Lampiran 1 : Form LAPORAN PELAYANAN KEFARMASIAN DI PUSKESMAS

Nama Puskesmas : Puskesmas Pedamaran Timur

Jenis Puskesmas : Non Perawatan
Kabupaten/Kota : Ogan Komering Ilir
Provinsi : Sumatera Selatan
Laporan bulan : September /Tahun 2020
Jumlah Apoteker : ASN : 1 Non ASN: -
Jumlah TTK : ASN : - Non ASN : -

Jumlah Pengkajian Pelayanan Resep

Jumlah Pelayanan
Jumlah Konseling
Rawat Jalan Rawat Inap Informasi Obat

1 2 3 4
123 0 0 123

Mengetahui
Kepala Puskesmas Penanggung Jawab Farmasi

Muherli, SKM Edisariadi Saragih, S. Farm., Apt.

NIP. 19770710 200501 1 004 NIP. 19790821 201001 1 003
 LAPORAN INDIKATOR PERESEPAN ANTIBIOTIK DI PUSKESMAS
BULAN SEPTEMBER TAHUN 2020

Nama Puskesmas : Pedamaran Timur

kabupaten : Ogan Komering Ilir
provinsi : Sumatera Selatan

Rerata item obat / lembar resep

% Penggunaan Antibiotik
pada Ispa atas dan % Penggunaan Antibiotik Ispa dan Batuk-
Batuk-Pilek (Common pada Diare non spesifik Pilek (Common Diare non spesifik rata rata
Cold) Cold)
(X1) (Y1) (Za) (Zb) (Z1)
1 2 3 4 5
0 0 2-3 2-3 2-3

Petugas, Kepala Puskesmas

Edisariadi Saragih, S. Farm., Apt Muherli, SKM

NIP. 197908221 201001 1 003 NIP. 19770710 200501 1 004
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAA
PUSKESMAS
PUSKESMAS : Pedamaran Timur PELAPORAN BULAN : September 2020
KECAMATAN : Pedamaran Timur PERMINTAAN BULAN :
KABUPATEN : OGAN KOMERING ILIR
PROPINSI : SUMATERA SELATAN

