LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( L P L P O )

NAMA PUSKESMAS : SEDAU NO DOC :

NAMA POSKESDES :PERESAK
KAB/KOTA : LOMBOK BARAT TAHUN :2023
LAPORAN BULAN : MEI TANGGAL : 23 MEI 2023
PERMINTAAN BULAN : JUNI

PENERIMAAN RATA-RATA PEMBERIAN

SATUA STOK TOTAL PERSEDIAAN PEMAKAIAN ED / SISA STOK PEMAKAIAN STOK OPT PERMINTAAN PEMBELI
NO NAMA OBAT AWAL PENERIMAAN RUSAK AN PKM
N SUMBER DANA PER BULAN SUMBER DANA
JML
IFK PKM LAIN-LAIN DAK DAU PROG
1 2 3 4 5 6 7 8=(5+6+7) 9=(4+7) 10 11 12=(9-10-11) 12 13 14=(13-11) 15 16 17 18 19

BAHAN MEDIS HABIS PAKAI (BMHP)

Alat Suntik Sekali Pakai - 1 cc Tuberculin 27G x

1 1/2" Set
11 0 11 0 11 0 0 0
2 Alat Suntik Sekali Pakai - 2.5 cc x 23G x 1 1/4" Set
26 0 26 6 20 0 10 0
3 Alat Suntik Sekali Pakai - 5 cc x 22G x 1 1/4" Set
17 0 17 1 16 0 2 0
4 Alat Suntik Sekali Pakai - 10 cc x 21G x 1 1/2" Set
8 0 8 1 7 0 2 0
5 Alat Suntik Sekali Pakai - 20 cc Set
0 0 0 0 0 0 0 0
Benang Operasi - Catgut Plain 2/0 + jarum 1/2
6 Set
GT 35 mm 0 0 0 0 0 0 0 0
8 Benang Operasi - Catgut Plain 3/0 + jarum 1/2 Set
GT 35 mm 0 0 0 0 0 0 0 0
9 Hand Scound Steril No 7 Pasang
0 0 0 0 0 0 0 0
10 Hand Scound Steril No 7,5 Pasang
0 0 0 0 0 0 0 10
11 Hand Scound Non Steril Ukuran L Lembar
11 0 11 0 11 0 0 0
12 Hand Scound Non Steril Ukuran M Lembar
87 0 87 76 11 3 127 100
13 Hand Scound Non Steril Ukuran S Lembar
0 0 0 0 0 0 0 0
14 Hand scound gynaecology non steril
0 0 0 0 0 0 0 0
 PENERIMAAN RATA-RATA PEMBERIAN
SATUA STOK TOTAL ED / PEMBELI
NO NAMA OBAT PERSEDIAAN PEMAKAIAN SISA STOK PEMAKAIAN STOK OPT PERMINTAAN
N AWAL SUMBER DANA PENERIMAAN RUSAK PER BULAN SUMBER DANA AN PKM
JML
IFK PKM LAIN-LAIN DAK DAU PROG
1 2 3 4 5 6 7 8=(5+6+7) 9=(4+7) 10 11 12=(9-10-11) 12 13 14=(13-11) 15 16 17 18 19
15 Hand scound Obgyn Steril Pasang
0 0 0 0 0 0 0 0
Non Woven Dressing for Fixation 10 cm X 5 m
16 Pasang
(hypafix) 0 0 0 0 0 0 0 1
17 Infus Set, IV, Wing needle - Infusion Set Dewasa set
(20 drops/ml) 5 0 5 0 5 0 0 0
18 Infus Set, IV, Wing needle - I.V Catheter No. 18 buah
G x 32 mm 4 0 4 2 2 0 3 3
19 Infus Set, IV, Wing needle - I.V Catheter No. 20 buah
G x 1 1/4 " 0 0 0 0 0 0 0 0
Kasa, Verband, Kapas - Kasa Pembalut /
20 absorben 250 gr Roll
0 0 0 0 0 0 0 1
Kasa, Verband, Kapas - Kasa Hydrophil 40 x 80
21 Roll
cm 0 0 0 0 0 0 0 0
Kasa, Verband, Kapas - Kasa Hydrophil Steril 16
22 x 16 cm Lembar
0 0 0 0 0 0 0 0
Kasa, Verband, Kapas - Kasa Hydrophil Steril 18
23 x 22 cm Lembar
0 0 0 0 0 0 0 0
Kasa, Verband, Kapas - Kasa Pembalut
24 Roll
Hydrophil 4 x 3 cm 0 0 0 0 0 0 0 0
Kasa, Verband, Kapas - Kasa Pembalut
25 Roll
Hydrophil 4 x 10 cm 0 0 0 0 0 0 0 0
Kasa, Verband, Kapas - Kasa Pembalut
26 Roll
Hydrophil 4 x 15 cm 0 0 0 0 0 0 0 0
Kasa, Verband, Kapas - Kasa Pembalut 2 x 80
27 Roll
cm 0 0 0 0 0 0 0 0
28 Mess 11 pcs
5 0 5 0 5 0 0 0
29 Mess 21 pcs
0 0 0 0 0 0 0 0
30 Mess 22 pcs
0 0 0 0 0 0 0 0
31 Plester 5 Yards X 2 inchi Roll
0 0 0 0 0 0 0 0
32 Surgical Mask - 3 ply Tie on (tali) pcs
0 0 0 0 0 0 0 0
33 Surgical Mask - 3 ply Earloop (karet) pcs
16 50 50 66 32 34 1 54 50
34 Underpad 60 cm x 90 cm pcs
4 0 4 0 4 0 0 0
35 Urologi - Folley Catheter 2 way No. 16
pcs 0 0 0 0 0 0 0 0
36 Urologi - Folley Catheter 2 way No. 18
pcs 0 0 0 0 0 0 0 0
 PENERIMAAN RATA-RATA PEMBERIAN
SATUA STOK TOTAL ED / PEMBELI
NO NAMA OBAT PERSEDIAAN PEMAKAIAN SISA STOK PEMAKAIAN STOK OPT PERMINTAAN
N AWAL SUMBER DANA PENERIMAAN RUSAK PER BULAN SUMBER DANA AN PKM
JML
IFK PKM LAIN-LAIN DAK DAU PROG
1 2 3 4 5 6 7 8=(5+6+7) 9=(4+7) 10 11 12=(9-10-11) 12 13 14=(13-11) 15 16 17 18 19
37 Urologi - Urine Bag Standard Steril 2 Lt (T Valve)
pcs 2 0 2 0 2 0 0 0

