PEMERINTAH KABUPATEN SUMENEP

DINAS KESEHATAN, PENGENDALIAN PENDUDUK DAN KELUARGA BERENCANA

PUSKESMAS RUBARU
Jln. Raya Rubaru No. 40 Telp. 082335393745
SUMENEP
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO )
PERIODE PEMAKAIAN : SEPTEMBER 2022
PERIODE PERMINTAAN : OKTOBER 2022

STOK AWAL PENERIMAAN PENGELUARAN SISA STOCK

TOTAL TOTAL TOTAL TOTAL

No NAMA OBAT SATUAN EXP DATE

f = a+b+c+d+e f = a+b+c+d+e f = a+b+c+d+e f = a+b+c+d+e

1 Albendazol tab 400 mg tablet - 5,000 4,400 600 maret /24

6 Amitriptilin 25 mg tablet - - - -
7 Amlodipin 10 mg tablet 700 1,000 1,150 550 Jan/24
8 Amoksisilin 500 mg tablet 5,050 - 2,090 2,960 Nov/23
Amoksisilin sir ker
9 botol 91 - 31 60 Sep 24
Forte 250 mg/5 ml

Asam Askorbat
16 tablet 2,500 - 1,800 300 Nov/23
(Vitamin C) tab 250 mg

Asam Mefenamat 500

18 tablet 4,000 - 2,550 1,450 Jan/24
mg
Betahistine mesilate 6
26 tablet 690 - 100 590 Des/22
mg
28 Bisakodil 5 mg tablet 100 - 20 80 Sep/23
Chlorfeniramina Maleat
34 tablet 50 - 180 120 Mei/23
4 mg (CTM)
Deksametason injeksi
35 ampul 1,740 - 407 1,333
i.v 5mg / ml
36 Deksametason 0.5 mg tablet 1,740 - 650 1,090

Diazepam Enema 5
37 mg/2,5 ml / Stesolid tube - - - -
Enema 5
Diazepam Enema 10
38 mg/5 ml / Stesolid tube - - - -
Enema 10
 Diazepam injeksi 5
39 ampul 140 - 2 138
mg / ml
Difenhidramin injeksi
41 ampul 900 - 662 238
10mg/ml
Diklofenak Natrium 50
44 tablet 6,170 - 1,100 5,070 Des/24
mg

46 Dimenhidrinat 50 mg tablet 250 - 50 200 April/23

Epinefrin / Adrenalin inj

49 ampul 16 - 7 9
0.1 ml (sebagai Hcl)

Fitomenadion (vitamin
57 ampul 180 - 30 150
K1) inj 2 mg/ml

Fitomenadion tab salut

58 tablet 200 - 50 200 Sep/23
gula10 mg (Vit. K1)

Gentamisin sulfat salep

63 tube 3,5 gr 45 24 10 59 Apr/24
mata

65 Glimepiride 2 mg tablet 1,000 1,000 1,000 1,000 Jan/26

67 Haloperidol 5 mg tablet - - - -
Hidrokortison krim
69 tube 52 - 16 36 Okt/25
2.5%
71 Ibuprofen 400 mg tablet 4,700 - 1,600 3,100 Nov/24

Insulin analog fast

acting inj 100 IU/mL,
73 pen 15 - - 5
penfill cartridge
(NOVORAPID)

Isosorbid Dinitrat
74 tablet 700 - - 300 Jun/23
sublingual 5 mg (ISDN)

77 Kaptopril 25 mg tablet 2,100 - 1,800 300 Jan/24

78 Karbamazepin 200 mg tablet - - - -

79 Ketoconazole krim 2% tube 15 gr 81 - 40 41 Feb/24

80 Ketokonazole 200 mg tablet 670 1,000 470 1,200 Agust/23

81 Klindamisin 300 mg kapsul - - - 300 Feb/24

Kloramfenicol Tetes
84 botol 5 ml 3 - 2 2 Jun/23
Mata 0.5%
 Kloramfenikol Salep
86 tube 40 - 5 35 Feb/23
Kulit 2%
89 Kodein 20 mg tablet - - - -

92 Kotrimoksasol 480 mg tablet 1,640 - 300 1,340 Sept/24

Larutan Infus Natrium

101 btl 500 ml 168 - 120 48
Klorida 0.9%

Larutan infus Ringer

102 btl 500 ml 308 100 180 20
Laktat

103 Lidokain inj 2% ampul 580 - 255 325

Magnesium Sulfat inj
108 vial 24 - 6 18
40% - 25 ml
109 Metamizol inj amp 1,610 - 440 1,170

110 Metformin 500 mg tablet 700 - 600 100 Feb/25

Metilergometrin Maleat
113 ampul 45 - 20 25
inj 0.200 mg-1 ml

Metoklopramide inj 5
115 ampul 200 - 50 150
mg/ml

117 Metronidasole 500 mg tablet 3,940 - 900 3,040 Sept/25

119 N-asetil sistein tablet 3,440 - 900 2,540 Des/23

Nistatin suspensi
121 botol 153 60 15 198 Jan/23
100.000 IU/mL
Oksitosin injeksi 10
125 ampul 580 - 92 500
IU/ml - 1ml
Omeprazol serb inj 40
126 vial 290 - 70 220
mg
127 Omeprazole 20 mg kapsul 730 1,000 980 750 Feb/24
Permetrin krim 5%
132 tube - 20 - 20
(Scabimite)
Piridoksin (Vitamin B6)
133 tablet - - - 80 Sept/23
tab 10 mg (Hcl)
134 Prednison 5 mg tablet 1,700 - 800 300 Okt/23

