Lplpo 2020

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
( LPLPO )
KODE PUSKESMAS :
PUSKESMAS : KUTA COT GLIE
KECAMATAN : KUTA COT GLIE
PUSKESMAS PEMBANTU YANG ADA :1
POSKESDES YANG ADA :
KABUPATEN/KOTA : ACEH BESAR
NO NAMA OBAT DAN PERBEKKES SATUAN STOK PENERIMA PERSEDIAA PEMAKAIA SISA STOCK
URUT AWAL AN N N STOCK OPT.
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9
1 Allopurinol tablet 100 mg Tablet 2,000 2,000 800 1,200
2 Ambroxol syrup 15 mg/ml - 60 ml Botol - - -
3 Ambroxol tablet 30 mg Tablet - - -
4 Aminophylin injeksi 24 mg/ml - 10 ml Ampul - - -
5 Aminophylin tablet 200 mg Tablet - - -
6 Amlodipin tablet 10 mg Tablet 2,400 2,400 1,080 1,320
7 Amlodipin tablet 5 mg Tablet - - -
8 Amoksisilin kaplet 500 mg Kaplet 4,200 4,200 2,700 1,500
9 Amoksisilin kapsul 250 mg Kapsul 200 200 200 -
10 Amoksisilin sirup kering 125 mg/5ml - 60 ml Botol - - -
Antasida DOEN Suspensi, kombinasi - 60ml :Mg-
11 Hidroksida 200mg/5 ml+Al Hidroksida 200 mg/5 ml Botol 200 200 100 100
Antasida DOEN tab,kombinasi: Mg-Hidroksida

12 200mg+Al. Hidroksida. 200 mg Tablet 5,100 5,100 3,200 1,900
13 Anti Diare Tablet Tablet - - -

Anti Hemoroid DOEN Kombinasi : Bismuth subgalat 150
14 mg + Heksaklorofen 2,5 mg Supp 43 43 15 28
15 Antimigren : Ergotamin tartrat 1 mg + Kofein 50 mg Tablet - - - -

16 Aqua pro injeksi steril, bebas pirogen 20 ml Vial 13 13 - 13
17 Asam Askorbat (Vit C) tablet 100 mg Tablet - - -
18 Asam Askorbat (Vit C) tablet 50 mg Tablet 1,650 1,650 1,150 500
19 Asam Mefenamat kaplet 500 mg Kaplet 100 100 - 100
20 Asiklovir krim 5 % - 5 gram Tube 50 50 - 50
21 Asiklovir tablet 200 mg Tablet 2,800 2,800 - 2,800
22 Asiklovir tablet 400 mg Tablet - - -
23 Benzatin benzil penisilin inj Vial - - -
24 Betametason krim 0.1% - 5 gram Tube 125 125 75 50
25 Cetirizin Sirup 5 ml Sirup 27 27 27 -
26 Cetirizin tablet 10 mg Tablet - - -
27 Deksametason injeksi 5 mg/ml - 1 ml Ampul - - -
28 Deksametason tablet 0,5 mg Tablet 3,300 3,300 2,600 700
29 Diazepam injeksi 5 mg/ml - 2 ml Ampul 2 2 - 2
30 Diazepam tablet 2 mg Tablet 202 202 191 11
31 Difenhidramin HCl inj 10 mg/ml-1 ml Ampul 25 25 - 25
32 Digoksin tablet 0,25 mg Tablet - - -
33 Domperidon suspensi 5 mg/5 ml - 60 ml Botol 150 150 7 143
34 Domperidon tablet 10 mg Tablet 1,600 1,600 700 900
35 Efedrin HCl tablet 25 mg Tablet - - -
36 Epinefrina HCl/Bitartrat (Adrenalina) Injeksi 0,1% - 1 ml Ampul 88 88 - 88
37 Erytromycin kapsul 500 mg Kapsul 2,000 2,000 - 2,000

38 Erytromycin sirup 200 mg/5 ml - 60 ml Botol - - -
39 Etakridin ( Rivanol ) larutan 0,1% - 300 ml Botol - - -
40 Etanol 70 % 100 ml Botol 6 6 6
41 Etanol 70 % 1000 ml Botol - - - -
42 Fenobarbital injeksi i.m/i.v. 50 mg/ml - 1 ml Ampul - - -
43 Fenobarbital tablet 30 mg Tablet 649 649 180 469
44 Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ml Ampul 60 60 - 60
45 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tablet - - -
46 Furosemid tablet 40 mg Tablet 300 300 200 100
47 Garam Oralit untuk 200 ml air Sachet - - -
48 Gentamisin salep kulit 3 % - 5 gram Tube - - -
49 Gentamisin Tetes Mata 0,3 % Botol - - -
50 Gentian Violet larutan 1 % -10 ml Botol - - -
51 Glibenklamid tablet 5 mg Tablet 700 700 - 700
52 Glimepirid tab 2 mg Tablet 800 800 800
53 Gliseril Guayakolat tablet 100 mg Tablet - - -
54 Glukosa larutan infus 5 % steril - 500 ml Botol 40 40 6 34
55 Griseofulvin tablet 125 mg, micronized Tablet 800 800 - 800
56 Hidrokortison krim 2,5 % - 5 gram Tube 96 96 96 -
57 Ibuprofen tablet 200 mg Tablet 800 800 600 200
58 Ibuprofen tablet 400 mg Tablet 860 860 860 -
59 Isosorbid Dinitrat tablet sublingual 5 mg Tablet 90 90 90
60 Kalsium Laktat (Kalk) tablet 500 mg Tablet 2,600 2,600 700 1,900
61 Kaptopril tablet 12,5 mg Tablet - - -
62 Kaptopril tablet 25 mg Tablet 1,600 1,600 1,600
63 Ketokonazol krem Tube 50 50 50 -
64 Ketokonazol tablet 200 mg Tablet 100 100 50 50
65 Ketorolac injeksi Ampul 85 85 - 85
66 Klindamisin kapsul 150 mg Kapsul 1,150 - 1,150 300 850
67 Kloramfenikol kapsul 250 mg Kapsul - - -
68 Kloramfenikol salep mata 1% Tube 72 72 72 -
69 Kloramfenikol Suspensi Botol - - -
70 Kloramfenikol tetes mata 0,5 % Botol - - -
71 Kloramfenikol tetes telinga 3 % - 5 ml Botol - - -
72 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 8,500 8,500 4,700 3,800
73 Kodein tablet 10 mg Tablet - - -
Kotrimoksazol DOEN I (dewasa) tablet kombinasi:
75 Sulfametoksazol 400 mg '+ Trimetoprim 80 mg Tablet 1,700 1,700 300 1,400
Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg

76 '+ Trimetoprim 40 mg / 5 ml - 60 ml Botol 151 151 51 100
77 Lidokain injeksi 2% - 2 ml Ampul 58 58 21 37
78 Loratadin tablet 10 mg Tablet 350 350 350 -
79 Magnesium Sulfat inj (IV) 20% - 25 ml Botol 12 12 12
80 Magnesium Sulfat inj (IV) 40% - 25 ml Botol - - -
81 Metformin HCl tablet 500 mg Tablet 400 400 - 400
Metilergometrin Maleat (Metilergometrin) tablet salut
82 Tablet 200 200 200
0,125 mg
83 Metilergometrin Maleat inj 0,200 mg - 1 ml Ampul - - -
84 Metilprednisolon tablet 4 mg Tablet - - -
85 Metoklopramide injeksi 5 mg/ml Ampul - - -
86 Metoklopropamide tablet 5 mg Tablet - - -
87 Metronidazol tablet 250 mg Tablet - - -
88 Metronidazol tablet 500 mg Tablet 3,800 3,800 3,800
89 Mikonazole krim/salep 2 % - 10 gram Tube - - -
90 Multivitamin Syrup Botol - - -
91 Multivitamin tablet Tablet - - -
92 Natrium diklofenak tablet 25 mg Tablet - - -
93 Natrium diklofenak tablet 50 mg Tablet 2,200 2,200 1,500 700
Natrium Klorida larutan infus 0,9 % steril (Produk lokal) -
94 Botol 97 97 23 74
500 ml
95 Nifedipin tablet 10 mg Tablet - - - -
96 Oksitetrasiklin salep kulit 3% (HCl) - 5 gr Tube - - -
97 Oksitetrasiklin salep mata 1% (HCl) - 3,5 gr Tube 100 100 75 25
98 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 45 45 45 -
99 Omeprazol 20 mg Kapsul 1,440 1,440 420 1,020
100 Paracetamol drops Botol - - -
101 Parasetamol sirup 120 mg/5 ml - 60 ml Botol - - -
102 Parasetamol tablet 500 mg Tablet 2,500 2,500 2,500 -
103 Phenol gliserol 10% tetes telinga Botol 120 120 - 120
104 Pirantel tab score (base) 125 mg Tablet 92 92 8 84
105 Piridoksin (Vitamin B6) tablet 10 mg Tablet 1,900 1,900 1,500 400
106 Piroksikam kapsul 20 mg Kapsul - - -
107 Piroksikam tablet 10 mg Tablet - - -
108 Povidon Iodida larutan 10 % - 30 ml Botol - - -
111 Prednison tablet 5 mg Tablet 2,100 2,100 2,100 -
112 Propanolol tablet 10 mg (HCl) Tablet - - -
113 Propiltiourasil tablet 100 mg Tablet 200 200 200
114 Ranitidin injeksi 25 mg/ml - 2ml Ampul 20 100 120 100 20
115 Ranitidin tablet 150 mg Tablet 37 37 - 37
116 Ringer laktat larutan infus - 500 ml Botol - - -
117 Salbutamol tablet 2 mg (sebagai sulfat) Tablet - - -
118 Salbutamol tablet 4 mg (sebagai sulfat) Tablet 1,500 1,500 500 1,000
Salep 2-4 , Kombinasi: Asam Salisilat 2% + Belerang
119 Endap 4% - 30 gram Pot 72 72 24 48
120 Salisil Bedak 2 % -50 gr Kotak - - -

121 Scabicid krem/Scabimit krem Tube 18 18 18 -
122 Sefadroksil kapsul 500 mg Kapsul - - -
123 Sefadroksil sirup kering 125 mg/5ml - 60 ml Botol 26 26 26 -
124 Sefadroksil sirup kering 250 mg/5ml - 60 ml Botol - - -
125 Sefotaksim injeksi 500 mg/vial Ampul - - -
126 Sianokobalamin (Vit.B12) injeksi 500 mcg/ml-1 ml Ampul - - -
127 Sianokobalamin (Vit.B12) tablet 50 mcg Tablet 2,400 2,400 1,600 800
128 Simvastatin tablet 10 mg Tablet 1,290 1,290 840 450
129 Siprofloksasin tablet 500 mg (sebagai HCl) Tablet 1,900 1,900 800 1,100
130 Tetrasiklin HCl kapsul 250 mg Kapsul - - -
132 Tiamfenicol kapsul 250 mg Kapsul - - -
133 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml Ampul - - -
134 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg Tablet 800 800 800 -
135 Tramadol injeksi 50 mg/ml Ampul - - -
136 Vitamin B Kompleks tablet Tablet 1,300 1,300 900 400
137 Zink Drops Botol - - -
138 Zink tablet Tablet 1,800 1,800 - 1,800
PERBEKALAN KESEHATAN
139 Abbocath no 18 Pcs 100 100 - 100
140 Abbocath no 20 Pcs 120 8 128 28 100
141 Abbocath no 22 Pcs 20 6 26 8 18
142 Abbocath no 24 Pcs 240 12 252 134 118
143 Alat Suntik Sekali Pakai 1 ml Pcs 257 257 11 246
144 Alat Suntik Sekali Pakai 2,5 ml Pcs 200 200 - 200
146 Alat Suntik Sekali Pakai 5 ml Pcs - - - -
147 Alkohol Swab Kotak - - - -
148 Blood Set Pcs 12 12 - 12
149 Catgut / Benang Bedah No. 2/0 dengan jarum bedah Pcs 41 41 - 41
150 Catgut / Benang Bedah No. 3/0 dengan jarum bedah Pcs - - - -
151 Foley Catheter Pcs - - - -

