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PEMERINTAH KABUPATEN KEPULAUAN SELAYAR

DINAS KESEHATAN
UPTD PUSKESMAS PARANGIA
KECAMATAN BONTOMATENE
Jln.Poros Unjuruiya Desa Tanete Nomor ……Telp…… Kode Pos 92854
Email : puskesmas.parangia@gmail.com

Parangia, ............................. 20...

Kepada Yth,
Nomor : 045.2/...../PKM.PRG/...../20.... Penanggung Jawab Pelayanan Farmasi
Lampiran : 1 (satu) UPTD Puskesmas Parangia
Perihal : Permintaan Obat Di –
Tempat

Berikut ini kami lampirkan Laporan Penggunaan dan Lembar Permintaan Obat (LPLPO) untuk
pelaksanaan kegiatan / administrasi perkantoran di Puskesmas Pembantu (PUSTU) / Poskesdes
................................................ Selama Sebulan.

Demikian Laporan ini dan permintaan obat ini di buat untuk pelaksanaan selanjutnya.

Mengetahui
Kepala UPTD Puskesmas Parangia Pimpinan PUSTU .................................

Abidin Marru, SKM ..........................................................


NIP. 19651212 198603 1 029 NIP.
UPTD PUSKESMAS PARANGIA
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
( LPLPO )
PUSTU / PKD : PUSTU BARRO
BULAN / TAHUN : NOVEMBER / 2019

