LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

PUSKESMAS

PUSKESMAS : AMPANA BARAT PELAPORAN BLN/PERIODE : DESEMBER 2021

KECAMATAN : AMPANA KOTA PERMINTAAN BLN/PERIODE : JANUARI 2022
KABUPATEN : TOJO UNA UNA
PROPINSI : SULAWESI TENGAH

Stok Penerima Persedia Pemakaia Stok Permintaa Pemberian

NO NAMA OBAT SATUAN Ket
Awal an an n Akhir n
APBD I APBD II Program Lain-lain Jumlah
1 2 3 4 5 6 ( 4+5) 7 8 (6-7) 9 10 11 12 13 14 15

1 Air untuk injeksi Botol 40 40 5 35

2 Albendazol susp 200 mg/5 ml Tablet 0 0 0
3 Albendazol tab 400 mg Tablet 0 0 0
4 Alopurinol tab 100 mg Tablet 8850 8850 850 8000
5 Alopurinol tab 300 mg Tablet 500 500 500
6 Alprazolam 0,5 mg Tablet 75 75 17 58
7 Ambroxol 30 mg Tablet 20600 20600 1000 19600
8 Ambroxol Syr 15 mg/ml Botol 594 594 14 580
9 Aminofilin inj 24 mg/ml Ampul 0 0 0
10 Aminofilin tab 150 mg Tablet 0 0 0
11 Amitriptilin tab sal 25 mg Tablet 0 0 0
12 Amlodipin tab 10 mg Tablet 0 0 0
13 Amlodipin tab 5 mg Tablet 21200 21200 3200 18000
14 Amoksisilin drops 100 mg/ml Botol 100 100 20 80
15 Amoksisilin sir forte 250 mg/5 ml Botol 0 0 0
16 Amoksisilin sir kering 125 mg/5 ml Botol 0 0 0
17 Amoksisilin tab 250 mg Tablet 4700 4700 700 4000
18 Amoksisilin tab 500 mg Tablet 37300 37300 1600 35700
19 Ampisilin 500 mg Kaplet 0 0 0
20 Ampisilin serb inj Ampul 0 0 0
21 Anestetik lokal gigi kombinasi : lidokain hcl 2% + epinefrin 1 : Ampul 540 540 540
80.000 inj 2 ml
22 Antasida, kombinasi Sirup Botol 0 0 0
23 Antasida, kombinasi Tablet Tablet 0 0 0 5000
24 Antifungi salep, kombinasi : asam benzoat 6%+ asam salisilat Pot 0 0 0
3%
25 Antihemoroid, kombinasi: bismut subgalat 150 mg + Suppo 50 50 50
heksaklorofen 2,5 mg + lidokain lidokain 10 mg+ seng oksida
120 mg + sup ad 2 g
26 Artesunat serb inj 60 mg/ml (i.v./i.m.) Ampul 0 0 0
27 Asam asetilsalisilat (asetosal) tab 80 mg Tablet 1000 1000 1000
28 Asam askorbat (vitamin C) tab 250 mg Tablet 0 0 0
29 Asam askorbat (vitamin C) tab 50 mg Tablet 35000 35000 1600 33400
30 Asam mefenamat kaps 500 mg Tablet 23300 23300 1000 22300
31 Asam Traneksamat inj Ampul 30 30 30
32 Asam Traneksamat Tab Tablet 0 0 0
33 Asiklovir cream Tube 10 10 10 0
