LAPORAN BULANAN PENGGUNAAN ATS

PUSKESMAS CIMANUK
MENU BULAN : DESEMBER 2020

PENGGUNAAN
STOK JUMLAH
NO PENERIMAAN NAMA
AWAL PERSEDIAAN UMUR ALAMAT
PASIEN
1 9 9 heri 46 dalam balar
8 herul 22 Rumingkang

JUMLAH

Kepala UPT Puskesmas DTP cimanuk

dr. Rita Permatasari

NIP : 19810920 200902 2 002
NAAN ATS
K
20

PENGGUNAAN
SISA
KET
JUMLAH PETUGAS STOK

1 Jaja 8
1 dewika 7

2 7

Cimanuk, 2 Desember 2020

Pengelola obat

Deden Arditia Nurjaman S.si.,Apt

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

PENGGUNAAN
STOK JUMLAH
NO PENERIMAAN NAMA
AWAL PERSEDIAAN UMUR ALAMAT
PASIEN
1 7 7 heri 46 batubantar

MENU

JUMLAH

Kepala UPT Puskesmas DTP cimanuk

dr. Rita Permatasari

NIP : 19810920 200902 2 002
 NAAN ABU
UK
020

NGGUNAAN
SISA
KET
JUMLAH PETUGAS STOK

1 jaja 6
0
0

1 6

Cimanuk, 2 Januari 2021

Pengelola obat

Deden Arditia Nurjaman S.si.,Apt

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

3 Carbamazepine 200 mg 300 300 600 400 200

Chlorpromazine hcl 100

4 200 500 700 600 100
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 20 60

Diazepam Rektal 0,5 mg

8 4 5 9 3 6
/ 2 ml

9 Divalproexsodium 0 0 0 0 0

10 Fluoksetin 10 mg 0 0 0 0 0

Fluphenazine decanoat
11 15 10 25 5 20
inj 25 mg

12 Haloperidol 1,5 mg 0 0 0 0 0

13 Haloperidol 2 mg 600 500 1100 200 900

Haloperidol decanoat inj

14 13 10 23 0 23
50 mg

15 Imipramicine hcl 25 mg 0 0 0 0 0

16 Phenobarbital 30 mg 100 0 100 0 100

17 Risperidon 2 mg 300 200 500 400 100

18 Shizonat injek 0 0 0 0 0

Trifluouperazine HCl 5
19 0 0 0 0 0
mg

20 Trihexipenidil 2 mg 100 600 700 500 200

Cimanuk, 2 Januari 2021

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 DESEMBER TAHUN 2020

NO NAMA OBAT SATUAN JUMLAH

Amoksilin 500 mg Tablet 7700
Antasida Doen tablet Tablet 6600
Metformin Tablet 6000
Vitamin B Complex Tablet 5900
Dexametason Tablet 5200
CTM Tablet 4100
Piridoksin Tablet 3400
Amlodipin 5 mg Tablet 2700
Kalsium laktat Tablet 2400
Prednison Tablet 2400

Cimanuk, 2 Januari 2021

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 PERMIN
PUSKESMAS
PUSKESMAS : CIMANUK
KECAMATAN : CIMANUK
KAB / KOTA : PANDEGLANG PELAPORAN BULAN / PERIODE : DESEMBER 2020
PROVINSI : BANTEN

