TANGGAL NO JAMINAN KES NAMA PASIEN UMUR KK

L P
1-Jan-16 1 0000001 Semi PAIJO

2-Jan-16 2 340000 Hastuti

3 Yuni
4 Supriyani
5
6 9 BAYI
7
8
9
10
 ALAMAT DIAGNOSA TINDAKAN TERAPI JML OBAT KET

Tegal Rejo K29 injeksi, medikasi CTM 8

dexsa 8
pamol
OBH
SALEP 24

Tegal Rejo
Tegal Rejo CTM 6
Tegal Rejo dexsa 6
PASIEN BALITA

NO NAMA/KK UMUR BB TB NN ALAMAT PARITAS TD UK LETAK

TFU HB GOLDA PROT HPM HPL
LAPORAN PELAYANAN RAWAT JALAN TINGKAT PERTAMA
BULAN : MARET TAHUN 2016
UPT PUSKESMAS GEDANGSARI II
Umur kunjungan
NO TANGGAL NAMA PASIEN No. Telp. No. Kartu Lama Baru
L P L P PT PTT

Keterangan :
- PT : Peserta Terdaftar
- PTT : Peserta Tidak Terdaftar
 Pelayanan yang diberikan
Alamat Diagnosa di Rujuk Tanda Tangan
Poli Jenis Tindakan

Mengetahui,
Ka. UPT Puskesmas Gedangsari II

drg. Dyah Mayun Hartanti

LAPORAN HASIL IMUNISASI TAHUN 2016

TEMPAT PELAYANAN
WILAYAH PUSKESMAS
BULAN
JENIS
KELAMIN ALAMAT NAMA ORTU
TANGGAL PE NO NAMA BAYI TGL. LAHIR L P DUSUN DESA
 IMUNISASI DASAR
HB-0 BCG PENTABO IPV CAMPAK
1 2 3 1 2 3 4
 RANGKUM PEMAKAIAN OBAT