STOK JUMLAH

N
SISA

A
NO NAMA OBAT BULAN MASUK KELUAR

ET
TU
STOK

K
LALU PERMINTAAN PENERIMAAN

SA
1 2 3 4 5 6 7 8 9 10

PELAYANAN KESEHATAN DASAR


1 ACETYLCYSTEIN KAPSUL 200MG KAPS 160 10 150

2 ALBENDAZOL TABLET 400 MG TAB 15 15 0

3 ALBENDAZOL SIRUP PCS 0

4 ALBOTHYL KONSENTRAT PCS 0

5 ALOPURINOL TABLET 100 MG TAB 150 150

6 ALOPURINOL TABLET 300 MG TAB 280 130 150

7 AMINOFILIN INJEKSI 24 MG/ML AMP 0

8 AMINOFILIN TABLET 200 MG TAB 190 190

9 AMITRIPTILIN TABLET SALUT 25 MG TAB 0

10 AMBROKSOL TAB 30 MG TAB 100 23 77 100

11 AMBROKSOL SIRUP PCS 0 3 3 5

12 AMLODIPIN 5 MG TAB 0

13 AMLODIPIN 10 MG TAB 0

14 AMOKSISILIN KAPSUL 250 MG KAPL 0

15 AMOKSISILIN KAPLET 500 MG KAPL 110 110 100

16 AMOKSISILIN VIAL 1 G VIAL 0

17 AMOKSISILIN SIROP KERING 125 PCS 4 1 3 5

18 AMPICILIN SERBUK INJ 1 G VIAL 0

19 AMPICILIN KAPLET 250 MG KAPL 0

20 AMPICILIN KAPLET 500 MG KAPL 0

21 ANTASIDA DOEN I TABLET KUNYAH TAB 200 30 170

22 ANTASIDA DOEN II SUSPENSI PCS 0 3 3

23 ANTI BAKTERI DOEN SALEP KOMBINASI POT 6 10 16

24 ANTIFUNGI DOEN KOMBINASI POT 0

25 ANTIHEMOROID DOEN KOMBINASI SUPP 4 4 0

26 ANTIMIGREIN DOEN KOMBINASI (ERGOTAMIN) TAB 100 100

27 ARTESUNATE INJEKSI VIAL 60 MG AMP 0

28 ARTESUNATE DEWASA TAB 0

29 ASAM ASETIL SALISILAT 100 MG TAB 100 20 80 100

30 ASAM ASKORBAT 25 MG (VIT C) TAB 0

31 ASAM ASKORBAT 50 MG (VIT C) TAB 200 200

32 ASAM MEFENAMAT TABLET SALUT 500 MG TAB 0

33 ASIKLOVIR KRIM 5 % TUBE 0

34 ASIKLOVIR TABLET 200 MG TAB 0

35 ASIKLOVIR TABLET 400 MG TAB 190 190

36 ATROPIN TETES MATA 0.5 % PCS 0

37 BETAMETASON KRIM 0,1 % TUBE 5 10 1 14

38 BETAHISTIN MESILAT TAB 6 MG / HISTIGO TAB 140 150 90 200

39 BISAKODIL SUPPOSITORIA 10 MG (DULCOLAX) SUPP 0

40 BISAKODIL SUPPOSITORIA 5MG PED (DULCOLAX) SUPP 0

41 BISOPROLOL FUMARATE TAB 0

42 CARBAMAZEPIN TAB 200 MG TAB 0

43 CETIRIZINE TAB 10 MG TAB 100 100

44 CETIRIZINE SIRUP PCS 0


STOK JUMLAH

N
SISA

A
NO NAMA OBAT BULAN MASUK KELUAR

ET
TU
STOK

K
LALU PERMINTAAN PENERIMAAN

SA
45 CLOBAZAM TAB 10 MG TAB 0

46 CLOZAPIN 25MG TAB 0

47 CURCUMA TAB TAB 0

48 DEKSAMETASON INJ 5 MG/ML AMP 0

49 DEKSAMETASON TABLET 0,5 MG TAB 50 200 250

50 DIAZEPAM INJ 5 MG/ML AMP 0

51 DIAZEPAM TABLET 2 MG TAB 0

52 DIAZEPAM TABLET 5 MG TAB 0

53 DIAZEPAM REKTAL TUBE 0

54 DIFENHIDRAMIN INJ 10 MG/ML AMP 0

55 DIGOKSIN TABLET 0,25 MG TAB 0

56 DILTIAZEM TAB 30 MG TAB 0

57 DIMENHIDRINAT TAB 50 MG TAB 90 90 100

58 DOMPERIDON TABLET 10 MG TAB 179 9 170

59 DOMPORIDON SIRUP PCS 5 5

60 DOMPERIDONE DROPS PCS 0

61 DOKSISIKLIN KAPSUL 100 MG KAPS 0

62 EKSTRAK BELLADONA TABLET 10 MG TAB 0

63 EPINEFRIN HCL / BITARTRAT (ADRENALIN) INJ AMP 1 1 0

64 ERITROMISIN KAPSUL 250 MG KAPS 0

65 ERITROMISIN TABLET 500 MG TAB 0

66 ERITROMISIN SIROP 200 MG/ 5 ML PCS 3 1 2

67 ETHYLIS CHLORIDUM SEMPROT PCS 0

68 FENOBARBITAL AMPUL 2 ML AMP 0

69 FENOBARBITAL TABLET 30 MG TAB 0

70 FITOMENADION TABLET 10 MG (VIT K) TAB 100 90 10 100

71 FITOMENADION INJ 1 MG/ML (VIT K) AMP 0

72 FITOMENADION INJ 10 MG/ML (VIT K) AMP 0

73 FUROSEMIDA TABLET 40 MG TAB 100 100

74 GARAM ORALIT 200ML AIR PCS 10 10

75 GEMFIBROZIL KAPSUL 300 MG KAPS 100 100

76 GENTAMISIN INJ 80 MG/ML AMP 0

77 GENTAMISIN SALEP KULIT POT 0

78 GENTAMISIN SULFAT TETES MATA 0,3 % POT 5 5

79 GENTIAN VIOLET 1 % PCS 0

80 GLIBENKLAMIDA TABLET 5 MG TAB 200 200

81 GLIMEPIRIDE 2 MG TAB 0

82 GLISERIL GUALAKOLAT TABLET 100 MG TAB 0

83 GLUKOSA LARUTAN INFUS 10 % PCS 0

84 GLUKOSA LARUTAN INFUS 40 % PCS 0

85 GLUKOSA LARUTAN INFUS 5 % PCS 0

86 GRISEOFULVIN TABLET 125 MG TAB 100 100

87 GRANTUSIF TAB 180 60 120

88 HALOPERIDOL TABLET 1.5 MG TAB 0

89 HALOPERIDOL DEKANOAT INJ 50MG/ML AMP 0

90 HALOPERIDOL INJ 5MG/ML (LODOMER) AMP 0

91 HIDROKLOROTIAZIDA TABLET 25 MG (HCT) TAB 0

92 HIDROKORTISON KRIM 2,5 % TUBE 4 4

93 HYOSIN BUTIL BROMIDA TAB 10 MG (SCOPMA) TAB 0

94 IBUPROFEN TABLET 200 MG TAB 0

95 IBUPROFEN TABLET 400 MG TAB 80 100 80 100 100

96 IBUPROFEN SIRUP 15 MG/ML PCS 3 3 5


STOK JUMLAH

N
SISA

A
NO NAMA OBAT BULAN MASUK KELUAR

ET
TU
STOK

K
LALU PERMINTAAN PENERIMAAN

SA
97 ISONIAZID TABLET 300 MG TAB 0

98 ISOSORBID DINITRAT TABLET 5 MG TAB 0

99 KALIUM DIKLOFENAK TAB 50 MG TAB 0

100 KALSIUM GLUCONAS INJ AMP 0

101 KALSIUM LAKTAT TABLET 500 MG TAB 90 90 100

102 KAPTOPRIL 12.5 MG TAB 0

103 KAPTOPRIL 25 MG TAB 0

104 KAPTOPRIL 50 MG TAB 200 200

105 KETOKENAZOL TAB 200 MG TAB 400 50 350

106 KETOKENAZOL KRIM TUBE 0

107 KLONIDIN TABLET 0.15 MG TAB 0

108 KLORAMFENIKOL SALEP MATA 1% TUBE 0

109 KLORAMFENIKOL SALEP KULIT (BUFACETIN) TUBE 3 3

110 KLORAMFENIKOL TETES TELINGA 3 % PCS 0

111 KLORAMFENIKOL TETES MATA 0.5 % PCS 0

112 KLORAMFENIKOL SUSP 125 MG/ 5 ML PCS 3 3 0

113 KLORAMFENIKOL KAPSUL 250 MG KAPS 100 100 0

114 KLORAMFENIKOL KAPSUL 500 MG KAPS 0

115 KLORFENIRAMINA MALEAT TAB 4 MG (CTM) TAB 0 500 160 340

116 KLORPROMAZIN TAB SALUT 25 MG (CPZ) TAB 0

117 KLORPROMAZIN TAB SALUT 100 MG (CPZ) TAB 0

118 KOTRIMOKSAZOL SUSPENSI PCS 3 5 1 7

119 KOTRIMOKSAZOL DEWASA TAB 480MG TAB 150 100 70 180

120 KUINIDIN 100 MG TABLET TAB 0

121 KUINIDIN 200 MG TABLET TAB 0

122 KUININ (KINA) TABLET 200 MG TAB 0

123 KUININ INJEKSI 25 % TAB 0

124 KUININ SULFAT TAB 222 MG (7 H2O) TAB 0

125 LANSOPRAZOL 30 MG KAPS 40 40

126 LANSOPRAZOL SIRUP PCS 0

127 LIDOKAIN INJ 2 % AMP 0

128 LIDOKAIN INJ 2 % + EPINEFRIN AMP 7 7

129 LIDOKAIN SPRAY AMP 1 1

130 LISOL DENGAN KRESOL SABUN 50 % PCS 0

131 LORATADIN TAB TAB 30 30

132 LOPERAMIDE TAB 270 90 180

133 MgSO4 20% PCS 0

134 MgSO4 40% PCS 0

135 MEBENDAZOL SIROP 100 MG/ 5 ML PCS 0

136 MEBENDAZOL TABLET 100 MG TAB 0

137 METAMPIRON TABLET 500 MG (ANTALGIN) TAB 0

138 METILERGOMETRIN MALEAT TABLET 0.125 MG TAB 0

139 METILERGOMETRIN MALEAT INJ 0.2 MG AMP 0

140 METILPREDNISOLON TAB 4 MG TAB 80 200 120 160

141 METILPREDNISOLON TAB16 MG TAB 0

142 METFORMIN TAB 500 MG TAB 0

143 METFORMIN TAB 850 MG TAB 0

144 METOKLOPRAMIDE TAB 10 MG TAB 200 200

145 MULTIVITAMIN SYR / CAMIVITA PCS 3 3

146 MULTIVITAMIN VINETRON TAB TAB 80 80 0 100

147 METRONIDAZOL TABLET 250 MG TAB 170 20 150

148 METRONIDAZOL TABLET 500 MG TAB 0


STOK JUMLAH

N
SISA

A
NO NAMA OBAT BULAN MASUK KELUAR

ET
TU
STOK

K
LALU PERMINTAAN PENERIMAAN

SA
149 MIKONAZOLE KRIM TUBE 0

150 MIKONAZOLE BEDAK TUBE 4 4

151 MINERAL MIX PCS 0

152 NATRIUM DKLOFENAK TABLET 25 MG TAB 0

