FARMASI

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
NOMOR :
PUSKESMAS : TEGAL BARAT
KOTA : TEGAL PELAPORAN BULAN : MARET 2020
PROPINSI : JAWA TENGAH
PENGELUARAN
JUMLAH STOK
STOK PERMINT PEMBERI
NO NAMA BARANG SATUAN TANGGAL ED STOK PENERIM PEMAKAIAN RUSAK/ED AKHIR KETERANGAN
AWAL AAN OPTIMUM AAN AN
(A) (B) (A+B) C D G
rsediaan Obat-obatan ( PKD ) Umum INDUK
1 Asetosal 100 mg tablet 0 0 0 0 0 0
2 Albendazol tab 400 mg tablet 504 0 504 0 0 504
3 Albendazol sirup 200 mg/5 ml botol 0 0 0 0 0 0
4 Allopurinol 300 mg tablet 80 0 80 0 0 80
5 Alopurinol tablet 100 mg tablet 01/08/2021 1830 0 1830 0 0 1830 1099
6 Aminofilin inj 24mg/ml ampul 0 0 0 0 0 0
7 Aminofillin 150 mg tablet 5/13/2020 20 0 20 0 0 20
8 Aminofillin 200 mg tablet 24 0 24 0 0 24
9 Amitriptyline tablet 5/1/2021 168 0 168 0 0 168
10 Amlodipin 5mg tablet 436 0 436 0 0 436 2650
11 Amlodipin 10mg tablet 0 0 0 0 0 0 2400
12 Amoksisilin drop 100 mg/ml btl 23 0 23 0 0 23
13 Amoksisilin serbuk injeksi 1000mg ampul 0 0 0 0 0 0
14 Amoksisilin sirup kering 125 mg/ 5 mg botol 0 0 0 0 0 0
15 Amoksisillin 250mg kaplet 3/1/2020 18740 0 18740 0 0 18740 retur gf 17130
16 Amoksisillin 500mg kaplet 6/1/2021 11273 0 11273 0 0 11273 14280
17 Amoksisillin sirup kering 250mg/5 ml botol 0 0 360 0 0 360
18 Ampisillin 500 mg kaplet 0 0 0 0 0 0
19 Antasida DOEN kombinasi tablet 4/1/2020 6978 0 6978 0 0 6978 8720
20 Antasida DOEN suspensi btl 60ml 7/1/2021 156 0 156 0 0 156 150
21
Anti Bakteri DOEN saleb kombinasi (Bacitracin) tube 0 0 0 0 0 0
23 Antifungi DOEN Kombinasi pot 5/1/2021 191 0 191 0 0 191 216
24 Antihemoroid DOEN supp 12/1/2020 906 0 906 0 0 906 90
25 Antiparkinson DOEN tablet 0 0 0 0 0 0
26 Aqua pro injeksi steril vial 0 0 0 0 0 0
28 Asam askorbat 50mg tablet 7/1/2020 40779 0 40779 0 0 40779 30140
29 Asam folat 1 mg (MARIN) tablet 9/1/2020 2320 0 2320 0 0 2320 884
30 Asam mefenamat 500mg tablet 7/31/2022 6406 0 6406 0 0 6406 2550
31 Asam traneksamat 100mg inj ampul 254 0 254 0 0 254
32 Asiklovir 200mg tablet 2/1/2022 1188 0 1188 0 0 1188 970
33 Asiklovir 400mg tablet 4/1/2021 452 0 452 0 0 452 258
34 Asiklovir krim 5% tube 7/1/2021 425 0 425 0 0 425 420
Atropin injeksi I m/lv/s.k.0,25 mg/ml (sulfat) ampul 7/31/2020
36 50 50 0
0 0 50
37 Attapulgit 600mg (New Antides) tablet 6/1/2020 22584 0 22584 0 0 22584
38 Azitromisin 500 mg tablet 1/9/2020 228 0 228 0 0 228 228
39 Bedak salisil 2% dus@50gr 3/1/2020 781 0 781 0 0 781 249
40 Besi (II) sulfat 200 mg kombinasi tablet 6/5/2020 2220 0 2220 0 0 2220 1430
41 Betahistin mesilat 6mg tablet 9/1/2021 0 0 0 0 0 0 2276
42 Betametason krim 0,1% tube 1/1/2021 276 0 276 0 0 276 159
43 Bisakodil 5 mg tab.salut 0 0 0 0 0 0 ed februari 20
44 Bisakodil supp 5 mg (DULCOLAX INFANT) supp 0 0 0 0 0 0
45 Bisakodil supp 10 mg supp 0 0 0 0 0 0
46 Bisoprolol 5 mg tablet 0 0 0 0 0 0
47
Budesonide 0,25 mg/ml Pulmicort Respules nebule 0 0 0 0 0 0
48 Cetirizin 10 mg tablet 120 0 120 0 0 120 101
49 Cetirizine sirup 5mg/5ml botol 5/1/2020 133 0 133 0 0 133 62
50 Clobazam 10mg tablet 3/1/2021 47 0 47 0 0 47
51 Co Amoxiclav tablet 0 0 0 0 0 0
Dexamethason 0,5mg 31/03/2020
52 tablet dan
01/08/2020 53271 0 53271 0 0 53271 68878
53 Dexamethason inj 5mg/ml ampul 35 0 35 0 5 30
54 Diazepam 2mg tablet 1/1/2021 1008 0 1008 0 0 1008 ed feb 20
57
Difenhidramin injeksi i.m 10mg/ml (HCl) ampul 5/1/2020 30 0 30 0 0 30
58 Digoksin 0,25mg tablet 165 0 165 0 0 165
59 Diazepam injeksi 5mg/ml-1ml ampul 4/1/2020 48 0 48 0 0 48
60 Diltiazem HCl 30mg tablet 0 0 0 0 0 0
Dimenhidrinat 50mg
01/09/2020
61 tablet dan
01/06/2022
8358 0 8358 0 0 8358 8070
62 Doksisiklin 100mg kapsul 01/03/2021 0 0 0 0 0 0
Domperidon suspensi 5mg/ 5ml 01/04/2020
63 botol dan
01/03/2020 0 0 0 0 0 0 200
Domperidon10 mg 30/04/2020
64 tablet dan
01/02/2021 9542 0 9542 0 0 9542 8285
65 Efedrin tablet 0 0 0 0 0 0 0
ampul 12/12/2020 0
66
Epinefrin (Adrenalin) injeksi 0,1% (sebagaiHCL) 55 0 55 0 55
67 Ergotamin 1mg+kofein 50mg tablet 0 0 0 0 0 0 ed 2019
68 Eritromisin 500mg kapsul 4/1/2021 520 0 520 0 0 520 510
69 Etakridin 0,1% btl 0 0 0 0 0 0
70 Etanol 70% btl 100ml 0 0 0 0 0 0 25
71 Fenitoin Na 30mg (DECATONA) tablet 0 0 0 0 0 0
72 Fenobarbital inj 50mg/ml ampul 0 0 0 0 0 0
Fenobarbital 30 mg Tablet 01/04/2020
73 tablet dan
01/11/2021 800 0 800 0 0 800
74 Fenoksimetil Penisilin tablet 250 mg tablet 0 0 0 0 0 0
75 Fitomenadion (Vit. K1) injeksi 10 mg/ml ampul 0 0 0 0 0 0
76 Fitomenadion (Vit. K1) injeksi i.m 2 mg/ml ampul 9/30/2019 0 0 0 0 0 0
77 Fitomenadion 10mg tab salut 8/23/2020 3494 0 3494 0 0 3494 3324
78 Flufenazine Decanoat inj 25 mg/ml ampul 6/1/2020 70 0 70 0 0 70
04/01/2020
79 dan
Furosemid 40 mg tablet 01/02/2021 133 0 133 0 0 133 5
80 Garam Oralit I serbuk sachet 1722 0 1722 0 0 1722 3641
81 Gentamisin Salep kulit 0,1% tube 9/30/2020 206 0 206 0 0 206 405
82 Gentamisin TM 0,3% botol 1/6/2020 77 0 77 0 0 77 159
83 Gentamisin injeksi ampul 0 0 0 0 0 0
84 Gentian Violet larutan 1% botol 8 0 8 0 0 8 17
85 Glibenklamid 5mg tablet 3/23/2023 2785 0 2785 0 0 2785 2478
86 Gliseril Guaiakolat 100mg tablet 1/4/2021 0 0 0 0 0 0 35335
87 GOM btl 8ml 9/1/2021 3 0 3 0 0 3
88 Griseofulvin 125 mg tablet 2/1/2020 0 0 0 0 0 0 ed 02/2020
89 Guaifenesin 100 mg tablet 7/1/2022 24864 0 24864 0 0 24864
90 Haloperidol 5mg tablet 01/02/2020 200 0 200 0 0 200
91 Haloperidol 1,5 mg tablet 10/30/2019 0 0 0 0 0 0
92 Haloperidol 2 mg tablet 8/1/2020 440 0 440 0 0 440
93 Haloperidol Deconat injeksi 50 mg/ml ampul 1/1/2020 5 0 5 0 0 5
94 Hidrokortison Krim 2,5% tube 3/1/2021 135 0 135 0 0 135 154
95 Hidroklorthiazid 25 mg tablet 9/1/2022 450 0 450 0 0 450 140
96 Hyosin Nbutilbromid 10mg tablet 11/1/2020 62 0 62 0 0 62
97 Ichtyol pot 15gr 7/1/2022 103 0 103 0 0 103 97
98 INH 100mg tablet 0 0 0 0 0 0
99 INH 300mg tablet 0 0 0 0 0 0
100 Ibuprofen 200mg tablet 9/1/2021 0 0 0 0 0 0 6000
101 Ibuprofen 400mg tablet 0 0 0 0 0 0
102 Ibuprofen suspensi 100mg/5ml botol 14 0 14 0 0 14 5
103 Ibuprofen suspensi 200mg/5ml botol 0 0 0 0 0 0
104 Isosorbid Dinitrat Tablet sublingual 5 mg tablet 0 0 0 0 0 0 300
105 Kalium Aspartat 300mg tablet 0 0 0 0 0 0
106 Kalium Klorida 600mg tablet 0 0 0 0 0 0
107 Kalsium laktat 500mg tablet 2/1/2020 26564 0 26564 0 0 26564 ed 03/2020 26760
108 Kaolin Pektin (New Diaform) tablet 6/1/2022 0 0 0 0 0 0
109 Kaptopril 12,5mg tablet 11/21/2021 3021 0 3021 0 0 3021 2569
110 Kaptopril tablet 25 mg tablet 11/16/2021 3773 0 3773 0 0 3773 380
111 Ketokonazol 200mg tablet 01/05/2021 3228 0 3228 0 0 3228 2667
112 Ketokonazol krim 2% tube 8/31/2021 239 0 239 0 0 239 199
113 Ketorolac injeksi 10mg ampul 0 0 0 0 0 0
114 Klindamisin 150mg tablet 0 0 0 0 0 0
115 Klonidin 0,15 mg tablet 0 0 0 0 0 0
116 Kloramfenikol 250 mg kapsul 8/1/2023 1126 0 1126 0 0 1126 892
117 Kloramfenikol TT 3% btl 0 0 0 0 0 0
118 Kloramfenikol suspensi 125mg/5 btl 60 ml 0 0 0 0 0 0
119 Kloramfenikol salep kulit (Bufacetine) 2% tube 5/1/2021 85 0 85 0 0 85 7
120 Klorampenikol TM 0,5% (RECO) btl 10/31/2020 210 0 210 0 0 210 79
Klorfeniramin maleat 4mg tablet
01/03/2021
121 dan
01/04/2022 261490 0 261490 0 0 261490 230134
122 Klorpromazine tablet 0 0 0 0 0 0
123 Kodein 10mg tablet 0 0 0 0 0 0
124 Kodein 20mg tablet 6/30/2021 0 0 0 0 0 0
125 Kotrimoksazol DOEN dewasa tablet 6/1/2020 12578 0 12578 0 0 12578 10472
126 Kotrimoksazol FORTE tablet 11/1/2021 5076 0 5076 0 0 5076 4600
127 Kotrimoksazol suspensi kombinasi botol 30/04/2020 360 0 360 0 0 360 273
128 Lansoprazol 30 mg kapsul 1/1/2022 387 0 387 0 0 387 243
129 Levofloksasin 500mg kapsul 0 0 0 0 0 0 0
130 Lidokain 2%+adrenalin 0,0125mg ampul 12/1/2020 1780 0 1780 0 0 1780
lidokain 2%+Epinefrin 1:80000-2ml 01/07/2020 ,
131 ampul 01/11/2020
&01/11/2022 728 0 728 0 0 728
132 Linkomisin 500mg kapsul 8/1/2020 1018 0 1018 0 0 1018 946
133 Loratadin tablet 4/1/2020 150 0 150 0 0 150
134 Mebendazol sirup 100 mg/5 ml botol 0 0 0 0 0 0
135 Mebendazol tablet tablet 0 0 0 0 0 0
136 Meloksikam 15mg tablet 31/06/2021 1854 0 1854 0 0 1854 2210
137 Metformin 500mg tablet 1/3/2020 40 0 40 0 0 40 4095
138 Methampiron 500mg tablet 8/1/2020 7808 0 7808 0 0 7808 6360
Metilergometrin Maleat tab salut 0,125 mg
01/02/2021
139 &
tablet 01/05/2021 2180 0 2180 0 0 2180 2180
140 Metilergometrin inj 0,2 mg/ml ampul 11/30/2020 30 0 30 0 0 30
141 Metoklopramid 5 mg tablet 190 0 190 0 0 190 142
142 Metoklopramide injeksi 5 mg/ml ampul 0 0 0 0 0 0
143 Metronidazol 500mg tablet 0 0 0 0 0 0
144 Metylprednisolon 4 mg tablet 8/1/2020 14747 0 14747 0 0 14747 15374
145 Metylprednisolon 8 mg tablet 0 0 0 0 0 0
146 Mg Sulfat injeksi 20% ampul 9/1/2019 0 0 0 0 0 0
147 Mg Sulfat injeksi 40% ampul 0 0 0 0 0 0
148 Mikonazol krim 2% tube 2/1/2021 191 0 191 0 0 191 139
149 N-asetil sistein 200 mg kapsul 4/8/2020 19187 0 19187 0 0 19187 11628
150 NaCl infus btl 500ml 20 0 20 0 0 20 5
01/12/2020
151 &
Nadifen 50 mg tablet 22/05/2021 38610 0 38610 0 0 38610 35886
Nifedipin 10mg 01/11/2020
152 tablet dan 0
01/03/2021 490 0 490 0 490
153 Nistatin tablet salut 500.000 IU tablet 8/1/2019 938 0 938 0 0 938 140
154 Nistatin Vag 100.000 IU/g ovula 18/11/2020 2330 0 2330 0 0 2330 230
01/01/2020
155 dan
OBH botol 01/03/2021 86 0 86 0 0 86 141
156 Oksitetrasiklin HCl salep kulit 3 % tube 9/1/2020 146 0 146 0 0 146 292
157 Oksitetrasiklin HCl salep mata 3 % tube 0 0 0 0 0 0
158 Omeprazol 20mg kapsul 0 0 0 0 0 0 266
159 Omeprazol injeksi ampul 0 0 0 0 0 0
160 Ondancentron inj ampul 4/1/2021 5 0 5 0 0 5
161 Parasetamol 500mg tablet 1/4/2020 152383 0 152383 0 0 152383 163305
162 Parasetamol sirup 120mg/5ml botol 60ml 63 0 63 0 0 63 103
163 Parasetamol drop btl 15 ml 8/24/2020 52 0 52 0 0 52 65
164 Pehacain injeksi ampul 0 0 0 0 0 0
165 Permetrin (Scabimite) krim 5% tube 7/1/2020 70 0 70 0 0 70
166 Pirantel tab.score base 125mg tablet 8/30/2020 0 0 0 0 0 0 100
167 Pirantel Pamoat susp 125mg/5ml botol 0 0 0 0 0 0
168 Piridoksin 10mg (vit. B6) tablet 9/1/2020 44261 0 44261 0 0 44261 12828
169 Piroksikam 10mg tablet 8/1/2021 2800 0 2800 0 0 2800 5115
170 Polikresulen cairan btl 10ml 6/3/2036 6 0 6 0 0 6
171 Povidon Iodin 10% btl 30 ml 11/1/2019 6 0 6 0 0 6
172 Povidon Iodin 10% btl 300ml 2/1/2020 0 0 0 0 0 0
173 Prednison 5mg tablet 7/1/2021 42164 0 42164 0 0 42164 11505
174 Propanolol 10mg tablet 480 0 480 0 0 480 210
175 Propiltiurasil tablet 100mg tablet 0 0 0 0 0 0
176 Ranitidin 150mg tablet 8/31/2020 203 0 203 0 0 203 retur gf 7500 235
177 Ranitidin inj 25mg/ml ampul 30/03/2021 10 0 10 0 0 10 0
178 Reserpin tablet 0,10 mg tablet 0 0 0 0 0 0
179 Respiredon 2 mg tablet 3/1/2021 0 0 0 0 0 0
180 Retinol ( Vitamin A ) kapsul 100.000 IU kapsul kapsul 0 0 0
lunak 0 0 0
181 Retinol ( Vitamin A ) kapsul 200.000 IU kapsul kapsul 0 0 0
lunak 0 0 0
182 Ringer Laktat infus btl 500ml 1/23/2022 20 0 20 0 0 20 160
183 Rivanol 300 ml botol 0 0 0 0 0 0
184 Salbutamol 2 mg tablet 3/31/2023 2696 0 2696 0 0 2696 2038
185 Salbutamol 4 mg tablet 12/1/2021 0 0 0 0 0 0
186 Salep 2-4 kombinasi pot 7/1/2021 679 0 679 0 0 679 445
03/01/2020
187 dan
Sefadroksil 500mg kapsul 01/10/2020 2850 0 2850 0 0 2850 1592
188 Sefadroksil sir.kering 125mg/5 btl 60ml 0 0 0 0 0 0 0
189 Sefiksim 100mg kapsul 0 0 0 0 0 0 0
190 Sefotaksim inj 1g/vial vial 0 0 0 0 0 0 0
191 Seftriakson 1g/vial vial 0 0 0 0 0 0 0
192 Seltifort kids (vit syrup) btl 60ml 5/31/2020 86 0 86 0 0 86 119
193 Sianokobalamin tab (vit B12) tab 50 mcg tablet 4/1/2022 29402 0 29402 0 0 29402 27476
194 Simetidin 200mg tablet 10/1/2020 120 0 120 0 0 120
195 Simvastatin 10mg tablet 0 0 0 0 0 0 0
196 Simvastatin 20mg tablet 03/05/2020 67 0 67 0 0 67 retur gf 5000 278
197 Siprofloksasin 500mg tablet 9/1/2020 44502 0 44502 0 0 44502 2355
198 Spiramisin 500mg tablet 0 0 0 0 0 0
199 Stesolid 10 mg injeksi ampul 0 0 0 0 0 0
200 Stesolid supp 10mg Tube 3/1/2022 10 0 10 0 0 10
201 Stesolid supp 5mg Tube 3/2/2022 12 0 12 0 0 12
202 Sulfasetamid TM 15% botol 0 0 0 0 0 0
203 Terbutalin sufat 2,5mg tablet 0 0 0 0 0 0
204 Tetrasiklin 250mg kapsul 0 0 0 0 0 0
205 Tetrasiklin kapsul 500 mg kapsul 3/1/2021 2332 0 2332 0 0 2332 2180
06/01/2020
206 tablet dan 0
Thiamin HCl 50mg (vit. B1) 01/05/2022 41300 0 41300 0 41300 29935
207 Tiamfenikol kapsul 500mg kapsul 0 0 0 0 0 0
208 Triheksifenidil 2mg tablet 0 0 0 0 0 0
209 Vit. B kompleks tablet 1/31/2020 8310 0 8310 0 0 8310 17200
210 Zinc sirup botol 01/03/2020 10 0 10 0 0 10
211 Zinc dispersibel 20mg tablet 12/1/2019 0 0 0 0 0 0 ed 20219 4180
ersediaan Obat-obatan ( PKD ) Gigi 0 0 0
1 Bahan tumpatan sementara (CAVITON) kotak 11/6/2019 8 0 8 0 0 8
2 Chlor Fenol Kamfer Menthol (CHKM) gigi botol 3/31/2022 12 0 12 0 0 12
3 Devitalisasi pasta non arsen (Pulp x) kotak 4/1/2022 6 0 6 0 0 6
botol
01/11/2020
4 &
Eugenol cairan 01/08/2039 16 0 16 0 0 16
5 Kalsium hidroksida (Hycal) 7 gram 8/1/2021 18 0 18 0 0 18
6 Mata bor gigi standar set/6 biji 1/6/2022 21 0 21 0 0 21
7 Mata bor gigi high speed set/6 biji 0 0 0 0 0 0
8 Mummifying Pasta/ Iodoform Pasta gigi kotak 7/1/2021 0 0 0 0 0 0
9 Pasta pengisi saluran akar(CRESOTIN) set 10/1/2020 28 0 28 0 0 28
10 Poliren (OCO) polishing pasta btl 15gr 7/1/2021 7 0 7 0 0 7 ed 2019
Semen seng fosfat serbuk dan cairan gigi
11 botol 10/31/2020 6 6 0
0 0 6
12 Tambalan sementara untuk gigi 28gr(3M ESPE kotak 1/1/2020 0 0 0
Cavit G) 0 0 0
13 Tambalan tetap gigi (Glass Ionomer,fuji) kotak 4/1/2022 37 0 37 0 0 37
14 Tricresol formalina (TKF) kotak 31/09/2021 12 0 12 0 0 12
15 Komposir resin (Master fill) kotak 2/1/2022 11 0 11 0 0 11
ediaan Obat-obatan ( PKD ) Penunjang 8/1/2020 0 0 0 0
1 Ambroksol 30 mg tablet 9/1/2020 11206 0 11206 0 0 11206 22880
2 Antiflu tab.kombinasi (Brocifar) tablet 0 3301 0 3301 0 0 3301 3345
3 Asam Tranexamat inj.500mg/ml ampul 1/1/2021 254 0 254 0 0 254
4 Calsium Gluconnat Injeksi ampul 11/1/2019 56 0 56 0 0 56
5
BIOSAT 1,5 Serum anti tetanus inj 1500IU/ml ampul 8/1/2019 0 0 0 0 0 0
6 Bromheksin HCl 8 mg tablet 8/1/2021 1000 0 1000 0 0 1000 1000
7 Ekstrak sonchi Folium 100% kapsul 4/1/2022 0 0 0 0 0 0
8 Etanol 70 %( One Med alcohol) botol 1 L 0 0 0 0 0 0 0
9 Fenoterol MDI 100 mcg/ 10ml fls 7/31/2020 0 0 0 0 0 0
10 Glimepirid 1mg 12/1/2020 5655 0 5655 0 0 5655 6170
11 Glimepirid 2mg 0 4310 0 4310 0 0 4310 4660
12 Kloramfenikol inj vial 4/1/2020 0 0 0 0 0 0
13 Kloramfenikol Salep mata 1% tube 5 gr 1/1/2022 123 0 123 0 0 123 138
14 Levertran15 g pot 15gr 01/02/2020 1 0 1 0 0 1
15 Metampiron 500mg+Diazepam 2 mg tablet 9/1/2021
(Neuroval) 1400 0 1400 0 0 1400
16 Obat anti flu sirup (Betaflu) botol 0 5 0 5 0 0 5 74
17 Obat batuk Kombinasi (Fenidryl) sirup 7/1/2022 0 0 0 0 0 0
18 Obat batuk kombinasi (Dextral) tablet 7/1/2021 10 0 0 0 0 0 45
19 Oksitosin injeksi ampul 4/1/2020 295 0 295 0 0 295
20 Phenol gliserol tetes telinga botol 106 0 106 0 0 106 44
21 Salbutamol nebules(Salbutamol 2,5mg/2,5 ml ampul 9/4/2020 10 10 0

