LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

(LPLPO)

Kode Puskesmas : 3517603 Bulan Jan - Des

Puskesmas : Blimbing Kesamben Tahun : 2019
Kecamatan : Kesamben
Kabupaten : Jombang
Provinsi : Jawa Timur

Pemberian
Kelas Stok Peneri Persedi Pemak Pemakaia Sisa Stok Permin
No Nama Obat & Perbekalan Kesehatan Satuan KET ED
terapi Awal maan aan aian n Rata2 Stok Opt taan I Askes APBD Lain2 Jumlah

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 28
OBAT
1 Albendazol tablet 400 mg tablet 6.1.1 0 5,790 5,790 5,670 2,835 120 8,505 100
3 Alopurinol tablet 100 mg tablet 1 2,178 4,600 6,778 3,613 301 3,165 903 2,000
5 Aminofilin tablet 200 mg tablet 26 0 1,000 1,000 115 19 885 -455 885
6 Aminofilina injeksi 24 mg/ml - 10 ml ampul 26 29 5 34 29 0 5 -5 29
7 Amitriptilin HCl tablet salut 25 mg tablet 23 780 900 1,680 830 69 850 -593
8 Amlodipin tablet 5 mg tablet 1,494 900 2,394 2,014 168 380 54
9 Amoksisilin kaplet 500 mg kaplet 6 0 42,000 42,000 19,806 2,201 22,194 -9,398 3,000
11 Amoksisilin sirup kering 125 mg/5ml botol 6 0 0 0 0 0 0
16 Antasida DOEN suspensi botol 25 0 300 300 155 39 145 66 100
17 Antasida DOEN tab,kombinasi:Mg-Hidroksida 200mg+tablet 25 3,370 12,300 15,670 10,557 880 5,113 1,939 3,500
18 Anti Bakteri DOEN salep kombinasi:Basitrasin 500 IU tube 18 0 0 0 0 0 0
19 Anti Hemoroid DOEN Kombinasi supp 25 50 0 50 26 2 24 -14
20 Antifungi DOEN Kombinasi:Asam Benzoat 6% + Asam pot 18 22 48 70 35 3 35 6 24
21 Antimigren:Ergotamin Tartrat 1 mg + Kofein 50 mg tablet 7 0 0 0 0 0 0 100
23 Aqua pro Injeksi steril 25 ml, bebas pirogen vial 20 236 120 356 65 5 291 -284
24 Aquadest steril 500 ml botol 30 6 6 2 0 4 -4
29 Asam Askorbat (Vit C) tablet 50 mg tablet 29 7,825 8,000 15,825 10,773 898 5,052 -907 1,000
30 Asam Mefenamat tablet salut selaput 500 mg tablet 3,848 38,800 42,648 28,178 2,348 14,470 1,045 7,000
Asam Asetilsalisilat (Asetosal) 80 mg tablet 0 100 100 0 0 100 -100
34 Asiklovir krim 5% tube 0 0 0 0 0 0
35 Asiklovir tablet 400 mg tablet 438 200 638 354 30 284 -112
36 Atapulgit tablet 600 mg tablet 396 2,800 3,196 1,947 162 1,249 87 500
37 Atropin injeksi im/iv/sk 0,25 mg/ml - 1 ml ( Sulfat ) vial 25 7 7 0 0 7 -2
38 Atropin Sulfat tablet 0,5 mg tablet 25 0 0 0 0 0 0
39 Bekarbon tablet tablet 0 0 0 0 0 0
42 Betametason krim 0,5 mg/g tube 70 150 220 178 15 42 -6
43 Bisacodyl suppositoria 10 mg dewasa suppo 0 0 0 0 0 0
44 Bisacodyl supposituria anak suppo 0 0 0 0 0 0
45 Bisacodyl tab. 5 mg ampul 0 100 100 0 0 100 -100
48 Deksametason injeksi iv. 5 mg/ml - 1 ml ampul 3 10 30 40 0 0 40 -32
49 Deksametason tablet 0,5 mg tablet 16 9,286 11,000 20,286 13,689 1,141 6,597 1,922 3,000
50 Dekstran 70 - larutan infus 6% steril botol 11 0 0 0 0 0 0
54 Diazepam lar rektal 10mg/ 2,5 ml (Stesolid) tube 5 0 0 0 0 0 0
55 Diazepam tablet 2 mg tablet 5 100 1,400 1,500 1,500 150 0 450
56 Diazepam tablet 5 mg tablet 5 0 0 0 0 0 0
57 Dietilkarbamazin Sitrat ta.100 mg tablet 6.1.2 0 0 0 0 0 0
58 Difenhidramin inj im.10 mg/ml-1 ml ( HCl ) ampul 3 22 30 52 22 0 30 -29 19
59 Digoksin tablet 0,25 mg tablet 18 599 310 909 620 35 289 -295 200
60 Dimenhidrinat tablet 50 mg tablet 657 2,300 2,957 1,987 166 970 97 500
61 Domperidon tablet 10 mg tablet 249 1,800 2,049 1,045 87 1,004 -39 300
64 Epinefrina ( Adrenalina ) Injeksi 0,1% - 1 ml ( HCl ) ampul 3 19 6 25 6 1 19 -5
65 Erytromycin kapsul 500 mg tablet 1,309 9,500 10,809 3,413 379 7,396 -562 10,000
66 Erytromycin kapsul 250 mg tablet 0 0 0 0 0 0
67 Erytromycin sirup 200 mg/5 ml botol 0 0 0 0 0 0
68 Etakridin ( Rivanol ) larutan 0,1% botol 6.2.4 0 0 0 0 0 0
69 Etanol 70% botol 6.2.4 667 300 967 967 17 0 50 768
71 Fenitoin Natrium kapsul 100 mg kapsul 5 1,400 1,400 0 0 1,400 -1,400
Fenol Gliserol tetes telinga 10% 0 0 0 0 0 0
77 Fitomenadion (Vit.K1) injeksi 2 mg/ml - 1 ml ampul 10 0 60 60 60 7 0 20
78 Fitomenadion (Vit.K1) tablet salut gula 10 mg tablet 10 177 100 277 138 12 139 -66
81 Furosemid tablet 40 mg tablet 14 325 1,000 1,325 462 46 863 -261
83 Garam Oralit untuk 200 ml air sak 20 793 4,200 4,993 3,509 170 1,484 -790 1640
88 Glibenklamid tablet 5 mg tablet 16.1.1 1,024 7,600 8,624 4,935 449 3,689 1,346 3,000
Glimepirid tab 1 mg tablet 0 500 500 200 0 300 0
Grisiofulvin 125 mg Mikronize tablet 0 2,000 2,000 160 0 1,840 -1,500
91 Glukosa larutan infus 5 % botol 20 6 0 6 6 0 0 -6 6
93 Haldol Decanoat 50 mg/ml inj ampul 40 80 120 100 14 20 23 30
94 Haloperidol 5mg/ml inj ampul 23 0 0 0 0 0 0 0
95 Haloperidol tablet 0,5 mg tablet 23 384 5,100 5,484 3,934 328 1,550 984 1,500
96 Haloperidol tablet 1,5 mg tablet 23 0 0 0 0 0 0
97 Haloperidol tablet 5 mg tablet 23 1,500 7,400 8,900 6,165 514 2,735 541 1,000
98 Hidrogen Peroksida cairan 3% botol 0 0 0 0 0 0 6
100 Hidrokortison krim 2,5 % tube 18 46 120 166 118 10 48 30 48
104 Isosorbid Dinitrat tablet sublingual 5 mg tablet 17 0 300 300 0 0 300 0 100
105 Kalium Permanganat serbuk botol 13 8 8 0 0 8 -8
106 Kalsium Glukonat inj 100mg/ml / Ca Gluconas botol 7 7 0 0 7 -5
107 Kalsium Laktat (Kalk) tablet 500 mg tablet 29 3,545 16,400 19,945 16,359 1,363 3,586 3,090 2,000
108 Kaptopril tablet 25 mg tablet 2,062 3,200 5,262 4,385 365 877 696
110 Karbamazepin tablet 200 mg tablet 1,210 3,700 4,910 3,575 260 1,335 279 1,000 460
