PUSTU/PKD TANGGAL PELAYANAN Bulan..........................

2017

UMUM
Bayar
JKN
KIA
Bayar
JKN
KB
Bayar
JKN
GIGI
Bayar
JKN
IMMUN
Bayar
JKN
JUMLAH PER TANGGAL
Bayar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
JKN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Pasien Umum Gigi KIA KB IMMUN Jumlah

Bayar 0 0 0 0 0 0
JKN 0 0 0 0 0 0
Jumlah 0 0 0 0 0 0
 Mengetahui Yang Memberi Yang Menerima
Kepala UPT Puskesmas Ngombol Pengelola Obat Penanggungjawab.......................................

dr. Utomo Budisantoso Ria Sutriana .................................

NIP.19700628 200212 1 005 NIP. 19880123 201101 2 008 ..................................................
.... 2017 Jumlah

0
0

0
0

0
0

0
0

0
0

0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
ungjawab.......................................
23
22
21
20
19
18
17
16
15
14
13
12
11
10 j
7j
6j
j
3j

9b
8b
4b
2b
1b
NO J/B

arsa
ilham

arserli

supami
zulfahri

manisah
deanova
darminto
sri winarni
ningmahyant
NAMA PASIEN

Aminoflin

10
Amoxicilin
Amox sy 125
Antasida
10
10
6

Antasida sy
1
1

Ant fungi
Asam Askorbat
VIT C
Asmef
10

Axiclovir zk
Betametason zk
Dexa
10
10
5

Gentamisin zk
GG
10
10
10
5

Hidro zk
1

Ibuprofen
Kaptopril 25mg
Kloramfenicol
500mg
kloram zm
kloram TM
kloram TT
Kalk
CTM
10
10
10
5

Kotrimox
Kotri sy
Metampiron
Metro 500mg
Mikonasol
Nifedipijn 10 mg
Nadik
10

Paracet
10
10 10
10
5

Paracet sy
LAPORAN PEMAKAIAN OBAT HARIAN PUSTU

Pyrantel
Pyridoxin b6
Povidon
Phenol TT
Prednison
JUMLAH 0 10 0 26 2 0 0 10 0 0 25 0 35 1 0 0 0 0 0 0 0 35 0 0 0 0 0 0 20 35 0 0 0 0 0 0
 Salbutamol 4mg
24 zk
salicyl bedak
Thiamfenicol
Thiamin b1
Bcomp
Ant Diare
6 Ant Diare sy
Caviplex
Neurotropik
Vitalex

5
5
5
Vitamin Syr
Zink
10

Zink syr
Ant fu
kombinasi sy
Garam Oralit
Zat Besi
Spuit 3cc
Kasa
Plester
NaCl
Alkohol
0 0 0 0 0 0 6 0 0 0 15 0 10 0 0 0 0 0 0 0 0 0 0 0 0
 14 J
13 J
12 J
11 J
10 J
9J
8J
7J
6B
5B
4B
3B
2B
1B
NO J/B

reva

niah
faizin
tusiyah
mulyat

naurele
tugimin

miswan

mujiyani
Sukinem

wagiyem

sumihart
susilowat

kelik sutanto
NAMA PASIEN

Aminoflin
Amoxicilin
Amox sy 125
Antasida
10
10
10

Antasida sy
Ant fungi
Asam Askorbat VIT
C
Asmef
Axiclovir zk
Betametason zk
Dexa
10
10

Gentamisin zk
GG
10

Hidro zk
Ibuprofen
10

Kaptopril 25mg
Kloramfenicol
500mg
kloram zm
kloram TM
kloram TT
Kalk
CTM
2

Kotrimox
10 10
10
10 10
10

Kotri sy
10

1
1

Metampiron
Metro 500mg
Mikonasol
Nifedipijn 10 mg
10

Nadik
10
10
10

Paracet
10
10
10
10
10
10

Paracet sy
LAPORAN PEMAKAIAN OBAT HARIAN PUSTU

Pyrantel
Pyridoxin b6
10
10
10
10
10

Povidon
Phenol TT
Prednison
JUMLAH 0 0 0 30 0 0 0 0 0 0 20 0 12 0 10 0 0 0 0 0 0 22 40 12 0 0 0 10 30 62 0 0 50 0 0 0
 Salbutamol 4mg
24 zk
salicyl bedak
Thiamfenicol
Thiamin b1
Bcomp
Ant Diare

