LAPORAN BULANAN PENGGUNAAN ATS

PUSKESMAS CIMANUK
MENU BULAN : JULI 2020

PENGGUNAAN
STOK JUMLAH
NO PENERIMAAN NAMA
AWAL PERSEDIAAN UMUR ALAMAT
PASIEN
1 19 19

JUMLAH

Kepala UPT Puskesmas DTP cimanuk

dr. Rita Permatasari

NIP : 19810920 200902 2 002
NAAN ATS
K

PENGGUNAAN
SISA
KET
JUMLAH PETUGAS STOK

19
0
0
0

19 19

Cimanuk, 3 Agustus 2020

Pengelola obat

Deden Arditia Nurjaman S.si.,Apt

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

PENGGUNAAN
STOK JUMLAH
NO PENERIMAAN NAMA
AWAL PERSEDIAAN UMUR ALAMAT
PASIEN
1 2 5 7 Farhan 30 Garokgek
6 Idamim 45 Mengger

MENU

JUMLAH

Kepala UPT Puskesmas DTP cimanuk

dr. Rita Permatasari

NIP : 19810920 200902 2 002
 NAAN ABU
UK

NGGUNAAN
SISA
KET
JUMLAH PETUGAS STOK

1 Dewika 6
1 Jaja 5

5 5

Cimanuk, 3 Agustus 2020

Pengelola obat

Deden Arditia Nurjaman S.si.,Apt

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

2 Amitriptilin 25 mg 300 300 600 300 300

3 Carbamazepine 200 mg 200 300 500 300 200

Chlorpromazine hcl 100

4 415 415 415 0
mg

5 Clobazam 10 mg 0 0 0 0

6 Clozapine 25 mg 0 0 0 0

7 Diazepam injeksi 80 80 0 80

Diazepam Rektal 0,5 mg

8 8 8 2 6
/ 2 ml

9 Divalproexsodium 0 0 0 0

10 Fluoksetin 10 mg 0 0 0 0

Fluphenazine decanoat
11 15 15 0 15
inj 25 mg

12 Haloperidol 1,5 mg 0 0 0 0

13 Haloperidol 2 mg 100 100 100 0

Haloperidol decanoat inj

14 0 0 0 0
50 mg

15 Imipramicine hcl 25 mg 0 0 0 0

16 Phenobarbital 30 mg 200 200 0 200

17 Risperidon 2 mg 400 400 800 500 300

18 Shizonat injek 0 0 0 0

Trifluouperazine HCl 5
19 0 0 0 0
mg

20 Trihexipenidil 2 mg 0 0 0 0

Cimanuk, 2 Agustus 2020

Kepala UPT Puskesmas DTP cimanuk Pengelola obat
 dr. Rita Permatasari Deden Arditia Nurjaman S.si.,Apt
NIP : 19810920 200902 2 002 NIP : 19861213 201101 1 005
 DAFTAR
10 BESAR PEMAKAIAN OBAT TERBANYAK
PUSKESMAS CIMANUK
BULAN JULI TAHUN 2020

NO NAMA OBAT SATUAN JUMLAH

1 Amoksilin 500 mg tab 7600
2 Vitamin B komplek tab 6800
3 Deksametason tablet tab 5500
4 Metformin tab 5400
5 Ranitidin tab 5000
6 CTM tab 5000
7 Amlodipin 10 mg tab 4200
8 Amlodipin 5 mg tab 4200
9 Piridoksin (Vitamin B6) tab 3600
10 Natrium Diklofenak 50 mg tab 2550

Cimanuk, 2 Agustus 2020

Kepala UPT Puskesmas DTP cimanuk Pengelola obat

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

NIP : 19810920 200902 2 002 NIP : 19861213 201101 1 005
 LAPORAN PEMAKAIAN DAN LEMBAR PERM
PUSKESMAS
PUSKESMAS : CIMANUK
KECAMATAN : CIMANUK
KAB / KOTA : PANDEGLANG PELAPORAN BULAN / PERIODE : JULI 2020
PROVINSI : BANTEN

