LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

OBAT ( LPLPO )

PUSKESMAS : WAWOTOBI DOKUMEN NOMOR TANGGAL

KECAMATAN : WAWOTOBI DINKES KOTA

PROVINSI : SULTRA PELAPORAN BULAN DESEMBER 2018 GUDANG KOTA

KABUPATEN : KONAWE PERMINTAAN BULAN   JANUARI 2019 PUSKESMAS

STOK
No NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR PERMINTAAN PEMBERIAN KETERANGAN
A%AL

1 2 3 4 5 6 7 8 11 12  

OBAT

1 Alopurinol tal!t 100 "# Tal!t $00 1000 1%$00 1

10
00 1%
1 %&00 (1,180)

2 Alopurinol tal!t &00 "# Tal!t &00 0 &00 ' &00 (300)
& A"ro()ol tal!t &0 "# Tal!t *00 1*00 2%000 *00 1%*00 (900)
$ A"ino+illin tal!t 200 "# Tal!t 200 0 200 ' 200 (200)
* A"lo,ipin tal!t * "# Tal!t ' 1200 1%200 1%200 ' 1,0
- A"lo,ipin tal!t 10 "# Tal!t ' -00 -00 ' -00 (!00)
. A"o()ilin (apl!t *00 "# Kapl!t 1
1%%000 2000 &%000 &%000 ' 3,!00

8 A"o()ilin )irup (!rin# 12* "#/ * "l ' -0 "l Botol 100 0 100 .0 &0 "
9 A"o()ilin )irup (!rin# 2*0 "#/ * "l ' -0 "l Botol ' 0 ' ' ' "0

 Anta)i,a DOEN I tal!t (un<a=% (o"ina)i  Alu"iniu"

10 Tal!t $%$00 0 $%$00 -00 &%800 (3,080)
i,ro()i,a 200 "# 3 Ma#n!)iu" i,ro()i,a 200 "#

11 Anta)i,a DOEN II )u)p!n)i% (o"ina)i Botol 20 *0 .0 .0 ' 8

12 Anti !""oroi, DOEN (o"ina)i Supp 10 0 10 10 ' 11
1& Anti+un#i DOEN (o"ina)i ot $8 0 $8 ' $8 (8)
1$ Anti"i#r!n  Er#ota"in Tartrat 1 "# 3 Ko+!in *0 "# Tal!t ' 0 ' ' ' 100
1* A4ua pro in5!()i )t!ril% !a) piro#!n 2* "l 6ial 20 0 20 ' 20 (20)
1- A)a" A)!til)ali)ilat tal!t 80 "# Tal!t ' 0 ' ' ' #
1. A)a" A)(orat 76ita"in  tal!t *0 "# Tal!t 1%000 1*00 2%*00 2%*00 ' 3,000
18 A)a" M!+!na"at (apl!t *00 "# Kapl!t 1%*00 0 1%*00 1%000 *00 $00
19 A)i(lo:ir tal!t 200 "# Botol *00 0 *00 ' *00 ("00)
20 A)i(lo:ir tal!t $00 "# Tal!t *00 0 *00 ' *00 ("00)
20 Atropin in5!()i i;";/i;:;/);(; 0%2* "#/"l 7)ul+at ' 1 "l A"pul 0 ' ' ' #
 

21 A)a" >olat Tal!t ' 0 ' ' ' "00

22 Ba?itra?in Tu! ' 2* 2* ' 2* (2")
B!)i II Sul+at 200 "# 3 A)a" >olat 0%2* "# 7tal!t ta"a=
2& Tal!t 21%0-0 0 21%0-0 &00 20%.-0 (20,00)
,ara= (o"ina)i
2$ B!ta=i)tin M!)ilat tal!t - "# Tal!t &00 0 &00 ' &00 (300)
2* B!ta"!ta)on Kri" 0;1 @ 7)!a#ai :al!rat ' * #r Tu! *0 0 *0 2* 2* 3
2- Bio AT Tal!t ' 0 ' ' ' !00
2. Bi)a?o,<l Tal!t 90 120 210 ' 210 (210)

28 Bu)?opan Tal!t Tal!t ' 0 ' ' ' 300

29 !
!tiriin Tal!t Tal!t ' 1200 1%200 1%200 ' 1,0
&0 !tiriin S<rup Botol 20 0 20 ' 20 (20)
&0 ?o"i:!nt :ial * 0 * * ' !
&1 D!()a"!ta)on in5!()i * "#/"l'1"l A"pul *. 0 *. 20 &. (1")
&2 D!()a"!ta)on tal!t 0%* "# Tal!t 1%000 *00 1%*00 1%*00 ' 1,800