152 Infusion Set Anak Set 83 83 - 83
153 Infusion Set Dewasa Set 173 173 - 173
154 Kapas Pembalut / Absorben 250 gram Bungkus 3 3 - 3
155 Kasa Hidrofil Steril ukuran 16x16 cm/ktk @ 16 lbr Lbr - 832 832 - 832
156 Kasa Pembalut Hidrofil 4m x 10 cm Rol 268 268 - 268
157 Kasa Gulung 40/80 cm Rol 2 2 - 2
158 Kasa Kompres 40/40 Steril Bungkus - - - -
159 Kasa Pembalut Hidrofil 4 m x 15 cm Elastic Rol - - - -
160 Lanset Pcs 1,000 1,000 - 1,000
161 Masker Pcs 350 350 200 150
162 Plester 5 yards x 2 inch Rol 4 12 16 12 4
163 Polypropilene 6/0 Pcs 24 24 - 24
164 Sarung Steril Size 7 Pasang 228 228 208 20
165 Sarung tangan Size L Pcs - - -
166 Sarung tangan Size M Pcs 200 200 200 -
167 Sarung tangan Size S Pcs - - -
168 Silk (Benang Bedah Sutera) No 2/0 Pcs - - -
169 Silk (Benang Bedah Sutera) No 3/0 Pcs - - -
OBAT GIGI
170 Air Raksa dental use Botol - - -
171 Caviton Botol - - -
172 Etil Klorida spray -100 ml Botol - - -
173 Eugenol cairan - 10 ml Botol - - -
174 Glass Ionomer Cement ART/ Fuji IX Botol - - -
175 Kalsium hidroksida Pasta Botol - - -
176 Klorfenol kamfer Menthol ( CHKM ) - 10 ml Botol 1 1 1
177 Mummifying Pasta Botol - - -
178 Pehacain inj Ampul 40 40 40
179 Semen Seng Fosfat serbuk dan cairan - 30 gram Botol - - -
180 Silver Amalgam Serbuk 65 - 75 % Botol - - -
181 Spons Gelatin cubicles Botol - - -
Temporary Stopping Fletcher (Fletcher) serbuk dan
182 Botol - - -
cairan - 100 gram
OBAT JIWA
183 Alprazolam 0,5 mg Tablet 176 176 - 176
184 Alprazolam 1 mg Tablet - - - -
185 Amitriptilin HCl tablet salut 25 mg Tablet 444 444 6 438
186 Clobazam 10 mg Tablet 282 282 - 282
187 Clozapin 25 mg Tablet 490 490 - 490
188 Diazepam 5 mg tablet Tablet 178 178 42 136
189 Flufenazine Decanoat Inj. 25 mg (Sikzonoat) Tablet - - -
190 Haloperidol Injeksi (Lodomer) Ampul - - -
191 Haloperidol tablet 0,5 mg Tablet 414 414 414 -
192 Haloperidol tablet 1,5 mg Tablet - 414 414 - 414
193 Haloperidol tablet 5 mg Tablet - - -
194 Imipramine HCL 25 mg (Trofanil) Tablet - - -
195 Karbamazepin tablet 200 mg Tablet 396 396 200 196
196 Klorpromazin HCl tablet salut 25 mg Tablet - - -
197 Klorpromazin tablet salut 100 mg (HCl) Tablet 134 700 834 340 494
198 Klorpromazina HCL inj Ampul - - -
199 Risperidon tablet 1 mg Tablet - - -
200 Risperidon tablet 2 mg Tablet - 1,691 1,691 1,042 649
201 Trifluoperazine HCL 5 mg (Stelosi) Tablet - - -
202 Triheksilfenidil Hidroklorida 2 mg Tablet 64 300 364 284 80
OBAT GIZI
Kombinasi : Ferro fumarat 60 mg + asam folat 0,4 mg
203 Tablet 3,510 3,510 120 3,390
tab salut
204 Iodium Tes Botol - - -
205 Mineral Mix Sashet - - -
206 Retinol (Vitamin A) kapsul 100.000IU Kapsul 100 100 50 50
OBAT TB PARU
208 Cartridge GeneXpert Buah - - -
209 Masker N 95 Pcs - - -
210 Obat Anti Tuberkulosis Kategori 1 dewasa (OAT FDC) Paket - - -
Obat Anti Tuberkulosis Kategori 1 dewasa (OAT

211 Kombipak) Paket 3 3 3
212 Obat Anti Tuberkulosis Kategori 2 (OAT FDC) Paket 1 1 - 1
213 Obat Anti Tuberkulosis Kategori anak (OAT Kombipak) Tablet - - -
214 Reagensia TB Set - - -

215 Slide Microscope Buah - - -
216 Sputum Pot Botol 50 50 - 50
OBAT MALARIA
Anti Malaria DOEN kombinasi Pirimetamin tablet 25 mg
217 Tablet - - -
+ Sulfadoksin tablet 500 mg
Act (Artesunate tablet 50 mg + Amodiaquine anhydrate
218 tablet 200 mg) (2 blister @ 12 tablet) Ampul - - -
219 Artemeter injeksi 80 mg/ml / ktk 6 amp Ampul - - -
220 Artesunate injeksi, vial 60 mg Tablet - - -
Kombinasi (DHP) : dihidroartemisin 40 mg + Piperakuin
221 Tablet - - -
320 mg tab sal selaput
222 Kuinin (Kina) tablet 200 mg Tablet 300 300 - 300
223 Primakuin tablet Tablet 200 200 200 -
OBAT PROGRAM
224 Albendazol tablet 400 mg Tablet 310 310 40 270
225 Dietilkarbamazin sitrat tablet 100 mg Tablet - - -
226 Doksisiklin kapsul 100 mg Kapsul - - -
227 Oseltamavir kaps 75 mg Kapsul - - -
228 Kotak
Bayar Tidak Bayar JUMLAH RESEP

JUMLAH KUNJUNGAN RESEP
0
Mengetahui / Menyetujui Yang Menyerahkan Yang meminta

Kepala Instalasi Farmasi Petugas IFK Kepala Puskesmas
(Rita Mutia, SKM, MKM) (…………………….) (Burhanuddi, SKM)

NIP. 19731124 199503 2 002 NIP. 19700605 199201 1 0
INTAAN OBAT
BULAN : JANUARI
TAHUN : 2020
PERMINTAA PEMBERIAN
N APBA APBK ASKES DAK OTSUS LAIN2 KET
10 11 12 13 14 15 15 16
1,000
200
2,000
1,000
5,000
5,000
500
300
5,000
3,000
100
200
2,000
200
5,000
500
1,000
200
200
10,000
240
2,000
2,000
200
200
500
240
100
100
10,000
100
100
300
5,000
240
200
3,000
240
240
20,000
300
5,000
100
2,000
500
48
200
50
2,000
200
3,000
500
1,000
5,000
300
200
500
20
200
2,000
12
1,000
2,000
500
1
100 EXP
Yang meminta Yang menerima

Kepala Puskesmas Petugas Puskesmas
(Burhanuddi, SKM) (Arif Mustaqin, A. Md. Far)

NIP. 19700605 199201 1 001 Nip. 19900606 201903 1 010
( LPLPO )
KODE PUSKESMAS :
NO NAMA OBAT DAN PERBEKKES SATUAN STOK PENERIMA PERSEDIAA PEMAKAIA SISA STOCK PERMINTAA
URUT AWAL AN N N STOCK OPT. N
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10
1 Allopurinol tablet 100 mg Tablet 1,200 1,000 2,200 1,400 800
6 Amlodipin tablet 10 mg Tablet 1,320 1,500 2,820 1,800 1,020
8 Amoksisilin kaplet 500 mg Kaplet 1,500 5,000 6,500 3,900 2,600
9 Amoksisilin kapsul 250 mg Kapsul - - -
11 Botol 100 100 200 127 73
Hidroksida 200mg/5 ml+Al Hidroksida 200 mg/5 ml
12 Tablet 1,900 5,000 6,900 3,800 3,100
200mg+Al. Hidroksida. 200 mg
13 Anti Diare Tablet Tablet - - -
14 Supp 28 28 24 4 30
mg + Heksaklorofen 2,5 mg
15 Antimigren : Ergotamin tartrat 1 mg + Kofein 50 mg Tablet - - -
18 Asam Askorbat (Vit C) tablet 50 mg Tablet 500 3,000 3,500 2,100 1,400
19 Asam Mefenamat kaplet 500 mg Kaplet 100 100 - 100
20 Asiklovir krim 5 % - 5 gram Tube 50 50 25 25
21 Asiklovir tablet 200 mg Tablet 2,800 2,800 300 2,500
24 Betametason krim 0.1% - 5 gram Tube 50 250 300 100 200
25 Cetirizin Sirup 5 ml Sirup - 100 100 19 81
26 Cetirizin tablet 10 mg Tablet - 2,000 2,000 1,100 900
27 Deksametason injeksi 5 mg/ml - 1 ml Ampul - 50 50 10 40
28 Deksametason tablet 0,5 mg Tablet 700 700 700
29 Diazepam injeksi 5 mg/ml - 2 ml Ampul 2 2 2
30 Diazepam tablet 2 mg Tablet 11 500 511 194 317
34 Domperidon tablet 10 mg Tablet 900 1,000 1,900 700 1,200

