LAPORAN BULANAN PENGGUNAAN ATS

PUSKESMAS CIMANUK
MENU BULAN : AGUSTUS 2020

PENGGUNAAN
STOK JUMLAH
NO PENERIMAAN NAMA
AWAL PERSEDIAAN UMUR ALAMAT
PASIEN
1 19 19 Halimi 17 tahun kukulu
18 Suhardi 38 tahun kadu korokrok

JUMLAH

Kepala UPT Puskesmas DTP cimanuk

dr. Rita Permatasari

NIP : 19810920 200902 2 002
NAAN ATS
K
0

PENGGUNAAN
SISA
KET
JUMLAH PETUGAS STOK

1 18
1 17
0
0

17 17

Cimanuk, 3 September 2020

Pengelola obat

Deden Arditia Nurjaman S.si.,Apt

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

PENGGUNAAN
STOK JUMLAH
NO PENERIMAAN NAMA
AWAL PERSEDIAAN UMUR ALAMAT
PASIEN
1 2 5 7

MENU

JUMLAH

Kepala UPT Puskesmas DTP cimanuk

dr. Rita Permatasari

NIP : 19810920 200902 2 002
 NAAN ABU
UK
20

NGGUNAAN
SISA
KET
JUMLAH PETUGAS STOK

7
0

Cimanuk, 3 September 2020

Pengelola obat

Deden Arditia Nurjaman S.si.,Apt

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

NO NAMA OBAT STOK PENERIMAAN JUMLAH PEMAKAIAN PERMINTAAN PEMBERIAN

AWAL PERSEDIAAN STOK AKHIR
3 4 5 6 7 8 9
1 2
(3+4) (5-6)

1 Alprazolam tab 0 0

2 Amitriptilin 25 mg 300 300 600 0 600

3 Carbamazepine 200 mg 200 300 500 100 400

Chlorpromazine hcl 100

4 0 500 500 200 300
mg

5 Clobazam 10 mg 0 0 0 0 0

6 Clozapine 25 mg 0 0 0 0 0

7 Diazepam injeksi 80 0 80 0 80

Diazepam Rektal 0,5 mg

8 6 0 6 1 5
/ 2 ml

9 Divalproexsodium 0 0 0 0 0

10 Fluoksetin 10 mg 0 0 0 0 0

Fluphenazine decanoat
11 15 10 25 0 25
inj 25 mg

12 Haloperidol 1,5 mg 0 0 0 0 0

13 Haloperidol 2 mg 0 300 300 200 100

Haloperidol decanoat inj

14 0 5 5 0 5
50 mg

15 Imipramicine hcl 25 mg 0 0 0 0 0

16 Phenobarbital 30 mg 200 200 0 200

17 Risperidon 2 mg 300 300 600 300 300

18 Shizonat injek 0 0 0 0 0

Trifluouperazine HCl 5
19 0 0 0 0 0
mg

20 Trihexipenidil 2 mg 0 800 800 200 600

Cimanuk, 2 September 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
 DAFTAR
10 BESAR PEMAKAIAN OBAT TERBANYAK
PUSKESMAS CIMANUK
BULAN AGUSTUS TAHUN 2020

NO NAMA OBAT SATUAN JUMLAH

1 Antasida Doen Tablet tab 7900
2 Amoksilin 500 mg tab tab 7200
3 Vitamin B Komplek tab 5000
4 Amlodipin 10 mg tablet tab 4800
5 CTM tab 4600
6 Metformin tab 4400
7 Dexametason tablet tab 3300
8 Natrium Diklofenak 50 mg tab 3250
9 Piridoksin (Vitamin B6) tab 2900
10 Amlodipin 5 mg tablet tab 2400

Cimanuk, 2 September 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
 LAPORAN PEMAKAIAN DAN LEMBAR PERM
PUSKESMAS
PUSKESMAS : CIMANUK
KECAMATAN : CIMANUK
KAB / KOTA : PANDEGLANG PELAPORAN BULAN / PERIODE : AGUSTUS 2020
PROVINSI : BANTEN

