LPLPO BMHP JKN PUSKESMAS KEDIRI 1

NAMA SUB UNIT : POLI LANSIA PELAPORAN BULAN : JANUARI 2021

PERMINTAAN BULAN : PEBRUARI 2021

PENER PERSE PEMA PERMI PEMBER

NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

1 Alat suntik sekali pakai 1 ml kotak @ 100 pcs - -

2 Alat suntik sekali pakai 2,5 ml kotak @ 100 pcs - -
3 Alat suntik sekali pakai 5 ml kotak @ 100 pcs - -
4 Catgut / benang bedah no 2/0 kotak @ 24 pcs - -
5 Catgut / benang bedah no 3/0 kotak @ 24 pcs - -
6 Kapas pembalut / Absorben 250 gram Roll - -
7 Kasa pembalut 2 x 80 Bungkus - -
8 Kasa pembalut hidrofill 4 x 15 Roll - -
9 Sarung tangan S Pcs - -
10 Sarung tangan M Pcs 0 200 200 120 80 -
11 Sarung tangan L Pcs 0 200 200 100 100 -
12 Silk( benang bedah sutera )no 3/0 Box / 36 - -
13 IV cath no.20 Pcs - -
14 IV cath no.18 Pcs - -
15 Kasa gulung Roll - -
16 Masker Box/ 50 100 100 70 30 -
17 Kasa hidrofil 4 x 10 Pcs - -
18 Kasa hidrofil 18 x 22 Pcs - -
19 Jarum injeksi Box / pcs - -
20 Sarung tangan steril M Pasang - -
21 Jelly Tube - -
22 Kertas perkamen Pak - -
23 Klip plastik obat 10 x 7 cm Pak 100 lembar - -
24 Klip plastik obat 13 x 8,7 cm Pak 100 lembar - -
25 Daryantulle Lembar - -
26 Hyfafik / Ultravix Roll - -
27 Spuit 10cc Pcs - -
28 Spuit 20 cc Pcs - -
29 Triway Pcs - -
30 Blood set Pcs - -
31 Bisturi no 20 Pcs - -
32 Wing needle no 23 Pcs - -
33 Jarum otot Lusin - -
34 Jarum kulit Lusin - -
35 Infusion set anak Pcs - -
36 Infusion set dewasa Pcs - -
37 Urine bag Pcs - -
38 I V Cateter no 22 Pcs - -
39 I V Cateter no 24 Pcs - -
40 Sabun cuci tangan 500 ml( Aseptik gel ) Botol - -
41 Sabun cuci alat 500 ml Botol - -
42 Bayclin 1000 ml Botol - -
43 Paravin cair 1 l Botol - -
44 Kertas lakmus merah & biru Bendel - -
45 Etanol 70 % 300 ml Botol - -
46 Gliserin Botol - -
47 Tissue Toilet Kotak - -
48 Kasa 4 x 3 Roll - -
49 Benang silk no 3/0 Roll - -
50 Karbol wangi 800 ml Botol - -
51 Tissue multi Kotak - -
52 Pengharum ruangan Botol - -
53 Alkohol swab pcs - -
54 Blood lancet safe T pcs - -
55 Folley chateter size 16 Pcs - -
56 Folley chateter size 18 Pcs - -
57 Folley chateter size 20 Pcs - -
58 Folley chateter no 22 Pcs - -
59 I V Cateter no 16 Pcs - -
60 Control normal serum3 ml vial - -
61 Strip Cholesterol Box/10 strip - -
62 Cholesterol Liquicolor 4 x 30 ml Kit - -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

63 HDL Cholesterol 20 ml Kit - -

64 LDL Cholesterol direct 1 x 80 ml Kit - -
65 Total & direct bilirubin liquid 2 x 100 ml Kit - -
66 Probe cleanser 17 ml Botol - -
67 Giserin 100 ml Botol - -
68 Benang silk no 2.0 Pack/12 - -
69 Benang Prolin no 3.0 Pack - -
70 Benang prolin no 5.0 pack - -
71 Reagen golongsn darah A Botol - -
72 Reagen golongsn darah B Botol - -
73 Ringer Laktat Botol - -
74 Wing needle no 27 G Pcs - -
75 Stik HB Box/50 test - -
76 Stik protein reduksi urin 3P Box/100 test - -
77 Cairan klorin 0,5 % Galon/5 liter - -
78 Kresek Plastik kecil ukuran 1 X 15 Pcs - -
79 Reagen gula darah Box/50 - -
80 Diluent M 30 Galon/20 liter - -
81 Rinze M 30 Galon/20 liter - -
82 Lise M 30 Botol/500 ml - -
83 EZ Cleanser M 30 Botol/100 ml - -
84 RPR test Kit Kit - -
85 Koh 10 % Botol/100 ml - -
86 Cat Gram Kit - -
87 Aquadest Botol/1 liter - -
88 Reagen control serum hematologi Botol/5 ml - -
89 Cotton aplicator Rectal (vaginal swap) Pcs - -
90 Cater Urine nelacton UK 20 Pcs - -
91 Lubricant Gel Buah - -
92 Plastik 1/2 kg Bungkus/5 Roll - -
93 Perhidrol H2O2 3 % Botol/100 ml - -
94 Betadin Botol/300 ml - -
95 Cotton aplicator (IVA) Pcs - -
96 Bisturi no 25 Pcs - -
97 Pot sputum 120 ml Pcs - -
98 Slide b71101 Pcs - -
99 Klem Tali pusat Pcs - -
100 Cater urine nelaton uk 18 Pcs - -
101 Nasogatic tube dewasa Pcs - -
102 Catton swab Bks/100 - -
103 Plester bulat Box/200 - -
104 Box slide Pcs - -
105 Rapid test siphillis Pcs - -
106 Aquadest Galon/20 ltr - -
107 Cup test sampel 1,5 ml Pcs - -
108 Tabung clot avtivator 5 ml tutup merah Pcs - -
109 Reagen Giemsa Botol/100 ml - -
110 Cairan infus Na cl 0,9 % Btl/500 ml - -
111 Aqua air mineral Botol /1,5 ml - -
112 Metanol Botol/500 ml - -
113 Tabung gel clot tutup kuning 5 ml Box /100 - -
114 Safety box 5 liter Buah - -
115 Alat suntik satu kali pakai 3 ml Pcs - -
116 Asam cuka / asam asetat 5 % Botol - -
117 Oil emersi Botol - -
118 Benang wol Roll - -
119 Kotak plastik untuk tempat obat Pcs - -
120 Kantong puyer Pak - -
121 Etanol 70 % 1000 ml Botol - -
122 Lisol mengandung Kresol Botol - -
123 Plester Botol - -
124 Sendok takar Roll - -
125 Klip platik obat 10 X 15 Pak - -
126 Etyl Klorida Botol - -
127 Fletcher Botol - -
128 Stik Gula darah Pcs - -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

129 Stik asam urat Pcs - -

130 Isi ulang sabun cuci tangan Galon/5 l - -
131 Amlodipin 5 mg Tablet - -
132 Ambroxol syrup Botol - -
133 Amoxicillyn syrup Botol - -
134 Amoxicillyn Tablet - -
135 Cefadroxyl syrup Botol - -
136 Dexametason 0,5 mg Tablet - -
137 Enbatic salp Tube - -
138 Gentamicyn salp mata Tube - -
139 Gentamicyn tetes mata Botol - -
140 Glimepirid 2 mg Tablet - -
141 Meloxicam 7,5 mg Tablet - -
142 Metformin Tablet - -
143 Miconazol Tube - -
144 Metronidazol 500 mg Tablet - -
145 Natrium Diklofenac 50 mg Tablet - -
146 Omeprazol Tablet - -
147 Oxitetrasiklin salp kulit Tube - -
148 Paracetamol syrup Botol - -
149 Paracetamol Tablet - -
150 Ranitidin Tablet - -
151 Simvastatin 10 mg Tablet - -
152 Stesoli Rektal Tube - -
153 Tetagam Ampul - -
154 Ventolin Botol - -
155 Rapid Test Covid 19 Test - -
156 Allopurinol Tablet - -
157 Salicyl bedak Botol - -
158 Amoxicylin syrup forte Botol - -
159 Daryantull Lembar - -
160 Livron B plex Tablet - -
161 Lytacur Syrup Botol - -
162 Lacto B Sachet - -
163 Kertas EKG Roll - -
164 Lampu Spiritus Botol - -
165 Safety box Pcs - -
166 Objek Glass fosted Pcs - -
167 Kertas Thermal uk 5 cm Roll - -
168 Cover glass Kotak - -
169 Spuit 3 ml Pcs - -
170 Masker N95 Pcs - -
171 Nurse cup Box 1 1 1 0 -
172 Acyclovir salp kulit Tube - -
173 Captopril 25 mg Tablet - -
174 Kalsium Laktat (Novakal) Tablet - -
175 Paracetamol Drop Botol - -
176 Ambroxol 30 mg Tablet - -
177 Cetirizin 10 mg Tablet - -
178 Betadin Botol/60 ml - -

Mengetahui
Plt Kepala UPTD Puskesmas Kediri 1 Petugas gudang Petugas Sub Unit

dr Ni Putu Widiyanti Jurni Sari Mansyur Ni Komang Suarningsih

NIP: 19860101 201101 2 044 NIP : 19720630 200501 2 006 NIP: 19671105 198902 2 001
 LPLPO BMHP JKN PUSKESMAS KEDIRI 1

NAMA SUB UNIT : POLI LANSIA PELAPORAN BULAN : PEBRUARI 2021

PERMINTAAN BULAN : MARET 2021

PENER PERSE PEMA PERMI PEMBER

NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

1 Alat suntik sekali pakai 1 ml kotak @ 100 pcs - -

2 Alat suntik sekali pakai 2,5 ml kotak @ 100 pcs - -
3 Alat suntik sekali pakai 5 ml kotak @ 100 pcs - -
4 Catgut / benang bedah no 2/0 kotak @ 24 pcs - -
5 Catgut / benang bedah no 3/0 kotak @ 24 pcs - -
6 Kapas pembalut / Absorben 250 gram Roll - -
7 Kasa pembalut 2 x 80 Bungkus - -
8 Kasa pembalut hidrofill 4 x 15 Roll - -
9 Sarung tangan S Pcs - -
10 Sarung tangan M Pcs 80 100 180 100 80 -
11 Sarung tangan L Pcs 100 100 60 40 -
12 Silk( benang bedah sutera )no 3/0 Box / 36 - -
13 IV cath no.20 Pcs - -
14 IV cath no.18 Pcs - -
15 Kasa gulung Roll - -
16 Masker Box/ 50 30 30 30 0 -
17 Kasa hidrofil 4 x 10 Pcs - -
18 Kasa hidrofil 18 x 22 Pcs - -
19 Jarum injeksi Box / pcs - -
20 Sarung tangan steril M Pasang - -
21 Jelly Tube - -
22 Kertas perkamen Pak - -
23 Klip plastik obat 10 x 7 cm Pak 100 lembar - -
24 Klip plastik obat 13 x 8,7 cm Pak 100 lembar - -
25 Daryantulle Lembar - -
26 Hyfafik / Ultravix Roll - -
27 Spuit 10cc Pcs - -
28 Spuit 20 cc Pcs - -
29 Triway Pcs - -
30 Blood set Pcs - -
31 Bisturi no 20 Pcs - -
32 Wing needle no 23 Pcs - -
33 Jarum otot Lusin - -
34 Jarum kulit Lusin - -
35 Infusion set anak Pcs - -
36 Infusion set dewasa Pcs - -
37 Urine bag Pcs - -
38 I V Cateter no 22 Pcs - -
39 I V Cateter no 24 Pcs - -
40 Sabun cuci tangan 500 ml( Aseptik gel ) Botol - -
41 Sabun cuci alat 500 ml Botol - -
42 Bayclin 1000 ml Botol - -
43 Paravin cair 1 l Botol - -
44 Kertas lakmus merah & biru Bendel - -
45 Etanol 70 % 300 ml Botol 2 2 1 1 -
46 Gliserin Botol - -
47 Tissue Toilet Kotak - -
48 Kasa 4 x 3 Roll - -
49 Benang silk no 3/0 Roll - -
50 Karbol wangi 800 ml Botol - -
51 Tissue multi Kotak - -
52 Pengharum ruangan Botol - -
53 Alkohol swab pcs - -
54 Blood lancet safe T pcs - -
55 Folley chateter size 16 Pcs - -
56 Folley chateter size 18 Pcs - -
57 Folley chateter size 20 Pcs - -
58 Folley chateter no 22 Pcs - -
59 I V Cateter no 16 Pcs - -
60 Control normal serum3 ml vial - -
61 Strip Cholesterol Box/10 strip - -
62 Cholesterol Liquicolor 4 x 30 ml Kit - -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