NaCl) 0 0 10
22 Salep bisul pot 7/1/2020 0 0 0 0 0 0
23 Salep luka bakar (Neocenta gel) tube 15gr 0 5 0 5 0 0 5
24 Tab. Curcuma 20mg tablet 0 0 0 0 0 0 0
25 Teofilin syrup 43,33 mg/ 5 ml botol 0 0 0 0 0 0 0
26 Terapi Diare sirup btl 60ml 0 0 0 0 0 0
27 Terapi Diare tab tablet 8/1/2020 0 0 0 0 0 0 21030
28 Vit neurotropik tablet 9/1/2022 2946 0 2946 0 0 2946 697
29 Etil klorid semprot Spray 7/1/2020 43 0 43 0 0 43
Persediaan Obat Asli Indonesia 0 0 0
1 Extrak Belladon tab 10 mg tablet 0 0 0 0 0 0 0
2 Enkasari 120 ml botol 0 0 0 0 0 0
3 Fitogen tablet 0 0 0 0 0 0 0
4 Ferris botol 0 0 0 0 0 0 0
5 Hemorogard kapsul 8/1/2020 2080 0 2080 0 0 2080 2024
6 Hepagard kapsul 0 0 0 0 0 0
7 Minyak telon botol 50 ml 0 0 0 0 0 0 0
8 Tensigard kapsul 0 433 0 433 0 0 433 210
rsediaan Obat dan Alkes PROGRAM 0 0 0 0
1 Diethylcarbamazine (DEC) 100 mg tablet 0 0 0 0 0 0 0
2 Albendazol tab 400 mg tablet 0 0 0 0 0 0 0 492
3 MDT Combi MB Adult blister 0 0 0 0 0 0 0
4 MDT Combi MB Child blister 0 0 0 0 0 0 0
5 MDT Combi PB Adult blister 0 0 0 0 0 0 0
6 MDT Combi PB Adult blister 0 0 0 0 0 0 0
7 MDT Combi PB Child blister 0 0 0 0 0 0 0
8 Obat Anti Tubercolusis kategori 1 FDC 0 0 0 0 0 0 0
9 Obat Anti Tubercolusis kategori anak FDC 0 0 0 0 0 0 0
10 Box slide pcs 0 0 0 0 0 0 0
11 Pot sputum pot 4/1/2022 300 0 300 0 0 300
12 Reagen BTA ( Ziehl Nelsen ) paket 0 0 0 0 0 0 0
13 Prokain Benzil Penisilin 3 jt IU vial 0 0 0 0 0 0 0
14 Depo Progestin/ suntik KB 3 bulan vial 0 0 0 0 0 0 0
15 Mineral Mix sachet 0 0 0 0 0 0 0
16 safety box 2,5 lt pcs 0 0 0 0 0 0 0
17 safety box 5 lt pcs 0 0 0 0 0 0 0
18 spuit 0,5 ml pcs 0 0 0 0 0 0 0
ersediaan ALKES Habis Pakai (PKD) 0 0 0 0
1 ADS 0,05ml pcs 7/1/2021 0 0 0 0 0 0
2 Blood Lancet box 8/1/2021 470 0 470 0 0 470 900
3 Cryotube 1.8 ml pcs 0 0 0 0 0 0 0
4 Cover Glass 22x22 mm box 3/1/2022 0 0 0 0 0 0
5 Deck Glass box/72pcs 0 34 0 34 0 0 34
6 E Care Handrub 500 ml botol 3/1/2020 40 0 40 0 0 40 25
7 Folley Catheter No.16 buah 11/1/2022 24 0 24 0 0 24 30
8 Folley Catheter setara Rush No.18 buah 12/1/2022 0 0 0 0 0 0 10
9 IV Catheter 18 G pcs 12/31/2023 0 0 0 0 0 0 30
10 IV Catheter 24 G pcs 1/31/2023 0 0 0 0 0 0 50
11 IV Catheter 22 G pcs 3/31/2024 0 0 0 0 0 0 50
12 IV catheter 20 G pcs 31/02/2024 0 0 0 0 0 0 50
13 Kapas 100 gr rol 0 0 0 0 0 0 0
14 Kasa 4m x 15 cm elastis roll 0 0 0 0 0 0 0
15 Kertas ECG Ukuran Besar roll 0 0 0 0 0 0 0
16 Kertas ECG Ukuran Standar roll 0 0 0 0 0 0 0
17 Pembalut Gips Uk. 3" roll 0 0 0 0 0 0 0
20 Plester 5 yard x 2 inchi roll 0 0 0 0 0 0 0
21 Pot Urine (pot sputum) bh/d.5,5cm 4/1/2022 0 0 0 0 0 0
22 Spuit 0,05 ml pcs 0 0 0 0 0
23 Tensocrepe 4" buah 0 0 0 0 0 0 0
24 Tensocrepe 6" buah 0 0 0 0 0 0 0
25 Wing Needle No. 21G buah 0 0 0 0 0 0 0
26 Wing Needle No. 25G buah 1/1/2020 200 0 200 0 0 200
27 alat suntik 1 ml pcs 11/1/2020 0 0 0 0 0 0 100
31 alkohol swab pcs 10/1/2021 2 0 2 0 0 2
32 aquadest botol 1 L 6/3/2036 0 0 0 0 0 0
33 Alkapram septalkan spray botol 7/1/2021 0 0 0 0 0 0
34 Alkapram alkacide 1 L botol 7/1/2020 0 0 0 0 0 0
35 Alkapharm alkazyme 25mg sachet 5/1/2021 0 0 0 0 0 0
36 bisturi kecil pcs 1/12/2020 79 0 79 0 0 79
37 bioplacenton tulle pcs 0 0 0 0 0 0
38 catgut cromic 2/0 box 30/12/2019 9 0 9 0 0 9 108
39 catgut cromic 3/0 box 30/09/2019 6 0 6 0 0 6 ed 2019
41 fixomul stretch 15cmx5m roll 28/07/2020 0 0 0 0 0 0
42 foley catheter No.14 pcs 7/1/2021 6 0 6 0 0 6 6
43 Gelang Bayi Pink pcs 2/1/2023 0 0 0 0 0 0
44 Gelang Bayi Biru pcs 2/1/2023 0 0 0 0 0 0
45 handscoon Uk S box 5/1/2021 94 0 94 0 0 94 229
46 handscoon Uk M box 5/1/2021 140 0 140 0 0 140 230
47 handscoon obgyn pcs 1/7/2021 0 0 0 0 0 0
48 handscoon steril pasang 12/1/2022 0 0 0 0 0 0
49 hipafik 5x5 pcs 2/1/2021 13 0 13 0 0 13
50 hipafik 15x10 box 01/102020 0 0 0 0 0 0
51 infus set anak set/ktg 5/1/2021 42 0 42 0 42
52 infus set dewasa set/ktg 7/1/2022 37 0 37 0 0 37 140
53 jarum hect kulit luar besar (12 pcs) pcs 1/10/2021 18 0 18 0 0 18
54 jarum hect kulit luar kecil (12 pcs) pcs 1/5/2022 59 0 59 0 0 59
55 jarum hect kulit luar sedang (12 pcs) pcs 1/9/2022 18 0 18 0 0 18
56 jarum hect otot luar besar bks/12pcs 1/6/2023 0 0 0 0 0 0
57 jarum hect otot luar sedang bks/12pcs 9/6/2022 1 0 1 0 0 1
58 jelly EKG botol 0 0 0 0 0 0
59 kapas absorben 250 gr bks 10/1/2021 15 0 15 0 0 15 5
60 Kapas Berlemak 500 gr roll 9/1/2033 0 0 0 0 0 0 15
61 kasa hidrofil 2x80cm pcs 30/04/2021 6 0 6 0 0 6 4
62 kasa hidrofil 40x80cm roll 5/1/2023 18 0 18 0 0 18 16
63 kasa pembalut elastic 4m x 15cm roll 8/6/2021 4 0 4 0 0 4
64 kasa pembalut elastic 4m x 3cm roll 8/6/2021 6 0 6 0 0 6
65 kasa pembalut hidrofil 4 m x 10cm roll 10/1/2033 0 0 0 0 0 0
66 kasa hidrofil steril 18x22 roll 10/1/2021 0 0 0 0 0 0
67 kasa kompres 40x40 steril roll 8/1/2021 0 0 0 0 0 0
68 kasa steril 16x16 cm box 11/1/2020 0 0 0 0 0 0 18
69 kertas gol.darah pak/100's 1/6/2022 50 0 50 0 0 50
70 kertas tissu gulung 06/01/2022 0 0 0 0 0 0 62
71 klem tali pusat pcs 0 0 0 0 0 0
72 masker box/50pcs 30/04/2021 225 0 225 0 0 225 216
73 Box Object Glass Grey and Orange box 3/1/2022 0 0 0 0 0 0
74 object glass box/72pcs 19/03/2021 57 0 57 0 0 57
75 Oxygen mask bayi (SERENITY) pcs 1/6/2022 2 0 2 0 0 2
76 Oxygen mask anak (SERENITY) pcs 1/7/2022 4 0 4 0 0 4
77 Oxygen mask dewasa (SERENITY) pcs 1/8/2022 5 0 5 0 0 5
78 Pita Lila pcs 1/6/2022 0 0 0 0 0 0
79 plester 5 yard 20 inch roll 19/02/2021 17 0 17 0 0 17
80 silk no 3/0 dg jarum bedah pcs 3/6/2037 4 0 4 0 0 4 48
81 spiritus btl / 1 liter 06/01/2022 23 0 23 0 0 23
82 spuit 0,5 ml pcs 7/1/2021 0 0 0 0 0 0
83 Stericline Indicator strip box 11/1/2022 0 0 0 0 0 0
84 Stericlin gusette 25x6,5cm roll 10/1/2022 0 0 0 0 0 0
85 tempat preparat BTA / cawan petri pcs 1/6/2022 4 0 4 0 0 4
86 tabung reaksi 1,5x10cm ktk/50pcs 60 0 60 0 0 60
87 test kehamilan box/50pcs 5/1/2020 8 0 8 0 0 8
88 tranfusi set dewasa pcs 3/31/2024 37 0 37 0 0 37
89 Wraping paper 50x50 box 12/1/2020 0 0 0 0 0 0
90 Wraping paper 75x75 box 11/7/2020 0 0 0 0 0 0
91 USG Gel 250 ml botol 1/31/2021 0 0 0 0 0 0
92 urin bag pcs 19/05/2021 35 0 35 0 0 35
93 Ammonium Oxalat Btl/100ml 8/1/2020 0 0 0 0 0 0
94 Asam Klorida 0,1 N btl/ 100 ml 6 0 6 0 0 6
95 pack/1000t
Blue Tip est 0 0 0 0 0 0
96 BD Tube EDTA plh 13 x 75 box 5/1/2021 0 0 0 0 0 0
97 Cell pack bok 9/5/2020 1 0 1 0 0 1
98 Cuka diksi botol 5/1/2024 1 0 1 0 0 1
99 EDTA btl 100ml 0 0 0 0 0 0
100 Purple cup EDTA K3 3ml, glass box 6/1/2020 3 0 3 0 0 3
101 HbsAg test strip 0 160 0 160 0 0 160
102 Kertas Lensa lembar 0 0 0 0 0 0 0
103 Larutan Giemsa Stain botol 10/6/2019 2 0 2 0 0 2
104 Paket Gol. Darah Anti AB paket 3/6/2020 9 0 9 0 0 9
105 Paket Gol. Darah anti Resus paket 4/6/2020 0 0 0 0 0 0
106 Reagensia Uji Widal S para Typhi AH vial 12/1/2020 0 0 0 0 0 0
107 Reagensia Uji Widal Typhi H vial 7/6/2020 0 0 0 0 0 0
108 Reagensia Uji Widal Typhi O vial 2/28/2021 0 0 0 0 0 0
109 Reagen ZN paket 15 0 15 0 0 15
110 alkohol asam btl 100ml 14 0 14 0 0 14
111 asam sulfosalisilat btl 100ml 0 0 0 0 0 0
112 asam urat stick btl/25 test 31/04/2021 10 0 10 0 0 10
113 dempul hematokrit pcs 0 0 0 0 0 0
114 glukoprotein stik 10 parameter pck/100's 2/1/2020 0 0 0 0 0 0
115 glukoprotein urin test box/10 test 0 29 0 29 0 0 29
116 glukosa stik btl/25 test 11/7/2020 31 0 31 0 0 31
117 hemoglobin stik box/25 test 11 0 11 0 0 11
118 haemoglobulin C btl 500ml 11/19/2020 0 0 0 0 0 0
119 hayam btl 100ml 1/6/2022 0 0 0 0 0 0
120 Immersion Oil btl 100ml 1/6/2022 1 0 1 0 0 1
121 kertas lakmus pack 0 0 0 0 0 0
122 kertas lensa lembar 0 0 0 0 0 0
123 kolesterol stik btl 10 test 1/31/2021 22 0 22 0 0 22
124 lar. benedict btl 100ml 6/3/2036 0 0 0 0 0 0
125 lar. eosin 2% btl 7/6/2020 1 0 1 0 0 1
126 lar. etanol asam btl 100ml 6/6/2020 57 0 57 0 0 57
127 lar. hypoklorit btl 1L 46 0 46 0 0 46
128 lar. karbol fuchsin btl 100ml 11 0 11 0 0 11
129 lar. metilen biru btl 100ml 0 0 0 0 0 0
130 larutan KOH btl 100ml 6 0 6 0 0 6
131 larutan Turk btl 100 ml 1/1/2023 0 0 0 0 0 0
132 larutan Poch-Pack L botol 11/1/2020 0 0 0 0 0 0
133 larutan Poch-Pack D botol 0 0 0 0 0 0
134 masker N95 box 12/1/2020 0 0 0 0 0 0
135 metanol botol 7/6/2020 0 0 0 0 0 0
136 minyak imersi btl 100ml 1 0 1 0 0 1
137 natrium citrat 3,13% btl 100ml 0 0 0 0 0 0
138 natrium citrat 3,8% btl 250ml 6/6/2019 5 0 5 0 0 5
139 paket gol. Drh anti AB paket 9 0 9 0 0 9
140 paket gol. Drh anti B paket 10 0 10 0 0 10
141 paket gol.drh anti A paket 1/6/2022 8 0 8 0 0 8
142 ress Ecker btl 100ml 1/6/2022 0 0 0 0 0 0
143 stik urinalisis 10 parameter botol 4/1/2021 15 0 15 0 0 15
144 Stomalizer Pcs 4/8/2020 0 0 0 0 0 0
145 thermal paper 57mm x 30 m roll 7/6/2020 7 0 7 0 0 7
146 tissu lensa pak 0 0 0 0 0 0
147 trigliserida botol 0 0 0 0 0 0
148 xylol btl 100ml 9/6/2019 3 0 3 0 0 3
149 yellow tip pak 2 0 2 0 0 2
150 Lisol btl 0 0 0 0 0 0
151 Larutan Nacl 0,86% botol 9/6/2019 5 0 5 0 0 5
Mengetahui/Menyetujui,
Kepala Puskesmas Tegal Barat
dr. Bambang Kuswanto

NIP.19651107 200212 1 004
KRATON MR UGD sisa akhir mar 20 stok awal maret 20
0 0 0
0 504 504
0 0 0
0 80 80
70 192 90 1451 1830 379
0 0 0
20 20 20 0
0 24 24
0 168 168
2650 436 -2214
2400 0 -2400
0 23 23
0 0 0
0 0 0
17130 18740 1610
1667 1030 286 17263 11273 -5990
0 0 0
0 0 0
1307 910 545 11482 6978 -4504
6 10 166 156 -10
0 0 0
24 240 191 -49
90 906 816
0 0 0
0 0 0
869 392 300 31701 40779 9078
60 944 2320 1376
950 494 609 4603 6406 1803
0 254 254
300 137 1407 1188 -219
120 199 432 1009 452 -557
5 11 12 448 425 -23
0 50 50
0 22584 22584
228 228 0
40 11 77 377 781 404
130 104 160 1824 2220 396
180 2456 0 -2456
29 20 38 246 276 30
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
101 120 19
40 102 133 31
0 47 47
0 0 0
1029 435 200 70542 53271 -17271

0 35 35
0 1008 1008
0 30 30
0 165 165
0 48 48
0 0 0
192 300 226 8788 8358 -430
390 390 0 -390
200 0 -200
215 8500 9542 1042

0 0 0
0 55 55
0 0 0
510 520 10
0 0 0
25 0 -25
0 0 0
0 0 0
0 800 800
0 0 0
0 0 0
0 0 0
52 240 236 3852 3494 -358
0 70 70
23 300 328 133 -195

80 117 3838 1722 -2116
15 14 434 206 -228
9 168 77 -91
0 0 0
3 2 22 8 -14
210 75 2763 2785 22
918 36253 0 -36253
0 3 3
0 0 0
294 294 24864 24570
0 200 200
0 0 0
0 440 440
0 5 5
17 19 42 232 135 -97
140 450 310
62 73 135 62 -73
3 24 21 145 103 -42
0 0 0
0 0 0
10 6010 0 -6010
0 0 0
5 14 9
0 0 0
107 407 0 -407
0 0 0
0 0 0
1071 625 268 28724 26564 -2160
0 0 0
192 408 3169 3021 -148
380 3773 3393
80 243 2990 3228 238
8 5 212 239 27
0 0 0
0 0 0
0 0 0
892 1126 234
0 0 0
0 0 0
20 27 85 58
10 13 13 115 210 95
487 407 231028 261490 30462
0 0 0
0 0 0
0 0 0
1122 366 315 12275 12578 303
154 4754 5076 322
42 18 8 341 360 19
243 387 144
0 0 0
0 1780 1780
0 728 728
50 996 1018 22
150 150 150 0
0 0 0
0 0 0
100 2310 1854 -456
80 40 40 4255 40 -4215
1030 234 7624 7808 184
2180 2180 0
0 30 30
142 190 48
0 0 0
0 0 0
298 112 112 15896 14747 -1149
0 0 0
0 0 0
0 0 0
15 22 176 191 15
2320 136 508 14592 19187 4595
5 20 15
308 102 254 36550 38610 2060
0 490 490
42 182 938 756
230 2330 2100
10 151 86 -65
10 2 304 146 -158
0 0 0
10 37 313 0 -313
0 0 0
0 5 5
2790 366 382 166843 152383 -14460
103 63 -40
65 52 -13
0 0 0
0 70 70
100 0 -100
0 0 0
524 165 411 13928 44261 30333
266 130 49 5560 2800 -2760
0 6 6
0 6 6
0 0 0
879 2 293 12679 42164 29485
190 400 480 80
0 0 0
190 91 516 203 -313
0 10 10
0 0 0
0 0 0
0 0 0
0 0 0
160 20 -140
0 0 0
320 444 2802 2696 -106
431 431 0 -431
10 455 679 224
244 452 134 2422 2850 428

0 0 0
0 0 0
0 0 0
0 0 0
1 8 128 86 -42
420 606 321 28823 29402 579
608 608 120 -488
0 0 0
278 67 -211
566 294 78 3293 44502 41209
0 0 0
0 0 0
0 10 10
0 12 12
0 0 0
0 0 0
64 64 0 -64
140 348 2668 2332 -336
1094 761 600 32390 41300 8910

0 0 0
0 0 0
192 280 17672 8310 -9362
0 10 10
186 4366 0 -4366
0 0
0 8 8
0 12 12
0 6 6
0 16 16
0 18 18
0 21 21
0 0 0
0 0 0
0 28 28
0 7 7
0 6 6
0 0 0
0 37 37
0 12 12
0 11 11
0 0 0
507 200 23587 11206 -12381
223 15 3583 3301 -282
0 254 254
0 56 56
0 0 0
1000 1000 0
0 0 0
0 0 0
0 0 0
6170 5655 -515
4660 4310 -350
0 0 0
14 4 24 180 123 -57
1 1 1 0
0 1400 1400
2 76 5 -71
0 0 0
48 93 10 -83
0 295 295
44 106 62
0 10 10
0 0 0
0 5 5
0 0 0
0 0 0
0 0 0
230 4000 208 25468 0 -25468
169 866 2946 2080
0 43 43
0 0
0 0 0
0 0 0
0 0 0
0 0 0
30 2054 2080 26
0 0 0
0 0 0
90 300 433 133
0 0 0
0 0 0
492 0 -492
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 300 300
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
900 470 -430
0 0 0
0 0 0
0 34 34
25 40 15
30 24 -6
10 0 -10
30 0 -30
50 0 -50
50 0 -50
50 0 -50
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 200 200
100 0 -100
6100 2100 -4000
400 1700 1300
3800 1200 -2600
0 2 2
0 0 0
0 0 0
0 0 0
0 0 0
0 79 79
0 0 0
108 9 -99
0 6 6
0 0 0
6 6 0
0 0 0
0 0 0
229 94 -135
230 140 -90
0 0 0
0 0 0
0 13 13
0 0 0
0 42 42
140 37 -103
0 18 18
0 59 59
0 18 18
0 0 0
0 1 1
0 0 0
5 15 10
15 0 -15
4 6 2
16 18 2
0 4 4
0 6 6
0 0 0
0 0 0
0 0 0
18 0 -18
0 50 50
62 0 -62
0 0 0
216 225 9
0 0 0
0 57 57
0 2 2
0 4 4
0 5 5
0 0 0
0 17 17
48 4 -44
0 23 23
0 0 0
0 0 0
0 0 0
0 4 4
0 60 60
0 8 8
0 37 37
0 0 0
0 0 0
0 0 0
0 35 35
0 0 0
0 6 6
0 0 0
0 0 0
0 1 1
0 1 1
0 0 0
0 3 3
0 160 160
0 0 0
0 2 2
0 9 9
0 0 0
0 0 0
0 0 0
0 0 0
0 15 15
0 14 14
0 0 0
0 10 10
0 0 0
0 0 0
0 29 29
0 31 31
0 11 11
0 0 0
0 0 0
0 1 1
0 0 0
0 0 0
0 22 22
0 0 0
0 1 1
0 57 57
0 46 46
0 11 11
0 0 0
0 6 6
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 1 1
0 0 0
0 5 5
0 9 9
0 10 10
0 8 8
0 0 0
0 15 15
0 0 0
0 7 7
0 0 0
0 0 0
0 3 3
0 2 2
0 0 0
0 5 5
NOMOR :
KOTA : TEGAL
PENGELUARAN
STOK AWAL PENERIMAAN JUMLAH
NO NAMA BARANG SATUAN TANGGAL ED PEMAKAIAN RUSAK/ED
(A) (B) (A+B) (A+B)-(K) (D)

Obat-obatan ( PKD ) Umum
1 Etanol 70% btl 1000ml 22 0 22 0
2 handscoon obgyn pcs 1/7/2021 0 0 0 0
3 handscoon Uk M pcs 5/1/2021 21700 0 21700 0
4 handscoon Uk S pcs 5/1/2021 23000 0 23000 0
5 masker pcs 30/04/2021 9500 1000 10500 500
6 Seltifort kids (vit syrup) btl 60ml 5/31/2020 138 0 138 36
7 4/1/2022
Sianokobalamin tab (vit B12) tab 50 mcg tablet 28514 0 28514 0
8 Thiamin HCl 50mg (vit. B1) tablet 5/1/2022 36890 0 36890 5799
9 Vit. B kompleks tablet 1/31/2020 17692 0 17692 518
10 Zinc dispersibel 20mg tablet 12/1/2019 4690 0 4690 810
Kepala Puskesmas Tegal Barat Petugas Kefarmasian
dr. Bambang Kuswanto Nurul Ardi Anti, S.Far., Apt

NIP.19651107 200212 1 004 NIP. 19830519 201101 2 009
T (LPLPO)
PELAPORAN : APRIL 2020
STOK SUMBER DANA

STOK AKHIR OPTIMU PERMINT PEMBERI PROG HIBA LAIN KETERANGAN
AAN AN DAK APBD
M RAM H NYA
(L)
pakai sisa pakai 2
22 0 0 0 22 0 0
0 59.04 138 17 102 -102 -102
21700 3280 28514 1002 38217 -16517 -16517
23000 9510.36 36890 2296 31091 -8091 -8091
10000 849.52 17692 298 17174 -6674 -6674
102 0 0 138 138
28514 1328.4 ed 20219 4690 125 3880 24634 24634

31091 0 230 230 36660 36660
17174 0 217 218 17474 17474
3880 0 0 77 4613 4613
armasian
ti, S.Far., Apt

201101 2 009
stok optimum
0 0 0 0 0
36 1.44 7.2 14.4 59.04
2000 80 400 800 3280
5799 231.96 1159.8 2319.6 9510.36
518 20.72 103.6 207.2 849.52
0 0 0 0 0
810 32.4 162 324 1328.4

0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
NOMOR :
KOTA : TEGAL
PENGELUARAN
STOK
TANGGAL STOK AWAL PENERIMAAN JUMLAH
AKHIR
NO NAMA BARANG SATUAN PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
1 Etanol 70 %( One Med alcohol) botol 1 L 0 22 0 22 8 14

2 handscoon obgyn pcs 1/7/2021 77 0 77 0 77
3 handscoon Uk M pcs 5/1/2021 21700 0 21700 1000 20700
4 handscoon Uk S pcs 5/1/2021 23000 0 23000 1300 21700
5 masker pcs 30/04/2021 10000 0 10000 1000 9000
6 Seltifort kids (vit syrup) btl 60ml 5/31/2022 102 10 112 0 112
7 Sianokobalamin tab (vit B12) tab 50 4/1/2022
mcg tablet 28514 0 28514 0 28514
01/05/2023
8 Thiamin HCl 50mg (vit. B1) tablet 31091 2000 33091 0 33091
01/05/2022
9 Vit. B kompleks tablet 31/02/2021 17174 8200 25374 1030 24344
10 Zinc dispersibel 20mg tablet 12/1/2020 3880 0 3880 125 3755
0

NIP.19651107 200212 1 004 NIP. 19830519 201101 2 009
NOMOR :
KOTA : TEGAL
PENGELUARAN STO
STOK
AKHIR
OPTIM
NO NAMA BARANG SATUAN PEMAKAIAN RUSAK/ED M
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)

3 handscoon Uk M pcs 5/1/2021 21700 0 21700 1000 20700
4 handscoon Uk S pcs 5/1/2021 23000 0 23000 1300 21700 849
5 masker pcs 30/04/2021 10000 0 10000 1000 9000
6 Seltifort kids (vit syrup) btl 60ml 5/31/2022 102 10 112 0 112 13
mcg tablet 28514 0 28514 0 28514 45
01/05/2023
8 Thiamin HCl 50mg (vit. B1) tablet 31091 2000 33091 0 33091
01/05/2022
0

NIP.19651107 200212 1 004 NIP. 19830519 201101 2 009
Lampiran 21. Laporan Bulanan Persediaan Dan Kebutuhan Logistik COVID-19
KODE :
INSTANSI : PUSKESMAS TEGAL BARAT
NAMA PENANGGUNGJAWAB/ HP : Nurul Ardi Anti, S. Far., Apt / 087785477033
BULAN/TAHUN : MARET - MEI / 2020
NO NAMA BARANG SATUAN PERSEDIAAN KEBUTUHAN
1 BOOTS KUNING PASANG 11 0

2 BAJU HAZMED (coverall+covershoes) SET 120 0
3 COVERALL BOHO BUAH 6 0
4 COVERALL PARASUT PUTIH BUAH 3 0
5 COVERALL PVC BUAH 4 0
6 COVERALL SPONBOUND JINGGA BUAH 3 3
7 COVERALL SPONBOUND PUTIH BUAH 61 0
8 COVERALL SPONBOUND TOSCA BUAH 10 0
9 COVERALL TYVEX BUAH 15 0
10 FACE SHIELD BUAH 11 0
11 GLOVE KUNING MULTIPURPOSE PASANG 11 0
12 GOGGLE BUAH 5 0
13 HAIRNET BUAH 6 0
14 HAND SANITIZER 5 L BOTOL 5 0
15 HAND SANITIZER 500 ML BOTOL 9 0
16 HANDSCOEN PENDEK DISPO BUAH 3 0
17 KN-95 BUAH 10 0
18 MASKER BEDAH PCS 300 0
19 MASKER BEDAH EARLOOP BUAH 7 0
20 MASKER BEDAH EARLOOP BOX (50PCS) 1 0
21 MASKER BEDAH EARLOOP (TANPA BOX BUAH 35 0
22 MASKER BEDAH SENSI BUAH 20 0
23 MASKER SPONBOUND PUTIH BUAH 50 0
24 N95 PUTIH BUAH 5 0
25 PAKET APD LENGKAP SET 20 0
26 SHOE COVER BUAH 3 0
27 SURGICAL GLOVES PASANG 9 0
28 THERMOGUN BUAH 2 0
32 COVERALL BUAH 2 0
33 MASKER EVOPLUSMED BUAH 50 0
35 HAND SANITIZER LIQUID BOTOL (1LITER) 1 0
36 SABUN CUCI TANGAN BOTOL (1LITER) 1 0

40 COVERALL PVC BUAH 20 20
41 MASKER BEDAH EARLOOP PACK (10PCS) 10 0
42 COVERALL SPONBOUND JINGGA BUAH 5 5
44 COVERALL SPONBOUND MAROON BUAH 3 0
49 KN-95 BOX (10PCS) 2 0
50 MASKER HIJAB BOX (50PCS) 5 0
53 COVERALL KALTECH BUAH 15 0
54 COVERALL PARASUT MERAH BUAH 20 0
56 PONCO PARASUT BIRU BUAH 15 0
58 BOOTS KUNING PASANG 3 0
61 GLOVE MULTI PURPOSE PASANG 3 0
Tegal, 1 Juni 2020

