Ganeas

LAPORAN PEMAKAIAN DAN LEMBAR PER
(LPLPO)
PUSKESMAS :GANEAS PELAPORAN/PERIODE JANUARI S/D

KECAMATAN : GANEAS PERMINTAAN/PERIODE MARET S/D
KABUPATEN : SUMEDANG
STOCK PENERI PERSE PEMA

NO NAMA OBAT SATUAN
AWAL MAAN DIAAN KAIAN
1 2 3 4 5 6 7
1 Acetyl Cysteine 200 mg Kapsul - -
2 Alat Suntik 0,05ml Buah - -
3 Alat Suntik Sekali Pakai 0.5 ml Pcs - -
4 Alat Suntik Sekali Pakai 1 ml Pcs 500 500 500
5 Alat Suntik Sekali Pakai 10 ml (Aximed) Buah - -
6 Alat Suntik Sekali Pakai 10 ml (Top Point) Buah - -
7 Alat Suntik Sekali Pakai 2,5 ml Pcs - -
8 Alat Suntik Sekali Pakai 20 ml Buah - -
9 Alat Suntik Sekali Pakai 3 ml Pcs 100 800 900 900
10 Alat Suntik Sekali Pakai 3 ml Pcs - -
11 Alat Suntik Sekali Pakai 5 ml Pcs - -
12 Albendazol 400 mg Tablet - -
13 Alkohol Swab ( PT. Bio Axion Healthindo) Sase - -
14 Alkohol Swab CHG + 0,5 % (e-care) Pcs - -
15 Alopurinol tablet 100 mg Tablet - -
16 Alopurinol tablet 300 mg Tablet - -
17 Ambroxol Sirup Botol - -
18 Ambroxol Tablet 30 mg Tablet - -
19 Aminofilin Inj 24 mg/ml-10 ml Ampul - -
20 Aminofilin Tablet 200 mg Tablet - -
21 Amitriptilina HCl tablet salut 25 mg Tablet - -
22 Amlodipin tablet 10 mg Tablet 1,500 1,500 1,500
23 Amlodipin tablet 5 mg Tablet 1,800 1,800 3,600 3,600
24 Amoksilin 500 mg Kaplet 6,000 5,000 11,000 6,100
25 Amoksilin Kapsul 250 mg Kapsul - -
26 Amoksilin sirup kering 125 mg/5ml Botol 200 200 200
27 Amoksilin sirup kering 125 mg/5ml Botol - -
28 Amoksilin sirup kering forte 250 mg/5ml Botol 105 120 225 225
29 Ampisilin 1 gr inj Ampul - -
30 Ampisilin Kaplet 500 mg Kaplet - -
31 Ampisilin Serbuk Injeksi Vial - -
32 Antalgin(Metampiron) Tablet 500 mg Tablet 2,000 1,000 3,000 3,000
33 Antasida DOEN I tablet kombinasi Tablet 7,100 16,800 23,900 14,900
34 Antasida DOEN II suspensi kombinasi Botol - -
35 Anti hemoroid suppositorida Supp - -
36 Antifungi DOEN kombinasi : Pot - -
37 Antimigren DOEN/Ergotamin kafein Tablet 100 100 100
38 Antiseptik Hand Rub 5 lt Galon - -
39 Antiseptik Hand Rub 500 ml Botol - -
40 Antiseptik Surgical Hand Scrub 5 lt Galon - -
41 Antiseptik Surgical Hand Scrub 500 ml Botol - -
42 Aqua Pro Injeksi steril bebas pirogen- 20 ml Ampul - -
43 Aquadest steril -500 ml Botol 3 - 3 3
44 Asam Askorbat (VIT C) Tablet 50 mg (KF) Tablet - -
45 Asam folat tablet 0,4 mg Tablet 2,000 2,000 1,500
46 Asam Mefenamat 500 mg Tablet 7,000 7,000 7,000
47 Asering Botol - -
48 Asetosal tablet 80 mg Tablet - -
49 Asetosal tablet 80 mg Tablet - -
50 Asiklovir cr Tube 50 50 50
51 Asiklovir tab 200 mg Tablet - -
52 Asiklovir tab 400 mg Tablet - -
53 Atapulgit Tablet 1,000 1,000 1,000
54 Atorvastatin 10 mg Tablet 900 900 900
55 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul - -
56 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul - -
57 Azitromisin 500 mg Kaplet - -
58 Bedak Salisil serbuk 2 % Buah 20 30 50 50
59 Benzatin benzil penisilin 1,2 juta IU/Vial Vial - -
60 Betametason Krim 0.1 % Tube 125 125 125
61 Bisakodil Supp (Dulcolax) Supp - -
62 Bisturi no 10 Buah - -
63 Bloodseet Buah 30 30 30
64 Carpul (Articain & Adrenalin) Ampul - -
65 Catgut Chromic 2/0 100 m Roll - -
66 Catgut Chromic 2/0 75C + Jarum 1/2 30 MR Roll 20 20 20
67 Catgut Chromic 3/0 75C + Jarum 1/2 22 MR Roll - - -
68 Catgut Plain 2/0 70C + Jarum 1/2 36M R Roll - -
69 Catgut Plain 3/0 70C + Jarum 3/8 19M C Roll - -
70 Catgut/Benang Bedah No.2/0-3/0 dg jarum bedah Roll - -
71 Cefiksim 100 mg Kapsul - -
72 Cetirizine Kapsul 2,000 2,000 2,000
73 Citoject Pcs - -
74 Clorofenol (CHKM) Ples - -
75 Deksametason inj 5 mg/ml-1 ml Ampul - -
76 Deksametason Tablet 0,5 mg Tablet 10,300 10,300 10,300
77 Devitalisasi Pasta (Non arsen) Botol - -
78 Dextaco Tablet - -
79 Dextrofen Syrup 60 ml Botol - -
80 Difenhidramin inj 10 mg/ml Ampul - -
81 Digoksin tablet 0,25 mg Tablet - -
82 Dimenhidrinat tablet 50 mg Tablet - -
83 Doksisiklin 100 mg Kapsul - -
84 Domperidon Syrup Botol 100 100 100
85 Domperidon tablet 10 mg Tablet 900 900 900
86 Ekstrak Belladona tablet 10 mg Tablet - -
87 Eosin 2% 1x100 ml Botol - -
88 Epinefrina(Adrenalin) inj i.v/s.k/i.m 1 mg/ml Ampul - -
89 Eritromisin 250 mg Tablet - -
90 Eritromisin 500 mg Tablet - -
91 Eritromisin sirup kering 200 mg/5 ml Botol - -
92 Etambutol Hcl tablet 250 mg Tablet - -
93 Etambutol Hcl Tablet 500 mg Tablet - -
94 Etambutol Hcl Tablet 500 mg Tablet - -
95 Etanol 70 %- 100 ml Botol - -
96 Etanol 70% - 1 L Botol 2 7 9 9
97 Etil Klorida semprot-100 ml Botol - -
98 Eugenol Cairan Botol - -
99 Female Catheter no 16 Pcs - -
100 Female Catheter no 18 Pcs - -
101 Fenitoin Kapsul100 mg Kapsul - -
102 Fenoksimetil Penisilin tablet 250 mg Tablet - -
103 Fenoksimetil Penisilin tablet 500 mg Tablet - -
104 Fenol Gliserol Tetes telinga 10 % Botol - -
105 Film IV Dressing 6x7 P Pcs - -
106 Fitomenadion(Vit K1) inj 10 mg/ml-1ml Ampul - -
107 Fitomenadion(Vit K1) inj 2 mg/ml-1ml Ampul - -
108 Fitomenadion(Vit K1) tablet salut gula 10 mg Tablet - -
109 Fluconazol 150 mg kapsul - -
110 Folley Cathether 2 way no 20 Pcs - -
111 Folley Cathether no 16 Pcs - -
112 Folley Cathether no 18 Pcs - -
113 Furosemid tablet 40 mg Tablet 400 400 400
114 Garam Oralit 200 ml air Sachet 300 300 300
115 Garam Oralit 200 ml air Sachet - -
116 Gentamisin Inj 40 mg/ml Vial - -
117 Gentamycin Salep Kulit Tube - - - -
118 Gentamycin Salep Mata Tube - -
119 Gentamycin Tetes Mata Tube 54 120 174 174
120 Gentian violet larutan 1 %-10 ml Botol - -
121 Glas Lonomer Cement Set - -
122 Glas Lonomer Cement Liquid Set - -
123 Glibenklamid tablet 5 mg Tablet - -
124 Glimepiride tablet 1 mg Tablet - -
125 Gliseril Gyayakolat tablet 100 mg Tablet 2,000 8,000 10,000 8,000
126 Glukosa Larutan infus 10% steril-500 ml Botol - -
127 Glukosa Larutan infus 5% steril-500 ml Botol 20 20 20
128 Griseofulvin tablet 125 mg micronized Tablet 200 200 200
129 Haloperidol Injeksi (Lodomer) Ampul - -
130 Haloperidol Injeksi (Lodomer) Ampul - -
131 Haloperidol tablet 0,5 mg Tablet - -
132 Haloperidol tablet 1,5 mg Tablet 1,000 400 1,400 1,400
133 Haloperidol tablet 2 mg Tablet - -
134 Haloperidol tablet 5 mg Tablet - -
135 Hansaplast 2,5 cm x 4,5 m Roll - -
136 Hansaplast 7,5 cm x 4,5 m Roll 1 4 5 5
137 Hemafort Tablet - -
138 Hidrogen Peroksida 3% (H2O2) Botol - -
139 Hidroklortiazid (HCT) tablet 25 mg Tablet - -
140 Hidrokortison krim 2,5 % Tube - -
141 Ibuprofen sirup 100 mg/5 ml Botol 200 - 200 200
142 Ibuprofen tablet 200 mg Tablet - - - -
143 Ibuprofen tablet 400 mg Tablet 3,000 500 3,500 3,500
144 Infusion set anak Set - -
145 Infusion set anak Set - -
146 Infusion set dewasa Set - -
147 Infusion Set Dewasa Set - - -
148 Isoniazida ( INH ) tablet 100 mg Tablet - -
151 Isosorbit 5 mg Tablet - -
152 IV Cateter 18 Buah - -
156 IV Cateter no 26 wings & port Buah - -
157 IV Cateter with injection port 26 G Buah - -
158 Jarum Citojek No 16 Pcs - -
159 Jarum Jahit kulit No.12 Pcs - -
160 Jarum Jahit Otot No.12 Pcs - -
161 Kalium Permanganat Pot - -
162 Kalsium Glukonat injeksi i.v 10 % Ampul - -
163 Kalsium Hidroksida Pasta Set - -
164 Kalsium laktat (Kalk) tablet 500 mg Tablet 2,000 5,000 7,000 5,500
165 Kapas pembalut/absorben 250 mg Buah - -
166 Kaptropil 12,5 mg Tablet 1,000 4,000 5,000 3,000
167 Kaptropil 25 mg Tablet - -
168 Karbamazepin tablet 200 mg Tablet - -
169 Karbogliserin Tetes Telinga Botol - -
170 Kasa hidrofil 36 m x 80 cm Roll - -
171 Kasa hidrofile 3 yard x 10 cm Buah 100 100 100
172 Kasa hidrofile 40 yard x 80 cm Roll - -
173 Kasa kompres 16x16 steril Buah - -
174 Kasa pembalut hidrofil 4 m x 10 cm Roll - -
175 Ketokonazol 200 mg Tablet - -
176 Ketokonazol Krim 2% Tube - -
177 Klindamisin 150 mg Tablet - -
178 Klindamisin 300 mg Tablet - -
179 Kloramfenikol kapsul 250 mg Kapsul 100 100 100
180 Kloramfenikol kapsul 250 mg Kapsul - -
181 Kloramfenikol salep kulit 2 % Tube - -
182 Kloramfenikol salep mata 1 % Tube 10 120 130 130
183 Kloramfenikol susp 125 ml Botol - -
184 Kloramfenikol tetes telinga 3 % Ples 24 24 24
185 Klorfenariamin maleat (CTM) tablet 4 mg Tablet 5,000 10,000 15,000 12,000
186 Klorine Botol - -
187 Klorpromazin 100 MG Tablet 100 100 100
188 Klorpromazin 25 mg Tablet - -
189 Klorpromazin injeksi 5 mg/ml-2ml Ampul - -
190 Kotrimoksazol anak Tablet - -
191 Kotrimoksazol Susp Botol 43 100 143 143
192 Kotrimoksazol Tablet 480 mg Tablet - - - -
193 Leucoplast 2,50 cm x 4,5 m Roll - -
194 Leucoplast 7,50 cm x 4,5 m Roll
195 Lidocain compositum inj kombinasi Ampul - -
196 Lidocain Injeksi 2% Ampul - -
197 Lidocain Jeli 2% Syringe - -
198 Lidokain Spray Oral 10%(Xylocaine spray) Botol - -
199 Lisol Botol - -
200 Lodecon Forte Tablet - -
201 Loratadine 10 mg Tablet - -
202 Magnesium Sulfat Inj 20% Vial - -
203 Magnesium Sulfat Inj 40% Ampul - -
204 Masker Karet Buah - -
205 Masker Tali Buah 100 700 800 700
206 Metformin Tablet - -
207 Metildopa 250 mg / Dopamet Tablet - -
208 Metilergometrin Maleat Inj Ampul - -
209 Metilergometrin Maleat tab Tablet - -
210 Metilprednisolone 4 mg Tablet - -
211 Metoklopramide Inj Ampul - -
212 Metoklopramide Inj Ampul - -
213 Metronidazol Syrup Botol - -
214 Metronidazol tablet 250 mg Tablet - -
215 Metronidazol tablet 500 mg Tablet - -
216 Mikonazol krim 2% Tube - -
217 Mummying Pasta Botol - -
218 Nasal Oxygen, O2 cannula size L/adult Pcs - -
219 Nasal Oxygen, O2 cannula size M Pcs - -
220 Nasal Oxygen, O2 cannula size S/infant Pcs - -
221 Nasal Oxygen, O2 cannula size XS Pcs - -
222 Natrium Bikarbonat tablet 500 mg Tablet 7,200 - 7,200 7,200
223 Natrium Diklofenak Tablet 5,600 5,600 5,600
224 Natrium Klorida Lar.infus 0,9 % steril Botol - -
225 Natrium Tiroksin Tablet - -
226 Nifedipin 10 mg Tablet - -
227 Nistatin Suspensi 100.000 IU/ml Botol 100 100 100
228 Nistatin tablet vaginal 100.000 IU/g Tablet - -
229 Nistatin tablet vaginal 500.000 IU/g Tablet - -
230 Norit Tablet - -
231 OAT Sisipan/FDC Sisipan Paket - -
232 Obat antituberkolosis Kombipak Kat.I Dewasa Paket - -
233 Obat antituberkulosis anak/FDC Anak Paket 7 7 7
234 Obat antituberkulosis anak/FDC Anak Paket - -
235 Obat antituberkulosis kategori 1/FDC 1 Paket 10 10 10
236 Obat antituberkulosis kategori 1/FDC 1 Paket - -
239 Obat Batuk Hitam (OBH) Cairan -100 ml Botol - -
240 OBH Nusantara Menthol Botol 30 60 90 90
241 OBH Plus Botol - -
242 Oksitetrasiklin HCl 1 % Salep mata Tube - -
243 Oksitetrasiklin HCl inj i.m 50 mg/ml-10 ml Vial - -
244 Oksitetrasiklin HCl Salep Kulit 3 % Tube 25 25 25
245 Oksitoksin inj 10 IU/ml- 1 ml Ampul 100 100 100
246 Oksitoksin inj 10 IU/ml- 1 ml Ampul - -
247 Omeprazol Kapsul 1,710 600 2,310 2,310
248 Omeprazol Injeksi Vial - -
249 Papaverin tab Tablet - -
250 Paraformaldehid Tablet - -
251 Parasetamol drop Botol 37 56 93 65
252 Parasetamol sirup 120 mg / 5ml Botol 107 100 207 207
253 Parasetamol tablet 500 mg Tablet 10,000 10,000 20,000 11,000
254 Parasetamol tablet 100 mg Tablet - -
255 Pehakain Ampul - -
256 Permetrin Krim 5% (Scabimite) Tube 20 120 140 140
257 Permetrin Krim 5% (Scabimite) Tube - -
258 PGA 2 75 C + Jarum 1/2 40 M Pcs - -
259 Piralent Inj Ampul - -
260 Pirantel Pamoat 125 mg Tablet - -
261 Pirazinamid 500 mg Tablet - -
262 Piridoksin HCl (Vit B6) tablet 10 mg Tablet 4,000 4,000 3,000
263 Piroxicam 10 mg Tablet 500 500 500
264 Plester 5 yard x 2 inch Roll - -
265 Plester 7,5 cm x 5 m Buah 1 1 1
266 Polypropylene 2/0 75C + Jarum 3/8 26m Pcs - -
267 Povidon Iodiada 10 %-30 ml Botol - -
270 Prednison tablet 5 mg Tablet - -
271 Probenesid 500 mg Tablet - -
272 Propanolol HCl tablet 10 mg Tablet - -
273 Propanolol HCl tablet 40 mg Tablet - -
274 Propiltiourasil tablet 100 mg Tablet - -
275 Ranitidin inj Ampul - -
276 Ranitidine 150 mg Tablet - -
277 Retinol (VIT A) Kapsul 100.000 IU Kapsul - -
278 Retinol (VIT A) Kapsul 200.000 IU Kapsul - -
279 Rifampisin kapsul 300 mg Kapsul - -
280 Rifampisin kapsul 450 mg Kapsul - -
281 Ringer Laktat Larutan Infus Steril Botol - -
282 Rivanol 300 ml Botol 15 15 15
283 Salbutamol tablet 2 mg Tablet 1,000 - 1,000 1,000
284 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 % Pot - -
285 Salisil Spiritus Botol - -
286 Sarung Tangan non steril no 6,5 Pasang - -
287 Sarung Tangan non steril no 7 Pasang - -
288 Sarung Tangan non steril no 7,5 Pasang - -
289 Sarung Tangan Obgyn steril Pasang - -
290 Sarung tangan steril no 6,5 Pasang 100 100 100
291 Sarung tangan steril no 7 Pasang - -
292 Sarung tangan steril no 7,5 Pasang 200 200 400 400
293 Scandonest Ampul - -
294 Seledril Tablet Tablet - -
295 Semen Seng Fosfat Serbuk Cairan Set - -
296 Semillas non Woven Medical Tape Pcs - -
297 Sepadroxil 500 mg Tablet - -
298 Sepadroxil Syrup Kering 125 mg/5 ml Botol 100 100 100
299 Serum anti tetanus (ATS) / Biosat Ampul - -
300 Serum anti tetanus (ATS) / Tetagam Ampul - -
301 Serum antibisa ular Polivalen inj 5 ml (SABU) I Ampul - -
302 Silk 2/0 75 C + Jarum 1/2 30M R Sase - - -
303 Silk 3/0 75 C + Jarum 1/2 17M R Sase - -
304 Silk 3/0 75 C + Jarum 3/8 26M C Sase - - -
305 Silk Black 2/0 DS 24 MM Sase - -
306 Silk Black 2/0 HR 26 MM Sase - - -
307 Silk Black 3/0 DS 24 MM Sase - -
308 Silk Black 3/0 HR 26 MM Sase - - -
309 Silk Black PFM 2/0 100 m Roll - -
310 Simvastatin tablet 10 mg Tablet - -
311 Simvastatin tablet 20 mg Tablet 1,500 - 1,500 1,500
312 Siprofloksasin 500 mg Tablet 300 300 300
313 Softanol antimicrobial 500 ml Botol - -
314 Softanol antimicrobial galon 5 liter Galon - -
315 Softanol antimicrobial galon 5 liter Galon - -
316 Solacort krim /Armacort Tube - -
317 Solafluz Botol - -
318 Soldextam Tablet - -
319 Solvitral Tablet 1,000 1,000 1,000
320 Spironolakton 25 mg Tablet - -
321 Streptomisin Inj Vial - -
322 Sulfasetamid Natrium Tetes mata 15 % Ples - -
323 Tablet Tambah darah kombinasi : Besi II Sulfat Tablet - -
324 Tablet Tambah darah kombinasi : Besi II Sulfat Tablet - -
325 Temporary Filling Material (Fermin) Botol - -
326 Temporary Stopping Fletcher serbuk &cairan Set - -
327 Tetrakain HCl tetes mata 0,5 % Botol - -
328 Tetrasiklin Kapsul 250 mg Kapsul - -
329 Tetrasiklin Kapsul 500 mg Kapsul - -
330 Tiamin HCL (Vit B1) tablet 50 mg Tablet 2,000 4,000 6,000 6,000
331 Transfusion Set Set - -
332 Triheksifenidil HCl tablet 2 mg Tablet 1,000 1,000 1,000
333 Trikesol Formalin (TKF) Botol - -
334 Trikesol Formalin (TKF) Botol - -
335 Truvit Syr Botol 100 100 80
336 Umbilical cord klem steril Pcs - -
337 Urine Drainage Bag, T valve with hanger Pcs 10 - 10 10
338 Ventolin nebules Nebule - -
339 Viorex no rinse antimicrobial Galon - -
340 Viorex no rinse antimicrobial Botol - -
341 Vitamin B 12 Injeksi Ampul - -
342 Vitamin B 12 tab Tablet 1,000 3,000 4,000 3,000
343 Vitamin B Kompleks tablet Tablet 5,000 5,000 5,000
344 Widabest Botol - -
345 Wing Nedle no 25 Tablet - -
346 Zink Tablet 400 600 1,000 1,000
347 Zink Tablet - -
348 Dextaco Tablet - -
349 Dextrofen Syrup 60 ml Botol - -
350 Hemafort Tablet - -
351 Lodecon Forte Tablet - -
352 Scandonest Ampul - -
353 Seledril Tablet Tablet - -
354 Solacort krim /Armacort Tube - - - -
355 Solafluz Botol - -
356 Soldextam Tablet - -
358 Truvit Syr Botol - -
359 Widabest Botol - -
360 Camabion Tablet - -
361 Diazepam inj 5 mg/ml-2 ml Ampul -
362 Diazepam tablet 2 mg Tablet 100 100 100
363 Diazepam tablet 5 mg Tablet
364 Fenobarbital inj 50 mg/ml-2ml Ampul
365 Fenobarbital tablet 30 mg Tablet
366 Stesolid (Diazepam Rectal) Tube
367 MB Dewasa Blister 2 2
BAYAR TDK BAYAR JUMLAH

