LPLPO Pustu

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
KODE PUSKESMAS : 7309300

PUSTU/ POSKESDES : BULAN PELAPORAN :
KAB/ KOTA : PANGKAJENE DAN KEPULAUAN BULAN PEMAKAIAN :
PROPINSI : SULAWESI SELATAN TAHUN : 2022
PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
DAU DAK P2 KESMAS BS. PROP KESGRA
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
1 Abacavir 300 mg Tablet/kaplet/kapsul 0 0

2 Air untuk injeksi Botol 100 ml 0 0

4 Air untuk injeksi ampul/vial/botol 10 mL 0 0
5 Air untuk injeksi amp 20 ml ampul/vial/botol 0 0
6 Air untuk injeksi amp 25 ml ampul/vial/botol 25 mL 0 0
7 Albendazol susp 200 mg/5 ml Botol 0 0
0 0
8 Albendazol tab 400 mg tablet/kapsul/kaplet
9 Alopurinol tab 100 mg Tab 0 0

10 Alopurinol tab 300 mg tablet/kapsul/kaplet 0 0
11 Aminofilin inj 24 mg/ml ampul/vial 10 ml 0 0
12 Aminofilin tab 150 mg tablet/kapsul/kaplet 0 0
13 Aminofilin Tab 200 mg tablet/kapsul/kaplet 0 0
14 Amitriptilin tab sal 25 mg tablet/kapsul/kaplet 0 0
15 Amlodipin tab 10 mg tablet/kapsul/kaplet 0 0
17 Amoksisilin drops 100 mg/ml Botol @15 ml 0 0
20 Amoksisilin sir forte 250 mg/5 ml botol 60 ml 0 0
21 Amoksisilin sir kering 125 mg/5 ml Botol 0 0
22 Amoksisilin tab 250 mg tablet/kapsul/kaplet 0 0
24 Ampisilin serb inj 1000 mg/vial ampul/vial 0 0
25 Ampisilin serb inj 250 mg/vial Vial 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
26 Anestetik lokal gigi kombinasi : lidokain hcl 2% + ampul/vial
epinefrin 1 : 80.000 inj 2 ml
0 0
27 Antasida, kombinasi : aluminium hidroksida 200 tablet/kapsul/kaplet
mg + magnesium hidroksida 200 mg
Antasida, kombinasi : aluminium hidroksida 200 0 0
28 mg + magnesium hidroksida 200 mg botol 60 ml
Anti Parkinson kombinasi : benzerasid 25 mg + 0 0
29 levodopa 100 mg Kaps
0 0
30 Antifungi salep, kombinasi : asam benzoat 6%+ pot 30 g
asam salisilat 3%
0 0
Antihemoroid, kombinasi: bismut subgalat 150
31 mg + heksaklorofen 2,5 mg + lidokain lidokain 10 Suppositoria
mg+ seng oksida 120 mg + sup ad 2 g
32 Aquadest cairan 500 ml Botol 500 ml 0 0

33 Artesunat serb inj 60 mg/ml (i.v./i.m.) ampul/vial 0 0
0 0
34 Articulating paper kertas warna penanda oklusi Kertas warna penanda
oklusi
35 Asam asetat tetes telinga 2% Botol 0 0
36 Asam asetilsalisilat (asetosal) tab 80 mg tablet/kapsul/kaplet 0 0
37 Asam askorbat (vitamin C) tab 250 mg Tab 0 0
38 Asam askorbat (vitamin C) tab 50 mg tablet/kapsul/kaplet 0 0
39 Asam folat tab 0,4 mg tablet/kapsul/kaplet 0 0
40 Asam folat tab 1 mg tablet/kapsul/kaplet 0 0
41 Asam folat tab 5 mg Tab 0 0
42 Asam mefenamat kaps 250 mg tablet/kapsul/kaplet 0 0
tablet/kapsul/kaplet/ 0 0
43 Asam mefenamat kaps 500 mg kaptab
44 Asam retinoat krim 0,05% Tube/pot 0 0
45 Asam retinoat krim 0,1% Tube @ 20 gram 0 0
47 Asam salisilat lar 0,1% Botol 0 0
48 Asam salisilat salep 10% Tube 0 0
51 Asiklovir tab 200 mg tablet/kapsul/kaplet 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
53 Atapulgit 600 mg tablet/kapsul/kaplet 0 0

54 Atapulgit tab 630 mg tablet/kapsul/kaplet 0 0
55 Atapulgit tablet 650 mg tablet/kapsul/kaplet 0 0
56 Atapulgit tablet 750 mg Tab 0 0
57 Atenolol tab 100 mg tablet/kapsul/kaplet 0 0
59 Atropin inj 0,25 mg/ml (i.m./i.v./s.k) Ampul 0 0
60 Atropin tab 0,5 mg Tab 0 0
61 Bahan tumpatan sementara lar, serb Botol 0 0
62 Bedak salisil serb 2% Dus/Sachet/Plastik 0 0
63 Betametason krim 0,1% tube 5 gram 0 0
64 Betametason krim 0,5 mg/g Tube 0 0
65 Betametason salep 0,1% tube 5 gram 0 0
66 Betametason tts mata 1 mg/ml botol @5 ml 0 0
67 Betametason tts mata 1 mg/ml catchcover, botol 0,6 mL 0 0
68 Bisakodil sup 10 mg Suppositoria 0 0
70 Bisakodil tab sal 5 mg tablet/kapsul/kaplet 0 0
71 Budesonid cairan ih 0,25mg/ml Botol @ 4 ml 0 0
0 0
72 Budesonid cairan ih 0,25mg/ml, respoules 2 ml respoules
73 Budesonid cairan ih 0,5 mg/ml Botol @ 4 ml 0 0

0 0
74 Budesonid cairan ih 0,5 mg/ml, respoules 2 ml respoules
75 Budesonid serb ih 100 mcg/dosis Botol 0 0

76 Budesonid serb ih 200 mcg/dosis 100 dosis 0 0
78 Copper T set/buah 0 0
79 Deksametason inj 5 mg/ml (i.v./i.m.) ampul/vial 0 0
80 Deksametason tab 0,5 mg tablet/kapsul/kaplet 0 0
81 Diazepam enema 10 mg/2,5 ml tube @ 2,5 mL 0 0
83 Diazepam inj 5 mg/ml (i.v./i.m.) ampul/vial 0 0
84 Diazepam tab 2 mg tablet/kapsul/kaplet 0 0
86 Dietilkarbamazin tab 100 mg tablet/kapsul/kaplet 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
87 Difenhidramin inj 10 mg/ml (i.v./i.m.) ampul/vial 0 0

88 Digoksin tab 0,25 mg tablet/kapsul/kaplet 0 0
89 Diltiazem kaps SR 100 mg Kapsul lepas lambat 0 0
91 Dimenhidrinat tab 50 mg tablet/kapsul/kaplet 0 0
92 Doksisiklin kaps 100 mg tablet/kapsul/kaplet 0 0
93 Dolutegravir tab 50 mg tablet/kapsul/kaplet 0 0
94 Domperidon susp 5 mg/5 ml botol @60 ml 0 0
95 Domperidon tab 10 mg tablet/kapsul/kaplet 0 0
96 Efavirenz tab 200 mg Tablet 0 0
0 0
97 Efavirenz tab sal 600 mg tablet salut selaput/kaplet
salut selaput
98 Epinefrin (adrenalin) inj 1 mg/ml Ampul 0 0

