FORMAT LPLPO 2021

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT/BMHP
KODE PUSKESMAS :
PUSKESMAS : RANGAS BULAN : FEBRUARI

KECAMATAN : SIMBORO TAHUN : 2021
KABUPATEN : MAMUJU
PROPINSI : SULAWESI BARAT
PEMBERIAN
STOK STOK JUMLAH
NO NAMA OBAT/BMHP KEMASAN STOK AWAL PENERIMAAN PERSEDIAAN PENGELUARAN PERMINTAAN KET
AKHIR PENGAMAN PEMBERIAN
PKD PROG/DKP LAIN2
1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
1 Acyclovir tab 200 mg Tablet 246 246 - 246 -
2 Acyclovir tab 400 mg Tablet 450 450 100 350 20
3 Alat Suntik Sekali Pakai 1 ml (Stera) Pieces 456 456 95 361 19
4 Alat Suntik Sekali Pakai 3 ml Pcs 293 293 293 - 59
5 Alat Suntik Sekali Pakai 5 ml Pcs 490 490 - 490 -
6 Allopurinol 100 mg Tablet 1,195 1,195 795 400 159
7 Aminophyllin 200 mg tab Tablet 100 100 - 100 -
8 Aminophyllin 24 mg/ml Injeksi Ampul 30 30 - 30 -
9 Amlodipin tablet 5 mg Tablet 402 900 1,302 359 943 72
10 Amlodipin tablet 10 mg Tablet 690 690 582 108 116
11 Amoxicillin 500 mg Tablet 2,187 3,000 5,187 2,378 2,809 476
12 Amoxicillin Sirup 125 mg/5 ml Botol 44 200 244 49 195 10
13 Antasida Tab Tablet 1,951 3,000 4,951 1,911 3,040 382
14 Antacida suspensi btl /60 ml 25 150 175 129 46 26
15 Antihaemorrid Supp Supp/2 g 42 60 102 5 97 1
16 Antimigrain : ergotamine + coffeine tablet 220 220 - 220 -
17 Antiseptik hand rub 500 ml Botol - - -
18 Aqua Pro Injeksi 25 ml Btl/25 ml 18 18 - 18 -
19 Aquasonic Gel 250 ml Botol 8 8 2 6 0
20 Asam Asetilsasilisilat tab 80 mg Tablet 100 100 - 100 -
21 Asam Askorbat tab 50 mg Tablet 1,354 1,000 2,354 2,254 100 451
22 Asam Askorbat tab 250 mg Tablet 8,000 8,000 1,900 6,100 380
23 Asam folat 1 mg tablet - - -
24 Asam Mefenamat tab 500 mg Tablet 1,030 5,500 6,530 2,240 4,290 448
25 Asering Infus Btl/500 ml - - -
26 Atapulgit tab 600 mg Tablet - - -
27 Atropin sulfat Injeksi 0,25 mg/ml Ampul 20 20 - 20 -
28 Basitrasin salep (polimixin B salep) tube 41 41 35 6 7
29 Bedak Salisil Pot 5 20 25 15 10 3
30 Betahistin 6 mg Tablet 320 500 820 90 730 18
31 Betametason 0,1% krim Tube 24 100 124 99 25 20
32 Bisturi No. 10 Pcs 95 95 20 75 4
33 Calcii Gluconas Inj Ampul 2 2 - 2 -
34 Captopril 12,5 mg Tablet 170 170 90 80 18
PEMBERIAN
STOK STOK JUMLAH
PKD PROG/DKP LAIN2
1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
35 Captopril 25 mg tablet 955 1,000 1,955 470 1,485 94
36 Carbamazepin tab 200 mg Tablet - - -
37 Catgut Chromic 2/0 HR 30 MM Pcs 156 156 12 144 2
38 Catgut Chromic 3/0 HR 30 MM Pcs 127 127 - 127 -
39 Cefadroxil 500 mg Tablet 225 500 725 260 465 52
40 Ciprofloxacin tab 500 mg Tablet 900 900 200 700 40
41 Dexamethasone 0,5 mg tablet Tablet 3,157 2,000 5,157 4,017 1,140 803
42 Dexamethasone Injeksi Ampul 10 10 5 5 1
43 Diazepam 2 mg Tablet 54 100 154 30 124 6
44 Diazepam 5 mg Tablet 270 270 10 260 2
45 Diazepam Injeksi Ampul 10 10 - 10 -
46 Difenhidramin Injeksi 10 mg/ml Ampul 20 20 - 20 -
47 Digoxin tablet 0,25 mg Tablet - - -
48 Diltiazem tab 30 mg Tablet - - -
49 Dimenhidrinat tab 50 mg Tablet 88 88 30 58 6
50 Domperidon tablet 10 mg Tablet 200 1,000 1,200 65 1,135 13
51 Efinefrin Injeksi 0,1% Ampul 11 50 61 - 61 -
52 Eritromisin kapsul 250 mg Tablet - - -
53 Eritromisin kapsul 500 mg Capsul - - -
54 Etakridin (Rivanol) 100 ml Botol - - -
55 Etakridin 0,1% 300 ml Btl/300 - - -
56 Etanol 70% 1000 ml Botol - - -
57 Etylchlorida semprot Btl/100 1 1 1 - 0
58 Fenobarbital tab 30 mg Tablet 190 190 - 190 -
59 Fitomenadion (Vit. K1) tab 10 mg Tablet 288 1,100 1,388 215 1,173 43
60 Fitomenadion (Vit. K1) Injeksi 2 mg/ml Ampul 45 45 - 45 -
Fitomenadion (Vit. K1) Injeksi 10
61 Ampul - - -
mg/ml
62 Furosemid tablet 40 mg Tablet - - -
63 Gentamicin salep kulit Tube 28 28 18 10 4
64 Gentamicin salep mata Tube - - -
65 Gentamicin sulfat TM 0,3% Btl/ 5 ml 5 5 - 5 -
66 Gentian Violet 1% Btl/ 5 ml - - -
67 Glibenklamid tab 5 mg Tablet 660 660 100 560 20
68 Glimepiride 2 mg Tablet 599 599 170 429 34
69 Glukosa Larutan Infus 5% 500 ml Botol 13 13 - 13 -
70 Glukosa Larutan Infus 10% 500 ml Botol - - -
71 Griseofulvin 250 mg Tablet 710 500 1,210 760 450 152
72 Haloperidol tab 0,5 mg Tablet - - -
74 Haloperidol 5 mg Tablet 179 179 10 169 2
75 Hidroklorothiazid (HCT) tab Tablet 263 263 - 263 -
76 Hidrokortison Cream 2,5% Tube 57 72 129 88 41 18
77 Hiosina butilbromida tab 10 mg Tablet 340 1,000 1,340 300 1,040 60
78 Hypafix 5 cm x 5 m Roll 1 3 4 4 - 1
79 Ibuprofen 200 mg Tablet 400 4,000 4,400 1,100 3,300 220
80 Ibuprofen 400 mg Tablet 380 1,000 1,380 1,325 55 265
PEMBERIAN
STOK STOK JUMLAH
PKD PROG/DKP LAIN2
1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
81 Infusion set anak Pcs 64 64 - 64 -
PEMBERIAN
STOK STOK JUMLAH
PKD PROG/DKP LAIN2
1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
82 Infusion set dewasa Pcs 55 55 - 55 -
83 Isosorbide Dinitrate tab 5 mg Tablet 100 100 - 100 -
84 IV Canula 18 G Pieces 97 97 10 87 2
85 IV Canula 20 G Pieces 6 6 - 6 -
88 Jarum Jahit bedah No. 9 Bungkus 24 24 - 24 -
91 Ka-en 3B Larutan infus botol - - -
92 Kalium Permanganas Serbuk Pot/ 5 g - - -
93 Kalsium Laktat tab 500 mg Tablet 117 300 417 117 300 23
94 Kapas 250 gram Roll 7 7 5 2 1
Karbogliserin Tetes Telinga (Fenol
95 btl/ 5 ml 18 18 1 17 0
Gliserol 10%)
96 Kasa Kompres 40 x 40 cm Pieces - - -
97 Kasa Roll 3,6 x 5 cm Roll - - -
98 Kasa Roll 3,6 x 15 cm Roll 20 20 20 - 4
99 Kasa Roll Panjang 40 Y x 80 cm Roll 3 5 8 7 1 1
100 Kasa Steril 16 x 16 cm Box 10 10 10 - 2
101 Ketoconazole 200 mg Tablet 260 260 190 70 38
102 Ketokonazol Krim Tube - - -
103 Khlorpheniramin Maleat 4 mg (CTM) Tablet 1,524 600 2,124 2,019 105 404
104 Kloramfenikol caps 250 mg Kapsul - - -
105 Kloramfenikol Salep kulit 2% Tube 48 48 13 35 3
106 Kloramfenikol Salep Mata 1% Tube - - -
107 Kloramfenikol suspensi botol - - -
108 Kloramfenikol Tetes Mata 0,5% Botol/5 ml - - -
109 Kloramfenikol Tetes Telinga Botol/5 ml 25 25 5 20 1
110 Klorpromazin tab 100 mg Tablet 224 224 10 214 2
111 Kotrimoxazole 480 mg Tablet 591 500 1,091 270 821 54
112 Kotrimoxazole Suspensi Botol 9 125 134 26 108 5
113 Lidocain HCl Compositum Injeksi Ampul 90 90 - 90 -
114 Lidocain HCl injeksi 2% Ampul 378 378 - 378 -
115 Loperamid tablet Tablet 460 300 760 340 420 68
116 Loratadine Tablet 10 mg Tab 255 255 190 65 38
117 Masker Pcs - - -
118 Metformin 500 mg tablet Tablet 968 968 538 430 108
119 Metformin 850 mg Tablet - - -
120 Methylprednisolon 4 mg Tablet 460 460 300 160 60
PEMBERIAN
STOK STOK JUMLAH
PKD PROG/DKP LAIN2
1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
121 Metoklorpropamide tab 10 mg Tablet - - -
122 Metoklorpropamide Injeksi Ampul 10 10 - 10 -
123 Metronidazol tab 250 mg Tablet - - -
124 Metronidazole 500 mg Tablet 500 500 265 235 53
125 Metylergometrin Maleat Inj Ampul 10 10 3 7 1
126 Metylergometrin Maleat tab. Tablet 300 300 30 270 6
127 Miconazole krim Tube 51 24 75 24 51 5
128 N-Asetil Sistein 200 mg Tablet 1,624 6,000 7,624 1,015 6,609 203
129 Natrium Diklofenak 25 mg Tablet 1,100 2,000 3,100 1,050 2,050 210
130 Natrium Diklofenak 50 mg Tablet 170 6,500 6,670 4,170 2,500 834
131 Natrium Klorida Inf 0,9% Btl/ 500 ml 65 65 25 40 5
132 Nifedipine 10 mg tablet Tablet 160 160 20 140 4
133 Nistatin Tab. Vag 100.000 UI Tablet vag 83 83 50 33 10
134 Nistatin Tab. Vag 500.000 UI Tablet 100 100 - 100 -
135 Omeprazole capsul 20 mg Kapsul 860 900 1,760 730 1,030 146
136 Omeprazole Injeksi Vial - - -
137 Oxytetracyclin Salep Mata 1% Tube - - -
138 Oxytocin Inj 10 mg/ml Ampul 20 20 15 5 3
139 Paracetamol syrup Btl/ 60 ml 59 300 359 81 278 16
140 Parasetamol tablet 500 mg Tablet 1,369 5,000 6,369 3,219 3,150 644
141 Pehacain Injeksi Ampul - - -
142 Plester 5 cm x 5 m Roll 1 9 10 10 - 2
143 Prednison tablet 5 mg Tablet 100 100 100 - 20
144 Propanolol 10 mg Tablet 100 100 - 100 -
145 Propiltiuourasil (PTU) Tablet 110 110 - 110 -
146 Pyridoxin HCl tablet 10 mg Tablet - - -
147 Ranitidine 150 mg tablet Tablet 1,104 1,104 936 168 187
148 Ranitidine Injeksi 25 mg/ml Ampul 30 30 16 14 3
149 Reagen Golda Botol - - -
150 Ringer Laktat Infus Btl/ 500 ml 50 50 5 45 1
151 Salbutamol tab 2 mg Tablet - - -
152 Salbutamol tab 4 mg Tablet 300 300 300 - 60
Salep 2-4 Kombinasi : As. Salisilat +
153 Tube - - -
Belerang
154 Salep Antifungi 30 gram Pot - - -
155 Sarung Tangan S Box 2 2 2 - 0
156 Sarung Tangan M Box 1 12 13 10 3 2
157 Sarung Tangan L Box - - -
158 Sarung Tangan Steril No. 6,5 Pasang 97 97 57 40 11
159 Sarung Tangan Steril no. 7 Pieces 104 104 54 50 11
160 Sarung Tangan Steril no. 7,5 Pasang 50 50 24 26 5
Sianocobalamin (Vit. B12) Injeksi 500
161 Ampul - - -
mcg
Sianocobalamin (Vit. B12) tablet 500
162 Tablet 130 130 30 100 6
mcg
163 Silk Black 2/0 HR 30 MM Pcs 48 48 48 - 10
164 Silk Black 3/0 HR 30 MM Pcs 12 12 - 12 -
165 Simvastatin 10 mg Tablet 710 710 360 350 72
166 Simvastatin 20 mg Tablet 1,035 1,035 394 641 79
PEMBERIAN
STOK STOK JUMLAH
PKD PROG/DKP LAIN2
1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
167 Strip Asam Urat Botol 2 2 2 - 0
168 Strip Glukosa Botol 2 2 2 - 0
PEMBERIAN
STOK STOK JUMLAH
PKD PROG/DKP LAIN2
1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
169 Strip Kolestrol Botol 2 2 2 - 0
170 Tetrasiklin 500 mg Kapsul - - -
171 Thiamin HCl (B1) Tab 50 mg Tablet 1,233 2,000 3,233 2,533 700 507
172 Vitamin B Complex tab Tablet 6,000 6,000 3,496 2,504 699
173 Yodium 300 ml Botol 7 5 12 8 4 2
174 IV Chateter with Wings No. 20 G Pieces 100 100 - 100 -
15 Jarum Jahit Bedah No. 10 Pieces 12 12 - 12 -
JUMLAH KUNJUNGAN RESEP

NO FASILITAS KESEHATAN KET
BPJS NON BPJS JUMLAH
1 PUSKESMAS
2 PUSKESMAS PEMBANTU
3 POSKESDES
4 PUSKESMAS KELILING
5 DLL
TOTAL
tempat, tanggal bulan tahun

Mengetahui, Menyetujui : Mengetahui,
kepala Dinas kesehatan Kab. Mamuju Kepala Instalasi Farmasi Kab. Mamuju Kepala Puskesmas …………. Yang Membuat Laporan
drg. H. FIRMON, MPH NENENG SALMIAH, S.Farm,M.Kes ………………………………………...……….. …………………………...………..

NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 NIP. NIP.
LAPORAN PEMAKAIAN OBAT/BMHP TAHUN 2020
KODE PUSKESMAS :
PUSKESMAS : RANGAS BULAN : FEBRUARI

KABUPATEN : MAMUJU
PEMBERIAN
STOK STOK JUMLAH
NO NAMA OBAT/BMHP SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PENGELUARAN PERMINTAAN KET
PKD PROG/DKP LAIN2
1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
1 Advokasi Kit Kit - - -
2 Albendazol tablet 400 mg Tablet 600 600 - 600 -
3 Albendazol tablet 400 mg Tablet - - -
5 Benner
Buku Kader Filariasis Mengenali Unit - - -
6 dan Mencegah Penyakit Kaki Buku - - -
7 Buku Register POPM Filariasis
Gajah Buku - - -
8 Buku Saku Malaria Pieces - - -
Buku Saku Perawatan Mandiri
9 Buku - - -
Kasus Kronis Filariasis
10 Calcium Gluconas Inj Ampul 24 24 - 24 -
11 Catrtridge Paket - - -
12 Clofazimin/Lamprene 100 mg Tablet 5 5 5 - 1
13 DEC 100 mg Tablet - - -
14 DHP (Malaria) Tablet 1 1 - 1 -
15 Etambutol 400 mg Tablet - - -
16 Ethionamide 250 mg Tablet - - -
17 Garam Oralit Sachet 363 363 34 329 7
18 Giemsa 100 ml Botol - - -
19 INH 300 mg Tablet - - -
20 Invermectin Tablet - - -
21 Kaca Slide/ Microscope Slide Pieces - - -
22 Kanamycin Sulfat Inj Vial - - -
23 Kit Advokasi POPM IDA Kit - - -
24 Kit Belkaga IDA Kit - - -
25 Kit POPM Filariasis Kit - - -
26 Kombipak Kategori 1 Paket - - -
27 Kondom Pieces - - -
28 Levofloxacin 250 mg Tablet - - -
29 Masker Bedah Box/50 - - -
30 MDT MB Adult Strip - - -
31 MDT MB Child Strip - - -
32 Moxifloxacin 400 mg (Moximed) Tablet - - -
PEMBERIAN
STOK STOK JUMLAH
PKD PROG/DKP LAIN2
1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
33 Natrium Klorida 0,9% inf 500 ml Botol - - -
34 Nevirapine tablet Tablet - - -
35 O A T Kategori 1 Paket 4 6 10 3 7 1
36 O A T Kategori Anak Paket 1 1 1 - 0
37 OAT Kategori 2 Paket - - -
38 Oxytetracycline
Panduan POPMSalep Matadengan
Filariasis Tube 55 55 22 33 4
39 Regimen Invermectin DEC, Buku - - -
40 PAS-Na 5,52 gram
Albendazole Sachet - - -
41 Pot Dahak Pcs 10 100 110 20 90 4
42 Primaquin Tablet Tablet - - -
43 Pyrazinamide 500 mg Tablet - - -
44 Pyridoxyn 100 mg (Vitamin B6) Tablet 5 5 5 - 1
45 Quinine tablet Tablet - - -
46 Rapid HIV 1 (Bioline) Pieces - - -
47 Rapid Test 3 Fokus test - - -
48 Rapid Test Hepatitis Test - - -
49 RDT Combo Test - - -
50 Reagen ZN Paket 1 1 - 1 -
51 Retinol 100.000 UI Tablet - - -
52 Retinol 200.000 UI Tablet 570 570 30 540 6
53 Sarung Tangan M Pieces - - -
54 Sarung Tangan L Pieces - - -
55 Spoit 0,05 ml Pieces 210 210 35 175 7
56 Spoit 0,5 ml Pieces 130 130 100 30 20
57 Spoit 5 ml Pieces - - -
58 Tablet Tambah Darah Tablet 11,350 11,350 3,450 7,900 690
59 Vaksin BCG Vial - - -
60 Vaksin BCG + pelarut vial 2 2 2 - 0
61 Vaksin Campak + Rubella (MR) vial 2 2 2 - 0
62 Vaksin DPT-HB-Hib Vial 23 23 20 3 4
63 Vaksin DT Vial 5 5 - 5 -
64 Vaksin HB0 Vial 12 12 5 7 1
65 Vaksin HbIg Vial - - -
66 Vaksin IPV Vial 5 5 5 - 1
67 Vaksin Polio (60pv) Vial 9 9 5 4 1
68 Vaksin Td Vial 12 12 5 7 1
69 Vitamin B1 Tablet Tablet - - -
70 Zinc 20 mg Tablet 690 500 1,190 650 540 130
71 Zinc Syr Botol 50 50 - 50 -
72 Euthyrox 50 mg Tablet 75 75 75 - 15 ED JAN 2021
PEMBERIAN
STOK STOK JUMLAH
PKD PROG/DKP LAIN2
1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13

1 PUSKESMAS
3 POSKESDES
5 DLL
TOTAL


NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 NIP. NIP.
KODE PUSKESMAS :
PUSKESMAS : RANGAS BULAN : MARET
KABUPATEN : MAMUJU
STOK STOK PEMBERIAN JUMLAH

AKHIR PENGAMAN PKD PROG/DKP LAIN2 PEMBERIAN
1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
1 Acyclovir tab 200 mg Tablet 246 246 100 146 20 (26)
3 Alat Suntik Sekali Pakai 1 ml (Stera) Pieces 361 361 31 330 6 (293)
4 Alat Suntik Sekali Pakai 3 ml Pcs - - - - 300
5 Alat Suntik Sekali Pakai 5 ml Pcs 490 490 490 - 98 100 ED Feb 21
6 Allopurinol 100 mg Tablet 400 400 120 280 24 (136)
7 Aminophyllin 200 mg tab Tablet 100 100 - 100 - (100)
8 Aminophyllin 24 mg/ml Injeksi Ampul 30 30 2 28 0 (26)
9 Amlodipin tablet 5 mg Tablet 943 943 413 530 83 (34)
10 Amlodipin tablet 10 mg Tablet 108 108 50 58 10 200
11 Amoxicillin 500 mg Tablet 2,809 2,809 1,131 1,678 226 (321)
12 Amoxicillin Sirup 125 mg/5 ml Botol 195 195 43 152 9 (100)
13 Antasida Tab Tablet 3,040 3,040 590 2,450 118 (1,742)
14 Antacida suspensi btl /60 ml 46 46 19 27 4 (4)
15 Antihaemorrid Supp Supp/2 g 97 97 3 94 1 (90)
16 Antimigrain : ergotamine + coffeine tablet 220 220 - 220 - (220)
17 Antiseptik hand rub 500 ml Botol - - - 10
18 Aqua Pro Injeksi 25 ml Btl/25 ml 18 18 - 18 - (18)
19 Aquasonic Gel 250 ml Botol 6 6 2 4 0 (2)
20 Asam Asetilsasilisilat tab 80 mg Tablet 100 100 100 - 20 - ED Feb 21
21 Asam Askorbat tab 50 mg Tablet 100 100 100 - 20 1,000
22 Asam Askorbat tab 250 mg Tablet 6,100 6,100 1,304 4,796 261 (3,231)
23 Asam folat 1 mg tablet - - - 500
24 Asam Mefenamat tab 500 mg Tablet 4,290 4,290 1,550 2,740 310 (880)
25 Asering Infus Btl/500 ml - - - -
26 Atapulgit tab 600 mg Tablet - - - 100
27 Atropin sulfat Injeksi 0,25 mg/ml Ampul 20 20 10 10 2 -
28 Basitrasin salep (polimixin B salep) tube 6 6 - 6 - (6)
30 Betahistin 6 mg Tablet 730 730 90 640 18 (532)
31 Betametason 0,1% krim Tube 25 25 11 14 2 48
32 Bisturi No. 10 Pcs 75 75 - 75 - (75)
33 Calcii Gluconas Inj Ampul 2 2 - 2 - (2)
34 Captopril 12,5 mg Tablet 80 80 20 60 4 (36)
35 Captopril 25 mg tablet 1,485 1,485 50 1,435 10 (1,375)
36 Carbamazepin tab 200 mg Tablet - - - -
37 Catgut Chromic 2/0 HR 30 MM Pcs 144 144 - 144 - (144)
39 Cefadroxil 500 mg Tablet 465 465 140 325 28 (157)
40 Ciprofloxacin tab 500 mg Tablet 700 700 200 500 40 (260)
41 Dexamethasone 0,5 mg tablet Tablet 1,140 1,140 1,052 88 210 3,000
42 Dexamethasone Injeksi Ampul 5 5 - 5 - 10
43 Diazepam 2 mg Tablet 124 124 15 109 3 (91)
45 Diazepam Injeksi Ampul 10 10 - 10 - (10)
46 Difenhidramin Injeksi 10 mg/ml Ampul 20 20 - 20 - (20)
47 Digoxin tablet 0,25 mg Tablet - - - -
48 Diltiazem tab 30 mg Tablet - - - -
49 Dimenhidrinat tab 50 mg Tablet 58 58 - 58 - (58)
50 Domperidon tablet 10 mg Tablet 1,135 1,135 36 1,099 7 (1,056)
51 Efinefrin Injeksi 0,1% Ampul 61 9 70 - 70 - (70)
52 Eritromisin kapsul 250 mg Tablet - - - -
53 Eritromisin kapsul 500 mg Capsul - - - -
54 Etakridin (Rivanol) 100 ml Botol - - - 12
55 Etakridin 0,1% 300 ml Btl/300 - - - 6
56 Etanol 70% 1000 ml Botol - - - -
57 Etylchlorida semprot Btl/100 - - - 2
58 Fenobarbital tab 30 mg Tablet 190 190 - 190 - (190)
59 Fitomenadion (Vit. K1) tab 10 mg Tablet 1,173 1,173 15 1,158 3 (1,140)
60 Fitomenadion (Vit. K1) Injeksi 2 mg/ml Ampul 45 45 - 45 - (45)
61 Ampul - - - -
mg/ml
62 Furosemid tablet 40 mg Tablet - - - -
63 Gentamicin salep kulit Tube 10 10 4 6 1 48
64 Gentamicin salep mata Tube - - - -
65 Gentamicin sulfat TM 0,3% Btl/ 5 ml 5 5 5 - 1 - ED Feb 21
66 Gentian Violet 1% Btl/ 5 ml - - - 12
67 Glibenklamid tab 5 mg Tablet 560 560 20 540 4 (516)
68 Glimepiride 2 mg Tablet 429 429 65 364 13 (286)
69 Glukosa Larutan Infus 5% 500 ml Botol 13 13 - 13 - (13)
70 Glukosa Larutan Infus 10% 500 ml Botol - - - -
71 Griseofulvin 250 mg Tablet 450 450 230 220 46 500
72 Haloperidol tab 0,5 mg Tablet - - - -
74 Haloperidol 5 mg Tablet 169 169 4 165 1 (160)
75 Hidroklorothiazid (HCT) tab Tablet 263 263 - 263 - (263)
77 Hiosina butilbromida tab 10 mg Tablet 1,040 1,040 330 710 66 (314)
78 Hypafix 5 cm x 5 m Roll - - - - 10
79 Ibuprofen 200 mg Tablet 3,300 3,300 1,100 2,200 220 (880)
80 Ibuprofen 400 mg Tablet 55 55 55 - 11 2,000
81 Infusion set anak Pcs 64 64 7 57 1 (49)
82 Infusion set dewasa Pcs 55 55 - 55 - (55)
83 Isosorbide Dinitrate tab 5 mg Tablet 100 100 - 100 - (100)
84 IV Canula 18 G Pieces 87 87 10 77 2 (65)
85 IV Canula 20 G Pieces 6 6 - 6 - (6)
88 Jarum Jahit bedah No. 9 Bungkus 24 24 - 24 - (24)
91 Ka-en 3B Larutan infus botol - - - -
92 Kalium Permanganas Serbuk Pot/ 5 g - - - 12
93 Kalsium Laktat tab 500 mg Tablet 300 300 300 - 60 2,000
94 Kapas 250 gram Roll 2 2 - 2 - 6
95 btl/ 5 ml 17 17 4 13 1 (8)
Gliserol 10%)
96 Kasa Kompres 40 x 40 cm Pieces - - - -
97 Kasa Roll 3,6 x 5 cm Roll - - - -
98 Kasa Roll 3,6 x 15 cm Roll - - - - -
99 Kasa Roll Panjang 40 Y x 80 cm Roll 1 1 - 1 - (1)
100 Kasa Steril 16 x 16 cm Box - - - 50
101 Ketoconazole 200 mg Tablet 70 70 10 60 2 100
102 Ketokonazol Krim Tube - - - 12
103 Khlorpheniramin Maleat 4 mg (CTM) Tablet 105 105 105 - 21 3,000
104 Kloramfenikol caps 250 mg Kapsul - - - -
105 Kloramfenikol Salep kulit 2% Tube 35 35 - 35 - (35)
106 Kloramfenikol Salep Mata 1% Tube - - - -
107 Kloramfenikol suspensi botol - - - -
108 Kloramfenikol Tetes Mata 0,5% Botol/5 ml - - - -
109 Kloramfenikol Tetes Telinga Botol/5 ml 20 20 7 13 1 (5)
110 Klorpromazin tab 100 mg Tablet 214 214 - 214 - (214)
111 Kotrimoxazole 480 mg Tablet 821 821 70 751 14 (667)
112 Kotrimoxazole Suspensi Botol 108 108 4 104 1 (99)
113 Lidocain HCl Compositum Injeksi Ampul 90 90 - 90 - (90)
114 Lidocain HCl injeksi 2% Ampul 378 378 - 378 - (378)
116 Loratadine Tablet 10 mg Tab 65 65 65 - 13 200
117 Masker Pcs - - - 1,000
118 Metformin 500 mg tablet Tablet 430 430 95 335 19 (221)
119 Metformin 850 mg Tablet - - - -
120 Methylprednisolon 4 mg Tablet 160 160 160 - 32 400
121 Metoklorpropamide tab 10 mg Tablet - - - -
122 Metoklorpropamide Injeksi Ampul 10 10 - 10 - (10)
123 Metronidazol tab 250 mg Tablet - - - -
124 Metronidazole 500 mg Tablet 235 235 220 15 44 600
125 Metylergometrin Maleat Inj Ampul 7 7 - 7 - (7)
126 Metylergometrin Maleat tab. Tablet 270 270 60 210 12 200
128 N-Asetil Sistein 200 mg Tablet 6,609 6,609 1,375 5,234 275 (3,584)
129 Natrium Diklofenak 25 mg Tablet 2,050 2,050 350 1,700 70 (1,280)
130 Natrium Diklofenak 50 mg Tablet 2,500 2,500 890 1,610 178 (542)
131 Natrium Klorida Inf 0,9% Btl/ 500 ml 40 40 25 15 5 20
132 Nifedipine 10 mg tablet Tablet 140 140 10 130 2 (118)
133 Nistatin Tab. Vag 100.000 UI Tablet vag 33 33 7 26 1 (18)
134 Nistatin Tab. Vag 500.000 UI Tablet 100 100 - 100 - (100)
135 Omeprazole capsul 20 mg Kapsul 1,030 1,030 390 640 78 (172)
136 Omeprazole Injeksi Vial - - - -
137 Oxytetracyclin Salep Mata 1% Tube - - - -
138 Oxytocin Inj 10 mg/ml Ampul 5 5 - 5 - (5)
139 Paracetamol syrup Btl/ 60 ml 278 278 56 222 11 (155)
140 Parasetamol tablet 500 mg Tablet 3,150 3,150 1,303 1,847 261 2,000
141 Pehacain Injeksi Ampul - - - -
142 Plester 5 cm x 5 m Roll - - - - 5
143 Prednison tablet 5 mg Tablet - - - - -
144 Propanolol 10 mg Tablet 100 100 - 100 - (100)
145 Propiltiuourasil (PTU) Tablet 110 110 - 110 - (110)
146 Pyridoxin HCl tablet 10 mg Tablet - - - 2,000
147 Ranitidine 150 mg tablet Tablet 168 168 168 - 34 1,000
148 Ranitidine Injeksi 25 mg/ml Ampul 14 14 - 14 - (14)
149 Reagen Golda Botol - - - -
150 Ringer Laktat Infus Btl/ 500 ml 45 45 - 45 - (45)
151 Salbutamol tab 2 mg Tablet - - - 200
152 Salbutamol tab 4 mg Tablet - - - - 400
153 Tube - - - 24
Belerang
154 Salep Antifungi 30 gram Pot - - - -
155 Sarung Tangan S Box - - - - 6
156 Sarung Tangan M Box 3 3 3 - 1 6
157 Sarung Tangan L Box - - - 6
158 Sarung Tangan Steril No. 6,5 Pasang 40 40 40 - 8 100
159 Sarung Tangan Steril no. 7 Pieces 50 50 50 - 10 100
160 Sarung Tangan Steril no. 7,5 Pasang 26 100 126 65 61 13 50
161 Ampul - - - -
mcg
162 Tablet 100 100 10 90 2 (78)
mcg
163 Silk Black 2/0 HR 30 MM Pcs - - - - -
164 Silk Black 3/0 HR 30 MM Pcs 12 12 - 12 - (12)
165 Simvastatin 10 mg Tablet 350 350 160 190 32 400
166 Simvastatin 20 mg Tablet 641 500 1,141 116 1,025 23 (886)
167 Strip Asam Urat Botol - - - 5
168 Strip Glukosa Botol - - - 5
169 Strip Kolestrol Botol - - - 5
170 Tetrasiklin 500 mg Kapsul - - - -
171 Thiamin HCl (B1) Tab 50 mg Tablet 700 700 700 - 140 2,000
172 Vitamin B Complex tab Tablet 2,504 2,504 2,329 175 466 3,000
173 Yodium 300 ml Botol 4 4 - 4 - (4)
174 IV Chateter with Wings No. 20 G Pieces 100 100 4 96 1 (91)
15 Jarum Jahit Bedah No. 10 Pieces 12 12 - 12 - (12)

