LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( L P L P O )

NAMA PUSKESMAS : Puskesmas Dasan Tapen NO DOC :

KAB/KOTA : Lombok Barat TAHUN : 2020
LAPORAN PERIODE/BULAN : Januari TANGGAL :
PERMINTAAN PERIODE/BULAN : Februari

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN PEMBE RIAN KET

1 2 3 4 5 6 7 = (5-6) 8 9 10 11

BAHAN MEDIS HABIS PAKAI

1 Alat Suntik Sekali Pakai - 1 cc Tuberculin 27G x 1/2" Set 7 7 7

2 Alat Suntik Sekali Pakai - 2.5 cc x 23G x 1 1/4" Set 14 14 2 12
3 Alat Suntik Sekali Pakai - 5 cc x 22G x 1 1/4" Set 2 2 2
4 Alat Suntik Sekali Pakai - 10 cc x 21G x 1 1/2" Set 0 -
5 Benang Operasi - Catgut Chromic 2/0 + jarum 1/2 GT 35 mm Set 0 -
6 Benang Operasi - Catgut Plain 3/0 + jarum 1/2 GT 35 mm Set 1 1 1
7 Infus Set, IV, Wing needle - Infusion Set Pediatric (60 drops/ml) set 1 1 1
8 Infus Set, IV, Wing needle - Infusion Set Dewasa (20 drops/ml) set 0 -
9 Infus Set, IV, Wing needle - I.V Catheter No. 18 G x 32 mm buah 3 5 8 4 4
10 Kasa, Verband, Kapas - Kasa Pembalut / absorben 250 gr Roll 1 1 1
11 MESS 11 pcs 2 10 12 4 8
12 PEMBALUT GIPS 3 INCI buah 0 -
13 PLESTER 5 YARDS X 2 INCHI Roll 0 -
14 Surgical Mask - 3 ply Tie on (tali) pcs 0 -
15 Surgical Mask - 3 ply Earloop (karet) pcs 50 50 50 -
0 -
0 -
TABLET DAN SERBUK ORAL 0 -
0 -
1 Asam Asetilsalisilat (asetosal) tablet 80 mg Tablet 36 36 36
2 Albendazol tablet/kapsul/kaplet 400 mg Tablet 14 14 4 10
3 Alopurinol tablet/kapsul/kaplet 100 mg Tablet 260 260 150 110 200
4 Aminofilin tablet scored 200 mg Tablet 90 90 90
5 ALPRAZOLAM 1 MG TABLET Tablet 106 106 60 46
6 AMITRIPILIN 25 MG TABLET Tablet 150 150 70 80 100
7 Asetylsytein 200 mg Tablet 2256 1200 3456 3152 304 1500
8 Amlodipin tablet 5 mg Tablet 244 4500 4744 3584 1,160 2000
9 Amoksisilin kapsul/kaplet/tablet scored 500 mg Kaplet 933 1000 1933 1,878 55 2000
10 Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroks Tablet 593 500 1093 894 199 1000
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN PEMBE RIAN KET