99 Ergotamin tab 1 mg Tab 0 0
100 Eritromisin kaps 250 mg tablet/kapsul/kaplet 0 0
101 Eritromisin sir 200 mg/5 ml Botol @ 60 ml 0 0
102 Eritromisin tab 500 mg tablet/kapsul/kaplet 0 0
tablet salut gula/kaplet 0 0
103 Estrogen terkonjugasi tab sal 0,625 mg
salut gula
104 Etambutol tab 400 mg tablet/kapsul/kaplet 0 0
105 Etanol 70% cairan 70% Botol 0 0
106 Etil klorida semprot 100 ml Botol 0 0
107 Etonogestrel implan 68 mg Set 0 0
108 Eugenol Botol 0 0
109 Fenitoin Na inj 50 mg/ml (100 mg/ 2 mL) ampul @ 2 ml 0 0
110 Fenitoin Na kaps 100 mg Kaps 0 0
112 Fenobarbital tab 100 mg Tab 0 0
113 Fenobarbital tab 30 mg tablet/kapsul/kaplet 0 0
0 0
114 Fenoksimetil penisilin (penisilin V) tab 250 mg Tab
0 0
116 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) ampul/vial 0 0

117 Fitomenadion (vitamin K 1) tab sal 10 mg Tab sal 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

118 Fitomenadion (vitamin K1) inj 10 mg/ml (i.m)
salut gula
119 Fluoksetin kaps 10 mg tablet/kapsul/kaplet 0 0
121 Fluor kapl 1 mg Kaplet 0 0
122 Fluor sediaan topikal Tube 0 0
123 Formokresol Botol 0 0
124 Framisetin Sulfat Tulle 1% Patch 0 0
125 Furosemid inj 10 mg/ml (i.v./i.m.) ampul/vial 0 0
126 Furosemid tab 40 mg tablet/kapsul/kaplet 0 0
Galactose microparticle 200-400 mg 0 0
127 micropart/ml Vial
Garam Fe, setara dengan Fe elemental 15 mg/5 0 0

128 mL Botol
129 Garam Fe, setara dengan Fe elemental 60 mg Sachet 0 0

130 Garam Fe, setara dengan Fe elemental 60 mg Botol 0 0
Garam oralit kombinasi : natrium klorida 0,52 g 0 0
131 + kalium klorida 0,30 g + trinatrium sitrat 0,58 g sachet
+ glukosa anhidrat 2,7 g
132 Gentamisin salep mata 0,3% Tube 0 0
133 Gentamisin tts mata 0,3% Botol 0 0
Glass ionomer ART (Atraumatic Restorative 0 0
134 Treatment) cocoa butter 5 g Sachet
0 0
135 Glass ionomer ART (Atraumatic Restorative Botol
Treatment) lar
0 0
136 Glass ionomer ART (Atraumatic Restorative Vial
Treatment) serb
137 Glibenklamid tab 2,5 mg tablet/kapsul/kaplet 0 0
138 Glibenklamid tab 5 mg tablet/kapsul/kaplet 0 0
139 Glikuidon tab 30 mg tablet/kapsul/kaplet 0 0
140 Glimepirid tab 1 mg tablet/kapsul/kaplet 0 0
142 Glipizid tab 5 mg tablet/kapsul/kaplet 0 0
143 Gliseril trinitrat tab 0,5 mg tablet/kapsul/kaplet 0 0
144 Gliserin tts 100 mg/ml Botol 0 0
145 Glukosa Larutan Infus 10% steril 100 ml Botol 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

148 Glukosa Larutan Infus 40% Ampul @25 ml 0 0
152 Griseofulvin (micronized) tab 125 mg tablet/kapsul/kaplet 0 0
153 Griseofulvin (micronized) tab scored 250 mg tablet/kapsul/kaplet 0 0
154 Gutta percha dan paper points 15 - 40 mm Roll 0 0
156 Haloperidol inj 5 mg/ml (i.m.) Vial 0 0
157 Haloperidol tab 0,5 mg tablet/kapsul/kaplet 0 0
159 Haloperidol tab 2 mg tablet/kapsul/kaplet 0 0
161 Haloperidol tts 2 mg/ml botol 0 0
0 0
162 Hepatitis
IU/1,5 ml
B imunoglobulin (human) inj 150 Ampul
163 Hidrogen peroksida cairan 3% Botol 0 0

164 Hidroklorotiazid tab 25 mg tablet/kapsul/kaplet 0 0
165 Hidrokortison krim 2,5% tube @ 5 g 0 0
166 Hidrokortison serb inj 100 mg Vial 0 0
167 Hiosina butilbromida tab 10 mg tablet/kapsul/kaplet 0 0
0 0
168 Human tetanus imunoglobulin inj 250 UI (i.m.) Ampul
0 0
170 Ibuprofen sir 100 mg/5 ml botol @ 60 ml 0 0

172 Ibuprofen tab 200 mg tablet/kapsul/kaplet 0 0
0 0
174 Ipratropium bromida aerosol 20 mcg/semprot Botol
175 Ipratropium bromida cairan ih 0,025% Botol 0 0

176 Isoniazid tab 100 mg Tab 0 0
178 Isosorbid dinitrat tab 5 mg tablet/kapsul/kaplet 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
179 IUD Cu T 380 A Set 0 0

180 IUD Levonorgestrel Set 0 0
181 Kalamin Tube 0 0
182 Kalsium glukonat inj 100 mg/ml ampul/vial 0 0
183 Kalsium hidroksida bubuk, pasta Tube 0 0
184 Kalsium karbonat tab 500 mg tablet/kapsul/kaplet 0 0
185 Kalsium laktat (kalk) tab 500 mg tablet/kapsul/kaplet 0 0
186 Kaptopril tab 12,5 mg tablet/kaplet 0 0
187 Kaptopril tab 25 mg tablet/kaplet 0 0
189 Karbamazepin sir 100 mg/5 ml Botol 0 0
190 Karbamazepin tab 100 mg Tab 0 0
191 Karbamazepin Tab 200 mg Tablet 0 0
192 Karbogliserin tts telinga 10 % Botol 0 0
193 Ketokonazol tab 200 mg tablet/kapsul/kaplet 0 0
194 Klindamisin kaps 150 mg Kaps 0 0
195 Klindamisin kaps 300 mg tablet/kapsul/kaplet 0 0
196 Klofazimin, micronized kaps 50 mg Kapsul 0 0
197 Klofazimin, micronizedkaps 100 mg kapsul 0 0
198 Klonidin tab 0,15 mg tablet/kapsul/kaplet 0 0
199 Kloramfenikol kaps 250 mg tablet/kapsul/kaplet 0 0
200 Kloramfenikol salep 2% tube 15g 0 0
201 Kloramfenikol salep mata 1% tube @ 5 gram 0 0
202 Kloramfenikol serb inj 1.000 mg/ml vial/ampul 0 0
203 Kloramfenikol susp 125 mg/5 ml botol 60 ml 0 0
204 Kloramfenikol tetes telinga 3% Botol 0 0
205 Kloramfenikol tts mata 0,5% botol 0 0
206 Kloramfenikol tts mata 1% Botol 0 0
207 Klorfeniramin tab 4 mg tablet/kapsul/kaplet 0 0
208 Klorfenol kamfer mentol (CHKM) Botol 0 0
209 Klorheksidin lar 0,2% Botol 0 0
210 Klorheksidin lar 15% Botol 0 0
211 Klorpromazin inj 25 mg/ml (i.m.) ampul/vial 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
213 Klorpromazin tab sal 100 mg tablet salut selaput/kaplet
salut selaput
214 Klorpromazin tab sal 25 mg Tab sal 0 0

215 Klortalidon tab 50 mg Tab 0 0
216 Klozapin tab 100 mg tablet 0 0
218 Kodein tab 10 mg tablet/kapsul/kaplet 0 0
0 0
219 Komb: Deksametason 0,1% Thymol 5%
Paraklorphenol 30 Botol
0 0
Kombinasi (DHP) : dihidroartemisin 40 mg + tablet salut selaput/kaplet
220 Piperakuin 320 mg tab sal selaput salut selaput
0 0
221 Kombinasi : (Zidovudin 60 mg + Lamivudin 30
mg + Nevirapin 50 mg) Ped Triple FDC Tab dispersible
Kombinasi : artemether 20 mg + lumefantrin 0 0

222 120 mg tablet/kapsul/kaplet
Kombinasi : Desogestrel 150 mcg Etinilestradiol 0 0

