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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

PUSKESMAS

PUSKESMAS : TETE PELAPORAN BLN/PERIODE : JANUARI


KECAMATAN : AMPANA TETE
KABUPATEN : TOJO UNA UNA PERMINTAAN BLN/PERIODE
PROPINSI : SUL TENG

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1 2 3 4 5 6 7 8 9 10 11 12
1 Abbocath No.18 Pcs 193 0 193 0 193
2 Abbocath No.20 Pcs 922 0 922 40 882
3 Abbocath No.22 Pcs 248 0 248 0 248
4 Abbocath No.24 Pcs 274 0 274 20 254
5 Acetylcysteine 200 mg Tab 0 0 0 0 0
6 Acyclovir 200 Mg Tab 100 0 100 0 100
7 Acyclovir 400 Mg Tab 12150 0 12150 0 12150
8 Acyclovir krim 5% Tube 339 0 339 0 339
9 Adidryl Inj Vial 0 0 0 0 0
10 Adimidon Inj Vial 0 0 0 0 0
11 Alat Autochek Unit 1 0 1 1 0
12 Alat Benechek Unit 1 0 1 1 0
13 Alat CO Analiser Unit 1 0 1 1 0
14 Alat Easy Touch Unit 1 0 1 1 0
15 Alat suntik sekali pakai 0,5 ml Pcs 100 150 250 200 50
16 Alat suntik sekali pakai 1 ml Pcs 444 0 444 0 444
17 Alat suntik sekali pakai 10 ml Pcs 0 0 0 0 0
18 Alat suntik sekali pakai 2,5 ml Pcs 0 0 0 0 0
19 Alat suntik sekali pakai 20 ml Pcs 70 0 70 0 70
20 Alat suntik sekali pakai 3 ml Pcs 785 0 785 270 515
21 Alat suntik sekali pakai 5 ml Pcs 1635 0 1635 105 1530
22 Albendazol 400 mg Tab 0 0 0 0 0
23 Alkohol Swab Dos 19 0 19 2 17
24 Alletrol T. Mata Botol 0 0 0 0 0
25 Allopurinol 100 mg Tab 8300 0 8300 500 7800
26 Allopurinol 300 mg Tab 3540 0 3540 0 3540
27 Alprazolam 0,5 mg Tab 0 0 0 0 0
28 Alprazolam 1 mg Tab 2927 0 2927 41 2886
29 Ambroxol 30 mg Tab 6600 0 6600 200 6400
30 Ambroxol Syr 15mg/ 5 ml Botol 215 0 215 20 195
31 Amitriptilin 25 mg Tab 4074 0 4074 0 4074
32 Amlodiphin 10 mg Tab 9450 0 9450 1500 7950
33 Amlodiphin 5 mg Tab 1560 0 1560 450 1110
34 Amoxycillin 250 mg Tab 0 0 0 0 0
35 Amoxycillin 500 mg Tab 25400 0 25400 400 25000
36 Amoxycillin Syr 125 mg/ 5 ml Botol 275 0 275 25 250
37 Ampicillin 500 mg Tab 0 0 0 0 0
38 Ampicillin Inj Vial 5 0 5 0 5
39 Ampicillin Syrup 125 mg/ 5 ml Botol 0 0 0 0 0
40 Analog Long Insulin (Levemir) Pen 3 0 3 0 3
41 Antalgin 500 mg Tab 0 0 0 0 0
42 Antalgin Inj 250 mg/ml Ampul 0 0 0 0 0
43 Antasida Doen 500 mg Tab 36600 0 36600 0 36600
44 Antasida Doen Susp Botol 340 0 340 0 340
45 Anti Hemoroid Doen Kombinasi Suppo 315 0 315 0 315
46 Antiseptik Hand Botol 54 0 54 2 52
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1 2 3 4 5 6 7 8 9 10 11 12
47 Antrain Inj Ampul 5 0 5 5 0
48 Aqua Pro Injeksi Vial 135 0 135 10 125
49 Aquadest 20 L Galon 2 0 2 0 2
50 As Asetil Salisilat 80 mg (Miniaspi) Tab 1700 0 1700 0 1700
51 Asam Askorbat (Vit C) 50 mg Tab 36600 0 36600 2000 34600
52 Asam Folac Tab 32000 0 32000 0 32000
53 Asam Mefenamat 500 mg Tab 41500 0 41500 1500 40000
54 Asam Tranexamat Inj 50 mg/ ml Ampul 10 0 10 0 10
55 Asetosal 100 mg Tab 0 0 0 0 0
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1 2 3 4 5 6 7 8 9 10 11 12
56 Asetosal 500 mg Tab 0 0 0 0 0
57 Aspar K Tab 0 0 0 0 0
58 Atorvastatin Calsium 10 Mg Tab 0 0 0 0 0
59 Atropin Inj 0,25 mg Ampul 121 0 121 0 121
60 Atrovent Inhaler Botol 95 0 95 0 95
61 Attapulgit (New Antides) Tab 200 0 200 200 0
62 Autocheck Cholesterol Dos 10 0 10 0 10
63 Autocheck Glucosa Dos 4 0 4 0 4
64 Autocheck Urin Acid Dos 4 0 4 0 4
65 Bacitracin Polimixyn B Salep Tube 0 0 0 0 0
66 Batang Pengaduk Buah 4 0 4 4 0
67 Benecheck Colesterol Dos 40 0 40 9 31
68 Benecheck Glucosa Dos 5 0 5 0 5
69 Benecheck Urin Acid Dos 14 0 14 0 14
70 Betahistin Mesilat 6 mg Tab 5300 0 5300 300 5000
71 Betametason Krim 0,1% Tube 2605 0 2605 25 2580
72 Biocombin 5000 Inj Ampul 0 0 0 0 0
73 Bionemi Tab 0 0 0 0 0
74 Bisoprolol 5 mg Tab 0 0 0 0 0
75 Blood Lancets 26 G Dos 0 0 0 0 0
76 Blood Lancets 28 G Dos 40 0 40 2 38
77 Buscopan Inj 20 mg/ ml Ampul 10 0 10 0 10
78 Calcium Gluconate Inj 100 mg/ml Ampul 17 0 17 0 17
79 Calsium Laktat (Calac) 500 mg Tab 0 0 0 0 0
80 Calxyl Radiopaque Buah 3 0 3 0 3
81 Candesartan Cilexetil 8 mg Tab 240 0 240 240 0
82 Captopril 12,5 mg Tab 0 0 0 0 0
83 Captopril 25 mg Tab 15400 0 15400 300 15100
84 Carbamazepin 200 mg Tab 0 0 0 0 0
85 Catapres Inj Ampul 10 0 10 0 10
86 Catarlent T Mata Botol 0 0 0 0 0
87 Catgut Chromic No. 2/0 Pcs 26 0 26 0 26
88 Catgut Chromic No. 3/0 Pcs 53 0 53 0 53
89 Catgut Chromic No. 4/0 Pcs 24 0 24 0 24
90 Catgut Chromik usp:2/0 100 M Dos 0 0 0 0 0
91 Catgut Plain 2/0 HR 37 MM Pcs 0 0 0 0 0
92 Catgut Plain 3/0 HR 26 MM Pcs 0 0 0 0 0
93 Catgut Plain 4/0 Pcs 0 0 0 0 0
94 Cathejell Lido 2% & CHG 0,05 % Flacon 5 0 5 0 5
95 Cavit (Bahan Tump Sementara) Dos 28 0 28 0 28
96 Cefadroxil 500 mg Tab 5100 0 5100 500 4600
97 Cefadroxil Syr 125 mg/ 5 ml Botol 753 0 753 20 733
98 Cendo Xytrol T. Mata Botol 250 0 250 0 250
99 Cetirizine 10 mg Tab 8900 0 8900 0 8900
100 Cetirizine Syr 5 mg/ 5 ml Botol 450 0 450 70 380
101 Chloramphenicol (Chloramex) 500 mg Tab 11500 0 11500 0 11500
102 Chloramphenicol (Novachlor) 250 mg Tab 5000 0 5000 200 4800
103 Chloramphenicol Salep Mata 1% Tube 1394 0 1394 24 1370
104 Chloramphenicol Suspensi Botol 921 0 921 0 921
105 Chloramphenicol T. Mata 0,5% Tube 0 0 0 0 0
106 Chloramphenicol T. Telinga 3% Botol 344 0 344 0 344
107 Chlorfeniramin Maleat 4 mg Tab 38900 0 38900 0 38900
108 Chlorpromazin 100 mg Tab 780 0 780 0 780
109 Chlorpromazin 25 mg Tab 696 0 696 696 0
110 Chlorpromazin Inj 5mg/ml Ampul 60 0 60 0 60
111 Cimetidin 200 mg Tab 0 0 0 0 0
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1 2 3 4 5 6 7 8 9 10 11 12
112 Citicoline 500 mg Tab 0 0 0 0 0
113 Clobasam 10 mg Tab 98 0 98 0 98
114 Clonidine 0,15 mg Tab 0 0 0 0 0
115 Clopidogrel 75 mg Tab 0 0 0 0 0
116 Codein 10 mg Tab 4010 0 4010 60 3950
117 Colcitine 0,5 mg Tab 3240 0 3240 0 3240
118 Combivent Nebulizer Flacon 0 0 0 0 0
119 Cotrimoxazol 480 mg Tab 900 0 900 300 600
120 Cotrimoxazol Pediatrik Tab 0 0 0 0 0
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1 2 3 4 5 6 7 8 9 10 11 12
121 Cotrimoxazol Susp Botol 240 0 240 10 230
122 Curcuma Tab 0 0 0 0 0
123 Cutimed Gel Tube 2 0 2 0 2
124 Cyanocobalamin 50 mg Tab 400 0 400 0 400
125 Cyanocobalamin Inj 500 mcg/ ml Ampul 3320 0 3320 0 3320
126 Cyprofloksasin 500 mg Tab 4200 0 4200 0 4200
127 Dexamethason 0,5 mg Tab 30000 0 30000 200 29800
128 Dexamethason Inj 5 mg/ml Ampul 710 0 710 100 610
129 Dextamec Tab 0 0 0 0 0
130 Diazepam 2 mg Tab 1694 0 1694 1694 0
131 Diazepam 5 mg Tab 0 0 0 0 0
132 Diazepam Inj Ampul 50 0 50 0 50
133 Digoxin 0,25 mg Tab 500 0 500 0 500
134 Diltiazem 30 mg Tab 200 0 200 0 200
135 Dimenhydrinate 50 mg Tab 0 0 0 0 0
136 Diphenhidramin Inj Ampul 2130 0 2130 0 2130
137 Diphenhidramin Inj (Sidiadryl) Vial 47 0 47 0 47
138 Disposible Needle No. 22 Pcs 0 0 0 0 0
139 Disposible Needle No. 23 Pcs 110 0 110 20 90
140 Domperidon 10 mg Tab 34000 0 34000 0 34000
141 Domperidon Susp 5 mg/ 5 ml Botol 1380 0 1380 10 1370
142 Double Check (Artikulating Paper) Dos 30 0 30 0 30
143 Doxyciclin 100 mg Tab 5400 0 5400 0 5400
144 Dulcolax 5 mg Tab 0 0 0 0 0
145 Dulcolax Suppo Anak Suppo 1014 0 1014 0 1014
146 Dumin Rektal 125 mg/ 4 ml Suppo 0 0 0 0 0
147 Dumin Rektal 250 mg/4 ml Suppo 30 0 30 2 28
148 Easy Touch Colestrol Dos 10 0 10 2 8
149 Easy Touch Glukosa Dos 2 0 2 2 0
150 Easy Touch Urine Acid Dos 2 0 2 2 0
151 Eflin Tab 9000 0 9000 300 8700
152 Elastis Verban 7,5 cm x 4,55 m Roll 29 0 29 0 29
153 Epinefrin Inj 1 mg/ml Ampul 155 0 155 0 155
154 Epoxidin (Pasta Pengisi Sal Akar) Dos 30 0 30 0 30
155 Erphatrim Forte 960 mg Tab 0 0 0 0 0
156 Erytromicin 250 mg Tab 0 0 0 0 0
157 Erytromicin 500 mg Tab 24000 0 24000 200 23800
158 Erytromicin Syr Botol 0 0 0 0 0
159 Etakridin (Rivanol Lar 0,1%) Botol 0 0 0 0 0
160 Etanol 70% 1 L Botol 24 0 24 0 24
161 Etanol 70% 100 ml Botol 0 0 0 0 0
162 Etanol 70% 300 ml Botol 111 0 111 5 106
163 Ethambutol 500 mg Tab 450 0 450 0 450
164 Farbion Inj Ampul 0 0 0 0 0
165 Fenilbutason (Novason) 200 mg Tab 8700 0 8700 0 8700
166 Fenobarbital 30 mg Tab 0 0 0 0 0
167 Fenobarbital Inj 50 mg/ml Ampul 0 0 0 0 0
168 Folley Catheter No. 10 FR Pcs 9 0 9 0 9
169 Folley Catheter No. 16 FR Pcs 10 0 10 0 10
170 Folley Catheter No. 18 FR Pcs 76 0 76 0 76
171 Folley Catheter No. 22 FR Pcs 109 0 109 0 109
172 Furosemid 40 mg Tab 1700 0 1700 0 1700
173 Furosemid Inj (Diuvar) Ampul 5 0 5 5 0
174 Gabapentin 300 mg Tab 330 0 330 0 330
175 Garam Oralit 200 ml Air Saset 1450 0 1450 150 1300
176 Gelas Ukur 250 ml Buah 1 0 1 1 0
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1 2 3 4 5 6 7 8 9 10 11 12
177 Gemfibrozil 300 mg Tab 2400 0 2400 0 2400
178 Gentamicin Inj 40 mg/ ml Ampul 140 0 140 20 120
179 Gentamicin Salep 0,1 % Tube 121 0 121 50 71
180 Gentian Violet lar 1% Botol 239 0 239 20 219
181 Glibenclamid 5 mg Tab 3600 0 3600 300 3300
182 Glimepiride 2 mg Tab 6000 0 6000 0 6000
183 Glimepiride 3 mg Tab 0 0 0 0 0
184 Glukosa lar infus 10 % Steril Kolf 0 0 0 0 0
185 Glukosa lar infus 5 % Steril Kolf 499 0 499 0 499
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1 2 3 4 5 6 7 8 9 10 11 12
186 Griseofulvin 125 mg Tab 78000 0 78000 300 77700
187 Guaifenesin 100 mg Tab 23700 0 23700 300 23400
188 Halloperidol 0,5 mg Tab 400 0 400 0 400
189 Halloperidol 1,5 mg Tab 600 0 600 0 600
190 Halloperidol 5 mg Tab 152 0 152 30 122
191 Handscoon Genekolog 7,5 16/40 cm Pcs 194 0 194 0 194
192 Handscoon No. 6,5 Steril Pcs 0 0 0 0 0
193 Handscoon No. 7 Steril Pcs 414 0 414 14 400
194 Handscoon No. 7,5 Steril Pcs 560 0 560 110 450
195 Handscoon No. 8 Steril Pcs 350 0 350 0 350
196 Handscoon Non Steril (L) Dos 0 0 0 0 0
197 Handscoon Non Steril (M) Dos 0 0 0 0 0
198 Hemafort Tab 0 0 0 0 0
199 Hidroklortiazid 25 mg Tab 6700 0 6700 0 6700
200 Hidrokortison Krim 2,5% Tube 5401 0 5401 0 5401
201 Hyoscine N-Butylbromide (Scopamin) Tab 11100 0 11100 0 11100
202 Hyscopan Tab 0 0 0 0 0
203 Ibuprofen 200 mg Tab 0 0 0 0 0
204 Ibuprofen 400 mg Tab 32500 0 32500 1000 31500
205 Ibuprofen Susp 100 mg/ 5 ml Botol 0 0 0 0 0
206 Ichtiyol Salep Pot 0 0 0 0 0
207 Iliadin T. Hidung Botol 98 0 98 0 98
208 Infusion Set Anak (Micro) Pcs 315 0 315 0 315
209 Infusion Set Dewasa (Macro) Pcs 265 0 265 45 220
210 Isoniasid 100 mg Tab 0 0 0 0 0
211 Isoniazid 300 mg Tab 200 0 200 0 200
212 Isosorbid Dinitrat 5 mg Tab 2700 0 2700 0 2700
213 Jarum Kulit GT 10 Pcs 56 0 56 0 56
214 Jarum Kulit GT 11 Pcs 2 0 2 0 2
215 Jarum Kulit GT 15 Pcs 7 0 7 0 7
216 Jarum Kulit GR 13 Pcs 5 0 5 0 5
217 Jarum Otot GR 10 Pcs 0 0 0 0 0
218 Jarum Otot GR 12 Pcs 0 0 0 0 0
219 Jarum Otot GR 14 Pcs 0 0 0 0 0
220 Jarum Otot GR 15 Pcs 11 0 11 0 11
221 Kanamicin Inj Vial 0 0 0 0 0
222 Kaolimec Suspensi Botol 0 0 0 0 0
223 Kaotin Suspensi Botol 0 0 0 0 0
224 Kapas Berlemak 500 mg Buah 0 0 0 0 0
225 Kapas Pembalut 250 mg Buah 158 0 158 4 154
226 Karbamazepin 200 mg Tab 0 0 0 0 0
227 Kasa Hidrofil 4 m x 15 m Roll 0 0 0 0 0
228 Kasa Hidrofil 4 m x 5 m Roll 0 0 0 0 0
229 Kasa Kompres 40 x 80 Steril Roll 0 0 0 0 0
230 Kasa Kompres 40 x 40 Roll 6 0 6 0 6
231 Kasa Pembalut 40 x 80 m Roll 0 0 0 0 0
232 Kasa Steril 18 x 22 cm (16 x 16) Dos 470 0 470 0 470
233 Kertas EKG Roll 16 0 16 0 16
234 Kertas USG Roll 0 0 0 0 0
235 Ketokonazol 200 mg Tab 21950 0 21950 200 21750
236 Ketokonazol Krim 2 % Tube 253 0 253 20 233
237 Kolicgon Tab 0 0 0 0 0
238 Larutan H2O2 Botol 0 0 0 0 0
239 Leukoplast 2,5 cm x 4,5 m Roll 200 0 200 10 190
240 Leukoplast 7,5 cm x 4,5 m Roll 128 0 128 0 128
241 Levofloxacin 500 mg Tab 0 0 0 0 0
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1 2 3 4 5 6 7 8 9 10 11 12
242 Lidocain Inj 20 mg/ 2 ml Ampul 3000 0 3000 0 3000
243 Lidocain Inj 40 mg Ampul 1480 0 1480 100 1380
244 Lidocain Kompositum 20 mg/ 2 ml Ampul 450 0 450 0 450
245 Lisol Botol 40 0 40 0 40
246 Loperamid 2 mg Tab 0 0 0 0 0
247 Loratadin 10 mg Tab 0 0 0 0 0
248 Masker Earloop Pcs 500 0 500 50 450
249 Masker N 95 Pcs 140 0 140 0 140
250 Masker Tali Pcs 150 0 150 50 100
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1 2 3 4 5 6 7 8 9 10 11 12
251 MDT MB Combi Dewasa Dos 0 4 4 4 0
252 Meloxicam 15 mg Tab 0 0 0 0 0
253 Metamizole Inj (Norages) Ampul 0 0 0 0 0
254 Metformin 500 mg Tab 33900 0 33900 300 33600
255 Methildopa 250 mg (Dopamet) Tab 300 0 300 100 200
256 Methylprednisolon 4 Mg Tab 600 0 600 500 100
257 Methylprednisolon 8 Mg Tab 400 0 400 200 200
258 Metilergometrin 0,125 mg Tab 15800 0 15800 0 15800
259 Metilergometrin Inj.0,2 mg Ampul 60 0 60 0 60
260 Metoclopramid 10 mg Tab 4700 0 4700 0 4700
261 Metoclopramid Inj 10 mg/ 2 ml Ampul 330 0 330 10 320
262 Metoclopramide Syr (Lexapram) Botol 1674 0 1674 0 1674
263 Metronidazol 250 mg Tab 0 0 0 0 0
264 Metronidazol 500 mg Tab 6800 0 6800 500 6300
265 Metronidazole Lat Infus Botol 13 0 13 0 13
266 MgSO4 Inj 20% - 25 ml Flacon 20 0 20 0 20
267 MgSO4 Inj 40% - 25 ml Flacon 5 0 5 0 5
268 MgSO4 Serbuk 30 gr Vial 0 0 0 0 0
269 Miconazol Krim 2 % Tube 2416 0 2416 24 2392
270 Mometason Furoate Krim 0,1 % Tube 75 0 75 0 75
271 Mortir dan Stemper 8 cm Buah 1 0 1 1 0
272 Mouth Piace Dos 1 0 1 1 0
273 Mucotussan Tab 0 0 0 0 0
274 My Jelli 82 Gram Tube 11 0 11 2 9
275 NaCl Lar infus 0,9 % Kolf 314 0 314 34 280
276 Natrium Diclofenak 25 mg Tab 19450 0 19450 800 18650
277 Natrium Diclofenak 50 mg Tab 3000 0 3000 0 3000
278 Neurovit E Tab 780 0 780 720 60
279 Neutotropic Plus Tab 0 0 0 0 0
280 Nifedipin 10 mg Tab 2700 0 2700 0 2700
281 Nistatin 500.000 IU Tab 3000 0 3000 0 3000
282 Nistatin 100.000 IU Tab 490 0 490 0 490
283 Nistatin Drops 100.000 IU Botol 40 0 40 0 40
284 Novadiar Syr Botol 187 0 187 10 177
285 Novadium Tab 1300 0 1300 0 1300
286 Novampiron Tab 0 0 0 0 0
287 Novapen Syr Botol 0 0 0 0 0
288 Novastan Tab 0 0 0 0 0
289 Novotwist ( Jarum Novorapid) Dos 2 0 2 0 2
290 OAT FDC Kategori Anak Paket 5 0 5 0 5
291 OAT FDC Kategori I Dewasa Paket 0 0 0 0 0
292 OAT FDC Kategori II Dewasa Paket 0 0 0 0 0
293 OAT FDC Sisipan Dewasa Paket 0 0 0 0 0
294 Obat Batuk Hitam ( OBH ) Syr Botol 85 0 85 10 75
295 Oksitetraciclin Inj 50 ml - 10 ml Ampul 0 0 0 0 0
296 Oksitetraciclin Salep Kulit 3 % Tube 18 0 18 5 13
297 Oksitetraciclin Salep Mata 1 % Tube 235 0 235 0 235
298 Oksitosin Inj 50 ml - 10 ml Ampul 1420 0 1420 0 1420
299 Omeprazole 20 mg Tab 6330 0 6330 150 6180
300 Ondansetron HCL Inj 4 mg/ 2 ml Ampul 115 0 115 0 115
301 Papaverin 40 mg Tab 6000 0 6000 0 6000
302 Papaverin Inj Ampul 0 0 0 0 0
303 Paracetamol 500 mg Tab 0 0 0 0 0
304 Paracetamol Lar Infus Steril Botol 9 0 9 0 9
305 Paracetamol Syr 120 mg/ 5 ml Botol 290 0 290 70 220
306 Pehacain Inj Ampul 620 0 620 0 620
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1 2 3 4 5 6 7 8 9 10 11 12
307 Pelarut Botol 0 0 0 0 0
308 Periokin Spray Dos 30 0 30 0 30
309 Permanganas kalikus (PK) Pot 0 0 0 0 0
310 Phenol Gliserol T. Telinga 10% Botol 33 0 33 0 33
311 Phitomenadion 10 mg Tab 1500 0 1500 300 1200
312 Phitomenadion Inj 10 mg/ml Ampul 0 0 0 0 0
313 Pipet Tetes Pendek Buah 100 0 100 100 0
314 Piracetam 800 mg Tab 0 0 0 0 0
315 Pirecetam 400 mg Tab 0 0 0 0 0
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1 2 3 4 5 6 7 8 9 10 11 12
316 Pirecetam Inj 200 mg/ ml Ampul 32 0 32 0 32
317 Piridoxyn (Vit B6) 10 mg Tab 40500 0 40500 0 40500
318 Piroxicam 20 mg Tab 600 0 600 200 400
319 Pisau Bedah Pcs 300 0 300 0 300
320 Plano Test Pcs 40 0 40 15 25
321 Plesterin Bulat Dos 27 0 27 1 26
322 Poligyp 5 cm x 27 cm Roll 2 0 2 0 2
323 Pot Urine Bauh 20 0 20 0 20
324 Povidon Iodida 10 % 30 ml Botol 0 0 0 0 0
325 Povidon Iodida 10 % 300 ml Botol 2 0 2 0 2
326 Povidon Iodida 10 % 60 ml Botol 16 0 16 10 6
327 Prednison 5 mg Tab 600 0 600 300 300
328 Promavit Tab 3780 0 3780 300 3480
329 Propanolol 10 mg Tab 0 0 0 0 0
330 Propanolol 40 mg Tab 0 0 0 0 0
331 Propiltiuracil 100 mg Tab 3300 0 3300 0 3300
332 Pyrantel Pamoat 125 mg Tab 20 0 20 0 20
333 Rabipur Vaksin Dos 0 0 0 0 0
334 Rak Tabung Stainless Buah 1 0 1 1 0
335 Ramipril 5 mg Tab 0 0 0 0 0
336 Ranitidin 150 mg Tab 14300 0 14300 200 14100
337 Ranitidin Inj 25 mg/ 2 ml Ampul 420 0 420 20 400
338 Ranitidin Inj 50 mg/ 2 ml Ampul 0 0 0 0 0
339 RDT DBD Dos 0 0 0 0 0
340 RDT Malaria Dos 0 0 0 0 0
341 Rifampisin 450 mg Tab 300 0 300 0 300
342 Rifampisin 600 mg Tab 0 0 0 0 0
343 Ringer Lactat Lar Infus Steril Kolf 212 0 212 42 170
344 Salbutamol 2 mg Tab 12200 0 12200 0 12200
345 Salbutamol 4 mg Tab 6800 0 6800 300 6500
346 Salep 2-4 Pot 1830 0 1830 0 1830
347 Salisil Bedak 2 % Dos 95 0 95 35 60
348 Sanbe Tears (Air Mata Buatan) Botol 0 0 0 0 0
349 Selediar Tab 0 0 0 0 0
350 Seledryil Tab 0 0 0 0 0
351 Selesbion Tab 0 0 0 0 0
352 Selkom C Tab 0 0 0 0 0
353 Selviplex Tab 0 0 0 0 0
354 Seven Seans Syr Botol 406 0 406 0 406
355 Sikat Pembersih Tabung Buah 2 0 2 2 0
356 Silk (Benang Bedah Sutra) No. 2/0 Pcs 34 0 34 0 34
357 Silk (Benang Bedah Sutra) No. 3/0 Pcs 19 0 19 0 19
358 Silk Braided Black usp:4/0 100 M Dos 0 0 0 0 0
359 Simvastatin 10 mg Tab 18240 0 18240 600 17640
360 Simvastatin 20 mg Tab 0 0 0 0 0
361 Skizon Zalf Tube 328 0 328 0 328
362 Soft U-Derm Krim Tube 120 0 120 0 120
363 Sohobion Inj Ampul 0 0 0 0 0
364 Soldextam Tab 0 0 0 0 0
365 Solvita Plus Syr Botol 0 0 0 0 0
366 Spasmolit Tab 0 0 0 0 0
367 Spironolactone 100 mg Tab 0 0 0 0 0
368 Spironolactone 25 mg Tab 0 0 0 0 0
369 Stesolid Suppo 5 mg/ 2,5 ml Suppo 13 0 13 2 11
370 Stesolid Suppo 10 mg/ 2,5 ml Suppo 0 0 0 0 0
371 Stik HB Family Dr Dos 10 0 10 4 6
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1 2 3 4 5 6 7 8 9 10 11 12
372 Tablet Tambah Darah Tab 0 0 0 0 0
373 Tablet Tambah Darah Neo Tab 0 5600 5600 5000 600
374 Tabung Reaksi 25 ml Buah 10 0 10 10 0
375 Termorex Syr Botol 0 0 0 0 0
376 TesKits Boraks Kit 1 0 1 1 0
377 TesKits Formaldehid (Formalin) Kit 1 0 1 1 0
378 TesKits Methanil Yellow Kit 1 0 1 1 0
379 TesKits Rhodamine B Kit 1 0 1 1 0
380 Tetagam Vaksin Dos 9 0 9 3 6
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1 2 3 4 5 6 7 8 9 10 11 12
381 Tetracyclin HCL 250 mg Tab 0 0 0 0 0
382 Tetracyclin HCL 500 mg Tab 15100 0 15100 0 15100
383 Tetrakain HCL T. Mata 0,5 % Botol 0 0 0 0 0
384 Thiamin HCL 50 mg Tab 700 0 700 0 700
385 Thiamin HCL Inj 100 ml - 1 ml Vial 1680 0 1680 0 1680
386 Tramadol 50 mg Tab 100 0 100 0 100
387 Tricresol Formalin 10 ml Botol 4 0 4 0 4
388 Triheksiphenidil HCL 2 mg Tab 2500 0 2500 0 2500
389 Truvit Syr Botol 206 0 206 0 206
390 Ultrasonic Gel 250 ml Botol 2 0 2 1 1
391 Urine Bag 1000 ml Pcs 90 0 90 0 90
392 Vaksin Campak Rubella Ampul 0 0 0 0 0
393 Vaksin DPT HB Combo Ampul 5 20 25 23 2
394 Vaksin HB 0 (Unijek) Ampul 5 30 35 27 8
395 Vaksin IPV Ampul 0 10 10 10 0
396 Vaksin TT Bumil Ampul 2 10 12 10 2
397 Vaksin Polio Ampul 3 20 23 20 3
398 Ventolin Nebulizer Flacon 0 0 0 0 0
399 Verorab Vaksin Dos 15 0 15 2 13
400 Viccillin - SX (Ampicilin) Inj 1,5 g Vial 30 0 30 0 30
401 Vit A 100.000 IU Kapsul 250 500 750 250 500
402 Vit A 200.000 IU Kapsul 6 30 36 6 30
403 Vitamin B Kompleks Tab 1700 0 1700 500 1200
404 Vitamin B Kompleks Inj Vial 120 0 120 20 100
405 Zinc Dispersible 20 mg Tab 1300 0 1300 900 400
406 Zinc Syr 20 mg/ 5 ml Botol 495 0 495 50 445

Umum
BPJS Jamkesda Jumlah
JUMLAH KUNJUNGAN RESEP Bayar Tdk Bayar

Mengetahui/Menyetujui Yang Menyerahkan Yang Memohon Yang M


Penanggung Jawab Gudang Farmasi Petug

Arini Priyanti Kandupi, S. Farm, Apt Moh. Rizal Sumaga, SKM Mujriah
Nip.19830402 200502 2 004 Nip. 19720123 199402 1 002 Nip : 1988100

KETERANGAN :
Lembar Putih : GFK
Lembar Merah : Puskesmas
N OBAT

: JANUARI 2019

Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Exp : 696
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Exp : 1665
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Yang Menerima
Petugas PKM

Mujriah A.Md, Far


Nip : 19881005 201001 2 001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS

PUSKESMAS : TETE PELAPORAN BLN/PERIODE : FEBRUARI


KECAMATAN : AMPANA TETE
KABUPATEN : TOJO UNA UNA PERMINTAAN BLN/PERIODE
PROPINSI : SUL TENG

Stok penerima persediaa pemakai stok permin Pemberian


NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
1 Abbocath No.18 Pcs 193 0 193 10 183
2 Abbocath No.20 Pcs 882 0 882 10 872
3 Abbocath No.22 Pcs 248 0 248 10 238
4 Abbocath No.24 Pcs 254 0 254 10 244
5 Acetylcysteine 200 mg Tab 0 0 0 0 0
6 Acyclovir 200 Mg Tab 100 0 100 100 0
7 Acyclovir 400 Mg Tab 12150 0 12150 600 11550
8 Acyclovir krim 5% Tube 339 0 339 0 339
9 Adidryl Inj Vial 0 0 0 0 0
10 Adimidon Inj Vial 0 0 0 0 0
11 Alat Autochek Unit 0 0 0 0 0
12 Alat Benechek Unit 0 0 0 0 0
13 Alat CO Analiser Unit 0 0 0 0 0
14 Alat Easy Touch Unit 0 0 0 0 0
15 Alat suntik sekali pakai 0,5 ml Pcs 50 0 50 0 50
16 Alat suntik sekali pakai 1 ml Pcs 444 0 444 0 444
17 Alat suntik sekali pakai 10 ml Pcs 0 0 0 0 0
18 Alat suntik sekali pakai 2,5 ml Pcs 0 0 0 0 0
19 Alat suntik sekali pakai 20 ml Pcs 70 0 70 0 70
20 Alat suntik sekali pakai 3 ml Pcs 515 0 515 220 295
21 Alat suntik sekali pakai 5 ml Pcs 1530 0 1530 20 1510
22 Albendazol 400 mg Tab 0 0 0 0 0
23 Alkohol Swab Dos 17 0 17 0 17
24 Alletrol T. Mata Botol 0 0 0 0 0
25 Allopurinol 100 mg Tab 7800 0 7800 1100 6700
26 Allopurinol 300 mg Tab 3540 0 3540 0 3540
27 Alprazolam 0,5 mg Tab 0 0 0 0 0
28 Alprazolam 1 mg Tab 2886 0 2886 112 2774
29 Ambroxol 30 mg Tab 6400 0 6400 1700 4700
30 Ambroxol Syr 15mg/ 5 ml Botol 195 0 195 25 170
31 Amitriptilin 25 mg Tab 4074 0 4074 0 4074
32 Amlodiphin 10 mg Tab 7950 0 7950 1590 6360
33 Amlodiphin 5 mg Tab 1110 0 1110 750 360
34 Amoxycillin 250 mg Tab 0 0 0 0 0
35 Amoxycillin 500 mg Tab 25000 0 25000 2800 22200
36 Amoxycillin Syr 125 mg/ 5 ml Botol 250 0 250 140 110
37 Ampicillin 500 mg Tab 0 0 0 0 0
38 Ampicillin Inj Vial 5 0 5 5 0
39 Ampicillin Syrup 125 mg/ 5 ml Botol 0 0 0 0 0
40 Analog Long Insulin (Levemir) Pen 3 0 3 3 0
41 Antalgin 500 mg Tab 0 0 0 0 0
42 Antalgin Inj 250 mg/ml Ampul 0 0 0 0 0
43 Antasida Doen 500 mg Tab 36600 0 36600 1100 35500
44 Antasida Doen Susp Botol 340 0 340 300 40
45 Anti Hemoroid Doen Kombinasi Suppo 315 0 315 0 315
46 Antiseptik Hand Botol 52 0 52 0 52
Stok penerima persediaa pemakai stok permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
47 Antrain Inj Ampul 0 0 0 0 0
48 Aqua Pro Injeksi Vial 125 0 125 5 120
49 Aquadest 20 L Galon 2 0 2 0 2
50 As Asetil Salisilat 80 mg (Miniaspi) Tab 1700 0 1700 0 1700
51 Asam Askorbat (Vit C) 50 mg Tab 34600 0 34600 1700 32900
52 Asam Folac Tab 32000 0 32000 20700 11300
53 Asam Mefenamat 500 mg Tab 40000 0 40000 1900 38100
54 Asam Tranexamat Inj 50 mg/ ml Ampul 10 0 10 10 0
55 Asetosal 100 mg Tab 0 0 0 0 0
Stok penerima persediaa pemakai stok permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
56 Asetosal 500 mg Tab 0 0 0 0 0
57 Aspar K Tab 0 0 0 0 0
58 Atorvastatin Calsium 10 Mg Tab 0 0 0 0 0
59 Atropin Inj 0,25 mg Ampul 121 0 121 0 121
60 Atrovent Inhaler Botol 95 0 95 5 90
61 Attapulgit (New Antides) Tab 0 0 0 0 0
62 Autocheck Cholesterol Dos 10 0 10 0 10
63 Autocheck Glucosa Dos 4 0 4 0 4
64 Autocheck Urin Acid Dos 4 0 4 0 4
65 Bacitracin Polimixyn B Salep Tube 0 0 0 0 0
66 Batang Pengaduk Buah 0 0 0 0 0
67 Benecheck Colesterol Dos 31 0 31 5 26
68 Benecheck Glucosa Dos 5 0 5 5 0
69 Benecheck Urin Acid Dos 14 0 14 5 9
70 Betahistin Mesilat 6 mg Tab 5000 0 5000 0 5000
71 Betametason Krim 0,1% Tube 2580 0 2580 1675 905
72 Biocombin 5000 Inj Ampul 0 0 0 0 0
73 Bionemi Tab 0 150 150 150 0
74 Bisoprolol 5 mg Tab 0 0 0 0 0
75 Blood Lancets 26 G Dos 0 0 0 0 0
76 Blood Lancets 28 G Dos 38 0 38 10 28
77 Buscopan Inj 20 mg/ ml Ampul 10 0 10 0 10
78 Calcium Gluconate Inj 100 mg/ml Ampul 17 0 17 0 17
79 Calsium Laktat (Calac) 500 mg Tab 0 0 0 0 0
80 Calxyl Radiopaque Buah 3 0 3 0 3
81 Candesartan Cilexetil 8 mg Tab 0 0 0 0 0
82 Captopril 12,5 mg Tab 0 0 0 0 0
83 Captopril 25 mg Tab 15100 0 15100 1300 13800
84 Carbamazepin 200 mg Tab 0 0 0 0 0
85 Catapres Inj Ampul 10 0 10 0 10
86 Catarlent T Mata Botol 0 0 0 0 0
87 Catgut Chromic No. 2/0 Pcs 26 0 26 5 21
88 Catgut Chromic No. 3/0 Pcs 53 0 53 5 48
89 Catgut Chromic No. 4/0 Pcs 24 0 24 0 24
90 Catgut Chromik usp:2/0 100 M Dos 0 0 0 0 0
91 Catgut Plain 2/0 HR 37 MM Pcs 0 0 0 0 0
92 Catgut Plain 3/0 HR 26 MM Pcs 0 0 0 0 0
93 Catgut Plain 4/0 Pcs 0 0 0 0 0
94 Cathejell Lido 2% & CHG 0,05 % Flacon 5 0 5 0 5
95 Cavit (Bahan Tump Sementara) Dos 28 0 28 0 28
96 Cefadroxil 500 mg Tab 4600 0 4600 400 4200
97 Cefadroxil Syr 125 mg/ 5 ml Botol 733 0 733 598 135
98 Cendo Xytrol T. Mata Botol 250 0 250 10 240
99 Cetirizine 10 mg Tab 8900 0 8900 1300 7600
100 Cetirizine Syr 5 mg/ 5 ml Botol 380 0 380 10 370
101 Chloramphenicol (Chloramex) 500 mg Tab 11500 0 11500 1000 10500
102 Chloramphenicol (Novachlor) 250 mg Tab 4800 0 4800 600 4200
103 Chloramphenicol Salep Mata 1% Tube 1370 0 1370 1226 144
104 Chloramphenicol Suspensi Botol 921 0 921 682 239
105 Chloramphenicol T. Mata 0,5% Tube 0 0 0 0 0
106 Chloramphenicol T. Telinga 3% Botol 344 0 344 199 145
107 Chlorfeniramin Maleat 4 mg Tab 38900 0 38900 1400 37500
108 Chlorpromazin 100 mg Tab 780 0 780 500 280
109 Chlorpromazin 25 mg Tab 0 0 0 0 0
110 Chlorpromazin Inj 5mg/ml Ampul 60 0 60 0 60
111 Cimetidin 200 mg Tab 0 0 0 0 0
Stok penerima persediaa pemakai stok permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
112 Citicoline 500 mg Tab 0 0 0 0 0
113 Clobasam 10 mg Tab 98 0 98 0 98
114 Clonidine 0,15 mg Tab 0 0 0 0 0
115 Clopidogrel 75 mg Tab 0 0 0 0 0
116 Codein 10 mg Tab 3950 0 3950 0 3950
117 Colcitine 0,5 mg Tab 3240 0 3240 300 2940
118 Combivent Nebulizer Flacon 0 0 0 0 0
119 Cotrimoxazol 480 mg Tab 600 0 600 400 200
120 Cotrimoxazol Pediatrik Tab 0 0 0 0 0
Stok penerima persediaa pemakai stok permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
121 Cotrimoxazol Susp Botol 230 0 230 40 190
122 Curcuma Tab 0 300 300 0 300
123 Cutimed Gel Tube 2 0 2 0 2
124 Cyanocobalamin 50 mg Tab 400 0 400 0 400
125 Cyanocobalamin Inj 500 mcg/ ml Ampul 3320 0 3320 300 3020
126 Cyprofloksasin 500 mg Tab 4200 0 4200 300 3900
127 Dexamethason 0,5 mg Tab 29800 0 29800 18000 11800
128 Dexamethason Inj 5 mg/ml Ampul 610 0 610 250 360
129 Dextamec Tab 0 0 0 0 0
130 Diazepam 2 mg Tab 0 0 0 0 0
131 Diazepam 5 mg Tab 0 0 0 0 0
132 Diazepam Inj Ampul 50 0 50 0 50
133 Digoxin 0,25 mg Tab 500 0 500 500 0
134 Diltiazem 30 mg Tab 200 0 200 200 0
135 Dimenhydrinate 50 mg Tab 0 200 200 200 0
136 Diphenhidramin Inj Ampul 2130 0 2130 1950 180
137 Diphenhidramin Inj (Sidiadryl) Vial 47 0 47 5 42
138 Disposible Needle No. 22 Pcs 0 0 0 0 0
139 Disposible Needle No. 23 Pcs 90 0 90 0 90
140 Domperidon 10 mg Tab 34000 0 34000 400 33600
141 Domperidon Susp 5 mg/ 5 ml Botol 1370 0 1370 35 1335
142 Double Check (Artikulating Paper) Dos 30 0 30 0 30
143 Doxyciclin 100 mg Tab 5400 0 5400 0 5400
144 Dulcolax 5 mg Tab 0 0 0 0 0
145 Dulcolax Suppo Anak Suppo 1014 0 1014 498 516
146 Dumin Rektal 125 mg/ 4 ml Suppo 0 0 0 0 0
147 Dumin Rektal 250 mg/4 ml Suppo 28 0 28 0 28
148 Easy Touch Colestrol Dos 8 0 8 5 3
149 Easy Touch Glukosa Dos 0 0 0 0 0
150 Easy Touch Urine Acid Dos 0 0 0 0 0
151 Eflin Tab 8700 0 8700 500 8200
152 Elastis Verban 7,5 cm x 4,55 m Roll 29 0 29 2 27
153 Epinefrin Inj 1 mg/ml Ampul 155 0 155 0 155
154 Epoxidin (Pasta Pengisi Sal Akar) Dos 30 0 30 0 30
155 Erphatrim Forte 960 mg Tab 0 0 0 0 0
156 Erytromicin 250 mg Tab 0 0 0 0 0
157 Erytromicin 500 mg Tab 23800 0 23800 0 23800
158 Erytromicin Syr Botol 0 0 0 0 0
159 Etakridin (Rivanol Lar 0,1%) Botol 0 0 0 0 0
160 Etanol 70% 1 L Botol 24 0 24 0 24
161 Etanol 70% 100 ml Botol 0 0 0 0 0
162 Etanol 70% 300 ml Botol 106 0 106 10 96
163 Ethambutol 500 mg Tab 450 0 450 0 450
164 Farbion Inj Ampul 0 0 0 0 0
165 Fenilbutason (Novason) 200 mg Tab 8700 0 8700 1600 7100
166 Fenobarbital 30 mg Tab 0 0 0 0 0
167 Fenobarbital Inj 50 mg/ml Ampul 0 0 0 0 0
168 Folley Catheter No. 10 FR Pcs 9 0 9 0 9
169 Folley Catheter No. 16 FR Pcs 10 0 10 0 10
170 Folley Catheter No. 18 FR Pcs 76 0 76 5 71
171 Folley Catheter No. 22 FR Pcs 109 0 109 15 94
172 Furosemid 40 mg Tab 1700 0 1700 0 1700
173 Furosemid Inj (Diuvar) Ampul 0 0 0 0 0
174 Gabapentin 300 mg Tab 330 0 330 0 330
175 Garam Oralit 200 ml Air Saset 1300 0 1300 250 1050
176 Gelas Ukur 250 ml Buah 0 0 0 0 0
Stok penerima persediaa pemakai stok permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
177 Gemfibrozil 300 mg Tab 2400 0 2400 0 2400
178 Gentamicin Inj 40 mg/ ml Ampul 120 0 120 5 115
179 Gentamicin Salep 0,1 % Tube 71 0 71 34 37
180 Gentian Violet lar 1% Botol 219 0 219 24 195
181 Glibenclamid 5 mg Tab 3300 0 3300 0 3300
182 Glimepiride 2 mg Tab 6000 0 6000 0 6000
183 Glimepiride 3 mg Tab 0 0 0 0 0
184 Glukosa lar infus 10 % Steril Kolf 0 0 0 0 0
185 Glukosa lar infus 5 % Steril Kolf 499 0 499 5 494
Stok penerima persediaa pemakai stok permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
186 Griseofulvin 125 mg Tab 77700 0 77700 700 77000
187 Guaifenesin 100 mg Tab 23400 0 23400 4200 19200
188 Halloperidol 0,5 mg Tab 400 0 400 0 400
189 Halloperidol 1,5 mg Tab 600 0 600 600 0
190 Halloperidol 5 mg Tab 122 0 122 30 92
191 Handscoon Genekolog 7,5 16/40 cm Pcs 194 0 194 0 194
192 Handscoon No. 6,5 Steril Pcs 0 0 0 0 0
193 Handscoon No. 7 Steril Pcs 400 0 400 100 300
194 Handscoon No. 7,5 Steril Pcs 450 0 450 100 350
195 Handscoon No. 8 Steril Pcs 350 0 350 0 350
196 Handscoon Non Steril (L) Dos 0 0 0 0 0
197 Handscoon Non Steril (M) Dos 0 0 0 0 0
198 Hemafort Tab 0 0 0 0 0
199 Hidroklortiazid 25 mg Tab 6700 0 6700 0 6700
200 Hidrokortison Krim 2,5% Tube 5401 0 5401 48 5353
201 Hyoscine N-Butylbromide (Scopamin) Tab 11100 0 11100 0 11100
202 Hyscopan Tab 0 0 0 0 0
203 Ibuprofen 200 mg Tab 0 0 0 0 0
204 Ibuprofen 400 mg Tab 31500 0 31500 4000 27500
205 Ibuprofen Susp 100 mg/ 5 ml Botol 0 200 200 20 180
206 Ichtiyol Salep Pot 0 0 0 0 0
207 Iliadin T. Hidung Botol 98 0 98 0 98
208 Infusion Set Anak (Micro) Pcs 315 0 315 5 310
209 Infusion Set Dewasa (Macro) Pcs 220 0 220 5 215
210 Isoniasid 100 mg Tab 0 0 0 0 0
211 Isoniazid 300 mg Tab 200 0 200 0 200
212 Isosorbid Dinitrat 5 mg Tab 2700 0 2700 0 2700
213 Jarum Kulit GT 10 Pcs 56 0 56 0 56
214 Jarum Kulit GT 11 Pcs 2 0 2 0 2
215 Jarum Kulit GT 15 Pcs 7 0 7 0 7
216 Jarum Kulit GR 13 Pcs 5 0 5 0 5
217 Jarum Otot GR 10 Pcs 0 0 0 0 0
218 Jarum Otot GR 12 Pcs 0 0 0 0 0
219 Jarum Otot GR 14 Pcs 0 0 0 0 0
220 Jarum Otot GR 15 Pcs 11 0 11 0 11
221 Kanamicin Inj Vial 0 0 0 0 0
222 Kaolimec Suspensi Botol 0 0 0 0 0
223 Kaotin Suspensi Botol 0 0 0 0 0
224 Kapas Berlemak 500 mg Buah 0 0 0 0 0
225 Kapas Pembalut 250 mg Buah 154 0 154 4 150
226 Karbamazepin 200 mg Tab 0 0 0 0 0
227 Kasa Hidrofil 4 m x 15 m Roll 0 0 0 0 0
228 Kasa Hidrofil 4 m x 5 m Roll 0 0 0 0 0
229 Kasa Kompres 40 x 80 Steril Roll 0 0 0 0 0
230 Kasa Kompres 40 x 40 Roll 6 0 6 0 6
231 Kasa Pembalut 40 x 80 m Roll 0 0 0 0 0
232 Kasa Steril 18 x 22 cm (16 x 16) Dos 470 0 470 70 400
233 Kertas EKG Roll 16 0 16 0 16
234 Kertas USG Roll 0 0 0 0 0
235 Ketokonazol 200 mg Tab 21750 0 21750 200 21550
236 Ketokonazol Krim 2 % Tube 233 0 233 10 223
237 Kolicgon Tab 0 0 0 0 0
238 Larutan H2O2 Botol 0 0 0 0 0
239 Leukoplast 2,5 cm x 4,5 m Roll 190 0 190 0 190
240 Leukoplast 7,5 cm x 4,5 m Roll 128 0 128 15 113
241 Levofloxacin 500 mg Tab 0 0 0 0 0
Stok penerima persediaa pemakai stok permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
242 Lidocain Inj 20 mg/ 2 ml Ampul 3000 0 3000 0 3000
243 Lidocain Inj 40 mg Ampul 1380 0 1380 100 1280
244 Lidocain Kompositum 20 mg/ 2 ml Ampul 450 0 450 0 450
245 Lisol Botol 40 0 40 0 40
246 Loperamid 2 mg Tab 0 0 0 0 0
247 Loratadin 10 mg Tab 0 0 0 0 0
248 Masker Earloop Pcs 450 0 450 0 450
249 Masker N 95 Pcs 140 0 140 0 140
250 Masker Tali Pcs 100 0 100 50 50
Stok penerima persediaa pemakai stok permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
251 MDT MB Combi Dewasa Dos 0 0 0 0 0
252 Meloxicam 15 mg Tab 0 0 0 0 0
253 Metamizole Inj (Norages) Ampul 0 0 0 0 0
254 Metformin 500 mg Tab 33600 0 33600 2000 31600
255 Methildopa 250 mg (Dopamet) Tab 200 0 200 0 200
256 Methylprednisolon 4 Mg Tab 100 0 100 100 0
257 Methylprednisolon 8 Mg Tab 200 0 200 200 0
258 Metilergometrin 0,125 mg Tab 15800 0 15800 100 15700
259 Metilergometrin Inj.0,2 mg Ampul 60 0 60 0 60
260 Metoclopramid 10 mg Tab 4700 0 4700 0 4700
261 Metoclopramid Inj 10 mg/ 2 ml Ampul 320 0 320 0 320
262 Metoclopramide Syr (Lexapram) Botol 1674 0 1674 1580 94
263 Metronidazol 250 mg Tab 0 0 0 0 0
264 Metronidazol 500 mg Tab 6300 0 6300 2400 3900
265 Metronidazole Lat Infus Botol 13 0 13 0 13
266 MgSO4 Inj 20% - 25 ml Flacon 20 0 20 0 20
267 MgSO4 Inj 40% - 25 ml Flacon 5 0 5 0 5
268 MgSO4 Serbuk 30 gr Vial 0 0 0 0 0
269 Miconazol Krim 2 % Tube 2392 0 2392 24 2368
270 Mometason Furoate Krim 0,1 % Tube 75 0 75 0 75
271 Mortir dan Stemper 8 cm Buah 0 0 0 0 0
272 Mouth Piace Dos 0 0 0 0 0
273 Mucotussan Tab 0 0 0 0 0
274 My Jelli 82 Gram Tube 9 0 9 4 5
275 NaCl Lar infus 0,9 % Kolf 280 0 280 5 275
276 Natrium Diclofenak 25 mg Tab 18650 0 18650 2300 16350
277 Natrium Diclofenak 50 mg Tab 3000 0 3000 0 3000
278 Neurovit E Tab 60 600 660 240 420
279 Neutotropic Plus Tab 0 0 0 0 0
280 Nifedipin 10 mg Tab 2700 0 2700 300 2400
281 Nistatin 500.000 IU Tab 3000 0 3000 1500 1500
282 Nistatin 100.000 IU Tab 490 0 490 0 490
283 Nistatin Drops 100.000 IU Botol 40 0 40 0 40
284 Novadiar Syr Botol 177 0 177 0 177
285 Novadium Tab 1300 0 1300 200 1100
286 Novampiron Tab 0 0 0 0 0
287 Novapen Syr Botol 0 0 0 0 0
288 Novastan Tab 0 0 0 0 0
289 Novotwist ( Jarum Novorapid) Dos 2 0 2 0 2
290 OAT FDC Kategori Anak Paket 5 0 5 5 0
291 OAT FDC Kategori I Dewasa Paket 0 5 5 0 5
292 OAT FDC Kategori II Dewasa Paket 0 0 0 0 0
293 OAT FDC Sisipan Dewasa Paket 0 0 0 0 0
294 Obat Batuk Hitam ( OBH ) Syr Botol 75 0 75 20 55
295 Oksitetraciclin Inj 50 ml - 10 ml Ampul 0 0 0 0 0
296 Oksitetraciclin Salep Kulit 3 % Tube 13 0 13 0 13
297 Oksitetraciclin Salep Mata 1 % Tube 235 0 235 20 215
298 Oksitosin Inj 50 ml - 10 ml Ampul 1420 0 1420 600 820
299 Omeprazole 20 mg Tab 6180 0 6180 600 5580
300 Ondansetron HCL Inj 4 mg/ 2 ml Ampul 115 0 115 0 115
301 Papaverin 40 mg Tab 6000 0 6000 2000 4000
302 Papaverin Inj Ampul 0 0 0 0 0
303 Paracetamol 500 mg Tab 0 1000 1000 1000 0
304 Paracetamol Lar Infus Steril Botol 9 0 9 5 4
305 Paracetamol Syr 120 mg/ 5 ml Botol 220 0 220 90 130
306 Pehacain Inj Ampul 620 0 620 240 380
Stok penerima persediaa pemakai stok permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
307 Pelarut Botol 0 10 10 8 2
308 Periokin Spray Dos 30 0 30 0 30
309 Permanganas kalikus (PK) Pot 0 0 0 0 0
310 Phenol Gliserol T. Telinga 10% Botol 33 0 33 9 24
311 Phitomenadion 10 mg Tab 1200 0 1200 200 1000
312 Phitomenadion Inj 10 mg/ml Ampul 0 0 0 0 0
313 Pipet Tetes Pendek Buah 0 0 0 0 0
314 Piracetam 800 mg Tab 0 0 0 0 0
315 Pirecetam 400 mg Tab 0 0 0 0 0
Stok penerima persediaa pemakai stok permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
316 Pirecetam Inj 200 mg/ ml Ampul 32 0 32 32 0
317 Piridoxyn (Vit B6) 10 mg Tab 40500 0 40500 21300 19200
318 Piroxicam 20 mg Tab 400 0 400 0 400
319 Pisau Bedah Pcs 300 0 300 0 300
320 Plano Test Pcs 25 300 325 75 250
321 Plesterin Bulat Dos 26 0 26 0 26
322 Poligyp 5 cm x 27 cm Roll 2 0 2 0 2
323 Pot Urine Bauh 20 0 20 0 20
324 Povidon Iodida 10 % 30 ml Botol 0 0 0 0 0
325 Povidon Iodida 10 % 300 ml Botol 2 0 2 0 2
326 Povidon Iodida 10 % 60 ml Botol 6 0 6 3 3
327 Prednison 5 mg Tab 300 1000 1300 400 900
328 Promavit Tab 3480 0 3480 1080 2400
329 Propanolol 10 mg Tab 0 400 400 400 0
330 Propanolol 40 mg Tab 0 0 0 0 0
331 Propiltiuracil 100 mg Tab 3300 0 3300 500 2800
332 Pyrantel Pamoat 125 mg Tab 20 0 20 20 0
333 Rabipur Vaksin Dos 0 0 0 0 0
334 Rak Tabung Stainless Buah 0 0 0 0 0
335 Ramipril 5 mg Tab 0 0 0 0 0
336 Ranitidin 150 mg Tab 14100 0 14100 600 13500
337 Ranitidin Inj 25 mg/ 2 ml Ampul 400 0 400 10 390
338 Ranitidin Inj 50 mg/ 2 ml Ampul 0 0 0 0 0
339 RDT DBD Dos 0 0 0 0 0
340 RDT Malaria Dos 0 0 0 0 0
341 Rifampisin 450 mg Tab 300 0 300 0 300
342 Rifampisin 600 mg Tab 0 0 0 0 0
343 Ringer Lactat Lar Infus Steril Kolf 170 0 170 69 101
344 Salbutamol 2 mg Tab 12200 0 12200 6100 6100
345 Salbutamol 4 mg Tab 6500 0 6500 0 6500
346 Salep 2-4 Pot 1830 0 1830 72 1758
347 Salisil Bedak 2 % Dos 60 0 60 20 40
348 Sanbe Tears (Air Mata Buatan) Botol 0 0 0 0 0
349 Selediar Tab 0 0 0 0 0
350 Seledryil Tab 0 0 0 0 0
351 Selesbion Tab 0 0 0 0 0
352 Selkom C Tab 0 0 0 0 0
353 Selviplex Tab 0 0 0 0 0
354 Seven Seans Syr Botol 406 0 406 30 376
355 Sikat Pembersih Tabung Buah 0 0 0 0 0
356 Silk (Benang Bedah Sutra) No. 2/0 Pcs 34 0 34 0 34
357 Silk (Benang Bedah Sutra) No. 3/0 Pcs 19 0 19 0 19
358 Silk Braided Black usp:4/0 100 M Dos 0 0 0 0 0
359 Simvastatin 10 mg Tab 17640 0 17640 7500 10140
360 Simvastatin 20 mg Tab 0 0 0 0 0
361 Skizon Zalf Tube 328 0 328 0 328
362 Soft U-Derm Krim Tube 120 0 120 0 120
363 Sohobion Inj Ampul 0 0 0 0 0
364 Soldextam Tab 0 0 0 0 0
365 Solvita Plus Syr Botol 0 0 0 0 0
366 Spasmolit Tab 0 0 0 0 0
367 Spironolactone 100 mg Tab 0 0 0 0 0
368 Spironolactone 25 mg Tab 0 0 0 0 0
369 Stesolid Suppo 5 mg/ 2,5 ml Suppo 11 0 11 0 11
370 Stesolid Suppo 10 mg/ 2,5 ml Suppo 0 0 0 0 0
371 Stik HB Family Dr Dos 6 5 11 9 2
Stok penerima persediaa pemakai stok permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
372 Tablet Tambah Darah Tab 0 0 0 0 0
373 Tablet Tambah Darah Neo Tab 600 11200 11800 5500 6300
374 Tabung Reaksi 25 ml Buah 0 0 0 0 0
375 Termorex Syr Botol 0 0 0 0 0
376 TesKits Boraks Kit 0 0 0 0 0
377 TesKits Formaldehid (Formalin) Kit 0 0 0 0 0
378 TesKits Methanil Yellow Kit 0 0 0 0 0
379 TesKits Rhodamine B Kit 0 0 0 0 0
380 Tetagam Vaksin Dos 6 0 6 3 3
Stok penerima persediaa pemakai stok permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
381 Tetracyclin HCL 250 mg Tab 0 0 0 0 0
382 Tetracyclin HCL 500 mg Tab 15100 0 15100 6600 8500
383 Tetrakain HCL T. Mata 0,5 % Botol 0 0 0 0 0
384 Thiamin HCL 50 mg Tab 700 1000 1700 900 800
385 Thiamin HCL Inj 100 ml - 1 ml Vial 1680 0 1680 60 1620
386 Tramadol 50 mg Tab 100 0 100 0 100
387 Tricresol Formalin 10 ml Botol 4 0 4 4 0
388 Triheksiphenidil HCL 2 mg Tab 2500 0 2500 0 2500
389 Truvit Syr Botol 206 0 206 40 166
390 Ultrasonic Gel 250 ml Botol 1 0 1 0 1
391 Urine Bag 1000 ml Pcs 90 0 90 10 80
392 Vaksin BCG Ampul 0 10 10 8 2
393 Vaksin Campak Rubella Ampul 0 0 0 0 0
394 Vaksin DPT HB Combo Ampul 2 20 22 20 2
395 Vaksin HB 0 (Unijek) Ampul 8 30 38 28 10
396 Vaksin IPV Ampul 0 5 5 3 2
397 Vaksin TT Bumil Ampul 2 10 12 8 4
398 Vaksin Polio Ampul 3 20 23 15 8
399 Ventolin Nebulizer Flacon 0 0 0 0 0
400 Verorab Vaksin Dos 13 0 13 5 8
401 Viccillin - SX (Ampicilin) Inj 1,5 g Vial 30 0 30 0 30
402 Vit A 100.000 IU Kapsul 500 0 500 500 0
403 Vit A 200.000 IU Kapsul 30 4 34 34 0
404 Vitamin B Kompleks Tab 1200 3000 4200 1400 2800
405 Vitamin B Kompleks Inj Vial 100 0 100 90 10
406 Zinc Dispersible 20 mg Tab 400 0 400 400 0
407 Zinc Syr 20 mg/ 5 ml Botol 445 0 445 70 375
408 HIV Tes Kit Strip 0 300 300 0 300
409 HBsAG Tes Kit Strip 0 50 50 50 0

