LAPORAN BULANAN PENGGUNAAN ATS

PUSKESMAS CIMANUK
BULAN : APRIL 2020
MENU

PENGGUNAAN
STOK JUMLAH
NO PENERIMAAN NAMA
AWAL PERSEDIAAN UMUR ALAMAT
PASIEN
1 17 17

JUMLAH

Kepala UPT Puskesmas DTP cimanuk

dr. Rita Permatasari

NIP : 19810920 200902 2 002
NAAN ATS
K

PENGGUNAAN
SISA
KET
JUMLAH PETUGAS STOK

17
0
0
0

Cimanuk, 2 mei 2020

Pengelola obat

Deden Arditia Nurjaman S.si.,Apt

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

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

MENU

JUMLAH 0

Kepala UPT Puskesmas DTP cimanuk

dr. Rita Permatasari

NIP : 19810920 200902 2 002
BU

AAN
SISA
KET
PETUGAS STOK

Cimanuk, 2 mei 2020

Pengelola obat

Deden Arditia Nurjaman S.si.,Apt

NIP : 19861213 201101 1 005
 LAPORAN BULANAN PSIKOTROPIKA
PUSKESMAS CIMANUK
MENU BULAN : APRIL 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 0 0 0

2 Amitriptilin 25 mg 235 0 235 35 200

3 Carbamazepine 200 mg 300 0 300 200 100

Chlorpromazine hcl 100

4 315 0 315 0 315
mg

5 Clobazam 10 mg 0 0 0 0 0

6 Clozapine 25 mg 0 0 0 0 0

7 Diazepam injeksi 110 0 110 20 90

Diazepam Rektal 0,5 mg

8 8 5 13 0 13
/ 2 ml

9 Divalproexsodium 75 0 75 75 0

10 Fluoksetin 10 mg 0 0 0 0 0

Fluphenazine decanoat
11 0 0 0 0 0
inj 25 mg

12 Haloperidol 1,5 mg 0 0 0 0 0

13 Haloperidol 2 mg 250 0 250 50 200

Haloperidol decanoat inj

14 0 0 0 0 0
50 mg

15 Imipramicine hcl 25 mg 0 0 0 0 0

16 Phenobarbital 30 mg 200 0 200 0 200

17 Risperidon 2 mg 500 500 1000 500 500

18 Shizonat injek 5 0 5 5 0

Trifluouperazine HCl 5
19 0 0 0 0 0
mg

20 Trihexipenidil 2 mg 355 400 755 455 300

Cimanuk, 2 mei 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 APRIL TAHUN 2020

NO NAMA OBAT SATUAN JUMLAH

1 Antasida tab Tab 5400
2 Amoksilin 500 mg tab Tab 5200
3 Metformin Tab 4300
4 Vitamin B komplek Tab 4200
5 Amlodipin 5 mg Tab 2800
6 Amlodipin 10 mg Tab 2450
7 Deksametason 0,5 mg Tab 2450
8 Ctm tablet Tab 2200
9 Natrium Dikofenak 50 mg Tab 1950
10 Asetylcistein Tab 1920

Cimanuk, 2 mei 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
man S.si.,Apt
1101 1 005
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO )
PUSKESMAS
PUSKESMAS : CIMANUK DOKUMEN NOMOR
KECAMATAN : CIMANUK DINKES KAB/KOTA
KAB / KOTA : PANDEGLANG PELAPORAN BULAN / PERIODE : APRIL 2020 : GFK KAB/KOTA
PROVINSI : BANTEN PUSKESMAS

Penerimaan
Jumlah Jumlah
N0 NAMA OBAT SATUAN Stok Awal
DAK APBD PROG LAIN 2 Penerimaan Persediaan

