DAFTAR TILIK

MONITORING KETERSEDIAAN OBAT

PUSKESMAS CIMANUK
BULAN JANUARI TAHUN 2020

NO NAMA OBAT SATUAN JUMLAH

1 Albendazol tab Tablet ADA
2 Amoxicillin 500 mg tab Tablet ADA
3 Amoxicillin syrup Botol KOSONG
4 Deksametason tab Tablet KOSONG
5 Diazepam injeksi 5 mg/mL Ampul ADA
6 Epinefrin (Adrenalin) injeksi 0,1% (sebagai
Ampul KOSONG
HCL)
7 Fitomenadion (Vitamin K) injeksi Ampul KOSONG
8 Furosemid tablet 40 mg/Hidroklorotiazid
Tablet KOSONG
(HCT)
9 Garam oralit Kantong ADA
10 Glibenklamid/Metformin Tablet ADA
11 Kaptopril tab Tablet ADA
12 Magnesium Sulfat injeksi 20 % Vial ADA
13 Metilergometrin Maleat inj 0,200 mg-1 ml Ampul KOSONG
14 Obat Anti Tuberculosis dewasa Paket ADA
15 Oksitosin injeksi Ampul ADA
16 Parasetamol 500 mg tab Tablet ADA
17 Tablet Tambah Darah Tablet KOSONG
18 Vaksin BCG Vial ADA
19 Vaksin DPT/ DPT-HB/ DPT-HB-Hib Vial ADA
20 Vaksin Td Vial ADA

Cimanuk, 2 februari 2020

Kepala UPT Puskesmas DTP cimanuk Pengelola obat

dr. Rita Permatasari Deden Arditia Nurjaman S.si.,Apt

NIP : 19810920 200902 2 002 NIP : 19861213 201101 1 005
aman S.si.,Apt
01101 1 005
 LAPORAN BULANAN PENGGUNAAN ATS
PUSKESMAS CIMANUK
MENU BULAN : JANUARI 2020

PENGGUNAAN
STOK JUMLAH
NO PENERIMAAN NAMA
AWAL PERSEDIAAN UMUR ALAMAT
PASIEN
1 - 10 10

JUMLAH

Kepala UPT Puskesmas DTP cimanuk

dr. Rita Permatasari

NIP : 19810920 200902 2 002
NAAN ATS
K
0

ENGGUNAAN
SISA
KET
JUMLAH PETUGAS STOK

10

Cimanuk, 2 februari 2020

Pengelola obat

Deden Arditia Nurjaman S.si.,Apt

NIP : 19861213 201101 1 005
 LAPORAN BULANAN PENGGUNAAN ABU
PUSKESMAS CIMANUK
MENU BULAN : JANUARI 2020

PENGGUNAAN
STOK JUMLAH
NO PENERIMAAN NAMA
AWAL PERSEDIAAN UMUR ALAMAT JUMLAH
PASIEN
1 4 2 6

MENU

JUMLAH 0

Kepala UPT Puskesmas DTP cimanuk

dr. Rita Permatasari

NIP : 19810920 200902 2 002
BU

AN
SISA
KET
PETUGAS STOK

Cimanuk, 2 februari 2020

Pengelola obat

Deden Arditia Nurjaman S.si.,Apt

NIP : 19861213 201101 1 005
 LAPORAN BULANAN PSIKOTROPIKA
PUSKESMAS CIMANUK
MENU BULAN : JANUARI 2020

NO NAMA OBAT STOK PENERIMAAN JUMLAH PEMAKAIAN STOK

AWAL PERSEDIAAN AKHIR
3 4 5 6 7
1 2
(3+4) (5-6)

1 Alprazolam tab 0 0 0 0 0

2 Amitriptilin 25 mg 585 585 150 435

3 Carbamazepine 200 mg 340 0 340 250 90

Chlorpromazine hcl 100

4 280 400 680 165 515
mg

5 Clobazam 10 mg 30 0 30 0 30

6 Clozapine 25 mg 0 500 500 0 500

Diazepam Rektal 0,5 mg

7 0 10 10 0 10
/ 2 ml

8 Divalproexsodium 75 0 75 0 75

9 Fluoksetin 10 mg 0 0 0 0 0

Fluphenazine decanoat
10 0 0 0 0 0
inj 25 mg

11 Haloperidol 1,5 mg 0 0 0 0 0

12 Haloperidol 2 mg 360 300 660 156 504

Haloperidol decanoat inj

13 5 0 5 0 5
50 mg

14 Imipramicine hcl 25 mg 0 0 0 0 0

15 Phenobarbital 30 mg 600 0 600 0 600

16 Risperidon 2 mg 375 300 675 662 13

17 Shizonat injek 0 22 0 22 0

Trifluouperazine HCl 5
18 0 0 0 0 0
mg

19 Trihexipenidil 2 mg 260 300 560 405 155

Kepala UPT Puskesmas DTP cimanuk

dr. Rita Permatasari

NIP : 19810920 200902 2 002
TROPIKA
UK
020

PERMINTAAN PEMBERIAN

8 9
 Cimanuk, 2 februari 2020
Pengelola obat

Deden Arditia Nurjaman S.si.,Apt

NIP : 19861213 201101 1 005
 DAFTAR
10 BESAR PEMAKAIAN OBAT TERBANYAK
PUSKESMAS CIMANUK
BULAN JANUARI TAHUN 2020

NO NAMA OBAT SATUAN JUMLAH

1 Paracetamol tablet 500 mg tab 17600
2 Amoksisilin Tablet 500 mg tab 15200
3 ANTASIDA DOEN Tablet tab 10500
4 Klorfeniramin maleat (ctm) tablet 4 mg tab 7000
5 Vitamin B komplek tab 6000
6 Prednison Tablet 5 mg tab 5400
7 Obat Batuk Flu ( Molexflu ) tab 3750
8 Deksametason tablet 0,5 mg tab 3400
9 Amlodipin Besilate 5 mg tab 3280
10 Tiamin Tablet 50 mg ( B1 ) tab 3100

Cimanuk, 2 februari 2020

Kepala UPT Puskesmas DTP cimanuk Pengelola obat

dr. Rita Permatasari Deden Arditia Nurjaman S.si.,Apt

NIP : 19810920 200902 2 002 NIP : 19861213 201101 1 005
an S.si.,Apt
101 1 005
 LAPORAN PEMAKAIAN DAN LEMBA
PUSKES
PUSKESMAS : CIMANUK
KECAMATAN : CIMANUK
KAB / KOTA : PANDEGLANG PELAPORAN BULAN / PERIODE : JANUARI 2020
PROVINSI : BANTEN