223 30 mcg Tab
224 Kombinasi : ergotamin 1 mg+ kafein 50 mg tablet/kapsul/kaplet 0 0

0 0
225 Kombinasi : Ferro fumarat 60 mg + asam folat tablet salut gula
0,4 mg tab salut
0 0
226 Kombinasi : levonorgestrel 150 mcg +
etinilestradiol 30 mcg tab salut gula
Kombinasi : Tenofovir 300 mg + Emtrisitabin 200 0 0

227 mg Tab
Kombinasi : Tenofovir 300 mg + Lamivudin 300 0 0

228 mg + Efavirenz 600 mg Tab
0 0
229 Kombinasi : zidovudin 300 mg +lamivudin 150 Tab
mg
0 0
230 Kombinasi: Ipratropium bromida 0,5 mg + Ampul/vial
Salbutamol 2,5 mg, cairan ih
231 Kombinasi: kaolin 550 mg + pektin 20 mg Tab 0 0
Kombinasi: lopinavir 200 mg + ritonavir (LVP) 50 0 0
232 mg, tab 250 mg Tab
Kombinasi: Tenofovir 300 mg + Lamivudin 300 0 0

233 mg + Dolutegravir 50 mg, tablet Tablet/kapsul/kaplet
0 0
234 Komibinasi: lidokain + medisinal creosote Botol
phenol + eugenol + benzil alkohol, cairan
PEMBERIAN
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235 Komposit resin Set 0 0

0 0
236 Kotrimoksazol (dewasa) kombinasi :
sulfametoksazol 400 mg+ trimetoprim 80 mg tab/kaptab
Kotrimoksazol (dewasa) kombinasi : 0 0

237 sulfametoksazol 800 mg+ trimetoprim 160 mg tab/kaptab
Kotrimoksazol kombinasi tiap 5 ml suspensi : 0 0

238 sulfametoksazol 200 mg + trimetoprim 40 mg botol 60 mL
239 Kuinin inj 25% (i.v.) Vial 0 0

240 Kuinin tab 200 mg tablet/kapsul/kaplet 0 0
241 Laktulosa sir 3,335 g/5 ml botol @ 60 mL 0 0
242 Lamivudin (3TC) tab 150 mg tablet/kapsul/kaplet 0 0
0 0
243 Larutan mengandung elektrolit (CaCl2H2O 0,165 Botol plastik @500 ml
gr, KCl 0,15 gr, NaCl 4,3 gr)
0 0
244 Larutan mengandung Elektrolit (Kalium Klorida) Botol
0 0
245 Larutan mengandung Elektrolit (KCl 0,15%, NaCL Botol
0,9%) (KN1)
Larutan mengandung Elektrolit (KCl 0,3%,NaCl 0 0
246 0,9%) (KN2) Botol
Larutan mengandung Elektrolit (Na 130 mEq, K 4 0 0

247 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq) Softbag @ 500 ml
Ringer Asetat
248 mEq, Cl 109 mEq, Ca 3 mEq, Asetat 28 mEq) Botol plastik @ 500 ml
Ringer Asetat
0 0
Larutan mengandung Elektrolit (Sodium Lactate
249 sol (50%) 113 gr/L, Potassium Chloride 0.3 gr/L, Botol
Calcium Chloride 0.2 gr/L, elektrolit)
0 0
Larutan mengandung Elektrolit (Tiap 1000 ml
mengandung electrolit: Sodium 145 mmol/l,
250 Potassium 4.0 mmol/l, Calcium 2.5 mmol/l, Botol
Magnesium 1.0 mmol/l, Chloride 118 mmol/l,
Acetate 24 mmol/l, Malate 5.0 mmol/l)
Larutan mengandung Karbohidrat (Fructose 120 0 0

251 g, glucose 66 g, Xylitol 60 g/ L) Botol
0 0
252 Larutan mengandung Karbohidrat (Fructose 15 softbag
mg, glucose monohydrate 30 mg, xylitol 15 mg)
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
253 Larutan mengandung Karbohidrat (Fructose 200 Botol
g, glucose 110 g, Xylitol 100 g/ L)
0 0
254 Larutan mengandung Karbohidrat (Fructose 60
g, glucose 33 g, Xylitol 30 g/ L) Botol
0 0
255 Larutan mengandung Karbohidrat (Maltose 10%) Botol
0 0
Larutan mengandung Karbohidrat + Elektrolit
(25.00g dextrose anhidrat, 3.00 g sodium
256 chloride, 0.15 g potassium chloride, 0.10 g Botol plastik @500 ml
calcium chloride dihydrate dan 1.55 g sodium
lactate)
Larutan mengandung Karbohidrat + Elektrolit 0 0

257 (25.00g maltose, 3.00 g sodium chloride, 0.15 g Botol plastik @500 ml
potassium chloride, 0.10 g calcium chloride
dihydrate dan 1.55 g sodium lactate)
0 0
258 Larutan mengandung Karbohidrat + Elektrolit Botol
(Acetate, Na, K, Cl, Ca, Mg, Sorbitol 50 gr/L)
0 0
(Dextrose 5%, NaCL 0,45%, KCl) (HSD)
260 (Fructose 120 g, glucose 66 g, Xylitol 60 g/ L + Botol
elektrolit)
261 (Glukosa 25 g, NaCl 2,0 g, KCl 1,3 g, Natrium Botol
Laktat 3,1 g, air untuk injeksi ad 1000 ml)
262 (Glukosa 55 g ; Natrium Chloride 9 g, air untuk Botol
injeksi ad 1000 ml) (D5-NS)
263 (Glukosa: 110.0 g; NaCl: 1.80 g) (D10-1/5NS) botol/softbag
0 0
(Glukosa: 25,0 g; NaCl: 4,5 g)
0 0
265 Larutan mengandung Karbohidrat + Elektrolit botol/softbag @ 100 mL
(Glukosa: 55.0 g; NaCl: 2.25 g) (D5-1/4NS)
0 0
266 Larutan mengandung Karbohidrat + Elektrolit
(Glukosa: 55.0 g; NaCl: 2.25 g) (D5-1/4NS) botol/softbag @ 500 mL
0 0
(Glukosa: 55.0 g; NaCl: 4.5 g) (D5-1/2NS) Botol
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

(Larutan nutrisi kombinasi infus per L: Na.
268 100mEQ, K 18mEQ, Ca. 4mEQ, Mg 6mEQ, Cl Botol
90mEQ, Asetat 38mEQ, Sorbitol 50g)
269 (Larutan Ringer & Glukosa 5%) Botol

270 (NaCl 1.125 gr, Dekstrosa 18.75 gr) (KA EN 1B) Botol
0 0
(NaCl 1.75 g, KCL 1.5g, Glukosa 100 gr)
272 (NaCl 1.75 g, KCL 1.5g, Na Lactate 2.24 g, Botol
Glukosa 100 gr)
273 (Nacl 1.75 gr, KCl 1.5 gr, Na Lactat 2.24 gr, Botol
Dekstrosa 27 gr) (KA EN 3B)
274 (Nacl 2.34 gr, Na Laktat 2.24 gr, KCL 0.75 gr Botol
Dekstrosa 27 gr) (KA EN 3A)
0 0
275 Levonorgestrel implan 2 rods, 75 mg (3-4 tahun) pack/ sachet/ set
276 Lidokain gel 2% syringe/syringe plastik 0 0

277 Lidokain inj 2% (infiltr/p.v.) ampul/vial 0 0
278 Lidokain salep 5% Tube 0 0
279 Lidokain spray oral 10% botol 0 0
280 Linestrenol tab 0,5 mg tablet/kapsul/kaplet 0 0
281 Liquor carbonis detergens lar 5% Botol 0 0
282 Loperamid tab 2 mg Tab 0 0
283 Lopinavir 100 mg + Ritonavir 25 mg tab sal selaput 0 0
284 Loratadin tab 10 mg tablet/kapsul/kaplet 0 0
285 Lorazepam tab 0,5 mg tablet/kapsul/kaplet 0 0
286 Lorazepam tab 1 mg tablet/kapsul/kaplet 0 0
287 Lorazepam tab sal 2 mg Tab sal 0 0
288 Lugol Botol 0 0
289 Magnesium sulfat inj 20% ampul/vial @25 ml 0 0
290 Magnesium sulfat inj 20% ampul/vial 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
293 Magnesium sulfat serb, ktg 30 g Sachet 0 0

