LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

(LPLPO)

POL/PP : PONED WADO PELAPORAN/PERIODE : JANUARI 2022 DOKUMEN NOMOR TANGGAL

KECAMATAN : Wado PERMINTAAN/PERIODE : FEBUARI 2022 POL/PP 2/19/2022
KABUPATEN : Sumedang PUSKESMA 31/Farm/PKMWD/II/2022 2/21/2022

STOCK PENERI PERSE PEMA SISA STOCK PERMIN PEMBERIAN

NO NAMA OBAT SATUAN KET
AWAL MAAN DIAAN KAIAN STOCK OPT TAAN APBD APBD DAK APBN LAIN2 JUMLAH
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 Alat Suntik Sekali Pakai 0.5 ml Pcs
2 Alat Suntik Sekali Pakai 1 ml Pcs 82 0 82 27 55 32.4
3 Alat Suntik Sekali Pakai 10 ml (Aximed) Buah 24 0 24 10 14 12
4 Alat Suntik Sekali Pakai 10 ml (Top Point) Buah 0 0 0
5 Alat Suntik Sekali Pakai 2,5 ml Pcs 0 0 0
6 Alat Suntik Sekali Pakai 20 ml Buah 0 0 0
7 Alat Suntik Sekali Pakai 3 ml Pcs 99 0 99 28 71 33.6 100 100 100
8 Alat Suntik Sekali Pakai 5 ml Pcs 351 0 351 9 342 10.8
9 Alkohol Swab ( PT. Bio Axion Healthindo) Sase 34 100 134 51 83 61.2 100 -
10 Alkohol Swab CHG + 0,5 % (e-care) Pcs 0 0 0
11 Amlodipin tablet 10 mg Tablet 0 0 0
12 Amlodipin tablet 5 mg Tablet 0 0 0
13 Amoksilin 500 mg Kaplet 150 300 450 210 240 252 100 100 100
14 Antasida DOEN I tablet kombinasi Tablet 86 0 86 30 56 36
15 Antasida DOEN II suspensi kombinasi Botol 0 0 0
16 Antiseptik Hand Rub 5 lt Galon 0 0 0
17 Antiseptik Hand Rub 500 ml Botol 0 0 0
18 Antiseptik Surgical Hand Scrub 5 lt Galon 0 0 0
19 Antiseptik Surgical Hand Scrub 500 ml Botol 0 0 0 2 2 2
20 Aqua Pro Injeksi steril bebas pirogen- 20 ml Ampul 2 5 7 7 0 8.4
21 Aquadest steril -500 ml Botol 0 0 0
22 Asam Askorbat (VIT C) Tablet 50 mg (KF) Tablet 0 0 0
23 Asam folat tablet 0,4 mg Tablet 0 0 0
24 Asam Mefenamat 500 mg Tablet 0 0 0
25 Asering Botol 0 0 0
26 Bisturi no 10 Buah 0 0 0
27 Bloodseet Buah 0 0 0
28 Catgut Chromic 2/0 100 m Roll 0 0 0
29 Catgut Chromic 2/0 75C + Jarum 1/2 30 MR Roll 0 0 0 12 12
30 Catgut Chromic 3/0 75C + Jarum 1/2 22 MR Roll 0 0 0
31 Catgut Plain 2/0 70C + Jarum 1/2 36M R Roll 0 36 36 20 16 24 24
32 Catgut Plain 3/0 70C + Jarum 3/8 19M C Roll 0 0 0
33 Catgut/Benang Bedah No.2/0-3/0 dg jarum bedah Roll 0 0 0
34 Cefiksim 100 mg Kapsul 0 0 0
35 Cetirizine Kapsul 0 0 0
36 Citoject Pcs 0 0 0
37 Domperidon Syrup Botol 0 0 0
38 Domperidon tablet 10 mg Tablet 50 0 50 50 0 60 50 50 50
