PEMERINTAH KABUPATEN KONAWE SELATAN

B A D A N L A Y A N A N U M U M D A E R A H (B L U D )
R U M A H S A K IT K O N A W E S E L A T A N
Jl.PorosAndoolo. No.1 – email :rsud.konawe_selatan@yahoo.com

FORMULIR EVALUASI PENGGUNAAN OBAT DI FKRTL

Periode Bulan

Nama Rumah Sakit : BLUD Rumah Sakit Konawe Selatan : JUNI

Kelas Rumah Sakit :C : 2019
Tipe Rumah Sakit : Rumah Sakit Umum ∑Item Obat dalam Formularium RS : 240
Kabupaten/ Kota : Konawe Selatan
Provinsi : Sulawesi Tenggara
Kepemilikan : Pemerintah Daerah

Kesesuaian
dengan
Nama Obat Bentuk Jumlah Jumlah Formularium Ket
NO
Sediaan Persediaan Penggunaan Nasional

Bermerek Generik Y T
1 2 3 4 5 6 7 8 9
1 ACARBOSE 500 MG TABLET 80 1
2 AKILEN 400 MG OFLOXACIN TABLET 30 1
3 AKILEN TETES TELINGA OFLOXACIN DROPS 9 1
4 ALBUMIN INF HUMAN ALBUMIN INFUS INFUS 6 1
5 ALLOPURINOL 100 MG TABLET 126 1
6 ALPRAZOLAM 0,5 MG TABLET 224 1
7 ALPRAZOLAM 1 MG TABLET 10 1
8 AMBROXOL 30 MG TABLET 836 0 1
9 AMBROXOL SIRUP SIRUP 13 0 1
10 AMINEFRON TABLET 30 1
11 AMINOFILIN INJEKSI 11 1
12 AMINOFLUID INFUS 61 1
13 AMLODIPIN 10 MG TABLET 950 1
14 AMLODIPIN 5 MG TABLET 194 1
15 AMOXAN DROP DROP 1 1
16 AMOXICILLIN 500 MG TABLET 714 1
17 AMOXICILLIN SIRUP 7 1
18 ANALTRAM KAPLET 48 1
19 ANESFAR MIDAZOLAM INJ INJEKSI 5 1
20 ANTALGIN 500 MG TABLET 30 0 1
21 ANTALGIN INJEKSI 4 0 1
22 ANTASIDA SIRUP SIRUP 10 1
23 ANTASIDA DOEN TABLET 66 1
24 ANTI HEMOROID SUPP 29 1
25 APIALYS DROP MULTIVITAMIN SIRUP 26 0 1
26 APIALYS SIRUP MULTIVITAMIN SIRUP 50 0 1
27 ASAM FOLAT TABLET 178 1
28 ASAM TRANEXAMAT INJEKSI 238 1
29 ASAM TRANEKSAMAT 500 MG TABLET 175 1
30 ASAM MEFENAMAT 500 MG TABLET 1451 1
31 ASAM VALPROAT SIRUP 11 1
32 ASERING INFUS 7 1
33 ASPILET TABLET 20 1
34 ATROPIN INJEKSI 8 1
35 ATTAPULGIT TABLET 10 1
36 AZITROMICIN 500 MG TABLET 113 1
37 AZITROMICIN INJEKSI 10 1
38 BATUGIN SIRUP SIRUP 7 0 1
39 BECEFORT VITAMIN KAPLET 474 1
40 BUCAIN SPINAL BUPIVACAIN INJEKSI 26 1
41 CAL 95 VITAMIN KAPSUL 105 0 1
42 CANDEFION 8 MG CANDESARTAN 8 MG TABLET 15 1
43 CANDESARTAN 16 MG TABLET 495 1
44 CANDESARTAN 8 MG TABLET 676 1
45 CAPTOPRIL 12,5 MG TABLET 115 1
46 CAPTOPRIL 25 MG TABLET 104 1
47 CEFADROXIL 500 MG KAPSUL 663 1
48 CEFADROXIL 125 MG/ 5 ML SIRUP 19 1
49 CEFIXIM 100 MG KAPSUL 753 1
50 CEFIXIM 200 MG KAPSUL 402 1
51 CEFIXIME 100 MG/5 ML SIRUP 21 1
52 CEFOTAXIM 1 G INJEKSI 158 1
53 CEFTAMAX INJEKSI 18 1
54 CEFTAZIDIM INJEKSI 159 1
55 CEFTRIAXON INJ INJEKSI 453 1
56 CETIRISIN 10 MG TABLET 629 1