63 HDL Cholesterol 20 ml Kit - -

64 LDL Cholesterol direct 1 x 80 ml Kit - -
65 Total & direct bilirubin liquid 2 x 100 ml Kit - -
66 Probe cleanser 17 ml Botol - -
67 Giserin 100 ml Botol - -
68 Benang silk no 2.0 Pack/12 - -
69 Benang Prolin no 3.0 Pack - -
70 Benang prolin no 5.0 pack - -
71 Reagen golongsn darah A Botol - -
72 Reagen golongsn darah B Botol - -
73 Ringer Laktat Botol - -
74 Wing needle no 27 G Pcs - -
75 Stik HB Box/50 test - -
76 Stik protein reduksi urin 3P Box/100 test - -
77 Cairan klorin 0,5 % Galon/5 liter - -
78 Kresek Plastik kecil ukuran 1 X 15 Pcs - -
79 Reagen gula darah Box/50 - -
80 Diluent M 30 Galon/20 liter - -
81 Rinze M 30 Galon/20 liter - -
82 Lise M 30 Botol/500 ml - -
83 EZ Cleanser M 30 Botol/100 ml - -
84 RPR test Kit Kit - -
85 Koh 10 % Botol/100 ml - -
86 Cat Gram Kit - -
87 Aquadest Botol/1 liter - -
88 Reagen control serum hematologi Botol/5 ml - -
89 Cotton aplicator Rectal (vaginal swap) Pcs - -
90 Cater Urine nelacton UK 20 Pcs - -
91 Lubricant Gel Buah - -
92 Plastik 1/2 kg Bungkus/5 Roll - -
93 Perhidrol H2O2 3 % Botol/100 ml - -
94 Betadin Botol/300 ml - -
95 Cotton aplicator (IVA) Pcs - -
96 Bisturi no 25 Pcs - -
97 Pot sputum 120 ml Pcs - -
98 Slide b71101 Pcs - -
99 Klem Tali pusat Pcs - -
100 Cater urine nelaton uk 18 Pcs - -
101 Nasogatic tube dewasa Pcs - -
102 Catton swab Bks/100 - -
103 Plester bulat Box/200 - -
104 Box slide Pcs - -
105 Rapid test siphillis Pcs - -
106 Aquadest Galon/20 ltr - -
107 Cup test sampel 1,5 ml Pcs - -
108 Tabung clot avtivator 5 ml tutup merah Pcs - -
109 Reagen Giemsa Botol/100 ml - -
110 Cairan infus Na cl 0,9 % Btl/500 ml - -
111 Aqua air mineral Botol /1,5 ml - -
112 Metanol Botol/500 ml - -
113 Tabung gel clot tutup kuning 5 ml Box /100 - -
114 Safety box 5 liter Buah - -
115 Alat suntik satu kali pakai 3 ml Pcs - -
116 Asam cuka / asam asetat 5 % Botol - -
117 Oil emersi Botol - -
118 Benang wol Roll - -
119 Kotak plastik untuk tempat obat Pcs - -
120 Kantong puyer Pak - -
121 Etanol 70 % 1000 ml Botol - -
122 Lisol mengandung Kresol Botol - -
123 Plester Botol - -
124 Sendok takar Roll - -
125 Klip platik obat 10 X 15 Pak - -
126 Etyl Klorida Botol - -
127 Fletcher Botol - -
128 Stik Gula darah Pcs - -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

129 Stik asam urat Pcs - -

130 Isi ulang sabun cuci tangan Galon/5 l - -
131 Amlodipin 5 mg Tablet - -
132 Ambroxol syrup Botol - -
133 Amoxicillyn syrup Botol - -
134 Amoxicillyn Tablet - -
135 Cefadroxyl syrup Botol - -
136 Dexametason 0,5 mg Tablet - -
137 Enbatic salp Tube - -
138 Gentamicyn salp mata Tube - -
139 Gentamicyn tetes mata Botol - -
140 Glimepirid 2 mg Tablet - -
141 Meloxicam 7,5 mg Tablet - -
142 Metformin Tablet - -
143 Miconazol Tube - -
144 Metronidazol 500 mg Tablet - -
145 Natrium Diklofenac 50 mg Tablet - -
146 Omeprazol Tablet - -
147 Oxitetrasiklin salp kulit Tube - -
148 Paracetamol syrup Botol - -
149 Paracetamol Tablet - -
150 Ranitidin Tablet - -
151 Simvastatin 10 mg Tablet - -
152 Stesoli Rektal Tube - -
153 Tetagam Ampul - -
154 Ventolin Botol - -
155 Rapid Test Covid 19 Test - -
156 Allopurinol Tablet - -
157 Salicyl bedak Botol - -
158 Amoxicylin syrup forte Botol - -
159 Daryantull Lembar - -
160 Livron B plex Tablet - -
161 Lytacur Syrup Botol - -
162 Lacto B Sachet - -
163 Kertas EKG Roll - -
164 Lampu Spiritus Botol - -
165 Safety box Pcs - -
166 Objek Glass fosted Pcs - -
167 Kertas Thermal uk 5 cm Roll - -
168 Cover glass Kotak - -
169 Spuit 3 ml Pcs - -
170 Masker N95 Pcs - -
171 Nurse cup Box - -
172 Acyclovir salp kulit Tube - -
173 Captopril 25 mg Tablet - -
174 Kalsium Laktat (Novakal) Tablet - -
175 Paracetamol Drop Botol - -
176 Ambroxol 30 mg Tablet - -
177 Cetirizin 10 mg Tablet - -
178 Betadin Botol/60 ml - -

Mengetahui
Plt Kepala UPTD Puskesmas Kediri 1 Petugas gudang Petugas Sub Unit

dr Ni Putu Widiyanti Jurni Sari Mansyur Ni Komang Suarningsih

NIP: 19860101 201101 2 044 NIP : 19720630 200501 2 006 NIP: 19671105 198902 2 001
 LPLPO BMHP JKN PUSKESMAS KEDIRI 1

NAMA SUB UNIT : POLI LANSIA PELAPORAN BULAN : MARET 2021

PERMINTAAN BULAN : APRIL 2021

PENER PERSE PEMA PERMI PEMBER

NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

1 Alat suntik sekali pakai 1 ml kotak @ 100 pcs - -

2 Alat suntik sekali pakai 2,5 ml kotak @ 100 pcs - -
3 Alat suntik sekali pakai 5 ml kotak @ 100 pcs - -
4 Catgut / benang bedah no 2/0 kotak @ 24 pcs - -
5 Catgut / benang bedah no 3/0 kotak @ 24 pcs - -
6 Kapas pembalut / Absorben 250 gram Roll - -
7 Kasa pembalut 2 x 80 Bungkus - -
8 Kasa pembalut hidrofill 4 x 15 Roll - -
9 Sarung tangan S Pcs - -
10 Sarung tangan M Pcs 80 200 280 250 30 -
11 Sarung tangan L Pcs 40 40 34 6 -
12 Silk( benang bedah sutera )no 3/0 Box / 36 - -
13 IV cath no.20 Pcs - -
14 IV cath no.18 Pcs - -
15 Kasa gulung Roll - -
16 Masker Box/ 50 - -
17 Kasa hidrofil 4 x 10 Pcs - -
18 Kasa hidrofil 18 x 22 Pcs - -
19 Jarum injeksi Box / pcs - -
20 Sarung tangan steril M Pasang - -
21 Jelly Tube - -
22 Kertas perkamen Pak - -
23 Klip plastik obat 10 x 7 cm Pak 100 lembar - -
24 Klip plastik obat 13 x 8,7 cm Pak 100 lembar - -
25 Daryantulle Lembar - -
26 Hyfafik / Ultravix Roll - -
27 Spuit 10cc Pcs - -
28 Spuit 20 cc Pcs - -
29 Triway Pcs - -
30 Blood set Pcs - -
31 Bisturi no 20 Pcs - -
32 Wing needle no 23 Pcs - -
33 Jarum otot Lusin - -
34 Jarum kulit Lusin - -
35 Infusion set anak Pcs - -
36 Infusion set dewasa Pcs - -
37 Urine bag Pcs - -
38 I V Cateter no 22 Pcs - -
39 I V Cateter no 24 Pcs - -
40 Sabun cuci tangan 500 ml( Aseptik gel ) Botol - -
41 Sabun cuci alat 500 ml Botol - -
42 Bayclin 1000 ml Botol - -
43 Paravin cair 1 l Botol - -
44 Kertas lakmus merah & biru Bendel - -
45 Etanol 70 % 300 ml Botol 1 0 1 1 0 -
46 Gliserin Botol - -
47 Tissue Toilet Kotak - -
48 Kasa 4 x 3 Roll - -
49 Benang silk no 3/0 Roll - -
50 Karbol wangi 800 ml Botol - -
51 Tissue multi Kotak - -
52 Pengharum ruangan Botol - -
53 Alkohol swab pcs - -
54 Blood lancet safe T pcs - -
55 Folley chateter size 16 Pcs - -
56 Folley chateter size 18 Pcs - -
57 Folley chateter size 20 Pcs - -
58 Folley chateter no 22 Pcs - -
59 I V Cateter no 16 Pcs - -
60 Control normal serum3 ml vial - -
61 Strip Cholesterol Box/10 strip - -
62 Cholesterol Liquicolor 4 x 30 ml Kit - -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

63 HDL Cholesterol 20 ml Kit - -

64 LDL Cholesterol direct 1 x 80 ml Kit - -
65 Total & direct bilirubin liquid 2 x 100 ml Kit - -
66 Probe cleanser 17 ml Botol - -
67 Giserin 100 ml Botol - -
68 Benang silk no 2.0 Pack/12 - -
69 Benang Prolin no 3.0 Pack - -
70 Benang prolin no 5.0 pack - -
71 Reagen golongsn darah A Botol - -
72 Reagen golongsn darah B Botol - -
73 Ringer Laktat Botol - -
74 Wing needle no 27 G Pcs - -
75 Stik HB Box/50 test - -
76 Stik protein reduksi urin 3P Box/100 test - -
77 Cairan klorin 0,5 % Galon/5 liter - -
78 Kresek Plastik kecil ukuran 1 X 15 Pcs - -
79 Reagen gula darah Box/50 - -
80 Diluent M 30 Galon/20 liter - -
81 Rinze M 30 Galon/20 liter - -
82 Lise M 30 Botol/500 ml - -
83 EZ Cleanser M 30 Botol/100 ml - -
84 RPR test Kit Kit - -
85 Koh 10 % Botol/100 ml - -
86 Cat Gram Kit - -
87 Aquadest Botol/1 liter - -
88 Reagen control serum hematologi Botol/5 ml - -
89 Cotton aplicator Rectal (vaginal swap) Pcs - -
90 Cater Urine nelacton UK 20 Pcs - -
91 Lubricant Gel Buah - -
92 Plastik 1/2 kg Bungkus/5 Roll - -
93 Perhidrol H2O2 3 % Botol/100 ml - -
94 Betadin Botol/300 ml - -
95 Cotton aplicator (IVA) Pcs - -
96 Bisturi no 25 Pcs - -
97 Pot sputum 120 ml Pcs - -
98 Slide b71101 Pcs - -
99 Klem Tali pusat Pcs - -
100 Cater urine nelaton uk 18 Pcs - -
101 Nasogatic tube dewasa Pcs - -
102 Catton swab Bks/100 - -
103 Plester bulat Box/200 - -
104 Box slide Pcs - -
105 Rapid test siphillis Pcs - -
106 Aquadest Galon/20 ltr - -
107 Cup test sampel 1,5 ml Pcs - -
108 Tabung clot avtivator 5 ml tutup merah Pcs - -
109 Reagen Giemsa Botol/100 ml - -
110 Cairan infus Na cl 0,9 % Btl/500 ml - -
111 Aqua air mineral Botol /1,5 ml - -
112 Metanol Botol/500 ml - -
113 Tabung gel clot tutup kuning 5 ml Box /100 - -
114 Safety box 5 liter Buah - -
115 Alat suntik satu kali pakai 3 ml Pcs - -
116 Asam cuka / asam asetat 5 % Botol - -
117 Oil emersi Botol - -
118 Benang wol Roll - -
119 Kotak plastik untuk tempat obat Pcs - -
120 Kantong puyer Pak - -
121 Etanol 70 % 1000 ml Botol - -
122 Lisol mengandung Kresol Botol - -
123 Plester Botol - -
124 Sendok takar Roll - -
125 Klip platik obat 10 X 15 Pak - -
126 Etyl Klorida Botol - -
127 Fletcher Botol - -
128 Stik Gula darah Pcs - -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

129 Stik asam urat Pcs - -

130 Isi ulang sabun cuci tangan Galon/5 l - -
131 Amlodipin 5 mg Tablet - -
132 Ambroxol syrup Botol - -
133 Amoxicillyn syrup Botol - -
134 Amoxicillyn Tablet - -
135 Cefadroxyl syrup Botol - -
136 Dexametason 0,5 mg Tablet - -
137 Enbatic salp Tube - -
138 Gentamicyn salp mata Tube - -
139 Gentamicyn tetes mata Botol - -
140 Glimepirid 2 mg Tablet - -
141 Meloxicam 7,5 mg Tablet - -
142 Metformin Tablet - -
143 Miconazol Tube - -
144 Metronidazol 500 mg Tablet - -
145 Natrium Diklofenac 50 mg Tablet - -
146 Omeprazol Tablet - -
147 Oxitetrasiklin salp kulit Tube - -
148 Paracetamol syrup Botol - -
149 Paracetamol Tablet - -
150 Ranitidin Tablet - -
151 Simvastatin 10 mg Tablet - -
152 Stesoli Rektal Tube - -
153 Tetagam Ampul - -
154 Ventolin Botol - -
155 Rapid Test Covid 19 Test - -
156 Allopurinol Tablet - -
157 Salicyl bedak Botol - -
158 Amoxicylin syrup forte Botol - -
159 Daryantull Lembar - -
160 Livron B plex Tablet - -
161 Lytacur Syrup Botol - -
162 Lacto B Sachet - -
163 Kertas EKG Roll - -
164 Lampu Spiritus Botol - -
165 Safety box Pcs - -
166 Objek Glass fosted Pcs - -
167 Kertas Thermal uk 5 cm Roll - -
168 Cover glass Kotak - -
169 Spuit 3 ml Pcs - -
170 Masker N95 Pcs - -
171 Nurse cup Box 0 1 1 1 0 -
172 Acyclovir salp kulit Tube - -
173 Captopril 25 mg Tablet - -
174 Kalsium Laktat (Novakal) Tablet - -
175 Paracetamol Drop Botol - -
176 Ambroxol 30 mg Tablet - -
177 Cetirizin 10 mg Tablet - -
178 Betadin Botol/60 ml - -

