LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN

PUSKESMAS CIKIDANG
KECAMATAN CIKIDANG
ALAMAT JALAN RAYA CIKIDANG KM 19
NAMA OBAT/SEDIAAN SEDIAAN
STOK AWAL
NO PENERIMAAN
(DESEMBER 2020)

A SERUM
1 ABU ampul 1
2 ATS ampul 0
B BHP GIGI 0
1 Temporary filling materail pcs 0
2 Glass Ionomer Cement kit A3 pcs 0
3 Coat bond pcs 0
4 Brilliant NG pcs 0
5 Eugenol botol 1
C CAIRAN 0
1 Air untuk injeksi (Aqua pro injeksi) 20 ml Botol 5
2 Glukosa Larutan infus 5% steril 500 ml Botol 3
3 Natrium Klorida lart.infus 0,9% steril - 500 ml Botol 35
4 Ringer Laktat larutan infus steril - 500 ml Botol 40
D OBAT 0
1 Allupurinol 100 mg Tablet Tab 0
2 Aminofillin inj 24 mg /ml-10ml ampul 0
3 Aminophylin tablet 200mg Tab 0
4 Amitriptilin HCl tablet salut 25 mg Tab 0
5 Amlodipin 10 mg Tab 200
6 Amoksisilin Kaplet 500 mg Kaplet 400
7 Amoksisilin Kapsul 250 mg Kapsul 50
8 Amoksisilin sirup kering 125 mg/5 ml Botol 50
9 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 0
10 Antasida Suspensi 60 ml Botol 50
11 Antasida DOEN tablet kombinasi Tab 500
12 Anti fungi DOEN komb sk tube 0
13 Anti Hemoroid DOEN kombinasi supp 10
14 Antimigren DOEN kombinasi Tab 0
15 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab 0
16 Asam Askorbat (Vit.C) tablet 50 mg Tab 0
17 Asam folat tablet 0.4 mg Tab 0
18 Asam mefenamat 500 mg Kaplet 200
19 Asetyl sestein 200mg kapsul 100
20 Asiklovir Tablet 400 mg Tab 0
21 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml ampul 0
22 Attalpugite tab 600 mg Tab 200
23 Benzatin Benzil Penisilin inj.1.2 juta IU/vial ampul 0
24 Betahistin maleat Tab 0
25 Betametasone Krim 0.1% tube 0
26 Bisakodil Supp 10 mg supp 5
27 Bisoprolol tablet tablet 0
28 Captopril 12,5 mg Tab 0
29 Captopril tablet 25 mg Tab 80
30 Deksametason injeksi 5 mg/ml - 1 ml ampul 0
31 Deksametasone tablet 0.5mg Tab 300
32 Diasepam 2 mg tablet Tab 100
33 Diazepam Inj 5 ml/2ml ampul 3
34 Diazepam lar rektal 5mg/2,5ml tube 2
35 Dietilkarbamazin sitrat tablet 100 mg Tab 0
36 Difenhidramin HCl injeksi 10 mg/ml - 1 ml ampul 10
37 Digoksin tablet 0,25 mg Tab 0
38 Doksisiklin 100 mg ampul 0
39 Domperidon tablet 10 mg Tab 0
40 Epinefrina (adrenalin) injeksi 0,1% - 1 ml ampul 2
41 Erytromycin 250 mg Kapsul 0
42 Etambutol HCL 250 mg Tab 0
43 Fenitoin Na kaps 100 mg Kapsul 0
44 Fenobarbital injeksi 50 mg/ml - 2 ml ampul 0
45 Fenobarbital tablet 30 mg Tab 0
46 Fenofibrat kaps 100 mg Kapsul 0
47 Fenoksimetil Penisilina tablet 500 mg Tab 0
48 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 0
49 Furosemid tablet 40 mg Tab 50
50 Gentamisin tetes mata Botol 0
51 Glibenklamid tablet 5 mg Tab 100
52 Glimepiride tab 0
53 Griseofulvin tablet 125 mg, micronized Tab 0
54 Hidroklorotiazid (HCT) tablet 25 mg Tab 0
55 Hidrokortison krim 2,5 % tube 0
56 Ibuprofen Suspensi 100mg 5ml botol 0
57 Ibuprofen tablet 400 mg Tab 50
58 Isoniazid tablet 300 mg Tab 0
59 Isosorbid Dinitrat 5 mg tablet sublingual Tab 0
60 Kalsium Glukonat Inj 100 mg/ml ampul 0
61 Kalsium lakate (kalk) tablet Tab 0
62 Karbamazepin tablet 200 mg Tab 0
63 Karbogliserin Tetes Telinga 10% Botol 0
64 Ketokonazol krim 2 % tube 0
65 Ketokonazol Tablet 200 mg Tab 0
 66 Klindamicin 150 mg Kapsul 200
67 Klopidogrel tab 75 mg Tab 0
68 Kloramfenikol Kapsul 500 mg Kapsul 0
69 Kloramfenikol salep kulit 2% (bufacetin) tube 0
70 Kloramfenikol Salep Mata 1% - 3,5 gr Botol 0
71 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 400
72 Klorpromazin HCL tablet 25 mg Tab 0
73 Klorpromazin inj. 25 mg/ml ampul 0
74 Kodein HCl tablet 10 mg Tab 0
75 Kotrimoksazol forte tablet Tab 0
76 Kotrimoksazol 480 tablet tab 0
77 Kotrimoksazol suspensi kombinasi Botol 0
78 Lansoprazol 30 mg Tab 0
79 Lidokain inj. 2% ampul 80
80 Lidokain komp. injeksi kombinasi ampul 0
81 Loratadin tab 10 mg Tab 200
82 Mebendazol tablet 0
83 Metformin tablet 500 mg Tab 0
84 metil dopa tab 250 mg Tab 0
85 Metilergometrin Maleat injeksi 0,200 mg - 1ml ampul 0
86 Metilergometrin Maleat tablet salut 0,125 mg Tab 0
87 Metilprednisolon tablet 4 mg Tab 200
88 Metoklorpropamid tablet 10 mg Tab 30
89 Metronidazol sirup 125mg/5ml Botol 0
90 Metronidazol tablet 500 mg Tab 200
91 Miconazol SK tube 0
92 Natrium bikarbonat tablet 500 mg Tab 800
93 Natrium Diklofenac 50 mg Tab 100
94 Nifedifin tablet 30 mg Tab 300
95 Nistatin 100.000 IU/gram tablet vaginal supp 0
96 Nistatin tablet salut gula 500.000 IU/g Tab 0
97 Oksitetrasiklin HCl salep 3% - 5 gram tube 0
98 Omeprazol 20 mg Tab 100
99 Ondansentron tab 8 mg Tab 200
100 parasetamol drop Botol 0
101 Parasetamol Kaplet 500 mg Tab 400
102 Parasetamol sirup Botol 1000
103 Permetrin/scabimite krim 5 % tube 0
104 Pirantel Pamoat tablet 125 mg Tab 0
105 Pirazinamid tablet 500 mg Tab 0
106 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 0
107 Prednison tablet 5 mg Tab 500
108 Propranolol HCl tablet 40 mg Tab 0
109 Ranitidin Injeksi 25 mg/ml ampul 120
110 Ranitidin tablet 150 mg Tab 300
 111 Rifampisin Kapsul 600 mg Kapsul 0
112 Salbutamol tablet 2 mg Tab 100
113 Salep 2 - 4 kombinasi tube 0
114 Setirizin sir 5 mg/ 5 ml Botol 0
115 Sianokobalamin (Vitamin B12) 50 mg Tab 0
116 Simvastatin 20 mg Tab 0
117 Teofilin tab 150 mg Tab 0
118 Tetrasiklin HCl Kapsul 500 mg Kapsul 0
119 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 0
120 Vitamin B komplek tablet Tab 0
121 Terbutaline sulfat ih 2.5 mg/ml ampul 0
122 Budesonid ih .5 mg/ml ampul 0
E ADDITIONAL OBAT 0
124 Amlodipin 5 mg tab 0
125 Amoxicillin 100 mg/ml drops botol 0
126 Asam Traneksamat Injeksi Ampul 0
127 Asiclovir 200 mg Tab 0
128 Asiclovir krim Tube 0
129 Bisakodil Tablet Tab 0
130 Ciprofloksasin 500 mg tablet Tab 0
131 Domperidon Sirup Btl 0
132 Furosemid Injeksi Ampul 0
133 Guaifenesin tab Tab 0
134 Kloramfenikol Tetes telinga botol 0
135 Multivitamin Dewasa Tab 0
137 Multivitamin Sirup Tab 0
136 Obat Batuk Hitam Tube 1
138 Oksitosin injeksi ampul 0
139 Ondansentron injeksi Ampul 2
140 Salbutamol inhaler ampul 15
141 Sefadroksil Kapsul 500 mg KAPSUL 2
142 Sefadroksil syrup 125 mg Botol 0
143 Sefadroksil Syrup 250 mg BOTOL 0
144 Setirizin Tab Tab 0
145 Sulfadiazine silver krim (Luka Bakar) Tube 9
OBAT PROGRAM 0
A MALARIA 0
1 Artesunate injeksi, vial 60 mg vial 0
2 Primakuin tablet 15 mg tablet 0
3 Kina tablet 200 mg tablet 0
4 Kina injeksi 25% - 2 ml ampul 0
5 Doksisiklin kapsul 100 mg kapsul 0
6 DHP (Dehidro Artemisin + Piperaquin) Tablet tablet 0
0
B FILARIASIS 0
1 DEC tablet 100 mg tablet 0
2 Albendazol tablet 400 mg tablet 0
3 Albendazol Sirup 200 mg/5 ml botol 0
0
C PENGENDALIAN PENYAKIT MENULAR (P2M) 0
1. DIARE 0
1 Garam oralit kantong 0
2 Zinc tablet 20 mg tablet 0
3 zink sirup botol 0
2. KUSTA 0
1 Prednison tablet 5 mg tablet 0
3. FRAMBUSIA 0
1 Azithromycin 500 mg tablet 0
0
D TB PARU (OAT FDC) 0
OAT FDC 0
1 Obat Anti Tuberculosis FDC kategori 1 paket 0
2 Obat Anti Tuberculosis FDC kategori 2 paket 0
3 Obat Anti Tuberculosis FDC anak paket 0
0
F AIDS PMS 0
1 Efavirenz tab 600 mg tablet 0
2 Lopinavir 200 mg + Ritonavir 50 mg tablet 0
3 Lopinavir 100 mg + Ritonavir 25 mg tablet 0
4 Nevirapin 200 mg tablet 0
5 Tenofovir tab 300 mg tablet 0
6 Zidovudin Kaps 100 mg kapsul 0
7 Lamivudin tab 150 mg tablet 0
8 Kombinasi Zidovudin 300 mg + Lamivudin 150 mg tablet 0
9 Efavirenz tab 200 mg tablet 0
10 Abacavir kaps 300 mg tablet 0
11 Tenofovir 300 mg + Emiricitabine 200 mg Tab tablet 0
12 Zidovudin 60 mg +Lamivudine 30 mg + Nevirapine 50 tablet 0
13 Tenofovir 300 mg + Lamivudin 300 mg + Efivirenz 60 tablet 0
14 Rilpivirine Tab 25 mg tablet 0
15 Zidovudine Syr 10 mg/ml botol 0
0
G KESEHATAN JIWA 0
1 Haloperidol dekanoat inj 50 mg/ml ampul 0
2 Klobazam 10 mg tablet tablet 0
3 Amitripilin HCL 25 mg tablet tablet 0
4 Klorpromazin 100 mg tablet tablet 0
5 Risperidon 2 mg Tablet tablet 0
 6 Klozapin 25 mg tablet tablet 0
7 Trifluoperazine HCL 5 mg tablet tablet 0
8 Haloperidol inj 5 mg/ml ampul 0
9 Imipramin HCL 25 mg tablet tablet 0
10 Fluoksetin 10 mg tablet tablet 0
11 Triheksifenidil 2 mg tab tablet 0
12 Haloperidol 5 mg tablet tablet 0
0
H VAKSIN RABIES 0
1 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster 0
2 Serum antirabies inj 200 UI/ml 0
0
I GIZI 0
1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul 0
2 Bayi (6 -(Vitamin
Retinol 11 bulan)
A) 200.000 IU Kapsul Lunak kapsul 0
3 Balita (11 - 59 bulan)
Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul 0
4 Ibu Nifas
Tablet Tambah Darah (Ibu Hamil) tablet 0
5 Tablet Tambah Darah (Remaja Putri) tablet 0
6 Mineral Mix sachet 0
0
J KESEHATAN IBU 0
1 Oksitosin Injeksi 10 IU/ml ampul 0
2 Metil Ergometrin Maleat injeksi 0,2 mg/ml ampul 0
3 Magnesium Sulfat Injeksi 40% ampul 0
4 Kalsium Glukonat Injeksi 10% ampul 0
5 Ampisilin Injeksi 1000 mg/vial vial 0
6 Gentamisin Injesi 40 mg/ml ampul 0
7 Metronidazol infus 5 mg/ml botol 0
0
K KESEHATAN ANAK 0
1 Fitomenadion (vit K1) injeksi 2 mg/ml ampul 0
2 Levotiroksin 50 mcg tablet 0
3 Oksitetrasiklin HCL Salep mata 1% tube 0
4 Ampicilin serb injeksi 1000 ml/vial ampul 0
5 Gentamisin injeksi 40 mg/ml ampul 0
6 Fenobarbital injeksi 50 mg/ml ampul 0
7 Diazepam injeksi 5 mg/ml ampul 0
0
L LANSIA 0
1 Risedronat kapsul 0
0
M IMUNISASI 0
1 Vaksin Hepatitis B vial 0
2 Vaksin BCG vial 0
 3 Vaksin Polio 10 ds vial 0
4 Vaksin DT vial 0
5 Vaksin Td vial 0
6 (Kelas
Vaksin2Td
SD) vial 0
7 (WUS)
Vaksin IPV vial 0
8 Vaksin DPT-HB-Hib vial 0
9 (Bayi)
Vaksin DPT-HB-Hib vial 0
10 (Baduta)
Vaksin MR vial 0
11 (Bayi)
Vaksin MR vial 0
12 (Baduta)
Vaksin HPV vial 0
13 Vaksin Pneumokokkus vial 0
14 Vaksin JE vial 0
A BMHP 0
1 Alat suntik sekali pakai 1 ml Pcs 90
2 Alat suntik sekali pakai 3 ml Pcs 200
3 Alat suntik sekali pakai 5 ml Pcs 0
4 alat suntik sekali pakai 10 ml pcs 0
5 Alkohol Swab box 4
6 autodisable no 0,05 ml Pcs 0
7 autodisable no. 0,5 ml Pcs 0
8 bloodset Pcs 0
9 Catgut Chromic 2/0 + jarum 1/2 HR 26 mm Pcs 2
10 Catgut Chromic 3/0 + jarum 1/2 HR 26 mm Pcs 0
11 ECG/USG jelly 82gr Pcs 1
12 Folley Catheter 2 way no 16 Pcs 20
13 Folley Catheter 2 way no 18 Pcs 20
Handscoon Non Steril 0
14 Ukuran L Pcs 9
15 Ukuran M Pcs 0
16 Ukuran S Pcs 0
Handscoon steril 0
17 Ukuran 6.5 Pcs 0
18 Ukuran 7.0 Pcs 0
19 Ukuran 7.5 Pcs 0
20 ID Patient Adult/Dewasa Biru Pcs 0
21 ID Patient Adult/Dewasa Pink Pcs 0
22 Infusion set anak Pcs 5
23 Infusion set dewasa Pcs 20
24 IV Catheter G - 18 Pcs 0
25 IV Catheter G - 20 Pcs 350
26 IV Catheter G - 22 Pcs 650
27 Kapas 250 gr Pcs 0
28 Kasa hidrofil 16x16 (steril) box 40
29 Kasa Kompres 40/40 steril Pcs 0
30 Kasa Pembalut 2 m x 80 cm Pcs 0
31 kasa pembalut hydrofil 40 cm x 80 cm Pcs 5
Masker 10
32 Tie on dus 0
33 Hijab dus 0
34 masker oksigen pcs 0
35 Plester Pcs 18
36 Plester Polifix 5 cm x 1 m Pcs 8
37 Policrepe Pembalut Elastis 7,5 cm x 4,55 m Roll 5
38 Silk 2/0 + jarum 1/2 GT 35 mm Pcs 0
39 Silk 3/0 + jarum 1/2 GT 35 mm Pcs 1
40 Urine bag Pcs 40
41 pot sampel pcs 0
B DESINFECTAN 0
1 Alkohol 70% - 1000 ml Btl 1
2 Antiseptik Hand Rub 500 ml Btl 1
3 cairan sterilisasi alat btl 0
4 Lisol 1 liter Btl 1
5 Povidon Iodida 300 ml Btl 4
6 Povidon Iodida 30 ml Btl 8
7 Rivanol larutan 0,1% - 300 cc Btl 4
C ADDITIONAL BHP 0
1 Bioplasenton tulle Pcs 0
2 Bisturi No. 11 box 0
3 Catgut Chromic 2/0 + Jatum 1/2 HR 20 mm pcs 1
4 Catgut Chromic 3/0 + Jatum 1/2 HR 20 mm pcs 3
5 Cuticell pcs 100
6 Dental Anastesi Citoject box 0
7 Handscoon Obgyn pairs 0
8 IV Catheter - G -24 pcs 150
9 IV Catheter G-26 PCS 0
10 kapas gigi pack 0
11 Kassa hydrofil 3 yard x 10 cm pack 5
12 Kassa hydrofil 3 yard x 15 cm pack 0
13 Kassa hydrofil 40 yard x 80 cm roll 0
14 Lidi Waten Steril box 0
15 masker karet box 0
16 Microfor box 0
17 Polifix 10 cm x 5 m roll 0
18 Polifix 5 cm x 5 m roll 2
19 Pot Sputum Steril pcs 0
20 Povidone Iodida 60 ml Btl 0
21 SD Bioline HCG pcs 0
22 SD Urocolor For Urinalysis pcs 0
23 Silk 4/0 DS 12 mm pcs 0
24 Silk 4/0 DS 19 mm pcs 0
25 Silk 4/0 HR 20 mm pcs 0
26 Silk 5/0 DS 16 mm pcs 0
27 Umbilical Cord Clamps pcs 0

Mengetahui,
Pimpinan UPTD Puskesmas Cikidang
Kabupaten Sukabumi

Asep Gumelar, SKM., M.Si.

AR PERMINTAAN OBAT (LPLPO)
BULAN JANUARI
TAHUN 2021

PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

1 1 2
0 0
0 0
0 0
0 0
0 0
0 0
1 1
0 0
5 5
3 3
35 35
40 40 20
0 0
0 0
0 0
0 0
0 0
200 200
400 400 1000
50 50
50 50
0 0
50 50
500 500 500
0 0
10 10
0 0
0 0
0 0
0 0
200 200 500
100 100
0 0
 0 0
200 200
0 0
0 0
0 0
5 5
0 0
0 0
80 80 200
0 0 50
300 300 500
100 100
3 3
2 2
0 0
10 10
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
50 50
0 0
100 100
0 0
0 0
0 0
0 0
0 0
50 50 500
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 200
0 0
0 0
0 0
0 0
400 400 500
0 0
0 0
0 0
0 0
0 0
0 0
0 0
80 80 100
0 0
200 200
0 0
0 0
0 0
0 0
0 0
200 200
30 30
0 0
200 200
0 0
800 800
100 100
300 300
0 0
0 0
0 0
100 100 200
200 200
0 0
400 400 1000
1000 1000
0 0
0 0
0 0
0 0
500 500
0 0
120 120
300 300
 0 0
100 100
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
1 1
0 0
2 2 30
15 15
2 2 500
0 0 20
0 0
0 0
9 9
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
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
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
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
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
90 90
200 200
0 0
0 0
4 4 2
0 0
0 0
0 0
2 2 5
0 0 5
1 1
20 20
20 20
0 0
9 9
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5 5
20 20
0 0
350 350
650 650
0 0
40 40
0 0
0 0
 5 5
10 10
0 0
0 0
0 0
18 18
8 8
5 5
0 0 5
1 1 5
40 40
0 0
0 0
1 1
1 1 1
0 0
1 1
4 4 5
8 8
4 4
0 0
0 0
0 0 20
1 1 5
3 3 5
100 100
0 0
0 0
150 150
0 0
0 0
5 5
0 0
0 0
0 0
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

Cikidang, 26 Januari 2021

Penanggung Jawab UGD

Socawana,S.Kep.Ners
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN
PUSKESMAS CIKIDANG
KECAMATAN CIKIDANG
ALAMAT JALAN RAYA CIKIDANG KM 19
NAMA OBAT/SEDIAAN SEDIAAN
NO STOK AWAL PENERIMAAN

A SERUM
1 ABU ampul 1
2 ATS ampul 0
B BHP GIGI 0
1 Temporary filling materail pcs 0
2 Glass Ionomer Cement kit A3 pcs 0
3 Coat bond pcs 0
4 Brilliant NG pcs 0
5 Eugenol botol 1
C CAIRAN 0
1 Air untuk injeksi (Aqua pro injeksi) 20 ml Botol 5
2 Glukosa Larutan infus 5% steril 500 ml Botol 3
3 Natrium Klorida lart.infus 0,9% steril - 500 ml Botol 35
4 Ringer Laktat larutan infus steril - 500 ml Botol 40
D OBAT 0
1 Allupurinol 100 mg Tablet Tab 0
2 Aminofillin inj 24 mg /ml-10ml ampul 0
3 Aminophylin tablet 200mg Tab 0
4 Amitriptilin HCl tablet salut 25 mg Tab 0
5 Amlodipin 10 mg Tab 200
6 Amoksisilin Kaplet 500 mg Kaplet 400
7 Amoksisilin Kapsul 250 mg Kapsul 50
8 Amoksisilin sirup kering 125 mg/5 ml Botol 50
9 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 0
10 Antasida Suspensi 60 ml Botol 50
11 Antasida DOEN tablet kombinasi Tab 500
12 Anti fungi DOEN komb sk tube 0
13 Anti Hemoroid DOEN kombinasi supp 10
14 Antimigren DOEN kombinasi Tab 0
15 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab 0
16 Asam Askorbat (Vit.C) tablet 50 mg Tab 0
17 Asam folat tablet 0.4 mg Tab 0
18 Asam mefenamat 500 mg Kaplet 200
19 Asetyl sestein 200mg kapsul 100
20 Asiklovir Tablet 400 mg Tab 0
21 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml ampul 0
22 Attalpugite tab 600 mg Tab 200
23 Benzatin Benzil Penisilin inj.1.2 juta IU/vial ampul 0
24 Betahistin maleat Tab 0
25 Betametasone Krim 0.1% tube 0
26 Bisakodil Supp 10 mg supp 5
27 Bisoprolol tablet tablet 0
28 Captopril 12,5 mg Tab 0
29 Captopril tablet 25 mg Tab 80
30 Deksametason injeksi 5 mg/ml - 1 ml ampul 0
31 Deksametasone tablet 0.5mg Tab 300
32 Diasepam 2 mg tablet Tab 100
33 Diazepam Inj 5 ml/2ml ampul 3
34 Diazepam lar rektal 5mg/2,5ml tube 2
35 Dietilkarbamazin sitrat tablet 100 mg Tab 0
36 Difenhidramin HCl injeksi 10 mg/ml - 1 ml ampul 10
37 Digoksin tablet 0,25 mg Tab 0
38 Doksisiklin 100 mg ampul 0
39 Domperidon tablet 10 mg Tab 0
40 Epinefrina (adrenalin) injeksi 0,1% - 1 ml ampul 2
41 Erytromycin 250 mg Kapsul 0
42 Etambutol HCL 250 mg Tab 0
43 Fenitoin Na kaps 100 mg Kapsul 0
44 Fenobarbital injeksi 50 mg/ml - 2 ml ampul 0
45 Fenobarbital tablet 30 mg Tab 0
46 Fenofibrat kaps 100 mg Kapsul 0
47 Fenoksimetil Penisilina tablet 500 mg Tab 0
48 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 0
49 Furosemid tablet 40 mg Tab 50
50 Gentamisin tetes mata Botol 0
51 Glibenklamid tablet 5 mg Tab 100
52 Glimepiride tab 0
53 Griseofulvin tablet 125 mg, micronized Tab 0
54 Hidroklorotiazid (HCT) tablet 25 mg Tab 0
55 Hidrokortison krim 2,5 % tube 0
56 Ibuprofen Suspensi 100mg 5ml botol 0
57 Ibuprofen tablet 400 mg Tab 50
58 Isoniazid tablet 300 mg Tab 0
59 Isosorbid Dinitrat 5 mg tablet sublingual Tab 0
60 Kalsium Glukonat Inj 100 mg/ml ampul 0
61 Kalsium lakate (kalk) tablet Tab 0
62 Karbamazepin tablet 200 mg Tab 0
63 Karbogliserin Tetes Telinga 10% Botol 0
64 Ketokonazol krim 2 % tube 0
65 Ketokonazol Tablet 200 mg Tab 0
 66 Klindamicin 150 mg Kapsul 200
67 Klopidogrel tab 75 mg Tab 0
68 Kloramfenikol Kapsul 500 mg Kapsul 0
69 Kloramfenikol salep kulit 2% (bufacetin) tube 0
70 Kloramfenikol Salep Mata 1% - 3,5 gr Botol 0
71 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 400
72 Klorpromazin HCL tablet 25 mg Tab 0
73 Klorpromazin inj. 25 mg/ml ampul 0
74 Kodein HCl tablet 10 mg Tab 0
75 Kotrimoksazol forte tablet Tab 0
76 Kotrimoksazol 480 tablet tab 0
77 Kotrimoksazol suspensi kombinasi Botol 0
78 Lansoprazol 30 mg Tab 0
79 Lidokain inj. 2% ampul 80
80 Lidokain komp. injeksi kombinasi ampul 0
81 Loratadin tab 10 mg Tab 200
82 Mebendazol tablet 0
83 Metformin tablet 500 mg Tab 0
84 metil dopa tab 250 mg Tab 0
85 Metilergometrin Maleat injeksi 0,200 mg - 1ml ampul 0
86 Metilergometrin Maleat tablet salut 0,125 mg Tab 0
87 Metilprednisolon tablet 4 mg Tab 200
88 Metoklorpropamid tablet 10 mg Tab 30
89 Metronidazol sirup 125mg/5ml Botol 0
90 Metronidazol tablet 500 mg Tab 200
91 Miconazol SK tube 0
92 Natrium bikarbonat tablet 500 mg Tab 800
93 Natrium Diklofenac 50 mg Tab 100
94 Nifedifin tablet 30 mg Tab 300
95 Nistatin 100.000 IU/gram tablet vaginal supp 0
96 Nistatin tablet salut gula 500.000 IU/g Tab 0
97 Oksitetrasiklin HCl salep 3% - 5 gram tube 0
98 Omeprazol 20 mg Tab 100
99 Ondansentron tab 8 mg Tab 200
100 parasetamol drop Botol 0
101 Parasetamol Kaplet 500 mg Tab 400
102 Parasetamol sirup Botol 1000
103 Permetrin/scabimite krim 5 % tube 0
104 Pirantel Pamoat tablet 125 mg Tab 0
105 Pirazinamid tablet 500 mg Tab 0
106 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 0
107 Prednison tablet 5 mg Tab 500
108 Propranolol HCl tablet 40 mg Tab 0
109 Ranitidin Injeksi 25 mg/ml ampul 120
110 Ranitidin tablet 150 mg Tab 300
 111 Rifampisin Kapsul 600 mg Kapsul 0
112 Salbutamol tablet 2 mg Tab 100
113 Salep 2 - 4 kombinasi tube 0
114 Setirizin sir 5 mg/ 5 ml Botol 0
115 Sianokobalamin (Vitamin B12) 50 mg Tab 0
116 Simvastatin 20 mg Tab 0
117 Teofilin tab 150 mg Tab 0
118 Tetrasiklin HCl Kapsul 500 mg Kapsul 0
119 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 0
120 Vitamin B komplek tablet Tab 0
121 Terbutaline sulfat ih 2.5 mg/ml ampul 0
122 Budesonid ih .5 mg/ml ampul 0
E ADDITIONAL OBAT 0
124 Amlodipin 5 mg tab 0
125 Amoxicillin 100 mg/ml drops botol 0
126 Asam Traneksamat Injeksi Ampul 0
127 Asiclovir 200 mg Tab 0
128 Asiclovir krim Tube 0
129 Bisakodil Tablet Tab 0
130 Ciprofloksasin 500 mg tablet Tab 0
131 Domperidon Sirup Btl 0
132 Furosemid Injeksi Ampul 0
133 Guaifenesin tab Tab 0
134 Kloramfenikol Tetes telinga botol 0
135 Multivitamin Dewasa Tab 0
137 Multivitamin Sirup Tab 0
136 Obat Batuk Hitam Tube 1
138 Oksitosin injeksi ampul 0
139 Ondansentron injeksi Ampul 2
140 Salbutamol inhaler ampul 15
141 Sefadroksil Kapsul 500 mg KAPSUL 2
142 Sefadroksil syrup 125 mg Botol 0
143 Sefadroksil Syrup 250 mg BOTOL 0
144 Setirizin Tab Tab 0
145 Sulfadiazine silver krim (Luka Bakar) Tube 9
OBAT PROGRAM 0
A MALARIA 0
1 Artesunate injeksi, vial 60 mg vial 0
2 Primakuin tablet 15 mg tablet 0
3 Kina tablet 200 mg tablet 0
4 Kina injeksi 25% - 2 ml ampul 0
5 Doksisiklin kapsul 100 mg kapsul 0
6 DHP (Dehidro Artemisin + Piperaquin) Tablet tablet 0
0
B FILARIASIS 0
1 DEC tablet 100 mg tablet 0
2 Albendazol tablet 400 mg tablet 0
3 Albendazol Sirup 200 mg/5 ml botol 0
0
C PENGENDALIAN PENYAKIT MENULAR (P2M) 0
1. DIARE 0
1 Garam oralit kantong 0
2 Zinc tablet 20 mg tablet 0
3 zink sirup botol 0
2. KUSTA 0
1 Prednison tablet 5 mg tablet 0
3. FRAMBUSIA 0
1 Azithromycin 500 mg tablet 0
0
D TB PARU (OAT FDC) 0
OAT FDC 0
1 Obat Anti Tuberculosis FDC kategori 1 paket 0
2 Obat Anti Tuberculosis FDC kategori 2 paket 0
3 Obat Anti Tuberculosis FDC anak paket 0
0
F AIDS PMS 0
1 Efavirenz tab 600 mg tablet 0
2 Lopinavir 200 mg + Ritonavir 50 mg tablet 0
3 Lopinavir 100 mg + Ritonavir 25 mg tablet 0
4 Nevirapin 200 mg tablet 0
5 Tenofovir tab 300 mg tablet 0
6 Zidovudin Kaps 100 mg kapsul 0
7 Lamivudin tab 150 mg tablet 0
8 Kombinasi Zidovudin 300 mg + Lamivudin 150 mg tablet 0
9 Efavirenz tab 200 mg tablet 0
10 Abacavir kaps 300 mg tablet 0
11 Tenofovir 300 mg + Emiricitabine 200 mg Tab tablet 0
12 Zidovudin 60 mg +Lamivudine 30 mg + Nevirapine 50 tablet 0
13 Tenofovir 300 mg + Lamivudin 300 mg + Efivirenz 60 tablet 0
14 Rilpivirine Tab 25 mg tablet 0
15 Zidovudine Syr 10 mg/ml botol 0
0
G KESEHATAN JIWA 0
1 Haloperidol dekanoat inj 50 mg/ml ampul 0
2 Klobazam 10 mg tablet tablet 0
3 Amitripilin HCL 25 mg tablet tablet 0
4 Klorpromazin 100 mg tablet tablet 0
5 Risperidon 2 mg Tablet tablet 0
 6 Klozapin 25 mg tablet tablet 0
7 Trifluoperazine HCL 5 mg tablet tablet 0
8 Haloperidol inj 5 mg/ml ampul 0
9 Imipramin HCL 25 mg tablet tablet 0
10 Fluoksetin 10 mg tablet tablet 0
11 Triheksifenidil 2 mg tab tablet 0
12 Haloperidol 5 mg tablet tablet 0
0
H VAKSIN RABIES 0
1 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster 0
2 Serum antirabies inj 200 UI/ml 0
0
I GIZI 0
1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul 0
2 Bayi (6 -(Vitamin
Retinol 11 bulan)
A) 200.000 IU Kapsul Lunak kapsul 0
3 Balita (11 - 59 bulan)
Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul 0
4 Ibu Nifas
Tablet Tambah Darah (Ibu Hamil) tablet 0
5 Tablet Tambah Darah (Remaja Putri) tablet 0
6 Mineral Mix sachet 0
0
J KESEHATAN IBU 0
1 Oksitosin Injeksi 10 IU/ml ampul 0
2 Metil Ergometrin Maleat injeksi 0,2 mg/ml ampul 0
3 Magnesium Sulfat Injeksi 40% ampul 0
4 Kalsium Glukonat Injeksi 10% ampul 0
5 Ampisilin Injeksi 1000 mg/vial vial 0
6 Gentamisin Injesi 40 mg/ml ampul 0
7 Metronidazol infus 5 mg/ml botol 0
0
K KESEHATAN ANAK 0
1 Fitomenadion (vit K1) injeksi 2 mg/ml ampul 0
2 Levotiroksin 50 mcg tablet 0
3 Oksitetrasiklin HCL Salep mata 1% tube 0
4 Ampicilin serb injeksi 1000 ml/vial ampul 0
5 Gentamisin injeksi 40 mg/ml ampul 0
6 Fenobarbital injeksi 50 mg/ml ampul 0
7 Diazepam injeksi 5 mg/ml ampul 0
0
L LANSIA 0
1 Risedronat kapsul 0
0
M IMUNISASI 0
1 Vaksin Hepatitis B vial 0
2 Vaksin BCG vial 0
 3 Vaksin Polio 10 ds vial 0
4 Vaksin DT vial 0
5 Vaksin Td vial 0
6 (Kelas
Vaksin2Td
SD) vial 0
7 (WUS)
Vaksin IPV vial 0
8 Vaksin DPT-HB-Hib vial 0
9 (Bayi)
Vaksin DPT-HB-Hib vial 0
10 (Baduta)
Vaksin MR vial 0
11 (Bayi)
Vaksin MR vial 0
12 (Baduta)
Vaksin HPV vial 0
13 Vaksin Pneumokokkus vial 0
14 Vaksin JE vial 0
A BMHP 0
1 Alat suntik sekali pakai 1 ml Pcs 90
2 Alat suntik sekali pakai 3 ml Pcs 200
3 Alat suntik sekali pakai 5 ml Pcs 0
4 alat suntik sekali pakai 10 ml pcs 0
5 Alkohol Swab box 4
6 autodisable no 0,05 ml Pcs 0
7 autodisable no. 0,5 ml Pcs 0
8 bloodset Pcs 0
9 Catgut Chromic 2/0 + jarum 1/2 HR 26 mm Pcs 2
10 Catgut Chromic 3/0 + jarum 1/2 HR 26 mm Pcs 0
11 ECG/USG jelly 82gr Pcs 1
12 Folley Catheter 2 way no 16 Pcs 20
13 Folley Catheter 2 way no 18 Pcs 20
Handscoon Non Steril 0
14 Ukuran L Pcs 9
15 Ukuran M Pcs 0
16 Ukuran S Pcs 0
Handscoon steril 0
17 Ukuran 6.5 Pcs 0
18 Ukuran 7.0 Pcs 0
19 Ukuran 7.5 Pcs 0
20 ID Patient Adult/Dewasa Biru Pcs 0
21 ID Patient Adult/Dewasa Pink Pcs 0
22 Infusion set anak Pcs 5
23 Infusion set dewasa Pcs 20
24 IV Catheter G - 18 Pcs 0
25 IV Catheter G - 20 Pcs 350
26 IV Catheter G - 22 Pcs 650
27 Kapas 250 gr Pcs 0
28 Kasa hidrofil 16x16 (steril) box 40
29 Kasa Kompres 40/40 steril Pcs 0
30 Kasa Pembalut 2 m x 80 cm Pcs 0
31 kasa pembalut hydrofil 40 cm x 80 cm Pcs 5
Masker 10
32 Tie on dus 0
33 Hijab dus 0
34 masker oksigen pcs 0
35 Plester Pcs 18
36 Plester Polifix 5 cm x 1 m Pcs 8
37 Policrepe Pembalut Elastis 7,5 cm x 4,55 m Roll 5
38 Silk 2/0 + jarum 1/2 GT 35 mm Pcs 0
39 Silk 3/0 + jarum 1/2 GT 35 mm Pcs 1
40 Urine bag Pcs 40
41 pot sampel pcs 0
B DESINFECTAN 0
1 Alkohol 70% - 1000 ml Btl 1
2 Antiseptik Hand Rub 500 ml Btl 1
3 cairan sterilisasi alat btl 0
4 Lisol 1 liter Btl 1
5 Povidon Iodida 300 ml Btl 4
6 Povidon Iodida 30 ml Btl 8
7 Rivanol larutan 0,1% - 300 cc Btl 4
C ADDITIONAL BHP 0
1 Bioplasenton tulle Pcs 0
2 Bisturi No. 11 box 0
3 Catgut Chromic 2/0 + Jatum 1/2 HR 20 mm pcs 1
4 Catgut Chromic 3/0 + Jatum 1/2 HR 20 mm pcs 3
5 Cuticell pcs 100
6 Dental Anastesi Citoject box 0
7 Handscoon Obgyn pairs 0
8 IV Catheter - G -24 pcs 150
9 IV Catheter G-26 PCS 0
10 kapas gigi pack 0
11 Kassa hydrofil 3 yard x 10 cm pack 5
12 Kassa hydrofil 3 yard x 15 cm pack 0
13 Kassa hydrofil 40 yard x 80 cm roll 0
14 Lidi Waten Steril box 0
15 masker karet box 0
16 Microfor box 0
17 Polifix 10 cm x 5 m roll 0
18 Polifix 5 cm x 5 m roll 2
19 Pot Sputum Steril pcs 0
20 Povidone Iodida 60 ml Btl 0
21 SD Bioline HCG pcs 0
22 SD Urocolor For Urinalysis pcs 0
23 Silk 4/0 DS 12 mm pcs 0
24 Silk 4/0 DS 19 mm pcs 0
25 Silk 4/0 HR 20 mm pcs 0
26 Silk 5/0 DS 16 mm pcs 0
27 Umbilical Cord Clamps pcs 0