34 Asiklovir tab 200 mg Tablet 1450 1450 1450
35 Asiklovir tab 400 mg Tablet 550 550 50 500
36 Atapulgit Tablet 3600 3600 3600
37 Atorvastatin Tablet 330 330 330
38 Bedak salisil serb 2% Pot 128 128 128
39 Betahistin 6 mg Tablet 2450 2450 950 1500
40 Betametason krim Tube 436 436 436
41 Betametason tts mata 1 mg/ml Botol 0 0 0
42 Biocombin Inj Ampul 125 125 125
43 Biocombin tab Tablet 2100 2100 1700 400
44 Bisakodil sup Suppo 0 0 0
45 Bisakodil tab sal Tablet 535 535 535
46 Bisoprolol 5 mg Tablet 600 600 600
47 Candesartan 8 mg Tablet 4320 4320 4320
48 Catarlen Tetes Mata Botol 2 2 2
49 Ceftriaxone inj Ampul 0 0 0
50 Clopidogrel 75 mg Tablet 810 810 810 ED. 420
51 Curcuma Tablet 100 100 100 0
52 Deksametason inj 5 mg/ml (i.v./i.m.) Ampul 500 500 500
53 Deksametason tab 0,5 mg Tablet 11000 11000 1000 10000
54 Diazepam enema Suppo 0 0 0
55 Diazepam inj 5 mg/ml (i.v./i.m.) Ampul 48 48 48
56 Diazepam tab 2 mg Tablet 889 889 2 887
57 Diazepam tab 5 mg Tablet 0 0 0
58 Dietilkarbamazin tab 100 mg Tablet 0 0 0
59 Difenhidramin inj 10 mg/ml (i.v./i.m.) Ampul 8 8 8
60 Digoksin tab 0,25 mg Tablet 100 100 100
61 Diltiazem hcl tab Tablet 0 0 0
62 Dimenhidrinat tab 50 mg Tablet 700 700 700
63 Doksisiklin kaps 100 mg Kaps 0 0 0
64 Domperidon susp 5 mg/5 ml Botol 505 505 10 495
65 Domperidon tab 10 mg Tablet 3500 3500 3500
66 Epinefrin (adrenalin) inj (i.v./s.k./i.m.) Ampul 0 0 0
67 Ergotamin tab 1 mg Tablet 0 0 0
68 Eritromisin kaps 250 mg Kaps 0 0 0
69 Eritromisin sir 200 mg/5 ml Botol 45 45 45
70 Eritromisin tab 500 mg Kaps 0 0 0
71 Erytromicin Syr Botol 0 0 0
72 Etil klorida semprot 100 ml Botol 2 2 2
73 Fenitoin Na inj 50 mg/ml Ampul 0 0 0
74 Fenitoin Na kaps Kaps 0 0 0
75 Fenobarbital injeksi Ampul 60 60 60
76 Fenobarbital tab 30 mg Tablet 200 200 200
77 Fitomenadion (vitamin K 1) inj Ampul 360 360 30 330
78 Fitomenadion (vitamin K 1) tab sal 10 mg Tablet 650 650 650
79 Furosemid inj 10 mg/ml (i.v./i.m.) Ampul 50 50 50
80 Furosemid tab 40 mg Tablet 0 0 0
81 Garam oralit kombinasi : natrium klorida 0,52 g + kalium saset 500 500 500
klorida 0,30 g + trinatrium sitrat 0,58 g + glukosa anhidrat 2,7 g