294 Manitol lar infus 20% Botol @ 250 ml 0 0
297 Mebendazol sir 100 mg/5 ml Botol 0 0
298 Mebendazol tab 100 mg Tan 0 0
299 Mebendazol tab 500 mg tablet/kapsul/kaplet 0 0
300 Medroksi progesteron asetat inj 150 mg/ml ampul/vial 0 0
301 Medroksi Progesteron Asetat Inj 50 mg/ml ampul/vial 0 0
Metenamin mandelat (heksamin mandelat) tab 0 0
302 salut enterik 500 mg Tab salut
303 Metformin tab 500 mg tablet/kapsul/kaplet 0 0

305 Metilergometrin inj 0,2 mg/ml ampul/vial 0 0
0 0
306 Metilergometrin tab salut 0,125 mg tablet/kaplet salut selaput
307 Metilprednisolon inj 125 mg/2 ml ampul/vial 0 0

308 Metoklopramid inj 5 mg/ml ampul/vial 0 0
309 Metoklopramid tab 10 mg tablet/kapsul/kaplet 0 0
311 Metronidazol lar inf 5 mg/ml botol 0 0
312 Metronidazol susp 125 mg/5 ml Botol @ 100 ml 0 0
314 Metronidazol tab 250 mg tablet/kapsul/kaplet 0 0
316 Mikonazol krim 2% tube 0 0
317 Mikonazol serb 2% botol / sachet 0 0
Mineral Mix (Bismuth Subcitrate Tripotasium, 0 0
318 Copper sulfate, Magnesium Chloride Anhydrous, Sachet
Potassium Chloride, Zinc Acetate)
319 N-asetil sistein kaps 200 mg tablet/kapsul/kaplet 0 0
320 NaCl 0,9% Larutan Botol @250 ml 0 0
321 NaCl 0,9% Larutan Ampul/botol @ 10 mL 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
325 NaCl 0,9% Larutan Botol @1.000 mL 0 0

326 NaCl 3% Larutan Botol plastik @500 ml 0 0
0 0
327 Natrium diklofenak tab 25 mg tablet salut enterik/kaplet
salut enterik
0 0
tablet salut enterik/kaplet
328 Natrium diklofenak tab 50 mg salut enterik
329 Natrium Diklofenak Tetes Mata 1 mg/ml botol 5 mL 0 0

330 Natrium hipoklorit cairan konsentrat 5% Botol 0 0
331 Natrium tiosulfat inj 25% (i.v.) Ampul 0 0
332 Nevirapin tab 200 mg tablet/kapsul/kaplet 0 0
333 Nifedipin kaps 10 mg tablet/kapsul/kaplet 0 0
334 Nistatin susp 100.000 UI/ml botol/vial 0 0
335 Nistatin tab salut 500.000 UI
salut gula
336 Nistatin tab vaginal 100.000 UI tablet/kaplet 0 0
337 Nitrofurantoin tab 50 mg Tab 0 0
338 Norepinefrin inj 1 mg/ml ampul/vial 0 0
339 Obat Anti Tuberculosis FDC Kategori Anak paket 0 0
340 Obat Anti Tuberculosis FDC Kategori I paket 0 0
341 Obat Anti Tuberculosis FDC Kategori II paket 0 0
342 Obat Anti Tuberculosis FDC Kategori Sisipan paket 0 0
343 Obat Anti Tuberculosis Kombipak Anak Paket 0 0
344 Obat Anti Tuberculosis Kombipak Dewasa paket 0 0
345 Oksigen ih, gas dlm tabung Botol 0 0
346 Oksimetazolin tts hidung 0,025% botol @ 10 mL 0 0
348 Oksitetrasiklin 1% Salep Mata tube 0 0
349 Oksitosin inj 10 UI/ml ampul/vial 0 0
350 Olopatadin tts mata 0,1% Botol 0 0
351 Omeprazol inj 40 mg/10 ml ampul/vial 0 0
352 Omeprazol kaps 20 mg tablet/kapsul/kaplet 0 0
353 Paraformaldehid tab 1 g Tab 0 0
354 Parasetamol sir 120 mg/5 ml botol @ 60 mL 0 0
355 Parasetamol tab 500 mg tablet/kapsul/kaplet 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
356 Parasetamol tts 60 mg/0,6 ml botol @ 15 mL 0 0

357 Pasta devitalisasi (non arsen) Tube 0 0
358 Pasta pengisi saluran akar (pasta) Tube 0 0
359 Perak nitrat lar 20% Botol 0 0
360 Perak sulfadiazin krim 1% Tube 0 0
361 Permetrin krim 5 % Tube 10 g 0 0
364 Pirantel pamoat susp 125 mg/5 ml Botol 0 0
365 Pirantel pamoat tab 500 mg Tab 0 0
366 Pirantel pamoat tab scored 125 mg tablet/kapsul/kaplet 0 0
367 Pirantel pamoat tab scored 250 mg Tab 0 0
368 Piridoksin (vitamin B6) inj 100 mg/ml Ampul 0 0
369 Piridoksin (vitamin B6) tab 10 mg tab/kap/kapl 0 0
370 Piridoksin (vitamin B6) tab 25 mg tablet/kapsul/kaplet 0 0
371 Povidon iodin lar 100 mg/ml Botol 300 ml 0 0
372 Povidon iodin lar 100 mg/ml botol @ 1.000 mL 0 0
373 Povidon iodin lar 100 mg/ml botol 30 mL 0 0
374 Povidon iodin lar 100 mg/ml botol @ 60 mL 0 0
375 Prednison tab 5 mg tablet/kapsul/kaplet 0 0
376 Primakuin tab 15 mg Tab 0 0
377 Probenesid tab 500 mg tablet/kapsul/kaplet 0 0
0 0
378 Prokain
(i.m.)
benzilpenisilin serb inj 3 juta UI/vial ampul/vial
379 Propiltiourasil tab 100 mg tablet/kapsul/kaplet 0 0

380 Propranolol tab 10 mg tablet/kapsul/kaplet 0 0
381 Ranitidin tab 150 mg tablet/kapsul/kaplet 0 0
382 Retinol (vitamin A) kaps lunak 100.000 UI kaps lunak 0 0
384 Rifampisin kaps 300 mg tablet/kapsul/kaplet 0 0
0 0
385 Rifapentin tablet 150 mg Tablet/kapsul/kaplet
386 Ringer Laktat Larutan Botol 0 0
387 Risperidon tab sal 1 mg tablet/kapsul/kaplet 0 0
389 Salbutamol cairan ih 1 mg/mL ampul/vial/botol 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
390 Salbutamol sir 2 mg/5 ml Botol 0 0

0 0
391 Salbutamol tab 2 mg tablet/kapsul/kaplet

0 0
0 0
393 Salep 2-4, kombinasi : asam salisilat 2 %+ pot 15 gram
belerang endap 4 %
0 0
belerang endap 4 %
395 Sefadroksil kaps 250 mg tablet/kapsul/kaplet 0 0
396 Sefadroksil kaps/tab 500 mg tablet/kapsul/kaplet 0 0
397 Sefadroksil sir kering 125 mg/5 ml botol @ 60 mL 0 0
Serum anti bisa ular : A.B.U. I (khusus ular dari 0 0
399 luar Papua) inj (i.m./i.v.) Vial
Serum anti bisa ular :A.B.U.II (khusus ular dari 0 0

