Puskesmas Hunduhon 2020

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
Kode Puskesmas : Format : 1

Nama Puskesmas : HUNDUHON
Kecamatan : LUWUK TIMUR
Puskesmas pembantu Yag Ada : Yang Lapor :
Kabupaten : Banggai Bulan : Januari
Propinsi : Sulawesi Tengah Tahun : 2020
SWK SWT
Stok Opt
NO NAMA OBAT/BHP Satuan Stok Awal penerimaan Persediaan Pengeluaran Sisa Stok SK BS Permintaan Ket
Hr Jml Hr Jml (SO)
a b c d e f g h i j k l m n p q r
A Dana Alokasi Khusus (DAK)

1 Ambroxol Tab 1000 1,000 400 600 15 - 7 108 40 52
2 Acyclovir Tab 200 mg Tab 0 - 0 - - 7 - - 0
3 Acyclovir Tab 400 mg Tab 1,750 1,750 1750 - - 7 - - 1750
4 Alupurinol Tab 100 mg Tab 3,700 3,700 3700 - - 7 - - 3700
5 Alprazolam tab 0,5 mg Tab 0 - 0 - - 7 - - 0
6 Aminophyllin Tab 200 mg Tab 2100 2,100 2100 - - 7 - - 2100
7 Amoxicillin Caps 500 mg / Pehamoxyl 500 Tab 16900 16,900 1,900 15000 73 - 7 512 190 12398
8 Ampicillin Caplet 500 mg Tab 0 - 0 - - 7 - - 0
9 Amlodipine 5 Mg Tab 2100 3,000 5,100 600 4500 23 - 7 162 60 3678
10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab 0 - 0 - - 7 - - 0
11 Antalgin Tab 500 mg Tab 0 - 0 - - 7 - - 0
12 Antasida Doen Tab Kombinasi Tab 2000 16,800 18,800 1,200 17600 46 - 7 323 120 15957
13 Attapulgit 600 mg tablet (5 x 10 tab) Tab 0 5,000 5,000 300 4700 12 - 7 81 30 4289
14 Asam Ascorbat (Vit C) Tab 50 mg Tab 0 7,000 7,000 - 7000 - - 7 - - 7000
15 Asam Mefenamat Tab 500 mg Tab 0 - 0 - - 7 - - 0
16 Betahistin Tb Tab 2600 2,600 100 2500 4 - 7 27 10 2363
17 Calsium Laktat (Calk) Tab 500 mg Tab 0 5,000 5,000 5000 - - 7 - - 5000
18 Captopril Tab 25 mg Tab 1200 1,200 400 800 15 - 7 108 40 252
19 CarbamazeineTab Tab 0 - 0 - - 7 - - 0
20 Cefadroxil Capsul 500 mg Tab 0 - 0 - - 7 - - 0
21 Cetirizine Tb Tab 0 2,000 2,000 2000 - - 7 - - 2000
22 Chloramphenicol Caps 250 mg Tab 0 - 0 - - 7 - - 0
23 Chlorpheniramin Maleat (CTM) Tab 4 mg Tab 11800 11,800 1,800 10000 69 - 7 485 180 7535
24 Chlorpromazin HCl Tab Salut 25 mg Tab 0 - 0 - - 7 - - 0
26 Ciprofloxacin Capl 500 mg Tab 0 - 0 - - 7 - - 0
27 Cimetidine Tab 200 mg Tab 0 - 0 - - 7 - - 0
28 Clonidine Tab 0 - 0 - - 7 - - 0
29 Cotrimoksazol Ped Tablet 120 mg Tab 0 - 0 - - 7 - - 0
30 Cotrimoksazol Dewasa Tab 480 mg/ Tab 0 5,000 5,000 5000 - - 7 - - 5000
31 Cyanocobalamin (Vit B12) Tab Tab 0 7,000 7,000 7000 - - 7 - - 7000
32 Dexametason Tab 0,5 mg Tab 17900 17,900 1,400 16500 54 - 7 377 140 14583
33 Diazepam Tab 2 mg ( @ 100 = @ 100 ) Tab 0 - 0 - - 7 - - 0
34 Diazepam Tab 5 mg ( @ 100 = @ 250 ) Tab 197 197 10 187 0 - 7 3 1 173
35 Domperidome ( @100 = @50 ) Tab 0 7,000 7,000 7000 - - 7 - - 7000
36 Ephedrin HCl Tab 25 mg Tab 0 - 0 - - 7 - - 0
37 Erytromysin 500 mg Tab Tab 1000 1,000 200 800 8 - 7 54 20 526
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
38 Fitomenadion (Vit K) Tab Salut 10 mg Tab 500 500 50 450 2 - 7 13 5 382

39 Furosemid Tablet 40 mg Tab 2,500 2,500 2500 - - 7 - - 2500
40 Glibenklamid Tab 5 mg Tab - - 0 - - 7 - - 0
41 Gliseril Guaiyacolat Tab 100 mg Tab - - 0 - - 7 - - 0
42 Griseofulvin Tab 125 mg micronized Tab - - 0 - - 7 - - 0
43 Haloperidol Tab 1,5 mg Tab - - 0 - - 7 - - 0
44 Haloperidol Tab 5 mg Tab - - 0 - - 7 - - 0
45 Hidroklorothiazid (HCT) Tab 25 mg Tab 2,500 2,500 2500 - - 7 - - 2500
46 Ibuprofen Tab 200 mg Tab - - 0 - - 7 - - 0
47 Ibuprofen Tab 400 mg Tab 2,000 2,000 2000 - - 7 - - 2000
48 Isosorbid Dinitrat Tab 5 mg Tab 300 300 300 - - 7 - - 300
49 Komb. Pirimetamin 25 mg + Sulfadoxin 500 mg Tab - - 0 - - 7 - - 0
50 Ketoconzol Tab Tab - - 0 - - 7 - - 0
51 LansoprasolenTb Tab - - 0 - - 7 - - 0
52 Levofloxacin Tab 500 mg Tab - - 0 - - 7 - - 0
53 Loperamide Tab Tab - - 0 - - 7 - - 0
54 Loratadin tab 10 mg Tab 1,800 1,800 300 1500 12 - 7 81 102 1306
55 Meloksikam 15 Mg Tab - - 0 - - 7 - - 0
56 Metform Tb Tab 600 1,000 1,600 700 900 27 - 7 188 237 448
57 Methyl Prednisolon Tb Tab - - 0 - - 7 - - 0
58 Metronidazole Tab 250 mg Tab - - 0 - - 7 - - 0
59 Metronidasole 500 Tab 1,000 1,000 1000 - - 7 - - 1000
60 Metoclopramide Tab 10 mg Tab - - - 0 - - 7 - - 0
61 Natrium Diklofenak Tab 50 mg Tab 5,100 2,800 7,900 1,200 6700 46 - 7 323 406 5925
62 Nifedipin Tab 10 mg Tab 30 30 30 - - 7 - - 30
63 Ofloxacin Tab 400 mg Tab - - 0 - - 7 - - 0
64 Omeprasole Tab - 2,910 2,910 2910 - - 7 - - 2910
65 Papaverin Tab 40 mg Tab - - 0 - - 7 - - 0
66 Paracetamol Tab 500 mg Tab 5,500 5,500 5500 - - 7 - - 5500
67 Phenobarbital Tab 30 mg Tab - - 0 - - 7 - - 0
68 Piridoxyn HCl Tab 10 mg Tab 3,200 7,000 10,200 10200 - - 7 - - 10200
69 Prednison Tab 5 mg Tab 9,100 9,100 - 9100 - - 7 - - 9100
70 Piroxicam Caps 20 mg Tab - - 0 - - 7 - - 0
71 PropilTioUrasil (PTU) Tab 100 mg Tab 600 600 600 - - 7 - - 600
72 Propanolol HCl Tab 40 mg Tab - - 0 - - 7 - - 0
73 Pyrantel HCl Tab 125 mg Tab 1,200 1,200 1200 - - 7 - - 1200
74 Ranitidine Tab 150 mg Tab - - 0 - - 7 - - 0
75 Retinol 100.000 Iu (Biru) Tab - - 0 - - 7 - - 0
76 Retinol 200.000 Iu (Merah) Tab - - 0 - - 7 - - 0
77 Salbutamol Tab 4 mg Tab - 1,000 1,000 350 650 13 - 7 94 118 424
78 Selviplex Tab - - 0 - - 7 - - 0
79 Simvastatin Tab - - 0 - - 7 - - 0
80 Tablet Tambah Darah Tab - 3,930 3,930 - 3930 - - 7 - - 3930
81 Tetracyclin HCl Caps 250 mg Tab - - 0 - - 7 - - 0
83 Thiamin HCl Monotartrat (Vit B1) Tab 50 mg Tab - 5,000 5,000 - 5000 - - 7 - - 5000
84 Trihexylfenidil Tab 60 60 60 - - 7 - - 60
85 Vitamin B Compleks Tab Tab - 10,000 10,000 10000 - - 7 - - 10000
86 Zink Tab - 5,000 5,000 700 4300 27 - 7 188 237 3848
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
0
87 Ambroxol Sy Btl - - 0 - - 7 - - 0
88 Amoxicillin Syrup Kering 125 mg / 5 ml Btl - - - 0 - - 7 - - 0
89 Ampicillin Syrup Kering 125 mg / 5 ml Btl - - 0 - - 7 - - 0
90 Antasida Doen Susp Kombinasi Btl 500 500 18 482 1 - 7 5 6 470
91 Antidiare syr Btl - 0 - - 7 - - 0
92 Antiinfluensa Syr (Erlaflu) Btl - - 0 - - 7 - - 0
93 Cotrimoksazol Susp Btl - 200 200 42 158 2 - 7 11 14 131
94 Cefadroxil Syr Btl - 100 100 100 - - 7 - - 100
95 Cetirizine Syr Btl - 200 200 200 - - 7 - - 200
96 Domperidome Sy Btl - 200 200 200 - - 7 - - 200
97 erytromysin Syrup Kering Btl - - 0 - - 7 - - 0
98 Garam Oralit 200 ml Air Btl 80 2,000 2,080 280 1800 11 - 7 75 95 1619
99 Ibuprofen Syr Btl - 200 200 200 - - 7 - - 200
100 Metocloperamide Syr Btl - - 0 - - 7 - - 0
101 Multivit Syr Btl - - 0 - - 7 - - 0
102 Obat Batuk Hitam (OBH) Cairan Btl - - 0 - - 7 - - 0
103 Paracetamol Syrup 100 mg / 5 ml Btl 548 548 59 489 2 - 7 16 20 451
104 Paracetamol Drops 10 ml Btl - 56 56 56 - - 7 - - 56
105 Pyrantel Syr Btl 54 54 4 50 0 - 7 1 1 47
106 Zinc Syr Btl - 250 250 35 215 1 - 7 9 12 192
0
107 Ampicillin 1 gram Inj Amp - - 0 - - 7 - - 0
108 Aminopyllin Inj Amp 38 38 38 - - 7 - - 38
109 Aqua Pro Injeksi Steril Bebas Pirogen Amp 180 180 180 - - 7 - - 180
110 Asering - Asetat Ringer Amp - - 0 - - 7 - - 0
111 Atropin inj 0,25 mg/mL (i.v./i.m./s.k.) Amp - - 0 - - 7 - - 0
112 Cefotaxim 1 g Inj Amp 80 80 80 - - 7 - - 80
113 Clorpromazine inj Amp - - 0 - - 7 - - 0
114 Cyanocobalamin (Vit B12) Inj 500 mg / ml Amp 680 680 10 670 0 - 7 3 3 664
115 Dexametason Inj 5 mg / ml - 1 ml Amp - 240 240 10 230 0 - 7 3 3 224
116 Diazepam Inj Amp 100 100 100 - - 7 - - 100
117 Diphenhydramin HCl Inj 10 mg / ml - 1 ml Amp 60 60 60 - - 7 - - 60
118 Ephinefrin HCl/Bitartrat (Adrenalin) Inj 0,1% - 1 ml Amp - - 0 - - 7 - - 0
119 Fitomenadion (Vit K) Inj 10 mg - 1 ml Amp 245 245 8 237 0 - 7 2 3 232
120 Furocemide Inj Amp 45 45 45 - - 7 - - 45
121 Glukosa Lar Infus 5% Steril Amp 70 70 70 - - 7 - - 70
122 KA EN 3B Amp - - 0 - - 7 - - 0
123 Ketorolac Inj ( @ 12 = @ 6 ) Amp 780 780 780 - - 7 - - 780
124 Lidocain Comp. Inj/Pehacain Inj. Amp 290 290 15 275 1 - 7 4 5 265
125 Magnesium Sulfat Inj (i.v.) 20% - 25 ml Amp - - - 0 - - 7 - - 0
126 Metil Ergometrin Maleat Inj 0,200 mg - 1 ml Amp 100 100 5 95 0 - 7 1 2 92
127 Metocloperamide Inj Amp - - 0 - - 7 - - 0
128 Natrium Klorida 0,9% Larutan Infus Steril Amp 250 250 250 - - 7 - - 250
129 Ondansetron Inj Amp 290 290 60 230 2 - 7 16 20 191
130 Oxytetracyklin HCl Inj (i.m.) 50 mg / ml - 10 ml Amp - - 0 - - 7 - - 0
131 Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Ampl ) Amp 15 15 15 0 1 - 7 4 5 10
132 Phenobarbital Inj Amp - - 0 - - 7 - - 0
133 Ranitidine inj ( @ 25 = @ 10 ) Amp 350 350 45 305 2 - 7 12 15 276
SK SWK SWT
Sisa Stok Opt
NO NAMA OBAT/BHP Satuan penerimaan Persediaan Pengeluaran BS Permintaan Ket
Stok Hr Jml Hr Jml (SO)
134 Ringer Laktat Lar Infus Steril Amp 710 600 1,310 310 1000 12 - 7 83 105 800
135 Thiamin HCl (Vit B1) Inj 100 mg / ml - 1 ml Amp 120 120 13 107 1 - 7 4 4 99
136 Vit B1, B6, B12 Inj Amp - - 0 - - 7 - - 0
0
137 Aciclovir cream (25 Tube) Tub - - 0 - - 7 - - 0
138 AntiHemoroid Doen Kombinasi Tub 120 120 120 - - 7 - - 120
139 Antifungi SK Tub 48 48 24 24 1 - 7 6 8 8
140 Betametason Cream 0,1% (25 Tube) Tub 475 475 163 312 6 - 7 44 55 207
141 Chloramphenicol Salep Kulit 1% (24 tube) Tub 14 14 14 - - 7 - - 14
142 Chloramphenicol Salep Mata 1% (24 tube) Tub - 72 72 72 - - 7 - - 72
143 Chloramphenicol Tetes mata (25 Btl) Tub - - 0 - - 7 - - 0
144 Chloramphenicol Tetes Telinga (24 Btl) Tub - - - 0 - - 7 - - 0
145 Diasepam Rectal ( Stesolid ) Tub - - 0 - - 7 - - 0
146 Etakridina laktat (Rivanol) Tub 60 60 60 - - 7 - - 60
147 Ethyl Klorida Semprot Tub - - 0 - - 7 - - 0
148 Gentian Violet Lar 1% Tub - - 0 - - 7 - - 0
149 Hidrokortison Cream 2,5% Tub 576 576 16 560 1 - 7 4 5 550
150 Ketoconazol SK Btl - - 0 - - 7 - - 0
151 Mikonazole Sk Btl - - - 0 - - 7 - - 0
152 Mycorine Powder Btl - - 0 - - 7 - - 0
153 Oxytetracyclin HCl Salep Kulit 3% Btl - - 0 - - 7 - - 0
154 Oxytetracyklin HCl Salep Mata (@25) Tub - - 0 - - 7 - - 0
155 Povidon Iodium Lar 60 ml Tub - - 0 - - 7 - - 0
156 Povidon Iodium Lar 300 ml Tub 37 37 2 35 0 - 7 1 1 34
158 Salep 2-4 Kombinasi Tub 64 64 - 64 - - 7 - - 64
159 Salisil Talk/Bedak 2% Tub - - 0 - - 7 - - 0
160 Scabimite Tub - - - 0 - - 7 - - 0
BMHP 0
161 Alat Suntik Sekali Pakai 1 ml Pcs 165 165 2 163 0 - 7 1 1 162
162 Alat Suntik Sekali Pakai 2.5 ml / 3 ml Pcs 1,410 1,410 250 1160 10 - 7 67 85 998
163 Alat Suntik Sekali Pakai 5 ml Pcs 1,100 1,100 135 965 5 - 7 36 46 878
165 Catgut/Benang Bedah no 2/0-3/0 (chromic) Pcs 148 148 148 - - 7 - - 148
Catgut/Benang Bedah plain 48 48 48
166 Canula Childr Pcs - - 0 - - 7 - - 0
167 Canula Adult Pcs 35 35 35 - - 7 - - 35
168 E-Care Alcohol Swab Pcs 13,100 13,100 400 12700 15 - 7 108 135 12442
169 Etanol 70 % Pcs 7 20 27 1 26 0 - 7 0 0 25
170 FM Crepe 7,5 cm x 4,55 m Pcs 6 6 6 - - 7 - - 6
171 FM Crepe 10 cm x 4,55 m Pcs 4 4 4 - - 7 - - 4
172 Folly Cath 18 Pcs 3 3 3 - - 7 - - 3
173 Folly Cath 20 Pcs - - 0 - - 7 - - 0
174 Handscoon Pcs 125 125 125 - - 7 - - 125
Handscoon L 1,100 1,100 700 400 27 - 7 188 237 52
Handscoon M 500 500 100 400 4 - 7 27 34 335
175 Infusion Set Anak Pcs - - - 0 - - 7 - - 0
176 Infusion Set Dewasa Pcs - - - - 0 - - 7 - - 0
177 i.v. Cathether 18 G Rol 15 15 15 - - 7 - - 15
178 i.v. Cathether 20 G Rol - - 0 - - 7 - - 0
179 i.v. Cathether 22 G Rol - - - 0 - - 7 - - 0
i.v. Cathether 26 G - - 0 - - 7 - - 0
SK SWK SWT
Stok Opt
NO NAMA OBAT/BHP Satuan Stok Awal penerimaan Persediaan Pengeluaran Sisa Stok BS Permintaan Ket
Hr Jml Hr Jml (SO)
181 Kapas Pembalut/Adsorben 100 g Rol 9 9 1 8 0 - 7 0 0 7

182 Kapas Pembalut/Adsorben 250 g Rol 50 50 50 - - 7 - - 50
183 Kasa Kompres 40/40 Steril Pcs 100 100 100 - - 7 - - 100
184 Kasa Pembalut 2 m x 80 cm Rol 99 99 10 89 0 - 7 3 3 83
185 Kasa Pembalut hidrofil 4 m x 15 cm Rol 100 100 100 - - 7 - - 100
186 Kasa Pembalut hidrofil 4 m x 3 cm Rol - - 0 - - 7 - - 0
187 Kasa Hidrofil 16 x 16 Pcs 150 150 150 - - 7 - - 150
188 Kasa 40 x 80 Btl 6 6 6 - - 7 - - 6
189 LISOL Rol 15 15 15 - - 7 - - 15
190 Masker Rol 2,350 2,350 250 2100 10 - 7 67 85 1938
Masker - - 0 - - 7 - - 0
191 Poligyp 5 cm x 2,7 m Pcs - - 0 - - 7 - - 0
192 Polifix 5 cm x 1 m Pcs 9 9 3 6 0 - 7 1 1 4
193 Poliband Btl - - 0 - - 7 - - 0
194 Policlean Handrub 500 ml Pcs 49 49 3 0 0 - 7 1 1 2
195 Plester 7,5 yard x 2 inch (Besar) Rol - - 0 - - 7 - - 0
196 Plester 5 yard x 2 inch (2,25 x 5 ) Pcs - - 0 - - 7 - - 0
197 Silk (Benang Bedah Sutra) no 3 / 0 Pcs 14 14 3 11 0 - 7 1 1 9
198 NGT Pcs - - 0 - - 7 - - 0
199 Urine bag Pcs 10 10 10 - - 7 - - 10
200 Aqua Gell Pcs - - 0 - - 7 - - 0
201 Catejeel Pcs - - 0 - - 7 - - 0
202 Scalvien Pcs 6 6 6 - - 7 - - 6
203 Do Care Wash Gloves Antiseptic Pcs 24 24 - 24 - - 7 - - 24
204 Feding Tube Pcs 2 2 2 - - 7 - - 2
Feding Tube Pcs 2 2 2 - - 7 - - 2
Feding Tube Pcs 2 2 2 - - 7 - - 2
Feding Tube Pcs 1 1 1 - - 7 - - 1
205 IV Cath 18 Pcs - - 0 - - 7 - - 0
- - 0 - - 7 - - 0
Tambahan : - - 0 - - 7 0
- - 0 - - 7 0
206 Bisacodyl Supp 5 mg Supp - - 0 - - 7 0
207 Salbutamol Syr Btl - 49 49 49 - - 7 49
208 Phenol Glycerol Btl - 0 - - 7 0
209 Anti Influenza (Noza) tab - 0 - - 7 0
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
210 Miniaspi Tab - - 0 - - 7 0

211 multivitamin (LVB) Tab - - 0 - - 7 0
212 Analgetik Inj (antrain ) Amp - - 0 - - 7 0
213 Phenitoin Inj Amp - - 0 - - 7 0
214 Griseofulvin 500 mg Tab Tab - - 0 - - 7 0
215 Oxymetazoline Spray 0,05 % Btl 20 20 20 - - 7 20
216 Oxymetazoline Drop 0,025 % Btl 12 12 12 - - 7 12
217 Asam tranexamat Inj amp 330 330 330 - - 7 330
218 Ipratropium Inh Unit 60 60 60 - - 7 60
219 Amoxicillin 250 Kap 4,000 4,000 200 3800 8 - 7 3792
As Folat 10 Mg tab 3,400 3,400 400 3000 15 - - 17 2968
Canula Infant pcs 50 50 15 35 35
ceftriaxone 1G inj btl 30 30 30 30
fixomull roll - - 0 0
livron tab 1,200 1,200 400 800 800
dulcolax supp 54 54 54 54
Phenol glycerin 10 % amp 48 48 48 48
antalgin inj amp 50 50 50 50
Acetyl cystein 200 mg tab 2,640 2,640 2640
Mengetahui
Kepala Puskesmas Hunduhon Pengelola Obat Puskesmas Hunduhon
( MARTINA LUMENTERI) (......................................................................................) (GEDE YOGI PRANA W., S.Farm)

Nip. 19670629 198703 2 008 Nip Nrpk: 19.7.0505817
Ket Kolom a Nomor Urut
Kolom b Nma Obat atau Sediaan
Kolom c Satuan diisi satuan terkecil
Kolom d Jumlah Volume sdiaan pd awal bulan berjalan
Kolom e Jumlah volume sediaan yg di terima dari Instalasi farmasi
Kolom f Jumlah Stok awal + Penerimaan
Kolom g Jumlah pengeluaran selama 1 (satu) bulan berjalan
Kolom h Jumlah Sisa Persedian setelah dikurangi Pengeluaran
Kolom i Jumlah Pengeluaran selama 1 (satu) bulan dibagi hari kerja (25 hr)
Kolom j Hari Kekosongan obat (dihitung sejak sediaan kosong sampai saat membuat laporan LPLPO )
Kolom k Jumlah volume sediaan yg kosong ( Jumlah hri kekosongan dikali denagn stok kebutuhan )
Kolom l Hari Waktu Tunggu (Jumlah hari menunggu penerimaan obat, ketikal LPLPO terkirim s/d terima distribusi obat)
Kolom m Jumlah volume Tunggu ( Jumlah hri kekosongan yang ditunggu dikali denagn stok kebutuhan )
Kolom n Jumlah volume penggunaan selama 1 (satu) bulan dikali 10 %
Kolom o Jumlah ( Pengeluaran+ Stok Kekosongan + Stok Tunggu ) x 10 % - Sisa Stok
Kolom p Jelas
Format : 2
B Anggaran Pendapatan dan Belanja Daerah (APBD I)
NO NAMA OBAT/BHP Satuan Stok Awal penerimaan Persediaan Pengeluaran Sisa Stok
1 Acyclovir Tab 400 mg Tab - - - - 0

2 Alupurinol Tab 100 mg Tab - - - - 0
3 Amoxicillin Caps 500 mg / Pehamoxyl 500 Tab - - - - 0
4 Asam Ascorbat (Vit C) Tab 50 mg Tab - - - - 0
5 Asam Mefenamat Tab 500 mg Tab - - - - 0
6 Calsium Laktat (Calk) Tab 500 mg Tab - - - - 0
7 Captopril Tab 25 mg Tab - - - - 0
8 Chlorpheniramin Maleat (CTM) Tab 4 mg Tab - - - - 0
9 Chlorpromazin HCl Tab Salut 25 mg Tab - - - - 0
11 Cotrimoksazol Dewasa Tab 480 mg/ Tab - - - - 0
12 Diazepam Tab 2 mg ( @ 100 = @ 100 ) Tab - - - - 0
13 Ephedrin HCl Tab 25 mg Tab - - - - 0
14 Gliseril Guaiyacolat Tab 100 mg Tab - - - - 0
15 Griseofulvin Tab 125 mg micronized Tab - - - - 0
16 Haloperidol Tab 5 mg Tab - - - - 0
17 Ibuprofen Tab 400 mg Tab - - - - 0
18 Metform Tb Tab - - - - 0
19 Piridoxyn HCl Tab 10 mg Tab - - - - 0
20 Prednison Tab 5 mg Tab - - - - 0
21 PropilTioUrasil (PTU) Tab 100 mg Tab - - - - 0
22 Retinol 10.000 IU Caps Tab - - - - 0
24 Cotrimoksazol Susp Btl - - - - 0