153 NATRIUM DKLOFENAK TABLET 50 MG TAB 30 100 130

154 NATRIUM KLORIDA LARUTAN INFUS 0.9 % PCS 0

155 NIPEDIFINE TAB 10 MG TAB 40 100 140

156 NISTATIN 500.000 IU TAB 100 100 0

157 NISTATIN VAGINAL TABLET TAB 0

158 OBAT ANTITUBERKULOSIS SISIPAN DEWASA PKT 0

159 OBAT ANTITUBERKULOSIS KAT 1 DEWASA PKT 0

160 OBAT ANTITUBERKULOSIS KAT 2 DEWASA PKT 0

161 OBAT ANTITUBERKULOSIS KAT ANAK PKT 0

162 OBAT BATUK HITAM CAIRAN PCS 0

163 OKSITETRASIKLIN HCL SALEP MATA 1 % TUBE 13 13

164 OKSITETRASIKLIN HCL SALEP KULIT 3 % TUBE 10 10

165 OKSITOSIN INJ 10 IU/ML AMP 0

166 OMEPERAZOLE KAPSUL KAPS 0

167 OMEPRAZOLE INJ VIAL 0

168 PAPAVERIN TABLET 40 MG TAB 60 60

169 PARASETAMOL DROPS PCS 1 3 4

170 PARASETAMOL SIROP 120 MG/ 5 ML PCS 2 3 3 2

171 PARASETAMOL TABLET 500 MG TAB 500 50 450

172 PENOL GLISEROL TETES TELINGA PCS 0

173 PEHACAIN INJ AMP 0

174 PIRANTEL TABLET SCORE 125 MG TAB 0

175 PIRANTEL SIRUP PCS 0

176 PIRASETAM 400 TAB 0

177 PIRASETAM 1200 TAB 0

178 PIRIDOKSIN TAB 10 MG (VIT B6) TAB 0

179 PIROKSIKAM TABLET 10 MG TAB 0

180 PIROKSIKAM TABLET 20 MG TAB 60 60

181 PITOGIN AMPUL 1 ML AMP 0

182 PREDNISON TABLET 5 MG TAB 950 50 900

183 PRIMAKUIN TABLET 15 MG TAB 0

184 PROPANOLOL TABLET 10 MG TAB 0

185 PROPILITIOURASIL TABLET 100 MG TAB 0

186 REGENSIA TB PKT 0

187 RANITIDIN TABLET 150 MG TAB 200 200

188 RANITIDIN INJ 25 MG / 2 ML AMP 0

189 RINGER LAKTAT INFUS PCS 0

190 RISPERIDON TABLET 2 MG TAB 0

191 SALBUTAMOL TABLET 2 MG TAB 100 100

192 SALBUTAMOL TABLET 4 MG TAB 90 90

193 SALBUTAMOL SIRUP 2 MG / 5 ML PCS 0

194 SALEP 2-4 KOMBINASI POT 2 5 7

195 SALISIL BEDAK 2 % PCS 0

196 SCABIMITE CREAM TUBE 3 3

197 SEFADROKSIL SIROP KERING 125 MG / 5 ML PCS 0

198 SEFADROKSIL KAPSUL 500 MG KAPS 180 20 160

199 SEFOTAKSIM 1000 MG INJ VIAL 0


200 SEFTRIAKSON SERBUK INJ 1000 MG VIAL 0

STOK JUMLAH

N
SISA

A
NO NAMA OBAT BULAN MASUK KELUAR

ET
TU
STOK

K
LALU PERMINTAAN PENERIMAAN

SA
201 SIANOKOBALAMIN VIT B12 INJ 500 AMP 4 4

202 SIANOKOBALAMIN TABLET 50 MCG TAB 180 30 150

203 SIMVASTATIN TABLET 10 MG TAB 120 120

204 SIPROFLOKSASIN KAPLET 500 MG KAPL 190 190

205 SULFADIMIDINE TABLET 500 MG TAB 0

206 SULFASETAMIDA NATRIUM TETES MATA 15 % PCS 0

207 TABLET TAMBAH DARAH KOMBINASI TAB 0

208 TETRASIKLIN KAPSUL 250 MG KAPS 0

209 TETRASIKLIN KAPSUL 500 MG KAPS 100 10 90

210 TIAMIN (VIT B1) INJ 100 MG/ML AMP 0

211 TIAMIN (VIT B1) TABLET 50 MG TAB 230 230

212 TIURAZOL 5 MG TAB TAB 0

213 TRAMADOL KAPS KAPS 0

214 TRAMADOL INJ AMP 0

215 TRIHEKSIFENIDIL 25 MG TAB TAB 0

216 VIT A MERAH PCS 0

217 VIT A BIRU PCS 0

218 VITAMIN B KOMPLEKS TABLET TAB 385 35 350

219 VAKSIN RABIES VIAL 0

220 ZINC TAB TAB 80 30 50 100

221 ZINC SIRUP PCS 3 3

PERBEKALAN KESEHATAN

1 ALAT SUNTIK SEKALI PAKAI 0,05 ML PCS 0

2 ALAT SUNTIK SEKALI PAKAI 0,5 ML PCS 0

3 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 9 9

4 ALAT SUNTIK SEKALI PAKAI 10 ML PCS 0

5 ALAT SUNTIK SEKALI PAKAI 2.5 ML / 3ML PCS 3 3

6 ALAT SUNTIK SEKALI PAKAI 5 ML PCS 9 9

7 ALKOHOL SWAB PCS 0

8 AQUA PRO INJEKSI STERIL 25 ML PCS 0

9 BISTURI NO. 21 PCS 3 3

10 BISTURI NO. 20 PCS 0

11 BISTURI NO. 19 PCS 0

12 BLOOD LANCET BOX 0

13 CATHEJELL 12,5G PCS 0

14 CATGUT NO 2/0 PCS 0

15 CATGUT NO 3/0 PCS 0

16 CATGUT NO 4/0 PCS 0

17 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300 ml PCS 0

18 ETANOL 70 % 100 ml PCS 0

19 ETANOL 70 % 1000 ml PCS 0

20 FOLEY CATETER 16 PCS 0

21 FOLEY CATETER 18 PCS 0

22 FOLEY CATETER 20 PCS 0

23 HANDSCON STERIL 6.5 PCS 0

24 HANDSCON STERIL 7 PCS 0

25 HANDSCON STERIL 7.5 PCS 0

26 HANDSCON STERIL 8 PCS 6 4 2 5


27 HANDSCON NON STERIL S PCS 0

28 HANDSCON NON STERIL M PCS 0

29 HANDSCON NON STERIL L PCS 0

STOK JUMLAH

N
SISA

A
NO NAMA OBAT BULAN MASUK KELUAR

ET
TU
STOK

K
SA LALU PERMINTAAN PENERIMAAN

30 HANDRUB PCS 0

31 HEXAGON SIPILIS PCS 0

32 INFUSION SET ANAK PCS 0

33 INFUSION SET DEWASA PCS 0

34 IV CATHETER NO 18 G PCS 0

35 IV CATHETER NO 20 G PCS 0

36 IV CATHETER NO 22 G PCS 0

37 IV CATHETER NO 24 G PCS 0

38 JARUM HECTING PCS 0

39 KAPAS PEMBALUT / ABSORBEN 250 GRAM PCS 0

40 KASA KOMPRES 40/40 STERIL PCS 0

41 KASA PEMBALUT 2 M X 80 CM PCS 0

42 KASA PEMBALUT HIDROFIL 4 M X 5 CM ELASTIS PCS 10 5 5 5

43 KASA PEMBALUT HIDROFIL 4 M X 15 CM ELASTIS PCS 0

44 KASA PEMBALUT HIDROFIL 16 M X 16 CM ELASTIS PCS 2 2 5

45 KASA PEMBALUT HIDROFIL 40 X 80 CM PCS 0

46 KASA PEMBALUT HIDROFIL 36 X 80 CM PCS 0

47 MASKER KARET PCS 3 3

48 NASAL OXYGEN CANULA DEWASA PCS 0

49 NASAL OXYGEN CANULA ANAK PCS 0

50 NASAL OXYGEN CANULA BAYI PCS 0

50 PLESTER 10CM X 5M PCS 1 1 0 1

51 POVIDON IODIDA 10 % 1000 ML PCS 0

52 POVIDON IODIDA 10 % 300 ML PCS 0

53 POVIDON IODIDA 10 % 60 ML PCS 0

54 POVIDON IODIDA 10 % 30 ML PCS 0

55 POVIDON SALEP TUBE 0

56 POT SPUTUM POT 0

57 RDT MALARIA (MONO TEST) BOX 0

58 RDT DBD NS1 BOX 0

59 RDT DBD igg/iggm BOX 0

60 STRIP ASAM URAT PCS 0

61 STRIP CHOLESTEROL PCS 0

62 STRIP GLUKOSA PCS 0

63 STRIP HIV PCS 0

64 SILK 2/0 PCS 0

65 SILK 3/0 PCS 0

66 SILK 4/0 PCS 0

67 STOMACH TUBE / MAAG SLANG NO. 3,5 PCS 0

68 STOMACH TUBE / MAAG SLANG NO. 5 PCS 0

69 STOMACH TUBE / MAAG SLANG NO. 12 PCS 0

70 STOMACH TUBE / MAAG SLANG NO. 16 PCS 0

71 URIN BAG PCS 0

72 WING NEEDLE NO.21 PCS 0

73 WING NEEDLE NO.23 PCS 0

74 WING NEEDLE NO.25 PCS 0

75 WING NEEDLE NO.27 PCS 0


OBAT GIGI 0

1 COMPOSIT POSTERIOR A3 SOLARE PCS 0

2 COMPOSIT ANTERIOR A3 SOLARE PCS 0

3 COMPOSIT POSTERIOR A2 SOLARE PCS 0

4 COMPOSIT ANTERIOR A2 SOLARE PCS 0

N STOK JUMLAH
SISA
A
NO NAMA OBAT BULAN MASUK KELUAR

ET
TU

STOK

K
LALU PERMINTAAN PENERIMAAN
SA

5 EUGENOL PCS 0

6 FUJI IX MINI (LIBRA PERSADA) PCS 0

7 XYLESTESIN PCS 0

TAMBAHAN PCS

1 PCS

2 PCS

3 PCS

4 PCS

5 PCS

6 PCS

7 PCS

8 PCS

9 PCS

10 PCS

11 PCS

12 PCS

13 PCS

14 PCS

15 PCS

Barro, 30 / 11 / 2019
PENANGGUNG JAWAB PELAYANA OBAT
PIMPINAN PUSTU / PKD ........................... PUSKESMAS PARANGIA

(ANUGRAH AJENG TRI UTAMI, AMD.KEB) (.........................................................................)

NIP. 19880227 201704 2 005 NIP. ..................................................................


UPTD PUSKESMAS PARANGIA
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
( LPLPO )
PUSTU / PKD : PUSTU BARRO
BULAN / TAHUN : NOVEMBER / 2019