10
10
10
Ant Diare sy
Caviplex

5
5

10
Neurotropik
Vitalex

10

5
Vitamin Syr
Zink
Zink syr
Ant fu kombinasi
sy
Garam Oralit

10
Zat Besi
Spuit 3cc
Kasa
Plester
NaCl
Alkohol
BETAFLU
1
0 0 0 0 0 0 30 0 20 0 15 0 0 0 0 10 0 0 0 0 0 0 1 0 0
 9
8

12
11
10
7j
0j
5j
4j
3j
2j
1j
NO J/B

sugiart

rubiyem
ngasirah
mujiyani

poninten
sri hartat
tut sukiyem
NAMA PASIEN

Aminoflin
Amoxicilin
Amox sy 125
Antasida
Antasida sy
Ant fungi
Asam Askorbat VIT
C
Asmef
10
10
10

Axiclovir zk
Betametason zk
Dexa
10
10
10

Gentamisin zk
GG
10
10
10

Hidro zk
1

Ibuprofen
Kaptopril 25mg
10
10
10

Kloramfenicol
500mg
kloram zm
kloram TM
kloram TT
Kalk
CTM
Kotrimox
Kotri sy
Metampiron
Metro 500mg
Mikonasol
Nifedipijn 10 mg
Nadik
10

Paracet
10
10
10

Paracet sy
Pyrantel
LAPORAN PEMAKAIAN OBAT HARIAN PUSTU

Pyridoxin b6
10
10

Povidon

Phenol TT
JUMLAH 0 0 0 0 0 0 0 30 0 0 30 0 30 1 0 30 0 0 0 0 0 0 0 0 0 0 0 0 10 30 0 0 20 0 0
 U
Prednison
Salbutamol 4mg
24 zk
salicyl bedak
Thiamfenicol
Thiamin b1
Bcomp
Ant Diare
Ant Diare sy
Caviplex
Neurotropik
Vitalex

5
5
5
5
Vitamin Syr
Zink
Zink syr
Ant fu kombinasi
sy
Garam Oralit
Zat Besi
Spuit 3cc
Kasa
Plester

NaCl
Alkohol
0 0 0 0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0
13 j
12 j
11 j
10 j
9j
7j
6j
5j
2j
1j

8b
4b
3b
NO J/B

niah
janah
ngatni
suysnt
suhart

miswan
suyanto
waltnem

sri hartatk
sri nursiyah
joyo pawiro

supriyaningsih

nur endah khasanah

NAMA PASIEN

Aminoflin

10
Amoxicilin
Amox sy 125
Antasida

10
10

5
Antasida sy
Ant fungi
Asam Askorbat VIT
C
Asmef
Axiclovir zk
Betametason zk
Dexa
10
10
10

Gentamisin zk
GG
10
10
10
10
10

Hidro zk
Ibuprofen
Kaptopril 25mg
10
10

Kloramfenicol
500mg
kloram zm
kloram TM
kloram TT
kalk
CTM
Kotrimox
10

Kotri sy
Metampiron
Metro 500mg
Mikonasol
Nifedipijn 10 mg
Nadik
Paracet
10
10
10
10
10
10

Paracet sy
LAPORAN PEMAKAIAN OBAT HARIAN PUSTU

Pyrantel
Pyridoxin b6
10
10
10

Povidon
Phenol TT
Prednison
JUMLAH 0 10 0 25 0 0 0 0 0 0 30 0 50 0 0 20 0 0 0 0 0 0 10 0 0 0 0 0 0 65 0 0 35 0 0 0
 Salbutamol 4mg
24 zk
salicyl bedak
Thiamfenicol
Thiamin b1
Bcomp
Ant Diare
Ant Diare sy
Caviplex

5
5 Neurotropik
10 Vitalex
5 Vitamin Syr
Zink

10
Zink syr
Ant fu kombinasi
sy
Garam Oralit
Zat Besi
10
30
10

Spuit 3cc
Kasa
Plester
NaCl
Alkohol
0 0 0 0 0 0 0 0 10 0 15 0 10 0 0 0 50 0 0 0 0 0 0 0 0
11 J
10 J
9J
8J
7J
6J
5J
4J
3J
2J
1B
NO J/B