STOK
NO. NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL
1 2 3 4 5 6 7
1 Absorbent tipped applicator (alcohol swab) Pcs 0 100 100 0
2 Acetylcystein Kapsul 200mg Kapsul 0 0 0 0
3 Acyclovir tab 200 mg Tablet 0 0 0 0
4 Acyclovir cream Tube 0 0 0 0
5 Albendazol tab 400 mg Tablet 0 0 0 0
6 Alkohol Liquid (etanol) 70%-1000 ml Btl 0 10 10 6
7 Allopurinol 100 mg Tablet 610 400 1010 210
8 Aminophylline Inj 24 mg/ml-10 ml Ampul 0 0 0 0
9 Aminophylline tab 200 mg Tablet 240 0 240 170
10 Amitriptyline 25 mg tab Tablet 0 0 0 0
11 Amlodipine tab 5 mg Tablet 1080 900 1980 510
12 Amoxycillin Syr Btl 108 0 108 37
13 Amoxycillin 250 mg Kapsul 0 0 0 0
14 Amoxycillin 500 mg Kaptab 8150 0 8150 860
15 Ampicilin 1 gr Inj Vial 0 0 0 0
16 Antasida Syr DOEN Btl 47 50 97 22
17 Antasida DOEN Kombinasi Tablet 0 5000 5000 700
18 Anti Bisa Ular 5 ml (ABU I)/ Biosave Vial 0 0 0 0
19 Asam Mefenamat 500 mg tab Tablet 2590 0 2590 710
20 Ascorbic acid (Vit.C) 50 mg Tablet 0 3000 3000 640
21 Ascorbic acid |calsium carbonate 500 mg (Pehavral) Tablet 0 0 0 0
22 Aspirin (miniaspi) 100 mg tab Tablet 0 0 0 0
23 Atropine inj 0,25 mg/ml Ampul 7 0 7 0
24 Attapulgite Tablet (Pularex) Tablet 100 0 100 30
25 Attapulgite Tablet 600 mg (New Antides) Tablet 40 0 40 0
26 Automated blood grouping (Tes Gol. Darah) Paket 0 0 0 0
27 Bahan Tambal Gigi Sementara (Fletcher/Caviton) Pcs 0 0 0 0
28 Bedak Salisil 2% Btl 0 0 0 0
29 Benzoic acid |salicylic acid salep (anti fungi) pot 0 24 24 6
30 Betahistine Mesylate 6 mg tab Tablet 0 0 0 0
31 Betamethasone 0,1% krim Tube 9 50 59 12
32 Bisacodyl 5mg Tablet 0 0 0 0
33 Bismuth subgallas (antihemoroid) Supp 0 50 50 30
34 Calcium chloride lactate infus (RL) Botol 33 0 33 0
35 Calsium Laktat (Kalk) 500 mg Tablet 80 1000 1080 400
36 Captopril 12,5 mg Tablet 940 0 940 400
37 Captopril 25 mg Tablet 430 0 430 180
38 Carbamazepin tab Tablet 0 0 0 0
39 Catgut/Benang Chromic Bedah No.2/0-3/0 Pcs 18 0 18 0
40 Catgut/Benang Plain Bedah No.2/0-3/0 Pcs 25 0 25 2
41 Cefadroxil 500mg Tablet 0 0 0 0
42 Cetirizine 5 mg/5 ml sirup Botol 0 0 0 0
43 Chloramhenicol Salep Mata 1% Tube 16 48 64 13
44 Chloramphenicol Suspensi 125 mg/ml Btl 0 0 0 0
45 Chloramphenicol 250 mg caps Tablet 90 0 90 60
46 Chloramphenicol TT 3% Botol 0 0 0 0
47 Chloramphenicol/ Hidrokortison krim 2,5% Tube 33 0 33 11
48 Chlorpheniramine Maleat (CTM) 4 mg Tablet 0 0 0 0
 STOK
NO. NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL
1 2 3 4 5 6 7
49 Chlorpromazine HCl 100 mg Tablet 2910 0 2910 660
50 Cimetidin 200 tab Tablet 0 0 0 0
51 Ciprofloxacin 500 mg tab Tablet 0 0 0 0
52 Ciprofloxacin Infus Botol 0 0 0 0
53 Clindamycin 300mg Kapsul 0 0 0 0
54 Cresol liquid 1 Liter (lysol) Botol 0 10 10 7