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

1 Alprazolam Tablet -
2 Albendazol Tablet 400 mg Tablet -
3 Allopurinol tablet 100 mg Tablet 200
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 10,500 6,000
9 Amlodipin Besilate 5 mg Tablet 6,900
10 Amoksisilin Forte sirup kering 125mg Botol -
11 Amoksisilin Injeksi 1 gr Vial -
12 Amoksisilin Tablet 500 mg Tablet 12,800 10,000
13 Amoksisillin kapsul 250 mg Kapsul -
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol -
15 Ampisilin Injeksi 1 gr Vial 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 -
21 ANTASIDA DOEN Tablet Tablet 17,000 3,000
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 60 60
29 Artermeter injeksi Ampul -
30 Artesunate injeksi 60 mg/ml vial -
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 3,900 1,000
32 Asam Folat Botol 400
33 Asam Fusidat Cream Tube -
34 Asam Klorida 0,1 N Botol -
35 Asam Mefenamat 500 mg Tablet -
36 Asam Traneksamat Inj 5% Ampul -
37 Asering Botol 120
38 Asetosal tablet 500 mg Tablet -
39 Asetyl Cysteine Capsul 7,800
40 Asiklovir Cream 5% Tube -
41 Asiklovir tablet 200 mg Tablet 200
42 Asiklovir tablet 400 mg Tablet 450
43 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul -
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 36 48
48 Betametason krim 0,1 % Tube 227 100
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 2,300 500
56 Captopril Tablet 25 mg Tablet -
57 Cefadroxil Capsul 500 mg Capsul -
58 Cefixime Capsul 100 mg Capsul -
59 Cefixime Sirup Botol -
60 Cefotaksime 1 gr Injeksi Vial -
61 Cetirizine Capsul 50 mg Capsul 2,000 500
62 Cetirizine sirup 5 mg/5 ml Botol -
63 Ciprofloxcacin 500 mg tablet Tablet -
64 Combivent UDV 2,5 mg+0,5mg/2,5 ml Ampul 240
65 D-Artepp tablet Tablet -
66 Deksametason tablet 0,5 mg Tablet 4,100 5,000
67 Dekstran 70 - larutan infus 6% steril Botol -
68 Dekstrometorfan sirup Botol -
69 Dekstrometorfan tablet 15 mg Tablet -
70 Diazepam Rektal 0,5 mg / 2 ml supp 8
71 Diazepam tablet 2 mg Tablet -
72 Diazepam tablet 5 mg Tablet -
73 Difenhidramin HCL injeksi 10 mg/ml - 1ml Ampul -
74 Digoksin tablet 0,25 mg Tablet 800
75 Diltiazem Tablet -
76 Doksisiklin Kapsul 100 mg Capsul -
77 Domperidon 10mg Tablet Tablet 1,200
78 Domperidon Suspensi 5 mg/ 5 ml Botol 150
79 Doxicyclin 500mg capsul -
80 Efedrin HCLTablet 25 mg Tablet -
81 Epinefrina HCL/Bitartrat Injeksi Ampul -
82 Eritromicyn kapsul 250 mg capsul 1,800
83 Erytromicin kapsul 500 mg Kapsul -
84 Erytromicin sirup 125 mg Botol -
85 Etakridin ( Rivanol ) larutan 0,1% Botol -
86 Etambutol 500 mg Tablet -
87 Etanol 70 % Botol -
88 Etil Klorida Semprot Botol -
89 Fenitoin Natrium kapsul 30 mg Kapsul -
90 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul -
91 Fenobarbital tablet 30 mg Tablet 200
92 Fenoksimetil Penisilina tablet 250 mg Tablet -
93 Fenol Gliserol tetes telinga 10 % Botol 24 48
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul -
 95 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 1,500
96 Flufenazine Deconat Inj 25 mg/ml Ampul 15
97 Furosemida tablet 40 mg Tablet 1,000
98 Furosemide Injeksi Ampul -
99 Garam Oralit Sachet -
100 Gemfibrozil 300 mg Tablet -
101 Gentamicin Injeksi Ampul 177
102 Gentamicin Salep Kulit Tube -
103 Gentamicin Salep mata Tube -
104 Gentamicin Tetes Mata Botol -
105 Gentian Violet 1 % Botol -
106 Glibenclamid tablet 5 mg Tablet 1,100
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet -
108 Glikazid 80 mg Tablet Tablet -
109 Glimepiride 2 mg Tablet 3,200
110 Glukosa larutan infus 10% steril Botol -
111 Glukosa larutan infus 5 % steril Botol -
112 Griseofulvin tablet 500 mg, Tablet 700
113 Guaiafenesin 100 mg Tablet -
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet -
115 Hidrokortison krim 2,5% Tube 144 96
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 700
121 KAEN 3B Infus Botol 20
122 Kalsium Glukonas Injeksi Ampul 95
123 Kalsium Laktat (Kalk) tablet 500 mg Tablet 4,000
124 Kapas Berlemak 500 mg Bungkus -
125 Ketokonazol Kream Tube 175
126 Ketokonazol Tablet 200 mg Tablet 950
127 Ketorolac inj Ampul -
128 Kifadene tablet 20 mg Tablet -
129 Kloramfenikol salep mata 1 % capsul 48
130 Kloramfenikol suspensi Botol 50
131 Kloramfenikol tetes telinga 3% Tube -
132 Kloramphenicol 250 mg Capsul -
133 Kloramphenicol 500 mg capsul 100
134 Kloramphenicol Tetes Mata Botol -
135 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 17,100
136 Klorokuin tablet 150 mg Tablet -
137 Klorpromazin HCL tablet salut 25 mg Tablet -
138 Kombinasi (Pirimetamin 25 mg + Solfadoxin Tablet -
139 Kotrimoksazol Dewasa Tablet 480 mg Tablet -
140 Kotrimoksazol Sirup / Suspensi Botol 300
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 170 200
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 3,500 7,000
153 Methilprednisolon tablet 4 mg Tablet -
154 Metilergometrin Maleat injeksi 1 ml Ampul -
155 Metilergometrin Maleat Tablet Tablet 800
156 Metoklopramid Suspensi Botol -
157 Metoklopramid tablet Tablet -
158 Metronidazol 500 mg Tablet -
159 Metronidazol infus / injeksi Botol -
160 Metronidazol Ovula supp -
161 Metronidazol suspensi Botol -
162 Mikonazol kream Tube 216
163 Multivitamin Anak Sirup Botol 120 50
164 Multivitamin Dewasa Antioksidan ( Becom c ) Tablet -
165 Natrium Diklofenak 25 mg Tablet Tablet -
166 Natrium Diklofenak 50 mg Tablet Tablet 6,950
167 Natrium Klorida Cairan Infus ( NaCL ) Botol 120
168 Nifedipine Tablet 10 mg Tablet -
169 Nistatin tablet vaginal 100.000 IU/g Tube 100
170 Obat anti Diare suspensi Botol -
171 Obat Anti Diare Tablet (Akita / Molagit ) Tablet 1,200 500
172 Obat Batuk Flu ( Molexflu ) Tablet 15 10
173 Obat Batuk Hitam (OBH) Botol -
174 Obat Batuk Sirup Herbal ( Herbacop ) Botol 96 96
175 Ofloxsacin Tetes Telinga Tube -
176 Oksitetrasiklin HCL salep mata 1% Botol 650
177 Oksitosin injeksi 10 IU/ml - 1 ml Ampul -
178 Omeprazol injeksi Ampul 20
179 Omeprazol Kapsul 20 mg capsul -
180 Ondancentron injeksi 4 mg Ampul 10
181 Ondancentron Tablet4 mg Tablet 420
182 Paracetamol Drop 15 ml Botol 120 180
183 Paracetamol Sirup 120 mg/5 ml Botol 400
184 Parafin Dresing ( Bioplacenton Tull ) pcs -
185 Parasetamol tablet 100 mg Tablet -
186 Parasetamol tablet 500 mg Tablet -
187 Permetrin Krim 5 % Tube 11 20
188 Pirantel Sirup Botol -
189 Pirantel tablet 125 mg Tablet -
190 Pirazinamid Botol -
191 Piridoksin HCL (VIT B6) tablet 10mg Botol 4,500 5,000
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 8,700 5,000
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 400
203 Ranitidin tablet Tablet 5,000
204 Resperidone 2 mg tablet Tablet -
205 Ringer Laktat cairan infus (MJB) -
206 Ringer Laktat cairan infus (Widatra) Botol 180 60
207 Rivanol 300 ml Botol -
208 Salbutamol Tablet 2 mg Tablet 1,300
209 Salbutamol tablet 4mg Tablet 900
210 Salep 2-4 Tube 96 5
211 Salep kombinasi cream ( Berloson ) Tube -
212 Salicil bedak Kotak -
213 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial 2 5
214 Serum Anti Tetanus inj 1500 IU ( Tetagam ) Vial 19
215 Sianokobalamin Injeksi Ampul -
216 Simvastatin 10 mg tablet Tablet 3,090 3,360
217 Simvastatin 20 mg tablet Tablet -
218 Sukralfat Suspensi Botol 100 50
219 Sukralfat tablet 500 mg Tablet -
220 Suspensi Seng Insulin inj.40 IU/ml - 10 ml Tube -
221 Temporary Stopping Fletcher serbuk & cairan Tablet -
222 Tetrakain HCL tetes mata 0,5% Tube -
223 Tetrasiklin 250 mg capsul capsul -
224 Tetrasiklin 500 mg capsul capsul -
225 Tiamin Tablet 50 mg ( B1 ) Tablet 2,800
226 Ventolin Nebulizer Ampul -
227 Vitamin B komplek Tablet 11,300 5,000
228 Zink sirup Botol 72
229 Zink tablet 20 mg Tablet 2,300 500
Antasida DOEN suspensi botol 240
Allopurinol 100 mg (2020) Tablet 500 1,500
Kotrimoksazol Dewasa Tablet 480 mg (2020) Tablet 900 1,200
Kloramphenicol 500 mg Kapsul 500
Kloramfenikol salep kulit 2% Tube 48
Natrium Klorida Cairan Infus ( NaCL ) Botol 40
Paracetamol Sirup 120 mg/5 ml (2020) Botol 400
Salep 2-4 (2020) Pot 43