NIYAH
NURUL F

FATIMAH
TUGIMIN

AKHMAD
SUBARMI

WATIMAN
WALTINEM

SRI WINARNI
NGARMIYEM
TUTI SUKIYEM
NAMA PASIEN

Aminoflin

10
Amoxicilin
Amox sy 125
10 Antasida
10
10

Antasida sy
Ant fungi
Asam Askorbat VIT
C
Asmef
10
10
10
10
10
10
10

Axiclovir zk
Betametason zk
Dexa
10
10

Gentamisin zk
GG
10
10
10
10
10
10

Hidro zk
Ibuprofen
Kaptopril 25mg
10
10

Kloramfenicol
500mg
kloram zm
kloram TM
1

kloram TT
Kalk
10

CTM
10
10
10
10
10

Kotrimox
10 10

Kotri sy
Metampiron
Metro 500mg
Mikonasol
Nifedipijn 10 mg
Nadik
10

Paracet
10

Paracet sy
LAPORAN PEMAKAIAN OBAT HARIAN PUSTU

Pyrantel
Pyridoxin b6
Povidon
Phenol TT
Prednison
JUMLAH 0 10 0 30 0 0 0 70 0 0 20 0 60 0 0 20 0 0 1 0 10 60 10 0 0 0 0 0 10 10 0 0 0 0 0 0
 Salbutamol 4mg
24 zk
salicyl bedak
Thiamfenicol
Thiamin b1
Bcomp
Ant Diare
Ant Diare sy
Caviplex

5
Neurotropik
Vitalex

5
5
5
5
5
5

Vitamin Syr
Zink
Zink syr
Ant fu kombinasi
sy
Garam Oralit
Zat Besi
Spuit 3cc
Kasa
Plester
NaCl
Alkohol
0 0 0 0 0 0 0 0 5 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 J

Nifedipijn 10 mg
Betametason zk

Kaptopril 25mg
Asam Askorbat

Gentamisin zk

Kloramfenicol
Amox sy 125

Metro 500mg
Metampiron

Pyridoxin b6
Aminoflin
Amoxicilin

Antasida sy

Axiclovir zk

kloram TM
NO J/B JOYO PAWIRO

kloram zm

Mikonasol

Prednison
Paracet sy
kloram TT

Phenol TT
Ibuprofen
Ant fungi

Kotrimox
Antasida

Pyrantel
Hidro zk

Povidon
Kotri sy

Paracet
500mg
Asmef

Nadik
C

Dexa

CTM
Kalk
VIT

GG
1B BONIYEM 10 10 10 10
2B SUKINEM 10 10 10
3J ATMOWIJOYO 10 10 10
4J MUHAMAD ZULFAHRI 10 10 10 10
5J SITI 10 10 10 10
6J DWI R 10 10
7J KELIK SUTANTO 10 10
8J MARSIH 10
9J ADI RAHARJO 10 10
10 B MINATUN 10 10 10 10
11 SUNARSIH 10 10 10 10
12 J NIYAH 10 10 10
13 J SRI HARTATI 10 10 10
14 B WATIMAN 10 10 10
15 J SUMIYATI 10 10 10
16 J JOYO PAWIRO 10 10 10
17 J AMRIYANI 10 10 10
18 J DARMINTO 10 10
18
19
20
21
22
23
24
25
JUMLAH 0 60 0 70 0 0 0 10 0 0 10 0 40 0 0 0 0 0 0 0 90 40 0 0 0 0 0 0 30### 0 0 50 0 0 0
 Salbutamol 4mg
24 zk
salicyl bedak
Thiamfenicol
Thiamin b1
Bcomp
Ant Diare
Ant Diare sy
Caviplex

5
5
Neurotropik
Vitalex
10

5
5
5
Vitamin Syr
Zink
10
10

Zink syr
Ant fu
kombinasi sy
Garam Oralit
Zat Besi
30

Spuit 3cc
Kasa
Plester
NaCl
Alkohol
pil KB
0 0 0 0 0 0 0 0 10 0 25 0 20 0 0 0 30 0 0 0 0 0 0 0 0
 9
8
7