82 Gemfibrozil 300 mg Kapsul 0 0 0

83 Gentamisin Inj 40 mg/ml Ampul 0 0 0
84 Gentamisin Salep Kulit Tube 168 168 168
85 Gentamisin salep mata 0,3% Tube 273 273 273
86 Gentamisin tts mata 0,3% Botol 0 0 0
87 Gentian Violet Botol 0 0 0
88 Glibenklamid tab 5 mg Tablet 0 0 0 0
89 Glimepirid tab 2 mg Tablet 7000 7000 700 6300
90 Gliserin tts 100 mg/ml Botol 0 0 0
91 Glukosa Larutan Infus 10% Botol 0 0 0
92 Glukosa Larutan Infus 40% Botol 0 0 0
93 Glukosa Larutan Infus 5% steril 500 ml Botol 38 38 38
94 Griseofulvin (micronized) tab 125 mg Tablet 1400 1400 200 1200
95 Griseofulvin (micronized) tab scored 250 mg Tablet 0 0 0
96 Guaifenesin 100 mg Tablet 20300 500 20800 20800
 97 Haloperidol 0,5 mg Tablet 0 0 0
98 Haloperidol tab 0,5 mg Tablet 99 99 99
99 Haloperidol tab 1,5 mg Tablet 95 95 95
100 Haloperidol tab 2 mg Tablet 0 0 0
101 Haloperidol tab 5 mg Tablet 0 0 0
102 Hepatitis B imunoglobulin (human) inj 150 IU/1,5 ml vial 0 0 0
103 Hidrogen peroksida cairan (Larutan H2O2) Botol 0 0 0
104 Hidroklorotiazid tab 25 mg Tablet 0 0 0
105 Hidrokortison krim 2,5% Tube 0 0 0
106 Hiosina butilbromida tab 10 mg Tablet 0 0 0
107 Ibuprofen sir 100 mg/5 ml Botol 0 0 0
108 Ibuprofen sir 200 mg/5 ml Botol 420 420 420
109 Ibuprofen tab 400 mg Tablet 10600 10600 500 10100
110 Iodina Test Botol 0 0 0
111 Ipratropium bromida aerosol 20 mcg/semprot Botol 0 0 0
112 Ipratropium bromida ih 20mcg/puff Ampul 0 0 0
113 Isosorbid dinitrat tab 5 mg Tablet 500 500 500
114 Kalsium glukonat inj 100 mg/ml vial 0 0 0
115 Kalsium laktat (kalk) tab 500 mg Tablet 15200 15200 600 14600
116 Kanamicin inj Vial 0 0 0
117 Kaptopril tab 12,5 mg Tablet 11300 11300 11300
118 Kaptopril tab 25 mg Tablet 0 0 0
119 Karbamazepin tab 100 mg Tablet 0 0 0
120 Karbogliserin tts telinga 10 % Botol 0 0 0
121 Ketorolac Inj Ampul 195 195 195
122 Ketokonazol tab 200 mg Tablet 400 400 400
123 Klindamisin kaps 300 mg Kaps 0 0 0
124 Klonidin tab 0,15 mg Tablet 0 0 0
125 Kloramfenikol kaps 250 mg Kaps 2700 2700 2700
126 Kloramfenikol salep kulit 2% Tube 8 8 8
127 Kloramfenikol salep mata 1% Tube 135 135 135
128 Kloramfenikol susp 125 mg/5 ml Botol 70 70 70
129 Kloramfenikol tetes telinga 3% Botol 100 100 10 90
130 Kloramfenikol tts mata Botol 90 90 10 80
131 Klorfeniramin tab 4 mg Tablet 800 800 800 0
132 Klorpromazin inj 25 mg/ml (i.m.) Ampul 0 0 0
133 Klorpromazin inj 5 mg/ml (i.m.) Ampul 0 0 0
134 Klorpromazin tab sal 100 mg Tablet 100 100 100
135 Klorpromazin tab sal 25 mg Tablet 0 0 0
136 Klozapin tab Tablet 0 0 0
137 Kodein tab 10 mg Tablet 275 275 275
138 Kombinasi (DHP) : dihidroartemisin 40 mg + Piperakuin 320 mg strip 0 0 0
tab sal selaput
139 Kombinasi : ergotamin 1 mg+ kafein 50 mg Tablet 100 100 100
140 Kombinasi : Ferro fumarat 60 mg + asam folat 0,4 mg tab salut Tablet 32800 32800 600 32200
(TABLET TAMBAH DARAH)
141 Kombinasi: ipratropium Br 0,5 mg+ salbutamol 2,5 mg nebules Ampul 0 0 0