25 erytromysin Syrup Kering Btl - - - - 0
26 Obat Batuk Hitam (OBH) Cairan Btl - - - - 0
27 Paracetamol Syrup 100 mg / 5 ml Btl - - - - 0
28 Aqua Pro Injeksi Steril Bebas Pirogen Amp - - - - 0

29 Clorpromazine inj Amp/Flc - - - - 0
30 Cyanocobalamin (Vit B12) Inj 500 mg / ml Amp/Flc - - - - 0
31 Diazepam Inj Amp/Flc - - - - 0
32 Magnesium Sulfat Inj (i.v.) 20% - 25 ml Amp/Flc - - - - 0
33 Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Ampl ) Amp/Flc - 20 20 - 20
34 Phenobarbital Inj Amp/Flc - - - - 0
35 AntiHemoroid Doen Kombinasi Tub - - - - 0

36 Antifungi SK Tub - - - - 0
37 Etanol 70 % Tub - - - - 0
38 Gentian Violet Lar 1% Tub - - - - 0
39 Hidrokortison Cream 2,5% Tub - - - - 0
40 Oxytetracyclin HCl Salep Kulit 3% Tub - 20 20 - 20
41 Povidon Iodium Lar 300 ml Tub - - - - 0
42 Salisil Talk/Bedak 2% Tub - - - - 0
43 Nystatin Suppo - - - -
44 Ergotamin Tab - - - -
BMHP
45 Catgut/Benang Bedah no 2/0-3/0 (plain&chromic) pcs - - - - 0
46 Folly cath 18 pcs - - - - 0
47 Handscoon pcs - - - - 0
48 i.v. Cathether 22 G pcs - - - - 0
50 Kapas Pembalut/Adsorben 250 g pcs - - - - 0
51 Kasa Pembalut 2 m x 80 cm pcs - - - - 0
52 Urine bag pcs - - - - 0
Tanbahan
a
b
c
d
e
f
g
Mengetahui

Nip. 19670629 198703 2 008 Nip Nrpk: 19.7.0505817
Format : 3
C Psikotropika / Precursor
1 Amitriptiline 25 mg Tab - - 0
2 Alprasolam 0,5 Tab - - 0
3 Carbamazepine 200 mg Tab Tab - - 0
4 Chlorpromazin HCl Tab Salut 25 mg Tab - - 0
6 Chlorpromazin HCl Inj Amp - - 0
7 Diazepam Tab 2 mg Tab - - 0
8 Diazepam Tab 5 mg Tab 197 197 10 187
9 Diasepam Rectal Tab - - 0
10 Diazepam Inj Amp 100 100 - 100
11 Haloperidol Tab 0,5 mg Tab - - 0
12 Haloperidol Tab 5 mg Tab - - 0
14 Phenobarbital Tab 30 mg Tab - - 0
15 Trihexyfenidil Tab 60 60 60
16 Phenobarbital Inj Amp - - 0
Mengetahui

Nip. 19670629 198703 2 008 Nip Nrpk: 19.7.0505817
Format : 4
D Program P2P
Diare
1 Zink Tab - 5,000 5,000 700 4300
2 Oralit Tab 80 2,000 2,080 280 1800
Imunisasi
1 BCG Amp - - 0
2 DPT - HB - Hib Amp - - 0
3 DT Amp - - 0
4 HB o Amp - - 0
5 IPV Amp - - 0
6 TD Amp - - 0
7 POLIO Amp - - 0
8 MR Amp - - 0
- - 0
9 ASSP 05 ml Pcs - - 0
10 ASSP 005 ml Pcs - - 0
TB paru
4 Kategori I Paket - - 0
5 Kategori II Paket - - 0
6 Kategori Anak Paket - - 0
7 Reagen Paket - - 0
HIV/ Kusta
9 PB Anak Blister - - 0
10 MB Anak Blister - - 0
11 PB Dewasa Blister - - 0
12 MB Dewasa Blister - - 0
Kecacingan
14 DEC Tab - - 0
15 Albendasole Tab - - 0
16 Paracetamol Tab - - 0
Rabies
Verorab Inj Amp - - 0
Malaria
17 Primaquin Tab - - 0
18 ACT Tab - - 0
19 Doxyciclin Tab - - 0
20 Artesunat Inj Amp - - 0
21 Artemeter Inj Amp - - 0
Mengetahui
Kepala Puskesmas....................... Pengelola Obat Puskesmas……...……
(.................................................................................) (..........................................................................) (...............................................................................)

Nip Nip Nip
LAPORAN BULANAN KEFARMASIAN
Format 5
A .Puskesmas Induk B : Jaringan Puskesmas
Jenis Pelayanan Resep Jenis Pelayanan Resep

Informasi
No Tanggal Konseling Informasi Obat Ket No Pustu/Polindes Konseling
Rawat Jalan Rawat Inap Rawat Jalan Rawat Inap Obat
a b c d d e f a b
1 1/1/2020 - 3 - - - 1 poindes kayutanyo 56.0 - - 0
2 1/2/2020 8 3 - - - 2 poskesdes bukit mulya 31.0 - - 0
3 1/3/2020 12 6 - - - 3 polindes lontos 10.0 - - 0
4 1/4/2020 17 - - - 4 pustu louk 28.0 - - 0
5 1/5/2020 - 1 - - - 5 pustu molino 33.0 - - 0
6 1/6/2020 37 2 - - - 6 polindes trans pohi 8.0 - - 0
7 1/7/2020 30 9 - - - 7 polindes indang sari 10.0 - - 0
8 1/8/2020 17 1 - - - 8 pustu uwedikan 32.0 - - 0
9 1/9/2020 15 4 - - - 9 pustu bantayan 30.0 - - 0
10 1/10/2020 13 9 - - - 10 polindes baya 35.0 - - 0
11 1/11/2020 17 3 - - - 11 - - - - 0
12 1/12/2020 2 - - - 12 - - - - 0
13 1/13/2020 23 6 - - - 13 - - - - 0
14 1/14/2020 24 3 - - - 14 - - - - 0
15 1/15/2020 18 - - - - 15 - - - - 0
16 1/16/2020 25 6 - - - 16 - - - - 0
17 1/17/2020 19 6 - - - 17 - - - - 0
18 1/18/2020 43 6 - - - 18 - - - - 0
19 1/19/2020 - 1 - - - 19 - - - - 0
20 1/20/2020 23 9 - - - 20 - - - - 0
21 1/21/2020 26 8 - - - Jumlah B 273.0 - - 0
22 1/22/2020 28 12 - - -
23 1/23/2020 14 7 - - - Total A + B 934 - - 0
24 1/24/2020 11 8 - - -
25 1/25/2020 - 2 - - -
26 1/26/2020 - 4 - - - Ket : Kolom a. jelas
27 1/27/2020 27 8 - - - Kolom b. Jelas
28 1/28/2020 16 4 - - - Kolom c dan d. Jumlah lembar Rese
29 1/29/2020 24 4 - - - Kolom e. Penderita yang minta penjelasan secara det
30 1/30/2020 12 5 - - - Kolom f. Penjelasan / informasi yang dilakukan /
Jumlah A 513 148 - - - Kolom f. Penjelasan / informasi yang dilakukan /diberikan kepada penderita/masyarakat
(LPLPO)

Nama Puskesmas : Puskesmas Hunduhon
Kecamatan :
Kabupaten : Banggai Bulan : Februari
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

1 Ambroxol Tab 600 600 200 400 8 - 7 54 20 126
2 Acyclovir Tab 200 mg Tab - - 0 - - 7 - - 0
3 Acyclovir Tab 400 mg Tab 1,750 1,750 350 1400 13 - 7 94 35 921
4 Alupurinol Tab 100 mg Tab 3,700 3,700 400 3300 15 - 7 108 40 2752
5 Alprazolam tab 0,5 mg Tab - - 0 - - 7 - - 0
6 Aminophyllin Tab 200 mg Tab 2,100 2,100 300 1800 12 - 7 81 30 1389
7 Amoxicillin Caps 500 mg / Pehamoxyl 500 Tab 15,000 15,000 2,000 13000 77 - 7 538 200 10262
8 Ampicillin Caplet 500 mg Tab - - 0 - - 7 - - 0
9 Amlodipine 5 Mg Tab 4,500 4,500 660 3840 25 - 7 178 66 2936
10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab - - 0 - - 7 - - 0
11 Antalgin Tab 500 mg Tab - - 0 - - 7 - - 0
12 Antasida Doen Tab Kombinasi Tab 17,600 17,600 2,300 15300 88 - 7 619 230 12151
13 Attapulgit 600 mg tablet (5 x 10 tab) Tab 4,700 4,700 500 4200 19 - 7 135 50 3515
14 Asam Ascorbat (Vit C) Tab 50 mg Tab 7,000 7,000 600 6400 23 - 7 162 60 5578
15 Asam Mefenamat Tab 500 mg Tab - - 0 - - 7 - - 0
16 Betahistin Tb Tab 2,500 2,500 300 2200 12 - 7 81 30 1789
17 Calsium Laktat (Calk) Tab 500 mg Tab 5,000 5,000 300 4700 12 - 7 81 30 4289
18 Captopril Tab 25 mg Tab 800 800 - 800 - - 7 - - 800
19 CarbamazeineTab Tab - - 0 - - 7 - - 0
20 Cefadroxil Capsul 500 mg Tab - - - 0 - - 7 - - 0
21 Cetirizine Tb Tab 2,000 2,000 200 1800 8 - 7 54 20 1526
22 Chloramphenicol Caps 250 mg Tab - - 0 - - 7 - - 0
23 Chlorpheniramin Maleat (CTM) Tab 4 mg Tab 10,000 10,000 - 10000 - - 7 - - 10000
24 Chlorpromazin HCl Tab Salut 25 mg Tab - - 0 - - 7 - - 0
26 Ciprofloxacin Capl 500 mg Tab - - - 0 - - 7 - - 0
27 Cimetidine Tab 200 mg Tab - - 0 - - 7 - - 0
28 Clonidine Tab - - 0 - - 7 - - 0
29 Cotrimoksazol Ped Tablet 120 mg Tab - - 0 - - 7 - - 0
30 Cotrimoksazol Dewasa Tab 480 mg/ Tab 5,000 5,000 400 4600 15 - 7 108 40 4052
31 Cyanocobalamin (Vit B12) Tab Tab 7,000 7,000 600 6400 23 - 7 162 60 5578
32 Dexametason Tab 0,5 mg Tab 16,500 16,500 2,400 14100 92 - 7 646 240 10814
33 Diazepam Tab 2 mg ( @ 100 = @ 100 ) Tab - - - 0 - - 7 - - 0
35 Domperidome ( @100 = @50 ) Tab 7,000 7,000 300 6700 12 - 7 81 30 6289
36 Ephedrin HCl Tab 25 mg Tab - - 0 - - 7 - - 0
37 Erytromysin 500 mg Tab Tab 800 800 100 700 4 - 7 27 10 563
SWK SWT
Stok Opt
NO NAMA OBAT/BHP Satuan Stok Awal Persediaan Pengeluaran Sisa Stok SK BS Permintaan Ket
Hr Jml Hr Jml (SO)
39 Furosemid Tablet 40 mg Tab 2,500 2,500 - 2500 - - 7 - - 2500
41 Gliseril Guaiyacolat Tab 100 mg Tab - - - 0 - - 7 - - 0
45 Hidroklorothiazid (HCT) Tab 25 mg Tab 2,500 2,500 - 2500 - - 7 - - 2500
54 Loratadin tab 10 mg Tab 1,500 1,500 500 1000 19 - 7 135 169 677
56 Metform Tb Tab 900 900 700 200 27 - 7 188 237 252
59 Metronidasole 500 Tab 1,000 1,000 200 800 8 - 7 54 68 671
60 Metoclopramide Tab 10 mg Tab - - - 0 - - 7 - - 0
61 Natrium Diklofenak Tab 50 mg Tab 6,700 6,700 1,400 5300 54 - 7 377 474 4395
64 Omeprasole Tab 2,910 2,910 2910 - - 7 - - 2910
66 Paracetamol Tab 500 mg Tab 5,500 5,500 900 4600 35 - 7 242 305 4018
68 Piridoxyn HCl Tab 10 mg Tab 10,200 10,200 400 9800 15 - 7 108 135 9542
69 Prednison Tab 5 mg Tab 9,100 9,100 - 9100 - - 7 - - 9100
71 PropilTioUrasil (PTU) Tab 100 mg Tab 600 600 200 400 8 - 7 54 68 271
73 Pyrantel HCl Tab 125 mg Tab 1,200 1,200 100 1100 4 - 7 27 34 1035
77 Salbutamol Tab 4 mg Tab 650 650 50 600 2 - 7 13 17 568
78 Selviplex Tab - - 0 - - 7 - - 0
79 Simvastatin Tab - - 0 - - 7 - - 0
80 Tablet Tambah Darah Tab 3,930 3,930 430 3500 17 - 7 116 146 3222
83 Thiamin HCl Monotartrat (Vit B1) Tab 50 mg Tab 5,000 5,000 500 4500 19 - 7 135 169 4177
84 Trihexylfenidil Tab 60 60 60 - - 7 - - 60
85 Vitamin B Compleks Tab Tab 10,000 10,000 700 9300 27 - 7 188 237 8848
86 Zink Tab 4,300 4,300 600 3700 23 - 7 162 203 3312
SWK SWT
Stok Opt
NO NAMA OBAT/BHP Satuan Stok Awal Persediaan Pengeluaran Sisa Stok SK BS Permintaan Ket
Hr Jml Hr Jml (SO)
- 0
87 Ambroxol Sy Btl - - 0 - - 7 - - 0
88 Amoxicillin Syrup Kering 125 mg / 5 ml Btl - - 0 - - 7 - - 0
91 Antidiare syr Btl - - 0 - - 7 - - 0
93 Cotrimoksazol Susp Btl 158 158 21 137 1 - 7 6 7 123
94 Cefadroxil Syr Btl 100 100 16 84 1 - 7 4 5 74
95 Cetirizine Syr Btl 200 200 20 180 1 - 7 5 7 167
96 Domperidome Sy Btl 200 200 23 177 1 - 7 6 8 162
98 Garam Oralit 200 ml Air Btl 1,800 1,800 - 1800 - - 7 - - 1800
99 Ibuprofen Syr Btl 200 200 33 167 1 - 7 9 11 146
101 Multivit Syr Btl - - 0 - - 7 - - 0
103 Paracetamol Syrup 100 mg / 5 ml Btl 489 489 489 - - 7 - - 489
104 Paracetamol Drops 10 ml Btl 56 56 56 - - 7 - - 56
105 Pyrantel Syr Btl 50 50 50 - - 7 - - 50
106 Zinc Syr Btl 215 215 33 182 1 - 7 9 11 161
0
108 Aminopyllin Inj Amp 38 38 - 38 - - 7 - - 38
109 Aqua Pro Injeksi Steril Bebas Pirogen Amp 180 180 - 180 - - 7 - - 180
110 Asering - Asetat Ringer Amp - - - 0 - - 7 - - 0
115 Dexametason Inj 5 mg / ml - 1 ml Amp 230 230 10 220 0 - 7 3 3 214
116 Diazepam Inj Amp - - 0 - - 7 - - 0
120 Furocemide Inj Amp 45 45 - 45 - - 7 - - 45
121 Glukosa Lar Infus 5% Steril Amp 70 70 70 0 3 - 7 19 24 45
122 KA EN 3B Amp - - - 0 - - 7 - - 0
123 Ketorolac Inj ( @ 12 = @ 6 ) Amp 780 780 10 770 0 - 7 3 3 764
125 Magnesium Sulfat Inj (i.v.) 20% - 25 ml Amp - - 0 - - 7 - - 0
126 Metil Ergometrin Maleat Inj 0,200 mg - 1 ml Amp 95 95 - 95 - - 7 - - 95
128 Natrium Klorida 0,9% Larutan Infus Steril Amp 250 250 50 200 2 - 7 13 17 168
131 Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Ampl ) Amp - - - 0 - - 7 - - 0
SK SWK SWT
Sisa Stok Opt
NO NAMA OBAT/BHP Satuan Stok Awal Persediaan Pengeluaran BS Permintaan Ket
134 Ringer Laktat Lar Infus Steril Amp 1,000 1,000 200 800 8 - 7 54 68 671
136 Vit B1, B6, B12 Inj Amp - - 0 - - 7 - - 0
0
137 Aciclovir cream (25 Tube) Tub - - - 0 - - 7 - - 0
139 Antifungi SK Tub 24 24 24 0 1 - 7 6 8 16
140 Betametason Cream 0,1% (25 Tube) Tub 312 312 - 312 - - 7 - - 312
141 Chloramphenicol Salep Kulit 1% (24 tube) Tub 14 14 7 7 0 - 7 2 2 2
142 Chloramphenicol Salep Mata 1% (24 tube) Tub 72 72 28 44 1 - 7 8 9 26
144 Chloramphenicol Tetes Telinga (24 Btl) Tub - - 0 - - 7 - - 0
146 Etakridina laktat (Rivanol) Tub 60 60 2 58 0 - 7 1 1 57
148 Gentian Violet Lar 1% Tub - - - 0 - - 7 - - 0
151 Mikonazole Sk Btl - - - 0 - - 7 - - 0
159 Salisil Talk/Bedak 2% Tub - - - 0 - - 7 - - 0
160 Scabimite Tub - - - 0 - - 7 - - 0
BMHP 0
164 Alat Suntik Sekali Pakai 10 ml Pcs 538 538 538 - - 7 - - 538
165 Catgut/Benang Bedah no 2/0-3/0 (chromic) Pcs 148 148 26 122 1 - 7 7 9 105
48 48 48
166 Canula Adult & Childr Pcs - - 0 - - 7 - - 0
167 Canula Adult & Childr Pcs 35 35 10 25 0 - 7 3 3 19
169 Etanol 70 % Pcs 26 26 3 23 0 - 7 1 1 21
170 FM Crepe 7,5 cm x 4,55 m Pcs 6 6 - 6 - - 7 - - 6
171 FM Crepe 10 cm x 4,55 m Pcs 4 4 4 - - 7 - - 4
172 Folly Cath 18 Pcs 3 3 3 - - 7 - - 3
173 Folly Cath 20 Pcs - - 0 - - 7 - - 0
174 Handscoon Pcs 125 125 125 - - 7 - - 125
Handscoon L 400 400 400 0 15 - 7 108 135 258
Handscoon M 400 400 300 100 12 - 7 81 102 94
176 Infusion Set Dewasa Pcs - - 0 - - 7 - - 0
i.v. Cathether 26 G - - 0 - - 7 - - 0
SK SWK SWT
Stok Opt
NO NAMA OBAT/BHP Satuan Stok Awal Persediaan Pengeluaran Sisa Stok BS Permintaan Ket
Hr Jml Hr Jml (SO)

182 Kapas Pembalut/Adsorben 250 g Rol 50 50 - 50 - - 7 - - 50
184 Kasa Pembalut 2 m x 80 cm Rol 89 89 89 - - 7 - - 89
187 Kasa Hidrofil 16 x 16 Pcs 150 150 - 150 - - 7 - - 150
188 Kasa 40 x 80 Btl 6 6 6 - - 7 - - 6
189 LISOL Rol 15 15 15 - - 7 - - 15
190 Masker Tie On Rol 2,100 2,100 400 1700 15 - 7 108 135 1442
Masker - - 0 - - 7 - - 0
191 Poligyp 5 cm x 2,7 m Pcs - - 0 - - 7 - - 0
192 Polifix 5 cm x 1 m Pcs 6 6 3 3 0 - 7 1 1 1
193 Poliband Btl - - 0 - - 7 - - 0
194 Policlean Handrub 500 ml Pcs - - 0 - - 7 - - 0
198 NGT Pcs - - 0 - - 7 - - 0
199 Urine bag Pcs 10 10 10 - - 7 - - 10
200 Aqua Gell - - 0 - - 7 - - 0
201 Catejeel - - 0 - - 7 - - 0
202 Scalvien 6 6 6 - - 7 - - 6
203 Do Care Wash Gloves Antiseptic 24 24 - 24 - - 7 - - 24
204 Feding Tube 2 2 2 - - 7 - - 2
Feding Tube 2 2 2 - - 7 - - 2
Feding Tube 2 2 2 - - 7 - - 2
Feding Tube 1 1 1 - - 7 - - 1
205 IV Cath 18 - - 0 - - 7 - - 0
- - 0 - - 7 - - 0
Tambahan : - - 0 - - 7 - - 0
- - 0 - - 7 - - 0
206 Bisacodyl Supp 5 mg - - 0 - - 7 - - 0
207 Salbutamol Syr 49 49 9 40 0 - 7 2 3 34
208 Phenol Glycerol - - 0 - - 7 - - 0
209 Anti Influenza (Noza) - - 0 - - 7 - - 0
SK SWK SWT
Stok Opt
NO NAMA OBAT/BHP Satuan Stok Awal Persediaan Pengeluaran Sisa Stok BS Permintaan Ket
Hr Jml Hr Jml (SO)
210 Miniaspi - - 0 - - 7 - - 0
211 multivitamin (LVB) - - 0 - - 7 - - 0
212 Analgetik Inj (antrain ) - - - 0 - - 7 - - 0
213 Phenitoin Inj - - - 0 - - 7 - - 0
214 Griseofulvin 500 mg Tab - - - 0 - - 7 - - 0
215 Oxymetazoline Spray 0,05 % 20 20 20 - - 7 - - 20
216 Oxymetazoline Drop 0,025 % 12 12 12 - - 7 - - 12
217 Asam tranexamat Inj 330 330 - 330 - - 7 - - 330
218 Ipratropium Inh 60 60 60 - - 7 - - 60
219 Amoxicillin 250 3,800 3,800 3800 - - 7 - - 3800
As Folat 10 Mg tab 3,000 3,000 3000 - - - - 3000
Canula Infant pcs 35 35 35
ceftriaxone 1G inj btl 30 30 30
fixomull roll - - 0
livron tab 800 800 800
dulcolax supp 54 54 54
Phenol glycerin 10 % amp 48 48 48
Acetyl cystein 200 mg tab 2,640 2,640 240 2400
Mengetahui

Nip. 19670629 198703 2 008 Nip Nrpk: 19.7.0505817

Kolom p Jelas
Format : 2



33 Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Ampl ) Amp/Flc 20 - 20 20 0

37 Etanol 70 % Tub - - - - 0
40 Oxytetracyclin HCl Salep Kulit 3% Tub - - - 0
BMHP
Tanbahan
a
b
c
d
e
f
g
Mengetahui

Nip. 19670629 198703 2 008 Nip Nrpk: 19.7.0505817
Format : 3
7 Diazepam Tab 2 mg Tab - - - 0
10 Diazepam Inj Amp 100 100 100
13
Haloperidol Tab 1,5 mg Tab - - 0
15 Trihexyfenidil Tab 60 60 60
Format : 4
D Program P2P
Diare
1 Zink Tab 4,300 4,300 600 3700
2 Oralit Tab 1,800 1,800 - 1800
Imunisasi
1 BCG Amp - - 0
3 DT Amp - - 0
4 HB o Amp - - 0
5 IPV Amp - - 0
6 TD Amp - - 0
7 POLIO Amp - - 0
8 MR Amp - - 0
- - 0
10 ASSP 005 ml Pcs - - 0
TB paru
HIV/ Kusta
Kecacingan
14 DEC Tab - - 0
Rabies
Malaria
18 ACT Tab - - 0
Mengetahui

Nip. 19670629 198703 2 008 Nip Nrpk: 19.7.0505817

Format 5
Jenis Pelayanan Resep Jenis Pelayanan Resep Informasi

a b c d d e f a b
1 2/1/2020 46 - - - - 1 LOUK 46.0 - - 0
2 2/2/2020 - 7 - - - 2 BUKIT MULYA 29.0 - - 0
3 2/3/2020 20 2 - - - 3 LONTOS 28.0 - - 0
4 2/4/2020 28 1 - - - 4 MOLINO 38.0 - - 0
5 2/5/2020 24 5 - - - 5 TRANSPOHI 11.0 - - 0
6 2/6/2020 22 4 - - - 6 KAYUTANYO 46.0 - - 0
7 2/7/2020 10 8 - - - 7 - - - - 0
8 2/8/2020 7 1 - - - 8 - - - - 0
9 2/9/2020 - 4 - - - 9 - - - - 0
10 2/10/2020 23 6 - - - 10 - - - - 0
11 2/11/2020 3 1 - - - 11 - - - - 0
12 2/12/2020 21 4 - - - 12 - - - - 0
13 2/13/2020 12 3 - - - 13 - - - - 0
2/14/2020 11 3 - - - 14 - - - - 0
15 2/15/2020 16 3 - - - 15 - - - - 0
16 2/16/2020 4 - - - 16 - - - - 0
17 2/17/2020 29 13 - - - 17 - - - - 0
18 2/18/2020 36 6 - - - 18 - - - - 0
19 2/19/2020 23 6 - - - 19 - - - - 0
20 2/20/2020 10 4 - - - 20 - - - - 0
21 2/21/2020 11 4 - - - Jumlah B 198.0 - - 0
22 2/22/2020 23 4 - - -
23 2/23/2020 - 2 - - - Total A + B 777 134 - 0
24 2/24/2020 54 8 - - -
25 2/25/2020 35 6 - - -
26 2/26/2020 27 4 - - - Ket : Kolom a. jelas
27 2/27/2020 25 10 - - - Kolom b. Jelas
29 2/29/2020 47 6 - - - Kolom e. Penderita yang minta penjelasan secara deta
30 - - - - - Kolom f. Penjelasan / informasi yang dilakukan /d
31 - - - - - Kolom e. Penderita yang minta penjelasan secara deta
Mengetahui
Form. POR 5 a
( MARTINA LUMENTERI) (......................................................................................) (GEDE YOGI PRANA W., S.Farm) :

