LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO) PUSKESMAS

PUSKESMAS : AIR SUGIHAN 27 PELAPORAN BULAN : SEPTEMBER 2020 DOKUMEN NOMOR TANGGAL
KECAMATAN : AIR SUGIHAN PERMINTAAS BULAN : OKTOBER, NOVEMBER DINKES KAB/KOTA
KABUPATEN : OGAN KOMERING ILIR DAN DESEMBER 2020 IFK KAB/KOTA
PROPINSI : SUMATERA SELATAN PUSKESMAS

STOK STOK STOK

NO. NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN PEMBERIAAN KET
AWAL AKHIR OPTIMUM

1 2 3 4 5 6 7 8 9 10 11 12
1 Absorbent tipped applicator (alcohol swab) Pcs 600 - 600 500 100 1,320 1,220 - -
2 Acetylcystein Kapsul 200mg Kapsul - - - - - - 2,000 - -
3 Acyclovir tab 200 mg Tablet - - - - - - 2,000 - -
4 Acyclovir cream Tube 13 - 13 13 - 40.8 40.8 - -
5 Albendazol tab 400 mg Tablet 200 - 200 - 200 - - - -
6 Alkohol Liquid (etanol) 70%-1000 ml Btl 13 - 13 7 6 10.8 4.8 - -
7 Allopurinol 100 mg Tablet 1,700 - 1,700 1,400 300 2,640 2,340 - -
8 Aminophylline Inj 24 mg/ml-10 ml Ampul 36 - 36 15 21 34.8 13.8 - -
9 Aminophylline tab 200 mg Tablet - - - - - - 2,000 - -
10 Amitriptyline 25 mg tab Tablet 400 - 400 - 400 - - - -
11 Amlodipine tab 5 mg Tablet - - - - - - 6,000 - -
12 Amoxycillin Syr Btl 118 - 118 42 76 106.8 30.8 - -
13 Amoxycillin 250 mg Kapsul 500 - 500 100 400 120 - - -
14 Amoxycillin 500 mg Kaptab 1,900 - 1,900 1,500 400 3,720 3,320 - -
15 Ampicilin 1 gr Inj Vial 12 - 12 3 9 6 - - -
16 Antasida Syr DOEN Btl 189 - 189 189 - 139.2 139.2 - -
17 Antasida DOEN Kombinasi Tablet 4,700 - 4,700 2,600 2,100 6,120 4,020 - -
18 Anti Bisa Ular 5 ml (ABU I)/ Biosave Vial 2 - 2 - 2 - - - -
19 Asam Mefenamat 500 mg tab Tablet 500 - 500 500 - 2,400 5,000 - -
20 Ascorbic acid (Vit.C) 50 mg Tablet 600 - 600 600 - 1,200 1,200 - -
21 Ascorbic acid |calsium carbonate 500 mg (Pehavral) Tablet - - - - - - 2,000 - -
22 Aspirin (miniaspi) 100 mg tab Tablet - - - - - - 1,500 - -
23 Atropine inj 0,25 mg/ml Ampul - - - - - - 120 - -
24 Attapulgite Tablet (Pularex) Tablet 700 - 700 100 600 360 - - -
25 Attapulgite Tablet 600 mg (New Antides) Tablet 700 - 700 - 700 - - - -
26 Automated blood grouping (Tes Gol. Darah) Paket - - - - - - 5 - -
27 Bahan Tambal Gigi Sementara (Fletcher/Caviton) Pcs - - - - - - 5 - -
28 Bedak Salisil 2% Btl - - - - - - 48 - -
29 Benzoic acid |salicylic acid salep (anti fungi) pot 53 - 53 - 53 22.8 - - -
30 Betahistine Mesylate 6 mg tab Tablet 1,900 - 1,900 1,100 800 1920 1,120 - -
31 Betamethasone 0,1% krim Tube 198 - 198 83 115 162 47 - -
HALAMAN : 2 LPLPO No : 0 LAPORAN BULAN : SEPTEMBER 2020
STOK STOK STOK
NO. NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN PEMBERIAAN KET
OPTIMUM
 STOK