0
TABLET DAN SERBUK ORAL
0

0
37 Amlodipin tablet 5 mg
Tablet 0 0 0 0 0 0 0 0
38 Amoksisilin kapsul/kaplet/tablet scored 500 mg
Kaplet 130 200 200 330 40 290 2 67 0
Antasida DOEN I tablet kunyah, kombinasi :
39 Aluminium Hidroksida 200 mg Magnesium
Hidroksida 200 mg Tablet 70 0 70 0 70 0 0 0
40 Asam Askorbat (Vitamin C) tablet 250 mg
Tablet 0 0 0 0 0 0 0 0
41 Asam Askorbat (Vitamin C) tablet 50 mg
Tablet 90 0 90 0 90 0 0 0
42 Asam Folat tablet/kapsul/kaplet 1 mg
Tablet 100 0 100 0 100 0 0 0
43 Asam Mefenamat 500 mg tab
Kaplet 110 100 100 210 40 170 2 67 0
44 Asetil N sistein 5 mg tablet
Tablet 0 0 0 0 0 0 0 0
45 Attapulgit Tablet 600 mg
Tablet 0 0 0 0 0 0 0 0
46 Domperidon tablet 10 mg
Tablet 0 0 0 0 0 0 0 0
47 Ibuprofen tablet 400 mg
Tablet 0 0 0 0 0 0 0 0
48 Kalsium Laktat 500 mg
Tablet 100 0 100 0 100 0 0 0
49 Klorfeniramini maleat tab 4 mg( ctm )
Tablet 0 0 0 0 0 0 0 0
50 Kombinasi tablet salut : Besi (II) Fumarat 180
mg Asam folat 0,4 mg (TTD) Tablet 2070 2000 2000 4070 1210 2860 47 2029 0
Kotrimoksazol DOEN I (dewasa) kombinasi :
51
Sulfametoksazol 400 mg Trimetoprim 80 mg Tablet 0 0 0 0 0 0 0 0
52 Mineral mix serbuk
Tablet 0 0 0 0 0 0 0 0
Metilergometrin Maleat (Metilergometrin)
53 tablet salut 0,125 mg
Tablet 100 0 100 0 100 0 0 0
54 Metoklopramide tablet 10 mg
Tablet 0 0 0 0 0 0 0 0
 PENERIMAAN RATA-RATA PEMBERIAN
SATUA STOK TOTAL ED / PEMBELI
NO NAMA OBAT PERSEDIAAN PEMAKAIAN SISA STOK PEMAKAIAN STOK OPT PERMINTAAN
N AWAL SUMBER DANA PENERIMAAN RUSAK PER BULAN SUMBER DANA AN PKM
JML
IFK PKM LAIN-LAIN DAK DAU PROG
1 2 3 4 5 6 7 8=(5+6+7) 9=(4+7) 10 11 12=(9-10-11) 12 13 14=(13-11) 15 16 17 18 19
55 Metronidazole 500 mg tab
Sachet 0 0 0 0 0 0 0 0
 PENERIMAAN RATA-RATA PEMBERIAN
SATUA STOK TOTAL ED / PEMBELI
NO NAMA OBAT PERSEDIAAN PEMAKAIAN SISA STOK PEMAKAIAN STOK OPT PERMINTAAN
N AWAL SUMBER DANA PENERIMAAN RUSAK PER BULAN SUMBER DANA AN PKM
JML
IFK PKM LAIN-LAIN DAK DAU PROG