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

1 Alprazolam Tablet -
2 Albendazol Tablet 400 mg Tablet -
3 Allopurinol tablet 100 mg Tablet -
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 12,300 4,500
9 Amlodipin Besilate 5 mg Tablet 2,700
10 Amoksisilin Forte sirup kering 125mg Botol -
11 Amoksisilin Injeksi 1 gr Vial -
12 Amoksisilin Tablet 500 mg Tablet 15,200 5,000
13 Amoksisillin kapsul 250 mg Kapsul -
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol -
15 Ampisilin Injeksi 1 gr Vial 157
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 -
21 ANTASIDA DOEN Tablet Tablet 16,000
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 78
29 Artermeter injeksi Ampul -
30 Artesunate injeksi 60 mg/ml vial -
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 4,300 1,000
32 Asam Folat Botol -
33 Asam Fusidat Cream Tube -
34 Asam Klorida 0,1 N Botol -
35 Asam Mefenamat 500 mg Tablet -
36 Asam Traneksamat Inj 5% Ampul -
37 Asering Botol 40 60
38 Asetosal tablet 500 mg Tablet -
39 Asetyl Cysteine Capsul 6,840
40 Asiklovir Cream 5% Tube -
41 Asiklovir tablet 200 mg Tablet 200
42 Asiklovir tablet 400 mg Tablet 250
43 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul - 50
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 72
48 Betametason krim 0,1 % Tube 200 50
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 1,500 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 2,000
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 200
65 D-Artepp tablet Tablet -
66 Deksametason tablet 0,5 mg Tablet 3,600 5,000
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 6
71 Diazepam tablet 2 mg Tablet -
72 Diazepam tablet 5 mg Tablet -
73 Difenhidramin HCL injeksi 10 mg/ml - 1ml Ampul -
74 Digoksin tablet 0,25 mg Tablet 800
75 Diltiazem Tablet -
76 Doksisiklin Kapsul 100 mg Capsul -
77 Domperidon 10mg Tablet Tablet 1,100
78 Domperidon Suspensi 5 mg/ 5 ml Botol 100
79 Doxicyclin 500mg capsul -
80 Efedrin HCLTablet 25 mg Tablet -
81 Epinefrina HCL/Bitartrat Injeksi Ampul - 100
82 Eritromicyn kapsul 250 mg capsul 1,800
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 200
92 Fenoksimetil Penisilina tablet 250 mg Tablet -
93 Fenol Gliserol tetes telinga 10 % Botol 48 48
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul -
 95 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 1,500
96 Flufenazine Deconat Inj 25 mg/ml Ampul 15
97 Furosemida tablet 40 mg Tablet 1,000
98 Furosemide Injeksi Ampul -
99 Garam Oralit Sachet -
100 Gemfibrozil 300 mg Tablet -
101 Gentamicin Injeksi Ampul 137
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 1,100
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet -
108 Glikazid 80 mg Tablet Tablet -
109 Glimepiride 2 mg Tablet 3,200
110 Glukosa larutan infus 10% steril Botol -
111 Glukosa larutan infus 5 % steril Botol -
112 Griseofulvin tablet 500 mg, Tablet 600
113 Guaiafenesin 100 mg Tablet -
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet -
115 Hidrokortison krim 2,5% Tube 144
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 400 300
121 KAEN 3B Infus Botol 20
122 Kalsium Glukonas Injeksi Ampul 72
123 Kalsium Laktat (Kalk) tablet 500 mg Tablet 2,900
124 Kapas Berlemak 500 mg Bungkus -
125 Ketokonazol Kream Tube 175
126 Ketokonazol Tablet 200 mg Tablet 650
127 Ketorolac inj Ampul - 100
128 Kifadene tablet 20 mg Tablet -
129 Kloramfenikol salep mata 1 % capsul 24
130 Kloramfenikol suspensi Botol 50
131 Kloramfenikol tetes telinga 3% Tube -
132 Kloramphenicol 250 mg Capsul -
133 Kloramphenicol 500 mg capsul -
134 Kloramphenicol Tetes Mata Botol -
135 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 12,100
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 -
140 Kotrimoksazol Sirup / Suspensi Botol 200
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 270
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 -
151 Metamizol 500 mg Tablet -
152 Metformin 500 mg Tablet Tablet 5,100 7,000
153 Methilprednisolon tablet 4 mg Tablet -
154 Metilergometrin Maleat injeksi 1 ml Ampul -
155 Metilergometrin Maleat Tablet Tablet 800
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 192
163 Multivitamin Anak Sirup Botol 140
164 Multivitamin Dewasa Antioksidan ( Becom c ) Tablet -
165 Natrium Diklofenak 25 mg Tablet Tablet -
166 Natrium Diklofenak 50 mg Tablet Tablet 4,400 2,000
167 Natrium Klorida Cairan Infus ( NaCL ) Botol 120
168 Nifedipine Tablet 10 mg Tablet -
169 Nistatin tablet vaginal 100.000 IU/g Tube 100
170 Obat anti Diare suspensi Botol -
171 Obat Anti Diare Tablet (Akita / Molagit ) Tablet 800 500
172 Obat Batuk Flu ( Molexflu ) Tablet 12 10
173 Obat Batuk Hitam (OBH) Botol -
174 Obat Batuk Sirup Herbal ( Herbacop ) Botol 182
175 Ofloxsacin Tetes Telinga Tube -
176 Oksitetrasiklin HCL salep mata 1% Botol 625
177 Oksitosin injeksi 10 IU/ml - 1 ml Ampul -
178 Omeprazol injeksi Ampul 10
179 Omeprazol Kapsul 20 mg capsul -
180 Ondancentron injeksi 4 mg Ampul -
181 Ondancentron Tablet4 mg Tablet 360
182 Paracetamol Drop 15 ml Botol 180 240
183 Paracetamol Sirup 120 mg/5 ml Botol 200
184 Parafin Dresing ( Bioplacenton Tull ) pcs -
185 Parasetamol tablet 100 mg Tablet -
186 Parasetamol tablet 500 mg Tablet -
187 Permetrin Krim 5 % Tube 15 5
188 Pirantel Sirup Botol -
189 Pirantel tablet 125 mg Tablet -
190 Pirazinamid Botol -
191 Piridoksin HCL (VIT B6) tablet 10mg Botol 5,900 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 12,600
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 300
203 Ranitidin tablet Tablet -
204 Resperidone 2 mg tablet Tablet -
205 Ringer Laktat cairan infus (MJB) -
206 Ringer Laktat cairan infus (Widatra) Botol 100 60
207 Rivanol 300 ml Botol -
208 Salbutamol Tablet 2 mg Tablet 1,200
209 Salbutamol tablet 4mg Tablet 800
210 Salep 2-4 Tube 101
211 Salep kombinasi cream ( Berloson ) Tube -
212 Salicil bedak Kotak -
213 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial 5 2
214 Serum Anti Tetanus inj 1500 IU ( Tetagam ) Vial 19
215 Sianokobalamin Injeksi Ampul -
216 Simvastatin 10 mg tablet Tablet 4,140
217 Simvastatin 20 mg tablet Tablet -
218 Sukralfat Suspensi Botol 125
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 2,400
226 Ventolin Nebulizer Ampul -
227 Vitamin B komplek Tablet 9,500
228 Zink sirup Botol 72
229 Zink tablet 20 mg Tablet 2,300
Antasida DOEN suspensi botol 150
Allopurinol 100 mg (2020) Tablet 1,800
Kotrimoksazol Dewasa Tablet 480 mg (2020) Tablet 1,600 600
Kloramphenicol 500 mg Kapsul 400 500
Kloramfenikol salep kulit 2% Tube 48
Natrium Klorida Cairan Infus ( NaCL ) Botol 40
Paracetamol Sirup 120 mg/5 ml (2020) Botol 400 100
Salep 2-4 (2020) Pot 43