1 PUSKESMAS
3 POSKESDES
5 DLL
TOTAL


NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 NIP. NIP.
KODE PUSKESMAS :
PUSKESMAS : RANGAS BULAN : MARET
KABUPATEN : MAMUJU

1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
2 Albendazol tablet 400 mg Tablet 600 600 397 203 79
5 Benner Unit - - -
Buku Kader Filariasis Mengenali
6 dan Mencegah Penyakit Kaki Buku - - -
Gajah
7 Buku Register POPM Filariasis Buku - - -
9 Buku - - -
12 Clofazimin/Lamprene 100 mg Tablet - - - -
13 DEC 100 mg Tablet - - -
20 Invermectin Tablet - - -
23 Kit Advokasi POPM IDA Kit - - -
24 Kit Belkaga IDA Kit - - -
25 Kit POPM Filariasis Kit - - -
30 MDT MB Adult Strip 1 1 1 - 0
35 O A T Kategori 1 Paket 7 7 2 5 0
36 O A T Kategori Anak Paket - - - -
38 Oxytetracycline Salep Mata Tube 33 33 2 31 0
Panduan POPM Filariasis dengan
39 Regimen Invermectin DEC, Buku - - -
Albendazole
40 PAS-Na 5,52 gram Sachet - - -
41 Pot Dahak Pcs 90 90 40 50 8
44 Pyridoxyn 100 mg (Vitamin B6) Tablet - - - -
46 Rapid HIV 1 (Bioline) Pieces - - -
51 Retinol 100.000 UI Tablet 200 200 200 - 40
52 Retinol 200.000 UI Tablet 540 500 1,040 740 300 148
53 Sarung Tangan M Pieces - - -
55 Spoit 0,05 ml Pieces 175 175 20 155 4
56 Spoit 0,5 ml Pieces 30 30 30 - 6
60 Vaksin BCG + pelarut vial - 20 20 15 5 3
61 Vaksin Campak + Rubella (MR) vial - - - -
62 Vaksin DPT-HB-Hib Vial 3 30 33 10 23 2
64 Vaksin HB0 Vial 7 7 7 - 1
66 Vaksin IPV Vial - 20 20 10 10 2
67 Vaksin Polio (60pv) Vial 4 4 4 - 1
68 Vaksin Td Vial 7 7 3 4 1
70 Zinc 20 mg Tablet 540 540 355 185 71
71 Zinc Syr Botol 50 50 9 41 2
72 Euthyrox 50 mg Tablet - - - -
73 CTM Tablet 500 500 500 - 100
1 PUSKESMAS
3 POSKESDES
5 DLL
TOTAL


NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 NIP. NIP.
KODE PUSKESMAS :
PUSKESMAS : RANGAS BULAN : APRIL
KABUPATEN : MAMUJU

1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
3 Alat Suntik Sekali Pakai 1 ml (Stera) Pieces 330 330 - 330 -
4 Alat Suntik Sekali Pakai 3 ml Pcs - - - -
6 Allopurinol 100 mg Tablet 280 280 80 200 16
7 Aminophyllin 200 mg tab Tablet 100 100 - 100 -
8 Aminophyllin 24 mg/ml Injeksi Ampul 28 28 5 23 1
9 Amlodipin tablet 5 mg Tablet 530 530 - 530 -
10 Amlodipin tablet 10 mg Tablet 58 200 258 258 - 52
11 Amoxicillin 500 mg Tablet 1,678 1,678 578 1,100 116
12 Amoxicillin Sirup 125 mg/5 ml Botol 152 152 68 84 14
13 Antasida Tab Tablet 2,450 2,450 670 1,780 134
14 Antacida suspensi btl /60 ml 27 27 10 17 2
15 Antihaemorrid Supp Supp/2 g 94 94 14 80 3
17 Antiseptik hand rub 500 ml Botol 4 4 4 - 1
19 Aquasonic Gel 250 ml Botol 4 4 - 4 -
20 Asam Asetilsasilisilat tab 80 mg Tablet - - - -
21 Asam Askorbat tab 50 mg Tablet - 1,000 1,000 300 700 60
22 Asam Askorbat tab 250 mg Tablet 4,796 4,796 1,591 3,205 318
24 Asam Mefenamat tab 500 mg Tablet 2,740 2,740 1,265 1,475 253
26 Atapulgit tab 600 mg Tablet 100 100 - 100 -
28 Basitrasin salep (polimixin B salep) tube 6 6 - 6 -
30 Betahistin 6 mg Tablet 640 640 50 590 10
31 Betametason 0,1% krim Tube 14 14 14 - 3
32 Bisturi No. 10 Pcs 75 75 5 70 1
34 Captopril 12,5 mg Tablet 60 60 40 20 8
35 Captopril 25 mg tablet 1,435 1,435 210 1,225 42
39 Cefadroxil 500 mg Tablet 325 325 90 235 18
40 Ciprofloxacin tab 500 mg Tablet 500 500 - 500 -
41 Dexamethasone 0,5 mg tablet Tablet 88 3,000 3,088 1,209 1,879 242
42 Dexamethasone Injeksi Ampul 5 5 - 5 -
49 Dimenhidrinat tab 50 mg Tablet 58 58 - 58 -
50 Domperidon tablet 10 mg Tablet 1,099 1,099 176 923 35
51 Efinefrin Injeksi 0,1% Ampul 70 70 - 70 -
55 Etakridin 0,1% 300 ml Btl/300 - - -
56 Etanol 70% 1000 ml Botol - - -
57 Etylchlorida semprot Btl/100 1 1 - 1 -
59 Fitomenadion (Vit. K1) tab 10 mg Tablet 1,158 1,158 146 1,012 29
60 Fitomenadion (Vit. K1) Injeksi 2 mg/ml Ampul 45 45 4 41 1
61 Ampul - - -
mg/ml
63 Gentamicin salep kulit Tube 6 6 6 - 1
65 Gentamicin sulfat TM 0,3% Btl/ 5 ml - - - -
68 Glimepiride 2 mg Tablet 364 364 20 344 4
69 Glukosa Larutan Infus 5% 500 ml Botol 13 13 5 8 1
74 Haloperidol 5 mg Tablet 165 165 - 165 -
75 Hidroklorothiazid (HCT) tab Tablet 263 263 - 263 -
77 Hiosina butilbromida tab 10 mg Tablet 710 710 100 610 20
78 Hypafix 5 cm x 5 m Roll - - - -
79 Ibuprofen 200 mg Tablet 2,200 2,200 1,066 1,134 213
80 Ibuprofen 400 mg Tablet - 2,000 2,000 70 1,930 14
82 Infusion set dewasa Pcs 55 55 30 25 6
83 Isosorbide Dinitrate tab 5 mg Tablet 100 100 100 - 20 ED 100
85 IV Canula 20 G Pieces 6 6 6 - 1
93 Kalsium Laktat tab 500 mg Tablet - - - -
94 Kapas 250 gram Roll 2 6 8 2 6 0
95 btl/ 5 ml 13 13 - 13 -
Gliserol 10%)
96 Kasa Kompres 40 x 40 cm Pieces - - -
97 Kasa Roll 3,6 x 5 cm Roll - - -
99 Kasa Roll Panjang 40 Y x 80 cm Roll 1 1 - 1 -
100 Kasa Steril 16 x 16 cm Box 20 20 - 20 -
101 Ketoconazole 200 mg Tablet 60 100 160 10 150 2
103 Khlorpheniramin Maleat 4 mg (CTM) Tablet - - - -
105 Kloramfenikol Salep kulit 2% Tube 35 35 6 29 1
109 Kloramfenikol Tetes Telinga Botol/5 ml 13 13 3 10 1
110 Klorpromazin tab 100 mg Tablet 214 214 20 194 4
111 Kotrimoxazole 480 mg Tablet 751 751 243 508 49
112 Kotrimoxazole Suspensi Botol 104 104 1 103 0
113 Lidocain HCl Compositum Injeksi Ampul 90 90 - 90 -
114 Lidocain HCl injeksi 2% Ampul 378 378 100 278 20
115 Loperamid tablet Tablet 200 200 30 170 6
116 Loratadine Tablet 10 mg Tab - - - -
117 Masker Pcs - - -
118 Metformin 500 mg tablet Tablet 335 335 110 225 22
119 Metformin 850 mg Tablet - - -
120 Methylprednisolon 4 mg Tablet - 400 400 200 200 40
124 Metronidazole 500 mg Tablet 15 600 615 100 515 20
125 Metylergometrin Maleat Inj Ampul 7 7 - 7 -
128 N-Asetil Sistein 200 mg Tablet 5,234 5,234 1,040 4,194 208
129 Natrium Diklofenak 25 mg Tablet 1,700 1,700 700 1,000 140
130 Natrium Diklofenak 50 mg Tablet 1,610 1,610 420 1,190 84
131 Natrium Klorida Inf 0,9% Btl/ 500 ml 15 20 35 10 25 2
132 Nifedipine 10 mg tablet Tablet 130 130 - 130 -
133 Nistatin Tab. Vag 100.000 UI Tablet vag 26 26 - 26 -
135 Omeprazole capsul 20 mg Kapsul 640 640 150 490 30
138 Oxytocin Inj 10 mg/ml Ampul 5 5 5 - 1
139 Paracetamol syrup Btl/ 60 ml 222 222 99 123 20
142 Plester 5 cm x 5 m Roll - 5 5 2 3 0
143 Prednison tablet 5 mg Tablet - - - -
145 Propiltiuourasil (PTU) Tablet 110 110 10 100 2
147 Ranitidine 150 mg tablet Tablet - - - -
148 Ranitidine Injeksi 25 mg/ml Ampul 14 14 - 14 -
149 Reagen Golda Botol - - -
150 Ringer Laktat Infus Btl/ 500 ml 45 45 3 42 1
152 Salbutamol tab 4 mg Tablet - - - -
153 Tube - - -
Belerang
155 Sarung Tangan S Box - - - -
156 Sarung Tangan M Box - - - -
158 Sarung Tangan Steril No. 6,5 Pasang - - - -
159 Sarung Tangan Steril no. 7 Pieces - - - -
160 Sarung Tangan Steril no. 7,5 Pasang 61 50 111 31 80 6
161 Ampul - - -
mcg
162 Tablet 90 90 - 90 -
mcg
163 Silk Black 2/0 HR 30 MM Pcs - - - -
165 Simvastatin 10 mg Tablet 190 390 580 60 520 12
166 Simvastatin 20 mg Tablet 1,025 1,025 200 825 40
167 Strip Asam Urat Botol 2 2 2 - 0
168 Strip Glukosa Botol 2 2 2 - 0
169 Strip Kolestrol Botol - - -
171 Thiamin HCl (B1) Tab 50 mg Tablet - - - -
172 Vitamin B Complex tab Tablet 175 3,000 3,175 975 2,200 195
173 Yodium 300 ml Botol 4 4 - 4 -
174 IV Chateter with Wings No. 20 G Pieces 96 96 20 76 4
15 Jarum Jahit Bedah No. 10 Pieces 12 12 - 12 -

