LAPORAN PEMAKAIAN DAN LEMBAR PERMINT

( LPLPO )

KODE PUSKESMAS
PUSKESMAS
KECAMATAN
KABUPATEN BOJONEGORO
PROPINSI JAWA TIMUR

KELAS SATU PENERI PERSE

KODE NAMA OBAT STOK AWAL
TERAPI AN MAAN DIAAN

1 2 3 4 5 6
0101 ACYCLOVIR CREAM 6.6.1 TUB -
0102 ACYCLOVIR TABLET 400 MG 6.6.1 TAB -
0103 ADONA INJEKSI 10.3 AMP -
0104 ADONA TABLET 10.3 TAB -
0105 ALAT SUNTIK SEKALI PAKAI 1 ML 32 SET -
0106 ALAT SUNTIK SEKALI PAKAI 10 ML 32 SET -
0107 ALAT SUNTIK SEKALI PAKAI 2,5 ML 32 SET -
0108 ALAT SUNTIK SEKALI PAKAI 5 ML 32 SET -
0109 ALBENDAZOL TABLET 400 MG 6.1.1 TAB -
0110 ALINAMIN F INJEKSI 29.2.1 AMP -
0111 ALOPURINOL TABLET 100 MG 1.3 TAB -
0112 ALOPURINOL TABLET 300 MG 1.3 TAB -
0113 ALPRAZOLAM TABLET 1 MG 23.1 TAB -
0114 AMBROXOL SIRUP 6.2.1 BTL -
0115 AMBROXOL TABLET 30 MG 6.2.1 TAB -
0116 AMINOFILIN INJEKSI 24 MG/ML-10 ML 26.1 AMP -
0117 AMINOFILIN TABLET 200 MG 26.1 TAB -
0118 AMITRIPTILIN HCL TABLET SALUT 25 MG 23.2 TAB -
0119 AMLODIPIN TABLET 5 MG 17.3.3 TAB -
0120 AMLODIPIN TABLET 10 MG 17.3.3 TAB -
0121 AMOKSISILIN KAPSUL 500 MG 6.2.1 KAPL -
0122 AMOKSISILIN SIRUP KERING 125 MG/ 5 ML 6.2.1 BTL -
0123 AMPICILIN INJEKSI 1 GRAM 6.2.1 VIAL -
0124 ANTASIDA DOEN SIRUP 25.1 BTL -
0125 ANTASIDA DOEN TABLET KOMBINASI 25.1 TAB -
0126 ANTI BAKTERI DOEN KOMBINASI 18.2 TUB -
0127 ANTI FUNGI DOEN KOMBINASI 18.3 POT -
0128 ANTI HEMOROID DOEN 25.3 SUPP -
0129 ANTI PARKINSON DOEN TABLET KOMBINASI 9 TAB -
0130 ANTIMIGRAIN KOMBINASI 7.2 TAB -
0131 ANTRAIN INJEKSI 1.2 AMP -
0132 AQUA PRO INJEKSI STERIL,BEBAS PIROGEN 20.3 AMP -
0133 AQUADEST STERIL 20 BTL -
0134 ASAM ASETAT 6 % 31 BTL -
0135 ASAM ASKORBAT (VIT C) TABLET 50 MG 29 TAB -
0136 ASAM KLORIDA 0,1 N 31 BTL -
0137 ASAM MEFENAMAT TABLET 500 MG 1.2 TAB -
0138 ASAM SULFOSALISILAT 20 % 31 BTL -
0139 ASERING 20.2 BTL -
0140 ASETAZOLAMID TABLET 250 MG 15 TAB -
0141 ASETOSAL TABLET 100 MG 1.2 TAB -
0142 ASETOSAL TABLET 500 MG 1.2 TAB -
0143 ASETOSAL TABLET 80 MG 1.2 TAB -
0144 ATROPIN SULFAT INJEKSI 0,25 MG/ML - 1 ML 25.4 AMP -
0145 ATROPIN SULFAT TABLET 0,5 MG 9 TAB -
0146 ATROPIN TETES MATA 0,5 % 21.2.4 BTL -
0201 BETAHISTIN MASILAT TABLET 6 MG 7.2 TAB -
0202 BETAMETASON KRIM 0,1 % 18.4 TUB -
0203 BISOPROLOL FUMARAT TABLET 5 MG 17.3.2 TAB -
0204 BLUE TIP 31 PAK -
0205 BROMHEKSIN TABLET 8 MG 26.3 TAB -
