LAPORAN PEMAKAIAN DANLAPORAN

LEMBAR PERMINTAAN
PEMAKAIANOBATDAN LEMBAR PERMINTAAN OBAT
PUSKESMAS PUSKESMAS
PUSKESMAS
PUSKESMAS : PEMATANG PANGGANG 1 PELAPORAN BULAN : JANUARI 2017 DOKUMEN NOMOR Tanggal
KECAMATAN : MESUJI PERMINTAAN BULAN : DINKES KAB / KOTA
KABUPATEN : OGAN KOMERING ILIR GFK KAB / KOTA
PROPINSI : SUMATERA SELATAN PUSKESMAS

NO NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 Acyclovir 200 mg tab Tablet 802 300 1102 93 1009
2 Acyclovir krim Tube 51 0 51 7 44
3 Air Raksa Dental Btl 0 0 0 0 0
4 Alat Suntik Sekali Pakai 1 ml Pcs 0 0 0 0 0
5 Alat Suntik Sekali Pakai 3 ml Pcs 924 0 924 265 659
6 Alat Suntik Sekali Pakai 5 ml Pcs 373 0 373 34 339
7 Albendasol 400 mg tab Tablet 0 0 0 0 0
8 Allupurinol 100 mg Tablet 1000 1000 2000 301 1699
9 Ambroxol Syr Btl 0 0 0 0 0
10 Ambroxol tab Tablet 0 0 0 0 0
11 Aminofillin 200 mg Tablet 0 0 0 0 0
12 Aminofillin inj 24 mg/ml-10 ml Ampul 0 0 0 0 0
13 Amitriptylin 25 mg tab Tablet 0 0 0 0 0
14 Amoksisilin 250 mg Tablet 716 600 1316 214 1102
15 Amoksisilin 500 mg Tablet 165 2000 2165 1457 700
16 Amoksisilin Syr Btl 200 0 200 36 164
17 Ampisilin 1 gr inj Vial 0 0 0 0 0
18 Ampisilin 500 mg Tablet 0 0 0 0 0
19 Antalgin 500 mg Tablet 1179 1000 2179 480 1699
20 Antalgin inj Ampul 100 0 100 8 92
21 Antasida DOEN Kombinasi Tablet 3280 2000 5280 776 4504
22 Antasida Syr DOEN Btl 35 200 235 32 203
23 Anti Haemoroid suppos Suppo 0 0 0 0 0
24 Antifungi DOEN Kombinasi Salep Pot 76 48 124 0 124
25 Antithrom / Heparin Na. Krim/Hico Tube 0 0 0 0 0
26 Aqua Pro Inj. Steril 20 ml Btl 20 40 60 20 40
27 Asam Asetilsalisilat 100 mg tab Tablet 1100 1000 2100 0 2100
28 asam Askorbat (Vit.C) 50 mg Tablet 4000 2000 6000 191 5809
29 Asam Mefenamat 500 mg Tablet 3110 3000 6110 880 5230
30 Atagip tab Tablet 0 0 0 0 0
31 Betahistin Masylate 6 mg tab Tablet 0 0 0 0 0
32 Betametason 0,1% Krim Tube 7 96 103 14 89
33 Calortusin tab Tablet 0 0 0 0 0
 HALAMAN :2 LPLPO NO: LAPORAN BULAN :
NO NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
32 Atagip Tab Tablet 0 0 0 0 0 0 0
33 Atropine Inj 0,25 mg/ml Ampul 0 0 0 0 0 0 0
34 Betahistin Masylate 6 mg tab Tablet 0 0 0 0 0 0 0
35 Betametason 0,1% Krim Tube 67 0 67 12 55 38 24
36 Calortusin tab Tablet 0 0 0 0 0 0 0
37 Captopril 12,5 mg Tablet 786 0 786 280 506 883 800
38 Captopril 25 mg Tube 2164 0 2164 340 1824 840 800
39 Catgut/Benang Chromic Bedah No.2/3-3/0 Pcs 85 0 85 32 53 55 50
40 Catgut/Benang Plain Bedah No.2/3-3/0 Pcs 112 0 112 35 77 43 40
41 Cefadroxil 500 mg Tablet 0 0 0 0 0 0 1000
42 Cetirizine 5 mg/ 5 ml Syr Btl 10 0 10 0 10 0 100
43 Cimetidin 200mg Tablet 1845 0 1845 50 1795 168 200
44 Ciprofloxacin 500 mg tab Tablet 2430 0 2430 141 2289 569 400
45 Ciprofloxacin infus Btl 3 0 3 2 1 1.8 2
46 Coparcetin tab Tablet 0 0 0 0 0 0 0
47 Deksametason 0,5 mg Tablet 4572 0 4572 632 3940 1680 1000
48 Deksametason inj 5 mg/ml - 1 ml Ampul 234 0 234 9 225 27 25
49 Dermafic S IV Pcs 0 0 0 0 0 0 0
50 Devitalisasi pasta Tablet 0 0 0 0 0 0 0
51 Diazepam 2 mg Tablet 0 0 0 0 0 2314 2000
52 Diazepam inj 5mg/ml - 2 ml Ampul 5 0 5 5 0 4 5
53 Difenhidramin HCL inj 10 mg/ml Ampul 189 0 189 56 133 110 50
54 Digoksin 0,25 mg Tablet 550 0 550 70 480 96 100
55 Domperidone 10 mg Tablet 747 0 747 130 617 546 300
56 Doxycycline 100 mg Kapsul Tablet 200 0 200 0 200 0 0
57 Epinefrin HCL /Bitartrat Inj 0,1 % Ampul 300 0 300 0 300 0 0
58 Erlamycetin TT Btl 0 0 0 0 0 0 100
59 Eryra Forte tab Kapsul 1740 0 1740 142 1598 322 200
60 Erytromicin 500 mg tab Kapsul 0 0 0 0 0 0 0
61 Erytromicin Syr Btl 68 0 68 47 21 79 50
62 Etakridina (Rivanol) 0,1 % Btl 58 0 58 4 54 8 0
63 Etanol 70% - 100 ml Btl 8 0 8 0 8 0.8 0
64 Etanol 70% - 1000 ml Btl 23 0 23 0 23 1.8 0
65 Etil klorida semprot Btl 0 0 0 0 0 0 40
66 Eugenol cairan Btl 6 0 6 0 6 0 0
67 Fenobarbital 100 mg Tablet 1000 0 1000 0 1000 0 0
68 Fenobarbital 30 mg Tablet 0 0 0 0 0 0 0
 HALAMAN : 3 LPLPO NO : LAPORAN BULAN :
NO NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
69 Fenobarbital inj 50mg/ml - 2 ml Ampul 30 0 30 0 30 0 0
70 Fenol Gliserol 10% TT Btl 173 0 173 4 169 14 10
71 Fetominadion (vit.K1) 10 mg Tablet 1680 0 1680 20 1660 32 0
72 Fetominadion (vit.K1) inj 10 mg/ml Ampul 0 0 0 0 0 76 76
73 Folley catheter NO.16 Pcs 4 0 4 0 4 0 6
74 Furosemida 40 mg Tablet 1433 0 1433 70 1363 270 200
75 Furosemida inj Ampul 25 0 25 0 25 0 0
76 Garam Oralit Sachet 498 0 498 37 461 191 0
77 Gentamicin 0,1 % SK Tube 67 0 67 10 57 50 48
78 Gentamicin 0,3% TM Btl 89 0 89 4 85 30 25
79 Gentamicin inj mg/ml Ampul 25 0 25 9 16 7 25
80 Gentian Violet 1% Larutan Btl 71 0 71 3 68 10 0
81 Glass Ionomerlement Set 0 0 0 0 0 0 0
82 Glibenklamid 5 mg Tablet 0 0 0 0 0 0 0
83 Glimepiride Tablet 500 0 500 0 500 0 0
84 Gliseril Guaikolat 100 mg Tablet 4412 0 4412 833 3579 1935 1000
85 Glukosa Larutan Infus 10% Btl 75 0 75 35 40 48 20
86 Glukosa Larutan Infus 5% Btl 72 0 72 16 56 22 20
87 Griseofulvin 125 mg Tablet 1200 0 1200 40 1160 192 200
88 Haloperidol 0,5 mg tab Tablet 1700 0 1700 0 1700 0 0
89 HandScuun No. 7,5 Pcs 1105 0 1105 120 985 154 200
90 HandScuun Steril No.7 Pcs 0 0 0 0 0 0 500
91 HandScuun Steril No. 7,5 Pcs 0 0 0 0 0 0 500
92 Hemafort Tablet 2890 0 2890 110 2780 176 200
93 Hexymer tab Tablet 1000 0 1000 0 1000 0 0
94 Hidroklorotiazida (HCT) 25 mg Tablet 1390 0 1390 0 1390 8 0
95 Hidrokortison krim 2,5% Tube 119 0 119 13 106 43 48
96 Ibuprofen 200 mg Tablet 5375 0 5375 80 5295 564 500
97 Ibuprofen 400 mg Tablet 5765 0 5765 150 5615 308 300
98 Ibuprofen Susp Btl 139 0 139 0 139 9 0
99 Ichtiol Salep Pot 0 0 0 0 0 0 0
100 Infusion Set Anak Pcs 107 0 107 24 83 38 20
101 Infusion Set Dewasa Pcs 82 0 82 23 59 37 20
102 Isosorbid Tablet Tablet 700 0 700 0 700 0 0
103 IV Cateter No.20 Pcs 129 0 129 30 99 49 20
104 IV Cateter No.22 Pcs 87 0 87 15 72 22 20
105 IV Cateter No.24 Pcs 107 0 107 107 0 104 100

HALAMAN : 4 LPLPO NO : LAPORAN BULAN :