OBAT PROGRAM
1 Albendazol Tablet 400 mg Tablet 8,880
2 Isoniazid Tablet 100 mg Tablet 200
3 Obat Antituberkulosis kategori 1 Paket 4
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 470
8 Reagen Ziehl Neelsen Kit 10
9 MDT MB Anak Tablet Tablet -
10 MDT MB Dewasa Tablet Tablet -
11 MDT PB Dewasa Tablet Tablet -
12 MDT PB Anak Tablet Tablet -
13 Retinol (Vitamin A) kapsul 200.000 IU capsul -
14 Retinol (Vitamin A) kapsul 100.000 IU capsul -
15 Tablet Penambah Darah ( FE ) Tablet -
16 Amitriptilin tablet 25 mg Tablet 300
17 Carbamazepin 200 mg tablet Tablet 200 300
18 Clobazam 10 mg Tablet Tablet -
19 Clozapine 25 mg Tablet Tablet -
20 Fenitoin Natrium kapsul 30 mg capsul -
21 Haloperidol 1,5 mg Tablet Tablet -
22 Haloperidol 2 mg tablet Tablet 100
23 Haloperidol 5 mg Tablet Tablet 0
24 Haloperidol Injeksi Ampul 0
25 Klorpromazin HCL tablet salut 100 mg Tablet 415
26 Klorpromazine Tablet 25 mg Tablet 0
27 Triheksilfenidil Hcl 2 mg tablet Tablet 0
28 Risperidone 2 mg tablet Tablet 400 400
29 Divalproexsodium Tablet 0
Diazepam injeksi (program) ampul 80
Magnesium Sulfat Inj. 25 ml 40 % (program) ampul 42
Kalsium Glukonas Injeksi ampul 60
Oksitosin injeksi 10 IU/ml - 1 ml ampul 511
Metilergometrin Maleat injeksi 1 ml ampul 300
Dehydro Artemisin 40 mg + Piperaquin 320 mg (DHP) tablet 0
Primakuin tablet 15 mg tablet 0
Masker karet ear loop hijab box 10
Masker N 95 box 0

NAMA BAHAN MEDIS HABIS PAKAI (BMHP )

B
1 Alat suntik 1 ml Pcs 300
2 Alat suntik 10 ml Pcs 0
3 Alat suntik 2,5 ml Pcs 0
4 Alat suntik 20 ml Pcs 0
5 Alat suntik 3 cc (Remedi) 300 500
6 Alat suntik 3 ml Pcs 0
7 Alat suntik 5 ml pcs 400
8 Alkazide 1 L High Level Desinfectant Botol 0
9 Alkazyme Sachet 25 mg Pack 0
10 Alkohol 70 % 1 L Botol 0
11 Alkohol swab Sachet 8 7
12 Anti Septik Hand Rub Botol 0
13 Anti Septik Surgikal Hand Scrub Botol 0
14 Cat Gut no 2/0 Sachet 48
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 24
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 40
24 I.V Cathetter No. 20 Set 150
25 I.V Cathetter No. 22 troge Set 0
26 I.V Cathetter No. 24 troge Set 100
27 I.V Cathetter No. 26 Set 0
28 Infuset Anak Set 150
29 Infuset Dewasa Set 180
30 Jarum Insulin Tablet 0
31 Kapas Berlemak 250 gr Bungkus 4
32 Kapas Berlemak 500 gr Bungkus 0
33 Kasa 4 m x 10 cm Rol 0
34 Kasa Hidrofil 36 x 80 cm Rol 4
35 Kasa Pembalut 2 x 80 cm Pack 9 40
36 Kasa Steril 16 x 16 cm Kotak 25 30
37 Lisol 1 L Botol 0
38 Masker karet Ear Loop Lembar 100 300
39 Masker tali Tube 0
40 Nasal Canula Oksigen Set 0
41 Plester kertas 1,25 cm x 9,14 m Rol 10 24
42 Plester Kertas 2,5 cm Rol 0
43 Plester Non Woven 5cm x 5 cm Rol 16 20
44 Policlean Botol 0 4
45 Polifik Kotak 0
46 Saraya Alsof A 500 ml Botol 0
47 Saraya Alsof Pure 500 ml Botol 0
48 Sarung Tangan Gynecolog No 7 Pasang 125 25
49 Sarung tangan M (Non Steril) Pasang 1250 1,000
50 Sarung tangan no 6,5 Pasang 0
51 Sarung tangan no 6,5 Steril Gloves Pasang 0
52 Sarung tangan no 7,0 Steril Pasang 0
Selang Section ( Surgikal Conection Tube with
53 yankauer) Pcs 24
54 Underpad Lembar 50 50
55 Urine Bag Biji 20
I.V Cathetter No. 24 jms pcs 50
I.V Cathetter No. 22 jms set 400
Alat suntik 1 ml (2020) box 3
Cat Gut no 2/0 pcs 72
Cat Gut no 3/0 pcs 72
I.V Cathetter No. 20 set 100

NAMA OBAT VAKSIN

1 Vaksin Anti Rabies ( VAR ) Vial 0

2 Vaksin BCG Vial 10
3 Vaksin DT Vial 40
4 Vaksin HB 0 Pcs 10
5 Vaksin HBIG Vial 0
6 Vaksin Measless Rubella (MR) Vial 2
7 Vaksin Pentabio ( DPT - HB - Hib ) Vial 0
8 Vaksin Polio B OPV Vial 0
9 Vaksin Polio IPV Vial 0
10 Vaksin TD Vial 45
11 Vaksin Tuberculin Vial 2
12 ADS 0,05 ml Unit 20
13 ADS 0,5 ml Unit 0
14 ADS 5 ml Unit 90
15 Safety Box Unit 10
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
N DAN LEMBAR PERMINTAAN OBAT ( LPLPO )
PUSKESMAS
DOKUMEN NOMOR
DINKES KAB/KOTA
DE : JULI 2020 : GFK KAB/KOTA
PUSKESMAS

Penerimaan
Jumlah Jumlah
PROG LAIN 2 Penerimaan Persediaan

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

- -
- -
- 200
- -
- -
- -
- -
6,000 16,500 900 900
- 6,900 900 900
- -
- -
10,000 22,800 400 500 400 400 300 200
- -
- -
- 177
- -
- -
- -
- -
- -
3,000 20,000 300
- -
- -
- -
- -
- -
- -
60 120
- -
- -
1,000 4,900
- 400
- -
- -
- -
- -
- 120
- -
- 7,800 420
- -
 - 200
- 450
- -
- -
- -
- -
48 84 3
100 327 25
- -
- -
- -
- -
- -
- -
500 2,800 300
- -
- -
- -
- -
- -
500 2,500 300
- -
- -
- 240
- -
5,000 9,100 600 500 500
- -
- -
- -
- 8 1 1
- -
- -
- -
- 800
- -
- -
- 1,200
- 150
- -
- -
- -
- 1,800
- -
- -
- -
- -
- -
- -
- -
- -
- 200
- -
48 72
- -
 - 1,500
- 15
- 1,000
- -
- -
- -
- 177
- -
- -
- -
- -
- 1,100
- -
- -
- 3,200
- -
- -
- 700
- -
- -
96 240 24
- -
- -
- -
- -
- 700 200
- 20
- 95
- 4,000 400 400
- -
- 175
- 950 100
- -
- -
- 48
- 50
- -
- -
- 100 100
- -
- 17,100 800 300 300
- -
- -
- -
- -
- 300
- -
- -
- -
- -
200 370
- -
- -
- -
 - -
- -
- -
7,000 10,500 1000 600
- -
- -
- 800
- -
- -
- -
- -
- -
- -
- 216
50 170
- -
- -
- 6,950 350 200
- 120
- -
- 100
- -
500 1,700 100 100
10 25 1 2 2
- -
96 192
- -
- 650
- -
- 20
- -
- 10
- 420 60
180 300 11
- 400
- -
- -
- -
20 31 4 5
- -
- -
- -
5,000 9,500 1000 1000
- -
- -
- -
- -
- -
5,000 13,700 300
- -
- -
- -
- -
- 400
 - 5,000 400 500 400
- -
- -
60 240
- -
- 1,300
- 900
5 101
- -
- -
5 7
- 19
- -
3,360 6,450 300 210 180
- -
50 150
- -
- -
- -
- -
- -
- -
- 2,800
- -
5,000 16,300 400 400 400 300
- 72
500 2,800 100
- 240
1,500 2,000
1,200 2,100 100
500 500
48 48
40 40
400 400
43 43