0206 BURNAZIN SALEP 18.2 TUB -
0301 CAPTOPRIL TABLET 25 MG 17.3 TAB -
0302 CATGUT/ BENANG BEDAH NO.2/0-3/0( PLAIN/CHROMIC ) 32 SET -
0303 CENDO PANTOCAIN TETES MATA BTL -
0304 CENDO XITROL TETES MATA BTL -
0305 CIMETIDIN TABLET 25.1 TAB -
0306 CIPROFLOXACIN TABLET 500 MG 6.2.2.6 TAB -
0307 CITICHOLINE INJEKSI 250 MG/ 2 ML 17.8 AMP -
0308 CLOBAZAM TABLET 23.1 TAB -
0309 CLOSAPIN TABLET 25MG 23.4 TAB -
0310 COVER GLASS 31 SET -
0401 D 5 % + NaCl 0,225 % 20.2 BTL -
0402 D 5 % + NaCl 0,45 % 20.2 BTL -
0403 DEKSAMETASON INJEKSI 5 MG/ML-1 ML 3 AMP -
0404 DEKSAMETASON TABLET 0,5 MG 16.4 TAB -
0405 DIAZEPAM INJEKSI 5 MG/ML- 2 ML 5 AMP -
0406 DIAZEPAM TABLET 2 MG 5 TAB -
0407 DIAZEPAM TABLET 5 MG 5 TAB -
0408 DIETIL KARBAMAZIN SITRAT TABLET 100 MG ( DEK ) 6.1.2 TAB -
0409 DIFENHIDRAMIN HCL INJ 10MG/ML-1 ML 3 AMP -
0410 DIFLATYL TABLET TAB -
0411 DIGOKSIN TABLET 0,25 MG 17.5 TAB -
0412 DIMENHIDRINAT TABLET 50 MG 25.2 TAB -
0413 DOKSISIKLIN KAPSUL 100 MG 6.2.7 KAP -
0414 DOMPERIDON TABLET 10 MG 25.2 TAB -
0415 DOPAMIN INJEKSI 200MG 17.7.1 AMP -
0416 DULCOLAX SUPPOSITORIA 10 MG ( DEWASA ) 25.6 SUPP -
0417 DULCOLAX SUPPOSITORIA 5 MG ( ANAK ) 25.6 SUPP -
0418 DULCOLAX TABLET 25.6 TAB -
0501 EKSTRAK BELLADON TABLET 10 MG 25.4 TAB -
0502 EPINEFRIN HCL/BITARTRAT( ADRENALIN ) INJ.0,1%-1 ML 3 AMP -
0503 ERYTROMICIN KAPLET 500MG 6.2.2.4 KAPL -
0504 ERYTROMICIN SIRUP 6.2.2.4 BTL -
0505 ETANOL 70 % 13.2 BTL -
0506 ETANOL 95 % 31 BTL -
0507 ETIL KLORIDA SEMPROT 14.1 BTL -
0508 EUGENOL CAIRAN 14.1 BTL -
0601 FENITOIN NATRIUM KAPSUL 100 MG 5 KAP -
0602 FENOBARBITAL INJ.50MG/ML-2 ML 5 AMP -
0603 FENOBARBITAL TABLET 30 MG 5 TAB -
0604 FENOKSIMETIL PENISILINA TABLET 500 MG 6.2.1 TAB -
0605 FENOL GLISEROL TETES TELINGA 10 % 28.2 BTL -
0606 FITOMENADION ( VIT K ) INJ.10 MG/ML 10.2 AMP -
0607 FITOMENADION ( VIT K ) TABLET SALUT 10 MG 10.2 TAB -
0608 FLUOR TABLET 0,5 MG 14.1 TAB -
0609 FLUOXETIN KAPSUL 2 MG 23.2 KAP -
0610 FOLEY CATHETHER NO.16 32 SET -
0611 FOLEY CATHETHER NO.18 32 SET -
0612 FUROSEMID INJEKSI 14 AMP -
0613 FUROSEMID TABLET 40 MG 14 TAB -
0701 GARAM ORALIT UNTUK 200 ML AIR 20.1 SAZE -
0702 GEMFIBROZIL KAPSUL 300 MG 17.7 KAP -
0703 GENTAMICIN INJEKSI 80 MG/ 2 ML 6.2.2.5 AMP -
0704 GENTAMICIN TETES MATA 21.2 BTL -
0705 GENTAMISIN SALEP KULIT 0,1 % 21.2 TUBE -