Penerimaan
N0 NAMA OBAT SATUAN Stok Awal
DAK APBD PROG
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 -
9 Amlodipin Besilate 5 mg Tablet -
10 Amoksisilin Forte sirup kering 125mg Botol -
11 Amoksisilin Injeksi 1 gr Vial -
12 Amoksisilin Tablet 500 mg Tablet 6,500 5,000
13 Amoksisillin kapsul 250 mg Kapsul -
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol -
15 Ampisilin Injeksi 1 gr Vial 110
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 5,100 5,000
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 12
29 Artermeter injeksi Ampul -
30 Artesunate injeksi 60 mg/ml vial -
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 4,300
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 40 100
38 Asetosal tablet 500 mg Tablet -
39 Asetyl Cysteine Capsul 5,520
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 48 48
48 Betametason krim 0,1 % Tube 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 2,000 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 -
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 180
65 D-Artepp tablet Tablet -
66 Deksametason tablet 0,5 mg Tablet 3,100 4,000
67 Dekstran 70 - larutan infus 6% steril Botol -
68 Dekstrometorfan sirup Botol -
69 Dekstrometorfan tablet 15 mg Tablet -
70 Diazepam Rektal 0,5 mg / 2 ml supp 4 5
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 -
75 Diltiazem Tablet -
76 Doksisiklin Kapsul 100 mg Capsul -
77 Domperidon 10mg Tablet Tablet 300 400
78 Domperidon Suspensi 5 mg/ 5 ml Botol 200
79 Doxicyclin 500mg capsul -
80 Efedrin HCLTablet 25 mg Tablet -
81 Epinefrina HCL/Bitartrat Injeksi Ampul 90
82 Eritromicyn kapsul 250 mg capsul 1,400
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 100
92 Fenoksimetil Penisilina tablet 250 mg Tablet -
93 Fenol Gliserol tetes telinga 10 % Botol 72
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul -
95 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 1,200
96 Flufenazine Deconat Inj 25 mg/ml Ampul 15 10
97 Furosemida tablet 40 mg Tablet 800
98 Furosemide Injeksi Ampul -
99 Garam Oralit Sachet - 100
100 Gemfibrozil 300 mg Tablet -
101 Gentamicin Injeksi Ampul 60
102 Gentamicin Salep Kulit Tube -
103 Gentamicin Salep mata Tube -
104 Gentamicin Tetes Mata Botol 72
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 1,500
110 Glukosa larutan infus 10% steril Botol -
111 Glukosa larutan infus 5 % steril Botol -
112 Griseofulvin tablet 500 mg, Tablet 500
113 Guaiafenesin 100 mg Tablet -
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet 1,000
115 Hidrokortison krim 2,5% Tube 168
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 1,700
121 KAEN 3B Infus Botol -
122 Kalsium Glukonas Injeksi Ampul -
123 Kalsium Laktat (Kalk) tablet 500 mg Tablet 1,600
124 Kapas Berlemak 500 mg Bungkus -
125 Ketokonazol Kream Tube 75
126 Ketokonazol Tablet 200 mg Tablet 500
127 Ketorolac inj Ampul 200 100
128 Kifadene tablet 20 mg Tablet -
129 Kloramfenikol salep mata 1 % capsul -
130 Kloramfenikol suspensi Botol -
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 -
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 100
141 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul -
142 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol -
143 Lactobacilus serbuk Sachet -
144 Lidocain 2%+efinefrin injeksi Ampul 60 60
145 Lidocain injeksi 2 ml Ampul 200 100
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 5,000 4,000
153 Methilprednisolon tablet 4 mg Tablet -
154 Metilergometrin Maleat injeksi 1 ml Ampul -
155 Metilergometrin Maleat Tablet Tablet 700
156 Metoklopramid Suspensi Botol -
157 Metoklopramid tablet Tablet -
158 Metronidazol 500 mg Tablet -
159 Metronidazol infus / injeksi Botol -
160 Metronidazol Ovula supp -
161 Metronidazol suspensi Botol -
162 Mikonazol kream Tube 96
163 Multivitamin Anak Sirup Botol 92
164 Multivitamin Dewasa Antioksidan ( Becom c ) Tablet -
165 Natrium Diklofenak 25 mg Tablet Tablet -
166 Natrium Diklofenak 50 mg Tablet Tablet - 1,000
167 Natrium Klorida Cairan Infus ( NaCL ) Botol 90
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 1,600 1,000
172 Obat Batuk Flu ( Molexflu ) Tablet 10
173 Obat Batuk Hitam (OBH) Botol -
174 Obat Batuk Sirup Herbal ( Herbacop ) Botol -
175 Ofloxsacin Tetes Telinga Tube -
176 Oksitetrasiklin HCL salep mata 1% Botol 475
177 Oksitosin injeksi 10 IU/ml - 1 ml Ampul -
178 Omeprazol injeksi Ampul -
179 Omeprazol Kapsul 20 mg capsul -
180 Ondancentron injeksi 4 mg Ampul -
181 Ondancentron Tablet4 mg Tablet 720
182 Paracetamol Drop 15 ml Botol -
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 6
188 Pirantel Sirup Botol -
189 Pirantel tablet 125 mg Tablet -
190 Pirazinamid Botol -
191 Piridoksin HCL (VIT B6) tablet 10mg Botol 3,500 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 5,300
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
203 Ranitidin tablet Tablet -
204 Resperidone 2 mg tablet Tablet -
205 Ringer Laktat cairan infus (MJB) -
206 Ringer Laktat cairan infus (Widatra) Botol -
207 Rivanol 300 ml Botol -
208 Salbutamol Tablet 2 mg Tablet 200
209 Salbutamol tablet 4mg Tablet 100
210 Salep 2-4 Tube -
211 Salep kombinasi cream ( Berloson ) Tube -
212 Salicil bedak Kotak -
213 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial 7
214 Serum Anti Tetanus inj 1500 IU ( Tetagam ) Vial 9
215 Sianokobalamin Injeksi Ampul -
216 Simvastatin 10 mg tablet Tablet 570
217 Simvastatin 20 mg tablet Tablet -
218 Sukralfat Suspensi Botol -
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 -
226 Ventolin Nebulizer Ampul -
227 Vitamin B komplek Tablet 2,900 5,000
228 Zink sirup Botol -
229 Zink tablet 20 mg Tablet 1,200
Antasida DOEN suspensi botol 220
Allopurinol 100 mg (2020) Tablet 800 1,000
Kotrimoksazol Dewasa Tablet 480 mg (2020) Tablet 1,000
Kloramphenicol 500 mg Kapsul 400
Kloramfenikol salep kulit 2% Tube 348
Natrium Klorida Cairan Infus ( NaCL ) Botol -
Paracetamol Sirup 120 mg/5 ml (2020) Botol -
Salep 2-4 (2020) Pot 43
Kotrimoksazol suspensi (2020) Botol 100
Klorfeniramin Maleat (CTM) tablet 4 mg (2020) Tablet 600 4,000
Ranitidin injeksi (2020) Ampul 100
Salbutamol Tablet 2 mg 92020) Tablet 400
Amoksisillin Sirup Kering 125 mg/5 ml (2020) Botol 250
Asam Folat (2020) Tablet 400 1,000
Multivitamin Dewasa (HB Vit) Box 5 5
Simvastatin 20 mg tablet (2020) Tablet 500 1,000
Tiamin Tablet 50 mg ( B1 ) (2020) Tablet 1,300 2,000
Amlodipin Besilate 5 mg (2020) Tablet 3,000