OBAT PROGRAM
1 Albendazol Tablet 400 mg Tablet 8,880
2 Isoniazid Tablet 100 mg Tablet 100
3 Obat Antituberkulosis kategori 1 Paket 7
4 Obat Antituberkulosis Kategori 2 Paket 1
5 Obat Antituberkulosis Kategori Anak Paket 1
6 Pot Dahak Non Steril Biji -
7 Pot Dahak Steril Biji 420
8 Reagen Ziehl Neelsen Kit 3
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 300
17 Carbamazepin 200 mg tablet Tablet 200 300
18 Clobazam 10 mg Tablet Tablet -
19 Clozapine 25 mg Tablet Tablet -
20 Fenitoin Natrium kapsul 30 mg capsul -
21 Haloperidol 1,5 mg Tablet Tablet -
22 Haloperidol 2 mg tablet Tablet 0 300
23 Haloperidol 5 mg Tablet Tablet 0
24 Haloperidol Injeksi Ampul 0
25 Klorpromazin HCL tablet salut 100 mg Tablet 0 500
26 Klorpromazine Tablet 25 mg Tablet 0
27 Triheksilfenidil Hcl 2 mg tablet Tablet 0 800
28 Risperidone 2 mg tablet Tablet 300 300
29 Divalproexsodium Tablet 0
Diazepam injeksi (program) ampul 80
Magnesium Sulfat Inj. 25 ml 40 % (program) ampul 12
Kalsium Glukonas Injeksi ampul 60
Oksitosin injeksi 10 IU/ml - 1 ml ampul 400
Metilergometrin Maleat injeksi 1 ml ampul 300
Dehydro Artemisin 40 mg + Piperaquin 320 mg (DHP) tablet 0
Primakuin tablet 15 mg tablet 0
Masker karet ear loop hijab box 10
Masker N 95 box 0

NAMA BAHAN MEDIS HABIS PAKAI (BMHP )

B
1 Alat suntik 1 ml Pcs 0
2 Alat suntik 10 ml Pcs 0
3 Alat suntik 2,5 ml Pcs 0
4 Alat suntik 20 ml Pcs 0
5 Alat suntik 3 cc (Remedi) 300 500
6 Alat suntik 3 ml Pcs 0
7 Alat suntik 5 ml pcs 400
8 Alkazide 1 L High Level Desinfectant Botol 0
9 Alkazyme Sachet 25 mg Pack 0
10 Alkohol 70 % 1 L Botol 0
11 Alkohol swab Sachet 7 7
12 Anti Septik Hand Rub Botol 0
13 Anti Septik Surgikal Hand Scrub Botol 0
14 Cat Gut no 2/0 Sachet 0
15 Cat Gut no 3/0 Sachet 0
16 Cat Gut No 3/0 (24 mm) Sachet 0
17 Cat Gut No 3/0 (26 mm) Sachet 0
18 Cathetter Jelly Biji 0
19 Demetech Silk 3/0 Set 48
20 E Care I.V Dresing Pcs 0
21 E-Care Surgical Mask Tie On Lembar 0
22 Folly No 14 Catether pcs 0
23 Folly No 16 Catether pcs 10 40
24 I.V Cathetter No. 20 Set 50
25 I.V Cathetter No. 22 troge Set 0
26 I.V Cathetter No. 24 troge Set 50
27 I.V Cathetter No. 26 Set 0
28 Infuset Anak Set 100
29 Infuset Dewasa Set 0 150
30 Jarum Insulin Tablet 0
31 Kapas Berlemak 250 gr Bungkus 1 5
32 Kapas Berlemak 500 gr Bungkus 0
33 Kasa 4 m x 10 cm Rol 0
34 Kasa Hidrofil 36 x 80 cm Rol 2 1
35 Kasa Pembalut 2 x 80 cm Pack 37 20
36 Kasa Steril 16 x 16 cm Kotak 24 50
37 Lisol 1 L Botol 0
38 Masker karet Ear Loop Lembar 0
39 Masker tali Tube 0
40 Nasal Canula Oksigen Set 0
41 Plester kertas 1,25 cm x 9,14 m Rol 34 10
42 Plester Kertas 2,5 cm Rol 0
43 Plester Non Woven 5cm x 5 cm Rol 21 10
44 Policlean Botol 4
45 Polifik Kotak 0
46 Saraya Alsof A 500 ml Botol 0
47 Saraya Alsof Pure 500 ml Botol 0
48 Sarung Tangan Gynecolog No 7 Pasang 150
49 Sarung tangan M (Non Steril) Pasang 1400 500
50 Sarung tangan no 6,5 Pasang 0
51 Sarung tangan no 6,5 Steril Gloves Pasang 0
52 Sarung tangan no 7,0 Steril Pasang 0
Selang Section ( Surgikal Conection Tube with
53 yankauer) Pcs 24
54 Underpad Lembar 60
55 Urine Bag Biji 0
I.V Cathetter No. 24 jms pcs 50
I.V Cathetter No. 22 jms set 250
Alat suntik 1 ml (2020) box 3
Cat Gut no 2/0 pcs 60
Cat Gut no 3/0 pcs 60
I.V Cathetter No. 20 set 100 100

NAMA OBAT VAKSIN

1 Vaksin Anti Rabies ( VAR ) Vial 0

2 Vaksin BCG Vial 10
3 Vaksin DT Vial 40
4 Vaksin HB 0 Pcs 60
5 Vaksin HBIG Vial 0
6 Vaksin Measless Rubella (MR) Vial 20
7 Vaksin Pentabio ( DPT - HB - Hib ) Vial 0
8 Vaksin Polio B OPV Vial 0
9 Vaksin Polio IPV Vial 0
10 Vaksin TD Vial 40
11 Vaksin Tuberculin Vial 2
12 ADS 0,05 ml Unit 100
13 ADS 0,5 ml Unit 130
14 ADS 5 ml Unit 50
15 Safety Box Unit 8
0
0
0
NAMA OBAT REAGEN
 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
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
N DAN LEMBAR PERMINTAAN OBAT ( LPLPO )
PUSKESMAS
DOKUMEN NOMOR
DINKES KAB/KOTA
DE : AGUSTUS 2020 : GFK KAB/KOTA
PUSKESMAS