Penerimaan
N0 NAMA OBAT SATUAN Stok Awal
DAK
1 2 3 4 5

1 Alprazolam Tablet -
2 Albendazol Tablet 400 mg Tablet -
3 Allopurinol tablet 100 mg Tablet 1,000
4 Ambroxol sirup Botol
5 Ambroxol tablet 30 mg Tablet -
6 Aminofilin Tablet 200 mg Tablet -
7 Aminofilina injeksi 24 mg/ml - 10 ml Ampul -
8 Amlodipin 10 mg Tablet 900 5,700
9 Amlodipin Besilate 5 mg Tablet 1,000 7,200
10 Amoksisilin Forte sirup kering 125mg Botol -
11 Amoksisilin Injeksi 1 gr Vial -
12 Amoksisilin Tablet 500 mg Tablet 5,000 16,000
13 Amoksisillin kapsul 250 mg Kapsul -
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol
15 Ampisilin Injeksi 1 gr Vial -
16 Analog insulin Long Acting Pen -
17 Analog insulin Mix Acting Pen -
18 Antalgin (Metampiron) tablet 500 mg Tablet -
19 Antalgin (Metampiron) tablet 500 mg Tablet -
20 Antasida DOEN suspensi Botol 50 100
21 ANTASIDA DOEN Tablet Tablet 7,700 13,000
22 Anti Bakteri DOEN ( Bacitrasin ) Tube -
23 anti hemoroid doen kombinasi supp -
24 Antifungi DOEN Tube -
25 Antimigren DOEN Kombinasi : Tablet -
26 Antiparkinson DOEN tablet Kombinasi : Tablet -
27 Antiparkinson Tablet ( Levopar ) Tablet -
28 Aqua Pro Injeksi Vial 14 -
29 Artermeter injeksi Ampul -
30 Artesunate injeksi 60 mg/ml vial -
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 1,500
32 Asam Folat Botol 400 -
33 Asam Fusidat Cream Tube -
34 Asam Klorida 0,1 N Botol -
35 Asam Mefenamat 500 mg Tablet
36 Asam Traneksamat Inj 5% Ampul 15 40
37 Asering Botol -
38 Asetosal tablet 500 mg Tablet -
39 Asetyl Cysteine Capsul -
40 Asiklovir Cream 5% Tube -
41 Asiklovir tablet 200 mg Tablet 300 -
42 Asiklovir tablet 400 mg Tablet 850 -
43 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul 90 -
44 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Vial -
45 Atropin Sulfat tablet 0,5 mg Tablet -
46 Berotec Metered Aerosol 100 mg Bok -
47 Betadine Salep Antiseptik 5 mg Tube -
48 Betametason krim 0,1 % Tube 200
49 Bisakodil Suppositoria supp -
50 Bisoprolol 2,5 mg Tablet -
51 Bisoprolol 5 mg Tablet -
52 Cairan Infus KN-3B Botol -
53 Cairan Infus Wida KDN 1 Botol -
54 Cairan Pembersih ( Protektor ) Botol -
55 Captopril Tablet 12,5 mg Tablet 1,000
56 Captopril Tablet 25 mg Tablet -
57 Cefadroxil Capsul 500 mg Capsul -
58 Cefixime Capsul 100 mg Capsul -
59 Cefixime Sirup Botol -
60 Cefotaksime 1 gr Injeksi Vial -
61 Cetirizine Capsul 50 mg Capsul 1,500
62 Cetirizine sirup 5 mg/5 ml Botol -
63 Ciprofloxcacin 500 mg tablet Tablet -
64 Combivent UDV 2,5 mg+0,5mg/2,5 ml Ampul 47 -
65 D-Artepp tablet Tablet -
66 Deksametason tablet 0,5 mg Tablet 4,000
67 Dekstran 70 - larutan infus 6% steril Botol -
68 Dekstrometorfan sirup Botol -
69 Dekstrometorfan tablet 15 mg Tablet -
70 Diazepam Rektal 0,5 mg / 2 ml supp 10
71 Diazepam tablet 2 mg Tablet 72 -
72 Diazepam tablet 5 mg Tablet -
73 Difenhidramin HCL injeksi 10 mg/ml - 1ml Ampul -
74 Digoksin tablet 0,25 mg Tablet
75 Diltiazem Tablet -
76 Doksisiklin Kapsul 100 mg Capsul -
77 Domperidon 10mg Tablet Tablet 1,000
78 Domperidon Suspensi 5 mg/ 5 ml Botol 50
79 Doxicyclin 500mg capsul -
80 Efedrin HCLTablet 25 mg Tablet -
81 Epinefrina HCL/Bitartrat Injeksi Ampul 70 -
82 Eritromicyn kapsul 250 mg capsul 2,600 -
83 Erytromicin kapsul 500 mg Kapsul -
 84 Erytromicin sirup 125 mg Botol -
85 Etakridin ( Rivanol ) larutan 0,1% Botol -
86 Etambutol 500 mg Tablet -
87 Etanol 70 % Botol -
88 Etil Klorida Semprot Botol -
89 Fenitoin Natrium kapsul 30 mg Kapsul -
90 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul -
91 Fenobarbital tablet 30 mg Tablet 600 -
92 Fenoksimetil Penisilina tablet 250 mg Tablet -
93 Fenol Gliserol tetes telinga 10 % Botol -
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul -
95 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 700 -
96 Flufenazine Deconat Inj 25 mg/ml Ampul -
97 Furosemida tablet 40 mg Tablet -
98 Furosemide Injeksi Ampul -
99 Garam Oralit Sachet 20 100
100 Gemfibrozil 300 mg Tablet -
101 Gentamicin Injeksi Ampul -
102 Gentamicin Salep Kulit Tube -
103 Gentamicin Salep mata Tube -
104 Gentamicin Tetes Mata Botol -
105 Gentian Violet 1 % Botol -
106 Glibenclamid tablet 5 mg Tablet 600 -
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet -
108 Glikazid 80 mg Tablet Tablet -
109 Glimepiride 2 mg Tablet 600 -
110 Glukosa larutan infus 10% steril Botol -
111 Glukosa larutan infus 5 % steril Botol 30 -
112 Griseofulvin tablet 500 mg, Tablet 1,000
113 Guaiafenesin 100 mg Tablet -
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet 200 -
115 Hidrokortison krim 2,5% Tube 240
116 Ibuprofen Suspensi Tablet -
117 Ibuprofen tablet 200 mg Tablet -
118 Ibuprofen tablet 400 mg Tablet -
119 Imunomodulator sirup( STIMUNO) Botol -
120 Isosorbid Dinitrat tablet sublingual 5 mg Tablet 100 1,000
121 KAEN 3B Infus Botol 20
122 Kalsium Glukonas Injeksi Ampul 47 -
123 Kalsium Laktat (Kalk) tablet 500 mg Tablet 1,000 5,000
124 Kapas Berlemak 500 mg Bungkus -
125 Ketokonazol Kream Tube 100
126 Ketokonazol Tablet 200 mg Tablet -
127 Ketorolac inj Ampul -
128 Kifadene tablet 20 mg Tablet -
129 Kloramfenikol salep mata 1 % capsul 96
130 Kloramfenikol suspensi Botol 100
131 Kloramfenikol tetes telinga 3% Tube -
132 Kloramphenicol 250 mg Capsul 300 -
133 Kloramphenicol 500 mg capsul 500
134 Kloramphenicol Tetes Mata Botol -
135 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 15,000
136 Klorokuin tablet 150 mg Tablet -
137 Klorpromazin HCL tablet salut 25 mg Tablet -
138 Kombinasi (Pirimetamin 25 mg + Solfadoxin Tablet -
139 Kotrimoksazol Dewasa Tablet 480 mg Tablet 1,000
140 Kotrimoksazol Sirup / Suspensi Botol 100
141 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul -
142 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol -
143 Lactobacilus serbuk Sachet -
144 Lidocain 2%+efinefrin injeksi Ampul -
145 Lidocain injeksi 2 ml Ampul -
146 Lisinopril 10 mg tablet Tablet -
147 Lisinopril 5 mg tablet Tablet -
148 Loperamid 4 mg tablet Tablet -
149 Lytacur Sirup Botol -
150 Magnesium Sulfat Inj. 25 ml Ampul 40 -
151 Metamizol 500 mg Tablet -
152 Metformin 500 mg Tablet Tablet 400 8,000
153 Methilprednisolon tablet 4 mg Tablet 50 -
154 Metilergometrin Maleat injeksi 1 ml Ampul -
155 Metilergometrin Maleat Tablet Tablet -
156 Metoklopramid Suspensi Botol -
157 Metoklopramid tablet Tablet -
158 Metronidazol 500 mg Tablet -
159 Metronidazol infus / injeksi Botol -
160 Metronidazol Ovula supp -
161 Metronidazol suspensi Botol -
162 Mikonazol kream Tube 96
163 Multivitamin Anak Sirup Botol 50
164 Multivitamin Dewasa Antioksidan ( Becom c ) Tablet -
165 Natrium Diklofenak 25 mg Tablet Tablet -
166 Natrium Diklofenak 50 mg Tablet Tablet 1,000 5,000
167 Natrium Klorida Cairan Infus ( NaCL ) Botol 20
168 Nifedipine Tablet 10 mg Tablet 200 -
169 Nistatin tablet vaginal 100.000 IU/g Tube -
170 Obat anti Diare suspensi Botol -
171 Obat Anti Diare Tablet (Akita / Molagit ) Tablet -
172 Obat Batuk Flu ( Molexflu ) Tablet
173 Obat Batuk Hitam (OBH) Botol -
174 Obat Batuk Sirup Herbal ( Herbacop ) Botol 96 -
175 Ofloxsacin Tetes Telinga Tube -
176 Oksitetrasiklin HCL salep mata 1% Botol -
177 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 150 -
178 Omeprazol injeksi Ampul 100
179 Omeprazol Kapsul 20 mg capsul 600
180 Ondancentron injeksi 4 mg Ampul 60
181 Ondancentron Tablet4 mg Tablet 120 -
182 Paracetamol Drop 15 ml Botol -
183 Paracetamol Sirup 120 mg/5 ml Botol 200 1,000
184 Parafin Dresing ( Bioplacenton Tull ) pcs -
185 Parasetamol tablet 100 mg Tablet -
186 Parasetamol tablet 500 mg Tablet
187 Permetrin Krim 5 % Tube 20
188 Pirantel Sirup Botol -
189 Pirantel tablet 125 mg Tablet -
190 Pirazinamid Botol -
191 Piridoksin HCL (VIT B6) tablet 10mg Botol 1,000 1,000
192 Piroksikam tablet 20 mg Tablet -
193 Polikresulen Tube -
194 Povidon lodida 10% 300 ml -
195 Povidon lodida 10% 60 ml Tablet -
196 Prazikuantel tablet 600 mg Botol -
197 Prednison Tablet 5 mg Tablet 6,000
198 Primakuin 15 mg Tablet -
199 Probenesid 500 mg tablet Tablet -
200 Prokain Benzil Penisilin 3 juta IU/vial injeksi Ampul -
201 Propanolol HCL tablet 10 mg Tablet -
202 Ranitidin injeksi Ampul 50 100
203 Ranitidin tablet Tablet
204 Resperidone 2 mg tablet Tablet -
205 Ringer Laktat cairan infus (Otsuka) 140 500
206 Ringer Laktat cairan infus (Widatra) Botol -
207 Rivanol 300 ml Botol -
208 Salbutamol Tablet 2 mg Tablet 300 200
209 Salbutamol tablet 4mg Tablet 400
210 Salep 2-4 Tube 24 24
211 Salep kombinasi cream ( Berloson ) Tube -
212 Salicil bedak Kotak -
213 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial 4 2
214 Serum Anti Tetanus inj 1500 IU ( Tetagam ) Vial 10
215 Sianokobalamin Injeksi Ampul -
216 Simvastatin 10 mg tablet Tablet 3,000
217 Simvastatin 20 mg tablet Tablet -
218 Sukralfat Suspensi Botol 50
219 Sukralfat tablet 500 mg Tablet -
220 Suspensi Seng Insulin inj.40 IU/ml - 10 ml Tube -
221 Temporary Stopping Fletcher serbuk & cairan Tablet -
222 Tetrakain HCL tetes mata 0,5% Tube -
223 Tetrasiklin 250 mg capsul capsul -
224 Tetrasiklin 500 mg capsul capsul -
225 Tiamin Tablet 50 mg ( B1 ) Tablet 1,000 8,000
226 Ventolin Nebulizer Ampul -
227 Vitamin B komplek Tablet 1,000 10,000
228 Zink sirup Botol -
229 Zink tablet 20 mg Tablet 1,000 -
OBAT PROGRAM
1 Albendazol Tablet 400 mg Tablet
2 Isoniazid Tablet 100 mg Tablet
3 Obat Antituberkulosis kategori 1 Paket 5
4 Obat Antituberkulosis Kategori 2 Paket 1
5 Obat Antituberkulosis Kategori Anak Paket 3
6 Pot Dahak Non Steril Biji
7 Pot Dahak Steril Biji
8 Reagen Ziehl Neelsen Kit
9 MDT MB Anak Tablet Tablet
10 MDT MB Dewasa Tablet Tablet
11 MDT PB Dewasa Tablet Tablet
12 MDT PB Anak Tablet Tablet
13 Retinol (Vitamin A) kapsul 200.000 IU capsul
14 Retinol (Vitamin A) kapsul 100.000 IU capsul
15 Tablet Penambah Darah ( FE ) Tablet
16 Amitriptilin tablet 25 mg Tablet 585
17 Carbamazepin 200 mg tablet Tablet 340
18 Clobazam 10 mg Tablet Tablet 30
19 Clozapine 25 mg Tablet Tablet 500
20 Fenitoin Natrium kapsul 30 mg capsul
21 Haloperidol 1,5 mg Tablet Tablet
22 Haloperidol 2 mg tablet Tablet 360 300
23 Haloperidol 5 mg Tablet Tablet
24 Haloperidol Injeksi Ampul 5
25 Klorpromazin HCL tablet salut 100 mg Tablet 280 400
26 Klorpromazine Tablet 25 mg Tablet
27 Triheksilfenidil Hcl 2 mg tablet Tablet 260 300
28 Risperidone 2 mg tablet Tablet 375 300
29 Divalproexsodium Tablet 75