NO. NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN PEMBERIAAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
32 Bisacodyl 5mg Tablet - - - - - - 1,500 - -
33 Bismuth subgallas (antihemoroid) Supp 20 - 20 20 - 36 50 - -
34 Calcium chloride lactate infus (RL) Botol 125 - 125 125 - 408 600 - -
35 Calsium Laktat (Kalk) 500 mg Tablet 1,900 - 1,900 1,400 500 3,480 2,980 - -
36 Captopril 12,5 mg Tablet 200 - 200 200 - 720 3,000 - -
37 Captopril 25 mg Tablet - - - - - - 5,000 - -
38 Carbamazepin tab Tablet 500 - 500 - 500 - - - -
39 Catgut/Benang Chromic Bedah No.2/0-3/0 Pcs 7 - 7 7 - 13.2 48 - -
40 Catgut/Benang Plain Bedah No.2/0-3/0 Pcs 20 - 20 20 - 50.4 50.4 - -
41 Cefadroxil 500mg Tablet - - - - - - 2,000 - -
42 Cetirizine 5 mg/5 ml sirup Botol - - - - - - 180 - -
43 Chloramhenicol Salep Mata 1% Tube 45 - 45 28 17 66 49 - -
44 Chloramphenicol Suspensi 125 mg/ml Btl - - - - - - 120 - -
45 Chloramphenicol 250 mg caps Tablet - - - - - - 2,000 - -
46 Chloramphenicol TT 3% Botol - - - - - - 48 - -
47 Chloramphenicol/ Hidrokortison krim 2,5% Tube 5 - 5 5 - 28.8 28.8 - -
48 Chlorpheniramine Maleat (CTM) 4 mg Tablet - - - - - - 6,000 - -
49 Chlorpromazine HCl 100 mg Tablet 900 - 900 400 500 1,080 580 - -
50 Cimetidin 200 tab Tablet - - - - - - 3,000 - -
51 Ciprofloxacin 500 mg tab Tablet - - - - - - 5,000 - -
52 Ciprofloxacin Infus Botol - - - - - - - - -
53 Clindamycin 300mg Kapsul - - - - - - 2,000 - -
54 Cresol liquid 1 Liter (lysol) Botol 6 - 6 4 2 7.2 5.2 - -
55 Cyanocobalamin (Vit B12) inj 500 mcg/ml Ampul - - - - - - 3,000 - -
56 Devitalisasi pasta pot - - - - - - 5 - -
57 Dexamethasone 0,5 mg Tablet - - - - - - 2,000 - -
58 Dexamethasone inj 5mg/ml-1ml Ampul 69 - 69 57 12 117.6 105.6 - -
59 Diazepam 5mg/ml-2 ml inj Ampul - - - - - - 60 - -
60 Diazepam 2 mg Tablet - - - - - - 5,000 - -
61 Diclofenac sodium 25 mg tab Tablet - - - - - - 6,000 - -
62 Digoxin 0,25 mg Tablet 600 - 600 600 - 1,200 1,200 - -
63 Dimenhydrinate 50mg Tablet 800 - 800 600 200 1,320 1,120 - -
64 Dipenhidramine HCl inj 10mg/ml Ampul 60 - 60 60 - 144 144 - -
65 Domperidone 10 mg Tablet 2,600 - 2,600 1,800 800 2,640 1,840 - -
66 Doxycycline 100 mg Kapsul Kapsul - - - - - - 2,000 - -
67 Epinephrine HCl/bitartrat inj 0,1% Ampul 6 - 6 6 - 8.4 8.4 - -
68 Erythromicin Syr Btl 20 - 20 7 13 13.2 - - -
HALAMAN : 3 LPLPO No : 0 LAPORAN BULAN : SEPTEMBER 2020
STOK STOK STOK
NO. NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN PEMBERIAAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
69 Erythromicin 500 mg capsul Kapsul 1,100 - 1,100 700 400 1,320 920 - -
70 Ethacridine (Rivanol) 0,1% Btl 8 - 8 4 4 9.6 5.6 - -
71 Ethanol ( Aseptan ) 500 cc+ Pump Botol 9 - 9 9 - 14.4 14.4 - -