400 Papua) inj (i.m./i.v.) Vial
0 0
401 Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m Vial
10.000 UI/
402 Serum antirabies inj 100 UI/ml Vial 0 0
Serum antitetanus (A.T.S) (i.m.) Inj 10.000 0 0
404 UI/vial (i.m /i.v.) Vial
0 0
405 Serum antitetanus (A.T.S) inj 1500 UI/amp (i.m.) Ampul
0 0
406 Serum antitetanus (A.T.S) inj 20.000 UI/vial Vial
(i.m /i.v.)
0 0
407 Serum antitetanus (A.T.S) inj 5.000 IU/mL (i.m) Ampul/vial
408 Setirizin sir 5 mg/5 ml. botol @ 60 mL 0 0

409 Sianokobalamin (vitamin B12) inj 500 mcg/ml ampul/vial 0 0
410 Sianokobalamin (vitamin B12) tab 50 mcg tablet/kapsul/kaplet 0 0
411 Simvastatin tab sal 10 mg tablet salut selaput/kaplet
salut selaput
salut selaput
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
413 Simvastatin tab sal selaput 40 mg Tab sal 0 0

0 0
tablet salut selaput/kaplet
414 Siprofloksasin tab scored 500 mg salut selaput
415 Spironolakton tab 25 mg tablet/kapsul/kaplet 0 0

Stannous pyrophosphate 27,6 mg sodium 0 0
416 pyrophosphate/vial Vial
417 Streptomisin serb inj 1.000 mg/vial ampul/vial 0 0

418 Surgical ginggival pack Tube 0 0
0 0
419 Tenofovir tab 300 mg salut selaput
420 Terbutalin cairan ih 2,5 mg/ml Botol 0 0

421 Terbutalin inj 0,5 mg/ml ampul/vial 0 0
422 Tetanus toxoid inj Ampul 0 0
423 Tetrakain tts mata 0,5% Botol 0 0
424 Tetrasiklin kaps 250 mg tablet/kapsul/kaplet 0 0
426 Tetrasiklin Salep Mata 1% Tube 0 0
427 Tiamin (vitamin B1) tab 50 mg tablet/kapsul/kaplet 0 0
428 Timolol tts mata 0,25% botol @ 5 mL 0 0
430 Urea krim 10 % Tube/pot 0 0
432 Vaksin BCG inj (i.k) Vial 0 0
433 Vaksin bivalen OPV (b-OPV) drops 10 dosis Vial 0 0
0 0
434 Vaksin Hepatitis Rekombinan Inj Prefilled Vial
Injection Device (Uniject) 0,5 ml (i.m)
0 0
435 Vaksin HPV (Human Papilloma Virus), vial 0,5 mL Ampul/vial
436 Vaksin Influenza Vial 0 0

437 Vaksin Japanese Enchepalitis (J.E) Vial 0 0
438 Vaksin jerap difteri tetanus (DT) Vial 0 0
439 Vaksin jerap difteri tetanus (Td) Vial 0 0
440 Vaksin kombinasi DPT-HB-Hib Vial 0 0
441 Vaksin measless rubella (MR) Inj 0,5 mL (s.k) Vial 0 0
442 Vaksin Meningitis Meningokokus Vial 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
443 Vaksin polio IPV inj 0,5 ml Vial 0 0

0 0
444 Vaksin
booster
rabies, untuk manusia serb inj (s.k./i.k) + Vial
445 Vaksin rabies, untuk manusia serb Inj 2,5 IU Vial 0 0

446 Vaksin Yellow Fever Vial 0 0
447 Valproat sir 250 mg/5 ml botol @ 120 ml 0 0
tablet salut enterik/ kaplet 0 0
448 Valproat tab sal 250 mg salut enterik
449 Vitamin B kompleks tablet 0 0
Tablet/kapsul/kaplet/tab 0 0
sal selaput/kaplet sal
450 Vitamin C 500 mg minimal non acidic 250 mg selaput/tab sal gula/kaplet
sal gula
451 Zidovudin kaps 100 mg tablet/kapsul/kaplet 0 0
452 Zinc drops 10 mg/ml Botol 0 0
453 Zinc serb 10 mg Sachet 0 0
454 Zinc sir 20 mg/5 ml botol 0 0
455 Zinc tab disp 20 mg tablet dispersible 0 0
0 0
OBAT TAMBAHAN 0 0
1 Ambroxol tab 30 mg Tab 0 0
2 BD Gard 0 0
3 Becefort tab 0 0
Becefort Sirup botol 60 mL 0 0
4 Chloramex 500 mg 0 0
5 Clobazam tab 10 mg Tab 0 0
6 Fenobarbital Injeksi Ampul 0 0
7 Gliseril Guaiakolat tablet 100 mg Kotak/100tab 0 0
Hemafort Tablet 0 0
8 Herbakof Botol 0 0
9 Multivitamin Sirup Botol 0 0
10 Multivitamin Tablet Tablet 0 0
11 Nevirapine 200 mg Kotak/30tablet 0 0
12 Onoiwa Kapsul 0 0
13 Oksitetrasiklin Salep Mata 1% Tube 0 0
14 Pritavit Kaplet 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
15 TDF(300)+3TC(300)+EVF(600) Botol 0 0
16 Triflourperazine 5 mg Tab 0 0
17 Triheksifenidil tab 2 mg Tablet 0 0
18 Vitamin D3 1000 Tablet 0 0
0 0
BAHAN MEDIS HABIS PAKAI (BMHP) 0 0
1 Alat suntik sekali pakai 0,05 ml Pcs 0 0
3 Alat suntik sekali pakai 1 ml Pcs 0 0
6 Alkohol swab Pcs 0 0
7 Asam Urat test strip Strip 0 0
8 Baju Hasmat/APD Pcs 0 0
9 Bioplacenton tulle Lembar 0 0
10 Bisturi/ pisau bedah Pcs 0 0
11 Blood Lancet Box/ 100 0 0
12 Catgut 2/0 Pcs 0 0
13 Catgut 3/0 Untuk Kulit Pcs 0 0
14 Catgut 3/0 untuk Otot Pcs 0 0
15 Celemek Plstik Pcs 0 0
16 Chlodine Jergen 5 l 0 0
17 DBD test NS 1 Pcs 0 0
18 Dermafix s IV Box/ 25 0 0
19 Disposible Safety Box 5 Liter Buah 0 0
20 Face Shield Anti Droplet Pcs 0 0
21 Folley Catheter No. 16 Pcs 0 0
23 Gluco Protein Pcs 0 0
24 Glukosa test strip btl 0 0
25 Glukosa test strip BTL/50 0 0
26 Golongan darah test Botol 0 0
27 Handsanitizer Botol 500 ml 0 0
29 Handsanitizer Jerigen 5 L 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
30 Handscoon non steril L Pcs 0 0

31 Handscoon non steril M Pcs 0 0
32 Handscoon non steril S Pcs 0 0
33 Handscoon Obgyn Steril Psng 0 0
34 Handscoon steril No. 6,5 Psng 0 0
35 Handscoon steril No. 7 Psng 0 0
37 HIV test Kotak 0 0
38 Hypafix Roll 0 0
39 I.V. Catheter No. 18 Pcs 0 0
43 Infusion set anak Pcs 0 0
44 Infusion set dewasa Pcs 0 0
45 Kalsium Hidroksida Pasta Set 0 0
46 Kapas pembalut 250 g Bungkus 0 0
48 Kasa 40 cm x 40 cm Bungkus 0 0
49 Kasa 40 x 80 cm Roll 0 0
50 Kasa Hidrofil Steril 16 x 16 Kotak 0 0
51 Kasa Kompres Steril 40 x 40 Pcs 0 0
52 Kasa Pembalut 2 m x 80 cm Roll 0 0
53 Kasa Pembalut Hidrofil 4 m x 10 cm Roll 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