STOK JUMLAH

N
SISA

A
NO NAMA OBAT BULAN MASUK KELUAR

ET
TU
STOK

K
LALU PERMINTAAN PENERIMAAN

SA
1 2 3 4 5 6 7 8 9 10

PELAYANAN KESEHATAN DASAR


1 ACETYLCYSTEIN KAPSUL 200MG KAPS 160 10 150

2 ALBENDAZOL TABLET 400 MG TAB 15 15 0

3 ALBENDAZOL SIRUP PCS 0

4 ALBOTHYL KONSENTRAT PCS 0

5 ALOPURINOL TABLET 100 MG TAB 150 150

6 ALOPURINOL TABLET 300 MG TAB 280 130 150

7 AMINOFILIN INJEKSI 24 MG/ML AMP 0

8 AMINOFILIN TABLET 200 MG TAB 190 190

9 AMITRIPTILIN TABLET SALUT 25 MG TAB 0

10 AMBROKSOL TAB 30 MG TAB 100 23 77 100

11 AMBROKSOL SIRUP PCS 0 3 3 5

12 AMLODIPIN 5 MG TAB 0

13 AMLODIPIN 10 MG TAB 0

14 AMOKSISILIN KAPSUL 250 MG KAPL 0

15 AMOKSISILIN KAPLET 500 MG KAPL 110 110 100

16 AMOKSISILIN VIAL 1 G VIAL 0

17 AMOKSISILIN SIROP KERING 125 PCS 4 1 3 5

18 AMPICILIN SERBUK INJ 1 G VIAL 0

19 AMPICILIN KAPLET 250 MG KAPL 0

20 AMPICILIN KAPLET 500 MG KAPL 0

21 ANTASIDA DOEN I TABLET KUNYAH TAB 200 30 170

22 ANTASIDA DOEN II SUSPENSI PCS 0 3 3

23 ANTI BAKTERI DOEN SALEP KOMBINASI POT 6 10 16

24 ANTIFUNGI DOEN KOMBINASI POT 0

25 ANTIHEMOROID DOEN KOMBINASI SUPP 4 4 0

26 ANTIMIGREIN DOEN KOMBINASI (ERGOTAMIN) TAB 100 100

27 ARTESUNATE INJEKSI VIAL 60 MG AMP 0

28 ARTESUNATE DEWASA TAB 0

29 ASAM ASETIL SALISILAT 100 MG TAB 100 20 80 100

30 ASAM ASKORBAT 25 MG (VIT C) TAB 0

31 ASAM ASKORBAT 50 MG (VIT C) TAB 200 200

32 ASAM MEFENAMAT TABLET SALUT 500 MG TAB 0

33 ASIKLOVIR KRIM 5 % TUBE 0

34 ASIKLOVIR TABLET 200 MG TAB 0

35 ASIKLOVIR TABLET 400 MG TAB 190 190

36 ATROPIN TETES MATA 0.5 % PCS 0

37 BETAMETASON KRIM 0,1 % TUBE 5 10 1 14

38 BETAHISTIN MESILAT TAB 6 MG / HISTIGO TAB 140 150 90 200

39 BISAKODIL SUPPOSITORIA 10 MG (DULCOLAX) SUPP 0

40 BISAKODIL SUPPOSITORIA 5MG PED (DULCOLAX) SUPP 0

41 BISOPROLOL FUMARATE TAB 0

42 CARBAMAZEPIN TAB 200 MG TAB 0

43 CETIRIZINE TAB 10 MG TAB 100 100

44 CETIRIZINE SIRUP PCS 0

45 CLOBAZAM TAB 10 MG TAB 0

46 CLOZAPIN 25MG TAB 0

47 CURCUMA TAB TAB 0

48 DEKSAMETASON INJ 5 MG/ML AMP 0

49 DEKSAMETASON TABLET 0,5 MG TAB 50 200 250

50 DIAZEPAM INJ 5 MG/ML AMP 0

51 DIAZEPAM TABLET 2 MG TAB 0


52 DIAZEPAM TABLET 5 MG TAB 0

53 DIAZEPAM REKTAL TUBE 0

54 DIFENHIDRAMIN INJ 10 MG/ML AMP 0

55 DIGOKSIN TABLET 0,25 MG TAB 0

56 DILTIAZEM TAB 30 MG TAB 0

57 DIMENHIDRINAT TAB 50 MG TAB 90 90 100

58 DOMPERIDON TABLET 10 MG TAB 179 9 170

59 DOMPORIDON SIRUP PCS 5 5

60 DOMPERIDONE DROPS PCS 0

61 DOKSISIKLIN KAPSUL 100 MG KAPS 0

62 EKSTRAK BELLADONA TABLET 10 MG TAB 0

63 EPINEFRIN HCL / BITARTRAT (ADRENALIN) INJ AMP 1 1 0

64 ERITROMISIN KAPSUL 250 MG KAPS 0

65 ERITROMISIN TABLET 500 MG TAB 0

66 ERITROMISIN SIROP 200 MG/ 5 ML PCS 3 1 2

67 ETHYLIS CHLORIDUM SEMPROT PCS 0

68 FENOBARBITAL AMPUL 2 ML AMP 0

69 FENOBARBITAL TABLET 30 MG TAB 0

70 FITOMENADION TABLET 10 MG (VIT K) TAB 100 90 10 100

71 FITOMENADION INJ 1 MG/ML (VIT K) AMP 0

72 FITOMENADION INJ 10 MG/ML (VIT K) AMP 0

73 FUROSEMIDA TABLET 40 MG TAB 100 100

74 GARAM ORALIT 200ML AIR PCS 10 10

75 GEMFIBROZIL KAPSUL 300 MG KAPS 100 100

76 GENTAMISIN INJ 80 MG/ML AMP 0

77 GENTAMISIN SALEP KULIT POT 0

78 GENTAMISIN SULFAT TETES MATA 0,3 % POT 5 5

79 GENTIAN VIOLET 1 % PCS 0

80 GLIBENKLAMIDA TABLET 5 MG TAB 200 200

81 GLIMEPIRIDE 2 MG TAB 0

82 GLISERIL GUALAKOLAT TABLET 100 MG TAB 0

83 GLUKOSA LARUTAN INFUS 10 % PCS 0

84 GLUKOSA LARUTAN INFUS 40 % PCS 0

85 GLUKOSA LARUTAN INFUS 5 % PCS 0

86 GRISEOFULVIN TABLET 125 MG TAB 100 100

87 GRANTUSIF TAB 180 60 120

88 HALOPERIDOL TABLET 1.5 MG TAB 0

89 HALOPERIDOL DEKANOAT INJ 50MG/ML AMP 0

90 HALOPERIDOL INJ 5MG/ML (LODOMER) AMP 0

91 HIDROKLOROTIAZIDA TABLET 25 MG (HCT) TAB 0

92 HIDROKORTISON KRIM 2,5 % TUBE 4 4

93 HYOSIN BUTIL BROMIDA TAB 10 MG (SCOPMA) TAB 0

94 IBUPROFEN TABLET 200 MG TAB 0

95 IBUPROFEN TABLET 400 MG TAB 80 100 80 100 100

96 IBUPROFEN SIRUP 15 MG/ML PCS 3 3 5

97 ISONIAZID TABLET 300 MG TAB 0

98 ISOSORBID DINITRAT TABLET 5 MG TAB 0

99 KALIUM DIKLOFENAK TAB 50 MG TAB 0

100 KALSIUM GLUCONAS INJ AMP 0

101 KALSIUM LAKTAT TABLET 500 MG TAB 90 90 100

102 KAPTOPRIL 12.5 MG TAB 0

103 KAPTOPRIL 25 MG TAB 0

104 KAPTOPRIL 50 MG TAB 200 200

105 KETOKENAZOL TAB 200 MG TAB 400 50 350

106 KETOKENAZOL KRIM TUBE 0

107 KLONIDIN TABLET 0.15 MG TAB 0

108 KLORAMFENIKOL SALEP MATA 1% TUBE 0

109 KLORAMFENIKOL SALEP KULIT (BUFACETIN) TUBE 3 3

110 KLORAMFENIKOL TETES TELINGA 3 % PCS 0

111 KLORAMFENIKOL TETES MATA 0.5 % PCS 0

112 KLORAMFENIKOL SUSP 125 MG/ 5 ML PCS 3 3 0


113 KLORAMFENIKOL KAPSUL 250 MG KAPS 100 100 0

114 KLORAMFENIKOL KAPSUL 500 MG KAPS 0

115 KLORFENIRAMINA MALEAT TAB 4 MG (CTM) TAB 0 500 160 340

116 KLORPROMAZIN TAB SALUT 25 MG (CPZ) TAB 0

117 KLORPROMAZIN TAB SALUT 100 MG (CPZ) TAB 0

118 KOTRIMOKSAZOL SUSPENSI PCS 3 5 1 7

119 KOTRIMOKSAZOL DEWASA TAB 480MG TAB 150 100 70 180

120 KUINIDIN 100 MG TABLET TAB 0

121 KUINIDIN 200 MG TABLET TAB 0

122 KUININ (KINA) TABLET 200 MG TAB 0

123 KUININ INJEKSI 25 % TAB 0

124 KUININ SULFAT TAB 222 MG (7 H2O) TAB 0

125 LANSOPRAZOL 30 MG KAPS 40 40

126 LANSOPRAZOL SIRUP PCS 0

127 LIDOKAIN INJ 2 % AMP 0

128 LIDOKAIN INJ 2 % + EPINEFRIN AMP 7 7

129 LIDOKAIN SPRAY AMP 1 1

130 LISOL DENGAN KRESOL SABUN 50 % PCS 0

131 LORATADIN TAB TAB 30 30

132 LOPERAMIDE TAB 270 90 180

133 MgSO4 20% PCS 0

134 MgSO4 40% PCS 0

135 MEBENDAZOL SIROP 100 MG/ 5 ML PCS 0

136 MEBENDAZOL TABLET 100 MG TAB 0

137 METAMPIRON TABLET 500 MG (ANTALGIN) TAB 0

138 METILERGOMETRIN MALEAT TABLET 0.125 MG TAB 0

139 METILERGOMETRIN MALEAT INJ 0.2 MG AMP 0

140 METILPREDNISOLON TAB 4 MG TAB 80 200 120 160

141 METILPREDNISOLON TAB16 MG TAB 0

142 METFORMIN TAB 500 MG TAB 0

143 METFORMIN TAB 850 MG TAB 0

144 METOKLOPRAMIDE TAB 10 MG TAB 200 200

145 MULTIVITAMIN SYR / CAMIVITA PCS 3 3

146 MULTIVITAMIN VINETRON TAB TAB 80 80 0 100

147 METRONIDAZOL TABLET 250 MG TAB 170 20 150

148 METRONIDAZOL TABLET 500 MG TAB 0

149 MIKONAZOLE KRIM TUBE 0

150 MIKONAZOLE BEDAK TUBE 4 4

151 MINERAL MIX PCS 0

152 NATRIUM DKLOFENAK TABLET 25 MG TAB 0

153 NATRIUM DKLOFENAK TABLET 50 MG TAB 30 100 130

154 NATRIUM KLORIDA LARUTAN INFUS 0.9 % PCS 0

155 NIPEDIFINE TAB 10 MG TAB 40 100 140

156 NISTATIN 500.000 IU TAB 100 100 0

157 NISTATIN VAGINAL TABLET TAB 0

158 OBAT ANTITUBERKULOSIS SISIPAN DEWASA PKT 0

159 OBAT ANTITUBERKULOSIS KAT 1 DEWASA PKT 0

160 OBAT ANTITUBERKULOSIS KAT 2 DEWASA PKT 0

161 OBAT ANTITUBERKULOSIS KAT ANAK PKT 0

162 OBAT BATUK HITAM CAIRAN PCS 0

163 OKSITETRASIKLIN HCL SALEP MATA 1 % TUBE 13 13

164 OKSITETRASIKLIN HCL SALEP KULIT 3 % TUBE 10 10

165 OKSITOSIN INJ 10 IU/ML AMP 0

166 OMEPERAZOLE KAPSUL KAPS 0

167 OMEPRAZOLE INJ VIAL 0

168 PAPAVERIN TABLET 40 MG TAB 60 60

169 PARASETAMOL DROPS PCS 1 3 4

170 PARASETAMOL SIROP 120 MG/ 5 ML PCS 2 3 3 2

171 PARASETAMOL TABLET 500 MG TAB 500 50 450

172 PENOL GLISEROL TETES TELINGA PCS 0

173 PEHACAIN INJ AMP 0


174 PIRANTEL TABLET SCORE 125 MG TAB 0

175 PIRANTEL SIRUP PCS 0

176 PIRASETAM 400 TAB 0

177 PIRASETAM 1200 TAB 0

178 PIRIDOKSIN TAB 10 MG (VIT B6) TAB 0

179 PIROKSIKAM TABLET 10 MG TAB 0

180 PIROKSIKAM TABLET 20 MG TAB 60 60

181 PITOGIN AMPUL 1 ML AMP 0

182 PREDNISON TABLET 5 MG TAB 950 50 900

183 PRIMAKUIN TABLET 15 MG TAB 0

184 PROPANOLOL TABLET 10 MG TAB 0

185 PROPILITIOURASIL TABLET 100 MG TAB 0

186 REGENSIA TB PKT 0

187 RANITIDIN TABLET 150 MG TAB 200 200

188 RANITIDIN INJ 25 MG / 2 ML AMP 0

189 RINGER LAKTAT INFUS PCS 0

190 RISPERIDON TABLET 2 MG TAB 0

191 SALBUTAMOL TABLET 2 MG TAB 100 100

192 SALBUTAMOL TABLET 4 MG TAB 90 90

193 SALBUTAMOL SIRUP 2 MG / 5 ML PCS 0

194 SALEP 2-4 KOMBINASI POT 2 5 7

195 SALISIL BEDAK 2 % PCS 0

196 SCABIMITE CREAM TUBE 3 3

197 SEFADROKSIL SIROP KERING 125 MG / 5 ML PCS 0

198 SEFADROKSIL KAPSUL 500 MG KAPS 180 20 160

199 SEFOTAKSIM 1000 MG INJ VIAL 0

200 SEFTRIAKSON SERBUK INJ 1000 MG VIAL 0

201 SIANOKOBALAMIN VIT B12 INJ 500 AMP 4 4

202 SIANOKOBALAMIN TABLET 50 MCG TAB 180 30 150

203 SIMVASTATIN TABLET 10 MG TAB 120 120

204 SIPROFLOKSASIN KAPLET 500 MG KAPL 190 190

205 SULFADIMIDINE TABLET 500 MG TAB 0

206 SULFASETAMIDA NATRIUM TETES MATA 15 % PCS 0

207 TABLET TAMBAH DARAH KOMBINASI TAB 0

208 TETRASIKLIN KAPSUL 250 MG KAPS 0

209 TETRASIKLIN KAPSUL 500 MG KAPS 100 10 90

210 TIAMIN (VIT B1) INJ 100 MG/ML AMP 0

211 TIAMIN (VIT B1) TABLET 50 MG TAB 230 230

212 TIURAZOL 5 MG TAB TAB 0

213 TRAMADOL KAPS KAPS 0

214 TRAMADOL INJ AMP 0

215 TRIHEKSIFENIDIL 25 MG TAB TAB 0

216 VIT A MERAH PCS 0

217 VIT A BIRU PCS 0

218 VITAMIN B KOMPLEKS TABLET TAB 385 35 350

219 VAKSIN RABIES VIAL 0

220 ZINC TAB TAB 80 30 50 100

221 ZINC SIRUP PCS 3 3

PERBEKALAN KESEHATAN

1 ALAT SUNTIK SEKALI PAKAI 0,05 ML PCS 0

2 ALAT SUNTIK SEKALI PAKAI 0,5 ML PCS 0

3 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 9 9

4 ALAT SUNTIK SEKALI PAKAI 10 ML PCS 0

5 ALAT SUNTIK SEKALI PAKAI 2.5 ML / 3ML PCS 3 3

6 ALAT SUNTIK SEKALI PAKAI 5 ML PCS 9 9

7 ALKOHOL SWAB PCS 0

8 AQUA PRO INJEKSI STERIL 25 ML PCS 0

9 BISTURI NO. 21 PCS 3 3

10 BISTURI NO. 20 PCS 0

11 BISTURI NO. 19 PCS 0


12 BLOOD LANCET BOX 0

13 CATHEJELL 12,5G PCS 0

14 CATGUT NO 2/0 PCS 0

15 CATGUT NO 3/0 PCS 0

16 CATGUT NO 4/0 PCS 0

17 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300 ml PCS 0

18 ETANOL 70 % 100 ml PCS 0

19 ETANOL 70 % 1000 ml PCS 0

20 FOLEY CATETER 16 PCS 0

21 FOLEY CATETER 18 PCS 0

22 FOLEY CATETER 20 PCS 0

23 HANDSCON STERIL 6.5 PCS 0

24 HANDSCON STERIL 7 PCS 0

25 HANDSCON STERIL 7.5 PCS 0

26 HANDSCON STERIL 8 PCS 6 4 2 5

27 HANDSCON NON STERIL S PCS 0

28 HANDSCON NON STERIL M PCS 0

29 HANDSCON NON STERIL L PCS 0

30 HANDRUB PCS 0

31 HEXAGON SIPILIS PCS 0

32 INFUSION SET ANAK PCS 0

33 INFUSION SET DEWASA PCS 0

34 IV CATHETER NO 18 G PCS 0

35 IV CATHETER NO 20 G PCS 0

36 IV CATHETER NO 22 G PCS 0

37 IV CATHETER NO 24 G PCS 0

38 JARUM HECTING PCS 0

39 KAPAS PEMBALUT / ABSORBEN 250 GRAM PCS 0

40 KASA KOMPRES 40/40 STERIL PCS 0

41 KASA PEMBALUT 2 M X 80 CM PCS 0

42 KASA PEMBALUT HIDROFIL 4 M X 5 CM ELASTIS PCS 10 5 5 5

43 KASA PEMBALUT HIDROFIL 4 M X 15 CM ELASTIS PCS 0

44 KASA PEMBALUT HIDROFIL 16 M X 16 CM ELASTIS PCS 2 2 5

45 KASA PEMBALUT HIDROFIL 40 X 80 CM PCS 0

46 KASA PEMBALUT HIDROFIL 36 X 80 CM PCS 0

47 MASKER KARET PCS 3 3

48 NASAL OXYGEN CANULA DEWASA PCS 0

49 NASAL OXYGEN CANULA ANAK PCS 0

50 NASAL OXYGEN CANULA BAYI PCS 0

50 PLESTER 10CM X 5M PCS 1 1 0 1

51 POVIDON IODIDA 10 % 1000 ML PCS 0

52 POVIDON IODIDA 10 % 300 ML PCS 0

53 POVIDON IODIDA 10 % 60 ML PCS 0

54 POVIDON IODIDA 10 % 30 ML PCS 0

55 POVIDON SALEP TUBE 0

56 POT SPUTUM POT 0

57 RDT MALARIA (MONO TEST) BOX 0

58 RDT DBD NS1 BOX 0

59 RDT DBD igg/iggm BOX 0

60 STRIP ASAM URAT PCS 0

61 STRIP CHOLESTEROL PCS 0

62 STRIP GLUKOSA PCS 0

63 STRIP HIV PCS 0

64 SILK 2/0 PCS 0

65 SILK 3/0 PCS 0

66 SILK 4/0 PCS 0

67 STOMACH TUBE / MAAG SLANG NO. 3,5 PCS 0

68 STOMACH TUBE / MAAG SLANG NO. 5 PCS 0

69 STOMACH TUBE / MAAG SLANG NO. 12 PCS 0

70 STOMACH TUBE / MAAG SLANG NO. 16 PCS 0

71 URIN BAG PCS 0


72 WING NEEDLE NO.21 PCS 0

73 WING NEEDLE NO.23 PCS 0

74 WING NEEDLE NO.25 PCS 0

75 WING NEEDLE NO.27 PCS 0

OBAT GIGI 0

1 COMPOSIT POSTERIOR A3 SOLARE PCS 0

2 COMPOSIT ANTERIOR A3 SOLARE PCS 0

3 COMPOSIT POSTERIOR A2 SOLARE PCS 0

4 COMPOSIT ANTERIOR A2 SOLARE PCS 0

5 EUGENOL PCS 0

6 FUJI IX MINI (LIBRA PERSADA) PCS 0

7 XYLESTESIN PCS 0

TAMBAHAN PCS

1 PCS

2 PCS

3 PCS

4 PCS

5 PCS

6 PCS

7 PCS

8 PCS

9 PCS

10 PCS

11 PCS

12 PCS

13 PCS

14 PCS

15 PCS

BARRO, 30 / 11 / 2019
PENANGGUNG JAWAB PELAYANA OBAT
PIMPINAN PUSTU / PKD ........................... PUSKESMAS PARANGIA

(ANUGRAH AJENG TRI UTAMI, AMD.KEB) (.........................................................................)

NIP. 19880227 201704 2 005 NIP. ..................................................................


UPTD PUSKESMAS PARANGIA
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
( LPLPO )
PUSTU / PKD : PUSTU BARRO
BULAN / TAHUN : DESEMBER / 2019