NO NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
106 Jarum Jahit Kulit Sutra Pcs 46 0 46 0 46 0 0
107 Kalium Permanganat Serbuk Pot 0 0 0 0 0 0 0
108 Kalsium Laktat (Kalk) 500 mg Tablet 4710 0 4710 900 3810 1592 700
109 Kapas Pembalut/Absorben 250 mg Pcs 26 0 26 0 26 3 0
110 Karbamazepin Pcs 0 0 0 0 0 0 0
111 Kasa Kompres 40/40 Steril Pcs 155 0 155 28 127 42 24
112 Kasa Pembalut 2x80 Pcs 79 0 79 0 79 0.8 0
113 Kasa Pembalut Hidrofil 4m x 15cm Pcs 181 0 181 54 127 82 30
114 Kasa pembalut Hidrofil 4m x 3cm Pcs 84 0 84 52 32 102 50
115 Ketokonazol 200 mg Krim Tube 0 0 0 0 0 8 8
116 Ketokonazol 200 mg Tablet 0 0 0 0 0 12 12
117 Kloramfenicol 250 mg Kapsul 0 0 0 0 0 0 0
118 Kloramfenicol 3% TT Btl 0 0 0 0 0 0 0
119 Kloramfenicol Suspensi 125 mg/ml Btl 71 0 71 11 60 45 50
120 Kloramfenicol 1% SM Tube 5 0 5 5 0 35 30
121 Klorfeniramin Maleat ( CTM ) 4 mg Tablet 6793 0 6793 1633 5160 3872 2300
122 Klorokina Fosfat 250 mg Tablet 0 0 0 0 0 0 0
123 Klorpromazin HCL 100 mg Tablet 1000 0 1000 0 1000 0 0
124 Komb. Pirimet 2 mg + Sulfadox 500 mg Tablet 0 0 0 0 0 0 0
125 Kotrimoksazol Kombinasi 120 mg Tablet 0 0 0 0 0 0 0
126 Kotrimoksazol Kombinasi 480 mg Tablet 1350 0 1350 150 1200 640 500
127 Kotrimoksazol Sups Btl 145 0 145 32 113 78 50
128 Leukoplast Rol 18 0 18 0 18 1.6 2
129 Levertran Salep / Salep Luka Bakar Pot 73 0 73 0 73 22 22
130 Lidokain 2 % Ampul 0 0 0 0 0 0 0
131 Lidokain Comp. Inj Kombinasi Ampul 225 0 225 63 162 118 55
132 Locoriz Krim Tube 0 0 0 0 0 0 0
133 Loperamid 2 mg tab Tablet 1610 0 1610 0 1610 152 200
134 Loratadine 10 mg tab Tablet 0 0 0 0 0 0 0
135 Lysol 1 Liter Btl 19 0 19 2 17 2 0
136 Magnesium Sulfat inj 40% ( MgSO4) Btl 4 0 4 2 2 1.6 2
137 Masker Pcs 534 0 534 41 493 86 45
138 Mess No.16 Pcs 19 0 19 6 13 14 8
139 Metformin 500 mg tab Tablet 1470 0 1470 70 1400 320 250
140 Metil Ergometrin Maleat 0,125 mg Tablet 0 0 0 0 0 0 0
141 Metil Ergometrin Maleat inj 0,2 mg/ml Ampul 120 0 120 10 110 16 6
142 Metil Prednisolon 4 mg Tablet 2820 0 2820 20 2800 160 140

HALAMAN : 5 LPLPO NO : LAPORAN BULAN :

NO NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
143 Metronidazol 250 mg Tablet 1465 0 1465 20 1445 124 100
144 Metronidazol 500 mg Tablet 1350 0 1350 80 1270 184 100
145 Metronidazol Infus Btl 0 0 0 0 0 0 0
146 Metronidazol Syr Btl 108 0 108 1 107 2 0
147 Miconazole 2% SK Tube 71 0 71 4 67 24 24
148 Momilen Baby Gold Sirup Btl 189 0 189 21 168 26 0
149 My Jelly 82 Gram Btl 0 0 0 0 0 0 0
150 Natrium Bikarbonat 500 mg Tablet 0 0 0 0 0 0 0
151 Natrium Diclopenac 25 mg tab Tablet 2010 0 2010 50 1960 432 382
152 Natrium Klorida Larutan Infus 0,9% Btl 141 0 141 11 130 24 0
153 New Antides Tablet Tablet 0 0 0 0 0 0 0
154 Nifedipin 10 mg tab Tablet 870 0 870 30 840 128 100
155 Nistatin tab Vag 100.000 iu/g Tab Vaginal 146 0 146 0 146 3 3
156 Novachlor Kapsul Kapsul 1676 0 1676 100 1576 339 250
157 Nutrifar Tab Tablet 0 0 0 0 0 0 2000
158 Obat Batuk Hitam Btl 0 0 0 0 0 0 150
159 OBH FM Btl 0 0 0 0 0 0 150
160 Oksitetrasiklin HCL 1% SM Tube 55 0 55 6 49 17 11
161 Oksitetrasiklin HCL 3% SK Tube 106 0 106 6 100 48 42
162 Omeprazol Kapsul 1330 0 1330 65 1265 508 420
163 Oxytocin Inj 10 IU Ampul 0 0 0 0 0 0 0
164 Papaverin 40 mg tab Tablet 0 0 0 0 0 0 1000
165 Papaverin inj Ampul 0 0 0 0 0 0 0
166 Parasetamol Drop 15 ml Btl 231 0 231 16 215 39 0
167 Parasetamol 100 mg Tablet 0 0 0 0 0 0 0
168 Parasetamol 120 mg/ml Syr Btl 180 0 180 95 85 172 150
169 Parasetamol 500 mg Tablet 2006 0 2006 1637 369 4505 3050
170 Pehavral Tablet 0 0 0 0 0 0 0
171 Piracetam 400 mg Tablet 0 0 0 0 0 0 0
172 Pirantel Pamoat 125 mg Tablet 385 0 385 0 385 12 0
173 Piridoksina HCL 10 mg Tablet 3170 0 3170 10 3160 32 0
174 Piroksikam 20 mg tab Tablet 5310 0 5310 540 4770 984 444
175 Pitogin inj 10 iu/ml Ampul 0 0 0 0 0 0 0
176 Plaster 5 yard x 2 inch Rol 0 0 0 0 0 3 0
177 Prednison 5 mg Tablet 5481 0 5481 183 5298 562 0
178 Primaquin 15 mg tab Tablet 0 0 0 0 0 0 0
179 Prokaina Penisilin G inj 3.000.000 iu Ampul 0 0 0 0 0 0 0

HALAMAN : 6 LPLPO NO : LAPORAN BULAN :

NO NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
180 Propil Tio Urasil 100 mg Tablet 0 0 0 0 0 0 0
181 Propranolol HCL 10 mg Tablet 800 0 800 5 795 4 0
182 Propranolol HCL 40 mg Tablet 700 0 700 10 690 88 78
183 Puralex Tablet Tablet 936 0 936 67 869 265 198
184 Ranitidin 150 mg Tablet 4430 0 4430 300 4130 696 396
185 Ranitidin inj Ampul 0 0 0 0 0 0 0
186 Retinol (Vit.A) Kaps 100.000 iu Kapsul 0 0 0 0 0 0 0
187 Retinol (Vit.A) Kaps 200.000 iu Kapsul 0 0 0 0 0 0 0
188 Ringer Laktat Larutan Infus Steril Btl 430 0 430 33 397 162 129
189 Salbutamol 2 mg Tablet 654 0 654 175 479 417 242
190 Salep 2-4 Kombinasi Pot 0 0 0 0 0 0 0
191 Salisil Bedak 2% Sachet 179 0 179 12 167 26 0
192 Scabimite Krim Tube 0 0 0 0 0 0 0
193 Scopma tab Tablet 0 0 0 0 0 0 1000
194 Semen Seng Fosfat Serbuk & Cairan Set 0 0 0 0 0 0 0
195 Serum Anti Bisa Ular 5ml (ABU I)Biosave Ampul 0 0 0 0 0 0 0
196 SErum Anti Tetanus Inj. 1500 iu Ampul 0 0 0 0 0 0 0
197 Sianocobalamin (Vit B12) 50 mg tab Tablet 4519 0 4519 622 3897 1682 1040
198 Sianocobalamin (Vit B12)inj 500 mcg/ml Ampul 126 0 126 58 68 154 96
199 Silk ( Benang Bedah ) No. 3/0 Pcs 33 0 33 33 0 56 23
200 Silver amalgam Serbuk Set 0 0 0 0 0 0 0
201 Simvastatin 10 mg tab Tablet 0 0 0 0 0 72 72
202 Sulfasetamida 15% TM Btl 0 0 0 0 0 0 0
203 Superhoid Supp Suppo 90 0 90 0 90 5 0
204 Tablet Tambah Darah Tablet 0 0 0 0 0 0 167460
205 Temporary Stopping Fletcher Set 0 0 0 0 0 0 0
206 Tes Golongan Darah Anti A Set 2 0 2 0 2 0.8 0
207 Tes Golongan Darah Anti AB Set 2 0 2 0 2 0.8 0
208 Tes Golongan Darah Anti B Set 1 0 1 0 1 1.6 0
209 Tes Golongan Darah Anti D Set 2 0 2 0 2 0.8 0
210 Tes Kehamilan Pcs 308 0 308 308 0 296 111
211 Tetagam Ampul 2 0 2 0 2 0 0
212 Tetrasiklin 250 mg Kapsul 1480 0 1480 40 1440 48 0
213 Tetrasiklin 500 mg Kapsul 1360 0 1360 30 1330 136 0
214 Tiacinon inj Ampul 280 0 280 0 280 0 0
215 Tiamfenikol 500 mg Kapsul 0 0 0 0 0 0 0
216 Tiamin HCL (Vit.B1 ) 50 mg Tablet 4780 0 4780 760 4020 1584 824

HALAMAN : 7 LPLPO NO : LAPORAN BULAN :

NO NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
217 Tiamin HCL (Vit.B1 ) inj 100 mg/ml Ampul 0 0 0 0 0 72 72
218 Trihexyphenidyl tab 2 mg Tablet 0 0 0 0 0 0 0
219 Truvit Syr Btl 0 0 0 0 0 0 200
220 Urin Bag Pcs 0 0 0 0 0 16 16
221 Vaksin Rabies Vero / Verorab Ampul 0 0 0 0 0 0 0
222 Vigel 30 mg Tube 2 0 2 0 0 0 0
223 Vit K Infant inj Ampul 0 0 0 0 0 0 0
224 Vit B Compleks Tablet 4408 0 4408 417 3991 1607 1190
225 Wing Needle No. 21 Pcs 58 0 58 2 56 3 0
226 Wing Needle No. 27 Pcs 0 0 0 0 0 0 58
227 Yodium Povidon 10% 30 ml Btl 28 0 28 0 28 50 50
228 Yodium Povidon 10% 300 ml Btl 78 0 78 6 72 11 5
229 Zinc tab Tablet 335 0 335 50 285 252 202
230
231
232
233
234
235
236
237
238
239
240

JUMLAH KUNJUNGAN UMUM JAMSOSKES BPJS JUMLAH

Mengetahui / Menyetujui Yang Menyerahkan Yang Meminta Yang Menerima
Kepala Dinas Kesehatan Kab. OKI Kepala UPOPPK Kepala Puskesmas Petugas Puskesmas