Karbogliserin tts telinga 10% botol 0 24 24 5 0 19 0
112 Ketokonazol tablet 200 mg ampul 300 300 43 4 257 11
Ketoprofen supp supp 10 10 2 0 8 -8
114 Kloramfenikol kapsul 250 mg kapsul 6.2.2 1,000 1,000 1,000 83 0 250 3,000
115 Kloramfenikol salep mata 1 % tube 21 60 144 204 178 15 26 24
116 Kloramfenikol suspensi 125 mg/5 ml botol 50 550 600 398 33 202 25 100
Kloramfenikol salep kulit 96 96 11 2 85 -43
119 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 3 6,547 23,900 30,447 20,647 1,721 9,800 962 5,000
122 Klorpromazin HCl tablet salut 100 mg(HCl) tablet 25 2,099 2,900 4,999 2,104 160 2,895 -2,421 187
124 Kodein tablet 10 mg tablet 26 190 300 490 190 16 300 -53 200
128 Kotrimoksazol Suspensi komb: Sulfametoksazol 200 botol 6.2.2 92 92 92 46 0 138
Loratadin tablet 10 mg tablet 100 100 0 0 100 -100
129 Kotrimoksazol tablet kombinasi: Sulfametoksazol 4 tablet 6.2.2 6,830 6,830 6,830 231 0 693 5445
134 Lidokain komp. injeksi, Kombinasi:Lidokain HCl 2% + ampul 14 286 286 121 10 165 -120
135 Lisol, mengandung Kresol tersabun 50% botol 13 0 0 0 0 0 0
138 Magnesium Sulfat injeksi (iv) 40 % - 25 ml ampul 5 7 7 3 0 4 -2
140 Metformin HCl tablet 500 mg tablet 2,942 5,500 8,442 4,712 258 3,730 -227 1,500 1620
141 Metilergometrin Maleat (Metilergometrin) tablet sa tablet 22 300 200 500 300 18 200 -145 100
142 Metilergometrin Maleat inj 0,200 mg-1 ml ampul 22 30 30 30 3 0 -18
145 Metronidazol tablet 250 mg tablet 6.2.2 0 0 0 0 0 0 0
146 Metronidazol tablet 500 mg tablet 6.2.2 142 142 142 36 0 107 1,000
147 Mikonazol cream tube 73 120 193 113 19 80 22 57
Mineral mix 14,400 14,400 14,400 0 0 0 0
N- Asetilsistein tablet 0 14,000 14,000 2,401 200 11,599 -4,400 5,000
150 Natrium Diklofenak tablet 50 mg tablet 0 5,800 5,800 2,679 447 3,121 390 1,000
151 Natrium Klorida larutan infus 0,9 % steril botol 20 18 18 6 1 12 -11
152 Nifedipin tablet 10 mg tablet 1,873 1,873 1,873 375 0 1,124
153 Nistatin tablet salut 500.000 IU/g tablet 0 0 0 0 0 0
154 Nistatin tablet vaginal 100.000 IU/g tablet 6 73 73 18 2 55 5
159 Oksitosin injeksi 10 IU/ml - 1 ml ampul 22 0 40 40 40 1 0 3 30
161 Omeprazol kapsul 20 mg kapsul 0 600 600 178 178 422 234
162 Parasetamol sirup 120 mg/5 ml botol 1 309 950 1,259 1,041 87 218 260 320
164 Parasetamol tablet 500 mg tablet 1 13,470 38,500 51,970 36,928 3,077 15,042 4,532 10,000
168 Piridoksin (Vit.B6) tablet 10 mg ( HCl ) tablet 29 4,396 21,200 25,596 19,333 1,611 6,263 1,833 5,000
169 Piroksikam tablet 20 mg tablet 0 0 0 0 0 0
172 Povidon Iodida 10 %, 300 ml botol 15 3 18 5 0 13 -13
173 Prednison tablet 5 mg tablet 16 795 7,500 8,295 5,506 459 2,789 -324
175 Propanolol tablet 10 mg (HCl) tablet 7 763 200 963 351 29 612 -112 100
179 Ranitidin tablet 150 mg tablet 0 0 0 0 0 0
181 Ringer Laktat larutan infus steril botol 20 10 20 30 18 2 12 -8
182 Risperidon 2 mg tablet 220 220 220 220 0 660 5,000
183 Salbutamol 2,5 mg respulles (Komb Ipratropium B ampul 26 49 80 129 89 8 40 -16 40
185 Salbutamol tablet 2 mg ( sebagai sulfat ) tablet 26 614 1,300 1,914 1,281 107 633 120 300
187 Salep 2-4 , Kombinasi:Asam Salisilat 2% + Belerang pot 18 36 216 252 161 13 91 -17
188 Salisil Bedak 2 % kotak 19 3 3 3 2 0 5
190 Sefadroksil kapsul 500 mg kapsul 0 0 0 0 0 0 7,000
191 Sefadroksil sirup kering 125 mg/ 5 ml botol 0 0 0 0 0 0 50
198 Simvastatin tablet 10 mg tablet 1,905 8,400 10,305 2,887 241 7,418 -2,698 1,000
199 Siprofloksasin tablet 500 mg (sebagai HCl) tablet 0 0 0 0 0 0 5,000
204 Tiamfenikol kapsul 500 mg kapsul 1,960 1,960 1,960 653 0 1,960 5,000
205 Tiamin (Viamin B1) tablet 50 mg (HCl / Mononitrat ) tablet 29 4,665 16,200 20,865 20,865 1,739 0 5,216 7,000
209 Trifluoperazine tablet 5 mg tablet 0 0 0 0 0 0 5,000
210 Triheksifenidil Hidroklorida tablet 2 mg tablet 9 1,150 8,100 9,250 9,250 771 0 2,313 5,000
211 Vitamin B Kompleks tablet tablet 29 3,127 29,000 32,127 27,070 2,256 5,057 6,368 7,000
213 Zinc tablet 20 mg tablet 400 200 600 350 29 250 -113
0
PERBEKALAN KESEHATAN 0
214 Alat suntik sekali pakai 1 ml set 32 300 700 1,000 1,000 83 0 150 500
215 Alat suntik sekali pakai 2,5 ml/3 ml set 32 0 0 0 0 0 0 1,000
216 Alat suntik sekali pakai 5 ml set 32 170 170 5 0 165 -169
220 Catgut / Benang Bedah No. 2/0 - 3/0 dengan jarum biji 32 0 0 0 0 0 0 10
221 Catgut / Benang Bedah No. 3/0 plain biji 32 0 0 0 0 0 0 10
222 Catgut / Benang Bedah No. 3/0 chromic biji 0 0 0 0 0 0 10
225 Hansaplast biji 0 0 0 0 0 0 0
226 Hands shoen non steril No. 7 biji 0 0 0 0 0 0 500
227 Hands shoen steril No. 7 pasang 0 0 0 0 0 0 0
229 Infusion set dewasa set 4 4 4 0 0 1 10
230 IV Catether No. 18 set 0 0 0 0 0 0 10
231 IV Catether No. 20 set 0 0 0 0 0 0 10
232 IV Catether No. 22 set 0 0 0 0 0 0 0
234 Jarum jahit bedah No. 9 s/d 14 biji 0 0 0 0 0 0 1
236 Kapas Pembalut / Absorben 250 gram bungkus 4 4 4 1 0 2 10
238 Kasa Pembalut 2 m x 80 cm biji 0 0 0 0 0 0 10
242 Kasa Pembalut Hidrofil 4 m x 3 cm hidrofil/elastic rol 80 30 110 80 7 30 10 30
243 Kasa Pembalut Hidrofil 4 m x 15 cm hidrofil/elastic rol 0 0 0 0 0 0 30
244 Kasa Steril 16 x 16 cm rol 531 480 1,011 435 36 576 -291 160
247 Masker biji 0 0 0 0 0 0 150
250 Plester 5 yards x 2 inch roll 0 0 0 0 0 0 6
251 Silk (Benang Bedah Sutera) No. 3/0 dengan jarum b biji 0 0 0 0 0 0 10

