LAPORAN PEMAKAIAN DA

PUSKESM

PUSKESMAS : PARSOBURAN
KECAMATAN : SIANTAR MARIHAT PELAPORAN BULAN/PERIODE
KOTA : Pematangsiantar PERMINTAAN BULAN/PERIODE

SATU- SISA PENERI- PERSE-

AN STOK MAAN DIAAN
No. NAMA OBAT AKHIR OBAT OBAT
BULAN BULAN BULAN
…………. ………… …………
1 2 3 4 5 6=(4 + 5)
1 Alat Suntik 2,5 - 3 ml
2 Albendazol 400 mg Tablet
3 Alkacide 1 Liter
4 Alkohol swab
5 Alluprinol Tablet 100 mg
6 Alluprinol Tablet 300 mg
7 Alprazolam tablet 0,5 mg ACETYLSISTEIN
8 Alprazolam tablet 1 mg Adalat oros
9 Amitripylin / DECAPIL
10 Aminofilin 200 mg
11 Amlodipin Tablet 10 mg
12 Amlodipin Tablet 5 mg
13 Amoksisillin Kaplet 500 mg
14 Amoksisillin Kapsul 250 mg
15 Amoksisillin S Kering 125 mg
16 Amoksisillin S Kering 250 mg
17 Ampisilin serbuk injeksi
18 Antasida Doen Tab 500 mg
19 Antasida Syr
20 Antifungi Doen Salep
21 Aqua Pro Injeksi Steril
22 As. Asetat 6%
23 As. Askorbat ( Vit. C.) Tab 50 mg
24 As. Askorbat ( Vit. C.) Tab 250 mg
25 As. Mefenamat Tablet 500 mg
26 Asiklovir Tablet 200 mg
27 Asiklovir Tablet 400 mg
28 Atrofin Sulfat Asiklovir cream
29 Azitromysin Tablet 500 mg
30 Bacitrasin Krim
31 Benechek P Glucosa Test Strip
32 Benechek P Total Chlosterol Test
33 Benechek Plus Uric Test Strip
34 Benzatin Benzil Penisilin
35 Besi II Sulfat Tablet 300 mg
36 Betahistin Tab 6 mg
37 Betametason 0,1%
38 Betadine Salep Antiseptik
39 Box Slide/ BISOPROLOL
40 Bufacetine Kloramfenikol SK 2%
41 Captopril Tablet 12,5 mg
42 Captopril Tablet 25 mg
43 Cefadroksil kapsul 500 mg
44 Cefadroksil Srp Krng 125 mg/5ml
45 Cefixime Kapsul 200 mg
46 Cefixime sirup 100mg/5ml
47 Cetirizine Sirup 5 mg/5ml
48 Cetirizine Tab 10 mg
49 Clindamysin Tab 150 mg
50 Clindamysin Tab 300 mg
51 Chlorpromazin 100mg
52 Chlobazam tab 10mg
53 Clozapine Tablet 25mg
54 Cosmomed IV canula no 24
55 Cosmomed IV canula no 22
56 Cotton Role prodental
57 Cutanplast
58 Cutgut no. 3/0 dengan jarum bedah
59 Cuticell clasic 10 cm
60 Defacil
61 Dehydro Artemisin D-Artep
62 Deksametason Injeksi 5 mg/1 ml
63 Deksametason Tablet 0,5 mg
64 Desinfectan Onescrub 5 L
65 Desinfectan Onescrub 500 ml
66 Devitalisasi Pasta
67 Diazepam tablet 2 mg
68 Diazepam Tablet 5 mg
69 Diethyl Carbamazine Tab 100 mg
70 Digoksin 0,25 mg
71 Dipenhidramin Injeksi 10mg/ ml
72 Doksisiklin Kaplet 100 mg
73 Domperidon 10 mg
74 Domperidon Suspensi 5 gm
75 Eosin 1% EFINEFRIN
76 Eritromisin Kaplet 250 mg
77 Eritromisin Kaplet 500 mg
78 Eritromisin Syr 200mg/5ml
79 Etakridin 0,1% (Rivanol)
80 Etanol 70% (Alkohol 70%) 1L
81 Etanol 70% (Alkohol 70%) 100ml
82 Etilklorida Semprot
83 Eugenol Cairan
84 Fetik Suppositoris 100 mg
85 Fenobarbital Inj 50 mg/ml
86 Fenobarbital Tablet 30 mg
87 Ferofolat ( Besi II Sulfat ) Tablet
88 Fitomenadion (Vit. K) 10mg
89 Fitomenadion Injeksi (Vit. K)
90 Fixomull Strach 5 cm x 5 m / Plester
91 Fludane plus sirup
92 Fluoksetin Tablet 10 Mg
93 Foley Catheter/ FUSIDEX ACID
94 Furosemide Tablet 40 mg
95 Garabiotic salep kulit
96 Garam Oralit 200 ml
97 Gentamisin Sulfat tetes mata
98 Gentamisin Injeksi 40 mg / Gentamisin salep mata
99 Gentamisin Salap Kulit
100 Glibenklamide Tablet 5 mg
101 Glimepirid 1 mg
102 Glimepirid 2 mg
103 Glukonas Kalsikus inj 10%
104 Grisiofulfin Tablet 125 mg
105 Hanscoon 6,5
106 Hanscoon 7/ GENTIAN VIOLET
107 Hanscoon Steril 7
108 Hanscoon Steril 7,5
109 Hidrokartison Krim 2,5%
110 Haloperidol tab 5mg
111 Ibufropen Tablet 400 mg
112 Ibuprofen sirup 100 mg/5 ml
113 Iliadin Oksimetazolin T. H. 0,025%
114 Iliadin Oksimetazolin TH. 0,050 %
115 Infus Set Adult ( Dewasa)
116 Infus set Pediatrik
117 Interzinc Sirup 2ml 10mg/ml
118 Interzol SS 2% Sol 2% Ketokenazol
119 Isosorbid Dinitrat Subl 5mg
120 IV Chateter No. 22
121 IV Chateter No. 24
122 Kaca Slide IV Chateter No. 20
123 Kaki Tiga
124 Kalsium Laktat Tablet 500 mg
125 Kapas 250 g
126 Kapas 500 g
127 Kasa Hydrofil Steril 16 x 16 cm
128 Kasa Pembalut 2 x 80 cm
129 Kasa Pembalut 4 x 10 cm
130 Kasa Pembalut 4 x 15 cm
131 Kasa Pembalut 4 x 5 cm
132 Ketokonazol Krim 2%
133 Ketokonazol Tablet 200 mg
134 Ketoprofen tab 100 mg
135 Kina Tablet/ CAC 250
136 Kloramfenikol Kapsul 250 mg
137 Kloramfenikol salep mata 1 %
138 Kloramfenikol Tts Kuping 3%
139 Klorfeniramin Maleat tab 4 mg
140 Kotrimoksazol Forte 960 mg
141 Kotrimoksazol Sirup 60 ml
142 Kotrimoksazol Tablet 480 mg
143 Lansoprazole Tab 30 mg
144 Lar. Amonium Hidro 28% LEKOPLAST 7,5
145 Larutan Infus Glukosa
146 Larutan Infus NaCl
147 Larutan Infus RL LEKOPLAST 2,5
148 Lidokain 2%(HCl)
149 Lisol Tersabun 1000 ml
150 Loperamid 2 mg
151 Loratadine 10 mg
152 Lorezepam 2mg
153 Lodomer Tablet Haloperidol
154 Masker
155 Masker Plus 3 Ply
156 Meloxicam Tab 15 mg
157 Meloxicam Tab 7,5 mg
158 Metilprednisolon Tablet 4 mg
159 Metilprednisolon Tablet 8 mg
160 Metilergometrin inj
161 Metilergometrin Maleat Tablet
162 Metoclopramida Tablet 10 mg
163 Metoclopramida Tablet 5 mg
164 Metronidazol Sirup
165 Metronidazol Tablet 250 mg
166 Metronidazol Tablet 500 mg
167 MgSo 4 20%
168 MgSo4 40%
169 Mikonazol Krim 2%
170 Mineral Mix
171 Nat. Diklofenak Tablet 25 mg
172 Nat. Diklofenak Tablet 50 mg
173 Nat. Karbonat Tablet 500 mg
174 Natrium Tiroksin 100 mcg
175 Nifedifin Tablet 10 mg
176 Nifedipin tablet 30 mg, oros
177 Nistatin Vaginal Tab 100.000IU
178 OAT Kusta MDT Anak-anak
179 OAT Reagensia TB Paru
180 Obat Batuk Hitam Molex
181 Obat Batuk Hitam Plus
182 Obat INH
183 Obat Kusta MDT Dewasa
184 Obat TB FDC Sisipan
185 Obat TB Kategori Anak
186 Obat TB Kategori FDC
187 Obat TB Kategori II
188 Obat TB Kombipak Kat I
189 Oksitetrasiklin HCl Slp Kulit 3%
190 Oksitetrasiklin HCl Slp Mata 1%
191 Oksitoksin injeksi
192 Omeprazol Kapsul
193 Parasetamol Drops 60 mg/0,6 ml
194 Parasetamol Sirup 120 mg
195 Parasetamol Tablet 500 mg
196 Pirantel Pamoat tablet 125mg
197 Pirantel Pamoat Susp 125 mg / 5 ml
198 Piridoksin 10 mg (Vit. B.6)
199 Plester 2 x 5 Yard
200 Plester 5cm x 5 m
201 Pot Sputum
202 Povidon Iodida Lar 10% 300 ml
203 Povidon Iodida Lar 10% 60 ml
204 Povidon Iodida Lar 10% 30 ml
205 Prednison Tablet 5 mg
206 Primaquin Tablet 15 Mg / PHENOBARBITAL INJ
207 Prokain Penisillin 3jtIU/vial
208 Risperidone tab 2mg
209 Ranitidine Injeksi 25 mg/ml
210 Ranitidine Tablet 150 mg
211 Rapid Tes Malaria
212 Rapid Test HIV 1/2 Biomerieux 5A
213 Rapid Sipplis ( Hexagon )
214 Reagen Asam Urat(Autochek)
215 Reagen Blood Lancet
216 Reagen Cholesterol(Autochek)
217 Reagen Gula Darah(Autochek)
218 Retinol ( Vit. A ) 100.000 iu
219 Retinol ( Vit. A ) 200.000 iu
220 Salap 24 Krim
221 Salbutamol Tablet 2 mg
222 Salisil Bedak 2 %
223 Sianokobalamin Inj (Vit. B.12)
224 Sianokobalamin Tablet (Vit. B.12)
225 Simvastatin Tablet 10 mg
226 Simvastatin Tablet 20 mg
227 Siprofloksasin Tablet 500 mg
228 Stesolid 10 Mg (Diazepam) STEVECILIN
229 Stesolid 5 Mg (Diazepam)
230 Tarivid Ofloksasin TT 3%
231 Tetagam Human tetanus
232 Tetrasiklin Kaplet 500 mg
233 Tetrasiklin Kapsul 250 mg
234 Thiamin 50 mg (Vit. B.1)
235 Thiamin Injeksi (Vit. B.1)
236 Thimolol 0,25% (isotic Adretor)
237 Vitamin B. Compleks
238 Zinc Tablet 20 mg
239 Sound Timer
240 SD-HIV
241 RPR Fokus Sipilis
242 Fokus HIV/ SELVIPLEX
243 Vikia/Biomeurux HIV
Neo Diagon
APD
Nurse Cap
Sabun Cair/ HANDRUB
Spuit 1ml
masker n95
arios gel/ k.reen hand gel 500ml/ HANDSCRB 500ML
vitamin c 500mg
selfipleks
rit Assay/TCM
coverall
kacamata google
Santa E\
selcom c