1 PUSKESMAS
3 POSKESDES
5 DLL
TOTAL

drg. H. FIRMON, MPH Agusti TenriPandiari, S.Farm, Apt ………………………………………...……….. Mulyani Badani, S.Si., Apt
NIP. 19610310 198710 1 002 NIP. 19810517 201001 2 014 NIP. NIP. 19790102 200604 2 013
KODE PUSKESMAS :
PUSKESMAS : RANGAS BULAN : APRIL
KABUPATEN : MAMUJU

1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
2 Albendazol tablet 400 mg Tablet 203 24,000 24,203 - 24,203 -
5 Benner Unit - - -
6 dan Mencegah Penyakit Kaki Buku 50 50 - 50 -
Gajah
7 Buku Register POPM Filariasis Buku 100 100 - 100 -
9 Buku 10 10 - 10 -
13 DEC 100 mg Tablet 60,000 60,000 - 60,000 -
20 Invermectin Tablet 32,000 32,000 - 32,000 -
23 Kit Advokasi POPM IDA Kit 5 5 - 5 -
24 Kit Belkaga IDA Kit 5 5 - 5 -
25 Kit POPM Filariasis Kit 60 60 - 60 -
30 MDT MB Adult Strip - - -
35 O A T Kategori 1 Paket 5 5 5 - 1
36 O A T Kategori Anak Paket - 1 1 1 - 0
38 Oxytetracycline Salep Mata Tube 31 31 2 29 0
39 Regimen Invermectin DEC, Buku 100 100 - 100 -
Albendazole
41 Pot Dahak Pcs 50 50 50 - 10
46 Rapid HIV 1 (Bioline) Pieces 125 125 50 75 10
52 Retinol 200.000 UI Tablet 300 300 25 275 5
53 Sarung Tangan M Pieces 200 200 100 100 20
55 Spoit 0,05 ml Pieces 155 100 255 45 210 9
56 Spoit 0,5 ml Pieces - 500 500 355 145 71
60 Vaksin BCG + pelarut vial 5 20 25 20 5 4
61 Vaksin Campak + Rubella (MR) vial - 30 30 15 15 3
62 Vaksin DPT-HB-Hib Vial 23 20 43 38 5 8
64 Vaksin HB0 Vial - 30 30 25 5 5
66 Vaksin IPV Vial 10 20 30 15 15 3
67 Vaksin Polio (60pv) Vial - - - -
68 Vaksin Td Vial 4 4 4 - 1
70 Zinc 20 mg Tablet 185 185 170 15 34
71 Zinc Syr Botol 41 41 24 17 5
73 CTM Tablet 100 100 100 - 20
74 Betametason 0,1 % Cr Tube 10 10 2 8 0
75 Thiamin Hcl Tablet 2,000 2,000 370 1,630 74
76 Rapid Test Siphillis Trepocher test 125 125 25 100 5
1 PUSKESMAS
3 POSKESDES
4 PUSKESMAS KELILING M,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,MMMMMMM,,,,,MMMMMM
5 DLL
TOTAL

drg. H. FIRMON, MPH Agusti TenriPandiari, S.Farm, Apt ………………………………………...……….. Mulyani Badani, S.Si., Apt
NIP. 19610310 198710 1 002 NIP. 19810517 201001 2 014 NIP. NIP. 19790102 200604 2 013
KODE PUSKESMAS :
PUSKESMAS : RANGAS BULAN : MEI
KABUPATEN : MAMUJU

1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
1 Acyclovir tab 200 mg Tablet 146 146 - 146 - (146)
2 Acyclovir tab 400 mg Tablet 335 335 - 335 - (335)
3 Alat Suntik Sekali Pakai 1 ml (Stera) Pieces 330 330 30 300 6 (264)
6 Allopurinol 100 mg Tablet 200 200 - 200 - (200)
7 Aminophyllin 200 mg tab Tablet 100 100 - 100 - (100)
8 Aminophyllin 24 mg/ml Injeksi Ampul 23 23 - 23 - (23)
10 Amlodipin tablet 10 mg Tablet - - - - 800
11 Amoxicillin 500 mg Tablet 1,100 3,000 4,100 1,872 2,228 374 4,000
13 Antasida Tab Tablet 1,780 1,780 580 1,200 116 (504)
17 Antiseptik hand rub 500 ml Botol 3 3 2 1 0 6
19 Aquasonic Gel 250 ml Botol 4 4 2 2 0 3
20 Asam Asetilsasilisilat tab 80 mg Tablet - - - - -
21 Asam Askorbat tab 50 mg Tablet 700 700 514 186 103 1,500
22 Asam Askorbat tab 250 mg Tablet 3,205 3,205 1,217 1,988 243 (528)
24 Asam Mefenamat tab 500 mg Tablet 1,475 1,500 2,975 1,485 1,490 297 2,000
26 Atapulgit tab 600 mg Tablet 100 100 - 100 - (100)
27 Atropin sulfat Injeksi 0,25 mg/ml Ampul 10 10 - 10 - (10)
28 Basitrasin salep (polimixin B salep) tube 6 6 - 6 - 24
31 Betametason 0,1% krim Tube - - - - 50
32 Bisturi No. 10 Pcs 70 70 2 68 0 (66)
33 Calcii Gluconas Inj Ampul 2 2 - 2 - (2)
34 Captopril 12,5 mg Tablet 20 20 20 - 4 200
35 Captopril 25 mg tablet 1,225 1,225 425 800 85 (290)
39 Cefadroxil 500 mg Tablet 235 235 146 89 29 200
40 Ciprofloxacin tab 500 mg Tablet 500 500 200 300 40 (60)
41 Dexamethasone 0,5 mg tablet Tablet 1,879 2,000 3,879 1,798 2,081 360 1,500
42 Dexamethasone Injeksi Ampul 5 5 5 - 1 10
46 Difenhidramin Injeksi 10 mg/ml Ampul 20 20 4 16 1 (11)
50 Domperidon tablet 10 mg Tablet 923 923 143 780 29 (608)
51 Efinefrin Injeksi 0,1% Ampul 70 70 70 - 14 20 ED 70
55 Etakridin 0,1% 300 ml Btl/300 - - - 6
56 Etanol 70% 1000 ml Botol - - - 12
57 Etylchlorida semprot Btl/100 1 1 - 1 - (1)
59 Fitomenadion (Vit. K1) tab 10 mg Tablet 1,012 1,012 20 992 4 (968)
60 Fitomenadion (Vit. K1) Injeksi 2 mg/ml Ampul 41 41 10 31 2 (19)
61 Ampul - - - -
mg/ml
62 Furosemid tablet 40 mg Tablet - - - 100
63 Gentamicin salep kulit Tube - - - - 50
65 Gentamicin sulfat TM 0,3% Btl/ 5 ml - - - - -
67 Glibenklamid tab 5 mg Tablet 310 310 10 300 2 (288)
68 Glimepiride 2 mg Tablet 344 344 165 179 33 300
69 Glukosa Larutan Infus 5% 500 ml Botol 8 8 5 3 1 10
71 Griseofulvin 250 mg Tablet 280 500 780 320 460 64 300
74 Haloperidol 5 mg Tablet 165 165 - 165 - (165)
76 Hidrokortison Cream 2,5% Tube 36 36 36 - 7 48
77 Hiosina butilbromida tab 10 mg Tablet 610 610 110 500 22 (368)
79 Ibuprofen 200 mg Tablet 1,134 1,134 300 834 60 (474)
80 Ibuprofen 400 mg Tablet 1,930 1,930 540 1,390 108 (742)
81 Infusion set anak Pcs 57 57 - 57 - (57)
82 Infusion set dewasa Pcs 25 25 8 17 2 (7)
83 Isosorbide Dinitrate tab 5 mg Tablet - - - - -
85 IV Canula 20 G Pieces - - - - -
93 Kalsium Laktat tab 500 mg Tablet - - - - 2,000
94 Kapas 250 gram Roll 6 6 6 - 1 7
95 btl/ 5 ml 13 13 7 6 1 24
Gliserol 10%)
96 Kasa Kompres 40 x 40 cm Pieces - - - -
98 Kasa Roll 3,6 x 15 cm Roll - - - - -
99 Kasa Roll Panjang 40 Y x 80 cm Roll 1 1 1 - 0 6
100 Kasa Steril 16 x 16 cm Box 20 20 13 7 3 25
101 Ketoconazole 200 mg Tablet 150 150 10 140 2 (128)
103 Khlorpheniramin Maleat 4 mg (CTM) Tablet - - - - 5,000
104 Kloramfenikol caps 250 mg Kapsul - - - -
105 Kloramfenikol Salep kulit 2% Tube 29 29 2 27 0 (25)
109 Kloramfenikol Tetes Telinga Botol/5 ml 10 10 - 10 - (10)
111 Kotrimoxazole 480 mg Tablet 508 508 391 117 78 500
113 Lidocain HCl Compositum Injeksi Ampul 90 90 10 80 2 (68)
114 Lidocain HCl injeksi 2% Ampul 278 278 78 200 16 (106)
115 Loperamid tablet Tablet 170 170 - 170 - (170)
116 Loratadine Tablet 10 mg Tab - - - - 200
117 Masker Pcs - - - 1,000
118 Metformin 500 mg tablet Tablet 225 225 225 - 45 500
119 Metformin 850 mg Tablet - - - 1,000
120 Methylprednisolon 4 mg Tablet 200 200 - 200 - (200)
121 Metoklorpropamide tab 10 mg Tablet - - - -
122 Metoklorpropamide Injeksi Ampul 10 10 2 8 0 (6)
124 Metronidazole 500 mg Tablet 515 515 15 500 3 (482)
125 Metylergometrin Maleat Inj Ampul 7 7 7 - 1 50
126 Metylergometrin Maleat tab. Tablet 300 300 40 260 8 (212)
128 N-Asetil Sistein 200 mg Tablet 4,194 4,194 560 3,634 112 (2,962)
129 Natrium Diklofenak 25 mg Tablet 1,000 1,000 300 700 60 (340)
130 Natrium Diklofenak 50 mg Tablet 1,190 1,190 620 570 124 800
131 Natrium Klorida Inf 0,9% Btl/ 500 ml 25 25 - 25 - (25)
132 Nifedipine 10 mg tablet Tablet 130 130 - 130 - (130)
133 Nistatin Tab. Vag 100.000 UI Tablet vag 26 26 - 26 - (26)
135 Omeprazole capsul 20 mg Kapsul 490 490 220 270 44 900
136 Omeprazole Injeksi Vial - - - -
138 Oxytocin Inj 10 mg/ml Ampul - - - - 50
140 Parasetamol tablet 500 mg Tablet 2,259 2,259 1,258 1,001 252 4,000
142 Plester 5 cm x 5 m Roll 3 5 8 5 3 1 6
143 Prednison tablet 5 mg Tablet - - - - 500
145 Propiltiuourasil (PTU) Tablet 100 100 - 100 - (100)
147 Ranitidine 150 mg tablet Tablet - - - - 700
148 Ranitidine Injeksi 25 mg/ml Ampul 14 14 - 14 - (14)
149 Reagen Golda Botol - - - 1
150 Ringer Laktat Infus Btl/ 500 ml 42 42 15 27 3 (9)
153 Tube - - - 50
Belerang
154 Salep Antifungi 30 gram Pot - - - 15
156 Sarung Tangan M Box - - - - 8
158 Sarung Tangan Steril No. 6,5 Pasang - - - - 100
159 Sarung Tangan Steril no. 7 Pieces - - - - 100
160 Sarung Tangan Steril no. 7,5 Pasang 80 50 130 19 111 4 (88)
161 Ampul - - - -
mcg
162 Tablet 90 90 - 90 - (90)
mcg
163 Silk Black 2/0 HR 30 MM Pcs - - - - 12
165 Simvastatin 10 mg Tablet 520 520 10 510 2 (498)
166 Simvastatin 20 mg Tablet 825 825 225 600 45 (330)
167 Strip Asam Urat Botol 2 2 1 1 0 5
168 Strip Glukosa Botol 2 2 1 1 0 5
171 Thiamin HCl (B1) Tab 50 mg Tablet - - - - 2,000
172 Vitamin B Complex tab Tablet 2,200 2,200 1,624 576 325 4,000
173 Yodium 300 ml Botol 4 4 2 2 0 6
174 IV Chateter with Wings No. 20 G Pieces 76 76 - 76 - (76)