Nip. 19670629 198703 2 008 Nip Nrpk: 19.7.0505817 :
(LPLPO)

Kabupaten : Banggai Bulan : MARET
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
19 Mar 19
No 042/III
1 Ambroxol Tab 400 400 400 0 15 - 7 108 40 548
2 Acyclovir Tab 200 mg Tab 0 - 0 - - 7 - - 0
3 Acyclovir Tab 400 mg Tab 1400 - 1,400 200 1200 8 - 7 54 20 926
4 Alupurinol Tab 100 mg Tab 3300 - 3,300 1,000 2300 38 - 7 269 100 931
5 Alprazolam tab 0,5 mg Tab 0 - 0 - - 7 - - 0
6 Aminophyllin Tab 200 mg Tab 1800 - 1,800 - 1800 - - 7 - - 1800
7 Amoxicillin Caps 500 mg / Pehamoxyl 500 Tab 13000 - 13,000 1,600 11400 62 - 7 431 160 9209
8 Ampicillin Caplet 500 mg Tab 0 - 0 - - 7 - - 0
9 Amlodipine 5 Mg Tab 3840 3,840 960 2880 37 - 7 258 96 1566
10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab 0 - 0 - - 7 - - 0
11 Antalgin Tab 500 mg Tab 0 - 0 - - 7 - - 0
12 Antasida Doen Tab Kombinasi Tab 15300 - 15,300 900 14400 35 - 7 242 90 13168
13 Attapulgit 600 mg tablet (5 x 10 tab) Tab 4200 4,200 300 3900 12 - 7 81 30 3489
14 Asam Ascorbat (Vit C) Tab 50 mg Tab 6400 - 6,400 1,200 5200 46 - 7 323 120 3557
15 Asam Mefenamat Tab 500 mg Tab 0 - - - 0 - - 7 - - 0
16 Betahistin Tb Tab 2200 2,200 300 1900 12 - 7 81 30 1489
17 Calsium Laktat (Calk) Tab 500 mg Tab 4700 4,700 400 4300 15 - 7 108 40 3752
18 Captopril Tab 25 mg Tab 800 - 800 400 400 15 - 7 108 40 148
19 CarbamazeineTab Tab 0 - 0 - - 7 - - 0
20 Cefadroxil Capsul 500 mg Tab 0 - - - 0 - - 7 - - 0
21 Cetirizine Tb Tab 1800 - 1,800 800 1000 31 - 7 215 80 95
22 Chloramphenicol Caps 250 mg Tab 0 - 0 - - 7 - - 0
23 Chlorpheniramin Maleat (CTM) Tab 4 mg Tab 10000 - 10,000 2,000 8000 77 - 7 538 200 5262
26 Ciprofloxacin Capl 500 mg Tab 0 - - 0 - - 7 - - 0
27 Cimetidine Tab 200 mg Tab 0 - 0 - - 7 - - 0
28 Clonidine Tab 0 - 0 - - 7 - - 0
29 Cotrimoksazol Ped Tablet 120 mg Tab 0 - 0 - - 7 - - 0
30 Cotrimoksazol Dewasa Tab 480 mg/ Tab 4600 4,600 700 3900 27 - 7 188 70 2942
31 Cyanocobalamin (Vit B12) Tab Tab 6400 - 6,400 800 5600 31 - 7 215 80 4505
32 Dexametason Tab 0,5 mg Tab 14100 - 14,100 2,100 12000 81 - 7 565 210 9125
33 Diazepam Tab 2 mg ( @ 100 = @ 100 ) Tab 0 - 0 - - 7 - - 0
35 Domperidome ( @100 = @50 ) Tab 6700 - 6,700 1,000 5700 38 - 7 269 100 4331
36 Ephedrin HCl Tab 25 mg Tab 0 - 0 - - 7 - - 0
37 Erytromysin 500 mg Tab Tab 700 - 700 300 400 12 - 7 81 30 11
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
38 Fitomenadion (Vit K) Tab Salut 10 mg Tab 350 - 350 - 350 - - 7 - - 350

39 Furosemid Tablet 40 mg Tab 2500 - 2,500 - 2500 - - 7 - - 2500
40 Glibenklamid Tab 5 mg Tab 0 - 0 - - 7 - - 0
41 Gliseril Guaiyacolat Tab 100 mg Tab 0 - - 0 - - 7 - - 0
42 Griseofulvin Tab 125 mg micronized Tab 0 - 0 - - 7 - - 0
43 Haloperidol Tab 1,5 mg Tab 0 - 0 - - 7 - - 0
44 Haloperidol Tab 5 mg Tab 0 - 0 - - 7 - - 0
45 Hidroklorothiazid (HCT) Tab 25 mg Tab 2500 - 2,500 100 2400 4 - 7 27 10 2263
46 Ibuprofen Tab 200 mg Tab 0 - - - 0 - - 7 - - 0
47 Ibuprofen Tab 400 mg Tab 2000 2,000 2000 - - 7 - - 2000
49 Komb. Pirimetamin 25 mg + Sulfadoxin 500 mg Tab 0 - 0 - - 7 - - 0
50 Ketoconzol Tab Tab 0 - 0 - - 7 - - 0
51 LansoprasolenTb Tab 0 - 0 - - 7 - - 0
52 Levofloxacin Tab 500 mg Tab 0 - 0 - - 7 - - 0
53 Loperamide Tab Tab 0 - 0 - - 7 - - 0
54 Loratadin tab 10 mg Tab 1000 - 1,000 - 1000 - - 7 - - 1000
55 Meloksikam 15 Mg Tab 0 - 0 - - 7 - - 0
56 Metform Tb Tab 200 200 200 0 8 - 7 54 68 129
57 Methyl Prednisolon Tb Tab 0 - 0 - - 7 - - 0
58 Metronidazole Tab 250 mg Tab 0 - 0 - - 7 - - 0
59 Metronidasole 500 Tab 800 800 200 600 8 - 7 54 68 471
60 Metoclopramide Tab 10 mg Tab 0 - 0 - - 7 - - 0
61 Natrium Diklofenak Tab 50 mg Tab 5300 5,300 200 5100 8 - 7 54 68 4971
63 Ofloxacin Tab 400 mg Tab 0 - 0 - - 7 - - 0
64 Omeprasole Tab 2910 2,910 30 2880 1 - 7 8 10 2861
65 Papaverin Tab 40 mg Tab 0 - 0 - - 7 - - 0
66 Paracetamol Tab 500 mg Tab 4600 - 4,600 200 4400 8 - 7 54 68 4271
67 Phenobarbital Tab 30 mg Tab 0 - 0 - - 7 - - 0
68 Piridoxyn HCl Tab 10 mg Tab 9800 - 9,800 200 9600 8 - 7 54 68 9471
69 Prednison Tab 5 mg Tab 9100 9,100 - 9100 - - 7 - - 9100
70 Piroxicam Caps 20 mg Tab 0 - 0 - - 7 - - 0
71 PropilTioUrasil (PTU) Tab 100 mg Tab 400 - 400 100 300 4 - 7 27 34 235
72 Propanolol HCl Tab 40 mg Tab 0 - 0 - - 7 - - 0
73 Pyrantel HCl Tab 125 mg Tab 1100 - 1,100 40 1060 2 - 7 11 14 1034
74 Ranitidine Tab 150 mg Tab 0 - - - 0 - - 7 - - 0
75 Retinol 100.000 Iu (Biru) Tab 0 - 0 - - 7 - - 0
76 Retinol 200.000 Iu (Merah) Tab 0 - 0 - - 7 - - 0
77 Salbutamol Tab 4 mg Tab 600 - 600 300 300 12 - 7 81 102 106
78 Selviplex Tab 0 - 0 - - 7 - - 0
79 Simvastatin Tab 0 - 0 - - 7 - - 0
80 Tablet Tambah Darah Tab 3500 - 3,500 330 3170 13 - 7 89 112 2957
81 Tetracyclin HCl Caps 250 mg Tab 0 - 0 - - 7 - - 0
82 Tetracyclin HCl Caps 500 mg Tab 0 - 0 - - 7 - - 0
83 Thiamin HCl Monotartrat (Vit B1) Tab 50 mg Tab 4500 - 4,500 600 3900 23 - 7 162 203 3512
84 Trihexylfenidil Tab 60 60 60 0 2 - 7 16 20 39 EXPIRED
85 Vitamin B Compleks Tab Tab 9300 - 9,300 900 8400 35 - 7 242 305 7818
86 Zink Tab 3700 - 3,700 400 3300 15 - 7 108 135 3042
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
0
87 Ambroxol Sy Btl 0 - 0 - - 7 - - 0
88 Amoxicillin Syrup Kering 125 mg / 5 ml Btl 0 - - 0 - - 7 - - 0
89 Ampicillin Syrup Kering 125 mg / 5 ml Btl 0 - 0 - - 7 - - 0
91 Antidiare syr Btl 0 - 0 - - 7 - - 0
92 Antiinfluensa Syr (Erlaflu) Btl 0 - 0 - - 7 - - 0
97 erytromysin Syrup Kering Btl 0 - - 0 - - 7 - - 0
98 Garam Oralit 200 ml Air Btl 1800 1,800 - 1800 - - 7 - - 1800
99 Ibuprofen Syr Btl 167 - 167 97 70 4 - 7 26 33 7
100 Metocloperamide Syr Btl 0 - 0 - - 7 - - 0
101 Multivit Syr Btl 0 - 0 - - 7 - - 0
102 Obat Batuk Hitam (OBH) Cairan Btl 0 - 0 - - 7 - - 0
103 Paracetamol Syrup 100 mg / 5 ml Btl 489 - 489 130 359 5 - 7 35 44 275
104 Paracetamol Drops 10 ml Btl 56 56 26 30 1 - 7 7 9 13
105 Pyrantel Syr Btl 50 - 50 - 50 - - 7 - - 50
106 Zinc Syr Btl 182 182 24 158 1 - 7 6 8 142
0 0
107 Ampicillin 1 gram Inj Amp 0 - 0 - - 7 - - 0
110 Asering - Asetat Ringer Amp 0 - - 0 - - 7 - - 0
111 Atropin inj 0,25 mg/mL (i.v./i.m./s.k.) Amp 0 - 0 - - 7 - - 0
112 Cefotaxim 1 g Inj Amp 80 - 80 80 - - 7 - - 80
113 Clorpromazine inj Amp 0 - 0 - - 7 - - 0
116 Diazepam Inj Amp 0 - - 0 - - 7 - - 0
118 Ephinefrin HCl/Bitartrat (Adrenalin) Inj 0,1% - 1 ml Amp 0 - 0 - - 7 - - 0
119 Fitomenadion (Vit K) Inj 10 mg - 1 ml Amp 210 - 210 18 192 1 - 7 5 6 180
121 Glukosa Lar Infus 5% Steril Amp 0 - - 0 - - 7 - - 0
122 KA EN 3B Amp 0 - 0 - - 7 - - 0
123 Ketorolac Inj ( @ 12 = @ 6 ) Amp 770 - 770 40 730 2 - 7 11 14 704
124 Lidocain Comp. Inj/Pehacain Inj. Amp 235 - 235 45 190 2 - 7 12 15 161
125 Magnesium Sulfat Inj (i.v.) 20% - 25 ml Amp 0 - 0 - - 7 - - 0
127 Metocloperamide Inj Amp 0 - 0 - - 7 - - 0
128 Natrium Klorida 0,9% Larutan Infus Steril Amp 200 200 140 60 5 - 7 38 47 30 EXPIRED
130 Oxytetracyklin HCl Inj (i.m.) 50 mg / ml - 10 ml Amp 0 - 0 - - 7 - - 0
131 Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Ampl ) Amp 0 - 0 - - 7 - - 0
132 Phenobarbital Inj Amp 0 - 0 - - 7 - - 0
133 Ranitidine inj ( @ 25 = @ 10 ) Amp 205 - 205 - 205 - - 7 - - 205
SK SWK SWT
Sisa Stok Opt
NO NAMA OBAT/BHP Satuan Stok Awal penerimaan Persediaan Pengeluaran BS Permintaan Ket
134 Ringer Laktat Lar Infus Steril Amp 800 - 800 260 540 10 - 7 70 88 372
136 Vit B1, B6, B12 Inj Amp 0 - 0 - - 7 - - 0
0 0
137 Aciclovir cream (25 Tube) Tub 0 - - - 0 - - 7 - - 0
138 AntiHemoroid Doen Kombinasi Tub 120 - 120 - 120 - - 7 - - 120
139 Antifungi SK Tub 0 - 0 - - 7 - - 0
143 Chloramphenicol Tetes mata (25 Btl) Tub 0 - 0 - - 7 - - 0
144 Chloramphenicol Tetes Telinga (24 Btl) Tub 0 - 0 - - 7 - - 0
145 Diasepam Rectal ( Stesolid ) Tub 0 - - 0 - - 7 - - 0
147 Ethyl Klorida Semprot Tub 0 - 0 - - 7 - - 0
148 Gentian Violet Lar 1% Tub 0 - - - 0 - - 7 - - 0
150 Ketoconazol SK Btl 0 - 0 - - 7 - - 0
151 Mikonazole Sk Btl 0 - 0 - - 7 - - 0
152 Mycorine Powder Btl 0 - 0 - - 7 - - 0
153 Oxytetracyclin HCl Salep Kulit 3% Btl 0 - 0 - - 7 - - 0
154 Oxytetracyklin HCl Salep Mata (@25) Tub 0 - - - 0 - - 7 - - 0
155 Povidon Iodium Lar 60 ml Tub 0 - 0 - - 7 - - 0
157 Povidon Iodium Lar 1000 ml Tub 0 - 0 - - 7 - - 0
158 Salep 2-4 Kombinasi Tub 64 - 64 11 53 0 - 7 3 4 46
159 Salisil Talk/Bedak 2% Tub 0 - - - 0 - - 7 - - 0
160 Scabimite Tub 0 - - - 0 - - 7 - - 0
BMHP 0 0
162 Alat Suntik Sekali Pakai 2.5 ml / 3 ml Pcs 930 930 310 620 12 - 7 83 105 420
163 Alat Suntik Sekali Pakai 5 ml Pcs 910 - 910 40 870 2 - 7 11 14 844
164 Alat Suntik Sekali Pakai 10 ml Pcs 538 - 538 - 538 - - 7 - - 538
165 Catgut/Benang Bedah no 2/0-3/0 (chromic) Pcs 122 - 122 7 115 0 - 7 2 2 110
Catgut/Benang Bedah no 2/0-3/0 (Palin) Pcs 48 - 48 48 -
166 Canula Anak Pcs 0 - 0 - - 7 - - 0
167 Canula dewasa Pcs 25 - 25 - 25 - - 7 - - 25
168 E-Care Alcohol Swab Pcs 12200 12,200 600 11600 23 - 7 162 203 11212
169 Etanol 70 % Pcs 23 - 23 5 18 0 - 7 1 2 15
170 FM Crepe 7,5 cm x 4,55 m Pcs 6 6 6 - - 7 - - 6
171 FM Crepe 10 cm x 4,55 m Pcs 4 4 4 - - 7 - - 4
172 Folly Cath 18 Pcs 3 3 - 3 - - 7 - - 3
173 Folly Cath 20 Pcs 0 - 0 - - 7 - - 0
174 Handscoon 7 Pcs 125 - 125 25 100 1 - 7 7 8 84
Handscoon L 0 - - - 0 - - 7 - - 0
Handscoon M 100 - 100 100 0 4 - 7 27 34 65
175 Infusion Set Anak Pcs 0 - - - 0 - - 7 - - 0
176 Infusion Set Dewasa Pcs 0 - - - 0 - - 7 - - 0
177 i.v. Cathether 18 G Rol 15 - 15 15 - - 7 - - 15
178 i.v. Cathether 20 G Rol 0 - - - 0 - - 7 - - 0
i.v. Cathether 26 G 0 - - - 0 - - 7 - - 0
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

182 Kapas Pembalut/Adsorben 250 g Rol 50 - 50 - 50 - - 7 - - 50
183 Kasa Kompres 40/40 Steril Pcs 100 - 100 - 100 - - 7 - - 100
186 Kasa Pembalut hidrofil 4 m x 3 cm Rol 0 - 0 - - 7 - - 0
187 Kasa Hidrofil 16 x 16 Pcs 150 - 150 18 132 1 - 7 5 6 120
188 Kasa 40 x 80 Btl 6 6 2 4 0 - 7 1 1 3
189 LISOL Rol 15 - 15 3 12 0 - 7 1 1 10
190 Masker Rol 1700 - 1,700 - 1700 - - 7 - - 1700
Masker 0 - 0 - - 7 - - 0
191 Poligyp 5 cm x 2,7 m Pcs 0 - 0 - - 7 - - 0
192 Polifix 5 cm x 1 m Pcs 3 3 1 2 0 - 7 0 0 1
193 Poliband Btl 0 - 0 - - 7 - - 0
194 Policlean Handrub 500 ml Pcs 0 - - - 0 - - 7 - - 0
195 Plester 7,5 yard x 2 inch (Besar) Rol 0 - 0 - - 7 - - 0
196 Plester 5 yard x 2 inch (2,25 x 5 ) Pcs 0 - - 0 - - 7 - - 0
198 NGT Pcs 0 - 0 - - 7 - - 0
199 Urine bag Pcs 10 10 10 - - 7 - - 10
200 Aqua Gell 0 - 0 - - 7 - - 0
201 Catejeel 0 - 0 - - 7 - - 0
202 Scalvien 6 6 6 0 0 - 7 2 2 4
204 Feding Tube 2 2 - 2 - - 7 - - 2
Feding Tube 2 2 2 - - 7 - - 2
Feding Tube 2 2 2 - - 7 - - 2
Feding Tube 1 1 1 - - 7 - - 1
205 IV Cath 16 0 - 0 - - 7 - - 0
0 - 0 - - 7 - - 0
Tambahan : 0 - 0 - - 7 - - 0
0 - 0 - - 7 - - 0
206 Bisacodyl Supp 5 mg 0 - - - 0 - - 7 - - 0
207 Salbutamol Syr 40 - 40 - 40 - - 7 - - 40
208 Phenol Glycerol 0 - 0 - - 7 - - 0
209 Anti Influenza (Noza) 0 - 0 - - 7 - - 0
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
210 Miniaspi 0 - 0 - - 7 - - 0
211 multivitamin (LVB) 0 - 0 - - 7 - - 0
212 Analgetik Inj (antrain ) 0 - - 0 - - 7 - - 0
213 Phenitoin Inj 0 - 0 - - 7 - - 0
214 Griseofulvin 500 mg Tab 0 - - - 0 - - 7 - - 0
218 Ipratropium Inh 60 60 60 0 2 - 7 16 20 39
219 Amoxicillin 250 3800 3,800 3800 - - 7 - - 3800
As Folat 10 Mg 3000 - 3,000 - 3000 - - 7 - - 3000
Canula Infant 35 35 10 25 0 - 7 3 3 19
ceftriaxone 1G inj 30 30 2 28 0 -
fixomull 0 - 0
livron 800 800 800 0
dulcolax 54 54 54
Phenol glycerin 10 % 48 48 24 24
antalgin inj 45 45 45
Acetyl cystein 200 mg 2400 2,400 340 2060
0

Nip. 19670629 198703 2 008 Nip Nrpk: 19.7.0505817
Kolom a Nomor Urut
Ket Kolom b Nma Obat atau Sediaan
Kolom p Jelas
Format : 2
Anggaran Pendapatan dan Belanja Daerah (APBD I)
B
NAMA OBAT/BHP Satuan Stok Awal penerimaan Persediaan Pengeluaran Sisa Stok
NO
Acyclovir Tab 400 mg Tab 0 - - - 0
1 Alupurinol Tab 100 mg Tab 0 - - - 0
2 Amoxicillin Caps 500 mg / Pehamoxyl 500 Tab 0 - - - 0
3 Asam Ascorbat (Vit C) Tab 50 mg Tab 0 - - - 0
4 Asam Mefenamat Tab 500 mg Tab 0 - - - 0
5 Calsium Laktat (Calk) Tab 500 mg Tab 0 - - - 0
6 Captopril Tab 25 mg Tab 0 - - - 0
7 Chlorpheniramin Maleat (CTM) Tab 4 mg Tab 0 - - - 0
8 Chlorpromazin HCl Tab Salut 25 mg Tab 0 - - - 0
9 Chlorpromazin HCl Tab Salut 100 mg Tab 0 - - - 0
10 Cotrimoksazol Dewasa Tab 480 mg/ Tab 0 - - - 0
11 Diazepam Tab 2 mg ( @ 100 = @ 100 ) Tab 0 - - - 0
12 Ephedrin HCl Tab 25 mg Tab 0 - - - 0
13 Gliseril Guaiyacolat Tab 100 mg Tab 0 - - - 0
14 Griseofulvin Tab 125 mg micronized Tab 0 - - - 0
15 Haloperidol Tab 5 mg Tab 0 - - - 0
16 Ibuprofen Tab 400 mg Tab 0 - - - 0
17 Metform Tb Tab 0 - - - 0
18 Piridoxyn HCl Tab 10 mg Tab 0 - - - 0
19 Prednison Tab 5 mg Tab 0 - - - 0
20 PropilTioUrasil (PTU) Tab 100 mg Tab 0 - - - 0
21 Retinol 10.000 IU Caps Tab 0 - - - 0
22 Retinol 20.000 IU Caps Tab 0 - - - 0
23
Cotrimoksazol Susp Btl 0 - - - 0
24 erytromysin Syrup Kering Btl 0 - - - 0
25 Obat Batuk Hitam (OBH) Cairan Btl 0 - - - 0
26 Paracetamol Syrup 100 mg / 5 ml Btl 0 - - - 0
27
Aqua Pro Injeksi Steril Bebas Pirogen Amp 0 - - - 0
28 Clorpromazine inj Amp/Flc 0 - - - 0
29 Cyanocobalamin (Vit B12) Inj 500 mg / ml Amp/Flc 0 - - - 0
30 Diazepam Inj Amp/Flc 0 - - - 0
31 Magnesium Sulfat Inj (i.v.) 20% - 25 ml Amp/Flc 0 - - - 0
32 Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Ampl ) Amp/Flc 0 - - - 0
33 Phenobarbital Inj Amp/Flc 0 - - - 0
34
AntiHemoroid Doen Kombinasi Tub 0 - - - 0
35 Antifungi SK Tub 0 - - - 0
36 Etanol 70 % Tub 0 - - - 0
37 Gentian Violet Lar 1% Tub 0 - - - 0
38 Hidrokortison Cream 2,5% Tub 0 - - - 0
39 Oxytetracyclin HCl Salep Kulit 3% Tub 0 - - - 0
40 Povidon Iodium Lar 300 ml Tub 0 - - - 0
41 Salisil Talk/Bedak 2% Tub 0 - - - 0
42 Nystatin Suppo 0 - - -
43 Ergotamin Tab 0 - - -
44
NO
BMHP
Catgut/Benang Bedah no 2/0-3/0 (plain&chromic) pcs 0 - - - 0
45 Folly cath 18 pcs 0 - - - 0
46 Handscoon pcs 0 - - - 0
47 i.v. Cathether 22 G pcs 0 - - - 0
48 i.v. Cathether 24 G pcs 0 - - - 0
49 Kapas Pembalut/Adsorben 250 g pcs 0 - - - 0
50 Kasa Pembalut 2 m x 80 cm pcs 0 - - - 0
51 Urine bag pcs 0 - - - 0
52
Tanbahan
a
b
c
d
e
f
g
Mengetahui

Nip. 19670629 198703 2 008 Nip Nrpk: 19.7.0505817
Format : 3
Psikotropika / Precursor
C
NO
Amitriptiline 25 mg Tab 0 - 0
1 Alprasolam 0,5 Tab 0 - 0
2 Carbamazepine 200 mg Tab Tab 0 - 0
3 Chlorpromazin HCl Tab Salut 25 mg Tab 0 - 0
4 Chlorpromazin HCl Tab Salut 100 mg Tab 0 - 0
5 Chlorpromazin HCl Inj Amp 0 - 0
6 Diazepam Tab 2 mg Tab 0 - 0
8 Diasepam Rectal Tab 0 - - 0
9 Diazepam Inj Amp 100 100 2 98
10 Haloperidol Tab 0,5 mg Tab 0 - 0
11 Haloperidol Tab 5 mg Tab 0 - 0
12 Haloperidol Tab 1,5 mg Tab 0 - 0
13 Phenobarbital Tab 30 mg Tab 0 - 0
14 Trihexyfenidil Tab 60 60 60 0
15 Phenobarbital Inj Amp 0 - 0
16
Mengetahui

Nip. 19670629 198703 2 008 Nip Nrpk: 19.7.0505817
Format : 4
Program P2P
D
NO
Diare
Zink Tab 3700 3,700 400 3300
1 Oralit Tab 1800 1,800 1800
2 Imunisasi
BCG Amp 0 - 0
1 DPT - HB - Hib Amp 0 - 0
2 DT Amp 0 - 0
3 HB o Amp 0 - 0
4 IPV Amp 0 - 0
5 TD Amp 0 - 0
6 POLIO Amp 0 - 0
7 MR Amp 0 - 0
8 0 - 0
ASSP 05 ml Pcs 0 - 0
9 ASSP 005 ml Pcs 0 - 0
10 ASSP 5 ml Pcs 0 - 0
11 TB paru
Kategori I Paket 0 - 0
4 Kategori II Paket 0 - 0
5 Kategori Anak Paket 0 - 0
6 Reagen Paket 0 - 0
7 HIV/ Kusta
PB Anak Blister 0 - 0
9 MB Anak Blister 0 - 0
10 PB Dewasa Blister 0 - 0
11 MB Dewasa Blister 0 - 0
12 Kecacingan
DEC Tab 0 - 0
14 Albendasole Tab 0 - 0
15 Paracetamol Tab 0 - 0
16 Rabies
Verorab Inj Amp 0 - 0
Malaria
Primaquin Tab 0 - 0
17 ACT Tab 0 - 0
18 Doxyciclin Tab 0 - 0
19 Artesunat Inj Amp 0 - 0
20 Artemeter Inj Amp 0 - 0
21
Mengetahui
(.................................................................................) (............................................................) (..................................................................)

