LAPORAN BULANAN PENGGUNAAN ATS

PUSKESMAS CIMANUK
MENU BULAN : FEBRUARI 2020

PENGGUNAAN
STOK JUMLAH
NO PENERIMAAN NAMA
AWAL PERSEDIAAN UMUR ALAMAT
PASIEN
1 - 10 10
10 10 rosi 29 cimanuk
9 9 iman 58 rocek
8 8 fahmi 25 batu bantar

JUMLAH

Kepala UPT Puskesmas DTP cimanuk

dr. Rita Permatasari

NIP : 19810920 200902 2 002
NAAN ATS
K
20

ENGGUNAAN
SISA
KET
JUMLAH PETUGAS STOK

10
1 desika 9
1 wiwin 8
1 desika 7

Cimanuk, 2 februari 2020

Pengelola obat

Deden Arditia Nurjaman S.si.,Apt

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

PENGGUNAAN
STOK JUMLAH
NO PENERIMAAN NAMA
AWAL PERSEDIAAN UMUR ALAMAT JUMLAH
PASIEN
1 6 6 ratna 25 sunar terang 1
5 5 bai 70 parigi 1
4 4 babay 54 giri anyar 1
3 3 firman 29 rocek 1
2MENU 2 mumun 32 dalam balar 1

JUMLAH 5

Kepala UPT Puskesmas DTP cimanuk

dr. Rita Permatasari

NIP : 19810920 200902 2 002
BU

AN
SISA
KET
PETUGAS STOK

wiwin 5
dewika 4
rosi 3
resni 2
desika 1

Cimanuk, 2 februari 2020

Pengelola obat

Deden Arditia Nurjaman S.si.,Apt

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

NO NAMA OBAT STOK PENERIMAAN JUMLAH PEMAKAIAN

AWAL PERSEDIAAN
3 4 5 6
1 2
(3+4)

1 Alprazolam tab 0 0

2 Amitriptilin 25 mg 435 0 435 200

3 Carbamazepine 200 mg 90 0 90 90

Chlorpromazine hcl 100

4 515 0 515 300
mg

5 Clobazam 10 mg 30 0 30 0

6 Clozapine 25 mg 500 0 500 250

7 Diazepam injeksi 0 126 126 6

Diazepam Rektal 0,5 mg

8 10 0 10 0
/ 2 ml

9 Divalproexsodium 75 0 75 0

10 Fluoksetin 10 mg 0 0 0 0

Fluphenazine decanoat
11 0 0 0 0
inj 25 mg

12 Haloperidol 1,5 mg 0 0 0 0

13 Haloperidol 2 mg 504 0 504 162

Haloperidol decanoat inj

14 5 0 5 0
50 mg

15 Imipramicine hcl 25 mg 0 0 0 0
16 Phenobarbital 30 mg 600 0 600 400

17 Risperidon 2 mg 13 300 313 300

18 Shizonat injek 22 0 22 7

Trifluouperazine HCl 5
19 0 0 0 0
mg

20 Trihexipenidil 2 mg 155 400 555 400

Kepala UPT Puskesmas DTP cimanuk

dr. Rita Permatasari

NIP : 19810920 200902 2 002
 NAN PSIKOTROPIKA
MAS CIMANUK
JANUARI 2020

PERMINTAAN PEMBERIAN
STOK AKHIR
7 8 9
(5-6)

235

215

30

250

120

10

75

342

0
200

13

15

155

Cimanuk, 2 maret 2020

Pengelola obat

Deden Arditia Nurjaman S.si.,Apt

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

NO NAMA OBAT SATUAN JUMLAH

1 Paracetamol tablet 500 mg tab 15600
2 Amoksisilin Tablet 500 mg tab 12800
3 ANTASIDA DOEN Tablet tab 12500
4 Klorfeniramin maleat (ctm) tablet 4 mg tab 9800
5 Vitamin B komplek tab 8000
6 Deksametason tablet 0,5 mg tab 6550
7 Amlodipin Besilate 5 mg tab 6420
8 Amlodipin Besilate 10 mg tab 4550
9 Metformin tab 4500
10 Natrium diklofenak 50 mg tab 4250