1 PUSKESMAS
3 POSKESDES
5 DLL
TOTAL

Drs. H. Tonga, M. AP Agusti TenriPandiari, S.Farm, Apt Nachsan, SKM Mulyani Badani, S.Si., Apt
NIP. 19640615 199003 1 028 NIP. 19810517 201001 2 014 NIP. 19630723 198903 1 009 NIP. 19790102 200604 2 013
KODE PUSKESMAS :
PUSKESMAS : RANGAS BULAN : MEI
KABUPATEN : MAMUJU

1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
1 Advokasi Kit Kit - - - - -
2 Albendazol tablet 400 mg Tablet 24,203 24,203 - 24,203 - (24,203)
3 Albendazol tablet 400 mg Tablet - - - -
4 Albendazol tablet 400 mg Tablet - - - -
5 Benner Unit - - - -
6 dan Mencegah Penyakit Kaki Buku 50 50 - 50 - (50)
Gajah
7 Buku Register POPM Filariasis Buku 100 100 - 100 - (100)
8 Buku Saku Malaria Pieces - - - -
9 Buku 10 10 - 10 - (10)
10 Calcium Gluconas Inj Ampul 24 24 - 24 - (24)
11 Catrtridge Paket - - - -
12 Clofazimin/Lamprene 100 mg Tablet - - - - -
13 DEC 100 mg Tablet 60,000 60,000 - 60,000 - (60,000)
14 DHP (Malaria) Tablet 1 1 - 1 - (1)
15 Etambutol 400 mg Tablet - - - -
16 Ethionamide 250 mg Tablet - - - -
17 Garam Oralit Sachet 179 179 5 174 1 (168)
18 Giemsa 100 ml Botol - - - -
19 INH 300 mg Tablet - - - -
20 Invermectin Tablet 32,000 32,000 - 32,000 - (32,000)
21 Kaca Slide/ Microscope Slide Pieces - - - -
22 Kanamycin Sulfat Inj Vial - - - -
23 Kit Advokasi POPM IDA Kit 5 5 - 5 - (5)
24 Kit Belkaga IDA Kit 5 5 - 5 - (5)
25 Kit POPM Filariasis Kit 60 60 - 60 - (60)
26 Kombipak Kategori 1 Paket - - - -
27 Kondom Pieces - - - -
28 Levofloxacin 250 mg Tablet - - - -
29 Masker Bedah Box/50 5 5 4 1 1 4
30 MDT MB Adult Strip 6 6 2 4 0 (2)
31 MDT MB Child Strip - - - -
32 Moxifloxacin 400 mg (Moximed) Tablet - - - -
33 Natrium Klorida 0,9% inf 500 ml Botol - - - -
34 Nevirapine tablet Tablet - - - -
35 O A T Kategori 1 Paket - 5 5 5 - 1 6
36 O A T Kategori Anak Paket - - - - -
37 OAT Kategori 2 Paket - - - -
38 Oxytetracycline Salep Mata Tube 29 29 - 29 - (29)
39 Regimen Invermectin DEC, Buku 100 100 - 100 - (100)
Albendazole
40 PAS-Na 5,52 gram Sachet - - - -
41 Pot Dahak Pcs - 100 100 80 20 16 76
42 Primaquin Tablet Tablet - - - -
43 Pyrazinamide 500 mg Tablet - - - -
44 Pyridoxyn 100 mg (Vitamin B6) Tablet - - - - -
45 Quinine tablet Tablet - - - -
46 Rapid HIV 1 (Bioline) Pieces 75 75 50 25 10 35
47 Rapid Test 3 Fokus test - - - -
48 Rapid Test Hepatitis Test - - - -
49 RDT Combo Test - - - -
50 Reagen ZN Paket 1 1 - 1 - (1)
51 Retinol 100.000 UI Tablet - - - -
52 Retinol 200.000 UI Tablet 275 275 275 - 55 330 ED 275
53 Sarung Tangan M Pieces 100 100 100 - 20 120
54 Sarung Tangan L Pieces - - - -
55 Spoit 0,05 ml Pieces 210 210 50 160 10 (100)
56 Spoit 0,5 ml Pieces 145 500 645 350 295 70 125
57 Spoit 5 ml Pieces - - - -
58 Tablet Tambah Darah Tablet 4,530 4,530 2,490 2,040 498 948 pake 2490
59 Vaksin BCG Vial - - - -
60 Vaksin BCG + pelarut vial 5 30 35 23 12 5 16
61 Vaksin Campak + Rubella (MR) vial 15 20 35 22 13 4 13
62 Vaksin DPT-HB-Hib Vial 5 50 55 35 20 7 22
63 Vaksin DT Vial 5 5 - 5 - (5)
64 Vaksin HB0 Vial 5 30 35 20 15 4 9
65 Vaksin HbIg Vial - - - -
66 Vaksin IPV Vial 15 20 35 20 15 4 9
67 Vaksin Polio (60pv) Vial - 50 50 20 30 4 (6)
68 Vaksin Td Vial - 30 30 5 25 1 (19)
69 Vitamin B1 Tablet Tablet - - - -
70 Zinc 20 mg Tablet 15 500 515 80 435 16 (339)
71 Zinc Syr Botol 17 17 17 - 3 20 ED 16
72 Euthyrox 50 mg Tablet - - - - -
73 CTM Tablet - - - -
74 Betametason 0,1 % Cr Tube 8 8 7 1 1 7
75 Thiamin Hcl Tablet 1,630 1,630 480 1,150 96 (574)
76 Rapid Test Siphillis Trepocher test 100 100 50 50 10 10
1 PUSKESMAS
3 POSKESDES
5 DLL
TOTAL

NIP. 19640615 199003 1 028 NIP. 19810517 201001 2 014 NIP. 19630723 198903 1 009 NIP. 19790102 200604 2 013
sisa 2040
KODE PUSKESMAS :
PUSKESMAS : RANGAS BULAN : JUNI
KABUPATEN : MAMUJU

1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
3 Alat Suntik Sekali Pakai 1 ml (Stera) Pieces 300 300 100 200 20
6 Allopurinol 100 mg Tablet 200 200 200 - 40
7 Aminophyllin 200 mg tab Tablet 100 100 100 - 20 ED 100
8 Aminophyllin 24 mg/ml Injeksi Ampul 23 23 - 23 -
10 Amlodipin tablet 10 mg Tablet - 300 300 150 150 30
11 Amoxicillin 500 mg Tablet 2,228 1,200 3,428 1,428 2,000 286
13 Antasida Tab Tablet 1,200 1,200 200 1,000 40
15 Antihaemorrid Supp Supp/2 g 65 65 - 65 -
17 Antiseptik hand rub 500 ml Botol 1 4 5 5 - 1
19 Aquasonic Gel 250 ml Botol 2 2 2 - 0 ED 2
20 Asam Asetilsasilisilat tab 80 mg Tablet - - - -
21 Asam Askorbat tab 50 mg Tablet 186 1,500 1,686 886 800 177
22 Asam Askorbat tab 250 mg Tablet 1,988 1,988 752 1,236 150
24 Asam Mefenamat tab 500 mg Tablet 1,490 2,000 3,490 1,320 2,170 264
26 Atapulgit tab 600 mg Tablet 100 100 - 100 -
28 Basitrasin salep (polimixin B salep) tube 6 6 6 - 1
30 Betahistin 6 mg Tablet 580 580 10 570 2
31 Betametason 0,1% krim Tube - - - -
32 Bisturi No. 10 Pcs 68 68 19 49 4
34 Captopril 12,5 mg Tablet - 200 200 - 200 -
35 Captopril 25 mg tablet 800 800 600 200 120
39 Cefadroxil 500 mg Tablet 89 89 89 - 18
40 Ciprofloxacin tab 500 mg Tablet 300 300 300 - 60
41 Dexamethasone 0,5 mg tablet Tablet 2,081 1,500 3,581 1,328 2,253 266
42 Dexamethasone Injeksi Ampul - - - -
49 Dimenhidrinat tab 50 mg Tablet 58 58 - 58 -
50 Domperidon tablet 10 mg Tablet 780 780 180 600 36
51 Efinefrin Injeksi 0,1% Ampul - 30 30 - 30 -
55 Etakridin 0,1% 300 ml Btl/300 - - -
56 Etanol 70% 1000 ml Botol - - -
57 Etylchlorida semprot Btl/100 1 1 1 - 0
59 Fitomenadion (Vit. K1) tab 10 mg Tablet 992 992 35 957 7
60 Fitomenadion (Vit. K1) Injeksi 2 mg/ml Ampul 31 31 10 21 2
61 Ampul - - -
mg/ml
63 Gentamicin salep kulit Tube - - - -
65 Gentamicin sulfat TM 0,3% Btl/ 5 ml - - - -
68 Glimepiride 2 mg Tablet 179 300 479 190 289 38
69 Glukosa Larutan Infus 5% 500 ml Botol 3 3 - 3 -
74 Haloperidol 5 mg Tablet 165 165 - 165 -
75 Hidroklorothiazid (HCT) tab Tablet 263 263 63 200 13 ED 63
76 Hidrokortison Cream 2,5% Tube - 96 96 25 71 5
77 Hiosina butilbromida tab 10 mg Tablet 500 500 200 300 40
78 Hypafix 5 cm x 5 m Roll - - - -
79 Ibuprofen 200 mg Tablet 834 834 634 200 127
80 Ibuprofen 400 mg Tablet 1,390 1,390 260 1,130 52
82 Infusion set dewasa Pcs 17 17 17 - 3
83 Isosorbide Dinitrate tab 5 mg Tablet - - - -
85 IV Canula 20 G Pieces - - - -
93 Kalsium Laktat tab 500 mg Tablet - - - -
94 Kapas 250 gram Roll - 6 6 - 6 -
95 btl/ 5 ml 6 24 30 4 26 1
Gliserol 10%)
96 Kasa Kompres 40 x 40 cm Pieces 10 10 - 10 -
97 Kasa Roll 3,6 x 5 cm Roll 10 10 - 10 -
98 Kasa Roll 3,6 x 15 cm Roll - 10 10 - 10 -
99 Kasa Roll Panjang 40 Y x 80 cm Roll - 6 6 1 5 0
101 Ketoconazole 200 mg Tablet 140 140 10 130 2
103 Khlorpheniramin Maleat 4 mg (CTM) Tablet - - - -
105 Kloramfenikol Salep kulit 2% Tube 27 27 - 27 -
109 Kloramfenikol Tetes Telinga Botol/5 ml 10 10 - 10 -
110 Klorpromazin tab 100 mg Tablet 194 194 - 194 -
111 Kotrimoxazole 480 mg Tablet 117 500 617 80 537 16
112 Kotrimoxazole Suspensi Botol 90 90 - 90 -
113 Lidocain HCl Compositum Injeksi Ampul 80 80 10 70 2
114 Lidocain HCl injeksi 2% Ampul 200 200 - 200 -
115 Loperamid tablet Tablet 170 170 20 150 4
116 Loratadine Tablet 10 mg Tab - - - -
117 Masker Pcs 1,000 1,000 845 155 169
118 Metformin 500 mg tablet Tablet - - - -
119 Metformin 850 mg Tablet 2,000 2,000 480 1,520 96
120 Methylprednisolon 4 mg Tablet 200 500 700 535 165 107
124 Metronidazole 500 mg Tablet 500 500 120 380 24
125 Metylergometrin Maleat Inj Ampul - 50 50 10 40 2
126 Metylergometrin Maleat tab. Tablet 260 260 120 140 24
127 Miconazole krim Tube 10 10 10 - 2
128 N-Asetil Sistein 200 mg Tablet 3,634 3,634 630 3,004 126
129 Natrium Diklofenak 25 mg Tablet 700 700 120 580 24
130 Natrium Diklofenak 50 mg Tablet 570 570 570 - 114
131 Natrium Klorida Inf 0,9% Btl/ 500 ml 25 25 11 14 2
132 Nifedipine 10 mg tablet Tablet 130 130 - 130 -
133 Nistatin Tab. Vag 100.000 UI Tablet vag 26 26 20 6 4
135 Omeprazole capsul 20 mg Kapsul 270 270 - 270 -
138 Oxytocin Inj 10 mg/ml Ampul - - - -
142 Plester 5 cm x 5 m Roll 3 3 2 1 0
143 Prednison tablet 5 mg Tablet - - - -
145 Propiltiuourasil (PTU) Tablet 100 100 30 70 6
147 Ranitidine 150 mg tablet Tablet - - - -
148 Ranitidine Injeksi 25 mg/ml Ampul 14 14 - 14 -
149 Reagen Golda Botol 1 1 - 1 -
150 Ringer Laktat Infus Btl/ 500 ml 27 27 - 27 -
152 Salbutamol tab 4 mg Tablet - - - -
153 Tube - - -
Belerang
155 Sarung Tangan S Box - - - -
156 Sarung Tangan M Box - - - -
158 Sarung Tangan Steril No. 6,5 Pasang - - - -
159 Sarung Tangan Steril no. 7 Pieces - - - -
160 Sarung Tangan Steril no. 7,5 Pasang 111 111 77 34 15
161 Ampul - - -
mcg
162 Tablet 90 90 - 90 -
mcg
163 Silk Black 2/0 HR 30 MM Pcs - 12 12 - 12 -
167 Strip Asam Urat Botol 1 2 3 3 - 1
168 Strip Glukosa Botol 1 2 3 3 - 1
169 Strip Kolestrol Botol - - -
171 Thiamin HCl (B1) Tab 50 mg Tablet - - - -
172 Vitamin B Complex tab Tablet 576 8,000 8,576 2,043 6,533 409
173 Yodium 300 ml Botol 2 6 8 1 7 0
174 IV Chateter with Wings No. 20 G Pieces 76 76 10 66 2
15 Jarum Jahit Bedah No. 10 Pieces 12 12 2 10 0

