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LEMBAR PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO )

PUSKESMAS TAHUN 2022
DOKUMEN Nomor Tanggal
DINKES KOTA
PUSKESMAS : WOLIO PELAPORAN BULAN / PERIODE : JANUARI 2023 PUSKESMAS
KECAMATAN : WOLIO PERMINTAAN BULAN / PERIODE : FEBRUARI 2023
KOTA : BAU-BAU
PROPINSI : SULAWESI TENGGARA

Stok Peneri- Perse- Pema- Stok Stok Permin- Pemberian

No Nama Obat Satuan Awal maan diaan kaian Akhir Opt. taan PKD PKPS- Prog- Lain- Keterangan
Jumlah
BBM ram Lain
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14 15= (11+12+13+14) 16

1 Abbocath No. 18 Buah 19 19 0 19

2 Abbocath No. 20 Buah 63 63 0 63

3 Abbocath No. 22 Buah 55 55 0 55

4 Abbocath No. 24 Buah 48 48 0 48

5 Acyclofir 200 mg Tablet 0 - 0 0

6 Acyclofir 400 mg Tablet 250 250 0 250

7 Acyclofir cream Tube 0 - 0

8 Alat suntik sekali pakai 1 ml Pcs 0 - 0 0

9 Alat suntik sekali pakai 2,5 ml Pcs 0 - 0

10 Alat Suntik Sekali Pakai 3 ml Pcs 47 200 247 200 47

11 Alat suntik sekali pakai 5 ml Pcs 25 25 0 25

12 Albendazole tablet 400 mg Tablet 200 200 0 200

13 Albendazole suspensi 200 mg/ 5 mL Btl 10 ml 0 - 0

14 Alopurinol tablet 100 mg Tablet 1300 2,000 3,300 2000 1300

15 Ambroksol tablet 30 mg Tablet 0 - 0 0

16 Aminofilina injeksi 24 mg/ml - 10 ml Ampul 0 - 0

17 Aminofilin tablet 200 mg Tablet 0 - 0

18 Amitriptilin HCl tablet salut 25 mg Tablet 100 100 0 100

19 Amlodipin Tab 10 mg Tablet 0 - 0

20 Amlodipin Tab 5 mg Tablet - 0

21 Amoksisilin kapsul 250 mg Tablet 0 - 0

22 Amoksisilin kaplet 500 mg Tablet - 0

23 Amoksisilin sirup kering 125 mg/5ml Btl 60 ml 115 115 0 115

24 Ampicillin 500 mg tablet Tablet 0 - 0

25 Ampicillin Sirup Kering 125 mg/ 5 ml Btl 60 ml 0 - 0

26 Antalgin (Metampiron) tablet 500 mg Tablet 0 - 0 0

27 Acetylcystein 200 mg Tablet 60 60 0 60

28 Antasida Doen tablet Tablet 0 - 0 0

29 Antasida DOEN suspensi Btl 60 ml 0 - 0 0

30 Antibakteri DOEN II Tube 0 - 0

31 Antifungi DOEN Kombinasi Pot 0 - 0 0

32 Anti Hemoroid Doen Kombinasi Suppo 3 30 33 30 3

33 Antimigren : Ergotamin tatrat 1mg + kofein 50 mg Tablet 0 - 0

34 Aqua pro Injeksi steril, bebas pirogen Ampul 0 - 0 0

35 Artesunate Tablet Tablet 0 - 0

36 Asam Folat tablet 1 mg Tablet 0 - 0 0

37 Asam Askorbat (Vit C) tablet 50 mg Tablet 0 - 0 0

38 Asam Askorbat (Vit C) tablet 250 mg Tablet 0 - 0

39 Asam Mefenamat tab 500 mg Tablet 100 2,500 2,600 2500 100

40 Asetosal tablet 100 mg Tablet 0 - 0

41 Asetosal tablet 500 mg Tablet 0 - 0