REAGEN LABORATORIUM
284 Reagen RPR Syphilis/Titer (Plasmatec/RPR tes kit, R set 200 200 0 0 200 -200
285 Rapid Syphilis/ Standar Diagnostic (Alere) Bioline 0 0 0 0 0 0 0
Reagen HBSAg (Fokus) 500 500 200 29 300 -14 500
Human Hexagon Syphilis 200 200 100 14 100 -57 500
Reagen HIV R1 (Standart Diagnostic) 500 500 200 25 300 75 500
Iodina Test 16 -16 0 16 0 10

OBAT GIGI
286 Dentorit botol 14 0 0 0 0 0 0 2
287 Etil Klorida spray botol 14 0 0 0 0 0 0 6
288 Eugenol cairan botol 14 4 3 7 6 1 1 1
289 Fluor tablet 0,5 mg tablet 14 0 0 0 0 0 0 0
290 Glass Ionomer Cement ART set 14 0 4 4 1 0 3 0 5
291 Kalsium Hidroksida Pasta set 14 0 0 0 0 0 0 2
292 Monochlorkamfer mentol ( CHKM ) botol 14 4 3 7 7 2 0 5
293 Mummifying Pasta botol 0 0 0 0 0 0 2
294 Povidon Iodine obat kumur botol 0 0 0 0 0 0 6
295 Semen Seng Fosfat serbuk dan cairan botol 0 0 0 0 0 0 1
296 Silver Amalgam serbuk 65 - 75 % botol 0 0 0 0 0 0 1
297 Temporary Stopping Fletcher (Fletcher) serbuk dan botol 0 0 0 0 0 0 1
298 Tri Kresol Formalin botol 0 0 0 0 0 0 1

OBAT PROGRAM
Gizi :
300 Retinol Kapsul ( Vitamin A ) 100.000 IU kapsul 0 2,050 2,050 2,050 171 0 513 513
301 Retinol kapsul ( Vitamin A ) 200.000 IU kapsul 0 3,450 3,450 3,450 288 0 863 863
302 Tablet Tambah Darah ( TTD ) tablet ### 11,200 130,065 130,065 10,839 0 32,516 32,516
Anti Lepra : 0
304 MB Anak blister 0 0 0 0 0 0 0
305 MB Dewasa blister 3 42 45 33 17 12 50 12
306 PB Anak blister 0 0 0 0 0 0 0
307 PB Dewasa blister 0 0 0 0 0 0 0
Anti TBC : 0
316 Ethambutol tablet 400 mg tablet 0 0 0 0 0 0 0
317 Ethambutol tablet 500 mg tablet 0 0 0 0 0 0 0
318 FDC KIT I / III paket 5 28 33 27 5 6 13 16
319 FDC kit II paket 0 3 3 3 1 0 3
0

UMUM JKN
JAMKE
NON jumlah R/
JUMLAH KUNJUNGAN RESEP BAYAR GRATIS PBI SDA
PBI

Jombang, 26 Desember 2019

Mengetahui
Kepala Puskesmas Blimbing Kesamben Pengelola Obat Puskesmas Blimbing Kes

MUCHTAR EFFENDY MUSABBIHAH

NIP. 197103132000031004 NIP. 19650510 198603 2 026
KOSONG

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 LAPORAN PEMAKAIAN DAN LEMBAR PERMINT
(LPLPO)

Kode Puskesmas : 3517603

Puskesmas : Blimbing Kesamben
Kecamatan : Kesamben
Kabupaten : Jombang
Provinsi : Jawa Timur