NAMA BAHAN MEDIS HABIS PAKAI (BMHP )

B
1 Alat suntik 1 ml Pcs 300 100
2 Alat suntik 10 ml Pcs -
3 Alat suntik 2,5 ml Pcs -
4 Alat suntik 20 ml Pcs -
5 Alat suntik 3 cc (Remedi) 200 400
6 Alat suntik 3 ml Pcs -
7 Alat suntik 5 ml pcs -
8 Alkazide 1 L High Level Desinfectant Botol -
9 Alkazyme Sachet 25 mg Pack -
10 Alkohol 70 % 1 L Botol -
11 Alkohol swab Sachet 5
12 Anti Septik Hand Rub Botol -
13 Anti Septik Surgikal Hand Scrub Botol -
14 Cat Gut no 2/0 Sachet 36
15 Cat Gut no 3/0 Sachet 36
16 Cat Gut No 3/0 (24 mm) Sachet -
17 Cat Gut No 3/0 (26 mm) Sachet -
18 Cathetter Jelly Biji 12 -
19 Demetech Silk 3/0 Set -
20 E Care I.V Dresing Pcs -
21 E-Care Surgical Mask Tie On Lembar 50 100
22 Folly No 14 Catether pcs -
23 Folly No 16 Catether pcs 24 -
24 I.V Cathetter No. 20 Set 100
25 I.V Cathetter No. 22 Set 100
26 I.V Cathetter No. 24 Set 50 100
27 I.V Cathetter No. 26 Set 20 -
28 Infuset Anak Set 70 -
29 Infuset Dewasa Set 40
30 Jarum Insulin Tablet -
31 Kapas Berlemak 250 gr Bungkus 8 -
32 Kapas Berlemak 500 gr Bungkus -
33 Kasa 4 m x 10 cm Rol -
34 Kasa Hidrofil 36 x 80 cm Rol 2 -
35 Kasa Pembalut 2 x 80 cm Pack -
36 Kasa Steril 16 x 16 cm Kotak 50 100
37 Lisol 1 L Botol -
38 Masker karet Ear Loop Lembar 200
39 Masker tali Tube 100 -
40 Nasal Canula Oksigen Set -
41 Plester 1" Rol -
42 Plester Kertas 2,5 cm Rol -
43 Plester Non Woven 5cm x 5 cm Rol -
44 Policlean Botol -
45 Polifik Kotak
46 Saraya Alsof A 500 ml Botol -
47 Saraya Alsof Pure 500 ml Botol -
48 Sarung Tangan Gynecolog No 7 Pasang 100 -
49 Sarung tangan M (Non Steril) Pasang -
50 Sarung tangan no 6,5 Pasang -
51 Sarung tangan no 6,5 Steril Gloves Pasang -
52 Sarung tangan no 7,0 Steril Pasang -
Selang Section ( Surgikal Conection Tube with
53 yankauer) Pcs -
54 Underpad Lembar 5 -
55 Urine Bag Biji 32 10

NAMA OBAT VAKSIN

1 Vaksin Anti Rabies ( VAR ) Vial 0

2 Vaksin BCG Vial 28 5
3 Vaksin DT Vial 40
4 Vaksin HB 0 Pcs 52 50
5 Vaksin HBIG Vial 0
6 Vaksin Measless Rubella (MR) Vial 17 10
7 Vaksin Pentabio ( DPT - HB - Hib ) Vial 40 60
8 Vaksin Polio B OPV Vial 50 60
9 Vaksin Polio IPV Vial 0
10 Vaksin TD Vial 70
11 Vaksin Tuberculin Vial 0
12 ADS 0,05 ml Unit 50
13 ADS 0,5 ml Unit 560
14 ADS 5 ml Unit 37
15 Safety Box Unit 20
0
0
0
NAMA OBAT REAGEN
0
1 Albumin (Reagen) Kotak
2 anti A Monoclonal ( GolDar 10 ml) Vial
3 Anti A-B Monoclonal ( GolDar 10 ml) Vial
4 Anti B Monoclonal ( GolDar 10ml) Vial
5 Anti D Monoclonal ( GolGar 10ml) Vial
6 Benecheck Plus Cholesterol Test Strip
7 Benecheck Plus Glukosa Test Strip
8 Benecheck Plus Uric Test Strip
9 Bilirubin T/D (Reagen) Kotak
10 Brilian Green Bile Broth Kotak
11 Cellclean (CL-50) (Reagen) Kotak
12 Cellpack (PK-30L) (Reagen) Kotak
13 Chikungunya IgM (Reagen) Kotak
14 Cholesterol (Reagen) Kotak
15 Cholesterol Stik (Reagen) Kotak
16 CK-MB (Reagen) Kotak
17 Creatinin Reagen Kit
18 Dengue IgM / IgM ( Reagen ) Kotak
19 Eight Check ( LNH ) Serial
20 Febrile Antingen H Parathpy Vial
21 Febrile Antingen H-A Parathpy Vial
22 Febrile Antingen H-B Parathpy Vial
23 Febrile Antingen H-C Parathpy Vial
24 Febrile Antingen O Parathpy Vial
25 Febrile Antingen O-A Parathpy Vial
26 Febrile Antingen O-B Parathpy Vial
27 Febrile Antingen O-C Parathpy Vial
28 Glukosa Reagen Kotak
29 GOT ( ALAT ) Kotak
30 GPT ( ALAT ) Kotak
31 HBSAG Reagen Box
32 HCG Strip Vial
33 HDL Cholesterol ( Precipitan ) Kotak
34 Hematologi Calibrator (Nscs 1000 ) Botol
35 Hemoglobin Reagen Kotak
36 Lactose Broth 500 mg Botol
37 LDL Cholesterol Kotak
38 Leptospira IgM (Reagen) Kotak
39 Micropippets MT-1-up to 200 ui Pcs
40 MIcropippets MT-up to 1 ml Pcs
41 NS1 Antigen Test (Reagen) Kotak
42 Pipet Ukur 10 ml biji
43 Poch Pack D (II) Reagen Kotak
44 Poch Pack L (II) Reagen Kotak
45 Stik Uric Acid Kotak
46 Strip Narkoba 3 Parameter Kotak
47 Strip Narkoba 5 Parameter Kotak
48 Strip Narkoba 6 Parameter Kotak
49 Total Protein Kotak
50 Trigleserida Kotak
51 Urea Kotak
52 Uric Acid Kotak
0 NAMA OBAT REAGEN PROGRAM HIV
1 Rapid 1 HIV (SD Bioline ) Tes 100
2 Rapid 2 HIV (Fokus ) Tes
3 Rapid 3 HIV (Biomeriux Vikia ) Tes
4 SD Biosensore Standart Q Syphlis Tes
5 RPR Syphlis ( Fokus ) Tes
6 Reagen CD4 Control Tes
7 Reagen CD4 Mobile Tes
8 RPR Syphlis Komponen Kit
9 Anuscopy Buah
10 Kertas PH Indikator Buah
11 Rotator Buah
12 Tip. Uk.60 Bks
13 Tip. Uk.61 Bks
14 Pronto / Holder Buah

