LAPO

PUSKESMAS PELAPORAN
KECAMATAN : JOHAR BARU PERMINTAAN
KAB/KOTA :JAKARTA PUSAT
PROPINSI : DKI JAKARTA

KODE STOK AWAL PENERIMAAN

NO OBAT NAMA OBAT SATUAN JUNI 2021 JUNI 2021
1 2 3 4 5

1 A.B.U. I (khusus ular dari luar Papua) inj (i.m./i.v.) vial 0

2 A.B.U.II (khusus ular dari Papua) inj (i.m./i.v.) vial 0
3 Air untuk injeksi amp 25 mL ampul 0
4 Albendazol tab 400 mg tablet 0
5 Albendazol susp 200 mg/5 mL botol 0
6 Alopurinol tab 100 mg tablet 52900
7 Alopurinol tab 300 mg tablet 2000
8 Amilorid tab 5 mg tablet 0
9 Aminofilin tab 150 mg tablet 0
10 Aminofilin tab 200 mg tablet 0
11 Aminofilin inj 24 mg/mL vial 0 60
tablet
12 Amitriptilin tab sal 25 mg salut 0
13 Amlodipin tab sal 5 mg tablet 34800 239400
14 Amlodipin tab 10 mg tablet 90600 466200
15 Amoksisilin tab 500 mg tablet 141900
16 Amoksisilin sir forte 250 mg/5 mL botol 0
17 Ampisilin serb inj 1000 mg/vial vial 0
18 Ampisilin serb inj 250 mg/vial vial 0
Anestetik lokal gigi kombinasi : lidokain HCl
vial
19 2% + epinefrin 1 : 80.000 inj 2 mL 0
Antasida, kombinasi : aluminium hidroksida 200 tablet
20 mg + magnesium hidroksida 200 mg kunyah 68000 60000
Antasida, kombinasi :aluminium hidroksida 200
botol
21 mg + magnesium hidroksida 200 mg 0
Antifungi salep, kombinasi : asam benzoat 6%
tube
22 + asam salisilat 3% 744
Antihemoroid, kombinasi: bismut subgalat 150
mg + heksaklorofen 2,5 mg + lidokain 10 mg + supp
23 seng oksida 120 mg, sup ad 2 g 260 100
Antimalaria kombinasi : sulfadoksin 500 mg +
kapsul
24 pirimetamin 25 mg 0
 Antiparkinson kombinasi : benserazid 25 mg +
25 levodopa 100 mg kapsul 0
26 Artemether inj 80 mg/mL vial 0
27 Artesunat serb inj 60 mg/mL (i.v./i.m.) vial 0