Penerimaan
Jumlah Jumlah
PROG LAIN 2 Penerimaan Persediaan

5 6
( 4+5 ) 1 2 3 4 5 6 7 8 9

- -
- -
- -
- -
- -
- -
- -
4,500 16,800 900
- 2,700 900
- -
- -
5,000 20,200 400 400 400 400 400
- -
- -
- 157
- -
- -
- -
- -
- -
- 16,000 400 400 400 400 400 400
- -
- -
- -
- -
- -
- -
- 78
- -
- -
1,000 5,300 500
- -
- -
- -
- -
- -
60 100
- -
- 6,840 180
- -
 - 200
- 250
50 50
- -
- -
- -
- 72 12
50 250 25
- -
- -
- -
- -
- -
- -
1,000 2,500 300
- -
- -
- -
- -
- -
- 2,000 200 100 100
- -
- -
- 200
- -
5,000 8,600 400 400 400
- -
- -
- -
- 6
- -
- -
- -
- 800
- -
- -
- 1,100
- 100 5
- -
- -
100 100
- 1,800
- -
- -
- -
- -
- -
- -
- -
- -
- 200
- -
48 96
- -
 - 1,500
10 10 25
- 1,000 200
- -
- -
- -
- 137
- -
- -
- -
- -
- 1,100
- -
- -
- 3,200
- -
- -
- 600
- -
- -
- 144 24 24
- -
- -
- -
- -
300 700 100
- 20
- 72
- 2,900 300
- -
- 175
- 650
100 100
- -
- 24
- 50
- -
- -
- -
- -
- 12,100 400 400
- -
- -
- -
- -
- 200
- -
- -
- -
- -
- 270 70
- -
- -
- -
 - -
- -
- -
7,000 12,100 400 600
- -
- -
- 800
- -
- -
- -
- -
- -
- -
- 192
- 140 40
- -
- -
2,000 6,400 200 300 200
- 120
- -
- 100
- -
500 1,300 100 100
10 22 1 2
- -
- 182
- -
- 625
- -
- 10
- -
- -
- 360 180
240 420 60 13
- 200 100
- -
- -
- -
5 20
- -
- -
- -
2,000 7,900 800
- -
- -
- -
- -
- -
- 12,600 400 400
- -
- -
- -
- -
- 300
 - -
- -
- -
60 160
- -
- 1,200 100
- 800
- 101
- -
- -
2 7
- 19 1
- -
- 4,140 150 60 210 120
- -
- 125
- -
- -
- -
- -
- -
- -
- 2,400
- -
- 9,500 400 400 100 400
- 72
- 2,300 200
- 150
- 1,800 200
600 2,200 100
500 900 100
- 48
- 40
100 500
- 43

- -
- 8,880
- 100
16 16 23 2
- 1
2 2 3 1
- -
- 420 20
- 3
- -
- -
- -
- -
- -
500 500 500
 - -
300 300 600
300 500 100
- -
- -
- -
- -
300 300
- -
5 5 5
500 500
- -
800 800
300 600
- -
- 80
- 12
- 60
- 400
- 300 6
- -
- -
- 10 1
- -
- -
- -
- -
- -
- -
- -
500 800
- -
- 400
- -
- -
- -
7 14 1
- -
- -
- -
- -
- -
- -
- -
- 48
- -
- -
- -
40 50
- 50
- -
- 50
- -
- 100
 150 150
- -
5 6
- -
- -
1 3
20 57
50 74
- -
- -
- -
- -
10 44
- -
10 31
- 4 1
- -
- -
- -
- 150 25
500 1,900 50 50 50
- -
- -
- -

- 24
- 60
- -
- 50
- 250
- 3
- 60
- 60
100 200
- -
- -
- -
- -
10 10 20 5
- 40
50 50 110 5 5 5 5
- -
20 20 40 10
60 60 60 10 10
50 50 50 10 10
- -
- 40 5
- 2
100 100 200 10 10
300 300 430 20 20 20
- 50 10 10
- 8 1 1
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
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- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
-
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
TANGGAL

Pemakaian Perhari / Tanggal diloket

7
10 11 12 13 14 15 16 17 18 19 20 21

600 900
900

200 400 400 400 400 900

200 400 400 400 400 900

 12
25 25

300 500 400

100

400 900

200

200
45
 24

200 100

200

50

300 100 400 900

 800

200 200 950

200 100 50 100 100

1 1 1 1 1

38

25

24

1100

400
 100

300 120

25

400 100 400 900

100 200

200
100
100

50 70

3 4

20

500
 200

200

200
200

100
 3

50

10 10 10

10
10 10 10 10
10 10 10

10 10
20 20 10
10 10
22 23 24 25 26 27 28 29 30 31 Pustu Pusling

kd dodol sekong gn cupu kd bumbang dalam balar

600 1200 600

600

300 400 400 400 400 400

500 400 400 400 400 400 200

200 200
 25 50

400

200 200

200 200 400

200

100
50

100

24
 24 10

100 200

200 200

10

14 10

400 400 500 400 400

 2600

400 250 250 300

100 100 100 50

1 2 1

120
60 8 10

1000

300
 200

15

300 300 180

400 300

400 400 500 400 100

200 100

200
200
100

90 40

100

4
100
 50 50 50

20
 Pengeluaran Sub Unit

Pusling poskesdes posyandu igd

Gunung kadu Kadu
rocek gn datar kp handap Dalam balar Cupu rocek cimanuk Madang Batu bantar Bungbang Kadu dodol

40
 8

20
 20

200 300 400 100 200

100
 20

10

10 10 10 5 10 10 10
15 15 20 20 10 10 10

100
60

40
 100 200

1 1 1

24
 60

20

200

50
50
 Jumlah Stok
Pengeluaran AkhirBulan
8 9
vk (1+ s.d31 + sub unit) (6-8)

0 0
0 0
0 0
0 0
0 0
0 0
0 0
4800 12000
2400 300
0 0
0 0
200 7200 13000
0 0
0 0
20 20 137
0 0
0 0
0 0
0 0
0 0
100 7900 8100
0 0
0 0
0 0
0 0
0 0
0 0
6 72
0 0
0 0
900 4400
0 0
0 0
0 0
0 0
0 0
20 60 40
0 0
180 6660
0 0
 0 200
0 250
0 50
0 0
0 0
0 0
32 40
150 100
0 0
0 0
0 0
0 0
0 0
0 0
1900 600
0 0
0 0
0 0
0 0
0 0
900 1100
0 0
0 0
20 180
0 0
3300 5300
0 0
0 0
0 0
1 5
0 0
0 0
0 0
400 400
0 0
0 0
300 800
100 0
0 0
0 0
0 100
100 1700
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 200
0 0
24 72
0 0
 0 1500
0 25
200 800
0 0
0 0
0 0
32 32 105
0 0
0 0
0 0
0 0
0 1100
0 0
0 0
0 3200
0 0
0 0
0 600
0 0
0 0
106 38
0 0
0 0
0 0
0 0
700 0
20 0
48 48 24
2100 800
0 0
10 165
50 600
100 0
0 0
24 0
0 50
0 0
0 0
0 0
0 0
4600 7500
0 0
0 0
0 0
0 0
0 200
0 0
0 0
0 0
0 0
100 170 100
0 0
0 0
0 0
 0 0
0 0
0 0
4400 7700
0 0
0 0
0 800
0 0
0 0
0 0
0 0
0 0
0 0
0 192
40 100
0 0
0 0
3250 3150
20 100
0 0
0 100
0 0
1100 200
12 10
0 0
38 144
0 0
25 600
0 0
10 0
0 0
0 0
300 60
240 180
200 0
0 0
0 0
0 0
0 20
0 0
0 0
0 0
2900 5000
0 0
0 0
0
0 0
0 0
1500 11100
0 0
0 0
0 0
0 0
100 200
 0 0
0 0
0 0
40 100 60
0 0
400 800
0 800
15 86
0 0
0 0
0 7
2 17
0 0
1740 2400
0 0
25 100
0 0
0 0
0 0
0 0
0 0
0 0
700 1700
0 0
100 5000 4500
0 72
800 1500
0 150
600 1200
400 1800
300 600
0 48
40 0
250 250
0 43