55 Cyanocobalamin (Vit B12) inj 500 mcg/ml Ampul 0 0 0 0
56 Devitalisasi pasta pot 0 0 0 0
57 Dexamethasone 0,5 mg Tablet 670 0 670 490
58 Dexamethasone inj 5mg/ml-1ml Ampul 32 0 32 11
59 Diazepam 5mg/ml-2 ml inj Ampul 10 0 10 0
60 Diazepam 2 mg Tablet 0 0 0 0
61 Diclofenac sodium 25 mg tab Tablet 20 0 20 20
62 Digoxin 0,25 mg Tablet 0 0 0 0
63 Dimenhydrinate 50mg Tablet 440 0 440 160
64 Dipenhidramine HCl inj 10mg/ml Ampul 41 60 101 19
65 Domperidone 10 mg Tablet 0 1000 1000 310
66 Doxycycline 100 mg Kapsul Kapsul 0 0 0 0
67 Epinephrine HCl/bitartrat inj 0,1% Ampul 9 0 9 5
68 Erythromicin Syr Btl 0 0 0 0
69 Erythromicin 500 mg capsul Kapsul 0 0 0 0
70 Ethacridine (Rivanol) 0,1% Kapsul 0 20 20 6
71 Ethanol ( Aseptan ) 500 cc+ Pump Btl 0 10 10 10
72 Eugenol cairan Botol 0 0 0 0
73 Ferrous fumarate ( Tab. Tambah Darah ) Tablet 0 0 0 0
74 Folic acid 1mg ( asam folat) Tablet 0 0 0 0
75 Folley Catheter No.16 Pcs 10 0 10 0
76 Furosemida Injeksi Ampul 0 0 0 0
77 Furosemida 40 mg Tablet 200 0 200 130
78 Garam Oralit Sachet 0 0 0 0
79 Gentamicyn 0,3% TM Botol 4 48 52 12
80 Gentamicyn Inj 40 mg/ml Ampul 0 0 0 0
81 Gentamicyn 0,1% SK Tube 0 0 0 0
82 Glass lonomer Paket 0 0 0 0
83 Glibenclamide 5 mg Tablet 80 600 680 180
84 Glimepiride 1 mg Tablet 0 0 0 0
85 Glukosa larutan infus 10% Botol 0 0 0 0
86 Glukosa larutan infus 5% Botol 0 0 0 0
87 Griseofulvin 125 mg Tablet 0 0 0 0
88 Guaifenesin 100 Tab (GG tab) Tablet 0 0 0 0
89 Haloperidol 0,5 mg tab Tablet 0 0 0 0
90 Haloperidol 5 mg tab Tablet 3600 0 3600 0
91 Human chorionic (HCG/Tes kehamilan ) Strip 0 0 0 0
92 Hydrochlorotiazide (HCT) 25 mg Tablet 0 0 0 0
93 Ibuprofen sirup Botol 0 0 0 0
94 Ibuprofen 200 mg Tablet 0 0 0 0
95 Ibuprofen 400 mg Tablet 0 0 0 0
96 Ichthyol salep 10% pot 0 0 0 0
97 Immunoglobulin human anti-tetanus (Tetagam) Ampul 0 0 0 0
98 Infus set dewasa Pcs 12 0 12 0
99 Infusi set anak Pcs 50 0 50 0
100 Iodium Povidon 10% 30 ml Botol 0 50 50 8
101 Isosorbide tablet Tablet 0 500 500 0
102 IV Catheter No.20 Pcs 37 0 37 0
103 IV Catheter No.22 Pcs 54 0 54 0
104 IV Catheter No.24 Pcs 30 0 30 0
105 Jarum Jahit Kulit Pcs 0 0 0 0
106 Kalium Permanganat Serbuk pot 0 0 0 0
 STOK
NO. NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL
1 2 3 4 5 6 7
107 Kapas pembalut/Absorben 250 g Pcs 1 13 14 8
108 Kasa pembalut 2x80 Pcs 2 18 20 5
109 Kasa pembalut hidrofil 4 m x 15 cm Pcs 1 50 51 11
110 Kasa pembalut hidrofil 4 m x 3 cm Pcs 46 150 196 43
111 Kasa kompres 40/40 steril Pcs 83 0 83 26
112 Ketoconazole 200 mg Cream Tube 3 50 53 15
113 Ketoconazole 200 mg tab Tablet 170 0 170 90
114 Klorokina Fosfat 250 mg Tablet 0 0 0 0
115 Levertran Salep/ Salep Luka Bakar pot 0 0 0 0
