Fom. LPLPO FARMASI

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
( L P L P O )
KODE PUSKESMAS : HAL 1
PUSKESMAS : Mubrani LB 2
KECAMATAN : Mubrani BULAN : Desember
KABUPATEN : TAMBRAUW TAHUN : 2021
PROPINSI : PAPUA BARAT
SATUAN STOK PENERI- PERSE- PEMA- SISA STOK PERMIN- PEMBERIAN
KODE NAMA OBAT KET
TERKECIL AWAL MAAN DIAAN KAIAN STOK OPT TAAN OTS DAK APBD P2M LAIN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 Acyclovir / Molavir cream 5 % TUBE
2 Acyclovir Salep Mata TUBE
3 Acyclovir / acifar tab 200 mg TABLET 0 0 0 0
4 Acyclovir 400 mg TABLET 0 0 0 0
5 Acytromicin 500 mg TABLET 0 0 0
6 Alkohol 70 % 100 ml BOTOL 3 3 0 3
7 Alkohol 70 % 300 ml BOTOL 0 0 0
9 Allupurinol tab 100 mg TABLET 0 0 0
10 Allopurinol 300 mg TABLET 0 0 0 0
11 Amlodpin 5 mg TABLET 0 0 0
12 Amlodipin 10 mg TABLET 0 0 0
13 Ambroxol tab TABLET 120 120 100 20
14 Ambroxol Syrup BOTOL 0 0 0 0
15 Aminofilin inj 24 mg/ml- 10 ml AMPUL 0 0 0
16 Aminofilin tab 200 mg TABLET 0 0 0
17 Amoxysilin 250 mg TABLET 0 0 0
18 Amoxysilin 500 mg TABLET 0 0 0 0
19 Amoxysilin syr kering 125mg/5ml / Ramoxyl BOTOL 0 0 0
20 Ampisilin syr kering 125 mg / 5 ml BOTOL 0 0 0
21 Ampisilin 500 mg TABLET 0 0 0
22 Ampisilin Inj 1 gr VIAL 0 0 0
23 Antalgin inj 2 ml / Benodon inj AMPUL 0 0 0
24 Antalgin tab 500 mg / Mitamisol Sodium TABLET 110 110 100 10
25 Antasid doen / lexacrool syrup BOTOL 0 0 0 0
26 Antasid doen tab TABLET 460 460 120 340
27 Anaria Syrup BOTOL 0 0 0
28 Anemolat / Folid Acid TABLET 0 0 0
29 Anuscopy PCS 0 0 0
30 Antihemoroid Supp SUPPO 0 0 0
31 Antoksid, Multivitamin CAPSUL 350 350 280 70
32 Aqua pro inj 20 ml VIAL 0 0 0 0
33 Artemeter inj AMPUL 0 0 0
34 Arterakin AMPUL 0 0 0
35 Artesunat inj AMPUL 0 0 0
36 Asifit kapsul Penambah ASI TABLET 0 0 0
37 Asam askorbat (vit c ) tab 50 mg TABLET 440 440 270 170
38 Asam mefenamat / Molasic 500 mg TABLET 0 0 0
39 Atropina sulfat inj 0.25 mg/ml- 1ml AMPUL 0 0 0
40 Atropina sulfat (atropina) tab. 0,5 mg TABLET 0 0 0
41 ATS inj 1500 Unit VIAL 0 0 0
42 Asetosal 100 mg / Gramasal TABLET 0 0 0 0
43 Asetosal 500 mg / Gramasal 500 mg TABLET 0 0 0
44 Albendazol tab TABLET 0 0 0
45 Baby Cough sirup BOTOL 0 0 0
46 Bacytracin Cream TUBE 0 0 0
47 Becefort KAPSUL 0 0 0
48 Benzatin benzil Penisilina Inj 1,2 jt VIAL 0 0 0
50 Betason - N crem / Nasagon cream TUBE 0 0 0
51 Betametason crem 0,1 % TUBE 0 0 0 0
52 Berotec 10 ml Inj VIAL 0 0 0
53 Biovision KAPSUL 0 0 0
54 Biosave Inj ( Anti bisa ular ) VIAL 0 0 0
55 Biosat Inj ( Serum Anti Tetanus ) VIAL 0 0 0
56 Bisacodil / Laxana TABLET 0 0 0
57 Bioplacenton cream TUBE 0 0 0
58 Buscopan TABLET 0 0 0
59 Captopril 12,5 mg TABLET 0 0 0 0
60 Captopril 25 TABLET 620 620 110 510
61 Calsidol syrup BOTOL 0 0 0
62 Capivlex KAPSUL 0 0 0
63 Cefadroxil 500 mg pharmaxil KAPSUL 0 0 0
64 Cefadroxil Syrup BOTOL 0 0 0
65 Cefotaxim inj VIAL 0 0 0
66 Ceftriaxon inj VIAL 0 0 0
67 Cefixime / Pharmafix Sirup BOTOL 0 0 0
68 Ceterizine / Pritacort TABLET 0 0 0
69 Ceterizine Syrup BOTOL 0 0 0
70 Cerebrovit X-Cell KAPSUL 0 0 0
71 Chinin antipirin inj AMPUL 0 0 0
72 Chloramfenikol Tetes Telinga / Erlamicetin BOTOL 0 0 0
73 Cianokobalamina (vit b 12) TABLET 0 0 0
74 Cianokobalamina (vit b 12) inj AMPUL 0 0 0
75 Cimetidine tab TABLET 210 210 150 60
76 Ciprofloxacin 250 mg TABLET 0 0 0
77 Ciprofloxacin 500 mg TABLET 200 200 100 100
78 Codein 10 mg tab TABLET 0 0 0
79 Chlorfeniramine Maleat ( ctm ) tab 4 mg TABLET 0 0 0
80 Cotrimoksazole syr BOTOL 0 0 0 0
81 Cotrimoksazole 120 mg TABLET 0 0 0
82 Cotrimoksazole tab 480 mg TABLET 0 0 0
83 CO-Amoxiclav 625 mg tab TABLET 0 0 0
84 Combantrin 150 mg TABLET 0 0 0
86 Combantrin syrup BOTOL 0 0 0
87 Chloroquin 250 mg tab TABLET 0 0 0
88 Cooton Butt PCS 0 0 0
89 Clorampenicol salep Mata TUBE 0 0 0 0
90 Clorampenicol Syrup BOTOL 0 0 0
91 Cloramphenicol 250 mg KAPSUL 0 0 0
92 Curcuma FC / Groucall Sirup BOTOL 0 0 0
93 Chloramfecort crem TUBE 0 0 0
94 Deksametason inj AMPUL 0 0 0 0
95 Deksametason / Molacort tab 0,5 mg / 0,7 mg TABLET 20 20 50 -30
96 Dekstrometrophan syr BOTOL 0 0 0
97 Dekstrometrophan tab 15 mg TABLET 0 0 0
98 Deladril inj / Adidryl inj VIAL 0 0 0
99 Dextrose 40 % BOTOL 0 0 0
100 Dextral TABLET 0 0 0
101 Dextral Sirup BOTOL 0 0 0
102 Desinfektan 1000 ml BOTOL 0 0 0 0
103 Diasepam inj (stesolid inj) AMPUL 96 96 0 96
104 Diasepam tab 2 mg TABLET 0 0 0
105 Dietilkarbamazin (DEC) 100 mg tab TABLET 0 0 0
106 Difenhidramin inj AMPUL 44 44 0 44
107 DHP/Obat Anti Malaria TABLET 0 0 0
108 Dasabiaon, Ramabio / Mirabion TABLET 0 0 0 0
109 Daryantulle PCS 0 0 0
110 DGLB MECRK 0,5 kg BOTOL 0 0 0
111 Domperidon tab TABLET 10 10 40 -30
112 Domperidon Syrup BOTOL 0 0 0 0
113 Dulcolax Suppo 5 ml SUPPO 0 0 0
114 Dulcolax TABLET 0 0 0
115 Efedrin tab 25 mg TABLET 0 0 0
116 Epinefrin hcl (adrenalin) AMPUL 0 0 0
117 Etambutol 500 mg TABLET 820 820 0 820
118 Ethyl klorida semprot BOTOL 0 0 0
119 Erytromicin Syrup BOTOL 0 0 0
120 Erytromicin 125 mg tab TABLET 20 20 0 20
121 Eritromicin 500 mg TABLET 0 0 0
122 Fenol gliserol tetes telinga BOTOL 0 0 0
123 Fitomenadion (vit K 1) inj 10 mg/ml-1ml AMPUL 0 0 0
124 Fitomenadion (vit K 1) tab 10 mg TABLET 0 0 0
125 Fituno TABLET 0 0 0
126 Furosemid tab 40 mg TABLET 0 0 0 0
127 Fenoksimetil Penisilin tab 250 mg TABLET 0 0 0
129 Garam oralit untuk 200 ml air SACHET 2 2 4 -2
130 Gentian violet larutan 1 % BOTOL 0 0 0 0
131 Gentamicine cream / Gentalex TUBE 0 0 0
132 Gentamicine salep mata TUBE 0 0 0
133 Gentamicin Tetes Mata / Genoint BOTOL 0 0 0 0
134 Gentamicine inj AMPUL 76 76 0 76
135 TABLET
Gliseril guayakolat tab 100 mg / Guaifenesin 0 0 0 0
136 Glibenclamide 5 mg TABLET 30 30 20 10
137 Glimepirid 4 mg TABLET 0 0 0
138 Glukosa larutan infus 5 % BOTOL 29 29 0 29
140 Griseovulvin tab 25 mg TABLET 100 100 70 30
141 Hidroklorotiazid (HCT) tablet 25 mg TABLET 610 610 180 430
142 Hidrokortison crem 2,5 % TUBE 0 0 0
143 Hustab tab 500 mg TABLET 0 0 0
144 Horvita G TABLET 0 0 0
145 Ibuprofen 200 mg TABLET 30 30 60 -30
146 Ibuprofen 400 mg / Lexaprofen TABLET 0 0 0
147 Ibuprofen Syrup BOTOL 0 0 0 0
148 Iodium povidon 30 ml BOTOL 0 0 0 0
149 Iodium povidon 60 ml BOTOL 0 0 0
151 Iodium povidon 1 liter BOTOL 0 0 0
152 Ichtiol salap POTT 0 0 0
153 Isoniasid ( Inh ) tab 100 mg TABLET 0 0 0
155 Kalsiumlaktat (kalk) Tab 500 mg TABLET 0 0 0
156 Ketoconazole TABLET 20 20 20 0
157 Ketoconazole Cream TUBE 0 0 0
158 Kina DHCL (kina) inj 25 % 2 ml AMPUL 0 0 0
159 Kina / Quinine 200 mg / 222 mg TABLET 0 0 0
160 KN 3B Larutan Infus BOTOL 11 11 0 11
161 Komb Sulfadoksin 500 mg + Pyrimetamin 25 mg TABLET 0 0 0
162 Komplax Sirup BOTOL 0 0 0
163 Lidokain comp inj 2 % AMPUL 0 0 0
164 Lisol lart BOTOL 0 0 0
165 Lifron B pleks TABLET 0 0 0
166 Loratadin TABLET 0 0 0
167 Levertran (Minyak ikan salap) POTT 0 0 0
168 Mebendazol tab 100 mg TABLET 0 0 0
169 Metilergometrin inj (Miomergin inj) AMPUL 8 8 0 8
170 Metilergometrin tab TABLET 580 580 30 550
171 Methoclopramide inj (Etiferan inj) AMPUL 0 0 0
172 Metochlopramide tab TABLET 0 0 0
173 Metochlopramide / Primpen Syrup BOTOL 0 0 0
174 Metronidazol tab 250 mg TABLET 0 0 0
175 Metronidazol tab 500 mg / Ragilforta TABLET 0 0 0
176 Methisoprinol 500 mg TABLET 0 0 0
177 Methisoprinol Syr 250 ml BOTOL 0 0 0
178 Methyilprednisolon 4 mg / Grasolon 8 mg TABLET 0 0 0
179 Metformin 500 mg KAPSUL 0 0 0
180 Meloxicam 7,5 mg TABLET 0 0 0
181 Meloxicam 15 mg TABLET 0 0 0
182 Mineral mix SACHET 0 0 0
183 Miconazole cream TUBE 0 0 0
184 MGSO4 BOTOL 0 0 0
185 Natrium diklofenat / Diclofam 50 mg TABLET 0 0 0 0
186 NaCl larutan infus 0,9 % ( Larutan Infus ) BOTOL 20 20 9 11
187 New Antides TABLET 0 0 0
188 Nifedipine tab TABLET 0 0 0
189 Nistatin 100 000 Iu/g tab faginal TABLET 0 0 0
190 Nistatin tab TABLET 0 0 0
191 Novabion KAPSUL 0 0 0
192 Norit POTT 0 0 0
193 OBH syr BOTOL 0 0 0
194 Oksitetrasiklin inj (Oksibiotic inj) AMPUL 0 0 0
195 Oksitetrasiklin salap kulit 3 % TUBE 0 0 0
196 Oksitetrasiklin salap mata 1 % TUBE 0 0 0
197 Oksitosin inj / Pytogin AMPUL 0 0 0
198 OAT Kategori Anak KAPSUL 0 0 0
199 OAT Kategori I KAPSUL 0 0 0
200 OAT Kategori II KAPSUL 0 0 0
201 Omeprazole 20 mg KAPSUL 0 0 0
202 Padonil TABLET 0 0 0
203 Papaferin inj AMPUL 0 0 0
204 Papaferin hcl 40 mg / tab TABLET 0 0 0
Paracetamol tab 500 mg / Ramagesic /
205 TABLET 0 0 20 -20
Alphamol
206 Paracetamol / Cetamol sirup 120 mg/ 5 ml BOTOL 0 0 0 0
207 Paracetamol Infus BOTOL 21 21 0 21
208 Pacetik BP syrup BOTOL 0 0 0 0
209 Prokaine Benzil Penicilin 3 jt IU BOTOL 0 0 0
210 Prokain penisilin inj 3 jt BOTOL 0 0 0
211 Penobarbital inj 50 mg /ml- 2ml AMPUL 0 0 0
212 Penobarbital tab 30 mg TABLET 190 190 0 190
213 Phenilbutason TABLET 0 0 0
214 Pehamoksil Forte 500 mg TABLET 0 0 0
215 Pehatifen TABLET 0 0 0
216 Pehavral KAPSUL 0 0 0
217 Piridoksin hcl Injeksi AMPUL 0 0 0
218 Piridoksin hcl (vit b6) tab 10 mg TABLET 0 0 0
219 Piroxicam / Triadene 20 mg KAPSUL 20 20 40 -20
220 Pyrazinamide 500 mg TABLET 0 0 0
221 Prednison tab 5 mg, TABLET 10 10 50 -40
222 Primaquin tab 15 mg TABLET 0 0 0
223 Propanolol TABLET 0 0 0
224 PTU 100 mg tab TABLET 0 0 0
225 Pirantel tab 125 mg TABLET 0 0 0
226 Pirantel tab 125 mg / sirup BOTOL 0 0 0
227 PK serbuk POTT 60 60 15 45
228 Rivanol 300 ml BOTOL 0 0 0
230 Ranitidin inj AMPUL 0 0 0
231 Ranitidin / Yekardin 150 mg TABLET 0 0 0
232 Retinol (vit A) kapsul lunak 200 000 Iu merah BOTOL 0 0 0 0
233 Retinol (vit A) kapsul lunak 100 000 Iu biru BOTOL 0 0 0 0
234 Rifampisin Kaplet 600 mg KAPSUL 0 0 0
235 Rifampisin kapsul 450 mg KAPSUL 0 0 0
236 Ringers laktat larutan infus BOTOL 0 0 0 0
237 Reserpin tab 0, 10 mg TABLET 0 0 0
239 Salbutamol 2 mg TABLET 20 20 40 -20
240 Salbutamol 4 mg TABLET 0 0 0
241 Salbutamol Syrup BOTOL 0 0 0
242 Salep 2-4 ( Anti Fungi ) POTT 9 9 4 5
243 Salisil talk bedak 25 POTT 0 0 0
244 Salisil spirtus 10 % BOTOL 0 0 0
245 Scot's Emulsion Syrup / Revital Vit. Anak BOTOL 0 0 0
246 Simvastatin 10 mg TABLET 0 0 0
247 Simvastatin 20 mg TABLET 0 0 0 0
248 Stiek Asam Urat BOTOL 0 0 0 0
249 Stiek Asam Colesterol BOTOL 0 0 0
250 Stiek Gula Darah BOTOL 0 0 0
251 Streptomisin inj 1 gr VIAL 0 0 0
252 Sulfa ferosus tab TABLET 0 0 0
253 Sangobion kids syr BOTOL 0 0 0
254 Tablet Tambah Darah TABLET 0 0 0
255 Tetrasiklin hcl Kapsul 250 mg KAPSUL 0 0 0 0
256 Tetrasiklin hcl Kapsul 500 mg KAPSUL 100 100 120 -20
257 Tespack PCS 0 0 0
258 Tensocrope 7,5 cm x 4,5 m ROLL 0 0 0
259 Tensocrope 15 cm x 4,5 m ROLL 0 0 0
260 Thiamin (vit b1 ) tab 50 mg TABLET 10 10 30 -20
261 Thiamin (vit b1 ) inj 100 mg / ml - 1 ml VIAL 0 0 0
262 Thiamphenicol 500 mg TABLET 0 0 0
263 Tiamphenicol Syrup BOTOL 0 0 0
264 Tramadol 50 mg TABLET 0 0 0
265 Tramadol injeksi AMPUL 0 0 0
266 Urin Bag PCS 0 0 0
267 Vagizol Ovula SUPPO 0 0 0
268 Vitamin B kompleks tab TABLET 0 0 0 0
269 Vitamin B kompleks Inj VIAL 0 0 0
270 Vical Syrup BOTOL 0 0 0
271 Vitka infart injeksi VIAL 0 0 0
272 Xilomidon inj VIAL 0 0 0
273 Zinc 20 mg TABLET 0 0 0
274 Zirkum Zink syrup BOTOL 0 0 0
275 Yekamulvita TABLET 70 70 80 -10
0 0 0
ALKES DAN BAHAN HABIS PAKAI 0 0 0
0 0 0
1 Abocath 18 PCS 76 76 2 74
2 Abocath 20 PCS 73 73 2 71
3 Abocath 22 PCS 70 70 2 68
4 Abocath 24 PCS 60 60 2 58
5 Abocath 26 PCS 72 72 2 70
6 Alkohol Swebs PCS -1 -1 15 -16
7 Bisturi 10 PCS 0 0 0
11 Blood lancets /Serenity PCS 0 0 0
12 Catgut Plain 2/0 ROOL 0 0 0
14 Catgut Cromic 2/0 ROOL 0 0 0
15 Catgot Cromic 3/0 ROOL 0 0 0
16 Cover Glass 20 x 20 BUAH 0 0 0
17 Catheter Aximed Suction zize 6 PCS 4 4 0 4
22 Catheter Aximed Suction zize 16 PCS 0 0 0
23 Drug Plastik ( Plastik Obat ) 8 x 5 cm PCS 0 0 0
24 Drug Plastik ( Plastik Obat ) 13 x 8, 7 cm PCS 0 0 0
25 H2O2 BOTOL 0 0 0
26 Holder Vacitainer PCS 0 0 0
27 Hipavix / Aximed 10 x 10 ROOL 35 35 0 35
29 Infusion set anak PCS 82 82 2 80
30 Infusion set Dewasa PCS 75 75 2 73
31 Intec ( Test KIT II ) PCS 0 0 0
32 Kapas 250 gr ROLL 2 2 0 2
33 Kapas berlemak 100 gr ROLL 0 0 0
34 Kasa Steril 16 /16 ROLL 0 0 0
35 Kasa 40 x 40 ROLL 0 0 0
36 Kasa pembalut 2 Y x 80 cm ROLL 0 0 0
37 Kasa pembalut hidrofil 4 m x 15 cmk ROLL 3 3 0 3
38 Kasa pembalut hidrofil 4 m x 3 cmk / 4x5 ROLL 6 6 2 4
39 Kasa Pembalut hidrofil 40 x 80 cm (roll besar) ROLL 0 0 0 0
40 Kantong Plastik ( Kresek ) PCS 0 0 0
41 Kertas puyer BKS 0 0 0
42 KOH 10% 100 ml BOTOL 0 0 0
43 Liqiud soap 500 ml BOTOL 0 0 0
44 Lampu Spritus 250 ml BOTOL 0 0 0
45 Masker elastis 3 lapis PCS 0 0 0
46 Masker Face Ear Loop PCS 0 0 15 -15
47 Masker Face Ties On PCS 0 0 0
48 Methylen Blue 100 ml BOTOL 0 0 0
49 Micropipet 5-50 ml UNIT 0 0 0
50 Microskop Olympus CX-22 UNIT 0 0 0
51 My Jelly 80 gr BOTOL 0 0 0
52 NGT Bayi PCS 0 0 0
53 NGT Anak PCS 0 0 0
54 NGT Dewasa PCS 0 0 0
55 NACL 0,9 % 100 ml BOTOL 0 0 0
56 Objek Glass ( Merah ) PCS 0 0 0
57 Oli Emerson BOTOL 0 0 0
58 One Scrobs 500 ml ( Anti Septik ) BOTOL 0 0 0
59 Oncoproc ( Test KIT I ) PCS 0 0 0
60 Plester 5 yards x 2 inch, 2,5 cm x 4,5 ROOL 0 0 0
61 PH Paper BKS 0 0 0
62 RDT ( Test pemeriksaan Malaria ) PCS 0 0 0
63 RPR Antigen TEST 0 0 0
64 Silk 3/0, Silk Black 3/0 ROOL 0 0 0
65 Spekulum uk 5 ml @ 9 bh BUAH 0 0 0
66 Spritus 1 Liter BOTOL 0 0 0
67 Torniquet BUAH 0 0 0
68 Vacutainer Needle 226 BOX 0 0 0
69 Vaculab 3 ml BOX 0 0 0
70 Vikia ( Test KIT III ) TEST 0 0 0
71 Yellow tip BAG 0 0 0
72 Lactose Broth 500 gr ( Merck ) BOTOL 0 0 0
73 Sarung tangan no. 7 PCS 0 0 0
74 Sarung tangan / Serenity no. 7,5 PCS 0 0 0
76 Sarung Tangan 6,5 ( S ) PCS 0 0 0
77 Sarung Tangan ( M ) PCS 0 0 0 0
78 Sarung Tangan ( L ) PCS 0 0 0
79 Sarung Tangan Non Steril PCS 0 0 0
80 Sarung tangan gynaecology PCS 0 0 0
81 Silk (benang bedah sutra ) 2/0 SACHET 0 0 0
82 Silk Black / SILK Brade (benang bedah sutra ) 3/0 SACHET 0 0 0
83 Sterilone BOTOL 0 0 0
84 Spoit 0,5 ml PCS 0 0 0
85 Spoit 0,05 ml PCS 0 0 0
86 Spoit 1 ml PCS 0 0 0
91 Syphilis 3.0 PCS 0 0 0
92 Hexagon Syphilis PCS 0 0 0
93 BD. Microtainer TEST 0 0 0
94 TP Rapid SD Biolin Sypilis TEST 0 0 0
95 Hcl 0,1 N BOTOL 0 0 0 KIA / BIDAN
96 Transfusi Set PCS 0 0 0 KIA / BIDAN
97 Hanskun Panjang / Pendek Ksusus ibu bersalin PCS 0 0 0 KIA / BIDAN
98 Underpad PCS 0 0 0 KIA / BIDAN
99 Jelly BOTOL 0 0 0 KIA / BIDAN
100 Penjepit Tali Pusar Bayi PCS 0 0 0 KIA / BIDAN
101 Pampers XL PCS 0 0 0 KIA / BIDAN
102 Dopler BUAH 0 0 0 KIA / BIDAN
103 Kateter,6,8,10,12,14,16 PCS 0 0 0 KIA / BIDAN
104 Bidan Kit PCS 0 0 0 KIA / BIDAN
0 0 0
PERMINTAAN DOKTER 0 0 0
0 0 0
105 Mifacetin TABLET 0 0 0
106 Latobasilus / LBO TABLET 0 0 0
107 Fentolin / Kombifen BOTOL 0 0 0
108 Antrophen Inhalasi BOTOL 0 0 0
109 Paracetamol Suppo TABLET 0 0 0
110 Sampo Ketokonazole BOTOL 0 0 0
111 Ibuprofen Suppo TABLET 0 0 0
112 Stesolid Suppo TABLET 0 0 0
113 Pekak Sirup BOTOL 0 0 0
114 Salompas Spree PCS 0 0 0
115 Elastis Parban PCS 0 0 0
116 Cakang Kapul KAPSUL 0 0 0
117 Pott / Wadah Salep POTT 0 0 0
118 Kassa Kompres PCS 0 0 0
119 Elkana Sirup BOTOL 0 0 0
120 Proris Sirup BOTOL 0 0 0
121 Dulcolax Suppo TABLET 0 0 0
122 Armsling TABLET 0 0 0
123 PAPAN Bidai PCS 0 0 0
124 Kalium Diklopenat TABLET 0 0 0
125 Burnasin TUBE 0 0 0
126 Aloclair Jell BOTOL 0 0 0
127 Sukralfat TABLET 0 0 0
128 BloodCatget ROOL 0 0 0
129 Coromic Gat ROOL 0 0 0
130 Kanamicin VIAL 0 0 0
131 Furosemide INJeksi VIAL 0 0 0
132 Manitol BOTOL 0 0 0
133 Paracetamol Infus BOTOL 0 0 0
134 Ciproloxacin Infus BOTOL 0 0 0
137 Curcuma TABLET 0 0 0
138 Curcuuma Sirup BOTOL 0 0 0
139 KAEN 3 A BOTOL 0 0 0
140 Wida ICN - 2 BOTOL 0 0 0
141 Faksin Anti Rabies AMPUL 0 0 0
142 Cefixime TABLET 0 0 0
144 Lisopronolol TABLET 0 0 0
146 Tandesartan TABLET 0 0 0
147 Gempibrozil TABLET 0 0 0
148 Brobenezit TABLET 0 0 0
149 Phenilbutasone TABLET 0 0 0
150 Amitriphilin TABLET 0 0 0
151 Fluoksetin TABLET 0 0 0
152 Gabapentin TABLET 0 0 0
153 Prazikuantel TABLET 0 0 0
154 Diklosamide TABLET 0 0 0
156 Tiamphenicol TABLET 0 0 0
158 Mupirozin Salep TUBE 0 0 0
159 Asambuzide TUBE 0 0 0
160 Etil Clorida BOTOL 0 0 0
161 Efgitrosite TABLET 0 0 0
162 Antidisteri TABLET 0 0 0
163 Pedialite BOTOL 0 0 0
UMUM
ASKES JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR
JUMLAH KUNJUNGAN RESEP
0 0
Mengetahui/Menyetujui Yang menyerahkan Yang Meminta Yang menerima