72 Eugenol cairan Btl - - - - - - - - -
73 Ferrous fumarate ( Tab. Tambah Darah ) Tablet - - - - - - - - -
74 Folic acid 1mg ( asam folat) Tablet - - - - - - 2,000 - -
75 Folley Catheter No.16 Pcs 16 - 16 2 14 6 - - -
76 Furosemida Injeksi Ampul - - - - - - 50 - -
77 Furosemida 40 mg Tablet 1,700 - 1,700 1,500 200 2,160 1,960 - -
78 Garam Oralit Sachet - - - - - - - - -
79 Gentamicyn 0,3% TM Botol 59 - 59 25 34 54 20 - -
80 Gentamicyn Inj 40 mg/ml Ampul 23 - 23 - 23 6 - - -
81 Gentamicyn 0,1% SK Tube - - - - - - 240 - -
82 Glass lonomer Paket - - - - - - - - -
83 Glibenclamide 5 mg Tablet 1,700 - 1,700 800 900 1,320 420 - -
84 Glimepiride 1 mg Tablet 1,400 - 1,400 100 1,300 240 - - -
85 Glukosa larutan infus 10% Botol - - - - - - 40 - -
86 Glukosa larutan infus 5% Botol - - - - - - 40 - -
87 Griseofulvin 125 mg Tablet - - - - - - - - -
88 Guaifenesin 100 Tab (GG tab) Tablet - - - - - - 10,000 - -
89 Haloperidol 0,5 mg tab Tablet - - - - - - - - -
90 Haloperidol 5 mg tab Tablet 400 - 400 200 200 360 3,000 - -
91 Human chorionic (HCG/Tes kehamilan ) Strip 67 - 67 43 24 55.2 100 - -
92 Hydrochlorotiazide (HCT) 25 mg Tablet - - - - - - - - -
93 Ibuprofen sirup Botol - - - - - - 300 - -
94 Ibuprofen 200 mg Tablet - - - - - - - - -
95 Ibuprofen 400 mg Tablet - - - - - - 4,000 - -
96 Ichthyol salep 10% pot - - - - - - 48 - -
97 Immunoglobulin human anti-tetanus (Tetagam) Ampul 4 - 4 1 3 1.2 - - -
98 Infus set dewasa Pcs 688 - 688 62 626 88.8 - - -
99 Infusi set anak Pcs 137 - 137 12 125 38.4 - - -
100 Iodium Povidon 10% 30 ml Botol 1 - 1 1 - 3.6 50 - -
101 Isosorbide tablet Tablet 600 - 600 200 400 360 - - -
102 IV Catheter No.20 Pcs 150 - 150 64 86 118.8 200 - -
103 IV Catheter No.22 Pcs 70 - 70 42 28 103.2 200 - -
104 IV Catheter No.24 Pcs 140 - 140 38 102 84 100 - -
105 Jarum Jahit Kulit Pcs - - - - - - - - -
HALAMAN : 4 LPLPO No : 0 LAPORAN BULAN : SEPTEMBER 2020
STOK STOK STOK
NO. NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN PEMBERIAAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
106 Kalium Permanganat Serbuk pot - - - - - - - - -
107 Kapas pembalut/Absorben 250 g Pcs 25 - 25 3 22 8.4 - - -
108 Kasa pembalut 2x80 Pcs 90 - 90 90 - 120 200 - -
109 Kasa pembalut hidrofil 4 m x 15 cm Pcs 60 - 60 60 - 96 200 - -
110 Kasa pembalut hidrofil 4 m x 3 cm Pcs - - - - - - 200 - -
111 Kasa kompres 40/40 steril Pcs 37 - 37 25 12 114 102 - -
112 Ketoconazole 200 mg Cream Tube 63 - 63 41 22 93.6 71.6 - -
113 Ketoconazole 200 mg tab Tablet - - - - - - 1,000 - -
114 Klorokina Fosfat 250 mg Tablet - - - - - - - - -
115 Levertran Salep/ Salep Luka Bakar pot 11 - 11 2 9 2.4 - - -