Cimanuk, 2 februari 2020

Kepala UPT Puskesmas DTP cimanuk Pengelola obat

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

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

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

1 Alprazolam Tablet - -
2 Albendazol Tablet 400 mg Tablet - -
3 Allopurinol tablet 100 mg Tablet - 2,500
4 Ambroxol sirup Botol 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 3,950 6,000
9 Amlodipin Besilate 5 mg Tablet 4,920 9,000
10 Amoksisilin Forte sirup kering 125mg Botol - -
11 Amoksisilin Injeksi 1 gr Vial - -
12 Amoksisilin Tablet 500 mg Tablet 5,800 13,000
13 Amoksisillin kapsul 250 mg Kapsul - -
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol - -
15 Ampisilin Injeksi 1 gr Vial - -
16 Analog insulin Long Acting Pen - -
17 Analog insulin Mix Acting Pen - -
18 Antalgin (Metampiron) tablet 500 mg Tablet - -
19 Antalgin (Metampiron) tablet 500 mg Tablet - -
20 Antasida DOEN suspensi Botol 80 100
21 ANTASIDA DOEN Tablet Tablet 10,200 10,000
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 8 50
29 Artermeter injeksi Ampul - -
30 Artesunate injeksi 60 mg/ml vial - -
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 1,200 1,600
32 Asam Folat Botol 380 1,000
33 Asam Fusidat Cream Tube - -
34 Asam Klorida 0,1 N Botol - -
35 Asam Mefenamat 500 mg Tablet - -
36 Asam Traneksamat Inj 5% Ampul 30 -
37 Asering Botol - 80
38 Asetosal tablet 500 mg Tablet - -
39 Asetyl Cysteine Capsul - -
40 Asiklovir Cream 5% Tube - -
41 Asiklovir tablet 200 mg Tablet 100 300
42 Asiklovir tablet 400 mg Tablet 600 -
43 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul 90 -
44 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Vial - -
45 Atropin Sulfat tablet 0,5 mg Tablet - -
46 Berotec Metered Aerosol 100 mg Bok - -
47 Betadine Salep Antiseptik 5 mg Tube - -
48 Betametason krim 0,1 % Tube 160 125
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 400 2,000
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 550 700
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 37 80
65 D-Artepp tablet Tablet - -
66 Deksametason tablet 0,5 mg Tablet 600 7,000
67 Dekstran 70 - larutan infus 6% steril Botol - -
68 Dekstrometorfan sirup Botol - -
69 Dekstrometorfan tablet 15 mg Tablet - -
70 Diazepam Rektal 0,5 mg / 2 ml supp 10 -
71 Diazepam tablet 2 mg Tablet 72 -
72 Diazepam tablet 5 mg Tablet - -
73 Difenhidramin HCL injeksi 10 mg/ml - 1ml Ampul - -
74 Digoksin tablet 0,25 mg Tablet 200 -
75 Diltiazem Tablet - -
76 Doksisiklin Kapsul 100 mg Capsul - -
77 Domperidon 10mg Tablet Tablet 650 -
78 Domperidon Suspensi 5 mg/ 5 ml Botol - 100
79 Doxicyclin 500mg capsul - -
80 Efedrin HCLTablet 25 mg Tablet - -
81 Epinefrina HCL/Bitartrat Injeksi Ampul - -
82 Eritromicyn kapsul 250 mg capsul 1,700 1,000
83 Erytromicin kapsul 500 mg Kapsul - -
 84 Erytromicin sirup 125 mg Botol - -
85 Etakridin ( Rivanol ) larutan 0,1% Botol - -
86 Etambutol 500 mg Tablet - -
87 Etanol 70 % Botol - -
88 Etil Klorida Semprot Botol - -
89 Fenitoin Natrium kapsul 30 mg Kapsul - -
90 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul - -
91 Fenobarbital tablet 30 mg Tablet 600 -
92 Fenoksimetil Penisilina tablet 250 mg Tablet - -
93 Fenol Gliserol tetes telinga 10 % Botol - -
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul - -
95 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 700 1,000
96 Flufenazine Deconat Inj 25 mg/ml Ampul - -
97 Furosemida tablet 40 mg Tablet - 600
98 Furosemide Injeksi Ampul - -
99 Garam Oralit Sachet 90 100
100 Gemfibrozil 300 mg Tablet - -
101 Gentamicin Injeksi Ampul - -
102 Gentamicin Salep Kulit Tube - -
103 Gentamicin Salep mata Tube - -
104 Gentamicin Tetes Mata Botol - -
105 Gentian Violet 1 % Botol - -
106 Glibenclamid tablet 5 mg Tablet 200 2,000
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet - -
108 Glikazid 80 mg Tablet Tablet - -
109 Glimepiride 2 mg Tablet 600 1,000
110 Glukosa larutan infus 10% steril Botol - -
111 Glukosa larutan infus 5 % steril Botol 20 20
112 Griseofulvin tablet 500 mg, Tablet 900 -
113 Guaiafenesin 100 mg Tablet - -
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet 200 -
115 Hidrokortison krim 2,5% Tube 206 120
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 800 500
121 KAEN 3B Infus Botol 20 40
122 Kalsium Glukonas Injeksi Ampul 47 48
123 Kalsium Laktat (Kalk) tablet 500 mg Tablet 4,031 2,000
124 Kapas Berlemak 500 mg Bungkus - -
125 Ketokonazol Kream Tube 80 100
126 Ketokonazol Tablet 200 mg Tablet - 1,000
127 Ketorolac inj Ampul - -
128 Kifadene tablet 20 mg Tablet - -
129 Kloramfenikol salep mata 1 % capsul 8 96
130 Kloramfenikol suspensi Botol 100 -
131 Kloramfenikol tetes telinga 3% Tube - -
132 Kloramphenicol 250 mg Capsul 200 -
133 Kloramphenicol 500 mg capsul 400 -
134 Kloramphenicol Tetes Mata Botol - -
135 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 8,000 8,000
136 Klorokuin tablet 150 mg Tablet - -
137 Klorpromazin HCL tablet salut 25 mg Tablet - -
138 Kombinasi (Pirimetamin 25 mg + Solfadoxin Tablet - -
139 Kotrimoksazol Dewasa Tablet 480 mg Tablet 150 -
140 Kotrimoksazol Sirup / Suspensi Botol 85 200
141 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul - -
142 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol - -
143 Lactobacilus serbuk Sachet - -
144 Lidocain 2%+efinefrin injeksi Ampul - -
145 Lidocain injeksi 2 ml Ampul - 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 28 20
151 Metamizol 500 mg Tablet - -
152 Metformin 500 mg Tablet Tablet 6,100 2,500
153 Methilprednisolon tablet 4 mg Tablet - -
154 Metilergometrin Maleat injeksi 1 ml Ampul - -
155 Metilergometrin Maleat Tablet Tablet - 500
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 68 96
163 Multivitamin Anak Sirup Botol 30 100
164 Multivitamin Dewasa Antioksidan ( Becom c ) Tablet - -
165 Natrium Diklofenak 25 mg Tablet Tablet - -
166 Natrium Diklofenak 50 mg Tablet Tablet 5,250 -
167 Natrium Klorida Cairan Infus ( NaCL ) Botol - 40
168 Nifedipine Tablet 10 mg Tablet 200 -
169 Nistatin tablet vaginal 100.000 IU/g Tube - 100
170 Obat anti Diare suspensi Botol - -
171 Obat Anti Diare Tablet (Akita / Molagit ) Tablet - -
172 Obat Batuk Flu ( Molexflu ) Tablet - -
173 Obat Batuk Hitam (OBH) Botol - -
174 Obat Batuk Sirup Herbal ( Herbacop ) Botol 43 -
175 Ofloxsacin Tetes Telinga Tube - -
176 Oksitetrasiklin HCL salep mata 1% Botol - -
177 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 150 100
178 Omeprazol injeksi Ampul 60 -
179 Omeprazol Kapsul 20 mg capsul 180 -
180 Ondancentron injeksi 4 mg Ampul 45 40
181 Ondancentron Tablet4 mg Tablet 120 300
182 Paracetamol Drop 15 ml Botol - -
183 Paracetamol Sirup 120 mg/5 ml Botol 490 200
184 Parafin Dresing ( Bioplacenton Tull ) pcs - -
185 Parasetamol tablet 100 mg Tablet - -
186 Parasetamol tablet 500 mg Tablet 400 -
187 Permetrin Krim 5 % Tube - 24
188 Pirantel Sirup Botol - -
189 Pirantel tablet 125 mg Tablet - -
190 Pirazinamid Botol - -
191 Piridoksin HCL (VIT B6) tablet 10mg Botol - 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 600 8,000
198 Primakuin 15 mg Tablet - -
199 Probenesid 500 mg tablet Tablet - -
200 Prokain Benzil Penisilin 3 juta IU/vial injeksi Ampul - -
201 Propanolol HCL tablet 10 mg Tablet - -
202 Ranitidin injeksi Ampul 50 200
203 Ranitidin tablet Tablet 2,500 -
204 Resperidone 2 mg tablet Tablet - -
205 Ringer Laktat cairan infus (Otsuka) 500 -
206 Ringer Laktat cairan infus (Widatra) Botol - -
207 Rivanol 300 ml Botol - -
208 Salbutamol Tablet 2 mg Tablet 300 1,000
209 Salbutamol tablet 4mg Tablet 300 1,000
210 Salep 2-4 Tube - 72
211 Salep kombinasi cream ( Berloson ) Tube - -
212 Salicil bedak Kotak - -
213 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial 6 -
214 Serum Anti Tetanus inj 1500 IU ( Tetagam ) Vial 10 -
215 Sianokobalamin Injeksi Ampul - -
216 Simvastatin 10 mg tablet Tablet 990 2,400
217 Simvastatin 20 mg tablet Tablet - -
218 Sukralfat Suspensi Botol 50 25
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 5,900 -
226 Ventolin Nebulizer Ampul - -
227 Vitamin B komplek Tablet 5,000 4,000
228 Zink sirup Botol - -
229 Zink tablet 20 mg Tablet 150 500
OBAT PROGRAM
1 Albendazol Tablet 400 mg Tablet - -
2 Isoniazid Tablet 100 mg Tablet 200 -
3 Obat Antituberkulosis kategori 1 Paket 13 -
4 Obat Antituberkulosis Kategori 2 Paket - 2
5 Obat Antituberkulosis Kategori Anak Paket - 2
6 Pot Dahak Non Steril Biji - -
7 Pot Dahak Steril Biji - -
8 Reagen Ziehl Neelsen Kit - -
9 MDT MB Anak Tablet Tablet - -
10 MDT MB Dewasa Tablet Tablet - -
11 MDT PB Dewasa Tablet Tablet - -
12 MDT PB Anak Tablet Tablet - -
13 Retinol (Vitamin A) kapsul 200.000 IU capsul - -
14 Retinol (Vitamin A) kapsul 100.000 IU capsul - -
15 Tablet Penambah Darah ( FE ) Tablet - -
16 Amitriptilin tablet 25 mg Tablet 435 -
17 Carbamazepin 200 mg tablet Tablet 90 -
18 Clobazam 10 mg Tablet Tablet 30 -
19 Clozapine 25 mg Tablet Tablet 500 -
20 Fenitoin Natrium kapsul 30 mg capsul - -
21 Haloperidol 1,5 mg Tablet Tablet - -
22 Haloperidol 2 mg tablet Tablet 504 -
23 Haloperidol 5 mg Tablet Tablet 0 -
24 Haloperidol Injeksi Ampul 5 -
25 Klorpromazin HCL tablet salut 100 mg Tablet 515 -
26 Klorpromazine Tablet 25 mg Tablet 0 -
27 Triheksilfenidil Hcl 2 mg tablet Tablet 155 300
28 Risperidone 2 mg tablet Tablet 13 -
29 Divalproexsodium Tablet 75 -
Diazepam injeksi (program) -
Magnesium Sulfat Inj. 25 ml 40 % (program) -
Kalsium Glukonas Injeksi
Oksitosin injeksi 10 IU/ml - 1 ml
Metilergometrin Maleat injeksi 1 ml
Dehydro Artemisin 40 mg + Piperaquin 320 mg (DHP)
Primakuin tablet 15 mg
Masker karet ear loop hijab