1 2 3 4 5 6 7 = (5-6) 8 9 10 11
11 Antimigren: Ergotamin Tartrat 1 mg + Kofein 50 mg Tablet 0 -
12 Asam Askorbat (Vitamin C) tablet 250 mg Tablet 0 -
13 Asam Askorbat (Vitamin C) tablet 50 mg Tablet 735 735 180 555
14 Asam Folat tablet/kapsul/kaplet 1 mg Tablet 478 478 114 364 200
15 ASAM MEFENAMAT 500 MG TAB Kaplet 1184 1000 2184 1257 927 1000
16 ASAM TRANEXAMAT TABLET 500 MG Tablet 0 -
17 Asiklovir tablet/kapsul/kaplet 400 mg Tablet 33 33 30 3 200
18 ATTAPULGIT TABLET 600 MG Tablet 185 310 495 381 114 400
19 AMBROXOL 30 MG TAB Tablet 580 580 505 75 600
20 BETAHISTIN MESILAT TABLET 6 MG Tablet 550 550 150 400 200
21 Bisakodil 5 mg (dulkolax) Tablet 10 10 10 -
22 Deksametason tablet 0,5 mg Tablet 1015 1000 2015 1595 420 1500
23 DIAZEPAM 2 MG TAB Tablet 0 -
24 DIAZEPAM 5 MG TAB Tablet 60 60 14 46 100
25 Digoksin tablet 0,25 mg Paket 95 95 95 - ED
26 Dimenhidrinat tablet 50 mg Tablet 150 150 98 52 100
27 Domperidon tablet 10 mg Tablet 263 263 111 152 100
28 Doksisiklin tablet/kapsul/kaplet 100 mg Tablet 100 100 20 80
29 EFEDRIN HCL 25 MG TAB Tablet 0 -
30 ERYTHROMYCIN 500 MG Tablet 100 100 100
31 Fenitoin kapsul/kaplet 100 mg Tablet 229 229 82 147 100
32 FENOBARBITAL 30 MG Tablet 106 106 14 92
33 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tablet 33 33 12 21 100
34 Furosemid tablet 40 mg Tablet 2 2 2 50
35 GLIMEFIRIDE 1 MG Tablet 704 500 1204 330 874
36 GLIMEFIRIDE 2 MG Tablet 520 500 1020 840 180 500
37 Garam Oralit I serbuk, kombinasi : Natrium klorida 0,52 g kalium k Sachet 622 622 338 284 300
38 Glibenklamid tablet 5 mg Tablet 0 -
39 HALOPERIDOL 1.5 MG Tablet 32 100 132 68 64 200
40 HALOPERIDOL 5 MG Tablet 172 300 472 432 40 400
41 HYOCINA N BUTILBROMID 10 MG TAB Tablet 140 200 340 332 8 500
42 Ibuprofen tablet 400 mg Tablet 1000 1000 850 150 1000
43 ISOSORBID DINITRAT SUB LINGUAL 5 MG Tablet 29 29 29
44 KALSIUM LAKTAT 500 MG Tablet 203 203 203
45 Kaptopril tablet scored 12,5 mg Tablet 779 779 10 769
46 Kaptopril tablet scored 25 mg Tablet 5 5 5 - 300
47 KARBAMAZIPIN 200 MG Tablet 58 300 358 126 232 100
48 KLORPROMAZINE 100 MG TABLET Tablet 85 100 185 112 73 200
49 KETOCENAZOLE 200 MG Tablet 157 157 90 67 100
50 Kloramfenikol tablet/kapsul/kaplet 250 mg Tablet 195 195 40 155 100
51 Kloramfenikol tablet/kapsul/kaplet 500 mg Kapsul 230 230 80 150 200
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN PEMBE RIAN KET