Kepala Puskesmas
Tegal Barat
dr. Bambang Kuswanto

NIP, 19651107 200212 1 004
NOMOR :
KOTA : TEGAL
PENGELUARAN
PEMAKAIAN RUSAK/ED
NO NAMA BARANG SATUAN ED
(A) (B) (A+B) (A+B)-(K) (D)
1 Asetosal 100 mg tablet 0 0 0 0
2 Albendazol tab 400 mg tablet 554 0 554 0
3 Albendazol sirup 200 mg/5 ml botol 0 0 0 0
4 Allopurinol 300 mg tablet 0 0 0 0
5 Alopurinol tablet 100 mg tablet 849 0 849 337
01/08/2021
6 Aminofilin inj 24mg/ml ampul 0 0 0 0
7 Aminofillin 150 mg tablet 5/13/2020 0 0 0 0
8 Aminofillin 200 mg tablet 0 0 0 0
9 Amitriptyline tablet 5/1/2021 168 0 168 0
10 Amlodipin 5mg tablet 2400 0 2400 768
12 Amoksisilin drop 100 mg/ml btl 0 0 0 0
13 Amoksisilin serbuk injeksi 1000mg ampul 0 0 0 0
14
Amoksisilin sirup kering 125 mg/ 5 mg botol 0 0 0 0
15 Amoksisillin 250mg kaplet 11/1/2021 9500 0 9500 149
17
Amoksisillin sirup kering 250mg/5 ml botol 0 0 0 0
18 Ampisillin 500 mg kaplet 0 0 0 0
19 Antasida DOEN kombinasi tablet 1/1/2022 2754 0 2754 1611
20 Antasida DOEN suspensi btl 60ml 7/1/2021 116 0 116 24
21 Anti Bakteri DOEN saleb kombinasi
(Bacitracin) tube 0 0 0 0
23 Antifungi DOEN Kombinasi pot 5/1/2021 216 0 216 0
24 Antihemoroid DOEN supp 12/1/2020 748 0 748 21
25 Antiparkinson DOEN tablet 0 0 0 0
26 Aqua pro injeksi steril vial 0 0 0 0
28 Asam askorbat 50mg tablet 7/1/2020 26859 0 26859 2277
29 Asam folat 1 mg (MARIN) tablet 9/1/2020 30 0 30 30
30 Asam mefenamat 500mg tablet 7/31/2022 2977 0 2977 949
31 Asam traneksamat 100mg tblt 180 0 180 20
32 Asiklovir 200mg tablet 2/1/2022 1308 0 1308 0
34 Asiklovir krim 5% tube 8/1/2022 495 0 495 2
Atropin injeksi I m/lv/s.k.0,25 mg/ml ampul 7/31/2020
36 (sulfat) 0
0 0 0
37 Attapulgit 600mg (New Antides) tablet 6/1/2020 21192 0 21192 346
38 Azitromisin 500 mg tablet 1/9/2020 208 0 208 1
39 Bedak salisil 2% dus@50gr 4/1/2022 491 0 491 28
40 Besi (II) sulfat 200 mg kombinasi tablet 6/5/2020 844 0 844 202
41 Betahistin mesilat 6mg tablet 9/1/2021 1720 0 1720 250
42 Betametason krim 0,1% tube 1/1/2021 166 0 166 39
43 Bisakodil 5 mg tab.salut 0 0 0 0
44 Bisakodil supp 5 mg (DULCOLAX
INFANT) supp 0 0 0 0
45 Bisakodil supp 10 mg supp 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
NO NAMA BARANG SATUAN
ED
(A) (B) (A+B) (A+B)-(K) (D)
46 Bisoprolol 5 mg tablet 0 0 0 0
47 Budesonide 0,25 mg/ml Pulmicort
Respules nebule 0 0 0 0
48 Cetirizin 10 mg tablet 4/1/2021 502 0 502 35
49 Cetirizine sirup 5mg/5ml botol 5/1/2020 0 0 0 0
50 Clobazam 10mg tablet 3/1/2021 53 0 53 0
51 Co Amoxiclav tablet 0 0 0 0
52 tablet dan
01/08/2020 20623 0 20623 1545 0
53 Dexamethason inj 5mg/ml ampul 0 0 0 0
54 Diazepam 2mg tablet 1/1/2021 0 0 0 0
57 Difenhidramin injeksi i.m 10mg/ml
(HCl) ampul 5/1/2020 0 0 0 0
58 Digoksin 0,25mg tablet 0 0 0 0
59 Diazepam injeksi 5mg/ml-1ml ampul 4/1/2020 0 0 0 0
60 Diltiazem HCl 30mg tablet 0 0 0 0
Dimenhidrinat 50mg 01/09/2020
61 tablet dan
01/06/2022 7795 0 7795 432
62 Doksisiklin 100mg kapsul 01/03/2021 0 0 0 0
63 Domperidon suspensi 5mg/ 5ml botol 6/1/2021 268 0 268 4
64 tablet dan
01/02/2021 5456 0 5456 70
65 Efedrin tablet 0 0 0 0 0
ampul 12/12/2020
66 Epinefrin (Adrenalin) injeksi 0,1%
(sebagaiHCL) 20 0 20 0 0
67 Ergotamin 1mg+kofein 50mg tablet 0 0 0 0
68 Eritromisin 500mg kapsul 4/1/2021 510 0 510 34
69 Etakridin 0,1% btl 0 0 0 0
70 Etanol 70% btl 100ml 22 0 22 11
71 Fenitoin Na 30mg (DECATONA) tablet 0 0 0 0
72 Fenobarbital inj 50mg/ml ampul 62 0 62 0
73 tablet dan
01/11/2021 800 0 800 0
74
Fenoksimetil Penisilin tablet 250 mg tablet 0 0 0 0
75 Fitomenadion (Vit. K1) injeksi 10
mg/ml ampul 0 0 0 0
76 Fitomenadion (Vit. K1) injeksi i.m 2
mg/ml ampul 9/30/2019 0 0 0 0
77 Fitomenadion 10mg tab salut 8/23/2020 3355 0 3355 44
78 Flufenazine Decanoat inj 25 mg/ml ampul 6/1/2020 70 0 70 0
04/01/2020
79 dan
Furosemid 40 mg tablet 01/02/2021 28 0 28 28
80 Garam Oralit I serbuk sachet 8/1/2022 5561 0 5561 98
81 Gentamisin Salep kulit 0,1% tube 7/1/2023 661 0 661 15
82 Gentamisin TM 0,3% botol 5/6/2022 284 0 284 0
83 Gentamisin injeksi ampul 0 0 0 0
84 Gentian Violet larutan 1% botol 18 0 18 2
85 Glibenklamid 5mg tablet 3/23/2023 2140 0 2140 330
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
86 Gliseril Guaiakolat 100mg tablet 1/4/2021 25200 0 25200 417
87 GOM btl 8ml 9/1/2021 0 0 0 0
88 Griseofulvin 125 mg tablet 2/1/2020 0 0 0 0
89 Guaifenesin 100 mg tablet 7/1/2022 49424 0 49424 63
90 Haloperidol 5mg tablet 01/02/2020 0 0 0 0
91 Haloperidol 1,5 mg tablet 10/30/2019 0 0 0 0
92 Haloperidol 2 mg tablet 8/1/2020 425 0 425 0
93
Haloperidol Deconat injeksi 50 mg/ml ampul 1/1/2020 7 0 7 0
94 Hidrokortison Krim 2,5% tube 3/1/2021 284 0 284 5
95 Hidroklorthiazid 25 mg tablet 9/1/2022 6 0 6 0
96 Hyosin Nbutilbromid 10mg tablet 11/1/2020 73 0 73 0
97 Ichtyol pot 15gr 7/1/2022 146 0 146 4
98 INH 100mg tablet 0 0 0 0
100 Ibuprofen 200mg tablet 9/1/2021 10882 0 10882 70
101 Ibuprofen 400mg tablet 0 0 0 20
102 Ibuprofen suspensi 100mg/5ml botol 0 0 0 0
104 Isosorbid Dinitrat Tablet sublingual 5
mg tablet 307 0 307 0
105 Kalium Aspartat 300mg tablet 0 0 0 0
106 Kalium Klorida 600mg tablet 0 0 0 0
107 Kalsium laktat 500mg tablet 2/1/2020 13100 0 13100 1640
108 Kaolin Pektin (New Diaform) tablet 6/1/2022 0 0 0 0
109 Kaptopril 12,5mg tablet 11/21/2021 536 0 536 536
110 Kaptopril tablet 25 mg tablet 11/16/2021 40 0 40 14
111 Ketokonazol 200mg tablet 01/05/2021 2775 0 2775 74
112 Ketokonazol krim 2% tube 8/31/2021 167 0 167 16
113 Ketorolac injeksi 10mg ampul 0 0 0 0
114 Klindamisin 150mg tablet 0 0 0 0
115 Klonidin 0,15 mg tablet 0 0 0 0
116 Kloramfenikol 250 mg kapsul 8/1/2023 820 0 820 34
117 Kloramfenikol TT 3% btl 0 0 0 0
118 Kloramfenikol suspensi 125mg/5 btl 60 ml 0 0 0 0
119 Kloramfenikol salep kulit (Bufacetine)
2% tube 5/1/2021 7 0 7 6
120 Klorampenikol TM 0,5% (RECO) btl 10/31/2020 96 0 96 21
121 01/03/2021
dan
01/04/2022 244919 0 244919 4889
122 Klorpromazine tablet 0 0 0 0
123 Kodein 10mg tablet 0 0 0 0
124 Kodein 20mg tablet 6/30/2021 0 0 0 0
125 Kotrimoksazol DOEN dewasa tablet 6/1/2020 11450 0 11450 513
126 Kotrimoksazol FORTE tablet 11/1/2021 1900 0 1900 0
127 Kotrimoksazol suspensi kombinasi botol 30/04/2020 265 0 265 10
128 Lansoprazol 30 mg kapsul 1/1/2022 78 0 78 78
129 Levofloksasin 500mg kapsul 0 0 0 0 0
130 Lidokain 2%+adrenalin 0,0125mg ampul 12/1/2020 1780 0 1780 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
01/07/2020
lidokain 2%+Epinefrin 1:80000-2ml ,
131 ampul 01/11/2020
&01/11/202 480 0 480 0 0
2
132 Linkomisin 500mg kapsul 8/1/2020 946 0 946 10
133 Loratadin tablet 4/1/2020 60 0 60 60
134 Mebendazol sirup 100 mg/5 ml botol 0 0 0 0
135 Mebendazol tablet tablet 0 0 0 0
136 Meloksikam 15mg tablet 31/06/2021 3969 0 3969 387
137 Metformin 500mg tablet 1/3/2020 0 0 0 0
138 Methampiron 500mg tablet 7/1/2022 14280 0 14280 835
Metilergometrin Maleat tab salut
0,125 mg
139 01/02/2021
&
tablet 01/05/2021 1960 0 1960 0
140 Metilergometrin inj 0,2 mg/ml ampul 11/30/2020 7 0 7 0
141 Metoklopramid 5 mg tablet 126 0 126 0
142 Metoklopramide injeksi 5 mg/ml ampul 0 0 0 0
143 Metronidazol 500mg tablet 0 0 0 0
144 Metylprednisolon 4 mg tablet 4/1/2022 18009 0 18009 1569
145 Metylprednisolon 8 mg tablet 0 0 0 0
146 Mg Sulfat injeksi 20% ampul 9/1/2019 0 0 0 0
147 Mg Sulfat injeksi 40% ampul 0 0 0 0
148 Mikonazol krim 2% tube 2/1/2021 182 0 182 33
149 N-asetil sistein 200 mg kapsul 4/8/2020 1765 0 1765 445
150 NaCl infus btl 500ml 45 0 45 0
151 01/12/2020
&
Nadifen 50 mg tablet 22/05/2021 33843 0 33843 1511
152 tablet dan
01/03/2021 200 0 200 0
153 Nistatin tablet salut 500.000 IU tablet 8/1/2019 112 0 112 24
Nistatin Vag 100.000 IU/g ovula
154 2313
18/11/2020 0 2313 15
155 OBH botol 01/03/2022 225 0 225 24
156 Oksitetrasiklin HCl salep kulit 3 % tube 9/1/2021 204 0 204 53
157 Oksitetrasiklin HCl salep mata 3 % tube 0 0 0 0
158 Omeprazol 20mg kapsul 6/1/2021 480 0 480 321
159 Omeprazol injeksi ampul 0 0 0 0
160 Ondancentron inj ampul 4/1/2021 0 0 0 0
161 Parasetamol 500mg tablet 1/1/2022 81394 0 81394 5394 0
162 Parasetamol sirup 120mg/5ml botol 60ml 1/1/2022 295 0 295 20
163 Parasetamol drop btl 15 ml 8/24/2020 14 0 14 5
164 Pehacain injeksi ampul 0 0 0 0
165 Permetrin (Scabimite) krim 5% tube 7/1/2020 63 0 63 9
166 Pirantel tab.score base 125mg tablet 8/30/2020 0 0 0 0
167 Pirantel Pamoat susp 125mg/5ml botol 0 0 0 0
168 Piridoksin 10mg (vit. B6) tablet 9/1/2020 39546 0 39546 757
169 Piroksikam 10mg tablet 5/1/2021 7953 0 7953 354
170 Polikresulen cairan btl 10ml 6/3/2036 6 0 6 0
171 Povidon Iodin 10% btl 30 ml 11/1/2019 203 0 203 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
172 Povidon Iodin 10% btl 300ml 2/1/2020 4 0 4 0
173 Prednison 5mg tablet 7/1/2021 10858 0 10858 565
174 Propanolol 10mg tablet 210 0 210 0
175 Propiltiurasil tablet 100mg tablet 0 0 0 0
176 Ranitidin 150mg tablet 8/31/2020 0 0 0 0
Ranitidin inj 25mg/ml ampul
177 0
30/03/2021 0 0 0
178 Reserpin tablet 0,10 mg tablet 0 0 0 0
179 Respiredon 2 mg tablet 3/1/2021 0 0 0 0
180 Retinol ( Vitamin A ) kapsul 100.000 IU kapsul 0
kapsul lunak 0 0 0
kapsul lunak 0 0 0
182 Ringer Laktat infus 23/01/2022
btl 500ml 01/07/2023 120 0 120 0
183 Rivanol 300 ml botol 0 0 0 0
184 Salbutamol 2 mg tablet 3/31/2023 2758 0 2758 363
186 Salep 2-4 kombinasi pot 7/1/2021 496 0 496 8
03/01/2020
187 dan
Sefadroksil 500mg kapsul 01/10/2020 940 0 940 140
188 Sefadroksil sir.kering 125mg/5 btl 60ml 0 0 0 0 0
189 Sefiksim 100mg kapsul 0 0 0 0 0
190 Sefotaksim inj 1g/vial vial 0 0 0 0 0
191 Seftriakson 1g/vial vial 0 0 0 0 0
mcg tablet 28514 0 28514 1450
194 Simetidin 200mg tablet 10/1/2020 148 0 148 88
195 Simvastatin 10mg tablet 0 0 0 0
196 Simvastatin 20mg tablet 03/05/2020 0 5000 5000 171
197 Siprofloksasin 500mg tablet 9/1/2020 2108 0 2108 721
198 Spiramisin 500mg tablet 0 0 0 0
199 Stesolid 10 mg injeksi ampul 0 0 0 0
200 Stesolid supp 10mg Tube 3/1/2022 10 0 10 0
202 Sulfasetamid TM 15% botol 0 0 0 0
203 Terbutalin sufat 2,5mg tablet 0 0 0 0
204 Tetrasiklin 250mg kapsul 0 0 0 0
205 Tetrasiklin kapsul 500 mg kapsul 3/1/2021 2721 0 2721 0
206 Thiamin HCl 50mg (vit. B1) tablet 01/05/2023
01/05/2022 33091 0 33091 2651
207 Tiamfenikol kapsul 500mg kapsul 0 0 0 0
208 Triheksifenidil 2mg tablet 0 0 0 0
210 Zinc sirup botol 01/03/2020 0 0 0 0
n Obat-obatan ( PKD ) Gigi 0 0 0 0
1 Bahan tumpatan sementara
(CAVITON) kotak 11/6/2019 2 0 2 0
2 Chlor Fenol Kamfer Menthol (CHKM)
gigi botol 3/31/2022 10 0 10 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
3
Devitalisasi pasta non arsen (Pulp x) kotak 4/1/2022 6 0 6 0
botol
4 01/11/2020
&
Eugenol cairan 01/08/2039 16 0 16 0
5 Kalsium hidroksida (Hycal) 7 gram 8/1/2021 18 0 18 0
6 Mata bor gigi standar set/6 biji 1/6/2022 1 0 1 0
7 Mata bor gigi high speed set/6 biji 0 0 0 0
Mummifying Pasta/ Iodoform Pasta kotak 7/1/2021
8 gigi 0
0 0 0
9
Pasta pengisi saluran akar(CRESOTIN) set 10/1/2020 28 0 28 0
10 Poliren (OCO) polishing pasta btl 15gr 7/1/2021 7 0 7 0
Semen seng fosfat serbuk dan cairan
11 gigi botol 10/31/2020 8
0 8 0
12 Tambalan sementara untuk gigi kotak 1/1/2020 0
28gr(3M ESPE Cavit G) 0 0 0
Tambalan tetap gigi (Glass kotak 4/1/2022
13 Ionomer,fuji) 35
0 35 0
Tricresol formalina (TKF) kotak 31/09/2021
14 12
0 12 0
15 Komposir resin (Master fill) kotak 2/1/2022 11 0 11 0
Obat-obatan ( PKD ) Penunjang 8/1/2020 0 0 0 0
1 Ambroksol 30 mg tablet 7/1/2021 35044 0 35044 618
2 Antiflu tab.kombinasi (Brocifar) tablet 6/1/2021 5727 0 5727 307
3 Asam Tranexamat inj.500mg/ml ampul 1/1/2021 0 0 0 0
4 Calsium Gluconnat Injeksi ampul 11/1/2019 0 0 0 0
5 BIOSAT 1,5 Serum anti tetanus inj
1500IU/ml ampul 8/1/2019 0 0 0 0
6 Bromheksin HCl 8 mg tablet 8/1/2021 1000 0 1000 0
7 Ekstrak sonchi Folium 100% kapsul 4/1/2022 0 0 0 0
8 Etanol 70 %( One Med alcohol) botol 1 L 0 0 0 0 0
9 Fenoterol MDI 100 mcg/ 10ml fls 7/31/2020 0 0 0 0
10 Glimepirid 1mg 5/1/2022 5880 0 5880 1090
11 Glimepirid 2mg 4/1/2022 4770 0 4770 940
12 Kloramfenikol inj vial 4/1/2020 0 0 0 0
13 Kloramfenikol Salep mata 1% tube 5 gr 1/1/2022 145 0 145 10
14 Levertran15 g pot 15gr 01/02/2020 1 0 1 0
(Neuroval) 946 0 946 48
16 Obat anti flu sirup (Betaflu) botol 6/1/2021 158 0 158 1
17 Obat batuk Kombinasi (Fenidryl) sirup 7/1/2022 0 0 0 0
18 Obat batuk kombinasi (Dextral) tablet 7/1/2021 1447 0 1447 280
19 Oksitosin injeksi ampul 4/1/2020 0 0 0 0
20 Phenol gliserol tetes telinga botol 0 0 0 0 24
21 Salbutamol nebules(Salbutamol ampul 9/4/2020 0
2,5mg/2,5 ml NaCl) 0 0 0
22 Salep bisul pot 7/1/2020 0 0 0 0
23 Salep luka bakar (Neocenta gel) tube 15gr 0 4 0 4 0
24 Tab. Curcuma 20mg tablet 0 0 0 0 0
25 Teofilin syrup 43,33 mg/ 5 ml botol 0 0 0 0 0
26 Terapi Diare sirup btl 60ml 0 0 0 0
27 Terapi Diare tab tablet 8/1/2020 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
28 Vit neurotropik tablet 9/1/2022 0 0 0 0
29 Etil klorid semprot Spray 7/1/2020 42 0 42 0
iaan Obat Asli Indonesia 0 0 0 0
1 Extrak Belladon tab 10 mg tablet 0 0 0 0 0
2 Enkasari 120 ml botol 0 0 0 0
3 Fitogen tablet 0 0 0 0 0
4 Ferris botol 0 0 0 0 0
5 Hemorogard kapsul 8/1/2020 1930 0 1930 22
6 Hepagard kapsul 0 0 0 0
7 Minyak telon botol 50 ml 0 0 0 0 0
8 Tensigard kapsul 0 90 0 90 20
Obat dan Alkes PROGRAM 0 0 0 0
1 Diethylcarbamazine (DEC) 100 mg tablet 0 0 0 0 0
2 Albendazol tab 400 mg tablet 0 0 0 0 0
3 MDT Combi MB Adult blister 0 0 0 0 0
4 MDT Combi MB Child blister 0 0 0 0 0
5 MDT Combi PB Adult blister 0 0 0 0 0
7 MDT Combi PB Child blister 0 0 0 0 0
8 Obat Anti Tubercolusis kategori 1 FDC 0 0 0 0 0
9
Obat Anti Tubercolusis kategori anak FDC 0 0 0 0 0
10 Box slide pcs 0 0 0 0 0
11 Pot sputum
01/04/2022
pot 01/03/2024 1500 0 1500 0
12 Reagen BTA ( Ziehl Nelsen ) paket 0 0 0 0 0
13 Prokain Benzil Penisilin 3 jt IU vial 0 0 0 0 0
14 Depo Progestin/ suntik KB 3 bulan vial 0 0 0 0 0
15 Mineral Mix sachet 0 0 0 0 0
16 safety box 2,5 lt pcs 0 0 0 0 0
17 safety box 5 lt pcs 0 0 0 0 0
18 spuit 0,5 ml pcs 0 0 0 0 0
an ALKES Habis Pakai (PKD) 0 0 0 0
1 ADS 0,05ml pcs 4/1/2023 300 0 300 0
2 Blood Lancet box 8/1/2021 470 0 470 0
3 Cryotube 1.8 ml pcs 0 0 0 0 0
4 Cover Glass 22x22 mm box 3/1/2022 0 0 0 0
5 Deck Glass box/72pcs 0 0 0 0 0
6 E Care Handrub 500 ml botol 3/1/2020 11 0 11 0
7 Folley Catheter No.16 buah 11/1/2022 30 0 30 0
8 Folley Catheter setara Rush No.18 buah 12/1/2022 10 0 10 0
9 IV Catheter 18 G pcs 12/31/2023 50 0 50 0
10 IV Catheter 24 G pcs 1/31/2023 108 0 108 0
11 IV Catheter 22 G pcs 3/31/2024 108 0 108 0
12 IV catheter 20 G pcs 31/02/2024 70 0 70 0
13 Kapas 100 gr rol 0 0 0 0 0
14 Kasa 4m x 15 cm elastis roll 0 0 0 0 0
15 Kertas ECG Ukuran Besar roll 0 0 0 0 0
16 Kertas ECG Ukuran Standar roll 0 0 0 0 0
17 Pembalut Gips Uk. 3" roll 0 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
20 Plester 5 yard x 2 inchi roll 0 0 0 0 0
21 Pot Urine (pot sputum) bh/d.5,5cm 4/1/2022 0 0 0 0
22 Spuit 0,05 ml pcs 0 0 0 0
23 Tensocrepe 4" buah 0 0 0 0 0
25 Wing Needle No. 21G buah 0 0 0 0 0
26 Wing Needle No. 25G buah 1/1/2020 0 0 0 0
27 alat suntik 1 ml pcs 11/1/2020 0 0 0 0
31 alkohol swab pcs 10/1/2021 0 0 0 0
32 aquadest botol 1 L 6/3/2036 0 0 0 0
33 Alkapram septalkan spray botol 7/1/2021 0 0 0 0
34 Alkapram alkacide 1 L botol 7/1/2020 0 0 0 0
35 Alkapharm alkazyme 25mg sachet 5/1/2021 0 0 0 0
36 bisturi kecil pcs 1/12/2020 65 0 65 0
37 bioplacenton tulle pcs 0 0 0 0
38 catgut cromic 2/0 box 30/12/2019 9 0 9 0
41 fixomul stretch 15cmx5m roll 28/07/2020 0 0 0 0
42 foley catheter No.14 pcs 7/1/2021 0 0 0 0
43 Gelang Bayi Pink pcs 2/1/2023 0 0 0 0
44 Gelang Bayi Biru pcs 2/1/2023 0 0 0 0
45 handscoon Uk S box 5/1/2021 217 0 217 21
46 handscoon Uk M box 5/1/2021 207 0 207 13
48 handscoon steril pasang 12/1/2022 0 0 0 0
49 hipafik 5x5 pcs 2/1/2021 3 0 3 0
50 hipafik 15x10 box 01/102020 16 0 16 1
51 infus set anak set/ktg 5/1/2021 50 0 50 0
52 infus set dewasa set/ktg 7/1/2022 207 0 207 0
53 jarum hect kulit luar besar (12 pcs) pcs 1/10/2021 15 0 15 0
54 jarum hect kulit luar kecil (12 pcs) pcs 1/5/2022 38 0 38 0
55
jarum hect kulit luar sedang (12 pcs) pcs 1/9/2022 9 0 9 0
56 jarum hect otot luar besar bks/12pcs 1/6/2023 0 0 0 0
57 jarum hect otot luar sedang bks/12pcs 9/6/2022 1 0 1 0
58 jelly EKG botol 0 0 0 0
59 kapas absorben 250 gr bks 10/1/2021 7 0 7 0
60 Kapas Berlemak 500 gr roll 9/1/2033 4 0 4 0
61 kasa hidrofil 2x80cm pcs 30/04/2021 0 0 0 0
62 kasa hidrofil 40x80cm roll 5/1/2023 0 0 0 0
63 kasa pembalut elastic 4m x 15cm roll 8/6/2021 0 0 0 0
65 kasa pembalut hidrofil 4 m x 10cm roll 10/1/2033 0 0 0 0
66 kasa hidrofil steril 18x22 roll 10/1/2021 0 0 0 0
67 kasa kompres 40x40 steril roll 8/1/2021 0 0 0 0
68 kasa steril 16x16 cm box 11/1/2020 0 0 0 0
69 kertas gol.darah pak/100's 1/6/2022 0 0 0 0
70 kertas tissu gulung 0 0 0 0
06/01/2022
71 klem tali pusat pcs 0 0 0 0
72 masker box/50pcs 30/04/2021 200 0 200 48
73 Box Object Glass Grey and Orange box 3/1/2022 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
74 object glass box/72pcs 19/03/2021 0 0 0 0
75 Oxygen mask bayi (SERENITY) pcs 1/6/2022 8 0 8 0
76 Oxygen mask anak (SERENITY) pcs 1/7/2022 11 0 11 0
77 Oxygen mask dewasa (SERENITY) pcs 1/8/2022 9 0 9 0
78 Pita Lila pcs 1/6/2022 0 0 0 0
79 plester 5 yard 20 inch roll 19/02/2021 0 0 0 0
80 silk no 3/0 dg jarum bedah pcs 3/6/2037 0 0 0 0
81 spiritus btl / 1 liter 06/01/2022 4 0 4 0
82 spuit 0,5 ml pcs 4/1/2023 2100 0 2100 0
83 Stericline Indicator strip box 11/1/2022 0 0 0 0
84 Stericlin gusette 25x6,5cm roll 10/1/2022 0 0 0 0
85 tempat preparat BTA / cawan petri pcs 1/6/2022 0 0 0 0
86 tabung reaksi 1,5x10cm ktk/50pcs 0 0 0 0
87 test kehamilan box/50pcs 5/1/2020 0 0 0 0
88 tranfusi set dewasa pcs 3/31/2024 50 0 50 0
89 Wraping paper 50x50 box 12/1/2020 0 0 0 0
91 USG Gel 250 ml botol 1/31/2021 7 0 7 0
92 urin bag pcs 19/05/2021 22 0 22 0
93 Ammonium Oxalat Btl/100ml 8/1/2020 0 0 0 0
94 Asam Klorida 0,1 N btl/ 100 ml 0 0 0 0
95 pack/100
Blue Tip 0test 0 0 0 0
96 BD Tube EDTA plh 13 x 75 box 5/1/2021 0 0 0 0
97 Cell pack bok 9/5/2020 0 0 0 0
98 Cuka diksi botol 5/1/2024 0 0 0 0
99 EDTA btl 100ml 0 0 0 0
100 Purple cup EDTA K3 3ml, glass box 6/1/2020 0 0 0 0
101 HbsAg test strip 0 0 0 0 0
102 Kertas Lensa lembar 0 0 0 0 0
103 Larutan Giemsa Stain botol 10/6/2019 0 0 0 0
104 Paket Gol. Darah Anti AB paket 3/6/2020 0 0 0 0
105 Paket Gol. Darah anti Resus paket 4/6/2020 0 0 0 0
106
Reagensia Uji Widal S para Typhi AH vial 12/1/2020 0 0 0 0
107 Reagensia Uji Widal Typhi H vial 7/6/2020 0 0 0 0
108 Reagensia Uji Widal Typhi O vial 2/28/2021 0 0 0 0
109 Reagen ZN paket 0 0 0 0
110 alkohol asam btl 100ml 0 0 0 0
111 asam sulfosalisilat btl 100ml 0 0 0 0
112 asam urat stick btl/25 test 31/04/2021 4 0 4 0
113 dempul hematokrit pcs 0 0 0 0
114 glukoprotein stik 10 parameter pck/100's 2/1/2020 0 0 0 0
115 glukoprotein urin test box/10 test 0 0 0 0 0
116 glukosa stik btl/25 test 11/7/2020 0 0 0 0
117 hemoglobin stik box/25 test 4 0 4 0
118 haemoglobulin C btl 500ml 11/19/2020 0 0 0 0
119 hayam btl 100ml 1/6/2022 0 0 0 0
120 Immersion Oil btl 100ml 1/6/2022 0 0 0 0
121 kertas lakmus pack 0 0 0 0
122 kertas lensa lembar 0 0 0 0
123 kolesterol stik btl 10 test 1/31/2021 5 0 5 0
124 lar. benedict btl 100ml 6/3/2036 0 0 0 0
125 lar. eosin 2% btl 7/6/2020 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
126 lar. etanol asam btl 100ml 6/6/2020 0 0 0 0
127 lar. hypoklorit btl 1L 0 0 0 0
128 lar. karbol fuchsin btl 100ml 0 0 0 0
129 lar. metilen biru btl 100ml 0 0 0 0
130 larutan KOH btl 100ml 0 0 0 0
131 larutan Turk btl 100 ml 1/1/2023 0 0 0 0
132 larutan Poch-Pack L botol 11/1/2020 0 0 0 0
133 larutan Poch-Pack D botol 0 0 0 0
134 masker N95 box 12/1/2020 0 0 0 0
135 metanol botol 7/6/2020 0 0 0 0
136 minyak imersi btl 100ml 0 0 0 0
137 natrium citrat 3,13% btl 100ml 0 0 0 0
138 natrium citrat 3,8% btl 250ml 6/6/2019 0 0 0 0
139 paket gol. Drh anti AB paket 0 0 0 0
140 paket gol. Drh anti B paket 0 0 0 0
141 paket gol.drh anti A paket 1/6/2022 0 0 0 0
142 ress Ecker btl 100ml 1/6/2022 0 0 0 0
143 stik urinalisis 10 parameter botol 4/1/2021 0 0 0 0
144 Stomalizer Pcs 4/8/2020 0 0 0 0
145 thermal paper 57mm x 30 m roll 7/6/2020 0 0 0 0
146 tissu lensa pak 0 0 0 0
147 trigliserida botol 0 0 0 0
148 xylol btl 100ml 9/6/2019 0 0 0 0
149 yellow tip pak 0 0 0 0
150 Lisol btl 0 0 0 0
151 Larutan Nacl 0,86% botol 9/6/2019 0 0 0 0
TAMBAHAN 0 0
1 Plester/tulling dress 10cm x10cm lembar 5/23/2023 92 0 92 0
2 Plastik klip obat 8,5cmx13cm kg 25 0 25 0
3 Plastik obat cetak etiket kg 25 0 25 0
4 Kantong puyer SCI box 1 0 1 0
0