0 0
100 8780
0 100
13 10
0 1
2 1
0 0
40 380
0 3
0 0
0 0
0 0
0 0
0 0
500 0
 0 0
0 600
100 400
0 0
0 0
0 0
0 0
200 100
0 0
0 5
200 300
0 0
200 600
300 300
0 0
0 80
12 12 0
60
100 100 300
100 106 194
0 0
0 0
1 9
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 500 300
0 0
0 400
0 0
0 0
0 0
1 5 9
0 0
0 0
0 0
0 0
0 0
0 0
0 0
24 24
0 0
0 0
0 0
0 50
50 50 0
0 0
0 50
0 0
0 100
 30 90 60
0 0
1 1 5
0 0
0 0
1 2 1
10 13 44
21 41 33
0 0
0 0
0 0
0 0
7 12 32
0 0
2 2 29
3 4 0
0 0
0 0
0 0
25 50 100
350 900 1000
0 0
0 0
0 0

0 24
0 60
0 0
50 0
50 100 150
1 1 2
0 60
48 48 12
0 200

0 0
0 0
0 0
5 15
0 40
50 60
0 0
20 20
60 0
50 0
0 0
5 35
0 2
40 160
130 300
40 10
2 6
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
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 ( L
PUSKESMAS
PUSKESMAS : CIMANUK
KECAMATAN : CIMANUK
KAB / KOTA : PANDEGLANG PELAPORAN BULAN / PERIODE : AGUSTUS 2020
PROVINSI : BANTEN PERMINTAAN BULAN / PERIODE : SEPTEMBER 2020

Jumlah Stok Stok

N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir Optimum

1 2 3 4 5 6 7 8 9
A NAMA OBAT ( 4+5 ) (6-7)
1 Alprazolam Tablet - - - - - -
2 Albendazol Tablet 400 mg Tablet - - - - - -
3 Allopurinol tablet 100 mg Tablet - - - - - -
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 12,300 4,500 16,800 4,800 12,000 5,760
9 Amlodipin Besilate 5 mg Tablet 2,700 - 2,700 2,400 300 2,880
10 Amoksisilin Forte sirup kering 250mg Botol - - - - - -
11 Amoksisilin Injeksi 1 gr Vial - - - - - -
12 Amoksisilin Tablet 500 mg Tablet 15,200 5,000 20,200 7,200 13,000 8,640
13 Amoksisillin kapsul 250 mg Kapsul - - - - - -
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol - - - - - -
15 Ampisilin Injeksi 1 gr Vial 157 - 157 20 137 24
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 - - - - - -
21 ANTASIDA DOEN Tablet Tablet 16,000 - 16,000 7,900 8,100 9,480
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 78 - 78 6 72 7
29 Artermeter injeksi Ampul - - - - - -
30 Artesunate injeksi 60 mg/ml vial - - - - - -
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 4,300 1,000 5,300 900 4,400 1,080
32 Asam Folat Botol - - - - - -
33 Asam Fusidat Cream Tube - - - - - -
34 Asam Klorida 0,1 N Botol - - - - - -
35 Asam Mefenamat 500 mg Tablet - - - - - -
36 Asam Traneksamat Inj 5% Ampul - - - - - -
37 Asering Botol 40 60 100 60 40 72
38 Asetosal tablet 500 mg Tablet - - - - - -
39 Asetyl Cysteine Capsul 6,840 - 6,840 180 6,660 216
40 Asiklovir Cream 5% Tube - - - - - -
41 Asiklovir tablet 200 mg Tablet 200 - 200 - 200 -
42 Asiklovir tablet 400 mg Tablet 250 - 250 - 250 -
43 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul - 50 50 - 50 -
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 - - - - - -
 Jumlah Stok Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir Optimum

1 2 3 4 5 6 7 8 9
A NAMA OBAT ( 4+5 ) (6-7)
47 Betadine Salep Antiseptik 5 mg Tube 72 - 72 32 40 38
48 Betametason krim 0,1 % Tube 200 50 250 150 100 180
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 1,500 1,000 2,500 1,900 600 2,280
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 2,000 - 2,000 900 1,100 1,080
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 200 - 200 20 180 24
65 D-Artepp tablet Tablet - - - - - -
66 Deksametason tablet 0,5 mg Tablet 3,600 5,000 8,600 3,300 5,300 3,960
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 6 - 6 1 5 1
71 Diazepam tablet 2 mg Tablet - - - - - -
72 Diazepam tablet 5 mg Tablet - - - - - -
73 Difenhidramin HCL injeksi 10 mg/ml - 1ml Ampul - - - - - -
74 Digoksin tablet 0,25 mg Tablet 800 - 800 400 400 480
75 Diltiazem Tablet - - - - - -
76 Doksisiklin Kapsul 100 mg Capsul - - - - - -
77 Domperidon 10mg Tablet Tablet 1,100 - 1,100 300 800 360
78 Domperidon Suspensi 5 mg/ 5 ml Botol 100 - 100 100 - 120
79 Doxicyclin 500mg capsul - - - - - -
80 Efedrin HCLTablet 25 mg Tablet - - - - - -
81 Epinefrina HCL/Bitartrat Injeksi Ampul - 100 100 - 100 -
82 Eritromicyn kapsul 250 mg capsul 1,800 - 1,800 100 1,700 120
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 200 - 200 - 200 -
92 Fenoksimetil Penisilina tablet 250 mg Tablet - - - - - -
93 Fenol Gliserol tetes telinga 10 % Botol 48 48 96 24 72 29
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul - - - - - -
95 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 1,500 - 1,500 - 1,500 -
96 Flufenazine Deconat Inj 25 mg/ml Ampul 15 10 25 - 25 -
97 Furosemida tablet 40 mg Tablet 1,000 - 1,000 200 800 240
98 Furosemide Injeksi Ampul - - - - - -
99 Garam Oralit Sachet - - - - - -
100 Gemfibrozil 300 mg Tablet - - - - - -
 Jumlah Stok Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir Optimum