KEPALA DINAS KESEHATAN KABUPATEN Petugas GFK Pimpinan Puskesmas Petugas Puskesmas
( ……………………………………………..) ( ……………………………...……...……… ) ( Atorina Ajmabani, Amd.Keb )

NIP. NIP. 19660718 199312 2 002 ( ……………………………...……...……… )
( L P L P O )
KECAMATAN : Mubrani BULAN : November
KODE NAMA OBAT KET
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
95 Deksametason / Molacort tab 0,5 mg / 0,7 mg TABLET 70 70 50 20
111 Domperidon tab TABLET 50 50 40 10
129 Garam oralit untuk 200 ml air SACHET 6 6 4 2
135 TABLET
145 Ibuprofen 200 mg TABLET 90 90 60 30
205 TABLET 20 20 20 0
Alphamol
219 Piroxicam / Triadene 20 mg KAPSUL 60 60 40 20
221 Prednison tab 5 mg, TABLET 60 60 50 10
239 Salbutamol 2 mg TABLET 60 60 40 20
260 Thiamin (vit b1 ) tab 50 mg TABLET 40 40 30 10
275 Yekamulvita TABLET 150 150 80 70
0 0 0
0 0 0
1 Abocath 18 PCS 78 78 2 76
2 Abocath 20 PCS 75 75 2 73
3 Abocath 22 PCS 72 72 2 70
4 Abocath 24 PCS 62 62 2 60
5 Abocath 26 PCS 74 74 2 72
6 Alkohol Swebs PCS 14 14 15 -1
25 H2O2 BOTOL 0 0 0
32 Kapas 250 gr ROLL 2 2 0 2
35 Kasa 40 x 40 ROLL 0 0 0
42 KOH 10% 100 ml BOTOL 0 0 0
46 Masker Face Ear Loop PCS 15 15 15 0
55 NACL 0,9 % 100 ml BOTOL 0 0 0
85 Spoit 0,05 ml PCS 0 0 0
0 0 0
0 0 0
UMUM
ASKES JUMLAH
0 0


NIP. NIP. 19660718 199312 2 002 ( ……………………………...……...……… )
( L P L P O )
KECAMATAN : Mubrani BULAN : Oktober
KODE NAMA OBAT KET
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
135 TABLET
205 TABLET 50 50 30 20
Alphamol
0 0 0
0 0 0
1 Abocath 18 PCS 80 80 2 78
2 Abocath 20 PCS 77 77 2 75
3 Abocath 22 PCS 74 74 2 72
4 Abocath 24 PCS 64 64 2 62
5 Abocath 26 PCS 76 76 2 74
6 Alkohol Swebs PCS 29 29 15 14
25 H2O2 BOTOL 0 0 0
32 Kapas 250 gr ROLL 2 2 0 2
35 Kasa 40 x 40 ROLL 0 0 0
42 KOH 10% 100 ml BOTOL 0 0 0
55 NACL 0,9 % 100 ml BOTOL 0 0 0
85 Spoit 0,05 ml PCS 0 0 0
0 0 0
0 0 0
UMUM
ASKES JUMLAH
0 0