40 Etanol 70 % 100 ml Botol 6 6 6
41 Etanol 70 % 1000 ml Botol - - - -
43 Fenobarbital tablet 30 mg Tablet 469 469 469
46 Furosemid tablet 40 mg Tablet 100 100 - 100
47 Garam Oralit untuk 200 ml air Sachet - 200 200 - 200
52 Glimepirid tab 2 mg Tablet 800 800 - 800
54 Glukosa larutan infus 5 % steril - 500 ml Botol 34 34 34
56 Hidrokortison krim 2,5 % - 5 gram Tube - 240 240 120 120
57 Ibuprofen tablet 200 mg Tablet 200 5,000 5,200 1,600 3,600
58 Ibuprofen tablet 400 mg Tablet - - -
59 Isosorbid Dinitrat tablet sublingual 5 mg Tablet 90 90 - 90
60 Kalsium Laktat (Kalk) tablet 500 mg Tablet 1,900 1,900 1,100 800
62 Kaptopril tablet 25 mg Tablet 1,600 1,600 1,100 500
63 Ketokonazol krem Tube - 100 100 50 50
64 Ketokonazol tablet 200 mg Tablet 50 150 200 - 200
66 Klindamisin kapsul 150 mg Kapsul 850 850 - 850
68 Kloramfenikol salep mata 1% Tube - 192 192 120 72
72 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 3,800 10,000 13,800 6,000 7,800
75 Tablet 1,400 1,400 - 1,400
Sulfametoksazol 400 mg '+ Trimetoprim 80 mg
76 Botol 100 100 200 100 100
'+ Trimetoprim 40 mg / 5 ml - 60 ml
78 Loratadin tablet 10 mg Tablet - 500 500 500 -
79 Magnesium Sulfat inj (IV) 20% - 25 ml Botol 12 12 - 12
81 Metformin HCl tablet 500 mg Tablet 400 400 400 - 3,000
82 Tablet 200 200 - 200
0,125 mg
83 Metilergometrin Maleat inj 0,200 mg - 1 ml Ampul - - - -
88 Metronidazol tablet 500 mg Tablet 3,800 3,800 - 3,800
93 Natrium diklofenak tablet 50 mg Tablet 700 700 700
94 Botol 74 74 - 74
500 ml
95 Nifedipin tablet 10 mg Tablet - - - -
97 Oksitetrasiklin salep mata 1% (HCl) - 3,5 gr Tube 25 100 125 100 25
98 Oksitosin injeksi 10 IU/ml - 1 ml Ampul - - - -
99 Omeprazol 20 mg Kapsul 1,020 1,020 840 180 900
102 Parasetamol tablet 500 mg Tablet - - -
104 Pirantel tab score (base) 125 mg Tablet 84 84 - 84
105 Piridoksin (Vitamin B6) tablet 10 mg Tablet 400 3,000 3,400 2,200 1,200
111 Prednison tablet 5 mg Tablet - 3,000 3,000 2,700 300
113 Propiltiourasil tablet 100 mg Tablet 200 200 200 - 100
114 Ranitidin injeksi 25 mg/ml - 2ml Ampul 20 100 120 - 120
115 Ranitidin tablet 150 mg Tablet 37 1,500 1,537 1,237 300
116 Ringer laktat larutan infus - 500 ml Botol - 200 200 100 100
118 Salbutamol tablet 4 mg (sebagai sulfat) Tablet 1,000 1,000 600 400
119 Endap 4% - 30 gram Pot 48 72 120 48 72

121 Scabicid krem/Scabimit krem Tube - 30 30 18 12
123 Sefadroksil sirup kering 125 mg/5ml - 60 ml Botol - 100 100 100
127 Sianokobalamin (Vit.B12) tablet 50 mcg Tablet 800 3,000 3,800 1,300 2,500
128 Simvastatin tablet 10 mg Tablet 450 1,680 2,130 240 1,890
129 Siprofloksasin tablet 500 mg (sebagai HCl) Tablet 1,100 1,000 2,100 900 1,200
134 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg Tablet - 3,000 3,000 2,100 900 2,000
136 Vitamin B Kompleks tablet Tablet 400 3,000 3,400 3,400
139 Abbocath no 18 Pcs 100 100 - 100
140 Abbocath no 20 Pcs 100 100 22 78
141 Abbocath no 22 Pcs 18 18 18 -
142 Abbocath no 24 Pcs 118 118 - 118
144 Alat Suntik Sekali Pakai 2,5 ml Pcs 200 200 100 100
146 Alat Suntik Sekali Pakai 5 ml Pcs - - - -
147 Alkohol Swab Kotak - 30 30 - 30
148 Blood Set Pcs 12 12 - 12
149 Catgut / Benang Bedah No. 2/0 dengan jarum bedah Pcs 41 41 11 30
150 Catgut / Benang Bedah No. 3/0 dengan jarum bedah Pcs - - -
151 Foley Catheter Pcs - - -

152 Infusion Set Anak Set 83 83 30 53
154 Kapas Pembalut / Absorben 250 gram Bungkus 3 3 2 1
155 Kasa Hidrofil Steril ukuran 16x16 cm/ktk @ 16 lbr Lbr 832 832 416 416
157 Kasa Gulung 40/80 cm Rol 2 2 4 2 2
158 Kasa Kompres 40/40 Steril Bungkus - - -
159 Kasa Pembalut Hidrofil 4 m x 15 cm Elastic Rol - - -
160 Lanset Pcs 1,000 1,000 400 600
161 Masker Pcs 150 400 550 450 100
164 Sarung Steril Size 7 Pasang 20 200 220 172 48 200
166 Sarung tangan Size M Pcs - - -
168 Silk (Benang Bedah Sutera) No 2/0 Pcs - - - -
169 Silk (Benang Bedah Sutera) No 3/0 Pcs - 12 12 - 12
OBAT GIGI
172 Etil Klorida spray -100 ml Botol - 1 1 1
178 Pehacain inj Ampul 40 40 80 - 80
182 Botol - - -
cairan - 100 gram
OBAT JIWA
183 Alprazolam 0,5 mg Tablet 176 176 176 -
184 Alprazolam 1 mg Tablet - - -
191 Haloperidol tablet 0,5 mg Tablet - - -
192 Haloperidol tablet 1,5 mg Tablet 414 414 30 384
195 Karbamazepin tablet 200 mg Tablet 196 196 144 52 200
197 Klorpromazin tablet salut 100 mg (HCl) Tablet 494 500 994 170 824
200 Risperidon tablet 2 mg Tablet 649 500 1,149 440 709
202 Triheksilfenidil Hidroklorida 2 mg Tablet 80 500 580 380 200 200
OBAT GIZI
203 tab salut Tablet 3,390 3,390 2,310 1,080 1,000

206 Retinol (Vitamin A) kapsul 100.000IU Kapsul 50 50 - 50
OBAT TB PARU

211 Paket 3 3 2 1
Kombipak)
213 Obat Anti Tuberkulosis Kategori anak (OAT Kombipak) Tablet - 1 1 - 1

216 Sputum Pot Botol 50 50 50
OBAT MALARIA
217 Tablet - - -

221 Tablet - - -
223 Primakuin tablet Tablet - - - 100
OBAT PROGRAM
228

0 1819 1819


NIP. 19731124 199503 2 002 NIP. 19700605 199201 1 001
N OBAT
BULAN : FEBRUARI
TAHUN : 2020
PEMBERIAN
APBA APBK ASKES DAK OTSUS LAIN2 KET
11 12 13 14 15 15 16
800 EXP
200 EXP
EXP
1200 EXP

19700605 199201 1 001 Nip. 19900606 201903 1 010
( LPLPO )
KODE PUSKESMAS :
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10
1 Allopurinol tablet 100 mg Tablet 800 800 500 300 2,000
2 Ambroxol syrup 15 mg/ml - 60 ml Botol - - - 200
3 Ambroxol tablet 30 mg Tablet - - - 2,000
6 Amlodipin tablet 10 mg Tablet 1,020 600 1,620 1,080 540 3,000
8 Amoksisilin kaplet 500 mg Kaplet 2,600 2,600 2,600 - 10,000
9 Amoksisilin kapsul 250 mg Kapsul - - - 3,000
10 Amoksisilin sirup kering 125 mg/5ml - 60 ml Botol - - - 500
11 Botol 73 73 73 - 300
12 Tablet 3,100 2,000 5,100 3,600 1,500 10,000
13 Anti Diare Tablet Tablet - 500 500 - 500
14 Supp 4 4 4 - 30
16 Aqua pro injeksi steril, bebas pirogen 20 ml Vial 13 13 13
18 Asam Askorbat (Vit C) tablet 50 mg Tablet 1,400 1,400 - 1,400
19 Asam Mefenamat kaplet 500 mg Kaplet 100 500 600 400 200 1,000
20 Asiklovir krim 5 % - 5 gram Tube 25 25 25 - 100
25 Cetirizin Sirup 5 ml Sirup 81 81 21 60
26 Cetirizin tablet 10 mg Tablet 900 900 900 - 3,000
27 Deksametason injeksi 5 mg/ml - 1 ml Ampul 40 40 10 30 100
28 Deksametason tablet 0,5 mg Tablet 700 700 700 - 5,000
34 Domperidon tablet 10 mg Tablet 1,200 1,200 600 600 1,000
37 Erytromycin kapsul 500 mg Kapsul 2,000 2,000 100 1,900

38 Erytromycin sirup 200 mg/5 ml - 60 ml Botol - - - -
39 Etakridin ( Rivanol ) larutan 0,1% - 300 ml Botol - 1 1 1 - 5
40 Etanol 70 % 100 ml Botol 6 6 3 3
41 Etanol 70 % 1000 ml Botol - - - - 5
43 Fenobarbital tablet 30 mg Tablet 469 469 - 469
45 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tablet - - - -
46 Furosemid tablet 40 mg Tablet 100 100 - 100
47 Garam Oralit untuk 200 ml air Sachet 200 200 - 200
48 Gentamisin salep kulit 3 % - 5 gram Tube - - - -
49 Gentamisin Tetes Mata 0,3 % Botol - - - -
54 Glukosa larutan infus 5 % steril - 500 ml Botol 34 34 - 34
56 Hidrokortison krim 2,5 % - 5 gram Tube 120 120 120 - 240
57 Ibuprofen tablet 200 mg Tablet 3,600 3,600 1,000 2,600
58 Ibuprofen tablet 400 mg Tablet - - - -
60 Kalsium Laktat (Kalk) tablet 500 mg Tablet 800 800 200 600
62 Kaptopril tablet 25 mg Tablet 500 500 200 300
63 Ketokonazol krem Tube 50 50 26 24 72
65 Ketorolac injeksi Ampul 85 85 17 68
66 Klindamisin kapsul 150 mg Kapsul 850 850 100 750
68 Kloramfenikol salep mata 1% Tube 72 72 144 120 24 240
75 Tablet 1,400 1,400 200 1,200
76 '+ Trimetoprim 40 mg / 5 ml - 60 ml Botol 100 100 58 42 300
77 Lidokain injeksi 2% - 2 ml Ampul 31 31 25 6 100

78 Loratadin tablet 10 mg Tablet - - -
81 Metformin HCl tablet 500 mg Tablet - 2,000 2,000 700 1,300 2,000
82 Tablet 200 200 - 200
0,125 mg
83 Metilergometrin Maleat inj 0,200 mg - 1 ml Ampul - - - -
84 Metilprednisolon tablet 4 mg Tablet - - - 5,000
93 Natrium diklofenak tablet 50 mg Tablet 700 700 700 - 3,000
94 500 ml Botol 74 74 15 59
95 Nifedipin tablet 10 mg Tablet - - -