1 2 3 4 5 6
( 4+5 ) 1 2 3 4 5 6 7 8
1 Alprazolam Tablet - - -
2 Albendazol Tablet 400 mg Tablet - - -
3 Allopurinol tablet 100 mg Tablet 1,250 - 1,250 100
4 Ambroxol sirup Botol 50 - 50 10 10
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 4,850 6,000 6,000 10,850
9 Amlodipin Besilate 5 mg Tablet 6,700 4,500 4,500 11,200
10 Amoksisilin Forte sirup kering 125mg Botol - - -
11 Amoksisilin Injeksi 1 gr Vial - - -
12 Amoksisilin Tablet 500 mg Tablet 2,200 15,000 15,000 17,200 300 300 300 400 300 200
13 Amoksisillin kapsul 250 mg Kapsul - - -
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol 30 - 30
15 Ampisilin Injeksi 1 gr Vial 177 - 177
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 34 - 34 10 1
21 ANTASIDA DOEN Tablet Tablet 7,100 15,000 15,000 22,100 400 300 300 300 100 400
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 10 30 30 40
29 Artermeter injeksi Ampul - - -
30 Artesunate injeksi 60 mg/ml vial - - -
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 2,100 2,000 2,000 4,100
32 Asam Folat Botol 980 - 980 100
33 Asam Fusidat Cream Tube - - -
34 Asam Klorida 0,1 N Botol - - -
35 Asam Mefenamat 500 mg Tablet 350 2,000 2,000 2,350 100 100
36 Asam Traneksamat Inj 5% Ampul - - -
37 Asering Botol 60 200 200 260
38 Asetosal tablet 500 mg Tablet - - -
39 Asetyl Cysteine Capsul 2,280 3,600 3,600 5,880 180 300 480 180 120
40 Asiklovir Cream 5% Tube - - -
41 Asiklovir tablet 200 mg Tablet 250 - 250
42 Asiklovir tablet 400 mg Tablet 450 - 450
43 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul 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 - 48 48 48
48 Betametason krim 0,1 % Tube 75 200 200 275 25 25
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 2,630 - 2,630 200
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 450 1,300 1,300 1,750
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 90 - 90
65 D-Artepp tablet Tablet - - -
66 Deksametason tablet 0,5 mg Tablet 1,950 6,000 6,000 7,950 200 200 100
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 8 5 5 13
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 1,000 - 1,000
75 Diltiazem Tablet - - -
76 Doksisiklin Kapsul 100 mg Capsul - - -
77 Domperidon 10mg Tablet Tablet 1,100 - 1,100 100
78 Domperidon Suspensi 5 mg/ 5 ml Botol 150 50 50 200
79 Doxicyclin 500mg capsul - - -
80 Efedrin HCLTablet 25 mg Tablet - - -
81 Epinefrina HCL/Bitartrat Injeksi Ampul - - -
82 Eritromicyn kapsul 250 mg capsul 1,900 - 1,900
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
92 Fenoksimetil Penisilina tablet 250 mg Tablet - - -
93 Fenol Gliserol tetes telinga 10 % Botol - 48 48 48
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul - - -
95 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 1,100 - 1,100
96 Flufenazine Deconat Inj 25 mg/ml Ampul - - -
97 Furosemida tablet 40 mg Tablet 800 - 800
98 Furosemide Injeksi Ampul - - -
99 Garam Oralit Sachet 150 - 150
100 Gemfibrozil 300 mg Tablet - - -
101 Gentamicin Injeksi Ampul 177 - 177
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 1,400 - 1,400
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet - - -
108 Glikazid 80 mg Tablet Tablet - - -
109 Glimepiride 2 mg Tablet 200 2,000 2,000 2,200
110 Glukosa larutan infus 10% steril Botol - - -
111 Glukosa larutan infus 5 % steril Botol - - -
112 Griseofulvin tablet 500 mg, Tablet 700 - 700
113 Guaiafenesin 100 mg Tablet - - -
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet 70 - 70
115 Hidrokortison krim 2,5% Tube 113 192 192 305 24 24
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 900 - 900 100
121 KAEN 3B Infus Botol 60 - 60
122 Kalsium Glukonas Injeksi Ampul 95 - 95
123 Kalsium Laktat (Kalk) tablet 500 mg Tablet 3,200 - 3,200
124 Kapas Berlemak 500 mg Bungkus - - -
125 Ketokonazol Kream Tube 186 - 186
126 Ketokonazol Tablet 200 mg Tablet 950 - 950
127 Ketorolac inj Ampul - - -
128 Kifadene tablet 20 mg Tablet - - -
129 Kloramfenikol salep mata 1 % capsul 96 - 96 24
130 Kloramfenikol suspensi Botol 68 - 68 18
131 Kloramfenikol tetes telinga 3% Tube - - -
132 Kloramphenicol 250 mg Capsul - - -
133 Kloramphenicol 500 mg capsul 400 - 400
134 Kloramphenicol Tetes Mata Botol - - -
135 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 7,300 12,000 12,000 19,300
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 50 - 50
140 Kotrimoksazol Sirup / Suspensi Botol 300 100 100 400
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 180 200 200 380
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 6,000 4,000 4,000 10,000 1200
153 Methilprednisolon tablet 4 mg Tablet - - -
154 Metilergometrin Maleat injeksi 1 ml Ampul - - -
155 Metilergometrin Maleat Tablet Tablet 900 - 900
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 129 - 129
163 Multivitamin Anak Sirup Botol 75 50 50 125 5 5 5
164 Multivitamin Dewasa Antioksidan ( Becom c ) Tablet - - -
165 Natrium Diklofenak 25 mg Tablet Tablet - - -
166 Natrium Diklofenak 50 mg Tablet Tablet 2,400 5,000 5,000 7,400 250 100 300 150
167 Natrium Klorida Cairan Infus ( NaCL ) Botol 60 60 60 120
168 Nifedipine Tablet 10 mg Tablet 50 - 50
169 Nistatin tablet vaginal 100.000 IU/g Tube 100 - 100
170 Obat anti Diare suspensi Botol - - -
171 Obat Anti Diare Tablet (Akita / Molagit ) Tablet - 2,000 2,000 2,000
172 Obat Batuk Flu ( Molexflu ) Tablet 3 20 20 23 1 1
173 Obat Batuk Hitam (OBH) Botol - - -
174 Obat Batuk Sirup Herbal ( Herbacop ) Botol 91 96 96 187 7 2
175 Ofloxsacin Tetes Telinga Tube - - -
176 Oksitetrasiklin HCL salep mata 1% Botol 711 - 711
177 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 147 100 100 247
178 Omeprazol injeksi Ampul 40 - 40
179 Omeprazol Kapsul 20 mg capsul - - -
180 Ondancentron injeksi 4 mg Ampul 75 - 75
181 Ondancentron Tablet4 mg Tablet 450 - 450 30
182 Paracetamol Drop 15 ml Botol - 240 240 240
183 Paracetamol Sirup 120 mg/5 ml Botol 200 100 100 300 20 90 10
184 Parafin Dresing ( Bioplacenton Tull ) pcs - - -
185 Parasetamol tablet 100 mg Tablet - - -
186 Parasetamol tablet 500 mg Tablet - - -
187 Permetrin Krim 5 % Tube 19 - 19
188 Pirantel Sirup Botol - - -
189 Pirantel tablet 125 mg Tablet - - -
190 Pirazinamid Botol - - -
191 Piridoksin HCL (VIT B6) tablet 10mg Botol 1,000 4,000 4,000 5,000 300 100
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 1,550 7,000 7,000 8,550 200 500 300
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 100 200 200 300
203 Ranitidin tablet Tablet 3,050 4,000 4,000 7,050 200 200 200
204 Resperidone 2 mg tablet Tablet - - -
205 Ringer Laktat cairan infus (MJB) 80 - 80
206 Ringer Laktat cairan infus (Widatra) Botol 500 500 500
207 Rivanol 300 ml Botol - - -
208 Salbutamol Tablet 2 mg Tablet 1,300 - 1,300
209 Salbutamol tablet 4mg Tablet 950 - 950
210 Salep 2-4 Tube 91 24 24 115 7
211 Salep kombinasi cream ( Berloson ) Tube - - -
212 Salicil bedak Kotak - - -
213 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial 6 - 6
214 Serum Anti Tetanus inj 1500 IU ( Tetagam ) Vial 17 - 17
215 Sianokobalamin Injeksi Ampul - - -
216 Simvastatin 10 mg tablet Tablet 1,440 4,500 4,500 5,940 150 180 150
217 Simvastatin 20 mg tablet Tablet - - -
218 Sukralfat Suspensi Botol 75 50 50 125
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 3,300 - 3,300 100
226 Ventolin Nebulizer Ampul - - -
227 Vitamin B komplek Tablet 4,200 10,000 10,000 14,200 300 500 300 500 200
228 Zink sirup Botol 36 36 36 72
229 Zink tablet 20 mg Tablet 1,300 1,500 1,500 2,800
Antasida DOEN suspensi botol 300 300 300
-

