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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

KABUPATEN : LANDAK
PUSKESMAS : PUSKESMAS KARANGAN
BULAN/TAHUN : JANUARI / 2023

OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
1 Acyclovir 400mg Tablet 600 600 - 600
2 Acyclovir Salep Tube 100 100 - 100
3 Albendazole 400 mg Tablet 800 800 - 800
4 Albendazole Suspensi Botol - -
5 Allopurinol 100 mg Tablet 5200 5,200 500 4,700
6 Allopurinol 300 mg Tablet 6300 6,300 500 5,800
7 Alprazolam 0,5 mg Tablet 775 775 775 - 500
8 Alprazolam 1 mg Tablet 690 690 185 505 500
9 Ambroxol 30 mg tab Tablet 1900 1,900 1,900 - 10,000
10 Ambroxol Syrup Botol - -
11 Aminofilin injeksi 24 mg/ml Ampul - -
12 Amitriptillin 25 mg Tablet - -
13 Amlodipin Tab 10 mg Tablet 7500 7,500 3,700 3,800 2,000
14 Amlodipin Tab 5 mg Tablet 6500 6,500 1,900 4,600 2,000
15 Amoxicillin 100 mg/ml Drops Botol 138 138 138 - 100
16 Amoxicillin 500 mg Tablet 4400 4,400 2,000 2,400 5,000
17 Amoxicillin dry syrup 125 mg / 5 ml Botol 411 411 411 - 100
18 Ampicillin injeksi Ampul 240 240 10 230
19 Antasida DOEN Kombinasi Tablet 6900 6,900 6,300 600 10,000
20 Antasida DOEN Syrup Botol - -
21 Antifungi DOEN Kombinasi Tube 83 83 5 78
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
22 Antihemoroid DOEN Kombinasi Supp 40 40 4 36
23 Apricot Syrup Botol 35 35 - 35
24 Asam Ascorbat (Vit c) Tab 50 mg Tablet 13400 13,400 4,300 9,100 5,000
25 Asam asetilsalisilat (Miniaspi 80 mg) Tablet - -
26 Asam Mefenamat 500 mg Tablet 8300 8,300 2,900 5,400 1,000
27 Asam Tranexamat inj 100 mg/ml Ampul 90 90 - 90
28 Asam Tranexamat inj 50 mg/ml Ampul 80 80 10 70
29 Asering Infuse 500 ml Kolf - -
30 Atropin sulfat injeksi 0,25 mg/mil -1 ml Ampul 94 94 - 94
31 Betahistine Besilat 6 mg Tablet - -
32 Betametason cream 0,1 % Tube 149 149 - 149
33 BIOSAT 1.500 (anti tetanus) Vial - -
34 BIOSAVE (anti bisa ular) VIAL 1 1 1 -
35 Bisoprolol 5 mg Tablet 870 870 - 870
36 Bufacetin salep kulit 1% Tube 120 120 29 91
37 Calcii Glukonas Inj Ampul 42 42 42
38 Captopril 12,5 mg Tablet 2100 2,100 1,100 1,000 1,000
39 Captopril 25 mg Tablet 2400 2,400 100 2,300
40 Cefadroxil 250 mg Tablet - -
41 Cefadroxil 500 mg Tablet 2600 2,600 900 1,700 2,000
42 Cefadroxil Dry Syrup 125 mg Botol 360 360 - 360
43 Cefotaxime Injeksi 1 gr Vial - - 100
44 Ceftriaxon Inj 1000 mg Vial 100 100 30 70 100
45 Cetirizin 10 mg tab Tablet 6500 6,500 3,700 2,800
46 Cetirizin Syrup Botol 135 12 147 - 147
47 Chloramfenicol 250 mg Capsul - -
48 Chloramfenicol 500 mg Capsul - -
49 Chloramfenicol tetes telinga Botol - -
50 Chlorfeniramin Maleat 4 mg (CTM) Tablet 12800 12,800 4,000 8,800 2,000
51 Chlorpromazine 100 mg Tablet 70 70 60 10 500
52 Chlorpromazine 25mg Tablet 1390 1,390 180 1,210
53 Ciprofloxacin 500 mg Tablet 3300 3,300 700 2,600
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
54 Clindamicin 150 mg Capsul - - 5,000
55 Clozapin 100 mg Tablet 265 265 265 - 2,000
56 Clozapin 25 mg Tablet - - 2,000
57 Codein hcl Tablet 10 mg Tablet - -
58 Combivent Nebules Vial - -
59 Cotrimoxazole 480mg Tablet - - 2,000
60 Cotrimoxazole 960 mg Tablet - - 2,000
61 Cotrimoxazole sirup Botol - -
62 Desoximetasone Krim 0.25% Tube 34 34 6 28
63 Dexamethason Tab 0,5 mg Tablet 5300 5,300 5,300 - 10,000
64 Dexamethasone injeksi 5 mg/ml - 1 ml Ampul 190 190 - 190
65 Dextrose monohydrat 40% Flacon 28 28 28 - 20
66 Diabetadex Fitofarmaka Tablet 210 210 - 210
67 Diazepam injeksi 5 mg / 2 ml Ampul 0 - - - 20
68 Diazepam Tablet 5 mg Tablet 170 170 15 155 500
69 Digoxin tablet 0,25 mg Tablet - -
70 Diltiazem HCL Tablet 30 mg Tablet 800 800 - 800
71 Dimenhidrinat 50 mg Tablet 500 500 100 400
72 Diphenhydramin HCl injeksi 10 mg/ml-1 ml Ampul 30 30 30 -
73 Domperidon Tablet Tablet 2400 2,400 500 1,900 1,000
74 Epineprin HCl (adrenalin ) inj 0,1 % - 1 ml Ampul 99 99 1 98
75 Ergotamin Coffein Tablet - -
76 Febrinex Ped Suspensi 60 ml Botol - -
77 Fenol Gliserol Tetes Telinga 10% Botol 34 34 1 33
78 Fitomenadion (Vit K) Injeksi 2 mg Ampul 300 300 - 300
79 Fitomenadion (Vit K) Tablet Salut 10 mg Tablet 500 500 100 400 500
80 Flutamol Syr Botol - -
81 Flutamol Tab Tablet - - 10,000
82 Furosemid 10 Mg/ml Injeksi Ampul 150 150 - 150
83 Furosemid Tablet 40 mg Tablet 1000 1,000 200 800
84 Garam Oralit 200 mg Bungkus 580 580 180 400
85 Gentamicin Salep Mata 0,3% Tube - -
86 Gentamicin Tetes Mata 0,3% Tube 192 192 30 162 100
87 Glibenklamid Tablet 5 mg Tablet 2400 2,400 400 2,000 1,000
88 Glukosa 10% Infus Kolf - -
89 Glukosa 5% Infus Kolf - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
90 Griseolfulvin Tablet 125 mg Micronized Tablet 800 800 100 700
91 Haloperidol 0,5 mg Tablet 196 196 196 - 500
92 Haloperidol 1,5 mg Tablet - -
93 Haloperidol 5 mg Tablet 1360 1,360 305 1,055 500
94 Herbakof Syrup Botol - -
95 Herbakof Tablet Tablet 2820 2,820 2,400 420
96 Herbapain (OHT) Obat Anti Nyeri Tablet Tablet 600 600 - 600
97 Herbavomitz obat herbal Botol - -
98 Herbavomitz Tablet Tablet 630 630 60 570
99 Hidroklorotiazid (HCT) Tablet 25 mg Tablet - -
100 Hidrokortison Krim 2,5% Tube 144 144 48 96
101 Ibuprofen (Zentarin) Tablet 400 mg Tablet 4100 4,100 400 3,700
102 Ibuprofen Suspensi 100 mg/ 5 ml Botol - -
103 Ibuprofen Suspensi 200 mg/ 5 ml Botol 116 116 - 116
104 Iliadin Drop Tetes Hidung Botol - -
105 Imunomodulator anak Syr 25 mg Botol 5 5 1 4
106 Imunomodulator Forte 50 mg Tablet 810 810 - 810
107 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet 400 400 - 400 500
108 KA EN 3A Kolf 8 8 - 8
109 KA EN 3B Kolf 35 35 3 32
110 Kalsium Laktat (kalk) Tablet 500 mg Tablet 10600 10,600 4,500 6,100 10,000
111 Karbamazepin 200 mg Tablet 1485 1,485 125 1,360
112 Ketoconazole 200 mg Tablet 2500 2,500 1,100 1,400
113 Ketoconazole Zalp Tube - - 100
114 Ketorolac Inj 30mg/ml Ampul 150 150 50 100
115 Lactulosa Syr 3,335 g/5ml (Kompolax) Botol 54 7 61 - 61
116 Lansoprazole Tablet 30mg Tablet 2700 2,700 200 2,500
117 Lidocain (HCI) 2 % 2 ml Injeksi Ampul 144 144 44 100 100
118 Lidocain (HCI) 2% + Epinefrin 2 mg Ampul - - - - 150
119 Loperamide 2 mg Tablet 4000 4,000 100 3,900
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
120 Loratadine tab Tablet 2500 2,500 - 2,500
121 Magnesium sulfat 20% (MgSO4) Ampul - -
122 Magnesium sulfat 40% (MgSO4) Ampul 19 19 - 19 10
123 Maltiron Syr 60 ml Botol - -
124 Mersibion Inj Ampul 90 90 30 60 100
125 Metformin HCl 500 mg Tablet 2800 2,800 1,400 1,400 5,000
126 Metilergometrin Inj 0,2 mg/ml Ampul 500 500 500 -
127 Metilergometrin maleat Tab 0,125 mg Tablet - -
128 Metilprednisolon 16 mg Tablet 2800 2,800 300 2,500
129 Metilprednisolon 4 mg Tablet 2500 2,500 1,000 1,500 2,000
130 Metilprednisolon 8 mg Tablet 2300 2,300 500 1,800
131 Metoklorpamide Tablet 10 mg Tablet - - 1,000
132 Metoklorpamide Tablet 5 mg Tablet 600 600 600 - 1,000
133 Metronidazol Tab 500mg Tablet 2200 2,200 800 1,400 1,000
134 Metronidazole Infus Kolf 10 10 - 10
135 Metronidazole Suspensi 125mg/5ml Botol 66 66 (4) 70
136 Metyldopa (Dopamet) 250 mg Tablet 100 100 - 100 500
137 Miconazole krim 2 % Tube 72 72 15 57 72
138 Mineral Mix Bungkus - - 100
139 Multivitamin Becefort Tablet - - 1,000
140 Multivitamin Becefort Syr 60 ml Botol - -
141 Multivitamin Natabion Dws Capsul - -
142 Multivitamin Oxyvit Tablet - - 1,000
143 Natrium Diklofenak tab 25 mg Tablet 4300 4,300 3,100 1,200 5,000
144 Natrium Diklofenak tab 50 mg Tablet 4000 4,000 1,200 2,800 5,000
145 Natrium Klorida 0,9% OTSU Botol 140 140 40 100 40
146 Nifedipin 10 Mg Tablet 600 600 - 600
147 Nistatin 100.000 IU tab vaginal Tablet 97 97 7 90
148 Nistatin 500.000 IU Tablet 400 400 - 400
149 Nistatin suspensi 100.000 IU/mL Botol 100 100 - 100
150 Noza Kaplet Kaplet - - 10,000
151 OBH Kaca Berlico 100ml Botol - -
152 Ofloxacin 200 mg Tablet - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
153 Oksimetazolin tetes hidung 0,05% Botol 33 33 - 33
154 Oksitetrasiklin HCl 1 % zalp mata Tube - -
155 Oksitosin Inj 10 IU/ml Ampul 500 500 100 400
156 Omeprazole caps (Lokev) Capsul - -
157 Ondansentron Injeksi Ampul 275 275 125 150 200
158 Ondansentron Tab 4 mg Tablet 300 300 300 - 500
159 Parasetamol Drops Botol - -
160 Parasetamol Infus btl 10 10 - 10
161 Parasetamol sirup 120mg/5ml Botol 451 6 457 - 457
162 Parasetamol Tab Tablet 8200 8,200 1,900 6,300 10,000
163 Phenobarbital injeksi 50 mg / 2 ml Ampul - -
164 Piridoksin HCl Tablet 10 mg ( Vit B6 ) Tablet 4000 4,000 800 3,200 2,000
165 Prednison tab 5 mg Tablet 3800 3,800 3,800 - 5,000
166 Procurma Syr Botol - -
167 Propiltiourasil (PTU) tab 100 mg Tablet 200 200 - 200 500
168 Pularex Tablet Tablet 800 800 400 400 500
169 Pyrantel Pamoat 125 mg Tablet - -
170 Pyrantel Pamoat Susp 125mg / 5ml Botol - -
171 Ranitidin 150 mg tab Tablet 3900 3,900 2,200 1,700 2,000
172 Ranitidin Injeksi Ampul - -
173 Retinol 100.000 IU BIRU Caps - -
174 Retinol 200.000 IU MERAH Caps 800 800 100 700
175 Ringer Laktat Infus Botol 760 760 160 600
176 Risperidon 1 mg Tablet - -
177 Risperidon 2 mg Tablet 2194 2,194 900 1,294 500
178 Salbutamol 2 mg Tablet 3300 3,300 700 2,600
179 Salbutamol 4 mg Tablet 3700 3,700 1,000 2,700
180 Salbutamol Cairan inhalasi Ampul - - 100
181 Salbutamol Syrup Botol 224 12 236 - 236
182 Salep 2- 4 kombinasi Tube - -
183 Sianokobalamin (Vit. B12) Tab Tablet 900 900 700 200 2,000
184 Simvastatin Tablet 10 mg Tablet 4300 4,300 300 4,000
185 Simvastatin Tablet 20 mg Tablet 4600 4,600 1,200 3,400
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
186 Soft U Derm 10% Crema 20gr Tube - -
187 Spironolactone 25 mg Tablet - -
188 Stesolid rectal 10 mg / 2,5 ml Tube - -
189 Stesolid rectal 5 mg / 2,5 ml Tube - -
190 Sukralfat Suspensi 500mg/ 5ml Botol 220 220 140 80 300
191 Sulfadoxine-Pyrimethamine (Suldox) Tablet - -
192 Tablet Tambah Darah FE Tablet 10000 10,000 5,400 4,600 5,000
193 Tetagam Inj Vial 3 3 - 3
194 Tetrasiklin 500 mg Tablet - -
195 Thiamin Hcl (Vit B1) Tablet 50 mg Tablet - - 1,000
196 Tramadol Inj Ampul - -
197 Trifluoperazin 5 mg Tablet 3675 3,675 330 3,345
198 Trihexylphenidil 2 mg Tablet 3079 3,079 1,180 1,899 1,000
199 Vitamin B komplek Tablet 11000 11,000 7,400 3,600 10,000
200 Vitamin D3 1000IU Tablet 300 300 90 210
201 Voltadex Gel 1% 20 gr Tube 1 1 1 -
202 Zinc 20 Mg Tablet Tablet 5000 5,000 900 4,100
203 Zinc Syr Botol - -
204 Zincpro Drop 15 ml Botol - -
205 Acetyl cysteine tablet 200 mg Tablet 360 360 - 360
206 Cefotaxime sodium serb inj 500 mg Injeksi - -
207 Cendo Lyteers tetes mata, botol @ 15 ml Botol - -
208 Chloramphenicol salep mata 1 % Tube - -
209 Curcuma Plus 60 mL Botol - -
210 Diazepam enema 10 mg/2,5 mL Tube 20 20 - 20
211 Diazepam enema 5 mg/2,5 mL Tube 20 20 6 14
212 Domperidone drops 5 mg/mL Botol - -
213 Domperidone sirup/suspensi 5 mg/5 ml Botol - -
214 Farbivent cairan inhalasi Ampul 120 120 30 90 100
215 Flamar Natrium diklofenak tetes mata 1 mg/ml Botol - -
216 Glimepiride tablet 2 mg Tablet 1000 1,000 1,000 - 2,000
217 Hidrokortison krim 1% Tube - -
218 Hyaloph Natrium hialuronat tetes mata Botol - -
219 Hyoscine Butylbromide Tab Tablet 1000 1,000 - 1,000
220 Midric 0,5% Tropikamid tts mata 0,5% Botol - -
221 Miniaspi Asam Asetilsalisilat tablet 80 mg Tablet 200 200 200 - 500
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
222 Multivitamin Ferbion Kapsul - -
223 Novadryl Tablet Tablet - -
224 Nuvopec Syrup Botol - -
225 Obat Batuk Hitam Combi Botol 200 200 56 144 100
226 Obat Batuk Hitam Anak Combi Botol 184 184 84 100 100
227 Obat Flu Anak (HUFA) Botol 94 7 101 - 101
228 Obat Flu Kombinasi (Noza) Tablet - -
229 Obat Flu Kombinasi Syrup (Febrinex) Botol - -
230 Octenic Gel 20 g Tube 6 6 - 6
231 Parafen Kaplet Kaplet - -
232 Permetrin Krim 5% Tube 50 50 30 20
233 Propranolol tablet 10 mg Tablet 800 800 100 700
234 Sianokobalamin (vitamin B12) injeksi 500 mcg/m Ampul 100 100 - 100
235 Vip Albumin Obat Herbal Tablet 630 630 - 630
236 Vitamin C 1000mg/ Provit C Tablet 1050 1,050 210 840
- -
BAHAN MEDIS HABIS PAKAI, REAGEN DAN LARUTAN - -
1 Alat Suntik 1 ml Stera Buah - -
2 Alat suntik 1 ml TP Pcs 1100 1,100 - 1,100
3 Alat Suntik 10 cc Stera Buah - -
4 Alat suntik 10 ml TP Pcs - -
5 Alat Suntik 3 cc Stera Buah - -
6 Alat suntik 3 ml TP Pcs 200 200 200 500
7 Alat Suntik 5 cc Stera buah - -
8 Alkohol 1 Liter Onemed Botol 4 4 2 2 5
9 Alkohol 70% 300 ml Botol - -
10 Alkohol swab Aximed Pcs 7300 7,300 1,900 5,400
11 Apron Plastik one Pcs 240 240 60 180 100
12 Aqua proinjeksi steril 20 ml Vial 235 235 35 200 200
13 Arm Sling Comfort L Buah 3 3 - 3
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
14 Arm Sling Comfort S Buah 6 6 - 6
15 Bactivec BTI DBD SL Botol - -
16 Baju APD Coverall Pcs - -
17 Bioplacenton Tulle Pcs - -
18 Blood Lancet Serenity Pcs 1900 1,900 - 1,900
19 Blood transfusion set ABADA Pcs 200 200 - 200
20 Blue Tips Bks 1 1 - 1 5
21 Catgut chromic 3/0 70 cm violet reverse cutting Pcs - -
22 Catgut Chromic Surgical Sutures Pcs 120 120 48 72 72
23 Catgut Plain Surgical Sutures box 96 96 12 84 72
24 Catgut provein 5/0 PV888 45 cm 18 mm Pcs - -
25 Catgut silk 3/0 75 cm 3/8 CC 19 mm Pcs - -
26 Cervical collar Buah - -
27 Derm transport dressing remedi Pcs - -
28 Dermafix S 4,4 x 4,4 cm Buah - -
29 Dermafix S 6 x 7 cm buah - -
30 Dermafix T 15cm x 20 cm Roll - -
31 Dermafix T 5x7 Buah - -
32 Dressing IV canulla non woven remedi Pcs - -
33 Endotracheal Tube (ETT) uk. 6,0 fesco Pcs - -
34 Endotracheal Tube (ETT) uk. 7,0 fesco Pcs - -
35 Endotracheal Tube (ETT) uk. 7,5 fesco Pcs - -
36 Endotracheal Tube (ETT) uk. 8,0 fesco Pcs - -
37 Female Cateter No 16 Aximed Pcs - -
38 Female Cateter No 18 Aximed Pcs - -
39 Foley catheter no. 16 latex 2 way ABADA Pcs 70 70 10 60
40 Pcs 60 60 - 60
Foley catheter no. 18 (2 way standard) serenity
41 Foley catheter no. 18 latex 2 way ABADA Pcs - -
42 - -
Folley catheter uro one 2 way, FR 16, FR 18 Buah
43 Hand Gel H1 100 ml+flip top Botol - -
44 Handrub 5 L Medika Ken - -
45 Handrub 500 ml Medika Botol 62 62 2 60
46 Handrub e-care 500 ml Botol 19 19 3 16
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
47 Handscrub e-care 500 ml Botol - - 50
48 Hazmat suit Winner Pcs - -
49 Indodent Saliva ejector Buah - -
50 Infusion set anak set 100 100 - 100 200
51 Infusion set dewasa ST01 set - - 200
52 Infusion set microdrip ABADA Pcs - -
53 Infusion set microdrip Otsu Pcs 80 80 20 60 100
54 Infusion Set Y Adaptor Otsu Pcs - -
55 IV Catheter No. 18G Cath Pro Pcs 230 230 80 150
56 IV Catheter No. 20G Cath Pro Pcs 100 100 50 50 100
57 IV Catheter No. 20G Otsu Pcs 100 100 100 -
58 IV Catheter No. 22G Cath Pro Pcs - - 100
59 IV Catheter No. 24G Cath Pro Pcs 200 200 50 150 100
60 IV Catheter With Teflon Catheter 1 way 18 G Set - -
61 IV Catheter With Teflon Catheter 1 way 24 G set - -
62 IV Catheter With Teflon Catheter 1 way 26 G set - -
63 IV Catheter WP No. 26G Aximed Pcs 140 140 50 90 100
64 Kantong Jenazah Pcs - -
65 Kantong limbah biohazard uk. L Pack 10 10 9 1 5
66 Kantong limbah biohazard uk. M Pack 17 17 12 5 5
67 Kantong limbah biohazard uk. S Pack 9 9 6 3 5
68 Kapas 250 gram Rol 11 11 3 8 50
69 Kapas 500 gram Bks - -
70 Kasa hidrofil 15 x 4 cm BIOKASA Pcs - -
71 Kasa hidrofil 2 m x 10 cm ABADA Rol - - 100
72 Kasa hidrofil 2 m x 80 cm Roll 10 10 10 - 100
73 Kasa hidrofil 20y x 80 cm ABADA Rol - - 100
74 Kasa hidrofil 36 cm x 80 cm BIOKASA Rol 5 5 5 - 100
75 Kasa hidrofil 4 m x 10 cm Roll - -
76 Kasa hidrofil 4 m x 15 cm Roll - -
77 Kasa hidrofil 4 m x 15 cm ABADA Rol - -
78 Kasa hidrofil 4 m x 3 cm Roll - -
79 Kasa hidrofil 4 m x 5 cm Roll - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
80 Kasa hidrofil 4 m x 7,5 cm ABADA Rol - -
81 Kasa hidrofil 40 cm x 80 cm Rol - -
82 Kasa hidropil 16 cm x 16 cm ABADA Kotak - - 100
83 Kasa Steril 10 cm x 10 cm 16 Ply isi 10 Roll 43 43 43 - 100
84 - -
Kasa Steril 10 cm x 10 cm 16 Ply isi 10 LDX Roll
85 Kasa Steril 16 x 16 cm Roll 320 320 47 273 100
86 Kasa Steril 18 cm x 22 cm Roll - -
87 Rol 5 5 - 5
Kertas EKG 4.5 in (11.4 cm) x 65.6 ft (20 m)
88 Kertas EKG 112 mm Rol - -
89 Kertas EKG Z-fold : 215×280mm Rol - -
90 Latex Examination Gloves Uk. L Pcs - -
91 Latex Examination Gloves Uk. M Pcs 5800 5,800 4,000 1,800 5,000
92 Latex Examination Gloves Uk. S Pcs - -
93 Latex Examination Gloves Uk. XS Pcs - -
94 Masker Ear Loop Pcs - - - 5,000
95 Masker N95 Particulate Respirator unit 165 165 5 160
96 Masker Nebulizer Anak Unit - -
97 Masker Nebulizer Dewasa Unit - -
98 Masker Nebulizer Dewasa Cosmo Pcs - -
99 Masker Nebulizer Uk M Anak ABADA Pcs - -
100 Masker Nebulizer Uk. L Dewasa ABADA Pcs - -
101 Masker Oksigen Adult Serenity Pcs - -
102 Masker Oksigen Anak Semillas Pcs - -
103 Masker Oksigen Dwsa Semillas Pcs 6 6 - 6
104 Masker Oksigen Infant Serenity Pcs
105 Masker Oksigen Pediatric Serenity Pcs 24 24 - 24
106 Maxiflow Anak Unit - -
107 Maxiflow Bayi unit - -
108 Maxiflow Dewasa unit 25 25 - 25
109 Micropipet Adjust Vol. 0,1-2,5 UL Pcs - -
110 Micropipet Adjust Vol. 0,5-10 UL Pcs - -
111 Micropipet Adjust Vol. 100-1.000 UL Pcs - -
112 Micropipet Adjust Vol. 10-100 UL Pcs - -
113 Micropipet Adjust Vol. 200-1.000 UL Pcs - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
114 Micropipet Adjust Vol. 2-20 UL Pcs - -
115 Micropipet Adjust Vol. 50-200 UL Pcs - -
116 Micropipet Adjust Vol. 5-50 UL Pcs - -
117 Micropipet Fixed Vol. 10 UL Pcs - -
118 Micropipet Fixed Vol. 100 UL Pcs - -
119 Micropipet Fixed Vol. 20 UL Pcs - -
120 Micropipet Fixed Vol. 25 UL Pcs - -
121 Micropipet Fixed Vol. 5 UL Pcs - -
122 Micropipet Fixed Vol. 50 UL Pcs - -
123 Micropipet Fixed Vol. 500 UL Pcs - -
124 Mucus Extractor buah - -
125 Mucus Extractor Serenity Pcs 18 18 - 18
126 M-Y Jelly 82 Gram Tube Buah 11 11 5 6 20
127 Nasal Oksigen Canula Anak Pcs - - 200
128 Nasal Oxygen Canula Adult Serenity Pcs - - 500
129 Nasal Oxygen Canula Infant Serenity Pcs - - 100
130 Nasal Oxygen Canula Pediatric Serenity Pcs - -
131 Needle CNV 21 x 1,5 ml (BD vacutainer) Pcs - -
132 Needle CNV 22 x 1,5 ml MLTSMPCE Pcs - -
133 Non Woven IV Dressing 6 x 8 cm Pcs - -
134 Nurse Cap Box 12 12 - 12
135 One Scrub 2% Antiseptic surgical scrub dispense Botol - -
136 One Scrub 4 %, 500 cc + dispenser Botol - - 50
137 Oxyflow Anak Buah 12 12 - 12 100
138 Oxyflow bayi Buah 4 4 - 4 100
139 Oxyflow Dewasa Buah 53 53 20 33 200
140 Paper tape 1,25 cm x 9,14 cm Aximed Rol 31 31 1 30
141 Paper tape 7,5 cm x 9,14 cm Aximed Rol 14 14 - 14
142 Papsmer Kit M Buah - -
143 Papsmer Kit S Buah - -
144 Parafilm 4 in x 125 FT Box - -
145 Plesterin Roll Non Woven roll 10cm x 5m Roll 16 16 - 16
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
146 Plesterin Roll Non Woven roll 15 cm x 5 m Roll 5 5 - 5
147 Plesterin Roll Non Woven roll 5cm x 5m Roll 11 11 - 11
148 Policrepe 10 cm x 4,55 m Rol - -
149 Policrepe 15 cm x 4,55 m Rol - -
150 Povidon Iodine 60 ml medika Botol 30 30 3 27
151 Povidone Iodine 300 ml BOTOL - -
152 Pot Sputum Buah - - 200
153 RDT Antigen - Healgen Pcs - - 200
154 Reagen Afinion HbA1c Botol - -
155 Reagen Afinion HbA1C Control KIT - -
156 Reagen Anti A 1 x 10 ml KIT - -
157 Reagen Anti AB 1 x 10 ml KIT - -
158 Reagen Anti B 1 x 10 ml KIT - -
159 Reagen Anti D 1 x 10 ml KIT - -
160 Reagen Diluent M-30 20 L Mindray Botol - -
161 Reagen Lyse 500 ml Zenix Botol - -
162 Reagen Proline Tryglicerides KIT - -
163 Reagen Rinse 20 L Mindray Botol - -
164 Reagen Salmonella Paratyphi AH 1x5 ml KIT - -
165 Reagen Salmonella Paratyphi AO 1x5 ml KIT - -
166 Reagen Salmonella Paratyphi BH 1x5 ml KIT - -
167 Reagen Salmonella Paratyphi BO 1x5 ml KIT - -
168 Reagen Salmonella Paratyphi CH 1x5 ml KIT - -
169 Reagen Salmonella Paratyphi CO 1x5 ml KIT - -
170 Reagen Salmonella Paratyphi H 1x5 ml KIT - -
171 Reagen Salmonella Paratyphi O 1x5 ml KIT - -
172 Rivanol 300 cc Botol 52 52 2 50
173 Safety box Buah - - 100
174 Saniswiss biosanitizer H1 500 ml Botol - -
175 Sepatu Boots Pair - -
176 Servical Collar Serenity Pcs - -
177 Silk Braided Surgical Sutures USP 3/0 box - -
178 Spalk first AID Pcs - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
179 Sterile Scalpel Blade#10F#3 Box - -
180 Sterile Scalpel Blade#12F#3 Box - -
181 Sterile Scalpel Blade#23F#34 Box - -
182 Sterile Scalpel Blade#24F#4 Box 1 1 - 1
183 Stomach Tube 85 cm No 16.Aximed Pcs 10 10 - 10
184 Stomach Tube 85 cm No.12 Aximed Pcs 7 7 - 7
185 Stomach Tube 85 cm No.14 Aximed Pcs 7 7 - 7
186 Stomach Tube 85 cm No.18 Aximed Pcs 10 10 - 10
187 Strip Test Cholestrol Autocheck Box - - 200
188 Strip Test Detecto HbsAg Onemed Buah 150 150 50 100
189 Strip Test Focus New HIV 1/2 3 Line Pcs - -
190 Strip Test Glucosa On Call Plus Box 50' 300 300 300 - 200
191 Strip test Hb Hemoglobin Mission Pcs 650 650 300 350
192 Strip Test Health Mate Syphilis Ab Plus Box 200 200 - 200
193 Strip test SD HIV Bioline Pcs 50 50 - 50
194 Strip Test Ultra One (Test kehamilan) Buah - - 100
195 Strip Test Uric Acid Autocheck Box - - 200
196 Strip test Uritest 11G Botol 12 12 - 12
197 Strip test Virotec dengue Combo Unit 75 75 - 75
198 Suction Catheter FR 10 unit - -
199 Suction Catheter FR 12 unit - -
200 Surfaces S 5000 ml Biosanitizer KEN - -
201 Surfaces S 750 ml Biosanitizer Botol - -
202 Surgical Examination Gynecolog Onemed Set - -
203 Surgical Gloves No. 6.5 Serenity Pcs - -
204 Thermal Paper EFG Roll Roll - -
205 Tips For Micro MT 200 IU Pcs - -
206 Tips For Micro MT II 1 ml Pcs - -
207 Tips For Micropipet MSTP Pcs - -
208 Umbilical cord clame fesco Pcs 150 150 50 100 200
209 Umbilical Cord Clamp Buah - - -
210 Underpad (Softpad) 60 x 90 cm Pcs 50 50 50 - 300
211 U-Pad Steril Buah - - 100
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
212 Urine bag + hanger Pcs 180 180 - 180
213 Urine bag + hanger Semilas Pcs - -
214 USG Gel 250 ml Botol 24 24 12 12
215 Viorex liquid Botol - -
216 White Tips Bks - -
217 Write On ID Bracelet Adult blue remedi Pcs 100 100 - 100
218 Write On ID Bracelet Adult pink remedi Pcs 100 100 - 100
219 Write On ID Bracelet Child hijau remedi Pcs 200 200 - 200
220 Write On ID Bracelet Child ungu remedi Pcs 100 100 - 100
221 Xpert MTB/ RIF Assay Kit Cartrigde TCM Pcs - -
222 Yellow Tip Bks - -
- -
Bahan Gigi - -
1 Articulating Paper Pcs - - 100
2 Calcimol LC Botol - - 10
3 Cavit G ( Ceivitron) Pot - - 50
4 Cement Spatula Pcs - - 20
5 CHKM Botol - - 20
6 Dycal/ Hydcal Botol - - 20
7 GC Fuji 9 Mini Pack Box - - 10
8 Mikroaplikator Tips Botol - - 10
9 Oco/ Poliren No. 1 Botol - - 10
10 Bedaquilline 100 mg Tablet 376 376 - 376
11 Clofazimin Tablet 200 200 - 200
12 DHP-Frimal 27 27 - 27
13 Etambutol 400 mg Tablet 448 448 - 448
14 Ethionamid 250 mg Tablet 300 300 - 300
15 Isoniazid 300 mg Tablet - -
16 KDT Dosis Harian Paket - -
17 Levofloxacin 250 mg Tablet 100 100 - 100
18 Moxyfloxacin 400 mg Tablet - -
19 OAT Kategori Anak Paket 3 3 - 3
20 OAT Kat. I FDC Paket 18 18 8 10
21 Piridosin Hcl Tablet 25 mg (Vit. B6) Tablet - - 500
22 Primaquine Tablet 100 100 100
23 Pyrazinamide 400 mg Tablet 448 448 448
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
24 Rapid tes Malaria Test - - 100
25 Sarung Tangan Obgyn - - 100
26 plester Winner 10x5 m - -
27 plester Winner 5x5 m - -
28 Tabung EDTA 3 ml - -
29 Foley Cateter 2 Fly FR 16 FR 18 - ABADA Pcs - -
30 Isoniazid 100 mg Tablet - -
31 Rifampicin 75 mg + Isoniazid 50 mg Tablet 84 84 - 84
32 Rifapentin 150 mg Tablet 90 90 - 90
33 Rifapentin 300 mg/Isoniazid 300 mg Tablet 90 90 - 90
34 Tuberkulin PPD RT 23 Vial - -
35 Surgical gloves No. 7,5 Trosensosurge Botol - -
36 Pehavral Tablet 1500 1,500 100 1400
37 Strip Test HIV 1/2 - One Step Pcs 50 50 - 50
38 Strip Test HIV 1/2 - Standar Q Pcs 100 100 - 100
39 Verorab Vaksin Rabies inj 2,5 IU Vial 81 81 30 51
40 STRIP TEST HIV/SHYPILIS DUO Pcs 225 225 25 200
41 Gentamisin salep Kulit Tube 85 85 32 53 50
42 GG Tablet Tablet 1900 1,900 1,900 0 5,000
43 Hyperhep (HBIG) Vial 5 5 - 5
44 Levofloxacin 100 mg Tablet 500 500 - 500
45 Solpenox Syr Botol 240 240 - 240
46 Strip Test Glucosa Autocheck Pcs 200 200 200 0
47 Safety Lancet Onemed Box 20 20 1 19