1 2 3 4 5 6 7 8=(5+6+7) 9=(4+7) 10 11 12=(9-10-11) 12 13 14=(13-11) 15 16 17 18 19
56 Natrium diklofenak 50 mg tab
Paket 0 0 0 0 0 0 0 0
57 Nifedipin tablet/kapsul 10 mg
Paket 30 0 30 0 30 0 0 0
58 Nistatin tablet salut 500.000 IU/ g
Paket 3 0 3 0 3 0 0 0
59 Parasetamol tablet 500 mg
Tablet 80 0 80 0 80 0 0 0
60 Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10
mg (HCl) Tablet 60 100 100 160 10 150 0 17 0
61 Retinol 100 000 iu kapsul (vit a biru)
Kapsul Lunak 0 0 0 0 0 0 0 0
62 Retinol 200 000 iu cap (vit a merah)
Kapsul Lunak 0 0 0 0 0 0 0 0
63 Setirizin tablet 10 mg
Tablet 0 0 0 0 0 0 0 0
64 Thiamin hcl 50 mg tab ( vit b1 )
Tablet 0 0 0 0 0 0 0 0
65 Vit B Komplek tab
Tablet 50 0 50 0 50 0 0 0
66 Zinc tab 20 mg
Tablet 30 0 30 0 30 0 0 0

0
SYRUP
0
67 Amoksisilin sirup kering 125 mg/ 5 ml
Botol 0 0 0 0 0 0 0 0
68 Amoksisilin sirup kering forte 250 mg/5 ml
Botol 0 0 0 0 0 0 0 0
Antasida DOEN II suspensi, kombinasi :
69 Aluminium Hidroksida 200 mg/5 ml Magnesium
Hidroksida 200 mg/5 ml Botol 0 0 0 0 0 0 0 0
70 Domperidon syrup
Botol 0 0 0 0 0 0 0 0
71 Ferosulfat Syrup
Botol 0 0 0 0 0 0 0 0
72 Ibuprofen Suspensi 100 mg/ 5ml
Botol 0 0 0 0 0 0 0 0
73 Kaolin Pectin Syrup
Botol 0 0 0 0 0 0 0 0
74 Kloramfenikol suspensi 125 mg/ 5 ml
Botol 0 0 0 0 0 0 0 0
Kotrimoksazol Suspensi komb: Sulfametoksazol
75 200 mg + Trimetoprim 40 mg / 5 ml
Botol 0 0 0 0 0 0 0 0
 PENERIMAAN RATA-RATA PEMBERIAN
SATUA STOK TOTAL ED / PEMBELI
NO NAMA OBAT PERSEDIAAN PEMAKAIAN SISA STOK PEMAKAIAN STOK OPT PERMINTAAN
N AWAL SUMBER DANA PENERIMAAN RUSAK PER BULAN SUMBER DANA AN PKM
JML
IFK PKM LAIN-LAIN DAK DAU PROG
1 2 3 4 5 6 7 8=(5+6+7) 9=(4+7) 10 11 12=(9-10-11) 12 13 14=(13-11) 15 16 17 18 19
76 Metoklopramide sirup 5 mg/ 5 ml
Botol 0 0 0 0 0 0 0 0
77 Metronidazol suspensi
Botol 0 0 0 0 0 0 0 0
78 Nistatin suspensi
Botol 0 0 0 0 0 0 0 0
79 Parasetamol drop 100 mg/ml btl @15ml
(60mg/0,6ml) Botol 0 0 0 0 0 0 0 0
80 Parasetamol sirup 120 mg / 5 ml
Botol 2 0 3 0 3 0 0 0