NIP.19651107 200212 1 004 NIP. 19830519 201101 2 009
NOMOR :
KOTA : TEGAL
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR
OP
(A) (B) (A+B) (A+B)-(K) (D) (L)
1 Asetosal 100 mg tablet 0 0 0 0 0
3 Albendazol sirup 200 mg/5 ml botol 0 0 0 0 0
4 Allopurinol 300 mg tablet 0 0 0 0 0
5 Alopurinol tablet 100 mg tablet 849 0 849 337 512
01/08/2021
6 Aminofilin inj 24mg/ml ampul 0 0 0 0 0
7 Aminofillin 150 mg tablet 5/13/2020 0 0 0 0 0
8 Aminofillin 200 mg tablet 0 0 0 0 0
9 Amitriptyline tablet 5/1/2021 168 0 168 0 168
10 Amlodipin 5mg tablet 2400 0 2400 768 1632
12 Amoksisilin drop 100 mg/ml btl 0 0 0 0 0
13 Amoksisilin serbuk injeksi 1000mg ampul 0 0 0 0 0
14
Amoksisilin sirup kering 125 mg/ 5 mg botol 0 0 0 0 0
15 Amoksisillin 250mg kaplet 11/1/2021 9500 0 9500 149 9351
17
Amoksisillin sirup kering 250mg/5 ml botol 0 0 0 0 0
18 Ampisillin 500 mg kaplet 0 0 0 0 0
19 Antasida DOEN kombinasi tablet 1/1/2022 2754 0 2754 1611 1143
20 Antasida DOEN suspensi btl 60ml 7/1/2021 116 0 116 24 92
(Bacitracin) tube 0 0 0 0 0
23 Antifungi DOEN Kombinasi pot 5/1/2021 216 0 216 0 216
24 Antihemoroid DOEN supp 12/1/2020 748 0 748 21 727
25 Antiparkinson DOEN tablet 0 0 0 0 0
26 Aqua pro injeksi steril vial 0 0 0 0 0
28 Asam askorbat 50mg tablet 7/1/2020 26859 0 26859 2277 24582
29 Asam folat 1 mg (MARIN) tablet 9/1/2020 30 0 30 30 0
30 Asam mefenamat 500mg tablet 7/31/2022 2977 0 2977 949 2028
31 Asam traneksamat 100mg tblt 180 0 180 20 160
32 Asiklovir 200mg tablet 2/1/2022 1308 0 1308 0 1308
34 Asiklovir krim 5% tube 8/1/2022 495 0 495 2 493
36 (sulfat) 0
0 0 0 0
37 Attapulgit 600mg (New Antides) tablet 6/1/2020 21192 0 21192 346 20846
38 Azitromisin 500 mg tablet 1/9/2020 208 0 208 1 207
39 Bedak salisil 2% dus@50gr 4/1/2022 491 0 491 28 463
40 Besi (II) sulfat 200 mg kombinasi tablet 6/5/2020 844 0 844 202 642
41 Betahistin mesilat 6mg tablet 9/1/2021 1720 0 1720 250 1470
42 Betametason krim 0,1% tube 1/1/2021 166 0 166 39 127
43 Bisakodil 5 mg tab.salut 0 0 0 0 0
INFANT) supp 0 0 0 0 0
45 Bisakodil supp 10 mg supp 0 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
46 Bisoprolol 5 mg tablet 0 0 0 0 0
Respules nebule 0 0 0 0 0
48 Cetirizin 10 mg tablet 4/1/2021 502 0 502 35 467
49 Cetirizine sirup 5mg/5ml botol 5/1/2020 0 0 0 0 0
50 Clobazam 10mg tablet 3/1/2021 53 0 53 0 53
51 Co Amoxiclav tablet 0 0 0 0 0
52 tablet dan
01/08/2020 20623 0 20623 1545 0 20623
53 Dexamethason inj 5mg/ml ampul 0 0 0 0 0
54 Diazepam 2mg tablet 1/1/2021 0 0 0 0 0
(HCl) ampul 5/1/2020 0 0 0 0 0
58 Digoksin 0,25mg tablet 0 0 0 0 0
59 Diazepam injeksi 5mg/ml-1ml ampul 4/1/2020 0 0 0 0 0
60 Diltiazem HCl 30mg tablet 0 0 0 0 0
61 tablet dan
01/06/2022 7795 0 7795 432 7363
62 Doksisiklin 100mg kapsul 01/03/2021 0 0 0 0 0
63 Domperidon suspensi 5mg/ 5ml botol 6/1/2021 268 0 268 4 264
64 tablet dan
01/02/2021 5456 0 5456 70 5386
65 Efedrin tablet 0 0 0 0 0 0
ampul 12/12/2020
(sebagaiHCL) 20 0 20 0 0 20
67 Ergotamin 1mg+kofein 50mg tablet 0 0 0 0 0
68 Eritromisin 500mg kapsul 4/1/2021 510 0 510 34 476
69 Etakridin 0,1% btl 0 0 0 0 0
70 Etanol 70% btl 100ml 22 0 22 11 11
71 Fenitoin Na 30mg (DECATONA) tablet 0 0 0 0 0
72 Fenobarbital inj 50mg/ml ampul 62 0 62 0 62
73 tablet dan
01/11/2021 800 0 800 0 800
74
Fenoksimetil Penisilin tablet 250 mg tablet 0 0 0 0 0
mg/ml ampul 0 0 0 0 0
mg/ml ampul 9/30/2019 0 0 0 0 0
77 Fitomenadion 10mg tab salut 8/23/2020 3355 0 3355 44 3311
78 Flufenazine Decanoat inj 25 mg/ml ampul 6/1/2020 70 0 70 0 70
04/01/2020
79 dan
Furosemid 40 mg tablet 01/02/2021 28 0 28 28 0
80 Garam Oralit I serbuk sachet 8/1/2022 5561 0 5561 98 5463
81 Gentamisin Salep kulit 0,1% tube 7/1/2023 661 0 661 15 646
82 Gentamisin TM 0,3% botol 5/6/2022 284 0 284 0 284
83 Gentamisin injeksi ampul 0 0 0 0 0
84 Gentian Violet larutan 1% botol 18 0 18 2 16
85 Glibenklamid 5mg tablet 3/23/2023 2140 0 2140 330 1810
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
86 Gliseril Guaiakolat 100mg tablet 1/4/2021 25200 0 25200 417 24783
87 GOM btl 8ml 9/1/2021 0 0 0 0 0
88 Griseofulvin 125 mg tablet 2/1/2020 0 0 0 0 0
89 Guaifenesin 100 mg tablet 7/1/2022 49424 0 49424 63 49361
90 Haloperidol 5mg tablet 01/02/2020 0 0 0 0 0
91 Haloperidol 1,5 mg tablet 10/30/2019 0 0 0 0 0
92 Haloperidol 2 mg tablet 8/1/2020 425 0 425 0 425
93
Haloperidol Deconat injeksi 50 mg/ml ampul 1/1/2020 7 0 7 0 7
94 Hidrokortison Krim 2,5% tube 3/1/2021 284 0 284 5 279
95 Hidroklorthiazid 25 mg tablet 9/1/2022 6 0 6 0 6
96 Hyosin Nbutilbromid 10mg tablet 11/1/2020 73 0 73 0 73
97 Ichtyol pot 15gr 7/1/2022 146 0 146 4 142
98 INH 100mg tablet 0 0 0 0 0
99 INH 300mg tablet 0 0 0 0 0
100 Ibuprofen 200mg tablet 9/1/2021 10882 0 10882 70 10812
101 Ibuprofen 400mg tablet 0 0 0 20 -20
102 Ibuprofen suspensi 100mg/5ml botol 0 0 0 0 0
mg tablet 307 0 307 0 307
105 Kalium Aspartat 300mg tablet 0 0 0 0 0
106 Kalium Klorida 600mg tablet 0 0 0 0 0
107 Kalsium laktat 500mg tablet 2/1/2020 13100 0 13100 1640 11460
108 Kaolin Pektin (New Diaform) tablet 6/1/2022 0 0 0 0 0
109 Kaptopril 12,5mg tablet 11/21/2021 536 0 536 536 0
110 Kaptopril tablet 25 mg tablet 11/16/2021 40 0 40 14 26
111 Ketokonazol 200mg tablet 01/05/2021 2775 0 2775 74 2701
112 Ketokonazol krim 2% tube 8/31/2021 167 0 167 16 151
113 Ketorolac injeksi 10mg ampul 0 0 0 0 0
114 Klindamisin 150mg tablet 0 0 0 0 0
115 Klonidin 0,15 mg tablet 0 0 0 0 0
116 Kloramfenikol 250 mg kapsul 8/1/2023 820 0 820 34 786
117 Kloramfenikol TT 3% btl 0 0 0 0 0
118 Kloramfenikol suspensi 125mg/5 btl 60 ml 0 0 0 0 0
2% tube 5/1/2021 7 0 7 6 1
120 Klorampenikol TM 0,5% (RECO) btl 10/31/2020 96 0 96 21 75
121 01/03/2021
dan
01/04/2022 244919 0 244919 4889 240030
122 Klorpromazine tablet 0 0 0 0 0
123 Kodein 10mg tablet 0 0 0 0 0
124 Kodein 20mg tablet 6/30/2021 0 0 0 0 0
125 Kotrimoksazol DOEN dewasa tablet 6/1/2020 11450 0 11450 513 10937
126 Kotrimoksazol FORTE tablet 11/1/2021 1900 0 1900 0 1900
127 Kotrimoksazol suspensi kombinasi botol 30/04/2020 265 0 265 10 255
128 Lansoprazol 30 mg kapsul 1/1/2022 78 0 78 78 0
129 Levofloksasin 500mg kapsul 0 0 0 0 0 0
130 Lidokain 2%+adrenalin 0,0125mg ampul 12/1/2020 1780 0 1780 0 1780
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
01/07/2020
131 ampul 01/11/2020
&01/11/202 480 0 480 0 0 480
2
132 Linkomisin 500mg kapsul 8/1/2020 946 0 946 10 936
133 Loratadin tablet 4/1/2020 60 0 60 60 0
134 Mebendazol sirup 100 mg/5 ml botol 0 0 0 0 0
135 Mebendazol tablet tablet 0 0 0 0 0
136 Meloksikam 15mg tablet 31/06/2021 3969 0 3969 387 3582
137 Metformin 500mg tablet 1/3/2020 0 0 0 0 0
138 Methampiron 500mg tablet 7/1/2022 14280 0 14280 835 13445
0,125 mg
139 01/02/2021
&
tablet 01/05/2021 1960 0 1960 0 1960
140 Metilergometrin inj 0,2 mg/ml ampul 11/30/2020 7 0 7 0 7
141 Metoklopramid 5 mg tablet 126 0 126 0 126
142 Metoklopramide injeksi 5 mg/ml ampul 0 0 0 0 0
143 Metronidazol 500mg tablet 0 0 0 0 0
144 Metylprednisolon 4 mg tablet 4/1/2022 18009 0 18009 1569 16440
145 Metylprednisolon 8 mg tablet 0 0 0 0 0
146 Mg Sulfat injeksi 20% ampul 9/1/2019 0 0 0 0 0
147 Mg Sulfat injeksi 40% ampul 0 0 0 0 0
148 Mikonazol krim 2% tube 2/1/2021 182 0 182 33 149
149 N-asetil sistein 200 mg kapsul 4/8/2020 1765 0 1765 445 1320
150 NaCl infus btl 500ml 45 0 45 0 45
151 01/12/2020
&
Nadifen 50 mg tablet 22/05/2021 33843 0 33843 1511 32332
152 tablet dan
01/03/2021 200 0 200 0 200
153 Nistatin tablet salut 500.000 IU tablet 8/1/2019 112 0 112 24 88
154 2313
18/11/2020 0 2313 15 2298
155 OBH botol 01/03/2022 225 0 225 24 201
156 Oksitetrasiklin HCl salep kulit 3 % tube 9/1/2021 204 0 204 53 151
157 Oksitetrasiklin HCl salep mata 3 % tube 0 0 0 0 0
158 Omeprazol 20mg kapsul 6/1/2021 480 0 480 321 159
159 Omeprazol injeksi ampul 0 0 0 0 0
160 Ondancentron inj ampul 4/1/2021 0 0 0 0 0
161 Parasetamol 500mg tablet 1/1/2022 81394 0 81394 5394 0 81394
162 Parasetamol sirup 120mg/5ml botol 60ml 1/1/2022 295 0 295 20 275
163 Parasetamol drop btl 15 ml 8/24/2020 14 0 14 5 9
164 Pehacain injeksi ampul 0 0 0 0 0
165 Permetrin (Scabimite) krim 5% tube 7/1/2020 63 0 63 9 54
166 Pirantel tab.score base 125mg tablet 8/30/2020 0 0 0 0 0
167 Pirantel Pamoat susp 125mg/5ml botol 0 0 0 0 0
168 Piridoksin 10mg (vit. B6) tablet 9/1/2020 39546 0 39546 757 38789
169 Piroksikam 10mg tablet 5/1/2021 7953 0 7953 354 7599
170 Polikresulen cairan btl 10ml 6/3/2036 6 0 6 0 6
171 Povidon Iodin 10% btl 30 ml 11/1/2019 203 0 203 0 203
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
172 Povidon Iodin 10% btl 300ml 2/1/2020 4 0 4 0 4
173 Prednison 5mg tablet 7/1/2021 10858 0 10858 565 10293
174 Propanolol 10mg tablet 210 0 210 0 210
175 Propiltiurasil tablet 100mg tablet 0 0 0 0 0
176 Ranitidin 150mg tablet 8/31/2020 0 0 0 0 0
Ranitidin inj 25mg/ml ampul
177 0
30/03/2021 0 0 0 0
178 Reserpin tablet 0,10 mg tablet 0 0 0 0 0
179 Respiredon 2 mg tablet 3/1/2021 0 0 0 0 0
kapsul lunak 0 0 0 0
btl 500ml 01/07/2023 120 0 120 0 120
183 Rivanol 300 ml botol 0 0 0 0 0
184 Salbutamol 2 mg tablet 3/31/2023 2758 0 2758 363 2395
186 Salep 2-4 kombinasi pot 7/1/2021 496 0 496 8 488
03/01/2020
187 dan
Sefadroksil 500mg kapsul 01/10/2020 940 0 940 140 800
188 Sefadroksil sir.kering 125mg/5 btl 60ml 0 0 0 0 0 0
189 Sefiksim 100mg kapsul 0 0 0 0 0 0
190 Sefotaksim inj 1g/vial vial 0 0 0 0 0 0
191 Seftriakson 1g/vial vial 0 0 0 0 0 0
mcg tablet 28514 0 28514 1450 27064
194 Simetidin 200mg tablet 10/1/2020 148 0 148 88 60
195 Simvastatin 10mg tablet 0 0 0 0 0
196 Simvastatin 20mg tablet 03/05/2020 0 5000 5000 171 4829
197 Siprofloksasin 500mg tablet 9/1/2020 2108 0 2108 721 1387
198 Spiramisin 500mg tablet 0 0 0 0 0
199 Stesolid 10 mg injeksi ampul 0 0 0 0 0
200 Stesolid supp 10mg Tube 3/1/2022 10 0 10 0 10
202 Sulfasetamid TM 15% botol 0 0 0 0 0
203 Terbutalin sufat 2,5mg tablet 0 0 0 0 0
204 Tetrasiklin 250mg kapsul 0 0 0 0 0
205 Tetrasiklin kapsul 500 mg kapsul 3/1/2021 2721 0 2721 0 2721
206 Thiamin HCl 50mg (vit. B1) tablet 01/05/2023
01/05/2022 33091 0 33091 2651 30440
207 Tiamfenikol kapsul 500mg kapsul 0 0 0 0 0
208 Triheksifenidil 2mg tablet 0 0 0 0 0
210 Zinc sirup botol 01/03/2020 0 0 0 0 0
n Obat-obatan ( PKD ) Gigi 0 0 0 0 0
(CAVITON) kotak 11/6/2019 2 0 2 0 2
gigi botol 3/31/2022 10 0 10 0 10
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
3
Devitalisasi pasta non arsen (Pulp x) kotak 4/1/2022 6 0 6 0 6
botol
4 01/11/2020
&
Eugenol cairan 01/08/2039 16 0 16 0 16
5 Kalsium hidroksida (Hycal) 7 gram 8/1/2021 18 0 18 0 18
6 Mata bor gigi standar set/6 biji 1/6/2022 1 0 1 0 1
7 Mata bor gigi high speed set/6 biji 0 0 0 0 0
8 gigi 0
0 0 0 0
9
Pasta pengisi saluran akar(CRESOTIN) set 10/1/2020 28 0 28 0 28
10 Poliren (OCO) polishing pasta btl 15gr 7/1/2021 7 0 7 0 7
11 gigi botol 10/31/2020 8
0 8 0 8
28gr(3M ESPE Cavit G) 0 0 0 0
13 Ionomer,fuji) 35
0 35 0 35
14 12
0 12 0 12
15 Komposir resin (Master fill) kotak 2/1/2022 11 0 11 0 11
Obat-obatan ( PKD ) Penunjang 8/1/2020 0 0 0 0 0
1 Ambroksol 30 mg tablet 7/1/2021 35044 0 35044 618 34426
2 Antiflu tab.kombinasi (Brocifar) tablet 6/1/2021 5727 0 5727 307 5420
3 Asam Tranexamat inj.500mg/ml ampul 1/1/2021 0 0 0 0 0
4 Calsium Gluconnat Injeksi ampul 11/1/2019 0 0 0 0 0
1500IU/ml ampul 8/1/2019 0 0 0 0 0
6 Bromheksin HCl 8 mg tablet 8/1/2021 1000 0 1000 0 1000
7 Ekstrak sonchi Folium 100% kapsul 4/1/2022 0 0 0 0 0
9 Fenoterol MDI 100 mcg/ 10ml fls 7/31/2020 0 0 0 0 0
10 Glimepirid 1mg 5/1/2022 5880 0 5880 1090 4790
11 Glimepirid 2mg 4/1/2022 4770 0 4770 940 3830
12 Kloramfenikol inj vial 4/1/2020 0 0 0 0 0
13 Kloramfenikol Salep mata 1% tube 5 gr 1/1/2022 145 0 145 10 135
14 Levertran15 g pot 15gr 01/02/2020 1 0 1 0 1
(Neuroval) 946 0 946 48 898
16 Obat anti flu sirup (Betaflu) botol 6/1/2021 158 0 158 1 157
17 Obat batuk Kombinasi (Fenidryl) sirup 7/1/2022 0 0 0 0 0
18 Obat batuk kombinasi (Dextral) tablet 7/1/2021 1447 0 1447 280 1167
19 Oksitosin injeksi ampul 4/1/2020 0 0 0 0 0
20 Phenol gliserol tetes telinga botol 0 0 0 0 24 -24
2,5mg/2,5 ml NaCl) 0 0 0 0
22 Salep bisul pot 7/1/2020 0 0 0 0 0
23 Salep luka bakar (Neocenta gel) tube 15gr 0 4 0 4 0 4
24 Tab. Curcuma 20mg tablet 0 0 0 0 0 0
25 Teofilin syrup 43,33 mg/ 5 ml botol 0 0 0 0 0 0
26 Terapi Diare sirup btl 60ml 0 0 0 0 0
27 Terapi Diare tab tablet 8/1/2020 0 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
28 Vit neurotropik tablet 9/1/2022 0 0 0 0 0
29 Etil klorid semprot Spray 7/1/2020 42 0 42 0 42
iaan Obat Asli Indonesia 0 0 0 0 0
1 Extrak Belladon tab 10 mg tablet 0 0 0 0 0 0
2 Enkasari 120 ml botol 0 0 0 0 0
3 Fitogen tablet 0 0 0 0 0 0
4 Ferris botol 0 0 0 0 0 0
5 Hemorogard kapsul 8/1/2020 1930 0 1930 22 1908
6 Hepagard kapsul 0 0 0 0 0
7 Minyak telon botol 50 ml 0 0 0 0 0 0
8 Tensigard kapsul 0 90 0 90 20 70
Obat dan Alkes PROGRAM 0 0 0 0 0
1 Diethylcarbamazine (DEC) 100 mg tablet 0 0 0 0 0 0
3 MDT Combi MB Adult blister 0 0 0 0 0 0
4 MDT Combi MB Child blister 0 0 0 0 0 0
5 MDT Combi PB Adult blister 0 0 0 0 0 0
7 MDT Combi PB Child blister 0 0 0 0 0 0
8 Obat Anti Tubercolusis kategori 1 FDC 0 0 0 0 0 0
9
Obat Anti Tubercolusis kategori anak FDC 0 0 0 0 0 0
10 Box slide pcs 0 0 0 0 0 0
11 Pot sputum
01/04/2022
pot 01/03/2024 1500 0 1500 0 1500
12 Reagen BTA ( Ziehl Nelsen ) paket 0 0 0 0 0 0
13 Prokain Benzil Penisilin 3 jt IU vial 0 0 0 0 0 0
14 Depo Progestin/ suntik KB 3 bulan vial 0 0 0 0 0 0
15 Mineral Mix sachet 0 0 0 0 0 0
16 safety box 2,5 lt pcs 0 0 0 0 0 0
17 safety box 5 lt pcs 0 0 0 0 0 0
18 spuit 0,5 ml pcs 0 0 0 0 0 0
an ALKES Habis Pakai (PKD) 0 0 0 0 0
1 ADS 0,05ml pcs 4/1/2023 300 0 300 0 300
2 Blood Lancet box 8/1/2021 470 0 470 0 470
3 Cryotube 1.8 ml pcs 0 0 0 0 0 0
4 Cover Glass 22x22 mm box 3/1/2022 0 0 0 0 0
5 Deck Glass box/72pcs 0 0 0 0 0 0
6 E Care Handrub 500 ml botol 3/1/2020 11 0 11 0 11
7 Folley Catheter No.16 buah 11/1/2022 30 0 30 0 30
8 Folley Catheter setara Rush No.18 buah 12/1/2022 10 0 10 0 10
9 IV Catheter 18 G pcs 12/31/2023 50 0 50 0 50
10 IV Catheter 24 G pcs 1/31/2023 108 0 108 0 108
11 IV Catheter 22 G pcs 3/31/2024 108 0 108 0 108
12 IV catheter 20 G pcs 31/02/2024 70 0 70 0 70
13 Kapas 100 gr rol 0 0 0 0 0 0
14 Kasa 4m x 15 cm elastis roll 0 0 0 0 0 0
15 Kertas ECG Ukuran Besar roll 0 0 0 0 0 0
16 Kertas ECG Ukuran Standar roll 0 0 0 0 0 0
17 Pembalut Gips Uk. 3" roll 0 0 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
20 Plester 5 yard x 2 inchi roll 0 0 0 0 0 0
21 Pot Urine (pot sputum) bh/d.5,5cm 4/1/2022 0 0 0 0 0
22 Spuit 0,05 ml pcs 0 0 0 0 0
23 Tensocrepe 4" buah 0 0 0 0 0 0
25 Wing Needle No. 21G buah 0 0 0 0 0 0
26 Wing Needle No. 25G buah 1/1/2020 0 0 0 0 0
27 alat suntik 1 ml pcs 11/1/2020 0 0 0 0 0
31 alkohol swab pcs 10/1/2021 0 0 0 0 0
32 aquadest botol 1 L 6/3/2036 0 0 0 0 0
33 Alkapram septalkan spray botol 7/1/2021 0 0 0 0 0
34 Alkapram alkacide 1 L botol 7/1/2020 0 0 0 0 0
35 Alkapharm alkazyme 25mg sachet 5/1/2021 0 0 0 0 0
36 bisturi kecil pcs 1/12/2020 65 0 65 0 65
37 bioplacenton tulle pcs 0 0 0 0 0
38 catgut cromic 2/0 box 30/12/2019 9 0 9 0 9
41 fixomul stretch 15cmx5m roll 28/07/2020 0 0 0 0 0
42 foley catheter No.14 pcs 7/1/2021 0 0 0 0 0
43 Gelang Bayi Pink pcs 2/1/2023 0 0 0 0 0
44 Gelang Bayi Biru pcs 2/1/2023 0 0 0 0 0
45 handscoon Uk S box 5/1/2021 217 0 217 21 196
46 handscoon Uk M box 5/1/2021 207 0 207 13 194
48 handscoon steril pasang 12/1/2022 0 0 0 0 0
49 hipafik 5x5 pcs 2/1/2021 3 0 3 0 3
50 hipafik 15x10 box 01/102020 16 0 16 1 15
52 infus set dewasa set/ktg 7/1/2022 207 0 207 0 207
53 jarum hect kulit luar besar (12 pcs) pcs 1/10/2021 15 0 15 0 15
54 jarum hect kulit luar kecil (12 pcs) pcs 1/5/2022 38 0 38 0 38
55
jarum hect kulit luar sedang (12 pcs) pcs 1/9/2022 9 0 9 0 9
56 jarum hect otot luar besar bks/12pcs 1/6/2023 0 0 0 0 0
57 jarum hect otot luar sedang bks/12pcs 9/6/2022 1 0 1 0 1
58 jelly EKG botol 0 0 0 0 0
59 kapas absorben 250 gr bks 10/1/2021 7 0 7 0 7
60 Kapas Berlemak 500 gr roll 9/1/2033 4 0 4 0 4
61 kasa hidrofil 2x80cm pcs 30/04/2021 0 0 0 0 0
62 kasa hidrofil 40x80cm roll 5/1/2023 0 0 0 0 0
63 kasa pembalut elastic 4m x 15cm roll 8/6/2021 0 0 0 0 0
65 kasa pembalut hidrofil 4 m x 10cm roll 10/1/2033 0 0 0 0 0
66 kasa hidrofil steril 18x22 roll 10/1/2021 0 0 0 0 0
67 kasa kompres 40x40 steril roll 8/1/2021 0 0 0 0 0
68 kasa steril 16x16 cm box 11/1/2020 0 0 0 0 0
69 kertas gol.darah pak/100's 1/6/2022 0 0 0 0 0
70 kertas tissu gulung 0 0 0 0 0
06/01/2022
71 klem tali pusat pcs 0 0 0 0 0
72 masker box/50pcs 30/04/2021 200 0 200 48 152
73 Box Object Glass Grey and Orange box 3/1/2022 0 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
74 object glass box/72pcs 19/03/2021 0 0 0 0 0
75 Oxygen mask bayi (SERENITY) pcs 1/6/2022 8 0 8 0 8
76 Oxygen mask anak (SERENITY) pcs 1/7/2022 11 0 11 0 11
77 Oxygen mask dewasa (SERENITY) pcs 1/8/2022 9 0 9 0 9
78 Pita Lila pcs 1/6/2022 0 0 0 0 0
79 plester 5 yard 20 inch roll 19/02/2021 0 0 0 0 0
80 silk no 3/0 dg jarum bedah pcs 3/6/2037 0 0 0 0 0
81 spiritus btl / 1 liter 06/01/2022 4 0 4 0 4
82 spuit 0,5 ml pcs 4/1/2023 2100 0 2100 0 2100
83 Stericline Indicator strip box 11/1/2022 0 0 0 0 0
84 Stericlin gusette 25x6,5cm roll 10/1/2022 0 0 0 0 0
85 tempat preparat BTA / cawan petri pcs 1/6/2022 0 0 0 0 0
86 tabung reaksi 1,5x10cm ktk/50pcs 0 0 0 0 0
87 test kehamilan box/50pcs 5/1/2020 0 0 0 0 0
88 tranfusi set dewasa pcs 3/31/2024 50 0 50 0 50
89 Wraping paper 50x50 box 12/1/2020 0 0 0 0 0
91 USG Gel 250 ml botol 1/31/2021 7 0 7 0 7
92 urin bag pcs 19/05/2021 22 0 22 0 22
93 Ammonium Oxalat Btl/100ml 8/1/2020 0 0 0 0 0
94 Asam Klorida 0,1 N btl/ 100 ml 0 0 0 0 0
95 pack/100
Blue Tip 0test 0 0 0 0 0
96 BD Tube EDTA plh 13 x 75 box 5/1/2021 0 0 0 0 0
97 Cell pack bok 9/5/2020 0 0 0 0 0
98 Cuka diksi botol 5/1/2024 0 0 0 0 0
99 EDTA btl 100ml 0 0 0 0 0
100 Purple cup EDTA K3 3ml, glass box 6/1/2020 0 0 0 0 0
101 HbsAg test strip 0 0 0 0 0 0
102 Kertas Lensa lembar 0 0 0 0 0 0
103 Larutan Giemsa Stain botol 10/6/2019 0 0 0 0 0
104 Paket Gol. Darah Anti AB paket 3/6/2020 0 0 0 0 0
105 Paket Gol. Darah anti Resus paket 4/6/2020 0 0 0 0 0
106
Reagensia Uji Widal S para Typhi AH vial 12/1/2020 0 0 0 0 0
107 Reagensia Uji Widal Typhi H vial 7/6/2020 0 0 0 0 0
108 Reagensia Uji Widal Typhi O vial 2/28/2021 0 0 0 0 0
109 Reagen ZN paket 0 0 0 0 0
110 alkohol asam btl 100ml 0 0 0 0 0
111 asam sulfosalisilat btl 100ml 0 0 0 0 0
112 asam urat stick btl/25 test 31/04/2021 4 0 4 0 4
113 dempul hematokrit pcs 0 0 0 0 0
114 glukoprotein stik 10 parameter pck/100's 2/1/2020 0 0 0 0 0
115 glukoprotein urin test box/10 test 0 0 0 0 0 0
116 glukosa stik btl/25 test 11/7/2020 0 0 0 0 0
117 hemoglobin stik box/25 test 4 0 4 0 4
118 haemoglobulin C btl 500ml 11/19/2020 0 0 0 0 0
119 hayam btl 100ml 1/6/2022 0 0 0 0 0
120 Immersion Oil btl 100ml 1/6/2022 0 0 0 0 0
121 kertas lakmus pack 0 0 0 0 0
122 kertas lensa lembar 0 0 0 0 0
123 kolesterol stik btl 10 test 1/31/2021 5 0 5 0 5
124 lar. benedict btl 100ml 6/3/2036 0 0 0 0 0
125 lar. eosin 2% btl 7/6/2020 0 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
126 lar. etanol asam btl 100ml 6/6/2020 0 0 0 0 0
127 lar. hypoklorit btl 1L 0 0 0 0 0
128 lar. karbol fuchsin btl 100ml 0 0 0 0 0
129 lar. metilen biru btl 100ml 0 0 0 0 0
130 larutan KOH btl 100ml 0 0 0 0 0
131 larutan Turk btl 100 ml 1/1/2023 0 0 0 0 0
132 larutan Poch-Pack L botol 11/1/2020 0 0 0 0 0
133 larutan Poch-Pack D botol 0 0 0 0 0
134 masker N95 box 12/1/2020 0 0 0 0 0
135 metanol botol 7/6/2020 0 0 0 0 0
136 minyak imersi btl 100ml 0 0 0 0 0
137 natrium citrat 3,13% btl 100ml 0 0 0 0 0
138 natrium citrat 3,8% btl 250ml 6/6/2019 0 0 0 0 0
139 paket gol. Drh anti AB paket 0 0 0 0 0
140 paket gol. Drh anti B paket 0 0 0 0 0
141 paket gol.drh anti A paket 1/6/2022 0 0 0 0 0
142 ress Ecker btl 100ml 1/6/2022 0 0 0 0 0
143 stik urinalisis 10 parameter botol 4/1/2021 0 0 0 0 0
144 Stomalizer Pcs 4/8/2020 0 0 0 0 0
145 thermal paper 57mm x 30 m roll 7/6/2020 0 0 0 0 0
146 tissu lensa pak 0 0 0 0 0
147 trigliserida botol 0 0 0 0 0
148 xylol btl 100ml 9/6/2019 0 0 0 0 0
149 yellow tip pak 0 0 0 0 0
150 Lisol btl 0 0 0 0 0
151 Larutan Nacl 0,86% botol 9/6/2019 0 0 0 0 0
TAMBAHAN 0 0
1 Plester/tulling dress 10cm x10cm lembar 5/23/2023 92 0 92 0 92
2 Plastik klip obat 8,5cmx13cm kg 25 0 25 0 25
3 Plastik obat cetak etiket kg 25 0 25 0 25
4 Kantong puyer SCI box 1 0 1 0 1
0