Mengetahui
Plt Kepala UPTD Puskesmas Kediri 1 Petugas gudang Petugas Sub Unit

dr Ni Putu Widiyanti Jurni Sari Mansyur Ni Komang Suarningsih

NIP: 19860101 201101 2 044 NIP : 19720630 200501 2 006 NIP: 19671105 198902 2 001
 LPLPO BMHP JKN PUSKESMAS KEDIRI 1

NAMA SUB UNIT : POLI LANSIA PELAPORAN BULAN : APRIL 2021

PERMINTAAN BULAN : MEI 2021

PENER PERSE PEMA PERMI PEMBER

NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

1 Alat suntik sekali pakai 1 ml kotak @ 100 pcs - -

2 Alat suntik sekali pakai 2,5 ml kotak @ 100 pcs - -
3 Alat suntik sekali pakai 5 ml kotak @ 100 pcs - -
4 Catgut / benang bedah no 2/0 kotak @ 24 pcs - -
5 Catgut / benang bedah no 3/0 kotak @ 24 pcs - -
6 Kapas pembalut / Absorben 250 gram Roll - -
7 Kasa pembalut 2 x 80 Bungkus - -
8 Kasa pembalut hidrofill 4 x 15 Roll - -
9 Sarung tangan S Pcs - -
10 Sarung tangan M Pcs 30 100 130 120 10 -
11 Sarung tangan L Pcs 6 100 106 56 50 -
12 Silk( benang bedah sutera )no 3/0 Box / 36 - -
13 IV cath no.20 Pcs - -
14 IV cath no.18 Pcs - -
15 Kasa gulung Roll - -
16 Masker Box/ 50 - -
17 Kasa hidrofil 4 x 10 Pcs - -
18 Kasa hidrofil 18 x 22 Pcs - -
19 Jarum injeksi Box / pcs - -
20 Sarung tangan steril M Pasang - -
21 Jelly Tube - -
22 Kertas perkamen Pak - -
23 Klip plastik obat 10 x 7 cm Pak 100 lembar - -
24 Klip plastik obat 13 x 8,7 cm Pak 100 lembar - -
25 Daryantulle Lembar - -
26 Hyfafik / Ultravix Roll - -
27 Spuit 10cc Pcs - -
28 Spuit 20 cc Pcs - -
29 Triway Pcs - -
30 Blood set Pcs - -
31 Bisturi no 20 Pcs - -
32 Wing needle no 23 Pcs - -
33 Jarum otot Lusin - -
34 Jarum kulit Lusin - -
35 Infusion set anak Pcs - -
36 Infusion set dewasa Pcs - -
37 Urine bag Pcs - -
38 I V Cateter no 22 Pcs - -
39 I V Cateter no 24 Pcs - -
40 Sabun cuci tangan 500 ml( Aseptik gel ) Botol - -
41 Sabun cuci alat 500 ml Botol - -
42 Bayclin 1000 ml Botol - -
43 Paravin cair 1 l Botol - -
44 Kertas lakmus merah & biru Bendel - -
45 Etanol 70 % 300 ml Botol 0 5 5 4 1 -
46 Gliserin Botol - -
47 Tissue Toilet Kotak - -
48 Kasa 4 x 3 Roll - -
49 Benang silk no 3/0 Roll - -
50 Karbol wangi 800 ml Botol - -
51 Tissue multi Kotak - -
52 Pengharum ruangan Botol - -
53 Alkohol swab pcs - -
54 Blood lancet safe T pcs - -
55 Folley chateter size 16 Pcs - -
56 Folley chateter size 18 Pcs - -
57 Folley chateter size 20 Pcs - -
58 Folley chateter no 22 Pcs - -
59 I V Cateter no 16 Pcs - -
60 Control normal serum3 ml vial - -
61 Strip Cholesterol Box/10 strip - -
62 Cholesterol Liquicolor 4 x 30 ml Kit - -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

63 HDL Cholesterol 20 ml Kit - -

64 LDL Cholesterol direct 1 x 80 ml Kit - -
65 Total & direct bilirubin liquid 2 x 100 ml Kit - -
66 Probe cleanser 17 ml Botol - -
67 Giserin 100 ml Botol - -
68 Benang silk no 2.0 Pack/12 - -
69 Benang Prolin no 3.0 Pack - -
70 Benang prolin no 5.0 pack - -
71 Reagen golongsn darah A Botol - -
72 Reagen golongsn darah B Botol - -
73 Ringer Laktat Botol - -
74 Wing needle no 27 G Pcs - -
75 Stik HB Box/50 test - -
76 Stik protein reduksi urin 3P Box/100 test - -
77 Cairan klorin 0,5 % Galon/5 liter - -
78 Kresek Plastik kecil ukuran 1 X 15 Pcs - -
79 Reagen gula darah Box/50 - -
80 Diluent M 30 Galon/20 liter - -
81 Rinze M 30 Galon/20 liter - -
82 Lise M 30 Botol/500 ml - -
83 EZ Cleanser M 30 Botol/100 ml - -
84 RPR test Kit Kit - -
85 Koh 10 % Botol/100 ml - -
86 Cat Gram Kit - -
87 Aquadest Botol/1 liter - -
88 Reagen control serum hematologi Botol/5 ml - -
89 Cotton aplicator Rectal (vaginal swap) Pcs - -
90 Cater Urine nelacton UK 20 Pcs - -
91 Lubricant Gel Buah - -
92 Plastik 1/2 kg Bungkus/5 Roll - -
93 Perhidrol H2O2 3 % Botol/100 ml - -
94 Betadin Botol/300 ml - -
95 Cotton aplicator (IVA) Pcs - -
96 Bisturi no 25 Pcs - -
97 Pot sputum 120 ml Pcs - -
98 Slide b71101 Pcs - -
99 Klem Tali pusat Pcs - -
100 Cater urine nelaton uk 18 Pcs - -
101 Nasogatic tube dewasa Pcs - -
102 Catton swab Bks/100 - -
103 Plester bulat Box/200 - -
104 Box slide Pcs - -
105 Rapid test siphillis Pcs - -
106 Aquadest Galon/20 ltr - -
107 Cup test sampel 1,5 ml Pcs - -
108 Tabung clot avtivator 5 ml tutup merah Pcs - -
109 Reagen Giemsa Botol/100 ml - -
110 Cairan infus Na cl 0,9 % Btl/500 ml - -
111 Aqua air mineral Botol /1,5 ml - -
112 Metanol Botol/500 ml - -
113 Tabung gel clot tutup kuning 5 ml Box /100 - -
114 Safety box 5 liter Buah - -
115 Alat suntik satu kali pakai 3 ml Pcs - -
116 Asam cuka / asam asetat 5 % Botol - -
117 Oil emersi Botol - -
118 Benang wol Roll - -
119 Kotak plastik untuk tempat obat Pcs - -
120 Kantong puyer Pak - -
121 Etanol 70 % 1000 ml Botol - -
122 Lisol mengandung Kresol Botol - -
123 Plester Botol - -
124 Sendok takar Roll - -
125 Klip platik obat 10 X 15 Pak - -
126 Etyl Klorida Botol - -
127 Fletcher Botol - -
128 Stik Gula darah Pcs - -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

129 Stik asam urat Pcs - -

130 Isi ulang sabun cuci tangan Galon/5 l - -
131 Amlodipin 5 mg Tablet - -
132 Ambroxol syrup Botol - -
133 Amoxicillyn syrup Botol - -
134 Amoxicillyn Tablet - -
135 Cefadroxyl syrup Botol - -
136 Dexametason 0,5 mg Tablet - -
137 Enbatic salp Tube - -
138 Gentamicyn salp mata Tube - -
139 Gentamicyn tetes mata Botol - -
140 Glimepirid 2 mg Tablet - -
141 Meloxicam 7,5 mg Tablet - -
142 Metformin Tablet - -
143 Miconazol Tube - -
144 Metronidazol 500 mg Tablet - -
145 Natrium Diklofenac 50 mg Tablet - -
146 Omeprazol Tablet - -
147 Oxitetrasiklin salp kulit Tube - -
148 Paracetamol syrup Botol - -
149 Paracetamol Tablet - -
150 Ranitidin Tablet - -
151 Simvastatin 10 mg Tablet - -
152 Stesoli Rektal Tube - -
153 Tetagam Ampul - -
154 Ventolin Botol - -
155 Rapid Test Covid 19 Test - -
156 Allopurinol Tablet - -
157 Salicyl bedak Botol - -
158 Amoxicylin syrup forte Botol - -
159 Daryantull Lembar - -
160 Livron B plex Tablet - -
161 Lytacur Syrup Botol - -
162 Lacto B Sachet - -
163 Kertas EKG Roll - -
164 Lampu Spiritus Botol - -
165 Safety box Pcs - -
166 Objek Glass fosted Pcs - -
167 Kertas Thermal uk 5 cm Roll - -
168 Cover glass Kotak - -
169 Spuit 3 ml Pcs - -
170 Masker N95 Pcs - -
171 Nurse cup Box 0 1 1 1 0 -
172 Acyclovir salp kulit Tube - -
173 Captopril 25 mg Tablet - -
174 Kalsium Laktat (Novakal) Tablet - -
175 Paracetamol Drop Botol - -
176 Ambroxol 30 mg Tablet - -
177 Cetirizin 10 mg Tablet - -
178 Betadin Botol/60 ml - -

Mengetahui
Plt Kepala UPTD Puskesmas Kediri 1 Petugas gudang Petugas Sub Unit

dr Ni Putu Widiyanti Jurni Sari Mansyur Ni Komang Suarningsih

NIP: 19860101 201101 2 044 NIP : 19720630 200501 2 006 NIP: 19671105 198902 2 001
 LPLPO BMHP JKN PUSKESMAS KEDIRI 1

NAMA SUB UNIT : POLI LANSIA PELAPORAN BULAN : MEI 2021

PERMINTAAN BULAN : JUNI 2021

PENER PERSE PEMA PERMI PEMBER

NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

1 Alat suntik sekali pakai 1 ml kotak @ 100 pcs - -

2 Alat suntik sekali pakai 2,5 ml kotak @ 100 pcs - -
3 Alat suntik sekali pakai 5 ml kotak @ 100 pcs - -
4 Catgut / benang bedah no 2/0 kotak @ 24 pcs - -
5 Catgut / benang bedah no 3/0 kotak @ 24 pcs - -
6 Kapas pembalut / Absorben 250 gram Roll - -
7 Kasa pembalut 2 x 80 Bungkus - -
8 Kasa pembalut hidrofill 4 x 15 Roll - -
9 Sarung tangan S Pcs - -
10 Sarung tangan M Pcs 10 100 110 106 4 -
11 Sarung tangan L Pcs 50 50 32 18 -
12 Silk( benang bedah sutera )no 3/0 Box / 36 - -
13 IV cath no.20 Pcs - -
14 IV cath no.18 Pcs - -
15 Kasa gulung Roll - -
16 Masker Box/ 50 - -
17 Kasa hidrofil 4 x 10 Pcs - -
18 Kasa hidrofil 18 x 22 Pcs - -
19 Jarum injeksi Box / pcs - -
20 Sarung tangan steril M Pasang - -
21 Jelly Tube - -
22 Kertas perkamen Pak - -
23 Klip plastik obat 10 x 7 cm Pak 100 lembar - -
24 Klip plastik obat 13 x 8,7 cm Pak 100 lembar - -
25 Daryantulle Lembar - -
26 Hyfafik / Ultravix Roll - -
27 Spuit 10cc Pcs - -
28 Spuit 20 cc Pcs - -
29 Triway Pcs - -
30 Blood set Pcs - -
31 Bisturi no 20 Pcs - -
32 Wing needle no 23 Pcs - -
33 Jarum otot Lusin - -
34 Jarum kulit Lusin - -
35 Infusion set anak Pcs - -
36 Infusion set dewasa Pcs - -
37 Urine bag Pcs - -
38 I V Cateter no 22 Pcs - -
39 I V Cateter no 24 Pcs - -
40 Sabun cuci tangan 500 ml( Aseptik gel ) Botol - -
41 Sabun cuci alat 500 ml Botol - -
42 Bayclin 1000 ml Botol - -
43 Paravin cair 1 l Botol - -
44 Kertas lakmus merah & biru Bendel - -
45 Etanol 70 % 300 ml Botol 1 1 0 1 -
46 Gliserin Botol - -
47 Tissue Toilet Kotak - -
48 Kasa 4 x 3 Roll - -
49 Benang silk no 3/0 Roll - -
50 Karbol wangi 800 ml Botol - -
51 Tissue multi Kotak - -
52 Pengharum ruangan Botol - -
53 Alkohol swab pcs - -
54 Blood lancet safe T pcs - -
55 Folley chateter size 16 Pcs - -
56 Folley chateter size 18 Pcs - -
57 Folley chateter size 20 Pcs - -
58 Folley chateter no 22 Pcs - -
59 I V Cateter no 16 Pcs - -
60 Control normal serum3 ml vial - -
61 Strip Cholesterol Box/10 strip - -
62 Cholesterol Liquicolor 4 x 30 ml Kit - -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