Nip Nip Nip
LAPORAN BULANAN KEFARMASIAN Format 5

Jenis Pelayanan Resep Informasi

Tanggal Konseling Informasi Obat Ket No Pustu/Polindes Jenis Pelayanan Resep Konseling
Obat
Rawat Jalan Rawat Inap Rawat Jalan Rawat Inap
No
b c d d e f a b
a 3/1/2020 - 2 - - - 1 pustu boitan 37.0 - - 0
1 3/2/2020 23 4 - - - 2 polindes trans pohi 10.0 - - 0
2 3/3/2020 21 3 - - - 3 poskesdes indang sari 12.0 - - 0
3 3/4/2020 11 2 - - - 4 polindes lontos 19.0 - - 0
4 3/5/2020 29 5 - - - 5 pustu bukit mulya 39.0 - - 0
5 3/6/2020 19 3 - - - 6 pustu molino 46.0 - - 0
6 3/7/2020 24 5 - - - 7 - - - - 0
7 3/8/2020 - 3 - - - 8 - - - - 0
8 3/9/2020 35 4 - - - 9 - - - - 0
9 3/10/2020 30 3 - - - 10 - - - - 0
10 3/11/2020 41 2 - - - 11 - - - - 0
11 3/12/2020 18 8 - - - 12 - - - - 0
12 3/13/2020 15 4 - - - 13 - - - - 0
13 3/14/2020 20 5 - - - 14 - - - - 0
14 3/15/2020 - 5 - - - 15 - - - - 0
15 3/16/2020 27 7 - - - 16 - - - - 0
16 3/17/2020 36 5 - - - 17 - - - - 0
17 3/18/2020 12 1 - - - 18 - - - - 0
18 3/19/2020 28 6 - - - 19 - - - - 0
19 3/20/2020 18 5 - - - 20 - - - - 0
20 3/21/2020 31 5 - - - Jumlah B 163.0 - - 0
21 3/22/2020 - 10 - - -
22 3/23/2020 28 3 - - - Total A + B 163 - - 0
23 3/24/2020 20 4 - - -
24 3/25/2020 - 5 - - -
25 3/26/2020 35 5 - - - Ket : Kolom a. jelas
26 3/27/2020 21 5 - - - Kolom b. Jelas
28 3/29/2020 - 3 - - - Kolom e. Penderita yang minta penjelasan secara deta
29 3/30/2020 31 6 - - - Kolom f. Penjelasan / informasi yang dilakukan /d
30
3/31/2020 28 2 - - - Kolom e. Penderita yang minta penjelasan secara deta
31 618 134 - - - Kolom f. Penjelasan / informasi yang dilakukan /diberikan kepada penderita/masyarakat
Jumlah A
Mengetahui

Nip. 19670629 198703 2 008 Nip Nrpk: 19.7.0505817
:
(LPLPO)

Kecamatan :
Kabupaten : Banggai Bulan : APRIL
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

1 Ambroxol Tab - 0 - - - 7 - - 0
2 Acyclovir Tab 200 mg Tab - 0 - - - 7 - - 0
3 Acyclovir Tab 400 mg Tab 1,200 1200 - 1,200 - - 7 - - 1200
4 Alupurinol Tab 100 mg Tab 2,300 2300 - 2,300 - - 7 - - 2300
5 Alprazolam tab 0,5 mg Tab - 0 - - - - 7 - - 0
6 Aminophyllin Tab 200 mg Tab 1,800 1800 - 1,800 - - 7 - - 1800
7 Amoxicillin Caps 500 mg / Pehamoxyl 500 Tab 11,400 11400 1,900 9,500 73 - 7 512 190 6898
8 Ampicillin Caplet 500 mg Tab - 0 - - - 7 - - 0
9 Amlodipine 5 Mg Tab 2,880 2880 2,880 - - 7 - - 2880
10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab - 0 - - - 7 - - 0
11 Antalgin Tab 500 mg Tab - 0 - - - 7 - - 0
12 Antasida Doen Tab Kombinasi Tab 14,400 14400 - 14,400 - - 7 - - 14400
13 Attapulgit 600 mg tablet (5 x 10 tab) Tab 3,900 3900 200 3,700 8 - 7 54 20 3426
14 Asam Ascorbat (Vit C) Tab 50 mg Tab 5,200 5200 1,600 3,600 62 - 7 431 160 1409
15 Asam Mefenamat Tab 500 mg Tab - 0 - - - - 7 - - 0
16 Betahistin Tb Tab 1,900 1900 1,900 - - 7 - - 1900
17 Calsium Laktat (Calk) Tab 500 mg Tab 4,300 4300 400 3,900 15 - 7 108 40 3352
18 Captopril Tab 25 mg Tab 400 400 300 100 12 - 7 81 30 311
19 CarbamazeineTab Tab - 0 - - - 7 - - 0
20 Cefadroxil Capsul 500 mg Tab - 0 - - - - 7 - - 0
21 Cetirizine Tb Tab 1,000 1000 600 400 23 - 7 162 60 422
22 Chloramphenicol Caps 250 mg Tab - 0 - - - 7 - - 0
23 Chlorpheniramin Maleat (CTM) Tab 4 mg Tab 8,000 8000 2,000 6,000 77 - 7 538 200 3262
24 Chlorpromazin HCl Tab Salut 25 mg Tab - 0 - - - 7 - - 0
25 Chlorpromazin HCl Tab Salut 100 mg Tab - 0 - - - 7 - - 0
26 Ciprofloxacin Capl 500 mg Tab - 0 - - - 7 - - 0
27 Cimetidine Tab 200 mg Tab - 0 - - - 7 - - 0
28 Clonidine Tab - 0 - - - 7 - - 0
29 Cotrimoksazol Ped Tablet 120 mg Tab - 0 - - - 7 - - 0
30 Cotrimoksazol Dewasa Tab 480 mg/ Tab 3,900 3900 3,900 - - 7 - - 3900
31 Cyanocobalamin (Vit B12) Tab Tab 5,600 5600 100 5,500 4 - 7 27 10 5363
32 Dexametason Tab 0,5 mg Tab 12,000 12000 7,500 4,500 288 - 7 2,019 750 5769
33 Diazepam Tab 2 mg ( @ 100 = @ 100 ) Tab - 0 - - - - 7 - - 0
35 Domperidome ( @100 = @50 ) Tab 5,700 5700 200 5,500 8 - 7 54 20 5226
36 Ephedrin HCl Tab 25 mg Tab - 0 - - - 7 - - 0
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
38 Fitomenadion (Vit K) Tab Salut 10 mg Tab 350 350 - 350 - - 7 - - 350

39 Furosemid Tablet 40 mg Tab 2,500 2500 - 2,500 - - 7 - - 2500
40 Glibenklamid Tab 5 mg Tab - 0 - - - 7 - - 0
41 Gliseril Guaiyacolat Tab 100 mg Tab - 0 - - - - 7 - - 0
42 Griseofulvin Tab 125 mg micronized Tab - 0 - - - 7 - - 0
43 Haloperidol Tab 1,5 mg Tab - 0 - - - 7 - - 0
44 Haloperidol Tab 5 mg Tab - 0 - - - 7 - - 0
45 Hidroklorothiazid (HCT) Tab 25 mg Tab 2,400 2400 100 2,300 4 - 7 27 10 2163
46 Ibuprofen Tab 200 mg Tab - 0 - - - - 7 - - 0
47 Ibuprofen Tab 400 mg Tab 2,000 2000 2,000 - - 7 - - 2000
49 Komb. Pirimetamin 25 mg + Sulfadoxin 500 mg Tab - 0 - - - 7 - - 0
50 Ketoconzol Tab Tab - 0 - - - 7 - - 0
51 LansoprasolenTb Tab - 0 - - - 7 - - 0
52 Levofloxacin Tab 500 mg Tab - 0 - - - 7 - - 0
53 Loperamide Tab Tab - 0 - - - 7 - - 0
54 Loratadin tab 10 mg Tab 1,000 1000 300 700 12 - 7 81 102 506
55 Meloksikam 15 Mg Tab - 0 - - - 7 - - 0
56 Metform Tb Tab - 0 - - - 7 - - 0
57 Methyl Prednisolon Tb Tab - 0 - - - 7 - - 0
58 Metronidazole Tab 250 mg Tab - 0 - - - 7 - - 0
59 Metronidasole 500 Tab 600 600 600 - - 7 - - 600
60 Metoclopramide Tab 10 mg Tab - 0 - - - 7 - - 0
61 Natrium Diklofenak Tab 50 mg Tab 5,100 5100 5,100 - - 7 - - 5100
63 Ofloxacin Tab 400 mg Tab - 0 - - - 7 - - 0
64 Omeprasole Tab 2,880 2880 2,880 - - 7 - - 2880
65 Papaverin Tab 40 mg Tab - 0 - - - 7 - - 0
66 Paracetamol Tab 500 mg Tab 4,400 4400 4,400 - - 7 - - 4400
67 Phenobarbital Tab 30 mg Tab - 0 - - - 7 - - 0
68 Piridoxyn HCl Tab 10 mg Tab 9,600 9600 400 9,200 15 - 7 108 135 8942
69 Prednison Tab 5 mg Tab 9,100 9100 6,100 3,000 235 - 7 1,642 2,065 942
70 Piroxicam Caps 20 mg Tab - 0 - - - 7 - - 0
72 Propanolol HCl Tab 40 mg Tab - 0 - - - 7 - - 0
73 Pyrantel HCl Tab 125 mg Tab 1,060 1060 1,060 - - 7 - - 1060
74 Ranitidine Tab 150 mg Tab - 0 - - - - 7 - - 0
75 Retinol 100.000 Iu (Biru) Tab - 0 - - - 7 - - 0
76 Retinol 200.000 Iu (Merah) Tab - 0 - - - 7 - - 0
78 Selviplex Tab - 0 - - - 7 - - 0
79 Simvastatin Tab - 0 - - - 7 - - 0
80 Tablet Tambah Darah Tab 3,170 3170 - 3,170 - - 7 - - 3170
81 Tetracyclin HCl Caps 250 mg Tab - 0 - - - - 7 - - 0
82 Tetracyclin HCl Caps 500 mg Tab - 0 - - - 7 - - 0
83 Thiamin HCl Monotartrat (Vit B1) Tab 50 mg Tab 3,900 3900 300 3,600 12 - 7 81 102 3406
84 Trihexylfenidil Tab - 0 - - - - 7 - - 0
85 Vitamin B Compleks Tab Tab 8,400 8400 200 8,200 8 - 7 54 68 8071
86 Zink Tab 3,300 3300 100 3,200 4 - 7 27 34 3135
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
0
87 Ambroxol Sy Btl - 0 - - - 7 - - 0
88 Amoxicillin Syrup Kering 125 mg / 5 ml Btl - 0 - - - 7 - - 0
89 Ampicillin Syrup Kering 125 mg / 5 ml Btl - 0 - - - 7 - - 0
91 Antidiare syr Btl - 0 - - - - 7 - - 0
92 Antiinfluensa Syr (Erlaflu) Btl - 0 - - - 7 - - 0
93 Cotrimoksazol Susp Btl 88 88 - 88 - - 7 - - 88
97 erytromysin Syrup Kering Btl - 0 - - - 7 - - 0
98 Garam Oralit 200 ml Air Btl 1,800 1800 - 1,800 - - 7 - - 1800
100 Metocloperamide Syr Btl - 0 - - - 7 - - 0
101 Multivit Syr Btl - 0 - - - 7 - - 0
102 Obat Batuk Hitam (OBH) Cairan Btl - 0 - - - 7 - - 0
105 Pyrantel Syr Btl 50 50 - 50 - - 7 - - 50
106 Zinc Syr Btl 158 158 15 143 1 - 7 4 5 133
0
107 Ampicillin 1 gram Inj Amp - 0 - - - 7 - - 0
109 Aqua Pro Injeksi Steril Bebas Pirogen Amp 180 180 - 180 - - 7 - - 180
110 Asering - Asetat Ringer Amp - 0 - - - - 7 - - 0
111 Atropin inj 0,25 mg/mL (i.v./i.m./s.k.) Amp - 0 - - - 7 - - 0
112 Cefotaxim 1 g Inj Amp 80 80 - 80 - - 7 - - 80
113 Clorpromazine inj Amp - 0 - - - 7 - - 0
114 Cyanocobalamin (Vit B12) Inj 500 mg / ml Amp 480 480 480 - - 7 - - 480
116 Diazepam Inj Amp - 0 - - - - 7 - - 0
118 Ephinefrin HCl/Bitartrat (Adrenalin) Inj 0,1% - 1 ml Amp - 0 - - - 7 - - 0
121 Glukosa Lar Infus 5% Steril Amp - 0 - - - - 7 - - 0
122 KA EN 3B Amp - 0 - - - - 7 - - 0
123 Ketorolac Inj ( @ 12 = @ 6 ) Amp 730 730 - 730 - - 7 - - 730
125 Magnesium Sulfat Inj (i.v.) 20% - 25 ml Amp - 0 - - - 7 - - 0
127 Metocloperamide Inj Amp - 0 - - - - 7 - - 0
128 Natrium Klorida 0,9% Larutan Infus Steril Amp 60 60 8 52 0 - 7 2 3 47
130 Oxytetracyklin HCl Inj (i.m.) 50 mg / ml - 10 ml Amp - 0 - - - 7 - - 0
131 Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Ampl ) Amp - 0 - - - 7 - - 0
132 Phenobarbital Inj Amp - 0 - - - 7 - - 0
133 Ranitidine inj ( @ 25 = @ 10 ) Amp 205 205 - 205 - - 7 - - 205
SK SWK SWT
Sisa Stok Opt
134 Ringer Laktat Lar Infus Steril Amp 540 200 740 240 500 9 - 7 65 81 345
135 Thiamin HCl (Vit B1) Inj 100 mg / ml - 1 ml Amp 82 82 82 - - 7 - - 82
136 Vit B1, B6, B12 Inj Amp - 0 - - - 7 - - 0
0
137 Aciclovir cream (25 Tube) Tub - 0 - - - - 7 - - 0
138 AntiHemoroid Doen Kombinasi Tub 120 120 - 120 - - 7 - - 120
139 Antifungi SK Tub - 0 - - - 7 - - 0
140 Betametason Cream 0,1% (25 Tube) Tub 300 300 - 300 - - 7 - - 300
141 Chloramphenicol Salep Kulit 1% (24 tube) Tub - 0 - - - - 7 - - 0
142 Chloramphenicol Salep Mata 1% (24 tube) Tub 37 37 37 - - 7 - - 37
143 Chloramphenicol Tetes mata (25 Btl) Tub - 0 - - - 7 - - 0
144 Chloramphenicol Tetes Telinga (24 Btl) Tub - 0 - - - 7 - - 0
145 Diasepam Rectal ( Stesolid ) Tub - 0 - - - - 7 - - 0
147 Ethyl Klorida Semprot Tub - 0 - - - - 7 - - 0
148 Gentian Violet Lar 1% Tub - 0 - - - - 7 - - 0
149 Hidrokortison Cream 2,5% Tub 508 508 - 508 - - 7 - - 508
150 Ketoconazol SK Btl - 0 - - - 7 - - 0
151 Mikonazole Sk Btl - 0 - - - 7 - - 0
152 Mycorine Powder Btl - 0 - - - 7 - - 0
153 Oxytetracyclin HCl Salep Kulit 3% Btl - 0 - - - 7 - - 0
154 Oxytetracyklin HCl Salep Mata (@25) Tub - 0 - - - - 7 - - 0
155 Povidon Iodium Lar 60 ml Tub - 0 - - - 7 - - 0
157 Povidon Iodium Lar 1000 ml Tub - 0 - - - 7 - - 0
158 Salep 2-4 Kombinasi Tub 53 53 29 24 1 - 7 8 10 5
159 Salisil Talk/Bedak 2% Tub - 0 - - - - 7 - - 0
160 Scabimite Tub - 0 - - - - 7 - - 0
BMHP - - - 0
catgut/benang bedah plain 48 48 48
166 Canula anak Pcs - 0 - - - 7 - - 0
167 Canula dewasa Pcs 25 25 - 25 - - 7 - - 25
168 E-Care Alcohol Swab Pcs 11,600 11600 800 10,800 31 - 7 215 271 10283
169 Etanol 70 % Pcs 18 18 6 12 0 - 7 2 2 8
170 FM Crepe 7,5 cm x 4,55 m Pcs 6 6 - 6 - - 7 - - 6
171 FM Crepe 10 cm x 4,55 m Pcs 4 4 - 4 - - 7 - - 4
172 Folly Cath 18 Pcs 3 3 3 - - 7 - - 3
173 Folly Cath 20 Pcs - 0 - - - 7 - - 0
174 Handscoon 7 Pcs 100 100 - 100 - - 7 - - 100
Handscoon L - 0 - - - - 7 - - 0
Handscoon M - 0 - - - - 7 - - 0
175 Infusion Set Anak Pcs - 0 - - - - 7 - - 0
176 Infusion Set Dewasa Pcs - 0 - - - - 7 - - 0
177 i.v. Cathether 18 G Rol 15 15 - 15 - - 7 - - 15
178 i.v. Cathether 20 G Rol - 0 - - - - 7 - - 0
i.v. Cathether 26 G - 0 - - - - 7 - - 0
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

183 Kasa Kompres 40/40 Steril Pcs 100 100 - 100 - - 7 - - 100
185 Kasa Pembalut hidrofil 4 m x 15 cm Rol 100 100 10 90 0 - 7 3 3 84
186 Kasa Pembalut hidrofil 4 m x 3 cm Rol - 0 - - - 7 - - 0
187 Kasa Hidrofil 16 x 16 Pcs 132 132 27 105 1 - 7 7 9 88
188 Kasa 40 x 80 Btl 4 4 2 2 0 - 7 1 1 1
189 LISOL Rol 12 12 - 12 - - 7 - - 12
190 Masker Rol 1,700 1700 1,600 100 62 - 7 431 542 934
Masker - 0 - - - 7 - - 0
191 Poligyp 5 cm x 2,7 m Pcs - 0 - - - 7 - - 0
192 Polifix 5 cm x 1 m Pcs 2 20 22 6 16 0 - 7 2 2 12
193 Poliband Btl - 0 - - - 7 - - 0
194 Policlean Handrub 500 ml Pcs - 0 - - - - 7 - - 0
195 Plester 7,5 yard x 2 inch (Besar) Rol - 0 - - - 7 - - 0
196 Plester 5 yard x 2 inch (2,25 x 5 ) Pcs - 0 - - - 7 - - 0
197 Silk (Benang Bedah Sutra) no 3 / 0 Pcs - 0 - - - 7 - - 0
198 NGT Pcs - 0 - - - 7 - - 0
199 Urine bag Pcs 10 10 10 - - 7 - - 10
200 Aqua Gell - 0 - - - 7 - - 0
201 Catejeel - 0 - - - 7 - - 0
202 Scalvien - 0 - - - 7 - - 0
204 Feding Tube 2 2 2 - - 7 - - 2
Feding Tube 2 2 2 - - 7 - - 2
Feding Tube 2 2 2 - - 7 - - 2
Feding Tube 1 1 1 - - 7 - - 1
205 IV Cath 16 - 0 - - - 7 - - 0
- 0 - - - 7 - - 0
Tambahan : - 0 - - - 7 - - 0
- 0 - - - 7 - - 0
206 Bisacodyl Supp 5 mg - 0 - - - - 7 - - 0
207 Salbutamol Syr 40 40 40 - - 7 - - 40
208 Phenol Glycerol - 0 - - - 7 - - 0
209 Anti Influenza (Noza) - 0 - - - 7 - - 0
210 Miniaspi - 0 - - - 7 - - 0
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
211 multivitamin (LVB) - 0 - - - 7 - - 0

212 Analgetik Inj (antrain ) - 0 - - - - 7 - - 0
213 Phenitoin Inj - 0 - - - 7 - - 0
214 Griseofulvin 500 mg Tab - 0 - - - - 7 - - 0
218 Ipratropium Inh - 0 - - - 7 - - 0
219 Amoxicillin 250 3,800 3800 100 3,700 4 - 7 27 34 3635
As Folat 10 Mg 3,000 3000 3,000 - 115 - 7 808 1,015 1938 ed
Canula Infant 25 25 25 - - 7 - - 25
ceftriaxone 1G inj 28 28 28
fixomull - 0 -
livron - 0 -
dulcolax 54 54 54
Phenol glycerin 10 % 24 24 24
antalgin inj 45 45 5 40
Acetyl cystein 200 mg 2,060 2060 180 1,880
Mengetahui
(.....................................................) (.............................................................) (.........................................................)

Kolom p Jelas
Format : 2
1 Acyclovir Tab 400 mg Tab - - 0 - -

2 Alupurinol Tab 100 mg Tab - - 0 - -
3 Amoxicillin Caps 500 mg / Pehamoxyl 500 Tab - - 0 - -
4 Asam Ascorbat (Vit C) Tab 50 mg Tab - - 0 - -
5 Asam Mefenamat Tab 500 mg Tab - - 0 - -
6 Calsium Laktat (Calk) Tab 500 mg Tab - - 0 - -
7 Captopril Tab 25 mg Tab - - 0 - -
8 Chlorpheniramin Maleat (CTM) Tab 4 mg Tab - - 0 - -
9 Chlorpromazin HCl Tab Salut 25 mg Tab - - 0 - -
10 Chlorpromazin HCl Tab Salut 100 mg Tab - - 0 - -
11 Cotrimoksazol Dewasa Tab 480 mg/ Tab - - 0 - -
12 Diazepam Tab 2 mg ( @ 100 = @ 100 ) Tab - - 0 - -
13 Ephedrin HCl Tab 25 mg Tab - - 0 - -
14 Gliseril Guaiyacolat Tab 100 mg Tab - - 0 - -
15 Griseofulvin Tab 125 mg micronized Tab - - 0 - -
16 Haloperidol Tab 5 mg Tab - - 0 - -
17 Ibuprofen Tab 400 mg Tab - - 0 - -
18 Metform Tb Tab - - 0 - -
19 Piridoxyn HCl Tab 10 mg Tab - - 0 - -
20 Prednison Tab 5 mg Tab - - 0 - -
21 PropilTioUrasil (PTU) Tab 100 mg Tab - - 0 - -
22 Retinol 10.000 IU Caps Tab - - 0 - -
23 Retinol 20.000 IU Caps Tab - - 0 - -
24 Cotrimoksazol Susp Btl - - 0 - -

25 erytromysin Syrup Kering Btl - - 0 - -
26 Obat Batuk Hitam (OBH) Cairan Btl - - 0 - -
27 Paracetamol Syrup 100 mg / 5 ml Btl - - 0 - -
28 Aqua Pro Injeksi Steril Bebas Pirogen Amp - - 0 - -

29 Clorpromazine inj Amp/Flc - - 0 - -
30 Cyanocobalamin (Vit B12) Inj 500 mg / ml Amp/Flc - - 0 - -
31 Diazepam Inj Amp/Flc - - 0 - -
32 Magnesium Sulfat Inj (i.v.) 20% - 25 ml Amp/Flc - - 0 - -
33 Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Ampl ) Amp/Flc - - 0 - -
34 Phenobarbital Inj Amp/Flc - - 0 - -
35 AntiHemoroid Doen Kombinasi Tub - - 0 - -

36 Antifungi SK Tub - - 0 - -
37 Etanol 70 % Tub - - 0 - -
38 Gentian Violet Lar 1% Tub - - 0 - -
39 Hidrokortison Cream 2,5% Tub - - 0 - -
40 Oxytetracyclin HCl Salep Kulit 3% Tub - - 0 - -
41 Povidon Iodium Lar 300 ml Tub - - 0 - -
42 Salisil Talk/Bedak 2% Tub - - 0 - -
43 Nystatin Suppo - - 0 -
44 Ergotamin Tab - - 0 -
BMHP
45 Catgut/Benang Bedah no 2/0-3/0 (plain&chromic) pcs - - 0 - -
46 Folly cath 18 pcs - - 0 - -
47 Handscoon pcs - - 0 - -
48 i.v. Cathether 22 G pcs - - 0 - -
49 i.v. Cathether 24 G pcs - - 0 - -
50 Kapas Pembalut/Adsorben 250 g pcs - - 0 - -
51 Kasa Pembalut 2 m x 80 cm pcs - - 0 - -
52 Urine bag pcs - - 0 - -
Tanbahan
a
b
c
d
e
f
g
Format : 3
1 Amitriptiline 25 mg Tab - 0 -
2 Alprasolam 0,5 Tab - 0 -
3 Carbamazepine 200 mg Tab Tab - 0 -
4 Chlorpromazin HCl Tab Salut 25 mg Tab - 0 -
5 Chlorpromazin HCl Tab Salut 100 mg Tab - 0 -
6 Chlorpromazin HCl Inj Amp - 0 -
7 Diazepam Tab 2 mg Tab - 0 10 (10)
9 Diasepam Rectal Tab - 0 - -
11 Haloperidol Tab 0,5 mg Tab - 0 -
12 Haloperidol Tab 5 mg Tab - 0 -
13 Haloperidol Tab 1,5 mg Tab - 0 -
14 Phenobarbital Tab 30 mg Tab - 0 -
15 Trihexyfenidil Tab - 0 - -
16 Phenobarbital Inj Amp - 0 -
Format : 4
D Program P2P
Diare
1 Zink Tab 3,300 3300 100 3,200
2 Oralit Tab 1,800 1800 1,800
Imunisasi
1 BCG Amp - 0 -
2 DPT - HB - Hib Amp - 0 -
3 DT Amp - 0 -
4 HB o Amp - 0 -
5 IPV Amp - 0 -
6 TD Amp - 0 -
7 POLIO Amp - 0 -
8 MR Amp - 0 -
- 0 -
9 ASSP 05 ml Pcs - 0 -
10 ASSP 005 ml Pcs - 0 -
11 ASSP 5 ml Pcs - 0 -
TB paru
4 Kategori I Paket - 0 -
5 Kategori II Paket - 0 -
6 Kategori Anak Paket - 0 -
7 Reagen Paket - 0 -
HIV/ Kusta
9 PB Anak Blister - 0 -
10 MB Anak Blister - 0 -
11 PB Dewasa Blister - 0 -
12 MB Dewasa Blister - 0 -
Kecacingan
14 DEC Tab - 0 -
15 Albendasole Tab - 0 -
16 Paracetamol Tab - 0 -
Rabies
Verorab Inj Amp - 0 -
Malaria
17 Primaquin Tab - 0 -
18 ACT Tab - 0 -
19 Doxyciclin Tab - 0 -
20 Artesunat Inj Amp - 0 -
21 Artemeter Inj Amp - 0 -
Format 5