1 Albendazol Tablet 400 mg Tablet -

2 Isoniazid Tablet 100 mg Tablet 100
3 Obat Antituberkulosis kategori 1 Paket 12
4 Obat Antituberkulosis Kategori 2 Paket -
5 Obat Antituberkulosis Kategori Anak Paket -
6 Pot Dahak Non Steril Biji -
7 Pot Dahak Steril Biji 260
8 Reagen Ziehl Neelsen Kit -
9 MDT MB Anak Tablet Tablet -
10 MDT MB Dewasa Tablet Tablet -
11 MDT PB Dewasa Tablet Tablet -
12 MDT PB Anak Tablet Tablet -
13 Retinol (Vitamin A) kapsul 200.000 IU capsul -
14 Retinol (Vitamin A) kapsul 100.000 IU capsul -
15 Tablet Penambah Darah ( FE ) Tablet -
16 Amitriptilin tablet 25 mg Tablet -
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 600 500
23 Haloperidol 5 mg Tablet Tablet 0
24 Haloperidol Injeksi Ampul 13 10
25 Klorpromazin HCL tablet salut 100 mg Tablet 200 500
26 Klorpromazine Tablet 25 mg Tablet 0
27 Triheksilfenidil Hcl 2 mg tablet Tablet 100 600
28 Risperidone 2 mg tablet Tablet 300 200
29 Divalproexsodium Tablet 0
Diazepam injeksi (program) ampul 80
Magnesium Sulfat Inj. 25 ml 40 % (program) ampul 0
Kalsium Glukonas Injeksi ampul 48
Oksitosin injeksi 10 IU/ml - 1 ml ampul 0
Metilergometrin Maleat injeksi 1 ml ampul 0
Dehydro Artemisin 40 mg + Piperaquin 320 mg (DHP) tablet 0
Primakuin tablet 15 mg tablet 0
Masker karet ear loop hijab box 5
Masker N 95 box 0
Tablet Penambah Darah (program) box 2359

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) 0
6 Alat suntik 3 ml Pcs 0
7 Alat suntik 5 ml pcs 400 500
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 2
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 12
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 20
24 I.V Cathetter No. 20 Set 0
25 I.V Cathetter No. 22 troge Set 0
26 I.V Cathetter No. 24 troge Set 0
27 I.V Cathetter No. 26 Set 0
28 Infuset Anak Set 59
29 Infuset Dewasa Set 30
30 Jarum Insulin Tablet 0
31 Kapas Berlemak 250 gr Bungkus 0 8
32 Kapas Berlemak 500 gr Bungkus 0
33 Kasa 4 m x 10 cm Rol 0
34 Kasa Hidrofil 36 x 80 cm Rol 0
35 Kasa Pembalut 2 x 80 cm Pack 20
36 Kasa Steril 16 x 16 cm Kotak 0
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 13 15
42 Plester Kertas 2,5 cm Rol 0
43 Plester Non Woven 5cm x 5 cm Rol 20
44 Policlean Botol 3 5
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
49 Sarung tangan M (Non Steril) Pasang 0
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 100 100
Selang Section ( Surgikal Conection Tube with
53 yankauer) Pcs 0
54 Underpad Lembar 0
55 Urine Bag Biji 0
I.V Cathetter No. 24 jms pcs 150 50
I.V Cathetter No. 22 jms set 150 50
Alat suntik 1 ml (2020) box 0
Cat Gut no 2/0 pcs 36
Cat Gut no 3/0 pcs 96
I.V Cathetter No. 20 set 150 50
Kasa Hidrofil 16 x 16 cm (2020) kotak 47 50
Kasa Hidrofil 3 x 15 cm (2020) Paket 2
Alat suntik 3 ml (2020) box 0

NAMA OBAT VAKSIN

1 Vaksin Anti Rabies ( VAR ) Vial 0

2 Vaksin BCG Vial 9 10
3 Vaksin DT Vial 40 60
4 Vaksin HB 0 Pcs 30 100
5 Vaksin HBIG Vial 0
6 Vaksin Measless Rubella (MR) Vial 25
7 Vaksin Pentabio ( DPT - HB - Hib ) Vial 20 60
8 Vaksin Polio B OPV Vial 35 60
9 Vaksin Polio IPV Vial 10 10
10 Vaksin TD Vial 27 170
11 Vaksin Tuberculin Vial 2
12 ADS 0,05 ml Unit 140
13 ADS 0,5 ml Unit 340 2,200
14 ADS 5 ml Unit 200
15 Safety Box Unit 2
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
 LEMBAR PERMINTAAN OBAT ( LPLPO )
PUSKESMAS
DOKUMEN NOMOR TANGGAL
DINKES KAB/KOTA
: GFK KAB/KOTA
PUSKESMAS

nerimaan
Jumlah Jumlah
Pema
LAIN 2 Penerimaan Persediaan

5 6
( 4+5 ) 1 2 3 4 5 6 7 8 9 10 11

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
5,000 11,500 400 300 500 300 500 300
- -
- -
- 110
- -
- -
- -
- -
- -
5,000 10,100 400 100 200 500 400 300
- -
- -
- -
- -
- -
- -
- 12
- -
- -
- 4,300 400
- -
- -
- -
- -
- -
100 140
- -
- 5,520 300
- -
- 200
 - 250
- 50
- -
- -
- -
48 96 24
- 25 25
- -
- -
- -
- -
- -
- -
1,000 3,000
- -
- -
- -
- -
- -
- -
- -
- -
- 180
- -
4,000 7,100 300 300 200 300 300
- -
- -
- -
5 9 1
- -
- -
- -
- -
- -
- -
400 700
- 200
- -
- -
- 90
- 1,400
- -
- -
- -
- -
- -
- -
- -
- -
- 100 100
- -
- 72 24
- -
- 1,200
10 25 1 2
- 800
 - -
100 100
- -
- 60
- -
- -
- 72
- -
- 1,100 400
- -
- -
- 1,500 400
- -
- -
- 500
- -
- 1,000
- 168 24
- -
- -
- -
- -
- 1,700
- -
- -
- 1,600 100 100 200 100
- -
- 75
- 500 50
100 300
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 100
- -
- -
- -
60 120
100 300
- -
- -
- -
- -
- -
- -
4,000 9,000 1600 2000
- -
 - -
- 700
- -
- -
- -
- -
- -
- -
- 96
- 92
- -
- -
1,000 1,000
- 90
- -
- 100
- -
1,000 2,600 100
- 10 1 2 1
- -
- -
- -
- 475
- -
- -
- -
- -
- 720 150
- -
- -
- -
- -
- -
- 6 2 4
- -
- -
- -
2,000 5,500 500
- -
- -
- -
- -
- -
- 5,300
- -
- -
- -
- -
100 100
- -
- -
- -
- -
- -
- 200
- 100
- -
- -
- -
- 7 1
- 9 2
- -
- 570 150 90
- -
 - -
- -
- -
- -
- -
- -
- -
- -
- -
5,000 7,900 300 200 300
- -
- 1,200
- 220
1,000 1,800
- 1,000
- 400
- 348
- -
- -
- 43
- 100
4,000 4,600 300 400 100
- 100
- 400
- 250
1,000 1,400
5 10
1,000 1,500
2,000 3,300 200
3,000 3,000