OBAT PROGRAM - -
1 Albendazol Tablet 400 mg Tablet 8,880 - 8,880
2 Isoniazid Tablet 100 mg Tablet - 200 200 200
3 Obat Antituberkulosis kategori 1 Paket 2 32 32 34 5
4 Obat Antituberkulosis Kategori 2 Paket 1 - 1
5 Obat Antituberkulosis Kategori Anak Paket 1 2 2 3
6 Pot Dahak Non Steril Biji - - -
7 Pot Dahak Steril Biji 770 - 770 20
8 Reagen Ziehl Neelsen Kit 30 - 30
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 235 - 235 35
17 Carbamazepin 200 mg tablet Tablet 300 - 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 250 300 300 550 100
23 Haloperidol 5 mg Tablet Tablet 0 - -
24 Haloperidol Injeksi Ampul 0 - -
25 Klorpromazin HCL tablet salut 100 mg Tablet 315 300 300 615
26 Klorpromazine Tablet 25 mg Tablet 0 - -
27 Triheksilfenidil Hcl 2 mg tablet Tablet 355 400 400 755 200
28 Risperidone 2 mg tablet Tablet 500 500 500 1,000 200
29 Divalproexsodium Tablet 75 - 75
Diazepam injeksi (program) ampul 110 - 110
Magnesium Sulfat Inj. 25 ml 40 % (program) ampul 106 - 106
Kalsium Glukonas Injeksi ampul 84 - 84
Oksitosin injeksi 10 IU/ml - 1 ml ampul 611 - 611
Metilergometrin Maleat injeksi 1 ml ampul 560 - 560
Dehydro Artemisin 40 mg + Piperaquin 320 mg (DHP) tablet 9 - 9
Primakuin tablet 15 mg tablet 100 - 100
Masker karet ear loop hijab box 40 - 40 5
Masker N 95 box 1 - 1
- - -
NAMA BAHAN MEDIS HABIS PAKAI (BMHP )
B - -
1 Alat suntik 1 ml Pcs 330 300 300 630
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) 700 200 200 900
6 Alat suntik 3 ml Pcs 0 - -
7 Alat suntik 5 ml pcs 452 100 100 552
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 6 10 10 16 2 1
12 Anti Septik Hand Rub Botol 0 - -
13 Anti Septik Surgikal Hand Scrub Botol 0 - -
14 Cat Gut no 2/0 Sachet 36 24 24 60
15 Cat Gut no 3/0 Sachet 45 - 45
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 60 24 24 84
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 45 - 45
24 I.V Cathetter No. 20 Set 275 - 275
25 I.V Cathetter No. 22 troge Set 35 - 35
26 I.V Cathetter No. 24 troge Set 190 - 190
27 I.V Cathetter No. 26 Set 0 - -
28 Infuset Anak Set 50 100 100 150
29 Infuset Dewasa Set 0 300 300 300
30 Jarum Insulin Tablet 0 - -
31 Kapas Berlemak 250 gr Bungkus 11 - 11
32 Kapas Berlemak 500 gr Bungkus 0 - -
33 Kasa 4 m x 10 cm Rol 0 - -
34 Kasa Hidrofil 36 x 80 cm Rol 6 - 6
35 Kasa Pembalut 2 x 80 cm Pack 74 - 74
36 Kasa Steril 16 x 16 cm Kotak 44 50 50 94
37 Lisol 1 L Botol 0 - -
38 Masker karet Ear Loop Lembar 200 500 500 700
39 Masker tali Tube 0 - -
40 Nasal Canula Oksigen Set 0 - -
41 Plester kertas 1,25 cm x 9,14 m Rol 0 24 24 24
42 Plester Kertas 2,5 cm Rol 0 - -
43 Plester Non Woven 5cm x 5 cm Rol 9 10 10 19 2 2
44 Policlean Botol 0 - -
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 0 75 75 75
49 Sarung tangan M (Non Steril) Pasang 400 1,500 1,500 1,900 100 100
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 - 24
54 Underpad Lembar 0 - -
55 Urine Bag Biji 30 30 30 60
I.V Cathetter No. 24 jms pcs 50 50 50
I.V Cathetter No. 22 jms set 300 300 300
- -
- -
- -
NAMA OBAT VAKSIN
- -
1 Vaksin Anti Rabies ( VAR ) Vial 0 - -
2 Vaksin BCG Vial 25 10 10 35 5 5
3 Vaksin DT Vial 40 - 40
4 Vaksin HB 0 Pcs 0 100 100 100 10 10
5 Vaksin HBIG Vial 0 - -
6 Vaksin Measless Rubella (MR) Vial 0 30 30 30 2 3
7 Vaksin Pentabio ( DPT - HB - Hib ) Vial 40 40 40 80 10
8 Vaksin Polio B OPV Vial 30 40 40 70 5 5
9 Vaksin Polio IPV Vial 0 - -
10 Vaksin TD Vial 55 - 55 1
11 Vaksin Tuberculin Vial 2 - 2
12 ADS 0,05 ml Unit 100 - 100 10 10
13 ADS 0,5 ml Unit 280 100 100 380 40 40
14 ADS 5 ml Unit 50 - 50 5
15 Safety Box Unit 23 - 23 2 1
 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 - -
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 - -
- -
- -
- -
NOMOR TANGGAL