Informasi
a b c d d e f a b
1 4/1/2020 9 - - 0 - 1 bantayan 30.0 - - 0
2 4/2/2020 19 7 - 0 - 2 lontos 24.0 - - 0
3 4/3/2020 9 7 - 0 - 3 trans pohi 10.0 - - 0
4 4/4/2020 12 - - 0 - 4 bukit mulya 33.0 - - 0
5 4/5/2020 - - - 0 - 5 molino 53.0 - - 0
6 4/6/2020 18 - - 0 - 6 - - - - 0
7 4/7/2020 15 6 - 0 - 7 - - - - 0
8 4/8/2020 12 3 - 0 - 8 - - - - 0
9 4/9/2020 13 3 - 0 - 9 - - - - 0
10 4/10/2020 - 1 - 0 - 10 - - - - 0
11 4/11/2020 8 4 - 0 - 11 - - - - 0
12 4/12/2020 - - 0 - 12 - - - - 0
13 4/13/2020 13 2 - 0 - 13 - - - - 0
14 4/14/2020 12 5 - 0 - 14 - - - - 0
15 4/15/2020 16 7 - 0 - 15 - - - - 0
16 4/16/2020 17 3 - 0 - 16 - - - - 0
17 4/17/2020 23 9 - 0 - 17 - - - - 0
18 4/18/2020 10 7 - 0 - 18 - - - - 0
19 4/19/2020 17 3 - 0 - 19 - - - - 0
20 4/20/2020 17 4 - 0 - 20 - - - - 0
21 4/21/2020 21 4 - 0 - Jumlah B 150.0 - - 0
22 4/22/2020 10 5 - 0 -
23 4/23/2020 8 4 - 0 - Total A + B 656 - - 0
24 4/24/2020 9 7 - 0 -
25 4/25/2020 8 6 - 0 -
26 4/26/2020 - 8 - 0 - Ket : Kolom a. jelas
27 4/27/2020 29 3 - 0 - Kolom b. Jelas
28 4/28/2020 21 6 - 0 - Kolom c dan d. Jumlah lembar Rese
29 4/29/2020 17 3 - 0 - Kolom e. Penderita yang minta penjelasan secara det
30 4/30/2020 20 6 - 0 - Kolom f. Penjelasan / informasi yang dilakukan /
31 - - - 0 - Kolom e. Penderita yang minta penjelasan secara det
Jumlah A 383 123 - 0 - Kolom f. Penjelasan / informasi yang dilakukan /diberikan kepada penderita/masyarakat
(LPLPO)

Kecamatan :
Kabupaten : Banggai Bulan : MEI
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

1 Ambroxol Tab - - 0 - - 7 - - 0
3 Acyclovir Tab 400 mg Tab 1,200 1,200 300 900 12 - 7 81 30 489
4 Alupurinol Tab 100 mg Tab 2,300 2,300 500 1800 19 - 7 135 50 1115
6 Aminophyllin Tab 200 mg Tab 1,800 1,800 1800 - - 7 - - 1800
10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab - - 0 - - 7 - - 0
12 Antasida Doen Tab Kombinasi Tab 14,400 14,400 700 13700 27 - 7 188 70 12742
14 Asam Ascorbat (Vit C) Tab 50 mg Tab 3,600 3,600 1,600 2000 62 - 7 431 160 191
15 Asam Mefenamat Tab 500 mg Tab - - - 0 - - 7 - - 0
16 Betahistin Tb Tab 1,900 1,900 1900 - - 7 - - 1900
18 Captopril Tab 25 mg Tab 100 100 100 0 4 - 7 27 10 137
20 Cefadroxil Capsul 500 mg Tab - - 0 - - 7 - - 0
21 Cetirizine Tb Tab 400 400 400 0 15 - 7 108 40 548
23 Chlorpheniramin Maleat (CTM) Tab 4 mg Tab 6,000 6,000 800 5200 31 - 7 215 80 4105
26 Ciprofloxacin Capl 500 mg Tab - - 0 - - 7 - - 0
28 Clonidine Tab - - 0 - - 7 - - 0
33 Diazepam Tab 2 mg ( @ 100 = @ 100 ) Tab - - 0 - - 7 - - 0
34 Diazepam Tab 5 mg ( @ 100 = @ 250 ) Tab 90 90 90 - - 7 - - 90
35 Domperidome ( @100 = @50 ) Tab 5,500 5,500 300 5200 12 - 7 81 30 4789
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
38 Fitomenadion (Vit K) Tab Salut 10 mg Tab 350 350 - 350 - - 7 - - 350

39 Furosemid Tablet 40 mg Tab 2,500 2,500 300 2200 12 - 7 81 30 1789
54 Loratadin tab 10 mg Tab 700 700 700 - - 7 - - 700
56 Metform Tb Tab - - 0 - - 7 - - 0
59 Metronidasole 500 Tab 600 600 600 - - 7 - - 600
60 Metoclopramide Tab 10 mg Tab - - 0 - - 7 - - 0
61 Natrium Diklofenak Tab 50 mg Tab 5,100 5,100 5100 - - 7 - - 5100
64 Omeprasole Tab 2,880 2,880 2,700 180 104 - 7 727 914 1565
68 Piridoxyn HCl Tab 10 mg Tab 9,200 9,200 1,700 7500 65 - 7 458 575 6402
69 Prednison Tab 5 mg Tab 3,000 3,000 900 2100 35 - 7 242 305 1518
73 Pyrantel HCl Tab 125 mg Tab 1,060 1,060 - 1060 - - 7 - - 1060
77 Salbutamol Tab 4 mg Tab 250 250 - 250 - - 7 - - 250
78 Selviplex Tab - - 0 - - 7 - - 0
79 Simvastatin Tab - - 0 - - 7 - - 0
84 Trihexylfenidil Tab - - 0 - - 7 - - 0
86 Zink Tab 3,200 3,200 300 2900 12 - 7 81 102 2706
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
0
87 Ambroxol Sy Btl - - 0 - - 7 - - 0
98 Garam Oralit 200 ml Air Btl 1,800 1,800 100 1700 4 - 7 27 34 1635
101 Multivit Syr Btl - - 0 - - 7 - - 0
105 Pyrantel Syr Btl 50 50 - 50 - - 7 - - 50
106 Zinc Syr Btl 143 143 13 130 1 - 7 4 4 122
0
110 Asering - Asetat Ringer Amp - - - 0 - - 7 - - 0
112 Cefotaxim 1 g Inj Amp 80 80 - 80 - - 7 - - 80
116 Diazepam Inj Amp - - 0 - - 7 - - 0
117 Diphenhydramin HCl Inj 10 mg / ml - 1 ml Amp 60 60 20 40 1 - 7 5 7 27
121 Glukosa Lar Infus 5% Steril Amp - - - 0 - - 7 - - 0
122 KA EN 3B Amp - - - 0 - - 7 - - 0
128 Natrium Klorida 0,9% Larutan Infus Steril Amp 52 52 - 52 - - 7 - - 52
131 Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Ampl ) Amp - - 0 - - 7 - - 0
SK SWK SWT
Sisa Stok Opt
134 Ringer Laktat Lar Infus Steril Amp 500 500 280 220 11 - 7 75 95 39
135 Thiamin HCl (Vit B1) Inj 100 mg / ml - 1 ml Amp 82 82 82 - - 7 - - 82
136 Vit B1, B6, B12 Inj Amp - - 0 - - 7 - - 0
0
139 Antifungi SK Tub - - 0 - - 7 - - 0
140 Betametason Cream 0,1% (25 Tube) Tub 300 300 300 - - 7 - - 300
141 Chloramphenicol Salep Kulit 1% (24 tube) Tub - - 0 - - 7 - - 0
151 Mikonazole Sk Btl - - 0 - - 7 - - 0
154 Oxytetracyklin HCl Salep Mata (@25) Tub - - - 0 - - 7 - - 0
160 Scabimite Tub - - - 0 - - 7 - - 0
BMHP 0
164 Alat Suntik Sekali Pakai 10 ml Pcs 528 528 - 528 - - 7 - - 528
166 Canula Anak Pcs - - 0 - - 7 - - 0
167 Canula dewasa Pcs 25 25 5 20 0 - 7 1 2 17
169 Etanol 70 % Pcs 12 12 2 10 0 - 7 1 1 9
170 FM Crepe 7,5 cm x 4,55 m Pcs 6 6 - 6 - - 7 - - 6
171 FM Crepe 10 cm x 4,55 m Pcs 4 4 4 - - 7 - - 4
172 Folly Cath 18 Pcs 3 3 - 3 - - 7 - - 3
173 Folly Cath 20 Pcs - - 0 - - 7 - - 0
174 Handscoon 7 Pcs 100 100 100 - - 7 - - 100
Handscoon L - - - 0 - - 7 - - 0
Handscoon M - - 0 - - 7 - - 0
i.v. Cathether 26 G - - - 0 - - 7 - - 0
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

188 Kasa 40 x 80 Btl 2 2 2 - - 7 - - 2
189 LISOL Rol 12 12 6 6 0 - 7 2 2 2
190 Masker Rol 100 100 100 0 4 - 7 27 34 65
Masker - - 0 - - 7 - - 0
191 Poligyp 5 cm x 2,7 m Pcs - - 0 - - 7 - - 0
192 Polifix 5 cm x 1 m Pcs 16 16 15 1 1 - 7 4 5 9
193 Poliband Btl - - 0 - - 7 - - 0
194 Policlean Handrub 500 ml Pcs - - - 0 - - 7 - - 0
197 Silk (Benang Bedah Sutra) no 3 / 0 Pcs - - 0 - - 7 - - 0
198 NGT Pcs - - 0 - - 7 - - 0
199 Urine bag Pcs 10 10 10 - - 7 - - 10
200 Aqua Gell - - 0 - - 7 - - 0
201 Catejeel - - 0 - - 7 - - 0
202 Scalvien - - 0 - - 7 - - 0
204 Feding Tube 2 2 2 - - 7 - - 2
Feding Tube 2 2 2 - - 7 - - 2
Feding Tube 2 2 2 - - 7 - - 2
Feding Tube 1 1 1 - - 7 - - 1
205 IV Cath 16 - - 0 - - 7 - - 0
- - 0 - - 7 - - 0
Tambahan : - - 0 - - 7 - - 0
- - 0 - - 7 - - 0
207 Salbutamol Syr 40 40 - 40 - - 7 - - 40
208 Phenol Glycerol - - 0 - - 7 - - 0
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
210 Miniaspi - - 0 - - 7 - - 0
212 Analgetik Inj (antrain ) - - - 0 - - 7 - - 0
213 Phenitoin Inj - - 0 - - 7 - - 0
214 Griseofulvin 500 mg Tab - - 0 - - 7 - - 0
215 Oxymetazoline Spray 0,05 % 20 20 20 0 1 - 7 5 7 13
216 Oxymetazoline Drop 0,025 % 12 12 12 0 0 - 7 3 4 8
218 Ipratropium Inh - - 0 - - 7 - - 0
219 Amoxicillin 250 3,700 3,700 3700 - - 7 - - 3700
As Folat 10 Mg - - 0 - - 7 - - 0
Canula Infant 25 25 5 20 0 - 7 1 2 17
ceftriaxone 1g inj 28 28 28
fixomull - - 0
livron - - 0
dulcolax 54 54 54
Acetyl cystein 200 mg 1,880 1,880 120 1760
Mengetahui
(.....................................................) (.............................................................) (.........................................................)

Kolom p Jelas
Format : 2



33 Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Ampl ) Amp/Flc - - - - 0

37 Etanol 70 % Tub - - - - 0
40 Oxytetracyclin HCl Salep Kulit 3% Tub - - - - 0
BMHP
Tanbahan
a
b
c
d
e
f
g
Format : 3
8 Diazepam Tab 5 mg Tab 90 90 90
15 Trihexyfenidil Tab - - - 0
Format : 4
D Program P2P
Diare
1 Zink Tab 3,200 3,200 300 2900
2 Oralit Tab 1,800 1,800 100 1700
Imunisasi
1 BCG Amp - - 0
3 DT Amp - - 0
4 HB o Amp - - 0
5 IPV Amp - - 0
6 TD Amp - - 0
7 POLIO Amp - - 0
8 MR Amp - - 0
- - 0
10 ASSP 005 ml Pcs - - 0
TB paru
HIV/ Kusta
Kecacingan
14 DEC Tab - - 0
Rabies
Malaria
18 ACT Tab - - 0
Format 5

Informasi
a b c d d e f a b
1 5/1/2020 - 6 - - - 1 BOITAN 16.0 - - 0
2 5/2/2020 10 3 - - - 2 TRANS POHI 10.0 - - 0
3 5/3/2020 - 3 - - - 3 BUKIT MULYA 29.0 - - 0
4 5/4/2020 20 12 - - - 4 LOUK 43.0 - - 0
5 5/5/2020 21 3 - - - 5 LONTOS 22.0 - - 0
6 5/6/2020 12 7 - - - 6 - - - - 0
7 5/7/2020 2 - - - 7 - - - - 0
8 5/8/2020 12 3 - - - 8 - - - - 0
9 5/9/2020 12 4 - - - 9 - - - - 0
10 5/10/2020 - 2 - - - 10 - - - - 0
11 5/11/2020 20 2 - - - 11 - - - - 0
12 5/12/2020 8 3 - - - 12 - - - - 0
13 5/13/2020 16 2 - - - 13 - - - - 0
14 5/14/2020 7 6 - - - 14 - - - - 0
15 5/15/2020 13 2 - - - 15 - - - - 0
16 5/16/2020 15 2 - - - 16 - - - - 0
17 5/17/2020 - 4 - - - 17 - - - - 0
18 5/18/2020 12 4 - - - 18 - - - - 0
19 5/19/2020 13 2 - - - 19 - - - - 0
20 5/20/2020 10 1 - - - 20 - - - - 0
21 5/21/2020 - 1 - - - Jumlah B 120.0 - - 0
22 5/22/2020 14 1 - - -
23 5/23/2020 5 1 - - - Total A + B 367 120 487 0
24 5/24/2020 - 2 - - -
25 5/25/2020 - 3 - - -
26 5/26/2020 8 7 - - - Ket : Kolom a. jelas
27 5/27/2020 7 6 - - - Kolom b. Jelas
28 5/28/2020 10 - - - - Kolom c dan d. Jumlah lembar Rese
30 5/30/2020 - 5 - - - Kolom f. Penjelasan / informasi yang dilakukan /
31 5/31/2020 - 5 - - - Kolom e. Penderita yang minta penjelasan secara det
(LPLPO)
Kode Puskesmas Format : 1

Kabupaten : Banggai Bulan : JUNI
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

1 Ambroxol Tab - - 0 - - 7 - - 0
3 Acyclovir Tab 400 mg Tab 900 900 900 - - 7 - - 900
4 Alupurinol Tab 100 mg Tab 1,800 1,800 1,800 0 69 - 7 485 180 2465
6 Aminophyllin Tab 200 mg Tab 1,800 1,800 100 1700 4 - 7 27 10 1563
9 Amlodipine 5 Mg Tab 2,580 2,580 2580 - - 7 - - 2580
10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab - - 0 - - 7 - - 0
18 Captopril Tab 25 mg Tab - - - 0 - - 7 - - 0
21 Cetirizine Tb Tab - 1,000 1,000 400 600 15 - 7 108 40 52
23 Chlorpheniramin Maleat (CTM) Tab 4 mg Tab 5,200 5,200 1,400 3800 54 - 7 377 140 1883
28 Clonidine Tab - - 0 - - 7 - - 0
31 Cyanocobalamin (Vit B12) Tab Tab 5,400 5,400 1,000 4400 38 - 7 269 100 3031
35 Domperidome ( @100 = @50 ) Tab 5,200 5,200 600 4600 23 - 7 162 60 3778
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

45 Hidroklorothiazid (HCT) Tab 25 mg Tab 2,300 2,300 400 1900 15 - 7 108 40 1352
54 Loratadin tab 10 mg Tab 700 700 200 500 8 - 7 54 68 371
56 Metform Tb Tab - - 0 - - 7 - - 0
61 Natrium Diklofenak Tab 50 mg Tab 5,100 5,100 5100 - - 7 - - 5100
64 Omeprasole Tab 180 2,760 2,940 450 2490 17 - 7 121 152 2199
69 Prednison Tab 5 mg Tab 2,100 2,100 2,100 0 81 - 7 565 711 1357 expired
71 PropilTioUrasil (PTU) Tab 100 mg Tab - - - 0 - - 7 - - 0
73 Pyrantel HCl Tab 125 mg Tab 1,060 1,060 60 1000 2 - 7 16 20 961
74 Ranitidine Tab 150 mg Tab - - - 0 - - 7 - - 0
78 Selviplex Tab - - 0 - - 7 - - 0
79 Simvastatin Tab - - 0 - - 7 - - 0
85 Vitamin B Compleks Tab Tab 7,600 7,600 1,100 6500 42 - 7 296 372 5789
86 Zink Tab 2,900 2,900 900 2000 35 - 7 242 305 1418
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
0
87 Ambroxol Sy Btl - - 0 - - 7 - - 0
93 Cotrimoksazol Susp Btl 73 73 73 - - 7 - - 73
97 erytromysin Syrup Kering Btl - - - 0 - - 7 - - 0
101 Multivit Syr Btl - - 0 - - 7 - - 0
105 Pyrantel Syr Btl 50 50 50 0 2 - 7 13 17 32
106 Zinc Syr Btl 130 130 25 105 1 - 7 7 8 89
0
116 Diazepam Inj Amp - - 0 - - 7 - - 0
119 Fitomenadion (Vit K) Inj 10 mg - 1 ml Amp 153 153 - 153 - - 7 - - 153
121 Glukosa Lar Infus 5% Steril Amp - - 0 - - 7 - - 0
122 KA EN 3B Amp - - 0 - - 7 - - 0
124 Lidocain Comp. Inj/Pehacain Inj. Amp 112 300 412 52 360 2 - 7 14 18 326
126 Metil Ergometrin Maleat Inj 0,200 mg - 1 ml Amp 90 90 90 - - 7 - - 90
129 Ondansetron Inj Amp - 440 440 40 400 2 - 7 11 14 374
133 Ranitidine inj ( @ 25 = @ 10 ) Amp 200 500 700 60 640 2 - 7 16 20 601
SK SWK SWT
Sisa Stok Opt
136 Vit B1, B6, B12 Inj Amp - - 0 - - 7 - - 0
0
139 Antifungi SK Tub - - 0 - - 7 - - 0
141 Chloramphenicol Salep Kulit 1% (24 tube) Tub - - - 0 - - 7 - - 0
160 Scabimite Tub - - - 0 - - 7 - - 0
BMHP 0
166 Canula Anak Pcs - - 0 - - 7 - - 0
167 Canula dewasa Pcs 20 25 45 5 40 0 - 7 1 2 37
168 E-Care Alcohol Swab Pcs 9,900 9,900 1,900 8000 73 - 7 512 643 6772
169 Etanol 70 % Pcs 10 10 2 8 0 - 7 1 1 7
170 FM Crepe 7,5 cm x 4,55 m Pcs 6 6 6 - - 7 - - 6
171 FM Crepe 10 cm x 4,55 m Pcs 4 4 4 - - 7 - - 4
172 Folly Cath 18 Pcs 3 3 3 - - 7 - - 3
173 Folly Cath 20 Pcs - - 0 - - 7 - - 0
174 Handscoon Pcs 100 100 50 50 2 - 7 13 17 18
Handscoon - - 0 - - 7 - - 0
Handscoon - - 0 - - 7 - - 0
i.v. Cathether 26 G - - 0 - - 7 - - 0
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

187 Kasa Hidrofil 16 x 16 Pcs 85 85 - 85 - - 7 - - 85
188 Kasa 40 x 80 Btl 2 2 - 2 - - 7 - - 2
189 LISOL Rol 6 6 2 4 0 - 7 1 1 3
190 Masker Rol - - - 0 - - 7 - - 0
Masker - - 0 - - 7 - - 0
191 Poligyp 5 cm x 2,7 m Pcs - - 0 - - 7 - - 0
192 Polifix 5 cm x 1 m Pcs 1 13 14 1 13 0 - 7 0 0 12
193 Poliband Btl - - 0 - - 7 - - 0
198 NGT Pcs - - 0 - - 7 - - 0
199 Urine bag Pcs 10 10 10 - - 7 - - 10
200 Aqua Gell - - 0 - - 7 - - 0
201 Catejeel - - 0 - - 7 - - 0
202 Scalvien - - 0 - - 7 - - 0
203 Do Care Wash Gloves Antiseptic 24 24 2 22 0 - 7 1 1 21
204 Feding Tube 12 2 2 2 - - 7 - - 2
Feding Tube 16 2 2 2 - - 7 - - 2
Feding Tube 18 2 2 2 - - 7 - - 2
Feding Tube 20 1 1 1 - - 7 - - 1
205 IV Cath 18 - - 0 - - 7 - - 0
- - 0 - - 7 - - 0
Tambahan : - - 0 - - 7 - - 0
- - 0 - - 7 - - 0
207 Salbutamol Syr 40 40 40 - - 7 - - 40
208 Phenol Glycerol - - 0 - - 7 - - 0
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
210 Miniaspi - - 0 - - 7 - - 0
212 Analgetik Inj (antrain ) - - 0 - - 7 - - 0
213 Phenitoin Inj - - 0 - - 7 - - 0
215 Oxymetazoline Spray 0,05 % - - 0 - - 7 - - 0
216 Oxymetazoline Drop 0,025 % - - 0 - - 7 - - 0
217 Asam tranexamat Inj 330 330 330 - - 7 - - 330
218 Ipratropium Inh - - 0 - - 7 - - 0
219 Amoxicillin 250 3,700 3,700 100 3600 4 - 7 27 34 3535
As Folat 10 Mg - - 0 - - 7 - - 0
Canula Infant 20 50 70 70 - - 7 - - 70
fixomull - - 0
livron - - 0
dulcolax 54 54 54
Acetyl cystein 200 mg 1,760 2640 4,400 240 4160
0
Mengetahui
( MARTINA LUMENTERI ) (.............................................................) ( GEDE YOGI PRANA WARDANA, S.Farm.)