JUMLAH KUNJUNGAN RESEP
MENGETAHUI YANG MENYERAHKAN

KEPALA DINKES KAB. SUMEDANG KEPALA UPTD GFK SUMEDANG
Dadang Sulaeman,.S,Sos., M.Kes Acep Umar Somali, SKM
NIP. 19701126 199303 1 006 NIP. 19630807 198502 1 001
KAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
PEBRUARI DOKUMEN NOMOR TANGGAL

APRIL PUSKESMAS 800/041/PKM GNS/III/2020 2-Mar-20
DINKES
UPTD Farmasi
SISA STOCK PERMIN PEMBERIAN

KET
STOCK OPT TAAN APBD APBD DAK APBN LAIN2 JUMLAH
8 9 10 11 12 13 14 15 16
- -
- -
- -
- 600 600 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 1,800 1,800 1,800 1,800
- 2,200 1,800 1,800 1,800
4,900 7,320 10,000 10,000 10,000
- -
- 240 300 -
- -
- 270 500 500 500
- -
- -
- -
- -
9,000 14,900 16,800 16,800 16,800
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 4 5 5 5
- -
500 1,800 2,000 1,300 1,300
- -
- -
- -
- -
10 -
- -
- -
- 1,200 1,200 1,200 1,200
-
- -
- -
- -
-
- -
- 150 150 150 150
- -
- -
36 40 40 40
- -
- -
24 30 -
- 30 -
- -
- -
- -
- -
- -
- -
- -
- -
- 12,360 12,000 -
- -
- -
- -
- -
- -
- -
- -
20 -
- 1,080 1,000 1,000 1,000
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 360 300 300 300
- -
- -
- - 100 -
- -
35 -
- -
- -
- -
- -
- -
2,000 9,600 10,000 -
- -
4 -
- 240 300 300 300
- -
- -
- -
- 1,680 1,500 1,500 1,500
- -
- -
- -
- -
- -
- -
- -
- -
- 240 200 200 200
- - 5,000 -
- 4,200 10,000 -
- -
- -
- -
- - -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
1,500 6,600 7,000 7,000 7,000
-
2,000 3,600 2,000 2,000 2,000
- -
- -
- -
- -
- - -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 29 48 24 24
3,000 14,400 5,000 5,000 5,000
- -
- -
- -
- -
- -
- -
- - 10,000 -
- -
-
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
100 840 1,000 -
- -
- -
- -
-
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 8,640 7,200 200 200
- -
- -
- -
- -
- 120 100 100 100
- -
- -
- -
- -
- -
1 -
- -
- 12 10 10 10
- -
- -
- -
- -
- 110 100 25 25
- -
- -
- -
- 25 200 50 50
20 -
- -
- 2,772 3,000 3,000 3,000
- -
- -
- -
28 78 56 56 56
- 242 300 300 300
9,000 13,200 16,800 16,800 16,800
- -
- -
- -
- -
- -
- -
- -
- -
1,000 3,600 2,000 2,000 2,000
100 -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
3 -
- 1,200 1,200 1,200 1,200
- -
- -
- -
- -
- -
- -
20 -
- -
80 -
- -
- -
- -
- -
- -
20 -
- -
- -
- -
- - 30 -
- -
- - 30 -
- -
- - 30 -
- -
- - 40 -
- -
- - -
- 1,800 1,500 1,500 1,500
60 -
- -
- -
- -
- -
- -
- -
- 1,200 1,500 500 500
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 7,200 7,000 7,000 7,000
- -
- 1,200 1,200 1,200 1,200
- -
- -
20 96 100 100 100
- - -
- 12 12 12 12
- -
- -
- -
- -
1,000 3,600 3,000 3,000 3,000
- 6,000 6,000 6,000 6,000
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- - 200 -
- -
- -
- 1,200 1,500 -
- -
- -
- -
- -
- -
-
-
-
-
- 3 3 3
-
JUMLAH
YANG MEMINTA/MELAPOR YANG MENERIMA

KEPALA UPTD PUSKESMAS PETUGAS OBAT PUSKESMAS
H. Yayan Karyani, SKM Elly Laviana
NIP 19630306 198603 1 026 NIP. 19630102 199603 2 001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
PUSKESMAS :GANEAS PELAPORAN/PERIODE APRIL S/D MEI DOKUMEN NOMOR TANGGAL

KECAMATAN : GANEAS PERMINTAAN/PERIODE JUNI S/D AGUSTUS PUSKESMAS 800/091/PKM GNS/VI/2020 4-Jun-20
KABUPATEN : SUMEDANG DINKES 217/FARM/VI/2020 11 Juni 2020
UPTD Farmasi
PEMBERIAN
NO NAMA OBAT SATUAN STOCK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOCK STOCK OPT PERMINTAAN KET
APBD APBD DAK APBN LAIN2 JUMLAH
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 Acetyl Cysteine 200 mg Kapsul - - - - 10,000 3,000 3,000
2 Alat Suntik 0,05ml Buah - - - - -
3 Alat Suntik Sekali Pakai 0.5 ml Pcs - - - - -
4 Alat Suntik Sekali Pakai 1 ml Pcs 500 - 500 500 - 600 600 600 600
5 Alat Suntik Sekali Pakai 10 ml (Aximed) Buah - - - - -
6 Alat Suntik Sekali Pakai 10 ml (Top Point) Buah - - - - -
7 Alat Suntik Sekali Pakai 2,5 ml Pcs - - - - -
8 Alat Suntik Sekali Pakai 20 ml Buah - - - - -
9 Alat Suntik Sekali Pakai 3 ml Pcs - - - - -
12 Albendazol 400 mg Tablet - - - - -
13 Alkohol Swab ( PT. Bio Axion Healthindo) Sase - - - - -
14 Alkohol Swab CHG + 0,5 % (e-care) Pcs - - - - -
15 Alopurinol tablet 100 mg Tablet 800 - 800 800 960 1,000 1,000 1,000
16 Alopurinol tablet 300 mg Tablet 700 - 700 700 840 900 -
17 Ambroxol Sirup Botol - - - - -
18 Ambroxol Tablet 30 mg Tablet - - - - -
19 Aminofilin Inj 24 mg/ml-10 ml Ampul - - - - -
20 Aminofilin Tablet 200 mg Tablet - - - - -
21 Amitriptilina HCl tablet salut 25 mg Tablet - - - - -
22 Amlodipin tablet 10 mg Tablet - 1,800 1,800 1,800 - 360 -
23 Amlodipin tablet 5 mg Tablet - 1,800 1,800 1,800 - 360 -
24 Amoksilin 500 mg Kaplet 4,900 10,000 14,900 14,900 - 2,980 -
25 Amoksilin Kapsul 250 mg Kapsul - - - - -
26 Amoksilin sirup kering 125 mg/5ml Botol - - - - - 300 -
27 Amoksilin sirup kering 125 mg/5ml Botol - - - - -
28 Amoksilin sirup kering forte 250 mg/5ml Botol - 500 500 500 - 100 -
29 Ampisilin 1 gr inj Ampul - - - - -
30 Ampisilin Kaplet 500 mg Kaplet - - - - -
31 Ampisilin Serbuk Injeksi Vial - - - - -
32 Antalgin(Metampiron) Tablet 500 mg Tablet 5,000 - 5,000 4,000 1,000 4,800 3,000 2,000 2,000
33 Antasida DOEN I tablet kombinasi Tablet 9,000 16,800 25,800 16,800 9,000 3,360 -
34 Antasida DOEN II suspensi kombinasi Botol 300 - 300 300 360 300 300 300
35 Anti hemoroid suppositorida Supp - - - - -
36 Antifungi DOEN kombinasi : Pot - - - - -
37 Antimigren DOEN/Ergotamin kafein Tablet - - - - -
38 Antiseptik Hand Rub 5 lt Galon - - - - -
39 Antiseptik Hand Rub 500 ml Botol - - - - -
40 Antiseptik Surgical Hand Scrub 5 lt Galon - - - - -
41 Antiseptik Surgical Hand Scrub 500 ml Botol - - - - -
42 Aqua Pro Injeksi steril bebas pirogen- 20 ml Ampul - - - - -
43 Aquadest steril -500 ml Botol - 5 5 5 - 1 -
44 Asam Askorbat (VIT C) Tablet 50 mg (KF) Tablet 4,000 - 4,000 3,000 1,000 3,800 2,000 2,000 2,000
45 Asam folat tablet 0,4 mg Tablet 500 1,300 1,800 1,300 500 260 -
46 Asam Mefenamat 500 mg Tablet - - - - -
47 Asering Botol - - - - -
48 Asetosal tablet 80 mg Tablet - - - - -
49 Asetosal tablet 80 mg Tablet - - - - -
50 Asiklovir cr Tube - - - - -
51 Asiklovir tab 200 mg Tablet - - - - -
52 Asiklovir tab 400 mg Tablet - - - - -
53 Atapulgit Tablet - 1,200 1,200 1,200 - 240 -
54 Atorvastatin 10 mg Tablet - - - - -
55 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul - - - - -
56 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul - - - - -
57 Azitromisin 500 mg Kaplet - - - - -
58 Bedak Salisil serbuk 2 % Buah 60 - 60 60 72 60 -
59 Benzatin benzil penisilin 1,2 juta IU/Vial Vial - - - - -
60 Betametason Krim 0.1 % Tube - 150 150 150 - 30 -
61 Bisakodil Supp (Dulcolax) Supp - - - - -
62 Bisturi no 10 Buah - - - - -
63 Bloodseet Buah 40 40 40 8 -
64 Carpul (Articain & Adrenalin) Ampul - - - - -
65 Catgut Chromic 2/0 100 m Roll - - - - -
66 Catgut Chromic 2/0 75C + Jarum 1/2 30 MR Pcs - - - - 36 36 36
67 Catgut Chromic 3/0 75C + Jarum 1/2 22 MR Roll - - - - 36 -
68 Catgut Plain 2/0 70C + Jarum 1/2 36M R Roll - - - - -
69 Catgut Plain 3/0 70C + Jarum 3/8 19M C Roll - - - - -
70 Catgut/Benang Bedah No.2/0-3/0 dg jarum bedah Roll - - - - -
71 Cefiksim 100 mg Kapsul - - - - -
72 Cetirizine Kapsul 2,000 - 2,000 2,000 2,400 2,000 1,000 1,000
73 Citoject Pcs - - - - -
74 Clorofenol (CHKM) Ples - - - - -
75 Deksametason inj 5 mg/ml-1 ml Ampul - - - - -
76 Deksametason Tablet 0,5 mg Tablet 10,000 - 10,000 10,000 - 12,000 12,000 -
77 Devitalisasi Pasta (Non arsen) Botol - - - - -
78 Dextaco Tablet - - - - -
79 Dextrofen Syrup 60 ml Botol - - - - -
80 Difenhidramin inj 10 mg/ml Ampul - - - - -
81 Digoksin tablet 0,25 mg Tablet - - - - -
82 Dimenhidrinat tablet 50 mg Tablet - - - - -
83 Doksisiklin 100 mg Kapsul - - - - -
84 Domperidon Syrup Botol - - - - -
85 Domperidon tablet 10 mg Tablet - 1,000 1,000 1,000 - 200 -
86 Ekstrak Belladona tablet 10 mg Tablet - - - - -
87 Eosin 2% 1x100 ml Botol - - - - -
88 Epinefrina(Adrenalin) inj i.v/s.k/i.m 1 mg/ml Ampul - - - - -
89 Eritromisin 250 mg Tablet - - - - -
90 Eritromisin 500 mg Tablet - - - - -
91 Eritromisin sirup kering 200 mg/5 ml Botol - - - - -
92 Etambutol Hcl tablet 250 mg Tablet - - - - -
93 Etambutol Hcl Tablet 500 mg Tablet - - - - -
94 Etambutol Hcl Tablet 500 mg Tablet - - - - -
95 Etanol 70 %- 100 ml Botol - - - - -
96 Etanol 70% - 1 L Botol - - - - -
97 Etil Klorida semprot-100 ml Botol - - - - -
98 Eugenol Cairan Botol - - - - -
99 Female Catheter no 16 Pcs - - - - -
100 Female Catheter no 18 Pcs - - - - -
101 Fenitoin Kapsul100 mg Kapsul - - - - -
102 Fenoksimetil Penisilin tablet 250 mg Tablet - - - - -
103 Fenoksimetil Penisilin tablet 500 mg Tablet - - - - -
104 Fenol Gliserol Tetes telinga 10 % Botol - - - - -
105 Film IV Dressing 6x7 P Pcs - - - - -
106 Fitomenadion(Vit K1) inj 10 mg/ml-1ml Ampul - - - - -
107 Fitomenadion(Vit K1) inj 2 mg/ml-1ml Ampul 100 - 100 100 120 200 200 200
108 Fitomenadion(Vit K1) tablet salut gula 10 mg Tablet - - - - -
109 Fluconazol 150 mg kapsul - - - - -
110 Folley Cathether 2 way no 20 Pcs - - - - -
111 Folley Cathether no 16 Pcs - - - - -
112 Folley Cathether no 18 Pcs - - - - -
113 Furosemid tablet 40 mg Tablet - - - - -
114 Garam Oralit 200 ml air Sachet - 300 300 300 - 60 -
115 Garam Oralit 200 ml air Sachet - - - - -
116 Gentamisin Inj 40 mg/ml Vial - - - - -
117 Gentamycin Salep Kulit Tube - - - - - - -
118 Gentamycin Salep Mata Tube - - - - -
119 Gentamycin Tetes Mata Tube - - - - -
120 Gentian violet larutan 1 %-10 ml Botol - - - - -
121 Glas Lonomer Cement Set - - - - -
122 Glas Lonomer Cement Liquid Set - - - - -
123 Glibenklamid tablet 5 mg Tablet - - - - -
124 Glimepiride tablet 1 mg Tablet 700 - 700 500 200 600 500 500 500
125 Gliseril Gyayakolat tablet 100 mg Tablet 10,000 - 10,000 10,000 12,000 12,000 -
126 Glukosa Larutan infus 10% steril-500 ml Botol - - - - -
127 Glukosa Larutan infus 5% steril-500 ml Botol 20 - 20 20 24 20 20 20
128 Griseofulvin tablet 125 mg micronized Tablet - 300 300 300 - 60 -
129 Haloperidol Injeksi (Lodomer) Ampul - - - - -
130 Haloperidol Injeksi (Lodomer) Ampul - - - - -
131 Haloperidol tablet 0,5 mg Tablet - - - - -
132 Haloperidol tablet 1,5 mg Tablet - 1,500 1,500 1,500 - 1,800 1,500 1,500 1,500
133 Haloperidol tablet 2 mg Tablet - - - - -
134 Haloperidol tablet 5 mg Tablet - - - - -
135 Hansaplast 2,5 cm x 4,5 m Roll - - - - -
136 Hansaplast 7,5 cm x 4,5 m Roll 5 - 5 5 6 6 -
137 Hemafort Tablet - - - - -
138 Hidrogen Peroksida 3% (H2O2) Botol - - - - -
139 Hidroklortiazid (HCT) tablet 25 mg Tablet - - - - -
140 Hidrokortison krim 2,5 % Tube - - - - -
141 Ibuprofen sirup 100 mg/5 ml Botol - 200 200 200 - 240 200 -
142 Ibuprofen tablet 200 mg Tablet - - - - - - -
143 Ibuprofen tablet 400 mg Tablet - - - - - - -
144 Infusion set anak Set - - - - -
145 Infusion set anak Set - - - - -
146 Infusion set dewasa Set - - - - -
147 Infusion Set Dewasa Set - - - - - - -
148 Isoniazida ( INH ) tablet 100 mg Tablet - - - - -
151 Isosorbit 5 mg Tablet - - - - -
152 IV Cateter 18 Buah - - - - -
156 IV Cateter no 26 wings & port Buah - - - - -
157 IV Cateter with injection port 26 G Buah - - - - -
158 Jarum Citojek No 16 Pcs - - - - -
159 Jarum Jahit kulit No.12 Pcs - - - - -
160 Jarum Jahit Otot No.12 Pcs - - - - -
161 Kalium Permanganat Pot - - - - -
162 Kalsium Glukonat injeksi i.v 10 % Ampul - - - - 10 10 10
163 Kalsium Hidroksida Pasta Set - - - - -
164 Kalsium laktat (Kalk) tablet 500 mg Tablet 1,500 7,000 8,500 7,000 1,500 1,400 -
165 Kapas pembalut/absorben 250 mg Buah - - - - -
166 Kaptropil 12,5 mg Tablet 2,000 2,000 4,000 2,000 2,000 400 -
167 Kaptropil 25 mg Tablet - - - - -
168 Karbamazepin tablet 200 mg Tablet - - - - -
169 Karbogliserin Tetes Telinga Botol 72 - 72 72 86 96 96 96
170 Kasa hidrofil 36 m x 80 cm Roll - - - - -
171 Kasa hidrofile 3 yard x 10 cm Buah - - - - - - -
172 Kasa hidrofile 40 yard x 80 cm Roll - - - - -
173 Kasa kompres 16x16 steril Buah - - - - -
174 Kasa pembalut hidrofil 4 m x 10 cm Roll - - - - -
175 Ketokonazol 200 mg Tablet - - - - -
176 Ketokonazol Krim 2% Tube 96 - 96 - 19 115 - 4 96 96 96
177 Klindamisin 150 mg Tablet - - - - -
178 Klindamisin 300 mg Tablet - - - - -
179 Kloramfenikol kapsul 250 mg Kapsul 500 - 500 500 600 500 -
180 Kloramfenikol kapsul 250 mg Kapsul - - - - -
181 Kloramfenikol salep kulit 2 % Tube 96 - 96 96 110 96 96 96
182 Kloramfenikol salep mata 1 % Tube - - - - -
183 Kloramfenikol susp 125 ml Botol - - - - -
184 Kloramfenikol tetes telinga 3 % Ples 38 24 62 62 - 78 72 48 48
185 Klorfenariamin maleat (CTM) tablet 4 mg Tablet 3,000 5,000 8,000 5,000 3,000 1,000 -
186 Klorine Botol - - - - -
187 Klorpromazin 100 MG Tablet - - - - -
188 Klorpromazin 25 mg Tablet - - - - -
189 Klorpromazin injeksi 5 mg/ml-2ml Ampul - - - - -
190 Kotrimoksazol anak Tablet - - - - -
191 Kotrimoksazol Susp Botol - - - - 100 100 100
192 Kotrimoksazol Tablet 480 mg Tablet - - - - - - 1,000 1,000 1,000
193 Leucoplast 2,50 cm x 4,5 m Roll - - - - -
194 Leucoplast 7,50 cm x 4,5 m Roll - - -
195 Lidocain compositum inj kombinasi Ampul - - - - -
196 Lidocain Injeksi 2% Ampul - 100 100 120 100 100 100
197 Lidocain Jeli 2% Syringe - - - - -
198 Lidokain Spray Oral 10%(Xylocaine spray) Botol - - - - -
199 Lisol Botol - - - - -
200 Lodecon Forte Tablet - - - - -
201 Loratadine 10 mg Tablet - - - - -
202 Magnesium Sulfat Inj 20% Vial - - - - -
203 Magnesium Sulfat Inj 40% Ampul - - - - 10 10 10
204 Masker Karet Buah - - - - -
205 Masker Tali Buah 100 - 100 - 100 - -
206 Metformin Tablet - - - - -
207 Metildopa 250 mg / Dopamet Tablet - - - - -
208 Metilergometrin Maleat Inj Ampul - - - - 200 200 200
209 Metilergometrin Maleat tab Tablet - - - - -
210 Metilprednisolone 4 mg Tablet 3,000 - 3,000 3,000 3,600 5,000 200 200
211 Metoklopramide Inj Ampul - - - - -
212 Metoklopramide Inj Ampul - - - - -
213 Metronidazol Syrup Botol - - - - -
214 Metronidazol tablet 250 mg Tablet - - - - -
215 Metronidazol tablet 500 mg Tablet - - - - -
216 Mikonazol krim 2% Tube - - - - -
217 Mummying Pasta Botol - - - - -
218 Nasal Oxygen, O2 cannula size L/adult Pcs - - - - -
219 Nasal Oxygen, O2 cannula size M Pcs - - - - -
220 Nasal Oxygen, O2 cannula size S/infant Pcs - - - - -
221 Nasal Oxygen, O2 cannula size XS Pcs - - - - -
222 Natrium Bikarbonat tablet 500 mg Tablet - 200 200 200 - 40 3,800 3,800
223 Natrium Diklofenak Tablet - - - - -
224 Natrium Klorida Lar.infus 0,9 % steril Botol - - - - -
225 Natrium Tiroksin Tablet - - - - -
226 Nifedipin 10 mg Tablet - - - - -
227 Nistatin Suspensi 100.000 IU/ml Botol - 100 100 100 - 20 -
228 Nistatin tablet vaginal 100.000 IU/g Tablet 100 - 100 100 120 100 100 100
229 Nistatin tablet vaginal 500.000 IU/g Tablet - - - - -
230 Norit Tablet - - - - -
231 OAT Sisipan/FDC Sisipan Paket - - - - -
232 Obat antituberkolosis Kombipak Kat.I Dewasa Paket - - - - -
233 Obat antituberkulosis anak/FDC Anak Paket - - - - -
234 Obat antituberkulosis anak/FDC Anak Paket - - - - -
235 Obat antituberkulosis kategori 1/FDC 1 Paket - 10 10 10 - 12 10 10 10
236 Obat antituberkulosis kategori 1/FDC 1 Paket - - - - -
239 Obat Batuk Hitam (OBH) Cairan -100 ml Botol - - - - -
240 OBH Nusantara Menthol Botol 56 25 81 61 20 69 70 -
241 OBH Plus Botol - - - - -
242 Oksitetrasiklin HCl 1 % Salep mata Tube - - - - -
243 Oksitetrasiklin HCl inj i.m 50 mg/ml-10 ml Vial - - - - -
244 Oksitetrasiklin HCl Salep Kulit 3 % Tube 25 50 75 75 - 90 100 10 10
245 Oksitoksin inj 10 IU/ml- 1 ml Ampul 100 - 100 100 120 300 300 300
246 Oksitoksin inj 10 IU/ml- 1 ml Ampul - - - - -
247 Omeprazol Kapsul - 3,000 3,000 3,000 - 600 -
248 Omeprazol Injeksi Vial 5 - 5 5 6 5 5 5
249 Papaverin tab Tablet - - - - -
250 Paraformaldehid Tablet - - - - -
251 Parasetamol drop Botol 28 56 84 56 28 11 -
252 Parasetamol sirup 120 mg / 5ml Botol - 300 300 300 - 60 -
253 Parasetamol tablet 500 mg Tablet 9,000 16,800 25,800 16,800 9,000 3,360 -
254 Parasetamol tablet 100 mg Tablet - - - - -
255 Pehakain Ampul - - - - -
256 Permetrin Krim 5% (Scabimite) Tube - - - - -
257 Permetrin Krim 5% (Scabimite) Tube - - - - -
258 PGA 2 75 C + Jarum 1/2 40 M Pcs - - - - -
259 Piralent Inj Ampul - - - - -
260 Pirantel Pamoat 125 mg Tablet - - - - -
261 Pirazinamid 500 mg Tablet - - - - -
262 Piridoksin HCl (Vit B6) tablet 10 mg Tablet 1,000 2,000 3,000 3,000 3,600 2,000 2,000 2,000
263 Piroxicam 10 mg Tablet - - - - 5,000 500 500
264 Plester 5 yard x 2 inch Roll - - - - -
265 Plester 7,5 cm x 5 m Buah - - - - -
266 Polypropylene 2/0 75C + Jarum 3/8 26m Pcs - - - - -
267 Povidon Iodiada 10 %-30 ml Botol - - - - -
270 Prednison tablet 5 mg Tablet - - - - 2,000 2,000
271 Probenesid 500 mg Tablet - - - - -
272 Propanolol HCl tablet 10 mg Tablet - - - - -
273 Propanolol HCl tablet 40 mg Tablet - - - - -
274 Propiltiourasil tablet 100 mg Tablet - - - - -
275 Ranitidin inj Ampul - - - - -
276 Ranitidine 150 mg Tablet - - - - -
277 Retinol (VIT A) Kapsul 100.000 IU Kapsul - - - - 250 250 250
278 Retinol (VIT A) Kapsul 200.000 IU Kapsul - - - - 1,750 1,750 1,750
279 Rifampisin kapsul 300 mg Kapsul - - - - -
280 Rifampisin kapsul 450 mg Kapsul - - - - -
281 Ringer Laktat Larutan Infus Steril Botol - - - - -
282 Rivanol 300 ml Botol - - - - -
283 Salbutamol tablet 2 mg Tablet - 1,200 1,200 1,200 - 240 -
284 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 % Pot - - - - -
285 Salisil Spiritus Botol - - - - -
286 Sarung Tangan non steril no 6,5 Pasang - - - - -
287 Sarung Tangan non steril no 7 Pasang - - - - -
288 Sarung Tangan non steril no 7,5 Pasang - - - - -
289 Sarung Tangan Obgyn steril Pasang - - - - -
290 Sarung tangan steril no 6,5 Pasang - - - - -
291 Sarung tangan steril no 7 Pasang - - - - -
292 Sarung tangan steril no 7,5 Pasang - - - - -
293 Scandonest Ampul - - - - -
294 Seledril Tablet Tablet - - - - -
295 Semen Seng Fosfat Serbuk Cairan Set - - - - -
296 Semillas non Woven Medical Tape Pcs - - - - -
297 Sepadroxil 500 mg Tablet - - - - -
298 Sepadroxil Syrup Kering 125 mg/5 ml Botol - - - - -
299 Serum anti tetanus (ATS) / Biosat Ampul - - - - -
300 Serum anti tetanus (ATS) / Tetagam Ampul - - - - -
301 Serum antibisa ular Polivalen inj 5 ml (SABU) I Ampul - - - - -
302 Silk 2/0 75 C + Jarum 1/2 30M R Sase - - - - - - 24 24 24
303 Silk 3/0 75 C + Jarum 1/2 17M R Sase - - - - -
304 Silk 3/0 75 C + Jarum 3/8 26M C Sase - - - - - - -
305 Silk Black 2/0 DS 24 MM Sase - - - - -
306 Silk Black 2/0 HR 26 MM Sase - - - - - - -
307 Silk Black 3/0 DS 24 MM Sase - - - - 36 -
308 Silk Black 3/0 HR 26 MM Sase - - - - - - -
309 Silk Black PFM 2/0 100 m Roll - - - - -
310 Simvastatin tablet 10 mg Tablet - - - - -
311 Simvastatin tablet 20 mg Tablet - 1,500 1,500 1,500 - 300 -
312 Siprofloksasin 500 mg Tablet 1,000 - 1,000 1,000 1,200 1,200 -
313 Softanol antimicrobial 500 ml Botol - - - - -
314 Softanol antimicrobial galon 5 liter Galon - - - - -
315 Softanol antimicrobial galon 5 liter Galon - - - - -
316 Solacort krim /Armacort Tube - - - - -
317 Solafluz Botol - - - - -
318 Soldextam Tablet - - - - -
319 Solvitral Tablet - 500 500 500 - 100 -
320 Spironolakton 25 mg Tablet - - - - -
321 Streptomisin Inj Vial - - - - -
322 Sulfasetamid Natrium Tetes mata 15 % Ples - - - - -
323 Tablet Tambah darah kombinasi : Besi II Sulfat Tablet - - - - 9,600 9,600 9,600
324 Tablet Tambah darah kombinasi : Besi II Sulfat Tablet - - - - -
325 Temporary Filling Material (Fermin) Botol - - - - -
326 Temporary Stopping Fletcher serbuk &cairan Set - - - - -
327 Tetrakain HCl tetes mata 0,5 % Botol - - - - -
328 Tetrasiklin Kapsul 250 mg Kapsul - - - - -
329 Tetrasiklin Kapsul 500 mg Kapsul - - - - -
330 Tiamin HCL (Vit B1) tablet 50 mg Tablet - 7,000 7,000 7,000 - 1,400 -
331 Transfusion Set Set - - - - -
332 Triheksifenidil HCl tablet 2 mg Tablet - 1,200 1,200 1,200 - 1,440 1,000 1,000 1,000
333 Trikesol Formalin (TKF) Botol - - - - -
334 Trikesol Formalin (TKF) Botol - - - - -
335 Truvit Syr Botol 20 100 120 100 20 20 -
336 Umbilical cord klem steril Pcs - - - - - - -
337 Urine Drainage Bag, T valve with hanger Pcs - 12 12 12 - 2 -
338 Ventolin nebules Nebule - - - - -
339 Viorex no rinse antimicrobial Galon - - - - -
340 Viorex no rinse antimicrobial Botol - - - - -
341 Vitamin B 12 Injeksi Ampul - - - - -
342 Vitamin B 12 tab Tablet 1,000 3,000 4,000 3,000 1,000 600 -
343 Vitamin B Kompleks tablet Tablet - 6,000 6,000 4,000 2,000 6,000 4,000 4,000 4,000
344 Widabest Botol - - - - -
345 Wing Nedle no 25 Tablet - - - - -
346 Zink Tablet - - - - -
347 Zink Tablet - - - - -
348 Dextaco Tablet - - - - -
349 Dextrofen Syrup 60 ml Botol - - - - -
350 Hemafort Tablet - - - - -
351 Lodecon Forte Tablet - - - - -
352 Scandonest Ampul - - - - -
353 Seledril Tablet Tablet - - - - -
354 Solacort krim /Armacort Tube - - - - - - 100 -
355 Solafluz Botol - - - - -
356 Soldextam Tablet - - - - -
357 Solvitral Tablet - - - - - - -
358 Truvit Syr Botol - - - - -
359 Widabest Botol - - - - -
360 Camabion Tablet - - - - -
361 Diazepam inj 5 mg/ml-2 ml Ampul 5 - 5 5 6 5 5 5
362 Diazepam tablet 2 mg Tablet - - - - -
363 Diazepam tablet 5 mg Tablet - - 100 100 100
364 Fenobarbital inj 50 mg/ml-2ml Ampul - - -
365 Fenobarbital tablet 30 mg Tablet 500 - 500 500 600 600 600 600
366 Stesolid (Diazepam Rectal) Tube 10 - 10 10 12 10 10 10
367 MB Dewasa Blister - 3 3 2 - 3 2 2 2
-
7899
MENGETAHUI YANG MENYERAHKAN YANG MEMINTA/MELAPOR YANG MENERIMA