142 Kombinasi: kaolin 550 mg + pektin 20 mg (suspensi) Botol 0 0 0

143 Kotrimoksazol (dewasa) kombinasi : sulfametoksazol 400 mg+ Tablet 900 900 900
trimetoprim 80 mg
144 Kotrimoksazol kombinasi tiap 5 ml suspensi : sulfametoksazol Botol 195 195 195
200 mg + trimetoprim 40 mg
145 Kuinin inj 25% (i.v.) Ampul 0 0 0
146 Lansoprazol Tablet 0 0 0
147 Lidokain gel 2% Tube 0 0 0
148 Lidokain inj 2% (infiltr/p.v.) Ampul 430 430 45 385
149 Lidokain spray oral 10% Botol 0 0 0
150 Loperamid 2 mg Botol 0 0 0
151 Loperamid tab 2 mg Tablet 3900 3900 3900
152 Loratadin tab 10 mg Tablet 9700 9700 1600 8100
153 Magnesium sulfat inj 20% Botol 0 0 0
154 Magnesium sulfat inj 40% Botol 0 0 0
155 Metampiron tab 500 mg Tablet 0 0 0
156 Metformin tab 500 mg Tablet 13200 13200 1200 12000
157 Metilergometrin inj 0,2 mg/ml Ampul 400 400 400
158 Metilergometrin tab salut 0,125 mg Tablet 200 200 40 160
159 Metilprednisolon tab 4 mg Tablet 6100 6100 6100
160 Metoklopramid inj 5 mg/ml Ampul 0 0 0
161 Metoklopramid tab 10 mg Tablet 1500 1500 1500
162 Metronidazol lar inf 5 mg/ml Botol 0 0 0
163 Metronidazol susp 125 mg/5 ml Botol 0 0 0
164 Metronidazol tab 250 mg Tablet 0 0 0
165 Metronidazol tab 500 mg Tablet 1000 1000 1000
166 Mikonazol krim 2% Tube 336 336 24 312
167 Mineral Mix (Bismuth Subcitrate Tripotasium, Copper sulfate, saset 0 0 0
Magnesium Chloride Anhydrous, Potassium Chloride, Zinc
Acetate)
168 NaCl 0,9% Larutan Botol 256 256 4 252
169 N-asetil sistein kaps 200 mg Tablet 0 0 0
170 Natrium diklofenak tab Tablet 0 0 0
171 Nifedipin kaps 10 mg ( Adalat) Tablet 400 400 400
172 Nistatin susp 100.000 UI/ml Botol 0 0 0
173 Nistatin tab salut 500.000 UI Tablet 100 100 100
174 Nistatin tab vaginal 100.000 UI Tablet 530 530 530
175 Obat Anti Tuberculosis FDC Kategori Anak Paket 0 0 0
176 Obat Anti Tuberculosis FDC Kategori I Paket 0 6 6 3 3
177 Obat Anti Tuberculosis FDC Kategori II Paket 0 0 0