&& Di+!n=i,ra"in in5!()i 10 "#/"l / ETADRL A"pul 8 0 8 ' 8 (8)

&$ D!Ctral Tal!t Tal!t -00 0 -00 &00 &00 !0
&$ D!Ctro+!n )irup Botol *0 0 *0 ' *0 ("0)
&* D
D!!)oCi"!ta)on! Kr!" 0%2* @ Tu! ' 0 ' ' ' 10
&- Di
Di#o()in tal!t 0%2* "# Tal!t ' 0 ' ' ' 100
&. Do"p!ri,on S<rup Botol *0 0 *0 *
*00 ' ""
&8 Dul?olaC ana( )uppo 18 0 18 ' 18 (18)
&9 Epin!+rin 7 A,r!nalin  in5!()i 0%1 @ A"pul &0 0 &0 ' &0 (30)
$0 Eritro"i)in (ap)ul *00 "# Kap)ul ' 0 ' ' ' 100
$1 Eta(ri,in 7Ri:anol Larutan 0%1 @ ' &00 "l Botol * 0 * * ' !
$2 >ito"!na,ion76it; K1 in5!()i A"pul &0
&0 0 &0 ' &0 (30)
$& >ito"!na,ion76it; K1 tal!t )alut #ula 10 "# Tal!t *00 0 *00 100 $00 (290)
$$ >u
> uro)!"i, tal!t $0 "# Tal!t ' 200 200 ' 200 (200)
$* ara" Oralit I )!ru(% (o"ina)i Sa?= *0
*00 0 *00 200 &00 (!0)
$- !"+iroil &00 "# (ap)ul Kap)ul ' *00 *00 *00 ' ""0
$. 
!
!nta"i?in t!t!) Mata otol 2$ 0 2$ ' 2$ (2)
$. !nta"<?in )al!p "ata 0%&@ Tu! ' 0 ' ' ' 2
$8 li!n(la"i, tal!t * "# Tal!t ' 1*00 1%*00 ' 1%*00 (1,"00)
$9 li)!ril uaia(olat tal!t 100 "# Tal!t 2%*00 0 2%*00 2%200 &00 2,30
*0 lu?o)! Larutan In+u) *@ )t!ril ' *00 "l Kol+ 20 0 20 ' 20 (20)
*1 ri)!o+ul:in tal!t 12* "# Tal!t -00 0 -00 200 $00 (180)
 

*2 i,ro(lortiai, 7T tal!t 2* "# Tal!t ' 0 ' ' ' 1,000
*& i,ro(orti)on (ri" 2%* @ ' * #r Tu! .2 0 .2 $8 2$ 29
*$ Iupro+!n S<rup Botol ' *0 *0 ' *0 ("0)
** Iupro+!n tal!t 200 "# Tal!t ' &000 &%000 2%*00 *00 2,"00
*- I
Iupro+!n tal!t $00 "# Tal!t ' 0 ' ' ' 1,000
*. Int!rin S<rup Botol ' &0 &0 ' &0 (30)
*8 I)o)ori, ,initrat 7ISDN tal!t )ulin#ual * "# Tal!t ' 0 ' ' ' 100
*9 Kal)iu" la(tat 7Kal( tal!t *00 "# Tal!t .00 0 .00 .00 ' $$0
-0 Kaptopril tal!t 12%* "# Tal!t 1%000 0 1%000 200 800 ("80)
-1 Kaptopril tal!t 2* "# Tal!t *00 1000 1%*00 &00 1%200 (80)
-2 K!to(onaol tal!t 200 "# Tal!t ' &00 &00 ' &00 (300)
-& K!to(onaol! Kr!" Tu! &0 0 &0 ' &0 (30)
-$ K!torola( In5!()i A"pul $0 0 $0 ' $0 (0)
-* Klin,a"i)in (ap)ul &00 "# Kap)ul 20
200 0 200 ' 200 (200)
-- Klora"+!ni(ol (ap)ul 2*0 "# Kap)ul ' 0 ' ' ' #
-. Klora"+!ni(ol )u)p!n)i 12* "#/*"l ' -0 "l Botol *0 0 *0 ' *0 ("0)
-8 Klora"+!ni(ol t!t!) t!lin#a & @ ' * "l Botol ' 0 ' ' ' "0
-9 Klor+!nira"in "al!at 7TM tal!t $ "# Tal!t 1%000 1-00 2%-00 1%$00 1%200 80
Kotri"o()aol DOEN I 7,!a)a (o"ina)i  Sul+a"!to()aol
.0 Tal!t 1%-00 0 1%-00 1%-00 ' 1,920
$00 "# 3 Tri"!topri" 80 "#