0706 GENTIAN VIOLET LARUTAN 1 % 14.2 BTL -
0707 GLASS IONOMER CEMENT ( GC IX ) 14.1 SET -
0708 GLIBENKLAMID TABLET 5 MG 16.1.1 TAB -
0709 GLISERIL GUAYAKOLAT TABLET 100 MG 26.3 TAB -
0710 GLUCO Dr 31 STRIP -
0711 GLUKOSA LARUTAN INFUS 10 % STERIL 20.2 BTL -
0712 GLUKOSA LARUTAN INFUS 40 % STERIL 20.2 AMP -
0713 GLUKOSA LARUTAN INFUS 5 % STERIL 20.2 BTL -
0714 GRISEOFULVIN TABLET 125 MG,MICRONIZED 6.3 TAB -
0801 H C G TEST STRIP( REAGEN TEST KEHAMILAN ) 31 STRIP -
0802 HALOPERIDOL TABLET 0,5 MG 23.4 TAB -
0803 HALOPERIDOL TABLET 1,5 MG 23.4 TAB -
0804 HALOPERIDOL TABLET 5 MG 23.4 TAB -
0805 HIDROKLOROTIAZID ( HCT ) TAB 25 MG 15 TAB -
0806 HIDROKORTISON KRIM 2,5 % 18.4 TUB -
0901 I.V CATHETHER NO.16 32 SET -
0902 I.V CATHETHER NO.18 32 SET -
0903 I.V CATHETHER NO.20 32 SET -
0904 I.V CATHETHER NO.22 32 SET -
0905 I.V CATHETHER NO.24 32 SET -
0906 IBUPROFEN TABLET 200 MG 1.2 TAB -
0907 IMIPRAMIN TABLET TAB -
0908 INFUSION SET ANAK 32 SET -
0909 INFUSION SET DEWASA 32 SET -
0910 ISOSORBID DINITRAT TABLET SUB LINGUAL 5 MG 17.1 TAB -
1001 JARUM HECTING NO.8 32 SET -
1002 JARUM HECTING NO.11 32 SET -
1101 KA EN 3A BTL -
1102 KA EN 3B BTL -
1103 KALSIUM HIDROKSIDA PASTA 14.1 TUBE -
1104 KALSIUM LAKTAT( KALK ) TABLET 500 MG 29 TAB -
1105 KAPAS PEMBALUT / ABSORBENS 250 GRAM 32 ROL -
1106 KARBAMAZEPIN TABLET 200 MG 5 TAB -
1107 KASA PEMBALUT 36 M X 80 CM 32 ROL -
1108 KASA PEMBALUT 4 M X 10 CM 32 ROL -
1109 KASA PEMBALUT 4 M X 5 CM 32 ROL -
1110 KASA PEMBALUT 40 M X 80 CM 32 ROL -
1111 KASA PEMBALUT ELASTIC 3 INCHI 32 ROL -
1112 KASA PEMBALUT ELASTIC 4 INCHI 32 ROL -
1113 KASA PEMBALUT KOMPRES 16 X 16 32 KTK -
1114 KASA PEMBALUT KOMPRES 18 X 22 32 KTK -
1115 KETOKONAZOL KRIM 2 % 6.5 TUB -
1116 KETOKONAZOL TABLET 200 MG 6.5 TAB -
1117 KLINDAMISIN KAPSUL 300 MG 6.2.2 KAP -
1118 KLORAMFENIKOL KAPSUL 250 MG 6.2.2 KAP -
1119 KLORAMFENIKOL SALEP MATA 21.2.1 TUB -
1120 KLORAMFENIKOL SIRUP 6.2.2 BTL -
1121 KLORAMFENIKOL TETES TELINGA 3 % 28.1 BTL -
1122 KLORFENIRAMIN MALEAT ( CTM ) TABLET 4MG 3 TAB -
1123 KLORPROMAZIN HCl INJ.25 MG/ML-1 ML 23.4 AMP -
1124 KLORPROMAZIN HCl TABLET SALUT 100 MG 23.4 TAB -
1125 KODEIN HCl TABLET 10 MG 26.2 TAB -
1126 KOMPOSIT BH -
1127 KOTRIMOKSAZOL DEWASA TABLET 6.2.2 TAB -
1128 KOTRIMOKSAZOL SUSPENSI 6.2.2 BTL -
1201 LANCET ( NEEDLE HOLDER ) 6.4.2.2 SET -
