LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

(LPLPO)

Polindes/ Pustu/ ponkesdes : : PENIDON

TAHUN : JANUARI 2021

STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT
NO. NAMA OBAT SATUAN
OPT AAN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24

A. OBAT ESSENSIAL

1 ALBENDAZOL TABLET 400 MG TAB

0 0 0
2 ALBENDAZOL SUSPENSI 200 MG / 5 ML BTL
0 0 0
3 ALOPURINOL TABLET 100 MG TAB
80 50 30 0
4 AMBROKSOL TABLET 30 MG TAB
0 0 0
6 AMINOFILLIN TABLET 200 MG TAB
0 0 0
8 AMLODIPIN TABLET 10 MG TAB
125 0 100 0 25
9 AMLODIPIN TABLET 5 MG TAB
0 0 0
10 AMOKSISILIN KAPLET 500 MG KAPL
200 200 0 0
11 AMOKSISILIN KAPSUL 250 MG KAP
0 0 0
13 AMOKSISILIN SIRUP KERING 125 MG / 5 ML BTL
3 3 0 0
16 ANTASIDA DOEN SUSPENSI BTL
0 0 0
17 ANTASIDA DOEN TABLET KOMBINASI TAB
240 0 200 0 40
18 ANTI BAKTERI DOEN SALEP KOMBINASI TUB
0 0 0
19 ANTI FUNGI DOEN KOMBINASI POT
0 0 0
21 ANTI INFEKSI KRIM TUB
0 0 0
22 ANTI MIGRAIN DOEN TABLET KOMBINASI TAB
0 0 0
25 ASAM ASKORBAT TABLET 250 MG TAB
0 0 0
26 ASAM ASKORBAT TABLET 50 MG TAB
100 100 0 0
27 ASAM ASKORBAT TABLET 500 MG TAB
0 0 0
28 ASAM FOLAT TABLET 0,4 MG TAB
0 0 0
29 ASAM MEFENAMAT TABLET 500 MG TAB
200 200 0 0
30 ASAM TRANEKSAMAT INJEKSI 50 MG / ML AMP
0 0 0
31 ASAM TRANEKSAMAT TABLET 500 MG TAB
0 0 0
33 ASIKLOVIR TABLET 200 MG TAB
0 0 0
34 ASIKLOVIR TABLET 400 MG TAB
30 30 0 0
35 ASIKLOVIR KRIM 5 % TUB
1 0 1 0 0
36 ATAPULGIT TABLET 600 MG TAB
0 0 0
40 BETAHISTIN MESILAT TABLET 6 MG TAB
0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT
NO. NAMA OBAT SATUAN
OPT AAN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24

41 BETAMETASON KRIM 0,1 % TUB

0 0 0
46 DEKSAMETASON INJEKSI 5 MG / ML - 1 ML AMP
0 0 0
47 DEKSAMETASON TABLET 0,5 MG TAB
210 20 170 40 20
52 DIFENHIDRAMIN HCL INJEKSI 10 MG / ML - 1 ML AMP
5 0 5 0 0
56 DIMENHIDRINAT TABLET 50 MG TAB
40 40 0 0
57 DOMPERIDON SIRUP 5 MG / 5 ML BTL
0 0 0
58 DOMPERIDON TABLET 10 MG TAB
0 0 0
59 EPINEPRIN HCL INJEKSI 0,1 % AMP
0 0 0
60 ERITROMISIN KAPSUL 500 MG KAP
0 0 0
61 ERITROMISIN SIRUP KERING 200 MG / 5 ML BTL
0 0 0
62 ETAKRIDIN LARUTAN 0,1 % BTL
0 0 0
63 ETANOL 70 % BTL
3 0 3 0
64 ETIL KLORIDA SEMPROT BTL
0 0 0
69 FENOL GLISEROL TETES TELINGA 10 % BTL
2 2 0 0
70 FITOMENADION INJEKSI 2 MG / ML - 1 ML AMP
0 0 0
71 FITOMENADION INJEKSI 10 MG / ML - 1 ML AMP
0 0 0
72 FITOMENADION TABLET SALUT 10 MG TAB
0 0 0
75 FUROSEMID INJEKSI 10 MG AMP
0 0 0
76 FUROSEMID TABLET 40 MG TAB
0 0 0
77 GARAM ORALIT KOMBINASI SAK
60 30 30 0
78 GEMFIBROZIL KAPSUL 300 MG KAP
0 0 0
79 GENTAMISIN INJEKSI 40 MG/ML AMP
0 0 0
80 GENTAMISIN TETES MATA 0,3 % BTL
2 2 0 0
81 GENTAMISIN SALEP KULIT 0,1 % TUB
0 0 0
82 GENTAMISIN SALEP MATA 0,3 % TUB
0 0 0
83 GENTIAN VIOLET LARUTAN 1 % BTL
0 0 0
84 GLIBENKLAMID TABLET 5 MG TAB
50 30 20 0
85 GLIMEPIRIDE TABLET 2 MG TAB
0 0 0
86 GLUKOSA LARUTAN INFUS 5 % STERIL BTL
0 0 0
87 GLUKOSA LARUTAN INFUS 10 % STERIL BTL
0 0 0
88 GLUKOSA LARUTAN INFUS 40 % STERIL AMP
0 0 0
89 GRISEOFULVIN TABLET 125 MG TAB
0 0 0
96 HIDROKLORTIAZID TABLET 25 MG TAB
0 0 0
97 HIDROKORTISON KRIM 2,5 % TUB
0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT
NO. NAMA OBAT SATUAN
OPT AAN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24

99 HIOSIN BUTILBROMIDA TABLET 10 MG TAB

50 30 20 0
100 IBUPROFEN SUSPENSI 100 MG / 5 ML BTL
0 0 0
101 IBUPROFEN TABLET 200 MG TAB
5 5 0 0
102 IBUPROFEN TABLET 400 MG TAB
0 0 0
103 INSULIN ANALOG LONG ACTING PEN
0 0 0
104 INSULIN ANALOG RAPID ACTING PEN
0 0 0
105 ISONIAZID TABLET 100 MG TAB
0 0 0
106 ISONIAZID TABLET 300 MG TAB
0 0 0
107 ISOSORBID DINITRAT TABLET 5 MG TAB
0 0 0
108 KALSIUM GLUKONAT INJEKSI 10 % AMP
0 0 0
109 KALSIUM LAKTAT TABLET 500 MG TAB
0 0 0
111 KAOLIN - PEKTIN SIRUP BTL
0 0 0
112 KAPTOPRIL TABLET 25 MG TAB
0 0 0
113 KARBAMAZEPIN TABLET 200 MG TAB
0 0 0
114 KETOKONAZOLE KRIM 2 % TUB
4 2 2 0
115 KETOKONAZOLE TABLET 200 MG TAB
0 0 0
116 KLINDAMISIN KAPSUL 300 MG KAP
0 0 0
120 KLORAMFENIKOL INJEKSI 1000 MG VIAL
0 0 0
121 KLORAMFENIKOL KAPSUL 250 MG KAP
0 0 0
122 KLORAMFENIKOL SALEP MATA 1% TUB
0 0 0
123 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BTL
5 3 2 0
124 KLORAMFENIKOL TETES MATA 0,5 % BTL
0 0 0
125 KLORAMFENIKOL TETES TELINGA 3 % BTL
0 0 0
126 KLORFENIRAMIN MALEAT TABLET 4 MG TAB
400 200 200 0
132 KOTRIMOKSAZOL DEWASA TABLET TAB
0 0 0
133 KOTRIMOKSAZOL PEDIATRIK TABLET TAB
0 0 0
134 KOTRIMOKSAZOL SUSPENSI 240 MG / 5 ML BTL
3 3 0 0
135 KURKUMA SIRUP BTL
0 0 0
136 KURKUMA TABLET TAB
0 0 0
137 LAKTULOSA SIRUP BTL
0 0 0
138 LEVOFLOKSASIN TABLET 500 MG TAB
0 0 0
139 LEVOTIROKSIN TABLET 100 MCG TAB
0 0 0
140 LIDOKAIN KOMPOSITUM INJEKSI AMP
0 0 0
141 LIDOKAIN SPRAY ORAL 10 % BTL
0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT
NO. NAMA OBAT SATUAN
OPT AAN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24

142 LISINOPRIL TABLET 5 MG TAB

0 0 0
143 LISINOPRIL TABLET 10 MG TAB
0 0 0
144 LOPERAMID TABLET 2 MG TAB
0 0 0
145 LORATADIN TABLET 10 MG TAB
0 0 0
146 MAGNESIUM SULFAT INJEKSI / IV 20% - 25 ML AMP
0 0 0
147 MAGNESIUM SULFAT INJEKSI / IV 40% - 25 ML AMP
0 0 0
149 MEBENDAZOL TABLET 100 MG TAB
0 0 0
150 MELOKSIKAM TABLET 15 MG TAB
0 0 0
151 METAMIZOL INJEKSI 500 MG / ML AMP
0 0 0
152 METFORMIN TABLET 500 MG TAB
130 100 30 0
153 METIL ERGOMETRIN INJEKSI 0,2 MG / ML - 1 ML AMP
0 0 0
154 METIL ERGOMETRIN TABLET 0,125 MG TAB
0 0 0
155 METIL PREDNISOLON INJEKSI 125 MG AMP
0 0 0
156 METIL PREDNISOLON TABLET 4 MG TAB
0 0 0
157 METOKLOPRAMID INJEKSI 5 MG / ML AMP
0 0 0
158 METOKLOPRAMID TABLET 10 MG TAB
0 0 0
159 METRONIDAZOL INFUS 5 MG / ML BTL
0 0 0
160 METRONIDAZOL SIRUP 125 MG / 5 ML BTL
0 0 0
161 METRONIDAZOL TABLET 250 MG TAB
0 0 0
162 METRONIDAZOL TABLET 500 MG TAB
0 0 0
163 MIKONAZOL KRIM 2% TUB
0 0 0
165 MOMETASON FUROAT KRIM 0,1 % TUB
0 0 0
166 N-ASETIL SISTEIN KAPSUL 200 MG KAP
160 50 110 0
167 NASALIN SPRAY 100 ML BTL
0 0 0
168 NATRIUM BIKARBONAT INJEKSI 8,4 % AMP
0 0 0
169 NATRIUM BIKARBONAT TABLET 500 MG TAB
0 0 0
170 NATRIUM DIKLOFENAK 50 MG TAB
0 0 0
171 NATRIUM FOSFAT ENEMA TUB
0 0 0
172 NATRIUM FUSIDAT SALEP 20 MG / G TUB
0 0 0
173 NATRIUM KLORIDA LARUTAN INFUS 0,9 % BTL
0 0 0
174 NIFEDIPIN TABLET 10 MG TAB
0 0 0
175 NIFEDIPIN TABLET 30 MG SR TAB
0 0 0
176 NISTATIN 100.000 IU / G TABLET VAGINA TAB
0 0 0
177 NISTATIN 500.000 IU TABLET SALUT TAB
0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT
NO. NAMA OBAT SATUAN
OPT AAN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24

178 NISTATIN SUSPENSI 100.000 IU / ML BTL

10 0 10 0 0
179 NORETISTERON TABLET 5 MG TAB
0 0 0
184 OBAT BATUK HITAM SIRUP BTL
0 0 0
185 OKSIMETAZOLIN TETES HIDUNG 0,025 % BTL
0 0 0
186 OKSIMETAZOLIN TETES HIDUNG 0,05 % BTL
0 0 0
187 OKSITETRASIKLIN HCL IM 50 MG / ML - 10 ML AMP
0 0 0
188 OKSITETRASIKLIN HCL SALEP KULIT 3 % TUB
0 0 0
189 OKSITETRASIKLIN HCL SALEP MATA 1 % TUB
0 0 0
190 OKSITOSIN INJEKSI 10 IU / ML - 1 ML AMP
5 3 2 0
191 OMEPRAZOLE INJEKSI 40 MG VIAL
0 0 0
192 OMEPRAZOLE KAPSUL 20 MG KAP
0 0 0
195 PARASETAMOL DROPS 100 MG / ML BTL
0 0 0
196 PARASETAMOL INFUS 10 MG / ML BTL
0 0 0
197 PARASETAMOL SIRUP 120 MG / 5 ML BTL
0 0 0
198 PARASETAMOL TABLET 500 MG TAB
100 100 0 0
199 PERAK SULFADIAZIN KRIM 1% TUB
0 0 0
200 PERMETRIN KRIM 5% TUB
0 0 0
202 PILOKARPIN HCL NITRAT TETES MATA 2 % BTL
0 0 0
204 PIRACETAM TABLET 400 MG TAB
0 0 0
205 PIRANTEL PAMOAT TABLET 125 MG TAB
0 0 0
206 PIRANTEL SUSPENSI 125 MG / 5 ML BTL
0 0 0
207 PIRIDOKSIN HCL TABLET 10 MG TAB
0 0 0
208 PREDNISON TABLET 5 MG TAB
150 150 0 0
209 PROKAIN BENZIL PENISILLIN INJEKSI 3 JUTA UI VIAL
0 0 0
210 PROPILTIOURASIL TABLET 100 MG TAB
0 0 0
211 PROPRANOLOL TABLET 10 MG TAB
0 0 0
212 PROPRANOLOL TABLET 40 MG TAB
0 0 0
213 PSEUDOEFEDRIN SIRUP BTL
0 0 0
215 RANITIDIN TABLET 150 MG TAB
5 0 5 0 0
216 RETINOL KAPSUL 100.000 IU KAP
0 0 0
217 RETINOL KAPSUL 200.000 IU KAP
0 0 0
218 RIFAMPISIN TABLET 450 MG TAB
0 0 0
219 RIFAMPISIN TABLET 600 MG TAB
0 0 0
220 RINGER LAKTAT LARUTAN INFUS STERIL BTL
0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT
NO. NAMA OBAT SATUAN
OPT AAN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24

221 RISPERIDON TABLET 2 MG TAB

0 0 0
222 SALBUTAMOL INHALASI BTL
0 0 0
223 SALBUTAMOL NEBUL AMP
0 0 0
224 SALBUTAMOL TABLET 4 MG TAB
0 0 0
225 SALEP 2 - 4 KOMBINASI TUB
3 3 0 0
226 SALISIL BEDAK 2 % KTK
0 0 0
227 SALISIL SPIRITUS 10 % BTL
0 0 0
228 SEFADROKSIL KAPSUL 500 MG KAP
0 0 0
229 SEFADROKSIL SIRUP KERING 125 MG / 5 ML BTL
0 0 0
230 SEFOTAKSIM SERBUK INJEKSI 1000 MG VIAL
0 0 0
231 SEFTRIAXON SERBUK INJEKSI 1000 MG VIAL
0 0 0
234 SETIRIZIN SYR 5 MG / 5ML TAB
0 0 0
235 SETIRIZIN TABLET 10 MG BTL
0 0 0
236 SIANOKOBALAMIN INJEKSI 500 MCG / ML AMP
0 0 0
237 SIMVASTATIN TABLET 10 MG TAB
0 0 0
238 SIMVASTATIN TABLET 20 MG TAB
0 0 0
239 SIPROFLOKSASIN TABLET 500 MG TAB
0 0 0
240 SPIRONOLAKTON TABLET 25 MG TAB
0 0 0
241 SULFASETAMID NATRIUM TETES MATA 15 % BTL
0 0 0
242 TABLET TAMBAH DARAH KOMBINASI TAB
620 300 320 0
244 TETRAKAIN HCL TETES MATA 0,5% BTL
0 0 0
245 TETRASIKLIN HCL KAPSUL 250 MG KAP
0 0 0
246 TIAMIN HCL INJEKSI 1.000 MCG / ML - 1 ML AMP
0 0 0
247 TIAMIN HCL MONONITRAT TABLET 50 MG TAB
100 0 100 0 0
250 UREA KRIM 10% TUB
0 0 0
251 VALPROAT SIRUP 250 MG / 5 ML BTL
0 0 0
252 VITAMIN B KOMPLEKS TABLET TAB
300 200 100 0
253 VITAMIN NEUROTROPIK INJEKSI AMP
0 0 0
254 WIDA BES BTL
0 0 0
255 YODIUM POVIDON GARGLE 240 ML BTL
0 0 0
256 YODIUM POVIDON LARUTAN 10 % 30 ML BTL
0 0 0
257 YODIUM POVIDON LARUTAN 10 % 300 ML BTL
0 0 0
258 ZINK DROPS 10 MG / ML BTL
0 0 0
259 ZINK SIRUP 20 MG / 5 ML BTL
0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT
NO. NAMA OBAT SATUAN
OPT AAN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24

260 ZINK TABLET 20 MG TAB

0 0 0
390 TEST HAMIL URINE / HCG TEST TEST
0 0 0
D. BAHAN MEDIS PAKAI HABIS

418 ALAT SUNTIK SEKALI PAKAI 0,05 ML SET

10 0 10 0 0
419 ALAT SUNTIK SEKALI PAKAI 0,5 ML SET
100 0 100 0 0
420 ALAT SUNTIK SEKALI PAKAI 1 ML SET
0 0 0
421 ALAT SUNTIK SEKALI PAKAI 10 ML SET
0 0 0
422 ALAT SUNTIK SEKALI PAKAI 3 ML SET
4 4 0 0
423 ALAT SUNTIK SEKALI PAKAI 5 ML SET
4 4 0 0
424 ALAT SUNTIK SEKALI PAKAI 20 ML SET
0 0 0
425 ALAT SUNTIK SEKALI PAKAI 50 ML SET
0 0 0
426 ALKOHOL SWAB BJ
0 0 0
427 ANTISEPTIK HANDRUB BTL
0 0 0
428 ANTISEPTIK HANDSCRUB BTL
0 0 0
429 APRON PLASTIK PCS
0 0 0
430 BIST MESS BJ
0 0 0
431 BLOOD LANCET 26 G / 28 G SET
0 0 0
432 BLOOD SET SET
0 0 0
435 CATGUT CHROMIC NO. 3/0 SACHET
0 0 0
436 CATGUT CHROMIC NO. 4/0 SACHET
0 0 0
437 CATGUT PLAIN / BENANG BEDAH NO. 2/0 SACHET
0 0 0
438 CATGUT PLAIN / BENANG BEDAH NO. 3/0 SACHET
2 2 0 0
441 FOLLEY CATHETER 2 WAY NO. 16 SET
0 0 0
442 FOLLEY CATHETER 2 WAY NO. 18 SET
0 0 0
444 ID BAND PCS
0 0 0
445 INFUS SET ANAK SET
0 0 0
446 INFUS SET DEWASA SET
1 0 1 0
447 IV CATHETER NO. 18 SET
2 0 2 0
448 IV CATHETER NO. 20 SET
0 0 0
449 IV CATHETER NO. 22 SET
0 0 0
450 IV CATHETER NO. 24 SET
0 0 0
451 IV CATHETER NO. 26 SET
0 0 0
452 JARUM JAHIT / BEDAH NO. 9 S/D 14 BJ
0 0 0
454 KAPAS BERLEMAK 500 GRAM ROL
0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT
NO. NAMA OBAT SATUAN
OPT AAN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24

455 KAPAS PEMBALUT / ABSORBEN 250 GRAM ROL

2 1 1 0
457 KASA 16x16 PCS
0 0 0
458 KASA 40X80 ROL
0 0 0
459 KASA HIDROFIL STERIL UKURAN 18 M X22 CM ROL
0 0 0
460 KASA KOMPRES 40/40 STERIL ROL
0 0 0
461 KASA PEMBALUT 2 M X 80 CM ROL
0 0 0
462 KASA PEMBALUT ELASTIS 4 INCI ROL
0 0 0
463 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL
0 0 0
464 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL
0 0 0
465 KASA PEMBALUT HIDROFIL 4 M X 3 CM ROL
0 0 0
466 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL
0 0 0
467 KASA PERAWATAN LUKA LBR
0 0 0
468 KASET WITH SCREEN GREEN PKT
0 0 0
469 KERTAS EKG 80 MM X 30 M ROL
0 0 0
470 MASKER PCS
0 0 0
471 MASKER N95 PCS
0 0 0
484 NURSE CAP PCS
0 0 0
485 PEMBALUT GIPS 4 INCI ROL
0 0 0
486 PLESTER 5 CM x 5 M ROL
0 0 0
487 PLESTER 10 CM X 5 M ROL
0 0 0
488 PLESTER 15 CM X 5 M ROL
0 0 0
489 PLESTER BULAT NON WOVEN PCS
0 0 0
490 PLESTER KAIN 7,5 X 4,5 M ROL
0 0 0
491 POT SPUTUM SET
0 0 0
492 POT URINE SET
0 0 0
493 SAFETY BOX 2,5 L KTK
0 0 0
494 SAFETY BOX 5 L KTK
0 0 0
495 SARUNG TANGAN KEBIDANAN (PANJANG) PSG
0 0 0
496 SARUNG TANGAN KERJA (TEBAL) M - L PSG
0 0 0
497 SARUNG TANGAN NON STERIL PSG
0 0 0
498 SARUNG TANGAN STERIL PSG
0 0 0
501 SENDOK SIRUP PCS
0 0 0
502 SILK / BENANG SUTERA NO. 3/0 SACHET
0 0 0
503 SLIM ZUIKER / MUCUS EXTRACTOR SET
0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT
NO. NAMA OBAT SATUAN
OPT AAN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24

508 SURGICAL GOWN PCS

0 0 0
516 UNDERPAD LBR
8 3 5 0
517 URINE BAG STERIL LBR
0 0 0
518 USG GEL TUB
0 0 0

JUMLAH KUNJUNGAN RESEP

KTP

BPJS

TUBAN, 25 JANUARI 2021

MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MENERIMA/MELAPOR

KEPALA PUSKESMAS PLUMPANG

dr H BOEDI WINOTO LESTI E. P., S.Farm., Apt. HARDININGSIH, A.Md. Keb.