KEPALA DINKES KAB. SUMEDANG KEPALA UPTD GFK SUMEDANG KEPALA UPTD PUSKESMAS PETUGAS OBAT PUSKESMAS
Dadang Sulaeman,.S,Sos., M.Kes Acep Umar Somali, SKM H. Yayan Karyani, SKM Elly Laviana
NIP. 19701126 199303 1 006 NIP. 19630807 198502 1 001 NIP 19630306 198603 1 026 NIP. 19630102 199603 2 001
PUSKESMAS :GANEAS PELAPORAN/PERIODE
KECAMATAN : GANEAS PERMINTAAN/PERIODE
NO NAMA OBAT SATUAN STOCK AWAL

1 2 3 4
1 Acetyl Cysteine 200 mg Kapsul
2 Alat Suntik 0,05ml Buah
3 Alat Suntik Sekali Pakai 0.5 ml Pcs
4 Alat Suntik Sekali Pakai 1 ml Pcs -
5 Alat Suntik Sekali Pakai 10 ml (Aximed) Buah
6 Alat Suntik Sekali Pakai 10 ml (Top Point) Buah
7 Alat Suntik Sekali Pakai 2,5 ml Pcs
8 Alat Suntik Sekali Pakai 20 ml Buah
9 Alat Suntik Sekali Pakai 3 ml Pcs
12 Albendazol 400 mg Tablet
13 Alkohol Swab ( PT. Bio Axion Healthindo) Sase
14 Alkohol Swab CHG + 0,5 % (e-care) Pcs
15 Alopurinol tablet 100 mg Tablet
16 Alopurinol tablet 300 mg Tablet 1,000
17 Ambroxol Sirup Botol
18 Ambroxol Tablet 30 mg Tablet
19 Aminofilin Inj 24 mg/ml-10 ml Ampul
20 Aminofilin Tablet 200 mg Tablet
21 Amitriptilina HCl tablet salut 25 mg Tablet
22 Amlodipin tablet 10 mg Tablet -
23 Amlodipin tablet 5 mg Tablet 1,800
24 Amoksilin 500 mg Kaplet 20,000
25 Amoksilin Kapsul 250 mg Kapsul 200
26 Amoksilin sirup kering 125 mg/5ml Botol -
27 Amoksilin sirup kering 125 mg/5ml Botol
28 Amoksilin sirup kering forte 250 mg/5ml Botol -
29 Ampisilin 1 gr inj Ampul
30 Ampisilin Kaplet 500 mg Kaplet
31 Ampisilin Serbuk Injeksi Vial
32 Antalgin(Metampiron) Tablet 500 mg Tablet 2,000
33 Antasida DOEN I tablet kombinasi Tablet 9,000
34 Antasida DOEN II suspensi kombinasi Botol
35 Anti hemoroid suppositorida Supp
36 Antifungi DOEN kombinasi : Pot
37 Antimigren DOEN/Ergotamin kafein Tablet
38 Antiseptik Hand Rub 5 lt Galon
39 Antiseptik Hand Rub 500 ml Botol
40 Antiseptik Surgical Hand Scrub 5 lt Galon
41 Antiseptik Surgical Hand Scrub 500 ml Botol
42 Aqua Pro Injeksi steril bebas pirogen- 20 ml Ampul
43 Aquadest steril -500 ml Botol -
44 Asam Askorbat (VIT C) Tablet 50 mg (KF) Tablet 1,000
45 Asam folat tablet 0,4 mg Tablet 500
46 Asam Mefenamat 500 mg Tablet 5,000
47 Asering Botol
48 Asetosal tablet 80 mg Tablet
50 Asiklovir cr Tube
51 Asiklovir tab 200 mg Tablet
53 Atapulgit Tablet -
54 Atorvastatin 10 mg Tablet
55 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul
57 Azitromisin 500 mg Kaplet
58 Bedak Salisil serbuk 2 % Buah 60
59 Benzatin benzil penisilin 1,2 juta IU/Vial Vial
60 Betametason Krim 0.1 % Tube 100
61 Bisakodil Supp (Dulcolax) Supp
62 Bisturi no 10 Buah
63 Bloodseet Buah
64 Carpul (Articain & Adrenalin) Ampul
65 Catgut Chromic 2/0 100 m Roll
66 Catgut Chromic 2/0 75C + Jarum 1/2 30 MR Pcs
67 Catgut Chromic 3/0 75C + Jarum 1/2 22 MR Roll
68 Catgut Plain 2/0 70C + Jarum 1/2 36M R Roll
69 Catgut Plain 3/0 70C + Jarum 3/8 19M C Roll
70 Catgut/Benang Bedah No.2/0-3/0 dg jarum bedah Roll
71 Cefiksim 100 mg Kapsul
72 Cetirizine Kapsul
73 Citoject Pcs
74 Clorofenol (CHKM) Ples
75 Deksametason inj 5 mg/ml-1 ml Ampul
76 Deksametason Tablet 0,5 mg Tablet 10,000
77 Devitalisasi Pasta (Non arsen) Botol
78 Dextaco Tablet
79 Dextrofen Syrup 60 ml Botol
80 Difenhidramin inj 10 mg/ml Ampul
81 Digoksin tablet 0,25 mg Tablet
82 Dimenhidrinat tablet 50 mg Tablet
83 Doksisiklin 100 mg Kapsul
84 Domperidon Syrup Botol
85 Domperidon tablet 10 mg Tablet -
86 Ekstrak Belladona tablet 10 mg Tablet
87 Eosin 2% 1x100 ml Botol
88 Epinefrina(Adrenalin) inj i.v/s.k/i.m 1 mg/ml Ampul
89 Eritromisin 250 mg Tablet
91 Eritromisin sirup kering 200 mg/5 ml Botol
92 Etambutol Hcl tablet 250 mg Tablet
93 Etambutol Hcl Tablet 500 mg Tablet
95 Etanol 70 %- 100 ml Botol
96 Etanol 70% - 1 L Botol
97 Etil Klorida semprot-100 ml Botol
98 Eugenol Cairan Botol
99 Female Catheter no 16 Pcs
101 Fenitoin Kapsul100 mg Kapsul
102 Fenoksimetil Penisilin tablet 250 mg Tablet
104 Fenol Gliserol Tetes telinga 10 % Botol
105 Film IV Dressing 6x7 P Pcs
106 Fitomenadion(Vit K1) inj 10 mg/ml-1ml Ampul
108 Fitomenadion(Vit K1) tablet salut gula 10 mg Tablet
109 Fluconazol 150 mg kapsul
110 Folley Cathether 2 way no 20 Pcs
111 Folley Cathether no 16 Pcs
113 Furosemid tablet 40 mg Tablet 600
114 Garam Oralit 200 ml air Sachet -
115 Garam Oralit 200 ml air Sachet
116 Gentamisin Inj 40 mg/ml Vial
117 Gentamycin Salep Kulit Tube -
118 Gentamycin Salep Mata Tube
119 Gentamycin Tetes Mata Tube 120
120 Gentian violet larutan 1 %-10 ml Botol
121 Glas Lonomer Cement Set
122 Glas Lonomer Cement Liquid Set
123 Glibenklamid tablet 5 mg Tablet
124 Glimepiride tablet 1 mg Tablet 200
125 Gliseril Gyayakolat tablet 100 mg Tablet
126 Glukosa Larutan infus 10% steril-500 ml Botol
128 Griseofulvin tablet 125 mg micronized Tablet -
129 Haloperidol Injeksi (Lodomer) Ampul
131 Haloperidol tablet 0,5 mg Tablet
132 Haloperidol tablet 1,5 mg Tablet -
133 Haloperidol tablet 2 mg Tablet
135 Hansaplast 2,5 cm x 4,5 m Roll
136 Hansaplast 7,5 cm x 4,5 m Roll 6
137 Hemafort Tablet
138 Hidrogen Peroksida 3% (H2O2) Botol
139 Hidroklortiazid (HCT) tablet 25 mg Tablet
140 Hidrokortison krim 2,5 % Tube 120
141 Ibuprofen sirup 100 mg/5 ml Botol -
142 Ibuprofen tablet 200 mg Tablet -
144 Infusion set anak Set
146 Infusion set dewasa Set
147 Infusion Set Dewasa Set -
148 Isoniazida ( INH ) tablet 100 mg Tablet
151 Isosorbit 5 mg Tablet
152 IV Cateter 18 Buah
156 IV Cateter no 26 wings & port Buah
157 IV Cateter with injection port 26 G Buah
158 Jarum Citojek No 16 Pcs
159 Jarum Jahit kulit No.12 Pcs
160 Jarum Jahit Otot No.12 Pcs
161 Kalium Permanganat Pot
162 Kalsium Glukonat injeksi i.v 10 % Ampul
163 Kalsium Hidroksida Pasta Set
164 Kalsium laktat (Kalk) tablet 500 mg Tablet 4,000
165 Kapas pembalut/absorben 250 mg Buah
166 Kaptropil 12,5 mg Tablet
167 Kaptropil 25 mg Tablet
168 Karbamazepin tablet 200 mg Tablet
169 Karbogliserin Tetes Telinga Botol
170 Kasa hidrofil 36 m x 80 cm Roll 3
171 Kasa hidrofile 3 yard x 10 cm Buah -
172 Kasa hidrofile 40 yard x 80 cm Roll
173 Kasa kompres 16x16 steril Buah
174 Kasa pembalut hidrofil 4 m x 10 cm Roll
175 Ketokonazol 200 mg Tablet
176 Ketokonazol Krim 2% Tube 115
177 Klindamisin 150 mg Tablet
179 Kloramfenikol kapsul 250 mg Kapsul
181 Kloramfenikol salep kulit 2 % Tube
182 Kloramfenikol salep mata 1 % Tube
183 Kloramfenikol susp 125 ml Botol
184 Kloramfenikol tetes telinga 3 % Ples -
185 Klorfenariamin maleat (CTM) tablet 4 mg Tablet
186 Klorine Botol
187 Klorpromazin 100 MG Tablet
188 Klorpromazin 25 mg Tablet
189 Klorpromazin injeksi 5 mg/ml-2ml Ampul
190 Kotrimoksazol anak Tablet
191 Kotrimoksazol Susp Botol
192 Kotrimoksazol Tablet 480 mg Tablet -
195 Lidocain compositum inj kombinasi Ampul
196 Lidocain Injeksi 2% Ampul
197 Lidocain Jeli 2% Syringe
198 Lidokain Spray Oral 10%(Xylocaine spray) Botol
199 Lisol Botol
200 Lodecon Forte Tablet
201 Loratadine 10 mg Tablet
202 Magnesium Sulfat Inj 20% Vial
203 Magnesium Sulfat Inj 40% Ampul
204 Masker Karet Buah
205 Masker Tali Buah 100
206 Metformin Tablet
207 Metildopa 250 mg / Dopamet Tablet
208 Metilergometrin Maleat Inj Ampul
209 Metilergometrin Maleat tab Tablet
210 Metilprednisolone 4 mg Tablet
211 Metoklopramide Inj Ampul
213 Metronidazol Syrup Botol
214 Metronidazol tablet 250 mg Tablet 2,000
215 Metronidazol tablet 500 mg Tablet
216 Mikonazol krim 2% Tube
217 Mummying Pasta Botol
218 Nasal Oxygen, O2 cannula size L/adult Pcs
219 Nasal Oxygen, O2 cannula size M Pcs
220 Nasal Oxygen, O2 cannula size S/infant Pcs
221 Nasal Oxygen, O2 cannula size XS Pcs
222 Natrium Bikarbonat tablet 500 mg Tablet 4,800
223 Natrium Diklofenak Tablet 5,600
224 Natrium Klorida Lar.infus 0,9 % steril Botol 40
225 Natrium Tiroksin Tablet
226 Nifedipin 10 mg Tablet
227 Nistatin Suspensi 100.000 IU/ml Botol -
228 Nistatin tablet vaginal 100.000 IU/g Tablet
230 Norit Tablet
231 OAT Sisipan/FDC Sisipan Paket
232 Obat antituberkolosis Kombipak Kat.I Dewasa Paket
233 Obat antituberkulosis anak/FDC Anak Paket
235 Obat antituberkulosis kategori 1/FDC 1 Paket -
236 Obat antituberkulosis kategori 1/FDC 1 Paket
239 Obat Batuk Hitam (OBH) Cairan -100 ml Botol
240 OBH Nusantara Menthol Botol
241 OBH Plus Botol
242 Oksitetrasiklin HCl 1 % Salep mata Tube
243 Oksitetrasiklin HCl inj i.m 50 mg/ml-10 ml Vial
244 Oksitetrasiklin HCl Salep Kulit 3 % Tube -
245 Oksitoksin inj 10 IU/ml- 1 ml Ampul
247 Omeprazol Kapsul 6,000
248 Omeprazol Injeksi Vial
249 Papaverin tab Tablet
250 Paraformaldehid Tablet
251 Parasetamol drop Botol 28
252 Parasetamol sirup 120 mg / 5ml Botol 300
253 Parasetamol tablet 500 mg Tablet 9,000
254 Parasetamol tablet 100 mg Tablet
255 Pehakain Ampul
256 Permetrin Krim 5% (Scabimite) Tube
258 PGA 2 75 C + Jarum 1/2 40 M Pcs
259 Piralent Inj Ampul
260 Pirantel Pamoat 125 mg Tablet
261 Pirazinamid 500 mg Tablet
262 Piridoksin HCl (Vit B6) tablet 10 mg Tablet
263 Piroxicam 10 mg Tablet
264 Plester 5 yard x 2 inch Roll
265 Plester 7,5 cm x 5 m Buah
266 Polypropylene 2/0 75C + Jarum 3/8 26m Pcs
267 Povidon Iodiada 10 %-30 ml Botol
268 Povidon Iodiada 10 %-300 ml Botol 7
270 Prednison tablet 5 mg Tablet
271 Probenesid 500 mg Tablet
272 Propanolol HCl tablet 10 mg Tablet
274 Propiltiourasil tablet 100 mg Tablet
275 Ranitidin inj Ampul
276 Ranitidine 150 mg Tablet
277 Retinol (VIT A) Kapsul 100.000 IU Kapsul
279 Rifampisin kapsul 300 mg Kapsul
281 Ringer Laktat Larutan Infus Steril Botol 80
282 Rivanol 300 ml Botol
283 Salbutamol tablet 2 mg Tablet 1,000
284 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 % Pot
285 Salisil Spiritus Botol
286 Sarung Tangan non steril no 6,5 Pasang
287 Sarung Tangan non steril no 7 Pasang
289 Sarung Tangan Obgyn steril Pasang
290 Sarung tangan steril no 6,5 Pasang
291 Sarung tangan steril no 7 Pasang
293 Scandonest Ampul
294 Seledril Tablet Tablet
295 Semen Seng Fosfat Serbuk Cairan Set
296 Semillas non Woven Medical Tape Pcs
297 Sepadroxil 500 mg Tablet
298 Sepadroxil Syrup Kering 125 mg/5 ml Botol
299 Serum anti tetanus (ATS) / Biosat Ampul
300 Serum anti tetanus (ATS) / Tetagam Ampul
301 Serum antibisa ular Polivalen inj 5 ml (SABU) I Ampul
302 Silk 2/0 75 C + Jarum 1/2 30M R Sase -
303 Silk 3/0 75 C + Jarum 1/2 17M R Sase
304 Silk 3/0 75 C + Jarum 3/8 26M C Sase -
305 Silk Black 2/0 DS 24 MM Sase
306 Silk Black 2/0 HR 26 MM Sase -
309 Silk Black PFM 2/0 100 m Roll
310 Simvastatin tablet 10 mg Tablet
311 Simvastatin tablet 20 mg Tablet -
312 Siprofloksasin 500 mg Tablet 2,000
313 Softanol antimicrobial 500 ml Botol
314 Softanol antimicrobial galon 5 liter Galon
316 Solacort krim /Armacort Tube
317 Solafluz Botol
318 Soldextam Tablet
319 Solvitral Tablet -
320 Spironolakton 25 mg Tablet
321 Streptomisin Inj Vial
322 Sulfasetamid Natrium Tetes mata 15 % Ples
323 Tablet Tambah darah kombinasi : Besi II Sulfat Tablet
325 Temporary Filling Material (Fermin) Botol
326 Temporary Stopping Fletcher serbuk &cairan Set
327 Tetrakain HCl tetes mata 0,5 % Botol
328 Tetrasiklin Kapsul 250 mg Kapsul
330 Tiamin HCL (Vit B1) tablet 50 mg Tablet -
331 Transfusion Set Set
332 Triheksifenidil HCl tablet 2 mg Tablet -
333 Trikesol Formalin (TKF) Botol
335 Truvit Syr Botol
336 Umbilical cord klem steril Pcs -
337 Urine Drainage Bag, T valve with hanger Pcs -
338 Ventolin nebules Nebule
339 Viorex no rinse antimicrobial Galon
340 Viorex no rinse antimicrobial Botol
341 Vitamin B 12 Injeksi Ampul
342 Vitamin B 12 tab Tablet 1,000
343 Vitamin B Kompleks tablet Tablet 2,000
344 Widabest Botol
345 Wing Nedle no 25 Tablet
346 Zink Tablet
347 Zink Tablet
348 Dextaco Tablet
350 Hemafort Tablet
354 Solacort krim /Armacort Tube -
355 Solafluz Botol
359 Widabest Botol
360 Camabion Tablet
361 Diazepam inj 5 mg/ml-2 ml Ampul
367 MB Dewasa Blister -
BAYAR
MENGETAHUI
KEPALA DINKES KAB. SUMEDANG
Dadang Sulaeman,.S,Sos., M.Kes
NIP. 19701126 199303 1 006
(LPLPO)
ORAN/PERIODE MEI S/D JUNI