1202 LARUTAN ANISOL 31 SET -
1202 LARUTAN BaCl2 31 BTL -
1202 LARUTAN BENEDICT 31 BTL -
1202 LARUTAN EDTA 10 % 31 BTL -
1202 LARUTAN EOSIN 2 % 31 BTL -
1202 LARUTAN ETANOL ASAM 31 BTL -
1202 LARUTAN GIEMSA STAIN 31 BTL -
1202 LARUTAN HAYEM 31 BTL -
1202 LARUTAN KARBOL FUKSIN 31 BTL -
1202 LARUTAN METILEN BIRU 31 BTL -
1202 LARUTAN MINYAK IMERSI 31 BTL -
1202 LARUTAN NATRIUM SITRAT 3,8 % 31 BTL -
1202 LARUTAN TURK 31 BTL -
1202 LARUTAN XYLOL 31 BTL -
1202 LIDOKAIN KOMPOSITUM INJEKSI 2.1 AMP -
1202 LIDOKAIN NON EPINEFRIN INJEKSI 2.1 AMP -
1202 LINCOMYCIN KAPSUL 500 MG 14.1 KAP -
1202 LISOL BTL -
1202 LODOMER INJEKSI ( HALOPERIDOL INJEKSI ) 23.4 AMP -
1202 LOPERAMID TABLET 25.5 TAB -
1202 LORATADIN TABLET 3 TAB -
1301 MAGNESIUM SULFAT INJEKSI ( IV ) 20 % - 25 ML 5 AMP -
1302 MAGNESIUM SULFAT INJEKSI ( IV ) 40 % - 25 ML 5 AMP -
1303 MASKER 32 BH -
1304 MASKER NEBULIZER ANAK 32 SET -
1305 MASKER NEBULIZER DEWASA 32 SET -
1306 MASKER OKSIGEN ANAK 32 SET -
1307 MASKER OKSIGEN DEWASA 32 SET -
1308 METANOL 31 BTL -
1309 METFORMIN TABLET 500 MG 31 TAB -
1310 METFORMIN TABLET 850 MG 31 TAB -
1311 METIL ERGOMETRIN MALEAT INJ.0,200 MG-1 ML 16.2.1 AMP -
1312 METIL ERGOMETRIN MALEAT TABLET SALUT 0,125 22.1 TAB -
1313 METOKLOPRAMID INJEKSI 25.2 AMP -
1314 METOKLOPRAMID SIRUP 25.2 BTL -
1315 METOKLOPRAMID TABLET 25.2 TAB -
1316 METRONIDAZOL TABLET 500 MG 6.2.2 TAB -
1317 MICONAZOL CREAM 6.2.2 TUB -
1318 MONOKLORKAMFER MENTOL CAIRAN( CHKM ) 14.1 BTL -
1319 MUMMIFYING PASTA 14.1 BTL -
1401 N-HYOSIN BUTILBROMIDA INJEKSI 25.4 AMP -
1402 N-HYOSIN BUTILBROMIDA TABLET 25.4 TAB -
1403 NASAL CANULA O2 ANAK 32 SET -
1404 NASAL CANULA O2 DEWASA 32 SET -
1405 NATRIUM DIKLOFENAK TABLET 50 MG 4.1 TAB -
1406 NATRIUM KLORIDA LARUTAN INFUS 0,9 % STERIL 12.2.3 BTL -
1407 NEEDLE 20.2 SET -
1408 NEODIAFORM TABLET 25.5 TAB -
1409 NEPHROLIT KAPSUL 30.6 KAP -
1410 NEUROTROPIC INJEKSI 29.2.2 AMP -
1411 NIFEDIPIN TABLET 10 MG 17.1 TAB -
1412 NISTATIN 100.000 IU / G TABLET VAGINAL 6.5 TAB -
1413 NISTATIN TABLET 500 IU TABLET SALUT 6.3 SUPP -
1501 OBAT ANTI TUBERKULOSIS ( FDC ) 6.2.4 PKT -
1502 OBAT ANTI TUBERKULOSIS ANAK 6.2.4 PKT -
1503 OBAT ANTI TUBERKULOSIS KATEGORI 2 6.2.4 PKT -
1504 OBAT ANTI TUBERKULOSIS SISIPAN 6.2.4 PKT -
1505 OBAT BATUK HITAM ( OBH ) CAIRAN 26.3 BTL -