Mengetahui,
Pimpinan UPTD Puskesmas Cikidang
Kabupaten Sukabumi

Asep Gumelar, SKM., M.Si.

AR PERMINTAAN OBAT (LPLPO)
BULAN FEBRUARI
TAHUN 2021

PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

1 1
0 0
0 0
0 0
0 0
0 0
0 0
1 1
0 0
5 5
3 3
35 35
40 40
0 0
0 0
0 0
0 0
0 0
200 200
400 400
50 50
50 50
0 0
50 50
500 500
0 0
10 10
0 0
0 0
0 0
0 0
200 200
100 100
0 0
 0 0
200 200
0 0
0 0
0 0
5 5
0 0
0 0
80 80
0 0
300 300
100 100
3 3
2 2
0 0
10 10
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
50 50
0 0
100 100
0 0
0 0
0 0
0 0
0 0
50 50
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 200
0 0
0 0
0 0
0 0
400 400
0 0
0 0
0 0
0 0
0 0
0 0
0 0
80 80
0 0
200 200
0 0
0 0
0 0
0 0
0 0
200 200
30 30
0 0
200 200
0 0
800 800
100 100
300 300
0 0
0 0
0 0
100 100
200 200
0 0
400 400
1000 1000
0 0
0 0
0 0
0 0
500 500
0 0
120 120
300 300
 0 0
100 100
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
1 1
0 0
2 2
15 15
2 2
0 0
0 0
0 0
9 9
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
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
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
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
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
90 90
200 200
0 0
0 0
4 4
0 0
0 0
0 0
2 2
0 0
1 1
20 20
20 20
0 0
9 9
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5 5
20 20
0 0
350 350
650 650
0 0
40 40
0 0
0 0
 5 5
10 10
0 0
0 0
0 0
18 18
8 8
5 5
0 0
1 1
40 40
0 0
0 0
1 1
1 1
0 0
1 1
4 4
8 8
4 4
0 0
0 0
0 0
1 1
3 3
100 100
0 0
0 0
150 150
0 0
0 0
5 5
0 0
0 0
0 0
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

Cikidang,
Penanggung Jawab

…………………………………….
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN
PUSKESMAS CIKIDANG
KECAMATAN CIKIDANG
ALAMAT JALAN RAYA CIKIDANG KM 19
NAMA OBAT/SEDIAAN SEDIAAN
NO STOK AWAL PENERIMAAN

A SERUM
1 ABU ampul 1
2 ATS ampul 0
B BHP GIGI 0
1 Temporary filling materail pcs 0
2 Glass Ionomer Cement kit A3 pcs 0
3 Coat bond pcs 0
4 Brilliant NG pcs 0
5 Eugenol botol 1
C CAIRAN 0
1 Air untuk injeksi (Aqua pro injeksi) 20 ml Botol 5
2 Glukosa Larutan infus 5% steril 500 ml Botol 3
3 Natrium Klorida lart.infus 0,9% steril - 500 ml Botol 35
4 Ringer Laktat larutan infus steril - 500 ml Botol 40
D OBAT 0
1 Allupurinol 100 mg Tablet Tab 0
2 Aminofillin inj 24 mg /ml-10ml ampul 0
3 Aminophylin tablet 200mg Tab 0
4 Amitriptilin HCl tablet salut 25 mg Tab 0
5 Amlodipin 10 mg Tab 200
6 Amoksisilin Kaplet 500 mg Kaplet 400
7 Amoksisilin Kapsul 250 mg Kapsul 50
8 Amoksisilin sirup kering 125 mg/5 ml Botol 50
9 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 0
10 Antasida Suspensi 60 ml Botol 50
11 Antasida DOEN tablet kombinasi Tab 500
12 Anti fungi DOEN komb sk tube 0
13 Anti Hemoroid DOEN kombinasi supp 10
14 Antimigren DOEN kombinasi Tab 0
15 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab 0
16 Asam Askorbat (Vit.C) tablet 50 mg Tab 0
17 Asam folat tablet 0.4 mg Tab 0
18 Asam mefenamat 500 mg Kaplet 200
19 Asetyl sestein 200mg kapsul 100
20 Asiklovir Tablet 400 mg Tab 0
21 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml ampul 0
22 Attalpugite tab 600 mg Tab 200
23 Benzatin Benzil Penisilin inj.1.2 juta IU/vial ampul 0
24 Betahistin maleat Tab 0
25 Betametasone Krim 0.1% tube 0
26 Bisakodil Supp 10 mg supp 5
27 Bisoprolol tablet tablet 0
28 Captopril 12,5 mg Tab 0
29 Captopril tablet 25 mg Tab 80
30 Deksametason injeksi 5 mg/ml - 1 ml ampul 0
31 Deksametasone tablet 0.5mg Tab 300
32 Diasepam 2 mg tablet Tab 100
33 Diazepam Inj 5 ml/2ml ampul 3
34 Diazepam lar rektal 5mg/2,5ml tube 2
35 Dietilkarbamazin sitrat tablet 100 mg Tab 0
36 Difenhidramin HCl injeksi 10 mg/ml - 1 ml ampul 10
37 Digoksin tablet 0,25 mg Tab 0
38 Doksisiklin 100 mg ampul 0
39 Domperidon tablet 10 mg Tab 0
40 Epinefrina (adrenalin) injeksi 0,1% - 1 ml ampul 2
41 Erytromycin 250 mg Kapsul 0
42 Etambutol HCL 250 mg Tab 0
43 Fenitoin Na kaps 100 mg Kapsul 0
44 Fenobarbital injeksi 50 mg/ml - 2 ml ampul 0
45 Fenobarbital tablet 30 mg Tab 0
46 Fenofibrat kaps 100 mg Kapsul 0
47 Fenoksimetil Penisilina tablet 500 mg Tab 0
48 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 0
49 Furosemid tablet 40 mg Tab 50
50 Gentamisin tetes mata Botol 0
51 Glibenklamid tablet 5 mg Tab 100
52 Glimepiride tab 0
53 Griseofulvin tablet 125 mg, micronized Tab 0
54 Hidroklorotiazid (HCT) tablet 25 mg Tab 0
55 Hidrokortison krim 2,5 % tube 0
56 Ibuprofen Suspensi 100mg 5ml botol 0
57 Ibuprofen tablet 400 mg Tab 50
58 Isoniazid tablet 300 mg Tab 0
59 Isosorbid Dinitrat 5 mg tablet sublingual Tab 0
60 Kalsium Glukonat Inj 100 mg/ml ampul 0
61 Kalsium lakate (kalk) tablet Tab 0
62 Karbamazepin tablet 200 mg Tab 0
63 Karbogliserin Tetes Telinga 10% Botol 0
64 Ketokonazol krim 2 % tube 0
65 Ketokonazol Tablet 200 mg Tab 0
 66 Klindamicin 150 mg Kapsul 200
67 Klopidogrel tab 75 mg Tab 0
68 Kloramfenikol Kapsul 500 mg Kapsul 0
69 Kloramfenikol salep kulit 2% (bufacetin) tube 0
70 Kloramfenikol Salep Mata 1% - 3,5 gr Botol 0
71 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 400
72 Klorpromazin HCL tablet 25 mg Tab 0
73 Klorpromazin inj. 25 mg/ml ampul 0
74 Kodein HCl tablet 10 mg Tab 0
75 Kotrimoksazol forte tablet Tab 0
76 Kotrimoksazol 480 tablet tab 0
77 Kotrimoksazol suspensi kombinasi Botol 0
78 Lansoprazol 30 mg Tab 0
79 Lidokain inj. 2% ampul 80
80 Lidokain komp. injeksi kombinasi ampul 0
81 Loratadin tab 10 mg Tab 200
82 Mebendazol tablet 0
83 Metformin tablet 500 mg Tab 0
84 metil dopa tab 250 mg Tab 0
85 Metilergometrin Maleat injeksi 0,200 mg - 1ml ampul 0
86 Metilergometrin Maleat tablet salut 0,125 mg Tab 0
87 Metilprednisolon tablet 4 mg Tab 200
88 Metoklorpropamid tablet 10 mg Tab 30
89 Metronidazol sirup 125mg/5ml Botol 0
90 Metronidazol tablet 500 mg Tab 200
91 Miconazol SK tube 0
92 Natrium bikarbonat tablet 500 mg Tab 800
93 Natrium Diklofenac 50 mg Tab 100
94 Nifedifin tablet 30 mg Tab 300
95 Nistatin 100.000 IU/gram tablet vaginal supp 0
96 Nistatin tablet salut gula 500.000 IU/g Tab 0
97 Oksitetrasiklin HCl salep 3% - 5 gram tube 0
98 Omeprazol 20 mg Tab 100
99 Ondansentron tab 8 mg Tab 200
100 parasetamol drop Botol 0
101 Parasetamol Kaplet 500 mg Tab 400
102 Parasetamol sirup Botol 1000
103 Permetrin/scabimite krim 5 % tube 0
104 Pirantel Pamoat tablet 125 mg Tab 0
105 Pirazinamid tablet 500 mg Tab 0
106 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 0
107 Prednison tablet 5 mg Tab 500
108 Propranolol HCl tablet 40 mg Tab 0
109 Ranitidin Injeksi 25 mg/ml ampul 120
110 Ranitidin tablet 150 mg Tab 300
 111 Rifampisin Kapsul 600 mg Kapsul 0
112 Salbutamol tablet 2 mg Tab 100
113 Salep 2 - 4 kombinasi tube 0
114 Setirizin sir 5 mg/ 5 ml Botol 0
115 Sianokobalamin (Vitamin B12) 50 mg Tab 0
116 Simvastatin 20 mg Tab 0
117 Teofilin tab 150 mg Tab 0
118 Tetrasiklin HCl Kapsul 500 mg Kapsul 0
119 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 0
120 Vitamin B komplek tablet Tab 0
121 Terbutaline sulfat ih 2.5 mg/ml ampul 0
122 Budesonid ih .5 mg/ml ampul 0
E ADDITIONAL OBAT 0
124 Amlodipin 5 mg tab 0
125 Amoxicillin 100 mg/ml drops botol 0
126 Asam Traneksamat Injeksi Ampul 0
127 Asiclovir 200 mg Tab 0
128 Asiclovir krim Tube 0
129 Bisakodil Tablet Tab 0
130 Ciprofloksasin 500 mg tablet Tab 0
131 Domperidon Sirup Btl 0
132 Furosemid Injeksi Ampul 0
133 Guaifenesin tab Tab 0
134 Kloramfenikol Tetes telinga botol 0
135 Multivitamin Dewasa Tab 0
137 Multivitamin Sirup Tab 0
136 Obat Batuk Hitam Tube 1
138 Oksitosin injeksi ampul 0
139 Ondansentron injeksi Ampul 2
140 Salbutamol inhaler ampul 15
141 Sefadroksil Kapsul 500 mg KAPSUL 2
142 Sefadroksil syrup 125 mg Botol 0
143 Sefadroksil Syrup 250 mg BOTOL 0
144 Setirizin Tab Tab 0
145 Sulfadiazine silver krim (Luka Bakar) Tube 9
OBAT PROGRAM 0
A MALARIA 0
1 Artesunate injeksi, vial 60 mg vial 0
2 Primakuin tablet 15 mg tablet 0
3 Kina tablet 200 mg tablet 0
4 Kina injeksi 25% - 2 ml ampul 0
5 Doksisiklin kapsul 100 mg kapsul 0
6 DHP (Dehidro Artemisin + Piperaquin) Tablet tablet 0
0
B FILARIASIS 0
1 DEC tablet 100 mg tablet 0
2 Albendazol tablet 400 mg tablet 0
3 Albendazol Sirup 200 mg/5 ml botol 0
0
C PENGENDALIAN PENYAKIT MENULAR (P2M) 0
1. DIARE 0
1 Garam oralit kantong 0
2 Zinc tablet 20 mg tablet 0
3 zink sirup botol 0
2. KUSTA 0
1 Prednison tablet 5 mg tablet 0
3. FRAMBUSIA 0
1 Azithromycin 500 mg tablet 0
0
D TB PARU (OAT FDC) 0
OAT FDC 0
1 Obat Anti Tuberculosis FDC kategori 1 paket 0
2 Obat Anti Tuberculosis FDC kategori 2 paket 0
3 Obat Anti Tuberculosis FDC anak paket 0
0
F AIDS PMS 0
1 Efavirenz tab 600 mg tablet 0
2 Lopinavir 200 mg + Ritonavir 50 mg tablet 0
3 Lopinavir 100 mg + Ritonavir 25 mg tablet 0
4 Nevirapin 200 mg tablet 0
5 Tenofovir tab 300 mg tablet 0
6 Zidovudin Kaps 100 mg kapsul 0
7 Lamivudin tab 150 mg tablet 0
8 Kombinasi Zidovudin 300 mg + Lamivudin 150 mg tablet 0
9 Efavirenz tab 200 mg tablet 0
10 Abacavir kaps 300 mg tablet 0
11 Tenofovir 300 mg + Emiricitabine 200 mg Tab tablet 0
12 Zidovudin 60 mg +Lamivudine 30 mg + Nevirapine 50 tablet 0
13 Tenofovir 300 mg + Lamivudin 300 mg + Efivirenz 60 tablet 0
14 Rilpivirine Tab 25 mg tablet 0
15 Zidovudine Syr 10 mg/ml botol 0
0
G KESEHATAN JIWA 0
1 Haloperidol dekanoat inj 50 mg/ml ampul 0
2 Klobazam 10 mg tablet tablet 0
3 Amitripilin HCL 25 mg tablet tablet 0
4 Klorpromazin 100 mg tablet tablet 0
5 Risperidon 2 mg Tablet tablet 0
 6 Klozapin 25 mg tablet tablet 0
7 Trifluoperazine HCL 5 mg tablet tablet 0
8 Haloperidol inj 5 mg/ml ampul 0
9 Imipramin HCL 25 mg tablet tablet 0
10 Fluoksetin 10 mg tablet tablet 0
11 Triheksifenidil 2 mg tab tablet 0
12 Haloperidol 5 mg tablet tablet 0
0
H VAKSIN RABIES 0
1 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster 0
2 Serum antirabies inj 200 UI/ml 0
0
I GIZI 0
1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul 0
2 Bayi (6 -(Vitamin
Retinol 11 bulan)
A) 200.000 IU Kapsul Lunak kapsul 0
3 Balita (11 - 59 bulan)
Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul 0
4 Ibu Nifas
Tablet Tambah Darah (Ibu Hamil) tablet 0
5 Tablet Tambah Darah (Remaja Putri) tablet 0
6 Mineral Mix sachet 0
0
J KESEHATAN IBU 0
1 Oksitosin Injeksi 10 IU/ml ampul 0
2 Metil Ergometrin Maleat injeksi 0,2 mg/ml ampul 0
3 Magnesium Sulfat Injeksi 40% ampul 0
4 Kalsium Glukonat Injeksi 10% ampul 0
5 Ampisilin Injeksi 1000 mg/vial vial 0
6 Gentamisin Injesi 40 mg/ml ampul 0
7 Metronidazol infus 5 mg/ml botol 0
0
K KESEHATAN ANAK 0
1 Fitomenadion (vit K1) injeksi 2 mg/ml ampul 0
2 Levotiroksin 50 mcg tablet 0
3 Oksitetrasiklin HCL Salep mata 1% tube 0
4 Ampicilin serb injeksi 1000 ml/vial ampul 0
5 Gentamisin injeksi 40 mg/ml ampul 0
6 Fenobarbital injeksi 50 mg/ml ampul 0
7 Diazepam injeksi 5 mg/ml ampul 0
0
L LANSIA 0
1 Risedronat kapsul 0
0
M IMUNISASI 0
1 Vaksin Hepatitis B vial 0
2 Vaksin BCG vial 0
 3 Vaksin Polio 10 ds vial 0
4 Vaksin DT vial 0
5 Vaksin Td vial 0
6 (Kelas
Vaksin2Td
SD) vial 0
7 (WUS)
Vaksin IPV vial 0
8 Vaksin DPT-HB-Hib vial 0
9 (Bayi)
Vaksin DPT-HB-Hib vial 0
10 (Baduta)
Vaksin MR vial 0
11 (Bayi)
Vaksin MR vial 0
12 (Baduta)
Vaksin HPV vial 0
13 Vaksin Pneumokokkus vial 0
14 Vaksin JE vial 0
A BMHP 0
1 Alat suntik sekali pakai 1 ml Pcs 90
2 Alat suntik sekali pakai 3 ml Pcs 200
3 Alat suntik sekali pakai 5 ml Pcs 0
4 alat suntik sekali pakai 10 ml pcs 0
5 Alkohol Swab box 4
6 autodisable no 0,05 ml Pcs 0
7 autodisable no. 0,5 ml Pcs 0
8 bloodset Pcs 0
9 Catgut Chromic 2/0 + jarum 1/2 HR 26 mm Pcs 2
10 Catgut Chromic 3/0 + jarum 1/2 HR 26 mm Pcs 0
11 ECG/USG jelly 82gr Pcs 1
12 Folley Catheter 2 way no 16 Pcs 20
13 Folley Catheter 2 way no 18 Pcs 20
Handscoon Non Steril 0
14 Ukuran L Pcs 9
15 Ukuran M Pcs 0
16 Ukuran S Pcs 0
Handscoon steril 0
17 Ukuran 6.5 Pcs 0
18 Ukuran 7.0 Pcs 0
19 Ukuran 7.5 Pcs 0
20 ID Patient Adult/Dewasa Biru Pcs 0
21 ID Patient Adult/Dewasa Pink Pcs 0
22 Infusion set anak Pcs 5
23 Infusion set dewasa Pcs 20
24 IV Catheter G - 18 Pcs 0
25 IV Catheter G - 20 Pcs 350
26 IV Catheter G - 22 Pcs 650
27 Kapas 250 gr Pcs 0
28 Kasa hidrofil 16x16 (steril) box 40
29 Kasa Kompres 40/40 steril Pcs 0
30 Kasa Pembalut 2 m x 80 cm Pcs 0
31 kasa pembalut hydrofil 40 cm x 80 cm Pcs 5
Masker 10
32 Tie on dus 0
33 Hijab dus 0
34 masker oksigen pcs 0
35 Plester Pcs 18
36 Plester Polifix 5 cm x 1 m Pcs 8
37 Policrepe Pembalut Elastis 7,5 cm x 4,55 m Roll 5
38 Silk 2/0 + jarum 1/2 GT 35 mm Pcs 0
39 Silk 3/0 + jarum 1/2 GT 35 mm Pcs 1
40 Urine bag Pcs 40
41 pot sampel pcs 0
B DESINFECTAN 0
1 Alkohol 70% - 1000 ml Btl 1
2 Antiseptik Hand Rub 500 ml Btl 1
3 cairan sterilisasi alat btl 0
4 Lisol 1 liter Btl 1
5 Povidon Iodida 300 ml Btl 4
6 Povidon Iodida 30 ml Btl 8
7 Rivanol larutan 0,1% - 300 cc Btl 4
C ADDITIONAL BHP 0
1 Bioplasenton tulle Pcs 0
2 Bisturi No. 11 box 0
3 Catgut Chromic 2/0 + Jatum 1/2 HR 20 mm pcs 1
4 Catgut Chromic 3/0 + Jatum 1/2 HR 20 mm pcs 3
5 Cuticell pcs 100
6 Dental Anastesi Citoject box 0
7 Handscoon Obgyn pairs 0
8 IV Catheter - G -24 pcs 150
9 IV Catheter G-26 PCS 0
10 kapas gigi pack 0
11 Kassa hydrofil 3 yard x 10 cm pack 5
12 Kassa hydrofil 3 yard x 15 cm pack 0
13 Kassa hydrofil 40 yard x 80 cm roll 0
14 Lidi Waten Steril box 0
15 masker karet box 0
16 Microfor box 0
17 Polifix 10 cm x 5 m roll 0
18 Polifix 5 cm x 5 m roll 2
19 Pot Sputum Steril pcs 0
20 Povidone Iodida 60 ml Btl 0
21 SD Bioline HCG pcs 0
22 SD Urocolor For Urinalysis pcs 0
23 Silk 4/0 DS 12 mm pcs 0
24 Silk 4/0 DS 19 mm pcs 0
25 Silk 4/0 HR 20 mm pcs 0
26 Silk 5/0 DS 16 mm pcs 0
27 Umbilical Cord Clamps pcs 0

Mengetahui,
Pimpinan UPTD Puskesmas Cikidang
Kabupaten Sukabumi

Asep Gumelar, SKM., M.Si.