Kolom p Jelas
Format : 2




37 Etanol 70 % Tub - - - - 0
BMHP
Tanbahan
a
b
c
d
e
f
g
Format : 3
15 Trihexyfenidil Tab - - 0
Format : 4
D Program P2P
Diare
1 Zink Tab 2,900 2,900 900 2000
2 Oralit Tab 1,700 1,700 1700
Imunisasi
1 BCG Amp - - 0
3 DT Amp - - 0
4 HB o Amp - - 0
5 IPV Amp - - 0
6 TD Amp - - 0
7 POLIO Amp - - 0
8 MR Amp - - 0
- - 0
10 ASSP 005 ml Pcs - - 0
TB paru
HIV/ Kusta
Kecacingan
14 DEC Tab - - 0
Rabies
Malaria
18 ACT Tab - - 0
Format 5

Informasi
a b c d d e f a b
1 6/1/2020 - 3 - - - 1 polindes indang sari - - - 0
2 6/2/2020 13 2 - - - 2 pustu bantayan - - - 0
3 6/3/2020 8 1 - - - 3 pustu louk 35.0 - - 0
4 6/4/2020 11 4 - - - 4 polindes kayutanyo - - - 0
5 6/5/2020 9 2 - - - 5 pustu molino 34.0 - - 0
7 6/7/2020 - 1 - - - 7 polindes pohi - - - 0
8 6/8/2020 7 5 - - - 8 pustu lauwon - - - 0
9 6/9/2020 19 5 - - - 9 polindes lontos 26.0 - - 0
10 6/10/2020 5 4 - - - 10 - - - - 0
11 6/11/2020 11 1 - - - 11 - - - - 0
12 6/12/2020 10 1 - - - 12 - - - - 0
13 6/13/2020 3 1 - - - 13 - - - - 0
14 6/14/2020 - 1 - - - 14 - - - - 0
15 6/15/2020 16 3 - - - 15 - - - - 0
16 6/16/2020 9 2 - - - 16 - - - - 0
17 6/17/2020 14 3 - - - 17 - - - - 0
18 6/18/2020 6 3 - - - 18 - - - - 0
19 6/19/2020 4 6 - - - 19 - - - - 0
20 6/20/2020 12 3 - - - 20 - - - - 0
21 6/21/2020 - 1 - - - Jumlah B 117.0 - - 0
22 6/22/2020 11 8 - - -
23 6/23/2020 14 3 - - - Total A + B 352 - - 0
24 6/24/2020 1 2 - - -
25 6/25/2020 10 2 - - -
26 6/26/2020 10 4 - - - Ket : Kolom a. jelas
27 6/27/2020 4 3 - - - Kolom b. Jelas
28 6/28/2020 - 2 - - - Kolom c dan d. Jumlah lembar Rese
31 - - - - - Kolom e. Penderita yang minta penjelasan secara det
Jumlah A 245 - - - - Kolom f. Penjelasan / informasi yang dilakukan /diberikan kepada penderita/masyarakat
(LPLPO)

Kabupaten : Banggai Bulan : JULI
Propinsi : Sulawesi Tengah Tahun :2019
SWK SWT
NO NAMA OBAT/BHP Satuan Stok Awal penerimaan Persediaan Pengeluaran Sisa Stok SK BS Stok Opt (SO) Permintaan Ket
Hr Jml Hr Jml
a b c d e f g h i j k l m n o p q

1 Ambroxol Tab - - 0 - - 7 - - 0
3 Acyclovir Tab 400 mg Tab 900 - 900 100 800 4 - 7 27 10 663
4 Alupurinol Tab 100 mg Tab - - 0 - - 7 - - 0
6 Aminophyllin Tab 200 mg Tab 1,700 - 1,700 1,700 0 65 - 7 458 170 2328 expired
7 Amoxicillin Caps 500 mg / Pehamoxyl 500 Tab 5,400 - 5,400 1,200 4200 46 - 7 323 120 2557
10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab - - 0 - - 7 - - 0
11 Antalgin Tab 500 mg Tab - - - 0 - - 7 - - 0
12 Antasida Doen Tab Kombinasi Tab 12,100 - 12,100 1,300 10800 50 - 7 350 130 9020
13 Attapulgit 600 mg tablet (5 x 10 tab) Tab 3,000 3,000 3000 - - 7 - - 3000
18 Captopril Tab 25 mg Tab - - - - 0 - - 7 - - 0
24 Chlorpromazin HCl Tab Salut 25 mg Tab - - - 0 - - 7 - - 0
28 Clonidine Tab - - 0 - - 7 - - 0
32 Dexametason Tab 0,5 mg Tab 600 - 600 600 0 23 - 7 162 60 822 expired
35 Domperidome ( @100 = @50 ) Tab 4,600 4,600 400 4200 15 - 7 108 40 3652
37 Erytromysin 500 mg Tab Tab - - 0 - - 7 - - 0
SWK SWT
Hr Jml Hr Jml
39 Furosemid Tablet 40 mg Tab 2,200 - 2,200 2200 - - 7 - - 2200
43 Haloperidol Tab 1,5 mg Tab - - - 0 - - 7 - - 0
45 Hidroklorothiazid (HCT) Tab 25 mg Tab 1,900 - 1,900 1900 - - 7 - - 1900
47 Ibuprofen Tab 400 mg Tab 2,000 2,000 300 1700 12 - 7 81 102 1506
54 Loratadin tab 10 mg Tab 500 - 500 100 400 4 - 7 27 34 335
56 Metform Tb Tab - - 0 - - 7 - - 0
61 Natrium Diklofenak Tab 50 mg Tab 5,100 5,100 3,500 1600 135 - 7 942 1,185 662
64 Omeprasole Tab 2,490 2,490 630 1860 24 - 7 170 213 1453
66 Paracetamol Tab 500 mg Tab 4,200 - 4,200 700 3500 27 - 7 188 237 3048
68 Piridoxyn HCl Tab 10 mg Tab 6,600 - 6,600 900 5700 35 - 7 242 305 5118
69 Prednison Tab 5 mg Tab - - - - 0 - - 7 - - 0
71 PropilTioUrasil (PTU) Tab 100 mg Tab - - - - 0 - - 7 - - 0
73 Pyrantel HCl Tab 125 mg Tab 1,000 - 1,000 50 950 2 - 7 13 17 918
78 Selviplex Tab - - 0 - - 7 - - 0
79 Simvastatin Tab - - 0 - - 7 - - 0
80 Tablet Tambah Darah Tab 2,210 2,210 - 2210 - - 7 - - 2210
83 Thiamin HCl Monotartrat (Vit B1) Tab 50 mg Tab 2,500 2,500 1,300 1200 50 - 7 350 440 360
86 Zink Tab 2,000 2,000 2000 - - 7 - - 2000
0
SWK SWT
Hr Jml Hr Jml
87 Ambroxol Sy Btl - - 0 - - 7 - - 0
93 Cotrimoksazol Susp Btl 73 - 73 - 73 - - 7 - - 73
99 Ibuprofen Syr Btl 29 29 29 - - 7 - - 29
101 Multivit Syr Btl - - 0 - - 7 - - 0
103 Paracetamol Syrup 100 mg / 5 ml Btl 225 - 225 35 190 1 - 7 9 12 167
105 Pyrantel Syr Btl - - - 0 - - 7 - - 0
106 Zinc Syr Btl 105 105 15 90 1 - 7 4 5 80
0
114 Cyanocobalamin (Vit B12) Inj 500 mg / ml Amp 450 - 450 20 430 1 - 7 5 7 417
115 Dexametason Inj 5 mg / ml - 1 ml Amp 140 140 140 - - 7 - - 140
116 Diazepam Inj Amp - - 0 - - 7 - - 0
122 KA EN 3B Amp - - 0 - - 7 - - 0
128 Natrium Klorida 0,9% Larutan Infus Steril Amp 52 - 52 - 52 - - 7 - - 52
133 Ranitidine inj ( @ 25 = @ 10 ) Amp 640 - 640 90 550 3 - 7 24 30 492
134 Ringer Laktat Lar Infus Steril Amp 500 - 500 200 300 8 - 7 54 68 171
SK SWK SWT
NO NAMA OBAT/BHP Satuan Stok Awal penerimaan Persediaan Pengeluaran Sisa Stok BS Stok Opt (SO) Permintaan Ket
Hr Jml Hr Jml
135 Thiamin HCl (Vit B1) Inj 100 mg / ml - 1 ml Amp 72 - 72 5 67 0 - 7 1 2 64
136 Vit B1, B6, B12 Inj Amp - - 0 - - 7 - - 0
0
138 AntiHemoroid Doen Kombinasi Tub 120 - 120 120 - - 7 - - 120
139 Antifungi SK Tub - - 0 - - 7 - - 0
149 Hidrokortison Cream 2,5% Tub 440 - 440 20 420 1 - 7 5 7 407
160 Scabimite Tub - - 0 - - 7 - - 0
BMHP 0
162 Alat Suntik Sekali Pakai 2.5 ml / 3 ml Pcs - 2,500 2,500 280 2220 11 - 7 75 95 2039
163 Alat Suntik Sekali Pakai 5 ml Pcs 290 300 590 165 425 6 - 7 44 56 318
164 Alat Suntik Sekali Pakai 10 ml Pcs 518 25 543 2 541 0 - 7 1 1 540
165 Catgut/Benang Bedah no 2/0-3/0 (chromic) Pcs 82 72 154 28 126 1 - 7 8 9 108
166 catgut/benang bedah plain Pcs 48 - 48 48 - - 7 - - 48
167 Canula Anak Pcs - - 0 - - 7 - - 0
canula dwwasa 40 40 40
169 Etanol 70 % Pcs 8 - 8 3 5 0 - 7 1 1 3
170 FM Crepe 7,5 cm x 4,55 m Pcs 6 6 6 - - 7 - - 6
171 FM Crepe 10 cm x 4,55 m Pcs 4 4 4 - - 7 - - 4
172 Folly Cath 18 Pcs 3 3 3 - - 7 - - 3
173 Folly Cath 20 Pcs - - 0 - - 7 - - 0
174 Handscoon 7 Pcs 50 200 250 50 200 2 - 7 13 17 168
Handscoon L Pcs - - 0 - - 7 - - 0
Handscoon M Pcs - - 0 - - 7 - - 0
175 Infusion Set Anak Pcs - 150 150 12 138 0 - 7 3 4 130
176 Infusion Set Dewasa Pcs - 500 500 36 464 1 - 7 10 12 441
178 i.v. Cathether 20 G Rol - 150 150 3 147 0 - 7 1 1 145
i.v. Cathether 26 G - 100 100 100 - - 7 - - 100
SK SWK SWT
Hr Jml Hr Jml
182 Kapas Pembalut/Adsorben 250 g Rol 49 - 49 1 48 0 - 7 0 0 47
183 Kasa Kompres 40/40 Steril Pcs 100 150 250 250 - - 7 - - 250
184 Kasa Pembalut 2 m x 80 cm Rol 70 40 110 110 - - 7 - - 110
185 Kasa Pembalut hidrofil 4 m x 15 cm Rol 75 150 225 2 223 0 - 7 1 1 222
187 Kasa Hidrofil 16 x 16 Pcs 85 100 185 38 147 1 - 7 10 13 122
188 Kasa 40 x 80 Btl 2 5 7 1 6 0 - 7 0 0 5
189 LISOL Rol 4 - 4 1 3 0 - 7 0 0 2
190 Masker Rol - - - - 0 - - 7 - - 0
Masker - - 0 - - 7 - - 0
191 Poligyp 5 cm x 2,7 m Pcs - - 0 - - 7 - - 0
192 Polifix 5 cm x 1 m Pcs 13 25 38 - 38 - - 7 - - 38
193 Poliband Btl - - 0 - - 7 - - 0
196 Plester 5 yard x 2 inch (2,25 x 5 ) Pcs - - - - 0 - - 7 - - 0
197 Silk (Benang Bedah Sutra) no 3 / 0 Pcs - 24 24 3 21 0 - 7 1 1 19
198 NGT Pcs - - 0 - - 7 - - 0
199 Urine bag Pcs 10 10 10 - - 7 - - 10
200 Aqua Gell - - 0 - - 7 - - 0
201 Catejeel - - 0 - - 7 - - 0
202 Scalvien - - 0 - - 7 - - 0
203 Do Care Wash Gloves Antiseptic 22 22 22 - - 7 - - 22
204 Feding Tube 12 2 2 2 - - 7 - - 2
Feding Tube 16 2 2 2 - - 7 - - 2
Feding Tube 18 2 2 2 - - 7 - - 2
Feding Tube 20 1 1 1 - - 7 - - 1
205 IV Cath 18 - - 0 - - 7 - - 0
- - 0 - - 7 - - 0
Tambahan : - - 0 - - 7 - - 0
- - 0 - - 7 - - 0
206 Bisacodyl Supp 5 mg - - - 0 - - 7 - - 0
207 Salbutamol Syr 40 40 40 - - 7 - - 40
208 Phenol Glycerol - - 0 - - 7 - - 0
SK SWK SWT
Hr Jml Hr Jml
210 Miniaspi - - 0 - - 7 - - 0
212 Analgetik Inj (antrain ) - - 0 - - 7 - - 0
213 Phenitoin Inj - - 0 - - 7 - - 0
215 Oxymetazoline Spray 0,05 % - - - 0 - - 7 - - 0
216 Oxymetazoline Drop 0,025 % - - - 0 - - 7 - - 0
217 Asam tranexamat Inj 330 330 330 - - 7 - - 330
218 Ipratropium Inh - - 0 - - 7 - - 0
219 Amoxicillin 250 3,600 3,600 3,000 600 115 - 7 808 1,015 1338
As Folat 10 Mg - - 0 - - 7 - - 0
Canula Infant 70 70 15 55 1 - 7 4 5 45
fixomull - - 0
livron - - 0
dulcolax 54 54 54
handscoon steril 7.5 150 150 150
0
Mengetahui
Kepala Puskesmas Hunduhon Pengelola Obat PuskesmaS HUNDUHON
( MARTINA LUMENTERI ) (.............................................................) ( GEDE YOGI PRANA WARDANA, S.Farm.)

Kolom p Jelas
Format : 2




37 Etanol 70 % Tub - - - - 0
BMHP
Tanbahan
a
b
c
d
e
f
g
Format : 3
4 Chlorpromazin HCl Tab Salut 25 mg Tab - - - 0
13 Haloperidol Tab 1,5 mg Tab - - - 0
Format : 4
D Program P2P
Diare
1 Zink Tab 2,000 2,000 2000
2 Oralit Tab 1,700 1,700 100 1600
Imunisasi
1 BCG Amp - - 0
3 DT Amp - - 0
4 HB o Amp - - 0
5 IPV Amp - - 0
6 TD Amp - - 0
7 POLIO Amp - - 0
8 MR Amp - - 0
- - 0
10 ASSP 005 ml Pcs - - 0
TB paru
HIV/ Kusta
Kecacingan
14 DEC Tab - - 0
Rabies
Malaria
18 ACT Tab - - 0
Format 5

No Tanggal Konseling Informasi Obat Ket No Pustu/Polindes Konseling Informasi Obat
Rawat Jalan Rawat Inap Rawat Jalan Rawat Inap
a b c d d e f a b
1 7/1/2020 16 5 - - - 1 polindes indang sari 10.0 - - 0
2 7/2/2020 16 2 - - - 2 pustu bantayan 48.0 - - 0
3 7/3/2020 3 3 - - - 3 pustu molino - - - 0
4 7/4/2020 4 4 - - - 4 polindes pohi - - - 0
5 7/5/2020 5 - - - 5 pustu bukit mulya - - - 0
6 7/6/2020 12 2 - - - 6 polindes baya 36.0 - - 0
7 7/7/2020 13 4 - - - 7 pustu louk - - - 0
8 7/8/2020 19 4 - - - 8 pustu boitan - - - 0
9 7/9/2020 11 3 - - - 9 polindes lontos 23.0 - - 0
10 7/10/2020 6 4 - - - 10 - - - - 0
11 7/11/2020 15 3 - - - 11 - - - - 0
12 7/12/2020 2 - - - 12 - - - - 0
13 7/13/2020 20 8 - - - 13 - - - - 0
14 7/14/2020 41 8 - - - 14 - - - - 0
15 7/15/2020 7 1 - - - 15 - - - - 0
16 7/16/2020 3 3 - - - 16 - - - - 0
17 7/17/2020 25 3 - - - 17 - - - - 0
18 7/18/2020 6 3 - - - 18 - - - - 0
19 7/19/2020 4 - - - 19 - - - - 0
20 7/20/2020 11 3 - - - 20 - - - - 0
21 7/21/2020 14 2 - - - Jumlah B 117.0 - - 0
22 7/22/2020 4 4 - - -
23 7/23/2020 7 3 - - - Total A + B 409 117 - 526
24 7/24/2020 8 2 - - -
25 7/25/2020 4 4 - - -
26 7/26/2020 - - - Ket : Kolom a. jelas
27 7/27/2020 13 4 - - - Kolom b. Jelas
31 7/31/2020 - - - Kolom e. Penderita yang minta penjelasan secara det
(LPLPO)

Nama Puskesmas : puskesmas Hunduhon
Kecamatan : Luwuk Timur
Kabupaten : Banggai Bulan : Agustus
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

1 Ambroxol Tab - - 0 - - 7 - - 0
3 Acyclovir Tab 400 mg Tab 800 - 800 200 600 8 - 7 54 20 326
4 Alupurinol Tab 100 mg Tab - - - 0 - - 7 - - 0
5 Alprazolam tab 0,5 mg Tab - - - 0 - - 7 - - 0
6 Aminophyllin Tab 200 mg Tab - - - 0 - - 7 - - 0
7 Amoxicillin Caps 500 mg / Pehamoxyl 500 Tab 4,200 12,000 16,200 1,400 14800 54 - 7 377 140 12883
8 Ampicillin Caplet 500 mg Tab - - - 0 - - 7 - - 0
9 Amlodipine 5 Mg Tab 1,900 - 1,900 250 1650 10 - 7 67 25 1308
10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab - - 0 - - 7 - - 0
12 Antasida Doen Tab Kombinasi Tab 10,800 - 10,800 500 10300 19 - 7 135 50 9615
14 Asam Ascorbat (Vit C) Tab 50 mg Tab - - - 0 - - 7 - - 0
15 Asam Mefenamat Tab 500 mg Tab - - - - 0 - - 7 - - 0
16 Betahistin Tb Tab 1,800 - 1,800 300 1500 12 - 7 81 30 1089
23 Chlorpheniramin Maleat (CTM) Tab 4 mg Tab 2,500 - 2,500 500 2000 19 - 7 135 50 1315
28 Clonidine Tab - - 0 - - 7 - - 0
30 Cotrimoksazol Dewasa Tab 480 mg/ Tab 2,500 2,500 2500 - - 7 - - 2500
31 Cyanocobalamin (Vit B12) Tab Tab 3,900 3,900 3900 - - 7 - - 3900
32 Dexametason Tab 0,5 mg Tab - - - - 0 - - 7 - - 0
35 Domperidome ( @100 = @50 ) Tab 4,200 4,200 200 4000 8 - 7 54 20 3726
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
38 Fitomenadion (Vit K) Tab Salut 10 mg Tab - - 0 - - 7 - - 0

45 Hidroklorothiazid (HCT) Tab 25 mg Tab 1,900 1,900 100 1800 4 - 7 27 10 1663
48 Isosorbid Dinitrat Tab 5 mg Tab 300 - 300 300 - - 7 - - 300
50 Ketoconzol Tab Tab - - - 0 - - 7 - - 0
54 Loratadin tab 10 mg Tab 400 - 400 400 0 15 - 7 108 135 258
55 Meloksikam 15 Mg Tab - - - 0 - - 7 - - 0
56 Metform Tb Tab - - - 0 - - 7 - - 0
59 Metronidasole 500 Tab 200 1,000 1,200 100 1100 4 - 7 27 34 1035
61 Natrium Diklofenak Tab 50 mg Tab 1,600 1,600 600 1000 23 - 7 162 203 612
62 Nifedipin Tab 10 mg Tab 30 - 30 30 - - 7 - - 30
64 Omeprasole Tab 1,860 1,860 480 1380 18 - 7 129 162 1070
66 Paracetamol Tab 500 mg Tab 3,500 5,000 8,500 - 8500 - - 7 - - 8500
69 Prednison Tab 5 mg Tab - - - - 0 - - 7 - - 0
71 PropilTioUrasil (PTU) Tab 100 mg Tab - - 0 - - 7 - - 0
73 Pyrantel HCl Tab 125 mg Tab 950 950 50 900 2 - 7 13 17 868
74 Ranitidine Tab 150 mg Tab - - - 0 - - 7 - - 0
77 Salbutamol Tab 4 mg Tab - - - 0 - - 7 - - 0
78 Selviplex Tab - - 0 - - 7 - - 0
79 Simvastatin Tab - 3,360 3,360 3360 - - 7 - - 3360
83 Thiamin HCl Monotartrat (Vit B1) Tab 50 mg Tab 1,200 1,200 1200 - - 7 - - 1200
84 Trihexylfenidil Tab - - - 0 - - 7 - - 0
86 Zink Tab 2,000 2,000 2,000 0 77 - 7 538 677 1292 expired
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
0
87 Ambroxol Sy Btl - - 0 - - 7 - - 0
93 Cotrimoksazol Susp Btl - - - 0 - - 7 - - 0 expired
95 Cetirizine Syr Btl 120 120 120 - - 7 - - 120
96 Domperidome Sy Btl 115 115 115 - - 7 - - 115
99 Ibuprofen Syr Btl 29 29 29 - - 7 - - 29
101 Multivit Syr Btl - - - 0 - - 7 - - 0
103 Paracetamol Syrup 100 mg / 5 ml Btl 190 500 690 - 690 - - 7 - - 690
104 Paracetamol Drops 10 ml Btl 6 6 6 - - 7 - - 6
105 Pyrantel Syr Btl - - 0 - - 7 - - 0
106 Zinc Syr Btl 90 50 140 2 138 0 - 7 1 1 137
0
108 Aminopyllin Inj Amp 38 - 38 38 - - 7 - - 38
109 Aqua Pro Injeksi Steril Bebas Pirogen Amp 180 - 180 180 - - 7 - - 180
116 Diazepam Inj Amp - - 0 - - 7 - - 0
122 KA EN 3B Amp - - 0 - - 7 - - 0
123 Ketorolac Inj ( @ 12 = @ 6 ) Amp 573 - 573 20 553 1 - 7 5 7 540
128 Natrium Klorida 0,9% Larutan Infus Steril Amp 52 40 92 92 - - 7 - - 92
129 Ondansetron Inj Amp 350 - 350 20 330 1 - 7 5 7 317
130 Oxytetracyklin HCl Inj (i.m.) 50 mg / ml - 10 ml Amp - - - 0 - - 7 - - 0
131 Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Ampl ) Amp - - - - 0 - - 7 - - 0
133 Ranitidine inj ( @ 25 = @ 10 ) Amp 550 - 550 65 485 3 - 7 18 22 443
SK SWK SWT
Sisa Stok Opt
135 Thiamin HCl (Vit B1) Inj 100 mg / ml - 1 ml Amp 67 67 - 67 - - 7 - - 67
136 Vit B1, B6, B12 Inj Amp - - 0 - - 7 - - 0
0
138 AntiHemoroid Doen Kombinasi Tub 120 - 120 - 120 - - 7 - - 120
139 Antifungi SK Tub - - 0 - - 7 - - 0
140 Betametason Cream 0,1% (25 Tube) Tub 280 280 280 - - 7 - - 280
149 Hidrokortison Cream 2,5% Tub 420 - 420 - 420 - - 7 - - 420
156 Povidon Iodium Lar 300 ml Tub 16 16 16 - - 7 - - 16
158 Salep 2-4 Kombinasi Tub 15 - 15 15 0 1 - 7 4 5 10
160 Scabimite Tub - - 0 - - 7 - - 0
BMHP 0
162 Alat Suntik Sekali Pakai 2.5 ml / 3 ml Pcs 2,220 - 2,220 20 2200 1 - 7 5 7 2187
163 Alat Suntik Sekali Pakai 5 ml Pcs 425 - 425 - 425 - - 7 - - 425
165 Catgut/Benang Bedah no 2/0-3/0 (chromic) Pcs 126 - 126 25 101 1 - 7 7 8 85
166 Canula Anak Pcs - - 0 - - 7 - - 0
168 E-Care Alcohol Swab Pcs 7,200 - 7,200 7200 - - 7 - - 7200
169 Etanol 70 % Pcs 5 - 5 3 2 0 - 7 1 1 0
170 FM Crepe 7,5 cm x 4,55 m Pcs 6 6 6 - - 7 - - 6
171 FM Crepe 10 cm x 4,55 m Pcs 4 4 4 - - 7 - - 4
172 Folly Cath 18 Pcs 3 3 3 - - 7 - - 3
173 Folly Cath 20 Pcs - - 0 - - 7 - - 0
174 Handscoon 7 Pcs 200 200 200 - - 7 - - 200
Handscoon L - - - 0 - - 7 - - 0
Handscoon M - - - 0 - - 7 - - 0
175 Infusion Set Anak Pcs 138 138 17 121 1 - 7 5 6 110
176 Infusion Set Dewasa Pcs 464 464 60 404 2 - 7 16 20 365
179 i.v. Cathether 22 G Rol 295 - 295 47 248 2 - 7 13 16 218
180 i.v. Cathether 24 G Rol 342 - 342 28 314 1 - 7 8 9 296
i.v. Cathether 26 G 100 100 100 - - 7 - - 100
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

183 Kasa Kompres 40/40 Steril Pcs 250 - 250 250 - - 7 - - 250
184 Kasa Pembalut 2 m x 80 cm Rol 110 - 110 - 110 - - 7 - - 110
187 Kasa Hidrofil 16 x 16 Pcs 147 - 147 32 115 1 - 7 9 11 94
188 Kasa 40 x 80 Btl 6 - 6 - 6 - - 7 - - 6
189 LISOL Rol 3 3 3 - - 7 - - 3
190 Masker Rol - - - - 0 - - 7 - - 0
Masker - - 0 - - 7 - - 0
191 Poligyp 5 cm x 2,7 m Pcs - - 0 - - 7 - - 0
192 Polifix 5 cm x 1 m Pcs 38 38 14 24 1 - 7 4 5 15
193 Poliband Btl - - 0 - - 7 - - 0
196 Plester 5 yard x 2 inch (2,25 x 5 ) Pcs - - - 0 - - 7 - - 0
197 Silk (Benang Bedah Sutra) no 3 / 0 Pcs 21 - 21 17 4 1 - 7 5 6 7
198 NGT Pcs - - 0 - - 7 - - 0
199 Urine bag Pcs 10 10 10 - - 7 - - 10
200 Aqua Gell - - 0 - - 7 - - 0
201 Catejeel - - 0 - - 7 - - 0
202 Scalvien - - 0 - - 7 - - 0
203 Do Care Wash Gloves Antiseptic 22 - 22 22 - - 7 - - 22
204 Feding Tube 2 2 2 - - 7 - - 2
Feding Tube 2 2 2 - - 7 - - 2
Feding Tube 2 2 2 - - 7 - - 2
Feding Tube 1 1 1 - - 7 - - 1
205 IV Cath 18 - - 0 - - 7 - - 0
- - 0 - - 7 - - 0
Tambahan : - - 0 - - 7 - - 0
- - 0 - - 7 - - 0
206 - - - 0 - - 7 - - 0
207 Salbutamol Syr 40 40 8 32 0 - 7 2 3 27
208 Phenol Glycerol - - 0 - - 7 - - 0
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
210 miniaspi - - - 0 - - 7 - - 0
212 Analgetik Inj (antrain ) - - 5 5 0 - 7 1 2 8
213 Phenitoin Inj - - 0 - - 7 - - 0
215 Oxymetazoline Spray 0,05 % - - 0 - - 7 - - 0
216 Oxymetazoline Drop 0,025 % - - 0 - - 7 - - 0
217 Asam tranexamat Inj 330 - 330 330 - - 7 - - 330
218 Ipratropium Inh - - 0 - - 7 - - 0
219 Amoxicillin 250 600 600 600 0 23 - 7 162 203 388 EXPIRED
As Folat 10 Mg - - - 0 - - 7 - - 0
Canula Infant 55 55 55 - - 7 - - 55
210 ceftriaxone 1G inj 28 - 28 28 - - 7 - - 28
Fixomul - 0 - 0 0
livron - - 0 0
dulcolax 54 54 6 48 48
handscoon steril 7.5 150 150 150
Mengetahui -
(MARTINA LUMENTERI) (.............................................................) (GEDE YOGI PRANA W., S.Farm)