NTAAN/PERIODE AGUSTUS S/D SEPTEMBER
PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOCK STOCK OPT

5 6 7 8 9
3,000 3,000 3,000 3,600
- - - -
- - - -
600 600 600 120
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
1,000 1,000 1,000 200
- 1,000 1,000 1,200
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 1,800 - 1,800 2,160
- 20,000 20,000 24,000
- 200 200 240
- - - -
- - - -
- - -
- - - -
- - - -
- - - -
2,000 4,000 4,000 4,800
- 9,000 9,000 10,800
300 300
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
2,000 3,000 3,000 600
- 500 500 100
- 5,000 5,000 6,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 60 60 72
- -
- 100 100 120
- - - -
- - - -
- - - -
- - - -
- - - -
36 36 36 43
- - - -
- - - -
- - - -
- - - -
- - - -
1,000 1,000 1,000
- - - -
- - - -
- - - -
- 10,000 10,000 12,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - -
- - - -
- - - -
200 200 200 240
- - - -
- - - -
- - - -
- - - -
- - - -
- 600 600 720
- - - -
- - - -
- - - -
- - - -
- - - -
- 120 120 142
- - - -
- - - -
- - - -
- - - -
500 700 700 140
- - - -
- - - -
20 20 20 24
- - - -
- - - -
- - - -
- - - -
1,500 1,500 1,500
- - - -
- - - -
- - - -
- 6 6 7
- - - -
- - - -
- - - -
- 120 120 144
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
10 10 10 2
- - - -
- 4,000 4,000 4,800
- - - -
- -
- - -
- - -
96 96 72 24 87
- 3 3 4
- - - -
- - - -
- - - -
- - - -
- - - -
96 211 211
- - - -
- - - -
- - - -
- - - -
96 96 96
- - - -
- - - -
48 48 48 58
- - -
- - - -
- - - -
- - - -
- - - -
- - - -
100 100 100 120
1,000 1,000 1,000 1,200
- - - -
- -
- - - -
100 100 100 120
- - - -
- - - -
- - - -
- - - -
- - -
- - - -
10 10 10
- - - -
- 100 100
- - - -
- - - -
200 200 200
- - - -
- - -
- - - -
- - - -
- - - -
- 2,000 2,000 2,400
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
4,800 4,800 5,760
- 5,600 5,600 6,720
- 40 40 48
- - - -
- - - -
- - - -
100 100 100
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
10 10 10 2
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
10 10 10
300 300 300
- - - -
- 6,000 6,000 7,200
5 5 5
- - - -
- - - -
- 28 28
- 300 300 360
- 9,000 9,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
2,000 2,000 2,000 2,400
500 500 500
- - - -
- - - -
- - - -
- - - -
- 7 5 2 3
- - - -
2,000 2,000 2,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
250 250 250 50
1,750 1,750 1,750
- - - -
- - - -
- 80 60 20 72
- - - -
- 1,000 1,000 1,200
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
24 24 24 30
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 2,000 2,000 2,400
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
9,600 9,600 9,600
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
1,000 1,000 1,000
- - - -
- - - -
- - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- 1,000 1,000
4,000 6,000 6,000
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
5 5 5
- - - -
100 -
- -
600 500 500
10 10 10
2 2 2
TDK BAYAR JUMLAH

6980
YANG MENYERAHKAN YANG MEMINTA/MEL

KEPALA UPTD GFK SUMEDANG KEPALA UPTD PUSKE
Acep Umar Somali, SKM H. Yayan Karyani, S
NIP. 19630807 198502 1 001 NIP 19630306 198603
DOKUMEN NOMOR TANGGAL
PUSKESMAS 800 / 115 /PKM / VIII / 2020 4-Jun-20
DINKES 11 Juni 2020
UPTD Farmasi
PEMBERIAN
PERMINTAAN KET
10 11 12 13 14 15 16
9,000 -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1,000 -
-
-
-
-
-
-
1,800 -
20,000 -
200 -
-
-
200 -
-
800 -
-
5,000 -
16,800 -
-
-
-
-
-
-
-
-
-
-
-
-
6,000 -
-
-
-
-
-
-
-
-
-
-
-
70 -
-
125 -
-
-
-
-
-
72 -
-
-
-
-
5,000 -
-
-
-
10 -
12,000 -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
300 -
-
-
-
-
-
600 -
-
-
-
-
-
120 -
-
-
-
-
-
10,000 -
-
20 -
300 -
-
-
-
-
-
-
20 -
10 -
-
-
-
144 -
-
-
-
-
-
-
-
-
-
-
-
50 -
50 -
-
-
-
-
-
-
-
-
-
-
4,000 -
-
-
2,000 -
-
72 -
4 -
-
-
-
-
-
-
-
-
-
200 -
-
-
-
48 -
-
-
-
-
-
-
100 -
2,000 -
20 -
10 -
-
100 -
-
-
-
-
1,000 -
-
-
-
-
-
-
-
-
10,000 -
-
-
-
3,000 -
-
-
-
-
-
-
-
4,800 -
5,600 -
40 -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
200 -
-
-
-
100 -
-
-
6,000 -
-
-
-
-
300 -
16,800 -
-
-
-
-
-
-
-
-
2,000 -
2,000 -
20 -
10 -
-
-
3 -
-
4,000 -
-
-
-
-
-
1,000 -
-
350 -
-
-
60 -
-
1,000 -
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
24 -
-
-
-
-
-
-
-
-
1,000 -
3,000 -
-
-
-
100 -
-
-
-
-
-
-
21,300 -
-
-
-
-
-
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YANG MEMINTA/MELAPOR YANG MENERIMA

KEPALA UPTD PUSKESMAS PETUGAS OBAT PUSKESMAS
H. Yayan Karyani, SKM Elly Laviana
NIP 19630306 198603 1 026 NIP. 19630102 199603 2 001
(LPLPO)
PUSKESMAS :GANEAS PELAPORAN/PERIODE AGUSTUS S/D SEPTEMBER DOKUMEN NOMOR TANGGAL