21
20
19
18
17
16
15
14
13
12
11
10
6J
5J
4J
3J
2J
1B
NO J/B

ENY S
MISWAN
SUKINEM
PONINTEN

SRI WINARNI
NURUL HIDAYAT
NAMA PASIEN

Aminoflin
10 Amoxicilin
Amox sy 125
Antasida
10

Antasida sy
Ant fungi
Asam Askorbat VIT
C
Asmef
10

Axiclovir zk
Betametason zk
Dexa
10
10

Gentamisin zk
GG
10
10
10

Hidro zk
Ibuprofen
Kaptopril 25mg
10

Kloramfenicol
500mg
kloram zm
kloram TM
kloram TT
Kalk
10

CTM
10
10 10
10

Kotrimox
Kotri sy
Metampiron
Metro 500mg
Mikonasol
Nifedipijn 10 mg
NADIK
10

Paracet
10
10

Paracet sy
LAPORAN PEMAKAIAN OBAT HARIAN PUSTU

Pyrantel
Pyridoxin b6
10

Povidon
Phenol TT
Prednison
JUMLAH 0 10 0 10 0 0 0 10 0 0 20 0 30 0 0 10 0 0 0 0 20 30 0 0 0 0 0 0 10 20 0 0 10 0 0 0
 Salbutamol 4mg
24 zk
salicyl bedak
Thiamfenicol
Thiamin b1
Bcomp
Ant Diare
Ant Diare sy
Caviplex
Neurotropik
Vitalex

5
5
5

Vitamin Syr
Zink
Zink syr
Ant fu kombinasi
sy
Garam Oralit
Zat Besi
10

Spuit 3cc
Kasa
Plester
NaCl
Alkohol
0 0 0 0 0 0 0 0 0 0 15 0 0 0 0 0 10 0 0 0 0 0 0 0 0
10 J
8J
7J
6J
5J
4J
2J
1J

9B
3B
NO J/B

DWI RUS
SUPANDI

RUMIYATI

MANISAH
NGATIJAH
SOFIATUN
NGADISAH
REISYA NUR

BUDI LESTARI
SELVIA DAMAYANTI
NAMA PASIEN

Aminoflin

10
Amoxicilin
Amox sy 125
Antasida
10

Antasida sy
Ant fungi
Asam Askorbat VIT
C
Asmef
Axiclovir zk
Betametason zk
Dexa
Gentamisin zk
GG
10
10
10

Hidro zk
Ibuprofen
Kaptopril 25mg
10

Kloramfenicol
500mg
kloram zm
kloram TM
kloram TT
Kalk
10
10

CTM
10
10
10

Kotrimox
Kotri sy
1

Metampiron
Metro 500mg
Mikonasol
Nifedipijn 10 mg
Nadik
10
10
10
10

Paracet
10
10
10
10

Paracet sy
LAPORAN PEMAKAIAN OBAT HARIAN PUSTU

Pyrantel
Pyridoxin b6
10
10
10

Povidon
Phenol TT
Prednison
JUMLAH 0 10 0 10 0 0 0 0 0 0 0 0 30 0 0 10 0 0 0 0 20 30 0 1 0 0 0 0 40 40 0 0 30 0 0 0
 Salbutamol 4mg
24 zk
salicyl bedak
Thiamfenicol
Thiamin b1
Bcomp
Ant Diare
Ant Diare sy
Caviplex

5
5
5
Neurotropik
Vitalex
Vitamin Syr
Zink
10

Zink syr
Ant fu kombinasi
sy
Garam Oralit
Zat Besi
10
10

Spuit 3cc
Kasa
Plester
NaCl
Alkohol
BETAFLU
1
0 0 0 0 0 0 0 0 15 0 0 0 10 0 0 0 20 0 0 0 0 0 1 0 0
 J
J
7J
6J
5J
4J
3J
2J
1J

B
B
NO J/B

HARTINI
SUHARTI

NAURELE

MARSIYAH
WALTINEM

SULISTIYANI
SRI HARTATI
SRI WINARSIH
SUMI HARTATI

ATMO WIJOYO

ENY SUKISMINI
NAMA PASIEN

Aminoflin

10
10
10
10

Amoxicilin
Amox sy 125
10 Antasida
10

Antasida sy
Ant fungi
Asam Askorbat VIT
C
Asmef
10

Axiclovir zk
Betametason zk
Dexa
10
10
10

Gentamisin zk
GG
10
3

Hidro zk
Ibuprofen
Kaptopril 25mg
10

Kloramfenicol
500mg
kloram zm
kloram TM
kloram TT
Kalk
10
10
10

CTM
3

Kotrimox
Kotri sy
Metampiron
Metro 500mg
Mikonasol
Nifedipijn 10 mg
Nadik
10
10
10