57 Kolesterol test strip Dus/10 Strip 0 0
58 Kondom Pcs 0 0
59 Lisol Botol 0 0
60 Masker Lembar 0 0
61 Masker N 95 Pcs 0 0
62 Nasal Oksigen Anak Pcs 0 0
63 Nasal Oksigen Bayi Pcs 0 0
64 Nasal Oksigen Dewasa Pcs 0 0
65 Nebuliser Anak Pcs 0 0
66 Nebuliser Dewasa Pcs 0 0
67 Nurse Cup Pcs 0 0
68 Plastik Packing Pcs 0 0
69 Plester (Microper Dispenser) Roll 0 0
70 Plester 7,5 cm x 4,5 cm Roll 0 0
71 Polipix 5 cm x 5 m Roll 0 0
72 Pot sputum non Steril Pcs 0 0
73 Pot Sputum steril Pcs 0 0
74 Rapid 1 HIV (RI) Tes 0 0
75 Rapid 2 HIV Tes 0 0
77 Rapid Test Antigen Test 0 0
78 Rapid Test HBsAg Tes 0 0
79 Rapid Test Syphilis (trepocheck) Pcs 0 0
80 Reagen ZN Paket 0 0
81 Safety Box HIV Pcs 0 0
82 Sarung Tangan Genokologi Non Steril Pcs 0 0
83 Silk 3/0 Pcs 0 0
84 Slide/ objec glass Ktk/ 72 pcs 0 0
85 Spons Gelatin (Hemospon) Ktk 0 0
86 Stericide 3 Galon 5 l 0 0
87 Test Kehamilan pcs 0 0
88 Tifoid test Pcs 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
89 Urine Bag Pcs 0 0

90 VTM Kit 0 0
91 Widal test Botol 0 0
UMUM BPJS TOTAL

JUMLAH KUNJUNGAN
Mengetahui/ Menyetujui, Yang Menyerahkan Yang Menerima/ melapor Yang menerima

Kepala Dinas Kesehatan Sub Kordinator Kefarmasian Kepala Puskesmas Petugas Pustu/Poskesdes
Kabupaten Pangkep Dinas Kesehatan
Hj. Herlina, S.Si.,Apt, M. Kes Nawir, S.Si, Apt Armiaty Arsyad, AMKG
NIP. 19670515 199803 2 001 NIP. 19741129 199702 1 001 NIP.19800608 200902 2 003 NIP.
(LPLPO)

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16


0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
0 0
0 0
asam salisilat 3%
0 0

0 0
oklusi
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0

0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
salut selaput

salut gula
0 0
0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

salut gula

128 mL Botol

0 0
Treatment) lar
0 0
Treatment) serb
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
162 Hepatitis
IU/1,5 ml

0 0
0 0

0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
179 IUD Cu T 380 A Set 0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
salut selaput

0 0
0 0
0 0


223 30 mcg Tab

0 0
0,4 mg tab salut
0 0

227 mg Tab

0 0
mg
0 0

0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0



0 0
0 0
0 0
0,9%) (KN1)
246 0,9%) (KN2) Botol

Ringer Asetat
Ringer Asetat
0 0
0 0

0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
0 0
0 0
0 0
lactate)

0 0
0 0
elektrolit)
0 0
0 0
0 0
0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16


0 0
Glukosa 100 gr)
0 0

288 Lugol Botol 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16


0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
salut enterik
0 0

salut gula
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
378 Prokain
(i.m.)

0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0

0 0
0 0
belerang endap 4 %
0 0
belerang endap 4 %

0 0
10.000 UI/
0 0
0 0
(i.m /i.v.)
0 0

salut selaput
salut selaput
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0


0 0

0 0
0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
444 Vaksin
booster

sal gula
0 0
OBAT TAMBAHAN 0 0
2 BD Gard 0 0
3 Becefort tab 0 0
Hemafort Tablet 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
15 TDF(300)+3TC(300)+EVF(600) Botol 0 0
0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

38 Hypafix Roll 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

58 Kondom Pcs 0 0
59 Lisol Botol 0 0
83 Silk 3/0 Pcs 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

90 VTM Kit 0 0
UMUM BPJS TOTAL

JUMLAH KUNJUNGAN

NIP. 19670515 199803 2 001 NIP. 19741129 199702 1 001 NIP.19800608 200902 2 003 NIP.
(LPLPO)

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16


0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
0 0
0 0
asam salisilat 3%
0 0

0 0
oklusi
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0

0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
salut selaput

salut gula
0 0
0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

salut gula

128 mL Botol

0 0
Treatment) lar
0 0
Treatment) serb
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
162 Hepatitis
IU/1,5 ml

0 0
0 0

0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
179 IUD Cu T 380 A Set 0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
salut selaput

0 0
0 0
0 0


223 30 mcg Tab

0 0
0,4 mg tab salut
0 0

227 mg Tab

0 0
mg
0 0

0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0



0 0
0 0
0 0
0,9%) (KN1)
246 0,9%) (KN2) Botol

Ringer Asetat
Ringer Asetat
0 0
0 0

0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
0 0
0 0
0 0
lactate)

0 0
0 0
elektrolit)
0 0
0 0
0 0
0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16


0 0
Glukosa 100 gr)
0 0

288 Lugol Botol 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16


0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
salut enterik
0 0

salut gula
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
378 Prokain
(i.m.)

0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0

0 0
0 0
belerang endap 4 %
0 0
belerang endap 4 %

0 0
10.000 UI/
0 0
0 0
(i.m /i.v.)
0 0

salut selaput
salut selaput
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0


0 0

0 0
0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
444 Vaksin
booster

sal gula
0 0
OBAT TAMBAHAN 0 0
2 BD Gard 0 0
3 Becefort tab 0 0
Hemafort Tablet 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
15 TDF(300)+3TC(300)+EVF(600) Botol 0 0
0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

38 Hypafix Roll 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

58 Kondom Pcs 0 0
59 Lisol Botol 0 0
83 Silk 3/0 Pcs 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

90 VTM Kit 0 0
UMUM BPJS TOTAL

JUMLAH KUNJUNGAN

NIP. 19670515 199803 2 001 NIP. 19741129 199702 1 001 NIP.19800608 200902 2 003 NIP.
(LPLPO)

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16


0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
0 0
0 0
asam salisilat 3%
0 0

0 0
oklusi
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0

0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
salut selaput

salut gula
0 0
0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

salut gula

128 mL Botol

0 0
Treatment) lar
0 0
Treatment) serb
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
162 Hepatitis
IU/1,5 ml

0 0
0 0

0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
179 IUD Cu T 380 A Set 0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
salut selaput

0 0
0 0
0 0


223 30 mcg Tab

0 0
0,4 mg tab salut
0 0

227 mg Tab

0 0
mg
0 0

0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0



0 0
0 0
0 0
0,9%) (KN1)
246 0,9%) (KN2) Botol

Ringer Asetat
Ringer Asetat
0 0
0 0

0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
0 0
0 0
0 0
lactate)

0 0
0 0
elektrolit)
0 0
0 0
0 0
0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16


0 0
Glukosa 100 gr)
0 0

288 Lugol Botol 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16


0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
salut enterik
0 0

salut gula
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
378 Prokain
(i.m.)

0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0

0 0
0 0
belerang endap 4 %
0 0
belerang endap 4 %

0 0
10.000 UI/
0 0
0 0
(i.m /i.v.)
0 0

salut selaput
salut selaput
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0


0 0

0 0
0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
444 Vaksin
booster

sal gula
0 0
OBAT TAMBAHAN 0 0
2 BD Gard 0 0
3 Becefort tab 0 0
Hemafort Tablet 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
15 TDF(300)+3TC(300)+EVF(600) Botol 0 0
0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

38 Hypafix Roll 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

58 Kondom Pcs 0 0
59 Lisol Botol 0 0
83 Silk 3/0 Pcs 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

90 VTM Kit 0 0
UMUM BPJS TOTAL

JUMLAH KUNJUNGAN

NIP. 19670515 199803 2 001 NIP. 19741129 199702 1 001 NIP.19800608 200902 2 003 NIP.
(LPLPO)

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16


0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
0 0
0 0
asam salisilat 3%
0 0

0 0
oklusi
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0

0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
salut selaput

salut gula
0 0
0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

salut gula

128 mL Botol

0 0
Treatment) lar
0 0
Treatment) serb
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
162 Hepatitis
IU/1,5 ml

0 0
0 0

0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
179 IUD Cu T 380 A Set 0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
salut selaput

0 0
0 0
0 0


223 30 mcg Tab

0 0
0,4 mg tab salut
0 0

227 mg Tab

0 0
mg
0 0

0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0



0 0
0 0
0 0
0,9%) (KN1)
246 0,9%) (KN2) Botol

Ringer Asetat
Ringer Asetat
0 0
0 0

0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
0 0
0 0
0 0
lactate)

0 0
0 0
elektrolit)
0 0
0 0
0 0
0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16


0 0
Glukosa 100 gr)
0 0

288 Lugol Botol 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16


0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
salut enterik
0 0

salut gula
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
378 Prokain
(i.m.)