Jumlah Kunjungan Resep Rawat Jalan Rawat Inap Total


3000 700 3,700

Mengetahui, Yang meminta/Melapor


Kepala Puskesmas Karangan Pengelola Obat Puskesmas Karangan
Kabupaten Landak
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
Marta Rahayu,SKM apt. M. Agustine Dwi Steviana, S.Farm
NIP. 196603031987032009 NIP. 199508042022032010
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

KABUPATEN : LANDAK
PUSKESMAS : PUSKESMAS KARANGAN
BULAN/TAHUN : FEBRUARI / 2023

OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
1 Acyclovir 400mg Tablet 600 600 - 600
2 Acyclovir Salep Tube 100 100 - 100
3 Albendazole 400 mg Tablet 800 800 300 500
4 Albendazole Suspensi Botol - -
5 Allopurinol 100 mg Tablet 4,700 4,700 500 4,200
6 Allopurinol 300 mg Tablet 5,800 5,800 500 5,300
7 Alprazolam 0,5 mg Tablet - 500 500 122 378 500
8 Alprazolam 1 mg Tablet 505 500 1,005 586 419 500
9 Ambroxol 30 mg tab Tablet - 5000 5,000 700 4,300 10,000
10 Ambroxol Syrup Botol - -
11 Aminofilin injeksi 24 mg/ml Ampul - -
12 Amitriptillin 25 mg Tablet - -
13 Amlodipin Tab 10 mg Tablet 3,800 2000 5,800 1,800 4,000 2,000
14 Amlodipin Tab 5 mg Tablet 4,600 2300 6,900 3,000 3,900 2,000
15 Amoxicillin 100 mg/ml Drops Botol - - - 100
16 Amoxicillin 500 mg Tablet 2,400 5000 7,400 2,600 4,800 5,000
17 Amoxicillin dry syrup 125 mg / 5 ml Botol - - - 100
18 Ampicillin injeksi Ampul 230 230 - 230
19 Antasida DOEN Kombinasi Tablet 600 10000 10,600 1,300 9,300 10,000
20 Antasida DOEN Syrup Botol - -
21 Antifungi DOEN Kombinasi Tube 78 78 6 72
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
22 Antihemoroid DOEN Kombinasi Supp 36 36 - 36
23 Apricot Syrup Botol 35 35 10 25
24 Asam Ascorbat (Vit c) Tab 50 mg Tablet 9,100 3000 12,100 5,000 7,100 5,000
25 Asam asetilsalisilat (Miniaspi 80 mg) Tablet - - 500
26 Asam Mefenamat 500 mg Tablet 5,400 1000 6,400 3,600 2,800 2,000
27 Asam Tranexamat inj 100 mg/ml Ampul 90 90 - 90
28 Asam Tranexamat inj 50 mg/ml Ampul 70 70 10 60
29 Asering Infuse 500 ml Kolf - -
30 Atropin sulfat injeksi 0,25 mg/mil -1 ml Ampul 94 94 4 90
31 Betahistine Besilat 6 mg Tablet - -
32 Betametason cream 0,1 % Tube 149 149 5 144
33 BIOSAT 1.500 (anti tetanus) Vial - -
34 BIOSAVE (anti bisa ular) VIAL - - -
35 Bisoprolol 5 mg Tablet 870 870 150 720
36 Bufacetin salep kulit 1% Tube 91 91 - 91
37 Calcii Glukonas Inj Ampul - - 50
38 Captopril 12,5 mg Tablet 1,000 1000 2,000 1,000 1,000 1,000
39 Captopril 25 mg Tablet 2,300 2,300 500 1,800 1,000
40 Cefadroxil 250 mg Tablet - -
41 Cefadroxil 500 mg Tablet 1,700 1000 2,700 200 2,500
42 Cefadroxil Dry Syrup 125 mg Botol 360 360 5 355
43 Cefotaxime Injeksi 1 gr Vial - - 100
44 Ceftriaxon Inj 1000 mg Vial 70 70 30 40 100
45 Cetirizin 10 mg tab Tablet 2,800 2,800 2,800 - 5,000
46 Cetirizin Syrup Botol 147 12 159 12 147
47 Chloramfenicol 250 mg Capsul - -
48 Chloramfenicol 500 mg Capsul - -
49 Chloramfenicol tetes telinga Botol - -
50 Chlorfeniramin Maleat 4 mg (CTM) Tablet 8,800 2000 10,800 5,300 5,500 5,000
51 Chlorpromazine 100 mg Tablet 10 500 510 10 500
52 Chlorpromazine 25mg Tablet 1,210 1,210 - 1,210
53 Ciprofloxacin 500 mg Tablet 2,600 2,600 400 2,200
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
54 Clindamicin 150 mg Capsul - - 5,000
55 Clozapin 100 mg Tablet - - - 2,000
56 Clozapin 25 mg Tablet - - 2,000
57 Codein hcl Tablet 10 mg Tablet - -
58 Combivent Nebules Vial - -
59 Cotrimoxazole 480mg Tablet 2000 2,000 400 1,600 2,000
60 Cotrimoxazole 960 mg Tablet - - 2,000
61 Cotrimoxazole sirup Botol - -
62 Desoximetasone Krim 0.25% Tube 28 28 3 25
63 Dexamethason Tab 0,5 mg Tablet - - - 10,000
64 Dexamethasone injeksi 5 mg/ml - 1 ml Ampul 190 190 - 190
65 Dextrose monohydrat 40% Flacon - - - 20
66 Diabetadex Fitofarmaka Tablet 210 210 - 210
67 Diazepam injeksi 5 mg / 2 ml Ampul - 40 40 11 29 20
68 Diazepam Tablet 5 mg Tablet 155 100 255 15 240 200
69 Digoxin tablet 0,25 mg Tablet - -
70 Diltiazem HCL Tablet 30 mg Tablet 800 800 - 800
71 Dimenhidrinat 50 mg Tablet 400 400 - 400
72 Diphenhydramin HCl injeksi 10 mg/ml-1 ml Ampul - - -
73 Domperidon Tablet Tablet 1,900 1000 2,900 600 2,300 1,000
74 Epineprin HCl (adrenalin ) inj 0,1 % - 1 ml Ampul 98 98 - 98
75 Ergotamin Coffein Tablet - -
76 Febrinex Ped Suspensi 60 ml Botol - -
77 Fenol Gliserol Tetes Telinga 10% Botol 33 33 - 33
78 Fitomenadion (Vit K) Injeksi 2 mg Ampul 300 300 - 300
79 Fitomenadion (Vit K) Tablet Salut 10 mg Tablet 400 400 200 200 500
80 Flutamol Syr Botol - -
81 Flutamol Tab Tablet - - 10,000
82 Furosemid 10 Mg/ml Injeksi Ampul 150 150 25 125
83 Furosemid Tablet 40 mg Tablet 800 800 - 800
84 Garam Oralit 200 mg Bungkus 400 400 - 400
85 Gentamicin Salep Mata 0,3% Tube - -
86 Gentamicin Tetes Mata 0,3% Tube 162 48 210 71 139 100
87 Glibenklamid Tablet 5 mg Tablet 2,000 1000 3,000 400 2,600 500
88 Glukosa 10% Infus Kolf - -
89 Glukosa 5% Infus Kolf - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
90 Griseolfulvin Tablet 125 mg Micronized Tablet 700 700 200 500
91 Haloperidol 0,5 mg Tablet - - - 500
92 Haloperidol 1,5 mg Tablet - -
93 Haloperidol 5 mg Tablet 1,055 500 1,555 497 1,058 1,000
94 Herbakof Syrup Botol - -
95 Herbakof Tablet Tablet 420 420 420 - 600
96 Herbapain (OHT) Obat Anti Nyeri Tablet Tablet 600 600 600 - 600
97 Herbavomitz obat herbal Botol - -
98 Herbavomitz Tablet Tablet 570 570 570 - 600
99 Hidroklorotiazid (HCT) Tablet 25 mg Tablet - - 1,000
100 Hidrokortison Krim 2,5% Tube 96 96 24 72
101 Ibuprofen (Zentarin) Tablet 400 mg Tablet 3,700 3,700 2,200 1,500 2,000
102 Ibuprofen Suspensi 100 mg/ 5 ml Botol - -
103 Ibuprofen Suspensi 200 mg/ 5 ml Botol 116 116 - 116
104 Iliadin Drop Tetes Hidung Botol - -
105 Imunomodulator anak Syr 25 mg Botol 4 4 - 4
106 Imunomodulator Forte 50 mg Tablet 810 810 300 510
107 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet 400 500 900 400 500 500
108 KA EN 3A Kolf 8 8 2 6
109 KA EN 3B Kolf 32 32 - 32
110 Kalsium Laktat (kalk) Tablet 500 mg Tablet 6,100 7000 13,100 6,300 6,800 10,000
111 Karbamazepin 200 mg Tablet 1,360 1,360 35 1,325
112 Ketoconazole 200 mg Tablet 1,400 1,400 200 1,200
113 Ketoconazole Zalp Tube - - 100
114 Ketorolac Inj 30mg/ml Ampul 100 100 - 100
115 Lactulosa Syr 3,335 g/5ml (Kompolax) Botol 61 7 68 13 55 100
116 Lansoprazole Tablet 30mg Tablet 2,500 2,500 700 1,800
117 Lidocain (HCI) 2 % 2 ml Injeksi Ampul 100 100 100 - 100
118 Lidocain (HCI) 2% + Epinefrin 2 mg Ampul - 150 150 30 120 90
119 Loperamide 2 mg Tablet 3,900 3,900 - 3,900
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
120 Loratadine tab Tablet 2,500 2,500 - 2,500
121 Magnesium sulfat 20% (MgSO4) Ampul - -
122 Magnesium sulfat 40% (MgSO4) Ampul 19 10 29 - 29 10
123 Maltiron Syr 60 ml Botol - -
124 Mersibion Inj Ampul 60 50 110 33 77 100
125 Metformin HCl 500 mg Tablet 1,400 5000 6,400 2,000 4,400 3,000
126 Metilergometrin Inj 0,2 mg/ml Ampul - - -
127 Metilergometrin maleat Tab 0,125 mg Tablet - -
128 Metilprednisolon 16 mg Tablet 2,500 2,500 500 2,000
129 Metilprednisolon 4 mg Tablet 1,500 2000 3,500 1,600 1,900 3,000
130 Metilprednisolon 8 mg Tablet 1,800 1,800 1,000 800
131 Metoklorpamide Tablet 10 mg Tablet - -
132 Metoklorpamide Tablet 5 mg Tablet - 1000 1,000 200 800 1,000
133 Metronidazol Tab 500mg Tablet 1,400 1000 2,400 2,400 1,000
134 Metronidazole Infus Kolf 10 10 - 10
135 Metronidazole Suspensi 125mg/5ml Botol 70 70 - 70
136 Metyldopa (Dopamet) 250 mg Tablet 100 100 - 100 200
137 Miconazole krim 2 % Tube 57 57 33 24 72
138 Mineral Mix Bungkus - - 100
139 Multivitamin Becefort Tablet - - 1,000
140 Multivitamin Becefort Syr 60 ml Botol - -
141 Multivitamin Natabion Dws Capsul - -
142 Multivitamin Oxyvit Tablet - - 1,000
143 Natrium Diklofenak tab 25 mg Tablet 1,200 1,200 1,200 - 5,000
144 Natrium Diklofenak tab 50 mg Tablet 2,800 5600 8,400 2,500 5,900 3,000
145 Natrium Klorida 0,9% OTSU Botol 100 40 140 20 120 60
146 Nifedipin 10 Mg Tablet 600 600 - 600
147 Nistatin 100.000 IU tab vaginal Tablet 90 90 20 70
148 Nistatin 500.000 IU Tablet 400 400 100 300
149 Nistatin suspensi 100.000 IU/mL Botol 100 100 - 100
150 Noza Kaplet Kaplet - - 10,000
151 OBH Kaca Berlico 100ml Botol - -
152 Ofloxacin 200 mg Tablet - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
153 Oksimetazolin tetes hidung 0,05% Botol 33 33 - 33
154 Oksitetrasiklin HCl 1 % zalp mata Tube - -
155 Oksitosin Inj 10 IU/ml Ampul 400 400 - 400
156 Omeprazole caps (Lokev) Capsul - -
157 Ondansentron Injeksi Ampul 150 100 250 145 105 200
158 Ondansentron Tab 4 mg Tablet - - - 500
159 Parasetamol Drops Botol - -
160 Parasetamol Infus btl 10 10 2 8
161 Parasetamol sirup 120mg/5ml Botol 457 6 463 6 457
162 Parasetamol Tab Tablet 6,300 10000 16,300 9,800 6,500 10,000
163 Phenobarbital injeksi 50 mg / 2 ml Ampul - -
164 Piridoksin HCl Tablet 10 mg ( Vit B6 ) Tablet 3,200 2000 5,200 1,600 3,600 2,000
165 Prednison tab 5 mg Tablet - 5000 5,000 1,500 3,500 5,000
166 Procurma Syr Botol - -
167 Propiltiourasil (PTU) tab 100 mg Tablet 200 200 100 100 500
168 Pularex Tablet Tablet 400 1000 1,400 400 1,000 500
169 Pyrantel Pamoat 125 mg Tablet - -
170 Pyrantel Pamoat Susp 125mg / 5ml Botol - -
171 Ranitidin 150 mg tab Tablet 1,700 2000 3,700 2,300 1,400 3,000
172 Ranitidin Injeksi Ampul - -
173 Retinol 100.000 IU BIRU Caps - -
174 Retinol 200.000 IU MERAH Caps 700 700 450 250 500
175 Ringer Laktat Infus Botol 600 600 360 240 200
176 Risperidon 1 mg Tablet - -
177 Risperidon 2 mg Tablet 1,294 500 1,794 1,510 284 500
178 Salbutamol 2 mg Tablet 2,600 2,600 700 1,900
179 Salbutamol 4 mg Tablet 2,700 2,700 600 2,100
180 Salbutamol Cairan inhalasi Ampul - - 100
181 Salbutamol Syrup Botol 236 12 248 12 236
182 Salep 2- 4 kombinasi Tube - -
183 Sianokobalamin (Vit. B12) Tab Tablet 200 200 - 200 2,000
184 Simvastatin Tablet 10 mg Tablet 4,000 4,000 600 3,400
185 Simvastatin Tablet 20 mg Tablet 3,400 3,400 1,000 2,400 1,000
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
186 Soft U Derm 10% Crema 20gr Tube - -
187 Spironolactone 25 mg Tablet - -
188 Stesolid rectal 10 mg / 2,5 ml Tube - -
189 Stesolid rectal 5 mg / 2,5 ml Tube - -
190 Sukralfat Suspensi 500mg/ 5ml Botol 80 80 80 - 300
191 Sulfadoxine-Pyrimethamine (Suldox) Tablet - -
192 Tablet Tambah Darah FE Tablet 4,600 4,600 3,760 840 5,000
193 Tetagam Inj Vial 3 3 - 3
194 Tetrasiklin 500 mg Tablet - -
195 Thiamin Hcl (Vit B1) Tablet 50 mg Tablet - - 1,000
196 Tramadol Inj Ampul - -
197 Trifluoperazin 5 mg Tablet 3,345 3,345 180 3,165
198 Trihexylphenidil 2 mg Tablet 1,899 1000 2,899 1,020 1,879 1,000
199 Vitamin B komplek Tablet 3,600 10000 13,600 5,600 8,000 10,000
200 Vitamin D3 1000IU Tablet 210 900 1,110 480 630
201 Voltadex Gel 1% 20 gr Tube - - -
202 Zinc 20 Mg Tablet Tablet 4,100 4,100 600 3,500
203 Zinc Syr Botol - -
204 Zincpro Drop 15 ml Botol - -
205 Acetyl cysteine tablet 200 mg Tablet 360 360 180 180
206 Cefotaxime sodium serb inj 500 mg Injeksi - -
207 Cendo Lyteers tetes mata, botol @ 15 ml Botol - -
208 Chloramphenicol salep mata 1 % Tube - -
209 Curcuma Plus 60 mL Botol - -
210 Diazepam enema 10 mg/2,5 mL Tube 20 20 - 20
211 Diazepam enema 5 mg/2,5 mL Tube 14 14 2 12
212 Domperidone drops 5 mg/mL Botol - -
213 Domperidone sirup/suspensi 5 mg/5 ml Botol - -
214 Farbivent cairan inhalasi Ampul 90 50 140 20 120 100
215 Flamar Natrium diklofenak tetes mata 1 mg/ml Botol - -
216 Glimepiride tablet 2 mg Tablet - - - - 2,000
217 Hidrokortison krim 1% Tube - -
218 Hyaloph Natrium hialuronat tetes mata Botol - -
219 Hyoscine Butylbromide Tab Tablet 1,000 1,000 - 1,000
220 Midric 0,5% Tropikamid tts mata 0,5% Botol - -
221 Miniaspi Asam Asetilsalisilat tablet 80 mg Tablet - - - - 500
222 Multivitamin Ferbion Kapsul - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
223 Novadryl Tablet Tablet - -
224 Nuvopec Syrup Botol - -
225 Obat Batuk Hitam Combi Botol 144 50 194 129 65 100
226 Obat Batuk Hitam Anak Combi Botol 100 48 148 77 71 100
227 Obat Flu Anak (HUFA) Botol 101 7 108 18 90
228 Obat Flu Kombinasi (Noza) Tablet - -
229 Obat Flu Kombinasi Syrup (Febrinex) Botol - -
230 Octenic Gel 20 g Tube 6 6 - 6 20
231 Parafen Kaplet Kaplet - -
232 Permetrin Krim 5% Tube 20 20 - 20
233 Propranolol tablet 10 mg Tablet 700 700 - 700
234 Sianokobalamin (vitamin B12) injeksi 500 mcg/m Ampul 100 100 - 100
235 Vip Albumin Obat Herbal Tablet 630 630 - 630
236 Vitamin C 1000mg/ Provit C Tablet 840 840 60 780
- -
BAHAN MEDIS HABIS PAKAI, REAGEN DAN LARUTAN - -
1 Alat Suntik 1 ml Stera Buah - -
2 Alat suntik 1 ml TP Pcs 1,100 1,100 100 1,000
3 Alat Suntik 10 cc Stera Buah - - - 500
4 Alat suntik 10 ml TP Pcs - - - 500
5 Alat Suntik 3 cc Stera Buah - - -
6 Alat suntik 3 ml TP Pcs - - - 500
7 Alat Suntik 5 cc Stera buah - - -
8 Alkohol 1 Liter Onemed Botol 2 2 2 - 5
9 Alkohol 70% 300 ml Botol - - 20
10 Alkohol swab Aximed Pcs 5,400 5,400 1,400 4,000
11 Apron Plastik one Pcs 180 100 280 10 270 100
12 Aqua proinjeksi steril 20 ml Vial 200 120 320 40 280 100
13 Arm Sling Comfort L Buah 3 3 - 3
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
14 Arm Sling Comfort S Buah 6 6 - 6
15 Bactivec BTI DBD SL Botol - -
16 Baju APD Coverall Pcs 20 20 - 20
17 Bioplacenton Tulle Pcs - - 50
18 Blood Lancet Serenity Pcs 1,900 1,900 - 1,900
19 Blood transfusion set ABADA Pcs 200 200 - 200
20 Blue Tips Bks 1 1 1 - 5
21 Catgut chromic 3/0 70 cm violet reverse cutting 1 Pcs - -
22 Catgut Chromic Surgical Sutures Pcs 72 72 144 60 84 72
23 Catgut Plain Surgical Sutures box 84 72 156 12 144 72
24 Catgut provein 5/0 PV888 45 cm 18 mm Pcs - -
25 Catgut silk 3/0 75 cm 3/8 CC 19 mm Pcs - -
26 Cervical collar Buah - -
27 Derm transport dressing remedi Pcs - -
28 Dermafix S 4,4 x 4,4 cm Buah - -
29 Dermafix S 6 x 7 cm buah - -
30 Dermafix T 15cm x 20 cm Roll - -
31 Dermafix T 5x7 Buah - -
32 Dressing IV canulla non woven remedi Pcs - -
33 Endotracheal Tube (ETT) uk. 6,0 fesco Pcs - -
34 Endotracheal Tube (ETT) uk. 7,0 fesco Pcs - -
35 Endotracheal Tube (ETT) uk. 7,5 fesco Pcs - -
36 Endotracheal Tube (ETT) uk. 8,0 fesco Pcs - -
37 Female Cateter No 16 Aximed Pcs - -
38 Female Cateter No 18 Aximed Pcs - -
39 Foley catheter no. 16 latex 2 way ABADA Pcs 60 60 10 50 20
40 Pcs 60 60 10 50
Foley catheter no. 18 (2 way standard) serenity 20
41 Foley catheter no. 18 latex 2 way ABADA Pcs - -
42 - -
Folley catheter uro one 2 way, FR 16, FR 18 Buah
43 Hand Gel H1 100 ml+flip top Botol - -
44 Handrub 5 L Medika Ken - -
45 Handrub 500 ml Medika Botol 60 60 - 60
46 Handrub e-care 500 ml Botol 16 16 - 16
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
47 Handscrub e-care 500 ml Botol - - 50
48 Hazmat suit Winner Pcs - -
49 Indodent Saliva ejector Buah - -
50 Infusion set anak set 100 100 50 50
51 Infusion set dewasa ST01 set - - 300
52 Infusion set microdrip ABADA Pcs - -
53 Infusion set microdrip Otsu Pcs 60 100 160 - 160
54 Infusion Set Y Adaptor Otsu Pcs - - 300
55 IV Catheter No. 18G Cath Pro Pcs 150 150 - 150
56 IV Catheter No. 20G Cath Pro Pcs 50 50 50 - 100
57 IV Catheter No. 20G Otsu Pcs - - - -
58 IV Catheter No. 22G Cath Pro Pcs - - - 100
59 IV Catheter No. 24G Cath Pro Pcs 150 150 - 150 100
60 IV Catheter With Teflon Catheter 1 way 18 G Set - -
61 IV Catheter With Teflon Catheter 1 way 24 G set - -
62 IV Catheter With Teflon Catheter 1 way 26 G set - -
63 IV Catheter WP No. 26G Aximed Pcs 90 90 40 50 100
64 Kantong Jenazah Pcs - -
65 Kantong limbah biohazard uk. L Pack 1 5 6 - 6 5
66 Kantong limbah biohazard uk. M Pack 5 5 10 - 10 5
67 Kantong limbah biohazard uk. S Pack 3 3 - 3 5
68 Kapas 250 gram Rol 8 10 18 - 18 50
69 Kapas 500 gram Bks - -
70 Kasa hidrofil 15 x 4 cm BIOKASA Pcs - -
71 Kasa hidrofil 2 m x 10 cm ABADA Rol - - 100
72 Kasa hidrofil 2 m x 80 cm Roll - - - 100
73 Kasa hidrofil 20y x 80 cm ABADA Rol - - 100
74 Kasa hidrofil 36 cm x 80 cm BIOKASA Rol - - - 100
75 Kasa hidrofil 4 m x 10 cm Roll - -
76 Kasa hidrofil 4 m x 15 cm Roll - -
77 Kasa hidrofil 4 m x 15 cm ABADA Rol - -
78 Kasa hidrofil 4 m x 3 cm Roll - -
79 Kasa hidrofil 4 m x 5 cm Roll - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
80 Kasa hidrofil 4 m x 7,5 cm ABADA Rol 500 500 270 230 500
81 Kasa hidrofil 40 cm x 80 cm Rol - -
82 Kasa hidropil 16 cm x 16 cm ABADA Kotak - - 100
83 Kasa Steril 10 cm x 10 cm 16 Ply isi 10 Roll - - - 100
84 300 300 - 300
Kasa Steril 10 cm x 10 cm 16 Ply isi 10 LDX Roll
85 Kasa Steril 16 x 16 cm Roll 273 273 61 212 100
86 Kasa Steril 18 cm x 22 cm Roll - -
87 Rol 5 5 - 5
Kertas EKG 4.5 in (11.4 cm) x 65.6 ft (20 m)
88 Kertas EKG 112 mm Rol - -
89 Kertas EKG Z-fold : 215×280mm Rol - -
90 Latex Examination Gloves Uk. L Pcs - -
91 Latex Examination Gloves Uk. M Pcs 1,800 2000 3,800 3,100 700 4,000
92 Latex Examination Gloves Uk. S Pcs - -
93 Latex Examination Gloves Uk. XS Pcs - -
94 Masker Ear Loop Pcs - 4000 4,000 4,000 - 5,000
95 Masker N95 Particulate Respirator unit 160 160 - 160
96 Masker Nebulizer Anak Unit - -
97 Masker Nebulizer Dewasa Unit - -
98 Masker Nebulizer Dewasa Cosmo Pcs - -
99 Masker Nebulizer Uk M Anak ABADA Pcs - -
100 Masker Nebulizer Uk. L Dewasa ABADA Pcs - -
101 Masker Oksigen Adult Serenity Pcs - -
102 Masker Oksigen Anak Semillas Pcs - -
103 Masker Oksigen Dwsa Semillas Pcs 6 6 - 6 20
104 Masker Oksigen Infant Serenity Pcs
105 Masker Oksigen Pediatric Serenity Pcs 24 24 - 24
106 Maxiflow Anak Unit - -
107 Maxiflow Bayi unit - -
108 Maxiflow Dewasa unit 25 25 50 - 50
109 Micropipet Adjust Vol. 0,1-2,5 UL Pcs - -
110 Micropipet Adjust Vol. 0,5-10 UL Pcs - -
111 Micropipet Adjust Vol. 100-1.000 UL Pcs - -
112 Micropipet Adjust Vol. 10-100 UL Pcs - -
113 Micropipet Adjust Vol. 200-1.000 UL Pcs - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
114 Micropipet Adjust Vol. 2-20 UL Pcs - -
115 Micropipet Adjust Vol. 50-200 UL Pcs - -
116 Micropipet Adjust Vol. 5-50 UL Pcs - -
117 Micropipet Fixed Vol. 10 UL Pcs - -
118 Micropipet Fixed Vol. 100 UL Pcs - -
119 Micropipet Fixed Vol. 20 UL Pcs - -
120 Micropipet Fixed Vol. 25 UL Pcs - -
121 Micropipet Fixed Vol. 5 UL Pcs - -
122 Micropipet Fixed Vol. 50 UL Pcs - -
123 Micropipet Fixed Vol. 500 UL Pcs - -
124 Mucus Extractor buah - -
125 Mucus Extractor Serenity Pcs 18 18 - 18
126 M-Y Jelly 82 Gram Tube Buah 6 6 5 1 20
127 Nasal Oksigen Canula Anak Pcs - - -
128 Nasal Oxygen Canula Adult Serenity Pcs 200 200 - 200 500
129 Nasal Oxygen Canula Infant Serenity Pcs 29 29 - 29 50
130 Nasal Oxygen Canula Pediatric Serenity Pcs 200 200 - 200
131 Needle CNV 21 x 1,5 ml (BD vacutainer) Pcs - -
132 Needle CNV 22 x 1,5 ml MLTSMPCE Pcs - -
133 Non Woven IV Dressing 6 x 8 cm Pcs - -
134 Nurse Cap Box 12 12 - 12
135 One Scrub 2% Antiseptic surgical scrub dispense Botol - -
136 One Scrub 4 %, 500 cc + dispenser Botol 12 12 2 10 50
137 Oxyflow Anak Buah 12 12 4 8 100
138 Oxyflow bayi Buah 4 4 1 3 100
139 Oxyflow Dewasa Buah 33 33 - 33 200
140 Paper tape 1,25 cm x 9,14 cm Aximed Rol 30 30 - 30
141 Paper tape 7,5 cm x 9,14 cm Aximed Rol 14 14 - 14
142 Papsmer Kit M Buah - -
143 Papsmer Kit S Buah - -
144 Parafilm 4 in x 125 FT Box - -
145 Plesterin Roll Non Woven roll 10cm x 5m Roll 16 16 - 16
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
146 Plesterin Roll Non Woven roll 15 cm x 5 m Roll 5 5 - 5
147 Plesterin Roll Non Woven roll 5cm x 5m Roll 11 11 - 11
148 Policrepe 10 cm x 4,55 m Rol - -
149 Policrepe 15 cm x 4,55 m Rol - -
150 Povidon Iodine 60 ml medika Botol 27 27 2 25
151 Povidone Iodine 300 ml BOTOL - -
152 Pot Sputum Buah - - - 300
153 RDT Antigen - Healgen Pcs - - 200
154 Reagen Afinion HbA1c Botol - -
155 Reagen Afinion HbA1C Control KIT - -
156 Reagen Anti A 1 x 10 ml KIT - -
157 Reagen Anti AB 1 x 10 ml KIT - -
158 Reagen Anti B 1 x 10 ml KIT - -
159 Reagen Anti D 1 x 10 ml KIT - -
160 Reagen Diluent M-30 20 L Mindray Botol - -
161 Reagen Lyse 500 ml Zenix Botol - -
162 Reagen Proline Tryglicerides KIT - -
163 Reagen Rinse 20 L Mindray Botol - -
164 Reagen Salmonella Paratyphi AH 1x5 ml KIT - -
165 Reagen Salmonella Paratyphi AO 1x5 ml KIT - -
166 Reagen Salmonella Paratyphi BH 1x5 ml KIT - -
167 Reagen Salmonella Paratyphi BO 1x5 ml KIT - -
168 Reagen Salmonella Paratyphi CH 1x5 ml KIT - -
169 Reagen Salmonella Paratyphi CO 1x5 ml KIT - -
170 Reagen Salmonella Paratyphi H 1x5 ml KIT - -
171 Reagen Salmonella Paratyphi O 1x5 ml KIT - -
172 Rivanol 300 cc Botol 50 50 1 49
173 Safety box Buah 100 100 - 100 100
174 Saniswiss biosanitizer H1 500 ml Botol 20 20 - 20
175 Sepatu Boots Pair 10 10 - 10
176 Servical Collar Serenity Pcs 50 50 - 50
177 Silk Braided Surgical Sutures USP 3/0 box - -
178 Spalk first AID Pcs - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
179 Sterile Scalpel Blade#10F#3 Box - -
180 Sterile Scalpel Blade#12F#3 Box - -
181 Sterile Scalpel Blade#23F#34 Box - -
182 Sterile Scalpel Blade#24F#4 Box 1 1 - 1
183 Stomach Tube 85 cm No 16.Aximed Pcs 10 10 - 10
184 Stomach Tube 85 cm No.12 Aximed Pcs 7 7 - 7
185 Stomach Tube 85 cm No.14 Aximed Pcs 7 7 - 7
186 Stomach Tube 85 cm No.18 Aximed Pcs 10 10 - 10
187 Strip Test Cholestrol Autocheck Box - - 200
188 Strip Test Detecto HbsAg Onemed Buah 100 100 - 100
189 Strip Test Focus New HIV 1/2 3 Line Pcs - -
190 Strip Test Glucosa On Call Plus Box 50' - - - 200
191 Strip test Hb Hemoglobin Mission Pcs 350 350 - 350
192 Strip Test Health Mate Syphilis Ab Plus Box 200 200 - 200
193 Strip test SD HIV Bioline Pcs 50 50 - 50
194 Strip Test Ultra One (Test kehamilan) Buah - - 100
195 Strip Test Uric Acid Autocheck Box - - 200
196 Strip test Uritest 11G Botol 12 12 1 11
197 Strip test Virotec dengue Combo Unit 75 75 - 75
198 Suction Catheter FR 10 unit - -
199 Suction Catheter FR 12 unit - -
200 Surfaces S 5000 ml Biosanitizer KEN - -
201 Surfaces S 750 ml Biosanitizer Botol - -
202 Surgical Examination Gynecolog Onemed Set - -
203 Surgical Gloves No. 6.5 Serenity Pcs - -
204 Thermal Paper EFG Roll Roll - -
205 Tips For Micro MT 200 IU Pcs - -
206 Tips For Micro MT II 1 ml Pcs - -
207 Tips For Micropipet MSTP Pcs - -
208 Umbilical cord clame fesco Pcs 100 100 - 100 200
209 Umbilical Cord Clamp Buah - - -
210 Underpad (Softpad) 60 x 90 cm Pcs - - - 300
211 U-Pad Steril Buah - - 100
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
212 Urine bag + hanger Pcs 180 180 5 175
213 Urine bag + hanger Semilas Pcs - -
214 USG Gel 250 ml Botol 12 12 24 - 24
215 Viorex liquid Botol - -
216 White Tips Bks - -
217 Write On ID Bracelet Adult blue remedi Pcs 100 100 - 100
218 Write On ID Bracelet Adult pink remedi Pcs 100 100 - 100
219 Write On ID Bracelet Child hijau remedi Pcs 200 200 - 200
220 Write On ID Bracelet Child ungu remedi Pcs 100 100 - 100
221 Xpert MTB/ RIF Assay Kit Cartrigde TCM Pcs - -
222 Yellow Tip Bks - -