- -
- 8,880
- 200 100
16 16 20 3
- 2 1
- 2
- -
- 470 20
- 10 3
- -
- -
- -
- -
3,500 3,500 3,500
400 400 400
- -
300 300 600
300 500 300
 - -
- -
- -
- -
- 100 100
- -
- -
- 415 100
- -
- -
400 800 100
- -
- 80
- 42
- 60
- 511
- 300
- -
- -
- 10
- -
- -
- -
- 300 100
- -
- -
- -
500 800
- -
- 400
- -
- -
- -
7 15 1 1
- -
- -
- 48 12
- -
- -
- -
- -
24 72
- -
- -
- -
- 40
- 150
- -
- 100
- -
- 150
- 180 60
- -
- 4 1
 - -
- -
- 4
40 49 2
30 55 3 6
- -
300 400 50 50 50
- -
- -
24 34
- -
20 36 1 2
4 4
- -
- -
- -
25 150
1,000 2,250 50 50 150 50
- -
- -
- -

- 24
50 100 10
- 20
- 50
- 400
- 3
72 72
72 72
100 100
- -
- -
- -
- -
10 10 20 10
- 40
100 100 110 10 10
- -
30 30 32 6 6
50 50 50 10 10
40 40 40 10 10
- -
- 45 2 2
- 2
100 100 120 10 10
300 300 300 40 40
- 90 10 10
- 10 1 1
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
-
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
TANGGAL

Pemakaian Perhari / Tanggal diloket

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

200

900 600
900 600

400 400 400 400 500 400

500 400 400 600 300

500
100 200

540
 200

25 27 25

500

100

400 300 400 400

10

10
 100

24 24

100

100 100 100

200

24

300 1000 400

100
 400 1500

24
30

200 300 250 300

100 100 100 100 100

2 2

10

25

16 10 24 49
400

200
300 400 400 1400 400

100
100

1 1

360 300 300

25

400 500 500 500 600 400

100 100

100

20
4

3500
400

300
115

200

100 100 100

1 1

1
 100

2 2 2

100 100 50 50

20

10
10

40
10
 Pengeluaran Sub Un

22 23 24 25 26 27 28 29 30 31 Pustu Pusling
kd dodol sekong gn cupu kd bumbang dalam balar

900
900

500 400 400 300 400 400 300

100 200 200 200 600

100
 25

200 300

100

300 100 400 500 400 400 300

100
40

14
 24

400 400 400 400 300

 900 400 600

300 300 200 150

100 100
2 2

10

5 2

800 800

100 200 300

 400 400

360 300

400

300 500 500 500 500

200
40 50
200
100 200
100

3 3

10
200

200

100

1
 150

50 50 100

10

20
10

50
10
 Pengeluaran Sub Unit Jumlah Stok
Pengeluaran AkhirBulan
8 9
Pusling poskesdes posyandu igd vk (1+ s.d31 + sub unit) (6-8)
rocek gn datar kp handap
0 0
0 0
200 0
0 0
0 0
0 0
0 0
4200 12300
4200 2700
0 0
0 0
200 7600 15200
0 0
0 0
20 20 157
0 0
0 0
0 0
0 0
0 0
200 4000 16000
0 0
0 0
0 0
0 0
0 0
0 0
36 6 42 78
0 0
0 0
600 4300
100 400 0
0 0
0 0
0 0
0 0
60 20 80 40
0 0
960 6840
0 0
 0 200
200 250
0 0
0 0
0 0
0 0
9 12 72
127 200
0 0
0 0
0 0
0 0
0 0
0 0
1300 1500
0 0
0 0
0 0
0 0
0 0
500 2000
0 0
0 0
40 40 200
0 0
5500 3600
0 0
0 0
0 0
2 6
0 0
0 0
0 0
0 800
0 0
0 0
100 1100
50 100
0 0
0 0
0 0
0 1800
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 200
0 0
24 48
0 0
 0 1500
0 15
0 1000
0 0
0 0
0 0
40 40 137
0 0
0 0
0 0
0 0
0 1100
0 0
0 0
0 3200
0 0
0 0
100 600
0 0
0 0
96 144
0 0
0 0
0 0
0 0
300 400
0 20
23 23 72
1100 2900
0 0
0 175
300 650
0 0
0 0
24 24
0 50
0 0
0 0
100 0
0 0
5000 12100
0 0
0 0
0 0
0 0
100 200
0 0
0 0
0 0
0 0
100 100 270
0 0
0 0
0 0
 0 0
0 0
0 0
5400 5100
0 0
0 0
0 800
0 0
0 0
0 0
0 0
0 0
0 0
24 192
30 140
0 0
0 0
2550 4400
0 120
0 0
0 100
0 0
900 800
13 12
0 0
10 182
0 0
25 625
0 0
10 10 10
0 0
10 10 0
60 360
120 180
400 0
0 0
0 0
0 0
16 15
0 0
0 0
0 0
3600 5900
0 0
0 0
0
0 0
0 0
1100 12600
0 0
0 0
0 0
0 0
100 100 300
 5000 0
0 0
0 0
100 40 140 100
0 0
100 1200
100 800
0 101
0 0
0 0
2 5
0 19
0 0
2310 4140
0 0
25 125
0 0
0 0
0 0
0 0
0 0
0 0
400 2400
0 0
100 6800 9500
0 72
500 2300
90 150
200 1800
500 1600
100 400
0 48
0 40
0 400
0 43

0 0
0 8880
100 100
13 7
1 1
1 1
0 0
50 420
7 3
0 0
0 0
0 0
0 0
3500 0
400 0
0 0
300 300
300 200
 0 0
0 0
0 0
0 0
100 0
0 0
0 0
415 0
0 0
0 0
500 300
0 0
0 80
30 30 12
0 60
111 111 400
0 300
0 0
0 0
0 10
0 0
0 0
0 0
100 100 300 0
0 0
0 0
0 0
100 500 300
0 0
0 400
0 0
0 0
0 0
2 1 8 7
0 0
0 0
24 12 48 0
0 0
0 0
0 0
0 0
24 24 48
0 0
0 0
0 0
20 10 30 10
50 50 100 50
0 0
50 50 50
0 0
50 50 100
90 30 180 0
0 0
1 3 1
 0 0
0 0
2 2 2
10 12 37
12 10 31 24
0 0
400 0
0 0
0 0
0 34
0 0
5 15 21
0 4
0 0
0 0
0 0
0 150
50 850 1400
0 0
0 0
0 0

0 24
10 20 40 60
10 10 20 0
0 50
100 50 150 250
0 3
12 12 60
12 12 60
0 100

0 0
0 0
0 0
10 10
0 40
50 60
0 0
12 20
50 0
40 0
0 0
5 40
0 2
20 100
170 130
40 50
2 8
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( L
PUSKESMAS
PUSKESMAS : CIMANUK
KECAMATAN : CIMANUK
KAB / KOTA : PANDEGLANG PELAPORAN BULAN / PERIODE : JULI 2020
PROVINSI : BANTEN PERMINTAAN BULAN / PERIODE : AGUSTUS 2020

