100000

80000

NO.
60000
NAMA OBAT
Column C
SATUAN
40000
STOK AWAL
PENERIMAAN
PERSEDIAAN
20000
PEMAKAIAN
STOK AKHIR
STOK OPTIMAL
0
PERMINTAAN
1
9
17
25

57

89
33
41
49

65
73
81

97
105
113
121
129
137
145
153
161
169
177

193
201

217
225
233
241

257
265
273
281
289
297
305
313
321
329
337
345
185

209

249
PEMBER IA
N
-20000 Column M
Column N
Column O
-40000 Column P
Column Q
JUMLAH

-60000

-80000
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO ) FORM : LPLPO hal.1
PUSKESMAS

PUSKESMAS : KarangMulya DOKUMEN NOMOR TANGGAL

KECAMATAN : BojongMangu DINKES KAB/KOTA
KAB / KOTA : Kab. Bekasi PELAPORAN BULAN / PERIODE : September 2018 GFK KAB/KOTA
PROPINSI : Jawa Barat PERMINTAAN BULAN / PERIODE : Oktober 2018 PUSKESMAS

PERSEDIA STOK PEMBERIAN

NO. NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR PERMINTAAN JUMLAH
AN OPTIMAL PKD/DPP ASKES APBD I APBD II PROGRAM LAIN-LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
1. OBAT
1 ALBENDAZOL TABLET 400 MG. - - - -
2 ALOPURINOL TABLET 100 MG. Tablet 1,000 1,000 - 1,000 1,380 380
3 AMBROXOL TABLET - 5,520 5,520
4 AMBROXOL SYRUP 15 MG/ML Botol - - 690 690
5 AMINOFILLIN INJEKSI 24 MG/ML-10ML - - -
6 AMINOFILLIN TABLET 200 MG. TABLET - - -
7 AMITRIPTILIN HCL TAB SALUT 25 MG - - -
8 AMLODIPIN TABLET 5MG Tablet - 1,200 1,200 190 1,010 552 (458)
9 AMLODIPIN TABLET 10MG Tablet - 600 600 300 300 552 252
10 AMOKSISILIN KAPSUL 250 MG Kapsul 1,990 3,000 4,990 630 4,360 5,520 1,160
11 AMOKSISILIN KAPLET 500 MG Tablet 5,513 6,500 12,013 2,958 9,055 16,560 7,505
12 AMOKSISILIN SYRUP KERING 125MG/5 ML Botol 290 150 440 213 227 828 601
13 AMOKSISILIN SYRUP KERING 250MG/5 ML - - -
14 AMOKSISILIN + ASAM KLAVULANAT 625MG TABLET - - -
15 AMOKSISILLIN INJEKSI 1000 MG - - -
16 AMPICILLLIN SERBUK INJEKSI 1G/VIAL - - -
17 AMPISILLIN KAPLET 500 MG. - - -
18 ANTALGIN(METAMPIRON) TABLET 500 MG Tablet 20 20 20 - 2,760 2,760
19 ANTALGIN ( METAMPIRON ) INJEKSI 250 MG/ML-2ML - - -
ANTASIDA DOEN TABLET, KOMBINASI :Mg.Hidroksida 200 mg+Al.Hidroksida 200 mg
20 Tablet 3,177 5,000 8,177 3,987 4,190 17,940 13,750
21 ANTASIDA DOEN SUSPENSI Botol 244 200 444 116 328 552 224
22 ANTI BAKTERI DOEN salep kombinasi : Basitrasin 500 IU/g+Polymixin 1000 IU/g Tube 53 50 103 17 86 1,104 1,018
23 ANTI FUNGI DOEN (WHITE FIELD) KOMBINASI : Asam Benzoat 6 % + Asam Salisilat 3 % Pot - - - - - -
24 ANTI HEMOROID DOEN KOMBINASI Supp 30 - 30 3 27 41 14
25 ANTIMIGREN DOEN kombinasi : Ergotamin Tartrat 1 mg + Kofein 50 mg Tablet 300 300 50 250 828 578