0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0

0 0
0 0
belerang endap 4 %
0 0
belerang endap 4 %

0 0
10.000 UI/
0 0
0 0
(i.m /i.v.)
0 0

salut selaput
salut selaput
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0


0 0

0 0
0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
444 Vaksin
booster

sal gula
0 0
OBAT TAMBAHAN 0 0
2 BD Gard 0 0
3 Becefort tab 0 0
Hemafort Tablet 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
15 TDF(300)+3TC(300)+EVF(600) Botol 0 0
0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

38 Hypafix Roll 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

58 Kondom Pcs 0 0
59 Lisol Botol 0 0
83 Silk 3/0 Pcs 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

90 VTM Kit 0 0
UMUM BPJS TOTAL

JUMLAH KUNJUNGAN

NIP. 19670515 199803 2 001 NIP. 19741129 199702 1 001 NIP.19800608 200902 2 003 NIP.
(LPLPO)

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16


0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
0 0
0 0
asam salisilat 3%
0 0

0 0
oklusi
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0

0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
salut selaput

salut gula
0 0
0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

salut gula

128 mL Botol

0 0
Treatment) lar
0 0
Treatment) serb
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
162 Hepatitis
IU/1,5 ml

0 0
0 0

0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
179 IUD Cu T 380 A Set 0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
salut selaput

0 0
0 0
0 0


223 30 mcg Tab

0 0
0,4 mg tab salut
0 0

227 mg Tab

0 0
mg
0 0

0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0



0 0
0 0
0 0
0,9%) (KN1)
246 0,9%) (KN2) Botol

Ringer Asetat
Ringer Asetat
0 0
0 0

0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
0 0
0 0
0 0
lactate)

0 0
0 0
elektrolit)
0 0
0 0
0 0
0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16


0 0
Glukosa 100 gr)
0 0

288 Lugol Botol 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16


0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
salut enterik
0 0

salut gula
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
378 Prokain
(i.m.)

0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0

0 0
0 0
belerang endap 4 %
0 0
belerang endap 4 %

0 0
10.000 UI/
0 0
0 0
(i.m /i.v.)
0 0

salut selaput
salut selaput
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0


0 0

0 0
0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
444 Vaksin
booster

sal gula
0 0
OBAT TAMBAHAN 0 0
2 BD Gard 0 0
3 Becefort tab 0 0
Hemafort Tablet 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
15 TDF(300)+3TC(300)+EVF(600) Botol 0 0
0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

38 Hypafix Roll 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

58 Kondom Pcs 0 0
59 Lisol Botol 0 0
83 Silk 3/0 Pcs 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

90 VTM Kit 0 0
UMUM BPJS TOTAL

JUMLAH KUNJUNGAN

NIP. 19670515 199803 2 001 NIP. 19741129 199702 1 001 NIP.19800608 200902 2 003 NIP.
(LPLPO)

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16


0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
0 0
0 0
asam salisilat 3%
0 0

0 0
oklusi
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0

0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
salut selaput

salut gula
0 0
0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

salut gula

128 mL Botol

0 0
Treatment) lar
0 0
Treatment) serb
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
162 Hepatitis
IU/1,5 ml

0 0
0 0

0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
179 IUD Cu T 380 A Set 0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
salut selaput

0 0
0 0
0 0


223 30 mcg Tab

0 0
0,4 mg tab salut
0 0

227 mg Tab

0 0
mg
0 0

0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0



0 0
0 0
0 0
0,9%) (KN1)
246 0,9%) (KN2) Botol

Ringer Asetat
Ringer Asetat
0 0
0 0

0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
0 0
0 0
0 0
lactate)

0 0
0 0
elektrolit)
0 0
0 0
0 0
0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16


0 0
Glukosa 100 gr)
0 0

288 Lugol Botol 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16


0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
salut enterik
0 0

salut gula
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
378 Prokain
(i.m.)

0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0

0 0
0 0
belerang endap 4 %
0 0
belerang endap 4 %

0 0
10.000 UI/
0 0
0 0
(i.m /i.v.)
0 0

salut selaput
salut selaput
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0


0 0

0 0
0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
444 Vaksin
booster

sal gula
0 0
OBAT TAMBAHAN 0 0
2 BD Gard 0 0
3 Becefort tab 0 0
Hemafort Tablet 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
15 TDF(300)+3TC(300)+EVF(600) Botol 0 0
0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

38 Hypafix Roll 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

58 Kondom Pcs 0 0
59 Lisol Botol 0 0
83 Silk 3/0 Pcs 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

90 VTM Kit 0 0
UMUM BPJS TOTAL

JUMLAH KUNJUNGAN

NIP. 19670515 199803 2 001 NIP. 19741129 199702 1 001 NIP.19800608 200902 2 003 NIP.
(LPLPO)

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16


0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
0 0
0 0
asam salisilat 3%
0 0

0 0
oklusi
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0

0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
salut selaput

salut gula
0 0
0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

salut gula

128 mL Botol

0 0
Treatment) lar
0 0
Treatment) serb
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
162 Hepatitis
IU/1,5 ml

0 0
0 0

0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
179 IUD Cu T 380 A Set 0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
salut selaput

0 0
0 0
0 0


223 30 mcg Tab

0 0
0,4 mg tab salut
0 0

227 mg Tab

0 0
mg
0 0

0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
0 0
237 Kotrimoksazol (dewasa) kombinasi : tab/kaptab
sulfametoksazol 800 mg+ trimetoprim 160 mg


Larutan mengandung elektrolit (CaCl2H2O 0,165 0 0
243 gr, KCl 0,15 gr, NaCl 4,3 gr) Botol plastik @500 ml
0 0
0 0
0,9%) (KN1)
0 0
246 Larutan mengandung Elektrolit (KCl 0,3%,NaCl Botol
0,9%) (KN2)
Ringer Asetat
Ringer Asetat
0 0
0 0

251 Botol
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
mg, glucose monohydrate 30 mg, xylitol 15 mg) softbag
0 0
0 0
0 0
0 0
lactate)
0 0
0 0
258 (Acetate, Na, K, Cl, Ca, Mg, Sorbitol 50 gr/L) Botol
0 0
(Dextrose 5%, NaCL 0,45%, KCl) (HSD) Botol

elektrolit)
0 0

0 0
263 Larutan mengandung Karbohidrat + Elektrolit botol/softbag

264 (Glukosa: 25,0 g; NaCl: 4,5 g) Botol
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
0 0
0 0
0 0
268 (Larutan nutrisi kombinasi infus per L: Na.
100mEQ, K 18mEQ, Ca. 4mEQ, Mg 6mEQ, Cl Botol
0 0
(Larutan Ringer & Glukosa 5%) Botol
0 0
(NaCl 1.125 gr, Dekstrosa 18.75 gr) (KA EN 1B)
0 0
271 (NaCl 1.75 g, KCL 1.5g, Glukosa 100 gr) Botol

Glukosa 100 gr)
0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

288 Lugol Botol 0 0

0 0

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
Mineral Mix (Bismuth Subcitrate Tripotasium,