- -
- -
- 100
- 12 2 2
- -
- -
- -
- 260 10 10
- -
- -
- -
- -
- -
- -
- -
- -
- -
300 600
- -
- -
- -
- -
500 1,100
- -
 10 23
500 700
- -
600 700 100
200 500
 - -
- 80
- -
- 48
- -
- -
- -
- -
- 5
- -
- 2,359 3 4 4

- -
- -
- -
- -
- -
- -
- -
- -
500 900
- -
- -
- -
- 2
- -
- -
- -
- -
- -
- -
- -
12 60
- -
- -
- -
- 20
- -
- -
- -
- -
- 59
- 30
- -
8 8
- -
- -
- -
- 20
- -
- -
- -
- -
- -
15 28
- -
- 20
5 8
 - -
- -
- -
- -
- -
- -
- -
100 200

- -
- -
- -
50 200
50 200
- -
- 36
- 96
50 200
50 97
- 2
- -
- -
- -
- -
- -
10 19 2 3 3
60 100 10 10 10
100 130 10 10 10
- -
- 25 2 2 2
60 80 10 20 10
60 95 10 10 10
10 20 1 2 1
170 197 20 30 20
- 2
- 140 10 10 10
2,200 2,540 200 300 300
- 200 5 5 5
- 2 1 1
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
-
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
 Pemakaian Perhari / Tanggal diloket

7
12 13 14 15 16 17 18 19 20 21

500 300 300 200 300 200

400 300 400 300 300 200

200
 300

300 400 300 300

1 1

1
 500

72

200 100

50 50

600 1600
 24

200 200

100
2 1 1

25

1000

100
240
300 400 300 300 200

100 200
10 10
200
200
100
16 20

19

400 300 300

50

200
900

10

400

200
200
200
200
 3 2
10 11
10 10

2 1
10 10
10 15
1
20 25

10
200 140
5
22 23 24 25 26 27 28 29 30 31 Pustu Pusling

kd dodol sekong gn cupu kd bumbang dalam balar

300 400 200 500 300 200 300

300 200 500 200 300

300
 300 300 300 200

100

100

1
24 48

300
150 200 150 100

100 100
1 1

1000

300 300 200

100
90
200 600 300 500

100
20
200
100

24

300 300 200

30 50 20
200

500
200 300
900

3 2

10
400
200
200
15 12 15
10
 Pengeluaran Sub Unit

Pusling poskesdes posyandu

Gunung kadu Kupa Kadu
rocek gn datar kp handap Dalam balar Cupu rocek cimanuk Madang Batu bantar handap Bungbang Kadu dodol
126 126 126 126 33
 Jumlah Stok
Pengeluaran AkhirBulan
8 9
PTM gigi igd vk (1+ s.d31 + sub unit) (6-8)
Gunung
Sekong Datar BAKSOS BIAS POPM
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 6500 5000
0 0
0 0
0 110
0 0
0 0
0 0
0 0
0 0
600 5900 4200
0 0
0 0
0 0
0 0
0 0
0 0
0 12
0 0
0 0
100 700 3600
0 0
0 0
0 0
0 0
0 0
80 20 100 40
0 0
360 960 4560
0 0
0 200
 0 250
0 50
0 0
0 0
0 0
24 48 48
25 0
0 0
0 0
0 0
0 0
0 0
0 0
300 2700
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 180
0 0
3800 3300
0 0
0 0
0 0
3 6
0 0
0 0
0 0
0 0
0 0
0 0
100 600
0 200
0 0
0 0
0 90
100 1300
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 0
0 0
24 48
0 0
0 1200
5 20
0 800
 0 0
0 100
0 0
60 60 0
0 0
0 0
0 72
0 0
400 700
0 0
0 0
900 600
0 0
0 0
0 500
0 0
0 1000
168 0
0 0
0 0
0 0
0 0
0 1700
0 0
0 0
500 1600 0
0 0
0 75
150 350
100 100 200
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 100
0 0
0 0
0 0
0 120
100 100 200
0 0
0 0
0 0
0 0
0 0
0 0
5800 3200
0 0
 0 0
0 700
0 0
0 0
0 0
0 0
0 0
0 0
24 72
0 92
0 0
0 0
1000 0
0 90
0 0
0 100
0 0
400 2200
10 0
0 0
0 0
0 0
25 450
0 0
0 0
0 0
0 0
150 570
0 0
0 0
0 0
0 0
0 0
6 0
0 0
0 0
0 0
2500 3000
0 0
0 0
0
0 0
0 0
600 1400 3900
0 0
0 0
0 0
0 0
100 100 0
0 0
0 0
0 0
0 0
0 0
200 0
0 100
 0 0
0 0
0 0
1 6
2 7
0 0
570 0
0 0
 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
300 4200 3700
0 0
400 800
40 180
400 1400
300 700
100 300
60 288
0 0
0 0
19 24
0 100
2600 2000
100 100 0
0 400
150 100
300 500 900
0 10
500 1000
900 2400
1800 1200