97 Oksitetrasiklin salep mata 1% (HCl) - 3,5 gr Tube 25 75 100 50 50 100
98 Oksitosin injeksi 10 IU/ml - 1 ml Ampul - 100 100 - 100
99 Omeprazol 20 mg Kapsul 180 180 180 - 900
101 Parasetamol sirup 120 mg/5 ml - 60 ml Botol - - - 1,000
102 Parasetamol tablet 500 mg Tablet - - - 15,000
105 Piridoksin (Vitamin B6) tablet 10 mg Tablet 1,200 1,200 1,000 200 3,000
106 Piroksikam kapsul 20 mg Kapsul - - - 1,000
107 Piroksikam tablet 10 mg Tablet - - - 1,000
111 Prednison tablet 5 mg Tablet 300 300 300 - 5
113 Propiltiourasil tablet 100 mg Tablet - - -
114 Ranitidin injeksi 25 mg/ml - 2ml Ampul 120 120 - 120
115 Ranitidin tablet 150 mg Tablet 300 300 300 - 5,000
116 Ringer laktat larutan infus - 500 ml Botol 100 100 100 - 300
118 Salbutamol tablet 4 mg (sebagai sulfat) Tablet 400 400 200 200 1,000
119 Pot 72 72 48 24 72
Endap 4% - 30 gram
120 Salisil Bedak 2 % -50 gr Kotak - - - 200
121 Scabicid krem/Scabimit krem Tube 12 12 12 - 50
122 Sefadroksil kapsul 500 mg Kapsul - - - 3,000
123 Sefadroksil sirup kering 125 mg/5ml - 60 ml Botol 100 100 100 - 300
127 Sianokobalamin (Vit.B12) tablet 50 mcg Tablet 2,500 2,500 1,200 1,300 3,000
128 Simvastatin tablet 10 mg Tablet 1,890 1,890 360 1,530
129 Siprofloksasin tablet 500 mg (sebagai HCl) Tablet 1,200 1,200 300 900
134 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg Tablet 900 900 900 - 5,000
136 Vitamin B Kompleks tablet Tablet 3,400 3,400 3,400 - 5,000
139 Abbocath no 18 Pcs 100 100 - 100
140 Abbocath no 20 Pcs 78 78 38 40 100
141 Abbocath no 22 Pcs - - - 200
142 Abbocath no 24 Pcs 118 118 - 118
143 Alat Suntik Sekali Pakai 1 ml Pcs 109 109 - 109
145 Alat Suntik Sekali Pakai 3 ml Pcs 100 100 100 - 300
146 Alat Suntik Sekali Pakai 5 ml Pcs - - -
147 Alkohol Swab Kotak 30 30 26 4 30
148 Blood Set Pcs 12 12 - 12
150 Catgut / Benang Bedah No. 3/0 dengan jarum bedah Pcs - - - 24

153 Infusion Set Dewasa Set 173 173 133 40
154 Kapas Pembalut / Absorben 250 gram Bungkus 1 1 1 -
160 Lanset Pcs 600 600 - 600
161 Masker Pcs 100 750 850 600 250 1,000
164 Sarung Steril Size 7 Pasang 48 48 48 - 200
165 Sarung tangan Size L Pcs - 500 500 500 -
166 Sarung tangan Size M Pcs - - - 1,000
168 Silk (Benang Bedah Sutera) No 2/0 Pcs - - - 12
169 Silk (Benang Bedah Sutera) No 3/0 Pcs 12 12 - 12
OBAT GIGI
172 Etil Klorida spray -100 ml Botol 1 1 - 1 5
176 Klorfenol kamfer Menthol ( CHKM ) - 10 ml Botol 1 1 - 1
178 Pehacain inj Ampul 80 80 20 60
182 Botol - - -
cairan - 100 gram
OBAT JIWA
183 Alprazolam 0,5 mg Tablet - - -
188 Diazepam 5 mg tablet Tablet 91 91 - 91
192 Haloperidol tablet 1,5 mg Tablet 384 384 - 384
195 Karbamazepin tablet 200 mg Tablet 52 500 552 152 400
197 Klorpromazin tablet salut 100 mg (HCl) Tablet 824 824 133 691
200 Risperidon tablet 2 mg Tablet 709 709 190 519
202 Triheksilfenidil Hidroklorida 2 mg Tablet 200 200 180 20 500
OBAT GIZI
203 Tablet 1,080 1,080 1,080 - 1,000
tab salut
206 Retinol (Vitamin A) kapsul 100.000IU Kapsul 50 50 - 50 50
OBAT TB PARU
209 Masker N 95 Pcs - - - 100

211 Paket 1 1 - 1
Kombipak)
213 Obat Anti Tuberkulosis Kategori anak (OAT Kombipak) Tablet 1 1 - 1

OBAT MALARIA
217 + Sulfadoksin tablet 500 mg Tablet - - - 100

218 Ampul - - - 100
tablet 200 mg) (2 blister @ 12 tablet)
221 Tablet - - - 100
223 Primakuin tablet Tablet - - - 100
OBAT PROGRAM
224 Albendazol tablet 400 mg Tablet 240 240 - 240
228

0 1673 1673


NIP. 19731124 199503 2 002 NIP. 19700605 199201 1 001
N OBAT
BULAN : MARET
TAHUN : 2020
PEMBERIAN
11 12 13 14 15 15 16
EXP

19700605 199201 1 001 Nip. 19900606 201903 1 010
( LPLPO )
KODE PUSKESMAS :
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10
1 Allopurinol tablet 100 mg Tablet 300 2,000 2,300 300 2,000
6 Amlodipin tablet 10 mg Tablet 540 6,000 6,540 540 6,000
8 Amoksisilin kaplet 500 mg Kaplet - 10,000 10,000 2,200 7,800
11 Botol - - -
12 Tablet 1,500 6,800 8,300 2,900 5,400
13 Anti Diare Tablet Tablet 500 500 300 200
14 Supp - 10 10 - 10
16 Aqua pro injeksi steril, bebas pirogen 20 ml Vial 13 13 10 3
18 Asam Askorbat (Vit C) tablet 50 mg Tablet 1,400 7,000 8,400 2,300 6,100
19 Asam Mefenamat kaplet 500 mg Kaplet 200 2,000 2,200 600 1,600
20 Asiklovir krim 5 % - 5 gram Tube - 50 50 25 25
27 Deksametason injeksi 5 mg/ml - 1 ml Ampul 30 50 80 - 80
28 Deksametason tablet 0,5 mg Tablet - 500 500 500 -
33 Domperidon suspensi 5 mg/5 ml - 60 ml Botol 100 100 100
34 Domperidon tablet 10 mg Tablet 600 1,000 1,600 300 1,300

39 Etakridin ( Rivanol ) larutan 0,1% - 300 ml Botol - 5 5 - 5
40 Etanol 70 % 100 ml Botol 3 10 13 2 11
41 Etanol 70 % 1000 ml Botol - - -
43 Fenobarbital tablet 30 mg Tablet 469 469 68 401
46 Furosemid tablet 40 mg Tablet 100 100 100 -
51 Glibenklamid tablet 5 mg Tablet 700 700 200 500
52 Glimepirid tab 2 mg Tablet 800 800 200 600
56 Hidrokortison krim 2,5 % - 5 gram Tube - 240 240 72 168
57 Ibuprofen tablet 200 mg Tablet 2,600 1,000 3,600 400 3,200
60 Kalsium Laktat (Kalk) tablet 500 mg Tablet 600 3,000 3,600 300 3,300
62 Kaptopril tablet 25 mg Tablet 300 300 - 300
68 Kloramfenikol salep mata 1% Tube 24 96 120 48 72
75 Tablet 1,200 1,200 100 1,100
76 '+ Trimetoprim 40 mg / 5 ml - 60 ml Botol 42 200 242 92 150

81 Metformin HCl tablet 500 mg Tablet 1,300 300 1,600 800 800
82 Tablet 200 200 - 200
0,125 mg
88 Metronidazol tablet 500 mg Tablet 3,800 3,800 100 3,700
89 Mikonazole krim/salep 2 % - 10 gram Tube - 120 120 48 72
93 Natrium diklofenak tablet 50 mg Tablet - 500 500 500 -
94 500 ml Botol 59 59 13 46

98 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 100 100 5 95
99 Omeprazol 20 mg Kapsul - 2,100 2,100 360 1,740
102 Parasetamol tablet 500 mg Tablet - 7,000 7,000 3,300 3,700
111 Prednison tablet 5 mg Tablet - 3,000 3,000 1,500 1,500
114 Ranitidin injeksi 25 mg/ml - 2ml Ampul 120 120 120
115 Ranitidin tablet 150 mg Tablet - 2,000 2,000 800 1,200
116 Ringer laktat larutan infus - 500 ml Botol - 300 300 72 228
118 Salbutamol tablet 4 mg (sebagai sulfat) Tablet 200 1,000 1,200 700 500
119 Pot 24 24 24 -
Endap 4% - 30 gram
121 Scabicid krem/Scabimit krem Tube - - -
127 Sianokobalamin (Vit.B12) tablet 50 mcg Tablet 1,300 2,000 3,300 200 3,100
128 Simvastatin tablet 10 mg Tablet 1,530 1,530 370 1,160
129 Siprofloksasin tablet 500 mg (sebagai HCl) Tablet 900 900 600 300
134 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg Tablet - 3,000 3,000 1,100 1,900
136 Vitamin B Kompleks tablet Tablet - 3,000 3,000 600 2,400
139 Abbocath no 18 Pcs 100 100 - 100
140 Abbocath no 20 Pcs 40 200 240 4 236
141 Abbocath no 22 Pcs - - -
142 Abbocath no 24 Pcs 118 118 - 118
145 Alat Suntik Sekali Pakai 3 ml Pcs - 300 300 - 300
147 Alkohol Swab Kotak 4 30 34 - 34
148 Blood Set Pcs 12 12 - 12
149 Catgut / Benang Bedah No. 2/0 dengan jarum bedah Pcs 24 24 24 -
150 Catgut / Benang Bedah No. 3/0 dengan jarum bedah Pcs - 24 24 - 24

152 Infusion Set Anak Set 35 35 35
153 Infusion Set Dewasa Set 40 40 16 24
154 Kapas Pembalut / Absorben 250 gram Bungkus - - -
157 Kasa Gulung 40/80 cm Rol 1 1 2 2 -
160 Lanset Pcs 600 600 - 600
161 Masker Pcs 250 750 1,000 1,000 -
164 Sarung Steril Size 7 Pasang - - -
165 Sarung tangan Size L Pcs - 500 500 500 -
166 Sarung tangan Size M Pcs - - -
169 Silk (Benang Bedah Sutera) No 3/0 Pcs 12 12 12 -
OBAT GIGI
172 Etil Klorida spray -100 ml Botol 1 5 6 - 6
182 Botol - - -
cairan - 100 gram
OBAT JIWA
187 Clozapin 25 mg Tablet 490 490 490 -
192 Haloperidol tablet 1,5 mg Tablet 384 384 384 -
202 Triheksilfenidil Hidroklorida 2 mg Tablet 20 20 20 -
OBAT GIZI
203 Tablet - 4,320 4,320 2,640 1,680
tab salut
206 Retinol (Vitamin A) kapsul 100.000IU Kapsul 50 50 50
OBAT TB PARU

211 Paket 1 3 4 2 2
Kombipak)
212 Obat Anti Tuberkulosis Kategori 2 (OAT FDC) Paket 1 1 1 -
213 Obat Anti Tuberkulosis Kategori anak (OAT Kombipak) Tablet 1 1 1 -

OBAT MALARIA
217 + Sulfadoksin tablet 500 mg Tablet - 18 18 - 18

218 Ampul - - -
tablet 200 mg) (2 blister @ 12 tablet)
221 Tablet - - -
223 Primakuin tablet Tablet - 100 100 - 100
OBAT PROGRAM
228

0 1025 1025


NIP. 19731124 199503 2 002 NIP. 19700605 199201 1 001
N OBAT
BULAN : APRIL
TAHUN : 2020
PEMBERIAN
11 12 13 14 15 15 16
EXP
EXP
EXP
EXP

19700605 199201 1 001 Nip. 19900606 201903 1 010
( LPLPO )
KODE PUSKESMAS : BULAN : MEI
PUSKESMAS : KUTA COT GLIE TAHUN : 2020
NO STOK PENERIMA PERSEDIAA PEMAKAIA SISA STOCK PERMINTAA PEMBERIAN