NIP. NIP. 19660718 199312 2 002 ( ……………………………...……...……… )
( L P L P O )
KECAMATAN : Mubrani BULAN : September
KODE NAMA OBAT KET
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
135 TABLET
205 TABLET 80 80 30 50
Alphamol
227 PK serbuk POTT 108 108 15 93
0 0 0
0 0 0
1 Abocath 18 PCS 82 82 2 80
2 Abocath 20 PCS 79 79 2 77
3 Abocath 22 PCS 76 76 2 74
4 Abocath 24 PCS 66 66 2 64
5 Abocath 26 PCS 78 78 2 76
25 H2O2 BOTOL 0 0 0
32 Kapas 250 gr ROLL 2 2 0 2
35 Kasa 40 x 40 ROLL 0 0 0
42 KOH 10% 100 ml BOTOL 0 0 0
55 NACL 0,9 % 100 ml BOTOL 0 0 0
85 Spoit 0,05 ml PCS 0 0 0
0 0 0
0 0 0
UMUM
ASKES JUMLAH
0 0


NIP. NIP. 19660718 199312 2 002 ( ……………………………...……...……… )
( L P L P O )
KECAMATAN : Mubrani BULAN : Agustus
KODE NAMA OBAT KET
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
135 TABLET
205 TABLET 110 110 30 80
Alphamol
227 PK serbuk POTT 117 117 9 108
0 0 0
0 0 0
1 Abocath 18 PCS 85 85 3 82
2 Abocath 20 PCS 82 82 3 79
3 Abocath 22 PCS 79 79 3 76
4 Abocath 24 PCS 69 69 3 66
5 Abocath 26 PCS 81 81 3 78
25 H2O2 BOTOL 0 0 0
32 Kapas 250 gr ROLL 2 2 0 2
35 Kasa 40 x 40 ROLL 0 0 0
42 KOH 10% 100 ml BOTOL 0 0 0
55 NACL 0,9 % 100 ml BOTOL 0 0 0
85 Spoit 0,05 ml PCS 0 0 0
0 0 0
0 0 0
UMUM
ASKES JUMLAH
0 0


NIP. NIP. 19660718 199312 2 002 ( ……………………………...……...……… )
( L P L P O )
KECAMATAN : Mubrani BULAN : Juli
KODE NAMA OBAT KET
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
135 TABLET
205 TABLET 160 160 50 110
Alphamol
227 PK serbuk POTT 133 133 16 117
0 0 0
0 0 0
1 Abocath 18 PCS 87 87 2 85
2 Abocath 20 PCS 84 84 2 82
3 Abocath 22 PCS 81 81 2 79
4 Abocath 24 PCS 71 71 2 69
5 Abocath 26 PCS 83 83 2 81
25 H2O2 BOTOL 0 0 0
32 Kapas 250 gr ROLL 2 2 0 2
35 Kasa 40 x 40 ROLL 0 0 0
42 KOH 10% 100 ml BOTOL 0 0 0
55 NACL 0,9 % 100 ml BOTOL 0 0 0
85 Spoit 0,05 ml PCS 0 0 0
0 0 0
0 0 0
UMUM
ASKES JUMLAH
0 0


NIP. NIP. 19660718 199312 2 002 ( ……………………………...……...……… )
( L P L P O )
KECAMATAN : Mubrani BULAN : Juni
KODE NAMA OBAT KET
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
135 TABLET
205 TABLET 210 210 50 160
Alphamol
227 PK serbuk POTT 145 145 12 133
0 0 0
0 0 0
1 Abocath 18 PCS 88 88 1 87
2 Abocath 20 PCS 86 86 2 84
3 Abocath 22 PCS 83 83 2 81
4 Abocath 24 PCS 73 73 2 71
5 Abocath 26 PCS 84 84 1 83
25 H2O2 BOTOL 0 0 0
32 Kapas 250 gr ROLL 2 2 0 2
35 Kasa 40 x 40 ROLL 0 0 0
42 KOH 10% 100 ml BOTOL 0 0 0
55 NACL 0,9 % 100 ml BOTOL 0 0 0
85 Spoit 0,05 ml PCS 0 0 0
0 0 0
0 0 0
UMUM
ASKES JUMLAH
0 0


NIP. NIP. 19660718 199312 2 002 ( ……………………………...……...……… )
( L P L P O )
KECAMATAN : Mubrani BULAN : Mei
KODE NAMA OBAT KET
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
135 TABLET
205 TABLET 280 280 70 210
Alphamol
227 PK serbuk POTT 159 159 14 145
0 0 0
0 0 0
1 Abocath 18 PCS 89 89 1 88
2 Abocath 20 PCS 88 88 2 86
3 Abocath 22 PCS 85 85 2 83
4 Abocath 24 PCS 75 75 2 73
5 Abocath 26 PCS 85 85 1 84
25 H2O2 BOTOL 0 0 0
32 Kapas 250 gr ROLL 2 2 0 2
35 Kasa 40 x 40 ROLL 0 0 0
42 KOH 10% 100 ml BOTOL 0 0 0
55 NACL 0,9 % 100 ml BOTOL 0 0 0
85 Spoit 0,05 ml PCS 0 0 0
0 0 0
0 0 0
UMUM
ASKES JUMLAH
0 0


NIP. NIP. 19660718 199312 2 002 ( ……………………………...……...……… )
( L P L P O )
KECAMATAN : Mubrani BULAN : April
KODE NAMA OBAT KET
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
135 TABLET
205 TABLET 370 370 90 280
Alphamol
227 PK serbuk POTT 169 169 10 159
0 0 0
0 0 0
1 Abocath 18 PCS 90 90 1 89
2 Abocath 20 PCS 89 89 1 88
3 Abocath 22 PCS 86 86 1 85
4 Abocath 24 PCS 76 76 1 75
5 Abocath 26 PCS 86 86 1 85
25 H2O2 BOTOL 0 0 0
32 Kapas 250 gr ROLL 2 2 0 2
35 Kasa 40 x 40 ROLL 0 0 0
42 KOH 10% 100 ml BOTOL 0 0 0
55 NACL 0,9 % 100 ml BOTOL 0 0 0
85 Spoit 0,05 ml PCS 0 0 0
0 0 0
0 0 0
UMUM
ASKES JUMLAH
0 0


NIP. NIP. 19660718 199312 2 002 ( ……………………………...……...……… )
( L P L P O )
KECAMATAN : Mubrani BULAN : Maret
KODE NAMA OBAT KET
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
135 TABLET
205 TABLET 450 450 80 370
Alphamol
227 PK serbuk POTT 182 182 13 169
0 0 0
0 0 0
1 Abocath 18 PCS 91 91 1 90
2 Abocath 20 PCS 90 90 1 89
3 Abocath 22 PCS 87 87 1 86
4 Abocath 24 PCS 77 77 1 76
5 Abocath 26 PCS 87 87 1 86
25 H2O2 BOTOL 0 0 0
32 Kapas 250 gr ROLL 2 2 0 2
35 Kasa 40 x 40 ROLL 0 0 0
42 KOH 10% 100 ml BOTOL 0 0 0
55 NACL 0,9 % 100 ml BOTOL 0 0 0
85 Spoit 0,05 ml PCS 0 0 0
0 0 0
0 0 0
UMUM
ASKES JUMLAH
0 0