Kelas Stok Peneri Persed Pemak

No Nama Obat & Perbekalan Kesehatan Satuan
terapi Awal maan iaan aian

1 2 3 4 5 6 7
OBAT
1 Albendazol tablet 400 mg tablet 6.1.1 120 0 120 0
2 Alopurinol tablet 100 mg tablet 1 3,165 0 3,165 175
3 Aminofilin tablet 200 mg tablet 26 885 0 885 0
4 Aminofilina injeksi 24 mg/ml - 10 ml ampul 26 5 0 5 0
5 Amitriptilin HCl tablet salut 25 mg tablet 23 850 0 850 45
6 Amlodipin tablet 5 mg tablet 380 0 380 268
7 Amoksisilin kaplet 500 mg kaplet 6 22,194 0 22,194 1,680
8 Amoksisilin sirup kering 125 mg/5ml botol 6 0 0 0 0
9 Antasida DOEN suspensi botol 25 145 0 145 40
10 Antasida DOEN tab,kombinasi:Mg-Hidroksida 200mg+tablet 25 5,113 0 5,113 976
11 Anti Bakteri DOEN salep kombinasi:Basitrasin 500 IU tube 18 0 0 0 0
12 Anti Hemoroid DOEN Kombinasi supp 25 17 0 17 0
13 Antifungi DOEN Kombinasi:Asam Benzoat 6% + Asam pot 18 35 0 35 4
14 Antimigren:Ergotamin Tartrat 1 mg + Kofein 50 mg tablet 7 0 0 0 0
15 Aqua pro Injeksi steril 25 ml, bebas pirogen vial 20 291 0 291 7
16 Aquadest steril 500 ml botol 30 4 0 4 1
17 Asam Askorbat (Vit C) tablet 50 mg tablet 29 5,052 0 5,052 987
18 Asam Mefenamat tablet salut selaput 500 mg tablet 14,470 0 14,470 2,512
19 Asam Asetilsalisilat (Asetosal) 80 mg tablet 100 0 100 0
20 N- Asetilsistein tablet 11,599 0 11,599 2,242
21 Asiklovir krim 5% tube 0 0 0 0
22 Asiklovir tablet 400 mg tablet 284 0 284 0
23 Atapulgit tablet 600 mg tablet 1,249 0 1,249 633
24 Atropin injeksi im/iv/sk 0,25 mg/ml - 1 ml ( Sulfat ) vial 25 7 0 7 0
25 Atropin Sulfat tablet 0,5 mg tablet 25 0 0 0 0
26 Bekarbon tablet tablet 0 0 0 0
27 Betametason krim 0,5 mg/g tube 42 0 42 10
28 Bisacodyl suppositoria 10 mg dewasa suppo 0 0 0
29 Bisacodyl supposituria anak suppo 0 0 0 0
30 Bisacodyl tab. 5 mg ampul 100 0 100 0
31 Captopril tablet 25 mg tablet 3,586 0 3,586 3,486
32 Deksametason injeksi iv. 5 mg/ml - 1 ml ampul 3 40 0 40 0
33 Deksametason tablet 0,5 mg tablet 16 6,597 0 6,597 1,125
34 Dekstran 70 - larutan infus 6% steril botol 11 0 0 0 0
35 Diazepam injeksi 5 mg/ml - 2 ml 0 0 0 0
36 Diazepam lar rektal 10mg/ 2,5 ml (Stesolid) tube 5 0 0 0 0
37 Diazepam tablet 2 mg tablet 5 0 0 0 0
38 Diazepam tablet 5 mg tablet 5 0 0 0 0
39 Dietilkarbamazin Sitrat ta.100 mg tablet 6.1.2 0 0 0 0
40 Difenhidramin inj im.10 mg/ml-1 ml ( HCl ) ampul 3 30 0 30 0
41 Digoksin tablet 0,25 mg tablet 18 289 0 289 0
42 Dimenhidrinat tablet 50 mg tablet 970 0 970 249
43 Domperidon tablet 10 mg tablet 1,004 0 1,004 510
44 Epinefrina ( Adrenalina ) Injeksi 0,1% - 1 ml ( HCl ) ampul 3 19 0 19 0
45 Erytromycin kapsul 500 mg tablet 7,396 0 7,396 509
46 Erytromycin kapsul 250 mg tablet 0 0 0 0
47 Erytromycin sirup 200 mg/5 ml botol 0 0 0 0
48 Etakridin ( Rivanol ) larutan 0,1% botol 6.2.4 0 0 0 0
49 Etanol 70% botol 6.2.4 0 0 0 0
50 Fenitoin Natrium kapsul 100 mg kapsul 5 1,400 0 1,400 0
51 Fenol Gliserol tetes telinga 10% 0 0 0 0
52 Fitomenadion (Vit.K1) injeksi 2 mg/ml - 1 ml ampul 10 0 0 0 0
53 Fitomenadion (Vit.K1) tablet salut gula 10 mg tablet 10 139 0 139 15
54 Furosemid tablet 40 mg tablet 14 863 0 863 91
55 Garam Oralit untuk 200 ml air sak 20 1,484 0 1,484 73
56 Glibenklamid tablet 5 mg tablet 16.1.1 3,689 0 3,689 464
57 Glimepirid tab 1 mg tablet 300 0 300 160
58 Grisiofulvin 125 mg Mikronize tablet 1,840 0 1,840 282
59 Glukosa larutan infus 5 % botol 20 0 0 0 0
60 Haldol Decanoat 50 mg/ml inj ampul 20 0 20 20
61 Haloperidol 5mg/ml inj ampul 23 0 0 0 0
62 Haloperidol tablet 0,5 mg tablet 23 1,550 0 1,550 460
63 Haloperidol tablet 1,5 mg tablet 23 0 0 0 0
64 Haloperidol tablet 5 mg tablet 23 2,735 0 2,735 455
65 Hidrogen Peroksida cairan 3% botol 0 0 0 0
66 Hidrokortison krim 2,5 % tube 18 48 0 48 3
67 Ibuprofen suspensi 100mg/ 5 ml botol 1 0 0 0 0
68 Ibuprofen tablet 200 mg tablet 1 0 0 0 0
69 Ibuprofen tablet 400 mg tablet 1 0 0 0 0