AR PERMINTAAN OBAT (LPLPO)
BULAN MARET
TAHUN 2021

PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

1 1
0 0
0 0
0 0
0 0
0 0
0 0
1 1
0 0
5 5
3 3
35 35
40 40
0 0
0 0
0 0
0 0
0 0
200 200
400 400
50 50
50 50
0 0
50 50
500 500
0 0
10 10
0 0
0 0
0 0
0 0
200 200
100 100
0 0
 0 0
200 200
0 0
0 0
0 0
5 5
0 0
0 0
80 80
0 0
300 300
100 100
3 3
2 2
0 0
10 10
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
50 50
0 0
100 100
0 0
0 0
0 0
0 0
0 0
50 50
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 200
0 0
0 0
0 0
0 0
400 400
0 0
0 0
0 0
0 0
0 0
0 0
0 0
80 80
0 0
200 200
0 0
0 0
0 0
0 0
0 0
200 200
30 30
0 0
200 200
0 0
800 800
100 100
300 300
0 0
0 0
0 0
100 100
200 200
0 0
400 400
1000 1000
0 0
0 0
0 0
0 0
500 500
0 0
120 120
300 300
 0 0
100 100
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
1 1
0 0
2 2
15 15
2 2
0 0
0 0
0 0
9 9
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
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
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
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
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
90 90
200 200
0 0
0 0
4 4
0 0
0 0
0 0
2 2
0 0
1 1
20 20
20 20
0 0
9 9
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5 5
20 20
0 0
350 350
650 650
0 0
40 40
0 0
0 0
 5 5
10 10
0 0
0 0
0 0
18 18
8 8
5 5
0 0
1 1
40 40
0 0
0 0
1 1
1 1
0 0
1 1
4 4
8 8
4 4
0 0
0 0
0 0
1 1
3 3
100 100
0 0
0 0
150 150
0 0
0 0
5 5
0 0
0 0
0 0
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

Cikidang,
Penanggung Jawab

…………………………………….
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN
PUSKESMAS CIKIDANG
KECAMATAN CIKIDANG
ALAMAT JALAN RAYA CIKIDANG KM 19
NAMA OBAT/SEDIAAN SEDIAAN
NO STOK AWAL PENERIMAAN

A SERUM
1 ABU ampul 1
2 ATS ampul 0
B BHP GIGI 0
1 Temporary filling materail pcs 0
2 Glass Ionomer Cement kit A3 pcs 0
3 Coat bond pcs 0
4 Brilliant NG pcs 0
5 Eugenol botol 1
C CAIRAN 0
1 Air untuk injeksi (Aqua pro injeksi) 20 ml Botol 5
2 Glukosa Larutan infus 5% steril 500 ml Botol 3
3 Natrium Klorida lart.infus 0,9% steril - 500 ml Botol 35
4 Ringer Laktat larutan infus steril - 500 ml Botol 40
D OBAT 0
1 Allupurinol 100 mg Tablet Tab 0
2 Aminofillin inj 24 mg /ml-10ml ampul 0
3 Aminophylin tablet 200mg Tab 0
4 Amitriptilin HCl tablet salut 25 mg Tab 0
5 Amlodipin 10 mg Tab 200
6 Amoksisilin Kaplet 500 mg Kaplet 400
7 Amoksisilin Kapsul 250 mg Kapsul 50
8 Amoksisilin sirup kering 125 mg/5 ml Botol 50
9 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 0
10 Antasida Suspensi 60 ml Botol 50
11 Antasida DOEN tablet kombinasi Tab 500
12 Anti fungi DOEN komb sk tube 0
13 Anti Hemoroid DOEN kombinasi supp 10
14 Antimigren DOEN kombinasi Tab 0
15 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab 0
16 Asam Askorbat (Vit.C) tablet 50 mg Tab 0
17 Asam folat tablet 0.4 mg Tab 0
18 Asam mefenamat 500 mg Kaplet 200
19 Asetyl sestein 200mg kapsul 100
20 Asiklovir Tablet 400 mg Tab 0
21 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml ampul 0
22 Attalpugite tab 600 mg Tab 200
23 Benzatin Benzil Penisilin inj.1.2 juta IU/vial ampul 0
24 Betahistin maleat Tab 0
25 Betametasone Krim 0.1% tube 0
26 Bisakodil Supp 10 mg supp 5
27 Bisoprolol tablet tablet 0
28 Captopril 12,5 mg Tab 0
29 Captopril tablet 25 mg Tab 80
30 Deksametason injeksi 5 mg/ml - 1 ml ampul 0
31 Deksametasone tablet 0.5mg Tab 300
32 Diasepam 2 mg tablet Tab 100
33 Diazepam Inj 5 ml/2ml ampul 3
34 Diazepam lar rektal 5mg/2,5ml tube 2
35 Dietilkarbamazin sitrat tablet 100 mg Tab 0
36 Difenhidramin HCl injeksi 10 mg/ml - 1 ml ampul 10
37 Digoksin tablet 0,25 mg Tab 0
38 Doksisiklin 100 mg ampul 0
39 Domperidon tablet 10 mg Tab 0
40 Epinefrina (adrenalin) injeksi 0,1% - 1 ml ampul 2
41 Erytromycin 250 mg Kapsul 0
42 Etambutol HCL 250 mg Tab 0
43 Fenitoin Na kaps 100 mg Kapsul 0
44 Fenobarbital injeksi 50 mg/ml - 2 ml ampul 0
45 Fenobarbital tablet 30 mg Tab 0
46 Fenofibrat kaps 100 mg Kapsul 0
47 Fenoksimetil Penisilina tablet 500 mg Tab 0
48 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 0
49 Furosemid tablet 40 mg Tab 50
50 Gentamisin tetes mata Botol 0
51 Glibenklamid tablet 5 mg Tab 100
52 Glimepiride tab 0
53 Griseofulvin tablet 125 mg, micronized Tab 0
54 Hidroklorotiazid (HCT) tablet 25 mg Tab 0
55 Hidrokortison krim 2,5 % tube 0
56 Ibuprofen Suspensi 100mg 5ml botol 0
57 Ibuprofen tablet 400 mg Tab 50
58 Isoniazid tablet 300 mg Tab 0
59 Isosorbid Dinitrat 5 mg tablet sublingual Tab 0
60 Kalsium Glukonat Inj 100 mg/ml ampul 0
61 Kalsium lakate (kalk) tablet Tab 0
62 Karbamazepin tablet 200 mg Tab 0
63 Karbogliserin Tetes Telinga 10% Botol 0
64 Ketokonazol krim 2 % tube 0
65 Ketokonazol Tablet 200 mg Tab 0
 66 Klindamicin 150 mg Kapsul 200
67 Klopidogrel tab 75 mg Tab 0
68 Kloramfenikol Kapsul 500 mg Kapsul 0
69 Kloramfenikol salep kulit 2% (bufacetin) tube 0
70 Kloramfenikol Salep Mata 1% - 3,5 gr Botol 0
71 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 400
72 Klorpromazin HCL tablet 25 mg Tab 0
73 Klorpromazin inj. 25 mg/ml ampul 0
74 Kodein HCl tablet 10 mg Tab 0
75 Kotrimoksazol forte tablet Tab 0
76 Kotrimoksazol 480 tablet tab 0
77 Kotrimoksazol suspensi kombinasi Botol 0
78 Lansoprazol 30 mg Tab 0
79 Lidokain inj. 2% ampul 80
80 Lidokain komp. injeksi kombinasi ampul 0
81 Loratadin tab 10 mg Tab 200
82 Mebendazol tablet 0
83 Metformin tablet 500 mg Tab 0
84 metil dopa tab 250 mg Tab 0
85 Metilergometrin Maleat injeksi 0,200 mg - 1ml ampul 0
86 Metilergometrin Maleat tablet salut 0,125 mg Tab 0
87 Metilprednisolon tablet 4 mg Tab 200
88 Metoklorpropamid tablet 10 mg Tab 30
89 Metronidazol sirup 125mg/5ml Botol 0
90 Metronidazol tablet 500 mg Tab 200
91 Miconazol SK tube 0
92 Natrium bikarbonat tablet 500 mg Tab 800
93 Natrium Diklofenac 50 mg Tab 100
94 Nifedifin tablet 30 mg Tab 300
95 Nistatin 100.000 IU/gram tablet vaginal supp 0
96 Nistatin tablet salut gula 500.000 IU/g Tab 0
97 Oksitetrasiklin HCl salep 3% - 5 gram tube 0
98 Omeprazol 20 mg Tab 100
99 Ondansentron tab 8 mg Tab 200
100 parasetamol drop Botol 0
101 Parasetamol Kaplet 500 mg Tab 400
102 Parasetamol sirup Botol 1000
103 Permetrin/scabimite krim 5 % tube 0
104 Pirantel Pamoat tablet 125 mg Tab 0
105 Pirazinamid tablet 500 mg Tab 0
106 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 0
107 Prednison tablet 5 mg Tab 500
108 Propranolol HCl tablet 40 mg Tab 0
109 Ranitidin Injeksi 25 mg/ml ampul 120
110 Ranitidin tablet 150 mg Tab 300
 111 Rifampisin Kapsul 600 mg Kapsul 0
112 Salbutamol tablet 2 mg Tab 100
113 Salep 2 - 4 kombinasi tube 0
114 Setirizin sir 5 mg/ 5 ml Botol 0
115 Sianokobalamin (Vitamin B12) 50 mg Tab 0
116 Simvastatin 20 mg Tab 0
117 Teofilin tab 150 mg Tab 0
118 Tetrasiklin HCl Kapsul 500 mg Kapsul 0
119 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 0
120 Vitamin B komplek tablet Tab 0
121 Terbutaline sulfat ih 2.5 mg/ml ampul 0
122 Budesonid ih .5 mg/ml ampul 0
E ADDITIONAL OBAT 0
124 Amlodipin 5 mg tab 0
125 Amoxicillin 100 mg/ml drops botol 0
126 Asam Traneksamat Injeksi Ampul 0
127 Asiclovir 200 mg Tab 0
128 Asiclovir krim Tube 0
129 Bisakodil Tablet Tab 0
130 Ciprofloksasin 500 mg tablet Tab 0
131 Domperidon Sirup Btl 0
132 Furosemid Injeksi Ampul 0
133 Guaifenesin tab Tab 0
134 Kloramfenikol Tetes telinga botol 0
135 Multivitamin Dewasa Tab 0
137 Multivitamin Sirup Tab 0
136 Obat Batuk Hitam Tube 1
138 Oksitosin injeksi ampul 0
139 Ondansentron injeksi Ampul 2
140 Salbutamol inhaler ampul 15
141 Sefadroksil Kapsul 500 mg KAPSUL 2
142 Sefadroksil syrup 125 mg Botol 0
143 Sefadroksil Syrup 250 mg BOTOL 0
144 Setirizin Tab Tab 0
145 Sulfadiazine silver krim (Luka Bakar) Tube 9
OBAT PROGRAM 0
A MALARIA 0
1 Artesunate injeksi, vial 60 mg vial 0
2 Primakuin tablet 15 mg tablet 0
3 Kina tablet 200 mg tablet 0
4 Kina injeksi 25% - 2 ml ampul 0
5 Doksisiklin kapsul 100 mg kapsul 0
6 DHP (Dehidro Artemisin + Piperaquin) Tablet tablet 0
0
B FILARIASIS 0
1 DEC tablet 100 mg tablet 0
2 Albendazol tablet 400 mg tablet 0
3 Albendazol Sirup 200 mg/5 ml botol 0
0
C PENGENDALIAN PENYAKIT MENULAR (P2M) 0
1. DIARE 0
1 Garam oralit kantong 0
2 Zinc tablet 20 mg tablet 0
3 zink sirup botol 0
2. KUSTA 0
1 Prednison tablet 5 mg tablet 0
3. FRAMBUSIA 0
1 Azithromycin 500 mg tablet 0
0
D TB PARU (OAT FDC) 0
OAT FDC 0
1 Obat Anti Tuberculosis FDC kategori 1 paket 0
2 Obat Anti Tuberculosis FDC kategori 2 paket 0
3 Obat Anti Tuberculosis FDC anak paket 0
0
F AIDS PMS 0
1 Efavirenz tab 600 mg tablet 0
2 Lopinavir 200 mg + Ritonavir 50 mg tablet 0
3 Lopinavir 100 mg + Ritonavir 25 mg tablet 0
4 Nevirapin 200 mg tablet 0
5 Tenofovir tab 300 mg tablet 0
6 Zidovudin Kaps 100 mg kapsul 0
7 Lamivudin tab 150 mg tablet 0
8 Kombinasi Zidovudin 300 mg + Lamivudin 150 mg tablet 0
9 Efavirenz tab 200 mg tablet 0
10 Abacavir kaps 300 mg tablet 0
11 Tenofovir 300 mg + Emiricitabine 200 mg Tab tablet 0
12 Zidovudin 60 mg +Lamivudine 30 mg + Nevirapine 50 tablet 0
13 Tenofovir 300 mg + Lamivudin 300 mg + Efivirenz 60 tablet 0
14 Rilpivirine Tab 25 mg tablet 0
15 Zidovudine Syr 10 mg/ml botol 0
0
G KESEHATAN JIWA 0
1 Haloperidol dekanoat inj 50 mg/ml ampul 0
2 Klobazam 10 mg tablet tablet 0
3 Amitripilin HCL 25 mg tablet tablet 0
4 Klorpromazin 100 mg tablet tablet 0
5 Risperidon 2 mg Tablet tablet 0
 6 Klozapin 25 mg tablet tablet 0
7 Trifluoperazine HCL 5 mg tablet tablet 0
8 Haloperidol inj 5 mg/ml ampul 0
9 Imipramin HCL 25 mg tablet tablet 0
10 Fluoksetin 10 mg tablet tablet 0
11 Triheksifenidil 2 mg tab tablet 0
12 Haloperidol 5 mg tablet tablet 0
0
H VAKSIN RABIES 0
1 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster 0
2 Serum antirabies inj 200 UI/ml 0
0
I GIZI 0
1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul 0
2 Bayi (6 -(Vitamin
Retinol 11 bulan)
A) 200.000 IU Kapsul Lunak kapsul 0
3 Balita (11 - 59 bulan)
Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul 0
4 Ibu Nifas
Tablet Tambah Darah (Ibu Hamil) tablet 0
5 Tablet Tambah Darah (Remaja Putri) tablet 0
6 Mineral Mix sachet 0
0
J KESEHATAN IBU 0
1 Oksitosin Injeksi 10 IU/ml ampul 0
2 Metil Ergometrin Maleat injeksi 0,2 mg/ml ampul 0
3 Magnesium Sulfat Injeksi 40% ampul 0
4 Kalsium Glukonat Injeksi 10% ampul 0
5 Ampisilin Injeksi 1000 mg/vial vial 0
6 Gentamisin Injesi 40 mg/ml ampul 0
7 Metronidazol infus 5 mg/ml botol 0
0
K KESEHATAN ANAK 0
1 Fitomenadion (vit K1) injeksi 2 mg/ml ampul 0
2 Levotiroksin 50 mcg tablet 0
3 Oksitetrasiklin HCL Salep mata 1% tube 0
4 Ampicilin serb injeksi 1000 ml/vial ampul 0
5 Gentamisin injeksi 40 mg/ml ampul 0
6 Fenobarbital injeksi 50 mg/ml ampul 0
7 Diazepam injeksi 5 mg/ml ampul 0
0
L LANSIA 0
1 Risedronat kapsul 0
0
M IMUNISASI 0
1 Vaksin Hepatitis B vial 0
2 Vaksin BCG vial 0
 3 Vaksin Polio 10 ds vial 0
4 Vaksin DT vial 0
5 Vaksin Td vial 0
6 (Kelas
Vaksin2Td
SD) vial 0
7 (WUS)
Vaksin IPV vial 0
8 Vaksin DPT-HB-Hib vial 0
9 (Bayi)
Vaksin DPT-HB-Hib vial 0
10 (Baduta)
Vaksin MR vial 0
11 (Bayi)
Vaksin MR vial 0
12 (Baduta)
Vaksin HPV vial 0
13 Vaksin Pneumokokkus vial 0
14 Vaksin JE vial 0
A BMHP 0
1 Alat suntik sekali pakai 1 ml Pcs 90
2 Alat suntik sekali pakai 3 ml Pcs 200
3 Alat suntik sekali pakai 5 ml Pcs 0
4 alat suntik sekali pakai 10 ml pcs 0
5 Alkohol Swab box 4
6 autodisable no 0,05 ml Pcs 0
7 autodisable no. 0,5 ml Pcs 0
8 bloodset Pcs 0
9 Catgut Chromic 2/0 + jarum 1/2 HR 26 mm Pcs 2
10 Catgut Chromic 3/0 + jarum 1/2 HR 26 mm Pcs 0
11 ECG/USG jelly 82gr Pcs 1
12 Folley Catheter 2 way no 16 Pcs 20
13 Folley Catheter 2 way no 18 Pcs 20
Handscoon Non Steril 0
14 Ukuran L Pcs 9
15 Ukuran M Pcs 0
16 Ukuran S Pcs 0
Handscoon steril 0
17 Ukuran 6.5 Pcs 0
18 Ukuran 7.0 Pcs 0
19 Ukuran 7.5 Pcs 0
20 ID Patient Adult/Dewasa Biru Pcs 0
21 ID Patient Adult/Dewasa Pink Pcs 0
22 Infusion set anak Pcs 5
23 Infusion set dewasa Pcs 20
24 IV Catheter G - 18 Pcs 0
25 IV Catheter G - 20 Pcs 350
26 IV Catheter G - 22 Pcs 650
27 Kapas 250 gr Pcs 0
28 Kasa hidrofil 16x16 (steril) box 40
29 Kasa Kompres 40/40 steril Pcs 0
30 Kasa Pembalut 2 m x 80 cm Pcs 0
31 kasa pembalut hydrofil 40 cm x 80 cm Pcs 5
Masker 10
32 Tie on dus 0
33 Hijab dus 0
34 masker oksigen pcs 0
35 Plester Pcs 18
36 Plester Polifix 5 cm x 1 m Pcs 8
37 Policrepe Pembalut Elastis 7,5 cm x 4,55 m Roll 5
38 Silk 2/0 + jarum 1/2 GT 35 mm Pcs 0
39 Silk 3/0 + jarum 1/2 GT 35 mm Pcs 1
40 Urine bag Pcs 40
41 pot sampel pcs 0
B DESINFECTAN 0
1 Alkohol 70% - 1000 ml Btl 1
2 Antiseptik Hand Rub 500 ml Btl 1
3 cairan sterilisasi alat btl 0
4 Lisol 1 liter Btl 1
5 Povidon Iodida 300 ml Btl 4
6 Povidon Iodida 30 ml Btl 8
7 Rivanol larutan 0,1% - 300 cc Btl 4
C ADDITIONAL BHP 0
1 Bioplasenton tulle Pcs 0
2 Bisturi No. 11 box 0
3 Catgut Chromic 2/0 + Jatum 1/2 HR 20 mm pcs 1
4 Catgut Chromic 3/0 + Jatum 1/2 HR 20 mm pcs 3
5 Cuticell pcs 100
6 Dental Anastesi Citoject box 0
7 Handscoon Obgyn pairs 0
8 IV Catheter - G -24 pcs 150
9 IV Catheter G-26 PCS 0
10 kapas gigi pack 0
11 Kassa hydrofil 3 yard x 10 cm pack 5
12 Kassa hydrofil 3 yard x 15 cm pack 0
13 Kassa hydrofil 40 yard x 80 cm roll 0
14 Lidi Waten Steril box 0
15 masker karet box 0
16 Microfor box 0
17 Polifix 10 cm x 5 m roll 0
18 Polifix 5 cm x 5 m roll 2
19 Pot Sputum Steril pcs 0
20 Povidone Iodida 60 ml Btl 0
21 SD Bioline HCG pcs 0
22 SD Urocolor For Urinalysis pcs 0
23 Silk 4/0 DS 12 mm pcs 0
24 Silk 4/0 DS 19 mm pcs 0
25 Silk 4/0 HR 20 mm pcs 0
26 Silk 5/0 DS 16 mm pcs 0
27 Umbilical Cord Clamps pcs 0

Mengetahui,
Pimpinan UPTD Puskesmas Cikidang
Kabupaten Sukabumi

Asep Gumelar, SKM., M.Si.

AR PERMINTAAN OBAT (LPLPO)
BULAN APRIL
TAHUN 2021

PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

1 1
0 0
0 0
0 0
0 0
0 0
0 0
1 1
0 0
5 5
3 3
35 35
40 40
0 0
0 0
0 0
0 0
0 0
200 200
400 400
50 50
50 50
0 0
50 50
500 500
0 0
10 10
0 0
0 0
0 0
0 0
200 200
100 100
0 0
 0 0
200 200
0 0
0 0
0 0
5 5
0 0
0 0
80 80
0 0
300 300
100 100
3 3
2 2
0 0
10 10
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
50 50
0 0
100 100
0 0
0 0
0 0
0 0
0 0
50 50
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 200
0 0
0 0
0 0
0 0
400 400
0 0
0 0
0 0
0 0
0 0
0 0
0 0
80 80
0 0
200 200
0 0
0 0
0 0
0 0
0 0
200 200
30 30
0 0
200 200
0 0
800 800
100 100
300 300
0 0
0 0
0 0
100 100
200 200
0 0
400 400
1000 1000
0 0
0 0
0 0
0 0
500 500
0 0
120 120
300 300
 0 0
100 100
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
1 1
0 0
2 2
15 15
2 2
0 0
0 0
0 0
9 9
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
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
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
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
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
90 90
200 200
0 0
0 0
4 4
0 0
0 0
0 0
2 2
0 0
1 1
20 20
20 20
0 0
9 9
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5 5
20 20
0 0
350 350
650 650
0 0
40 40
0 0
0 0
 5 5
10 10
0 0
0 0
0 0
18 18
8 8
5 5
0 0
1 1
40 40
0 0
0 0
1 1
1 1
0 0
1 1
4 4
8 8
4 4
0 0
0 0
0 0
1 1
3 3
100 100
0 0
0 0
150 150
0 0
0 0
5 5
0 0
0 0
0 0
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

Cikidang,
Penanggung Jawab

…………………………………….
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN
PUSKESMAS CIKIDANG
KECAMATAN CIKIDANG
ALAMAT JALAN RAYA CIKIDANG KM 19
NAMA OBAT/SEDIAAN SEDIAAN
NO STOK AWAL PENERIMAAN

A SERUM
1 ABU ampul 1
2 ATS ampul 0
B BHP GIGI 0
1 Temporary filling materail pcs 0
2 Glass Ionomer Cement kit A3 pcs 0
3 Coat bond pcs 0
4 Brilliant NG pcs 0
5 Eugenol botol 1
C CAIRAN 0
1 Air untuk injeksi (Aqua pro injeksi) 20 ml Botol 5
2 Glukosa Larutan infus 5% steril 500 ml Botol 3
3 Natrium Klorida lart.infus 0,9% steril - 500 ml Botol 35
4 Ringer Laktat larutan infus steril - 500 ml Botol 40
D OBAT 0
1 Allupurinol 100 mg Tablet Tab 0
2 Aminofillin inj 24 mg /ml-10ml ampul 0
3 Aminophylin tablet 200mg Tab 0
4 Amitriptilin HCl tablet salut 25 mg Tab 0
5 Amlodipin 10 mg Tab 200
6 Amoksisilin Kaplet 500 mg Kaplet 400
7 Amoksisilin Kapsul 250 mg Kapsul 50
8 Amoksisilin sirup kering 125 mg/5 ml Botol 50
9 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 0
10 Antasida Suspensi 60 ml Botol 50
11 Antasida DOEN tablet kombinasi Tab 500
12 Anti fungi DOEN komb sk tube 0
13 Anti Hemoroid DOEN kombinasi supp 10
14 Antimigren DOEN kombinasi Tab 0
15 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab 0
16 Asam Askorbat (Vit.C) tablet 50 mg Tab 0
17 Asam folat tablet 0.4 mg Tab 0
18 Asam mefenamat 500 mg Kaplet 200
19 Asetyl sestein 200mg kapsul 100
20 Asiklovir Tablet 400 mg Tab 0
21 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml ampul 0
22 Attalpugite tab 600 mg Tab 200
23 Benzatin Benzil Penisilin inj.1.2 juta IU/vial ampul 0
24 Betahistin maleat Tab 0
25 Betametasone Krim 0.1% tube 0
26 Bisakodil Supp 10 mg supp 5
27 Bisoprolol tablet tablet 0
28 Captopril 12,5 mg Tab 0
29 Captopril tablet 25 mg Tab 80
30 Deksametason injeksi 5 mg/ml - 1 ml ampul 0
31 Deksametasone tablet 0.5mg Tab 300
32 Diasepam 2 mg tablet Tab 100
33 Diazepam Inj 5 ml/2ml ampul 3
34 Diazepam lar rektal 5mg/2,5ml tube 2
35 Dietilkarbamazin sitrat tablet 100 mg Tab 0
36 Difenhidramin HCl injeksi 10 mg/ml - 1 ml ampul 10
37 Digoksin tablet 0,25 mg Tab 0
38 Doksisiklin 100 mg ampul 0
39 Domperidon tablet 10 mg Tab 0
40 Epinefrina (adrenalin) injeksi 0,1% - 1 ml ampul 2
41 Erytromycin 250 mg Kapsul 0
42 Etambutol HCL 250 mg Tab 0
43 Fenitoin Na kaps 100 mg Kapsul 0
44 Fenobarbital injeksi 50 mg/ml - 2 ml ampul 0
45 Fenobarbital tablet 30 mg Tab 0
46 Fenofibrat kaps 100 mg Kapsul 0
47 Fenoksimetil Penisilina tablet 500 mg Tab 0
48 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 0
49 Furosemid tablet 40 mg Tab 50
50 Gentamisin tetes mata Botol 0
51 Glibenklamid tablet 5 mg Tab 100
52 Glimepiride tab 0
53 Griseofulvin tablet 125 mg, micronized Tab 0
54 Hidroklorotiazid (HCT) tablet 25 mg Tab 0
55 Hidrokortison krim 2,5 % tube 0
56 Ibuprofen Suspensi 100mg 5ml botol 0
57 Ibuprofen tablet 400 mg Tab 50
58 Isoniazid tablet 300 mg Tab 0
59 Isosorbid Dinitrat 5 mg tablet sublingual Tab 0
60 Kalsium Glukonat Inj 100 mg/ml ampul 0
61 Kalsium lakate (kalk) tablet Tab 0
62 Karbamazepin tablet 200 mg Tab 0
63 Karbogliserin Tetes Telinga 10% Botol 0
64 Ketokonazol krim 2 % tube 0
65 Ketokonazol Tablet 200 mg Tab 0
 66 Klindamicin 150 mg Kapsul 200
67 Klopidogrel tab 75 mg Tab 0
68 Kloramfenikol Kapsul 500 mg Kapsul 0
69 Kloramfenikol salep kulit 2% (bufacetin) tube 0
70 Kloramfenikol Salep Mata 1% - 3,5 gr Botol 0
71 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 400
72 Klorpromazin HCL tablet 25 mg Tab 0
73 Klorpromazin inj. 25 mg/ml ampul 0
74 Kodein HCl tablet 10 mg Tab 0
75 Kotrimoksazol forte tablet Tab 0
76 Kotrimoksazol 480 tablet tab 0
77 Kotrimoksazol suspensi kombinasi Botol 0
78 Lansoprazol 30 mg Tab 0
79 Lidokain inj. 2% ampul 80
80 Lidokain komp. injeksi kombinasi ampul 0
81 Loratadin tab 10 mg Tab 200
82 Mebendazol tablet 0
83 Metformin tablet 500 mg Tab 0
84 metil dopa tab 250 mg Tab 0
85 Metilergometrin Maleat injeksi 0,200 mg - 1ml ampul 0
86 Metilergometrin Maleat tablet salut 0,125 mg Tab 0
87 Metilprednisolon tablet 4 mg Tab 200
88 Metoklorpropamid tablet 10 mg Tab 30
89 Metronidazol sirup 125mg/5ml Botol 0
90 Metronidazol tablet 500 mg Tab 200
91 Miconazol SK tube 0
92 Natrium bikarbonat tablet 500 mg Tab 800
93 Natrium Diklofenac 50 mg Tab 100
94 Nifedifin tablet 30 mg Tab 300
95 Nistatin 100.000 IU/gram tablet vaginal supp 0
96 Nistatin tablet salut gula 500.000 IU/g Tab 0
97 Oksitetrasiklin HCl salep 3% - 5 gram tube 0
98 Omeprazol 20 mg Tab 100
99 Ondansentron tab 8 mg Tab 200
100 parasetamol drop Botol 0
101 Parasetamol Kaplet 500 mg Tab 400
102 Parasetamol sirup Botol 1000
103 Permetrin/scabimite krim 5 % tube 0
104 Pirantel Pamoat tablet 125 mg Tab 0
105 Pirazinamid tablet 500 mg Tab 0
106 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 0
107 Prednison tablet 5 mg Tab 500
108 Propranolol HCl tablet 40 mg Tab 0
109 Ranitidin Injeksi 25 mg/ml ampul 120
110 Ranitidin tablet 150 mg Tab 300
 111 Rifampisin Kapsul 600 mg Kapsul 0
112 Salbutamol tablet 2 mg Tab 100
113 Salep 2 - 4 kombinasi tube 0
114 Setirizin sir 5 mg/ 5 ml Botol 0
115 Sianokobalamin (Vitamin B12) 50 mg Tab 0
116 Simvastatin 20 mg Tab 0
117 Teofilin tab 150 mg Tab 0
118 Tetrasiklin HCl Kapsul 500 mg Kapsul 0
119 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 0
120 Vitamin B komplek tablet Tab 0
121 Terbutaline sulfat ih 2.5 mg/ml ampul 0
122 Budesonid ih .5 mg/ml ampul 0
E ADDITIONAL OBAT 0
124 Amlodipin 5 mg tab 0
125 Amoxicillin 100 mg/ml drops botol 0
126 Asam Traneksamat Injeksi Ampul 0
127 Asiclovir 200 mg Tab 0
128 Asiclovir krim Tube 0
129 Bisakodil Tablet Tab 0
130 Ciprofloksasin 500 mg tablet Tab 0
131 Domperidon Sirup Btl 0
132 Furosemid Injeksi Ampul 0
133 Guaifenesin tab Tab 0
134 Kloramfenikol Tetes telinga botol 0
135 Multivitamin Dewasa Tab 0
137 Multivitamin Sirup Tab 0
136 Obat Batuk Hitam Tube 1
138 Oksitosin injeksi ampul 0
139 Ondansentron injeksi Ampul 2
140 Salbutamol inhaler ampul 15
141 Sefadroksil Kapsul 500 mg KAPSUL 2
142 Sefadroksil syrup 125 mg Botol 0
143 Sefadroksil Syrup 250 mg BOTOL 0
144 Setirizin Tab Tab 0
145 Sulfadiazine silver krim (Luka Bakar) Tube 9
OBAT PROGRAM 0
A MALARIA 0
1 Artesunate injeksi, vial 60 mg vial 0
2 Primakuin tablet 15 mg tablet 0
3 Kina tablet 200 mg tablet 0
4 Kina injeksi 25% - 2 ml ampul 0
5 Doksisiklin kapsul 100 mg kapsul 0
6 DHP (Dehidro Artemisin + Piperaquin) Tablet tablet 0
0
B FILARIASIS 0
1 DEC tablet 100 mg tablet 0
2 Albendazol tablet 400 mg tablet 0
3 Albendazol Sirup 200 mg/5 ml botol 0
0
C PENGENDALIAN PENYAKIT MENULAR (P2M) 0
1. DIARE 0
1 Garam oralit kantong 0
2 Zinc tablet 20 mg tablet 0
3 zink sirup botol 0
2. KUSTA 0
1 Prednison tablet 5 mg tablet 0
3. FRAMBUSIA 0
1 Azithromycin 500 mg tablet 0
0
D TB PARU (OAT FDC) 0
OAT FDC 0
1 Obat Anti Tuberculosis FDC kategori 1 paket 0
2 Obat Anti Tuberculosis FDC kategori 2 paket 0
3 Obat Anti Tuberculosis FDC anak paket 0
0
F AIDS PMS 0
1 Efavirenz tab 600 mg tablet 0
2 Lopinavir 200 mg + Ritonavir 50 mg tablet 0
3 Lopinavir 100 mg + Ritonavir 25 mg tablet 0
4 Nevirapin 200 mg tablet 0
5 Tenofovir tab 300 mg tablet 0
6 Zidovudin Kaps 100 mg kapsul 0
7 Lamivudin tab 150 mg tablet 0
8 Kombinasi Zidovudin 300 mg + Lamivudin 150 mg tablet 0
9 Efavirenz tab 200 mg tablet 0
10 Abacavir kaps 300 mg tablet 0
11 Tenofovir 300 mg + Emiricitabine 200 mg Tab tablet 0
12 Zidovudin 60 mg +Lamivudine 30 mg + Nevirapine 50 tablet 0
13 Tenofovir 300 mg + Lamivudin 300 mg + Efivirenz 60 tablet 0
14 Rilpivirine Tab 25 mg tablet 0
15 Zidovudine Syr 10 mg/ml botol 0
0
G KESEHATAN JIWA 0
1 Haloperidol dekanoat inj 50 mg/ml ampul 0
2 Klobazam 10 mg tablet tablet 0
3 Amitripilin HCL 25 mg tablet tablet 0
4 Klorpromazin 100 mg tablet tablet 0
5 Risperidon 2 mg Tablet tablet 0
 6 Klozapin 25 mg tablet tablet 0
7 Trifluoperazine HCL 5 mg tablet tablet 0
8 Haloperidol inj 5 mg/ml ampul 0
9 Imipramin HCL 25 mg tablet tablet 0
10 Fluoksetin 10 mg tablet tablet 0
11 Triheksifenidil 2 mg tab tablet 0
12 Haloperidol 5 mg tablet tablet 0
0
H VAKSIN RABIES 0
1 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster 0
2 Serum antirabies inj 200 UI/ml 0
0
I GIZI 0
1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul 0
2 Bayi (6 -(Vitamin
Retinol 11 bulan)
A) 200.000 IU Kapsul Lunak kapsul 0
3 Balita (11 - 59 bulan)
Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul 0
4 Ibu Nifas
Tablet Tambah Darah (Ibu Hamil) tablet 0
5 Tablet Tambah Darah (Remaja Putri) tablet 0
6 Mineral Mix sachet 0
0
J KESEHATAN IBU 0
1 Oksitosin Injeksi 10 IU/ml ampul 0
2 Metil Ergometrin Maleat injeksi 0,2 mg/ml ampul 0
3 Magnesium Sulfat Injeksi 40% ampul 0
4 Kalsium Glukonat Injeksi 10% ampul 0
5 Ampisilin Injeksi 1000 mg/vial vial 0
6 Gentamisin Injesi 40 mg/ml ampul 0
7 Metronidazol infus 5 mg/ml botol 0
0
K KESEHATAN ANAK 0
1 Fitomenadion (vit K1) injeksi 2 mg/ml ampul 0
2 Levotiroksin 50 mcg tablet 0
3 Oksitetrasiklin HCL Salep mata 1% tube 0
4 Ampicilin serb injeksi 1000 ml/vial ampul 0
5 Gentamisin injeksi 40 mg/ml ampul 0
6 Fenobarbital injeksi 50 mg/ml ampul 0
7 Diazepam injeksi 5 mg/ml ampul 0
0
L LANSIA 0
1 Risedronat kapsul 0
0
M IMUNISASI 0
1 Vaksin Hepatitis B vial 0
2 Vaksin BCG vial 0
 3 Vaksin Polio 10 ds vial 0
4 Vaksin DT vial 0
5 Vaksin Td vial 0
6 (Kelas
Vaksin2Td
SD) vial 0
7 (WUS)
Vaksin IPV vial 0
8 Vaksin DPT-HB-Hib vial 0
9 (Bayi)
Vaksin DPT-HB-Hib vial 0
10 (Baduta)
Vaksin MR vial 0
11 (Bayi)
Vaksin MR vial 0
12 (Baduta)
Vaksin HPV vial 0
13 Vaksin Pneumokokkus vial 0
14 Vaksin JE vial 0
A BMHP 0
1 Alat suntik sekali pakai 1 ml Pcs 90
2 Alat suntik sekali pakai 3 ml Pcs 200
3 Alat suntik sekali pakai 5 ml Pcs 0
4 alat suntik sekali pakai 10 ml pcs 0
5 Alkohol Swab box 4
6 autodisable no 0,05 ml Pcs 0
7 autodisable no. 0,5 ml Pcs 0
8 bloodset Pcs 0
9 Catgut Chromic 2/0 + jarum 1/2 HR 26 mm Pcs 2
10 Catgut Chromic 3/0 + jarum 1/2 HR 26 mm Pcs 0
11 ECG/USG jelly 82gr Pcs 1
12 Folley Catheter 2 way no 16 Pcs 20
13 Folley Catheter 2 way no 18 Pcs 20
Handscoon Non Steril 0
14 Ukuran L Pcs 9
15 Ukuran M Pcs 0
16 Ukuran S Pcs 0
Handscoon steril 0
17 Ukuran 6.5 Pcs 0
18 Ukuran 7.0 Pcs 0
19 Ukuran 7.5 Pcs 0
20 ID Patient Adult/Dewasa Biru Pcs 0
21 ID Patient Adult/Dewasa Pink Pcs 0
22 Infusion set anak Pcs 5
23 Infusion set dewasa Pcs 20
24 IV Catheter G - 18 Pcs 0
25 IV Catheter G - 20 Pcs 350
26 IV Catheter G - 22 Pcs 650
27 Kapas 250 gr Pcs 0
28 Kasa hidrofil 16x16 (steril) box 40
29 Kasa Kompres 40/40 steril Pcs 0
30 Kasa Pembalut 2 m x 80 cm Pcs 0
31 kasa pembalut hydrofil 40 cm x 80 cm Pcs 5
Masker 10
32 Tie on dus 0
33 Hijab dus 0
34 masker oksigen pcs 0
35 Plester Pcs 18
36 Plester Polifix 5 cm x 1 m Pcs 8
37 Policrepe Pembalut Elastis 7,5 cm x 4,55 m Roll 5
38 Silk 2/0 + jarum 1/2 GT 35 mm Pcs 0
39 Silk 3/0 + jarum 1/2 GT 35 mm Pcs 1
40 Urine bag Pcs 40
41 pot sampel pcs 0
B DESINFECTAN 0
1 Alkohol 70% - 1000 ml Btl 1
2 Antiseptik Hand Rub 500 ml Btl 1
3 cairan sterilisasi alat btl 0
4 Lisol 1 liter Btl 1
5 Povidon Iodida 300 ml Btl 4
6 Povidon Iodida 30 ml Btl 8
7 Rivanol larutan 0,1% - 300 cc Btl 4
C ADDITIONAL BHP 0
1 Bioplasenton tulle Pcs 0
2 Bisturi No. 11 box 0
3 Catgut Chromic 2/0 + Jatum 1/2 HR 20 mm pcs 1
4 Catgut Chromic 3/0 + Jatum 1/2 HR 20 mm pcs 3
5 Cuticell pcs 100
6 Dental Anastesi Citoject box 0
7 Handscoon Obgyn pairs 0
8 IV Catheter - G -24 pcs 150
9 IV Catheter G-26 PCS 0
10 kapas gigi pack 0
11 Kassa hydrofil 3 yard x 10 cm pack 5
12 Kassa hydrofil 3 yard x 15 cm pack 0
13 Kassa hydrofil 40 yard x 80 cm roll 0
14 Lidi Waten Steril box 0
15 masker karet box 0
16 Microfor box 0
17 Polifix 10 cm x 5 m roll 0
18 Polifix 5 cm x 5 m roll 2
19 Pot Sputum Steril pcs 0
20 Povidone Iodida 60 ml Btl 0
21 SD Bioline HCG pcs 0
22 SD Urocolor For Urinalysis pcs 0
23 Silk 4/0 DS 12 mm pcs 0
24 Silk 4/0 DS 19 mm pcs 0
25 Silk 4/0 HR 20 mm pcs 0
26 Silk 5/0 DS 16 mm pcs 0
27 Umbilical Cord Clamps pcs 0