NIP.19651107 200212 1 004 NIP. 19830519 201101 2 009
LAPORAN PENERIMAAN DAN PEMAKAIAN BAHAN MEDIS HABIS PAKAI
BULAN : JUNI 2020
KOTA : TEGAL
PEMAKAIAN
STOK PENERIMA
JUMLAH
NO NAMA BARANG SATUAN AWAL AN
PPI LAB VK
(A) (B) (A+B) (C)
1 APRON DISPOSIBLE pcs 22 0 22

2 BOOTS KUNING pasang 8 0 8
3 BAJU HAZMED (coverall+cover shoes) set 0 120 120
4 COVERALL BOHO DISPOSIBLE (L) pcs 57 0 57
5 COVERALL BOHO DISPOSIBLE (XL) pcs 43 0 43
COVERALL KALTECH DISPOSIBLE
6 pcs 100 0 100
(L)
7 pcs 150 0 150
(xL)
8 COVERALL PARASUT PUTIH & HIJAU pcs 45 0 45
9 COVERALL SPONBOUND merah/marron pcs 18 0 18
10 COVERALL SPONBOUND PUTIH pcs 81 0 81
11 COVERALL SPONBOUND TOSCA pcs 3 0 3
12 FACE SHIELD pcs 28 0 28
13 GLOVE KUNING MULTIPURPOSE pasang 9 0 9
14 GOOGLE pcs 3 0 3
15 HAIRNET DISPOSIBLE pcs 156 0 156
16 HAND SANITIZER 5 liter botol 5 l 0 5 5
17 HAND SANITIZER 500ml botol 500ml 0 9 9
18 JAS HUJAN pcs 11 0 11
19 MASKER BEDAH pcs 0 300 300
20 MASKER KAIN pcs 32 0 32
21 MASKER KN95 pcs 0 0 0
22 MASKER N95 PUTIH pcs 0 0 0
PAKET APD LENGKAP
23 (coverall,covershoes,shoes,HS,masker set
bedah,google) 0 20 20
24 SURGICAL GLOVES pasang 36 79 115
25 Coverall allsize disposible set 96 0 96
Kepala Puskesmas Tegal Barat Petugas Kefa
dr. Bambang Kuswanto Nurul Ardi Anti

NIP.19651107 200212 1 004 NIP. 19830519 2
BULAN : JUNI 2020
KOTA : TEGAL
PEMAKAIAN
STOK PENERIMA
JUMLAH
NO NAMA BARANG SATUAN AWAL AN
PPI LAB VK UGD
(A) (B) (A+B) (C)
1 APRON DISPOSIBLE pcs 22 0 22

2 BOOTS KUNING pasang 8 0 8
3 BAJU HAZMED (coverall+cover shoes) set 0 120 120
4 COVERALL BOHO DISPOSIBLE (L) pcs 57 0 57
5 COVERALL BOHO DISPOSIBLE (XL) pcs 43 0 43
6 pcs 100 0 100
(L)
7 pcs 150 0 150
(xL)
8 COVERALL PARASUT PUTIH & HIJAU pcs 45 0 45
9 COVERALL SPONBOUND merah/marron pcs 18 0 18
10 COVERALL SPONBOUND PUTIH pcs 81 0 81
11 COVERALL SPONBOUND TOSCA pcs 3 0 3
12 FACE SHIELD pcs 28 0 28
13 GLOVE KUNING MULTIPURPOSE pasang 9 0 9
14 GOOGLE pcs 3 0 3
15 HAIRNET DISPOSIBLE pcs 156 0 156
16 HAND SANITIZER 5 liter botol 5 l 0 5 5
17 HAND SANITIZER 500ml botol 500ml 0 9 9
18 JAS HUJAN pcs 11 0 11
19 MASKER BEDAH pcs 0 300 300
20 MASKER KAIN pcs 32 0 32
21 MASKER KN95 pcs 0 0 0
22 MASKER N95 PUTIH pcs 0 0 0
PAKET APD LENGKAP
23 (coverall,covershoes,shoes,HS,masker set
bedah,google) 0 20 20
24 SURGICAL GLOVES pasang 36 79 115
25 Coverall allsize disposible set 96 0 96
Kepala Puskesmas Tegal Barat Petugas Kefa
dr. Bambang Kuswanto Nurul Ardi Anti

NIP.19651107 200212 1 004 NIP. 19830519 2
NOMOR :
KOTA : TEGAL
PENGELUARAN
PEMAKAIAN RUSAK/ED
(A) (B) (A+B) (A+B)-(K) (D)
01/08/2021
14
17
36 (sulfat) 0
0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
52 tablet dan
01/08/2020 20623 0 20623 5278 0
(HCl) ampul 5/1/2020 0 0 0 0
61 tablet dan
01/06/2022 7363 0 7363 783
64 tablet dan
01/02/2021 5386 0 5386 664
ampul 12/12/2020
70 Etanol 70% btl 100ml 11 0 11 0
73 tablet dan
01/11/2021 800 0 800 0
74
mg/ml ampul 0 0 0 0
mg/ml ampul 9/30/2019 0 0 0 0
04/01/2020
79 dan
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
87 GOM btl 8ml 9/1/2021 0 0 0 0
93
97 Ichtyol pot 15gr 7/1/2022 142 0 142 5
mg tablet 307 0 307 30
2% tube 5/1/2021 1 0 1 1
121 01/03/2021
dan
01/04/2022 240030 0 240030 4703
124 Kodein 20mg tablet 6/30/2021 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
01/07/2020
131 ampul 01/11/2020
&01/11/202 480 0 480 90 0
2
0,125 mg
139 01/02/2021
&
tablet 01/05/2021 1960 0 1960 0
151 01/12/2020
&
152 tablet dan
01/03/2021 200 1000 1200 507
154 2298
18/11/2020 0 2298 0
155 OBH botol 01/03/2022 201 0 201 27
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
177 Ranitidin inj 25mg/ml ampul 30/03/2021 0 0 0 0
kapsul lunak 0 0 0
kapsul lunak 0 0 0
btl 500ml 01/07/2023 120 0 120 0
03/01/2020
187 dan
mcg tablet 27064 0 27064 1348
01/05/2023
210 Zinc sirup botol 01/03/2020 0 0 0 0
(CAVITON) kotak 11/6/2019 2 0 2 0
gigi botol 3/31/2022 10 0 10 0
3
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
botol
4 01/11/2020
&
Eugenol cairan 01/08/2039 16 0 16 0
8 gigi 0
0 0 0
9
11 gigi botol 10/31/2020 8
0 8 0
13 Ionomer,fuji) 35
0 35 0
14 12
0 12 0
1500IU/ml ampul 8/1/2019 0 0 0 0
10 Glimepirid 1mg 5/1/2022 4790 0 4790 650
11 Glimepirid 2mg 4/1/2022 3830 0 3830 1195
(Neuroval) 898 0 898 132
2,5mg/2,5 ml NaCl) 0 0 0
22 Salep bisul pot 7/1/2020 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
9
11 Pot sputum
01/04/2022
pot 01/03/2024 1500 0 1500 0
18 spuit 0,5 ml pcs 0 0 0 0 0
1 ADS 0,05ml pcs 4/1/2023 300 0 300 0
2 Blood Lancet box 8/1/2021 470 0 470 0
9 IV Catheter 18 G pcs 12/31/2023 50 0 50 0
10 IV Catheter 24 G pcs 1/31/2023 108 0 108 0
11 IV Catheter 22 G pcs 3/31/2024 108 0 108 0
12 IV catheter 20 G pcs 31/02/2024 70 0 70 0
13 Kapas 100 gr rol 0 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
22 Spuit 0,05 ml pcs 0 0 0 0
31 alkohol swab pcs 10/1/2021 0 0 0 0
32 aquadest botol 1 L 6/3/2036 0 0 0 0
49 hipafik 5x5 pcs 2/1/2021 3 0 3 0
50 hipafik 15x10 box 01/102020 15 0 15 0
55
06/01/2022
72 masker box/50pcs 30/04/2021 152 0 152 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
78 Pita Lila pcs 1/6/2022 0 0 0 0
82 spuit 0,5 ml pcs 4/1/2023 2100 0 2100 0
91 USG Gel 250 ml botol 1/31/2021 7 0 7 0
92 urin bag pcs 19/05/2021 22 0 22 0
95 pack/100
97 Cell pack bok 9/5/2020 0 0 0 0
98 Cuka diksi botol 5/1/2024 0 0 0 0
99 EDTA btl 100ml 0 0 0 0
106
119 hayam btl 100ml 1/6/2022 0 0 0 0
125 lar. eosin 2% btl 7/6/2020 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
134 masker N95 box 12/1/2020 0 0 0 0
135 metanol botol 7/6/2020 0 0 0 0
142 ress Ecker btl 100ml 1/6/2022 0 0 0 0
144 Stomalizer Pcs 4/8/2020 0 0 0 0
148 xylol btl 100ml 9/6/2019 0 0 0 0
150 Lisol btl 0 0 0 0
TAMBAHAN 0 0
0
Tegal, 14 Agustus 2020


NIP.19651107 200212 1 004 NIP. 19830519 201101 2 009
NOMOR :
KOTA : TEGAL
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR
OP
(A) (B) (A+B) (A+B)-(K) (D) (L)
01/08/2021
14
17
36 (sulfat) 0
0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
52 tablet dan
01/08/2020 20623 0 20623 5278 0 15345
(HCl) ampul 5/1/2020 0 0 0 0 0
61 tablet dan
01/06/2022 7363 0 7363 783 6580
64 tablet dan
01/02/2021 5386 0 5386 664 4722
ampul 12/12/2020
(sebagaiHCL) 20 0 20 0 0 20
69 Etakridin 0,1% btl 0 0 0 0 0
70 Etanol 70% btl 100ml 11 0 11 0 11
73 tablet dan
01/11/2021 800 0 800 0 800
74
mg/ml ampul 9/30/2019 0 0 0 0 0
04/01/2020
79 dan
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
87 GOM btl 8ml 9/1/2021 0 0 0 0 0
93
97 Ichtyol pot 15gr 7/1/2022 142 0 142 5 137
98 INH 100mg tablet 0 0 0 0 0
99 INH 300mg tablet 0 0 0 0 0
101 Ibuprofen 400mg tablet 0 0 0 0 0
mg tablet 307 0 307 30 277
2% tube 5/1/2021 1 0 1 1 0
121 01/03/2021
dan
01/04/2022 240030 0 240030 4703 235327
124 Kodein 20mg tablet 6/30/2021 0 0 0 0 0
128 Lansoprazol 30 mg kapsul 1/1/2022 0 900 900 106 794
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
01/07/2020
131 ampul 01/11/2020
&01/11/202 480 0 480 90 0 390
2
0,125 mg
139 01/02/2021
&
tablet 01/05/2021 1960 0 1960 0 1960
150 NaCl infus btl 500ml 45 0 45 0 45
151 01/12/2020
&
152 tablet dan
01/03/2021 200 1000 1200 507 693
154 2298
18/11/2020 0 2298 0 2298
155 OBH botol 01/03/2022 201 0 201 27 174
157 Oksitetrasiklin HCl salep mata 3 % tube 0 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
177 Ranitidin inj 25mg/ml ampul 30/03/2021 0 0 0 0 0
btl 500ml 01/07/2023 120 0 120 0 120
03/01/2020
187 dan
mcg tablet 27064 0 27064 1348 25716
01/05/2023
206 Thiamin HCl 50mg (vit. B1) tablet 01/05/2022 30440 0 30440 1343 29097
210 Zinc sirup botol 01/03/2020 0 0 0 0 0
(CAVITON) kotak 11/6/2019 2 0 2 0 2
gigi botol 3/31/2022 10 0 10 0 10
3
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
botol
4 01/11/2020
&
Eugenol cairan 01/08/2039 16 0 16 0 16
8 gigi 0
0 0 0 0
9
11 gigi botol 10/31/2020 8
0 8 0 8
13 Ionomer,fuji) 35
0 35 0 35
14 12
0 12 0 12
1500IU/ml ampul 8/1/2019 0 0 0 0 0
10 Glimepirid 1mg 5/1/2022 4790 0 4790 650 4140
11 Glimepirid 2mg 4/1/2022 3830 0 3830 1195 2635
(Neuroval) 898 0 898 132 766
20 Phenol gliserol tetes telinga botol 0 0 0 0 0 0
2,5mg/2,5 ml NaCl) 0 0 0 0
22 Salep bisul pot 7/1/2020 0 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
9
10 Box slide pcs 0 0 0 0 0 0
11 Pot sputum
01/04/2022
pot 01/03/2024 1500 0 1500 0 1500
16 safety box 2,5 lt pcs 0 0 0 0 0 0
18 spuit 0,5 ml pcs 0 0 0 0 0 0
1 ADS 0,05ml pcs 4/1/2023 300 0 300 0 300
2 Blood Lancet box 8/1/2021 470 0 470 0 470
3 Cryotube 1.8 ml pcs 0 0 0 0 0 0
9 IV Catheter 18 G pcs 12/31/2023 50 0 50 0 50
10 IV Catheter 24 G pcs 1/31/2023 108 0 108 0 108
11 IV Catheter 22 G pcs 3/31/2024 108 0 108 0 108
12 IV catheter 20 G pcs 31/02/2024 70 0 70 0 70
13 Kapas 100 gr rol 0 0 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
22 Spuit 0,05 ml pcs 0 0 0 0 0
31 alkohol swab pcs 10/1/2021 0 0 0 0 0
32 aquadest botol 1 L 6/3/2036 0 0 0 0 0
49 hipafik 5x5 pcs 2/1/2021 3 0 3 0 3
50 hipafik 15x10 box 01/102020 15 0 15 0 15
55
06/01/2022
72 masker box/50pcs 30/04/2021 152 0 152 0 152
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
78 Pita Lila pcs 1/6/2022 0 0 0 0 0
82 spuit 0,5 ml pcs 4/1/2023 2100 0 2100 0 2100
91 USG Gel 250 ml botol 1/31/2021 7 0 7 0 7
92 urin bag pcs 19/05/2021 22 0 22 0 22
95 pack/100
97 Cell pack bok 9/5/2020 0 0 0 0 0
98 Cuka diksi botol 5/1/2024 0 0 0 0 0
99 EDTA btl 100ml 0 0 0 0 0
106
119 hayam btl 100ml 1/6/2022 0 0 0 0 0
125 lar. eosin 2% btl 7/6/2020 0 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
134 masker N95 box 12/1/2020 0 0 0 0 0
135 metanol botol 7/6/2020 0 0 0 0 0
142 ress Ecker btl 100ml 1/6/2022 0 0 0 0 0
144 Stomalizer Pcs 4/8/2020 0 0 0 0 0
148 xylol btl 100ml 9/6/2019 0 0 0 0 0
150 Lisol btl 0 0 0 0 0
TAMBAHAN 0 0
0
Tegal, 14 Agustus 2020


NIP.19651107 200212 1 004 NIP. 19830519 201101 2 009
LAPORAN PENERIMAAN DAN PEMAKAIAN BAHAN MEDIS HABIS PAKAI UN
BULAN : JULI 2020
KOTA : TEGAL
PEMAKAIAN
STOK PENERI
JUMLAH Pustu
NO NAMA BARANG SATUAN AWAL MAAN Poli Poli Pustu
LAB VK UGD Muarar
Umum Gigi Kraton
eja
(A) (B) (A+B) (C)
BANTUAN COVID 19
1 Coverall disposible all size pcs 93 0 93
2 Boots pasang 8 0 8
3 Coverall boho disposible L pcs 57 0 57 3
4 Coverall boho disposible XL pcs 43 0 43
5 Coverall parasut putih pcs 20 0 20
6 Coverall parasut hijau pcs 3 0 3
7 Coverall (parasut) pcs 7 0 7
8 Coverall sponbound merah pcs 17 0 17
9 Coverall sponbound maroon pcs 1 0 1
10 Coverall sponbound tosca pcs 3 0 3
11 Face shield helm pcs 9 0 9
12 Face shield biasa pcs 6 0 6
13 Face shield bando pcs 12 0 12
14 Face shield hijau (Dinkes) pcs 0 0
15 Glove kuning multipurpose pasang 9 0 9
16 Hairnet pcs 156 0 156
17 Hand sanitizer 5 liter botol 1 liter 4 0 4
18 Masker KN 95 pcs 0 0 0
19 Masker N95 putih pcs 0 0 0
Paket APD Lengkap (baju APD,cover

20 shoes,shoes,Hscoon,masker set 20 0 20 2
bedah,google)
21 Shoe cover pasang 0 0 0

22 Coverall kaltech disposibel L pcs 100 0 100
23 Coverall kaltech disposibel XL pcs 150 0 150
24 Cover all+cover shoes set 120 0 120
25 Google pcs 3 0 3
26 Masker kain pcs 32 0 32
27 Hand sanitizer 500 ml 500 ml 9 0 9
28 Surgical gloves no. 8 pasang 79 0 79 7
29 Appron disposible pcs 9 0 9
30 Jas Hujan pcs 11 0 11
31 Apron lengan panjang spongebound pcs 0 0 0
32 Etanol 70 % 1 liter 0 0 0
33 Handscoon m pcs 0 0 0
34 Handscoon L pcs 0 0 0
PEMAKAIAN
STOK PENERI
JUMLAH Pustu
NO NAMA BARANG SATUAN AWAL MAAN Poli Poli Pustu
LAB VK UGD Muarar
Umum Gigi Kraton
eja
(A) (B) (A+B) (C)
Tegal, 14
Kepala Puskesmas Tegal Barat Petugas K
dr. Bambang Kuswanto Nurul Ardi A

NIP.19651107 200212 1 004 NIP. 1983051
BULAN : JULI 2020
KOTA : TEGAL
PEMAKAIAN
STOK PENERI
JUMLAH Pustu Pustu
NO NAMA BARANG SATUAN AWAL MAAN Poli Poli Pustu V
LAB VK UGD Muarar Tegal
Umum Gigi Kraton
eja Sari
(A) (B) (A+B) (C)
BANTUAN COVID 19
1 Coverall disposible all size pcs 93 0 93
14 Face shield hijau (Dinkes) pcs 0 0
16 Hairnet pcs 156 0 156
17 Hand sanitizer 5 liter botol 1 liter 4 0 4
18 Masker KN 95 pcs 0 0 0

20 shoes,shoes,Hscoon,masker set 20 0 20 2
bedah,google)

25 Google pcs 3 0 3
31 Apron lengan panjang spongebound pcs 0 0 0
32 Etanol 70 % 1 liter 0 0 0
PEMAKAIAN
STOK PENERI
JUMLAH Pustu Pustu
NO NAMA BARANG SATUAN AWAL MAAN Poli Poli Pustu V
Umum Gigi Kraton
eja Sari
(A) (B) (A+B) (C)
Tegal, 14

NIP.19651107 200212 1 004 NIP. 1983051
NOMOR :
KOTA : TEGAL
PENGELUARAN
PEMAKAIAN RUSAK/ED
(A) (B) (A+B) (A+B)-(K) (D)
01/08/2021
14
17
36 (sulfat) 0
0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
52 tablet dan
01/08/2020 15345 0 15345 1549 0
(HCl) ampul 5/1/2020 0 0 0 0
61 tablet dan
01/06/2022 6580 0 6580 566
64 tablet dan
01/02/2021 4722 0 4722 590
ampul 12/12/2020
70 Etanol 70% btl 100ml 11 0 11 0
73 tablet dan
01/11/2021 800 0 800 0
74
mg/ml ampul 0 0 0 0
mg/ml ampul 9/30/2021 0 388 388 0
04/01/2020
79 dan
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
87 GOM btl 8ml 9/1/2021 0 0 0 0
93
97 Ichtyol pot 15gr 7/1/2022 137 0 137 35
mg tablet 277 0 277 40
2% tube 5/1/2021 0 0 0 0
121 01/03/2021
dan
01/04/2022 235327 0 235327 6359
124 Kodein 20mg tablet 6/30/2021 0 0 0 0
128 Lansoprazol 30 mg kapsul 1/1/2022 794 794 300
0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
01/07/2020
131 ampul 01/11/2020
&01/11/202 390 0 390 18 0
2
0,125 mg
139 01/02/2021
&
tablet 01/05/2021 1960 0 1960 0
151 01/12/2020
&
152 tablet dan
01/03/2021 693 2500 3193 720
154 2298
18/11/2020 0 2298 0
155 OBH botol 01/03/2022 174 30 204 33
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
kapsul lunak 0 0 0
kapsul lunak 0 0 0
btl 500ml 01/07/2023 120 10 130 0
03/01/2020
187 dan
mcg tablet 25716 0 25716 2057
01/05/2023
210 Zinc sirup botol 01/03/2020 0 0 0 0
(CAVITON) kotak 11/6/2019 2 0 2 2
gigi botol 3/31/2022 10 0 10 0
3
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
botol
4 01/11/2020
&
Eugenol cairan 01/08/2039 16 0 16 0
8 gigi 0
0 0 0
9
11 gigi botol 10/31/2020 8
0 8 0
13 Ionomer,fuji) 35
0 35 0
14 12
0 12 0
1500IU/ml ampul 8/1/2019 0 0 0 0
10 Glimepirid 1mg 5/1/2022 4140 1400 5540 780
11 Glimepirid 2mg 4/1/2022 2635 0 2635 885
(Neuroval) 766 0 766 108
2,5mg/2,5 ml NaCl) 0 0 0
22 Salep bisul pot 7/1/2020 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
9
11 Pot sputum
01/04/2022
pot 01/03/2024 1500 0 1500 0
18 spuit 0,5 ml pcs 0 0 0 0 0
1 ADS 0,05ml pcs 4/1/2023 300 0 300 0
2 Blood Lancet box 8/1/2021 470 0 470 0
9 IV Catheter 18 G pcs 12/31/2023 50 0 50 0
10 IV Catheter 24 G pcs 1/31/2023 108 0 108 0
11 IV Catheter 22 G pcs 3/31/2024 108 0 108 0
12 IV catheter 20 G pcs 31/02/2024 70 0 70 0
13 Kapas 100 gr rol 0 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
22 Spuit 0,05 ml pcs 0 0 0 0
31 alkohol swab pcs 10/1/2021 0 0 0 0
32 aquadest botol 1 L 6/3/2036 0 0 0 0
49 hipafik 5x5 pcs 2/1/2021 3 0 3 0
50 hipafik 15x10 box 01/102020 15 0 15 0
55
06/01/2022
72 masker box/50pcs 30/04/2021 152 40 192 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
78 Pita Lila pcs 1/6/2022 0 0 0 0
82 spuit 0,5 ml pcs 4/1/2023 2100 0 2100 0
91 USG Gel 250 ml botol 1/31/2021 7 0 7 0
92 urin bag pcs 19/05/2021 22 0 22 0
95 pack/100
97 Cell pack bok 9/5/2020 0 0 0 0
98 Cuka diksi botol 5/1/2024 0 0 0 0
99 EDTA btl 100ml 0 0 0 0
106
119 hayam btl 100ml 1/6/2022 0 0 0 0
125 lar. eosin 2% btl 7/6/2020 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
134 masker N95 box 12/1/2020 0 0 0 0
135 metanol botol 7/6/2020 0 0 0 0
142 ress Ecker btl 100ml 1/6/2022 0 0 0 0
144 Stomalizer Pcs 4/8/2020 0 0 0 0
148 xylol btl 100ml 9/6/2019 0 0 0 0
150 Lisol btl 0 0 0 0
TAMBAHAN 0 0
5 Vaccum Tube Steril EDTA K-3 (3ml) pack 0 3 3 3
6
Vaccum Tube Steril Clot Activator(3ml) pack 0 6 6 6
7 Pot Dahak Steril pot 0 200 200 200
8 Rapid test Syphilis test 0 100 100 100
9 Reagen Syphilis (SD biosensor standart
Q) pcs 0 550 550 550
Tegal, 10 September 2020