kertas
warna
penanda
28 Articulating paper oklusi 0
29 Asam asetilsalisilat (asetosal) tab 80 mg tablet 3900
30 Asam askorbat (vitamin C) tab 50 mg tablet 73200 10000
31 Asam askorbat (vitamin C) tab 250 mg tablet 0
32 Asam folat tab 0,4 mg tablet 0
33 Asam folat tab 1 mg tablet 1600 40000
34 Asam folat tab 5 mg tablet 0 40000
35 Asam mefenamat kaps 250 kapsul 0
36 Asam mefenamat kaps 500 kapsul 42100
37 Asam salisilat 5% salep 0
38 Asam salisilat 0,1% larutan 0
39 Asiklovir tab 200 mg tablet 3500
40 Asiklovir tab 400 mg tablet 41350
41 Atapulgit tablet 12900
42 Atenolol tab 50 mg tablet 0
43 Atropin tab 0,5 mg tablet 0 100
44 Atropin inj 0,25 mg/mL (i.v./i.m./s.k.) vial 0
45 Bahan tumpatan sementara lar, serb botol 0
46 Bedak salisil serb 2% serbuk 1236
47 Benzatin penisilin inj 1,2 juta UI/mL (i.m.) vial 0
48 Benzatin penisilin inj 2,4 juta UI/mL (i.m.) vial 0
49 Betametason krim 0,5 mg/g krim 400
50 Betametason tts mata 1 mg/mL botol 0
Bisakodil sup 10 mg tab salut
51 0
52 Bisakodil sup 5 mg supp 600
53 Bisakodil tab salut 5 mg supp 4790
54 Coal tar lar 5 % botol 0
Copper T set/buah
55 0
tab
Dapson tab scored 100 mg
56 scored 0
57 Deksametason inj 5 mg/mL (i.v./i.m.) vial 40 5000
58 Deksametason tab 0,5 mg tablet 54429
59 Diazepam inj 5 mg/mL (i.v./i.m.) vial 4
Diazepam lar rektal 10 mg/2,5 mL lar rektal
60 35
Diazepam lar rektal 5 mg/2,5 mL lar rektal
61 35 4
 62 Diazepam tab 2 mg tablet 2389
63 Diazepam tab 5 mg tablet 0
64 Dietilkarbamazin tab 100 mg tablet 0
65 Difenhidramin inj 10 mg/mL (i.v./i.m.) vial 0
66 Digoksin tab 0,25 mg tablet 0
67 Diltiazem HCl tab 30 mg tablet 0
68 Dimenhidrinat tab 50 mg tablet 0
69 Doksisiklin kaps 100 mg kapsul 0
70 Domperidon tab 10 mg tablet 29400
71 Epinefrin (adrenalin) inj 0,1% (i.v./s.k./i.m.) ampul 0
72 Epinefrin (adrenalin) inj 1 mg/mL ampul 7
73 Ergokalsiferol (vitamin D2) kaps 50.000 UI kapsul 0
74 Ergokalsiferol (vitamin D2) susp 10.000 UI/mL botol 0
75 Ergotamin tab 1 mg tablet 0
76 Eritromisin kaps 250 mg kapsul 0
77 Eritromisin sir 200 mg/5 mL botol 0
78 Etambutol tab 250 mg tablet 0
79 Etambutol tab 400 mg tablet 0
80 Etambutol tab 500 mg tablet 0
81 Etanol botol 70% botol 0
82 Etil klorida semprot 100 mL botol 0
83 Etonogestrel implan 68 mg implan 0
84 Eugenol botol 0
85 Fenitoin Na kaps 50 mg kapsul 0
86 Fenitoin Na kaps 100 mg kapsul 0
87 Fenitoin Na inj 100 mg/2 ampul 0
88 Fenitoin Na inj 50 mg/mL ampul 0
89 Fenobarbital tab 30 mg tablet 0
90 Fenobarbital tab 100 mg tablet 0
Fenoksimetil penisilin (penisilin V) tab 250 mg tablet
91 0
Fenoksimetil penisilin (penisilin V) tab 500 mg tablet
92 0
Fenoksimetil penisilin (penisilin V) serb inj 3
vial
93 juta UI/vial (i.m.) 0
kaps.
Ferro fumarat kaps lunak 300 mg
94 Lunak 0
tablet
Ferro sulfat tab salut 300 mg
95 salut 0
96 Ferro sulfat sir. 15 mg/5 mL botol 0
tab.
Fitomenadion (vitamin K 1) tab sal 10 mg
97 Salut 4100
Fitomenadion (vitamin K 1) inj 2 mg/mL (i.m.) vial
98 50
99 Fluor tab 0,5 mg tablet 0
100 Fluor kapl 1 mg kapsul 0
101 Fluor sediaan topikal tube 0
102 Fluoresein tts mata 2,5 mg/mL botol 0
103 Formokresol botol 0
104 Furosemid tab 40 mg tablet 0
105 Furosemid inj 10 mg/mL (i.v./i.m.) ampul 0
Galactose microparticle200- 400 mg
gel
106 micropart/mL 0
Garam oralit kombinasi : natrium klorida 0,52 g
+ kalium klorida 0,30 g + trinatrium sitrat
sachet
dihidrat 0,58 g+ glukosa anhidrat 2,7 g serbuk
107 untuk 200 ml air 30225
Glass ionomer ART (Atraumatic Restorative
sachet
108 Treatment) 0
Glass ionomer ART (Atraumatic Restorative
botol
109 Treatment) 0
Glass ionomer ART (Atraumatic Restorative cocoa
110 Treatment) cocoa butter 5 g butter 0
111 Glibenklamid tab 2,5 mg tablet 0
112 Glibenklamid tab 5 mg tablet 4100 15000
113 Glimepirid tab 1 mg tablet 0
114 Glimepirid tab 2 mg tablet 2100
115 Glipizid tab 5 mg tablet 0
tablet
Gliseril trinitrat tab sublingual 0,5 mg
116 sub. 0
117 Gliserin tts 10 mg/mL botol 0
118 Gliserin tts 100 mg/mL botol 0
119 Griseofulvin (micronized ) tab 125 mg tablet 3500 1500
tablet
Griseofulvin (micronized ) tab scored 250 mg
120 score 0
121 Gutta percha dan paper points 15 - 40 mm roll 0
122 Gutta percha dan paper points 45 - 80 mm roll 0
123 Haloperidol tab 0,5 mg tablet 0
124 Haloperidol tab 1,5 mg tablet 3000
125 Haloperidol tab 2 mg tablet 0 3500
126 Haloperidol tab 5 mg tablet 0
127 Haloperidol tts 2 mg/mL botol 0
128 Haloperidol inj 5 mg/mL (i.m.) vial 0
Hepatitis B imunoglobulin (human) inj 0,5 mL vial
129 0
130 Hidrogen peroksida botol 3% botol 10
131 Hidrogen peroksida lar. konsentrat 3% botol 0
132 Hidroklorotiazid tab 25 mg tablet 5000 500
133 Hidrokortison serb inj 100 mg/vial vial 0
134 Hidrokortison krim 2,5% krim 1368
135 Hiosina butilbromida tab 10 mg tablet 1700
 Human tetanus imunoglobulin inj 250 UI(i.m) vial
136 0
Human tetanus imunoglobulin inj 500 UI (i.m.) vial
137 0
138 Ibuprofen tab 200 mg tablet 9500
139 Ibuprofen tab 400 mg tablet 7600
140 Ibuprofen sir 100 mg/5 mL botol 300
141 Ibuprofen sir 200 mg/5 mL botol 0
142 Ipratropium bromida ih padat 20 mg botol 0
143 Ipratropium bromida nebulizer 0,025% botol 0
144 Isoniazid tab 100 mg tablet 0
145 Isoniazid tab 300 mg tablet 0
146 Isosorbid dinitrat tab 5 mg tablet 2100
147 Kalamin botol 0
148 Kalsium glukonat inj 100 mg/mL ampul 0
149 Kalsium hidroksida pasta 0
150 Kalsium karbonat tab 500 mg tablet 0
151 Kalsium laktat (kalk) tab 500 mg tablet 51300 100000
152 Kaptopril tab 12,5 mg tablet 24000
153 Kaptopril tab 25 mg tablet 32000
154 Karbamazepin tab 200 mg tablet 0
155 Karbamazepin sir 100 mg/5 mL botol 0
156 Karbo adsorben tab 0,5 g tablet 0
157 Karbogliserin tts telinga 10 % botol 384
158 Ketamin inj 50 mg/mL ampul 0
159 Ketamin inj 100 mg/mL (i.v.) ampul 0
160 Ketokonazol tab 200 mg tablet 3200
161 Klofazimin, micronizedkaps 100 mg kapsul 0
162 Kloramfenikol kaps 250 mg kapsil 0
163 Kloramfenikol susp 125 mg/5 mL botol 0
164 Kloramfenikol salep kulit 2% pot 480
165 Kloramfenikol tts mata 0,5% botol 0
166 Kloramfenikol tts mata 1% botol 75
167 Kloramfenikol salep mata 1% pot 48
168 Klorfeniramin maleat tab 4 mg tablet 591200 15000
169 Klorfenol kamfer mentol (CHKM) botol 0
170 Klorheksidin lar 15% botol 0
171 Klorheksidin lar 0,2% botol 0
tablet
Klorpromazin tab sal 25 mg
172 salut 0
tablet
Klorpromazin tab sal 100 mg
173 salut 2500
174 Klorpromazin inj 5 mg/mL (i.m.) vial 0
175 Klorpromazin inj 25 mg/mL vial (i.m.) vial 0
176 Klortalidon tab 50 mg tablet 0
177 Kodein tab 10 mg tablet 0
178 Kodein tab 20 mg tablet 0
Kombinasi untuk anak : Paduan dalam bentuk
dosis tetap (KDT/FDC) Rifampisin kaplet 75 mg Paket
179 + isoniazid tablet 50 mg 0
kombinasi (kombipak) : artesunat tab 50 mg +
Tablet
180 amodiakuin tab 200 mg 0
kombinasi : tablet salut ferro sulfat 200 mg + Tablet
181 asam folat 0,25 mg salut 269700
Kombinasi : artemeter 20 mg + lumefantrin 120
Tablet
182 mg 0

kombinasi untuk anak : (Paduan dalam bentuk

Kombipak) Rifampisin kaplet 75 mg + isoniazid Paket
tablet 100 mg + pirazinamid tablet 200 mg
183 0
kombinasi untuk anak : (Paduan dalam bentuk
kombipak) Rifampicin kaplet75 mg + isoniazid
tablet
100 mg
184 Paket 0
Kombinasi untuk anak : Paduan dalam bentuk
dosis tetap (KDT/FDC) Rifampisin kaplet 75 mg
+ isoniazid tablet 50 mg + pirazinamid tablet
185 150 mg Paket 0
Kombinasi untuk dewasa : Paduan dalam
bentuk kombipak Rifampisin kaplet 450 mg +
186 isoniazid tablet 300 mg Paket 0

kombinasi untuk dewasa: (Paduan

dalam bentuk Kombipak) Rifampisin
kaplet 450 mg + isoniazid tablet 300
mg + pirazinamid tablet 500 mg +
etambutol tablet 250 mg dan 500 mg
187 Paket 0
kombinasi untuk dewasa: Paduan dalam
bentuk dosis tetap (KDT/FDC) Rifampisin
kaplet 150 mg + isoniazid tablet 75 mg +
pirazinamid tablet 400 mg + etambutol tablet
188 275 mg Paket 0

kombinasi untuk dewasa: Paduan dalam bentuk

dosis tetap (KDT/FDC) Rifampisin kaplet 150 mg + Paket
189 isoniazid tablet 150 mg 0
190 Kombinasi: kaolin 550 mg + pektin 20 mg tablet 47500
kombinasi: ipratropium Br 0,5 mg + salbutamol 2,5
191 mg botol 0
192 Komposit resin set 0
 Kontrasepsi oral kombinasi tablet : levonorgestrel
193 150 mcg + etinilestradiol 30 mcg tablet 0
Kotrimoksazol 240 mg : sulfametoksazol 200 mg +
194 trimetoprim 40 mg botol 150
Kotrimoksazol (dewasa) 480 mg : sulfametoksazol
195 400 mg + trimetoprim 80 tablet 5700