1506 OBYEK GLASS 31 SET -
1507 OKSITETRASIKLIN HCl SALEP 3 % 18.2 TUB -
1508 OKSITETRASIKLIN HCl SALEP MATA 18.2 TUB -
1509 OKSITOSIN INJEKSI 10 IU/ML-1 ML 21.2.2 AMP -
1510 OMEPRASOL KAPSUL 20 MG 22.1 KAP -
1601 PAPAVERIN TABLET 25.4 TAB -
1602 PARASETAMOL SIRUP 120 MG/5ML 1.2 BTL -
1603 PARASETAMOL TABLET 500 MG 1.2 TAB -
1604 PEHAVRAL 29.2.2 TAB -
1605 PEMBALUT GIPS 1.2 ROL -
1606 PEMBERSIH LANTAI BTL -
1607 PERHIDROL( H2O2 ) 32 BTL -
1608 PILOKARPIN HCl/ NITRAT TETES MATA 2% 1.1 BTL -
1609 PIRACETAM INJEKSI 21.2.5 AMP -
1610 PIRACETAM KAPSUL 800 MG 21.2.5 KAP -
1611 PIRANTEL PAMOAT TABLET 125 MG 6.1.1 TAB -
1612 PIRIDOKSIN TABLET 10MG 29 TAB -
1613 PIROKSIKAM KAPSUL 10 MG 4.1 TAB -
1614 PLESTER 5 YARD X 2 INCH 32 ROL -
1615 POLIKRESULEN ( ALBOTYL ) CONCENTRATE 13.1 BTL -
1616 PREDNISON TABLET 5 MG 6.4.2.2 TAB -
1617 PRIMPERAN DROP 25.2 BTL -
1618 PROFENID SUPP 1.2 SUPP -
1619 PROKAIN BENZIL PENISILINA 3 JUTA IU/VIAL INJ 6.2.1 VIAL -
1620 PROPILTIOURASIL TABLET 100 MG TAB -
1621 PROPRANOLOL TABLET 10 MG 16.3 TAB -
1622 PROPRANOLOL TABLET 40 MG 16.3 TAB -
1623 PROTEIN URINE STRIP 2 PM 31 STRIP -
1701 RANITIDIN INJEKSI 7.1 AMP -
1702 RANITIDIN TABLET 7.1 TAB -
1703 REAGEN REES ECKER 31 SET -
1704 REAGEN FOTOMETER : -
- SGOT 31 SET -
- SGPT 31 SET -
- GLUCOSE 31 SET -
- URIC ACID 31 SET -
- CHOLESTEROL 31 SET -
- CREATININ 31 SET -
- UREUM 31 SET -
- BILIRUBIN 31 SET -
- CHOLESTEROL HDL 31 SET -
- CHOLESTEROL LDL 31 SET -
- TRIGLISERID 31 SET -
1705 REAGEN HEMATOLOGI ANALYZER( SYSMEX ) -
- POCH PACK D 31 BTL -
- POCH PACK L 31 BTL -
- TABUNG K3 EDTA 31 BTL -
- CELL CLEAN 31 SET -
- TERMAL PAPER 31 ROL -
- EIGHT CHECK ( L,N,H ) 31 SET -
1706 REAGEN HEMATOLOGI ANALYZER(NIHON KOHDEN ) -
- DILUENT (ISOTONAC) 31 box 18 L -
- CLEANER (CLEANAC 3N) 31 box 5 L -
- CLEANER (CLEANAC) 31 box 5 L -
 - EIGHT CHECK ( L,N,H ) 31 vial 3ml -
- LYSE (HEMOLINAC 3N) 31 btl 500 ml -
1707 REAGEN HEMATOLOGY ANALYZER ( ORPHEE/ MITHYC 18) -
- MYTHIC 18 DILUENT 31 btl 10 L -
- MYTHIC 18 CYANIDE FREE LYTIC SOLUTION 31 btl 1 L -
- MYTHIC 18/22 ENZYMATIC CLEANER 31 btl 1 L -
- CONTROL MYT-3D TRI LEVEL ( N,H,L ) 31 3 x 2.5 ml -
1708 REAGEN ASAM URAT BENECHECK 31 STRIP -
1709 REAGEN CHOLESTEROL BENECHECK 31 STRIP -
1710 REAGEN HB HEMOCUE 31 STRIP -
1711 REAGEN HIV 31 PKT -