NAMA BAHAN MEDIS HABIS PAKAI (BMHP )

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

NAMA OBAT VAKSIN

1 Vaksin Anti Rabies ( VAR ) Vial 0

2 Vaksin BCG Vial 25
3 Vaksin DT Vial 40
4 Vaksin HB 0 Pcs 65
5 Vaksin HBIG Vial 0
6 Vaksin Measless Rubella (MR) Vial 5
7 Vaksin Pentabio ( DPT - HB - Hib ) Vial 47
8 Vaksin Polio B OPV Vial 59
9 Vaksin Polio IPV Vial 0
10 Vaksin TD Vial 65
11 Vaksin Tuberculin Vial 0
12 ADS 0,05 ml Unit 30
13 ADS 0,5 ml Unit 315
14 ADS 5 ml Unit 5
15 Safety Box Unit 15
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
KAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO )
PUSKESMAS
DOKUMEN
DINKES KAB/KOTA
/ PERIODE : FEBRUARI 2020 : GFK KAB/KOTA
PUSKESMAS

Penerimaan
Jumlah Jumlah
APBD PROG LAIN 2 Penerimaan Persediaan

5 6
( 4+5 ) 1 2 3 4 5 6
- - - - -
- - - - -
- - - 2,500 2,500
300 - - 300 350 50
- - - - -
- - - - -
- - - - -
- - - 6,000 9,950 300 300 300
- - - 9,000 13,920 300 300 300 300
- - - - -
- - - - -
- - - 13,000 18,800 500 500 500 500 500
- - - - -
600 - - 600 600 60 60
- 177 - 177 177
- - - - -
- - - - -
- - - - -
- - - - -
- - - 100 180 50
- - - 10,000 20,200 600 600 600 600 700
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - 50 58 8
- - - - -
- - - - -
- - - 1,600 2,800 300 300 300
- - - 1,000 1,380 200
- - - - -
- - - - -
3,000 - - 3,000 3,000
 - - - - 30
- - - 80 80
- - - - -
- - - - -
- - - - -
- - - 300 400
- - - - 600
- - - - 90
- - - - -
- - - - -
- - - - -
- - - - -
- - - 125 285 25 25 25
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - 2,000 2,400 100 100
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - 700 1,250
- - - - -
- - - - -
- - - 80 117 7
- - - - -
- - - 7,000 7,600 300 200 300 300
- - - - -
- - - - -
- - - - -
- - - - 10
- - - - 72
- - - - -
- - - - -
1,000 - - 1,000 1,200
- - - - -
- - - - -
- - - - 650
- - - 100 100
- - - - -
- - - - -
- - - - -
- - - 1,000 2,700
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - 600
- - - - -
- - - - -
- - - - -
- - - 1,000 1,700 100 100
- - - - -
- - - 600 600
- - - - -
- - - 100 190 2
- - - - -
- 177 - 177 177
- - - - -
- - - - -
- - - - -
- - - - -
- - - 2,000 2,200 100 100
- - - - -
- - - - -
- - - 1,000 1,600 200 200
- - - - -
- - - 20 40
- - - - 900 200
- - - - -
- - - - 200
- - - 120 326 24 24 24
- - - - -
- - - - -
- - - - -
- - - - -
- - - 500 1,300 100 100
- - - 40 60
- - 48 95
- - - 2,000 6,031 100 100 81 100
- - - - -
- - - 100 180 30
- - - 1,000 1,000
- - - - -
- - - - -
- - - 96 104
- - - - 100
- - - - -
 - - - - 200
- - - - 400
- - - - -
- - - 8,000 16,000 500 500 500
- - - - -
- - - - -
- - - - -
- - - - 150
- - - 200 285 20 15
- - - - -
- - - - -
- - - - -
- - - - -
- - - 100 100
- - - - -
- - - - -
- - - - -
- - - - -
- - - 20 48
- - - - -
- - - 2,500 8,600 300 300 300
- - - - -
- - - -
- - - 500 500
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - 96 164 10 7
- - - 100 130 7
- - - - -
- - - - -
- - - - 5,250 50 50
- - - 40 40
- - - - 200
- - - 100 100
- - - - -
- - - - -
15 - - 15 15
- - - - -
96 - - 96 139 43
- - - - -
- 844 - 844 844
- - 100 250 3
- - - - 60 4
- - - - 180 30 30 30
 - - - 40 85
- - - 300 420 30 30
- - - - -
- - 300 500 990 90 100 100
- - - - -
- - - - -
20,000 - - 20,000 20,400 300 300 500 500 300
- - - 24 24
- - - - -
- - - - -
- - - - -
- - - 2,000 2,000
- - - - -
- - - - -
3 - - 3 3
- - - - -
- - - - -
- - - 8,000 8,600
- - - - -
- - - - -
- - - - -
- - - - -
- - - 200 250 50
2,000 - - 2,000 4,500 200 200 200 200
- - - - -
- - - - 500 20 20
- - - - -
- - - - -
- - - 1,000 1,300 100 100
- - - 1,000 1,300
- - - 72 72
- - - - -
- - - - -
- - - - 6 1 1 1 1
- - - - 10 1 1
- - - - -
- - - 2,400 3,390 60 60 60 60 60
- - - - -
- - - 25 75
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - 5,900
- - - - -
- - - 4,000 9,000 200 300 500 300
- - - - -
- 1,000 - 1,500 1,650 100
- -
- - - - -
- 200 - 200 400
- 32 - 32 45
- - - 2 2
- - - 2 2
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- 4,000 - 4,000 4,000
- 500 - 500 500
- 9,000 - 9,000 9,000
- - - - 435
- - - - 90
- - - - 30
- - - - 500
- - - - -
- - - - -
- - - - 504
- - - - -
- - - - 5
- - - - 515
- - - - -
- - - 300 455
- 300 - 300 313
- - - - 75
- 126 - 126 126
- 106 - 106 106
84 84 84
663 663 663 20
697 697 697
- -