KECAMATAN : GANEAS PERMINTAAN/PERIODE OKTOBER S/D NOPEMBER PUSKESMAS 800 / 115 /PKM / X / 2020 5-Oct-20
KABUPATEN : SUMEDANG DINKES 377/Farm/X/2020 10/13/2020
UPTD Farmasi
PEMBERIAN
NO NAMA OBAT SATUAN STOCK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOCK STOCK OPT PERMINTAAN KET
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 Acetyl Cysteine 200 mg Kapsul 6,000 6,000 6,000 1,200 -
2 Alat Suntik 0,05ml Buah - - - -
3 Alat Suntik Sekali Pakai 0.5 ml Pcs - - - -
4 Alat Suntik Sekali Pakai 1 ml Pcs - - - -
5 Alat Suntik Sekali Pakai 10 ml (Aximed) Buah - - - -
6 Alat Suntik Sekali Pakai 10 ml (Top Point) Buah - - - -
7 Alat Suntik Sekali Pakai 2,5 ml Pcs - - - -
8 Alat Suntik Sekali Pakai 20 ml Buah - - - -
9 Alat Suntik Sekali Pakai 3 ml Pcs 1,000 1,000 1,000 1,200 1,000 1,000 1,000
12 Albendazol 400 mg Tablet - - - -
13 Alkohol Swab ( PT. Bio Axion Healthindo) Sase - - - -
14 Alkohol Swab CHG + 0,5 % (e-care) Pcs - - - -
15 Alopurinol tablet 100 mg Tablet 1,000 1,000 1,000 1,200 1,000 1,000 1,000
16 Alopurinol tablet 300 mg Tablet 1,000 1,000 1,000 1,200 1,000 - tap
17 Ambroxol Sirup Botol - - - -
18 Ambroxol Tablet 30 mg Tablet - - - -
19 Aminofilin Inj 24 mg/ml-10 ml Ampul - - - -
20 Aminofilin Tablet 200 mg Tablet - - - -
21 Amitriptilina HCl tablet salut 25 mg Tablet - - - -
22 Amlodipin tablet 10 mg Tablet 1,800 1,800 1,800 2,160 1,800 1,800 1,800
23 Amlodipin tablet 5 mg Tablet 1,800 2,000 3,800 3,800 - 4,560 2,400 2,400 2,400
24 Amoksilin 500 mg Kaplet 20,000 20,000 20,000 4,000 -
25 Amoksilin Kapsul 250 mg Kapsul 200 200 200 40 -
26 Amoksilin sirup kering 125 mg/5ml Botol - - - 200 200 200
27 Amoksilin sirup kering 125 mg/5ml Botol - - - -
28 Amoksilin sirup kering forte 250 mg/5ml Botol 180 180 180 216 180 180 180
29 Ampisilin 1 gr inj Ampul - - - -
30 Ampisilin Kaplet 500 mg Kaplet 300 300 300 60 -
31 Ampisilin Serbuk Injeksi Vial - - - -
32 Antalgin(Metampiron) Tablet 500 mg Tablet 5,000 5,000 5,000 1,000 -
33 Antasida DOEN I tablet kombinasi Tablet 16,800 16,800 16,800 3,360 -
34 Antasida DOEN II suspensi kombinasi Botol - - -
35 Anti hemoroid suppositorida Supp - - - -
36 Antifungi DOEN kombinasi : Pot - - - -
37 Antimigren DOEN/Ergotamin kafein Tablet - - - -
38 Antiseptik Hand Rub 5 lt Galon - - - -
39 Antiseptik Hand Rub 500 ml Botol - - - -
40 Antiseptik Surgical Hand Scrub 5 lt Galon - - - -
41 Antiseptik Surgical Hand Scrub 500 ml Botol - - - -
42 Aqua Pro Injeksi steril bebas pirogen- 20 ml Ampul - - - -
43 Aquadest steril -500 ml Botol - - - -
44 Asam Askorbat (VIT C) Tablet 50 mg (KF) Tablet 2,000 2,000 2,000 2,400 2,000 2,000 2,000
45 Asam folat tablet 0,4 mg Tablet - - - -
46 Asam Mefenamat 500 mg Tablet 6,000 6,000 6,000 1,200 2,000 2,000 2,000
47 Asering Botol - - - -
48 Asetosal tablet 80 mg Tablet - - - -
49 Asetosal tablet 80 mg Tablet - - - -
50 Asiklovir cr Tube 120 120 120 144 120 120 120
51 Asiklovir tab 200 mg Tablet - - - -
52 Asiklovir tab 400 mg Tablet - - - -
53 Atapulgit Tablet - - - -
54 Atorvastatin 10 mg Tablet - - - -
55 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul - - - -
56 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul - - -
57 Azitromisin 500 mg Kaplet - - -
58 Bedak Salisil serbuk 2 % Buah 80 80 80 96 80 80 80
59 Benzatin benzil penisilin 1,2 juta IU/Vial Vial - - -
60 Betametason Krim 0.1 % Tube 125 125 125 25 -
61 Bisakodil Supp (Dulcolax) Supp - - - -
62 Bisturi no 10 Buah - - - -
63 Bloodseet Buah - - - 50 - tap
64 Carpul (Articain & Adrenalin) Ampul - - - -
65 Catgut Chromic 2/0 100 m Roll - - - -
66 Catgut Chromic 2/0 75C + Jarum 1/2 30 MR Pcs 72 72 72 86 144 - tap
67 Catgut Chromic 3/0 75C + Jarum 1/2 22 MR Roll - - - -
68 Catgut Plain 2/0 70C + Jarum 1/2 36M R Roll - - - -
69 Catgut Plain 3/0 70C + Jarum 3/8 19M C Roll - - - -
70 Catgut/Benang Bedah No.2/0-3/0 dg jarum b Roll - - - -
71 Cefiksim 100 mg Kapsul - - - -
72 Cetirizine Kapsul - - - -
73 Citoject Pcs - - - -
74 Clorofenol (CHKM) Ples 10 10 10 12 10 1 1
75 Deksametason inj 5 mg/ml-1 ml Ampul 10 10 10 2 -
76 Deksametason Tablet 0,5 mg Tablet - - - 10,000 1,000 1,000
77 Devitalisasi Pasta (Non arsen) Botol - - - -
78 Dextaco Tablet - - - -
79 Dextrofen Syrup 60 ml Botol - - - -
80 Difenhidramin inj 10 mg/ml Ampul - - - 20 20 20
81 Digoksin tablet 0,25 mg Tablet - - - -
82 Dimenhidrinat tablet 50 mg Tablet - - - -
83 Doksisiklin 100 mg Kapsul - - - -
84 Domperidon Syrup Botol - - - -
85 Domperidon tablet 10 mg Tablet - - - -
86 Ekstrak Belladona tablet 10 mg Tablet - - - -
87 Eosin 2% 1x100 ml Botol - - - -
88 Epinefrina(Adrenalin) inj i.v/s.k/i.m 1 mg/ml Ampul - - - -
89 Eritromisin 250 mg Tablet - - - -
90 Eritromisin 500 mg Tablet - - - -
91 Eritromisin sirup kering 200 mg/5 ml Botol - - - -
92 Etambutol Hcl tablet 250 mg Tablet - - - -
93 Etambutol Hcl Tablet 500 mg Tablet - - - -
94 Etambutol Hcl Tablet 500 mg Tablet - - - -
95 Etanol 70 %- 100 ml Botol 10 10 8 2 9 10 - tap
96 Etanol 70% - 1 L Botol - - - -
97 Etil Klorida semprot-100 ml Botol - - - -
98 Eugenol Cairan Botol - - - -
99 Female Catheter no 16 Pcs - - - -
100 Female Catheter no 18 Pcs - - - -
101 Fenitoin Kapsul100 mg Kapsul - - - -
102 Fenoksimetil Penisilin tablet 250 mg Tablet - - - -
103 Fenoksimetil Penisilin tablet 500 mg Tablet - - - -
104 Fenol Gliserol Tetes telinga 10 % Botol - - - -
105 Film IV Dressing 6x7 P Pcs - - - -
106 Fitomenadion(Vit K1) inj 10 mg/ml-1ml Ampul - - - -
107 Fitomenadion(Vit K1) inj 2 mg/ml-1ml Ampul 300 300 300 360 300 300 300
108 Fitomenadion(Vit K1) tablet salut gula 10 mg Tablet - - - -
109 Fluconazol 150 mg kapsul - - - -
110 Folley Cathether 2 way no 20 Pcs - - - -
111 Folley Cathether no 16 Pcs - - - -
112 Folley Cathether no 18 Pcs - - - -
113 Furosemid tablet 40 mg Tablet 600 600 600 120 -
114 Garam Oralit 200 ml air Sachet - - - -
115 Garam Oralit 200 ml air Sachet - - - -
116 Gentamisin Inj 40 mg/ml Vial - - - -
117 Gentamycin Salep Kulit Tube - - - -
118 Gentamycin Salep Mata Tube - - - -
119 Gentamycin Tetes Mata Tube 120 120 120 24 -
120 Gentian violet larutan 1 %-10 ml Botol - - - -
121 Glas Lonomer Cement Set - - - -
122 Glas Lonomer Cement Liquid Set - - - -
123 Glibenklamid tablet 5 mg Tablet - - - -
124 Glimepiride tablet 1 mg Tablet 800 800 800 960 1,000 1,000 1,000
125 Gliseril Gyayakolat tablet 100 mg Tablet - - - -
126 Glukosa Larutan infus 10% steril-500 ml Botol - - - -
127 Glukosa Larutan infus 5% steril-500 ml Botol 20 20 20 4 -
128 Griseofulvin tablet 125 mg micronized Tablet 300 300 300 60 -
129 Haloperidol Injeksi (Lodomer) Ampul - - - -
130 Haloperidol Injeksi (Lodomer) Ampul - - - -
131 Haloperidol tablet 0,5 mg Tablet - - - -
132 Haloperidol tablet 1,5 mg Tablet 2,700 2,700 2,100 600 2,520 2,000 - -
133 Haloperidol tablet 2 mg Tablet - - - -
134 Haloperidol tablet 5 mg Tablet - - - -
135 Hansaplast 2,5 cm x 4,5 m Roll - - - -
136 Hansaplast 7,5 cm x 4,5 m Roll - - - -
137 Hemafort Tablet - - - -
138 Hidrogen Peroksida 3% (H2O2) Botol - - - -
139 Hidroklortiazid (HCT) tablet 25 mg Tablet - - - -
140 Hidrokortison krim 2,5 % Tube 144 144 144 29 -
141 Ibuprofen sirup 100 mg/5 ml Botol - - - -
142 Ibuprofen tablet 200 mg Tablet - - - -
143 Ibuprofen tablet 400 mg Tablet - - - 5,000 5,000 5,000
144 Infusion set anak Set - - - -
145 Infusion set anak Set - - - -
146 Infusion set dewasa Set - - - 50 50 50
147 Infusion Set Dewasa Set - - - -
148 Isoniazida ( INH ) tablet 100 mg Tablet - - - -
151 Isosorbit 5 mg Tablet - - - -
152 IV Cateter 18 Buah 50 50 30 20 26 30 20 20
153 IV Cateter 20 Buah 50 50 30 20 26 30 20 20
154 IV Cateter 22 Buah - - - -
155 IV Cateter 24 Buah 30 30 30 36 30 20 20
156 IV Cateter no 26 wings & port Buah - - - 30 20 20
157 IV Cateter with injection port 26 G Buah - - - -
158 Jarum Citojek No 16 Pcs - - - -
159 Jarum Jahit kulit No.12 Pcs - - - -
160 Jarum Jahit Otot No.12 Pcs - - - -
161 Kalium Permanganat Pot - - - -
162 Kalsium Glukonat injeksi i.v 10 % Ampul - - - 10 10 10
163 Kalsium Hidroksida Pasta Set - - - -
164 Kalsium laktat (Kalk) tablet 500 mg Tablet 5,000 5,000 5,000 6,000 6,000 6,000 6,000
165 Kapas pembalut/absorben 250 mg Buah - - - -
166 Kaptropil 12,5 mg Tablet 4,000 4,000 4,000 4,800 4,000 4,000 4,000
167 Kaptropil 25 mg Tablet - - - -
168 Karbamazepin tablet 200 mg Tablet - - - -
169 Karbogliserin Tetes Telinga Botol 24 72 96 96 19 -
170 Kasa hidrofil 36 m x 80 cm Roll 4 4 4 1 -
171 Kasa hidrofile 3 yard x 10 cm Buah - - - -
172 Kasa hidrofile 40 yard x 80 cm Roll - - - -
173 Kasa kompres 16x16 steril Buah 3,200 3,200 3,200 3,640 3,200 - tap
174 Kasa pembalut hidrofil 4 m x 10 cm Roll - - - -
175 Ketokonazol 200 mg Tablet - - - -
176 Ketokonazol Krim 2% Tube 120 120 95 25 114 100 100 100
177 Klindamisin 150 mg Tablet - - - -
178 Klindamisin 300 mg Tablet - - - -
179 Kloramfenikol kapsul 250 mg Kapsul - - - -
180 Kloramfenikol kapsul 250 mg Kapsul - - - -
181 Kloramfenikol salep kulit 2 % Tube - - - -
182 Kloramfenikol salep mata 1 % Tube - - - -
183 Kloramfenikol susp 125 ml Botol - - - -
184 Kloramfenikol tetes telinga 3 % Ples 48 48 48 10 -
185 Klorfenariamin maleat (CTM) tablet 4 mg Tablet 10,000 10,000 10,000 12,000 10,000 10,000 10,000
186 Klorine Botol - - - -
187 Klorpromazin 100 MG Tablet - - - -
188 Klorpromazin 25 mg Tablet - - - -
189 Klorpromazin injeksi 5 mg/ml-2ml Ampul - - - -
190 Kotrimoksazol anak Tablet - - - -
191 Kotrimoksazol Susp Botol 100 100 100 20 -
192 Kotrimoksazol Tablet 480 mg Tablet 2,000 2,000 2,000 2,400 4,000 3,500 3,500
193 Leucoplast 2,50 cm x 4,5 m Roll 20 20 20 4 -
194 Leucoplast 7,50 cm x 4,5 m Roll 10 - -
195 Lidocain compositum inj kombinasi Ampul - - - -
196 Lidocain Injeksi 2% Ampul 100 100 100 120 200 200 200
197 Lidocain Jeli 2% Syringe - - - -
198 Lidokain Spray Oral 10%(Xylocaine spray) Botol - - - -
199 Lisol Botol - - - -
200 Lodecon Forte Tablet - - - -
201 Loratadine 10 mg Tablet 1,000 1,000 1,000 200 -
202 Magnesium Sulfat Inj 20% Vial - - - -
203 Magnesium Sulfat Inj 40% Ampul - - 10 -
204 Masker Karet Buah - - - -
205 Masker Tali Buah - - - -
206 Metformin Tablet 2,000 2,000 2,000 2,400 2,000 2,000 2,000
207 Metildopa 250 mg / Dopamet Tablet - - - -
208 Metilergometrin Maleat Inj Ampul - - - 200 200 200
209 Metilergometrin Maleat tab Tablet - - - -
210 Metilprednisolone 4 mg Tablet - - - -
211 Metoklopramide Inj Ampul - - - -
212 Metoklopramide Inj Ampul - - - -
213 Metronidazol Syrup Botol - - - -
214 Metronidazol tablet 250 mg Tablet - - - -
215 Metronidazol tablet 500 mg Tablet - - - 3,000 1,000 1,000
216 Mikonazol krim 2% Tube 96 96 72 24 86 96 72 72
217 Mummying Pasta Botol - - - -
218 Nasal Oxygen, O2 cannula size L/adult Pcs - - - -
219 Nasal Oxygen, O2 cannula size M Pcs - - - -
220 Nasal Oxygen, O2 cannula size S/infant Pcs - - - -
221 Nasal Oxygen, O2 cannula size XS Pcs - - - -
222 Natrium Bikarbonat tablet 500 mg Tablet - - - 4,800 4,000 4,000
223 Natrium Diklofenak Tablet 5,600 5,600 5,600 1,120 -
224 Natrium Klorida Lar.infus 0,9 % steril Botol 40 40 40 8 -
225 Natrium Tiroksin Tablet - - - -
226 Nifedipin 10 mg Tablet - - - -
227 Nistatin Suspensi 100.000 IU/ml Botol - - - -
228 Nistatin tablet vaginal 100.000 IU/g Tablet - - - -
229 Nistatin tablet vaginal 500.000 IU/g Tablet - - - -
230 Norit Tablet - - - -
231 OAT Sisipan/FDC Sisipan Paket - - - -
232 Obat antituberkolosis Kombipak Kat.I Dewasa Paket - -
233 Obat antituberkulosis anak/FDC Anak Paket 1 1 1 0 -
234 Obat antituberkulosis anak/FDC Anak Paket - - - -
235 Obat antituberkulosis kategori 1/FDC 1 Paket 15 15 15 3 18 15 15
236 Obat antituberkulosis kategori 1/FDC 1 Paket - - - -
239 Obat Batuk Hitam (OBH) Cairan -100 ml Botol - - - -
240 OBH Nusantara Menthol Botol - - - -
241 OBH Plus Botol - - - -
242 Oksitetrasiklin HCl 1 % Salep mata Tube - - - -
243 Oksitetrasiklin HCl inj i.m 50 mg/ml-10 ml Vial - - - -
244 Oksitetrasiklin HCl Salep Kulit 3 % Tube - - - -
245 Oksitoksin inj 10 IU/ml- 1 ml Ampul 200 200 200 240 300 -
246 Oksitoksin inj 10 IU/ml- 1 ml Ampul - - - -
247 Omeprazol Kapsul 3,000 3,000 3,000 3,600 3,600 - tap
248 Omeprazol Injeksi Vial - - - -
249 Papaverin tab Tablet - - - -
250 Paraformaldehid Tablet - - - -
251 Parasetamol drop Botol 131 131 102 29 122 112 112 112
252 Parasetamol sirup 120 mg / 5ml Botol 300 300 300 60 -
253 Parasetamol tablet 500 mg Tablet 11,500 15,000 26,500 20,000 6,500 24,000 18,600 17,500 17,500
254 Parasetamol tablet 100 mg Tablet - - - -
255 Pehakain Ampul - - - -
256 Permetrin Krim 5% (Scabimite) Tube - - - -
257 Permetrin Krim 5% (Scabimite) Tube 160 160 160 192 180 180 180
258 PGA 2 75 C + Jarum 1/2 40 M Pcs - - - -
259 Piralent Inj Ampul - - - -
260 Pirantel Pamoat 125 mg Tablet - - - -
261 Pirazinamid 500 mg Tablet - - - -
262 Piridoksin HCl (Vit B6) tablet 10 mg Tablet 2,000 2,000 2,000 2,400 2,000 2,000 2,000
263 Piroxicam 10 mg Tablet 500 500 500 600 3,000 300 300
264 Plester 5 yard x 2 inch Roll - - - -
265 Plester 7,5 cm x 5 m Buah - - - -
266 Polypropylene 2/0 75C + Jarum 3/8 26m Pcs - - - -
267 Povidon Iodiada 10 %-30 ml Botol - - - -
268 Povidon Iodiada 10 %-300 ml Botol 2 3 5 3 2 1 -
269 Povidon Iodiada 10 %-60 ml Botol - - - -
270 Prednison tablet 5 mg Tablet 4,000 4,000 3,000 1,000 3,600 2,000 2,000 2,000
271 Probenesid 500 mg Tablet - - - -
272 Propanolol HCl tablet 10 mg Tablet - - - -
273 Propanolol HCl tablet 40 mg Tablet - - - -
274 Propiltiourasil tablet 100 mg Tablet - - - -
275 Ranitidin inj Ampul - - - -
276 Ranitidine 150 mg Tablet 500 500 500 600 3,000 3,000 3,000
277 Retinol (VIT A) Kapsul 100.000 IU Kapsul - - - -
278 Retinol (VIT A) Kapsul 200.000 IU Kapsul 100 100 100 120 200 100 100
279 Rifampisin kapsul 300 mg Kapsul - - - -
280 Rifampisin kapsul 450 mg Kapsul - - - -
281 Ringer Laktat Larutan Infus Steril Botol 20 60 80 60 20 12 -
282 Rivanol 300 ml Botol - - - -
283 Salbutamol tablet 2 mg Tablet 1,000 1,000 1,000 200 -
284 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 % Pot - - - -
285 Salisil Spiritus Botol - - - -
286 Sarung Tangan non steril no 6,5 Pasang - - - -
287 Sarung Tangan non steril no 7 Pasang 1,250 1,250 1,250 1,500 1,500 100 100
288 Sarung Tangan non steril no 7,5 Pasang - - - -
289 Sarung Tangan Obgyn steril Pasang - - - -
290 Sarung tangan steril no 6,5 Pasang 1,000 1,000 1,000 1,200 1,200 - tap
291 Sarung tangan steril no 7 Pasang - - - -
292 Sarung tangan steril no 7,5 Pasang - - - -
293 Scandonest Ampul - - - -
294 Seledril Tablet Tablet - - - -
295 Semen Seng Fosfat Serbuk Cairan Set - - - -
296 Semillas non Woven Medical Tape Pcs - - - -
297 Sepadroxil 500 mg Tablet - - - -
298 Sepadroxil Syrup Kering 125 mg/5 ml Botol - - - -
299 Serum anti tetanus (ATS) / Biosat Ampul - - - -
300 Serum anti tetanus (ATS) / Tetagam Ampul - - - 3 3 3
301 Serum antibisa ular Polivalen inj 5 ml (SABU) Ampul - - - -
302 Silk 2/0 75 C + Jarum 1/2 30M R Sase - - - -
303 Silk 3/0 75 C + Jarum 1/2 17M R Sase - - - -
304 Silk 3/0 75 C + Jarum 3/8 26M C Sase - - - -
305 Silk Black 2/0 DS 24 MM Sase - - - -
306 Silk Black 2/0 HR 26 MM Sase 24 24 24 29 48 - tap
307 Silk Black 3/0 DS 24 MM Sase - - - -
308 Silk Black 3/0 HR 26 MM Sase - - - -
309 Silk Black PFM 2/0 100 m Roll - - - -
310 Simvastatin tablet 10 mg Tablet 1,200 1,200 1,200 1,440 1,200 1,200 1,200
311 Simvastatin tablet 20 mg Tablet 1,500 1,500 1,500 1,800 1,500 - tap
312 Siprofloksasin 500 mg Tablet 2,000 2,000 2,000 2,400 3,000 1,000 1,000
313 Softanol antimicrobial 500 ml Botol - - - -
314 Softanol antimicrobial galon 5 liter Galon - - - -
315 Softanol antimicrobial galon 5 liter Galon - - - -
317 Solafluz Botol - - - -
318 Soldextam Tablet - - - -
319 Solvitral Tablet - - - -
320 Spironolakton 25 mg Tablet - - - -
321 Streptomisin Inj Vial - - - -
322 Sulfasetamid Natrium Tetes mata 15 % Ples - - - 144 96 96
323 Tablet Tambah darah kombinasi : Besi II Sulf Tablet 14,000 14,000 14,000 2,800 14,460 9,240 9,240
324 Tablet Tambah darah kombinasi : Besi II Sulf Tablet - - - -
325 Temporary Filling Material (Fermin) Botol - - - -
326 Temporary Stopping Fletcher serbuk &cairan Set - - - -
327 Tetrakain HCl tetes mata 0,5 % Botol - - - -
328 Tetrasiklin Kapsul 250 mg Kapsul - - - -
329 Tetrasiklin Kapsul 500 mg Kapsul - - -
330 Tiamin HCL (Vit B1) tablet 50 mg Tablet 4,000 4,000 4,000 4,800 5,000 4,000 4,000
331 Transfusion Set Set - - - -
332 Triheksifenidil HCl tablet 2 mg Tablet 1,500 1,500 1,500 1,800 1,800 1,800 1,800
333 Trikesol Formalin (TKF) Botol - - - -
334 Trikesol Formalin (TKF) Botol - - - -
335 Truvit Syr Botol - - - -
336 Umbilical cord klem steril Pcs - - - -
337 Urine Drainage Bag, T valve with hanger Pcs - - - -
338 Ventolin nebules Nebule - - - -
339 Viorex no rinse antimicrobial Galon - - - -
340 Viorex no rinse antimicrobial Botol - - - -
341 Vitamin B 12 Injeksi Ampul - - - -
342 Vitamin B 12 tab Tablet 2,000 2,000 2,000 2,400 3,000 3,000 3,000
343 Vitamin B Kompleks tablet Tablet 4,000 4,000 4,000 4,800 5,000 5,000 5,000
344 Widabest Botol - - - -
345 Wing Nedle no 25 Tablet - - - -
346 Zink Tablet - - - -
347 Zink Tablet 800 800 800 960 1,000 1,000 1,000
348 Dextaco Tablet - - - -
349 Dextrofen Syrup 60 ml Botol - - - -
350 Hemafort Tablet - - - -
351 Lodecon Forte Tablet - - - -
352 Scandonest Ampul - - - -
353 Seledril Tablet Tablet - - - -
355 Solafluz Botol - - - -
356 Soldextam Tablet - - - -
357 Solvitral Tablet - - - -
358 Truvit Syr Botol - - - -
359 Widabest Botol - - - -
360 Camabion Tablet - - - -
361 Diazepam inj 5 mg/ml-2 ml Ampul 5 5 1 -
362 Diazepam tablet 2 mg Tablet - - - -
363 Diazepam tablet 5 mg Tablet - -
364 Fenobarbital inj 50 mg/ml-2ml Ampul - -
365 Fenobarbital tablet 30 mg Tablet 800 800 700 100 840 700 700 700
366 Stesolid (Diazepam Rectal) Tube 10 10 2 -
367 MB Dewasa Blister 2 2 2 3 2 2 2
-
6980

KEPALA DINKES KAB. SUMEDANG KEPALA UPTD FARMASI SUMEDANG KEPALA UPTD PUSKESMAS PETUGAS OBAT PUSKESMAS
Dadang Sulaeman,.S,Sos., M.Kes Apt.Rita Juwita,S.Farm H. Yayan Karyani, SKM Elly Laviana
NIP. 19701126 199303 1 006 NIP. 19851115 200902 2 002 NIP 19630306 198603 1 026 NIP. 19630102 199603 2 001
(LPLPO)
PUSKESMAS :GANEAS PELAPORAN/PERIODE DESEMBER 202 S/D JANUARI 2021 DOKUMEN NOMOR TANGGAL
KECAMATAN : GANEAS PERMINTAAN/PERIODE FEBRUAR 2021I S/D MARET 2021 PUSKESMAS 800 / 016.5 /PKM / X / 2021 11 Februari 2021
KABUPATEN : SUMEDANG DINKES 63/Farm/Obat/II/2021 2/16/2021
UPTD Farmasi
STOCK SISA STOCK PEMBERIAN

NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN KET
AWAL STOCK OPT APBD APBD DAK APBN LAIN2 JUMLAH
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 Acetyl Cysteine 200 mg Kapsul 3,360 2520 840 3,024 8,100 3,000 3,000
2 Alat Suntik 0,05ml Buah 500 100 400 120 -
3 Alat Suntik Sekali Pakai 0.5 ml Pcs -
4 Alat Suntik Sekali Pakai 1 ml Pcs 1,300 656 344 788 500 500 500
5 Alat Suntik Sekali Pakai 10 ml (Aximed) Buah -
6 Alat Suntik Sekali Pakai 10 ml (Top Point) Buah -
7 Alat Suntik Sekali Pakai 2,5 ml Pcs -
8 Alat Suntik Sekali Pakai 20 ml Buah -
9 Alat Suntik Sekali Pakai 3 ml Pcs 1,350 1,000 2,350 2,250 -
10 Alat Suntik Sekali Pakai 3 ml Pcs -
11 Alat Suntik Sekali Pakai 5 ml Pcs 5 95 6 300 - -
12 Albendazol 400 mg Tablet 9,519 9,519 -
13 Alkohol Swab ( PT. Bio Axion Healthindo) Sase 5,000 200 200
14 Alkohol Swab CHG + 0,5 % (e-care) Pcs -
15 Alopurinol tablet 100 mg Tablet 1,000 200 800 240 1,000 - -
16 Alopurinol tablet 300 mg Tablet -
17 Ambroxol Sirup Botol -
18 Ambroxol Tablet 30 mg Tablet -
19 Aminofilin Inj 24 mg/ml-10 ml Ampul -
20 Aminofilin Tablet 200 mg Tablet -
21 Amitriptilina HCl tablet salut 25 mg Tablet -
22 Amlodipin tablet 10 mg Tablet 1,500 1,200 2,700 900 1,800 1,080 1,500 - -
23 Amlodipin tablet 5 mg Tablet 1,500 1,200 2,700 900 1,800 1,080 1,500 - -
24 Amoksilin 500 mg Kaplet 15,600 3,200 12,400 3,840 10,000 3,000 3,000 ed dekat
25 Amoksilin Kapsul 250 mg Kapsul -
26 Amoksilin sirup kering 125 mg/5ml Botol 90 5 85 6 300 - -
27 Amoksilin sirup kering 125 mg/5ml Botol -
28 Amoksilin sirup kering forte 250 mg/5ml Botol 193 180 373 75 298 90 -
29 Ampisilin 1 gr inj Ampul -
30 Ampisilin Kaplet 500 mg Kaplet -
31 Ampisilin Serbuk Injeksi Vial -
32 Antalgin(Metampiron) Tablet 500 mg Tablet 4,200 1,100 3,200 1,320 3,000 - -
33 Antasida DOEN I tablet kombinasi Tablet 15,000 3,800 11,300 4,560 1,000 - -
34 Antasida DOEN II suspensi kombinasi Botol 200 50 150 60 100 - -
35 Anti hemoroid suppositorida Supp -
36 Antifungi DOEN kombinasi : Pot 72 5 67 6 -
37 Antimigren DOEN/Ergotamin kafein Tablet 1,000 300 300
38 Antiseptik Hand Rub 5 lt Galon 3 - tap
39 Antiseptik Hand Rub 500 ml Botol 3 - tap
40 Antiseptik Surgical Hand Scrub 5 lt Galon -
41 Antiseptik Surgical Hand Scrub 500 ml Botol -
42 Aqua Pro Injeksi steril bebas pirogen- 20 ml Ampul -
43 Aquadest steril -500 ml Botol 4 4 4 -
44 Asam ascorbat 250 mg Tablet 5000 2,000 3,000 2,400 -
45 Asam Askorbat (VIT C) Tablet 50 mg (KF) Tablet 800 3,000 3,800 1,200 2,600 1,440 2,000 1,000 1,000
46 Asam folat tablet 0,4 mg Tablet 3,000 200 2,300 240 1,000 - -
47 Asam Mefenamat 500 mg Tablet 4,400 1,500 2,900 1,800 2,000 - -
48 Asering Botol -
49 Asetosal tablet 80 mg Tablet -
50 Asetosal tablet 80 mg Tablet -
51 Asiklovir cr Tube 135 35 95 42 50 - -
52 Asiklovir tab 200 mg Tablet -
53 Asiklovir tab 400 mg Tablet 400 200 200 240 500 100 100
54 Atapulgit Tablet 700 700 1,200 840 1,000 - - ED dekat
55 Atorvastatin 10 mg Tablet 1,320 300 1,020 360 1,000 - -
56 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul -
57 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul -
58 Azitromisin 500 mg Kaplet -
59 Bedak Salisil serbuk 2 % Buah 88 100 188 15 55 18 30 - -
60 Benzatin benzil penisilin 1,2 juta IU/Vial Vial -
61 Betametason Krim 0.1 % Tube 188 68 120 82 100 - -
62 Bisakodil Supp (Dulcolax) Supp -
63 Bisturi no 10 Buah -
64 Bloodseet Buah -
65 Bundavin Tablet 1000 200 800 240 -
66 Camabion Tablet -
67 Carpul (Articain & Adrenalin) Ampul -
68 Catgut Chromic 2/0 100 m Roll -
69 Catgut Chromic 2/0 75C + Jarum 1/2 30 MR Pcs -
70 Catgut Chromic 3/0 75C + Jarum 1/2 22 MR Roll -
71 Catgut Plain 2/0 70C + Jarum 1/2 36M R Roll -
72 Catgut Plain 3/0 70C + Jarum 3/8 19M C Roll -
73 Catgut/Benang Bedah No.2/0-3/0 dg jarum b Roll -
74 Cefiksim 100 mg Kapsul -
75 Cetirizine Kapsul 500 500 67 600 2,000 - tap
76 Citoject Pcs -
77 Clorofenol (CHKM) Ples 3 1 1
78 Deksametason inj 5 mg/ml-1 ml Ampul -
79 Deksametason Tablet 0,5 mg Tablet 2,000 2,000 - 2,400 5,000 500 500
80 Devitalisasi Pasta (Non arsen) Botol -
81 Dextaco Tablet -
82 Dextaco Tablet -
83 Dextrofen Syrup 60 ml Botol -
84 Dextrofen Syrup 60 ml Botol -
85 Diazepam inj 5 mg/ml-2 ml Ampul -
86 Diazepam tablet 2 mg Tablet -
87 Diazepam tablet 5 mg Tablet -
88 Difenhidramin inj 10 mg/ml Ampul 4 4 -
89 Digoksin tablet 0,25 mg Tablet -
90 Dimenhidrinat tablet 50 mg Tablet 5,000 - tap
91 Doksisiklin 100 mg Kapsul -
92 Domperidon Syrup Botol 45 45 100 - -
93 Domperidon tablet 10 mg Tablet 1,000 300 300
94 Ekstrak Belladona tablet 10 mg Tablet -
95 Eosin 2% 1x100 ml Botol -
96 Epinefrina(Adrenalin) inj i.v/s.k/i.m 1 mg/ml Ampul -
97 Eritromisin 250 mg Tablet -
98 Eritromisin 500 mg Tablet -
99 Eritromisin sirup kering 200 mg/5 ml Botol -
100 Etambutol Hcl tablet 250 mg Tablet -
101 Etambutol Hcl Tablet 500 mg Tablet -
102 Etambutol Hcl Tablet 500 mg Tablet -
103 Etanol 70 %- 100 ml Botol -
104 Etanol 70% - 1 L Botol 3 1 2 2 3 - -
105 Etil Klorida semprot-100 ml Botol 3 - tap
106 Eugenol Cairan Botol 3 2 2
107 Female Catheter no 16 Pcs -
108 Female Catheter no 18 Pcs -
109 Fenitoin Kapsul100 mg Kapsul -
110 Fenobarbital inj 50 mg/ml-2ml Ampul -
111 Fenobarbital tablet 30 mg Tablet 600 200 400 240 800 - -
112 Fenoksimetil Penisilin tablet 250 mg Tablet -
113 Fenoksimetil Penisilin tablet 500 mg Tablet -
114 Fenol Gliserol Tetes telinga 10 % Botol 120 - tap
115 Film IV Dressing 6x7 P Pcs -
116 Fitomenadion(Vit K1) inj 10 mg/ml-1ml Ampul -
117 Fitomenadion(Vit K1) inj 2 mg/ml-1ml Ampul -
118 Fitomenadion(Vit K1) tablet salut gula 10 mg Tablet 500 100 400 120 300 - - ed dekat
119 Fluconazol 150 mg kapsul -
120 Folley Cathether 2 way no 20 Pcs -
121 Folley Cathether no 16 Pcs -
122 Folley Cathether no 18 Pcs 15 15 -
123 Furosemid tablet 40 mg Tablet 500 500 400 - -
124 Garam Oralit 200 ml air Sachet 169 500 669 160 1,009 192 300 - -
125 Garam Oralit 200 ml air Sachet -
126 Gentamisin Inj 40 mg/ml Vial -
127 Gentamycin Salep Kulit Tube 100 - tap
128 Gentamycin Salep Mata Tube 80 5 70 6 48 - -
129 Gentamycin Tetes Mata Tube 68 6 62 8 48 - -
130 Gentian violet larutan 1 %-10 ml Botol -
131 Glas Lonomer Cement Set -
132 Glas Lonomer Cement Liquid Set -
133 Glibenklamid tablet 5 mg Tablet 500 500 500 - -
134 Glimepiride tablet 1 mg Tablet 1,200 900 500 - -
135 Gliseril Gyayakolat tablet 100 mg Tablet -
136 Glukosa Larutan infus 10% steril-500 ml Botol -
137 Glukosa Larutan infus 5% steril-500 ml Botol 24 24 -
138 Griseofulvin tablet 125 mg micronized Tablet -
139 Haloperidol Injeksi (Lodomer) Ampul -
140 Haloperidol Injeksi (Lodomer) Ampul -
141 Haloperidol tablet 0,5 mg Tablet -
142 Haloperidol tablet 1,5 mg Tablet 1,200 500 700 600 500 - -
143 Haloperidol tablet 2 mg Tablet -
144 Haloperidol tablet 5 mg Tablet -
145 Hansaplast 2,5 cm x 4,5 m Roll -
146 Hansaplast 7,5 cm x 4,5 m Roll -
147 Hemafort Tablet -
148 Hemafort Tablet -
149 Hidrogen Peroksida 3% (H2O2) Botol -
150 Hidroklortiazid (HCT) tablet 25 mg Tablet 300 300 500 - - ed dekat
151 Hidrokortison krim 2,5 % Tube 85 72 157 34 164 41 120 - -
152 Ibuprofen sirup 100 mg/5 ml Botol 62 62 100 - -
154 Ibuprofen tablet 400 mg Tablet 3,800 4,000 7,800 2,200 5,600 2,640 2,000 - -
155 Infusion set anak Set -
156 Infusion set anak Set -
157 Infusion set dewasa Set -
158 Infusion Set Dewasa Set -
159 Isoniazida ( INH ) tablet 100 mg Tablet -
162 Isosorbit 5 mg Tablet -
163 IV Cateter 18 Buah -
167 IV Cateter no 26 wings & port Buah -
168 IV Cateter with injection port 26 G Buah -
169 Jarum Citojek No 16 Pcs -
170 Jarum Jahit kulit No.12 Pcs -
171 Jarum Jahit Otot No.12 Pcs -
172 Kalium Permanganat Pot -
173 Kalsium Glukonat injeksi i.v 10 % Ampul -
174 Kalsium Hidroksida Pasta Set -
175 Kalsium laktat (Kalk) tablet 500 mg Tablet 2,800 4,000 6,800 3,600 3,200 4,320 5,000 1,500 1,500
176 Kapas pembalut/absorben 250 mg Buah 5 1 1
177 Kaptropil 12,5 mg Tablet 2,400 500 2,000 1,900 1,000 2,280 5,000 - tap
178 Kaptropil 25 mg Tablet -
179 Karbamazepin tablet 200 mg Tablet 400 400 -
180 Karbogliserin Tetes Telinga Botol -
181 Kasa hidrofil 36 m x 80 cm Roll 2 1 1 2 2 - -
182 Kasa hidrofile 3 yard x 10 cm Buah 60 5 55 6 -
183 Kasa hidrofile 40 yard x 80 cm Roll -
184 Kasa kompres 16x16 steril Buah 276 172 120 207 120 - tap
185 Kasa pembalut hidrofil 4 m x 10 cm Roll 5 5 -
186 Ketokonazol 200 mg Tablet 1,000 400 600 480 500 - -
187 Ketokonazol Krim 2% Tube 145 33 112 40 250 - -
188 Klindamisin 150 mg Tablet -
189 Klindamisin 300 mg Tablet -
190 Kloramfenikol kapsul 250 mg Kapsul -
191 Kloramfenikol kapsul 250 mg Kapsul -
192 Kloramfenikol salep kulit 2 % Tube 144 39 105 47 125 - -
193 Kloramfenikol salep mata 1 % Tube 85 85 - -
194 Kloramfenikol susp 125 ml Botol -
195 Kloramfenikol tetes telinga 3 % Ples 48 48 96 28 68 34 -
196 Klorfenariamin maleat (CTM) tablet 4 mg Tablet 10,000 2,500 7,500 3,000 1,000 - -
197 Klorine Botol -
198 Klorpromazin 100 MG Tablet -
199 Klorpromazin 25 mg Tablet -
200 Klorpromazin injeksi 5 mg/ml-2ml Ampul -
201 Kotrimoksazol anak Tablet -
202 Kotrimoksazol Susp Botol 125 14 111 17 100 - -
203 Kotrimoksazol Tablet 480 mg Tablet 4,300 600 3,700 720 1,000 - -
204 Leucoplast 2,50 cm x 4,5 m Roll 17 1 16 2 -
205 Leucoplast 7,50 cm x 4,5 m Roll 10 10 -
206 Lidocain compositum inj kombinasi Ampul -
207 Lidocain Injeksi 2% Ampul 195 105 100 126 300 50 50
208 Lidocain Jeli 2% Syringe -
209 Lidokain Spray Oral 10%(Xylocaine spray) Botol 5 -
210 Lisol Botol -
211 Lodecon Forte Tablet -
212 Lodecon Forte Tablet -
213 Loratadine 10 mg Tablet 500 500 500 - -
214 Magnesium Sulfat Inj 20% Vial -
215 Magnesium Sulfat Inj 40% Ampul -
216 Masker kain pcs 2100 20 2120 10 2,090 12 -
217 Masker Karet Buah 1,100 1,500 2,600 290 2,140 348 1,000 - -
218 Masker N95 pcs 90 38 57 46 250 - tap
219 Masker Tali Buah -
220 MB Dewasa Blister -
221 Metformin Tablet 1,500 2,000 3,500 500 3,000 600 3,000 - -
222 Metildopa 250 mg / Dopamet Tablet 200 100 100 500 100 100
223 Metilergometrin Maleat Inj Ampul 180 180 - -
224 Metilergometrin Maleat tab Tablet -
225 Metilprednisolone 4 mg Tablet -
226 Metoklopramide Inj Ampul -
227 Metoklopramide Inj Ampul -
228 Metronidazol Syrup Botol -
229 Metronidazol tablet 250 mg Tablet -
230 Metronidazol tablet 500 mg Tablet 500 2,000 2,500 900 1,600 1,080 2,000 - -
231 Mikonazol krim 2% Tube 110 6 104 8 -
232 Mummying Pasta Botol -
233 Nasal Oxygen, O2 cannula size L/adult Pcs 12 12 -
234 Nasal Oxygen, O2 cannula size M Pcs -
235 Nasal Oxygen, O2 cannula size S/infant Pcs 4 4 -
236 Nasal Oxygen, O2 cannula size XS Pcs -
237 Natrium Bikarbonat tablet 500 mg Tablet 2,100 3,500 5,600 700 4,900 840 2,400 - -
238 Natrium Diklofenak Tablet 5,600 2,800 2,000 - -
239 Natrium Klorida Lar.infus 0,9 % steril Botol 57 3 54 4 -
240 Natrium Tiroksin Tablet -
241 Nifedipin 10 mg Tablet -
242 Nistatin Suspensi 100.000 IU/ml Botol 136 136 -
243 Nistatin tablet vaginal 100.000 IU/g Tablet -
244 Nistatin tablet vaginal 500.000 IU/g Tablet -
245 Norit Tablet -
246 OAT Sisipan/FDC Sisipan Paket -
247 Obat antituberkolosis Kombipak Kat.I Dewasa Paket -
248 Obat antituberkulosis anak/FDC Anak Paket 8 5 13 13 -
249 Obat antituberkulosis anak/FDC Anak Paket -
250 Obat antituberkulosis kategori 1/FDC 1 Paket 12 15 27 3 24 4 20 - -
254 Obat Batuk Hitam (OBH) Cairan -100 ml Botol -
255 OBH Nusantara Menthol Botol -
256 OBH Plus Botol -
257 Oksitetrasiklin HCl 1 % Salep mata Tube 49 5 44 6 50 - -
258 Oksitetrasiklin HCl inj i.m 50 mg/ml-10 ml Vial -
259 Oksitetrasiklin HCl Salep Kulit 3 % Tube -
260 Oksitoksin inj 10 IU/ml- 1 ml Ampul -
261 Oksitoksin inj 10 IU/ml- 1 ml Ampul -
262 Omeprazol Kapsul -
263 Omeprazol Injeksi Vial -
264 Papaverin tab Tablet -
265 Paraformaldehid Tablet -
266 Parasetamol drop Botol 119 78 58 94 112 112 112
267 Parasetamol sirup 120 mg / 5ml Botol 293 200 493 45 448 54 200 - -
268 Parasetamol tablet 500 mg Tablet 12,300 10,000 22,300 8,200 14,100 9,840 3,000 - -
269 Parasetamol tablet 100 mg Tablet -
270 Pehakain Ampul -
271 Permetrin Krim 5% (Scabimite) Tube 187 10 171 12 180 - -
272 Permetrin Krim 5% (Scabimite) Tube -
273 PGA 2 75 C + Jarum 1/2 40 M Pcs -
274 Piralent Inj Ampul -
275 Pirantel Pamoat 125 mg Tablet -
276 Pirazinamid 500 mg Tablet -
277 Piridoksin HCl (Vit B6) tablet 10 mg Tablet 2,900 1,600 1,300 1,920 4,000 1,000 1,000
278 Piroxicam 10 mg Tablet 1,000 1,000 - 3,000 500 500
279 Plester 5 yard x 2 inch Roll -
280 Plester 7,5 cm x 5 m Buah -
281 Polypropylene 2/0 75C + Jarum 3/8 26m Pcs -
282 Povidon Iodiada 10 %-30 ml Botol -
283 Povidon Iodiada 10 %-300 ml Botol 1 6 7 2 5 3 -
284 Povidon Iodiada 10 %-60 ml Botol -
285 Prednison tablet 5 mg Tablet 2,200 1,000 1,200 5,000 600 600
286 Probenesid 500 mg Tablet -
287 Propanolol HCl tablet 10 mg Tablet -
288 Propanolol HCl tablet 40 mg Tablet -
289 Propiltiourasil tablet 100 mg Tablet -
290 Ranitidin inj Ampul -
291 Ranitidine 150 mg Tablet 2,000 4,000 6,000 1,000 3,500 1,200 3,000 - -
292 rapid tes pcs 100 24 124 21 3 26 200 - -
293 Retinol (VIT A) Kapsul 100.000 IU Kapsul 250 250 -
294 Retinol (VIT A) Kapsul 200.000 IU Kapsul 1,750 175 100 100 100
295 Rifampisin kapsul 300 mg Kapsul -
296 Rifampisin kapsul 450 mg Kapsul -
297 Ringer Laktat Larutan Infus Steril Botol 51 5 46 6 -
298 Rivanol 300 ml Botol 9 9 -
299 Salbutamol tablet 2 mg Tablet 1,000 300 700 360 500 - -
300 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 % Pot 15 24 39 8 31 10 24 - -
301 Salisil Spiritus Botol -
302 Sarung Tangan non steril no 6,5 Pasang 550 500 50 600 20,000 - -
303 Sarung Tangan non steril no 7 Pasang -
304 Sarung Tangan non steril no 7,5 Pasang -
305 Sarung Tangan Obgyn steril Pasang 28 1 27 2 100 - -
306 Sarung tangan steril no 6,5 Pasang 450 200 650 600 50 720 300 - tap
307 Sarung tangan steril no 7 Pasang -
308 Sarung tangan steril no 7,5 Pasang -
309 Scandonest Ampul -
310 Scandonest Ampul -
311 Seledril Tablet Tablet -
312 Seledril Tablet Tablet -
313 Semen Seng Fosfat Serbuk Cairan Set -
314 Semillas non Woven Medical Tape Pcs -
315 Sepadroxil 500 mg Tablet -
316 Sepadroxil Syrup Kering 125 mg/5 ml Botol 67 67 100 - -
317 Serum anti tetanus (ATS) / Biosat Ampul -
318 Serum anti tetanus (ATS) Ampul 2 2 2
319 Serum antibisa ular Polivalen inj 5 ml (SABU) Ampul -
322 Silk 3/0 75 C + Jarum 3/8 26M C Sase -
323 Silk Black 2/0 DS 24 MM Sase -
324 Silk Black 2/0 HR 26 MM Sase 24 24 -
325 Silk Black 3/0 DS 24 MM Sase -
327 Silk Black PFM 2/0 100 m Roll -
328 Simvastatin tablet 10 mg Tablet 900 300 600 360 1,000 300 300 ed dekat
329 Simvastatin tablet 20 mg Tablet -
330 Siprofloksasin 500 mg Tablet 1,000 1,000 1,000 - -
331 Softanol antimicrobial 500 ml Botol -
332 Softanol antimicrobial galon 5 liter Galon -
333 Softanol antimicrobial galon 5 liter Galon -
336 Solafluz Botol -
337 Solafluz Botol -
338 Soldextam Tablet -
339 Soldextam Tablet -
340 Solvitral Tablet 1,000 2,000 3,000 400 2,600 480 1,000 - -
342 Spironolakton 25 mg Tablet -
343 Stesolid (Diazepam Rectal) Tube -
344 Streptomisin Inj Vial -
345 Sulfasetamid Natrium Tetes mata 15 % Ples 46 46 -
346 Tablet Tambah darah kombinasi : Besi II Sulf Tablet 13,170 6,900 6,270 8,280 20,000 3,870 3,870
347 Tablet Tambah darah kombinasi : Besi II Sulf Tablet -
348 Temporary Filling Material / cavit Botol 3 3 3
349 Temporary Stopping Fletcher serbuk &cairan Set -
350 Tetrakain HCl tetes mata 0,5 % Botol -
351 Tetrasiklin Kapsul 250 mg Kapsul -
352 Tetrasiklin Kapsul 500 mg Kapsul -
353 Tiamin HCL (Vit B1) tablet 50 mg Tablet 2,300 6,000 8,300 2,600 5,500 3,120 3,000 - -
354 Transfusion Set Set -
355 Triheksifenidil HCl tablet 2 mg Tablet 1,800 900 900 1,080 1,000 200 200
356 Trikesol Formalin (TKF) Botol 2 1 1
357 Trikesol Formalin (TKF) Botol -
358 Truvit Syr Botol 20 120 140 78 60 94 180 60 60
359 Truvit Syr Botol -
360 Umbilical cord klem steril Pcs -
361 Urine Drainage Bag, T valve with hanger Pcs 9 9 -
362 Ventolin nebules Nebule -
363 Viorex no rinse antimicrobial Galon -
364 Viorex no rinse antimicrobial Botol -
365 Vitamin B 12 Injeksi Ampul -
366 Vitamin B 12 tab Tablet 1,700 600 400 720 2,000 400 400
367 Vitamin B Kompleks tablet Tablet 8,000 1,000 5,100 1,200 8,000 1,000 1,000 ed dekat
372 Widabest Botol -
372 Widabest Botol -
373 Wing Nedle no 25 Tablet -
374 Zink Tablet 400 1,600 500 - -
375 Zink Tablet -