Kotrimoksazol forte kombinasi 960 mg:

196 sulfametoksazol 800 mg + trimetoprim 160 mg tablet 0
197 Kuinin tab 200 mg tablet 0
198 Kuinin tab 222 mg tablet 0
199 Kuinin tab 250 mg tablet 0
200 Kuinin inj 25% (i.v.) vial 0

201 Levonorgestrel implan 2 rods, 75 mg (3-4 tahun) implan 0

202 Lidokain inj 1 % (infltr) ampul 0
203 Lidokain inj 2% (infiltr/p.v.) ampul 600
204 Lidokain gel 2% gel 0
205 Lidokain semprot 10% botol 0
206 Lidokain pasta 5% (HCl) tube 0
207 Lidokain semprot 15% (HCl) botol 0
208 Loratadin tab 10 mg tablet 37900
209 Lugol botol 0
210 Magnesium sulfat serb, ktg 30 g sachet 0
211 Magnesium sulfat inj 20% ampul 35 10
212 Magnesium sulfat inj 40% ampul 0
213 Mebendazol tab 100 mg tablet 0
214 Mebendazol tab 500 mg tablet 0
215 Mebendazol sir 50 mg/mL botol 0
Medroksi progesteron asetat inj depo 150 mg vial
216 0
Metenamin mandelat (heksamin mandelat) tab tablet
217 salut enterik 500 mg salut 0
218 Metformin tab 500 mg tablet 100100 100000
219 Metformin tab 850 mg tablet 0
220 Metilergometrin tab salut 0,125 mg tablet 0
221 Metilergometrin inj 0,2 mg/Ml ampul 0
222 Metoklopramid tab 5 mg tablet 0
223 Metoklopramid tab 10 mg tablet 0
224 Metronidazol tab 250 mg tablet 0
225 Metronidazol tab 500 mg tablet 1900
226 Metronidazol sir 125 mg/5 mL botol 0
227 Metronidazol lar inf 5 mg/mL botol 0
228 Metronidazol ovula 500 mg supp 0
229 Mikonazol serb 2% vial 0
230 Mikonazol krim 2% krim 1704
231 Natrium bikarbonat tab 500 mg tablet 0
232 Natrium diklofenak tab 25 mg tablet 24000
tab 50
233 Natrium diklofenak tab 50 mg mg 0
234 Natrium hipoklorit botol konsentrat 5% botol 0
235 Natrium tiosulfat inj 25% (i.v.) vial 0
236 Nifedipin kaps 10 mg kapsul 3800
237 Nikotinamid tab 5 mg tablet 0
238 Nikotinamid tab 20 mg tabet 0
239 Nikotinamid tab 100 mg tablet 0
tablet
240 Nistatin tab salut 500.000 UI salut 0
241 Nistatin susp 100.000 UI/mL botol 0
242 Nistatin tab vaginal 100.000 UI/tab supp 1400
243 Nitrofurantoin tab 50 mg tablet 0
244 Norepinefrin inj 1 mg/mL ampul 0
245 Oksigen ih, gas dlm tabung botl 0
246 Oksimetazolin tts hidung 0,025% botol 0
247 Oksimetazolin tts hidung 0,05% botol 0
248 Oksitosin inj 10 UI/mL ampul 0
249 Olopatadin tts mata 0,1% botol 0
250 Omeprazol kaps 20 mg kapsul 42120
251 Omeprazol inj 40 mg/10 mL ampul 0
252 Paraformaldehid tab 1 g tablet 0
253 Parasetamol tab 500 mg tablet 60100 150000
254 Parasetamol sir 120 mg/5 mL botol 13241
255 Parasetamol tts 60 mg/0,6 mL botol 1380
256 Pasta devitalisasi (non arsen) tube 0
257 Pasta pengisi saluran akar tube 0
258 Perak nitrat lar 20% botol 0
259 Perak sulfadiazin krim 1% pot 0
260 Permetrin krim 5 % pot 79
tablet
261 Pirantel pamoat tab scored 125 mg score 0
tablet
262 Pirantel pamoat tab scored 250 mg score 0
263 Pirantel pamoat tab 500 mg tablet 0
264 Pirantel pamoat susp 125 mg/5 mL botol 0
265 Pirazinamid tab 500 mg tablet 0
266 Piridoksin (vitamin B6) tab 10 mg tablet 12900
267 Piridoksin (vitamin B6) tab 25 mg tablet 0
268 Piridoksin (vitamin B6) inj 100 mg/mL ampul 0
269 Povidon iodin lar 100 mg/mL botol 0
 tablet
Prazikuantel tab scored 300 mg
270 score 0
tablet
Prazikuantel tab scored 600 mg
271 score 0
272 Prednison 5 mg tablet 3200
273 Primakuin 15 mg tablet 0
274 Probenesid 500 mg tablet 0
275 Prokain benzilpenisilin inj 1 juta UI/vial (i.m.) vial 0
Prokain benzilpenisilin serb inj 3 juta UI/vial
vial
276 (i.m.) 0
277 Propiltiourasil 100 mg tablet 0
278 propranolol 10 mg tablet 0
279 Ranitidin 150 mg tablet 43000 40000
kapsul
Retinol (vitamin A) kaps lunak 100.000 UI
280 lunak 0
kaps
Retinol (vitamin A) kaps lunak 200.000 UI
281 lunak 0 212
282 Rifampisin 300 mg kapsul 0
283 Salbutamol 2 mg tablet 0
284 Salbutamol 4 mg tablet 10500
285 Salbutamol lar ih 0,5 % botol 160
286 Salbutamol botol ih 0,1% botol 0
Salep 2-4, kombinasi : asam salisilat 2% + belerang tube
287 endap 4% 0
288 Serum antidifteri (A.D.S) i.m 10.000 UI/vial vial 0
289 Serum antidifteri (A.D.S) i.m 20.000 UI/vial vial 0
290 Serum antirabies inj 200 UI/mL vial 0
291 Serum antirabies inj100 UI/mL vial 0
Serum antitetanus (A.T.S) inj 1500 UI/amp
ampul
292 (i.m.) 0
Serum antitetanus (A.T.S) inj 10.000 UI/vial
vial
293 (i.m /i.v.) 0
Serum antitetanus (A.T.S) inj 20.000 UI/vial
vial
294 (i.m /i.v.) 0
295 Setirizin 5 mg/5 mL botol 2150
296 Sianokobalamin (vitamin B12) 50 mcg tablet 152700
297 Sianokobalamin (vitamin B12) 500 mcg/mL ampul 0
tablet
Simvastatin 10 mg
298 salut 23010 12000
tabet
Simvastatin 20 mg
299 salut 114500 5000
tablet
Siprofloksasin 500 mg
300 scored 19800
301 Spironolakton 25 mg tablet 0
302 Streptomisin 1000 mg/vial vial 0
303 Surgical ginggival pack pasta 0
304 Tetanus toxoid vial 0
305 Tetrakain 0,5% botol 0
306 Tetrasiklin 250 mg kapsul 0
307 Tetrasiklin 500 mg kapsul 0
308 Tiamin (vitamin B1) 50 mg tablet 8200
309 Triheksifenidil 2 mg tablet 500 7500
Tuberkulin protein purified derivative 1:10 (i.k.) ampul
310 0
311 Vaksin BCG vial 0
312 Vaksin campak vial 0
313 Vaksin jerap difteri tetanus pertusis (DTP) vial 0
314 Vaksin jerap difteri tetanus (DT) vial 0