57 CIFROFLOXACIN INFUS INFUS 29 1
58 CIPROFLAXACIN 500 MG TABLET 836 1
59 CITICOLIN INJEKSI 35 1
60 CITION CITICOLIN INJEKSI 34 1
61 CLINDAMICIN 300 MG KAPSUL 10 1
62 CLINDAMICYN 150MG KAPSUL 30 1
63 CLOPIDOGREL 75 MG TABLET 626 1
64 CODEIN 10 MG TABLET 307 1
65 COLTIN COLTIN KAPSUL 257 1
66 COMBIVENT SALBUTAMOL NEBU 454 1
67 GLUKOSA 10% INFUS 29 1
68 GLUKOSA 5% INFUS 52 1
69 DANSEFION ONDANSENTRON 4 MG/ 2 ML INJEKSI 70 1
70 DEXAMETHASON INJEKSI 468 1
71 DEXAMETHASON 0.5 MG TABLET 755 1
72 DIAZEPAM 2 MG TABLET 64 1
73 STESOLID RECTAL DIAZEPAM RECTAL 10 MG SUPP 1 1
74 STESOLID RECTAL DIAZEPAM RECTAL 5 MG SUPP 1 1
75 DIPENHIDRAMID INJ INJEKSI 11 1
76 DOBUTAMIN INJ INJEKSI 2 1
77 DOMPERIDON 10 MG TABLET 1009 1
78 DOMPERIDONE SIRUP SIRUP 5 1
79 DOPAMET 250 MG METILDOPA TABLET 73 1
80 DULCOLAX 5 MG SUPP BYSACODIL SUPP 8 1
81 DULCOLAX 10 MG BYSACODIL TABLET 10 1
82 EFEDRIN INJEKSI 8 1
83 EPEXOL DROP AMBROXOL SIRUP 28 0 1
84 EPINEFRIN INJEKSI 17 1
85 ERITROMICIN SIRUP 3 1
86 ERITROMYCIN 250 MG KAPSUL 100 1
87 FARELAX INJEKSI ATRACURIUM BASILATE INJEKSI 5 1
88 FENTANIL INJ INJEKSI 18 1
89 FIOCILAS IMIPENEM INJEKSI 36 1
90 FIONDAZOL METRONIDAZOLE INJEKSI 134 1
91 FIOPRAS PANTOPRASOLE INJEKSI 368 1
92 FIORAMOL PARACETAMOL INFUS 155 1
93 FLADISTIN SUPP 42 1
94 FOLAMIL GENIO SUPLEMEN KAPSUL 475 0 1
95 FOLIC ACID TABLET 40 1
96 FOSMICIN INJ INJEKSI 72 1
97 FUROSEMID 40 MG TABLET 164 1
98 FUROSEMID INJ INJEKSI 101 1
99 GELAFUSAL INFUS 21 1
100 GENTAMICIN SALEP 21 1
101 GENTAMICIN INJ INJEKSI 72 1
102 GLIMEPIRID 1 MG TABLET 25 1
103 GLIMEPIRID 2 MG TABLET 220 1
104 GLIMEPIRID 4 MG TABLET 10 1
105 HEPARMIN TABLET 26 0 1
106 HEPATIN KAPLET 74 0 1
107 HIDROCORTISON SALEP 15 1
108 HUSTAB BROMHEXIN;DIPHENHIDRAMIN;PARA TABLET
CETAMOL 42
1
109 IBUPROFEN 200 MG TABLET 176 1
110 IMIPENEM INFUS 16 1
111 IMUNOS SIRUP 29 0 1
112 IMUNOS KAPLET 40 0 1
113 INBACEF 200 MG CEFIXIM KAPSUL 30 1
114 INFENEM MEROPENEM INJEKSI 27 1
115 INFUXAN INFUS 2 1
116 INTERHISTIN 50 MG TABLET 45 0 1
117 IREMAX IBUPROFEN;PARACETAMOL KAPSUL 2337 1
118 ISDN 5 mg TABLET 259 1
119 ISOFLURAN INFUS 1 1
120 KAEN 3B INFUS 92 1
121 KETOKONAZOL 200 mg TABLET 34 1
122 KETOCONAZOLE SALEP 4 1
123 KETOROLAC INJ INJEKSI 473 1
124 KIDMIN INFUS 8 1
125 KSR TABLET 66 1
126 KTM KETAMIN INJEKSI 2 1
127 L BIO SERBUK 111 0 1
128 L ZINK ZINK SULFATE SIRUP 11 1
129 LACIDOFIL SERBUK 18 0 1
130 LANSOPRAZOL 30 MG KAPSUL 3496 1
131 LAPIBAL MECOBALAMIN KAPSUL 1192 1
132 LAPIBAL INJ MECOBALAMIN INJEKSI 87 1