Mengetahui,
Pimpinan UPTD Puskesmas Cikidang
Kabupaten Sukabumi

Asep Gumelar, SKM., M.Si.

AR PERMINTAAN OBAT (LPLPO)
BULAN MEI
TAHUN 2021

PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

1 1
0 0
0 0
0 0
0 0
0 0
0 0
1 1
0 0
5 5
3 3
35 35
40 40
0 0
0 0
0 0
0 0
0 0
200 200
400 400
50 50
50 50
0 0
50 50
500 500
0 0
10 10
0 0
0 0
0 0
0 0
200 200
100 100
0 0
 0 0
200 200
0 0
0 0
0 0
5 5
0 0
0 0
80 80
0 0
300 300
100 100
3 3
2 2
0 0
10 10
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
50 50
0 0
100 100
0 0
0 0
0 0
0 0
0 0
50 50
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 200
0 0
0 0
0 0
0 0
400 400
0 0
0 0
0 0
0 0
0 0
0 0
0 0
80 80
0 0
200 200
0 0
0 0
0 0
0 0
0 0
200 200
30 30
0 0
200 200
0 0
800 800
100 100
300 300
0 0
0 0
0 0
100 100
200 200
0 0
400 400
1000 1000
0 0
0 0
0 0
0 0
500 500
0 0
120 120
300 300
 0 0
100 100
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
1 1
0 0
2 2
15 15
2 2
0 0
0 0
0 0
9 9
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
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
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
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
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
90 90
200 200
0 0
0 0
4 4
0 0
0 0
0 0
2 2
0 0
1 1
20 20
20 20
0 0
9 9
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5 5
20 20
0 0
350 350
650 650
0 0
40 40
0 0
0 0
 5 5
10 10
0 0
0 0
0 0
18 18
8 8
5 5
0 0
1 1
40 40
0 0
0 0
1 1
1 1
0 0
1 1
4 4
8 8
4 4
0 0
0 0
0 0
1 1
3 3
100 100
0 0
0 0
150 150
0 0
0 0
5 5
0 0
0 0
0 0
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

Cikidang,
Penanggung Jawab

…………………………………….
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN
PUSKESMAS CIKIDANG
KECAMATAN CIKIDANG
ALAMAT JALAN RAYA CIKIDANG KM 19
NAMA OBAT/SEDIAAN SEDIAAN
NO STOK AWAL PENERIMAAN

A SERUM
1 ABU ampul 1
2 ATS ampul 0
B BHP GIGI 0
1 Temporary filling materail pcs 0
2 Glass Ionomer Cement kit A3 pcs 0
3 Coat bond pcs 0
4 Brilliant NG pcs 0
5 Eugenol botol 1
C CAIRAN 0
1 Air untuk injeksi (Aqua pro injeksi) 20 ml Botol 5
2 Glukosa Larutan infus 5% steril 500 ml Botol 3
3 Natrium Klorida lart.infus 0,9% steril - 500 ml Botol 35
4 Ringer Laktat larutan infus steril - 500 ml Botol 40
D OBAT 0
1 Allupurinol 100 mg Tablet Tab 0
2 Aminofillin inj 24 mg /ml-10ml ampul 0
3 Aminophylin tablet 200mg Tab 0
4 Amitriptilin HCl tablet salut 25 mg Tab 0
5 Amlodipin 10 mg Tab 200
6 Amoksisilin Kaplet 500 mg Kaplet 400
7 Amoksisilin Kapsul 250 mg Kapsul 50
8 Amoksisilin sirup kering 125 mg/5 ml Botol 50
9 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 0
10 Antasida Suspensi 60 ml Botol 50
11 Antasida DOEN tablet kombinasi Tab 500
12 Anti fungi DOEN komb sk tube 0
13 Anti Hemoroid DOEN kombinasi supp 10
14 Antimigren DOEN kombinasi Tab 0
15 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab 0
16 Asam Askorbat (Vit.C) tablet 50 mg Tab 0
17 Asam folat tablet 0.4 mg Tab 0
18 Asam mefenamat 500 mg Kaplet 200
19 Asetyl sestein 200mg kapsul 100
20 Asiklovir Tablet 400 mg Tab 0
21 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml ampul 0
22 Attalpugite tab 600 mg Tab 200
23 Benzatin Benzil Penisilin inj.1.2 juta IU/vial ampul 0
24 Betahistin maleat Tab 0
25 Betametasone Krim 0.1% tube 0
26 Bisakodil Supp 10 mg supp 5
27 Bisoprolol tablet tablet 0
28 Captopril 12,5 mg Tab 0
29 Captopril tablet 25 mg Tab 80
30 Deksametason injeksi 5 mg/ml - 1 ml ampul 0
31 Deksametasone tablet 0.5mg Tab 300
32 Diasepam 2 mg tablet Tab 100
33 Diazepam Inj 5 ml/2ml ampul 3
34 Diazepam lar rektal 5mg/2,5ml tube 2
35 Dietilkarbamazin sitrat tablet 100 mg Tab 0
36 Difenhidramin HCl injeksi 10 mg/ml - 1 ml ampul 10
37 Digoksin tablet 0,25 mg Tab 0
38 Doksisiklin 100 mg ampul 0
39 Domperidon tablet 10 mg Tab 0
40 Epinefrina (adrenalin) injeksi 0,1% - 1 ml ampul 2
41 Erytromycin 250 mg Kapsul 0
42 Etambutol HCL 250 mg Tab 0
43 Fenitoin Na kaps 100 mg Kapsul 0
44 Fenobarbital injeksi 50 mg/ml - 2 ml ampul 0
45 Fenobarbital tablet 30 mg Tab 0
46 Fenofibrat kaps 100 mg Kapsul 0
47 Fenoksimetil Penisilina tablet 500 mg Tab 0
48 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 0
49 Furosemid tablet 40 mg Tab 50
50 Gentamisin tetes mata Botol 0
51 Glibenklamid tablet 5 mg Tab 100
52 Glimepiride tab 0
53 Griseofulvin tablet 125 mg, micronized Tab 0
54 Hidroklorotiazid (HCT) tablet 25 mg Tab 0
55 Hidrokortison krim 2,5 % tube 0
56 Ibuprofen Suspensi 100mg 5ml botol 0
57 Ibuprofen tablet 400 mg Tab 50
58 Isoniazid tablet 300 mg Tab 0
59 Isosorbid Dinitrat 5 mg tablet sublingual Tab 0
60 Kalsium Glukonat Inj 100 mg/ml ampul 0
61 Kalsium lakate (kalk) tablet Tab 0
62 Karbamazepin tablet 200 mg Tab 0
63 Karbogliserin Tetes Telinga 10% Botol 0
64 Ketokonazol krim 2 % tube 0
65 Ketokonazol Tablet 200 mg Tab 0
 66 Klindamicin 150 mg Kapsul 200
67 Klopidogrel tab 75 mg Tab 0
68 Kloramfenikol Kapsul 500 mg Kapsul 0
69 Kloramfenikol salep kulit 2% (bufacetin) tube 0
70 Kloramfenikol Salep Mata 1% - 3,5 gr Botol 0
71 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 400
72 Klorpromazin HCL tablet 25 mg Tab 0
73 Klorpromazin inj. 25 mg/ml ampul 0
74 Kodein HCl tablet 10 mg Tab 0
75 Kotrimoksazol forte tablet Tab 0
76 Kotrimoksazol 480 tablet tab 0
77 Kotrimoksazol suspensi kombinasi Botol 0
78 Lansoprazol 30 mg Tab 0
79 Lidokain inj. 2% ampul 80
80 Lidokain komp. injeksi kombinasi ampul 0
81 Loratadin tab 10 mg Tab 200
82 Mebendazol tablet 0
83 Metformin tablet 500 mg Tab 0
84 metil dopa tab 250 mg Tab 0
85 Metilergometrin Maleat injeksi 0,200 mg - 1ml ampul 0
86 Metilergometrin Maleat tablet salut 0,125 mg Tab 0
87 Metilprednisolon tablet 4 mg Tab 200
88 Metoklorpropamid tablet 10 mg Tab 30
89 Metronidazol sirup 125mg/5ml Botol 0
90 Metronidazol tablet 500 mg Tab 200
91 Miconazol SK tube 0
92 Natrium bikarbonat tablet 500 mg Tab 800
93 Natrium Diklofenac 50 mg Tab 100
94 Nifedifin tablet 30 mg Tab 300
95 Nistatin 100.000 IU/gram tablet vaginal supp 0
96 Nistatin tablet salut gula 500.000 IU/g Tab 0
97 Oksitetrasiklin HCl salep 3% - 5 gram tube 0
98 Omeprazol 20 mg Tab 100
99 Ondansentron tab 8 mg Tab 200
100 parasetamol drop Botol 0
101 Parasetamol Kaplet 500 mg Tab 400
102 Parasetamol sirup Botol 1000
103 Permetrin/scabimite krim 5 % tube 0
104 Pirantel Pamoat tablet 125 mg Tab 0
105 Pirazinamid tablet 500 mg Tab 0
106 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 0
107 Prednison tablet 5 mg Tab 500
108 Propranolol HCl tablet 40 mg Tab 0
109 Ranitidin Injeksi 25 mg/ml ampul 120
110 Ranitidin tablet 150 mg Tab 300
 111 Rifampisin Kapsul 600 mg Kapsul 0
112 Salbutamol tablet 2 mg Tab 100
113 Salep 2 - 4 kombinasi tube 0
114 Setirizin sir 5 mg/ 5 ml Botol 0
115 Sianokobalamin (Vitamin B12) 50 mg Tab 0
116 Simvastatin 20 mg Tab 0
117 Teofilin tab 150 mg Tab 0
118 Tetrasiklin HCl Kapsul 500 mg Kapsul 0
119 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 0
120 Vitamin B komplek tablet Tab 0
121 Terbutaline sulfat ih 2.5 mg/ml ampul 0
122 Budesonid ih .5 mg/ml ampul 0
E ADDITIONAL OBAT 0
124 Amlodipin 5 mg tab 0
125 Amoxicillin 100 mg/ml drops botol 0
126 Asam Traneksamat Injeksi Ampul 0
127 Asiclovir 200 mg Tab 0
128 Asiclovir krim Tube 0
129 Bisakodil Tablet Tab 0
130 Ciprofloksasin 500 mg tablet Tab 0
131 Domperidon Sirup Btl 0
132 Furosemid Injeksi Ampul 0
133 Guaifenesin tab Tab 0
134 Kloramfenikol Tetes telinga botol 0
135 Multivitamin Dewasa Tab 0
137 Multivitamin Sirup Tab 0
136 Obat Batuk Hitam Tube 1
138 Oksitosin injeksi ampul 0
139 Ondansentron injeksi Ampul 2
140 Salbutamol inhaler ampul 15
141 Sefadroksil Kapsul 500 mg KAPSUL 2
142 Sefadroksil syrup 125 mg Botol 0
143 Sefadroksil Syrup 250 mg BOTOL 0
144 Setirizin Tab Tab 0
145 Sulfadiazine silver krim (Luka Bakar) Tube 9
OBAT PROGRAM 0
A MALARIA 0
1 Artesunate injeksi, vial 60 mg vial 0
2 Primakuin tablet 15 mg tablet 0
3 Kina tablet 200 mg tablet 0
4 Kina injeksi 25% - 2 ml ampul 0
5 Doksisiklin kapsul 100 mg kapsul 0
6 DHP (Dehidro Artemisin + Piperaquin) Tablet tablet 0
0
B FILARIASIS 0
1 DEC tablet 100 mg tablet 0
2 Albendazol tablet 400 mg tablet 0
3 Albendazol Sirup 200 mg/5 ml botol 0
0
C PENGENDALIAN PENYAKIT MENULAR (P2M) 0
1. DIARE 0
1 Garam oralit kantong 0
2 Zinc tablet 20 mg tablet 0
3 zink sirup botol 0
2. KUSTA 0
1 Prednison tablet 5 mg tablet 0
3. FRAMBUSIA 0
1 Azithromycin 500 mg tablet 0
0
D TB PARU (OAT FDC) 0
OAT FDC 0
1 Obat Anti Tuberculosis FDC kategori 1 paket 0
2 Obat Anti Tuberculosis FDC kategori 2 paket 0
3 Obat Anti Tuberculosis FDC anak paket 0
0
F AIDS PMS 0
1 Efavirenz tab 600 mg tablet 0
2 Lopinavir 200 mg + Ritonavir 50 mg tablet 0
3 Lopinavir 100 mg + Ritonavir 25 mg tablet 0
4 Nevirapin 200 mg tablet 0
5 Tenofovir tab 300 mg tablet 0
6 Zidovudin Kaps 100 mg kapsul 0
7 Lamivudin tab 150 mg tablet 0
8 Kombinasi Zidovudin 300 mg + Lamivudin 150 mg tablet 0
9 Efavirenz tab 200 mg tablet 0
10 Abacavir kaps 300 mg tablet 0
11 Tenofovir 300 mg + Emiricitabine 200 mg Tab tablet 0
12 Zidovudin 60 mg +Lamivudine 30 mg + Nevirapine 50 tablet 0
13 Tenofovir 300 mg + Lamivudin 300 mg + Efivirenz 60 tablet 0
14 Rilpivirine Tab 25 mg tablet 0
15 Zidovudine Syr 10 mg/ml botol 0
0
G KESEHATAN JIWA 0
1 Haloperidol dekanoat inj 50 mg/ml ampul 0
2 Klobazam 10 mg tablet tablet 0
3 Amitripilin HCL 25 mg tablet tablet 0
4 Klorpromazin 100 mg tablet tablet 0
5 Risperidon 2 mg Tablet tablet 0
 6 Klozapin 25 mg tablet tablet 0
7 Trifluoperazine HCL 5 mg tablet tablet 0
8 Haloperidol inj 5 mg/ml ampul 0
9 Imipramin HCL 25 mg tablet tablet 0
10 Fluoksetin 10 mg tablet tablet 0
11 Triheksifenidil 2 mg tab tablet 0
12 Haloperidol 5 mg tablet tablet 0
0
H VAKSIN RABIES 0
1 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster 0
2 Serum antirabies inj 200 UI/ml 0
0
I GIZI 0
1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul 0
2 Bayi (6 -(Vitamin
Retinol 11 bulan)
A) 200.000 IU Kapsul Lunak kapsul 0
3 Balita (11 - 59 bulan)
Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul 0
4 Ibu Nifas
Tablet Tambah Darah (Ibu Hamil) tablet 0
5 Tablet Tambah Darah (Remaja Putri) tablet 0
6 Mineral Mix sachet 0
0
J KESEHATAN IBU 0
1 Oksitosin Injeksi 10 IU/ml ampul 0
2 Metil Ergometrin Maleat injeksi 0,2 mg/ml ampul 0
3 Magnesium Sulfat Injeksi 40% ampul 0
4 Kalsium Glukonat Injeksi 10% ampul 0
5 Ampisilin Injeksi 1000 mg/vial vial 0
6 Gentamisin Injesi 40 mg/ml ampul 0
7 Metronidazol infus 5 mg/ml botol 0
0
K KESEHATAN ANAK 0
1 Fitomenadion (vit K1) injeksi 2 mg/ml ampul 0
2 Levotiroksin 50 mcg tablet 0
3 Oksitetrasiklin HCL Salep mata 1% tube 0
4 Ampicilin serb injeksi 1000 ml/vial ampul 0
5 Gentamisin injeksi 40 mg/ml ampul 0
6 Fenobarbital injeksi 50 mg/ml ampul 0
7 Diazepam injeksi 5 mg/ml ampul 0
0
L LANSIA 0
1 Risedronat kapsul 0
0
M IMUNISASI 0
1 Vaksin Hepatitis B vial 0
2 Vaksin BCG vial 0
 3 Vaksin Polio 10 ds vial 0
4 Vaksin DT vial 0
5 Vaksin Td vial 0
6 (Kelas
Vaksin2Td
SD) vial 0
7 (WUS)
Vaksin IPV vial 0
8 Vaksin DPT-HB-Hib vial 0
9 (Bayi)
Vaksin DPT-HB-Hib vial 0
10 (Baduta)
Vaksin MR vial 0
11 (Bayi)
Vaksin MR vial 0
12 (Baduta)
Vaksin HPV vial 0
13 Vaksin Pneumokokkus vial 0
14 Vaksin JE vial 0
A BMHP 0
1 Alat suntik sekali pakai 1 ml Pcs 90
2 Alat suntik sekali pakai 3 ml Pcs 200
3 Alat suntik sekali pakai 5 ml Pcs 0
4 alat suntik sekali pakai 10 ml pcs 0
5 Alkohol Swab box 4
6 autodisable no 0,05 ml Pcs 0
7 autodisable no. 0,5 ml Pcs 0
8 bloodset Pcs 0
9 Catgut Chromic 2/0 + jarum 1/2 HR 26 mm Pcs 2
10 Catgut Chromic 3/0 + jarum 1/2 HR 26 mm Pcs 0
11 ECG/USG jelly 82gr Pcs 1
12 Folley Catheter 2 way no 16 Pcs 20
13 Folley Catheter 2 way no 18 Pcs 20
Handscoon Non Steril 0
14 Ukuran L Pcs 9
15 Ukuran M Pcs 0
16 Ukuran S Pcs 0
Handscoon steril 0
17 Ukuran 6.5 Pcs 0
18 Ukuran 7.0 Pcs 0
19 Ukuran 7.5 Pcs 0
20 ID Patient Adult/Dewasa Biru Pcs 0
21 ID Patient Adult/Dewasa Pink Pcs 0
22 Infusion set anak Pcs 5
23 Infusion set dewasa Pcs 20
24 IV Catheter G - 18 Pcs 0
25 IV Catheter G - 20 Pcs 350
26 IV Catheter G - 22 Pcs 650
27 Kapas 250 gr Pcs 0
28 Kasa hidrofil 16x16 (steril) box 40
29 Kasa Kompres 40/40 steril Pcs 0
30 Kasa Pembalut 2 m x 80 cm Pcs 0
31 kasa pembalut hydrofil 40 cm x 80 cm Pcs 5
Masker 10
32 Tie on dus 0
33 Hijab dus 0
34 masker oksigen pcs 0
35 Plester Pcs 18
36 Plester Polifix 5 cm x 1 m Pcs 8
37 Policrepe Pembalut Elastis 7,5 cm x 4,55 m Roll 5
38 Silk 2/0 + jarum 1/2 GT 35 mm Pcs 0
39 Silk 3/0 + jarum 1/2 GT 35 mm Pcs 1
40 Urine bag Pcs 40
41 pot sampel pcs 0
B DESINFECTAN 0
1 Alkohol 70% - 1000 ml Btl 1
2 Antiseptik Hand Rub 500 ml Btl 1
3 cairan sterilisasi alat btl 0
4 Lisol 1 liter Btl 1
5 Povidon Iodida 300 ml Btl 4
6 Povidon Iodida 30 ml Btl 8
7 Rivanol larutan 0,1% - 300 cc Btl 4
C ADDITIONAL BHP 0
1 Bioplasenton tulle Pcs 0
2 Bisturi No. 11 box 0
3 Catgut Chromic 2/0 + Jatum 1/2 HR 20 mm pcs 1
4 Catgut Chromic 3/0 + Jatum 1/2 HR 20 mm pcs 3
5 Cuticell pcs 100
6 Dental Anastesi Citoject box 0
7 Handscoon Obgyn pairs 0
8 IV Catheter - G -24 pcs 150
9 IV Catheter G-26 PCS 0
10 kapas gigi pack 0
11 Kassa hydrofil 3 yard x 10 cm pack 5
12 Kassa hydrofil 3 yard x 15 cm pack 0
13 Kassa hydrofil 40 yard x 80 cm roll 0
14 Lidi Waten Steril box 0
15 masker karet box 0
16 Microfor box 0
17 Polifix 10 cm x 5 m roll 0
18 Polifix 5 cm x 5 m roll 2
19 Pot Sputum Steril pcs 0
20 Povidone Iodida 60 ml Btl 0
21 SD Bioline HCG pcs 0
22 SD Urocolor For Urinalysis pcs 0
23 Silk 4/0 DS 12 mm pcs 0
24 Silk 4/0 DS 19 mm pcs 0
25 Silk 4/0 HR 20 mm pcs 0
26 Silk 5/0 DS 16 mm pcs 0
27 Umbilical Cord Clamps pcs 0

Mengetahui,
Pimpinan UPTD Puskesmas Cikidang
Kabupaten Sukabumi

Asep Gumelar, SKM., M.Si.