NIP 19640723 199602 1 001 NIP. 199007042019032021 19720421 199203 2 011

PEMBERI
KETR.
AN

25 26
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AN

25 26
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KETR.
AN

25 26
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KETR.
AN

25 26
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KETR.
AN

25 26
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KETR.
AN

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KETR.
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25 26
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KETR.
AN

25 26
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AN

25 26
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

Polindes/ Pustu/ ponkesdes : : PENIDON

TAHUN : FEBRUARI 2021

STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24 25 26

A. OBAT ESSENSIAL

1 ALBENDAZOL TABLET 400 MG TAB

0 0 60 30 30 0
2 ALBENDAZOL SUSPENSI 200 MG / 5 ML BTL
0 0 0 0
3 ALOPURINOL TABLET 100 MG TAB
30 0 100 50 80 0
4 AMBROKSOL TABLET 30 MG TAB
0 0 0 0 0
6 AMINOFILLIN TABLET 200 MG TAB
0 0 0 0 0
8 AMLODIPIN TABLET 10 MG TAB
0 25 100 60 40 25
9 AMLODIPIN TABLET 5 MG TAB
0 0 0 0 0
10 AMOKSISILIN KAPLET 500 MG KAPL
0 0 500 200 300 0
11 AMOKSISILIN KAPSUL 250 MG KAP
0 0 0 0 0
13 AMOKSISILIN SIRUP KERING 125 MG / 5 ML BTL
0 0 10 3 7 0
16 ANTASIDA DOEN SUSPENSI BTL
0 0 5 2 3 0
17 ANTASIDA DOEN TABLET KOMBINASI TAB
0 40 300 100 200 40
18 ANTI BAKTERI DOEN SALEP KOMBINASI TUB
0 0 0 0 0
19 ANTI FUNGI DOEN KOMBINASI POT
0 0 0 0 0
21 ANTI INFEKSI KRIM TUB
0 0 0 0 0
22 ANTI MIGRAIN DOEN TABLET KOMBINASI TAB
0 0 0 0 0
25 ASAM ASKORBAT TABLET 250 MG TAB
0 0 0 0 0
26 ASAM ASKORBAT TABLET 50 MG TAB
0 0 0 0 0
27 ASAM ASKORBAT TABLET 500 MG TAB
0 0 0 0 0
28 ASAM FOLAT TABLET 0,4 MG TAB
0 0 0 0 0
29 ASAM MEFENAMAT TABLET 500 MG TAB
0 0 500 150 350 0
30 ASAM TRANEKSAMAT INJEKSI 50 MG / ML AMP
0 0 0 0 0
31 ASAM TRANEKSAMAT TABLET 500 MG TAB
0 0 0 0 0
33 ASIKLOVIR TABLET 200 MG TAB
0 0 0 0 0
34 ASIKLOVIR TABLET 400 MG TAB
0 0 100 30 70 0
35 ASIKLOVIR KRIM 5 % TUB
0 0 0 0
36 ATAPULGIT TABLET 600 MG TAB
0 0 0 0 0
40 BETAHISTIN MESILAT TABLET 6 MG TAB
0 0 0 0 0
41 BETAMETASON KRIM 0,1 % TUB
0 0 10 2 8 0
46 DEKSAMETASON INJEKSI 5 MG / ML - 1 ML AMP
0 0 0 0 0
47 DEKSAMETASON TABLET 0,5 MG TAB
40 20 300 100 240 20
52 DIFENHIDRAMIN HCL INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0
56 DIMENHIDRINAT TABLET 50 MG TAB
0 0 100 30 70 0
57 DOMPERIDON SIRUP 5 MG / 5 ML BTL
0 0 0 0 0
58 DOMPERIDON TABLET 10 MG TAB
0 0 0 0 0
59 EPINEPRIN HCL INJEKSI 0,1 % AMP
0 0 0 0 0
60 ERITROMISIN KAPSUL 500 MG KAP
0 0 0 0 0
61 ERITROMISIN SIRUP KERING 200 MG / 5 ML BTL
0 0 0 0 0
62 ETAKRIDIN LARUTAN 0,1 % BTL
0 0 2 0 2 0
63 ETANOL 70 % BTL
3 0 0 3 0
64 ETIL KLORIDA SEMPROT BTL
0 0 0 0 0
69 FENOL GLISEROL TETES TELINGA 10 % BTL
0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24 25 26

70 FITOMENADION INJEKSI 2 MG / ML - 1 ML AMP

0 0 0 0 0
71 FITOMENADION INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0
72 FITOMENADION TABLET SALUT 10 MG TAB
0 0 0 0 0
75 FUROSEMID INJEKSI 10 MG AMP
0 0 0 0 0
76 FUROSEMID TABLET 40 MG TAB
0 0 0 0 0
77 GARAM ORALIT KOMBINASI SAK
30 0 100 30 100 0
78 GEMFIBROZIL KAPSUL 300 MG KAP
0 0 0 0 0
79 GENTAMISIN INJEKSI 40 MG/ML AMP
0 0 0 0 0
80 GENTAMISIN TETES MATA 0,3 % BTL
0 0 5 2 3 0
81 GENTAMISIN SALEP KULIT 0,1 % TUB
0 0 0 0 0
82 GENTAMISIN SALEP MATA 0,3 % TUB
0 0 0 0 0
83 GENTIAN VIOLET LARUTAN 1 % BTL
0 0 0 0 0
84 GLIBENKLAMID TABLET 5 MG TAB
20 0 100 60 60 0
85 GLIMEPIRIDE TABLET 2 MG TAB
0 0 0 0 0
86 GLUKOSA LARUTAN INFUS 5 % STERIL BTL
0 0 0 0 0
87 GLUKOSA LARUTAN INFUS 10 % STERIL BTL
0 0 0 0 0
88 GLUKOSA LARUTAN INFUS 40 % STERIL AMP
0 0 0 0 0
89 GRISEOFULVIN TABLET 125 MG TAB
0 0 0 0 0
96 HIDROKLORTIAZID TABLET 25 MG TAB
0 0 0 0 0
97 HIDROKORTISON KRIM 2,5 % TUB
0 0 5 2 3 0
99 HIOSIN BUTILBROMIDA TABLET 10 MG TAB
20 0 20 0 0
100 IBUPROFEN SUSPENSI 100 MG / 5 ML BTL
0 0 0 0 0
101 IBUPROFEN TABLET 200 MG TAB
0 0 200 50 150 0
102 IBUPROFEN TABLET 400 MG TAB
0 0 200 100 100 0
103 INSULIN ANALOG LONG ACTING PEN
0 0 0 0 0
104 INSULIN ANALOG RAPID ACTING PEN
0 0 0 0 0
105 ISONIAZID TABLET 100 MG TAB
0 0 0 0 0
106 ISONIAZID TABLET 300 MG TAB
0 0 0 0 0
107 ISOSORBID DINITRAT TABLET 5 MG TAB
0 0 0 0 0
108 KALSIUM GLUKONAT INJEKSI 10 % AMP
0 0 0 0 0
109 KALSIUM LAKTAT TABLET 500 MG TAB
0 0 500 100 400 0
111 KAOLIN - PEKTIN SIRUP BTL
0 0 0 0 0
112 KAPTOPRIL TABLET 25 MG TAB
0 0 0 0 0
113 KARBAMAZEPIN TABLET 200 MG TAB
0 0 0 0 0
114 KETOKONAZOLE KRIM 2 % TUB
2 0 3 2 3 0
115 KETOKONAZOLE TABLET 200 MG TAB
0 0 0 0 0
116 KLINDAMISIN KAPSUL 300 MG KAP
0 0 0 0 0
120 KLORAMFENIKOL INJEKSI 1000 MG VIAL
0 0 0 0 0
121 KLORAMFENIKOL KAPSUL 250 MG KAP
0 0 100 20 0 80
122 KLORAMFENIKOL SALEP MATA 1% TUB
0 0 5 2 3 0
123 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BTL
2 0 1 1 0
124 KLORAMFENIKOL TETES MATA 0,5 % BTL
0 0 0 0 0
125 KLORAMFENIKOL TETES TELINGA 3 % BTL
0 0 3 1 2 0
126 KLORFENIRAMIN MALEAT TABLET 4 MG TAB
200 0 200 50 350 0
132 KOTRIMOKSAZOL DEWASA TABLET TAB
0 0 0 0 0
133 KOTRIMOKSAZOL PEDIATRIK TABLET TAB
0 0 0 0 0
134 KOTRIMOKSAZOL SUSPENSI 240 MG / 5 ML BTL
0 0 5 2 3 0
135 KURKUMA SIRUP BTL
0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24 25 26

136 KURKUMA TABLET TAB

0 0 0 0 0
137 LAKTULOSA SIRUP BTL
0 0 0 0 0
138 LEVOFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0
139 LEVOTIROKSIN TABLET 100 MCG TAB
0 0 0 0 0
140 LIDOKAIN KOMPOSITUM INJEKSI AMP
0 0 0 0 0
141 LIDOKAIN SPRAY ORAL 10 % BTL
0 0 0 0 0
142 LISINOPRIL TABLET 5 MG TAB
0 0 0 0 0
143 LISINOPRIL TABLET 10 MG TAB
0 0 0 0 0
144 LOPERAMID TABLET 2 MG TAB
0 0 0 0 0
145 LORATADIN TABLET 10 MG TAB
0 0 0 0 0
146 MAGNESIUM SULFAT INJEKSI / IV 20% - 25 ML AMP
0 0 0 0 0
147 MAGNESIUM SULFAT INJEKSI / IV 40% - 25 ML AMP
0 0 0 0 0
149 MEBENDAZOL TABLET 100 MG TAB
0 0 0 0 0
150 MELOKSIKAM TABLET 15 MG TAB
0 0 0 0 0
151 METAMIZOL INJEKSI 500 MG / ML AMP
0 0 0 0 0
152 METFORMIN TABLET 500 MG TAB
30 0 30 0 0
153 METIL ERGOMETRIN INJEKSI 0,2 MG / ML - 1 ML AMP
0 0 0 0 0
154 METIL ERGOMETRIN TABLET 0,125 MG TAB
0 0 0 0 0
155 METIL PREDNISOLON INJEKSI 125 MG AMP
0 0 0 0 0
156 METIL PREDNISOLON TABLET 4 MG TAB
0 0 0 0 0
157 METOKLOPRAMID INJEKSI 5 MG / ML AMP
0 0 0 0 0
158 METOKLOPRAMID TABLET 10 MG TAB
0 0 0 0 0
159 METRONIDAZOL INFUS 5 MG / ML BTL
0 0 0 0 0
160 METRONIDAZOL SIRUP 125 MG / 5 ML BTL
0 0 0 0 0
161 METRONIDAZOL TABLET 250 MG TAB
0 0 0 0 0
162 METRONIDAZOL TABLET 500 MG TAB
0 0 0 0 0
163 MIKONAZOL KRIM 2% TUB
0 0 0 0 0
165 MOMETASON FUROAT KRIM 0,1 % TUB
0 0 0 0 0
166 N-ASETIL SISTEIN KAPSUL 200 MG KAP
110 0 300 100 310 0
167 NASALIN SPRAY 100 ML BTL
0 0 0 0 0
168 NATRIUM BIKARBONAT INJEKSI 8,4 % AMP
0 0 0 0 0
169 NATRIUM BIKARBONAT TABLET 500 MG TAB
0 0 0 0 0
170 NATRIUM DIKLOFENAK 50 MG TAB
0 0 0 0 0
171 NATRIUM FOSFAT ENEMA TUB
0 0 0 0 0
172 NATRIUM FUSIDAT SALEP 20 MG / G TUB
0 0 0 0 0
173 NATRIUM KLORIDA LARUTAN INFUS 0,9 % BTL
0 0 0 0 0
174 NIFEDIPIN TABLET 10 MG TAB
0 0 0 0 0
175 NIFEDIPIN TABLET 30 MG SR TAB
0 0 0 0 0
176 NISTATIN 100.000 IU / G TABLET VAGINA TAB
0 0 0 0 0
177 NISTATIN 500.000 IU TABLET SALUT TAB
0 0 0 0 0
178 NISTATIN SUSPENSI 100.000 IU / ML BTL
0 0 10 0 0 10
179 NORETISTERON TABLET 5 MG TAB
0 0 0 0 0
184 OBAT BATUK HITAM SIRUP BTL
0 0 0 0 0
185 OKSIMETAZOLIN TETES HIDUNG 0,025 % BTL
0 0 0 0 0
186 OKSIMETAZOLIN TETES HIDUNG 0,05 % BTL
0 0 0 0 0
187 OKSITETRASIKLIN HCL IM 50 MG / ML - 10 ML AMP
0 0 0 0 0
188 OKSITETRASIKLIN HCL SALEP KULIT 3 % TUB
0 0 0 0 0
189 OKSITETRASIKLIN HCL SALEP MATA 1 % TUB
0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24 25 26

190 OKSITOSIN INJEKSI 10 IU / ML - 1 ML AMP

2 0 0 2 0
191 OMEPRAZOLE INJEKSI 40 MG VIAL
0 0 0 0 0
192 OMEPRAZOLE KAPSUL 20 MG KAP
0 0 0 0 0
195 PARASETAMOL DROPS 100 MG / ML BTL
0 0 0 0 0
196 PARASETAMOL INFUS 10 MG / ML BTL
0 0 0 0 0
197 PARASETAMOL SIRUP 120 MG / 5 ML BTL
0 0 10 5 5 0
198 PARASETAMOL TABLET 500 MG TAB
0 0 500 200 300 0
199 PERAK SULFADIAZIN KRIM 1% TUB
0 0 0 0 0
200 PERMETRIN KRIM 5% TUB
0 0 0 0 0
202 PILOKARPIN HCL NITRAT TETES MATA 2 % BTL
0 0 0 0 0
204 PIRACETAM TABLET 400 MG TAB
0 0 0 0 0
205 PIRANTEL PAMOAT TABLET 125 MG TAB
0 0 0 0 0
206 PIRANTEL SUSPENSI 125 MG / 5 ML BTL
0 0 0 0 0
207 PIRIDOKSIN HCL TABLET 10 MG TAB
0 0 0 0 0
208 PREDNISON TABLET 5 MG TAB
0 0 500 150 0 350
209 PROKAIN BENZIL PENISILLIN INJEKSI 3 JUTA UI VIAL
0 0 0 0 0
210 PROPILTIOURASIL TABLET 100 MG TAB
0 0 0 0 0
211 PROPRANOLOL TABLET 10 MG TAB
0 0 0 0 0
212 PROPRANOLOL TABLET 40 MG TAB
0 0 0 0 0
213 PSEUDOEFEDRIN SIRUP BTL
0 0 0 0 0
215 RANITIDIN TABLET 150 MG TAB
0 0 0 0 0
216 RETINOL KAPSUL 100.000 IU KAP
0 0 50 50 0 0
217 RETINOL KAPSUL 200.000 IU KAP
0 0 400 400 0 0
218 RIFAMPISIN TABLET 450 MG TAB
0 0 0 0 0
219 RIFAMPISIN TABLET 600 MG TAB
0 0 0 0 0
220 RINGER LAKTAT LARUTAN INFUS STERIL BTL
0 0 0 0 0
221 RISPERIDON TABLET 2 MG TAB
0 0 0 0 0
222 SALBUTAMOL INHALASI BTL
0 0 0 0 0
223 SALBUTAMOL NEBUL AMP
0 0 0 0 0
224 SALBUTAMOL TABLET 4 MG TAB
0 0 0 0 0
225 SALEP 2 - 4 KOMBINASI TUB
0 0 0 0 0
226 SALISIL BEDAK 2 % KTK
0 0 0 0 0
227 SALISIL SPIRITUS 10 % BTL
0 0 0 0 0
228 SEFADROKSIL KAPSUL 500 MG KAP
0 0 0 0 0
229 SEFADROKSIL SIRUP KERING 125 MG / 5 ML BTL
0 0 0 0 0
230 SEFOTAKSIM SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0
231 SEFTRIAXON SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0
234 SETIRIZIN SYR 5 MG / 5ML TAB
0 0 0 0 0
235 SETIRIZIN TABLET 10 MG BTL
0 0 0 0 0
236 SIANOKOBALAMIN INJEKSI 500 MCG / ML AMP
0 0 0 0 0
237 SIMVASTATIN TABLET 10 MG TAB
0 0 0 0 0
238 SIMVASTATIN TABLET 20 MG TAB
0 0 0 0 0
239 SIPROFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0
240 SPIRONOLAKTON TABLET 25 MG TAB
0 0 0 0 0
241 SULFASETAMID NATRIUM TETES MATA 15 % BTL
0 0 0 0 0
242 TABLET TAMBAH DARAH KOMBINASI TAB
320 0 1,000 200 1,120 0
244 TETRAKAIN HCL TETES MATA 0,5% BTL
0 0 0 0 0
245 TETRASIKLIN HCL KAPSUL 250 MG KAP
0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24 25 26