Umum
BPJS Jamkesda Jumlah
JUMLAH KUNJUNGAN RESEP Bayar Tdk Bayar

Mengetahui/Menyetujui Yang Menyerahkan Yang Memohon Yang M


Penanggung Jawab Gudang Farmasi Petuga

Arini Priyanti Kandupi, S. Farm, Apt Moh. Rizal Sumaga, SKM Mujriah A
Nip.19830402 200502 2 004 Nip. 19720123 199402 1 002 Nip : 19881005

KETERANGAN :
Lembar Putih : GFK
Lembar Merah : Puskesmas
AN OBAT

: FEBRUARI 2019

Pemberian
Ket
lain-lain Jml
13 14 15

Exp : 3

Dinkes : 250
Pemberian
Ket
lain-lain Jml
13 14 15

Dinkes:15000
Pemberian
Ket
lain-lain Jml
13 14 15

Dinkes: 1500

Dinkes : 528

Dinkes: 1154
Dinkes : 672

Dinkes : 144

Dinkes : 500
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Dinkes: 16500
Dinkes : 200

Dinkes: 1800

Dinkes : 480
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Exp : 600
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Dinkes: 1500

Dinkes : 500

Dinkes: 1500

Dinkes : 600

Dinkes : 200
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Dinkes : 32
Dinkes: 21000

Dinkes: 5000

Dinkes: 6000
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Dinkes: 5000

Dinkes : 50

Yang Menerima
Petugas PKM

Mujriah A.Md, Far


Nip : 19881005 201001 2 001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS

PUSKESMAS : TETE PELAPORAN BLN/PERIODE : MARET


KECAMATAN : AMPANA TETE
KABUPATEN : TOJO UNA UNA PERMINTAAN BLN/PERIODE
PROPINSI : SUL TENG

Stok Penerima Persediaa Pemakai Stok Permin Pemberian


NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
1 Abbocath No.18 Pcs 183 0 183 105 78
2 Abbocath No.20 Pcs 872 0 872 62 810
3 Abbocath No.22 Pcs 238 0 238 118 120
4 Abbocath No.24 Pcs 244 0 244 45 199
5 Acetylcysteine 200 mg Tab 0 0 0 0 0
6 Acyclovir 200 Mg Tab 0 0 0 0 0
7 Acyclovir 400 Mg Tab 11550 0 11550 400 11150
8 Acyclovir krim 5% Tube 339 0 339 0 339
9 Adidryl Inj Vial 0 0 0 0 0
10 Adimidon Inj Vial 0 0 0 0 0
11 Alat Autochek Unit 0 0 0 0 0
12 Alat Benechek Unit 0 0 0 0 0
13 Alat CO Analiser Unit 0 0 0 0 0
14 Alat Easy Touch Unit 0 0 0 0 0
15 Alat suntik sekali pakai 0,5 ml Pcs 50 300 350 250 100
16 Alat suntik sekali pakai 1 ml Pcs 444 0 444 120 324
17 Alat suntik sekali pakai 10 ml Pcs 0 0 0 0 0
18 Alat suntik sekali pakai 2,5 ml Pcs 0 0 0 0 0
19 Alat suntik sekali pakai 20 ml Pcs 70 0 70 0 70
20 Alat suntik sekali pakai 3 ml Pcs 295 0 295 195 100
21 Alat suntik sekali pakai 5 ml Pcs 1510 0 1510 245 1265
22 Albendazol 400 mg Tab 0 0 0 0 0
23 Alkohol Swab Dos 17 0 17 1 16
24 Alletrol T. Mata Botol 0 0 0 0 0
25 Allopurinol 100 mg Tab 6700 0 6700 4000 2700
26 Allopurinol 300 mg Tab 3540 0 3540 150 3390
27 Alprazolam 0,5 mg Tab 0 0 0 0 0
28 Alprazolam 1 mg Tab 2774 0 2774 20 2754
29 Ambroxol 30 mg Tab 4700 0 4700 1500 3200
30 Ambroxol Syr 15mg/ 5 ml Botol 170 0 170 45 125
31 Amitriptilin 25 mg Tab 4074 0 4074 0 4074
32 Amlodiphin 10 mg Tab 6360 0 6360 1560 4800
33 Amlodiphin 5 mg Tab 360 0 360 360 0
34 Amoxycillin 250 mg Tab 0 0 0 0 0
35 Amoxycillin 500 mg Tab 22200 0 22200 5400 16800
36 Amoxycillin Syr 125 mg/ 5 ml Botol 110 0 110 90 20
37 Ampicillin 500 mg Tab 0 0 0 0 0
38 Ampicillin Inj Vial 0 0 0 0 0
39 Ampicillin Syrup 125 mg/ 5 ml Botol 0 0 0 0 0
40 Analog Long Insulin (Levemir) Pen 0 0 0 0 0
41 Antalgin 500 mg Tab 0 0 0 0 0
42 Antalgin Inj 250 mg/ml Ampul 0 0 0 0 0
43 Antasida Doen 500 mg Tab 35500 0 35500 2300 33200
44 Antasida Doen Susp Botol 40 0 40 40 0
45 Anti Hemoroid Doen Kombinasi Suppo 315 0 315 30 285
46 Antiseptik Hand Botol 52 0 52 2 50
Stok Penerima Persediaa Pemakai Stok Permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
47 Antrain Inj Ampul 0 0 0 0 0
48 Aqua Pro Injeksi Vial 120 0 120 0 120
49 Aquadest 20 L Galon 2 0 2 0 2
50 As Asetil Salisilat 80 mg (Miniaspi) Tab 1700 0 1700 0 1700
51 Asam Askorbat (Vit C) 50 mg Tab 32900 0 32900 5500 27400
52 Asam Folac Tab 11300 0 11300 8500 2800
53 Asam Mefenamat 500 mg Tab 38100 0 38100 5500 32600
54 Asam Tranexamat Inj 50 mg/ ml Ampul 0 0 0 0 0
55 Asetosal 100 mg Tab 0 0 0 0 0
Stok Penerima Persediaa Pemakai Stok Permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
56 Asetosal 500 mg Tab 0 0 0 0 0
57 Aspar K Tab 0 0 0 0 0
58 Atorvastatin Calsium 10 Mg Tab 0 0 0 0 0
59 Atropin Inj 0,25 mg Ampul 121 0 121 0 121
60 Atrovent Inhaler Botol 90 0 90 5 85
61 Attapulgit (New Antides) Tab 0 0 0 0 0
62 Autocheck Cholesterol Dos 10 0 10 0 10
63 Autocheck Glucosa Dos 4 0 4 2 2
64 Autocheck Urin Acid Dos 4 0 4 0 4
65 Bacitracin Polimixyn B Salep Tube 0 0 0 0 0
66 Batang Pengaduk Buah 0 0 0 0 0
67 Benecheck Colesterol Dos 26 0 26 5 21
68 Benecheck Glucosa Dos 0 0 0 0 0
69 Benecheck Urin Acid Dos 9 0 9 0 9
70 Betahistin Mesilat 6 mg Tab 5000 0 5000 400 4600
71 Betametason Krim 0,1% Tube 905 0 905 255 650
72 Biocombin 5000 Inj Ampul 0 0 0 0 0
73 Bionemi Tab 0 100 100 0 100
74 Bisoprolol 5 mg Tab 0 0 0 0 0
75 Blood Lancets 26 G Dos 0 0 0 0 0
76 Blood Lancets 28 G Dos 28 0 28 0 28
77 Buscopan Inj 20 mg/ ml Ampul 10 0 10 0 10
78 Calcium Gluconate Inj 100 mg/ml Ampul 17 0 17 0 17
79 Calsium Laktat (Calac) 500 mg Tab 0 0 0 0 0
80 Calxyl Radiopaque Buah 3 0 3 0 3
81 Candesartan Cilexetil 8 mg Tab 0 0 0 0 0
82 Captopril 12,5 mg Tab 0 5200 5200 0 5200
83 Captopril 25 mg Tab 13800 0 13800 2400 11400
84 Carbamazepin 200 mg Tab 0 0 0 0 0
85 Catapres Inj Ampul 10 0 10 0 10
86 Catarlent T Mata Botol 0 0 0 0 0
87 Catgut Chromic No. 2/0 Pcs 21 0 21 15 6
88 Catgut Chromic No. 3/0 Pcs 48 0 48 36 12
89 Catgut Chromic No. 4/0 Pcs 24 0 24 12 12
90 Catgut Chromik usp:2/0 100 M Dos 0 0 0 0 0
91 Catgut Plain 2/0 HR 37 MM Pcs 0 0 0 0 0
92 Catgut Plain 3/0 HR 26 MM Pcs 0 0 0 0 0
93 Catgut Plain 4/0 Pcs 0 0 0 0 0
94 Cathejell Lido 2% & CHG 0,05 % Flacon 5 0 5 5 0
95 Cavit (Bahan Tump Sementara) Dos 28 6 34 0 34
96 Cefadroxil 500 mg Tab 4200 0 4200 900 3300
97 Cefadroxil Syr 125 mg/ 5 ml Botol 135 0 135 59 76
98 Cendo Xytrol T. Mata Botol 240 0 240 25 215
99 Cetirizine 10 mg Tab 7600 0 7600 900 6700
100 Cetirizine Syr 5 mg/ 5 ml Botol 370 0 370 45 325
101 Chloramphenicol (Chloramex) 500 mg Tab 10500 0 10500 1400 9100
102 Chloramphenicol (Novachlor) 250 mg Tab 4200 0 4200 1300 2900
103 Chloramphenicol Salep Mata 1% Tube 144 0 144 11 133
104 Chloramphenicol Suspensi Botol 239 0 239 60 179
105 Chloramphenicol T. Mata 0,5% Tube 0 0 0 0 0
106 Chloramphenicol T. Telinga 3% Botol 145 0 145 85 60
107 Chlorfeniramin Maleat 4 mg Tab 37500 0 37500 5800 31700
108 Chlorpromazin 100 mg Tab 280 0 280 0 280
109 Chlorpromazin 25 mg Tab 0 0 0 0 0
110 Chlorpromazin Inj 5mg/ml Ampul 60 0 60 0 60
111 Cimetidin 200 mg Tab 0 0 0 0 0
Stok Penerima Persediaa Pemakai Stok Permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
112 Citicoline 500 mg Tab 0 0 0 0 0
113 Clobasam 10 mg Tab 98 0 98 0 98
114 Clonidine 0,15 mg Tab 0 0 0 0 0
115 Clopidogrel 75 mg Tab 0 0 0 0 0
116 Codein 10 mg Tab 3950 0 3950 20 3930
117 Colcitine 0,5 mg Tab 2940 300 3240 150 3090
118 Combivent Nebulizer Flacon 0 0 0 0 0
119 Cotrimoxazol 480 mg Tab 200 1000 1200 200 1000
120 Cotrimoxazol Pediatrik Tab 0 0 0 0 0
Stok Penerima Persediaa Pemakai Stok Permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
121 Cotrimoxazol Susp Botol 190 0 190 15 175
122 Curcuma Tab 300 0 300 0 300
123 Cutimed Gel Tube 2 0 2 0 2
124 Cyanocobalamin 50 mg Tab 400 0 400 400 0
125 Cyanocobalamin Inj 500 mcg/ ml Ampul 3020 0 3020 550 2470
126 Cyprofloksasin 500 mg Tab 3900 0 3900 800 3100
127 Dexamethason 0,5 mg Tab 11800 2000 13800 6000 7800
128 Dexamethason Inj 5 mg/ml Ampul 360 0 360 160 200
129 Dextamec Tab 0 0 0 0 0
130 Diazepam 2 mg Tab 0 0 0 0 0
131 Diazepam 5 mg Tab 0 0 0 0 0
132 Diazepam Inj Ampul 50 0 50 0 50
133 Digoxin 0,25 mg Tab 0 0 0 0 0
134 Diltiazem 30 mg Tab 0 0 0 0 0
135 Dimenhydrinate 50 mg Tab 0 0 0 0 0
136 Diphenhidramin Inj Ampul 180 0 180 120 60
137 Diphenhidramin Inj (Sidiadryl) Vial 42 0 42 12 30
138 Disposible Needle No. 22 Pcs 0 0 0 0 0
139 Disposible Needle No. 23 Pcs 90 0 90 40 50
140 Domperidon 10 mg Tab 33600 0 33600 1600 32000
141 Domperidon Susp 5 mg/ 5 ml Botol 1335 0 1335 80 1255
142 Double Check (Artikulating Paper) Dos 30 6 36 0 36
143 Doxyciclin 100 mg Tab 5400 0 5400 0 5400
144 Dulcolax 5 mg Tab 0 0 0 0 0
145 Dulcolax Suppo Anak Suppo 516 0 516 138 378
146 Dumin Rektal 125 mg/ 4 ml Suppo 0 0 0 0 0
147 Dumin Rektal 250 mg/4 ml Suppo 28 0 28 1 27
148 Easy Touch Colestrol Dos 3 0 3 3 0
149 Easy Touch Glukosa Dos 0 0 0 0 0
150 Easy Touch Urine Acid Dos 0 0 0 0 0
151 Eflin Tab 8200 2000 10200 1800 8400
152 Elastis Verban 7,5 cm x 4,55 m Roll 27 0 27 4 23
153 Epinefrin Inj 1 mg/ml Ampul 155 0 155 0 155
154 Epoxidin (Pasta Pengisi Sal Akar) Dos 30 0 30 0 30
155 Erphatrim Forte 960 mg Tab 0 0 0 0 0
156 Erytromicin 250 mg Tab 0 0 0 0 0
157 Erytromicin 500 mg Tab 23800 0 23800 0 23800
158 Erytromicin Syr Botol 0 0 0 0 0
159 Etakridin (Rivanol Lar 0,1%) Botol 0 0 0 0 0
160 Etanol 70% 1 L Botol 24 0 24 0 24
161 Etanol 70% 100 ml Botol 0 0 0 0 0
162 Etanol 70% 300 ml Botol 96 0 96 21 75
163 Ethambutol 500 mg Tab 450 0 450 0 450
164 Farbion Inj Ampul 0 0 0 0 0
165 Fenilbutason (Novason) 200 mg Tab 7100 0 7100 1300 5800
166 Fenobarbital 30 mg Tab 0 0 0 0 0
167 Fenobarbital Inj 50 mg/ml Ampul 0 0 0 0 0
168 Folley Catheter No. 10 FR Pcs 9 0 9 0 9
169 Folley Catheter No. 16 FR Pcs 10 0 10 0 10
170 Folley Catheter No. 18 FR Pcs 71 0 71 20 51
171 Folley Catheter No. 22 FR Pcs 94 0 94 25 69
172 Furosemid 40 mg Tab 1700 0 1700 0 1700
173 Furosemid Inj (Diuvar) Ampul 0 0 0 0 0
174 Gabapentin 300 mg Tab 330 0 330 0 330
175 Garam Oralit 200 ml Air Saset 1050 0 1050 220 830
176 Gelas Ukur 250 ml Buah 0 0 0 0 0
Stok Penerima Persediaa Pemakai Stok Permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
177 Gemfibrozil 300 mg Tab 2400 0 2400 0 2400
178 Gentamicin Inj 40 mg/ ml Ampul 115 0 115 20 95
179 Gentamicin Salep 0,1 % Tube 37 0 37 10 27
180 Gentian Violet lar 1% Botol 195 0 195 5 190
181 Glibenclamid 5 mg Tab 3300 0 3300 0 3300
182 Glimepiride 2 mg Tab 6000 0 6000 0 6000
183 Glimepiride 3 mg Tab 0 0 0 0 0
184 Glukosa lar infus 10 % Steril Kolf 0 0 0 0 0
185 Glukosa lar infus 5 % Steril Kolf 494 0 494 20 474
Stok Penerima Persediaa Pemakai Stok Permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
186 Griseofulvin 125 mg Tab 77000 0 77000 8300 68700
187 Guaifenesin 100 mg Tab 19200 0 19200 1500 17700
188 Halloperidol 0,5 mg Tab 400 0 400 0 400
189 Halloperidol 1,5 mg Tab 0 0 0 0 0
190 Halloperidol 5 mg Tab 92 0 92 0 92
191 Handscoon Genekolog 7,5 16/40 cm Pcs 194 0 194 0 194
192 Handscoon No. 6,5 Steril Pcs 0 0 0 0 0
193 Handscoon No. 7 Steril Pcs 300 0 300 100 200
194 Handscoon No. 7,5 Steril Pcs 350 10 360 110 250
195 Handscoon No. 8 Steril Pcs 350 0 350 15 335
196 Handscoon Non Steril (L) Dos 0 0 0 0 0
197 Handscoon Non Steril (M) Dos 0 0 0 0 0
198 Hemafort Tab 0 0 0 0 0
199 Hidroklortiazid 25 mg Tab 6700 0 6700 0 6700
200 Hidrokortison Krim 2,5% Tube 5353 0 5353 216 5137
201 Hyoscine N-Butylbromide (Scopamin) Tab 11100 0 11100 600 10500
202 Hyscopan Tab 0 0 0 0 0
203 Ibuprofen 200 mg Tab 0 0 0 0 0
204 Ibuprofen 400 mg Tab 27500 0 27500 5000 22500
205 Ibuprofen Susp 100 mg/ 5 ml Botol 180 300 480 150 330
206 Ichtiyol Salep Pot 0 0 0 0 0
207 Iliadin T. Hidung Botol 98 0 98 6 92
208 Infusion Set Anak (Micro) Pcs 310 0 310 50 260
209 Infusion Set Dewasa (Macro) Pcs 215 100 315 55 260
210 Isoniasid 100 mg Tab 0 0 0 0 0
211 Isoniazid 300 mg Tab 200 0 200 0 200
212 Isosorbid Dinitrat 5 mg Tab 2700 0 2700 0 2700
213 Jarum Kulit GT 10 Pcs 56 0 56 0 56
214 Jarum Kulit GT 11 Pcs 2 0 2 1 1
215 Jarum Kulit GT 15 Pcs 7 0 7 0 7
216 Jarum Kulit GR 13 Pcs 5 0 5 1 4
217 Jarum Otot GR 10 Pcs 0 0 0 0 0
218 Jarum Otot GR 12 Pcs 0 0 0 0 0
219 Jarum Otot GR 14 Pcs 0 0 0 0 0
220 Jarum Otot GR 15 Pcs 11 0 11 1 10
221 Kanamicin Inj Vial 0 0 0 0 0
222 Kaolimec Suspensi Botol 0 0 0 0 0
223 Kaotin Suspensi Botol 0 0 0 0 0
224 Kapas Berlemak 500 mg Buah 0 0 0 0 0
225 Kapas Pembalut 250 mg Buah 150 0 150 15 135
226 Karbamazepin 200 mg Tab 0 0 0 0 0
227 Kasa Hidrofil 4 m x 15 m Roll 0 0 0 0 0
228 Kasa Hidrofil 4 m x 5 m Roll 0 0 0 0 0
229 Kasa Kompres 40 x 80 Steril Roll 0 0 0 0 0
230 Kasa Kompres 40 x 40 Roll 6 0 6 0 6
231 Kasa Pembalut 40 x 80 m Roll 0 0 0 0 0
232 Kasa Steril 18 x 22 cm (16 x 16) Dos 400 0 400 130 270
233 Kertas EKG Roll 16 20 36 5 31
234 Kertas USG Roll 0 0 0 0 0
235 Ketokonazol 200 mg Tab 21550 0 21550 1000 20550
236 Ketokonazol Krim 2 % Tube 223 0 223 30 193
237 Kolicgon Tab 0 0 0 0 0
238 Larutan H2O2 Botol 0 0 0 0 0
239 Leukoplast 2,5 cm x 4,5 m Roll 190 0 190 0 190
240 Leukoplast 7,5 cm x 4,5 m Roll 113 0 113 33 80
241 Levofloxacin 500 mg Tab 0 0 0 0 0
Stok Penerima Persediaa Pemakai Stok Permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
242 Lidocain Inj 20 mg/ 2 ml Ampul 3000 1200 4200 0 4200
243 Lidocain Inj 40 mg Ampul 1280 0 1280 450 830
244 Lidocain Kompositum 20 mg/ 2 ml Ampul 450 0 450 0 450
245 Lisol Botol 40 0 40 1 39
246 Loperamid 2 mg Tab 0 0 0 0 0
247 Loratadin 10 mg Tab 0 0 0 0 0
248 Masker Earloop Pcs 450 0 450 140 310
249 Masker N 95 Pcs 140 0 140 0 140
250 Masker Tali Pcs 50 300 350 150 200
Stok Penerima Persediaa Pemakai Stok Permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
251 MDT MB Combi Dewasa Dos 0 0 0 0 0
252 Meloxicam 15 mg Tab 0 0 0 0 0
253 Metamizole Inj (Norages) Ampul 0 0 0 0 0
254 Metformin 500 mg Tab 31600 0 31600 800 30800
255 Methildopa 250 mg (Dopamet) Tab 200 0 200 0 200
256 Methylprednisolon 4 Mg Tab 0 0 0 0 0
257 Methylprednisolon 8 Mg Tab 0 0 0 0 0
258 Metilergometrin 0,125 mg Tab 15700 0 15700 0 15700
259 Metilergometrin Inj.0,2 mg Ampul 60 0 60 0 60
260 Metoclopramid 10 mg Tab 4700 0 4700 0 4700
261 Metoclopramid Inj 10 mg/ 2 ml Ampul 320 0 320 10 310
262 Metoclopramide Syr (Lexapram) Botol 94 0 94 10 84
263 Metronidazol 250 mg Tab 0 0 0 0 0
264 Metronidazol 500 mg Tab 3900 0 3900 300 3600
265 Metronidazole Lat Infus Botol 13 0 13 0 13
266 MgSO4 Inj 20% - 25 ml Flacon 20 0 20 0 20
267 MgSO4 Inj 40% - 25 ml Flacon 5 0 5 0 5
268 MgSO4 Serbuk 30 gr Vial 0 0 0 0 0
269 Miconazol Krim 2 % Tube 2368 0 2368 240 2128
270 Mometason Furoate Krim 0,1 % Tube 75 0 75 0 75
271 Mortir dan Stemper 8 cm Buah 0 0 0 0 0
272 Mouth Piace Dos 0 0 0 0 0
273 Mucotussan Tab 0 0 0 0 0
274 My Jelli 82 Gram Tube 5 0 5 0 5
275 NaCl Lar infus 0,9 % Kolf 275 0 275 21 254
276 Natrium Diclofenak 25 mg Tab 16350 0 16350 1300 15050
277 Natrium Diclofenak 50 mg Tab 3000 0 3000 0 3000
278 Neurovit E Tab 420 1020 1440 300 1140
279 Neutotropic Plus Tab 0 0 0 0 0
280 Nifedipin 10 mg Tab 2400 0 2400 500 1900
281 Nistatin 500.000 IU Tab 1500 0 1500 900 600
282 Nistatin 100.000 IU Tab 490 0 490 0 490
283 Nistatin Drops 100.000 IU Botol 40 0 40 0 40
284 Novadiar Syr Botol 177 0 177 38 139
285 Novadium Tab 1100 0 1100 0 1100
286 Novampiron Tab 0 0 0 0 0
287 Novapen Syr Botol 0 0 0 0 0
288 Novastan Tab 0 0 0 0 0
289 Novotwist ( Jarum Novorapid) Dos 2 0 2 0 2
290 OAT FDC Kategori Anak Paket 0 0 0 0 0
291 OAT FDC Kategori I Dewasa Paket 5 0 5 5 0
292 OAT FDC Kategori II Dewasa Paket 0 0 0 0 0
293 OAT FDC Sisipan Dewasa Paket 0 0 0 0 0
294 Obat Batuk Hitam ( OBH ) Syr Botol 55 0 55 35 20
295 Oksitetraciclin Inj 50 ml - 10 ml Ampul 0 0 0 0 0
296 Oksitetraciclin Salep Kulit 3 % Tube 13 0 13 0 13
297 Oksitetraciclin Salep Mata 1 % Tube 215 0 215 0 215
298 Oksitosin Inj 50 ml - 10 ml Ampul 820 0 820 180 640
299 Omeprazole 20 mg Tab 5580 0 5580 1260 4320
300 Ondansetron HCL Inj 4 mg/ 2 ml Ampul 115 0 115 10 105
301 Papaverin 40 mg Tab 4000 0 4000 4000 0
302 Papaverin Inj Ampul 0 0 0 0 0
303 Paracetamol 500 mg Tab 0 1000 1000 0 1000
304 Paracetamol Lar Infus Steril Botol 4 0 4 0 4
305 Paracetamol Syr 120 mg/ 5 ml Botol 130 0 130 115 15
306 Pehacain Inj Ampul 380 0 380 120 260
Stok Penerima Persediaa Pemakai Stok Permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
307 Pelarut Botol 2 10 12 12 0
308 Periokin Spray Dos 30 3 33 0 33
309 Permanganas kalikus (PK) Pot 0 0 0 0 0
310 Phenol Gliserol T. Telinga 10% Botol 24 0 24 0 24
311 Phitomenadion 10 mg Tab 1000 600 1600 400 1200
312 Phitomenadion Inj 10 mg/ml Ampul 0 13 13 8 5
313 Pipet Tetes Pendek Buah 0 0 0 0 0
314 Piracetam 800 mg Tab 0 0 0 0 0
315 Pirecetam 400 mg Tab 0 0 0 0 0
Stok Penerima Persediaa Pemakai Stok Permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
316 Pirecetam Inj 200 mg/ ml Ampul 0 0 0 0 0
317 Piridoxyn (Vit B6) 10 mg Tab 19200 0 19200 6000 13200
318 Piroxicam 20 mg Tab 400 0 400 200 200
319 Pisau Bedah Pcs 300 0 300 100 200
320 Plano Test Pcs 250 180 430 185 245
321 Plesterin Bulat Dos 26 0 26 1 25
322 Poligyp 5 cm x 27 cm Roll 2 0 2 0 2
323 Pot Urine Bauh 20 0 20 0 20
324 Povidon Iodida 10 % 30 ml Botol 0 50 50 0 50
325 Povidon Iodida 10 % 300 ml Botol 2 0 2 2 0
326 Povidon Iodida 10 % 60 ml Botol 3 0 3 0 3
327 Prednison 5 mg Tab 900 4000 4900 300 4600
328 Promavit Tab 2400 60 2460 900 1560
329 Propanolol 10 mg Tab 0 0 0 0 0
330 Propanolol 40 mg Tab 0 0 0 0 0
331 Propiltiuracil 100 mg Tab 2800 0 2800 0 2800
332 Pyrantel Pamoat 125 mg Tab 0 0 0 0 0
333 Rabipur Vaksin Dos 0 0 0 0 0
334 Rak Tabung Stainless Buah 0 0 0 0 0
335 Ramipril 5 mg Tab 0 0 0 0 0
336 Ranitidin 150 mg Tab 13500 0 13500 3100 10400
337 Ranitidin Inj 25 mg/ 2 ml Ampul 390 0 390 70 320
338 Ranitidin Inj 50 mg/ 2 ml Ampul 0 0 0 0 0
339 RDT DBD Dos 0 0 0 0 0
340 RDT Malaria Dos 0 0 0 0 0
341 Rifampisin 450 mg Tab 300 0 300 0 300
342 Rifampisin 600 mg Tab 0 0 0 0 0
343 Ringer Lactat Lar Infus Steril Kolf 101 40 141 70 71
344 Salbutamol 2 mg Tab 6100 0 6100 6100 0
345 Salbutamol 4 mg Tab 6500 0 6500 0 6500
346 Salep 2-4 Pot 1758 0 1758 192 1566
347 Salisil Bedak 2 % Dos 40 0 40 40 0
348 Sanbe Tears (Air Mata Buatan) Botol 0 0 0 0 0
349 Selediar Tab 0 0 0 0 0
350 Seledryil Tab 0 0 0 0 0
351 Selesbion Tab 0 0 0 0 0
352 Selkom C Tab 0 0 0 0 0
353 Selviplex Tab 0 0 0 0 0
354 Seven Seans Syr Botol 376 0 376 33 343
355 Sikat Pembersih Tabung Buah 0 0 0 0 0
356 Silk (Benang Bedah Sutra) No. 2/0 Pcs 34 0 34 10 24
357 Silk (Benang Bedah Sutra) No. 3/0 Pcs 19 0 19 7 12
358 Silk Braided Black usp:4/0 100 M Dos 0 0 0 0 0
359 Simvastatin 10 mg Tab 10140 1050 11190 2850 8340
360 Simvastatin 20 mg Tab 0 0 0 0 0
361 Skizon Zalf Tube 328 0 328 0 328
362 Soft U-Derm Krim Tube 120 0 120 0 120
363 Sohobion Inj Ampul 0 0 0 0 0
364 Soldextam Tab 0 0 0 0 0
365 Solvita Plus Syr Botol 0 0 0 0 0
366 Spasmolit Tab 0 0 0 0 0
367 Spironolactone 100 mg Tab 0 0 0 0 0
368 Spironolactone 25 mg Tab 0 0 0 0 0
369 Stesolid Suppo 5 mg/ 2,5 ml Suppo 11 0 11 0 11
370 Stesolid Suppo 10 mg/ 2,5 ml Suppo 0 0 0 0 0
371 Stik HB Family Dr Dos 2 4 6 2 4
Stok Penerima Persediaa Pemakai Stok Permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
372 Tablet Tambah Darah Tab 0 0 0 0 0
373 Tablet Tambah Darah Neo Tab 6300 0 6300 6300 0
374 Tabung Reaksi 25 ml Buah 0 0 0 0 0
375 Termorex Syr Botol 0 0 0 0 0
376 TesKits Boraks Kit 0 0 0 0 0
377 TesKits Formaldehid (Formalin) Kit 0 0 0 0 0
378 TesKits Methanil Yellow Kit 0 0 0 0 0
379 TesKits Rhodamine B Kit 0 0 0 0 0
380 Tetagam Vaksin Dos 3 0 3 3 0
Stok Penerima Persediaa Pemakai Stok Permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12
381 Tetracyclin HCL 250 mg Tab 0 0 0 0 0
382 Tetracyclin HCL 500 mg Tab 8500 0 8500 1500 7000
383 Tetrakain HCL T. Mata 0,5 % Botol 0 0 0 0 0
384 Thiamin HCL 50 mg Tab 800 1000 1800 800 1000
385 Thiamin HCL Inj 100 ml - 1 ml Vial 1620 0 1620 110 1510
386 Tramadol 50 mg Tab 100 0 100 0 100
387 Tricresol Formalin 10 ml Botol 0 0 0 0 0
388 Triheksiphenidil HCL 2 mg Tab 2500 0 2500 0 2500
389 Truvit Syr Botol 166 0 166 0 166
390 Ultrasonic Gel 250 ml Botol 1 0 1 1 0
391 Urine Bag 1000 ml Pcs 80 0 80 45 35
392 Vaksin BCG Ampul 2 0 2 2 0
393 Vaksin Campak Rubella Ampul 0 10 10 10 0
394 Vaksin DPT HB Combo Ampul 2 20 22 20 2
395 Vaksin HB 0 (Unijek) Ampul 10 0 10 10 0
396 Vaksin IPV Ampul 2 5 7 4 3
397 Vaksin TT Bumil Ampul 4 0 4 4 0
398 Vaksin Polio Ampul 8 10 18 8 10
399 Ventolin Nebulizer Flacon 0 0 0 0 0
400 Verorab Vaksin Dos 8 0 8 3 5
401 Viccillin - SX (Ampicilin) Inj 1,5 g Vial 30 2 32 0 32
402 Vit A 100.000 IU Kapsul 0 0 0 0 0
403 Vit A 200.000 IU Kapsul 0 0 0 0 0
404 Vitamin B Kompleks Tab 2800 5000 7800 2800 5000
405 Vitamin B Kompleks Inj Vial 10 0 10 0 10
406 Zinc Dispersible 20 mg Tab 0 0 0 0 0
407 Zinc Syr 20 mg/ 5 ml Botol 375 0 375 30 345
408 HIV Tes Kit Strip 300 0 300 0 300
409 HBsAG Tes Kit Strip 0 0 0 0 0
410 HS Posterior Dos 0 4 4 0 4
411 Filtek Z350 XT Pcs 0 35 35 0 35
412 Pulp - X Dos 0 32 32 0 32
413 Iodium Tes Botol 0 5 5 0 5
414 Mitela (Kain SegiTiga) Pcs 0 2 2 0 2
415 Poligyp 10 cm x 2,7 m Roll 0 5 5 0 5
416 Asam Asetat 100 ml Botol 0 2 2 0 2

Umum
BPJS Jamkesda Jumlah
JUMLAH KUNJUNGAN RESEP Bayar Tdk Bayar

Mengetahui/Menyetujui Yang Menyerahkan Yang Memohon Yang M


Penanggung Jawab Gudang Farmasi Petuga
Stok Penerima Persediaa Pemakai Stok Permin Pemberian
NO NAMA OBAT / BMHP Satuan
awal an n an akhir taan APBD I APBD II program

1 2 3 4 5 6 7 8 9 10 11 12

Arini Priyanti Kandupi, S. Farm, Apt Moh. Rizal Sumaga, SKM Mujriah A
Nip.19830402 200502 2 004 Nip. 19720123 199402 1 002 Nip : 19881005

KETERANGAN :
Lembar Putih : GFK
Lembar Merah : Puskesmas
AN OBAT

: MARET 2019

Pemberian
Ket
lain-lain Jml
13 14 15

Exp : 35
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Yang Menerima
Petugas PKM
Pemberian
Ket
lain-lain Jml
13 14 15

Mujriah A.Md, Far


Nip : 19881005 201001 2 001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS

PUSKESMAS : TETE PELAPORAN BLN/PERIODE : APRIL 2


KECAMATAN : AMPANA TETE
KABUPATEN : TOJO UNA UNA PERMINTAAN BLN/PERIODE
PROPINSI : SUL TENG

Stok Peneri Persedi Pemak Stok Permi Pemberian


No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
1 Abbocath No.18 Pcs 78 0 78 0 78
2 Abbocath No.20 Pcs 810 0 810 30 780
3 Abbocath No.22 Pcs 120 0 120 0 120
4 Abbocath No.24 Pcs 199 0 199 0 199
5 Acetylcysteine 200 mg Tab 0 0 0 0 0
6 Acyclovir 200 Mg Tab 0 0 0 0 0
7 Acyclovir 400 Mg Tab 11150 0 11150 0 11150
8 Acyclovir krim 5% Tube 339 0 339 49 290
9 Adidryl Inj Vial 0 0 0 0 0
10 Adimidon Inj Vial 0 0 0 0 0
11 Alat Autochek Unit 0 0 0 0 0
12 Alat Benechek Unit 0 0 0 0 0
13 Alat CO Analiser Unit 0 0 0 0 0
14 Alat Easy Touch Unit 0 0 0 0 0
15 Alat suntik sekali pakai 0,5 ml Pcs 100 300 400 250 150
16 Alat suntik sekali pakai 1 ml Pcs 324 0 324 60 264
17 Alat suntik sekali pakai 10 ml Pcs 0 0 0 0 0
18 Alat suntik sekali pakai 2,5 ml Pcs 0 0 0 0 0
19 Alat suntik sekali pakai 20 ml Pcs 70 0 70 0 70
20 Alat suntik sekali pakai 3 ml Pcs 100 0 100 0 100
21 Alat suntik sekali pakai 5 ml Pcs 1265 0 1265 100 1165
22 Albendazol 400 mg Tab 0 0 0 0 0
23 Alkohol Swab Dos 16 0 16 1 15
24 Alletrol T. Mata Botol 0 0 0 0 0
25 Allopurinol 100 mg Tab 2700 0 2700 200 2500
26 Allopurinol 300 mg Tab 3390 0 3390 750 2640
27 Alprazolam 0,5 mg Tab 0 0 0 0 0
28 Alprazolam 1 mg Tab 2754 0 2754 15 2739
29 Ambroxol 30 mg Tab 3200 0 3200 1200 2000
30 Ambroxol Syr 15mg/ 5 ml Botol 125 0 125 35 90
31 Amitriptilin 25 mg Tab 4074 0 4074 0 4074
32 Amlodiphin 10 mg Tab 4800 0 4800 2100 2700
33 Amlodiphin 5 mg Tab 0 0 0 0 0
34 Amoxycillin 250 mg Tab 0 0 0 0 0
35 Amoxycillin 500 mg Tab 16800 0 16800 3000 13800
36 Amoxycillin Syr 125 mg/ 5 ml Botol 20 0 20 20 0
37 Ampicillin 500 mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
38 Ampicillin Inj Vial 0 0 0 0 0
39 Ampicillin Syrup 125 mg/ 5 ml Botol 0 0 0 0 0
40 Analog Long Insulin (Levemir) Pen 0 0 0 0 0
41 Antalgin 500 mg Tab 0 0 0 0 0
42 Antalgin Inj 250 mg/ml Ampul 0 0 0 0 0
43 Antasida Doen 500 mg Tab 33200 0 33200 2000 31200
44 Antasida Doen Susp Botol 0 0 0 0 0
45 Anti Hemoroid Doen Kombinasi Suppo 285 0 285 0 285
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
46 Antiseptik Hand Botol 50 0 50 2 48
47 Antrain Inj Ampul 0 0 0 0 0
48 Aqua Pro Injeksi Vial 120 0 120 0 120
49 Aquadest 20 L Galon 2 0 2 0 2
50 As Asetil Salisilat 80 mg (Miniaspi) Tab 1700 0 1700 0 1700
51 Asam Askorbat (Vit C) 50 mg Tab 27400 0 27400 3900 23500
52 Asam Folac Tab 2800 0 2800 0 2800
53 Asam Mefenamat 500 mg Tab 32600 0 32600 2700 29900
54 Asam Tranexamat Inj 50 mg/ ml Ampul 0 0 0 0 0
55 Asetosal 100 mg Tab 0 0 0 0 0
56 Asetosal 500 mg Tab 0 0 0 0 0
57 Aspar K Tab 0 0 0 0 0
58 Atorvastatin Calsium 10 Mg Tab 0 0 0 0 0
59 Atropin Inj 0,25 mg Ampul 121 0 121 0 121
60 Atrovent Inhaler Botol 85 0 85 0 85
61 Attapulgit (New Antides) Tab 0 0 0 0 0
62 Autocheck Cholesterol Dos 10 0 10 3 7
63 Autocheck Glucosa Dos 2 0 2 2 0
64 Autocheck Urin Acid Dos 4 0 4 3 1
65 Bacitracin Polimixyn B Salep Tube 0 0 0 0 0
66 Batang Pengaduk Buah 0 0 0 0 0
67 Benecheck Colesterol Dos 21 0 21 5 16
68 Benecheck Glucosa Dos 0 0 0 0 0
69 Benecheck Urin Acid Dos 9 0 9 0 9
70 Betahistin Mesilat 6 mg Tab 4600 0 4600 800 3800
71 Betametason Krim 0,1% Tube 650 0 650 75 575
72 Biocombin 5000 Inj Ampul 0 0 0 0 0
73 Bionemi Tab 100 0 100 100 0
74 Bisoprolol 5 mg Tab 0 0 0 0 0
75 Blood Lancets 26 G Dos 0 0 0 0 0
76 Blood Lancets 28 G Dos 28 0 28 2 26
77 Buscopan Inj 20 mg/ ml Ampul 10 0 10 0 10
78 Calcium Gluconate Inj 100 mg/ml Ampul 17 0 17 0 17
79 Calsium Laktat (Calac) 500 mg Tab 0 0 0 0 0
80 Calxyl Radiopaque Buah 3 0 3 0 3
81 Candesartan Cilexetil 8 mg Tab 0 0 0 0 0
82 Captopril 12,5 mg Tab 5200 0 5200 500 4700
83 Captopril 25 mg Tab 11400 0 11400 500 10900
84 Carbamazepin 200 mg Tab 0 0 0 0 0
85 Catapres Inj Ampul 10 0 10 0 10
86 Catarlent T Mata Botol 0 0 0 0 0
87 Catgut Chromic No. 2/0 Pcs 6 0 6 6 0
88 Catgut Chromic No. 3/0 Pcs 12 0 12 12 0
89 Catgut Chromic No. 4/0 Pcs 12 0 12 0 12
90 Catgut Chromik usp:2/0 100 M Dos 0 0 0 0 0
91 Catgut Plain 2/0 HR 37 MM Pcs 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
92 Catgut Plain 3/0 HR 26 MM Pcs 0 0 0 0 0
93 Catgut Plain 4/0 Pcs 0 0 0 0 0
94 Cathejell Lido 2% & CHG 0,05 % Flacon 0 0 0 0 0
95 Cavit (Bahan Tump Sementara) Dos 34 0 34 0 34
96 Cefadroxil 500 mg Tab 3300 0 3300 1500 1800
97 Cefadroxil Syr 125 mg/ 5 ml Botol 76 0 76 55 21
98 Cendo Xytrol T. Mata Botol 215 0 215 10 205
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
99 Cetirizine 10 mg Tab 6700 0 6700 1500 5200
100 Cetirizine Syr 5 mg/ 5 ml Botol 325 0 325 20 305
101 Chloramphenicol (Chloramex) 500 mg Tab 9100 0 9100 0 9100
102 Chloramphenicol (Novachlor) 250 mg Tab 2900 0 2900 0 2900
103 Chloramphenicol Salep Mata 1% Tube 133 0 133 0 133
104 Chloramphenicol Suspensi Botol 179 0 179 5 174
105 Chloramphenicol T. Mata 0,5% Tube 0 0 0 0 0
106 Chloramphenicol T. Telinga 3% Botol 60 0 60 0 60
107 Chlorfeniramin Maleat 4 mg Tab 31700 0 31700 1000 30700
108 Chlorpromazin 100 mg Tab 280 0 280 0 280
109 Chlorpromazin 25 mg Tab 0 0 0 0 0
110 Chlorpromazin Inj 5mg/ml Ampul 60 0 60 0 60
111 Cimetidin 200 mg Tab 0 0 0 0 0
112 Citicoline 500 mg Tab 0 0 0 0 0
113 Clobasam 10 mg Tab 98 0 98 0 98
114 Clonidine 0,15 mg Tab 0 0 0 0 0
115 Clopidogrel 75 mg Tab 0 0 0 0 0
116 Codein 10 mg Tab 3930 0 3930 70 3860
117 Colcitine 0,5 mg Tab 3090 0 3090 600 2490
118 Combivent Nebulizer Flacon 0 0 0 0 0
119 Cotrimoxazol 480 mg Tab 1000 0 1000 300 700
120 Cotrimoxazol Pediatrik Tab 0 0 0 0 0
121 Cotrimoxazol Susp Botol 175 0 175 20 155
122 Curcuma Tab 300 0 300 0 300
123 Cutimed Gel Tube 2 0 2 0 2
124 Cyanocobalamin 50 mg Tab 0 0 0 0 0
125 Cyanocobalamin Inj 500 mcg/ ml Ampul 2470 0 2470 100 2370
126 Cyprofloksasin 500 mg Tab 3100 0 3100 800 2300
127 Dexamethason 0,5 mg Tab 7800 0 7800 3500 4300
128 Dexamethason Inj 5 mg/ml Ampul 200 0 200 0 200
129 Dextamec Tab 0 0 0 0 0
130 Diazepam 2 mg Tab 0 0 0 0 0
131 Diazepam 5 mg Tab 0 0 0 0 0
132 Diazepam Inj Ampul 50 0 50 0 50
133 Digoxin 0,25 mg Tab 0 0 0 0 0
134 Diltiazem 30 mg Tab 0 0 0 0 0
135 Dimenhydrinate 50 mg Tab 0 0 0 0 0
136 Diphenhidramin Inj Ampul 60 0 60 0 60
137 Diphenhidramin Inj (Sidiadryl) Vial 30 0 30 5 25
138 Disposible Needle No. 22 Pcs 0 0 0 0 0
139 Disposible Needle No. 23 Pcs 50 0 50 10 40
140 Domperidon 10 mg Tab 32000 0 32000 300 31700
141 Domperidon Susp 5 mg/ 5 ml Botol 1255 0 1255 20 1235
142 Double Check (Artikulating Paper) Dos 36 0 36 0 36
143 Doxyciclin 100 mg Tab 5400 0 5400 0 5400
144 Dulcolax 5 mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
145 Dulcolax Suppo Anak Suppo 378 0 378 0 378
146 Dumin Rektal 125 mg/ 4 ml Suppo 0 0 0 0 0
147 Dumin Rektal 250 mg/4 ml Suppo 27 0 27 1 26
148 Easy Touch Colestrol Dos 0 0 0 0 0
149 Easy Touch Glukosa Dos 0 0 0 0 0
150 Easy Touch Urine Acid Dos 0 0 0 0 0
151 Eflin Tab 8400 0 8400 700 7700
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
152 Elastis Verban 7,5 cm x 4,55 m Roll 23 0 23 3 20
153 Epinefrin Inj 1 mg/ml Ampul 155 0 155 0 155
154 Epoxidin (Pasta Pengisi Sal Akar) Dos 30 0 30 0 30
155 Erphatrim Forte 960 mg Tab 0 0 0 0 0
156 Erytromicin 250 mg Tab 0 0 0 0 0
157 Erytromicin 500 mg Tab 23800 0 23800 500 23300
158 Erytromicin Syr Botol 0 0 0 0 0
159 Etakridin (Rivanol Lar 0,1%) Botol 0 0 0 0 0
160 Etanol 70% 1 L Botol 24 0 24 0 24
161 Etanol 70% 100 ml Botol 0 0 0 0 0
162 Etanol 70% 300 ml Botol 75 0 75 0 75
163 Ethambutol 500 mg Tab 450 0 450 0 450
164 Farbion Inj Ampul 0 0 0 0 0
165 Fenilbutason (Novason) 200 mg Tab 5800 0 5800 1700 4100
166 Fenobarbital 30 mg Tab 0 0 0 0 0
167 Fenobarbital Inj 50 mg/ml Ampul 0 0 0 0 0
168 Folley Catheter No. 10 FR Pcs 9 0 9 0 9
169 Folley Catheter No. 16 FR Pcs 10 0 10 10 0
170 Folley Catheter No. 18 FR Pcs 51 0 51 0 51
171 Folley Catheter No. 22 FR Pcs 69 0 69 0 69
172 Furosemid 40 mg Tab 1700 0 1700 0 1700
173 Furosemid Inj (Diuvar) Ampul 0 0 0 0 0
174 Gabapentin 300 mg Tab 330 0 330 0 330
175 Garam Oralit 200 ml Air Saset 830 0 830 100 730
176 Gelas Ukur 250 ml Buah 0 0 0 0 0
177 Gemfibrozil 300 mg Tab 2400 0 2400 0 2400
178 Gentamicin Inj 40 mg/ ml Ampul 95 0 95 0 95
179 Gentamicin Salep 0,1 % Tube 27 0 27 27 0
180 Gentian Violet lar 1% Botol 190 0 190 0 190
181 Glibenclamid 5 mg Tab 3300 0 3300 0 3300
182 Glimepiride 2 mg Tab 6000 0 6000 0 6000
183 Glimepiride 3 mg Tab 0 0 0 0 0
184 Glukosa lar infus 10 % Steril Kolf 0 0 0 0 0
185 Glukosa lar infus 5 % Steril Kolf 474 0 474 30 444
186 Griseofulvin 125 mg Tab 68700 0 68700 1000 67700
187 Guaifenesin 100 mg Tab 17700 0 17700 800 16900
188 Halloperidol 0,5 mg Tab 400 0 400 0 400
189 Halloperidol 1,5 mg Tab 0 0 0 0 0
190 Halloperidol 5 mg Tab 92 0 92 0 92
191 Handscoon Genekolog 7,5 16/40 cm Pcs 194 0 194 0 194
192 Handscoon No. 6,5 Steril Pcs 0 0 0 0 0
193 Handscoon No. 7 Steril Pcs 200 0 200 50 150
194 Handscoon No. 7,5 Steril Pcs 250 0 250 50 200
195 Handscoon No. 8 Steril Pcs 335 0 335 0 335
196 Handscoon Non Steril (L) Dos 0 0 0 0 0
197 Handscoon Non Steril (M) Dos 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
198 Hemafort Tab 0 0 0 0 0
199 Hidroklortiazid 25 mg Tab 6700 0 6700 0 6700
200 Hidrokortison Krim 2,5% Tube 5137 0 5137 48 5089
201 Hyoscine N-Butylbromide (Scopamin) Tab 10500 0 10500 100 10400
202 Hyscopan Tab 0 0 0 0 0
203 Ibuprofen 200 mg Tab 0 0 0 0 0
204 Ibuprofen 400 mg Tab 22500 0 22500 3100 19400
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
205 Ibuprofen Susp 100 mg/ 5 ml Botol 330 0 330 65 265
206 Ichtiyol Salep Pot 0 0 0 0 0
207 Iliadin T. Hidung Botol 92 0 92 5 87
208 Infusion Set Anak (Micro) Pcs 260 0 260 0 260
209 Infusion Set Dewasa (Macro) Pcs 260 0 260 25 235
210 Isoniasid 100 mg Tab 0 0 0 0 0
211 Isoniazid 300 mg Tab 200 0 200 0 200
212 Isosorbid Dinitrat 5 mg Tab 2700 0 2700 0 2700
213 Jarum Kulit GT 10 Pcs 56 0 56 0 56
214 Jarum Kulit GT 11 Pcs 1 0 1 0 1
215 Jarum Kulit GT 15 Pcs 7 0 7 0 7
216 Jarum Kulit GR 13 Pcs 4 0 4 0 4
217 Jarum Otot GR 10 Pcs 0 0 0 0 0
218 Jarum Otot GR 12 Pcs 0 0 0 0 0
219 Jarum Otot GR 14 Pcs 0 0 0 0 0
220 Jarum Otot GR 15 Pcs 10 0 10 0 10
221 Kanamicin Inj Vial 0 0 0 0 0
222 Kaolimec Suspensi Botol 0 0 0 0 0
223 Kaotin Suspensi Botol 0 0 0 0 0
224 Kapas Berlemak 500 mg Buah 0 0 0 0 0
225 Kapas Pembalut 250 mg Buah 135 0 135 0 135
226 Karbamazepin 200 mg Tab 0 0 0 0 0
227 Kasa Hidrofil 4 m x 15 m Roll 0 0 0 0 0
228 Kasa Hidrofil 4 m x 5 m Roll 0 0 0 0 0
229 Kasa Kompres 40 x 80 Steril Roll 0 0 0 0 0
230 Kasa Kompres 40 x 40 Roll 6 0 6 0 6
231 Kasa Pembalut 40 x 80 m Roll 0 2 2 2 0
232 Kasa Steril 18 x 22 cm (16 x 16) Dos 270 0 270 50 220
233 Kertas EKG Roll 31 0 31 0 31
234 Kertas USG Roll 0 0 0 0 0
235 Ketokonazol 200 mg Tab 20550 0 20550 500 20050
236 Ketokonazol Krim 2 % Tube 193 0 193 25 168
237 Kolicgon Tab 0 0 0 0 0
238 Larutan H2O2 Botol 0 0 0 0 0
239 Leukoplast 2,5 cm x 4,5 m Roll 190 0 190 1 189
240 Leukoplast 7,5 cm x 4,5 m Roll 80 0 80 5 75
241 Levofloxacin 500 mg Tab 0 0 0 0 0
242 Lidocain Inj 20 mg/ 2 ml Ampul 4200 0 4200 0 4200
243 Lidocain Inj 40 mg Ampul 830 0 830 130 700
244 Lidocain Kompositum 20 mg/ 2 ml Ampul 450 0 450 0 450
245 Lisol Botol 39 0 39 0 39
246 Loperamid 2 mg Tab 0 0 0 0 0
247 Loratadin 10 mg Tab 0 0 0 0 0
248 Masker Earloop Pcs 310 0 310 50 260
249 Masker N 95 Pcs 140 0 140 40 100
250 Masker Tali Pcs 200 0 200 50 150
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
251 MDT MB Combi Dewasa Dos 0 0 0 0 0
252 Meloxicam 15 mg Tab 0 0 0 0 0
253 Metamizole Inj (Norages) Ampul 0 0 0 0 0
254 Metformin 500 mg Tab 30800 0 30800 1800 29000
255 Methildopa 250 mg (Dopamet) Tab 200 0 200 200 0
256 Methylprednisolon 4 Mg Tab 0 0 0 0 0
257 Methylprednisolon 8 Mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
258 Metilergometrin 0,125 mg Tab 15700 0 15700 0 15700
259 Metilergometrin Inj.0,2 mg Ampul 60 0 60 0 60
260 Metoclopramid 10 mg Tab 4700 0 4700 300 4400
261 Metoclopramid Inj 10 mg/ 2 ml Ampul 310 0 310 40 270
262 Metoclopramide Syr (Lexapram) Botol 84 0 84 55 29
263 Metronidazol 250 mg Tab 0 0 0 0 0
264 Metronidazol 500 mg Tab 3600 0 3600 500 3100
265 Metronidazole Lat Infus Botol 13 0 13 0 13
266 MgSO4 Inj 20% - 25 ml Flacon 20 0 20 0 20
267 MgSO4 Inj 40% - 25 ml Flacon 5 0 5 0 5
268 MgSO4 Serbuk 30 gr Vial 0 0 0 0 0
269 Miconazol Krim 2 % Tube 2128 0 2128 168 1960
270 Mometason Furoate Krim 0,1 % Tube 75 0 75 0 75
271 Mortir dan Stemper 8 cm Buah 0 0 0 0 0
272 Mouth Piace Dos 0 0 0 0 0
273 Mucotussan Tab 0 0 0 0 0
274 My Jelli 82 Gram Tube 5 0 5 3 2
275 NaCl Lar infus 0,9 % Kolf 254 0 254 20 234
276 Natrium Diclofenak 25 mg Tab 15050 0 15050 1200 13850
277 Natrium Diclofenak 50 mg Tab 3000 0 3000 200 2800
278 Neurovit E Tab 1140 0 1140 360 780
279 Neutotropic Plus Tab 0 0 0 0 0
280 Nifedipin 10 mg Tab 1900 0 1900 200 1700
281 Nistatin 500.000 IU Tab 600 0 600 200 400
282 Nistatin 100.000 IU Tab 490 0 490 10 480
283 Nistatin Drops 100.000 IU Botol 40 0 40 0 40
284 Novadiar Syr Botol 139 0 139 5 134
285 Novadium Tab 1100 0 1100 100 1000
286 Novampiron Tab 0 0 0 0 0
287 Novapen Syr Botol 0 0 0 0 0
288 Novastan Tab 0 0 0 0 0
289 Novotwist ( Jarum Novorapid) Dos 2 0 2 0 2
290 OAT FDC Kategori Anak Paket 0 0 0 0 0
291 OAT FDC Kategori I Dewasa Paket 0 0 0 0 0
292 OAT FDC Kategori II Dewasa Paket 0 0 0 0 0
293 OAT FDC Sisipan Dewasa Paket 0 0 0 0 0
294 Obat Batuk Hitam ( OBH ) Syr Botol 20 0 20 0 20
295 Oksitetraciclin Inj 50 ml - 10 ml Ampul 0 0 0 0 0
296 Oksitetraciclin Salep Kulit 3 % Tube 13 0 13 0 13
297 Oksitetraciclin Salep Mata 1 % Tube 215 0 215 0 215
298 Oksitosin Inj 50 ml - 10 ml Ampul 640 0 640 0 640
299 Omeprazole 20 mg Tab 4320 0 4320 600 3720
300 Ondansetron HCL Inj 4 mg/ 2 ml Ampul 105 0 105 20 85
301 Papaverin 40 mg Tab 0 0 0 0 0
302 Papaverin Inj Ampul 0 0 0 0 0
303 Paracetamol 500 mg Tab 1000 0 1000 1000 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
304 Paracetamol Lar Infus Steril Botol 4 0 4 1 3
305 Paracetamol Syr 120 mg/ 5 ml Botol 15 0 15 15 0
306 Pehacain Inj Ampul 260 0 260 40 220
307 Pelarut Botol 0 0 0 0 0
308 Periokin Spray Dos 33 0 33 0 33
309 Permanganas kalikus (PK) Pot 0 0 0 0 0
310 Phenol Gliserol T. Telinga 10% Botol 24 0 24 24 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
311 Phitomenadion 10 mg Tab 1200 0 1200 100 1100
312 Phitomenadion Inj 10 mg/ml Ampul 5 25 30 30 0
313 Pipet Tetes Pendek Buah 0 0 0 0 0
314 Piracetam 800 mg Tab 0 0 0 0 0
315 Pirecetam 400 mg Tab 0 0 0 0 0
316 Pirecetam Inj 200 mg/ ml Ampul 0 0 0 0 0
317 Piridoxyn (Vit B6) 10 mg Tab 13200 0 13200 1000 12200
318 Piroxicam 20 mg Tab 200 0 200 200 0
319 Pisau Bedah Pcs 200 0 200 0 200
320 Plano Test Pcs 245 0 245 95 150
321 Plesterin Bulat Dos 25 0 25 0 25
322 Poligyp 5 cm x 27 cm Roll 2 0 2 2 0
323 Pot Urine Bauh 20 0 20 0 20
324 Povidon Iodida 10 % 30 ml Botol 50 0 50 0 50
325 Povidon Iodida 10 % 300 ml Botol 0 0 0 0 0
326 Povidon Iodida 10 % 60 ml Botol 3 0 3 1 2
327 Prednison 5 mg Tab 4600 0 4600 2200 2400
328 Promavit Tab 1560 0 1560 1080 480
329 Propanolol 10 mg Tab 0 0 0 0 0
330 Propanolol 40 mg Tab 0 0 0 0 0
331 Propiltiuracil 100 mg Tab 2800 0 2800 0 2800
332 Pyrantel Pamoat 125 mg Tab 0 0 0 0 0
333 Rabipur Vaksin Dos 0 0 0 0 0
334 Rak Tabung Stainless Buah 0 0 0 0 0
335 Ramipril 5 mg Tab 0 0 0 0 0
336 Ranitidin 150 mg Tab 10400 0 10400 2400 8000
337 Ranitidin Inj 25 mg/ 2 ml Ampul 320 0 320 80 240
338 Ranitidin Inj 50 mg/ 2 ml Ampul 0 0 0 0 0
339 RDT DBD Dos 0 0 0 0 0
340 RDT Malaria Dos 0 0 0 0 0
341 Rifampisin 450 mg Tab 300 0 300 0 300
342 Rifampisin 600 mg Tab 0 0 0 0 0
343 Ringer Lactat Lar Infus Steril Kolf 71 0 71 42 29
344 Salbutamol 2 mg Tab 0 0 0 0 0
345 Salbutamol 4 mg Tab 6500 0 6500 500 6000
346 Salep 2-4 Pot 1566 0 1566 48 1518
347 Salisil Bedak 2 % Dos 0 0 0 0 0
348 Sanbe Tears (Air Mata Buatan) Botol 0 0 0 0 0
349 Selediar Tab 0 0 0 0 0
350 Seledryil Tab 0 0 0 0 0
351 Selesbion Tab 0 0 0 0 0
352 Selkom C Tab 0 0 0 0 0
353 Selviplex Tab 0 0 0 0 0
354 Seven Seans Syr Botol 343 0 343 57 286
355 Sikat Pembersih Tabung Buah 0 0 0 0 0
356 Silk (Benang Bedah Sutra) No. 2/0 Pcs 24 0 24 0 24
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
357 Silk (Benang Bedah Sutra) No. 3/0 Pcs 12 0 12 0 12
358 Silk Braided Black usp:4/0 100 M Dos 0 0 0 0 0
359 Simvastatin 10 mg Tab 8340 0 8340 1860 6480
360 Simvastatin 20 mg Tab 0 0 0 0 0
361 Skizon Zalf Tube 328 0 328 10 318
362 Soft U-Derm Krim Tube 120 0 120 0 120
363 Sohobion Inj Ampul 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
364 Soldextam Tab 0 0 0 0 0
365 Solvita Plus Syr Botol 0 0 0 0 0
366 Spasmolit Tab 0 0 0 0 0
367 Spironolactone 100 mg Tab 0 0 0 0 0
368 Spironolactone 25 mg Tab 0 0 0 0 0
369 Stesolid Suppo 5 mg/ 2,5 ml Suppo 11 0 11 0 11
370 Stesolid Suppo 10 mg/ 2,5 ml Suppo 0 0 0 0 0
371 Stik HB Family Dr Dos 4 0 4 4 0
372 Tablet Tambah Darah Tab 0 0 0 0 0
373 Tablet Tambah Darah Neo Tab 0 8640 8640 3750 4890
374 Tabung Reaksi 25 ml Buah 0 0 0 0 0
375 Termorex Syr Botol 0 0 0 0 0
376 TesKits Boraks Kit 0 0 0 0 0
377 TesKits Formaldehid (Formalin) Kit 0 0 0 0 0
378 TesKits Methanil Yellow Kit 0 0 0 0 0
379 TesKits Rhodamine B Kit 0 0 0 0 0
380 Tetagam Vaksin Dos 0 0 0 0 0
381 Tetracyclin HCL 250 mg Tab 0 0 0 0 0
382 Tetracyclin HCL 500 mg Tab 7000 0 7000 500 6500
383 Tetrakain HCL T. Mata 0,5 % Botol 0 0 0 0 0
384 Thiamin HCL 50 mg Tab 1000 0 1000 500 500
385 Thiamin HCL Inj 100 ml - 1 ml Vial 1510 0 1510 0 1510
386 Tramadol 50 mg Tab 100 0 100 100 0
387 Tricresol Formalin 10 ml Botol 0 0 0 0 0
388 Triheksiphenidil HCL 2 mg Tab 2500 0 2500 0 2500
389 Truvit Syr Botol 166 0 166 55 111
390 Ultrasonic Gel 250 ml Botol 0 0 0 0 0
391 Urine Bag 1000 ml Pcs 35 0 35 0 35
392 Vaksin BCG Ampul 0 0 0 0 0
393 Vaksin Campak Rubella Ampul 0 0 0 0 0
394 Vaksin DPT HB Combo Ampul 2 20 22 20 2
395 Vaksin HB 0 (Unijek) Ampul 0 30 30 25 5
396 Vaksin IPV Ampul 3 5 8 5 3
397 Vaksin TT Bumil Ampul 0 15 15 10 5
398 Vaksin Polio Ampul 10 20 30 27 3
399 Ventolin Nebulizer Flacon 0 0 0 0 0
400 Verorab Vaksin Dos 5 0 5 5 0
401 Viccillin - SX (Ampicilin) Inj 1,5 g Vial 32 0 32 0 32
402 Vit A 100.000 IU Kapsul 0 0 0 0 0
403 Vit A 200.000 IU Kapsul 0 0 0 0 0
404 Vitamin B Kompleks Tab 5000 0 5000 2600 2400
405 Vitamin B Kompleks Inj Vial 10 0 10 0 10
406 Zinc Dispersible 20 mg Tab 0 0 0 0 0
407 Zinc Syr 20 mg/ 5 ml Botol 345 0 345 20 325
408 HIV Tes Kit Strip 300 0 300 0 300
409 HBsAG Tes Kit Strip 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
410 HS Posterior Dos 4 0 4 0 4
411 Filtek Z350 XT Pcs 35 0 35 0 35
412 Pulp - X Dos 32 0 32 0 32
413 Iodium Tes Botol 5 0 5 0 5
414 Mitela (Kain SegiTiga) Pcs 2 0 2 2 0
415 Poligyp 10 cm x 2,7 m Roll 5 0 5 2 3
416 Asam Asetat 100 ml Botol 2 0 2 1 1
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12

Umum
BPJS Jamkesda Jumlah
JUMLAH KUNJUNGAN RESEP Bayar Tdk Bayar

Mengetahui/Menyetujui Yang Menyerahkan Yang Memohon Yang


Penanggung Jawab Gudang Farmasi Petu

Arini Priyanti Kandupi, S. Farm, Apt Moh. Rizal Sumaga, SKM Mujria
Nip.19830402 200502 2 004 Nip. 19720123 199402 1 002 Nip : 19881
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12

KETERANGAN :
Lembar Putih : GFK
Lembar Merah : Puskesmas
N OBAT

: APRIL 2019

Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Dinkes : 120
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Yang Menerima
Petugas PKM

Mujriah A.Md, Far


Nip : 19881005 201001 2 001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS

PUSKESMAS : TETE PELAPORAN BLN/PERIODE : MEI 201


KECAMATAN : AMPANA TETE
KABUPATEN : TOJO UNA UNA PERMINTAAN BLN/PERIODE
PROPINSI : SUL TENG

Stok Peneri Persedi Pemak Stok Permi Pemberian


No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
1 Abbocath No.18 Pcs 78 0 78 0 78
2 Abbocath No.20 Pcs 780 0 780 80 700
3 Abbocath No.22 Pcs 120 0 120 20 100
4 Abbocath No.24 Pcs 199 0 199 20 179
5 Acetylcysteine 200 mg Tab 0 0 0 0 0
6 Acyclovir 200 Mg Tab 0 0 0 0 0
7 Acyclovir 400 Mg Tab 11150 0 11150 0 11150
8 Acyclovir krim 5% Tube 290 0 290 0 290
9 Adidryl Inj Vial 0 0 0 0 0
10 Adimidon Inj Vial 0 0 0 0 0
11 Alat Autochek Unit 0 0 0 0 0
12 Alat Benechek Unit 0 0 0 0 0
13 Alat CO Analiser Unit 0 0 0 0 0
14 Alat Easy Touch Unit 0 0 0 0 0
15 Alat suntik sekali pakai 0,5 ml Pcs 150 400 550 350 200
16 Alat suntik sekali pakai 1 ml Pcs 264 0 264 10 254
17 Alat suntik sekali pakai 10 ml Pcs 0 0 0 0 0
18 Alat suntik sekali pakai 2,5 ml Pcs 0 0 0 0 0
19 Alat suntik sekali pakai 20 ml Pcs 70 0 70 0 70
20 Alat suntik sekali pakai 3 ml Pcs 100 300 400 200 200
21 Alat suntik sekali pakai 5 ml Pcs 1165 0 1165 180 985
22 Albendazol 400 mg Tab 0 0 0 0 0
23 Alkohol Swab Dos 15 0 15 1 14
24 Alletrol T. Mata Botol 0 0 0 0 0
25 Allopurinol 100 mg Tab 2500 0 2500 700 1800
26 Allopurinol 300 mg Tab 2640 0 2640 300 2340
27 Alprazolam 0,5 mg Tab 0 0 0 0 0
28 Alprazolam 1 mg Tab 2739 0 2739 1565 1174
29 Ambroxol 30 mg Tab 2000 0 2000 1200 800
30 Ambroxol Syr 15mg/ 5 ml Botol 90 0 90 70 20
31 Amitriptilin 25 mg Tab 4074 0 4074 3074 1000
32 Amlodiphin 10 mg Tab 2700 0 2700 1800 900
33 Amlodiphin 5 mg Tab 0 0 0 0 0
34 Amoxycillin 250 mg Tab 0 0 0 0 0
35 Amoxycillin 500 mg Tab 13800 0 13800 4000 9800
36 Amoxycillin Syr 125 mg/ 5 ml Botol 0 120 120 40 80
37 Ampicillin 500 mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
38 Ampicillin Inj Vial 0 0 0 0 0
39 Ampicillin Syrup 125 mg/ 5 ml Botol 0 0 0 0 0
40 Analog Long Insulin (Levemir) Pen 0 0 0 0 0
41 Antalgin 500 mg Tab 0 0 0 0 0
42 Antalgin Inj 250 mg/ml Ampul 0 0 0 0 0
43 Antasida Doen 500 mg Tab 31200 0 31200 1200 30000
44 Antasida Doen Susp Botol 0 100 100 50 50
45 Anti Hemoroid Doen Kombinasi Suppo 285 0 285 0 285
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
46 Antiseptik Hand Botol 48 0 48 3 45
47 Antrain Inj Ampul 0 10 10 5 5
48 Aqua Pro Injeksi Vial 120 0 120 10 110
49 Aquadest 20 L Galon 2 0 2 0 2
50 As Asetil Salisilat 80 mg (Miniaspi) Tab 1700 0 1700 300 1400
51 Asam Askorbat (Vit C) 50 mg Tab 23500 0 23500 5700 17800
52 Asam Folac Tab 2800 0 2800 2800 0
53 Asam Mefenamat 500 mg Tab 29900 0 29900 4800 25100
54 Asam Tranexamat Inj 50 mg/ ml Ampul 0 0 0 0 0
55 Asetosal 100 mg Tab 0 0 0 0 0
56 Asetosal 500 mg Tab 0 0 0 0 0
57 Aspar K Tab 0 0 0 0 0
58 Atorvastatin Calsium 10 Mg Tab 0 0 0 0 0
59 Atropin Inj 0,25 mg Ampul 121 0 121 0 121
60 Atrovent Inhaler Botol 85 0 85 0 85
61 Attapulgit (New Antides) Tab 0 0 0 0 0
62 Autocheck Cholesterol Dos 7 0 7 0 7
63 Autocheck Glucosa Dos 0 0 0 0 0
64 Autocheck Urin Acid Dos 1 0 1 0 1
65 Bacitracin Polimixyn B Salep Tube 0 0 0 0 0
66 Batang Pengaduk Buah 0 0 0 0 0
67 Benecheck Colesterol Dos 16 0 16 10 6
68 Benecheck Glucosa Dos 0 3 3 0 3
69 Benecheck Urin Acid Dos 9 0 9 0 9
70 Betahistin Mesilat 6 mg Tab 3800 0 3800 0 3800
71 Betametason Krim 0,1% Tube 575 0 575 575 0
72 Biocombin 5000 Inj Ampul 0 0 0 0 0
73 Bionemi Tab 0 0 0 0 0
74 Bisoprolol 5 mg Tab 0 0 0 0 0
75 Blood Lancets 26 G Dos 0 0 0 0 0
76 Blood Lancets 28 G Dos 26 0 26 2 24
77 Buscopan Inj 20 mg/ ml Ampul 10 0 10 0 10
78 Calcium Gluconate Inj 100 mg/ml Ampul 17 0 17 0 17
79 Calsium Laktat (Calac) 500 mg Tab 0 0 0 0 0
80 Calxyl Radiopaque Buah 3 0 3 0 3
81 Candesartan Cilexetil 8 mg Tab 0 0 0 0 0
82 Captopril 12,5 mg Tab 4700 0 4700 2200 2500
83 Captopril 25 mg Tab 10900 0 10900 1600 9300
84 Carbamazepin 200 mg Tab 0 0 0 0 0
85 Catapres Inj Ampul 10 0 10 0 10
86 Catarlent T Mata Botol 0 0 0 0 0
87 Catgut Chromic No. 2/0 Pcs 0 0 0 0 0
88 Catgut Chromic No. 3/0 Pcs 0 0 0 0 0
89 Catgut Chromic No. 4/0 Pcs 12 0 12 12 0
90 Catgut Chromik usp:2/0 100 M Dos 0 0 0 0 0
91 Catgut Plain 2/0 HR 37 MM Pcs 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
92 Catgut Plain 3/0 HR 26 MM Pcs 0 0 0 0 0
93 Catgut Plain 4/0 Pcs 0 0 0 0 0
94 Cathejell Lido 2% & CHG 0,05 % Flacon 0 0 0 0 0
95 Cavit (Bahan Tump Sementara) Dos 34 0 34 0 34
96 Cefadroxil 500 mg Tab 1800 0 1800 500 1300
97 Cefadroxil Syr 125 mg/ 5 ml Botol 21 0 21 21 0
98 Cendo Xytrol T. Mata Botol 205 0 205 20 185
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
99 Cetirizine 10 mg Tab 5200 0 5200 1200 4000
100 Cetirizine Syr 5 mg/ 5 ml Botol 305 0 305 70 235
101 Chloramphenicol (Chloramex) 500 mg Tab 9100 0 9100 3000 6100
102 Chloramphenicol (Novachlor) 250 mg Tab 2900 0 2900 400 2500
103 Chloramphenicol Salep Mata 1% Tube 133 0 133 15 118
104 Chloramphenicol Suspensi Botol 174 0 174 0 174
105 Chloramphenicol T. Mata 0,5% Tube 0 0 0 0 0
106 Chloramphenicol T. Telinga 3% Botol 60 0 60 56 4
107 Chlorfeniramin Maleat 4 mg Tab 30700 0 30700 1400 29300
108 Chlorpromazin 100 mg Tab 280 0 280 0 280
109 Chlorpromazin 25 mg Tab 0 0 0 0 0
110 Chlorpromazin Inj 5mg/ml Ampul 60 0 60 60 0
111 Cimetidin 200 mg Tab 0 0 0 0 0
112 Citicoline 500 mg Tab 0 0 0 0 0
113 Clobasam 10 mg Tab 98 0 98 0 98
114 Clonidine 0,15 mg Tab 0 0 0 0 0
115 Clopidogrel 75 mg Tab 0 0 0 0 0
116 Codein 10 mg Tab 3860 0 3860 0 3860
117 Colcitine 0,5 mg Tab 2490 0 2490 300 2190
118 Combivent Nebulizer Flacon 0 0 0 0 0
119 Cotrimoxazol 480 mg Tab 700 0 700 200 500
120 Cotrimoxazol Pediatrik Tab 0 0 0 0 0
121 Cotrimoxazol Susp Botol 155 0 155 5 150
122 Curcuma Tab 300 0 300 300 0
123 Cutimed Gel Tube 2 0 2 2 0
124 Cyanocobalamin 50 mg Tab 0 0 0 0 0
125 Cyanocobalamin Inj 500 mcg/ ml Ampul 2370 0 2370 0 2370
126 Cyprofloksasin 500 mg Tab 2300 0 2300 0 2300
127 Dexamethason 0,5 mg Tab 4300 0 4300 3000 1300
128 Dexamethason Inj 5 mg/ml Ampul 200 0 200 0 200
129 Dextamec Tab 0 0 0 0 0
130 Diazepam 2 mg Tab 0 0 0 0 0
131 Diazepam 5 mg Tab 0 0 0 0 0
132 Diazepam Inj Ampul 50 0 50 0 50
133 Digoxin 0,25 mg Tab 0 0 0 0 0
134 Diltiazem 30 mg Tab 0 0 0 0 0
135 Dimenhydrinate 50 mg Tab 0 0 0 0 0
136 Diphenhidramin Inj Ampul 60 0 60 30 30
137 Diphenhidramin Inj (Sidiadryl) Vial 25 0 25 0 25
138 Disposible Needle No. 22 Pcs 0 0 0 0 0
139 Disposible Needle No. 23 Pcs 40 0 40 10 30
140 Domperidon 10 mg Tab 31700 0 31700 20300 11400
141 Domperidon Susp 5 mg/ 5 ml Botol 1235 0 1235 420 815
142 Double Check (Artikulating Paper) Dos 36 0 36 0 36
143 Doxyciclin 100 mg Tab 5400 0 5400 0 5400
144 Dulcolax 5 mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
145 Dulcolax Suppo Anak Suppo 378 0 378 0 378
146 Dumin Rektal 125 mg/ 4 ml Suppo 0 0 0 0 0
147 Dumin Rektal 250 mg/4 ml Suppo 26 0 26 0 26
148 Easy Touch Colestrol Dos 0 0 0 0 0
149 Easy Touch Glukosa Dos 0 0 0 0 0
150 Easy Touch Urine Acid Dos 0 0 0 0 0
151 Eflin Tab 7700 0 7700 400 7300
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
152 Elastis Verban 7,5 cm x 4,55 m Roll 20 0 20 2 18
153 Epinefrin Inj 1 mg/ml Ampul 155 0 155 0 155
154 Epoxidin (Pasta Pengisi Sal Akar) Dos 30 0 30 0 30
155 Erphatrim Forte 960 mg Tab 0 0 0 0 0
156 Erytromicin 250 mg Tab 0 0 0 0 0
157 Erytromicin 500 mg Tab 23300 0 23300 16000 7300
158 Erytromicin Syr Botol 0 0 0 0 0
159 Etakridin (Rivanol Lar 0,1%) Botol 0 0 0 0 0
160 Etanol 70% 1 L Botol 24 0 24 0 24
161 Etanol 70% 100 ml Botol 0 0 0 0 0
162 Etanol 70% 300 ml Botol 75 0 75 8 67
163 Ethambutol 500 mg Tab 450 0 450 0 450
164 Farbion Inj Ampul 0 0 0 0 0
165 Fenilbutason (Novason) 200 mg Tab 4100 0 4100 700 3400
166 Fenobarbital 30 mg Tab 0 0 0 0 0
167 Fenobarbital Inj 50 mg/ml Ampul 0 0 0 0 0
168 Folley Catheter No. 10 FR Pcs 9 0 9 0 9
169 Folley Catheter No. 16 FR Pcs 0 0 0 0 0
170 Folley Catheter No. 18 FR Pcs 51 0 51 21 30
171 Folley Catheter No. 22 FR Pcs 69 0 69 0 69
172 Furosemid 40 mg Tab 1700 0 1700 0 1700
173 Furosemid Inj (Diuvar) Ampul 0 0 0 0 0
174 Gabapentin 300 mg Tab 330 0 330 0 330
175 Garam Oralit 200 ml Air Saset 730 0 730 100 630
176 Gelas Ukur 250 ml Buah 0 0 0 0 0
177 Gemfibrozil 300 mg Tab 2400 0 2400 240 2160
178 Gentamicin Inj 40 mg/ ml Ampul 95 0 95 35 60
179 Gentamicin Salep 0,1 % Tube 0 0 0 0 0
180 Gentian Violet lar 1% Botol 190 0 190 0 190
181 Glibenclamid 5 mg Tab 3300 0 3300 400 2900
182 Glimepiride 2 mg Tab 6000 0 6000 500 5500
183 Glimepiride 3 mg Tab 0 0 0 0 0
184 Glukosa lar infus 10 % Steril Kolf 0 0 0 0 0
185 Glukosa lar infus 5 % Steril Kolf 444 0 444 160 284
186 Griseofulvin 125 mg Tab 67700 0 67700 40000 27700
187 Guaifenesin 100 mg Tab 16900 0 16900 1900 15000
188 Halloperidol 0,5 mg Tab 400 0 400 0 400
189 Halloperidol 1,5 mg Tab 0 0 0 0 0
190 Halloperidol 5 mg Tab 92 0 92 30 62
191 Handscoon Genekolog 7,5 16/40 cm Pcs 194 0 194 34 160
192 Handscoon No. 6,5 Steril Pcs 0 0 0 0 0
193 Handscoon No. 7 Steril Pcs 150 0 150 80 70
194 Handscoon No. 7,5 Steril Pcs 200 0 200 35 165
195 Handscoon No. 8 Steril Pcs 335 0 335 5 330
196 Handscoon Non Steril (L) Dos 0 0 0 0 0
197 Handscoon Non Steril (M) Dos 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
198 Hemafort Tab 0 0 0 0 0
199 Hidroklortiazid 25 mg Tab 6700 0 6700 0 6700
200 Hidrokortison Krim 2,5% Tube 5089 0 5089 2208 2881
201 Hyoscine N-Butylbromide (Scopamin) Tab 10400 0 10400 100 10300
202 Hyscopan Tab 0 0 0 0 0
203 Ibuprofen 200 mg Tab 0 0 0 0 0
204 Ibuprofen 400 mg Tab 19400 0 19400 6900 12500
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
205 Ibuprofen Susp 100 mg/ 5 ml Botol 265 0 265 175 90
206 Ichtiyol Salep Pot 0 0 0 0 0
207 Iliadin T. Hidung Botol 87 0 87 0 87
208 Infusion Set Anak (Micro) Pcs 260 0 260 20 240
209 Infusion Set Dewasa (Macro) Pcs 235 0 235 75 160
210 Isoniasid 100 mg Tab 0 0 0 0 0
211 Isoniazid 300 mg Tab 200 0 200 0 200
212 Isosorbid Dinitrat 5 mg Tab 2700 0 2700 0 2700
213 Jarum Kulit GT 10 Pcs 56 0 56 0 56
214 Jarum Kulit GT 11 Pcs 1 0 1 0 1
215 Jarum Kulit GT 15 Pcs 7 0 7 0 7
216 Jarum Kulit GR 13 Pcs 4 0 4 0 4
217 Jarum Otot GR 10 Pcs 0 0 0 0 0
218 Jarum Otot GR 12 Pcs 0 0 0 0 0
219 Jarum Otot GR 14 Pcs 0 0 0 0 0
220 Jarum Otot GR 15 Pcs 10 0 10 0 10
221 Kanamicin Inj Vial 0 0 0 0 0
222 Kaolimec Suspensi Botol 0 0 0 0 0
223 Kaotin Suspensi Botol 0 0 0 0 0
224 Kapas Berlemak 500 mg Buah 0 0 0 0 0
225 Kapas Pembalut 250 mg Buah 135 0 135 3 132
226 Karbamazepin 200 mg Tab 0 0 0 0 0
227 Kasa Hidrofil 4 m x 15 m Roll 0 0 0 0 0
228 Kasa Hidrofil 4 m x 5 m Roll 0 0 0 0 0
229 Kasa Kompres 40 x 80 Steril Roll 0 0 0 0 0
230 Kasa Kompres 40 x 40 Roll 6 0 6 6 0
231 Kasa Pembalut 40 x 80 m Roll 0 0 0 0 0
232 Kasa Steril 18 x 22 cm (16 x 16) Dos 220 0 220 60 160
233 Kertas EKG Roll 31 0 31 0 31
234 Kertas USG Roll 0 0 0 0 0
235 Ketokonazol 200 mg Tab 20050 0 20050 0 20050
236 Ketokonazol Krim 2 % Tube 168 0 168 0 168
237 Kolicgon Tab 0 0 0 0 0
238 Larutan H2O2 Botol 0 0 0 0 0
239 Leukoplast 2,5 cm x 4,5 m Roll 189 0 189 0 189
240 Leukoplast 7,5 cm x 4,5 m Roll 75 0 75 3 72
241 Levofloxacin 500 mg Tab 0 0 0 0 0
242 Lidocain Inj 20 mg/ 2 ml Ampul 4200 0 4200 0 4200
243 Lidocain Inj 40 mg Ampul 700 0 700 100 600
244 Lidocain Kompositum 20 mg/ 2 ml Ampul 450 0 450 0 450
245 Lisol Botol 39 0 39 0 39
246 Loperamid 2 mg Tab 0 0 0 0 0
247 Loratadin 10 mg Tab 0 0 0 0 0
248 Masker Earloop Pcs 260 0 260 160 100
249 Masker N 95 Pcs 100 0 100 0 100
250 Masker Tali Pcs 150 0 150 100 50
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
251 MDT MB Combi Dewasa Dos 0 0 0 0 0
252 Meloxicam 15 mg Tab 0 0 0 0 0
253 Metamizole Inj (Norages) Ampul 0 0 0 0 0
254 Metformin 500 mg Tab 29000 0 29000 1200 27800
255 Methildopa 250 mg (Dopamet) Tab 0 0 0 0 0
256 Methylprednisolon 4 Mg Tab 0 0 0 0 0
257 Methylprednisolon 8 Mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
258 Metilergometrin 0,125 mg Tab 15700 0 15700 0 15700
259 Metilergometrin Inj.0,2 mg Ampul 60 0 60 0 60
260 Metoclopramid 10 mg Tab 4400 0 4400 0 4400
261 Metoclopramid Inj 10 mg/ 2 ml Ampul 270 0 270 0 270
262 Metoclopramide Syr (Lexapram) Botol 29 0 29 0 29
263 Metronidazol 250 mg Tab 0 0 0 0 0
264 Metronidazol 500 mg Tab 3100 0 3100 500 2600
265 Metronidazole Lat Infus Botol 13 0 13 0 13
266 MgSO4 Inj 20% - 25 ml Flacon 20 0 20 5 15
267 MgSO4 Inj 40% - 25 ml Flacon 5 0 5 3 2
268 MgSO4 Serbuk 30 gr Vial 0 0 0 0 0
269 Miconazol Krim 2 % Tube 1960 0 1960 432 1528
270 Mometason Furoate Krim 0,1 % Tube 75 0 75 0 75
271 Mortir dan Stemper 8 cm Buah 0 0 0 0 0
272 Mouth Piace Dos 0 0 0 0 0
273 Mucotussan Tab 0 0 0 0 0
274 My Jelli 82 Gram Tube 2 20 22 8 14
275 NaCl Lar infus 0,9 % Kolf 234 0 234 30 204
276 Natrium Diclofenak 25 mg Tab 13850 0 13850 2800 11050
277 Natrium Diclofenak 50 mg Tab 2800 0 2800 0 2800
278 Neurovit E Tab 780 0 780 780 0
279 Neutotropic Plus Tab 0 0 0 0 0
280 Nifedipin 10 mg Tab 1700 0 1700 0 1700
281 Nistatin 500.000 IU Tab 400 0 400 400 0
282 Nistatin 100.000 IU Tab 480 0 480 0 480
283 Nistatin Drops 100.000 IU Botol 40 0 40 0 40
284 Novadiar Syr Botol 134 0 134 0 134
285 Novadium Tab 1000 0 1000 200 800
286 Novampiron Tab 0 0 0 0 0
287 Novapen Syr Botol 0 0 0 0 0
288 Novastan Tab 0 0 0 0 0
289 Novotwist ( Jarum Novorapid) Dos 2 0 2 0 2
290 OAT FDC Kategori Anak Paket 0 0 0 0 0
291 OAT FDC Kategori I Dewasa Paket 0 0 0 0 0
292 OAT FDC Kategori II Dewasa Paket 0 0 0 0 0
293 OAT FDC Sisipan Dewasa Paket 0 0 0 0 0
294 Obat Batuk Hitam ( OBH ) Syr Botol 20 10 30 0 30
295 Oksitetraciclin Inj 50 ml - 10 ml Ampul 0 0 0 0 0
296 Oksitetraciclin Salep Kulit 3 % Tube 13 0 13 0 13
297 Oksitetraciclin Salep Mata 1 % Tube 215 0 215 10 205
298 Oksitosin Inj 50 ml - 10 ml Ampul 640 0 640 0 640
299 Omeprazole 20 mg Tab 3720 0 3720 300 3420
300 Ondansetron HCL Inj 4 mg/ 2 ml Ampul 85 0 85 0 85
301 Papaverin 40 mg Tab 0 0 0 0 0
302 Papaverin Inj Ampul 0 0 0 0 0
303 Paracetamol 500 mg Tab 0 3000 3000 2800 200
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
304 Paracetamol Lar Infus Steril Botol 3 0 3 0 3
305 Paracetamol Syr 120 mg/ 5 ml Botol 0 100 100 65 35
306 Pehacain Inj Ampul 220 0 220 0 220
307 Pelarut Botol 0 15 15 0 15
308 Periokin Spray Dos 33 0 33 0 33
309 Permanganas kalikus (PK) Pot 0 0 0 0 0
310 Phenol Gliserol T. Telinga 10% Botol 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
311 Phitomenadion 10 mg Tab 1100 0 1100 0 1100
312 Phitomenadion Inj 10 mg/ml Ampul 0 180 180 40 140
313 Pipet Tetes Pendek Buah 0 0 0 0 0
314 Piracetam 800 mg Tab 0 0 0 0 0
315 Pirecetam 400 mg Tab 0 0 0 0 0
316 Pirecetam Inj 200 mg/ ml Ampul 0 0 0 0 0
317 Piridoxyn (Vit B6) 10 mg Tab 12200 0 12200 11200 1000
318 Piroxicam 20 mg Tab 0 100 100 100 0
319 Pisau Bedah Pcs 200 0 200 100 100
320 Plano Test Pcs 150 0 150 50 100
321 Plesterin Bulat Dos 25 0 25 1 24
322 Poligyp 5 cm x 27 cm Roll 0 0 0 0 0
323 Pot Urine Bauh 20 0 20 0 20
324 Povidon Iodida 10 % 30 ml Botol 50 0 50 5 45
325 Povidon Iodida 10 % 300 ml Botol 0 0 0 0 0
326 Povidon Iodida 10 % 60 ml Botol 2 0 2 2 0
327 Prednison 5 mg Tab 2400 0 2400 500 1900
328 Promavit Tab 480 0 480 480 0
329 Propanolol 10 mg Tab 0 200 200 200 0
330 Propanolol 40 mg Tab 0 0 0 0 0
331 Propiltiuracil 100 mg Tab 2800 0 2800 500 2300
332 Pyrantel Pamoat 125 mg Tab 0 0 0 0 0
333 Rabipur Vaksin Dos 0 0 0 0 0
334 Rak Tabung Stainless Buah 0 0 0 0 0
335 Ramipril 5 mg Tab 0 0 0 0 0
336 Ranitidin 150 mg Tab 8000 0 8000 2700 5300
337 Ranitidin Inj 25 mg/ 2 ml Ampul 240 0 240 40 200
338 Ranitidin Inj 50 mg/ 2 ml Ampul 0 0 0 0 0
339 RDT DBD Dos 0 0 0 0 0
340 RDT Malaria Dos 0 0 0 0 0
341 Rifampisin 450 mg Tab 300 0 300 0 300
342 Rifampisin 600 mg Tab 0 0 0 0 0
343 Ringer Lactat Lar Infus Steril Kolf 29 120 149 64 85
344 Salbutamol 2 mg Tab 0 0 0 0 0
345 Salbutamol 4 mg Tab 6000 0 6000 0 6000
346 Salep 2-4 Pot 1518 0 1518 480 1038
347 Salisil Bedak 2 % Dos 0 0 0 0 0
348 Sanbe Tears (Air Mata Buatan) Botol 0 0 0 0 0
349 Selediar Tab 0 0 0 0 0
350 Seledryil Tab 0 0 0 0 0
351 Selesbion Tab 0 0 0 0 0
352 Selkom C Tab 0 0 0 0 0
353 Selviplex Tab 0 0 0 0 0
354 Seven Seans Syr Botol 286 0 286 25 261
355 Sikat Pembersih Tabung Buah 0 0 0 0 0
356 Silk (Benang Bedah Sutra) No. 2/0 Pcs 24 0 24 0 24
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
357 Silk (Benang Bedah Sutra) No. 3/0 Pcs 12 0 12 0 12
358 Silk Braided Black usp:4/0 100 M Dos 0 0 0 0 0
359 Simvastatin 10 mg Tab 6480 0 6480 6480 0
360 Simvastatin 20 mg Tab 0 0 0 0 0
361 Skizon Zalf Tube 318 0 318 66 252
362 Soft U-Derm Krim Tube 120 0 120 0 120
363 Sohobion Inj Ampul 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
364 Soldextam Tab 0 0 0 0 0
365 Solvita Plus Syr Botol 0 0 0 0 0
366 Spasmolit Tab 0 0 0 0 0
367 Spironolactone 100 mg Tab 0 0 0 0 0
368 Spironolactone 25 mg Tab 0 0 0 0 0
369 Stesolid Suppo 5 mg/ 2,5 ml Suppo 11 0 11 0 11
370 Stesolid Suppo 10 mg/ 2,5 ml Suppo 0 0 0 0 0
371 Stik HB Family Dr Dos 0 0 0 0 0
372 Tablet Tambah Darah Tab 0 0 0 0 0
373 Tablet Tambah Darah Neo Tab 4890 2160 7050 6870 180
374 Tabung Reaksi 25 ml Buah 0 0 0 0 0
375 Termorex Syr Botol 0 0 0 0 0
376 TesKits Boraks Kit 0 0 0 0 0
377 TesKits Formaldehid (Formalin) Kit 0 0 0 0 0
378 TesKits Methanil Yellow Kit 0 0 0 0 0
379 TesKits Rhodamine B Kit 0 0 0 0 0
380 Tetagam Vaksin Dos 0 10 10 0 10
381 Tetracyclin HCL 250 mg Tab 0 0 0 0 0
382 Tetracyclin HCL 500 mg Tab 6500 0 6500 200 6300
383 Tetrakain HCL T. Mata 0,5 % Botol 0 0 0 0 0
384 Thiamin HCL 50 mg Tab 500 0 500 500 0
385 Thiamin HCL Inj 100 ml - 1 ml Vial 1510 0 1510 0 1510
386 Tramadol 50 mg Tab 0 0 0 0 0
387 Tricresol Formalin 10 ml Botol 0 0 0 0 0
388 Triheksiphenidil HCL 2 mg Tab 2500 0 2500 1500 1000
389 Truvit Syr Botol 111 0 111 25 86
390 Ultrasonic Gel 250 ml Botol 0 0 0 0 0
391 Urine Bag 1000 ml Pcs 35 0 35 10 25
392 Vaksin BCG Ampul 0 15 15 0 15
393 Vaksin Campak Rubella Ampul 0 10 10 3 7
394 Vaksin DPT HB Combo Ampul 2 25 27 24 3
395 Vaksin HB 0 (Unijek) Ampul 5 30 35 20 15
396 Vaksin IPV Ampul 3 0 3 3 0
397 Vaksin TT Bumil Ampul 5 10 15 5 10
398 Vaksin Polio Ampul 3 0 3 3 0
399 Ventolin Nebulizer Flacon 0 0 0 0 0
400 Verorab Vaksin Dos 0 11 11 3 8
401 Viccillin - SX (Ampicilin) Inj 1,5 g Vial 32 0 32 0 32
402 Vit A 100.000 IU Kapsul 0 0 0 0 0
403 Vit A 200.000 IU Kapsul 0 0 0 0 0
404 Vitamin B Kompleks Tab 2400 5000 7400 3800 3600
405 Vitamin B Kompleks Inj Vial 10 0 10 2 8
406 Zinc Dispersible 20 mg Tab 0 0 0 0 0
407 Zinc Syr 20 mg/ 5 ml Botol 325 0 325 20 305
408 HIV Tes Kit Strip 300 0 300 0 300
409 HBsAG Tes Kit Strip 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
410 HS Posterior Dos 4 0 4 0 4
411 Filtek Z350 XT Pcs 35 0 35 0 35
412 Pulp - X Dos 32 0 32 0 32
413 Iodium Tes Botol 5 0 5 0 5
414 Mitela (Kain SegiTiga) Pcs 0 0 0 0 0
415 Poligyp 10 cm x 2,7 m Roll 3 0 3 0 3
416 Asam Asetat 100 ml Botol 1 0 1 0 1
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
417 Elatomull Haft Dos 0 3 3 3 0