NAMA OBAT DAN PERBEKKES SATUAN
URUT AWAL AN N N STOCK OPT. N APBA APBK ASKES DAK OTSUS LAIN2 KET
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14 15 15 16
2 Ambroxol syrup 15 mg/ml - 60 ml Botol - - - 50
3 Ambroxol tablet 30 mg Tablet - - - 3,000
6 Amlodipin tablet 10 mg Tablet 6,000 6,000 870 5,130
11 Botol - - - 300
12 Tablet 5,400 5,400 2,200 3,200 3,000
13 Anti Diare Tablet Tablet 200 200 100 100 500
14 Supp 10 30 40 11 29
18 Asam Askorbat (Vit C) tablet 50 mg Tablet 6,100 6,100 1,000 5,100
19 Asam Mefenamat kaplet 500 mg Kaplet 1,600 1,600 400 1,200
20 Asiklovir krim 5 % - 5 gram Tube 25 25 25 - 50
26 Cetirizin tablet 10 mg Tablet - - - 5,000
27 Deksametason injeksi 5 mg/ml - 1 ml Ampul 80 80 - 80
28 Deksametason tablet 0,5 mg Tablet - - -
30 Diazepam tablet 2 mg Tablet 363 363 - 363
33 Domperidon suspensi 5 mg/5 ml - 60 ml Botol 100 100 - 100
34 Domperidon tablet 10 mg Tablet 1,300 1,300 300 1,000

39 Etakridin ( Rivanol ) larutan 0,1% - 300 ml Botol 5 5 - 5
40 Etanol 70 % 100 ml Botol 11 11 1 10
41 Etanol 70 % 1000 ml Botol - - -
46 Furosemid tablet 40 mg Tablet - - -
48 Gentamisin salep kulit 3 % - 5 gram Tube - - - 300
56 Hidrokortison krim 2,5 % - 5 gram Tube 168 168 72 96 96
57 Ibuprofen tablet 200 mg Tablet 3,200 3,200 500 2,700
62 Kaptopril tablet 25 mg Tablet 300 300 200 100 500
63 Ketokonazol krem Tube 48 48 - 48
64 Ketokonazol tablet 200 mg Tablet 100 100 100 - 500
65 Ketorolac injeksi Ampul 68 68 68 - 100 EXP
75 Sulfametoksazol 400 mg '+ Trimetoprim 80 mg Tablet 1,100 1,100 100 1,000

76 Botol 150 150 150 - 100 EXP
78 Loratadin tablet 10 mg Tablet - - - 1,000
81 Metformin HCl tablet 500 mg Tablet 800 1,000 1,800 600 1,200 1,000
82 Tablet 200 200 - 200
0,125 mg
89 Mikonazole krim/salep 2 % - 10 gram Tube 72 72 48 24 96
93 Natrium diklofenak tablet 50 mg Tablet - - - 5,000
94 Botol 46 46 10 36
500 ml
95 Nifedipin tablet 10 mg Tablet - - - 300
99 Omeprazol 20 mg Kapsul 1,740 1,740 240 1,500
101 Parasetamol sirup 120 mg/5 ml - 60 ml Botol - 100 100 - 100 100
102 Parasetamol tablet 500 mg Tablet 3,700 3,700 3,700 - 15,000
105 Piridoksin (Vitamin B6) tablet 10 mg Tablet 1,500 1,500 900 600 3,000
108 Povidon Iodida larutan 10 % - 30 ml Botol - - - 10
111 Prednison tablet 5 mg Tablet 1,500 1,500 1,500 - 5,000
115 Ranitidin tablet 150 mg Tablet 1,200 1,200 800 400 3,000
116 Ringer laktat larutan infus - 500 ml Botol 228 228 34 194
119 Pot - 48 48 24 24 48
Endap 4% - 30 gram
121 Scabicid krem/Scabimit krem Tube - - - 100
122 Sefadroksil kapsul 500 mg Kapsul - - - 5,000
123 Sefadroksil sirup kering 125 mg/5ml - 60 ml Botol - - - 100
127 Sianokobalamin (Vit.B12) tablet 50 mcg Tablet 3,100 3,100 300 2,800
129 Siprofloksasin tablet 500 mg (sebagai HCl) Tablet 300 300 300 - 1,000
134 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg Tablet 1,900 1,900 1,400 500 5,000
136 Vitamin B Kompleks tablet Tablet 2,400 2,400 600 1,800
139 Abbocath no 18 Pcs 100 100 - 100
140 Abbocath no 20 Pcs 236 236 2 234
142 Abbocath no 24 Pcs 118 118 - 118
147 Alkohol Swab Kotak 34 34 - 34
148 Blood Set Pcs 12 12 - 12

157 Kasa Gulung 40/80 cm Rol - 1 1 1 - 2
160 Lanset Pcs 600 600 - 600
161 Masker Pcs - 250 250 250 - 1,000
162 Plester 5 yards x 2 inch Rol 20 20 5 15
166 Sarung tangan Size M Pcs - 1,000 1,000 600 400 1,000
168 Silk (Benang Bedah Sutera) No 2/0 Pcs 72 72 24 48
169 Silk (Benang Bedah Sutera) No 3/0 Pcs - - - 12
OBAT GIGI
172 Etil Klorida spray -100 ml Botol 6 6 1 5
182 cairan - 100 gram Botol - - -
OBAT JIWA
185 Amitriptilin HCl tablet salut 25 mg Tablet 380 380 - 380
187 Clozapin 25 mg Tablet - - -
192 Haloperidol tablet 1,5 mg Tablet - 1,000 1,000 - 1,000
195 Karbamazepin tablet 200 mg Tablet 90 200 290 170 120 1,000
200 Risperidon tablet 2 mg Tablet 44 1,000 1,044 164 880
202 Triheksilfenidil Hidroklorida 2 mg Tablet - - -
OBAT GIZI
203 Tablet 1,680 5,040 6,720 1,350 5,370
tab salut
OBAT TB PARU

211 Kombipak) Paket 2 2 - 2
212 Obat Anti Tuberkulosis Kategori 2 (OAT FDC) Paket - - -
213 Obat Anti Tuberkulosis Kategori anak (OAT Kombipak) Tablet - - - 1

OBAT MALARIA
217 Tablet 18 18 - 18

221 Tablet - - -
223 Primakuin tablet Tablet 100 100 - 100
OBAT PROGRAM
224 Albendazol tablet 400 mg Tablet 180 180 180 - EXP
228

0 763 763
Mengetahui / Menyetujui Yang Menyerahkan Yang meminta Yang menerima

Kepala Instalasi Farmasi Petugas IFK Kepala Puskesmas Petugas Puskesmas
(Rita Mutia, SKM, MKM) (…………………….) (Burhanuddi, SKM) (Arif Mustaqin, A. Md. Far)
NIP. 19731124 199503 2 002 NIP. 19700605 199201 1 001 Nip. 19900606 201903 1 010
( LPLPO )
KODE PUSKESMAS : BULAN : JUNI

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14 15 15 16
11 Botol - 300 300 89 211
12 Tablet 3,200 5,000 8,200 3,200 5,000
14 Supp 29 29 4 25
19 Asam Mefenamat kaplet 500 mg Kaplet 1,200 1,200 700 500
20 Asiklovir krim 5 % - 5 gram Tube - 50 50 25 25
24 Betametason krim 0.1% - 5 gram Tube 50 125 175 - 175
29 Diazepam injeksi 5 mg/ml - 2 ml Ampul 2 2 2 - EXP
34 Domperidon tablet 10 mg Tablet 1,000 1,000 400 600
36 Epinefrina HCl/Bitartrat (Adrenalina) Injeksi 0,1% - 1 ml Ampul 88 88 88 - EXP

39 Etakridin ( Rivanol ) larutan 0,1% - 300 ml Botol 5 5 5 - EXP
40 Etanol 70 % 100 ml Botol 10 10 1 9
41 Etanol 70 % 1000 ml Botol - - -
57 Ibuprofen tablet 200 mg Tablet 2,700 2,700 2,200 500
62 Kaptopril tablet 25 mg Tablet 100 100 100 -
63 Ketokonazol krem Tube 48 48 23 25
64 Ketokonazol tablet 200 mg Tablet - 500 500 150 350
65 Ketorolac injeksi Ampul - 100 100 100 - EXP 94
75 Sulfametoksazol 400 mg '+ Trimetoprim 80 mg Tablet 1,000 1,000 - 1,000

76 Botol - 100 100 8 92
79 Magnesium Sulfat inj (IV) 20% - 25 ml Botol 12 12 12 - EXP
81 Metformin HCl tablet 500 mg Tablet 1,200 3,000 4,200 600 3,600
82 Tablet 200 200 103 97
0,125 mg
89 Mikonazole krim/salep 2 % - 10 gram Tube 24 120 144 48 96
93 Natrium diklofenak tablet 50 mg Tablet - 2,800 2,800 1,200 1,600
94 Botol 36 36 - 36
500 ml
95 Nifedipin tablet 10 mg Tablet - 300 300 - 300
96 Oksitetrasiklin salep kulit 3% (HCl) - 5 gr Tube - - - -
99 Omeprazol 20 mg Kapsul 1,500 1,500 720 780
101 Parasetamol sirup 120 mg/5 ml - 60 ml Botol 100 200 300 75 225
102 Parasetamol tablet 500 mg Tablet - 12,800 12,800 4,100 8,700
111 Prednison tablet 5 mg Tablet - 5,000 5,000 1,400 3,600
115 Ranitidin tablet 150 mg Tablet 400 400 400 -
118 Salbutamol tablet 4 mg (sebagai sulfat) Tablet 200 1,000 1,200 400 800
119 Pot 24 48 72 48 24
Endap 4% - 30 gram
121 Scabicid krem/Scabimit krem Tube - 60 60 2 58
127 Sianokobalamin (Vit.B12) tablet 50 mcg Tablet 2,800 2,800 1,000 1,800
128 Simvastatin tablet 10 mg Tablet 840 840 270 570
129 Siprofloksasin tablet 500 mg (sebagai HCl) Tablet - - -
134 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg Tablet 500 5,200 5,700 700 5,000
136 Vitamin B Kompleks tablet Tablet 1,800 1,800 1,300 500
138 Zink tablet Tablet 1,800 1,800 100 1,700
139 Abbocath no 18 Pcs 100 100 - 100
140 Abbocath no 20 Pcs 234 234 - 234
141 Abbocath no 22 Pcs - 100 100 25 75
142 Abbocath no 24 Pcs 118 118 - 118
147 Alkohol Swab Kotak 34 34 - 34
148 Blood Set Pcs 12 12 - 12
150 Catgut / Benang Bedah No. 3/0 dengan jarum bedah Pcs 2 2 - 2

153 Infusion Set Dewasa Set 24 50 74 24 50
157 Kasa Gulung 40/80 cm Rol - 2 2 - 2
160 Lanset Pcs 600 600 - 600
161 Masker Pcs - 350 350 150 200
166 Sarung tangan Size M Pcs 400 1,000 1,400 500 900
OBAT GIGI
172 Etil Klorida spray -100 ml Botol 5 5 - 5
178 Pehacain inj Ampul 56 56 16 40 EXP 15
OBAT JIWA
186 Clobazam 10 mg Tablet 282 282 20 262
192 Haloperidol tablet 1,5 mg Tablet 1,000 1,000 120 880
195 Karbamazepin tablet 200 mg Tablet 120 1,000 1,120 270 850
OBAT GIZI
203 Tablet 5,370 5,370 3,900 1,470
tab salut
OBAT TB PARU