42 Becefort Tablet 0 - 0

43 Auto Disable Syringe (ADS) 0,5 ml DPT-BD Pcs 0 - 0

44 Auto Disable Syringe (ADS) 0,05 ml DPT-BD Pcs 0 - 0 0

45 Betametason krim 0.1% Tube 0 30 30 30 0

46 Bisturi Buah 23 23 0 23

47 Captopril tablet 12,5 mg Tablet 500 1,000 1,500 1000 500

48 Captopril tablet 25 mg Tablet 400 1,000 1,400 1000 400

49 Cat Gut No.2/0 Pcs 12 12 24 12 12

50 Cat Gut No.3/0 Pcs 47 47 0 47

51 Carbamazepin Tablet 0 - 0 0

52 Cetirizine 10 mg Tablet 0 - 0

53 Cimetidin tablet 200 mg Tablet 0 - 0 0

54 Betahistine 6 mg Tablet 0 - 0

55 Deksametason injeksi 5 mg/ml - 1 ml Ampul 0 - 0 0

56 Deksametason tablet 0,5 mg Tablet 0 - 0 0

57 Cetirizin Syrup Botol 0 - 0 0

58 Difenhidramin HCl inj 10 mg/ml-1 ml Ampul 5 5 0 5

59 Diazepam 2 mg Tablet 0 200 200 200 0

60 Diazepam 5 mg Tablet 0 - 0 0

61 Domperidon Tab 10 mg Tablet 0 - 0 0

62 Domperidon suspensi 5 mg/ 5 mL Btl 60 ml 0 - 0 0

63 Dulcolax Suppo 4 4 0 4

64 Efedrin HCl tablet 25 mg Tablet 0 - 0 0

65 Dulcolax suppo 0 - 0 0

66 Epinefrina / Adrenalina Injeksi 0,1% Ampul 0 - 0

67 Erytromisin 250 kapsul Tablet 0 - 0 0

68 Erytromisin 500 kaplet Tablet 0 - 0 0

69 Erytromisin Sirup Kering 200 mg/ Btl 60 ml 0 - 0 0

70 Etakridin ( Rivanol ) larutan 0,1% Btl 300 ml 0 - 0 0

71 Diazepam Injeksi Ampul 9 9 0 9

72 Etanol 70 % 1 liter 3 20 23 20 3

73 Etanol 70 % Btl 100 ml 0 - 0

74 Etil klorida semprot Btl 100 ml 0 - 0 0

75 Eugenol Btl 10 ml 3 3 0 3

76 Foley Catheter 16 G Pcs 0 - 0

77 Foley Catheter 18 G Pcs 0 - 0 0

78 Foley Catheter 20 G Pcs 0 15 15 15 0

79 Foley Catheter 22 G Pcs 0 - 0 0

80 Fenitoin Natrium 30 mg Kapsul 0 - 0 0

81 Fenobarbital injeksi 50 mg/ml - 1 ml Ampul 0 - 0 0

82 Fenobarbital tablet 30 mg Tablet 200 200 0 200

83 Fenol Gliserol tetes telinga 10% Btl 5 ml 0 - 0 0

84 Fitomenadion (Vit.K1) injeksi 10 mg/ml - 1 ml Ampul 30 30 0 30

85 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tablet 0 - 0 0

86 Flouride 1 mg tablet Tablet 0 - 0

87 Furosemid tablet 40 mg Tablet 50 50 0 50

88 Furosemid Inj I.V/I.M 10 mg/ml Ampul 0 - 0

89 Garam Oralit untuk 200 ml air Sase 85 100 185 100 85

90 Gentamisin salep kulit 0,3 % Tube 0 - 0 0

91 Gentamisin salep mata 0,1 % Tube 0 - 0 0

92 Gentian Violet larutan 1 % Btl 10 ml 0 - 0

93 Glass Ionemer Set 0 - 0 0

94 Guaifenesin Tablet 0 - 0

95 Glibenklamid tablet 5 mg Tablet 400 400 0 400

96 Glimepirid 1 mg Tablet 400 500 900 500 400

97 Glukosa larutan infus 5 % steril Btl 500 ml 0 - 0