Umum
BPJS Jamkesda Jumlah
JUMLAH KUNJUNGAN RESEP Bayar Tdk Bayar

Mengetahui/Menyetujui Yang Menyerahkan Yang Memohon Yan


Penanggung Jawab Gudang Farmasi Pet

Sahrul, SKM Arini Priyanti Kandupi, S. Farm, Apt Moh. Rizal Sumaga, SKM Mujri
Nip. 19820714 200502 1 002 Nip.19830402 200502 2 004 Nip. 19720123 199402 1 002 Nip : 19881
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12

KETERANGAN :
Lembar Putih : GFK
Lembar Merah : Puskesmas
AN OBAT

: MEI 2019

Pemberian
Ket
lain-lain Jml
13 14 15

Dinkes : 1500

Exp : 3074
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Exp : 2800

Exp : 575
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Dinkes : 3000

Exp : 31

Exp : 60

Dinkes : 20000
Dinkes : 400
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Dinkes : 16000

Exp : 30

Dinkes : 160
Dinkes : 40000
Pemberian
Ket
lain-lain Jml
13 14 15

Dinkes : 2160
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Dinkes : 432
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Dinkes : 8400

Dinkes : 480
Pemberian
Ket
lain-lain Jml
13 14 15

Exp : 6480
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Yang Menerima
Petugas PKM

Mujriah A.Md, Far


Nip : 19881005 201001 2 001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS

PUSKESMAS : TETE PELAPORAN BLN/PERIODE : JUNI 20


KECAMATAN : AMPANA TETE
KABUPATEN : TOJO UNA UNA PERMINTAAN BLN/PERIODE
PROPINSI : SUL TENG

Stok Peneri Persedi Pemak Stok Permi Pemberian


No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
1 Abbocath No.18 Pcs 78 0 78 0 78
2 Abbocath No.20 Pcs 700 0 700 50 650
3 Abbocath No.22 Pcs 100 0 100 0 100
4 Abbocath No.24 Pcs 179 0 179 15 164
5 Acetylcysteine 200 mg Tab 0 0 0 0 0
6 Acyclovir 200 Mg Tab 0 0 0 0 0
7 Acyclovir 400 Mg Tab 11150 0 11150 700 10450
8 Acyclovir krim 5% Tube 290 0 290 15 275
9 Adidryl Inj Vial 0 0 0 0 0
10 Adimidon Inj Vial 0 0 0 0 0
11 Alat Autochek Unit 0 0 0 0 0
12 Alat Benechek Unit 0 0 0 0 0
13 Alat CO Analiser Unit 0 0 0 0 0
14 Alat Easy Touch Unit 0 0 0 0 0
15 Alat suntik sekali pakai 0,5 ml Pcs 200 0 200 170 30
16 Alat suntik sekali pakai 1 ml Pcs 254 0 254 20 234
17 Alat suntik sekali pakai 10 ml Pcs 0 0 0 0 0
18 Alat suntik sekali pakai 2,5 ml Pcs 0 0 0 0 0
19 Alat suntik sekali pakai 20 ml Pcs 70 0 70 0 70
20 Alat suntik sekali pakai 3 ml Pcs 200 200 400 140 260
21 Alat suntik sekali pakai 5 ml Pcs 985 0 985 100 885
22 Albendazol 400 mg Tab 0 0 0 0 0
23 Alkohol Swab Dos 14 0 14 0 14
24 Alletrol T. Mata Botol 0 0 0 0 0
25 Allopurinol 100 mg Tab 1800 0 1800 300 1500
26 Allopurinol 300 mg Tab 2340 0 2340 600 1740
27 Alprazolam 0,5 mg Tab 0 0 0 0 0
28 Alprazolam 1 mg Tab 1174 0 1174 106 1068
29 Ambroxol 30 mg Tab 800 0 800 500 300
30 Ambroxol Syr 15mg/ 5 ml Botol 20 0 20 20 0
31 Amitriptilin 25 mg Tab 1000 0 1000 0 1000
32 Amlodiphin 10 mg Tab 900 0 900 900 0
33 Amlodiphin 5 mg Tab 0 0 0 0 0
34 Amoxycillin 250 mg Tab 0 0 0 0 0
35 Amoxycillin 500 mg Tab 9800 0 9800 7900 1900
36 Amoxycillin Syr 125 mg/ 5 ml Botol 80 180 260 110 150
37 Ampicillin 500 mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
38 Ampicillin Inj Vial 0 0 0 0 0
39 Ampicillin Syrup 125 mg/ 5 ml Botol 0 0 0 0 0
40 Analog Long Insulin (Levemir) Pen 0 0 0 0 0
41 Antalgin 500 mg Tab 0 0 0 0 0
42 Antalgin Inj 250 mg/ml Ampul 0 0 0 0 0
43 Antasida Doen 500 mg Tab 30000 0 30000 1900 28100
44 Antasida Doen Susp Botol 50 100 150 68 82
45 Anti Hemoroid Doen Kombinasi Suppo 285 0 285 0 285
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
46 Antiseptik Hand Botol 45 0 45 2 43
47 Antrain Inj Ampul 5 0 5 0 5
48 Aqua Pro Injeksi Vial 110 0 110 0 110
49 Aquadest 20 L Galon 2 0 2 0 2
50 As Asetil Salisilat 80 mg (Miniaspi) Tab 1400 0 1400 0 1400
51 Asam Askorbat (Vit C) 50 mg Tab 17800 0 17800 3800 14000
52 Asam Folac Tab 0 0 0 0 0
53 Asam Mefenamat 500 mg Tab 25100 0 25100 6800 18300
54 Asam Tranexamat Inj 50 mg/ ml Ampul 0 0 0 0 0
55 Asetosal 100 mg Tab 0 0 0 0 0
56 Asetosal 500 mg Tab 0 0 0 0 0
57 Aspar K Tab 0 0 0 0 0
58 Atorvastatin Calsium 10 Mg Tab 0 0 0 0 0
59 Atropin Inj 0,25 mg Ampul 121 0 121 0 121
60 Atrovent Inhaler Botol 85 0 85 10 75
61 Attapulgit (New Antides) Tab 0 0 0 0 0
62 Autocheck Cholesterol Dos 7 0 7 3 4
63 Autocheck Glucosa Dos 0 0 0 0 0
64 Autocheck Urin Acid Dos 1 0 1 0 1
65 Bacitracin Polimixyn B Salep Tube 0 0 0 0 0
66 Batang Pengaduk Buah 0 0 0 0 0
67 Benecheck Colesterol Dos 6 0 6 5 1
68 Benecheck Glucosa Dos 3 0 3 3 0
69 Benecheck Urin Acid Dos 9 0 9 3 6
70 Betahistin Mesilat 6 mg Tab 3800 1000 4800 200 4600
71 Betametason Krim 0,1% Tube 0 0 0 0 0
72 Biocombin 5000 Inj Ampul 0 0 0 0 0
73 Bionemi Tab 0 0 0 0 0
74 Bisoprolol 5 mg Tab 0 0 0 0 0
75 Blood Lancets 26 G Dos 0 0 0 0 0
76 Blood Lancets 28 G Dos 24 0 24 2 22
77 Buscopan Inj 20 mg/ ml Ampul 10 0 10 0 10
78 Calcium Gluconate Inj 100 mg/ml Ampul 17 0 17 0 17
79 Calsium Laktat (Calac) 500 mg Tab 0 0 0 0 0
80 Calxyl Radiopaque Buah 3 0 3 0 3
81 Candesartan Cilexetil 8 mg Tab 0 600 600 300 300
82 Captopril 12,5 mg Tab 2500 0 2500 300 2200
83 Captopril 25 mg Tab 9300 0 9300 1600 7700
84 Carbamazepin 200 mg Tab 0 0 0 0 0
85 Catapres Inj Ampul 10 0 10 0 10
86 Catarlent T Mata Botol 0 0 0 0 0
87 Catgut Chromic No. 2/0 Pcs 0 0 0 0 0
88 Catgut Chromic No. 3/0 Pcs 0 0 0 0 0
89 Catgut Chromic No. 4/0 Pcs 0 0 0 0 0
90 Catgut Chromik usp:2/0 100 M Dos 0 0 0 0 0
91 Catgut Plain 2/0 HR 37 MM Pcs 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
92 Catgut Plain 3/0 HR 26 MM Pcs 0 0 0 0 0
93 Catgut Plain 4/0 Pcs 0 0 0 0 0
94 Cathejell Lido 2% & CHG 0,05 % Flacon 0 0 0 0 0
95 Cavit (Bahan Tump Sementara) Dos 34 0 34 0 34
96 Cefadroxil 500 mg Tab 1300 2000 3300 1000 2300
97 Cefadroxil Syr 125 mg/ 5 ml Botol 0 0 0 0 0
98 Cendo Xytrol T. Mata Botol 185 0 185 10 175
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
99 Cetirizine 10 mg Tab 4000 0 4000 500 3500
100 Cetirizine Syr 5 mg/ 5 ml Botol 235 0 235 100 135
101 Chloramphenicol (Chloramex) 500 mg Tab 6100 0 6100 500 5600
102 Chloramphenicol (Novachlor) 250 mg Tab 2500 0 2500 900 1600
103 Chloramphenicol Salep Mata 1% Tube 118 48 166 55 111
104 Chloramphenicol Suspensi Botol 174 0 174 24 150
105 Chloramphenicol T. Mata 0,5% Tube 0 0 0 0 0
106 Chloramphenicol T. Telinga 3% Botol 4 0 4 2 2
107 Chlorfeniramin Maleat 4 mg Tab 29300 0 29300 6300 23000
108 Chlorpromazin 100 mg Tab 280 0 280 3 277
109 Chlorpromazin 25 mg Tab 0 0 0 0 0
110 Chlorpromazin Inj 5mg/ml Ampul 0 0 0 0 0
111 Cimetidin 200 mg Tab 0 0 0 0 0
112 Citicoline 500 mg Tab 0 0 0 0 0
113 Clobasam 10 mg Tab 98 0 98 0 98
114 Clonidine 0,15 mg Tab 0 0 0 0 0
115 Clopidogrel 75 mg Tab 0 0 0 0 0
116 Codein 10 mg Tab 3860 0 3860 0 3860
117 Colcitine 0,5 mg Tab 2190 0 2190 180 2010
118 Combivent Nebulizer Flacon 0 0 0 0 0
119 Cotrimoxazol 480 mg Tab 500 500 1000 900 100
120 Cotrimoxazol Pediatrik Tab 0 0 0 0 0
121 Cotrimoxazol Susp Botol 150 0 150 45 105
122 Curcuma Tab 0 0 0 0 0
123 Cutimed Gel Tube 0 0 0 0 0
124 Cyanocobalamin 50 mg Tab 0 0 0 0 0
125 Cyanocobalamin Inj 500 mcg/ ml Ampul 2370 0 2370 170 2200
126 Cyprofloksasin 500 mg Tab 2300 0 2300 0 2300
127 Dexamethason 0,5 mg Tab 1300 3000 4300 3200 1100
128 Dexamethason Inj 5 mg/ml Ampul 200 0 200 60 140
129 Dextamec Tab 0 0 0 0 0
130 Diazepam 2 mg Tab 0 0 0 0 0
131 Diazepam 5 mg Tab 0 0 0 0 0
132 Diazepam Inj Ampul 50 0 50 2 48
133 Digoxin 0,25 mg Tab 0 0 0 0 0
134 Diltiazem 30 mg Tab 0 0 0 0 0
135 Dimenhydrinate 50 mg Tab 0 0 0 0 0
136 Diphenhidramin Inj Ampul 30 0 30 15 15
137 Diphenhidramin Inj (Sidiadryl) Vial 25 0 25 3 22
138 Disposible Needle No. 22 Pcs 0 0 0 0 0
139 Disposible Needle No. 23 Pcs 30 0 30 30 0
140 Domperidon 10 mg Tab 11400 0 11400 300 11100
141 Domperidon Susp 5 mg/ 5 ml Botol 815 0 815 10 805
142 Double Check (Artikulating Paper) Dos 36 0 36 0 36
143 Doxyciclin 100 mg Tab 5400 0 5400 600 4800
144 Dulcolax 5 mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
145 Dulcolax Suppo Anak Suppo 378 0 378 0 378
146 Dumin Rektal 125 mg/ 4 ml Suppo 0 0 0 0 0
147 Dumin Rektal 250 mg/4 ml Suppo 26 0 26 0 26
148 Easy Touch Colestrol Dos 0 0 0 0 0
149 Easy Touch Glukosa Dos 0 0 0 0 0
150 Easy Touch Urine Acid Dos 0 0 0 0 0
151 Eflin Tab 7300 0 7300 2500 4800
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
152 Elastis Verban 7,5 cm x 4,55 m Roll 18 0 18 6 12
153 Epinefrin Inj 1 mg/ml Ampul 155 0 155 0 155
154 Epoxidin (Pasta Pengisi Sal Akar) Dos 30 0 30 0 30
155 Erphatrim Forte 960 mg Tab 0 0 0 0 0
156 Erytromicin 250 mg Tab 0 0 0 0 0
157 Erytromicin 500 mg Tab 7300 0 7300 200 7100
158 Erytromicin Syr Botol 0 0 0 0 0
159 Etakridin (Rivanol Lar 0,1%) Botol 0 0 0 0 0
160 Etanol 70% 1 L Botol 24 0 24 0 24
161 Etanol 70% 100 ml Botol 0 0 0 0 0
162 Etanol 70% 300 ml Botol 67 0 67 6 61
163 Ethambutol 500 mg Tab 450 0 450 0 450
164 Farbion Inj Ampul 0 0 0 0 0
165 Fenilbutason (Novason) 200 mg Tab 3400 0 3400 1300 2100
166 Fenobarbital 30 mg Tab 0 0 0 0 0
167 Fenobarbital Inj 50 mg/ml Ampul 0 0 0 0 0
168 Folley Catheter No. 10 FR Pcs 9 0 9 0 9
169 Folley Catheter No. 16 FR Pcs 0 0 0 0 0
170 Folley Catheter No. 18 FR Pcs 30 0 30 5 25
171 Folley Catheter No. 22 FR Pcs 69 0 69 0 69
172 Furosemid 40 mg Tab 1700 0 1700 0 1700
173 Furosemid Inj (Diuvar) Ampul 0 0 0 0 0
174 Gabapentin 300 mg Tab 330 0 330 0 330
175 Garam Oralit 200 ml Air Saset 630 0 630 130 500
176 Gelas Ukur 250 ml Buah 0 0 0 0 0
177 Gemfibrozil 300 mg Tab 2160 0 2160 960 1200
178 Gentamicin Inj 40 mg/ ml Ampul 60 0 60 0 60
179 Gentamicin Salep 0,1 % Tube 0 0 0 0 0
180 Gentian Violet lar 1% Botol 190 0 190 0 190
181 Glibenclamid 5 mg Tab 2900 0 2900 500 2400
182 Glimepiride 2 mg Tab 5500 0 5500 0 5500
183 Glimepiride 3 mg Tab 0 0 0 0 0
184 Glukosa lar infus 10 % Steril Kolf 0 0 0 0 0
185 Glukosa lar infus 5 % Steril Kolf 284 0 284 0 284
186 Griseofulvin 125 mg Tab 27700 0 27700 500 27200
187 Guaifenesin 100 mg Tab 15000 0 15000 4800 10200
188 Halloperidol 0,5 mg Tab 400 0 400 0 400
189 Halloperidol 1,5 mg Tab 0 0 0 0 0
190 Halloperidol 5 mg Tab 62 0 62 62 0
191 Handscoon Genekolog 7,5 16/40 cm Pcs 160 0 160 0 160
192 Handscoon No. 6,5 Steril Pcs 0 0 0 0 0
193 Handscoon No. 7 Steril Pcs 70 0 70 10 60
194 Handscoon No. 7,5 Steril Pcs 165 0 165 70 95
195 Handscoon No. 8 Steril Pcs 330 0 330 20 310
196 Handscoon Non Steril (L) Dos 0 0 0 0 0
197 Handscoon Non Steril (M) Dos 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
198 Hemafort Tab 0 0 0 0 0
199 Hidroklortiazid 25 mg Tab 6700 0 6700 0 6700
200 Hidrokortison Krim 2,5% Tube 2881 0 2881 24 2857
201 Hyoscine N-Butylbromide (Scopamin) Tab 10300 0 10300 700 9600
202 Hyscopan Tab 0 0 0 0 0
203 Ibuprofen 200 mg Tab 0 0 0 0 0
204 Ibuprofen 400 mg Tab 12500 0 12500 3700 8800
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
205 Ibuprofen Susp 100 mg/ 5 ml Botol 90 0 90 90 0
206 Ichtiyol Salep Pot 0 0 0 0 0
207 Iliadin T. Hidung Botol 87 0 87 0 87
208 Infusion Set Anak (Micro) Pcs 240 0 240 15 225
209 Infusion Set Dewasa (Macro) Pcs 160 0 160 5 155
210 Isoniasid 100 mg Tab 0 0 0 0 0
211 Isoniazid 300 mg Tab 200 0 200 0 200
212 Isosorbid Dinitrat 5 mg Tab 2700 0 2700 0 2700
213 Jarum Kulit GT 10 Pcs 56 0 56 0 56
214 Jarum Kulit GT 11 Pcs 1 0 1 0 1
215 Jarum Kulit GT 15 Pcs 7 0 7 0 7
216 Jarum Kulit GR 13 Pcs 4 0 4 0 4
217 Jarum Otot GR 10 Pcs 0 0 0 0 0
218 Jarum Otot GR 12 Pcs 0 0 0 0 0
219 Jarum Otot GR 14 Pcs 0 0 0 0 0
220 Jarum Otot GR 15 Pcs 10 0 10 0 10
221 Kanamicin Inj Vial 0 0 0 0 0
222 Kaolimec Suspensi Botol 0 0 0 0 0
223 Kaotin Suspensi Botol 0 0 0 0 0
224 Kapas Berlemak 500 mg Buah 0 0 0 0 0
225 Kapas Pembalut 250 mg Buah 132 0 132 0 132
226 Karbamazepin 200 mg Tab 0 0 0 0 0
227 Kasa Hidrofil 4 m x 15 m Roll 0 0 0 0 0
228 Kasa Hidrofil 4 m x 5 m Roll 0 0 0 0 0
229 Kasa Kompres 40 x 80 Steril Roll 0 0 0 0 0
230 Kasa Kompres 40 x 40 Roll 0 0 0 0 0
231 Kasa Pembalut 40 x 80 m Roll 0 0 0 0 0
232 Kasa Steril 18 x 22 cm (16 x 16) Dos 160 0 160 120 40
233 Kertas EKG Roll 31 0 31 0 31
234 Kertas USG Roll 0 0 0 0 0
235 Ketokonazol 200 mg Tab 20050 0 20050 0 20050
236 Ketokonazol Krim 2 % Tube 168 0 168 5 163
237 Kolicgon Tab 0 0 0 0 0
238 Larutan H2O2 Botol 0 0 0 0 0
239 Leukoplast 2,5 cm x 4,5 m Roll 189 0 189 0 189
240 Leukoplast 7,5 cm x 4,5 m Roll 72 0 72 16 56
241 Levofloxacin 500 mg Tab 0 0 0 0 0
242 Lidocain Inj 20 mg/ 2 ml Ampul 4200 0 4200 0 4200
243 Lidocain Inj 40 mg Ampul 600 0 600 170 430
244 Lidocain Kompositum 20 mg/ 2 ml Ampul 450 0 450 0 450
245 Lisol Botol 39 0 39 0 39
246 Loperamid 2 mg Tab 0 0 0 0 0
247 Loratadin 10 mg Tab 0 0 0 0 0
248 Masker Earloop Pcs 100 200 300 50 250
249 Masker N 95 Pcs 100 0 100 0 100
250 Masker Tali Pcs 50 100 150 80 70
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
251 MDT MB Combi Dewasa Dos 0 0 0 0 0
252 Meloxicam 15 mg Tab 0 0 0 0 0
253 Metamizole Inj (Norages) Ampul 0 0 0 0 0
254 Metformin 500 mg Tab 27800 0 27800 200 27600
255 Methildopa 250 mg (Dopamet) Tab 0 0 0 0 0
256 Methylprednisolon 4 Mg Tab 0 0 0 0 0
257 Methylprednisolon 8 Mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
258 Metilergometrin 0,125 mg Tab 15700 0 15700 0 15700
259 Metilergometrin Inj.0,2 mg Ampul 60 0 60 0 60
260 Metoclopramid 10 mg Tab 4400 0 4400 0 4400
261 Metoclopramid Inj 10 mg/ 2 ml Ampul 270 0 270 0 270
262 Metoclopramide Syr (Lexapram) Botol 29 0 29 29 0
263 Metronidazol 250 mg Tab 0 0 0 0 0
264 Metronidazol 500 mg Tab 2600 0 2600 0 2600
265 Metronidazole Lat Infus Botol 13 0 13 0 13
266 MgSO4 Inj 20% - 25 ml Flacon 15 0 15 0 15
267 MgSO4 Inj 40% - 25 ml Flacon 2 0 2 0 2
268 MgSO4 Serbuk 30 gr Vial 0 0 0 0 0
269 Miconazol Krim 2 % Tube 1528 0 1528 24 1504
270 Mometason Furoate Krim 0,1 % Tube 75 0 75 0 75
271 Mortir dan Stemper 8 cm Buah 0 0 0 0 0
272 Mouth Piace Dos 0 0 0 0 0
273 Mucotussan Tab 0 0 0 0 0
274 My Jelli 82 Gram Tube 14 0 14 0 14
275 NaCl Lar infus 0,9 % Kolf 204 0 204 13 191
276 Natrium Diclofenak 25 mg Tab 11050 0 11050 1100 9950
277 Natrium Diclofenak 50 mg Tab 2800 0 2800 0 2800
278 Neurovit E Tab 0 600 600 240 360
279 Neutotropic Plus Tab 0 0 0 0 0
280 Nifedipin 10 mg Tab 1700 0 1700 600 1100
281 Nistatin 500.000 IU Tab 0 0 0 0 0
282 Nistatin 100.000 IU Tab 480 0 480 0 480
283 Nistatin Drops 100.000 IU Botol 40 0 40 0 40
284 Novadiar Syr Botol 134 0 134 5 129
285 Novadium Tab 800 0 800 600 200
286 Novampiron Tab 0 0 0 0 0
287 Novapen Syr Botol 0 0 0 0 0
288 Novastan Tab 0 0 0 0 0
289 Novotwist ( Jarum Novorapid) Dos 2 0 2 0 2
290 OAT FDC Kategori Anak Paket 0 3 3 3 0
291 OAT FDC Kategori I Dewasa Paket 0 1 1 1 0
292 OAT FDC Kategori II Dewasa Paket 0 0 0 0 0
293 OAT FDC Sisipan Dewasa Paket 0 0 0 0 0
294 Obat Batuk Hitam ( OBH ) Syr Botol 30 0 30 30 0
295 Oksitetraciclin Inj 50 ml - 10 ml Ampul 0 0 0 0 0
296 Oksitetraciclin Salep Kulit 3 % Tube 13 0 13 13 0
297 Oksitetraciclin Salep Mata 1 % Tube 205 0 205 10 195
298 Oksitosin Inj 50 ml - 10 ml Ampul 640 0 640 170 470
299 Omeprazole 20 mg Tab 3420 0 3420 810 2610
300 Ondansetron HCL Inj 4 mg/ 2 ml Ampul 85 0 85 0 85
301 Papaverin 40 mg Tab 0 0 0 0 0
302 Papaverin Inj Ampul 0 0 0 0 0
303 Paracetamol 500 mg Tab 200 2000 2200 2000 200
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
304 Paracetamol Lar Infus Steril Botol 3 0 3 2 1
305 Paracetamol Syr 120 mg/ 5 ml Botol 35 0 35 35 0
306 Pehacain Inj Ampul 220 0 220 60 160
307 Periokin Spray Dos 33 0 33 0 33
308 Permanganas kalikus (PK) Pot 0 0 0 0 0
309 Phenol Gliserol T. Telinga 10% Botol 0 48 48 5 43
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
310 Phitomenadion 10 mg Tab 1100 0 1100 0 1100
311 Phitomenadion Inj 10 mg/ml Ampul 140 90 230 68 162
312 Pipet Tetes Pendek Buah 0 0 0 0 0
313 Piracetam 800 mg Tab 0 0 0 0 0
314 Pirecetam 400 mg Tab 0 0 0 0 0
315 Pirecetam Inj 200 mg/ ml Ampul 0 0 0 0 0
316 Piridoxyn (Vit B6) 10 mg Tab 1000 0 1000 1000 0
317 Piroxicam 20 mg Tab 0 0 0 0 0
318 Pisau Bedah Pcs 100 0 100 0 100
319 Plano Test Pcs 100 120 220 55 165
320 Plesterin Bulat Dos 24 0 24 0 24
321 Poligyp 5 cm x 27 cm Roll 0 0 0 0 0
322 Pot Urine Bauh 20 0 20 0 20
323 Povidon Iodida 10 % 30 ml Botol 45 0 45 20 25
324 Povidon Iodida 10 % 300 ml Botol 0 0 0 0 0
325 Povidon Iodida 10 % 60 ml Botol 0 0 0 0 0
326 Prednison 5 mg Tab 1900 0 1900 1200 700
327 Promavit Tab 0 0 0 0 0
328 Propanolol 10 mg Tab 0 200 200 200 0
329 Propanolol 40 mg Tab 0 0 0 0 0
330 Propiltiuracil 100 mg Tab 2300 0 2300 0 2300
331 Pyrantel Pamoat 125 mg Tab 0 0 0 0 0
332 Rabipur Vaksin Dos 0 0 0 0 0
333 Rak Tabung Stainless Buah 0 0 0 0 0
334 Ramipril 5 mg Tab 0 0 0 0 0
335 Ranitidin 150 mg Tab 5300 0 5300 2100 3200
336 Ranitidin Inj 25 mg/ 2 ml Ampul 200 0 200 20 180
337 Ranitidin Inj 50 mg/ 2 ml Ampul 0 0 0 0 0
338 RDT DBD Dos 0 0 0 0 0
339 RDT Malaria Dos 0 0 0 0 0
340 Rifampisin 450 mg Tab 300 0 300 0 300
341 Rifampisin 600 mg Tab 0 0 0 0 0
342 Ringer Lactat Lar Infus Steril Kolf 85 60 145 65 80
343 Salbutamol 2 mg Tab 0 0 0 0 0
344 Salbutamol 4 mg Tab 6000 0 6000 1300 4700
345 Salep 2-4 Pot 1038 0 1038 0 1038
346 Salisil Bedak 2 % Dos 0 0 0 0 0
347 Sanbe Tears (Air Mata Buatan) Botol 0 0 0 0 0
348 Selediar Tab 0 0 0 0 0
349 Seledryil Tab 0 0 0 0 0
350 Selesbion Tab 0 0 0 0 0
351 Selkom C Tab 0 0 0 0 0
352 Selviplex Tab 0 0 0 0 0
353 Seven Seans Syr Botol 261 0 261 0 261
354 Sikat Pembersih Tabung Buah 0 0 0 0 0
355 Silk (Benang Bedah Sutra) No. 2/0 Pcs 24 0 24 0 24
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
356 Silk (Benang Bedah Sutra) No. 3/0 Pcs 12 0 12 0 12
357 Silk Braided Black usp:4/0 100 M Dos 0 0 0 0 0
358 Simvastatin 10 mg Tab 0 0 0 0 0
359 Simvastatin 20 mg Tab 0 0 0 0 0
360 Skizon Zalf Tube 252 0 252 174 78
361 Soft U-Derm Krim Tube 120 0 120 20 100
362 Sohobion Inj Ampul 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
363 Soldextam Tab 0 0 0 0 0
364 Solvita Plus Syr Botol 0 0 0 0 0
365 Spasmolit Tab 0 0 0 0 0
366 Spironolactone 100 mg Tab 0 0 0 0 0
367 Spironolactone 25 mg Tab 0 0 0 0 0
368 Stesolid Suppo 5 mg/ 2,5 ml Suppo 11 0 11 0 11
369 Stesolid Suppo 10 mg/ 2,5 ml Suppo 0 0 0 0 0
370 Stik HB Family Dr Dos 0 0 0 0 0
371 Tablet Tambah Darah Tab 0 0 0 0 0
372 Tablet Tambah Darah Neo Tab 180 29360 29540 6290 23250
373 Tabung Reaksi 25 ml Buah 0 0 0 0 0
374 Termorex Syr Botol 0 0 0 0 0
375 TesKits Boraks Kit 0 0 0 0 0
376 TesKits Formaldehid (Formalin) Kit 0 0 0 0 0
377 TesKits Methanil Yellow Kit 0 0 0 0 0
378 TesKits Rhodamine B Kit 0 0 0 0 0
379 Tetagam Vaksin Dos 10 0 10 5 5
380 Tetracyclin HCL 250 mg Tab 0 0 0 0 0
381 Tetracyclin HCL 500 mg Tab 6300 0 6300 700 5600
382 Tetrakain HCL T. Mata 0,5 % Botol 0 0 0 0 0
383 Thiamin HCL 50 mg Tab 0 0 0 0 0
384 Thiamin HCL Inj 100 ml - 1 ml Vial 1510 0 1510 110 1400
385 Tramadol 50 mg Tab 0 0 0 0 0
386 Tricresol Formalin 10 ml Botol 0 0 0 0 0
387 Triheksiphenidil HCL 2 mg Tab 1000 0 1000 0 1000
388 Truvit Syr Botol 86 0 86 0 86
389 Ultrasonic Gel 250 ml Botol 0 0 0 0 0
390 Urine Bag 1000 ml Pcs 25 0 25 0 25
391 Vaksin BCG Ampul 15 0 15 5 10
392 Pelarut BCG Vial 15 0 15 5 10
393 Vaksin Campak Rubella Vial 7 0 7 2 5
394 Pelarut Campak Rubella Ampul 10 0 10 5 5
395 Vaksin DPT HB Combo Ampul 3 0 3 3 0
396 Vaksin HB 0 (Unijek) Ampul 15 0 15 0 15
397 Vaksin IPV Ampul 0 0 0 0 0
398 Vaksin TT Bumil Ampul 10 0 10 2 8
399 Vaksin Polio Ampul 0 0 0 0 0
400 Ventolin Nebulizer Flacon 0 0 0 0 0
401 Verorab Vaksin Dos 8 0 8 1 7
402 Viccillin - SX (Ampicilin) Inj 1,5 g Vial 32 0 32 0 32
403 Vit A 100.000 IU Kapsul 0 0 0 0 0
404 Vit A 200.000 IU Kapsul 0 0 0 0 0
405 Vitamin B Kompleks Tab 3600 3000 6600 3400 3200
406 Vitamin B Kompleks Inj Vial 8 0 8 5 3
407 Zinc Dispersible 20 mg Tab 0 0 0 0 0
408 Zinc Syr 20 mg/ 5 ml Botol 305 0 305 80 225
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
409 HIV Tes Kit Strip 300 0 300 300 0
410 HBsAG Tes Kit Strip 0 0 0 0 0
411 HS Posterior Dos 4 0 4 0 4
412 Filtek Z350 XT Pcs 35 0 35 0 35
413 Pulp - X Dos 32 0 32 0 32
414 Iodium Tes Botol 5 0 5 0 5
415 Mitela (Kain SegiTiga) Pcs 0 0 0 0 0
416 Poligyp 10 cm x 2,7 m Roll 3 0 3 0 3
417 Asam Asetat 100 ml Botol 1 0 1 0 1
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
418 Elatomull Haft Dos 0 0 0 0 0
419 Paracetamol Drops Botol 0 56 56 0 56
420 Omeprazole 40 mg Inj Ampul 0 10 10 0 10
421 Metcovazin Cr Tube 0 5 5 0 5

Umum
BPJS Jamkesda Jumlah
JUMLAH KUNJUNGAN RESEP Bayar Tdk Bayar

Mengetahui/Menyetujui Yang Menyerahkan Yang Memohon Yan


Penanggung Jawab Gudang Farmasi Pet

Sahrul, SKM Arini Priyanti Kandupi, S. Farm, Apt Moh. Rizal Sumaga, SKM Mujri
Nip. 19820714 200502 1 002 Nip.19830402 200502 2 004 Nip. 19720123 199402 1 002 Nip : 19881
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12

KETERANGAN :
Lembar Putih : GFK
Lembar Merah : Puskesmas
AN OBAT

: JUNI 2019

Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Exp : 62
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Yang Menerima
Petugas PKM

Mujriah A.Md, Far


Nip : 19881005 201001 2 001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS

PUSKESMAS : TETE PELAPORAN BLN/PERIODE : JULI 20


KECAMATAN : AMPANA TETE
KABUPATEN : TOJO UNA UNA PERMINTAAN BLN/PERIODE
PROPINSI : SUL TENG

Stok Peneri Persedi Pemak Stok Permi Pemberian


No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
1 Abbocath No.18 Pcs 78 0 78 0 78
2 Abbocath No.20 Pcs 650 0 650 10 640
3 Abbocath No.22 Pcs 100 0 100 0 100
4 Abbocath No.24 Pcs 164 0 164 10 154
5 Acetylcysteine 200 mg Tab 0 0 0 0 0
6 Acyclovir 200 Mg Tab 0 0 0 0 0
7 Acyclovir 400 Mg Tab 10450 0 10450 1000 9450
8 Acyclovir krim 5% Tube 275 0 275 50 225
9 Adidryl Inj Vial 0 0 0 0 0
10 Adimidon Inj Vial 0 0 0 0 0
11 Alat Autochek Unit 0 0 0 0 0
12 Alat Benechek Unit 0 0 0 0 0
13 Alat CO Analiser Unit 0 0 0 0 0
14 Alat Easy Touch Unit 0 0 0 0 0
15 Alat suntik sekali pakai 0,5 ml Pcs 30 0 30 30
16 Alat suntik sekali pakai 1 ml Pcs 234 0 234 0 234
17 Alat suntik sekali pakai 10 ml Pcs 0 0 0 0 0
18 Alat suntik sekali pakai 2,5 ml Pcs 0 0 0 0 0
19 Alat suntik sekali pakai 20 ml Pcs 70 0 70 0 70
20 Alat suntik sekali pakai 3 ml Pcs 260 0 260 200 60
21 Alat suntik sekali pakai 5 ml Pcs 885 0 885 100 785
22 Albendazol 400 mg Tab 0 0 0 0 0
23 Alkohol Swab Dos 14 0 14 2 12
24 Alletrol T. Mata Botol 0 0 0 0 0
25 Allopurinol 100 mg Tab 1500 0 1500 0 1500
26 Allopurinol 300 mg Tab 1740 0 1740 300 1440
27 Alprazolam 0,5 mg Tab 0 0 0 0 0
28 Alprazolam 1 mg Tab 1068 0 1068 97 971
29 Ambroxol 30 mg Tab 300 0 300 300 0
30 Ambroxol Syr 15mg/ 5 ml Botol 0 0 0 0 0
31 Amitriptilin 25 mg Tab 1000 0 1000 0 1000
32 Amlodiphin 10 mg Tab 0 0 0 0 0
33 Amlodiphin 5 mg Tab 0 0 0 0 0
34 Amoxycillin 250 mg Tab 0 0 0 0 0
35 Amoxycillin 500 mg Tab 1900 5000 6900 800 6100
36 Amoxycillin Syr 125 mg/ 5 ml Botol 150 60 210 65 145
37 Ampicillin 500 mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
38 Ampicillin Inj Vial 0 0 0 0 0
39 Ampicillin Syrup 125 mg/ 5 ml Botol 0 0 0 0 0
40 Analog Long Insulin (Levemir) Pen 0 0 0 0 0
41 Antalgin 500 mg Tab 0 0 0 0 0
42 Antalgin Inj 250 mg/ml Ampul 0 0 0 0 0
43 Antasida Doen 500 mg Tab 28100 0 28100 1200 26900
44 Antasida Doen Susp Botol 82 0 82 32 50
45 Anti Hemoroid Doen Kombinasi Suppo 285 0 285 0 285
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
46 Antiseptik Hand Botol 43 0 43 3 40
47 Antrain Inj Ampul 5 0 5 5 0
48 Aqua Pro Injeksi Vial 110 0 110 0 110
49 Aquadest 20 L Galon 2 0 2 0 2
50 As Asetil Salisilat 80 mg (Miniaspi) Tab 1400 0 1400 0 1400
51 Asam Askorbat (Vit C) 50 mg Tab 14000 0 14000 2800 11200
52 Asam Folac Tab 0 0 0 0 0
53 Asam Mefenamat 500 mg Tab 18300 0 18300 3400 14900
54 Asam Tranexamat Inj 50 mg/ ml Ampul 0 0 0 0 0
55 Asetosal 100 mg Tab 0 0 0 0 0
56 Asetosal 500 mg Tab 0 0 0 0 0
57 Aspar K Tab 0 0 0 0 0
58 Atorvastatin Calsium 10 Mg Tab 0 0 0 0 0
59 Atropin Inj 0,25 mg Ampul 121 0 121 0 121
60 Atrovent Inhaler Botol 75 0 75 20 55
61 Attapulgit (New Antides) Tab 0 0 0 0 0
62 Autocheck Cholesterol Dos 4 0 4 4 0
63 Autocheck Glucosa Dos 0 0 0 0 0
64 Autocheck Urin Acid Dos 1 0 1 1 0
65 Bacitracin Polimixyn B Salep Tube 0 0 0 0 0
66 Batang Pengaduk Buah 0 0 0 0 0
67 Benecheck Colesterol Dos 1 0 1 1 0
68 Benecheck Glucosa Dos 0 0 0 0 0
69 Benecheck Urin Acid Dos 6 0 6 4 2
70 Betahistin Mesilat 6 mg Tab 4600 0 4600 500 4100
71 Betametason Krim 0,1% Tube 0 0 0 0 0
72 Biocombin 5000 Inj Ampul 0 0 0 0 0
73 Bionemi Tab 0 0 0 0 0
74 Bisoprolol 5 mg Tab 0 0 0 0 0
75 Blood Lancets 26 G Dos 0 0 0 0 0
76 Blood Lancets 28 G Dos 22 0 22 2 20
77 Buscopan Inj 20 mg/ ml Ampul 10 0 10 10 0
78 Calcium Gluconate Inj 100 mg/ml Ampul 17 0 17 0 17
79 Calsium Laktat (Calac) 500 mg Tab 0 0 0 0 0
80 Calxyl Radiopaque Buah 3 0 3 0 3
81 Candesartan Cilexetil 8 mg Tab 300 0 300 150 150
82 Captopril 12,5 mg Tab 2200 0 2200 1800 400
83 Captopril 25 mg Tab 7700 0 7700 1500 6200
84 Carbamazepin 200 mg Tab 0 0 0 0 0
85 Catapres Inj Ampul 10 0 10 0 10
86 Catarlent T Mata Botol 0 0 0 0 0
87 Catgut Chromic No. 2/0 Pcs 0 0 0 0 0
88 Catgut Chromic No. 3/0 Pcs 0 0 0 0 0
89 Catgut Chromic No. 4/0 Pcs 0 0 0 0 0
90 Catgut Chromik usp:2/0 100 M Dos 0 0 0 0 0
91 Catgut Plain 2/0 HR 37 MM Pcs 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
92 Catgut Plain 3/0 HR 26 MM Pcs 0 0 0 0 0
93 Catgut Plain 4/0 Pcs 0 0 0 0 0
94 Cathejell Lido 2% & CHG 0,05 % Flacon 0 0 0 0 0
95 Cavit (Bahan Tump Sementara) Dos 34 0 34 0 34
96 Cefadroxil 500 mg Tab 2300 0 2300 1500 800
97 Cefadroxil Syr 125 mg/ 5 ml Botol 0 0 0 0 0
98 Cendo Xytrol T. Mata Botol 175 0 175 10 165
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
99 Cetirizine 10 mg Tab 3500 0 3500 1900 1600
100 Cetirizine Syr 5 mg/ 5 ml Botol 135 0 135 30 105
101 Chloramphenicol (Chloramex) 500 mg Tab 5600 0 5600 200 5400
102 Chloramphenicol (Novachlor) 250 mg Tab 1600 0 1600 0 1600
103 Chloramphenicol Salep Mata 1% Tube 111 0 111 48 63
104 Chloramphenicol Suspensi Botol 150 0 150 0 150
105 Chloramphenicol T. Mata 0,5% Tube 0 0 0 0 0
106 Chloramphenicol T. Telinga 3% Botol 2 0 2 2 0
107 Chlorfeniramin Maleat 4 mg Tab 23000 0 23000 1000 22000
108 Chlorpromazin 100 mg Tab 277 0 277 2 275
109 Chlorpromazin 25 mg Tab 0 0 0 0 0
110 Chlorpromazin Inj 5mg/ml Ampul 0 0 0 0 0
111 Cimetidin 200 mg Tab 0 0 0 0 0
112 Citicoline 500 mg Tab 0 0 0 0 0
113 Clobasam 10 mg Tab 98 0 98 98 0
114 Clonidine 0,15 mg Tab 0 0 0 0 0
115 Clopidogrel 75 mg Tab 0 0 0 0 0
116 Codein 10 mg Tab 3860 0 3860 30 3830
117 Colcitine 0,5 mg Tab 2010 0 2010 300 1710
118 Combivent Nebulizer Flacon 0 0 0 0 0
119 Cotrimoxazol 480 mg Tab 100 500 600 200 400
120 Cotrimoxazol Pediatrik Tab 0 0 0 0 0
121 Cotrimoxazol Susp Botol 105 0 105 20 85
122 Curcuma Tab 0 0 0 0 0
123 Cutimed Gel Tube 0 0 0 0 0
124 Cyanocobalamin 50 mg Tab 0 0 0 0 0
125 Cyanocobalamin Inj 500 mcg/ ml Ampul 2200 0 2200 0 2200
126 Cyprofloksasin 500 mg Tab 2300 0 2300 0 2300
127 Dexamethason 0,5 mg Tab 1100 1500 2600 1300 1300
128 Dexamethason Inj 5 mg/ml Ampul 140 0 140 10 130
129 Dextamec Tab 0 0 0 0 0
130 Diazepam 2 mg Tab 0 0 0 0 0
131 Diazepam 5 mg Tab 0 0 0 0 0
132 Diazepam Inj Ampul 48 0 48 0 48
133 Digoxin 0,25 mg Tab 0 0 0 0 0
134 Diltiazem 30 mg Tab 0 0 0 0 0
135 Dimenhydrinate 50 mg Tab 0 0 0 0 0
136 Diphenhidramin Inj Ampul 15 0 15 15 0
137 Diphenhidramin Inj (Sidiadryl) Vial 22 0 22 0 22
138 Disposible Needle No. 22 Pcs 0 0 0 0 0
139 Disposible Needle No. 23 Pcs 0 0 0 0 0
140 Domperidon 10 mg Tab 11100 0 11100 500 10600
141 Domperidon Susp 5 mg/ 5 ml Botol 805 0 805 10 795
142 Double Check (Artikulating Paper) Dos 36 0 36 0 36
143 Doxyciclin 100 mg Tab 4800 0 4800 500 4300
144 Dulcolax 5 mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
145 Dulcolax Suppo Anak Suppo 378 0 378 276 102
146 Dumin Rektal 125 mg/ 4 ml Suppo 0 0 0 0 0
147 Dumin Rektal 250 mg/4 ml Suppo 26 0 26 0 26
148 Easy Touch Colestrol Dos 0 0 0 0 0
149 Easy Touch Glukosa Dos 0 0 0 0 0
150 Easy Touch Urine Acid Dos 0 0 0 0 0
151 Eflin Tab 4800 0 4800 1200 3600
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
152 Elastis Verban 7,5 cm x 4,55 m Roll 12 0 12 5 7
153 Epinefrin Inj 1 mg/ml Ampul 155 0 155 0 155
154 Epoxidin (Pasta Pengisi Sal Akar) Dos 30 0 30 0 30
155 Erphatrim Forte 960 mg Tab 0 0 0 0 0
156 Erytromicin 250 mg Tab 0 0 0 0 0
157 Erytromicin 500 mg Tab 7100 0 7100 0 7100
158 Erytromicin Syr Botol 0 0 0 0 0
159 Etakridin (Rivanol Lar 0,1%) Botol 0 0 0 0 0
160 Etanol 70% 1 L Botol 24 0 24 0 24
161 Etanol 70% 100 ml Botol 0 0 0 0 0
162 Etanol 70% 300 ml Botol 61 0 61 0 61
163 Ethambutol 500 mg Tab 450 0 450 0 450
164 Farbion Inj Ampul 0 0 0 0 0
165 Fenilbutason (Novason) 200 mg Tab 2100 0 2100 1200 900
166 Fenobarbital 30 mg Tab 0 0 0 0 0
167 Fenobarbital Inj 50 mg/ml Ampul 0 0 0 0 0
168 Folley Catheter No. 10 FR Pcs 9 0 9 0 9
169 Folley Catheter No. 16 FR Pcs 0 0 0 0 0
170 Folley Catheter No. 18 FR Pcs 25 0 25 0 25
171 Folley Catheter No. 22 FR Pcs 69 0 69 0 69
172 Furosemid 40 mg Tab 1700 0 1700 0 1700
173 Furosemid Inj (Diuvar) Ampul 0 0 0 0 0
174 Gabapentin 300 mg Tab 330 0 330 330 0
175 Garam Oralit 200 ml Air Saset 500 0 500 100 400
176 Gelas Ukur 250 ml Buah 0 0 0 0 0
177 Gemfibrozil 300 mg Tab 1200 0 1200 480 720
178 Gentamicin Inj 40 mg/ ml Ampul 60 0 60 10 50
179 Gentamicin Salep 0,1 % Tube 0 0 0 0 0
180 Gentian Violet lar 1% Botol 190 0 190 0 190
181 Glibenclamid 5 mg Tab 2400 0 2400 0 2400
182 Glimepiride 2 mg Tab 5500 0 5500 0 5500
183 Glimepiride 3 mg Tab 0 0 0 0 0
184 Glukosa lar infus 10 % Steril Kolf 0 0 0 0 0
185 Glukosa lar infus 5 % Steril Kolf 284 0 284 25 259
186 Griseofulvin 125 mg Tab 27200 0 27200 0 27200
187 Guaifenesin 100 mg Tab 10200 0 10200 1700 8500
188 Halloperidol 0,5 mg Tab 400 0 400 0 400
189 Halloperidol 1,5 mg Tab 0 0 0 0 0
190 Halloperidol 5 mg Tab 0 0 0 0 0
191 Handscoon Genekolog 7,5 16/40 cm Pcs 160 0 160 0 160
192 Handscoon No. 6,5 Steril Pcs 0 0 0 0 0
193 Handscoon No. 7 Steril Pcs 60 0 60 50 10
194 Handscoon No. 7,5 Steril Pcs 95 0 95 60 35
195 Handscoon No. 8 Steril Pcs 310 0 310 0 310
196 Handscoon Non Steril (L) Dos 0 0 0 0 0
197 Handscoon Non Steril (M) Dos 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
198 Hemafort Tab 0 0 0 0 0
199 Hidroklortiazid 25 mg Tab 6700 0 6700 0 6700
200 Hidrokortison Krim 2,5% Tube 2857 0 2857 0 2857
201 Hyoscine N-Butylbromide (Scopamin) Tab 9600 0 9600 500 9100
202 Hyscopan Tab 0 0 0 0 0
203 Ibuprofen 200 mg Tab 0 0 0 0 0
204 Ibuprofen 400 mg Tab 8800 0 8800 2800 6000
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
205 Ibuprofen Susp 100 mg/ 5 ml Botol 0 100 100 20 80
206 Ichtiyol Salep Pot 0 0 0 0 0
207 Iliadin T. Hidung Botol 87 0 87 13 74
208 Infusion Set Anak (Micro) Pcs 225 0 225 0 225
209 Infusion Set Dewasa (Macro) Pcs 155 0 155 20 135
210 Isoniasid 100 mg Tab 0 0 0 0 0
211 Isoniazid 300 mg Tab 200 0 200 0 200
212 Isosorbid Dinitrat 5 mg Tab 2700 0 2700 500 2200
213 Jarum Kulit GT 10 Pcs 56 0 56 0 56
214 Jarum Kulit GT 11 Pcs 1 0 1 0 1
215 Jarum Kulit GT 15 Pcs 7 0 7 0 7
216 Jarum Kulit GR 13 Pcs 4 0 4 0 4
217 Jarum Otot GR 10 Pcs 0 0 0 0 0
218 Jarum Otot GR 12 Pcs 0 0 0 0 0
219 Jarum Otot GR 14 Pcs 0 0 0 0 0
220 Jarum Otot GR 15 Pcs 10 0 10 0 10
221 Kanamicin Inj Vial 0 0 0 0 0
222 Kaolimec Suspensi Botol 0 0 0 0 0
223 Kaotin Suspensi Botol 0 0 0 0 0
224 Kapas Berlemak 500 mg Buah 0 0 0 0 0
225 Kapas Pembalut 250 mg Buah 132 0 132 5 127
226 Karbamazepin 200 mg Tab 0 0 0 0 0
227 Kasa Hidrofil 4 m x 15 m Roll 0 0 0 0 0
228 Kasa Hidrofil 4 m x 5 m Roll 0 0 0 0 0
229 Kasa Kompres 40 x 80 Steril Roll 0 0 0 0 0
230 Kasa Kompres 40 x 40 Roll 0 0 0 0 0
231 Kasa Pembalut 40 x 80 m Roll 0 0 0 0 0
232 Kasa Steril 18 x 22 cm (16 x 16) Dos 40 0 40 10 30
233 Kertas EKG Roll 31 0 31 0 31
234 Kertas USG Roll 0 0 0 0 0
235 Ketokonazol 200 mg Tab 20050 0 20050 0 20050
236 Ketokonazol Krim 2 % Tube 163 0 163 25 138
237 Kolicgon Tab 0 0 0 0 0
238 Larutan H2O2 Botol 0 0 0 0 0
239 Leukoplast 2,5 cm x 4,5 m Roll 189 0 189 0 189
240 Leukoplast 7,5 cm x 4,5 m Roll 56 0 56 0 56
241 Levofloxacin 500 mg Tab 0 0 0 0 0
242 Lidocain Inj 20 mg/ 2 ml Ampul 4200 0 4200 0 4200
243 Lidocain Inj 40 mg Ampul 430 0 430 0 430
244 Lidocain Kompositum 20 mg/ 2 ml Ampul 450 0 450 0 450
245 Lisol Botol 39 0 39 0 39
246 Loperamid 2 mg Tab 0 0 0 0 0
247 Loratadin 10 mg Tab 0 0 0 0 0
248 Masker Earloop Pcs 250 0 250 150 100
249 Masker N 95 Pcs 100 0 100 0 100
250 Masker Tali Pcs 70 0 70 50 20
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
251 MDT MB Combi Dewasa Dos 0 0 0 0 0
252 Meloxicam 15 mg Tab 0 0 0 0 0
253 Metamizole Inj (Norages) Ampul 0 0 0 0 0
254 Metformin 500 mg Tab 27600 0 27600 0 27600
255 Methildopa 250 mg (Dopamet) Tab 0 0 0 0 0
256 Methylprednisolon 4 Mg Tab 0 0 0 0 0
257 Methylprednisolon 8 Mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
258 Metilergometrin 0,125 mg Tab 15700 0 15700 0 15700
259 Metilergometrin Inj.0,2 mg Ampul 60 0 60 0 60
260 Metoclopramid 10 mg Tab 4400 0 4400 800 3600
261 Metoclopramid Inj 10 mg/ 2 ml Ampul 270 0 270 0 270
262 Metoclopramide Syr (Lexapram) Botol 0 0 0 0 0
263 Metronidazol 250 mg Tab 0 0 0 0 0
264 Metronidazol 500 mg Tab 2600 0 2600 300 2300
265 Metronidazole Lat Infus Botol 13 0 13 0 13
266 MgSO4 Inj 20% - 25 ml Flacon 15 0 15 0 15
267 MgSO4 Inj 40% - 25 ml Flacon 2 0 2 0 2
268 MgSO4 Serbuk 30 gr Vial 0 0 0 0 0
269 Miconazol Krim 2 % Tube 1504 0 1504 48 1456
270 Mometason Furoate Krim 0,1 % Tube 75 0 75 0 75
271 Mortir dan Stemper 8 cm Buah 0 0 0 0 0
272 Mouth Piace Dos 0 0 0 0 0
273 Mucotussan Tab 0 0 0 0 0
274 My Jelli 82 Gram Tube 14 0 14 3 11
275 NaCl Lar infus 0,9 % Kolf 191 0 191 10 181
276 Natrium Diclofenak 25 mg Tab 9950 0 9950 1300 8650
277 Natrium Diclofenak 50 mg Tab 2800 0 2800 100 2700
278 Neurovit E Tab 360 0 360 360 0
279 Neutotropic Plus Tab 0 0 0 0 0
280 Nifedipin 10 mg Tab 1100 0 1100 0 1100
281 Nistatin 500.000 IU Tab 0 0 0 0 0
282 Nistatin 100.000 IU Tab 480 0 480 100 380
283 Nistatin Drops 100.000 IU Botol 40 0 40 0 40
284 Novadiar Syr Botol 129 0 129 0 129
285 Novadium Tab 200 0 200 200 0
286 Novampiron Tab 0 0 0 0 0
287 Novapen Syr Botol 0 0 0 0 0
288 Novastan Tab 0 0 0 0 0
289 Novotwist ( Jarum Novorapid) Dos 2 0 2 0 2
290 OAT FDC Kategori Anak Paket 0 0 0 0 0
291 OAT FDC Kategori I Dewasa Paket 0 4 4 4 0
292 OAT FDC Kategori II Dewasa Paket 0 2 2 2 0
293 OAT FDC Sisipan Dewasa Paket 0 0 0 0 0
294 Obat Batuk Hitam ( OBH ) Syr Botol 0 0 0 0 0
295 Oksitetraciclin Inj 50 ml - 10 ml Ampul 0 0 0 0 0
296 Oksitetraciclin Salep Kulit 3 % Tube 0 0 0 0 0
297 Oksitetraciclin Salep Mata 1 % Tube 195 0 195 0 195
298 Oksitosin Inj 50 ml - 10 ml Ampul 470 0 470 110 360
299 Omeprazole 20 mg Tab 2610 0 2610 900 1710
300 Ondansetron HCL Inj 4 mg/ 2 ml Ampul 85 0 85 20 65
301 Papaverin 40 mg Tab 0 0 0 0 0
302 Papaverin Inj Ampul 0 0 0 0 0
303 Paracetamol 500 mg Tab 200 1000 1200 900 300
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
304 Paracetamol Lar Infus Steril Botol 1 0 1 1 0
305 Paracetamol Syr 120 mg/ 5 ml Botol 0 0 0 0 0
306 Pehacain Inj Ampul 160 0 160 160 0
307 Periokin Spray Dos 33 0 33 0 33
308 Permanganas kalikus (PK) Pot 0 0 0 0 0
309 Phenol Gliserol T. Telinga 10% Botol 43 0 43 19 24
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
310 Phitomenadion 10 mg Tab 1100 0 1100 200 900
311 Phitomenadion Inj 10 mg/ml Ampul 162 0 162 60 102
312 Pipet Tetes Pendek Buah 0 0 0 0 0
313 Piracetam 800 mg Tab 0 0 0 0 0
314 Pirecetam 400 mg Tab 0 0 0 0 0
315 Pirecetam Inj 200 mg/ ml Ampul 0 0 0 0 0
316 Piridoxyn (Vit B6) 10 mg Tab 0 0 0 0 0
317 Piroxicam 20 mg Tab 0 0 0 0 0
318 Pisau Bedah Pcs 100 0 100 0 100
319 Plano Test Pcs 165 0 165 0 165
320 Plesterin Bulat Dos 24 0 24 2 22
321 Poligyp 5 cm x 27 cm Roll 0 0 0 0 0
322 Pot Urine Bauh 20 0 20 0 20
323 Povidon Iodida 10 % 30 ml Botol 25 0 25 10 15
324 Povidon Iodida 10 % 300 ml Botol 0 0 0 0 0
325 Povidon Iodida 10 % 60 ml Botol 0 0 0 0 0
326 Prednison 5 mg Tab 700 0 700 700 0
327 Promavit Tab 0 0 0 0 0
328 Propanolol 10 mg Tab 0 0 0 0 0
329 Propanolol 40 mg Tab 0 0 0 0 0
330 Propiltiuracil 100 mg Tab 2300 0 2300 300 2000
331 Pyrantel Pamoat 125 mg Tab 0 0 0 0 0
332 Rabipur Vaksin Dos 0 0 0 0 0
333 Rak Tabung Stainless Buah 0 0 0 0 0
334 Ramipril 5 mg Tab 0 0 0 0 0
335 Ranitidin 150 mg Tab 3200 0 3200 2100 1100
336 Ranitidin Inj 25 mg/ 2 ml Ampul 180 0 180 20 160
337 Ranitidin Inj 50 mg/ 2 ml Ampul 0 0 0 0 0
338 RDT DBD Dos 0 0 0 0 0
339 RDT Malaria Dos 0 0 0 0 0
340 Rifampisin 450 mg Tab 300 0 300 0 300
341 Rifampisin 600 mg Tab 0 0 0 0 0
342 Ringer Lactat Lar Infus Steril Kolf 80 0 80 45 35
343 Salbutamol 2 mg Tab 0 0 0 0 0
344 Salbutamol 4 mg Tab 4700 0 4700 1200 3500
345 Salep 2-4 Pot 1038 0 1038 0 1038
346 Salisil Bedak 2 % Dos 0 0 0 0 0
347 Sanbe Tears (Air Mata Buatan) Botol 0 0 0 0 0
348 Selediar Tab 0 0 0 0 0
349 Seledryil Tab 0 0 0 0 0
350 Selesbion Tab 0 0 0 0 0
351 Selkom C Tab 0 0 0 0 0
352 Selviplex Tab 0 0 0 0 0
353 Seven Seans Syr Botol 261 0 261 50 211
354 Sikat Pembersih Tabung Buah 0 0 0 0 0
355 Silk (Benang Bedah Sutra) No. 2/0 Pcs 24 0 24 0 24
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
356 Silk (Benang Bedah Sutra) No. 3/0 Pcs 12 0 12 12 0
357 Silk Braided Black usp:4/0 100 M Dos 0 0 0 0 0
358 Simvastatin 10 mg Tab 0 3360 3360 1830 1530
359 Simvastatin 20 mg Tab 0 0 0 0 0
360 Skizon Zalf Tube 78 0 78 0 78
361 Soft U-Derm Krim Tube 100 0 100 16 84
362 Sohobion Inj Ampul 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
363 Soldextam Tab 0 0 0 0 0
364 Solvita Plus Syr Botol 0 0 0 0 0
365 Spasmolit Tab 0 0 0 0 0
366 Spironolactone 100 mg Tab 0 0 0 0 0
367 Spironolactone 25 mg Tab 0 0 0 0 0
368 Stesolid Suppo 5 mg/ 2,5 ml Suppo 11 0 11 11 0
369 Stesolid Suppo 10 mg/ 2,5 ml Suppo 0 0 0 0 0
370 Stik HB Family Dr Dos 0 0 0 0 0
371 Tablet Tambah Darah Tab 0 0 0 0 0
372 Tablet Tambah Darah Neo Tab 23250 0 23250 3720 19530
373 Tabung Reaksi 25 ml Buah 0 0 0 0 0
374 Termorex Syr Botol 0 0 0 0 0
375 TesKits Boraks Kit 0 0 0 0 0
376 TesKits Formaldehid (Formalin) Kit 0 0 0 0 0
377 TesKits Methanil Yellow Kit 0 0 0 0 0
378 TesKits Rhodamine B Kit 0 0 0 0 0
379 Tetagam Vaksin Dos 5 0 5 3 2
380 Tetracyclin HCL 250 mg Tab 0 0 0 0 0
381 Tetracyclin HCL 500 mg Tab 5600 0 5600 0 5600
382 Tetrakain HCL T. Mata 0,5 % Botol 0 0 0 0 0
383 Thiamin HCL 50 mg Tab 0 0 0 0 0
384 Thiamin HCL Inj 100 ml - 1 ml Vial 1400 0 1400 290 1110
385 Tramadol 50 mg Tab 0 0 0 0 0
386 Tricresol Formalin 10 ml Botol 0 0 0 0 0
387 Triheksiphenidil HCL 2 mg Tab 1000 0 1000 0 1000
388 Truvit Syr Botol 86 0 86 55 31
389 Ultrasonic Gel 250 ml Botol 0 0 0 0 0
390 Urine Bag 1000 ml Pcs 25 0 25 0 25
391 Vaksin BCG Ampul 10 3 13 10 3
392 Pelarut BCG Vial 10 3 13 10 3
393 Vaksin Campak Rubella Vial 5 10 15 10 5
394 Pelarut Campak Rubella Ampul 5 10 15 10 5
395 Vaksin DPT HB Combo Ampul 0 23 23 20 3
396 Vaksin HB 0 (Unijek) Ampul 15 0 15 15 0
397 Vaksin IPV Ampul 0 0 0 0 0
398 Vaksin TT Bumil Ampul 8 0 8 8 0
399 Vaksin Polio Ampul 0 15 15 15 0
400 Ventolin Nebulizer Flacon 0 0 0 0 0
401 Verorab Vaksin Dos 7 0 7 0 7
402 Viccillin - SX (Ampicilin) Inj 1,5 g Vial 32 0 32 0 32
403 Vit A 100.000 IU Kapsul 0 0 0 0 0
404 Vit A 200.000 IU Kapsul 0 0 0 0 0
405 Vitamin B Kompleks Tab 3200 10000 13200 2600 10600
406 Vitamin B Kompleks Inj Vial 3 0 3 3 0
407 Zinc Dispersible 20 mg Tab 0 0 0 0 0
408 Zinc Syr 20 mg/ 5 ml Botol 225 0 225 0 225
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
409 HIV Tes Kit Strip 0 0 0 0 0
410 HBsAG Tes Kit Strip 0 0 0 0 0
411 HS Posterior Dos 4 0 4 0 4
412 Filtek Z350 XT Pcs 35 0 35 0 35
413 Pulp - X Dos 32 0 32 0 32
414 Iodium Tes Botol 5 0 5 5 0
415 Mitela (Kain SegiTiga) Pcs 0 0 0 0 0
416 Poligyp 10 cm x 2,7 m Roll 3 0 3 0 3
417 Asam Asetat 100 ml Botol 1 0 1 0 1
418 Elatomull Haft Dos 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
419 Paracetamol Drops Botol 56 0 56 56 0
420 Omeprazole 40 mg Inj Ampul 10 0 10 5 5
421 Metcovazin Cr Tube 5 0 5 0 5
422 Asam Tranexamat 500 mg Tab 0 300 300 200 100

Umum
BPJS Jamkesda Jumlah
JUMLAH KUNJUNGAN RESEP Bayar Tdk Bayar

Mengetahui/Menyetujui Yang Menyerahkan Yang Memohon Yan


Penanggung Jawab Gudang Farmasi Pet

Sahrul, SKM Arini Priyanti Kandupi, S. Farm, Apt Moh. Rizal Sumaga, SKM Mujri
Nip. 19820714 200502 1 002 Nip.19830402 200502 2 004 Nip. 19720123 199402 1 002 Nip : 19881
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
KETERANGAN :
Lembar Putih : GFK
Lembar Merah : Puskesmas
AN OBAT

: JULI 2019

Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Exp : 98
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Yang Menerima
Petugas PKM

Mujriah A.Md, Far


Nip : 19881005 201001 2 001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS

PUSKESMAS : TETE PELAPORAN BLN/PERIODE : AGUSTUS


KECAMATAN : AMPANA TETE
KABUPATEN : TOJO UNA UNA PERMINTAAN BLN/PERIODE
PROPINSI : SUL TENG

Stok Peneri Persedi Pemak Stok Permi Pemberian


No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
1 Abbocath No.18 Pcs 78 0 78 0 78
2 Abbocath No.20 Pcs 640 0 640 40 600
3 Abbocath No.22 Pcs 100 0 100 50 50
4 Abbocath No.24 Pcs 154 0 154 20 134
5 Acetylcysteine 200 mg Tab 0 0 0 0 0
6 Acyclovir 200 Mg Tab 0 0 0 0 0
7 Acyclovir 400 Mg Tab 9450 100 9550 0 9550
8 Acyclovir krim 5% Tube 225 0 225 0 225
9 Adidryl Inj Vial 0 0 0 0 0
10 Adimidon Inj Vial 0 0 0 0 0
11 Alat Autochek Unit 0 0 0 0 0
12 Alat Benechek Unit 0 0 0 0 0
13 Alat CO Analiser Unit 0 0 0 0 0
14 Alat Easy Touch Unit 0 0 0 0 0
15 Alat suntik sekali pakai 0,5 ml Pcs 30 0 30 0 30
16 Alat suntik sekali pakai 1 ml Pcs 234 0 234 0 234
17 Alat suntik sekali pakai 10 ml Pcs 0 0 0 0 0
18 Alat suntik sekali pakai 2,5 ml Pcs 0 0 0 0 0
19 Alat suntik sekali pakai 20 ml Pcs 70 0 70 0 70
20 Alat suntik sekali pakai 3 ml Pcs 60 0 60 25 35
21 Alat suntik sekali pakai 5 ml Pcs 785 0 785 0 785
22 Albendazol 400 mg Tab 0 0 0 0 0
23 Alkohol Swab Dos 12 0 12 1 11
24 Alletrol T. Mata Botol 0 0 0 0 0
25 Allopurinol 100 mg Tab 1500 100 1600 100 1500
26 Allopurinol 300 mg Tab 1440 0 1440 0 1440
27 Alprazolam 0,5 mg Tab 0 0 0 0 0
28 Alprazolam 1 mg Tab 971 0 971 67 904
29 Ambroxol 30 mg Tab 0 0 0 0 0
30 Ambroxol Syr 15mg/ 5 ml Botol 0 0 0 0 0
31 Amitriptilin 25 mg Tab 1000 0 1000 0 1000
32 Amlodiphin 10 mg Tab 0 0 0 0 0
33 Amlodiphin 5 mg Tab 0 0 0 0 0
34 Amoxycillin 250 mg Tab 0 0 0 0 0
35 Amoxycillin 500 mg Tab 6100 1600 7700 5200 2500
36 Amoxycillin Syr 125 mg/ 5 ml Botol 145 60 205 115 90
37 Ampicillin 500 mg Tab 0 100 100 100 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
38 Ampicillin Inj Vial 0 0 0 0 0
39 Ampicillin Syrup 125 mg/ 5 ml Botol 0 0 0 0 0
40 Analog Long Insulin (Levemir) Pen 0 0 0 0 0
41 Antalgin 500 mg Tab 0 0 0 0 0
42 Antalgin Inj 250 mg/ml Ampul 0 0 0 0 0
43 Antasida Doen 500 mg Tab 26900 300 27200 1000 26200
44 Antasida Doen Susp Botol 50 30 80 45 35
45 Anti Hemoroid Doen Kombinasi Suppo 285 0 285 0 285
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
46 Antiseptik Hand Botol 40 0 40 4 36
47 Antrain Inj Ampul 0 0 0 0 0
48 Aqua Pro Injeksi Vial 110 0 110 10 100
49 Aquadest 20 L Galon 2 0 2 0 2
50 As Asetil Salisilat 80 mg (Miniaspi) Tab 1400 0 1400 0 1400
51 Asam Askorbat (Vit C) 50 mg Tab 11200 2300 13500 3300 10200
52 Asam Folac Tab 0 0 0 0 0
53 Asam Mefenamat 500 mg Tab 14900 0 14900 3900 11000
54 Asam Tranexamat Inj 50 mg/ ml Ampul 0 0 0 0 0
55 Asetosal 100 mg Tab 0 0 0 0 0
56 Asetosal 500 mg Tab 0 0 0 0 0
57 Aspar K Tab 0 0 0 0 0
58 Atorvastatin Calsium 10 Mg Tab 0 60 60 60 0
59 Atropin Inj 0,25 mg Ampul 121 0 121 0 121
60 Atrovent Inhaler Botol 55 0 55 0 55
61 Attapulgit (New Antides) Tab 0 0 0 0 0
62 Autocheck Cholesterol Dos 0 0 0 0 0
63 Autocheck Glucosa Dos 0 0 0 0 0
64 Autocheck Urin Acid Dos 0 0 0 0 0
65 Bacitracin Polimixyn B Salep Tube 0 0 0 0 0
66 Batang Pengaduk Buah 0 0 0 0 0
67 Benecheck Colesterol Dos 0 0 0 0 0
68 Benecheck Glucosa Dos 0 0 0 0 0
69 Benecheck Urin Acid Dos 2 0 2 0 2
70 Betahistin Mesilat 6 mg Tab 4100 500 4600 500 4100
71 Betametason Krim 0,1% Tube 0 0 0 0 0
72 Biocombin 5000 Inj Ampul 0 0 0 0 0
73 Bionemi Tab 0 0 0 0 0
74 Bisoprolol 5 mg Tab 0 0 0 0
75 Blood Lancets 26 G Dos 0 0 0 0 0
76 Blood Lancets 28 G Dos 20 1 21 0 21
77 Buscopan Inj 20 mg/ ml Ampul 0 0 0 0 0
78 Calcium Gluconate Inj 100 mg/ml Ampul 17 0 17 0 17
79 Calsium Laktat (Calac) 500 mg Tab 0 0 0 0 0
80 Calxyl Radiopaque Buah 3 0 3 0 3
81 Candesartan Cilexetil 8 mg Tab 150 690 840 150 690
82 Captopril 12,5 mg Tab 400 5000 5400 1400 4000
83 Captopril 25 mg Tab 6200 300 6500 500 6000
84 Carbamazepin 200 mg Tab 0 0 0 0 0
85 Catapres Inj Ampul 10 0 10 0 10
86 Catarlent T Mata Botol 0 0 0 0 0
87 Catgut Chromic No. 2/0 Pcs 0 0 0 0 0
88 Catgut Chromic No. 3/0 Pcs 0 0 0 0 0
89 Catgut Chromic No. 4/0 Pcs 0 0 0 0 0
90 Catgut Chromik usp:2/0 100 M Dos 0 0 0 0 0
91 Catgut Plain 2/0 HR 37 MM Pcs 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
92 Catgut Plain 3/0 HR 26 MM Pcs 0 0 0 0 0
93 Catgut Plain 4/0 Pcs 0 0 0 0 0
94 Cathejell Lido 2% & CHG 0,05 % Flacon 0 0 0 0 0
95 Cavit (Bahan Tump Sementara) Dos 34 0 34 0 34
96 Cefadroxil 500 mg Tab 800 1500 2300 1000 1300
97 Cefadroxil Syr 125 mg/ 5 ml Botol 0 0 0 0 0
98 Cendo Xytrol T. Mata Botol 165 0 165 38 127
99 Cetirizine 10 mg Tab 1600 0 1600 900 700
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
100 Cetirizine Syr 5 mg/ 5 ml Botol 105 105 50 55
101 Chloramphenicol (Chloramex) 500 mg Tab 5400 0 5400 0 5400
102 Chloramphenicol (Novachlor) 250 mg Tab 1600 0 1600 500 1100
103 Chloramphenicol Salep Mata 1% Tube 63 24 87 0 87
104 Chloramphenicol Suspensi Botol 150 0 150 0 150
105 Chloramphenicol T. Mata 0,5% Tube 0 0 0 0 0
106 Chloramphenicol T. Telinga 3% Botol 0 0 0 0 0
107 Chlorfeniramin Maleat 4 mg Tab 22000 500 22500 1800 20700
108 Chlorpromazin 100 mg Tab 275 0 275 0 275
109 Chlorpromazin 25 mg Tab 0 0 0 0 0
110 Chlorpromazin Inj 5mg/ml Ampul 0 0 0 0 0
111 Cimetidin 200 mg Tab 0 0 0 0 0
112 Citicoline 500 mg Tab 0 0 0 0 0
113 Clobasam 10 mg Tab 0 0 0 0 0
114 Clonidine 0,15 mg Tab 0 0 0 0 0
115 Clopidogrel 75 mg Tab 0 0 0 0 0
116 Codein 10 mg Tab 3830 0 3830 0 3830
117 Colcitine 0,5 mg Tab 1710 90 1800 840 960
118 Combivent Nebulizer Flacon 0 0 0 0 0
119 Cotrimoxazol 480 mg Tab 400 300 700 400 300
120 Cotrimoxazol Pediatrik Tab 0 0 0 0 0
121 Cotrimoxazol Susp Botol 85 7 92 35 57
122 Curcuma Tab 0 0 0 0 0
123 Cutimed Gel Tube 0 0 0 0 0
124 Cyanocobalamin 50 mg Tab 0 0 0 0 0
125 Cyanocobalamin Inj 500 mcg/ ml Ampul 2200 0 2200 50 2150
126 Cyprofloksasin 500 mg Tab 2300 300 2600 500 2100
127 Dexamethason 0,5 mg Tab 1300 3000 4300 2300 2000
128 Dexamethason Inj 5 mg/ml Ampul 130 0 130 5 125
129 Dextamec Tab 0 0 0 0 0
130 Diazepam 2 mg Tab 0 0 0 0 0
131 Diazepam 5 mg Tab 0 0 0 0 0
132 Diazepam Inj Ampul 48 0 48 0 48
133 Digoxin 0,25 mg Tab 0 0 0 0 0
134 Diltiazem 30 mg Tab 0 0 0 0 0
135 Dimenhydrinate 50 mg Tab 0 0 0 0 0
136 Diphenhidramin Inj Ampul 0 0 0 0 0
137 Diphenhidramin Inj (Sidiadryl) Vial 22 2 24 2 22
138 Disposible Needle No. 22 Pcs 0 0 0 0 0
139 Disposible Needle No. 23 Pcs 0 0 0 0 0
140 Domperidon 10 mg Tab 10600 1060 11660 300 11360
141 Domperidon Susp 5 mg/ 5 ml Botol 795 0 795 0 795
142 Double Check (Artikulating Paper) Dos 36 0 36 0 36
143 Doxyciclin 100 mg Tab 4300 0 4300 0 4300
144 Dulcolax 5 mg Tab 0 1980 1980 0 1980
145 Dulcolax Suppo Anak Suppo 102 0 102 102 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
146 Dumin Rektal 125 mg/ 4 ml Suppo 0 0 0 0 0
147 Dumin Rektal 250 mg/4 ml Suppo 26 0 26 4 22
148 Easy Touch Colestrol Dos 0 0 0 0 0
149 Easy Touch Glukosa Dos 0 0 0 0 0
150 Easy Touch Urine Acid Dos 0 0 0 0 0
151 Eflin Tab 3600 200 3800 800 3000
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
152 Elastis Verban 7,5 cm x 4,55 m Roll 7 0 7 3 4
153 Epinefrin Inj 1 mg/ml Ampul 155 0 155 0 155
154 Epoxidin (Pasta Pengisi Sal Akar) Dos 30 0 30 0 30
155 Erphatrim Forte 960 mg Tab 0 0 0 0 0
156 Erytromicin 250 mg Tab 0 0 0 0 0
157 Erytromicin 500 mg Tab 7100 0 7100 0 7100
158 Erytromicin Syr Botol 0 0 0 0 0
159 Etakridin (Rivanol Lar 0,1%) Botol 0 4 4 0 4
160 Etanol 70% 1 L Botol 24 0 24 2 22
161 Etanol 70% 100 ml Botol 0 0 0 0 0
162 Etanol 70% 300 ml Botol 61 0 61 15 46
163 Ethambutol 500 mg Tab 450 0 450 0 450
164 Farbion Inj Ampul 0 0 0 0 0
165 Fenilbutason (Novason) 200 mg Tab 900 0 900 500 400
166 Fenobarbital 30 mg Tab 0 0 0 0 0
167 Fenobarbital Inj 50 mg/ml Ampul 0 0 0 0 0
168 Folley Catheter No. 10 FR Pcs 9 0 9 0 9
169 Folley Catheter No. 16 FR Pcs 0 0 0 0 0
170 Folley Catheter No. 18 FR Pcs 25 0 25 5 20
171 Folley Catheter No. 22 FR Pcs 69 0 69 10 59
172 Furosemid 40 mg Tab 1700 0 1700 100 1600
173 Furosemid Inj (Diuvar) Ampul 0 0 0 0 0
174 Gabapentin 300 mg Tab 0 0 0 0 0
175 Garam Oralit 200 ml Air Saset 400 300 700 0 700
176 Gelas Ukur 250 ml Buah 0 0 0 0 0
177 Gemfibrozil 300 mg Tab 720 200 920 0 920
178 Gentamicin Inj 40 mg/ ml Ampul 50 0 50 0 50
179 Gentamicin Salep 0,1 % Tube 0 0 0 0 0
180 Gentian Violet lar 1% Botol 190 0 190 0 190
181 Glibenclamid 5 mg Tab 2400 0 2400 1500 900
182 Glimepiride 2 mg Tab 5500 200 5700 1000 4700
183 Glimepiride 3 mg Tab 0 0 0 0 0
184 Glukosa lar infus 10 % Steril Kolf 0 0 0 0 0
185 Glukosa lar infus 5 % Steril Kolf 259 0 259 20 239
186 Griseofulvin 125 mg Tab 27200 0 27200 500 26700
187 Guaifenesin 100 mg Tab 8500 500 9000 800 8200
188 Halloperidol 0,5 mg Tab 400 0 400 30 370
189 Halloperidol 1,5 mg Tab 0 0 0 0 0
190 Halloperidol 5 mg Tab 0 0 0 0 0
191 Handscoon Genekolog 7,5 16/40 cm Pcs 160 0 160 0 160
192 Handscoon No. 6,5 Steril Pcs 0 0 0 0 0
193 Handscoon No. 7 Steril Pcs 10 0 10 10 0
194 Handscoon No. 7,5 Steril Pcs 35 0 35 25 10
195 Handscoon No. 8 Steril Pcs 310 0 310 105 205
196 Handscoon Non Steril (L) Dos 0 0 0 0 0
197 Handscoon Non Steril (M) Dos 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
198 Hemafort Tab 0 0 0 0 0
199 Hidroklortiazid 25 mg Tab 6700 0 6700 0 6700
200 Hidrokortison Krim 2,5% Tube 2857 0 2857 0 2857
201 Hyoscine N-Butylbromide (Scopamin) Tab 9100 1200 10300 1400 8900
202 Hyscopan Tab 0 0 0 0 0
203 Ibuprofen 200 mg Tab 0 0 0 0 0
204 Ibuprofen 400 mg Tab 6000 0 6000 3300 2700
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
205 Ibuprofen Susp 100 mg/ 5 ml Botol 80 0 80 50 30
206 Ichtiyol Salep Pot 0 0 0 0 0
207 Iliadin T. Hidung Botol 74 0 74 0 74
208 Infusion Set Anak (Micro) Pcs 225 24 249 0 249
209 Infusion Set Dewasa (Macro) Pcs 135 50 185 30 155
210 Isoniasid 100 mg Tab 0 0 0 0 0
211 Isoniazid 300 mg Tab 200 0 200 0 200
212 Isosorbid Dinitrat 5 mg Tab 2200 200 2400 0 2400
213 Jarum Kulit GT 10 Pcs 56 0 56 0 56
214 Jarum Kulit GT 11 Pcs 1 0 1 0 1
215 Jarum Kulit GT 15 Pcs 7 0 7 0 7
216 Jarum Kulit GR 13 Pcs 4 0 4 0 4
217 Jarum Otot GR 10 Pcs 0 0 0 0 0
218 Jarum Otot GR 12 Pcs 0 0 0 0 0
219 Jarum Otot GR 14 Pcs 0 0 0 0 0
220 Jarum Otot GR 15 Pcs 10 0 10 0 10
221 Kanamicin Inj Vial 0 0 0 0 0
222 Kaolimec Suspensi Botol 0 0 0 0 0
223 Kaotin Suspensi Botol 0 0 0 0 0
224 Kapas Berlemak 500 mg Buah 0 0 0 0 0
225 Kapas Pembalut 250 mg Buah 127 2 129 0 129
226 Karbamazepin 200 mg Tab 0 0 0 0 0
227 Kasa Hidrofil 4 m x 15 m Roll 0 0 0 0 0
228 Kasa Hidrofil 4 m x 5 m Roll 0 0 0 0 0
229 Kasa Kompres 40 x 80 Steril Roll 0 0 0 0 0
230 Kasa Kompres 40 x 40 Roll 0 0 0 0 0
231 Kasa Pembalut 40 x 80 m Roll 0 0 0 0 0
232 Kasa Steril 18 x 22 cm (16 x 16) Dos 30 0 30 25 5
233 Kertas EKG Roll 31 0 31 0 31
234 Kertas USG Roll 0 0 0 0 0
235 Ketokonazol 200 mg Tab 20050 0 20050 0 20050
236 Ketokonazol Krim 2 % Tube 138 0 138 0 138
237 Kolicgon Tab 0 0 0 0 0
238 Larutan H2O2 Botol 0 0 0 0 0
239 Leukoplast 2,5 cm x 4,5 m Roll 189 0 189 45 144
240 Leukoplast 7,5 cm x 4,5 m Roll 56 13 69 6 63
241 Levofloxacin 500 mg Tab 0 0 0 0 0
242 Lidocain Inj 20 mg/ 2 ml Ampul 4200 1300 5500 0 5500
243 Lidocain Inj 40 mg Ampul 430 0 430 0 430
244 Lidocain Kompositum 20 mg/ 2 ml Ampul 450 0 450 0 450
245 Lisol Botol 39 0 39 0 39
246 Loperamid 2 mg Tab 0 100 100 0 100
247 Loratadin 10 mg Tab 0 0 0 0 0
248 Masker Earloop Pcs 100 0 100 100 0
249 Masker N 95 Pcs 100 0 100 0 100
250 Masker Tali Pcs 20 0 20 20 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
251 MDT MB Combi Dewasa Dos 0 0 0 0 0
252 Meloxicam 15 mg Tab 0 0 0 0 0
253 Metamizole Inj (Norages) Ampul 0 0 0 0 0
254 Metformin 500 mg Tab 27600 0 27600 2000 25600
255 Methildopa 250 mg (Dopamet) Tab 0 0 0 0 0
256 Methylprednisolon 4 Mg Tab 0 0 0 0 0
257 Methylprednisolon 8 Mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
258 Metilergometrin 0,125 mg Tab 15700 0 15700 500 15200
259 Metilergometrin Inj.0,2 mg Ampul 60 0 60 50 10
260 Metoclopramid 10 mg Tab 3600 0 3600 0 3600
261 Metoclopramid Inj 10 mg/ 2 ml Ampul 270 0 270 0 270
262 Metoclopramide Syr (Lexapram) Botol 0 15 15 0 15
263 Metronidazol 250 mg Tab 0 0 0 0 0
264 Metronidazol 500 mg Tab 2300 0 2300 0 2300
265 Metronidazole Lat Infus Botol 13 0 13 0 13
266 MgSO4 Inj 20% - 25 ml Flacon 15 6 21 0 21
267 MgSO4 Inj 40% - 25 ml Flacon 2 0 2 0 2
268 MgSO4 Serbuk 30 gr Vial 0 0 0 0 0
269 Miconazol Krim 2 % Tube 1456 0 1456 0 1456
270 Mometason Furoate Krim 0,1 % Tube 75 0 75 0 75
271 Mortir dan Stemper 8 cm Buah 0 0 0 0 0
272 Mouth Piace Dos 0 0 0 0 0
273 Mucotussan Tab 0 0 0 0 0
274 My Jelli 82 Gram Tube 11 0 11 4 7
275 NaCl Lar infus 0,9 % Kolf 181 60 241 42 199
276 Natrium Diclofenak 25 mg Tab 8650 0 8650 1100 7550
277 Natrium Diclofenak 50 mg Tab 2700 0 2700 500 2200
278 Neurovit E Tab 0 180 180 60 120
279 Neutotropic Plus Tab 0 0 0 0 0
280 Nifedipin 10 mg Tab 1100 0 1100 400 700
281 Nistatin 500.000 IU Tab 0 0 0 0 0
282 Nistatin 100.000 IU Tab 380 0 380 0 380
283 Nistatin Drops 100.000 IU Botol 40 0 40 0 40
284 Novadiar Syr Botol 129 0 129 0 129
285 Novadium Tab 0 0 0 0 0
286 Novampiron Tab 0 0 0 0 0
287 Novapen Syr Botol 0 0 0 0 0
288 Novastan Tab 0 0 0 0 0
289 Novotwist ( Jarum Novorapid) Dos 2 0 2 0 2
290 OAT FDC Kategori Anak Paket 0 0 0 0 0
291 OAT FDC Kategori I Dewasa Paket 0 0 0 0 0
292 OAT FDC Kategori II Dewasa Paket 0 0 0 0 0
293 OAT FDC Sisipan Dewasa Paket 0 0 0 0 0
294 Obat Batuk Hitam ( OBH ) Syr Botol 0 0 0 0 0
295 Oksitetraciclin Inj 50 ml - 10 ml Ampul 0 0 0 0 0
296 Oksitetraciclin Salep Kulit 3 % Tube 0 0 0 0 0
297 Oksitetraciclin Salep Mata 1 % Tube 195 0 195 0 195
298 Oksitosin Inj 50 ml - 10 ml Ampul 360 0 360 0 360
299 Omeprazole 20 mg Tab 1710 0 1710 1200 510
300 Ondansetron HCL Inj 4 mg/ 2 ml Ampul 65 0 65 0 65
301 Papaverin 40 mg Tab 0 0 0 0 0
302 Papaverin Inj Ampul 0 0 0 0 0
303 Paracetamol 500 mg Tab 300 300 600 600 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
304 Paracetamol Lar Infus Steril Botol 0 0 0 0 0
305 Paracetamol Syr 120 mg/ 5 ml Botol 0 0 0 0 0
306 Pehacain Inj Ampul 0 0 0 0 0
307 Periokin Spray Dos 33 0 33 0 33
308 Permanganas kalikus (PK) Pot 0 0 0 0 0
309 Phenol Gliserol T. Telinga 10% Botol 24 0 24 0 24
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
310 Phitomenadion 10 mg Tab 900 100 1000 400 600
311 Phitomenadion Inj 10 mg/ml Ampul 102 120 222 50 172
312 Pipet Tetes Pendek Buah 0 0 0 0 0
313 Piracetam 800 mg Tab 0 0 0 0 0
314 Pirecetam 400 mg Tab 0 0 0 0 0
315 Pirecetam Inj 200 mg/ ml Ampul 0 0 0 0 0
316 Piridoxyn (Vit B6) 10 mg Tab 0 0 0 0 0
317 Piroxicam 20 mg Tab 0 0 0 0 0
318 Pisau Bedah Pcs 100 0 100 0 100
319 Plano Test Pcs 165 180 345 60 285
320 Plesterin Bulat Dos 22 6 28 0 28
321 Poligyp 5 cm x 27 cm Roll 0 0 0 0 0
322 Pot Urine Bauh 20 0 20 0 20
323 Povidon Iodida 10 % 30 ml Botol 15 50 65 2 63
324 Povidon Iodida 10 % 300 ml Botol 0 0 0 0 0
325 Povidon Iodida 10 % 60 ml Botol 0 0 0 0 0
326 Prednison 5 mg Tab 0 0 0 0 0
327 Promavit Tab 0 0 0 0 0
328 Propanolol 10 mg Tab 0 0 0 0 0
329 Propanolol 40 mg Tab 0 0 0 0 0
330 Propiltiuracil 100 mg Tab 2000 0 2000 1000 1000
331 Pyrantel Pamoat 125 mg Tab 0 0 0 0 0
332 Rabipur Vaksin Dos 0 0 0 0 0
333 Rak Tabung Stainless Buah 0 0 0 0 0
334 Ramipril 5 mg Tab 0 0 0 0 0
335 Ranitidin 150 mg Tab 1100 0 1100 0 1100
336 Ranitidin Inj 25 mg/ 2 ml Ampul 160 200 360 10 350
337 Ranitidin Inj 50 mg/ 2 ml Ampul 0 0 0 0 0
338 RDT DBD Dos 0 0 0 0 0
339 RDT Malaria Dos 0 0 0 0 0
340 Rifampisin 450 mg Tab 300 0 300 0 300
341 Rifampisin 600 mg Tab 0 0 0 0 0
342 Ringer Lactat Lar Infus Steril Kolf 35 100 135 55 80
343 Salbutamol 2 mg Tab 0 0 0 0 0
344 Salbutamol 4 mg Tab 3500 600 4100 0 4100
345 Salep 2-4 Pot 1038 0 1038 0 1038
346 Salisil Bedak 2 % Dos 0 0 0 0 0
347 Sanbe Tears (Air Mata Buatan) Botol 0 0 0 0 0
348 Selediar Tab 0 0 0 0 0
349 Seledryil Tab 0 0 0 0 0
350 Selesbion Tab 0 0 0 0 0
351 Selkom C Tab 0 0 0 0 0
352 Selviplex Tab 0 0 0 0 0
353 Seven Seans Syr Botol 211 5 216 2 214
354 Sikat Pembersih Tabung Buah 0 0 0 0 0
355 Silk (Benang Bedah Sutra) No. 2/0 Pcs 24 0 24 12 12
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
356 Silk (Benang Bedah Sutra) No. 3/0 Pcs 0 0 0 0 0
357 Silk Braided Black usp:4/0 100 M Dos 0 0 0 0 0
358 Simvastatin 10 mg Tab 1530 300 1830 1350 480
359 Simvastatin 20 mg Tab 0 0 0 0 0
360 Skizon Zalf Tube 78 0 78 24 54
361 Soft U-Derm Krim Tube 84 10 94 15 79
362 Sohobion Inj Ampul 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
363 Soldextam Tab 0 0 0 0 0
364 Solvita Plus Syr Botol 0 0 0 0 0
365 Spasmolit Tab 0 0 0 0 0
366 Spironolactone 100 mg Tab 0 0 0 0 0
367 Spironolactone 25 mg Tab 0 0 0 0 0
368 Stesolid Suppo 5 mg/ 2,5 ml Suppo 0 0 0 0 0
369 Stesolid Suppo 10 mg/ 2,5 ml Suppo 0 0 0 0 0
370 Stik HB Family Dr Dos 0 0 0 0 0
371 Tablet Tambah Darah Tab 0 0 0 0 0
372 Tablet Tambah Darah Neo Tab 19530 4320 23850 4440 19410
373 Tabung Reaksi 25 ml Buah 0 0 0 0 0
374 Termorex Syr Botol 0 0 0 0 0
375 TesKits Boraks Kit 0 0 0 0 0
376 TesKits Formaldehid (Formalin) Kit 0 0 0 0 0
377 TesKits Methanil Yellow Kit 0 0 0 0 0
378 TesKits Rhodamine B Kit 0 0 0 0 0
379 Tetagam Vaksin Dos 2 10 12 4 8
380 Tetracyclin HCL 250 mg Tab 0 0 0 0 0
381 Tetracyclin HCL 500 mg Tab 5600 0 5600 0 5600
382 Tetrakain HCL T. Mata 0,5 % Botol 0 0 0 0 0
383 Thiamin HCL 50 mg Tab 0 100 100 100 0
384 Thiamin HCL Inj 100 ml - 1 ml Vial 1110 0 1110 0 1110
385 Tramadol 50 mg Tab 0 0 0 0 0
386 Tricresol Formalin 10 ml Botol 0 0 0 0 0
387 Triheksiphenidil HCL 2 mg Tab 1000 0 1000 0 1000
388 Truvit Syr Botol 31 0 31 0 31
389 Ultrasonic Gel 250 ml Botol 0 0 0 0 0
390 Urine Bag 1000 ml Pcs 25 0 25 10 15
391 Vaksin BCG Ampul 3 0 3 0 3
392 Pelarut BCG Vial 3 0 3 0 3
393 Vaksin Campak Rubella Vial 5 0 5 0 5
394 Pelarut Campak Rubella Ampul 5 0 5 0 5
395 Vaksin DPT HB Combo Ampul 3 0 3 0 3
396 Vaksin HB 0 (Unijek) Ampul 0 0 0 0 0
397 Vaksin IPV Ampul 0 0 0 0 0
398 Vaksin TT Bumil Ampul 0 0 0 0 0
399 Vaksin Polio Ampul 0 0 0 0 0
400 Ventolin Nebulizer Flacon 0 0 0 0 0
401 Verorab Vaksin Dos 7 0 7 1 6
402 Viccillin - SX (Ampicilin) Inj 1,5 g Vial 32 0 32 0 32
403 Vit A 100.000 IU Kapsul 0 0 0 0 0
404 Vit A 200.000 IU Kapsul 0 0 0 0 0
405 Vitamin B Kompleks Tab 10600 0 10600 3800 6800
406 Vitamin B Kompleks Inj Vial 0 50 50 0 50
407 Zinc Dispersible 20 mg Tab 0 1000 1000 0 1000
408 Zinc Syr 20 mg/ 5 ml Botol 225 0 225 20 205
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
409 HIV Tes Kit Strip 0 0 0 0 0
410 HBsAG Tes Kit Strip 0 0 0 0 0
411 HS Posterior Dos 4 0 4 0 4
412 Filtek Z350 XT Pcs 35 0 35 0 35
413 Pulp - X Dos 32 0 32 0 32
414 Iodium Tes Botol 0 0 0 0 0
415 Mitela (Kain SegiTiga) Pcs 0 0 0 0 0
416 Poligyp 10 cm x 2,7 m Roll 3 0 3 0 3
417 Asam Asetat 100 ml Botol 1 0 1 0 1
418 Elatomull Haft Dos 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
419 Paracetamol Drops Botol 0 0 0 0 0
420 Omeprazole 40 mg Inj Ampul 5 0 5 0 5
421 Metcovazin Cr Tube 5 0 5 0 5
422 Asam Tranexamat 500 mg Tab 100 200 300 0 300
423 Nifedipin 20 mg (Adalat) Tab 0 450 450 0 450