70 Isosorbid Dinitrat tablet sublingual 5 mg tablet 17 300 0 300 0
71 Kalium Permanganat serbuk botol 13 8 0 8 0
72 Kalsium Glukonat inj 100mg/ml / Ca Gluconas botol 7 0 7 0
73 Kalsium Laktat (Kalk) tablet 500 mg tablet 29 3,586 0 3,586 1,369
74 Karbamazepin tablet 200 mg tablet 1,335 0 1,335 435
76 Karbogliserin tts telinga 10% botol 19 0 19 8
77 Ketokonazol tablet 200 mg ampul 257 0 257 0
78 Ketoprofen supp supp 8 0 8 0
79 Kloramfenikol kapsul 250 mg kapsul 6.2.2 0 0 0 0
80 Kloramfenikol salep mata 1 % tube 21 26 0 26 26
81 Kloramfenikol suspensi 125 mg/5 ml botol 202 0 202 66
82 Kloramfenikol tetes mata 1 % botol 0 0 0 ###
83 Kloramfenikol tetes telinga 3 % botol 0 0 0 0
84 Kloramfenikol salep kulit 85 0 85 0
85 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 3 9,800 0 9,800 1,723
86 Klorpromazin injeksi 25 mg/ml - 1 ml ( HCl ) ampul 25 0 0 0 0
87 Klorpromazin injeksi 5 mg/ml - 1 ml ( HCl ) ampul 25 0 0 0 0
88 Klorpromazin HCl tablet salut 100 mg(HCl) tablet 25 2,895 0 2,895 180
89 Klorpromazin tablet salut 25 mg ( HCl ) tablet 25 0 0 0 0
90 Kodein tablet 10 mg tablet 26 300 0 300 0
91 Kotrimoksazol Suspensi komb: Sulfametoksazol 200 botol 6.2.2 0 0 0 0
92 Loratadin tablet 10 mg tablet 100 0 100 0
93 Kotrimoksazol tablet kombinasi: Sulfametoksazol 4 tablet 6.2.2 0 0 0 0
94 Lidokain komp. injeksi, Kombinasi:Lidokain HCl 2% + ampul 14 165 0 165 0
95 Lisol, mengandung Kresol tersabun 50% botol 13 0 0 0 0
96 Magnesium Sulfat injeksi (iv) 20 % - 25 ml ampul 5 3 0 3 0
97 Metformin HCl tablet 500 mg tablet 3,730 0 3,730 1,295
98 Metilergometrin Maleat (Metilergometrin) tablet sa tablet 22 200 0 200 0
99 Metilergometrin Maleat inj 0,200 mg-1 ml ampul 22 0 0 0 0
100 Metoklopramide tablet 10 mg tablet 0 0 0 0
101 Metronidazol tablet 250 mg tablet 6.2.2 0 0 0 0
102 Metronidazol tablet 500 mg tablet 6.2.2 0 0 0 0
103 Mikonazol cream tube 80 0 80 2
104 Mineral mix 0 0 0 0
105 Natrium Diklofenak tablet 50 mg tablet 3,121 0 3,121 1,436
106 Natrium Klorida larutan infus 0,9 % steril botol 20 12 0 12 0
107 Nifedipin tablet 10 mg tablet 0 0 0 0
108 Nistatin tablet salut 500.000 IU/g tablet 0 0 0 0
109 Nistatin tablet vaginal 100.000 IU/g tablet 6 55 0 55 0
110 Oksitosin injeksi 10 IU/ml - 1 ml ampul 22 0 0 0 0
111 Omeprazol kapsul 20 mg kapsul 422 0 422 259
112 Parasetamol sirup 120 mg/5 ml botol 1 218 0 218 98
113 Parasetamol tablet 500 mg tablet 1 15,042 0 15,042 3,188
114 Piridoksin (Vit.B6) tablet 10 mg ( HCl ) tablet 29 6,648 0 6,648 2,993
115 Piroksikam tablet 20 mg tablet 0 0 0 0
116 Povidon Iodida 10 %, 300 ml botol 13 0 13 0
117 Prednison tablet 5 mg tablet 16 2,789 0 2,789 247
118 Propanolol tablet 10 mg (HCl) tablet 7 612 0 612 27
119 Ranitidin tablet 150 mg tablet 0 0 0 0
120 Ringer Laktat larutan infus steril botol 20 12 0 12 3
121 Risperidon 2 mg tablet 0 0 0 0
122 Salbutamol 2,5 mg respulles (Komb Ipratropium B ampul 26 40 0 40 0
123 Salbutamol tablet 2 mg ( sebagai sulfat ) tablet 26 633 0 633 425
124 Salep 2-4 , Kombinasi:Asam Salisilat 2% + Belerang pot 18 91 0 91 10
125 Salisil Bedak 2 % kotak 19 0 0 0 0
126 Sefadroksil kapsul 500 mg kapsul 0 0 0 0
127 Sefadroksil sirup kering 125 mg/ 5 ml botol 0 0 0 0
128 Serum Anti Bisa Ular Polivalen injeksi 5 ml (ABU I) vial 0 0 0 0
129 Serum Anti Difteri 20.000 SI/vial (A.D.S.) ampul 0 0 0 0
130 Serum Anti Tetanus Injeksi 1.500 IU/ampul (A.T.S.) ampul 0 0 0 0
131 Simetidin tablet 200 mg tablet 0 0 0 0
132 Simvastatin tablet 10 mg tablet 7,418 0 7,418 451
133 Siprofloksasin tablet 500 mg (sebagai HCl) tablet 0 0 0 0
134 Tiamfenikol kapsul 500 mg kapsul 0 0 0 0
135 Tiamin (Viamin B1) tablet 50 mg (HCl / Mononitrat ) tablet 29 0 0 0 0
136 Trifluoperazine tablet 5 mg tablet 0 0 0 0
137 Triheksifenidil Hidroklorida tablet 2 mg tablet 9 738 0 738 738
138 Vitamin B Kompleks tablet tablet 29 5,057 0 5,057 2,952
139 Zinc tablet 20 mg tablet 250 0 250 250