98 Griseofulvin tablet 125 mg, micronized Tablet 0 - 0 0

99 Haloperidol tablet 0,5 mg Tablet 125 125 0 125

100 Haloperidol tablet 1,5 mg Tablet 120 120 0 120

101 Haloperidol tablet 5 mg Tablet 40 40 0 40

102 hansd Schun no. 7 Set 0 50 50 50

103 hansd Schun no. 8 Set 0 - 0

104 Handscoon Non Steril No. 7 Box 0 3 3 3 0

105 Handscoon Steril No. 7,5 Set 80 50 130 50 80

106 Hidroklorotiazid (HCT) tablet 25 mg Tablet 0 - 0 0

107 Hidrokortison krim 2,5 % Tube 0 - 0 0

108 Ibuprofen tablet 200 mg Tablet 0 - 0 0

109 Ibuprofen tablet 400 mg Tablet 0 - 0 0

110 Infusion set anak Set 0 - 0

111 infusion set dewasa Set 148 148 0 148

112 Isoniasida tab 100 mg Tablet 0 - 0 0

113 Ibuprofen sirup botol 0 - 0

114 Isosorbid Dinitrat tablet sublingual 5 mg Tablet 0 - 0

115 Jarum jahit hect otot No.9 Lusin 0 - 0

116 Jarum jahit hect otot No.10 Lusin 0 - 0 0

117 Jarum jahit hect otot No.11 Lusin 0 - 0

118 Jarum jahit hect otot No.12 Lusin 0 - 0 0

119 Jarum jahit hect otot No.13 Lusin 0 - 0

120 Kalsium hidroksida pasta Tube 0 - 0

121 Kalsium Laktat (Kalk) tablet 500 mg Tablet 800 1,000 1,800 1000 800

122 Kapas pembalut 250 gr Bungkus 0 - -5 5

123 Kasa Pembalut Hidrofil 4 m x 3 cm elastic Roll 224 224 4 220

124 Kasa Pembalut Hidrofil 4 m x 15 cm Roll 0 - 0 0

125 Kasa Pembalut 2 m x 80 cm Bungkus 0 - 0

126 Ketokenazol 200 mg Tablet 0 - 0 0

127 Ketokenazol salep Tube 0 - 0 0

128 Ketorolac Injeksi 30 mg Ampul 0 - 0

129 Kloramfenikol kapsul 250 mg Tablet 0 - 0

130 Kloramfenikol tetes telinga 3 % Botol 0 - 0

131 Kloramfenikol salep mata 1 % Tube 0 - 0

132 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet 400 400 0 400

133 Klorfenol kamfer mentol (CHKM) Botol 1 1 0 1

134 Klorpromazin HCl tablet salut 100 mg Tablet - 0

135 Klorpromazin HCl tablet salut 100 mg Tablet 0 - 0

136 Kombinasi Pirimetamin 25 mg + Sulfadoxin 500 mg Tablet 0 - 0

Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg
Btl 60 ml
137
+ Trimetoprim 40 mg / 5 ml 37 37 0 37

138 Kotrimoksazol tablet kombinasi: Sulfametoksazol 400 mg Tablet

+ Trimetoprim 80 mg 0 500 500 500 0
Kotrimoksazol tablet pediatrik, kombinasi:
139 Tablet
Sulfametoksazol 100 mg + Trimetoprim 20 mg 0 - 0

140 Kombinasi Ergotamin 1 mg + Cafein 50 mh Tablet 0 - 0

141 Kuinin (Kina) tablet 200 mg Tablet 0 - 0

142 Lexavit Tablet 0 - 0

143 Loperamid Hcl 2 mg Tablet 0 - 0

144 Lidokain Injeksi 2 % Ampul 90 90 0 90

Lidokain komp. injeksi, Kombinasi:
145 Ampul
Lidokain HCl 2% + Epinefrin 1:80.000 - 2 ml 30 30 60 30 30