Paracet
10
10
10 10
10
10 10

Paracet sy
1
LAPORAN PEMAKAIAN OBAT HARIAN PUSTU

Pyrantel
Pyridoxin b6
10
10
10
10
10
10

Povidon
Phenol TT
Prednison
JUMLAH 0 43 0 20 0 0 0 10 0 0 30 0 13 0 0 10 0 0 0 0 30 3 0 0 0 0 0 0 50 50 1 0 60 0 0 0
 Salbutamol 4mg
24 zk
salicyl bedak
Thiamfenicol
Thiamin b1
Bcomp
Ant Diare
Ant Diare sy
Caviplex

5
5
Neurotropik
Vitalex
Vitamin Syr
Zink
Zink syr
Ant fu kombinasi
sy
Garam Oralit
Zat Besi
10 Spuit 3cc
Kasa
Plester
NaCl
Alkohol
0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0
 9
8
7
6
5
4
3
2
1

17
16
15
14
13
12
11
10
NO J/B
NAMA PASIEN

Aminoflin
Amoxicilin
Amox sy 125
Antasida
Antasida sy
Ant fungi
Asam Askorbat VIT
C
Asmef
Axiclovir zk
Betametason zk
Dexa
Gentamisin zk
GG
Hidro zk
Ibuprofen
Kaptopril 25mg
Kloramfenicol
500mg
kloram zm
kloram TM
kloram TT
Kalk
CTM
Kotrimox
Kotri sy
Metampiron
Metro 500mg
Mikonasol
Nifedipijn 10 mg
Nadik
Paracet
Paracet sy
LAPORAN PEMAKAIAN OBAT HARIAN PUSTU

Pyrantel
Pyridoxin b6
Povidon
Phenol TT
Prednison
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Salbutamol 4mg
24 zk
salicyl bedak
Thiamfenicol
Thiamin b1
Bcomp
Ant Diare
Ant Diare sy
Caviplex
Neurotropik
Vitalex
Vitamin Syr
Zink
Zink syr
Ant fu kombinasi
sy
Garam Oralit
Zat Besi
Spuit 3cc
Kasa
Plester
NaCl
Alkohol
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 9
8
7
6
5
4
3
2
1

12
11
10
NO J/B
NAMA PASIEN

Aminoflin
Amoxicilin
Amox sy 125
Antasida
Antasida sy
Ant fungi
Asam Askorbat VIT
C
Asmef
Axiclovir zk
Betametason zk
Dexa
Gentamisin zk
GG
Hidro zk
Ibuprofen
Kaptopril 25mg
Kloramfenicol
500mg
kloram zm
kloram TM
kloram TT
Kalk
CTM
Kotrimox
Kotri sy
Metampiron
Metro 500mg
Mikonasol
Nifedipijn 10 mg
Nadik
Paracet
Paracet sy
LAPORAN PEMAKAIAN OBAT HARIAN PUSTU

Pyrantel
Pyridoxin b6
Povidon
Phenol TT
Prednison
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Salbutamol 4mg
24 zk
salicyl bedak
Thiamfenicol
Thiamin b1
Bcomp
Ant Diare
Ant Diare sy
Caviplex
Neurotropik
Vitalex
Vitamin Syr
Zink
Zink syr
Ant fu kombinasi
sy
Garam Oralit
Zat Besi
Spuit 3cc
Kasa
Plester
NaCl
Alkohol
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 9
8
7
6
5
4
3
2
1

10
NO J/B
NAMA PASIEN

Aminoflin
Amoxicilin
Amox sy 125
Antasida
Antasida sy
Ant fungi
Asam Askorbat VIT
C
Asmef
Axiclovir zk
Betametason zk
Dexa
Gentamisin zk
GG
Hidro zk
Ibuprofen
Kaptopril 25mg
Kloramfenicol
500mg
kloram zm
kloram TM
kloram TT
Kalk
CTM
Kotrimox
Kotri sy
Metampiron
Metro 500mg
Mikonasol
Nifedipijn 10 mg
Nadik
Paracet
Paracet sy
LAPORAN PEMAKAIAN OBAT HARIAN PUSTU

Pyrantel
Pyridoxin b6
Povidon
Phenol TT
Prednison
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Salbutamol 4mg
24 zk
salicyl bedak
Thiamfenicol
Thiamin b1
Bcomp
Ant Diare
Ant Diare sy
Caviplex
Neurotropik
Vitalex
Vitamin Syr
Zink
Zink syr
Ant fu kombinasi
sy
Garam Oralit
Zat Besi
Spuit 3cc
Kasa
Plester
NaCl
Alkohol
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 9
8
7
6
5
4
3
2
1

