LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

(LPLPO)

KODE PUSKESMAS : 1010444 BULAN SEPTEMBER

PUSKESMAS : PintuPohan Meranti TAHUN : 2022
KECAMATAN / KAB : PintuPohan Meranti / Toba

PERSEDIA- PERMINTA- PEMBERIAN

NO NAMA OBAT SATUAN STOK AWAL PENERIMA-AN PEMAKAI-AN SISA STOK STOK OPT KET
AN AN Buffer Stok DAK Lain-lain
1 Alkohol 95% 1 Liter Botol 14 24 38 28 10 - 50
2 Alkohol Swab 2-ply @ 100 pcs Kotak - 24 24 22 2 - 50
3 Alopurinol tablet 300 mg Tablet 200 600 800 800 - - 2,000
4 Amlodipin tablet 5 mg Tablet 300 2,100 2,400 1,700 700 - 2,000
5 Amoksisilin sirup 250 mg / 5 ml Botol - 120 120 91 29 - 120
6 Amoksisilin tablet 250 mg Tablet 100 1,500 1,600 1,400 200 - 2,000
7 Amoksisilin tablet 500 mg Kaplet 300 1,500 1,800 1,370 430 - 2,000
8 Antasida sirup Botol - 100 100 100 - - 200
9 Antasida Tablet Tablet 1,100 1,100 1,100 - - 1,500
10 Anti Bisa Ular Serum (ABU) Injeksi Vial - - - -
11 Anti Tetanus Serus (ATS) injeksi 1.500 IU ml Ampul - - - -
12 Antihemoroid supp Suppo 12 10 22 12 10 - 30
Antiseptik pembersih tangan 100 ml (Chlorhexidine Gluconate 0,5 % +
13 Botol 2 10 12 6 6 - 50
alkohol 70 %)
Antiseptik pembersih tangan 500 ml (Chlorhexidine Gluconate 0,5 % +
14 Botol 8 36 44 31 13 - 50
alkohol 70 %)
15 Antiseptik pencuci tangan 500 ml Botol 10 24 34 17 17 - 50
16 Asam askorbat (Vitamin C) tab 250 mg Tablet 600 6,500 7,100 6,250 850 - 7,000
17 Asam askorbat (Vitamin C) tab 50 mg Tablet 500 2,000 2,500 2,100 400 - 3,000
18 Asam folat tablet 1 mg Tablet - - - - - 5,000
19 Asam Mefenamat 500 mg Kaplet 500 5,000 5,500 5,200 300 - 7,000
20 Aseptan Solution 2 % 500 ml Botol 6 4 10 - 10 - 50
21 Asering asetat ringer Botol - 24 24 8 16 - 50
22 Asetil sistein kapsul 200 mg Tablet 2,000 2,640 4,640 4,640 - - 5,000
23 Asetosal tablet 80 mg Tablet 300 - 300 300 - - 2,000
24 Asiklovir tablet 400 mg Tablet - - - - - 5,000
25 Atropin injeksi 0,25 mg/ml (i.m./i.v./s.k) Ampul - - - - - 200
26 Benang Catgut Plain 3/0 + jarum 1/2 GT 35 mm Kotak 6 10 16 10 6 - 20
27 Benang Silk 3/0, 1/2 TP 25 mm, 75 cm Pcs 36 36 36 - - 50
28 Betametasone Dipropionate krim 0,5 mg/g Tube - 75 75 54 21 - 100
29 Blood Lancet Kotak 1 12 13 9 4 - 25
30 Bricasma Respules Terbutaline sulfate respules - 20 20 20 - - 50
31 CTM Tablet 4 mg Tablet 1,050 2,000 3,050 2,550 500 - 5,000
32 Deksametason injeksi 5 mg/ml (i.v./i.m.) Ampul - 25 25 25 - - 100
33 Dextrofen Syr 60 ml Botol 5 100 105 100 5 - 200
34 Diazepam injeksi 5 mg / ml (i.v./i.m.) Ampul - 10 10 20 - 10 - 20
35 diazepam tablet / kapsul / kaplet 2 mg Tablet 100 200 300 100 200 - 100
36 Difenhidramin injeksi 10 mg/ml Ampul 20 - 20 10 10 - 20
37 Domperidon tablet/kapsul/kaplet 10 mg Tablet - 100 100 200 - 100 - 2,000
38 Domperidone sirup 5 mg/5 ml Botol 5 15 20 15 5 - 200