NAMA OBAT GIGI

1 Anastesi Citojek Box

2 Articulating Paper (Kertas warna penanda oklusi) Kotak
3 Bahan Tumpatan sementara Botol
4 Bonding Syringe
5 Cairan Desinfectan ( Perendaman Instrumen Gigi ) Botol
6 Cairan untuk desinfectan pembersih permukaan Botol
7 Carpule Citojek Kotak
8 Chlorfeson Kamfer menthol ( CHKM ) Cairan Botol
9 Composite Nanohibrid A1 Tube
10 Composite Nanohibrid A2 Tube
11 Composite Nanohibrid A3 Tube
12 Composite Nanohibrid A3,5 Tube
13 Devitalisasi Pasta Pot
14 Disclosing Solution Botol
15 Etcing Gel Pcs
16 Etil Klorida Semprot Botol
17 Eugenol Cairan Botol
18 Formokesol Botol
19 Gas Powred Jet Injector Botol
20 Glass Ionomer Cement ART Pot
21 Jarum citojek uk 16 mm Box
22 Kalsium Hidroksida pasta Botol
23 Klorhekdidin Larutan 2 % Botol
24 Mummifiying Fasta Botol
25 Natrium Hipoklorit airan konsentrat 5% Botol
26 Paper Points 15-40 mm Box
27 Pasta Devitalisasi ( Non Arsen ) Tube
28 Pasta Pengisi Saluran Akar Syringe
29 Semen seng Fosfat serbuk Set
30 Spon Gelatin Cubicis 1x1x1 cm (Spongostan) Botol
31 Temporary Filling Fasta Set
32 Tooth Stain Remover ( TSR ) Botol
33 Wipes Desinfektan Botol
0
0
0
0
0
KAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO )
PUSKESMAS
DOKUMEN
DINKES KAB/KOTA
/ PERIODE : JANUARI 2020 : GFK KAB/KOTA
PUSKESMAS

Penerimaan
Jumlah Jumlah
APBD PROG LAIN 2 Penerimaan Persediaan

5 6
( 4+5 ) 1 2 3 4 5 6
- - -
- - -
- 1,000 1,000
200 - 200 200
- - -
- - -
- - -
- 5,700 6,600
- 7,200 8,200
- - -
- - -
- 16,000 21,000 500 500
- - -
360 - 360 360 60
- - -
- - -
- - -
- - -
- - -
- 100 150
- 13,000 20,700
- - -
- - -
- - -
- - -
- - -
- - -
- - 14
- - -
- - -
- 1,500 1,500
- 400
- -
- - -
2,000 - 2,000 2,000
 - 40 55
- - -
- - -
- -
- - -
- - 300
- 850
- 90
- - -
- - -
- - -
- - -
- 200 200
- - -
- - -
- - -
- - -
- -
- - -
- 1,000 1,000
- - -
- - -
- - -
- - -
- - -
- 1,500 1,500
- - -
- -
- 47
- - -
- 4,000 4,000 500
- - -
- - -
- - -
10 10
- 72
- -
- - -
200 200 200
- - -
- - -
- 1,000 1,000
- 50 50
- - -
- - -
- - 70
- 2,600
- - -
- - -
- - -
- - -
- - -
- -
- - -
- -
- 600
- - -
- - -
- - -
- 700
- - -
- - -
- - -
- 100 120
- - -
- - -
- - -
- - -
- - -
- - -
- - 600
- - -
- - -
- 600
- - -
- - 30
1,000 1,000
- - -
- 200
- 240 240
- - -
- - -
- - -
- - -
1,000 1,100
20 20
- 47
5,000 6,000
- - -
100 100
- -
- - -
- - -
- 96 96
100 100
- - -
 - 300
500 500
- - -
15,000 15,000
- - -
- - -
- - -
- 1,000 1,000
- 100 100
- - -
- - -
- - -
- - -
- -
- - -
- - -
- - -
- - -
- 40
- - -
8,000 8,400
- - 50
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
96 96
50 50
- - -
- - -
- 5,000 6,000
- 20 20
- - 200
- -
- - -
- -
25 - 25 25
- - -
- - 96
- - -
- - -
- - 150
100 100
- 600 600 30
 - 60 60
- 120
- - -
- 1,000 1,200 100
- - -
- - -
18,000 - 18,000 18,000 1000 600 500 500
- 20 20
- - -
- - -
- - -
1,000 2,000
- - -
- - -
- -
- - -
- - -
- 6,000 6,000
- - -
- - -
- - -
- - -
100 150
4,000 - 4,000 4,000
- - -
- 500 640
- - -
- -
- 200 500 50
400 400
24 48
- - -
- - -
2 6
10 10
- - -
- 3,000 3,000 120 150
- - -
- 50 50
- - -
- - -
- - -
- - -
- - -
- - -
8,000 9,000
- - -
- 10,000 11,000
 - - -
- - 1,000
- -
- -
400 400 400
32 32 37
1 1
3 3
- -
- -
2 2 2
- -
- -
- -
- -
- -
- -
- -
- 585
- 340
- 30
500 500
- -
- -
300 660
- -
- 5
400 680
- -
300 560
300 675
- 75
- -
- -
100 400
- - -
- - -
- - -
400 600
- - -
- -
- - -
- - -
- -
10 10 15
- - -
- - -
36 36
 36 36
- - -
- - -
- 12
- - -
- - -
- 100 150
- - -
- - 24
100 100
100 100
100 150
- 20
- 70
120 120 160
- - -
- 8
- - -
- - -
- 2
- -
- 100 150
- -
100 100 300
- 100
- -
- - -
- - -
- -
- - -
10 10 10
- - -
- - -
- - 100
- -
- - -
- -
- - -

- - -
- - 5
10 42
- -
- -
- -
5 33
- 40
50 102
 - -
10 27
60 100
60 110
- -
- 70
- -
- 50
- 560
- 37
- 20
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
 - -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
300 300 400
- -
- -
- -
200 200 200
- -
- -
-
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
 DOKUMEN NOMOR TANGGAL
NKES KAB/KOTA
FK KAB/KOTA
USKESMAS

Pemakaian Perhari / Tanggal diloket

7
7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
0
0
500 200 0 100
50 0
0
0
0
600 0
700 600 0
0
0
1000 300 1000 1000 1600 1000 500 600 600 600
0
60 60 0 60
0
0
0
0
0
50 0
500 600 1000 500 400 600 600
0
0
0
0
0
0
6
0
0
0
20
0
0
400 200 200
 25
0
0
0
0
100 0
150 0
0
0
0
0
0
10 0
0
0
0
0
0
0
300 0
0
0
0
0
0
0
0
0
10
0
500 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
70
300 0 400
0
 0
0
0
0
0
0
0
0
0
0

0
0
0
0
20 0
0
0
0
0
0
0
100 0
0
0
0
0
10
0
0
0
24 0 10
0
0
0
0
100 0
0
0
300 100 300
0
0
0
0
0
24 21 4
0
0
 0
0
0
1000 600 0 600 600
0
0
0
400 100 300
0
0
0
0
0

0
0
0
0
12
0
500 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0 50
20
0
0
0
0
1 1 2 2 3 0 3
0
48 0
0
0
0
40
30 90 0
 5 10 0
0
0
50 50 50 100 40 0
0
0
500 500 500 500 1000 500 700 600 600 500 800 2000 600
4 4 3 3 0
0
0
0
0
0
0
0
0
0
500 400 500 0 600
0
0
0
0
100
0
0
120
0
0
50 50 0
0
0
0
0
0
0
0
150 150 90 150 0 180
0
0
0
0
0
0
0
0
500 0
0
700 500 0 500 600
 0
200 200 0 200