AR PERMINTAAN OBAT (LPLPO)
BULAN JUNI
TAHUN 2021

PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

1 1
0 0
0 0
0 0
0 0
0 0
0 0
1 1
0 0
5 5
3 3
35 35
40 40
0 0
0 0
0 0
0 0
0 0
200 200
400 400
50 50
50 50
0 0
50 50
500 500
0 0
10 10
0 0
0 0
0 0
0 0
200 200
100 100
0 0
 0 0
200 200
0 0
0 0
0 0
5 5
0 0
0 0
80 80
0 0
300 300
100 100
3 3
2 2
0 0
10 10
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
50 50
0 0
100 100
0 0
0 0
0 0
0 0
0 0
50 50
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 200
0 0
0 0
0 0
0 0
400 400
0 0
0 0
0 0
0 0
0 0
0 0
0 0
80 80
0 0
200 200
0 0
0 0
0 0
0 0
0 0
200 200
30 30
0 0
200 200
0 0
800 800
100 100
300 300
0 0
0 0
0 0
100 100
200 200
0 0
400 400
1000 1000
0 0
0 0
0 0
0 0
500 500
0 0
120 120
300 300
 0 0
100 100
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
1 1
0 0
2 2
15 15
2 2
0 0
0 0
0 0
9 9
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
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
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
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
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
90 90
200 200
0 0
0 0
4 4
0 0
0 0
0 0
2 2
0 0
1 1
20 20
20 20
0 0
9 9
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5 5
20 20
0 0
350 350
650 650
0 0
40 40
0 0
0 0
 5 5
10 10
0 0
0 0
0 0
18 18
8 8
5 5
0 0
1 1
40 40
0 0
0 0
1 1
1 1
0 0
1 1
4 4
8 8
4 4
0 0
0 0
0 0
1 1
3 3
100 100
0 0
0 0
150 150
0 0
0 0
5 5
0 0
0 0
0 0
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

Cikidang,
Penanggung Jawab

…………………………………….
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN
PUSKESMAS CIKIDANG
KECAMATAN CIKIDANG
ALAMAT JALAN RAYA CIKIDANG KM 19
NAMA OBAT/SEDIAAN SEDIAAN
NO STOK AWAL PENERIMAAN

A SERUM
1 ABU ampul 1
2 ATS ampul 0
B BHP GIGI 0
1 Temporary filling materail pcs 0
2 Glass Ionomer Cement kit A3 pcs 0
3 Coat bond pcs 0
4 Brilliant NG pcs 0
5 Eugenol botol 1
C CAIRAN 0
1 Air untuk injeksi (Aqua pro injeksi) 20 ml Botol 5
2 Glukosa Larutan infus 5% steril 500 ml Botol 3
3 Natrium Klorida lart.infus 0,9% steril - 500 ml Botol 35
4 Ringer Laktat larutan infus steril - 500 ml Botol 40
D OBAT 0
1 Allupurinol 100 mg Tablet Tab 0
2 Aminofillin inj 24 mg /ml-10ml ampul 0
3 Aminophylin tablet 200mg Tab 0
4 Amitriptilin HCl tablet salut 25 mg Tab 0
5 Amlodipin 10 mg Tab 200
6 Amoksisilin Kaplet 500 mg Kaplet 400
7 Amoksisilin Kapsul 250 mg Kapsul 50
8 Amoksisilin sirup kering 125 mg/5 ml Botol 50
9 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 0
10 Antasida Suspensi 60 ml Botol 50
11 Antasida DOEN tablet kombinasi Tab 500
12 Anti fungi DOEN komb sk tube 0
13 Anti Hemoroid DOEN kombinasi supp 10
14 Antimigren DOEN kombinasi Tab 0
15 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab 0
16 Asam Askorbat (Vit.C) tablet 50 mg Tab 0
17 Asam folat tablet 0.4 mg Tab 0
18 Asam mefenamat 500 mg Kaplet 200
19 Asetyl sestein 200mg kapsul 100
20 Asiklovir Tablet 400 mg Tab 0
21 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml ampul 0
22 Attalpugite tab 600 mg Tab 200
23 Benzatin Benzil Penisilin inj.1.2 juta IU/vial ampul 0
24 Betahistin maleat Tab 0
25 Betametasone Krim 0.1% tube 0
26 Bisakodil Supp 10 mg supp 5
27 Bisoprolol tablet tablet 0
28 Captopril 12,5 mg Tab 0
29 Captopril tablet 25 mg Tab 80
30 Deksametason injeksi 5 mg/ml - 1 ml ampul 0
31 Deksametasone tablet 0.5mg Tab 300
32 Diasepam 2 mg tablet Tab 100
33 Diazepam Inj 5 ml/2ml ampul 3
34 Diazepam lar rektal 5mg/2,5ml tube 2
35 Dietilkarbamazin sitrat tablet 100 mg Tab 0
36 Difenhidramin HCl injeksi 10 mg/ml - 1 ml ampul 10
37 Digoksin tablet 0,25 mg Tab 0
38 Doksisiklin 100 mg ampul 0
39 Domperidon tablet 10 mg Tab 0
40 Epinefrina (adrenalin) injeksi 0,1% - 1 ml ampul 2
41 Erytromycin 250 mg Kapsul 0
42 Etambutol HCL 250 mg Tab 0
43 Fenitoin Na kaps 100 mg Kapsul 0
44 Fenobarbital injeksi 50 mg/ml - 2 ml ampul 0
45 Fenobarbital tablet 30 mg Tab 0
46 Fenofibrat kaps 100 mg Kapsul 0
47 Fenoksimetil Penisilina tablet 500 mg Tab 0
48 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 0
49 Furosemid tablet 40 mg Tab 50
50 Gentamisin tetes mata Botol 0
51 Glibenklamid tablet 5 mg Tab 100
52 Glimepiride tab 0
53 Griseofulvin tablet 125 mg, micronized Tab 0
54 Hidroklorotiazid (HCT) tablet 25 mg Tab 0
55 Hidrokortison krim 2,5 % tube 0
56 Ibuprofen Suspensi 100mg 5ml botol 0
57 Ibuprofen tablet 400 mg Tab 50
58 Isoniazid tablet 300 mg Tab 0
59 Isosorbid Dinitrat 5 mg tablet sublingual Tab 0
60 Kalsium Glukonat Inj 100 mg/ml ampul 0
61 Kalsium lakate (kalk) tablet Tab 0
62 Karbamazepin tablet 200 mg Tab 0
63 Karbogliserin Tetes Telinga 10% Botol 0
64 Ketokonazol krim 2 % tube 0
65 Ketokonazol Tablet 200 mg Tab 0
 66 Klindamicin 150 mg Kapsul 200
67 Klopidogrel tab 75 mg Tab 0
68 Kloramfenikol Kapsul 500 mg Kapsul 0
69 Kloramfenikol salep kulit 2% (bufacetin) tube 0
70 Kloramfenikol Salep Mata 1% - 3,5 gr Botol 0
71 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 400
72 Klorpromazin HCL tablet 25 mg Tab 0
73 Klorpromazin inj. 25 mg/ml ampul 0
74 Kodein HCl tablet 10 mg Tab 0
75 Kotrimoksazol forte tablet Tab 0
76 Kotrimoksazol 480 tablet tab 0
77 Kotrimoksazol suspensi kombinasi Botol 0
78 Lansoprazol 30 mg Tab 0
79 Lidokain inj. 2% ampul 80
80 Lidokain komp. injeksi kombinasi ampul 0
81 Loratadin tab 10 mg Tab 200
82 Mebendazol tablet 0
83 Metformin tablet 500 mg Tab 0
84 metil dopa tab 250 mg Tab 0
85 Metilergometrin Maleat injeksi 0,200 mg - 1ml ampul 0
86 Metilergometrin Maleat tablet salut 0,125 mg Tab 0
87 Metilprednisolon tablet 4 mg Tab 200
88 Metoklorpropamid tablet 10 mg Tab 30
89 Metronidazol sirup 125mg/5ml Botol 0
90 Metronidazol tablet 500 mg Tab 200
91 Miconazol SK tube 0
92 Natrium bikarbonat tablet 500 mg Tab 800
93 Natrium Diklofenac 50 mg Tab 100
94 Nifedifin tablet 30 mg Tab 300
95 Nistatin 100.000 IU/gram tablet vaginal supp 0
96 Nistatin tablet salut gula 500.000 IU/g Tab 0
97 Oksitetrasiklin HCl salep 3% - 5 gram tube 0
98 Omeprazol 20 mg Tab 100
99 Ondansentron tab 8 mg Tab 200
100 parasetamol drop Botol 0
101 Parasetamol Kaplet 500 mg Tab 400
102 Parasetamol sirup Botol 1000
103 Permetrin/scabimite krim 5 % tube 0
104 Pirantel Pamoat tablet 125 mg Tab 0
105 Pirazinamid tablet 500 mg Tab 0
106 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 0
107 Prednison tablet 5 mg Tab 500
108 Propranolol HCl tablet 40 mg Tab 0
109 Ranitidin Injeksi 25 mg/ml ampul 120
110 Ranitidin tablet 150 mg Tab 300
 111 Rifampisin Kapsul 600 mg Kapsul 0
112 Salbutamol tablet 2 mg Tab 100
113 Salep 2 - 4 kombinasi tube 0
114 Setirizin sir 5 mg/ 5 ml Botol 0
115 Sianokobalamin (Vitamin B12) 50 mg Tab 0
116 Simvastatin 20 mg Tab 0
117 Teofilin tab 150 mg Tab 0
118 Tetrasiklin HCl Kapsul 500 mg Kapsul 0
119 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 0
120 Vitamin B komplek tablet Tab 0
121 Terbutaline sulfat ih 2.5 mg/ml ampul 0
122 Budesonid ih .5 mg/ml ampul 0
E ADDITIONAL OBAT 0
124 Amlodipin 5 mg tab 0
125 Amoxicillin 100 mg/ml drops botol 0
126 Asam Traneksamat Injeksi Ampul 0
127 Asiclovir 200 mg Tab 0
128 Asiclovir krim Tube 0
129 Bisakodil Tablet Tab 0
130 Ciprofloksasin 500 mg tablet Tab 0
131 Domperidon Sirup Btl 0
132 Furosemid Injeksi Ampul 0
133 Guaifenesin tab Tab 0
134 Kloramfenikol Tetes telinga botol 0
135 Multivitamin Dewasa Tab 0
137 Multivitamin Sirup Tab 0
136 Obat Batuk Hitam Tube 1
138 Oksitosin injeksi ampul 0
139 Ondansentron injeksi Ampul 2
140 Salbutamol inhaler ampul 15
141 Sefadroksil Kapsul 500 mg KAPSUL 2
142 Sefadroksil syrup 125 mg Botol 0
143 Sefadroksil Syrup 250 mg BOTOL 0
144 Setirizin Tab Tab 0
145 Sulfadiazine silver krim (Luka Bakar) Tube 9
OBAT PROGRAM 0
A MALARIA 0
1 Artesunate injeksi, vial 60 mg vial 0
2 Primakuin tablet 15 mg tablet 0
3 Kina tablet 200 mg tablet 0
4 Kina injeksi 25% - 2 ml ampul 0
5 Doksisiklin kapsul 100 mg kapsul 0
6 DHP (Dehidro Artemisin + Piperaquin) Tablet tablet 0
0
B FILARIASIS 0
1 DEC tablet 100 mg tablet 0
2 Albendazol tablet 400 mg tablet 0
3 Albendazol Sirup 200 mg/5 ml botol 0
0
C PENGENDALIAN PENYAKIT MENULAR (P2M) 0
1. DIARE 0
1 Garam oralit kantong 0
2 Zinc tablet 20 mg tablet 0
3 zink sirup botol 0
2. KUSTA 0
1 Prednison tablet 5 mg tablet 0
3. FRAMBUSIA 0
1 Azithromycin 500 mg tablet 0
0
D TB PARU (OAT FDC) 0
OAT FDC 0
1 Obat Anti Tuberculosis FDC kategori 1 paket 0
2 Obat Anti Tuberculosis FDC kategori 2 paket 0
3 Obat Anti Tuberculosis FDC anak paket 0
0
F AIDS PMS 0
1 Efavirenz tab 600 mg tablet 0
2 Lopinavir 200 mg + Ritonavir 50 mg tablet 0
3 Lopinavir 100 mg + Ritonavir 25 mg tablet 0
4 Nevirapin 200 mg tablet 0
5 Tenofovir tab 300 mg tablet 0
6 Zidovudin Kaps 100 mg kapsul 0
7 Lamivudin tab 150 mg tablet 0
8 Kombinasi Zidovudin 300 mg + Lamivudin 150 mg tablet 0
9 Efavirenz tab 200 mg tablet 0
10 Abacavir kaps 300 mg tablet 0
11 Tenofovir 300 mg + Emiricitabine 200 mg Tab tablet 0
12 Zidovudin 60 mg +Lamivudine 30 mg + Nevirapine 50 tablet 0
13 Tenofovir 300 mg + Lamivudin 300 mg + Efivirenz 60 tablet 0
14 Rilpivirine Tab 25 mg tablet 0
15 Zidovudine Syr 10 mg/ml botol 0
0
G KESEHATAN JIWA 0
1 Haloperidol dekanoat inj 50 mg/ml ampul 0
2 Klobazam 10 mg tablet tablet 0
3 Amitripilin HCL 25 mg tablet tablet 0
4 Klorpromazin 100 mg tablet tablet 0
5 Risperidon 2 mg Tablet tablet 0
 6 Klozapin 25 mg tablet tablet 0
7 Trifluoperazine HCL 5 mg tablet tablet 0
8 Haloperidol inj 5 mg/ml ampul 0
9 Imipramin HCL 25 mg tablet tablet 0
10 Fluoksetin 10 mg tablet tablet 0
11 Triheksifenidil 2 mg tab tablet 0
12 Haloperidol 5 mg tablet tablet 0
0
H VAKSIN RABIES 0
1 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster 0
2 Serum antirabies inj 200 UI/ml 0
0
I GIZI 0
1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul 0
2 Bayi (6 -(Vitamin
Retinol 11 bulan)
A) 200.000 IU Kapsul Lunak kapsul 0
3 Balita (11 - 59 bulan)
Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul 0
4 Ibu Nifas
Tablet Tambah Darah (Ibu Hamil) tablet 0
5 Tablet Tambah Darah (Remaja Putri) tablet 0
6 Mineral Mix sachet 0
0
J KESEHATAN IBU 0
1 Oksitosin Injeksi 10 IU/ml ampul 0
2 Metil Ergometrin Maleat injeksi 0,2 mg/ml ampul 0
3 Magnesium Sulfat Injeksi 40% ampul 0
4 Kalsium Glukonat Injeksi 10% ampul 0
5 Ampisilin Injeksi 1000 mg/vial vial 0
6 Gentamisin Injesi 40 mg/ml ampul 0
7 Metronidazol infus 5 mg/ml botol 0
0
K KESEHATAN ANAK 0
1 Fitomenadion (vit K1) injeksi 2 mg/ml ampul 0
2 Levotiroksin 50 mcg tablet 0
3 Oksitetrasiklin HCL Salep mata 1% tube 0
4 Ampicilin serb injeksi 1000 ml/vial ampul 0
5 Gentamisin injeksi 40 mg/ml ampul 0
6 Fenobarbital injeksi 50 mg/ml ampul 0
7 Diazepam injeksi 5 mg/ml ampul 0
0
L LANSIA 0
1 Risedronat kapsul 0
0
M IMUNISASI 0
1 Vaksin Hepatitis B vial 0
2 Vaksin BCG vial 0
 3 Vaksin Polio 10 ds vial 0
4 Vaksin DT vial 0
5 Vaksin Td vial 0
6 (Kelas
Vaksin2Td
SD) vial 0
7 (WUS)
Vaksin IPV vial 0
8 Vaksin DPT-HB-Hib vial 0
9 (Bayi)
Vaksin DPT-HB-Hib vial 0
10 (Baduta)
Vaksin MR vial 0
11 (Bayi)
Vaksin MR vial 0
12 (Baduta)
Vaksin HPV vial 0
13 Vaksin Pneumokokkus vial 0
14 Vaksin JE vial 0
A BMHP 0
1 Alat suntik sekali pakai 1 ml Pcs 90
2 Alat suntik sekali pakai 3 ml Pcs 200
3 Alat suntik sekali pakai 5 ml Pcs 0
4 alat suntik sekali pakai 10 ml pcs 0
5 Alkohol Swab box 4
6 autodisable no 0,05 ml Pcs 0
7 autodisable no. 0,5 ml Pcs 0
8 bloodset Pcs 0
9 Catgut Chromic 2/0 + jarum 1/2 HR 26 mm Pcs 2
10 Catgut Chromic 3/0 + jarum 1/2 HR 26 mm Pcs 0
11 ECG/USG jelly 82gr Pcs 1
12 Folley Catheter 2 way no 16 Pcs 20
13 Folley Catheter 2 way no 18 Pcs 20
Handscoon Non Steril 0
14 Ukuran L Pcs 9
15 Ukuran M Pcs 0
16 Ukuran S Pcs 0
Handscoon steril 0
17 Ukuran 6.5 Pcs 0
18 Ukuran 7.0 Pcs 0
19 Ukuran 7.5 Pcs 0
20 ID Patient Adult/Dewasa Biru Pcs 0
21 ID Patient Adult/Dewasa Pink Pcs 0
22 Infusion set anak Pcs 5
23 Infusion set dewasa Pcs 20
24 IV Catheter G - 18 Pcs 0
25 IV Catheter G - 20 Pcs 350
26 IV Catheter G - 22 Pcs 650
27 Kapas 250 gr Pcs 0
28 Kasa hidrofil 16x16 (steril) box 40
29 Kasa Kompres 40/40 steril Pcs 0
30 Kasa Pembalut 2 m x 80 cm Pcs 0
31 kasa pembalut hydrofil 40 cm x 80 cm Pcs 5
Masker 10
32 Tie on dus 0
33 Hijab dus 0
34 masker oksigen pcs 0
35 Plester Pcs 18
36 Plester Polifix 5 cm x 1 m Pcs 8
37 Policrepe Pembalut Elastis 7,5 cm x 4,55 m Roll 5
38 Silk 2/0 + jarum 1/2 GT 35 mm Pcs 0
39 Silk 3/0 + jarum 1/2 GT 35 mm Pcs 1
40 Urine bag Pcs 40
41 pot sampel pcs 0
B DESINFECTAN 0
1 Alkohol 70% - 1000 ml Btl 1
2 Antiseptik Hand Rub 500 ml Btl 1
3 cairan sterilisasi alat btl 0
4 Lisol 1 liter Btl 1
5 Povidon Iodida 300 ml Btl 4
6 Povidon Iodida 30 ml Btl 8
7 Rivanol larutan 0,1% - 300 cc Btl 4
C ADDITIONAL BHP 0
1 Bioplasenton tulle Pcs 0
2 Bisturi No. 11 box 0
3 Catgut Chromic 2/0 + Jatum 1/2 HR 20 mm pcs 1
4 Catgut Chromic 3/0 + Jatum 1/2 HR 20 mm pcs 3
5 Cuticell pcs 100
6 Dental Anastesi Citoject box 0
7 Handscoon Obgyn pairs 0
8 IV Catheter - G -24 pcs 150
9 IV Catheter G-26 PCS 0
10 kapas gigi pack 0
11 Kassa hydrofil 3 yard x 10 cm pack 5
12 Kassa hydrofil 3 yard x 15 cm pack 0
13 Kassa hydrofil 40 yard x 80 cm roll 0
14 Lidi Waten Steril box 0
15 masker karet box 0
16 Microfor box 0
17 Polifix 10 cm x 5 m roll 0
18 Polifix 5 cm x 5 m roll 2
19 Pot Sputum Steril pcs 0
20 Povidone Iodida 60 ml Btl 0
21 SD Bioline HCG pcs 0
22 SD Urocolor For Urinalysis pcs 0
23 Silk 4/0 DS 12 mm pcs 0
24 Silk 4/0 DS 19 mm pcs 0
25 Silk 4/0 HR 20 mm pcs 0
26 Silk 5/0 DS 16 mm pcs 0
27 Umbilical Cord Clamps pcs 0

Mengetahui,
Pimpinan UPTD Puskesmas Cikidang
Kabupaten Sukabumi

Asep Gumelar, SKM., M.Si.

AR PERMINTAAN OBAT (LPLPO)
BULAN JULI
TAHUN 2021

PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

1 1
0 0
0 0
0 0
0 0
0 0
0 0
1 1
0 0
5 5
3 3
35 35
40 40
0 0
0 0
0 0
0 0
0 0
200 200
400 400
50 50
50 50
0 0
50 50
500 500
0 0
10 10
0 0
0 0
0 0
0 0
200 200
100 100
0 0
 0 0
200 200
0 0
0 0
0 0
5 5
0 0
0 0
80 80
0 0
300 300
100 100
3 3
2 2
0 0
10 10
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
50 50
0 0
100 100
0 0
0 0
0 0
0 0
0 0
50 50
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 200
0 0
0 0
0 0
0 0
400 400
0 0
0 0
0 0
0 0
0 0
0 0
0 0
80 80
0 0
200 200
0 0
0 0
0 0
0 0
0 0
200 200
30 30
0 0
200 200
0 0
800 800
100 100
300 300
0 0
0 0
0 0
100 100
200 200
0 0
400 400
1000 1000
0 0
0 0
0 0
0 0
500 500
0 0
120 120
300 300
 0 0
100 100
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
1 1
0 0
2 2
15 15
2 2
0 0
0 0
0 0
9 9
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
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
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
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
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
90 90
200 200
0 0
0 0
4 4
0 0
0 0
0 0
2 2
0 0
1 1
20 20
20 20
0 0
9 9
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5 5
20 20
0 0
350 350
650 650
0 0
40 40
0 0
0 0
 5 5
10 10
0 0
0 0
0 0
18 18
8 8
5 5
0 0
1 1
40 40
0 0
0 0
1 1
1 1
0 0
1 1
4 4
8 8
4 4
0 0
0 0
0 0
1 1
3 3
100 100
0 0
0 0
150 150
0 0
0 0
5 5
0 0
0 0
0 0
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

Cikidang,
Penanggung Jawab

…………………………………….
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN
PUSKESMAS CIKIDANG
KECAMATAN CIKIDANG
ALAMAT JALAN RAYA CIKIDANG KM 19
NAMA OBAT/SEDIAAN SEDIAAN
NO STOK AWAL PENERIMAAN