1712 REAGEN HIV ONCOPROBE 31 PKT -
1713 REAGEN HIV SD 31 PKT -
1714 REAGEN WIDAL 31 SET -
1715 RETINOL ( VITAMIN A ) KAPSUL 100.000 IU 29 KAP -
1716 RETINOL ( VITAMIN A ) KAPSUL 200.000 IU 29 KAP -
1717 RINGER LAKTAT LARUTAN INFUS STERIL 20.2 BTL -
1718 RISPERIDON TABLET 2 MG 23.4 TAB -
1801 SALBUTAMOL TABLET 2 MG 26.1 TAB -
1802 SALEP 2 - 4 KOMBINASI 18.5 POT -
1803 SALISIL BEDAK 2% 18.8 KTK -
1804 SARUNG TANGAN NON STERIL NO.7.,7,5 DAN 8 32 PSG -
1805 SARUNG TANGAN STERIL NO.7.,7,5 DAN 8 32 PSG -
1806 SCABISID CREAM 21.2.2 TUB -
1807 SEFADROKSIL KAPSUL 500 MG 18.8 KAP -
1808 SEFADROKSIL SIRUP 125 MG/5 ML 6.2.1 BTL -
1809 SEFTRIAKSON INJEKSI 1 GR 6.2.1 VIAL -
1810 SEMEN SENG FOSFAT SERBUK DAN CAIRAN 14.4 BTL -
1811 SERUM A,B DAN AB( SERUM GOL DARAH ) 31 SET -
1812 SERUM ANTI BISA ULAR POLIVALEN INJ 5 ML ( ABU I 14.2 VIAL -
1813 SERUM ANTI DIFTERI INJ.20.000 IU/VIAL ( A.D.S) 27.1 VIAL -
1814 SERUM ANTI TETANUS INJ.1.500 IU/VIAL ( A.T.S ) 27.1 AMP -
1815 SIANOKOBALAMIN ( VIT B12 ) INJ.500 MCG/ML 29 AMP -
1816 SIANOKOBALAMIN ( VIT B12 )TABLET 50 MCG 10.1 TAB -
1817 SIKZONOAT INJEKSI ( FLUPHENAZIN ) 23.4 AMP -
1818 SILK ( BENANG BEDAH SUTERA ) NO.3/0 32 SET -
1819 SIMVASTATIN TABLET 10 MG 17.7 TAB -
1820 SPIRONOLAKTON TABLET 100 MG 14.1 TAB -
1821 SPONS GELATIN CUBICLE CUBICLES 1X1X1 CM 14.4 KTK -
1822 STESOLID RECTAL TUBE 5 MG 5 TUB -
1823 STOMACH TUBE 32 SET -
1901 TABLET TAMBAH DARAH KOMBINASI 14.1 TAB -
1902 TERBUTALIN TABLET TAB -
1902 TETRAKAIN HCl TETES MATA 6.2.2 BTL -
1903 TETRASIKLIN HCl KAPSUL 500 MG 6.2.7 KAP -
1904 TIAMIN HCl MONONITRAT ( VIT B1 ) TABLET 50 MG 29 TAB -
1905 TRANFUSION SET 32 SET -
1906 TRANSAMIN INJEKSI 10.3 AMP -
1907 TRIFLUOPERAZIN TABLET 23.4 TAB -
1908 TRIHEKSIFENIDIL HIDROKLORIDA TABLET 2 MG 9.1 TAB -
1909 TRIKRESOL FORMALIN ( TKF ) CAIRAN 9 BTL -
1910 TUMPATAN SEMENTARA 9 BH -
2001 URINE BAG 32 SET -
2002 URINE ANALIZER 10 PM 31 BTL -
2003 URINE ANALIZER 11 PM 31 BTL -
2004 URINE ANALIZER 13 PM 31 BTL -
2101 VITAMIN B KOMPLEK TABLET 29 TAB -
2102 VENTOLIN NEBULIZER / SALBUTAMOL NEBULIZER 26.1 AMP -
2201 YODIUM POVIDON LARUTAN 10 % 30 ML 13.1 BTL -
2202 YODIUM POVIDON LARUTAN 10 % 60 ML 13.1 BTL -
2203 YODIUM POVIDON LARUTAN 10 % 300 ML 13.1 BTL -
2301 YELLOW TIP 31 PAK -
2401 ZINC DISPERSIBLE TAB 20 MG 20.1 TAB -