Jumlah Stok Stok

N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir Optimum

1 2 3 4 5 6 7 8 9
A NAMA OBAT ( 4+5 ) (6-7)
1 Alprazolam Tablet - - - - - -
2 Albendazol Tablet 400 mg Tablet - - - - - -
3 Allopurinol tablet 100 mg Tablet 200 - 200 200 - 240
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 10,500 6,000 16,500 4,200 12,300 5,040
9 Amlodipin Besilate 5 mg Tablet 6,900 - 6,900 4,200 2,700 5,040
10 Amoksisilin Forte sirup kering 250mg Botol - - - - - -
11 Amoksisilin Injeksi 1 gr Vial - - - - - -
12 Amoksisilin Tablet 500 mg Tablet 12,800 10,000 22,800 7,600 15,200 9,120
13 Amoksisillin kapsul 250 mg Kapsul - - - - - -
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol - - - - - -
15 Ampisilin Injeksi 1 gr Vial 177 - 177 20 157 24
16 Analog insulin Long Acting Pen - - - - - -
17 Analog insulin Mix Acting Pen - - - - - -
18 Antalgin (Metampiron) tablet 500 mg Tablet - - - - - -
19 Antalgin (Metampiron) tablet 500 mg Tablet - - - - - -
20 Antasida DOEN suspensi Botol - - - - - -
21 ANTASIDA DOEN Tablet Tablet 17,000 3,000 20,000 4,000 16,000 4,800
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 60 60 120 42 78 50
29 Artermeter injeksi Ampul - - - - - -
30 Artesunate injeksi 60 mg/ml vial - - - - - -
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 3,900 1,000 4,900 600 4,300 720
32 Asam Folat Botol 400 - 400 400 - 480
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 120 - 120 80 40 96
38 Asetosal tablet 500 mg Tablet - - - - - -
39 Asetyl Cysteine Capsul 7,800 - 7,800 960 6,840 1,152
40 Asiklovir Cream 5% Tube - - - - - -
41 Asiklovir tablet 200 mg Tablet 200 - 200 - 200 -
42 Asiklovir tablet 400 mg Tablet 450 - 450 200 250 240
43 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul - - - - - -
44 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Vial - - - - - -
45 Atropin Sulfat tablet 0,5 mg Tablet - - - - - -
46 Berotec Metered Aerosol 100 mg Bok - - - - - -
 Jumlah Stok Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir Optimum

1 2 3 4 5 6 7 8 9
A NAMA OBAT ( 4+5 ) (6-7)
47 Betadine Salep Antiseptik 5 mg Tube 36 48 84 12 72 14
48 Betametason krim 0,1 % Tube 227 100 327 127 200 152
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 2,300 500 2,800 1,300 1,500 1,560
56 Captopril Tablet 25 mg Tablet - - - - - -
57 Cefadroxil Capsul 500 mg Capsul - - - - - -
58 Cefixime Capsul 100 mg Capsul - - - - - -
59 Cefixime Sirup Botol - - - - - -
60 Cefotaksime 1 gr Injeksi Vial - - - - - -
61 Cetirizine Capsul 50 mg Capsul 2,000 500 2,500 500 2,000 600
62 Cetirizine sirup 5 mg/5 ml Botol - - - - - -
63 Ciprofloxcacin 500 mg tablet Tablet - - - - - -
64 Combivent UDV 2,5 mg+0,5mg/2,5 ml Ampul 240 - 240 40 200 48
65 D-Artepp tablet Tablet - - - - - -
66 Deksametason tablet 0,5 mg Tablet 4,100 5,000 9,100 5,500 3,600 6,600
67 Dekstran 70 - larutan infus 6% steril Botol - - - - - -
68 Dekstrometorfan sirup Botol - - - - - -
69 Dekstrometorfan tablet 15 mg Tablet - - - - - -
70 Diazepam Rektal 0,5 mg / 2 ml supp 8 - 8 2 6 2
71 Diazepam tablet 2 mg Tablet - - - - - -
72 Diazepam tablet 5 mg Tablet - - - - - -
73 Difenhidramin HCL injeksi 10 mg/ml - 1ml Ampul - - - - - -
74 Digoksin tablet 0,25 mg Tablet 800 - 800 - 800 -
75 Diltiazem Tablet - - - - - -
76 Doksisiklin Kapsul 100 mg Capsul - - - - - -
77 Domperidon 10mg Tablet Tablet 1,200 - 1,200 100 1,100 120
78 Domperidon Suspensi 5 mg/ 5 ml Botol 150 - 150 50 100 60
79 Doxicyclin 500mg capsul - - - - - -
80 Efedrin HCLTablet 25 mg Tablet - - - - - -
81 Epinefrina HCL/Bitartrat Injeksi Ampul - - - - - -
82 Eritromicyn kapsul 250 mg capsul 1,800 - 1,800 - 1,800 -
83 Erytromicin kapsul 500 mg Kapsul - - - - - -
84 Erytromicin sirup 125 mg Botol - - - - - -
85 Etakridin ( Rivanol ) larutan 0,1% Botol - - - - - -
86 Etambutol 500 mg Tablet - - - - - -
87 Etanol 70 % Botol - - - - - -
88 Etil Klorida Semprot Botol - - - - - -
89 Fenitoin Natrium kapsul 30 mg Kapsul - - - - - -
90 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul - - - - - -
91 Fenobarbital tablet 30 mg Tablet 200 - 200 - 200 -
92 Fenoksimetil Penisilina tablet 250 mg Tablet - - - - - -
93 Fenol Gliserol tetes telinga 10 % Botol 24 48 72 24 48 29
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul - - - - - -
95 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 1,500 - 1,500 - 1,500 -
96 Flufenazine Deconat Inj 25 mg/ml Ampul 15 - 15 - 15 -
97 Furosemida tablet 40 mg Tablet 1,000 - 1,000 - 1,000 -
98 Furosemide Injeksi Ampul - - - - - -
99 Garam Oralit Sachet - - - - - -
100 Gemfibrozil 300 mg Tablet - - - - - -
 Jumlah Stok Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir Optimum

1 2 3 4 5 6 7 8 9
A NAMA OBAT ( 4+5 ) (6-7)
101 Gentamicin Injeksi Ampul 177 - 177 40 137 48
102 Gentamicin Salep Kulit Tube - - - - - -
103 Gentamicin Salep mata Tube - - - - - -
104 Gentamicin Tetes Mata Botol - - - - - -
105 Gentian Violet 1 % Botol - - - - - -
106 Glibenclamid tablet 5 mg Tablet 1,100 - 1,100 - 1,100 -
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet - - - - - -
108 Glikazid 80 mg Tablet Tablet - - - - - -
109 Glimepiride 2 mg Tablet 3,200 - 3,200 - 3,200 -
110 Glukosa larutan infus 10% steril Botol - - - - - -
111 Glukosa larutan infus 5 % steril Botol - - - - - -
112 Griseofulvin tablet 500 mg, Tablet 700 - 700 100 600 120
113 Guaiafenesin 100 mg Tablet - - - - - -
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet - - - - - -
115 Hidrokortison krim 2,5% Tube 144 96 240 96 144 115
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 700 - 700 300 400 360
121 KAEN 3B Infus Botol 20 - 20 - 20 -
122 Kalsium Glukonas Injeksi Ampul 95 - 95 23 72 28
123 Kalsium Laktat (Kalk) tablet 500 mg Tablet 4,000 - 4,000 1,100 2,900 1,320
124 Kapas Berlemak 500 mg Bungkus - - - - - -
125 Ketokonazol Kream Tube 175 - 175 - 175 -
126 Ketokonazol Tablet 200 mg Tablet 950 - 950 300 650 360
127 Ketorolac inj Ampul - - - - - -
128 Kifadene tablet 20 mg Tablet - - - - - -
129 Kloramfenikol salep mata 1 % capsul 48 - 48 24 24 29
130 Kloramfenikol suspensi Botol 50 - 50 - 50 -
131 Kloramfenikol tetes telinga 3% Tube - - - - - -
132 Kloramphenicol 250 mg Capsul - - - - - -
133 Kloramphenicol 500 mg capsul 100 - 100 100 - 120
134 Kloramphenicol Tetes Mata Botol - - - - - -
135 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 17,100 - 17,100 5,000 12,100 6,000
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 - - - - - -
140 Kotrimoksazol Sirup / Suspensi Botol 300 - 300 100 200 120
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 170 200 370 100 270 120
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 3,500 7,000 10,500 5,400 5,100 6,480
153 Methilprednisolon tablet 4 mg Tablet - - - - - -
154 Metilergometrin Maleat injeksi 1 ml Ampul - - - - - -
 Jumlah Stok Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir Optimum