135 Propiltiourasil 100 mg tablet - - - -

137 Risperidon 2 mg tablet 78 - 414 183

138 Salbutamol 2 mg tablet 4,570 - 200 4,370 Des/23
 Salep 2-4 kombinasi
140 asam salisilat 2% pot - - - -
belerang endap 4%
141 Salisil Bedak 2% box 50 gr 10 - 30 15 Maret/26

143 Sefadroksil 500 mg kapsul 1,500 - 300 1,200 April/23

Sefotaksim injeksi 1
144 vial 124 288 56 356
gram
Sianokobalamin inj 500
147 ampul 1,850 - 330 1,520
mcg/ml

148 Simvastatin 20 mg tablet 4,250 - 650 3,600 Sept/23

149 Siprofloksasin 500 mg tablet 4,100 - 600 3,500 Maret/27

Sulfadiazin Silver Krim

150 tube 35 gr 23 - 15 8 Okt/23
1%
154 Triheksifenidil 2 mg tablet 588 - 291 297
Zinc tab dispersible 20
156 tablet - - - 1,000
mg
157 Kloramfenikol tablet tablet 250 Apr/26
158 Metilergoemtrin tab tablet 80 Agust/23

BMHP

1 Alkohol 70% 1000 ml botol - - - -

2 Alkohol 70% 100 ml botol - - - -

3 Alkohol 95% 100 ml botol 89 - 7 82

4 Alkohol Swab box isi 100 40 - 15 25

Antiseptik Sabun
5 tangan/Onescrub 2% botol 6 - 1 5
500 ml + Dispenser

Antiseptik tangan tanpa

6 bilas /Alkohol botol 3 - 2 1
Perokside 500 ml
7 Apron 75 x 130/025 pcs - - - -

Benang Catgut Plain

8 pcs - - - -
2/0+jarum
Benang Catgut Plain
9 pcs - 36 - 36
3/0 tanpa jarum
Benang Catgut Plain
10 pcs - - - -
3/0+jarum
Benang Catgut
11 pcs - - - -
Chromic 2/0+jarum

Benang Catgut
12 pcs - 36 12 24
Chromic 3/0+jarum

13 Benang Silk 3/0+jarum pcs 95 - 12 83

14 Blood transfusion set pcs 60 - 28 32

15 Foley Catheter (16 fr) pcs 5 - 10 -

16 Foley Catheter (18 fr) pcs 22 - 13 9

Hidrogen Peroxide 3%
17 botol 12 - 2 12
botol 100ml
18 Infusion set anak pcs 340 - 290 50

19 Infusion set dewasa pcs 532 - 150 382

20 IV Catheter 18G pcs 143 - 2 141

21 IV Catheter 20G pcs 199 - 50 149
22 IV Catheter 22G pcs 247 - 101 150
23 IV Catheter 24G pcs 150 - 50 100
24 IV catheter 26 G pcs - - - -
Kapas Pembalut 250
25 bungkus - - - -
gram
Kasa Kompres Steril
26 box - - - -
16 x 16cm
Kasa Kompres Steril
27 box - - - -
40cm x 40cm
Kasa Pembalut Hidrofil
28 rol 4 - - 4
36y x 80cm
Kasa Pembalut Hidrofil
29 rol - - - -
4 x 3cm
Kasa Pembalut Hidrofil
30 rol - - - -
4 x 5cm
31 Masker box isi 50 84 - 8 76

32 Masker Nebulizer Adult pcs 11 - 7 4

Masker Nebulizer
33 pcs - - - -
Pediatric

34 Masker Oxygen Adult pcs - - - -

Masker Oxygen
35 pcs 4 - 6 -
Pediatric
36 Mucus Extractor pcs - - - -
Nasal Oxygen Canula
37 pcs 101 - 10 100
Adult

Nasal Oxygen Canula

38 pcs 94 - 15 79
Child (Pediatric)

Nasal Oxygen Canula

39 pcs - - - -
Infant

Plester adhesive 5m x
40 10cm winner roll 24 - 7 17
(Pharmafix)

41 Pot Sputum pcs - - - -

 POVIDONE IODINE
42 botol 8 - 4 4
LARUTAN 10% 60 ml

POVIDONE IODINE
43 botol - - - -
LARUTAN 10% 300 ml

Sarung Tangan
44 pcs 1,400 - 300 1,100
Examination size L
Sarung Tangan
45 pcs 1,700 - 1,500 200
Examination Size M
Sarung Tangan
46 pcs - - - -
Examination Size S

47 Sarung Tangan Obgyn pasang 75 200 75 200

Sarung tangan steril

48 pasang 279 - 61 218
no. 7
Sarung tangan steril
49 pasang 100 - - 100
no. 7,5
Spuit 20 ml tanpa
50 pcs - - - -
jarum

51 Spuit /Alat Suntik 1ml pcs 45 - 10 35

52 Spuit/Alat Suntik 3 ml pcs 2,400 1,000 1,700 1,700

53 Spuit/Alat Suntik 5 ml pcs 800 - 300 500

54 Underpad pcs 630 - 110 520

55 Urine bag 2L pcs 118 - 10 108

Mengetahui,
KEPALA PUSKESMAS RUBARU

DESI FEBRYANA S.ST., M.MKes

NIP.19840214 200801 2 008