OBAT 1 2 3 4 5 6 7 8 9 10 11 12
ctm 8 6 4 8
dexa 8 4
1 Acyclovir krim 5 % 23 5
2 Acyclovir tablet 400 mg 2 7
3 Albendazol tablet 400 mg 4 3 8
4 Albendazole suspensi 2
5 Alopurinol tablet 100 mg 6
6 Alopurinol tablet 300 mg 4
7 Ambroksol syrup 7
8 Ambroxol tablet 30 mg 3
9 Aminofilin tablet 200 mg 9
10 Aminofilina injeksi 24 mg/ml - 26
11 Amitriptilin HCl tablet salut 2 48
12 Amlodipine 5 mg tablet 94
13 Amoksilin Forte sirup 250mg/ 59
14 Amoxicillin Injeksi 1 g 37
15 Amoxicillin kaplet 500 mg 52
16 Amoxicillin sirup kering 125 m 74
17 Ampicillin injeksi 1 gr 28
18 Antalgin (Metampiron) tablet 54
19 Antalgin
Antasida injeksi
DOEN 250 mg/ml - 2
tab,kombinasi: 4
10 Mg-Hidroksida 200 mg + Al. Hidroksida.
72 200 mg
21 Antasida
Anti suspensi
Bakteri DOEN salep kombinasi:6
22 Basitrasin 500 IU/g + Polimiksin 10.000
2 IU/g
23 Anti Hemoroid DOEN Kombinas 56
24 Anti Scabies krim 10 gr
25 Anti Spasmodik injeksi
26 Anti Spasmodik
Antifungi DOEN tablet: Hyoscine-N-Butylbromide 10 mg (Spashi®)
Kombinasi:
27 Asam Benzoat 6% + Asam Salisilat 3%
Antimigren:
28 Ergotamin Tartrat 1 mg + Kofein 50 mg
29 Antiparkinson DOEN tablet kombinasi : Benserazid 25 mg Levodopa 100 mg
30 Aqua pro Injeksi steril, bebas pirogen
31 Aquadest Steril
32 Asam Askorbat (Vit C) tablet 250 mg
33 Asam Askorbat (Vit C) tablet 50 mg
34 Asam folat tablet 1 mg
35 Asam Mefenamat 500 mg kaplet
36 Asam Traneksamat 500 mg kapl
37 Asam Traneksamat Injeksi 250 mg
38 Asetosal tablet 100 mg
39 Asetosal tablet 500 mg
40 Atapulgit tablet 600 mg
41 Atropin sulfat inj 0,25mg/ml
42 Atropine 0.5 mg Tablet
43 Betametason krim 0.1%
44 Bisacodyl Suppo 10 mg
45 Bisacodyl Suppo 5 mg
46 Bisacodyl tablet 5 mg
47 Bisoprolol Fumarate 5mg tablet
48 Calcusol® kapsul
49 Carbo-adsorbent tablet 250 mg
50 Cefadroksil kapsul 500 mg
51 Ceftriaxone injeksi 1 g/vial
52 Cimetidin tablet 200 mg
53 Cinnarizine 25 mg tablet
54 Ciprofloksasin Kapsul 500 mg
55 Codein
56 Curcuma® degree
57 Deksametason injeksi 5 mg/ml - 1 ml
58 Deksametason tablet 0,5 mg
59 Dekstran 70 - larutan infus 6% steril
60 Dekstrometorfan tablet 15 mg
61 Dekstrometorfan sirup 10 mg/5 ml
62 Diazepam 10 mg / 2,5 ml lar rectal (Stesolid®)
63 Diazepam injeksi 5 mg/ml - 2 ml
64 Diazepam tablet 2 mg
65 Diazepam tablet 5 mg
66 Dietilkarbamazin Sitrat 100mg tablet
67 Difenhidramin HCl inj 10 mg/ml-1 ml
68 Digoksin tablet 0,25 mg
69 Diltiazem Hcl tablet 25 mg
70 Dimenhidrinat 50 mg tablet
71 Doksisiklin 100 mg kapsul
72 Domperidon syrup
73 Domperidon tablet 10 mg
74 Efedrin HCl tablet 25 mg
75 Ekstrak Belladon tablet 10 mg
76 Epineprin injeksi ( adrenalin injeksi )
77 Eritromisin sirup 200 mg/5 mL
78 Erytromisin 250 mg
79 Etambutol 250 mg
80 Etambutol 500 mg
81 Etanol 70 %
82 Fenitoin Injeksi 100 mg/2 mL
83 Fenitoin Natrium kapsul 100 mg
84 Fenitoin Natrium kapsul 30 mg
85 Fenobarbital injeksi 50 mg/ml - 1 ml
 86 Fenobarbital tablet 30 mg
87 Fenoksimetil Penisilina tablet 250 mg
88 Fenoksimetil Penisilina tablet 500 mg
89 Fenol Gliserol tetes telinga 10%
90 Fitomenadion (Vit.K1) injeksi
91 Fitomenadion (Vit.K1) tablet salut gula 10 mg
92 Fluoxetin 10 mg kapsul
93 Fluticasone Propionate 0.5 mg dalam 2ml NaCl
94 Furosemid injeksi 10mg/ml
95 Furosemid tablet 40 mg
96 Garam Oralit untuk 200 ml air
97 Gemfibrozil 300 mg
98 Gentamisin salb kulit 1%
99 Gentian Violet larutan 1 %
100 Glibenklamid tablet 5 mg
101 Glimepirid tablet 2 mg
102 Glipizid 5 mg tablet
103 Gliquidone 30 mg tablet
104 Gliseril Guayakolat tablet 100 mg
105 Glukosa larutan infus 10 % steril
106 Glukosa larutan infus 40 % steril
107 Glukosa larutan infus 5 % steril
108 Griseofulvin tablet 125 mg, micronized
109 Haloperidol tablet 0,5 mg
110 Haloperidol tablet 1,5 mg
111 Haloperidol tablet 5 mg
112 Hepagard® kapsul
113 Hidroklorotiazid (HCT) tablet 25 mg
114 Hidrokortison krim 2,5 %
115 Ibuprofen sirup 200 mg/ 5mL
116 Ibuprofen suspensi 100mg/5ml
117 Ibuprofen tablet 200 mg
118 Ibuprofen tablet 400 mg
119 INH 300 mg tab
120 Isosorbid Dinitrat tablet sublingual 5 mg
121 KA EN 3A
122 KA EN 3B
123 Kalamin lotion
124 Kalium Declovenak 50 mg
125 Kalium L-aspartate tablet 300 mg tablet
126 Kalium Permanganat serbuk
127 Kalsium Glukonat Inj 100 mg/mL
128 Kalsium Laktat (Kalk) tablet 500 mg
129 kaolin + pectin tablet
130 Kaolin-Pektin 760mg syrup
131 Kaptopril tablet 25 mg
132 Karbamazepin tablet 200 mg
133 Ketamin injeksi 1000 mg/ 10 mL
134 Ketokonazol crem 2 %
135 Ketokonazol tablet
136 Ketoprofen 100 mg Suppositoria
137 Klindamicin 150 mg kapsul
138 Klonidin 0,15 mg tablet
139 Kloramfenikol kapsul 250 mg
140 Kloramfenikol salb kulit 2%
141 Kloramfenikol salb mata 1 %
142 Kloramfenikol syrup
143 Kloramfenikol tetes mata 0.5%
144 Kloramfenikol tetes telinga 3 %
145 Klorfeniramin Maleat (CTM) tablet 4 mg
146 Klorokuin 250mg tablet
147 Klorpromazin HCl injeksi 25 mg/ml - 2 ml
148 Klorpromazin HCl tablet salut 100 mg
149 Klorpromazin
KotrimoksazolHCl tablet komb:
Suspensi salut 25 mg
Sulfametoksazol 200 mg
150 +Kotrimoksazol
Trimetoprim tablet
40 mg /kombinasi:
5 ml Sulfametoksazol 400 mg
151 +Kotrimoksazol
Trimetoprim tablet
80 mgpediatrik, kombinasi:
152 Sulfametoksazol 100 mg + Trimetoprim 20 mg
153 Kuinin (Kina) tablet 200 mg
154 Lidocain Injeksi non adrenalin
155 Lidokain
Lidokain 2% jellyinjeksi,
komp. 10 gr Kombinasi:
156 Lidokain HCl 2% + Epinefrin 1:80.000 - 2 ml
157 Loperamid tablet 2 mg
158 Loratadin tablet 10 mg
159 Magnesium Sulfat Injeksi ( IV ) 40%-25 ml
160 Metformin Hcl tablet 500 mg
161 Metil Prednisolone tablet 4 mg
162 Metilergometrin Maleat inj 0,200 mg-1 ml
163 Metilergometrin Maleat tablet salut 0,125 mg
164 Metoclopramid 10 mg tablet
165 Metoclopramid Hcl injeksi
166 Metronidazol 500 mg Suppositoria
167 Metronidazol larutan infus 500 mg /ml
168 Metronidazol tablet 250 mg
169 Metronidazol tablet 500 mg
170 Metronidazole sirup 125 mg/ 5mL
171 Mikonazol crem
172 Mikronutrien Ibu Hamil Tablet
173 Multivitamin Syrup PKD
174 Multivitamin Syrup Program Gizi
175 Natrium Bikarbonat tablet 500 mg
176 Natrium Diklofenac 50 mg tablet
177 Natrium Diklofenak tablet 25 mg
178 Natrium Klorida larutan infus 0,9 % steril
179 Neurotropik tablet
180 Nifedipin tablet 10 mg
181 Nistatin 500.000 IU tablet
182 Nistatin suspensi 100000Ui/ml
183 Nistatin tablet Vagina 100.000 IU
184 Nosirax® kapsul
185 OAT Kategori Anak FDC
186 OAT Kategori I FDC
187 OAT Kategori II FDC
188 OAT Sisipan FDC
189 Obat Batuk Hitam (O.B.H.) syr 1
190 Obat Sal Cerna : Antasida 200 mg; dimeticone 40 mg kaplet (Berlocid®)
191 Obat Tetes Mata Kombinasi: Polymyxin B sulfate 6.000 IU; neomycin sulfate 3.5 mg; sodium sulphate 1 mg
192 Oksitetrasiklin HCl salep kulit 3 %
193 Oksitetrasiklin HCl salep mata 1 %
194 Oksitosin injeksi 10 IU/ml - 1 ml
195 Omeprazole kapsul 20 mg
196 Oseltamivir Phosphate tablet (Tamiflu®)
197 Parasetamol drops
198 Parasetamol sirup 120 mg/5 m 1
199 Parasetamol Suppositoria
200 Parasetamol tablet 500 mg
201 Perak Sulfadiazin krim
202 Piracetam kaplet 1200 mg
203 Piracetam tablet 800 mg
204 Pirantel Pamoat tablet 125 mg
205 Pirazinamid 500 mg tablet
206 Piridoksin HCl (Vit.B6) tablet 10 mg
207 Piroksikam 20 mg
208 Polikresulen solution
209 Povidon Iodida 1 % MW/Kumur
210 Povidon Iodida 10 % 30 ml
211 Povidon Iodida 10 % 300 ml
212 Prednison tablet 5 mg
213 Primakuin 15 mg
214 Propiltiourasil tablet 100 mg
215 Propranolol HCl tablet 10 mg
216 Propranolol HCl tablet 40 mg
217 Ranitidin injeksi 25mg/2ml
218 Ranitidin tablet 150 mg
219 Reserpin tablet 0,10 mg
220 Reserpin tablet 0,25 mg
221 Retinol ( Vit A ) 100.000.IU
222 Retinol ( Vit A ) 200.000.IU
223 Riffampisin 600 mg tablet
224 Ringer Laktat larutan infus steril
225 Salbutamol 2 mg tablet
226 Salbutamol 4 mg tablet
227 Salbutamol Sulphate Nebules 2.5 mg / 2.5 ml (Ventolin®)
Salep 2-4 , Kombinasi:
228 Asam Salisilat 2% + Belerang Endap14%
229 Salisil Bedak 2 %
230 Serum Anti Bisa Ular Polivalen injeksi 5 ml (ABU I)
231 Serum Anti Tetanus (ATS) Injeksi 1.500 IU/ampul
232 Serum Anti Tetanus (ATS) Injeksi 20.000 IU / Vial
233 Setirizin sirup 5mg/ml
234 Sianokobalamin (Vit.B12) 50 mcg tablet
235 Sianokobalamin (Vit.B12) injeksi 500 mcg-ml
236 Simvastatin tablet 10 mg
237 Spironolakton tablet 25 mg
238 Streptomicin injeksi
239 Sulfasetamida Natrium tetes mata 15 %
240 Tablet Tambah Darah
241 Tablet Zink Dispersible
242 Tetrasiklin HCl kapsul 250 mg
243 Tetrasiklin HCl kapsul 500 mg
244 Thiamfenikol 500mg kapsul
245 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml
246 Tiamin HCl Mononitrat (Vit.B1) tablet 50 mg
247 Triheksifenidil Hidroklorida tablet 2 mg
248 Vitamin B Kompleks tablet
249 Zinc sirup 10 mg/mL