KEPALA DINKES KAB. SUMEDANG KEPALA UPTD FARMASI SUMEDANG KEPALA UPTD PUSKESMAS PETUGAS OBAT PUSKESMAS
Dadang Sulaeman,.S,Sos., M.Kes Apt.Rita Juwita,S.Farm H. Yayan Karyani, SKM Resmiati Wahyuni, A.M.Keb
NIP. 19701126 199303 1 006 NIP. 19851115 200902 2 002 NIP 19630306 198603 1 026 NIP. 198105162008012005
LPLPO DES-JANUARI
NO NAMA OBAT SATUAN STOCK AWALPENERIMAANPERSEDIAAN
1 2 3 4 5 6
1 Acetyl Cysteine 200 mg Kapsul 3,360
2 Alat Suntik 0,05ml Buah 500
4 Alat Suntik Sekali Pakai 1 ml Pcs 1,300
5 Alat Suntik Sekali Pakai 10 ml (Axime Buah
6 Alat Suntik Sekali Pakai 10 ml (Top Po Buah
9 Alat Suntik Sekali Pakai 3 ml Pcs 1,350 1,000 2,350
12 Albendazol 400 mg Tablet 9,519
13 Alkohol Swab ( PT. Bio Axion Healthin Sase
15 Alopurinol tablet 100 mg Tablet 1,000
24 Amoksilin 500 mg Kaplet 15,600
25 Amoksilin Kapsul 250 mg Kapsul
26 Amoksilin sirup kering 125 mg/5ml Botol 90
28 Amoksilin sirup kering forte 250 mg/5m Botol 193 180 373
29 Ampisilin 1 gr inj Ampul 61
32 Antalgin(Metampiron) Tablet 500 mg Tablet 4,200
33 Antasida DOEN I tablet kombinasi Tablet 15,000
34 Antasida DOEN II suspensi kombinasi Botol 200
36 Antifungi DOEN kombinasi : Pot 72
42 Aqua Pro Injeksi steril bebas pirogen- Ampul
43 Aquadest steril -500 ml Botol
44 Asam Askorbat (VIT C) Tablet 50 mg Tablet 800 3,000 3,800
45 Asam folat tablet 0,4 mg Tablet 3,000
46 Asam Mefenamat 500 mg Tablet 4,400
47 Asering Botol
50 Asiklovir cr Tube 135
52 Asiklovir tab 400 mg Tablet 400
53 Atapulgit Tablet 700
54 Atorvastatin 10 mg Tablet 1,320
58 Bedak Salisil serbuk 2 % Buah 88 100 188
59 Benzatin benzil penisilin 1,2 juta IU/Via Vial
60 Betametason Krim 0.1 % Tube
63 Bloodseet Buah
66 Catgut Chromic 2/0 75C + Jarum 1/2 Pcs
67 Catgut Chromic 3/0 75C + Jarum 1/2 Roll
68 Catgut Plain 2/0 70C + Jarum 1/2 36M Roll
69 Catgut Plain 3/0 70C + Jarum 3/8 19M Roll
70 Catgut/Benang Bedah No.2/0-3/0 dg j Roll
72 Cetirizine Kapsul 500
73 Citoject Pcs
76 Deksametason Tablet 0,5 mg Tablet 2,000
78 Dextaco Tablet
84 Domperidon Syrup Botol 45
85 Domperidon tablet 10 mg Tablet
88 Epinefrina(Adrenalin) inj i.v/s.k/i.m 1 Ampul
96 Etanol 70% - 1 L Botol 3
108 Fitomenadion(Vit K1) tablet salut gula Tablet 500
112 Folley Cathether no 18 Pcs 15
117 Gentamycin Salep Kulit Tube
118 Gentamycin Salep Mata Tube 80
119 Gentamycin Tetes Mata Tube 68
123 Glibenklamid tablet 5 mg Tablet 500
124 Glimepiride tablet 1 mg Tablet 1,200
126 Glukosa Larutan infus 10% steril-500 Botol
127 Glukosa Larutan infus 5% steril-500 m Botol 24
128 Griseofulvin tablet 125 mg micronized Tablet
132 Haloperidol tablet 1,5 mg Tablet 1,200
137 Hemafort Tablet
139 Hidroklortiazid (HCT) tablet 25 mg Tablet 300
140 Hidrokortison krim 2,5 % Tube 85 72 157
141 Ibuprofen sirup 100 mg/5 ml Botol 62
142 Ibuprofen tablet 200 mg Tablet
143 Ibuprofen tablet 400 mg Tablet 3,800 4,000 7,800
147 Infusion Set Dewasa Set
164 Kalsium laktat (Kalk) tablet 500 mg Tablet 2,800 4,000 6,800
166 Kaptropil 12,5 mg Tablet 2,400 500 2,000
168 Karbamazepin tablet 200 mg Tablet 400
169 Karbogliserin Tetes Telinga Botol 96
170 Kasa hidrofil 36 m x 80 cm Roll 2
171 Kasa hidrofile 3 yard x 10 cm Buah
173 Kasa kompres 16x16 steril Buah 276
174 Kasa pembalut hidrofil 4 m x 10 cm Roll 5
175 Ketokonazol 200 mg Tablet 1,000
176 Ketokonazol Krim 2% Tube 145
181 Kloramfenikol salep kulit 2 % Tube 144
182 Kloramfenikol salep mata 1 % Tube 85
184 Kloramfenikol tetes telinga 3 % Ples 48 48 96
185 Klorfenariamin maleat (CTM) tablet 4 Tablet 10,000
186 Klorine Botol
191 Kotrimoksazol Susp Botol 125
192 Kotrimoksazol Tablet 480 mg Tablet 4,300
196 Lidocain Injeksi 2% Ampul 195
198 Lidokain Spray Oral 10%(Xylocaine sp Botol 5
199 Lisol Botol
201 Loratadine 10 mg Tablet 500
204 Masker Karet Buah 1,100 1,500 2,600
205 Masker Tali Buah
206 Metformin Tablet 1,500 2,000 3,500
207 Metildopa 250 mg / Dopamet Tablet 200
208 Metilergometrin Maleat Inj Ampul 180
215 Metronidazol tablet 500 mg Tablet 500 2,000 2,500
216 Mikonazol krim 2% Tube 110
218 Nasal Oxygen, O2 cannula size L/adul Pcs 12
220 Nasal Oxygen, O2 cannula size S/infa Pcs 4
222 Natrium Bikarbonat tablet 500 mg Tablet 2,100 3,500 5,600
223 Natrium Diklofenak Tablet 5,600
224 Natrium Klorida Lar.infus 0,9 % steril Botol 57
227 Nistatin Suspensi 100.000 IU/ml Botol 136
230 Norit Tablet
232 Obat antituberkolosis Kombipak Kat.I Paket
233 Obat antituberkulosis anak/FDC Anak Paket 8 5 13
235 Obat antituberkulosis kategori 1/FDC Paket 12 15 27
236 Obat antituberkulosis kategori 1/FDC Paket
239 Obat Batuk Hitam (OBH) Cairan -100 Botol
241 OBH Plus Botol
242 Oksitetrasiklin HCl 1 % Salep mata Tube 49
243 Oksitetrasiklin HCl inj i.m 50 mg/ml-10 Vial
244 Oksitetrasiklin HCl Salep Kulit 3 % Tube
247 Omeprazol Kapsul
251 Parasetamol drop Botol 119
252 Parasetamol sirup 120 mg / 5ml Botol 293 200 493
253 Parasetamol tablet 500 mg Tablet 12,300 10,000 22,300
255 Pehakain Ampul
256 Permetrin Krim 5% (Scabimite) Tube 187
258 PGA 2 75 C + Jarum 1/2 40 M Pcs
262 Piridoksin HCl (Vit B6) tablet 10 mg Tablet 2,900
263 Piroxicam 10 mg Tablet 1,000
266 Polypropylene 2/0 75C + Jarum 3/8 2 Pcs
268 Povidon Iodiada 10 %-300 ml Botol 1 6 7
270 Prednison tablet 5 mg Tablet 2,200
276 Ranitidine 150 mg Tablet 2,000 4,000 6,000
277 Retinol (VIT A) Kapsul 100.000 IU Kapsul 250
278 Retinol (VIT A) Kapsul 200.000 IU Kapsul 1,750
281 Ringer Laktat Larutan Infus Steril Botol 51
282 Rivanol 300 ml Botol 9
283 Salbutamol tablet 2 mg Tablet 1,000
284 Salep 2-4 kombinasi : as.asal 2 % + B Pot 15 24 39
286 Sarung Tangan non steril no 6,5 Pasang 350
289 Sarung Tangan Obgyn steril Pasang 28
290 Sarung tangan steril no 6,5 Pasang 450
298 Sepadroxil Syrup Kering 125 mg/5 ml Botol 67
301 Serum antibisa ular Polivalen inj 5 ml Ampul
304 Silk 3/0 75 C + Jarum 3/8 26M C Sase
306 Silk Black 2/0 HR 26 MM Sase 24
308 Silk Black 3/0 HR 26 MM Sase
310 Simvastatin tablet 10 mg Tablet 900
312 Siprofloksasin 500 mg Tablet 1,000
317 Solafluz Botol
322 Sulfasetamid Natrium Tetes mata 15 Ples 46
323 Tablet Tambah darah kombinasi : Besi Tablet 13,170
324 Tablet Tambah darah kombinasi : Besi Tablet
326 Temporary Stopping Fletcher serbuk & Set
330 Tiamin HCL (Vit B1) tablet 50 mg Tablet 2,300 6,000 8,300
332 Triheksifenidil HCl tablet 2 mg Tablet 1,800
336 Umbilical cord klem steril Pcs
337 Urine Drainage Bag, T valve with hang Pcs 9
342 Vitamin B 12 tab Tablet 1,700
343 Vitamin B Kompleks tablet Tablet 8,000
344 Widabest Botol
346 Zink Tablet 400
347 Zink Tablet
348 Dextaco Tablet
350 Hemafort Tablet
355 Solafluz Botol
357 Solvitral Tablet
359 Widabest Botol
360 Camabion Tablet
367 MB Dewasa Blister
368 Fenobarbital 30 mg Tablet 600
369 leukoplast 2,5 roll 17
370 Leukoplast 7,5 roll 10
371 MB Dewasa pcs
372 Masker N95 pcs 90
372 rapid tes pcs 100 24 124
373 Masker kain pcs 2100 20 2120
374 Asam ascorbat 250 mg Tablet 5000
375 Bundavin Tablet 1000
PEMAKAIAN SISA STOCK
7 8
NO NAMA OBAT SATUAN DESEMBER JANUARI JUMLAH
1 2 3
1 Acetyl Cysteine 200 mg Kapsul 1020 1500 2520
3 Alat Suntik Sekali Pakai 0.5 ml Pcs 0
4 Alat Suntik Sekali Pakai 1 ml Pcs 600 56 656
5 Alat Suntik Sekali Pakai 10 ml (Aximed Buah 0
6 Alat Suntik Sekali Pakai 10 ml (Top Po Buah 0
7 Alat Suntik Sekali Pakai 2,5 ml Pcs 0
8 Alat Suntik Sekali Pakai 20 ml Buah 0
9 Alat Suntik Sekali Pakai 3 ml Pcs 0
11 Alat Suntik Sekali Pakai 5 ml Pcs 5 5
12 Albendazol 400 mg Tablet 0
13 Alkohol Swab ( PT. Bio Axion Healthin Sase 0
14 Alkohol Swab CHG + 0,5 % (e-care) Pcs 0
15 Alopurinol tablet 100 mg Tablet 200 200
16 Alopurinol tablet 300 mg Tablet 0
17 Ambroxol Sirup Botol 0
18 Ambroxol Tablet 30 mg Tablet 0
19 Aminofilin Inj 24 mg/ml-10 ml Ampul 0
20 Aminofilin Tablet 200 mg Tablet 0
21 Amitriptilina HCl tablet salut 25 mg Tablet 0
22 Amlodipin tablet 10 mg Tablet 900 900
23 Amlodipin tablet 5 mg Tablet 900 900
24 Amoksilin 500 mg Kaplet 1700 1500 3200
25 Amoksilin Kapsul 250 mg Kapsul 0
26 Amoksilin sirup kering 125 mg/5ml Botol 5 5
27 Amoksilin sirup kering 125 mg/5ml Botol 0
28 Amoksilin sirup kering forte 250 mg/5m Botol 70 5 75
29 Ampisilin 1 gr inj Ampul 0
30 Ampisilin Kaplet 500 mg Kaplet 0
31 Ampisilin Serbuk Injeksi Vial 0
32 Antalgin(Metampiron) Tablet 500 mg Tablet 1000 100 1100
33 Antasida DOEN I tablet kombinasi Tablet 1600 2200 3800
34 Antasida DOEN II suspensi kombinasi Botol 50 50
35 Anti hemoroid suppositorida Supp 0
36 Antifungi DOEN kombinasi : Pot 5 5
37 Antimigren DOEN/Ergotamin kafein Tablet 0
38 Antiseptik Hand Rub 5 lt Galon 0
39 Antiseptik Hand Rub 500 ml Botol 0
40 Antiseptik Surgical Hand Scrub 5 lt Galon 0
41 Antiseptik Surgical Hand Scrub 500 ml Botol 0
42 Aqua Pro Injeksi steril bebas pirogen- Ampul 0
43 Aquadest steril -500 ml Botol 0
44 Asam Askorbat (VIT C) Tablet 50 mg ( Tablet 800 400 1200
45 Asam folat tablet 0,4 mg Tablet 200 200
46 Asam Mefenamat 500 mg Tablet 200 1300 1500
47 Asering Botol 0
48 Asetosal tablet 80 mg Tablet 0
49 Asetosal tablet 80 mg Tablet 0
50 Asiklovir cr Tube 35 35
51 Asiklovir tab 200 mg Tablet 0
52 Asiklovir tab 400 mg Tablet 200 200
53 Atapulgit Tablet 700 700
54 Atorvastatin 10 mg Tablet 300 300
55 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul 0
56 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul 0
57 Azitromisin 500 mg Kaplet 0
58 Bedak Salisil serbuk 2 % Buah 15 15
59 Benzatin benzil penisilin 1,2 juta IU/Via Vial 0
60 Betametason Krim 0.1 % Tube 33 35 68
61 Bisakodil Supp (Dulcolax) Supp 0
62 Bisturi no 10 Buah 0
63 Bloodseet Buah 0
64 Carpul (Articain & Adrenalin) Ampul 0
65 Catgut Chromic 2/0 100 m Roll 0
66 Catgut Chromic 2/0 75C + Jarum 1/2 Pcs 0
67 Catgut Chromic 3/0 75C + Jarum 1/2 Roll 0
68 Catgut Plain 2/0 70C + Jarum 1/2 36M Roll 0
69 Catgut Plain 3/0 70C + Jarum 3/8 19M Roll 0
70 Catgut/Benang Bedah No.2/0-3/0 dg j Roll 0
71 Cefiksim 100 mg Kapsul 0
72 Cetirizine Kapsul 500 500
73 Citoject Pcs 0
74 Clorofenol (CHKM) Ples 0
75 Deksametason inj 5 mg/ml-1 ml Ampul 0
76 Deksametason Tablet 0,5 mg Tablet 1000 1000
77 Devitalisasi Pasta (Non arsen) Botol 0
78 Dextaco Tablet 0
79 Dextrofen Syrup 60 ml Botol 0
80 Difenhidramin inj 10 mg/ml Ampul 0
81 Digoksin tablet 0,25 mg Tablet 0
82 Dimenhidrinat tablet 50 mg Tablet 0
83 Doksisiklin 100 mg Kapsul 0
84 Domperidon Syrup Botol 0
85 Domperidon tablet 10 mg Tablet 0
86 Ekstrak Belladona tablet 10 mg Tablet 0
87 Eosin 2% 1x100 ml Botol 0
88 Epinefrina(Adrenalin) inj i.v/s.k/i.m 1 Ampul 0
89 Eritromisin 250 mg Tablet 0
90 Eritromisin 500 mg Tablet 0
91 Eritromisin sirup kering 200 mg/5 ml Botol 0
92 Etambutol Hcl tablet 250 mg Tablet 0
93 Etambutol Hcl Tablet 500 mg Tablet 0
94 Etambutol Hcl Tablet 500 mg Tablet 0
95 Etanol 70 %- 100 ml Botol 0
96 Etanol 70% - 1 L Botol 1 1
97 Etil Klorida semprot-100 ml Botol 0
98 Eugenol Cairan Botol 0
99 Female Catheter no 16 Pcs 0
100 Female Catheter no 18 Pcs 0
101 Fenitoin Kapsul100 mg Kapsul 0
102 Fenoksimetil Penisilin tablet 250 mg Tablet 0
103 Fenoksimetil Penisilin tablet 500 mg Tablet 0
104 Fenol Gliserol Tetes telinga 10 % Botol 0
105 Film IV Dressing 6x7 P Pcs 0
106 Fitomenadion(Vit K1) inj 10 mg/ml-1ml Ampul 0
107 Fitomenadion(Vit K1) inj 2 mg/ml-1ml Ampul 0
108 Fitomenadion(Vit K1) tablet salut gula Tablet 100 100
109 Fluconazol 150 mg kapsul 0
110 Folley Cathether 2 way no 20 Pcs 0
115 Garam Oralit 200 ml air Sachet 0
116 Gentamisin Inj 40 mg/ml Vial 0
117 Gentamycin Salep Kulit Tube 0
118 Gentamycin Salep Mata Tube 5 5
119 Gentamycin Tetes Mata Tube 6 6
120 Gentian violet larutan 1 %-10 ml Botol 0
121 Glas Lonomer Cement Set 0
122 Glas Lonomer Cement Liquid Set 0
123 Glibenklamid tablet 5 mg Tablet 0
124 Glimepiride tablet 1 mg Tablet 0
125 Gliseril Gyayakolat tablet 100 mg Tablet 0
126 Glukosa Larutan infus 10% steril-500 Botol 0
127 Glukosa Larutan infus 5% steril-500 m Botol 0
128 Griseofulvin tablet 125 mg micronized Tablet 0
129 Haloperidol Injeksi (Lodomer) Ampul 0
130 Haloperidol Injeksi (Lodomer) Ampul 0
131 Haloperidol tablet 0,5 mg Tablet 0
132 Haloperidol tablet 1,5 mg Tablet 500 500
133 Haloperidol tablet 2 mg Tablet 0
134 Haloperidol tablet 5 mg Tablet 0
137 Hemafort Tablet 0
138 Hidrogen Peroksida 3% (H2O2) Botol 0
139 Hidroklortiazid (HCT) tablet 25 mg Tablet 0
140 Hidrokortison krim 2,5 % Tube 24 10 34
141 Ibuprofen sirup 100 mg/5 ml Botol 0
142 Ibuprofen tablet 200 mg Tablet 0
143 Ibuprofen tablet 400 mg Tablet 1100 1100 2200
144 Infusion set anak Set 0
145 Infusion set anak Set 0
146 Infusion set dewasa Set 0
147 Infusion Set Dewasa Set 0
148 Isoniazida ( INH ) tablet 100 mg Tablet 0
151 Isosorbit 5 mg Tablet 0
152 IV Cateter 18 Buah 0
156 IV Cateter no 26 wings & port Buah 0
157 IV Cateter with injection port 26 G Buah 0
158 Jarum Citojek No 16 Pcs 0
159 Jarum Jahit kulit No.12 Pcs 0
160 Jarum Jahit Otot No.12 Pcs 0
161 Kalium Permanganat Pot 0
162 Kalsium Glukonat injeksi i.v 10 % Ampul 0
163 Kalsium Hidroksida Pasta Set 0
164 Kalsium laktat (Kalk) tablet 500 mg Tablet 1900 1700 3600
165 Kapas pembalut/absorben 250 mg Buah 0
166 Kaptropil 12,5 mg Tablet 1000 900 1900
167 Kaptropil 25 mg Tablet 0
168 Karbamazepin tablet 200 mg Tablet 0
169 Karbogliserin Tetes Telinga Botol 0
170 Kasa hidrofil 36 m x 80 cm Roll 1 1
171 Kasa hidrofile 3 yard x 10 cm Buah 5 5
172 Kasa hidrofile 40 yard x 80 cm Roll 0
173 Kasa kompres 16x16 steril Buah 172 172
174 Kasa pembalut hidrofil 4 m x 10 cm Roll 5 5
175 Ketokonazol 200 mg Tablet 400 400
176 Ketokonazol Krim 2% Tube 8 25 33
177 Klindamisin 150 mg Tablet 0
178 Klindamisin 300 mg Tablet 0
179 Kloramfenikol kapsul 250 mg Kapsul 0
180 Kloramfenikol kapsul 250 mg Kapsul 0
181 Kloramfenikol salep kulit 2 % Tube 39 39
182 Kloramfenikol salep mata 1 % Tube 0
183 Kloramfenikol susp 125 ml Botol 0
184 Kloramfenikol tetes telinga 3 % Ples 28 28
185 Klorfenariamin maleat (CTM) tablet 4 Tablet 2000 500 2500
186 Klorine Botol 0
187 Klorpromazin 100 MG Tablet 0
188 Klorpromazin 25 mg Tablet 0
189 Klorpromazin injeksi 5 mg/ml-2ml Ampul 0
190 Kotrimoksazol anak Tablet 0
191 Kotrimoksazol Susp Botol 6 8 14
192 Kotrimoksazol Tablet 480 mg Tablet 400 200 600
193 Leucoplast 2,50 cm x 4,5 m Roll 0
194 Leucoplast 7,50 cm x 4,5 m Roll 0
195 Lidocain compositum inj kombinasi Ampul 0
196 Lidocain Injeksi 2% Ampul 105 105
197 Lidocain Jeli 2% Syringe 0
198 Lidokain Spray Oral 10%(Xylocaine sp Botol 0
199 Lisol Botol 0
200 Lodecon Forte Tablet 0
201 Loratadine 10 mg Tablet 0
202 Magnesium Sulfat Inj 20% Vial 0
203 Magnesium Sulfat Inj 40% Ampul 0
204 Masker Karet Buah 30 260 290
205 Masker Tali Buah 0
206 Metformin Tablet 500 500
207 Metildopa 250 mg / Dopamet Tablet 100 100
208 Metilergometrin Maleat Inj Ampul 180 180
209 Metilergometrin Maleat tab Tablet 0
210 Metilprednisolone 4 mg Tablet 0
211 Metoklopramide Inj Ampul 0
212 Metoklopramide Inj Ampul 0
213 Metronidazol Syrup Botol 0
214 Metronidazol tablet 250 mg Tablet 0
215 Metronidazol tablet 500 mg Tablet 600 300 900
216 Mikonazol krim 2% Tube 6 6
217 Mummying Pasta Botol 0
218 Nasal Oxygen, O2 cannula size L/adul Pcs 0
219 Nasal Oxygen, O2 cannula size M Pcs 0
220 Nasal Oxygen, O2 cannula size S/infa Pcs 0
221 Nasal Oxygen, O2 cannula size XS Pcs 0
222 Natrium Bikarbonat tablet 500 mg Tablet 400 300 700
223 Natrium Diklofenak Tablet 0
224 Natrium Klorida Lar.infus 0,9 % steril Botol 3 3
225 Natrium Tiroksin Tablet 0
226 Nifedipin 10 mg Tablet 0
227 Nistatin Suspensi 100.000 IU/ml Botol 0
228 Nistatin tablet vaginal 100.000 IU/g Tablet 0
229 Nistatin tablet vaginal 500.000 IU/g Tablet 0
230 Norit Tablet 0
231 OAT Sisipan/FDC Sisipan Paket 0
232 Obat antituberkolosis Kombipak Kat.I Paket 0
233 Obat antituberkulosis anak/FDC Anak Paket 0
234 Obat antituberkulosis anak/FDC Anak Paket 0
235 Obat antituberkulosis kategori 1/FDC Paket 3 3
236 Obat antituberkulosis kategori 1/FDC Paket 0
239 Obat Batuk Hitam (OBH) Cairan -100 Botol 0
240 OBH Nusantara Menthol Botol 0
241 OBH Plus Botol 0
242 Oksitetrasiklin HCl 1 % Salep mata Tube 0
243 Oksitetrasiklin HCl inj i.m 50 mg/ml-10 Vial 0
244 Oksitetrasiklin HCl Salep Kulit 3 % Tube 0
245 Oksitoksin inj 10 IU/ml- 1 ml Ampul 0
246 Oksitoksin inj 10 IU/ml- 1 ml Ampul 0
247 Omeprazol Kapsul 0
248 Omeprazol Injeksi Vial 0
249 Papaverin tab Tablet 0
250 Paraformaldehid Tablet 0
251 Parasetamol drop Botol 61 17 78
252 Parasetamol sirup 120 mg / 5ml Botol 15 30 45
253 Parasetamol tablet 500 mg Tablet 3500 4700 8200
254 Parasetamol tablet 100 mg Tablet 0
255 Pehakain Ampul 0
256 Permetrin Krim 5% (Scabimite) Tube 5 5 10
257 Permetrin Krim 5% (Scabimite) Tube 0
258 PGA 2 75 C + Jarum 1/2 40 M Pcs 0
259 Piralent Inj Ampul 0
260 Pirantel Pamoat 125 mg Tablet 0
261 Pirazinamid 500 mg Tablet 0
262 Piridoksin HCl (Vit B6) tablet 10 mg Tablet 1000 600 1600
263 Piroxicam 10 mg Tablet 1000 1000
264 Plester 5 yard x 2 inch Roll 0
265 Plester 7,5 cm x 5 m Buah 0
266 Polypropylene 2/0 75C + Jarum 3/8 2 Pcs 0
268 Povidon Iodiada 10 %-300 ml Botol 1 1 2
270 Prednison tablet 5 mg Tablet 800 200 1000
271 Probenesid 500 mg Tablet 0
272 Propanolol HCl tablet 10 mg Tablet 0
273 Propanolol HCl tablet 40 mg Tablet 0
274 Propiltiourasil tablet 100 mg Tablet 0
275 Ranitidin inj Ampul 0
276 Ranitidine 150 mg Tablet 1000 1000
279 Rifampisin kapsul 300 mg Kapsul 0
280 Rifampisin kapsul 450 mg Kapsul 0
281 Ringer Laktat Larutan Infus Steril Botol 5 5
282 Rivanol 300 ml Botol 0
283 Salbutamol tablet 2 mg Tablet 100 200 300
284 Salep 2-4 kombinasi : as.asal 2 % + B Pot 5 3 8
285 Salisil Spiritus Botol 0
286 Sarung Tangan non steril no 6,5 Pasang 50 300 350
287 Sarung Tangan non steril no 7 Pasang 0
288 Sarung Tangan non steril no 7,5 Pasang 0
289 Sarung Tangan Obgyn steril Pasang 0
290 Sarung tangan steril no 6,5 Pasang 150 59 209
291 Sarung tangan steril no 7 Pasang 0
292 Sarung tangan steril no 7,5 Pasang 0
293 Scandonest Ampul 0
294 Seledril Tablet Tablet 0
295 Semen Seng Fosfat Serbuk Cairan Set 0
296 Semillas non Woven Medical Tape Pcs 0
297 Sepadroxil 500 mg Tablet 0
298 Sepadroxil Syrup Kering 125 mg/5 ml Botol 0
299 Serum anti tetanus (ATS) / Biosat Ampul 0
300 Serum anti tetanus (ATS) / Tetagam Ampul 0
301 Serum antibisa ular Polivalen inj 5 ml Ampul 0
302 Silk 2/0 75 C + Jarum 1/2 30M R Sase 0
303 Silk 3/0 75 C + Jarum 1/2 17M R Sase 0
304 Silk 3/0 75 C + Jarum 3/8 26M C Sase 0
305 Silk Black 2/0 DS 24 MM Sase 0
307 Silk Black 3/0 DS 24 MM Sase 0
309 Silk Black PFM 2/0 100 m Roll 0
310 Simvastatin tablet 10 mg Tablet 300 300
311 Simvastatin tablet 20 mg Tablet 0
312 Siprofloksasin 500 mg Tablet 0
313 Softanol antimicrobial 500 ml Botol 0
314 Softanol antimicrobial galon 5 liter Galon 0
315 Softanol antimicrobial galon 5 liter Galon 0
316 Solacort krim /Armacort Tube 0
317 Solafluz Botol 0
318 Soldextam Tablet 0
319 Solvitral Tablet 100 100
320 Spironolakton 25 mg Tablet 0
321 Streptomisin Inj Vial 0
322 Sulfasetamid Natrium Tetes mata 15 Ples 0
323 Tablet Tambah darah kombinasi : Besi Tablet 6900 6900
324 Tablet Tambah darah kombinasi : Besi Tablet 0
325 Temporary Filling Material (Fermin) Botol 0
326 Temporary Stopping Fletcher serbuk & Set 0
327 Tetrakain HCl tetes mata 0,5 % Botol 0
328 Tetrasiklin Kapsul 250 mg Kapsul 0
329 Tetrasiklin Kapsul 500 mg Kapsul 0
330 Tiamin HCL (Vit B1) tablet 50 mg Tablet 2100 500 2600
331 Transfusion Set Set 0
332 Triheksifenidil HCl tablet 2 mg Tablet 400 500 900
333 Trikesol Formalin (TKF) Botol 0
334 Trikesol Formalin (TKF) Botol 0
336 Umbilical cord klem steril Pcs 0
337 Urine Drainage Bag, T valve with hang Pcs 0
338 Ventolin nebules Nebule 0
339 Viorex no rinse antimicrobial Galon 0
340 Viorex no rinse antimicrobial Botol 0
341 Vitamin B 12 Injeksi Ampul 0
342 Vitamin B 12 tab Tablet 600 600
343 Vitamin B Kompleks tablet Tablet 1000 1000
344 Widabest Botol 0
345 Wing Nedle no 25 Tablet 0
346 Zink Tablet 0
347 Zink Tablet 0
348 Dextaco Tablet 0
349 Dextrofen Syrup 60 ml Botol 0
350 Hemafort Tablet 0
351 Lodecon Forte Tablet 0
352 Scandonest Ampul 0
353 Seledril Tablet Tablet 0
354 Solacort krim /Armacort Tube 0
355 Solafluz Botol 0
356 Soldextam Tablet 0
357 Solvitral Tablet 0
358 Truvit Syr Botol 0
359 Widabest Botol 0
360 Camabion Tablet 0
361 Diazepam inj 5 mg/ml-2 ml Ampul 0
362 Diazepam tablet 2 mg Tablet 0
363 Diazepam tablet 5 mg Tablet 0
364 Fenobarbital inj 50 mg/ml-2ml Ampul 0
365 Fenobarbital tablet 30 mg Tablet 0
366 Stesolid (Diazepam Rectal) Tube 0
367 MB Dewasa Blister 0
368 Fenobarbital 30 mg Tablet 200 200
369 leukoplast 2,5 roll 1 1 2
370 Leukoplast 7,5 roll 0
371 MB Dewasa pcs 0
372 Masker N95 pcs 20 18 38
372 rapid tes pcs 21 21
373 Masker kain pcs 10 10
374 Asam ascorbat 250 mg Tablet 0
375 Bundavin Tablet 200 200
LAPORAN PEMAKAIAN DAN LE
(LPLP
PUSKESMAS :GANEAS PELAPORAN/PERIODE