1 PUSKESMAS 591 188
3 POSKESDES 290 300
5 DLL
TOTAL 881 488 1369

Drs. H. Tonga, M. AP Fatmawati, S.Si., Apt Nachsan, SKM Mulyani Badani, S.Si., Apt
NIP. 19640615 199003 1 028 NIP. 19810807 201503 2 003 NIP. 19630723 198903 1 009 NIP. 19790102 200604 2 013
KODE PUSKESMAS :
PUSKESMAS : RANGAS BULAN : JUNI
KABUPATEN : MAMUJU

1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
1 Advokasi Kit Kit - - - -
2 Albendazol tablet 400 mg Tablet 24,203 24,203 - 24,203 -
5 Benner Unit - - -
Gajah
9 Buku 10 10 - 10 -
13 DEC 100 mg Tablet 60,000 60,000 - 60,000 -
14 DHP (Malaria) Tablet 1 1 1 - 0 ED
29 Masker Bedah Box/50 1 1 1 - 0
30 MDT MB Adult Strip 4 4 4 - 1
35 O A T Kategori 1 Paket - 10 10 7 3 1
36 O A T Kategori Anak Paket - - - -
38 Oxytetracycline Salep Mata Tube 29 29 - 29 -
Albendazole
41 Pot Dahak Pcs 20 100 120 120 - 24
46 Rapid HIV 1 (Bioline) Pieces 25 100 125 50 75 10
52 Retinol 200.000 UI Tablet - - - -
53 Sarung Tangan M Pieces - - - -
55 Spoit 0,05 ml Pieces 160 160 30 130 6
56 Spoit 0,5 ml Pieces 295 295 195 100 39
58 Tablet Tambah Darah Tablet 2,040 2,040 2,010 30 402
60 Vaksin BCG + pelarut vial 12 12 12 - 2
61 Vaksin Campak + Rubella (MR) vial 13 13 13 - 3
62 Vaksin DPT-HB-Hib Vial 20 20 20 - 4
64 Vaksin HB0 Vial 15 15 10 5 2
66 Vaksin IPV Vial 15 15 10 5 2
67 Vaksin Polio (60pv) Vial 30 30 22 8 4
68 Vaksin Td Vial 25 25 10 15 2
70 Zinc 20 mg Tablet 453 453 118 335 24
71 Zinc Syr Botol - - - -
73 CTM Tablet - - -
74 Betametason 0,1 % Cr Tube 1 1 1 - 0
75 Thiamin Hcl Tablet 1,150 1,150 490 660 98
76 Rapid Test Siphillis Trepocher test 50 50 25 25 5
1 PUSKESMAS 591 188
3 POSKESDES 290 300
5 DLL
TOTAL 881 488 1369

NIP. 19640615 199003 1 028 NIP. 19810517 201001 2 014 NIP. 19630723 198903 1 009 NIP. 19790102 200604 2 013
KODE PUSKESMAS :
PUSKESMAS : RANGAS BULAN : JULI
KABUPATEN : MAMUJU

1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
1 Acyclovir tab 200 mg Tablet 146 146 60 86 12 300
3 Alat Suntik Sekali Pakai 1 ml (Stera) Pieces 200 200 100 100 20 300
6 Allopurinol 100 mg Tablet - 1,200 1,200 326 874 65 1,000
7 Aminophyllin 200 mg tab Tablet - - - - -
8 Aminophyllin 24 mg/ml Injeksi Ampul 23 6 29 23 6 5 - ED 23
9 Amlodipin tablet 5 mg Tablet 100 900 1,000 443 557 89 1,000
10 Amlodipin tablet 10 mg Tablet 150 600 750 240 510 48 1,000
11 Amoxicillin 500 mg Tablet 2,000 2,800 4,800 1,770 3,030 354 1,500
12 Amoxicillin Sirup 125 mg/5 ml Botol 23 100 123 58 65 12 100
13 Antasida Tab Tablet 1,000 1,000 200 800 40 (560)
17 Antiseptik hand rub 500 ml Botol - 2 2 2 - 0 6
19 Aquasonic Gel 250 ml Botol - - - - 6
20 Asam Asetilsasilisilat tab 80 mg Tablet - - - - -
21 Asam Askorbat tab 50 mg Tablet 800 1,500 2,300 1,245 1,055 249 2,000
22 Asam Askorbat tab 250 mg Tablet 1,236 1,236 436 800 87 (277)
24 Asam Mefenamat tab 500 mg Tablet 2,170 2,000 4,170 2,180 1,990 436 3,000
26 Atapulgit tab 600 mg Tablet 100 100 - 100 - (100)
27 Atropin sulfat Injeksi 0,25 mg/ml Ampul 10 10 - 10 - (10)
28 Basitrasin salep (polimixin B salep) tube - - - - 12
31 Betametason 0,1% krim Tube - - - - 50
32 Bisturi No. 10 Pcs 49 49 30 19 6 100
33 Calcii Gluconas Inj Ampul 2 6 8 - 8 - (8)
34 Captopril 12,5 mg Tablet 200 800 1,000 449 551 90 500
35 Captopril 25 mg tablet 200 200 90 110 18 500
37 Catgut Chromic 2/0 HR 30 MM Pcs 144 144 12 132 2 (118)
39 Cefadroxil 500 mg Tablet - - - - - 300
40 Ciprofloxacin tab 500 mg Tablet - 300 300 - 300 - (300)
41 Dexamethasone 0,5 mg tablet Tablet 2,253 1,000 3,253 3,133 120 627 2,500
42 Dexamethasone Injeksi Ampul - - - - 10
43 Diazepam 2 mg Tablet 45 100 145 88 57 18 200
46 Difenhidramin Injeksi 10 mg/ml Ampul 16 16 - 16 - (16)
50 Domperidon tablet 10 mg Tablet 600 600 163 437 33 (241)
51 Efinefrin Injeksi 0,1% Ampul 30 30 - 30 - (30)
55 Etakridin 0,1% 300 ml Btl/300 - - - 6
56 Etanol 70% 1000 ml Botol - - - 6
57 Etylchlorida semprot Btl/100 - - - - 1
59 Fitomenadion (Vit. K1) tab 10 mg Tablet 957 957 90 867 18 (759)
60 Fitomenadion (Vit. K1) Injeksi 2 mg/ml Ampul 21 21 10 11 2 30
61 Ampul - - - -
mg/ml
62 Furosemid tablet 40 mg Tablet - - - -
63 Gentamicin salep kulit Tube - - - - 50
65 Gentamicin sulfat TM 0,3% Btl/ 5 ml - - - - -
67 Glibenklamid tab 5 mg Tablet 110 110 30 80 6 1,000
68 Glimepiride 2 mg Tablet 289 800 1,089 72 1,017 14 (931)
69 Glukosa Larutan Infus 5% 500 ml Botol 3 3 - 3 - (3)
71 Griseofulvin 250 mg Tablet 250 300 550 410 140 82 800
74 Haloperidol 5 mg Tablet 165 165 - 165 - (165)
77 Hiosina butilbromida tab 10 mg Tablet 300 300 113 187 23 500
79 Ibuprofen 200 mg Tablet 200 200 200 - 40 1,500
80 Ibuprofen 400 mg Tablet 1,130 500 1,630 960 670 192 2,000
81 Infusion set anak Pcs 57 57 - 57 - (57)
82 Infusion set dewasa Pcs - 50 50 10 40 2 (28)
83 Isosorbide Dinitrate tab 5 mg Tablet - - - - -
85 IV Canula 20 G Pieces - - - - -
86 IV Canula 22 G Pieces 55 55 20 35 4 50
88 Jarum Jahit bedah No. 9 Bungkus 24 24 12 12 2 2
93 Kalsium Laktat tab 500 mg Tablet - - - - 1,000
94 Kapas 250 gram Roll 6 6 1 5 0 (4)
95 btl/ 5 ml 26 26 1 25 0 (24)
Gliserol 10%)
96 Kasa Kompres 40 x 40 cm Pieces 10 10 - 10 - (10)
97 Kasa Roll 3,6 x 5 cm Roll 10 10 5 5 1 10
98 Kasa Roll 3,6 x 15 cm Roll 10 10 - 10 - (10)
99 Kasa Roll Panjang 40 Y x 80 cm Roll 5 3 8 6 2 1 5
101 Ketoconazole 200 mg Tablet 130 130 - 130 - (130)
103 Khlorpheniramin Maleat 4 mg (CTM) Tablet - - - - 4,000
104 Kloramfenikol caps 250 mg Kapsul 300 300 90 210 18 (102)
105 Kloramfenikol Salep kulit 2% Tube 27 27 1 26 0 (25)
109 Kloramfenikol Tetes Telinga Botol/5 ml 10 10 - 10 - (10)
111 Kotrimoxazole 480 mg Tablet 537 537 31 506 6 (469)
113 Lidocain HCl Compositum Injeksi Ampul 70 70 70 - 14 84 ED 70
114 Lidocain HCl injeksi 2% Ampul 200 200 120 80 24 200
116 Loratadine Tablet 10 mg Tab - - - - 200
117 Masker Pcs 155 500 655 655 - 131 1,000
118 Metformin 500 mg tablet Tablet - - - - 2,000
119 Metformin 850 mg Tablet 1,520 1,520 1,520 - 304 1,500 ED 800
120 Methylprednisolon 4 mg Tablet 165 1,000 1,165 465 700 93 (142)
121 Metoklorpropamide tab 10 mg Tablet 100 100 - 100 - (100)
122 Metoklorpropamide Injeksi Ampul 8 8 8 - 2 10 ED 5
124 Metronidazole 500 mg Tablet 380 380 336 44 67 1,000
125 Metylergometrin Maleat Inj Ampul 40 40 3 37 1 (33)
127 Miconazole krim Tube - - - - 50
128 N-Asetil Sistein 200 mg Tablet 3,004 3,004 480 2,524 96 (1,948)
129 Natrium Diklofenak 25 mg Tablet 580 580 580 - 116 1,500
130 Natrium Diklofenak 50 mg Tablet - - - - 1,500
131 Natrium Klorida Inf 0,9% Btl/ 500 ml 14 14 - 14 - (14)
132 Nifedipine 10 mg tablet Tablet 130 130 - 130 - (130)
133 Nistatin Tab. Vag 100.000 UI Tablet vag 6 6 2 4 0 20
135 Omeprazole capsul 20 mg Kapsul 270 270 270 - 54 1,000
136 Omeprazole Injeksi Vial 10 10 - 10 - (10)
138 Oxytocin Inj 10 mg/ml Ampul - - - - -
139 Paracetamol syrup Btl/ 60 ml 31 100 131 106 25 21 102
140 Parasetamol tablet 500 mg Tablet 3,291 1,500 4,791 2,857 1,934 571 3,000
142 Plester 5 cm x 5 m Roll 1 1 1 - 0 6
143 Prednison tablet 5 mg Tablet - - - - 500
145 Propiltiuourasil (PTU) Tablet 70 70 10 60 2 (48)
147 Ranitidine 150 mg tablet Tablet - - - - 2,000
148 Ranitidine Injeksi 25 mg/ml Ampul 14 14 5 9 1 (3)
149 Reagen Golda Botol 1 1 1 - 0 -
150 Ringer Laktat Infus Btl/ 500 ml 27 27 15 12 3 -
153 Tube - - - 50
Belerang
154 Salep Antifungi 30 gram Pot - - - 25
156 Sarung Tangan M Box - - - - 6
158 Sarung Tangan Steril No. 6,5 Pasang - - - - 100
159 Sarung Tangan Steril no. 7 Pieces - - - - 100
160 Sarung Tangan Steril no. 7,5 Pasang 34 34 34 - 7 100
161 Ampul - - - -
mcg
162 Tablet 90 90 10 80 2 (68)
mcg
164 Silk Black 3/0 HR 30 MM Pcs 12 12 3 9 1 (5)
165 Simvastatin 10 mg Tablet 395 1,680 2,075 371 1,704 74 (1,259)
166 Simvastatin 20 mg Tablet 470 470 335 135 67 -
167 Strip Asam Urat Botol - - - - 5
168 Strip Glukosa Botol - 2 2 2 - 0 5
171 Thiamin HCl (B1) Tab 50 mg Tablet - - - - 1,000
172 Vitamin B Complex tab Tablet 6,533 500 7,033 3,533 3,500 707 2,000
173 Yodium 300 ml Botol 7 7 2 5 0 3
174 IV Chateter with Wings No. 20 G Pieces 66 66 16 50 3 (31)