39 Epinefrin (Adrenalin) injeksi 0,1% Ampul - - - - - - 20
40 Eritromisin sirup 200 mg/5 ml Botol 21 100 121 50 71 - 100
41 Ertromisin tablet / kapsul kaplet 500 mg Tablet 100 - 100 - 100 - 3,000
42 Fitomenadion (Vit. K) injeksi i.m 2 mg/ml Ampul 5 15 20 - 20 - 200
43 Fitomenadion (Vit. K) tablet 10 mg Tablet 190 600 790 - 790 - 1,000
44 Furosemid Tablet 40 mg Tablet - - - - - - 1,000
garam oralit I serbuk komb : na klorida 0,52 gr+ k klorida 0,30 gr+
45 sachet 100 - 100 100 - - 100
trinatrium sitrat
46 Glibenklamid tablet/kapsul/kaplet 5 mg Tablet - - - - - 2,000
47 Glimepiride tablet/kapsul/kaplet 1 mg Tablet - - - - - 2,000
48 Glukosa larutan infus 5 % 500 mL Botol 18 - 18 18 - - 200
49 Griseofulvin (micronized) tablet 125 mg Tablet 200 300 500 400 100 - 1,000
50 Hidrokortison krim 2,5 % Tube 8 48 56 52 4 - 100
51 Hustab Syr 60 ml Botol 3 100 103 103 - - 200
52 Ibuprofen suspensi 100 mg/5 ml Botol 8 50 58 38 20 - 200
53 Infusion Set Anak 60 drops/ml Set 2 12 14 2 12 - 25
54 Infusion Set type Y Set - 12 12 - 12 - 25
55 Isosorbid Dinitrat tablet 5 mg Tablet 50 250 300 300 - - 1,000
56 Kalsium Laktat tablet 500 mg Tablet 400 300 700 600 100 - 5,000
57 Kapas Pembalut 250 gr Roll - 10 10 2 8 - 25
58 Kaptopril tablet 12,5 mg Tablet - - - - - 5,000
59 Karbogliserin tetes telinga 10% Botol 12 12 24 24 - - 100
60 Kasa Hydrofil Steril 18 x 22 cm Kotak 5 25 30 20 10 - 50
61 kasa parafun pcs - 100 100 100 - - 200
62 Kasa Pembalut Hydrofil 4 m x 5 cm Roll 5 50 55 45 10 - 100
63 Kateter IV No. 22 G x 1" Pcs 2 - 2 - 2 - 10
64 Kateter IV No. 24 G x 3/4" Pcs 1 - 1 - 1 - 10
65 Ketokonazol krim 2% Tube - 50 50 90 - 40 - 100
66 Ketokonazol tablet 200 mg Tablet - - - - - 2,000
67 Ketorolak injeksi 30 mg/ml (3%) Ampul - - - - - 100
68 Klindamisin kapsul 300 mg Kapsul - 1,500 1,500 1,200 300 - 2,000
69 Kotrimoksazol suspensi: sulfametoksazol 200 mg + trimetoprim 40 mg Botol 5 - 5 5 - 100
70 Kotrimoksazol tablet 480 mg Tablet 250 1,000 1,250 400 850 - 5,000
71 Lansoprazole 30 mg Kapsul - 2,400 2,400 2,400 - - 1,000
72 Lidokain injeksi 2% Ampul - - - - - 50
 Lidokain injeksi 2% + Epinefrin 1: 80.000 - injeksi @ kotak 30 ampul 2
73 Ampul - - - - 50
ml
74 Loratadin tablet 10 mg Tablet 400 1,000 1,400 700 700 - 1,000
75 Metformin tablet 500 mg Tablet - 100 100 200 - 100 - 5,000
76 Metillergometrin injeksi 0,2 mg/ml Ampul - 50 50 100 - 50 - 100
77 Metilprednisolon tablet 4 mg Tablet - 1,200 1,200 1,200 - - 5,000
78 Metronidazole sirup 125 mg/5 ml Botol 55 200 255 230 25 - 100
79 Metronidazole Tablet 500 mg Tablet 30 500 530 230 300 - 1,000
80 NaCl 0,9 % 500 ml Fls 5 40 45 30 15 - 50
81 Natrium Diklofenak 50 mg Tablet 200 1,800 2,000 1,300 700 - 3,000
82 Oksitetrasiklin salep mata 1 % Botol - - - - - 50
83 Oksitosin injeksi 10 IU/ml Ampul 1 25 26 25 1 - 25