1 2 3 4 5 6 7 = (5-6) 8 9 10 11
52 KLORFENIRAMINI MALEAT TAB 4 MG( CTM ) Tablet 1890 1890 1830 60 2000
53 Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg Asam folat Tablet 580 580 160 420 200
54 Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 40 Tablet 210 210 21 189
55 METFORMIN 500 MG Tablet 405 500 905 675 230 500
56 METIL ERGOMETRIN Tablet 30 30 30
57 Metoklopramide tablet 10 mg Tablet 0 -
58 METRONIDAZOLE 500 MG TAB Tablet 110 850 960 816 144 600
59 NATRIUM DIKLOFENAK 50 MG TAB Tablet 0 -
60 Nifedipin tablet/kapsul 10 mg Tablet 62 62 62
61 Omeprazol kapsul/kaplet 20 mg kaplet 197 180 377 255 122 500
62 Parasetamol tablet 500 mg Tablet 574 5000 5574 4,371 1,203 5000
63 Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg (HCl) Tablet 184 184 8 176
64 PIROKSIKAM 10 MG TAB Tablet 0 -
65 PIROKSIKAM 20 MG TAB Tablet 180 800 980 890 90 800
66 Prednison tablet/kapsul/kaplet 5 mg Tablet 210 100 310 110 200 400
67 PTU 100 MG Tablet 210 210 210
68 PYRANTEL SCORE (BASE) 125 MG TAB Tablet 0 -
69 Ranitidin tablet 150 mg Tablet 286 800 1086 826 260 800
70 RISPERODON 2 MG Tablet 143 100 243 136 107 100
71 RETINO MERAH Tablet 58 58 58
72 SALBUTAMOL 4 MG TAB Tablet 390 390 150 240 400
73 SALBUTAMOL 2MG Tablet 80 80 60 20 200
74 Setirizin tablet 10 mg Tablet 361 200 561 484 77 400
75 SIMVASTATIN 20 MG Tablet 113 850 963 493 470 400
76 SIPROFLOXACIN 500 MG Kapsul 238 200 438 256 182 200
77 THIAMPENICOL KAPSUL 250 MG Kapsul 0 -
78 THIAMPENICOL KAPSUL 500 MG Kapsul 0 -
79 THIAMIN HCL 50 MG TAB ( VIT B1 ) Tablet 0 -
80 TRIHEKSIFENIDIL HCL 2 MG TAB Tablet 128 600 728 488 240 600
81 VIT B KOMPLEK TAB Tablet 755 3100 3855 3,684 171 3000
82 ZINC TAB 20 MG Tablet 210 500 710 580 130 500
83 ERGOTAMIN Tablet 18 100 118 26 92
-
SYRUP 0 -
0 -
1 Amoksisilin sirup kering 125 mg/ 5 ml Botol 39 120 159 119 40 120
2 Amoksisilin sirup kering forte 250 mg/5 ml Botol 1 35 36 7 29
3 Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 2 Botol 26 26 10 16 10
4 AMBROXOL SYR Botol 41 20 61 42 19 25
5 Domperidon Syrup Botol 5 30 35 33 2 30
6 Ibuprofen 100 mg suspensi Botol 5 13 18 18 - 15
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN PEMBE RIAN KET

1 2 3 4 5 6 7 = (5-6) 8 9 10 11
7 Kloramfenikol suspensi 125 mg/ 5 ml Botol 17 17 4 13
8 Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg + Trimeto Botol 18 18 6 12 10
9 Metoklopramide sirup 5 mg/ 5 ml Botol 0 -
10 METRONIDAZOL SUSPENSI Botol 0 -
11 Multivitamin Syr Botol 21 21 21 - 200
12 Nistatin Drops Botol 2 15 17 9 8
13 O B H SYR Botol 0 -
14 Parasetamol drop 100 mg/ml btl @15ml (60mg/0,6ml) Botol 10 10 4 6 10
15 Parasetamol sirup 120 mg / 5 ml Botol 13 279 292 215 77 300
0 -
INJEKSI 0 -
0 -
1 Ampisilin serbuk injeksi i.v. 1000 mg/vial Vial 9 9 9
2 Deksametason injeksi i.v./i.m. 5 mg/ml Ampul 9 9 9
3 Diazepam injeksi i.v./i.m 5 mg/ml Ampul 0 -
4 METAMIZOLE INJEKSI Ampul 4 4 4
5 HYOCINA N BUTILBROMID INJ 20 MG Ampul 0 -
6 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml Ampul 1 1 1
7 Lidokain injeksi 2% (HCL) Ampul 0 -
8 Metoklopramide INJ 5 MG/ML Ampul 8 8 8
9 RANITIDIN INJ 25 MG/2 ML Ampul 5 5 5
0 -
OBAT KHUSUS 0 -
0 -
1 Antihemoroid, kombinasi: bismut subgalat 150 mg heksaklorofen SUPP 10 10 10 - 20
2 BISACODYL SUPP (DULCOLAX) 10 MG / Stolax supp SUPP 11 11 2 9
3 DULCOLAX SUUP ANAK SUUP 4 4 4
4 MICROLAX TUBE 0 -
5 NISTATIN VAGINAL SUUP 55 55 55
6 PARASETAMOL SUPP 80 MG SUPP 0 - 10
7 PARASETAMOL SUPP 160 MG SUPP 10 10 2 8 10
8 PARASETAMOL SUUP 125 MG SUUP 7 7 7 - 10
9 SABU I 5 ML VIAL 0 -
10 SALBUTAMOL (AS SULPHATE) 2,5 MG/2,5 ML NEBULS Ampul 11 11 11 - 20
11 SERUM ATS 1 500 IU VIAL 0 -
0 -
0 -
OBAT LUAR 0 -
0 -
1 Anti Bakteri DOEN salep kombinasi: Basitrasin 500 IU/g Polimiksi Tube 0 -
2 ASIKLOVIR CREAM 5% Tube 24 24 4 20
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN PEMBE RIAN KET