PERBEKALAN KESEHATAN
140 Alat suntik sekali pakai 1 ml set 32 0 0 0 0
141 Alat suntik sekali pakai 2,5 ml/3 ml set 32 0 0 0 0
142 Alat suntik sekali pakai 5 ml set 32 165 0 165 165
143 Catgut / Benang Bedah No. 2/0 - 3/0 dengan jarum biji 32 0 0 0 0
144 Catgut / Benang Bedah No. 3/0 plain biji 32 0 0 0 0
145 Catgut / Benang Bedah No. 3/0 chromic biji 0 0 0 0
146 Hansaplast biji 0 0 0 0
147 Hands shoen non steril No. 7 biji 0 0 0 0
148 Hands shoen steril No. 7 pasang 0 0 0 0
149 Infusion set dewasa set 0 0 0 0
150 IV Catether No. 18 set 0 0 0 0
151 IV Catether No. 20 set 0 0 0 0
152 IV Catether No. 22 set 0 0 0 0
153 Jarum jahit bedah No. 9 s/d 14 biji 0 0 0 0
154 Kapas Pembalut / Absorben 250 gram bungkus 0 0 0 0
155 Kasa Pembalut 2 m x 80 cm biji 0 0 0 0
156 KI 0.05 ml set 0 0 0 0
157 KI 0.5 ml set 0 0 0 0
158 KI 5 ml set 0 0 0 0
159 Kasa Pembalut Hidrofil 4 m x 3 cm hidrofil/elastic rol 30 0 30 0
160 Kasa Pembalut Hidrofil 4 m x 15 cm hidrofil/elastic rol 0 0 0 0
161 Kasa Steril 16 x 16 cm rol 576 0 576 96
162 Maag Slang No. 16 biji 0 0 0 0
163 Maag Slang No. 18 biji 0 0 0 0
164 Masker biji 0 0 0 0
165 Plester 5 yards x 2 inch roll 0 0 0 0
166 Silk (Benang Bedah Sutera) No. 3/0 dengan jarum b biji 0 0 0 0
167 Safety Box 2,5 L lembar 0 0 0 0