116 Lidocain 2% Ampul 7 0 7 7
117 Lidokain Comp. inj Kombinasi Ampul 10 0 10 5
118 Lidocaine spray (Xylocaine spray) Botol 0 0 0 0
119 Liquorice liquid extract (OBH) Botol 0 0 0 0
120 Locoriz Cream Tube 0 0 0 0
121 Loperamid 2 m tab Tablet 10 0 10 10
122 Loratadine 10 mg tab Tablet 0 3000 3000 940
123 Magnesium Sulfat Injeksi 20% (MgSO4) Ampul 0 10 10 0
124 Magnesium Sulfat Injeksi 40% (MgSO4) Ampul 0 0 0 0
125 Masker Pcs 0 0 0 0
126 Medical adhesive tape (dermafix/leukomed) Pcs 13 0 13 0
127 Metamizole injeksi (antalgin 1000) Ampul 2 0 2 0
128 Metformin 500mg tab Tablet 260 500 760 170
129 Methyl Ergometrin Maleat inj 0,2 mg/ml Ampul 0 0 0 0
130 Methyl Ergometrin Maleat 0,125 mg Tab 70 1000 1070 110
131 Methyl Prednisolon tab 4 mg Tablet 290 500 790 240
132 Methyl Rosanilinium (gentian violet) Botol 0 0 0 0
133 Metronidazol 250 mg tab Tablet 0 0 0 0
134 Metronidazol 500 mg tab Tablet 0 0 0 0
135 Metronidazol Infus Botol 0 0 0 0
136 Metronidazol syr Botol 0 0 0 0
137 Miconazole 2% Salep Kulit Tube 2 48 50 10
138 Momilen Baby Gold Sirup Botol 0 0 0 0
139 Natrium Bikarbonat 500 mg Tablet 0 0 0 0
140 Nifedipin 10 mg tab Kapsul 0 0 0 0
141 Nystatin Tab Vag 10.000 iu/g Tablet 40 0 40 0
142 Omeprazole inj Vial 0 0 0 0
143 Omeprazole kaps Kapsul 0 0 0 0
144 Oxytetracycline HCl 1% Salep Mata Tube 8 25 33 6
145 Oxytetracycline HCl 3% Salep Kulit Tube 0 0 0 0
146 Oxytocin inj 10 IU Ampul 0 0 0 0
147 Papaverin 40 mg tab Tablet 0 0 0 0
148 Papaverin inj Tablet 0 0 0 0
149 Paracetamol Drops 15 ml Botol 0 0 0 0
150 Parasetamol 120 mg/5 ml Syr Botol 134 0 134 39
151 Parasetamol 500 mg Tablet 3400 0 3400 1230
152 Patient Lubricant (My Jelly ) Tube 0 0 0 0
153 Permethrin (Scabimite Cream) Tube 0 0 0 0
154 Phenobarbital inj 50mg/ml-2ml Ampul 0 0 0 0
155 Phenobarbital 100 mg Tablet 0 0 0 0
156 Phenol gliserol 10% TT Botol 1 0 1 1
157 Phytomenadione (Vit.K1) inj 10 mg/ml Ampul 0 120 120 10
158 Phytomenadione (Vit.K1) 10 mg Tablet 0 1000 1000 220
159 Piracetam 400 mg Tablet 0 0 0 0
160 Piroxicam 20 mg tab Tablet 0 0 0 0
161 Pisau Disposable (Mess No.14/21) Pcs 0 0 0 0
162 Plesterku (Leukoplast) Pcs 0 20 20 9
163 Polivalen serum (Anti Tetanus Inj. 1500 iu/Biosat) Ampul 0 0 0 0
164 Povidon iodium 10% 300 ml Botol 0 10 10 7
 STOK
NO. NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL
1 2 3 4 5 6 7
165 Prednison 5 mg Tablet 250 1300 1550 440
166 Primaquin 15 mg tab Tablet 0 0 0 0
167 Profolat tab Tablet 0 0 0 0
168 Prokaina Penisilin G inj 3.000.000 iu Ampul 0 0 0 0
169 Propranolol HCl 10 mg Tablet 0 0 0 0
170 Propranolol HCl 40 mg Tablet 0 0 0 0
171 Propylthiouracil 100 mg Tablet 0 0 0 0
172 Protein Gluco Test Strip 0 0 0 0
173 Pyrantel Pamoat 125 mg Tablet 0 0 0 0