39 Epinefrina(Adrenalin) inj i.v/s.k/i.m 1 mg/ml Ampul 1 0 1 0 1 0 0
40 Female Catheter no 16 Pcs 0 0 0
41 Female Catheter no 18 Pcs 0 0 0
42 Fitomenadion(Vit K1) inj 2 mg/ml-1ml Ampul 11 30 41 12 29 14.4 30 15 15
43 Fitomenadion(Vit K1) tablet salut gula 10 mg Tablet 0 0 0
44 Folley Cathether 2 way no 20 Pcs 0 0 0
45 Folley Cathether no 16 Pcs 0 0 0
46 Folley Cathether no 18 Pcs 0 5 5 5 0 6 15 5 5
47 Furosemid tablet 40 mg Tablet 0 0 0
48 Glukosa Larutan infus 10% steril-500 ml Botol 0 0 0 5 5 5
49 Glukosa Larutan infus 5% steril-500 ml Botol 0 0 0 10 5 5
50 Hansaplast 2,5 cm x 4,5 m Roll 0 0 0
51 Hansaplast 7,5 cm x 4,5 m Roll 0 0 0 2
52 Infusion set dewasa Set 67 50 117 25 92 30 0
53 IV Cateter 18 Buah 0 0 0
54 IV Cateter 20 Buah 0 0 0
55 IV Cateter 22 Buah 0 50 50 34 16 40.8 0
56 IV Cateter 24 Buah 0 0 0
57 IV Cateter no 26 wings & port Buah 0 0 0
58 IV Cateter with injection port 26 G Buah 0 0 0
59 Jarum Citojek No 16 Pcs 0 0 0
60 Jarum Jahit kulit No.12 Pcs 0 0 0 2
61 Kalsium Glukonat injeksi i.v 10 % Ampul 19 0 19 0 19 0 0
62 Jarum Jahit Otot No.12 Pcs 0 0 0 2
63 Kasa hidrofil 36 m x 80 cm Roll 0 0 0
64 Kasa hidrofile 3 yard x 10 cm Buah 3 0 3 0 3 0
65 Kasa hidrofile 40 yard x 80 cm Roll 0 0 0
66 Kasa kompres 16x16 steril Buah 0 0 0
67 Kasa pembalut hidrofil 4 m x 10 cm Roll 0 0 0
68 Klorfenariamin maleat (CTM) tablet 4 mg Tablet 0 0 0
69 Klorine Botol 0 0 0 9
70 Kotrimoksazol Tablet 480 mg Tablet 0 0 0
71 Leucoplast 2,50 cm x 4,5 m Roll 0 0 0
72 Leucoplast 7,50 cm x 4,5 m Roll 0 0 0 2 2 2
73 Lidocain compositum inj kombinasi Ampul 0 0 0
74 Lidocain Injeksi 2% Ampul 0 0 0 30 30 30
75 Lidocain Jeli 2% Syringe 0 0 0
76 Lidokain Spray Oral 10%(Xylocaine spray) Botol 0 0 0
77 Lisol Botol 0 0 0
78 Loratadine 10 mg Tablet 0 0 0
79 Magnesium Sulfat Inj 20% Vial 0 0 0
80 Magnesium Sulfat Inj 40% Ampul 10 0 10 8 2 9.6 5 5 5
81 Masker Karet Buah 0 0 0
82 Masker Tali Buah 0 0 0
83 Metformin Tablet 0 0 0
84 Metildopa 250 mg / Dopamet Tablet 25 20 45 14 31 16.8
85 Metilergometrin Maleat Inj Ampul 0 0 0
86 Metilergometrin Maleat tab Tablet 0 0 0
87 Metoklopramide Inj Ampul 0 0 0
88 Metronidazol tablet 250 mg Tablet 0 0 0
89 Metronidazol tablet 500 mg Tablet 0 0 0
90 Nasal Oxygen, O2 cannula size L Pcs 0 0 0