84 Parasetamol drops 60 mg, 15 ml Botol 56 48 104 52 52 - 100

85 Parasetamol sirup 120 mg / 5 ml, 60 ml Botol 100 200 300 250 50 - 100

86 Parasetamol Tablet 500 mg Tablet 1,100 5,000 6,100 5,600 500 - 10,000
87 Perban Elastis unifleks ( 10 cmx 4,5 m / 96 pcs - - - - - - 10
88 Pirantel tablet 125 mg Tablet - 50 50 50 - - 5,000
89 Plester penutup luka lebar 5 cm x 5 m Roll 1 - 1 1 - - 20
90 Prednison Tab 5 mg Tablet - - - - - 5,000
91 Ranitidin injeksi Vial - 10 10 10 - - 200
92 Ranitidin tablet 150 mg Tablet - 2,000 2,000 1,600 400 - 5,000
93 Retinol 100.000 IU Kapsul Lunak - - - - 100
94 Retinol 200.000 IU Kapsul Lunak - - - - 100
95 Ringer Laktat 500 ml Botol 5 100 105 100 5 - 100
96 Risperidon tablet 2 mg Tablet 100 - 100 100 - 200
97 Salbutamol tablet 2 mg Tablet - 800 800 500 300 - 5,000
98 Sefiksim sirup 100 mg/ 5 ml botol 30 ml Botol 2 25 27 25 2 - 100
99 Sefiksim tablet 200 mg Tablet - 1,700 1,700 1,500 200 - 3,000
100 Setirizin HCl sirup 5 mg/5 ml Botol 5 50 55 45 10 - 200
101 Setirizin HCl tablet 10 mg Tablet 300 2,500 2,800 2,600 200 - 5,000
102 Simvastatin tablet 10 mg Tablet - 500 500 500 - - 5,000
103 Siprofloksasin tablet 500 mg Tablet 100 1,500 1,600 1,200 400 - 3,000
104 Spuit 3 cc Pcs - 300 300 150 150 - 600
105 Strip uji glukosa Kotak 2 3 5 1 4 - 25
106 Surgical Glove Sterile Pasang 50 200 250 200 50 - 1,000
107 Surgical Gynaecology glove Pasang - 25 25 20 5 - 1,000
108 Surgical mask (Masker Bedah) Pcs 500 2,000 2,500 1,900 600 - 5,000
109 Thiamin ( vit b1) tablet 50 mg Tablet - 100 100 100 - - 1,000
110 Trihexyphenidyl HCl 2 mg Botol - 50 50 - 50 - 100
111 Vaksin Rabies Untuk Manusia Serbuk injeksi 2,5 IU (s.k) Vial - - - - 3
112 Vitamin B kompleks Tablet 1,100 - 1,100 1,100 - - 1,000
113 Zink sirup 20 mg / 5 ml Botol 16 36 52 31 21 - 50

Disetujui Oleh:
Kepala Bidang Pelayanan dan Sumber Daya Kesehatan Diketahui,
Kepala Seksi SDK, Kefarmasian, Alkes, dan PKRT Kepala Puskesmas Petugas Puskesmas,