Bahan Gigi
1 Articulating Paper Pcs - - 100
2 Calcimol LC Botol - - 10
3 Cavit G ( Ceivitron) Pot - - 50
4 Cement Spatula Pcs - - 20
5 CHKM Botol - - 20
6 Dycal/ Hydcal Botol - - 20
7 GC Fuji 9 Mini Pack Box - - 10
8 Mikroaplikator Tips Botol - - 10
9 Oco/ Poliren No. 1 Botol - - 10
10 Bedaquilline 100 mg Tablet 376 376 - 376
11 Clofazimin Tablet 200 200 - 200
12 DHP-Frimal 27 27 - 27
13 Etambutol 400 mg Tablet 448 448 - 448
14 Ethionamid 250 mg Tablet 300 300 - 300
15 Isoniazid 300 mg Tablet - -
16 KDT Dosis Harian Paket 5 5 - 5
17 Levofloxacin 250 mg Tablet 100 100 - 100
18 Moxyfloxacin 400 mg Tablet - -
19 OAT Kategori Anak Paket 3 3 - 3
20 OAT Kat. I FDC Paket 10 10 5 5
21 Piridosin Hcl Tablet 25 mg (Vit. B6) Tablet - - - 500
22 Primaquine Tablet - -
23 Pyrazinamide 400 mg Tablet 448 448 - 448
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
24 Rapid tes Malaria Test - - 100
25 Sarung Tangan Obgyn - - 100
26 plester Winner 10x5 m - -
27 plester Winner 5x5 m - -
28 Tabung EDTA 3 ml - -
29 Latex Goves Powder M Chorona Care Pcs - 2,000 2,000 - 2000 2000
30 Isoniazid 100 mg Tablet - -
31 Rifampicin 75 mg + Isoniazid 50 mg Tablet 84 84 - 84
32 Rifapentin 150 mg Tablet 90 90 - 90
33 Rifapentin 300 mg/Isoniazid 300 mg Tablet 90 90 - 90
34 Tuberkulin PPD RT 23 Vial - -
35 Surgical gloves No. 7,5 Trosensosurge Botol - -
36 Pehavral Tablet 1400 1,400 300 1100
37 Strip Test HIV 1/2 - One Step Pcs 50 50 - 50
38 Strip Test HIV 1/2 - Standar Q Pcs 100 100 - 100
39 Verorab Vaksin Rabies inj 2,5 IU Vial 51 51 51
40 STRIP TEST HIV/SHYPILIS DUO Pcs 200 200 - 200
41 Gentamisin salep Kulit Tube 53 53 33 20 50
42 GG/Guaifenesin Tablet Tablet - 4000 4,000 200 3800 5,000
43 Hyperhep (HBIG) Vial 5 5 5
44 Levofloxacin 100 mg Tablet 500 500 - 500
45 Solpenox Syr Botol 240 120 360 10 350
46 Strip Test Glucosa Autocheck Pcs - 500 500 - 500
47 Safety Lancet Onemed Box 19 19 6 13
48 Reco Tetes Telinga Botol 100 100 25 75

Jumlah Kunjungan Resep Rawat Jalan Rawat Inap Total


2500 500 3,000

Mengetahui, Yang meminta/Melapor


Kepala Puskesmas Karangan Pengelola Obat Puskesmas Karangan
Kabupaten Landak
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket

Marta Rahayu,SKM apt. M. Agustine Dwi Steviana, S.Farm


NIP. 196603031987032009 NIP. 199508042022032010
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

KABUPATEN : LANDAK
PUSKESMAS : PUSKESMAS KARANGAN
BULAN/TAHUN : MARET / 2023

OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
1 Acyclovir 400mg Tablet 600 600 90 510
2 Acyclovir Salep Tube 100 100 - 100
3 Albendazole 400 mg Tablet 500 2500 3,000 3,000 - 1,000
4 Albendazole Suspensi Botol - -
5 Allopurinol 100 mg Tablet 4,200 4,200 300 3,900
6 Allopurinol 300 mg Tablet 5,300 5,300 600 4,700
7 Alprazolam 0,5 mg Tablet 378 500 878 93 785 500
8 Alprazolam 1 mg Tablet 419 500 919 381 538 500
9 Ambroxol 30 mg tab Tablet 4,300 2000 6,300 2,700 3,600 10,000
10 Ambroxol Syrup Botol - -
11 Aminofilin injeksi 24 mg/ml Ampul - -
12 Amitriptillin 25 mg Tablet - -
13 Amlodipin Tab 10 mg Tablet 4,000 5000 9,000 1,500 7,500 2,000
14 Amlodipin Tab 5 mg Tablet 3,900 3,900 1,500 2,400 2,000
15 Amoxicillin 100 mg/ml Drops Botol - - 100
16 Amoxicillin 500 mg Tablet 4,800 5000 9,800 4,200 5,600 10,000
17 Amoxicillin dry syrup 125 mg / 5 ml Botol - - 100
18 Ampicillin injeksi Ampul 230 230 - 230
19 Antasida DOEN Kombinasi Tablet 9,300 7000 16,300 9,300 7,000 15,000
20 Antasida DOEN Syrup Botol - -
21 Antifungi DOEN Kombinasi Tube 72 72 12 60
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
22 Antihemoroid DOEN Kombinasi Supp 36 36 6 30
23 Apricot Syrup Botol 25 25 11 14 50
24 Asam Ascorbat (Vit c) Tab 50 mg Tablet 7,100 7,100 2,800 4,300 5,000
25 Asam asetilsalisilat (Miniaspi 80 mg) Tablet - - 1,000
26 Asam Mefenamat 500 mg Tablet 2,800 2000 4,800 3,000 1,800 5,000
27 Asam Tranexamat inj 100 mg/ml Ampul 90 90 - 90
28 Asam Tranexamat inj 50 mg/ml Ampul 60 60 20 40
29 Asering Infuse 500 ml Kolf - -
30 Atropin sulfat injeksi 0,25 mg/mil -1 ml Ampul 90 90 2 88 100
31 Betahistine Besilat 6 mg Tablet - - 5,000
32 Betametason cream 0,1 % Tube 144 144 20 124 100
33 BIOSAT 1.500 (anti tetanus) Vial - -
34 BIOSAVE (anti bisa ular) VIAL - - 20
35 Bisoprolol 5 mg Tablet 720 720 - 720
36 Bufacetin salep kulit 1% Tube 91 91 19 72 100
37 Calcii Glukonas Inj Ampul - - 50
38 Captopril 12,5 mg Tablet 1,000 1000 2,000 200 1,800 1,000
39 Captopril 25 mg Tablet 1,800 1000 2,800 500 2,300 1,000
40 Cefadroxil 250 mg Tablet - -
41 Cefadroxil 500 mg Tablet 2,500 2,500 1,600 900 3,000
42 Cefadroxil Dry Syrup 125 mg Botol 355 355 10 345
43 Cefotaxime Injeksi 1 gr Vial - - 100
44 Ceftriaxon Inj 1000 mg Vial 40 40 30 10 100
45 Cetirizin 10 mg tab Tablet - 5000 5,000 - 5,000 7,000
46 Cetirizin Syrup Botol 147 147 - 147
47 Chloramfenicol 250 mg Capsul - -
48 Chloramfenicol 500 mg Capsul - -
49 Chloramfenicol tetes telinga Botol - -
50 Chlorfeniramin Maleat 4 mg (CTM) Tablet 5,500 5000 10,500 3,900 6,600 10,000
51 Chlorpromazine 100 mg Tablet 500 500 - 500
52 Chlorpromazine 25mg Tablet 1,210 1,210 120 1,090
53 Ciprofloxacin 500 mg Tablet 2,200 2,200 400 1,800 1,000
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
54 Clindamicin 150 mg Capsul - - 5,000
55 Clozapin 100 mg Tablet - - - 2,000
56 Clozapin 25 mg Tablet - - 2,000
57 Codein hcl Tablet 10 mg Tablet - -
58 Combivent Nebules Vial - -
59 Cotrimoxazole 480mg Tablet 1,600 2000 3,600 200 3,400
60 Cotrimoxazole 960 mg Tablet - - 2,000
61 Cotrimoxazole sirup Botol - -
62 Desoximetasone Krim 0.25% Tube 25 25 15 10 50
63 Dexamethason Tab 0,5 mg Tablet 2600 2,600 - 2,600 10,000
64 Dexamethasone injeksi 5 mg/ml - 1 ml Ampul 190 190 20 170
65 Dextrose monohydrat 40% Flacon - - 20
66 Diabetadex Fitofarmaka Tablet 210 210 - 210
67 Diazepam injeksi 5 mg / 2 ml Ampul 29 10 39 2 37 30
68 Diazepam Tablet 5 mg Tablet 240 100 340 - 340 200
69 Digoxin tablet 0,25 mg Tablet - -
70 Diltiazem HCL Tablet 30 mg Tablet 800 800 - 800
71 Dimenhidrinat 50 mg Tablet 400 400 400 - 500
72 Diphenhydramin HCl injeksi 10 mg/ml-1 ml Ampul - - 200
73 Domperidon Tablet Tablet 2,300 1000 3,300 800 2,500 1,000
74 Epineprin HCl (adrenalin ) inj 0,1 % - 1 ml Ampul 98 98 10 88 100
75 Ergotamin Coffein Tablet - -
76 Febrinex Ped Suspensi 60 ml Botol - -
77 Fenol Gliserol Tetes Telinga 10% Botol 33 33 - 33
78 Fitomenadion (Vit K) Injeksi 2 mg Ampul 300 300 70 230
79 Fitomenadion (Vit K) Tablet Salut 10 mg Tablet 200 200 - 200 1,000
80 Flutamol Syr Botol - -
81 Flutamol Tab Tablet - - 10,000
82 Furosemid 10 Mg/ml Injeksi Ampul 125 125 - 125
83 Furosemid Tablet 40 mg Tablet 800 800 200 600
84 Garam Oralit 200 mg Bungkus 400 400 100 300 100
85 Gentamicin Salep Mata 0,3% Tube - - 100
86 Gentamicin Tetes Mata 0,3% Tube 139 96 235 67 168 100
87 Glibenklamid Tablet 5 mg Tablet 2,600 500 3,100 200 2,900 1,000
88 Glukosa 10% Infus Kolf - -
89 Glukosa 5% Infus Kolf - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
90 Griseolfulvin Tablet 125 mg Micronized Tablet 500 500 100 400 500
91 Haloperidol 0,5 mg Tablet - - 500
92 Haloperidol 1,5 mg Tablet - -
93 Haloperidol 5 mg Tablet 1,058 1000 2,058 400 1,658 1,000
94 Herbakof Syrup Botol - -
95 Herbakof Tablet Tablet - - - 1,000
96 Herbapain (OHT) Obat Anti Nyeri Tablet Tablet - - - 600
97 Herbavomitz obat herbal Botol - -
98 Herbavomitz Tablet Tablet - - - 600
99 Hidroklorotiazid (HCT) Tablet 25 mg Tablet - - 1,000
100 Hidrokortison Krim 2,5% Tube 72 72 24 48 100
101 Ibuprofen (Zentarin) Tablet 400 mg Tablet 1,500 2000 3,500 900 2,600 2,000
102 Ibuprofen Suspensi 100 mg/ 5 ml Botol - -
103 Ibuprofen Suspensi 200 mg/ 5 ml Botol 116 116 - 116
104 Iliadin Drop Tetes Hidung Botol - -
105 Imunomodulator anak Syr 25 mg Botol 4 4 4 - 50
106 Imunomodulator Forte 50 mg Tablet 510 510 30 480
107 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet 500 500 1,000 - 1,000 500
108 KA EN 3A Kolf 6 6 6 - 20
109 KA EN 3B Kolf 32 32 20 12 20
110 Kalsium Laktat (kalk) Tablet 500 mg Tablet 6,800 5000 11,800 3,800 8,000 10,000
111 Karbamazepin 200 mg Tablet 1,325 1,325 91 1,234
112 Ketoconazole 200 mg Tablet 1,200 1,200 600 600 3,000
113 Ketoconazole Zalp Tube 50 50 25 25 100
114 Ketorolac Inj 30mg/ml Ampul 100 100 20 80 100
115 Lactulosa Syr 3,335 g/5ml (Kompolax) Botol 55 55 - 55 100
116 Lansoprazole Tablet 30mg Tablet 1,800 1,800 700 1,100
117 Lidocain (HCI) 2 % 2 ml Injeksi Ampul - - - 100
118 Lidocain (HCI) 2% + Epinefrin 2 mg Ampul 120 150 270 120 150 150
119 Loperamide 2 mg Tablet 3,900 3,900 300 3,600
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
120 Loratadine tab Tablet 2,500 2,500 200 2,300
121 Magnesium sulfat 20% (MgSO4) Ampul 10 10 - 10
122 Magnesium sulfat 40% (MgSO4) Ampul 29 10 39 - 39
123 Maltiron Syr 60 ml Botol - -
124 Mersibion Inj Ampul 77 50 127 27 100 100
125 Metformin HCl 500 mg Tablet 4,400 3000 7,400 1,800 5,600 2,000
126 Metilergometrin Inj 0,2 mg/ml Ampul - -
127 Metilergometrin maleat Tab 0,125 mg Tablet - -
128 Metilprednisolon 16 mg Tablet 2,000 2,000 600 1,400
129 Metilprednisolon 4 mg Tablet 1,900 1000 2,900 500 2,400 3,000
130 Metilprednisolon 8 mg Tablet 800 1000 1,800 300 1,500 1,000
131 Metoklorpamide Tablet 10 mg Tablet - -
132 Metoklorpamide Tablet 5 mg Tablet 800 1000 1,800 - 1,800
133 Metronidazol Tab 500mg Tablet 1,600 1,600 400 1,200 1,000
134 Metronidazole Infus Kolf 10 10 - 10
135 Metronidazole Suspensi 125mg/5ml Botol 70 70 - 70
136 Metyldopa (Dopamet) 250 mg Tablet 100 100 - 100 200
137 Miconazole krim 2 % Tube 24 24 24 - 72
138 Mineral Mix Bungkus 120 120 - 120 100
139 Multivitamin Becefort Tablet - - 1,000
140 Multivitamin Becefort Syr 60 ml Botol - -
141 Multivitamin Natabion Dws Capsul - -
142 Multivitamin Oxyvit Tablet - - 1,000
143 Natrium Diklofenak tab 25 mg Tablet - - - 5,000
144 Natrium Diklofenak tab 50 mg Tablet 5,900 3000 8,900 3,600 5,300 5,000
145 Natrium Klorida 0,9% OTSU Botol 120 80 200 80 120 100
146 Nifedipin 10 Mg Tablet 600 600 - 600
147 Nistatin 100.000 IU tab vaginal Tablet 70 70 10 60 100
148 Nistatin 500.000 IU Tablet 300 300 - 300
149 Nistatin suspensi 100.000 IU/mL Botol 100 100 - 100
150 Noza Kaplet Kaplet - - 10,000
151 OBH Kaca Berlico 100ml Botol - -
152 Ofloxacin 200 mg Tablet - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
153 Oksimetazolin tetes hidung 0,05% Botol 33 33 33 -
154 Oksitetrasiklin HCl 1 % zalp mata Tube - -
155 Oksitosin Inj 10 IU/ml Ampul 400 400 - 400
156 Omeprazole caps (Lokev) Capsul - -
157 Ondansentron Injeksi Ampul 105 150 255 - 255
158 Ondansentron Tab 4 mg Tablet - - 500
159 Parasetamol Drops Botol - -
160 Parasetamol Infus btl 8 8 1 7
161 Parasetamol sirup 120mg/5ml Botol 457 457 - 457
162 Parasetamol Tab Tablet 6,500 10000 16,500 10,500 6,000 20,000
163 Phenobarbital injeksi 50 mg / 2 ml Ampul - -
164 Piridoksin HCl Tablet 10 mg ( Vit B6 ) Tablet 3,600 2000 5,600 1,600 4,000 3,000
165 Prednison tab 5 mg Tablet 3,500 3000 6,500 3,200 3,300 6,000
166 Procurma Syr Botol - -
167 Propiltiourasil (PTU) tab 100 mg Tablet 100 100 - 100 500
168 Pularex Tablet Tablet 1,000 500 1,500 - 1,500 500
169 Pyrantel Pamoat 125 mg Tablet - -
170 Pyrantel Pamoat Susp 125mg / 5ml Botol - -
171 Ranitidin 150 mg tab Tablet 1,400 3000 4,400 1,700 2,700 5,000
172 Ranitidin Injeksi Ampul - -
173 Retinol 100.000 IU BIRU Caps - -
174 Retinol 200.000 IU MERAH Caps 250 500 750 100 650 500
175 Ringer Laktat Infus Botol 240 200 440 200 240 500
176 Risperidon 1 mg Tablet - -
177 Risperidon 2 mg Tablet 284 500 784 210 574 1,000
178 Salbutamol 2 mg Tablet 1,900 1,900 100 1,800 1,000
179 Salbutamol 4 mg Tablet 2,100 2,100 900 1,200 1,000
180 Salbutamol Cairan inhalasi Ampul - - 100
181 Salbutamol Syrup Botol 236 236 - 236
182 Salep 2- 4 kombinasi Tube - -
183 Sianokobalamin (Vit. B12) Tab Tablet 200 200 100 100 2,000
184 Simvastatin Tablet 10 mg Tablet 3,400 3,400 400 3,000 1,000
185 Simvastatin Tablet 20 mg Tablet 2,400 1000 3,400 2,450 950 1,000
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
186 Soft U Derm 10% Crema 20gr Tube - - -
187 Spironolactone 25 mg Tablet - - -
188 Stesolid rectal 10 mg / 2,5 ml Tube - - -
189 Stesolid rectal 5 mg / 2,5 ml Tube - - -
190 Sukralfat Suspensi 500mg/ 5ml Botol - - - - 500
191 Sulfadoxine-Pyrimethamine (Suldox) Tablet - - -
192 Tablet Tambah Darah FE Tablet 840 840 840 -
193 Tetagam Inj Vial 3 3 - 3
194 Tetrasiklin 500 mg Tablet - - -