91 Nasal Oxygen, O2 cannula size M Pcs 0 0 0
92 Nasal Oxygen, O2 cannula size S Pcs 0 0 0
93 Nasal Oxygen, O2 cannula size XS Pcs 0 0 0
94 Nifedipin 10 mg Tablet 0 0 0
95 Obat Batuk Hitam (OBH) Cairan -100 ml Botol 0 0 0
96 OBH Nusantara Menthol Botol 0 0 0
97 OBH Plus Botol 0 0 0
98 Oksitetrasiklin HCl 1 % Salep mata Tube 0 0 0
99 Oksitetrasiklin HCl inj i.m 50 mg/ml-10 ml Vial 0 0 0
100 Oksitetrasiklin HCl Salep Kulit 3 % Tube 0 0 0
101 Oksitoksin inj 10 IU/ml- 1 ml Ampul 0 0 0 30 30 30
102 Omeprazol Kapsul 0 0 0
103 Parasetamol drop Botol 0 0 0
104 Parasetamol sirup 120 mg / 5ml Botol 0 0 0
105 Parasetamol tablet 500 mg Tablet 20 500 520 170 350 204 200 200 200
106 Parasetamol tablet 100 mg Tablet 0 0 0
107 Piridoksin HCl (Vit B6) tablet 10 mg Tablet 40 0 40 0 40 0
108 Piroxicam 10 mg Tablet 0 0 0
109 Plester 5 yard x 2 inch Roll 0 0 0
110 Plester 7,5 cm x 5 m Buah 0 0 0 2
111 Polypropylene 2/0 75C + Jarum 3/8 26m Pcs 0 0 0
112 Povidon Iodiada 10 %-60 ml Botol 0 0 0 2 2
113 Povidon Iodiada 10 %-300 ml Botol 0 0 0 1
114 Ranitidine 150 mg Tablet 0 0 0
115 Retinol (VIT A) Kapsul 100.000 IU Kapsul 0 0 0
116 Retinol (VIT A) Kapsul 200.000 IU Kapsul 0 0 0
117 Ringer Laktat Larutan Infus Steril Botol 4 60 64 37 27 44.4 60 25 25
118 Rivanol 300 ml Botol 0 0 0
119 Salbutamol tablet 2 mg Tablet 0 0 0
120 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 % Pot 0 0 0
121 Sarung Tangan non steril no 6,5 Pasang 0 0 0
122 Sarung Tangan non steril no 7 Pasang 0 0 0
123 Sarung Tangan non steril no 7,5 Pasang 50 50 33 17 39.6 50 50 50
124 Sarung Tangan Obgyn steril Pasang 0 0 0 5 5 5
125 Sarung tangan steril no 6,5 Pasang 0 0 0 20 20 20
126 Sarung tangan steril no 7 Pasang 0 0 0
127 Sarung tangan steril no 7,5 Pasang 0 0 0 20 20 20
128 Tablet Tambah darah kombinasi : Besi II Sulfat Tablet 330 0 330 150 180 180 0
129 Tiamin HCL (Vit B1) tablet 50 mg Tablet 240 240 50 190 60 0
130 Transfusion Set Set 0 0 0
131 Umbilical cord klem steril Pcs 0 0 0 30 30 30
132 Urine bag pcs 0 0 0
133 Urine Drainage Bag, T valve with hanger Pcs 0 0 0
134 Ventolin nebules Nebule 0 0 0
135 Vitamin B Kompleks tablet Tablet 0 0 0 100
136 Wing Nedle no 25 Tablet 0 0 0
137 Widabest Botol 0 0 0
138 Bundavin Tablet 0 0 0 100 100 100
0 0
0 0
0 0
0 0
0 0