Pemakaian Perhari / Tanggal diloket Pengeluaran Sub Unit

7
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Pustu Pusling poskesdes posyandu igd vk

100 100 100 50 100

10 20

900 50 900 600

900 100 900 900

200 100 100 600 600 600 500 200 300 200

30

23
300 400 400 400 300 500 200 400 400 300

10 18

200 300 500 400

80 100

50 200 200 100

100 40

180 120 120 120 120

50

25

30

100 50

30

300 300 300 500 50 300 200

100
 300

24

150

300

70
24 17 24

60

11

24

300 500 500 200 300 400

50

180

1400 600 600 500

9
10 5 6

200 200 200 250 150 150

40
50
 200 200
1 1 1 1

5 5 24

11
147
20

45

80 100

400 200 400

200 300 50

100
200 200 100 200 50

80
60 40

50
12

30 120 180 180 150 240

24 1

300 400 200 300 300 300 200 400

200

2 3 5

30

200

150 200

300
 55 300
300
75
20
40

160
9
100
5 5 5 4
1

50 100 80

100 100 100

100 52

1 1 2 1

12 24
12 9

36

5 10
25
35
50 40

30 30

1
7 17
51 10

50 50 50 50 50 50 50 50

2 1 1 4

25
200 100 100 100 100

50

10

20 20 20 20

10 10
 Jumlah Stok
Pengeluaran AkhirBulan
8 9
(1+ s.d31 + sub unit) (6-8)
0 0
0 0
550 700
50 0
0 0
0 0
0 0
2450 8400
2800 8400
0 0
0 0
5200 12000
0 0
30 0
0 177
0 0
0 0
0 0
0 0
34 0
5400 16700
0 0
0 0
0 0
0 0
0 0
0 0
28 12
0 0
0 0
1400 2700
280 700
0 0
0 0
750 1600
0 0
140 120
0 0
1920 3960
0 0
50 200
0 450
0 90
0 0
0 0
0 0
0 48
75 200
0 0
0 0
0 0
0 0
0 0
0 0
230 2400
0 0
0 0
0 0
0 0
0 0
150 1600
0 0
0 0
30 60
0 0
2450 5500
0 0
0 0
0 0
0 13
0 0
0 0
0 0
0 1000
0 0
0 0
200 900
 0 200
0 0
0 0
0 0
300 1600
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 200
0 0
24 24
0 0
0 1100
0 0
0 800
0 0
150 0
0 0
0 177
0 0
0 0
0 0
0 0
300 1100
0 0
0 0
0 2200
0 0
0 0
0 700
0 0
70 0
113 192
0 0
0 0
0 0
0 0
100 800
60 0
0 95
0 3200
0 0
11 175
0 950
0 0
0 0
48 48
18 50
0 0
0 0
0 400
0 0
2200 17100
0 0
0 0
0 0
50 0
0 400
0 0
0 0
0 0
0 0
180 200
0 0
0 0
0 0
0 0
0 0
0 0
4300 5700
0 0
0 0
0 900
0 0
0 0
0 0
0 0
0 0
0 0
9 120
36 89
0 0
0 0
1950 5450
40 80
50 0
 0 100
0 0
400 1600
6 17
0 0
43 144
0 0
11 700
147 100
20 20
0 0
45 30
30 420
0 240
300 0
0 0
0 0
0 0
0 19
0 0
0 0
0 0
1400 3600
0 0
0 0
0
0 0
0 0
1550 7000
0 0
0 0
0 0
0 0
100 200
1350 5700
0 0
80 0
100 400
0 0
0 1300
50 900
19 96
0 0
0 0
0 6
0 17
0 0
1380 4560
0 0
25 100
0 0
0 0
0 0
0 0
0 0
0 0
100 3200
0 0
4200 10000
0 72
200 2600
300