NIP.19651107 200212 1 004 NIP. 19830519 201101 2 009
NOMOR :
KOTA : TEGAL
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR
OP
(A) (B) (A+B) (A+B)-(K) (D) (L)
01/08/2021
14
17
36 (sulfat) 0
0 0 0 0
38 Azitromisin 500 mg tablet 1/9/2020 205 0 205 105 100 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
52 tablet dan
01/08/2020 15345 0 15345 1549 0 13796
(HCl) ampul 5/1/2020 0 0 0 0 0
61 tablet dan
01/06/2022 6580 0 6580 566 6014
64 tablet dan
01/02/2021 4722 0 4722 590 4132
ampul 12/12/2020
(sebagaiHCL) 20 0 20 0 0 20
69 Etakridin 0,1% btl 0 0 0 0 0
70 Etanol 70% btl 100ml 11 0 11 0 11
73 tablet dan
01/11/2021 800 0 800 0 800
74
mg/ml ampul 9/30/2021 0 388 388 0 388
04/01/2020
79 dan
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
87 GOM btl 8ml 9/1/2021 0 0 0 0 0
93
97 Ichtyol pot 15gr 7/1/2022 137 0 137 35 102
98 INH 100mg tablet 0 0 0 0 0
99 INH 300mg tablet 0 0 0 0 0
101 Ibuprofen 400mg tablet 0 0 0 0 0
mg tablet 277 0 277 40 237
2% tube 5/1/2021 0 0 0 0 0
121 01/03/2021
dan
01/04/2022 235327 0 235327 6359 228968
124 Kodein 20mg tablet 6/30/2021 0 0 0 0 0
0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
01/07/2020
131 ampul 01/11/2020
&01/11/202 390 0 390 18 0 372
2
0,125 mg
139 01/02/2021
&
tablet 01/05/2021 1960 0 1960 0 1960
150 NaCl infus btl 500ml 45 0 45 0 45
151 01/12/2020
&
152 tablet dan
01/03/2021 693 2500 3193 720 2473
154 2298
18/11/2020 0 2298 0 2298
155 OBH botol 01/03/2022 174 30 204 33 171
157 Oksitetrasiklin HCl salep mata 3 % tube 0 0 0 6 -6
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
177 Ranitidin inj 25mg/ml ampul 30/03/2021 0 0 0 0 0
btl 500ml 01/07/2023 120 10 130 0 130
03/01/2020
187 dan
mcg tablet 25716 0 25716 2057 23659
01/05/2023
206 Thiamin HCl 50mg (vit. B1) tablet 01/05/2022 29097 0 29097 976 28121
210 Zinc sirup botol 01/03/2020 0 0 0 0 0
(CAVITON) kotak 11/6/2019 2 0 2 2 0
gigi botol 3/31/2022 10 0 10 0 10
3
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
botol
4 01/11/2020
&
Eugenol cairan 01/08/2039 16 0 16 0 16
8 gigi 0
0 0 0 0
9
11 gigi botol 10/31/2020 8
0 8 0 8
13 Ionomer,fuji) 35
0 35 0 35
14 12
0 12 0 12
1500IU/ml ampul 8/1/2019 0 0 0 0 0
10 Glimepirid 1mg 5/1/2022 4140 1400 5540 780 4760
11 Glimepirid 2mg 4/1/2022 2635 0 2635 885 1750
(Neuroval) 766 0 766 108 658
20 Phenol gliserol tetes telinga botol 0 0 0 0 0 0
2,5mg/2,5 ml NaCl) 0 0 0 0
22 Salep bisul pot 7/1/2020 0 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
9
10 Box slide pcs 0 0 0 0 0 0
11 Pot sputum
01/04/2022
pot 01/03/2024 1500 0 1500 0 1500
16 safety box 2,5 lt pcs 0 0 0 0 0 0
18 spuit 0,5 ml pcs 0 0 0 0 0 0
1 ADS 0,05ml pcs 4/1/2023 300 0 300 0 300
2 Blood Lancet box 8/1/2021 470 0 470 0 470
3 Cryotube 1.8 ml pcs 0 0 0 0 0 0
9 IV Catheter 18 G pcs 12/31/2023 50 0 50 0 50
10 IV Catheter 24 G pcs 1/31/2023 108 0 108 0 108
11 IV Catheter 22 G pcs 3/31/2024 108 0 108 0 108
12 IV catheter 20 G pcs 31/02/2024 70 0 70 0 70
13 Kapas 100 gr rol 0 0 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
22 Spuit 0,05 ml pcs 0 0 0 0 0
31 alkohol swab pcs 10/1/2021 0 0 0 0 0
32 aquadest botol 1 L 6/3/2036 0 0 0 0 0
49 hipafik 5x5 pcs 2/1/2021 3 0 3 0 3
50 hipafik 15x10 box 01/102020 15 0 15 0 15
55
06/01/2022
72 masker box/50pcs 30/04/2021 152 40 192 0 192
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
78 Pita Lila pcs 1/6/2022 0 0 0 0 0
82 spuit 0,5 ml pcs 4/1/2023 2100 0 2100 0 2100
91 USG Gel 250 ml botol 1/31/2021 7 0 7 0 7
92 urin bag pcs 19/05/2021 22 0 22 0 22
95 pack/100
97 Cell pack bok 9/5/2020 0 0 0 0 0
98 Cuka diksi botol 5/1/2024 0 0 0 0 0
99 EDTA btl 100ml 0 0 0 0 0
106
119 hayam btl 100ml 1/6/2022 0 0 0 0 0
125 lar. eosin 2% btl 7/6/2020 0 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
134 masker N95 box 12/1/2020 0 0 0 0 0
135 metanol botol 7/6/2020 0 0 0 0 0
142 ress Ecker btl 100ml 1/6/2022 0 0 0 0 0
144 Stomalizer Pcs 4/8/2020 0 0 0 0 0
148 xylol btl 100ml 9/6/2019 0 0 0 0 0
150 Lisol btl 0 0 0 0 0
TAMBAHAN 0 0
5 Vaccum Tube Steril EDTA K-3 (3ml) pack 0 3 3 3 0
6
Vaccum Tube Steril Clot Activator(3ml) pack 0 6 6 6 0
7 Pot Dahak Steril pot 0 200 200 200 0
8 Rapid test Syphilis test 0 100 100 100 0
Q) pcs 0 550 550 550 0
Tegal, 10 September 2020


NIP.19651107 200212 1 004 NIP. 19830519 201101 2 009
BULAN : AGUSTUS 2020
KOTA : TEGAL
PEMAKAIAN
STOK PENERI JUMLA
AWAL MAAN H Poli Pustu
NO NAMA BARANG SATUAN Poli Pustu
Umu LAB VK UGD Muara
Gigi Kraton
reja
m
(A) (B) (A+B) (C)
BANTUAN COVID 19
1 Baju Hazmed pcs 0 0 0
3 Coverall boho disposible L set 57 0 57
13 Face shield bando pasang 12 0 12
14 Face shield hijau (Dinkes) pcs 0 0 0
15 Glove kuning multipurpose pcs 9 0 9
16 Hairnet botol 5 l 156 5 161
17 Hand sanitizer 5 liter botol 500ml 4 9 13
18 Masker KN 95 pcs 20 20
19 Paket
MaskerAPD
N95Lengkap
putih (baju APD,cover pcs 0 0
shoes,shoes,Hscoon,masker
20 bedah,google) pcs 18 0 18
21 Shoe cover pcs 0 0
23 Coverall kaltech disposibel XL set 150 0 150
24 Cover all+cover shoes pasang 120 0 120
25 Google pcs 3 10 13
26 Masker kain pcs 0
27 Hand sanitizer 500 ml 500 ml 9 0
28 Surgical gloves no. 8 pasang 79 0
29 Appron disposible pcs 9 0
30 Jas Hujan pcs 11 0
31 Apron lengan panjang spongebound pcs 10
32 Etanol 70 % 1 liter 5
33 Handscoon m pcs 100
34 Handscoon L pcs 300
PEMAKAIAN
STOK PENERI JUMLA
AWAL MAAN H Poli Pustu
NO NAMA BARANG SATUAN Poli Pustu
Umu LAB VK UGD Muara
Gigi Kraton
reja
m
(A) (B) (A+B) (C)

NIP.19651107 200212 1 004 NIP. 1983051
BULAN : AGUSTUS 2020
KOTA : TEGAL
PEMAKAIAN
STOK PENERI JUMLA
AWAL MAAN H Poli Pustu Pustu
NO NAMA BARANG SATUAN Poli Pustu V
Umu LAB VK UGD Muara Tegal
Gigi Kraton
reja I
m Sari
(A) (B) (A+B) (C)
BANTUAN COVID 19
1 Baju Hazmed pcs 0 0 0
3 Coverall boho disposible L set 57 0 57
13 Face shield bando pasang 12 0 12
15 Glove kuning multipurpose pcs 9 0 9
16 Hairnet botol 5 l 156 5 161
17 Hand sanitizer 5 liter botol 500ml 4 9 13
18 Masker KN 95 pcs 20 20
19 Paket
MaskerAPD
N95Lengkap
putih (baju APD,cover pcs 0 0
shoes,shoes,Hscoon,masker
20 bedah,google) pcs 18 0 18
21 Shoe cover pcs 0 0
23 Coverall kaltech disposibel XL set 150 0 150
24 Cover all+cover shoes pasang 120 0 120
26 Masker kain pcs 0
27 Hand sanitizer 500 ml 500 ml 9 0
28 Surgical gloves no. 8 pasang 79 0
29 Appron disposible pcs 9 0
30 Jas Hujan pcs 11 0
31 Apron lengan panjang spongebound pcs 10
32 Etanol 70 % 1 liter 5
33 Handscoon m pcs 100
34 Handscoon L pcs 300
PEMAKAIAN
STOK PENERI JUMLA
AWAL MAAN H Poli Pustu Pustu
NO NAMA BARANG SATUAN Poli Pustu V
Umu LAB VK UGD Muara Tegal
Gigi Kraton
reja I
m Sari
(A) (B) (A+B) (C)

NIP.19651107 200212 1 004 NIP. 1983051
NOMOR :
KOTA : TEGAL
PENGELUARAN
PEMAKAIAN RUSAK/ED
(A) (B) (A+B) (A+B)-(K) (D)
1 Asetosal 100 mg tablet 0 0 0
2 Albendazol tab 400 mg tablet 9037 9037 11
3 Albendazol sirup 200 mg/5 ml botol 900 900 0
4 Allopurinol 300 mg tablet 0 0 0
5 Alopurinol tablet 100 mg tablet 67 67 67
01/08/2021
6 Aminofilin inj 24mg/ml ampul 0 0 0
7 Aminofillin 150 mg tablet 5/13/2020 0 0 0
8 Aminofillin 200 mg tablet 0 0 0
9 Amitriptyline tablet 5/1/2021 168 168 0
10 Amlodipin 5mg tablet 266 266 266
12 Amoksisilin drop 100 mg/ml btl 0 0 0
13 Amoksisilin serbuk injeksi 1000mg ampul 0 0 0
14
Amoksisilin sirup kering 125 mg/ 5 mg botol 0 0 0
15 Amoksisillin 250mg kaplet 11/1/2021 8857 8857 93
17
Amoksisillin sirup kering 250mg/5 ml botol 117 117 14
18 Ampisillin 500 mg kaplet 0 0 0
19 Antasida DOEN kombinasi tablet 1/1/2022 0 0 0
20 Antasida DOEN suspensi btl 60ml 7/1/2021 104 104 48
(Bacitracin) tube 0 0 0
23 Antifungi DOEN Kombinasi pot 5/1/2021 187 187 2
24 Antihemoroid DOEN supp 12/1/2020 692 692 0
25 Antiparkinson DOEN tablet 0 0 0
26 Aqua pro injeksi steril vial 0 0 0
28 Asam askorbat 50mg tablet 7/1/2020 18369 18369 10861
29 Asam folat 1 mg (MARIN) tablet 9/1/2020 0 0 0
30 Asam mefenamat 500mg tablet 7/31/2022 1154 1154 723
31 Asam traneksamat 100mg tblt 110 110 55
32 Asiklovir 200mg tablet 2/1/2022 624 624 56
34 Asiklovir krim 5% tube 8/1/2022 460 460 2
36 (sulfat) 0
0 0
37 Attapulgit 600mg (New Antides) tablet 6/1/2020 20307 20307 232
39 Bedak salisil 2% dus@50gr 4/1/2022 373 373 20
40 Besi (II) sulfat 200 mg kombinasi tablet 6/5/2020 22134 22134 157
41 Betahistin mesilat 6mg tablet 9/1/2021 940 940 280
42 Betametason krim 0,1% tube 1/1/2021 38 38 16
43 Bisakodil 5 mg tab.salut 0 0 0
INFANT) supp 0 0 0
45 Bisakodil supp 10 mg supp 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
46 Bisoprolol 5 mg tablet 0 0 0
Respules nebule 0 0 0
48 Cetirizin 10 mg tablet 4/1/2021 1003 1003 108
49 Cetirizine sirup 5mg/5ml botol 5/1/2020 0 0 0
50 Clobazam 10mg tablet 3/1/2021 53 53 0
51 Co Amoxiclav tablet 0 0 0
52 tablet dan
01/08/2020 13796 13796 1229 0
53 Dexamethason inj 5mg/ml ampul 0 0 0
54 Diazepam 2mg tablet 1/1/2021 0 0 0
(HCl) ampul 5/1/2020 0 0 0
58 Digoksin 0,25mg tablet 0 0 0
59 Diazepam injeksi 5mg/ml-1ml ampul 4/1/2020 0 0 0
60 Diltiazem HCl 30mg tablet 0 0 0
61 tablet dan
01/06/2022 6014 6014 456
62 Doksisiklin 100mg kapsul 01/03/2021 0 0 0
63 Domperidon suspensi 5mg/ 5ml botol 6/1/2021 247 247 6
64 tablet dan
01/02/2021 4132 4132 668
65 Efedrin tablet 0 0 0 0
ampul 12/12/2020
(sebagaiHCL) 20 20 0 0
67 Ergotamin 1mg+kofein 50mg tablet 0 0 0
68 Eritromisin 500mg kapsul 4/1/2021 424 424 253
69 Etakridin 0,1% btl 0 0 0
70 Etanol 70% btl 100ml 11 11 0
71 Fenitoin Na 30mg (DECATONA) tablet 0 0 0
72 Fenobarbital inj 50mg/ml ampul 62 62 0
73 tablet dan
01/11/2021 800 800 0
74
Fenoksimetil Penisilin tablet 250 mg tablet 0 0 0
mg/ml ampul 0 0 0
mg/ml ampul 9/30/2021 388 388 0
77 Fitomenadion 10mg tab salut 8/23/2020 3123 3123 66
04/01/2020
79 dan
Furosemid 40 mg tablet 01/02/2021 1542 1542 42
80 Garam Oralit I serbuk sachet 8/1/2022 8726 8726 47
81 Gentamisin Salep kulit 0,1% tube 7/1/2023 604 604 24
82 Gentamisin TM 0,3% botol 5/6/2022 355 355 0
83 Gentamisin injeksi ampul 0 0 0
84 Gentian Violet larutan 1% botol 8 8 0
85 Glibenklamid 5mg tablet 3/23/2023 1240 1240 210
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
86 Gliseril Guaiakolat 100mg tablet 1/4/2021 22971 22971 711
87 GOM btl 8ml 9/1/2021 0 0 0
88 Griseofulvin 125 mg tablet 2/1/2020 0 0 0
89 Guaifenesin 100 mg tablet 7/1/2022 49361 49361 0
90 Haloperidol 5mg tablet 01/02/2020 0 0 0
91 Haloperidol 1,5 mg tablet 10/30/2019 0 0 0
92 Haloperidol 2 mg tablet 8/1/2020 425 425 0
93
Haloperidol Deconat injeksi 50 mg/ml ampul 1/1/2020 7 7 0
94 Hidrokortison Krim 2,5% tube 3/1/2021 329 329 42
95 Hidroklorthiazid 25 mg tablet 9/1/2022 6 6 0
96 Hyosin Nbutilbromid 10mg tablet 11/1/2020 53 53 18
97 Ichtyol pot 15gr 7/1/2022 102 102 4
98 INH 100mg tablet 0 0 0
100 Ibuprofen 200mg tablet 9/1/2021 17931 17931 699
101 Ibuprofen 400mg tablet 0 0 0
102 Ibuprofen suspensi 100mg/5ml botol 0 0 0
mg tablet 237 237 3
105 Kalium Aspartat 300mg tablet 0 0 0
106 Kalium Klorida 600mg tablet 0 0 0
107 Kalsium laktat 500mg tablet 2/1/2020 8602 8602 0
108 Kaolin Pektin (New Diaform) tablet 6/1/2022 0 0 0
109 Kaptopril 12,5mg tablet 11/21/2021 2480 2480 1356
110 Kaptopril tablet 25 mg tablet 11/16/2021 2221 2221 1100
111 Ketokonazol 200mg tablet 01/05/2021 2543 2543 190
112 Ketokonazol krim 2% tube 8/31/2021 115 115 18
113 Ketorolac injeksi 10mg ampul 0 0 0
114 Klindamisin 150mg tablet 0 0 0
115 Klonidin 0,15 mg tablet 0 0 0
116 Kloramfenikol 250 mg kapsul 8/1/2023 736 736 0
117 Kloramfenikol TT 3% btl 58 58 2
118 Kloramfenikol suspensi 125mg/5 btl 60 ml 0 0 0
2% tube 5/1/2021 0 0 0
120 Klorampenikol TM 0,5% (RECO) btl 10/31/2020 44 44 17
121 01/03/2021
dan
01/04/2022 228968 228968 3399
122 Klorpromazine tablet 0 0 0
123 Kodein 10mg tablet 0 0 0
124 Kodein 20mg tablet 6/30/2021 0 0 0
125 Kotrimoksazol DOEN dewasa tablet 6/1/2020 10105 10105 733
126 Kotrimoksazol FORTE tablet 11/1/2021 1876 1876 22
127 Kotrimoksazol suspensi kombinasi botol 30/04/2020 228 228 14
128 Lansoprazol 30 mg kapsul 1/1/2022 494 494
295
129 Levofloksasin 500mg kapsul 0 0 0 0
130 Lidokain 2%+adrenalin 0,0125mg ampul 12/1/2020 1780 1780 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
01/07/2020
131 ampul 01/11/2020
&01/11/202 372 372 0 0
2
132 Linkomisin 500mg kapsul 8/1/2020 916 916 0
133 Loratadin tablet 4/1/2020 470 470 10
134 Mebendazol sirup 100 mg/5 ml botol 0 0 0
135 Mebendazol tablet tablet 0 0 0
136 Meloksikam 15mg tablet 31/06/2021 3804 3804 87
137 Metformin 500mg tablet 1/3/2020 2430 2430 2310
138 Methampiron 500mg tablet 7/1/2022 11196 11196 1071
0,125 mg
139 01/02/2021
&
tablet 01/05/2021 1960 1960 0
140 Metilergometrin inj 0,2 mg/ml ampul 11/30/2020 7 7 0
141 Metoklopramid 5 mg tablet 116 116 30
142 Metoklopramide injeksi 5 mg/ml ampul 0 0 0
143 Metronidazol 500mg tablet 0 0 0
144 Metylprednisolon 4 mg tablet 4/1/2022 12875 12875 1600
145 Metylprednisolon 8 mg tablet 0 0 0
146 Mg Sulfat injeksi 20% ampul 9/1/2019 0 0 0
147 Mg Sulfat injeksi 40% ampul 0 0 0
148 Mikonazol krim 2% tube 2/1/2021 128 128 2
149 N-asetil sistein 200 mg kapsul 4/8/2020 0 0 0
150 NaCl infus btl 500ml 45 45 45
151 01/12/2020
&
Nadifen 50 mg tablet 22/05/2021 29264 29264 2318
152 tablet dan
01/03/2021 2473 2473 1955
153 Nistatin tablet salut 500.000 IU tablet 8/1/2019 88 88 88
154 2298
18/11/2020 2298 14
155 OBH botol 01/03/2022 171 171 17
156 Oksitetrasiklin HCl salep kulit 3 % tube 9/1/2021 176 176 46
157 Oksitetrasiklin HCl salep mata 3 % tube 0 0 0
158 Omeprazol 20mg kapsul 6/1/2021 250 250 152
159 Omeprazol injeksi ampul 0 0 0
160 Ondancentron inj ampul 4/1/2021 0 0 0
161 Parasetamol 500mg tablet 1/1/2022 81394 81394 4121 0
162 Parasetamol sirup 120mg/5ml botol 60ml 1/1/2022 516 516 173
163 Parasetamol drop btl 15 ml 8/24/2020 174 174 43
164 Pehacain injeksi ampul 0 0 0
165 Permetrin (Scabimite) krim 5% tube 7/1/2020 42 42 0
166 Pirantel tab.score base 125mg tablet 8/30/2020 0 0 0
167 Pirantel Pamoat susp 125mg/5ml botol 0 0 0
168 Piridoksin 10mg (vit. B6) tablet 9/1/2020 34631 34631 6954
169 Piroksikam 10mg tablet 5/1/2021 11306 11306 542
170 Polikresulen cairan btl 10ml 6/3/2036 6 6 0
171 Povidon Iodin 10% btl 30 ml 11/1/2019 196 196 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
172 Povidon Iodin 10% btl 300ml 2/1/2020 4 4 0
173 Prednison 5mg tablet 7/1/2021 9014 9014 724
174 Propanolol 10mg tablet 210 210 0
175 Propiltiurasil tablet 100mg tablet 0 0 0
176 Ranitidin 150mg tablet 8/31/2020 0 0 0
177 Ranitidin inj 25mg/ml ampul 30/03/2021 0 0 0
178 Reserpin tablet 0,10 mg tablet 0 0 0
kapsul lunak 0 0
kapsul lunak 0 0
btl 500ml 01/07/2023 130 130 0
183 Rivanol 300 ml botol 0 0 0
184 Salbutamol 2 mg tablet 3/31/2023 1707 1707 307
186 Salep 2-4 kombinasi pot 7/1/2021 462 462 4
03/01/2020
187 dan
Sefadroksil 500mg kapsul 01/10/2020 225 225 225
188 Sefadroksil sir.kering 125mg/5 btl 60ml 0 0 0 0
189 Sefiksim 100mg kapsul 0 0 0 0
190 Sefotaksim inj 1g/vial vial 0 0 0 0
191 Seftriakson 1g/vial vial 0 0 0 0
192 Seltifort kids (vit syrup) btl 60ml 5/31/2022 36 36 18
mcg tablet 23659 23659 4015
194 Simetidin 200mg tablet 10/1/2020 533 533 330
195 Simvastatin 10mg tablet 0 0 0
196 Simvastatin 20mg tablet 03/05/2020 4531 4531 83
197 Siprofloksasin 500mg tablet 9/1/2020 230 230 230
198 Spiramisin 500mg tablet 0 0 0
199 Stesolid 10 mg injeksi ampul 0 0 0
200 Stesolid supp 10mg Tube 3/1/2022 10 10 0
202 Sulfasetamid TM 15% botol 0 0 0
203 Terbutalin sufat 2,5mg tablet 0 0 0
204 Tetrasiklin 250mg kapsul 0 0 0
205 Tetrasiklin kapsul 500 mg kapsul 3/1/2021 2629 2629 76
01/05/2023
206 Thiamin HCl 50mg (vit. B1) tablet 01/05/2022 28121 28121 0
207 Tiamfenikol kapsul 500mg kapsul 0 0 0
208 Triheksifenidil 2mg tablet 0 0 0
209 Vit. B kompleks tablet 31/02/2021 15767 15767 4811
210 Zinc sirup botol 01/03/2020 0 0 0
211 Zinc dispersibel 20mg tablet 12/1/2019 3291 3291 1711
n Obat-obatan ( PKD ) Gigi 0 0 0
(CAVITON) kotak 11/6/2019 0 0 0
gigi botol 3/31/2022 10 10 0
3
Devitalisasi pasta non arsen (Pulp x) kotak 4/1/2022 6 6 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
botol
4 01/11/2020
&
Eugenol cairan 01/08/2039 16 16 0
5 Kalsium hidroksida (Hycal) 7 gram 8/1/2021 18 18 0
6 Mata bor gigi standar set/6 biji 1/6/2022 1 1 0
7 Mata bor gigi high speed set/6 biji 0 0 0
8 gigi 0
0 0
9
10 Poliren (OCO) polishing pasta btl 15gr 7/1/2021 5 5 0
11 gigi botol 10/31/2020 8
8 0
28gr(3M ESPE Cavit G) 0 0
13 Ionomer,fuji) 35
35 0
14 12
12 0
15 Komposir resin (Master fill) kotak 2/1/2022 9 9 0
Obat-obatan ( PKD ) Penunjang 8/1/2020 0 0 0
1 Ambroksol 30 mg tablet 7/1/2021 33973 33973 247
2 Antiflu tab.kombinasi (Brocifar) tablet 6/1/2021 4887 4887 841
3 Asam Tranexamat inj.500mg/ml ampul 1/1/2021 0 0 0
4 Calsium Gluconnat Injeksi ampul 11/1/2019 0 0 0
1500IU/ml ampul 8/1/2019 0 0 0
6 Bromheksin HCl 8 mg tablet 8/1/2021 1000 1000 0
7 Ekstrak sonchi Folium 100% kapsul 4/1/2022 0 0 0
8 Etanol 70 %( One Med alcohol) botol 1 L 0 0 0 0
9 Fenoterol MDI 100 mcg/ 10ml fls 7/31/2020 0 0 0
10 Glimepirid 1mg 5/1/2022 4760 4760 570
11 Glimepirid 2mg 4/1/2022 1750 1750 1390
12 Kloramfenikol inj vial 4/1/2020 0 0 0
13 Kloramfenikol Salep mata 1% tube 5 gr 1/1/2022 146 146 5
14 Levertran15 g pot 15gr 01/02/2020 1 1 0
(Neuroval) 658 658 104
16 Obat anti flu sirup (Betaflu) botol 6/1/2021 152 152 0
17 Obat batuk Kombinasi (Fenidryl) sirup 7/1/2022 0 0 0
18 Obat batuk kombinasi (Dextral) tablet 7/1/2021 1440 1440 0
19 Oksitosin injeksi ampul 4/1/2020 0 0 0
20 Phenol gliserol tetes telinga botol 0 0 0 0
2,5mg/2,5 ml NaCl) 0 0
22 Salep bisul pot 7/1/2020 0 0 0
23 Salep luka bakar (Neocenta gel) tube 15gr 0 1 1 0
24 Tab. Curcuma 20mg tablet 0 0 0 0
25 Teofilin syrup 43,33 mg/ 5 ml botol 0 0 0 0
26 Terapi Diare sirup btl 60ml 0 0 0
27 Terapi Diare tab tablet 8/1/2020 0 0 0
28 Vit neurotropik tablet 9/1/2022 0 0 0
29 Etil klorid semprot Spray 7/1/2020 42 42 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
iaan Obat Asli Indonesia 0 0 0
1 Extrak Belladon tab 10 mg tablet 0 0 0 0
2 Enkasari 120 ml botol 0 0 0
3 Fitogen tablet 0 0 0 0
4 Ferris botol 0 0 0 0
5 Hemorogard kapsul 8/1/2020 2198 2198 0
6 Hepagard kapsul 0 0 0
7 Minyak telon botol 50 ml 0 0 0 0
8 Tensigard kapsul 0 4 4 0
Obat dan Alkes PROGRAM 0 0 0
1 Diethylcarbamazine (DEC) 100 mg tablet 0 0 0 0
3 MDT Combi MB Adult blister 0 0 0 0
4 MDT Combi MB Child blister 0 0 0 0
5 MDT Combi PB Adult blister 0 0 0 0
7 MDT Combi PB Child blister 0 0 0 0
8 Obat Anti Tubercolusis kategori 1 FDC 0 16 16 0
9
Obat Anti Tubercolusis kategori anak FDC 0 0 0 0
10 Box slide pcs 0 0 0 0
11 Pot sputum
01/04/2022
pot 01/03/2024 1500 1500 0
12 Reagen BTA ( Ziehl Nelsen ) paket 0 0 0 0
13 Prokain Benzil Penisilin 3 jt IU vial 0 0 0 0
14 Depo Progestin/ suntik KB 3 bulan vial 0 0 0 0
15 Mineral Mix sachet 0 0 0 0
16 safety box 2,5 lt pcs 0 0 0 0
17 safety box 5 lt pcs 0 0 0 0
18 spuit 0,5 ml pcs 0 0 0 0
an ALKES Habis Pakai (PKD) 0 0 0
1 ADS 0,05ml pcs 4/1/2023 300 300 0
2 Blood Lancet box 8/1/2021 470 470 0
3 Cryotube 1.8 ml pcs 0 0 0 0
4 Cover Glass 22x22 mm box 3/1/2022 0 0 0
5 Deck Glass box/72pcs 0 0 0 0
6 E Care Handrub 500 ml botol 3/1/2020 11 11 0
7 Folley Catheter No.16 buah 11/1/2022 30 30 0
8 Folley Catheter setara Rush No.18 buah 12/1/2022 10 10 0
9 IV Catheter 18 G pcs 12/31/2023 50 50 0
10 IV Catheter 24 G pcs 1/31/2023 108 108 0
11 IV Catheter 22 G pcs 3/31/2024 108 108 0
12 IV catheter 20 G pcs 31/02/2024 70 70 0
13 Kapas 100 gr rol 0 0 0 0
14 Kasa 4m x 15 cm elastis roll 0 0 0 0
15 Kertas ECG Ukuran Besar roll 0 0 0 0
16 Kertas ECG Ukuran Standar roll 0 0 0 0
17 Pembalut Gips Uk. 3" roll 0 0 0 0
20 Plester 5 yard x 2 inchi roll 0 0 0 0
21 Pot Urine (pot sputum) bh/d.5,5cm 4/1/2022 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
22 Spuit 0,05 ml pcs 0 0 0
23 Tensocrepe 4" buah 0 0 0 0
25 Wing Needle No. 21G buah 0 0 0 0
26 Wing Needle No. 25G buah 1/1/2020 0 0 0
27 alat suntik 1 ml pcs 11/1/2020 0 0 0
31 alkohol swab pcs 10/1/2021 0 0 0
32 aquadest botol 1 L 6/3/2036 0 0 0
33 Alkapram septalkan spray botol 7/1/2021 0 0 0
34 Alkapram alkacide 1 L botol 7/1/2020 0 0 0
35 Alkapharm alkazyme 25mg sachet 5/1/2021 0 0 0
36 bisturi kecil pcs 1/12/2020 65 65 0
37 bioplacenton tulle pcs 0 0 0
38 catgut cromic 2/0 box 30/12/2019 9 9 0
41 fixomul stretch 15cmx5m roll 28/07/2020 0 0 0
42 foley catheter No.14 pcs 7/1/2021 0 0 0
43 Gelang Bayi Pink pcs 2/1/2023 0 0 0
44 Gelang Bayi Biru pcs 2/1/2023 0 0 0
45 handscoon Uk S box 5/1/2021 196 196 53
46 handscoon Uk M box 5/1/2021 194 194 54
47 handscoon obgyn pcs 1/7/2021 0 0 0
48 handscoon steril pasang 12/1/2022 0 0 0
49 hipafik 5x5 pcs 2/1/2021 3 3 0
50 hipafik 15x10 box 01/102020 15 15 0
51 infus set anak set/ktg 5/1/2021 50 50 0
52 infus set dewasa set/ktg 7/1/2022 207 207 0
53 jarum hect kulit luar besar (12 pcs) pcs 1/10/2021 15 15 0
54 jarum hect kulit luar kecil (12 pcs) pcs 1/5/2022 38 38 0
55
jarum hect kulit luar sedang (12 pcs) pcs 1/9/2022 9 9 0
56 jarum hect otot luar besar bks/12pcs 1/6/2023 0 0 0
57 jarum hect otot luar sedang bks/12pcs 9/6/2022 1 1 0
58 jelly EKG botol 0 0 0
59 kapas absorben 250 gr bks 10/1/2021 7 7 0
60 Kapas Berlemak 500 gr roll 9/1/2033 4 4 0
61 kasa hidrofil 2x80cm pcs 30/04/2021 0 0 0
62 kasa hidrofil 40x80cm roll 5/1/2023 0 0 0
63 kasa pembalut elastic 4m x 15cm roll 8/6/2021 0 0 0
65 kasa pembalut hidrofil 4 m x 10cm roll 10/1/2033 0 0 0
66 kasa hidrofil steril 18x22 roll 10/1/2021 0 0 0
67 kasa kompres 40x40 steril roll 8/1/2021 0 0 0
68 kasa steril 16x16 cm box 11/1/2020 0 0 0
69 kertas gol.darah pak/100's 1/6/2022 0 0 0
70 kertas tissu gulung 0 0 0
06/01/2022
71 klem tali pusat pcs 0 0 0
72 masker box/50pcs 30/04/2021 192 192 100
73 Box Object Glass Grey and Orange box 3/1/2022 0 0 0
74 object glass box/72pcs 19/03/2021 9 9 0
75 Oxygen mask bayi (SERENITY) pcs 1/6/2022 8 8 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
76 Oxygen mask anak (SERENITY) pcs 1/7/2022 11 11 0
77 Oxygen mask dewasa (SERENITY) pcs 1/8/2022 9 9 0
78 Pita Lila pcs 1/6/2022 0 0 0
79 plester 5 yard 20 inch roll 19/02/2021 0 0 0
80 silk no 3/0 dg jarum bedah pcs 3/6/2037 0 0 0
81 spiritus btl / 1 liter 06/01/2022 4 4 0
82 spuit 0,5 ml pcs 4/1/2023 2100 2100 0
83 Stericline Indicator strip box 11/1/2022 0 0 0
84 Stericlin gusette 25x6,5cm roll 10/1/2022 0 0 0
85 tempat preparat BTA / cawan petri pcs 1/6/2022 0 0 0
86 tabung reaksi 1,5x10cm ktk/50pcs 0 0 0
87 test kehamilan box/50pcs 5/1/2020 0 0 0
88 tranfusi set dewasa pcs 3/31/2024 50 50 0
89 Wraping paper 50x50 box 12/1/2020 0 0 0
91 USG Gel 250 ml botol 1/31/2021 7 7 0
92 urin bag pcs 19/05/2021 22 22 0
93 Ammonium Oxalat Btl/100ml 8/1/2020 0 0 0
94 Asam Klorida 0,1 N btl/ 100 ml 0 0 0
95 pack/100
Blue Tip 0test 0 0 0
96 BD Tube EDTA plh 13 x 75 box 5/1/2021 0 0 0
97 Cell pack bok 9/5/2020 0 0 0
98 Cuka diksi botol 5/1/2024 0 0 0
99 EDTA btl 100ml 0 0 0
100 Purple cup EDTA K3 3ml, glass box 6/1/2020 0 0 0
101 HbsAg test strip 0 0 0 0
102 Kertas Lensa lembar 0 0 0 0
103 Larutan Giemsa Stain botol 10/6/2019 0 0 0
104 Paket Gol. Darah Anti AB paket 3/6/2020 0 0 0
105 Paket Gol. Darah anti Resus paket 4/6/2020 0 0 0
106
Reagensia Uji Widal S para Typhi AH vial 12/1/2020 0 0 0
107 Reagensia Uji Widal Typhi H vial 7/6/2020 0 0 0
108 Reagensia Uji Widal Typhi O vial 2/28/2021 0 0 0
109 Reagen ZN paket 7 7 0
110 alkohol asam btl 100ml 0 0 0
111 asam sulfosalisilat btl 100ml 0 0 0
112 asam urat stick btl/25 test 31/04/2021 4 4 0
113 dempul hematokrit pcs 0 0 0
114 glukoprotein stik 10 parameter pck/100's 2/1/2020 0 0 0
115 glukoprotein urin test box/10 test 0 0 0 0
116 glukosa stik btl/25 test 11/7/2020 0 0 0
117 hemoglobin stik box/25 test 4 4 0
118 haemoglobulin C btl 500ml 11/19/2020 0 0 0
119 hayam btl 100ml 1/6/2022 0 0 0
120 Immersion Oil btl 100ml 1/6/2022 0 0 0
121 kertas lakmus pack 0 0 0
122 kertas lensa lembar 0 0 0
123 kolesterol stik btl 10 test 1/31/2021 5 5 0
124 lar. benedict btl 100ml 6/3/2036 0 0 0
125 lar. eosin 2% btl 7/6/2020 0 0 0
126 lar. etanol asam btl 100ml 6/6/2020 0 0 0
127 lar. hypoklorit btl 1L 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
128 lar. karbol fuchsin btl 100ml 0 0 0
129 lar. metilen biru btl 100ml 0 0 0
130 larutan KOH btl 100ml 0 0 0
131 larutan Turk btl 100 ml 1/1/2023 0 0 0
132 larutan Poch-Pack L botol 11/1/2020 0 0 0
133 larutan Poch-Pack D botol 0 0 0
134 masker N95 box 12/1/2020 0 0 0
135 metanol botol 7/6/2020 0 0 0
136 minyak imersi btl 100ml 0 0 0
137 natrium citrat 3,13% btl 100ml 0 0 0
138 natrium citrat 3,8% btl 250ml 6/6/2019 0 0 0
139 paket gol. Drh anti AB paket 0 0 0
140 paket gol. Drh anti B paket 0 0 0
141 paket gol.drh anti A paket 1/6/2022 0 0 0
142 ress Ecker btl 100ml 1/6/2022 0 0 0
143 stik urinalisis 10 parameter botol 4/1/2021 0 0 0
144 Stomalizer Pcs 4/8/2020 0 0 0
145 thermal paper 57mm x 30 m roll 7/6/2020 0 0 0
146 tissu lensa pak 0 0 0
147 trigliserida botol 0 0 0
148 xylol btl 100ml 9/6/2019 0 0 0
149 yellow tip pak 0 0 0
150 Lisol btl 0 0 0
151 Larutan Nacl 0,86% botol 9/6/2019 0 0 0
TAMBAHAN
1 Plester/tulling dress 10cm x10cm lembar 5/23/2023 92 92 13
2 Plastik klip obat 8,5cmx13cm kg 25 25 0
3 Plastik obat cetak etiket kg 25 25 0
4 Kantong puyer SCI box 1 1 0
5 Vaccum Tube Steril EDTA K-3 (3ml) pack 0 0 0
6
Vaccum Tube Steril Clot Activator(3ml) pack 0 0 0
7 Pot Dahak Steril pot 0 0 0
8 Rapid test Syphilis test 0 0 0
Q) pcs 0 0 0
10 Diazepam 5 mg tablet 10/1/2023 200 200 0
11 Trifluoperazine HCl 5 mg tablet 2/28/2024 1000 1000 0
12 Clozapine 25 mg tablet 3/30/2022 1500 1500 0
Tegal, 6 Oktober 2020