- - -
- -
- - - 200 600 100 59
- - - - -
- - - - -
- - - - -
- - - 400 1,000 100
- - - - -
 - - - 400 400
- - - - -
- - - - -
- - - - -
4 - - 4 15
- - - - -
- - - - -
- - - 12 48
- - - 36 60
- - - - -
- - - - -
- - - 5 17
- - - - -
- - - - -
- - - 400 400
- - - - -
- - - 30 30
- - - 100 200
- - - 100 163
- - - 100 219 1
- - - - -
- - - 100 170
90 - - 90 250 24
- - - - -
- - - 3 8
- - - - -
- - - - -
- - - 4 6
- - - 40 40
- - - 100 125 1
- - - - -
400 - - 400 700 50
- - - - 100
- - - - -
- - - - -
- - - - -
10 - - 10 10
- - - - -
- - - - 10
- - - - -
- - - - -
- - - 50 100
- - - - -
- - - - -
- - - - -
- - - - -

- - - - -
- - - - -
- - - - 40
- -
- -
- - -
10 10 35 10
- - 40
50 50 115 10 10
- - -
30 30 35 10 10
60 60 107 20 20
60 60 119 20 20
- - -
- - 65 2 2
2 2 2
100 100 130 10
- - 315 50 50
100 100 105 10
- - 15 5
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
 - -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
-
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
1 1 1 1
 - -
- -
- -
- -
5 5 5 1 1
- -
- -
- -
1 1 1 1
- -
1 1 1 1
- -
- -
- -
- -
5 5 5 1 1
3 3 3 1 1
- -
- -
2 2 2 1
- -
- -
- -
- -
- -
- -
5 5 5 1 1 1
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
 DOKUMEN NOMOR TANGGAL
NKES KAB/KOTA
FK KAB/KOTA
USKESMAS

Pemakaian Perhari / Tanggal diloket

7
7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

200 100 400 200

50 25 10 30 10 20 20

900 600 300

1200 900

500 500 400 400 400 100 1000 600 600 200 600

20 15 30 10

5 10 5
400 400 400 300 400 800 300 600 400 400

300 400 200 200 200

400 300 200 200

 22 25

200 600

200

20

400 400 400 200 600 400 400 200 200

400

200

200 200
 100

200

400

200

100

24 24

200

100 200

20

24
500 400 400 400 400 600 200 400 400 200 400

10 17 10 10

300 500 500 400 600

24 10
10

200 200 200 200 250 350 100 200 250 250

2 2 1 1 2

10 10 5 5
 60

100 45 50 10 30 20

400 400 800 400 400 1900 400 900 600 500 600 300 400
3

400 200 200 200

100
300 600 400

20

100 300
50

90 180 120 150 60 60 120 180 60

25 5

400

400 400 400 400 400 600 400 200 400

 200 100 100

200 200
10 10
1
1 1

32
50 50 29

100
 100 100 100

50
4
1

7 2

50

25 25
 20 22

12
20 22
20 19

10
50 50 50 65
10 15
5 5
 1 1 1

1 1 1
1

1 1
 Pengeluaran Sub Unit

22 23 24 25 26 27 28 29 30 31 Pustu Pusling poskesdes posyandu

0 0 0 0
0 0 0 0
150 200 0 0
30 0 35 0 0
0 0 0 0
0 0 0 0
0 0 0 0
850 100 750 150 0
360 900 900 50 700 210 0
0 0 0 0
0 0 0 0
400 400 400 800 300 200 500 1300 200 0
0 0 0 0
4 20 10 20 15 10 10 50 11 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
5 10 8 5 27 5 0
300 400 400 400 400 300 200 600 1800 200 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
100 100 0 200 0 0
0 0 0 0
0 0 0 0
0 0 0 0
400 100 200 100 0 300 0 0
 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 50 0 0
0 50 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
25 26 15 27 10 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
200 100 250 100 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
200 150 250 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
200 400 200 200 300 850 100 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
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 50 0 50 0
25 25 25 0 5 5 0
0 0 0 0
0 0 0 0
0 0 0 0
0 100 0 0
0 0 0 0
 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
300 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
100 0 50 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 10 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 280 0 0
0 0 0 0
100 0 20 0 0
16 24 5 22 10 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
500 700 100 0
0 0 0 0
5 19 0 0
50 150 0 0
0 0 0 0
0 0 0 0
0 0 0 0
2 0 10 0 0
0 0 0 0
 0 0 0 0
0 0 0 0
0 0 0 0
200 400 200 200 300 200 500 1900 100 0
0 0 0 0
0 0 0 0
0 0 0 0
100 0 0 0 0
10 15 10 18 10 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1300 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
5 17 0 0
0 0 0 0
0 0 0 0
0 0 0 0
150 200 100 100 150 100 300 750 100 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
1 2 1 1 0 1 0 0
0 0 0 0
15 15 20 16 0 0 0 0
0 0 0 0
17 5 28 10 0
0 0 0 0
0 0 0 0
90 0 0 0 0
 0 0 0 0
0 30 0 0
0 0 0 0
20 45 30 20 40 20 15 65 10 0
0 0 0 0
0 0 0 0
400 600 400 900 400 400 200 400 1600 200 0
5 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
100 500 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
400 200 100 600 750 200 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
200 200 200 200 250 500 100 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
50 100 150 0 0
0 200 0 0
0 5 10 0
0 0 0 0
0 0 0 0
1 0 0 0 0
1 0 0 0 0
0 0 0 0
90 120 120 120 120 120 90 330 60 0
0 0 0 0
11 10 0 5 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
300 900 0 0
0 0 0 0
300 400 400 200 100 200 400 1000 100 0
 0 0 0 0
100 200 100 100 50 200 0 0

0 0 0
0 0 0
12 0 0 0
1 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 4000
0 0 0 500
0 0 0
200 0 0 0
90 0 0 0
0 0 0
250 0 0 0
0 0 0
0 0 0
162 0 0 0
0 0 0
0 0 0
300 0 0 0
0 0 0
400 0 0 0
300 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 10 0
0 0 0
 100 0 0 0
0 0 0
0 0 0
0 0 0
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
30 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 0 0 0
1 0 0 0
0 0 0
50 50 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1 0 0 0
0 0 0
0 0 0
25 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0