246 TIAMIN HCL INJEKSI 1.000 MCG / ML - 1 ML AMP

0 0 0 0 0
247 TIAMIN HCL MONONITRAT TABLET 50 MG TAB
0 0 0 0 0
250 UREA KRIM 10% TUB
0 0 0 0 0
251 VALPROAT SIRUP 250 MG / 5 ML BTL
0 0 0 0 0
252 VITAMIN B KOMPLEKS TABLET TAB
100 0 300 100 300 0
253 VITAMIN NEUROTROPIK INJEKSI AMP
0 0 0 0 0
254 WIDA BES BTL
0 0 0 0 0
255 YODIUM POVIDON GARGLE 240 ML BTL
0 0 0 0 0
256 YODIUM POVIDON LARUTAN 10 % 30 ML BTL
0 0 0 0 0
257 YODIUM POVIDON LARUTAN 10 % 300 ML BTL
0 0 0 0 0
258 ZINK DROPS 10 MG / ML BTL
0 0 0 0 0
259 ZINK SIRUP 20 MG / 5 ML BTL
0 0 0 0 0
260 ZINK TABLET 20 MG TAB
0 0 0 0 0
390 TEST HAMIL URINE / HCG TEST TEST
0 0 10 2 8 0
D. BAHAN MEDIS PAKAI HABIS
0 0
418 ALAT SUNTIK SEKALI PAKAI 0,05 ML SET
0 0 0 0 0
419 ALAT SUNTIK SEKALI PAKAI 0,5 ML SET
0 0 0 0 0
420 ALAT SUNTIK SEKALI PAKAI 1 ML SET
0 0 0 0 0
421 ALAT SUNTIK SEKALI PAKAI 10 ML SET
0 0 0 0 0
422 ALAT SUNTIK SEKALI PAKAI 3 ML SET
0 0 10 3 7 0
423 ALAT SUNTIK SEKALI PAKAI 5 ML SET
0 0 10 3 7 0
424 ALAT SUNTIK SEKALI PAKAI 20 ML SET
0 0 0 0 0
425 ALAT SUNTIK SEKALI PAKAI 50 ML SET
0 0 0 0 0
426 ALKOHOL SWAB BJ
0 0 0 0 0
427 ANTISEPTIK HANDRUB BTL
0 0 0 0 0
428 ANTISEPTIK HANDSCRUB BTL
0 0 0 0 0
429 APRON PLASTIK PCS
0 0 0 0 0
430 BIST MESS BJ
0 0 0 0 0
431 BLOOD LANCET 26 G / 28 G SET
0 0 0 0 0
432 BLOOD SET SET
0 0 0 0 0
435 CATGUT CHROMIC NO. 3/0 SACHET
0 0 0 0 0
436 CATGUT CHROMIC NO. 4/0 SACHET
0 0 0 0 0
437 CATGUT PLAIN / BENANG BEDAH NO. 2/0 SACHET
0 0 0 0 0
438 CATGUT PLAIN / BENANG BEDAH NO. 3/0 SACHET
0 0 3 0 3 0
441 FOLLEY CATHETER 2 WAY NO. 16 SET
0 0 0 0 0
442 FOLLEY CATHETER 2 WAY NO. 18 SET
0 0 0 0 0
444 ID BAND PCS
0 0 0 0 0
445 INFUS SET ANAK SET
0 0 0 0 0
446 INFUS SET DEWASA SET
1 0 0 1 0
447 IV CATHETER NO. 18 SET
2 0 0 2 0
448 IV CATHETER NO. 20 SET
0 0 0 0 0
449 IV CATHETER NO. 22 SET
0 0 0 0 0
450 IV CATHETER NO. 24 SET
0 0 0 0 0
451 IV CATHETER NO. 26 SET
0 0 0 0 0
452 JARUM JAHIT / BEDAH NO. 9 S/D 14 BJ
0 0 0 0 0
454 KAPAS BERLEMAK 500 GRAM ROL
0 0 0 0 0
455 KAPAS PEMBALUT / ABSORBEN 250 GRAM ROL
1 0 1 1 1 0
457 KASA 16x16 PCS
0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24 25 26

458 KASA 40X80 ROL

0 0 0 0 0
459 KASA HIDROFIL STERIL UKURAN 18 M X22 CM ROL
0 0 0 0 0
460 KASA KOMPRES 40/40 STERIL ROL
0 0 0 0 0
461 KASA PEMBALUT 2 M X 80 CM ROL
0 0 0 0 0
462 KASA PEMBALUT ELASTIS 4 INCI ROL
0 0 0 0 0
463 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL
0 0 0 0 0
464 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL
0 0 0 0 0
465 KASA PEMBALUT HIDROFIL 4 M X 3 CM ROL
0 0 0 0 0
466 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL
0 0 0 0 0
467 KASA PERAWATAN LUKA LBR
0 0 0 0 0
468 KASET WITH SCREEN GREEN PKT
0 0 0 0 0
469 KERTAS EKG 80 MM X 30 M ROL
0 0 0 0 0
470 MASKER PCS
0 0 0 0 0
471 MASKER N95 PCS
0 0 0 0 0
484 NURSE CAP PCS
0 0 0 0 0
485 PEMBALUT GIPS 4 INCI ROL
0 0 0 0 0
486 PLESTER 5 CM x 5 M ROL
0 0 0 0 0
487 PLESTER 10 CM X 5 M ROL
0 0 0 0 0
488 PLESTER 15 CM X 5 M ROL
0 0 0 0 0
489 PLESTER BULAT NON WOVEN PCS
0 0 0 0 0
490 PLESTER KAIN 7,5 X 4,5 M ROL
0 0 0 0 0
491 POT SPUTUM SET
0 0 0 0 0
492 POT URINE SET
0 0 0 0 0
493 SAFETY BOX 2,5 L KTK
0 0 0 0 0
494 SAFETY BOX 5 L KTK
0 0 0 0 0
495 SARUNG TANGAN KEBIDANAN (PANJANG) PSG
0 0 0 0 0
496 SARUNG TANGAN KERJA (TEBAL) M - L PSG
0 0 0 0 0
497 SARUNG TANGAN NON STERIL PSG
0 0 0 0 0
498 SARUNG TANGAN STERIL PSG
0 0 0 0 0
501 SENDOK SIRUP PCS
0 0 0 0 0
502 SILK / BENANG SUTERA NO. 3/0 SACHET
0 0 0 0 0
503 SLIM ZUIKER / MUCUS EXTRACTOR SET
0 0 0 0 0
508 SURGICAL GOWN PCS
0 0 0 0 0
516 UNDERPAD LBR
5 0 0 5 0
517 URINE BAG STERIL LBR
0 0 0 0 0
518 USG GEL TUB
0 0 0 0 0

JUMLAH KUNJUNGAN RESEP

KTP

BPJS

TUBAN, 27 JANUARI 2021

MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MENERIMA/MELAPOR

KEPALA PUSKESMAS PLUMPANG

dr H BOEDI WINOTO LESTI E. P., S.Farm., Apt. HARDININGSIH, A.Md. Keb.

NIP 19640723 199602 1 001 NIP. 199007042019032021 19720421 199203 2 011

 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

Polindes/ Pustu/ ponkesdes : : PENIDON

TAHUN : MARET 2021

STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN
OPT AAN AN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24 25

A. OBAT ESSENSIAL

1 ALBENDAZOL TABLET 400 MG TAB

30 0 30 0 0 80
2 ALBENDAZOL SUSPENSI 200 MG / 5 ML BTL
0 0 0 0 0 0
3 ALOPURINOL TABLET 100 MG TAB
80 0 30 50 0 173
4 AMBROKSOL TABLET 30 MG TAB
0 0 0 0 0 0
6 AMINOFILLIN TABLET 200 MG TAB
0 0 0 0 0 0
8 AMLODIPIN TABLET 10 MG TAB
40 25 35 5 25 260
9 AMLODIPIN TABLET 5 MG TAB
0 0 0 0 0 0
10 AMOKSISILIN KAPLET 500 MG KAPL
300 0 150 150 0 733
11 AMOKSISILIN KAPSUL 250 MG KAP
0 0 0 0 0 0
13 AMOKSISILIN SIRUP KERING 125 MG / 5 ML BTL
7 0 3 4 0 12
16 ANTASIDA DOEN SUSPENSI BTL
3 0 1 2 0 4
17 ANTASIDA DOEN TABLET KOMBINASI TAB
200 40 100 100 40 533
18 ANTI BAKTERI DOEN SALEP KOMBINASI TUB
0 0 0 0 0 0
19 ANTI FUNGI DOEN KOMBINASI POT
0 0 0 0 0 0
21 ANTI INFEKSI KRIM TUB
0 0 0 0 0 0
22 ANTI MIGRAIN DOEN TABLET KOMBINASI TAB
0 0 0 0 0 0
25 ASAM ASKORBAT TABLET 250 MG TAB
0 0 0 0 0 0
26 ASAM ASKORBAT TABLET 50 MG TAB
0 0 0 0 0 133
27 ASAM ASKORBAT TABLET 500 MG TAB
0 0 0 0 0 0
28 ASAM FOLAT TABLET 0,4 MG TAB
0 0 0 0 0 0
29 ASAM MEFENAMAT TABLET 500 MG TAB
350 0 150 200 0 667
30 ASAM TRANEKSAMAT INJEKSI 50 MG / ML AMP
0 0 0 0 0 0
31 ASAM TRANEKSAMAT TABLET 500 MG TAB
0 0 0 0 0 0
33 ASIKLOVIR TABLET 200 MG TAB
0 0 0 0 0 0
34 ASIKLOVIR TABLET 400 MG TAB
70 0 20 50 0 107
35 ASIKLOVIR KRIM 5 % TUB
0 0 0 0 1
36 ATAPULGIT TABLET 600 MG TAB
0 0 0 0 0 0
40 BETAHISTIN MESILAT TABLET 6 MG TAB
0 0 0 0 0 0
41 BETAMETASON KRIM 0,1 % TUB
8 0 2 6 0 5
46 DEKSAMETASON INJEKSI 5 MG / ML - 1 ML AMP
0 0 0 0 0 0
47 DEKSAMETASON TABLET 0,5 MG TAB
240 20 100 140 20 493
52 DIFENHIDRAMIN HCL INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0 7
56 DIMENHIDRINAT TABLET 50 MG TAB
70 0 20 50 0 120
57 DOMPERIDON SIRUP 5 MG / 5 ML BTL
0 0 0 0 0 0
58 DOMPERIDON TABLET 10 MG TAB
0 0 0 0 0 0
59 EPINEPRIN HCL INJEKSI 0,1 % AMP
0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN
OPT AAN AN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24 25

60 ERITROMISIN KAPSUL 500 MG KAP

0 0 0 0 0 0
61 ERITROMISIN SIRUP KERING 200 MG / 5 ML BTL
0 0 0 0 0 0
62 ETAKRIDIN LARUTAN 0,1 % BTL
2 0 0 2 0 0
63 ETANOL 70 % BTL
3 0 0 3 0 0
64 ETIL KLORIDA SEMPROT BTL
0 0 0 0 0 0
69 FENOL GLISEROL TETES TELINGA 10 % BTL
0 0 0 0 0 3
70 FITOMENADION INJEKSI 2 MG / ML - 1 ML AMP
0 0 0 0 0 0
71 FITOMENADION INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0 0
72 FITOMENADION TABLET SALUT 10 MG TAB
0 0 0 0 0 0
75 FUROSEMID INJEKSI 10 MG AMP
0 0 0 0 0 0
76 FUROSEMID TABLET 40 MG TAB
0 0 0 0 0 0
77 GARAM ORALIT KOMBINASI SAK
100 0 40 60 0 133
78 GEMFIBROZIL KAPSUL 300 MG KAP
0 0 0 0 0 0
79 GENTAMISIN INJEKSI 40 MG/ML AMP
0 0 0 0 0 0
80 GENTAMISIN TETES MATA 0,3 % BTL
3 0 1 2 0 7
81 GENTAMISIN SALEP KULIT 0,1 % TUB
0 0 0 0 0 0
82 GENTAMISIN SALEP MATA 0,3 % TUB
0 0 0 0 0 0
83 GENTIAN VIOLET LARUTAN 1 % BTL
0 0 0 0 0 0
84 GLIBENKLAMID TABLET 5 MG TAB
60 0 30 30 0 160
85 GLIMEPIRIDE TABLET 2 MG TAB
0 0 0 0 0 0
86 GLUKOSA LARUTAN INFUS 5 % STERIL BTL
0 0 0 0 0 0
87 GLUKOSA LARUTAN INFUS 10 % STERIL BTL
0 0 0 0 0 0
88 GLUKOSA LARUTAN INFUS 40 % STERIL AMP
0 0 0 0 0 0
89 GRISEOFULVIN TABLET 125 MG TAB
0 0 0 0 0 0
96 HIDROKLORTIAZID TABLET 25 MG TAB
0 0 0 0 0 0
97 HIDROKORTISON KRIM 2,5 % TUB
3 0 2 1 0 5
99 HIOSIN BUTILBROMIDA TABLET 10 MG TAB
0 0 0 0 0 67
100 IBUPROFEN SUSPENSI 100 MG / 5 ML BTL
0 0 0 0 0 0
101 IBUPROFEN TABLET 200 MG TAB
150 0 60 90 0 153
102 IBUPROFEN TABLET 400 MG TAB
100 0 50 50 0 200
103 INSULIN ANALOG LONG ACTING PEN
0 0 0 0 0 0
104 INSULIN ANALOG RAPID ACTING PEN
0 0 0 0 0 0
105 ISONIAZID TABLET 100 MG TAB
0 0 0 0 0 0
106 ISONIAZID TABLET 300 MG TAB
0 0 0 0 0 0
107 ISOSORBID DINITRAT TABLET 5 MG TAB
0 0 0 0 0 0
108 KALSIUM GLUKONAT INJEKSI 10 % AMP
0 0 0 0 0 0
109 KALSIUM LAKTAT TABLET 500 MG TAB
400 0 150 250 0 333
111 KAOLIN - PEKTIN SIRUP BTL
0 0 0 0 0 0
112 KAPTOPRIL TABLET 25 MG TAB
0 0 0 0 0 0
113 KARBAMAZEPIN TABLET 200 MG TAB
0 0 0 0 0 0
114 KETOKONAZOLE KRIM 2 % TUB
3 0 1 2 0 7
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN
OPT AAN AN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24 25

115 KETOKONAZOLE TABLET 200 MG TAB

0 0 0 0 0 0
116 KLINDAMISIN KAPSUL 300 MG KAP
0 0 0 0 0 0
120 KLORAMFENIKOL INJEKSI 1000 MG VIAL
0 0 0 0 0 0
121 KLORAMFENIKOL KAPSUL 250 MG KAP
0 80 0 20 0 60 53
122 KLORAMFENIKOL SALEP MATA 1% TUB
3 0 2 1 0 5
123 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BTL
1 0 1 0 0 7
124 KLORAMFENIKOL TETES MATA 0,5 % BTL
0 0 0 0 0 0
125 KLORAMFENIKOL TETES TELINGA 3 % BTL
2 0 1 1 0 3
126 KLORFENIRAMIN MALEAT TABLET 4 MG TAB
350 0 70 280 0 427
132 KOTRIMOKSAZOL DEWASA TABLET TAB
0 0 0 0 0 0
133 KOTRIMOKSAZOL PEDIATRIK TABLET TAB
0 0 0 0 0 0
134 KOTRIMOKSAZOL SUSPENSI 240 MG / 5 ML BTL
3 0 2 1 0 9
135 KURKUMA SIRUP BTL
0 0 0 0 0 0
136 KURKUMA TABLET TAB
0 0 0 0 0 0
137 LAKTULOSA SIRUP BTL
0 0 0 0 0 0
138 LEVOFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0 0
139 LEVOTIROKSIN TABLET 100 MCG TAB
0 0 0 0 0 0
140 LIDOKAIN KOMPOSITUM INJEKSI AMP
0 0 0 0 0 0
141 LIDOKAIN SPRAY ORAL 10 % BTL
0 0 0 0 0 0
142 LISINOPRIL TABLET 5 MG TAB
0 0 0 0 0 0
143 LISINOPRIL TABLET 10 MG TAB
0 0 0 0 0 0
144 LOPERAMID TABLET 2 MG TAB
0 0 0 0 0 0
145 LORATADIN TABLET 10 MG TAB
0 0 0 0 0 0
146 MAGNESIUM SULFAT INJEKSI / IV 20% - 25 ML AMP
0 0 0 0 0 0
147 MAGNESIUM SULFAT INJEKSI / IV 40% - 25 ML AMP
0 0 0 0 0 0
149 MEBENDAZOL TABLET 100 MG TAB
0 0 0 0 0 0
150 MELOKSIKAM TABLET 15 MG TAB
0 0 0 0 0 0
151 METAMIZOL INJEKSI 500 MG / ML AMP
0 0 0 0 0 0
152 METFORMIN TABLET 500 MG TAB
0 0 0 0 0 173
153 METIL ERGOMETRIN INJEKSI 0,2 MG / ML - 1 ML AMP
0 0 0 0 0 0
154 METIL ERGOMETRIN TABLET 0,125 MG TAB
0 0 0 0 0 0
155 METIL PREDNISOLON INJEKSI 125 MG AMP
0 0 0 0 0 0
156 METIL PREDNISOLON TABLET 4 MG TAB
0 0 0 0 0 0
157 METOKLOPRAMID INJEKSI 5 MG / ML AMP
0 0 0 0 0 0
158 METOKLOPRAMID TABLET 10 MG TAB
0 0 0 0 0 0
159 METRONIDAZOL INFUS 5 MG / ML BTL
0 0 0 0 0 0
160 METRONIDAZOL SIRUP 125 MG / 5 ML BTL
0 0 0 0 0 0
161 METRONIDAZOL TABLET 250 MG TAB
0 0 0 0 0 0
162 METRONIDAZOL TABLET 500 MG TAB
0 0 0 0 0 0
163 MIKONAZOL KRIM 2% TUB
0 0 0 0 0 0
165 MOMETASON FUROAT KRIM 0,1 % TUB
0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN
OPT AAN AN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24 25