195 Thiamin Hcl (Vit B1) Tablet 50 mg Tablet - - - 1,000
196 Tramadol Inj Ampul - - -
197 Trifluoperazin 5 mg Tablet 3,165 3,165 330 2,835
198 Trihexylphenidil 2 mg Tablet 1,879 1000 2,879 964 1,915 2,000
199 Vitamin B komplek Tablet 8,000 8,000 5,200 2,800 10,000
200 Vitamin D3 1000IU Tablet 630 630 120 510
201 Voltadex Gel 1% 20 gr Tube - - - 20
202 Zinc 20 Mg Tablet Tablet 3,500 3,500 800 2,700 2,000
203 Zinc Syr Botol - - -
204 Zincpro Drop 15 ml Botol - - -
205 Acetyl cysteine tablet 200 mg Tablet 180 180 180 - 500
206 Cefotaxime sodium serb inj 500 mg Injeksi - - -
207 Cendo Lyteers tetes mata, botol @ 15 ml Botol - - -
208 Chloramphenicol salep mata 1 % Tube - - -
209 Curcuma Plus 60 mL Botol - - -
210 Diazepam enema 10 mg/2,5 mL Tube 20 20 3 17
211 Diazepam enema 5 mg/2,5 mL Tube 12 12 - 12
212 Domperidone drops 5 mg/mL Botol - - -
213 Domperidone sirup/suspensi 5 mg/5 ml Botol - - -
214 Farbivent cairan inhalasi Ampul 120 120 10 110 100
215 Flamar Natrium diklofenak tetes mata 1 mg/ml Botol - - -
216 Glimepiride tablet 2 mg Tablet - - - - 2,000
217 Hidrokortison krim 1% Tube - - -
218 Hyaloph Natrium hialuronat tetes mata Botol - - -
219 Hyoscine Butylbromide Tab Tablet 1,000 1,000 - 1,000
220 Midric 0,5% Tropikamid tts mata 0,5% Botol - - -
221 Miniaspi Asam Asetilsalisilat tablet 80 mg Tablet - - - - 500
222 Multivitamin Ferbion Kapsul - - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
223 Novadryl Tablet Tablet - - -
224 Nuvopec Syrup Botol - - -
225 Obat Batuk Hitam Combi Botol 65 50 115 40 75 100
226 Obat Batuk Hitam Anak Combi Botol 71 48 119 61 58 100
227 Obat Flu Anak (HUFA) Botol 90 90 30 60 100
228 Obat Flu Kombinasi (Noza) Tablet - - - 5,000
229 Obat Flu Kombinasi Syrup (Febrinex) Botol - - -
230 Octenic Gel 20 g Tube 6 6 2 4 20
231 Parafen Kaplet Kaplet - - -
232 Permetrin Krim 5% Tube 20 20 - 20
233 Propranolol tablet 10 mg Tablet 700 700 100 600
234 Sianokobalamin (vitamin B12) injeksi 500 mcg/m Ampul 100 100 - 100
235 Vip Albumin Obat Herbal Tablet 630 630 20 610
236 Vitamin C 1000mg/ Provit C Tablet 780 780 90 690
- -
BAHAN MEDIS HABIS PAKAI, REAGEN DAN LARUTAN - -
1 Alat Suntik 1 ml Stera Buah - -
2 Alat suntik 1 ml TP Pcs 1,000 1,000 400 600
3 Alat Suntik 10 cc Stera Buah - - - 500
4 Alat suntik 10 ml TP Pcs - - - 500
5 Alat Suntik 3 cc Stera Buah - - -
6 Alat suntik 3 ml TP Pcs - - - 500
7 Alat Suntik 5 cc Stera buah - - -
8 Alkohol 1 Liter Onemed Botol - 22 22 13 9 5
9 Alkohol 70% 300 ml Botol - - 20
10 Alkohol swab Aximed Pcs 4,000 4,000 2,500 1,500
11 Apron Plastik one Pcs 270 100 370 80 290 100
12 Aqua proinjeksi steril 20 ml Vial 280 120 400 40 360
13 Arm Sling Comfort L Buah 3 3 1 2
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
14 Arm Sling Comfort S Buah 6 6 - 6
15 Bactivec BTI DBD SL Botol - - -
16 Baju APD Coverall Pcs 20 20 - 20
17 Bioplacenton Tulle Pcs - - 50
18 Blood Lancet Serenity Pcs 1,900 1,900 - 1,900
19 Blood transfusion set ABADA Pcs 200 200 75 125
20 Blue Tips Bks - 5 5 - 5 5
21 Catgut chromic 3/0 70 cm violet reverse cutting 1 Pcs - -
22 Catgut Chromic Surgical Sutures Pcs 84 84 168 36 132 72
23 Catgut Plain Surgical Sutures box 144 84 228 60 168 72
24 Catgut provein 5/0 PV888 45 cm 18 mm Pcs - - -
25 Catgut silk 3/0 75 cm 3/8 CC 19 mm Pcs - -
26 Cervical collar Buah - -
27 Derm transport dressing remedi Pcs - -
28 Dermafix S 4,4 x 4,4 cm Buah - -
29 Dermafix S 6 x 7 cm buah - -
30 Dermafix T 15cm x 20 cm Roll - -
31 Dermafix T 5x7 Buah - -
32 Dressing IV canulla non woven remedi Pcs - -
33 Endotracheal Tube (ETT) uk. 6,0 fesco Pcs - -
34 Endotracheal Tube (ETT) uk. 7,0 fesco Pcs - -
35 Endotracheal Tube (ETT) uk. 7,5 fesco Pcs - -
36 Endotracheal Tube (ETT) uk. 8,0 fesco Pcs - -
37 Female Cateter No 16 Aximed Pcs - -
38 Female Cateter No 18 Aximed Pcs - -
39 Foley catheter no. 16 latex 2 way ABADA Pcs 50 50 - 50 20
40 Pcs 50 50 - 50
Foley catheter no. 18 (2 way standard) serenity 20
41 Foley catheter no. 18 latex 2 way ABADA Pcs - -
42 40 40 20 20
Folley catheter uro one 2 way, FR 16, FR 18 Buah
43 Hand Gel H1 100 ml+flip top Botol - -
44 Handrub 5 L Medika Ken - -
45 Handrub 500 ml Medika Botol 60 72 - 72
46 Handrub e-care 500 ml Botol 16 48 64 49 15
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
47 Handscrub e-care 500 ml Botol 24 24 6 18 50
48 Hazmat suit Winner Pcs - -
49 Indodent Saliva ejector Buah - -
50 Infusion set anak set 60 60 - 60
51 Infusion set dewasa ST01 set - - 300
52 Infusion set microdrip ABADA Pcs - -
53 Infusion set microdrip Otsu Pcs 160 160 40 120
54 Infusion Set Y Adaptor Otsu Pcs - - 300
55 IV Catheter No. 18G Cath Pro Pcs 150 150 - 150
56 IV Catheter No. 20G Cath Pro Pcs - - - 100
57 IV Catheter No. 20G Otsu Pcs - - -
58 IV Catheter No. 22G Cath Pro Pcs - - - 100
59 IV Catheter No. 24G Cath Pro Pcs 150 150 50 100 100
60 IV Catheter With Teflon Catheter 1 way 18 G Set - -
61 IV Catheter With Teflon Catheter 1 way 24 G set - -
62 IV Catheter With Teflon Catheter 1 way 26 G set - -
63 IV Catheter WP No. 26G Aximed Pcs 50 50 - 50 100
64 Kantong Jenazah Pcs - -
65 Kantong limbah biohazard uk. L Pack 6 5 11 - 11 5
66 Kantong limbah biohazard uk. M Pack 10 5 15 - 15 5
67 Kantong limbah biohazard uk. S Pack 3 3 - 3 5
68 Kapas 250 gram Rol 18 10 28 1 27 50
69 Kapas 500 gram Bks - -
70 Kasa hidrofil 15 x 4 cm BIOKASA Pcs - -
71 Kasa hidrofil 2 m x 10 cm ABADA Rol 500 500 - 500
72 Kasa hidrofil 2 m x 80 cm Roll - - 100
73 Kasa hidrofil 20y x 80 cm ABADA Rol - - 100
74 Kasa hidrofil 36 cm x 80 cm BIOKASA Rol - - 100
75 Kasa hidrofil 4 m x 10 cm Roll - -
76 Kasa hidrofil 4 m x 15 cm Roll - -
77 Kasa hidrofil 4 m x 15 cm ABADA Rol - -
78 Kasa hidrofil 4 m x 3 cm Roll - -
79 Kasa hidrofil 4 m x 5 cm Roll - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
80 Kasa hidrofil 4 m x 7,5 cm ABADA Rol 230 230 80 150 500
81 Kasa hidrofil 40 cm x 80 cm Rol 10 10 10 -
82 Kasa hidropil 16 cm x 16 cm ABADA Kotak - - - 100
83 Kasa Steril 10 cm x 10 cm 16 Ply isi 10 Roll - - - 100
84 300 300 100 200
Kasa Steril 10 cm x 10 cm 16 Ply isi 10 LDX Roll
85 Kasa Steril 16 x 16 cm Roll 212 100 312 112 200 100
86 Kasa Steril 18 cm x 22 cm Roll - -
87 Rol 5 5 - 5
Kertas EKG 4.5 in (11.4 cm) x 65.6 ft (20 m)
88 Kertas EKG 112 mm Rol - -
89 Kertas EKG Z-fold : 215×280mm Rol - -
90 Latex Examination Gloves Uk. L Pcs - -
91 Latex Examination Gloves Uk. M Pcs 700 700 700 - 4,000
92 Latex Examination Gloves Uk. S Pcs - -
93 Latex Examination Gloves Uk. XS Pcs - -
94 Masker Ear Loop Pcs - 4000 4,000 1,000 3,000 5,000
95 Masker N95 Particulate Respirator unit 160 160 - 160
96 Masker Nebulizer Anak Unit - -
97 Masker Nebulizer Dewasa Unit - -
98 Masker Nebulizer Dewasa Cosmo Pcs - -
99 Masker Nebulizer Uk M Anak ABADA Pcs - -
100 Masker Nebulizer Uk. L Dewasa ABADA Pcs - -
101 Masker Oksigen Adult Serenity Pcs - -
102 Masker Oksigen Anak Semillas Pcs - -
103 Masker Oksigen Dwsa Semillas Pcs 6 6 - 6 20
104 Masker Oksigen Infant Serenity Pcs
105 Masker Oksigen Pediatric Serenity Pcs 24 24 - 24
106 Maxiflow Anak Unit - -
107 Maxiflow Bayi unit - -
108 Maxiflow Dewasa unit 50 50 - 50
109 Micropipet Adjust Vol. 0,1-2,5 UL Pcs - -
110 Micropipet Adjust Vol. 0,5-10 UL Pcs - -
111 Micropipet Adjust Vol. 100-1.000 UL Pcs - -
112 Micropipet Adjust Vol. 10-100 UL Pcs - -
113 Micropipet Adjust Vol. 200-1.000 UL Pcs - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
114 Micropipet Adjust Vol. 2-20 UL Pcs - -
115 Micropipet Adjust Vol. 50-200 UL Pcs - -
116 Micropipet Adjust Vol. 5-50 UL Pcs - -
117 Micropipet Fixed Vol. 10 UL Pcs - -
118 Micropipet Fixed Vol. 100 UL Pcs - -
119 Micropipet Fixed Vol. 20 UL Pcs - -
120 Micropipet Fixed Vol. 25 UL Pcs - -
121 Micropipet Fixed Vol. 5 UL Pcs - -
122 Micropipet Fixed Vol. 50 UL Pcs - -
123 Micropipet Fixed Vol. 500 UL Pcs - -
124 Mucus Extractor buah 50 50 - 50
125 Mucus Extractor Serenity Pcs 18 18 - 18
126 M-Y Jelly 82 Gram Tube Buah 1 1 - 1 20
127 Nasal Oksigen Canula Anak Pcs - - -
128 Nasal Oxygen Canula Adult Serenity Pcs 200 100 300 - 300 500
129 Nasal Oxygen Canula Infant Serenity Pcs 29 29 - 29 50
130 Nasal Oxygen Canula Pediatric Serenity Pcs 200 200 - 200
131 Needle CNV 21 x 1,5 ml (BD vacutainer) Pcs - -
132 Needle CNV 22 x 1,5 ml MLTSMPCE Pcs - -
133 Non Woven IV Dressing 6 x 8 cm Pcs - -
134 Nurse Cap Box 12 12 - 12
135 One Scrub 2% Antiseptic surgical scrub dispense Botol - -
136 One Scrub 4 %, 500 cc + dispenser Botol 10 12 22 4 18 50
137 Oxyflow Anak Buah 8 8 - 8 100
138 Oxyflow bayi Buah 3 3 - 3 100
139 Oxyflow Dewasa Buah 33 50 83 3 80 200
140 Paper tape 1,25 cm x 9,14 cm Aximed Rol 30 30 - 30
141 Paper tape 7,5 cm x 9,14 cm Aximed Rol 14 14 - 14
142 Papsmer Kit M Buah - -
143 Papsmer Kit S Buah - -
144 Parafilm 4 in x 125 FT Box - -
145 Plesterin Roll Non Woven roll 10cm x 5m Roll 16 16 7 9
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
146 Plesterin Roll Non Woven roll 15 cm x 5 m Roll 5 5 1 4
147 Plesterin Roll Non Woven roll 5cm x 5m Roll 11 11 - 11
148 Policrepe 10 cm x 4,55 m Rol - -
149 Policrepe 15 cm x 4,55 m Rol - -
150 Povidon Iodine 60 ml medika Botol 25 25 1 24
151 Povidone Iodine 300 ml BOTOL - -
152 Pot Sputum Buah - - - 300
153 RDT Antigen - Healgen Pcs - - 200
154 Reagen Afinion HbA1c Botol - -
155 Reagen Afinion HbA1C Control KIT - -
156 Reagen Anti A 1 x 10 ml KIT - -
157 Reagen Anti AB 1 x 10 ml KIT - -
158 Reagen Anti B 1 x 10 ml KIT - -
159 Reagen Anti D 1 x 10 ml KIT - -
160 Reagen Diluent M-30 20 L Mindray Botol - -
161 Reagen Lyse 500 ml Zenix Botol - -
162 Reagen Proline Tryglicerides KIT - -
163 Reagen Rinse 20 L Mindray Botol - -
164 Reagen Salmonella Paratyphi AH 1x5 ml KIT - -
165 Reagen Salmonella Paratyphi AO 1x5 ml KIT - -
166 Reagen Salmonella Paratyphi BH 1x5 ml KIT - -
167 Reagen Salmonella Paratyphi BO 1x5 ml KIT - -
168 Reagen Salmonella Paratyphi CH 1x5 ml KIT - -
169 Reagen Salmonella Paratyphi CO 1x5 ml KIT - -
170 Reagen Salmonella Paratyphi H 1x5 ml KIT - -
171 Reagen Salmonella Paratyphi O 1x5 ml KIT - -
172 Rivanol 300 cc Botol 49 49 - 49
173 Safety box Buah 100 100 200 - 200 100
174 Saniswiss biosanitizer H1 500 ml Botol 20 20 1 19
175 Sepatu Boots Pair 10 10 - 10
176 Servical Collar Serenity Pcs 50 50 - 50
177 Silk Braided Surgical Sutures USP 3/0 box - -
178 Spalk first AID Pcs - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
179 Sterile Scalpel Blade#10F#3 Box - -
180 Sterile Scalpel Blade#12F#3 Box - -
181 Sterile Scalpel Blade#23F#34 Box - -
182 Sterile Scalpel Blade#24F#4 Box 1 1 - 1
183 Stomach Tube 85 cm No 16.Aximed Pcs 10 10 - 10
184 Stomach Tube 85 cm No.12 Aximed Pcs 7 7 - 7
185 Stomach Tube 85 cm No.14 Aximed Pcs 7 7 - 7
186 Stomach Tube 85 cm No.18 Aximed Pcs 10 10 - 10
187 Strip Test Cholestrol Autocheck Box - - - 200
188 Strip Test Detecto HbsAg Onemed Buah 100 100 75 25
189 Strip Test Focus New HIV 1/2 3 Line Pcs - -
190 Strip Test Glucosa On Call Plus Box 50' - - 200
191 Strip test Hb Hemoglobin Mission Pcs 350 350 - 350
192 Strip Test Health Mate Syphilis Ab Plus Box 200 200 - 200
193 Strip test SD HIV Bioline Pcs 50 50 25 25
194 Strip Test Ultra One (Test kehamilan) Buah - - 100
195 Strip Test Uric Acid Autocheck Box - - 200
196 Strip test Uritest 11G Botol 11 11 - 11
197 Strip test Virotec dengue Combo Unit 75 75 50 25
198 Suction Catheter FR 10 unit - -
199 Suction Catheter FR 12 unit - -
200 Surfaces S 5000 ml Biosanitizer KEN - -
201 Surfaces S 750 ml Biosanitizer Botol - -
202 Surgical Examination Gynecolog Onemed Set - -
203 Surgical Gloves No. 6.5 Serenity Pcs - -
204 Thermal Paper EFG Roll Roll - -
205 Tips For Micro MT 200 IU Pcs - -
206 Tips For Micro MT II 1 ml Pcs - -
207 Tips For Micropipet MSTP Pcs - -
208 Umbilical cord clame fesco Pcs 100 100 - 100 200
209 Umbilical Cord Clamp Buah - -
210 Underpad (Softpad) 60 x 90 cm Pcs - - 300
211 U-Pad Steril Buah - - 100
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
212 Urine bag + hanger Pcs 175 175 1 174
213 Urine bag + hanger Semilas Pcs - -
214 USG Gel 250 ml Botol 24 24 - 24
215 Viorex liquid Botol - -
216 White Tips Bks - -
217 Write On ID Bracelet Adult blue remedi Pcs 100 100 - 100
218 Write On ID Bracelet Adult pink remedi Pcs 100 100 - 100
219 Write On ID Bracelet Child hijau remedi Pcs 200 200 - 200
220 Write On ID Bracelet Child ungu remedi Pcs 100 100 - 100
221 Xpert MTB/ RIF Assay Kit Cartrigde TCM Pcs - -
222 Yellow Tip Bks - -