100
6 6
1
1 1

1 1

25 75
50 50

56 50

25 75

105 100
222 200

0
0
0

0
0
0
0

4
0
0
 12
0
0

0
50
0
24

37
31
20

0
3
0
0

0
125
0

0
0
0
0
0
0
0
50

0
0
0

0
5
2

37
22
53
51

20
245
32
5
100 100

100 100
 Pengeluaran Sub Unit

22 23 24 25 26 27 28 29 30 31 Pustu Pusling Posyandu Dll

100 100
20 50 30

900 900 250

900 900 180

500 800 800 400 400 600 400 800 1300

35 12 48 25

20
500 800 400 200 400 400 500 600 700 1800

300

400 300 100 100 100 200

 100
100

30

300

300 200 100 350

800 400 300 300 400 200

200 100 50
50

200
 10

300

100

200

300 300 269 400

20

24 15
 100
100

500 400 400 200 400 400 600 1300

50
15

800 500 500

50

28
10 10

100 200 400

3 1 1 1 1 2 1 2 1

60 90 30 90
100 80 100 10 30

500 800 400 400 400 400 500 400 500 1400
1 5

400 400 400 400 400

500 400 300 300 300 500 500 600

300 300 300 200 400

20

50
100
24 24

300 240 120 150 60 150

400 300 400 400 1100

300 300 400 600 500 800 800

 100 150

100
6 6

50
50 100

50

30 35

100 100
100 140
100
100 100
 Jumlah Stok
Pengeluaran AkhirBulan
8 9
(1+ s.d31 + sub unit) (6-8)
0 0
0 0
1000 0
150 50
0 0
0 0
0 0
2650 3950
3280 4920
0 0
0 0
15200 5800
0 0
360 0
0 0
0 0
0 0
0 0
0 0
70 80
10500 10200
0 0
0 0
0 0
0 0
0 0
0 0
6 8
0 0
0 0
300 1200
20 380
0 0
0 0
2000 0
 25 30
0 0
0 0
0 0
0 0
200 100
250 600
0 90
0 0
0 0
0 0
0 0
40 160
0 0
0 0
0 0
0 0
0 0
0 0
600 400
0 0
0 0
0 0
0 0
0 0
950 550
0 0
0 0
10 37
0 0
3400 600
0 0
0 0
0 0
0 10
0 72
0 0
0 0
0 200
0 0
0 0
350 650
50 0
0 0
0 0
70 0
900 1700
0 0
 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 600
0 0
0 0
0 0
0 700
0 0
0 0
0 0
30 90
0 0
0 0
0 0
0 0
0 0
0 0
400 200
0 0
0 0
0 600
0 0
10 20
100 900
0 0
0 200
34 206
0 0
0 0
0 0
0 0
300 800
0 20
0 47
1969 4031
0 0
20 80
0 0
0 0
0 0
88 8
0 100
0 0
 100 200
100 400
0 0
7000 8000
0 0
0 0
0 0
850 150
15 85
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
12 28
0 0
2300 6100
50 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
28 68
20 30
0 0
0 0
750 5250
20 0
0 200
0 0
0 0
0 0
25 0
0 0
53 43
0 0
0 0
0 150
40 60
420 180
 15 45
0 120
0 0
710 490
0 0
0 0
17600 400
20 0
0 0
0 0
0 0
2000 0
0 0
0 0
0
0 0
0 0
5400 600
0 0
0 0
0 0
0 0
100 50
1500 2500
0 0
140 500
0 0
0 0
200 300
100 300
48 0
0 0
0 0
0 6
0 10
0 0
2010 990
0 0
0 50
0 0
0 0
0 0
0 0
0 0
0 0
3100 5900
0 0
6000 5000
 0 0
850 150
0 0
0 0
200 200
24 13
1 0
3 0
0 0
0 0
2 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
150 435
250 90
0 30
0 500
0 0
0 0
156 504
0 0
0 5
165 515
0 0
405 155
662 13
0 75
0 0
0 0
0 400
0 0
0 0
0 0
0 600
0 0
0 0
0 0
0 0
0 0
4 11
0 0
0 0
0 36
 12 24
0 0
0 0
0 12
0 0
0 0
150 0
0 0
24 0
0 100
37 63
31 119
20 0
0 70
0 160
0 0
3 5
0 0
0 0
0 2
0 0
125 25
0 0
0 300
0 100
0 0
0 0
0 0
0 0
0 0
0 10
0 0
0 0
50 50
0 0
0 0
0 0
0 0

0 0
5 0
2 40
0 0
0 0
0 0
8 25
0 40
37 65
 0 0
22 5
53 47
51 59
0 0
5 65
0 0
20 30
245 315
32 5
5 15
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
400 0
0 0
0 0
0 0
200 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS
PUSKESMAS : CIMANUK
KECAMATAN : CIMANUK
KAB / KOTA : PANDEGLANG PELAPORAN BULAN / PERIODE : JANUARI 2020
PROVINSI : BANTEN PERMINTAAN BULAN / PERIODE : FEBRUARI 2020

Jumlah Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir

1 2 3 4 5 6 7 8
A NAMA OBAT ( 4+5 ) (6-7)
1 Alprazolam Tablet - - - - -
2 Albendazol Tablet 400 mg Tablet - - - - -
3 Allopurinol tablet 100 mg Tablet - 1,000 1,000 1,000 -
4 Ambroxol sirup Botol - 200 200 150 50
5 Ambroxol tablet 30 mg Tablet - - - - -
6 Aminofilin Tablet 200 mg Tablet - - - - -
7 Aminofilina injeksi 24 mg/ml - 10 ml Ampul - - - - -
8 Amlodipin 10 mg Tablet 900 5,700 6,600 2,650 3,950
9 Amlodipin Besilate 5 mg Tablet 1,000 7,200 8,200 3,280 4,920
10 Amoksisilin Forte sirup kering 250mg Botol - - - - -
11 Amoksisilin Injeksi 1 gr Vial - - - - -
12 Amoksisilin Tablet 500 mg Tablet 5,000 16,000 21,000 15,200 5,800
13 Amoksisillin kapsul 250 mg Kapsul - - - - -
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol - 360 360 360 -
15 Ampisilin Injeksi 1 gr Vial - - - - -
16 Analog insulin Long Acting Pen - - - - -
17 Analog insulin Mix Acting Pen - - - - -
18 Antalgin (Metampiron) tablet 500 mg Tablet - - - - -
19 Antalgin (Metampiron) tablet 500 mg Tablet - - - - -
20 Antasida DOEN suspensi Botol 50 100 150 70 80
21 ANTASIDA DOEN Tablet Tablet 7,700 13,000 20,700 10,500 10,200
22 Anti Bakteri DOEN ( Bacitrasin ) Tube - - - - -
23 anti hemoroid doen kombinasi supp - - - - -
24 Antifungi DOEN Tube - - - - -
25 Antimigren DOEN Kombinasi : Tablet - - - - -
26 Antiparkinson DOEN tablet Kombinasi : Tablet - - - - -
27 Antiparkinson Tablet ( Levopar ) Tablet - - - - -
28 Aqua Pro Injeksi Vial 14 - 14 6 8
29 Artermeter injeksi Ampul - - - - -
30 Artesunate injeksi 60 mg/ml vial - - - - -
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet - 1,500 1,500 300 1,200
32 Asam Folat Botol 400 - 400 20 380
33 Asam Fusidat Cream Tube - - - - -
34 Asam Klorida 0,1 N Botol - - - - -
35 Asam Mefenamat 500 mg Tablet - 2,000 2,000 2,000 -
36 Asam Traneksamat Inj 5% Ampul 15 40 55 25 30
37 Asering Botol - - - - -
38 Asetosal tablet 500 mg Tablet - - - - -
39 Asetyl Cysteine Capsul - - - - -
40 Asiklovir Cream 5% Tube - - - - -
41 Asiklovir tablet 200 mg Tablet 300 - 300 200 100
42 Asiklovir tablet 400 mg Tablet 850 - 850 250 600
43 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul 90 - 90 - 90
44 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Vial - - - - -
45 Atropin Sulfat tablet 0,5 mg Tablet - - - - -
46 Berotec Metered Aerosol 100 mg Bok - - - - -
47 Betadine Salep Antiseptik 5 mg Tube - - - - -
 Jumlah Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir

1 2 3 4 5 6 7 8
A NAMA OBAT ( 4+5 ) (6-7)
48 Betametason krim 0,1 % Tube - 200 200 40 160
49 Bisakodil Suppositoria supp - - - - -
50 Bisoprolol 2,5 mg Tablet - - - - -
51 Bisoprolol 5 mg Tablet - - - - -
52 Cairan Infus KN-3B Botol - - - - -
53 Cairan Infus Wida KDN 1 Botol - - - - -
54 Cairan Pembersih ( Protektor ) Botol - - - - -
55 Captopril Tablet 12,5 mg Tablet - 1,000 1,000 600 400
56 Captopril Tablet 25 mg Tablet - - - - -
57 Cefadroxil Capsul 500 mg Capsul - - - - -
58 Cefixime Capsul 100 mg Capsul - - - - -
59 Cefixime Sirup Botol - - - - -
60 Cefotaksime 1 gr Injeksi Vial - - - - -
61 Cetirizine Capsul 50 mg Capsul - 1,500 1,500 950 550
62 Cetirizine sirup 5 mg/5 ml Botol - - - - -
63 Ciprofloxcacin 500 mg tablet Tablet - - - - -
64 Combivent UDV 2,5 mg+0,5mg/2,5 ml Ampul 47 - 47 10 37
65 D-Artepp tablet Tablet - - - - -
66 Deksametason tablet 0,5 mg Tablet - 4,000 4,000 3,400 600
67 Dekstran 70 - larutan infus 6% steril Botol - - - - -
68 Dekstrometorfan sirup Botol - - - - -
69 Dekstrometorfan tablet 15 mg Tablet - - - - -
70 Diazepam Rektal 0,5 mg / 2 ml supp - 10 10 - 10
71 Diazepam tablet 2 mg Tablet 72 - 72 - 72
72 Diazepam tablet 5 mg Tablet - - - - -
73 Difenhidramin HCL injeksi 10 mg/ml - 1ml Ampul - - - - -
74 Digoksin tablet 0,25 mg Tablet - 200 200 - 200
75 Diltiazem Tablet - - - - -
76 Doksisiklin Kapsul 100 mg Capsul - - - - -
77 Domperidon 10mg Tablet Tablet - 1,000 1,000 350 650
78 Domperidon Suspensi 5 mg/ 5 ml Botol - 50 50 50 -
79 Doxicyclin 500mg capsul - - - - -
80 Efedrin HCLTablet 25 mg Tablet - - - - -
81 Epinefrina HCL/Bitartrat Injeksi Ampul 70 - 70 70 -
82 Eritromicyn kapsul 250 mg capsul 2,600 - 2,600 900 1,700
83 Erytromicin kapsul 500 mg Kapsul - - - - -
84 Erytromicin sirup 125 mg Botol - - - - -
85 Etakridin ( Rivanol ) larutan 0,1% Botol - - - - -
86 Etambutol 500 mg Tablet - - - - -
87 Etanol 70 % Botol - - - - -
88 Etil Klorida Semprot Botol - - - - -
89 Fenitoin Natrium kapsul 30 mg Kapsul - - - - -
90 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul - - - - -
91 Fenobarbital tablet 30 mg Tablet 600 - 600 - 600
92 Fenoksimetil Penisilina tablet 250 mg Tablet - - - - -
93 Fenol Gliserol tetes telinga 10 % Botol - - - - -
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul - - - - -
95 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 700 - 700 - 700
96 Flufenazine Deconat Inj 25 mg/ml Ampul - - - - -
97 Furosemida tablet 40 mg Tablet - - - - -
98 Furosemide Injeksi Ampul - - - - -
99 Garam Oralit Sachet 20 100 120 30 90
100 Gemfibrozil 300 mg Tablet - - - - -
101 Gentamicin Injeksi Ampul - - - - -
102 Gentamicin Salep Kulit Tube - - - - -
103 Gentamicin Salep mata Tube - - - - -
 Jumlah Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir

1 2 3 4 5 6 7 8
A NAMA OBAT ( 4+5 ) (6-7)
104 Gentamicin Tetes Mata Botol - - - - -
105 Gentian Violet 1 % Botol - - - - -
106 Glibenclamid tablet 5 mg Tablet 600 - 600 400 200
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet - - - - -
108 Glikazid 80 mg Tablet Tablet - - - - -
109 Glimepiride 2 mg Tablet 600 - 600 - 600
110 Glukosa larutan infus 10% steril Botol - - - - -
111 Glukosa larutan infus 5 % steril Botol 30 - 30 10 20
112 Griseofulvin tablet 500 mg, Tablet - 1,000 1,000 100 900
113 Guaiafenesin 100 mg Tablet - - - - -
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet 200 - 200 - 200
115 Hidrokortison krim 2,5% Tube - 240 240 34 206
116 Ibuprofen Suspensi Tablet - - - - -
117 Ibuprofen tablet 200 mg Tablet - - - - -
118 Ibuprofen tablet 400 mg Tablet - - - - -
119 Imunomodulator sirup( STIMUNO) Botol - - - - -
120 Isosorbid Dinitrat tablet sublingual 5 mg Tablet 100 1,000 1,100 300 800
121 KAEN 3B Infus Botol - 20 20 - 20
122 Kalsium Glukonas Injeksi Ampul 47 - 47 - 47
123 Kalsium Laktat (Kalk) tablet 500 mg Tablet 1,000 5,000 6,000 1,969 4,031
124 Kapas Berlemak 500 mg Bungkus - - - - -
125 Ketokonazol Kream Tube - 100 100 20 80
126 Ketokonazol Tablet 200 mg Tablet - - - - -
127 Ketorolac inj Ampul - - - - -
128 Kifadene tablet 20 mg Tablet - - - - -
129 Kloramfenikol salep mata 1 % capsul - 96 96 88 8
130 Kloramfenikol suspensi Botol - 100 100 - 100
131 Kloramfenikol tetes telinga 3% Tube - - - - -
132 Kloramphenicol 250 mg Capsul 300 - 300 100 200
133 Kloramphenicol 500 mg capsul - 500 500 100 400
134 Kloramphenicol Tetes Mata Botol - - - - -
135 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet - 15,000 15,000 7,000 8,000
136 Klorokuin tablet 150 mg Tablet - - - - -
137 Klorpromazin HCL tablet salut 25 mg Tablet - - - - -
138 Kombinasi (Pirimetamin 25 mg + Solfadoxin Tablet - - - - -
139 Kotrimoksazol Dewasa Tablet 480 mg Tablet - 1,000 1,000 850 150
140 Kotrimoksazol Sirup / Suspensi Botol - 100 100 15 85
141 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul - - - - -
142 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol - - - - -
143 Lactobacilus serbuk Sachet - - - - -
144 Lidocain 2%+efinefrin injeksi Ampul - - - - -
145 Lidocain injeksi 2 ml Ampul - - - - -
146 Lisinopril 10 mg tablet Tablet - - - - -
147 Lisinopril 5 mg tablet Tablet - - - - -
148 Loperamid 4 mg tablet Tablet - - - - -
149 Lytacur Sirup Botol - - - - -
150 Magnesium Sulfat Inj. 25 ml Ampul 40 - 40 12 28
151 Metamizol 500 mg Tablet - - - - -
152 Metformin 500 mg Tablet Tablet 400 8,000 8,400 2,300 6,100
153 Methilprednisolon tablet 4 mg Tablet 50 - 50 50 -
154 Metilergometrin Maleat injeksi 1 ml Ampul - - - - -
155 Metilergometrin Maleat Tablet Tablet - - - - -
156 Metoklopramid Suspensi Botol - - - - -
157 Metoklopramid tablet Tablet - - - - -
158 Metronidazol 500 mg Tablet - - - - -
159 Metronidazol infus / injeksi Botol - - - - -
 Jumlah Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir

1 2 3 4 5 6 7 8
A NAMA OBAT ( 4+5 ) (6-7)
160 Metronidazol Ovula supp - - - - -
161 Metronidazol suspensi Botol - - - - -
162 Mikonazol kream Tube - 96 96 28 68
163 Multivitamin Anak Sirup Botol - 50 50 20 30
164 Multivitamin Dewasa Antioksidan ( Becom c ) Tablet - - - - -
165 Natrium Diklofenak 25 mg Tablet Tablet - - - - -
166 Natrium Diklofenak 50 mg Tablet Tablet 1,000 5,000 6,000 750 5,250
167 Natrium Klorida Cairan Infus ( NaCL ) Botol - 20 20 20 -
168 Nifedipine Tablet 10 mg Tablet 200 - 200 - 200
169 Nistatin tablet vaginal 100.000 IU/g Tube - - - - -
170 Obat anti Diare suspensi Botol - - - - -
171 Obat Anti Diare Tablet (Akita / Molagit ) Tablet - - - - -
172 Obat Batuk Flu ( Molexflu ) Tablet - 25 25 25 -
173 Obat Batuk Hitam (OBH) Botol - - - - -
174 Obat Batuk Sirup Herbal ( Herbacop ) Botol 96 - 96 53 43
175 Ofloxsacin Tetes Telinga Tube - - - - -
176 Oksitetrasiklin HCL salep mata 1% Botol - - - - -
177 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 150 - 150 - 150
178 Omeprazol injeksi Ampul - 100 100 40 60
179 Omeprazol Kapsul 20 mg capsul - 600 600 420 180
180 Ondancentron injeksi 4 mg Ampul - 60 60 15 45
181 Ondancentron Tablet4 mg Tablet 120 - 120 - 120
182 Paracetamol Drop 15 ml Botol - - - - -
183 Paracetamol Sirup 120 mg/5 ml Botol 200 1,000 1,200 710 490
184 Parafin Dresing ( Bioplacenton Tull ) pcs - - - - -
185 Parasetamol tablet 100 mg Tablet - - - - -
186 Parasetamol tablet 500 mg Tablet - 18,000 18,000 17,600 400
187 Permetrin Krim 5 % Tube - 20 20 20 -
188 Pirantel Sirup Botol - - - - -
189 Pirantel tablet 125 mg Tablet - - - - -
190 Pirazinamid Botol - - - - -
191 Piridoksin HCL (VIT B6) tablet 10mg Botol 1,000 1,000 2,000 2,000 -
192 Piroksikam tablet 20 mg Tablet - - - - -
193 Polikresulen Tube - - - - -
194 Povidon lodida 10% 300 ml - - - - -
195 Povidon lodida 10% 60 ml Tablet - - - - -
196 Prazikuantel tablet 600 mg Botol - - - - -
197 Prednison Tablet 5 mg Tablet - 6,000 6,000 5,400 600
198 Primakuin 15 mg Tablet - - - - -
199 Probenesid 500 mg tablet Tablet - - - - -
200 Prokain Benzil Penisilin 3 juta IU/vial injeksi Ampul - - - - -
201 Propanolol HCL tablet 10 mg Tablet - - - - -
202 Ranitidin injeksi Ampul 50 100 150 100 50
203 Ranitidin tablet Tablet - 4,000 4,000 1,500 2,500
204 Resperidone 2 mg tablet Tablet - - - - -
205 Ringer Laktat cairan infus (Otsuka) 140 500 640 140 500
206 Ringer Laktat cairan infus (Widatra) Botol - - - - -
207 Rivanol 300 ml Botol - - - - -
208 Salbutamol Tablet 2 mg Tablet 300 200 500 200 300
209 Salbutamol tablet 4mg Tablet - 400 400 100 300
210 Salep 2-4 Tube 24 24 48 48 -
211 Salep kombinasi cream ( Berloson ) Tube - - - - -
212 Salicil bedak Kotak - - - - -
213 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial 4 2 6 - 6
214 Serum Anti Tetanus inj 1500 IU ( Tetagam ) Vial - 10 10 - 10
215 Sianokobalamin Injeksi Ampul - - - - -
 Jumlah Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir

1 2 3 4 5 6 7 8
A NAMA OBAT ( 4+5 ) (6-7)
216 Simvastatin 10 mg tablet Tablet - 3,000 3,000 2,010 990
217 Simvastatin 20 mg tablet Tablet - - - - -
218 Sukralfat Suspensi Botol - 50 50 - 50
219 Sukralfat tablet 500 mg Tablet - - - - -
220 Suspensi Seng Insulin inj.40 IU/ml - 10 ml Tube - - - - -
221 Temporary Stopping Fletcher serbuk & cairan Tablet - - - - -
222 Tetrakain HCL tetes mata 0,5% Tube - - - - -
223 Tetrasiklin 250 mg capsul capsul - - - - -
224 Tetrasiklin 500 mg capsul capsul - - - - -
225 Tiamin Tablet 50 mg ( B1 ) Tablet 1,000 8,000 9,000 3,100 5,900
226 Ventolin Nebulizer Ampul - - - - -
227 Vitamin B komplek Tablet 1,000 10,000 11,000 6,000 5,000
228 Zink sirup Botol - - - - -
229 Zink tablet 20 mg Tablet 1,000 - 1,000 850 150
OBAT PROGRAM - - - - -
1 Albendazol Tablet 400 mg Tablet - - - - -
2 Isoniazid Tablet 100 mg Tablet - 400 400 200 200
3 Obat Antituberkulosis kategori 1 Paket 5 32 37 24 13
4 Obat Antituberkulosis Kategori 2 Paket - 1 1 1 -
5 Obat Antituberkulosis Kategori Anak Paket - 3 3 3 -
6 Pot Dahak Non Steril Biji - - - - -
7 Pot Dahak Steril Biji - - - - -
8 Reagen Ziehl Neelsen Kit - 2 2 2 -
9 MDT MB Anak Tablet Tablet - - - - -
10 MDT MB Dewasa Tablet Tablet - - - - -
11 MDT PB Dewasa Tablet Tablet - - - - -
12 MDT PB Anak Tablet Tablet - - - - -
13 Retinol (Vitamin A) kapsul 200.000 IU capsul - - - - -
14 Retinol (Vitamin A) kapsul 100.000 IU capsul - - - - -
15 Tablet Penambah Darah ( FE ) Tablet - - - - -
16 Amitriptilin tablet 25 mg Tablet 585 - 585 150 435
17 Carbamazepin 200 mg tablet Tablet 340 - 340 250 90
18 Clobazam 10 mg Tablet Tablet 30 - 30 - 30
19 Clozapine 25 mg Tablet Tablet - 500 500 - 500
20 Fenitoin Natrium kapsul 30 mg capsul - - - - -
21 Haloperidol 1,5 mg Tablet Tablet - - - - -
22 Haloperidol 2 mg tablet Tablet 360 300 660 156 504
23 Haloperidol 5 mg Tablet Tablet - - - - -
24 Haloperidol Injeksi Ampul 5 - 5 - 5
25 Klorpromazin HCL tablet salut 100 mg Tablet 280 400 680 165 515
26 Klorpromazine Tablet 25 mg Tablet - - - - -
27 Triheksilfenidil Hcl 2 mg tablet Tablet 260 300 560 405 155
28 Risperidone 2 mg tablet Tablet 375 300 675 662 13
29 Divalproexsodium Tablet 75 - 75 - 75
Diazepam injeksi (program) ampul
Magnesium Sulfat Inj. 25 ml 40 % (program) ampul
Kalsium Glukonas Injeksi ampul
Oksitosin injeksi 10 IU/ml - 1 ml ampul
Metilergometrin Maleat injeksi 1 ml ampul
Dehydro Artemisin 40 mg + Piperaquin 320 mg (DHP) tablet
Primakuin tablet 15 mg tablet
Masker karet ear loop hijab box
Masker N 95 box
- - - - -
NAMA BAHAN MEDIS HABIS PAKAI (BMHP )
B - - - - -
1 Alat suntik 1 ml Pcs 300 100 400 - 400
 Jumlah Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir

1 2 3 4 5 6 7 8
A NAMA OBAT ( 4+5 ) (6-7)
2 Alat suntik 10 ml Pcs - - - - -
3 Alat suntik 2,5 ml Pcs - - - - -
4 Alat suntik 20 ml Pcs - - - - -
5 Alat suntik 3 cc (Remedi) 200 400 600 - 600
6 Alat suntik 3 ml Pcs - - - - -
7 Alat suntik 5 ml pcs - - - - -
8 Alkazide 1 L High Level Desinfectant Botol - - - - -
9 Alkazyme Sachet 25 mg Pack - - - - -
10 Alkohol 70 % 1 L Botol - - - - -
11 Alkohol swab Sachet 5 10 15 4 11
12 Anti Septik Hand Rub Botol - - - - -
13 Anti Septik Surgikal Hand Scrub Botol - - - - -
14 Cat Gut no 2/0 Sachet - 36 36 - 36
15 Cat Gut no 3/0 Sachet - 36 36 12 24
16 Cat Gut No 3/0 (24 mm) Sachet - - - - -
17 Cat Gut No 3/0 (26 mm) Sachet - - - - -
18 Cathetter Jelly Biji 12 - 12 - 12
19 Demetech Silk 3/0 Set - - - - -
20 E Care I.V Dresing Pcs - - - - -
21 E-Care Surgical Mask Tie On Lembar 50 100 150 150 -
22 Folly No 14 Catether pcs - - - - -
23 Folly No 16 Catether pcs 24 - 24 24 -
24 I.V Cathetter No. 20 Set - 100 100 - 100
25 I.V Cathetter No. 22 Set - 100 100 37 63
26 I.V Cathetter No. 24 Set 50 100 150 31 119
27 I.V Cathetter No. 26 Set 20 - 20 20 -
28 Infuset Anak Set 70 - 70 - 70
29 Infuset Dewasa Set 40 120 160 - 160
30 Jarum Insulin Tablet - - - - -
31 Kapas Berlemak 250 gr Bungkus 8 - 8 3 5
32 Kapas Berlemak 500 gr Bungkus - - - - -
33 Kasa 4 m x 10 cm Rol - - - - -
34 Kasa Hidrofil 36 x 80 cm Rol 2 - 2 - 2
35 Kasa Pembalut 2 x 80 cm Pack - - - - -
36 Kasa Steril 16 x 16 cm Kotak 50 100 150 125 25
37 Lisol 1 L Botol - - - - -
38 Masker karet Ear Loop Lembar 200 100 300 - 300
39 Masker tali Tube 100 - 100 - 100
40 Nasal Canula Oksigen Set - - - -
41 Plester 1" Rol - - - - -
42 Plester Kertas 2,5 cm Rol - - - - -
43 Plester Non Woven 5cm x 5 cm Rol - - - - -
44 Policlean Botol - - - - -
45 Polifik Kotak - 10 10 - 10
46 Saraya Alsof A 500 ml Botol - - - - -
47 Saraya Alsof Pure 500 ml Botol - - - - -
48 Sarung Tangan Gynecolog No 7 Pasang 100 - 100 50 50
49 Sarung tangan M (Non Steril) Pasang - - - - -
50 Sarung tangan no 6,5 Pasang - - - - -
51 Sarung tangan no 6,5 Steril Gloves Pasang - - - - -
52 Sarung tangan no 7,0 Steril Pasang - - - - -

53 Selang Section ( Surgikal Conection Tube with yankauer) Pcs - - - - -

54 Underpad Lembar 5 - 5 5 -
55 Urine Bag Biji 32 10 42 2 40
- - - - -
NAMA OBAT VAKSIN
 Jumlah Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir

1 2 3 4 5 6 7 8
A NAMA OBAT ( 4+5 ) (6-7)
NAMA OBAT VAKSIN

1 Vaksin Anti Rabies ( VAR ) Vial - - - -

2 Vaksin BCG Vial 28 5 33 8 25
3 Vaksin DT Vial 40 - 40 - 40
4 Vaksin HB 0 Pcs 52 50 102 37 65
5 Vaksin HBIG Vial - - - - -
6 Vaksin Measless Rubella (MR) Vial 17 10 27 22 5
7 Vaksin Pentabio ( DPT - HB - Hib ) Vial 40 60 100 53 47
8 Vaksin Polio B OPV Vial 50 60 110 51 59
9 Vaksin Polio IPV Vial - - - - -
10 Vaksin TD Vial 70 - 70 5 65
11 Vaksin Tuberculin Vial - - - - -
12 ADS 0,05 ml Unit 50 - 50 20 30
13 ADS 0,5 ml Unit 560 - 560 245 315
14 ADS 5 ml Unit 37 - 37 32 5
15 Safety Box Unit 20 - 20 5 15
- - - - -
- - - - -
- - - - -
NAMA OBAT REAGEN
- - - - -
1 Albumin (Reagen) Kotak - - - - -
2 anti A Monoclonal ( GolDar 10 ml) Vial - - - - -
3 Anti A-B Monoclonal ( GolDar 10 ml) Vial - - - - -
4 Anti B Monoclonal ( GolDar 10ml) Vial - - - - -
5 Anti D Monoclonal ( GolGar 10ml) Vial - - - - -
6 Benecheck Plus Cholesterol Test Strip - - - - -
7 Benecheck Plus Glukosa Test Strip - - - - -
8 Benecheck Plus Uric Test Strip - - - - -
9 Bilirubin T/D (Reagen) Kotak - - - - -
10 Brilian Green Bile Broth Kotak - - - - -
11 Cellclean (CL-50) (Reagen) Kotak - - - - -
12 Cellpack (PK-30L) (Reagen) Kotak - - - - -
13 Chikungunya IgM (Reagen) Kotak - - - - -
14 Cholesterol (Reagen) Kotak - - - - -
15 Cholesterol Stik (Reagen) Kotak - - - - -
16 CK-MB (Reagen) Kotak - - - - -
17 Creatinin Reagen Kit - - - - -
18 Dengue IgM / IgM ( Reagen ) Kotak - - - - -
19 Eight Check ( LNH ) Serial - - - - -
20 Febrile Antingen H Parathpy Vial - - - - -
21 Febrile Antingen H-A Parathpy Vial - - - - -
22 Febrile Antingen H-B Parathpy Vial - - - - -
23 Febrile Antingen H-C Parathpy Vial - - - - -
24 Febrile Antingen O Parathpy Vial - - - - -
25 Febrile Antingen O-A Parathpy Vial - - - - -
26 Febrile Antingen O-B Parathpy Vial - - - - -
27 Febrile Antingen O-C Parathpy Vial - - - - -
28 Glukosa Reagen Kotak - - - - -
29 GOT ( ALAT ) Kotak - - - - -
30 GPT ( ALAT ) Kotak - - - - -
31 HBSAG Reagen Box - - - - -
32 HCG Strip Vial - - - - -
33 HDL Cholesterol ( Precipitan ) Kotak - - - - -
34 Hematologi Calibrator (Nscs 1000 ) Botol - - - - -
35 Hemoglobin Reagen Kotak - - - - -
36 Lactose Broth 500 mg Botol - - - - -
 Jumlah Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir

1 2 3 4 5 6 7 8
A NAMA OBAT ( 4+5 ) (6-7)
37 LDL Cholesterol Kotak - - - - -
38 Leptospira IgM (Reagen) Kotak - - - - -
39 Micropippets MT-1-up to 200 ui Pcs - - - - -
40 MIcropippets MT-up to 1 ml Pcs - - - - -
41 NS1 Antigen Test (Reagen) Kotak - - - - -
42 Pipet Ukur 10 ml biji - - - - -
43 Poch Pack D (II) Reagen Kotak - - - - -
44 Poch Pack L (II) Reagen Kotak - - - - -
45 Stik Uric Acid Kotak - - - - -
46 Strip Narkoba 3 Parameter Kotak - - - - -
47 Strip Narkoba 5 Parameter Kotak - - - - -
48 Strip Narkoba 6 Parameter Kotak - - - - -
49 Total Protein Kotak - - - - -
50 Trigleserida Kotak - - - - -
51 Urea Kotak - - - - -
52 Uric Acid Kotak - - - - -
NAMA OBAT REAGEN PROGRAM HIV - - - - -
1 Rapid 1 HIV (SD Bioline ) Tes
2 Rapid 2 HIV (Fokus ) Tes
3 Rapid 3 HIV (Biomeriux Vikia ) Tes
4 SD Biosensore Standart Q Syphlis Tes
5 RPR Syphlis ( Fokus ) Tes
6 Reagen CD4 Control Tes
7 Reagen CD4 Mobile Tes
8 RPR Syphlis Komponen Kit
9 Anuscopy Buah
10 Kertas PH Indikator Buah
11 Rotator Buah
12 Tip. Uk.60 Bks
13 Tip. Uk.61 Bks
14 Pronto / Holder Buah - - - - -
- - - - -
NAMA OBAT GIGI
- - - - -
1 Anastesi Citojek Box - - - - -
2 Articulating Paper (Kertas warna penanda oklusi) Kotak - - - - -
3 Bahan Tumpatan sementara Botol - - - - -
4 Bonding Syringe - - - - -
5 Cairan Desinfectan ( Perendaman Instrumen Gigi ) Botol - - - - -
6 Cairan untuk desinfectan pembersih permukaan Botol - - - - -
7 Carpule Citojek Kotak - - - - -
8 Chlorfeson Kamfer menthol ( CHKM ) Cairan Botol - - - - -
9 Composite Nanohibrid A1 Tube - - - - -
10 Composite Nanohibrid A2 Tube - - - - -
11 Composite Nanohibrid A3 Tube - - - - -
12 Composite Nanohibrid A3,5 Tube - - - - -
13 Devitalisasi Pasta Pot - - - - -
14 Disclosing Solution Botol - - - - -
15 Etcing Gel Pcs - - - - -
16 Etil Klorida Semprot Botol - - - - -
17 Eugenol Cairan Botol - - - - -
18 Formokesol Botol - - - - -
19 Gas Powred Jet Injector Botol - - - - -
20 Glass Ionomer Cement ART Pot - - - - -
21 Jarum citojek uk 16 mm Box - - - - -
22 Kalsium Hidroksida pasta Botol - - - - -
23 Klorhekdidin Larutan 2 % Botol - - - - -
 Jumlah Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir

1 2 3 4 5 6 7 8
A NAMA OBAT ( 4+5 ) (6-7)
24 Mummifiying Fasta Botol - - - - -
25 Natrium Hipoklorit airan konsentrat 5% Botol - - - - -
26 Paper Points 15-40 mm Box - - - - -
27 Pasta Devitalisasi ( Non Arsen ) Tube - - - - -
28 Pasta Pengisi Saluran Akar Syringe - - - - -
29 Semen seng Fosfat serbuk Set - - - - -
30 Spon Gelatin Cubicis 1x1x1 cm (Spongostan) Botol - - - - -
31 Temporary Filling Fasta Set - - - - -
32 Tooth Stain Remover ( TSR ) Botol - - - - -
33 Wipes Desinfektan Botol - - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -

RAWAT RAWAT INAP

JUMLAH KUNJUNGAN PUSKESMAS JALAN
JUMLAH

UMUM / BAYAR 2913

UMUM / TIDAK BAYAR 32
JKN 2057
TOTAL KUNJUNGAN 5002

Mengetahui / Menyetujui
KEPALA DINAS KESEHATAN YANG MENYERAHKAN YANG MEMINTA
KABUPATEN PANDEGLANG KEPALA UPT. GUDANG FARMASI KEPALA PUSKESMA

………………………………………… …………………………………………………… …………………………………

NIP. NIP. NIP.
ERMINTAAN OBAT ( LPLPO )
S
DOKUMEN NOMOR TANGGAL
DINKES KAB/KOTA
GFK KAB/KOTA
PUSKESMAS

Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

-
-
1,200 2500
180 200
- 2500
-
-
3,180 6000
3,936 6000
-
-
18,240 13,000
-
432 480
-
-
-
-
-
84 100
12,600 5000
-
-
-
-
-
-
7 50
-
-
360 1600
24 1000
-
-
2,400 4000
30 20
- 40
-
- 3120
- 50
240 300
300
-
-
-
-
- 50
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

48 125
-
-
- 200
-
-
- 5
720 2000
- 1000
-
-
-
- 50
1,140 700
-
-
12 80
-
4,080 5000
-
-
-
-
-
-
-
- 1000
-
-
420
60 100
-
-
84 100
1,080 1000
-
-
-
-
-
-
-
-
-
-
- 100
- 100
- 1000
-
- 500
- 200
36 100
- 1000
- 50
- 200
- 100
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

- 50
-
480 2000
- 3000
-
- 1000
- 20
12 20
120 1000
- 3000
-
41 120
- 100
- 3000
-
- 100
360 500
- 40
- 48
2,363 2000
-
24 100
- 1000
-
-
106 144
-
- 125
120 500
120
- 100
8,400 7000
-
-
-
1,020 1200
18 100
-
-
- 100
-
- 60
-
-
- 1000
- 50
14 20
-
2,760 2500
60 5000
- 100
- 500
-
-
- 500
-
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

- 50
- 50
34 96
24 100
- 500
-
900
24 40
- 500
- 100
-
- 1000
30 4500
-
64 96
- 100
-
- 100
48
504 330
18 40
- 300
-
852 300
-
-
21,120 25000
24 24
-
-
-
2,400 2000
- 2000
-
- 10
- 10
-
6,480 6000
-
-
-
-
120 200
1,800 2000
-
168
-
-
240 1000
120 1000
58 120
-
- 50
-
-
-
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

2,412 1500
- 1500
- 25
-
-
-
-
-
-
3,720
- 40
7,200 3000
-
1,020 1000
-
-
240
29
1
4
-
-
2
-
-
-
-
-
-
-
180
300
-
-
-
-
187
-
-
198
-
486
794
-

-
-
- 200
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

-
-
-
- 400
-
- 400
-
-
- 10
5 800
- 10
-
- 12
14 36
-
-
- 15
- 24
-
180
- 48
29 48
- 100
44 100
37 100
24 100
- 50
- 96
-
4 3
-
-
- 5
- 40
150 100
-
- 400
- 400
- 10
- 10
- 10
- 10
-
-
-
-
60 50
- 500
-
- 50
- 50

-
6 20
2
-
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

10
-
44
-
26
64
61
-
6
-
24
294
38
6
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

Harap Dilampirkan : 1. LB 1

2. Lap. Psikotropika & Narkotika

3. Lap. Pemakaian Serum ABU
4. Lap. 20 Pemakaian Obat Terbanyak

YANG MEMINTA YANG MEMINTA :

KEPALA PUSKESMAS PETUGAS OBAT PUSKESMAS

………………………………………… ……………………………………..
NIP.