26 AQUA PRO INJEKSI STERIL , bebas pirogen Pcs 30 - 30 6 24 55 31
27 ASAM ASKORBAT ( Vit.C ) tablet 50 mg Tablet 5,000 5,000 267 4,733 5,520 787
28 ASAM ASKORBAT ( Vit.C ) tablet 250 mg Tablet - - 1,104 1,104
29 ASAM FOLAT TABLET 1MG Tablet 1,000 1,000 300 640 1,104 464
30 ASAM MEFENAMAT KAPLET 500 MG Tablet 1,140 2,500 3,640 1,300 2,340 5,520 3,180
31 Asam. Traneksamat inj 50mg Ampul 10 10 10 55 45
32 ASIKLOVIR CREAM Tube - - 69 69
33 ASIKLOVIR TAB 200 Tablet 10 500 510 120 390 552 162
34 ASIKLOVIR TAB 400MG Tablet 25 500 525 75 450 552 542
35 AZITROMICIN 250MG KAPSUL - - -
36 BETAMETASON KRIM 0,1 % Tube 85 - 85 6 79 124 45
37 CALCIUM GLUCONAS inj Ampul 19 19 - 19 - (19)
38 CAPTOPRIL 12,5 MG Tablet 2,273 1,000 3,273 1,388 1,885 4,140 2,255
39 CAPTOPRIL 25 MG Tablet 880 1,000 1,880 665 1,215 2,760 1,545
40 CEFADROXIL 500 MG Kapsul 636 - 636 80 556 4,140 3,584
41 CEFADROXIL SYRUP KERING 125MG/ML botol - 690 690
42 CETIRIZINE TAB 10MG Kapsul 515 620 1,135 270 865 828 (37)
43 CIPROFLOXACIN 500 MG Tablet 1,070 1,000 2,070 620 1,450 2,484 1,034
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 hal.1
44 DEKSAMETASON INJEKSI 5 mg/ml - 1 ml Ampul 168 168 2 166 - (166)
45 DEKSAMETASON TABLET 0,5 MG. Tablet 2,624 6,000 8,624 4,020 4,604 20,700 16,096
46 DEKSTROMETORFAN SYRUP 10 mg/5 ml - - -
47 DEKSTROMETORFAN TABLET 15 mg - - -
48 DIAZEPAM TABLET 2 MG. - - -
49 DIAZEPAM TABLET 5 MG. - - -
50 DIAZEPAM INJEKSI 5 MG/ML-2ML - - -
51 DIAZEPAM SUPPOSITORIA Supp - - - -
52 DIFENHIDRAMIN INJEKSI 10 mg/ml - 1 ml Ampul 20 20 - 20 41 21
53 DIGOKSIN TABLET 0,25 mg Tablet 200 200 100 100 - (100)
54 DOKSISIKLIN 100 MG kapsul - - - -
55 DOMPERIDON Tablet Tablet 1,014 500 1,514 359 1,155 4,140 2,985
56 DOMPERIDON SUSPENSI Botol 150 150 7 143 166 23
57 EFEDRIN HCL TABLET 25 MG - - -
58 EKSTRAK BELADON TABLET 10 MG - - -
59 EPINEFRINA HCL/BITARTRAT ( Epinefrina/Adrenalin ) Injeksi 0,1%-1ml Ampul 48 48 - 48 - (48)
60 ERITROMICYN KAPSUL 250 MG Kapsul - 1,000 1,000 30 970 1,104 134
61 ERITROMICYN KAPSUL 500 MG - - -
62 ERITROMICYN SIRUP 200MG/ML - - - - - -
63 ETAKRIDIN ( Rivanol ) LARUTAN 0,1 % 100ML Botol 17 10 27 7 20 28 8
64 ETAKRIDIN ( Rivanol ) LARUTAN 1000 ML ( 1 LITER) - - -
65 ETANOL 70 % Botol 17 - 17 2 15 - (15)
66 FENOBARBITAL TABLET 30 MG - - - -
67 FENOBARBITAL TABLET 100 MG - - - -
68 FENOBARBITAL INJEKSI 50 MG/ML - 2 ML - - - -
69 FENOKSIMETIL PENISILINA TABLET 500 MG - - - -