116 Lidocain 2% Ampul - - - - - - - - -
117 Lidokain Comp. inj Kombinasi Ampul - - - - - - 180 - -
118 Lidocaine spray (Xylocaine spray) Botol - - - - - - 5 - -
119 Liquorice liquid extract (OBH) Botol - - - - - - 120 - -
120 Locoriz Cream Tube - - - - - - 48 - -
121 Loperamid 2 m tab Tablet 300 - 300 100 200 120 - - -
122 Loratadine 10 mg tab Tablet 3,000 - 3,000 2,400 600 3,480 2,880 - -
123 Magnesium Sulfat Injeksi 20% (MgSO4) Ampul 14 - 14 - 14 1.2 - - -
124 Magnesium Sulfat Injeksi 40% (MgSO4) Ampul 14 - 14 - 14 1.2 - - -
125 Masker Pcs - - - - - - 1,000 - -
126 Medical adhesive tape (dermafix/leukomed) Pcs - - - - - - 100 - -
127 Metamizole injeksi (antalgin 1000) Ampul - - - - - - 200 - -
128 Metformin 500mg tab Tablet 1,000 - 1,000 600 400 1,200 800 - -
129 Methyl Ergometrin Maleat inj 0,2 mg/ml Ampul 6 - 6 - 6 2.4 - - -
130 Methyl Ergometrin Maleat 0,125 mg Tab 200 - 200 - 200 - - - -
131 Methyl Prednisolon tab 4 mg Tablet 1,900 - 1,900 1,600 300 3,240 2,940 - -
132 Methyl Rosanilinium (gentian violet) Botol - - - - - - 48 - -
133 Metronidazol 250 mg tab Tablet 300 - 300 - 300 120 - - -
134 Metronidazol 500 mg tab Tablet 200 - 200 200 - 360 1,000 - -
135 Metronidazol Infus Botol - - - - - - - - -
136 Metronidazol syr Botol 24 - 24 3 21 3.6 - - -
137 Miconazole 2% Salep Kulit Tube 31 - 31 31 - 61.2 61.2 - -
138 Momilen Baby Gold Sirup Botol - - - - - - 120 - -
139 Natrium Bikarbonat 500 mg Tablet - - - - - - 500 - -
140 Nifedipin 10 mg tab Kapsul - - - - - - 3,000 - -
141 Nystatin Tab Vag 10.000 iu/g Tablet 82 - 82 82 - 124.8 124.8 - -
142 Omeprazole inj Vial - - - - - - 120 - -
HALAMAN : 5 LPLPO No : 0 LAPORAN BULAN : SEPTEMBER 2020
STOK STOK STOK
NO. NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN PEMBERIAAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
143 Omeprazole kaps Kapsul - - - - - - 1,200 - -
144 Oxytetracycline HCl 1% Salep Mata Tube 10 - 10 - 10 - - - -
145 Oxytetracycline HCl 3% Salep Kulit Tube - - - - - - 48 - -
146 Oxytocin inj 10 IU Ampul - - - - - - 200 - -
147 Papaverin 40 mg tab Tablet - - - - - - 1,000 - -
148 Papaverin inj Tablet - - - - - - 100 - -
149 Paracetamol Drops 15 ml Botol - - - - - - 60 - -
150 Parasetamol 120 mg/5 ml Syr Botol 158 - 158 75 83 260.4 177.4 - -
151 Parasetamol 500 mg Tablet 11,400 - 11,400 7,800 3,600 13,680 10,080 - -
152 Patient Lubricant (My Jelly ) Tube - - - - - - 10 - -
153 Permethrin (Scabimite Cream) Tube - - - - - - 120 - -
154 Phenobarbital inj 50mg/ml-2ml Ampul - - - - - - 60 - -
155 Phenobarbital 100 mg Tablet 900 - 900 - 900 240 - - -
156 Phenol gliserol 10% TT Botol - - - - - - 48 - -
157 Phytomenadione (Vit.K1) inj 10 mg/ml Ampul 40 - 40 40 - 72 72 - -