0 0
0 0
salut enterik

335 Nistatin tab salut 500.000 UI salut gula
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

Prokain benzilpenisilin serb inj 3 juta UI/vial 0 0
378 (i.m.) ampul/vial

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

0 0
0 0

0 0
Salep 2-4, kombinasi : asam salisilat 2 %+ 0 0

393 belerang endap 4 % pot 15 gram
0 0
belerang endap 4 %
0 0
399 Serum anti bisa ular : A.B.U. I (khusus ular dari
luar Papua) inj (i.m./i.v.) Vial

Serum antidifteri (A.D.S) inj (i.m./i.v.) Inj i.m 0 0

401 10.000 UI/ Vial

0 0
0 0
(i.m /i.v.)
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0

salut selaput
salut selaput
0 0
414 Siprofloksasin tab scored 500 mg tablet salut selaput/kaplet
salut selaput

0 0
416 Stannous pyrophosphate 27,6 mg sodium Vial
pyrophosphate/vial
0 0
419 Tenofovir tab 300 mg tablet salut selaput/kaplet
salut selaput

PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
0 0
0 0

Vaksin rabies, untuk manusia serb inj (s.k./i.k) + 0 0
444 booster Vial

sal gula
0 0
OBAT TAMBAHAN 0 0
2 BD Gard 0 0
3 Becefort tab 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

Hemafort Tablet 0 0
15 TDF(300)+3TC(300)+EVF(600) Botol 0 0
0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

38 Hypafix Roll 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

58 Kondom Pcs 0 0
59 Lisol Botol 0 0
83 Silk 3/0 Pcs 0 0
PEMBERIAN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16

90 VTM Kit 0 0
UMUM BPJS TOTAL

JUMLAH KUNJUNGAN

NIP. 19670515 199803 2 001 NIP. 19741129 199702 1 001 NIP.19800608 200902 2 003 NIP.
(LPLPO)

PROPINSI : SULAWESI SELATAN TAHUN :
NO NAMA OBAT SATUAN STOK PENERIM PERSEDIA PEMAKAI SISA PERMINTA PEMBERIAN
AWAL AAN AN AN STOK AN DAU DAK P2 KESMAS BS. PROP KESGRA KET
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
UMUM BPJS TOTAL

JUMLAH KUNJUNGAN

NIP. 19670515 199803 2 001 NIP. 19741129 199702 1 001 NIP.19800608 200902 2 003 NIP.
(LPLPO)

RUANGAN / PROGRAM : BULAN PELAPORAN :
PROPINSI : SULAWESI SELATAN TAHUN :
STOK PENERIMA PERSEDIA PEMAKAIA SISA PERMINTA PEMBERIAN

NO NAMA OBAT SATUAN DAU DAK P2 KESMAS BS. PROP KESGRA KET
AWAL AN AN N STOK AN
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
1 2 3 4 5 6 (4 + 5) 7 8 (6 - 7) 9 10 11 12 13 14 15 16
89
90
91
92
93
94
95
96
97
98
99
100
UMUM BPJS TOTAL

JUMLAH KUNJUNGAN

Kepala Dinas Kesehatan Sub Kordinator Kefarmasian Kepala Puskesmas
Hj. Herlina, S.Si.,Apt, M. Kes Nawir, S.Si, Apt Armiaty Arsyad, S.Tr.Kes
NIP. 19670515 199803 2 001 NIP. 19741129 199702 1 001 NIP.19800608 200902 2 003 NIP.

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

KODE PUSKESMAS : 7309300

1 Abacavir 300 mg Tablet/kaplet/kapsul 0 0

3 Air untuk injeksi Botol 250 ml 0 0

9 Alopurinol tab 100 mg Tab 0 0

32 Aquadest cairan 500 ml Botol 500 ml 0 0

53 Atapulgit 600 mg tablet/kapsul/kaplet 0 0

73 Budesonid cairan ih 0,5 mg/ml Botol @ 4 ml 0 0

75 Budesonid serb ih 100 mcg/dosis Botol 0 0

87 Difenhidramin inj 10 mg/ml (i.v./i.m.) ampul/vial 0 0

98 Epinefrin (adrenalin) inj 1 mg/ml Ampul 0 0

116 Fitomenadion (vitamin K 1) inj 2 mg/ml (i.m.) ampul/vial 0 0

tablet salut gula/kaplet 0 0

Garam Fe, setara dengan Fe elemental 15 mg/5 0 0

129 Garam Fe, setara dengan Fe elemental 60 mg Sachet 0 0

147 Glukosa Larutan Infus 10% steril 500 ml Botol 0 0

163 Hidrogen peroksida cairan 3% Botol 0 0

170 Ibuprofen sir 100 mg/5 ml botol @ 60 ml 0 0

175 Ipratropium bromida cairan ih 0,025% Botol 0 0

179 IUD Cu T 380 A Set 0 0

214 Klorpromazin tab sal 25 mg Tab sal 0 0

Kombinasi : artemether 20 mg + lumefantrin 0 0

Kombinasi : Desogestrel 150 mcg Etinilestradiol 0 0

224 Kombinasi : ergotamin 1 mg+ kafein 50 mg tablet/kapsul/kaplet 0 0

Kombinasi : Tenofovir 300 mg + Emtrisitabin 200 0 0

Kombinasi : Tenofovir 300 mg + Lamivudin 300 0 0

Kombinasi: Tenofovir 300 mg + Lamivudin 300 0 0

235 Komposit resin Set 0 0

Kotrimoksazol (dewasa) kombinasi : 0 0

Kotrimoksazol kombinasi tiap 5 ml suspensi : 0 0

239 Kuinin inj 25% (i.v.) Vial 0 0

Larutan mengandung Elektrolit (Na 130 mEq, K 4 0 0

Larutan mengandung Karbohidrat (Fructose 120 0 0

Larutan mengandung Karbohidrat + Elektrolit 0 0

Larutan mengandung Karbohidrat + Elektrolit 0 0

Larutan mengandung Karbohidrat + Elektrolit 0 0

276 Lidokain gel 2% syringe/syringe plastik 0 0

293 Magnesium sulfat serb, ktg 30 g Sachet 0 0

303 Metformin tab 500 mg tablet/kapsul/kaplet 0 0

307 Metilprednisolon inj 125 mg/2 ml ampul/vial 0 0

325 NaCl 0,9% Larutan Botol @1.000 mL 0 0

329 Natrium Diklofenak Tetes Mata 1 mg/ml botol 5 mL 0 0

356 Parasetamol tts 60 mg/0,6 ml botol @ 15 mL 0 0

379 Propiltiourasil tab 100 mg tablet/kapsul/kaplet 0 0

390 Salbutamol sir 2 mg/5 ml Botol 0 0

392 Salbutamol tab 4 mg tablet/kapsul/kaplet

Serum anti bisa ular :A.B.U.II (khusus ular dari 0 0

408 Setirizin sir 5 mg/5 ml. botol @ 60 mL 0 0

413 Simvastatin tab sal selaput 40 mg Tab sal 0 0

415 Spironolakton tab 25 mg tablet/kapsul/kaplet 0 0

417 Streptomisin serb inj 1.000 mg/vial ampul/vial 0 0

420 Terbutalin cairan ih 2,5 mg/ml Botol 0 0

436 Vaksin Influenza Vial 0 0

443 Vaksin polio IPV inj 0,5 ml Vial 0 0

445 Vaksin rabies, untuk manusia serb Inj 2,5 IU Vial 0 0

30 Handscoon non steril L Pcs 0 0

54 Kasa Pembalut Hidrofil 4 m x 15 cm Roll 0 0

89 Urine Bag Pcs 0 0

UMUM BPJS TOTAL

Mengetahui/ Menyetujui, Yang Menyerahkan Yang Menerima/ melapor Yang menerima

KODE PUSKESMAS : 7309300

1 Abacavir 300 mg Tablet/kaplet/kapsul 0 0

3 Air untuk injeksi Botol 250 ml 0 0

9 Alopurinol tab 100 mg Tab 0 0