0 0 0
0 0 0
0 0 0
uaran Sub Unit Jumlah Stok
Pengeluaran AkhirBulan
8 9
igd vk (1+ s.d31 + sub unit) (6-8)
0 0
0 0
1250 1250
280 70
0 0
0 0
0 0
4550 5400
6420 7500
0 0
0 0
500 12800 6000
0 0
345 255
0 177
0 0
0 0
0 0
0 0
130 50
12500 7700
0 0
0 0
0 0
0 0
0 0
0 0
20 28 30
0 0
0 0
2600 200
200 1180
0 0
0 0
100 2300 700
20 5 25 5
80 80 0
0 0
0 0
0 0
50 350
50 550
0 90
0 0
0 0
0 0
0 0
225 60
0 0
0 0
0 0
0 0
0 0
0 0
1650 750
0 0
0 0
0 0
0 0
0 0
800 450
0 0
0 0
27 90
0 0
6550 1050
0 0
0 0
0 0
0 10
0 72
0 0
0 0
400 800
0 0
0 0
400 250
85 15
0 0
0 0
0 0
500 2200
0 0
 0 0
0 0
0 0
0 0
0 0
0 0
0 0
400 200
0 0
0 0
0 0
550 1150
0 0
0 600
0 0
12 178
0 0
0 177
0 0
0 0
0 0
0 0
600 1600
0 0
0 0
600 1000
0 0
40 40 0
580 320
0 0
120 80
197 129
0 0
0 0
0 0
0 0
400 900
60 60 0
0 95
1981 4050
0 0
74 106
200 800
0 0
0 0
24 80
12 88
0 0
 0 200
0 400
0 0
9800 6200
0 0
0 0
0 0
100 50
145 140
0 0
0 0
0 0
0 0
100 100 0
0 0
0 0
0 0
0 0
20 20 28
0 0
4500 4100
0 0
0 0
0 500
0 0
0 0
0 0
0 0
0 0
0 0
73 91
17 113
0 0
0 0
4250 1000
40 40 0
50 50 150
0 100
0 0
0 0
14 1
0 0
139 0
0 0
60 784
3 247
26 30 30
180 0
 30 30 55
150 270
0 0
810 180
0 0
0 0
200 15600 4800
8 16
0 0
0 0
0 0
600 1400
0 0
0 0
3 3
0 0
0 0
3250 5350
0 0
0 0
0 0
0 0
100 250 0
3750 750
0 0
220 100 380 120
0 0
0 0
900 400
250 1050
15 57
0 0
0 0
5 1
3 7
0 0
2490 900
0 0
56 19
0 0
0 0
0 0
0 0
0 0
0 0
1600 4300
0 0
8000 1000
 0 0
1250 400
0 0
0 0
400 0
32 13
2 0
2 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
4000 0
500 0
0 9000
200 235
90 0
0 30
250 250
0 0
0 0
162 342
0 0
0 5
300 215
0 0
400 55
300 13
0 75
6 6 120
0 106
0 84
52 611
129 568
0 0

0 0
0 0
100 50 409 191
0 0
0 0
0 0
190 50 450 550
0 0
 28 128 272
0 0
0 0
0 0
1 3 12
0 0
0 0
12 12 24 24
24 24 36
0 0
0 0
7 10 17 0
0 0
0 0
100 400 0
0 0
10 10 20 10
50 100 100
109 25 138 25
38 29 69 150
0 0
20 20 150
37 30 130 120
0 0
0 8
0 0
0 0
1 1 2 4
1 39
24 25 56 69
0 0
100 50 300 400
50 100 0
0 0
0 0
0 0
5 5 5
0 0
1 9
0 0
0 0
25 100 0
0 0
0 0
0 0
0 0