178 Obat Anti Tuberculosis FDC Kategori Sisipan Paket 0 0 0
179 Obat Anti Tuberculosis Kombipak Anak Paket 0 0 0
180 Obat Anti Tuberculosis Kombipak Dewasa Paket 0 0 0
181 OBH Botol 0 0 0
182 Oksimetazolin tts hidung Botol 0 0 0
183 Oksitosin inj 10 UI/ml Ampul 170 170 13 157
184 Omeprazol inj 40 mg/10 ml Ampul 100 100 100
185 Omeprazol kaps 20 mg Tablet 2400 2400 1200 1200
186 Ondansentron inj Ampul 40 40 15 25
187 Oxytetracyclin salep kulit Tube 80 80 80
188 Oxytetracyclin salep mata Tube 145 145 5 140
189 Oxytetracyclin Inj Vial 0 0 0
190 Parasetamol sir 120 mg/5 ml Botol 965 965 10 955 RETUR 900
191 Parasetamol tab 500 mg Tablet 35000 35000 4500 30500
192 Parasetamol tts 60 mg/0,6 ml Botol 0 0 0
193 Perak sulfadiazin krim 1% Tube 25 25 10 15
194 Phenol Gliserol Tetes Telinga Botol 72 72 72
195 Piracetam 400 mg Kaplet 900 900 900
196 Pirantel pamoat susp 125 mg/5 ml Botol 0 0 0
197 Pirantel pamoat tab scored 125 mg Tablet 0 0 0
198 Pirantel pamoat tab scored 250 mg Tablet 530 530 530
199 Piridoksin (vitamin B6) inj Ampul 0 0 0
200 Piridoksin (vitamin B6) tab Tablet 3300 3300 3300
201 Piroksikam 10 mg Tablet 3400 1000 4400 300 4100
202 Prednison tab 5 mg Tablet 17800 17800 17800
203 Primakuin tab 15 mg Tablet 200 200 200
204 Propiltiourasil tab 100 mg Tablet 400 400 400
205 Propranolol tab 10 mg Tablet 550 550 550
206 Ramipril 10 mg Tablet 0 0 0
207 Ranitidin inj Ampul 295 295 25 270 ED. 90
208 Ranitidin tab 150 mg Tablet 0 0 0
209 Retinol (vitamin A) kaps lunak 100.000 UI Kapsul 0 0 0
210 Retinol (vitamin A) kaps lunak 200.000 UI Kapsul 100 100 100 0
211 Ringer Laktat Larutan Botol 519 519 12 507
212 Risperidon tab sal 1 mg Tablet 0 0 0
213 Risperidon tab sal 2 mg Tablet 0 0 0
214 Salbutamol lar ih 0,5 % Botol 0 0 0
215 Salbutamol sir 2 mg/5 ml Botol 0 0 0
216 Salbutamol tab 2 mg Tablet 1850 1850 1850
217 Salbutamol tab 4 mg Tablet 0 0 0
218 Salep 2-4, kombinasi : asam salisilat 2 %+ belerang endap 4 % Pot 0 0 0