Umum
BPJS Jamkesda Jumlah
JUMLAH KUNJUNGAN RESEP Bayar Tdk Bayar

Mengetahui/Menyetujui Yang Menyerahkan Yang Memohon Yan


Penanggung Jawab Gudang Farmasi Pe

Sahrul, SKM Arini Priyanti Kandupi, S. Farm, Apt Moh. Rizal Sumaga, SKM Mujr
Nip. 19820714 200502 1 002 Nip.19830402 200502 2 004 Nip. 19720123 199402 1 002 Nip : 1988
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
KETERANGAN :
Lembar Putih : GFK
Lembar Merah : Puskesmas
AN OBAT

: AGUSTUS 2019

Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Exp : 102
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Yang Menerima
Petugas PKM

Mujriah A.Md, Far


Nip : 19881005 201001 2 001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS

PUSKESMAS : TETE PELAPORAN BLN/PERIODE : SEPTEMB


KECAMATAN : AMPANA TETE
KABUPATEN : TOJO UNA UNA PERMINTAAN BLN/PERIODE
PROPINSI : SUL TENG

Stok Peneri Persedi Pemak Stok Permi Pemberian


No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
1 Abbocath No.18 Pcs 78 0 78 0 78
2 Abbocath No.20 Pcs 600 0 600 180 420
3 Abbocath No.22 Pcs 50 0 50 10 40
4 Abbocath No.24 Pcs 134 0 134 0 134
5 Acetylcysteine 200 mg Tab 0 0 0 0 0
6 Acyclovir 200 Mg Tab 0 0 0 0 0
7 Acyclovir 400 Mg Tab 9550 0 9550 200 9350
8 Acyclovir krim 5% Tube 225 0 225 0 225
9 Adidryl Inj Vial 0 0 0 0 0
10 Adimidon Inj Vial 0 0 0 0 0
11 Alat Autochek Unit 0 0 0 0 0
12 Alat Benechek Unit 0 0 0 0 0
13 Alat CO Analiser Unit 0 0 0 0 0
14 Alat Easy Touch Unit 0 0 0 0 0
15 Alat suntik sekali pakai 0,5 ml Pcs 30 100 130 120 10
16 Alat suntik sekali pakai 1 ml Pcs 234 0 234 0 234
17 Alat suntik sekali pakai 10 ml Pcs 0 0 0 0 0
18 Alat suntik sekali pakai 2,5 ml Pcs 0 0 0 0 0
19 Alat suntik sekali pakai 20 ml Pcs 70 0 70 0 70
20 Alat suntik sekali pakai 3 ml Pcs 35 200 235 135 100
21 Alat suntik sekali pakai 5 ml Pcs 785 0 785 330 455
22 Albendazol 400 mg Tab 0 0 0 0 0
23 Alkohol Swab Dos 11 0 11 1 10
24 Alletrol T. Mata Botol 0 0 0 0 0
25 Allopurinol 100 mg Tab 1500 0 1500 0 1500
26 Allopurinol 300 mg Tab 1440 0 1440 600 840
27 Alprazolam 0,5 mg Tab 0 0 0 0 0
28 Alprazolam 1 mg Tab 904 0 904 72 832
29 Ambroxol 30 mg Tab 0 0 0 0 0
30 Ambroxol Syr 15mg/ 5 ml Botol 0 0 0 0 0
31 Amitriptilin 25 mg Tab 1000 0 1000 0 1000
32 Amlodiphin 10 mg Tab 0 6000 6000 1230 4770
33 Amlodiphin 5 mg Tab 0 0 0 0 0
34 Amoxycillin 250 mg Tab 0 0 0 0 0
35 Amoxycillin 500 mg Tab 2500 10000 12500 3200 9300
36 Amoxycillin Syr 125 mg/ 5 ml Botol 90 120 210 55 155
37 Ampicillin 500 mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
38 Ampicillin Inj Vial 0 0 0 0 0
39 Ampicillin Syrup 125 mg/ 5 ml Botol 0 0 0 0 0
40 Analog Long Insulin (Levemir) Pen 0 0 0 0 0
41 Antalgin 500 mg Tab 0 0 0 0 0
42 Antalgin Inj 250 mg/ml Ampul 0 0 0 0 0
43 Antasida Doen 500 mg Tab 26200 0 26200 1400 24800
44 Antasida Doen Susp Botol 35 50 85 45 40
45 Anti Hemoroid Doen Kombinasi Suppo 285 0 285 0 285
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
46 Antiseptik Hand Botol 36 10 46 8 38
47 Antrain Inj Ampul 0 0 0 0 0
48 Aqua Pro Injeksi Vial 100 0 100 0 100
49 Aquadest 20 L Galon 2 0 2 0 2
50 As Asetil Salisilat 80 mg (Miniaspi) Tab 1400 0 1400 0 1400
51 Asam Askorbat (Vit C) 50 mg Tab 10200 0 10200 1600 8600
52 Asam Folac Tab 0 0 0 0 0
53 Asam Mefenamat 500 mg Tab 11000 0 11000 3200 7800
54 Asam Tranexamat Inj 50 mg/ ml Ampul 0 20 20 10 10
55 Asetosal 100 mg Tab 0 0 0 0 0
56 Asetosal 500 mg Tab 0 0 0 0 0
57 Aspar K Tab 0 0 0 0 0
58 Atorvastatin Calsium 10 Mg Tab 0 0 0 0 0
59 Atropin Inj 0,25 mg Ampul 121 0 121 0 121
60 Atrovent Inhaler Botol 55 0 55 0 55
61 Attapulgit (New Antides) Tab 0 2000 2000 1000 1000
62 Autocheck Cholesterol Dos 0 0 0 0 0
63 Autocheck Glucosa Dos 0 0 0 0 0
64 Autocheck Urin Acid Dos 0 0 0 0 0
65 Bacitracin Polimixyn B Salep Tube 0 0 0 0 0
66 Batang Pengaduk Buah 0 0 0 0 0
67 Benecheck Colesterol Dos 0 0 0 0 0
68 Benecheck Glucosa Dos 0 0 0 0 0
69 Benecheck Urin Acid Dos 2 0 2 0 2
70 Betahistin Mesilat 6 mg Tab 4100 0 4100 0 4100
71 Betametason Krim 0,1% Tube 0 0 0 0 0
72 Biocombin 5000 Inj Ampul 0 0 0 0 0
73 Bionemi Tab 0 0 0 0 0
74 Bisoprolol 5 mg Tab 0 200 200 200 0
75 Blood Lancets 26 G Dos 0 0 0 0 0
76 Blood Lancets 28 G Dos 21 0 21 2 19
77 Buscopan Inj 20 mg/ ml Ampul 0 0 0 0 0
78 Calcium Gluconate Inj 100 mg/ml Ampul 17 0 17 0 17
79 Calsium Laktat (Calac) 500 mg Tab 0 0 0 0 0
80 Calxyl Radiopaque Buah 3 0 3 0 3
81 Candesartan Cilexetil 8 mg Tab 690 0 690 150 540
82 Captopril 12,5 mg Tab 4000 0 4000 800 3200
83 Captopril 25 mg Tab 6000 0 6000 1200 4800
84 Carbamazepin 200 mg Tab 0 0 0 0 0
85 Catapres Inj Ampul 10 0 10 0 10
86 Catarlent T Mata Botol 0 0 0 0 0
87 Catgut Chromic No. 2/0 Pcs 0 0 0 0 0
88 Catgut Chromic No. 3/0 Pcs 0 36 36 34 2
89 Catgut Chromic No. 4/0 Pcs 0 60 60 36 24
90 Catgut Chromik usp:2/0 100 M Dos 0 0 0 0 0
91 Catgut Plain 2/0 HR 37 MM Pcs 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
92 Catgut Plain 3/0 HR 26 MM Pcs 0 0 0 0 0
93 Catgut Plain 4/0 Pcs 0 0 0 0 0
94 Cathejell Lido 2% & CHG 0,05 % Flacon 0 0 0 0 0
95 Cavit (Bahan Tump Sementara) Dos 34 0 34 0 34
96 Cefadroxil 500 mg Tab 1300 0 1300 500 800
97 Cefadroxil Syr 125 mg/ 5 ml Botol 0 0 0 0 0
98 Cendo Xytrol T. Mata Botol 127 0 127 0 127
99 Cetirizine 10 mg Tab 700 0 700 400 300
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
100 Cetirizine Syr 5 mg/ 5 ml Botol 55 0 55 20 35
101 Chloramphenicol (Chloramex) 500 mg Tab 5400 0 5400 300 5100
102 Chloramphenicol (Novachlor) 250 mg Tab 1100 0 1100 100 1000
103 Chloramphenicol Salep Mata 1% Tube 87 0 87 0 87
104 Chloramphenicol Suspensi Botol 150 0 150 10 140
105 Chloramphenicol T. Mata 0,5% Tube 0 0 0 0 0
106 Chloramphenicol T. Telinga 3% Botol 0 0 0 0 0
107 Chlorfeniramin Maleat 4 mg Tab 20700 0 20700 1000 19700
108 Chlorpromazin 100 mg Tab 275 0 275 5 270
109 Chlorpromazin 25 mg Tab 0 0 0 0 0
110 Chlorpromazin Inj 5mg/ml Ampul 0 0 0 0 0
111 Cimetidin 200 mg Tab 0 0 0 0 0
112 Citicoline 500 mg Tab 0 0 0 0 0
113 Clobasam 10 mg Tab 0 0 0 0 0
114 Clonidine 0,15 mg Tab 0 0 0 0 0
115 Clopidogrel 75 mg Tab 0 0 0 0 0
116 Codein 10 mg Tab 3830 0 3830 20 3810
117 Colcitine 0,5 mg Tab 960 900 1860 0 1860
118 Combivent Nebulizer Flacon 0 0 0 0 0
119 Cotrimoxazol 480 mg Tab 300 0 300 300 0
120 Cotrimoxazol Pediatrik Tab 0 0 0 0 0
121 Cotrimoxazol Susp Botol 57 0 57 10 47
122 Curcuma Tab 0 0 0 0 0
123 Cutimed Gel Tube 0 0 0 0 0
124 Cyanocobalamin 50 mg Tab 0 0 0 0 0
125 Cyanocobalamin Inj 500 mcg/ ml Ampul 2150 0 2150 40 2110
126 Cyprofloksasin 500 mg Tab 2100 0 2100 0 2100
127 Dexamethason 0,5 mg Tab 2000 2000 4000 1700 2300
128 Dexamethason Inj 5 mg/ml Ampul 125 0 125 40 85
129 Dextamec Tab 0 0 0 0 0
130 Diazepam 2 mg Tab 0 0 0 0 0
131 Diazepam 5 mg Tab 0 0 0 0 0
132 Diazepam Inj Ampul 48 0 48 1 47
133 Digoxin 0,25 mg Tab 0 0 0 0 0
134 Diltiazem 30 mg Tab 0 0 0 0 0
135 Dimenhydrinate 50 mg Tab 0 0 0 0 0
136 Diphenhidramin Inj Ampul 0 0 0 0 0
137 Diphenhidramin Inj (Sidiadryl) Vial 22 0 22 0 22
138 Disposible Needle No. 22 Pcs 0 0 0 0 0
139 Disposible Needle No. 23 Pcs 0 0 0 0 0
140 Domperidon 10 mg Tab 11360 0 11360 300 11060
141 Domperidon Susp 5 mg/ 5 ml Botol 795 0 795 50 745
142 Double Check (Artikulating Paper) Dos 36 0 36 0 36
143 Doxyciclin 100 mg Tab 4300 0 4300 0 4300
144 Dulcolax 5 mg Tab 1980 0 1980 90 1890
145 Dulcolax Suppo Anak Suppo 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
146 Dumin Rektal 125 mg/ 4 ml Suppo 0 0 0 0 0
147 Dumin Rektal 250 mg/4 ml Suppo 22 0 22 0 22
148 Easy Touch Colestrol Dos 0 0 0 0 0
149 Easy Touch Glukosa Dos 0 0 0 0 0
150 Easy Touch Urine Acid Dos 0 0 0 0 0
151 Eflin Tab 3000 0 3000 500 2500
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
152 Elastis Verban 7,5 cm x 4,55 m Roll 4 0 4 3 1
153 Epinefrin Inj 1 mg/ml Ampul 155 0 155 17 138
154 Epoxidin (Pasta Pengisi Sal Akar) Dos 30 0 30 0 30
155 Erphatrim Forte 960 mg Tab 0 0 0 0 0
156 Erytromicin 250 mg Tab 0 0 0 0 0
157 Erytromicin 500 mg Tab 7100 0 7100 0 7100
158 Erytromicin Syr Botol 0 0 0 0 0
159 Etakridin (Rivanol Lar 0,1%) Botol 4 0 4 4 0
160 Etanol 70% 1 L Botol 22 0 22 0 22
161 Etanol 70% 100 ml Botol 0 0 0 0 0
162 Etanol 70% 300 ml Botol 46 0 46 12 34
163 Ethambutol 500 mg Tab 450 0 450 0 450
164 Farbion Inj Ampul 0 0 0 0 0
165 Fenilbutason (Novason) 200 mg Tab 400 0 400 200 200
166 Fenobarbital 30 mg Tab 0 0 0 0 0
167 Fenobarbital Inj 50 mg/ml Ampul 0 0 0 0 0
168 Folley Catheter No. 10 FR Pcs 9 0 9 0 9
169 Folley Catheter No. 16 FR Pcs 0 0 0 0 0
170 Folley Catheter No. 18 FR Pcs 20 0 20 0 20
171 Folley Catheter No. 22 FR Pcs 59 0 59 0 59
172 Furosemid 40 mg Tab 1600 0 1600 0 1600
173 Furosemid Inj (Diuvar) Ampul 0 0 0 0 0
174 Gabapentin 300 mg Tab 0 0 0 0 0
175 Garam Oralit 200 ml Air Saset 700 0 700 0 700
176 Gelas Ukur 250 ml Buah 0 0 0 0 0
177 Gemfibrozil 300 mg Tab 920 0 920 0 920
178 Gentamicin Inj 40 mg/ ml Ampul 50 0 50 10 40
179 Gentamicin Salep 0,1 % Tube 0 0 0 0 0
180 Gentian Violet lar 1% Botol 190 0 190 0 190
181 Glibenclamid 5 mg Tab 900 0 900 100 800
182 Glimepiride 2 mg Tab 4700 0 4700 0 4700
183 Glimepiride 3 mg Tab 0 0 0 0 0
184 Glukosa lar infus 10 % Steril Kolf 0 0 0 0 0
185 Glukosa lar infus 5 % Steril Kolf 239 0 239 0 239
186 Griseofulvin 125 mg Tab 26700 0 26700 0 26700
187 Guaifenesin 100 mg Tab 8200 0 8200 1300 6900
188 Halloperidol 0,5 mg Tab 370 0 370 30 340
189 Halloperidol 1,5 mg Tab 0 0 0 0 0
190 Halloperidol 5 mg Tab 0 0 0 0 0
191 Handscoon Genekolog 7,5 16/40 cm Pcs 160 0 160 0 160
192 Handscoon No. 6,5 Steril Pcs 0 0 0 0 0
193 Handscoon No. 7 Steril Pcs 0 0 0 0 0
194 Handscoon No. 7,5 Steril Pcs 10 0 10 10 0
195 Handscoon No. 8 Steril Pcs 205 0 205 50 155
196 Handscoon Non Steril (L) Dos 0 0 0 0 0
197 Handscoon Non Steril (M) Dos 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
198 Hemafort Tab 0 0 0 0 0
199 Hidroklortiazid 25 mg Tab 6700 0 6700 0 6700
200 Hidrokortison Krim 2,5% Tube 2857 0 2857 0 2857
201 Hyoscine N-Butylbromide (Scopamin) Tab 8900 0 8900 0 8900
202 Hyscopan Tab 0 0 0 0 0
203 Ibuprofen 200 mg Tab 0 0 0 0 0
204 Ibuprofen 400 mg Tab 2700 0 2700 1800 900
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
205 Ibuprofen Susp 100 mg/ 5 ml Botol 30 0 30 30 0
206 Ichtiyol Salep Pot 0 0 0 0 0
207 Iliadin T. Hidung Botol 74 0 74 0 74
208 Infusion Set Anak (Micro) Pcs 249 0 249 0 249
209 Infusion Set Dewasa (Macro) Pcs 155 0 155 75 80
210 Isoniasid 100 mg Tab 0 0 0 0 0
211 Isoniazid 300 mg Tab 200 0 200 0 200
212 Isosorbid Dinitrat 5 mg Tab 2400 0 2400 0 2400
213 Jarum Kulit GT 10 Pcs 56 0 56 56 0
214 Jarum Kulit GT 11 Pcs 1 0 1 1 0
215 Jarum Kulit GT 15 Pcs 7 0 7 7 0
216 Jarum Kulit GR 13 Pcs 4 0 4 4 0
217 Jarum Otot GR 10 Pcs 0 0 0 0 0
218 Jarum Otot GR 12 Pcs 0 0 0 0 0
219 Jarum Otot GR 14 Pcs 0 0 0 0 0
220 Jarum Otot GR 15 Pcs 10 0 10 10 0
221 Kanamicin Inj Vial 0 0 0 0 0
222 Kaolimec Suspensi Botol 0 0 0 0 0
223 Kaotin Suspensi Botol 0 0 0 0 0
224 Kapas Berlemak 500 mg Buah 0 0 0 0 0
225 Kapas Pembalut 250 mg Buah 129 0 129 7 122
226 Karbamazepin 200 mg Tab 0 0 0 0 0
227 Kasa Hidrofil 4 m x 15 m Roll 0 0 0 0 0
228 Kasa Hidrofil 4 m x 5 m Roll 0 0 0 0 0
229 Kasa Kompres 40 x 80 Steril Roll 0 0 0 0 0
230 Kasa Kompres 40 x 40 Roll 0 0 0 0 0
231 Kasa Pembalut 40 x 80 m Roll 0 5 5 3 2
232 Kasa Steril 18 x 22 cm (16 x 16) Dos 5 30 35 0 35
233 Kertas EKG Roll 31 0 31 0 31
234 Kertas USG Roll 0 0 0 0 0
235 Ketokonazol 200 mg Tab 20050 0 20050 0 20050
236 Ketokonazol Krim 2 % Tube 138 0 138 5 133
237 Kolicgon Tab 0 0 0 0 0
238 Larutan H2O2 Botol 0 0 0 0 0
239 Leukoplast 2,5 cm x 4,5 m Roll 144 0 144 55 89
240 Leukoplast 7,5 cm x 4,5 m Roll 63 0 63 0 63
241 Levofloxacin 500 mg Tab 0 0 0 0 0
242 Lidocain Inj 20 mg/ 2 ml Ampul 5500 0 5500 0 5500
243 Lidocain Inj 40 mg Ampul 430 0 430 50 380
244 Lidocain Kompositum 20 mg/ 2 ml Ampul 450 0 450 0 450
245 Lisol Botol 39 0 39 0 39
246 Loperamid 2 mg Tab 100 0 100 100 0
247 Loratadin 10 mg Tab 0 0 0 0 0
248 Masker Earloop Pcs 0 0 0 0 0
249 Masker N 95 Pcs 100 0 100 20 80
250 Masker Tali Pcs 0 250 250 200 50
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
251 MDT MB Combi Dewasa Dos 0 0 0 0 0
252 Meloxicam 15 mg Tab 0 0 0 0 0
253 Metamizole Inj (Norages) Ampul 0 0 0 0 0
254 Metformin 500 mg Tab 25600 0 25600 800 24800
255 Methildopa 250 mg (Dopamet) Tab 0 0 0 0 0
256 Methylprednisolon 4 Mg Tab 0 0 0 0 0
257 Methylprednisolon 8 Mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
258 Metilergometrin 0,125 mg Tab 15200 0 15200 0 15200
259 Metilergometrin Inj.0,2 mg Ampul 10 0 10 0 10
260 Metoclopramid 10 mg Tab 3600 0 3600 0 3600
261 Metoclopramid Inj 10 mg/ 2 ml Ampul 270 0 270 10 260
262 Metoclopramide Syr (Lexapram) Botol 15 0 15 0 15
263 Metronidazol 250 mg Tab 0 0 0 0 0
264 Metronidazol 500 mg Tab 2300 0 2300 300 2000
265 Metronidazole Lat Infus Botol 13 0 13 0 13
266 MgSO4 Inj 20% - 25 ml Flacon 21 0 21 0 21
267 MgSO4 Inj 40% - 25 ml Flacon 2 0 2 0 2
268 MgSO4 Serbuk 30 gr Vial 0 0 0 0 0
269 Miconazol Krim 2 % Tube 1456 0 1456 0 1456
270 Mometason Furoate Krim 0,1 % Tube 75 0 75 0 75
271 Mortir dan Stemper 8 cm Buah 0 0 0 0 0
272 Mouth Piace Dos 0 0 0 0 0
273 Mucotussan Tab 0 0 0 0 0
274 My Jelli 82 Gram Tube 7 0 7 5 2
275 NaCl Lar infus 0,9 % Kolf 199 0 199 52 147
276 Natrium Diclofenak 25 mg Tab 7550 0 7550 200 7350
277 Natrium Diclofenak 50 mg Tab 2200 0 2200 0 2200
278 Neurovit E Tab 120 60 180 0 180
279 Neutotropic Plus Tab 0 0 0 0 0
280 Nifedipin 10 mg Tab 700 0 700 300 400
281 Nistatin 500.000 IU Tab 0 0 0 0 0
282 Nistatin 100.000 IU Tab 380 0 380 0 380
283 Nistatin Drops 100.000 IU Botol 40 0 40 0 40
284 Novadiar Syr Botol 129 0 129 0 129
285 Novadium Tab 0 0 0 0 0
286 Novampiron Tab 0 0 0 0 0
287 Novapen Syr Botol 0 0 0 0 0
288 Novastan Tab 0 0 0 0 0
289 Novotwist ( Jarum Novorapid) Dos 2 0 2 0 2
290 OAT FDC Kategori Anak Paket 0 0 0 0 0
291 OAT FDC Kategori I Dewasa Paket 0 0 0 0 0
292 OAT FDC Kategori II Dewasa Paket 0 0 0 0 0
293 OAT FDC Sisipan Dewasa Paket 0 0 0 0 0
294 Obat Batuk Hitam ( OBH ) Syr Botol 0 0 0 0 0
295 Oksitetraciclin Inj 50 ml - 10 ml Ampul 0 0 0 0 0
296 Oksitetraciclin Salep Kulit 3 % Tube 0 0 0 0 0
297 Oksitetraciclin Salep Mata 1 % Tube 195 0 195 20 175
298 Oksitosin Inj 50 ml - 10 ml Ampul 360 0 360 200 160
299 Omeprazole 20 mg Tab 510 90 600 300 300
300 Ondansetron HCL Inj 4 mg/ 2 ml Ampul 65 0 65 0 65
301 Papaverin 40 mg Tab 0 0 0 0 0
302 Papaverin Inj Ampul 0 0 0 0 0
303 Paracetamol 500 mg Tab 0 2500 2500 1000 1500
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
304 Paracetamol Lar Infus Steril Botol 0 24 24 8 16
305 Paracetamol Syr 120 mg/ 5 ml Botol 0 0 0 0 0
306 Pehacain Inj Ampul 0 0 0 0 0
307 Periokin Spray Dos 33 0 33 0 33
308 Permanganas kalikus (PK) Pot 0 0 0 0 0
309 Phenol Gliserol T. Telinga 10% Botol 24 0 24 24 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
310 Phitomenadion 10 mg Tab 600 0 600 0 600
311 Phitomenadion Inj 10 mg/ml Ampul 172 120 292 5 287
312 Pipet Tetes Pendek Buah 0 0 0 0 0
313 Piracetam 800 mg Tab 0 0 0 0 0
314 Pirecetam 400 mg Tab 0 0 0 0 0
315 Pirecetam Inj 200 mg/ ml Ampul 0 0 0 0 0
316 Piridoxyn (Vit B6) 10 mg Tab 0 0 0 0 0
317 Piroxicam 20 mg Tab 0 0 0 0 0
318 Pisau Bedah Pcs 100 0 100 0 100
319 Plano Test Pcs 285 0 285 85 200
320 Plesterin Bulat Dos 28 0 28 0 28
321 Poligyp 5 cm x 27 cm Roll 0 0 0 0 0
322 Pot Urine Bauh 20 0 20 20 0
323 Povidon Iodida 10 % 30 ml Botol 63 0 63 20 43
324 Povidon Iodida 10 % 300 ml Botol 0 0 0 0 0
325 Povidon Iodida 10 % 60 ml Botol 0 0 0 0 0
326 Prednison 5 mg Tab 0 0 0 0 0
327 Promavit Tab 0 0 0 0 0
328 Propanolol 10 mg Tab 0 0 0 0 0
329 Propanolol 40 mg Tab 0 0 0 0 0
330 Propiltiuracil 100 mg Tab 1000 0 1000 0 1000
331 Pyrantel Pamoat 125 mg Tab 0 0 0 0 0
332 Rabipur Vaksin Dos 0 0 0 0 0
333 Rak Tabung Stainless Buah 0 0 0 0 0
334 Ramipril 5 mg Tab 0 0 0 0 0
335 Ranitidin 150 mg Tab 1100 0 1100 1100 0
336 Ranitidin Inj 25 mg/ 2 ml Ampul 350 0 350 40 310
337 Ranitidin Inj 50 mg/ 2 ml Ampul 0 0 0 0 0
338 RDT DBD Dos 0 0 0 0 0
339 RDT Malaria Dos 0 0 0 0 0
340 Rifampisin 450 mg Tab 300 0 300 0 300
341 Rifampisin 600 mg Tab 0 0 0 0 0
342 Ringer Lactat Lar Infus Steril Kolf 80 0 80 80 0
343 Salbutamol 2 mg Tab 0 0 0 0 0
344 Salbutamol 4 mg Tab 4100 1000 5100 700 4400
345 Salep 2-4 Pot 1038 0 1038 0 1038
346 Salisil Bedak 2 % Dos 0 0 0 0 0
347 Sanbe Tears (Air Mata Buatan) Botol 0 0 0 0 0
348 Selediar Tab 0 0 0 0 0
349 Seledryil Tab 0 0 0 0 0
350 Selesbion Tab 0 0 0 0 0
351 Selkom C Tab 0 0 0 0 0
352 Selviplex Tab 0 0 0 0 0
353 Seven Seans Syr Botol 214 0 214 30 184
354 Sikat Pembersih Tabung Buah 0 0 0 0 0
355 Silk (Benang Bedah Sutra) No. 2/0 Pcs 12 0 12 0 12
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
356 Silk (Benang Bedah Sutra) No. 3/0 Pcs 0 0 0 0 0
357 Silk Braided Black usp:4/0 100 M Dos 0 0 0 0 0
358 Simvastatin 10 mg Tab 480 1680 2160 1020 1140
359 Simvastatin 20 mg Tab 0 0 0 0 0
360 Skizon Zalf Tube 54 0 54 0 54
361 Soft U-Derm Krim Tube 79 0 79 0 79
362 Sohobion Inj Ampul 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
363 Soldextam Tab 0 0 0 0 0
364 Solvita Plus Syr Botol 0 0 0 0 0
365 Spasmolit Tab 0 0 0 0 0
366 Spironolactone 100 mg Tab 0 0 0 0 0
367 Spironolactone 25 mg Tab 0 0 0 0 0
368 Stesolid Suppo 5 mg/ 2,5 ml Suppo 0 0 0 0 0
369 Stesolid Suppo 10 mg/ 2,5 ml Suppo 0 0 0 0 0
370 Stik HB Family Dr Dos 0 0 0 0 0
371 Tablet Tambah Darah Tab 0 0 0 0 0
372 Tablet Tambah Darah Neo Tab 19410 0 19410 4410 15000
373 Tabung Reaksi 25 ml Buah 0 0 0 0 0
374 Termorex Syr Botol 0 0 0 0 0
375 TesKits Boraks Kit 0 0 0 0 0
376 TesKits Formaldehid (Formalin) Kit 0 0 0 0 0
377 TesKits Methanil Yellow Kit 0 0 0 0 0
378 TesKits Rhodamine B Kit 0 0 0 0 0
379 Tetagam Vaksin Dos 8 0 8 2 6
380 Tetracyclin HCL 250 mg Tab 0 0 0 0 0
381 Tetracyclin HCL 500 mg Tab 5600 0 5600 500 5100
382 Tetrakain HCL T. Mata 0,5 % Botol 0 0 0 0 0
383 Thiamin HCL 50 mg Tab 0 0 0 0 0
384 Thiamin HCL Inj 100 ml - 1 ml Vial 1110 0 1110 30 1080
385 Tramadol 50 mg Tab 0 0 0 0 0
386 Tricresol Formalin 10 ml Botol 0 0 0 0 0
387 Triheksiphenidil HCL 2 mg Tab 1000 0 1000 0 1000
388 Truvit Syr Botol 31 0 31 10 21
389 Ultrasonic Gel 250 ml Botol 0 0 0 0 0
390 Urine Bag 1000 ml Pcs 15 0 15 0 15
391 Vaksin BCG Ampul 3 5 8 3 5
392 Pelarut BCG Vial 3 5 8 3 5
393 Vaksin Campak Rubella Vial 5 10 15 10 5
394 Pelarut Campak Rubella Ampul 5 10 15 10 5
395 Vaksin DPT HB Combo Ampul 3 20 23 18 5
396 Vaksin HB 0 (Unijek) Ampul 0 0 0 0 0
397 Vaksin IPV Ampul 0 0 0 0 0
398 Vaksin TT Bumil Ampul 0 10 10 7 3
399 Vaksin Polio Ampul 0 20 20 17 3
400 Ventolin Nebulizer Flacon 0 0 0 0 0
401 Verorab Vaksin Dos 6 0 6 5 1
402 Viccillin - SX (Ampicilin) Inj 1,5 g Vial 32 0 32 0 32
403 Vit A 100.000 IU Kapsul 0 0 0 0 0
404 Vit A 200.000 IU Kapsul 0 0 0 0 0
405 Vitamin B Kompleks Tab 6800 0 6800 1500 5300
406 Vitamin B Kompleks Inj Vial 50 0 50 7 43
407 Zinc Dispersible 20 mg Tab 1000 0 1000 500 500
408 Zinc Syr 20 mg/ 5 ml Botol 205 0 205 40 165
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
409 HIV Tes Kit Strip 0 0 0 0 0
410 HBsAG Tes Kit Strip 0 0 0 0 0
411 HS Posterior Dos 4 0 4 0 4
412 Filtek Z350 XT Pcs 35 0 35 0 35
413 Pulp - X Dos 32 0 32 0 32
414 Iodium Tes Botol 0 0 0 0 0
415 Mitela (Kain SegiTiga) Pcs 0 0 0 0 0
416 Poligyp 10 cm x 2,7 m Roll 3 0 3 0 3
417 Asam Asetat 100 ml Botol 1 0 1 0 1
418 Elatomull Haft Dos 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
419 Paracetamol Drops Botol 0 0 0 0 0
420 Omeprazole 40 mg Inj Ampul 5 10 15 10 5
421 Metcovazin Cr Tube 5 0 5 1 4
422 Asam Tranexamat 500 mg Tab 300 0 300 0 300
423 Nifedipin 20 mg (Adalat) Tab 450 0 450 0 450
424 Ketorolac Inj Ampul 0 100 100 20 80
425 Primaquin 15 mg Tab 0 200 200 200 0
426 Selang Oxygen Pcs 0 5 5 5 0
427 Xylocame Pump Spray Botol 0 1 1 0 1

Umum
BPJS Jamkesda Jumlah
JUMLAH KUNJUNGAN RESEP Bayar Tdk Bayar

Mengetahui/Menyetujui Yang Menyerahkan Yang Memohon Yan


Penanggung Jawab Gudang Farmasi Pe

Sahrul, SKM Arini Priyanti Kandupi, S. Farm, Apt Moh. Rizal Sumaga, SKM Mujr
Nip. 19820714 200502 1 002 Nip.19830402 200502 2 004 Nip. 19720123 199402 1 002 Nip : 1988
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
KETERANGAN :
Lembar Putih : GFK
Lembar Merah : Puskesmas
AN OBAT

: SEPTEMBER 2019

Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Yang Menerima
Petugas PKM

Mujriah A.Md, Far


Nip : 19881005 201001 2 001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS

PUSKESMAS : TETE PELAPORAN BLN/PERIODE : OKTOBER


KECAMATAN : AMPANA TETE
KABUPATEN : TOJO UNA UNA PERMINTAAN BLN/PERIODE
PROPINSI : SUL TENG

Stok Peneri Persedi Pemak Stok Permi Pemberian


No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
1 Abbocath No.18 Pcs 78 0 78 0 78
2 Abbocath No.20 Pcs 420 0 420 50 370
3 Abbocath No.22 Pcs 40 0 40 0 40
4 Abbocath No.24 Pcs 134 0 134 0 134
5 Acetylcysteine 200 mg Tab 0 0 0 0 0
6 Acyclovir 200 Mg Tab 0 0 0 0 0
7 Acyclovir 400 Mg Tab 9350 0 9350 0 9350
8 Acyclovir krim 5% Tube 225 0 225 0 225
9 Adidryl Inj Vial 0 0 0 0 0
10 Adimidon Inj Vial 0 0 0 0 0
11 Alat Autochek Unit 0 0 0 0 0
12 Alat Benechek Unit 0 0 0 0 0
13 Alat CO Analiser Unit 0 0 0 0 0
14 Alat Easy Touch Unit 0 0 0 0 0
15 Alat suntik sekali pakai 0,5 ml Pcs 10 0 10 0 10
16 Alat suntik sekali pakai 1 ml Pcs 234 0 234 0 234
17 Alat suntik sekali pakai 10 ml Pcs 0 0 0 0 0
18 Alat suntik sekali pakai 2,5 ml Pcs 0 0 0 0 0
19 Alat suntik sekali pakai 20 ml Pcs 70 0 70 0 70
20 Alat suntik sekali pakai 3 ml Pcs 100 500 600 51 549
21 Alat suntik sekali pakai 5 ml Pcs 455 0 455 50 405
22 Albendazol 400 mg Tab 0 0 0 0 0
23 Alkohol Swab Dos 10 0 10 2 8
24 Alletrol T. Mata Botol 0 0 0 0 0
25 Allopurinol 100 mg Tab 1500 1500 3000 500 2500
26 Allopurinol 300 mg Tab 840 0 840 300 540
27 Alprazolam 0,5 mg Tab 0 0 0 0 0
28 Alprazolam 1 mg Tab 832 0 832 0 832
29 Ambroxol 30 mg Tab 0 0 0 0 0
30 Ambroxol Syr 15mg/ 5 ml Botol 0 0 0 0 0
31 Amitriptilin 25 mg Tab 1000 0 1000 0 1000
32 Amlodiphin 10 mg Tab 4770 2100 6870 3330 3540
33 Amlodiphin 5 mg Tab 0 600 600 0 600
34 Amoxycillin 250 mg Tab 0 0 0 0 0
35 Amoxycillin 500 mg Tab 9300 5000 14300 4000 10300
36 Amoxycillin Syr 125 mg/ 5 ml Botol 155 0 155 85 70
37 Ampicillin 500 mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
38 Ampicillin Inj Vial 0 0 0 0 0
39 Ampicillin Syrup 125 mg/ 5 ml Botol 0 0 0 0 0
40 Analog Long Insulin (Levemir) Pen 0 0 0 0 0
41 Antalgin 500 mg Tab 0 0 0 0 0
42 Antalgin Inj 250 mg/ml Ampul 0 0 0 0 0
43 Antasida Doen 500 mg Tab 24800 0 24800 2300 22500
44 Antasida Doen Susp Botol 40 0 40 5 35
45 Anti Hemoroid Doen Kombinasi Suppo 285 0 285 0 285
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
46 Antiseptik Hand Botol 38 0 38 0 38
47 Antrain Inj Ampul 0 0 0 0 0
48 Aqua Pro Injeksi Vial 100 50 150 5 145
49 Aquadest 20 L Galon 2 0 2 0 2
50 As Asetil Salisilat 80 mg (Miniaspi) Tab 1400 0 1400 0 1400
51 Asam Askorbat (Vit C) 50 mg Tab 8600 0 8600 5400 3200
52 Asam Folac Tab 0 0 0 0 0
53 Asam Mefenamat 500 mg Tab 7800 5000 12800 3200 9600
54 Asam Tranexamat Inj 50 mg/ ml Ampul 10 50 60 3 57
55 Asetosal 100 mg Tab 0 0 0 0 0
56 Asetosal 500 mg Tab 0 0 0 0 0
57 Aspar K Tab 0 0 0 0 0
58 Atorvastatin Calsium 20 Mg Tab 0 600 600 0 600
59 Atropin Inj 0,25 mg Ampul 121 0 121 11 110
60 Atrovent Inhaler Botol 55 0 55 10 45
61 Attapulgit (New Antides) Tab 1000 3000 4000 200 3800
62 Autocheck Cholesterol Dos 0 0 0 0 0
63 Autocheck Glucosa Dos 0 0 0 0 0
64 Autocheck Urin Acid Dos 0 0 0 0 0
65 Bacitracin Polimixyn B Salep Tube 0 0 0 0 0
66 Batang Pengaduk Buah 0 0 0 0 0
67 Benecheck Colesterol Dos 0 0 0 0 0
68 Benecheck Glucosa Dos 0 0 0 0 0
69 Benecheck Urin Acid Dos 2 0 2 2 0
70 Betahistin Mesilat 6 mg Tab 4100 0 4100 600 3500
71 Betametason Krim 0,1% Tube 0 0 0 0 0
72 Biocombin 5000 Inj Ampul 0 20 20 0 20
73 Bionemi Tab 0 0 0 0 0
74 Bisoprolol 5 mg Tab 0 500 500 0 500
75 Blood Lancets 26 G Dos 0 0 0 0 0
76 Blood Lancets 28 G Dos 19 0 19 2 17
77 Buscopan Inj 20 mg/ ml Ampul 0 0 0 0 0
78 Calcium Gluconate Inj 100 mg/ml Ampul 17 0 17 10 7
79 Calsium Laktat (Calac) 500 mg Tab 0 5000 5000 0 5000
80 Calxyl Radiopaque Buah 3 0 3 0 3
81 Candesartan Cilexetil 8 mg Tab 540 450 990 0 990
82 Captopril 12,5 mg Tab 3200 1000 4200 1000 3200
83 Captopril 25 mg Tab 4800 1000 5800 900 4900
84 Carbamazepin 200 mg Tab 0 1000 1000 0 1000
85 Catapres Inj Ampul 10 0 10 10 0
86 Catarlent T Mata Botol 0 10 10 0 10
87 Catgut Chromic No. 2/0 Pcs 0 36 36 0 36
88 Catgut Chromic No. 3/0 Pcs 2 72 74 0 74
89 Catgut Chromic No. 4/0 Pcs 24 72 96 0 96
90 Catgut Chromik usp:2/0 100 M Dos 0 0 0 0 0
91 Catgut Plain 2/0 HR 37 MM Pcs 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
92 Catgut Plain 3/0 HR 26 MM Pcs 0 36 36 0 36
93 Catgut Plain 4/0 Pcs 0 0 0 0 0
94 Cathejell Lido 2% & CHG 0,05 % Flacon 0 0 0 0 0
95 Cavit (Bahan Tump Sementara) Dos 34 0 34 0 34
96 Cefadroxil 500 mg Tab 800 3000 3800 100 3700
97 Cefadroxil Syr 125 mg/ 5 ml Botol 0 0 0 0 0
98 Cendo Xytrol T. Mata Botol 127 0 127 10 117
99 Cetirizine 10 mg Tab 300 500 800 300 500
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
100 Cetirizine Syr 5 mg/ 5 ml Botol 35 200 235 0 235
101 Chloramphenicol (Chloramex) 500 mg Tab 5100 0 5100 500 4600
102 Chloramphenicol (Novachlor) 250 mg Tab 1000 1000 2000 0 2000
103 Chloramphenicol Salep Mata 1% Tube 87 0 87 0 87
104 Chloramphenicol Suspensi Botol 140 0 140 0 140
105 Chloramphenicol T. Mata 0,5% Tube 0 0 0 0 0
106 Chloramphenicol T. Telinga 3% Botol 0 100 100 25 75
107 Chlorfeniramin Maleat 4 mg Tab 19700 0 19700 2700 17000
108 Chlorpromazin 100 mg Tab 270 0 270 0 270
109 Chlorpromazin 25 mg Tab 0 0 0 0 0
110 Chlorpromazin Inj 5mg/ml Ampul 0 0 0 0 0
111 Cimetidin 200 mg Tab 0 0 0 0 0
112 Citicoline 500 mg Tab 0 0 0 0 0
113 Clobasam 10 mg Tab 0 0 0 0 0
114 Clonidine 0,15 mg Tab 0 0 0 0 0
115 Clopidogrel 75 mg Tab 0 0 0 0 0
116 Codein 10 mg Tab 3810 0 3810 0 3810
117 Colcitine 0,5 mg Tab 1860 990 2850 60 2790
118 Combivent Nebulizer Flacon 0 20 20 0 20
119 Cotrimoxazol 480 mg Tab 0 3000 3000 500 2500
120 Cotrimoxazol Pediatrik Tab 0 0 0 0 0
121 Cotrimoxazol Susp Botol 47 0 47 40 7
122 Curcuma Tab 0 200 200 0 200
123 Cutimed Gel Tube 0 0 0 0 0
124 Cyanocobalamin 50 mg Tab 0 0 0 0 0
125 Cyanocobalamin Inj 500 mcg/ ml Ampul 2110 0 2110 160 1950
126 Cyprofloksasin 500 mg Tab 2100 0 2100 0 2100
127 Dexamethason 0,5 mg Tab 2300 3000 5300 1500 3800
128 Dexamethason Inj 5 mg/ml Ampul 85 100 185 15 170
129 Dextamec Tab 0 0 0 0 0
130 Diazepam 2 mg Tab 0 500 500 0 500
131 Diazepam 5 mg Tab 0 200 200 0 200
132 Diazepam Inj Ampul 47 0 47 0 47
133 Digoxin 0,25 mg Tab 0 200 200 0 200
134 Diltiazem 30 mg Tab 0 500 500 0 500
135 Dimenhydrinate 50 mg Tab 0 0 0 0 0
136 Diphenhidramin Inj Ampul 0 90 90 0 90
137 Diphenhidramin Inj (Sidiadryl) Vial 22 0 22 8 14
138 Disposible Needle No. 22 Pcs 0 100 100 0 100
139 Disposible Needle No. 23 Pcs 0 0 0 0 0
140 Domperidon 10 mg Tab 11060 0 11060 1600 9460
141 Domperidon Susp 5 mg/ 5 ml Botol 745 0 745 10 735
142 Double Check (Artikulating Paper) Dos 36 0 36 3 33
143 Doxyciclin 100 mg Tab 4300 0 4300 0 4300
144 Dulcolax 5 mg Tab 1890 0 1890 420 1470
145 Dulcolax Suppo Anak Suppo 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
146 Dumin Rektal 125 mg/ 4 ml Suppo 0 0 0 0 0
147 Dumin Rektal 250 mg/4 ml Suppo 22 0 22 6 16
148 Easy Touch Colestrol Dos 0 4 4 0 4
149 Easy Touch Glukosa Dos 0 4 4 0 4
150 Easy Touch Urine Acid Dos 0 4 4 0 4
151 Eflin Tab 2500 0 2500 100 2400
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
152 Elastis Verban 7,5 cm x 4,55 m Roll 1 0 1 1 0
153 Epinefrin Inj 1 mg/ml Ampul 138 0 138 6 132
154 Epoxidin (Pasta Pengisi Sal Akar) Dos 30 0 30 5 25
155 Erphatrim Forte 960 mg Tab 0 0 0 0 0
156 Erytromicin 250 mg Tab 0 0 0 0 0
157 Erytromicin 500 mg Tab 7100 0 7100 0 7100
158 Erytromicin Syr Botol 0 0 0 0 0
159 Etakridin (Rivanol Lar 0,1%) Botol 0 0 0 0 0
160 Etanol 70% 1 L Botol 22 0 22 2 20
161 Etanol 70% 100 ml Botol 0 0 0 0 0
162 Etanol 70% 300 ml Botol 34 0 34 12 22
163 Ethambutol 500 mg Tab 450 0 450 0 450
164 Farbion Inj Ampul 0 0 0 0 0
165 Fenilbutason (Novason) 200 mg Tab 200 0 200 200 0
166 Fenobarbital 30 mg Tab 0 0 0 0 0
167 Fenobarbital Inj 50 mg/ml Ampul 0 0 0 0 0
168 Folley Catheter No. 10 FR Pcs 9 0 9 0 9
169 Folley Catheter No. 16 FR Pcs 0 0 0 0 0
170 Folley Catheter No. 18 FR Pcs 20 0 20 0 20
171 Folley Catheter No. 22 FR Pcs 59 0 59 0 59
172 Furosemid 40 mg Tab 1600 0 1600 0 1600
173 Furosemid Inj (Diuvar) Ampul 0 25 25 0 25
174 Gabapentin 300 mg Tab 0 0 0 0 0
175 Garam Oralit 200 ml Air Saset 700 0 700 170 530
176 Gelas Ukur 250 ml Buah 0 0 0 0 0
177 Gemfibrozil 300 mg Tab 920 0 920 120 800
178 Gentamicin Inj 40 mg/ ml Ampul 40 0 40 0 40
179 Gentamicin Salep 0,1 % Tube 0 100 100 0 100
180 Gentian Violet lar 1% Botol 190 0 190 5 185
181 Glibenclamid 5 mg Tab 800 0 800 0 800
182 Glimepiride 2 mg Tab 4700 0 4700 0 4700
183 Glimepiride 3 mg Tab 0 0 0 0 0
184 Glukosa lar infus 10 % Steril Kolf 0 0 0 0 0
185 Glukosa lar infus 5 % Steril Kolf 239 0 239 0 239
186 Griseofulvin 125 mg Tab 26700 0 26700 0 26700
187 Guaifenesin 100 mg Tab 6900 0 6900 1700 5200
188 Halloperidol 0,5 mg Tab 340 0 340 0 340
189 Halloperidol 1,5 mg Tab 0 0 0 0 0
190 Halloperidol 5 mg Tab 0 0 0 0 0
191 Handscoon Genekolog 7,5 16/40 cm Pcs 160 0 160 0 160
192 Handscoon No. 6,5 Steril Pcs 0 0 0 0 0
193 Handscoon No. 7 Steril Pcs 0 0 0 0 0
194 Handscoon No. 7,5 Steril Pcs 0 100 100 0 100
195 Handscoon No. 8 Steril Pcs 155 0 155 50 105
196 Handscoon Non Steril (L) Dos 0 0 0 0 0
197 Handscoon Non Steril (M) Dos 0 10 10 0 10
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
198 Hemafort Tab 0 0 0 0 0
199 Hidroklortiazid 25 mg Tab 6700 0 6700 0 6700
200 Hidrokortison Krim 2,5% Tube 2857 0 2857 96 2761
201 Hyoscine N-Butylbromide (Scopamin) Tab 8900 0 8900 0 8900
202 Hyscopan Tab 0 0 0 0 0
203 Ibuprofen 200 mg Tab 0 0 0 0 0
204 Ibuprofen 400 mg Tab 900 1000 1900 800 1100
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
205 Ibuprofen Susp 100 mg/ 5 ml Botol 0 500 500 150 350
206 Ichtiyol Salep Pot 0 36 36 0 36
207 Iliadin T. Hidung Botol 74 0 74 20 54
208 Infusion Set Anak (Micro) Pcs 249 0 249 0 249
209 Infusion Set Dewasa (Macro) Pcs 80 100 180 25 155
210 Isoniasid 100 mg Tab 0 0 0 0 0
211 Isoniazid 300 mg Tab 200 0 200 0 200
212 Isosorbid Dinitrat 5 mg Tab 2400 0 2400 0 2400
213 Jarum Kulit GT 10 Pcs 0 0 0 0 0
214 Jarum Kulit GT 11 Pcs 0 0 0 0 0
215 Jarum Kulit GT 15 Pcs 0 0 0 0 0
216 Jarum Kulit GR 13 Pcs 0 0 0 0 0
217 Jarum Otot GR 10 Pcs 0 0 0 0 0
218 Jarum Otot GR 12 Pcs 0 0 0 0 0
219 Jarum Otot GR 14 Pcs 0 0 0 0 0
220 Jarum Otot GR 15 Pcs 0 0 0 0 0
221 Kanamicin Inj Vial 0 0 0 0 0
222 Kaolimec Suspensi Botol 0 0 0 0 0
223 Kaotin Suspensi Botol 0 0 0 0 0
224 Kapas Berlemak 500 mg Buah 0 0 0 0 0
225 Kapas Pembalut 250 mg Buah 122 0 122 4 118
226 Karbamazepin 200 mg Tab 0 1000 1000 0 1000
227 Kasa Hidrofil 4 m x 15 m Roll 0 0 0 0 0
228 Kasa Hidrofil 4 m x 5 m Roll 0 0 0 0 0
229 Kasa Kompres 40 x 80 Steril Roll 0 0 0 0 0
230 Kasa Kompres 40 x 40 Roll 0 0 0 0 0
231 Kasa Pembalut 40 x 80 m Roll 2 10 12 0 12
232 Kasa Steril 18 x 22 cm (16 x 16) Dos 35 0 35 21 14
233 Kertas EKG Roll 31 0 31 0 31
234 Kertas USG Roll 0 0 0 0 0
235 Ketokonazol 200 mg Tab 20050 0 20050 0 20050
236 Ketokonazol Krim 2 % Tube 133 0 133 20 113
237 Kolicgon Tab 0 0 0 0 0
238 Larutan H2O2 Botol 0 0 0 0 0
239 Leukoplast 2,5 cm x 4,5 m Roll 89 0 89 10 79
240 Leukoplast 7,5 cm x 4,5 m Roll 63 0 63 0 63
241 Levofloxacin 500 mg Tab 0 0 0 0 0
242 Lidocain Inj 20 mg/ 2 ml Ampul 5500 0 5500 0 5500
243 Lidocain Inj 40 mg Ampul 380 0 380 80 300
244 Lidocain Kompositum 20 mg/ 2 ml Ampul 450 0 450 30 420
245 Lisol Botol 39 0 39 0 39
246 Loperamid 2 mg Tab 0 0 0 0 0
247 Loratadin 10 mg Tab 0 3000 3000 0 3000
248 Masker Earloop Pcs 0 250 250 0 250
249 Masker N 95 Pcs 80 0 80 0 80
250 Masker Tali Pcs 50 250 300 100 200
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
251 MDT MB Combi Dewasa Dos 0 0 0 0 0
252 Meloxicam 15 mg Tab 0 0 0 0 0
253 Metamizole Inj (Norages) Ampul 0 0 0 0 0
254 Metformin 500 mg Tab 24800 0 24800 1200 23600
255 Methildopa 250 mg (Dopamet) Tab 0 0 0 0 0
256 Methylprednisolon 4 Mg Tab 0 1000 1000 500 500
257 Methylprednisolon 8 Mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
258 Metilergometrin 0,125 mg Tab 15200 0 15200 0 15200
259 Metilergometrin Inj.0,2 mg Ampul 10 0 10 0 10
260 Metoclopramid 10 mg Tab 3600 0 3600 0 3600
261 Metoclopramid Inj 10 mg/ 2 ml Ampul 260 0 260 0 260
262 Metoclopramide Syr (Lexapram) Botol 15 0 15 10 5
263 Metronidazol 250 mg Tab 0 0 0 0 0
264 Metronidazol 500 mg Tab 2000 0 2000 800 1200
265 Metronidazole Lat Infus Botol 13 0 13 10 3
266 MgSO4 Inj 20% - 25 ml Flacon 21 0 21 0 21
267 MgSO4 Inj 40% - 25 ml Flacon 2 0 2 0 2
268 MgSO4 Serbuk 30 gr Vial 0 0 0 0 0
269 Miconazol Krim 2 % Tube 1456 0 1456 96 1360
270 Mometason Furoate Krim 0,1 % Tube 75 0 75 0 75
271 Mortir dan Stemper 8 cm Buah 0 0 0 0 0
272 Mouth Piace Dos 0 0 0 0 0
273 Mucotussan Tab 0 0 0 0 0
274 My Jelli 82 Gram Tube 2 0 2 2 0
275 NaCl Lar infus 0,9 % Kolf 147 0 147 5 142
276 Natrium Diclofenak 25 mg Tab 7350 0 7350 1600 5750
277 Natrium Diclofenak 50 mg Tab 2200 0 2200 0 2200
278 Neurovit E Tab 180 0 180 0 180
279 Neutotropic Plus Tab 0 0 0 0 0
280 Nifedipin 10 mg Tab 400 0 400 400 0
281 Nistatin 500.000 IU Tab 0 500 500 0 500
282 Nistatin 100.000 IU Tab 380 0 380 70 310
283 Nistatin Drops 100.000 IU Botol 40 0 40 0 40
284 Novadiar Syr Botol 129 0 129 5 124
285 Novadium Tab 0 0 0 0 0
286 Novampiron Tab 0 0 0 0 0
287 Novapen Syr Botol 0 0 0 0 0
288 Novastan Tab 0 0 0 0 0
289 Novotwist ( Jarum Novorapid) Dos 2 0 2 0 2
290 OAT FDC Kategori Anak Paket 0 0 0 0 0
291 OAT FDC Kategori I Dewasa Paket 0 6 6 6 0
292 OAT FDC Kategori II Dewasa Paket 0 0 0 0 0
293 OAT FDC Sisipan Dewasa Paket 0 0 0 0 0
294 Obat Batuk Hitam ( OBH ) Syr Botol 0 300 300 0 300
295 Oksitetraciclin Inj 50 ml - 10 ml Ampul 0 0 0 0 0
296 Oksitetraciclin Salep Kulit 3 % Tube 0 350 350 25 325
297 Oksitetraciclin Salep Mata 1 % Tube 175 0 175 35 140
298 Oksitosin Inj 50 ml - 10 ml Ampul 160 0 160 5 155
299 Omeprazole 20 mg Tab 300 0 300 300 0
300 Ondansetron HCL Inj 4 mg/ 2 ml Ampul 65 0 65 20 45
301 Papaverin 40 mg Tab 0 0 0 0 0
302 Papaverin Inj Ampul 0 0 0 0 0
303 Paracetamol 500 mg Tab 1500 0 1500 1200 300
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
304 Paracetamol Lar Infus Steril Botol 16 0 16 0 16
305 Paracetamol Syr 120 mg/ 5 ml Botol 0 0 0 0 0
306 Pehacain Inj Ampul 0 0 0 0 0
307 Periokin Spray Dos 33 0 33 0 33
308 Permanganas kalikus (PK) Pot 0 0 0 0 0
309 Phenol Gliserol T. Telinga 10% Botol 0 48 48 0 48
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
310 Phitomenadion 10 mg Tab 600 0 600 300 300
311 Phitomenadion Inj 10 mg/ml Ampul 287 0 287 77 210
312 Pipet Tetes Pendek Buah 0 0 0 0 0
313 Piracetam 800 mg Tab 0 0 0 0 0
314 Pirecetam 400 mg Tab 0 0 0 0 0
315 Pirecetam Inj 200 mg/ ml Ampul 0 0 0 0 0
316 Piridoxyn (Vit B6) 10 mg Tab 0 0 0 0 0
317 Piroxicam 20 mg Tab 0 0 0 0 0
318 Pisau Bedah Pcs 100 0 100 0 100
319 Plano Test Pcs 200 180 380 180 200
320 Plesterin Bulat Dos 28 0 28 1 27
321 Poligyp 5 cm x 27 cm Roll 0 0 0 0 0
322 Pot Urine Bauh 0 0 0 0 0
323 Povidon Iodida 10 % 30 ml Botol 43 0 43 10 33
324 Povidon Iodida 10 % 300 ml Botol 0 0 0 0 0
325 Povidon Iodida 10 % 60 ml Botol 0 0 0 0 0
326 Prednison 5 mg Tab 0 0 0 0 0
327 Promavit Tab 0 0 0 0 0
328 Propanolol 10 mg Tab 0 0 0 0 0
329 Propanolol 40 mg Tab 0 0 0 0 0
330 Propiltiuracil 100 mg Tab 1000 0 1000 0 1000
331 Pyrantel Pamoat 125 mg Tab 0 0 0 0 0
332 Rabipur Vaksin Dos 0 0 0 0 0
333 Rak Tabung Stainless Buah 0 0 0 0 0
334 Ramipril 5 mg Tab 0 0 0 0 0
335 Ranitidin 150 mg Tab 0 0 0 0 0
336 Ranitidin Inj 25 mg/ 2 ml Ampul 310 0 310 40 270
337 Ranitidin Inj 50 mg/ 2 ml Ampul 0 0 0 0 0
338 RDT DBD Dos 0 0 0 0 0
339 RDT Malaria Dos 0 0 0 0 0
340 Rifampisin 450 mg Tab 300 0 300 0 300
341 Rifampisin 600 mg Tab 0 0 0 0 0
342 Ringer Lactat Lar Infus Steril Kolf 0 600 600 83 517
343 Salbutamol 2 mg Tab 0 0 0 0 0
344 Salbutamol 4 mg Tab 4400 0 4400 700 3700
345 Salep 2-4 Pot 1038 0 1038 0 1038
346 Salisil Bedak 2 % Dos 0 100 100 0 100
347 Sanbe Tears (Air Mata Buatan) Botol 0 0 0 0 0
348 Selediar Tab 0 0 0 0 0
349 Seledryil Tab 0 0 0 0 0
350 Selesbion Tab 0 0 0 0 0
351 Selkom C Tab 0 0 0 0 0
352 Selviplex Tab 0 0 0 0 0
353 Seven Seans Syr Botol 184 0 184 0 184
354 Sikat Pembersih Tabung Buah 0 0 0 0 0
355 Silk (Benang Bedah Sutra) No. 2/0 Pcs 12 0 12 0 12
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
356 Silk (Benang Bedah Sutra) No. 3/0 Pcs 0 0 0 0 0
357 Silk Braided Black usp:4/0 100 M Dos 0 0 0 0 0
358 Simvastatin 10 mg Tab 1140 3360 4500 900 3600
359 Simvastatin 20 mg Tab 0 0 0 0 0
360 Skizon Zalf Tube 54 0 54 36 18
361 Soft U-Derm Krim Tube 79 0 79 5 74
362 Sohobion Inj Ampul 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
363 Soldextam Tab 0 0 0 0 0
364 Solvita Plus Syr Botol 0 0 0 0 0
365 Spasmolit Tab 0 0 0 0 0
366 Spironolactone 100 mg Tab 0 0 0 0 0
367 Spironolactone 25 mg Tab 0 0 0 0 0
368 Stesolid Suppo 5 mg/ 2,5 ml Suppo 0 0 0 0 0
369 Stesolid Suppo 10 mg/ 2,5 ml Suppo 0 0 0 0 0
370 Stik HB Family Dr Dos 0 0 0 0 0
371 Tablet Tambah Darah Tab 0 0 0 0 0
372 Tablet Tambah Darah Neo Tab 15000 0 15000 6300 8700
373 Tabung Reaksi 25 ml Buah 0 0 0 0 0
374 Termorex Syr Botol 0 0 0 0 0
375 TesKits Boraks Kit 0 0 0 0 0
376 TesKits Formaldehid (Formalin) Kit 0 0 0 0 0
377 TesKits Methanil Yellow Kit 0 0 0 0 0
378 TesKits Rhodamine B Kit 0 0 0 0 0
379 Tetagam Vaksin Dos 6 0 6 2 4
380 Tetracyclin HCL 250 mg Tab 0 0 0 0 0
381 Tetracyclin HCL 500 mg Tab 5100 0 5100 500 4600
382 Tetrakain HCL T. Mata 0,5 % Botol 0 0 0 0 0
383 Thiamin HCL 50 mg Tab 0 2000 2000 1000 1000
384 Thiamin HCL Inj 100 ml - 1 ml Vial 1080 0 1080 0 1080
385 Tramadol 50 mg Tab 0 0 0 0 0
386 Tricresol Formalin 10 ml Botol 0 0 0 0 0
387 Triheksiphenidil HCL 2 mg Tab 1000 0 1000 0 1000
388 Truvit Syr Botol 21 0 21 21 0
389 Ultrasonic Gel 250 ml Botol 0 0 0 0 0
390 Urine Bag 1000 ml Pcs 15 0 15 5 10
391 Vaksin BCG Ampul 5 0 5 0 5
392 Pelarut BCG Vial 5 0 5 0 5
393 Vaksin Campak Rubella Vial 5 0 5 0 5
394 Pelarut Campak Rubella Ampul 5 0 5 0 5
395 Vaksin DPT HB Combo Ampul 5 0 5 0 5
396 Vaksin HB 0 (Unijek) Ampul 0 0 0 0 0
397 Vaksin IPV Ampul 0 0 0 0 0
398 Vaksin TT Bumil Ampul 3 0 3 0 3
399 Vaksin Polio Ampul 3 0 3 0 3
400 Ventolin Nebulizer Flacon 0 20 20 0 20
401 Verorab Vaksin Dos 1 6 7 3 4
402 Viccillin - SX (Ampicilin) Inj 1,5 g Vial 32 0 32 12 20
403 Vit A 100.000 IU Kapsul 0 0 0 0 0
404 Vit A 200.000 IU Kapsul 0 0 0 0 0
405 Vitamin B Kompleks Tab 5300 3000 8300 3900 4400
406 Vitamin B Kompleks Inj Vial 43 0 43 20 23
407 Zinc Dispersible 20 mg Tab 500 0 500 500 0
408 Zinc Syr 20 mg/ 5 ml Botol 165 100 265 45 220
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
409 HIV Tes Kit Strip 0 100 100 100 0
410 HBsAG Tes Kit Strip 0 50 50 50 0
411 HS Posterior Dos 4 0 4 2 2
412 Filtek Z350 XT Pcs 35 0 35 4 31
413 Pulp - X Dos 32 0 32 2 30
414 Iodium Tes Botol 0 0 0 0 0
415 Mitela (Kain SegiTiga) Pcs 0 0 0 0 0
416 Poligyp 10 cm x 2,7 m Roll 3 0 3 0 3
417 Asam Asetat 100 ml Botol 1 0 1 0 1
418 Elatomull Haft Dos 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
419 Paracetamol Drops Botol 0 0 0 0 0
420 Omeprazole 40 mg Inj Ampul 5 50 55 5 50
421 Metcovazin Cr Tube 4 0 4 0 4
422 Asam Tranexamat 500 mg Tab 300 500 800 0 800
423 Nifedipin 20 mg (Adalat) Tab 450 0 450 330 120
424 Ketorolac Inj Ampul 80 0 80 20 60
425 Primaquin 15 mg Tab 0 0 0 0 0
426 Selang Oxygen Pcs 0 0 0 0 0
427 Xylocame Pump Spray Botol 1 0 1 1 0
428 Pritagesik Tab 0 2000 2000 0 2000
429 Elastis Verban 10 cm x 4,5 m Buah 0 5 5 0 5
430 Handscoon Non Steril (S) Dos 0 10 10 0 10
431 Enbatic Cr Tube 0 24 24 24 0

Umum
BPJS Jamkesda Jumlah
JUMLAH KUNJUNGAN RESEP Bayar Tdk Bayar

Mengetahui/Menyetujui Yang Menyerahkan Yang Memohon Yan


Penanggung Jawab Gudang Farmasi Pe

Sahrul, SKM Arini Priyanti Kandupi, S. Farm, Apt Moh. Rizal Sumaga, SKM Mujr
Nip. 19820714 200502 1 002 Nip.19830402 200502 2 004 Nip. 19720123 199402 1 002 Nip : 1988
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
KETERANGAN :
Lembar Putih : GFK
Lembar Merah : Puskesmas
AN OBAT

: OKTOBER 2019

Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Exp : 11
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Retur : 200
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Yang Menerima
Petugas PKM

Mujriah A.Md, Far


Nip : 19881005 201001 2 001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS

PUSKESMAS : TETE PELAPORAN BLN/PERIODE : NOVEMBE


KECAMATAN : AMPANA TETE
KABUPATEN : TOJO UNA UNA PERMINTAAN BLN/PERIODE
PROPINSI : SUL TENG

Stok Peneri Persedi Pemak Stok Permi Pemberian


No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
1 Abbocath No.18 Pcs 78 0 78 0 78
2 Abbocath No.20 Pcs 370 0 370 50 320
3 Abbocath No.22 Pcs 40 0 40 0 40
4 Abbocath No.24 Pcs 134 0 134 0 134
5 Acetylcysteine 200 mg Tab 0 0 0 0 0
6 Acyclovir 200 Mg Tab 0 500 500 0 500
7 Acyclovir 400 Mg Tab 9350 0 9350 600 8750
8 Acyclovir krim 5% Tube 225 0 225 25 200
9 Adidryl Inj Vial 0 0 0 0 0
10 Adimidon Inj Vial 0 0 0 0 0
11 Alat Autochek Unit 0 0 0 0 0
12 Alat Benechek Unit 0 0 0 0 0
13 Alat CO Analiser Unit 0 0 0 0 0
14 Alat Easy Touch Unit 0 0 0 0 0
15 Alat suntik sekali pakai 0,5 ml Pcs 10 300 310 153 157
16 Alat suntik sekali pakai 1 ml Pcs 234 300 534 0 534
17 Alat suntik sekali pakai 10 ml Pcs 0 100 100 0 100
18 Alat suntik sekali pakai 2,5 ml Pcs 0 0 0 0 0
19 Alat suntik sekali pakai 20 ml Pcs 70 0 70 0 70
20 Alat suntik sekali pakai 3 ml Pcs 549 500 1049 125 924
21 Alat suntik sekali pakai 5 ml Pcs 405 300 705 0 705
22 Albendazol 400 mg Tab 0 0 0 0 0
23 Alkohol Swab Dos 8 0 8 0 8
24 Alletrol T. Mata Botol 0 0 0 0 0
25 Allopurinol 100 mg Tab 2500 3000 5500 700 4800
26 Allopurinol 300 mg Tab 540 0 540 450 90
27 Alprazolam 0,5 mg Tab 0 0 0 0 0
28 Alprazolam 1 mg Tab 832 0 832 158 674
29 Ambroxol 30 mg Tab 0 2800 2800 100 2700
30 Ambroxol Syr 15mg/ 5 ml Botol 0 200 200 0 200
31 Amitriptilin 25 mg Tab 1000 0 1000 0 1000
32 Amlodiphin 10 mg Tab 3540 6000 9540 1620 7920
33 Amlodiphin 5 mg Tab 600 0 600 300 300
34 Amoxycillin 250 mg Tab 0 10000 10000 0 10000
35 Amoxycillin 500 mg Tab 10300 5000 15300 2400 12900
36 Amoxycillin Syr 125 mg/ 5 ml Botol 70 540 610 35 575
37 Ampicillin 500 mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
38 Ampicillin Inj Vial 0 0 0 0 0
39 Ampicillin Syrup 125 mg/ 5 ml Botol 0 0 0 0 0
40 Analog Long Insulin (Levemir) Pen 0 0 0 0 0
41 Antalgin 500 mg Tab 0 0 0 0 0
42 Antalgin Inj 250 mg/ml Ampul 0 0 0 0 0
43 Antasida Doen 500 mg Tab 22500 0 22500 1200 21300
44 Antasida Doen Susp Botol 35 0 35 35 0
45 Anti Hemoroid Doen Kombinasi Suppo 285 0 285 0 285
46 Antiseptik Hand Botol 38 80 118 4 114
47 Antrain Inj Ampul 0 0 0 0 0
48 Aqua Pro Injeksi Vial 145 0 145 0 145
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
49 Aquadest 20 L Galon 2 0 2 0 2
50 As Asetil Salisilat 80 mg (Miniaspi) Tab 1400 1000 2400 0 2400
51 Asam Askorbat (Vit C) 50 mg Tab 3200 0 3200 1700 1500
52 Asam Folac Tab 0 0 0 0 0
53 Asam Mefenamat 500 mg Tab 9600 20000 29600 3000 26600
54 Asam Tranexamat Inj 50 mg/ ml Ampul 57 0 57 0 57
55 Asetosal 100 mg Tab 0 0 0 0 0
56 Asetosal 500 mg Tab 0 0 0 0 0
57 Aspar K Tab 0 0 0 0 0
58 Atorvastatin Calsium 20 Mg Tab 600 3840 4440 300 4140
59 Atropin Inj 0,25 mg Ampul 110 0 110 0 110
60 Atrovent Inhaler Botol 45 0 45 10 35
61 Attapulgit (New Antides) Tab 3800 2800 6600 400 6200
62 Autocheck Cholesterol Dos 0 0 0 0 0
63 Autocheck Glucosa Dos 0 0 0 0 0
64 Autocheck Urin Acid Dos 0 0 0 0 0
65 Bacitracin Polimixyn B Salep Tube 0 0 0 0 0
66 Batang Pengaduk Buah 0 0 0 0 0
67 Benecheck Colesterol Dos 0 0 0 0 0
68 Benecheck Glucosa Dos 0 0 0 0 0
69 Benecheck Urin Acid Dos 0 0 0 0 0
70 Betahistin Mesilat 6 mg Tab 3500 1100 4600 600 4000
71 Betametason Krim 0,1% Tube 0 0 0 0 0
72 Biocombin 5000 Inj Ampul 20 20 40 20 20
73 Bionemi Tab 0 0 0 0 0
74 Bisoprolol 5 mg Tab 500 1800 2300 0 2300
75 Blood Lancets 26 G Dos 0 0 0 0 0
76 Blood Lancets 28 G Dos 17 20 37 0 37
77 Buscopan Inj 20 mg/ ml Ampul 0 0 0 0 0
78 Calcium Gluconate Inj 100 mg/ml Ampul 7 14 21 0 21
79 Calsium Laktat (Calac) 500 mg Tab 5000 4400 9400 2600 6800
80 Calxyl Radiopaque Buah 3 0 3 3 0
81 Candesartan Cilexetil 8 mg Tab 990 0 990 0 990
82 Captopril 12,5 mg Tab 3200 3300 6500 1400 5100
83 Captopril 25 mg Tab 4900 0 4900 1400 3500
84 Carbamazepin 200 mg Tab 1000 0 1000 10 990
85 Catapres Inj Ampul 0 0 0 0 0
86 Catarlent T Mata Botol 10 0 10 0 10
87 Catgut Chromic No. 2/0 Pcs 36 60 96 0 96
88 Catgut Chromic No. 3/0 Pcs 74 0 74 14 60
89 Catgut Chromic No. 4/0 Pcs 96 36 132 0 132
90 Catgut Chromik usp:2/0 100 M Dos 0 0 0 0 0
91 Catgut Plain 2/0 HR 37 MM Pcs 0 0 0 0 0
92 Catgut Plain 3/0 HR 26 MM Pcs 36 0 36 0 36
93 Catgut Plain 4/0 Pcs 0 0 0 0 0
94 Cathejell Lido 2% & CHG 0,05 % Flacon 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
95 Cavit (Bahan Tump Sementara) Dos 34 0 34 0 34
96 Cefadroxil 500 mg Tab 3700 0 3700 400 3300
97 Cefadroxil Syr 125 mg/ 5 ml Botol 0 200 200 0 200
98 Cendo Xytrol T. Mata Botol 117 133 250 42 208
99 Cetirizine 10 mg Tab 500 0 500 200 300
100 Cetirizine Syr 5 mg/ 5 ml Botol 235 200 435 20 415
101 Chloramphenicol (Chloramex) 500 mg Tab 4600 0 4600 100 4500
102 Chloramphenicol (Novachlor) 250 mg Tab 2000 0 2000 300 1700
103 Chloramphenicol Salep Mata 1% Tube 87 0 87 0 87
104 Chloramphenicol Suspensi Botol 140 0 140 0 140
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
105 Chloramphenicol T. Mata 0,5% Tube 0 0 0 0 0
106 Chloramphenicol T. Telinga 3% Botol 75 200 275 0 275
107 Chlorfeniramin Maleat 4 mg Tab 17000 0 17000 1000 16000
108 Chlorpromazin 100 mg Tab 270 0 270 0 270
109 Chlorpromazin 25 mg Tab 0 0 0 0 0
110 Chlorpromazin Inj 5mg/ml Ampul 0 0 0 0 0
111 Cimetidin 200 mg Tab 0 0 0 0 0
112 Citicoline 500 mg Tab 0 0 0 0 0
113 Clobasam 10 mg Tab 0 0 0 0 0
114 Clonidine 0,15 mg Tab 0 0 0 0 0
115 Clopidogrel 75 mg Tab 0 0 0 0 0
116 Codein 10 mg Tab 3810 0 3810 0 3810
117 Colcitine 0,5 mg Tab 2790 2880 5670 390 5280
118 Combivent Nebulizer Flacon 20 20 40 0 40
119 Cotrimoxazol 480 mg Tab 2500 4000 6500 700 5800
120 Cotrimoxazol Pediatrik Tab 0 0 0 0 0
121 Cotrimoxazol Susp Botol 7 300 307 0 307
122 Curcuma Tab 200 500 700 0 700
123 Cutimed Gel Tube 0 0 0 0 0
124 Cyanocobalamin 50 mg Tab 0 0 0 0 0
125 Cyanocobalamin Inj 500 mcg/ ml Ampul 1950 0 1950 120 1830
126 Cyprofloksasin 500 mg Tab 2100 0 2100 600 1500
127 Dexamethason 0,5 mg Tab 3800 3200 7000 2000 5000
128 Dexamethason Inj 5 mg/ml Ampul 170 0 170 0 170
129 Dextamec Tab 0 0 0 0 0
130 Diazepam 2 mg Tab 500 0 500 0 500
131 Diazepam 5 mg Tab 200 0 200 0 200
132 Diazepam Inj Ampul 47 0 47 47
133 Digoxin 0,25 mg Tab 200 0 200 0 200
134 Diltiazem 30 mg Tab 500 1000 1500 0 1500
135 Dimenhydrinate 50 mg Tab 0 1000 1000 0 1000
136 Diphenhidramin Inj Ampul 90 120 210 30 180
137 Diphenhidramin Inj (Sidiadryl) Vial 14 4 18 2 16
138 Disposible Needle No. 22 Pcs 100 100 200 0 200
139 Disposible Needle No. 23 Pcs 0 0 0 0 0
140 Domperidon 10 mg Tab 9460 0 9460 100 9360
141 Domperidon Susp 5 mg/ 5 ml Botol 735 0 735 70 665
142 Double Check (Artikulating Paper) Dos 33 0 33 0 33
143 Doxyciclin 100 mg Tab 4300 0 4300 0 4300
144 Dulcolax 5 mg Tab 1470 0 1470 0 1470
145 Dulcolax Suppo Anak Suppo 0 42 42 0 42
146 Dumin Rektal 125 mg/ 4 ml Suppo 0 0 0 0 0
147 Dumin Rektal 250 mg/4 ml Suppo 16 0 16 0 16
148 Easy Touch Colestrol Dos 4 1 5 0 5
149 Easy Touch Glukosa Dos 4 4 8 0 8
150 Easy Touch Urine Acid Dos 4 4 8 0 8
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
151 Eflin Tab 2400 0 2400 600 1800
152 Elastis Verban 7,5 cm x 4,55 m Roll 0 0 0 0 0
153 Epinefrin Inj 1 mg/ml Ampul 132 200 332 0 332
154 Epoxidin (Pasta Pengisi Sal Akar) Dos 25 0 25 0 25
155 Erphatrim Forte 960 mg Tab 0 0 0 0 0
156 Erytromicin 250 mg Tab 0 2000 2000 0 2000
157 Erytromicin 500 mg Tab 7100 0 7100 0 7100
158 Erytromicin Syr Botol 0 0 0 0 0
159 Etakridin (Rivanol Lar 0,1%) Botol 0 11 11 0 11
160 Etanol 70% 1 L Botol 20 0 20 0 20
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
161 Etanol 70% 100 ml Botol 0 0 0 0 0
162 Etanol 70% 300 ml Botol 22 0 22 3 19
163 Ethambutol 500 mg Tab 450 0 450 0 450
164 Farbion Inj Ampul 0 0 0 0 0
165 Fenilbutason (Novason) 200 mg Tab 0 0 0 0 0
166 Fenobarbital 30 mg Tab 0 0 0 0 0
167 Fenobarbital Inj 50 mg/ml Ampul 0 90 90 0 90
168 Folley Catheter No. 10 FR Pcs 9 10 19 0 19
169 Folley Catheter No. 16 FR Pcs 0 10 10 0 10
170 Folley Catheter No. 18 FR Pcs 20 10 30 0 30
171 Folley Catheter No. 22 FR Pcs 59 0 59 0 59
172 Furosemid 40 mg Tab 1600 0 1600 0 1600
173 Furosemid Inj (Diuvar) Ampul 25 0 25 0 25
174 Gabapentin 300 mg Tab 0 0 0 0 0
175 Garam Oralit 200 ml Air Saset 530 1000 1530 200 1330
176 Gelas Ukur 250 ml Buah 0 0 0 0 0
177 Gemfibrozil 300 mg Tab 800 0 800 0 800
178 Gentamicin Inj 40 mg/ ml Ampul 40 0 40 0 40
179 Gentamicin Salep 0,1 % Tube 100 288 388 0 388
180 Gentian Violet lar 1% Botol 185 0 185 0 185
181 Glibenclamid 5 mg Tab 800 0 800 0 800
182 Glimepiride 2 mg Tab 4700 0 4700 0 4700
183 Glimepiride 3 mg Tab 0 0 0 0 0
184 Glukosa lar infus 10 % Steril Kolf 0 0 0 0 0
185 Glukosa lar infus 5 % Steril Kolf 239 0 239 0 239
186 Griseofulvin 125 mg Tab 26700 0 26700 1000 25700
187 Guaifenesin 100 mg Tab 5200 5100 10300 3000 7300
188 Halloperidol 0,5 mg Tab 340 0 340 0 340
189 Halloperidol 1,5 mg Tab 0 0 0 0 0
190 Halloperidol 5 mg Tab 0 0 0 0 0
191 Handscoon Genekolog 7,5 16/40 cm Pcs 160 0 160 0 160
192 Handscoon No. 6,5 Steril Pcs 0 0 0 0 0
193 Handscoon No. 7 Steril Pcs 0 0 0 0 0
194 Handscoon No. 7,5 Steril Pcs 100 100 200 100 100
195 Handscoon No. 8 Steril Pcs 105 0 105 0 105
196 Handscoon Non Steril (L) Dos 0 0 0 0 0
197 Handscoon Non Steril (M) Dos 10 0 10 2 8
198 Hemafort Tab 0 0 0 0 0
199 Hidroklortiazid 25 mg Tab 6700 0 6700 0 6700
200 Hidrokortison Krim 2,5% Tube 2761 0 2761 72 2689
201 Hyoscine N-Butylbromide (Scopamin) Tab 8900 0 8900 1000 7900
202 Hyscopan Tab 0 0 0 0 0
203 Ibuprofen 200 mg Tab 0 0 0 0 0
204 Ibuprofen 400 mg Tab 1100 600 1700 800 900
205 Ibuprofen Susp 100 mg/ 5 ml Botol 350 200 550 30 520
206 Ichtiyol Salep Pot 36 0 36 0 36
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
207 Iliadin T. Hidung Botol 54 0 54 0 54
208 Infusion Set Anak (Micro) Pcs 249 0 249 0 249
209 Infusion Set Dewasa (Macro) Pcs 155 154 309 0 309
210 Isoniasid 100 mg Tab 0 0 0 0 0
211 Isoniazid 300 mg Tab 200 0 200 200 0
212 Isosorbid Dinitrat 5 mg Tab 2400 0 2400 0 2400
213 Jarum Kulit GT 10 Pcs 0 0 0 0 0
214 Jarum Kulit GT 11 Pcs 0 0 0 0 0
215 Jarum Kulit GT 15 Pcs 0 0 0 0 0
216 Jarum Kulit GR 13 Pcs 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
217 Jarum Otot GR 10 Pcs 0 0 0 0 0
218 Jarum Otot GR 12 Pcs 0 0 0 0 0
219 Jarum Otot GR 14 Pcs 0 0 0 0 0
220 Jarum Otot GR 15 Pcs 0 0 0 0 0
221 Kanamicin Inj Vial 0 0 0 0 0
222 Kaolimec Suspensi Botol 0 0 0 0 0
223 Kaotin Suspensi Botol 0 0 0 0 0
224 Kapas Berlemak 500 mg Buah 0 0 0 0 0
225 Kapas Pembalut 250 mg Buah 118 0 118 3 115
226 Karbamazepin 200 mg Tab 1000 0 1000 10 990
227 Kasa Hidrofil 4 m x 15 m Roll 0 0 0 0 0
228 Kasa Hidrofil 4 m x 5 m Roll 0 0 0 0 0
229 Kasa Kompres 40 x 80 Steril Roll 0 0 0 0 0
230 Kasa Kompres 40 x 40 Roll 0 0 0 0 0
231 Kasa Pembalut 40 x 80 m Roll 12 0 12 3 9
232 Kasa Steril 18 x 22 cm (16 x 16) Dos 14 0 14 14 0
233 Kertas EKG Roll 31 0 31 0 31
234 Kertas USG Roll 0 0 0 0 0
235 Ketokonazol 200 mg Tab 20050 0 20050 500 19550
236 Ketokonazol Krim 2 % Tube 113 100 213 15 198
237 Kolicgon Tab 0 0 0 0 0
238 Larutan H2O2 Botol 0 0 0 0 0
239 Leukoplast 2,5 cm x 4,5 m Roll 79 0 79 79 0
240 Leukoplast 7,5 cm x 4,5 m Roll 63 0 63 0 63
241 Levofloxacin 500 mg Tab 0 0 0 0 0
242 Lidocain Inj 20 mg/ 2 ml Ampul 5500 0 5500 100 5400
243 Lidocain Inj 40 mg Ampul 300 0 300 300 0
244 Lidocain Kompositum 20 mg/ 2 ml Ampul 420 0 420 0 420
245 Lisol Botol 39 0 39 0 39
246 Loperamid 2 mg Tab 0 0 0 0 0
247 Loratadin 10 mg Tab 3000 900 3900 1050 2850
248 Masker Earloop Pcs 250 200 450 150 300
249 Masker N 95 Pcs 80 0 80 0 80
250 Masker Tali Pcs 200 0 200 150 50
251 MDT MB Combi Dewasa Dos 0 0 0 0 0
252 Meloxicam 15 mg Tab 0 0 0 0 0
253 Metamizole Inj (Norages) Ampul 0 0 0 0 0
254 Metformin 500 mg Tab 23600 0 23600 300 23300
255 Methildopa 250 mg (Dopamet) Tab 0 0 0 0 0
256 Methylprednisolon 4 Mg Tab 500 0 500 300 200
257 Methylprednisolon 8 Mg Tab 0 0 0 0 0
258 Metilergometrin 0,125 mg Tab 15200 0 15200 0 15200
259 Metilergometrin Inj.0,2 mg Ampul 10 0 10 0 10
260 Metoclopramid 10 mg Tab 3600 0 3600 0 3600
261 Metoclopramid Inj 10 mg/ 2 ml Ampul 260 0 260 0 260
262 Metoclopramide Syr (Lexapram) Botol 5 50 55 0 55
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
263 Metronidazol 250 mg Tab 0 0 0 0 0
264 Metronidazol 500 mg Tab 1200 0 1200 0 1200
265 Metronidazole Lat Infus Botol 3 40 43 3 40
266 MgSO4 Inj 20% - 25 ml Flacon 21 0 21 3 18
267 MgSO4 Inj 40% - 25 ml Flacon 2 0 2 0 2
268 MgSO4 Serbuk 30 gr Vial 0 0 0 0 0
269 Miconazol Krim 2 % Tube 1360 0 1360 312 1048
270 Mometason Furoate Krim 0,1 % Tube 75 0 75 0 75
271 Mortir dan Stemper 8 cm Buah 0 0 0 0 0
272 Mouth Piace Dos 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
273 Mucotussan Tab 0 0 0 0 0
274 My Jelli 82 Gram Tube 0 0 0 0 0
275 NaCl Lar infus 0,9 % Kolf 142 0 142 32 110
276 Natrium Diclofenak 25 mg Tab 5750 5600 11350 800 10550
277 Natrium Diclofenak 50 mg Tab 2200 0 2200 50 2150
278 Neurovit E Tab 180 0 180 0 180
279 Neutotropic Plus Tab 0 0 0 0 0
280 Nifedipin 10 mg Tab 0 0 0 0 0
281 Nistatin 500.000 IU Tab 500 0 500 200 300
282 Nistatin 100.000 IU Tab 310 0 310 0 310
283 Nistatin Drops 100.000 IU Botol 40 0 40 30 10
284 Novadiar Syr Botol 124 200 324 0 324
285 Novadium Tab 0 2000 2000 0 2000
286 Novampiron Tab 0 0 0 0 0
287 Novapen Syr Botol 0 0 0 0 0
288 Novastan Tab 0 0 0 0 0
289 Novotwist ( Jarum Novorapid) Dos 2 0 2 0 2
290 OAT FDC Kategori Anak Paket 0 0 0 0 0
291 OAT FDC Kategori I Dewasa Paket 0 0 0 0 0
292 OAT FDC Kategori II Dewasa Paket 0 0 0 0 0
293 OAT FDC Sisipan Dewasa Paket 0 0 0 0 0
294 Obat Batuk Hitam ( OBH ) Syr Botol 300 0 300 5 295
295 Oksitetraciclin Inj 50 ml - 10 ml Ampul 0 0 0 0 0
296 Oksitetraciclin Salep Kulit 3 % Tube 325 0 325 5 320
297 Oksitetraciclin Salep Mata 1 % Tube 140 100 240 5 235
298 Oksitosin Inj 50 ml - 10 ml Ampul 155 200 355 30 325
299 Omeprazole 20 mg Tab 0 0 0 0 0
300 Ondansetron HCL Inj 4 mg/ 2 ml Ampul 45 20 65 0 65
301 Papaverin 40 mg Tab 0 0 0 0 0
302 Papaverin Inj Ampul 0 0 0 0 0
303 Paracetamol 500 mg Tab 300 20000 20300 1500 18800
304 Paracetamol Lar Infus Steril Botol 16 24 40 0 40
305 Paracetamol Syr 120 mg/ 5 ml Botol 0 0 0 0 0
306 Pehacain Inj Ampul 0 0 0 0 0
307 Periokin Spray Dos 33 0 33 0 33
308 Permanganas kalikus (PK) Pot 0 0 0 0 0
309 Phenol Gliserol T. Telinga 10% Botol 48 0 48 0 48
310 Phitomenadion 10 mg Tab 300 0 300 100 200
311 Phitomenadion Inj 10 mg/ml Ampul 210 0 210 0 210
312 Pipet Tetes Pendek Buah 0 0 0 0 0
313 Piracetam 800 mg Tab 0 0 0 0 0
314 Pirecetam 400 mg Tab 0 2500 2500 0 2500
315 Pirecetam Inj 200 mg/ ml Ampul 0 0 0 0 0
316 Piridoxyn (Vit B6) 10 mg Tab 0 0 0 0 0
317 Piroxicam 20 mg Tab 0 0 0 0 0
318 Pisau Bedah Pcs 100 0 100 0 100
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
319 Plano Test Pcs 200 600 800 80 720
320 Plesterin Bulat Dos 27 0 27 0 27
321 Poligyp 5 cm x 27 cm Roll 0 0 0 0 0
322 Pot Urine Bauh 0 0 0 0 0
323 Povidon Iodida 10 % 30 ml Botol 33 0 33 5 28
324 Povidon Iodida 10 % 300 ml Botol 0 0 0 0 0
325 Povidon Iodida 10 % 60 ml Botol 0 0 0 0 0
326 Prednison 5 mg Tab 0 0 0 0 0
327 Promavit Tab 0 0 0 0 0
328 Propanolol 10 mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
329 Propanolol 40 mg Tab 0 0 0 0 0
330 Propiltiuracil 100 mg Tab 1000 0 1000 0 1000
331 Pyrantel Pamoat 125 mg Tab 0 0 0 0 0
332 Rabipur Vaksin Dos 0 0 0 0 0
333 Rak Tabung Stainless Buah 0 0 0 0 0
334 Ramipril 5 mg Tab 0 0 0 0 0
335 Ranitidin 150 mg Tab 0 0 0 0 0
336 Ranitidin Inj 25 mg/ 2 ml Ampul 270 0 270 0 270
337 Ranitidin Inj 50 mg/ 2 ml Ampul 0 0 0 0 0
338 RDT DBD Dos 0 0 0 0 0
339 RDT Malaria Dos 0 0 0 0 0
340 Rifampisin 450 mg Tab 300 100 400 200 200
341 Rifampisin 600 mg Tab 0 0 0 0 0
342 Ringer Lactat Lar Infus Steril Kolf 517 200 717 60 657
343 Salbutamol 2 mg Tab 0 1000 1000 0 1000
344 Salbutamol 4 mg Tab 3700 0 3700 700 3000
345 Salep 2-4 Pot 1038 0 1038 96 942
346 Salisil Bedak 2 % Dos 100 0 100 10 90
347 Sanbe Tears (Air Mata Buatan) Botol 0 0 0 0 0
348 Selediar Tab 0 0 0 0 0
349 Seledryil Tab 0 0 0 0 0
350 Selesbion Tab 0 0 0 0 0
351 Selkom C Tab 0 0 0 0 0
352 Selviplex Tab 0 0 0 0 0
353 Seven Seans Syr Botol 184 0 184 121 63
354 Sikat Pembersih Tabung Buah 0 0 0 0 0
355 Silk (Benang Bedah Sutra) No. 2/0 Pcs 12 0 12 0 12
356 Silk (Benang Bedah Sutra) No. 3/0 Pcs 0 0 0 0 0
357 Silk Braided Black usp:4/0 100 M Dos 0 0 0 0 0
358 Simvastatin 10 mg Tab 3600 3360 6960 1500 5460
359 Simvastatin 20 mg Tab 0 0 0 0 0
360 Skizon Zalf Tube 18 0 18 18 0
361 Soft U-Derm Krim Tube 74 0 74 20 54
362 Sohobion Inj Ampul 0 0 0 0 0
363 Soldextam Tab 0 0 0 0 0
364 Solvita Plus Syr Botol 0 0 0 0 0
365 Spasmolit Tab 0 0 0 0 0
366 Spironolactone 100 mg Tab 0 0 0 0 0
367 Spironolactone 25 mg Tab 0 0 0 0 0
368 Stesolid Suppo 5 mg/ 2,5 ml Suppo 0 0 0 0 0
369 Stesolid Suppo 10 mg/ 2,5 ml Suppo 0 0 0 0 0
370 Stik HB Family Dr Dos 0 0 0 0 0
371 Tablet Tambah Darah Tab 0 0 0 0 0
372 Tablet Tambah Darah Neo Tab 8700 0 8700 8700 0
373 Tabung Reaksi 25 ml Buah 0 0 0 0 0
374 Termorex Syr Botol 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
375 TesKits Boraks Kit 0 0 0 0 0
376 TesKits Formaldehid (Formalin) Kit 0 0 0 0 0
377 TesKits Methanil Yellow Kit 0 0 0 0 0
378 TesKits Rhodamine B Kit 0 0 0 0 0
379 Tetagam Vaksin Dos 4 20 24 2 22
380 Tetracyclin HCL 250 mg Tab 0 2000 2000 0 2000
381 Tetracyclin HCL 500 mg Tab 4600 0 4600 0 4600
382 Tetrakain HCL T. Mata 0,5 % Botol 0 0 0 0 0
383 Thiamin HCL 50 mg Tab 1000 0 1000 0 1000
384 Thiamin HCL Inj 100 ml - 1 ml Vial 1080 0 1080 0 1080
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
385 Tramadol 50 mg Tab 0 0 0 0 0
386 Tricresol Formalin 10 ml Botol 0 0 0 0 0
387 Triheksiphenidil HCL 2 mg Tab 1000 0 1000 0 1000
388 Truvit Syr Botol 0 120 120 0 120
389 Ultrasonic Gel 250 ml Botol 0 0 0 0 0
390 Urine Bag 1000 ml Pcs 10 0 10 0 10
391 Vaksin BCG Ampul 5 20 25 10 15
392 Pelarut BCG Vial 5 20 25 10 15
393 Vaksin Campak Rubella Vial 5 20 25 10 15
394 Pelarut Campak Rubella Ampul 5 20 25 10 15
395 Vaksin DPT HB Combo Ampul 5 30 35 5 30
396 Vaksin HB 0 (Unijek) Ampul 0 35 35 20 15
397 Vaksin IPV Ampul 0 10 10 3 7
398 Vaksin TT Bumil Ampul 3 40 43 3 40
399 Vaksin Polio Ampul 3 20 23 4 19
400 Ventolin Nebulizer Flacon 20 0 20 5 15
401 Verorab Vaksin Dos 4 0 4 3 1
402 Viccillin - SX (Ampicilin) Inj 1,5 g Vial 20 0 20 0 20
403 Vit A 100.000 IU Kapsul 0 0 0 0 0
404 Vit A 200.000 IU Kapsul 0 0 0 0 0
405 Vitamin B Kompleks Tab 4400 0 4400 1400 3000
406 Vitamin B Kompleks Inj Vial 23 0 23 1 22
407 Zinc Dispersible 20 mg Tab 0 0 0 0 0
408 Zinc Syr 20 mg/ 5 ml Botol 220 100 320 60 260
409 HIV Tes Kit Strip 0 0 0 0 0
410 HBsAG Tes Kit Strip 0 100 100 100 0
411 HS Posterior Dos 2 0 2 0 2
412 Filtek Z350 XT Pcs 31 0 31 0 31
413 Pulp - X Dos 30 0 30 0 30
414 Iodium Tes Botol 0 0 0 0 0
415 Mitela (Kain SegiTiga) Pcs 0 0 0 0 0
416 Poligyp 10 cm x 2,7 m Roll 3 0 3 0 3
417 Asam Asetat 100 ml Botol 1 0 1 0 1
418 Elatomull Haft Dos 0 0 0 0 0
419 Paracetamol Drops Botol 0 0 0 0 0
420 Omeprazole 40 mg Inj Ampul 50 0 50 0 50
421 Metcovazin Cr Tube 4 0 4 0 4
422 Asam Tranexamat 500 mg Tab 800 300 1100 0 1100
423 Nifedipin 20 mg (Adalat) Tab 120 1680 1800 60 1740
424 Ketorolac 30 mg/ml Inj Ampul 60 100 160 0 160
425 Primaquin 15 mg Tab 0 500 500 0 500
426 Selang Oxygen Pcs 0 10 10 0 10
427 Xylocame Pump Spray Botol 0 10 10 0 10
428 Pritagesik Tab 2000 0 2000 600 1400
429 Elastis Verban 10 cm x 4,5 m Buah 5 5 10 0 10
430 Handscoon Non Steril (S) Dos 10 0 10 1 9
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
431 Enbatic Cr Tube 0 0 0 0 0
432 Selang Oxygen (L) Pcs 0 10 10 0 10
433 Selang Oxygen (XS) Pcs 0 0 0 0 0
434 Biocombin Tab 0 800 800 0 800
435 Sulfadiazine Silver 10 mg Tube 0 20 20 0 20
436 Polifix 10 cm X 5 m Roll 0 5 5 0 5
437 Tramadol 100 mg/2 ml Inj Ampul 0 50 50 0 50
438 Paper Tape 5 X 9,14 Roll 0 12 12 0 12
439 Ramipril 10 mg Tab 0 990 990 0 990
440 Pyrantel Pamoat 250 mg Tab 0 800 800 0 800
441 Eyefresh Tetes Mata Botol 0 100 100 0 100
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
442 Pantocain 2% Botol 0 29 29 0 29
443 Ethyl Chloride Spray 100 ml Botol 0 2 2 1 1