0 0
0 8880
0 200
15 19
0 1
0 3
0 0
50 720
0 30
0 0
0 0
0 0
0 0
0 0
0 0
0 0
35 200
200 100
0 0
0 0
0 0
0 0
450 100
0 0
0 0
300 315
0 0
555 200
500 500
75 0
20 90
40 66
0 84
0 611
160 400
9 0
100 0
24 16
1 0
0 0
0 0
230 400
0 0
0 0
0 0
300 600
0 0
152 400
0 0
0 0
0 0
8 8
0 0
0 0
36 24
21 24
0 0
0 0
0 0
36 48
0 0
0 0
0 0
15 30
25 250
35 0
90 100
0 0
0 150
60 240
0 0
4 7
0 0
0 0
1 5
24 50
61 33
0 0
400 300
0 0
0 0
3 21
0 0
12 7
0 0
0 0
0 0
0 0
25 50
800 1100
0 0
0 0
0 0

0 24
0 0
0 60
0 50
50 250

0 0
0 0
0 0
20 15
0 40
100 0
0 0
5 25
10 70
30 40
0 0
1 54
0 2
20 80
80 300
5 45
3 20
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
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 : APRIL 2020
PROVINSI : BANTEN PERMINTAAN BULAN / PERIODE : APRIL DAN MEI 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 1,250 - 1,250 550 700
4 Ambroxol sirup Botol 50 - 50 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 4,850 6,000 10,850 2,450 8,400
9 Amlodipin Besilate 5 mg Tablet 6,700 4,500 11,200 2,800 8,400
10 Amoksisilin Forte sirup kering 250mg Botol - - - - -
11 Amoksisilin Injeksi 1 gr Vial - - - - -
12 Amoksisilin Tablet 500 mg Tablet 2,200 15,000 17,200 5,200 12,000
13 Amoksisillin kapsul 250 mg Kapsul - - - - -
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol 30 - 30 30 -
15 Ampisilin Injeksi 1 gr Vial 177 - 177 - 177
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 34 - 34 34 -
21 ANTASIDA DOEN Tablet Tablet 7,100 15,000 22,100 5,400 16,700
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 10 30 40 28 12
29 Artermeter injeksi Ampul - - - - -
30 Artesunate injeksi 60 mg/ml vial - - - - -
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 2,100 2,000 4,100 1,400 2,700
32 Asam Folat Botol 980 - 980 280 700
33 Asam Fusidat Cream Tube - - - - -
34 Asam Klorida 0,1 N Botol - - - - -
35 Asam Mefenamat 500 mg Tablet 350 2,000 2,350 750 1,600
36 Asam Traneksamat Inj 5% Ampul - - - - -
37 Asering Botol 60 200 260 140 120
38 Asetosal tablet 500 mg Tablet - - - - -
39 Asetyl Cysteine Capsul 2,280 3,600 5,880 1,920 3,960
40 Asiklovir Cream 5% Tube - - - - -
41 Asiklovir tablet 200 mg Tablet 250 - 250 50 200
42 Asiklovir tablet 400 mg Tablet 450 - 450 - 450
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 - 48 48 - 48
48 Betametason krim 0,1 % Tube 75 200 275 75 200
49 Bisakodil Suppositoria supp - - - - -
50 Bisoprolol 2,5 mg Tablet - - - - -
51 Bisoprolol 5 mg Tablet - - - - -
52 Cairan Infus KN-3B 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)
53 Cairan Infus Wida KDN 1 Botol - - - - -
54 Cairan Pembersih ( Protektor ) Botol - - - - -
55 Captopril Tablet 12,5 mg Tablet 2,630 - 2,630 230 2,400
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 450 1,300 1,750 150 1,600
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 90 - 90 30 60
65 D-Artepp tablet Tablet - - - - -
66 Deksametason tablet 0,5 mg Tablet 1,950 6,000 7,950 2,450 5,500
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 8 5 13 - 13
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 1,000 - 1,000 - 1,000
75 Diltiazem Tablet - - - - -
76 Doksisiklin Kapsul 100 mg Capsul - - - - -
77 Domperidon 10mg Tablet Tablet 1,100 - 1,100 200 900
78 Domperidon Suspensi 5 mg/ 5 ml Botol 150 50 200 - 200
79 Doxicyclin 500mg capsul - - - - -
80 Efedrin HCLTablet 25 mg Tablet - - - - -
81 Epinefrina HCL/Bitartrat Injeksi Ampul - - - - -
82 Eritromicyn kapsul 250 mg capsul 1,900 - 1,900 300 1,600
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 200 - 200 - 200
92 Fenoksimetil Penisilina tablet 250 mg Tablet - - - - -
93 Fenol Gliserol tetes telinga 10 % Botol - 48 48 24 24
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul - - - - -
95 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 1,100 - 1,100 - 1,100
96 Flufenazine Deconat Inj 25 mg/ml Ampul - - - - -
97 Furosemida tablet 40 mg Tablet 800 - 800 - 800
98 Furosemide Injeksi Ampul - - - - -
99 Garam Oralit Sachet 150 - 150 150 -
100 Gemfibrozil 300 mg Tablet - - - - -
101 Gentamicin Injeksi Ampul 177 - 177 - 177
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 1,400 - 1,400 300 1,100
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet - - - - -
108 Glikazid 80 mg Tablet Tablet - - - - -
109 Glimepiride 2 mg Tablet 200 2,000 2,200 - 2,200
110 Glukosa larutan infus 10% steril Botol - - - - -
111 Glukosa larutan infus 5 % steril Botol - - - - -
112 Griseofulvin tablet 500 mg, Tablet 700 - 700 - 700