146 Lisol larutan Btl 1000 ml 1 1 0 1

147 Magnesium Sulfat inj (IV) 20% - 25 ml Vial 0 - 0

148 Magnesium Sulfat inj (IV) 40% - 25 ml Vial 0 - 0

149 Masker Pcs 0 - 0 0

150 Meloksikam Tab 15 mg Tablet 0 - 0 0

Metilergometrin Maleat (Metilergometrin)
151 Tablet
tablet salut 0,125 mg 0 - 0

152 Metilergometrin Maleat inj 0,200 mg-1 ml Ampul 0 - 0

153 Mebendazol sirup 100 mg/5 ml Botol 30 ml 0 - 0

154 Metil prednisolone 4 mg Tablet 0 - 0

155 Metformin HCl tablet 500 mg Tablet 0 - 0

156 Metoklorperamide syrup Btl 60 ml 0 - 0

157 Metoklorperamide 10 mg Tablet 700 700 0 700

158 Metronidazol tablet 250 mg Tablet 0 - 0

159 Metronidazol tablet 500 mg Tablet 200 1,000 1,200 1000 200

160 Miconazole krim 2 % Tube 24 96 120 96 24

161 Mummyflying pasta Botol 0 - 0

162 New Diatab Tablet 0 - 0

163 Natrium diklofenat 25 mg Tablet 0 - 0 0

164 Natrium diklofenat 50 mg Tablet 0 - 0

165 Natrium Klorida (NaCL)larutan infus 0,9 % steril Btl 500 ml 13 20 33 20 13

166 Nifedipin 20 mg tablet Tablet 0 - 0

167 Nistatin tablet salut 500.000 IU Tablet 100 100 0 100

168 Nistatin tablet vaginal 100.000 IU/g Tablet 95 95 0 95

169 Obat anti TB kategori sisipan Paket 0 - 0

170 Obat Anti Tb Kategori II (FDC) Paket 0 - 0

171 Obat Anti TB kategori I (FDC) Paket 4 4 0 4

172 Obat Anti TB Kategori Anak Paket 5 5 0 5

173 Obat Batuk Hitam ( O.B.H. ) cairan Btl 100 ml 0 - 0

174 OAM Tablet 0 - 0

175 Oksitetrasiklin HCl SK 3 % Tube 25 25 25 0

176 Oksitetrasiklin HCl salep mata 1 % Tube 0 - 0 0

177 Oksitosin injeksi 10 IU/ml - 1 ml Ampul 50 50 0 50

178 Omeprazol kapsul 20 mg Tablet 0 1,000 1,000 1000

179 Papaverin tablet Tablet 0 - 0

180 Parasetamol drop 100 mg/ml Botol 0 - 0 0

181 Parasetamol sirup 120 mg/5 ml Btl 60 ml 0 - 0 0

182 Parasetamol tablet 100 mg Tablet 0 - 0

183 Parasetamol tablet 500 mg Tablet 0 - 0 0

184 Pot Dahak Buah 200 200 0 200

185 Pirantel Pamoat tab 125 mg Tablet 198 198 0 198

186 Piridoksin HCl (Vit.B6) tablet 10 mg Tablet 600 2,000 2,600 2000 600

187 Piroksikam tab 20 mg Tablet 0 - 0 0

188 Plester 5 yard x 2 inci Roll 0 - 0

189 Prednison tablet 5 mg Tablet 0 2,000 2,000 2000 0

190 Primakuin tablet 15 mg Tablet 0 - 0

191 Propiltiourasil tablet 100 mg Tablet 100 100 0 100

192 Plester / Non woven 10 x 10 Roll 11 11 0 11

193 Paper tape 7,5 x 9,14 Roll 9 9 0 9

194 Ranitidin tab 150 mg Tablet 0 - 0 0

195 Ranitidin Inj Ampul 0 - 0

196 Reserpin 0.25 mg Tablet 0 - 0

197 Retinol (Vitamin A) Kapsul 200.000 IU Kapsul 500 500 0 500

198 Retinol (Vitamin A) Kapsul 100.000 IU Kapsul 0 - 0

199 Rifampisin kaplet 450 mg Tablet 0 - 0

200 Ringer Laktat larutan infus steril (Produk lokal) Btl 500 ml 19 20 39 20 19

201 Risperidon Tab 3 mg Tablet 5 200 205 200 5

202 Salbutamol tablet 2 mg Tablet 0 1,000 1,000 1000 0

203 Salbutamol tablet 4 mg Tablet 0 - 0 0

Salep 2-4 , Kombinasi:
204 Pot
Asam Salisilat 2% + Belerang Endap 4% 28 28 0 28

205 Salisil Bedak 2 % Ktk 50 gram 8 48 56 48 8

206 Salisil spritus 10 % Btl 10 ml 0 - 0

207 Sefadroksil kapsul 500 mg Tablet 0 - 0

208 Sefadroksil sirup kering 125 mg/5 ml Btl 60 ml 26 26 0 26

209 Semen seng fos. Serbuk/ cair Btl 30 gram 0 - 0

210 Serum Anti Tetanus Injeksi 1.500 IU/ampul (A.T.S.) Ampul 0 - 0 0

211 Serum Anti Tetanus Injeksi 20.000 IU/ampul (A.T.S.) Ampul 0 - 0

212 Sianokobalamin (Vit.B12) Tab 500 mcg-ml Tablet 0 1,000 1,000 1000

213 Sianokobalamin (Vit.B12) INJ Ampul 0 - 0

214 Silk (ben. Bedah sutra) no.3/0 Sase 9 12 21 12 9

215 Silver amalgam ser. 55-75 % Botol 0 - 0

216 Simvastatin 10 mg Tablet 0 - 0

217 Siprofloksasin tablet 500 mg Tablet 200 500 700 500 200
218 Sulfacetamida nat 15 % T M Botol 0 - 0

219 Tablet tambah darah kombinasi Tablet 9450 9,450 0 9450

220 Tempor. Stopp.flet.serb. & cair Set 0 - 0

221 Tetrasiklin HCl kapsul 250 mg Kapsul 0 - 0

222 Tetrasiklin HCl kapsul 500 mg Kapsul 0 - 0

223 Thiamfenikol 500 mg Kapsul 0 - 0

224 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml Ampul 0 - 0

225 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg Tablet 0 1,000 1,000 1000 0