.1 Kotri"o()aol DOEN II 7p!,riati( (o"ina)i  Sul+a"!to()aol Tal!t ' 0 ' ' ' "00
100 "# 3 Tri"!topri" 20 "#
Kotri"o()aol Su)p!n)i (o"ina)i  Sul+a"!to()aol 200 "# 3
.2 Botol ' 100 100 -* &* 3$
Tri"!topri" $0 "#/ * "l ' -0 "l

Li,o(ain ?o"p in5!()i 7Li,o?ain 2@ 7l 3 Epin!+rin 1 

.& A"pul -0 &0 90 90 ' 108
80;000 ' 2 "l
.$ Lop!ra"i, tal!t 2 "# Tal!t ' .00 .00 ' .00 ($00)
.* L
Loorata,in tal!t 10 "# Tal!t *00 0 *00 *00 ' ""0
.- M!loCi?a" (ap)ul ' 1000 1%000 1%000 ' 1,200
.. M!ta"piron 7Antal#in tal!t *00 "# Tal!t ' 0 ' ' ' #
.8 M!t+or"in l tal!t *00 "# Tal!t $00 1000 1%$00 -00 800 (80)
.9 M!til!r#o"!trin Mal!at 7M!til!r#o"!trin tal!t )alut 0%12* "# Tal!t *00 0 *00 ' *00 ("00)
.9 "!t=<l !r#o"!trin in5!()i a"pul 100 0 100 ' 100 (100)
.9 M!t=<l pr!,ni)olon tal!t ' 1000 1%000 1%000 ' 1,"00
.9 M!
M!to?=lopra"i,! Tal!t ' 1000 1%000 ' 1%000 (1,000)
 

.9 M!troni,aol! )irup otol 20 0 20 ' 20 (20)

.9 M!troni,aol in+u) otol 9 0 9 ' 9 (9)
.9 M
M!!troni,aol tal!t *00 "# Tal!t ' 0 ' ' ' "00
80 Mi(onaol (ri"/ )al!p 2 @ 7Nitrat ' 10 #r Tu! ' 0 ' ' ' 2
81 Multi:it Sirup ' -0 "l / ro?ur"a lu) Botol ' 0 ' ' ' "0
u : rup ' "
81 Botol ' *0 *0 *0 ' 100
)iru
82 Multi:it Tal!t / B!?!+ort tal!t Tal!t ' 0 ' ' ' 1,000
8& Natriu" Di(lo+!na( tal!t *0 "# Tal!t 2*0 *00 .*0 ' .*0 ($"0)
8$ Natriu" Klori,a larutan in+u) 0%9@ ' *00 "l Kol+ 1* 0 1* 1* ' 0
8* Ni+!,ipin tal!t 10 "# Tal!t ' 0 ' ' ' 200
8- Ni)tatin tal!t )alut *00;000 IU/# Tal!t ' 0 ' ' ' #
8- N
Nii)tatin ,rop)7 NNDIA BOTOL 1* 0 1* ' 1* (1")
8. Ni)tatin :a#inal tal!t 100;000 IU/# Tal!t 100 100 200 ' 200 (200)
88 Oat atu( ita" 7OB airan '100 "l non Al(o=ol Botol ' 0 ' ' ' 20
89 O()it!tra)i(lin l )al!p (ulit & @ ' * #r Tu! ' 0 ' ' ' 2"
90 O()it!tra)i(lin l )al!p "ata 1 @ ' * #r Tu! ' 2* 2* * 20 (1")
100 O"!praol (ap)ul 20 "# Kap)ul ' 1200 1%200 -00 -00 120
100 O"!prool! in+u) otol ' $ $ ' $ ()
101 apa:!rin tal!t $0 "# Tal!t ' 0 ' ' ' 1,000
102 ara)!ta"ol ,rop) 1* "l Botol ' 20 20 ' 20 (20)
10& ara)!ta"ol )irup 120 "# / *"l ' -0 "l Botol *0 *0 100 100 ' 120
10$ a
 ara)!ta"ol tal!t *00 "# Tal!t .00 .*00 8%200 2%.00 *%*00 (2,2!0)
10* ara)!ta"ol tal!t 100 "# Tal!t ' 0 ' ' ' #
10* para?!ta"ol in+u) otol * 0 * ' * (")
10- iri,o()in 76ita"in B- tal!t 10 "# 7l Tal!t ' 1000 1%000 1%000 ' 1,100
10. oli(r!)ul!n 7(on,!n)a)i 10 "l / ATIL/ALBOTL Botol ' 0 ' ' ' #
108 on?olin D S<rup Botol ' 0 ' ' ' 30
109 
o
o:i,on Io,i,a larutan 10 @ ' &0 "l Botol 1* 0 1* 1* ' 18
110 r
r!,ni)on tal!t * "# Tal!t 1
1%%000 *00 1%*00 1%*00 ' 1,800
111 ropanolol Tal!t 100 0 100 ' 100 (100)
111 
rropiltioura)il tal!t 100 "# Tal!t &00 0 &00 &00 ' 330
112 Ra
Raniti,in tal!t 1*0 "# Tal!t *00 1000 1%*00 1%100 $00 920
112 Raniti,in in5!()i A"pul 20 0 20 ' 20 (20)
11& R
Riin#!r La(tat larutan in+u) ' *00 "l Kol+ 10 $0 *0 *0 ' !0
 