(Poltak Sianturi, S.Gz) (Mart Diana M. S ( Ferawati Ginting, SKM, MKM ) ( Yuly Artha Butarbutar, Amd. Farm)
Pembina Penata Tk. I Penata Tk I Pengatur
NIP. 19720909 199503 1 001 NIP. 19850306 201001 2 026 NIP. 19790206 200604 004 NIP. 19900717 202203 2 003
82 Alkohol 95% 1 Liter Botol
83 Alkohol Swab 2-ply @ 100 pcs Kotak
1 Alopurinol tablet 300 mg Tablet
2 Amlodipin tablet 5 mg Tablet
3 Amoksisilin sirup 250 mg / 5 ml Botol
4 Amoksisilin tablet 250 mg Tablet
5 Amoksisilin tablet 500 mg Kaplet
6 Antasida sirup Botol
7 Antasida Tablet Tablet
8 Anti Bisa Ular Serum (ABU) Injeksi Vial
9 Anti Tetanus Serus (ATS) injeksi 1.500 IU ml Ampul
10 Antihemoroid supp Suppo
84 Antiseptik pembersih tangan 100 ml (Chlorhexidine Gluconate 0,5 % + alkohol 70 %) Botol
85 Antiseptik pembersih tangan 500 ml (Chlorhexidine Gluconate 0,5 % + alkohol 70 %) Botol
86 Antiseptik pencuci tangan 500 ml Botol
11 Asam askorbat (Vitamin C) tab 250 mg Tablet
12 Asam askorbat (Vitamin C) tab 50 mg Tablet
13 Asam folat tablet 1 mg Tablet
14 Asam Mefenamat 500 mg Kaplet
87 Aseptan Solution 2 % 500 ml Botol
106 Asering asetat ringer Botol
15 Asetil sistein kapsul 200 mg Tablet
16 Asetosal tablet 80 mg Tablet
17 Asiklovir tablet 400 mg Tablet
18 Atropin injeksi 0,25 mg/ml (i.m./i.v./s.k) Ampul
88 Benang Catgut Plain 3/0 + jarum 1/2 GT 35 mm Kotak
89 Benang Silk 3/0, 1/2 TP 25 mm, 75 cm Pcs
19 Betametasone Dipropionate krim 0,5 mg/g Tube
90 Blood Lancet Kotak
107 Bricasma Respules Terbutaline sulfate respules
20 CTM Tablet 4 mg Tablet
21 Deksametason injeksi 5 mg/ml (i.v./i.m.) Ampul
22 Dextrofen Syr 60 ml Botol
23 Diazepam injeksi 5 mg / ml (i.v./i.m.) Ampul
108 diazepam tablet / kapsul / kaplet 2 mg Tablet
24 Difenhidramin injeksi 10 mg/ml Ampul
25 Domperidon tablet/kapsul/kaplet 10 mg Tablet
26 Domperidone sirup 5 mg/5 ml Botol
27 Epinefrin (Adrenalin) injeksi 0,1% Ampul
28 Eritromisin sirup 200 mg/5 ml Botol
109 ertromisin tablet / kapsul kaplet 500 mg Tablet
29 Fitomenadion (Vit. K) injeksi i.m 2 mg/ml Ampul
30 Fitomenadion (Vit. K) tablet 10 mg Tablet
104 Furosemid Tablet 40 mg Tablet
110 garam oralit I serbuk komb : na klorida 0,52 gr+ k klorida 0,30 gr+ trinatrium sitrat sachet
31 Glibenklamid tablet/kapsul/kaplet 5 mg Tablet
32 Glimepiride tablet/kapsul/kaplet 1 mg Tablet
33 Glukosa larutan infus 5 % 500 mL Botol
34 Griseofulvin (micronized) tablet 125 mg Tablet
35 Hidrokortison krim 2,5 % Tube
36 Hustab Syr 60 ml Botol
37 Ibuprofen suspensi 100 mg/5 ml Botol
91 Infusion Set Anak 60 drops/ml Set
92 Infusion Set type Y Set
38 Isosorbid Dinitrat tablet 5 mg Tablet
39 Kalsium Laktat tablet 500 mg Tablet
93 Kapas Pembalut 250 gr Roll
40 Kaptopril tablet 12,5 mg Tablet
41 Karbogliserin tetes telinga 10% Botol
94 Kasa Hydrofil Steril 18 x 22 cm Kotak
111 kasa parafun pcs
95 Kasa Pembalut Hydrofil 4 m x 5 cm Roll
96 Kateter IV No. 22 G x 1" Pcs
97 Kateter IV No. 24 G x 3/4" Pcs
42 Ketokonazol krim 2% Tube
43 Ketokonazol tablet 200 mg Tablet
44 Ketorolak injeksi 30 mg/ml (3%) Ampul
45 Klindamisin kapsul 300 mg Kapsul
46 Kotrimoksazol suspensi: sulfametoksazol 200 mg + trimetoprim 40 mg Botol
47 Kotrimoksazol tablet 480 mg Tablet
48 Lansoprazole 30 mg Kapsul
49 Lidokain injeksi 2% Ampul
50 Lidokain injeksi 2% + Epinefrin 1: 80.000 - injeksi @ kotak 30 ampul 2 ml Ampul
51 Loratadin tablet 10 mg Tablet
52 Metformin tablet 500 mg Tablet
53 Metillergometrin injeksi 0,2 mg/ml Ampul
54 Metilprednisolon tablet 4 mg Tablet
55 Metronidazole sirup 125 mg/5 ml Botol
56 Metronidazole Tablet 500 mg Tablet
57 NaCl 0,9 % 500 ml Fls
58 Natrium Diklofenak 50 mg Tablet
59 Oksitetrasiklin salep mata 1 % Botol
60 Oksitosin injeksi 10 IU/ml Ampul