219 Serum anti bisa ular : A.B.U. inj (i.m./i.v.) vial 0 0 0

220 Serum antitetanus (A.T.S) (i.m.) Inj vial 0 0 0
221 Setirizin sir 5 mg/5 ml. Botol 120 120 10 110
222 Sianokobalamin (vitamin B12) inj 500 mcg/ml Ampul 195 195 195
223 Sianokobalamin (vitamin B12) tab 50 mcg Tablet 9400 9400 9400
224 Simvastatin tab sal 10 mg Tablet 13200 13200 900 12300
225 Simvastatin tab sal 20 mg Tablet 2000 2000 2000
226 Siprofloksasin tab scored 500 mg Tablet 500 500 500
227 Siterizin 10 mg Tablet 0 0 0 0
228 Spironolakton tab 25 mg Botol 0 0 0
229 Sulfadiazine tube 0 0 0
230 Tetanus toxoid inj vial 0 0 0
231 Tetrakain tts mata 0,5% Botol 0 0 0
232 Tetrasiklin kaps 250 mg Kaps 0 0 0
233 Tetrasiklin kaps 500 mg Kaps 5180 5180 5180
234 Tiamin (B1) inj Ampul 0 0 0 0
235 Tiamin (vitamin B1) tab 50 mg Tablet 580 580 580
236 Triheksifenidil tab 2 mg Tablet 100 100 100
237 Urea krim 10 % Tube 0 0 0
238 Vaksin BCG inj (i.k) vial 0 0 0 0
239 Vaksin bivalen OPV (b-OPV) drops 10 dosis vial 0 0 0 0
240 Vaksin Hepatitis Rekombinan Inj Prefilled Injection Device vial 0 0 0 0
(Uniject) 0,5 ml (i.m)
241 Vaksin Influenza vial 0 0 0
242 Vaksin Japanese Enchepalitis (J.E) vial 0 0 0
243 Vaksin jerap difteri tetanus (DT) vial 0 0 0 0
244 Vaksin jerap difteri tetanus (Td) vial 0 0 0 0
245 Vaksin kombinasi DPT-HB-Hib vial 0 0 0 0
246 Vaksin measless rubella (MR) Inj 0,5 mL (s.k) vial 0 0 0 0
247 Vaksin Meningitis Meningokokus vial 0 0 0
248 Vaksin polio IPV inj 0,5 ml vial 0 0 0 0
249 Vaksin rabies, untuk manusia serb Inj 2,5 IU Ampul 0 0 0
250 Vaksin Yellow Fever vial 0 0 0
251 Valproat sir 250 mg/5 ml Botol 0 0 0
252 Valproat tab sal Kaps 0 0 0
253 Vitamin B kompleks tab Tablet 22000 22000 2000 20000
254 Zinc drops 10 mg/ml Botol 0 0 0
255 Zinc sir 20 mg/5 ml Botol 0 0 0
256 Zinc tab disp 20 mg Botol 0 0 0 0
257 Becefort Tablet 9200 9200 9200
258 Becefort Syr Botol 300 300 300
259 Cendo xitrol Botol 40 40 40
260 Dumin Tube 0 0 0
261 Eflin Tablet 4500 4500 500 4000
262 Enbatic Krim Tube 120 120 120
263 Eyefresh Botol 30 30 30
264 Histolan Tablet 0 0 0
265 Ichtiyol Pot 15 15 15
266 ILIADIN tts Hidung Dus 16 16 16 ED. 16
267 Levemir Insulin Pen 14 14 3 11
268 Multivitamin Seven Seas Botol 0 0 0
269 Neurovit E Tablet 0 0 0
270 Novadiar syr Botol 200 200 200
271 Novadryl Syr botol 390 390 10 380
272 Novampyron Tablet 0 0 0 0
273 Novorapid insulin Pen 0 0 0
274 Pantocain tetes Mata Botol 18 18 18
275 Pritagesic Tablet 0 0 0
276 Scopamin Inj Ampul 0 0 0
277 Seledril Tablet 0 0 0
278 Selesbion Tablet 1500 1500 1500
279 Selkom C Tablet 0 0 0
280 Seven Seas Sirup Botol 0 0 0
281 Sidiadryl inj Vial 0 0 0
282 Siobion Tablet 0 0 0
283 Soft Uderm tube 0 0 0
284 Stesolid Injeksi Tube 0 0 0
285 Stesolid Rectal Tablet 19 19 1 18
286 Tetagam Vial 5 5 2 3
287 Truvit Syr Botol 60 60 60
288 Ventolin Nebulizer Ampul 80 80 80
289 Vitamulti DHA Tablet 900 900 300 600
290 Bionemi Tablet 0 0 0
291 Teramycin Inj Vial 0 0 0
292 Taburia Sachet 200 200 200 Program Gizi
293 Adalat Oros 20 mg Tablet 0 0 0
294 Kolkisin 0,5 mg Tablet 0 0 0
295 Etambutol 250 mg Tablet 200 200 200
296 Ketokonazol Cream Tube 75 75 50 25
297 Atropin inj 0,25 mg/mL (i.m./i.v./s.k.) Ampul 0 0 0
298 sefadroksil sir kering 125 mg/5 mL Botol 80 80 80
299 Caviplex Tab Tablet 1000 1000 200 800
300 Phenitoin Sodium INJ ( MEPRO ) vial 60 60 60
301 Piroksikam 20 mg Tablet 100 100 100
302 Parasetamol Inf Botol 7 7 4 3
303 Hiosina butilbromida Inj Box 30 30 30
304 Striatamin Multivitamin Tablet 2130 2130 2130
305 Onoiwa Multivitamin Tablet 3800 3800 3800
306 Channa Multivitamin sirup Botol 24 24 24
307 Novokid Syrup Botol 240 240 240
308 Curcuma DHA Emulsion Botol 72 72 72