BAYAR UMUM TIDAK BAYAR

JUMLAH KUNJUNGAN RESEP 23

Mengetahui / menyetujui Yang menyerahkan

Kepala Dinas Kesehatan Kasie Farmasi, Alkes & PKRT
Kota Pematangsiantar

( ………………………………. ) ( …………………………… )
NIP. NIP.
AN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS ( LPLPO ) 2021

DOKUMEN
AN BULAN/PERIODE : NOVEMBER 2021 GFK
AAN BULAN/PERIODE : DESEMBER 2021 PUSKESMAS

PEMA- SISA STOK PERMIN- PEMBERIAN

KAIAN STOK OPT TAAN
OBAT OBAT OBAT OBAQT
DAK DAU PROG LAIN2
BULAN BULAN BULAN BULAN
…………. ………… ………… .............
7=(6 - 8) 8 9 10 11 12 13 14

198

1130

4
252

510

1414

20
683

41

1045

351

32
900
40

40
366

24
1000
738

30

192
9

1310
12

37

3
130

19
24

514

422

46

13

12
 2

800
1
2
25
4
22

13

4
2
2227
280
26
1053
4
36

1
20

376

50

220
164
21

107
6

103

24

2
54
821

10
17
14
860
30
400

66
178
28

53

630

1094

1078
932

136

710
110
 110

UM TIDAK BAYAR JUMLAH

nyerahkan Yang Meminta Yang mene

i, Alkes & PKRT Pimpinanan Puskesmas Petugas Pusk

………… ) ( ………………………………. )
NIP.
 TANGGAL
...........................................
...........................................