Bahan Gigi
1 Articulating Paper Pcs - - 100
2 Calcimol LC Botol - - 10
3 Cavit G ( Ceivitron) Pot - - 50
4 Cement Spatula Pcs - - 20
5 CHKM Botol - - 20
6 Dycal/ Hydcal Botol - - 20
7 GC Fuji 9 Mini Pack Box - - 10
8 Mikroaplikator Tips Botol - - 10
9 Oco/ Poliren No. 1 Botol - - 10
10 Bedaquilline 100 mg Tablet 376 376 - 376
11 Clofazimin Tablet 200 200 - 200
12 DHP-Frimal 27 27 - 27
13 Etambutol 400 mg Tablet 448 448 - 448
14 Ethionamid 250 mg Tablet 300 300 - 300
15 Isoniazid 300 mg Tablet - - -
16 KDT Dosis Harian Paket 5 5 - 5
17 Levofloxacin 250 mg Tablet 100 100 - 100
18 Moxyfloxacin 400 mg Tablet - - -
19 OAT Kategori Anak Paket 3 3 1 2
20 OAT Kat. I FDC Paket 5 16 21 3 18
21 Piridosin Hcl Tablet 25 mg (Vit. B6) Tablet - - - - 500
22 Primaquine Tablet - - -
23 Pyrazinamide 400 mg Tablet 448 448 - 448
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
24 Rapid tes Malaria Test - - 100
25 Sarung Tangan Obgyn - - 100
26 plester Winner 10x5 m - -
27 plester Winner 5x5 m - -
28 Tabung EDTA 3 ml - -
29 Latex Goves Powder M Chorona Care Pcs 2000 4,000 6,000 3,000 3000 2000
30 Isoniazid 100 mg Tablet - -
31 Rifampicin 75 mg + Isoniazid 50 mg Tablet 84 84 - 84
32 Rifapentin 150 mg Tablet 90 90 - 90
33 Rifapentin 300 mg/Isoniazid 300 mg Tablet 90 90 - 90
34 Tuberkulin PPD RT 23 Vial - - -
35 Surgical gloves No. 7,5 Trosensosurge Botol - -
36 Pehavral Tablet 1100 1,100 100 1000
37 Strip Test HIV 1/2 - One Step Pcs 50 50 - 50
38 Strip Test HIV 1/2 - Standar Q Pcs 100 100 - 100
39 Verorab Vaksin Rabies inj 2,5 IU Vial 14 14 - 14
40 STRIP TEST HIV/SHYPILIS DUO Pcs 200 200 - 200
41 Gentamisin salep Kulit Tube 20 60 80 26 54 50
42 GG/Guaifenesin Tablet Tablet 3800 3000 6,800 1,600 5200 5,000
43 Hyperhep (HBIG) Vial - -
44 Levofloxacin 100 mg Tablet 500 500 - 500
45 Solpenox Syr Botol 350 120 470 88 382
46 Strip Test Glucosa Autocheck Pcs 500 500 - 500
47 Safety Lancet Onemed Box 13 13 - 13
48 Reco Tetes Telinga Botol 75 75 - 75
49 Lisol 1 liter Botol 10 10 - 10 10
50 Vaksin Rabivax-S Vial 25 25 - 25
51 Asam Ascorbat (Vit c) Tab 500 mg Tablet 3000 3,000 - 3000

Jumlah Kunjungan Resep Rawat Jalan Rawat Inap Total


2500 500 3,000

Mengetahui, Yang meminta/Melapor


Kepala Puskesmas Karangan Pengelola Obat Puskesmas Karangan
Kabupaten Landak
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket

Marta Rahayu,SKM apt. M. Agustine Dwi Steviana, S.Farm


NIP. 196603031987032009 NIP. 199508042022032010
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