BMHP
1 abbocath No. 18 Piece 374 374 20 354
2 abbocath No. 20 Piece 240 240 25 215
3 Abbocath no. 22 Piece 242 242 10 232
4 Abocath no. 24 Piece 225 225 225
5 Abocath no. 26 Piece 50 50 50
6 Alat Pemeriksaan HB Buah 0 0 0
7 Alat Suntik 0,05 ml Piece 291 291 291
8 Alat Suntik 0,5 ml Piece 123 123 123
9 Alat suntik 1 ml Piece 450 450 50 400
10 Alat Suntik 10 ml Piece 310 310 10 300
11 Alat Suntik 20 ml Piece 0 0 0
12 Alat suntik 3 ml Piece 6095 6095 95 6000
13 Alat suntik 5 ml Piece 194 194 14 180
14 Alcohol Swab CHG + 0,5 % Dus 18 18 11 7
15 Antiseptik E-Care 500 ml (Hand rub) Botol 17 17 4 13
16 Aqua gel Tube 0 0 0
17 Asering Cairan Botol 0 0 0
18 Blood Lancet 28 G (TWIST) Dus 100 100 100
19 Cangkang Kapsul Buah 0 0 0
20 Cat gut Chromic 2/0 75C + jarum 1/2 30M R Dus 10 10 1 9
21 Cat gut Chromic 3/0 75C + jarum 1/2 37M R Dus 5 5 0 5
22 Cat qut chromic 4/0 70C + Jarum 3/8 19M C Dus 0 0 0 0
23 Catgut plain 3/0 100 M Dus 0 0 0 0
24 Catgut plain 3/0 70C + Jarum 1/2 25M R Piece 0 0 0
25 Cutimed gel 5mg Piece 0 0 0
26 Cutimed Siltec Super Piece 0 0 0
27 Elastis Verban Rol 5 5 5
28 Elastomul Haft Dus 3 3 3 ED 3
29 Etakridin (rivanol Lar 0,1 %) botol 47 47 47
30 Etanol botol 70% 100 ml botol 0 0 0
31 Etanol botol 70% 1000 ml Botol 94 94 2 92
32 Etanol botol 70% 300 ml Botol 0 0 0
33 Eugenol Botol 0 0 0
34 Folley catheter No. 16 Piece 2 2 2
35 Folley catheter No. 18 Piece 0 0 0
36 Folley catheter No. 22 Piece 0 0 0
37 Handscan no. 7 steril Pasang 650 650 50 600
38 Handscan no. 7,5 Biasa (M) Pasang 0 0 0
39 Handscan no. 7,5 steril Pasang 550 550 5 545
40 Handscoend genecolog 50 cm Pasang 0 0 0
41 Handscoon Non Steril ( L ) Piece 0 0 0 0
42 Handscoon Non Steril ( S ) Piece 0 0 0 0
43 hypafix/poliflix 10 cm x 5 cm Dus 0 0 0
44 Infusion Set Anak Piece 502 502 502
45 Infusion Set Dewasa Piece 239 239 27 212
46 jarum jahit lengkung, 3/8, lingkaran penampang bulat (jarum 0 0 0
Piece
otot)
47 0 0 0
jarum jahit lengkung, 3/8, lingkaran penampang segitiga Piece