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KUNJUNGAN

JUMLAH KUNJUNGAN RESEP BAYAR GRATIS BPJS

OBAT GENERIK OBAT NON GENER

PERESEPAN ( R/ )

MENGETAHUI / MENYETUJUI YANG MENYERAHKAN

KEPALA DINKES KEPALA INFALKES

) Dr.SUNHADI,M.Kes ( ) TITIK RUSIANA SETIJAWATI,SE.,MM (

NIP.19590721 198701 1 001 NIP.19720111 199203 2 003
AIAN DAN LEMBAR PERMINTAAN OBAT
( LPLPO )

BULAN :
TAHUN :

PEMA PERMIN PEMBERIAN

SISA STOK STOK OPT KET
KAIAN TAAN

APBD PROGRAM LAIN JUMLAH

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- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -
- - -

- - -
- - -
- - -
- - -
 - - -
- - -
- - -
- - -
- - -
- - -

TOTAL KUNJUNGAN
BPJS

0
OBAT NON GENERIK

KAN YANG MEMINTA/ MELAPOR YANG MENERIMA

ES KEPALA PUSKESMAS PETUGAS PUSKESMAS

ATI,SE.,MM (
3 2 003
 Rata2
pemakaian
perbulan th
sebelumnya

16
 LAPORAN SISA STOK TERINCI PENGADAAN REAGEN
PUSKESMAS 2016

HARGA
SISA STOK 31
NAMA REAGEN SATUAN SUDAH
NO DESEMBER TOTAL HARGA
KEMASAN TERMASUK
2016
PPN 10%

1 2 3 4 5 6=4X5
REAGEN
HIV (Intech) ktk 40 bh 1,520,000 0
Poch pack L btl 500 ml 1,575,000 0
Eight check (L,N,H) set/3x1,5 ml 815,000 0
0
Poch pack L Botol 1,703,000 0
Poch pack D Box 5 lt 540,000 0
Eight check set 862,000 0
Golongan darah A Vial 105,000 0
Golongan darah B Vial 105,000 0
Golongan darah AB Vial 105,000 0
Widal O lorne vial 172,000 0
Widal H lorne Vial 172,000 0
Widal AO lorne Vial 172,000 0
Widal BO lorne Vial 172,000 0
Larutan Giemsa Botol 100 ml 650,000 0
Obyek glass Kotak 27,000 0
Urine analyzer botol 312,500 0
Etanol 95 % Botol 10,000 0
Reagen HIV Intec box 100 4,180,000 0
Lanset Kotak 100 40,000 0
Gliko Dr. 352,000 0
0
Humatrol N set 1,600,000 0
Asam urat botol 1,573,000 0
Cholesterol botol 1,760,000 0
Trigliserid botol 2,541,000 0
halogen lamp unit 390,000 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
 0
0
0
0
0
0
0
0
0
0
0
TOTAL 0
 LAPORAN SISA STOK TERINCI PENGADAAN BMHP
PUSKESMAS 2016

HARGA
SISA STOK 31
SATUAN SUDAH
NO NAMA BMHP DESEMBER TOTAL HARGA
KEMASAN TERMASUK
2016
PPN 10%

1 2 3 4 5 6=4X5
BMHP
Pampers XL pcs 4,500 0
Pampers L pcs 4,500 0
Pampers M pcs 4,500 0
0
TE-15 Spalk 10x15 cm pcs 60 3,375.00 202500
TE-60 Spalk 60x10x8 cm pcs 40 17,100 684000
TE-80 Spalk 80x10x8 cm pcs 30 24,300 729000
pane Arm sling M pcs 18 19,800 356400
pane Arm sling L pcs 18 19,800 356400
0
USG gel galon 5 lt galon 3 117,150.00 351450
Google protective onemed buah 26,250 0
0
Pampers dws M Bag 137 38,543.4 5280445.8
Pampers dws L Bag 270 38,543.4 10406718
0
Stardec latek exam powder glove-S, Box 43,272.73 0
Stardec latek exam powder glove-M, Box 43,272.73 0
Stardec Nebulezer with mask (adult) piece 88 25,727 2263999.76
Stardec Nebulezer with mask (pediatric) piece 101 25,727 2598454.27
0
BBRAUN Bbraun softaman 1000 ml Botol 8 153,000.00 1224000
BBRAUN Bbraun softaman 500 ml Botol 14 78,750 1102500
0
ALKAPHARM,FRANCE Alkazyme sachet 25
MG Pack 50 801,000.00 40050000
0
0
0
0
SERENITY Mucus Extraktor 25 ml pcs 125 6,900.00 862500
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
TOTAL 66468367.83
PENGADAAN BMHP DENGAN DANA KAPITASI JKN PUSKESMAS BAURENO TAHUN 2016

NO NAMA PENYEDIA NAMA BMHP KEMASAN JUMLAH HARGA

1 PT. dIVA MULYA PRATAMA. Pampers XL pcs 40 4,500
Pampers L pcs 300 4,500
Pampers M pcs 150 4,500

PT. GAYOLINDO PUTRA LINGE TE-15 Spalk 10x15 cm pcs 80 3,375.00

TE-60 Spalk 60x10x8 cm pcs 50 17,100
TE-80 Spalk 80x10x8 cm pcs 40 24,300
pane Arm sling M pcs 20 19,800
pane Arm sling L pcs 20 19,800