 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)
113 Guaiafenesin 100 mg Tablet - - - - -
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet 70 - 70 70 -
115 Hidrokortison krim 2,5% Tube 113 192 305 113 192
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 900 - 900 100 800
121 KAEN 3B Infus Botol 60 - 60 60 -
122 Kalsium Glukonas Injeksi Ampul 95 - 95 - 95
123 Kalsium Laktat (Kalk) tablet 500 mg Tablet 3,200 - 3,200 - 3,200
124 Kapas Berlemak 500 mg Bungkus - - - - -
125 Ketokonazol Kream Tube 186 - 186 11 175
126 Ketokonazol Tablet 200 mg Tablet 950 - 950 - 950
127 Ketorolac inj Ampul - - - - -
128 Kifadene tablet 20 mg Tablet - - - - -
129 Kloramfenikol salep mata 1 % capsul 96 - 96 48 48
130 Kloramfenikol suspensi Botol 68 - 68 18 50
131 Kloramfenikol tetes telinga 3% Tube - - - - -
132 Kloramphenicol 250 mg Capsul - - - - -
133 Kloramphenicol 500 mg capsul 400 - 400 - 400
134 Kloramphenicol Tetes Mata Botol - - - - -
135 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 7,300 12,000 19,300 2,200 17,100
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 50 - 50 50 -
140 Kotrimoksazol Sirup / Suspensi Botol 300 100 400 - 400
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 180 200 380 180 200
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 6,000 4,000 10,000 4,300 5,700
153 Methilprednisolon tablet 4 mg Tablet - - - - -
154 Metilergometrin Maleat injeksi 1 ml Ampul - - - - -
155 Metilergometrin Maleat Tablet Tablet 900 - 900 - 900
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 129 - 129 9 120
163 Multivitamin Anak Sirup Botol 75 50 125 36 89
164 Multivitamin Dewasa Antioksidan ( Becom c ) Tablet - - - - -
165 Natrium Diklofenak 25 mg Tablet Tablet - - - - -
166 Natrium Diklofenak 50 mg Tablet Tablet 2,400 5,000 7,400 1,950 5,450
167 Natrium Klorida Cairan Infus ( NaCL ) Botol 60 60 120 40 80
168 Nifedipine Tablet 10 mg Tablet 50 - 50 50 -
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 - 2,000 2,000 400 1,600
172 Obat Batuk Flu ( Molexflu ) Tablet 3 20 23 6 17
 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)
173 Obat Batuk Hitam (OBH) Botol - - - - -
174 Obat Batuk Sirup Herbal ( Herbacop ) Botol 91 96 187 43 144
175 Ofloxsacin Tetes Telinga Tube - - - - -
176 Oksitetrasiklin HCL salep mata 1% Botol 711 - 711 11 700
177 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 147 100 247 147 100
178 Omeprazol injeksi Ampul 40 - 40 20 20
179 Omeprazol Kapsul 20 mg capsul - - - - -
180 Ondancentron injeksi 4 mg Ampul 75 - 75 45 30
181 Ondancentron Tablet4 mg Tablet 450 - 450 30 420
182 Paracetamol Drop 15 ml Botol - 240 240 - 240
183 Paracetamol Sirup 120 mg/5 ml Botol 200 100 300 300 -
184 Parafin Dresing ( Bioplacenton Tull ) pcs - - - - -
185 Parasetamol tablet 100 mg Tablet - - - - -
186 Parasetamol tablet 500 mg Tablet - - - - -
187 Permetrin Krim 5 % Tube 19 - 19 - 19
188 Pirantel Sirup Botol - - - - -
189 Pirantel tablet 125 mg Tablet - - - - -
190 Pirazinamid Botol - - - - -
191 Piridoksin HCL (VIT B6) tablet 10mg Botol 1,000 4,000 5,000 1,400 3,600
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 1,550 7,000 8,550 1,550 7,000
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 100 200 300 100 200
203 Ranitidin tablet Tablet 3,050 4,000 7,050 1,350 5,700
204 Resperidone 2 mg tablet Tablet - - - - -
205 Ringer Laktat cairan infus (Otsuka) 80 - 80 80 -
206 Ringer Laktat cairan infus (Widatra) Botol - 500 500 100 400
207 Rivanol 300 ml Botol - - - - -
208 Salbutamol Tablet 2 mg Tablet 1,300 - 1,300 - 1,300
209 Salbutamol tablet 4mg Tablet 950 - 950 50 900
210 Salep 2-4 Tube 91 24 115 19 96
211 Salep kombinasi cream ( Berloson ) Tube - - - - -
212 Salicil bedak Kotak - - - - -
213 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial 6 - 6 - 6
214 Serum Anti Tetanus inj 1500 IU ( Tetagam ) Vial 17 - 17 - 17
215 Sianokobalamin Injeksi Ampul - - - - -
216 Simvastatin 10 mg tablet Tablet 1,440 4,500 5,940 1,380 4,560
217 Simvastatin 20 mg tablet Tablet - - - - -
218 Sukralfat Suspensi Botol 75 50 125 25 100
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 3,300 - 3,300 100 3,200
226 Ventolin Nebulizer Ampul - - - - -
227 Vitamin B komplek Tablet 4,200 10,000 14,200 4,200 10,000
228 Zink sirup Botol 36 36 72 - 72
229 Zink tablet 20 mg Tablet 1,300 1,500 2,800 200 2,600
Antasida DOEN suspensi botol - 300 300 - 300
 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)