STOK JUMLAH

N
SISA

A
NO NAMA OBAT BULAN MASUK KELUAR

ET
TU
STOK

K
LALU PERMINTAAN PENERIMAAN

SA
1 2 3 4 5 6 7 8 9 10

PELAYANAN KESEHATAN DASAR


1 ACETYLCYSTEIN KAPSUL 200MG KAPS 150 150

2 ALBENDAZOL TABLET 400 MG TAB 0 0

3 ALBENDAZOL SIRUP PCS 0 0

4 ALBOTHYL KONSENTRAT PCS 0 0

5 ALOPURINOL TABLET 100 MG TAB 150 150

6 ALOPURINOL TABLET 300 MG TAB 150 150

7 AMINOFILIN INJEKSI 24 MG/ML AMP 0 0

8 AMINOFILIN TABLET 200 MG TAB 190 190

9 AMITRIPTILIN TABLET SALUT 25 MG TAB 0 0

10 AMBROKSOL TAB 30 MG TAB 77 100 20 157

11 AMBROKSOL SIRUP PCS 3 1 2

12 AMLODIPIN 5 MG TAB 0 0

13 AMLODIPIN 10 MG TAB 0 0

14 AMOKSISILIN KAPSUL 250 MG KAPL 0 0

15 AMOKSISILIN KAPLET 500 MG KAPL 110 100 20 190

16 AMOKSISILIN VIAL 1 G VIAL 0 0

17 AMOKSISILIN SIROP KERING 125 PCS 3 3 1 5

18 AMPICILIN SERBUK INJ 1 G VIAL 0 0

19 AMPICILIN KAPLET 250 MG KAPL 0 0

20 AMPICILIN KAPLET 500 MG KAPL 0 0

21 ANTASIDA DOEN I TABLET KUNYAH TAB 170 170

22 ANTASIDA DOEN II SUSPENSI PCS 3 3

23 ANTI BAKTERI DOEN SALEP KOMBINASI POT 16 16

24 ANTIFUNGI DOEN KOMBINASI POT 0 0

25 ANTIHEMOROID DOEN KOMBINASI SUPP 0 0

26 ANTIMIGREIN DOEN KOMBINASI (ERGOTAMIN) TAB 100 100

27 ARTESUNATE INJEKSI VIAL 60 MG AMP 0 0

28 ARTESUNATE DEWASA TAB 0 0

29 ASAM ASETIL SALISILAT 100 MG TAB 80 80

30 ASAM ASKORBAT 25 MG (VIT C) TAB 0 0

31 ASAM ASKORBAT 50 MG (VIT C) TAB 200 50 150

32 ASAM MEFENAMAT TABLET SALUT 500 MG TAB 0 0

33 ASIKLOVIR KRIM 5 % TUBE 0 0

34 ASIKLOVIR TABLET 200 MG TAB 0 0

35 ASIKLOVIR TABLET 400 MG TAB 190 190

36 ATROPIN TETES MATA 0.5 % PCS 0 0

37 BETAMETASON KRIM 0,1 % TUBE 14 14

38 BETAHISTIN MESILAT TAB 6 MG / HISTIGO TAB 200 200

39 BISAKODIL SUPPOSITORIA 10 MG (DULCOLAX) SUPP 0 0

40 BISAKODIL SUPPOSITORIA 5MG PED (DULCOLAX) SUPP 0 0

41 BISOPROLOL FUMARATE TAB 0 0

42 CARBAMAZEPIN TAB 200 MG TAB 0 0

43 CETIRIZINE TAB 10 MG TAB 100 30 70

44 CETIRIZINE SIRUP PCS 0 0

45 CLOBAZAM TAB 10 MG TAB 0 0

46 CLOZAPIN 25MG TAB 0 0

47 CURCUMA TAB TAB 0 0

48 DEKSAMETASON INJ 5 MG/ML AMP 0 0

49 DEKSAMETASON TABLET 0,5 MG TAB 250 50 200

50 DIAZEPAM INJ 5 MG/ML AMP 0 0

51 DIAZEPAM TABLET 2 MG TAB 0 0


52 DIAZEPAM TABLET 5 MG TAB 0 0

53 DIAZEPAM REKTAL TUBE 0 0

54 DIFENHIDRAMIN INJ 10 MG/ML AMP 0 0

55 DIGOKSIN TABLET 0,25 MG TAB 0 0

56 DILTIAZEM TAB 30 MG TAB 0 0

57 DIMENHIDRINAT TAB 50 MG TAB 90 90

58 DOMPERIDON TABLET 10 MG TAB 170 170

59 DOMPORIDON SIRUP PCS 5 5

60 DOMPERIDONE DROPS PCS 0 0

61 DOKSISIKLIN KAPSUL 100 MG KAPS 0 0

62 EKSTRAK BELLADONA TABLET 10 MG TAB 0 0

63 EPINEFRIN HCL / BITARTRAT (ADRENALIN) INJ AMP 0 0

64 ERITROMISIN KAPSUL 250 MG KAPS 0 0

65 ERITROMISIN TABLET 500 MG TAB 0 0

66 ERITROMISIN SIROP 200 MG/ 5 ML PCS 2 2

67 ETHYLIS CHLORIDUM SEMPROT PCS 0 0

68 FENOBARBITAL AMPUL 2 ML AMP 0 0

69 FENOBARBITAL TABLET 30 MG TAB 0 0

70 FITOMENADION TABLET 10 MG (VIT K) TAB 10 10

71 FITOMENADION INJ 1 MG/ML (VIT K) AMP 0 0

72 FITOMENADION INJ 10 MG/ML (VIT K) AMP 0 0

73 FUROSEMIDA TABLET 40 MG TAB 100 100

74 GARAM ORALIT 200ML AIR PCS 10 10

75 GEMFIBROZIL KAPSUL 300 MG KAPS 100 100

76 GENTAMISIN INJ 80 MG/ML AMP 0 0

77 GENTAMISIN SALEP KULIT POT 0 0

78 GENTAMISIN SULFAT TETES MATA 0,3 % POT 5 5

79 GENTIAN VIOLET 1 % PCS 0 0

80 GLIBENKLAMIDA TABLET 5 MG TAB 200 100 100

81 GLIMEPIRIDE 2 MG TAB 0 0

82 GLISERIL GUALAKOLAT TABLET 100 MG TAB 0 0

83 GLUKOSA LARUTAN INFUS 10 % PCS 0 0

84 GLUKOSA LARUTAN INFUS 40 % PCS 0 0

85 GLUKOSA LARUTAN INFUS 5 % PCS 0 0

86 GRISEOFULVIN TABLET 125 MG TAB 100 100

87 GRANTUSIF TAB 120 20 100

88 HALOPERIDOL TABLET 1.5 MG TAB 0 0

89 HALOPERIDOL DEKANOAT INJ 50MG/ML AMP 0 0

90 HALOPERIDOL INJ 5MG/ML (LODOMER) AMP 0 0

91 HIDROKLOROTIAZIDA TABLET 25 MG (HCT) TAB 0 0

92 HIDROKORTISON KRIM 2,5 % TUBE 4 4

93 HYOSIN BUTIL BROMIDA TAB 10 MG (SCOPMA) TAB 0 0

94 IBUPROFEN TABLET 200 MG TAB 0 0

95 IBUPROFEN TABLET 400 MG TAB 100 100 0

96 IBUPROFEN SIRUP 15 MG/ML PCS 3 3

97 ISONIAZID TABLET 300 MG TAB 0 0

98 ISOSORBID DINITRAT TABLET 5 MG TAB 0 0

99 KALIUM DIKLOFENAK TAB 50 MG TAB 0 0

100 KALSIUM GLUCONAS INJ AMP 0 0

101 KALSIUM LAKTAT TABLET 500 MG TAB 90 100 190

102 KAPTOPRIL 12.5 MG TAB 0 0

103 KAPTOPRIL 25 MG TAB 0 0

104 KAPTOPRIL 50 MG TAB 200 100 100

105 KETOKENAZOL TAB 200 MG TAB 350 350

106 KETOKENAZOL KRIM TUBE 0 0

107 KLONIDIN TABLET 0.15 MG TAB 0 0

108 KLORAMFENIKOL SALEP MATA 1% TUBE 0 0

109 KLORAMFENIKOL SALEP KULIT (BUFACETIN) TUBE 3 1 2

110 KLORAMFENIKOL TETES TELINGA 3 % PCS 0 0

111 KLORAMFENIKOL TETES MATA 0.5 % PCS 0 0

112 KLORAMFENIKOL SUSP 125 MG/ 5 ML PCS 0 0


113 KLORAMFENIKOL KAPSUL 250 MG KAPS 0 0

114 KLORAMFENIKOL KAPSUL 500 MG KAPS 0 0

115 KLORFENIRAMINA MALEAT TAB 4 MG (CTM) TAB 340 40 300

116 KLORPROMAZIN TAB SALUT 25 MG (CPZ) TAB 0 0

117 KLORPROMAZIN TAB SALUT 100 MG (CPZ) TAB 0 0

118 KOTRIMOKSAZOL SUSPENSI PCS 7 7

119 KOTRIMOKSAZOL DEWASA TAB 480MG TAB 180 180

120 KUINIDIN 100 MG TABLET TAB 0 0

121 KUINIDIN 200 MG TABLET TAB 0 0

122 KUININ (KINA) TABLET 200 MG TAB 0 0

123 KUININ INJEKSI 25 % TAB 0 0

124 KUININ SULFAT TAB 222 MG (7 H2O) TAB 0 0

125 LANSOPRAZOL 30 MG KAPS 40 40

126 LANSOPRAZOL SIRUP PCS 0 0

127 LIDOKAIN INJ 2 % AMP 0 0

128 LIDOKAIN INJ 2 % + EPINEFRIN AMP 7 7

129 LIDOKAIN SPRAY AMP 1 1

130 LISOL DENGAN KRESOL SABUN 50 % PCS 0 0

131 LORATADIN TAB TAB 30 30

132 LOPERAMIDE TAB 180 180

133 MgSO4 20% PCS 0 0

134 MgSO4 40% PCS 0 0

135 MEBENDAZOL SIROP 100 MG/ 5 ML PCS 0 0

136 MEBENDAZOL TABLET 100 MG TAB 0 0

137 METAMPIRON TABLET 500 MG (ANTALGIN) TAB 0 0

138 METILERGOMETRIN MALEAT TABLET 0.125 MG TAB 0 0

139 METILERGOMETRIN MALEAT INJ 0.2 MG AMP 0 0

140 METILPREDNISOLON TAB 4 MG TAB 160 50 110

141 METILPREDNISOLON TAB16 MG TAB 0 0

142 METFORMIN TAB 500 MG TAB 0 0

143 METFORMIN TAB 850 MG TAB 0 0

144 METOKLOPRAMIDE TAB 10 MG TAB 200 200

145 MULTIVITAMIN SYR / CAMIVITA PCS 3 1 2

146 MULTIVITAMIN VINETRON TAB TAB 0 100 10 90

147 METRONIDAZOL TABLET 250 MG TAB 150 150

148 METRONIDAZOL TABLET 500 MG TAB 0 0

149 MIKONAZOLE KRIM TUBE 0 0

150 MIKONAZOLE BEDAK TUBE 4 4

151 MINERAL MIX PCS 0 0

152 NATRIUM DKLOFENAK TABLET 25 MG TAB 0 0

153 NATRIUM DKLOFENAK TABLET 50 MG TAB 130 20 110