48 jarum jahit,lengkung,lingkaran penampang bulat Piece 0 0 0

49 jarum jahit,lengkung,lingkaran penampang segitiga Piece 0 0 0
50 Kapas pembalut 250 mg Piece 31 31 2 29
51 Kasa Hidrofil 40 x 80 cm Rol 18 18 3 15
52 Kasa hydrofil Steril 16x16 cm Dus 277 277 4 273
53 Kasa Pembalut hidrofil 2x80 cm Piece 0 0 0
54 kertas lakmus Piece 0 0 0
55 kertas saring Piece 0 0 0
56 Lisol Botol 3 3 1 2
57 Maag Slang no. 18 Piece 0 0 0
58 Maag Slang no. 5 Piece 0 0 0
59 Masker Earloop Dus 70 70 4 66
60 Masker N95 Dus 28 28 28
61 Masker Non Rebrithing Anak Piece 0 0 0
62 Masker Non Rebrithing Dewasa Piece 0 0 0
63 Masker Oksigen Piece 0 0 0
64 Masker Rebrithing Anak Piece 0 0 0
65 Masker Rebrithing Dewasa Piece 0 0 0
66 Masker tali Dus 57 57 57
67 Nasal kanul (oksigen) ukuran S Piece 0 0 0
68 Nasal kanul Ukuran L Piece 600 600 600
69 Nasal kanul XS (Neonatus) Piece 3 3 3
70 Needle No. 23 Piece 0 0 0
71 NGT anak Piece 0 0 0
72 NGT dewasa Piece 0 0 0
73 Novotwist Dus 0 0 0
74 Paper Tape Rol 36 36 4 32
75 Pisau Bedah Piece 0 0 0
76 Plano Test Dus 18 18 18
77 Plester 2,5 Yard x 4,5 cm Piece 8 8 1 7
78 Plester 7 Yard x inchi Piece 0 0 0
79 Plester 7,5 cm x 4,5 m Piece 0 0 0
80 Plesterin Box 51 51 1 50
81 Polygips Rol 0 0 0
82 Pot Sputum Piece 260 260 260
83 Povidon lodida 10%-30 ml botol 0 0 0
84 Povidon lodida 10%-300 ml botol 48 48 48
85 Povidon lodida 10% 1000 ml botol 11 11 11
86 RDT DBD Piece 0 0 0
87 RDT Malaria Piece 0 0 0
88 Reagen TB Kit 39 39 39
89 Safety Box Buah 0 0 0 Untuk Imunisasi
90 silk 2/0 100 m Dus 0 0 0
91 silk 3/0 100 m Dus 12 12 12
92 Spiritus 1000ml botol 0 0 0
93 stik Easy Touch glukosa Dus 0 0 0
94 stik Easy Touch Kolesterol Dus 0 0 0
95 stik Easy Touch uric acid Dus 0 0 0
 96 Stik Autocheck Asam Urat Dus 0 0 0
97 Stik Autocheck Cholesterol Dus 0 0 0
98 Stik Autocheck Glukosa Dus 0 0 0
99 Stik Benecheck Asam Urat Dus 17 17 4 13
100 Stik Benecheck Glukosa Dus 76 76 6 70
101 Stik Benecheck Kolesterol Dus 0 0 0
102 Stik HB family Dr Dus 28 28 3 25
103 Tabung EDTA Piece 0 0 0
104 Urin bag Piece 8 8 8
105 Aximed Fiding Tub 40 CM Piece 0 0 0
106 Batang Pengaduk Piece 0 0 0 0
107 Plester 1,25 Yard x 4,5 cm Piece 20 20 20
108 objeck Glass FROST ONE LAB 7105 Paket 5 5 5
109 Stomach Tube 85 Cm NO.18 Piece 0 0 0
110 Combivent UDV Vial 0 0 0
111 Farbivent Solution Inhaler Ampul 20 20 20 0
112 DIRUI Reagen Paket 0 0 0
113 Antiseptik 5000 ml (Hand rub) Jerigen 10 10 10
114 Polycrepe 7,5 x 4,55 m Piece 5 5 5

Mengetahui/Menyetujui Yang Menyerahkan Yang Memohon Yang Menerima

Kepala Seksi Kefarmasian Penanggung Jawab Gudang Farmasi Kepala Puskesmas Ampana Barat Petugas Puskesmas

Nurlin HI Abd Halim, S.Farm Arini Priyanti Kandupi. S.Farm, Apt Nur Hadist,SKM Djafar A Kalube, S.Farm.,Apt
Nip.19810421 200502 2 006 Nip.19830402 200502 2 004 Nip.19730616 199203 2 002