KABUPATEN : LANDAK
PUSKESMAS : PUSKESMAS KARANGAN
BULAN/TAHUN : APRIL / 2023

OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
1 Acyclovir 400mg Tablet 510 510 60 450
2 Acyclovir Salep Tube 100 100 - 100
3 Albendazole 400 mg Tablet - 1000 1,000 - 1000
4 Albendazole Suspensi Botol - -
5 Allopurinol 100 mg Tablet 3,900 3,900 900 3000
6 Allopurinol 300 mg Tablet 4,700 4,700 700 4000
7 Alprazolam 0,5 mg Tablet 785 500 1,285 160 1125
8 Alprazolam 1 mg Tablet 538 500 1,038 372 666 600
9 Ambroxol 30 mg tab Tablet 3,600 1000 4,600 3,000 1600 10,000
10 Ambroxol Syrup Botol - - 200
11 Aminofilin injeksi 24 mg/ml Ampul - -
12 Amitriptillin 25 mg Tablet - -
13 Amlodipin Tab 10 mg Tablet 7,500 2100 9,600 3,080 6520 2,000
14 Amlodipin Tab 5 mg Tablet 2,400 2,400 1,100 1300 1,000
15 Amoxicillin 100 mg/ml Drops Botol - - 100
16 Amoxicillin 500 mg Tablet 5,600 3000 8,600 5,000 3600 10,000
17 Amoxicillin dry syrup 125 mg / 5 ml Botol 100 100 - 100
18 Ampicillin injeksi Ampul 230 230 30 200
19 Antasida DOEN Kombinasi Tablet 7,000 11400 18,400 7,000 11400 15,000
20 Antasida DOEN Syrup Botol - - 200
21 Antifungi DOEN Kombinasi Tube 60 60 - 60
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
22 Antihemoroid DOEN Kombinasi Supp 30 30 - 30
23 Apricot Syrup Botol 14 14 14 0 50
24 Asam Ascorbat (Vit c) Tab 50 mg Tablet 4,300 4,300 4,300 0 10,000
25 Asam asetilsalisilat (Miniaspi 80 mg) Tablet - - 1,000
26 Asam Mefenamat 500 mg Tablet 1,800 5000 6,800 2,000 4800 10,000
27 Asam Tranexamat inj 100 mg/ml Ampul 90 90 10 80
28 Asam Tranexamat inj 50 mg/ml Ampul 40 40 10 30
29 Asering Infuse 500 ml Kolf - -
30 Atropin sulfat injeksi 0,25 mg/mil -1 ml Ampul 88 88 2 86 100
31 Betahistine Besilat 6 mg Tablet - - 5,000
32 Betametason cream 0,1 % Tube 124 100 224 49 175 100
33 BIOSAT 1.500 (anti tetanus) Vial - -
34 BIOSAVE (anti bisa ular) VIAL - - 20
35 Bisoprolol 5 mg Tablet 720 720 120 600
36 Bufacetin salep kulit 1% Tube 72 72 144 24 120 100
37 Calcii Glukonas Inj Ampul - - 50
38 Captopril 12,5 mg Tablet 1,800 1000 2,800 200 2600 1,000
39 Captopril 25 mg Tablet 2,300 1000 3,300 500 2800 1,000
40 Cefadroxil 250 mg Tablet - -
41 Cefadroxil 500 mg Tablet 900 900 200 700 3,000
42 Cefadroxil Dry Syrup 125 mg Botol 345 345 2 343
43 Cefotaxime Injeksi 1 gr Vial - - 100
44 Ceftriaxon Inj 1000 mg Vial 10 10 10 100
45 Cetirizin 10 mg tab Tablet 5,000 5000 10,000 5,200 4800 7,000
46 Cetirizin Syrup Botol 147 147 - 147
47 Chloramfenicol 250 mg Capsul - -
48 Chloramfenicol 500 mg Capsul - -
49 Chloramfenicol tetes telinga Botol - -
50 Chlorfeniramin Maleat 4 mg (CTM) Tablet 6,600 10000 16,600 5,100 11500 10,000
51 Chlorpromazine 100 mg Tablet 500 500 - 500
52 Chlorpromazine 25mg Tablet 1,090 1,090 120 970
53 Ciprofloxacin 500 mg Tablet 1,800 1000 2,800 700 2100 1,000
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
54 Clindamicin 150 mg Capsul - - 5,000
55 Clozapin 100 mg Tablet - - 2,000
56 Clozapin 25 mg Tablet - - 2,000
57 Codein hcl Tablet 10 mg Tablet - -
58 Combivent Nebules Vial - -
59 Cotrimoxazole 480mg Tablet 3,400 3,400 300 3100
60 Cotrimoxazole 960 mg Tablet - - 2,000
61 Cotrimoxazole sirup Botol - - 50
62 Desoximetasone Krim 0.25% Tube 10 10 2 8 50
63 Dexamethason Tab 0,5 mg Tablet 2,600 5000 7,600 2,600 5000 10,000
64 Dexamethasone injeksi 5 mg/ml - 1 ml Ampul 170 170 70 100
65 Dextrose monohydrat 40% Flacon - - 20
66 Diabetadex Fitofarmaka Tablet 210 210 - 210
67 Diazepam injeksi 5 mg / 2 ml Ampul 37 37 28 9 50
68 Diazepam Tablet 5 mg Tablet 340 340 - 340
69 Digoxin tablet 0,25 mg Tablet - - 500
70 Diltiazem HCL Tablet 30 mg Tablet 800 800 - 800
71 Dimenhidrinat 50 mg Tablet - - - 1,000
72 Diphenhydramin HCl injeksi 10 mg/ml-1 ml Ampul - - 200
73 Domperidon Tablet Tablet 2,500 1000 3,500 1,000 2500
74 Epineprin HCl (adrenalin ) inj 0,1 % - 1 ml Ampul 88 100 188 4 184 100
75 Ergotamin Coffein Tablet - - 500
76 Febrinex Ped Suspensi 60 ml Botol - - 100
77 Fenol Gliserol Tetes Telinga 10% Botol 33 33 - 33
78 Fitomenadion (Vit K) Injeksi 2 mg Ampul 230 230 30 200
79 Fitomenadion (Vit K) Tablet Salut 10 mg Tablet 200 200 200 0 1,000
80 Flutamol Syr Botol - - 100
81 Flutamol Tab Tablet - - 10,000
82 Furosemid 10 Mg/ml Injeksi Ampul 125 125 25 100
83 Furosemid Tablet 40 mg Tablet 600 600 100 500
84 Garam Oralit 200 mg Bungkus 300 300 300 0 100
85 Gentamicin Salep Mata 0,3% Tube - - 100
86 Gentamicin Tetes Mata 0,3% Tube 168 96 264 82 182 100
87 Glibenklamid Tablet 5 mg Tablet 2,900 1000 3,900 800 3100
88 Glukosa 10% Infus Kolf - -
89 Glukosa 5% Infus Kolf - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
90 Griseolfulvin Tablet 125 mg Micronized Tablet 400 1000 1,400 200 1200 500
91 Haloperidol 0,5 mg Tablet - - 500
92 Haloperidol 1,5 mg Tablet - - 1,000
93 Haloperidol 5 mg Tablet 1,658 1000 2,658 354 2304 1,000
94 Herbakof Syrup Botol - - 100
95 Herbakof Tablet Tablet - - 1,000
96 Herbapain (OHT) Obat Anti Nyeri Tablet Tablet - - 600
97 Herbavomitz obat herbal Botol - -
98 Herbavomitz Tablet Tablet - - 600
99 Hidroklorotiazid (HCT) Tablet 25 mg Tablet - - 1,000
100 Hidrokortison Krim 2,5% Tube 48 48 48 0 100
101 Ibuprofen (Zentarin) Tablet 400 mg Tablet 2,600 2000 4,600 2,000 2600 3,000
102 Ibuprofen Suspensi 100 mg/ 5 ml Botol - -
103 Ibuprofen Suspensi 200 mg/ 5 ml Botol 116 116 - 116
104 Iliadin Drop Tetes Hidung Botol - -
105 Imunomodulator anak Syr 25 mg Botol - - - 100
106 Imunomodulator Forte 50 mg Tablet 480 480 60 420
107 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet 1,000 500 1,500 - 1500 500
108 KA EN 3A Kolf - - - 20
109 KA EN 3B Kolf 12 12 12 0 20
110 Kalsium Laktat (kalk) Tablet 500 mg Tablet 8,000 5000 13,000 7,300 5700 10,000
111 Karbamazepin 200 mg Tablet 1,234 1,234 142 1092
112 Ketoconazole 200 mg Tablet 600 3000 3,600 600 3000
113 Ketoconazole Zalp Tube 25 50 75 25 50 100
114 Ketorolac Inj 30mg/ml Ampul 80 100 180 - 180 100
115 Lactulosa Syr 3,335 g/5ml (Kompolax) Botol 55 55 1 54 100
116 Lansoprazole Tablet 30mg Tablet 1,100 1,100 500 600 2,000
117 Lidocain (HCI) 2 % 2 ml Injeksi Ampul - - 100
118 Lidocain (HCI) 2% + Epinefrin 2 mg Ampul 150 150 300 90 210 150
119 Loperamide 2 mg Tablet 3,600 3,600 500 3100
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
120 Loratadine tab Tablet 2,300 2,300 300 2000
121 Magnesium sulfat 20% (MgSO4) Ampul 10 10 - 10
122 Magnesium sulfat 40% (MgSO4) Ampul 39 39 18 21
123 Maltiron Syr 60 ml Botol - - 100
124 Mersibion Inj Ampul 100 50 150 60 90 100
125 Metformin HCl 500 mg Tablet 5,600 5,600 1,200 4400 2,000
126 Metilergometrin Inj 0,2 mg/ml Ampul - -
127 Metilergometrin maleat Tab 0,125 mg Tablet - -
128 Metilprednisolon 16 mg Tablet 1,400 1,400 600 800
129 Metilprednisolon 4 mg Tablet 2,400 2,400 1,400 1000 3,000
130 Metilprednisolon 8 mg Tablet 1,500 1000 2,500 800 1700 1,000
131 Metoklorpamide Tablet 10 mg Tablet - -
132 Metoklorpamide Tablet 5 mg Tablet 1,800 1,800 - 1800
133 Metronidazol Tab 500mg Tablet 1,200 1,200 600 600 2,000
134 Metronidazole Infus Kolf 10 10 1 9
135 Metronidazole Suspensi 125mg/5ml Botol 70 70 - 70
136 Metyldopa (Dopamet) 250 mg Tablet 100 100 - 100 200
137 Miconazole krim 2 % Tube - - - 72
138 Mineral Mix Bungkus 120 120 - 120
139 Multivitamin Becefort Tablet - - 1,000
140 Multivitamin Becefort Syr 60 ml Botol - - 100
141 Multivitamin Natabion Dws Capsul - - 1,000
142 Multivitamin Oxyvit Tablet - - 1,000
143 Natrium Diklofenak tab 25 mg Tablet - - 5,000
144 Natrium Diklofenak tab 50 mg Tablet 5,300 5,300 5,300 0 5,000
145 Natrium Klorida 0,9% OTSU Botol 120 100 220 60 160 100
146 Nifedipin 10 Mg Tablet 600 600 - 600
147 Nistatin 100.000 IU tab vaginal Tablet 60 100 160 60 100 100
148 Nistatin 500.000 IU Tablet 300 300 100 200
149 Nistatin suspensi 100.000 IU/mL Botol 100 100 1 99
150 Noza Kaplet Kaplet - - 10,000
151 OBH Kaca Berlico 100ml Botol - - 100
152 Ofloxacin 200 mg Tablet - - 2,000
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
153 Oksimetazolin tetes hidung 0,05% Botol - - -
154 Oksitetrasiklin HCl 1 % zalp mata Tube - -
155 Oksitosin Inj 10 IU/ml Ampul 400 400 100 300
156 Omeprazole caps (Lokev) Capsul - - 2,000
157 Ondansentron Injeksi Ampul 255 255 10 245
158 Ondansentron Tab 4 mg Tablet - - 500
159 Parasetamol Drops Botol - - 100
160 Parasetamol Infus btl 7 7 1 6
161 Parasetamol sirup 120mg/5ml Botol 457 457 - 457
162 Parasetamol Tab Tablet 6,000 6,000 6,000 0 20,000
163 Phenobarbital injeksi 50 mg / 2 ml Ampul - -
164 Piridoksin HCl Tablet 10 mg ( Vit B6 ) Tablet 4,000 1000 5,000 1,900 3100 3,000
165 Prednison tab 5 mg Tablet 3,300 6000 9,300 2,600 6700 6,000
166 Procurma Syr Botol - - 100
167 Propiltiourasil (PTU) tab 100 mg Tablet 100 100 100 0 500
168 Pularex Tablet Tablet 1,500 500 2,000 400 1600 500
169 Pyrantel Pamoat 125 mg Tablet - -
170 Pyrantel Pamoat Susp 125mg / 5ml Botol - -
171 Ranitidin 150 mg tab Tablet 2,700 5000 7,700 2,700 5000 7,000
172 Ranitidin Injeksi Ampul - - 100
173 Retinol 100.000 IU BIRU Caps - -
174 Retinol 200.000 IU MERAH Caps 650 500 1,150 100 1050
175 Ringer Laktat Infus Botol 240 500 740 340 400 700
176 Risperidon 1 mg Tablet - -
177 Risperidon 2 mg Tablet 574 1000 1,574 552 1022 2,000
178 Salbutamol 2 mg Tablet 1,800 1000 2,800 1,700 1100
179 Salbutamol 4 mg Tablet 1,200 1000 2,200 500 1700
180 Salbutamol Cairan inhalasi Ampul - - 100
181 Salbutamol Syrup Botol 236 236 - 236
182 Salep 2- 4 kombinasi Tube - -
183 Sianokobalamin (Vit. B12) Tab Tablet 100 100 100 0 2,000
184 Simvastatin Tablet 10 mg Tablet 3,000 1000 4,000 1,700 2300 1,000
185 Simvastatin Tablet 20 mg Tablet 950 1000 1,950 700 1250 1,000
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
186 Soft U Derm 10% Crema 20gr Tube - - -
187 Spironolactone 25 mg Tablet - - - 1,000
188 Stesolid rectal 10 mg / 2,5 ml Tube - - -
189 Stesolid rectal 5 mg / 2,5 ml Tube - - -
190 Sukralfat Suspensi 500mg/ 5ml Botol - - - 500
191 Sulfadoxine-Pyrimethamine (Suldox) Tablet - - -
192 Tablet Tambah Darah FE Tablet - - - 10,000
193 Tetagam Inj Vial 3 3 - 3
194 Tetrasiklin 500 mg Tablet - - -
195 Thiamin Hcl (Vit B1) Tablet 50 mg Tablet - - - 2,000
196 Tramadol Inj Ampul - - -
197 Trifluoperazin 5 mg Tablet 2,835 2,835 240 2595
198 Trihexylphenidil 2 mg Tablet 1,915 2000 3,915 776 3139 1,000
199 Vitamin B komplek Tablet 2,800 2,800 2,800 0 10,000
200 Vitamin D3 1000IU Tablet 510 510 510 0 1,000
201 Voltadex Gel 1% 20 gr Tube - - - 20
202 Zinc 20 Mg Tablet Tablet 2,700 2,700 2,000 700 500
203 Zinc Syr Botol - - - 100
204 Zincpro Drop 15 ml Botol - - - 100
205 Acetyl cysteine tablet 200 mg Tablet - 600 600 - 600 500
206 Cefotaxime sodium serb inj 500 mg Injeksi - - -
207 Cendo Lyteers tetes mata, botol @ 15 ml Botol - - - 10
208 Chloramphenicol salep mata 1 % Tube - - -
209 Curcuma Plus 60 mL Botol - - - 100
210 Diazepam enema 10 mg/2,5 mL Tube 17 17 - 17
211 Diazepam enema 5 mg/2,5 mL Tube 12 12 5 7
212 Domperidone drops 5 mg/mL Botol - - -
213 Domperidone sirup/suspensi 5 mg/5 ml Botol - - -
214 Farbivent cairan inhalasi Ampul 110 110 60 50 100
215 Flamar Natrium diklofenak tetes mata 1 mg/ml Botol - - -
216 Glimepiride tablet 2 mg Tablet - - - 2,000
217 Hidrokortison krim 1% Tube - - - 100
218 Hyaloph Natrium hialuronat tetes mata Botol - - -
219 Hyoscine Butylbromide Tab Tablet 1,000 1,000 - 1000
220 Midric 0,5% Tropikamid tts mata 0,5% Botol - - -
221 Miniaspi Asam Asetilsalisilat tablet 80 mg Tablet - - - 500
222 Multivitamin Ferbion Kapsul - - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
223 Novadryl Tablet Tablet - - -
224 Nuvopec Syrup Botol - - -
225 Obat Batuk Hitam Combi Botol 75 50 125 35 90 100
226 Obat Batuk Hitam Anak Combi Botol 58 96 154 58 96 100
227 Obat Flu Anak (HUFA) Botol 60 60 120 12 108 100
228 Obat Flu Kombinasi (Noza) Tablet - - - 5,000
229 Obat Flu Kombinasi Syrup (Febrinex) Botol - - - 100
230 Octenic Gel 20 g Tube 4 4 1 3 20
231 Parafen Kaplet Kaplet - - -
232 Permetrin Krim 5% Tube 20 20 7 13 20
233 Propranolol tablet 10 mg Tablet 600 600 - 600
234 Sianokobalamin (vitamin B12) injeksi 500 mcg/m Ampul 100 100 - 100
235 Vip Albumin Obat Herbal Tablet 610 610 - 610
236 Vitamin C 1000mg/ Provit C Tablet 690 690 180 510
- -
BAHAN MEDIS HABIS PAKAI, REAGEN DAN LARUTAN - -
1 Alat Suntik 1 ml Stera Buah - -
2 Alat suntik 1 ml TP Pcs 600 600 200 400 500
3 Alat Suntik 10 cc Stera Buah - -
4 Alat suntik 10 ml TP Pcs - - 500
5 Alat Suntik 3 cc Stera Buah - -
6 Alat suntik 3 ml TP Pcs - - 1,000
7 Alat Suntik 5 cc Stera buah - - 1,000
8 Alkohol 1 Liter Onemed Botol 9 22 31 - 31
9 Alkohol 70% 300 ml Botol - - 10
10 Alkohol swab Aximed Pcs 1,500 1,500 1,100 400 5,000
11 Apron Plastik one Pcs 310 100 410 - 410
12 Aqua proinjeksi steril 20 ml Vial 360 360 - 360 100
13 Arm Sling Comfort L Buah 3 3 - 3
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
14 Arm Sling Comfort S Buah 7 7 - 7
15 Bactivec BTI DBD SL Botol - - -
16 Baju APD Coverall Pcs 20 20 - 20
17 Bioplacenton Tulle Pcs - - 20
18 Blood Lancet Serenity Pcs 1,900 1,900 - 1900 5,000
19 Blood transfusion set ABADA Pcs 125 125 55 70 100
20 Blue Tips Bks 5 5 - 5
21 Catgut chromic 3/0 70 cm violet reverse cutting 1 Pcs - -
22 Catgut Chromic Surgical Sutures Pcs 132 48 180 72 108 108
23 Catgut Plain Surgical Sutures box 168 48 216 - 216 72
24 Catgut provein 5/0 PV888 45 cm 18 mm Pcs - - -
25 Catgut silk 3/0 75 cm 3/8 CC 19 mm Pcs - - 72
26 Cervical collar Buah - -
27 Derm transport dressing remedi Pcs - -
28 Dermafix S 4,4 x 4,4 cm Buah - -
29 Dermafix S 6 x 7 cm buah - -
30 Dermafix T 15cm x 20 cm Roll - -
31 Dermafix T 5x7 Buah - -
32 Dressing IV canulla non woven remedi Pcs - -
33 Endotracheal Tube (ETT) uk. 6,0 fesco Pcs - -
34 Endotracheal Tube (ETT) uk. 7,0 fesco Pcs - -
35 Endotracheal Tube (ETT) uk. 7,5 fesco Pcs - -
36 Endotracheal Tube (ETT) uk. 8,0 fesco Pcs - -
37 Female Cateter No 16 Aximed Pcs - -
38 Female Cateter No 18 Aximed Pcs - -
39 Foley catheter no. 16 latex 2 way ABADA Pcs 50 20 70 10 60
40 Pcs 50 20 70 -
Foley catheter no. 18 (2 way standard) serenity 70
41 Foley catheter no. 18 latex 2 way ABADA Pcs - -
42 20 20 20
Folley catheter uro one 2 way, FR 16, FR 18 Buah 0
43 Hand Gel H1 100 ml+flip top Botol - -
44 Handrub 5 L Medika Ken - -
45 Handrub 500 ml Medika Botol 72 48 72 - 146
46 Handrub e-care 500 ml Botol 15 15 1 14
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
47 Handscrub e-care 500 ml Botol 18 18 - 18
48 Hazmat suit Winner Pcs - -
49 Indodent Saliva ejector Buah - -
50 Infusion set anak set 60 60 10 50 100
51 Infusion set dewasa ST01 set - - 200
52 Infusion set microdrip ABADA Pcs - - 200
53 Infusion set microdrip Otsu Pcs 120 120 30 90
54 Infusion Set Y Adaptor Otsu Pcs - - 200
55 IV Catheter No. 18G Cath Pro Pcs 150 150 50 100
56 IV Catheter No. 20G Cath Pro Pcs - - 100
57 IV Catheter No. 20G Otsu Pcs - -
58 IV Catheter No. 22G Cath Pro Pcs - - 300
59 IV Catheter No. 24G Cath Pro Pcs 100 100 50 50 300
60 IV Catheter With Teflon Catheter 1 way 18 G Set - -
61 IV Catheter With Teflon Catheter 1 way 24 G set - -
62 IV Catheter With Teflon Catheter 1 way 26 G set - -
63 IV Catheter WP No. 26G Aximed Pcs 50 50 50 0 100
64 Kantong Jenazah Pcs - -
65 Kantong limbah biohazard uk. L Pack 11 5 16 16 0 5
66 Kantong limbah biohazard uk. M Pack 15 15 15 0 5
67 Kantong limbah biohazard uk. S Pack 3 3 3 0 5
68 Kapas 250 gram Rol 27 27 - 27
69 Kapas 500 gram Bks - -
70 Kasa hidrofil 15 x 4 cm BIOKASA Pcs - -
71 Kasa hidrofil 2 m x 10 cm ABADA Rol 500 500 50 450
72 Kasa hidrofil 2 m x 80 cm Roll - - 20
73 Kasa hidrofil 20y x 80 cm ABADA Rol - -
74 Kasa hidrofil 36 cm x 80 cm BIOKASA Rol - -
75 Kasa hidrofil 4 m x 10 cm Roll - -
76 Kasa hidrofil 4 m x 15 cm Roll - -
77 Kasa hidrofil 4 m x 15 cm ABADA Rol - -
78 Kasa hidrofil 4 m x 3 cm Roll - -
79 Kasa hidrofil 4 m x 5 cm Roll - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
80 Kasa hidrofil 4 m x 7,5 cm ABADA Rol 150 100 250 - 400
81 Kasa hidrofil 40 cm x 80 cm Rol - 10 10 10 0 10
82 Kasa hidropil 16 cm x 16 cm ABADA Kotak - - - 100
83 Kasa Steril 10 cm x 10 cm 16 Ply isi 10 Roll - - -
84 200 300 500 -
Kasa Steril 10 cm x 10 cm 16 Ply isi 10 LDX Roll 500
85 Kasa Steril 16 x 16 cm Roll 200 200 92 108 100
86 Kasa Steril 18 cm x 22 cm Roll - -
87 Rol 5 5 -
Kertas EKG 4.5 in (11.4 cm) x 65.6 ft (20 m) 5
88 Kertas EKG 112 mm Rol - -
89 Kertas EKG Z-fold : 215×280mm Rol - -
90 Latex Examination Gloves Uk. L Pcs - - 2,000
91 Latex Examination Gloves Uk. M Pcs - - - 0 5,000
92 Latex Examination Gloves Uk. S Pcs - - 1,000
93 Latex Examination Gloves Uk. XS Pcs - -
94 Masker Ear Loop Pcs 3,000 3000 6,000 6,000 0 5,000
95 Masker N95 Particulate Respirator unit 160 160 - 160
96 Masker Nebulizer Anak Unit - -
97 Masker Nebulizer Dewasa Unit - -
98 Masker Nebulizer Dewasa Cosmo Pcs - -
99 Masker Nebulizer Uk M Anak ABADA Pcs - -
100 Masker Nebulizer Uk. L Dewasa ABADA Pcs - -
101 Masker Oksigen Adult Serenity Pcs - -
102 Masker Oksigen Anak Semillas Pcs - -
103 Masker Oksigen Dwsa Semillas Pcs 6 6 - 6
104 Masker Oksigen Infant Serenity Pcs -
105 Masker Oksigen Pediatric Serenity Pcs 24 24 24 0
106 Maxiflow Anak Unit - -
107 Maxiflow Bayi unit - -
108 Maxiflow Dewasa unit 50 50 28 22
109 Micropipet Adjust Vol. 0,1-2,5 UL Pcs - -
110 Micropipet Adjust Vol. 0,5-10 UL Pcs - -
111 Micropipet Adjust Vol. 100-1.000 UL Pcs - -
112 Micropipet Adjust Vol. 10-100 UL Pcs - -
113 Micropipet Adjust Vol. 200-1.000 UL Pcs - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
114 Micropipet Adjust Vol. 2-20 UL Pcs - -
115 Micropipet Adjust Vol. 50-200 UL Pcs - -
116 Micropipet Adjust Vol. 5-50 UL Pcs - -
117 Micropipet Fixed Vol. 10 UL Pcs - -
118 Micropipet Fixed Vol. 100 UL Pcs - -
119 Micropipet Fixed Vol. 20 UL Pcs - -
120 Micropipet Fixed Vol. 25 UL Pcs - -
121 Micropipet Fixed Vol. 5 UL Pcs - -
122 Micropipet Fixed Vol. 50 UL Pcs - -
123 Micropipet Fixed Vol. 500 UL Pcs - -
124 Mucus Extractor buah 50 50 - 50
125 Mucus Extractor Serenity Pcs 18 18 - 18
126 M-Y Jelly 82 Gram Tube Buah 1 1 1 0 50
127 Nasal Oksigen Canula Anak Pcs - -
128 Nasal Oxygen Canula Adult Serenity Pcs 300 200 500 - 500
129 Nasal Oxygen Canula Infant Serenity Pcs 29 29 29 0
130 Nasal Oxygen Canula Pediatric Serenity Pcs 200 200 - 200
131 Needle CNV 21 x 1,5 ml (BD vacutainer) Pcs - -
132 Needle CNV 22 x 1,5 ml MLTSMPCE Pcs - -
133 Non Woven IV Dressing 6 x 8 cm Pcs - -
134 Nurse Cap Box 12 12 1 11
135 One Scrub 2% Antiseptic surgical scrub dispense Botol - -
136 One Scrub 4 %, 500 cc + dispenser Botol 18 18 - 18 10
137 Oxyflow Anak Buah 8 8 - 12 100
138 Oxyflow bayi Buah 3 3 - 4 100
139 Oxyflow Dewasa Buah 80 50 130 80 50 200
140 Paper tape 1,25 cm x 9,14 cm Aximed Rol 30 30 - 30
141 Paper tape 7,5 cm x 9,14 cm Aximed Rol 14 14 - 14
142 Papsmer Kit M Buah - -
143 Papsmer Kit S Buah - -
144 Parafilm 4 in x 125 FT Box - -
145 Plesterin Roll Non Woven roll 10cm x 5m Roll 9 9 2 7 10
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
146 Plesterin Roll Non Woven roll 15 cm x 5 m Roll 4 4 1 3 10
147 Plesterin Roll Non Woven roll 5cm x 5m Roll 11 11 1 10 10
148 Policrepe 10 cm x 4,55 m Rol - -
149 Policrepe 15 cm x 4,55 m Rol - -
150 Povidon Iodine 60 ml medika Botol 24 24 1 23
151 Povidone Iodine 300 ml BOTOL - -
152 Pot Sputum Buah - -
153 RDT Antigen - Healgen Pcs - - 200
154 Reagen Afinion HbA1c Botol - -
155 Reagen Afinion HbA1C Control KIT - -
156 Reagen Anti A 1 x 10 ml KIT - -
157 Reagen Anti AB 1 x 10 ml KIT - -
158 Reagen Anti B 1 x 10 ml KIT - -
159 Reagen Anti D 1 x 10 ml KIT - -
160 Reagen Diluent M-30 20 L Mindray Botol - -
161 Reagen Lyse 500 ml Zenix Botol - -
162 Reagen Proline Tryglicerides KIT - -
163 Reagen Rinse 20 L Mindray Botol - -
164 Reagen Salmonella Paratyphi AH 1x5 ml KIT - -
165 Reagen Salmonella Paratyphi AO 1x5 ml KIT - -
166 Reagen Salmonella Paratyphi BH 1x5 ml KIT - -
167 Reagen Salmonella Paratyphi BO 1x5 ml KIT - -
168 Reagen Salmonella Paratyphi CH 1x5 ml KIT - -
169 Reagen Salmonella Paratyphi CO 1x5 ml KIT - -
170 Reagen Salmonella Paratyphi H 1x5 ml KIT - -
171 Reagen Salmonella Paratyphi O 1x5 ml KIT - -
172 Rivanol 300 cc Botol 49 49 2 47
173 Safety box Buah 200 100 300 - 300
174 Saniswiss biosanitizer H1 500 ml Botol 20 20 - 20
175 Sepatu Boots Pair 10 10 - 10
176 Servical Collar Serenity Pcs 50 50 - 50
177 Silk Braided Surgical Sutures USP 3/0 box - -
178 Spalk first AID Pcs - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
179 Sterile Scalpel Blade#10F#3 Box - -
180 Sterile Scalpel Blade#12F#3 Box - -
181 Sterile Scalpel Blade#23F#34 Box - -
182 Sterile Scalpel Blade#24F#4 Box 1 1 - 1
183 Stomach Tube 85 cm No 16.Aximed Pcs 10 10 - 10
184 Stomach Tube 85 cm No.12 Aximed Pcs 7 7 - 7
185 Stomach Tube 85 cm No.14 Aximed Pcs 7 7 - 7
186 Stomach Tube 85 cm No.18 Aximed Pcs 10 10 - 10
187 Strip Test Cholestrol Autocheck Box - - - 200
188 Strip Test Detecto HbsAg Onemed Buah 25 100 125 100 25 200
189 Strip Test Focus New HIV 1/2 3 Line Pcs - - 200
190 Strip Test Glucosa On Call Plus Box 50' - - 200
191 Strip test Hb Hemoglobin Mission Pcs 350 350 150 200 200
192 Strip Test Health Mate Syphilis Ab Plus Box 200 200 125 75 200
193 Strip test SD HIV Bioline Pcs 25 25 25 0
194 Strip Test Ultra One (Test kehamilan) Buah - - 100
195 Strip Test Uric Acid Autocheck Box - - 200
196 Strip test Uritest 11G Botol 11 11 1 10
197 Strip test Virotec dengue Combo Unit 25 25 - 25 200
198 Suction Catheter FR 10 unit - -
199 Suction Catheter FR 12 unit - -
200 Surfaces S 5000 ml Biosanitizer KEN - -
201 Surfaces S 750 ml Biosanitizer Botol - -
202 Surgical Examination Gynecolog Onemed Set - -
203 Surgical Gloves No. 6.5 Serenity Pcs - -
204 Thermal Paper EFG Roll Roll - -
205 Tips For Micro MT 200 IU Pcs - -
206 Tips For Micro MT II 1 ml Pcs - -
207 Tips For Micropipet MSTP Pcs - -
208 Umbilical cord clame fesco Pcs 100 100 - 100 300
209 Umbilical Cord Clamp Buah - -
210 Underpad (Softpad) 60 x 90 cm Pcs - - 0 300
211 U-Pad Steril Buah - - 0 100
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
212 Urine bag + hanger Pcs 174 174 4 170
213 Urine bag + hanger Semilas Pcs - -
214 USG Gel 250 ml Botol 36 36 - 36
215 Viorex liquid Botol - -
216 White Tips Bks - -
217 Write On ID Bracelet Adult blue remedi Pcs 100 100 - 100 200
218 Write On ID Bracelet Adult pink remedi Pcs 100 100 - 100 200
219 Write On ID Bracelet Child hijau remedi Pcs 200 200 - 200 100
220 Write On ID Bracelet Child ungu remedi Pcs 100 100 - 100 200
221 Xpert MTB/ RIF Assay Kit Cartrigde TCM Pcs 100 100 100 0
222 Yellow Tip Bks - -