KECAMATAN : GANEAS PERMINTAAN/PERIODE
NO NAMA OBAT SATUAN STOCK AWAL PENERIMAAN

1 2 3 4 5
1 Acetyl Cysteine 200 mg Kapsul 4,176
5 Alat Suntik Sekali Pakai 10 ml (Aximed) Buah
6 Alat Suntik Sekali Pakai 10 ml (Top Point) Buah
9 Alat Suntik Sekali Pakai 3 ml Pcs 1,350
12 Albendazol 400 mg Tablet 9,519
13 Alkohol Swab ( PT. Bio Axion Healthindo) Sase
22 Amlodipin tablet 10 mg Tablet
23 Amlodipin tablet 5 mg Tablet
24 Amoksilin 500 mg Kaplet
25 Amoksilin Kapsul 250 mg Kapsul
28 Amoksilin sirup kering forte 250 mg/5ml Botol
29 Ampisilin 1 gr inj Ampul
32 Antalgin(Metampiron) Tablet 500 mg Tablet
33 Antasida DOEN I tablet kombinasi Tablet
34 Antasida DOEN II suspensi kombinasi Botol
36 Antifungi DOEN kombinasi : Pot
42 Aqua Pro Injeksi steril bebas pirogen- 20 ml Ampul
43 Aquadest steril -500 ml Botol
44 Asam Askorbat (VIT C) Tablet 50 mg (KF) Tablet
45 Asam folat tablet 0,4 mg Tablet
46 Asam Mefenamat 500 mg Tablet
47 Asering Botol
50 Asiklovir cr Tube
53 Atapulgit Tablet
54 Atorvastatin 10 mg Tablet
58 Bedak Salisil serbuk 2 % Buah
59 Benzatin benzil penisilin 1,2 juta IU/Vial Vial
60 Betametason Krim 0.1 % Tube
63 Bloodseet Buah
66 Catgut Chromic 2/0 75C + Jarum 1/2 30 MR Pcs
67 Catgut Chromic 3/0 75C + Jarum 1/2 22 MR Roll
68 Catgut Plain 2/0 70C + Jarum 1/2 36M R Roll
69 Catgut Plain 3/0 70C + Jarum 3/8 19M C Roll
70 Catgut/Benang Bedah No.2/0-3/0 dg jarum bed Roll
72 Cetirizine Kapsul
73 Citoject Pcs
76 Deksametason Tablet 0,5 mg Tablet
78 Dextaco Tablet
84 Domperidon Syrup Botol
85 Domperidon tablet 10 mg Tablet
88 Epinefrina(Adrenalin) inj i.v/s.k/i.m 1 mg/ml Ampul
96 Etanol 70% - 1 L Botol
108 Fitomenadion(Vit K1) tablet salut gula 10 mg Tablet
113 Furosemid tablet 40 mg Tablet
117 Gentamycin Salep Kulit Tube
118 Gentamycin Salep Mata Tube
119 Gentamycin Tetes Mata Tube
123 Glibenklamid tablet 5 mg Tablet
124 Glimepiride tablet 1 mg Tablet
128 Griseofulvin tablet 125 mg micronized Tablet
137 Hemafort Tablet
139 Hidroklortiazid (HCT) tablet 25 mg Tablet
140 Hidrokortison krim 2,5 % Tube
141 Ibuprofen sirup 100 mg/5 ml Botol
147 Infusion Set Dewasa Set
164 Kalsium laktat (Kalk) tablet 500 mg Tablet
166 Kaptropil 12,5 mg Tablet
168 Karbamazepin tablet 200 mg Tablet
169 Karbogliserin Tetes Telinga Botol
170 Kasa hidrofil 36 m x 80 cm Roll
171 Kasa hidrofile 3 yard x 10 cm Buah
173 Kasa kompres 16x16 steril Buah
174 Kasa pembalut hidrofil 4 m x 10 cm Roll
175 Ketokonazol 200 mg Tablet
176 Ketokonazol Krim 2% Tube
181 Kloramfenikol salep kulit 2 % Tube
182 Kloramfenikol salep mata 1 % Tube
184 Kloramfenikol tetes telinga 3 % Ples
185 Klorfenariamin maleat (CTM) tablet 4 mg Tablet
186 Klorine Botol
191 Kotrimoksazol Susp Botol
192 Kotrimoksazol Tablet 480 mg Tablet
196 Lidocain Injeksi 2% Ampul
198 Lidokain Spray Oral 10%(Xylocaine spray) Botol
199 Lisol Botol
201 Loratadine 10 mg Tablet
204 Masker Karet Buah
205 Masker Tali Buah
206 Metformin Tablet
207 Metildopa 250 mg / Dopamet Tablet
208 Metilergometrin Maleat Inj Ampul
216 Mikonazol krim 2% Tube
218 Nasal Oxygen, O2 cannula size L/adult Pcs
220 Nasal Oxygen, O2 cannula size S/infant Pcs
222 Natrium Bikarbonat tablet 500 mg Tablet
223 Natrium Diklofenak Tablet
224 Natrium Klorida Lar.infus 0,9 % steril Botol
227 Nistatin Suspensi 100.000 IU/ml Botol
230 Norit Tablet
232 Obat antituberkolosis Kombipak Kat.I Dewasa Paket
239 Obat Batuk Hitam (OBH) Cairan -100 ml Botol
241 OBH Plus Botol
242 Oksitetrasiklin HCl 1 % Salep mata Tube
243 Oksitetrasiklin HCl inj i.m 50 mg/ml-10 ml Vial
244 Oksitetrasiklin HCl Salep Kulit 3 % Tube
247 Omeprazol Kapsul
251 Parasetamol drop Botol
252 Parasetamol sirup 120 mg / 5ml Botol
255 Pehakain Ampul
258 PGA 2 75 C + Jarum 1/2 40 M Pcs
262 Piridoksin HCl (Vit B6) tablet 10 mg Tablet
263 Piroxicam 10 mg Tablet
266 Polypropylene 2/0 75C + Jarum 3/8 26m Pcs
270 Prednison tablet 5 mg Tablet
276 Ranitidine 150 mg Tablet
281 Ringer Laktat Larutan Infus Steril Botol
282 Rivanol 300 ml Botol
283 Salbutamol tablet 2 mg Tablet
284 Salep 2-4 kombinasi : as.asal 2 % + Bel. 4 % Pot
289 Sarung Tangan Obgyn steril Pasang
298 Sepadroxil Syrup Kering 125 mg/5 ml Botol
301 Serum antibisa ular Polivalen inj 5 ml (SABU) I Ampul
304 Silk 3/0 75 C + Jarum 3/8 26M C Sase
312 Siprofloksasin 500 mg Tablet
317 Solafluz Botol
322 Sulfasetamid Natrium Tetes mata 15 % Ples
326 Temporary Stopping Fletcher serbuk &cairan Set
330 Tiamin HCL (Vit B1) tablet 50 mg Tablet
332 Triheksifenidil HCl tablet 2 mg Tablet
336 Umbilical cord klem steril Pcs
337 Urine Drainage Bag, T valve with hanger Pcs
342 Vitamin B 12 tab Tablet
343 Vitamin B Kompleks tablet Tablet
344 Widabest Botol
346 Zink Tablet
347 Zink Tablet
348 Dextaco Tablet
350 Hemafort Tablet
355 Solafluz Botol
359 Widabest Botol
360 Camabion Tablet
367 MB Dewasa Blister
BAYAR TDK BAYAR

MENGETAHUI YANG MENYERAHKAN

KEPALA DINKES KAB. SUMEDANG KEPALA UPTD FARMASI SUMEDA
Dadang Sulaeman,.S,Sos., M.Kes Apt.Rita Juwita,S.Farm
NIP. 19701126 199303 1 006 NIP. 19851115 200902 2 002
(LPLPO)
DESEMBER S/D JANUARI DOKUMEN NOMOR

FEBRUARI S/D MARET PUSKESM 800 / 115 /PKM / X / 2020
DINKES 377/Farm/X/2020
UPTD Farm
PEMBERIAN
PERSEDIAAN PEMAKAIAN SISA STOCK STOCK OPT PERMINTAAN
APBD APBD DAK
6 7 8 9 10 11 12
TDK BAYAR JUMLAH
6980
YANG MENYERAHKAN YANG MEMINTA/MELAPOR

KEPALA UPTD FARMASI SUMEDANG KEPALA UPTD PUSKESMAS
Apt.Rita Juwita,S.Farm H. Yayan Karyani, SKM
NIP. 19851115 200902 2 002 NIP 19630306 198603 1 026
NOMOR TANGGAL
800 / 115 /PKM / X / 2020 5-Oct-20
377/Farm/X/2020 10/13/2020
PEMBERIAN
KET
APBN LAIN2 JUMLAH
13 14 15 16
YANG MENERIMA
PETUGAS OBAT PUSKESMAS
Elly Laviana
NIP. 19630102 199603 2 001

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LAPORAN PEMAKAIAN DAN LEMBAR PER

PUSKESMAS :GANEAS PELAPORAN/PERIODE JANUARI S/D

STOCK PENERI PERSE PEMA

BAYAR TDK BAYAR JUMLAH

MENGETAHUI YANG MENYERAHKAN

PEBRUARI DOKUMEN NOMOR TANGGAL

SISA STOCK PERMIN PEMBERIAN

YANG MEMINTA/MELAPOR YANG MENERIMA

PUSKESMAS :GANEAS PELAPORAN/PERIODE APRIL S/D MEI DOKUMEN NOMOR TANGGAL

MENGETAHUI YANG MENYERAHKAN YANG MEMINTA/MELAPOR YANG MENERIMA

NO NAMA OBAT SATUAN STOCK AWAL

ORAN/PERIODE MEI S/D JUNI

PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOCK STOCK OPT

TDK BAYAR JUMLAH

YANG MENYERAHKAN YANG MEMINTA/MEL

YANG MEMINTA/MELAPOR YANG MENERIMA

PUSKESMAS :GANEAS PELAPORAN/PERIODE AGUSTUS S/D SEPTEMBER DOKUMEN NOMOR TANGGAL

MENGETAHUI YANG MENYERAHKAN YANG MEMINTA/MELAPOR YANG MENERIMA

STOCK SISA STOCK PEMBERIAN

MENGETAHUI YANG MENYERAHKAN YANG MEMINTA/MELAPOR YANG MENERIMA

PUSKESMAS :GANEAS PELAPORAN/PERIODE

NO NAMA OBAT SATUAN STOCK AWAL PENERIMAAN

BAYAR TDK BAYAR

MENGETAHUI YANG MENYERAHKAN

DESEMBER S/D JANUARI DOKUMEN NOMOR

YANG MENYERAHKAN YANG MEMINTA/MELAPOR

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