11$ airan KAEN&B Botol 2* 0 2* * 20 (1")

11* Saluta"ol tal!t $ "# 7)!a#ai )ul+at Tal!t ' *00 *00 ' *00 ("00)
Sal!p 2'$ (o"ina)i  A)a" Sali)ilat 2 @ 3 B!l!ran# !n,ap $
11- ot 28 0 28 28 ' 31
@ ' &0 #r 
11. Sali)il B!,a( 2 @ ' *0 #r Kota( ' 20 20 20 ' 22
118 S!
S!+a,ro()il Kap)ul *00 "# Kap)ul ' 1*00 1%*00 1%*00 ' 1,800
119 S!+a,ro()il )irup (!rin# Botol $8 0 $8 $8 ' "3
120 S!+ota()i" In5!()i A"pul ' 0 ' ' ' # '

121 Siano(oala"in 7:ita"in B12 tal!t *0 "?# Tal!t ' 0 ' ' ' #
122 Si":a)tatin tal!t 10 "# Tal!t ' 0 ' ' ' 1,000
12& Si":a)tatin tal!t 20 "# Tal!t 100 *00 -00 -00 ' $20
12$ Sip
iprro+lo()a
()a)in tal!t *00 "# 7)!a#ai l Tal!t 1 %0
%000 *00 1%*00 ' 1%*00 (1,"00)
12* Sul+a)!ta"i,a Natriu" t!t!) "ata 1* @ ' * "l Botol ' 0 ' ' ' #
12- S!+i()i" S<rup Botol ' 0 ' ' ' 10

12. T!tra)i(lin Kap)ul 2*0 "# Kap)ul ' 0 ' ' ' #
128 T!tra)i(lin (ap)ul *00 "# Kap)ul ' *00 *00 *00 ' ""0
129 Tia"in 76ita"in B1 tal!t *0 "# 7l/ Nitrat Tal!t ' 0 ' ' ' 1,000
1&0 6
6iita"in B Ko"pl!() tal!t Tal!t ' *000 *%000 *%000 ' !,000
1&1 Fin? tal!t 20 "# Tal!t 1%000 0 1%000 .00 &00 $0
1&2 S?
S ?ai"it! Kri" ' !r"!trin Kri" * @ Tu! Tu! ' 0 ' ' ' 10

1&& !ntian 6iol!t Botol ' 0 ' ' ' 10

OBAT PROGRAM TB PARU
1&$ Oat >D Kat!#ori 1 pa(!t - 0 - ' - (!)
1&* Oat >D Kat!#ori 2 a(!t ' 0 ' ' ' #
1&- Oat >D Ana( a(!t 1 0 1 ' 1 (1)
1&. Oat >D Si)ipan a(!t ' 0 ' ' ' #

1&. ot ,a=a( otol $0 0 $0 $0 ' 8

1&. Sli,! oC 2 0 2 ' 2 (2)
OBAT PROGRAM KECACINGAN
1&. Al
Al!n,aol! tal!t $00 "# Tal!t &00 0 &00 200 100 10
1&8 
iirant!l tal!t )?or! 7a)! 12* "# Tal!t ' 0 ' ' ' 100
1&9 irant!l S<rup Botol ' 0 ' ' ' 30