154 NATRIUM KLORIDA LARUTAN INFUS 0.9 % PCS 0 0

155 NIPEDIFINE TAB 10 MG TAB 140 140

156 NISTATIN 500.000 IU TAB 0 0

157 NISTATIN VAGINAL TABLET TAB 0 0

158 OBAT ANTITUBERKULOSIS SISIPAN DEWASA PKT 0 0

159 OBAT ANTITUBERKULOSIS KAT 1 DEWASA PKT 0 0

160 OBAT ANTITUBERKULOSIS KAT 2 DEWASA PKT 0 0

161 OBAT ANTITUBERKULOSIS KAT ANAK PKT 0 0

162 OBAT BATUK HITAM CAIRAN PCS 0 0

163 OKSITETRASIKLIN HCL SALEP MATA 1 % TUBE 13 13

164 OKSITETRASIKLIN HCL SALEP KULIT 3 % TUBE 10 10

165 OKSITOSIN INJ 10 IU/ML AMP 0 0

166 OMEPERAZOLE KAPSUL KAPS 0 0

167 OMEPRAZOLE INJ VIAL 0 0

168 PAPAVERIN TABLET 40 MG TAB 60 60

169 PARASETAMOL DROPS PCS 4 4

170 PARASETAMOL SIROP 120 MG/ 5 ML PCS 2 1 1

171 PARASETAMOL TABLET 500 MG TAB 450 250 200

172 PENOL GLISEROL TETES TELINGA PCS 0 0

173 PEHACAIN INJ AMP 0 0


174 PIRANTEL TABLET SCORE 125 MG TAB 0 0

175 PIRANTEL SIRUP PCS 0 0

176 PIRASETAM 400 TAB 0 0

177 PIRASETAM 1200 TAB 0 0

178 PIRIDOKSIN TAB 10 MG (VIT B6) TAB 0 0

179 PIROKSIKAM TABLET 10 MG TAB 0 0

180 PIROKSIKAM TABLET 20 MG TAB 60 10 50

181 PITOGIN AMPUL 1 ML AMP 0 0

182 PREDNISON TABLET 5 MG TAB 900 80 820

183 PRIMAKUIN TABLET 15 MG TAB 0 0

184 PROPANOLOL TABLET 10 MG TAB 0 0

185 PROPILITIOURASIL TABLET 100 MG TAB 0 0

186 REGENSIA TB PKT 0 0

187 RANITIDIN TABLET 150 MG TAB 200 200

188 RANITIDIN INJ 25 MG / 2 ML AMP 0 0

189 RINGER LAKTAT INFUS PCS 0 0

190 RISPERIDON TABLET 2 MG TAB 0 0

191 SALBUTAMOL TABLET 2 MG TAB 100 100

192 SALBUTAMOL TABLET 4 MG TAB 90 90

193 SALBUTAMOL SIRUP 2 MG / 5 ML PCS 0 0

194 SALEP 2-4 KOMBINASI POT 7 7

195 SALISIL BEDAK 2 % PCS 0 0

196 SCABIMITE CREAM TUBE 3 3

197 SEFADROKSIL SIROP KERING 125 MG / 5 ML PCS 0 0

198 SEFADROKSIL KAPSUL 500 MG KAPS 160 30 130

199 SEFOTAKSIM 1000 MG INJ VIAL 0 0

200 SEFTRIAKSON SERBUK INJ 1000 MG VIAL 0 0

201 SIANOKOBALAMIN VIT B12 INJ 500 AMP 4 4

202 SIANOKOBALAMIN TABLET 50 MCG TAB 150 10 140

203 SIMVASTATIN TABLET 10 MG TAB 120 120

204 SIPROFLOKSASIN KAPLET 500 MG KAPL 190 190

205 SULFADIMIDINE TABLET 500 MG TAB 0 0

206 SULFASETAMIDA NATRIUM TETES MATA 15 % PCS 0 0

207 TABLET TAMBAH DARAH KOMBINASI TAB 0 0

208 TETRASIKLIN KAPSUL 250 MG KAPS 0 0

209 TETRASIKLIN KAPSUL 500 MG KAPS 90 90

210 TIAMIN (VIT B1) INJ 100 MG/ML AMP 0 0

211 TIAMIN (VIT B1) TABLET 50 MG TAB 230 230

212 TIURAZOL 5 MG TAB TAB 0 0

213 TRAMADOL KAPS KAPS 0 0

214 TRAMADOL INJ AMP 0 0

215 TRIHEKSIFENIDIL 25 MG TAB TAB 0 0

216 VIT A MERAH PCS 0 0

217 VIT A BIRU PCS 0 0

218 VITAMIN B KOMPLEKS TABLET TAB 350 10 340

219 VAKSIN RABIES VIAL 0 0

220 ZINC TAB TAB 50 100 10 140

221 ZINC SIRUP PCS 3 3

PERBEKALAN KESEHATAN

1 ALAT SUNTIK SEKALI PAKAI 0,05 ML PCS 0 0

2 ALAT SUNTIK SEKALI PAKAI 0,5 ML PCS 0 0

3 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 9 9

4 ALAT SUNTIK SEKALI PAKAI 10 ML PCS 0 0

5 ALAT SUNTIK SEKALI PAKAI 2.5 ML / 3ML PCS 3 3

6 ALAT SUNTIK SEKALI PAKAI 5 ML PCS 9 9

7 ALKOHOL SWAB PCS 0 0

8 AQUA PRO INJEKSI STERIL 25 ML PCS 0 0

9 BISTURI NO. 21 PCS 3 3

10 BISTURI NO. 20 PCS 0 0

11 BISTURI NO. 19 PCS 0 0


12 BLOOD LANCET BOX 0 0

13 CATHEJELL 12,5G PCS 0 0

14 CATGUT NO 2/0 PCS 0 0

15 CATGUT NO 3/0 PCS 0 0

16 CATGUT NO 4/0 PCS 0 0

17 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300 ml PCS 0 0

18 ETANOL 70 % 100 ml PCS 0 0

19 ETANOL 70 % 1000 ml PCS 0 0

20 FOLEY CATETER 16 PCS 0 0

21 FOLEY CATETER 18 PCS 0 0

22 FOLEY CATETER 20 PCS 0 0

23 HANDSCON STERIL 6.5 PCS 0 0

24 HANDSCON STERIL 7 PCS 0 0

25 HANDSCON STERIL 7.5 PCS 0 0

26 HANDSCON STERIL 8 PCS 2 5 2 5

27 HANDSCON NON STERIL S PCS 0 0

28 HANDSCON NON STERIL M PCS 0 0

29 HANDSCON NON STERIL L PCS 0 0

30 HANDRUB PCS 0 0

31 HEXAGON SIPILIS PCS 0 0

32 INFUSION SET ANAK PCS 0 0

33 INFUSION SET DEWASA PCS 0 0

34 IV CATHETER NO 18 G PCS 0 0

35 IV CATHETER NO 20 G PCS 0 0

36 IV CATHETER NO 22 G PCS 0 0

37 IV CATHETER NO 24 G PCS 0 0

38 JARUM HECTING PCS 0 0

39 KAPAS PEMBALUT / ABSORBEN 250 GRAM PCS 0 0

40 KASA KOMPRES 40/40 STERIL PCS 0 0

41 KASA PEMBALUT 2 M X 80 CM PCS 0 0

42 KASA PEMBALUT HIDROFIL 4 M X 5 CM ELASTIS PCS 5 10 5 10

43 KASA PEMBALUT HIDROFIL 4 M X 15 CM ELASTIS PCS 0 0

44 KASA PEMBALUT HIDROFIL 16 M X 16 CM ELASTIS PCS 2 5 2 5

45 KASA PEMBALUT HIDROFIL 40 X 80 CM PCS 0 0

46 KASA PEMBALUT HIDROFIL 36 X 80 CM PCS 0 0

47 MASKER KARET PCS 3 3 0

48 NASAL OXYGEN CANULA DEWASA PCS 0 0

49 NASAL OXYGEN CANULA ANAK PCS 0 0

50 NASAL OXYGEN CANULA BAYI PCS 0 0

50 PLESTER 10CM X 5M PCS 0 1 1

51 POVIDON IODIDA 10 % 1000 ML PCS 0 0

52 POVIDON IODIDA 10 % 300 ML PCS 0 0

53 POVIDON IODIDA 10 % 60 ML PCS 0 0

54 POVIDON IODIDA 10 % 30 ML PCS 0 0

55 POVIDON SALEP TUBE 0 0

56 POT SPUTUM POT 0 0

57 RDT MALARIA (MONO TEST) BOX 0 0

58 RDT DBD NS1 BOX 0 0

59 RDT DBD igg/iggm BOX 0 0

60 STRIP ASAM URAT PCS 0 0

61 STRIP CHOLESTEROL PCS 0 0

62 STRIP GLUKOSA PCS 0 0

63 STRIP HIV PCS 0 0

64 SILK 2/0 PCS 0 0

65 SILK 3/0 PCS 0 0

66 SILK 4/0 PCS 0 0

67 STOMACH TUBE / MAAG SLANG NO. 3,5 PCS 0 0

68 STOMACH TUBE / MAAG SLANG NO. 5 PCS 0 0

69 STOMACH TUBE / MAAG SLANG NO. 12 PCS 0 0

70 STOMACH TUBE / MAAG SLANG NO. 16 PCS 0 0

71 URIN BAG PCS 0 0


72 WING NEEDLE NO.21 PCS 0 0

73 WING NEEDLE NO.23 PCS 0 0

74 WING NEEDLE NO.25 PCS 0 0

75 WING NEEDLE NO.27 PCS 0 0

OBAT GIGI 0 0

1 COMPOSIT POSTERIOR A3 SOLARE PCS 0 0

2 COMPOSIT ANTERIOR A3 SOLARE PCS 0 0

3 COMPOSIT POSTERIOR A2 SOLARE PCS 0 0

4 COMPOSIT ANTERIOR A2 SOLARE PCS 0 0

5 EUGENOL PCS 0 0

6 FUJI IX MINI (LIBRA PERSADA) PCS 0 0

7 XYLESTESIN PCS 0 0

TAMBAHAN PCS

1 PCS

2 PCS

3 PCS

4 PCS

5 PCS

6 PCS

7 PCS

8 PCS

9 PCS

10 PCS

11 PCS

12 PCS

13 PCS

14 PCS

15 PCS

BARRO, 15 / 12 / 2019
PENANGGUNG JAWAB PELAYANA OBAT
PIMPINAN PUSTU / PKD ........................... PUSKESMAS PARANGIA

(ANUGRAH AJENG TRI UTAMI, AMD.KEB) (.........................................................................)

NIP. 19880227 201704 2 005 NIP. ..................................................................


UPTD PUSKESMAS PARANGIA
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
( LPLPO )
PUSTU / PKD : PUSTU BARRO
BULAN / TAHUN : DESEMBER / 2019