70 FENOL GLISEROL TETES TELINGA 10 % Botol - 72 72 1 71 41 (30)
71 FITOMENADION ( Vit.K ) INJEKSI 10 mg/ml - 1 ml Ampul 62 - 62 8 54 110 56
72 FITOMENADION ( Vit.K ) TABLET SALUT GULA 10 Mg Tablet 355 200 555 10 545 690 145
73 FLUKONAZOL 150 MG TABLET - - - -
74 FUROSEMID TABLET 40 mg Tablet 23 300 323 65 258 414 156
75 GARAM ORALIT Pcs 1,166 - 1,166 427 739 1,932 1,193
76 GENTAMISIN INJEKSI Ampul - - 22 22
77 GENTAMISIN SALEP MATA Pcs - - - -
78 GENTAMISIN TETES MATA 0,3% Pcs - - 166 166
79 GENTAMYCIN SALEP KULIT Tube - - 138 138
80 GENTIAN VIOLET LARUTAN 1 % pcs - 276 276
81 GLIBENKLAMID TABLET 5 MG Tablet - - - - 1,380 1,380
82 GLISERIL GUAYA KOLAT TABLET 100 MG Tablet - - - -
83 GLUKOSA LARUTAN INFUS 5% STERIL Pcs - - - - - -
84 GRISEOFULVIN TABLET 125 MG, Micronized Tablet 400 - 400 - 400 414 14
85 GRISEOFULVIN TABLET 500 MG, Micronized - - -
86 HIDROKORTISON krim 2,5 % tube 43 96 139 39 100 132 32
87 HYDROKLOROTIAZID ( HCT ) TABLET 25 MG tablet 200 200 - 200 276 76
88 IBUPROFEN tablet 200 mg tablet 2,000 2,000 300 1,700 2,760 1,060
89 IBUPROFEN tablet 400 mg tablet 1,920 1,000 2,920 670 2,250 4,140 1,890
90 IBUPROFEN SUSPENSI Botol 100 100 - 100 - (100)
91 ICHTIOL SALEP pcs - - - - 17 17
92 IRBESARTAN TAB 150 MG - - - -
93 ISOSORBID DINITRAT Tablet sublingual 5 mg Tablet 300 300 100 200 - (200)
94 KALIUM DIKLOFENAK 25 mg Tablet - 1,104 1,104
95 KALIUM DIKLOFENAK 50 mg Tablet - 1,104 1,104
96 KALSIUM LAKTAT ( Kalk ) Tablet 500 mg Tablet 6,260 - 6,260 165 6,095 5,520 (575)
97 KETOKONAZOL TAB 200 MG Tablet 140 - 140 70 70 552 482
98 KETOKONAZOL KRIM 2% Tube 72 - 72 12 60 110 50
99 KLARITROMISIN 500 MG TABLET - - -
 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 hal.1
100 KLINDAMISIN 300MG - - -
101 KLORAMPENIKOL KAPSUL 500 MG. 500 500 - 500 828 328
102 KLORAMPENIKOL SALEP MATA 1 % Tube 16 120 136 22 114 124 10
103 KLORAMPENIKOL SUSPENSI 50 50 - 50 - (50)
104 KLORAMPENIKOL TETES MATA - - - - - 69 69
105 KLORAMPENIKOL TETES TELINGA 3 % Pcs - 69 69
106 KLORFENIRAMIN MELEAT (CTM) TABLET 4 MG Tablet 2,472 8,000 10,472 4,227 6,245 20,700 14,455
107 KLORPROMAZIN TABLET SALUT 25 MG - - -
108 KODEIN FOSFAT TABLET 10 MG - - -
109 KOTRIMOXAZOL SUSPENSI, Kombinasi : Sulfametoksazol 200 mg + Trimetoprim 40 mg / 5 m Botol 155 50 205 23 182 193 11
110 KOTRIMOXAZOL TABLET PEDRIATIK, kombinasi : Sulfametoksazol 100 mg + Trimetoprim 2 Tablet - - - -
111 KOTRIMOXAZOL TABLET,Kombinasi : Sulfametoksazol 400 mg + Trimetoprim 80 mg Tablet 390 390 40 350 828 478