1 2 3 4 5 6 7 8 9
A NAMA OBAT ( 4+5 ) (6-7)
155 Metilergometrin Maleat Tablet Tablet 800 - 800 - 800 -
156 Metoklopramid Suspensi Botol - - - - - -
157 Metoklopramid tablet Tablet - - - - - -
158 Metronidazol 500 mg Tablet - - - - - -
159 Metronidazol infus / injeksi Botol - - - - - -
160 Metronidazol Ovula supp - - - - - -
161 Metronidazol suspensi Botol - - - - - -
162 Mikonazol kream Tube 216 - 216 24 192 29
163 Multivitamin Anak Sirup Botol 120 50 170 30 140 36
164 Multivitamin Dewasa Antioksidan ( Becom c ) Tablet - - - - - -
165 Natrium Diklofenak 25 mg Tablet Tablet - - - - - -
166 Natrium Diklofenak 50 mg Tablet Tablet 6,950 - 6,950 2,550 4,400 3,060
167 Natrium Klorida Cairan Infus ( NaCL ) Botol 120 - 120 - 120 -
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 1,200 500 1,700 900 800 1,080
172 Obat Batuk Flu ( Molexflu ) Tablet 15 10 25 13 12 16
173 Obat Batuk Hitam (OBH) Botol - - - - - -
174 Obat Batuk Sirup Herbal ( Herbacop ) Botol 96 96 192 10 182 12
175 Ofloxsacin Tetes Telinga Tube - - - - - -
176 Oksitetrasiklin HCL salep mata 1% Botol 650 - 650 25 625 30
177 Oksitosin injeksi 10 IU/ml - 1 ml Ampul - - - - - -
178 Omeprazol injeksi Ampul 20 - 20 10 10 12
179 Omeprazol Kapsul 20 mg capsul - - - - - -
180 Ondancentron injeksi 4 mg Ampul 10 - 10 10 - 12
181 Ondancentron Tablet4 mg Tablet 420 - 420 60 360 72
182 Paracetamol Drop 15 ml Botol 120 180 300 120 180 144
183 Paracetamol Sirup 120 mg/5 ml Botol 400 - 400 400 - 480
184 Parafin Dresing ( Bioplacenton Tull ) pcs - - - - - -
185 Parasetamol tablet 100 mg Tablet - - - - - -
186 Parasetamol tablet 500 mg Tablet - - - - - -
187 Permetrin Krim 5 % Tube 11 20 31 16 15 19
188 Pirantel Sirup Botol - - - - - -
189 Pirantel tablet 125 mg Tablet - - - - - -
190 Pirazinamid Botol - - - - - -
191 Piridoksin HCL (VIT B6) tablet 10mg Botol 4,500 5,000 9,500 3,600 5,900 4,320
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 8,700 5,000 13,700 1,100 12,600 1,320
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 400 - 400 100 300 120
203 Ranitidin tablet Tablet 5,000 - 5,000 5,000 - 6,000
204 Resperidone 2 mg tablet Tablet - - - - - -
205 Ringer Laktat cairan infus (Otsuka) - - - - - -
206 Ringer Laktat cairan infus (Widatra) Botol 180 60 240 140 100 168
207 Rivanol 300 ml Botol - - - - - -
208 Salbutamol Tablet 2 mg Tablet 1,300 - 1,300 100 1,200 120
 Jumlah Stok Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir Optimum

1 2 3 4 5 6 7 8 9
A NAMA OBAT ( 4+5 ) (6-7)
209 Salbutamol tablet 4mg Tablet 900 - 900 100 800 120
210 Salep 2-4 Tube 96 5 101 - 101 -
211 Salep kombinasi cream ( Berloson ) Tube - - - - - -
212 Salicil bedak Kotak - - - - - -
213 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial 2 5 7 2 5 2
214 Serum Anti Tetanus inj 1500 IU ( Tetagam ) Vial 19 - 19 - 19 -
215 Sianokobalamin Injeksi Ampul - - - - - -
216 Simvastatin 10 mg tablet Tablet 3,090 3,360 6,450 2,310 4,140 2,772
217 Simvastatin 20 mg tablet Tablet - - - - - -
218 Sukralfat Suspensi Botol 100 50 150 25 125 30
219 Sukralfat tablet 500 mg Tablet - - - - - -
220 Suspensi Seng Insulin inj.40 IU/ml - 10 ml Tube - - - - - -
221 Temporary Stopping Fletcher serbuk & cairan Tablet - - - - - -
222 Tetrakain HCL tetes mata 0,5% Tube - - - - - -
223 Tetrasiklin 250 mg capsul capsul - - - - - -
224 Tetrasiklin 500 mg capsul capsul - - - - - -
225 Tiamin Tablet 50 mg ( B1 ) Tablet 2,800 - 2,800 400 2,400 480
226 Ventolin Nebulizer Ampul - - - - - -
227 Vitamin B komplek Tablet 11,300 5,000 16,300 6,800 9,500 8,160
228 Zink sirup Botol 72 - 72 - 72 -
229 Zink tablet 20 mg Tablet 2,300 500 2,800 500 2,300 600
Antasida DOEN suspensi botol 240 - 240 90 150 108
Allopurinol 100 mg (2020) Tablet 500 1,500 2,000 200 1,800 240
Kotrimoksazol Dewasa Tablet 480 mg (2020) Tablet 900 1,200 2,100 500 1,600 600
Kloramphenicol 500 mg Kapsul - 500 500 100 400 120
Kloramfenikol salep kulit 2% Tube - 48 48 - 48 -
Natrium Klorida Cairan Infus ( NaCL ) Wida Botol - 40 40 - 40 -
Paracetamol Sirup 120 mg/5 ml (2020) Botol - 400 400 - 400 -
Salep 2-4 (2020) Pot - 43 43 - 43 -

OBAT PROGRAM - - - - - -
1 Albendazol Tablet 400 mg Tablet 8,880 - 8,880 - 8,880 -
2 Isoniazid Tablet 100 mg Tablet 200 - 200 100 100 120
3 Obat Antituberkulosis kategori 1 Paket 4 16 20 13 7 16
4 Obat Antituberkulosis Kategori 2 Paket 2 - 2 1 1 1
5 Obat Antituberkulosis Kategori Anak Paket 2 - 2 1 1 1
6 Pot Dahak Non Steril Biji - - - - - -
7 Pot Dahak Steril Biji 470 - 470 50 420 60
8 Reagen Ziehl Neelsen Kit 10 - 10 7 3 8
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 - 3,500 3,500 3,500 - 4,200
14 Retinol (Vitamin A) kapsul 100.000 IU capsul - 400 400 400 - 480
15 Tablet Penambah Darah ( FE ) Tablet - - - - - -
16 Amitriptilin tablet 25 mg Tablet 300 300 600 300 300 360
17 Carbamazepin 200 mg tablet Tablet 200 300 500 300 200 360
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 100 - 100 100 - 120
23 Haloperidol 5 mg Tablet Tablet - - - - - -
 Jumlah Stok Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir Optimum