63 HDL Cholesterol 20 ml Kit - -

64 LDL Cholesterol direct 1 x 80 ml Kit - -
65 Total & direct bilirubin liquid 2 x 100 ml Kit - -
66 Probe cleanser 17 ml Botol - -
67 Giserin 100 ml Botol - -
68 Benang silk no 2.0 Pack/12 - -
69 Benang Prolin no 3.0 Pack - -
70 Benang prolin no 5.0 pack - -
71 Reagen golongsn darah A Botol - -
72 Reagen golongsn darah B Botol - -
73 Ringer Laktat Botol - -
74 Wing needle no 27 G Pcs - -
75 Stik HB Box/50 test - -
76 Stik protein reduksi urin 3P Box/100 test - -
77 Cairan klorin 0,5 % Galon/5 liter - -
78 Kresek Plastik kecil ukuran 1 X 15 Pcs - -
79 Reagen gula darah Box/50 - -
80 Diluent M 30 Galon/20 liter - -
81 Rinze M 30 Galon/20 liter - -
82 Lise M 30 Botol/500 ml - -
83 EZ Cleanser M 30 Botol/100 ml - -
84 RPR test Kit Kit - -
85 Koh 10 % Botol/100 ml - -
86 Cat Gram Kit - -
87 Aquadest Botol/1 liter - -
88 Reagen control serum hematologi Botol/5 ml - -
89 Cotton aplicator Rectal (vaginal swap) Pcs - -
90 Cater Urine nelacton UK 20 Pcs - -
91 Lubricant Gel Buah - -
92 Plastik 1/2 kg Bungkus/5 Roll - -
93 Perhidrol H2O2 3 % Botol/100 ml - -
94 Betadin Botol/300 ml - -
95 Cotton aplicator (IVA) Pcs - -
96 Bisturi no 25 Pcs - -
97 Pot sputum 120 ml Pcs - -
98 Slide b71101 Pcs - -
99 Klem Tali pusat Pcs - -
100 Cater urine nelaton uk 18 Pcs - -
101 Nasogatic tube dewasa Pcs - -
102 Catton swab Bks/100 - -
103 Plester bulat Box/200 - -
104 Box slide Pcs - -
105 Rapid test siphillis Pcs - -
106 Aquadest Galon/20 ltr - -
107 Cup test sampel 1,5 ml Pcs - -
108 Tabung clot avtivator 5 ml tutup merah Pcs - -
109 Reagen Giemsa Botol/100 ml - -
110 Cairan infus Na cl 0,9 % Btl/500 ml - -
111 Aqua air mineral Botol /1,5 ml - -
112 Metanol Botol/500 ml - -
113 Tabung gel clot tutup kuning 5 ml Box /100 - -
114 Safety box 5 liter Buah - -
115 Alat suntik satu kali pakai 3 ml Pcs - -
116 Asam cuka / asam asetat 5 % Botol - -
117 Oil emersi Botol - -
118 Benang wol Roll - -
119 Kotak plastik untuk tempat obat Pcs - -
120 Kantong puyer Pak - -
121 Etanol 70 % 1000 ml Botol - -
122 Lisol mengandung Kresol Botol - -
123 Plester Botol - -
124 Sendok takar Roll - -
125 Klip platik obat 10 X 15 Pak - -
126 Etyl Klorida Botol - -
127 Fletcher Botol - -
128 Stik Gula darah Pcs - -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

129 Stik asam urat Pcs - -

130 Isi ulang sabun cuci tangan Galon/5 l - -
131 Amlodipin 5 mg Tablet - -
132 Ambroxol syrup Botol - -
133 Amoxicillyn syrup Botol - -
134 Amoxicillyn Tablet - -
135 Cefadroxyl syrup Botol - -
136 Dexametason 0,5 mg Tablet - -
137 Enbatic salp Tube - -
138 Gentamicyn salp mata Tube - -
139 Gentamicyn tetes mata Botol - -
140 Glimepirid 2 mg Tablet - -
141 Meloxicam 7,5 mg Tablet - -
142 Metformin Tablet - -
143 Miconazol Tube - -
144 Metronidazol 500 mg Tablet - -
145 Natrium Diklofenac 50 mg Tablet - -
146 Omeprazol Tablet - -
147 Oxitetrasiklin salp kulit Tube - -
148 Paracetamol syrup Botol - -
149 Paracetamol Tablet - -
150 Ranitidin Tablet - -
151 Simvastatin 10 mg Tablet - -
152 Stesoli Rektal Tube - -
153 Tetagam Ampul - -
154 Ventolin Botol - -
155 Rapid Test Covid 19 Test - -
156 Allopurinol Tablet - -
157 Salicyl bedak Botol - -
158 Amoxicylin syrup forte Botol - -
159 Daryantull Lembar - -
160 Livron B plex Tablet - -
161 Lytacur Syrup Botol - -
162 Lacto B Sachet - -
163 Kertas EKG Roll - -
164 Lampu Spiritus Botol - -
165 Safety box Pcs - -
166 Objek Glass fosted Pcs - -
167 Kertas Thermal uk 5 cm Roll - -
168 Cover glass Kotak - -
169 Spuit 3 ml Pcs - -
170 Masker N95 Pcs - -
171 Nurse cup Box - -
172 Acyclovir salp kulit Tube - -
173 Captopril 25 mg Tablet - -
174 Kalsium Laktat (Novakal) Tablet - -
175 Paracetamol Drop Botol - -
176 Ambroxol 30 mg Tablet - -
177 Cetirizin 10 mg Tablet - -
178 Betadin Botol/60 ml - -

Mengetahui
Plt Kepala UPTD Puskesmas Kediri 1 Petugas gudang Petugas Sub Unit

dr Ni Putu Widiyanti Jurni Sari Mansyur Ni Komang Suarningsih

NIP: 19860101 201101 2 044 NIP : 19720630 200501 2 006 NIP: 19671105 198902 2 001
 LPLPO BMHP JKN PUSKESMAS KEDIRI 1

NAMA SUB UNIT : POLI LANSIA PELAPORAN BULAN : JUNI 2021

PERMINTAAN BULAN : JULI 2021

PENER PERSE PEMA PERMI PEMBER

NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

1 Alat suntik sekali pakai 1 ml kotak @ 100 pcs - -

2 Alat suntik sekali pakai 2,5 ml kotak @ 100 pcs - -
3 Alat suntik sekali pakai 5 ml kotak @ 100 pcs - -
4 Catgut / benang bedah no 2/0 kotak @ 24 pcs - -
5 Catgut / benang bedah no 3/0 kotak @ 24 pcs - -
6 Kapas pembalut / Absorben 250 gram Roll - -
7 Kasa pembalut 2 x 80 Bungkus - -
8 Kasa pembalut hidrofill 4 x 15 Roll - -
9 Sarung tangan S Pcs - -
10 Sarung tangan M Pcs 4 200 204 154 50 -
11 Sarung tangan L Pcs 18 100 118 106 12 -
12 Silk( benang bedah sutera )no 3/0 Box / 36 - -
13 IV cath no.20 Pcs - -
14 IV cath no.18 Pcs - -
15 Kasa gulung Roll - -
16 Masker Box/ 50 - -
17 Kasa hidrofil 4 x 10 Pcs - -
18 Kasa hidrofil 18 x 22 Pcs - -
19 Jarum injeksi Box / pcs - -
20 Sarung tangan steril M Pasang - -
21 Jelly Tube - -
22 Kertas perkamen Pak - -
23 Klip plastik obat 10 x 7 cm Pak 100 lembar - -
24 Klip plastik obat 13 x 8,7 cm Pak 100 lembar - -
25 Hyfafik / Ultravix Roll - -
26 Spuit 10cc Pcs - -
27 Spuit 20 cc Pcs - -
28 Triway Pcs - -
29 Blood set Pcs - -
30 Bisturi no 20 Pcs - -
31 Wing needle no 23 Pcs - -
32 Jarum otot Lusin - -
33 Jarum kulit Lusin - -
34 Infusion set anak Pcs - -
35 Infusion set dewasa Pcs - -
36 Urine bag Pcs - -
37 I V Cateter no 22 Pcs - -
38 I V Cateter no 24 Pcs - -
39 Sabun cuci tangan 500 ml( Aseptik gel ) Botol - -
40 Sabun cuci alat 500 ml Botol - -
41 Bayclin 1000 ml Botol - -
42 Paravin cair 1 l Botol - -
43 Kertas lakmus merah & biru Bendel - -
44 Etanol 70 % 300 ml Botol 1 5 6 5 1 -
45 Gliserin Botol - -
46 Tissue Toilet Kotak - -
47 Kasa 4 x 3 Roll - -
48 Benang silk no 3/0 Roll - -
49 Karbol wangi 800 ml Botol - -
50 Tissue multi Kotak - -
51 Pengharum ruangan Botol - -
52 Alkohol swab pcs - -
53 Blood lancet safe T pcs - -
54 Folley chateter size 16 Pcs - -
55 Folley chateter size 18 Pcs - -
56 Folley chateter size 20 Pcs - -
57 Folley chateter no 22 Pcs - -
58 I V Cateter no 16 Pcs - -
59 Control normal serum3 ml vial - -
60 Strip Cholesterol Box/10 strip - -
61 Cholesterol Liquicolor 4 x 30 ml Kit - -
62 HDL Cholesterol 20 ml Kit - -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

63 LDL Cholesterol direct 1 x 80 ml Kit - -

64 Total & direct bilirubin liquid 2 x 100 ml Kit - -
65 Probe cleanser 17 ml Botol - -
66 Giserin 100 ml Botol - -
67 Benang silk no 2.0 Pack/12 - -
68 Benang Prolin no 3.0 Pack - -
69 Benang prolin no 5.0 pack - -
70 Reagen golongsn darah A Botol - -
71 Reagen golongsn darah B Botol - -
72 Ringer Laktat Botol - -
73 Wing needle no 27 G Pcs - -
74 Stik HB Box/50 test - -
75 Stik protein reduksi urin 3P Box/100 test - -
76 Cairan klorin 0,5 % Galon/5 liter - -
77 Kresek Plastik kecil ukuran 1 X 15 Pcs - -
78 Reagen gula darah Box/50 - -
79 Diluent M 30 Galon/20 liter - -
80 Rinze M 30 Galon/20 liter - -
81 Lise M 30 Botol/500 ml - -
82 EZ Cleanser M 30 Botol/100 ml - -
83 RPR test Kit Kit - -
84 Koh 10 % Botol/100 ml - -
85 Cat Gram Kit - -
86 Aquadest Botol/1 liter - -
87 Reagen control serum hematologi Botol/5 ml - -
88 Cotton aplicator Rectal (vaginal swap) Pcs - -
89 Cater Urine nelacton UK 20 Pcs - -
90 Lubricant Gel Buah - -
91 Plastik 1/2 kg Bungkus/5 Roll - -
92 Perhidrol H2O2 3 % Botol/100 ml - -
93 Betadin Botol/300 ml - -
94 Cotton aplicator (IVA) Pcs - -
95 Bisturi no 25 Pcs - -
96 Pot sputum 120 ml Pcs - -
97 Slide b71101 Pcs - -
98 Klem Tali pusat Pcs - -
99 Cater urine nelaton uk 18 Pcs - -
100 Nasogatic tube dewasa Pcs - -
101 Catton swab Bks/100 - -
102 Plester bulat Box/200 - -
103 Box slide Pcs - -
104 Rapid test siphillis Pcs - -
105 Aquadest Galon/20 ltr - -
106 Cup test sampel 1,5 ml Pcs - -
107 Tabung clot avtivator 5 ml tutup merah Pcs - -
108 Reagen Giemsa Botol/100 ml - -
109 Cairan infus Na cl 0,9 % Btl/500 ml - -
110 Aqua air mineral Botol /1,5 ml - -
111 Metanol Botol/500 ml - -
112 Tabung gel clot tutup kuning 5 ml Box /100 - -
113 Safety box 5 liter Buah - -
114 Alat suntik satu kali pakai 3 ml Pcs - -
115 Asam cuka / asam asetat 5 % Botol - -
116 Oil emersi Botol - -
117 Benang wol Roll - -
118 Kotak plastik untuk tempat obat Pcs - -
119 Kantong puyer Pak - -
120 Etanol 70 % 1000 ml Botol - -
121 Lisol mengandung Kresol Botol - -
122 Plester Botol - -
123 Sendok takar Roll - -
124 Klip platik obat 10 X 15 Pak - -
125 Etyl Klorida Botol - -
126 Fletcher Botol - -
127 Stik Gula darah Pcs - -
128 Stik asam urat Pcs - -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

129 Isi ulang sabun cuci tangan Galon/5 l - -

130 Amlodipin 5 mg Tablet - -
131 Ambroxol syrup Botol - -
132 Amoxicillyn syrup Botol - -
133 Amoxicillyn Tablet - -
134 Cefadroxyl syrup Botol - -
135 Dexametason 0,5 mg Tablet - -
136 Enbatic salp Tube - -
137 Gentamicyn salp mata Tube - -
138 Gentamicyn tetes mata Botol - -
139 Glimepirid 2 mg Tablet - -
140 Meloxicam 7,5 mg Tablet - -
141 Metformin Tablet - -
142 Miconazol Tube - -
143 Metronidazol 500 mg Tablet - -
144 Natrium Diklofenac 50 mg Tablet - -
145 Omeprazol Tablet - -
146 Oxitetrasiklin salp kulit Tube - -
147 Paracetamol syrup Botol - -
148 Paracetamol Tablet - -
149 Ranitidin Tablet - -
150 Simvastatin 10 mg Tablet - -
151 Stesoli Rektal Tube - -
152 Tetagam Ampul - -
153 Ventolin Botol - -
154 Rapid Test Covid 19 Test - -
155 Allopurinol Tablet - -
156 Salicyl bedak Botol - -
157 Amoxicylin syrup forte Botol - -
158 Daryantull Lembar - -
159 Livron B plex Tablet - -
160 Lytacur Syrup Botol - -
161 Lacto B Sachet - -
162 Kertas EKG Roll - -
163 Lampu Spiritus Botol - -
164 Safety box Pcs - -
165 Objek Glass fosted Pcs - -
166 Kertas Thermal uk 5 cm Roll - -
167 Cover glass Kotak - -
168 Spuit 3 ml Pcs - -
169 Masker N95 Pcs - -
170 Nurse cup Box 0 1 1 1 0 -
171 Acyclovir salp kulit Tube - -
172 Captopril 25 mg Tablet - -
173 Kalsium Laktat (Novakal) Tablet - -
174 Paracetamol Drop Botol - -
175 Ambroxol 30 mg Tablet - -
176 Cetirizin 10 mg Tablet - -
177 Betadin Botol/60 ml - -