BAHAN MEDIS PAKAI HABIS

250 Alat suntik sekali pakai 1 ml
251 Alat suntik sekali pakai 10 ml
252 Alat suntik sekali pakai 2,5 ml
253 Alat suntik sekali pakai 3 ml
254 Alat suntik sekali pakai 5 ml
255 Alkohol swab
256 Antiseptik dan Disinfektan Gel
257 Aqua DM
258 Asering plabot 500 mL
259 Bayclin® (Klorin 5.25%) 4 Liter
260 Benang sutra hitam 2/0
261 Benang sutra hitam 3/0
262 Catgut Chromic Benang Bedah 3/0
263 Catgut Plain Benang Bedah 3/0
264 Daryantule® (Kasa Pembalut ukuran 10x10 cm direndam dlm 1% Framicetin SO4)
265 Foly Cateter No 16
266 Foly Cateter No 18
267 Infusion set anak
268 Infusion set dewasa
269 IV Catheter No. 18 G
270 IV Catheter No. 20 G
271 IV Catheter No. 22 G
272 IV Catheter No. 24 G
273 Jarum Jahit
274 Jelly Lubricant Steril
275 Kantong Urin
276 Kapas Pembalut / Absorben 250 gram
277 Kasa 16 x 16
278 Kasa hidrofil 40 x 80 cm elastis
279 Kasa Kompres 40/40 steril
280 Kasa Pembalut 2 m x 80 cm
281 Kasa Pembalut Hidrofil 4 m x 15 cm elastic
282 Kasa Pembalut Hidrofil 4 m x 3 cm elastic
283 Kertas EKG CARDIOLINE®
284 Kertas EKG FUKUDA®
285 Klem Umbilical
286 Lysol® (kresol tersabun 50%)
287 Masker Nebulizer Anak
288 Masker Nebulizer Dewasa
289 Masker Wajah Ear Loop
290 Masker Wajah Tali
291 Pembalut Gips
292 Perhidrol
293 Pisau Bedah No .11
294 Plester 5 yards x 2 inch
295 Pot Dahak
296 Sarung Tangan non steril No. 7
297 Sarung Tangan Persalinan (panjang)
298 Sarung Tangan Sanitasi (orange)
299 Sarung Tangan Steril No.6,5
300 Sarung Tangan Steril No.7
301 Sarung Tangan Steril No.7,5
302 Sarung Tangan Steril No.8
303 Selang Oksigen Anak
304 Selang Oksigen Bayi
305 Selang Oksigen Dewasa
306 Sendok sirup
307 Silk Benang Bedah Sutera No. 3/0 dengan jarum bedah
308 Spalk
309 Tissue
310 Tranfusi set
311 Ultra Sonique Gel 260 gr® (Gel Lubrikasi USG)
312 Ultra Sonique Gel 5 L® (Refill Gel Lubrikasi USG)
313 Underpad 60 x 90
314 Wing Needle No. 23 G
315 Wing Needle No. 25 G
316 Wing Needle No. 27 G