NIP. NIP. 19660718 199312 2 002 ( ……………………………...……...……… )
( L P L P O )
KECAMATAN : Mubrani BULAN : Februari
KODE NAMA OBAT KET
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
3 Acyclovir / acifar tab 200 mg TABLET 180 180 30 150 150
4 Acyclovir 400 mg TABLET 360 360 40 320 320
5 Acytromicin 500 mg TABLET 0 0 0 0
6 Alkohol 70 % 100 ml BOTOL 4 4 0 4 4
8 Alkohol 70 % 1000 ml BOTOL 3 3 3 3
9 Allupurinol tab 100 mg TABLET 0 0 0 0
10 Allopurinol 300 mg TABLET 10 10 10 0 0
11 Amlodpin 5 mg TABLET 0 0 0 0
12 Amlodipin 10 mg TABLET 0 0 0 0
13 Ambroxol tab TABLET 890 890 50 840 840
14 Ambroxol Syrup BOTOL 1 1 0 1 1
15 Aminofilin inj 24 mg/ml- 10 ml AMPUL 0 0 0 0
16 Aminofilin tab 200 mg TABLET 0 0 0 0
18 Amoxysilin 500 mg TABLET 320 320 70 250 250
19 Amoxysilin syr kering 125mg/5ml / Ramoxyl BOTOL 0 0 0 0
20 Ampisilin syr kering 125 mg / 5 ml BOTOL 0 0 0 0
21 Ampisilin 500 mg TABLET 0 0 0 0
22 Ampisilin Inj 1 gr VIAL 0 0 0 0
23 Antalgin inj 2 ml / Benodon inj AMPUL 0 0 0 0
24 Antalgin tab 500 mg / Mitamisol Sodium TABLET 1330 1330 190 1140 1140
25 Antasid doen / lexacrool syrup BOTOL 11 11 3 8 8
26 Antasid doen tab TABLET 1820 1820 110 1710 1710
27 Anaria Syrup BOTOL 0 0 0 0
28 Anemolat / Folid Acid TABLET 0 0 0 0
29 Anuscopy PCS 0 0 0 0
30 Antihemoroid Supp SUPPO 0 0 0 0
31 Antoksid, Multivitamin CAPSUL 2610 2610 190 2420 2420
32 Aqua pro inj 20 ml VIAL 1 1 1 0 0
33 Artemeter inj AMPUL 0 0 0 0
34 Arterakin AMPUL 0 0 0 0
35 Artesunat inj AMPUL 0 0 0 0
36 Asifit kapsul Penambah ASI TABLET 0 0 0 0
37 Asam askorbat (vit c ) tab 50 mg TABLET 2530 2530 160 2370 2370
38 Asam mefenamat / Molasic 500 mg TABLET 0 0 0 0
39 Atropina sulfat inj 0.25 mg/ml- 1ml AMPUL 0 0 0 0
40 Atropina sulfat (atropina) tab. 0,5 mg TABLET 0 0 0 0
41 ATS inj 1500 Unit VIAL 0 0 0 0
42 Asetosal 100 mg / Gramasal TABLET 420 420 60 360 360
43 Asetosal 500 mg / Gramasal 500 mg TABLET 0 0 0 0
44 Albendazol tab TABLET 0 0 0 0
45 Baby Cough sirup BOTOL 0 0 0 0
46 Bacytracin Cream TUBE 0 0 0 0
47 Becefort KAPSUL 0 0 0 0
48 Benzatin benzil Penisilina Inj 1,2 jt VIAL 0 0 0 0
50 Betason - N crem / Nasagon cream TUBE 0 0 0 0
51 Betametason crem 0,1 % TUBE 2 2 1 1 1
52 Berotec 10 ml Inj VIAL 0 0 0 0
53 Biovision KAPSUL 0 0 0 0
54 Biosave Inj ( Anti bisa ular ) VIAL 0 0 0 0
55 Biosat Inj ( Serum Anti Tetanus ) VIAL 0 0 0 0
56 Bisacodil / Laxana TABLET 0 0 0 0
57 Bioplacenton cream TUBE 0 0 0 0
58 Buscopan TABLET 0 0 0 0
59 Captopril 12,5 mg TABLET 70 70 30 40 40
60 Captopril 25 TABLET 1440 1440 50 1390 1390
61 Calsidol syrup BOTOL 0 0 0 0
62 Capivlex KAPSUL 0 0 0 0
63 Cefadroxil 500 mg pharmaxil KAPSUL 0 0 0 0
64 Cefadroxil Syrup BOTOL 0 0 0 0
65 Cefotaxim inj VIAL 0 0 0 0
66 Ceftriaxon inj VIAL 0 0 0 0
67 Cefixime / Pharmafix Sirup BOTOL 0 0 0 0
68 Ceterizine / Pritacort TABLET 0 0 0 0
69 Ceterizine Syrup BOTOL 0 0 0 0
70 Cerebrovit X-Cell KAPSUL 0 0 0 0
71 Chinin antipirin inj AMPUL 0 0 0 0
72 Chloramfenikol Tetes Telinga / Erlamicetin BOTOL 0 0 0 0
73 Cianokobalamina (vit b 12) TABLET 0 0 0 0
74 Cianokobalamina (vit b 12) inj AMPUL 0 0 0 0
75 Cimetidine tab TABLET 1540 1540 120 1420 1420
77 Ciprofloxacin 500 mg TABLET 930 930 70 860 860
78 Codein 10 mg tab TABLET 0 0 0 0
79 Chlorfeniramine Maleat ( ctm ) tab 4 mg TABLET 0 0 0 0
80 Cotrimoksazole syr BOTOL 2 2 0 2 2
81 Cotrimoksazole 120 mg TABLET 0 0 0 0
82 Cotrimoksazole tab 480 mg TABLET 0 0 0 0
83 CO-Amoxiclav 625 mg tab TABLET 0 0 0 0
84 Combantrin 150 mg TABLET 0 0 0 0
86 Combantrin syrup BOTOL 0 0 0 0
87 Chloroquin 250 mg tab TABLET 0 0 0 0
88 Cooton Butt PCS 0 0 0 0
89 Clorampenicol salep Mata TUBE 0 0 0 0 0
90 Clorampenicol Syrup BOTOL 0 0 0 0
91 Cloramphenicol 250 mg KAPSUL 0 0 0 0
92 Curcuma FC / Groucall Sirup BOTOL 0 0 0 0
93 Chloramfecort crem TUBE 0 0 0 0
94 Deksametason inj AMPUL 3 3 1 2 2
95 Deksametason / Molacort tab 0,5 mg / 0,7 mg TABLET 780 780 60 720 720
96 Dekstrometrophan syr BOTOL 0 0 0 0
97 Dekstrometrophan tab 15 mg TABLET 0 0 0 0
98 Deladril inj / Adidryl inj VIAL 0 0 0 0
99 Dextrose 40 % BOTOL 0 0 0 0
100 Dextral TABLET 0 0 0 0
101 Dextral Sirup BOTOL 0 0 0 0
103 Diasepam inj (stesolid inj) AMPUL 96 96 0 96 96
104 Diasepam tab 2 mg TABLET 0 0 0 0
105 Dietilkarbamazin (DEC) 100 mg tab TABLET 0 0 0 0
106 Difenhidramin inj AMPUL 44 44 0 44 44
107 DHP/Obat Anti Malaria TABLET 0 0 0 0
108 Dasabiaon, Ramabio / Mirabion TABLET 70 70 20 50 50
109 Daryantulle PCS 0 0 0 0
110 DGLB MECRK 0,5 kg BOTOL 0 0 0 0
111 Domperidon tab TABLET 640 640 60 580 580
112 Domperidon Syrup BOTOL 1 1 0 1 1
113 Dulcolax Suppo 5 ml SUPPO 0 0 0 0
114 Dulcolax TABLET 0 0 0 0
115 Efedrin tab 25 mg TABLET 0 0 0 0
116 Epinefrin hcl (adrenalin) AMPUL 0 0 0 0
117 Etambutol 500 mg TABLET 920 920 0 920 920
118 Ethyl klorida semprot BOTOL 0 0 0 0
119 Erytromicin Syrup BOTOL 0 0 0 0
120 Erytromicin 125 mg tab TABLET 30 30 10 20 20
121 Eritromicin 500 mg TABLET 0 0 0 0
122 Fenol gliserol tetes telinga BOTOL 0 0 0 0
123 Fitomenadion (vit K 1) inj 10 mg/ml-1ml AMPUL 0 0 0 0
124 Fitomenadion (vit K 1) tab 10 mg TABLET 0 0 0 0
125 Fituno TABLET 0 0 0 0
126 Furosemid tab 40 mg TABLET 520 520 80 440 440
127 Fenoksimetil Penisilin tab 250 mg TABLET 0 0 0 0
129 Garam oralit untuk 200 ml air SACHET 106 106 10 96 96
130 Gentian violet larutan 1 % BOTOL 10 10 5 5 5
131 Gentamicine cream / Gentalex TUBE 0 0 0 0
132 Gentamicine salep mata TUBE 0 0 0 0
133 Gentamicin Tetes Mata / Genoint BOTOL 1 1 0 1 1
134 Gentamicine inj AMPUL 79 79 2 77 77
135 TABLET
Gliseril guayakolat tab 100 mg / Guaifenesin 250 250 90 160 160
136 Glibenclamide 5 mg TABLET 620 620 90 530 530
137 Glimepirid 4 mg TABLET 0 0 0 0
138 Glukosa larutan infus 5 % BOTOL 45 45 3 42 42
140 Griseovulvin tab 25 mg TABLET 1190 1190 150 1040 1040
141 Hidroklorotiazid (HCT) tablet 25 mg TABLET 1600 1600 60 1540 1540
142 Hidrokortison crem 2,5 % TUBE 0 0 0 0
143 Hustab tab 500 mg TABLET 0 0 0 0
144 Horvita G TABLET 0 0 0 0
145 Ibuprofen 200 mg TABLET 1730 1730 170 1560 1560
146 Ibuprofen 400 mg / Lexaprofen TABLET 0 0 0 0
147 Ibuprofen Syrup BOTOL 3 3 1 2 2
148 Iodium povidon 30 ml BOTOL 2 2 1 1 1
151 Iodium povidon 1 liter BOTOL 0 0 0 0
152 Ichtiol salap POTT 0 0 0 0
153 Isoniasid ( Inh ) tab 100 mg TABLET 0 0 0 0
155 Kalsiumlaktat (kalk) Tab 500 mg TABLET 0 0 0 0
156 Ketoconazole TABLET 490 490 70 420 420
157 Ketoconazole Cream TUBE 0 0 0 0
158 Kina DHCL (kina) inj 25 % 2 ml AMPUL 0 0 0 0
159 Kina / Quinine 200 mg / 222 mg TABLET 0 0 0 0
160 KN 3B Larutan Infus BOTOL 13 13 0 13 13
161 Komb Sulfadoksin 500 mg + Pyrimetamin 25 mg TABLET 0 0 0 0
162 Komplax Sirup BOTOL 0 0 0 0
163 Lidokain comp inj 2 % AMPUL 0 0 0 0
164 Lisol lart BOTOL 0 0 0 0
165 Lifron B pleks TABLET 0 0 0 0
166 Loratadin TABLET 0 0 0 0
167 Levertran (Minyak ikan salap) POTT 0 0 0 0
168 Mebendazol tab 100 mg TABLET 0 0 0 0
169 Metilergometrin inj (Miomergin inj) AMPUL 8 8 0 8 8
170 Metilergometrin tab TABLET 900 900 30 870 870
171 Methoclopramide inj (Etiferan inj) AMPUL 0 0 0 0
172 Metochlopramide tab TABLET 0 0 0 0
173 Metochlopramide / Primpen Syrup BOTOL 0 0 0 0
174 Metronidazol tab 250 mg TABLET 0 0 0 0
175 Metronidazol tab 500 mg / Ragilforta TABLET 0 0 0 0
176 Methisoprinol 500 mg TABLET 0 0 0 0
177 Methisoprinol Syr 250 ml BOTOL 0 0 0 0
178 Methyilprednisolon 4 mg / Grasolon 8 mg TABLET 0 0 0 0
179 Metformin 500 mg KAPSUL 0 0 0 0
180 Meloxicam 7,5 mg TABLET 0 0 0 0
181 Meloxicam 15 mg TABLET 0 0 0 0
182 Mineral mix SACHET 0 0 0 0
183 Miconazole cream TUBE 0 0 0 0
184 MGSO4 BOTOL 0 0 0 0
185 Natrium diklofenat / Diclofam 50 mg TABLET 10 10 10 0 0
186 NaCl larutan infus 0,9 % ( Larutan Infus ) BOTOL 74 74 6 68 68
187 New Antides TABLET 0 0 0 0
188 Nifedipine tab TABLET 0 0 0 0
189 Nistatin 100 000 Iu/g tab faginal TABLET 0 0 0 0
190 Nistatin tab TABLET 0 0 0 0
191 Novabion KAPSUL 0 0 0 0
192 Norit POTT 0 0 0 0
193 OBH syr BOTOL 0 0 0 0
194 Oksitetrasiklin inj (Oksibiotic inj) AMPUL 0 0 0 0
195 Oksitetrasiklin salap kulit 3 % TUBE 0 0 0 0
196 Oksitetrasiklin salap mata 1 % TUBE 0 0 0 0
197 Oksitosin inj / Pytogin AMPUL 0 0 0 0
198 OAT Kategori Anak KAPSUL 0 0 0 0
199 OAT Kategori I KAPSUL 0 0 0 0
200 OAT Kategori II KAPSUL 0 0 0 0
201 Omeprazole 20 mg KAPSUL 0 0 0 0
202 Padonil TABLET 0 0 0 0
203 Papaferin inj AMPUL 0 0 0 0
204 Papaferin hcl 40 mg / tab TABLET 0 0 0 0
205 TABLET 590 590 70 520 520
Alphamol
206 Paracetamol / Cetamol sirup 120 mg/ 5 ml BOTOL 11 11 2 9 9
207 Paracetamol Infus BOTOL 27 27 0 27 27
208 Pacetik BP syrup BOTOL 0 0 0 0 0
209 Prokaine Benzil Penicilin 3 jt IU BOTOL 0 0 0 0
210 Prokain penisilin inj 3 jt BOTOL 0 0 0 0
211 Penobarbital inj 50 mg /ml- 2ml AMPUL 0 0 0 0
212 Penobarbital tab 30 mg TABLET 230 230 0 230 230
213 Phenilbutason TABLET 0 0 0 0
214 Pehamoksil Forte 500 mg TABLET 0 0 0 0
215 Pehatifen TABLET 0 0 0 0
216 Pehavral KAPSUL 0 0 0 0
217 Piridoksin hcl Injeksi AMPUL 0 0 0 0
218 Piridoksin hcl (vit b6) tab 10 mg TABLET 0 0 0 0
219 Piroxicam / Triadene 20 mg KAPSUL 930 930 120 810 810
220 Pyrazinamide 500 mg TABLET 0 0 0 0
221 Prednison tab 5 mg, TABLET 760 760 90 670 670
222 Primaquin tab 15 mg TABLET 0 0 0 0
223 Propanolol TABLET 0 0 0 0
224 PTU 100 mg tab TABLET 0 0 0 0
225 Pirantel tab 125 mg TABLET 0 0 0 0
226 Pirantel tab 125 mg / sirup BOTOL 0 0 0 0
227 PK serbuk POTT 207 207 15 192 192
228 Rivanol 300 ml BOTOL 0 0 0 0
230 Ranitidin inj AMPUL 0 0 0 0
231 Ranitidin / Yekardin 150 mg TABLET 0 0 0 0
232 Retinol (vit A) kapsul lunak 200 000 Iu merah BOTOL 45 45 10 35 35
233 Retinol (vit A) kapsul lunak 100 000 Iu biru BOTOL 45 45 10 35 35
234 Rifampisin Kaplet 600 mg KAPSUL 0 0 0 0
235 Rifampisin kapsul 450 mg KAPSUL 0 0 0 0
236 Ringers laktat larutan infus BOTOL 5 5 3 2 2
237 Reserpin tab 0, 10 mg TABLET 0 0 0 0
239 Salbutamol 2 mg TABLET 770 770 60 710 710
241 Salbutamol Syrup BOTOL 0 0 0 0
242 Salep 2-4 ( Anti Fungi ) POTT 70 70 7 63 63
243 Salisil talk bedak 25 POTT 0 0 0 0
244 Salisil spirtus 10 % BOTOL 0 0 0 0
245 Scot's Emulsion Syrup / Revital Vit. Anak BOTOL 0 0 0 0
247 Simvastatin 20 mg TABLET 210 210 20 190 190
248 Stiek Asam Urat BOTOL 4 4 2 2 2
249 Stiek Asam Colesterol BOTOL 0 0 0 0
250 Stiek Gula Darah BOTOL 0 0 0 0
251 Streptomisin inj 1 gr VIAL 0 0 0 0
252 Sulfa ferosus tab TABLET 0 0 0 0
253 Sangobion kids syr BOTOL 0 0 0 0
254 Tablet Tambah Darah TABLET 0 0 0 0
255 Tetrasiklin hcl Kapsul 250 mg KAPSUL 180 180 70 110 110
257 Tespack PCS 0 0 0 0
258 Tensocrope 7,5 cm x 4,5 m ROLL 0 0 0 0
259 Tensocrope 15 cm x 4,5 m ROLL 0 0 0 0
260 Thiamin (vit b1 ) tab 50 mg TABLET 1030 1030 190 840 840
261 Thiamin (vit b1 ) inj 100 mg / ml - 1 ml VIAL 0 0 0 0
262 Thiamphenicol 500 mg TABLET 0 0 0 0
263 Tiamphenicol Syrup BOTOL 0 0 0 0
264 Tramadol 50 mg TABLET 0 0 0 0
265 Tramadol injeksi AMPUL 0 0 0 0
266 Urin Bag PCS 0 0 0 0
267 Vagizol Ovula SUPPO 0 0 0 0
268 Vitamin B kompleks tab TABLET 810 810 60 750 750
269 Vitamin B kompleks Inj VIAL 0 0 0 0
270 Vical Syrup BOTOL 0 0 0 0
271 Vitka infart injeksi VIAL 0 0 0 0
272 Xilomidon inj VIAL 0 0 0 0
273 Zinc 20 mg TABLET 0 0 0 0
274 Zirkum Zink syrup BOTOL 0 0 0 0
275 Yekamulvita TABLET 1920 1920 160 1760 1760
0 0 0 0
ALKES DAN BAHAN HABIS PAKAI 0 0 0 0
0 0 0 0
1 Abocath 18 PCS 92 92 0 92 92
2 Abocath 20 PCS 91 91 0 91 91
3 Abocath 22 PCS 90 90 2 88 88
4 Abocath 24 PCS 80 80 2 78 78
5 Abocath 26 PCS 90 90 2 88 88
6 Alkohol Swebs PCS 134 134 10 124 124
7 Bisturi 10 PCS 0 0 0 0
11 Blood lancets /Serenity PCS 0 0 0 0
12 Catgut Plain 2/0 ROOL 0 0 0 0
14 Catgut Cromic 2/0 ROOL 0 0 0 0
15 Catgot Cromic 3/0 ROOL 0 0 0 0
16 Cover Glass 20 x 20 BUAH 0 0 0 0
17 Catheter Aximed Suction zize 6 PCS 5 5 1 4 4
23 Drug Plastik ( Plastik Obat ) 8 x 5 cm PCS 0 0 0 0
24 Drug Plastik ( Plastik Obat ) 13 x 8, 7 cm PCS 0 0 0 0
25 H2O2 BOTOL 0 0 0 0
26 Holder Vacitainer PCS 0 0 0 0
27 Hipavix / Aximed 10 x 10 ROOL 35 35 0 35 35
29 Infusion set anak PCS 109 109 4 105 105
30 Infusion set Dewasa PCS 103 103 3 100 100
31 Intec ( Test KIT II ) PCS 0 0 0 0
32 Kapas 250 gr ROLL 2 2 0 2 2
33 Kapas berlemak 100 gr ROLL 0 0 0 0
34 Kasa Steril 16 /16 ROLL 0 0 0 0
35 Kasa 40 x 40 ROLL 0 0 0 0
36 Kasa pembalut 2 Y x 80 cm ROLL 0 0 0 0
37 Kasa pembalut hidrofil 4 m x 15 cmk ROLL 3 3 0 3 3
38 Kasa pembalut hidrofil 4 m x 3 cmk / 4x5 ROLL 14 14 0 14 14
39 Kasa Pembalut hidrofil 40 x 80 cm (roll besar) ROLL 1 1 0 1 1
40 Kantong Plastik ( Kresek ) PCS 0 0 0 0
41 Kertas puyer BKS 0 0 0 0
42 KOH 10% 100 ml BOTOL 0 0 0 0
43 Liqiud soap 500 ml BOTOL 0 0 0 0
44 Lampu Spritus 250 ml BOTOL 0 0 0 0
45 Masker elastis 3 lapis PCS 0 0 0 0
46 Masker Face Ear Loop PCS 156 156 10 146 146
47 Masker Face Ties On PCS 0 0 0 0
48 Methylen Blue 100 ml BOTOL 0 0 0 0
49 Micropipet 5-50 ml UNIT 0 0 0 0
50 Microskop Olympus CX-22 UNIT 0 0 0 0
51 My Jelly 80 gr BOTOL 0 0 0 0
52 NGT Bayi PCS 0 0 0 0
53 NGT Anak PCS 0 0 0 0
54 NGT Dewasa PCS 0 0 0 0
55 NACL 0,9 % 100 ml BOTOL 0 0 0 0
56 Objek Glass ( Merah ) PCS 0 0 0 0
57 Oli Emerson BOTOL 0 0 0 0
58 One Scrobs 500 ml ( Anti Septik ) BOTOL 0 0 0 0
59 Oncoproc ( Test KIT I ) PCS 0 0 0 0
60 Plester 5 yards x 2 inch, 2,5 cm x 4,5 ROOL 0 0 0 0
61 PH Paper BKS 0 0 0 0
62 RDT ( Test pemeriksaan Malaria ) PCS 0 0 0 0
63 RPR Antigen TEST 0 0 0 0
64 Silk 3/0, Silk Black 3/0 ROOL 0 0 0 0
65 Spekulum uk 5 ml @ 9 bh BUAH 0 0 0 0
66 Spritus 1 Liter BOTOL 0 0 0 0
67 Torniquet BUAH 0 0 0 0
68 Vacutainer Needle 226 BOX 0 0 0 0
69 Vaculab 3 ml BOX 0 0 0 0
70 Vikia ( Test KIT III ) TEST 0 0 0 0
71 Yellow tip BAG 0 0 0 0
72 Lactose Broth 500 gr ( Merck ) BOTOL 0 0 0 0
73 Sarung tangan no. 7 PCS 0 0 0 0
74 Sarung tangan / Serenity no. 7,5 PCS 0 0 0 0
76 Sarung Tangan 6,5 ( S ) PCS 0 0 0 0
77 Sarung Tangan ( M ) PCS 33 33 7 26 26
78 Sarung Tangan ( L ) PCS 0 0 0 0
79 Sarung Tangan Non Steril PCS 0 0 0 0
80 Sarung tangan gynaecology PCS 0 0 0 0
81 Silk (benang bedah sutra ) 2/0 SACHET 0 0 0 0
82 Silk Black / SILK Brade (benang bedah sutra ) 3/0 SACHET 0 0 0 0
83 Sterilone BOTOL 0 0 0 0
84 Spoit 0,5 ml PCS 0 0 0 0
85 Spoit 0,05 ml PCS 0 0 0 0
86 Spoit 1 ml PCS 0 0 0 0
89 Spoit 10 ml PCS 0 0 0 0
90 Spoit 50 ml PCS 0 0 0 0
91 Syphilis 3.0 PCS 0 0 0 0
92 Hexagon Syphilis PCS 0 0 0 0
93 BD. Microtainer TEST 0 0 0 0
94 TP Rapid SD Biolin Sypilis TEST 0 0 0 0
95 Hcl 0,1 N BOTOL 0 0 0 0 KIA / BIDAN
96 Transfusi Set PCS 0 0 0 0 KIA / BIDAN
97 Hanskun Panjang / Pendek Ksusus ibu bersalin PCS 0 0 0 0 KIA / BIDAN
98 Underpad PCS 0 0 0 0 KIA / BIDAN
99 Jelly BOTOL 0 0 0 0 KIA / BIDAN
100 Penjepit Tali Pusar Bayi PCS 0 0 0 0 KIA / BIDAN
101 Pampers XL PCS 0 0 0 0 KIA / BIDAN
102 Dopler BUAH 0 0 0 0 KIA / BIDAN
103 Kateter,6,8,10,12,14,16 PCS 0 0 0 0 KIA / BIDAN
104 Bidan Kit PCS 0 0 0 0 KIA / BIDAN
0 0 0 0
PERMINTAAN DOKTER 0 0 0 0
0 0 0 0
105 Mifacetin TABLET 0 0 0 0
106 Latobasilus / LBO TABLET 0 0 0 0
107 Fentolin / Kombifen BOTOL 0 0 0 0
108 Antrophen Inhalasi BOTOL 0 0 0 0
109 Paracetamol Suppo TABLET 0 0 0 0
110 Sampo Ketokonazole BOTOL 0 0 0 0
111 Ibuprofen Suppo TABLET 0 0 0 0
112 Stesolid Suppo TABLET 0 0 0 0
113 Pekak Sirup BOTOL 0 0 0 0
114 Salompas Spree PCS 0 0 0 0
115 Elastis Parban PCS 0 0 0 0
116 Cakang Kapul KAPSUL 0 0 0 0
117 Pott / Wadah Salep POTT 0 0 0 0
118 Kassa Kompres PCS 0 0 0 0
119 Elkana Sirup BOTOL 0 0 0 0
120 Proris Sirup BOTOL 0 0 0 0
121 Dulcolax Suppo TABLET 0 0 0 0
122 Armsling TABLET 0 0 0 0
123 PAPAN Bidai PCS 0 0 0 0
124 Kalium Diklopenat TABLET 0 0 0 0
125 Burnasin TUBE 0 0 0 0
126 Aloclair Jell BOTOL 0 0 0 0
127 Sukralfat TABLET 0 0 0 0
128 BloodCatget ROOL 0 0 0 0
129 Coromic Gat ROOL 0 0 0 0
130 Kanamicin VIAL 0 0 0 0
131 Furosemide INJeksi VIAL 0 0 0 0
132 Manitol BOTOL 0 0 0 0
134 Ciproloxacin Infus BOTOL 0 0 0 0
137 Curcuma TABLET 0 0 0 0
138 Curcuuma Sirup BOTOL 0 0 0 0
139 KAEN 3 A BOTOL 0 0 0 0
140 Wida ICN - 2 BOTOL 0 0 0 0
141 Faksin Anti Rabies AMPUL 0 0 0 0
142 Cefixime TABLET 0 0 0 0
144 Lisopronolol TABLET 0 0 0 0
146 Tandesartan TABLET 0 0 0 0
147 Gempibrozil TABLET 0 0 0 0
148 Brobenezit TABLET 0 0 0 0
149 Phenilbutasone TABLET 0 0 0 0
150 Amitriphilin TABLET 0 0 0 0
151 Fluoksetin TABLET 0 0 0 0
152 Gabapentin TABLET 0 0 0 0
153 Prazikuantel TABLET 0 0 0 0
154 Diklosamide TABLET 0 0 0 0
156 Tiamphenicol TABLET 0 0 0 0
158 Mupirozin Salep TUBE 0 0 0 0
159 Asambuzide TUBE 0 0 0 0
160 Etil Clorida BOTOL 0 0 0 0
161 Efgitrosite TABLET 0 0 0 0
162 Antidisteri TABLET 0 0 0 0
163 Pedialite BOTOL 0 0 0 0
UMUM
ASKES JUMLAH
0 0