17
16
15
14
13
12
11
10
NO J/B
NAMA PASIEN

Aminoflin
Amoxicilin
Amox sy 125
Antasida
Antasida sy
Ant fungi
Asam Askorbat VIT
C
Asmef
Axiclovir zk
Betametason zk
Dexa
Gentamisin zk
GG
Hidro zk
Ibuprofen
Kaptopril 25mg
Kloramfenicol
500mg
kloram zm
kloram TM
kloram TT
Kalk
CTM
Kotrimox
Kotri sy
Metampiron
Metro 500mg
Mikonasol
Nifedipijn 10 mg
Nadik
Paracet
Paracet sy
LAPORAN PEMAKAIAN OBAT HARIAN PUSTU

Pyrantel
Pyridoxin b6
Povidon
Phenol TT
Prednison
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Salbutamol 4mg
24 zk
salicyl bedak
Thiamfenicol
Thiamin b1
Bcomp
Ant Diare
Ant Diare sy
Caviplex
Neurotropik
Vitalex
Vitamin Syr
Zink
Zink syr
Ant fu kombinasi
sy
Garam Oralit
Zat Besi
Spuit 3cc
Kasa
Plester
NaCl
Alkohol
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 NO J/B
NAMA PASIEN

Aminoflin
Amoxicilin
Amox sy 125
Antasida
Antasida sy
Ant fungi
Asam Askorbat VIT
C
Asmef
Axiclovir zk
Betametason zk
Dexa
Gentamisin zk
GG
Hidro zk
Ibuprofen
Kaptopril 25mg
Kloramfenicol
500mg
kloram zm
kloram TM
kloram TT
Kalk
CTM
Kotrimox
Kotri sy
Metampiron
Metro 500mg
Mikonasol
Nifedipijn 10 mg
Nadik
Paracet
Paracet sy
LAPORAN PEMAKAIAN OBAT HARIAN PUSTU

Pyrantel
Pyridoxin b6
Povidon
Phenol TT
Prednison
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Salbutamol 4mg
24 zk
salicyl bedak
Thiamfenicol
Thiamin b1
Bcomp
Ant Diare
Ant Diare sy
Caviplex
Neurotropik
Vitalex
Vitamin Syr
Zink
Zink syr
Ant fu kombinasi
sy
Garam Oralit
Zat Besi
Spuit 3cc
Kasa
Plester
NaCl
Alkohol
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 NO J/B
NAMA PASIEN

Aminoflin
Amoxicilin
Amox sy 125
Antasida
Antasida sy
Ant fungi
Asam Askorbat VIT
C
Asmef
Axiclovir zk
Betametason zk
Dexa
Gentamisin zk
GG
Hidro zk
Ibuprofen
Kaptopril 25mg
Kloramfenicol
500mg
kloram zm
kloram TM
kloram TT
Kalk
CTM
Kotrimox
Kotri sy
Metampiron
Metro 500mg
Mikonasol
Nifedipijn 10 mg
Nadik
Paracet
Paracet sy
LAPORAN PEMAKAIAN OBAT HARIAN PUSTU

Pyrantel
Pyridoxin b6
Povidon
Phenol TT
Prednison
JUMLAH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Salbutamol 4mg
24 zk
salicyl bedak
Thiamfenicol
Thiamin b1
Bcomp
Ant Diare
Ant Diare sy
Caviplex
Neurotropik
Vitalex
Vitamin Syr
Zink
Zink syr
Ant fu kombinasi
sy
Garam Oralit
Zat Besi
Spuit 3cc
Kasa
Plester
NaCl
Alkohol
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 Asam Askorbat VIT