0
INJEKSI
0

0
81 Ampisilin serbuk injeksi i.v. 1000 mg/vial
Vial 3 0 3 0 3 0 0 0
82 Aqua Pro Inj 25 ml steril
Vial 0 0 0 0 0 0 0 0
83 Deksametason injeksi i.v./i.m. 5 mg/ml
Ampul 0 0 0 0 0 0 0 0
84 Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml
Ampul 0 0 0 0 0 0 0 0
85 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml
Ampul 5 0 5 0 5 0 0 0
86 Kalsium Glukonas Inj 100 mg/ml
Ampul 2 0 2 0 2 0 0 0
87 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 -
2ml Ampul 0 0 0 0 0 0 0 0
88 Lidokain injeksi 2% (HCL)
Ampul 3 0 3 0 3 0 0 0
89 Magnesium Sulfat 20 % Inj 25 ml
Vial 0 0 0 0 0 0 0 0
90 Magnesium Sulfat 40 % Inj 25 ml
Vial 1 0 1 0 1 0 0 0
91 Metilergometrin Maleat injeksi 0,200 mg-1 ml
Ampul 0 0 0 0 0 0 0 0
92 Oksitosin injeksi 10 IU/ml
Ampul 12 0 12 0 12 0 0 0

0
OBAT KHUSUS 0
 PENERIMAAN RATA-RATA PEMBERIAN
SATUA STOK TOTAL ED / PEMBELI
NO NAMA OBAT PERSEDIAAN PEMAKAIAN SISA STOK PEMAKAIAN STOK OPT PERMINTAAN
N AWAL SUMBER DANA PENERIMAAN RUSAK PER BULAN SUMBER DANA AN PKM
JML
IFK PKM LAIN-LAIN DAK DAU PROG
1 2 3 4 5 6 7 8=(5+6+7) 9=(4+7) 10 11 12=(9-10-11) 12 13 14=(13-11) 15 16 17 18 19

0
93 Nistatin Vaginal tab 100 000 iu/gr
TABLET 3 0 3 0 3 0 0 6

0
CAIRAN
0

0
94 Glukosa larutan infus 5 % steril
Botol 5 0 5 0 5 0 0 0
95 Nacl 0,9%
Botol 0 0 0 0 0 0 0 0
96 Ringer Laktat larutan infus
Botol 5 0 5 0 5 0 0 0

0
OBAT LUAR
0

0
97 Antiseptik dan Disinfektan - alkohol 70% 100 ml
Botol 0 0 0 0 0 0 0 0
98 Antiseptik dan Disinfektan - alkohol 70% 1 liter
Botol 0 0 0 0 0 0 0 0
99 Betametason Cream 0,1 %
Tube 0 0 0 0 0 0 0 0
100 Gentamicin SK 0,1%
Tube 0 0 0 0 0 0 0 0
101 Gentamicin Salep Mata 0,3%
Tube 0 0 0 0 0 0 0 0
102 Gentamisin Sulfat Tetes Mata
Tube 0 0 0 0 0 0 0 0
103 Hidrokortison Cream 2,5 %
Tube 0 0 0 0 0 0 0 0
104 Kloramfenikol Salep Kulit 2 %
Tube 0 0 0 0 0 0 0 0
105 Kloramfenikol salep mata 1 %
Tube 2 0 2 0 2 0 0 0
106 Kloramfenikol teter telinga 3 %
Botol 0 0 0 0 0 0 0 0
107 Povidon Iodida larutan 10% 30 ml
3 0 3 1 2 0 2 0
 PENERIMAAN RATA-RATA PEMBERIAN
SATUA STOK TOTAL ED / PEMBELI
NO NAMA OBAT PERSEDIAAN PEMAKAIAN SISA STOK PEMAKAIAN STOK OPT PERMINTAAN
N AWAL SUMBER DANA PENERIMAAN RUSAK PER BULAN SUMBER DANA AN PKM
JML
IFK PKM LAIN-LAIN DAK DAU PROG
1 2 3 4 5 6 7 8=(5+6+7) 9=(4+7) 10 11 12=(9-10-11) 12 13 14=(13-11) 15 16 17 18 19
108 Povidon Iodida larutan 10% 300 ml
Botol 0 0 0 0 0 0 0 0