H.M.LUBIS,SKM.M.Kes HIMAYANTI,S.Si.M.Kes,Apt MUHERLI,SKM SATRIO,AM.Kep

NIP.19660603 198703 1 003 NIP.19770221 200501 2 005 NIP.19770710 200501 1 004 NIP.19791231 200801 1 008

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

PUSKESMAS
PUSKESMAS : PEMATANG PANGGANG 1 PELAPORAN BULAN : MARET 2017 DOKUMEN NOMOR TANGGAL
KECAMATAN : MESUJI PERMINTAAN BULAN : APRIL 2017 DINKES KAB /KOTA
KABUPATEN : OGAN KOMERING ILIR GFK KAB/KOTA
PROPINSI : SUMATERA SELATAN PUSKESMAS

NO NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
1 Acetylcystein Kapsul 200 mg Tablet 600 0 600 0 600 0 400
2 Acyclovir 200 mg tab Tablet 909 0 909 110 799 242 200
3 Acyclovir krim Tube 13 0 13 10 3 38 48
4 Air Raksa Dental Btl 0 0 0 0 0 0 0
5 Alat Suntik Sekali Pakai 1 ml Pcs 0 0 0 0 0 0 200
6 Alat Suntik Sekali Pakai 3 ml Pcs 407 0 407 162 245 543 600
7 Alat Suntik Sekali Pakai 5 ml Pcs 259 0 259 112 147 181 100
8 Albendasol 400 mg tab Tablet 0 0 0 0 0 0 0
9 Alcohol Swab Pcs 96 0 96 4 92 6 100
10 Allupurinol 100 mg Tablet 1359 0 1359 280 1079 734 500
11 Aminofillin 200 mg Tablet 0 0 0 0 0 0 500
12 Aminofillin inj 24 mg/ml-10 ml Ampul 0 0 0 0 0 0 20
13 Amitriptylin 25 mg tab Tablet 0 0 0 0 0 0 0
14 Amlodipin Tab 5 mg Tablet 970 0 970 30 940 40 100
15 Amoksisilin 250 mg Tablet 792 0 792 370 422 715 500
16 Amoksisilin 500 mg Tablet 0 0 0 0 0 1726 1700
17 Amoksisilin Syr Btl 127 0 127 23 104 77 100
18 Ampisilin 1 gr inj Vial 0 0 0 0 0 0 0
19 Ampisilin 500 mg Tablet 0 0 0 0 0 0 0
20 Antalgin 500 mg Tablet 1159 0 1159 790 369 1448 1000
21 Antalgin inj Ampul 44 0 44 44 0 80 40
22 Antasida DOEN Kombinasi Tablet 3444 0 3444 742 2702 2062 1500
23 Antasida Syr DOEN Btl 164 0 164 43 121 91 100
24 Anti Haemoroid suppos Suppo 0 0 0 0 0 0 0
25 Antifungi DOEN Kombinasi Salep Pot 122 0 122 0 122 1.8 0
26 Antithrom / Heparin Na. Krim/Hico Tube 0 0 0 0 0 0 50
27 Aqua Pro Inj. Steril 20 ml Btl 29 0 29 29 0 48 20
28 Asam Asetilsalisilat 100 mg tab Tablet 2100 0 2100 0 2100 0 0
29 asam Askorbat (Vit.C) 50 mg Tablet 5479 0 5479 125 5354 517 0
30 Asam Mefenamat 500 mg Tablet 4247 0 4247 920 3327 2226 1700
31 Aseptan 500 cc+Pump Botol 0 0 0 0 0 0 0
 HALAMAN : 7 LPLPO NO : LAPORAN BULAN :
NO NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
217 Tiamin HCL (Vit.B1 ) inj 100 mg/ml Ampul
218 Trihexyphenidyl tab 2 mg Tablet
219 Truvit Syr Btl
220 Urin Bag Pcs
221 Vaksin Rabies Vero / Verorab Ampul
222 Vigel 30 mg Tube
223 Vit K Infant inj Ampul
224 Vit B Compleks Tablet
225 Wing Needle No. 21 Pcs
226 Wing Needle No. 27 Pcs
227 Yodium Povidon 10% 30 ml Btl
228 Yodium Povidon 10% 300 ml Btl
229 Zinc tab Tablet
230
231
232
233
234
235
236
237
238
239
240

UMUM JAMSOSKES BPJS JUMLAH

JUMLAH KUNJUNGAN

Mengetahui Pimpinan Yang Menerima Yang Melapor

Puskesmas Petugas Puskesmas Petugas Puskesmas,Pustu/Bides

MUHERLI,SKM SATRIO,AM.Kep ...................................

NIP.197707102005011004 NIP.197912312008011008 NIP.
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS
PUSKESMAS : PEMATANG PANGGANG 1 PELAPORAN BULAN : APRIL 2017 DOKUMEN NOMOR TANGGAL
KECAMATAN : MESUJI PERMINTAAN BULAN : DINKES KAB /KOTA
KABUPATEN : OGAN KOMERING ILIR GFK KAB/KOTA
PROPINSI : SUMATERA SELATAN PUSKESMAS

NO NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
1 Acetylcystein Kapsul 200 mg Tablet 600 420 1020 20 1000
2 Acyclovir 200 mg tab Tablet 799 200 999 21 978
3 Acyclovir krim Tube 3 50 53 7 46
4 Air Raksa Dental Btl 0 0 0 0 0
5 Alat Suntik Sekali Pakai 1 ml Pcs 0 200 200 0 200
6 Alat Suntik Sekali Pakai 3 ml Pcs 245 600 845 193 652 350 300
7 Alat Suntik Sekali Pakai 5 ml Pcs 147 100 247 47 200
8 Albendasol 400 mg tab Tablet 0 0 0 0 0
9 Alcohol Swab Pcs 92 0 92 2 90
10 Allupurinol 100 mg Tablet 1079 0 1079 280 799
11 Aminofillin 200 mg Tablet 0 0 0 0 0
12 Aminofillin inj 24 mg/ml-10 ml Ampul 0 30 30 0 30
13 Amitriptylin 25 mg tab Tablet 0 0 0 0 0
14 Amlodipin Tab 5 mg Tablet 940 120 1060 40 1020
15 Amoksisilin 250 mg Tablet 422 500 922 231 691
16 Amoksisilin 500 mg Tablet 0 4700 4700 630 4070
17 Amoksisilin Syr Btl 104 96 200 28 172
18 Ampisilin 1 gr inj Vial 0 0 0 0 0
19 Ampisilin 500 mg Tablet 0 0 0 0 0
20 Antalgin 500 mg Tablet 369 1000 1369 520 849
21 Antalgin inj Ampul 0 60 60 11 49
22 Antasida DOEN Kombinasi Tablet 2702 1500 4202 801 3401
23 Antasida Syr DOEN Btl 121 100 221 34 187
24 Anti Haemoroid suppos Suppo 0 0 0 0 0
25 Antifungi DOEN Kombinasi Salep Pot 122 0 122 4 118
26 Antithrom / Heparin Na. Krim/Hico Tube 0 0 0 0 0 400 350
27 Aqua Pro Inj. Steril 20 ml Btl 0 0 0 0 0 300 200
28 Asam Asetilsalisilat 100 mg tab Tablet 2100 0 2100 0 2100
29 asam Askorbat (Vit.C) 50 mg Tablet 5354 0 5354 577 4777
30 Asam Mefenamat 500 mg Tablet 3327 0 3327 744 2583
31 Aseptan 500 cc+Pump Botol 0 0 0 0 0
Halaman : 2 LPLPO NO: LAPORAN BULAN :
NO NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
32 Atagip Tab Tablet 0 0 0 0 0
33 Atropine Inj 0,25 mg/ml Ampul 0 0 0 0 0
34 Betahistin Masylate 6 mg tab Tablet 0 0 0 0 0
35 Betametason 0,1% Krim Tube 55 24 79 17 62
36 Calortusin tab Tablet 0 0 0 0 0
37 Captopril 12,5 mg Tablet 506 0 506 250 256
38 Captopril 25 mg Tube 1824 800 2624 445 2179
39 Catgut/Benang Chromic Bedah No.2/3-3/0 Pcs 53 48 101 3 98
40 Catgut/Benang Plain Bedah No.2/3-3/0 Pcs 77 48 125 1 124
41 Cefadroxil 500 mg Tablet 0 0 0 0 0 2500 2000
42 Cetirizine 5 mg/ 5 ml Syr Btl 10 0 10 0 10 300 250
43 Cimetidin 200mg Tablet 1795 600 2395 0 2395
44 Ciprofloxacin 500 mg tab Tablet 2289 400 2689 234 2455
45 Ciprofloxacin infus Btl 1 2 3 0 3
46 Coparcetin tab Tablet 0 0 0 0 0
47 Deksametason 0,5 mg Tablet 3940 100 4040 891 3149
48 Deksametason inj 5 mg/ml - 1 ml Ampul 225 0 225 7 218
49 Dermafic S IV Pcs 0 100 100 0 100
50 Devitalisasi pasta Tablet 0 0 0 0 0
51 Diazepam 2 mg Tablet 0 0 0 0 0 600 500
52 Diazepam inj 5mg/ml - 2 ml Ampul 0 0 0 0 0
53 Difenhidramin HCL inj 10 mg/ml Ampul 133 60 193 72 121
54 Digoksin 0,25 mg Tablet 480 100 580 0 580
55 Domperidone 10 mg Tablet 617 300 917 90 827
56 Doxycycline 100 mg Kapsul Tablet 200 0 200 0 200
57 Epinefrin HCL /Bitartrat Inj 0,1 % Ampul 300 0 300 0 300
58 Erlamycetin TT Btl 0 0 0 0 0
59 Eryra Forte tab Kapsul 1598 0 1598 191 1407
60 Erytromicin 500 mg tab Kapsul 0 200 200 0 200
61 Erytromicin Syr Btl 21 120 141 25 116
62 Etakridina (Rivanol) 0,1 % Btl 54 0 54 1 53
63 Etanol 70% - 100 ml Btl 8 0 8 0 8
64 Etanol 70% - 1000 ml Btl 23 0 23 0 23
65 Etil klorida semprot Btl 0 0 0 0 0 250 300
66 Eugenol cairan Btl 6 0 6 0 6
67 Fenobarbital 100 mg Tablet 1000 0 1000 30 970
68 Fenobarbital 30 mg Tablet 0 0 0 0 0

HALAMAN : 3 LPLPO NO : LAPORAN BULAN :