KET
JML

15 16

ed 52,

ED 500tab juni 2020

ED 788 tab sep 2020

ED juni 2020. 104pot

 ED april 2021 510

ed 12 botol april 2020

ED 300 mei 2020

ED 20

ED 150

ed 670 April 2021

 ed 168

ED 56

ed 300

ed 536
ed 90

ed 362 juli 2021

ed 300 juli 2021

ED 10, juni 2021

ED 290 juli 2021

ed 13 juni 2021
ED 519 mei 2020

ed 330

ed 15

ED 15

ED 120
ED 267

ED 51

ED 35

ED 300
yang diterima ed juli 2020 20pot

ED 273 juni 2021

ED 5tab
ED 9 sub
 Yang menerima
Petugas Puskesmas

( …………………………….. )
NIP.
 BUKU HARIAN PEMAKAIAN OBAT-OBATAN/ ALAT KESEHATAN

PUSKESMAS : PARSOBURAN
KOTA : PEMATANGSIANTAR
PROPINSI : SUMATERA UTARA

SISA STOK
BULAN OBAT
NO NAMA OBAT SATUAN
................... MASUK
1 2
Alat Suntik 2,5 - 3 ml Buah
2 Albendazol 400 mg Tablet Tablet
3 Alkacide 1 Liter Botol
4 Alkohol swab Saset
5 Alluprinol Tablet 100 mg Tablet 12
6 Alluprinol Tablet 300 mg Tablet
7 Alprazolam tablet 0,5 mg ACETYLSISTEIN Tablet 19
8 Alprazolam tablet 1 mg Tablet
9 Amitripylin / DECAPIL
10 Aminofilin 200 mg Tablet
11 Amlodipin Tablet 10 mg Tablet 21
12 Amlodipin Tablet 5 mg Tablet
13 Amoksisillin Kaplet 500 mg Kaplet 18 13
14 Amoksisillin Kapsul 250 mg Kapsul
15 Amoksisillin S Kering 125 mg Botol
16 Amoksisillin S Kering 250 mg Botol
17 Ampisilin serbuk injeksi
18 Antasida Doen Tab 500 mg Tablet 58 50
19 Antasida Syr Botol
20 Antifungi Doen Salep Pot
21 Aqua Pro Injeksi Steril Vial
22 As. Asetat 6% Botol
23 As. Askorbat ( Vit. C.) Tab 50 mg Tablet 85 70
24 As. Askorbat ( Vit. C.) Tab 250 mg Tablet
25 As. Mefenamat Tablet 500 mg Tablet 19 70
26 Asiklovir Tablet 200 mg Tablet 6
27 Asiklovir Tablet 400 mg Tablet
28 Atrofin Sulfat Asiklovir cream Ampul
29 Azitromysin Tablet 500 mg Tablet
30 Bacitrasin Krim
31 Benechek P Glucosa Test Strip Stik
32 Benechek P Total Chlosterol Test Stik
33 Benechek Plus Uric Test Strip Stik
34 Benzatin Benzil Penisilin
35 Besi II Sulfat Tablet 300 mg Kapsul
36 Betahistin Tab 6 mg Tablet 10
37 Betametason 0,1% Tube
38 Betadine Salep Antiseptik
39 Box Slide/ BISOPROLOL Box
40 Bufacetine Kloramfenikol SK 2% Tube 1
41 Captopril Tablet 12,5 mg Tablet
42 Captopril Tablet 25 mg Tablet
43 Cefadroksil kapsul 500 mg Kapsul
44 Cefadroksil Srp Krng 125 mg/5ml Botol
45 Cefixime Kapsul 200 mg Kapsul
46 Cefixime sirup 100mg/5ml Botol
47 Cetirizine Sirup 5 mg/5ml Botol 3 1
48 Cetirizine Tab 10 mg Tablet
49 Clindamysin Tab 150 mg Tablet
50 Clindamysin Tab 300 mg Tablet
51 Chlorpromazin 100mg Bungkus
52 Chlobazam tab 10mg Tablet
53 Clozapine Tablet 25mg Tablet
54 Cosmomed IV canula no 24 pcs
55 Cosmomed IV canula no 22 pcs
56 Cotton Role prodental Bungkus
57 Cutanplast Botol
58 Cutgut no. 3/0 dengan jarum bedah Set
59 Cuticell clasic 10 cm Kotak
60 Defacil
61 Dehydro Artemisin D-Artep Tablet
62 Deksametason Injeksi 5 mg/1 ml Ampul
63 Deksametason Tablet 0,5 mg Tablet
64 Desinfectan Onescrub 5 L Botol
65 Desinfectan Onescrub 500 ml Botol
66 Devitalisasi Pasta
67 Diazepam tablet 2 mg Tablet
68 Diazepam Tablet 5 mg Tablet
69 Diethyl Carbamazine Tab 100 mg Tablet
70 Digoksin 0,25 mg Tablet
71 Dipenhidramin Injeksi 10mg/ ml Ampul
72 Doksisiklin Kaplet 100 mg Kaplet
73 Domperidon 10 mg Tablet 6
74 Domperidon Suspensi 5 gm Botol
75 Eosin 1% EFINEFRIN
76 Eritromisin Kaplet 250 mg Kaplet 40 110
77 Eritromisin Kaplet 500 mg Kaplet
78 Eritromisin Syr 200mg/5ml Botol
79 Etakridin 0,1% (Rivanol) Botol
80 Etanol 70% (Alkohol 70%) 1L
81 Etanol 70% (Alkohol 70%) 100ml
82 Etilklorida Semprot Botol
83 Eugenol Cairan Botol
84 Fetik Suppositoris 100 mg Tablet
85 Fenobarbital Inj 50 mg/ml Ampul
86 Fenobarbital Tablet 30 mg Tablet
87 Ferofolat ( Besi II Sulfat ) Tablet Tablet
88 Fitomenadion (Vit. K) 10mg Tablet
89 Fitomenadion Injeksi (Vit. K) Ampul
90 Fixomull Strach 5 cm x 5 m / Plester Rol
91 Fludane plus sirup
92 Fluoksetin Tablet 10 Mg Tablet
93 Foley Catheter/ FUSIDEX ACID Saset
94 Furosemide Tablet 40 mg Tablet
95 Garabiotic salep kulit Tube
96 Garam Oralit 200 ml Saset
97 Gentamisin Sulfat tetes mata Botol
98 Gentamisin Injeksi 40 mg Ampul
99 Gentamisin Salap Kulit Botol
100 Glibenklamide Tablet 5 mg Tablet 3
101 Glimepirid 1 mg Tablet
102 Glimepirid 2 mg Tablet
103 Glukonas Kalsikus inj 10% Ampul
104 Grisiofulfin Tablet 125 mg Tablet
105 Hanscoon 6,5 Pasang
106 Hanscoon 7/ GENTIAN VIOLET Pasang
107 Hanscoon Steril 7 Pasang
108 Hanscoon Steril 7,5 Pasang
109 Hidrokartison Krim 2,5% Tube 1
110 Haloperidol tab 5mg
111 Ibufropen Tablet 400 mg Tablet
112 Ibuprofen sirup 100 mg/5 ml Botol
113 Iliadin Oksimetazolin T. H. 0,025% Botol
114 Iliadin Oksimetazolin TH. 0,050 % Botol