NIP. NIP. 19660718 199312 2 002 ( ……………………………...……...……… )
( L P L P O )
KECAMATAN : Mubrani BULAN : Januari
KODE NAMA OBAT KET
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
3 Acyclovir / acifar tab 200 mg TABLET 200 200 20 180 180
4 Acyclovir 400 mg TABLET 400 400 40 360 360
5 Acytromicin 500 mg TABLET 0 0 0 0
6 Alkohol 70 % 100 ml BOTOL 5 5 1 4 4
8 Alkohol 70 % 1000 ml BOTOL 3 3 3 3
9 Allupurinol tab 100 mg TABLET 0 0 0 0
10 Allopurinol 300 mg TABLET 30 30 20 10 10
11 Amlodpin 5 mg TABLET 0 0 0 0
12 Amlodipin 10 mg TABLET 0 0 0 0
13 Ambroxol tab TABLET 960 960 70 890 890
14 Ambroxol Syrup BOTOL 2 2 1 1 1
15 Aminofilin inj 24 mg/ml- 10 ml AMPUL 0 0 0 0
16 Aminofilin tab 200 mg TABLET 0 0 0 0
18 Amoxysilin 500 mg TABLET 380 380 60 320 320
19 Amoxysilin syr kering 125mg/5ml / Ramoxyl BOTOL 0 0 0 0
20 Ampisilin syr kering 125 mg / 5 ml BOTOL 0 0 0 0
21 Ampisilin 500 mg TABLET 0 0 0 0
22 Ampisilin Inj 1 gr VIAL 0 0 0 0
23 Antalgin inj 2 ml / Benodon inj AMPUL 0 0 0 0
24 Antalgin tab 500 mg / Mitamisol Sodium TABLET 1520 1520 190 1330 1330
25 Antasid doen / lexacrool syrup BOTOL 13 13 2 11 11
26 Antasid doen tab TABLET 1930 1930 110 1820 1820
27 Anaria Syrup BOTOL 0 0 0 0
28 Anemolat / Folid Acid TABLET 0 0 0 0
29 Anuscopy PCS 0 0 0 0
30 Antihemoroid Supp SUPPO 0 0 0 0
31 Antoksid, Multivitamin CAPSUL 2780 2780 170 2610 2610
32 Aqua pro inj 20 ml VIAL 1 1 0 1 1
33 Artemeter inj AMPUL 0 0 0 0
34 Arterakin AMPUL 0 0 0 0
35 Artesunat inj AMPUL 0 0 0 0
36 Asifit kapsul Penambah ASI TABLET 0 0 0 0
37 Asam askorbat (vit c ) tab 50 mg TABLET 2720 2720 190 2530 2530
38 Asam mefenamat / Molasic 500 mg TABLET 0 0 0 0
39 Atropina sulfat inj 0.25 mg/ml- 1ml AMPUL 0 0 0 0
40 Atropina sulfat (atropina) tab. 0,5 mg TABLET 0 0 0 0
41 ATS inj 1500 Unit VIAL 0 0 0 0
42 Asetosal 100 mg / Gramasal TABLET 470 470 50 420 420
43 Asetosal 500 mg / Gramasal 500 mg TABLET 0 0 0 0
44 Albendazol tab TABLET 0 0 0 0
45 Baby Cough sirup BOTOL 0 0 0 0
46 Bacytracin Cream TUBE 0 0 0 0
47 Becefort KAPSUL 0 0 0 0
50 Betason - N crem / Nasagon cream TUBE 0 0 0 0
51 Betametason crem 0,1 % TUBE 3 3 1 2 2
52 Berotec 10 ml Inj VIAL 0 0 0 0
53 Biovision KAPSUL 0 0 0 0
54 Biosave Inj ( Anti bisa ular ) VIAL 0 0 0 0
55 Biosat Inj ( Serum Anti Tetanus ) VIAL 0 0 0 0
56 Bisacodil / Laxana TABLET 0 0 0 0
57 Bioplacenton cream TUBE 0 0 0 0
58 Buscopan TABLET 0 0 0 0
59 Captopril 12,5 mg TABLET 110 110 40 70 70
60 Captopril 25 TABLET 1480 1480 40 1440 1440
61 Calsidol syrup BOTOL 0 0 0 0
62 Capivlex KAPSUL 0 0 0 0
63 Cefadroxil 500 mg pharmaxil KAPSUL 0 0 0 0
64 Cefadroxil Syrup BOTOL 0 0 0 0
65 Cefotaxim inj VIAL 0 0 0 0
66 Ceftriaxon inj VIAL 0 0 0 0
67 Cefixime / Pharmafix Sirup BOTOL 0 0 0 0
68 Ceterizine / Pritacort TABLET 0 0 0 0
69 Ceterizine Syrup BOTOL 0 0 0 0
70 Cerebrovit X-Cell KAPSUL 0 0 0 0
71 Chinin antipirin inj AMPUL 0 0 0 0
72 Chloramfenikol Tetes Telinga / Erlamicetin BOTOL 0 0 0 0
73 Cianokobalamina (vit b 12) TABLET 0 0 0 0
74 Cianokobalamina (vit b 12) inj AMPUL 0 0 0 0
75 Cimetidine tab TABLET 1650 1650 110 1540 1540
77 Ciprofloxacin 500 mg TABLET 1030 1030 100 930 930
78 Codein 10 mg tab TABLET 0 0 0 0
79 Chlorfeniramine Maleat ( ctm ) tab 4 mg TABLET 0 0 0 0
80 Cotrimoksazole syr BOTOL 3 3 1 2 2
81 Cotrimoksazole 120 mg TABLET 0 0 0 0
82 Cotrimoksazole tab 480 mg TABLET 0 0 0 0
83 CO-Amoxiclav 625 mg tab TABLET 0 0 0 0
86 Combantrin syrup BOTOL 0 0 0 0
87 Chloroquin 250 mg tab TABLET 0 0 0 0
88 Cooton Butt PCS 0 0 0 0
89 Clorampenicol salep Mata TUBE 0 0 0 0 0
90 Clorampenicol Syrup BOTOL 0 0 0 0
91 Cloramphenicol 250 mg KAPSUL 0 0 0 0
92 Curcuma FC / Groucall Sirup BOTOL 0 0 0 0
93 Chloramfecort crem TUBE 0 0 0 0
94 Deksametason inj AMPUL 5 5 2 3 3
95 Deksametason / Molacort tab 0,5 mg / 0,7 mg TABLET 840 840 60 780 780
96 Dekstrometrophan syr BOTOL 0 0 0 0
97 Dekstrometrophan tab 15 mg TABLET 0 0 0 0
98 Deladril inj / Adidryl inj VIAL 0 0 0 0
99 Dextrose 40 % BOTOL 0 0 0 0
100 Dextral TABLET 0 0 0 0
101 Dextral Sirup BOTOL 0 0 0 0
103 Diasepam inj (stesolid inj) AMPUL 96 96 0 96 96
104 Diasepam tab 2 mg TABLET 0 0 0 0
105 Dietilkarbamazin (DEC) 100 mg tab TABLET 0 0 0 0
106 Difenhidramin inj AMPUL 44 44 0 44 44
107 DHP/Obat Anti Malaria TABLET 0 0 0 0
108 Dasabiaon, Ramabio / Mirabion TABLET 100 100 30 70 70
109 Daryantulle PCS 0 0 0 0
110 DGLB MECRK 0,5 kg BOTOL 0 0 0 0
111 Domperidon tab TABLET 700 700 60 640 640
112 Domperidon Syrup BOTOL 3 3 2 1 1
113 Dulcolax Suppo 5 ml SUPPO 0 0 0 0
114 Dulcolax TABLET 0 0 0 0
115 Efedrin tab 25 mg TABLET 0 0 0 0
116 Epinefrin hcl (adrenalin) AMPUL 0 0 0 0
117 Etambutol 500 mg TABLET 920 920 0 920 920
118 Ethyl klorida semprot BOTOL 0 0 0 0
119 Erytromicin Syrup BOTOL 0 0 0 0
120 Erytromicin 125 mg tab TABLET 50 50 20 30 30
121 Eritromicin 500 mg TABLET 0 0 0 0
122 Fenol gliserol tetes telinga BOTOL 0 0 0 0
123 Fitomenadion (vit K 1) inj 10 mg/ml-1ml AMPUL 0 0 0 0
124 Fitomenadion (vit K 1) tab 10 mg TABLET 0 0 0 0
125 Fituno TABLET 0 0 0 0
126 Furosemid tab 40 mg TABLET 610 610 90 520 520
129 Garam oralit untuk 200 ml air SACHET 122 122 16 106 106
130 Gentian violet larutan 1 % BOTOL 18 18 8 10 10
131 Gentamicine cream / Gentalex TUBE 0 0 0 0
132 Gentamicine salep mata TUBE 0 0 0 0
133 Gentamicin Tetes Mata / Genoint BOTOL 2 2 1 1 1
134 Gentamicine inj AMPUL 82 82 3 79 79
135 TABLET
Gliseril guayakolat tab 100 mg / Guaifenesin 310 310 60 250 250
136 Glibenclamide 5 mg TABLET 730 730 110 620 620
140 Griseovulvin tab 25 mg TABLET 1310 1310 120 1190 1190
141 Hidroklorotiazid (HCT) tablet 25 mg TABLET 1700 1700 100 1600 1600
142 Hidrokortison crem 2,5 % TUBE 0 0 0 0
143 Hustab tab 500 mg TABLET 0 0 0 0
144 Horvita G TABLET 0 0 0 0
145 Ibuprofen 200 mg TABLET 1870 1870 140 1730 1730
146 Ibuprofen 400 mg / Lexaprofen TABLET 0 0 0 0
147 Ibuprofen Syrup BOTOL 3 3 0 3 3
148 Iodium povidon 30 ml BOTOL 2 2 0 2 2
151 Iodium povidon 1 liter BOTOL 0 0 0 0
152 Ichtiol salap POTT 0 0 0 0
155 Kalsiumlaktat (kalk) Tab 500 mg TABLET 0 0 0 0
156 Ketoconazole TABLET 560 560 70 490 490
157 Ketoconazole Cream TUBE 0 0 0 0
158 Kina DHCL (kina) inj 25 % 2 ml AMPUL 0 0 0 0
159 Kina / Quinine 200 mg / 222 mg TABLET 0 0 0 0
160 KN 3B Larutan Infus BOTOL 14 14 1 13 13
161 Komb Sulfadoksin 500 mg + Pyrimetamin 25 mg TABLET 0 0 0 0
162 Komplax Sirup BOTOL 0 0 0 0
163 Lidokain comp inj 2 % AMPUL 0 0 0 0
164 Lisol lart BOTOL 0 0 0 0
165 Lifron B pleks TABLET 0 0 0 0
166 Loratadin TABLET 0 0 0 0
167 Levertran (Minyak ikan salap) POTT 0 0 0 0
168 Mebendazol tab 100 mg TABLET 0 0 0 0
169 Metilergometrin inj (Miomergin inj) AMPUL 8 8 0 8 8
170 Metilergometrin tab TABLET 900 900 0 900 900
171 Methoclopramide inj (Etiferan inj) AMPUL 0 0 0 0
172 Metochlopramide tab TABLET 0 0 0 0
173 Metochlopramide / Primpen Syrup BOTOL 0 0 0 0
174 Metronidazol tab 250 mg TABLET 0 0 0 0
175 Metronidazol tab 500 mg / Ragilforta TABLET 0 0 0 0
176 Methisoprinol 500 mg TABLET 0 0 0 0
177 Methisoprinol Syr 250 ml BOTOL 0 0 0 0
178 Methyilprednisolon 4 mg / Grasolon 8 mg TABLET 0 0 0 0
179 Metformin 500 mg KAPSUL 0 0 0 0
180 Meloxicam 7,5 mg TABLET 0 0 0 0
181 Meloxicam 15 mg TABLET 0 0 0 0
182 Mineral mix SACHET 0 0 0 0
183 Miconazole cream TUBE 0 0 0 0
184 MGSO4 BOTOL 0 0 0 0
185 Natrium diklofenat / Diclofam 50 mg TABLET 30 30 20 10 10
186 NaCl larutan infus 0,9 % ( Larutan Infus ) BOTOL 83 83 9 74 74
187 New Antides TABLET 0 0 0 0
188 Nifedipine tab TABLET 0 0 0 0
189 Nistatin 100 000 Iu/g tab faginal TABLET 0 0 0 0
190 Nistatin tab TABLET 0 0 0 0
191 Novabion KAPSUL 0 0 0 0
192 Norit POTT 0 0 0 0
193 OBH syr BOTOL 0 0 0 0
194 Oksitetrasiklin inj (Oksibiotic inj) AMPUL 0 0 0 0
195 Oksitetrasiklin salap kulit 3 % TUBE 0 0 0 0
196 Oksitetrasiklin salap mata 1 % TUBE 0 0 0 0
197 Oksitosin inj / Pytogin AMPUL 0 0 0 0
198 OAT Kategori Anak KAPSUL 0 0 0 0
199 OAT Kategori I KAPSUL 0 0 0 0
200 OAT Kategori II KAPSUL 0 0 0 0
201 Omeprazole 20 mg KAPSUL 0 0 0 0
202 Padonil TABLET 0 0 0 0
203 Papaferin inj AMPUL 0 0 0 0
204 Papaferin hcl 40 mg / tab TABLET 0 0 0 0
205 TABLET 680 680 90 590 590
Alphamol
206 Paracetamol / Cetamol sirup 120 mg/ 5 ml BOTOL 16 16 5 11 11
207 Paracetamol Infus BOTOL 28 28 1 27 27
208 Pacetik BP syrup BOTOL 1 1 1 0 0
209 Prokaine Benzil Penicilin 3 jt IU BOTOL 0 0 0 0
210 Prokain penisilin inj 3 jt BOTOL 0 0 0 0
211 Penobarbital inj 50 mg /ml- 2ml AMPUL 0 0 0 0
212 Penobarbital tab 30 mg TABLET 230 230 0 230 230
213 Phenilbutason TABLET 0 0 0 0
214 Pehamoksil Forte 500 mg TABLET 0 0 0 0
215 Pehatifen TABLET 0 0 0 0
216 Pehavral KAPSUL 0 0 0 0
217 Piridoksin hcl Injeksi AMPUL 0 0 0 0
218 Piridoksin hcl (vit b6) tab 10 mg TABLET 0 0 0 0
219 Piroxicam / Triadene 20 mg KAPSUL 1080 1080 150 930 930
220 Pyrazinamide 500 mg TABLET 0 0 0 0
221 Prednison tab 5 mg, TABLET 840 840 80 760 760
222 Primaquin tab 15 mg TABLET 0 0 0 0
223 Propanolol TABLET 0 0 0 0
224 PTU 100 mg tab TABLET 0 0 0 0
225 Pirantel tab 125 mg TABLET 0 0 0 0
226 Pirantel tab 125 mg / sirup BOTOL 0 0 0 0
227 PK serbuk POTT 228 228 21 207 207
230 Ranitidin inj AMPUL 0 0 0 0
231 Ranitidin / Yekardin 150 mg TABLET 0 0 0 0
232 Retinol (vit A) kapsul lunak 200 000 Iu merah BOTOL 55 55 10 45 45
233 Retinol (vit A) kapsul lunak 100 000 Iu biru BOTOL 55 55 10 45 45
234 Rifampisin Kaplet 600 mg KAPSUL 0 0 0 0
235 Rifampisin kapsul 450 mg KAPSUL 0 0 0 0
236 Ringers laktat larutan infus BOTOL 6 6 1 5 5
239 Salbutamol 2 mg TABLET 790 790 20 770 770
241 Salbutamol Syrup BOTOL 0 0 0 0
242 Salep 2-4 ( Anti Fungi ) POTT 74 74 4 70 70
243 Salisil talk bedak 25 POTT 0 0 0 0
244 Salisil spirtus 10 % BOTOL 0 0 0 0
245 Scot's Emulsion Syrup / Revital Vit. Anak BOTOL 0 0 0 0
247 Simvastatin 20 mg TABLET 240 240 30 210 210
248 Stiek Asam Urat BOTOL 6 6 2 4 4
249 Stiek Asam Colesterol BOTOL 0 0 0 0
250 Stiek Gula Darah BOTOL 0 0 0 0
251 Streptomisin inj 1 gr VIAL 0 0 0 0
252 Sulfa ferosus tab TABLET 0 0 0 0
253 Sangobion kids syr BOTOL 0 0 0 0
254 Tablet Tambah Darah TABLET 0 0 0 0
257 Tespack PCS 0 0 0 0
258 Tensocrope 7,5 cm x 4,5 m ROLL 0 0 0 0
259 Tensocrope 15 cm x 4,5 m ROLL 0 0 0 0
260 Thiamin (vit b1 ) tab 50 mg TABLET 1200 1200 170 1030 1030
261 Thiamin (vit b1 ) inj 100 mg / ml - 1 ml VIAL 0 0 0 0
262 Thiamphenicol 500 mg TABLET 0 0 0 0
263 Tiamphenicol Syrup BOTOL 0 0 0 0
264 Tramadol 50 mg TABLET 0 0 0 0
265 Tramadol injeksi AMPUL 0 0 0 0
266 Urin Bag PCS 0 0 0 0
267 Vagizol Ovula SUPPO 0 0 0 0
268 Vitamin B kompleks tab TABLET 860 860 50 810 810
269 Vitamin B kompleks Inj VIAL 0 0 0 0
270 Vical Syrup BOTOL 0 0 0 0
271 Vitka infart injeksi VIAL 0 0 0 0
272 Xilomidon inj VIAL 0 0 0 0
273 Zinc 20 mg TABLET 0 0 0 0
274 Zirkum Zink syrup BOTOL 0 0 0 0
275 Yekamulvita TABLET 2090 2090 170 1920 1920
0 0 0 0
ALKES DAN BAHAN HABIS PAKAI 0 0 0 0
0 0 0 0
1 Abocath 18 PCS 92 92 0 92 92
2 Abocath 20 PCS 91 91 0 91 91
3 Abocath 22 PCS 91 91 1 90 90
4 Abocath 24 PCS 81 81 1 80 80
5 Abocath 26 PCS 91 91 1 90 90
6 Alkohol Swebs PCS 144 144 10 134 134
11 Blood lancets /Serenity PCS 0 0 0 0
14 Catgut Cromic 2/0 ROOL 0 0 0 0
15 Catgot Cromic 3/0 ROOL 0 0 0 0
16 Cover Glass 20 x 20 BUAH 0 0 0 0
23 Drug Plastik ( Plastik Obat ) 8 x 5 cm PCS 0 0 0 0
24 Drug Plastik ( Plastik Obat ) 13 x 8, 7 cm PCS 0 0 0 0
25 H2O2 BOTOL 0 0 0 0
26 Holder Vacitainer PCS 0 0 0 0
29 Infusion set anak PCS 109 109 0 109 109
30 Infusion set Dewasa PCS 103 103 0 103 103
31 Intec ( Test KIT II ) PCS 0 0 0 0
32 Kapas 250 gr ROLL 2 2 0 2 2
33 Kapas berlemak 100 gr ROLL 0 0 0 0
34 Kasa Steril 16 /16 ROLL 0 0 0 0
35 Kasa 40 x 40 ROLL 0 0 0 0
36 Kasa pembalut 2 Y x 80 cm ROLL 0 0 0 0
37 Kasa pembalut hidrofil 4 m x 15 cmk ROLL 3 3 0 3 3
38 Kasa pembalut hidrofil 4 m x 3 cmk / 4x5 ROLL 14 14 0 14 14
39 Kasa Pembalut hidrofil 40 x 80 cm (roll besar) ROLL 1 1 0 1 1
40 Kantong Plastik ( Kresek ) PCS 0 0 0 0
41 Kertas puyer BKS 0 0 0 0
42 KOH 10% 100 ml BOTOL 0 0 0 0
43 Liqiud soap 500 ml BOTOL 0 0 0 0
44 Lampu Spritus 250 ml BOTOL 0 0 0 0
45 Masker elastis 3 lapis PCS 0 0 0 0
46 Masker Face Ear Loop PCS 164 164 8 156 156
47 Masker Face Ties On PCS 0 0 0 0
48 Methylen Blue 100 ml BOTOL 0 0 0 0
49 Micropipet 5-50 ml UNIT 0 0 0 0
50 Microskop Olympus CX-22 UNIT 0 0 0 0
51 My Jelly 80 gr BOTOL 0 0 0 0
52 NGT Bayi PCS 0 0 0 0
53 NGT Anak PCS 0 0 0 0
54 NGT Dewasa PCS 0 0 0 0
55 NACL 0,9 % 100 ml BOTOL 0 0 0 0
56 Objek Glass ( Merah ) PCS 0 0 0 0
57 Oli Emerson BOTOL 0 0 0 0
58 One Scrobs 500 ml ( Anti Septik ) BOTOL 0 0 0 0
59 Oncoproc ( Test KIT I ) PCS 0 0 0 0
60 Plester 5 yards x 2 inch, 2,5 cm x 4,5 ROOL 0 0 0 0
61 PH Paper BKS 0 0 0 0
62 RDT ( Test pemeriksaan Malaria ) PCS 0 0 0 0
63 RPR Antigen TEST 0 0 0 0
64 Silk 3/0, Silk Black 3/0 ROOL 0 0 0 0
65 Spekulum uk 5 ml @ 9 bh BUAH 0 0 0 0
66 Spritus 1 Liter BOTOL 0 0 0 0
67 Torniquet BUAH 0 0 0 0
68 Vacutainer Needle 226 BOX 0 0 0 0
69 Vaculab 3 ml BOX 0 0 0 0
70 Vikia ( Test KIT III ) TEST 0 0 0 0
71 Yellow tip BAG 0 0 0 0
72 Lactose Broth 500 gr ( Merck ) BOTOL 0 0 0 0
74 Sarung tangan / Serenity no. 7,5 PCS 0 0 0 0
76 Sarung Tangan 6,5 ( S ) PCS 0 0 0 0
77 Sarung Tangan ( M ) PCS 38 38 5 33 33
78 Sarung Tangan ( L ) PCS 0 0 0 0
79 Sarung Tangan Non Steril PCS 0 0 0 0
80 Sarung tangan gynaecology PCS 0 0 0 0
81 Silk (benang bedah sutra ) 2/0 SACHET 0 0 0 0
82 Silk Black / SILK Brade (benang bedah sutra ) 3/0 SACHET 0 0 0 0
83 Sterilone BOTOL 0 0 0 0
84 Spoit 0,5 ml PCS 0 0 0 0
85 Spoit 0,05 ml PCS 0 0 0 0
89 Spoit 10 ml PCS 0 0 0 0
90 Spoit 50 ml PCS 0 0 0 0
91 Syphilis 3.0 PCS 0 0 0 0
92 Hexagon Syphilis PCS 0 0 0 0
93 BD. Microtainer TEST 0 0 0 0
94 TP Rapid SD Biolin Sypilis TEST 0 0 0 0
95 Hcl 0,1 N BOTOL 0 0 0 0 KIA / BIDAN
96 Transfusi Set PCS 0 0 0 0 KIA / BIDAN
97 Hanskun Panjang / Pendek Ksusus ibu bersalin PCS 0 0 0 0 KIA / BIDAN
98 Underpad PCS 0 0 0 0 KIA / BIDAN
99 Jelly BOTOL 0 0 0 0 KIA / BIDAN
100 Penjepit Tali Pusar Bayi PCS 0 0 0 0 KIA / BIDAN
101 Pampers XL PCS 0 0 0 0 KIA / BIDAN
102 Dopler BUAH 0 0 0 0 KIA / BIDAN
103 Kateter,6,8,10,12,14,16 PCS 0 0 0 0 KIA / BIDAN
104 Bidan Kit PCS 0 0 0 0 KIA / BIDAN
0 0 0 0
PERMINTAAN DOKTER 0 0 0 0
0 0 0 0
105 Mifacetin TABLET 0 0 0 0
106 Latobasilus / LBO TABLET 0 0 0 0
107 Fentolin / Kombifen BOTOL 0 0 0 0
108 Antrophen Inhalasi BOTOL 0 0 0 0
109 Paracetamol Suppo TABLET 0 0 0 0
110 Sampo Ketokonazole BOTOL 0 0 0 0
111 Ibuprofen Suppo TABLET 0 0 0 0
112 Stesolid Suppo TABLET 0 0 0 0
113 Pekak Sirup BOTOL 0 0 0 0
114 Salompas Spree PCS 0 0 0 0
115 Elastis Parban PCS 0 0 0 0
116 Cakang Kapul KAPSUL 0 0 0 0
117 Pott / Wadah Salep POTT 0 0 0 0
118 Kassa Kompres PCS 0 0 0 0
119 Elkana Sirup BOTOL 0 0 0 0
120 Proris Sirup BOTOL 0 0 0 0
121 Dulcolax Suppo TABLET 0 0 0 0
122 Armsling TABLET 0 0 0 0
123 PAPAN Bidai PCS 0 0 0 0
124 Kalium Diklopenat TABLET 0 0 0 0
125 Burnasin TUBE 0 0 0 0
126 Aloclair Jell BOTOL 0 0 0 0
127 Sukralfat TABLET 0 0 0 0
128 BloodCatget ROOL 0 0 0 0
129 Coromic Gat ROOL 0 0 0 0
130 Kanamicin VIAL 0 0 0 0
131 Furosemide INJeksi VIAL 0 0 0 0
132 Manitol BOTOL 0 0 0 0
134 Ciproloxacin Infus BOTOL 0 0 0 0
137 Curcuma TABLET 0 0 0 0
138 Curcuuma Sirup BOTOL 0 0 0 0
139 KAEN 3 A BOTOL 0 0 0 0
140 Wida ICN - 2 BOTOL 0 0 0 0
141 Faksin Anti Rabies AMPUL 0 0 0 0
142 Cefixime TABLET 0 0 0 0
144 Lisopronolol TABLET 0 0 0 0
146 Tandesartan TABLET 0 0 0 0
147 Gempibrozil TABLET 0 0 0 0
148 Brobenezit TABLET 0 0 0 0
149 Phenilbutasone TABLET 0 0 0 0
150 Amitriphilin TABLET 0 0 0 0
151 Fluoksetin TABLET 0 0 0 0
152 Gabapentin TABLET 0 0 0 0
153 Prazikuantel TABLET 0 0 0 0
154 Diklosamide TABLET 0 0 0 0
156 Tiamphenicol TABLET 0 0 0 0
158 Mupirozin Salep TUBE 0 0 0 0
159 Asambuzide TUBE 0 0 0 0
160 Etil Clorida BOTOL 0 0 0 0
161 Efgitrosite TABLET 0 0 0 0
162 Antidisteri TABLET 0 0 0 0
163 Pedialite BOTOL 0 0 0 0
UMUM
ASKES JUMLAH
0 0