Nifedipijn 10 mg

Salbutamol 4mg
Betametason zk

Kaptopril 25mg
Gentamisin zk

Kloramfenicol
Amox sy 125

Metro 500mg

Thiamfenicol
salicyl bedak

Ant Diare sy
Metampiron

Pyridoxin b6
Aminoflin
Amoxicilin

Antasida sy

Axiclovir zk
NO

Thiamin b1
kloram TM
kloram zm

Mikonasol

Prednison
Paracet sy

Ant Diare
kloram TT

Phenol TT
Ibuprofen
Ant fungi

Kotrimox
Antasida

Pyrantel
Hidro zk

Povidon
Kotri sy

Paracet

Bcomp
500mg
Asmef

Nadik

24 zk
Dexa

CTM
Kalk
GG
C
h1 0 10 0 26 2 0 0 10 0 0 25 0 35 1 0 0 0 0 0 0 0 35 0 0 0 0 0 0 20 35 0 0 0 0 0 0 0 0 0 0 0 0 6 0
h2 0 0 0 30 0 0 0 0 0 0 20 0 12 0 10 0 0 0 0 0 0 22 40 12 0 0 0 10 30 62 0 0 50 0 0 0 0 0 0 0 0 0 30 0
h3 0 0 0 0 0 0 0 30 0 0 30 0 30 1 0 30 0 0 0 0 0 0 0 0 0 0 0 0 10 30 0 0 20 0 0 0 0 0 0 0 0 0 0 0
h4 0 10 0 25 0 0 0 0 0 0 30 0 50 0 0 20 0 0 0 0 0 0 10 0 0 0 0 0 0 65 0 0 35 0 0 0 0 0 0 0 0 0 0 0
h5 0 10 0 30 0 0 0 70 0 0 20 0 60 0 0 20 0 0 1 0 10 60 10 0 0 0 0 0 10 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h6 0 60 0 70 0 0 0 10 0 0 10 0 40 0 0 0 0 0 0 0 90 40 0 0 0 0 0 0 30### 0 0 50 0 0 0 0 0 0 0 0 0 0 0
h7 0 10 0 10 0 0 0 10 0 0 20 0 30 0 0 10 0 0 0 0 20 30 0 0 0 0 0 0 10 20 0 0 10 0 0 0 0 0 0 0 0 0 0 0
h8 0 10 0 10 0 0 0 0 0 0 0 0 30 0 0 10 0 0 0 0 20 30 0 1 0 0 0 0 40 40 0 0 30 0 0 0 0 0 0 0 0 0 0 0
h9 0 43 0 20 0 0 0 10 0 0 30 0 13 0 0 10 0 0 0 0 30 3 0 0 0 0 0 0 50 50 1 0 60 0 0 0 0 0 0 0 0 0 0 0
h10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL 0### 0### 2 0 0### 0 0### 0### 2 10### 0 0 1 0###### 60 13 0 0 0 10###### 1 0### 0 0 0 0 0 0 0 0 0 36 0
Ant fu kombinasi
Garam Oralit
Neurotropik

Vitamin Syr

Spuit 3cc
Caviplex

Zat Besi
Zink syr

Alkohol
Plester
Vitalex

NaCl
Kasa
Zink

sy
0 0 15 0 10 0 0 0 0 0 0 0 0 0 0 0 0
20 0 15 0 0 0 0 10 0 0 0 0 0 0 1 0 0
0 0 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 0 15 0 10 0 0 0 50 0 0 0 0 0 0 0 0
5 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10 0 25 0 20 0 0 0 30 0 0 0 0 0 0 0 0
0 0 15 0 0 0 0 0 10 0 0 0 0 0 0 0 0
15 0 0 0 10 0 0 0 20 0 0 0 0 0 1 0 0
10 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
70 0### 0 50 0 0 10### 0 0 0 0 0 2 0 0
 Asam Askorbat VIT