OBAT PROGRAM GI&I

1$0 R!tinol 76ita"in A 100;000 IU (ap)ul luna( Kap)ul 2*0 0 2*0 ' 2*0 (2"0)
1$1 R!tinol 76ita"in A 200;000 IU (ap)ul luna( Kap)ul &00 0 &00 ' &00 (300)
 

1$2 Io,iu" t!)t Botol ' 0 ' ' ' 20

OBAT KE'I%AAN
1$2 Alpraola" tal!t 1 "# Tal!t ' 0 ' ' ' #
1$& Dia!pa" tal!t 2 "# Tal!t ' 200 200 100 100 20
1$$ Dia!pa" tu! R!?tal * "#/"l / STESOLID Tu! r!?tal ' * * * ' !
1$* Dia!pan in5!()i * "# /"l ' 2 "l A"pul ' 0 ' ' ' 10
1$- Lu"inal Tal!t ' 0 ' ' ' 100
OBAT GIGI
1$. KM Botol ' 0 ' ' ' #
1$8 D
D!
!:itali)a)i a)ta 7Non Ar)!n Btl / (t( 1 0 1 ' 1 (1)
1$9 Etil =lori,a )pra< ' 100 "l Botol ' 0 ' ' '
1*0 Eu#!nol ?airan ' 1* "l Botol ' 0 ' ' ' #
1*1 l
 la)) Iono"!r !"!nt ART 7IG / >UJI IG S!t ' 0 ' ' ' #
1*2 Kal)iu" i,ro()i,a pa)ta / ALIDO K Kal)iu" i,ro()i,a p S!t ' 0 ' ' #
1*& Mu""i+<in# a)ta / Io,o+or" Btl / (t( ' 0 ' ' ' #
1*$ S!"!n S!n# >o)+at 7o,!r &0 #r% Li4ui, 10 "l S!t ' 0 ' ' ' #
1** Sil:!r A"al#a" Botol ' 0 ' ' ' #
1*- T!"porar< Stoppin# >l!t?=!r S!ru( 7o,!r ot ' 0 ' ' ' #
1*. li,o?ain pu"p )pra< otol * 0 * ' * ("00)
PERBEKALAN KESEHATAN
1*. A
Allat Sunti( )!(ali pa(ai 0%0* "l ?) 100 0 100 100 ' 110
1*8 Al
Alat Sunti( )!(ali pa(ai 0%* "l ?) 200 0 200 ' 200 (200)
1*9 Alat Sunti( )!(ali pa(ai 1 "l ?) ' 0 ' ' ' 100
1-0 Alat Sunti( )!(ali pa(ai & "l ?) ' 200 200 190 10 218
1-1 Alat Sunti( )!(ali pa(ai * "l ?) 280 0 280 &0 2*0 (21$)
1-2 B!
B !nan# B!,a= at#ut No; &/0 DS &0 MM Sa)!t ' 0 ' ' ' #
1-& B!
B !nan# B!,a= at#ut No; &/0 R &0 MM Sa)!t 2$ 0 2$ 22 2 2
1-$ B!
B!nan# B!,a= at#ut No;&/0 R 2- MM Sa)!t ' 0 ' ' ' #
1-* B!
B !nan# B!,a= Sil( Bla?( &/0 DS 2$ MM a))!t! ' 0 ' ' ' 2
1-- B
B!!nan# B!,a= Sil( Bla?( &/0 R &0 MM Sa?= 12 0 12 12 ' 2
1-. Etanol .0 @ ' 1 L Botol ' 0 ' ' ' "
1-8 Etanol .0 @ ' 100 "l Botol/100"l 1* 0 1* 12 & 11
1-9 >oll!< at!t!r N0;18 ?) 8 0 8 ' 8 (8)
1.0 In+u)ion S!t Ana( ?) $0 0 $0 ' $0 (0)
 