Kolom p Jelas
Format : 2




37 Etanol 70 % Tub - - - - 0
BMHP
Tanbahan
a
b
c
d
e
f
g
Format : 3
Format : 4
D Program P2P
Diare
1 Zink Tab 2,000 2,000 2,000 0
2 Oralit Tab 1,600 1,600 1600
Imunisasi
1 BCG Amp - - 0
3 DT Amp - - 0
4 HB o Amp - - 0
5 IPV Amp - - 0
6 TD Amp - - 0
7 POLIO Amp - - 0
8 MR Amp - - 0
- - 0
10 ASSP 005 ml Pcs - - 0
TB paru
HIV/ Kusta
Kecacingan
14 DEC Tab - - 0
Rabies
Malaria
18 ACT Tab - - 0
Format 5

Informasi
a b c d d e f a b
1 8/1/2020 5 4 - - - 1 polindes indang sari - - - 0
2 8/2/2020 4 - - - 2 pustu lontos 21.0 - - 0
3 8/3/2020 20 4 - - - 3 pustu molino 57.0 - - 0
4 8/4/2020 17 4 - - - 4 polindes pohi - - 0
6 8/6/2020 11 5 - - - 6 polindes baya - - 0
7 8/7/2020 15 6 - - - 7 pustu louk - - 0
8 8/8/2020 19 2 - - - 8 pustu transpohi 20.0 - 0
9 8/9/2020 2 - - - 9 - - - - 0
10 8/10/2020 19 3 - - - 10 - - - - 0
11 8/11/2020 17 4 - - - 11 - - - - 0
12 8/12/2020 14 2 - - - 12 - - - - 0
13 8/13/2020 17 4 - - - 13 - - - - 0
14 8/14/2020 7 3 - - - 14 - - - - 0
15 8/15/2020 3 4 - - - 15 - - - - 0
16 8/16/2020 2 - - - 16 - - - - 0
17 8/17/2020 - - - 17 - - - - 0
18 8/18/2020 19 4 - - - 18 - - - - 0
19 8/19/2020 17 3 - - - 19 - - - - 0
20 8/20/2020 1 - - - 20 - - - - 0
21 8/21/2020 8 - - - Jumlah B 119.0 - - 0
22 8/22/2020 5 4 - - -
23 8/23/2020 2 - - - Total A + B 541 - - 0
24 8/24/2020 31 4 - - -
25 8/25/2020 20 4 - - -
26 8/26/2020 8 3 - - - Ket : Kolom a. jelas
27 8/27/2020 15 5 - - - Kolom b. Jelas
30 8/30/2020 2 - - - Kolom f. Penjelasan / informasi yang dilakukan /
LAPORAN MONITORING INDIKATOR PERESEPAN
*) Coret yg tdk perlu
Ket : Data Pada Laporan Ini diambil dari data laporan POR ( Jumlah Persentase Puskesmas Induk dan Pustu )
Mengetahui
(MARTINA LUMENTERI) (......................................................................................) (GEDE YOGI PRANA W., S.Farm)

Nip. 19670629 198703 2 008 Nip NRPK. 19.7.0505817
(LPLPO)

Kecamatan :
Kabupaten : Banggai Bulan : SEPTEMBER

SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

1 Ambroxol Tab - 3,000 3,000 600 2400 23 - 7 162 60 1578
3 Acyclovir Tab 400 mg Tab 600 600 - 600 - - 7 - - 600
4 Alupurinol Tab 100 mg Tab - - - 0 - - 7 - - 0
6 Aminophyllin Tab 200 mg Tab - - 0 - - 7 - - 0
9 Amlodipine 5 Mg Tab 1,650 6,000 7,650 510 7140 20 - 7 137 51 6442
10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab - - 0 - - 7 - - 0
14 Asam Ascorbat (Vit C) Tab 50 mg Tab - - - 0 - - 7 - - 0
15 Asam Mefenamat Tab 500 mg Tab - 1,500 1,500 - 1500 - - 7 - - 1500
21 Cetirizine Tb Tab - - 0 - - 7 - - 0
28 Clonidine Tab - - 0 - - 7 - - 0
31 Cyanocobalamin (Vit B12) Tab Tab 3,900 5,000 8,900 200 8700 8 - 7 54 20 8426
32 Dexametason Tab 0,5 mg Tab - 2,500 2,500 1,000 1500 38 - 7 269 100 131
35 Domperidome ( @100 = @50 ) Tab 4,000 4,000 700 3300 27 - 7 188 70 2342
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

47 Ibuprofen Tab 400 mg Tab 1,700 1,000 2,700 2700 - - 7 - - 2700
54 Loratadin tab 10 mg Tab - - - 0 - - 7 - - 0
56 Metform Tb Tab - - 0 - - 7 - - 0
59 Metronidasole 500 Tab 1,100 1,100 1100 - - 7 - - 1100
61 Natrium Diklofenak Tab 50 mg Tab 1,000 1,000 900 100 35 - 7 242 305 482
64 Omeprasole Tab 1,380 1,380 990 390 38 - 7 267 335 250
69 Prednison Tab 5 mg Tab - - - 0 - - 7 - - 0
73 Pyrantel HCl Tab 125 mg Tab 900 900 900 - - 7 - - 900
74 Ranitidine Tab 150 mg Tab - 3,000 3,000 300 2700 12 - 7 81 102 2506
77 Salbutamol Tab 4 mg Tab - - 0 - - 7 - - 0
78 Selviplex Tab - - 0 - - 7 - - 0
79 Simvastatin Tab 3,360 3,360 3360 - - 7 - - 3360
80 Tablet Tambah Darah Tab 1,710 1,710 150 1560 6 - 7 40 51 1463 2000 EXPIRED
83 Thiamin HCl Monotartrat (Vit B1) Tab 50 mg Tab 1,200 1,000 2,200 2200 - - 7 - - 2200
85 Vitamin B Compleks Tab Tab 5,000 5,000 - 5000 - - 7 - - 5000
86 Zink Tab - - - 0 - - 7 - - 0
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
0
87 Ambroxol Sy Btl - 150 150 23 127 1 - 7 6 8 112
93 Cotrimoksazol Susp Btl - - 0 - - 7 - - 0
95 Cetirizine Syr Btl 120 120 120 - - 7 - - 120
98 Garam Oralit 200 ml Air Btl 1,600 1,600 1600 - - 7 - - 1600
101 Multivit Syr Btl - - 0 - - 7 - - 0
105 Pyrantel Syr Btl - - 0 - - 7 - - 0
106 Zinc Syr Btl 138 138 20 118 1 - 7 5 7 105
0
116 Diazepam Inj Amp - - 0 - - 7 - - 0
122 KA EN 3B Amp - - 0 - - 7 - - 0
SK SWK SWT
Sisa Stok Opt
136 Vit B1, B6, B12 Inj Amp - - 0 - - 7 - - 0
0
139 Antifungi SK Tub - - 0 - - 7 - - 0
145 Diasepam Rectal ( Stesolid ) Tub - - - 0 - - 7 - - 0 expired
146 Etakridina laktat (Rivanol) Tub 20 20 - 20 - - 7 - - 20 expired
148 Gentian Violet Lar 1% Tub - - - 0 - - 7 - - 0
156 Povidon Iodium Lar 300 ml Tub 16 72 88 7 81 0 - 7 2 2 76
158 Salep 2-4 Kombinasi Tub - - 0 - - 7 - - 0
160 Scabimite Tub - - 0 - - 7 - - 0
BMHP 0
166 Canula anak Pcs - - 0 - - 7 - - 0
169 Etanol 70 % Pcs 2 2 - 2 - - 7 - - 2
170 FM Crepe 7,5 cm x 4,55 m Pcs 6 6 6 - - 7 - - 6
171 FM Crepe 10 cm x 4,55 m Pcs 4 4 4 - - 7 - - 4
172 Folly Cath 18 Pcs 3 3 3 - - 7 - - 3
173 Folly Cath 20 Pcs - - 0 - - 7 - - 0
174 Handscoon 7 Pcs 200 200 200 - - 7 - - 200
Handscoon L Pcs - - - 0 - - 7 - - 0
Handscoon M Pcs - - - 0 - - 7 - - 0
175 Infusion Set Anak Pcs 121 - 121 16 105 1 - 7 4 5 95
176 Infusion Set Dewasa Pcs 404 - 404 73 331 3 - 7 20 25 284
177 i.v. Cathether 18 G Pcs 15 15 15 - - 7 - - 15
178 i.v. Cathether 20 G Pcs 147 147 6 141 0 - 7 2 2 137
i.v. Cathether 26 G 100 100 100 - - 7 - - 100
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

188 Kasa 40 x 80 Btl 6 6 2 4 0 - 7 1 1 3
189 LISOL Rol 3 3 1 2 0 - 7 0 0 1
190 Masker Rol - - - 0 - - 7 - - 0
Masker - - 0 - - 7 - - 0
191 Poligyp 5 cm x 2,7 m Pcs - - 0 - - 7 - - 0
192 Polifix 5 cm x 1 m Pcs 24 24 2 22 0 - 7 1 1 21
193 Poliband Btl - - 0 - - 7 - - 0
198 NGT Pcs - - 0 - - 7 - - 0
199 Urine bag Pcs 10 10 10 - - 7 - - 10
200 Aqua Gell Pcs - - 0 - - 7 - - 0
201 Catejeel Pcs - - 0 - - 7 - - 0
202 Scalvien Pcs - - 0 - - 7 - - 0
204 Feding Tube Pcs 2 2 2 - - 7 - - 2
Feding Tube Pcs 2 2 2 - - 7 - - 2
Feding Tube Pcs 2 2 2 - - 7 - - 2
Feding Tube Pcs 1 1 1 - - 7 - - 1
205 IV Cath 18 Pcs - - 0 - - 7 - - 0
Pcs - - 0 - - 7 - - 0
Tambahan : Pcs - - 0 - - 7 - - 0
Pcs - - 0 - - 7 - - 0
206 Bisacodyl Supp 5 mg Pcs - - 0 - - 7 - - 0
207 Salbutamol Syr Pcs 32 32 - 32 - - 7 - - 32
208 Phenol Glycerol Pcs - - 0 - - 7 - - 0
209 Anti Influenza (Noza) Pcs - - 0 - - 7 - - 0
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
210 Miniaspi Pcs - - - 0 - - 7 - - 0

211 multivitamin (LVB) Pcs - - 0 - - 7 - - 0
212 Analgetik Inj (antrain ) Pcs - - 0 - - 7 - - 0
213 Phenitoin Inj Pcs - - 0 - - 7 - - 0
214 Griseofulvin 500 mg Tab Pcs - - - 0 - - 7 - - 0
215 Oxymetazoline Spray 0,05 % Pcs - - 0 - - 7 - - 0
216 Oxymetazoline Drop 0,025 % Pcs - - 0 - - 7 - - 0
217 Asam tranexamat Inj Pcs 330 330 - 330 - - 7 - - 330
218 Ipratropium Inh Pcs - - 0 - - 7 - - 0
219 Amoxicillin 250 Pcs - - 0 - - 7 - - 0
As Folat 10 Mg - - 0 - - 7 - - 0
Canula Infant 55 55 55 - - 7 - - 55
fixomull - - 0
livron - - 0
dulcolax 48 48 48
Acetyl cystein 200 mg 2,430 2,430 2430
handscoon steril 7.5 150 150 5 145
Mengetahui
Kepala Puskesmas hunduhon Pengelola Obat Puskesmas hunduhon

Kolom p Jelas
Format : 2




37 Etanol 70 % Tub - - - - 0
BMHP
Tanbahan
a
b
c
d
e
f
g
Format : 3
Format : 4
D Program P2P
Diare
1 Zink Tab - - 0
2 Oralit Tab 1,600 1,600 1600
Imunisasi
1 BCG Amp - - 0
3 DT Amp - - 0
4 HB o Amp - - 0
5 IPV Amp - - 0
6 TD Amp - - 0
7 POLIO Amp - - 0
8 MR Amp - - 0
- - 0
10 ASSP 005 ml Pcs - - 0
TB paru
HIV/ Kusta
Kecacingan
14 DEC Tab - - 0
Rabies
Malaria
18 ACT Tab - - 0
Format 5

Informasi
a b c d d e f a b
1 9/1/2020 12 4 - - - 1 pustu bantayan - - 0
2 9/2/2020 12 2 - - - 2 pustu louk - - 0
3 9/3/2020 10 2 - - - 3 pustu molino 35.0 - - 0
4 9/4/2020 7 4 - - - 4 polindes pohi - - 0
5 9/5/2020 4 - - - 5 pustu bukit mulya 19.0 - - 0
6 9/6/2020 1 - - - 6 pustu boitan 28.0 - - 0
7 9/7/2020 20 7 - - - 7 pustu lontos 23.0 - - 0
8 9/8/2020 11 4 - - - 8 pustu indang sari - - 0
9 9/9/2020 12 2 - - - 9 pustu lauwon - - 0
10 9/10/2020 18 4 - - - 10 - - - - 0
11 9/11/2020 10 - - - 11 - - - - 0
12 9/12/2020 8 2 - - - 12 - - - - 0
13 9/13/2020 3 - - - 13 - - - - 0
14 9/14/2020 21 8 - - - 14 - - - - 0
15 9/15/2020 19 5 - - - 15 - - - - 0
16 9/16/2020 10 4 - - - 16 - - - - 0
17 9/17/2020 11 3 - - - 17 - - - - 0
18 9/18/2020 5 1 - - - 18 - - - - 0
19 9/19/2020 9 1 - - - 19 - - - - 0
20 9/20/2020 1 - - - 20 - - - - 0
21 9/21/2020 16 8 - - - Jumlah B 105.0 - - 0
22 9/22/2020 7 5 - - -
23 9/23/2020 15 - - - Total A + B 509 - 0
24 9/24/2020 17 2 - - -
25 9/25/2020 13 1 - - -
26 9/26/2020 3 5 - - - Ket : Kolom a. jelas
27 9/27/2020 1 - - - Kolom b. Jelas

Nip. 19670629 198703 2 008 Nip Nrpk: 19.7.0505817
(LPLPO)

Nama Puskesmas : puskesmas hunduhon
Kecamatan :
Kabupaten : Banggai Bulan : Oktober
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

1 Ambroxol Tab 2,400 2,400 400 2000 15 - 7 108 40 1452
3 Acyclovir Tab 400 mg Tab 600 600 - 600 - - 7 - - 600
10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab - - 0 - - 7 - - 0
13 Attapulgit 600 mg tablet (5 x 10 tab) Tab 2,500 3,000 5,500 300 5200 12 - 7 81 30 4789
14 Asam Ascorbat (Vit C) Tab 50 mg Tab - - 0 - - 7 - - 0
15 Asam Mefenamat Tab 500 mg Tab 1,500 1,500 1500 - - 7 - - 1500
18 Captopril Tab 25 mg Tab - - 0 - - 7 - - 0
23 Chlorpheniramin Maleat (CTM) Tab 4 mg Tab 800 2,500 3,300 400 2900 15 - 7 108 40 2352
28 Clonidine Tab - - 0 - - 7 - - 0
32 Dexametason Tab 0,5 mg Tab 1,500 2,000 3,500 300 3200 12 - 7 81 30 2789
35 Domperidome ( @100 = @50 ) Tab 3,300 3,300 300 3000 12 - 7 81 30 2589
SWK SWT
Stok Opt
NO NAMA OBAT/BHP Satuan Sisa Stok penerimaan Persediaan Pengeluaran Sisa Stok SK BS Permintaan Ket
Hr Jml Hr Jml (SO)

47 Ibuprofen Tab 400 mg Tab 2,700 1,500 4,200 200 4000 8 - 7 54 68 3871
54 Loratadin tab 10 mg Tab - - 0 - - 7 - - 0
56 Metform Tb Tab - - 0 - - 7 - - 0
59 Metronidasole 500 Tab 1,100 1,100 200 900 8 - 7 54 68 771
61 Natrium Diklofenak Tab 50 mg Tab 100 100 100 0 4 - 7 27 34 65
64 Omeprasole Tab 390 390 390 0 15 - 7 105 132 252
69 Prednison Tab 5 mg Tab - 10,000 10,000 10000 - - 7 - - 10000
74 Ranitidine Tab 150 mg Tab 2,700 2,700 100 2600 4 - 7 27 34 2535
78 Selviplex Tab - - 0 - - 7 - - 0
79 Simvastatin Tab 3,360 3,360 3360 - - 7 - - 3360
80 Tablet Tambah Darah Tab 1,560 1,560 1,560 0 60 - 7 420 528 1008
86 Zink Tab - - 0 - - 7 - - 0
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
0
87 Ambroxol Sy Btl 127 127 22 105 1 - 7 6 7 91
88 Amoxicillin Syrup Kering 125 mg / 5 ml Btl - 400 400 400 - - 7 - - 400
90 Antasida Doen Susp Kombinasi Btl - - 0 - - 7 - - 0
96 Domperidome Sy Btl 97 50 147 5 142 0 - 7 1 2 139
101 Multivit Syr Btl - - 0 - - 7 - - 0
104 Paracetamol Drops 10 ml Btl - 50 50 50 - - 7 - - 50
105 Pyrantel Syr Btl - - 0 - - 7 - - 0
106 Zinc Syr Btl 118 118 16 102 1 - 7 4 5 92
0
112 Cefotaxim 1 g Inj Amp 80 80 80 0 3 - 7 22 27 52
116 Diazepam Inj Amp - - 0 - - 7 - - 0
119 Fitomenadion (Vit K) Inj 10 mg - 1 ml Amp 90 90 90 - - 7 - - 90 expired
122 KA EN 3B Amp - - 0 - - 7 - - 0
126 Metil Ergometrin Maleat Inj 0,200 mg - 1 ml Amp 75 50 125 125 - - 7 - - 125
131 Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Ampl ) Amp - 100 100 100 - - 7 - - 100
SK SWK SWT
Sisa Stok Opt
135 Thiamin HCl (Vit B1) Inj 100 mg / ml - 1 ml Amp 22 22 15 7 1 - 7 4 5 3 expired
136 Vit B1, B6, B12 Inj Amp - - 0 - - 7 - - 0
0
139 Antifungi SK Tub - - 0 - - 7 - - 0
146 Etakridina laktat (Rivanol) Tub 20 - 20 - 20 - - 7 - - 20
156 Povidon Iodium Lar 300 ml Tub 81 - 81 2 79 0 - 7 1 1 78
158 Salep 2-4 Kombinasi Tub - - 0 - - 7 - - 0
159 Salisil Talk/Bedak 2% Tub - - - 0 - - 7 - - 0 expired
160 Scabimite Tub - - 0 - - 7 - - 0
BMHP 0
161 Alat Suntik Sekali Pakai 1 ml Pcs - - - 0 - - 7 - - 0
catgut/benang bedah plain 48 48 - 48 expired
166 Canula Anak Pcs - - - 0 - - 7 - - 0
169 Etanol 70 % Pcs 2 24 26 1 25 0 - 7 0 0 24
170 FM Crepe 7,5 cm x 4,55 m Pcs 6 6 6 0 0 - 7 2 2 4
171 FM Crepe 10 cm x 4,55 m Pcs 4 4 4 0 0 - 7 1 1 3
172 Folly Cath 18 Pcs 3 3 3 0 0 - 7 1 1 2
173 Folly Cath 20 Pcs - - 0 - - 7 - - 0
174 Handscoon 7 Pcs 200 200 25 175 1 - 7 7 8 159
Handscoon L Pcs - - - - 0 - - 7 - - 0
Handscoon M Pcs - - - - 0 - - 7 - - 0
176 Infusion Set Dewasa Pcs 331 - 331 80 251 3 - 7 22 27 199
178 i.v. Cathether 20 G Pcs 141 141 - 141 - - 7 - - 141
i.v. Cathether 26 G 100 100 100 - - 7 - - 100
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

188 Kasa 40 x 80 Btl 4 4 4 - - 7 - - 4
189 LISOL Rol 2 2 - 2 - - 7 - - 2
190 Masker Rol - - - - 0 - - 7 - - 0
Masker - - 0 - - 7 - - 0
191 Poligyp 5 cm x 2,7 m Pcs - - 0 - - 7 - - 0
192 Polifix 5 cm x 1 m Pcs 22 22 2 20 0 - 7 1 1 19
193 Poliband Btl - - 0 - - 7 - - 0
197 Silk (Benang Bedah Sutra) no 3 / 0 Pcs - - - 0 - - 7 - - 0
198 NGT Pcs - - 0 - - 7 - - 0
199 Urine bag Pcs 10 10 10 - - 7 - - 10
200 Aqua Gell Pcs - - 0 - - 7 - - 0
201 Catejeel Pcs - - 0 - - 7 - - 0
202 Scalvien Pcs - - 0 - - 7 - - 0
204 Feding Tube Pcs 2 2 2 - - 7 - - 2
Feding Tube Pcs 2 2 2 - - 7 - - 2
Feding Tube Pcs 2 2 2 - - 7 - - 2
Feding Tube Pcs 1 1 1 - - 7 - - 1
205 IV Cath 18 Pcs - - 0 - - 7 - - 0
Pcs - - 0 - - 7 - - 0
Tambahan : Pcs - - 0 - - 7 - - 0
Pcs - - 0 - - 7 - - 0
206 Bisacodyl Supp 5 mg Pcs - 15 15 15 - - 7 - - 15
207 Salbutamol Syr Pcs - - 0 - - 7 - - 0
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
210 Miniaspi Pcs - - 0 - - 7 - - 0

214 Griseofulvin 500 mg Tab Pcs - - 0 - - 7 - - 0
217 Asam tranexamat Inj Pcs 330 330 330 - - 7 - - 330
219 Amoxicillin 250 Pcs - - 0 - - 7 - - 0
As Folat 10 Mg - - 0 - - 7 - - 0
Canula Infant 55 55 55 - - 7 - - 55
ceftriaxone 1g inj 28 28 28 0
fixomull - - 0
livron - - 0
dulcolax 48 48 6 42
Mengetahui
Kepala Puskesmas hunduhon Pengelola Obat Puskesmas hunduhon

Kolom p Jelas
Format : 2




37 Etanol 70 % Tub - - - - 0
BMHP
Tanbahan
a
b
c
d
e
f
g
Format : 3
Format : 4
D Program P2P
Diare
1 Zink Tab - - 0
2 Oralit Tab 1,600 1,600 1600
Imunisasi
1 BCG Amp - - 0
3 DT Amp - - 0
4 HB o Amp - - 0
5 IPV Amp - - 0
6 TD Amp - - 0
7 POLIO Amp - - 0
8 MR Amp - - 0
- - 0
10 ASSP 005 ml Pcs - - 0
TB paru
HIV/ Kusta
Kecacingan
14 DEC Tab - - 0
Rabies
Malaria
18 ACT Tab - - 0
Format 5

Informasi
a b c d d e f a b
1 10/1/2020 20 8 - - - 1 polindes baya 30.0 - - 0
2 10/2/2020 10 4 - - - 2 pustu louk 24.0 - - 0
3 10/3/2020 7 3 - - - 3 polindes lontos 21.0 - - 0
4 10/4/2020 - - - 4 pustu molino 32.0 - - 0
6 10/6/2020 16 3 - - - 6 - - 0
7 10/7/2020 8 4 - - - 7 - - - - 0
8 10/8/2020 8 4 - - - 8 - - - - 0
9 10/9/2020 8 6 - - - 9 - - - - 0
10 10/10/2020 13 4 - - - 10 - - - - 0
11 10/11/2020 - - - - 11 - - - - 0
12 10/12/2020 10 4 - - - 12 - - - - 0
13 10/13/2020 12 6 - - - 13 - - - - 0
14 10/14/2020 9 6 - - - 14 - - - - 0
15 10/15/2020 15 3 - - - 15 - - - - 0
16 10/16/2020 13 6 - - - 16 - - - - 0
17 10/17/2020 10 1 - - - 17 - - - - 0
18 10/18/2020 2 - - - 18 - - - - 0
19 10/19/2020 16 4 - - - 19 - - - - 0
20 10/20/2020 17 6 - - - 20 - - - - 0
21 10/21/2020 13 8 - - - Jumlah B 143.0 - - 0
22 10/22/2020 7 6 - - -
23 10/23/2020 8 8 - - - Total A + B 542 - - 0
24 10/24/2020 4 2 - - -
25 10/25/2020 2 - - -
26 10/26/2020 12 3 - - - Ket : Kolom a. jelas
27 10/27/2020 13 4 - - - Kolom b. Jelas
28 10/28/2020 5 - - - Kolom c dan d. Jumlah lembar Rese
29 10/29/2020 2 - - - Kolom e. Penderita yang minta penjelasan secara det
*) Coret yg tdk perlu
Ket : Data Pada Laporan Ini diambil dari data laporan POR ( Jumlah Persentase Puskesmas Induk dan Pustu )
Mengetahui