Mengetahui
Plt Kepala UPTD Puskesmas Kediri 1 Petugas gudang Petugas Sub Unit

dr Ni Putu Widiyanti Jurni Sari Mansyur Ni Komang Suarningsih

NIP: 19860101 201101 2 044 NIP : 19720630 200501 2 006 NIP: 19671105 198902 2 001
 LPLPO BMHP JKN PUSKESMAS KEDIRI 1

NAMA SUB UNIT : POLI LANSIA PELAPORAN BULAN : JULI 2021

PERMINTAAN BULAN : AGUSTUS 2021

PENER PERSE PEMA PERMI PEMBER

NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

1 Alat suntik sekali pakai 1 ml kotak @ 100 pcs - -

2 Alat suntik sekali pakai 2,5 ml kotak @ 100 pcs - -
3 Alat suntik sekali pakai 5 ml kotak @ 100 pcs - -
4 Catgut / benang bedah no 2/0 kotak @ 24 pcs - -
5 Catgut / benang bedah no 3/0 kotak @ 24 pcs - -
6 Kapas pembalut / Absorben 250 gram Roll - -
7 Kasa pembalut 2 x 80 Bungkus - -
8 Kasa pembalut hidrofill 4 x 15 Roll - -
9 Sarung tangan S Pcs - -
10 Sarung tangan M Pcs 50 200 250 180 70 -
11 Sarung tangan L Pcs 12 100 112 112 0 -
12 Silk( benang bedah sutera )no 3/0 Box / 36 - -
13 IV cath no.20 Pcs - -
14 IV cath no.18 Pcs - -
15 Kasa gulung Roll - -
16 Masker Box/ 50 0 100 100 80 20 -
17 Kasa hidrofil 4 x 10 Pcs - -
18 Kasa hidrofil 18 x 22 Pcs - -
19 Jarum injeksi Box / pcs - -
20 Sarung tangan steril M Pasang - -
21 Jelly Tube - -
22 Kertas perkamen Pak - -
23 Klip plastik obat 10 x 7 cm Pak 100 lembar - -
24 Klip plastik obat 13 x 8,7 cm Pak 100 lembar - -
25 Hyfafik / Ultravix Roll - -
26 Spuit 10cc Pcs - -
27 Spuit 20 cc Pcs - -
28 Triway Pcs - -
29 Blood set Pcs - -
30 Bisturi no 20 Pcs - -
31 Wing needle no 23 Pcs - -
32 Jarum otot Lusin - -
33 Jarum kulit Lusin - -
34 Infusion set anak Pcs - -
35 Infusion set dewasa Pcs - -
36 Urine bag Pcs - -
37 I V Cateter no 22 Pcs - -
38 I V Cateter no 24 Pcs - -
39 Sabun cuci tangan 500 ml( Aseptik gel ) Botol - -
40 Sabun cuci alat 500 ml Botol - -
41 Bayclin 1000 ml Botol - -
42 Paravin cair 1 l Botol - -
43 Kertas lakmus merah & biru Bendel - -
44 Etanol 70 % 300 ml Botol 1 5 6 6 0 -
45 Gliserin Botol - -
46 Tissue Toilet Kotak - -
47 Kasa 4 x 3 Roll - -
48 Benang silk no 3/0 Roll - -
49 Karbol wangi 800 ml Botol - -
50 Tissue multi Kotak - -
51 Pengharum ruangan Botol - -
52 Alkohol swab pcs - -
53 Blood lancet safe T pcs - -
54 Folley chateter size 16 Pcs - -
55 Folley chateter size 18 Pcs - -
56 Folley chateter size 20 Pcs - -
57 Folley chateter no 22 Pcs - -
58 I V Cateter no 16 Pcs - -
59 Control normal serum3 ml vial - -
60 Strip Cholesterol Box/10 strip - -
61 Cholesterol Liquicolor 4 x 30 ml Kit - -
62 HDL Cholesterol 20 ml Kit - -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

63 LDL Cholesterol direct 1 x 80 ml Kit - -

64 Total & direct bilirubin liquid 2 x 100 ml Kit - -
65 Probe cleanser 17 ml Botol - -
66 Giserin 100 ml Botol - -
67 Benang silk no 2.0 Pack/12 - -
68 Benang Prolin no 3.0 Pack - -
69 Benang prolin no 5.0 pack - -
70 Reagen golongsn darah A Botol - -
71 Reagen golongsn darah B Botol - -
72 Ringer Laktat Botol - -
73 Wing needle no 27 G Pcs - -
74 Stik HB Box/50 test - -
75 Stik protein reduksi urin 3P Box/100 test - -
76 Cairan klorin 0,5 % Galon/5 liter - -
77 Kresek Plastik kecil ukuran 1 X 15 Pcs - -
78 Reagen gula darah Box/50 - -
79 Diluent M 30 Galon/20 liter - -
80 Rinze M 30 Galon/20 liter - -
81 Lise M 30 Botol/500 ml - -
82 EZ Cleanser M 30 Botol/100 ml - -
83 RPR test Kit Kit - -
84 Koh 10 % Botol/100 ml - -
85 Cat Gram Kit - -
86 Aquadest Botol/1 liter - -
87 Reagen control serum hematologi Botol/5 ml - -
88 Cotton aplicator Rectal (vaginal swap) Pcs - -
89 Cater Urine nelacton UK 20 Pcs - -
90 Lubricant Gel Buah - -
91 Plastik 1/2 kg Bungkus/5 Roll - -
92 Perhidrol H2O2 3 % Botol/100 ml - -
93 Betadin Botol/300 ml - -
94 Cotton aplicator (IVA) Pcs - -
95 Bisturi no 25 Pcs - -
96 Pot sputum 120 ml Pcs - -
97 Slide b71101 Pcs - -
98 Klem Tali pusat Pcs - -
99 Cater urine nelaton uk 18 Pcs - -
100 Nasogatic tube dewasa Pcs - -
101 Catton swab Bks/100 - -
102 Plester bulat Box/200 - -
103 Box slide Pcs - -
104 Rapid test siphillis Pcs - -
105 Aquadest Galon/20 ltr - -
106 Cup test sampel 1,5 ml Pcs - -
107 Tabung clot avtivator 5 ml tutup merah Pcs - -
108 Reagen Giemsa Botol/100 ml - -
109 Cairan infus Na cl 0,9 % Btl/500 ml - -
110 Aqua air mineral Botol /1,5 ml - -
111 Metanol Botol/500 ml - -
112 Tabung gel clot tutup kuning 5 ml Box /100 - -
113 Safety box 5 liter Buah - -
114 Alat suntik satu kali pakai 3 ml Pcs - -
115 Asam cuka / asam asetat 5 % Botol - -
116 Oil emersi Botol - -
117 Benang wol Roll - -
118 Kotak plastik untuk tempat obat Pcs - -
119 Kantong puyer Pak - -
120 Etanol 70 % 1000 ml Botol - -
121 Lisol mengandung Kresol Botol - -
122 Plester Botol - -
123 Sendok takar Roll - -
124 Klip platik obat 10 X 15 Pak - -
125 Etyl Klorida Botol - -
126 Fletcher Botol - -
127 Stik Gula darah Pcs - -
128 Stik asam urat Pcs - -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

129 Isi ulang sabun cuci tangan Galon/5 l - -

130 Amlodipin 5 mg Tablet - -
131 Ambroxol syrup Botol - -
132 Amoxicillyn syrup Botol - -
133 Amoxicillyn Tablet - -
134 Cefadroxyl syrup Botol - -
135 Dexametason 0,5 mg Tablet - -
136 Enbatic salp Tube - -
137 Gentamicyn salp mata Tube - -
138 Gentamicyn tetes mata Botol - -
139 Glimepirid 2 mg Tablet - -
140 Meloxicam 7,5 mg Tablet - -
141 Metformin Tablet - -
142 Miconazol Tube - -
143 Metronidazol 500 mg Tablet - -
144 Natrium Diklofenac 50 mg Tablet - -
145 Omeprazol Tablet - -
146 Oxitetrasiklin salp kulit Tube - -
147 Paracetamol syrup Botol - -
148 Paracetamol Tablet - -
149 Ranitidin Tablet - -
150 Simvastatin 10 mg Tablet - -
151 Stesoli Rektal Tube - -
152 Tetagam Ampul - -
153 Ventolin Botol - -
154 Rapid Test Covid 19 Test - -
155 Allopurinol Tablet - -
156 Salicyl bedak Botol - -
157 Amoxicylin syrup forte Botol - -
158 Daryantull Lembar - -
159 Livron B plex Tablet - -
160 Lytacur Syrup Botol - -
161 Lacto B Sachet - -
162 Kertas EKG Roll - -
163 Lampu Spiritus Botol - -
164 Safety box Pcs - -
165 Objek Glass fosted Pcs - -
166 Kertas Thermal uk 5 cm Roll - -
167 Cover glass Kotak - -
168 Spuit 3 ml Pcs - -
169 Masker N95 Pcs - -
170 Nurse cup Box 0 1 1 1 0 -
171 Acyclovir salp kulit Tube - -
172 Captopril 25 mg Tablet - -
173 Kalsium Laktat (Novakal) Tablet - -
174 Paracetamol Drop Botol - -
175 Ambroxol 30 mg Tablet - -
176 Cetirizin 10 mg Tablet - -
177 Betadin Botol/60 ml - -

Mengetahui
Plt Kepala UPTD Puskesmas Kediri 1 Petugas gudang Petugas Sub Unit

dr Ni Putu Widiyanti Jurni Sari Mansyur Ni Komang Suarningsih

NIP: 19860101 201101 2 044 NIP : 19720630 200501 2 006 NIP: 19671105 198902 2 001
 LPLPO BMHP JKN PUSKESMAS KEDIRI 1

NAMA SUB UNIT : POLI LANSIA PELAPORAN BULAN : AGUSTUS 2021

PERMINTAAN BULAN : SEPTEMBER 2021

PENER PERSE PEMA PERMI PEMBER

NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

1 Alat suntik sekali pakai 1 ml kotak @ 100 pcs - -

2 Alat suntik sekali pakai 2,5 ml kotak @ 100 pcs - -
3 Alat suntik sekali pakai 5 ml kotak @ 100 pcs - -
4 Catgut / benang bedah no 2/0 kotak @ 24 pcs - -
5 Catgut / benang bedah no 3/0 kotak @ 24 pcs - -
6 Kapas pembalut / Absorben 250 gram Roll - -
7 Kasa pembalut 2 x 80 Bungkus - -
8 Kasa pembalut hidrofill 4 x 15 Roll - -
9 Sarung tangan S Pcs 0 100 100 100 0 -
10 Sarung tangan M Pcs 70 0 70 0 70 -
11 Sarung tangan L Pcs 0 100 100 100 0 -
12 Silk( benang bedah sutera )no 3/0 Box / 36 - -
13 IV cath no.20 Pcs - -
14 IV cath no.18 Pcs - -
15 Kasa gulung Roll - -
16 Masker Box/ 50 20 50 70 50 20 -
17 Kasa hidrofil 4 x 10 Pcs - -
18 Kasa hidrofil 18 x 22 Pcs - -
19 Jarum injeksi Box / pcs - -
20 Sarung tangan steril M Pasang - -
21 Jelly Tube - -
22 Kertas perkamen Pak - -
23 Klip plastik obat 10 x 7 cm Pak 100 lembar - -
24 Klip plastik obat 13 x 8,7 cm Pak 100 lembar - -
25 Hyfafik / Ultravix Roll - -
26 Spuit 10cc Pcs - -
27 Spuit 20 cc Pcs - -
28 Triway Pcs - -
29 Blood set Pcs - -
30 Bisturi no 20 Pcs - -
31 Wing needle no 23 Pcs - -
32 Jarum otot Lusin - -
33 Jarum kulit Lusin - -
34 Infusion set anak Pcs - -
35 Infusion set dewasa Pcs - -
36 Urine bag Pcs - -
37 I V Cateter no 22 Pcs - -
38 I V Cateter no 24 Pcs - -
39 Sabun cuci tangan 500 ml( Aseptik gel ) Botol - -
40 Sabun cuci alat 500 ml Botol - -
41 Bayclin 1000 ml Botol - -
42 Paravin cair 1 l Botol - -
43 Kertas lakmus merah & biru Bendel - -
44 Etanol 70 % 300 ml Botol - -
45 Gliserin Botol - -
46 Tissue Toilet Kotak - -
47 Kasa 4 x 3 Roll - -
48 Benang silk no 3/0 Roll - -
49 Karbol wangi 800 ml Botol - -
50 Tissue multi Kotak - -
51 Pengharum ruangan Botol - -
52 Alkohol swab pcs - -
53 Blood lancet safe T pcs - -
54 Folley chateter size 16 Pcs - -
55 Folley chateter size 18 Pcs - -
56 Folley chateter size 20 Pcs - -
57 Folley chateter no 22 Pcs - -
58 I V Cateter no 16 Pcs - -
59 Control normal serum3 ml vial - -
60 Strip Cholesterol Box/10 strip - -
61 Cholesterol Liquicolor 4 x 30 ml Kit - -
62 HDL Cholesterol 20 ml Kit - -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