174 Pyridoxine HCl 10 mg Tablet 740 0 740 290
175 Ranitidin 150 mg Tablet 0 0 0 0
176 Ranitidin Injeksi Ampul 0 0 0 0
177 Retinol (Vit.A) kaps 100.000 iu Kapsul 600 0 600 600
178 Retinol (Vit.A) kaps 200.000 iu Kapsul 0 0 0 0
179 Risperidone 2mg Tablet 2220 0 2220 1620
180 Salbutamol 2 mg Tablet 1030 1400 2430 600
181 Salep 2-4 Kombinasi pot 0 0 0 0
182 Sarung tangan (HandScuun) No.7,5/M Pcs 0 0 0 0
183 Sarung tangan (HandScuun Steril) No. 6,5 Pcs 0 0 0 0
184 Sarung tangan (HandScuun Steril) No.7 Pcs 0 0 0 0
185 Sarung tangan (HandScuun Steril) No.7,5 Pcs 0 0 0 0
186 Semen Seng Fosfat Serbuk & Cairan Set 0 0 0 0
187 Sianocobalamin (Vit B12) 50 mg tab Tablet 3940 0 3940 640
188 Silk (Benang Bedah) No. 3/0 Pcs 25 0 25 5
189 Silver Sulfadiazine Tube 0 0 0 0
190 Simvastatin 10 mg tab Tablet 160 0 160 100
191 Sodium cloride infus 0,9% ( NACL ) Botol 46 0 46 5
192 Spuit 1 ml Pcs 0 500 500 260
193 Spuit 3 ml Pcs 10 1000 1010 0
194 Spuit 5 ml Pcs 17 300 317 50
195 Sulfadoxine | Pyrimethamine Tablet 500mg|25mg Tablet 0 0 0 0
196 Sulfamethoxazole | trimethoprim (cotri) syr Botol 92 0 92 35
197 Sulfasetamida 15% TM Botol 0 0 0 0
198 Tetracycline 250 mg Tablet 0 0 0 0
199 Tetracycline 500 mg Tablet 0 0 0 0
200 Thiamine HCl (Vit B1) inj 100 mg/ml Ampul 0 0 0 0
201 Thiamine HCl (Vit B1) 50 mg Tablet 0 2000 2000 600
202 Trihexyphenidyl tab 2 mg Tablet 0 0 0 0
203 Trimethoprim (cotrimoxazol 480 mg) tablet Tablet 1390 0 1390 550
204 Urin Bag Pcs 20 0 20 0
205 Usg Gel Botol 0 0 0 0
206 Vaksin Rabies Vero/ Verorab Paket 0 0 0 0
207 Vitamin B Kompleks Tablet 5380 0 5380 1340
208 Vitamin K Infant Inj Ampul 0 0 0 0
209 Water liquid (aqua P,I) Botol 0 0 0 0
210 Wing Needle No.21 Pcs 0 0 0 0
211 Wing Needle No.27 Pcs 0 0 0 0
212 Zinc Sulphate Suppositoria (Superhoid) Kapsul 0 0 0 0
213 Zinc tab Tablet 110 0 110 110
214 Ondansetron iv/im 4 mg Ampul 0 0 0 0
215 Tranexamic Acid inj 5% Ampul 0 0 0 0
216 Poliwash 500 ml Botol 0 0 0 0
217 Policlean Handrub Botol 0 0 0 0
218 Sarung Tangan (Handscuun) L Pcs 0 0 0 0
219 Cefotaxime Sodium inj 1 gr Vial 0 0 0 0
220 Methyl Prednisolon tab 16 mg Tablet 0 0 0 0
221 Lancet Pcs 0 0 0 0
222 Strip Kolesterol Pcs 0 0 0 0
 STOK
NO. NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL
1 2 3 4 5 6 7
223 Strip Gula Darah Pcs 0 0 0 0
224 Strip Asam Urat Pcs 0 0 0 0
225 Nonwoven Fixation Rol Pcs 0 0 0 0
226 Paracetamol 1000 mg /100 ml Botol 0 0 0 0
227 Otsu D-40 25 ml Botol 0 0 0 0
228 Ketorolac inj 30 mg Ampul 0 0 0 0
229 Dulcolax tab Tablet 0 0 0 0
230 Ibuprofen 400 mg.1 Tablet 1280 0 1280 460
231 Permethrin (Scabimite Cream).1 Tube 0 0 0 0
232 Masker Plus Pcs 0 0 0 0
233 0 0 0 0 0 0
234 0 0 0 0 0 0
0