Nip. 19670629 198703 2 008 Nip Nrpk: 19.7.0505817
(LPLPO)

Nama Puskesmas : Puskesmas Hunduhon
Kecamatan :
Kabupaten : Banggai Bulan : November
Propinsi : Sulawesi Tengah Tahun 2,020
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

1 Ambroxol Tab 2,000 2,000 400 1600 15 - 7 108 40 1052
3 Acyclovir Tab 400 mg Tab 600 500 1,100 1100 - - 7 - - 1100
7 Amoxicillin Caps 500 mg / Pehamoxyl 500 Tab 9,600 10,000 19,600 2,200 17400 85 - 7 592 220 14388
9 Amlodipine 5 Mg Tab 6,900 6,000 12,900 690 12210 27 - 7 186 69 11265
10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab - - 0 - - 7 - - 0
12 Antasida Doen Tab Kombinasi Tab 7,700 7,700 7700 - - 7 - - 7700
14 Asam Ascorbat (Vit C) Tab 50 mg Tab - 14,000 14,000 400 13600 15 - 7 108 40 13052
15 Asam Mefenamat Tab 500 mg Tab 1,500 1,500 1500 - - 7 - - 1500
16 Betahistin Tb Tab 1,400 3,600 5,000 100 4900 4 - 7 27 10 4763
17 Calsium Laktat (Calk) Tab 500 mg Tab 700 700 500 200 19 - 7 135 50 485
28 Clonidine Tab - - 0 - - 7 - - 0
35 Domperidome ( @100 = @50 ) Tab 3,000 7,000 10,000 1,100 8900 42 - 7 296 110 7394
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
38 Fitomenadion (Vit K) Tab Salut 10 mg Tab - 500 500 50 450 2 - 7 13 5 382

47 Ibuprofen Tab 400 mg Tab 4,000 4,000 1,200 2800 46 - 7 323 406 2025
56 Metform Tb Tab - - 0 - - 7 - - 0
61 Natrium Diklofenak Tab 50 mg Tab - 8,400 8,400 550 7850 21 - 7 148 186 7495
62 Nifedipin Tab 10 mg Tab 30 30 30 0 1 - 7 8 10 19
64 Omeprasole Tab - - 0 - - 7 - - 0
68 Piridoxyn HCl Tab 10 mg Tab 4,000 7,000 11,000 400 10600 15 - 7 108 135 10342
69 Prednison Tab 5 mg Tab 10,000 20,000 30,000 2,600 27400 100 - 7 700 880 25720
78 Selviplex Tab - - 0 - - 7 - - 0
79 Simvastatin Tab 3,360 5,940 9,300 9300 - - 7 - - 9300
80 Tablet Tambah Darah Tab - - 0 - - 7 - - 0
85 Vitamin B Compleks Tab Tab 3,900 10,000 13,900 1,800 12100 69 - 7 485 609 10937
86 Zink Tab - - 0 - - 7 - - 0
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
0
87 Ambroxol Sy Btl 105 105 15 90 1 - 7 4 5 80
88 Amoxicillin Syrup Kering 125 mg / 5 ml Btl 400 400 94 306 4 - 7 25 32 245
90 Antasida Doen Susp Kombinasi Btl - 300 300 20 280 1 - 7 5 7 267
94 Cefadroxil Syr Btl - 100 100 100 - - 7 - - 100
101 Multivit Syr Btl - - 0 - - 7 - - 0
105 Pyrantel Syr Btl - - 0 - - 7 - - 0
106 Zinc Syr Btl 102 100 202 26 176 1 - 7 7 9 159
0
112 Cefotaxim 1 g Inj Amp - - 0 - - 7 - - 0
114 Cyanocobalamin (Vit B12) Inj 500 mg / ml Amp 395 100 495 495 - - 7 - - 495
116 Diazepam Inj Amp - - 0 - - 7 - - 0
119 Fitomenadion (Vit K) Inj 10 mg - 1 ml Amp 90 210 300 15 285 1 - 7 4 5 275
121 Glukosa Lar Infus 5% Steril Amp - 60 60 60 - - 7 - - 60
122 KA EN 3B Amp - - 0 - - 7 - - 0
124 Lidocain Comp. Inj/Pehacain Inj. Amp 223 150 373 54 319 2 - 7 15 18 284
128 Natrium Klorida 0,9% Larutan Infus Steril Amp 92 100 192 192 - - 7 - - 192
SK SWK SWT
Sisa Stok Opt
136 Vit B1, B6, B12 Inj Amp - - 0 - - 7 - - 0
0
138 AntiHemoroid Doen Kombinasi Tub 120 50 170 170 - - 7 - - 170
139 Antifungi SK Tub - 96 96 96 - - 7 - - 96
140 Betametason Cream 0,1% (25 Tube) Tub 229 400 629 20 609 1 - 7 5 7 596
141 Chloramphenicol Salep Kulit 1% (24 tube) Tub - 288 288 288 - - 7 - - 288
151 Mikonazole Sk Btl - 192 192 192 - - 7 - - 192
154 Oxytetracyklin HCl Salep Mata (@25) Tub - 100 100 100 - - 7 - - 100
158 Salep 2-4 Kombinasi Tub - 120 120 120 - - 7 - - 120
160 Scabimite Tub - - 0 - - 7 - - 0
BMHP 0
161 Alat Suntik Sekali Pakai 1 ml Pcs - - 0 - - 7 - - 0
165 Catgut/Benang Bedah no 2/0-3/0 (chromic) Pcs 41 41 41 - - 7 - - 41
catgut/benan bedah plain 48 48 14 34
166 Canula Anak Pcs - - 0 - - 7 - - 0
169 Etanol 70 % Pcs 25 25 2 23 0 - 7 1 1 22
170 FM Crepe 7,5 cm x 4,55 m Pcs - - 0 - - 7 - - 0
171 FM Crepe 10 cm x 4,55 m Pcs - - 0 - - 7 - - 0
172 Folly Cath 18 Pcs - - 0 - - 7 - - 0
173 Folly Cath 20 Pcs - - 0 - - 7 - - 0
174 Handscoon 7 Pcs 175 175 75 100 3 - 7 20 25 52
Handscoon L Pcs - - 0 - - 7 - - 0
Handscoon M Pcs - - 0 - - 7 - - 0
177 i.v. Cathether 18 G Pcs - - 0 - - 7 - - 0
178 i.v. Cathether 20 G Pcs 141 141 141 - - 7 - - 141
i.v. Cathether 26 G 100 100 100 - - 7 - - 100
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

188 Kasa 40 x 80 Btl 4 4 1 3 0 - 7 0 0 2
189 LISOL Rol 2 2 1 1 0 - 7 0 0 0
190 Masker Rol - - 0 - - 7 - - 0
Masker - - 0 - - 7 - - 0
191 Poligyp 5 cm x 2,7 m Pcs - - 0 - - 7 - - 0
192 Polifix 5 cm x 1 m Pcs 20 20 2 18 0 - 7 1 1 17
193 Poliband Btl - - 0 - - 7 - - 0
198 NGT Pcs - - 0 - - 7 - - 0
199 Urine bag Pcs 10 10 10 - - 7 - - 10
200 Aqua Gell Pcs - - 0 - - 7 - - 0
201 Catejeel Pcs - - 0 - - 7 - - 0
202 Scalvien Pcs - - 0 - - 7 - - 0
203 Do Care Wash Gloves Antiseptic Pcs 22 22 22 - - 7 - - 22
204 Feding Tube Pcs 2 2 2 - - 7 - - 2
Feding Tube Pcs 2 2 2 - - 7 - - 2
Feding Tube Pcs 2 2 2 - - 7 - - 2
Feding Tube Pcs 1 1 1 - - 7 - - 1
205 IV Cath 18 Pcs - - 0 - - 7 - - 0
Pcs - - 0 - - 7 - - 0
Tambahan : Pcs - - 0 - - 7 - - 0
Pcs - - 0 - - 7 - - 0
206 Bisacodyl Supp 5 mg Pcs 15 15 15 - - 7 - - 15
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
210 Miniaspi Pcs - - 0 - - 7 - - 0

219 Amoxicillin 250 Pcs - - 0 - - 7 - - 0
As Folat 10 Mg - - 0 - - 7 - - 0
Canula Infant 55 55 55 - - 7 - - 55
ceftriaxone 1g inj - - 0
fixomull - - 0
livron - - 0
dulcolax 42 42 0 42
Mengetahui -

Nip. 19670629 198703 2 008 Nip Nrpk: 19.7.0505817
Kolom p Jelas
Format : 2




37 Etanol 70 % Tub - - - - 0
BMHP
Tanbahan
a
b
c
d
e
f
g
Format : 3
Format : 4
D Program P2P
Diare
1 Zink Tab - - 0
2 Oralit Tab 1,600 1,600 400 1200
Imunisasi
1 BCG Amp - - 0
3 DT Amp - - 0
4 HB o Amp - - 0
5 IPV Amp - - 0
6 TD Amp - - 0
7 POLIO Amp - - 0
8 MR Amp - - 0
- - 0
10 ASSP 005 ml Pcs - - 0
TB paru
HIV/ Kusta
Kecacingan
14 DEC Tab - - 0
Rabies
Malaria
18 ACT Tab - - 0
Format 5

Informasi
a b c d d e f a b
1 11/1/2020 1 - - - 1 pustu louk 21.0 - - 0
2 11/2/2020 13 8 - - - 2 pustu transpohi 23.0 - - 0
4 11/4/2020 12 2 - - - 4 pustu molino 34.0 - - 0
5 11/5/2020 11 1 - - - 5 polindes indangsari 16.0 - - 0
6 11/6/2020 6 4 - - - 6 pustu lontos 21.0 - - 0
7 11/7/2020 7 1 - - - 7 - - - - 0
8 11/8/2020 5 - - - 8 - - - - 0
9 11/9/2020 10 5 - - - 9 - - - - 0
10 11/10/2020 9 4 - - - 10 - - - - 0
11 11/11/2020 12 4 - - - 11 - - - - 0
12 11/12/2020 4 2 - - - 12 - - - - 0
13 11/13/2020 6 2 - - - 13 - - - - 0
14 11/14/2020 5 - - - 14 - - - - 0
15 11/15/2020 1 - - - 15 - - - - 0
16 11/16/2020 6 1 - - - 16 - - - - 0
17 11/17/2020 9 1 - - - 17 - - - - 0
18 11/18/2020 10 7 - - - 18 - - - - 0
19 11/19/2020 8 2 - - - 19 - - - - 0
20 11/20/2020 9 6 - - - 20 - - - - 0
21 11/21/2020 7 5 - - - Jumlah B 153.0 - - 0
22 11/22/2020 5 - - -
23 11/23/2020 15 1 - - - Total A + B 329 185 - 482
24 11/24/2020 15 4 - - -
25 11/25/2020 10 2 - - -
26 11/26/2020 10 9 - - - Ket : Kolom a. jelas
27 11/27/2020 5 4 - - - Kolom b. Jelas
29 11/29/2020 1 - - - Kolom e. Penderita yang minta penjelasan secara det
(LPLPO)

Nama Puskesmas : PUSKESMAS HUNDUHON
Puskesmas pembantu Yag Ada : 13 Yang Lapor :3
Kabupaten : Banggai Bulan : DESEMBER
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

1 Ambroxol Tab 1,000 1,000 400 600 15 - 7 108 40 52
3 Acyclovir Tab 400 mg Tab 1,100 1,100 1100 - - 7 - - 1100
10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab - - 0 - - 7 - - 0
15 Asam Mefenamat Tab 500 mg Tab 1,500 1,500 500 1000 19 - 7 135 50 315
17 Calsium Laktat (Calk) Tab 500 mg Tab 200 200 200 0 8 - 7 54 20 274
23 Chlorpheniramin Maleat (CTM) Tab 4 mg Tab 1,500 1,500 800 700 31 - 7 215 80 395
28 Clonidine Tab - - 0 - - 7 - - 0
32 Dexametason Tab 0,5 mg Tab 1,900 1,900 900 1000 35 - 7 242 90 232
35 Domperidome ( @100 = @50 ) Tab 8,900 8,900 300 8600 12 - 7 81 30 8189
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

47 Ibuprofen Tab 400 mg Tab 2,800 0 - - 7 - - 0
48 Isosorbid Dinitrat Tab 5 mg Tab 300 300 300 0 12 - 7 81 102 194
56 Metform Tb Tab - - 0 - - 7 - - 0
61 Natrium Diklofenak Tab 50 mg Tab 7,850 7,850 1,050 6800 40 - 7 283 355 6122
62 Nifedipin Tab 10 mg Tab - - 0 - - 7 - - 0
64 Omeprasole Tab - - 0 - - 7 - - 0
69 Prednison Tab 5 mg Tab 27,400 27,400 2,300 25100 88 - 7 619 778 23614
73 Pyrantel HCl Tab 125 mg Tab 500 500 500 - - 7 - - 500
78 Selviplex Tab - - 0 - - 7 - - 0
79 Simvastatin Tab 9,300 9,300 400 8900 15 - 7 108 135 8642
80 Tablet Tambah Darah Tab - - 0 - - 7 - - 0
83 Thiamin HCl Monotartrat (Vit B1) Tab 50 mg Tab 800 800 300 500 12 - 7 81 102 306
86 Zink Tab - - 0 - - 7 - - 0
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
0
87 Ambroxol Sy Btl 90 90 10 80 0 - 7 3 3 74
88 Amoxicillin Syrup Kering 125 mg / 5 ml Btl 306 306 15 291 1 - 7 4 5 281
99 Ibuprofen Syr Btl - - 0 - - 7 - - 0
101 Multivit Syr Btl - - 0 - - 7 - - 0
105 Pyrantel Syr Btl - - 0 - - 7 - - 0
106 Zinc Syr Btl 176 176 15 161 1 - 7 4 5 151
- 0
108 Aminopyllin Inj Amp 38 38 2 36 0 - 7 1 1 35
112 Cefotaxim 1 g Inj Amp - - 0 - - 7 - - 0
116 Diazepam Inj Amp - - 0 - - 7 - - 0
117 Diphenhydramin HCl Inj 10 mg / ml - 1 ml Amp - - 0 - - 7 - - 0
121 Glukosa Lar Infus 5% Steril Amp 60 60 2 58 0 - 7 1 1 57
122 KA EN 3B Amp - - 0 - - 7 - - 0
SK SWK SWT
Sisa Stok Opt
135 Thiamin HCl (Vit B1) Inj 100 mg / ml - 1 ml Amp - - 0 - - 7 - - 0
136 Vit B1, B6, B12 Inj Amp - - 0 - - 7 - - 0
0
138 AntiHemoroid Doen Kombinasi Tub 170 170 20 150 1 - 7 5 7 137
139 Antifungi SK Tub 96 96 96 - - 7 - - 96
151 Mikonazole Sk Btl 192 192 48 144 2 - 7 13 16 113
154 Oxytetracyklin HCl Salep Mata (@25) Tub 100 100 25 75 1 - 7 7 8 59
160 Scabimite Tub - - 0 - - 7 - - 0
BMHP 0
161 Alat Suntik Sekali Pakai 1 ml Pcs - - 0 - - 7 - - 0
catgut/benang bedah plain 34 34 17 17 1 -
166 Canula Anak Pcs - - 0 - - 7 - - 0
167 Canula dewasa Pcs - - 0 - - 7 - - 0
168 E-Care Alcohol Swab Pcs 5,400 5,400 1,100 4300 42 - 7 296 372 3589
169 Etanol 70 % Pcs 23 23 6 17 0 - 7 2 2 13
170 FM Crepe 7,5 cm x 4,55 m Pcs - - 0 - - 7 - - 0
171 FM Crepe 10 cm x 4,55 m Pcs - - 0 - - 7 - - 0
172 Folly Cath 18 Pcs - - 0 - - 7 - - 0
173 Folly Cath 20 Pcs - - 0 - - 7 - - 0
174 Handscoon 7 Pcs 100 100 100 - - 7 - - 100
Handscoon L Pcs - - 0 - - 7 - - 0
Handscoon M Pcs - - 0 - - 7 - - 0
177 i.v. Cathether 18 G Pcs - - 0 - - 7 - - 0
i.v. Cathether 26 G 100 100 23 77 1 - 7 6 8 62
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)

188 Kasa 40 x 80 Btl 3 3 1 2 0 - 7 0 0 1
189 LISOL Rol 1 1 1 - - 7 - - 1
190 Masker Rol - - 0 - - 7 - - 0
Masker - - 0 - - 7 - - 0
191 Poligyp 5 cm x 2,7 m Pcs - - 0 - - 7 - - 0
192 Polifix 5 cm x 1 m Pcs 18 18 2 16 0 - 7 1 1 15
193 Poliband Btl - - 0 - - 7 - - 0
198 NGT Pcs - - 0 - - 7 - - 0
199 Urine bag Pcs 10 10 10 - - 7 - - 10
200 Aqua Gell Pcs - - 0 - - 7 - - 0
201 Catejeel Pcs - - 0 - - 7 - - 0
202 Scalvien Pcs - - 0 - - 7 - - 0
203 Do Care Wash Gloves Antiseptic Pcs 22 22 22 - - 7 - - 22
204 Feding Tube Pcs 2 2 2 - - 7 - - 2
Feding Tube Pcs 2 2 2 - - 7 - - 2
Feding Tube Pcs 2 2 2 - - 7 - - 2
Feding Tube Pcs 1 1 1 - - 7 - - 1
205 IV Cath 18 Pcs - - 0 - - 7 - - 0
Pcs - - 0 - - 7 - - 0
Tambahan : Pcs - - 0 - - 7 - - 0
Pcs - - 0 - - 7 - - 0
206 Bisacodyl Supp 5 mg Pcs 15 15 15 - - 7 - - 15
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
210 Miniaspi Pcs - - 0 - - 7 - - 0

219 Amoxicillin 250 Pcs - - 0 - - 7 - - 0
As Folat 10 Mg tab - - 0 - - 7 - - 0
Canula Infant pcs 55 55 55 - - 7 - - 55
ceftriaxone 1g inj btl - - 0
fixomull roll - - 0
livron tab - - 0
dulcolax supp 42 42 42
Phenol glycerin 10 % amp 72 72 72
Mengetahui

Nip. 19670629 198703 2 008 Nip Nrpk: 19.7.0505817
Kolom p Jelas
Format : 2




37 Etanol 70 % Tub - - - - 0
BMHP
Tanbahan
a
b
c
d
e
f
g
Format : 3
Format : 4
D Program P2P
Diare
1 Zink Tab - - 0
2 Oralit Tab 1,200 1,200 1200
Imunisasi
1 BCG Amp - - 0
3 DT Amp - - 0
4 HB o Amp - - 0
5 IPV Amp - - 0
6 TD Amp - - 0
7 POLIO Amp - - 0
8 MR Amp - - 0
- - 0
10 ASSP 005 ml Pcs - - 0
TB paru
HIV/ Kusta
Kecacingan
14 DEC Tab - - 0
Rabies
Malaria
18 ACT Tab - - 0
Format 5

Informasi
a b c d d e f a b
1 12/1/2020 5 1 - - - 1 polindes lontos 20.0 - - 0
3 12/3/2020 5 3 - - - 3 - - 0
4 12/4/2020 5 2 - - - 4 - - - - 0
5 12/5/2020 5 1 - - - 5 - - - - 0
6 12/6/2020 2 - - - 6 - - - - 0
7 12/7/2020 10 3 - - - 7 - - - - 0
8 12/8/2020 14 2 - - - 8 - - - - 0
9 12/9/2020 10 5 - - - 9 - - - - 0
10 12/10/2020 4 2 - - - 10 - - - - 0
11 12/11/2020 7 1 - - - 11 - - - - 0
12 12/12/2020 3 3 - - - 12 - - - - 0
13 12/13/2020 1 - - - 13 - - - - 0
14 12/14/2020 10 3 - - - 14 - - - - 0
15 12/15/2020 12 2 - - - 15 - - - - 0
16 12/16/2020 6 5 - - - 16 - - - - 0
17 12/17/2020 11 7 - - - 17 - - - - 0
18 12/18/2020 9 5 - - - 18 - - - - 0
19 12/19/2020 7 4 - - - 19 - - - - 0
20 12/20/2020 4 - - - 20 - - - - 0
21 12/21/2020 18 3 - - - Jumlah B 44.0 - - 0
22 12/22/2020 12 - - -
23 12/23/2020 12 2 - - - Total A + B 347 - - 0
24 12/24/2020 - 3 - - -
25 12/25/2020 - 1 - - -
26 12/26/2020 10 4 - - - Ket : Kolom a. jelas
27 12/27/2020 9 6 - - - Kolom b. Jelas

Puskesmas Hunduhon 2020

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Puskesmas Hunduhon 2020

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Format Tersedia

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

Kode Puskesmas : Format : 1

A Dana Alokasi Khusus (DAK)

38 Fitomenadion (Vit K) Tab Salut 10 mg Tab 500 500 50 450 2 - 7 13 5 382

181 Kapas Pembalut/Adsorben 100 g Rol 9 9 1 8 0 - 7 0 0 7

210 Miniaspi Tab - - 0 - - 7 0

( MARTINA LUMENTERI) (......................................................................................) (GEDE YOGI PRANA W., S.Farm)

1 Acyclovir Tab 400 mg Tab - - - - 0

24 Cotrimoksazol Susp Btl - - - - 0

28 Aqua Pro Injeksi Steril Bebas Pirogen Amp - - - - 0

35 AntiHemoroid Doen Kombinasi Tub - - - - 0

( MARTINA LUMENTERI) (......................................................................................) (GEDE YOGI PRANA W., S.Farm)

( MARTINA LUMENTERI) (......................................................................................) (GEDE YOGI PRANA W., S.Farm)

(.................................................................................) (..........................................................................) (...............................................................................)

Jenis Pelayanan Resep Jenis Pelayanan Resep

Kode Puskesmas : Format : 1

A Dana Alokasi Khusus (DAK)

181 Kapas Pembalut/Adsorben 100 g Rol 8 8 8 - - 7 - - 8

( MARTINA LUMENTERI) (......................................................................................) (GEDE YOGI PRANA W., S.Farm)

Kolom n Jumlah volume penggunaan selama 1 (satu) bulan dikali 10 %

1 Acyclovir Tab 400 mg Tab - - - - 0

24 Cotrimoksazol Susp Btl - - - - 0

28 Aqua Pro Injeksi Steril Bebas Pirogen Amp - - - - 0

35 AntiHemoroid Doen Kombinasi Tub - - - - 0

Kepala Puskesmas Hunduhon Pengelola Obat Puskesmas Hunduhon

( MARTINA LUMENTERI) (......................................................................................) (GEDE YOGI PRANA W., S.Farm)

( MARTINA LUMENTERI) (......................................................................................) (GEDE YOGI PRANA W., S.Farm)

LAPORAN BULANAN KEFARMASIAN

Jenis Pelayanan Resep Jenis Pelayanan Resep Informasi

( MARTINA LUMENTERI) (......................................................................................) (GEDE YOGI PRANA W., S.Farm) :

Kode Puskesmas : Format : 1

38 Fitomenadion (Vit K) Tab Salut 10 mg Tab 350 - 350 - 350 - - 7 - - 350

181 Kapas Pembalut/Adsorben 100 g Rol 8 8 8 - - 7 - - 8

( MARTINA LUMENTERI) (......................................................................................) (GEDE YOGI PRANA W., S.Farm)

( MARTINA LUMENTERI) (......................................................................................) (GEDE YOGI PRANA W., S.Farm)

( MARTINA LUMENTERI) (......................................................................................) (GEDE YOGI PRANA W., S.Farm)

(.................................................................................) (............................................................) (..................................................................)

LAPORAN BULANAN KEFARMASIAN Format 5

Jenis Pelayanan Resep Informasi

( MARTINA LUMENTERI) (......................................................................................) (GEDE YOGI PRANA W., S.Farm)

Kode Puskesmas : Format : 1

A Dana Alokasi Khusus (DAK)

38 Fitomenadion (Vit K) Tab Salut 10 mg Tab 350 350 - 350 - - 7 - - 350

181 Kapas Pembalut/Adsorben 100 g Rol 8 8 8 - - 7 - - 8

211 multivitamin (LVB) - 0 - - - 7 - - 0

(.....................................................) (.............................................................) (.........................................................)

1 Acyclovir Tab 400 mg Tab - - 0 - -

24 Cotrimoksazol Susp Btl - - 0 - -

28 Aqua Pro Injeksi Steril Bebas Pirogen Amp - - 0 - -

35 AntiHemoroid Doen Kombinasi Tub - - 0 - -

Jenis Pelayanan Resep Jenis Pelayanan Resep

Kode Puskesmas : Format : 1

A Dana Alokasi Khusus (DAK)

38 Fitomenadion (Vit K) Tab Salut 10 mg Tab 350 350 - 350 - - 7 - - 350

181 Kapas Pembalut/Adsorben 100 g Rol 8 8 8 - - 7 - - 8

(.....................................................) (.............................................................) (.........................................................)

1 Acyclovir Tab 400 mg Tab - - - - 0

24 Cotrimoksazol Susp Btl - - - - 0

28 Aqua Pro Injeksi Steril Bebas Pirogen Amp - - - - 0

35 AntiHemoroid Doen Kombinasi Tub - - - - 0

Jenis Pelayanan Resep Jenis Pelayanan Resep

Kode Puskesmas Format : 1

A Dana Alokasi Khusus (DAK)