63 LDL Cholesterol direct 1 x 80 ml Kit - -

64 Total & direct bilirubin liquid 2 x 100 ml Kit - -
65 Probe cleanser 17 ml Botol - -
66 Giserin 100 ml Botol - -
67 Benang silk no 2.0 Pack/12 - -
68 Benang Prolin no 3.0 Pack - -
69 Benang prolin no 5.0 pack - -
70 Reagen golongsn darah A Botol - -
71 Reagen golongsn darah B Botol - -
72 Ringer Laktat Botol - -
73 Wing needle no 27 G Pcs - -
74 Stik HB Box/50 test - -
75 Stik protein reduksi urin 3P Box/100 test - -
76 Cairan klorin 0,5 % Galon/5 liter - -
77 Kresek Plastik kecil ukuran 1 X 15 Pcs - -
78 Reagen gula darah Box/50 - -
79 Diluent M 30 Galon/20 liter - -
80 Rinze M 30 Galon/20 liter - -
81 Lise M 30 Botol/500 ml - -
82 EZ Cleanser M 30 Botol/100 ml - -
83 RPR test Kit Kit - -
84 Koh 10 % Botol/100 ml - -
85 Cat Gram Kit - -
86 Aquadest Botol/1 liter - -
87 Reagen control serum hematologi Botol/5 ml - -
88 Cotton aplicator Rectal (vaginal swap) Pcs - -
89 Cater Urine nelacton UK 20 Pcs - -
90 Lubricant Gel Buah - -
91 Plastik 1/2 kg Bungkus/5 Roll - -
92 Perhidrol H2O2 3 % Botol/100 ml - -
93 Betadin Botol/300 ml - -
94 Cotton aplicator (IVA) Pcs - -
95 Bisturi no 25 Pcs - -
96 Pot sputum 120 ml Pcs - -
97 Slide b71101 Pcs - -
98 Klem Tali pusat Pcs - -
99 Cater urine nelaton uk 18 Pcs - -
100 Nasogatic tube dewasa Pcs - -
101 Catton swab Bks/100 - -
102 Plester bulat Box/200 - -
103 Box slide Pcs - -
104 Rapid test siphillis Pcs - -
105 Aquadest Galon/20 ltr - -
106 Cup test sampel 1,5 ml Pcs - -
107 Tabung clot avtivator 5 ml tutup merah Pcs - -
108 Reagen Giemsa Botol/100 ml - -
109 Cairan infus Na cl 0,9 % Btl/500 ml - -
110 Aqua air mineral Botol /1,5 ml - -
111 Metanol Botol/500 ml - -
112 Tabung gel clot tutup kuning 5 ml Box /100 - -
113 Safety box 5 liter Buah - -
114 Alat suntik satu kali pakai 3 ml Pcs - -
115 Asam cuka / asam asetat 5 % Botol - -
116 Oil emersi Botol - -
117 Benang wol Roll - -
118 Kotak plastik untuk tempat obat Pcs - -
119 Kantong puyer Pak - -
120 Etanol 70 % 1000 ml Botol - -
121 Lisol mengandung Kresol Botol - -
122 Plester Botol - -
123 Sendok takar Roll - -
124 Klip platik obat 10 X 15 Pak - -
125 Etyl Klorida Botol - -
126 Fletcher Botol - -
127 Stik Gula darah Pcs - -
128 Stik asam urat Pcs - -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

129 Isi ulang sabun cuci tangan Galon/5 l - -

130 Amlodipin 5 mg Tablet - -
131 Ambroxol syrup Botol - -
132 Amoxicillyn syrup Botol - -
133 Amoxicillyn Tablet - -
134 Cefadroxyl syrup Botol - -
135 Dexametason 0,5 mg Tablet - -
136 Enbatic salp Tube - -
137 Gentamicyn salp mata Tube - -
138 Gentamicyn tetes mata Botol - -
139 Glimepirid 2 mg Tablet - -
140 Meloxicam 7,5 mg Tablet - -
141 Metformin Tablet - -
142 Miconazol Tube - -
143 Metronidazol 500 mg Tablet - -
144 Natrium Diklofenac 50 mg Tablet - -
145 Omeprazol Tablet - -
146 Oxitetrasiklin salp kulit Tube - -
147 Paracetamol syrup Botol - -
148 Paracetamol Tablet - -
149 Ranitidin Tablet - -
150 Simvastatin 10 mg Tablet - -
151 Stesoli Rektal Tube - -
152 Tetagam Ampul - -
153 Ventolin Botol - -
154 Rapid Test Covid 19 Test - -
155 Allopurinol Tablet - -
156 Salicyl bedak Botol - -
157 Amoxicylin syrup forte Botol - -
158 Daryantull Lembar - -
159 Livron B plex Tablet - -
160 Lytacur Syrup Botol - -
161 Lacto B Sachet - -
162 Kertas EKG Roll - -
163 Lampu Spiritus Botol - -
164 Safety box Pcs - -
165 Objek Glass fosted Pcs - -
166 Kertas Thermal uk 5 cm Roll - -
167 Cover glass Kotak - -
168 Spuit 3 ml Pcs - -
169 Masker N95 Pcs - -
170 Nurse cup Box 0 1 1 1 0 -
171 Acyclovir salp kulit Tube - -
172 Captopril 25 mg Tablet - -
173 Kalsium Laktat (Novakal) Tablet - -
174 Paracetamol Drop Botol - -
175 Ambroxol 30 mg Tablet - -
176 Cetirizin 10 mg Tablet - -
177 Betadin Botol/60 ml - -

Mengetahui
Plt Kepala UPTD Puskesmas Kediri 1 Petugas gudang Petugas Sub Unit

dr Ni Putu Widiyanti Jurni Sari Mansyur Ni Komang Suarningsih

NIP: 19860101 201101 2 044 NIP : 19720630 200501 2 006 NIP: 19671105 198902 2 001
 LPLPO BMHP JKN PUSKESMAS KEDIRI 1

NAMA SUB UNIT : POLI LANSIA PELAPORAN BULAN : SEPTEMBER 2021

PERMINTAAN BULAN : OKTOBER 2021

PENER PERSE PEMA PERMI PEMBER

NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

1 Alat suntik sekali pakai 1 ml kotak @ 100 pcs -

2 Alat suntik sekali pakai 2,5 ml kotak @ 100 pcs -
3 Alat suntik sekali pakai 5 ml kotak @ 100 pcs -
4 Catgut / benang bedah no 2/0 kotak @ 24 pcs -
5 Catgut / benang bedah no 3/0 kotak @ 24 pcs -
6 Kapas pembalut / Absorben 250 gram Roll -
7 Kasa pembalut 2 x 80 Bungkus -
8 Kasa pembalut hidrofill 4 x 15 Roll -
9 Sarung tangan S Pcs 0 100 100 64 36
10 Sarung tangan M Pcs 70 70 38 32
11 Sarung tangan L Pcs 0 -
12 Silk( benang bedah sutera )no 3/0 Box / 36 -
13 IV cath no.20 Pcs -
14 IV cath no.18 Pcs -
15 Kasa gulung Roll -
16 Masker Box/ 50 20 50 70 59 11
17 Kasa hidrofil 4 x 10 Pcs -
18 Kasa hidrofil 18 x 22 Pcs -
19 Jarum injeksi Box / pcs -
20 Sarung tangan steril M Pasang -
21 Jelly Tube -
22 Kertas perkamen Pak -
23 Klip plastik obat 10 x 7 cm Pak 100 lembar -
24 Klip plastik obat 13 x 8,7 cm Pak 100 lembar -
25 Hyfafik / Ultravix Roll -
26 Spuit 10cc Pcs -
27 Spuit 20 cc Pcs -
28 Triway Pcs -
29 Blood set Pcs -
30 Bisturi no 20 Pcs -
31 Wing needle no 23 Pcs -
32 Jarum otot Lusin -
33 Jarum kulit Lusin -
34 Infusion set anak Pcs -
35 Infusion set dewasa Pcs -
36 Urine bag Pcs -
37 I V Cateter no 22 Pcs -
38 I V Cateter no 24 Pcs -
39 Sabun cuci tangan 500 ml( Aseptik gel ) Botol -
40 Sabun cuci alat 500 ml Botol -
41 Bayclin 1000 ml Botol -
42 Paravin cair 1 l Botol -
43 Kertas lakmus merah & biru Bendel -
44 Etanol 70 % 300 ml Botol -
45 Gliserin Botol -
46 Tissue Toilet Kotak -
47 Kasa 4 x 3 Roll -
48 Benang silk no 3/0 Roll -
49 Karbol wangi 800 ml Botol -
50 Tissue multi Kotak -
51 Pengharum ruangan Botol -
52 Alkohol swab pcs -
53 Blood lancet safe T pcs -
54 Folley chateter size 16 Pcs -
55 Folley chateter size 18 Pcs -
56 Folley chateter size 20 Pcs -
57 Folley chateter no 22 Pcs -
58 I V Cateter no 16 Pcs -
59 Control normal serum3 ml vial -
60 Strip Cholesterol Box/10 strip -
61 Cholesterol Liquicolor 4 x 30 ml Kit -
62 HDL Cholesterol 20 ml Kit -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

63 LDL Cholesterol direct 1 x 80 ml Kit -

64 Total & direct bilirubin liquid 2 x 100 ml Kit -
65 Probe cleanser 17 ml Botol -
66 Giserin 100 ml Botol -
67 Benang silk no 2.0 Pack/12 -
68 Benang Prolin no 3.0 Pack -
69 Benang prolin no 5.0 pack -
70 Reagen golongsn darah A Botol -
71 Reagen golongsn darah B Botol -
72 Ringer Laktat Botol -
73 Wing needle no 27 G Pcs -
74 Stik HB Box/50 test -
75 Stik protein reduksi urin 3P Box/100 test -
76 Cairan klorin 0,5 % Galon/5 liter -
77 Kresek Plastik kecil ukuran 1 X 15 Pcs -
78 Reagen gula darah Box/50 -
79 Diluent M 30 Galon/20 liter -
80 Rinze M 30 Galon/20 liter -
81 Lise M 30 Botol/500 ml -
82 EZ Cleanser M 30 Botol/100 ml -
83 RPR test Kit Kit -
84 Koh 10 % Botol/100 ml -
85 Cat Gram Kit -
86 Aquadest Botol/1 liter -
87 Reagen control serum hematologi Botol/5 ml -
88 Cotton aplicator Rectal (vaginal swap) Pcs -
89 Cater Urine nelacton UK 20 Pcs -
90 Lubricant Gel Buah -
91 Plastik 1/2 kg Bungkus/5 Roll -
92 Perhidrol H2O2 3 % Botol/100 ml -
93 Betadin Botol/300 ml -
94 Cotton aplicator (IVA) Pcs -
95 Bisturi no 25 Pcs -
96 Pot sputum 120 ml Pcs -
97 Slide b71101 Pcs -
98 Klem Tali pusat Pcs -
99 Cater urine nelaton uk 18 Pcs -
100 Nasogatic tube dewasa Pcs -
101 Catton swab Bks/100 -
102 Plester bulat Box/200 -
103 Box slide Pcs -
104 Rapid test siphillis Pcs -
105 Aquadest Galon/20 ltr -
106 Cup test sampel 1,5 ml Pcs -
107 Tabung clot avtivator 5 ml tutup merah Pcs -
108 Reagen Giemsa Botol/100 ml -
109 Cairan infus Na cl 0,9 % Btl/500 ml -
110 Aqua air mineral Botol /1,5 ml -
111 Metanol Botol/500 ml -
112 Tabung gel clot tutup kuning 5 ml Box /100 -
113 Safety box 5 liter Buah -
114 Alat suntik satu kali pakai 3 ml Pcs -
115 Asam cuka / asam asetat 5 % Botol -
116 Oil emersi Botol -
117 Benang wol Roll -
118 Kotak plastik untuk tempat obat Pcs -
119 Kantong puyer Pak -
120 Etanol 70 % 1000 ml Botol -
121 Lisol mengandung Kresol Botol -
122 Plester Botol -
123 Sendok takar Roll -
124 Klip platik obat 10 X 15 Pak -
125 Etyl Klorida Botol -
126 Fletcher Botol -
127 Stik Gula darah Pcs -
128 Stik asam urat Pcs -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

129 Isi ulang sabun cuci tangan Galon/5 l -

130 Amlodipin 5 mg Tablet -
131 Ambroxol syrup Botol -
132 Amoxicillyn syrup Botol -
133 Amoxicillyn Tablet -
134 Cefadroxyl syrup Botol -
135 Dexametason 0,5 mg Tablet -
136 Enbatic salp Tube -
137 Gentamicyn salp mata Tube -
138 Gentamicyn tetes mata Botol -
139 Glimepirid 2 mg Tablet -
140 Meloxicam 7,5 mg Tablet -
141 Metformin Tablet -
142 Miconazol Tube -
143 Metronidazol 500 mg Tablet -
144 Natrium Diklofenac 50 mg Tablet -
145 Omeprazol Tablet -
146 Oxitetrasiklin salp kulit Tube -
147 Paracetamol syrup Botol -
148 Paracetamol Tablet -
149 Ranitidin Tablet -
150 Simvastatin 10 mg Tablet -
151 Stesoli Rektal Tube -
152 Tetagam Ampul -
153 Ventolin Botol -
154 Rapid Test Covid 19 Test -
155 Allopurinol Tablet -
156 Salicyl bedak Botol -
157 Amoxicylin syrup forte Botol -
158 Daryantull Lembar -
159 Livron B plex Tablet -
160 Lytacur Syrup Botol -
161 Lacto B Sachet -
162 Kertas EKG Roll -
163 Lampu Spiritus Botol -
164 Safety box Pcs -
165 Objek Glass fosted Pcs -
166 Kertas Thermal uk 5 cm Roll -
167 Cover glass Kotak -
168 Spuit 3 ml Pcs -
169 Masker N95 Pcs -
170 Nurse cup Box 0 1 1 1 0
171 Acyclovir salp kulit Tube -
172 Captopril 25 mg Tablet -
173 Kalsium Laktat (Novakal) Tablet -
174 Paracetamol Drop Botol -
175 Ambroxol 30 mg Tablet -
176 Cetirizin 10 mg Tablet -
177 Betadin Botol/60 ml -