1 2 3 4 5 6 7 = (5-6) 8 9 10 11
3 BETAMETASON CREAM 0,1 % Tube 14 24 38 14 24 24
4 FENOL GLISEROL TT 10% TUBE 0 -
5 GENTAMICIN SK 0,1% Botol 114 114 84 30 100
6 GENTAMICIN SALEP MATA 0,3% Tube 17 17 4 13 10
7 GENTAMISIN SULFAT TETES MATA Tube 24 24 24
8 GENTIAN VIOLET LART 1% Botol 14 14 1 13
9 HEXACHLOROCYLOHEXANE 0,5% (Peditox) Botol 0 -
10 HIDROGEN PEROKSIDA LARUTAN 3% Botol 0 -
11 ICHTIOL SALEP HITAM Pot 0 -
12 FENOL GLISEROL TT 10% BOTOL 8 8 7 1
13 KETOKONAZOL KRIM 2% Tube 13 24 37 35 2 24
14 Kloramfenikol salep mata 1 % Tube 16 16 4 12 15
15 Kloramfenikol teter telinnga 3 % Botol 7 7 7 - 10
16 Kloramfenikol tetes mata Botol 13 13 9 4 15
17 OKSITETRASIKLIN SK 3% Tube 0 -
18 OKSITETRASIKLIN SM 1% Tube 8 8 8
19 Povidon Iodida larutan 10% 30 ml Botol 0 -
20 Povidon Iodida larutan 10% 300 ml Botol 0 -
21 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% Botol 42 42 9 33 24
22 SALEP LUKA BAKAR Pot 0 -
23 Bedak salisil serbuk 2% Tube 4 36 40 32 8 40
24 kloramfenikol salep kulit Tube 23 23 6 17 20
25 Sulfadiazin salep kulit Tube 1 1 1
0 -
TAMBAHAN 0 -
1 KANINA SYR Botol 6 6 6
2 ROHTO Botol 7 7 7
3 GUANISTREP SYR Botol 3 3 3
4 ILIADIN TETES HIDUNG Botol 5 5 5
5 LOPERAMIDE 2 MG TAB Tablet 0 -
6 SANGOBION KID SYR Botol 10 10 9 1
7 HEMABION kapsul 10 100 110 110
8 CAVIVPLEX KAPLET kaplet 600 600 320 280 500
9 implant SET 0 -
10 spuit 3 cc SET 0 -
11 plester LEMBAR 2 2 1 1
12 SCABIMITE TUBE 1 9 10 10 -
13 ALKOHOL 70% 100 ML BOTOL 1 1 1
14 CLOZAPIN 25 MG TABLET 8 50 58 14 44
15 CLOZAPINE 100MG TABLET 50 50 50
16 lidocain AMPUL 10 10 1 9
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN PEMBE RIAN KET

1 2 3 4 5 6 7 = (5-6) 8 9 10 11
17 IUD SET 2 2 2

UMUM
BAYAR TIDAK BAYAR
JUMLAH KUNJUNGAN RESEP
BPJS UKS GR
297
1043 8 1348

Mengetahui Yang Menyerahkan Yang Melapor

Pemimpin UPT BLUD Puskesmas Dasan Tapen Pengelola Obat Puskesmas Petugas Obat UGD
APOTEK

Ns. H. Hasmuni Budiawan, S.Kep Dyah Noor Hidayati IDA FARIDA

NIP. 19680702 199003 1006 NIP.19780402 199803 2001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( L P L P O )
SUB UNIT : APOTEK NO DOC :
KAB/KOTA : Lombok Barat TAHUN : 2021
LAPORAN PERIODE/BULAN : JANUARI TANGGAL :
PERMINTAAN PERIODE/BULAN : FEBRUARI