A SERUM
1 ABU ampul 1
2 ATS ampul 0
B BHP GIGI 0
1 Temporary filling materail pcs 0
2 Glass Ionomer Cement kit A3 pcs 0
3 Coat bond pcs 0
4 Brilliant NG pcs 0
5 Eugenol botol 1
C CAIRAN 0
1 Air untuk injeksi (Aqua pro injeksi) 20 ml Botol 5
2 Glukosa Larutan infus 5% steril 500 ml Botol 3
3 Natrium Klorida lart.infus 0,9% steril - 500 ml Botol 35
4 Ringer Laktat larutan infus steril - 500 ml Botol 40
D OBAT 0
1 Allupurinol 100 mg Tablet Tab 0
2 Aminofillin inj 24 mg /ml-10ml ampul 0
3 Aminophylin tablet 200mg Tab 0
4 Amitriptilin HCl tablet salut 25 mg Tab 0
5 Amlodipin 10 mg Tab 200
6 Amoksisilin Kaplet 500 mg Kaplet 400
7 Amoksisilin Kapsul 250 mg Kapsul 50
8 Amoksisilin sirup kering 125 mg/5 ml Botol 50
9 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 0
10 Antasida Suspensi 60 ml Botol 50
11 Antasida DOEN tablet kombinasi Tab 500
12 Anti fungi DOEN komb sk tube 0
13 Anti Hemoroid DOEN kombinasi supp 10
14 Antimigren DOEN kombinasi Tab 0
15 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab 0
16 Asam Askorbat (Vit.C) tablet 50 mg Tab 0
17 Asam folat tablet 0.4 mg Tab 0
18 Asam mefenamat 500 mg Kaplet 200
19 Asetyl sestein 200mg kapsul 100
20 Asiklovir Tablet 400 mg Tab 0
21 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml ampul 0
22 Attalpugite tab 600 mg Tab 200
23 Benzatin Benzil Penisilin inj.1.2 juta IU/vial ampul 0
24 Betahistin maleat Tab 0
25 Betametasone Krim 0.1% tube 0
26 Bisakodil Supp 10 mg supp 5
27 Bisoprolol tablet tablet 0
28 Captopril 12,5 mg Tab 0
29 Captopril tablet 25 mg Tab 80
30 Deksametason injeksi 5 mg/ml - 1 ml ampul 0
31 Deksametasone tablet 0.5mg Tab 300
32 Diasepam 2 mg tablet Tab 100
33 Diazepam Inj 5 ml/2ml ampul 3
34 Diazepam lar rektal 5mg/2,5ml tube 2
35 Dietilkarbamazin sitrat tablet 100 mg Tab 0
36 Difenhidramin HCl injeksi 10 mg/ml - 1 ml ampul 10
37 Digoksin tablet 0,25 mg Tab 0
38 Doksisiklin 100 mg ampul 0
39 Domperidon tablet 10 mg Tab 0
40 Epinefrina (adrenalin) injeksi 0,1% - 1 ml ampul 2
41 Erytromycin 250 mg Kapsul 0
42 Etambutol HCL 250 mg Tab 0
43 Fenitoin Na kaps 100 mg Kapsul 0
44 Fenobarbital injeksi 50 mg/ml - 2 ml ampul 0
45 Fenobarbital tablet 30 mg Tab 0
46 Fenofibrat kaps 100 mg Kapsul 0
47 Fenoksimetil Penisilina tablet 500 mg Tab 0
48 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 0
49 Furosemid tablet 40 mg Tab 50
50 Gentamisin tetes mata Botol 0
51 Glibenklamid tablet 5 mg Tab 100
52 Glimepiride tab 0
53 Griseofulvin tablet 125 mg, micronized Tab 0
54 Hidroklorotiazid (HCT) tablet 25 mg Tab 0
55 Hidrokortison krim 2,5 % tube 0
56 Ibuprofen Suspensi 100mg 5ml botol 0
57 Ibuprofen tablet 400 mg Tab 50
58 Isoniazid tablet 300 mg Tab 0
59 Isosorbid Dinitrat 5 mg tablet sublingual Tab 0
60 Kalsium Glukonat Inj 100 mg/ml ampul 0
61 Kalsium lakate (kalk) tablet Tab 0
62 Karbamazepin tablet 200 mg Tab 0
63 Karbogliserin Tetes Telinga 10% Botol 0
64 Ketokonazol krim 2 % tube 0
65 Ketokonazol Tablet 200 mg Tab 0
 66 Klindamicin 150 mg Kapsul 200
67 Klopidogrel tab 75 mg Tab 0
68 Kloramfenikol Kapsul 500 mg Kapsul 0
69 Kloramfenikol salep kulit 2% (bufacetin) tube 0
70 Kloramfenikol Salep Mata 1% - 3,5 gr Botol 0
71 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 400
72 Klorpromazin HCL tablet 25 mg Tab 0
73 Klorpromazin inj. 25 mg/ml ampul 0
74 Kodein HCl tablet 10 mg Tab 0
75 Kotrimoksazol forte tablet Tab 0
76 Kotrimoksazol 480 tablet tab 0
77 Kotrimoksazol suspensi kombinasi Botol 0
78 Lansoprazol 30 mg Tab 0
79 Lidokain inj. 2% ampul 80
80 Lidokain komp. injeksi kombinasi ampul 0
81 Loratadin tab 10 mg Tab 200
82 Mebendazol tablet 0
83 Metformin tablet 500 mg Tab 0
84 metil dopa tab 250 mg Tab 0
85 Metilergometrin Maleat injeksi 0,200 mg - 1ml ampul 0
86 Metilergometrin Maleat tablet salut 0,125 mg Tab 0
87 Metilprednisolon tablet 4 mg Tab 200
88 Metoklorpropamid tablet 10 mg Tab 30
89 Metronidazol sirup 125mg/5ml Botol 0
90 Metronidazol tablet 500 mg Tab 200
91 Miconazol SK tube 0
92 Natrium bikarbonat tablet 500 mg Tab 800
93 Natrium Diklofenac 50 mg Tab 100
94 Nifedifin tablet 30 mg Tab 300
95 Nistatin 100.000 IU/gram tablet vaginal supp 0
96 Nistatin tablet salut gula 500.000 IU/g Tab 0
97 Oksitetrasiklin HCl salep 3% - 5 gram tube 0
98 Omeprazol 20 mg Tab 100
99 Ondansentron tab 8 mg Tab 200
100 parasetamol drop Botol 0
101 Parasetamol Kaplet 500 mg Tab 400
102 Parasetamol sirup Botol 1000
103 Permetrin/scabimite krim 5 % tube 0
104 Pirantel Pamoat tablet 125 mg Tab 0
105 Pirazinamid tablet 500 mg Tab 0
106 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 0
107 Prednison tablet 5 mg Tab 500
108 Propranolol HCl tablet 40 mg Tab 0
109 Ranitidin Injeksi 25 mg/ml ampul 120
110 Ranitidin tablet 150 mg Tab 300
 111 Rifampisin Kapsul 600 mg Kapsul 0
112 Salbutamol tablet 2 mg Tab 100
113 Salep 2 - 4 kombinasi tube 0
114 Setirizin sir 5 mg/ 5 ml Botol 0
115 Sianokobalamin (Vitamin B12) 50 mg Tab 0
116 Simvastatin 20 mg Tab 0
117 Teofilin tab 150 mg Tab 0
118 Tetrasiklin HCl Kapsul 500 mg Kapsul 0
119 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 0
120 Vitamin B komplek tablet Tab 0
121 Terbutaline sulfat ih 2.5 mg/ml ampul 0
122 Budesonid ih .5 mg/ml ampul 0
E ADDITIONAL OBAT 0
124 Amlodipin 5 mg tab 0
125 Amoxicillin 100 mg/ml drops botol 0
126 Asam Traneksamat Injeksi Ampul 0
127 Asiclovir 200 mg Tab 0
128 Asiclovir krim Tube 0
129 Bisakodil Tablet Tab 0
130 Ciprofloksasin 500 mg tablet Tab 0
131 Domperidon Sirup Btl 0
132 Furosemid Injeksi Ampul 0
133 Guaifenesin tab Tab 0
134 Kloramfenikol Tetes telinga botol 0
135 Multivitamin Dewasa Tab 0
137 Multivitamin Sirup Tab 0
136 Obat Batuk Hitam Tube 1
138 Oksitosin injeksi ampul 0
139 Ondansentron injeksi Ampul 2
140 Salbutamol inhaler ampul 15
141 Sefadroksil Kapsul 500 mg KAPSUL 2
142 Sefadroksil syrup 125 mg Botol 0
143 Sefadroksil Syrup 250 mg BOTOL 0
144 Setirizin Tab Tab 0
145 Sulfadiazine silver krim (Luka Bakar) Tube 9
OBAT PROGRAM 0
A MALARIA 0
1 Artesunate injeksi, vial 60 mg vial 0
2 Primakuin tablet 15 mg tablet 0
3 Kina tablet 200 mg tablet 0
4 Kina injeksi 25% - 2 ml ampul 0
5 Doksisiklin kapsul 100 mg kapsul 0
6 DHP (Dehidro Artemisin + Piperaquin) Tablet tablet 0
0
B FILARIASIS 0
1 DEC tablet 100 mg tablet 0
2 Albendazol tablet 400 mg tablet 0
3 Albendazol Sirup 200 mg/5 ml botol 0
0
C PENGENDALIAN PENYAKIT MENULAR (P2M) 0
1. DIARE 0
1 Garam oralit kantong 0
2 Zinc tablet 20 mg tablet 0
3 zink sirup botol 0
2. KUSTA 0
1 Prednison tablet 5 mg tablet 0
3. FRAMBUSIA 0
1 Azithromycin 500 mg tablet 0
0
D TB PARU (OAT FDC) 0
OAT FDC 0
1 Obat Anti Tuberculosis FDC kategori 1 paket 0
2 Obat Anti Tuberculosis FDC kategori 2 paket 0
3 Obat Anti Tuberculosis FDC anak paket 0
0
F AIDS PMS 0
1 Efavirenz tab 600 mg tablet 0
2 Lopinavir 200 mg + Ritonavir 50 mg tablet 0
3 Lopinavir 100 mg + Ritonavir 25 mg tablet 0
4 Nevirapin 200 mg tablet 0
5 Tenofovir tab 300 mg tablet 0
6 Zidovudin Kaps 100 mg kapsul 0
7 Lamivudin tab 150 mg tablet 0
8 Kombinasi Zidovudin 300 mg + Lamivudin 150 mg tablet 0
9 Efavirenz tab 200 mg tablet 0
10 Abacavir kaps 300 mg tablet 0
11 Tenofovir 300 mg + Emiricitabine 200 mg Tab tablet 0
12 Zidovudin 60 mg +Lamivudine 30 mg + Nevirapine 50 tablet 0
13 Tenofovir 300 mg + Lamivudin 300 mg + Efivirenz 60 tablet 0
14 Rilpivirine Tab 25 mg tablet 0
15 Zidovudine Syr 10 mg/ml botol 0
0
G KESEHATAN JIWA 0
1 Haloperidol dekanoat inj 50 mg/ml ampul 0
2 Klobazam 10 mg tablet tablet 0
3 Amitripilin HCL 25 mg tablet tablet 0
4 Klorpromazin 100 mg tablet tablet 0
5 Risperidon 2 mg Tablet tablet 0
 6 Klozapin 25 mg tablet tablet 0
7 Trifluoperazine HCL 5 mg tablet tablet 0
8 Haloperidol inj 5 mg/ml ampul 0
9 Imipramin HCL 25 mg tablet tablet 0
10 Fluoksetin 10 mg tablet tablet 0
11 Triheksifenidil 2 mg tab tablet 0
12 Haloperidol 5 mg tablet tablet 0
0
H VAKSIN RABIES 0
1 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster 0
2 Serum antirabies inj 200 UI/ml 0
0
I GIZI 0
1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul 0
2 Bayi (6 -(Vitamin
Retinol 11 bulan)
A) 200.000 IU Kapsul Lunak kapsul 0
3 Balita (11 - 59 bulan)
Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul 0
4 Ibu Nifas
Tablet Tambah Darah (Ibu Hamil) tablet 0
5 Tablet Tambah Darah (Remaja Putri) tablet 0
6 Mineral Mix sachet 0
0
J KESEHATAN IBU 0
1 Oksitosin Injeksi 10 IU/ml ampul 0
2 Metil Ergometrin Maleat injeksi 0,2 mg/ml ampul 0
3 Magnesium Sulfat Injeksi 40% ampul 0
4 Kalsium Glukonat Injeksi 10% ampul 0
5 Ampisilin Injeksi 1000 mg/vial vial 0
6 Gentamisin Injesi 40 mg/ml ampul 0
7 Metronidazol infus 5 mg/ml botol 0
0
K KESEHATAN ANAK 0
1 Fitomenadion (vit K1) injeksi 2 mg/ml ampul 0
2 Levotiroksin 50 mcg tablet 0
3 Oksitetrasiklin HCL Salep mata 1% tube 0
4 Ampicilin serb injeksi 1000 ml/vial ampul 0
5 Gentamisin injeksi 40 mg/ml ampul 0
6 Fenobarbital injeksi 50 mg/ml ampul 0
7 Diazepam injeksi 5 mg/ml ampul 0
0
L LANSIA 0
1 Risedronat kapsul 0
0
M IMUNISASI 0
1 Vaksin Hepatitis B vial 0
2 Vaksin BCG vial 0
 3 Vaksin Polio 10 ds vial 0
4 Vaksin DT vial 0
5 Vaksin Td vial 0
6 (Kelas
Vaksin2Td
SD) vial 0
7 (WUS)
Vaksin IPV vial 0
8 Vaksin DPT-HB-Hib vial 0
9 (Bayi)
Vaksin DPT-HB-Hib vial 0
10 (Baduta)
Vaksin MR vial 0
11 (Bayi)
Vaksin MR vial 0
12 (Baduta)
Vaksin HPV vial 0
13 Vaksin Pneumokokkus vial 0
14 Vaksin JE vial 0
A BMHP 0
1 Alat suntik sekali pakai 1 ml Pcs 90
2 Alat suntik sekali pakai 3 ml Pcs 200
3 Alat suntik sekali pakai 5 ml Pcs 0
4 alat suntik sekali pakai 10 ml pcs 0
5 Alkohol Swab box 4
6 autodisable no 0,05 ml Pcs 0
7 autodisable no. 0,5 ml Pcs 0
8 bloodset Pcs 0
9 Catgut Chromic 2/0 + jarum 1/2 HR 26 mm Pcs 2
10 Catgut Chromic 3/0 + jarum 1/2 HR 26 mm Pcs 0
11 ECG/USG jelly 82gr Pcs 1
12 Folley Catheter 2 way no 16 Pcs 20
13 Folley Catheter 2 way no 18 Pcs 20
Handscoon Non Steril 0
14 Ukuran L Pcs 9
15 Ukuran M Pcs 0
16 Ukuran S Pcs 0
Handscoon steril 0
17 Ukuran 6.5 Pcs 0
18 Ukuran 7.0 Pcs 0
19 Ukuran 7.5 Pcs 0
20 ID Patient Adult/Dewasa Biru Pcs 0
21 ID Patient Adult/Dewasa Pink Pcs 0
22 Infusion set anak Pcs 5
23 Infusion set dewasa Pcs 20
24 IV Catheter G - 18 Pcs 0
25 IV Catheter G - 20 Pcs 350
26 IV Catheter G - 22 Pcs 650
27 Kapas 250 gr Pcs 0
28 Kasa hidrofil 16x16 (steril) box 40
29 Kasa Kompres 40/40 steril Pcs 0
30 Kasa Pembalut 2 m x 80 cm Pcs 0
31 kasa pembalut hydrofil 40 cm x 80 cm Pcs 5
Masker 10
32 Tie on dus 0
33 Hijab dus 0
34 masker oksigen pcs 0
35 Plester Pcs 18
36 Plester Polifix 5 cm x 1 m Pcs 8
37 Policrepe Pembalut Elastis 7,5 cm x 4,55 m Roll 5
38 Silk 2/0 + jarum 1/2 GT 35 mm Pcs 0
39 Silk 3/0 + jarum 1/2 GT 35 mm Pcs 1
40 Urine bag Pcs 40
41 pot sampel pcs 0
B DESINFECTAN 0
1 Alkohol 70% - 1000 ml Btl 1
2 Antiseptik Hand Rub 500 ml Btl 1
3 cairan sterilisasi alat btl 0
4 Lisol 1 liter Btl 1
5 Povidon Iodida 300 ml Btl 4
6 Povidon Iodida 30 ml Btl 8
7 Rivanol larutan 0,1% - 300 cc Btl 4
C ADDITIONAL BHP 0
1 Bioplasenton tulle Pcs 0
2 Bisturi No. 11 box 0
3 Catgut Chromic 2/0 + Jatum 1/2 HR 20 mm pcs 1
4 Catgut Chromic 3/0 + Jatum 1/2 HR 20 mm pcs 3
5 Cuticell pcs 100
6 Dental Anastesi Citoject box 0
7 Handscoon Obgyn pairs 0
8 IV Catheter - G -24 pcs 150
9 IV Catheter G-26 PCS 0
10 kapas gigi pack 0
11 Kassa hydrofil 3 yard x 10 cm pack 5
12 Kassa hydrofil 3 yard x 15 cm pack 0
13 Kassa hydrofil 40 yard x 80 cm roll 0
14 Lidi Waten Steril box 0
15 masker karet box 0
16 Microfor box 0
17 Polifix 10 cm x 5 m roll 0
18 Polifix 5 cm x 5 m roll 2
19 Pot Sputum Steril pcs 0
20 Povidone Iodida 60 ml Btl 0
21 SD Bioline HCG pcs 0
22 SD Urocolor For Urinalysis pcs 0
23 Silk 4/0 DS 12 mm pcs 0
24 Silk 4/0 DS 19 mm pcs 0
25 Silk 4/0 HR 20 mm pcs 0
26 Silk 5/0 DS 16 mm pcs 0
27 Umbilical Cord Clamps pcs 0

Mengetahui,
Pimpinan UPTD Puskesmas Cikidang
Kabupaten Sukabumi

Asep Gumelar, SKM., M.Si.

AR PERMINTAAN OBAT (LPLPO)
BULAN AGUSTUS
TAHUN 2021

PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

1 1
0 0
0 0
0 0
0 0
0 0
0 0
1 1
0 0
5 5
3 3
35 35
40 40
0 0
0 0
0 0
0 0
0 0
200 200
400 400
50 50
50 50
0 0
50 50
500 500
0 0
10 10
0 0
0 0
0 0
0 0
200 200
100 100
0 0
 0 0
200 200
0 0
0 0
0 0
5 5
0 0
0 0
80 80
0 0
300 300
100 100
3 3
2 2
0 0
10 10
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
50 50
0 0
100 100
0 0
0 0
0 0
0 0
0 0
50 50
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 200
0 0
0 0
0 0
0 0
400 400
0 0
0 0
0 0
0 0
0 0
0 0
0 0
80 80
0 0
200 200
0 0
0 0
0 0
0 0
0 0
200 200
30 30
0 0
200 200
0 0
800 800
100 100
300 300
0 0
0 0
0 0
100 100
200 200
0 0
400 400
1000 1000
0 0
0 0
0 0
0 0
500 500
0 0
120 120
300 300
 0 0
100 100
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
1 1
0 0
2 2
15 15
2 2
0 0
0 0
0 0
9 9
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
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
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
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
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
90 90
200 200
0 0
0 0
4 4
0 0
0 0
0 0
2 2
0 0
1 1
20 20
20 20
0 0
9 9
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5 5
20 20
0 0
350 350
650 650
0 0
40 40
0 0
0 0
 5 5
10 10
0 0
0 0
0 0
18 18
8 8
5 5
0 0
1 1
40 40
0 0
0 0
1 1
1 1
0 0
1 1
4 4
8 8
4 4
0 0
0 0
0 0
1 1
3 3
100 100
0 0
0 0
150 150
0 0
0 0
5 5
0 0
0 0
0 0
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

Cikidang,
Penanggung Jawab

…………………………………….
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN
PUSKESMAS CIKIDANG
KECAMATAN CIKIDANG
ALAMAT JALAN RAYA CIKIDANG KM 19
NAMA OBAT/SEDIAAN SEDIAAN
NO STOK AWAL PENERIMAAN

A SERUM
1 ABU ampul 1
2 ATS ampul 0
B BHP GIGI 0
1 Temporary filling materail pcs 0
2 Glass Ionomer Cement kit A3 pcs 0
3 Coat bond pcs 0
4 Brilliant NG pcs 0
5 Eugenol botol 1
C CAIRAN 0
1 Air untuk injeksi (Aqua pro injeksi) 20 ml Botol 5
2 Glukosa Larutan infus 5% steril 500 ml Botol 3
3 Natrium Klorida lart.infus 0,9% steril - 500 ml Botol 35
4 Ringer Laktat larutan infus steril - 500 ml Botol 40
D OBAT 0
1 Allupurinol 100 mg Tablet Tab 0
2 Aminofillin inj 24 mg /ml-10ml ampul 0
3 Aminophylin tablet 200mg Tab 0
4 Amitriptilin HCl tablet salut 25 mg Tab 0
5 Amlodipin 10 mg Tab 200
6 Amoksisilin Kaplet 500 mg Kaplet 400
7 Amoksisilin Kapsul 250 mg Kapsul 50
8 Amoksisilin sirup kering 125 mg/5 ml Botol 50
9 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 0
10 Antasida Suspensi 60 ml Botol 50
11 Antasida DOEN tablet kombinasi Tab 500
12 Anti fungi DOEN komb sk tube 0
13 Anti Hemoroid DOEN kombinasi supp 10
14 Antimigren DOEN kombinasi Tab 0
15 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab 0
16 Asam Askorbat (Vit.C) tablet 50 mg Tab 0
17 Asam folat tablet 0.4 mg Tab 0
18 Asam mefenamat 500 mg Kaplet 200
19 Asetyl sestein 200mg kapsul 100
20 Asiklovir Tablet 400 mg Tab 0
21 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml ampul 0
22 Attalpugite tab 600 mg Tab 200
23 Benzatin Benzil Penisilin inj.1.2 juta IU/vial ampul 0
24 Betahistin maleat Tab 0
25 Betametasone Krim 0.1% tube 0
26 Bisakodil Supp 10 mg supp 5
27 Bisoprolol tablet tablet 0
28 Captopril 12,5 mg Tab 0
29 Captopril tablet 25 mg Tab 80
30 Deksametason injeksi 5 mg/ml - 1 ml ampul 0
31 Deksametasone tablet 0.5mg Tab 300
32 Diasepam 2 mg tablet Tab 100
33 Diazepam Inj 5 ml/2ml ampul 3
34 Diazepam lar rektal 5mg/2,5ml tube 2
35 Dietilkarbamazin sitrat tablet 100 mg Tab 0
36 Difenhidramin HCl injeksi 10 mg/ml - 1 ml ampul 10
37 Digoksin tablet 0,25 mg Tab 0
38 Doksisiklin 100 mg ampul 0
39 Domperidon tablet 10 mg Tab 0
40 Epinefrina (adrenalin) injeksi 0,1% - 1 ml ampul 2
41 Erytromycin 250 mg Kapsul 0
42 Etambutol HCL 250 mg Tab 0
43 Fenitoin Na kaps 100 mg Kapsul 0
44 Fenobarbital injeksi 50 mg/ml - 2 ml ampul 0
45 Fenobarbital tablet 30 mg Tab 0
46 Fenofibrat kaps 100 mg Kapsul 0
47 Fenoksimetil Penisilina tablet 500 mg Tab 0
48 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 0
49 Furosemid tablet 40 mg Tab 50
50 Gentamisin tetes mata Botol 0
51 Glibenklamid tablet 5 mg Tab 100
52 Glimepiride tab 0
53 Griseofulvin tablet 125 mg, micronized Tab 0
54 Hidroklorotiazid (HCT) tablet 25 mg Tab 0
55 Hidrokortison krim 2,5 % tube 0
56 Ibuprofen Suspensi 100mg 5ml botol 0
57 Ibuprofen tablet 400 mg Tab 50
58 Isoniazid tablet 300 mg Tab 0
59 Isosorbid Dinitrat 5 mg tablet sublingual Tab 0
60 Kalsium Glukonat Inj 100 mg/ml ampul 0
61 Kalsium lakate (kalk) tablet Tab 0
62 Karbamazepin tablet 200 mg Tab 0
63 Karbogliserin Tetes Telinga 10% Botol 0
64 Ketokonazol krim 2 % tube 0
65 Ketokonazol Tablet 200 mg Tab 0
 66 Klindamicin 150 mg Kapsul 200
67 Klopidogrel tab 75 mg Tab 0
68 Kloramfenikol Kapsul 500 mg Kapsul 0
69 Kloramfenikol salep kulit 2% (bufacetin) tube 0
70 Kloramfenikol Salep Mata 1% - 3,5 gr Botol 0
71 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 400
72 Klorpromazin HCL tablet 25 mg Tab 0
73 Klorpromazin inj. 25 mg/ml ampul 0
74 Kodein HCl tablet 10 mg Tab 0
75 Kotrimoksazol forte tablet Tab 0
76 Kotrimoksazol 480 tablet tab 0
77 Kotrimoksazol suspensi kombinasi Botol 0
78 Lansoprazol 30 mg Tab 0
79 Lidokain inj. 2% ampul 80
80 Lidokain komp. injeksi kombinasi ampul 0
81 Loratadin tab 10 mg Tab 200
82 Mebendazol tablet 0
83 Metformin tablet 500 mg Tab 0
84 metil dopa tab 250 mg Tab 0
85 Metilergometrin Maleat injeksi 0,200 mg - 1ml ampul 0
86 Metilergometrin Maleat tablet salut 0,125 mg Tab 0
87 Metilprednisolon tablet 4 mg Tab 200
88 Metoklorpropamid tablet 10 mg Tab 30
89 Metronidazol sirup 125mg/5ml Botol 0
90 Metronidazol tablet 500 mg Tab 200
91 Miconazol SK tube 0
92 Natrium bikarbonat tablet 500 mg Tab 800
93 Natrium Diklofenac 50 mg Tab 100
94 Nifedifin tablet 30 mg Tab 300
95 Nistatin 100.000 IU/gram tablet vaginal supp 0
96 Nistatin tablet salut gula 500.000 IU/g Tab 0
97 Oksitetrasiklin HCl salep 3% - 5 gram tube 0
98 Omeprazol 20 mg Tab 100
99 Ondansentron tab 8 mg Tab 200
100 parasetamol drop Botol 0
101 Parasetamol Kaplet 500 mg Tab 400
102 Parasetamol sirup Botol 1000
103 Permetrin/scabimite krim 5 % tube 0
104 Pirantel Pamoat tablet 125 mg Tab 0
105 Pirazinamid tablet 500 mg Tab 0
106 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 0
107 Prednison tablet 5 mg Tab 500
108 Propranolol HCl tablet 40 mg Tab 0
109 Ranitidin Injeksi 25 mg/ml ampul 120
110 Ranitidin tablet 150 mg Tab 300
 111 Rifampisin Kapsul 600 mg Kapsul 0
112 Salbutamol tablet 2 mg Tab 100
113 Salep 2 - 4 kombinasi tube 0
114 Setirizin sir 5 mg/ 5 ml Botol 0
115 Sianokobalamin (Vitamin B12) 50 mg Tab 0
116 Simvastatin 20 mg Tab 0
117 Teofilin tab 150 mg Tab 0
118 Tetrasiklin HCl Kapsul 500 mg Kapsul 0
119 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 0
120 Vitamin B komplek tablet Tab 0
121 Terbutaline sulfat ih 2.5 mg/ml ampul 0
122 Budesonid ih .5 mg/ml ampul 0
E ADDITIONAL OBAT 0
124 Amlodipin 5 mg tab 0
125 Amoxicillin 100 mg/ml drops botol 0
126 Asam Traneksamat Injeksi Ampul 0
127 Asiclovir 200 mg Tab 0
128 Asiclovir krim Tube 0
129 Bisakodil Tablet Tab 0
130 Ciprofloksasin 500 mg tablet Tab 0
131 Domperidon Sirup Btl 0
132 Furosemid Injeksi Ampul 0
133 Guaifenesin tab Tab 0
134 Kloramfenikol Tetes telinga botol 0
135 Multivitamin Dewasa Tab 0
137 Multivitamin Sirup Tab 0
136 Obat Batuk Hitam Tube 1
138 Oksitosin injeksi ampul 0
139 Ondansentron injeksi Ampul 2
140 Salbutamol inhaler ampul 15
141 Sefadroksil Kapsul 500 mg KAPSUL 2
142 Sefadroksil syrup 125 mg Botol 0
143 Sefadroksil Syrup 250 mg BOTOL 0
144 Setirizin Tab Tab 0
145 Sulfadiazine silver krim (Luka Bakar) Tube 9
OBAT PROGRAM 0
A MALARIA 0
1 Artesunate injeksi, vial 60 mg vial 0
2 Primakuin tablet 15 mg tablet 0
3 Kina tablet 200 mg tablet 0
4 Kina injeksi 25% - 2 ml ampul 0
5 Doksisiklin kapsul 100 mg kapsul 0
6 DHP (Dehidro Artemisin + Piperaquin) Tablet tablet 0
0
B FILARIASIS 0
1 DEC tablet 100 mg tablet 0
2 Albendazol tablet 400 mg tablet 0
3 Albendazol Sirup 200 mg/5 ml botol 0
0
C PENGENDALIAN PENYAKIT MENULAR (P2M) 0
1. DIARE 0
1 Garam oralit kantong 0
2 Zinc tablet 20 mg tablet 0
3 zink sirup botol 0
2. KUSTA 0
1 Prednison tablet 5 mg tablet 0
3. FRAMBUSIA 0
1 Azithromycin 500 mg tablet 0
0
D TB PARU (OAT FDC) 0
OAT FDC 0
1 Obat Anti Tuberculosis FDC kategori 1 paket 0
2 Obat Anti Tuberculosis FDC kategori 2 paket 0
3 Obat Anti Tuberculosis FDC anak paket 0
0
F AIDS PMS 0
1 Efavirenz tab 600 mg tablet 0
2 Lopinavir 200 mg + Ritonavir 50 mg tablet 0
3 Lopinavir 100 mg + Ritonavir 25 mg tablet 0
4 Nevirapin 200 mg tablet 0
5 Tenofovir tab 300 mg tablet 0
6 Zidovudin Kaps 100 mg kapsul 0
7 Lamivudin tab 150 mg tablet 0
8 Kombinasi Zidovudin 300 mg + Lamivudin 150 mg tablet 0
9 Efavirenz tab 200 mg tablet 0
10 Abacavir kaps 300 mg tablet 0
11 Tenofovir 300 mg + Emiricitabine 200 mg Tab tablet 0
12 Zidovudin 60 mg +Lamivudine 30 mg + Nevirapine 50 tablet 0
13 Tenofovir 300 mg + Lamivudin 300 mg + Efivirenz 60 tablet 0
14 Rilpivirine Tab 25 mg tablet 0
15 Zidovudine Syr 10 mg/ml botol 0
0
G KESEHATAN JIWA 0
1 Haloperidol dekanoat inj 50 mg/ml ampul 0
2 Klobazam 10 mg tablet tablet 0
3 Amitripilin HCL 25 mg tablet tablet 0
4 Klorpromazin 100 mg tablet tablet 0
5 Risperidon 2 mg Tablet tablet 0
 6 Klozapin 25 mg tablet tablet 0
7 Trifluoperazine HCL 5 mg tablet tablet 0
8 Haloperidol inj 5 mg/ml ampul 0
9 Imipramin HCL 25 mg tablet tablet 0
10 Fluoksetin 10 mg tablet tablet 0
11 Triheksifenidil 2 mg tab tablet 0
12 Haloperidol 5 mg tablet tablet 0
0
H VAKSIN RABIES 0
1 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster 0
2 Serum antirabies inj 200 UI/ml 0
0
I GIZI 0
1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul 0
2 Bayi (6 -(Vitamin
Retinol 11 bulan)
A) 200.000 IU Kapsul Lunak kapsul 0
3 Balita (11 - 59 bulan)
Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul 0
4 Ibu Nifas
Tablet Tambah Darah (Ibu Hamil) tablet 0
5 Tablet Tambah Darah (Remaja Putri) tablet 0
6 Mineral Mix sachet 0
0
J KESEHATAN IBU 0
1 Oksitosin Injeksi 10 IU/ml ampul 0
2 Metil Ergometrin Maleat injeksi 0,2 mg/ml ampul 0
3 Magnesium Sulfat Injeksi 40% ampul 0
4 Kalsium Glukonat Injeksi 10% ampul 0
5 Ampisilin Injeksi 1000 mg/vial vial 0
6 Gentamisin Injesi 40 mg/ml ampul 0
7 Metronidazol infus 5 mg/ml botol 0
0
K KESEHATAN ANAK 0
1 Fitomenadion (vit K1) injeksi 2 mg/ml ampul 0
2 Levotiroksin 50 mcg tablet 0
3 Oksitetrasiklin HCL Salep mata 1% tube 0
4 Ampicilin serb injeksi 1000 ml/vial ampul 0
5 Gentamisin injeksi 40 mg/ml ampul 0
6 Fenobarbital injeksi 50 mg/ml ampul 0
7 Diazepam injeksi 5 mg/ml ampul 0
0
L LANSIA 0
1 Risedronat kapsul 0
0
M IMUNISASI 0
1 Vaksin Hepatitis B vial 0
2 Vaksin BCG vial 0
 3 Vaksin Polio 10 ds vial 0
4 Vaksin DT vial 0
5 Vaksin Td vial 0
6 (Kelas
Vaksin2Td
SD) vial 0
7 (WUS)
Vaksin IPV vial 0
8 Vaksin DPT-HB-Hib vial 0
9 (Bayi)
Vaksin DPT-HB-Hib vial 0
10 (Baduta)
Vaksin MR vial 0
11 (Bayi)
Vaksin MR vial 0
12 (Baduta)
Vaksin HPV vial 0
13 Vaksin Pneumokokkus vial 0
14 Vaksin JE vial 0
A BMHP 0
1 Alat suntik sekali pakai 1 ml Pcs 90
2 Alat suntik sekali pakai 3 ml Pcs 200
3 Alat suntik sekali pakai 5 ml Pcs 0
4 alat suntik sekali pakai 10 ml pcs 0
5 Alkohol Swab box 4
6 autodisable no 0,05 ml Pcs 0
7 autodisable no. 0,5 ml Pcs 0
8 bloodset Pcs 0
9 Catgut Chromic 2/0 + jarum 1/2 HR 26 mm Pcs 2
10 Catgut Chromic 3/0 + jarum 1/2 HR 26 mm Pcs 0
11 ECG/USG jelly 82gr Pcs 1
12 Folley Catheter 2 way no 16 Pcs 20
13 Folley Catheter 2 way no 18 Pcs 20
Handscoon Non Steril 0
14 Ukuran L Pcs 9
15 Ukuran M Pcs 0
16 Ukuran S Pcs 0
Handscoon steril 0
17 Ukuran 6.5 Pcs 0
18 Ukuran 7.0 Pcs 0
19 Ukuran 7.5 Pcs 0
20 ID Patient Adult/Dewasa Biru Pcs 0
21 ID Patient Adult/Dewasa Pink Pcs 0
22 Infusion set anak Pcs 5
23 Infusion set dewasa Pcs 20
24 IV Catheter G - 18 Pcs 0
25 IV Catheter G - 20 Pcs 350
26 IV Catheter G - 22 Pcs 650
27 Kapas 250 gr Pcs 0
28 Kasa hidrofil 16x16 (steril) box 40
29 Kasa Kompres 40/40 steril Pcs 0
30 Kasa Pembalut 2 m x 80 cm Pcs 0
31 kasa pembalut hydrofil 40 cm x 80 cm Pcs 5
Masker 10
32 Tie on dus 0
33 Hijab dus 0
34 masker oksigen pcs 0
35 Plester Pcs 18
36 Plester Polifix 5 cm x 1 m Pcs 8
37 Policrepe Pembalut Elastis 7,5 cm x 4,55 m Roll 5
38 Silk 2/0 + jarum 1/2 GT 35 mm Pcs 0
39 Silk 3/0 + jarum 1/2 GT 35 mm Pcs 1
40 Urine bag Pcs 40
41 pot sampel pcs 0
B DESINFECTAN 0
1 Alkohol 70% - 1000 ml Btl 1
2 Antiseptik Hand Rub 500 ml Btl 1
3 cairan sterilisasi alat btl 0
4 Lisol 1 liter Btl 1
5 Povidon Iodida 300 ml Btl 4
6 Povidon Iodida 30 ml Btl 8
7 Rivanol larutan 0,1% - 300 cc Btl 4
C ADDITIONAL BHP 0
1 Bioplasenton tulle Pcs 0
2 Bisturi No. 11 box 0
3 Catgut Chromic 2/0 + Jatum 1/2 HR 20 mm pcs 1
4 Catgut Chromic 3/0 + Jatum 1/2 HR 20 mm pcs 3
5 Cuticell pcs 100
6 Dental Anastesi Citoject box 0
7 Handscoon Obgyn pairs 0
8 IV Catheter - G -24 pcs 150
9 IV Catheter G-26 PCS 0
10 kapas gigi pack 0
11 Kassa hydrofil 3 yard x 10 cm pack 5
12 Kassa hydrofil 3 yard x 15 cm pack 0
13 Kassa hydrofil 40 yard x 80 cm roll 0
14 Lidi Waten Steril box 0
15 masker karet box 0
16 Microfor box 0
17 Polifix 10 cm x 5 m roll 0
18 Polifix 5 cm x 5 m roll 2
19 Pot Sputum Steril pcs 0
20 Povidone Iodida 60 ml Btl 0
21 SD Bioline HCG pcs 0
22 SD Urocolor For Urinalysis pcs 0
23 Silk 4/0 DS 12 mm pcs 0
24 Silk 4/0 DS 19 mm pcs 0
25 Silk 4/0 HR 20 mm pcs 0
26 Silk 5/0 DS 16 mm pcs 0
27 Umbilical Cord Clamps pcs 0

Mengetahui,
Pimpinan UPTD Puskesmas Cikidang
Kabupaten Sukabumi

Asep Gumelar, SKM., M.Si.