226 Tramadol 50 mg Tablet 0 - 0

227 Tramadol Inj 50 mg/ml Ampul 0 - 0

228 Triheksifenidil tablet 2 mg Tablet - 0

229 Trikesol formalin (TKF) cairan Botol 0 - 0

230 Urin bag Pcs 17 17 0 17

231 Vitamin B Kompleks tablet Tablet 2700 5,000 7,700 5000 2700

232 Vaksin Anti Rabies Kuur 0 - 0 0

233 Wing Needle No. 21 G Buah 0 - 0

234 Wing Needle No. 23 G Buah 0 - 0

235 Wing Needle No. 25 G Buah 0 - 0

236 Wing Needle No. 27 G Buah 0 - 0

237 Yodium pov. Lar. 10 % 30 ml Botol 21 21 0 21

238 Yodium pov. Lar. 10 % 60 ml Botol 0 - 0 0

239 Yodium pov. Lar. 10 % 300 ml Botol 0 - 0 0

240 Zinc Sirup 20 mg/ 5 ml Btl 60 ml 55 55 0 55

241 Zinc tablet 20 mg Tablet 300 500 800 500 300

242 Alkohol Swab Dus 30 24 54 24 30

243 Bedaquline Tablet 0 - - 0 0

244 Ethambutol 400 mg Tablet 0 - 0 0

245 Levofloxacin Tablet 0 - - 0 0

246 ethionamida Tablet 0 - 0 0

247 Pyrazinamid Tablet 0 - 0 0

248 MB Tablet 2 2 0 2

249 PB Tablet 0 - 0 0

250 Klofazimin lampren 100 mg Tablet 0 - - 0 0

251 Rapid hbsAg Test 0 - 0 0

252 Reagen TB Kit 0 - 0 0

253 Masker N95 Aero Pro Pcs 0 - 0 0

254 Masker N95 Orcamcan Pcs 0 - 0 0

255 Haloperidol inj. 50 mg/ml Ampul 13 13 0 13

256 Accugence blood uric acid strip 25 test Box 0 - 0 0

257 On Call Sure Blood Glucose Strip 25 test Box 0 - 0 0

258 Masker Medical Respiratori Pcs 0 - 0 0

259 Masker 3-Plyhijab type Box 0 - 0 0

260 Masker Earloop Box 0 - 0 0

261 Kasa Pembalut Hidrofil 3,6 m x 10 cm Roll 1414 1,414 0 1414

262 Sikzonoate Ampul 3 3 0 3

263 Strip kolesterol box 0 - 0 0

264 Asam askorbat 500 mg Tablet 0 - 0 0

265 Strip gula darah Box 11 11 11 0

266 Diazepam Injeksi Ampul 0 - 0

267 Clozapin Tablet 0 - 0

268 Alprazolam 0,5 mg Tablet 0 - 0

269 Tuberkulin Ampul 0 - 0 0

270 Handrub 100 ml Botol 1 1 0 1

271 Handrub 500 ml Botol 1 1 0 1

272 TPT(Isonoazid + Rifampicin) 0 - 0 0

273 Caviton 0 - 0 0

274 Salbutamol syrup 10 10 0 10

275 Rapid HIV Test 0 - 0 0

276 KDT Dosis Harian KIT 3 3 3 0

277 Masker tie on 4 10 14 10 4

278 Masker head loop 6 6 0 6

279

JUMLAH UMUM
BPJS JUMLAH
 BPJS JUMLAH
KUNJUNGAN BAYAR TIDAK BAYAR
RESEP

Mengetahui / Menyetujui Yang Menyerahkan Yang Meminta / Yang Menerima

An. Kepala Dinas Kesehatan Kota Baubau Kasi. Kefarmasian , Alkes dan PKRT Kepala Puskesmas Wolio…………… Petugas Pengelola Obat
Kabid. Pelayanan dan Sumber Daya Manusia

HERLIN, S.Farm.,Apt M. SAID POASA.,S.Si.,Apt dr. WA ODE AZIZA AMALIA IZAT FIFIYANTI, S.Si, Apt
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