NIP.19651107 200212 1 004 NIP. 19830519 201101 2 009
NOMOR :
KOTA : TEGAL
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR
OP
(A) (B) (A+B) (A+B)-(K) (D) (L)
01/08/2021
14
17
36 (sulfat) 0
0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
52 tablet dan
01/08/2020 13796 13796 1229 0 12567
(HCl) ampul 5/1/2020 0 0 0 0
61 tablet dan
01/06/2022 6014 6014 456 5558
64 tablet dan
01/02/2021 4132 4132 668 3464
ampul 12/12/2020
70 Etanol 70% btl 100ml 11 11 0 11
73 tablet dan
01/11/2021 800 800 0 800
74
mg/ml ampul 0 0 0 0
mg/ml ampul 9/30/2021 388 388 0 388
78 Flufenazine Decanoat inj 25 mg/ml ampul 6/1/2020 70 5 75 0 70 5
04/01/2020
79 dan
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
87 GOM btl 8ml 9/1/2021 0 0 0 0
93
97 Ichtyol pot 15gr 7/1/2022 102 102 4 98
mg tablet 237 237 3 234
2% tube 5/1/2021 0 0 0 0
121 01/03/2021
dan
01/04/2022 228968 228968 3399 225569
124 Kodein 20mg tablet 6/30/2021 0 0 0 0
295
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
01/07/2020
131 ampul 01/11/2020
&01/11/202 372 372 0 0 372
2
0,125 mg
139 01/02/2021
&
tablet 01/05/2021 1960 1960 0 1960
151 01/12/2020
&
152 tablet dan
01/03/2021 2473 2473 1955 518
154 2298
18/11/2020 2298 14 2284
155 OBH botol 01/03/2022 171 171 17 154
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
kapsul lunak 0 0 0
kapsul lunak 0 0 0
btl 500ml 01/07/2023 130 130 0 130
03/01/2020
187 dan
mcg tablet 23659 23659 4015 19644
01/05/2023
210 Zinc sirup botol 01/03/2020 0 0 0 0
(CAVITON) kotak 11/6/2019 0 0 0 0
gigi botol 3/31/2022 10 10 0 10
3
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
botol
4 01/11/2020
&
Eugenol cairan 01/08/2039 16 16 0 16
8 gigi 0
0 0 0
9
11 gigi botol 10/31/2020 8
8 0 8
13 Ionomer,fuji) 35
35 0 35
14 12
12 0 12
1500IU/ml ampul 8/1/2019 0 0 0 0
10 Glimepirid 1mg 5/1/2022 4760 4760 570 4190
11 Glimepirid 2mg 4/1/2022 1750 1750 1390 360
(Neuroval) 658 658 104 554
2,5mg/2,5 ml NaCl) 0 0 0
22 Salep bisul pot 7/1/2020 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
9
11 Pot sputum
01/04/2022
pot 01/03/2024 1500 1500 0 1500
18 spuit 0,5 ml pcs 0 0 0 0 0
1 ADS 0,05ml pcs 4/1/2023 300 300 0 300
2 Blood Lancet box 8/1/2021 470 470 0 470
9 IV Catheter 18 G pcs 12/31/2023 50 50 0 50
10 IV Catheter 24 G pcs 1/31/2023 108 108 0 108
11 IV Catheter 22 G pcs 3/31/2024 108 108 0 108
12 IV catheter 20 G pcs 31/02/2024 70 70 0 70
13 Kapas 100 gr rol 0 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
22 Spuit 0,05 ml pcs 0 0 0 0
31 alkohol swab pcs 10/1/2021 0 0 0 0
32 aquadest botol 1 L 6/3/2036 0 0 0 0
49 hipafik 5x5 pcs 2/1/2021 3 3 0 3
50 hipafik 15x10 box 01/102020 15 15 0 15
55
06/01/2022
72 masker box/50pcs 30/04/2021 192 192 100 92
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
78 Pita Lila pcs 1/6/2022 0 0 0 0
82 spuit 0,5 ml pcs 4/1/2023 2100 2100 0 2100
91 USG Gel 250 ml botol 1/31/2021 7 7 0 7
92 urin bag pcs 19/05/2021 22 22 0 22
95 pack/100
97 Cell pack bok 9/5/2020 0 0 0 0
98 Cuka diksi botol 5/1/2024 0 0 0 0
99 EDTA btl 100ml 0 0 0 0
106
119 hayam btl 100ml 1/6/2022 0 0 0 0
125 lar. eosin 2% btl 7/6/2020 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
134 masker N95 box 12/1/2020 0 0 0 0
135 metanol botol 7/6/2020 0 0 0 0
142 ress Ecker btl 100ml 1/6/2022 0 0 0 0
144 Stomalizer Pcs 4/8/2020 0 0 0 0
148 xylol btl 100ml 9/6/2019 0 0 0 0
150 Lisol btl 0 0 0 0
TAMBAHAN
6
Q) pcs 0 0 0 0
10 Diazepam 5 mg tablet 10/1/2023 200 200 0 200
11 Trifluoperazine HCl 5 mg tablet 2/28/2024 1000 1000 0 1000
12 Clozapine 25 mg tablet 3/30/2022 1500 1500 0 1500
Tegal, 6 Oktober 2020


NIP.19651107 200212 1 004 NIP. 19830519 201101 2 009
BULAN : SEPTEMBER 2020
KOTA : TEGAL
PEMAKAIAN
STOK PENERIM
JUMLAH Pustu
NO NAMA BARANG SATUAN AWAL AAN Poli Poli Pustu
LAB VK UGD Muarar
Umum Gigi Kraton
eja
(A) (B) (A+B) (C)

BANTUAN COVID 19
2 Apron lengan panjang pcs 0 0 10
8 Coverall disposible all size pcs 93 0 65 3
11 Coverall parasut hijau pcs 3 0 2 1
12 Coverall parasut putih pcs 20 0 17 1
16 Etanol 70 % 1 liter 0 0 4
22 Google pcs 3 0 12 2
23 Hairnet pcs 156 0 134 10
24 Hand sanitizer botol 5 liter 4 0 4
30 Masker KN 95 pcs 0 0 13 3
32 Masker try ply pcs 0 0 400
33 shoes,shoes,Hscoon,masker set 18 18
bedah,google) 0
PEMAKAIAN
STOK PENERIM
JUMLAH Pustu
LAB VK UGD Muarar
Umum Gigi Kraton
eja
(A) (B) (A+B) (C)
Tegal, 6 O

NIP.19651107 200212 1 004 NIP. 1983051
BULAN : SEPTEMBER 2020
KOTA : TEGAL
PEMAKAIAN
STOK PENERIM
JUMLAH Pustu Pustu
NO NAMA BARANG SATUAN AWAL AAN Poli Poli Pustu V
Umum Gigi Kraton
eja Sari
(A) (B) (A+B) (C)

BANTUAN COVID 19
11 Coverall parasut hijau pcs 3 0 2 1
12 Coverall parasut putih pcs 20 0 17 1
16 Etanol 70 % 1 liter 0 0 4
22 Google pcs 3 0 12 2
23 Hairnet pcs 156 0 134 10
30 Masker KN 95 pcs 0 0 13 3
33 shoes,shoes,Hscoon,masker set 18 18
bedah,google) 0
PEMAKAIAN
STOK PENERIM
JUMLAH Pustu Pustu
NO NAMA BARANG SATUAN AWAL AAN Poli Poli Pustu V
Umum Gigi Kraton
eja Sari
(A) (B) (A+B) (C)
Tegal, 6 O