vial
315 Vaksin jerap tetanus (tetanus adsorbed toxoid 0
316 Vaksin kombinasi DPT + hepatitis B vial 0
317 Vaksin polio botol 0
318 Vaksin rabies, untuk manusia vial 0
tablet
319 Valproat 250 mg salut 0
tablet
320 Valproat 500 mg salut 0
321 Valproat 250 mg/5 mL botol 0
322 Vitamin B kompleks tablet 58600 75000
323 Zinc 10 mg botol 0
tablet
324 Zinc 20 mg disp 1900
325 Zinc 20 mg/5 mL botol 666 2000
326 Zinc 10 mg/ml sachet 0

UMUM
BPJS
JUMLAH KUNJUNGAN RESEP BAYAR TDK

Mengetahui
Kepala Puskesmas Kecamatan Johar Baru
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
BULAN : JUNI 2021

: DOKUMEN
DINKES
IF KAB/KOTA
PUSKESMAS

PEMAKAIAN STOK AKHIR PEMBERIA

PERSEDIAAN 2021 JUNI 2021 JUNI 2021 STOK OPTIMUM PERMINTAAN APBD I APBD II
6=4+5 7 8=6-7 9 10 11 12

0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
52900 5800 47100
2000 0 2000
0 0
0 0 0
0 0 0
60 20 40

0 0 0
274200 136800 137400
556800 30000 526800
141900 5400 136500
0 0 0
0 0 0
0 0 0

0 0 0

128000 3100 124900

0 0 0

744 0 744

360 180 180

0 0 0
 0 0 0
0 0 0
0 0 0

0 0 0
3900 200 3700
83200 1900 81300
0 0 0
0 0 0
41600 6300 35300
40000 40000 0
0 0 0
42100 4800 37300
0 0 0
0 0 0
3500 2800 700
41350 200 41150
12900 0 12900
0 0 0
100 31 69
0 0 0
0 0 0
1236 184 1052
0 0 0
0 0 0
400 20 380
0 0 0

0 0 0 DULCOLAX
600 0 600 DULCOLAX
4790 0 4790
0 0 0

0 0 0

0 0 0
5040 5040 0
54429 7103 47326
4 0 4

35 0 35

39 0 39
 2389 4 2385
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
29400 4600 24800
0 0 0
7 0 7
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0
0 0 0

4100 4100 0

50 0 50
0 0 0
0 0 0
 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0

0 0 0

30225 30225 0 ORALIT

0 0 0

0 0 0

0 0 0
0 0 0
19100 4400 14700
0 0 0
2100 400 1700
0 0 0

0 0 0
0 0 0
0 0 0
5000 0 5000

0 0 0
0 0 0
0 0 0
0 0 0
3000 500 2500
3500 0 3500
0 0 0
0 0 0
0 0 0

0 0 0
10 0 10
0 0 0
5500 2300 3200
0 0 0
1368 72 1296
1700 100 1600
 0 0 0

0 0 0
9500 400 9100
7600 2100 5500
300 50 250
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
2100 0 2100
0 0 0
0 0 0
0 0 0
0 0 0
151300 11500 139800
24000 1700 22300
32000 4000 28000
0 0 0
0 0 0
0 0 0
384 0 384
0 0 0
0 0 0
3200 0 3200
0 0 0
0 0 0
0 0 0
480 96 384
0 0 0
75 25 50
48 0 48
606200 32600 573600
0 0 0
0 0 0
0 0 0

0 0 0

2500 0 2500
0 0 0
0 0 0
0 0 0
0 0 0
 0 0 0

0 0 0

0 0 0

269700 15000 254700

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0

0 0 0
47500 0 47500 DIAFORM

0 0 0
0 0 0
 0 0 0

150 0 150

5700 0 5700

0 0 0
0 0 0
0 0 0
0 0 0
0 0 0

0 0 0
0 0 0
600 0 600
0 0 0
0 0 0
0 0 0
0 0 0
37900 1300 36600
0 0 0
0 0 0
45 0 45
0 0 0
0 0 0
0 0 0
0 0 0

0 0 0

0 0 0
200100 9500 190600
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1900 700 1200
0 0 0
0 0 0
0 0 0
 0 0 0
1704 288 1416
0 0 0
24000 2000 22000

0 0 0
0 0 0
0 0 0
3800 0 3800
0 0 0
0 0 0
0 0 0

0 0 0
0 0 0
1400 100 1300
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
42120 5880 36240
0 0 0
0 0 0
210100 58500 151600
13241 250 12991
1380 240 1140
0 0 0
0 0 0
0 0 0
0 0 0
79 23 56

0 0

0 0 0
0 0 0
0 0 0
0 0 0
12900 5000 7900
0 0 0
0 0 0
0 0 0
 0 0 0

0 0 0
3200 0 3200
0 0 0
0 0 0
0 0 0

0 0 0
0 0 0
0 0 0
83000 3900 79100

0 0 0

212 3 209
0 0 0
0 0 0
10500 400 10100
160 0 160
0 0 0

0 0 0
0 0 0
0 0 0
0 0 0
0 0 0

0 0 0

0 0 0

0 0 0
2150 250 1900
152700 8000 144700
0 0 0

35010 14670 20340

119500 1000 118500

19800 1100 18700

0 0 0
0 0 0
0 0 0
 0 0 0
0 0 0
0 0 0
0 0 0
8200 0 8200
8000 500 7500

0 0 0
0 0 0
0 0 0
0 0 0
0 0 0

0 0 0
0 0 0
0 0 0
0 0 0

0 0 0

0 0 0
0 0 0
133600 18700 114900
0 0 0

1900 0 1900
2666 162 2504
0 0 0

JUMLAH

12871
 NOMOR TGL

PEMBERIAN TIDAK MAMPU

DAK PROGRAM LAIN-LAIN JUMLAH DILAPORKAN KETERANGAN
13 14 15 16=11+12+13+14

0
Jakarta , 05 JULI 2021
Yang
Petugas
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

PUSKESMAS PELAPORAN
KECAMATAN : PERMINTAAN
KAB/KOTA :
PROPINSI :

KODE
NO NAMA OBAT SATUAN
OBAT
STOK AWAL PENERIMAAN
JUNI 2021 JUNI 2021
1 2 3 4 5
1 Akarbose tab 100 mg 0
2 Alprazolam tab 0,5 mg 0
3 Alprazolam tab 1 mg 0
Alumunium Hidroksida, Magnesium Hidroksida,
4 0
Simethicone
5 Ambroksol Drop 7.5 Mg/ml 0
6 Ambroksol Syr 15mg/5ml 60 Ml 930
7 Ambroksol Syr 30mg/5ml 60 Ml 0
8 Ambroksol Tablet 30 Mg 23100
9 Amiodaron tab 200 mg 0
10 Amiodaron inj 150 mg/3 ml 0
11 Amoksisilin drop 100 mg/ml 0
12 Amoksisilin kaps. 250 mg 0
13 Amoksisilin sirup kering 125mg/5ml 4080