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN PEMBE RIAN KET

1 2 3 4 5 6 7 = (5-6) 8 9 10 11

BAHAN MEDIS HABIS PAKAI

1 Alat Suntik Sekali Pakai - 1 cc Tuberculin 27G x 1/2" Set 5 5 1 4

2 Alat Suntik Sekali Pakai - 2.5 cc x 23G x 1 1/4" Set 0 11 11 6 5 5
3 Alat Suntik Sekali Pakai - 5 cc x 22G x 1 1/4" Set 0 0 -
4 Alat Suntik Sekali Pakai - 10 cc x 21G x 1 1/2" Set 0 0 -
5 Benang Operasi - Catgut Chromic 2/0 + jarum 1/2 GT 35 mm Set 0 0 -
6 Benang Operasi - Catgut Plain 3/0 + jarum 1/2 GT 35 mm Set 0 0 -
7 Infus Set, IV, Wing needle - Infusion Set Pediatric (60 drops/ml) set 0 0 -
8 Infus Set, IV, Wing needle - Infusion Set Dewasa (20 drops/ml) set 0 0 -
9 Infus Set, IV, Wing needle - I.V Catheter No. 18 G x 32 mm buah 0 0 -
10 Kasa, Verband, Kapas - Kasa Pembalut / absorben 250 gr Roll 0 0 -
11 MESS 11 pcs 9 9 6 3
12 PEMBALUT GIPS 3 INCI buah 0 0 -
13 PLESTER 5 YARDS X 2 INCHI Roll 0 0 -
14 Surgical Mask - 3 ply Tie on (tali) pcs 0 0 -
15 Surgical Mask - 3 ply Earloop (karet) pcs 0 100 100 70 30
16 HANSANITALIZER BOTOL 1 1 1
17 HANSCOON NON STERIL ( M ) 0 0 -
0 0 -
0 0 -
TABLET DAN SERBUK ORAL 0 0 -
0 0 -
1 Asam Asetilsalisilat (asetosal) tablet 80 mg Tablet 0 0 -
2 Albendazol tablet/kapsul/kaplet 400 mg Tablet 18 18 1 17
3 Alopurinol tablet/kapsul/kaplet 100 mg Tablet 150 300 450 190 260 300
4 Aminofilin tablet scored 200 mg Tablet 0 0 -
5 ALPRAZOLAM 1 MG TABLET Tablet 190 190 9 181
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN PEMBE RIAN KET

1 2 3 4 5 6 7 = (5-6) 8 9 10 11
6 AMITRIPILIN 25 MG TABLET Tablet 84 84 28 56
7 Asetylsytein 200 mg Tablet 223 1500 1723 1103 620 1500
8 Amlodipin tablet 5 mg Tablet 231 3300 3531 3191 340 2500
9 Amoksisilin kapsul/kaplet/tablet scored 500 mg Kaplet 1077 1000 2077 1,055 1,022 1000
10 Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksi Tablet 770 1000 1770 830 940 400
11 Antimigren: Ergotamin Tartrat 1 mg + Kofein 50 mg Tablet 42 42 42
12 Asam Askorbat (Vitamin C) tablet 250 mg Tablet 364 500 864 449 415 200
13 Asam Askorbat (Vitamin C) tablet 50 mg Tablet 0 500 500 450 50 500
14 Asam Folat tablet/kapsul/kaplet 1 mg Tablet 16 200 216 100 116 200
15 ASAM MEFENAMAT 500 MG TAB Kaplet 1212 1212 264 948
16 ASAM TRANEXAMAT TABLET 500 MG Tablet 0 0 -
75 Asiklovir tablet/kapsul/kaplet 400 mg Tablet 25 200 225 24 201
18 ATTAPULGIT TABLET 600 MG Tablet 90 90 90
603 AMBROXOL 30 MG TAB Tablet 973 973 443 530 300
20 BETAHISTIN MESILAT TABLET 6 MG Tablet 200 200 100 100
21 Bisakodil 5 mg (dulkolax) Tablet 0 0 -
22 Deksametason tablet 0,5 mg Tablet 850 1000 1850 807 1,043 1000
23 DIAZEPAM 2 MG TAB Tablet 0 0 -
24 DIAZEPAM 5 MG TAB Tablet 22 22 22
25 Digoksin tablet 0,25 mg Paket 0 0 -
26 Dimenhidrinat tablet 50 mg Tablet 0 300 300 230 70 300
27 Domperidon tablet 10 mg Tablet 64 100 164 80 84
28 Doksisiklin tablet/kapsul/kaplet 100 mg Tablet 60 60 60
29 EFEDRIN HCL 25 MG TAB Tablet 0 0 -
30 ERYTHROMYCIN 500 MG Tablet 80 80 80
31 Fenitoin kapsul/kaplet 100 mg Tablet 143 143 70 73
32 FENOBARBITAL 30 MG Tablet 22 22 22