61 Parasetamol drops 60 mg, 15 ml Botol

62 Parasetamol sirup 120 mg / 5 ml, 60 ml Botol

63 Parasetamol Tablet 500 mg Tablet

105 Perban Elastis unifleks ( 10 cmx 4,5 m / 96 pcs
64 Pirantel tablet 125 mg Tablet
98 Plester penutup luka lebar 5 cm x 5 m Roll
65 Prednison Tab 5 mg Tablet
66 Ranitidin injeksi Vial
67 Ranitidin tablet 150 mg Tablet
Kapsul
68 Retinol 100.000 IU
Lunak
Kapsul
69 Retinol 200.000 IU
Lunak
70 Ringer Laktat 500 ml Botol
71 Risperidon tablet 2 mg Tablet
72 Salbutamol tablet 2 mg Tablet
73 Sefiksim sirup 100 mg/ 5 ml botol 30 ml Botol
74 Sefiksim tablet 200 mg Tablet
75 Setirizin HCl sirup 5 mg/5 ml Botol
76 Setirizin HCl tablet 10 mg Tablet
77 Simvastatin tablet 10 mg Tablet
78 Siprofloksasin tablet 500 mg Tablet
99 Spuit 3 cc Pcs
100 Strip uji glukosa Kotak
101 Surgical Glove Sterile Pasang
102 Surgical Gynaecology glove Pasang
103 Surgical mask (Masker Bedah) Pcs
112 Thiamin ( vit b1) tablet 50 mg Tablet
79 Trihexyphenidyl HCl 2 mg Botol
80 Vaksin Rabies Untuk Manusia Serbuk injeksi 2,5 IU (s.k) Vial
113 vitamin b kompleks Tablet
81 Zink sirup 20 mg / 5 ml Botol
 14 24 38 28 10 - 50
- 24 24 22 2 - 50
200 600 800 800 - - 2,000
300 2,100 2,400 1,700 700 - 2,000
- 120 120 91 29 - 120
100 1,500 1,600 1,400 200 - 2,000
300 1,500 1,800 1,370 430 - 2,000
- 100 100 100 - - 200
1,100 1,100 1,100 - - 1,500
- - - -
- - - -
12 10 22 12 10 - 30
2 10 12 6 6 - 50
8 36 44 31 13 - 50
10 24 34 17 17 - 50
600 6,500 7,100 6,250 850 - 7,000
500 2,000 2,500 2,100 400 - 3,000
- - - - - 5,000
500 5,000 5,500 5,200 300 - 7,000
6 4 10 - 10 - 50
- 24 24 8 16 - 50
2,000 2,640 4,640 4,640 - - 5,000
300 - 300 300 - - 2,000
- - - - - 5,000
- - - - - 200
6 10 16 10 6 - 20
36 36 36 - - 50
- 75 75 54 21 - 100
1 12 13 9 4 - 25
- 20 20 20 - - 50
1,050 2,000 3,050 2,550 500 - 5,000