115 Infus Set Adult ( Dewasa) Set
116 Infus set Pediatrik Set
117 Interzinc Sirup 2ml 10mg/ml Botol
118 Interzol SS 2% Sol 2% Ketokenazol Tube
119 Isosorbid Dinitrat Subl 5mg Tablet
120 IV Chateter No. 22 Set
121 IV Chateter No. 24 Set
122 Kaca Slide IV Chateter No. 20 Buah
123 Kaki Tiga Buah
124 Kalsium Laktat Tablet 500 mg Tablet 10 20
125 Kapas 250 g Bungkus
126 Kapas 500 g Bungkus
127 Kasa Hydrofil Steril 16 x 16 cm Rol
128 Kasa Pembalut 2 x 80 cm Roll
129 Kasa Pembalut 4 x 10 cm Roll
130 Kasa Pembalut 4 x 15 cm Rol
131 Kasa Pembalut 4 x 5 cm Roll
132 Ketokonazol Krim 2% Tube
133 Ketokonazol Tablet 200 mg Tablet
134 Ketoprofen tab 100 mg Tablet
135 Kina Tablet/ CAC 250 Tablet
136 Kloramfenikol Kapsul 250 mg Kapsul
137 Kloramfenikol salep mata 1 % Tube
138 Kloramfenikol Tts Kuping 3% Botol
139 Klorfeniramin Maleat tab 4 mg Tablet 10 10
140 Kotrimoksazol Forte 960 mg Tablet
141 Kotrimoksazol Sirup 60 ml Botol 1
142 Kotrimoksazol Tablet 480 mg Tablet 10
143 Lansoprazole Tab 30 mg Tablet 12 20
144 Lar. Amonium Hidro 28% LEKOPLAST 7,5 Botol
145 Larutan Infus Glukosa Botol
146 Larutan Infus NaCl Botol
147 Larutan Infus RL LEKOPLAST 2,5 Botol
148 Lidokain 2%(HCl)+Epinefrin Inj Ampul
149 Lisol Tersabun 1000 ml Botol
150 Loperamid 2 mg Tablet
151 Loratadine 10 mg
152 Lorezepam 2mg
153 Lodomer Tablet Haloperidol
154 Masker Buah
155 Masker Plus 3 Ply Buah
156 Meloxicam Tab 15 mg Tablet
157 Meloxicam Tab 7,5 mg Tablet
158 Metilprednisolon Tablet 4 mg Tablet
159 Metilprednisolon Tablet 8 mg Tablet
160 Metilergometrin inj Ampul
161 Metilergometrin Maleat Tablet Tablet
162 Metoclopramida Tablet 10 mg Tablet
163 Metoclopramida Tablet 5 mg Tablet
164 Metronidazol Sirup Botol
165 Metronidazol Tablet 250 mg Tablet
166 Metronidazol Tablet 500 mg Tablet
167 MgSo 4 20% Botol
168 MgSo4 40% Botol
169 Mikonazol Krim 2% Tube
170 Mineral Mix Saset
171 Nat. Diklofenak Tablet 25 mg Tablet
172 Nat. Diklofenak Tablet 50 mg Tablet
173 Nat. Karbonat Tablet 500 mg Tablet
174 Natrium Tiroksin 100 mcg Tablet
175 Nifedifin Tablet 10 mg Tablet
176 Nifedipin tablet 30 mg, oros Tablet
177 Nistatin Vaginal Tab 100.000IU Tablet
178 OAT Kusta MDT Anak-anak
179 OAT Reagensia TB Paru
180 Obat Batuk Hitam Molex Botol
181 Obat Batuk Hitam Plus Botol
182 Obat INH
183 Obat Kusta MDT Dewasa Paket
184 Obat TB FDC Sisipan Paket
185 Obat TB Kategori Anak Paket
186 Obat TB Kategori FDC Paket
187 Obat TB Kategori II Paket
188 Obat TB Kombipak Kat I Paket
189 Oksitetrasiklin HCl Slp Kulit 3% Tube
190 Oksitetrasiklin HCl Slp Mata 1% Tube
191 Oksitoksin injeksi Ampul
192 Omeprazol Kapsul Kapsul
193 Parasetamol Drops 60 mg/0,6 ml Botol
194 Parasetamol Sirup 120 mg Botol 2
195 Parasetamol Tablet 500 mg Tablet 24 45
196 Pirantel Pamoat tablet 125mg
197 Pirantel Pamoat Susp 125 mg / 5 ml Botol
198 Piridoksin 10 mg (Vit. B.6) Tablet 10 15
199 Plester 2 x 5 Yard Rol
200 Plester 5cm x 5 m Rol
201 Pot Sputum Pot
202 Povidon Iodida Lar 10% 300 ml Botol
203 Povidon Iodida Lar 10% 60 ml Botol
204 Povidon Iodida Lar 10% 30 ml Botol
205 Prednison Tablet 5 mg Tablet 52 90
206 Primaquin Tablet 15 Mg Tablet
207 Prokain Penisillin 3jtIU/vial Vial
208 Risperidone tab 2mg
209 Ranitidine Injeksi 25 mg/ml Ampul
210 Ranitidine Tablet 150 mg Tablet
211 Rapid Tes Malaria Kapsul
212 Rapid Test HIV 1/2 Biomerieux 5A Test
213 Rapid Sipplis ( Hexagon ) Test
214 Reagen Asam Urat(Autochek) Stik
215 Reagen Blood Lancet Stik
216 Reagen Cholesterol(Autochek) Stik
217 Reagen Gula Darah(Autochek) Stik
218 Retinol ( Vit. A ) 100.000 iu Kapsul
219 Retinol ( Vit. A ) 200.000 iu Kapsul
220 Salap 24 Krim Pot
221 Salbutamol Tablet 2 mg Tablet
222 Salisil Bedak 2 % Kotak
223 Sianokobalamin Inj (Vit. B.12) Ampul
224 Sianokobalamin Tablet (Vit. B.12)
225 Simvastatin Tablet 10 mg Tablet
226 Simvastatin Tablet 20 mg 3
227 Siprofloksasin Tablet 500 mg Tablet
228 Stesolid 10 Mg (Diazepam) STEVECILIN
229 Stesolid 5 Mg (Diazepam) Sub
230 Tarivid Ofloksasin TT 3% Botol
231 Tetagam Human tetanus
232 Tetrasiklin Kaplet 500 mg Kaplet
233 Tetrasiklin Kapsul 250 mg Kapsul
234 Thiamin 50 mg (Vit. B.1) Tablet 38 20
235 Thiamin Injeksi (Vit. B.1) Ampul
236 Thimolol 0,25% (isotic Adretor) Botol
237 Vitamin B. Compleks Tablet 20 10
238 Zinc Tablet 20 mg Tablet
239 Sound Timer
240 SD-HIV
241 RPR Fokus Sipilis
242 Fokus HIV/ SELVIPLEX
243 Vikia/Biomeurux HIV
Neo Diagon 12
APD
Nurse Cap
Sabun Cair/ HANDRUB
Spuit 1ml
masker n95
arios gel/ k.reen hand gel 500ml/ HANDSCRB 500ML
vitamin c 500mg/ IMMUANCE
selfipleks 20
rit Assay/TCM
coverall
kacamata google
Santa E\ v
 PENGELUARAN OBAT-OBATAN