0
OBAT NON FORNAS
0
 PENERIMAAN RATA-RATA PEMBERIAN
SATUA STOK TOTAL ED / PEMBELI
NO NAMA OBAT PERSEDIAAN PEMAKAIAN SISA STOK PEMAKAIAN STOK OPT PERMINTAAN
N AWAL SUMBER DANA PENERIMAAN RUSAK PER BULAN SUMBER DANA AN PKM
JML
IFK PKM LAIN-LAIN DAK DAU PROG
1 2 3 4 5 6 7 8=(5+6+7) 9=(4+7) 10 11 12=(9-10-11) 12 13 14=(13-11) 15 16 17 18 19
109 Ambroxol 30 mg tablet
Tablet 0 0 0 0 0 0 0 0
110 Gliseryl guaiakolat 100 mg tab
Tablet 30 0 30 0 30 0 0 0
111 Multi micro nutrien / caviplex tab
Tablet 0 0 0 0 0 0 0 0

0
SIRUP
0
112 Multivitamin syrup
Botol 0 0 0 0 0 0 0 0

0
OBAT LUAR
0

0
113 Asiklovir krim 5 %
Tube 0 0 0 0 0 0 0 0
114 Gentian violet larutan 1 %
Botol 0 0 0 0 0 0 0 0
115 Oksitetrasiklin SK 3%
Tube 0 0 0 0 0 0 0 0
116 Oksitetrasiklin sm 1%
Tube 0 0 0 0 0 0 0 0

0
TAMBAHAN OBAT FORNAS 0
117 vitamin K tablet
tablet 0 0 0 0 0 0 0 0
118 Lexavit
tablet 0 1300 1300 1300 260 1040 10 436 0
119
0 0 0 0 0 0 0 0
120
11 0 11 0 11 0 0 -11
121
11 0 11 0 11 0 0 -11
122
11 0 11 0 11 0 0 -11
 PENERIMAAN RATA-RATA PEMBERIAN
SATUA STOK TOTAL ED / PEMBELI
NO NAMA OBAT PERSEDIAAN PEMAKAIAN SISA STOK PEMAKAIAN STOK OPT PERMINTAAN
N AWAL SUMBER DANA PENERIMAAN RUSAK PER BULAN SUMBER DANA AN PKM
JML
IFK PKM LAIN-LAIN DAK DAU PROG
1 2 3 4 5 6 7 8=(5+6+7) 9=(4+7) 10 11 12=(9-10-11) 12 13 14=(13-11) 15 16 17 18 19

UMUM
TIDAK BAYAR JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR
JKN UKS LAIN-LAIN
0 33 0 19 52

Mengetahui Yang Memberi Yang Menerima dan Melaporkan

pemimpin UPT Puskesmas Petugas Gudang Puskesmas Petugas

Ns. Junaidi, S.Kep Lalu Syarif Hidayatullah, Amd.Far IINDAWATI,Amd keb

NIP. 19730415 199203 1 007 NIP. 19881023 201001 1 006 NIP. 19880126 201101 2 012

KETERANGAN :
LEMBAR PERTAMA (ASLI) : IFK
LEMBAR KEDUA : DIKES LOBAR
LEMBAR KETIGA : ARSIP / PUSKESMAS
NOMOR 58 s/d 247 : OBAT FORNAS
TAMBAHAN FORNAS DAN NON FORNAS : URUTAN SESUAI ABJAD
LAIN-LAIN : DILUAR IFK DAN PKM
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

PUSKESMAS : UPT BLUD PUSKESMAS SEDAU

KAB / KOTA : LOMBOK BARAT
LAPORAN PERIODE / BULAN : NOVEMBER
PERMINTAAN PERIODE / BULAN : DESEMBER

PEMAKAIAN
N0 NAMA OBAT SATUAN STOK AWAL
24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