211 Kombipak) Paket 2 2 - 2
213 Obat Anti Tuberkulosis Kategori anak (OAT Kombipak) Tablet - 1 1 - 1

OBAT MALARIA
217 Tablet 18 18 - 18

221 Tablet - - -
OBAT PROGRAM
224 Albendazol tablet 400 mg Tablet - - -
228

0 1321 1321

NIP. 19731124 199503 2 002 NIP. 19700605 199201 1 001 Nip. 19900606 201903 1 010
( LPLPO )
KODE PUSKESMAS : BULAN : JULI

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14 15 15 16
1 Allopurinol tablet 100 mg Tablet 1,200 1,200 400 800 1,000
11 Botol 211 211 86 125 200
12 Tablet 5,000 5,000 2,800 2,200 5,000
13 Anti Diare Tablet Tablet 500 500 - 500
14 Supp 25 25 7 18 10
19 Asam Mefenamat kaplet 500 mg Kaplet 500 500 300 200 500
20 Asiklovir krim 5 % - 5 gram Tube 25 25 25
25 Cetirizin Sirup 5 ml Sirup 8 8 8 -
29 Diazepam injeksi 5 mg/ml - 2 ml Ampul - - - -
30 Diazepam tablet 2 mg Tablet 176 176 172 4 1,000
34 Domperidon tablet 10 mg Tablet 600 600 600 - 3,000
36 Epinefrina HCl/Bitartrat (Adrenalina) Injeksi 0,1% - 1 ml Ampul - - - -

39 Etakridin ( Rivanol ) larutan 0,1% - 300 ml Botol - - - -
40 Etanol 70 % 100 ml Botol 9 9 1 8
41 Etanol 70 % 1000 ml Botol - - -
43 Fenobarbital tablet 30 mg Tablet 401 401 101 300 500
52 Glimepirid tab 2 mg Tablet 600 600 100 500
57 Ibuprofen tablet 200 mg Tablet 500 500 500 - 5,000
58 Ibuprofen tablet 400 mg Tablet - - - 5,000
62 Kaptopril tablet 25 mg Tablet - - - -
63 Ketokonazol krem Tube 25 25 - 25 100
64 Ketokonazol tablet 200 mg Tablet 350 350 - 350
65 Ketorolac injeksi Ampul - - - -
66 Klindamisin kapsul 150 mg Kapsul 500 500 - 500
75 Sulfametoksazol 400 mg '+ Trimetoprim 80 mg Tablet 1,000 1,000 200 800

76 Botol 92 92 17 75
79 Magnesium Sulfat inj (IV) 20% - 25 ml Botol - - - -
81 Metformin HCl tablet 500 mg Tablet 3,600 3,600 600 3,000
82 Tablet 97 97 - 97
0,125 mg
89 Mikonazole krim/salep 2 % - 10 gram Tube 96 96 34 62
93 Natrium diklofenak tablet 50 mg Tablet 1,600 1,600 1,550 50 5,000
94 Botol 36 36 - 36
500 ml
95 Nifedipin tablet 10 mg Tablet 300 300 - 300
96 Oksitetrasiklin salep kulit 3% (HCl) - 5 gr Tube - - - -
97 Oksitetrasiklin salep mata 1% (HCl) - 3,5 gr Tube 75 75 - 75
98 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 58 58 24 34 100
99 Omeprazol 20 mg Kapsul 780 780 780 - 3,000
102 Parasetamol tablet 500 mg Tablet 8,700 8,700 3,800 4,900 10,000
103 Phenol gliserol 10% tetes telinga Botol 120 120 24 96
105 Piridoksin (Vitamin B6) tablet 10 mg Tablet 2,300 2,300 1,300 1,000 3,000
109 Povidon Iodida larutan 10 % - 300 ml Botol - 5 5 - 5
111 Prednison tablet 5 mg Tablet 3,600 3,600 2,300 1,300 5,000
115 Ranitidin tablet 150 mg Tablet - - - - 5,000
116 Ringer laktat larutan infus - 500 ml Botol 140 140 100 40 300
118 Salbutamol tablet 4 mg (sebagai sulfat) Tablet 800 800 200 600
119 Pot 24 24 24 - 48
Endap 4% - 30 gram
121 Scabicid krem/Scabimit krem Tube 58 58 23 35 100
123 Sefadroksil sirup kering 125 mg/5ml - 60 ml Botol - - - 1,000
128 Simvastatin tablet 10 mg Tablet 570 570 300 270 1,000
134 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg Tablet 5,000 5,000 1,200 3,800 3,000
136 Vitamin B Kompleks tablet Tablet 500 5,000 5,500 900 4,600
139 Abbocath no 18 Pcs 100 100 2 98
140 Abbocath no 20 Pcs 234 234 20 214
141 Abbocath no 22 Pcs 75 75 15 60
142 Abbocath no 24 Pcs 118 118 1 117
145 Alat Suntik Sekali Pakai 3 ml Pcs 100 100 100 - 100
147 Alkohol Swab Kotak 34 34 1 33
148 Blood Set Pcs 12 12 - 12
149 Catgut / Benang Bedah No. 2/0 dengan jarum bedah Pcs - - - 24
150 Catgut / Benang Bedah No. 3/0 dengan jarum bedah Pcs 2 24 26 7 19 24

160 Lanset Pcs 600 600 - 600
161 Masker Pcs 200 250 450 200 250 500
166 Sarung tangan Size M Pcs 900 900 500 400 1,000
OBAT GIGI
172 Etil Klorida spray -100 ml Botol 5 5 - 5
178 Pehacain inj Ampul 40 40 - 40
OBAT JIWA
186 Clobazam 10 mg Tablet 262 262 20 242
188 Diazepam 5 mg tablet Tablet 58 58 58 -
192 Haloperidol tablet 1,5 mg Tablet 880 880 112 768
193 Haloperidol tablet 5 mg Tablet - - - 300
195 Karbamazepin tablet 200 mg Tablet 850 850 450 400 1,000
197 Klorpromazin tablet salut 100 mg (HCl) Tablet 100 100 100 - 1,000
200 Risperidon tablet 2 mg Tablet 370 370 179 191 1,000
202 Triheksilfenidil Hidroklorida 2 mg Tablet - - - 1,000
OBAT GIZI
203 Tablet 1,470 3,450 4,920 1,470 3,450
tab salut
OBAT TB PARU

211 Kombipak) Paket 2 2 1 1
213 Obat Anti Tuberkulosis Kategori anak (OAT Kombipak) Tablet 1 1 - 1

OBAT MALARIA
217 Tablet 18 18 - 18

221 Tablet - - -
OBAT PROGRAM
228

0 1139 1139

NIP. 19731124 199503 2 002 NIP. 19700605 199201 1 001 Nip. 19900606 201903 1 010
( LPLPO )
KODE PUSKESMAS : BULAN : AGUSTUS

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14 15 15 16
11 Botol 125 200 325 65 260
12 Tablet 2,200 5,000 7,200 2,300 4,900
13 Anti Diare Tablet Tablet 500 500 200 300
14 Supp 18 100 118 14 104
18 Asam Askorbat (Vit C) tablet 50 mg Tablet 2,500 2,500 2,100 400
19 Asam Mefenamat kaplet 500 mg Kaplet 200 1,000 1,200 400 800
20 Asiklovir krim 5 % - 5 gram Tube 25 25 25 -
25 Cetirizin Sirup 5 ml Sirup - - -
27 Deksametason injeksi 5 mg/ml - 1 ml Ampul 80 80 80
29 Diazepam injeksi 5 mg/ml - 2 ml Ampul - - -
30 Diazepam tablet 2 mg Tablet 4 1,000 1,004 34 970
31 Difenhidramin HCl inj 10 mg/ml-1 ml Ampul 25 25 25
34 Domperidon tablet 10 mg Tablet - 500 500 200 300
36 Epinefrina HCl/Bitartrat (Adrenalina) Injeksi 0,1% - 1 ml Ampul - - -
37 Erytromycin kapsul 500 mg Kapsul 1,600 1,600 1,600

40 Etanol 70 % 100 ml Botol 8 8 1 7
41 Etanol 70 % 1000 ml Botol - - -
43 Fenobarbital tablet 30 mg Tablet 300 500 800 50 750
44 Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ml Ampul 60 60 60
47 Garam Oralit untuk 200 ml air Sachet 200 200 200
55 Griseofulvin tablet 125 mg, micronized Tablet 800 800 800
57 Ibuprofen tablet 200 mg Tablet - 3,000 3,000 300 2,700
60 Kalsium Laktat (Kalk) tablet 500 mg Tablet 1,800 1,800 1,800 - EXP
62 Kaptopril tablet 25 mg Tablet - - -
64 Ketokonazol tablet 200 mg Tablet 350 350 350
65 Ketorolac injeksi Ampul - - -
75 Sulfametoksazol 400 mg '+ Trimetoprim 80 mg Tablet 800 800 800

76 Botol 75 75 20 55
82 Tablet 97 97 7 90
0,125 mg
88 Metronidazol tablet 500 mg Tablet 3,600 3,600 3,600
89 Mikonazole krim/salep 2 % - 10 gram Tube 62 62 62 -
93 Natrium diklofenak tablet 50 mg Tablet 50 2,800 2,850 350 2,500
94 Botol 36 36 10 26
500 ml
95 Nifedipin tablet 10 mg Tablet 300 300 300 - EXP
99 Omeprazol 20 mg Kapsul - - -
103 Phenol gliserol 10% tetes telinga Botol 96 96 96
109 Povidon Iodida larutan 10 % - 300 ml Botol 5 5 10 5 5
114 Ranitidin injeksi 25 mg/ml - 2ml Ampul 120 120 120
115 Ranitidin tablet 150 mg Tablet - 3,000 3,000 600 2,400
116 Ringer laktat larutan infus - 500 ml Botol 40 400 440 60 380
118 Salbutamol tablet 4 mg (sebagai sulfat) Tablet 600 600 300 300
119 Pot - 96 96 24 72
Endap 4% - 30 gram
121 Scabicid krem/Scabimit krem Tube 35 30 65 16 49
127 Sianokobalamin (Vit.B12) tablet 50 mcg Tablet 400 3,000 3,400 700 2,700
128 Simvastatin tablet 10 mg Tablet 270 900 1,170 420 750
136 Vitamin B Kompleks tablet Tablet 4,600 5,000 9,600 6,400 3,200
138 Zink tablet Tablet 1,700 1,700 1,700 - EXP
139 Abbocath no 18 Pcs 98 98 98
140 Abbocath no 20 Pcs 214 214 214
141 Abbocath no 22 Pcs 60 60 50 10
142 Abbocath no 24 Pcs 117 117 5 112
143 Alat Suntik Sekali Pakai 1 ml Pcs 109 109 109
144 Alat Suntik Sekali Pakai 2,5 ml Pcs 83 83 83
145 Alat Suntik Sekali Pakai 3 ml Pcs - 100 100 100
147 Alkohol Swab Kotak 33 33 33
148 Blood Set Pcs 12 12 12
149 Catgut / Benang Bedah No. 2/0 dengan jarum bedah Pcs - 48 48 24 24
150 Catgut / Benang Bedah No. 3/0 dengan jarum bedah Pcs 19 24 43 12 31