BAHAN KEDOKTERAN GIGI

316 Air Raksa Dental Use
317 Alvogyl Pasta
318 Arkansas Bur Hijau
319 Arkansas Bur Putih
320 Artikulating Papper
321 Bahan Tambalan Sinar BONDING
322 Bahan Tambalan Sinar ETCHING
323 Bahan Tambalan Sinar SOLARE A2.5 Anterior
324 Bahan Tambalan Sinar SOLARE A2.5 Posterior
325 Bahan Tambalan Sinar SOLARE A3
326 Bor Poilsh composite
327 Caviton
328 Celluloid Strip
329 Dentocain® Mepivacaine HCL 3% carpule 1.8 ml
330 Devitalisasi Pasta (Non Arsen)
331 Disposible Dental Needle
332 Etil Klorida spray
333 Eugenol cairan
334 Finishing Strip
335 Gelas Kumur Disposible
336 Glass Ionomer Cement ART Fuji I
337 Glass Ionomer Cement ART Fuji IX
338 Glass Ionomer Cement ART Fuji VII
339 Iod Gliserin
340 Iodoform (Mummifying Pasta)
341 Kalsium Hidroksida Pasta
342 Klorfenol kamfer Menthol ( CHKM )
343 Mata Bor High speed Fissure
344 Mata Bor High Speed Inverted
345 Mata Bor High Speed Round
346 Mata Bor Low speed
347 MD Cleanser
348 Microbrush
349 Occo Liquid
350 Saliva ejector disposible
351 Semen Seng Fosfat serbuk dan cairan
352 Silver Amalgam
353 Smear Layer Removal
354 Spon Gelatin cublices 1x1x1 cm
355 Temporary Stopping Fletcher (Fletcher) serbuk dan cairan
356 Tri Kresol Formalin (TKF)
13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
9 6

6 4 7
5 9
7 8 3
30
8 49
12
 STOK
NO NAMA OBAT/ BARANG
AWAL Pemakaian

PERSEDIAAN OBAT
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
ctm 30 49 0 0 0 0 0 0 0 0 0 0 0 0 0 0
dexsa 20 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 Acyclovir krim 5 %
2 Acyclovir tablet 400 mg
3 Albendazol tablet 400 mg
4 Albendazole suspensi
5 Alopurinol tablet 100 mg
6 Alopurinol tablet 300 mg
7 Ambroksol syrup
8 Ambroxol tablet 30 mg
9 Aminofilin tablet 200 mg