Mengetahui
Plt Kepala UPTD Puskesmas Kediri 1 Petugas gudang Petugas Sub Unit

dr Ni Putu Widiyanti Jurni Sari Mansyur Ni Komang Suarningsih

NIP: 19860101 201101 2 044 NIP : 19720630 200501 2 006 NIP: 19671105 198902 2 001
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 LPLPO BMHP JKN PUSKESMAS KEDIRI 1

NAMA SUB UNIT : POLI LANSIA PELAPORAN BULAN : OKTOBER 2021

PERMINTAAN BULAN : NOVEMBER 2021

PENER PERSE PEMA PERMI PEMBER

NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

1 Alat suntik sekali pakai 1 ml kotak @ 100 pcs -

2 Alat suntik sekali pakai 2,5 ml kotak @ 100 pcs -
3 Alat suntik sekali pakai 5 ml kotak @ 100 pcs -
4 Catgut / benang bedah no 2/0 kotak @ 24 pcs -
5 Catgut / benang bedah no 3/0 kotak @ 24 pcs -
6 Kapas pembalut / Absorben 250 gram Roll -
7 Kasa pembalut 2 x 80 Bungkus -
8 Kasa pembalut hidrofill 4 x 15 Roll -
9 Sarung tangan S Pcs 36 0 36 36 0
10 Sarung tangan M Pcs 32 100 132 132 0
11 Sarung tangan L Pcs -
12 Silk( benang bedah sutera )no 3/0 Box / 36 -
13 IV cath no.20 Pcs -
14 IV cath no.18 Pcs -
15 Kasa gulung Roll -
16 Masker Box/ 50 11 50 61 49 12
17 Kasa hidrofil 4 x 10 Pcs -
18 Kasa hidrofil 18 x 22 Pcs -
19 Jarum injeksi Box / pcs -
20 Sarung tangan steril M Pasang -
21 Jelly Tube -
22 Kertas perkamen Pak -
23 Klip plastik obat 10 x 7 cm Pak 100 lembar -
24 Klip plastik obat 13 x 8,7 cm Pak 100 lembar -
25 Hyfafik / Ultravix Roll -
26 Spuit 10cc Pcs -
27 Spuit 20 cc Pcs -
28 Triway Pcs -
29 Blood set Pcs -
30 Bisturi no 20 Pcs -
31 Wing needle no 23 Pcs -
32 Jarum otot Lusin -
33 Jarum kulit Lusin -
34 Infusion set anak Pcs -
35 Infusion set dewasa Pcs -
36 Urine bag Pcs -
37 I V Cateter no 22 Pcs -
38 I V Cateter no 24 Pcs -
39 Sabun cuci tangan 500 ml( Aseptik gel ) Botol -
40 Sabun cuci alat 500 ml Botol -
41 Bayclin 1000 ml Botol -
42 Paravin cair 1 l Botol -
43 Kertas lakmus merah & biru Bendel -
44 Etanol 70 % 300 ml Botol -
45 Gliserin Botol -
46 Tissue Toilet Kotak -
47 Kasa 4 x 3 Roll -
48 Benang silk no 3/0 Roll -
49 Karbol wangi 800 ml Botol -
50 Tissue multi Kotak -
51 Pengharum ruangan Botol -
52 Alkohol swab pcs -
53 Blood lancet safe T pcs -
54 Folley chateter size 16 Pcs -
55 Folley chateter size 18 Pcs -
56 Folley chateter size 20 Pcs -
57 Folley chateter no 22 Pcs -
58 I V Cateter no 16 Pcs -
59 Control normal serum3 ml vial -
60 Strip Cholesterol Box/10 strip -
61 Cholesterol Liquicolor 4 x 30 ml Kit -
62 HDL Cholesterol 20 ml Kit -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

63 LDL Cholesterol direct 1 x 80 ml Kit -

64 Total & direct bilirubin liquid 2 x 100 ml Kit -
65 Probe cleanser 17 ml Botol -
66 Giserin 100 ml Botol -
67 Benang silk no 2.0 Pack/12 -
68 Benang Prolin no 3.0 Pack -
69 Benang prolin no 5.0 pack -
70 Reagen golongsn darah A Botol -
71 Reagen golongsn darah B Botol -
72 Ringer Laktat Botol -
73 Wing needle no 27 G Pcs -
74 Stik HB Box/50 test -
75 Stik protein reduksi urin 3P Box/100 test -
76 Cairan klorin 0,5 % Galon/5 liter -
77 Kresek Plastik kecil ukuran 1 X 15 Pcs -
78 Reagen gula darah Box/50 -
79 Diluent M 30 Galon/20 liter -
80 Rinze M 30 Galon/20 liter -
81 Lise M 30 Botol/500 ml -
82 EZ Cleanser M 30 Botol/100 ml -
83 RPR test Kit Kit -
84 Koh 10 % Botol/100 ml -
85 Cat Gram Kit -
86 Aquadest Botol/1 liter -
87 Reagen control serum hematologi Botol/5 ml -
88 Cotton aplicator Rectal (vaginal swap) Pcs -
89 Cater Urine nelacton UK 20 Pcs -
90 Lubricant Gel Buah -
91 Plastik 1/2 kg Bungkus/5 Roll -
92 Perhidrol H2O2 3 % Botol/100 ml -
93 Betadin Botol/300 ml -
94 Cotton aplicator (IVA) Pcs -
95 Bisturi no 25 Pcs -
96 Pot sputum 120 ml Pcs -
97 Slide b71101 Pcs -
98 Klem Tali pusat Pcs -
99 Cater urine nelaton uk 18 Pcs -
100 Nasogatic tube dewasa Pcs -
101 Catton swab Bks/100 -
102 Plester bulat Box/200 -
103 Box slide Pcs -
104 Rapid test siphillis Pcs -
105 Aquadest Galon/20 ltr -
106 Cup test sampel 1,5 ml Pcs -
107 Tabung clot avtivator 5 ml tutup merah Pcs -
108 Reagen Giemsa Botol/100 ml -
109 Cairan infus Na cl 0,9 % Btl/500 ml -
110 Aqua air mineral Botol /1,5 ml -
111 Metanol Botol/500 ml -
112 Tabung gel clot tutup kuning 5 ml Box /100 -
113 Safety box 5 liter Buah -
114 Alat suntik satu kali pakai 3 ml Pcs -
115 Asam cuka / asam asetat 5 % Botol -
116 Oil emersi Botol -
117 Benang wol Roll -
118 Kotak plastik untuk tempat obat Pcs -
119 Kantong puyer Pak -
120 Etanol 70 % 1000 ml Botol -
121 Lisol mengandung Kresol Botol -
122 Plester Botol -
123 Sendok takar Roll -
124 Klip platik obat 10 X 15 Pak -
125 Etyl Klorida Botol -
126 Fletcher Botol -
127 Stik Gula darah Pcs -
128 Stik asam urat Pcs -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

129 Isi ulang sabun cuci tangan Galon/5 l -

130 Amlodipin 5 mg Tablet -
131 Ambroxol syrup Botol -
132 Amoxicillyn syrup Botol -
133 Amoxicillyn Tablet -
134 Cefadroxyl syrup Botol -
135 Dexametason 0,5 mg Tablet -
136 Enbatic salp Tube -
137 Gentamicyn salp mata Tube -
138 Gentamicyn tetes mata Botol -
139 Glimepirid 2 mg Tablet -
140 Meloxicam 7,5 mg Tablet -
141 Metformin Tablet -
142 Miconazol Tube -
143 Metronidazol 500 mg Tablet -
144 Natrium Diklofenac 50 mg Tablet -
145 Omeprazol Tablet -
146 Oxitetrasiklin salp kulit Tube -
147 Paracetamol syrup Botol -
148 Paracetamol Tablet -
149 Ranitidin Tablet -
150 Simvastatin 10 mg Tablet -
151 Stesoli Rektal Tube -
152 Tetagam Ampul -
153 Ventolin Botol -
154 Rapid Test Covid 19 Test -
155 Allopurinol Tablet -
156 Salicyl bedak Botol -
157 Amoxicylin syrup forte Botol -
158 Daryantull Lembar -
159 Livron B plex Tablet -
160 Lytacur Syrup Botol -
161 Lacto B Sachet -
162 Kertas EKG Roll -
163 Lampu Spiritus Botol -
164 Safety box Pcs -
165 Objek Glass fosted Pcs -
166 Kertas Thermal uk 5 cm Roll -
167 Cover glass Kotak -
168 Spuit 3 ml Pcs -
169 Masker N95 Pcs -
170 Nurse cup Box 0 -
171 Acyclovir salp kulit Tube -
172 Captopril 25 mg Tablet -
173 Kalsium Laktat (Novakal) Tablet -
174 Paracetamol Drop Botol -
175 Ambroxol 30 mg Tablet -
176 Cetirizin 10 mg Tablet -
177 Betadin Botol/60 ml -

Mengetahui
Plt Kepala UPTD Puskesmas Kediri 1 Petugas gudang Petugas Sub Unit

dr Ni Putu Widiyanti Jurni Sari Mansyur Ni Komang Suarningsih

NIP: 19860101 201101 2 044 NIP : 19720630 200501 2 006 NIP: 19671105 198902 2 001
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 LPLPO BMHP JKN PUSKESMAS KEDIRI 1

NAMA SUB UNIT : POLI LANSIA PELAPORAN BULAN : NOVEMBER 2021

PERMINTAAN BULAN : DESEMBER 2021

PENER PERSE PEMA PERMI PEMBER

NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

1 Alat suntik sekali pakai 1 ml kotak @ 100 pcs -

2 Alat suntik sekali pakai 2,5 ml kotak @ 100 pcs -
3 Alat suntik sekali pakai 5 ml kotak @ 100 pcs -
4 Catgut / benang bedah no 2/0 kotak @ 24 pcs -
5 Catgut / benang bedah no 3/0 kotak @ 24 pcs -
6 Kapas pembalut / Absorben 250 gram Roll -
7 Kasa pembalut 2 x 80 Bungkus -
8 Kasa pembalut hidrofill 4 x 15 Roll -
9 Sarung tangan S Pcs -
10 Sarung tangan M Pcs -
11 Sarung tangan L Pcs -
12 Silk( benang bedah sutera )no 3/0 Box / 36 -
13 IV cath no.20 Pcs -
14 IV cath no.18 Pcs -
15 Kasa gulung Roll -
16 Masker Box/ 50 12 12 12 0
17 Kasa hidrofil 4 x 10 Pcs -
18 Kasa hidrofil 18 x 22 Pcs -
19 Jarum injeksi Box / pcs -
20 Sarung tangan steril M Pasang -
21 Jelly Tube -
22 Kertas perkamen Pak -
23 Klip plastik obat 10 x 7 cm Pak 100 lembar -
24 Klip plastik obat 13 x 8,7 cm Pak 100 lembar -
25 Hyfafik / Ultravix Roll -
26 Spuit 10cc Pcs -
27 Spuit 20 cc Pcs -
28 Triway Pcs -
29 Blood set Pcs -
30 Bisturi no 20 Pcs -
31 Wing needle no 23 Pcs -
32 Jarum otot Lusin -
33 Jarum kulit Lusin -
34 Infusion set anak Pcs -
35 Infusion set dewasa Pcs -
36 Urine bag Pcs -
37 I V Cateter no 22 Pcs -
38 I V Cateter no 24 Pcs -
39 Sabun cuci tangan 500 ml( Aseptik gel ) Botol -
40 Sabun cuci alat 500 ml Botol -
41 Bayclin 1000 ml Botol -
42 Paravin cair 1 l Botol -
43 Kertas lakmus merah & biru Bendel -
44 Etanol 70 % 300 ml Botol -
45 Gliserin Botol -
46 Tissue Toilet Kotak -
47 Kasa 4 x 3 Roll -
48 Benang silk no 3/0 Roll -
49 Karbol wangi 800 ml Botol -
50 Tissue multi Kotak -
51 Pengharum ruangan Botol -
52 Alkohol swab pcs -
53 Blood lancet safe T pcs -
54 Folley chateter size 16 Pcs -
55 Folley chateter size 18 Pcs -
56 Folley chateter size 20 Pcs -
57 Folley chateter no 22 Pcs -
58 I V Cateter no 16 Pcs -
59 Control normal serum3 ml vial -
60 Strip Cholesterol Box/10 strip -
61 Cholesterol Liquicolor 4 x 30 ml Kit -
62 HDL Cholesterol 20 ml Kit -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