156 Kasa Pembalut Hidrofil 4m x 10 cm Rol 268 268 268
160 Lanset Pcs 600 600 600
161 Masker Pcs 250 300 550 550 -
163 Polypropilene 6/0 Pcs 24 24 24
166 Sarung tangan Size M Pcs 400 1,000 1,400 600 800
168 Silk (Benang Bedah Sutera) No 2/0 Pcs 38 38 38
OBAT GIGI
172 Etil Klorida spray -100 ml Botol 5 5 1 4
OBAT JIWA
185 Amitriptilin HCl tablet salut 25 mg Tablet 300 300 300
186 Clobazam 10 mg Tablet 242 242 242
188 Diazepam 5 mg tablet Tablet - - -
192 Haloperidol tablet 1,5 mg Tablet 768 768 768
193 Haloperidol tablet 5 mg Tablet - 500 500 30 470
195 Karbamazepin tablet 200 mg Tablet 400 1,000 1,400 90 1,310
197 Klorpromazin tablet salut 100 mg (HCl) Tablet - - -
200 Risperidon tablet 2 mg Tablet 191 600 791 231 560
OBAT GIZI
203 Tablet 3,450 3,450 6,900 5,730 1,170
tab salut
OBAT TB PARU

211 Kombipak) Paket 1 1 1 -
213 Obat Anti Tuberkulosis Kategori anak (OAT Kombipak) Tablet 1 1 1

OBAT MALARIA
217 Tablet 18 18 18

221 Tablet - - -
222 Kuinin (Kina) tablet 200 mg Tablet 300 300 300
223 Primakuin tablet Tablet 100 100 100
OBAT PROGRAM
228

0 798 798

NIP. 19731124 199503 2 002 NIP. 19700605 199201 1 001 Nip. 19900606 201903 1 010
( LPLPO )
KODE PUSKESMAS : BULAN : SEPTEMBER

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14 15 15 16
1 Allopurinol tablet 100 mg Tablet 1,400 1,400 700 700 2,000
8 Amoksisilin kaplet 500 mg Kaplet 1,900 1,900 1,200 700 3,000
11 Botol 260 260 87 173 100
12 Tablet 4,900 4,900 1,400 3,500 3,000
14 Supp 104 104 104 - 100 EXP
18 Asam Askorbat (Vit C) tablet 50 mg Tablet 400 5,000 5,400 700 4,700
19 Asam Mefenamat kaplet 500 mg Kaplet 800 800 200 600
20 Asiklovir krim 5 % - 5 gram Tube - - -
33 Domperidon suspensi 5 mg/5 ml - 60 ml Botol 69 69 - 69
34 Domperidon tablet 10 mg Tablet 300 300 200 100 1,000

40 Etanol 70 % 100 ml Botol 7 7 4 3 10
41 Etanol 70 % 1000 ml Botol - - -
44 Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ml Ampul 60 60 60
47 Garam Oralit untuk 200 ml air Sachet 200 200 200
57 Ibuprofen tablet 200 mg Tablet 2,700 2,700 1,000 1,700 3,000
60 Kalsium Laktat (Kalk) tablet 500 mg Tablet - 2,000 2,000 200 1,800
64 Ketokonazol tablet 200 mg Tablet 350 350 150 200 500
66 Klindamisin kapsul 150 mg Kapsul 450 450 450
68 Kloramfenikol salep mata 1% Tube 72 96 168 72 96 96
75 Sulfametoksazol 400 mg '+ Trimetoprim 80 mg Tablet 800 800 200 600

76 Botol 55 55 5 50 200
82 Tablet 90 90 90
0,125 mg
89 Mikonazole krim/salep 2 % - 10 gram Tube - 96 96 24 72
93 Natrium diklofenak tablet 50 mg Tablet 2,500 2,500 1,450 1,050 5,000
94 Botol 26 26 10 16 40
500 ml
104 Pirantel tab score (base) 125 mg Tablet 24 24 12 12 80
105 Piridoksin (Vitamin B6) tablet 10 mg Tablet 1,700 1,700 1,100 600 3,000
109 Povidon Iodida larutan 10 % - 300 ml Botol 5 5 4 1 5
114 Ranitidin injeksi 25 mg/ml - 2ml Ampul 120 120 25 95
115 Ranitidin tablet 150 mg Tablet 2,400 2,400 1,200 1,200 3,000
118 Salbutamol tablet 4 mg (sebagai sulfat) Tablet 300 300 100 200 500
119 Pot 72 72 72
Endap 4% - 30 gram
121 Scabicid krem/Scabimit krem Tube 49 49 9 40
127 Sianokobalamin (Vit.B12) tablet 50 mcg Tablet 2,700 2,700 1,200 1,500 3,000
128 Simvastatin tablet 10 mg Tablet 750 750 360 390 1,000
134 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg Tablet 5,200 5,200 900 4,300
138 Zink tablet Tablet - - -
139 Abbocath no 18 Pcs 98 98 1 97
140 Abbocath no 20 Pcs 214 214 7 207
142 Abbocath no 24 Pcs 112 112 112
143 Alat Suntik Sekali Pakai 1 ml Pcs 109 109 109
144 Alat Suntik Sekali Pakai 2,5 ml Pcs 83 83 83
145 Alat Suntik Sekali Pakai 3 ml Pcs 100 300 400 105 295

154 Kapas Pembalut / Absorben 250 gram Bungkus - 4 4 1 3 2
155 Kasa Hidrofil Steril ukuran 16x16 cm/ktk @ 16 lbr Lbr 64 64 64 - 640
156 Kasa Pembalut Hidrofil 4m x 10 cm Rol 268 268 18 250
157 Kasa Gulung 40/80 cm Rol 1 2 3 1 2 2
160 Lanset Pcs 600 600 600
161 Masker Pcs - 250 250 250 - 1,000
163 Polypropilene 6/0 Pcs 24 24 9 15 24
166 Sarung tangan Size M Pcs 800 700 1,500 700 800 1,000
OBAT GIGI
172 Etil Klorida spray -100 ml Botol 4 4 4
OBAT JIWA
193 Haloperidol tablet 5 mg Tablet 470 470 470
195 Karbamazepin tablet 200 mg Tablet 1,310 1,310 70 1,240
197 Klorpromazin tablet salut 100 mg (HCl) Tablet - - - 5,000
OBAT GIZI
203 Tablet 1,170 1,170 1,020 150 10,000
tab salut
OBAT TB PARU
210 Obat Anti Tuberkulosis Kategori 1 dewasa (OAT FDC) Paket - - - 2

211 Kombipak) Paket - - - 2

OBAT MALARIA
217 Tablet 18 18 18

221 Tablet - - -
OBAT PROGRAM
224 Albendazol tablet 400 mg Tablet - - - 100
228

0 809 809

NIP. 19731124 199503 2 002 NIP. 19700605 199201 1 001 Nip. 19900606 201903 1 010
( LPLPO )
KODE PUSKESMAS : BULAN : OKTOBER

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14 15 15 16
2 Ambroxol syrup 15 mg/ml - 60 ml Botol - 50 50 3 47
3 Ambroxol tablet 30 mg Tablet - 1,000 1,000 200 800
6 Amlodipin tablet 10 mg Tablet 3,390 3,390 1,260 2,130
8 Amoksisilin kaplet 500 mg Kaplet 700 3,000 3,700 1,700 2,000
11 Botol 173 100 273 89 184
12 Tablet 3,500 3,000 6,500 1,900 4,600
13 Anti Diare Tablet Tablet 100 100 100 -
14 Supp - 50 50 10 40
18 Asam Askorbat (Vit C) tablet 50 mg Tablet 4,700 4,700 800 3,900
19 Asam Mefenamat kaplet 500 mg Kaplet 600 600 300 300
28 Deksametason tablet 0,5 mg Tablet - 1,200 1,200 1,200
33 Domperidon suspensi 5 mg/5 ml - 60 ml Botol 69 69 69 - EXP
34 Domperidon tablet 10 mg Tablet 100 1,000 1,100 200 900

40 Etanol 70 % 100 ml Botol 3 10 13 8 5
41 Etanol 70 % 1000 ml Botol - - -
44 Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ml Ampul 60 60 60 - EXP
47 Garam Oralit untuk 200 ml air Sachet 200 200 100 100
51 Glibenklamid tablet 5 mg Tablet 300 300 300
54 Glukosa larutan infus 5 % steril - 500 ml Botol 34 34 6 28
55 Griseofulvin tablet 125 mg, micronized Tablet 800 800 100 700
58 Ibuprofen tablet 400 mg Tablet - 3,000 3,000 100 2,900
60 Kalsium Laktat (Kalk) tablet 500 mg Tablet 1,800 1,800 1,800
64 Ketokonazol tablet 200 mg Tablet 200 500 700 50 650
72 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 2,100 1,000 3,100 3,100 -
75 Sulfametoksazol 400 mg '+ Trimetoprim 80 mg Tablet 600 600 600

76 Botol 50 200 250 5 245
81 Metformin HCl tablet 500 mg Tablet 2,000 2,000 1,000 1,000
82 Tablet 90 90 90
0,125 mg
89 Mikonazole krim/salep 2 % - 10 gram Tube 72 72 72 -
93 Natrium diklofenak tablet 50 mg Tablet 1,050 2,000 3,050 450 2,600
94 Botol 16 40 56 16 40
500 ml
104 Pirantel tab score (base) 125 mg Tablet 12 100 112 52 60
105 Piridoksin (Vitamin B6) tablet 10 mg Tablet 600 3,000 3,600 400 3,200
109 Povidon Iodida larutan 10 % - 300 ml Botol 1 5 6 6
114 Ranitidin injeksi 25 mg/ml - 2ml Ampul 95 95 15 80
115 Ranitidin tablet 150 mg Tablet 1,200 3,000 4,200 800 3,400
118 Salbutamol tablet 4 mg (sebagai sulfat) Tablet 200 500 700 200 500
119 Pot 72 72 24 48
Endap 4% - 30 gram
120 Salisil Bedak 2 % -50 gr Kotak - 36 36 36
121 Scabicid krem/Scabimit krem Tube 40 40 20 20
123 Sefadroksil sirup kering 125 mg/5ml - 60 ml Botol - 50 50 6 44
128 Simvastatin tablet 10 mg Tablet 390 900 1,290 270 1,020
134 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg Tablet 4,300 4,300 1,500 2,800
PERBEKALAN KESEHATAN -
140 Abbocath no 20 Pcs 207 207 207
141 Abbocath no 22 Pcs 10 10 10 -
142 Abbocath no 24 Pcs 112 112 1 111
144 Alat Suntik Sekali Pakai 2,5 ml Pcs 83 83 83 -

154 Kapas Pembalut / Absorben 250 gram Bungkus 3 2 5 1 4
155 Kasa Hidrofil Steril ukuran 16x16 cm/ktk @ 16 lbr Lbr - 800 800 144 656
160 Lanset Pcs 600 600 100 500
161 Masker Pcs - 500 500 500 -
163 Polypropilene 6/0 Pcs 15 24 39 2 37
166 Sarung tangan Size M Pcs 800 1,000 1,800 1,000 800
OBAT GIGI
OBAT JIWA
193 Haloperidol tablet 5 mg Tablet 470 470 470
195 Karbamazepin tablet 200 mg Tablet 1,240 1,240 300 940
197 Klorpromazin tablet salut 100 mg (HCl) Tablet - - -
OBAT GIZI
203 Tablet 150 3,450 3,600 1,740 1,860
tab salut
OBAT TB PARU
210 Obat Anti Tuberkulosis Kategori 1 dewasa (OAT FDC) Paket - 2 2 2