NIP.19651107 200212 1 004 NIP. 1983051
NOMOR :
KOTA : TEGAL
PENGELUARAN
PEMAKAIAN RUSAK/ED
(A) (B) (A+B) (A+B)-(K) (D)
1 Asetosal 100 mg tablet 0 0 0
2 Albendazol tab 400 mg tablet 9026 9026 3
3 Albendazol sirup 200 mg/5 ml botol 900 900 0
4 Allopurinol 300 mg tablet 0 0 0
5 Alopurinol tablet 100 mg tablet 0 0 0
01/08/2021
6 Aminofilin inj 24mg/ml ampul 0 0 0
7 Aminofillin 150 mg tablet 5/13/2020 0 0 0
8 Aminofillin 200 mg tablet 0 0 0
9 Amitriptyline tablet 5/1/2021 168 168 0
12 Amoksisilin drop 100 mg/ml btl 0 0 0
13 Amoksisilin serbuk injeksi 1000mg ampul 0 0 0
14
Amoksisilin sirup kering 125 mg/ 5 mg botol 0 0 0
17
Amoksisillin sirup kering 250mg/5 ml botol 103 103 58
18 Ampisillin 500 mg kaplet 0 0 0
19 Antasida DOEN kombinasi tablet 1/1/2022 0 0 0
20 Antasida DOEN suspensi btl 60ml 7/1/2021 56 56 56
(Bacitracin) tube 0 0 0
23 Antifungi DOEN Kombinasi pot 5/1/2021 185 185 20
24 Antihemoroid DOEN supp 12/1/2020 692 692 0
25 Antiparkinson DOEN tablet 0 0 0
26 Aqua pro injeksi steril vial 0 0 0
28 Asam askorbat 50mg tablet 7/1/2020 7508 7508 3124
29 Asam folat 1 mg (MARIN) tablet 9/1/2020 0 0 0
30 Asam mefenamat 500mg tablet 7/31/2022 431 431 0
31 Asam traneksamat 100mg tblt 55 55 0
34 Asiklovir krim 5% tube 8/1/2022 458 458 56
36 (sulfat) 0
0 0
37 Attapulgit 600mg (New Antides) tablet 6/1/2020 20075 20075 7316
39 Bedak salisil 2% dus@50gr 4/1/2022 353 353 33
40 Besi (II) sulfat 200 mg kombinasi tablet 6/5/2020 21977 21977 20057
41 Betahistin mesilat 6mg tablet 9/1/2021 660 660 316
42 Betametason krim 0,1% tube 1/1/2021 22 22 10
43 Bisakodil 5 mg tab.salut 0 0 0
INFANT) supp 0 0 0
45 Bisakodil supp 10 mg supp 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
46 Bisoprolol 5 mg tablet 0 0 0
Respules nebule 0 0 0
48 Cetirizin 10 mg tablet 4/1/2021 895 895 200
49 Cetirizine sirup 5mg/5ml botol 5/1/2020 0 0 0
50 Clobazam 10mg tablet 3/1/2021 53 53 0
51 Co Amoxiclav tablet 0 0 0
52 tablet dan
01/08/2020 12567 12567 1401 0
53 Dexamethason inj 5mg/ml ampul 0 0 0
54 Diazepam 2mg tablet 1/1/2021 0 0 0
(HCl) ampul 5/1/2020 0 0 0
58 Digoksin 0,25mg tablet 0 0 0
59 Diazepam injeksi 5mg/ml-1ml ampul 4/1/2020 0 0 0
60 Diltiazem HCl 30mg tablet 0 0 0
61 tablet dan
01/06/2022 5558 5558 430
62 Doksisiklin 100mg kapsul 01/03/2021 0 0 0
63 Domperidon suspensi 5mg/ 5ml botol 6/1/2021 241 241 18
64 tablet dan
01/02/2021 3464 3464 1038
65 Efedrin tablet 0 0 0 0
ampul 12/12/2020
(sebagaiHCL) 20 20 2 0
67 Ergotamin 1mg+kofein 50mg tablet 0 0 0
68 Eritromisin 500mg kapsul 4/1/2021 171 171 106
69 Etakridin 0,1% btl 0 0 0
70 Etanol 70% btl 100ml 11 11 0
71 Fenitoin Na 30mg (DECATONA) tablet 0 0 0
72 Fenobarbital inj 50mg/ml ampul 62 62 0
73 tablet dan
01/11/2021 800 800 0 200
74
Fenoksimetil Penisilin tablet 250 mg tablet 0 0 0
mg/ml ampul 0 0 0
mg/ml ampul 9/30/2021 388 388 0
77 Fitomenadion 10mg tab salut 8/23/2020 3057 3057 30
04/01/2020
79 dan
Furosemid 40 mg tablet 01/02/2021 1500 1500 15
80 Garam Oralit I serbuk sachet 8/1/2022 8679 8679 132
81 Gentamisin Salep kulit 0,1% tube 7/1/2023 580 580 22
82 Gentamisin TM 0,3% botol 5/6/2022 355 355 15
83 Gentamisin injeksi ampul 0 0 0
84 Gentian Violet larutan 1% botol 8 8 0
85 Glibenklamid 5mg tablet 3/23/2023 1030 1030 300
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
86 Gliseril Guaiakolat 100mg tablet 1/4/2021 22260 22260 743
87 GOM btl 8ml 9/1/2021 0 0 0
88 Griseofulvin 125 mg tablet 2/1/2020 0 0 0
89 Guaifenesin 100 mg tablet 7/1/2022 49361 49361 0
90 Haloperidol 5mg tablet 01/02/2020 0 0 0
91 Haloperidol 1,5 mg tablet 10/30/2019 0 0 0
93
Haloperidol Deconat injeksi 50 mg/ml ampul 1/1/2020 7 7 0
94 Hidrokortison Krim 2,5% tube 3/1/2021 287 287 31
95 Hidroklorthiazid 25 mg tablet 9/1/2022 6 6 0
96 Hyosin Nbutilbromid 10mg tablet 11/1/2020 35 35 0
97 Ichtyol pot 15gr 7/1/2022 98 98 36
100 Ibuprofen 200mg tablet 9/1/2021 17232 17232 3287
101 Ibuprofen 400mg tablet 0 0 0
mg tablet 234 234 25
105 Kalium Aspartat 300mg tablet 0 0 0
106 Kalium Klorida 600mg tablet 0 0 0
107 Kalsium laktat 500mg tablet 2/1/2020 8602 8602 1344
108 Kaolin Pektin (New Diaform) tablet 6/1/2022 0 0 0
109 Kaptopril 12,5mg tablet 11/21/2021 1124 1124 1124
110 Kaptopril tablet 25 mg tablet 11/16/2021 1121 1121 1121
111 Ketokonazol 200mg tablet 01/05/2021 2353 2353 66
112 Ketokonazol krim 2% tube 8/31/2021 97 97 15
113 Ketorolac injeksi 10mg ampul 0 0 0
114 Klindamisin 150mg tablet 0 0 0
115 Klonidin 0,15 mg tablet 0 0 0
116 Kloramfenikol 250 mg kapsul 8/1/2023 736 736 40
117 Kloramfenikol TT 3% btl 56 56 11
118 Kloramfenikol suspensi 125mg/5 btl 60 ml 0 0 0
2% tube 5/1/2021 0 0 0
120 Klorampenikol TM 0,5% (RECO) btl 10/31/2020 27 27 24
121 01/03/2021
dan
01/04/2022 225569 225569 3313
122 Klorpromazine tablet 0 0 0
123 Kodein 10mg tablet 0 0 0
124 Kodein 20mg tablet 6/30/2021 0 0 0
125 Kotrimoksazol DOEN dewasa tablet 6/1/2020 9372 9372 598
126 Kotrimoksazol FORTE tablet 11/1/2021 1854 1854 0
127 Kotrimoksazol suspensi kombinasi botol 30/04/2020 214 214 22
128 Lansoprazol 30 mg kapsul 1/1/2022 199 199
199
129 Levofloksasin 500mg kapsul 0 0 0 0
130 Lidokain 2%+adrenalin 0,0125mg ampul 12/1/2020 1780 1780 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
01/07/2020
131 ampul 01/11/2020
&01/11/202 372 372 18 0
2
132 Linkomisin 500mg kapsul 8/1/2020 916 916 10
133 Loratadin tablet 4/1/2020 460 460 26
134 Mebendazol sirup 100 mg/5 ml botol 0 0 0
135 Mebendazol tablet tablet 0 0 0
136 Meloksikam 15mg tablet 31/06/2021 3717 3717 227
137 Metformin 500mg tablet 1/3/2020 120 120 120
138 Methampiron 500mg tablet 7/1/2022 10125 10125 1813
0,125 mg
139 01/02/2021
&
tablet 01/05/2021 1960 1960 500
140 Metilergometrin inj 0,2 mg/ml ampul 11/30/2020 7 7 0
141 Metoklopramid 5 mg tablet 86 86 0
142 Metoklopramide injeksi 5 mg/ml ampul 0 0 0
143 Metronidazol 500mg tablet 0 0 0
144 Metylprednisolon 4 mg tablet 4/1/2022 11275 11275 641
145 Metylprednisolon 8 mg tablet 0 0 0
146 Mg Sulfat injeksi 20% ampul 9/1/2019 0 0 0
147 Mg Sulfat injeksi 40% ampul 0 0 0
148 Mikonazol krim 2% tube 2/1/2021 126 126 8
149 N-asetil sistein 200 mg kapsul 4/8/2020 0 0 0
150 NaCl infus btl 500ml 0 0 0
151 01/12/2020
&
Nadifen 50 mg tablet 22/05/2021 26946 26946 1654
152 tablet dan
01/03/2021 518 518 518
153 Nistatin tablet salut 500.000 IU tablet 8/1/2019 0 0 0
154 2284
18/11/2020 2284 3
155 OBH botol 01/03/2022 154 154 20
156 Oksitetrasiklin HCl salep kulit 3 % tube 9/1/2021 130 130 36
157 Oksitetrasiklin HCl salep mata 3 % tube 0 0 0
158 Omeprazol 20mg kapsul 6/1/2021 98 98 98
159 Omeprazol injeksi ampul 0 0 0
160 Ondancentron inj ampul 4/1/2021 0 0 0
161 Parasetamol 500mg tablet 1/1/2022 77273 77273 4732 0
162 Parasetamol sirup 120mg/5ml botol 60ml 1/1/2022 343 343 81
163 Parasetamol drop btl 15 ml 8/24/2020 131 131 32
164 Pehacain injeksi ampul 0 0 0
166 Pirantel tab.score base 125mg tablet 8/30/2020 0 0 0
167 Pirantel Pamoat susp 125mg/5ml botol 0 0 0
168 Piridoksin 10mg (vit. B6) tablet 9/1/2020 27677 27677 2366
169 Piroksikam 10mg tablet 5/1/2021 10764 10764 234
170 Polikresulen cairan btl 10ml 6/3/2036 6 6 0
171 Povidon Iodin 10% btl 30 ml 11/1/2019 196 196 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
172 Povidon Iodin 10% btl 300ml 2/1/2020 4 4 0
173 Prednison 5mg tablet 7/1/2021 8290 8290 708
174 Propanolol 10mg tablet 210 210 0
175 Propiltiurasil tablet 100mg tablet 0 0 0
176 Ranitidin 150mg tablet 8/31/2020 0 0 0
177 Ranitidin inj 25mg/ml ampul 30/03/2021 0 0 0
178 Reserpin tablet 0,10 mg tablet 0 0 0
179 Respiredon 2 mg tablet 3/1/2021 2000 2000 0
kapsul lunak 0 0
kapsul lunak 0 0
btl 500ml 01/07/2023 130 130 0
183 Rivanol 300 ml botol 0 0 0
186 Salep 2-4 kombinasi pot 7/1/2021 458 458 10
03/01/2020
187 dan
Sefadroksil 500mg kapsul 01/10/2020 0 0 0
188 Sefadroksil sir.kering 125mg/5 btl 60ml 0 0 0 0
189 Sefiksim 100mg kapsul 0 0 0 0
190 Sefotaksim inj 1g/vial vial 0 0 0 0
191 Seftriakson 1g/vial vial 0 0 0 0
192 Seltifort kids (vit syrup) btl 60ml 5/31/2022 18 18 6
mcg tablet 19644 19644 2103
194 Simetidin 200mg tablet 10/1/2020 203 203 203
195 Simvastatin 10mg tablet 0 0 0
196 Simvastatin 20mg tablet 03/05/2020 4448 4448 836
197 Siprofloksasin 500mg tablet 9/1/2020 0 0 0
198 Spiramisin 500mg tablet 0 0 0
199 Stesolid 10 mg injeksi ampul 0 0 0
202 Sulfasetamid TM 15% botol 0 0 0
203 Terbutalin sufat 2,5mg tablet 0 0 0
204 Tetrasiklin 250mg kapsul 0 0 0
205 Tetrasiklin kapsul 500 mg kapsul 3/1/2021 2553 2553 11
01/05/2023
206 Thiamin HCl 50mg (vit. B1) tablet 01/05/2022 28121 28121 1557
207 Tiamfenikol kapsul 500mg kapsul 0 0 0
208 Triheksifenidil 2mg tablet 0 0 0
209 Vit. B kompleks tablet 31/02/2021 10956 10956 3317
210 Zinc sirup botol 01/03/2020 0 0 0
211 Zinc dispersibel 20mg tablet 12/1/2019 1580 1580 365
n Obat-obatan ( PKD ) Gigi 0 0 0
(CAVITON) kotak 11/6/2019 0 0 0
gigi botol 3/31/2022 10 10 0
3
Devitalisasi pasta non arsen (Pulp x) kotak 4/1/2022 6 6 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
botol
4 01/11/2020
&
Eugenol cairan 01/08/2039 16 16 0
5 Kalsium hidroksida (Hycal) 7 gram 8/1/2021 18 18 0
6 Mata bor gigi standar set/6 biji 1/6/2022 1 1 0
7 Mata bor gigi high speed set/6 biji 0 0 0
8 gigi 0
0 0
9
10 Poliren (OCO) polishing pasta btl 15gr 7/1/2021 5 5 0
11 gigi botol 10/31/2020 8
8 0
28gr(3M ESPE Cavit G) 0 0
13 Ionomer,fuji) 35
35 0
14 12
12 0
15 Komposir resin (Master fill) kotak 2/1/2022 9 9 0
Obat-obatan ( PKD ) Penunjang 8/1/2020 0 0 0
1 Ambroksol 30 mg tablet 7/1/2021 33726 33726 815
2 Antiflu tab.kombinasi (Brocifar) tablet 6/1/2021 4046 4046 173
3 Asam Tranexamat inj.500mg/ml ampul 1/1/2021 0 0 0
4 Calsium Gluconnat Injeksi ampul 11/1/2019 0 0 0
1500IU/ml ampul 8/1/2019 0 0 0
6 Bromheksin HCl 8 mg tablet 8/1/2021 1000 1000 0
7 Ekstrak sonchi Folium 100% kapsul 4/1/2022 0 0 0
8 Etanol 70 %( One Med alcohol) botol 1 L 0 0 0 0
9 Fenoterol MDI 100 mcg/ 10ml fls 7/31/2020 0 0 0
10 Glimepirid 1mg 5/1/2022 4190 4190 786
11 Glimepirid 2mg 4/1/2022 360 360 360
12 Kloramfenikol inj vial 4/1/2020 0 0 0
13 Kloramfenikol Salep mata 1% tube 5 gr 1/1/2022 141 141 4
14 Levertran15 g pot 15gr 01/02/2020 1 1 1
(Neuroval) 554 554 30
16 Obat anti flu sirup (Betaflu) botol 6/1/2021 152 152 17
17 Obat batuk Kombinasi (Fenidryl) sirup 7/1/2022 0 0 0
18 Obat batuk kombinasi (Dextral) tablet 7/1/2021 1440 1440 213
19 Oksitosin injeksi ampul 4/1/2020 0 0 0
20 Phenol gliserol tetes telinga botol 0 0 0 0
2,5mg/2,5 ml NaCl) 0 0
22 Salep bisul pot 7/1/2020 0 0 0
23 Salep luka bakar (Neocenta gel) tube 15gr 0 1 1 0
24 Tab. Curcuma 20mg tablet 0 0 0 0
25 Teofilin syrup 43,33 mg/ 5 ml botol 0 0 0 0
26 Terapi Diare sirup btl 60ml 0 0 0
27 Terapi Diare tab tablet 8/1/2020 0 0 0
28 Vit neurotropik tablet 9/1/2022 0 0 0
29 Etil klorid semprot Spray 7/1/2020 42 42 3
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
iaan Obat Asli Indonesia 0 0 0
1 Extrak Belladon tab 10 mg tablet 0 0 0 0
2 Enkasari 120 ml botol 0 0 0
3 Fitogen tablet 0 0 0 0
4 Ferris botol 0 0 0 0
5 Hemorogard kapsul 8/1/2020 2198 2198 48
6 Hepagard kapsul 0 0 0
7 Minyak telon botol 50 ml 0 0 0 0
8 Tensigard kapsul 0 4 4 0
Obat dan Alkes PROGRAM 0 0 0
1 Diethylcarbamazine (DEC) 100 mg tablet 0 0 0 0
3 MDT Combi MB Adult blister 0 0 0 0
4 MDT Combi MB Child blister 0 0 0 0
7 MDT Combi PB Child blister 0 0 0 0
8 Obat Anti Tubercolusis kategori 1 FDC 0 16 16 0
9
Obat Anti Tubercolusis kategori anak FDC 0 0 0 0
10 Box slide pcs 0 0 0 0
11 Pot sputum
01/04/2022
pot 01/03/2024 1500 1500 0
12 Reagen BTA ( Ziehl Nelsen ) paket 0 0 0 0
13 Prokain Benzil Penisilin 3 jt IU vial 0 0 0 0
14 Depo Progestin/ suntik KB 3 bulan vial 0 0 0 0
15 Mineral Mix sachet 0 0 0 0
16 safety box 2,5 lt pcs 0 0 0 0
17 safety box 5 lt pcs 0 0 0 0
18 spuit 0,5 ml pcs 0 0 0 0
an ALKES Habis Pakai (PKD) 0 0 0
1 ADS 0,05ml pcs 4/1/2023 300 300 0
2 Blood Lancet box 8/1/2021 470 470 0
3 Cryotube 1.8 ml pcs 0 0 0 0
4 Cover Glass 22x22 mm box 3/1/2022 0 0 0
5 Deck Glass box/72pcs 0 0 0 0
6 E Care Handrub 500 ml botol 3/1/2020 11 11 11
7 Folley Catheter No.16 buah 11/1/2022 30 30 0
8 Folley Catheter setara Rush No.18 buah 12/1/2022 10 10 0
9 IV Catheter 18 G pcs 12/31/2023 50 50 0
10 IV Catheter 24 G pcs 1/31/2023 108 108 0
11 IV Catheter 22 G pcs 3/31/2024 108 108 0
12 IV catheter 20 G pcs 31/02/2024 70 70 0
13 Kapas 100 gr rol 0 0 0 0
14 Kasa 4m x 15 cm elastis roll 0 0 0 0
15 Kertas ECG Ukuran Besar roll 0 0 0 0
16 Kertas ECG Ukuran Standar roll 0 0 0 0
20 Plester 5 yard x 2 inchi roll 0 0 0 0
21 Pot Urine (pot sputum) bh/d.5,5cm 4/1/2022 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
22 Spuit 0,05 ml pcs 0 0 0
25 Wing Needle No. 21G buah 0 0 0 0
26 Wing Needle No. 25G buah 1/1/2020 0 0 0
31 alkohol swab pcs 10/1/2021 0 0 0
32 aquadest botol 1 L 6/3/2036 0 0 0
33 Alkapram septalkan spray botol 7/1/2021 0 0 0
34 Alkapram alkacide 1 L botol 7/1/2020 0 0 0
35 Alkapharm alkazyme 25mg sachet 5/1/2021 0 0 0
36 bisturi kecil pcs 1/12/2020 65 65 0
37 bioplacenton tulle pcs 0 0 0
41 fixomul stretch 15cmx5m roll 28/07/2020 0 0 0
42 foley catheter No.14 pcs 7/1/2021 0 0 0
43 Gelang Bayi Pink pcs 2/1/2023 0 0 0
44 Gelang Bayi Biru pcs 2/1/2023 0 0 0
45 handscoon Uk S box 5/1/2021 143 143 3
46 handscoon Uk M box 5/1/2021 140 140 24
47 handscoon obgyn pcs 1/7/2021 0 0 0
48 handscoon steril pasang 12/1/2022 0 0 0
49 hipafik 5x5 pcs 2/1/2021 3 3 0
50 hipafik 15x10 box 01/102020 15 15 0
51 infus set anak set/ktg 5/1/2021 50 50 0
52 infus set dewasa set/ktg 7/1/2022 207 207 0
53 jarum hect kulit luar besar (12 pcs) pcs 1/10/2021 15 15 0
54 jarum hect kulit luar kecil (12 pcs) pcs 1/5/2022 38 38 0
55
jarum hect kulit luar sedang (12 pcs) pcs 1/9/2022 9 9 0
56 jarum hect otot luar besar bks/12pcs 1/6/2023 0 0 0
57 jarum hect otot luar sedang bks/12pcs 9/6/2022 1 1 0
58 jelly EKG botol 0 0 0
59 kapas absorben 250 gr bks 10/1/2021 7 7 0
60 Kapas Berlemak 500 gr roll 9/1/2033 4 4 0
61 kasa hidrofil 2x80cm pcs 30/04/2021 0 0 0
62 kasa hidrofil 40x80cm roll 5/1/2023 0 0 0
65 kasa pembalut hidrofil 4 m x 10cm roll 10/1/2033 0 0 0
66 kasa hidrofil steril 18x22 roll 10/1/2021 0 0 0
67 kasa kompres 40x40 steril roll 8/1/2021 0 0 0
68 kasa steril 16x16 cm box 11/1/2020 0 0 0
69 kertas gol.darah pak/100's 1/6/2022 0 0 0
70 kertas tissu gulung 0 0 0
06/01/2022
71 klem tali pusat pcs 0 0 0
72 masker box/50pcs 30/04/2021 92 92 10
73 Box Object Glass Grey and Orange box 3/1/2022 0 0 0
74 object glass box/72pcs 19/03/2021 9 9 0
75 Oxygen mask bayi (SERENITY) pcs 1/6/2022 8 8 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
76 Oxygen mask anak (SERENITY) pcs 1/7/2022 11 11 0
77 Oxygen mask dewasa (SERENITY) pcs 1/8/2022 9 9 0
78 Pita Lila pcs 1/6/2022 0 0 0
79 plester 5 yard 20 inch roll 19/02/2021 0 0 0
80 silk no 3/0 dg jarum bedah pcs 3/6/2037 0 0 0
81 spiritus btl / 1 liter 06/01/2022 4 4 0
82 spuit 0,5 ml pcs 4/1/2023 2100 2100 0
83 Stericline Indicator strip box 11/1/2022 0 0 0
84 Stericlin gusette 25x6,5cm roll 10/1/2022 0 0 0
85 tempat preparat BTA / cawan petri pcs 1/6/2022 0 0 0
86 tabung reaksi 1,5x10cm ktk/50pcs 0 0 0
87 test kehamilan box/50pcs 5/1/2020 0 0 0
88 tranfusi set dewasa pcs 3/31/2024 50 50 0
91 USG Gel 250 ml botol 1/31/2021 7 7 0
92 urin bag pcs 19/05/2021 22 22 0
93 Ammonium Oxalat Btl/100ml 8/1/2020 0 0 0
94 Asam Klorida 0,1 N btl/ 100 ml 0 0 0
95 pack/100
Blue Tip 0test 0 0 0
96 BD Tube EDTA plh 13 x 75 box 5/1/2021 0 0 0
97 Cell pack bok 9/5/2020 0 0 0
98 Cuka diksi botol 5/1/2024 0 0 0
99 EDTA btl 100ml 0 0 0
100 Purple cup EDTA K3 3ml, glass box 6/1/2020 0 0 0
101 HbsAg test strip 0 0 0 0
102 Kertas Lensa lembar 0 0 0 0
103 Larutan Giemsa Stain botol 10/6/2019 0 0 0
104 Paket Gol. Darah Anti AB paket 3/6/2020 0 0 0
105 Paket Gol. Darah anti Resus paket 4/6/2020 0 0 0
106
Reagensia Uji Widal S para Typhi AH vial 12/1/2020 0 0 0
107 Reagensia Uji Widal Typhi H vial 7/6/2020 0 0 0
108 Reagensia Uji Widal Typhi O vial 2/28/2021 0 0 0
109 Reagen ZN paket 7 7 0
110 alkohol asam btl 100ml 0 0 0
111 asam sulfosalisilat btl 100ml 0 0 0
112 asam urat stick btl/25 test 31/04/2021 4 4 4
113 dempul hematokrit pcs 0 0 0
114 glukoprotein stik 10 parameter pck/100's 2/1/2020 0 0 0
115 glukoprotein urin test box/10 test 0 0 0 0
116 glukosa stik btl/25 test 11/7/2020 0 0 0
117 hemoglobin stik box/25 test 4 4 4
118 haemoglobulin C btl 500ml 11/19/2020 0 0 0
119 hayam btl 100ml 1/6/2022 0 0 0
120 Immersion Oil btl 100ml 1/6/2022 0 0 0
121 kertas lakmus pack 0 0 0
122 kertas lensa lembar 0 0 0
123 kolesterol stik btl 10 test 1/31/2021 5 5 5
124 lar. benedict btl 100ml 6/3/2036 0 0 0
125 lar. eosin 2% btl 7/6/2020 0 0 0
126 lar. etanol asam btl 100ml 6/6/2020 0 0 0
127 lar. hypoklorit btl 1L 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
ED
(A) (B) (A+B) (A+B)-(K) (D)
128 lar. karbol fuchsin btl 100ml 0 0 0
129 lar. metilen biru btl 100ml 0 0 0
130 larutan KOH btl 100ml 0 0 0
131 larutan Turk btl 100 ml 1/1/2023 0 0 0
132 larutan Poch-Pack L botol 11/1/2020 0 0 0
133 larutan Poch-Pack D botol 0 0 0
134 masker N95 box 12/1/2020 0 0 0
135 metanol botol 7/6/2020 0 0 0
136 minyak imersi btl 100ml 0 0 0
137 natrium citrat 3,13% btl 100ml 0 0 0
138 natrium citrat 3,8% btl 250ml 6/6/2019 0 0 0
139 paket gol. Drh anti AB paket 0 0 0
140 paket gol. Drh anti B paket 0 0 0
141 paket gol.drh anti A paket 1/6/2022 0 0 0
142 ress Ecker btl 100ml 1/6/2022 0 0 0
143 stik urinalisis 10 parameter botol 4/1/2021 0 0 0
144 Stomalizer Pcs 4/8/2020 0 0 0
145 thermal paper 57mm x 30 m roll 7/6/2020 0 0 0
146 tissu lensa pak 0 0 0
147 trigliserida botol 0 0 0
148 xylol btl 100ml 9/6/2019 0 0 0
149 yellow tip pak 0 0 0
150 Lisol btl 0 0 0
151 Larutan Nacl 0,86% botol 9/6/2019 0 0 0
TAMBAHAN 0
1 Plester/tulling dress 10cm x10cm lembar 5/23/2023 79 79 0
2 Plastik klip obat 8,5cmx13cm kg 25 25 0
3 Plastik obat cetak etiket kg 25 25 0
4 Kantong puyer SCI box 1 1 0
5 Vaccum Tube Steril EDTA K-3 (3ml) pack 0 0 0
6
Vaccum Tube Steril Clot Activator(3ml) pack 0 0 0
7 Pot Dahak Steril pot 0 0 0
8 Rapid test Syphilis test 0 0 0
Q) pcs 0 0 0
10 Diazepam 5 mg tablet 10/1/2023 200 200 0
11 Trifluoperazine HCl 5 mg tablet 2/28/2024 1000 1000 0
12 Clozapine 25 mg tablet 3/30/2022 1500 1500 0
Tegal, 10 November 2020


NIP.19651107 200212 1 004 NIP. 19830519 201101 2 009
NOMOR :
KOTA : TEGAL
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR
OP
(A) (B) (A+B) (A+B)-(K) (D) (L)
01/08/2021
14
17
36 (sulfat) 0
0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
52 tablet dan
01/08/2020 12567 12567 1401 0 11166
(HCl) ampul 5/1/2020 0 0 0 0
61 tablet dan
01/06/2022 5558 5558 430 5128
64 tablet dan
01/02/2021 3464 3464 1038 2426
ampul 12/12/2020
70 Etanol 70% btl 100ml 11 11 0 11
73 tablet dan
01/11/2021 800 800 0 200 600
74
mg/ml ampul 0 0 0 0
mg/ml ampul 9/30/2021 388 388 0 388
04/01/2020
79 dan
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
87 GOM btl 8ml 9/1/2021 0 0 0 0
93
97 Ichtyol pot 15gr 7/1/2022 98 98 36 62
mg tablet 234 234 25 209
2% tube 5/1/2021 0 0 0 0
121 01/03/2021
dan
01/04/2022 225569 225569 3313 222256
124 Kodein 20mg tablet 6/30/2021 0 0 0 0
199
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
01/07/2020
131 ampul 01/11/2020
&01/11/202 372 372 18 0 354
2
0,125 mg
139 01/02/2021
&
tablet 01/05/2021 1960 1960 500 1460
151 01/12/2020
&
152 tablet dan
01/03/2021 518 518 518 0
154 2284
18/11/2020 2284 3 2281
155 OBH botol 01/03/2022 154 154 20 134
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
kapsul lunak 0 0 0
kapsul lunak 0 0 0
btl 500ml 01/07/2023 130 130 0 130
03/01/2020
187 dan
mcg tablet 19644 19644 2103 17541
01/05/2023
210 Zinc sirup botol 01/03/2020 0 0 0 0
(CAVITON) kotak 11/6/2019 0 0 0 0
gigi botol 3/31/2022 10 10 0 10
3
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
botol
4 01/11/2020
&
Eugenol cairan 01/08/2039 16 16 0 16
8 gigi 0
0 0 0
9
11 gigi botol 10/31/2020 8
8 0 8
13 Ionomer,fuji) 35
35 0 35
14 12
12 0 12
1500IU/ml ampul 8/1/2019 0 0 0 0
10 Glimepirid 1mg 5/1/2022 4190 4190 786 3404
11 Glimepirid 2mg 4/1/2022 360 360 360 0
(Neuroval) 554 554 30 524
2,5mg/2,5 ml NaCl) 0 0 0
22 Salep bisul pot 7/1/2020 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
9
11 Pot sputum
01/04/2022
pot 01/03/2024 1500 1500 0 1500
18 spuit 0,5 ml pcs 0 0 0 0 0
1 ADS 0,05ml pcs 4/1/2023 300 300 0 300
2 Blood Lancet box 8/1/2021 470 470 0 470
9 IV Catheter 18 G pcs 12/31/2023 50 50 0 50
10 IV Catheter 24 G pcs 1/31/2023 108 108 0 108
11 IV Catheter 22 G pcs 3/31/2024 108 108 0 108
12 IV catheter 20 G pcs 31/02/2024 70 70 0 70
13 Kapas 100 gr rol 0 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
22 Spuit 0,05 ml pcs 0 0 0 0
31 alkohol swab pcs 10/1/2021 0 0 0 0
32 aquadest botol 1 L 6/3/2036 0 0 0 0
49 hipafik 5x5 pcs 2/1/2021 3 3 0 3
50 hipafik 15x10 box 01/102020 15 15 0 15
55
06/01/2022
72 masker box/50pcs 30/04/2021 92 92 10 82
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
78 Pita Lila pcs 1/6/2022 0 0 0 0
82 spuit 0,5 ml pcs 4/1/2023 2100 2100 0 2100
91 USG Gel 250 ml botol 1/31/2021 7 7 0 7
92 urin bag pcs 19/05/2021 22 22 0 22
95 pack/100
97 Cell pack bok 9/5/2020 0 0 0 0
98 Cuka diksi botol 5/1/2024 0 0 0 0
99 EDTA btl 100ml 0 0 0 0
106
119 hayam btl 100ml 1/6/2022 0 0 0 0
125 lar. eosin 2% btl 7/6/2020 0 0 0 0
PENGELUARAN
PEMAKAIAN RUSAK/ED
STOK AKHIR OP
ED
(A) (B) (A+B) (A+B)-(K) (D) (L)
134 masker N95 box 12/1/2020 0 0 0 0
135 metanol botol 7/6/2020 0 0 0 0
142 ress Ecker btl 100ml 1/6/2022 0 0 0 0
144 Stomalizer Pcs 4/8/2020 0 0 0 0
148 xylol btl 100ml 9/6/2019 0 0 0 0
150 Lisol btl 0 0 0 0
TAMBAHAN 0
6
Q) pcs 0 0 0 0
10 Diazepam 5 mg tablet 10/1/2023 200 200 0 200
11 Trifluoperazine HCl 5 mg tablet 2/28/2024 1000 1000 0 1000
12 Clozapine 25 mg tablet 3/30/2022 1500 1500 0 1500
Tegal, 10 November 2020


NIP.19651107 200212 1 004 NIP. 19830519 201101 2 009
BULAN : OKTOBER 2020
KOTA : TEGAL
PEMAKAIAN
STOK PENERIM
JUMLAH Pustu
LAB VK UGD Muara
Umum Gigi Kraton
reja
(A) (B) (A+B) (C)

BANTUAN COVID 19
7 Coverall boho disposible XL pcs 43 0 43 2
10 Coverall kaltech disposibel XL pcs 180 0 180 1
16 Etanol 70 % 1 liter 3 0 3 1 1 1
20 Face shield anak pcs 0 25 25
24 Hairnet pcs 118 0 118 1 18
26 Hand sanitizer 500 ml 500 ml 9 0 9 1 1
31 Masker KN 95 pcs 7 0 7 3
34 shoes,shoes,Hscoon,masker set 18
bedah,google) 0 18
PEMAKAIAN
STOK PENERIM
JUMLAH Pustu
LAB VK UGD Muara
Umum Gigi Kraton
reja
(A) (B) (A+B) (C)

37 Hand soap 500ml botol 0 1 1
38 Gentong air+kran pcs 0 1 1 1
39 Safety box 5 liter pcs 0 50 50 50
ANGGARAN BLUD PUSKESMAS 0
1 Alkohol 70% botol 1 L 0 30 30
2 Desinfektan non korosif (Medisap) botol 5 liter 0 6 6
4 Masker KN 95 pcs 0 120 120
5 Surgical gloves no. 7 pasang 0 120 120
Mengetahui/Menyetujui, Tegal, 2 No

NIP.19651107 200212 1 004 NIP. 1983051
BULAN : OKTOBER 2020
KOTA : TEGAL
PEMAKAIAN
STOK PENERIM
JUMLAH Pustu Pustu
NO NAMA BARANG SATUAN AWAL AAN Poli Poli Pustu VC
LAB VK UGD Muara Tegal
Umum Gigi Kraton
reja Sari
(A) (B) (A+B) (C)

BANTUAN COVID 19
7 Coverall boho disposible XL pcs 43 0 43 2
10 Coverall kaltech disposibel XL pcs 180 0 180 1
16 Etanol 70 % 1 liter 3 0 3 1 1 1
20 Face shield anak pcs 0 25 25
24 Hairnet pcs 118 0 118 1 18
26 Hand sanitizer 500 ml 500 ml 9 0 9 1 1
31 Masker KN 95 pcs 7 0 7 3
34 shoes,shoes,Hscoon,masker set 18
bedah,google) 0 18
PEMAKAIAN
STOK PENERIM
JUMLAH Pustu Pustu
NO NAMA BARANG SATUAN AWAL AAN Poli Poli Pustu VC
LAB VK UGD Muara Tegal
Umum Gigi Kraton
reja Sari
(A) (B) (A+B) (C)

37 Hand soap 500ml botol 0 1 1
38 Gentong air+kran pcs 0 1 1 1
39 Safety box 5 liter pcs 0 50 50 50
ANGGARAN BLUD PUSKESMAS 0
1 Alkohol 70% botol 1 L 0 30 30
2 Desinfektan non korosif (Medisap) botol 5 liter 0 6 6
4 Masker KN 95 pcs 0 120 120
5 Surgical gloves no. 7 pasang 0 120 120
Mengetahui/Menyetujui, Tegal, 2 No

NIP.19651107 200212 1 004 NIP. 1983051

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

21 Salbutamol nebules(Salbutamol 2,5mg/2,5 ml ampul 9/4/2020 10 10 0

dr. Bambang Kuswanto

1029 435 200 70542 53271 -17271

215 8500 9542 1042

23 300 328 133 -195

244 452 134 2422 2850 428

1094 761 600 32390 41300 8910

(A) (B) (A+B) (A+B)-(K) (D)

dr. Bambang Kuswanto Nurul Ardi Anti, S.Far., Apt

PELAPORAN : APRIL 2020

STOK SUMBER DANA

28514 1328.4 ed 20219 4690 125 3880 24634 24634

ti, S.Far., Apt

810 32.4 162 324 1328.4

1 Etanol 70 %( One Med alcohol) botol 1 L 0 22 0 22 8 14

dr. Bambang Kuswanto Nurul Ardi Anti, S.Far., Apt

1 Etanol 70 %( One Med alcohol) botol 1 L 0 22 0 22 8 14

dr. Bambang Kuswanto Nurul Ardi Anti, S.Far., Apt

NO NAMA BARANG SATUAN PERSEDIAAN KEBUTUHAN

1 BOOTS KUNING PASANG 11 0

38 FACE SHIELD BUAH 7 0

Tegal, 1 Juni 2020

dr. Bambang Kuswanto

dr. Bambang Kuswanto Nurul Ardi Anti, S.Far., Apt

dr. Bambang Kuswanto Nurul Ardi Anti, S.Far., Apt

(A) (B) (A+B) (C)

1 APRON DISPOSIBLE pcs 22 0 22

dr. Bambang Kuswanto Nurul Ardi Anti

(A) (B) (A+B) (C)

1 APRON DISPOSIBLE pcs 22 0 22

dr. Bambang Kuswanto Nurul Ardi Anti

Tegal, 14 Agustus 2020

dr. Bambang Kuswanto Nurul Ardi Anti, S.Far., Apt

Tegal, 14 Agustus 2020

dr. Bambang Kuswanto Nurul Ardi Anti, S.Far., Apt

Paket APD Lengkap (baju APD,cover

21 Shoe cover pasang 0 0 0

dr. Bambang Kuswanto Nurul Ardi A

Paket APD Lengkap (baju APD,cover

21 Shoe cover pasang 0 0 0

dr. Bambang Kuswanto Nurul Ardi A

Tegal, 10 September 2020

dr. Bambang Kuswanto Nurul Ardi Anti, S.Far., Apt

Tegal, 10 September 2020

dr. Bambang Kuswanto Nurul Ardi Anti, S.Far., Apt

dr. Bambang Kuswanto Nurul Ardi A

dr. Bambang Kuswanto Nurul Ardi A

Tegal, 6 Oktober 2020

dr. Bambang Kuswanto Nurul Ardi Anti, S.Far., Apt

Tegal, 6 Oktober 2020

dr. Bambang Kuswanto Nurul Ardi Anti, S.Far., Apt

(A) (B) (A+B) (C)

(A) (B) (A+B) (C)

dr. Bambang Kuswanto Nurul Ardi A

(A) (B) (A+B) (C)

(A) (B) (A+B) (C)

dr. Bambang Kuswanto Nurul Ardi A

Tegal, 10 November 2020

dr. Bambang Kuswanto Nurul Ardi Anti, S.Far., Apt

Tegal, 10 November 2020

dr. Bambang Kuswanto Nurul Ardi Anti, S.Far., Apt

(A) (B) (A+B) (C)

(A) (B) (A+B) (C)