166 N-ASETIL SISTEIN KAPSUL 200 MG KAP

310 0 100 210 0 333
167 NASALIN SPRAY 100 ML BTL
0 0 0 0 0 0
168 NATRIUM BIKARBONAT INJEKSI 8,4 % AMP
0 0 0 0 0 0
169 NATRIUM BIKARBONAT TABLET 500 MG TAB
0 0 0 0 0 0
170 NATRIUM DIKLOFENAK 50 MG TAB
0 0 0 0 0 0
171 NATRIUM FOSFAT ENEMA TUB
0 0 0 0 0 0
172 NATRIUM FUSIDAT SALEP 20 MG / G TUB
0 0 0 0 0 0
173 NATRIUM KLORIDA LARUTAN INFUS 0,9 % BTL
0 0 0 0 0 0
174 NIFEDIPIN TABLET 10 MG TAB
0 0 0 0 0 0
175 NIFEDIPIN TABLET 30 MG SR TAB
0 0 0 0 0 0
176 NISTATIN 100.000 IU / G TABLET VAGINA TAB
0 0 0 0 0 0
177 NISTATIN 500.000 IU TABLET SALUT TAB
0 0 0 0 0 0
178 NISTATIN SUSPENSI 100.000 IU / ML BTL
0 10 0 0 10 13
179 NORETISTERON TABLET 5 MG TAB
0 0 0 0 0 0
184 OBAT BATUK HITAM SIRUP BTL
0 0 0 0 0 0
185 OKSIMETAZOLIN TETES HIDUNG 0,025 % BTL
0 0 0 0 0 0
186 OKSIMETAZOLIN TETES HIDUNG 0,05 % BTL
0 0 0 0 0 0
187 OKSITETRASIKLIN HCL IM 50 MG / ML - 10 ML AMP
0 0 0 0 0 0
188 OKSITETRASIKLIN HCL SALEP KULIT 3 % TUB
0 0 0 0 0 0
189 OKSITETRASIKLIN HCL SALEP MATA 1 % TUB
0 0 0 0 0 0
190 OKSITOSIN INJEKSI 10 IU / ML - 1 ML AMP
2 0 1 1 0 5
191 OMEPRAZOLE INJEKSI 40 MG VIAL
0 0 0 0 0 0
192 OMEPRAZOLE KAPSUL 20 MG KAP
0 0 0 0 0 0
195 PARASETAMOL DROPS 100 MG / ML BTL
0 0 0 0 0 0
196 PARASETAMOL INFUS 10 MG / ML BTL
0 0 0 0 0 0
197 PARASETAMOL SIRUP 120 MG / 5 ML BTL
5 0 3 2 0 11
198 PARASETAMOL TABLET 500 MG TAB
300 0 120 180 0 560
199 PERAK SULFADIAZIN KRIM 1% TUB
0 0 0 0 0 0
200 PERMETRIN KRIM 5% TUB
0 0 0 0 0 0
202 PILOKARPIN HCL NITRAT TETES MATA 2 % BTL
0 0 0 0 0 0
204 PIRACETAM TABLET 400 MG TAB
0 0 0 0 0 0
205 PIRANTEL PAMOAT TABLET 125 MG TAB
0 0 0 0 0 0
206 PIRANTEL SUSPENSI 125 MG / 5 ML BTL
0 0 0 0 0 0
207 PIRIDOKSIN HCL TABLET 10 MG TAB
0 0 0 0 0 0
208 PREDNISON TABLET 5 MG TAB
0 350 0 100 0 250 533
209 PROKAIN BENZIL PENISILLIN INJEKSI 3 JUTA UI VIAL
0 0 0 0 0 0
210 PROPILTIOURASIL TABLET 100 MG TAB
0 0 0 0 0 0
211 PROPRANOLOL TABLET 10 MG TAB
0 0 0 0 0 0
212 PROPRANOLOL TABLET 40 MG TAB
0 0 0 0 0 0
213 PSEUDOEFEDRIN SIRUP BTL
0 0 0 0 0 0
215 RANITIDIN TABLET 150 MG TAB
0 0 0 0 0 7
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN
OPT AAN AN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24 25

216 RETINOL KAPSUL 100.000 IU KAP

0 0 0 0 0 67
217 RETINOL KAPSUL 200.000 IU KAP
0 0 0 0 0 533
218 RIFAMPISIN TABLET 450 MG TAB
0 0 0 0 0 0
219 RIFAMPISIN TABLET 600 MG TAB
0 0 0 0 0 0
220 RINGER LAKTAT LARUTAN INFUS STERIL BTL
0 0 0 0 0 0
221 RISPERIDON TABLET 2 MG TAB
0 0 0 0 0 0
222 SALBUTAMOL INHALASI BTL
0 0 0 0 0 0
223 SALBUTAMOL NEBUL AMP
0 0 0 0 0 0
224 SALBUTAMOL TABLET 4 MG TAB
0 0 0 0 0 0
225 SALEP 2 - 4 KOMBINASI TUB
0 0 0 0 0 4
226 SALISIL BEDAK 2 % KTK
0 0 0 0 0 0
227 SALISIL SPIRITUS 10 % BTL
0 0 0 0 0 0
228 SEFADROKSIL KAPSUL 500 MG KAP
0 0 0 0 0 0
229 SEFADROKSIL SIRUP KERING 125 MG / 5 ML BTL
0 0 0 0 0 0
230 SEFOTAKSIM SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0 0
231 SEFTRIAXON SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0 0
234 SETIRIZIN SYR 5 MG / 5ML TAB
0 0 0 0 0 0
235 SETIRIZIN TABLET 10 MG BTL
0 0 0 0 0 0
236 SIANOKOBALAMIN INJEKSI 500 MCG / ML AMP
0 0 0 0 0 0
237 SIMVASTATIN TABLET 10 MG TAB
0 0 0 0 0 0
238 SIMVASTATIN TABLET 20 MG TAB
0 0 0 0 0 0
239 SIPROFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0 0
240 SPIRONOLAKTON TABLET 25 MG TAB
0 0 0 0 0 0
241 SULFASETAMID NATRIUM TETES MATA 15 % BTL
0 0 0 0 0 0
242 TABLET TAMBAH DARAH KOMBINASI TAB
1,120 0 200 920 0 933
244 TETRAKAIN HCL TETES MATA 0,5% BTL
0 0 0 0 0 0
245 TETRASIKLIN HCL KAPSUL 250 MG KAP
0 0 0 0 0 0
246 TIAMIN HCL INJEKSI 1.000 MCG / ML - 1 ML AMP
0 0 0 0 0 0
247 TIAMIN HCL MONONITRAT TABLET 50 MG TAB
0 0 0 0 0 133
250 UREA KRIM 10% TUB
0 0 0 0 0 0
251 VALPROAT SIRUP 250 MG / 5 ML BTL
0 0 0 0 0 0
252 VITAMIN B KOMPLEKS TABLET TAB
300 0 100 200 0 533
253 VITAMIN NEUROTROPIK INJEKSI AMP
0 0 0 0 0 0
254 WIDA BES BTL
0 0 0 0 0 0
255 YODIUM POVIDON GARGLE 240 ML BTL
0 0 0 0 0 0
256 YODIUM POVIDON LARUTAN 10 % 30 ML BTL
0 0 0 0 0 0
257 YODIUM POVIDON LARUTAN 10 % 300 ML BTL
0 0 0 0 0 0
258 ZINK DROPS 10 MG / ML BTL
0 0 0 0 0 0
259 ZINK SIRUP 20 MG / 5 ML BTL
0 0 0 0 0 0
260 ZINK TABLET 20 MG TAB
0 0 0 0 0 0
390 TEST HAMIL URINE / HCG TEST TEST
8 0 3 5 0 7
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN
OPT AAN AN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24 25

D. BAHAN MEDIS PAKAI HABIS

0 0 0
418 ALAT SUNTIK SEKALI PAKAI 0,05 ML SET
0 0 20 20 0 0 40
419 ALAT SUNTIK SEKALI PAKAI 0,5 ML SET
0 0 200 200 0 0 400
420 ALAT SUNTIK SEKALI PAKAI 1 ML SET
0 0 0 0 0 0
421 ALAT SUNTIK SEKALI PAKAI 10 ML SET
0 0 0 0 0 0
422 ALAT SUNTIK SEKALI PAKAI 3 ML SET
7 0 3 4 0 13
423 ALAT SUNTIK SEKALI PAKAI 5 ML SET
7 0 5 2 0 16
424 ALAT SUNTIK SEKALI PAKAI 20 ML SET
0 0 0 0 0 0
425 ALAT SUNTIK SEKALI PAKAI 50 ML SET
0 0 0 0 0 0
426 ALKOHOL SWAB BJ
0 0 0 0 0 0
427 ANTISEPTIK HANDRUB BTL
0 0 0 0 0 0
428 ANTISEPTIK HANDSCRUB BTL
0 0 0 0 0 0
429 APRON PLASTIK PCS
0 0 0 0 0 0
430 BIST MESS BJ
0 0 0 0 0 0
431 BLOOD LANCET 26 G / 28 G SET
0 0 0 0 0 0
432 BLOOD SET SET
0 0 0 0 0 0
435 CATGUT CHROMIC NO. 3/0 SACHET
0 0 0 0 0 0
436 CATGUT CHROMIC NO. 4/0 SACHET
0 0 0 0 0 0
437 CATGUT PLAIN / BENANG BEDAH NO. 2/0 SACHET
0 0 0 0 0 0
438 CATGUT PLAIN / BENANG BEDAH NO. 3/0 SACHET
3 0 0 3 0 3
441 FOLLEY CATHETER 2 WAY NO. 16 SET
0 0 0 0 0 0
442 FOLLEY CATHETER 2 WAY NO. 18 SET
0 0 0 0 0 0
444 ID BAND PCS
0 0 0 0 0 0
445 INFUS SET ANAK SET
0 0 0 0 0 0
446 INFUS SET DEWASA SET
1 0 0 1 0 0
447 IV CATHETER NO. 18 SET
2 0 0 2 0 0
448 IV CATHETER NO. 20 SET
0 0 0 0 0 0
449 IV CATHETER NO. 22 SET
0 0 0 0 0 0
450 IV CATHETER NO. 24 SET
0 0 0 0 0 0
451 IV CATHETER NO. 26 SET
0 0 0 0 0 0
452 JARUM JAHIT / BEDAH NO. 9 S/D 14 BJ
0 0 0 0 0 0
454 KAPAS BERLEMAK 500 GRAM ROL
0 0 0 0 0 0
455 KAPAS PEMBALUT / ABSORBEN 250 GRAM ROL
1 0 1 0 0 4
457 KASA 16x16 PCS
0 0 0 0 0 0
458 KASA 40X80 ROL
0 0 0 0 0 0
459 KASA HIDROFIL STERIL UKURAN 18 M X22 CM ROL
0 0 0 0 0 0
460 KASA KOMPRES 40/40 STERIL ROL
0 0 0 0 0 0
461 KASA PEMBALUT 2 M X 80 CM ROL
0 0 0 0 0 0
462 KASA PEMBALUT ELASTIS 4 INCI ROL
0 0 0 0 0 0
463 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL
0 0 0 0 0 0
464 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL
0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN
OPT AAN AN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24 25

465 KASA PEMBALUT HIDROFIL 4 M X 3 CM ROL

0 0 0 0 0 0
466 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL
0 0 0 0 0 0
467 KASA PERAWATAN LUKA LBR
0 0 0 0 0 0
468 KASET WITH SCREEN GREEN PKT
0 0 0 0 0 0
469 KERTAS EKG 80 MM X 30 M ROL
0 0 0 0 0 0
470 MASKER PCS
0 0 0 0 0 0
471 MASKER N95 PCS
0 0 0 0 0 0
484 NURSE CAP PCS
0 0 0 0 0 0
485 PEMBALUT GIPS 4 INCI ROL
0 0 0 0 0 0
486 PLESTER 5 CM x 5 M ROL
0 0 0 0 0 0
487 PLESTER 10 CM X 5 M ROL
0 0 0 0 0 0
488 PLESTER 15 CM X 5 M ROL
0 0 0 0 0 0
489 PLESTER BULAT NON WOVEN PCS
0 0 0 0 0 0
490 PLESTER KAIN 7,5 X 4,5 M ROL
0 0 0 0 0 0
491 POT SPUTUM SET
0 0 0 0 0 0
492 POT URINE SET
0 0 0 0 0 0
493 SAFETY BOX 2,5 L KTK
0 0 0 0 0 0
494 SAFETY BOX 5 L KTK
0 0 0 0 0 0
495 SARUNG TANGAN KEBIDANAN (PANJANG) PSG
0 0 0 0 0 0
496 SARUNG TANGAN KERJA (TEBAL) M - L PSG
0 0 0 0 0 0
497 SARUNG TANGAN NON STERIL PSG
0 0 0 0 0 0
498 SARUNG TANGAN STERIL PSG
0 0 0 0 0 0
501 SENDOK SIRUP PCS
0 0 0 0 0 0
502 SILK / BENANG SUTERA NO. 3/0 SACHET
0 0 0 0 0 0
503 SLIM ZUIKER / MUCUS EXTRACTOR SET
0 0 0 0 0 0
508 SURGICAL GOWN PCS
0 0 0 0 0 0
516 UNDERPAD LBR
5 0 1 4 0 5
517 URINE BAG STERIL LBR
0 0 0 0 0 0
518 USG GEL TUB
0 0 0 0 0 0

JUMLAH KUNJUNGAN RESEP

KTP

BPJS

TUBAN, 28 MARET 2021

MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MENERIMA/MELAPOR

KEPALA PUSKESMAS PLUMPANG

dr H BOEDI WINOTO LESTI E. P., S.Farm., Apt. HARDININGSIH, A.Md. Keb.

NIP 19640723 199602 1 001 NIP. 199007042019032021 19720421 199203 2 011

 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

Polindes/ Pustu/ ponkesdes : : PENIDON

TAHUN : APRIL 2021

STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT
NO. NAMA OBAT SATUAN
OPT AAN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24

A. OBAT ESSENSIAL

1 ALBENDAZOL TABLET 400 MG TAB

0 0 0 0 0
2 ALBENDAZOL SUSPENSI 200 MG / 5 ML BTL
0 0 0 0 0
3 ALOPURINOL TABLET 100 MG TAB
50 0 50 0 0
4 AMBROKSOL TABLET 30 MG TAB
0 0 0 0 0
6 AMINOFILLIN TABLET 200 MG TAB
0 0 0 0 0
8 AMLODIPIN TABLET 10 MG TAB
5 25 5 25 0 0
9 AMLODIPIN TABLET 5 MG TAB
0 0 0 0 0
10 AMOKSISILIN KAPLET 500 MG KAPL
150 0 100 50 0
11 AMOKSISILIN KAPSUL 250 MG KAP
0 0 0 0 0
13 AMOKSISILIN SIRUP KERING 125 MG / 5 ML BTL
4 0 4 0 0
16 ANTASIDA DOEN SUSPENSI BTL
2 0 2 0 0
17 ANTASIDA DOEN TABLET KOMBINASI TAB
100 40 70 30 40
18 ANTI BAKTERI DOEN SALEP KOMBINASI TUB
0 0 0 0 0
19 ANTI FUNGI DOEN KOMBINASI POT
0 0 0 0 0
21 ANTI INFEKSI KRIM TUB
0 0 0 0 0
22 ANTI MIGRAIN DOEN TABLET KOMBINASI TAB
0 0 0 0 0
25 ASAM ASKORBAT TABLET 250 MG TAB
0 0 0 0 0
26 ASAM ASKORBAT TABLET 50 MG TAB
0 0 0 0 0
27 ASAM ASKORBAT TABLET 500 MG TAB
0 0 0 0 0
28 ASAM FOLAT TABLET 0,4 MG TAB
0 0 0 0 0
29 ASAM MEFENAMAT TABLET 500 MG TAB
200 0 100 100 0
30 ASAM TRANEKSAMAT INJEKSI 50 MG / ML AMP
0 0 0 0 0
31 ASAM TRANEKSAMAT TABLET 500 MG TAB
0 0 0 0 0
33 ASIKLOVIR TABLET 200 MG TAB
0 0 0 0 0
34 ASIKLOVIR TABLET 400 MG TAB
50 0 30 20 0
35 ASIKLOVIR KRIM 5 % TUB
0 0 0 0
36 ATAPULGIT TABLET 600 MG TAB
0 0 0 0 0
40 BETAHISTIN MESILAT TABLET 6 MG TAB
0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT
NO. NAMA OBAT SATUAN
OPT AAN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24

41 BETAMETASON KRIM 0,1 % TUB

6 0 1 5 0
46 DEKSAMETASON INJEKSI 5 MG / ML - 1 ML AMP
0 0 0 0 0
47 DEKSAMETASON TABLET 0,5 MG TAB
140 20 80 60 20
52 DIFENHIDRAMIN HCL INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0
56 DIMENHIDRINAT TABLET 50 MG TAB
50 0 30 20 0
57 DOMPERIDON SIRUP 5 MG / 5 ML BTL
0 0 0 0 0
58 DOMPERIDON TABLET 10 MG TAB
0 0 0 0 0
59 EPINEPRIN HCL INJEKSI 0,1 % AMP
0 0 0 0 0
60 ERITROMISIN KAPSUL 500 MG KAP
0 0 0 0 0
61 ERITROMISIN SIRUP KERING 200 MG / 5 ML BTL
0 0 0 0 0
62 ETAKRIDIN LARUTAN 0,1 % BTL
2 0 0 2 0
63 ETANOL 70 % BTL
3 0 0 3 0
64 ETIL KLORIDA SEMPROT BTL
0 0 0 0 0
69 FENOL GLISEROL TETES TELINGA 10 % BTL
0 0 0 0 0
70 FITOMENADION INJEKSI 2 MG / ML - 1 ML AMP
0 0 0 0 0
71 FITOMENADION INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0
72 FITOMENADION TABLET SALUT 10 MG TAB
0 0 0 0 0
75 FUROSEMID INJEKSI 10 MG AMP
0 0 0 0 0
76 FUROSEMID TABLET 40 MG TAB
0 0 0 0 0
77 GARAM ORALIT KOMBINASI SAK
60 0 30 30 0
78 GEMFIBROZIL KAPSUL 300 MG KAP
0 0 0 0 0
79 GENTAMISIN INJEKSI 40 MG/ML AMP
0 0 0 0 0
80 GENTAMISIN TETES MATA 0,3 % BTL
2 0 2 0 0
81 GENTAMISIN SALEP KULIT 0,1 % TUB
0 0 0 0 0
82 GENTAMISIN SALEP MATA 0,3 % TUB
0 0 0 0 0
83 GENTIAN VIOLET LARUTAN 1 % BTL
0 0 0 0 0
84 GLIBENKLAMID TABLET 5 MG TAB
30 0 30 0 0
85 GLIMEPIRIDE TABLET 2 MG TAB
0 0 0 0 0
86 GLUKOSA LARUTAN INFUS 5 % STERIL BTL
0 0 0 0 0
87 GLUKOSA LARUTAN INFUS 10 % STERIL BTL
0 0 0 0 0
88 GLUKOSA LARUTAN INFUS 40 % STERIL AMP
0 0 0 0 0
89 GRISEOFULVIN TABLET 125 MG TAB
0 0 0 0 0
96 HIDROKLORTIAZID TABLET 25 MG TAB
0 0 0 0 0
97 HIDROKORTISON KRIM 2,5 % TUB
1 0 1 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT
NO. NAMA OBAT SATUAN
OPT AAN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24

99 HIOSIN BUTILBROMIDA TABLET 10 MG TAB

0 0 0 0 0
100 IBUPROFEN SUSPENSI 100 MG / 5 ML BTL
0 0 0 0 0
101 IBUPROFEN TABLET 200 MG TAB
90 0 50 40 0
102 IBUPROFEN TABLET 400 MG TAB
50 0 50 0 0
103 INSULIN ANALOG LONG ACTING PEN
0 0 0 0 0
104 INSULIN ANALOG RAPID ACTING PEN
0 0 0 0 0
105 ISONIAZID TABLET 100 MG TAB
0 0 0 0 0
106 ISONIAZID TABLET 300 MG TAB
0 0 0 0 0
107 ISOSORBID DINITRAT TABLET 5 MG TAB
0 0 0 0 0
108 KALSIUM GLUKONAT INJEKSI 10 % AMP
0 0 0 0 0
109 KALSIUM LAKTAT TABLET 500 MG TAB
250 0 100 150 0
111 KAOLIN - PEKTIN SIRUP BTL
0 0 0 0 0
112 KAPTOPRIL TABLET 25 MG TAB
0 0 0 0 0
113 KARBAMAZEPIN TABLET 200 MG TAB
0 0 0 0 0
114 KETOKONAZOLE KRIM 2 % TUB
2 0 2 0 0
115 KETOKONAZOLE TABLET 200 MG TAB
0 0 0 0 0
116 KLINDAMISIN KAPSUL 300 MG KAP
0 0 0 0 0
120 KLORAMFENIKOL INJEKSI 1000 MG VIAL
0 0 0 0 0
121 KLORAMFENIKOL KAPSUL 250 MG KAP
0 60 30 0 30
122 KLORAMFENIKOL SALEP MATA 1% TUB
1 0 1 0 0
123 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BTL
0 0 0 0 0
124 KLORAMFENIKOL TETES MATA 0,5 % BTL
0 0 0 0 0
125 KLORAMFENIKOL TETES TELINGA 3 % BTL
1 0 1 0 0
126 KLORFENIRAMIN MALEAT TABLET 4 MG TAB
280 0 40 240 0
132 KOTRIMOKSAZOL DEWASA TABLET TAB
0 0 0 0 0
133 KOTRIMOKSAZOL PEDIATRIK TABLET TAB
0 0 0 0 0
134 KOTRIMOKSAZOL SUSPENSI 240 MG / 5 ML BTL
1 0 1 0 0
135 KURKUMA SIRUP BTL
0 0 0 0 0
136 KURKUMA TABLET TAB
0 0 0 0 0
137 LAKTULOSA SIRUP BTL
0 0 0 0 0
138 LEVOFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0
139 LEVOTIROKSIN TABLET 100 MCG TAB
0 0 0 0 0
140 LIDOKAIN KOMPOSITUM INJEKSI AMP
0 0 0 0 0
141 LIDOKAIN SPRAY ORAL 10 % BTL
0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT
NO. NAMA OBAT SATUAN
OPT AAN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24