JUMLAH UMUM
JUMLAH
KUNJUNGAN JAMSOSKES BPJS
RESEP 305 427 732

Mengetahui/ menyetujui Yang menyerahkan Yang meminta

Kepala Dinas Kesehatan Kab. OKI Kepala UPOPPK Kepala Puskesmas

Iwan Setiawan, SKM, Mkes Himayanti, S. Si., M. Kes., Apt. Muherli, SKM
Nip. 19730905 199803 1 005 NIP. 19770221 200501 2 005 NIP. 19770710 200501 1 004
 DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS
DOKUMEN Nomor Tanggal
DINKES KAB/KOTA
GFK KAB/KOTA
PUSKESMAS

STOK STOK
PERMINTAAN PEMBERIAN KET
AKHIR OPTIMUM
8 9 10 11 12
100 0 0
0 5000 5000
0 1000 1000
0 30 30
0 0 0
4 10 6
800 642 0
0 0 0
70 394 0
0 0 0
1470 1132 0
71 136 65
0 1500 1500
7290 2882 0
0 0 0
75 86 0
4300 840 0
0 0 0
1880 3000 1120
2360 768 0
0 0 0
0 0 0
7 3 0
70 146 0
40 10 0
0 0 0
0 3 3
0 50 50
18 21 0
0 700 700
47 46 0
0 700 700
20 36 0
33 13 0
680 720 0
540 1600 1060
250 1276 1026
0 0 0
18 2 0
23 2 0
0 0 0
0 0 0
51 40 0
0 0 0
30 252 0
0 30 30
22 45 23
0 5000 5000
STOK STOK
PERMINTAAN PEMBERIAN KET
AKHIR OPTIMUM
8 9 10 11 12
2250 1482 0
0 0 0
0 0 0
0 0 0
0 0 0
3 8 5
0 0 0
0 3 3
180 3000 2820
21 15 0
10 0 0
0 2000 2000
0 1000 1000
0 0 0
280 232 0
82 27 0
690 412 0
0 0 0
4 7 0
0 0 0
0 0 0
14 16 0
0 12 12
0 6 6
0 0 0
0 1000 1000
10 0 0
0 0 0
70 0 0
0 0 0
40 31 0
0 0 0
0 60 60
0 3 3
500 306 0
0 0 0
0 0 0
0 0 0
0 1000 1000
0 5000 5000
0 0 0
3600 0 0
0 1000 1000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
12 5 0
50 0 0
42 10 0
500 30 0
37 5 0
54 1 0
30 0 0
0 0 0
0 0 0
STOK STOK
PERMINTAAN PEMBERIAN KET
AKHIR OPTIMUM
8 9 10 11 12
6 19 13
15 11 0
40 15 0
153 62 0
57 45 0
38 34 0
80 1000 920
0 0 0
0 0 0
0 30 30
5 90 85
0 6 6
0 100 100
0 0 0
0 0 0
2060 1128 0
10 0 0
0 0 0
0 5000 5000
13 2 0
2 0 0
590 304 0
0 0 0
960 262 0
550 718 0
0 30 30
0 0 0
0 1000 1000
0 0 0
0 0 0
40 31 0
0 0 0
0 1000 1000
0 1000 1000
40 40 0
0 0 0
0 1000 1000
27 15 0
0 60 60
0 100 100
0 0 0
0 0 0
0 100 100
95 145 50
2170 3656 1486
0 0 0
0 0 0
0 0 0
0 0 0
0 30 30
110 12 0
780 364 0
0 0 0
0 1500 1500
0 0 0
11 11 0
0 0 0
3 8 5
STOK STOK
PERMINTAAN PEMBERIAN KET
AKHIR OPTIMUM
8 9 10 11 12
1110 1098 0
0 0 0
0 1000 1000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
450 1600 1150
0 1000 1000
0 0 0
0 720 0
0 0 0
600 4000 3400
1830 1330 0
0 24 24
0 500 500
0 0 0
0 0 0
0 1000 1000
0 3 3
3300 1828 0
20 7 0
0 20 20
60 1000 940
41 8 0
240 312 0
1010 3 0
267 69 0
0 0 0
57 67 0
0 30 30
0 0 0
0 0 0
0 0 0
1400 770 0
0 4000 4000
840 1130 0
20 0 0
0 0 0
0 0 0
4040 2868 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
 STOK STOK
PERMINTAAN PEMBERIAN KET
AKHIR OPTIMUM
8 9 10 11 12
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
820 1632 812
0 0 0
0 0 0
0 0 0
0 0 0

Yang meminta Yang menerima

Kepala Puskesmas Petugas Puskesmas

Muherli, SKM Edisariadi Saragih, S. Farm., Apt

NIP. 19770710 200501 1 004 NIP. 19790821 201001 1 003
 MONITORING INDIKATOR PERESEPAN
Bulan : September 2020