33 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tablet 76 76 14 62

34 Furosemid tablet 40 mg Tablet 44 44 44
35 GLIMEFIRIDE 1 MG Tablet 518 518 518
36 GLIMEFIRIDE 2 MG Tablet 265 1000 1265 1110 155 1000
37 Garam Oralit I serbuk, kombinasi : Natrium klorida 0,52 g kalium k Sachet 86 100 186 126 60 100
38 Glibenklamid tablet 5 mg Tablet 0 0 -
39 HALOPERIDOL 1.5 MG Tablet 125 125 25 100
40 HALOPERIDOL 5 MG Tablet 24 400 424 238 186 400
41 HALOPERIDOL 0.5 MG Tablet 0 0 -
42 HYOCINA N BUTILBROMID 10 MG TAB Tablet 269 269 145 124 200
43 Ibuprofen tablet 400 mg Tablet 640 1000 1640 700 940 1000
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN PEMBE RIAN KET

1 2 3 4 5 6 7 = (5-6) 8 9 10 11
44 ISOSORBID DINITRAT SUB LINGUAL 5 MG Tablet 9 9 9
45 KALSIUM LAKTAT 500 MG Tablet 0 0 -
46 Kaptopril tablet scored 12,5 mg Tablet 349 349 30 319
47 Kaptopril tablet scored 25 mg Tablet 299 299 71 228
48 KARBAMAZIPIN 200 MG Tablet 86 86 70 16 200
49 KLORPROMAZINE 100 MG TABLET Tablet 18 200 218 77 141 200
50 KETOCENAZOLE 200 MG Tablet 73 100 173 40 133
51 Kloramfenikol tablet/kapsul/kaplet 250 mg Tablet 78 78 78
52 Kloramfenikol tablet/kapsul/kaplet 500 mg Kapsul 120 120 20 100
53 KLORFENIRAMINI MALEAT TAB 4 MG( CTM ) Tablet 1250 1000 2250 1177 1,073 1000
54 Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg Asam folat 0 Tablet 200 600 800 560 240 600
55 Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 Tablet 60 60 60
56 METFORMIN 500 MG Tablet 762 1000 1762 1132 630 1000
57 METIL ERGOMETRIN Tablet 0 0 -
58 Metoklopramide tablet 10 mg Tablet 30 30 30

59 METRONIDAZOLE 500 MG TAB Tablet 63 200 263 38 225

60 NATRIUM DIKLOFENAK 50 MG TAB Tablet 554 500 1054 694 360 800
61 Nifedipin tablet/kapsul 10 mg Tablet 0 0 -
62 Omeprazol kapsul/kaplet 20 mg kaplet 65 360 425 155 270 200
63 Parasetamol tablet 500 mg Tablet 1571 3000 4571 2,906 1,665 2000
64 Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg (HCl) Tablet 216 216 216
65 PIROKSIKAM 10 MG TAB Tablet 0 0 -
66 PIROKSIKAM 20 MG TAB Tablet 350 350 350
67 Prednison tablet/kapsul/kaplet 5 mg Tablet 213 1000 1213 455 758 500
68 PTU 100 MG Tablet 200 200 200
69 PYRANTEL SCORE (BASE) 125 MG TAB Tablet 0 0 -
70 Ranitidin tablet 150 mg Tablet 392 600 992 772 220 400
71 RISPERODON 2 MG Tablet 159 159 46 113
72 RETINO MERAH Tablet 50 50 50
73 SALBUTAMOL 4 MG TAB Tablet 112 300 412 299 113 300
74 SALBUTAMOL 2MG Tablet 0 0 -
75 Setirizin tablet 10 mg Tablet 637 500 1137 890 247 700
76 SIMVASTATIN 20 MG Tablet 117 117 87 30 100
77 SIPROFLOXACIN 500 MG Kapsul 125 200 325 150 175 200
78 THIAMPENICOL KAPSUL 250 MG Kapsul 0 0 -
79 THIAMPENICOL KAPSUL 500 MG Kapsul 0 0 -
80 THIAMIN HCL 50 MG TAB ( VIT B1 ) Tablet 0 0 -
81 TRIHEKSIFENIDIL HCL 2 MG TAB Tablet 64 200 264 252 12 300
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN PEMBE RIAN KET