1.1 In+u)ion S!t D!a)a ?) 20 2* $* 2* 20 10

1.2 I6; at=!t!r No;18  S!t $ 10 1$ ' 1$ (1)
1.& I6; at=!t!r No;20  S!t 2 *0 *2 1. &* (1")
1.$ I6; at=!t!r No;22  S!t $ 20 2$ 1* 9 9
1.* I6; at=!t!r No;2$  S!t 20 0 20 ' 20 (20)
1.- Kapa) !"alut / a)or!n 2*0 #ra" Bun#(u) ' 0 ' ' ' 10
1.. Kapa) !"alut / a)or!n 100 #ra" Bun#(u) 8 0 8 8 ' 10
1.8 Ka))a i,ro+il St!ril u(; 1- C 1- Kota( 10 20 &0 &0 ' 3!
1.9 Ka))a i,ro+il u(; &- " C $0 ?" / $0 <ar, C 80 ?" Roll ' 2 2 2 ' 2
180 Ka
Ka))a p!"alut =i,ro+il 2 " C 80 ?" Roll 10 10 20 20 ' 2
181 Larutan Eo)in Botol ' 0 ' ' ' #
182 Larutan i"a Botol ' 0 ' ' ' #
18& Larutan M!t=anol Botol ' 0 ' ' ' #
18$ Larutan E"!r)ion Oil Botol ' 0 ' ' ' #
18* Ma)(!r Kota( 2*0 100 &*0 &10 $0 332
18* "a)(!r tali (ota( 100 0 100 20
20 80 ("!)
18* "a)(!r N9* S 20 20 $0 ' $0 (000)
18- RDT Malaria/Malaria T!)t oC 2 0 2 ' 2 (2)
18. l!)t!r * <ar, G 2 in?= Roll $ 0 $ $ ' 12
188 Sarun# Tan#an No; -%* ?) ' 0 ' ' ' "0
189 Sarun# Tan#an No; .%* ?) ' *0 *0 ' *0 ("0)
190 Sarun# tan#an No;. p?) *0 0 *0 ' *0 ("0)
191 Sa
Sarun# Tan#an Non )t!ril u(;M S 100 100 200 200 ' 20
191 S
Sa
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190 Win# N!!,l! N0;21 ?) ' 0 ' ' ' #
192 K!rta) u<!r ri" 1& 0 1& 1& ' 1!
19& )a( Oat pa( ' 10 10 2 8 (!)
191 Al(o=ol Sa p?) 100 100 200 ' 200 (200)
191 Boo* L+-./ p?) ' $00 $00 &00 100 2!0
191 -+./ Bo BoC 1 0 1 ' 1 (1)
191 U"li?al or, p?) *0 0 *0 ' *0 ("0)
192 Rapit t!)t I6 oC ' .* .* ' .* ($")
192 OL l!an otol & * 8 * & 3
OBAT PONED
 

11- M#SO$ 20 @ in5!()i Botol 29$ 0 29$ ' 29$ (29)

11. M#SO$ $0 @ in5!()i Botol ' 0 ' ' ' #
118 O()ito)in in5!()i 10 IU/"l ' 1 "l A"pul 10 $0 *0 &0 20 1!
VAKSIN
119 ATS A"pul 0 0 ' ' ' #
120 Anti Bi)a Ular A"pul 0 0 ' ' ' #
121 :a()in B AMUL 2 1* 1. 1$ & 1"
122 6AKSIN DT'B'iB A"pul * &0 &* && 2 0
12& 6AKSIN OLIO 1& 19 &0 $9 2- 2& 8
12& 6AKSIN AMAK 1& 20 && 18 1* "
12$ 6AKSIN B UNIJEK A"pul $ 20 2$ 1$ 10 $
12* 6AKSIN TT/T, A"pul 18 10 28 1* 1& 
12- 6AKSIN I6 A"pul 0 20 20 ' 1"
12. Rai!) 6!ro 6ial 0 0 ' ' ' #

UMUM ASKES  BP'S K IS 'AMKESDA 'UMLAH

'UMLAH KUN'UNGAN RESEP
  323 "0 3 1,30!

M.4./+567  M../667 +4 M..+5;+ , +4 M.<7/+ , +4 M.<=6+/ ,

K.>++ D7+- K.-.5+/+ K+=Ko+?. K.>++ I-/++-7 @+<+-7 K+=Ko+?. K.>++ P6-;.-<+- P./64+- P6-;.-<+-

H M65 A7-SKM,MS7 M65G+-+7, SS7, A>/ S7 R./o?+/7,SKM,MK.- N674-75 '6<+/7, A<  
NIP 19"$032$ 198003 2 00! NIP 19$!1119200"1210001 NIP19$2111! 199"03 2 003 NIP 1980302 2010$ 2 00

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