AR PERMINTAAN OBAT (LPLPO)
BULAN SEPTEMBER
TAHUN 2021

PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

1 1
0 0
0 0
0 0
0 0
0 0
0 0
1 1
0 0
5 5
3 3
35 35
40 40
0 0
0 0
0 0
0 0
0 0
200 200
400 400
50 50
50 50
0 0
50 50
500 500
0 0
10 10
0 0
0 0
0 0
0 0
200 200
100 100
0 0
 0 0
200 200
0 0
0 0
0 0
5 5
0 0
0 0
80 80
0 0
300 300
100 100
3 3
2 2
0 0
10 10
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
50 50
0 0
100 100
0 0
0 0
0 0
0 0
0 0
50 50
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 200
0 0
0 0
0 0
0 0
400 400
0 0
0 0
0 0
0 0
0 0
0 0
0 0
80 80
0 0
200 200
0 0
0 0
0 0
0 0
0 0
200 200
30 30
0 0
200 200
0 0
800 800
100 100
300 300
0 0
0 0
0 0
100 100
200 200
0 0
400 400
1000 1000
0 0
0 0
0 0
0 0
500 500
0 0
120 120
300 300
 0 0
100 100
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
1 1
0 0
2 2
15 15
2 2
0 0
0 0
0 0
9 9
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
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
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
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
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
90 90
200 200
0 0
0 0
4 4
0 0
0 0
0 0
2 2
0 0
1 1
20 20
20 20
0 0
9 9
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5 5
20 20
0 0
350 350
650 650
0 0
40 40
0 0
0 0
 5 5
10 10
0 0
0 0
0 0
18 18
8 8
5 5
0 0
1 1
40 40
0 0
0 0
1 1
1 1
0 0
1 1
4 4
8 8
4 4
0 0
0 0
0 0
1 1
3 3
100 100
0 0
0 0
150 150
0 0
0 0
5 5
0 0
0 0
0 0
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

Cikidang,
Penanggung Jawab

…………………………………….
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN
PUSKESMAS CIKIDANG
KECAMATAN CIKIDANG
ALAMAT JALAN RAYA CIKIDANG KM 19
NAMA OBAT/SEDIAAN SEDIAAN
NO STOK AWAL PENERIMAAN

A SERUM
1 ABU ampul 1
2 ATS ampul 0
B BHP GIGI 0
1 Temporary filling materail pcs 0
2 Glass Ionomer Cement kit A3 pcs 0
3 Coat bond pcs 0
4 Brilliant NG pcs 0
5 Eugenol botol 1
C CAIRAN 0
1 Air untuk injeksi (Aqua pro injeksi) 20 ml Botol 5
2 Glukosa Larutan infus 5% steril 500 ml Botol 3
3 Natrium Klorida lart.infus 0,9% steril - 500 ml Botol 35
4 Ringer Laktat larutan infus steril - 500 ml Botol 40
D OBAT 0
1 Allupurinol 100 mg Tablet Tab 0
2 Aminofillin inj 24 mg /ml-10ml ampul 0
3 Aminophylin tablet 200mg Tab 0
4 Amitriptilin HCl tablet salut 25 mg Tab 0
5 Amlodipin 10 mg Tab 200
6 Amoksisilin Kaplet 500 mg Kaplet 400
7 Amoksisilin Kapsul 250 mg Kapsul 50
8 Amoksisilin sirup kering 125 mg/5 ml Botol 50
9 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 0
10 Antasida Suspensi 60 ml Botol 50
11 Antasida DOEN tablet kombinasi Tab 500
12 Anti fungi DOEN komb sk tube 0
13 Anti Hemoroid DOEN kombinasi supp 10
14 Antimigren DOEN kombinasi Tab 0
15 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab 0
16 Asam Askorbat (Vit.C) tablet 50 mg Tab 0
17 Asam folat tablet 0.4 mg Tab 0
18 Asam mefenamat 500 mg Kaplet 200
19 Asetyl sestein 200mg kapsul 100
20 Asiklovir Tablet 400 mg Tab 0
21 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml ampul 0
22 Attalpugite tab 600 mg Tab 200
23 Benzatin Benzil Penisilin inj.1.2 juta IU/vial ampul 0
24 Betahistin maleat Tab 0
25 Betametasone Krim 0.1% tube 0
26 Bisakodil Supp 10 mg supp 5
27 Bisoprolol tablet tablet 0
28 Captopril 12,5 mg Tab 0
29 Captopril tablet 25 mg Tab 80
30 Deksametason injeksi 5 mg/ml - 1 ml ampul 0
31 Deksametasone tablet 0.5mg Tab 300
32 Diasepam 2 mg tablet Tab 100
33 Diazepam Inj 5 ml/2ml ampul 3
34 Diazepam lar rektal 5mg/2,5ml tube 2
35 Dietilkarbamazin sitrat tablet 100 mg Tab 0
36 Difenhidramin HCl injeksi 10 mg/ml - 1 ml ampul 10
37 Digoksin tablet 0,25 mg Tab 0
38 Doksisiklin 100 mg ampul 0
39 Domperidon tablet 10 mg Tab 0
40 Epinefrina (adrenalin) injeksi 0,1% - 1 ml ampul 2
41 Erytromycin 250 mg Kapsul 0
42 Etambutol HCL 250 mg Tab 0
43 Fenitoin Na kaps 100 mg Kapsul 0
44 Fenobarbital injeksi 50 mg/ml - 2 ml ampul 0
45 Fenobarbital tablet 30 mg Tab 0
46 Fenofibrat kaps 100 mg Kapsul 0
47 Fenoksimetil Penisilina tablet 500 mg Tab 0
48 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 0
49 Furosemid tablet 40 mg Tab 50
50 Gentamisin tetes mata Botol 0
51 Glibenklamid tablet 5 mg Tab 100
52 Glimepiride tab 0
53 Griseofulvin tablet 125 mg, micronized Tab 0
54 Hidroklorotiazid (HCT) tablet 25 mg Tab 0
55 Hidrokortison krim 2,5 % tube 0
56 Ibuprofen Suspensi 100mg 5ml botol 0
57 Ibuprofen tablet 400 mg Tab 50
58 Isoniazid tablet 300 mg Tab 0
59 Isosorbid Dinitrat 5 mg tablet sublingual Tab 0
60 Kalsium Glukonat Inj 100 mg/ml ampul 0
61 Kalsium lakate (kalk) tablet Tab 0
62 Karbamazepin tablet 200 mg Tab 0
63 Karbogliserin Tetes Telinga 10% Botol 0
64 Ketokonazol krim 2 % tube 0
65 Ketokonazol Tablet 200 mg Tab 0
 66 Klindamicin 150 mg Kapsul 200
67 Klopidogrel tab 75 mg Tab 0
68 Kloramfenikol Kapsul 500 mg Kapsul 0
69 Kloramfenikol salep kulit 2% (bufacetin) tube 0
70 Kloramfenikol Salep Mata 1% - 3,5 gr Botol 0
71 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 400
72 Klorpromazin HCL tablet 25 mg Tab 0
73 Klorpromazin inj. 25 mg/ml ampul 0
74 Kodein HCl tablet 10 mg Tab 0
75 Kotrimoksazol forte tablet Tab 0
76 Kotrimoksazol 480 tablet tab 0
77 Kotrimoksazol suspensi kombinasi Botol 0
78 Lansoprazol 30 mg Tab 0
79 Lidokain inj. 2% ampul 80
80 Lidokain komp. injeksi kombinasi ampul 0
81 Loratadin tab 10 mg Tab 200
82 Mebendazol tablet 0
83 Metformin tablet 500 mg Tab 0
84 metil dopa tab 250 mg Tab 0
85 Metilergometrin Maleat injeksi 0,200 mg - 1ml ampul 0
86 Metilergometrin Maleat tablet salut 0,125 mg Tab 0
87 Metilprednisolon tablet 4 mg Tab 200
88 Metoklorpropamid tablet 10 mg Tab 30
89 Metronidazol sirup 125mg/5ml Botol 0
90 Metronidazol tablet 500 mg Tab 200
91 Miconazol SK tube 0
92 Natrium bikarbonat tablet 500 mg Tab 800
93 Natrium Diklofenac 50 mg Tab 100
94 Nifedifin tablet 30 mg Tab 300
95 Nistatin 100.000 IU/gram tablet vaginal supp 0
96 Nistatin tablet salut gula 500.000 IU/g Tab 0
97 Oksitetrasiklin HCl salep 3% - 5 gram tube 0
98 Omeprazol 20 mg Tab 100
99 Ondansentron tab 8 mg Tab 200
100 parasetamol drop Botol 0
101 Parasetamol Kaplet 500 mg Tab 400
102 Parasetamol sirup Botol 1000
103 Permetrin/scabimite krim 5 % tube 0
104 Pirantel Pamoat tablet 125 mg Tab 0
105 Pirazinamid tablet 500 mg Tab 0
106 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 0
107 Prednison tablet 5 mg Tab 500
108 Propranolol HCl tablet 40 mg Tab 0
109 Ranitidin Injeksi 25 mg/ml ampul 120
110 Ranitidin tablet 150 mg Tab 300
 111 Rifampisin Kapsul 600 mg Kapsul 0
112 Salbutamol tablet 2 mg Tab 100
113 Salep 2 - 4 kombinasi tube 0
114 Setirizin sir 5 mg/ 5 ml Botol 0
115 Sianokobalamin (Vitamin B12) 50 mg Tab 0
116 Simvastatin 20 mg Tab 0
117 Teofilin tab 150 mg Tab 0
118 Tetrasiklin HCl Kapsul 500 mg Kapsul 0
119 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 0
120 Vitamin B komplek tablet Tab 0
121 Terbutaline sulfat ih 2.5 mg/ml ampul 0
122 Budesonid ih .5 mg/ml ampul 0
E ADDITIONAL OBAT 0
124 Amlodipin 5 mg tab 0
125 Amoxicillin 100 mg/ml drops botol 0
126 Asam Traneksamat Injeksi Ampul 0
127 Asiclovir 200 mg Tab 0
128 Asiclovir krim Tube 0
129 Bisakodil Tablet Tab 0
130 Ciprofloksasin 500 mg tablet Tab 0
131 Domperidon Sirup Btl 0
132 Furosemid Injeksi Ampul 0
133 Guaifenesin tab Tab 0
134 Kloramfenikol Tetes telinga botol 0
135 Multivitamin Dewasa Tab 0
137 Multivitamin Sirup Tab 0
136 Obat Batuk Hitam Tube 1
138 Oksitosin injeksi ampul 0
139 Ondansentron injeksi Ampul 2
140 Salbutamol inhaler ampul 15
141 Sefadroksil Kapsul 500 mg KAPSUL 2
142 Sefadroksil syrup 125 mg Botol 0
143 Sefadroksil Syrup 250 mg BOTOL 0
144 Setirizin Tab Tab 0
145 Sulfadiazine silver krim (Luka Bakar) Tube 9
OBAT PROGRAM 0
A MALARIA 0
1 Artesunate injeksi, vial 60 mg vial 0
2 Primakuin tablet 15 mg tablet 0
3 Kina tablet 200 mg tablet 0
4 Kina injeksi 25% - 2 ml ampul 0
5 Doksisiklin kapsul 100 mg kapsul 0
6 DHP (Dehidro Artemisin + Piperaquin) Tablet tablet 0
0
B FILARIASIS 0
1 DEC tablet 100 mg tablet 0
2 Albendazol tablet 400 mg tablet 0
3 Albendazol Sirup 200 mg/5 ml botol 0
0
C PENGENDALIAN PENYAKIT MENULAR (P2M) 0
1. DIARE 0
1 Garam oralit kantong 0
2 Zinc tablet 20 mg tablet 0
3 zink sirup botol 0
2. KUSTA 0
1 Prednison tablet 5 mg tablet 0
3. FRAMBUSIA 0
1 Azithromycin 500 mg tablet 0
0
D TB PARU (OAT FDC) 0
OAT FDC 0
1 Obat Anti Tuberculosis FDC kategori 1 paket 0
2 Obat Anti Tuberculosis FDC kategori 2 paket 0
3 Obat Anti Tuberculosis FDC anak paket 0
0
F AIDS PMS 0
1 Efavirenz tab 600 mg tablet 0
2 Lopinavir 200 mg + Ritonavir 50 mg tablet 0
3 Lopinavir 100 mg + Ritonavir 25 mg tablet 0
4 Nevirapin 200 mg tablet 0
5 Tenofovir tab 300 mg tablet 0
6 Zidovudin Kaps 100 mg kapsul 0
7 Lamivudin tab 150 mg tablet 0
8 Kombinasi Zidovudin 300 mg + Lamivudin 150 mg tablet 0
9 Efavirenz tab 200 mg tablet 0
10 Abacavir kaps 300 mg tablet 0
11 Tenofovir 300 mg + Emiricitabine 200 mg Tab tablet 0
12 Zidovudin 60 mg +Lamivudine 30 mg + Nevirapine 50 tablet 0
13 Tenofovir 300 mg + Lamivudin 300 mg + Efivirenz 60 tablet 0
14 Rilpivirine Tab 25 mg tablet 0
15 Zidovudine Syr 10 mg/ml botol 0
0
G KESEHATAN JIWA 0
1 Haloperidol dekanoat inj 50 mg/ml ampul 0
2 Klobazam 10 mg tablet tablet 0
3 Amitripilin HCL 25 mg tablet tablet 0
4 Klorpromazin 100 mg tablet tablet 0
5 Risperidon 2 mg Tablet tablet 0
 6 Klozapin 25 mg tablet tablet 0
7 Trifluoperazine HCL 5 mg tablet tablet 0
8 Haloperidol inj 5 mg/ml ampul 0
9 Imipramin HCL 25 mg tablet tablet 0
10 Fluoksetin 10 mg tablet tablet 0
11 Triheksifenidil 2 mg tab tablet 0
12 Haloperidol 5 mg tablet tablet 0
0
H VAKSIN RABIES 0
1 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster 0
2 Serum antirabies inj 200 UI/ml 0
0
I GIZI 0
1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul 0
2 Bayi (6 -(Vitamin
Retinol 11 bulan)
A) 200.000 IU Kapsul Lunak kapsul 0
3 Balita (11 - 59 bulan)
Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul 0
4 Ibu Nifas
Tablet Tambah Darah (Ibu Hamil) tablet 0
5 Tablet Tambah Darah (Remaja Putri) tablet 0
6 Mineral Mix sachet 0
0
J KESEHATAN IBU 0
1 Oksitosin Injeksi 10 IU/ml ampul 0
2 Metil Ergometrin Maleat injeksi 0,2 mg/ml ampul 0
3 Magnesium Sulfat Injeksi 40% ampul 0
4 Kalsium Glukonat Injeksi 10% ampul 0
5 Ampisilin Injeksi 1000 mg/vial vial 0
6 Gentamisin Injesi 40 mg/ml ampul 0
7 Metronidazol infus 5 mg/ml botol 0
0
K KESEHATAN ANAK 0
1 Fitomenadion (vit K1) injeksi 2 mg/ml ampul 0
2 Levotiroksin 50 mcg tablet 0
3 Oksitetrasiklin HCL Salep mata 1% tube 0
4 Ampicilin serb injeksi 1000 ml/vial ampul 0
5 Gentamisin injeksi 40 mg/ml ampul 0
6 Fenobarbital injeksi 50 mg/ml ampul 0
7 Diazepam injeksi 5 mg/ml ampul 0
0
L LANSIA 0
1 Risedronat kapsul 0
0
M IMUNISASI 0
1 Vaksin Hepatitis B vial 0
2 Vaksin BCG vial 0
 3 Vaksin Polio 10 ds vial 0
4 Vaksin DT vial 0
5 Vaksin Td vial 0
6 (Kelas
Vaksin2Td
SD) vial 0
7 (WUS)
Vaksin IPV vial 0
8 Vaksin DPT-HB-Hib vial 0
9 (Bayi)
Vaksin DPT-HB-Hib vial 0
10 (Baduta)
Vaksin MR vial 0
11 (Bayi)
Vaksin MR vial 0
12 (Baduta)
Vaksin HPV vial 0
13 Vaksin Pneumokokkus vial 0
14 Vaksin JE vial 0
A BMHP 0
1 Alat suntik sekali pakai 1 ml Pcs 90
2 Alat suntik sekali pakai 3 ml Pcs 200
3 Alat suntik sekali pakai 5 ml Pcs 0
4 alat suntik sekali pakai 10 ml pcs 0
5 Alkohol Swab box 4
6 autodisable no 0,05 ml Pcs 0
7 autodisable no. 0,5 ml Pcs 0
8 bloodset Pcs 0
9 Catgut Chromic 2/0 + jarum 1/2 HR 26 mm Pcs 2
10 Catgut Chromic 3/0 + jarum 1/2 HR 26 mm Pcs 0
11 ECG/USG jelly 82gr Pcs 1
12 Folley Catheter 2 way no 16 Pcs 20
13 Folley Catheter 2 way no 18 Pcs 20
Handscoon Non Steril 0
14 Ukuran L Pcs 9
15 Ukuran M Pcs 0
16 Ukuran S Pcs 0
Handscoon steril 0
17 Ukuran 6.5 Pcs 0
18 Ukuran 7.0 Pcs 0
19 Ukuran 7.5 Pcs 0
20 ID Patient Adult/Dewasa Biru Pcs 0
21 ID Patient Adult/Dewasa Pink Pcs 0
22 Infusion set anak Pcs 5
23 Infusion set dewasa Pcs 20
24 IV Catheter G - 18 Pcs 0
25 IV Catheter G - 20 Pcs 350
26 IV Catheter G - 22 Pcs 650
27 Kapas 250 gr Pcs 0
28 Kasa hidrofil 16x16 (steril) box 40
29 Kasa Kompres 40/40 steril Pcs 0
30 Kasa Pembalut 2 m x 80 cm Pcs 0
31 kasa pembalut hydrofil 40 cm x 80 cm Pcs 5
Masker 10
32 Tie on dus 0
33 Hijab dus 0
34 masker oksigen pcs 0
35 Plester Pcs 18
36 Plester Polifix 5 cm x 1 m Pcs 8
37 Policrepe Pembalut Elastis 7,5 cm x 4,55 m Roll 5
38 Silk 2/0 + jarum 1/2 GT 35 mm Pcs 0
39 Silk 3/0 + jarum 1/2 GT 35 mm Pcs 1
40 Urine bag Pcs 40
41 pot sampel pcs 0
B DESINFECTAN 0
1 Alkohol 70% - 1000 ml Btl 1
2 Antiseptik Hand Rub 500 ml Btl 1
3 cairan sterilisasi alat btl 0
4 Lisol 1 liter Btl 1
5 Povidon Iodida 300 ml Btl 4
6 Povidon Iodida 30 ml Btl 8
7 Rivanol larutan 0,1% - 300 cc Btl 4
C ADDITIONAL BHP 0
1 Bioplasenton tulle Pcs 0
2 Bisturi No. 11 box 0
3 Catgut Chromic 2/0 + Jatum 1/2 HR 20 mm pcs 1
4 Catgut Chromic 3/0 + Jatum 1/2 HR 20 mm pcs 3
5 Cuticell pcs 100
6 Dental Anastesi Citoject box 0
7 Handscoon Obgyn pairs 0
8 IV Catheter - G -24 pcs 150
9 IV Catheter G-26 PCS 0
10 kapas gigi pack 0
11 Kassa hydrofil 3 yard x 10 cm pack 5
12 Kassa hydrofil 3 yard x 15 cm pack 0
13 Kassa hydrofil 40 yard x 80 cm roll 0
14 Lidi Waten Steril box 0
15 masker karet box 0
16 Microfor box 0
17 Polifix 10 cm x 5 m roll 0
18 Polifix 5 cm x 5 m roll 2
19 Pot Sputum Steril pcs 0
20 Povidone Iodida 60 ml Btl 0
21 SD Bioline HCG pcs 0
22 SD Urocolor For Urinalysis pcs 0
23 Silk 4/0 DS 12 mm pcs 0
24 Silk 4/0 DS 19 mm pcs 0
25 Silk 4/0 HR 20 mm pcs 0
26 Silk 5/0 DS 16 mm pcs 0
27 Umbilical Cord Clamps pcs 0

Mengetahui,
Pimpinan UPTD Puskesmas Cikidang
Kabupaten Sukabumi

Asep Gumelar, SKM., M.Si.

AR PERMINTAAN OBAT (LPLPO)
BULAN OKTOBER
TAHUN 2021

PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

1 1
0 0
0 0
0 0
0 0
0 0
0 0
1 1
0 0
5 5
3 3
35 35
40 40
0 0
0 0
0 0
0 0
0 0
200 200
400 400
50 50
50 50
0 0
50 50
500 500
0 0
10 10
0 0
0 0
0 0
0 0
200 200
100 100
0 0
 0 0
200 200
0 0
0 0
0 0
5 5
0 0
0 0
80 80
0 0
300 300
100 100
3 3
2 2
0 0
10 10
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
50 50
0 0
100 100
0 0
0 0
0 0
0 0
0 0
50 50
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 200
0 0
0 0
0 0
0 0
400 400
0 0
0 0
0 0
0 0
0 0
0 0
0 0
80 80
0 0
200 200
0 0
0 0
0 0
0 0
0 0
200 200
30 30
0 0
200 200
0 0
800 800
100 100
300 300
0 0
0 0
0 0
100 100
200 200
0 0
400 400
1000 1000
0 0
0 0
0 0
0 0
500 500
0 0
120 120
300 300
 0 0
100 100
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
1 1
0 0
2 2
15 15
2 2
0 0
0 0
0 0
9 9
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
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
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
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
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
90 90
200 200
0 0
0 0
4 4
0 0
0 0
0 0
2 2
0 0
1 1
20 20
20 20
0 0
9 9
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5 5
20 20
0 0
350 350
650 650
0 0
40 40
0 0
0 0
 5 5
10 10
0 0
0 0
0 0
18 18
8 8
5 5
0 0
1 1
40 40
0 0
0 0
1 1
1 1
0 0
1 1
4 4
8 8
4 4
0 0
0 0
0 0
1 1
3 3
100 100
0 0
0 0
150 150
0 0
0 0
5 5
0 0
0 0
0 0
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

Cikidang,
Penanggung Jawab

…………………………………….
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN
PUSKESMAS CIKIDANG
KECAMATAN CIKIDANG
ALAMAT JALAN RAYA CIKIDANG KM 19
NAMA OBAT/SEDIAAN SEDIAAN
NO STOK AWAL PENERIMAAN