14 Amoksisilin 125 mg + Kalium Klavulanat 31,25 mg sirup 0

15 Amoksisilin 250 mg + Kalium Klavulanat 62,5 mg sirup 0

16 Amoksisilin 500 mg + Kalium klavulanat 125 mg 0

17 Ampisilin tablet 500 mg 0
18 Ampisilin 1 gram + Sulbaktam 500 mg injeksi 0
19 Ampisilin 500 mg + Sulbaktam 250 mg 0
Amylase, protease, lipase, desoxycholic acid,
20 dimethylpolysiloxane, vit B1, vit B2, vit B6, vit B12, 0
niacinamide, Ca pantothenate tablet
21 Antalgin Tablet 500 Mg 0
22 Antalgin injeksi 0
Antibakteri, kombinasi : basitrasin 500 UI/g+
23 125
Polimiskin B 10.000 UI/g

24 Antimigrain DOEN kombinasi : Ergotamin + Caffein 0

25 Aquadest steril 500 ml 7

26 Antidulafungin 100 mg injeksi 0
27 Aripiprazol 10 mg tablet 0
28 Asam asetilsalisilat tab 500 mg 0
29 Asam asetilsalisilat tab 100 mg 0
30 Asam askorbat (vitamin C) tab 100 mg 0
31 Asam askorbat (vitamin C) tab 25 mg 0
As.Folat, ß-Carotene, Vit.B1, B2, B6, Ca.Pantothenate,
32 Ca carbonate, vitamin D3, vitamin K1, biotin, besi 0
glukonat, IPC, DHA, ARA
33 Asam Risedronic tablet 35 mg 0
34 Asam pipemidat 400 mg 0
35 Asam traneksamat tab 500 mg 0
36 Asam traneksamat injeksi 0
37 Asefillin Piperazine injeksi 500 mg/5 ml 0
38 Asetazolamide tab 250 mg (glaucon) 0
39 Asiklovir injeksi 0
40 Asiklovir Krim 5 % 1290 100
41 Astasantin kapsul 0
42 Atorvastatin 10 Mg Tab 0
43 Atorvastatin 20mg tab 0
44 Azitromisin tab 500 mg 3720 3000
45 Azitromisin tab 250 mg 0
46 Azitromisin 500mg inj 120
Besi II Sulfat , Folic acid, Magnesium, Vit A, Copper, vit
47 0
B
48 Betahistine tablet 6 mg 8400
Beta karoten 6000 IU, Extract billberry 80 mg, Vitamin
49 C 100 mg, Vitamin E 25 mg, Lutein 3 mg, Lycopene 2 0
mg, Zn 10 mg

50 Betametason valerat 0,1 % + neomisin sulfat 0,5 % 0

Betamethasone valerate 0.1% + Gentamicin sulfate

51 0
0.1%
52 Bisoprolol 1.25 mg 0
53 Bisoprolol 2,5 mg 0
54 Borak Glyserol 5 % larutan 72
55 Bromheksin HCl 4 mg/2ml injeksi 0
56 Bromheksin HCl Elixir 4 Mg/5 Ml 60 Ml 0
57 Bromheksin HCl Sol 2mg/ml 50 Ml 0
58 Bromheksin HCl Tablet 8 Mg 0
59 Celecoxib 100 mg 0
60 Celecoxib 200 mg 0
61 Chlorhexidine 0
62 Clidinium Br 2.5 Mg, Chlordiazepoxide 5 Mg. 0
63 Curcuma Root Sirup 0
64 Curcumaminoid, B1, B2, B6, B12, B caroten 0
65 Deksketoprofen injeksi 50 mg 0
66 Deksketoprofen tablet 25 mg 0
67 Dekspanthenol krim 5 % 0
68 Desonide Krim 0,05 % 0
69 Dextromethorphan, maleate, phenylephrine sirup 0
70 Diazepam 2 mg + Metampiron 500 mg 0

71 Dibasic Ca phosphate 200 mg, Ca lactate 100 0

mg, vit B6 20 mg, vit C 25 mg, vit D3 100 IU tablet
72 Dibekacin Vial 100 mg/2 ml 0
73 Dibekacin vial 50 mg/ 2 ml 0
74 Diosmin 450 mg + hesperidin 50 mg tablet 0
75 Domperidone Suspensi 830
76 Dopamine HCL Injeksi. 0

77 Drop per ml : Isothipendyl HCl 1 mg, 0

acetaminophen 120 mg, phenylephrine HCl 1 mg
78 Efedrin HCl tablet 25 mg 0
79 Ekstrak Belladona tab 10 mg 0
80 Ekstrak plasenta 10 %, neomisin sulfat 0.5 % Gel 14

Ekstrak plasenta 15 mg, Vitamin B12 20 mcg, dan

81 tribasic calcium phosphate 12 mcg.  0

82 Elemen Besi + Asam Folat oral drop 15 mg/ml 0

83 Entecavir 0.5 mg 0
84 Eperisone Tablet 200
85 Erdosteine sirup 175 mg/5 ml 0
86 Eritromisin tab 500 mg 600
87 Estazolam Tablet 2 Mg 0
88 Ethamsilat injeksi 250 mg 0
89 Etoricoxib tab 60 mg 0
90 Famotidin tab 40 mg 0
91 Fenilbutazon tab 200 mg 0
92 Fenobarbital inj. 50 mg/ml 0
93 Flavoxate hidroklorida 200 mg 0
94 Florometolon 1 mg + Neomisin sulfat 3.5 mg/ml 0
fludrocortisone, lidocaine, neomysin, polymiksin B
95 0
tetes telinga
96 Fluphenazine dekanoat injeksi 25 mg/ml 0
97 Flukonazole kaps 150 mg 0
98 Flunarizin tablet 10 mg 0
99 Flunarizin tablet 5 mg 0
100 Fluorometolon tts mata 0,1% 0
101 Fluoxetine tab 0
102 Fosfomisin Vial 2 G 0
 Fradiomisin Sulfat 2,5 mg, Gramisidin-S HCl 1 mg
103 0
tablet
104 Framisetin sulfat kassa steril 0
105 Fructus schizandrae extract siccum 7,5mg 0
106 Gatifloxacin tetes mata 0
107 Gemfibrozil tab 300 mg 2300 2580
108 Gentamisin injeksi 40 mg/ml 0
109 Gentamisin sulfat salep mata 0
110 Gentamisin tts mata 0,3% 96
111 Gentamisin Salep Kulit 804
112 Gentian Violet Larutan 1 % 144
113 Gliseril guaiakolat 100 mg 119800
114 Glikuidon tablet 0

115 Glucosamin Hcl 500 Mg + Kondroitin Sulfat 400 Mg 0

116 Glucosamin Tablet 250 Mg 0

117 Glucosamin tablet 500 mg 0

Glucosamine sulphate 500 mg, chondroitin sulfate 400

118 mg, vit C 50 mg, manganese 0.5 mg, Mg 10 mg, 0
selenium 10 mcg, Zn 5 mg, MSM 350 mg tablet