112 LEVOFLOKSASIN 500 MG Tablet - 1,380 1,380
113 LIDOKAIN HCl INJEKSI 2% Ampul 117 - 117 42 75 221 146
114 LIDOKAIN KOMP INJEKSI Kombinasi : Lidokain Hcl 2% + Epinefrin 1:80.000-2ml Ampul 210 - 210 189 21 cek ? #VALUE!
115 LISOL , mengandung Kresol tersabun 50 % Botol 3 5 8 4 4 cek ? #VALUE!
116 LOPERAMID 2MG TABLET Tablet 250 - 250 80 170 552 382
117 LORATADIN TABLET 10MG Tablet - - 276 276
118 LYNCOMISIN 500MG - 828 828
119 MAGNESIUM SULFAT INJEKSI ( IV ) 20%-25 ml Pcs 6 6 2 4 28 24
120 MAGNESIUM SULFAT INJEKSI ( IV ) 40%-25 ml Pcs 18 - 18 2 16 28 12
121 MELOXICAM TABLET 7.5 MG - 1,104 1,104
122 MELOXICAM TABLET 15MG Tablet - - 1,104 1,104
123 METFORMIN 500MG TABLET Tablet 900 1,000 1,900 900 1,000 1,932 932
124 METILERGOMETRIN MALEAT ( Metilergometrin ) tablet salut 0,125 mg Tablet - - 138 138
125 METILERGOMETRIN MALEAT INJ 0,200 mg-1ml Ampul - 100 100 - 100 - (100)
126 METOKLORPROPAMID INJEKSI - - -
127 METROCLOPRAMIDE 10MG TABLET - - -
128 METRONIDAZOL TABLET 250 mg Tablet 100 200 300 20 280 138 138
129 METRONIDAZOLE 500MG Tablet 770 500 1,270 310 960 2,760 1,800
130 MICONAZOLE CREAM Tube - - - -
131 NATRIUM BIKARBONAT TABLET 500 mg Tablet - - 1,380 1,380
132 NATRIUM DIKLOFENAK TABLET 25MG - - - - - 552 552
133 NATRIUM DIKLOFENAK TABLET 50MG Tablet 596 2,800 3,396 1,026 2,370 4,140 1,770
134 NATRIUM KLORIDA Larutan Infus 0,9 % steril Pcs 40 40 8 32 69 37
135 NIFEDIPIN 10 MG. Tablet 600 600 10 590 -
136 NISTATIN TABLET SALUT 500.000 IU/g Tablet 230 100 330 330 - jml? #VALUE!
137 NISTATIN TABLET VAGINAL 100.000 IU/g Supp 100 100 93 7 jml? #VALUE!
138 OBAT ANTITUBERKULOSIS ANAK Paket - 6 6 - 6 6 (0)
139 OBAT ANTITUBERKULOSIS KATEGORI 1 Paket 14 - 14 - 14 22 8
140 OBAT ANTITUBERKULOSIS KATEGORI 2 Paket - - - - - -
141 OBAT ANTITUBERKULOSIS KATEGORI 3 - - -
142 OBAT ANTITUBERKULOSIS SISIPAN - -
143 OBAT BATUK HITAM ( O.B.H ) CAIRAN Botol - - -
144 OKSITETRASIKLIN SALEP KULIT 3% Tube - - 166 166
145 OKSITETRASIKLIN SALEP MATA 1% Tube - 83 83
146 OKSITOSIN INJEKSI 10 IU/ML-1ML Ampul 90 90 26 64 138 74
147 OMEPRAZOLE TABLET 20MG Kapsul 132 630 762 362 400 2,760 2,360
148 PARASETAMOL DROP Botol - - 55 55
149 PARASETAMOL SUPPOSITORIA - 55 55
150 PARASETAMOL SYRUP 120 MG/5 ML Botol 136 600 736 186 550 828 278
151 PARASETAMOL TABLET 500 MG. Tablet 10,100 16,800 26,900 10,248 16,652 33,120 16,468
152 PARASETAMOL100 MG. TABLET - - - -
153 PETHIDIN INJEKSI 50MG/ML - - - -