142 LISINOPRIL TABLET 5 MG TAB

0 0 0 0 0
143 LISINOPRIL TABLET 10 MG TAB
0 0 0 0 0
144 LOPERAMID TABLET 2 MG TAB
0 0 0 0 0
145 LORATADIN TABLET 10 MG TAB
0 0 0 0 0
146 MAGNESIUM SULFAT INJEKSI / IV 20% - 25 ML AMP
0 0 0 0 0
147 MAGNESIUM SULFAT INJEKSI / IV 40% - 25 ML AMP
0 0 0 0 0
149 MEBENDAZOL TABLET 100 MG TAB
0 0 0 0 0
150 MELOKSIKAM TABLET 15 MG TAB
0 0 0 0 0
151 METAMIZOL INJEKSI 500 MG / ML AMP
0 0 0 0 0
152 METFORMIN TABLET 500 MG TAB
0 0 0 0 0
153 METIL ERGOMETRIN INJEKSI 0,2 MG / ML - 1 ML AMP
0 0 0 0 0
154 METIL ERGOMETRIN TABLET 0,125 MG TAB
0 0 0 0 0
155 METIL PREDNISOLON INJEKSI 125 MG AMP
0 0 0 0 0
156 METIL PREDNISOLON TABLET 4 MG TAB
0 0 0 0 0
157 METOKLOPRAMID INJEKSI 5 MG / ML AMP
0 0 0 0 0
158 METOKLOPRAMID TABLET 10 MG TAB
0 0 0 0 0
159 METRONIDAZOL INFUS 5 MG / ML BTL
0 0 0 0 0
160 METRONIDAZOL SIRUP 125 MG / 5 ML BTL
0 0 0 0 0
161 METRONIDAZOL TABLET 250 MG TAB
0 0 0 0 0
162 METRONIDAZOL TABLET 500 MG TAB
0 0 0 0 0
163 MIKONAZOL KRIM 2% TUB
0 0 0 0 0
165 MOMETASON FUROAT KRIM 0,1 % TUB
0 0 0 0 0
166 N-ASETIL SISTEIN KAPSUL 200 MG KAP
210 0 210 0 0
167 NASALIN SPRAY 100 ML BTL
0 0 0 0 0
168 NATRIUM BIKARBONAT INJEKSI 8,4 % AMP
0 0 0 0 0
169 NATRIUM BIKARBONAT TABLET 500 MG TAB
0 0 0 0 0
170 NATRIUM DIKLOFENAK 50 MG TAB
0 0 0 0 0
171 NATRIUM FOSFAT ENEMA TUB
0 0 0 0 0
172 NATRIUM FUSIDAT SALEP 20 MG / G TUB
0 0 0 0 0
173 NATRIUM KLORIDA LARUTAN INFUS 0,9 % BTL
0 0 0 0 0
174 NIFEDIPIN TABLET 10 MG TAB
0 0 0 0 0
175 NIFEDIPIN TABLET 30 MG SR TAB
0 0 0 0 0
176 NISTATIN 100.000 IU / G TABLET VAGINA TAB
0 0 0 0 0
177 NISTATIN 500.000 IU TABLET SALUT TAB
0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT
NO. NAMA OBAT SATUAN
OPT AAN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24

178 NISTATIN SUSPENSI 100.000 IU / ML BTL

0 10 0 0 10
179 NORETISTERON TABLET 5 MG TAB
0 0 0 0 0
184 OBAT BATUK HITAM SIRUP BTL
0 0 0 0 0
185 OKSIMETAZOLIN TETES HIDUNG 0,025 % BTL
0 0 0 0 0
186 OKSIMETAZOLIN TETES HIDUNG 0,05 % BTL
0 0 0 0 0
187 OKSITETRASIKLIN HCL IM 50 MG / ML - 10 ML AMP
0 0 0 0 0
188 OKSITETRASIKLIN HCL SALEP KULIT 3 % TUB
0 0 0 0 0
189 OKSITETRASIKLIN HCL SALEP MATA 1 % TUB
0 0 0 0 0
190 OKSITOSIN INJEKSI 10 IU / ML - 1 ML AMP
1 0 1 0 0
191 OMEPRAZOLE INJEKSI 40 MG VIAL
0 0 0 0 0
192 OMEPRAZOLE KAPSUL 20 MG KAP
0 0 0 0 0
195 PARASETAMOL DROPS 100 MG / ML BTL
0 0 0 0 0
196 PARASETAMOL INFUS 10 MG / ML BTL
0 0 0 0 0
197 PARASETAMOL SIRUP 120 MG / 5 ML BTL
2 0 2 0 0
198 PARASETAMOL TABLET 500 MG TAB
180 0 100 80 0
199 PERAK SULFADIAZIN KRIM 1% TUB
0 0 0 0 0
200 PERMETRIN KRIM 5% TUB
0 0 0 0 0
202 PILOKARPIN HCL NITRAT TETES MATA 2 % BTL
0 0 0 0 0
204 PIRACETAM TABLET 400 MG TAB
0 0 0 0 0
205 PIRANTEL PAMOAT TABLET 125 MG TAB
0 0 0 0 0
206 PIRANTEL SUSPENSI 125 MG / 5 ML BTL
0 0 0 0 0
207 PIRIDOKSIN HCL TABLET 10 MG TAB
0 0 0 0 0
208 PREDNISON TABLET 5 MG TAB
0 250 100 0 150
209 PROKAIN BENZIL PENISILLIN INJEKSI 3 JUTA UI VIAL
0 0 0 0 0
210 PROPILTIOURASIL TABLET 100 MG TAB
0 0 0 0 0
211 PROPRANOLOL TABLET 10 MG TAB
0 0 0 0 0
212 PROPRANOLOL TABLET 40 MG TAB
0 0 0 0 0
213 PSEUDOEFEDRIN SIRUP BTL
0 0 0 0 0
215 RANITIDIN TABLET 150 MG TAB
0 0 0 0 0
216 RETINOL KAPSUL 100.000 IU KAP
0 0 0 0 0
217 RETINOL KAPSUL 200.000 IU KAP
0 0 0 0 0
218 RIFAMPISIN TABLET 450 MG TAB
0 0 0 0 0
219 RIFAMPISIN TABLET 600 MG TAB
0 0 0 0 0
220 RINGER LAKTAT LARUTAN INFUS STERIL BTL
0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT
NO. NAMA OBAT SATUAN
OPT AAN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24

221 RISPERIDON TABLET 2 MG TAB

0 0 0 0 0
222 SALBUTAMOL INHALASI BTL
0 0 0 0 0
223 SALBUTAMOL NEBUL AMP
0 0 0 0 0
224 SALBUTAMOL TABLET 4 MG TAB
0 0 0 0 0
225 SALEP 2 - 4 KOMBINASI TUB
0 0 0 0 0
226 SALISIL BEDAK 2 % KTK
0 0 0 0 0
227 SALISIL SPIRITUS 10 % BTL
0 0 0 0 0
228 SEFADROKSIL KAPSUL 500 MG KAP
0 0 0 0 0
229 SEFADROKSIL SIRUP KERING 125 MG / 5 ML BTL
0 0 0 0 0
230 SEFOTAKSIM SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0
231 SEFTRIAXON SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0
234 SETIRIZIN SYR 5 MG / 5ML TAB
0 0 0 0 0
235 SETIRIZIN TABLET 10 MG BTL
0 0 0 0 0
236 SIANOKOBALAMIN INJEKSI 500 MCG / ML AMP
0 0 0 0 0
237 SIMVASTATIN TABLET 10 MG TAB
0 0 0 0 0
238 SIMVASTATIN TABLET 20 MG TAB
0 0 0 0 0
239 SIPROFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0
240 SPIRONOLAKTON TABLET 25 MG TAB
0 0 0 0 0
241 SULFASETAMID NATRIUM TETES MATA 15 % BTL
0 0 0 0 0
242 TABLET TAMBAH DARAH KOMBINASI TAB
920 0 250 670 0
244 TETRAKAIN HCL TETES MATA 0,5% BTL
0 0 0 0 0
245 TETRASIKLIN HCL KAPSUL 250 MG KAP
0 0 0 0 0
246 TIAMIN HCL INJEKSI 1.000 MCG / ML - 1 ML AMP
0 0 0 0 0
247 TIAMIN HCL MONONITRAT TABLET 50 MG TAB
0 0 0 0 0
250 UREA KRIM 10% TUB
0 0 0 0 0
251 VALPROAT SIRUP 250 MG / 5 ML BTL
0 0 0 0 0
252 VITAMIN B KOMPLEKS TABLET TAB
200 0 100 100 0
253 VITAMIN NEUROTROPIK INJEKSI AMP
0 0 0 0 0
254 WIDA BES BTL
0 0 0 0 0
255 YODIUM POVIDON GARGLE 240 ML BTL
0 0 0 0 0
256 YODIUM POVIDON LARUTAN 10 % 30 ML BTL
0 0 0 0 0
257 YODIUM POVIDON LARUTAN 10 % 300 ML BTL
0 0 0 0 0
258 ZINK DROPS 10 MG / ML BTL
0 0 0 0 0
259 ZINK SIRUP 20 MG / 5 ML BTL
0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT
NO. NAMA OBAT SATUAN
OPT AAN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24

260 ZINK TABLET 20 MG TAB

0 0 0 0 0
390 TEST HAMIL URINE / HCG TEST TEST
5 0 3 2 0
D. BAHAN MEDIS PAKAI HABIS
0 0
418 ALAT SUNTIK SEKALI PAKAI 0,05 ML SET
0 0 0 0 0
419 ALAT SUNTIK SEKALI PAKAI 0,5 ML SET
0 0 0 0 0
420 ALAT SUNTIK SEKALI PAKAI 1 ML SET
0 0 0 0 0
421 ALAT SUNTIK SEKALI PAKAI 10 ML SET
0 0 0 0 0
422 ALAT SUNTIK SEKALI PAKAI 3 ML SET
4 0 2 2 0
423 ALAT SUNTIK SEKALI PAKAI 5 ML SET
2 0 2 0 0
424 ALAT SUNTIK SEKALI PAKAI 20 ML SET
0 0 0 0 0
425 ALAT SUNTIK SEKALI PAKAI 50 ML SET
0 0 0 0 0
426 ALKOHOL SWAB BJ
0 0 0 0 0
427 ANTISEPTIK HANDRUB BTL
0 0 0 0 0
428 ANTISEPTIK HANDSCRUB BTL
0 0 0 0 0
429 APRON PLASTIK PCS
0 0 0 0 0
430 BIST MESS BJ
0 0 0 0 0
431 BLOOD LANCET 26 G / 28 G SET
0 0 0 0 0
432 BLOOD SET SET
0 0 0 0 0
435 CATGUT CHROMIC NO. 3/0 SACHET
0 0 0 0 0
436 CATGUT CHROMIC NO. 4/0 SACHET
0 0 0 0 0
437 CATGUT PLAIN / BENANG BEDAH NO. 2/0 SACHET
0 0 0 0 0
438 CATGUT PLAIN / BENANG BEDAH NO. 3/0 SACHET
3 0 2 1 0
441 FOLLEY CATHETER 2 WAY NO. 16 SET
0 0 0 0 0
442 FOLLEY CATHETER 2 WAY NO. 18 SET
0 0 0 0 0
444 ID BAND PCS
0 0 0 0 0
445 INFUS SET ANAK SET
0 0 0 0 0
446 INFUS SET DEWASA SET
1 0 0 1 0
447 IV CATHETER NO. 18 SET
2 0 0 2 0
448 IV CATHETER NO. 20 SET
0 0 0 0 0
449 IV CATHETER NO. 22 SET
0 0 0 0 0
450 IV CATHETER NO. 24 SET
0 0 0 0 0
451 IV CATHETER NO. 26 SET
0 0 0 0 0
452 JARUM JAHIT / BEDAH NO. 9 S/D 14 BJ
0 0 0 0 0
454 KAPAS BERLEMAK 500 GRAM ROL
0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT
NO. NAMA OBAT SATUAN
OPT AAN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24

455 KAPAS PEMBALUT / ABSORBEN 250 GRAM ROL

0 0 0 0 0
457 KASA 16x16 PCS
0 0 0 0 0
458 KASA 40X80 ROL
0 0 0 0 0
459 KASA HIDROFIL STERIL UKURAN 18 M X22 CM ROL
0 0 0 0 0
460 KASA KOMPRES 40/40 STERIL ROL
0 0 0 0 0
461 KASA PEMBALUT 2 M X 80 CM ROL
0 0 0 0 0
462 KASA PEMBALUT ELASTIS 4 INCI ROL
0 0 0 0 0
463 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL
0 0 0 0 0
464 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL
0 0 0 0 0
465 KASA PEMBALUT HIDROFIL 4 M X 3 CM ROL
0 0 0 0 0
466 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL
0 0 0 0 0
467 KASA PERAWATAN LUKA LBR
0 0 0 0 0
468 KASET WITH SCREEN GREEN PKT
0 0 0 0 0
469 KERTAS EKG 80 MM X 30 M ROL
0 0 0 0 0
470 MASKER PCS
0 0 0 0 0
471 MASKER N95 PCS
0 0 0 0 0
484 NURSE CAP PCS
0 0 0 0 0
485 PEMBALUT GIPS 4 INCI ROL
0 0 0 0 0
486 PLESTER 5 CM x 5 M ROL
0 0 0 0 0
487 PLESTER 10 CM X 5 M ROL
0 0 0 0 0
488 PLESTER 15 CM X 5 M ROL
0 0 0 0 0
489 PLESTER BULAT NON WOVEN PCS
0 0 0 0 0
490 PLESTER KAIN 7,5 X 4,5 M ROL
0 0 0 0 0
491 POT SPUTUM SET
0 0 0 0 0
492 POT URINE SET
0 0 0 0 0
493 SAFETY BOX 2,5 L KTK
0 0 0 0 0
494 SAFETY BOX 5 L KTK
0 0 0 0 0
495 SARUNG TANGAN KEBIDANAN (PANJANG) PSG
0 0 0 0 0
496 SARUNG TANGAN KERJA (TEBAL) M - L PSG
0 0 0 0 0
497 SARUNG TANGAN NON STERIL PSG
0 0 0 0 0
498 SARUNG TANGAN STERIL PSG
0 0 0 0 0
501 SENDOK SIRUP PCS
0 0 0 0 0
502 SILK / BENANG SUTERA NO. 3/0 SACHET
0 0 0 0 0
503 SLIM ZUIKER / MUCUS EXTRACTOR SET
0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT
NO. NAMA OBAT SATUAN
OPT AAN
APBD APBD JKN
APBD JKN JKN APBD JKN
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 7 10 12 14 16 17 20 21 23 24

508 SURGICAL GOWN PCS

0 0 0 0 0
516 UNDERPAD LBR
4 0 2 2 0
517 URINE BAG STERIL LBR
0 0 0 0 0
518 USG GEL TUB
0 0 0 0 0

JUMLAH KUNJUNGAN RESEP

KTP

BPJS

TUBAN,27 April 2021

MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MENERIMA/MELAPOR

KEPALA PUSKESMAS PLUMPANG

dr H BOEDI WINOTO LESTI E. P., S.Farm., Apt. HARDININGSIH, A.Md. Keb.

NIP 19640723 199602 1 001 NIP. 199007042019032021 19720421 199203 2 011

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 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

Polindes/ Pustu/ ponkesdes : :

TAHUN :

STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

A. OBAT ESSENSIAL
GFK
1 ALBENDAZOL TABLET 400 MG TAB
0 0 0 0 0 0 0 0 0
2 ALBENDAZOL SUSPENSI 200 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
3 ALOPURINOL TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0
4 AMBROKSOL TABLET 30 MG TAB
0 0 0 0 0 0 0 0 0
6 AMINOFILLIN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
8 AMLODIPIN TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
9 AMLODIPIN TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
10 AMOKSISILIN KAPLET 500 MG KAPL
50 0 50 0 50 50 0 0 0 50
11 AMOKSISILIN KAPSUL 250 MG KAP
0 0 0 0 0 0 0 0 0
13 AMOKSISILIN SIRUP KERING 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
16 ANTASIDA DOEN SUSPENSI BTL
0 0 0 0 0 0 0 0 0
17 ANTASIDA DOEN TABLET KOMBINASI TAB
30 40 70 0 10 20 30 20 20 40 10
18 ANTI BAKTERI DOEN SALEP KOMBINASI TUB
0 0 0 0 0 0 0 0 0
19 ANTI FUNGI DOEN KOMBINASI POT
0 0 0 0 0 0 0 0 0
21 ANTI INFEKSI KRIM TUB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

22 ANTI MIGRAIN DOEN TABLET KOMBINASI TAB

0 0 0 0 0 0 0 0 0
25 ASAM ASKORBAT TABLET 250 MG TAB
0 0 0 0 0 0 0 0 0
26 ASAM ASKORBAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0
27 ASAM ASKORBAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
28 ASAM FOLAT TABLET 0,4 MG TAB
0 0 0 0 0 0 0 0 0
29 ASAM MEFENAMAT TABLET 500 MG TAB
100 0 100 0 50 50 50 0 50 50
30 ASAM TRANEKSAMAT INJEKSI 50 MG / ML AMP
0 0 0 0 0 0 0 0 0
31 ASAM TRANEKSAMAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
33 ASIKLOVIR TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
34 ASIKLOVIR TABLET 400 MG TAB
20 0 20 0 5 5 15 0 15 5
35 ASIKLOVIR KRIM 5 % TUB
0 0 0 0 0 0 0 0 0
36 ATAPULGIT TABLET 600 MG TAB
0 0 0 0 0 0 0 0 0
40 BETAHISTIN MESILAT TABLET 6 MG TAB
0 0 0 0 0 0 0 0 0
41 BETAMETASON KRIM 0,1 % TUB
5 0 5 0 2 2 3 0 3 2
46 DEKSAMETASON INJEKSI 5 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
47 DEKSAMETASON TABLET 0,5 MG TAB
60 20 80 0 30 20 50 30 0 30 30
52 DIFENHIDRAMIN HCL INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
56 DIMENHIDRINAT TABLET 50 MG TAB
20 0 20 0 10 10 10 0 10 10
57 DOMPERIDON SIRUP 5 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
58 DOMPERIDON TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
59 EPINEPRIN HCL INJEKSI 0,1 % AMP
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