1 2 3 4 5 6 7 8 9
A NAMA OBAT ( 4+5 ) (6-7)
101 Gentamicin Injeksi Ampul 137 - 137 32 105 38
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 1,100 - 1,100 - 1,100 -
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet - - - - - -
108 Glikazid 80 mg Tablet Tablet - - - - - -
109 Glimepiride 2 mg Tablet 3,200 - 3,200 - 3,200 -
110 Glukosa larutan infus 10% steril Botol - - - - - -
111 Glukosa larutan infus 5 % steril Botol - - - - - -
112 Griseofulvin tablet 500 mg, Tablet 600 - 600 - 600 -
113 Guaiafenesin 100 mg Tablet - - - - - -
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet - - - - - -
115 Hidrokortison krim 2,5% Tube 144 - 144 106 38 127
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 400 300 700 700 - 840
121 KAEN 3B Infus Botol 20 - 20 20 - 24
122 Kalsium Glukonas Injeksi Ampul 72 - 72 48 24 58
123 Kalsium Laktat (Kalk) tablet 500 mg Tablet 2,900 - 2,900 2,100 800 2,520
124 Kapas Berlemak 500 mg Bungkus - - - - - -
125 Ketokonazol Kream Tube 175 - 175 10 165 12
126 Ketokonazol Tablet 200 mg Tablet 650 - 650 50 600 60
127 Ketorolac inj Ampul - 100 100 100 - 120
128 Kifadene tablet 20 mg Tablet - - - - - -
129 Kloramfenikol salep mata 1 % capsul 24 - 24 24 - 29
130 Kloramfenikol suspensi Botol 50 - 50 - 50 -
131 Kloramfenikol tetes telinga 3% Tube - - - - - -
132 Kloramphenicol 250 mg Capsul - - - - - -
133 Kloramphenicol 500 mg capsul - - - - - -
134 Kloramphenicol Tetes Mata Botol - - - - - -
135 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 12,100 - 12,100 4,600 7,500 5,520
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 - - - - - -
140 Kotrimoksazol Sirup / Suspensi Botol 200 - 200 - 200 -
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 270 - 270 170 100 204
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 - - - - - -
151 Metamizol 500 mg Tablet - - - - - -
152 Metformin 500 mg Tablet Tablet 5,100 7,000 12,100 4,400 7,700 5,280
153 Methilprednisolon tablet 4 mg Tablet - - - - - -
154 Metilergometrin Maleat injeksi 1 ml Ampul - - - - - -
 Jumlah Stok Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir Optimum

1 2 3 4 5 6 7 8 9
A NAMA OBAT ( 4+5 ) (6-7)
155 Metilergometrin Maleat Tablet Tablet 800 - 800 - 800 -
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 192 - 192 - 192 -
163 Multivitamin Anak Sirup Botol 140 - 140 40 100 48
164 Multivitamin Dewasa Antioksidan ( Becom c ) Tablet - - - - - -
165 Natrium Diklofenak 25 mg Tablet Tablet - - - - - -
166 Natrium Diklofenak 50 mg Tablet Tablet 4,400 2,000 6,400 3,250 3,150 3,900
167 Natrium Klorida Cairan Infus ( NaCL ) Botol 120 - 120 20 100 24
168 Nifedipine Tablet 10 mg Tablet - - - - - -
169 Nistatin tablet vaginal 100.000 IU/g Tube 100 - 100 - 100 -
170 Obat anti Diare suspensi Botol - - - - - -
171 Obat Anti Diare Tablet (Akita / Molagit ) Tablet 800 500 1,300 1,100 200 1,320
172 Obat Batuk Flu ( Molexflu ) Tablet 12 10 22 12 10 14
173 Obat Batuk Hitam (OBH) Botol - - - - - -
174 Obat Batuk Sirup Herbal ( Herbacop ) Botol 182 - 182 38 144 46
175 Ofloxsacin Tetes Telinga Tube - - - - - -
176 Oksitetrasiklin HCL salep mata 1% Botol 625 - 625 25 600 30
177 Oksitosin injeksi 10 IU/ml - 1 ml Ampul - - - - - -
178 Omeprazol injeksi Ampul 10 - 10 10 - 12
179 Omeprazol Kapsul 20 mg capsul - - - - - -
180 Ondancentron injeksi 4 mg Ampul - - - - - -
181 Ondancentron Tablet4 mg Tablet 360 - 360 300 60 360
182 Paracetamol Drop 15 ml Botol 180 240 420 240 180 288
183 Paracetamol Sirup 120 mg/5 ml Botol - - - - - -
184 Parafin Dresing ( Bioplacenton Tull ) pcs - - - - - -
185 Parasetamol tablet 100 mg Tablet - - - - - -
186 Parasetamol tablet 500 mg Tablet - - - - - -
187 Permetrin Krim 5 % Tube 15 5 20 - 20 -
188 Pirantel Sirup Botol - - - - - -
189 Pirantel tablet 125 mg Tablet - - - - - -
190 Pirazinamid Botol - - - - - -
191 Piridoksin HCL (VIT B6) tablet 10mg Botol 5,900 2,000 7,900 2,900 5,000 3,480
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 12,600 - 12,600 1,500 11,100 1,800
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 300 - 300 100 200 120
203 Ranitidin tablet Tablet - - - - - -
204 Resperidone 2 mg tablet Tablet - - - - - -
205 Ringer Laktat cairan infus (Otsuka) - - - - - -
206 Ringer Laktat cairan infus (Widatra) Botol 100 60 160 100 60 120
207 Rivanol 300 ml Botol - - - - - -
208 Salbutamol Tablet 2 mg Tablet 1,200 - 1,200 400 800 480
 Jumlah Stok Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir Optimum