154 PIRANTEL TABLET 125 MG. Tablet - 200 200 - 200 276 76
155 PIRIDOXIN HCL (VIT.B6) TABLET 10 MG. Tablet 1,382 - 1,382 162 1,220 2,208 988
 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 hal.1
156 PIROXICAM 10 MG TABLET Tablet - 1,656 1,656
157 PIROXICAM 20 MG. TAB. - - -
158 POLIKRESULEN ( KONDENSASI METAKRESOL SULFONAT DAN METANAL) 360 MG/G Pcs 4 4 1 3 28 25
159 POVIDON YODIDA 10 % 30 ML. - - -
160 POVIDON YODIDA 10 % 60 ML. Botol 10 20 30 1 29 22 22
161 POVIDON YODIDA 10 % 300 ML. Botol - - - - 8 8
162 PREDNISON TABLET 5 MG. Tablet 1,799 2,000 3,799 1,504 2,295 8,280 5,985
163 PROPANOLOL HCL TABLET 40 MG. Tablet - - - - - -
164 PROPILTIOURASIL TABLET 100 MG. - - -
165 PYRAZINAMIDE 500 MG. TABLET Tablet - - - -
166 RANITIDIN INJEKSI Ampul 45 - 45 17 28 97 69
167 RANITIDIN TABLET 150 MG Tablet 971 2,000 2,971 1,859 1,112 3,036 1,924
168 RESERPIN TABLET 0,25 MG - - -
169 RETINOL (VIT.A) KAPSUL 100.000 IU Kapsul - - - - - - -
170 RETINOL (VIT.A) KAPSUL 200.000 IU Kapsul 500 - 500 - 500 - -
171 RIFAMPISIN 300 MG. KAPLET - - -
172 RIFAMPISIN 450 MG. KAPLET - - -
173 RIFAMPISIN 600 MG. KAPLET - - -
174 RINGER LAKTAT LARUTAN INFUS STERIL Pcs 153 153 - 153 276 123
175 SALBUTAMOL TABLET 2 MG Tablet 413 2,000 2,413 563 1,850 2,484 634
176 SALBUTAMOL TABLET 4 MG. 1,100 1,000 2,100 800 1,300 - (1,300)
177 SALBUTAMOL NEBULIZER 2,5ML Pcs - - 55 55
178 SALEP 2-4, KOMBINASI: ASAM SALISILAT 2%+BELERANG ENDAP 4% Pcs 51 48 99 26 73 55 55
179 SALISIL BEDAK 2% Pcs 121 100 221 41 180 248 68
180 SEFIKSIM 100MG TAB /KAPSUL - - -
181 SEFIKSIM SIRUP KERING 100MG/5ML - - -
182 SEFOTAKSIM INJEKSI 1GRAM - - -
183 SEFTRIAKSON INJEKSI 1GRAM - - -
184 SERUM ANTI BISA ULAR POLIVAREN INJEKSI 5 ML.(ABU 1) - - -
185 SERUM ANTI TETANUS INJ. 1500 IU AMPUL(ATS) - - -
186 SIANOKOBALAMIN INJEKSI(VIT.B12) INJ. 500 MCG/ML-1ML - - -
187 SIMVASTATIN 200 MG TABLET SALUT Tablet 720 720 75 645 1,932 1,287
188 SULFASETAMIDA NATRIUM TETES MATA 15% Pcs - 138 138
189 TABLET TAMBAH DARAH KOMBINASI:BESI 2 SULFAT 200 MG+ASAM FOLAT 0,25 MG. Tablet 34,200 39,000 73,200 690 72,510 - (72,510)
190 TETRASIKLIN HCL KAPSUL 250 MG. Kapsul - - - -
191 TETRASIKLIN HCL KAPSUL 500 MG. Kapsul - - - - - -
192 TIAMFENICOL KAPSUL 500 MG Kapsul - - 1,932 1,932
193 TIAMIN HCL (VIT.B1) INJEKSI 100 MG/ML-1ML - - -
194 TIAMIN HCL / MONONITRAT (VIT.B1) TABLET 50 MG. Tablet 3,080 3,080 1,330 1,750 8,280 6,530
195 TRAMADOL 50 MG/KAMADOL - - -
196 TRAMADOL INJEKSI - - -