60 ERITROMISIN KAPSUL 500 MG KAP

0 0 0 0 0 0 0 0 0
61 ERITROMISIN SIRUP KERING 200 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
62 ETAKRIDIN LARUTAN 0,1 % BTL
2 0 2 0 0 2 0 2 0
63 ETANOL 70 % BTL
3 0 3 0 0 3 0 3 0
64 ETIL KLORIDA SEMPROT BTL
0 0 0 0 0 0 0 0 0
69 FENOL GLISEROL TETES TELINGA 10 % BTL
0 0 0 0 0 0 0 0 0
70 FITOMENADION INJEKSI 2 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
71 FITOMENADION INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
72 FITOMENADION TABLET SALUT 10 MG TAB
0 0 0 0 0 0 0 0 0
75 FUROSEMID INJEKSI 10 MG AMP
0 0 0 0 0 0 0 0 0
76 FUROSEMID TABLET 40 MG TAB
0 0 0 0 0 0 0 0 0
77 GARAM ORALIT KOMBINASI SAK
30 0 30 0 10 10 20 0 20 10
78 GEMFIBROZIL KAPSUL 300 MG KAP
0 0 0 0 0 0 0 0 0
79 GENTAMISIN INJEKSI 40 MG/ML AMP
0 0 0 0 0 0 0 0 0
80 GENTAMISIN TETES MATA 0,3 % BTL
0 0 0 0 0 0 0 0 0
81 GENTAMISIN SALEP KULIT 0,1 % TUB
0 0 0 0 0 0 0 0 0
82 GENTAMISIN SALEP MATA 0,3 % TUB
0 0 0 0 0 0 0 0 0
83 GENTIAN VIOLET LARUTAN 1 % BTL
0 0 0 0 0 0 0 0 0
84 GLIBENKLAMID TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
85 GLIMEPIRIDE TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0
86 GLUKOSA LARUTAN INFUS 5 % STERIL BTL
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

87 GLUKOSA LARUTAN INFUS 10 % STERIL BTL

0 0 0 0 0 0 0 0 0
88 GLUKOSA LARUTAN INFUS 40 % STERIL AMP
0 0 0 0 0 0 0 0 0
89 GRISEOFULVIN TABLET 125 MG TAB
0 0 0 0 0 0 0 0 0
96 HIDROKLORTIAZID TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0
97 HIDROKORTISON KRIM 2,5 % TUB
0 0 0 0 0 0 0 0 0
99 HIOSIN BUTILBROMIDA TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
100 IBUPROFEN SUSPENSI 100 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
101 IBUPROFEN TABLET 200 MG TAB
40 0 40 0 20 20 20 0 20 20
102 IBUPROFEN TABLET 400 MG TAB
0 0 0 0 0 0 0 0 0
103 INSULIN ANALOG LONG ACTING PEN
0 0 0 0 0 0 0 0 0
104 INSULIN ANALOG RAPID ACTING PEN
0 0 0 0 0 0 0 0 0
105 ISONIAZID TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0
106 ISONIAZID TABLET 300 MG TAB
0 0 0 0 0 0 0 0 0
107 ISOSORBID DINITRAT TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
108 KALSIUM GLUKONAT INJEKSI 10 % AMP
0 0 0 0 0 0 0 0 0
109 KALSIUM LAKTAT TABLET 500 MG TAB
150 0 150 0 70 70 80 0 80 70
111 KAOLIN - PEKTIN SIRUP BTL
0 0 0 0 0 0 0 0 0
112 KAPTOPRIL TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0
113 KARBAMAZEPIN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
114 KETOKONAZOLE KRIM 2 % TUB
0 0 0 0 0 0 0 0 0
115 KETOKONAZOLE TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

116 KLINDAMISIN KAPSUL 300 MG KAP

0 0 0 0 0 0 0 0 0
120 KLORAMFENIKOL INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0
121 KLORAMFENIKOL KAPSUL 250 MG KAP
0 30 30 0 10 10 0 20 20 0
122 KLORAMFENIKOL SALEP MATA 1% TUB
0 0 0 0 0 0 0 0 0
123 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BTL
0 0 0 0 0 0 0 0 0
124 KLORAMFENIKOL TETES MATA 0,5 % BTL
0 0 0 0 0 0 0 0 0
125 KLORAMFENIKOL TETES TELINGA 3 % BTL
0 0 0 0 0 0 0 0 0
126 KLORFENIRAMIN MALEAT TABLET 4 MG TAB
240 0 240 0 100 100 140 0 140 100
132 KOTRIMOKSAZOL DEWASA TABLET TAB
0 0 0 0 0 0 0 0 0
133 KOTRIMOKSAZOL PEDIATRIK TABLET TAB
0 0 0 0 0 0 0 0 0
134 KOTRIMOKSAZOL SUSPENSI 240 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
135 KURKUMA SIRUP BTL
0 0 0 0 0 0 0 0 0
136 KURKUMA TABLET TAB
0 0 0 0 0 0 0 0 0
137 LAKTULOSA SIRUP BTL
0 0 0 0 0 0 0 0 0
138 LEVOFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
139 LEVOTIROKSIN TABLET 100 MCG TAB
0 0 0 0 0 0 0 0 0
140 LIDOKAIN KOMPOSITUM INJEKSI AMP
0 0 0 0 0 0 0 0 0
141 LIDOKAIN SPRAY ORAL 10 % BTL
0 0 0 0 0 0 0 0 0
142 LISINOPRIL TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
143 LISINOPRIL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
144 LOPERAMID TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

145 LORATADIN TABLET 10 MG TAB

0 0 0 0 0 0 0 0 0
146 MAGNESIUM SULFAT INJEKSI / IV 20% - 25 ML AMP
0 0 0 0 0 0 0 0 0
147 MAGNESIUM SULFAT INJEKSI / IV 40% - 25 ML AMP
0 0 0 0 0 0 0 0 0
149 MEBENDAZOL TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0
150 MELOKSIKAM TABLET 15 MG TAB
0 0 0 0 0 0 0 0 0
151 METAMIZOL INJEKSI 500 MG / ML AMP
0 0 0 0 0 0 0 0 0
152 METFORMIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
153 METIL ERGOMETRIN INJEKSI 0,2 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
154 METIL ERGOMETRIN TABLET 0,125 MG TAB
0 0 0 0 0 0 0 0 0
155 METIL PREDNISOLON INJEKSI 125 MG AMP
0 0 0 0 0 0 0 0 0
156 METIL PREDNISOLON TABLET 4 MG TAB
0 0 0 0 0 0 0 0 0
157 METOKLOPRAMID INJEKSI 5 MG / ML AMP
0 0 0 0 0 0 0 0 0
158 METOKLOPRAMID TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
159 METRONIDAZOL INFUS 5 MG / ML BTL
0 0 0 0 0 0 0 0 0
160 METRONIDAZOL SIRUP 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
161 METRONIDAZOL TABLET 250 MG TAB
0 0 0 0 0 0 0 0 0
162 METRONIDAZOL TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
163 MIKONAZOL KRIM 2% TUB
0 0 0 0 0 0 0 0 0
165 MOMETASON FUROAT KRIM 0,1 % TUB
0 0 0 0 0 0 0 0 0
166 N-ASETIL SISTEIN KAPSUL 200 MG KAP
0 0 0 0 0 0 0 0 0
167 NASALIN SPRAY 100 ML BTL
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

168 NATRIUM BIKARBONAT INJEKSI 8,4 % AMP

0 0 0 0 0 0 0 0 0
169 NATRIUM BIKARBONAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
170 NATRIUM DIKLOFENAK 50 MG TAB
0 0 0 0 0 0 0 0 0
171 NATRIUM FOSFAT ENEMA TUB
0 0 0 0 0 0 0 0 0
172 NATRIUM FUSIDAT SALEP 20 MG / G TUB
0 0 0 0 0 0 0 0 0
173 NATRIUM KLORIDA LARUTAN INFUS 0,9 % BTL
0 0 0 0 0 0 0 0 0
174 NIFEDIPIN TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
175 NIFEDIPIN TABLET 30 MG SR TAB
0 0 0 0 0 0 0 0 0
176 NISTATIN 100.000 IU / G TABLET VAGINA TAB
0 0 0 0 0 0 0 0 0
177 NISTATIN 500.000 IU TABLET SALUT TAB
0 0 0 0 0 0 0 0 0
178 NISTATIN SUSPENSI 100.000 IU / ML BTL
0 10 10 0 0 0 10 10 0
179 NORETISTERON TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
184 OBAT BATUK HITAM SIRUP BTL
0 0 0 0 0 0 0 0 0
185 OKSIMETAZOLIN TETES HIDUNG 0,025 % BTL
0 0 0 0 0 0 0 0 0
186 OKSIMETAZOLIN TETES HIDUNG 0,05 % BTL
0 0 0 0 0 0 0 0 0
187 OKSITETRASIKLIN HCL IM 50 MG / ML - 10 ML AMP
0 0 0 0 0 0 0 0 0
188 OKSITETRASIKLIN HCL SALEP KULIT 3 % TUB
0 0 0 0 0 0 0 0 0
189 OKSITETRASIKLIN HCL SALEP MATA 1 % TUB
0 0 0 0 0 0 0 0 0
190 OKSITOSIN INJEKSI 10 IU / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
191 OMEPRAZOLE INJEKSI 40 MG VIAL
0 0 0 0 0 0 0 0 0
192 OMEPRAZOLE KAPSUL 20 MG KAP
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

195 PARASETAMOL DROPS 100 MG / ML BTL

0 0 0 0 0 0 0 0 0
196 PARASETAMOL INFUS 10 MG / ML BTL
0 0 0 0 0 0 0 0 0
197 PARASETAMOL SIRUP 120 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
198 PARASETAMOL TABLET 500 MG TAB
80 0 80 0 40 40 40 0 40 40
199 PERAK SULFADIAZIN KRIM 1% TUB
0 0 0 0 0 0 0 0 0
200 PERMETRIN KRIM 5% TUB
0 0 0 0 0 0 0 0 0
202 PILOKARPIN HCL NITRAT TETES MATA 2 % BTL
0 0 0 0 0 0 0 0 0
204 PIRACETAM TABLET 400 MG TAB
0 0 0 0 0 0 0 0 0
205 PIRANTEL PAMOAT TABLET 125 MG TAB
0 0 0 0 0 0 0 0 0
206 PIRANTEL SUSPENSI 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
207 PIRIDOKSIN HCL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
208 PREDNISON TABLET 5 MG TAB
0 150 150 0 50 50 0 100 100 0
209 PROKAIN BENZIL PENISILLIN INJEKSI 3 JUTA UI VIAL
0 0 0 0 0 0 0 0 0
210 PROPILTIOURASIL TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0
211 PROPRANOLOL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
212 PROPRANOLOL TABLET 40 MG TAB
0 0 0 0 0 0 0 0 0
213 PSEUDOEFEDRIN SIRUP BTL
0 0 0 0 0 0 0 0 0
215 RANITIDIN TABLET 150 MG TAB
0 0 0 0 0 0 0 0 0
216 RETINOL KAPSUL 100.000 IU KAP
0 0 0 0 0 0 0 0 0
217 RETINOL KAPSUL 200.000 IU KAP
0 0 0 0 0 0 0 0 0
218 RIFAMPISIN TABLET 450 MG TAB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

219 RIFAMPISIN TABLET 600 MG TAB

0 0 0 0 0 0 0 0 0
220 RINGER LAKTAT LARUTAN INFUS STERIL BTL
0 0 0 0 0 0 0 0 0
221 RISPERIDON TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0
222 SALBUTAMOL INHALASI BTL
0 0 0 0 0 0 0 0 0
223 SALBUTAMOL NEBUL AMP
0 0 0 0 0 0 0 0 0
224 SALBUTAMOL TABLET 4 MG TAB
0 0 0 0 0 0 0 0 0
225 SALEP 2 - 4 KOMBINASI TUB
0 0 0 0 0 0 0 0 0
226 SALISIL BEDAK 2 % KTK
0 0 0 0 0 0 0 0 0
227 SALISIL SPIRITUS 10 % BTL
0 0 0 0 0 0 0 0 0
228 SEFADROKSIL KAPSUL 500 MG KAP
0 0 0 0 0 0 0 0 0
229 SEFADROKSIL SIRUP KERING 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
230 SEFOTAKSIM SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0
231 SEFTRIAXON SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0
234 SETIRIZIN SYR 5 MG / 5ML TAB
0 0 0 0 0 0 0 0 0
235 SETIRIZIN TABLET 10 MG BTL
0 0 0 0 0 0 0 0 0
236 SIANOKOBALAMIN INJEKSI 500 MCG / ML AMP
0 0 0 0 0 0 0 0 0
237 SIMVASTATIN TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
238 SIMVASTATIN TABLET 20 MG TAB
0 0 0 0 0 0 0 0 0
239 SIPROFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
240 SPIRONOLAKTON TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0
241 SULFASETAMID NATRIUM TETES MATA 15 % BTL
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

242 TABLET TAMBAH DARAH KOMBINASI TAB

670 0 670 0 200 200 470 0 470 200
244 TETRAKAIN HCL TETES MATA 0,5% BTL
0 0 0 0 0 0 0 0 0
245 TETRASIKLIN HCL KAPSUL 250 MG KAP
0 0 0 0 0 0 0 0 0
246 TIAMIN HCL INJEKSI 1.000 MCG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
247 TIAMIN HCL MONONITRAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0
250 UREA KRIM 10% TUB
0 0 0 0 0 0 0 0 0
251 VALPROAT SIRUP 250 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
252 VITAMIN B KOMPLEKS TABLET TAB
100 0 100 0 40 40 60 0 60 40
253 VITAMIN NEUROTROPIK INJEKSI AMP
0 0 0 0 0 0 0 0 0
254 WIDA BES BTL
0 0 0 0 0 0 0 0 0
255 YODIUM POVIDON GARGLE 240 ML BTL
0 0 0 0 0 0 0 0 0
256 YODIUM POVIDON LARUTAN 10 % 30 ML BTL
0 0 0 0 0 0 0 0 0
257 YODIUM POVIDON LARUTAN 10 % 300 ML BTL
0 0 0 0 0 0 0 0 0
258 ZINK DROPS 10 MG / ML BTL
0 0 0 0 0 0 0 0 0
259 ZINK SIRUP 20 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
260 ZINK TABLET 20 MG TAB
0 0 0 0 0 0 0 0 0
390 TEST HAMIL URINE / HCG TEST TEST
2 0 2 0 2 2 0 0 0 2
D. BAHAN MEDIS PAKAI HABIS
0 0 0
418 ALAT SUNTIK SEKALI PAKAI 0,05 ML SET
0 0 0 0 0 0 0 0 0
419 ALAT SUNTIK SEKALI PAKAI 0,5 ML SET
0 0 0 0 0 0 0 0 0
420 ALAT SUNTIK SEKALI PAKAI 1 ML SET
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

421 ALAT SUNTIK SEKALI PAKAI 10 ML SET

0 0 0 0 0 0 0 0 0
422 ALAT SUNTIK SEKALI PAKAI 3 ML SET
2 0 2 0 2 2 0 0 0 2
423 ALAT SUNTIK SEKALI PAKAI 5 ML SET
0 0 0 0 0 0 0 0 0
424 ALAT SUNTIK SEKALI PAKAI 20 ML SET
0 0 0 0 0 0 0 0 0
425 ALAT SUNTIK SEKALI PAKAI 50 ML SET
0 0 0 0 0 0 0 0 0
426 ALKOHOL SWAB BJ
0 0 0 0 0 0 0 0 0
427 ANTISEPTIK HANDRUB BTL
0 0 0 0 0 0 0 0 0
428 ANTISEPTIK HANDSCRUB BTL
0 0 0 0 0 0 0 0 0
429 APRON PLASTIK PCS
0 0 0 0 0 0 0 0 0
430 BIST MESS BJ
0 0 0 0 0 0 0 0 0
431 BLOOD LANCET 26 G / 28 G SET
0 0 0 0 0 0 0 0 0
432 BLOOD SET SET
0 0 0 0 0 0 0 0 0
435 CATGUT CHROMIC NO. 3/0 SACHET
0 0 0 0 0 0 0 0 0
436 CATGUT CHROMIC NO. 4/0 SACHET
0 0 0 0 0 0 0 0 0
437 CATGUT PLAIN / BENANG BEDAH NO. 2/0 SACHET
0 0 0 0 0 0 0 0 0
438 CATGUT PLAIN / BENANG BEDAH NO. 3/0 SACHET
1 0 1 0 1 1 0 0 0 1
441 FOLLEY CATHETER 2 WAY NO. 16 SET
0 0 0 0 0 0 0 0 0
442 FOLLEY CATHETER 2 WAY NO. 18 SET
0 0 0 0 0 0 0 0 0
444 ID BAND PCS
0 0 0 0 0 0 0 0 0
445 INFUS SET ANAK SET
0 0 0 0 0 0 0 0 0
446 INFUS SET DEWASA SET
1 0 1 0 0 1 0 1 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

447 IV CATHETER NO. 18 SET

2 0 2 0 0 2 0 2 0
448 IV CATHETER NO. 20 SET
0 0 0 0 0 0 0 0 0
449 IV CATHETER NO. 22 SET
0 0 0 0 0 0 0 0 0
450 IV CATHETER NO. 24 SET
0 0 0 0 0 0 0 0 0
451 IV CATHETER NO. 26 SET
0 0 0 0 0 0 0 0 0
452 JARUM JAHIT / BEDAH NO. 9 S/D 14 BJ
0 0 0 0 0 0 0 0 0
454 KAPAS BERLEMAK 500 GRAM ROL
0 0 0 0 0 0 0 0 0
455 KAPAS PEMBALUT / ABSORBEN 250 GRAM ROL
0 0 0 0 0 0 0 0 0
457 KASA 16x16 PCS
0 0 0 0 0 0 0 0 0
458 KASA 40X80 ROL
0 0 0 0 0 0 0 0 0
459 KASA HIDROFIL STERIL UKURAN 18 M X22 CM ROL
0 0 0 0 0 0 0 0 0
460 KASA KOMPRES 40/40 STERIL ROL
0 0 0 0 0 0 0 0 0
461 KASA PEMBALUT 2 M X 80 CM ROL
0 0 0 0 0 0 0 0 0
462 KASA PEMBALUT ELASTIS 4 INCI ROL
0 0 0 0 0 0 0 0 0
463 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL
0 0 0 0 0 0 0 0 0
464 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL
0 0 0 0 0 0 0 0 0
465 KASA PEMBALUT HIDROFIL 4 M X 3 CM ROL
0 0 0 0 0 0 0 0 0
466 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL
0 0 0 0 0 0 0 0 0
467 KASA PERAWATAN LUKA LBR
0 0 0 0 0 0 0 0 0
468 KASET WITH SCREEN GREEN PKT
0 0 0 0 0 0 0 0 0
469 KERTAS EKG 80 MM X 30 M ROL
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

470 MASKER PCS

0 0 0 0 0 0 0 0 0
471 MASKER N95 PCS
0 0 0 0 0 0 0 0 0
484 NURSE CAP PCS
0 0 0 0 0 0 0 0 0
485 PEMBALUT GIPS 4 INCI ROL
0 0 0 0 0 0 0 0 0
486 PLESTER 5 CM x 5 M ROL
0 0 0 0 0 0 0 0 0
487 PLESTER 10 CM X 5 M ROL
0 0 0 0 0 0 0 0 0
488 PLESTER 15 CM X 5 M ROL
0 0 0 0 0 0 0 0 0
489 PLESTER BULAT NON WOVEN PCS
0 0 0 0 0 0 0 0 0
490 PLESTER KAIN 7,5 X 4,5 M ROL
0 0 0 0 0 0 0 0 0
491 POT SPUTUM SET
0 0 0 0 0 0 0 0 0
492 POT URINE SET
0 0 0 0 0 0 0 0 0
493 SAFETY BOX 2,5 L KTK
0 0 0 0 0 0 0 0 0
494 SAFETY BOX 5 L KTK
0 0 0 0 0 0 0 0 0
495 SARUNG TANGAN KEBIDANAN (PANJANG) PSG
0 0 0 0 0 0 0 0 0
496 SARUNG TANGAN KERJA (TEBAL) M - L PSG
0 0 0 0 0 0 0 0 0
497 SARUNG TANGAN NON STERIL PSG
0 0 0 0 0 0 0 0 0
498 SARUNG TANGAN STERIL PSG
0 0 0 0 0 0 0 0 0
501 SENDOK SIRUP PCS
0 0 0 0 0 0 0 0 0
502 SILK / BENANG SUTERA NO. 3/0 SACHET
0 0 0 0 0 0 0 0 0
503 SLIM ZUIKER / MUCUS EXTRACTOR SET
0 0 0 0 0 0 0 0 0
508 SURGICAL GOWN PCS
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

516 UNDERPAD LBR

2 0 2 0 1 1 1 0 1 1
517 URINE BAG STERIL LBR
0 0 0 0 0 0 0 0 0
518 USG GEL TUB
0 0 0 0 0 0 0 0 0

JUMLAH KUNJUNGAN RESEP

KTP

BPJS

TUBAN, 2021

MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MENERIMA/MELAPOR

KEPALA PUSKESMAS PLUMPANG

dr H BOEDI WINOTO LESTI E. P., S.Farm., Apt.