211 Kombipak) Paket - 2 2 2

OBAT MALARIA
217 Tablet 18 18 18

221 Tablet - - -
OBAT PROGRAM
224 Albendazol tablet 400 mg Tablet - 150 150 30 120
228

0 1010 1010

NIP. 19731124 199503 2 002 NIP. 19700605 199201 1 001 Nip. 19900606 201903 1 010
( LPLPO )
KODE PUSKESMAS : BULAN : NOVEMBER

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14 15 15 16
2 Ambroxol syrup 15 mg/ml - 60 ml Botol 47 47 26 21 50
3 Ambroxol tablet 30 mg Tablet 800 800 600 200 2,000
6 Amlodipin tablet 10 mg Tablet 2,130 2,130 1,290 840 3,000
8 Amoksisilin kaplet 500 mg Kaplet 2,000 2,000 1,200 800 2,000
10 Amoksisilin sirup kering 125 mg/5ml - 60 ml Botol - - - 100
11 Botol 184 184 84 100 100
12 Tablet 4,600 4,600 1,600 3,000 3,000
13 Anti Diare Tablet Tablet - 500 500 100 400
14 Supp 40 40 5 35
18 Asam Askorbat (Vit C) tablet 50 mg Tablet 3,900 3,900 3,300 600 5,000
19 Asam Mefenamat kaplet 500 mg Kaplet 300 300 300 - 500
25 Cetirizin Sirup 5 ml Sirup - - - 50
26 Cetirizin tablet 10 mg Tablet - - - 1,000
28 Deksametason tablet 0,5 mg Tablet 1,200 1,200 200 1,000
33 Domperidon suspensi 5 mg/5 ml - 60 ml Botol - - -
34 Domperidon tablet 10 mg Tablet 900 900 600 300 1,000

39 Etakridin ( Rivanol ) larutan 0,1% - 300 ml Botol - - - 5
40 Etanol 70 % 100 ml Botol 5 5 4 1 10
41 Etanol 70 % 1000 ml Botol - - -
44 Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ml Ampul - - -
47 Garam Oralit untuk 200 ml air Sachet 100 100 100 100
48 Gentamisin salep kulit 3 % - 5 gram Tube - - - 1,000
51 Glibenklamid tablet 5 mg Tablet 300 300 300
54 Glukosa larutan infus 5 % steril - 500 ml Botol 28 40 68 28 40
57 Ibuprofen tablet 200 mg Tablet 1,600 1,600 1,600
60 Kalsium Laktat (Kalk) tablet 500 mg Tablet 1,800 1,800 600 1,200 1,000
68 Kloramfenikol salep mata 1% Tube 144 144 48 96
72 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet - - - 10,000
75 Sulfametoksazol 400 mg '+ Trimetoprim 80 mg Tablet 600 600 100 500

76 Botol 245 245 12 233
77 Lidokain injeksi 2% - 2 ml Ampul 100 100 100
81 Metformin HCl tablet 500 mg Tablet 1,000 1,000 500 500 3,000
82 Tablet 90 90 90
0,125 mg
89 Mikonazole krim/salep 2 % - 10 gram Tube - 120 120 48 72 48
90 Multivitamin Syrup Botol - - - 100
93 Natrium diklofenak tablet 50 mg Tablet 2,600 2,600 1,300 1,300 3,000
94 Botol 40 40 20 20 20
500 ml
101 Parasetamol sirup 120 mg/5 ml - 60 ml Botol 316 316 66 250
109 Povidon Iodida larutan 10 % - 300 ml Botol 6 6 6
111 Prednison tablet 5 mg Tablet 2,100 2,100 1,900 200 5,000
114 Ranitidin injeksi 25 mg/ml - 2ml Ampul 80 80 40 40 100
115 Ranitidin tablet 150 mg Tablet 3,400 3,400 1,000 2,400
119 Pot 48 48 48
Endap 4% - 30 gram
120 Salisil Bedak 2 % -50 gr Kotak 36 36 3 33
121 Scabicid krem/Scabimit krem Tube 20 20 20 - 100
122 Sefadroksil kapsul 500 mg Kapsul - - - 500
123 Sefadroksil sirup kering 125 mg/5ml - 60 ml Botol 44 44 8 36
127 Sianokobalamin (Vit.B12) tablet 50 mcg Tablet 3,800 3,800 800 3,000
129 Siprofloksasin tablet 500 mg (sebagai HCl) Tablet - - - 500
140 Abbocath no 20 Pcs 207 207 15 192
142 Abbocath no 24 Pcs 111 111 9 102
144 Alat Suntik Sekali Pakai 2,5 ml Pcs - - - 100
145 Alat Suntik Sekali Pakai 3 ml Pcs 200 300 500 10 490
147 Alkohol Swab Kotak 31 31 31
149 Catgut / Benang Bedah No. 2/0 dengan jarum bedah Pcs 24 24 24

153 Infusion Set Dewasa Set 55 55 55
154 Kapas Pembalut / Absorben 250 gram Bungkus 4 4 4
157 Kasa Gulung 40/80 cm Rol 3 3 3
160 Lanset Pcs 500 500 500
161 Masker Pcs - 300 300 300 - 1,000
163 Polypropilene 6/0 Pcs 37 37 37
166 Sarung tangan Size M Pcs 800 800 500 300 1,000
168 Silk (Benang Bedah Sutera) No 2/0 Pcs 20 20 10 10 24
169 Silk (Benang Bedah Sutera) No 3/0 Pcs 12 12 12 - 24
OBAT GIGI
OBAT JIWA
193 Haloperidol tablet 5 mg Tablet 470 470 110 360
197 Klorpromazin tablet salut 100 mg (HCl) Tablet - - - 1,000
200 Risperidon tablet 2 mg Tablet 200 200 150 50 1,000
202 Triheksilfenidil Hidroklorida 2 mg Tablet - 1,000 1,000 60 940
OBAT GIZI
203 Tablet 1,860 3,450 5,310 3,750 1,560 3,450
tab salut
OBAT TB PARU
210 Obat Anti Tuberkulosis Kategori 1 dewasa (OAT FDC) Paket 2 2 2

211 Kombipak) Paket 2 2 2

OBAT MALARIA
217 Tablet 18 18 18

221 Tablet - - -
OBAT PROGRAM
224 Albendazol tablet 400 mg Tablet 120 120 120
228

0 1197 1197

NIP. 19731124 199503 2 002 NIP. 19700605 199201 1 001 Nip. 19900606 201903 1 010

Lplpo 2020

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

Antasida DOEN tab,kombinasi: Mg-Hidroksida

13 Anti Diare Tablet Tablet - - -

15 Antimigren : Ergotamin tartrat 1 mg + Kofein 50 mg Tablet - - - -

36 Epinefrina HCl/Bitartrat (Adrenalina) Injeksi 0,1% - 1 ml Ampul 88 88 - 88

37 Erytromycin kapsul 500 mg Kapsul 2,000 2,000 - 2,000

Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg

120 Salisil Bedak 2 % -50 gr Kotak - - -

151 Foley Catheter Pcs - - - -

210 Obat Anti Tuberkulosis Kategori 1 dewasa (OAT FDC) Paket - - -

Obat Anti Tuberkulosis Kategori 1 dewasa (OAT

212 Obat Anti Tuberkulosis Kategori 2 (OAT FDC) Paket 1 1 - 1

213 Obat Anti Tuberkulosis Kategori anak (OAT Kombipak) Tablet - - -

214 Reagensia TB Set - - -

Bayar Tidak Bayar JUMLAH RESEP

Mengetahui / Menyetujui Yang Menyerahkan Yang meminta

(Rita Mutia, SKM, MKM) (…………………….) (Burhanuddi, SKM)

Yang meminta Yang menerima

(Burhanuddi, SKM) (Arif Mustaqin, A. Md. Far)

36 Epinefrina HCl/Bitartrat (Adrenalina) Injeksi 0,1% - 1 ml Ampul 88 88 - 88

37 Erytromycin kapsul 500 mg Kapsul 2,000 2,000 - 2,000

120 Salisil Bedak 2 % -50 gr Kotak - - -

151 Foley Catheter Pcs - - -

204 Iodium Tes Botol - - -

210 Obat Anti Tuberkulosis Kategori 1 dewasa (OAT FDC) Paket - - -

Obat Anti Tuberkulosis Kategori 1 dewasa (OAT

213 Obat Anti Tuberkulosis Kategori anak (OAT Kombipak) Tablet - 1 1 - 1

219 Artemeter injeksi 80 mg/ml / ktk 6 amp Ampul - - -

Bayar Tidak Bayar JUMLAH RESEP

Mengetahui / Menyetujui Yang Menyerahkan Yang meminta

(Rita Mutia, SKM, MKM) (…………………….) (Burhanuddi, SKM)

(Burhanuddi, SKM) (Arif Mustaqin, A. Md. Far)

36 Epinefrina HCl/Bitartrat (Adrenalina) Injeksi 0,1% - 1 ml Ampul 88 88 - 88

37 Erytromycin kapsul 500 mg Kapsul 2,000 2,000 100 1,900

77 Lidokain injeksi 2% - 2 ml Ampul 31 31 25 6 100

95 Nifedipin tablet 10 mg Tablet - - -

151 Foley Catheter Pcs - - -

210 Obat Anti Tuberkulosis Kategori 1 dewasa (OAT FDC) Paket - - -

Obat Anti Tuberkulosis Kategori 1 dewasa (OAT

213 Obat Anti Tuberkulosis Kategori anak (OAT Kombipak) Tablet 1 1 - 1

214 Reagensia TB Set - - -

Act (Artesunate tablet 50 mg + Amodiaquine anhydrate

Bayar Tidak Bayar JUMLAH RESEP

Mengetahui / Menyetujui Yang Menyerahkan Yang meminta

(Rita Mutia, SKM, MKM) (…………………….) (Burhanuddi, SKM)

(Burhanuddi, SKM) (Arif Mustaqin, A. Md. Far)

36 Epinefrina HCl/Bitartrat (Adrenalina) Injeksi 0,1% - 1 ml Ampul 88 88 - 88

37 Erytromycin kapsul 500 mg Kapsul 1,900 1,900 - 1,900

77 Lidokain injeksi 2% - 2 ml Ampul 6 100 106 31 75

95 Nifedipin tablet 10 mg Tablet - - -

151 Foley Catheter Pcs - - -

210 Obat Anti Tuberkulosis Kategori 1 dewasa (OAT FDC) Paket - - -

Obat Anti Tuberkulosis Kategori 1 dewasa (OAT

213 Obat Anti Tuberkulosis Kategori anak (OAT Kombipak) Tablet 1 1 1 -

214 Reagensia TB Set - - -

Act (Artesunate tablet 50 mg + Amodiaquine anhydrate

Bayar Tidak Bayar JUMLAH RESEP

Mengetahui / Menyetujui Yang Menyerahkan Yang meminta

(Rita Mutia, SKM, MKM) (…………………….) (Burhanuddi, SKM)

(Burhanuddi, SKM) (Arif Mustaqin, A. Md. Far)

NO STOK PENERIMA PERSEDIAA PEMAKAIA SISA STOCK PERMINTAA PEMBERIAN

36 Epinefrina HCl/Bitartrat (Adrenalina) Injeksi 0,1% - 1 ml Ampul 88 88 - 88

37 Erytromycin kapsul 500 mg Kapsul 1,900 1,900 100 1,800