133 LAPIFED EXPECTORAN

TRIPOLIDIN;PSEUDOEPHEDRIN;GU SIRUP 3 1
AIFENESIN
134 LAPIFED SIRUP TRIPOLIDIN;PSEUDOEPHEDRIN SIRUP 1 1
135 LAPIFED TAB TRIPOLIDIN;PSEUDOEPHEDRIN TABLET 202 1
136 LEVEMIR INSULIN DETEMIR INSULIN PEN 35 1
137 LEVOFLOXACIN 500 mg TABLET 157 1
138 LIDOCAIN IN 119 1
139 LORATADIN 10 mg TABLET 11 1
140 MELOXICAM 15 mg TABLET 370 1
141 MELOXICAM 7,5 MG TABLET 120 1
142 MEROPENEM INJEKSI 22 1
143 MERTIGO 6 mg BETAHISTIN 6 MG TABLET 96 1
144 METIL ERGOMETRIN INJEKSI 10 1
145 METFORMIN 500 MG TABLET 776 1
146 METHYLPREDNISOLONE 4 MG TABLET 1006 1
147 METHYLPREDNISOLONE 8 MG TABLET 120 1
148 METHYLPREDNISOLONE INJEKSI 80 1
149 METIL ERGOMETRIN 0.5 MG TABLET 40 1
150 METOCLOPERAMID 10 MG TABLET 10 1
151 METRONIDASOL 500 MG TABLET 382 1
152 METRONIDAZOL INFUS 14 1
153 MGSO4 20% INJEKSI 2 1
154 MGSO4 40% INJEKSI 5 1
155 MICONAZOLE SALEP 14 1
156 NATRIUM FENITOIN INJEKSI 4 1
157 NACL INFUS 581 1
158 NATRIUM DICLOFENAK 25 MG TABLET 103 1
159 NEUROSANBE VITAMIN TABLET 10 1
160 NEW ANTIDES TABLET 33 1
161 NICARDIPIN INJEKSI 3 1
162 NIFEDIPIN 10 MG TABLET 120 1
163 NISTATIN DROP SIRUP 19 1
164 NORESTIL NORETHISTERON 5 MG TABLET 30 1
165 NOVOMIX INSULIN ASPARD INSULIN PEN 12 1
166 NOVORAPID INSULIN ASPARD INSULIN PEN 26 1
167 OMEPRAZOL INJEKSI 7 1
168 OMEPRAZOLE 20 MG KAPSUL 65 1
169 ONDANSENTRON 4 MG/ 2 ML INJEKSI 338 1
170 ORALIT SERBUK 20 1
171 PARACETAMOL 500 MG TABLET 1437 1
172 PARACETAMOL INFUS 80 1
173 PARACETAMOL SIRUP SIRUP 34 1
174 PHIFION PHYTOMENADION INJEKSI 8 1
175 PHYTOMENADION INJW 98 1
176 PIRACETAM 1 GR INJEKSI 22 1
177 PIRACETAM 3 GR INJEKSI 19 1
178 PIRACETAM 800 MG KAPSUL 163 1
179 PREDNISON 5 MG TABLET 85 1
180 PROMAVIT SUPLEMEN KAPSUL 550 0 1
181 PRONOLOL 10 MG TABLET 423 1
182 PROSTER MISOPROSTOL TABLET 32 1
183 PSDII EKSTRAK JAMBU BIJI KAPSUL 35 0 1
184 RANITDIN 150 MG TABLET 1460 1
185 RANITIDIN INJEKSI 494 1
186 RECOFOL INJEKSI 7 1
187 RHINOS NEO PSEUDOEPHEDRIN HCl SIRUP 15 1
188 RHINOS SR PSEUDOEPHEDRIN HCl; LORATADIN KAPSUL 315 1
189 RINGER LAKTAT INFUS 1057 1
190 SAGESTAM GENTAMICIN SALEP 15 1
191 SALBUTAMOL 2 MG TABLET 454 1
192 SALBUTAMOL 4 MG TABLET 110 1
193 SANTOCYN OXYTOSIN INJEKSI 112 1
194 TABLET TAMBAH DARAH TABLET 760 1
195 SIMVASTATIN 10 MG TABLET 120 1
196 SIMVASTATIN 20 MG TABLET 820 1
197 SOLFION 4 MG METYLPREDNISOLON TABLET 217 1
198 SPIRONOLACTON 25 MG TABLET 357 1
199 STESOLID RECTAL 10 MG DIAZEPAM SUPP 3 1
200 STESOLID RECTAL 5 MG DIAZEPAM SUPP 6 1
201 TEBOKAN INJEKSI 70 0 1
202 TERMOFEN SIRUP IBUPROFEN SIRUP 10 1
203 TROMBO ASPILET TABLET 15 1

204 URDEX URSODEOXYCHOLIC ACID 250 MG KAPLET 120 1

NATURAL MICRONISED
205 UTROGESTAN 200 MG PROGESTERONE 100 MG TABLET 20 1
206 VECTRIN 30 MG ERDOSTEIN KAPSUL 320 1
207 VENTOLIN SALBUTAMOL NEBU 15 1
208 VICCILLIN AMPICILLIN SULBACTAM INJEKSI 97 1
209 VIP ALBUMIN EKSTRAK IKAN GABUS KAPSUL 528 0 1
210 VITAMIN C TABLET 75 1
211 VITAMIN B KOMPLEKS TABLET 65 1
212 VOMIL B6 TABLET 92 1
213 VOMIPER DOMPERIDON SIRUP 2 1
214 WIDOXIL CEFADROXIL SIRUP 15 1
215 ZINC SULPHATE TABLET 66 1
JUMLAH 42891 194 21
%KESESUAIAN FORNAS 90.23

ANDOOLO, JUNI 2019

PEMBUAT LAPORAN

DANANG EKO SUTRISNO,S.Farm., Apt