0 0
0 0
0 100
12 0
0 0
0 0
0 0
40 220
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
400 200
0 0
0 0
0 0
0 0
200 900
0 0
 0 23
600 100
0 0
500 200
400 100
 0 0
20 20 60
0 0
0 48
0 0
0 0
0 0
0 0
0 5
0 0
126 10 726 1633

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 100 300 600
0 0
0 0
0 0
1 1 2 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
12 12 24 36
0 0
0 0
0 0
0 20
0 0
0 0
0 0
0 0
29 29 30
30 30 0
0 0
1 2 3 5
0 0
0 0
0 0
10 10 20 0
0 0
0 0
0 0
0 0
0 0
14 11 25 3
0 0
4 2 6 14
3 2 5 3
 0 0
0 0
0 0
0 0
0 0
0 0
0 0
50 50 150

0 0
0 0
0 0
50 50 150
100 50 150 50
0 0
24 24 12
12 12 24 72
50 50 150
35 27 62 35
0 2
0 0

0 0
0 0
0 0
13 6
51 49
60 70
0 0
9 16
60 20
55 40
5 15
115 82
0 2
40 100
1140 1400
20 180
2 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
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 OB
PUSKESMAS
PUSKESMAS : CIMANUK
KECAMATAN : CIMANUK
KAB / KOTA : PANDEGLANG PELAPORAN BULAN / PERIODE : DESEMBER 2020
PROVINSI : BANTEN PERMINTAAN BULAN / PERIODE : JANUARI 2021