STOK JUMLAH

N
SISA

A
NO NAMA OBAT BULAN MASUK KELUAR

ET
TU
STOK

K
LALU PERMINTAAN PENERIMAAN

SA
1 2 3 4 5 6 7 8 9 10

PELAYANAN KESEHATAN DASAR


1 ACETYLCYSTEIN KAPSUL 200MG KAPS 150 150

2 ALBENDAZOL TABLET 400 MG TAB 0 0

3 ALBENDAZOL SIRUP PCS 0 0

4 ALBOTHYL KONSENTRAT PCS 0 0

5 ALOPURINOL TABLET 100 MG TAB 150 150

6 ALOPURINOL TABLET 300 MG TAB 150 150

7 AMINOFILIN INJEKSI 24 MG/ML AMP 0 0

8 AMINOFILIN TABLET 200 MG TAB 190 190

9 AMITRIPTILIN TABLET SALUT 25 MG TAB 0 0

10 AMBROKSOL TAB 30 MG TAB 77 77

11 AMBROKSOL SIRUP PCS 3 3

12 AMLODIPIN 5 MG TAB 0 0

13 AMLODIPIN 10 MG TAB 0 0

14 AMOKSISILIN KAPSUL 250 MG KAPL 0 0

15 AMOKSISILIN KAPLET 500 MG KAPL 110 110

16 AMOKSISILIN VIAL 1 G VIAL 0 0

17 AMOKSISILIN SIROP KERING 125 PCS 3 3

18 AMPICILIN SERBUK INJ 1 G VIAL 0 0

19 AMPICILIN KAPLET 250 MG KAPL 0 0

20 AMPICILIN KAPLET 500 MG KAPL 0 0

21 ANTASIDA DOEN I TABLET KUNYAH TAB 170 170

22 ANTASIDA DOEN II SUSPENSI PCS 3 3

23 ANTI BAKTERI DOEN SALEP KOMBINASI POT 16 16

24 ANTIFUNGI DOEN KOMBINASI POT 0 0

25 ANTIHEMOROID DOEN KOMBINASI SUPP 0 0

26 ANTIMIGREIN DOEN KOMBINASI (ERGOTAMIN) TAB 100 100

27 ARTESUNATE INJEKSI VIAL 60 MG AMP 0 0

28 ARTESUNATE DEWASA TAB 0 0

29 ASAM ASETIL SALISILAT 100 MG TAB 80 80

30 ASAM ASKORBAT 25 MG (VIT C) TAB 0 0

31 ASAM ASKORBAT 50 MG (VIT C) TAB 200 200

32 ASAM MEFENAMAT TABLET SALUT 500 MG TAB 0 0

33 ASIKLOVIR KRIM 5 % TUBE 0 0

34 ASIKLOVIR TABLET 200 MG TAB 0 0

35 ASIKLOVIR TABLET 400 MG TAB 190 190

36 ATROPIN TETES MATA 0.5 % PCS 0 0

37 BETAMETASON KRIM 0,1 % TUBE 14 14

38 BETAHISTIN MESILAT TAB 6 MG / HISTIGO TAB 200 200

39 BISAKODIL SUPPOSITORIA 10 MG (DULCOLAX) SUPP 0 0

40 BISAKODIL SUPPOSITORIA 5MG PED (DULCOLAX) SUPP 0 0

41 BISOPROLOL FUMARATE TAB 0 0

42 CARBAMAZEPIN TAB 200 MG TAB 0 0

43 CETIRIZINE TAB 10 MG TAB 100 100

44 CETIRIZINE SIRUP PCS 0 0

45 CLOBAZAM TAB 10 MG TAB 0 0

46 CLOZAPIN 25MG TAB 0 0

47 CURCUMA TAB TAB 0 0

48 DEKSAMETASON INJ 5 MG/ML AMP 0 0

49 DEKSAMETASON TABLET 0,5 MG TAB 250 250

50 DIAZEPAM INJ 5 MG/ML AMP 0 0

51 DIAZEPAM TABLET 2 MG TAB 0 0


52 DIAZEPAM TABLET 5 MG TAB 0 0

53 DIAZEPAM REKTAL TUBE 0 0

54 DIFENHIDRAMIN INJ 10 MG/ML AMP 0 0

55 DIGOKSIN TABLET 0,25 MG TAB 0 0

56 DILTIAZEM TAB 30 MG TAB 0 0

57 DIMENHIDRINAT TAB 50 MG TAB 90 90

58 DOMPERIDON TABLET 10 MG TAB 170 170

59 DOMPORIDON SIRUP PCS 5 5

60 DOMPERIDONE DROPS PCS 0 0

61 DOKSISIKLIN KAPSUL 100 MG KAPS 0 0

62 EKSTRAK BELLADONA TABLET 10 MG TAB 0 0

63 EPINEFRIN HCL / BITARTRAT (ADRENALIN) INJ AMP 0 0

64 ERITROMISIN KAPSUL 250 MG KAPS 0 0

65 ERITROMISIN TABLET 500 MG TAB 0 0

66 ERITROMISIN SIROP 200 MG/ 5 ML PCS 2 2

67 ETHYLIS CHLORIDUM SEMPROT PCS 0 0

68 FENOBARBITAL AMPUL 2 ML AMP 0 0

69 FENOBARBITAL TABLET 30 MG TAB 0 0

70 FITOMENADION TABLET 10 MG (VIT K) TAB 10 10

71 FITOMENADION INJ 1 MG/ML (VIT K) AMP 0 0

72 FITOMENADION INJ 10 MG/ML (VIT K) AMP 0 0

73 FUROSEMIDA TABLET 40 MG TAB 100 100

74 GARAM ORALIT 200ML AIR PCS 10 10

75 GEMFIBROZIL KAPSUL 300 MG KAPS 100 100

76 GENTAMISIN INJ 80 MG/ML AMP 0 0

77 GENTAMISIN SALEP KULIT POT 0 0

78 GENTAMISIN SULFAT TETES MATA 0,3 % POT 5 5

79 GENTIAN VIOLET 1 % PCS 0 0

80 GLIBENKLAMIDA TABLET 5 MG TAB 200 200

81 GLIMEPIRIDE 2 MG TAB 0 0

82 GLISERIL GUALAKOLAT TABLET 100 MG TAB 0 0

83 GLUKOSA LARUTAN INFUS 10 % PCS 0 0

84 GLUKOSA LARUTAN INFUS 40 % PCS 0 0

85 GLUKOSA LARUTAN INFUS 5 % PCS 0 0

86 GRISEOFULVIN TABLET 125 MG TAB 100 100

87 GRANTUSIF TAB 120 120

88 HALOPERIDOL TABLET 1.5 MG TAB 0 0

89 HALOPERIDOL DEKANOAT INJ 50MG/ML AMP 0 0

90 HALOPERIDOL INJ 5MG/ML (LODOMER) AMP 0 0

91 HIDROKLOROTIAZIDA TABLET 25 MG (HCT) TAB 0 0

92 HIDROKORTISON KRIM 2,5 % TUBE 4 4

93 HYOSIN BUTIL BROMIDA TAB 10 MG (SCOPMA) TAB 0 0

94 IBUPROFEN TABLET 200 MG TAB 0 0

95 IBUPROFEN TABLET 400 MG TAB 100 100

96 IBUPROFEN SIRUP 15 MG/ML PCS 3 3

97 ISONIAZID TABLET 300 MG TAB 0 0

98 ISOSORBID DINITRAT TABLET 5 MG TAB 0 0

99 KALIUM DIKLOFENAK TAB 50 MG TAB 0 0

100 KALSIUM GLUCONAS INJ AMP 0 0

101 KALSIUM LAKTAT TABLET 500 MG TAB 90 90

102 KAPTOPRIL 12.5 MG TAB 0 0

103 KAPTOPRIL 25 MG TAB 0 0

104 KAPTOPRIL 50 MG TAB 200 200

105 KETOKENAZOL TAB 200 MG TAB 350 350

106 KETOKENAZOL KRIM TUBE 0 0

107 KLONIDIN TABLET 0.15 MG TAB 0 0

108 KLORAMFENIKOL SALEP MATA 1% TUBE 0 0

109 KLORAMFENIKOL SALEP KULIT (BUFACETIN) TUBE 3 3

110 KLORAMFENIKOL TETES TELINGA 3 % PCS 0 0

111 KLORAMFENIKOL TETES MATA 0.5 % PCS 0 0

112 KLORAMFENIKOL SUSP 125 MG/ 5 ML PCS 0 0


113 KLORAMFENIKOL KAPSUL 250 MG KAPS 0 0

114 KLORAMFENIKOL KAPSUL 500 MG KAPS 0 0

115 KLORFENIRAMINA MALEAT TAB 4 MG (CTM) TAB 340 340

116 KLORPROMAZIN TAB SALUT 25 MG (CPZ) TAB 0 0

117 KLORPROMAZIN TAB SALUT 100 MG (CPZ) TAB 0 0

118 KOTRIMOKSAZOL SUSPENSI PCS 7 7

119 KOTRIMOKSAZOL DEWASA TAB 480MG TAB 180 180

120 KUINIDIN 100 MG TABLET TAB 0 0

121 KUINIDIN 200 MG TABLET TAB 0 0

122 KUININ (KINA) TABLET 200 MG TAB 0 0

123 KUININ INJEKSI 25 % TAB 0 0

124 KUININ SULFAT TAB 222 MG (7 H2O) TAB 0 0

125 LANSOPRAZOL 30 MG KAPS 40 40

126 LANSOPRAZOL SIRUP PCS 0 0

127 LIDOKAIN INJ 2 % AMP 0 0

128 LIDOKAIN INJ 2 % + EPINEFRIN AMP 7 7

129 LIDOKAIN SPRAY AMP 1 1

130 LISOL DENGAN KRESOL SABUN 50 % PCS 0 0

131 LORATADIN TAB TAB 30 30

132 LOPERAMIDE TAB 180 180

133 MgSO4 20% PCS 0 0

134 MgSO4 40% PCS 0 0

135 MEBENDAZOL SIROP 100 MG/ 5 ML PCS 0 0

136 MEBENDAZOL TABLET 100 MG TAB 0 0

137 METAMPIRON TABLET 500 MG (ANTALGIN) TAB 0 0

138 METILERGOMETRIN MALEAT TABLET 0.125 MG TAB 0 0

139 METILERGOMETRIN MALEAT INJ 0.2 MG AMP 0 0

140 METILPREDNISOLON TAB 4 MG TAB 160 160

141 METILPREDNISOLON TAB16 MG TAB 0 0

142 METFORMIN TAB 500 MG TAB 0 0

143 METFORMIN TAB 850 MG TAB 0 0

144 METOKLOPRAMIDE TAB 10 MG TAB 200 200

145 MULTIVITAMIN SYR / CAMIVITA PCS 3 3

146 MULTIVITAMIN VINETRON TAB TAB 0 0

147 METRONIDAZOL TABLET 250 MG TAB 150 150

148 METRONIDAZOL TABLET 500 MG TAB 0 0

149 MIKONAZOLE KRIM TUBE 0 0

150 MIKONAZOLE BEDAK TUBE 4 4

151 MINERAL MIX PCS 0 0

152 NATRIUM DKLOFENAK TABLET 25 MG TAB 0 0

153 NATRIUM DKLOFENAK TABLET 50 MG TAB 130 130

154 NATRIUM KLORIDA LARUTAN INFUS 0.9 % PCS 0 0

155 NIPEDIFINE TAB 10 MG TAB 140 140

156 NISTATIN 500.000 IU TAB 0 0

157 NISTATIN VAGINAL TABLET TAB 0 0

158 OBAT ANTITUBERKULOSIS SISIPAN DEWASA PKT 0 0

159 OBAT ANTITUBERKULOSIS KAT 1 DEWASA PKT 0 0

160 OBAT ANTITUBERKULOSIS KAT 2 DEWASA PKT 0 0

161 OBAT ANTITUBERKULOSIS KAT ANAK PKT 0 0

162 OBAT BATUK HITAM CAIRAN PCS 0 0

163 OKSITETRASIKLIN HCL SALEP MATA 1 % TUBE 13 13

164 OKSITETRASIKLIN HCL SALEP KULIT 3 % TUBE 10 10

165 OKSITOSIN INJ 10 IU/ML AMP 0 0

166 OMEPERAZOLE KAPSUL KAPS 0 0

167 OMEPRAZOLE INJ VIAL 0 0

168 PAPAVERIN TABLET 40 MG TAB 60 60

169 PARASETAMOL DROPS PCS 4 4

170 PARASETAMOL SIROP 120 MG/ 5 ML PCS 2 2

171 PARASETAMOL TABLET 500 MG TAB 450 450

172 PENOL GLISEROL TETES TELINGA PCS 0 0

173 PEHACAIN INJ AMP 0 0


174 PIRANTEL TABLET SCORE 125 MG TAB 0 0

175 PIRANTEL SIRUP PCS 0 0

176 PIRASETAM 400 TAB 0 0

177 PIRASETAM 1200 TAB 0 0

178 PIRIDOKSIN TAB 10 MG (VIT B6) TAB 0 0

179 PIROKSIKAM TABLET 10 MG TAB 0 0

180 PIROKSIKAM TABLET 20 MG TAB 60 60

181 PITOGIN AMPUL 1 ML AMP 0 0

182 PREDNISON TABLET 5 MG TAB 900 900

183 PRIMAKUIN TABLET 15 MG TAB 0 0

184 PROPANOLOL TABLET 10 MG TAB 0 0

185 PROPILITIOURASIL TABLET 100 MG TAB 0 0

186 REGENSIA TB PKT 0 0

187 RANITIDIN TABLET 150 MG TAB 200 200

188 RANITIDIN INJ 25 MG / 2 ML AMP 0 0

189 RINGER LAKTAT INFUS PCS 0 0

190 RISPERIDON TABLET 2 MG TAB 0 0

191 SALBUTAMOL TABLET 2 MG TAB 100 100

192 SALBUTAMOL TABLET 4 MG TAB 90 90

193 SALBUTAMOL SIRUP 2 MG / 5 ML PCS 0 0

194 SALEP 2-4 KOMBINASI POT 7 7

195 SALISIL BEDAK 2 % PCS 0 0

196 SCABIMITE CREAM TUBE 3 3

197 SEFADROKSIL SIROP KERING 125 MG / 5 ML PCS 0 0

198 SEFADROKSIL KAPSUL 500 MG KAPS 160 160

199 SEFOTAKSIM 1000 MG INJ VIAL 0 0

200 SEFTRIAKSON SERBUK INJ 1000 MG VIAL 0 0

201 SIANOKOBALAMIN VIT B12 INJ 500 AMP 4 4

202 SIANOKOBALAMIN TABLET 50 MCG TAB 150 150

203 SIMVASTATIN TABLET 10 MG TAB 120 120

204 SIPROFLOKSASIN KAPLET 500 MG KAPL 190 190

205 SULFADIMIDINE TABLET 500 MG TAB 0 0

206 SULFASETAMIDA NATRIUM TETES MATA 15 % PCS 0 0

207 TABLET TAMBAH DARAH KOMBINASI TAB 0 0

208 TETRASIKLIN KAPSUL 250 MG KAPS 0 0

209 TETRASIKLIN KAPSUL 500 MG KAPS 90 90

210 TIAMIN (VIT B1) INJ 100 MG/ML AMP 0 0

211 TIAMIN (VIT B1) TABLET 50 MG TAB 230 230

212 TIURAZOL 5 MG TAB TAB 0 0

213 TRAMADOL KAPS KAPS 0 0

214 TRAMADOL INJ AMP 0 0

215 TRIHEKSIFENIDIL 25 MG TAB TAB 0 0

216 VIT A MERAH PCS 0 0

217 VIT A BIRU PCS 0 0

218 VITAMIN B KOMPLEKS TABLET TAB 350 350

219 VAKSIN RABIES VIAL 0 0

220 ZINC TAB TAB 50 50

221 ZINC SIRUP PCS 3 3

PERBEKALAN KESEHATAN

1 ALAT SUNTIK SEKALI PAKAI 0,05 ML PCS 0 0

2 ALAT SUNTIK SEKALI PAKAI 0,5 ML PCS 0 0

3 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 9 9

4 ALAT SUNTIK SEKALI PAKAI 10 ML PCS 0 0

5 ALAT SUNTIK SEKALI PAKAI 2.5 ML / 3ML PCS 3 3

6 ALAT SUNTIK SEKALI PAKAI 5 ML PCS 9 9

7 ALKOHOL SWAB PCS 0 0

8 AQUA PRO INJEKSI STERIL 25 ML PCS 0 0

9 BISTURI NO. 21 PCS 3 3

10 BISTURI NO. 20 PCS 0 0

11 BISTURI NO. 19 PCS 0 0


12 BLOOD LANCET BOX 0 0

13 CATHEJELL 12,5G PCS 0 0

14 CATGUT NO 2/0 PCS 0 0

15 CATGUT NO 3/0 PCS 0 0

16 CATGUT NO 4/0 PCS 0 0

17 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300 ml PCS 0 0

18 ETANOL 70 % 100 ml PCS 0 0

19 ETANOL 70 % 1000 ml PCS 0 0

20 FOLEY CATETER 16 PCS 0 0

21 FOLEY CATETER 18 PCS 0 0

22 FOLEY CATETER 20 PCS 0 0

23 HANDSCON STERIL 6.5 PCS 0 0

24 HANDSCON STERIL 7 PCS 0 0

25 HANDSCON STERIL 7.5 PCS 0 0

26 HANDSCON STERIL 8 PCS 2 2

27 HANDSCON NON STERIL S PCS 0 0

28 HANDSCON NON STERIL M PCS 0 0

29 HANDSCON NON STERIL L PCS 0 0

30 HANDRUB PCS 0 0

31 HEXAGON SIPILIS PCS 0 0

32 INFUSION SET ANAK PCS 0 0

33 INFUSION SET DEWASA PCS 0 0

34 IV CATHETER NO 18 G PCS 0 0

35 IV CATHETER NO 20 G PCS 0 0

36 IV CATHETER NO 22 G PCS 0 0

37 IV CATHETER NO 24 G PCS 0 0

38 JARUM HECTING PCS 0 0

39 KAPAS PEMBALUT / ABSORBEN 250 GRAM PCS 0 0

40 KASA KOMPRES 40/40 STERIL PCS 0 0

41 KASA PEMBALUT 2 M X 80 CM PCS 0 0

42 KASA PEMBALUT HIDROFIL 4 M X 5 CM ELASTIS PCS 5 5

43 KASA PEMBALUT HIDROFIL 4 M X 15 CM ELASTIS PCS 0 0

44 KASA PEMBALUT HIDROFIL 16 M X 16 CM ELASTIS PCS 2 2

45 KASA PEMBALUT HIDROFIL 40 X 80 CM PCS 0 0

46 KASA PEMBALUT HIDROFIL 36 X 80 CM PCS 0 0

47 MASKER KARET PCS 3 3

48 NASAL OXYGEN CANULA DEWASA PCS 0 0

49 NASAL OXYGEN CANULA ANAK PCS 0 0

50 NASAL OXYGEN CANULA BAYI PCS 0 0

50 PLESTER 10CM X 5M PCS 0 0

51 POVIDON IODIDA 10 % 1000 ML PCS 0 0

52 POVIDON IODIDA 10 % 300 ML PCS 0 0

53 POVIDON IODIDA 10 % 60 ML PCS 0 0

54 POVIDON IODIDA 10 % 30 ML PCS 0 0

55 POVIDON SALEP TUBE 0 0

56 POT SPUTUM POT 0 0

57 RDT MALARIA (MONO TEST) BOX 0 0

58 RDT DBD NS1 BOX 0 0

59 RDT DBD igg/iggm BOX 0 0

60 STRIP ASAM URAT PCS 0 0

61 STRIP CHOLESTEROL PCS 0 0

62 STRIP GLUKOSA PCS 0 0

63 STRIP HIV PCS 0 0

64 SILK 2/0 PCS 0 0

65 SILK 3/0 PCS 0 0

66 SILK 4/0 PCS 0 0

67 STOMACH TUBE / MAAG SLANG NO. 3,5 PCS 0 0

68 STOMACH TUBE / MAAG SLANG NO. 5 PCS 0 0

69 STOMACH TUBE / MAAG SLANG NO. 12 PCS 0 0

70 STOMACH TUBE / MAAG SLANG NO. 16 PCS 0 0

71 URIN BAG PCS 0 0


72 WING NEEDLE NO.21 PCS 0 0

73 WING NEEDLE NO.23 PCS 0 0

74 WING NEEDLE NO.25 PCS 0 0

75 WING NEEDLE NO.27 PCS 0 0

OBAT GIGI 0 0

1 COMPOSIT POSTERIOR A3 SOLARE PCS 0 0

2 COMPOSIT ANTERIOR A3 SOLARE PCS 0 0

3 COMPOSIT POSTERIOR A2 SOLARE PCS 0 0

4 COMPOSIT ANTERIOR A2 SOLARE PCS 0 0

5 EUGENOL PCS 0 0

6 FUJI IX MINI (LIBRA PERSADA) PCS 0 0

7 XYLESTESIN PCS 0 0

TAMBAHAN PCS

1 PCS

2 PCS

3 PCS

4 PCS

5 PCS

6 PCS

7 PCS

8 PCS

9 PCS

10 PCS

11 PCS

12 PCS

13 PCS

14 PCS

15 PCS

BARRO, 31 / 12 / 2019
PENANGGUNG JAWAB PELAYANA OBAT
PIMPINAN PUSTU / PKD ........................... PUSKESMAS PARANGIA

(ANUGRAH AJENG TRI UTAMI, AMD.KEB) (.........................................................................)

NIP. 19880227 201704 2 005 NIP. ..................................................................


UPTD PUSKESMAS PARANGIA
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
( LPLPO )
PUSTU / PKD : PUSTU BARRO
BULAN / TAHUN : DESEMBER / 2019