1 2 3 4 5 6 7 8 9
A NAMA OBAT ( 4+5 ) (6-7)
209 Salbutamol tablet 4mg Tablet 800 - 800 - 800 -
210 Salep 2-4 Tube 101 - 101 15 86 18
211 Salep kombinasi cream ( Berloson ) Tube - - - - - -
212 Salicil bedak Kotak - - - - - -
213 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial 5 2 7 - 7 -
214 Serum Anti Tetanus inj 1500 IU ( Tetagam ) Vial 19 - 19 2 17 2
215 Sianokobalamin Injeksi Ampul - - - - - -
216 Simvastatin 10 mg tablet Tablet 4,140 - 4,140 1,740 2,400 2,088
217 Simvastatin 20 mg tablet Tablet - - - - - -
218 Sukralfat Suspensi Botol 125 - 125 25 100 30
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 2,400 - 2,400 700 1,700 840
226 Ventolin Nebulizer Ampul - - - - - -
227 Vitamin B komplek Tablet 9,500 - 9,500 5,000 4,500 6,000
228 Zink sirup Botol 72 - 72 - 72 -
229 Zink tablet 20 mg Tablet 2,300 - 2,300 800 1,500 960
Antasida DOEN suspensi botol 150 - 150 - 150 -
Allopurinol 100 mg (2020) Tablet 1,800 - 1,800 600 1,200 720
Kotrimoksazol Dewasa Tablet 480 mg (2020) Tablet 1,600 600 2,200 400 1,800 480
Kloramphenicol 500 mg Kapsul 400 500 900 300 600 360
Kloramfenikol salep kulit 2% Tube 48 - 48 - 48 -
Natrium Klorida Cairan Infus ( NaCL ) Wida Botol 40 - 40 40 - 48
Paracetamol Sirup 120 mg/5 ml (2020) Botol 400 100 500 250 250 300
Salep 2-4 (2020) Pot 43 - 43 - 43 -

OBAT PROGRAM - - - - - -
1 Albendazol Tablet 400 mg Tablet 8,880 - 8,880 100 8,780 120
2 Isoniazid Tablet 100 mg Tablet 100 - 100 - 100 -
3 Obat Antituberkulosis kategori 1 Paket 7 16 23 13 10 16
4 Obat Antituberkulosis Kategori 2 Paket 1 - 1 - 1 -
5 Obat Antituberkulosis Kategori Anak Paket 1 2 3 2 1 2
6 Pot Dahak Non Steril Biji - - - - - -
7 Pot Dahak Steril Biji 420 - 420 40 380 48
8 Reagen Ziehl Neelsen Kit 3 - 3 - 3 -
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 - 500 500 500 - 600
15 Tablet Penambah Darah ( FE ) Tablet - - - - - -
16 Amitriptilin tablet 25 mg Tablet 300 300 600 - 600 -
17 Carbamazepin 200 mg tablet Tablet 200 300 500 100 400 120
18 Clobazam 10 mg Tablet Tablet - - - - - -
19 Clozapine 25 mg Tablet Tablet - - - - - -
20 Fenitoin Natrium kapsul 30 mg capsul - - - - - -
21 Haloperidol 1,5 mg Tablet Tablet - - - - - -
22 Haloperidol 2 mg tablet Tablet - 300 300 200 100 240
23 Haloperidol 5 mg Tablet Tablet - - - - - -
 Jumlah Stok Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir Optimum

1 2 3 4 5 6 7 8 9
A NAMA OBAT ( 4+5 ) (6-7)
24 Haloperidol Injeksi Ampul - 5 5 - 5 -
25 Klorpromazin HCL tablet salut 100 mg Tablet - 500 500 200 300 240
26 Klorpromazine Tablet 25 mg Tablet - - - - - -
27 Triheksilfenidil Hcl 2 mg tablet Tablet - 800 800 200 600 240
28 Risperidone 2 mg tablet Tablet 300 300 600 300 300 360
29 Divalproexsodium Tablet - - - - - -
Diazepam injeksi (program) ampul 80 80 - 80 -
Magnesium Sulfat Inj. 25 ml 40 % (program) ampul 12 12 12 - 14
Kalsium Glukonas Injeksi ampul 60 60 - 60 -
Oksitosin injeksi 10 IU/ml - 1 ml ampul 400 100 300 120
Metilergometrin Maleat injeksi 1 ml ampul 300 106 194 127
Dehydro Artemisin 40 mg + Piperaquin 320 mg (DHP) tablet - - - -
Primakuin tablet 15 mg tablet - - - -
Masker karet ear loop hijab box 10 1 9 1
Masker N 95 box - - - -
- - - - - -
NAMA BAHAN MEDIS HABIS PAKAI (BMHP )
B - - - - - -
1 Alat suntik 1 ml Pcs - - - - - -
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) 300 500 800 500 300 600
6 Alat suntik 3 ml Pcs - - - - - -
7 Alat suntik 5 ml pcs 400 - 400 - 400 -
8 Alkazide 1 L High Level Desinfectant Botol - - - - - -
9 Alkazyme Sachet 25 mg Pack - - - - - -
10 Alkohol 70 % 1 L Botol - - - - - -
11 Alkohol swab Sachet 7 7 14 5 9 6
12 Anti Septik Hand Rub Botol - - - - - -
13 Anti Septik Surgikal Hand Scrub Botol - - - - - -
14 Cat Gut no 2/0 Sachet - - - - - -
15 Cat Gut no 3/0 Sachet - - - - - -
16 Cat Gut No 3/0 (24 mm) Sachet - - - - - -
17 Cat Gut No 3/0 (26 mm) Sachet - - - - - -
18 Cathetter Jelly Biji - - - - - -
19 Demetech Silk 3/0 Set 48 - 48 24 24 29
20 E Care I.V Dresing Pcs - - - - - -
21 E-Care Surgical Mask Tie On Lembar - - - - - -
22 Folly No 14 Catether pcs - - - - - -
23 Folly No 16 Catether pcs 10 40 50 - 50 -
24 I.V Cathetter No. 20 Set 50 - 50 50 - 60
25 I.V Cathetter No. 22 Set - - - - - -
26 I.V Cathetter No. 24 Set 50 - 50 - 50 -
27 I.V Cathetter No. 26 Set - - - - - -
28 Infuset Anak Set 100 - 100 - 100 -
29 Infuset Dewasa Set - 150 150 90 60 108
30 Jarum Insulin Tablet - - - - - -
31 Kapas Berlemak 250 gr Bungkus 1 5 6 1 5 1
32 Kapas Berlemak 500 gr Bungkus - - - - - -
33 Kasa 4 m x 10 cm Rol - - - - - -
34 Kasa Hidrofil 36 x 80 cm Rol 2 1 3 2 1 2
35 Kasa Pembalut 2 x 80 cm Pack 37 20 57 13 44 16
36 Kasa Steril 16 x 16 cm Kotak 24 50 74 41 33 49
37 Lisol 1 L Botol - - - - - -
 Jumlah Stok Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir Optimum