0 0
 0 0
20 10 30 10
0 0
0 0
0 0
10 25
0 40
62 53
0 0
32 3
82 25
79 40
0 0
4 61
0 2
20 110
315 0
35 70
15 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 0
0 0
0 0
0 0
0 0
5 0
0 0
0 0
0 0
1 0
0 0
1 0
0 0
0 0
0 0
0 0
5 0
3 0
0 0
0 0
2 0
0 0
0 0
0 0
0 0
0 0
0 0
5 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 : FEBRUARI 2020
PROVINSI : BANTEN PERMINTAAN BULAN / PERIODE : MARET 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 - 2,500 2,500 1,250 1,250
4 Ambroxol sirup Botol 50 300 350 280 70
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 3,950 6,000 9,950 4,550 5,400
9 Amlodipin Besilate 5 mg Tablet 4,920 9,000 13,920 6,420 7,500
10 Amoksisilin Forte sirup kering 250mg Botol - - - - -
11 Amoksisilin Injeksi 1 gr Vial - - - - -
12 Amoksisilin Tablet 500 mg Tablet 5,800 13,000 18,800 12,800 6,000
13 Amoksisillin kapsul 250 mg Kapsul - - - - -
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol - 600 600 345 255
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 80 100 180 130 50
21 ANTASIDA DOEN Tablet Tablet 10,200 10,000 20,200 12,500 7,700
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 8 50 58 28 30
29 Artermeter injeksi Ampul - - - - -
30 Artesunate injeksi 60 mg/ml vial - - - - -
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 1,200 1,600 2,800 2,600 200
32 Asam Folat Botol 380 1,000 1,380 200 1,180
33 Asam Fusidat Cream Tube - - - - -
34 Asam Klorida 0,1 N Botol - - - - -
35 Asam Mefenamat 500 mg Tablet - 3,000 3,000 2,300 700
36 Asam Traneksamat Inj 5% Ampul 30 - 30 25 5
37 Asering Botol - 80 80 80 -
38 Asetosal tablet 500 mg Tablet - - - - -
39 Asetyl Cysteine Capsul - - - - -
40 Asiklovir Cream 5% Tube - - - - -
41 Asiklovir tablet 200 mg Tablet 100 300 400 50 350
42 Asiklovir tablet 400 mg Tablet 600 - 600 50 550
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 Betametason krim 0,1 % Tube 160 125 285 225 60
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 400 2,000 2,400 1,650 750
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 550 700 1,250 800 450
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 37 80 117 27 90
65 D-Artepp tablet Tablet - - - - -
66 Deksametason tablet 0,5 mg Tablet 600 7,000 7,600 6,550 1,050
67 Dekstran 70 - larutan infus 6% steril Botol - - - - -
68 Dekstrometorfan sirup Botol - - - - -
69 Dekstrometorfan tablet 15 mg Tablet - - - - -
70 Diazepam Rektal 0,5 mg / 2 ml supp 10 - 10 - 10
71 Diazepam tablet 2 mg Tablet 72 - 72 - 72
72 Diazepam tablet 5 mg Tablet - - - - -
73 Difenhidramin HCL injeksi 10 mg/ml - 1ml Ampul - - - - -
74 Digoksin tablet 0,25 mg Tablet 200 1,000 1,200 400 800
75 Diltiazem Tablet - - - - -
76 Doksisiklin Kapsul 100 mg Capsul - - - - -
77 Domperidon 10mg Tablet Tablet 650 - 650 400 250
78 Domperidon Suspensi 5 mg/ 5 ml Botol - 100 100 85 15
79 Doxicyclin 500mg capsul - - - - -
80 Efedrin HCLTablet 25 mg Tablet - - - - -
81 Epinefrina HCL/Bitartrat Injeksi Ampul - - - - -
82 Eritromicyn kapsul 250 mg capsul 1,700 1,000 2,700 500 2,200
83 Erytromicin kapsul 500 mg Kapsul - - - - -
84 Erytromicin sirup 125 mg Botol - - - - -
85 Etakridin ( Rivanol ) larutan 0,1% Botol - - - - -
86 Etambutol 500 mg Tablet - - - - -
87 Etanol 70 % Botol - - - - -
88 Etil Klorida Semprot Botol - - - - -
89 Fenitoin Natrium kapsul 30 mg Kapsul - - - - -
90 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul - - - - -
91 Fenobarbital tablet 30 mg Tablet 600 - 600 400 200
92 Fenoksimetil Penisilina tablet 250 mg Tablet - - - - -
93 Fenol Gliserol tetes telinga 10 % Botol - - - - -
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul - - - - -
95 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 700 1,000 1,700 550 1,150
96 Flufenazine Deconat Inj 25 mg/ml Ampul - - - - -
97 Furosemida tablet 40 mg Tablet - 600 600 - 600
98 Furosemide Injeksi Ampul - - - - -
99 Garam Oralit Sachet 90 100 190 12 178
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 200 2,000 2,200 600 1,600
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet - - - - -
108 Glikazid 80 mg Tablet Tablet - - - - -
109 Glimepiride 2 mg Tablet 600 1,000 1,600 600 1,000
110 Glukosa larutan infus 10% steril Botol - - - - -
111 Glukosa larutan infus 5 % steril Botol 20 20 40 40 -
112 Griseofulvin tablet 500 mg, Tablet 900 - 900 580 320
113 Guaiafenesin 100 mg Tablet - - - - -
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet 200 - 200 120 80
115 Hidrokortison krim 2,5% Tube 206 120 326 197 129
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 800 500 1,300 400 900
121 KAEN 3B Infus Botol 20 40 60 60 -
122 Kalsium Glukonas Injeksi Ampul 47 48 95 - 95
123 Kalsium Laktat (Kalk) tablet 500 mg Tablet 4,031 2,000 6,031 1,981 4,050
124 Kapas Berlemak 500 mg Bungkus - - - - -
125 Ketokonazol Kream Tube 80 100 180 74 106
126 Ketokonazol Tablet 200 mg Tablet - 1,000 1,000 200 800
127 Ketorolac inj Ampul - - - - -
128 Kifadene tablet 20 mg Tablet - - - - -
129 Kloramfenikol salep mata 1 % capsul 8 96 104 24 80
130 Kloramfenikol suspensi Botol 100 - 100 12 88
131 Kloramfenikol tetes telinga 3% Tube - - - - -
132 Kloramphenicol 250 mg Capsul 200 - 200 - 200
133 Kloramphenicol 500 mg capsul 400 - 400 - 400
134 Kloramphenicol Tetes Mata Botol - - - - -
135 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 8,000 8,000 16,000 9,800 6,200
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 150 - 150 100 50
140 Kotrimoksazol Sirup / Suspensi Botol 85 200 285 145 140
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 - 100 100 100 -
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 28 20 48 20 28
151 Metamizol 500 mg Tablet - - - - -
152 Metformin 500 mg Tablet Tablet 6,100 2,500 8,600 4,500 4,100
153 Methilprednisolon tablet 4 mg Tablet - - - - -
154 Metilergometrin Maleat injeksi 1 ml Ampul - - - - -
155 Metilergometrin Maleat Tablet Tablet - 500 500 - 500
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 68 96 164 73 91
163 Multivitamin Anak Sirup Botol 30 100 130 17 113
164 Multivitamin Dewasa Antioksidan ( Becom c ) Tablet - - - - -
165 Natrium Diklofenak 25 mg Tablet Tablet - - - - -
166 Natrium Diklofenak 50 mg Tablet Tablet 5,250 - 5,250 4,250 1,000
167 Natrium Klorida Cairan Infus ( NaCL ) Botol - 40 40 40 -
168 Nifedipine Tablet 10 mg Tablet 200 - 200 50 150
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 - - - - -
172 Obat Batuk Flu ( Molexflu ) Tablet - 15 15 14 1
173 Obat Batuk Hitam (OBH) Botol - - - - -