119 Glukosa 70% (Dextran 70) larutan steril 0

120 Glukosa 40% larutan infus 18
121 Glukosa 10% larutan infus 8
122 Glukosa 5% larutan infus 0
123 Granisetron injeksi 3 mg 0
124 Hidrokortison krim 0,5% 0
125 Hidrokortison krim 1% 192
Hidrokortison 0.5 % + Kloramfenikol 0.2 % salep mata
126 0
3,5 g

127 Hyoscine-N-butylbromide 10 mg, Paracetamol 500 mg 0

128 Hyoscine-N-butylbromide 20 mg/ml injeksi 350

129 Ibuprofen Supp 125mg 0
130 Ichtyol salep ( salep hitam ) 336
131 Ilberry extract, gliserin, gelatin, minyak sayur 0
132 Imipenem Cilastatin Vial 1 G 0
Ion Natrium & Kalium dengan Benzalkonium Cl tetes
133 0
mata
134 Isoksuprine Hcl Injeksi 0
135 Isoksuprine Tablet 20 Mg 0
136 Itraconazole Kapsul 100 Mg 0
137 Kalium Diklofenak 25 mg tablet 0
138 Kalium Diklofenak 50 Mg Tablet 0
139 Kalium Permanganat ( PK ) 0
140 Kalium L-Aspartat tab 300 mg 0
141 Kanamisin Inj. 1 G 0
142 Kaolin + Pektin Sirup 0

Kaplet mengandung:Acetaminofen 500 mg, Gliseril

143 guaiacolat 50 mg, Fenilpropanolamin HCl 15 mg, 0
Dekstrometorfan HBr 15 mg, Chlorfeniramine maleat

144 Kaptopril tablet 50 mg 0

145 Karbazochrom Na. Inj. 0
146 Karboksimetilselulosa 5 mg tetes mata 0
147 Ketoacid essensial 0
148 Ketokonazole krim 0
149 Ketoprofen Injeksi 0
150 Ketoprofen Suppos 0
151 Ketoprofen Tablet 100 Mg 0
152 Ketorolac injeksi 10 mg/ml 0
153 Ketorolac tablet 10 mg 0
154 Ketotifen sirup 0,2 mg/ml 0
155 Ketotifen tablet 1 mg 0
156 Klindamisin kaps. 150 mg 0
157 Klindamisin kaps. 300 mg 7500
158 Klobazam tab 10 mg 0
159 Klobetasol 10 G Krim 0
160 Klobetasol Propionat Salep 0
161 Klopidogrel tab 75 mg 0
162 Kloramfenikol kaps. 500 mg 0
163 Kloramfenikol 2% + Hydrokortison 2,5% krim 648
164 Kloramfenikol Basa + Prednisolone krim 0
165 Kloramfenikol tetes telinga 3 % 870
166 Klozapine tab 25 mg 0
167 Kodein 30 mg + feniltoloksamin 10 mg 0
Setiap tablet tambah darah SEKURANGNYA
mengandung Zat besi setara dengan 60 mg besi
168 elemental (dalam bentuk sediaan Ferro) Asam folat 25368
0,400 mg

Kombinasi : MedroksiprogesteronAsetat 50 mg,

169 0
Estradiol Sipinoat 10 mg (Cyclofem Inj.)

Kombinasi Larutan Infus Per L : Ca++ 3 mEq, Na+ 130

mEq, Cl- 109 mEq, Asetat 28 mEq (Asering Infus) 0

Kombinasi Larutan Infus Per L: NaCl 1,75 g, KCL 1,5 g,

0
Na. Laktat 2, 24 g, Dekstrosa Anhidrat 27 g (KAEN 3B)

170 Kombinasi Fe, Asam folat, Vitamin B 0

171 Kombinasi Metampiron 500 mg + Vit B tablet 0
172 Kombinasi Suspensi Parafin+Gliserin+Fenolftalein 0

173 Kortison Acetat Inj 5 ml 0

174 Lactobacillus serbuk 0
175 Lansoprazole kaps. 40 mg 0
176 Levofloxacin tab 500 mg 0
177 Levofloxacin Tetes Mata 0
178 Larutan mengandung Lipid (Emulsi lemak 20%) 0

179 Lecithin 100 mg + Serratiopeptidase 5 mg + pancreatin 0

25 mg kapsul
180 Lincomycin 500 MG 700
181 Linezolid infus 600 mg 0
182 Lisinopril tab 10 mg 0
183 Loperamide tab 2 mg 0
184 Losartan tab 50 mg 0

185 Loratadine 5 mg, pseudoephedrine sulfate 120 mg 0

186 L-Ornithine-L-Aspartate injeksi 500 mg/ml 0

187 Mekobalamin 500 Mcg 0
188 Mekobalamin 250 Mcg 0
189 Mekobalamin Injeksi 0
190 Meloksikam Tablet 15 Mg 0
191 Meloksikam Tablet 7,5 Mg 25350
192 Menadion ( Vit K 3) Amp 10 mg/ml 0
Metampiron 500 mg + Thiamin HCl50 mg + Pridoksin
193 HCl 10 mg + Sianokobalamin HCl 10 mcg + 0
Trimetilsantin 50 mg tablet (Neuralgin)
194 Methildopa tablet 250 mg 0
195 Methil prednisolone tab 4 mg 4000
196 Methil prednisolone tab 8 mg 0
197 Methil prednisolone tab 16 mg 0
198 Methisoprinol 250 mg/5 ml sirup 60 ml 0
199 Methisoprinol Tablet 500 Mg 0
Methyl salicylate 102 mg, menthol 54.4 mg, eugenol
200 0
13.6 mg krim
201 Metoklopramide injeksi 5 mg/5 ml 0
202 Metoklopramide 5 mg/5ml sirup 60 ml 0

203 Metronidazole 500 mg + nystatin 100.000 iu ovula 0

Micobacterium Tuberculosisi 0,4 mcg + disodium

204 fosfat 7,6 mg+Potasium fosfat 1,45 mg +sodium 0
klorida 4,8 mg (PPD RT23)
205 Milrinone injeksi 0
206 Misoprostol Tablet 200 Mcg 0
207 Moksifloksasin tts mata 0,5% 0
208 Multivitamin + Lysine Drop 0
209 Multivitamin + Lysine Sirup Anak 250
211 Mupirosin Krim 0
212 Na Hyaluronat 0.1% tetes mata 0

Na lauril sulfoasetat 45 mg, Na sitrat 450 mg, asam

213 0
sorbat 5 mg, PEG-400 625 mg, sorbitol 4.465 mg

214 NaCL 0,9% 100 ml 0

215 NaCL 0,9% 500 ml 155
216 Naftidrofuryl Oxalate tablet 100 mg 0
217 Natium diklofenak tetes mata 1 mg 0
218 Natrium diklofenak gel 1% 0
219 Natrium dokusate tetes telinga 5 mg 0