197 TRIHEKSIPENIDIL HIDROKLORIDA TABLET 2 MG. - - -
198 VIT. B KOMPLEK TABLET Tablet 2,379 10,000 12,379 5,522 6,857 19,320 12,463
199 ZINC TABLET 20MG Tablet 270 500 770 118 652 828 176
200 ZINC SYRUP 50 107 157 - 157 166 9
201 Cetirizine Sirup Botol 97 - 97 61 36 138 102
202 Metil Prednison Tablet 788 2,000 2,788 708 2,080 2,208 128
203 MB Dewasa Strip 15 15 - 15 (15)
204 PB Dewasa Strip 1 1 - 1 (1)
205 Tablet -
2. BAHAN HABIS PAKAI {BHP} 0 -
1 ALAT SUNTIK SEKALI PAKAI 1 ML. Pcs 130 100 200 50 150 414 264
2 ALAT SUNTIK SEKALI PAKAI 2,5 ML Pcs 477 300 777 112 665 828 163
3 ALAT SUNTIK SEKALI PAKAI 5 ML Pcs 300 - 300 36 264 966 702
4 ALAT SUNTIK SEKALI PAKAI 10 ML Pcs - 15 15 - 15 - (15)
5 AUTOMATIC DISABLE SYRINGE 0.05ML Pcs - - 828 828
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 hal.1
6 ALKOHOL SWAB 600 2,400 3,000 100 2,900 828 (2,072)
7 BISTURI - 22 22
8 CAIRAN ANTISEPTIK SOFTAMAN Pcs - - 11 11
9 CATGUT CHROMIC Pcs - - 14 14
10 CATGUT PLAIN 2 2 - 2 8 6
11 FOLLEY CATHETER NO.18, 20, 22 Pcs - - - -
12 GAUSE SWAB STERILL - - -
13 INFUS SET ANAK Pcs 19 19 - 19 10 10
14 INFUS SET DEWASA Pcs 28 50 78 10 68 146 78
15 IV CATETHER (18) Pcs 40 40 10 30 69 39
16 IV CATETHER (24) Pcs 50 50 10 40 69 29
17 IV CATETHER (20) 84 - 84 10 74 138 64
18 IV CATETHER (22) 96 - 96 16 80 138 58
19 JARUM JAHIT (BEDAH) NO.9 s/d 14 KULIT/OTOT - - 28 28
20 KAPAS Berlemak 500 gram Pcs - - -
21 KAPAS Pembalut/Absorben 250 gram Pcs 8 - 8 - 8 8 0
22 KASA Kompres 40 X 40 steril Pcs 45 20 65 15 50 69 19
23 KASA Pembalut 16CM X 16CM 7 20 27 20 7 jml? #VALUE!
24 KASA Pembalut 2 m X 80 cm Pcs 140 140 - 140 - (140)
25 KASA PEMBALUT 40CM X 80CM - 28 28
26 KASA PEMBALUT 4M X 4CM - 28 28
27 KASA PEMBALUT HIDRIFIL 4 M x 3 CM Pcs - - - -
28 KASA PEMBALUT HIDROFIL 4 M x 15 CM Pcs 100 100 - 100 - (100)
29 MASKER DISPOSIBLE Pcs 700 1,200 1,900 350 1,550 1,932 382
30 NELATON CATETHER - - -
31 OKSIGEN REFILL Pcs - 55 55
32 PARAFFIN GAUZE DRESSING Pcs - - - -
33 PEMBALUT ELASTIS - 8 8
34 PEMBALUT GIPS - 8 8
35 PLESTER 5 YARDS X 1 INCH Pcs 22 - 22 1 21 28 7
36 PLESTER 5 YARDS X ½ INCH 24 - 24 2 22 28 6
37 POT SPUTUM - - -
38 POT URIN STERIL - - -
39 SABUN CUCI TANGAN 16 16 4 12 14 2
40 SARUNG TANGAN GYNEKOLOG 20 20 5 15 1,380 1,365
41 SARUNG TANGAN NON STERIL Pcs 700 1,000 1,700 400 1,300 2,208 908
42 SARUNG TANGAN STERIL Pcs - 552 552
43 SILK (BENANG BEDAH SUTERA) NO.3/0 DENGAN JARUM BEDAH Pcs - - - - 30 30
44 UMBILICAL KLEM NYLON 50 50 - 50 - (50)