1 PUSKESMAS 662 150
3 POSKESDES 326 323
5 DLL
TOTAL 988 473 1461

NIP. 19640615 199003 1 028 NIP. 19810807 201503 2 003 NIP. 19630723 198903 1 009 NIP. 19790102 200604 2 013
KODE PUSKESMAS :
KABUPATEN : MAMUJU

1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
2 Albendazol tablet 400 mg Tablet 24,203 24,203 - 24,203 -
5 Benner Unit - - -
Gajah
9 Buku 10 10 - 10 -
13 DEC 100 mg Tablet 60,000 60,000 - 60,000 -
14 DHP (Malaria) Tablet - - -
29 Masker Bedah Box/50 - 5 5 5 - 1
30 MDT MB Adult Strip - 6 6 4 2 1
35 O A T Kategori 1 Paket 3 5 8 8 - 2
36 O A T Kategori Anak Paket - 2 2 1 1 0
38 Oxytetracycline Salep Mata Tube 29 29 - 29 -
Albendazole
41 Pot Dahak Pcs - 100 100 80 20 16
46 Rapid HIV 1 (Bioline) Pieces 75 75 50 25 10
51 Retinol 100.000 UI Tablet 250 250 - 250 -
52 Retinol 200.000 UI Tablet - 1,750 1,750 100 1,650 20
53 Sarung Tangan M Pieces - - - -
55 Spoit 0,05 ml Pieces 130 100 230 50 180 10
56 Spoit 0,5 ml Pieces 100 500 600 285 315 57
58 Tablet Tambah Darah Tablet 30 13,590 13,620 3,980 9,640 796
59 Vaksin BCG Vial 20 20 15 5 3
60 Vaksin BCG + pelarut vial - - - -
61 Vaksin Campak + Rubella (MR) vial - 30 30 20 10 4
62 Vaksin DPT-HB-Hib Vial - - - - -
64 Vaksin HB0 Vial 5 30 35 15 20 3
66 Vaksin IPV Vial 5 20 25 18 7 4
67 Vaksin Polio (60pv) Vial 8 30 38 21 17 4
68 Vaksin Td Vial 15 - 15 3 12 1
69 Vitamin B1 Tablet Tablet - -
70 Zinc 20 mg Tablet 335 500 835 166 669 33
71 Zinc Syr Botol - - - -
73 CTM Tablet 1,000 1,000 1,000 - 200
74 Betametason 0,1 % Cr Tube - 10 10 6 4 1
75 Thiamin Hcl Tablet 660 500 1,160 430 730 86
76 Rapid Test Siphillis Trepocher test 25 25 25 - 5
77 Sarung Tangan Non Steril Pcs 1,000 1,000 1,000 - 200
78 Kalsium Laktat Tablet 500 500 200 300 40

1 PUSKESMAS 662 150
3 POSKESDES 326 323
5 DLL
TOTAL 988 473 1461

NIP. 19640615 199003 1 028 NIP. 19810807 201503 2 003 NIP. 19630723 198903 1 009 NIP. 19790102 200604 2 013
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT/BMHP BANTUAN
KODE PUSKESMAS :
KABUPATEN : MAMUJU

1 2 3 4 5 6=4+5 7 8=6-7 9=7x20% 10 11 12 13
1 Ambroxol 30 mg Tablet 700 700 462 238 92 1,000
2 Amoksisilin 500 mg Tablet 200 200 - 200 -

NIP. 19640615 199003 1 028 NIP. 19810807 201503 2 003 NIP. 19630723 198903 1 009 NIP. 19790102 200604 2 013
LAPORAN PEM
KODE PUSKESMAS :
PUSKESMAS : RANGAS
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU
NO NAMA OBAT/BMHP KEMASAN STOK AWAL

1 2 3 4
Acyclovir tab 200 mg Tablet 86
2 Acyclovir tab 400 mg Tablet 300
3 Alat Suntik Sekali Pakai 1 ml (Stera) Pieces 100
4 Alat Suntik Sekali Pakai 3 ml Pcs -
5 Alat Suntik Sekali Pakai 5 ml Pcs -
6 Allopurinol 100 mg Tablet 874
7 Aminophyllin 200 mg tab Tablet -
8 Aminophyllin 24 mg/ml Injeksi Ampul 6
9 Amlodipin tablet 5 mg Tablet 557
10 Amlodipin tablet 10 mg Tablet 510
11 Amoxicillin 500 mg Tablet 3,030
12 Amoxicillin Sirup 125 mg/5 ml Botol 65
13 Antasida Tab Tablet 800
14 Antacida suspensi btl /60 ml 1
15 Antihaemorrid Supp Supp/2 g 55
16 Antimigrain : ergotamine + coffeine tablet 220
17 Antiseptik hand rub 500 ml Botol -
18 Aqua Pro Injeksi 25 ml Btl/25 ml 18
19 Aquasonic Gel 250 ml Botol -
20 Asam Asetilsasilisilat tab 80 mg Tablet -
21 Asam Askorbat tab 50 mg Tablet 1,055
22 Asam Askorbat tab 250 mg Tablet 800
23 Asam folat 1 mg tablet
24 Asam Mefenamat tab 500 mg Tablet 1,990
25 Asering Infus Btl/500 ml
26 Atapulgit tab 600 mg Tablet 100
27 Atropin sulfat Injeksi 0,25 mg/ml Ampul 10
28 Basitrasin salep (polimixin B salep) tube -
29 Bedak Salisil Pot 5
30 Betahistin 6 mg Tablet 490
31 Betametason 0,1% krim Tube -
32 Bisturi No. 10 Pcs 19
33 Calcii Gluconas Inj Ampul 8
34 Captopril 12,5 mg Tablet 551
35 Captopril 25 mg tablet 110
36 Carbamazepin tab 200 mg Tablet
37 Catgut Chromic 2/0 HR 30 MM Pcs 132
38 Catgut Chromic 3/0 HR 30 MM Pcs 127
39 Cefadroxil 500 mg Tablet -
40 Ciprofloxacin tab 500 mg Tablet 300
41 Dexamethasone 0,5 mg tablet Tablet 120
42 Dexamethasone Injeksi Ampul -
43 Diazepam 2 mg Tablet 57
44 Diazepam 5 mg Tablet 131
45 Diazepam Injeksi Ampul 10
46 Difenhidramin Injeksi 10 mg/ml Ampul 16
47 Digoxin tablet 0,25 mg Tablet
48 Diltiazem tab 30 mg Tablet
49 Dimenhidrinat tab 50 mg Tablet 58
50 Domperidon tablet 10 mg Tablet 437
51 Efinefrin Injeksi 0,1% Ampul 30
52 Eritromisin kapsul 250 mg Tablet
53 Eritromisin kapsul 500 mg Capsul
54 Etakridin (Rivanol) 100 ml Botol
55 Etakridin 0,1% 300 ml Btl/300
56 Etanol 70% 1000 ml Botol
57 Etylchlorida semprot Btl/100 -
58 Fenobarbital tab 30 mg Tablet 190
59 Fitomenadion (Vit. K1) tab 10 mg Tablet 867
60 Fitomenadion (Vit. K1) Injeksi 2 mg/ml Ampul 11
61 Ampul
mg/ml
62 Furosemid tablet 40 mg Tablet
63 Gentamicin salep kulit Tube -
64 Gentamicin salep mata Tube
65 Gentamicin sulfat TM 0,3% Btl/ 5 ml -
66 Gentian Violet 1% Btl/ 5 ml
67 Glibenklamid tab 5 mg Tablet 80
68 Glimepiride 2 mg Tablet 1,017
69 Glukosa Larutan Infus 5% 500 ml Botol 3
70 Glukosa Larutan Infus 10% 500 ml Botol
71 Griseofulvin 250 mg Tablet 140
72 Haloperidol tab 0,5 mg Tablet
73 Haloperidol tab 1,5 mg Tablet
74 Haloperidol 5 mg Tablet 165
75 Hidroklorothiazid (HCT) tab Tablet 200
76 Hidrokortison Cream 2,5% Tube 44
77 Hiosina butilbromida tab 10 mg Tablet 187
78 Hypafix 5 cm x 5 m Roll -
79 Ibuprofen 200 mg Tablet -
80 Ibuprofen 400 mg Tablet 670
81 Infusion set anak Pcs 57
82 Infusion set dewasa Pcs 40
83 Isosorbide Dinitrate tab 5 mg Tablet -
84 IV Canula 18 G Pieces 58
85 IV Canula 20 G Pieces -
88 Jarum Jahit bedah No. 9 Bungkus 12
91 Ka-en 3B Larutan infus botol
92 Kalium Permanganas Serbuk Pot/ 5 g
93 Kalsium Laktat tab 500 mg Tablet -
94 Kapas 250 gram Roll 5
95 btl/ 5 ml 25
Gliserol 10%)
96 Kasa Kompres 40 x 40 cm Pieces 10
97 Kasa Roll 3,6 x 5 cm Roll 5
98 Kasa Roll 3,6 x 15 cm Roll 10
99 Kasa Roll Panjang 40 Y x 80 cm Roll 2
100 Kasa Steril 16 x 16 cm Box 10
101 Ketoconazole 200 mg Tablet 130
102 Ketokonazol Krim Tube
103 Khlorpheniramin Maleat 4 mg (CTM) Tablet -
104 Kloramfenikol caps 250 mg Kapsul 210
105 Kloramfenikol Salep kulit 2% Tube 26
106 Kloramfenikol Salep Mata 1% Tube
107 Kloramfenikol suspensi botol
108 Kloramfenikol Tetes Mata 0,5% Botol/5 ml
109 Kloramfenikol Tetes Telinga Botol/5 ml 10
110 Klorpromazin tab 100 mg Tablet 194
111 Kotrimoxazole 480 mg Tablet 506
112 Kotrimoxazole Suspensi Botol 85
113 Lidocain HCl Compositum Injeksi Ampul -
114 Lidocain HCl injeksi 2% Ampul 80
115 Loperamid tablet Tablet 100
116 Loratadine Tablet 10 mg Tab -
117 Masker Pcs -
118 Metformin 500 mg tablet Tablet -
119 Metformin 850 mg Tablet -
120 Methylprednisolon 4 mg Tablet 700
121 Metoklorpropamide tab 10 mg Tablet 100
122 Metoklorpropamide Injeksi Ampul -
123 Metronidazol tab 250 mg Tablet
124 Metronidazole 500 mg Tablet 44
125 Metylergometrin Maleat Inj Ampul 37
126 Metylergometrin Maleat tab. Tablet 100
127 Miconazole krim Tube -
128 N-Asetil Sistein 200 mg Tablet 2,524
129 Natrium Diklofenak 25 mg Tablet -
130 Natrium Diklofenak 50 mg Tablet -
131 Natrium Klorida Inf 0,9% Btl/ 500 ml 14
132 Nifedipine 10 mg tablet Tablet 130
133 Nistatin Tab. Vag 100.000 UI Tablet vag 4
134 Nistatin Tab. Vag 500.000 UI Tablet 100
135 Omeprazole capsul 20 mg Kapsul -
136 Omeprazole Injeksi Vial 10
137 Oxytetracyclin Salep Mata 1% Tube
138 Oxytocin Inj 10 mg/ml Ampul -
139 Paracetamol syrup Btl/ 60 ml 25
140 Parasetamol tablet 500 mg Tablet 1,934
141 Pehacain Injeksi Ampul
142 Plester 5 cm x 5 m Roll -
143 Prednison tablet 5 mg Tablet -
144 Propanolol 10 mg Tablet 100
145 Propiltiuourasil (PTU) Tablet 60
146 Pyridoxin HCl tablet 10 mg Tablet
147 Ranitidine 150 mg tablet Tablet -
148 Ranitidine Injeksi 25 mg/ml Ampul 9
149 Reagen Golda Botol -
150 Ringer Laktat Infus Btl/ 500 ml 12
151 Salbutamol tab 2 mg Tablet
152 Salbutamol tab 4 mg Tablet -
153 Tube
Belerang
154 Salep Antifungi 30 gram Pot
155 Sarung Tangan S Box -
156 Sarung Tangan M Box -
157 Sarung Tangan L Box
158 Sarung Tangan Steril No. 6,5 Pasang -
159 Sarung Tangan Steril no. 7 Pieces -
160 Sarung Tangan Steril no. 7,5 Pasang -
161 Ampul
mcg
162 Tablet 80
mcg
163 Silk Black 2/0 HR 30 MM Pcs 12
164 Silk Black 3/0 HR 30 MM Pcs 9
165 Simvastatin 10 mg Tablet 1,704
166 Simvastatin 20 mg Tablet 135
167 Strip Asam Urat Botol -
168 Strip Glukosa Botol -
169 Strip Kolestrol Botol
170 Tetrasiklin 500 mg Kapsul
171 Thiamin HCl (B1) Tab 50 mg Tablet -
172 Vitamin B Complex tab Tablet 3,500
173 Yodium 300 ml Botol 5
174 IV Chateter with Wings No. 20 G Pieces 50
15 Jarum Jahit Bedah No. 10 Pieces 10

NO FASILITAS KESEHATAN
BPJS NON BPJS
1 PUSKESMAS
3 POSKESDES
5 DLL
TOTAL
Mengetahui,
kepala Dinas kesehatan Kab. Mamuju Kepala Instalasi Farmasi Kab. Mamu
Drs. H. Tonga, M. AP Fatmawati, S.Si., Apt

