiar Botol 5 5
22 Antalgin Ampul 21 21
23 Atrovent Botol 3 3
24 Avamys Botol 3 3
25 Calci Glukonas Ampul 10 10
26 Combivent Tube 60 60
27 Dumin Rectal Tube 20 20
28 Illiadin Botol 1 1
29 Metyl Prednisolon Ampul 13 13
30 Ventolin Tube 20 20
31 urine cath no 12 pcs 10 10
32 Masker Nebu Anak pcs 4 4
33 Masker Nebu Dewasa pcs 4 4
34 Alat Suntik sekali pakai 0,05 ml Box 2 2
35
36

UMUM JAMKESDA
Tidak BPJS
Bayar JKP
JUMLAH KUJUNGAN RESEP Bayar

271 1 48
 Yang Meminta Mengetahui/ Menyetujui
Kepala UPT.Puskesmas Kepala Dinkes II/ GFK

dr. Carlos Alfons Sibarani …………………………………………

NIP. 19780520 201412 1 001 NIP:
AIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS
FORM : LPLPO PUSKESMAS KARANG
LAPORAN BULAN : JANUARI NO / TGL DOKUMEN
PERMINTAAN BULAN/PERIODE : GFK
PUSK
DINKES

PEMBERIAN
SISA
PEMAKAIAN PERMINTAAN INPRES ASKES APBD APBD LAIN JUMLAH
STOK
I II LAIN
7 8 9 10

0
0
0
400 3200
0
0
0
0 1290
0 600
0
1600 1200
0
0
0
0
0
200 2800
0
100 500
0
0
300 0
0
0
0 1200
0
0
0
0
 0
0
0
90 780
0
0
0
0
800 1100
0

0
0
0 1400
0
200 200
200 500
0
0
0
0
0
0
0
0 200
0
0
0
0
0
0
0
0
0
0

400 1500
0
0
0
100 500
0
0
100 800
0
 0
0
200 800
0
100 900
0
0
0 970
0
0
0 100
0
0
400 900
0
0
0
0
0
100 1100
0
0
0
200 2200
0
0
200 1800
0
0
0
0
0 900
0
0
0 500
0
0
0 30
0
0
200 1300
0 200
0
0
0
0
0 150
0
 0
0
400 0
0

0
0 100
0
0 600
50 800
0
0
0
0
0
0
0
0 500
0
0 800
0
0
0 200
0
0
0 1000
0
0 400
0 2500
200 200
200 800
0
0
0
0 3000
0
100 300
0
0
90 180
0
0
2000 1700

0
0
 0
100 1500
0
0
0
0
0
0
0
0
200 700
0
0
0
0
100 1500
0
200 1800
0
0 200
0 500
300 2700
0
0 1860
200 1500
0
0 1300
0
0
0
0 500
0 600
0
0 100
150 200
100 1400
0 300
0
0
0
0
0

0
200 1000

900 1500

0 7
10 172
0
45 45
10
15 165
0
0 95
0
0
0
0
0 94
0
0
0
0 39
16 190
0
0
0
0
0
0 60
0 15
0
0
0 100
9 91
0

0 40
0
0
30 0
0
5 122
0
0
0 50
0
0
0

0
0

6 19
0 2
0 2
0
0 2
0 2
0
0
0
0
0
0
0
0
0
1 0
0
1 5
0
0
0
0 95
45 150
0 50
0 50
0 50
0 50
0 50
0
0
0
0
0 3
0
0
0
0
0
0
0 4
0
0
0
0
0
0
0
0
0 1
0
0
0
0
0 4
0 4
0 3
0
0
0
0
0
0 10
0 15
0
0
0
0
0
0
0
0 5
0
0
0
0
0
0
0
0
5 195
 0 10
0 45
0
0
0 4
0
0
0
0
10 25
0
0
40 40
0
0 19
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 89
0
10 180
0
0 12
5 95
 0
0
60 140
0
0 15
0 180
0
0
10
0
0
20 50
0
120 180
0
0 16
0
0
0 1
0
0 9
0
0
0
0
0
0
0
0
0
0
0
0
0
60 110