45 URINE BAG Pcs 20 - 20 - 20 83 63
46 USG JELLY pcs 23 - 23 3 20 - (20)
47 AUTOMATIC DISABLE SYRINGE 0.5ML Pcs 7,200 - 7,200 - 7,200 8,280 1,080
48 Safety Box Pcs 125 - 125 - 125 - (125)
49 AUTOMATIC DISABLE SYRINGE 5ML Pcs - - 1,242 1,242
50 UnderPad - 40 40 10 30 50 20
51 Kertas Puyer PCS Pcs 60,000 - 60,000 60,000 -
-
3. OBAT GIGI - -
1 AIR RAKSA DENTAL USE Pcs - - -
2 BONDING (BUAT TAMBALAN) Pcs - - -
3 DEVITALISASI PASTA ( Non Arsen ) Pcs - - 3 3
Dexamethasone 0,125 g, Phenol 36,7 g, Formaldehyde 32,4 g, Gaiacol 24,46 g, Excipient qs
4 ad 100 g Pcs - - 3 3
5 ETCHING Pcs - - 3 3
6 ETIL KLORIDA SEMPROT Pcs - - 25 25
7 EUGENOL CAIRAN Pcs 6 6 - 6 - (6)
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 hal.1
8 GLASSIONOMER CEMENT ( GC IX ) Pcs - - 14 14
9 GLASSIONOMER FILLING MATERIAL ART Pcs - - 14 14
Hydrocortison Acetate 1, 0 g, Excipient : thymol iodide, Barium Sulfate, Zink Okside, Mg
10 Stearate qs ad 100 g Pcs - - 3 3
11 KACA MULUT Pcs - - 11 11
12 KALSIUM HIDROXIDA PASTA Pcs - - 3 3
13 KALSIUM HIDROXIDA DENGAN IODOFORM Pcs - - 3 3
14 MATA BOR (HIGH SPEED/BULAT, PISUR, INVERT) Pcs - - 22 22
15 MONOKLOR KAMPER MENTHOL CAIRAN Pcs - - 3 3
16 MUMMIFYING PASTA Pcs - - 3 3
17 SEMEN SENG FOSPAT SERBUK DAN CAIRAN Pcs - - 3 3
18 SILVER AMALGAM SERBUK 65-75% Pcs - - 8 8
19 SPONS GELATIN CUBICLRS 1X1X1 CM Pcs - - - -
20 SULFA CONUS KERUCUT PREFARAT Pcs - - - -
21 SYNTHETIC FILLING MATERIAL Pcs - - 11 11
22 TEMPORARY FILLING MATERIAL Pcs - - 11 11
23 TEMPORARY STOPPING FLETCHER(FLETCHER) SERBUK DAN CAIRAN Pcs - - 11 11
24 TRIKRESOL FORMALIN (TKF) CAIRAN Pcs - - 3 3
25 - - - -
26 - - - -
4. REAGEN - - - -
1 ALKOHOL ASAM - - - -
2 AMONIUM OKSALAT - - - -
3 ANISOL - - - -
4 AQUA BIDESTILATA - - - -
5 ASAM KLORIDA 0,1 N-100ML. ( HCl 0.1N ) - - - -
6 ASAM SULFO SALISILAT 20%-100ML. - - - -
7 ASTO LATEX - - - -
8 BIOCHEMISTRY 9 SAMSUNG - - - -
9 BLOOD LANCET ACCU-CHECK '200 2 2 4 1 3 220 217
10 CHOLESTEROL LIQ - - - -
11 DRUBKIN ( HAEMOGLOBIN C )100 ML - - - -
12 EDTA 10% 100 ML 4 4 - 4 66 62
13 EOSIN 2% - - - -
14 GIEMSA STAIN - - - -
15 GLUKOSA LIQ - - - -
16 GOLONGAN DARAH + KARTU 2 2 - 2 6 4
17 GRAM PEWARNA - - - -
18 HAYEM - - - -
19 HBSAB STRIP - - 2 2
20 HBSAG STRIP - - - -
21 HCG TEST KEHAMILAN 100 100 - 100 - (100)
22 IMERSION OIL - - - -
23 IODINE TEST - - - -
24 KARBOL FUCHSIN - - - -
25 NARKOBA AMP - - - -
26 NARKOBA MOP - - - -
27 NARKOBA THC - - - -
28 NATRIUM SITRAT 3.8% - - - -
29 POCH D - - - -
30 POCH L - - - -