NIP. NIP. 19660718 199312 2 002 ( ……………………………...……...……… )
( L P L P O )
KECAMATAN : Mubrani BULAN : Desember
KODE NAMA OBAT KET
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
31 Antoksid, Multivitamin CAPSUL 2,910 2,910 130 2780
37 Asam askorbat (vit c ) tab 50 mg TABLET 2,890 2,890 170 2720
102 Desinfektan 1000 ml BOTOL 1 1 1
135 TABLET
145 Ibuprofen 200 mg TABLET 1,980 1,980 110 1870
205 TABLET 740 740 60 680
Alphamol
219 Piroxicam / Triadene 20 mg KAPSUL 1,210 1,210 130 1080
227 PK serbuk POTT 245 245 17 228
260 Thiamin (vit b1 ) tab 50 mg TABLET 1,340 1,340 140 1200
275 Yekamulvita TABLET 2,250 2,250 160 2090
0 0 0
0 0 0
1 Abocath 18 PCS 92 92 0 92
2 Abocath 20 PCS 91 91 0 91
3 Abocath 22 PCS 92 92 1 91
4 Abocath 24 PCS 82 82 1 81
5 Abocath 26 PCS 91 91 0 91
25 H2O2 BOTOL 0 0 0
32 Kapas 250 gr ROLL 2 2 0 2
35 Kasa 40 x 40 ROLL 0 0 0
42 KOH 10% 100 ml BOTOL 0 0 0
55 NACL 0,9 % 100 ml BOTOL 0 0 0
85 Spoit 0,05 ml PCS 0 0 0
0 0 0
0 0 0
UMUM
ASKES JUMLAH
0 0