158 Phytomenadione (Vit.K1) 10 mg Tablet 800 - 800 700 100 1,080 980 - -
159 Piracetam 400 mg Tablet 1,800 - 1,800 200 1,600 480 - - -
160 Piroxicam 20 mg tab Tablet - - - - - - 6,000 - -
161 Pisau Disposable (Mess No.14/21) Pcs - - - - - - 20 - -
162 Plesterku (Leukoplast) Pcs 19 - 19 9 10 1 6.8 - -
163 Polivalen serum (Anti Tetanus Inj. 1500 iu/Biosat) Ampul - - - - - - - - -
164 Povidon iodium 10% 300 ml Botol 3 - 3 2 1 0 12 - -
165 Prednison 5 mg Tablet 1,000 - 1,000 200 800 360 - - -
166 Primaquin 15 mg tab Tablet 200 - 200 - 200 - - - -
167 Profolat tab Tablet - - - - - - 2,000 - -
168 Prokaina Penisilin G inj 3.000.000 iu Ampul - - - - - - 15 - -
169 Propranolol HCl 10 mg Tablet 900 - 900 100 800 120 - - -
170 Propranolol HCl 40 mg Tablet - - - - - - 1,000 - -
171 Propylthiouracil 100 mg Tablet - - - - - - 500 - -
172 Protein Gluco Test Strip 10 - 10 10 - 1 14.4 - -
173 Pyrantel Pamoat 125 mg Tablet 800 - 800 - 800 - - - -
174 Pyridoxine HCl 10 mg Tablet 200 - 200 200 - 600 2,000 - -
175 Ranitidin 150 mg Tablet - - - - - - 4,000 - -
176 Ranitidin Injeksi Ampul - - - - - - 100 - -
177 Retinol (Vit.A) kaps 100.000 iu Kapsul - - - - - - - - -
178 Retinol (Vit.A) kaps 200.000 iu Kapsul - - - - - - - - -
179 Risperidone 2mg Tablet 2,300 - 2,300 600 1,700 1,560 - - -
HALAMAN : 6 LPLPO No : 0 LAPORAN BULAN : SEPTEMBER 2020
STOK STOK STOK
NO. NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN PEMBERIAAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
180 Salbutamol 2 mg Tablet 1,900 - 1,900 1,200 700 2,640 1,940 - -
181 Salep 2-4 Kombinasi pot 8 - 8 8 - 9.8 120 - -
182 Sarung tangan (HandScuun) No.7,5 Pcs - - - - - - 1,000 - -
183 Sarung tangan (HandScuun Steril) No. 6,5 Pcs - - - - - - 1,000 - -
184 Sarung tangan (HandScuun Steril) No.7 Pcs - - - - - - 1,000 - -
185 Sarung tangan (HandScuun Steril) No.7,5 Pcs - - - - - - 1,000 - -
186 Semen Seng Fosfat Serbuk & Cairan Set - - - - - - - - -
187 Sianocobalamin (Vit B12) 50 mg tab Tablet 900 - 900 900 - 2,640 4,000 - -
188 Silk (Benang Bedah) No. 3/0 Pcs 5 - 5 5 - 6 48 - -
189 Silver Sulfadiazine Tube - - - - - - 12 - -
190 Simvastatin 10 mg tab Tablet - - - - - - 1,200 - -
191 Sodium cloride infus 0,9% ( NACL ) Botol 36 - 36 36 - 54 54 - -
192 Spuit 1 ml Pcs - - - - - - 200 - -
193 Spuit 3 ml Pcs 2,300 - 2,300 700 1,600 1,200 - - -
194 Spuit 5 ml Pcs 200 - 200 200 - 240 240 - -
195 Sulfadoxine | Pyrimethamine Tablet 500mg|25mg Tablet 300 - 300 - 300 - - - -
196 Sulfamethoxazole | trimethoprim (cotri) syr Botol 123 - 123 93 30 204 174 - -
197 Sulfasetamida 15% TM Botol - - - - - - 48 - -