NIP 19640723 199602 1 001 NIP. 199007042019032021

JKN

20

0
 0

20

0
0

0
0

0
 0

10

0
0

0
0

0
 0

50

0
0

0
0

0
0

0
0

0
0

0
0

0
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

Polindes/ Pustu/ ponkesdes : :

TAHUN :

STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

A. OBAT ESSENSIAL
GFK
1 ALBENDAZOL TABLET 400 MG TAB
0 0 0 0 0 0 0 0 0 0
2 ALBENDAZOL SUSPENSI 200 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
3 ALOPURINOL TABLET 100 MG TAB
200 0 200 0 50 50 150 0 150 133 200 200 50
4 AMBROKSOL TABLET 30 MG TAB
0 0 0 0 0 0 0 0 0 0
6 AMINOFILLIN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0 100 0
8 AMLODIPIN TABLET 10 MG TAB
100 0 100 0 30 30 70 0 70 80 100 100 30
9 AMLODIPIN TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0 0
10 AMOKSISILIN KAPLET 500 MG KAPL
300 0 300 0 100 100 200 0 200 333 300 300 100
11 AMOKSISILIN KAPSUL 250 MG KAP
0 0 0 0 0 0 0 0 0 0
13 AMOKSISILIN SIRUP KERING 125 MG / 5 ML BTL
5 0 5 0 2 2 3 0 3 8 5 5 2
16 ANTASIDA DOEN SUSPENSI BTL
5 0 5 0 1 1 4 0 4 4 5 5 1
17 ANTASIDA DOEN TABLET KOMBINASI TAB
220 20 240 0 80 20 100 140 0 140 267 200 200 80
18 ANTI BAKTERI DOEN SALEP KOMBINASI TUB
0 0 0 0 0 0 0 0 0 0
19 ANTI FUNGI DOEN KOMBINASI POT
0 0 0 0 0 0 0 0 0 0
21 ANTI INFEKSI KRIM TUB
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

22 ANTI MIGRAIN DOEN TABLET KOMBINASI TAB

0 0 0 0 0 0 0 0 0 0
25 ASAM ASKORBAT TABLET 250 MG TAB
0 0 0 0 0 0 0 0 0 0
26 ASAM ASKORBAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0 0
27 ASAM ASKORBAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
28 ASAM FOLAT TABLET 0,4 MG TAB
0 0 0 0 0 0 0 0 0 0
29 ASAM MEFENAMAT TABLET 500 MG TAB
350 0 350 0 100 100 250 0 250 333 300 300 100
30 ASAM TRANEKSAMAT INJEKSI 50 MG / ML AMP
0 0 0 0 0 0 0 0 0 0
31 ASAM TRANEKSAMAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
33 ASIKLOVIR TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0 0
34 ASIKLOVIR TABLET 400 MG TAB
115 0 115 0 35 35 80 0 80 93 200 100 35
35 ASIKLOVIR KRIM 5 % TUB
5 0 5 0 2 2 3 0 3 3 5 5 2
36 ATAPULGIT TABLET 600 MG TAB
0 0 0 0 0 0 0 0 0 0
40 BETAHISTIN MESILAT TABLET 6 MG TAB
0 0 0 0 0 0 0 0 0 0
41 BETAMETASON KRIM 0,1 % TUB
8 0 8 0 3 3 5 0 5 8 5 5 3
46 DEKSAMETASON INJEKSI 5 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
47 DEKSAMETASON TABLET 0,5 MG TAB
230 0 230 0 70 70 160 0 160 267 200 200 70
52 DIFENHIDRAMIN HCL INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
56 DIMENHIDRINAT TABLET 50 MG TAB
10 0 10 0 10 10 0 0 0 67 10
57 DOMPERIDON SIRUP 5 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
58 DOMPERIDON TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
59 EPINEPRIN HCL INJEKSI 0,1 % AMP
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

60 ERITROMISIN KAPSUL 500 MG KAP

0 0 0 0 0 0 0 0 0 0
61 ERITROMISIN SIRUP KERING 200 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
62 ETAKRIDIN LARUTAN 0,1 % BTL
2 0 2 0 0 2 0 2 0 0
63 ETANOL 70 % BTL
3 0 3 0 0 3 0 3 0 0
64 ETIL KLORIDA SEMPROT BTL
0 0 0 0 0 0 0 0 0 0
69 FENOL GLISEROL TETES TELINGA 10 % BTL
5 0 5 0 1 1 4 0 4 1 5 5 1
70 FITOMENADION INJEKSI 2 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
71 FITOMENADION INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
72 FITOMENADION TABLET SALUT 10 MG TAB
0 0 0 0 0 0 0 0 0 0
75 FUROSEMID INJEKSI 10 MG AMP
0 0 0 0 0 0 0 0 0 0
76 FUROSEMID TABLET 40 MG TAB
0 0 0 0 0 0 0 0 0 0
77 GARAM ORALIT KOMBINASI SAK
20 0 20 0 10 10 10 0 10 67 10
78 GEMFIBROZIL KAPSUL 300 MG KAP
0 0 0 0 0 0 0 0 0 0
79 GENTAMISIN INJEKSI 40 MG/ML AMP
0 0 0 0 0 0 0 0 0 0
80 GENTAMISIN TETES MATA 0,3 % BTL
0 0 0 0 0 0 0 0 3 0
81 GENTAMISIN SALEP KULIT 0,1 % TUB
0 0 0 0 0 0 0 0 0 0
82 GENTAMISIN SALEP MATA 0,3 % TUB
0 0 0 0 0 0 0 0 0 0
83 GENTIAN VIOLET LARUTAN 1 % BTL
0 0 0 0 0 0 0 0 0 0
84 GLIBENKLAMID TABLET 5 MG TAB
100 0 100 0 30 30 70 0 70 80 100 100 30
85 GLIMEPIRIDE TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0 0
86 GLUKOSA LARUTAN INFUS 5 % STERIL BTL
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

87 GLUKOSA LARUTAN INFUS 10 % STERIL BTL

0 0 0 0 0 0 0 0 0 0
88 GLUKOSA LARUTAN INFUS 40 % STERIL AMP
0 0 0 0 0 0 0 0 0 0
89 GRISEOFULVIN TABLET 125 MG TAB
0 0 0 0 0 0 0 0 0 0
96 HIDROKLORTIAZID TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0 0
97 HIDROKORTISON KRIM 2,5 % TUB
5 0 5 0 2 2 3 0 3 4 10 5 2
99 HIOSIN BUTILBROMIDA TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
100 IBUPROFEN SUSPENSI 100 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
101 IBUPROFEN TABLET 200 MG TAB
20 0 20 0 20 20 0 0 0 120 20
102 IBUPROFEN TABLET 400 MG TAB
200 0 200 0 50 50 150 0 150 133 200 200 50
103 INSULIN ANALOG LONG ACTING PEN
0 0 0 0 0 0 0 0 0 0
104 INSULIN ANALOG RAPID ACTING PEN
0 0 0 0 0 0 0 0 0 0
105 ISONIAZID TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0 0
106 ISONIAZID TABLET 300 MG TAB
0 0 0 0 0 0 0 0 0 0
107 ISOSORBID DINITRAT TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0 0
108 KALSIUM GLUKONAT INJEKSI 10 % AMP
0 0 0 0 0 0 0 0 0 0
109 KALSIUM LAKTAT TABLET 500 MG TAB
80 0 80 0 50 50 30 0 30 293 50
111 KAOLIN - PEKTIN SIRUP BTL
0 0 0 0 0 0 0 0 0 0
112 KAPTOPRIL TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0 0
113 KARBAMAZEPIN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0 0
114 KETOKONAZOLE KRIM 2 % TUB
5 0 5 0 2 2 3 0 3 5 5 5 2
115 KETOKONAZOLE TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

116 KLINDAMISIN KAPSUL 300 MG KAP

0 0 0 0 0 0 0 0 0 0
120 KLORAMFENIKOL INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0 0
121 KLORAMFENIKOL KAPSUL 250 MG KAP
0 20 20 0 10 10 0 10 10 67 0
122 KLORAMFENIKOL SALEP MATA 1% TUB
5 0 5 0 2 2 3 0 3 4 5 5 2
123 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BTL
0 0 0 0 0 0 0 0 0 0
124 KLORAMFENIKOL TETES MATA 0,5 % BTL
0 0 0 0 0 0 0 0 0 0
125 KLORAMFENIKOL TETES TELINGA 3 % BTL
0 0 0 0 0 0 0 0 1 0
126 KLORFENIRAMIN MALEAT TABLET 4 MG TAB
340 0 340 0 100 100 240 0 240 320 200 200 100
132 KOTRIMOKSAZOL DEWASA TABLET TAB
0 0 0 0 0 0 0 0 0 0
133 KOTRIMOKSAZOL PEDIATRIK TABLET TAB
0 0 0 0 0 0 0 0 0 0
134 KOTRIMOKSAZOL SUSPENSI 240 MG / 5 ML BTL
0 0 0 0 0 0 0 0 1 0
135 KURKUMA SIRUP BTL
0 0 0 0 0 0 0 0 0 0
136 KURKUMA TABLET TAB
0 0 0 0 0 0 0 0 0 0
137 LAKTULOSA SIRUP BTL
0 0 0 0 0 0 0 0 0 0
138 LEVOFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
139 LEVOTIROKSIN TABLET 100 MCG TAB
0 0 0 0 0 0 0 0 0 0
140 LIDOKAIN KOMPOSITUM INJEKSI AMP
0 0 0 0 0 0 0 0 0 0
141 LIDOKAIN SPRAY ORAL 10 % BTL
0 0 0 0 0 0 0 0 0 0
142 LISINOPRIL TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0 0
143 LISINOPRIL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
144 LOPERAMID TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

145 LORATADIN TABLET 10 MG TAB

0 0 0 0 0 0 0 0 0 0
146 MAGNESIUM SULFAT INJEKSI / IV 20% - 25 ML AMP
0 0 0 0 0 0 0 0 0 0
147 MAGNESIUM SULFAT INJEKSI / IV 40% - 25 ML AMP
0 0 0 0 0 0 0 0 0 0
149 MEBENDAZOL TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0 0
150 MELOKSIKAM TABLET 15 MG TAB
0 0 0 0 0 0 0 0 0 0
151 METAMIZOL INJEKSI 500 MG / ML AMP
0 0 0 0 0 0 0 0 0 0
152 METFORMIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
153 METIL ERGOMETRIN INJEKSI 0,2 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
154 METIL ERGOMETRIN TABLET 0,125 MG TAB
0 0 0 0 0 0 0 0 0 0
155 METIL PREDNISOLON INJEKSI 125 MG AMP
0 0 0 0 0 0 0 0 0 0
156 METIL PREDNISOLON TABLET 4 MG TAB
0 0 0 0 0 0 0 0 0 0
157 METOKLOPRAMID INJEKSI 5 MG / ML AMP
0 0 0 0 0 0 0 0 0 0
158 METOKLOPRAMID TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
159 METRONIDAZOL INFUS 5 MG / ML BTL
0 0 0 0 0 0 0 0 0 0
160 METRONIDAZOL SIRUP 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
161 METRONIDAZOL TABLET 250 MG TAB
0 0 0 0 0 0 0 0 0 0
162 METRONIDAZOL TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
163 MIKONAZOL KRIM 2% TUB
0 0 0 0 0 0 0 0 0 0
165 MOMETASON FUROAT KRIM 0,1 % TUB
0 0 0 0 0 0 0 0 0 0
166 N-ASETIL SISTEIN KAPSUL 200 MG KAP
0 0 0 0 0 0 0 0 280 0
167 NASALIN SPRAY 100 ML BTL
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

168 NATRIUM BIKARBONAT INJEKSI 8,4 % AMP

0 0 0 0 0 0 0 0 0 0
169 NATRIUM BIKARBONAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
170 NATRIUM DIKLOFENAK 50 MG TAB
0 0 0 0 0 0 0 0 0 0
171 NATRIUM FOSFAT ENEMA TUB
0 0 0 0 0 0 0 0 0 0
172 NATRIUM FUSIDAT SALEP 20 MG / G TUB
0 0 0 0 0 0 0 0 0 0
173 NATRIUM KLORIDA LARUTAN INFUS 0,9 % BTL
0 0 0 0 0 0 0 0 0 0
174 NIFEDIPIN TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
175 NIFEDIPIN TABLET 30 MG SR TAB
0 0 0 0 0 0 0 0 0 0
176 NISTATIN 100.000 IU / G TABLET VAGINA TAB
0 0 0 0 0 0 0 0 0 0
177 NISTATIN 500.000 IU TABLET SALUT TAB
0 0 0 0 0 0 0 0 0 0
178 NISTATIN SUSPENSI 100.000 IU / ML BTL
0 20 20 0 0 0 20 20 0 10 10 0
179 NORETISTERON TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0 0
184 OBAT BATUK HITAM SIRUP BTL
0 0 0 0 0 0 0 0 0 0
185 OKSIMETAZOLIN TETES HIDUNG 0,025 % BTL
0 0 0 0 0 0 0 0 0 0
186 OKSIMETAZOLIN TETES HIDUNG 0,05 % BTL
0 0 0 0 0 0 0 0 0 0
187 OKSITETRASIKLIN HCL IM 50 MG / ML - 10 ML AMP
0 0 0 0 0 0 0 0 0 0
188 OKSITETRASIKLIN HCL SALEP KULIT 3 % TUB
5 0 5 0 1 1 4 0 4 1 10 5 1
189 OKSITETRASIKLIN HCL SALEP MATA 1 % TUB
0 0 0 0 0 0 0 0 0 0
190 OKSITOSIN INJEKSI 10 IU / ML - 1 ML AMP
0 0 0 0 0 0 0 0 1 0
191 OMEPRAZOLE INJEKSI 40 MG VIAL
0 0 0 0 0 0 0 0 0 0
192 OMEPRAZOLE KAPSUL 20 MG KAP
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

195 PARASETAMOL DROPS 100 MG / ML BTL

0 0 0 0 0 0 0 0 0 0
196 PARASETAMOL INFUS 10 MG / ML BTL
0 0 0 0 0 0 0 0 0 0
197 PARASETAMOL SIRUP 120 MG / 5 ML BTL
5 0 5 0 2 2 3 0 3 5 5 5 2
198 PARASETAMOL TABLET 500 MG TAB
540 0 540 0 150 150 390 0 390 387 500 500 150
199 PERAK SULFADIAZIN KRIM 1% TUB
0 0 0 0 0 0 0 0 0 0
200 PERMETRIN KRIM 5% TUB
0 0 0 0 0 0 0 0 0 0
202 PILOKARPIN HCL NITRAT TETES MATA 2 % BTL
0 0 0 0 0 0 0 0 0 0
204 PIRACETAM TABLET 400 MG TAB
0 0 0 0 0 0 0 0 0 0
205 PIRANTEL PAMOAT TABLET 125 MG TAB
0 0 0 0 0 0 0 0 0 0
206 PIRANTEL SUSPENSI 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
207 PIRIDOKSIN HCL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
208 PREDNISON TABLET 5 MG TAB
500 100 600 0 100 50 150 400 50 450 400 300 500 100
209 PROKAIN BENZIL PENISILLIN INJEKSI 3 JUTA UI VIAL
0 0 0 0 0 0 0 0 0 0
210 PROPILTIOURASIL TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0 0
211 PROPRANOLOL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
212 PROPRANOLOL TABLET 40 MG TAB
0 0 0 0 0 0 0 0 0 0
213 PSEUDOEFEDRIN SIRUP BTL
0 0 0 0 0 0 0 0 0 0
215 RANITIDIN TABLET 150 MG TAB
0 0 0 0 0 0 0 0 0 0
216 RETINOL KAPSUL 100.000 IU KAP
0 0 0 0 0 0 0 0 0 0
217 RETINOL KAPSUL 200.000 IU KAP
0 0 0 0 0 0 0 0 0 0
218 RIFAMPISIN TABLET 450 MG TAB
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

219 RIFAMPISIN TABLET 600 MG TAB

0 0 0 0 0 0 0 0 0 0
220 RINGER LAKTAT LARUTAN INFUS STERIL BTL
0 0 0 0 0 0 0 0 0 0
221 RISPERIDON TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0 0
222 SALBUTAMOL INHALASI BTL
0 0 0 0 0 0 0 0 0 0
223 SALBUTAMOL NEBUL AMP
0 0 0 0 0 0 0 0 0 0
224 SALBUTAMOL TABLET 4 MG TAB
0 0 0 0 0 0 0 0 0 0
225 SALEP 2 - 4 KOMBINASI TUB
3 0 3 0 1 1 2 0 2 1 5 3 1
226 SALISIL BEDAK 2 % KTK
0 0 0 0 0 0 0 0 0 0
227 SALISIL SPIRITUS 10 % BTL
0 0 0 0 0 0 0 0 0 0
228 SEFADROKSIL KAPSUL 500 MG KAP
0 0 0 0 0 0 0 0 0 0
229 SEFADROKSIL SIRUP KERING 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
230 SEFOTAKSIM SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0 0
231 SEFTRIAXON SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0 0
234 SETIRIZIN SYR 5 MG / 5ML TAB
0 0 0 0 0 0 0 0 0 0
235 SETIRIZIN TABLET 10 MG BTL
0 0 0 0 0 0 0 0 0 0
236 SIANOKOBALAMIN INJEKSI 500 MCG / ML AMP
0 0 0 0 0 0 0 0 0 0
237 SIMVASTATIN TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
238 SIMVASTATIN TABLET 20 MG TAB
0 0 0 0 0 0 0 0 0 0
239 SIPROFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
240 SPIRONOLAKTON TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0 0
241 SULFASETAMID NATRIUM TETES MATA 15 % BTL
5 0 5 0 2 2 3 0 3 3 5 5 2
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