BAYAR TDK BAYAR JUMLAH

JUMLAH KUNJUNGAN RESEP
30 81 111

MENGETAHUI YANG MENYERAHKAN YANG MENERIMA

KEPALA UPTD PUSKESMAS WADO PETUGAS OBAT PUSKESMAS PETUGAS OBAT POL/PP

dr. Eka. Damayanti

NIP. 197509122005012008 Apt. Nurelawati, S.Si Sri Rahayu Utami
NIP. 19841109 201903 2 006 NIP. -
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

POL/PP : PONED WADO PELAPORAN/PERIODE : Febuary 2022 DOKUMEN

KECAMATAN : Wado PERMINTAAN/PERIODE : POL/PP
KABUPATEN : Sumedang PUSKESMA

STOCK PENERI PERSE PEMA SISA STOCK PERMIN PEMB

NO NAMA OBAT SATUAN
AWAL MAAN DIAAN KAIAN STOCK OPT TAAN APBD
1 2 3 4 5 6 7 8 9 10 11
1 Alat Suntik Sekali Pakai 0.5 ml Pcs
2 Alat Suntik Sekali Pakai 1 ml Pcs 55
3 Alat Suntik Sekali Pakai 10 ml (Aximed) Buah 14
4 Alat Suntik Sekali Pakai 10 ml (Top Point) Buah 0
5 Alat Suntik Sekali Pakai 2,5 ml Pcs 0
6 Alat Suntik Sekali Pakai 20 ml Buah 0
7 Alat Suntik Sekali Pakai 3 ml Pcs 71
8 Alat Suntik Sekali Pakai 5 ml Pcs 342
9 Alkohol Swab ( PT. Bio Axion Healthindo) Sase 83
10 Alkohol Swab CHG + 0,5 % (e-care) Pcs 0
11 Amlodipin tablet 10 mg Tablet 0
12 Amlodipin tablet 5 mg Tablet 0
13 Amoksilin 500 mg Kaplet 240
14 Antasida DOEN I tablet kombinasi Tablet 56
15 Antasida DOEN II suspensi kombinasi Botol 0
16 Antiseptik Hand Rub 5 lt Galon 0
17 Antiseptik Hand Rub 500 ml Botol 0
18 Antiseptik Surgical Hand Scrub 5 lt Galon 0
19 Antiseptik Surgical Hand Scrub 500 ml Botol 0
20 Aqua Pro Injeksi steril bebas pirogen- 20 ml Ampul 0
21 Aquadest steril -500 ml Botol 0
22 Asam Askorbat (VIT C) Tablet 50 mg (KF) Tablet 0
23 Asam folat tablet 0,4 mg Tablet 0
24 Asam Mefenamat 500 mg Tablet 0
25 Asering Botol 0
26 Bisturi no 10 Buah 0
27 Bloodseet Buah 0
28 Catgut Chromic 2/0 100 m Roll 0
29 Catgut Chromic 2/0 75C + Jarum 1/2 30 M Roll 0
30 Catgut Chromic 3/0 75C + Jarum 1/2 22 M Roll 0
31 Catgut Plain 2/0 70C + Jarum 1/2 36M R Roll 16
32 Catgut Plain 3/0 70C + Jarum 3/8 19M C Roll 0
33 Catgut/Benang Bedah No.2/0-3/0 dg jaru Roll 0
34 Cefiksim 100 mg Kapsul 0
35 Cetirizine Kapsul 0
36 Citoject Pcs 0
37 Domperidon Syrup Botol 0
38 Domperidon tablet 10 mg Tablet 0
39 Epinefrina(Adrenalin) inj i.v/s.k/i.m 1 mg/ml Ampul 1
40 Female Catheter no 16 Pcs 0
41 Female Catheter no 18 Pcs 0
42 Fitomenadion(Vit K1) inj 2 mg/ml-1ml Ampul 29
43 Fitomenadion(Vit K1) tablet salut gula 10 Tablet 0
44 Folley Cathether 2 way no 20 Pcs 0
45 Folley Cathether no 16 Pcs 0
46 Folley Cathether no 18 Pcs 0
47 Furosemid tablet 40 mg Tablet 0
48 Glukosa Larutan infus 10% steril-500 ml Botol 0
49 Glukosa Larutan infus 5% steril-500 ml Botol 0
50 Hansaplast 2,5 cm x 4,5 m Roll 0
51 Hansaplast 7,5 cm x 4,5 m Roll 0
52 Infusion set dewasa Set 92
53 IV Cateter 18 Buah 0
54 IV Cateter 20 Buah 0
55 IV Cateter 22 Buah 16
56 IV Cateter 24 Buah 0
57 IV Cateter no 26 wings & port Buah 0
58 IV Cateter with injection port 26 G Buah 0
59 Jarum Citojek No 16 Pcs 0
60 Jarum Jahit kulit No.12 Pcs 0
61 Kalsium Glukonat injeksi i.v 10 % Ampul 19
62 Jarum Jahit Otot No.12 Pcs 0
63 Kasa hidrofil 36 m x 80 cm Roll 0
64 Kasa hidrofile 3 yard x 10 cm Buah 3
65 Kasa hidrofile 40 yard x 80 cm Roll 0
66 Kasa kompres 16x16 steril Buah 0
67 Kasa pembalut hidrofil 4 m x 10 cm Roll 0