NO NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
69 Fenobarbital inj 50mg/ml - 2 ml Ampul 30 0 30 0 30
70 Fenol Gliserol 10% TT Btl 169 0 169 169 0
71 Fetominadion (vit.K1) 10 mg Tablet 1660 0 1660 0 1660
72 Fetominadion (vit.K1) inj 10 mg/ml Ampul 0 90 90 3 87
73 Folley catheter NO.16 Pcs 4 20 24 0 24
74 Furosemida 40 mg Tablet 1363 200 1563 46 1517
75 Furosemida inj Ampul 25 0 25 0 25
76 Garam Oralit Sachet 461 0 461 78 383
77 Gentamicin 0,1 % SK Tube 57 50 107 26 81
78 Gentamicin 0,3% TM Btl 85 48 133 4 129
79 Gentamicin inj mg/ml Ampul 16 0 16 16 0
80 Gentian Violet 1% Larutan Btl 68 0 68 2 66
81 Glass Ionomerlement Set 0 0 0 0 0
82 Glibenklamid 5 mg Tablet 0 0 0 0 0
83 Glimepiride Tablet 500 0 500 20 480
84 Gliseril Guaikolat 100 mg Tablet 3579 0 3579 1198 2381
85 Glukosa Larutan Infus 10% Btl 40 20 60 3 57
86 Glukosa Larutan Infus 5% Btl 56 20 76 2 74
87 Griseofulvin 125 mg Tablet 1160 0 1160 26 1134
88 Haloperidol 0,5 mg tab Tablet 1700 0 1700 0 1700
89 HandScuun No. 7,5 Pcs 985 200 1185 1105 80 700 600
90 HandScuun Steril No.7 Pcs 0 0 0 0 0 300 200
91 HandScuun Steril No. 7,5 Pcs 0 0 0 0 0 300 200
92 Hemafort Tablet 2780 0 2780 10 2770
93 Hexymer tab Tablet 1000 0 1000 0 1000
94 Hidroklorotiazida (HCT) 25 mg Tablet 1390 0 1390 0 1390
95 Hidrokortison krim 2,5% Tube 106 48 154 12 142
96 Ibuprofen 200 mg Tablet 5295 500 5795 385 5410
97 Ibuprofen 400 mg Tablet 5615 300 5915 820 5095
98 Ibuprofen Susp Btl 139 0 139 17 122
99 Ichtiol Salep Pot 0 0 0 0 0 280 240
100 Infusion Set Anak Pcs 83 50 133 4 129
101 Infusion Set Dewasa Pcs 59 50 109 22 87
102 Isosorbid Tablet Tablet 700 0 700 0 700
103 IV Cateter No.20 Pcs 99 50 149 13 136
104 IV Cateter No.22 Pcs 72 50 122 23 99 250 200
105 IV Cateter No.24 Pcs 0 100 100 2 98

HALAMAN : 4 LPLPO NO : LAPORAN BULAN :

NO NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
106 Jarum Jahit Kulit Sutra Pcs 46 0 46 10 36
107 Kalium Permanganat Serbuk Pot 0 0 0 0 0 280 240
108 Kalsium Laktat (Kalk) 500 mg Tablet 3810 700 4510 320 4190
109 Kapas Pembalut/Absorben 250 mg Pcs 26 0 26 1 25
110 Karbamazepin Pcs 0 0 0 0 0
111 Kasa Kompres 40/40 Steril Pcs 127 100 227 10 217
112 Kasa Pembalut 2x80 Pcs 79 0 79 0 79
113 Kasa Pembalut Hidrofil 4m x 15cm Pcs 127 50 177 2 175
114 Kasa pembalut Hidrofil 4m x 3cm Pcs 32 50 82 17 65
115 Ketokonazol 200 mg Krim Tube 0 25 25 0 25
116 Ketokonazol 200 mg Tablet 0 0 0 0 0
117 Kloramfenicol 250 mg Kapsul 0 0 0 0 0
118 Kloramfenicol 3% TT Btl 0 0 0 0 0 350 300
119 Kloramfenicol Suspensi 125 mg/ml Btl 60 50 110 23 87
120 Kloramfenicol 1% SM Tube 0 0 0 0 0 350 300
121 Klorfeniramin Maleat ( CTM ) 4 mg Tablet 5160 2300 7460 1432 6028
122 Klorokina Fosfat 250 mg Tablet 0 0 0 0 0
123 Klorpromazin HCL 100 mg Tablet 1000 0 1000 0 1000
124 Komb. Pirimet 2 mg + Sulfadox 500 mg Tablet 0 0 0 0 0
125 Kotrimoksazol Kombinasi 120 mg Tablet 0 0 0 0 0
126 Kotrimoksazol Kombinasi 480 mg Tablet 1200 500 1700 210 1490
127 Kotrimoksazol Sups Btl 113 50 163 27 136
128 Leukoplast Rol 18 10 28 0 28
129 Levertran Salep / Salep Luka Bakar Pot 73 24 97 5 92
130 Lidokain 2 % Ampul 0 0 0 0 0 180 120
131 Lidokain Comp. Inj Kombinasi Ampul 162 60 222 184 38 400 360
132 Locoriz Krim Tube 0 0 0 0 0
133 Loperamid 2 mg tab Tablet 1610 200 1810 12 1798
134 Loratadine 10 mg tab Tablet 0 0 0 0 0
135 Lysol 1 Liter Btl 17 0 17 0 17
136 Magnesium Sulfat inj 40% ( MgSO4) Btl 2 0 2 0 2
137 Masker Pcs 493 50 543 12 531
138 Mess No.16 Pcs 13 0 13 5 8
139 Metformin 500 mg tab Tablet 1400 300 1700 40 1660
140 Metil Ergometrin Maleat 0,125 mg Tablet 0 0 0 0 0
141 Metil Ergometrin Maleat inj 0,2 mg/ml Ampul 110 30 140 0 140
142 Metil Prednisolon 4 mg Tablet 2800 200 3000 100 2900

HALAMAN : 5 LPLPO NO : LAPORAN BULAN :

NO NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
143 Metronidazol 250 mg Tablet 1445 100 1545 10 1535
144 Metronidazol 500 mg Tablet 1270 100 1370 80 1290
145 Metronidazol Infus Btl 0 0 0 0 0
146 Metronidazol Syr Btl 107 0 107 1 106
147 Miconazole 2% SK Tube 67 0 67 0 67
148 Momilen Baby Gold Sirup Btl 168 0 168 29 139
149 My Jelly 82 Gram Btl 0 20 20 0 20
150 Natrium Bikarbonat 500 mg Tablet 0 0 0 0 0
151 Natrium Diclopenac 25 mg tab Tablet 1960 0 1960 190 1770
152 Natrium Klorida Larutan Infus 0,9% Btl 130 0 130 10 120
153 New Antides Tablet Tablet 0 0 0 0 0
154 Nifedipin 10 mg tab Tablet 840 100 940 81 859
155 Nistatin tab Vag 100.000 iu/g Tab Vaginal 146 100 246 2 244
156 Novachlor Kapsul Kapsul 1576 300 1876 310 1566
157 Nutrifar Tab Tablet 0 0 0 0 0
158 Obat Batuk Hitam Btl 0 0 0 0 0
159 OBH FM Btl 0 0 0 0 0
160 Oksitetrasiklin HCL 1% SM Tube 49 0 49 49 0 300 250
161 Oksitetrasiklin HCL 3% SK Tube 100 0 100 30 70
162 Omeprazol Kapsul 1265 420 1685 36 1649
163 Oxytocin Inj 10 IU Ampul 0 0 0 0 0
164 Papaverin 40 mg tab Tablet 0 0 0 0 0
165 Papaverin inj Ampul 0 0 0 0 0
166 Parasetamol Drop 15 ml Btl 215 448 663 239 424
167 Parasetamol 100 mg Tablet 0 0 0 0 0
168 Parasetamol 120 mg/ml Syr Btl 85 150 235 65 170
169 Parasetamol 500 mg Tablet 369 13000 13369 281 13088
170 Pehavral Tablet 0 0 0 0 0
171 Piracetam 400 mg Tablet 0 0 0 0 0
172 Pirantel Pamoat 125 mg Tablet 385 0 385 9 376
173 Piridoksina HCL 10 mg Tablet 3160 0 3160 100 3060
174 Piroksikam 20 mg tab Tablet 4770 500 5270 520 4750
175 Pitogin inj 10 iu/ml Ampul 0 0 0 0 0
176 Plaster 5 yard x 2 inch Rol 0 0 0 0 0 200 150
177 Prednison 5 mg Tablet 5298 0 5298 405 4893
178 Primaquin 15 mg tab Tablet 0 0 0 0 0
179 Prokaina Penisilin G inj 3.000.000 iu Ampul 0 0 0 0 0

HALAMAN : 6 LPLPO NO : LAPORAN BULAN :

NO NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
180 Propil Tio Urasil 100 mg Tablet 0 0 0 0 0
181 Propranolol HCL 10 mg Tablet 795 0 795 30 765
182 Propranolol HCL 40 mg Tablet 690 0 690 0 690
183 Puralex Tablet Tablet 869 0 869 869 0
184 Ranitidin 150 mg Tablet 4130 0 4130 4130 0 5500 5000
185 Ranitidin inj Ampul 0 0 0 0 0 250 200
186 Retinol (Vit.A) Kaps 100.000 iu Kapsul 0 0 0 0 0
187 Retinol (Vit.A) Kaps 200.000 iu Kapsul 0 0 0 0 0
188 Ringer Laktat Larutan Infus Steril Btl 397 140 537 80 457
189 Salbutamol 2 mg Tablet 497 300 797 240 557
190 Salep 2-4 Kombinasi Pot 0 0 0 0 0
191 Salisil Bedak 2% Sachet 167 0 167 17 150
192 Scabimite Krim Tube 0 0 0 0 0
193 Scopma tab Tablet 0 0 0 0 0 3500 3000
194 Semen Seng Fosfat Serbuk & Cairan Set 0 0 0 0 0
195 Serum Anti Bisa Ular 5ml (ABU I)Biosave Ampul 0 0 0 0 0
196 SErum Anti Tetanus Inj. 1500 iu Ampul 0 0 0 0 0
197 Sianocobalamin (Vit B12) 50 mg tab Tablet 3897 1100 4997 1000 3997
198 Sianocobalamin (Vit B12)inj 500 mcg/ml Ampul 68 100 168 99 69
199 Silk ( Benang Bedah ) No. 3/0 Pcs 0 0 0 0 0
200 Silver amalgam Serbuk Set 0 0 0 0 0
201 Simvastatin 10 mg tab Tablet 0 0 0 0 0 3500 3000
202 Sulfasetamida 15% TM Btl 0 0 0 0 0
203 Superhoid Supp Suppo 90 0 90 4 86
204 Tablet Tambah Darah Tablet 0 0 0 0 0
205 Temporary Stopping Fletcher Set 0 0 0 0 0
206 Tes Golongan Darah Anti A Set 2 2 4 0 4
207 Tes Golongan Darah Anti AB Set 2 2 4 0 4
208 Tes Golongan Darah Anti B Set 1 2 3 0 3
209 Tes Golongan Darah Anti D Set 2 2 4 0 4
210 Tes Kehamilan Pcs 0 0 0 0 0 600 500
211 Tetagam Ampul 2 0 2 0 2
212 Tetrasiklin 250 mg Kapsul 1440 0 1440 0 1440
213 Tetrasiklin 500 mg Kapsul 1330 0 1330 30 1300
214 Tiacinon inj Ampul 280 0 280 0 280
215 Tiamfenikol 500 mg Kapsul 0 0 0 0
216 Tiamin HCL (Vit.B1 ) 50 mg Tablet 4020 900 4920 650 4270