Umum
BPJS Jamkesda Jumlah
JUMLAH KUNJUNGAN RESEP Bayar Tdk Bayar

Mengetahui/Menyetujui Yang Menyerahkan Yang Memohon Yang


Penanggung Jawab Gudang Farmasi Pet

Sahrul, SKM Arini Priyanti Kandupi, S. Farm, Apt Moh. Rizal Sumaga, SKM Mujria
Nip. 19820714 200502 1 002 Nip.19830402 200502 2 004 Nip. 19720123 199402 1 002 Nip : 19881

KETERANGAN :
Lembar Putih : GFK
Lembar Merah : Puskesmas
N OBAT

: NOVEMBER 2019

Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15
Pemberian
Ket
lain-lain Jml
13 14 15

Yang Menerima
Petugas PKM

Mujriah A.Md, Far


Nip : 19881005 201001 2 001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS

PUSKESMAS : TETE PELAPORAN BLN/PERIODE : DESEMBE


KECAMATAN : AMPANA TETE
KABUPATEN : TOJO UNA UNA PERMINTAAN BLN/PERIODE
PROPINSI : SUL TENG

Stok Peneri Persedi Pemak Stok Permi Pemberian


No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
1 Abbocath No.18 Pcs 78 100 178 0 178
2 Abbocath No.20 Pcs 320 200 520 120 400
3 Abbocath No.22 Pcs 40 145 185 40 145
4 Abbocath No.24 Pcs 134 0 134 0 134
5 Acetylcysteine 200 mg Tab 0 0 0 0 0
6 Acyclovir 200 Mg Tab 500 0 500 0 500
7 Acyclovir 400 Mg Tab 8750 0 8750 500 8250
8 Acyclovir krim 5% Tube 200 0 200 0 200
9 Adidryl Inj Vial 0 0 0 0 0
10 Adimidon Inj Vial 0 0 0 0 0
11 Alat Autochek Unit 0 0 0 0 0
12 Alat Benechek Unit 0 0 0 0 0
13 Alat CO Analiser Unit 0 0 0 0 0
14 Alat Easy Touch Unit 0 0 0 0 0
15 Alat suntik sekali pakai 0,5 ml Pcs 157 0 157 115 42
16 Alat suntik sekali pakai 1 ml Pcs 534 0 534 105 429
17 Alat suntik sekali pakai 10 ml Pcs 100 93 193 0 193
18 Alat suntik sekali pakai 2,5 ml Pcs 0 0 0 0 0
19 Alat suntik sekali pakai 20 ml Pcs 70 0 70 10 60
20 Alat suntik sekali pakai 3 ml Pcs 924 0 924 185 739
21 Alat suntik sekali pakai 5 ml Pcs 705 57 762 40 722
22 Albendazol 400 mg Tab 0 0 0 0 0
23 Alkohol Swab Dos 8 0 8 1 7
24 Alletrol T. Mata Botol 0 0 0 0 0
25 Allopurinol 100 mg Tab 4800 0 4800 1800 3000
26 Allopurinol 300 mg Tab 90 0 90 90 0
27 Alprazolam 0,5 mg Tab 0 0 0 0 0
28 Alprazolam 1 mg Tab 674 0 674 54 620
29 Ambroxol 30 mg Tab 2700 0 2700 1000 1700
30 Ambroxol Syr 15mg/ 5 ml Botol 200 100 300 50 250
31 Amitriptilin 25 mg Tab 1000 0 1000 0 1000
32 Amlodiphin 10 mg Tab 7920 0 7920 4350 3570
33 Amlodiphin 5 mg Tab 300 0 300 300 0
34 Amoxycillin 250 mg Tab 10000 0 10000 500 9500
35 Amoxycillin 500 mg Tab 12900 0 12900 6300 6600
36 Amoxycillin Syr 125 mg/ 5 ml Botol 575 0 575 130 445
37 Ampicillin 500 mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
38 Ampicillin Inj Vial 0 0 0 0 0
39 Ampicillin Syrup 125 mg/ 5 ml Botol 0 0 0 0 0
40 Analog Long Insulin (Levemir) Pen 0 0 0 0 0
41 Antalgin 500 mg Tab 0 0 0 0 0
42 Antalgin Inj 250 mg/ml Ampul 0 0 0 0 0
43 Antasida Doen 500 mg Tab 21300 0 21300 7300 14000
44 Antasida Doen Susp Botol 0 50 50 50 0
45 Anti Hemoroid Doen Kombinasi Suppo 285 0 285 30 255
46 Antiseptik Hand Botol 114 0 114 4 110
47 Antrain Inj Ampul 0 0 0 0 0
48 Aqua Pro Injeksi Vial 145 0 145 0 145
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
49 Aquadest 20 L Galon 2 0 2 0 2
50 As Asetil Salisilat 80 mg (Miniaspi) Tab 2400 0 2400 0 2400
51 Asam Askorbat (Vit C) 50 mg Tab 1500 21000 22500 3000 19500
52 Asam Folac Tab 0 0 0 0 0
53 Asam Mefenamat 500 mg Tab 26600 10000 36600 6800 29800
54 Asam Tranexamat Inj 50 mg/ ml Ampul 57 0 57 0 57
55 Asetosal 100 mg Tab 0 0 0 0 0
56 Asetosal 500 mg Tab 0 0 0 0 0
57 Aspar K Tab 0 0 0 0 0
58 Atorvastatin Calsium 20 Mg Tab 4140 870 5010 1920 3090
59 Atropin Inj 0,25 mg Ampul 110 0 110 0 110
60 Atrovent Inhaler Botol 35 0 35 0 35
61 Attapulgit (New Antides) Tab 6200 0 6200 700 5500
62 Autocheck Cholesterol Dos 0 0 0 0 0
63 Autocheck Glucosa Dos 0 0 0 0 0
64 Autocheck Urin Acid Dos 0 0 0 0 0
65 Bacitracin Polimixyn B Salep Tube 0 0 0 0 0
66 Batang Pengaduk Buah 0 0 0 0 0
67 Benecheck Colesterol Dos 0 0 0 0 0
68 Benecheck Glucosa Dos 0 0 0 0 0
69 Benecheck Urin Acid Dos 0 0 0 0 0
70 Betahistin Mesilat 6 mg Tab 4000 0 4000 500 3500
71 Betametason Krim 0,1% Tube 0 0 0 0 0
72 Biocombin 5000 Inj Ampul 20 20 40 40 0
73 Bionemi Tab 0 0 0 0 0
74 Bisoprolol 5 mg Tab 2300 0 2300 500 1800
75 Blood Lancets 26 G Dos 0 0 0 0 0
76 Blood Lancets 28 G Dos 37 0 37 5 32
77 Buscopan Inj 20 mg/ ml Ampul 0 20 20 0 20
78 Calcium Gluconate Inj 100 mg/ml Ampul 21 0 21 0 21
79 Calsium Laktat (Calac) 500 mg Tab 6800 0 6800 5200 1600
80 Calxyl Radiopaque Buah 0 0 0 0 0
81 Candesartan Cilexetil 8 mg Tab 990 210 1200 0 1200
82 Captopril 12,5 mg Tab 5100 0 5100 300 4800
83 Captopril 25 mg Tab 3500 0 3500 2200 1300
84 Carbamazepin 200 mg Tab 990 0 990 0 990
85 Catapres Inj Ampul 0 0 0 0 0
86 Catarlent T Mata Botol 10 0 10 10 0
87 Catgut Chromic No. 2/0 Pcs 96 0 96 0 96
88 Catgut Chromic No. 3/0 Pcs 60 0 60 5 55
89 Catgut Chromic No. 4/0 Pcs 132 0 132 0 132
90 Catgut Chromik usp:2/0 100 M Dos 0 0 0 0 0
91 Catgut Plain 2/0 HR 37 MM Pcs 0 0 0 0 0
92 Catgut Plain 3/0 HR 26 MM Pcs 36 180 216 0 216
93 Catgut Plain 4/0 Pcs 0 0 0 0 0
94 Cathejell Lido 2% & CHG 0,05 % Flacon 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
95 Cavit (Bahan Tump Sementara) Dos 34 0 34 0 34
96 Cefadroxil 500 mg Tab 3300 0 3300 1600 1700
97 Cefadroxil Syr 125 mg/ 5 ml Botol 200 0 200 55 145
98 Cendo Xytrol T. Mata Botol 208 0 208 15 193
99 Cetirizine 10 mg Tab 300 450 750 750 0
100 Cetirizine Syr 5 mg/ 5 ml Botol 415 0 415 45 370
101 Chloramphenicol (Chloramex) 500 mg Tab 4500 0 4500 1700 2800
102 Chloramphenicol (Novachlor) 250 mg Tab 1700 0 1700 900 800
103 Chloramphenicol Salep Mata 1% Tube 87 0 87 0 87
104 Chloramphenicol Suspensi Botol 140 0 140 50 90
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
105 Chloramphenicol T. Mata 0,5% Tube 0 0 0 0 0
106 Chloramphenicol T. Telinga 3% Botol 275 0 275 75 200
107 Chlorfeniramin Maleat 4 mg Tab 16000 0 16000 2600 13400
108 Chlorpromazin 100 mg Tab 270 0 270 0 270
109 Chlorpromazin 25 mg Tab 0 0 0 0 0
110 Chlorpromazin Inj 5mg/ml Ampul 0 0 0 0 0
111 Cimetidin 200 mg Tab 0 0 0 0 0
112 Citicoline 500 mg Tab 0 0 0 0 0
113 Clobasam 10 mg Tab 0 0 0 0 0
114 Clonidine 0,15 mg Tab 0 0 0 0 0
115 Clopidogrel 75 mg Tab 0 0 0 0 0
116 Codein 10 mg Tab 3810 0 3810 0 3810
117 Colcitine 0,5 mg Tab 5280 0 5280 0 5280
118 Combivent Nebulizer Flacon 40 0 40 0 40
119 Cotrimoxazol 480 mg Tab 5800 0 5800 1500 4300
120 Cotrimoxazol Pediatrik Tab 0 0 0 0 0
121 Cotrimoxazol Susp Botol 307 0 307 65 242
122 Curcuma Tab 700 0 700 700 0
123 Cutimed Gel Tube 0 0 0 0 0
124 Cyanocobalamin 50 mg Tab 0 14000 14000 7000 7000
125 Cyanocobalamin Inj 500 mcg/ ml Ampul 1830 0 1830 150 1680
126 Cyprofloksasin 500 mg Tab 1500 0 1500 0 1500
127 Dexamethason 0,5 mg Tab 5000 0 5000 2600 2400
128 Dexamethason Inj 5 mg/ml Ampul 170 0 170 70 100
129 Dextamec Tab 0 0 0 0 0
130 Diazepam 2 mg Tab 500 0 500 76 424
131 Diazepam 5 mg Tab 200 0 200 5 195
132 Diazepam Inj Ampul 47 0 47 0 47
133 Digoxin 0,25 mg Tab 200 0 200 0 200
134 Diltiazem 30 mg Tab 1500 0 1500 0 1500
135 Dimenhydrinate 50 mg Tab 1000 0 1000 400 600
136 Diphenhidramin Inj Ampul 180 0 180 0 180
137 Diphenhidramin Inj (Sidiadryl) Vial 16 0 16 2 14
138 Disposible Needle No. 22 Pcs 200 0 200 200 0
139 Disposible Needle No. 23 Pcs 0 0 0 0 0
140 Domperidon 10 mg Tab 9360 0 9360 700 8660
141 Domperidon Susp 5 mg/ 5 ml Botol 665 0 665 50 615
142 Double Check (Artikulating Paper) Dos 33 0 33 0 33
143 Doxyciclin 100 mg Tab 4300 0 4300 0 4300
144 Dulcolax 5 mg Tab 1470 0 1470 900 570
145 Dulcolax Suppo Anak Suppo 42 0 42 42 0
146 Dumin Rektal 125 mg/ 4 ml Suppo 0 0 0 0 0
147 Dumin Rektal 250 mg/4 ml Suppo 16 0 16 0 16
148 Easy Touch Colestrol Dos 5 0 5 5 0
149 Easy Touch Glukosa Dos 8 0 8 5 3
150 Easy Touch Urine Acid Dos 8 0 8 0 8
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
151 Eflin Tab 1800 500 2300 300 2000
152 Elastis Verban 7,5 cm x 4,55 m Roll 0 0 0 0 0
153 Epinefrin Inj 1 mg/ml Ampul 332 0 332 0 332
154 Epoxidin (Pasta Pengisi Sal Akar) Dos 25 0 25 0 25
155 Erphatrim Forte 960 mg Tab 0 0 0 0 0
156 Erytromicin 250 mg Tab 2000 0 2000 300 1700
157 Erytromicin 500 mg Tab 7100 0 7100 300 6800
158 Erytromicin Syr Botol 0 0 0 0 0
159 Etakridin (Rivanol Lar 0,1%) Botol 11 0 11 3 8
160 Etanol 70% 1 L Botol 20 0 20 4 16
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
161 Etanol 70% 100 ml Botol 0 0 0 0 0
162 Etanol 70% 300 ml Botol 19 0 19 8 11
163 Ethambutol 500 mg Tab 450 0 450 0 450
164 Farbion Inj Ampul 0 0 0 0 0
165 Fenilbutason (Novason) 200 mg Tab 0 0 0 0 0
166 Fenobarbital 30 mg Tab 0 0 0 0 0
167 Fenobarbital Inj 50 mg/ml Ampul 90 0 90 0 90
168 Folley Catheter No. 10 FR Pcs 19 0 19 5 14
169 Folley Catheter No. 16 FR Pcs 10 0 10 0 10
170 Folley Catheter No. 18 FR Pcs 30 0 30 0 30
171 Folley Catheter No. 22 FR Pcs 59 0 59 0 59
172 Furosemid 40 mg Tab 1600 0 1600 0 1600
173 Furosemid Inj (Diuvar) Ampul 25 0 25 0 25
174 Gabapentin 300 mg Tab 0 0 0 0 0
175 Garam Oralit 200 ml Air Saset 1330 0 1330 80 1250
176 Gelas Ukur 250 ml Buah 0 0 0 0 0
177 Gemfibrozil 300 mg Tab 800 0 800 0 800
178 Gentamicin Inj 40 mg/ ml Ampul 40 0 40 40 0
179 Gentamicin Salep 0,1 % Tube 388 0 388 52 336
180 Gentian Violet lar 1% Botol 185 0 185 6 179
181 Glibenclamid 5 mg Tab 800 0 800 0 800
182 Glimepiride 2 mg Tab 4700 0 4700 0 4700
183 Glimepiride 3 mg Tab 0 0 0 0 0
184 Glukosa lar infus 10 % Steril Kolf 0 0 0 0 0
185 Glukosa lar infus 5 % Steril Kolf 239 0 239 0 239
186 Griseofulvin 125 mg Tab 25700 0 25700 0 25700
187 Guaifenesin 100 mg Tab 7300 0 7300 3100 4200
188 Halloperidol 0,5 mg Tab 340 0 340 0 340
189 Halloperidol 1,5 mg Tab 0 0 0 0 0
190 Halloperidol 5 mg Tab 0 0 0 0 0
191 Handscoon Genekolog 7,5 16/40 cm Pcs 160 0 160 40 120
192 Handscoon No. 6,5 Steril Pcs 0 0 0 0 0
193 Handscoon No. 7 Steril Pcs 0 300 300 60 240
194 Handscoon No. 7,5 Steril Pcs 100 200 300 100 200
195 Handscoon No. 8 Steril Pcs 105 0 105 0 105
196 Handscoon Non Steril (L) Dos 0 0 0 0 0
197 Handscoon Non Steril (M) Dos 8 20 28 3 25
198 Hemafort Tab 0 0 0 0 0
199 Hidroklortiazid 25 mg Tab 6700 0 6700 0 6700
200 Hidrokortison Krim 2,5% Tube 2689 0 2689 0 2689
201 Hyoscine N-Butylbromide (Scopamin) Tab 7900 0 7900 3300 4600
202 Hyscopan Tab 0 0 0 0 0
203 Ibuprofen 200 mg Tab 0 0 0 0 0
204 Ibuprofen 400 mg Tab 900 15000 15900 900 15000
205 Ibuprofen Susp 100 mg/ 5 ml Botol 520 50 570 145 425
206 Ichtiyol Salep Pot 36 0 36 24 12
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
207 Iliadin T. Hidung Botol 54 0 54 54 0
208 Infusion Set Anak (Micro) Pcs 249 0 249 0 249
209 Infusion Set Dewasa (Macro) Pcs 309 0 309 35 274
210 Isoniasid 100 mg Tab 0 0 0 0 0
211 Isoniazid 300 mg Tab 0 0 0 0 0
212 Isosorbid Dinitrat 5 mg Tab 2400 0 2400 0 2400
213 Jarum Kulit GT 10 Pcs 0 0 0 0 0
214 Jarum Kulit GT 11 Pcs 0 0 0 0 0
215 Jarum Kulit GT 15 Pcs 0 0 0 0 0
216 Jarum Kulit GR 13 Pcs 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
217 Jarum Otot GR 10 Pcs 0 0 0 0 0
218 Jarum Otot GR 12 Pcs 0 0 0 0 0
219 Jarum Otot GR 14 Pcs 0 0 0 0 0
220 Jarum Otot GR 15 Pcs 0 0 0 0 0
221 Kanamicin Inj Vial 0 0 0 0 0
222 Kaolimec Suspensi Botol 0 0 0 0 0
223 Kaotin Suspensi Botol 0 0 0 0 0
224 Kapas Berlemak 500 mg Buah 0 0 0 0 0
225 Kapas Pembalut 250 mg Buah 115 0 115 15 100
226 Karbamazepin 200 mg Tab 990 0 990 0 990
227 Kasa Hidrofil 4 m x 15 m Roll 0 0 0 0 0
228 Kasa Hidrofil 4 m x 5 m Roll 0 0 0 0 0
229 Kasa Kompres 40 x 80 Steril Roll 0 0 0 0 0
230 Kasa Kompres 40 x 40 Roll 0 0 0 0 0
231 Kasa Pembalut 40 x 80 m Roll 9 0 9 2 7
232 Kasa Steril 18 x 22 cm (16 x 16) Dos 0 0 0 0 0
233 Kertas EKG Roll 31 0 31 0 31
234 Kertas USG Roll 0 0 0 0 0
235 Ketokonazol 200 mg Tab 19550 0 19550 0 19550
236 Ketokonazol Krim 2 % Tube 198 0 198 25 173
237 Kolicgon Tab 0 0 0 0 0
238 Larutan H2O2 Botol 0 0 0 0 0
239 Leukoplast 2,5 cm x 4,5 m Roll 0 0 0 0 0
240 Leukoplast 7,5 cm x 4,5 m Roll 63 0 63 5 58
241 Levofloxacin 500 mg Tab 0 0 0 0 0
242 Lidocain Inj 20 mg/ 2 ml Ampul 5400 0 5400 320 5080
243 Lidocain Inj 40 mg Ampul 0 0 0 0 0
244 Lidocain Kompositum 20 mg/ 2 ml Ampul 420 0 420 30 390
245 Lisol Botol 39 0 39 2 37
246 Loperamid 2 mg Tab 0 0 0 0 0
247 Loratadin 10 mg Tab 2850 0 2850 1150 1700
248 Masker Earloop Pcs 300 0 300 100 200
249 Masker N 95 Pcs 80 0 80 0 80
250 Masker Tali Pcs 50 0 50 50 0
251 MDT MB Combi Dewasa Dos 0 0 0 0 0
252 Meloxicam 15 mg Tab 0 0 0 0 0
253 Metamizole Inj (Norages) Ampul 0 0 0 0 0
254 Metformin 500 mg Tab 23300 0 23300 2900 20400
255 Methildopa 250 mg (Dopamet) Tab 0 0 0 0 0
256 Methylprednisolon 4 Mg Tab 200 4000 4200 1600 2600
257 Methylprednisolon 8 Mg Tab 0 0 0 0 0
258 Metilergometrin 0,125 mg Tab 15200 0 15200 200 15000
259 Metilergometrin Inj.0,2 mg Ampul 10 0 10 0 10
260 Metoclopramid 10 mg Tab 3600 0 3600 200 3400
261 Metoclopramid Inj 10 mg/ 2 ml Ampul 260 0 260 10 250
262 Metoclopramide Syr (Lexapram) Botol 55 0 55 15 40
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
263 Metronidazol 250 mg Tab 0 0 0 0 0
264 Metronidazol 500 mg Tab 1200 5000 6200 600 5600
265 Metronidazole Lat Infus Botol 40 0 40 0 40
266 MgSO4 Inj 20% - 25 ml Flacon 18 0 18 0 18
267 MgSO4 Inj 40% - 25 ml Flacon 2 0 2 0 2
268 MgSO4 Serbuk 30 gr Vial 0 0 0 0 0
269 Miconazol Krim 2 % Tube 1048 0 1048 0 1048
270 Mometason Furoate Krim 0,1 % Tube 75 0 75 25 50
271 Mortir dan Stemper 8 cm Buah 0 0 0 0 0
272 Mouth Piace Dos 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
273 Mucotussan Tab 0 0 0 0 0
274 My Jelli 82 Gram Tube 0 0 0 0 0
275 NaCl Lar infus 0,9 % Kolf 110 0 110 10 100
276 Natrium Diclofenak 25 mg Tab 10550 0 10550 3100 7450
277 Natrium Diclofenak 50 mg Tab 2150 0 2150 0 2150
278 Neurovit E Tab 180 0 180 180 0
279 Neutotropic Plus Tab 0 0 0 0 0
280 Nifedipin 10 mg Tab 0 0 0 0 0
281 Nistatin 500.000 IU Tab 300 0 300 0 300
282 Nistatin 100.000 IU Tab 310 0 310 310 0
283 Nistatin Drops 100.000 IU Botol 10 0 10 10 0
284 Novadiar Syr Botol 324 0 324 13 311
285 Novadium Tab 2000 0 2000 0 2000
286 Novampiron Tab 0 0 0 0 0
287 Novapen Syr Botol 0 0 0 0 0
288 Novastan Tab 0 0 0 0 0
289 Novotwist ( Jarum Novorapid) Dos 2 0 2 0 2
290 OAT FDC Kategori Anak Paket 0 0 0 0 0
291 OAT FDC Kategori I Dewasa Paket 0 3 3 3 0
292 OAT FDC Kategori II Dewasa Paket 0 0 0 0 0
293 OAT FDC Sisipan Dewasa Paket 0 0 0 0 0
294 Obat Batuk Hitam ( OBH ) Syr Botol 295 0 295 95 200
295 Oksitetraciclin Inj 50 ml - 10 ml Ampul 0 0 0 0 0
296 Oksitetraciclin Salep Kulit 3 % Tube 320 0 320 45 275
297 Oksitetraciclin Salep Mata 1 % Tube 235 0 235 50 185
298 Oksitosin Inj 50 ml - 10 ml Ampul 325 0 325 70 255
299 Omeprazole 20 mg Tab 0 0 0 0 0
300 Ondansetron HCL Inj 4 mg/ 2 ml Ampul 65 0 65 15 50
301 Papaverin 40 mg Tab 0 0 0 0 0
302 Papaverin Inj Ampul 0 0 0 0 0
303 Paracetamol 500 mg Tab 18800 10000 28800 6600 22200
304 Paracetamol Lar Infus Steril Botol 40 0 40 0 40
305 Paracetamol Syr 120 mg/ 5 ml Botol 0 20 20 0 20
306 Pehacain Inj Ampul 0 0 0 0 0
307 Periokin Spray Dos 33 0 33 0 33
308 Permanganas kalikus (PK) Pot 0 0 0 0 0
309 Phenol Gliserol T. Telinga 10% Botol 48 0 48 24 24
310 Phitomenadion 10 mg Tab 200 0 200 200 0
311 Phitomenadion Inj 10 mg/ml Ampul 210 0 210 60 150
312 Pipet Tetes Pendek Buah 0 0 0 0 0
313 Piracetam 800 mg Tab 0 0 0 0 0
314 Pirecetam 400 mg Tab 2500 0 2500 500 2000
315 Pirecetam Inj 200 mg/ ml Ampul 0 0 0 0 0
316 Piridoxyn (Vit B6) 10 mg Tab 0 2000 2000 600 1400
317 Piroxicam 20 mg Tab 0 0 0 0 0
318 Pisau Bedah Pcs 100 0 100 0 100
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
319 Plano Test Pcs 720 0 720 290 430
320 Plesterin Bulat Dos 27 0 27 0 27
321 Poligyp 5 cm x 27 cm Roll 0 0 0 0 0
322 Pot Urine Bauh 0 0 0 0 0
323 Povidon Iodida 10 % 30 ml Botol 28 0 28 17 11
324 Povidon Iodida 10 % 300 ml Botol 0 0 0 0 0
325 Povidon Iodida 10 % 60 ml Botol 0 4 4 4 0
326 Prednison 5 mg Tab 0 10000 10000 1000 9000
327 Promavit Tab 0 0 0 0 0
328 Propanolol 10 mg Tab 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
329 Propanolol 40 mg Tab 0 0 0 0 0
330 Propiltiuracil 100 mg Tab 1000 0 1000 0 1000
331 Pyrantel Pamoat 125 mg Tab 0 0 0 0 0
332 Rabipur Vaksin Dos 0 0 0 0 0
333 Rak Tabung Stainless Buah 0 0 0 0 0
334 Ramipril 5 mg Tab 0 0 0 0 0
335 Ranitidin 150 mg Tab 0 10000 10000 1500 8500
336 Ranitidin Inj 25 mg/ 2 ml Ampul 270 0 270 0 270
337 Ranitidin Inj 50 mg/ 2 ml Ampul 0 0 0 0 0
338 RDT DBD Dos 0 0 0 0 0
339 RDT Malaria Dos 0 0 0 0 0
340 Rifampisin 450 mg Tab 200 0 200 100 100
341 Rifampisin 600 mg Tab 0 0 0 0 0
342 Ringer Lactat Lar Infus Steril Kolf 657 0 657 68 589
343 Salbutamol 2 mg Tab 1000 0 1000 500 500
344 Salbutamol 4 mg Tab 3000 0 3000 1000 2000
345 Salep 2-4 Pot 942 0 942 24 918
346 Salisil Bedak 2 % Dos 90 0 90 54 36
347 Sanbe Tears (Air Mata Buatan) Botol 0 0 0 0 0
348 Selediar Tab 0 0 0 0 0
349 Seledryl Tab 0 2880 2880 0 2880
350 Selesbion Tab 0 0 0 0 0
351 Selkom C Tab 0 3000 3000 500 2500
352 Selviplex Tab 0 0 0 0 0
353 Seven Seans Syr Botol 63 230 293 63 230
354 Sikat Pembersih Tabung Buah 0 0 0 0 0
355 Silk (Benang Bedah Sutra) No. 2/0 Pcs 12 0 12 8 4
356 Silk (Benang Bedah Sutra) No. 3/0 Pcs 0 0 0 0 0
357 Silk Braided Black usp:4/0 100 M Dos 0 0 0 0 0
358 Simvastatin 10 mg Tab 5460 300 5760 2850 2910
359 Simvastatin 20 mg Tab 0 0 0 0 0
360 Skizon Zalf Tube 0 0 0 0 0
361 Soft U-Derm Krim Tube 54 0 54 4 50
362 Sohobion Inj Ampul 0 0 0 0 0
363 Soldextam Tab 0 0 0 0 0
364 Solvita Plus Syr Botol 0 0 0 0 0
365 Spasmolit Tab 0 0 0 0 0
366 Spironolactone 100 mg Tab 0 0 0 0 0
367 Spironolactone 25 mg Tab 0 0 0 0 0
368 Stesolid Suppo 5 mg/ 2,5 ml Suppo 0 0 0 0 0
369 Stesolid Suppo 10 mg/ 2,5 ml Suppo 0 0 0 0 0
370 Stik HB Family Dr Dos 0 0 0 0 0
371 Tablet Tambah Darah Tab 0 0 0 0 0
372 Tablet Tambah Darah Neo Tab 0 12960 12960 7560 5400
373 Tabung Reaksi 25 ml Buah 0 0 0 0 0
374 Termorex Syr Botol 0 0 0 0 0
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
375 TesKits Boraks Kit 0 0 0 0 0
376 TesKits Formaldehid (Formalin) Kit 0 0 0 0 0
377 TesKits Methanil Yellow Kit 0 0 0 0 0
378 TesKits Rhodamine B Kit 0 0 0 0 0
379 Tetagam Vaksin Dos 22 0 22 5 17
380 Tetracyclin HCL 250 mg Tab 2000 0 2000 0 2000
381 Tetracyclin HCL 500 mg Tab 4600 0 4600 1800 2800
382 Tetrakain HCL T. Mata 0,5 % Botol 0 0 0 0 0
383 Thiamin HCL 50 mg Tab 1000 0 1000 0 1000
384 Thiamin HCL Inj 100 ml - 1 ml Vial 1080 0 1080 30 1050
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
385 Tramadol 50 mg Tab 0 0 0 0 0
386 Tricresol Formalin 10 ml Botol 0 0 0 0 0
387 Triheksiphenidil HCL 2 mg Tab 1000 0 1000 10 990
388 Truvit Syr Botol 120 0 120 20 100
389 Ultrasonic Gel 250 ml Botol 0 0 0 0 0
390 Urine Bag 1000 ml Pcs 10 0 10 0 10
391 Vaksin BCG Ampul 15 0 15 9 6
392 Pelarut BCG Vial 15 0 15 9 6
393 Vaksin Campak Rubella Vial 15 0 15 5 10
394 Pelarut Campak Rubella Ampul 15 0 15 5 10
395 Vaksin DPT HB Combo Ampul 30 0 30 26 4
396 Vaksin HB 0 (Unijek) Ampul 15 0 15 0 15
397 Vaksin IPV Ampul 7 0 7 0 7
398 Vaksin TT Bumil Ampul 40 0 40 20 20
399 Vaksin Polio Ampul 19 0 19 17 2
400 Ventolin Nebulizer Flacon 15 0 15 5 10
401 Verorab Vaksin Dos 1 10 11 4 7
402 Viccillin - SX (Ampicilin) Inj 1,5 g Vial 20 0 20 0 20
403 Vit A 100.000 IU Kapsul 0 0 0 0 0
404 Vit A 200.000 IU Kapsul 0 0 0 0 0
405 Vitamin B Kompleks Tab 3000 0 3000 2800 200
406 Vitamin B Kompleks Inj Vial 22 0 22 22 0
407 Zinc Dispersible 20 mg Tab 0 4800 4800 500 4300
408 Zinc Syr 20 mg/ 5 ml Botol 260 0 260 80 180
409 HIV Tes Kit Strip 0 0 0 0 0
410 HBsAG Tes Kit Strip 0 0 0 0 0
411 HS Posterior Dos 2 0 2 0 2
412 Filtek Z350 XT Pcs 31 0 31 0 31
413 Pulp - X Dos 30 0 30 0 30
414 Iodium Tes Botol 0 0 0 0 0
415 Mitela (Kain SegiTiga) Pcs 0 0 0 0 0
416 Poligyp 10 cm x 2,7 m Roll 3 0 3 0 3
417 Asam Asetat 100 ml Botol 1 0 1 0 1
418 Elatomull Haft Dos 0 0 0 0 0
419 Paracetamol Drops Botol 0 4 4 4 0
420 Omeprazole 40 mg Inj Ampul 50 0 50 10 40
421 Metcovazin Cr Tube 4 0 4 4 0
422 Asam Tranexamat 500 mg Tab 1100 0 1100 300 800
423 Nifedipin 20 mg (Adalat) Tab 1740 0 1740 120 1620
424 Ketorolac 30 mg/ml Inj Ampul 160 0 160 10 150
425 Primaquin 15 mg Tab 500 0 500 400 100
426 Selang Oxygen Pcs 10 10 20 0 20
427 Xylocame Pump Spray Botol 10 0 10 0 10
428 Pritagesik Tab 1400 1000 2400 700 1700
429 Elastis Verban 10 cm x 4,5 m Buah 10 0 10 5 5
430 Handscoon Non Steril (S) Dos 9 20 29 4 25
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
431 Enbatic Cr Tube 0 48 48 24 24
432 Selang Oxygen (L) Pcs 10 10 20 4 16
433 Selang Oxygen (XS) Pcs 0 0 0 0 0
434 Biocombin Tab 800 0 800 800 0
435 Sulfadiazine Silver 10 mg Tube 20 0 20 5 15
436 Polifix 10 cm X 5 m Roll 5 0 5 0 5
437 Tramadol 100 mg/2 ml Inj Ampul 50 0 50 0 50
438 Paper Tape 5 X 9,14 Roll 12 0 12 0 12
439 Ramipril 10 mg Tab 990 0 990 300 690
440 Pyrantel Pamoat 250 mg Tab 800 0 800 100 700
441 Eyefresh Tetes Mata Botol 100 0 100 25 75
Stok Peneri Persedi Pemak Stok Permi Pemberian
No NAMA OBAT / BMHP Satuan
awal maan aan aian akhir ntaan APBD I APBD IIprogram

1 2 3 4 5 6 7 8 9 10 11 12
442 Pantocain 2% Botol 29 0 29 29 0
443 Ethyl Chloride Spray 100 ml Botol 1 0 1 0 1
444 Kasa Steril 2 m X 80 cm Buah 0 15 15 2 13
445 Apialis Syr Botol 0 5 5 5 0
446 Depakote Tab 0 300 300 300 0
447 Siobion Tab 0 2000 2000 1000 1000

Umum
BPJS Jamkesda Jumlah
JUMLAH KUNJUNGAN RESEP Bayar Tdk Bayar

Mengetahui/Menyetujui Yang Menyerahkan Yang Memohon Yang


Penanggung Jawab Gudang Farmasi Pet

Sahrul, SKM Arini Priyanti Kandupi, S. Farm, Apt Moh. Rizal Sumaga, SKM Mujria
Nip. 19820714 200502 1 002 Nip.19830402 200502 2 004 Nip. 19720123 199402 1 002 Nip : 19881

KETERANGAN :
Lembar Putih : GFK
Lembar Merah : Puskesmas
N OBAT

: DESEMBER 2019

Pemberian
Ket
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13 14 15
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13 14 15
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13 14 15
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Yang Menerima
Petugas PKM

Mujriah A.Md, Far


Nip : 19881005 201001 2 001