1 2 3 4 5 6 7 8 9
A NAMA OBAT ( 4+5 ) (6-7)
24 Haloperidol Injeksi Ampul - - - - - -
25 Klorpromazin HCL tablet salut 100 mg Tablet 415 - 415 415 - 498
26 Klorpromazine Tablet 25 mg Tablet - - - - - -
27 Triheksilfenidil Hcl 2 mg tablet Tablet - - - - - -
28 Risperidone 2 mg tablet Tablet 400 400 800 500 300 600
29 Divalproexsodium Tablet - - - - - -
Diazepam injeksi (program) ampul 80 80 - 80 -
Magnesium Sulfat Inj. 25 ml 40 % (program) ampul 42 42 30 12 36
Kalsium Glukonas Injeksi ampul 60 60 - 60 -
Oksitosin injeksi 10 IU/ml - 1 ml ampul 511 111 400 133
Metilergometrin Maleat injeksi 1 ml ampul 300 - 300 -
Dehydro Artemisin 40 mg + Piperaquin 320 mg (DHP) tablet - - - -
Primakuin tablet 15 mg tablet - - - -
Masker karet ear loop hijab box 10 - 10 -
Masker N 95 box - - - -
- - - - - -
NAMA BAHAN MEDIS HABIS PAKAI (BMHP )
B - - - - - -
1 Alat suntik 1 ml Pcs 300 - 300 300 - 360
2 Alat suntik 10 ml Pcs - - - - - -
3 Alat suntik 2,5 ml Pcs - - - - - -
4 Alat suntik 20 ml Pcs - - - - - -
5 Alat suntik 3 cc (Remedi) 300 500 800 500 300 600
6 Alat suntik 3 ml Pcs - - - - - -
7 Alat suntik 5 ml pcs 400 - 400 - 400 -
8 Alkazide 1 L High Level Desinfectant Botol - - - - - -
9 Alkazyme Sachet 25 mg Pack - - - - - -
10 Alkohol 70 % 1 L Botol - - - - - -
11 Alkohol swab Sachet 8 7 15 8 7 10
12 Anti Septik Hand Rub Botol - - - - - -
13 Anti Septik Surgikal Hand Scrub Botol - - - - - -
14 Cat Gut no 2/0 Sachet 48 - 48 48 - 58
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 24 72 24 48 29
20 E Care I.V Dresing Pcs - - - - - -
21 E-Care Surgical Mask Tie On Lembar - - - - - -
22 Folly No 14 Catether pcs - - - - - -
23 Folly No 16 Catether pcs 40 - 40 30 10 36
24 I.V Cathetter No. 20 Set 150 - 150 100 50 120
25 I.V Cathetter No. 22 Set - - - - - -
26 I.V Cathetter No. 24 Set 100 - 100 50 50 60
27 I.V Cathetter No. 26 Set - - - - - -
28 Infuset Anak Set 150 - 150 50 100 60
29 Infuset Dewasa Set 180 - 180 180 - 216
30 Jarum Insulin Tablet - - - - - -
31 Kapas Berlemak 250 gr Bungkus 4 - 4 3 1 4
32 Kapas Berlemak 500 gr Bungkus - - - - - -
33 Kasa 4 m x 10 cm Rol - - - - - -
34 Kasa Hidrofil 36 x 80 cm Rol 4 - 4 2 2 2
35 Kasa Pembalut 2 x 80 cm Pack 9 40 49 12 37 14
36 Kasa Steril 16 x 16 cm Kotak 25 30 55 31 24 37
37 Lisol 1 L Botol - - - - - -
 Jumlah Stok Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir Optimum

1 2 3 4 5 6 7 8 9
A NAMA OBAT ( 4+5 ) (6-7)
38 Masker karet Ear Loop Lembar 100 300 400 400 - 480
39 Masker tali Tube - - - - - -
40 Nasal Canula Oksigen Set - - - - -
41 Plester 1" Rol 10 24 34 - 34 -
42 Plester Kertas 2,5 cm Rol - - - - - -
43 Plester Non Woven 5cm x 5 cm Rol 16 20 36 15 21 18
44 Policlean Botol - 4 4 - 4 -
45 Polifik Kotak - - - - - -
46 Saraya Alsof A 500 ml Botol - - - - - -
47 Saraya Alsof Pure 500 ml Botol - - - - - -
48 Sarung Tangan Gynecolog No 7 Pasang 125 25 150 - 150 -
49 Sarung tangan M (Non Steril) Pasang 1,250 1,000 2,250 850 1,400 1,020
50 Sarung tangan no 6,5 Pasang - - - - - -
51 Sarung tangan no 6,5 Steril Gloves Pasang - - - - - -
52 Sarung tangan no 7,0 Steril Pasang - - - - - -

53 Selang Section ( Surgikal Conection Tube with yankauer) Pcs 24 - 24 - 24 -

54 Underpad Lembar 50 50 100 40 60 48
55 Urine Bag Biji 20 - 20 20 - 24
I.V Cathetter No. 24 jms pcs 50 - 50 - 50 -
I.V Cathetter No. 22 jms set 400 - 400 150 250 180
Alat suntik 1 ml (2020) box 3 - 3 - 3 -
Cat Gut no 2/0 pcs - 72 72 12 60 14
Cat Gut no 3/0 pcs - 72 72 12 60 14
I.V Cathetter No. 20 set - 100 100 - 100 -

- - - - - -
NAMA OBAT VAKSIN
-
1 Vaksin Anti Rabies ( VAR ) Vial - - - -
2 Vaksin BCG Vial 28 10 20 10 10 12
3 Vaksin DT Vial 40 - 40 - 40 -
4 Vaksin HB 0 Pcs 52 100 110 50 60 60
5 Vaksin HBIG Vial - - - - - -
6 Vaksin Measless Rubella (MR) Vial 17 30 32 12 20 14
7 Vaksin Pentabio ( DPT - HB - Hib ) Vial 40 50 50 50 - 60
8 Vaksin Polio B OPV Vial 50 40 40 40 - 48
9 Vaksin Polio IPV Vial - - - - - -
10 Vaksin TD Vial 70 - 45 5 40 6
11 Vaksin Tuberculin Vial - - 2 - 2 -
12 ADS 0,05 ml Unit 50 100 120 20 100 24
13 ADS 0,5 ml Unit 560 300 300 170 130 204
14 ADS 5 ml Unit 37 - 90 40 50 48
15 Safety Box Unit 20 - 10 2 8 2
- - - - - -
- - - - - -
- - - - - -
NAMA OBAT REAGEN
- - - - - -
1 Albumin (Reagen) Kotak - - - - - -
2 anti A Monoclonal ( GolDar 10 ml) Vial - - - - - -
3 Anti A-B Monoclonal ( GolDar 10 ml) Vial - - - - - -
4 Anti B Monoclonal ( GolDar 10ml) Vial - - - - - -
5 Anti D Monoclonal ( GolGar 10ml) Vial - - - - - -
6 Benecheck Plus Cholesterol Test Strip - - - - - -
7 Benecheck Plus Glukosa Test Strip - - - - - -
 Jumlah Stok Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir Optimum