198 Tetracycline 250 mg Tablet - - - - - - - - -
199 Tetracycline 500 mg Tablet 1,200 - 1,200 - 1,200 - - - -
200 Thiamine HCl (Vit B1) inj 100 mg/ml Ampul - - - - - - 120 - -
201 Thiamine HCl (Vit B1) 50 mg Tablet 4,800 - 4,800 400 4,400 720 - - -
202 Trihexyphenidyl tab 2 mg Tablet - - - - - - 5,000 - -
203 Trimethoprim (cotrimoxazol 480 mg) tablet Tablet 1,200 - 1,200 1,000 200 1,680 1,480 - -
204 Urin Bag Pcs 13 - 13 1 12 6 - - -
205 Usg Gel Botol - - - - - - - - -
206 Vaksin Rabies Vero/ Verorab Paket - - - - - - - - -
207 Vitamin B Kompleks Tablet 1,700 - 1,700 1,500 200 3,360 3,160 - -
208 Vitamin K Infant Inj Ampul - - - - - - 30 - -
209 Water liquid (aqua P,I) Botol 93 - 93 - 93 - - - -
210 Wing Needle No.21 Pcs 18 - 18 - 18 - - - -
211 Wing Needle No.27 Pcs - - - - - - - - -
212 Zinc Sulphate Suppositoria (Superhoid) Kapsul - - - - - - 12 - -
213 Zinc tab Tablet 400 - 400 - 400 - - - -
214 Ondansetron iv/im 4 mg Ampul 15 - 15 15 - 48 48 - -
215 Tranexamic Acid inj 5% Ampul - - - - - - 60 - -
216 Poliwash 500 ml Botol - - - - - - 12 - -
HALAMAN : 7 LPLPO No : 0 LAPORAN BULAN : SEPTEMBER 2020
STOK STOK STOK
NO. NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN PEMBERIAAN KET
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11 12
217 Policlean Handrub Botol - - - - - - - - -
218 Sarung Tangan (Handscuun) L Pcs - - - - - - - - -
219 Cefotaxime Sodium inj 1 gr Vial 35 - 35 30 5 48 43 - -
220 Methyl Prednisolon tab 16 mg Tablet - - - - - - 2,000 - -
221 Lancet Pcs 200 - 200 100 100 120 - - -
222 Strip Kolestrol Pcs - - - - - - 5 - -
223 Strip Gula Darah Pcs - - - - - - 5 - -
224 Strip Asam Urat Pcs - - - - - - 5 - -
225 Nonwoven Fixation Rol Pcs 1 - 1 - 1 - - - -
226 Paracetamol 1000 mg /100 ml Botol - - - - - - 20 - -
227 Otsu D-40 25 ml Botol 90 - 90 - 90 - - - -
228 Ketorolac inj 30 mg Ampul - - - - - - 150 - -
229 Dulcolax tab Tablet - - - - - - 200 - -
230 Ibuprofen 400 mg.1 Tablet 200 - 200 200 - 1,200 2,000 - -
231 Permethrin (Scabimite Cream).1 Tube - - - - - - 120 - -
232 Masker Plus Pcs - - - - - - 1,000 - -
233 Haloperidol Injeksi Ampul - - - - - - 30 - -
234 - - - - - - - - -
235 - - - - - - - - -
236 - - - - - - - - -
237 - - - - - - - - -
238 - - - - - - - - -
239 - - - - - - - - -
240 - - - - - - - - -
241 - - - - - - - - -

UMUM JAMSOSKES BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP
906 - 460 1366

Mengetahui Mengetahui Mengetahui/ Menyetujui Yang Membuat

Kepala Dinas Kesehatan Kab. OKI Kepala Instalasi Farmasi Dinkes OKI Pimpinan Puskesmas Pengelola Obat Puskesmas

………………………………….. ……………………………………. ETI LENITA, SKM FATMAWATI, Am.Keb

NIP. 197606262000122002 NIP. 197209052000122003