1 2 3 4 5 6 7 8 9
A NAMA OBAT ( 4+5 ) (6-7)
38 Masker karet Ear Loop Lembar - - - - - -
39 Masker tali Tube - - - - - -
40 Nasal Canula Oksigen Set - - - - -
41 Plester 1" Rol 34 10 44 12 32 14
42 Plester Kertas 2,5 cm Rol - - - - - -
43 Plester Non Woven 5cm x 5 cm Rol 21 10 31 2 29 2
44 Policlean Botol 4 - 4 4 - 5
45 Polifik Kotak - - - - - -
46 Saraya Alsof A 500 ml Botol - - - - - -
47 Saraya Alsof Pure 500 ml Botol - - - - - -
48 Sarung Tangan Gynecolog No 7 Pasang 150 - 150 50 100 60
49 Sarung tangan M (Non Steril) Pasang 1,400 500 1,900 900 1,000 1,080
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 24 - 24 - 24 -

54 Underpad Lembar 60 - 60 - 60 -
55 Urine Bag Biji - - - - - -
I.V Cathetter No. 24 jms pcs 50 - 50 50 - 60
I.V Cathetter No. 22 jms set 250 - 250 100 150 120
Alat suntik 1 ml (2020) box 3 - 3 1 2 1
Cat Gut no 2/0 pcs 60 - 60 - 60 -
Cat Gut no 3/0 pcs 60 - 60 48 12 58
I.V Cathetter No. 20 set 100 100 200 - 200 -

- - - - - -
NAMA OBAT VAKSIN
-
1 Vaksin Anti Rabies ( VAR ) Vial - - - -
2 Vaksin BCG Vial 28 10 20 5 15 6
3 Vaksin DT Vial 40 - 40 - 40 -
4 Vaksin HB 0 Pcs 52 50 110 50 60 60
5 Vaksin HBIG Vial - - - - - -
6 Vaksin Measless Rubella (MR) Vial 17 20 40 20 20 24
7 Vaksin Pentabio ( DPT - HB - Hib ) Vial 40 60 60 60 - 72
8 Vaksin Polio B OPV Vial 50 50 50 50 - 60
9 Vaksin Polio IPV Vial - - - - - -
10 Vaksin TD Vial 70 - 40 5 35 6
11 Vaksin Tuberculin Vial - - 2 - 2 -
12 ADS 0,05 ml Unit 50 100 200 40 160 48
13 ADS 0,5 ml Unit 560 300 430 130 300 156
14 ADS 5 ml Unit 37 - 50 40 10 48
15 Safety Box Unit 20 - 8 2 6 2
- - - - - -
- - - - - -
- - - - - -
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 - - - - - -
 Jumlah Stok Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir Optimum

1 2 3 4 5 6 7 8 9
A NAMA OBAT ( 4+5 ) (6-7)
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 - - - - - -
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
 Jumlah Stok Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir Optimum

1 2 3 4 5 6 7 8 9
A NAMA OBAT ( 4+5 ) (6-7)
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 - - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -

RAWAT
JUMLAH KUNJUNGAN PUSKESMAS JALAN RAWAT INAP JUMLAH
 Jumlah Stok Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir Optimum

1 2 3 4 5 6 7 8 9
A NAMA OBAT ( 4+5 ) (6-7)
UMUM / BAYAR 2423
UMUM / TIDAK BAYAR 14
JKN 1697
TOTAL KUNJUNGAN 4134

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

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

NIP. NIP. NIP.
N OBAT ( LPLPO )

DOKUMEN NOMOR TANGGAL

DINKES KAB/KOTA
GFK KAB/KOTA
PUSKESMAS

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

10 11 12 13 14 15 16

750
2500

3000
6000

5,000

5000

18

1000
5000

6000
50
60

100
500
 Jumlah PEMBERIAN
Permintaa BUFFER JUMLAH
APBD II JKN PROG LAIN LAIN
n STOK

10 11 12 13 14 15 16

72
100

5000

100
1000

5000

1000

100

100

10

48

200

1000
 Jumlah PEMBERIAN
Permintaa BUFFER JUMLAH
APBD II JKN PROG LAIN LAIN
n STOK

10 11 12 13 14 15 16

200
100
50

500
240
100
3000

100
1500
60

3000

100

125

100
3000

100

100
200
200

1000
50

10000
 Jumlah PEMBERIAN
Permintaa BUFFER JUMLAH
APBD II JKN PROG LAIN LAIN
n STOK

10 11 12 13 14 15 16

500

50

50
500

2000

200

50
2000
15

100

20
330
80
60
360
0

2000
2000

10
10

2000

100
 Jumlah PEMBERIAN
Permintaa BUFFER JUMLAH
APBD II JKN PROG LAIN LAIN
n STOK

10 11 12 13 14 15 16

50
2

2100
1500
50

40
2500

500

500

800
 Jumlah PEMBERIAN
Permintaa BUFFER JUMLAH
APBD II JKN PROG LAIN LAIN
n STOK

10 11 12 13 14 15 16

500

500

10
10
10

15
24

50
100

180

2
20
100
 Jumlah PEMBERIAN
Permintaa BUFFER JUMLAH
APBD II JKN PROG LAIN LAIN
n STOK

10 11 12 13 14 15 16

600

24
10
10
5
15

50
1000

200
200

70
50

3
48
48
 Jumlah PEMBERIAN
Permintaa BUFFER JUMLAH
APBD II JKN PROG LAIN LAIN
n STOK

10 11 12 13 14 15 16
 Jumlah PEMBERIAN
Permintaa BUFFER JUMLAH
APBD II JKN PROG LAIN LAIN
n STOK

10 11 12 13 14 15 16

Harap Dilampirkan : 1. LB 1

2. Lap. Psikotropika & Narkotika

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

10 11 12 13 14 15 16

3. Lap. Pemakaian Serum ABU

4. Lap. 20 Pemakaian Obat Terbanyak

MEMINTA YANG MEMINTA :

PUSKESMAS PETUGAS OBAT PUSKESMAS

………………………… ……………………………………..
NIP.