3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

10 16 24 6 26 6 10 16

13

10 7 18 14 5 9 3

10 23 56 35 30 50 15 30 50 20 60 10

65 75 40 91 68 40 59 40 63 16 20 80 39

40 23 24 118 83 59 30 16 55 40 10 75 20

60 10 25 64 30 35 24 20 5 10 10
19 10

6 6 12 6 6 24
 1 1 1

1 2 3 3 1

20 10 6 10 21

20 20 50 30 20 20
 1

1 2 2

20 10 10 25 16 16 6 6 6

30 33 22 29 20 30 30 29 40 20 105 60
6 6 10 10
1 1 1 1 1 1 2 1
10 10 40 10
22 26 18 10 6 10 26 34 28 6 12 13
 20 6

1
2 1 1 1 1 1 1
41 73 46 45 53 51 30 55 59 60 15 100 33
 20 10 14 10 10 20 30 20

30 15 55 84 63 66 40 51 43 80 38 105 50

1 1 1 1 1

9 18 6 12 13 9 4

10 20 10 20 10

40 60 10 55 40 50 30 56 10 40

20 30 32 10 10 35 30 10 37 30 20 10
10

3
30 10 8
 10
8 8 10 5 9 20 10

\
 TAHUN

JUMLAH STOK
N
PEMA- AKHIR
KET
KAIAN ............
20 21 22 23 24 25 26 27 28 29 30
0
2
0
0
10 6 6 12 6 6 172
0
32
0
0
0
5 6 8 106
0
13 36 10 10 40 15 62 15 621
0
0
0
0
114 120 50 101 20 60 86 1355
0
1 2
0
0
5 40 40 10 55 91 22 1011
0
10 25 11 10 10 448
35
0
0
0
0
0
0
0
0
0
6 76
0
0
 0
1 5
0
0
0
0
0
0
1 1 2 18
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
20 32 6 10 20 15 176
0
0
20 20 10 360
0
0
0
0
0
0
0
0
0
0
30 30
0
0
0
0
 0
1
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
1 1 8
0
0
0
0
0
0
0
0
0
0
0
0
0
0
12 18 15 10 12 212
0
0
0
0
0
0
0
0
0
0
0
0
1 1 1 1 4
0
13 20 20 10 36 68 10 645
32
1 1 12
10 90
36 24 18 24 6 12 42 405
0
 0
0
0
0
0
0
4 30
0
0
0
0
0
0
0
0
0
0
0
0
1 1
0
0
0
0
1 1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
1 2 1 1 6
1 1 1 1 1 15
6 63 20 20 25 16 83 50 1013
0
0
 26 10 20 215
0
0
0
0
0
0
10 24 45 30 60 25 73 47 1176
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2 1 1 1 5
0
5
0
0
0
10 3 2 3 9 3 10 3 117
0
0
0
0
0
70
0
86 50 10 40 10 20 67 732
0
0
20 20 23 10 10 387
3 13
0
0
0
0
3
6 8 8 10 92
0
0
0
0
0
0
 10
20 110
0
0
0
0
 LAPORAN PEMAKAIAN DAN LEM
PUSKESMAS ( LPL