A SERUM
1 ABU ampul 1
2 ATS ampul 0
B BHP GIGI 0
1 Temporary filling materail pcs 0
2 Glass Ionomer Cement kit A3 pcs 0
3 Coat bond pcs 0
4 Brilliant NG pcs 0
5 Eugenol botol 1
C CAIRAN 0
1 Air untuk injeksi (Aqua pro injeksi) 20 ml Botol 5
2 Glukosa Larutan infus 5% steril 500 ml Botol 3
3 Natrium Klorida lart.infus 0,9% steril - 500 ml Botol 35
4 Ringer Laktat larutan infus steril - 500 ml Botol 40
D OBAT 0
1 Allupurinol 100 mg Tablet Tab 0
2 Aminofillin inj 24 mg /ml-10ml ampul 0
3 Aminophylin tablet 200mg Tab 0
4 Amitriptilin HCl tablet salut 25 mg Tab 0
5 Amlodipin 10 mg Tab 200
6 Amoksisilin Kaplet 500 mg Kaplet 400
7 Amoksisilin Kapsul 250 mg Kapsul 50
8 Amoksisilin sirup kering 125 mg/5 ml Botol 50
9 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 0
10 Antasida Suspensi 60 ml Botol 50
11 Antasida DOEN tablet kombinasi Tab 500
12 Anti fungi DOEN komb sk tube 0
13 Anti Hemoroid DOEN kombinasi supp 10
14 Antimigren DOEN kombinasi Tab 0
15 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab 0
16 Asam Askorbat (Vit.C) tablet 50 mg Tab 0
17 Asam folat tablet 0.4 mg Tab 0
18 Asam mefenamat 500 mg Kaplet 200
19 Asetyl sestein 200mg kapsul 100
20 Asiklovir Tablet 400 mg Tab 0
21 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml ampul 0
22 Attalpugite tab 600 mg Tab 200
23 Benzatin Benzil Penisilin inj.1.2 juta IU/vial ampul 0
24 Betahistin maleat Tab 0
25 Betametasone Krim 0.1% tube 0
26 Bisakodil Supp 10 mg supp 5
27 Bisoprolol tablet tablet 0
28 Captopril 12,5 mg Tab 0
29 Captopril tablet 25 mg Tab 80
30 Deksametason injeksi 5 mg/ml - 1 ml ampul 0
31 Deksametasone tablet 0.5mg Tab 300
32 Diasepam 2 mg tablet Tab 100
33 Diazepam Inj 5 ml/2ml ampul 3
34 Diazepam lar rektal 5mg/2,5ml tube 2
35 Dietilkarbamazin sitrat tablet 100 mg Tab 0
36 Difenhidramin HCl injeksi 10 mg/ml - 1 ml ampul 10
37 Digoksin tablet 0,25 mg Tab 0
38 Doksisiklin 100 mg ampul 0
39 Domperidon tablet 10 mg Tab 0
40 Epinefrina (adrenalin) injeksi 0,1% - 1 ml ampul 2
41 Erytromycin 250 mg Kapsul 0
42 Etambutol HCL 250 mg Tab 0
43 Fenitoin Na kaps 100 mg Kapsul 0
44 Fenobarbital injeksi 50 mg/ml - 2 ml ampul 0
45 Fenobarbital tablet 30 mg Tab 0
46 Fenofibrat kaps 100 mg Kapsul 0
47 Fenoksimetil Penisilina tablet 500 mg Tab 0
48 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 0
49 Furosemid tablet 40 mg Tab 50
50 Gentamisin tetes mata Botol 0
51 Glibenklamid tablet 5 mg Tab 100
52 Glimepiride tab 0
53 Griseofulvin tablet 125 mg, micronized Tab 0
54 Hidroklorotiazid (HCT) tablet 25 mg Tab 0
55 Hidrokortison krim 2,5 % tube 0
56 Ibuprofen Suspensi 100mg 5ml botol 0
57 Ibuprofen tablet 400 mg Tab 50
58 Isoniazid tablet 300 mg Tab 0
59 Isosorbid Dinitrat 5 mg tablet sublingual Tab 0
60 Kalsium Glukonat Inj 100 mg/ml ampul 0
61 Kalsium lakate (kalk) tablet Tab 0
62 Karbamazepin tablet 200 mg Tab 0
63 Karbogliserin Tetes Telinga 10% Botol 0
64 Ketokonazol krim 2 % tube 0
65 Ketokonazol Tablet 200 mg Tab 0
 66 Klindamicin 150 mg Kapsul 200
67 Klopidogrel tab 75 mg Tab 0
68 Kloramfenikol Kapsul 500 mg Kapsul 0
69 Kloramfenikol salep kulit 2% (bufacetin) tube 0
70 Kloramfenikol Salep Mata 1% - 3,5 gr Botol 0
71 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 400
72 Klorpromazin HCL tablet 25 mg Tab 0
73 Klorpromazin inj. 25 mg/ml ampul 0
74 Kodein HCl tablet 10 mg Tab 0
75 Kotrimoksazol forte tablet Tab 0
76 Kotrimoksazol 480 tablet tab 0
77 Kotrimoksazol suspensi kombinasi Botol 0
78 Lansoprazol 30 mg Tab 0
79 Lidokain inj. 2% ampul 80
80 Lidokain komp. injeksi kombinasi ampul 0
81 Loratadin tab 10 mg Tab 200
82 Mebendazol tablet 0
83 Metformin tablet 500 mg Tab 0
84 metil dopa tab 250 mg Tab 0
85 Metilergometrin Maleat injeksi 0,200 mg - 1ml ampul 0
86 Metilergometrin Maleat tablet salut 0,125 mg Tab 0
87 Metilprednisolon tablet 4 mg Tab 200
88 Metoklorpropamid tablet 10 mg Tab 30
89 Metronidazol sirup 125mg/5ml Botol 0
90 Metronidazol tablet 500 mg Tab 200
91 Miconazol SK tube 0
92 Natrium bikarbonat tablet 500 mg Tab 800
93 Natrium Diklofenac 50 mg Tab 100
94 Nifedifin tablet 30 mg Tab 300
95 Nistatin 100.000 IU/gram tablet vaginal supp 0
96 Nistatin tablet salut gula 500.000 IU/g Tab 0
97 Oksitetrasiklin HCl salep 3% - 5 gram tube 0
98 Omeprazol 20 mg Tab 100
99 Ondansentron tab 8 mg Tab 200
100 parasetamol drop Botol 0
101 Parasetamol Kaplet 500 mg Tab 400
102 Parasetamol sirup Botol 1000
103 Permetrin/scabimite krim 5 % tube 0
104 Pirantel Pamoat tablet 125 mg Tab 0
105 Pirazinamid tablet 500 mg Tab 0
106 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 0
107 Prednison tablet 5 mg Tab 500
108 Propranolol HCl tablet 40 mg Tab 0
109 Ranitidin Injeksi 25 mg/ml ampul 120
110 Ranitidin tablet 150 mg Tab 300
 111 Rifampisin Kapsul 600 mg Kapsul 0
112 Salbutamol tablet 2 mg Tab 100
113 Salep 2 - 4 kombinasi tube 0
114 Setirizin sir 5 mg/ 5 ml Botol 0
115 Sianokobalamin (Vitamin B12) 50 mg Tab 0
116 Simvastatin 20 mg Tab 0
117 Teofilin tab 150 mg Tab 0
118 Tetrasiklin HCl Kapsul 500 mg Kapsul 0
119 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 0
120 Vitamin B komplek tablet Tab 0
121 Terbutaline sulfat ih 2.5 mg/ml ampul 0
122 Budesonid ih .5 mg/ml ampul 0
E ADDITIONAL OBAT 0
124 Amlodipin 5 mg tab 0
125 Amoxicillin 100 mg/ml drops botol 0
126 Asam Traneksamat Injeksi Ampul 0
127 Asiclovir 200 mg Tab 0
128 Asiclovir krim Tube 0
129 Bisakodil Tablet Tab 0
130 Ciprofloksasin 500 mg tablet Tab 0
131 Domperidon Sirup Btl 0
132 Furosemid Injeksi Ampul 0
133 Guaifenesin tab Tab 0
134 Kloramfenikol Tetes telinga botol 0
135 Multivitamin Dewasa Tab 0
137 Multivitamin Sirup Tab 0
136 Obat Batuk Hitam Tube 1
138 Oksitosin injeksi ampul 0
139 Ondansentron injeksi Ampul 2
140 Salbutamol inhaler ampul 15
141 Sefadroksil Kapsul 500 mg KAPSUL 2
142 Sefadroksil syrup 125 mg Botol 0
143 Sefadroksil Syrup 250 mg BOTOL 0
144 Setirizin Tab Tab 0
145 Sulfadiazine silver krim (Luka Bakar) Tube 9
OBAT PROGRAM 0
A MALARIA 0
1 Artesunate injeksi, vial 60 mg vial 0
2 Primakuin tablet 15 mg tablet 0
3 Kina tablet 200 mg tablet 0
4 Kina injeksi 25% - 2 ml ampul 0
5 Doksisiklin kapsul 100 mg kapsul 0
6 DHP (Dehidro Artemisin + Piperaquin) Tablet tablet 0
0
B FILARIASIS 0
1 DEC tablet 100 mg tablet 0
2 Albendazol tablet 400 mg tablet 0
3 Albendazol Sirup 200 mg/5 ml botol 0
0
C PENGENDALIAN PENYAKIT MENULAR (P2M) 0
1. DIARE 0
1 Garam oralit kantong 0
2 Zinc tablet 20 mg tablet 0
3 zink sirup botol 0
2. KUSTA 0
1 Prednison tablet 5 mg tablet 0
3. FRAMBUSIA 0
1 Azithromycin 500 mg tablet 0
0
D TB PARU (OAT FDC) 0
OAT FDC 0
1 Obat Anti Tuberculosis FDC kategori 1 paket 0
2 Obat Anti Tuberculosis FDC kategori 2 paket 0
3 Obat Anti Tuberculosis FDC anak paket 0
0
F AIDS PMS 0
1 Efavirenz tab 600 mg tablet 0
2 Lopinavir 200 mg + Ritonavir 50 mg tablet 0
3 Lopinavir 100 mg + Ritonavir 25 mg tablet 0
4 Nevirapin 200 mg tablet 0
5 Tenofovir tab 300 mg tablet 0
6 Zidovudin Kaps 100 mg kapsul 0
7 Lamivudin tab 150 mg tablet 0
8 Kombinasi Zidovudin 300 mg + Lamivudin 150 mg tablet 0
9 Efavirenz tab 200 mg tablet 0
10 Abacavir kaps 300 mg tablet 0
11 Tenofovir 300 mg + Emiricitabine 200 mg Tab tablet 0
12 Zidovudin 60 mg +Lamivudine 30 mg + Nevirapine 50 tablet 0
13 Tenofovir 300 mg + Lamivudin 300 mg + Efivirenz 60 tablet 0
14 Rilpivirine Tab 25 mg tablet 0
15 Zidovudine Syr 10 mg/ml botol 0
0
G KESEHATAN JIWA 0
1 Haloperidol dekanoat inj 50 mg/ml ampul 0
2 Klobazam 10 mg tablet tablet 0
3 Amitripilin HCL 25 mg tablet tablet 0
4 Klorpromazin 100 mg tablet tablet 0
5 Risperidon 2 mg Tablet tablet 0
 6 Klozapin 25 mg tablet tablet 0
7 Trifluoperazine HCL 5 mg tablet tablet 0
8 Haloperidol inj 5 mg/ml ampul 0
9 Imipramin HCL 25 mg tablet tablet 0
10 Fluoksetin 10 mg tablet tablet 0
11 Triheksifenidil 2 mg tab tablet 0
12 Haloperidol 5 mg tablet tablet 0
0
H VAKSIN RABIES 0
1 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster 0
2 Serum antirabies inj 200 UI/ml 0
0
I GIZI 0
1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul 0
2 Bayi (6 -(Vitamin
Retinol 11 bulan)
A) 200.000 IU Kapsul Lunak kapsul 0
3 Balita (11 - 59 bulan)
Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul 0
4 Ibu Nifas
Tablet Tambah Darah (Ibu Hamil) tablet 0
5 Tablet Tambah Darah (Remaja Putri) tablet 0
6 Mineral Mix sachet 0
0
J KESEHATAN IBU 0
1 Oksitosin Injeksi 10 IU/ml ampul 0
2 Metil Ergometrin Maleat injeksi 0,2 mg/ml ampul 0
3 Magnesium Sulfat Injeksi 40% ampul 0
4 Kalsium Glukonat Injeksi 10% ampul 0
5 Ampisilin Injeksi 1000 mg/vial vial 0
6 Gentamisin Injesi 40 mg/ml ampul 0
7 Metronidazol infus 5 mg/ml botol 0
0
K KESEHATAN ANAK 0
1 Fitomenadion (vit K1) injeksi 2 mg/ml ampul 0
2 Levotiroksin 50 mcg tablet 0
3 Oksitetrasiklin HCL Salep mata 1% tube 0
4 Ampicilin serb injeksi 1000 ml/vial ampul 0
5 Gentamisin injeksi 40 mg/ml ampul 0
6 Fenobarbital injeksi 50 mg/ml ampul 0
7 Diazepam injeksi 5 mg/ml ampul 0
0
L LANSIA 0
1 Risedronat kapsul 0
0
M IMUNISASI 0
1 Vaksin Hepatitis B vial 0
2 Vaksin BCG vial 0
 3 Vaksin Polio 10 ds vial 0
4 Vaksin DT vial 0
5 Vaksin Td vial 0
6 (Kelas
Vaksin2Td
SD) vial 0
7 (WUS)
Vaksin IPV vial 0
8 Vaksin DPT-HB-Hib vial 0
9 (Bayi)
Vaksin DPT-HB-Hib vial 0
10 (Baduta)
Vaksin MR vial 0
11 (Bayi)
Vaksin MR vial 0
12 (Baduta)
Vaksin HPV vial 0
13 Vaksin Pneumokokkus vial 0
14 Vaksin JE vial 0
A BMHP 0
1 Alat suntik sekali pakai 1 ml Pcs 90
2 Alat suntik sekali pakai 3 ml Pcs 200
3 Alat suntik sekali pakai 5 ml Pcs 0
4 alat suntik sekali pakai 10 ml pcs 0
5 Alkohol Swab box 4
6 autodisable no 0,05 ml Pcs 0
7 autodisable no. 0,5 ml Pcs 0
8 bloodset Pcs 0
9 Catgut Chromic 2/0 + jarum 1/2 HR 26 mm Pcs 2
10 Catgut Chromic 3/0 + jarum 1/2 HR 26 mm Pcs 0
11 ECG/USG jelly 82gr Pcs 1
12 Folley Catheter 2 way no 16 Pcs 20
13 Folley Catheter 2 way no 18 Pcs 20
Handscoon Non Steril 0
14 Ukuran L Pcs 9
15 Ukuran M Pcs 0
16 Ukuran S Pcs 0
Handscoon steril 0
17 Ukuran 6.5 Pcs 0
18 Ukuran 7.0 Pcs 0
19 Ukuran 7.5 Pcs 0
20 ID Patient Adult/Dewasa Biru Pcs 0
21 ID Patient Adult/Dewasa Pink Pcs 0
22 Infusion set anak Pcs 5
23 Infusion set dewasa Pcs 20
24 IV Catheter G - 18 Pcs 0
25 IV Catheter G - 20 Pcs 350
26 IV Catheter G - 22 Pcs 650
27 Kapas 250 gr Pcs 0
28 Kasa hidrofil 16x16 (steril) box 40
29 Kasa Kompres 40/40 steril Pcs 0
30 Kasa Pembalut 2 m x 80 cm Pcs 0
31 kasa pembalut hydrofil 40 cm x 80 cm Pcs 5
Masker 10
32 Tie on dus 0
33 Hijab dus 0
34 masker oksigen pcs 0
35 Plester Pcs 18
36 Plester Polifix 5 cm x 1 m Pcs 8
37 Policrepe Pembalut Elastis 7,5 cm x 4,55 m Roll 5
38 Silk 2/0 + jarum 1/2 GT 35 mm Pcs 0
39 Silk 3/0 + jarum 1/2 GT 35 mm Pcs 1
40 Urine bag Pcs 40
41 pot sampel pcs 0
B DESINFECTAN 0
1 Alkohol 70% - 1000 ml Btl 1
2 Antiseptik Hand Rub 500 ml Btl 1
3 cairan sterilisasi alat btl 0
4 Lisol 1 liter Btl 1
5 Povidon Iodida 300 ml Btl 4
6 Povidon Iodida 30 ml Btl 8
7 Rivanol larutan 0,1% - 300 cc Btl 4
C ADDITIONAL BHP 0
1 Bioplasenton tulle Pcs 0
2 Bisturi No. 11 box 0
3 Catgut Chromic 2/0 + Jatum 1/2 HR 20 mm pcs 1
4 Catgut Chromic 3/0 + Jatum 1/2 HR 20 mm pcs 3
5 Cuticell pcs 100
6 Dental Anastesi Citoject box 0
7 Handscoon Obgyn pairs 0
8 IV Catheter - G -24 pcs 150
9 IV Catheter G-26 PCS 0
10 kapas gigi pack 0
11 Kassa hydrofil 3 yard x 10 cm pack 5
12 Kassa hydrofil 3 yard x 15 cm pack 0
13 Kassa hydrofil 40 yard x 80 cm roll 0
14 Lidi Waten Steril box 0
15 masker karet box 0
16 Microfor box 0
17 Polifix 10 cm x 5 m roll 0
18 Polifix 5 cm x 5 m roll 2
19 Pot Sputum Steril pcs 0
20 Povidone Iodida 60 ml Btl 0
21 SD Bioline HCG pcs 0
22 SD Urocolor For Urinalysis pcs 0
23 Silk 4/0 DS 12 mm pcs 0
24 Silk 4/0 DS 19 mm pcs 0
25 Silk 4/0 HR 20 mm pcs 0
26 Silk 5/0 DS 16 mm pcs 0
27 Umbilical Cord Clamps pcs 0

Mengetahui,
Pimpinan UPTD Puskesmas Cikidang
Kabupaten Sukabumi

Asep Gumelar, SKM., M.Si.

AR PERMINTAAN OBAT (LPLPO)
BULAN NOVEMBER
TAHUN 2021

PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

1 1
0 0
0 0
0 0
0 0
0 0
0 0
1 1
0 0
5 5
3 3
35 35
40 40
0 0
0 0
0 0
0 0
0 0
200 200
400 400
50 50
50 50
0 0
50 50
500 500
0 0
10 10
0 0
0 0
0 0
0 0
200 200
100 100
0 0
 0 0
200 200
0 0
0 0
0 0
5 5
0 0
0 0
80 80
0 0
300 300
100 100
3 3
2 2
0 0
10 10
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
50 50
0 0
100 100
0 0
0 0
0 0
0 0
0 0
50 50
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 200
0 0
0 0
0 0
0 0
400 400
0 0
0 0
0 0
0 0
0 0
0 0
0 0
80 80
0 0
200 200
0 0
0 0
0 0
0 0
0 0
200 200
30 30
0 0
200 200
0 0
800 800
100 100
300 300
0 0
0 0
0 0
100 100
200 200
0 0
400 400
1000 1000
0 0
0 0
0 0
0 0
500 500
0 0
120 120
300 300
 0 0
100 100
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
1 1
0 0
2 2
15 15
2 2
0 0
0 0
0 0
9 9
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
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
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
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
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
90 90
200 200
0 0
0 0
4 4
0 0
0 0
0 0
2 2
0 0
1 1
20 20
20 20
0 0
9 9
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
5 5
20 20
0 0
350 350
650 650
0 0
40 40
0 0
0 0
 5 5
10 10
0 0
0 0
0 0
18 18
8 8
5 5
0 0
1 1
40 40
0 0
0 0
1 1
1 1
0 0
1 1
4 4
8 8
4 4
0 0
0 0
0 0
1 1
3 3
100 100
0 0
0 0
150 150
0 0
0 0
5 5
0 0
0 0
0 0
0 0
0 0
0 0
2 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

Cikidang,
Penanggung Jawab

…………………………………….
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN
PUSKESMAS CIKIDANG
KECAMATAN CIKIDANG
ALAMAT JALAN RAYA CIKIDANG KM 19
NAMA OBAT/SEDIAAN SEDIAAN
NO STOK AWAL PENERIMAAN

A SERUM
1 ABU ampul 0
2 ATS ampul 0
B BHP GIGI 0
1 Temporary filling materail pcs 0
2 Glass Ionomer Cement kit A3 pcs 0
3 Coat bond pcs 0
4 Brilliant NG pcs 0
5 Eugenol botol 0
C CAIRAN 0
1 Air untuk injeksi (Aqua pro injeksi) 20 ml Botol 0
2 Glukosa Larutan infus 5% steril 500 ml Botol 0
3 Natrium Klorida lart.infus 0,9% steril - 500 ml Botol 0
4 Ringer Laktat larutan infus steril - 500 ml Botol 0
D OBAT 0
1 Allupurinol 100 mg Tablet Tab 0
2 Aminofillin inj 24 mg /ml-10ml ampul 0
3 Aminophylin tablet 200mg Tab 0
4 Amitriptilin HCl tablet salut 25 mg Tab 0
5 Amlodipin 10 mg Tab 0
6 Amoksisilin Kaplet 500 mg Kaplet 0
7 Amoksisilin Kapsul 250 mg Kapsul 0
8 Amoksisilin sirup kering 125 mg/5 ml Botol 0
9 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 0
10 Antasida Suspensi 60 ml Botol 0
11 Antasida DOEN tablet kombinasi Tab 0
12 Anti fungi DOEN komb sk tube 0
13 Anti Hemoroid DOEN kombinasi supp 0
14 Antimigren DOEN kombinasi Tab 0
15 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab 0
16 Asam Askorbat (Vit.C) tablet 50 mg Tab 0
17 Asam folat tablet 0.4 mg Tab 0
18 Asam mefenamat 500 mg Kaplet 0
19 Asetyl sestein 200mg kapsul 0
20 Asiklovir Tablet 400 mg Tab 0
21 Atropin Sulfat injeksi 0,25 mg/ml - 1 ml ampul 0
22 Attalpugite tab 600 mg Tab 0
23 Benzatin Benzil Penisilin inj.1.2 juta IU/vial ampul 0
24 Betahistin maleat Tab 0
25 Betametasone Krim 0.1% tube 0
26 Bisakodil Supp 10 mg supp 0
27 Bisoprolol tablet tablet 0
28 Captopril 12,5 mg Tab 0
29 Captopril tablet 25 mg Tab 0
30 Deksametason injeksi 5 mg/ml - 1 ml ampul 0
31 Deksametasone tablet 0.5mg Tab 0
32 Diasepam 2 mg tablet Tab 0
33 Diazepam Inj 5 ml/2ml ampul 0
34 Diazepam lar rektal 5mg/2,5ml tube 0
35 Dietilkarbamazin sitrat tablet 100 mg Tab 0
36 Difenhidramin HCl injeksi 10 mg/ml - 1 ml ampul 0
37 Digoksin tablet 0,25 mg Tab 0
38 Doksisiklin 100 mg ampul 0
39 Domperidon tablet 10 mg Tab 0
40 Epinefrina (adrenalin) injeksi 0,1% - 1 ml ampul 0
41 Erytromycin 250 mg Kapsul 0
42 Etambutol HCL 250 mg Tab 0
43 Fenitoin Na kaps 100 mg Kapsul 0
44 Fenobarbital injeksi 50 mg/ml - 2 ml ampul 0
45 Fenobarbital tablet 30 mg Tab 0
46 Fenofibrat kaps 100 mg Kapsul 0
47 Fenoksimetil Penisilina tablet 500 mg Tab 0
48 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 0
49 Furosemid tablet 40 mg Tab 0
50 Gentamisin tetes mata Botol 0
51 Glibenklamid tablet 5 mg Tab 0
52 Glimepiride tab 0
53 Griseofulvin tablet 125 mg, micronized Tab 0
54 Hidroklorotiazid (HCT) tablet 25 mg Tab 0
55 Hidrokortison krim 2,5 % tube 0
56 Ibuprofen Suspensi 100mg 5ml botol 0
57 Ibuprofen tablet 400 mg Tab 0
58 Isoniazid tablet 300 mg Tab 0
59 Isosorbid Dinitrat 5 mg tablet sublingual Tab 0
60 Kalsium Glukonat Inj 100 mg/ml ampul 0
61 Kalsium lakate (kalk) tablet Tab 0
62 Karbamazepin tablet 200 mg Tab 0
63 Karbogliserin Tetes Telinga 10% Botol 0
64 Ketokonazol krim 2 % tube 0
65 Ketokonazol Tablet 200 mg Tab 0
 66 Klindamicin 150 mg Kapsul 0
67 Klopidogrel tab 75 mg Tab 0
68 Kloramfenikol Kapsul 500 mg Kapsul 0
69 Kloramfenikol salep kulit 2% (bufacetin) tube 0
70 Kloramfenikol Salep Mata 1% - 3,5 gr Botol 0
71 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 0
72 Klorpromazin HCL tablet 25 mg Tab 0
73 Klorpromazin inj. 25 mg/ml ampul 0
74 Kodein HCl tablet 10 mg Tab 0
75 Kotrimoksazol forte tablet Tab 0
76 Kotrimoksazol 480 tablet tab 0
77 Kotrimoksazol suspensi kombinasi Botol 0
78 Lansoprazol 30 mg Tab 0
79 Lidokain inj. 2% ampul 0
80 Lidokain komp. injeksi kombinasi ampul 0
81 Loratadin tab 10 mg Tab 0
82 Mebendazol tablet 0
83 Metformin tablet 500 mg Tab 0
84 metil dopa tab 250 mg Tab 0
85 Metilergometrin Maleat injeksi 0,200 mg - 1ml ampul 0
86 Metilergometrin Maleat tablet salut 0,125 mg Tab 0
87 Metilprednisolon tablet 4 mg Tab 0
88 Metoklorpropamid tablet 10 mg Tab 0
89 Metronidazol sirup 125mg/5ml Botol 0
90 Metronidazol tablet 500 mg Tab 0
91 Miconazol SK tube 0
92 Natrium bikarbonat tablet 500 mg Tab 0
93 Natrium Diklofenac 50 mg Tab 0
94 Nifedifin tablet 30 mg Tab 0
95 Nistatin 100.000 IU/gram tablet vaginal supp 0
96 Nistatin tablet salut gula 500.000 IU/g Tab 0
97 Oksitetrasiklin HCl salep 3% - 5 gram tube 0
98 Omeprazol 20 mg Tab 0
99 Ondansentron tab 8 mg Tab 0
100 parasetamol drop Botol 0
101 Parasetamol Kaplet 500 mg Tab 0
102 Parasetamol sirup Botol 0
103 Permetrin/scabimite krim 5 % tube 0
104 Pirantel Pamoat tablet 125 mg Tab 0
105 Pirazinamid tablet 500 mg Tab 0
106 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 0
107 Prednison tablet 5 mg Tab 0
108 Propranolol HCl tablet 40 mg Tab 0
109 Ranitidin Injeksi 25 mg/ml ampul 0
110 Ranitidin tablet 150 mg Tab 0
 111 Rifampisin Kapsul 600 mg Kapsul 0
112 Salbutamol tablet 2 mg Tab 0
113 Salep 2 - 4 kombinasi tube 0
114 Setirizin sir 5 mg/ 5 ml Botol 0
115 Sianokobalamin (Vitamin B12) 50 mg Tab 0
116 Simvastatin 20 mg Tab 0
117 Teofilin tab 150 mg Tab 0
118 Tetrasiklin HCl Kapsul 500 mg Kapsul 0
119 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 0
120 Vitamin B komplek tablet Tab 0
121 Terbutaline sulfat ih 2.5 mg/ml ampul 0
122 Budesonid ih .5 mg/ml ampul 0
E ADDITIONAL OBAT 0
124 Amlodipin 5 mg tab 0
125 Amoxicillin 100 mg/ml drops botol 0
126 Asam Traneksamat Injeksi Ampul 0
127 Asiclovir 200 mg Tab 0
128 Asiclovir krim Tube 0
129 Bisakodil Tablet Tab 0
130 Ciprofloksasin 500 mg tablet Tab 0
131 Domperidon Sirup Btl 0
132 Furosemid Injeksi Ampul 0
133 Guaifenesin tab Tab 0
134 Kloramfenikol Tetes telinga botol 0
135 Multivitamin Dewasa Tab 0
137 Multivitamin Sirup Tab 0
136 Obat Batuk Hitam Tube 0
138 Oksitosin injeksi ampul 0
139 Ondansentron injeksi Ampul 0
140 Salbutamol inhaler ampul 0
141 Sefadroksil Kapsul 500 mg KAPSUL 0
142 Sefadroksil syrup 125 mg Botol 0
143 Sefadroksil Syrup 250 mg BOTOL 0
144 Setirizin Tab Tab 0
145 Sulfadiazine silver krim (Luka Bakar) Tube 0
OBAT PROGRAM 0
A MALARIA 0
1 Artesunate injeksi, vial 60 mg vial 0
2 Primakuin tablet 15 mg tablet 0
3 Kina tablet 200 mg tablet 0
4 Kina injeksi 25% - 2 ml ampul 0
5 Doksisiklin kapsul 100 mg kapsul 0
6 DHP (Dehidro Artemisin + Piperaquin) Tablet tablet 0
0
B FILARIASIS 0
1 DEC tablet 100 mg tablet 0
2 Albendazol tablet 400 mg tablet 0
3 Albendazol Sirup 200 mg/5 ml botol 0
0
C PENGENDALIAN PENYAKIT MENULAR (P2M) 0
1. DIARE 0
1 Garam oralit kantong 0
2 Zinc tablet 20 mg tablet 0
3 zink sirup botol 0
2. KUSTA 0
1 Prednison tablet 5 mg tablet 0
3. FRAMBUSIA 0
1 Azithromycin 500 mg tablet 0
0
D TB PARU (OAT FDC) 0
OAT FDC 0
1 Obat Anti Tuberculosis FDC kategori 1 paket 0
2 Obat Anti Tuberculosis FDC kategori 2 paket 0
3 Obat Anti Tuberculosis FDC anak paket 0
0
F AIDS PMS 0
1 Efavirenz tab 600 mg tablet 0
2 Lopinavir 200 mg + Ritonavir 50 mg tablet 0
3 Lopinavir 100 mg + Ritonavir 25 mg tablet 0
4 Nevirapin 200 mg tablet 0
5 Tenofovir tab 300 mg tablet 0
6 Zidovudin Kaps 100 mg kapsul 0
7 Lamivudin tab 150 mg tablet 0
8 Kombinasi Zidovudin 300 mg + Lamivudin 150 mg tablet 0
9 Efavirenz tab 200 mg tablet 0
10 Abacavir kaps 300 mg tablet 0
11 Tenofovir 300 mg + Emiricitabine 200 mg Tab tablet 0
12 Zidovudin 60 mg +Lamivudine 30 mg + Nevirapine 50 tablet 0
13 Tenofovir 300 mg + Lamivudin 300 mg + Efivirenz 60 tablet 0
14 Rilpivirine Tab 25 mg tablet 0
15 Zidovudine Syr 10 mg/ml botol 0
0
G KESEHATAN JIWA 0
1 Haloperidol dekanoat inj 50 mg/ml ampul 0
2 Klobazam 10 mg tablet tablet 0
3 Amitripilin HCL 25 mg tablet tablet 0
4 Klorpromazin 100 mg tablet tablet 0
5 Risperidon 2 mg Tablet tablet 0
 6 Klozapin 25 mg tablet tablet 0
7 Trifluoperazine HCL 5 mg tablet tablet 0
8 Haloperidol inj 5 mg/ml ampul 0
9 Imipramin HCL 25 mg tablet tablet 0
10 Fluoksetin 10 mg tablet tablet 0
11 Triheksifenidil 2 mg tab tablet 0
12 Haloperidol 5 mg tablet tablet 0
0
H VAKSIN RABIES 0
1 Vaksin rabies, untuk manusia serb inj (s.k./i.k) + booster 0
2 Serum antirabies inj 200 UI/ml 0
0
I GIZI 0
1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul 0
2 Bayi (6 -(Vitamin
Retinol 11 bulan)
A) 200.000 IU Kapsul Lunak kapsul 0
3 Balita (11 - 59 bulan)
Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul 0
4 Ibu Nifas
Tablet Tambah Darah (Ibu Hamil) tablet 0
5 Tablet Tambah Darah (Remaja Putri) tablet 0
6 Mineral Mix sachet 0
0
J KESEHATAN IBU 0
1 Oksitosin Injeksi 10 IU/ml ampul 0
2 Metil Ergometrin Maleat injeksi 0,2 mg/ml ampul 0
3 Magnesium Sulfat Injeksi 40% ampul 0
4 Kalsium Glukonat Injeksi 10% ampul 0
5 Ampisilin Injeksi 1000 mg/vial vial 0
6 Gentamisin Injesi 40 mg/ml ampul 0
7 Metronidazol infus 5 mg/ml botol 0
0
K KESEHATAN ANAK 0
1 Fitomenadion (vit K1) injeksi 2 mg/ml ampul 0
2 Levotiroksin 50 mcg tablet 0
3 Oksitetrasiklin HCL Salep mata 1% tube 0
4 Ampicilin serb injeksi 1000 ml/vial ampul 0
5 Gentamisin injeksi 40 mg/ml ampul 0
6 Fenobarbital injeksi 50 mg/ml ampul 0
7 Diazepam injeksi 5 mg/ml ampul 0
0
L LANSIA 0
1 Risedronat kapsul 0
0
M IMUNISASI 0
1 Vaksin Hepatitis B vial 0
2 Vaksin BCG vial 0
 3 Vaksin Polio 10 ds vial 0
4 Vaksin DT vial 0
5 Vaksin Td vial 0
6 (Kelas
Vaksin2Td
SD) vial 0
7 (WUS)
Vaksin IPV vial 0
8 Vaksin DPT-HB-Hib vial 0
9 (Bayi)
Vaksin DPT-HB-Hib vial 0
10 (Baduta)
Vaksin MR vial 0
11 (Bayi)
Vaksin MR vial 0
12 (Baduta)
Vaksin HPV vial 0
13 Vaksin Pneumokokkus vial 0
14 Vaksin JE vial 0
A BMHP 0
1 Alat suntik sekali pakai 1 ml Pcs 0
2 Alat suntik sekali pakai 3 ml Pcs 0
3 Alat suntik sekali pakai 5 ml Pcs 0
4 alat suntik sekali pakai 10 ml pcs 0
5 Alkohol Swab box 0
6 autodisable no 0,05 ml Pcs 0
7 autodisable no. 0,5 ml Pcs 0
8 bloodset Pcs 0
9 Catgut Chromic 2/0 + jarum 1/2 HR 26 mm Pcs 0
10 Catgut Chromic 3/0 + jarum 1/2 HR 26 mm Pcs 0
11 ECG/USG jelly 82gr Pcs 0
12 Folley Catheter 2 way no 16 Pcs 0
13 Folley Catheter 2 way no 18 Pcs 0
Handscoon Non Steril 0
14 Ukuran L Pcs 0
15 Ukuran M Pcs 0
16 Ukuran S Pcs 0
Handscoon steril 0
17 Ukuran 6.5 Pcs 0
18 Ukuran 7.0 Pcs 0
19 Ukuran 7.5 Pcs 0
20 ID Patient Adult/Dewasa Biru Pcs 0
21 ID Patient Adult/Dewasa Pink Pcs 0
22 Infusion set anak Pcs 0
23 Infusion set dewasa Pcs 0
24 IV Catheter G - 18 Pcs 0
25 IV Catheter G - 20 Pcs 0
26 IV Catheter G - 22 Pcs 0
27 Kapas 250 gr Pcs 0
28 Kasa hidrofil 16x16 (steril) box 0
29 Kasa Kompres 40/40 steril Pcs 0
30 Kasa Pembalut 2 m x 80 cm Pcs 0
31 kasa pembalut hydrofil 40 cm x 80 cm Pcs 0
Masker 0
32 Tie on dus 0
33 Hijab dus 0
34 masker oksigen pcs 0
35 Plester Pcs 0
36 Plester Polifix 5 cm x 1 m Pcs 0
37 Policrepe Pembalut Elastis 7,5 cm x 4,55 m Roll 0
38 Silk 2/0 + jarum 1/2 GT 35 mm Pcs 0
39 Silk 3/0 + jarum 1/2 GT 35 mm Pcs 0
40 Urine bag Pcs 0
41 pot sampel pcs 0
B DESINFECTAN 0
1 Alkohol 70% - 1000 ml Btl 0
2 Antiseptik Hand Rub 500 ml Btl 0
3 cairan sterilisasi alat btl 0
4 Lisol 1 liter Btl 0
5 Povidon Iodida 300 ml Btl 0
6 Povidon Iodida 30 ml Btl 0
7 Rivanol larutan 0,1% - 300 cc Btl 0
C ADDITIONAL BHP 0
1 Bioplasenton tulle Pcs 0
2 Bisturi No. 11 box 0
3 Catgut Chromic 2/0 + Jatum 1/2 HR 20 mm pcs 0
4 Catgut Chromic 3/0 + Jatum 1/2 HR 20 mm pcs 0
5 Cuticell pcs 0
6 Dental Anastesi Citoject box 0
7 Handscoon Obgyn pairs 0
8 IV Catheter - G -24 pcs 0
9 IV Catheter G-26 PCS 0
10 kapas gigi pack 0
11 Kassa hydrofil 3 yard x 10 cm pack 0
12 Kassa hydrofil 3 yard x 15 cm pack 0
13 Kassa hydrofil 40 yard x 80 cm roll 0
14 Lidi Waten Steril box 0
15 masker karet box 0
16 Microfor box 0
17 Polifix 10 cm x 5 m roll 0
18 Polifix 5 cm x 5 m roll 0
19 Pot Sputum Steril pcs 0
20 Povidone Iodida 60 ml Btl 0
21 SD Bioline HCG pcs 0
22 SD Urocolor For Urinalysis pcs 0
23 Silk 4/0 DS 12 mm pcs 0
24 Silk 4/0 DS 19 mm pcs 0
25 Silk 4/0 HR 20 mm pcs 0
26 Silk 5/0 DS 16 mm pcs 0
27 Umbilical Cord Clamps pcs 0

Mengetahui,
Pimpinan UPTD Puskesmas Cikidang
Kabupaten Sukabumi

Asep Gumelar, SKM., M.Si.

AR PERMINTAAN OBAT (LPLPO)
BULAN DESEMBER
TAHUN 2021

PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
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0 0
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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
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0 0
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0 0
0 0
0 0
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0 0
0 0
0 0
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0 0
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0 0
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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
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
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0 0
0 0
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0 0
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0 0
0 0
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Cikidang,
Penanggung Jawab

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