OBAT PROGRAM - - - - -
1 Albendazol Tablet 400 mg Tablet 8,880 - 8,880 - 8,880
2 Isoniazid Tablet 100 mg Tablet - 200 200 - 200
3 Obat Antituberkulosis kategori 1 Paket 2 32 34 15 19
4 Obat Antituberkulosis Kategori 2 Paket 1 - 1 - 1
5 Obat Antituberkulosis Kategori Anak Paket 1 2 3 - 3
6 Pot Dahak Non Steril Biji - - - - -
7 Pot Dahak Steril Biji 770 - 770 50 720
8 Reagen Ziehl Neelsen Kit 30 - 30 - 30
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 235 - 235 35 200
17 Carbamazepin 200 mg tablet Tablet 300 - 300 200 100
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 250 300 550 450 100
23 Haloperidol 5 mg Tablet Tablet - - - - -
24 Haloperidol Injeksi Ampul - - - - -
25 Klorpromazin HCL tablet salut 100 mg Tablet 315 300 615 300 315
26 Klorpromazine Tablet 25 mg Tablet - - - - -
27 Triheksilfenidil Hcl 2 mg tablet Tablet 355 400 755 555 200
28 Risperidone 2 mg tablet Tablet 500 500 1,000 500 500
29 Divalproexsodium Tablet 75 - 75 75 -
Diazepam injeksi (program) ampul 110 110 20 90
Magnesium Sulfat Inj. 25 ml 40 % (program) ampul 106 106 40 66
Kalsium Glukonas Injeksi ampul 84 84 - 84
Oksitosin injeksi 10 IU/ml - 1 ml ampul 611 - 611
Metilergometrin Maleat injeksi 1 ml ampul 560 160 400
Dehydro Artemisin 40 mg + Piperaquin 320 mg (DHP) tablet 9 9 -
Primakuin tablet 15 mg tablet 100 100 -
Masker karet ear loop hijab box 40 24 16
Masker N 95 box 1 1 -
- - - - -
NAMA BAHAN MEDIS HABIS PAKAI (BMHP )
B - - - - -
1 Alat suntik 1 ml Pcs 330 300 630 230 400
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) 700 200 900 300 600
6 Alat suntik 3 ml Pcs - - - - -
7 Alat suntik 5 ml pcs 452 100 552 152 400
8 Alkazide 1 L High Level Desinfectant Botol - - - - -
9 Alkazyme Sachet 25 mg Pack - - - - -
10 Alkohol 70 % 1 L Botol - - - - -
11 Alkohol swab Sachet 6 10 16 8 8
12 Anti Septik Hand Rub Botol - - - - -
13 Anti Septik Surgikal Hand Scrub Botol - - - - -
14 Cat Gut no 2/0 Sachet 36 24 60 36 24
15 Cat Gut no 3/0 Sachet 45 - 45 21 24
16 Cat Gut No 3/0 (24 mm) Sachet - - - - -
17 Cat Gut No 3/0 (26 mm) Sachet - - - - -
18 Cathetter Jelly Biji - - - - -
 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)
19 Demetech Silk 3/0 Set 60 24 84 36 48
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 45 - 45 15 30
24 I.V Cathetter No. 20 Set 275 - 275 25 250
25 I.V Cathetter No. 22 Set 35 - 35 35 -
26 I.V Cathetter No. 24 Set 190 - 190 90 100
27 I.V Cathetter No. 26 Set - - - - -
28 Infuset Anak Set 50 100 150 - 150
29 Infuset Dewasa Set - 300 300 60 240
30 Jarum Insulin Tablet - - - - -
31 Kapas Berlemak 250 gr Bungkus 11 - 11 4 7
32 Kapas Berlemak 500 gr Bungkus - - - - -
33 Kasa 4 m x 10 cm Rol - - - - -
34 Kasa Hidrofil 36 x 80 cm Rol 6 - 6 1 5
35 Kasa Pembalut 2 x 80 cm Pack 74 - 74 24 50
36 Kasa Steril 16 x 16 cm Kotak 44 50 94 61 33
37 Lisol 1 L Botol - - - - -
38 Masker karet Ear Loop Lembar 200 500 700 400 300
39 Masker tali Tube - - - - -
40 Nasal Canula Oksigen Set - - - -
41 Plester 1" Rol - 24 24 3 21
42 Plester Kertas 2,5 cm Rol - - - - -
43 Plester Non Woven 5cm x 5 cm Rol 9 10 19 12 7
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 - 75 75 25 50
49 Sarung tangan M (Non Steril) Pasang 400 1,500 1,900 800 1,100
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 - - - - -
55 Urine Bag Biji 30 30 60 - 60
I.V Cathetter No. 24 pcs - 50 50 - 50
I.V Cathetter No. 22 set - 300 300 50 250