Bahan Gigi
1 Articulating Paper Pcs - - 100
2 Calcimol LC Botol - - 10
3 Cavit G ( Ceivitron) Pot - - 50
4 Cement Spatula Pcs - - 20
5 CHKM Botol - - 20
6 Dycal/ Hydcal Botol - - 20
7 GC Fuji 9 Mini Pack Box - - 10
8 Mikroaplikator Tips Botol - - 10
9 Oco/ Poliren No. 1 Botol - - 10
10 Bedaquilline 100 mg Tablet 376 376 - 376
11 Clofazimin Tablet 200 200 - 200
12 DHP-Frimal 27 27 - 27
13 Etambutol 400 mg Tablet 448 448 - 448
14 Ethionamid 250 mg Tablet 300 300 - 300
15 Isoniazid 300 mg Tablet - - -
16 KDT Dosis Harian Paket 5 5 - 5
17 Levofloxacin 250 mg Tablet 100 100 - 100
18 Moxyfloxacin 400 mg Tablet - - -
19 OAT Kategori Anak Paket 2 2 - 2
20 OAT Kat. I FDC Paket 18 18 8 10
21 Piridosin Hcl Tablet 25 mg (Vit. B6) Tablet - - - 500
22 Primaquine Tablet 100 100 - 100
23 Pyrazinamide 400 mg Tablet 448 448 - 448
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
24 Rapid tes Malaria Test - - 200
25 Tabung EDTA 3 ml - - 500
26 Latex Goves Powder M Chorona Care Pcs 3000 2,000 5,000 3,000 2000 2000
27 Isoniazid 100 mg Tablet - -
28 Rifampicin 75 mg + Isoniazid 50 mg Tablet 84 84 84 0
29 Rifapentin 150 mg Tablet 90 90 - 90
30 Rifapentin 300 mg/Isoniazid 300 mg Tablet 90 90 - 90
31 Pehavral Tablet 1000 1,000 500 500 1000
32 Strip Test HIV 1/2 - One Step Pcs 50 200 250 50 200
33 Strip Test HIV 1/2 - Standar Q Pcs 100 100 50 50
34 Verorab Vaksin Rabies inj 2,5 IU Vial 14 14 14 0
35 STRIP TEST HIV/SHYPILIS DUO Pcs 200 200 - 200
36 Gentamisin salep Kulit Tube 54 60 114 42 72 100
37 GG/Guaifenesin Tablet Tablet 5200 2000 7,200 3,400 3800 7,000
38 Hyperhep (HBIG) Vial 5 5 1 4
39 Levofloxacin 100 mg Tablet 500 500 - 500
40 Solpenox Syr Botol 382 382 124 258
41 Strip Test Glucosa Autocheck Pcs 500 500 150 350
42 Safety Lancet Onemed Box 13 13 - 13
43 Reco Tetes Telinga Botol 75 75 - 75
44 Lisol 1 liter Botol 10 10 2 8
45 Vaksin Rabivax-S Vial 25 20 45 45 0
46 Octenic Spray 50 ML Vial 10 10 - 10
47 Latex Powder Gloves Uk (S,M,L) Pcs 2000 2,000 - 2000
48 Reagen Ziehl Neelsen/TB Paket 2 2 2 0
49 Write On ID Bracelet Adult yellow remedi Pcs - - 0 200
50 Asam Ascorbat (Vit c) Tab 500 mg Tablet 3000 3,000 1,400 1600 10,000

Jumlah Kunjungan Resep Rawat Jalan Rawat Inap Total


2500 500 3,000

Mengetahui, Yang meminta/Melapor


Kepala Puskesmas Karangan Pengelola Obat Puskesmas Karangan
Kabupaten Landak
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
Marta Rahayu,SKM apt. M. Agustine Dwi Steviana, S.Farm
NIP. 196603031987032009 NIP. 199508042022032010
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

KABUPATEN : LANDAK
PUSKESMAS : PUSKESMAS KARANGAN
BULAN/TAHUN : MEI / 2023

OBAT
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
1 Acyclovir 400mg Tablet 450 450 270 180 500
2 Acyclovir Salep Tube 100 100 25 75
3 Albendazole 400 mg Tablet 1000 1,000 200 800
4 Albendazole Suspensi Botol - -
5 Allopurinol 100 mg Tablet 3000 3,000 1,200 1800 1,000
6 Allopurinol 300 mg Tablet 4000 4,000 600 3400
7 Alprazolam 0,5 mg Tablet 1125 1,125 173 952
8 Alprazolam 1 mg Tablet 666 600 1,266 333 933 600
9 Ambroxol 30 mg tab Tablet 1600 1,600 1,600 0 10,000
10 Ambroxol Syrup Botol - - 200
11 Aminofilin injeksi 24 mg/ml Ampul - -
12 Amitriptillin 25 mg Tablet - -
13 Amlodipin Tab 10 mg Tablet 6520 3000 9,520 3,570 5950 2,000
14 Amlodipin Tab 5 mg Tablet 1300 1,300 800 500 1,000
15 Amoxicillin 100 mg/ml Drops Botol - - 100
16 Amoxicillin 500 mg Tablet 3600 3,600 3,600 0 10,000
17 Amoxicillin dry syrup 125 mg / 5 ml Botol 100 100 - 100
18 Ampicillin injeksi Ampul 200 200 - 200
19 Antasida DOEN Kombinasi Tablet 11400 15000 26,400 9,900 16500 20,000
20 Antasida DOEN Syrup Botol - - 200
21 Antifungi DOEN Kombinasi Tube 60 60 - 60
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
22 Antihemoroid DOEN Kombinasi Supp 30 30 30 0 10
23 Apricot Syrup Botol 0 - - 0 50
24 Asam Ascorbat (Vit c) Tab 50 mg Tablet 0 - - 0 10,000
25 Asam asetilsalisilat (Miniaspi 80 mg) Tablet 1000 1,000 - 1000 1,000
26 Asam Mefenamat 500 mg Tablet 4800 6000 10,800 4,900 5900 10,000
27 Asam Tranexamat inj 100 mg/ml Ampul 80 80 - 80
28 Asam Tranexamat inj 50 mg/ml Ampul 30 30 - 30
29 Asering Infuse 500 ml Kolf - -
30 Atropin sulfat injeksi 0,25 mg/mil -1 ml Ampul 86 86 - 86 100
31 Betahistine Besilat 6 mg Tablet 3000 3,000 500 2500 5,000
32 Betametason cream 0,1 % Tube 175 100 275 50 225 100
33 BIOSAT 1.500 (anti tetanus) Vial - -
34 BIOSAVE (anti bisa ular) VIAL - - 20
35 Bisoprolol 5 mg Tablet 600 600 - 600
36 Bufacetin salep kulit 1% Tube 120 72 192 34 158 100
37 Calcii Glukonas Inj Ampul 24 24 - 24 50
38 Captopril 12,5 mg Tablet 2600 1000 3,600 500 3100 1,000
39 Captopril 25 mg Tablet 2800 1000 3,800 1,200 2600 2,000
40 Cefadroxil 250 mg Tablet - -
41 Cefadroxil 500 mg Tablet 700 700 700 0 3,000
42 Cefadroxil Dry Syrup 125 mg Botol 343 343 343 0 100
43 Cefotaxime Injeksi 1 gr Vial - - 100
44 Ceftriaxon Inj 1000 mg Vial 100 100 - 100 100
45 Cetirizin 10 mg tab Tablet 4800 7000 11,800 4,300 7500 7,000
46 Cetirizin Syrup Botol 147 147 - 147
47 Chloramfenicol 250 mg Capsul - -
48 Chloramfenicol 500 mg Capsul - -
49 Chloramfenicol tetes telinga Botol - -
50 Chlorfeniramin Maleat 4 mg (CTM) Tablet 11500 5000 16,500 4,000 12500 10,000
51 Chlorpromazine 100 mg Tablet 500 500 90 410
52 Chlorpromazine 25mg Tablet 970 970 90 880
53 Ciprofloxacin 500 mg Tablet 2100 1000 3,100 1,000 2100 1,000
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
54 Clindamicin 150 mg Capsul - - 5,000
55 Clozapin 100 mg Tablet 500 500 30 470 2,000
56 Clozapin 25 mg Tablet 2000 2,000 - 2000 2,000
57 Codein hcl Tablet 10 mg Tablet - -
58 Combivent Nebules Vial - -
59 Cotrimoxazole 480mg Tablet 3100 3,100 800 2300
60 Cotrimoxazole 960 mg Tablet - - 2,000
61 Cotrimoxazole sirup Botol - - 50
62 Desoximetasone Krim 0.25% Tube 8 8 1 7 50
63 Dexamethason Tab 0,5 mg Tablet 5000 800 5,800 5,000 800 10,000
64 Dexamethasone injeksi 5 mg/ml - 1 ml Ampul 100 100 - 100
65 Dextrose monohydrat 40% Flacon - - 20
66 Diabetadex Fitofarmaka Tablet 210 210 - 210
67 Diazepam injeksi 5 mg / 2 ml Ampul 9 10 19 9 10 50
68 Diazepam Tablet 5 mg Tablet 340 340 120 220
69 Digoxin tablet 0,25 mg Tablet - - 500
70 Diltiazem HCL Tablet 30 mg Tablet 800 800 - 800
71 Dimenhidrinat 50 mg Tablet - - 1,000
72 Diphenhydramin HCl injeksi 10 mg/ml-1 ml Ampul - - 200
73 Domperidon Tablet Tablet 2500 2,500 1,200 1300 2,000
74 Epineprin HCl (adrenalin ) inj 0,1 % - 1 ml Ampul 184 184 3 181 100
75 Ergotamin Coffein Tablet - - 500
76 Febrinex Ped Suspensi 60 ml Botol - - 100
77 Fenol Gliserol Tetes Telinga 10% Botol 33 33 24 9
78 Fitomenadion (Vit K) Injeksi 2 mg Ampul 200 200 - 200
79 Fitomenadion (Vit K) Tablet Salut 10 mg Tablet 0 - - 1,000
80 Flutamol Syr Botol - - 100
81 Flutamol Tab Tablet - - 10,000
82 Furosemid 10 Mg/ml Injeksi Ampul 100 100 - 100
83 Furosemid Tablet 40 mg Tablet 500 500 - 500
84 Garam Oralit 200 mg Bungkus 0 - - 100
85 Gentamicin Salep Mata 0,3% Tube - - 100
86 Gentamicin Tetes Mata 0,3% Tube 182 182 96 86 100
87 Glibenklamid Tablet 5 mg Tablet 3100 3,100 1,300 1800 1,000
88 Glukosa 10% Infus Kolf - -
89 Glukosa 5% Infus Kolf - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
90 Griseolfulvin Tablet 125 mg Micronized Tablet 1200 1000 2,200 100 2100 500
91 Haloperidol 0,5 mg Tablet - - 500
92 Haloperidol 1,5 mg Tablet - - 1,000
93 Haloperidol 5 mg Tablet 2304 1000 3,304 837 2467 1,000
94 Herbakof Syrup Botol - - 100
95 Herbakof Tablet Tablet - - 1,000
96 Herbapain (OHT) Obat Anti Nyeri Tablet Tablet - - 600
97 Herbavomitz obat herbal Botol - -
98 Herbavomitz Tablet Tablet - - 600
99 Hidroklorotiazid (HCT) Tablet 25 mg Tablet - - 1,000
100 Hidrokortison Krim 2,5% Tube 0 - - 0 100
101 Ibuprofen (Zentarin) Tablet 400 mg Tablet 2600 1000 3,600 2,300 1300 5,000
102 Ibuprofen Suspensi 100 mg/ 5 ml Botol - -
103 Ibuprofen Suspensi 200 mg/ 5 ml Botol 116 120 236 - 236
104 Iliadin Drop Tetes Hidung Botol - -
105 Imunomodulator anak Syr 25 mg Botol - - 100
106 Imunomodulator Forte 50 mg Tablet 420 420 150 270
107 Isosorbid Dinitrat Tablet Sublingual 5 mg Tablet 1500 500 2,000 - 2000
108 KA EN 3A Kolf - - 20
109 KA EN 3B Kolf 0 - - 0 20
110 Kalsium Laktat (kalk) Tablet 500 mg Tablet 5700 10000 15,700 3,800 11900 10,000
111 Karbamazepin 200 mg Tablet 1092 1,092 212 880
112 Ketoconazole 200 mg Tablet 3000 3,000 1,500 1500 3,000
113 Ketoconazole Zalp Tube 50 50 - 50
114 Ketorolac Inj 30mg/ml Ampul 180 100 280 - 280
115 Lactulosa Syr 3,335 g/5ml (Kompolax) Botol 54 54 1 53 100
116 Lansoprazole Tablet 30mg Tablet 600 600 200 400 2,000
117 Lidocain (HCI) 2 % 2 ml Injeksi Ampul - - 100
118 Lidocain (HCI) 2% + Epinefrin 2 mg Ampul 210 150 360 170 190 150
119 Loperamide 2 mg Tablet 3100 3,100 1,100 2000 1,000
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
120 Loratadine tab Tablet 2000 2,000 500 1500
121 Magnesium sulfat 20% (MgSO4) Ampul 10 10 - 10 10
122 Magnesium sulfat 40% (MgSO4) Ampul 21 21 21 0 10
123 Maltiron Syr 60 ml Botol - - 100
124 Mersibion Inj Ampul 90 90 60 30 100
125 Metformin HCl 500 mg Tablet 4400 4,400 2,000 2400 4,000
126 Metilergometrin Inj 0,2 mg/ml Ampul - -
127 Metilergometrin maleat Tab 0,125 mg Tablet - -
128 Metilprednisolon 16 mg Tablet 800 800 100 700
129 Metilprednisolon 4 mg Tablet 1000 1,000 500 500 3,000
130 Metilprednisolon 8 mg Tablet 1700 1000 2,700 400 2300 1,000
131 Metoklorpamide Tablet 10 mg Tablet - -
132 Metoklorpamide Tablet 5 mg Tablet 1800 1,800 200 1600
133 Metronidazol Tab 500mg Tablet 600 600 600 0 5,000
134 Metronidazole Infus Kolf 9 9 - 9
135 Metronidazole Suspensi 125mg/5ml Botol 70 70 - 70
136 Metyldopa (Dopamet) 250 mg Tablet 100 100 - 100 200
137 Miconazole krim 2 % Tube - - 72
138 Mineral Mix Bungkus 120 120 - 120
139 Multivitamin Becefort Tablet - - 1,000
140 Multivitamin Becefort Syr 60 ml Botol - - 100
141 Multivitamin Natabion Dws Capsul - - 1,000
142 Multivitamin Oxyvit Tablet - - 1,000
143 Natrium Diklofenak tab 25 mg Tablet - - 5,000
144 Natrium Diklofenak tab 50 mg Tablet 0 6000 6,000 500 5500 6,000
145 Natrium Klorida 0,9% OTSU Botol 160 100 260 - 260 100
146 Nifedipin 10 Mg Tablet 600 600 - 600
147 Nistatin 100.000 IU tab vaginal Tablet 100 100 200 100 100 100
148 Nistatin 500.000 IU Tablet 200 200 - 200 200
149 Nistatin suspensi 100.000 IU/mL Botol 99 99 6 93
150 Noza Kaplet Kaplet - - 10,000
151 OBH Kaca Berlico 100ml Botol - - 100
152 Ofloxacin 200 mg Tablet - - 2,000
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
153 Oksimetazolin tetes hidung 0,05% Botol - -
154 Oksitetrasiklin HCl 1 % zalp mata Tube - -
155 Oksitosin Inj 10 IU/ml Ampul 300 300 - 300
156 Omeprazole caps (Lokev) Capsul - - 2,000
157 Ondansentron Injeksi Ampul 245 245 - 245
158 Ondansentron Tab 4 mg Tablet - - 0 1,000
159 Parasetamol Drops Botol - - 100
160 Parasetamol Infus btl 6 6 - 6
161 Parasetamol sirup 120mg/5ml Botol 457 457 - 457
162 Parasetamol Tab Tablet 0 20000 20,000 3,800 16200 20,000
163 Phenobarbital injeksi 50 mg / 2 ml Ampul - -
164 Piridoksin HCl Tablet 10 mg ( Vit B6 ) Tablet 3100 3000 6,100 500 5600 3,000
165 Prednison tab 5 mg Tablet 6700 2000 8,700 6,000 2700 10,000
166 Procurma Syr Botol - - 100
167 Propiltiourasil (PTU) tab 100 mg Tablet 0 - - 0 500
168 Pularex Tablet Tablet 1600 500 2,100 200 1900 500
169 Pyrantel Pamoat 125 mg Tablet - -
170 Pyrantel Pamoat Susp 125mg / 5ml Botol - -
171 Ranitidin 150 mg tab Tablet 5000 1600 6,600 3,000 3600 7,000
172 Ranitidin Injeksi Ampul 100 100 - 100
173 Retinol 100.000 IU BIRU Caps - -
174 Retinol 200.000 IU MERAH Caps 1050 1,050 50 1000
175 Ringer Laktat Infus Botol 400 500 900 200 700 200
176 Risperidon 1 mg Tablet - -
177 Risperidon 2 mg Tablet 1022 2000 3,022 1,140 1882 2,500
178 Salbutamol 2 mg Tablet 1100 1,100 500 600 1,000
179 Salbutamol 4 mg Tablet 1700 1,700 800 900 1,000
180 Salbutamol Cairan inhalasi Ampul 100 100 - 100 100
181 Salbutamol Syrup Botol 236 236 - 236
182 Salep 2- 4 kombinasi Tube - -
183 Sianokobalamin (Vit. B12) Tab Tablet 0 - - 0 2,000
184 Simvastatin Tablet 10 mg Tablet 2300 1000 3,300 1,000 2300 1,000
185 Simvastatin Tablet 20 mg Tablet 1250 1,250 - 1250 1,000
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
186 Soft U Derm 10% Crema 20gr Tube - -
187 Spironolactone 25 mg Tablet - - 1,000
188 Stesolid rectal 10 mg / 2,5 ml Tube - -
189 Stesolid rectal 5 mg / 2,5 ml Tube - -
190 Sukralfat Suspensi 500mg/ 5ml Botol 144 144 - 144 500
191 Sulfadoxine-Pyrimethamine (Suldox) Tablet - -
192 Tablet Tambah Darah FE Tablet 330000 330,000 330,000 0
193 Tetagam Inj Vial 3 3 - 3
194 Tetrasiklin 500 mg Tablet - -
195 Thiamin Hcl (Vit B1) Tablet 50 mg Tablet - - 2,000
196 Tramadol Inj Ampul - -
197 Trifluoperazin 5 mg Tablet 2595 2,595 400 2195
198 Trihexylphenidil 2 mg Tablet 3139 1000 4,139 1,661 2478 2,000
199 Vitamin B komplek Tablet 0 - - 10,000
200 Vitamin D3 1000IU Tablet 0 - - 1,000
201 Voltadex Gel 1% 20 gr Tube - - 20
202 Zinc 20 Mg Tablet Tablet 700 700 400 300 1,000
203 Zinc Syr Botol 108 108 - 108 100
204 Zincpro Drop 15 ml Botol - - 100
205 Acetyl cysteine tablet 200 mg Tablet 600 600 - 600 500
206 Cefotaxime sodium serb inj 500 mg Injeksi - -
207 Cendo Lyteers tetes mata, botol @ 15 ml Botol - - 10
208 Chloramphenicol salep mata 1 % Tube - -
209 Curcuma Plus 60 mL Botol - - 100
210 Diazepam enema 10 mg/2,5 mL Tube 17 17 - 17
211 Diazepam enema 5 mg/2,5 mL Tube 7 7 1 6
212 Domperidone drops 5 mg/mL Botol - -
213 Domperidone sirup/suspensi 5 mg/5 ml Botol - -
214 Farbivent cairan inhalasi Ampul 50 50 - 50 100
215 Flamar Natrium diklofenak tetes mata 1 mg/ml Botol - -
216 Glimepiride tablet 2 mg Tablet 2000 2,000 400 1600 2,000
217 Hidrokortison krim 1% Tube 100 100 16 84 100
218 Hyaloph Natrium hialuronat tetes mata Botol - -
219 Hyoscine Butylbromide Tab Tablet 1000 1,000 100 900
220 Midric 0,5% Tropikamid tts mata 0,5% Botol - -
221 Miniaspi Asam Asetilsalisilat tablet 80 mg Tablet - - 500
222 Multivitamin Ferbion Kapsul - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
223 Novadryl Tablet Tablet - -
224 Nuvopec Syrup Botol - -
225 Obat Batuk Hitam Combi Botol 90 90 5 85 100
226 Obat Batuk Hitam Anak Combi Botol 96 48 144 88 56 100
227 Obat Flu Anak (HUFA) Botol 108 108 11 97 100
228 Obat Flu Kombinasi (Noza) Tablet - - 5,000
229 Obat Flu Kombinasi Syrup (Febrinex) Botol - - 100
230 Octenic Gel 20 g Tube 3 3 1 2 20
231 Parafen Kaplet Kaplet - -
232 Permetrin Krim 5% Tube 13 13 8 5 20
233 Propranolol tablet 10 mg Tablet 600 600 100 500
234 Sianokobalamin (vitamin B12) injeksi 500 mcg/m Ampul 100 100 - 100
235 Vip Albumin Obat Herbal Tablet 610 610 130 480
236 Vitamin C 1000mg/ Provit C Tablet 510 510 120 390