NIP. 19640615 199003 1 028 NIP. 19810807 201503 2 003
STOK STOK
PENERIMAAN PERSEDIAAN PENGELUARAN
AKHIR PENGAMAN
5 6=4+5 7 8=6-7 9=7x20%
200 286 86 200 17
300 - 300 -
300 400 90 310 18
- - -
- - -
1,000 1,874 284 1,590 57
- - -
6 - 6 -
900 1,457 411 1,046 82
900 1,410 88 1,322 18
1,400 4,430 1,753 2,677 351
100 165 58 107 12
800 - 800 -
1 1 - 0
55 4 51 1
220 - 220 -
- - -
18 - 18 -
- - -
- - -
2,000 3,055 1,604 1,451 321
800 100 700 20
- - -
3,000 4,990 1,880 3,110 376
- - -
100 10 90 2
10 - 10 -
- - -
20 25 11 14 2
490 65 425 13
- - -
100 119 19 100 4
8 - 8 -
500 1,051 321 730 64
110 96 14 19
- - -
132 - 132 -
127 - 127 -
- - -
300 94 206 19
2,500 2,620 1,020 1,600 204
- - -
200 257 48 209 10
131 32 99 6
10 - 10 -
16 - 16 -
- - -
- - -
58 - 58 -
437 177 260 35
30 3 27 1
- - -
- - -
- - -
- - -
- - -
1 1 - 1 -
190 - 190 -
867 120 747 24
30 41 - 41 -
- - -
- - -
- - -
- - -
- - -
- - -
80 80 - 16
1,017 80 937 16
3 1 2 0
- - -
300 440 310 130 62
- - -
- - -
165 - 165 -
200 - 200 -
48 92 64 28 13
500 687 40 647 8
- - -
1,400 1,400 146 1,254 29
1,100 1,770 910 860 182
57 - 57 -
40 3 37 1
- - -
58 - 58 -
- - -
50 85 - 85 -
60 - 60 -
24 36 - 36 -
24 - 24 -
12 - 12 -
- - -
- - -
500 500 400 100 80
5 1 4 0
25 1 24 0
10 10 - 2
5 5 - 1
10 - 10 -
5 7 2 5 0
10 5 5 1
130 50 80 10
- - -
500 500 500 - 100
210 - 210 -
26 - 26 -
- - -
- - -
- - -
10 - 10 -
194 15 179 3
506 151 355 30
85 7 78 1
90 90 - 90 -
200 280 20 260 4
100 - 100 -
- - -
1,000 1,000 950 50 190
- - -
- - -
700 400 300 80
100 30 70 6
10 10 - 10 -
- - -
44 44 - 9
37 10 27 2
200 300 - 300 -
- - -
2,524 561 1,963 112
- - -
- - -
40 54 12 42 2
130 - 130 -
100 104 - 104 -
100 - 100 -
- - -
10 5 5 1
- - -
- - -
100 125 61 64 12
3,000 4,934 2,104 2,830 421
- - -
- - -
- - -
100 - 100 -
60 40 20 8
- - -
- - -
9 9 - 2
- - -
60 72 - 72 -
- - -
- - -
- - -
- - -
2 2 2 - 0
2 2 2 - 0
2 2 2 - 0
100 100 36 64 7
100 100 60 40 12
100 100 50 50 10
- - -
80 - 80 -
12 - 12 -
9 - 9 -
1,704 284 1,420 57
135 65 70 13
- - -
- - -
- - -
- - -
- - -
2,000 5,500 1,980 3,520 396
3 8 - 8 -
50 10 40 2
10 - 10 -
NJUNGAN RESEP
KET
JUMLAH
Menyetujui : Mengetahui,
Kepala Instalasi Farmasi Kab. Mamuju Kepala Puskesmas ………….
Fatmawati, S.Si., Apt Nachsan, SKM

NIP. 19810807 201503 2 003 NIP. 19630723 198903 1 009
BAT/BMHP
BULAN : AGUSTUS
TAHUN : 2021
PEMBERIAN JUMLAH
PERMINTAAN KET
PKD PROG/DKP LAIN2 PEMBERIAN
10 11 12 13
skesmas …………. Yang Membuat Laporan
chsan, SKM Mulyani Badani, S.Si., Apt

0723 198903 1 009 NIP. 19790102 200604 2 013
LAPOR
KODE PUSKESMAS :
PUSKESMAS : RANGAS
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU
NO NAMA OBAT/BMHP SATUAN STOK AWAL

1 2 3 4
1 Advokasi Kit Kit
2 Albendazol tablet 400 mg Tablet 24,203
3 Albendazol tablet 400 mg Tablet
4 Albendazol tablet 400 mg Tablet
5 Benner Unit
6 dan Mencegah Penyakit Kaki Buku 50
Gajah
7 Buku Register POPM Filariasis Buku 100
8 Buku Saku Malaria Pieces
9 Buku 10
10 Calcium Gluconas Inj Ampul 24
11 Catrtridge Paket
12 Clofazimin/Lamprene 100 mg Tablet -
13 DEC 100 mg Tablet 60,000
14 DHP (Malaria) Tablet
15 Etambutol 400 mg Tablet
16 Ethionamide 250 mg Tablet
17 Garam Oralit Sachet 42
18 Giemsa 100 ml Botol
19 INH 300 mg Tablet
20 Invermectin Tablet 32,000
21 Kaca Slide/ Microscope Slide Pieces
22 Kanamycin Sulfat Inj Vial
23 Kit Advokasi POPM IDA Kit 5
24 Kit Belkaga IDA Kit 5
25 Kit POPM Filariasis Kit 60
26 Kombipak Kategori 1 Paket
27 Kondom Pieces
28 Levofloxacin 250 mg Tablet
29 Masker Bedah Box/50 -
30 MDT MB Adult Strip 2
31 MDT MB Child Strip
32 Moxifloxacin 400 mg (Moximed) Tablet
33 Natrium Klorida 0,9% inf 500 ml Botol
34 Nevirapine tablet Tablet
35 O A T Kategori 1 Paket -
36 O A T Kategori Anak Paket 1
37 OAT Kategori 2 Paket
38 Oxytetracycline Salep Mata Tube 29
39 Regimen Invermectin DEC, Buku 100
Albendazole
40 PAS-Na 5,52 gram Sachet
41 Pot Dahak Pcs 20
42 Primaquin Tablet Tablet
43 Pyrazinamide 500 mg Tablet
44 Pyridoxyn 100 mg (Vitamin B6) Tablet -
45 Quinine tablet Tablet
46 Rapid HIV 1 (Bioline) Pieces 25
47 Rapid Test 3 Fokus test
48 Rapid Test Hepatitis Test
49 RDT Combo Test
50 Reagen ZN Paket 1
51 Retinol 100.000 UI Tablet 250
52 Retinol 200.000 UI Tablet 1,650
53 Sarung Tangan M Pieces -
54 Sarung Tangan L Pieces
55 Spoit 0,05 ml Pieces 180
56 Spoit 0,5 ml Pieces 315
57 Spoit 5 ml Pieces
58 Tablet Tambah Darah Tablet 9,640
59 Vaksin BCG Vial 5
60 Vaksin BCG + pelarut vial -
61 Vaksin Campak + Rubella (MR) vial 10
62 Vaksin DPT-HB-Hib Vial -
63 Vaksin DT Vial 5
64 Vaksin HB0 Vial 20
65 Vaksin HbIg Vial
66 Vaksin IPV Vial 7
67 Vaksin Polio (60pv) Vial 17
68 Vaksin Td Vial 12
69 Vitamin B1 Tablet Tablet
70 Zinc 20 mg Tablet 669
71 Zinc Syr Botol -
72 Euthyrox 50 mg Tablet -
73 CTM Tablet
74 Betametason 0,1 % Cr Tube 4
75 Thiamin Hcl Tablet 730
76 Rapid Test Siphillis Trepocher test -
77 Sarung Tangan Non Steril Pcs
78 Kalsium Laktat Tablet 300

NO FASILITAS KESEHATAN
BPJS NON BPJS
1 PUSKESMAS
3 POSKESDES
5 DLL
TOTAL
Mengetahui,
kepala Dinas kesehatan Kab. Mamuju Kepala Instalasi Farmasi Kab. Mamu
Drs. H. Tonga, M. AP Fatmawati, S.Si., Apt

NIP. 19640615 199003 1 028 NIP. 19810807 201503 2 003
STOK STOK
AKHIR PENGAMAN
5 6=4+5 7 8=6-7 9=7x20%
- -
24,203 2,603 21,600
- -
- -
- -
50 50 -
100 100 -
- -
10 10 -
24 24 -
- -
- -
60,000 7,000 53,000
- -
- -
- -
42 42 -
- -
- -
32,000 13,000 19,000
- -
- -
5 5 -
5 5 -
60 60 -
- -
- -
- -
4 4 3 1
2 2 -
- -
- -
- -
- -
10 10 5 5
1 - 1
- -
29 - 29
100 100 -
- -
50 70 70 -
- -
- -
- -
- -
25 25 -
- -
- -
- -
1 1 -
250 50 -
1,650 50 1,600
- -
- -
100 280 35 245
300 615 280 335
100 100 30 70
9,640 3,170 6,470
5 5 -
- -
30 40 22 18
50 50 30 20
5 - 5
20 40 20 20
- -
20 27 8 19
30 47 18 29
20 32 5 27
- -
669 285 384
- -
- -
- -
4 4 -
730 455 275
- -
- -
300 300 -
UNJUNGAN RESEP
KET
JUMLAH
Menyetujui : Mengetahui,
Kepala Instalasi Farmasi Kab. Mamuju Kepala Puskesmas ………….

NIP. 19810807 201503 2 003 NIP. 19630723 198903 1 009
21
BULAN : AGUSTUS
TAHUN : 2021
PEMBERIAN JUMLAH
PERMINTAAN KET
10 11 12 13
ED 24
ED 1
ED 200
skesmas …………. Yang Membuat Laporan
chsan, SKM Mulyani Badani, S.Si., Apt

23 198903 1 009 NIP. 19790102 200604 2 013
LAPORAN PEMAKAI
KODE PUSKESMAS :
PUSKESMAS : RANGAS
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU
NO NAMA OBAT/BMHP KEMASAN STOK AWAL

1 2 3 4
1 Ambroxol 30 mg Tablet 238
2 Amoksisilin 500 mg Tablet 200
Mengetahui,
kepala Dinas kesehatan Kab. Mamuju
Drs. H. Tonga, M. AP
NIP. 19640615 199003 1 028
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT/BMHP BANTUAN
STOK STOK
AKHIR PENGAMAN
5 6=4+5 7 8=6-7 9=7x20%
238 238 -
100 300 300 -
Menyetujui :
Kepala Instalasi Farmasi Kab. Mamuju Kepala Puskesmas ………

NIP. 19810807 201503 2 003 NIP. 19630723 198903 1 0
MHP BANTUAN
BULAN : AGUSTUS
TAHUN : 2021
PEMBERIAN JUMLAH
PERMINTAAN KET
10 11 12 13
Mengetahui,
Kepala Puskesmas …………. Yang Membuat Laporan
Nachsan, SKM Mulyani Badani, S.Si., Apt

NIP. 19630723 198903 1 009 NIP. 19790102 200604 2 013

FORMAT LPLPO 2021

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT/BMHP

PUSKESMAS : RANGAS BULAN : FEBRUARI

JUMLAH KUNJUNGAN RESEP

tempat, tanggal bulan tahun

drg. H. FIRMON, MPH NENENG SALMIAH, S.Farm,M.Kes ………………………………………...……….. …………………………...………..

PUSKESMAS : RANGAS BULAN : FEBRUARI

JUMLAH KUNJUNGAN RESEP

tempat, tanggal bulan tahun

drg. H. FIRMON, MPH NENENG SALMIAH, S.Farm,M.Kes ………………………………………...……….. …………………………...………..

STOK STOK PEMBERIAN JUMLAH

JUMLAH KUNJUNGAN RESEP

tempat, tanggal bulan tahun

drg. H. FIRMON, MPH NENENG SALMIAH, S.Farm,M.Kes ………………………………………...……….. …………………………...………..

STOK STOK PEMBERIAN JUMLAH

tempat, tanggal bulan tahun

drg. H. FIRMON, MPH NENENG SALMIAH, S.Farm,M.Kes ………………………………………...……….. …………………………...………..

STOK STOK PEMBERIAN JUMLAH

JUMLAH KUNJUNGAN RESEP

tempat, tanggal bulan tahun

STOK STOK PEMBERIAN JUMLAH

tempat, tanggal bulan tahun

STOK STOK PEMBERIAN JUMLAH

JUMLAH KUNJUNGAN RESEP

tempat, tanggal bulan tahun

STOK STOK PEMBERIAN JUMLAH

tempat, tanggal bulan tahun

STOK STOK PEMBERIAN JUMLAH

JUMLAH KUNJUNGAN RESEP

tempat, tanggal bulan tahun

STOK STOK PEMBERIAN JUMLAH

tempat, tanggal bulan tahun

STOK STOK PEMBERIAN JUMLAH

JUMLAH KUNJUNGAN RESEP

tempat, tanggal bulan tahun

STOK STOK PEMBERIAN JUMLAH

JUMLAH KUNJUNGAN RESEP

tempat, tanggal bulan tahun

STOK STOK PEMBERIAN JUMLAH

Mengetahui, Menyetujui : Mengetahui,

NO NAMA OBAT/BMHP KEMASAN STOK AWAL

JUMLAH KUNJUNGAN RESEP

Drs. H. Tonga, M. AP Fatmawati, S.Si., Apt

Fatmawati, S.Si., Apt Nachsan, SKM

skesmas …………. Yang Membuat Laporan

chsan, SKM Mulyani Badani, S.Si., Apt

NO NAMA OBAT/BMHP SATUAN STOK AWAL

JUMLAH KUNJUNGAN RESEP

Drs. H. Tonga, M. AP Fatmawati, S.Si., Apt

Fatmawati, S.Si., Apt Nachsan, SKM

skesmas …………. Yang Membuat Laporan

chsan, SKM Mulyani Badani, S.Si., Apt

NO NAMA OBAT/BMHP KEMASAN STOK AWAL

Fatmawati, S.Si., Apt Nachsan, SKM

Nachsan, SKM Mulyani Badani, S.Si., Apt

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