REAGEN LABORATORIUM
168 EDTA Powder botol 31 0 0 0 0
169 KOH 10 % botol 31 0 0 0 0
170 Larutan Asam asetat 6% botol 31 0 0 0 0
171 Larutan Asam Klorida 0,1 N botol 31 0 0 0 0
172 Larutan Benedict botol 31 0 0 0 0
173 Larutan Eosin 2% botol 31 0 0 0 0
174 Larutan Ether Alkohol botol 31 0 0 0 0
175 Larutan Giemsa Stain botol 0 0 0 0
176 Larutan HCl-alkohol /Lart. Etanol asam botol 0 0 0 0
177 Larutan Karbol Fuksin botol 0 0 0 0
178 Larutan Metilen Biru botol 0 0 0 0
179 Larutan Rees Ecker botol 0 0 0 0
180 Larutan Turk botol 0 0 0 0
181 Metanol botol 0 0 0 0
182 Oil imersion botol 0 0 0 0
183 Reagen Asam Urat / STIK Asam Urat btl 0 0 0 0
184 Reagen Golongan Darah Antigen A set 0 0 0 0
185 Reagen Golongan Darah Antigen B set 0 0 0 0
186 Reagen Gula Darah/ STIK set 0 0 0 0
187 Reagen Kolesterol/ STIK set 0 0 0 0
188 Reagen Urin Stik 10 Parameter set 0 0 0 0
189 Reagen Widal (AO, BO,H,O) set 0 0 0 0
190 Xylol botol 0 0 0 0
191 Reagen RPR Syphilis/Titer (Plasmatec/RPR tes kit, R set 0 0 0 0
192 Rapid Syphilis/ Standar Diagnostic (Alere) Bioline 0 0 0 0
193 Reagen HBSAg (Fokus) 300 0 300 25
194 Human Hexagon Syphilis 200 0 200 25
195 Reagen HIV R1 (Standart Diagnostic) 300 0 300 100
196 Iodina Test 16 0 0

OBAT GIGI
197 Dentorit botol 14 0 0 0 0
198 Etil Klorida spray botol 14 0 0 0 0
199 Eugenol cairan botol 14 1 0 1 0
200 Fluor tablet 0,5 mg tablet 14 0 0 0 0
201 Glass Ionomer Cement ART set 14 3 0 3 0
202 Kalsium Hidroksida Pasta set 14 0 0 0 0
203 Monochlorkamfer mentol ( CHKM ) botol 14 0 0 0 0
204 Mummifying Pasta botol 0 0 0 0
205 Povidon Iodine obat kumur botol 0 0 0 0
206 Semen Seng Fosfat serbuk dan cairan botol 0 0 0 0
207 Silver Amalgam serbuk 65 - 75 % botol 0 0 0 0
208 Temporary Stopping Fletcher (Fletcher) serbuk dan botol 0 0 0 0
209 Tri Kresol Formalin botol 0 0 0 0
0
OBAT PROGRAM 0
Gizi : 0
210 Retinol Kapsul ( Vitamin A ) 100.000 IU kapsul 0
211 Retinol kapsul ( Vitamin A ) 200.000 IU kapsul 0
212 Tablet Tambah Darah ( TTD ) tablet 0
223 Yodiol kapsul 0 300 300 300
2,600 2,600 2,600
Anti Lepra : 0 0 0
224 MB Anak blister 0 0 0 0
225 MB Dewasa blister 12 0
226 PB Anak blister 0 0 0 0
227 PB Dewasa blister 0 0 0 0
0 0 0
Anti Malaria : 0 0 0
228 ACT ( Artesunate + Amodiaquin ) Arsuamoon tablet 0 0
229 ACT ( Dehidro Artemisin + Piperaquin ) Arterakine tablet 0 0 0 0
230 Artemeter inj. 80 mg/ml ampul 0 0 0 0
231 Artesunate inj. kotak 0 0 0 0
232 Doksisiklin kapsul 100 mg kapsul 0 0 0 0
233 Kina dihidroklorida inj. 25 %-2ml ampul 0 0 0 0
234 Kina tablet 200 mg tablet 0 0 0 0
235 Primakuin tablet 15 mg tablet 0 0 0 0
0 0 0
Anti TBC : 0
236 Ethambutol tablet 400 mg tablet 0 0 0 0
237 Ethambutol tablet 500 mg tablet 0 0 0 0
238 FDC KIT I / III paket 6 0 6 2
239 FDC kit II paket 0 0 0 0
240 OAT Anak paket 0 0 0 0
241 OAT Kategori I paket 0 0 0 0
242 OAT Kategori II paket 0 0 0 0
243 OAT Kategori III paket 0 0 0 0
244 OAT Sisipan paket 0 0 0 0
245 Pirazinamid tablet 500 mg tablet 0 0 0 0
0
246 Imunisasi : 0 0 0
247 Vaksin BCG bayi vial 0 0 0 0
248 Vaksin Campak vial 0 0 0 0
249 HB Uniject 0,5 ml ampul 0 0
KIA : 0 0 0
250 Kondom 0 0 0 0
251 IUD botol 0 0 0 0
252 Urine Rapid Test pak 0 0 0 0
253 Progesteron Depo inj ( 3 bulan ) vial 0 0 0 0
254 Spuit KB bj 0 0 0 0
255 Metronidazole 500 mg inj vial 0 0 0 0
256 Calcium Gluconas inj ampul 0 0 0 0
257 Catgut Chromic 1/0 set 0 0 0 0
258 Kantung Urine Dewasa set 0 0 0 0
259 Rapid Test Siphilis set 0 0 0 0
260 Urine Strip set 0 0 0 0
261 Implant KB / Levonogestrel 75 mg set 0 0 0 0
262 Transfusion Set set 0 0 0 0
263 Pil Kontrasepsi ( Microdiol ) strip 0 0
264 ANTI RETROVIRAL: 0 0 0
265 Nevirapine (NVP) 200 mg set 0 0 0 0
266 Zidofudine (ZDV) 300 mg + Lamivudine (3TC) 150 m set 0 0 0 0
267 Tenofovir 300 mg (TDF) + Emcitritabine 200 mg (FTC set 0 0
 UMUM JKN
JAMKE
JUMLAH KUNJUNGAN RESEP NON SDA
BAYAR GRATIS PBI
PBI