- - - - -
NAMA OBAT VAKSIN

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

2 Vaksin BCG Vial 28 10 35 20 15
3 Vaksin DT Vial 40 - 40 - 40
4 Vaksin HB 0 Pcs 52 100 100 100 -
5 Vaksin HBIG Vial - - - - -
6 Vaksin Measless Rubella (MR) Vial 17 30 30 5 25
7 Vaksin Pentabio ( DPT - HB - Hib ) Vial 40 40 80 10 70
8 Vaksin Polio B OPV Vial 50 40 70 30 40
9 Vaksin Polio IPV Vial - - - - -
10 Vaksin TD Vial 70 - 55 1 54
11 Vaksin Tuberculin Vial - - 2 - 2
12 ADS 0,05 ml Unit 50 - 100 20 80
13 ADS 0,5 ml Unit 560 100 380 80 300
14 ADS 5 ml Unit 37 - 50 5 45
15 Safety Box Unit 20 - 23 3 20
- - - - -
 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 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 - - - - -
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
 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)
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 - - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -

RAWAT
JUMLAH KUNJUNGAN PUSKESMAS JALAN RAWAT INAP JUMLAH

UMUM / BAYAR 1045

UMUM / TIDAK BAYAR 1
 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)
JKN 682
TOTAL KUNJUNGAN 1728

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

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

NIP. NIP. NIP.
RMINTAAN OBAT ( LPLPO )

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

-
-
660 2500
60 750
- 2500
-
-
2,940 9000
3,360 8000
-
-
6,240 30,000
-
36 600
-
-
-
-
-
41 500
6,480 19000
-
-
-
-
-
-
34 100
-
-
1,680 2000
336
-
-
900 6000
- 50
168 140
-
2,304 12480
- 100
60
-
-
-
-
-
- 50
90 400
-
-
-
-
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

-
- 5
276
-
-
-
-
- 100
180 1300
-
-
36
-
2,940 13000
-
-
-
- 5
-
-
-
-
-
-
240
- 50
-
-
- 200
360
-
-
-
-
- 10
-
-
-
-
-
29 100
- 100
-
-
-
- 200
180
- 1000
-
- 200
- 100
- 50
-
360
- 3000
-
- 2000
- 40
- 40
-
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

- 3000
84
136 400
- 100
- 3000
-
- 100
120
72 140
-
-
-
13
-
-
-
58 144
22
- 125
- 500
-
- 100
2,640 17000
-
-
-
60 1200
- 100
-
-
- 100
-
216 200
-
-
- 1000
- 50
- 12
-
5,160 5000
-
-
-
-
-
- 500
-
-
- 50
11
43 20
- 500
-
2,340 8000
48 40
60 200
-
-
480 2000
7 9000
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

-
52 96
- 100
13
176 100
24
- 330
54
36
-
360 2000
-
-
-
-
-
-
-
1,680 5000
- 2000
-
- 10
- 10
-
1,860 10000
-
-
-
-
120 140
1,620 3500
-
96 500
120
-
-
60
23 60
-
- 50
-
-
-
1,656 5000
- 1500
30 50
-
-
-
-
-
-
120
- 40
5,040 15000
- 36
240 1500
- 1500
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

-
-
-
18
-
-
-
60
-
-
-
-
-
-
-
-
42
240
-
-
-
-
540
-
-
360
-
666
600
90
24
48
-
-
192
11
120
29
1
-
-
276 300
-
-
-
360 200
-
182 100
-
-
- 10
10 4000
- 10
-
43 24
25 24
-
-
- 15
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

43 24
-
- 500
-
18
30
42 450
108 50
- 100
- 200
72 400
-
5
-
-
1
29
73 300
-
480 2000
-
- 10
4 10
- 10
14 30
-
- 15
-
-
30 125
960 1700
-
- 200
- 200

-
- 50
- 70
70
70

-
-

24
-
120
-
6
12
36
-
1
-
24
96
6
4
-
 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
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

YANG MEMINTA YANG MEMINTA :

KEPALA PUSKESMAS PETUGAS OBAT PUSKESMAS

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