Nifedipijn 10 mg

Salbutamol 4mg
Betametason zk

Kaptopril 25mg
Gentamisin zk

Kloramfenicol
Amox sy 125

Metro 500mg
Metampiron

Pyridoxin b6
Aminoflin
Amoxicilin

Axiclovir zk
antasyd sy
NO

kloram TM
kloram zm

Mikonasol

Prednison
Paracet sy
kloram TT

Phenol TT
Ibuprofen
Ant fungi

Kotrimox
Antasida

Pyrantel
Hidro zk

Povidon
Kotri sy

Paracet
500mg
Asmef

Nadik

24 zk
Dexa

CTM
Kalk
GG
C
Stok Awal
Penerimaan
Jumlah Stok 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Pemakaian
h1 0 10 0 26 2 0 0 10 0 0 25 0 35 1 0 0 0 0 0 0 0 35 0 0 0 0 0 0 20 35 0 0 0 0 0 0 0 0
h2 0 0 0 30 0 0 0 0 0 0 20 0 12 0 10 0 0 0 0 0 0 22 40 12 0 0 0 10 30 62 0 0 50 0 0 0 0 0
h3 0 0 0 0 0 0 0 30 0 0 30 0 30 1 0 30 0 0 0 0 0 0 0 0 0 0 0 0 10 30 0 0 20 0 0 0 0 0
h4 0 10 0 25 0 0 0 0 0 0 30 0 50 0 0 20 0 0 0 0 0 0 10 0 0 0 0 0 0 65 0 0 35 0 0 0 0 0
h5 0 10 0 30 0 0 0 70 0 0 20 0 60 0 0 20 0 0 1 0 10 60 10 0 0 0 0 0 10 10 0 0 0 0 0 0 0 0
h6 0 60 0 70 0 0 0 10 0 0 10 0 40 0 0 0 0 0 0 0 90 40 0 0 0 0 0 0 30 130 0 0 50 0 0 0 0 0
h7 0 10 0 10 0 0 0 10 0 0 20 0 30 0 0 10 0 0 0 0 20 30 0 0 0 0 0 0 10 20 0 0 10 0 0 0 0 0
h8 0 10 0 10 0 0 0 0 0 0 0 0 30 0 0 10 0 0 0 0 20 30 0 1 0 0 0 0 40 40 0 0 30 0 0 0 0 0
h9 0 43 0 20 0 0 0 10 0 0 30 0 13 0 0 10 0 0 0 0 30 3 0 0 0 0 0 0 50 50 1 0 60 0 0 0 0 0
h10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
h15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
TOTAL 0 153 0 221 2 0 0 140 0 0 185 0 300 2 10 100 0 0 1 0 170 220 60 13 0 0 0 10 200 442 1 0 255 0 0 0 0 0
Stok Akhir 0 -153 0 -221 -2 0 0 -140 0 0 -185 0 -300 -2 -10 -100 0 0 -1 0 -170 -220 -60 -13 0 0 0 -10 -200 -442 -1 0 -255 0 0 0 0 0
Permintaan 0 230 0 332 3 0 0 210 0 0 278 0 450 3 15 150 0 0 1.5 0 255 330 90 19.5 0 0 0 15 300 663 1.5 0 383 0 0 0 0 0
Pemberian
Keterangan

Mengetahui Yang Memberi

 Kepala UPT Puskesmas Ngombol Pengelola Obat Penanggungjawab....

dr. Utomo Budisantoso Ria Sutriana

NIP.19700628 200212 1 005 NIP.198801232011012008
 Ant fu kombinasi
Thiamfenicol

Garam Oralit
salicyl bedak

Ant Diare sy

Neurotropik

Vitamin Syr
Thiamin b1

Ant Diare

Spuit 3cc
Caviplex

Zat Besi
Zink syr

Alkohol
Bcomp

Plester
Vitalex

NaCl
Kasa
Zink

sy
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 6 0 0 0 15 0 10 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 30 0 20 0 15 0 0 0 0 10 0 0 0 0 0 0 1 0 0
0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 10 0 15 0 10 0 0 0 50 0 0 0 0 0 0 0 0
0 0 0 0 0 0 5 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 10 0 25 0 20 0 0 0 30 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 15 0 0 0 0 0 10 0 0 0 0 0 0 0 0
0 0 0 0 0 0 15 0 0 0 10 0 0 0 20 0 0 0 0 0 1 0 0
0 0 0 0 0 0 10 0 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 36 0 70 0 135 0 50 0 0 10 120 0 0 0 0 0 2 0 0
0 0 0 0 -36 0 -70 0 -135 0 -50 0 0 -10 -120 0 0 0 0 0 -2 0 0
0 0 0 0 54 0 105 0 203 0 75 0 0 15 180 0 0 0 0 0 3 0 0

Yang Menerima
Penanggungjawab............................................
 BULAN:

TANGGAL
NO
Aminoflin
Amoxicilin
Amox sy
Antasida
Antasida sy
Ant fungi
Asam Askorbat
Asmef
Axiclovir zk
Dexa
Gentamisin zk
GG
Hidro zk
Ibuprofen
Kaptopril
Kloramfenicol
kloram zm
kloram TM
REKAPAN BON O
kloram TT
Kalk
CTM
Kotrimox
Kotri sy
Metampiron
Metro
Mikonasol
Nadik
Paracet
Paracet sy
Pyrantel
B6
REKAPAN BON OBAT DAN BMHP PUSTU / PKD

Povidon
Prednison
Salbutamol
24 zk
salicyl bedak
Thiamfenicol
Bcomp
Ant Diare
Ant Diare sy
Caviplex
Neurotropik
Ant fu kombinasi sy
Garam Oralit
Zat Besi
Spuit 3cc
Kasa
Plester
NaCl
Alkohol