BAHAN MEDIS HABIS PAKAI (BMHP)

Alat Suntik Sekali Pakai - 1 cc Tuberculin 27G x 1/2" Set

1
2 Alat Suntik Sekali Pakai - 2.5 cc x 23G x 1 1/4" Set 2 2 2
3 Alat Suntik Sekali Pakai - 5 cc x 22G x 1 1/4" Set 1
4 Alat Suntik Sekali Pakai - 10 cc x 21G x 1 1/2" Set
5 Alat Suntik Sekali Pakai - 20 cc Set
Benang Operasi - Catgut Plain 2/0 + jarum 1/2 GT 35 Set
6 mm
Benang Operasi - Catgut Plain 3/0 + jarum 1/2 GT 35 Set
8 mm
9 Hand Scound Steril No 7 Pasang
10 Hand Scound Steril No 7,5 Pasang
11 Hand Scound Non Steril Ukuran L Lembar
12 Hand Scound Non Steril Ukuran M Lembar 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
13 Hand Scound Non Steril Ukuran S Lembar
14 Hand scound gynaecology non steril
15 Hand scound Obgyn Steril Pasang
Non Woven Dressing for Fixation 10 cm X 5 m Pasang
16 (hypafix)
Infus Set, IV, Wing needle - Infusion Set Dewasa (20 set
17 drops/ml)
Infus Set, IV, Wing needle - I.V Catheter No. 18 G x 32 buah
18 mm 1 1
Infus Set, IV, Wing needle - I.V Catheter No. 20 G x 1 buah
19 1/4 "
Kasa, Verband, Kapas - Kasa Pembalut / absorben 250 Roll
20 gr

Kasa, Verband, Kapas - Kasa Hydrophil 40 x 80 cm Roll

21
Kasa, Verband, Kapas - Kasa Hydrophil Steril 16 x 16 Lembar
22 cm
Kasa, Verband, Kapas - Kasa Hydrophil Steril 18 x 22 Lembar
23 cm
Kasa, Verband, Kapas - Kasa Pembalut Hydrophil 4 x 3 Roll
24 cm
Kasa, Verband, Kapas - Kasa Pembalut Hydrophil 4 x Roll
25 10 cm
Kasa, Verband, Kapas - Kasa Pembalut Hydrophil 4 x Roll
26 15 cm
27 Kasa, Verband, Kapas - Kasa Pembalut 2 x 80 cm Roll
28 Mess 11 pcs
29 Mess 21 pcs
30 Mess 22 pcs
31 Plester 5 Yards X 2 inchi Roll
32 Surgical Mask - 3 ply Tie on (tali) pcs
33 Surgical Mask - 3 ply Earloop (karet) pcs 1 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
34 Underpad 60 cm x 90 cm pcs
35 Urologi - Folley Catheter 2 way No. 16 pcs
36 Urologi - Folley Catheter 2 way No. 18 pcs
37 Urologi - Urine Bag Standard Steril 2 Lt (T Valve) pcs

TABLET DAN SERBUK ORAL

37 Amlodipin tablet 5 mg Tablet

38 Amoksisilin kapsul/kaplet/tablet scored 500 mg Kaplet 10 10 10 10
 Antasida DOEN I tablet kunyah, kombinasi :
Aluminium Hidroksida 200 mg Magnesium Hidroksida Tablet
39
200 mg
40 Asam Askorbat (Vitamin C) tablet 250 mg Tablet
41 Asam Askorbat (Vitamin C) tablet 50 mg Tablet
42 Asam Folat tablet/kapsul/kaplet 1 mg Tablet
43 Asam Mefenamat 500 mg tab Kaplet 10 10 10 10
44 Asetil N sistein 5 mg tablet Tablet
45 Attapulgit Tablet 600 mg Tablet
46 Domperidon tablet 10 mg Tablet
47 Ibuprofen tablet 400 mg Tablet
48 Kalsium Laktat 500 mg Tablet
49 Klorfeniramini maleat tab 4 mg( ctm ) Tablet
Kombinasi tablet salut : Besi (II) Fumarat 180 mg
50 Asam folat 0,4 mg (TTD) Tablet 100 90 540 210
Kotrimoksazol DOEN I (dewasa) kombinasi :
51 Sulfametoksazol 400 mg Trimetoprim 80 mg Tablet
52 Mineral mix serbuk Tablet
Metilergometrin Maleat (Metilergometrin) tablet
53 salut 0,125 mg Tablet
54 Metoklopramide tablet 10 mg Tablet
55 Metronidazole 500 mg tab Sachet
56 Natrium diklofenak 50 mg tab Paket
57 Nifedipin tablet/kapsul 10 mg Paket
58 Nistatin tablet salut 500.000 IU/ g Paket
59 Parasetamol tablet 500 mg Tablet
Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg
60 (HCl) Tablet 10
61 Retinol 100 000 iu kapsul (vit a biru) Kapsul Lunak
62 Retinol 200 000 iu cap (vit a merah) Kapsul Lunak
63 Setirizin tablet 10 mg Tablet
64 Thiamin hcl 50 mg tab ( vit b1 ) Tablet
65 Vit B Komplek tab Tablet
66 Zinc tab 20 mg Tablet