Neomisin 3,5 mg + Polimiksin 16.250 IU + Fenilefrin

220 0
1,2 mg + asam borat 1,769 mg/ ml tetes mata 

Neomisin sulfat 3,5 mg + polimiksin B sulfat 10000 iu +

221 0
deksametason sodium fospat 1 mg tetes mata

neomycin sulfate setara dengan neomycin base 3.5

222 mg polymixin b sulfate 10000 iu dan dexamethason 0
sodium phosphate 1 mg
223 Nifuroksazide sirup 250 mg/5 ml 0
224 Nitrogliserin injeksi 10 mg 0
225 Norephineprine injeksi 0
226 Noretisteron tab 5 mg 0
Obat Batuk Pilek Sirup Anak (Mengandung
227 0
Pseudoefedrin, Tanpa Parasetamol)
Obat Batuk Pilek Sirup Anak (Mengandung
228 0
Parasetamol)
229 Obat Batuk Hitam (OBH) sirup 509
230 Ofloksasin 2 Mg/ml Infus 100 Ml 0
231 Ofloksasin 3 mg tetes mata mini dose 0.6 ml 0
232 Ofloxacin 3mg/ml tetes telinga 0
233 Oksitetrasiklin Salep Kulit 3 % 0
234 Ondansetron injeksi 0
235 Ondansetron tab 8 mg 0
236 Ossein hydroxyapatite compound tablet 800 mg 0
237 Otilonium Br 0
238 Oxytetrasiklin salep Kulit 0
239 Oxytetrasiklin salep mata 275
240 Pantoprazole Injeksi 40 Mg 0
241 Pantoprazole kapsul 20 mg 0
242 Papaverin injeksi 0
243 Papaverin 40 mg tablet 500
 Paracetamol 500mg, Phenylpropanolamine HCl
244 0
12,5mg, chlorpheniramine maleate 2mg

245 Parasetamol 500 mg + n-asetilsitein 200 mg tablet 0

246 Parasetamol supp 80 mg 0

247 Parasetamol supp 125 mg 0
248 Parasetamol supp 160 mg 0
249 Parasetamol supp 240 mg 0
250 Parasetamol supp 250mg 0
251 Parekoksib injeksi 40 mg/2 ml 0
252 Piperacillin 4 g, tazobactam 500 mg injeksi 0
253 PIRASETAM 12gr 60ml infus 0
254 PIRASETAM 1gr injeksi 0
255 Pirasetam Amp 3 G 0
256 Pirasetam tablet 800 mg 0
257 Pirasetam tablet 1200 mg 0
258 Pirenoxin Sodium 0.05 mg/ml tts mata 0
259 Piroksikam 15 mg gel 0
260 Piroksikam Tablet 10 Mg 0
261 Piroksikam Tablet 20 Mg 0

Polimiksin B sulfat 10.000 UI, Neomisin sulfat 5 mg,

262 0
Fludokortison asetat 1 mg, Lidokain HCl 40 mg

Polikresulen 10 ml (Albothyl) 0
263 Polivinilpirolidon 20 mg tetes mata 0
Polymixin b-sulfat 1.000.000 IU, Neomisin sulfat 0.5
264 mg, Fludokortison asetat 100 mg, Lidokain HCl 4 g, 0
PEG, Gliserin Tetes telinga
265 Povidon Iodine Gargle 1% 0
266 Pregabalin kapsul 150 mg 0
267 Pregabalin kapsul 75 mg 0
268 Preparat optalmik tetes mata 0
Propanolol tab 40 mg 0
269 Pseudoefedrin 7,5 mg Drop 0
Pseudoefedrin HCL 15 mg + Terfenadine HCl 20 mg/ml
270 0
sirup
271 Pseudoefedrin HCl 30 mg + Terfenadin 40 mg 0
272 Pseudoefedrin Hcl 60 mg + Loratadin 5 mg 0
Pseudoephedrine Hcl 15 mg + klorfeniramin maleat 1
273 mg sirup 0

Pseudoephedrine HCl 30 mg + Brompheniramine

274 maleat 2 mg/5 ml sirup 0

275 Pseudoephedrine Hcl 30 mg, Triprolidine 2,5 mg tab 0

Pulmicort Respules 0,25 mg/ml (anak) @ 2 ml 0

 Pulmicort Respules 0,50 mg/ml (dewasa) @ 2 ml 0
Pure lecithin (PPC 95%) 300 mg, vit B1 6 mg, vit B2 6
276 mg, vit B6 6 mg, vit B12 6 mcg, vit E 10 mg, 0
nicotinamide 30 mg kapsul
277 Ramipril tab 5 mg 0
278 Ranitidin injeksi 0
279 Ranitidin sirup 75 mg/5 ml 0
280 Rebamipide 100 Mg Tablet 0

281 Recombinan hepatitis B inj 10 mcg/0.5 mL (syringe) 0

0.5 mL
282 Reserpin tab 0,25 mg 0
283 Retinol (Vitamin A) 6000 UI 0
284 Rifampisin kaps. 600 mg 0
285 Rifampisin kaps. 450 mg 0
286 Ringer Laktar (RL) Larutan Infus 132
287 Risperidone tab 2 mg 500
288 Rivanol (ETAKRIDIN) 0
289 Rocuronium Bromide 0
290 Ropivacain hidroklorida injeksi 2 mg/ml 0
291 Salbutamol sulfat rotacaps 200 mcg 0

292 Salbutamol sulfat injeksi 2,5 mg/ml (Ventolin Nebules) 0

293 Sefadroksil kaps. 500 mg 0

294 Sefadroksil kaps. 250 mg 0
295 Sefadroksil sirup kering 0
296 Sefaleksin kaps. 500 mg 0
297 Sefiksim kapsul/kaplet 200 mg 0
298 Sefiksim kapsul/kaplet 100 mg 3450
299 Sefiksim sirup kering 100 mg/5ml 0
300 Sefoperazone + Sulbactam Vial 1 G 0
301 Sefotiam dihidroklorida 1 gram injeksi 0
302 Sefotaksim serbuk injeksi 1 G 0
303 Seftriaksone serbuk injeksi 1 G 0
304 Septocain Inj. (Articane HCL dan Epinephrine) 0
305 Setirizine tablet 10 mg 1050
306 Setirizine drop 0
307 Sianokobalamin (vitamin B12) tab 50 mcg 0
308 Simetidine tab 200 mg 0
309 Siprofloksasin 3 mg/ml tetes mata 0
310 Sitikolin Amp 1000 mg/8 ml 0
311 Sitikolin Amp 500 mg/4 ml 0
312 Sitikolin Amp 125mg/ml 2ml 0
313 Sitikolin Tablet 1000 Mg 0
314 Sitikolin Tablet 500 Mg 0
315 Sodium Klorida Semprot Hidung 0
 Monoammonium glycyrrhizinate (sebagai glycyrrhizin)
316 4 mg 0
Aminoacetic acid 40 mg
L-cystein hydrochloride 2 mg Injeksi
317 Sulpirida tablet 200 mg 0
318 Sulpirida tablet 50 mg 0
Tablet Flu Batuk Bromheksin, Difenhidramin,
319 0
Parasetamol
Tetes Mata : CaCl2 anhidrat 0.075 gr, Kalium iodida
320 0.075 gr, Na Tiosulfat 0.005 gr, Fenilmerkuri nitrat 0.3 0
mg Mini Dose

Tetes Mata : CaCl2 anhidrat 0.075 gr, Kalium iodida

321 0.075 gr, Na Tiosulfat 0.005 gr, Fenilmerkuri nitrat 0.3 0
mg

Tetes Mata : Dexamethasone/Deksametason 0,1 %,

322 Neomisin sulfat 3,5 mg/mL, Polimiksin B sulfat 6000 0
iu/mL. Mini Dose
Tetes Mata : Deksametason 0,1%, Neomisin sulfat 3,5
323 0
mg, Polimiksin-B-Sulfat 6000 UI

324 Tetes Mata : HPMC 5 mg, Dextran (70) 1 mg Minidose 0

Tetes Mata : HPMC 5 mg, Dextran (70) 1 mg Tetes

325 0
mata

326 tetesMata :Tobramisin 3 mg + Deksametason 1 mg 0

mini dose/ml.