STOK JUMLAH

N
SISA

A
NO NAMA OBAT BULAN MASUK KELUAR

ET
TU
STOK

K
LALU PERMINTAAN PENERIMAAN

SA
1 2 3 4 5 6 7 8 9 10

PELAYANAN KESEHATAN DASAR


1 ACETYLCYSTEIN KAPSUL 200MG KAPS 150 150

2 ALBENDAZOL TABLET 400 MG TAB 0 0

3 ALBENDAZOL SIRUP PCS 0 0

4 ALBOTHYL KONSENTRAT PCS 0 0

5 ALOPURINOL TABLET 100 MG TAB 150 150

6 ALOPURINOL TABLET 300 MG TAB 150 150

7 AMINOFILIN INJEKSI 24 MG/ML AMP 0 0

8 AMINOFILIN TABLET 200 MG TAB 190 190

9 AMITRIPTILIN TABLET SALUT 25 MG TAB 0 0

10 AMBROKSOL TAB 30 MG TAB 77 100 20 157

11 AMBROKSOL SIRUP PCS 3 1 2

12 AMLODIPIN 5 MG TAB 0 0

13 AMLODIPIN 10 MG TAB 0 0

14 AMOKSISILIN KAPSUL 250 MG KAPL 0 0

15 AMOKSISILIN KAPLET 500 MG KAPL 110 100 20 190

16 AMOKSISILIN VIAL 1 G VIAL 0 0

17 AMOKSISILIN SIROP KERING 125 PCS 3 3 1 5

18 AMPICILIN SERBUK INJ 1 G VIAL 0 0

19 AMPICILIN KAPLET 250 MG KAPL 0 0

20 AMPICILIN KAPLET 500 MG KAPL 0 0

21 ANTASIDA DOEN I TABLET KUNYAH TAB 170 170

22 ANTASIDA DOEN II SUSPENSI PCS 3 3

23 ANTI BAKTERI DOEN SALEP KOMBINASI POT 16 16

24 ANTIFUNGI DOEN KOMBINASI POT 0 0

25 ANTIHEMOROID DOEN KOMBINASI SUPP 0 0

26 ANTIMIGREIN DOEN KOMBINASI (ERGOTAMIN) TAB 100 100

27 ARTESUNATE INJEKSI VIAL 60 MG AMP 0 0

28 ARTESUNATE DEWASA TAB 0 0

29 ASAM ASETIL SALISILAT 100 MG TAB 80 80

30 ASAM ASKORBAT 25 MG (VIT C) TAB 0 0

31 ASAM ASKORBAT 50 MG (VIT C) TAB 200 50 150

32 ASAM MEFENAMAT TABLET SALUT 500 MG TAB 0 0

33 ASIKLOVIR KRIM 5 % TUBE 0 0

34 ASIKLOVIR TABLET 200 MG TAB 0 0

35 ASIKLOVIR TABLET 400 MG TAB 190 190

36 ATROPIN TETES MATA 0.5 % PCS 0 0

37 BETAMETASON KRIM 0,1 % TUBE 14 14

38 BETAHISTIN MESILAT TAB 6 MG / HISTIGO TAB 200 200

39 BISAKODIL SUPPOSITORIA 10 MG (DULCOLAX) SUPP 0 0

40 BISAKODIL SUPPOSITORIA 5MG PED (DULCOLAX) SUPP 0 0

41 BISOPROLOL FUMARATE TAB 0 0

42 CARBAMAZEPIN TAB 200 MG TAB 0 0

43 CETIRIZINE TAB 10 MG TAB 100 30 70

44 CETIRIZINE SIRUP PCS 0 0

45 CLOBAZAM TAB 10 MG TAB 0 0

46 CLOZAPIN 25MG TAB 0 0

47 CURCUMA TAB TAB 0 0

48 DEKSAMETASON INJ 5 MG/ML AMP 0 0

49 DEKSAMETASON TABLET 0,5 MG TAB 250 50 200

50 DIAZEPAM INJ 5 MG/ML AMP 0 0

51 DIAZEPAM TABLET 2 MG TAB 0 0


52 DIAZEPAM TABLET 5 MG TAB 0 0

53 DIAZEPAM REKTAL TUBE 0 0

54 DIFENHIDRAMIN INJ 10 MG/ML AMP 0 0

55 DIGOKSIN TABLET 0,25 MG TAB 0 0

56 DILTIAZEM TAB 30 MG TAB 0 0

57 DIMENHIDRINAT TAB 50 MG TAB 90 90

58 DOMPERIDON TABLET 10 MG TAB 170 170

59 DOMPORIDON SIRUP PCS 5 5

60 DOMPERIDONE DROPS PCS 0 0

61 DOKSISIKLIN KAPSUL 100 MG KAPS 0 0

62 EKSTRAK BELLADONA TABLET 10 MG TAB 0 0

63 EPINEFRIN HCL / BITARTRAT (ADRENALIN) INJ AMP 0 0

64 ERITROMISIN KAPSUL 250 MG KAPS 0 0

65 ERITROMISIN TABLET 500 MG TAB 0 0

66 ERITROMISIN SIROP 200 MG/ 5 ML PCS 2 2

67 ETHYLIS CHLORIDUM SEMPROT PCS 0 0

68 FENOBARBITAL AMPUL 2 ML AMP 0 0

69 FENOBARBITAL TABLET 30 MG TAB 0 0

70 FITOMENADION TABLET 10 MG (VIT K) TAB 10 10

71 FITOMENADION INJ 1 MG/ML (VIT K) AMP 0 0

72 FITOMENADION INJ 10 MG/ML (VIT K) AMP 0 0

73 FUROSEMIDA TABLET 40 MG TAB 100 100

74 GARAM ORALIT 200ML AIR PCS 10 10

75 GEMFIBROZIL KAPSUL 300 MG KAPS 100 100

76 GENTAMISIN INJ 80 MG/ML AMP 0 0

77 GENTAMISIN SALEP KULIT POT 0 0

78 GENTAMISIN SULFAT TETES MATA 0,3 % POT 5 5

79 GENTIAN VIOLET 1 % PCS 0 0

80 GLIBENKLAMIDA TABLET 5 MG TAB 200 100 100

81 GLIMEPIRIDE 2 MG TAB 0 0

82 GLISERIL GUALAKOLAT TABLET 100 MG TAB 0 0

83 GLUKOSA LARUTAN INFUS 10 % PCS 0 0

84 GLUKOSA LARUTAN INFUS 40 % PCS 0 0

85 GLUKOSA LARUTAN INFUS 5 % PCS 0 0

86 GRISEOFULVIN TABLET 125 MG TAB 100 100

87 GRANTUSIF TAB 120 20 100

88 HALOPERIDOL TABLET 1.5 MG TAB 0 0

89 HALOPERIDOL DEKANOAT INJ 50MG/ML AMP 0 0

90 HALOPERIDOL INJ 5MG/ML (LODOMER) AMP 0 0

91 HIDROKLOROTIAZIDA TABLET 25 MG (HCT) TAB 0 0

92 HIDROKORTISON KRIM 2,5 % TUBE 4 4

93 HYOSIN BUTIL BROMIDA TAB 10 MG (SCOPMA) TAB 0 0

94 IBUPROFEN TABLET 200 MG TAB 0 0

95 IBUPROFEN TABLET 400 MG TAB 100 100 0

96 IBUPROFEN SIRUP 15 MG/ML PCS 3 3

97 ISONIAZID TABLET 300 MG TAB 0 0

98 ISOSORBID DINITRAT TABLET 5 MG TAB 0 0

99 KALIUM DIKLOFENAK TAB 50 MG TAB 0 0

100 KALSIUM GLUCONAS INJ AMP 0 0

101 KALSIUM LAKTAT TABLET 500 MG TAB 90 100 190

102 KAPTOPRIL 12.5 MG TAB 0 0

103 KAPTOPRIL 25 MG TAB 0 0

104 KAPTOPRIL 50 MG TAB 200 100 100

105 KETOKENAZOL TAB 200 MG TAB 350 350

106 KETOKENAZOL KRIM TUBE 0 0

107 KLONIDIN TABLET 0.15 MG TAB 0 0

108 KLORAMFENIKOL SALEP MATA 1% TUBE 0 0

109 KLORAMFENIKOL SALEP KULIT (BUFACETIN) TUBE 3 1 2

110 KLORAMFENIKOL TETES TELINGA 3 % PCS 0 0

111 KLORAMFENIKOL TETES MATA 0.5 % PCS 0 0

112 KLORAMFENIKOL SUSP 125 MG/ 5 ML PCS 0 0


113 KLORAMFENIKOL KAPSUL 250 MG KAPS 0 0

114 KLORAMFENIKOL KAPSUL 500 MG KAPS 0 0

115 KLORFENIRAMINA MALEAT TAB 4 MG (CTM) TAB 340 40 300

116 KLORPROMAZIN TAB SALUT 25 MG (CPZ) TAB 0 0

117 KLORPROMAZIN TAB SALUT 100 MG (CPZ) TAB 0 0

118 KOTRIMOKSAZOL SUSPENSI PCS 7 7

119 KOTRIMOKSAZOL DEWASA TAB 480MG TAB 180 180

120 KUINIDIN 100 MG TABLET TAB 0 0

121 KUINIDIN 200 MG TABLET TAB 0 0

122 KUININ (KINA) TABLET 200 MG TAB 0 0

123 KUININ INJEKSI 25 % TAB 0 0

124 KUININ SULFAT TAB 222 MG (7 H2O) TAB 0 0

125 LANSOPRAZOL 30 MG KAPS 40 40

126 LANSOPRAZOL SIRUP PCS 0 0

127 LIDOKAIN INJ 2 % AMP 0 0

128 LIDOKAIN INJ 2 % + EPINEFRIN AMP 7 7

129 LIDOKAIN SPRAY AMP 1 1

130 LISOL DENGAN KRESOL SABUN 50 % PCS 0 0

131 LORATADIN TAB TAB 30 30

132 LOPERAMIDE TAB 180 180

133 MgSO4 20% PCS 0 0

134 MgSO4 40% PCS 0 0

135 MEBENDAZOL SIROP 100 MG/ 5 ML PCS 0 0

136 MEBENDAZOL TABLET 100 MG TAB 0 0

137 METAMPIRON TABLET 500 MG (ANTALGIN) TAB 0 0

138 METILERGOMETRIN MALEAT TABLET 0.125 MG TAB 0 0

139 METILERGOMETRIN MALEAT INJ 0.2 MG AMP 0 0

140 METILPREDNISOLON TAB 4 MG TAB 160 50 110

141 METILPREDNISOLON TAB16 MG TAB 0 0

142 METFORMIN TAB 500 MG TAB 0 0

143 METFORMIN TAB 850 MG TAB 0 0

144 METOKLOPRAMIDE TAB 10 MG TAB 200 200

145 MULTIVITAMIN SYR / CAMIVITA PCS 3 1 2

146 MULTIVITAMIN VINETRON TAB TAB 0 100 10 90

147 METRONIDAZOL TABLET 250 MG TAB 150 150

148 METRONIDAZOL TABLET 500 MG TAB 0 0

149 MIKONAZOLE KRIM TUBE 0 0

150 MIKONAZOLE BEDAK TUBE 4 4

151 MINERAL MIX PCS 0 0

152 NATRIUM DKLOFENAK TABLET 25 MG TAB 0 0

153 NATRIUM DKLOFENAK TABLET 50 MG TAB 130 20 110

154 NATRIUM KLORIDA LARUTAN INFUS 0.9 % PCS 0 0

155 NIPEDIFINE TAB 10 MG TAB 140 140

156 NISTATIN 500.000 IU TAB 0 0

157 NISTATIN VAGINAL TABLET TAB 0 0

158 OBAT ANTITUBERKULOSIS SISIPAN DEWASA PKT 0 0

159 OBAT ANTITUBERKULOSIS KAT 1 DEWASA PKT 0 0

160 OBAT ANTITUBERKULOSIS KAT 2 DEWASA PKT 0 0

161 OBAT ANTITUBERKULOSIS KAT ANAK PKT 0 0

162 OBAT BATUK HITAM CAIRAN PCS 0 0

163 OKSITETRASIKLIN HCL SALEP MATA 1 % TUBE 13 13

164 OKSITETRASIKLIN HCL SALEP KULIT 3 % TUBE 10 10

165 OKSITOSIN INJ 10 IU/ML AMP 0 0

166 OMEPERAZOLE KAPSUL KAPS 0 0

167 OMEPRAZOLE INJ VIAL 0 0

168 PAPAVERIN TABLET 40 MG TAB 60 60

169 PARASETAMOL DROPS PCS 4 4

170 PARASETAMOL SIROP 120 MG/ 5 ML PCS 2 1 1

171 PARASETAMOL TABLET 500 MG TAB 450 250 200

172 PENOL GLISEROL TETES TELINGA PCS 0 0

173 PEHACAIN INJ AMP 0 0


174 PIRANTEL TABLET SCORE 125 MG TAB 0 0

175 PIRANTEL SIRUP PCS 0 0

176 PIRASETAM 400 TAB 0 0

177 PIRASETAM 1200 TAB 0 0

178 PIRIDOKSIN TAB 10 MG (VIT B6) TAB 0 0

179 PIROKSIKAM TABLET 10 MG TAB 0 0

180 PIROKSIKAM TABLET 20 MG TAB 60 10 50

181 PITOGIN AMPUL 1 ML AMP 0 0

182 PREDNISON TABLET 5 MG TAB 900 80 820

183 PRIMAKUIN TABLET 15 MG TAB 0 0

184 PROPANOLOL TABLET 10 MG TAB 0 0

185 PROPILITIOURASIL TABLET 100 MG TAB 0 0

186 REGENSIA TB PKT 0 0

187 RANITIDIN TABLET 150 MG TAB 200 200

188 RANITIDIN INJ 25 MG / 2 ML AMP 0 0

189 RINGER LAKTAT INFUS PCS 0 0

190 RISPERIDON TABLET 2 MG TAB 0 0

191 SALBUTAMOL TABLET 2 MG TAB 100 100

192 SALBUTAMOL TABLET 4 MG TAB 90 90

193 SALBUTAMOL SIRUP 2 MG / 5 ML PCS 0 0

194 SALEP 2-4 KOMBINASI POT 7 7

195 SALISIL BEDAK 2 % PCS 0 0

196 SCABIMITE CREAM TUBE 3 3

197 SEFADROKSIL SIROP KERING 125 MG / 5 ML PCS 0 0

198 SEFADROKSIL KAPSUL 500 MG KAPS 160 30 130

199 SEFOTAKSIM 1000 MG INJ VIAL 0 0

200 SEFTRIAKSON SERBUK INJ 1000 MG VIAL 0 0

201 SIANOKOBALAMIN VIT B12 INJ 500 AMP 4 4

202 SIANOKOBALAMIN TABLET 50 MCG TAB 150 10 140

203 SIMVASTATIN TABLET 10 MG TAB 120 120

204 SIPROFLOKSASIN KAPLET 500 MG KAPL 190 190

205 SULFADIMIDINE TABLET 500 MG TAB 0 0

206 SULFASETAMIDA NATRIUM TETES MATA 15 % PCS 0 0

207 TABLET TAMBAH DARAH KOMBINASI TAB 0 0

208 TETRASIKLIN KAPSUL 250 MG KAPS 0 0

209 TETRASIKLIN KAPSUL 500 MG KAPS 90 90

210 TIAMIN (VIT B1) INJ 100 MG/ML AMP 0 0

211 TIAMIN (VIT B1) TABLET 50 MG TAB 230 230

212 TIURAZOL 5 MG TAB TAB 0 0

213 TRAMADOL KAPS KAPS 0 0

214 TRAMADOL INJ AMP 0 0

215 TRIHEKSIFENIDIL 25 MG TAB TAB 0 0

216 VIT A MERAH PCS 0 0

217 VIT A BIRU PCS 0 0

218 VITAMIN B KOMPLEKS TABLET TAB 350 10 340

219 VAKSIN RABIES VIAL 0 0

220 ZINC TAB TAB 50 100 10 140

221 ZINC SIRUP PCS 3 3

PERBEKALAN KESEHATAN

1 ALAT SUNTIK SEKALI PAKAI 0,05 ML PCS 0 0

2 ALAT SUNTIK SEKALI PAKAI 0,5 ML PCS 0 0

3 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 9 9

4 ALAT SUNTIK SEKALI PAKAI 10 ML PCS 0 0

5 ALAT SUNTIK SEKALI PAKAI 2.5 ML / 3ML PCS 3 3

6 ALAT SUNTIK SEKALI PAKAI 5 ML PCS 9 9

7 ALKOHOL SWAB PCS 0 0

8 AQUA PRO INJEKSI STERIL 25 ML PCS 0 0

9 BISTURI NO. 21 PCS 3 3

10 BISTURI NO. 20 PCS 0 0

11 BISTURI NO. 19 PCS 0 0


12 BLOOD LANCET BOX 0 0

13 CATHEJELL 12,5G PCS 0 0

14 CATGUT NO 2/0 PCS 0 0

15 CATGUT NO 3/0 PCS 0 0

16 CATGUT NO 4/0 PCS 0 0

17 ETAKRIDIN (RIVANOL) LARUTAN 0,1 % 300 ml PCS 0 0

18 ETANOL 70 % 100 ml PCS 0 0

19 ETANOL 70 % 1000 ml PCS 0 0

20 FOLEY CATETER 16 PCS 0 0

21 FOLEY CATETER 18 PCS 0 0

22 FOLEY CATETER 20 PCS 0 0

23 HANDSCON STERIL 6.5 PCS 0 0

24 HANDSCON STERIL 7 PCS 0 0

25 HANDSCON STERIL 7.5 PCS 0 0

26 HANDSCON STERIL 8 PCS 2 5 2 5

27 HANDSCON NON STERIL S PCS 0 0

28 HANDSCON NON STERIL M PCS 0 0

29 HANDSCON NON STERIL L PCS 0 0

30 HANDRUB PCS 0 0

31 HEXAGON SIPILIS PCS 0 0

32 INFUSION SET ANAK PCS 0 0

33 INFUSION SET DEWASA PCS 0 0

34 IV CATHETER NO 18 G PCS 0 0

35 IV CATHETER NO 20 G PCS 0 0

36 IV CATHETER NO 22 G PCS 0 0

37 IV CATHETER NO 24 G PCS 0 0

38 JARUM HECTING PCS 0 0

39 KAPAS PEMBALUT / ABSORBEN 250 GRAM PCS 0 0

40 KASA KOMPRES 40/40 STERIL PCS 0 0

41 KASA PEMBALUT 2 M X 80 CM PCS 0 0

42 KASA PEMBALUT HIDROFIL 4 M X 5 CM ELASTIS PCS 5 10 5 10

43 KASA PEMBALUT HIDROFIL 4 M X 15 CM ELASTIS PCS 0 0

44 KASA PEMBALUT HIDROFIL 16 M X 16 CM ELASTIS PCS 2 5 2 5

45 KASA PEMBALUT HIDROFIL 40 X 80 CM PCS 0 0

46 KASA PEMBALUT HIDROFIL 36 X 80 CM PCS 0 0

47 MASKER KARET PCS 3 3 0

48 NASAL OXYGEN CANULA DEWASA PCS 0 0

49 NASAL OXYGEN CANULA ANAK PCS 0 0

50 NASAL OXYGEN CANULA BAYI PCS 0 0

50 PLESTER 10CM X 5M PCS 0 1 1

51 POVIDON IODIDA 10 % 1000 ML PCS 0 0

52 POVIDON IODIDA 10 % 300 ML PCS 0 0

53 POVIDON IODIDA 10 % 60 ML PCS 0 0

54 POVIDON IODIDA 10 % 30 ML PCS 0 0

55 POVIDON SALEP TUBE 0 0

56 POT SPUTUM POT 0 0

57 RDT MALARIA (MONO TEST) BOX 0 0

58 RDT DBD NS1 BOX 0 0

59 RDT DBD igg/iggm BOX 0 0

60 STRIP ASAM URAT PCS 0 0

61 STRIP CHOLESTEROL PCS 0 0

62 STRIP GLUKOSA PCS 0 0

63 STRIP HIV PCS 0 0

64 SILK 2/0 PCS 0 0

65 SILK 3/0 PCS 0 0

66 SILK 4/0 PCS 0 0

67 STOMACH TUBE / MAAG SLANG NO. 3,5 PCS 0 0

68 STOMACH TUBE / MAAG SLANG NO. 5 PCS 0 0

69 STOMACH TUBE / MAAG SLANG NO. 12 PCS 0 0

70 STOMACH TUBE / MAAG SLANG NO. 16 PCS 0 0

71 URIN BAG PCS 0 0


72 WING NEEDLE NO.21 PCS 0 0

73 WING NEEDLE NO.23 PCS 0 0

74 WING NEEDLE NO.25 PCS 0 0

75 WING NEEDLE NO.27 PCS 0 0

OBAT GIGI 0 0

1 COMPOSIT POSTERIOR A3 SOLARE PCS 0 0

2 COMPOSIT ANTERIOR A3 SOLARE PCS 0 0

3 COMPOSIT POSTERIOR A2 SOLARE PCS 0 0

4 COMPOSIT ANTERIOR A2 SOLARE PCS 0 0

5 EUGENOL PCS 0 0

6 FUJI IX MINI (LIBRA PERSADA) PCS 0 0

7 XYLESTESIN PCS 0 0

TAMBAHAN PCS

1 PCS

2 PCS

3 PCS

4 PCS

5 PCS

6 PCS

7 PCS

8 PCS

9 PCS

10 PCS

11 PCS

12 PCS

13 PCS

14 PCS

15 PCS

BARRO, 15 / 12 / 2019
PENANGGUNG JAWAB PELAYANA OBAT
PIMPINAN PUSTU / PKD ........................... PUSKESMAS PARANGIA

(ANUGRAH AJENG TRI UTAMI, AMD.KEB) (.........................................................................)

NIP. 19880227 201704 2 005 NIP. ..................................................................