- 25 25 25 - - 100
5 100 105 100 5 - 200
- 10 10 20 - 10 - 20
100 200 300 100 200 - 100
20 - 20 10 10 - 20
 - 100 100 200 - 100 - 2,000
5 15 20 15 5 - 200
- - - - - - 20
21 100 121 50 71 - 100
100 - 100 - 100 - 3,000
5 15 20 - 20 - 200
190 600 790 - 790 - 1,000
- - - - - - 1,000
100 - 100 100 - - 100
- - - - - 2,000
- - - - - 2,000
18 - 18 18 - - 200
200 300 500 400 100 - 1,000
8 48 56 52 4 - 100
3 100 103 103 - - 200
8 50 58 38 20 - 200
2 12 14 2 12 - 25
- 12 12 - 12 - 25
50 250 300 300 - - 1,000
400 300 700 600 100 - 5,000
- 10 10 2 8 - 25
- - - - - 5,000
12 12 24 24 - - 100
5 25 30 20 10 - 50
- 100 100 100 - - 200
5 50 55 45 10 - 100
2 - 2 - 2 - 10
1 - 1 - 1 - 10
- 50 50 90 - 40 - 100
- - - - - 2,000
- - - - - 100
- 1,500 1,500 1,200 300 - 2,000
5 - 5 5 - 100
250 1,000 1,250 400 850 - 5,000
- 2,400 2,400 2,400 - - 1,000
- - - - - 50
 - - - - 50
400 1,000 1,400 700 700 - 1,000
- 100 100 200 - 100 - 5,000
- 50 50 100 - 50 - 100
- 1,200 1,200 1,200 - - 5,000
55 200 255 230 25 - 100
30 500 530 230 300 - 1,000
5 40 45 30 15 - 50
200 1,800 2,000 1,300 700 - 3,000
- - - - - 50
1 25 26 25 1 - 25

56 48 104 52 52 - 100

100 200 300 250 50 - 100

1,100 5,000 6,100 5,600 500 - 10,000

- - - - - - 10
- 50 50 50 - - 5,000
1 - 1 1 - - 20
- - - - - 5,000
- 10 10 10 - - 200
- 2,000 2,000 1,600 400 - 5,000
- - - - 100
- - - - 100
5 100 105 100 5 - 100
100 - 100 100 - 200
- 800 800 500 300 - 5,000
2 25 27 25 2 - 100
- 1,700 1,700 1,500 200 - 3,000
5 50 55 45 10 - 200
300 2,500 2,800 2,600 200 - 5,000
- 500 500 500 - - 5,000
100 1,500 1,600 1,200 400 - 3,000
- 300 300 150 150 - 600
2 3 5 1 4 - 25
50 200 250 200 50 - 1,000
- 25 25 20 5 - 1,000
 500 2,000 2,500 1,900 600 - 5,000
- 100 100 100 - - 1,000
- 50 50 - 50 - 100
- - - - 3
1,100 - 1,100 1,100 - - 1,000
16 36 52 31 21 - 50