63 LDL Cholesterol direct 1 x 80 ml Kit -

64 Total & direct bilirubin liquid 2 x 100 ml Kit -
65 Probe cleanser 17 ml Botol -
66 Giserin 100 ml Botol -
67 Benang silk no 2.0 Pack/12 -
68 Benang Prolin no 3.0 Pack -
69 Benang prolin no 5.0 pack -
70 Reagen golongsn darah A Botol -
71 Reagen golongsn darah B Botol -
72 Ringer Laktat Botol -
73 Wing needle no 27 G Pcs -
74 Stik HB Box/50 test -
75 Stik protein reduksi urin 3P Box/100 test -
76 Cairan klorin 0,5 % Galon/5 liter -
77 Kresek Plastik kecil ukuran 1 X 15 Pcs -
78 Reagen gula darah Box/50 -
79 Diluent M 30 Galon/20 liter -
80 Rinze M 30 Galon/20 liter -
81 Lise M 30 Botol/500 ml -
82 EZ Cleanser M 30 Botol/100 ml -
83 RPR test Kit Kit -
84 Koh 10 % Botol/100 ml -
85 Cat Gram Kit -
86 Aquadest Botol/1 liter -
87 Reagen control serum hematologi Botol/5 ml -
88 Cotton aplicator Rectal (vaginal swap) Pcs -
89 Cater Urine nelacton UK 20 Pcs -
90 Lubricant Gel Buah -
91 Plastik 1/2 kg Bungkus/5 Roll -
92 Perhidrol H2O2 3 % Botol/100 ml -
93 Betadin Botol/300 ml -
94 Cotton aplicator (IVA) Pcs -
95 Bisturi no 25 Pcs -
96 Pot sputum 120 ml Pcs -
97 Slide b71101 Pcs -
98 Klem Tali pusat Pcs -
99 Cater urine nelaton uk 18 Pcs -
100 Nasogatic tube dewasa Pcs -
101 Catton swab Bks/100 -
102 Plester bulat Box/200 -
103 Box slide Pcs -
104 Rapid test siphillis Pcs -
105 Aquadest Galon/20 ltr -
106 Cup test sampel 1,5 ml Pcs -
107 Tabung clot avtivator 5 ml tutup merah Pcs -
108 Reagen Giemsa Botol/100 ml -
109 Cairan infus Na cl 0,9 % Btl/500 ml -
110 Aqua air mineral Botol /1,5 ml -
111 Metanol Botol/500 ml -
112 Tabung gel clot tutup kuning 5 ml Box /100 -
113 Safety box 5 liter Buah -
114 Alat suntik satu kali pakai 3 ml Pcs -
115 Asam cuka / asam asetat 5 % Botol -
116 Oil emersi Botol -
117 Benang wol Roll -
118 Kotak plastik untuk tempat obat Pcs -
119 Kantong puyer Pak -
120 Etanol 70 % 1000 ml Botol -
121 Lisol mengandung Kresol Botol -
122 Plester Botol -
123 Sendok takar Roll -
124 Klip platik obat 10 X 15 Pak -
125 Etyl Klorida Botol -
126 Fletcher Botol -
127 Stik Gula darah Pcs -
128 Stik asam urat Pcs -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

129 Isi ulang sabun cuci tangan Galon/5 l -

130 Amlodipin 5 mg Tablet -
131 Ambroxol syrup Botol -
132 Amoxicillyn syrup Botol -
133 Amoxicillyn Tablet -
134 Cefadroxyl syrup Botol -
135 Dexametason 0,5 mg Tablet -
136 Enbatic salp Tube -
137 Gentamicyn salp mata Tube -
138 Gentamicyn tetes mata Botol -
139 Glimepirid 2 mg Tablet -
140 Meloxicam 7,5 mg Tablet -
141 Metformin Tablet -
142 Miconazol Tube -
143 Metronidazol 500 mg Tablet -
144 Natrium Diklofenac 50 mg Tablet -
145 Omeprazol Tablet -
146 Oxitetrasiklin salp kulit Tube -
147 Paracetamol syrup Botol -
148 Paracetamol Tablet -
149 Ranitidin Tablet -
150 Simvastatin 10 mg Tablet -
151 Stesoli Rektal Tube -
152 Tetagam Ampul -
153 Ventolin Botol -
154 Rapid Test Covid 19 Test -
155 Allopurinol Tablet -
156 Salicyl bedak Botol -
157 Amoxicylin syrup forte Botol -
158 Daryantull Lembar -
159 Livron B plex Tablet -
160 Lytacur Syrup Botol -
161 Lacto B Sachet -
162 Kertas EKG Roll -
163 Lampu Spiritus Botol -
164 Safety box Pcs -
165 Objek Glass fosted Pcs -
166 Kertas Thermal uk 5 cm Roll -
167 Cover glass Kotak -
168 Spuit 3 ml Pcs -
169 Masker N95 Pcs -
170 Nurse cup Box -
171 Acyclovir salp kulit Tube -
172 Captopril 25 mg Tablet -
173 Kalsium Laktat (Novakal) Tablet -
174 Paracetamol Drop Botol -
175 Ambroxol 30 mg Tablet -
176 Cetirizin 10 mg Tablet -
177 Betadin Botol/60 ml -

Mengetahui
Plt Kepala UPTD Puskesmas Kediri 1 Petugas gudang Petugas Sub Unit

dr Ni Putu Widiyanti Jurni Sari Mansyur Ni Komang Suarningsih

NIP: 19860101 201101 2 044 NIP : 19720630 200501 2 006 NIP: 19671105 198902 2 001
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 LPLPO BMHP JKN PUSKESMAS KEDIRI 1

NAMA SUB UNIT : POLI LANSIA PELAPORAN BULAN : DESEMBER 2021

PERMINTAAN BULAN : JANUARI 2022

PENER PERSE PEMA PERMI PEMBER

NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

1 Alat suntik sekali pakai 1 ml kotak @ 100 pcs -

2 Alat suntik sekali pakai 2,5 ml kotak @ 100 pcs -
3 Alat suntik sekali pakai 5 ml kotak @ 100 pcs -
4 Catgut / benang bedah no 2/0 kotak @ 24 pcs -
5 Catgut / benang bedah no 3/0 kotak @ 24 pcs -
6 Kapas pembalut / Absorben 250 gram Roll -
7 Kasa pembalut 2 x 80 Bungkus -
8 Kasa pembalut hidrofill 4 x 15 Roll -
9 Sarung tangan S Pcs -
10 Sarung tangan M Pcs 0 200 200 175 25
11 Sarung tangan L Pcs -
12 Silk( benang bedah sutera )no 3/0 Box / 36 -
13 IV cath no.20 Pcs -
14 IV cath no.18 Pcs -
15 Kasa gulung Roll -
16 Masker Box/ 50 -
17 Kasa hidrofil 4 x 10 Pcs -
18 Kasa hidrofil 18 x 22 Pcs -
19 Jarum injeksi Box / pcs -
20 Sarung tangan steril M Pasang -
21 Jelly Tube -
22 Kertas perkamen Pak -
23 Klip plastik obat 10 x 7 cm Pak 100 lembar -
24 Klip plastik obat 13 x 8,7 cm Pak 100 lembar -
25 Hyfafik / Ultravix Roll -
26 Spuit 10cc Pcs -
27 Spuit 20 cc Pcs -
28 Triway Pcs -
29 Blood set Pcs -
30 Bisturi no 20 Pcs -
31 Wing needle no 23 Pcs -
32 Jarum otot Lusin -
33 Jarum kulit Lusin -
34 Infusion set anak Pcs -
35 Infusion set dewasa Pcs -
36 Urine bag Pcs -
37 I V Cateter no 22 Pcs -
38 I V Cateter no 24 Pcs -
39 Sabun cuci tangan 500 ml( Aseptik gel ) Botol -
40 Sabun cuci alat 500 ml Botol -
41 Bayclin 1000 ml Botol -
42 Paravin cair 1 l Botol -
43 Kertas lakmus merah & biru Bendel -
44 Etanol 70 % 300 ml Botol -
45 Gliserin Botol -
46 Tissue Toilet Kotak -
47 Kasa 4 x 3 Roll -
48 Benang silk no 3/0 Roll -
49 Karbol wangi 800 ml Botol -
50 Tissue multi Kotak -
51 Pengharum ruangan Botol -
52 Alkohol swab pcs -
53 Blood lancet safe T pcs -
54 Folley chateter size 16 Pcs -
55 Folley chateter size 18 Pcs -
56 Folley chateter size 20 Pcs -
57 Folley chateter no 22 Pcs -
58 I V Cateter no 16 Pcs -
59 Control normal serum3 ml vial -
60 Strip Cholesterol Box/10 strip -
61 Cholesterol Liquicolor 4 x 30 ml Kit -
62 HDL Cholesterol 20 ml Kit -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

63 LDL Cholesterol direct 1 x 80 ml Kit -

64 Total & direct bilirubin liquid 2 x 100 ml Kit -
65 Probe cleanser 17 ml Botol -
66 Giserin 100 ml Botol -
67 Benang silk no 2.0 Pack/12 -
68 Benang Prolin no 3.0 Pack -
69 Benang prolin no 5.0 pack -
70 Reagen golongsn darah A Botol -
71 Reagen golongsn darah B Botol -
72 Ringer Laktat Botol -
73 Wing needle no 27 G Pcs -
74 Stik HB Box/50 test -
75 Stik protein reduksi urin 3P Box/100 test -
76 Cairan klorin 0,5 % Galon/5 liter -
77 Kresek Plastik kecil ukuran 1 X 15 Pcs -
78 Reagen gula darah Box/50 -
79 Diluent M 30 Galon/20 liter -
80 Rinze M 30 Galon/20 liter -
81 Lise M 30 Botol/500 ml -
82 EZ Cleanser M 30 Botol/100 ml -
83 RPR test Kit Kit -
84 Koh 10 % Botol/100 ml -
85 Cat Gram Kit -
86 Aquadest Botol/1 liter -
87 Reagen control serum hematologi Botol/5 ml -
88 Cotton aplicator Rectal (vaginal swap) Pcs -
89 Cater Urine nelacton UK 20 Pcs -
90 Lubricant Gel Buah -
91 Plastik 1/2 kg Bungkus/5 Roll -
92 Perhidrol H2O2 3 % Botol/100 ml -
93 Betadin Botol/300 ml -
94 Cotton aplicator (IVA) Pcs -
95 Bisturi no 25 Pcs -
96 Pot sputum 120 ml Pcs -
97 Slide b71101 Pcs -
98 Klem Tali pusat Pcs -
99 Cater urine nelaton uk 18 Pcs -
100 Nasogatic tube dewasa Pcs -
101 Catton swab Bks/100 -
102 Plester bulat Box/200 -
103 Box slide Pcs -
104 Rapid test siphillis Pcs -
105 Aquadest Galon/20 ltr -
106 Cup test sampel 1,5 ml Pcs -
107 Tabung clot avtivator 5 ml tutup merah Pcs -
108 Reagen Giemsa Botol/100 ml -
109 Cairan infus Na cl 0,9 % Btl/500 ml -
110 Aqua air mineral Botol /1,5 ml -
111 Metanol Botol/500 ml -
112 Tabung gel clot tutup kuning 5 ml Box /100 -
113 Safety box 5 liter Buah -
114 Alat suntik satu kali pakai 3 ml Pcs -
115 Asam cuka / asam asetat 5 % Botol -
116 Oil emersi Botol -
117 Benang wol Roll -
118 Kotak plastik untuk tempat obat Pcs -
119 Kantong puyer Pak -
120 Etanol 70 % 1000 ml Botol -
121 Lisol mengandung Kresol Botol -
122 Plester Botol -
123 Sendok takar Roll -
124 Klip platik obat 10 X 15 Pak -
125 Etyl Klorida Botol -
126 Fletcher Botol -
127 Stik Gula darah Pcs -
128 Stik asam urat Pcs -
 PENER PERSE PEMA PERMI PEMBER
NO NAMA KEMASAN STOK IMA DIA KAI SISA NTA IA KET
AWAL AN AN AN STOK AN AN

129 Isi ulang sabun cuci tangan Galon/5 l -

130 Amlodipin 5 mg Tablet -
131 Ambroxol syrup Botol -
132 Amoxicillyn syrup Botol -
133 Amoxicillyn Tablet -
134 Cefadroxyl syrup Botol -
135 Dexametason 0,5 mg Tablet -
136 Enbatic salp Tube -
137 Gentamicyn salp mata Tube -
138 Gentamicyn tetes mata Botol -
139 Glimepirid 2 mg Tablet -
140 Meloxicam 7,5 mg Tablet -
141 Metformin Tablet -
142 Miconazol Tube -
143 Metronidazol 500 mg Tablet -
144 Natrium Diklofenac 50 mg Tablet -
145 Omeprazol Tablet -
146 Oxitetrasiklin salp kulit Tube -
147 Paracetamol syrup Botol -
148 Paracetamol Tablet -
149 Ranitidin Tablet -
150 Simvastatin 10 mg Tablet -
151 Stesoli Rektal Tube -
152 Tetagam Ampul -
153 Ventolin Botol -
154 Rapid Test Covid 19 Test -
155 Allopurinol Tablet -
156 Salicyl bedak Botol -
157 Amoxicylin syrup forte Botol -
158 Daryantull Lembar -
159 Livron B plex Tablet -
160 Lytacur Syrup Botol -
161 Lacto B Sachet -
162 Kertas EKG Roll -
163 Lampu Spiritus Botol -
164 Safety box Pcs -
165 Objek Glass fosted Pcs -
166 Kertas Thermal uk 5 cm Roll -
167 Cover glass Kotak -
168 Spuit 3 ml Pcs -
169 Masker N95 Pcs -
170 Nurse cup Box -
171 Acyclovir salp kulit Tube -
172 Captopril 25 mg Tablet -
173 Kalsium Laktat (Novakal) Tablet -
174 Paracetamol Drop Botol -
175 Ambroxol 30 mg Tablet -
176 Cetirizin 10 mg Tablet -
177 Betadin Botol/60 ml -

Mengetahui
Plt Kepala UPTD Puskesmas Kediri 1 Petugas gudang Petugas Sub Unit

dr Ni Putu Widiyanti Jurni Sari Mansyur Ni Komang Suarningsih

NIP: 19860101 201101 2 044 NIP : 19720630 200501 2 006 NIP: 19671105 198902 2 001
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