10 Aminofilina injeksi 24 mg/ml - 10

ml

11 Amitriptilin HCl tablet salut 25 mg

12 Amlodipine 5 mg tablet

13 Amoksilin Forte sirup 250mg/5ml

14 Amoxicillin Injeksi 1 g
15 Amoxicillin kaplet 500 mg

16 Amoxicillin
mg/5ml
sirup kering 125

17 Ampicillin injeksi 1 gr
Antalgin (Metampiron) tablet 500
18 mg

19 Antalgin injeksi 250 mg/ml - 2 ml

0
Antasida DOEN tab,kombinasi:
10 Mg-Hidroksida 200 mg + Al.
Hidroksida. 200 mg
1606 20 30 36 10 40 50 20 33
21 Antasida suspensi 30 1 2 1 2 2
Anti Bakteri DOEN salep
22 kombinasi:
Basitrasin 500 IU/g + Polimiksin
10.000 IU/g 23 1 1 1
23 Anti Hemoroid DOEN Kombinasi
0
24 Anti Scabies krim 10 gr 3
25 Anti Spasmodik injeksi 0
Anti Spasmodik tablet: Hyoscine-
26 N-Butylbromide 10 mg (Spashi®)
184
 Antifungi DOEN Kombinasi:
27 Asam Benzoat 6% + Asam Salisilat
3% 5
Antimigren:
28 Ergotamin Tartrat 1 mg + Kofein
50 mg 0
Antiparkinson DOEN tablet
29 kombinasi : Benserazid 25 mg
Levodopa 100 mg 0
Aqua pro Injeksi steril, bebas
30 pirogen
0
31 Aquadest Steril 0
Asam Askorbat (Vit C) tablet 250
32 mg
887 30 20 20 37 20 15 10 22
33 Asam Askorbat (Vit C) tablet 50
mg 1330 20 36 40 66 50 35
34 Asam folat tablet 1 mg 0
35
Asam Mefenamat 500 mg kaplet 1220 10 25
36 Asam Traneksamat 500 mg kapl
0
37 Asam Traneksamat Injeksi 250 mg
0
38 Asetosal tablet 100 mg 50
39 Asetosal tablet 500 mg 0
40 Atapulgit tablet 600 mg 50
41 Atropin sulfat inj 0,25mg/ml 0
42 Atropine 0.5 mg Tablet 0
43 Betametason krim 0.1% 49 1 3 1 2 1 3
44 Bisacodyl Suppo 10 mg 0
45 Bisacodyl Suppo 5 mg 0
46 Bisacodyl tablet 5 mg 50
47 Bisoprolol Fumarate 5mg tablet
0
48 Calcusol® kapsul 0
49 Carbo-adsorbent tablet 250 mg
0
50 Cefadroksil kapsul 500 mg 0
51 Ceftriaxone injeksi 1 g/vial 0
52 Cimetidin tablet 200 mg 300 10 15 10
53 Cinnarizine 25 mg tablet 343 10 10
54 Ciprofloksasin Kapsul 500 mg 314 20 10 6
55 Codein 0
56 Curcuma® degree 40 4 10
57 Deksametason injeksi 5 mg/ml - 1
ml 23 1
58 Deksametason tablet 0,5 mg 894 10 20 32 30 10
59 Dekstran
steril
70 - larutan infus 6%
0
60 Dekstrometorfan tablet 15 mg 0
61 Dekstrometorfan sirup 10 mg/5
ml 0
62 Diazepam 10 mg / 2,5 ml lar
rectal (Stesolid®) 0
63 Diazepam injeksi 5 mg/ml - 2 ml
0
64 Diazepam tablet 2 mg 0
65 Diazepam tablet 5 mg 0
66 Dietilkarbamazin Sitrat 100mg
tablet 0
67 Difenhidramin
ml
HCl inj 10 mg/ml-1
10
68 Digoksin tablet 0,25 mg 0
69 Diltiazem Hcl tablet 25 mg 0
70 Dimenhidrinat 50 mg tablet 20
71 Doksisiklin 100 mg kapsul 200 20
72 Domperidon syrup 1 1
73 Domperidon tablet 10 mg 365 5 5 10
74 Efedrin HCl tablet 25 mg 0
75 Ekstrak Belladon tablet 10 mg 2
76 Epineprin injeksi ( adrenalin
injeksi ) 1
77 Eritromisin sirup 200 mg/5 mL 0
78 Erytromisin 250 mg 100
79 Etambutol 250 mg 0
80 Etambutol 500 mg 0
81 Etanol 70 % 1.5
82 Fenitoin Injeksi 100 mg/2 mL 0
83 Fenitoin Natrium kapsul 100 mg
0
84 Fenitoin Natrium kapsul 30 mg
0
Fenobarbital injeksi 50 mg/ml - 1
85 ml
0
86 Fenobarbital tablet 30 mg 0
87 Fenoksimetil Penisilina tablet 250
mg 0
88 Fenoksimetil
mg
Penisilina tablet 500
0
89 Fenol Gliserol tetes telinga 10%
16 1 1
90 Fitomenadion (Vit.K1) injeksi 0
Fitomenadion (Vit.K1) tablet salut
91
gula 10 mg 90
92 Fluoxetin 10 mg kapsul 0
Fluticasone Propionate 0.5 mg
93 dalam 2ml NaCl
0
94 Furosemid injeksi 10mg/ml 0
95 Furosemid tablet 40 mg 196 6 10
96 Garam Oralit untuk 200 ml air 75 4
97 Gemfibrozil 300 mg 0
98 Gentamisin salb kulit 1% 30 3 1 2
99 Gentian Violet larutan 1 % 12 1
100 Glibenklamid tablet 5 mg 0
101 Glimepirid tablet 2 mg 0
102 Glipizid 5 mg tablet 0
103 Gliquidone 30 mg tablet 0
104 Gliseril Guayakolat tablet 100 mg
227 20 10 25
105 Glukosa larutan infus 10 % steril
0
106 Glukosa larutan infus 40 % steril
0
107 Glukosa larutan infus 5 % steril
0
Griseofulvin tablet 125 mg,
108 micronized
170 20
109 Haloperidol tablet 0,5 mg 0
110 Haloperidol tablet 1,5 mg 0
111 Haloperidol tablet 5 mg 0
112 Hepagard® kapsul 0
Hidroklorotiazid (HCT) tablet 25
113 mg
284
114 Hidrokortison krim 2,5 % 8
115 Ibuprofen sirup 200 mg/ 5mL 3
116 Ibuprofen suspensi 100mg/5ml
2
117 Ibuprofen tablet 200 mg 1200 10 25 20 10
118 Ibuprofen tablet 400 mg 767 16 15 10 20 25 30
119 INH 300 mg tab 0
120 Isosorbid Dinitrat tablet
sublingual 5 mg 0
121 KA EN 3A 0
122 KA EN 3B 0
123 Kalamin lotion 0