1 2 3 4 5 6 7 = (5-6) 8 9 10 11
82 VIT B KOMPLEK TAB Tablet 636 2000 2636 2,301 335 2500
83 ZINC TAB 20 MG Tablet 389 389 254 135 200
84 VIT A BIRU KAP 0 0 -
0 -
SYRUP 0 0 -
0 0 -
1 Amoksisilin sirup kering 125 mg/ 5 ml Botol 0 0 -
2 Amoksisilin sirup kering forte 250 mg/5 ml Botol 41 60 101 71 30 60
3 Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 2 Botol 10 12 22 19 3 20
4 AMBROXOL SYR Botol 22 20 42 29 13 15
5 Domperidon Syrup Botol 10 15 25 13 12 10
6 Ibuprofen 100 mg suspensi Botol 0 0 -
7 Kloramfenikol suspensi 125 mg/ 5 ml Botol 1 10 11 4 7
8 Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg + Trimeto Botol 16 16 1 15
9 Metoklopramide sirup 5 mg/ 5 ml Botol 0 0 -
10 METRONIDAZOL SUSPENSI Botol 0 0 -
11 Multivitamin Syr Botol 5 69 74 22 52 15

12 Nistatin Drops Botol 3 5 8 7 1 6

13 O B H SYR Botol 7 7 1 6
14 Parasetamol drop 100 mg/ml btl @15ml (60mg/0,6ml) Botol 13 13 4 9
15 Parasetamol sirup 120 mg / 5 ml Botol 65 100 165 159 6 100
0 0 -
INJEKSI 0 0 -
0 0 -
1 Ampisilin serbuk injeksi i.v. 1000 mg/vial Vial 7 7 7
2 Deksametason injeksi i.v./i.m. 5 mg/ml Ampul 0 0 -
3 Diazepam injeksi i.v./i.m 5 mg/ml Ampul 0 0 -
4 METAMIZOLE INJEKSI Ampul 4 4 4
5 HYOCINA N BUTILBROMID INJ 20 MG Ampul 0 0 -
6 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml Ampul 11 11 5 6
7 Lidokain injeksi 2% (HCL) Ampul 0 0 -
8 Metoklopramide INJ 5 MG/ML Ampul 8 8 8
9 RANITIDIN INJ 25 MG/2 ML Ampul 0 0 -
0 0 -
OBAT KHUSUS 0 0 -
0 0 -
1 Antihemoroid, kombinasi: bismut subgalat 150 mg heksaklorofen SUPP 20 20 12 8 20
2 BISACODYL SUPP (DULCOLAX) 10 MG / Stolax supp SUPP 3 3 1 2
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN PEMBE RIAN KET