174 Obat Batuk Sirup Herbal ( Herbacop ) Botol 43 96 139 139 -
175 Ofloxsacin Tetes Telinga Tube - - - - -
176 Oksitetrasiklin HCL salep mata 1% Botol - 844 844 60 784
177 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 150 100 250 3 247
178 Omeprazol injeksi Ampul 60 - 60 30 30
179 Omeprazol Kapsul 20 mg capsul 180 - 180 180 -
180 Ondancentron injeksi 4 mg Ampul 45 40 85 30 55
181 Ondancentron Tablet4 mg Tablet 120 300 420 150 270
182 Paracetamol Drop 15 ml Botol - - - - -
183 Paracetamol Sirup 120 mg/5 ml Botol 490 500 990 810 180
184 Parafin Dresing ( Bioplacenton Tull ) pcs - - - - -
185 Parasetamol tablet 100 mg Tablet - - - - -
186 Parasetamol tablet 500 mg Tablet 400 20,000 20,400 15,600 4,800
187 Permetrin Krim 5 % Tube - 24 24 8 16
188 Pirantel Sirup Botol - - - - -
189 Pirantel tablet 125 mg Tablet - - - - -
190 Pirazinamid Botol - - - - -
191 Piridoksin HCL (VIT B6) tablet 10mg Botol - 2,000 2,000 600 1,400
192 Piroksikam tablet 20 mg Tablet - - - - -
193 Polikresulen Tube - - - - -
194 Povidon lodida 10% 300 ml - 3 3 3 -
195 Povidon lodida 10% 60 ml Tablet - - - - -
196 Prazikuantel tablet 600 mg Botol - - - - -
197 Prednison Tablet 5 mg Tablet 600 8,000 8,600 3,250 5,350
198 Primakuin 15 mg Tablet - - - - -
199 Probenesid 500 mg tablet Tablet - - - - -
200 Prokain Benzil Penisilin 3 juta IU/vial injeksi Ampul - - - - -
201 Propanolol HCL tablet 10 mg Tablet - - - - -
202 Ranitidin injeksi Ampul 50 200 250 250 -
203 Ranitidin tablet Tablet 2,500 2,000 4,500 3,750 750
204 Resperidone 2 mg tablet Tablet - - - - -
205 Ringer Laktat cairan infus (Otsuka) 500 - 500 380 120
206 Ringer Laktat cairan infus (Widatra) Botol - - - - -
207 Rivanol 300 ml Botol - - - - -
208 Salbutamol Tablet 2 mg Tablet 300 1,000 1,300 900 400
209 Salbutamol tablet 4mg Tablet 300 1,000 1,300 250 1,050
210 Salep 2-4 Tube - 72 72 15 57
211 Salep kombinasi cream ( Berloson ) Tube - - - - -
212 Salicil bedak Kotak - - - - -
213 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial 6 - 6 5 1
214 Serum Anti Tetanus inj 1500 IU ( Tetagam ) Vial 10 - 10 3 7
215 Sianokobalamin Injeksi Ampul - - - - -
216 Simvastatin 10 mg tablet Tablet 990 2,400 3,390 2,490 900
217 Simvastatin 20 mg tablet Tablet - - - - -
218 Sukralfat Suspensi Botol 50 25 75 56 19
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 5,900 - 5,900 1,600 4,300
226 Ventolin Nebulizer Ampul - - - - -
227 Vitamin B komplek Tablet 5,000 4,000 9,000 8,000 1,000
228 Zink sirup Botol - - - - -
229 Zink tablet 20 mg Tablet 150 1,500 1,650 1,250 400
OBAT PROGRAM - - - - -
1 Albendazol Tablet 400 mg Tablet - - - - -
2 Isoniazid Tablet 100 mg Tablet 200 200 400 400 -
3 Obat Antituberkulosis kategori 1 Paket 13 32 45 32 13
4 Obat Antituberkulosis Kategori 2 Paket - 2 2 2 -
5 Obat Antituberkulosis Kategori Anak Paket - 2 2 2 -
6 Pot Dahak Non Steril Biji - - - - -
7 Pot Dahak Steril Biji - - - - -
8 Reagen Ziehl Neelsen Kit - - - - -
9 MDT MB Anak Tablet Tablet - - - - -
10 MDT MB Dewasa Tablet Tablet - - - - -
11 MDT PB Dewasa Tablet Tablet - - - - -
12 MDT PB Anak Tablet Tablet - - - - -
13 Retinol (Vitamin A) kapsul 200.000 IU capsul - 4,000 4,000 4,000 -
14 Retinol (Vitamin A) kapsul 100.000 IU capsul - 500 500 500 -
15 Tablet Penambah Darah ( FE ) Tablet - 9,000 9,000 - 9,000
16 Amitriptilin tablet 25 mg Tablet 435 - 435 200 235
17 Carbamazepin 200 mg tablet Tablet 90 - 90 90 -
18 Clobazam 10 mg Tablet Tablet 30 - 30 - 30
19 Clozapine 25 mg Tablet Tablet 500 - 500 250 250
20 Fenitoin Natrium kapsul 30 mg capsul - - - - -
21 Haloperidol 1,5 mg Tablet Tablet - - - - -
22 Haloperidol 2 mg tablet Tablet 504 - 504 162 342
23 Haloperidol 5 mg Tablet Tablet - - - - -
24 Haloperidol Injeksi Ampul 5 - 5 - 5
25 Klorpromazin HCL tablet salut 100 mg Tablet 515 - 515 300 215
26 Klorpromazine Tablet 25 mg Tablet - - - - -
27 Triheksilfenidil Hcl 2 mg tablet Tablet 155 300 455 400 55
28 Risperidone 2 mg tablet Tablet 13 300 313 300 13
29 Divalproexsodium Tablet 75 - 75 - 75
Diazepam injeksi (program) - 126 6 120
Magnesium Sulfat Inj. 25 ml 40 % (program) - 106 - 106
Kalsium Glukonas Injeksi - 84 - 84
Oksitosin injeksi 10 IU/ml - 1 ml 663 52 611
Metilergometrin Maleat injeksi 1 ml 697 129 568
Dehydro Artemisin 40 mg + Piperaquin 320 mg (DHP)
Primakuin tablet 15 mg
Masker karet ear loop hijab
Masker N 95
- - - - -
NAMA BAHAN MEDIS HABIS PAKAI (BMHP )
B - - - - -
1 Alat suntik 1 ml Pcs 400 200 600 409 191
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) 600 400 1,000 450 550
6 Alat suntik 3 ml Pcs - - - - -
7 Alat suntik 5 ml pcs - 400 400 128 272
8 Alkazide 1 L High Level Desinfectant Botol - - - - -
9 Alkazyme Sachet 25 mg Pack - - - - -
10 Alkohol 70 % 1 L Botol - - - - -
11 Alkohol swab Sachet 11 4 15 3 12
12 Anti Septik Hand Rub Botol - - - - -
13 Anti Septik Surgikal Hand Scrub Botol - - - - -
14 Cat Gut no 2/0 Sachet 36 12 48 24 24
15 Cat Gut no 3/0 Sachet 24 36 60 24 36
16 Cat Gut No 3/0 (24 mm) Sachet - - - - -
17 Cat Gut No 3/0 (26 mm) Sachet - - - - -
18 Cathetter Jelly Biji 12 5 17 17 -
19 Demetech Silk 3/0 Set - - - - -
20 E Care I.V Dresing Pcs - - - - -
21 E-Care Surgical Mask Tie On Lembar - 400 400 400 -
22 Folly No 14 Catether pcs - - - - -
23 Folly No 16 Catether pcs - 30 30 20 10
24 I.V Cathetter No. 20 Set 100 100 200 100 100
25 I.V Cathetter No. 22 Set 63 100 163 138 25
26 I.V Cathetter No. 24 Set 119 100 219 69 150
27 I.V Cathetter No. 26 Set - - - - -
28 Infuset Anak Set 70 100 170 20 150
29 Infuset Dewasa Set 160 90 250 130 120
30 Jarum Insulin Tablet - - - - -
31 Kapas Berlemak 250 gr Bungkus 5 3 8 - 8
32 Kapas Berlemak 500 gr Bungkus - - - - -
33 Kasa 4 m x 10 cm Rol - - - - -
34 Kasa Hidrofil 36 x 80 cm Rol 2 4 6 2 4
35 Kasa Pembalut 2 x 80 cm Pack - 40 40 1 39
36 Kasa Steril 16 x 16 cm Kotak 25 100 125 56 69
37 Lisol 1 L Botol - - - - -
38 Masker karet Ear Loop Lembar 300 400 700 300 400
39 Masker tali Tube 100 - 100 100 -
40 Nasal Canula Oksigen Set - - - -
41 Plester 1" Rol - - - - -
42 Plester Kertas 2,5 cm Rol - - - - -
43 Plester Non Woven 5cm x 5 cm Rol - 10 10 5 5
44 Policlean Botol - - - - -
45 Polifik Kotak 10 - 10 1 9
46 Saraya Alsof A 500 ml Botol - - - - -
47 Saraya Alsof Pure 500 ml Botol - - - - -
48 Sarung Tangan Gynecolog No 7 Pasang 50 50 100 100 -
49 Sarung tangan M (Non Steril) Pasang - - - - -
50 Sarung tangan no 6,5 Pasang - - - - -
51 Sarung tangan no 6,5 Steril Gloves Pasang - - - - -
52 Sarung tangan no 7,0 Steril Pasang - - - - -