31 CELL CLEAN - - - -
32 8-CHECK - - - -
33 RA LATEX - - - -
 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 hal.1
34 REES ECKER - - - -
35 SERUM KONTROL - - - -
36 STICK ASAM URAT EASY TOUCH 10 10 20 1 19 - (19)
37 STICK CHOLESTEROL EASY TOUCH 15 20 35 - 35 - (35)
38 STICK GLUKOSA ACCU-CHECK '25 - - -
39 STICK GLUKOSA ACCU-CHECK '100 4 5 9 1 8 - (8)
40 STICK HB METER 4 4 - 4 - (4)
41 STICK URINE 3 PM - - 138 138
5. OBAT TAMBAHAN -
1 BURNAZINE CREAM 10MG Pcs 10 - 10 3 7 11 4
2 CAIRAN ANTISEPTIK SOFTAMAN - 166 166
3 FG THROCHES - - -
4 MOLAKRIM 30GRAM Pcs - - 414 414
5 NEO KAOMINAL Pcs - - 83 83
6 PAPAVERIN HCL 30 MG, ANTALGIN 500 MG, EXTRAK BELLADON 5 MG (SPASMAL) - - 55 55
7 PARAFFIN GAUZE DRESSING - - -
8 PULAREX Pcs - - 552 552
9 SALBUTAMOL NEBULIZER 2,5ML - 138 138
10 SANMAG SUSPENSI - - -
11 ZAM BUK OINT - - -
12 ZINKID SYRUP Botol - - 72 72
13 Mineral Mix Pcs - - -
14 Iliadin Tetes Hidung 10 10 - 10 - (10)
15 Ketorolac inj Ampul - - - -
16 Nipedipin 20mg (adalat oros) Pcs - - - -
17 Bisakodil supp 5mg sup 28 28 - 28 - (28)
18 Attapulgite 650mg Tablet 502 500 1,002 270 732 - (732)
19 Acetylstein Tablet 2640 2,640 400 2240 1,380 (860)

* TIDAK BOLEH MENAMBAHKAN "ROW" YG BARU, KLO ADA NAMA OBAT YG BARU/TDK ADA NAMA OBATNYA TAMBAHKAN DIBAWAHNYA SAJA.

UMUM
JUMLAH
KUNJUN JUMLAH
BAYAR TIDAK BAYAR
GAN
RESEP
1658 1658

Yang Meminta, Yang Menerima,

KEPALA DINAS KESEHATAN KAB. BEKASI Kepala UPTD Farmasi Kepala Puskesmas Petugas Puskesmas

dr. Hj. Sri Enny Mainiarti, MKM Eva Yanti Hermansyah, S. Farm. Apt H. DADAN MULYANA SKM. MM ATIN NURHAYATIN, Amd.Keb
NIP. 19700525 200003 2 004 NIP. 19790621 200212 2 004 NIP. 19670214 199101 1 003 NIP. 19761013 200501 2 008

KETERANGAN :
Lembar 1 ( Putih ) : Puskesmas
Lembar 2 ( Merah ) : Dinkes Kab. Bekasi
Lembar 3 ( Biru ) : GFK kab. Bekasi
Lembar 4 ( kuning ) : PT. Askes