PUSKESMAS : PARSOBURAN
KECAMATAN : SIANTAR MARIHAT PELAPORAN BULAN/PERIODE
KOTA : Pematangsiantar PERMINTAAN BULAN/PERIODE
SATU- SISA PENERI- PERSE-
AN STOK MAAN DIAAN
No. NAMA OBAT AKHIR OBAT OBAT
BULAN BULAN BULAN
…………. ………… …………
1 2 3 4 5 6=(4 + 5)
1 Alat Suntik 2,5 - 3 ml Buah 100 100
2 Albendazol 400 mg Tablet Tablet 0 100 100
3 Alkacide 1 Liter Botol 0 0
4 Alkohol swab Saset 0 0
5 Alluprinol Tablet 100 mg Tablet 953 600 1553
6 Alluprinol Tablet 300 mg Tablet 0 0
7 Alprazolam tablet 0,5 mg ACETYLSISTEIN Tablet 13 13
8 Alprazolam tablet 1 mg Tablet 0 0
9 Amitripylin / DECAPIL Tablet 0 0
10 Aminofilin 200 mg Tablet 0 0
11 Amlodipin Tablet 10 mg Tablet 722 722
12 Amlodipin Tablet 5 mg Tablet 0 0
13 Amoksisillin Kaplet 500 mg Kaplet 1583 1000 2583
14 Amoksisillin Kapsul 250 mg Kapsul 0 0
15 Amoksisillin S Kering 125 mg Botol 0 0
16 Amoksisillin S Kering 250 mg Botol 0 0
17 Ampisilin serbuk injeksi 20 20
18 Antasida Doen Tab 500 mg Tablet 1474 1000 2474
19 Antasida Syr Botol 0 0
20 Antifungi Doen Salep Pot 149 149
21 Aqua Pro Injeksi Steril Vial 0 0
22 As. Asetat 6% Botol 0 0
23 As. Askorbat ( Vit. C.) Tab 50 mg Tablet 620 1500 2120
24 As. Askorbat ( Vit. C.) Tab 250 mg Tablet 0 0
SATU- SISA PENERI- PERSE-
AN STOK MAAN DIAAN
No. NAMA OBAT AKHIR OBAT OBAT
BULAN BULAN BULAN
…………. ………… …………
1 2 3 4 5 6=(4 + 5)
25 As. Mefenamat Tablet 500 mg Tablet 232 232
26 Asiklovir Tablet 200 mg Tablet 407 407
27 Asiklovir Tablet 400 mg Tablet 0 0
28 Atrofin Sulfat Asiklovir cream Ampul 0 0
29 Azitromysin Tablet 500 mg Tablet 0 0
30 Bacitrasin Krim 37 37
31 Benechek P Glucosa Test Strip Stik 0 0
32 Benechek P Total Chlosterol Test Stik 0 0
33 Benechek Plus Uric Test Strip Stik 0 0
34 Benzatin Benzil Penisilin 0 0
35 Besi II Sulfat Tablet 300 mg Kapsul 0 0
36 Betahistin Tab 6 mg Tablet 257 257
37 Betametason 0,1% Tube 0 0
38 Betadine Salep Antiseptik 0 0
39 Box Slide/ BISOPROLOL Box 510 510
40 Bufacetine Kloramfenikol SK 2% Tube 35 35
41 Captopril Tablet 12,5 mg Tablet 550 550
42 Captopril Tablet 25 mg Tablet 762 762
43 Cefadroksil kapsul 500 mg Kapsul 0 0
44 Cefadroksil Srp Krng 125 mg/5ml Botol 0 0
45 Cefixime Kapsul 200 mg Kapsul 0 0
46 Cefixime sirup 100mg/5ml Botol 0 0
47 Cetirizine Sirup 5 mg/5ml Botol 26 20 46
48 Cetirizine Tab 10 mg Tablet 32 32
49 Clindamysin Tab 150 mg Tablet 0 0
50 Clindamysin Tab 300 mg Tablet 0 0
51 Chlorpromazin 100mg Bungkus 0 0
52 Chlobazam tab 10mg Tablet 0 0
53 Clozapine Tablet 25mg Tablet 300 300
54 Cosmomed IV canula no 24 pcs 0 0
55 Cosmomed IV canula no 22 pcs 0 0
56 Cotton Role prodental Bungkus 0 0
57 Cutanplast Botol 0 0
SATU- SISA PENERI- PERSE-
AN STOK MAAN DIAAN
No. NAMA OBAT AKHIR OBAT OBAT
BULAN BULAN BULAN
…………. ………… …………
1 2 3 4 5 6=(4 + 5)
58 Cutgut no. 3/0 dengan jarum bedah Set 20 20
59 Cuticell clasic 10 cm Kotak 0 0
60 Defacil 0 0
61 Dehydro Artemisin D-Artep Tablet 0 0
62 Deksametason Injeksi 5 mg/1 ml Ampul 180 180
63 Deksametason Tablet 0,5 mg Tablet 60 60
64 Desinfectan Onescrub 5 L Botol 0 0
65 Desinfectan Onescrub 500 ml Botol 0 0
66 Devitalisasi Pasta 0 0
67 Diazepam tablet 2 mg Tablet 0 0
68 Diazepam Tablet 5 mg Tablet 0 0
69 Diethyl Carbamazine Tab 100 mg Tablet 0 0
70 Digoksin 0,25 mg Tablet 0 0
71 Dipenhidramin Injeksi 10mg/ ml Ampul 240 240
72 Doksisiklin Kaplet 100 mg Kaplet 206 206
73 Domperidon 10 mg Tablet 202 202
74 Domperidon Suspensi 5 gm Botol 0 0
75 Eosin 1% EFINEFRIN 3 3
76 Eritromisin Kaplet 250 mg Kaplet 2570 2570
77 Eritromisin Kaplet 500 mg Kaplet 168 168
78 Eritromisin Syr 200mg/5ml Botol 0 0
79 Etakridin 0,1% (Rivanol) Botol 80 80
80 Etanol 70% (Alkohol 70%) 1L 2 2
81 Etanol 70% (Alkohol 70%) 100ml 0 0
82 Etilklorida Semprot Botol 1 1
83 Eugenol Cairan Botol 2 2
84 Fetik Suppositoris 100 mg Tablet 0 0
85 Fenobarbital Inj 50 mg/ml Ampul 30 30
86 Fenobarbital Tablet 30 mg Tablet 300 300
87 Ferofolat ( Besi II Sulfat ) Tablet Tablet 0 0
88 Fitomenadion (Vit. K) 10mg Tablet 730 730
89 Fitomenadion Injeksi (Vit. K) Ampul 90 90
SATU- SISA PENERI- PERSE-
AN STOK MAAN DIAAN
No. NAMA OBAT AKHIR OBAT OBAT
BULAN BULAN BULAN
…………. ………… …………
1 2 3 4 5 6=(4 + 5)
90 Fixomull Strach 5 cm x 5 m / Plester Rol 27 27
91 Fludane plus sirup 0 0
92 Fluoksetin Tablet 10 Mg Tablet 0 0
93 Foley Catheter/ FUSIDEX ACID Saset 4 4
94 Furosemide Tablet 40 mg Tablet 550 550
95 Garabiotic salep kulit Tube 0 0
96 Garam Oralit 200 ml Saset 300 300
97 Gentamisin Sulfat tetes mata Botol 21 21
98 Gentamisin Injeksi 40 mg / Gentamisin salep mata Ampul 24 24
99 Gentamisin Salap Kulit Botol 0 0
100 Glibenklamide Tablet 5 mg Tablet 531 531
101 Glimepirid 1 mg Tablet 0 0
102 Glimepirid 2 mg Tablet 320 320
103 Glukonas Kalsikus inj 10% Ampul 0 0
104 Grisiofulfin Tablet 125 mg Tablet 474 474
105 Hanscoon 6,5 Pasang 0 200 200
106 Hanscoon 7/ GENTIAN VIOLET Pasang 24 24
107 Hanscoon Steril 7 Pasang 0 50 50
108 Hanscoon Steril 7,5 Pasang 100 100
109 Hidrokartison Krim 2,5% Tube 31 24 55
110 Haloperidol tab 5mg 0 0
111 Ibufropen Tablet 400 mg Tablet 0 0
112 Ibuprofen sirup 100 mg/5 ml Botol 10 10
113 Iliadin Oksimetazolin T. H. 0,025% Botol 14 14
114 Iliadin Oksimetazolin TH. 0,050 % Botol 0 0
115 Infus Set Adult ( Dewasa) Set 3 3
116 Infus set Pediatrik Set 0 0
117 Interzinc Sirup 2ml 10mg/ml Botol 0 0
118 Interzol SS 2% Sol 2% Ketokenazol Tube 0 0
119 Isosorbid Dinitrat Subl 5mg Tablet 290 290
120 IV Chateter No. 22 Set 13 13
121 IV Chateter No. 24 Set 13 13
SATU- SISA PENERI- PERSE-
AN STOK MAAN DIAAN
No. NAMA OBAT AKHIR OBAT OBAT
BULAN BULAN BULAN
…………. ………… …………
1 2 3 4 5 6=(4 + 5)