0
25 75

0
0

0
0
0
0
0
0
0
5 95

0
3 22
0
0
0
0 34
0
0 20
0
0
0
0
0
0
2 50
0 35
0
0
0 9
0
9 34
0
0
0
0
0 50
0
0 10
0
0
0
0
0
0
0
0
0

0
0
17 26
0
0 12
0
0

0
0
0
0
0
0
0
0
0 1
0
0
0
0

0 10

0
0 2
0
0
0

0
0
0
0
0

2 28
0
0
0
0
 0
0
0
0
0
0
0
0
0
0
0 120
0
0
0 100
0 30
0
0 90
0 400
0 45
0
0
0
0
0
0
0
0

0
0
0
0
0
0 91
0 10
0
0
0
0
0
0 1176
0 1176
0
0
0 147
200 200
 0 100
0
0
0
0
0
0
0
0
0
0
0
0
0
0
200 1000

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

0
0
0
0
0
0
0
 300 700
0 30
0 500
0 1410
0 150
0 60
0 480
0 60
0 500
0 50
0 60
0 105
0 24
0 18
0 15
0 2
0 10
0 28
5 45
0 29
0 5
0 21
0 3
0 3
0 10
0 60
0 20
0 1
0 13
0 20
0 10
0 4
0 4
0 2

JAMKESDA
Total Item Obat Jumlah Item % Penggunaan
Jumlah Dalam R/ Obat Generik Obat Generik
sktm

320 1095 815 74.43%

 Yang Menyerahkan Yang Menerima
Petugas GFK Petugas Puskesmas

…………………………………… Nandang Prasetyo W. S.Farm..,Apt

NIP. NRPK : 17.7.0500211
USKESMAS KARANGAN

Masa ED KETERA
NGAN

11 12

Nov-20

Jul-21
Sep-20

May-21

Mar-21

Aug-19

May-19
 Jul-20

Jun-20

Apr-20

Feb-23
Dec-20

May-22

Aug-19

Jan-21

Jul-23
Sep-22

Aug-20

Aug-20

Aug-20

Jun-20

Jul-20

Jul-20

Jul-20

Jun-19

Mar-19

Oct-20
Apr-21

Jul-20
May-21

Sep-22

Jun-19

Jan-20

May-21

Sep-19
Sep-20
Jun-20
Nov-21

Jul-23

Jan-20

Aug-21

Aug-20
Feb-21

Jul-20

Apr-22

Jan-20

Mar-20
Mar-20
Mar-23

Jul-20
Jul-20

Jun-20

Feb-21
Jun-22

Jun-20
Aug-22
Mar-21
Aug-22

Feb-21

Jul-20
Sep-20

Aug-19
ED
Aug-20

Aug-20

Oct-19

Jun-19
May-20

Aug-19
Jul-19

Nov-21
Aug-20

Aug-19

ED

Jul-19

Jul-20
Apr-20

Oct-22
Nov-22
Sep-22
Mar-22
Oct-22
Sep-22
Oct-22
 Jan-23

Sep-22

Mar-22
Apr-22
Mar-22

Mar-19

Apr-20
Oct-21
Aug-19

May-19

Mar-21

Jan-20
May-21
Apr-21

Apr-21

Sep-19

Sep-19

Aug-21
Mar-21

Feb-19

Jun-21
May-19

Jul-20

Feb-22

Apr-22
Nov-21

May-19

Jul-21

Mar-19
Mar-22

Aug-20

Nov-19
Oct-20
Nov-19

Mar-20

Apr-20
May-21

Jul-20
May-20
Nov-20
Jul-22
Mar-21
Mar-20
Mar-20

Oct-19
Apr-23
Apr-21
Jul-19
Aug-19
Sep-19
Mar-20
Aug-20
Jun-21
Aug-19
Jun-20
Sep-21
Aug-20
Mar-21
Aug-21
Jul-19
Feb-20
Sep-19
Feb-19
Apr-21
Mar-19
May-20
Jul-20

Nov-21
Aug-22
. S.Farm..,Apt