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 - - - - -
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 - - - - -
9 Amlodipin Besilate 5 mg Tablet - - - - -
10 Amoksisilin Forte sirup kering 250mg Botol - - - - -
11 Amoksisilin Injeksi 1 gr Vial - - - - -
12 Amoksisilin Tablet 500 mg Tablet 6,500 5,000 11,500 6,500 5,000
13 Amoksisillin kapsul 250 mg Kapsul - - - - -
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol - - - - -
15 Ampisilin Injeksi 1 gr Vial 110 - 110 - 110
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 5,100 5,000 10,100 5,900 4,200
22 Anti Bakteri DOEN ( Bacitrasin ) Tube - - - - -
23 anti hemoroid doen kombinasi supp - - - - -
24 Antifungi DOEN Tube - - - - -
25 Antimigren DOEN Kombinasi : Tablet - - - - -
26 Antiparkinson DOEN tablet Kombinasi : Tablet - - - - -
27 Antiparkinson Tablet ( Levopar ) Tablet - - - - -
28 Aqua Pro Injeksi Vial 12 - 12 - 12
29 Artermeter injeksi Ampul - - - - -
30 Artesunate injeksi 60 mg/ml vial - - - - -
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 4,300 - 4,300 700 3,600
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 40 100 140 100 40
38 Asetosal tablet 500 mg Tablet - - - - -
39 Asetyl Cysteine Capsul 5,520 - 5,520 960 4,560
40 Asiklovir Cream 5% Tube - - - - -
41 Asiklovir tablet 200 mg Tablet 200 - 200 - 200
42 Asiklovir tablet 400 mg Tablet 250 - 250 - 250
 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)
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 - - - - -
47 Betadine Salep Antiseptik 5 mg Tube 48 48 96 48 48
48 Betametason krim 0,1 % Tube 25 - 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 2,000 1,000 3,000 300 2,700
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 - - - - -
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 180 - 180 - 180
65 D-Artepp tablet Tablet - - - - -
66 Deksametason tablet 0,5 mg Tablet 3,100 4,000 7,100 3,800 3,300
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 4 5 9 3 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 - - - - -
75 Diltiazem Tablet - - - - -
76 Doksisiklin Kapsul 100 mg Capsul - - - - -
77 Domperidon 10mg Tablet Tablet 300 400 700 100 600
78 Domperidon Suspensi 5 mg/ 5 ml Botol 200 - 200 - 200
79 Doxicyclin 500mg capsul - - - - -
80 Efedrin HCLTablet 25 mg Tablet - - - - -
81 Epinefrina HCL/Bitartrat Injeksi Ampul 90 - 90 - 90
82 Eritromicyn kapsul 250 mg capsul 1,400 - 1,400 100 1,300
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 100 - 100 100 -
92 Fenoksimetil Penisilina tablet 250 mg Tablet - - - - -
93 Fenol Gliserol tetes telinga 10 % Botol 72 - 72 24 48
 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)
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul - - - - -
95 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 1,200 - 1,200 - 1,200
96 Flufenazine Deconat Inj 25 mg/ml Ampul 15 10 25 5 20
97 Furosemida tablet 40 mg Tablet 800 - 800 - 800
98 Furosemide Injeksi Ampul - - - - -
99 Garam Oralit Sachet - 100 100 - 100
100 Gemfibrozil 300 mg Tablet - - - - -
101 Gentamicin Injeksi Ampul 60 - 60 60 -
102 Gentamicin Salep Kulit Tube - - - - -
103 Gentamicin Salep mata Tube - - - - -
104 Gentamicin Tetes Mata Botol 72 - 72 - 72
105 Gentian Violet 1 % Botol - - - - -
106 Glibenclamid tablet 5 mg Tablet 1,100 - 1,100 400 700
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet - - - - -
108 Glikazid 80 mg Tablet Tablet - - - - -
109 Glimepiride 2 mg Tablet 1,500 - 1,500 900 600
110 Glukosa larutan infus 10% steril Botol - - - - -
111 Glukosa larutan infus 5 % steril Botol - - - - -
112 Griseofulvin tablet 500 mg, Tablet 500 - 500 - 500
113 Guaiafenesin 100 mg Tablet - - - - -
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet 1,000 - 1,000 - 1,000
115 Hidrokortison krim 2,5% Tube 168 - 168 168 -
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 1,700 - 1,700 - 1,700
121 KAEN 3B Infus Botol - - - - -
122 Kalsium Glukonas Injeksi Ampul - - - - -
123 Kalsium Laktat (Kalk) tablet 500 mg Tablet 1,600 - 1,600 1,600 -
124 Kapas Berlemak 500 mg Bungkus - - - - -
125 Ketokonazol Kream Tube 75 - 75 - 75
126 Ketokonazol Tablet 200 mg Tablet 500 - 500 150 350
127 Ketorolac inj Ampul 200 100 300 100 200
128 Kifadene tablet 20 mg Tablet - - - - -
129 Kloramfenikol salep mata 1 % capsul - - - - -
130 Kloramfenikol suspensi Botol - - - - -
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 - - - - -
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 100 - 100 - 100
141 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul - - - - -
142 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol - - - - -
143 Lactobacilus serbuk Sachet - - - - -
144 Lidocain 2%+efinefrin injeksi Ampul 60 60 120 - 120
 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)
145 Lidocain injeksi 2 ml Ampul 200 100 300 100 200
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 5,000 4,000 9,000 5,800 3,200
153 Methilprednisolon tablet 4 mg Tablet - - - - -
154 Metilergometrin Maleat injeksi 1 ml Ampul - - - - -
155 Metilergometrin Maleat Tablet Tablet 700 - 700 - 700
156 Metoklopramid Suspensi Botol - - - - -
157 Metoklopramid tablet Tablet - - - - -
158 Metronidazol 500 mg Tablet - - - - -
159 Metronidazol infus / injeksi Botol - - - - -
160 Metronidazol Ovula supp - - - - -
161 Metronidazol suspensi Botol - - - - -
162 Mikonazol kream Tube 96 - 96 24 72
163 Multivitamin Anak Sirup Botol 92 - 92 - 92
164 Multivitamin Dewasa Antioksidan ( Becom c ) Tablet - - - - -
165 Natrium Diklofenak 25 mg Tablet Tablet - - - - -
166 Natrium Diklofenak 50 mg Tablet Tablet - 1,000 1,000 1,000 -
167 Natrium Klorida Cairan Infus ( NaCL ) Botol 90 - 90 - 90
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 1,600 1,000 2,600 400 2,200
172 Obat Batuk Flu ( Molexflu ) Tablet 10 - 10 10 -
173 Obat Batuk Hitam (OBH) Botol - - - - -
174 Obat Batuk Sirup Herbal ( Herbacop ) Botol - - - - -
175 Ofloxsacin Tetes Telinga Tube - - - - -
176 Oksitetrasiklin HCL salep mata 1% Botol 475 - 475 25 450
177 Oksitosin injeksi 10 IU/ml - 1 ml Ampul - - - - -
178 Omeprazol injeksi Ampul - - - - -
179 Omeprazol Kapsul 20 mg capsul - - - - -
180 Ondancentron injeksi 4 mg Ampul - - - - -
181 Ondancentron Tablet4 mg Tablet 720 - 720 150 570
182 Paracetamol Drop 15 ml Botol - - - - -
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 6 - 6 6 -
188 Pirantel Sirup Botol - - - - -
189 Pirantel tablet 125 mg Tablet - - - - -
190 Pirazinamid Botol - - - - -
191 Piridoksin HCL (VIT B6) tablet 10mg Botol 3,500 2,000 5,500 2,500 3,000
192 Piroksikam tablet 20 mg Tablet - - - - -
193 Polikresulen Tube - - - - -
194 Povidon lodida 10% 300 ml - - - - -
195 Povidon lodida 10% 60 ml Tablet - - - - -
 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)
196 Prazikuantel tablet 600 mg Botol - - - - -
197 Prednison Tablet 5 mg Tablet 5,300 - 5,300 1,400 3,900
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 - 100 100 100 -
203 Ranitidin tablet Tablet - - - - -
204 Resperidone 2 mg tablet Tablet - - - - -
205 Ringer Laktat cairan infus (Otsuka) - - - - -
206 Ringer Laktat cairan infus (Widatra) Botol - - - - -
207 Rivanol 300 ml Botol - - - - -
208 Salbutamol Tablet 2 mg Tablet 200 - 200 200 -
209 Salbutamol tablet 4mg Tablet 100 - 100 - 100
210 Salep 2-4 Tube - - - - -
211 Salep kombinasi cream ( Berloson ) Tube - - - - -
212 Salicil bedak Kotak - - - - -
213 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial 7 - 7 1 6
214 Serum Anti Tetanus inj 1500 IU ( Tetagam ) Vial 9 - 9 2 7
215 Sianokobalamin Injeksi Ampul - - - - -
216 Simvastatin 10 mg tablet Tablet 570 - 570 570 -
217 Simvastatin 20 mg tablet Tablet - - - - -
218 Sukralfat Suspensi Botol - - - - -
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 - - - - -
226 Ventolin Nebulizer Ampul - - - - -
227 Vitamin B komplek Tablet 2,900 5,000 7,900 4,200 3,700
228 Zink sirup Botol - - - - -
229 Zink tablet 20 mg Tablet 1,200 - 1,200 400 800
Antasida DOEN suspensi botol 220 - 220 40 180
Allopurinol 100 mg (2020) Tablet 800 1,000 1,800 400 1,400
Kotrimoksazol Dewasa Tablet 480 mg (2020) Tablet 1,000 - 1,000 300 700
Kloramphenicol 500 mg Kapsul 400 - 400 100 300
Kloramfenikol salep kulit 2% Tube 348 - 348 60 288
Natrium Klorida Cairan Infus ( NaCL ) Wida Botol - - - - -
Paracetamol Sirup 120 mg/5 ml (2020) Botol - - - - -
Salep 2-4 (2020) Pot 43 - 43 19 24
Kotrimoksazol suspensi (2020) Botol 100 - 100 - 100
Klorfeniramin Maleat (CTM) tablet 4 mg (2020) Tablet 600 4,000 4,600 2,600 2,000
Ranitidin injeksi (2020) Ampul 100 - 100 100 -
Salbutamol Tablet 2 mg (2020) Tablet 400 - 400 - 400
Amoksisillin Sirup Kering 125 mg/5 ml (2020) Botol 250 - 250 150 100
Asam Folat (2020) Tablet 400 1,000 1,400 500 900
Multivitamin Dewasa (HB Vit) Box 5 5 10 - 10
Simvastatin 20 mg tablet (2020) Tablet 500 1,000 1,500 500 1,000
Tiamin Tablet 50 mg ( B1 ) (2020) Tablet 1,300 2,000 3,300 900 2,400
 Jumlah Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir

1 2 3 4 5 6 7 8
A NAMA OBAT ( 4+5 ) (6-7)
Amlodipin Besilate 5 mg (2020) Tablet - 3,000 3,000 1,800 1,200

OBAT PROGRAM - - - - -
1 Albendazol Tablet 400 mg Tablet - - - - -
2 Isoniazid Tablet 100 mg Tablet 100 - 100 - 100
3 Obat Antituberkulosis kategori 1 Paket 12 - 12 12 -
4 Obat Antituberkulosis Kategori 2 Paket - - - - -
5 Obat Antituberkulosis Kategori Anak Paket - - - - -
6 Pot Dahak Non Steril Biji - - - - -
7 Pot Dahak Steril Biji 260 - 260 40 220
8 Reagen Ziehl Neelsen Kit - - - - -
9 MDT MB Anak Tablet Tablet - - - - -
10 MDT MB Dewasa Tablet Tablet - - - - -
11 MDT PB Dewasa Tablet Tablet - - - - -
12 MDT PB Anak Tablet Tablet - - - - -
13 Retinol (Vitamin A) kapsul 200.000 IU capsul - - - - -
14 Retinol (Vitamin A) kapsul 100.000 IU capsul - - - - -
15 Tablet Penambah Darah ( FE ) Tablet - - - - -
16 Amitriptilin tablet 25 mg Tablet - - - - -
17 Carbamazepin 200 mg tablet Tablet 300 300 600 400 200
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 600 500 1,100 200 900
23 Haloperidol 5 mg Tablet Tablet - - - - -
24 Haloperidol Injeksi Ampul 13 10 23 - 23
25 Klorpromazin HCL tablet salut 100 mg Tablet 200 500 700 600 100
26 Klorpromazine Tablet 25 mg Tablet - - - - -
27 Triheksilfenidil Hcl 2 mg tablet Tablet 100 600 700 500 200
28 Risperidone 2 mg tablet Tablet 300 200 500 400 100
29 Divalproexsodium Tablet - - - - -
Diazepam injeksi (program) ampul 80 - 80 20 60
Magnesium Sulfat Inj. 25 ml 40 % (program) ampul - - - - -
Kalsium Glukonas Injeksi ampul 48 - 48 - 48
Oksitosin injeksi 10 IU/ml - 1 ml ampul - - - - -
Metilergometrin Maleat injeksi 1 ml ampul - - - - -
Dehydro Artemisin 40 mg + Piperaquin 320 mg (DHP) tablet - - - - -
Primakuin tablet 15 mg tablet - - - - -
Masker karet ear loop hijab box 5 - 5 - 5
Masker N 95 box - - - - -
Tablet Penambah Darah (program) box 2,359 - 2,359 726 1,633

- - - - -
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) - - - - -
 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)
6 Alat suntik 3 ml Pcs - - - - -
7 Alat suntik 5 ml pcs 400 500 900 300 600
8 Alkazide 1 L High Level Desinfectant Botol - - - - -
9 Alkazyme Sachet 25 mg Pack - - - - -
10 Alkohol 70 % 1 L Botol - - - - -
11 Alkohol swab Sachet 2 - 2 2 -
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 12 60 24 36
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 20 - 20 - 20
24 I.V Cathetter No. 20 Set - - - - -
25 I.V Cathetter No. 22 Set - - - - -
26 I.V Cathetter No. 24 Set - - - - -
27 I.V Cathetter No. 26 Set - - - - -
28 Infuset Anak Set 59 - 59 29 30
29 Infuset Dewasa Set 30 - 30 30 -
30 Jarum Insulin Tablet - - - - -
31 Kapas Berlemak 250 gr Bungkus - 8 8 3 5
32 Kapas Berlemak 500 gr Bungkus - - - - -
33 Kasa 4 m x 10 cm Rol - - - - -
34 Kasa Hidrofil 36 x 80 cm Rol - - - - -
35 Kasa Pembalut 2 x 80 cm Pack 20 - 20 20 -
36 Kasa Steril 16 x 16 cm Kotak - - - - -
37 Lisol 1 L Botol - - - - -
38 Masker karet Ear Loop Lembar - - - - -
39 Masker tali Tube - - - - -
40 Nasal Canula Oksigen Set - - - -
41 Plester 1" Rol 13 15 28 25 3
42 Plester Kertas 2,5 cm Rol - - - - -
43 Plester Non Woven 5cm x 5 cm Rol 20 - 20 6 14
44 Policlean Botol 3 5 8 5 3
45 Polifik Kotak - - - - -
46 Saraya Alsof A 500 ml Botol - - - - -
47 Saraya Alsof Pure 500 ml Botol - - - - -
48 Sarung Tangan Gynecolog No 7 Pasang - - - - -
49 Sarung tangan M (Non Steril) Pasang - - - - -
50 Sarung tangan no 6,5 Pasang - - - - -
51 Sarung tangan no 6,5 Steril Gloves Pasang - - - - -
52 Sarung tangan no 7,0 Steril Pasang 100 100 200 50 150