124 Kalium Declovenak 50 mg 200 10 20 16
Kalium L-aspartate tablet 300 mg
125 tablet
0
126 Kalium Permanganat serbuk 10 1
127 Kalsium Glukonat Inj 100 mg/mL
0
Kalsium Laktat (Kalk) tablet 500
128 mg
1867 10 10
129 kaolin + pectin tablet 0
130 Kaolin-Pektin 760mg syrup 7 1 1 1
131 Kaptopril tablet 25 mg 1697 10 20 10
132 Karbamazepin tablet 200 mg 0
133 Ketamin injeksi 1000 mg/ 10 mL
0
134 Ketokonazol crem 2 % 15 1 1
135 Ketokonazol tablet 130 10
136 Ketoprofen 100 mg Suppositoria
0
137 Klindamicin 150 mg kapsul 0
138 Klonidin 0,15 mg tablet 0
139 Kloramfenikol kapsul 250 mg 100
140 Kloramfenikol salb kulit 2% 4 1
141 Kloramfenikol salb mata 1 % 26 1
142 Kloramfenikol syrup 1
143 Kloramfenikol tetes mata 0.5% 15 1
144 Kloramfenikol tetes telinga 3 %
16 1
Klorfeniramin Maleat (CTM)
145 tablet 4 mg
3829 28 55 40 30 55 50 60 60 45 30
146 Klorokuin 250mg tablet 0
Klorpromazin HCl injeksi 25
147 mg/ml - 2 ml
0
148 Klorpromazin HCl tablet salut 100
mg 0
149 Klorpromazin
mg
HCl tablet salut 25
0
Kotrimoksazol Suspensi komb:
150 Sulfametoksazol 200 mg
+ Trimetoprim 40 mg / 5 ml 12
Kotrimoksazol tablet kombinasi:
151 Sulfametoksazol 400 mg
+ Trimetoprim 80 mg
180
Kotrimoksazol tablet pediatrik,
152 kombinasi:
Sulfametoksazol 100 mg +
Trimetoprim 20 mg 0
153 Kuinin (Kina) tablet 200 mg 0
154 Lidocain Injeksi non adrenalin
5
155 Lidokain 2% jelly 10 gr 0
Lidokain komp. injeksi,
Kombinasi:
156 Lidokain HCl 2% + Epinefrin
1:80.000 - 2 ml 7 1
157 Loperamid tablet 2 mg 65
158 Loratadin tablet 10 mg 378 5 10 5
159 Magnesium
40%-25 ml
Sulfat Injeksi ( IV )
3
160 Metformin Hcl tablet 500 mg 0
161 Metil Prednisolone tablet 4 mg
429 10 10 5
Metilergometrin Maleat inj 0,200
162 mg-1 ml
80
163 Metilergometrin Maleat tablet
salut 0,125 mg 0
164 Metoclopramid 10 mg tablet 57 10
165 Metoclopramid Hcl injeksi 0
166 Metronidazol 500 mg
Suppositoria 0
167 Metronidazol
mg /ml
larutan infus 500
0
168 Metronidazol tablet 250 mg 617
169 Metronidazol tablet 500 mg 0
170 Metronidazole sirup 125 mg/
5mL 0
171 Mikonazol crem 22 1 2
172 Mikronutrien Ibu Hamil Tablet 200 20 30 40 30 20
173 Multivitamin Syrup PKD 50 1 2 1 1 2
174 Multivitamin Syrup Program Gizi
0
175 Natrium Bikarbonat tablet 500
mg 0
176
Natrium Diklofenac 50 mg tablet 953
177 Natrium Diklofenak tablet 25 mg
0
Natrium Klorida larutan infus 0,9
178 % steril
1
179 Neurotropik tablet 300 10 15 20 15
180 Nifedipin tablet 10 mg 0
181 Nistatin 500.000 IU tablet 0
182 Nistatin suspensi 100000Ui/ml
0
183 Nistatin tablet Vagina 100.000 IU
37
184 Nosirax® kapsul 0
185 OAT Kategori Anak FDC 0
186 OAT Kategori I FDC 0
187 OAT Kategori II FDC 0
188 OAT Sisipan FDC 0
189 Obat Batuk Hitam (O.B.H.) syrup
10 1
Obat Sal Cerna : Antasida 200 mg;
190 dimeticone 40 mg kaplet
(Berlocid®) 328 25 20 18 20
Obat Tetes Mata Kombinasi:
191 Polymyxin B sulfate 6.000 IU;
neomycin sulfate 3.5 mg; sodium
sulphate 1 mg 20 1
192 Oksitetrasiklin HCl salep kulit 3 %
17 2
Oksitetrasiklin HCl salep mata 1
193 %
0
194 Oksitosin injeksi 10 IU/ml - 1 ml
0
195 Omeprazole kapsul 20 mg 60
196 Oseltamivir Phosphate tablet
(Tamiflu®) 0
197 Parasetamol drops 0
198 Parasetamol sirup 120 mg/5 ml
35 2 1 3 1 1
199 Parasetamol Suppositoria 0
200 Parasetamol tablet 500 mg 4450 100 120 95 50 95 108 98 125 95 88
201 Perak Sulfadiazin krim 0
202 Piracetam kaplet 1200 mg 0
203 Piracetam tablet 800 mg 0
204 Pirantel Pamoat tablet 125 mg 27 4 8
205 Pirazinamid 500 mg tablet 0
206 Piridoksin HCl (Vit.B6) tablet 10
mg 1943
207 Piroksikam 20 mg 554
208 Polikresulen solution 0.5
209 Povidon Iodida 1 % MW/Kumur
6
210 Povidon Iodida 10 % 30 ml 14
211 Povidon Iodida 10 % 300 ml 0.25
212 Prednison tablet 5 mg 877
213 Primakuin 15 mg 0
214 Propiltiourasil tablet 100 mg 0
215 Propranolol HCl tablet 10 mg 0
216 Propranolol HCl tablet 40 mg 0
217 Ranitidin injeksi 25mg/2ml 2
218 Ranitidin tablet 150 mg 469
219 Reserpin tablet 0,10 mg 0
220 Reserpin tablet 0,25 mg 0
221 Retinol ( Vit A ) 100.000.IU 0
222 Retinol ( Vit A ) 200.000.IU 0
223 Riffampisin 600 mg tablet 0
224 Ringer Laktat larutan infus steril
1
225 Salbutamol 2 mg tablet 454
226 Salbutamol 4 mg tablet 150
227 Salbutamol Sulphate Nebules 2.5
mg / 2.5 ml (Ventolin®) 0
Salep 2-4 , Kombinasi:
228 Asam Salisilat 2% + Belerang