SYRUP
67 Amoksisilin sirup kering 125 mg/ 5 ml Botol
68 Amoksisilin sirup kering forte 250 mg/5 ml Botol
Antasida DOEN II suspensi, kombinasi : Aluminium
Hidroksida 200 mg/5 ml Magnesium Hidroksida 200
69
mg/5 ml Botol
70 Domperidon syrup Botol
71 Ferosulfat Syrup Botol
72 Ibuprofen Suspensi 100 mg/ 5ml Botol
73 Kaolin Pectin Syrup Botol
74 Kloramfenikol suspensi 125 mg/ 5 ml Botol
Kotrimoksazol Suspensi komb: Sulfametoksazol 200
75 mg + Trimetoprim 40 mg / 5 ml Botol
76 Metoklopramide sirup 5 mg/ 5 ml Botol
77 Metronidazol suspensi Botol
78 Nistatin suspensi Botol

Parasetamol drop 100 mg/ml btl @15ml (60mg/0,6ml)

79 Botol
80 Parasetamol sirup 120 mg / 5 ml Botol

INJEKSI

81 Ampisilin serbuk injeksi i.v. 1000 mg/vial Vial

82 Aqua Pro Inj 25 ml steril Vial
83 Deksametason injeksi i.v./i.m. 5 mg/ml Ampul
84 Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml Ampul
85 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul
86 Kalsium Glukonas Inj 100 mg/ml Ampul

Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml

87 Ampul
88 Lidokain injeksi 2% (HCL) Ampul
89 Magnesium Sulfat 20 % Inj 25 ml Vial
90 Magnesium Sulfat 40 % Inj 25 ml Vial
91 Metilergometrin Maleat injeksi 0,200 mg-1 ml Ampul
92 Oksitosin injeksi 10 IU/ml Ampul

OBAT KHUSUS

93 Nistatin Vaginal tab 100 000 iu/gr TABLET

CAIRAN

94 Glukosa larutan infus 5 % steril Botol

95 Nacl 0,9% Botol
96 Ringer Laktat larutan infus Botol

OBAT LUAR

97 Antiseptik dan Disinfektan - alkohol 70% 100 ml Botol

98 Antiseptik dan Disinfektan - alkohol 70% 1 liter Botol
99 Betametason Cream 0,1 % Tube
100 Gentamicin SK 0,1% Tube
101 Gentamicin Salep Mata 0,3% Tube
102 Gentamisin Sulfat Tetes Mata Tube
103 Hidrokortison Cream 2,5 % Tube
104 Kloramfenikol Salep Kulit 2 % Tube
105 Kloramfenikol salep mata 1 % Tube
106 Kloramfenikol teter telinga 3 % Botol
107 Povidon Iodida larutan 10% 30 ml 1
108 Povidon Iodida larutan 10% 300 ml Botol

OBAT NON FORNAS

109 Ambroxol 30 mg tablet Tablet
110 Gliseryl guaiakolat 100 mg tab Tablet
111 Multi micro nutrien / caviplex tab Tablet

SIRUP
112 Multivitamin syrup Botol

OBAT LUAR

113 Asiklovir krim 5 % Tube

114 Gentian violet larutan 1 % Botol
115 Oksitetrasiklin SK 3% Tube
116 Oksitetrasiklin sm 1% Tube

TAMBAHAN OBAT FORNAS

117 vitamin k tablet
118 lexavit 50
119
120
121
122
 /X/2015

KET
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