1 2 3 4 5 6 7 = (5-6) 8 9 10 11
3 DULCOLAX SUUP ANAK SUUP 1 1 1
4 MICROLAX TUBE 0 0 -
5 NISTATIN VAGINAL SUUP 0 0 -
6 PARASETAMOL SUPP 80 MG SUPP 12 12 1 11
7 PARASETAMOL SUPP 160 MG SUPP 9 9 3 6
8 PARASETAMOL SUUP 125 MG SUUP 2 2 2
9 SABU I 5 ML VIAL 0 0 -
10 SALBUTAMOL (AS SULPHATE) 2,5 MG/2,5 ML NEBULS Ampul 10 20 30 12 18 20
11 SERUM ATS 1 500 IU VIAL 0 0 -
0 0 -
0 0 -
OBAT LUAR 0 0 -
0 0 -
1 Anti Bakteri DOEN salep kombinasi: Basitrasin 500 IU/g Polimiksin Tube 0 0 -
5 ASIKLOVIR CREAM 5% Tube 16 16 4 12
3 BETAMETASON CREAM 0,1 % Tube 17 17 11 6 24
4 GENTAMICIN SK 0,1% Botol 0 20 20 20 60
5 GENTAMICIN SALEP MATA 0,3% Tube 30 30 18 12 10
6 GENTAMISIN SULFAT TETES MATA Tube 9 9 2 7
7 GENTIAN VIOLET LART 1% Botol 9 9 9
8 HEXACHLOROCYLOHEXANE 0,5% (Peditox) Botol 4 4 4
9 HIDROGEN PEROKSIDA LARUTAN 3% Botol 0 0 -
10 ICHTIOL SALEP HITAM Pot 2 2 1 1
11 FENOL GLISEROL TT 10% BOTOL 0 24 24 5 19
12 KETOKONAZOL KRIM 2% Tube 12 12 12 - 24
13 Kloramfenikol salep mata 1 % Tube 18 18 12 6 10
14 Kloramfenikol teter telinnga 3 % Botol 3 10 13 3 10
15 Kloramfenikol tetes mata Botol 19 24 43 22 21
16 OKSITETRASIKLIN SK 3% Tube 0 0 -
17 OKSITETRASIKLIN SM 1% Tube 0 0 -
18 Povidon Iodida larutan 10% 30 ml Botol 0 0 -
19 Povidon Iodida larutan 10% 300 ml Botol 0 0 -
20 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% Botol 24 24 19 5 24
21 SALEP LUKA BAKAR Pot 0 0 -
22 Bedak salisil serbuk 2% Tube 24 30 54 32 22 30
23 kloramfenikol salep kulit Tube 22 72 94 67 27 70
24 Sulfadiazin salep kulit Tube 0 0 -
25 Hidrokortison salep kulit tube 2 24 26 7 19
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN PEMBE RIAN KET

1 2 3 4 5 6 7 = (5-6) 8 9 10 11
TAMBAHAN 0 0 -
1 KANINA SYR Botol 0 0 -
2 ROHTO Botol 0 0 -
3 GUANISTREP SYR Botol 0 0 -
4 ILIADIN TETES HIDUNG Botol 0 0 -
5 LOPERAMIDE 2 MG TAB Tablet 60 60 60 -
6 SANGOBION KID SYR Botol 5 5 3 2
7 HEMABION kapsul 0 0 -
8 CAVIVPLEX KAPLET kaplet 0 0 -
9 implant SET 3 3 3 -
10 spuit 3 cc SET 0 0 -
11 plester / Dermafix LEMBAR 1 1 1 -
12 SCABIMITE TUBE 0 0 -
13 ALKOHOL 70% 100 ML BOTOL 0 0 -
14 CLOZAPIN 25 MG TABLET 0 0 -
15 CLOZAPINE 100MG TABLET 0 0 -
16 lidocain AMPUL 0 0 -
17 IUD SET 3 3 3
18 LORATADINE TAB TABLET 0 0 -
19 klip tanggung pak 6 6 6
20 klip besar pak 13 13 7 6
21 Hanscoon steril PCS 8 8 8
22 ASAM MEFENAMAT TABLET 50 50 50
23 Sendok obat 100 100 100 -
24 klip tanggung / besar 7 7 7
25 kertas punyer 2 2 2
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK STOK OPT PERMINTAAN PEMBE RIAN KET

1 2 3 4 5 6 7 = (5-6) 8 9 10 11

JUMLAH KUNJUNGAN RESEP UMUM

BAYAR TIDAK BAYAR JUMLAH
GR
170 752 9 931

Mengetahui Yang Menyerahkan Yang Melapor

Pemimpin UPT BLUD Puskesmas Dasan Tapen Pengelola Obat Puskesmas Petugas Obat APOTEK

ZULHANA,SKM.MM DYAH NOOR HIDAYATI IDA FARIDA

NIP. 19690904 199303 2 009 NIP.19780402 199803 2001