Endap 4% 20
229 Salisil Bedak 2 % 26
230 Serum Anti Bisa Ular Polivalen
injeksi 5 ml (ABU I) 0
231 Serum Anti Tetanus (ATS) Injeksi
1.500 IU/ampul 0
Serum Anti Tetanus (ATS) Injeksi
232 20.000 IU / Vial
0
233 Setirizin sirup 5mg/ml 0
Sianokobalamin (Vit.B12) 50 mcg
234 tablet
1968
Sianokobalamin (Vit.B12) injeksi
235 500 mcg-ml
2
236 Simvastatin tablet 10 mg 0
237 Spironolakton tablet 25 mg 0
238 Streptomicin injeksi 0
Sulfasetamida Natrium tetes
239 mata 15 %
0
240 Tablet Tambah Darah 1566
241 Tablet Zink Dispersible 250
242 Tetrasiklin HCl kapsul 250 mg 0
243 Tetrasiklin HCl kapsul 500 mg 40
244 Thiamfenikol 500mg kapsul 0
245 Tiamin HCl (Vit.B1) injeksi 100
mg/ml-1 ml 0
Tiamin HCl Mononitrat (Vit.B1)
246 tablet 50 mg
3040
247 Triheksifenidil Hidroklorida tablet
2 mg 0
248 Vitamin B Kompleks tablet 0
249 Zinc sirup 10 mg/mL 0
0
BAHAN MEDIS PAKAI HABIS 0
250 Alat suntik sekali pakai 1 ml 0
251 Alat suntik sekali pakai 10 ml 0
252 Alat suntik sekali pakai 2,5 ml 0
253 Alat suntik sekali pakai 3 ml 192
254 Alat suntik sekali pakai 5 ml 5
255 Alkohol swab 0
256 Antiseptik dan Disinfektan Gel 1.5
257 Aqua DM 0
258 Asering plabot 500 mL 0
259 Bayclin® (Klorin 5.25%) 4 Liter 0
260 Benang sutra hitam 2/0 0
261 Benang sutra hitam 3/0 0
Catgut Chromic Benang Bedah
262 3/0
0
263
Catgut Plain Benang Bedah 3/0 0
 Daryantule® (Kasa Pembalut
264 ukuran 10x10 cm direndam dlm
1% Framicetin SO4) 5
265 Foly Cateter No 16 0
266 Foly Cateter No 18 0
267 Infusion set anak 1
268 Infusion set dewasa 1
269 IV Catheter No. 18 G 0
270 IV Catheter No. 20 G 0
271 IV Catheter No. 22 G 1
272 IV Catheter No. 24 G 1
273 Jarum Jahit 7
274 Jelly Lubricant Steril 0
275 Kantong Urin 0
Kapas Pembalut / Absorben 250
276 gram
0.5
277 Kasa 16 x 16 13
278
Kasa hidrofil 40 x 80 cm elastis 0
279 Kasa Kompres 40/40 steril 30
280 Kasa Pembalut 2 m x 80 cm 4
Kasa Pembalut Hidrofil 4 m x 15
281 cm elastic
1
Kasa Pembalut Hidrofil 4 m x 3
282 cm elastic
0
283 Kertas EKG CARDIOLINE® 0
284 Kertas EKG FUKUDA® 0
285 Klem Umbilical 0
286 Lysol® (kresol tersabun 50%) 0
287 Masker Nebulizer Anak 0
288 Masker Nebulizer Dewasa 0
289 Masker Wajah Ear Loop 80
290 Masker Wajah Tali 0
291 Pembalut Gips 0
292 Perhidrol 0
293 Pisau Bedah No .11 0
294 Plester 5 yards x 2 inch 2
295 Pot Dahak 0
Sarung Tangan non steril No. 7
296 8
Sarung Tangan Persalinan
297 (panjang) 0
Sarung Tangan Sanitasi (orange)
298 0
299 Sarung Tangan Steril No.6,5 0
300 Sarung Tangan Steril No.7 2
301 Sarung Tangan Steril No.7,5 0
302 Sarung Tangan Steril No.8 0
303 Selang Oksigen Anak 0
304 Selang Oksigen Bayi 0
305 Selang Oksigen Dewasa 0
306 Sendok sirup 0
Silk Benang Bedah Sutera No. 3/0
307 dengan jarum bedah 0
308 Spalk 0
309 Tissue 0
310 Tranfusi set 0
Ultra Sonique Gel 260 gr® (Gel
311 Lubrikasi USG) 0
Ultra Sonique Gel 5 L® (Refill Gel
312 Lubrikasi USG) 0
313 Underpad 60 x 90 0
314 Wing Needle No. 23 G 0
315 Wing Needle No. 25 G 0
316 Wing Needle No. 27 G 0
0
BAHAN KEDOKTERAN GIGI 0
316 Air Raksa Dental Use 0
317 Alvogyl Pasta 0
318 Arkansas Bur Hijau 0
319 Arkansas Bur Putih 0
320 Artikulating Papper 0
Bahan Tambalan Sinar BONDING
321 0
Bahan Tambalan Sinar ETCHING
322 0
Bahan Tambalan Sinar SOLARE
323 A2.5 Anterior 0
324 Bahan Tambalan Sinar SOLARE A 0
325 Bahan Tambalan Sinar SOLARE 0
326 Bor Poilsh composite 0
327 Caviton 0
328 Celluloid Strip 0
329 Dentocain® Mepivacaine HCL 3% 0
330 Devitalisasi Pasta (Non Arsen) 0
331 Disposible Dental Needle 0
332 Etil Klorida spray 0
333 Eugenol cairan 0
334 Finishing Strip 0
335 Gelas Kumur Disposible 0
336 Glass Ionomer Cement ART Fuji 0
337 Glass Ionomer Cement ART Fuji 0
338 Glass Ionomer Cement ART Fuji 0
339 Iod Gliserin 0
340 Iodoform (Mummifying Pasta) 0
341 Kalsium Hidroksida Pasta 0
342 Klorfenol kamfer Menthol ( CH 0
343 Mata Bor High speed Fissure 0
344 Mata Bor High Speed Inverted 0
345 Mata Bor High Speed Round 0
346 Mata Bor Low speed 0
347 MD Cleanser 0
348 Microbrush 0
349 Occo Liquid 0
350 Saliva ejector disposible 0
351 Semen Seng Fosfat serbuk dan c 0
352 Silver Amalgam 0
353 Smear Layer Removal 0
354 Spon Gelatin cublices 1x1x1 cm 0
355 Temporary Stopping Fletcher (Fl 0
356 Tri Kresol Formalin (TKF) 0
 JML
SISA
Pemakaian PEMAK ED
STOK
AIAN