HALAMAN : 7 LPLPO NO : LAPORAN BULAN :

NO NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
217 Tiamin HCL (Vit.B1 ) inj 100 mg/ml Ampul 0 90 90 27 63
218 Trihexyphenidyl tab 2 mg Tablet 0 0 0 0 0
219 Truvit Syr Btl 0 0 0 0 0 250 200
220 Urin Bag Pcs 0 20 20 0 20
221 Vaksin Rabies Vero / Verorab Ampul 0 0 0 0 0
222 Vigel 30 mg Tube 0 0 0 0 0
223 Vit K Infant inj Ampul 0 0 0 0 0
224 Vit B Compleks Tablet 3991 1200 5191 351 4840
225 Wing Needle No. 21 Pcs 56 0 56 0 56
226 Wing Needle No. 27 Pcs 0 58 58 0 58
227 Yodium Povidon 10% 30 ml Btl 28 50 78 3 75
228 Yodium Povidon 10% 300 ml Btl 72 5 77 0 77
229 Zinc tab Tablet 285 0 285 0 285
230
231
232
233
234
235
236
237
238
239
240

JUMLAH KUNJUNGAN UMUM JAMSOSKES BPJS JUMLAH

Megetahui / Menyetujui Yang Menyerahkan Yang Meminta Yang Menerima
Kepala Dinas Kesehatan Kab. OKI Kepala UPOPPK Kepala Puskesmas Petugas Puskesmas

H.M.LUBIS,SKM.M.Kes HIMAYANTI,S.Si.M.Kes,Apt MUHERLI,SKM SATRIO,AM.Kep

NIP.19660603 198703 1 003 NIP.19770221 200501 2 005 NIP.19770710 200501 1 004 NIP.19791231 200801 1 008
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS
PUSKESMAS : PEMATANG PANGGANG 1 PELAPORAN BULAN ::MEI
MEI201
2017 DOKUMEN NOMOR TANGGAL
KECAMATAN : MESUJI PERMINTAAN BULAN : DINKES KAB /KOTA
KABUPATEN : OGAN KOMERING ILIR GFK KAB/KOTA
PROPINSI : SUMATERA SELATAN PUSKESMAS

NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
1 Acetylcystein Kapsul 200 mg Tablet 1000 0 1000 0 1000
2 Acyclovir 200 mg tab Tablet 978 0 978 80 898
3 Acyclovir krim Tube 46 0 46 7 39
4 Air Raksa Dental Btl 0 0 0 0 0
5 Alat Suntik Sekali Pakai 1 ml Pcs 200 0 200 0 200
6 Alat Suntik Sekali Pakai 3 ml Pcs 652 0 652 250 402
7 Alat Suntik Sekali Pakai 5 ml Pcs 200 0 200 41 159
8 Albendasol 400 mg tab Tablet 0 0 0 0 0
9 Alcohol Swab Pcs 90 0 90 2 88
10 Allupurinol 100 mg Tablet 799 0 799 296 503
11 Aminofillin 200 mg Tablet 0 0 0 0 0
12 Aminofillin inj 24 mg/ml-10 ml Ampul 30 0 30 0 30
13 Amitriptylin 25 mg tab Tablet 0 0 0 0 0
14 Amlodipin Tab 5 mg Tablet 1020 0 1020 60 960
15 Amoksisilin 250 mg Tablet 691 0 691 110 581
16 Amoksisilin 500 mg Tablet 4070 0 4070 813 3257
17 Amoksisilin Syr Btl 172 0 172 45 127
18 Ampisilin 1 gr inj Vial 0 0 0 0 0
19 Ampisilin 500 mg Tablet 0 0 0 0 0
20 Antalgin 500 mg Tablet 849 0 849 420 429
21 Antalgin inj Ampul 49 0 49 20 29
22 Antasida DOEN Kombinasi Tablet 3401 0 3401 900 2501
23 Antasida Syr DOEN Btl 187 0 187 58 129
24 Anti Haemoroid suppos Suppo 0 0 0 0 0
25 Antifungi DOEN Kombinasi Salep Pot 118 0 118 0 118
26 Antithrom / Heparin Na. Krim/Hico Tube 0 0 0 0 0
27 Aqua Pro Inj. Steril 20 ml Btl 0 0 0 0 0
28 Asam Asetilsalisilat 100 mg tab Tablet 2100 0 2100 0 2100
29 asam Askorbat (Vit.C) 50 mg Tablet 4777 0 4777 295 4482
30 Asam Mefenamat 500 mg Tablet 2583 0 2583 670 1913
31 Aseptan 500 cc+Pump Botol 0 0 0 0 0

HALAMAN :2 LPLPO NO: LAPORAN BULAN :

NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
32 Atagip Tab Tablet 0 0 0 0 0
33 Atropine Inj 0,25 mg/ml Ampul 0 0 0 0 0
34 Betahistin Masylate 6 mg tab Tablet 0 0 0 0 0
35 Betametason 0,1% Krim Tube 62 0 62 1 61
36 Calortusin tab Tablet 0 0 0 0 0
37 Captopril 12,5 mg Tablet 256 0 256 50 206
38 Captopril 25 mg Tablet 2179 0 2179 240 1939
39 Catgut/Benang Chromic Bedah No.2/3-3/0 Pcs 98 0 98 71 27
40 Catgut/Benang Plain Bedah No.2/3-3/0 Pcs 124 0 124 4 120
41 Cefadroxil 500 mg Tablet 0 0 0 0 0
42 Cetirizine 5 mg/ 5 ml Syr Btl 10 0 10 0 10
43 Cimetidin 200mg Tablet 2395 0 2395 20 2375
44 Ciprofloxacin 500 mg tab Tablet 2455 0 2455 373 2082
45 Ciprofloxacin infus Btl 3 0 3 0 3
46 Coparcetin tab Tablet 0 0 0 0 0
47 Deksametason 0,5 mg Tablet 3149 0 3149 735 2414
48 Deksametason inj 5 mg/ml - 1 ml Ampul 218 0 218 5 213
49 Dermafic S IV Pcs 100 0 100 0 100
50 Devitalisasi pasta Tablet 0 0 0 0 0
51 Diazepam 2 mg Tablet 0 0 0 0 0
52 Diazepam inj 5mg/ml - 2 ml Ampul 0 0 0 0 0
53 Difenhidramin HCL inj 10 mg/ml Ampul 121 0 121 56 65
54 Digoksin 0,25 mg Tablet 580 0 580 0 580
55 Domperidone 10 mg Tablet 827 0 827 191 636
56 Doxycycline 100 mg Kapsul Tablet 200 0 200 0 200
57 Epinefrin HCL /Bitartrat Inj 0,1 % Ampul 300 0 300 0 300
58 Erlamycetin TT Btl 0 0 0 0 0
59 Eryra Forte tab Kapsul 1407 0 1407 130 1277
60 Erytromicin 500 mg tab Kapsul 200 0 200 100 100
61 Erytromicin Syr Btl 116 0 116 20 96
62 Etakridina (Rivanol) 0,1 % Btl 53 0 53 1 52
63 Etanol 70% - 100 ml Btl 8 0 8 0 8
64 Etanol 70% - 1000 ml Btl 23 0 23 2 21
65 Etil klorida semprot Btl 0 0 0 0 0
66 Eugenol cairan Btl 6 0 6 0 6
67 Fenobarbital 100 mg Tablet 970 0 970 60 910
68 Fenobarbital 30 mg Tablet 0 0 0 0 0

HALAMAN : 3 LPLPO NO : LAPORAN BULAN :

NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
69 Fenobarbital inj 50mg/ml - 2 ml Ampul 30 0 30 0 30
70 Fenol Gliserol 10% TT Btl 0 0 0 0 0
71 Fetominadion (vit.K1) 10 mg Tablet 1660 0 1660 10 1650
72 Fetominadion (vit.K1) inj 10 mg/ml Ampul 87 0 87 2 85
73 Folley catheter NO.16 Pcs 24 0 24 0 24
74 Furosemida 40 mg Tablet 1517 0 1517 85 1432
75 Furosemida inj Ampul 25 0 25 2 23
76 Garam Oralit Sachet 383 0 383 36 347
77 Gentamicin 0,1 % SK Tube 81 0 81 18 63
78 Gentamicin 0,3% TM Btl 129 0 129 1 128
79 Gentamicin inj mg/ml Ampul 0 0 0 0 0
80 Gentian Violet 1% Larutan Btl 66 0 66 3 63
81 Glass Ionomerlement Set 0 0 0 0 0
82 Glibenklamid 5 mg Tablet 0 0 0 0 0
83 Glimepiride Tablet 480 0 480 60 420
84 Gliseril Guaikolat 100 mg Tablet 2381 0 2381 1210 1171
85 Glukosa Larutan Infus 10% Btl 57 0 57 0 57
86 Glukosa Larutan Infus 5% Btl 74 0 74 3 71
87 Griseofulvin 125 mg Tablet 1134 0 1134 10 1124
88 Haloperidol 0,5 mg tab Tablet 1700 0 1700 0 1700
89 HandScuun No. 7,5 Pcs 80 0 80 0 80
90 HandScuun Steril No.7 Pcs 0 0 0 0 0
91 HandScuun Steril No. 7,5 Pcs 0 0 0 0 0
92 Hemafort Tablet 2770 0 2770 140 2630
93 Hexymer tab Tablet 1000 0 1000 0 1000
94 Hidroklorotiazida (HCT) 25 mg Tablet 1390 0 1390 0 1390
95 Hidrokortison krim 2,5% Tube 142 0 142 6 136
96 Ibuprofen 200 mg Tablet 5410 0 5410 213 5197
97 Ibuprofen 400 mg Tablet 5095 0 5095 700 4395
98 Ibuprofen Susp Btl 122 0 122 8 114
99 Ichtiol Salep Pot 0 0 0 0 0
100 Infusion Set Anak Pcs 129 0 129 1 128
101 Infusion Set Dewasa Pcs 87 0 87 11 76
102 Isosorbid Tablet Tablet 700 0 700 0 700
103 IV Cateter No.20 Pcs 136 0 136 10 126
104 IV Cateter No.22 Pcs 99 0 99 15 84
105 IV Cateter No.24 Pcs 98 0 98 1 97

HALAMAN : 4 LPLPO NO : LAPORAN BULAN :

NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
106 Jarum Jahit Kulit Sutra Pcs 36 0 36 2 34
107 Kalium Permanganat Serbuk Pot 0 0 0 0 0
108 Kalsium Laktat (Kalk) 500 mg Tablet 4190 0 4190 220 3970
109 Kapas Pembalut/Absorben 250 mg Pcs 25 0 25 0 25
110 Karbamazepin Pcs 0 0 0 0 0
111 Kasa Kompres 40/40 Steril Pcs 217 0 217 11 206
112 Kasa Pembalut 2x80 Pcs 79 0 79 0 79
113 Kasa Pembalut Hidrofil 4m x 15cm Pcs 175 0 175 7 168
114 Kasa pembalut Hidrofil 4m x 3cm Pcs 65 0 65 8 57
115 Ketokonazol 200 mg Krim Tube 25 0 25 2 23
116 Ketokonazol 200 mg Tablet 0 0 0 0 0
117 Kloramfenicol 250 mg Kapsul 0 0 0 0 0
118 Kloramfenicol 3% TT Btl 0 0 0 0 0
119 Kloramfenicol Suspensi 125 mg/ml Btl 87 0 87 11 76
120 Kloramfenicol 1% SM Tube 0 0 0 0 0
121 Klorfeniramin Maleat ( CTM ) 4 mg Tablet 6028 0 6028 2610 3418
122 Klorokina Fosfat 250 mg Tablet 0 0 0 0 0
123 Klorpromazin HCL 100 mg Tablet 1000 0 1000 0 1000
124 Komb. Pirimet 2 mg + Sulfadox 500 mg Tablet 0 0 0 0 0
125 Kotrimoksazol Kombinasi 120 mg Tablet 0 0 0 0 0
126 Kotrimoksazol Kombinasi 480 mg Tablet 1490 0 1490 123 1367
127 Kotrimoksazol Sups Btl 136 0 136 28 108
128 Leukoplast Rol 28 0 28 0 28
129 Levertran Salep / Salep Luka Bakar Pot 92 0 92 4 88
130 Lidokain 2 % Ampul 0 0 0 0 0
131 Lidokain Comp. Inj Kombinasi Ampul 38 0 38 13 25
132 Locoriz Krim Tube 0 0 0 0 0
133 Loperamid 2 mg tab Tablet 1798 0 1798 85 1713
134 Loratadine 10 mg tab Tablet 0 0 0 0 0
135 Lysol 1 Liter Btl 17 0 17 1 16
136 Magnesium Sulfat inj 40% ( MgSO4) Btl 2 0 2 0 2
137 Masker Pcs 531 0 531 68 463
138 Mess No.16 Pcs 8 0 8 1 7
139 Metformin 500 mg tab Tablet 1660 0 1660 90 1570
140 Metil Ergometrin Maleat 0,125 mg Tablet 0 0 0 0 0
141 Metil Ergometrin Maleat inj 0,2 mg/ml Ampul 140 0 140 0 140
142 Metil Prednisolon 4 mg Tablet 2900 0 2900 210 2690

HALAMAN : 5 LPLPO NO : LAPORAN BULAN :

NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
143 Metronidazol 250 mg Tablet 1535 0 1535 50 1485
144 Metronidazol 500 mg Tablet 1290 0 1290 10 1280
145 Metronidazol Infus Btl 0 0 0 0 0
146 Metronidazol Syr Btl 106 0 106 1 105
147 Miconazole 2% SK Tube 67 0 67 1 66
148 Momilen Baby Gold Sirup Btl 139 0 139 38 101
149 My Jelly 82 Gram Btl 20 0 20 0 20
150 Natrium Bikarbonat 500 mg Tablet 0 0 0 0 0
151 Natrium Diclopenac 25 mg tab Tablet 1770 0 1770 300 1470
152 Natrium Klorida Larutan Infus 0,9% Btl 120 0 120 7 113
153 New Antides Tablet Tablet 0 0 0 0 0
154 Nifedipin 10 mg tab Tablet 859 0 859 40 819
155 Nistatin tab Vag 100.000 iu/g Tab Vaginal 244 0 244 0 244
156 Novachlor Kapsul Kapsul 1566 0 1566 180 1386
157 Nutrifar Tab Tablet 0 0 0 0 0
158 Obat Batuk Hitam Btl 0 0 0 0 0
159 OBH FM Btl 0 0 0 0 0
160 Oksitetrasiklin HCL 1% SM Tube 0 0 0 0 0
161 Oksitetrasiklin HCL 3% SK Tube 70 0 70 1 69
162 Omeprazol Kapsul 1649 0 1649 266 1383
163 Oxytocin Inj 10 IU Ampul 0 0 0 0 0
164 Papaverin 40 mg tab Tablet 0 0 0 0 0
165 Papaverin inj Ampul 0 0 0 0 0
166 Parasetamol Drop 15 ml Btl 424 0 424 18 406
167 Parasetamol 100 mg Tablet 0 0 0 0 0
168 Parasetamol 120 mg/ml Syr Btl 170 0 170 68 102
169 Parasetamol 500 mg Tablet 13088 0 13088 1178 11910
170 Pehavral Tablet 0 0 0 0 0
171 Piracetam 400 mg Tablet 0 0 0 0 0
172 Pirantel Pamoat 125 mg Tablet 376 0 376 5 371
173 Piridoksina HCL 10 mg Tablet 3060 0 3060 100 2960
174 Piroksikam 20 mg tab Tablet 4750 0 4750 630 4120
175 Pitogin inj 10 iu/ml Ampul 0 0 0 0 0
176 Plaster 5 yard x 2 inch Rol 0 0 0 0 0
177 Prednison 5 mg Tablet 4893 0 4893 716 4177
178 Primaquin 15 mg tab Tablet 0 0 0 0 0
179 Prokaina Penisilin G inj 3.000.000 iu Ampul 0 0 0 0 0

HALAMAN : 6 LPLPO NO : LAPORAN BULAN :

NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
180 Propil Tio Urasil 100 mg Tablet 0 0 0 0 0
181 Propranolol HCL 10 mg Tablet 765 0 765 0 765
182 Propranolol HCL 40 mg Tablet 690 0 690 0 690
183 Puralex Tablet Tablet 0 0 0 0 0
184 Ranitidin 150 mg Tablet 0 0 0 0 0
185 Ranitidin inj Ampul 0 0 0 0 0
186 Retinol (Vit.A) Kaps 100.000 iu Kapsul 0 0 0 0 0
187 Retinol (Vit.A) Kaps 200.000 iu Kapsul 0 0 0 0 0
188 Ringer Laktat Larutan Infus Steril Btl 457 0 457 47 410
189 Salbutamol 2 mg Tablet 557 0 557 160 397
190 Salep 2-4 Kombinasi Pot 0 0 0 0 0
191 Salisil Bedak 2% Sachet 150 0 150 8 142
192 Scabimite Krim Tube 0 0 0 0 0
193 Scopma tab Tablet 0 0 0 0 0
194 Semen Seng Fosfat Serbuk & Cairan Set 0 0 0 0 0
195 Serum Anti Bisa Ular 5ml (ABU I)Biosave Ampul 0 0 0 0 0
196 SErum Anti Tetanus Inj. 1500 iu Ampul 0 0 0 0 0
197 Sianocobalamin (Vit B12) 50 mg tab Tablet 3997 0 3997 630 3367
198 Sianocobalamin (Vit B12)inj 500 mcg/ml Ampul 69 0 69 67 2
199 Silk ( Benang Bedah ) No. 3/0 Pcs 0 0 0 0 0
200 Silver amalgam Serbuk Set 0 0 0 0 0
201 Simvastatin 10 mg tab Tablet 0 0 0 0 0
202 Sulfasetamida 15% TM Btl 0 0 0 0 0
203 Superhoid Supp Suppo 86 0 86 4 82
204 Tablet Tambah Darah Tablet 0 0 0 0 0
205 Temporary Stopping Fletcher Set 0 0 0 0 0
206 Tes Golongan Darah Anti A Set 4 0 4 0 4
207 Tes Golongan Darah Anti AB Set 4 0 4 0 4
208 Tes Golongan Darah Anti B Set 3 0 3 0 3
209 Tes Golongan Darah Anti D Set 4 0 4 0 4
210 Tes Kehamilan Pcs 0 0 0 0 0
211 Tetagam Ampul 2 0 2 0 2
212 Tetrasiklin 250 mg Kapsul 1440 0 1440 0 1440
213 Tetrasiklin 500 mg Kapsul 1300 0 1300 60 1240
214 Tiacinon inj Ampul 280 0 280 0 280
215 Tiamfenikol 500 mg Kapsul 0 0 0 0 0
216 Tiamin HCL (Vit.B1 ) 50 mg Tablet 4270 0 4270 170 4100

HALAMAN : 7 LPLPO NO : LAPORAN BULAN :

NO NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN STOK STOK PERMINTAAN PEMBERIAN KET
AWAL AKHIR OPTIMUM
1 2 3 5 6 7 8 9 10 11 12
217 Tiamin HCL (Vit.B1 ) inj 100 mg/ml Ampul 63 0 63 12 51
218 Trihexyphenidyl tab 2 mg Tablet 0 0 0 0 0
219 Truvit Syr Btl 0 0 0 0 0
220 Urin Bag Pcs 20 0 20 3 17
221 Vaksin Rabies Vero / Verorab Ampul 0 0 0 0 0
222 Vigel 30 mg Tube 0 0 0 0 0
223 Vit K Infant inj Ampul 0 0 0 0 0
224 Vit B Compleks Tablet 4840 0 4840 710 4130
225 Wing Needle No. 21 Pcs 56 0 56 0 56
226 Wing Needle No. 27 Pcs 58 0 58 0 58
227 Yodium Povidon 10% 30 ml Btl 75 0 75 2 73
228 Yodium Povidon 10% 300 ml Btl 77 0 77 0 77
229 Zinc tab Tablet 285 0 285 30 255
230
231
232
233
234
235
236
237
238
239
240
 JUMLAH KUNJUNGAN UMUM JAMSOSKES BPJS JUMLAH

Mengetahui / Menyetujui Yang Menyerahka Yang Meminta Yang Menerima

Kepala Dinas Kesehatan Kab. OKI Kepala UPOPPK Kepala Puskesmas Petugas Puskesmas

H.M.LUBIS,SKM.M.Kes HIMAYANTI,S.Si.M.Kes,Apt MUHERLI,SKM SATRIO,AM.Kep

NIP.19660603 198703 1 003 NIP.19770221 200501 2 005 NIP.19770710 200501 1 004 NIP.19791231 200801 1 008
LAMPIRAN BERITA ACARA PENCACAHAN OBAT AKHIR TAHUN