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

54 Underpad Lembar - - - - -
55 Urine Bag 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)
I.V Cathetter No. 24 jms pcs 150 50 200 50 150
I.V Cathetter No. 22 jms set 150 50 200 150 50
Alat suntik 1 ml (2020) box - - - - -
Cat Gut no 2/0 pcs 36 - 36 24 12
Cat Gut no 3/0 pcs 96 - 96 24 72
I.V Cathetter No. 20 jms set 150 50 200 50 150
Kasa Hidrofil 16 x 16 cm (2020) kotak 47 50 97 62 35
Kasa Hidrofil 3 x 15 cm (2020) Paket 2 - 2 - 2
Alat suntik 3 ml (2020) box - - - - -
-
- - - - -
NAMA OBAT VAKSIN

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

2 Vaksin BCG Vial 28 10 19 13 6
3 Vaksin DT Vial 40 60 100 51 49
4 Vaksin HB 0 Pcs 52 100 130 60 70
5 Vaksin HBIG Vial - - - - -
6 Vaksin Measless Rubella (MR) Vial 17 - 25 9 16
7 Vaksin Pentabio ( DPT - HB - Hib ) Vial 40 60 80 60 20
8 Vaksin Polio B OPV Vial 50 60 95 55 40
9 Vaksin Polio IPV Vial - 10 20 5 15
10 Vaksin TD Vial 70 170 197 115 82
11 Vaksin Tuberculin Vial - - 2 - 2
12 ADS 0,05 ml Unit 50 - 140 40 100
13 ADS 0,5 ml Unit 560 2,200 2,540 1,140 1,400
14 ADS 5 ml Unit 37 - 200 20 180
15 Safety Box Unit 20 - 2 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 - - - - -
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 - - - - -
 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)
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
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 - - - - -
 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)
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 2423

UMUM / TIDAK BAYAR 14
JKN 1697
TOTAL KUNJUNGAN 4134

Mengetahui / Menyetujui
 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)
KEPALA DINAS KESEHATAN YANG MENYERAHKAN YANG MEMIN
KABUPATEN PANDEGLANG KEPALA UPT. GUDANG FARMASI KEPALA PUSKES

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

NIP. NIP. NIP.
INTAAN 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

-
-
-
- 750
- 2500
-
-
- 9000
- 9000
-
-
7,800 10,000
-
- 300
-
-
-
-
-
-
7,080 10000
-
-
-
-
-
-
- 120
-
-
840
-
-
-
- 5000
- 50
120 90
-
1,152
- 100
- 500
-
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

-
-
-
-
58 48
30 175
-
-
-
-
-
-
360 2000
-
-
-
-
-
- 2000
-
-
-
-
4,560 5000
-
-
-
4 5
-
-
-
- 1000
-
-
120 400
-
-
-
-
120
-
-
-
-
- 10
-
-
-
120
-
29 48
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

-
-
6
-
- 200
- 100
- 1000
72
-
-
- 72
-
480
-
-
1,080 3000
-
- 90
-
-
-
202 240
- 100
- 3000
-
- 100
- 1000
- 60
-
1,920 2500
-
- 150
180
120 100
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
- 100
- 60
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

120 100
-
-
- 1000
- 50
- 60
-
6,960 10000
-
-
-
-
-
- 500
-
-
- 50
29 96
-
-
-
1,200 5000
-
-
-
- 50
480 1000
12 20
-
- 96
- 100
30
-
- 20
- 330
- 80
180
- 360
-
-
-
- 10000
7 30
-
-
-
3,000 3000
- 2000
-
- 10
- 10
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

-
1,680 2000
-
-
-
-
120 200
- 2000
-
-
- 140
-
240 2000
- 500
-
-
- 50
1 3
2 10
-
684 5000
-
- 50
-
-
-
-
-
-
- 2000
- 40
5,040
- 48
480 1000
48
480 1000
360 1000
120 500
72
-
- 500
23 96
-
3,120 5000
120 100
-
180 300
600 2000
- 5
600 1000
1,080 1000
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

2,160 9000

-
-
-
14
-
-
-
48
-
-
-
-
-
-
-
-
-
480
-
-
-
-
240
-
-
720
-
600
480
-
24
-
-
-
-
-
-
-
-
871

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

9 10 11 12 13 14 15 16

-
360 500
-
-
- 10
2 10
- 10
-
-
-
-
-
- 15
29 12
-
-
-
- 20
-
-
-
-
35
36 180
-
4 8
-
-
- 2
24 60
-
-
-
-
-
30 48
-
7 10
6 5
-
-
-
- 100
- 1500
-
- 200
60 200

-
- 40
- 70
 Jumlah PEMBERIAN
Stok
Permintaa BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
n STOK

9 10 11 12 13 14 15 16

60 50
180 300
- 6
29 48
29 48
60 150
74 100
-
- 10

-
-

16
61
72
-
11
72
66
6
138
-
48
1,368
24
2
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
 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.