NIP. NIP. 19660718 199312 2 002 ( ……………………………...……...……… )
( L P L P O )
KECAMATAN : Mubrani BULAN : November
KODE NAMA OBAT KET
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
25 Antasid doen / lexacrool syrup BOTOL 15 15 15
32 Aqua pro inj 20 ml VIAL 1 1 1
51 Betametason crem 0,1 % TUBE 3 3 3
102 Desinfektan 1000 ml BOTOL 1 1 1
133 Gentamicin Tetes Mata / Genoint BOTOL 2 2 2
135 TABLET
205 TABLET 830 830 90 740
Alphamol
208 Pacetik BP syrup BOTOL 3 3 3
227 PK serbuk POTT 257 257 12 245
232 Retinol (vit A) kapsul lunak 200 000 Iu merah BOTOL 70 70 70
233 Retinol (vit A) kapsul lunak 100 000 Iu biru BOTOL 70 70 70
0 0 0
0 0 0
1 Abocath 18 PCS 94 94 2 92
2 Abocath 20 PCS 93 93 2 91
3 Abocath 22 PCS 94 94 2 92
4 Abocath 24 PCS 84 84 2 82
5 Abocath 26 PCS 93 93 2 91
25 H2O2 BOTOL 0 0 0
32 Kapas 250 gr ROLL 2 2 0 2
35 Kasa 40 x 40 ROLL 0 0 0
42 KOH 10% 100 ml BOTOL 0 0 0
55 NACL 0,9 % 100 ml BOTOL 0 0 0
78 Sarung Tangan ( L ) PCS 0
79 Sarung Tangan Non Steril PCS 0
80 Sarung tangan gynaecology PCS 0
81 Silk (benang bedah sutra ) 2/0 SACHET 0
82 Silk Black / SILK Brade (benang bedah sutra ) 3/0 SACHET 0
83 Sterilone BOTOL 0
84 Spoit 0,5 ml PCS 0
85 Spoit 0,05 ml PCS 0
86 Spoit 1 ml PCS 0
87 Spoit 3 ml PCS 0
88 Spoit 5 ml PCS 0
89 Spoit 10 ml PCS 0
90 Spoit 50 ml PCS 0
91 Syphilis 3.0 PCS 0
92 Hexagon Syphilis PCS 0
93 BD. Microtainer TEST 0
94 TP Rapid SD Biolin Sypilis TEST 0
95 Hcl 0,1 N BOTOL 0 KIA / BIDAN
96 Transfusi Set PCS 0 KIA / BIDAN
97 Hanskun Panjang / Pendek Ksusus ibu bersalin PCS 0 KIA / BIDAN
98 Underpad PCS 0 KIA / BIDAN
99 Jelly BOTOL 0 KIA / BIDAN
100 Penjepit Tali Pusar Bayi PCS 0 KIA / BIDAN
101 Pampers XL PCS 0 KIA / BIDAN
102 Dopler BUAH 0 KIA / BIDAN
103 Kateter,6,8,10,12,14,16 PCS 0 KIA / BIDAN
104 Bidan Kit PCS 0 KIA / BIDAN
0
PERMINTAAN DOKTER 0
0
105 Mifacetin TABLET 0
106 Latobasilus / LBO TABLET 0
107 Fentolin / Kombifen BOTOL 0
108 Antrophen Inhalasi BOTOL 0
109 Paracetamol Suppo TABLET 0
110 Sampo Ketokonazole BOTOL 0
111 Ibuprofen Suppo TABLET 0
112 Stesolid Suppo TABLET 0
113 Pekak Sirup BOTOL 0
114 Salompas Spree PCS 0
115 Elastis Parban PCS 0
116 Cakang Kapul KAPSUL 0
117 Pott / Wadah Salep POTT 0
118 Kassa Kompres PCS 0
119 Elkana Sirup BOTOL 0
120 Proris Sirup BOTOL 0
121 Dulcolax Suppo TABLET 0
122 Armsling TABLET 0
123 PAPAN Bidai PCS 0
124 Kalium Diklopenat TABLET 0
125 Burnasin TUBE 0
126 Aloclair Jell BOTOL 0
127 Sukralfat TABLET 0
128 BloodCatget ROOL 0
129 Coromic Gat ROOL 0
130 Kanamicin VIAL 0
131 Furosemide INJeksi VIAL 0
132 Manitol BOTOL 0
133 Paracetamol Infus BOTOL 0
134 Ciproloxacin Infus BOTOL 0
135 Glimepirid 2 mg TABLET 0
137 Curcuma TABLET 0
138 Curcuuma Sirup BOTOL 0
139 KAEN 3 A BOTOL 0
140 Wida ICN - 2 BOTOL 0
141 Faksin Anti Rabies AMPUL 0
142 Cefixime TABLET 0
144 Lisopronolol TABLET 0
146 Tandesartan TABLET 0
147 Gempibrozil TABLET 0
148 Brobenezit TABLET 0
149 Phenilbutasone TABLET 0
150 Amitriphilin TABLET 0
151 Fluoksetin TABLET 0
152 Gabapentin TABLET 0
153 Prazikuantel TABLET 0
154 Diklosamide TABLET 0
156 Tiamphenicol TABLET 0
158 Mupirozin Salep TUBE 0
159 Asambuzide TUBE 0
160 Etil Clorida BOTOL 0
161 Efgitrosite TABLET 0
162 Antidisteri TABLET 0
163 Pedialite BOTOL 0
UMUM
ASKES JUMLAH
0 0