Mengetahui
Kepala Puskesmas Blimbing Kesamben

MUCHTAR EFFENDY
NIP. 197103132000031004
AN LEMBAR PERMINTAAN OBAT
LPLPO)

Bulan : Jan - Des

Tahun : 2020

Pemak Pemberian
Sisa Stok Permin
aian KET ED
Stok Opt taan I Askes APBD Lain2 Jumlah
Rata2
8 9 10 11 12 13 14 15 16 28

0 120 0 100
15 2,990 44 2,000
0 885 0 0
0 5 -800 885
4 805 6
22 112 -733
140 20,514 -30
0 0 -16,000 3,000
0 105 0
81 4,137 194 100
0 0 -700 3,500
0 17 0
0 31 -19
0 0 -4 24
0 284 0 100
0 3 -300
82 4,065 243
209 11,958 -2,972 1,000
0 100 -6,000 7,000
0 9,357 -100
0 0 0
0 284 -200
53 616 -242 500
0 7 -2
0 0 0
0 0 0
0 32 0
0 0
0 0 0
0 100 -100
291 100 840
0 40 -1,500 3,000
0 5,472 0
 0 0 0
0 0 0
0 0 0
0 0 0
0 0 -30
0 0 -400
0 30 -400 500
0 289 -300 300
21 721 56
43 494 -1,573 10,000
0 19 0
0 6,887 0
0 0 0
0 0 0
0 0 -1,400
0 0 0
0 1,400 0
0 0 -100
0 0 -400
1 124 -1,296
8 772 23 3,000
0 1,411 0
0 3,225 -1,500
13 140 34
24 1,558 51 30
0 0 0
2 0 5 1,500
0 0 0
38 1,090 -885 1,000
0 0 0 6
38 2,280 114 48
0 0 0
0 45 1
0 0 0
0 0 0 100
0 0 -8
0 300 -5
0 8 -1,000 2,000
0 7 -400
114 2,217 -158 1,000
0 900 0
1 11 2
0 257 -8
0 8 0 3,000
0 0 -21
2 0 -69 100
6 136 17
### ### ###
 0 0 -48
0 85 -4,200 5,000
144 8,077 431
0 0 0
0 0 -2,900
15 2,715 45
0 0 -100 200
0 300 0
0 0 -100
0 100 0
0 0 -150
0 165 0
0 0 -3
0 3 -1,000 1,500
108 2,435 124
0 200 -25
0 0 0 0
0 0 0 0
0 0 0 1,000
0 0 -35 0
0 78 0 0
0 0 -5,000 5,000
120 1,685 -591 1,000
0 12 -12
0 0
0 0 0
0 55 0
0 0 0
22 163 -235
8 120 25 320
266 11,854 -3,903 10,000
249 3,655 -2,252 5,000
0 0 0
0 13 -14
21 2,542 -1,638
2 585 -193 100
0 0 0
0 9 -11
0 0 0 5,000
0 40 -40 40
35 208 -94 300
1 81 -55
0 0 0
0 0 0 7,000
0 0 0 50
0 0 0
0 0 0
0 0 0
 0 0 0
38 6,967 -3,307 1,000
0 0 0 5,000
0 0 0 5,000
0 0 0 7,000
0 0 0 5,000
62 0 185 5,000
246 2,105 338 7,000
21 0 -138
0
0
0 0 -100 500
0 0 0 1,000
14 0 -129
0 0 0 10
0 0 0 10
0 0 0 10
0 0 0 0
0 0 0 500
0 0 0 0
0 0 0 10
0 0 0 10
0 0 0 10
0 0 0 0
0 0 0 1
0 0 0 10
0 0 0 10
0 0 0 0
0 0 0 0
0 0 0 0
0 30 -10 30
0 0 0 30
8 480 -376 160
0 0 0 0
0 0 0 0
0 0 0 150
0 0 0 6
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 10
0 0 0 2
0 0 0 2
0 0 0 10
0 0 0 20
0 0 0 1
0 0 0 2
0 0 0 0
0 0 -200
0 0 0 0
2 275 -94 500
2 175 -94 500
8 200 25 500
0 0 0 10

0 0 0 2
0 0 0 6
0 1 -1
0 0 0 0
0 3 -1 5
0 0 0 2
0 0 0
0 0 0 2
0 0 0 6
0 0 0 1
0 0 0 1
0 0 0 1
0 0 0 1
0
0
0
0
0
0
25 0 75 75
217 650 650
0 0 0
0 0 0 100
0 12
0 0 0 0
0 0 0 12
0 0 0
0 0 0
0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0
0
0 0 0 0
0 0 0 0
0 4 -3 1
0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0
0 0 0
0 0 0 0
0 0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0
0 0 0
0 0 0 0
0 0 0 0
0 0
jumlah R/

Jombang, 26 Desember 2019

Pengelola Obat Puskesmas Blimbing Kes

MUSABBIHAH
NIP. 19650510 198603 2 026
KOSONG
Hari

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