68 Klorfenariamin maleat (CTM) tablet 4 mg Tablet 0
69 Klorine Botol 0
70 Kotrimoksazol Tablet 480 mg Tablet 0
71 Leucoplast 2,50 cm x 4,5 m Roll 0
72 Leucoplast 7,50 cm x 4,5 m Roll 0
73 Lidocain compositum inj kombinasi Ampul 0
74 Lidocain Injeksi 2% Ampul 0
75 Lidocain Jeli 2% Syringe 0
76 Lidokain Spray Oral 10%(Xylocaine spray) Botol 0
77 Lisol Botol 0
78 Loratadine 10 mg Tablet 0
79 Magnesium Sulfat Inj 20% Vial 0
80 Magnesium Sulfat Inj 40% Ampul 2
81 Masker Karet Buah 0
82 Masker Tali Buah 0
83 Metformin Tablet 0
84 Metildopa 250 mg / Dopamet Tablet 31
85 Metilergometrin Maleat Inj Ampul 0
86 Metilergometrin Maleat tab Tablet 0
87 Metoklopramide Inj Ampul 0
88 Metronidazol tablet 250 mg Tablet 0
89 Metronidazol tablet 500 mg Tablet 0
90 Nasal Oxygen, O2 cannula size L Pcs 0
91 Nasal Oxygen, O2 cannula size M Pcs 0
92 Nasal Oxygen, O2 cannula size S Pcs 0
93 Nasal Oxygen, O2 cannula size XS Pcs 0
94 Nifedipin 10 mg Tablet 0
95 Obat Batuk Hitam (OBH) Cairan -100 ml Botol 0
96 OBH Nusantara Menthol Botol 0
97 OBH Plus Botol 0
98 Oksitetrasiklin HCl 1 % Salep mata Tube 0
99 Oksitetrasiklin HCl inj i.m 50 mg/ml-10 ml Vial 0
100 Oksitetrasiklin HCl Salep Kulit 3 % Tube 0
101 Oksitoksin inj 10 IU/ml- 1 ml Ampul 0
102 Omeprazol Kapsul 0
103 Parasetamol drop Botol 0
104 Parasetamol sirup 120 mg / 5ml Botol 0
105 Parasetamol tablet 500 mg Tablet 350
106 Parasetamol tablet 100 mg Tablet 0
107 Piridoksin HCl (Vit B6) tablet 10 mg Tablet 40
108 Piroxicam 10 mg Tablet 0
109 Plester 5 yard x 2 inch Roll 0
110 Plester 7,5 cm x 5 m Buah 0
111 Polypropylene 2/0 75C + Jarum 3/8 26m Pcs 0
112 Povidon Iodiada 10 %-60 ml Botol 0
113 Povidon Iodiada 10 %-300 ml Botol 0
114 Ranitidine 150 mg Tablet 0
115 Retinol (VIT A) Kapsul 100.000 IU Kapsul 0
116 Retinol (VIT A) Kapsul 200.000 IU Kapsul 0
117 Ringer Laktat Larutan Infus Steril Botol 27
118 Rivanol 300 ml Botol 0
119 Salbutamol tablet 2 mg Tablet 0
120 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 % Pot 0
121 Sarung Tangan non steril no 6,5 Pasang 0
122 Sarung Tangan non steril no 7 Pasang 0
123 Sarung Tangan non steril no 7,5 Pasang 17
124 Sarung Tangan Obgyn steril Pasang 0
125 Sarung tangan steril no 6,5 Pasang 0
126 Sarung tangan steril no 7 Pasang 0
127 Sarung tangan steril no 7,5 Pasang 0
128 Tablet Tambah darah kombinasi : Besi II Su Tablet 180
129 Tiamin HCL (Vit B1) tablet 50 mg Tablet 190
130 Transfusion Set Set 0
131 Umbilical cord klem steril Pcs 0
132 Urine bag pcs 0
133 Urine Drainage Bag, T valve with hanger Pcs 0
134 Ventolin nebules Nebule 0
135 Vitamin B Kompleks tablet Tablet 0
136 Wing Nedle no 25 Tablet 0
137 Widabest Botol 0
138 Bundavin Tablet 0
0
0
0
0 0 0
0 0 0

BAYAR TDK BAYAR JUMLAH

JUMLAH KUNJUNGAN RESEP
30 81 111

MENGETAHUI YANG MENYERAHKAN

KEPALA UPTD PUSKESMAS WADO PETUGAS OBAT PUSKESMAS
 dr. Eka. Damayanti
NIP. 197509122005012008 Apt. Nurelawati, S.Si
NIP. 19841109 201903 2 006
 NOMOR TANGGAL
2/19/2022
31/Farm/PKMWD/II/2022 2/21/2022

PEMBERIAN
KET
APBD DAK APBN LAIN2 JUMLAH
12 13 14 15 16

100 100

100

2
12

50

15

5
5
2

30

5
30

200

25
 50
5
20

20

30

100

YANG MENERIMA
PETUGAS OBAT POL/PP
 Sri Rahayu Utami
NIP. -