NIP. NIP. 19660718 199312 2 002 ( ……………………………...……...……… )
( L P L P O )
KECAMATAN : Mubrani BULAN : Oktober
KODE NAMA OBAT KET
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
5 Acytromicin 500 mg TABLET 0
7 Alkohol 70 % 300 ml BOTOL 0
8 Alkohol 70 % 1000 ml BOTOL 4 4 1 3
9 Allupurinol tab 100 mg TABLET 0
11 Amlodpin 5 mg TABLET 0
12 Amlodipin 10 mg TABLET 0
15 Aminofilin inj 24 mg/ml- 10 ml AMPUL 0
16 Aminofilin tab 200 mg TABLET 0
17 Amoxysilin 250 mg TABLET 0
19 Amoxysilin syr kering 125mg/5ml / Ramoxyl BOTOL 0
20 Ampisilin syr kering 125 mg / 5 ml BOTOL 0
21 Ampisilin 500 mg TABLET 0
22 Ampisilin Inj 1 gr VIAL 0
23 Antalgin inj 2 ml / Benodon inj AMPUL 0
27 Anaria Syrup BOTOL 0
28 Anemolat / Folid Acid TABLET 0
29 Anuscopy PCS 0
30 Antihemoroid Supp SUPPO 0
33 Artemeter inj AMPUL 0
34 Arterakin AMPUL 0
35 Artesunat inj AMPUL 0
36 Asifit kapsul Penambah ASI TABLET 0
38 Asam mefenamat / Molasic 500 mg TABLET 0
39 Atropina sulfat inj 0.25 mg/ml- 1ml AMPUL 0
40 Atropina sulfat (atropina) tab. 0,5 mg TABLET 0
41 ATS inj 1500 Unit VIAL 0
43 Asetosal 500 mg / Gramasal 500 mg TABLET 0
44 Albendazol tab TABLET 0
45 Baby Cough sirup BOTOL 0
46 Bacytracin Cream TUBE 0
47 Becefort KAPSUL 0
48 Benzatin benzil Penisilina Inj 1,2 jt VIAL 0
49 Benzatin benzil Penisilina Inj 2,4 jt VIAL 0
50 Betason - N crem / Nasagon cream TUBE 0
52 Berotec 10 ml Inj VIAL 0
53 Biovision KAPSUL 0
54 Biosave Inj ( Anti bisa ular ) VIAL 0
55 Biosat Inj ( Serum Anti Tetanus ) VIAL 0
56 Bisacodil / Laxana TABLET 0
57 Bioplacenton cream TUBE 0
58 Buscopan TABLET 0
61 Calsidol syrup BOTOL 0
62 Capivlex KAPSUL 0
63 Cefadroxil 500 mg pharmaxil KAPSUL 0
64 Cefadroxil Syrup BOTOL 0
65 Cefotaxim inj VIAL 0
66 Ceftriaxon inj VIAL 0
67 Cefixime / Pharmafix Sirup BOTOL 0
68 Ceterizine / Pritacort TABLET 0
69 Ceterizine Syrup BOTOL 0
70 Cerebrovit X-Cell KAPSUL 0
71 Chinin antipirin inj AMPUL 0
72 Chloramfenikol Tetes Telinga / Erlamicetin BOTOL 0
73 Cianokobalamina (vit b 12) TABLET 0
74 Cianokobalamina (vit b 12) inj AMPUL 0
76 Ciprofloxacin 250 mg TABLET 0
78 Codein 10 mg tab TABLET 0
79 Chlorfeniramine Maleat ( ctm ) tab 4 mg TABLET 0
81 Cotrimoksazole 120 mg TABLET 0
82 Cotrimoksazole tab 480 mg TABLET 0
83 CO-Amoxiclav 625 mg tab TABLET 0
84 Combantrin 150 mg TABLET 0
85 Combantrin 250 mg TABLET 0
86 Combantrin syrup BOTOL 0
87 Chloroquin 250 mg tab TABLET 0
88 Cooton Butt PCS 0
90 Clorampenicol Syrup BOTOL 0
91 Cloramphenicol 250 mg KAPSUL 0
92 Curcuma FC / Groucall Sirup BOTOL 0
93 Chloramfecort crem TUBE 0
96 Dekstrometrophan syr BOTOL 0
97 Dekstrometrophan tab 15 mg TABLET 0
98 Deladril inj / Adidryl inj VIAL 0
99 Dextrose 40 % BOTOL 0
100 Dextral TABLET 0
101 Dextral Sirup BOTOL 0
104 Diasepam tab 2 mg TABLET 0
105 Dietilkarbamazin (DEC) 100 mg tab TABLET 0
107 DHP/Obat Anti Malaria TABLET 0
109 Daryantulle PCS 0
110 DGLB MECRK 0,5 kg BOTOL 0
113 Dulcolax Suppo 5 ml SUPPO 0
114 Dulcolax TABLET 0
115 Efedrin tab 25 mg TABLET 0
116 Epinefrin hcl (adrenalin) AMPUL 0
118 Ethyl klorida semprot BOTOL 0
119 Erytromicin Syrup BOTOL 0
121 Eritromicin 500 mg TABLET 0
122 Fenol gliserol tetes telinga BOTOL 0
123 Fitomenadion (vit K 1) inj 10 mg/ml-1ml AMPUL 0
124 Fitomenadion (vit K 1) tab 10 mg TABLET 0
125 Fituno TABLET 0
127 Fenoksimetil Penisilin tab 250 mg TABLET 0
128 Fenoksimetil Penisilin tab 500 mg TABLET 0
131 Gentamicine cream / Gentalex TUBE 0
132 Gentamicine salep mata TUBE 0
135 TABLET
137 Glimepirid 4 mg TABLET 0
142 Hidrokortison crem 2,5 % TUBE 0
143 Hustab tab 500 mg TABLET 0
144 Horvita G TABLET 0
146 Ibuprofen 400 mg / Lexaprofen TABLET 0
149 Iodium povidon 60 ml BOTOL 0
150 Iodium povidon 300 ml BOTOL 0
151 Iodium povidon 1 liter BOTOL 0
152 Ichtiol salap POTT 0
153 Isoniasid ( Inh ) tab 100 mg TABLET 0
154 Isoniasid ( Inh ) tab 300 mg TABLET 0
155 Kalsiumlaktat (kalk) Tab 500 mg TABLET 0
157 Ketoconazole Cream TUBE 0
158 Kina DHCL (kina) inj 25 % 2 ml AMPUL 0
159 Kina / Quinine 200 mg / 222 mg TABLET 0
161 Komb Sulfadoksin 500 mg + Pyrimetamin 25 mg TABLET 0
162 Komplax Sirup BOTOL 0
163 Lidokain comp inj 2 % AMPUL 0
164 Lisol lart BOTOL 0
165 Lifron B pleks TABLET 0
166 Loratadin TABLET 0
167 Levertran (Minyak ikan salap) POTT 0
168 Mebendazol tab 100 mg TABLET 0
171 Methoclopramide inj (Etiferan inj) AMPUL 0
172 Metochlopramide tab TABLET 0
173 Metochlopramide / Primpen Syrup BOTOL 0
174 Metronidazol tab 250 mg TABLET 0
175 Metronidazol tab 500 mg / Ragilforta TABLET 0
176 Methisoprinol 500 mg TABLET 0
177 Methisoprinol Syr 250 ml BOTOL 0
178 Methyilprednisolon 4 mg / Grasolon 8 mg TABLET 0
179 Metformin 500 mg KAPSUL 0
180 Meloxicam 7,5 mg TABLET 0
181 Meloxicam 15 mg TABLET 0
182 Mineral mix SACHET 0
183 Miconazole cream TUBE 0
184 MGSO4 BOTOL 0
187 New Antides TABLET 0
188 Nifedipine tab TABLET 0
189 Nistatin 100 000 Iu/g tab faginal TABLET 0
190 Nistatin tab TABLET 0
191 Novabion KAPSUL 0
192 Norit POTT 0
193 OBH syr BOTOL 0
194 Oksitetrasiklin inj (Oksibiotic inj) AMPUL 0
195 Oksitetrasiklin salap kulit 3 % TUBE 0
196 Oksitetrasiklin salap mata 1 % TUBE 0
197 Oksitosin inj / Pytogin AMPUL 0
198 OAT Kategori Anak KAPSUL 0
199 OAT Kategori I KAPSUL 0
200 OAT Kategori II KAPSUL 0
201 Omeprazole 20 mg KAPSUL 0
202 Padonil TABLET 0
203 Papaferin inj AMPUL 0
204 Papaferin hcl 40 mg / tab TABLET 0
205 TABLET 1050 1050 220 830
Alphamol
209 Prokaine Benzil Penicilin 3 jt IU BOTOL 0
210 Prokain penisilin inj 3 jt BOTOL 0
211 Penobarbital inj 50 mg /ml- 2ml AMPUL 0
213 Phenilbutason TABLET 0
214 Pehamoksil Forte 500 mg TABLET 0
215 Pehatifen TABLET 0
216 Pehavral KAPSUL 0
217 Piridoksin hcl Injeksi AMPUL 0
218 Piridoksin hcl (vit b6) tab 10 mg TABLET 0
220 Pyrazinamide 500 mg TABLET 0
222 Primaquin tab 15 mg TABLET 0
223 Propanolol TABLET 0
224 PTU 100 mg tab TABLET 0
225 Pirantel tab 125 mg TABLET 0
226 Pirantel tab 125 mg / sirup BOTOL 0
227 PK serbuk POTT 278 278 21 257
228 Rivanol 300 ml BOTOL 0
229 Rivanol 100 ml BOTOL 0
230 Ranitidin inj AMPUL 0
231 Ranitidin / Yekardin 150 mg TABLET 0
234 Rifampisin Kaplet 600 mg KAPSUL 0
235 Rifampisin kapsul 450 mg KAPSUL 0
237 Reserpin tab 0, 10 mg TABLET 0
238 Reserpin tab 0, 25 mg TABLET 0
240 Salbutamol 4 mg TABLET 0
241 Salbutamol Syrup BOTOL 0
243 Salisil talk bedak 25 POTT 0
244 Salisil spirtus 10 % BOTOL 0
245 Scot's Emulsion Syrup / Revital Vit. Anak BOTOL 0
246 Simvastatin 10 mg TABLET 0
251 Streptomisin inj 1 gr VIAL 0
252 Sulfa ferosus tab TABLET 0
253 Sangobion kids syr BOTOL 0
254 Tablet Tambah Darah TABLET 0
257 Tespack PCS 0
258 Tensocrope 7,5 cm x 4,5 m ROLL 0
259 Tensocrope 15 cm x 4,5 m ROLL 0
261 Thiamin (vit b1 ) inj 100 mg / ml - 1 ml VIAL 0
262 Thiamphenicol 500 mg TABLET 0
263 Tiamphenicol Syrup BOTOL 0
264 Tramadol 50 mg TABLET 0
265 Tramadol injeksi AMPUL 0
266 Urin Bag PCS 0
267 Vagizol Ovula SUPPO 0
269 Vitamin B kompleks Inj VIAL 0
270 Vical Syrup BOTOL 0
271 Vitka infart injeksi VIAL 0
272 Xilomidon inj VIAL 0
273 Zinc 20 mg TABLET 0
274 Zirkum Zink syrup BOTOL 0
0
ALKES DAN BAHAN HABIS PAKAI 0
0
1 Abocath 18 PCS 99 99 5 94
2 Abocath 20 PCS 98 98 5 93
3 Abocath 22 PCS 99 99 5 94
4 Abocath 24 PCS 89 89 5 84
5 Abocath 26 PCS 98 98 5 93
7 Bisturi 10 PCS 0
8 Bisturi 12 PCS 0
9 Bisturi 15 PCS 0
10 Bisturi 20 PCS 0
11 Blood lancets /Serenity PCS 0
12 Catgut Plain 2/0 ROOL 0
13 Catgut Plain 3/0 ROOL 0
14 Catgut Cromic 2/0 ROOL 0
15 Catgot Cromic 3/0 ROOL 0
16 Cover Glass 20 x 20 BUAH 0
22 Catheter Aximed Suction zize 16 PCS 0
23 Drug Plastik ( Plastik Obat ) 8 x 5 cm PCS 0
24 Drug Plastik ( Plastik Obat ) 13 x 8, 7 cm PCS 0
25 H2O2 BOTOL 0
26 Holder Vacitainer PCS 0
31 Intec ( Test KIT II ) PCS 0
32 Kapas 250 gr ROLL 2 2 0 2
33 Kapas berlemak 100 gr ROLL 0
34 Kasa Steril 16 /16 ROLL 0
35 Kasa 40 x 40 ROLL 0
36 Kasa pembalut 2 Y x 80 cm ROLL 0
40 Kantong Plastik ( Kresek ) PCS 0
41 Kertas puyer BKS 0
42 KOH 10% 100 ml BOTOL 0
43 Liqiud soap 500 ml BOTOL 0
44 Lampu Spritus 250 ml BOTOL 0
45 Masker elastis 3 lapis PCS 0
47 Masker Face Ties On PCS 0
48 Methylen Blue 100 ml BOTOL 0
49 Micropipet 5-50 ml UNIT 0
50 Microskop Olympus CX-22 UNIT 0
51 My Jelly 80 gr BOTOL 0
52 NGT Bayi PCS 0
53 NGT Anak PCS 0
54 NGT Dewasa PCS 0
55 NACL 0,9 % 100 ml BOTOL 0
56 Objek Glass ( Merah ) PCS 0
57 Oli Emerson BOTOL 0
58 One Scrobs 500 ml ( Anti Septik ) BOTOL 0
59 Oncoproc ( Test KIT I ) PCS 0
60 Plester 5 yards x 2 inch, 2,5 cm x 4,5 ROOL 0
61 PH Paper BKS 0
62 RDT ( Test pemeriksaan Malaria ) PCS 0
63 RPR Antigen TEST 0
64 Silk 3/0, Silk Black 3/0 ROOL 0
65 Spekulum uk 5 ml @ 9 bh BUAH 0
66 Spritus 1 Liter BOTOL 0
67 Torniquet BUAH 0
68 Vacutainer Needle 226 BOX 0
69 Vaculab 3 ml BOX 0
70 Vikia ( Test KIT III ) TEST 0
71 Yellow tip BAG 0
72 Lactose Broth 500 gr ( Merck ) BOTOL 0
73 Sarung tangan no. 7 PCS 0
74 Sarung tangan / Serenity no. 7,5 PCS 0
75 Sarung tangan no. 8 PCS 0
76 Sarung Tangan 6,5 ( S ) PCS 0
78 Sarung Tangan ( L ) PCS
79 Sarung Tangan Non Steril PCS
80 Sarung tangan gynaecology PCS
81 Silk (benang bedah sutra ) 2/0 SACHET
82 Silk Black / SILK Brade (benang bedah sutra ) 3/0 SACHET
83 Sterilone BOTOL
84 Spoit 0,5 ml PCS
85 Spoit 0,05 ml PCS
86 Spoit 1 ml PCS
87 Spoit 3 ml PCS
88 Spoit 5 ml PCS
89 Spoit 10 ml PCS
90 Spoit 50 ml PCS
91 Syphilis 3.0 PCS
92 Hexagon Syphilis PCS
93 BD. Microtainer TEST
94 TP Rapid SD Biolin Sypilis TEST
95 Hcl 0,1 N BOTOL KIA / BIDAN
96 Transfusi Set PCS KIA / BIDAN
97 Hanskun Panjang / Pendek Ksusus ibu bersalin PCS KIA / BIDAN
98 Underpad PCS KIA / BIDAN
99 Jelly BOTOL KIA / BIDAN
100 Penjepit Tali Pusar Bayi PCS KIA / BIDAN
101 Pampers XL PCS KIA / BIDAN
102 Dopler BUAH KIA / BIDAN
103 Kateter,6,8,10,12,14,16 PCS KIA / BIDAN
104 Bidan Kit PCS KIA / BIDAN
PERMINTAAN DOKTER
105 Mifacetin TABLET

106 Latobasilus / LBO TABLET
107 Fentolin / Kombifen BOTOL
108 Antrophen Inhalasi BOTOL
109 Paracetamol Suppo TABLET
110 Sampo Ketokonazole BOTOL
111 Ibuprofen Suppo TABLET
112 Stesolid Suppo TABLET
113 Pekak Sirup BOTOL
114 Salompas Spree PCS
115 Elastis Parban PCS
116 Cakang Kapul KAPSUL
117 Pott / Wadah Salep POTT
118 Kassa Kompres PCS
119 Elkana Sirup BOTOL
120 Proris Sirup BOTOL
121 Dulcolax Suppo TABLET
122 Armsling TABLET
123 PAPAN Bidai PCS
124 Kalium Diklopenat TABLET
125 Burnasin TUBE
126 Aloclair Jell BOTOL
127 Sukralfat TABLET
128 BloodCatget ROOL
129 Coromic Gat ROOL
130 Kanamicin VIAL
131 Furosemide INJeksi VIAL
132 Manitol BOTOL
133 Paracetamol Infus BOTOL
134 Ciproloxacin Infus BOTOL
135 Glimepirid 2 mg TABLET
137 Curcuma TABLET
138 Curcuuma Sirup BOTOL
139 KAEN 3 A BOTOL
140 Wida ICN - 2 BOTOL
141 Faksin Anti Rabies AMPUL
142 Cefixime TABLET
144 Lisopronolol TABLET
146 Tandesartan TABLET
147 Gempibrozil TABLET
148 Brobenezit TABLET
149 Phenilbutasone TABLET
150 Amitriphilin TABLET
151 Fluoksetin TABLET
152 Gabapentin TABLET
153 Prazikuantel TABLET
154 Diklosamide TABLET
156 Tiamphenicol TABLET
158 Mupirozin Salep TUBE
159 Asambuzide TUBE
160 Etil Clorida BOTOL
161 Efgitrosite TABLET
162 Antidisteri TABLET
163 Pedialite BOTOL
UMUM
ASKES JUMLAH
0 0


NIP. NIP. 19660718 199312 2 002 ( ……………………………...……...……… )

Fom. LPLPO FARMASI

Diunggah oleh

Informasi Dokumen

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

Fom. LPLPO FARMASI

Diunggah oleh

Hak Cipta:

Format Tersedia

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

Mengetahui/Menyetujui Yang menyerahkan Yang Meminta Yang menerima

( ……………………………………………..) ( ……………………………...……...……… ) ( Atorina Ajmabani, Amd.Keb )

Mengetahui/Menyetujui Yang menyerahkan Yang Meminta Yang menerima

( ……………………………………………..) ( ……………………………...……...……… ) ( Atorina Ajmabani, Amd.Keb )

Mengetahui/Menyetujui Yang menyerahkan Yang Meminta Yang menerima

( ……………………………………………..) ( ……………………………...……...……… ) ( Atorina Ajmabani, Amd.Keb )

Mengetahui/Menyetujui Yang menyerahkan Yang Meminta Yang menerima

( ……………………………………………..) ( ……………………………...……...……… ) ( Atorina Ajmabani, Amd.Keb )

Mengetahui/Menyetujui Yang menyerahkan Yang Meminta Yang menerima

( ……………………………………………..) ( ……………………………...……...……… ) ( Atorina Ajmabani, Amd.Keb )

Mengetahui/Menyetujui Yang menyerahkan Yang Meminta Yang menerima

( ……………………………………………..) ( ……………………………...……...……… ) ( Atorina Ajmabani, Amd.Keb )

Mengetahui/Menyetujui Yang menyerahkan Yang Meminta Yang menerima

( ……………………………………………..) ( ……………………………...……...……… ) ( Atorina Ajmabani, Amd.Keb )

Mengetahui/Menyetujui Yang menyerahkan Yang Meminta Yang menerima

( ……………………………………………..) ( ……………………………...……...……… ) ( Atorina Ajmabani, Amd.Keb )

Mengetahui/Menyetujui Yang menyerahkan Yang Meminta Yang menerima

( ……………………………………………..) ( ……………………………...……...……… ) ( Atorina Ajmabani, Amd.Keb )

Mengetahui/Menyetujui Yang menyerahkan Yang Meminta Yang menerima

( ……………………………………………..) ( ……………………………...……...……… ) ( Atorina Ajmabani, Amd.Keb )

Mengetahui/Menyetujui Yang menyerahkan Yang Meminta Yang menerima

( ……………………………………………..) ( ……………………………...……...……… ) ( Atorina Ajmabani, Amd.Keb )

Mengetahui/Menyetujui Yang menyerahkan Yang Meminta Yang menerima

( ……………………………………………..) ( ……………………………...……...……… ) ( Atorina Ajmabani, Amd.Keb )

Mengetahui/Menyetujui Yang menyerahkan Yang Meminta Yang menerima

( ……………………………………………..) ( ……………………………...……...……… ) ( Atorina Ajmabani, Amd.Keb )

Mengetahui/Menyetujui Yang menyerahkan Yang Meminta Yang menerima

( ……………………………………………..) ( ……………………………...……...……… ) ( Atorina Ajmabani, Amd.Keb )

105 Mifacetin TABLET

Mengetahui/Menyetujui Yang menyerahkan Yang Meminta Yang menerima

( ……………………………………………..) ( ……………………………...……...……… ) ( Atorina Ajmabani, Amd.Keb )

Anda mungkin juga menyukai