1 2 3 4 5 6 7 8 9
A NAMA OBAT ( 4+5 ) (6-7)
8 Benecheck Plus Uric Test Strip - - - - - -
9 Bilirubin T/D (Reagen) Kotak - - - - - -
10 Brilian Green Bile Broth Kotak - - - - - -
11 Cellclean (CL-50) (Reagen) Kotak - - - - - -
12 Cellpack (PK-30L) (Reagen) Kotak - - - - - -
13 Chikungunya IgM (Reagen) Kotak - - - - - -
14 Cholesterol (Reagen) Kotak - - - - - -
15 Cholesterol Stik (Reagen) Kotak - - - - - -
16 CK-MB (Reagen) Kotak - - - - - -
17 Creatinin Reagen Kit - - - - - -
18 Dengue IgM / IgM ( Reagen ) Kotak - - - - - -
19 Eight Check ( LNH ) Serial - - - - - -
20 Febrile Antingen H Parathpy Vial - - - - - -
21 Febrile Antingen H-A Parathpy Vial - - - - - -
22 Febrile Antingen H-B Parathpy Vial - - - - - -
23 Febrile Antingen H-C Parathpy Vial - - - - - -
24 Febrile Antingen O Parathpy Vial - - - - - -
25 Febrile Antingen O-A Parathpy Vial - - - - - -
26 Febrile Antingen O-B Parathpy Vial - - - - - -
27 Febrile Antingen O-C Parathpy Vial - - - - - -
28 Glukosa Reagen Kotak - - - - - -
29 GOT ( ALAT ) Kotak - - - - - -
30 GPT ( ALAT ) Kotak - - - - - -
31 HBSAG Reagen Box - - - - - -
32 HCG Strip Vial - - - - - -
33 HDL Cholesterol ( Precipitan ) Kotak - - - - - -
34 Hematologi Calibrator (Nscs 1000 ) Botol - - - - - -
35 Hemoglobin Reagen Kotak - - - - - -
36 Lactose Broth 500 mg Botol - - - - - -
37 LDL Cholesterol Kotak - - - - - -
38 Leptospira IgM (Reagen) Kotak - - - - - -
39 Micropippets MT-1-up to 200 ui Pcs - - - - - -
40 MIcropippets MT-up to 1 ml Pcs - - - - - -
41 NS1 Antigen Test (Reagen) Kotak - - - - - -
42 Pipet Ukur 10 ml biji - - - - - -
43 Poch Pack D (II) Reagen Kotak - - - - - -
44 Poch Pack L (II) Reagen Kotak - - - - - -
45 Stik Uric Acid Kotak - - - - - -
46 Strip Narkoba 3 Parameter Kotak - - - - - -
47 Strip Narkoba 5 Parameter Kotak - - - - - -
48 Strip Narkoba 6 Parameter Kotak - - - - - -
49 Total Protein Kotak - - - - - -
50 Trigleserida Kotak - - - - - -
51 Urea Kotak - - - - - -
52 Uric Acid Kotak - - - - - -
NAMA OBAT REAGEN PROGRAM HIV - - - - - -
1 Rapid 1 HIV (SD Bioline ) Tes
2 Rapid 2 HIV (Fokus ) Tes
3 Rapid 3 HIV (Biomeriux Vikia ) Tes
4 SD Biosensore Standart Q Syphlis Tes
5 RPR Syphlis ( Fokus ) Tes
6 Reagen CD4 Control Tes
7 Reagen CD4 Mobile Tes
8 RPR Syphlis Komponen Kit
 Jumlah Stok Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir Optimum

1 2 3 4 5 6 7 8 9
A NAMA OBAT ( 4+5 ) (6-7)
9 Anuscopy Buah
10 Kertas PH Indikator Buah
11 Rotator Buah
12 Tip. Uk.60 Bks
13 Tip. Uk.61 Bks
14 Pronto / Holder Buah - - - - - -
- - - - - -
NAMA OBAT GIGI
- - - - - -
1 Anastesi Citojek Box - - - - - -
2 Articulating Paper (Kertas warna penanda oklusi) Kotak - - - - - -
3 Bahan Tumpatan sementara Botol - - - - - -
4 Bonding Syringe - - - - - -
5 Cairan Desinfectan ( Perendaman Instrumen Gigi ) Botol - - - - - -
6 Cairan untuk desinfectan pembersih permukaan Botol - - - - - -
7 Carpule Citojek Kotak - - - - - -
8 Chlorfeson Kamfer menthol ( CHKM ) Cairan Botol - - - - - -
9 Composite Nanohibrid A1 Tube - - - - - -
10 Composite Nanohibrid A2 Tube - - - - - -
11 Composite Nanohibrid A3 Tube - - - - - -
12 Composite Nanohibrid A3,5 Tube - - - - - -
13 Devitalisasi Pasta Pot - - - - - -
14 Disclosing Solution Botol - - - - - -
15 Etcing Gel Pcs - - - - - -
16 Etil Klorida Semprot Botol - - - - - -
17 Eugenol Cairan Botol - - - - - -
18 Formokesol Botol - - - - - -
19 Gas Powred Jet Injector Botol - - - - - -
20 Glass Ionomer Cement ART Pot - - - - - -
21 Jarum citojek uk 16 mm Box - - - - - -
22 Kalsium Hidroksida pasta Botol - - - - - -
23 Klorhekdidin Larutan 2 % Botol - - - - - -
24 Mummifiying Fasta Botol - - - - - -
25 Natrium Hipoklorit airan konsentrat 5% Botol - - - - - -
26 Paper Points 15-40 mm Box - - - - - -
27 Pasta Devitalisasi ( Non Arsen ) Tube - - - - - -
28 Pasta Pengisi Saluran Akar Syringe - - - - - -
29 Semen seng Fosfat serbuk Set - - - - - -
30 Spon Gelatin Cubicis 1x1x1 cm (Spongostan) Botol - - - - - -
31 Temporary Filling Fasta Set - - - - - -
32 Tooth Stain Remover ( TSR ) Botol - - - - - -
33 Wipes Desinfektan Botol - - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -

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

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

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

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

NIP. NIP. NIP.
N OBAT ( LPLPO )

DOKUMEN NOMOR TANGGAL

DINKES KAB/KOTA
GFK KAB/KOTA
PUSKESMAS

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

10 11 12 13 14 15 16

750
2500

3000
6000

5,000

100

1000
2000

6000
50
60

100
500

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

10 11 12 13 14 15 16

50

1000

100

5000

200

10

96

200

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

10 11 12 13 14 15 16

200
100
50

48
100
3000

100
300
60

125
500
500
100
3000

100

1000
50

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

10 11 12 13 14 15 16

500

50

500

2000

200

500
10

100

10
330
80

240
800

2000
2000

10
10

2000

60
 Jumlah PEMBERIAN
Permintaa BUFFER JUMLAH
APBD II JKN PROG LAIN LAIN
n STOK

10 11 12 13 14 15 16

50
2

1500

40
 Jumlah PEMBERIAN
Permintaa BUFFER JUMLAH
APBD II JKN PROG LAIN LAIN
n STOK

10 11 12 13 14 15 16

500

10
10
10

15

40
100

100

180

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

10 11 12 13 14 15 16

600

24
10
10

15

500

200
200

70
 Jumlah PEMBERIAN
Permintaa BUFFER JUMLAH
APBD II JKN PROG LAIN LAIN
n STOK

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

10 11 12 13 14 15 16

Harap Dilampirkan : 1. LB 1

2. Lap. Psikotropika & Narkotika

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

10 11 12 13 14 15 16

3. Lap. Pemakaian Serum ABU

4. Lap. 20 Pemakaian Obat Terbanyak

MEMINTA YANG MEMINTA :

PUSKESMAS PETUGAS OBAT PUSKESMAS

………………………… ……………………………………..
NIP.