PT. INTISUMBER HASIL SEMPURNA USG gel galon 5 lt galon 4 117,150.00

Google protective onemed buah 20 26,250

PT.KREASI PERDANA INDONESIA. Pampers dws M Bag 20 38,543.4

Pampers dws L Bag 37 38,543.4

Stardec latek exam powder

PT.ANUGRAH ARGON MEDIKA glove-S, Box 40 43,272.73
Stardec latek exam powder
glove-M, Box 60 43,272.73
Stardec Nebulezer with mask (ad piece 100 25,727
Stardec Nebulezer with mask (pe piece 100 25,727

BBRAUN Bbraun softaman

PT. DOS NI ROHA SURABAYA. 1000 ml Botol 20 153,000.00
BBRAUN Bbraun softaman
500 ml Botol 14 78,750

ALKAPHARM,FRANCE
Pack 2 801,000.00
PT. MILENIUM PHARMACON INTERNAS Alkazyme sachet 25 MG

PT. PRATAMINDO MITRA RIZKY

SERENITY Mucus Extraktor

PT. INDOFARMA GLOBAL MEDIKA 25 ml pcs 140 6,900.00
PENGADAAN REAGEN DENGAN DANA KAPITASI JKN PUSKESMAS BAURENO TAHUN 2016

NO NAMA PENYEDIA NAMA REAGEN KEMASAN JUMLAH HARGA

PT. DIVA MULYA PRATAMA HIV (Intech) ktk 40 bh 2 1,520,000
Poch pack L btl 500 ml 1 1,575,000
Eight check (L,N,H) set/3x1,5 ml 1 815,000

PT. PRATAMINDO MITRA RIZKY Poch pack L Botol 3 1,703,000

Poch pack D Box 5 lt 6 540,000
Eight check set 1 862,000
Golongan darah A Vial 1 105,000
Golongan darah B Vial 1 105,000
Golongan darah AB Vial 1 105,000
Widal O lorne vial 1 172,000
Widal H lorne Vial 1 172,000
Widal AO lorne Vial 1 172,000
Widal BO lorne Vial 1 172,000
Larutan Giemsa Botol 100 ml 1 650,000
Obyek glass Kotak 10 27,000
Urine analyzer botol 2 312,500
Etanol 95 % Botol 5 10,000
Reagen HIV Intec box 100 2 4,180,000
Lanset Kotak 100 5 40,000
Gliko Dr. 10 352,000

PT. RAJAWALI NUSINDO Humatrol N set 1 1,600,000

Asam urat botol 1 1,573,000
Cholesterol botol 1 1,760,000
Trigliserid botol 1 2,541,000
halogen lamp unit 1 390,000

PENGADAAN ALKES DENGAN DANA KAPITASI JKN PUSKESMAS BAURENO TAHUN 2016

NO NAMA PENYEDIA NAMA REAGEN KEMASAN JUMLAH HARGA

SHENZEN JUMPER
PT.MITRA ASA PRATAMA. MEDICAL EQUIPMENT UNIT 4 475,000.00

PT. RAJAWALI NUSINDO, Poly tiang infus k.5.p.c unit 10 604,000

ABN Digital thermometer unit 20 44,476.35
ABN Calibra Aneroid tensimeter unit 5 137.922
Roche urisys unit 1 8,470,000
 PT.MITRA ASA PRATAMA.

TOTAL PT. INDOFARMA GLOBAL M

180,000
1,350,000 PT. RAJAWALI NUSINDO,
675,000

270,000
855,000
972,000
396,000
396,000

468,600
525,000
-
770,868
1,426,106

1,730,909

2,596,364
2,572,727
2,572,727
-

3,060,000

1,102,500
-

1,602,000
-
-
-
-

966,000
-
-
-
-
-
-
-
TOTAL
3,040,000
1,575,000
815,000

5,109,000
3,240,000
862,000
105,000
105,000
105,000
172,000
172,000
172,000
172,000
650,000
270,000
625,000
50,000
8,360,000
200,000
3,520,000

1,600,000
1,573,000
1,760,000
2,541,000
390,000

TOTAL

1,900,000

6,040,000
889,527
690
8,470,000
-
-
-
-
-
-
-
-
-
-
SHENZEN JUMPER
MEDICAL UNIT 4 ###
EQUIPMENT

SERENITY Mucus
Extraktor 25 ml pcs 140 6,900.00

Poly tiang infus k.5.p. unit 10 604,000

ABN Digital thermome unit 20 ###
ABN Calibra Aneroid t unit 5 137.922
Roche urisys unit 1 ###