327 tetes Mata : Tobramisin 3 mg + Dexamethason 1 0

mg/ml.
328 Thiamphenicol sirup 125/5ml 0
329 Tiamfenikol kapsul 500 mg 0

330 Tiap 100 gram mengandung Heparin sodum 20.000 IU 0

331 Tigesiklin injeksi 50 mg/5ml 0

332 Tizanidine tablet 2 mg 0
333 Tramadol 37,5 mg + Parasetamol 325 mg 0
334 Tramadol injeksi 0
335 Tramadol Kapsul 50 Mg 0
336 Tramadol Supp 100 mg 0
337 Terbutaline sulfat injeksi 0
338 Terbutaline sulfat tab 2,5 mg 0
339 Trifluoperazine tab 1 mg 0
340 Trifluoperazine tab 5 mg 0
341 Trimetazidine hidroklorida tablet 35 mg 0
Tripolidin HCl 2mg,Pseudoefedrin HCl 30 mg,
342 0
Parasetamol 500 mg tablet
343 Valsartan tab 160 mg 0
344 Valsartan tab 80 mg 0
345 Vekuronium bromida Vial 10 Mg 0
346 Vekuronium bromida Vial 4 Mg 0
347 Vit A palmitate, karbomer gel 10 gram 0
348 Vit B1 100 mg, B6 200 mg, B12 200 mcg injeksi 0
Vit B1 100 Mg, Vit B6 50 Mg, Vit B12 100 Mcg, Vit E 30
349 0
Iu.
350 Vit B1 100 mg,vit B6 100 mg, vit B12 5000 mcg 0

351 Vit B1 100mg + Vit B6 100mg + Vit B12 5000ug tablet 0

352 Vit B1 100mg + Vit B6 200mg + Vit B12 200ug tablet 0

Vit B1, B2, B6, B12, Vit C 500Mg, Ca Pantotenate

353 tablet 0

Vit B1, B2, B3, B6, B12, Vit C 500Mg, Ca Pantotenate,

354 Tocopherol Vit E) tablet 0

Vitamin A 4000 IU, C 50 mg, D 400 IU, E 10 mg, B1

3mg, B2 3 mg, B6 2 mg, B12 2 mcg, B3 20 mg, Ca
355 pantotenat 5 mg, Asam folat 1 mg, Biotin 0.1 mg, Fe 0
fumarat 20 mg, Ca 100 mg, Cu 0.5 mg, Mn 0.5 mg, Mg
1 mg, Zn 0.25 mg tablet

356 Caviplex Sirup 0

357 Caviplex Tab 6700
358 n-asetilsitein 200 mg 23200
359 Permetrin 49
360 NaCL 25 ML 27
361 Neo Diagon ( Atapulgite ) 0
362 Vitamin C 500 MG 231302 30000
363 Vitamin SIVIT Zink 112530
364 Biovitan 3500
365 OBH Combi 530
366 Prove D3 2700
367 Meylon 25 ML 30
368
369

UMUM
JUMLAH KUNJUNGAN RESEP BPJS
BAYAR TDK

Mengetahui
Kepala Puskesmas Kecamatan Johar Baru
: DOKUMEN
DINKES
IF KAB/KOTA
PUSKESMAS

PEMBERIAN
STOK OPTIMUM PERMINTAAN
PERSEDIAAN PEMAKAIAN STOK AKHIR APBD I APBD II
2021 JUNI 2021 JUNI 2021
6=4+5 7 8=6-7 9 10 11 12
0 0
0 0
0 0

0 0

0 0
930 880 50
0 0
23100 21300 1800
0 0
0 0
0 0
0 0
4080 1300 2780

0 0

0 0

0 0
0 0
0 0
0 0

0 0

0 0
0 0

125 125

0 0

7 0 7
0 0
 0 0
0 0
0 0
0 0
0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
1390 390 1000
0
0 0
0 0
6720 3580 3140
0 0
120 120

0 0

8400 8400

0 0

0 0

0 0

0 0
0 0
72 72
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0
0 0
0 0
830 530 300
0 0

0 0

0 0
0 0
14 4 10 BIOPLACENTON

0 0

0 0
0 0
200 200
0 0
600 600
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
 0 0

0 0
0 0
0 0
4880 2960 1920
0 0
0 0
96 72 24
804 288 516
144 72 72
119800 61800 58000
0 0

0 0

0 0
0 0

0 0

0 0
18 0 18
8 0 8
0 0
0 0
0 0
192 192

0 0

0 0

350 0 350
0 0
336 120 216
0 0
0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
 0 0
0 0
0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
7500 2000 5500
0 0
0 0
0 0
0 0
0 0
648 324 324 KLORFESON
0 0
870 120 750
0 0
0 0

25368 25368

0 0

0 0

0 0

0 0
0 0
 0 0

0 0
0 0
0 0
0 0
0 0
0 0

0 0

700 700 0
0 0
0 0
0 0
0 0

0 0

0 0
0 0
0 0
0 0
0 0
25350 12350 13000
0 0

0 0

0 0
4000 2500 1500
0 0
0 0
0 0
0 0

0 0

0 0
0 0

0 0

0 0

0 0
0 0
0 0
 0 0
250 250 CURVIPLEX
0 0
0 0

0 0

0 0
155 66 89
0 0
0 0
0 0 MEGATIC GEL
0 0

0 0

0 0

0 0

0 0
0 0
0 0
0 0

0 0

0 0

509 452 57
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
275 200 75
0 0
0 0
0 0
500 500
0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0
0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0
0 0

0 0

0 0

0 0

0 0
 0 0

0 0

0 0
0 0
0 0
0 0

0 0

0 0
0 0
0 0
0 0
132 32 100
500 500 0
0 0
0 0
0 0
0 0

0 0

0 0
0 0
0 0
0 0
0 0
3450 1700 1750
0 0
0 0
0 0
0 0
0 0
0 0
1050 0 1050
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
0 0

0 0

0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

0 0

0 0
 0 0
0 0
0 0
0 0
0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0

0 0
6700 800 5900
23200 14600 8600
49 49
27 0 27
0 0
261302 202502 58800
112530 57930 54600
3500 700 2800
530 290 240
2700 2700 0
30 0 30

JUMLAH

12871
 NOMOR TGL

PEMBERIAN
TIDAK MAMPU
KETERANGAN
DILAPORKAN
DAK PROGRAM LAIN-LAIN JUMLAH

13 14 15 16=11+12+13+14
Jakarta , 05 JULII 2021
Yang
Petugas