Jumlah Jumlah Antibiotik Injeksi Jumlah

No Diagnosis 1/1O
Pasien R/ 1/O Generik

1 2 3 4 5 6 7
1 4 ABCES 12 0 0 12
2 28 ALERGI 61 0 0 61
3 2 ANEMIA 4 0 0 4
4 2 ANOREXIA 4 0 0 4
5 19 ASAM URAT 63 0 0 63
6 21 ASMA 66 0 0 66
7 1 Asma + Hipertensi 4 0 0 4
8 4 BRONCHITIS 14 3 0 14
9 8 CHEPALGIA 19 0 0 19
10 6 COMBUSTIO 21 2 0 21
11 24 DERMATITIS 75 5 0 75
12 25 DIARE 73 1 0 73
13 1 Disentri 3 0 0 3
14 6 DISMENORHOE 13 0 0 13
15 1 DISPEPSIA 2 0 0 2
16 17 DM 54 0 0 54
17 2 EMESIS 6 0 0 6
18 1 FARINGITIS 3 0 0 3
19 32 FEBRIS 100 4 0 100
20 65 GASTRITIS 205 0 0 205
21 6 GATAL JAMUR 13 0 0 13
22 40 GIGI 128 11 3 128
23 11 Haemoroid 33 0 0 33
24 1 headache 2 0 0 2
25 55 HIPERTENSI 177 0 0 177
26 1 Hipertensi + Gastritis 4 0 0 4
27 1 Hipertensi + Myalgia 4 0 0 4
28 1 Hipertensi + Rhematik 4 0 0 4
29 15 Infeksi kulit 45 0 0 45
30 33 INFLUENSA 96 1 1 96
31 2 ISK 6 1 0 6
32 27 ISPA 90 6 2 90
33 54 KIA 257 0 3 157
34 16 Kolesterol 45 0 0 45
35 10 konjungtivitis 30 0 0 30
36 1 KONTROL SIRCUMSISI 2 1 0 2
37 4 Mata 12 0 0 12
38 25 MYALGIA 71 0 0 71
 Jumlah Jumlah Antibiotik Injeksi Jumlah
No Diagnosis 1/1O
Pasien R/ 1/O Generik

1 2 3 4 5 6 7
39 44 ODGJ 88 0 0 88
40 59 RHEMATIK 182 0 0 182
41 1 Rhinitis akut 3 0 0 3
42 15 STOMATITIS 45 1 0 45
43 4 SUSP TB 4 0 0 4
44 16 Telinga 48 0 0 48
45 9 TONSILITIS 28 2 1 28
46 1 URTIKARIA 3 0 0 3
47 2 VERTIGO 6 0 0 6
48 9 VULNUS 35 5 5 35
0 0 0 0 0 0
0 0 0 0 0 0
Jumla
h 732
Jumlah Pasien Total keseluruhan 2263 43 15 2163
Rata-rata
Prosentase 5.87 2.05

Mengetahui
Pimpinan Puskesmas Pedamaran timur Pengelola Obat

Muherli, SKM Edisariadi Saragih, S. Farm., Apt

NIP. 19770710 200501 1 004 NIP. 19790821 201001 1 003
 MONITORING INDIKATOR PERESEPAN

PUSKESMAS : PEDAMARAN TIMUR BULAN : September

KABUPATEN : OGAN KOMERING ILIR TAHUN: 2020
PROPINSI : SUMARERA SELATAN

Jumlah Antibiotik Injeksi Jumlah

Tgl No Nama Umur Diagnosis
R/ 1/0 1/0 generik

1 2 3 4 5 6 7 8 9
4/9 1 Tn. Juli 32 th Diare 3 3

8/9 2 An. Revi Akbar 5 th 2 2

9/9 3 Purwanti Muher 28 th 2 2

10/9 4 Tegar Sandia 5 th 2 2

12/9 5 Justi Arsena 2 th 2 2

Mengetahui
Pimpinan Puskesmas Pedamaran Timur

Muherli, SKM
NIP. 19770710 200501 1 004
RESEPAN

: September

Sesuai
Jumla
Nama Obat Dosis Pedoman
h
Ya/Tidak
10 11 12 13
Pularex 10 3x1
Zink 10 1x1
Oralit 6 tiap BAB
oralit 6 tiap BAB
zink 10 1x1
oralit 6 tiap BAB
zink 10 1x1
oralit 6 tiap BAB
zink 10 1x1
oralit 6 tiap BAB
zink 10 1x1

Pengelola Obat

Edisariadi Saragih, S. Farm., Apt.