BAHAN MEDIS HABIS PAKAI, REAGEN DAN LARUTAN


1 Alat Suntik 1 ml Stera Buah - -
2 Alat suntik 1 ml TP Pcs 400 500 900 - 900
3 Alat Suntik 10 cc Stera Buah - -
4 Alat suntik 10 ml TP Pcs 200 200 - 200 500
5 Alat Suntik 3 cc Stera Buah - -
6 Alat suntik 3 ml TP Pcs - - 1,000
7 Alat Suntik 5 cc Stera buah - - 1,000
8 Alkohol 1 Liter Onemed Botol 31 31 3 28
9 Alkohol 70% 300 ml Botol - -
10 Alkohol swab Aximed Pcs 400 5000 5,400 500 4900 2,000
11 Apron Plastik one Pcs 410 410 60 350
12 Aqua proinjeksi steril 20 ml Vial 360 360 360 0 100
13 Arm Sling Comfort L Buah 3 3 - 3
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
14 Arm Sling Comfort S Buah 7 7 1 6
15 Bactivec BTI DBD SL Botol - -
16 Baju APD Coverall Pcs 20 20 - 20
17 Bioplacenton Tulle Pcs - - 20
18 Blood Lancet Serenity Pcs 1900 1500 3,400 1,500 1900 5,000
19 Blood transfusion set ABADA Pcs 70 70 43 27 100
20 Blue Tips Bks 5 5 - 5
21 Catgut chromic 3/0 70 cm violet reverse cutting 1 Pcs - -
22 Catgut Chromic Surgical Sutures Pcs 108 108 24 84 72
23 Catgut Plain Surgical Sutures box 216 72 288 - 288
24 Catgut provein 5/0 PV888 45 cm 18 mm Pcs - -
25 Catgut silk 3/0 75 cm 3/8 CC 19 mm Pcs - - 72
26 Cervical collar Buah - -
27 Derm transport dressing remedi Pcs - -
28 Dermafix S 4,4 x 4,4 cm Buah - -
29 Dermafix S 6 x 7 cm buah - -
30 Dermafix T 15cm x 20 cm Roll - -
31 Dermafix T 5x7 Buah - -
32 Dressing IV canulla non woven remedi Pcs - -
33 Endotracheal Tube (ETT) uk. 6,0 fesco Pcs - -
34 Endotracheal Tube (ETT) uk. 7,0 fesco Pcs - -
35 Endotracheal Tube (ETT) uk. 7,5 fesco Pcs - -
36 Endotracheal Tube (ETT) uk. 8,0 fesco Pcs - -
37 Female Cateter No 16 Aximed Pcs - -
38 Female Cateter No 18 Aximed Pcs - -
39 Foley catheter no. 16 latex 2 way ABADA Pcs
40 Pcs 100 100 - 100
Foley catheter no. 18 (2 way standard) serenity
41 Foley catheter no. 18 latex 2 way ABADA Pcs - -
42 - -
Folley catheter uro one 2 way, FR 16, FR 18 Buah
43 Hand Gel H1 100 ml+flip top Botol - -
44 Handrub 5 L Medika Ken - -
45 Handrub 500 ml Medika Botol 146 146 - 146
46 Handrub e-care 500 ml Botol 14 20 34 2 32
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
47 Handscrub e-care 500 ml Botol 18 18 3 15 10
48 Hazmat suit Winner Pcs - -
49 Indodent Saliva ejector Buah - -
50 Infusion set anak set 50 50 35 15 100
51 Infusion set dewasa ST01 set - - 200
52 Infusion set microdrip ABADA Pcs - - 200
53 Infusion set microdrip Otsu Pcs 90 90 10 80
54 Infusion Set Y Adaptor Otsu Pcs - - 200
55 IV Catheter No. 18G Cath Pro Pcs 100 100 - 100
56 IV Catheter No. 20G Cath Pro Pcs - - 100
57 IV Catheter No. 20G Otsu Pcs - - 100
58 IV Catheter No. 22G Cath Pro Pcs - - 300
59 IV Catheter No. 24G Cath Pro Pcs 50 50 50 0 300
60 IV Catheter With Teflon Catheter 1 way 18 G Set - -
61 IV Catheter With Teflon Catheter 1 way 24 G set - -
62 IV Catheter With Teflon Catheter 1 way 26 G set - -
63 IV Catheter WP No. 26G Aximed Pcs 0 - - 0 100
64 Kantong Jenazah Pcs - -
65 Kantong limbah biohazard uk. L Pack 0 5 5 - 5 5
66 Kantong limbah biohazard uk. M Pack 0 - - 5
67 Kantong limbah biohazard uk. S Pack 0 - - 5
68 Kapas 250 gram Rol 27 27 1 26
69 Kapas 500 gram Bks - -
70 Kasa hidrofil 15 x 4 cm BIOKASA Pcs - -
71 Kasa hidrofil 2 m x 10 cm ABADA Rol 450 450 50 400
72 Kasa hidrofil 2 m x 80 cm Roll - -
73 Kasa hidrofil 20y x 80 cm ABADA Rol - -
74 Kasa hidrofil 36 cm x 80 cm BIOKASA Rol - -
75 Kasa hidrofil 4 m x 10 cm Roll - -
76 Kasa hidrofil 4 m x 15 cm Roll - -
77 Kasa hidrofil 4 m x 15 cm ABADA Rol - -
78 Kasa hidrofil 4 m x 3 cm Roll - -
79 Kasa hidrofil 4 m x 5 cm Roll - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
80 Kasa hidrofil 4 m x 7,5 cm ABADA Rol 400 400 - 400
81 Kasa hidrofil 40 cm x 80 cm Rol 10 10 20 5 15 10
82 Kasa hidropil 16 cm x 16 cm ABADA Kotak - - 100
83 Kasa Steril 10 cm x 10 cm 16 Ply isi 10 Roll - -
84 500 500 100 400
Kasa Steril 10 cm x 10 cm 16 Ply isi 10 LDX Roll
85 Kasa Steril 16 x 16 cm Roll 900 900 20 880 100
86 Kasa Steril 18 cm x 22 cm Roll - -
87 Rol 5 5 - 5
Kertas EKG 4.5 in (11.4 cm) x 65.6 ft (20 m)
88 Kertas EKG 112 mm Rol - - 5
89 Kertas EKG Z-fold : 215×280mm Rol - - 5
90 Latex Examination Gloves Uk. L Pcs 2000 2,000 - 2000 2,000
91 Latex Examination Gloves Uk. M Pcs 2000 2,000 - 2000 5,000
92 Latex Examination Gloves Uk. S Pcs 1000 1,000 200 800 1,000
93 Latex Examination Gloves Uk. XS Pcs - -
94 Masker Ear Loop Pcs 0 2000 2,000 2,000 0 5,000
95 Masker N95 Particulate Respirator unit 160 160 - 160
96 Masker Nebulizer Anak Unit - -
97 Masker Nebulizer Dewasa Unit - -
98 Masker Nebulizer Dewasa Cosmo Pcs - -
99 Masker Nebulizer Uk M Anak ABADA Pcs - -
100 Masker Nebulizer Uk. L Dewasa ABADA Pcs - -
101 Masker Oksigen Adult Serenity Pcs - -
102 Masker Oksigen Anak Semillas Pcs - -
103 Masker Oksigen Dwsa Semillas Pcs 6 6 6 0 20
104 Masker Oksigen Infant Serenity Pcs - -
105 Masker Oksigen Pediatric Serenity Pcs 0 - - 0
106 Maxiflow Anak Unit - - 50
107 Maxiflow Bayi unit - - 50
108 Maxiflow Dewasa unit 22 25 47 - 47
109 Micropipet Adjust Vol. 0,1-2,5 UL Pcs - -
110 Micropipet Adjust Vol. 0,5-10 UL Pcs - -
111 Micropipet Adjust Vol. 100-1.000 UL Pcs - -
112 Micropipet Adjust Vol. 10-100 UL Pcs - -
113 Micropipet Adjust Vol. 200-1.000 UL Pcs - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
114 Micropipet Adjust Vol. 2-20 UL Pcs - -
115 Micropipet Adjust Vol. 50-200 UL Pcs - -
116 Micropipet Adjust Vol. 5-50 UL Pcs - -
117 Micropipet Fixed Vol. 10 UL Pcs - -
118 Micropipet Fixed Vol. 100 UL Pcs - -
119 Micropipet Fixed Vol. 20 UL Pcs - -
120 Micropipet Fixed Vol. 25 UL Pcs - -
121 Micropipet Fixed Vol. 5 UL Pcs - -
122 Micropipet Fixed Vol. 50 UL Pcs - -
123 Micropipet Fixed Vol. 500 UL Pcs - -
124 Mucus Extractor buah 50 50 - 50
125 Mucus Extractor Serenity Pcs 18 18 - 18
126 M-Y Jelly 82 Gram Tube Buah 0 - - 50
127 Nasal Oksigen Canula Anak Pcs - -
128 Nasal Oxygen Canula Adult Serenity Pcs 500 500 - 500
129 Nasal Oxygen Canula Infant Serenity Pcs 0 - - 100
130 Nasal Oxygen Canula Pediatric Serenity Pcs 200 200 - 200
131 Needle CNV 21 x 1,5 ml (BD vacutainer) Pcs - -
132 Needle CNV 22 x 1,5 ml MLTSMPCE Pcs - -
133 Non Woven IV Dressing 6 x 8 cm Pcs - -
134 Nurse Cap Box 11 11 1 10
135 One Scrub 2% Antiseptic surgical scrub dispense Botol - -
136 One Scrub 4 %, 500 cc + dispenser Botol 18 18 18 0 10
137 Oxyflow Anak Buah 12 12 12 0 100
138 Oxyflow bayi Buah 4 4 4 0 100
139 Oxyflow Dewasa Buah 50 100 150 33 117
140 Paper tape 1,25 cm x 9,14 cm Aximed Rol 30 30 - 30
141 Paper tape 7,5 cm x 9,14 cm Aximed Rol 14 14 - 14
142 Papsmer Kit M Buah - -
143 Papsmer Kit S Buah - -
144 Parafilm 4 in x 125 FT Box - -
145 Plesterin Roll Non Woven roll 10cm x 5m Roll 7 10 17 4 13 10
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
146 Plesterin Roll Non Woven roll 15 cm x 5 m Roll 3 5 8 - 8 10
147 Plesterin Roll Non Woven roll 5cm x 5m Roll 10 10 4 6 10
148 Policrepe 10 cm x 4,55 m Rol - -
149 Policrepe 15 cm x 4,55 m Rol - -
150 Povidon Iodine 60 ml medika Botol 23 23 3 20
151 Povidone Iodine 300 ml BOTOL - -
152 Pot Sputum Buah 400 400 400 0
153 RDT Antigen - Healgen Pcs - - 0 200
154 Reagen Afinion HbA1c Botol - -
155 Reagen Afinion HbA1C Control KIT - -
156 Reagen Anti A 1 x 10 ml KIT - -
157 Reagen Anti AB 1 x 10 ml KIT - -
158 Reagen Anti B 1 x 10 ml KIT - -
159 Reagen Anti D 1 x 10 ml KIT - -
160 Reagen Diluent M-30 20 L Mindray Botol - -
161 Reagen Lyse 500 ml Zenix Botol - -
162 Reagen Proline Tryglicerides KIT - -
163 Reagen Rinse 20 L Mindray Botol - -
164 Reagen Salmonella Paratyphi AH 1x5 ml KIT - -
165 Reagen Salmonella Paratyphi AO 1x5 ml KIT - -
166 Reagen Salmonella Paratyphi BH 1x5 ml KIT - -
167 Reagen Salmonella Paratyphi BO 1x5 ml KIT - -
168 Reagen Salmonella Paratyphi CH 1x5 ml KIT - -
169 Reagen Salmonella Paratyphi CO 1x5 ml KIT - -
170 Reagen Salmonella Paratyphi H 1x5 ml KIT - -
171 Reagen Salmonella Paratyphi O 1x5 ml KIT - -
172 Rivanol 300 cc Botol 47 47 1 46
173 Safety box Buah 300 300 - 300
174 Saniswiss biosanitizer H1 500 ml Botol 20 20 6 14
175 Sepatu Boots Pair 10 10 - 10
176 Servical Collar Serenity Pcs 50 50 - 50
177 Silk Braided Surgical Sutures USP 3/0 box - -
178 Spalk first AID Pcs - -
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
179 Sterile Scalpel Blade#10F#3 Box - -
180 Sterile Scalpel Blade#12F#3 Box - -
181 Sterile Scalpel Blade#23F#34 Box - -
182 Sterile Scalpel Blade#24F#4 Box 1 1 - 1
183 Stomach Tube 85 cm No 16.Aximed Pcs 10 10 - 10
184 Stomach Tube 85 cm No.12 Aximed Pcs 7 7 - 7
185 Stomach Tube 85 cm No.14 Aximed Pcs 7 7 - 7
186 Stomach Tube 85 cm No.18 Aximed Pcs 10 10 - 10
187 Strip Test Cholestrol Autocheck Box - - 0 200
188 Strip Test Detecto HbsAg Onemed Buah 25 25 25 0 200
189 Strip Test Focus New HIV 1/2 3 Line Pcs - - 200
190 Strip Test Glucosa On Call Plus Box 50' - - 200
191 Strip test Hb Hemoglobin Mission Pcs 200 200 - 200 200
192 Strip Test Health Mate Syphilis Ab Plus Box 75 75 25 50 200
193 Strip test SD HIV Bioline Pcs 0 - -
194 Strip Test Ultra One (Test kehamilan) Buah - - 100
195 Strip Test Uric Acid Autocheck Box - - 200
196 Strip test Uritest 11G Botol 10 10 - 10
197 Strip test Virotec dengue Combo Unit 25 25 - 25 200
198 Suction Catheter FR 10 unit - -
199 Suction Catheter FR 12 unit - -
200 Surfaces S 5000 ml Biosanitizer KEN - -
201 Surfaces S 750 ml Biosanitizer Botol - -
202 Surgical Examination Gynecolog Onemed Set - -
203 Surgical Gloves No. 6.5 Serenity Pcs - -
204 Thermal Paper EFG Roll Roll - -
205 Tips For Micro MT 200 IU Pcs - -
206 Tips For Micro MT II 1 ml Pcs - -
207 Tips For Micropipet MSTP Pcs - -
208 Umbilical cord clame fesco Pcs 100 100 100 0 300
209 Umbilical Cord Clamp Buah - -
210 Underpad (Softpad) 60 x 90 cm Pcs 0 - - 300
211 U-Pad Steril Buah 0 - - 100
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
212 Urine bag + hanger Pcs 170 170 20 150
213 Urine bag + hanger Semilas Pcs - -
214 USG Gel 250 ml Botol 36 36 8 28
215 Viorex liquid Botol - -
216 White Tips Bks - -
217 Write On ID Bracelet Adult blue remedi Pcs 100 100 - 100
218 Write On ID Bracelet Adult pink remedi Pcs 100 100 - 100
219 Write On ID Bracelet Child hijau remedi Pcs 200 200 - 200
220 Write On ID Bracelet Child ungu remedi Pcs 100 100 - 100
221 Xpert MTB/ RIF Assay Kit Cartrigde TCM Pcs 0 100 100 100 0
222 Yellow Tip Bks - -

Bahan Gigi
1 Articulating Paper Pcs - - 100
2 Calcimol LC Botol - - 10
3 Cavit G ( Ceivitron) Pot - - 50
4 Cement Spatula Pcs - - 20
5 CHKM Botol - - 20
6 Dycal/ Hydcal Botol - - 20
7 GC Fuji 9 Mini Pack Box - - 10
8 Mikroaplikator Tips Botol - - 10
9 Oco/ Poliren No. 1 Botol - - 10
10 Bedaquilline 100 mg Tablet 376 376 - 376
11 Clofazimin Tablet 200 200 - 200
12 DHP-Frimal 27 27 27 0
13 Etambutol 400 mg Tablet 448 448 - 448
14 Ethionamid 250 mg Tablet 300 300 - 300
15 Isoniazid 300 mg Tablet - - 0
16 KDT Dosis Harian Paket 5 5 1 4
17 Levofloxacin 250 mg Tablet 100 100 - 100
18 Moxyfloxacin 400 mg Tablet - -
19 OAT Kategori Anak Paket 2 2 4 - 4
20 OAT Kat. I FDC Paket 10 10 6 4
21 Piridosin Hcl Tablet 25 mg (Vit. B6) Tablet - - 500
22 Primaquine Tablet 100 100 - 100
23 Pyrazinamide 400 mg Tablet 448 448 - 448
No Nama Item SATUAN Kelas Terapi Stok Awal Penerimaan Persediaan Pemakaian Kadaluarsa Sisa Stok Permintaan Pemberian Ket
24 Tabung EDTA 3 ml 500 500 - 500 500
25 Latex Goves Powder M Chorona Care Pcs 2000 2,000 2,000 0 2000
26 Isoniazid 100 mg Tablet - - 0
27 Rifampicin 75 mg + Isoniazid 50 mg Tablet 0 - - 0
28 Rifapentin 150 mg Tablet 90 90 - 90
29 Rifapentin 300 mg/Isoniazid 300 mg Tablet 90 90 - 90
30 Pehavral Tablet 500 500 500 0 1000
31 Strip Test HIV 1/2 - One Step Pcs 200 200 50 150
32 Strip Test HIV 1/2 - Standar Q Pcs 50 50 - 50
33 Verorab Vaksin Rabies inj 2,5 IU Vial 0 - - 0
34 STRIP TEST HIV/SHYPILIS DUO Pcs 200 200 - 200
35 Gentamisin salep Kulit Tube 72 100 172 64 108 100
36 GG/Guaifenesin Tablet Tablet 3800 3000 6,800 3,400 3400 7,000
37 Hyperhep (HBIG) Vial 4 4 1 3
38 Levofloxacin 100 mg Tablet 500 500 - 500
39 Solpenox Syr Botol 258 258 118 140
40 Strip Test Glucosa Autocheck Pcs 350 350 - 350
41 Safety Lancet Onemed Box 13 13 - 13
42 Reco Tetes Telinga Botol 75 75 - 75
43 Lisol 1 liter Botol 8 8 3 5
44 Vaksin Rabivax-S Vial 0 20 20 20 0
45 Octenic Spray 50 ML Vial 10 10 20 4 16
46 Latex Powder Gloves Uk (S,M,L) Pcs 2000 2,000 2,000 0
47 Asam Ascorbat (Vit c) Tab 500 mg Tablet 1600 3000 4,600 1,600 3000 10,000
48 Alkohol 70% 500 ML AYN Botol 24 24 - 24
49 Masker bedah DP Pcs 2500 2,500 - 2500

Jumlah Kunjungan Resep Rawat Jalan Rawat Inap Total


2500 500 3,000

Mengetahui, Yang meminta/Melapor


Kepala Puskesmas Karangan Pengelola Obat Puskesmas Karangan
Kabupaten Landak

Marta Rahayu,SKM apt. M. Agustine Dwi Steviana, S.Farm


NIP. 196603031987032009 NIP. 199508042022032010

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