122 Kaca Slide IV Chateter No. 20 Buah 3 3
123 Kaki Tiga Buah 0 0
124 Kalsium Laktat Tablet 500 mg Tablet 374 500 874
125 Kapas 250 g Bungkus 33 33
126 Kapas 500 g Bungkus 11 11
127 Kasa Hydrofil Steril 16 x 16 cm Rol 28 28
128 Kasa Pembalut 2 x 80 cm Roll 30 30
129 Kasa Pembalut 4 x 10 cm Roll 28 28
130 Kasa Pembalut 4 x 15 cm Rol 28 28
131 Kasa Pembalut 4 x 5 cm Roll 50 50
132 Ketokonazol Krim 2% Tube 0 0
133 Ketokonazol Tablet 200 mg Tablet 519 519
134 Ketoprofen tab 100 mg Tablet 0 0
135 Kina Tablet/ CAC 250 Tablet 330 330
136 Kloramfenikol Kapsul 250 mg Kapsul 0 0
137 Kloramfenikol salep mata 1 % Tube 27 27
138 Kloramfenikol Tts Kuping 3% Botol 3 3
139 Klorfeniramin Maleat tab 4 mg Tablet 2955 2955
140 Kotrimoksazol Forte 960 mg Tablet 309 309
141 Kotrimoksazol Sirup 60 ml Botol 20 20 40
142 Kotrimoksazol Tablet 480 mg Tablet 618 618
143 Lansoprazole Tab 30 mg Tablet 1568 1568
144 Lar. Amonium Hidro 28% LEKOPLAST 7,5 Botol 3 3
145 Larutan Infus Glukosa Botol 15 15
146 Larutan Infus NaCl Botol 1 1
147 Larutan Infus RL LEKOPLAST 2,5 Botol 34 34
148 Lidokain 2%(HCl) Ampul 120 120
149 Lisol Tersabun 1000 ml Botol 0 0
150 Loperamid 2 mg Tablet 0 0
151 Loratadine 10 mg 380 100 480
152 Lorezepam 2mg 0 0
153 Lodomer Tablet Haloperidol 0 0
SATU- SISA PENERI- PERSE-
AN STOK MAAN DIAAN
No. NAMA OBAT AKHIR OBAT OBAT
BULAN BULAN BULAN
…………. ………… …………
1 2 3 4 5 6=(4 + 5)
154 Masker Buah 0 1000 1000
155 Masker Plus 3 Ply Buah 0 0
156 Meloxicam Tab 15 mg Tablet 0 0
157 Meloxicam Tab 7,5 mg Tablet 0 0
158 Metilprednisolon Tablet 4 mg Tablet 0 0
159 Metilprednisolon Tablet 8 mg Tablet 0 0
160 Metilergometrin inj Ampul 0 0
161 Metilergometrin Maleat Tablet Tablet 0 0
162 Metoclopramida Tablet 10 mg Tablet 317 317
163 Metoclopramida Tablet 5 mg Tablet 200 200
164 Metronidazol Sirup Botol 22 22
165 Metronidazol Tablet 250 mg Tablet 0 0
166 Metronidazol Tablet 500 mg Tablet 0 0
167 MgSo 4 20% Botol 267 267
168 MgSo4 40% Botol 0 0
169 Mikonazol Krim 2% Tube 51 10 61
170 Mineral Mix Saset 40 40
171 Nat. Diklofenak Tablet 25 mg Tablet 0 0
172 Nat. Diklofenak Tablet 50 mg Tablet 0 0
173 Nat. Karbonat Tablet 500 mg Tablet 0 0
174 Natrium Tiroksin 100 mcg Tablet 0 0
175 Nifedifin Tablet 10 mg Tablet 0 0
176 Nifedipin tablet 30 mg, oros Tablet 0 0
177 Nistatin Vaginal Tab 100.000IU Tablet 82 82
178 OAT Kusta MDT Anak-anak 0 0
179 OAT Reagensia TB Paru 0 0
180 Obat Batuk Hitam Molex Botol 0 0
181 Obat Batuk Hitam Plus Botol 0 0
182 Obat INH 0 0
183 Obat Kusta MDT Dewasa Paket 0 0
184 Obat TB FDC Sisipan Paket 0 0
185 Obat TB Kategori Anak Paket 0 0
SATU- SISA PENERI- PERSE-
AN STOK MAAN DIAAN
No. NAMA OBAT AKHIR OBAT OBAT
BULAN BULAN BULAN
…………. ………… …………
1 2 3 4 5 6=(4 + 5)
186 Obat TB Kategori FDC Paket 0 0
187 Obat TB Kategori II Paket 0 0
188 Obat TB Kombipak Kat I Paket 0 0
189 Oksitetrasiklin HCl Slp Kulit 3% Tube 0 0
190 Oksitetrasiklin HCl Slp Mata 1% Tube 60 60
191 Oksitoksin injeksi Ampul 0 0
192 Omeprazol Kapsul Kapsul 0 0
193 Parasetamol Drops 60 mg/0,6 ml Botol 8 8
194 Parasetamol Sirup 120 mg 53 20 73
195 Parasetamol Tablet 500 mg Tablet 1159 1000 2159
196 Pirantel Pamoat tablet 125mg 300 300
197 Pirantel Pamoat Susp 125 mg / 5 ml Botol 0 0
198 Piridoksin 10 mg (Vit. B.6) Tablet 732 732
199 Plester 2 x 5 Yard Rol 0 0
200 Plester 5cm x 5 m Rol 20 20
201 Pot Sputum Pot 0 0
202 Povidon Iodida Lar 10% 300 ml Botol 1 2 3
203 Povidon Iodida Lar 10% 60 ml Botol 22 20 42
204 Povidon Iodida Lar 10% 30 ml Botol 26 10 36
205 Prednison Tablet 5 mg Tablet 1139 1000 2139
206 Primaquin Tablet 15 Mg Tablet 0 0
207 Prokain Penisillin 3jtIU/vial Vial 0 0
208 Risperidone tab 2mg 0 0
209 Ranitidine Injeksi 25 mg/ml Ampul 0 0
210 Ranitidine Tablet 150 mg Tablet 0 0
211 Rapid Tes Malaria Kapsul 0 0
212 Rapid Test HIV 1/2 Biomerieux 5A Test 0 0
213 Rapid Sipplis ( Hexagon ) Test 0 0
214 Reagen Asam Urat(Autochek) Stik 0 0
215 Reagen Blood Lancet Stik 500 500
216 Reagen Cholesterol(Autochek) Stik 0 0
217 Reagen Gula Darah(Autochek) Stik 1000 1000
SATU- SISA PENERI- PERSE-
AN STOK MAAN DIAAN
No. NAMA OBAT AKHIR OBAT OBAT
No. NAMA OBAT
BULAN BULAN BULAN
…………. ………… …………
1 2 3 4 5 6=(4 + 5)
218 Retinol ( Vit. A ) 100.000 iu Kapsul 0 0
219 Retinol ( Vit. A ) 200.000 iu Kapsul 0 0
220 Salap 24 Krim Pot 99 99
221 Salbutamol Tablet 2 mg Tablet 182 182
222 Salisil Bedak 2 % Kotak 23 23
223 Sianokobalamin Inj (Vit. B.12) Ampul 0 0
224 Sianokobalamin Tablet (Vit. B.12) 0 0
225 Simvastatin Tablet 10 mg Tablet 0 0
226 Simvastatin Tablet 20 mg 391 391
227 Siprofloksasin Tablet 500 mg Tablet 0 0
228 Stesolid 10 Mg (Diazepam) STEVECILIN 5 5
229 Stesolid 5 Mg (Diazepam) Sub 9 9
230 Tarivid Ofloksasin TT 3% Botol 0 0
231 Tetagam Human tetanus 0 0
232 Tetrasiklin Kaplet 500 mg Kaplet 574 100 674
233 Tetrasiklin Kapsul 250 mg Kapsul 0 0
234 Thiamin 50 mg (Vit. B.1) Tablet 378 1000 1378
235 Thiamin Injeksi (Vit. B.1) Ampul 0 0
236 Thimolol 0,25% (isotic Adretor) Botol 0 0
237 Vitamin B. Compleks Tablet 1393 1393
238 Zinc Tablet 20 mg Tablet 783 783
239 Sound Timer 0 0
240 SD-HIV 0 0
241 RPR Fokus Sipilis 0 0
242 Fokus HIV/ SELVIPLEX 526 526
243 Vikia/Biomeurux HIV 0 0
244 Neo Diagon 148 100 248
245 APD 0 0
246 Nurse Cap 0 200 200
247 Sabun Cair/ HANDRUB 0 5 5
248 Spuit 1ml 3 3
249 masker n95 0 0
250 arios gel/ k.reen hand gel 500ml/ HANDSCRB 500ML 0 2 2
251 vitamin c 500mg/ IMMUANCE 0 1200 1200
252 selfipleks 0 0
253 rit Assay/TCM 0 0
254 coverall 0 0
255 kacamata google 0 0
256 Santa E 0 0
 BAYAR UMUM TIDAK BAYAR
JUMLAH KUNJUNGAN RESEP 35 714