LAPORAN PENCACAHAN OBAT AKHIR TAHUN PUSKESMAS PEMATANG PANGGANG I

PERIODE 01 JANUARI 2017 S/D 30 DESEMBER 2017

MENURUT PENCATATAN HASIL KETERANGAN

NO NAMA OBAT SATUAN Saldo 01 jan Penerimaan 01 jan Pengeluaran 01 jan Saldo 30 des 2017 PENCACAHAN SELISIH Kadaluarsa Rusak Hilang
2017 s/d 30 des 2017 s/d 30 des 2017
1 Acetylcystein Kapsul 200 mg Tablet 0 2040 150 1890 1890
2 Acyclovir 200 mg tab Tablet 802 3200 1133 2869 2869
3 Acyclovir krim Tube 51 250 144 157 157
4 Air Raksa Dental Btl 0 0 0 0 0
5 Alat Suntik Sekali Pakai 1 ml Pcs 0 700 33 667 667
6 Alat Suntik Sekali Pakai 3 ml Pcs 924 2600 2778 746 746
7 Alat Suntik Sekali Pakai 5 ml Pcs 373 600 569 404 404
8 Albendasol 400 mg tab Tablet 0 0 0 0 0
9 Alcohol Swab Pcs 0 800 300 500 500
10 Allupurinol 100 mg Tablet 1000 3000 2695 1305 1305
11 Aminofillin 200 mg Tablet 0 1500 0 1500 1500
12 Aminofillin inj 24 mg/ml-10 ml Ampul 0 120 0 120 120
13 Amitriptylin 25 mg tab Tablet 0 0 0 0 0
14 Amlodipin Tab 5 mg Tablet 0 4230 1035 3195 3195
15 Amoksisilin 250 mg Tablet 716 4100 3500 1316 1316
16 Amoksisilin 500 mg Tablet 165 19900 11290 8775 8775
17 Amoksisilin Syr Btl 235 672 468 439 439
18 Ampisilin 1 gr inj Vial 0 0 0 0 0
19 Ampisilin 500 mg Tablet 0 0 0 0 0
20 Antalgin 500 mg Tablet 1179 2000 3179 0 0
21 Antalgin inj Ampul 100 120 171 49 49
22 Antasida DOEN Kombinasi Tablet 3280 13200 10128 6352 6352
23 Antasida Syr DOEN Btl 35 850 461 424 424
24 Anti Haemoroid suppos Suppo 0 0 0 0 0
25 Antifungi DOEN Kombinasi Salep Pot 76 48 89 35 35
26 Antithrom / Heparin Na. Krim/Hico Tube 0 0 0 0 0
27 Aqua Pro Inj. Steril 20 ml Btl 20 240 100 160 160
28 Asam Asetilsalisilat 100 mg tab Tablet 1100 7000 9 8091 8091
29 asam Askorbat (Vit.C) 50 mg Tablet 4000 5400 6135 3265 3265
30 Asam Mefenamat 500 mg Tablet 3110 11000 9060 5050 5050
31 Aseptan 500 cc+Pump Botol 0 24 19 5 5
32 Atagip Tab Tablet 0 0 0 0 0
 MENURUT PENCATATAN HASIL KETERANGAN
NO NAMA OBAT SATUAN SELISIH
Saldo 01 jan Penerimaan 01 jan Pengeluaran 01 jan Saldo 30 des 2017 PENCACAHAN Kadaluarsa Rusak Hilang
33 Atropine Inj 0,25 mg/ml Ampul 5 50 5 55 50
34 Betahistin Masylate 6 mg tab Tablet 0 1500 40 1500 1460
35 Betametason 0,1% Krim Tube 7 386 180 393 213
36 Calortusin tab Tablet 0 0 0 0 0
37 Captopril 12,5 mg Tablet 610 3700 3420 4310 890
38 Captopril 25 mg Tablet 874 7100 4985 7974 2989
39 Catgut/Benang Chromic Bedah No.2/3-3/0 Pcs 26 144 170 170 0
40 Catgut/Benang Plain Bedah No.2/3-3/0 Pcs 35 408 102 443 341
41 Cefadroxil 500 mg Tablet 0 3500 100 3500 3400
42 Cetirizine 5 mg/ 5 ml Syr Btl 10 0 10 10 0
43 Cimetidin 200mg Tablet 2005 600 2390 2605 215
44 Ciprofloxacin 500 mg tab Tablet 1000 3200 3723 4200 477
45 Ciprofloxacin infus Btl 0 10 2 10 8
46 Coparcetin tab Tablet 0 0 0 0 0
47 Deksametason 0,5 mg Tablet 1040 9400 6716 10440 3724
48 Deksametason inj 5 mg/ml - 1 ml Ampul 59 900 466 959 493
49 Dermafic S IV Pcs 0 300 0 300 300
50 Devitalisasi pasta Tablet 0 0 0 0 0
51 Diazepam 2 mg Tablet 2893 0 2893 2893 0
52 Diazepam inj 5mg/ml - 2 ml Ampul 0 5 5 5 0
53 Difenhidramin HCL inj 10 mg/ml Ampul 60 510 542 570 28
54 Digoksin 0,25 mg Tablet 300 1400 180 1700 1520
55 Domperidone 10 mg Tablet 299 3800 3245 4099 854
56 Doxycycline 100 mg Kapsul Tablet 0 200 10 200 190
57 Epinefrin HCL /Bitartrat Inj 0,1 % Ampul 300 600 0 900 900
58 Erlamycetin TT Btl 0 0 0 0 0
59 Eryra Forte tab Kapsul 600 1400 2000 2000 0
60 Erytromicin 500 mg tab Kapsul 0 4700 230 4700 4470
61 Erytromicin Syr Btl 0 510 312 510 198
62 Etakridina (Rivanol) 0,1 % Btl 16 51 25 67 42
63 Etanol 70% - 100 ml Btl 9 0 5 9 4
64 Etanol 70% - 1000 ml Btl 15 24 13 39 26
65 Etil klorida semprot Btl 0 0 0 0 0
66 Eugenol cairan Btl 4 2 0 6 6
67 Fenobarbital 100 mg Tablet 0 1000 760 1000 240
68 Fenobarbital 30 mg Tablet 0 0 0 0 0
69 Fenobarbital inj 50mg/ml - 2 ml Ampul 30 0 10 30 20
 MENURUT PENCATATAN HASIL KETERANGAN
NO NAMA OBAT SATUAN Saldo 01 jan Penerimaan 01 jan Pengeluaran 01 jan Saldo 30 des 2017 PENCACAHAN SELISIH Kadaluarsa Rusak Hilang
2017 s/d 30 des 2017 s/d 30 des 2017
70 Fenol Gliserol 10% TT Btl 90 528 251 367 367
71 Fetominadion (vit.K1) 10 mg Tablet 700 4000 151 4549 4549
72 Fetominadion (vit.K1) inj 10 mg/ml Ampul 100 300 155 245 245
73 Folley catheter NO.16 Pcs 4 60 2 62 62
74 Furosemida 40 mg Tablet 1700 3000 1363 3337 3337
75 Furosemida inj Ampul 25 50 12 63 63
76 Garam Oralit Sachet 700 1200 1612 288 288
77 Gentamicin 0,1 % SK Tube 0 380 265 115 115
78 Gentamicin 0,3% TM Btl 50 432 108 374 374
79 Gentamicin inj mg/ml Ampul 20 205 25 200 200
80 Gentian Violet 1% Larutan Btl 80 132 63 149 149
81 Glass Ionomerlement Set 0 0 0 0 0
82 Glibenklamid 5 mg Tablet 0 0 0 0 0
83 Glimepiride Tablet 0 1500 155 1345 1345
84 Gliseril Guaikolat 100 mg Tablet 2000 10000 7626 4374 4374
85 Glukosa Larutan Infus 10% Btl 100 80 64 116 116
86 Glukosa Larutan Infus 5% Btl 83 80 49 114 114
87 Griseofulvin 125 mg Tablet 400 1300 1026 674 674
88 Haloperidol 0,5 mg tab Tablet 700 1000 20 1680 1680
89 HandScuun No. 7,5 Pcs 177 2500 1782 895 895
90 HandScuun Steril No.7 Pcs 0 200 0 200 200
91 HandScuun Steril No. 7,5 Pcs 0 200 0 200 200
92 Hemafort Tablet 0 3000 1210 1790 1790
93 Hexymer tab Tablet 0 1000 0 1000 1000
94 Hidroklorotiazida (HCT) 25 mg Tablet 1400 0 10 1390 1390
95 Hidrokortison krim 2,5% Tube 40 240 209 71 71
96 Ibuprofen 200 mg Tablet 2000 14500 4708 11792 11792
97 Ibuprofen 400 mg Tablet 0 15300 5641 9659 9659
98 Ibuprofen Susp Btl 0 450 131 319 319
99 Ichtiol Salep Pot 0 0 0 0 0
100 Infusion Set Anak Pcs 30 350 66 314 314
101 Infusion Set Dewasa Pcs 5 500 192 313 313
102 Isosorbid Tablet Tablet 700 1000 280 1420 1420
103 IV Cateter No.20 Pcs 60 400 142 318 318
104 IV Cateter No.22 Pcs 0 500 141 359 359
105 IV Cateter No.24 Pcs 30 450 156 324 324
106 Jarum Jahit Kulit Sutra Pcs 10 204 16 198 198