NIP. 19790821 201001 1 003
 MONITORING INDIKATOR PERESEPAN

PUSKESMAS : PEDAMARAN TIMUR BULAN : September

KABUPATEN : OGAN KOMERING ILIR TAHUN : 2020
PROPINSI : SUMARERA SELATAN

Jumlah Antibiotik Injeksi Jumlah

Tgl No Nama Umur Diagnosis Nama Ob
R/ 1/0 1/0 generik

1 2 3 4 5 6 7 8 9 10
7/9 1 An. Nita 3 th Ispa non pneumonia 2 2 Paracetamol syr
Loratadine tab

7/9 2 Tri Murti 15 th 3 3 Paracetamol 500

Loratadin 10 mg
Vit B Comp

11/9 3 An. Elisa 2 th 2 2 Paracetamol syr

Loratadin 10 mg

16/9 4 Ny. Ismawiyah 23 th 3 3 Paracetamol 500

Loratadin 10 mg
Vit B Comp

30/9 5 An. Ria 2,5 th 2 2 Paracetamol syr

Loratadin 10 mg

30/9 6 An. Lutfi 2,5 th 2 2 Paracetamol syr

Loratadin 10 mg

Mengetahui
Pimpinan Puskesmas Pedamaran Timur

Muherli, SKM Edisa

NIP. 19770710 200501 1 004 NIP
MONITORING INDIKATOR PERESEPAN

: September

Sesuai
Nama Obat Dosis Jumlah Pedoman
Ya/Tidak
10 11 12 13
Paracetamol syr 3x1 sdt 1 fls
Loratadine tab 1x1/2 ta 3

Paracetamol 500 mg tab 3x1 10

Loratadin 10 mg tab 1x1 5
Vit B Comp 1x1 10

Paracetamol syr 3x1 sdt 1 fls

Loratadin 10 mg tab 1x1/2 ta 3

Paracetamol 500 mg 3x1 10

Loratadin 10 mg tab 1x1 5
Vit B Comp 1x1 10

Paracetamol syr 3x1 sdt 1 fls

Loratadin 10 mg tab 1x1/2 ta 3

Paracetamol syr 3x1 sdt 1 fls

Loratadin 10 mg tab 1x1/2 ta 3

Pengelola Obat

Edisariadi Saragih, S. Farm., Apt.

NIP. 19790821 201001 1 003
 MONITORING INDIKATOR PERESEPAN

PUSKESMAS : PEDAMARAN TIMUR BULAN : September

KABUPATEN : OGAN KOMERING ILIR TAHUN : 2020
PROPINSI : SUMARERA SELATAN

Jumlah Injeksi Jumlah

Tgl No Nama Umur Diagnosis Antibiotik 1/0
R/ 1/0 generik

1 2 3 4 5 6 7 8 9
26/9 1 Ny. Sekar 39 th Myalgia 2 2

28/9 2 Ny. Jayanti 47 th 2 2

28/9 3 Tn. Edi Mulyadi 51 th 3 3

Mengetahui
Pimpinan Puskesmas Pedamaran Timur

Muherli, SKM
NIP. 19770710 200501 1 004
mber

Nama Obat Dosis Jumlah Sesuai Pedoman Ya/Tidak

10 11 12 13
Vit B comp 2X1 10
Paracetamol 500 mg 3X1 10
Ibuprofen 400 mg tab 3x1 10
Vit B Comp 2x1 10
Paracetamol 500 mg 3x1 10
Metil prednisolon 4 mg tab3x1 10
Vit B Komp 2x1 10

Pengelola Obat

Edisariadi Saragih, S. Farm., Apt.

NIP. 19790821 201001 1 003