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

54 Underpad Lembar - - - - -
55 Urine Bag Biji 40 - 40 30 10
- - - - -
NAMA OBAT VAKSIN

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

2 Vaksin BCG Vial 28 10 35 10 25
3 Vaksin DT Vial 40 - 40 - 40
4 Vaksin HB 0 Pcs 52 50 115 62 53
5 Vaksin HBIG Vial - - - - -
6 Vaksin Measless Rubella (MR) Vial 17 30 35 32 3
7 Vaksin Pentabio ( DPT - HB - Hib ) Vial 40 60 107 82 25
8 Vaksin Polio B OPV Vial 50 60 119 79 40
9 Vaksin Polio IPV Vial - - - - -
10 Vaksin TD Vial 70 - 65 4 61
11 Vaksin Tuberculin Vial - 2 2 - 2
12 ADS 0,05 ml Unit 50 100 130 20 110
13 ADS 0,5 ml Unit 560 - 315 315 -
14 ADS 5 ml Unit 37 100 105 35 70
15 Safety Box Unit 20 - 15 15 -
- - - - -
- - - - -
- - - - -
NAMA OBAT REAGEN
- - - - -
1 Albumin (Reagen) Kotak - - - - -
2 anti A Monoclonal ( GolDar 10 ml) Vial - - - - -
3 Anti A-B Monoclonal ( GolDar 10 ml) Vial - - - - -
4 Anti B Monoclonal ( GolDar 10ml) Vial - - - - -
5 Anti D Monoclonal ( GolGar 10ml) Vial - - - - -
6 Benecheck Plus Cholesterol Test Strip - - - - -
7 Benecheck Plus Glukosa Test Strip - - - - -
8 Benecheck Plus Uric Test Strip - - - - -
9 Bilirubin T/D (Reagen) Kotak - - - - -
10 Brilian Green Bile Broth Kotak - - - - -
11 Cellclean (CL-50) (Reagen) Kotak - - - - -
12 Cellpack (PK-30L) (Reagen) Kotak - - - - -
13 Chikungunya IgM (Reagen) Kotak - - - - -
14 Cholesterol (Reagen) Kotak - - - - -
15 Cholesterol Stik (Reagen) Kotak - - - - -
16 CK-MB (Reagen) Kotak - - - - -
17 Creatinin Reagen Kit - - - - -
18 Dengue IgM / IgM ( Reagen ) Kotak - - - - -
19 Eight Check ( LNH ) Serial - - - - -
20 Febrile Antingen H Parathpy Vial - - - - -
21 Febrile Antingen H-A Parathpy Vial - - - - -
22 Febrile Antingen H-B Parathpy Vial - - - - -
23 Febrile Antingen H-C Parathpy Vial - - - - -
24 Febrile Antingen O Parathpy Vial - - - - -
25 Febrile Antingen O-A Parathpy Vial - - - - -
26 Febrile Antingen O-B Parathpy Vial - - - - -
27 Febrile Antingen O-C Parathpy Vial - - - - -
28 Glukosa Reagen Kotak - - - - -
29 GOT ( ALAT ) Kotak - - - - -
30 GPT ( ALAT ) Kotak - - - - -
31 HBSAG Reagen Box - - - - -
32 HCG Strip Vial - - - - -
33 HDL Cholesterol ( Precipitan ) Kotak - - - - -
34 Hematologi Calibrator (Nscs 1000 ) Botol - - - - -
35 Hemoglobin Reagen Kotak - - - - -
36 Lactose Broth 500 mg Botol - - - - -
37 LDL Cholesterol Kotak - - - - -
38 Leptospira IgM (Reagen) Kotak - - - - -
39 Micropippets MT-1-up to 200 ui Pcs - - - - -
40 MIcropippets MT-up to 1 ml Pcs - - - - -
41 NS1 Antigen Test (Reagen) Kotak - - - - -
42 Pipet Ukur 10 ml biji - - - - -
43 Poch Pack D (II) Reagen Kotak - - - - -
44 Poch Pack L (II) Reagen Kotak - - - - -
45 Stik Uric Acid Kotak - - - - -
46 Strip Narkoba 3 Parameter Kotak - - - - -
47 Strip Narkoba 5 Parameter Kotak - - - - -
48 Strip Narkoba 6 Parameter Kotak - - - - -
49 Total Protein Kotak - - - - -
50 Trigleserida Kotak - - - - -
51 Urea Kotak - - - - -
52 Uric Acid Kotak - - - - -
NAMA OBAT REAGEN PROGRAM HIV - - - - -
1 Rapid 1 HIV (SD Bioline ) Tes
2 Rapid 2 HIV (Fokus ) Tes
3 Rapid 3 HIV (Biomeriux Vikia ) Tes
4 SD Biosensore Standart Q Syphlis Tes
5 RPR Syphlis ( Fokus ) Tes
6 Reagen CD4 Control Tes
7 Reagen CD4 Mobile Tes
8 RPR Syphlis Komponen Kit
9 Anuscopy Buah
10 Kertas PH Indikator Buah
11 Rotator Buah
12 Tip. Uk.60 Bks
13 Tip. Uk.61 Bks
14 Pronto / Holder Buah - - - - -
- - - - -
NAMA OBAT GIGI
- - - - -
1 Anastesi Citojek Box - - - - -
2 Articulating Paper (Kertas warna penanda oklusi) Kotak - - - - -
3 Bahan Tumpatan sementara Botol - - - - -
4 Bonding Syringe - 1 1 1 -
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 - 5 5 5 -
10 Composite Nanohibrid A2 Tube - - - - -
11 Composite Nanohibrid A3 Tube - - - - -
12 Composite Nanohibrid A3,5 Tube - - - - -
13 Devitalisasi Pasta Pot - 1 1 1 -
14 Disclosing Solution Botol - - - - -
15 Etcing Gel Pcs - 1 1 1 -
16 Etil Klorida Semprot Botol - - - - -
17 Eugenol Cairan Botol - - - - -
18 Formokesol Botol - - - - -
19 Gas Powred Jet Injector Botol - - - - -
20 Glass Ionomer Cement ART Pot - 5 5 5 -
21 Jarum citojek uk 16 mm Box - 3 3 3 -
22 Kalsium Hidroksida pasta Botol - - - - -
23 Klorhekdidin Larutan 2 % Botol - - - - -
24 Mummifiying Fasta Botol - 2 2 2 -
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 - 5 5 5 -
32 Tooth Stain Remover ( TSR ) Botol - - - - -
33 Wipes Desinfektan Botol - - - - -
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RAWAT
JUMLAH KUNJUNGAN PUSKESMAS JALAN
RAWAT INAP JUMLAH

UMUM / BAYAR 2755

UMUM / TIDAK BAYAR 36
JKN 2038
TOTAL KUNJUNGAN 4829
 Mengetahui / Menyetujui
KEPALA DINAS KESEHATAN YANG MENYERAHKAN YANG MEMINTA
KABUPATEN PANDEGLANG KEPALA UPT. GUDANG FARMASI KEPALA PUSKESMA

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

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

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

9 10 11 12 13 14 15 16

-
-
1,500 2500
336 350
- 2500
-
-
5,460 5000
7,704 5000
-
-
15,360 10,000
-
414 300
-
-
-
-
-
156 250
15,000 10000
-
-
-
-
-
-
34 50
-
-
3,120 3000
240 500
-
-
2,760 4000
30 35
96 100
-
- 6240
- 100
60
60
- 100
-
-
-
- 50
 270 300
-
-
- 200
-
-
- 5
1,980 2000
- 1000
-
-
-
- 100
960 700
-
-
32 40
-
7,860 10000
-
-
-
- 5
-
-
-
480 200
-
-
480 1000
102 150
-
-
- 200
600
-
-
-
-
- 10
-
-
-
480
-
- 100
- 100
660
-
- 200
- 200
14
- 1000
-
- 200
- 100
- 50
-
720
- 3000
 -
720
- 40
48 100
696 500
- 3000
144
236 120
- 100
- 3000
-
- 100
480
72 100
-
2,377
-
89 100
240 200
-
-
29 144
14
- 125
- 200
-
- 100
11,760 10000
-
-
-
120 1200
174 300
-
-
- 100
-
120 200
-
-
- 1000
- 50
24 24
-
5,400 5000
- 5000
-
- 500
-
-
- 500
-
- 50
- 50
88 96
20
- 500
-
5,100 5000
48 100
 60 200
-
-
- 2000
17 4500
-
167 192
- 100
72
4
36 30
216 330
36 40
180 270
-
972 1000
-
-
18,720 20000
10 10
-
-
-
720 2000
- 2000
-
4 10
- 10
-
3,900 1000
-
-
-
-
300 600
4,500 5000
-
456 400
-
-
1,080 1000
300
18 120
-
- 50
6 10
4 10
-
2,988 3600
- 1500
67 100
-
-
-
-
-
-
1,920
- 40
9,600 10000
 - 100
1,500 2000
-
-
480
38
2
2
-
-
-
-
-
-
-
4,800
600
-
240
108
-
300
-
-
194
-
-
360
-
480
360
-
7
-
-
62
155

-
-
491 600
-
-
-
540 500
-
154 400
-
-
- 10
4 800
- 10
-
29 24
29 36
-
-
 20 15
- 24
-
480
- 48
24 48
120 200
166 250
83 100
- 100
24
156 100
-
- 3
-
-
2 5
1 40
67 100
-
360 400
120 1000
- 10
- 10
- 10
6 10
-
1 5
-
-
120 50
- 1000
-
- 50
- 50

- 30
- 50
36 60
-
-

12
-
74
-
38
98
95
-
5
-
24
378
42
18
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1
-
-
-
-
6
-
-
-
1
-
1
-
-
-
-
6
4
-
-
2
-
-
-
-
-
-
6
-
-
-
-
-
-
-

Harap Dilampirkan : 1. LB 1

2. Lap. Psikotropika & Narkotika

3. Lap. Pemakaian Serum ABU
4. Lap. 20 Pemakaian Obat Terbanyak
 YANG MEMINTA YANG MEMINTA :
KEPALA PUSKESMAS PETUGAS OBAT PUSKESMAS

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