Mengetahui / menyetujui Yang menyerahkan

Kepala Dinas Kesehatan Kasie Farmasi, Alkes & PKRT
Kota Pematangsiantar

( ………………………………. ) ( …………………………… )
NIP. NIP.
AKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS ( LPLPO ) 2021

DOKUMEN
AN BULAN/PERIODE : NOVEMBER 2021 GFK
AAN BULAN/PERIODE : DESEMBER 2021 PUSKESMAS
PEMA- SISA STOK PERMIN- PEMBERIAN
KAIAN STOK OPT TAAN
OBAT OBAT OBAT OBAQT
DAK DAU PROG LAIN2
BULAN BULAN BULAN BULAN
…………. ………… ………… .............
7=(6 - 8) 8 9 10 11 12 13 14
0 100
2 98
0 0
0 0 1000
172 1381
0 0
13 0
0 0
0 0
0 0
106 616
0 0
621 1962
0 0
0 0
0 0
0 20
1355 1119 500
0 0
2 147
0 0
0 0
1011 1109 1000
0 0
PEMA- SISA STOK PERMIN- PEMBERIAN
KAIAN STOK OPT TAAN
OBAT OBAT OBAT OBAQT
DAK DAU PROG LAIN2
BULAN BULAN BULAN BULAN
…………. ………… ………… .............
7=(6 - 8) 8 9 10 11 12 13 14
232 0 1000
35 372
 0 0
0 0
0 0
0 37
0 0
0 0 100
0 0 100
0 0
0 0
76 181 200
0 0 24
0 0
0 510
5 30
0 550
0 762
0 0
0 0
0 0
0 0
18 28 10
32 0 200
0 0 400
0 0
0 0
0 0
0 300
0 0
0 0
0 0
0 0
PEMA- SISA PERMIN- PEMBERIAN
KAIAN STOK TAAN
OBAT OBAT OBAQT
DAK DAU PROG LAIN2
BULAN BULAN BULAN
…………. ………… .............
7=(6 - 8) 8 10 11 12 13 14
0 20
0 0
0 0
0 0
0 180
60 0
0 0
0 0
 0 0
0 0
0 0
0 0
0 0
0 240
0 206
176 26
0 0
0 3
360 2210
0 168
0 0
0 80
0 2
0 0
0 1
0 2
0 0
0 30
0 300
0 0
0 730
0 90
PEMA- SISA STOK PERMIN- PEMBERIAN
KAIAN STOK OPT TAAN
OBAT OBAT OBAT OBAQT
DAK DAU PROG LAIN2
BULAN BULAN BULAN BULAN
…………. ………… ………… .............
7=(6 - 8) 8 9 10 11 12 13 14
0 27
0 0
0 0
1 3
0 550
0 0
0 300
0 21
0 24
0 0
3 528
0 0
0 320
0 0
0 474
 200 0 200
0 24
50 0 50
0 100
8 47
0 0
0 0
0 10
0 14
0 0
0 3
0 0
0 0
0 0
0 290
0 13
0 13
PEMA- SISA STOK PERMIN- PEMBERIAN
KAIAN STOK OPT TAAN
OBAT OBAT OBAT OBAQT
DAK DAU PROG LAIN2
BULAN BULAN BULAN BULAN
…………. ………… ………… .............
7=(6 - 8) 8 9 10 11 12 13 14
0 3
0 0
212 662 500
0 33
0 11
0 28
0 30
0 28
0 28
0 50
0 0
0 519
0 0
0 330
0 0
4 23
0 3
645 2310
32 277
12 28
90 528
 405 1163
0 3
0 15
0 1
0 34
0 120
0 0 10
0 0
30 450
0 0
0 0
PEMA- SISA STOK PERMIN- PEMBERIAN
KAIAN STOK OPT TAAN
OBAT OBAT OBAT OBAQT
DAK DAU PROG LAIN2
BULAN BULAN BULAN BULAN
…………. ………… ………… .............
7=(6 - 8) 8 9 10 11 12 13 14
1000 0 1000
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 317
0 200
1 21
0 0
0 0
0 267
0 0
1 60
0 40
0 0 1000
0 0
0 0
0 0
0 0
0 0
0 82
0 0
0 0
0 0
0 0
 0 0
0 0
0 0
0 0
PEMA- SISA STOK PERMIN- PEMBERIAN
KAIAN STOK OPT TAAN
OBAT OBAT OBAT OBAQT
DAK DAU PROG LAIN2
BULAN BULAN BULAN BULAN
…………. ………… ………… .............
7=(6 - 8) 8 9 10 11 12 13 14
0 0
0 0
0 0 1
0 0
1 59
0 0
0 0
6 2 10
15 58
1013 1146 500
0 300
0 0
732 0 500
0 0
0 20
0 0
0 3
0 42
0 36
1176 963
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
500 0 500
0 0
0 1000
PEMA- SISA STOK PERMIN- PEMBERIAN
KAIAN STOK OPT TAAN
OBAT OBAT OBAT OBAQT
DAK DAU PROG LAIN2
 DAK DAU PROG LAIN2
BULAN BULAN BULAN BULAN
…………. ………… ………… .............
7=(6 - 8) 8 9 10 11 12 13 14
0 0
0 0
5 94
0 182
5 18
0 0
0 0
0 0 500
117 274
0 0
0 5
0 9
0 0
0 0
70 604
0 0
732 646 1000
0 0
0 0
387 1006 500
13 770
0 0
0 0
0 0
0 526
0 0
92 156 100
0 0
200 0 200
5 0 5
0 3
0 0 20
2 0 10
1200 0
0 0
0 0
0 0
0 0
0 0
UM TIDAK BAYAR JUMLAH
749

nyerahkan Yang Meminta Yang menerima

i, Alkes & PKRT Pimpinanan Puskesmas Petugas Puskesmas

………… ) ( ………………………………. )
NIP.
 TANGGAL
...........................................
...........................................

KET
JML

15 16

ed 52,

ED 500tab
ED 788 tab

ED 104pot

KET
JML

15 16
 ED 510

ed 12 botol

ED 300

KET
JML

15 16
ED 20

ED 150
 ed 670
ed 168

ED 56

ed 300

ed 536
ed 90

KET
JML

15 16

ed 362

ed 300
 ED 10

ED 290

ed 13

KET
JML

15 16

ED 519

ed 330

ed 15
 ED 15

ED 120

KET
JML

15 16

ED 267

ED 51
 KET
JML

15 16

ED 35

ED 300

KET
JML
 KET
JML

15 16

ed2 0pot

ED 273

ED 5tab
ED 9 sub
 Yang menerima
Petugas Puskesmas

( …………………………….. )
NIP.