16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -19

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 12

0 0 0

30 20 36 20 30 26 10 411 0 1195
1 2 1 3 1 16 0 14

2 1 3 1 10 0 13

0 0 0
0 0 3
0 0 0

0 0 184
 0 0 5

0 0 0

0 0 0

0 0 0
0 0 0

30 25 20 35 12 296 0 591

40 34 55 376 954
0 0 0

30 10 40 6 121 0 1099

0 0 0

0 0 0
0 0 50
0 0 0
0 0 50
0 0 0
0 0 0
1 1 2 1 16 0 33
0 0 0
0 0 0
0 0 50

0 0 0
0 0 0

0 0 0
0 0 0
0 0 0
20 9 64 0 236
10 10 20 60 0 283
6 12 18 72 0 242
0 0 0
14 0 26

1 0 22
10 20 10 142 0 752

0 0 0
 0 0 0

0 0 0

0 0 0

0 0 0
0 0 0
0 0 0

0 0 0

0 0 10
0 0 0
0 0 0
0 0 20
18 38 0 162
1 0
20 0 345
0 0 0
0 0 2

0 0 1
0 0 0
0 0 100
0 0 0
0 0 0
0.5 0.5 0 1
0 0 0

0 0 0

0 0 0

0 0 0
0 0 0

0 0 0

0 0 0

1 3 0 13
0 0 0

0 0 90
0 0 0

0 0 0
0 0 0
 6 22 0 174
4 0 71
0 0 0
1 1 8 0 22
1 0 11
0 0 0
0 0 0
0 0 0
0 0 0

10 20 60 145 0 82

0 0 0

0 0 0

0 0 0

10 30 0 140
0 0 0
0 0 0
0 0 0
0 0 0

0 0 284
0 0 8
0 0 3

0 0 2
24 30 20 139 0 1061
32 20 20 20 208 0 559
0 0 0

0 0 0
0 0 0
0 0 0
0 0 0
18 64 0 136

0 0 0
1 0 9

0 0 0

20 25 65 0 1802
0 0 0
1 4 0 3
20 10 40 110 0 1587
 0 0 0

0 0 0
2 2 1 7 0 8
10 20 0 110

0 0 0
0 0 0
0 0 0
0 0 100
1 0 3
1 1 3 0 23
0 0 1
1 2 0 13

1 0 15

28 40 38 80 40 34 50 74 837 0 2992
0 0 0

0 0 0

0 0 0

0 0 0

0 0 12

0 0 180

0 0 0
0 0 0

0 0 5
0 0 0

1 0 6
0 0 65
4 4 6 34 0 344

0 0 3
0 0 0
 10 15 50 0 379

0 0 80

0 0 0
10 0 47
0 0 0

0 0 0

0 0 0
0 0 617
0 0 0

0 0 0
1 1 1 1 7 0 15
10 1 20 20 191 0 9
1 3 2 4 17 0 33

0 0 0

0 0 0

0 0 953

0 0 0

0 0 1
20 10 10 100 0 200
0 0 0
0 0 0

0 0 0

0 0 37
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0

1 2 0 8

10 10 20 123 0 205

1 2 0 18
 1 1 4 0 13

0 0 0

0 0 0
0 0 60

0 0 0
0 0 0

1 1 2 1 1 14 0 21
0 0 0
98 86 65 80 90 98 80 95 1666 0 2784
0 0 0
0 0 0
0 0 0
2 14 0 13
0 0 0

10 10 0 1933
0 0 554
0 0 0.5

1 1 0 5
0 0 14
0 0 0.25
0 0 877
0 0 0
0 0 0
0 0 0
0 0 0
0 0 2
0 0 469
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0

0 0 1
30 30 0 424
0 0 150

0 0 0

0 0 20
 2 2 0 24

0 0 0

0 0 0

0 0 0
0 0 0

38 38 0 1930

0 0 2
0 0 0
0 0 0
0 0 0

0 0 0
0 0 1566
0 0 250
0 0 0
0 0 40
0 0 0

0 0 0

30 30 0 3010

0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 192
0 0 5
0 0 0
0 0 1.5
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0

0 0 0

0 0 0
 0 0 5
0 0 0
0 0 0
0 0 1
0 0 1
0 0 0
0 0 0
0 0 1
0 0 1
0 0 7
0 0 0
0 0 0

0 0 0.5
0 0 13

0 0 0
0 0 30
0 0 4

0 0 1

0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 1 0 79
0 0 0
0 0 0
0 0 0
0 0 0
0 0 2
0 0 0

0 0 8

0 0 0

0 0 0
0 0 0
0 0 2
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0

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

0 0 0

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

0 0 0

0 0 0

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