MENURUT PENCATATAN HASIL KETERANGAN

NO NAMA OBAT SATUAN Saldo 01 jan Penerimaan 01 jan Pengeluaran 01 jan Saldo 30 des 2017 PENCACAHAN SELISIH Kadaluarsa Rusak Hilang
2017 s/d 30 des 2017 s/d 30 des 2017
107 Kalium Permanganat Serbuk Pot 0 0 0 0 0
108 Kalsium Laktat (Kalk) 500 mg Tablet 800 12700 8075 5425 5425
109 Kapas Pembalut/Absorben 250 mg Pcs 20 15 16 19 19
110 Karbamazepin Pcs 0 0 0 0 0
111 Kasa Kompres 40/40 Steril Pcs 80 800 164 716 716
112 Kasa Pembalut 2x80 Pcs 30 250 29 251 251
113 Kasa Pembalut Hidrofil 4m x 15cm Pcs 130 500 150 480 480
114 Kasa pembalut Hidrofil 4m x 3cm Pcs 60 300 203 157 157
115 Ketokonazol 200 mg Krim Tube 0 45 42 3 3
116 Ketokonazol 200 mg Tablet 0 625 65 560 560
117 Kloramfenicol 250 mg Kapsul 0 0 0 0 0
118 Kloramfenicol 3% TT Btl 0 0 0 0 0
119 Kloramfenicol Suspensi 125 mg/ml Btl 16 250 228 38 38
120 Kloramfenicol 1% SM Tube 20 48 49 19 19
121 Klorfeniramin Maleat ( CTM ) 4 mg Tablet 3000 19600 17769 4831 4831
122 Klorokina Fosfat 250 mg Tablet 0 0 0 0 0
123 Klorpromazin HCL 100 mg Tablet 0 1000 0 1000 1000
124 Komb. Pirimet 2 mg + Sulfadox 500 mg Tablet 0 0 0 0 0
125 Kotrimoksazol Kombinasi 120 mg Tablet 0 0 0 0 0
126 Kotrimoksazol Kombinasi 480 mg Tablet 800 5100 3044 2856 2856
127 Kotrimoksazol Sups Btl 60 550 303 307 307
128 Leukoplast Rol 0 220 22 198 198
129 Levertran Salep / Salep Luka Bakar Pot 40 204 77 167 167
130 Lidokain 2 % Ampul 0 200 11 189 189
131 Lidokain Comp. Inj Kombinasi Ampul 250 480 410 320 320
132 Locoriz Krim Tube 0 0 0 0 0
133 Loperamid 2 mg tab Tablet 800 5000 1019 4781 4781
134 Loratadine 10 mg tab Tablet 0 0 0 0 0
135 Lysol 1 Liter Btl 9 13 12 10 10
136 Magnesium Sulfat inj 40% ( MgSO4) Btl 4 0 2 2 2
137 Masker Pcs 200 1550 729 1021 1021
138 Mess No.16 Pcs 30 100 43 87 87
139 Metformin 500 mg tab Tablet 800 2700 2085 1415 1415
140 Metil Ergometrin Maleat 0,125 mg Tablet 0 0 0 0 0
141 Metil Ergometrin Maleat inj 0,2 mg/ml Ampul 30 130 75 85 85
142 Metil Prednisolon 4 mg Tablet 0 8200 1870 6330 6330
143 Metronidazol 250 mg Tablet 1000 3700 1275 3425 3425

MENURUT PENCATATAN HASIL KETERANGAN

NO NAMA OBAT SATUAN Saldo 01 jan Penerimaan 01 jan Pengeluaran 01 jan Saldo 30 des 2017 PENCACAHAN SELISIH Kadaluarsa Rusak Hilang
2017 s/d 30 des 2017 s/d 30 des 2017
144 Metronidazol 500 mg Tablet 900 3200 1263 2837 2837
145 Metronidazol Infus Btl 0 50 6 44 44
146 Metronidazol Syr Btl 10 350 33 327 327
147 Miconazole 2% SK Tube 49 48 71 26 26
148 Momilen Baby Gold Sirup Btl 0 200 200 0 0
149 My Jelly 82 Gram Btl 0 60 0 60 60
150 Natrium Bikarbonat 500 mg Tablet 0 0 0 0 0
151 Natrium Diclopenac 25 mg tab Tablet 500 5700 2747 3453 3453
152 Natrium Klorida Larutan Infus 0,9% Btl 120 100 67 153 153
153 New Antides Tablet Tablet 0 500 40 460 460
154 Nifedipin 10 mg tab Tablet 300 2800 981 2119 2119
155 Nistatin tab Vag 100.000 iu/g Tab Vag 50 700 34 716 716
156 Novachlor Kapsul Kapsul 600 1700 2300 0 0
157 Nutrifar Tab Tablet 0 0 0 0 0
158 Obat Batuk Hitam Btl 0 240 24 216 216
159 OBH FM Btl 0 0 0 0 0
160 Oksitetrasiklin HCL 1% SM Tube 70 0 70 0 0
161 Oksitetrasiklin HCL 3% SK Tube 60 100 160 0 0
162 Omeprazol Kapsul 400 4620 2532 2488 2488
163 Oxytocin Inj 10 IU Ampul 0 100 0 100 100
164 Papaverin 40 mg tab Tablet 0 0 0 0 0
165 Papaverin inj Ampul 0 0 0 0 0
166 Parasetamol Drop 15 ml Btl 40 772 712 100 100
167 Parasetamol 100 mg Tablet 0 0 0 0 0
168 Parasetamol 120 mg/ml Syr Btl 50 1050 718 382 382
169 Parasetamol 500 mg Tablet 2400 35100 26913 10587 10587
170 Pehavral Tablet 0 0 0 0 0
171 Piracetam 400 mg Tablet 0 0 0 0 0
172 Pirantel Pamoat 125 mg Tablet 400 3700 2100 2000 2000
173 Piridoksina HCL 10 mg Tablet 200 3000 400 2800 2800
174 Piroksikam 20 mg tab Tablet 2000 13500 6007 9493 9493
175 Pitogin inj 10 iu/ml Ampul 0 0 0 0 0
176 Plaster 5 yard x 2 inch Rol 4 0 4 0 0
177 Prednison 5 mg Tablet 0 16900 8302 8598 8598
178 Primaquin 15 mg tab Tablet 0 1000 0 1000 1000
179 Prokaina Penisilin G inj 3.000.000 iu Ampul 0 0 0 0 0
180 Propil Tio Urasil 100 mg Tablet 0 0 0 0 0

MENURUT PENCATATAN HASIL KETERANGAN

NO NAMA OBAT SATUAN Saldo 01 jan Penerimaan 01 jan Pengeluaran 01 jan Saldo 30 des 2017 PENCACAHAN SELISIH Kadaluarsa Rusak Hilang
2017 s/d 30 des 2017 s/d 30 des 2017
181 Propranolol HCL 10 mg Tablet 800 0 35 765 765
182 Propranolol HCL 40 mg Tablet 800 0 210 590 590
183 Puralex Tablet Tablet 200 1700 1230 670 670
184 Ranitidin 150 mg Tablet 0 11000 6230 4770 4770
185 Ranitidin inj Ampul 0 0 0 0 0
186 Retinol (Vit.A) Kaps 100.000 iu Kapsul 0 0 0 0 0
187 Retinol (Vit.A) Kaps 200.000 iu Kapsul 0 0 0 0 0
188 Ringer Laktat Larutan Infus Steril Btl 40 900 896 44 44
189 Salbutamol 2 mg Tablet 300 3300 2633 967 967
190 Salep 2-4 Kombinasi Pot 0 120 26 94 94
191 Salisil Bedak 2% Sachet 100 400 244 256 256
192 Scabimite Krim Tube 0 0 0 0 0
193 Scopma tab Tablet 0 0 0 0 0
194 Semen Seng Fosfat Serbuk & Cairan Set 0 0 0 0 0
195 Serum Anti Bisa Ular 5ml (ABU I)Biosave Ampul 0 1 0 1 1
196 SErum Anti Tetanus Inj. 1500 iu Ampul 0 0 0 0 0
197 Sianocobalamin (Vit B12) 50 mg tab Tablet 1600 13000 7203 7397 7397
198 Sianocobalamin (Vit B12)inj 500 mcg/ml Ampul 160 700 585 275 275
199 Silk ( Benang Bedah ) No. 3/0 Pcs 70 216 70 216 216
200 Silver amalgam Serbuk Set 0 0 0 0 0
201 Simvastatin 10 mg tab Tablet 0 1590 100 1490 1490
202 Sulfasetamida 15% TM Btl 0 0 0 0 0
203 Superhoid Supp Suppo 0 216 40 176 176
204 Tablet Tambah Darah Tablet 0 5600 210 5390 5390
205 Temporary Stopping Fletcher Set 0 1 0 1 1
206 Tes Golongan Darah Anti A Set 0 7 5 2 2
207 Tes Golongan Darah Anti AB Set 0 7 5 2 2
208 Tes Golongan Darah Anti B Set 0 7 5 2 2
209 Tes Golongan Darah Anti D Set 0 7 5 2 2
210 Tes Kehamilan Pcs 370 900 430 840 840
211 Tetagam Ampul 0 2 0 2 2
212 Tetrasiklin 250 mg Kapsul 800 5700 230 6270 6270
213 Tetrasiklin 500 mg Kapsul 700 800 662 838 838
214 Tiacinon inj Ampul 80 200 280 0 0
215 Tiamfenikol 500 mg Kapsul 0 0 0 0 0
216 Tiamin HCL (Vit.B1 ) 50 mg Tablet 1300 15400 6610 10090 10090
217 Tiamin HCL (Vit.B1 ) inj 100 mg/ml Ampul 90 510 429 171 171

MENURUT PENCATATAN HASIL KETERANGAN

NO NAMA OBAT SATUAN Saldo 01 jan Penerimaan 01 jan Pengeluaran 01 jan Saldo 30 des 2017 PENCACAHAN SELISIH Kadaluarsa Rusak Hilang
2017 s/d 30 des 2017 s/d 30 des 2017
218 Trihexyphenidyl tab 2 mg Tablet 0 700 0 700 700
219 Truvit Syr Btl 0 0 0 0 0
220 Urin Bag Pcs 10 80 23 67 67
221 Vaksin Rabies Vero / Verorab Ampul 0 0 0 0 0
222 Vigel 30 mg Tube 2 0 2 0 0
223 Vit K Infant inj Ampul 0 0 0 0 0
224 Vit B Compleks Tablet 2600 8260 8189 2671 2671
225 Wing Needle No. 21 Pcs 60 100 4 156 156
226 Wing Needle No. 27 Pcs 0 158 1 157 157
227 Yodium Povidon 10% 30 ml Btl 90 110 101 99 99
228 Yodium Povidon 10% 300 ml Btl 60 29 16 73 73
229 Zinc tab Tablet 600 2100 1805 895 895
230 Magnesium Sulfat Injeksi 20%(MgSO4) btl 0 0 0 0 0
231 Sulfadiazine Silver Tube 0 4 0 4 4
232 Usg Gel Btl 0 0 0 0 0
233 Gluco Protein Btl 0 20 0 20 20
234 Bisakodil 5 mg Tablet 0 150 0 150 150
235 Dimenhydrinat 50 mg Tablet 0 300 0 300 300
236 Risperidone 2 mg Tablet 0 0 0 0 0
237 Haloperidol 5 mg tab Tablet 0 0 0 0 0
238 Clindamyacin 300 mg Tablet 0 300 0 300 300
239 Xylocaine 10 Spray Tablet 0 5 0 5 5
240 Omeprazole inj Vial 0 0 0 0 0
241 Profolat tab Tablet 0 200 0 200 200
242
Mengetahui Pematang Panggang I, 30 Desember 2017
Pimpinan Puskesmas pematang Panggang I Pengelola Obat Puskesmas Pematang Panggang I

MUHERLI,SKM SAKSI - SAKSI SATRIO.AM.Kep

NIP.19770710 200501 1 004 NIP.19791231 200801 1 008

Saksi 1...............................(....................................) Sakssi 2...........................(..........................)