242 TABLET TAMBAH DARAH KOMBINASI TAB

1,470 0 1,470 0 200 200 1,270 0 1,270 867 300 1,000 200
244 TETRAKAIN HCL TETES MATA 0,5% BTL
0 0 0 0 0 0 0 0 0 0
245 TETRASIKLIN HCL KAPSUL 250 MG KAP
0 0 0 0 0 0 0 0 0 0
246 TIAMIN HCL INJEKSI 1.000 MCG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
247 TIAMIN HCL MONONITRAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0 0
250 UREA KRIM 10% TUB
0 0 0 0 0 0 0 0 0 0
251 VALPROAT SIRUP 250 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
252 VITAMIN B KOMPLEKS TABLET TAB
260 0 260 0 100 100 160 0 160 320 200 200 100
253 VITAMIN NEUROTROPIK INJEKSI AMP
0 0 0 0 0 0 0 0 0 0
254 WIDA BES BTL
0 0 0 0 0 0 0 0 0 0
255 YODIUM POVIDON GARGLE 240 ML BTL
0 0 0 0 0 0 0 0 0 0
256 YODIUM POVIDON LARUTAN 10 % 30 ML BTL
0 0 0 0 0 0 0 0 0 0
257 YODIUM POVIDON LARUTAN 10 % 300 ML BTL
0 0 0 0 0 0 0 0 0 0
258 ZINK DROPS 10 MG / ML BTL
0 0 0 0 0 0 0 0 0 0
259 ZINK SIRUP 20 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
260 ZINK TABLET 20 MG TAB
0 0 0 0 0 0 0 0 0 0
390 TEST HAMIL URINE / HCG TEST TEST
0 0 0 0 0 0 0 0 7 0
D. BAHAN MEDIS PAKAI HABIS
0 0 0 0
418 ALAT SUNTIK SEKALI PAKAI 0,05 ML SET
0 0 0 0 0 0 0 0 0 0
419 ALAT SUNTIK SEKALI PAKAI 0,5 ML SET
0 0 0 0 0 0 0 0 0 0
420 ALAT SUNTIK SEKALI PAKAI 1 ML SET
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

421 ALAT SUNTIK SEKALI PAKAI 10 ML SET

0 0 0 0 0 0 0 0 0 0
422 ALAT SUNTIK SEKALI PAKAI 3 ML SET
10 0 10 0 3 3 7 0 7 9 10 10 3
423 ALAT SUNTIK SEKALI PAKAI 5 ML SET
10 0 10 0 2 2 8 0 8 5 10 10 2
424 ALAT SUNTIK SEKALI PAKAI 20 ML SET
0 0 0 0 0 0 0 0 0 0
425 ALAT SUNTIK SEKALI PAKAI 50 ML SET
0 0 0 0 0 0 0 0 0 0
426 ALKOHOL SWAB BJ
0 0 0 0 0 0 0 0 0 0
427 ANTISEPTIK HANDRUB BTL
0 0 0 0 0 0 0 0 0 0
428 ANTISEPTIK HANDSCRUB BTL
0 0 0 0 0 0 0 0 0 0
429 APRON PLASTIK PCS
0 0 0 0 0 0 0 0 0 0
430 BIST MESS BJ
0 0 0 0 0 0 0 0 0 0
431 BLOOD LANCET 26 G / 28 G SET
0 0 0 0 0 0 0 0 0 0
432 BLOOD SET SET
0 0 0 0 0 0 0 0 0 0
435 CATGUT CHROMIC NO. 3/0 SACHET
0 0 0 0 0 0 0 0 0 0
436 CATGUT CHROMIC NO. 4/0 SACHET
0 0 0 0 0 0 0 0 0 0
437 CATGUT PLAIN / BENANG BEDAH NO. 2/0 SACHET
0 0 0 0 0 0 0 0 0 0
438 CATGUT PLAIN / BENANG BEDAH NO. 3/0 SACHET
3 0 3 0 0 3 0 3 4 3 3 0
441 FOLLEY CATHETER 2 WAY NO. 16 SET
0 0 0 0 0 0 0 0 0 0
442 FOLLEY CATHETER 2 WAY NO. 18 SET
0 0 0 0 0 0 0 0 0 0
444 ID BAND PCS
0 0 0 0 0 0 0 0 0 0
445 INFUS SET ANAK SET
0 0 0 0 0 0 0 0 0 0
446 INFUS SET DEWASA SET
1 0 1 0 0 1 0 1 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

447 IV CATHETER NO. 18 SET

2 0 2 0 0 2 0 2 0 0
448 IV CATHETER NO. 20 SET
0 0 0 0 0 0 0 0 0 0
449 IV CATHETER NO. 22 SET
0 0 0 0 0 0 0 0 0 0
450 IV CATHETER NO. 24 SET
0 0 0 0 0 0 0 0 0 0
451 IV CATHETER NO. 26 SET
0 0 0 0 0 0 0 0 0 0
452 JARUM JAHIT / BEDAH NO. 9 S/D 14 BJ
0 0 0 0 0 0 0 0 0 0
454 KAPAS BERLEMAK 500 GRAM ROL
0 0 0 0 0 0 0 0 0 0
455 KAPAS PEMBALUT / ABSORBEN 250 GRAM ROL
1 0 1 0 0 1 0 1 0 1 1 0
457 KASA 16x16 PCS
0 0 0 0 0 0 0 0 0 0
458 KASA 40X80 ROL
0 0 0 0 0 0 0 0 0 0
459 KASA HIDROFIL STERIL UKURAN 18 M X22 CM ROL
0 0 0 0 0 0 0 0 0 0
460 KASA KOMPRES 40/40 STERIL ROL
0 0 0 0 0 0 0 0 0 0
461 KASA PEMBALUT 2 M X 80 CM ROL
0 0 0 0 0 0 0 0 0 0
462 KASA PEMBALUT ELASTIS 4 INCI ROL
0 0 0 0 0 0 0 0 0 0
463 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL
0 0 0 0 0 0 0 0 0 0
464 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL
0 0 0 0 0 0 0 0 0 0
465 KASA PEMBALUT HIDROFIL 4 M X 3 CM ROL
0 0 0 0 0 0 0 0 0 0
466 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL
0 0 0 0 0 0 0 0 0 0
467 KASA PERAWATAN LUKA LBR
0 0 0 0 0 0 0 0 0 0
468 KASET WITH SCREEN GREEN PKT
0 0 0 0 0 0 0 0 0 0
469 KERTAS EKG 80 MM X 30 M ROL
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

470 MASKER PCS

0 0 0 0 0 0 0 0 0 0
471 MASKER N95 PCS
0 0 0 0 0 0 0 0 0 0
484 NURSE CAP PCS
0 0 0 0 0 0 0 0 0 0
485 PEMBALUT GIPS 4 INCI ROL
0 0 0 0 0 0 0 0 0 0
486 PLESTER 5 CM x 5 M ROL
0 0 0 0 0 0 0 0 0 0
487 PLESTER 10 CM X 5 M ROL
0 0 0 0 0 0 0 0 0 0
488 PLESTER 15 CM X 5 M ROL
0 0 0 0 0 0 0 0 0 0
489 PLESTER BULAT NON WOVEN PCS
0 0 0 0 0 0 0 0 0 0
490 PLESTER KAIN 7,5 X 4,5 M ROL
0 0 0 0 0 0 0 0 0 0
491 POT SPUTUM SET
0 0 0 0 0 0 0 0 0 0
492 POT URINE SET
0 0 0 0 0 0 0 0 0 0
493 SAFETY BOX 2,5 L KTK
0 0 0 0 0 0 0 0 0 0
494 SAFETY BOX 5 L KTK
0 0 0 0 0 0 0 0 0 0
495 SARUNG TANGAN KEBIDANAN (PANJANG) PSG
0 0 0 0 0 0 0 0 0 0
496 SARUNG TANGAN KERJA (TEBAL) M - L PSG
0 0 0 0 0 0 0 0 0 0
497 SARUNG TANGAN NON STERIL PSG
0 0 0 0 0 0 0 0 0 0
498 SARUNG TANGAN STERIL PSG
0 0 0 0 0 0 0 0 0 0
501 SENDOK SIRUP PCS
0 0 0 0 0 0 0 0 0 0
502 SILK / BENANG SUTERA NO. 3/0 SACHET
0 0 0 0 0 0 0 0 0 0
503 SLIM ZUIKER / MUCUS EXTRACTOR SET
0 0 0 0 0 0 0 0 0 0
508 SURGICAL GOWN PCS
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

516 UNDERPAD LBR

1 0 1 0 0 1 0 1 4 0
517 URINE BAG STERIL LBR
0 0 0 0 0 0 0 0 0 0
518 USG GEL TUB
0 0 0 0 0 0 0 0 0 0

JUMLAH KUNJUNGAN RESEP

KTP
16
BPJS
8

TUBAN, 2021

MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MENERIMA/MELAPOR

KEPALA PUSKESMAS PLUMPANG

dr H BOEDI WINOTO LESTI E. P., S.Farm., Apt.

NIP 19640723 199602 1 001 NIP. 199007042019032021

JKN

20

0
0

0
0

0
0

0
 0

10

0
0

0
0

0
 0

50

0
0

0
0

0
0

0
0

0
0

0
0

0
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

Polindes/ Pustu/ ponkesdes : :

TAHUN :

STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

A. OBAT ESSENSIAL
GFK
1 ALBENDAZOL TABLET 400 MG TAB
0 0 0 0 0 0 0 0 0
2 ALBENDAZOL SUSPENSI 200 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
3 ALOPURINOL TABLET 100 MG TAB
150 0 150 0 0 150 0 150 0
4 AMBROKSOL TABLET 30 MG TAB
0 0 0 0 0 0 0 0 0
6 AMINOFILLIN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
8 AMLODIPIN TABLET 10 MG TAB
70 0 70 0 0 70 0 70 0
9 AMLODIPIN TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
10 AMOKSISILIN KAPLET 500 MG KAPL
200 0 200 0 0 200 0 200 0
11 AMOKSISILIN KAPSUL 250 MG KAP
0 0 0 0 0 0 0 0 0
13 AMOKSISILIN SIRUP KERING 125 MG / 5 ML BTL
3 0 3 0 0 3 0 3 0
16 ANTASIDA DOEN SUSPENSI BTL
4 0 4 0 0 4 0 4 0
17 ANTASIDA DOEN TABLET KOMBINASI TAB
140 0 140 0 0 140 0 140 0
18 ANTI BAKTERI DOEN SALEP KOMBINASI TUB
0 0 0 0 0 0 0 0 0
19 ANTI FUNGI DOEN KOMBINASI POT
0 0 0 0 0 0 0 0 0
21 ANTI INFEKSI KRIM TUB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

22 ANTI MIGRAIN DOEN TABLET KOMBINASI TAB

0 0 0 0 0 0 0 0 0
25 ASAM ASKORBAT TABLET 250 MG TAB
0 0 0 0 0 0 0 0 0
26 ASAM ASKORBAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0
27 ASAM ASKORBAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
28 ASAM FOLAT TABLET 0,4 MG TAB
0 0 0 0 0 0 0 0 0
29 ASAM MEFENAMAT TABLET 500 MG TAB
250 0 250 0 0 250 0 250 0
30 ASAM TRANEKSAMAT INJEKSI 50 MG / ML AMP
0 0 0 0 0 0 0 0 0
31 ASAM TRANEKSAMAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
33 ASIKLOVIR TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
34 ASIKLOVIR TABLET 400 MG TAB
80 0 80 0 0 80 0 80 0
35 ASIKLOVIR KRIM 5 % TUB
3 0 3 0 0 3 0 3 0
36 ATAPULGIT TABLET 600 MG TAB
0 0 0 0 0 0 0 0 0
40 BETAHISTIN MESILAT TABLET 6 MG TAB
0 0 0 0 0 0 0 0 0
41 BETAMETASON KRIM 0,1 % TUB
5 0 5 0 0 5 0 5 0
46 DEKSAMETASON INJEKSI 5 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
47 DEKSAMETASON TABLET 0,5 MG TAB
160 0 160 0 0 160 0 160 0
52 DIFENHIDRAMIN HCL INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
56 DIMENHIDRINAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0
57 DOMPERIDON SIRUP 5 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
58 DOMPERIDON TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
59 EPINEPRIN HCL INJEKSI 0,1 % AMP
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

60 ERITROMISIN KAPSUL 500 MG KAP

0 0 0 0 0 0 0 0 0
61 ERITROMISIN SIRUP KERING 200 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
62 ETAKRIDIN LARUTAN 0,1 % BTL
2 0 2 0 0 2 0 2 0
63 ETANOL 70 % BTL
3 0 3 0 0 3 0 3 0
64 ETIL KLORIDA SEMPROT BTL
0 0 0 0 0 0 0 0 0
69 FENOL GLISEROL TETES TELINGA 10 % BTL
4 0 4 0 0 4 0 4 0
70 FITOMENADION INJEKSI 2 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
71 FITOMENADION INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
72 FITOMENADION TABLET SALUT 10 MG TAB
0 0 0 0 0 0 0 0 0
75 FUROSEMID INJEKSI 10 MG AMP
0 0 0 0 0 0 0 0 0
76 FUROSEMID TABLET 40 MG TAB
0 0 0 0 0 0 0 0 0
77 GARAM ORALIT KOMBINASI SAK
10 0 10 0 0 10 0 10 0
78 GEMFIBROZIL KAPSUL 300 MG KAP
0 0 0 0 0 0 0 0 0
79 GENTAMISIN INJEKSI 40 MG/ML AMP
0 0 0 0 0 0 0 0 0
80 GENTAMISIN TETES MATA 0,3 % BTL
0 0 0 0 0 0 0 0 0
81 GENTAMISIN SALEP KULIT 0,1 % TUB
0 0 0 0 0 0 0 0 0
82 GENTAMISIN SALEP MATA 0,3 % TUB
0 0 0 0 0 0 0 0 0
83 GENTIAN VIOLET LARUTAN 1 % BTL
0 0 0 0 0 0 0 0 0
84 GLIBENKLAMID TABLET 5 MG TAB
70 0 70 0 0 70 0 70 0
85 GLIMEPIRIDE TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0
86 GLUKOSA LARUTAN INFUS 5 % STERIL BTL
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

87 GLUKOSA LARUTAN INFUS 10 % STERIL BTL

0 0 0 0 0 0 0 0 0
88 GLUKOSA LARUTAN INFUS 40 % STERIL AMP
0 0 0 0 0 0 0 0 0
89 GRISEOFULVIN TABLET 125 MG TAB
0 0 0 0 0 0 0 0 0
96 HIDROKLORTIAZID TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0
97 HIDROKORTISON KRIM 2,5 % TUB
3 0 3 0 0 3 0 3 0
99 HIOSIN BUTILBROMIDA TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
100 IBUPROFEN SUSPENSI 100 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
101 IBUPROFEN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
102 IBUPROFEN TABLET 400 MG TAB
150 0 150 0 0 150 0 150 0
103 INSULIN ANALOG LONG ACTING PEN
0 0 0 0 0 0 0 0 0
104 INSULIN ANALOG RAPID ACTING PEN
0 0 0 0 0 0 0 0 0
105 ISONIAZID TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0
106 ISONIAZID TABLET 300 MG TAB
0 0 0 0 0 0 0 0 0
107 ISOSORBID DINITRAT TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
108 KALSIUM GLUKONAT INJEKSI 10 % AMP
0 0 0 0 0 0 0 0 0
109 KALSIUM LAKTAT TABLET 500 MG TAB
30 0 30 0 0 30 0 30 0
111 KAOLIN - PEKTIN SIRUP BTL
0 0 0 0 0 0 0 0 0
112 KAPTOPRIL TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0
113 KARBAMAZEPIN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
114 KETOKONAZOLE KRIM 2 % TUB
3 0 3 0 0 3 0 3 0
115 KETOKONAZOLE TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

116 KLINDAMISIN KAPSUL 300 MG KAP

0 0 0 0 0 0 0 0 0
120 KLORAMFENIKOL INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0
121 KLORAMFENIKOL KAPSUL 250 MG KAP
0 10 10 0 0 0 10 10 0
122 KLORAMFENIKOL SALEP MATA 1% TUB
3 0 3 0 0 3 0 3 0
123 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BTL
0 0 0 0 0 0 0 0 0
124 KLORAMFENIKOL TETES MATA 0,5 % BTL
0 0 0 0 0 0 0 0 0
125 KLORAMFENIKOL TETES TELINGA 3 % BTL
0 0 0 0 0 0 0 0 0
126 KLORFENIRAMIN MALEAT TABLET 4 MG TAB
240 0 240 0 0 240 0 240 0
132 KOTRIMOKSAZOL DEWASA TABLET TAB
0 0 0 0 0 0 0 0 0
133 KOTRIMOKSAZOL PEDIATRIK TABLET TAB
0 0 0 0 0 0 0 0 0
134 KOTRIMOKSAZOL SUSPENSI 240 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
135 KURKUMA SIRUP BTL
0 0 0 0 0 0 0 0 0
136 KURKUMA TABLET TAB
0 0 0 0 0 0 0 0 0
137 LAKTULOSA SIRUP BTL
0 0 0 0 0 0 0 0 0
138 LEVOFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
139 LEVOTIROKSIN TABLET 100 MCG TAB
0 0 0 0 0 0 0 0 0
140 LIDOKAIN KOMPOSITUM INJEKSI AMP
0 0 0 0 0 0 0 0 0
141 LIDOKAIN SPRAY ORAL 10 % BTL
0 0 0 0 0 0 0 0 0
142 LISINOPRIL TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
143 LISINOPRIL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
144 LOPERAMID TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

145 LORATADIN TABLET 10 MG TAB

0 0 0 0 0 0 0 0 0
146 MAGNESIUM SULFAT INJEKSI / IV 20% - 25 ML AMP
0 0 0 0 0 0 0 0 0
147 MAGNESIUM SULFAT INJEKSI / IV 40% - 25 ML AMP
0 0 0 0 0 0 0 0 0
149 MEBENDAZOL TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0
150 MELOKSIKAM TABLET 15 MG TAB
0 0 0 0 0 0 0 0 0
151 METAMIZOL INJEKSI 500 MG / ML AMP
0 0 0 0 0 0 0 0 0
152 METFORMIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
153 METIL ERGOMETRIN INJEKSI 0,2 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
154 METIL ERGOMETRIN TABLET 0,125 MG TAB
0 0 0 0 0 0 0 0 0
155 METIL PREDNISOLON INJEKSI 125 MG AMP
0 0 0 0 0 0 0 0 0
156 METIL PREDNISOLON TABLET 4 MG TAB
0 0 0 0 0 0 0 0 0
157 METOKLOPRAMID INJEKSI 5 MG / ML AMP
0 0 0 0 0 0 0 0 0
158 METOKLOPRAMID TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
159 METRONIDAZOL INFUS 5 MG / ML BTL
0 0 0 0 0 0 0 0 0
160 METRONIDAZOL SIRUP 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
161 METRONIDAZOL TABLET 250 MG TAB
0 0 0 0 0 0 0 0 0
162 METRONIDAZOL TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
163 MIKONAZOL KRIM 2% TUB
0 0 0 0 0 0 0 0 0
165 MOMETASON FUROAT KRIM 0,1 % TUB
0 0 0 0 0 0 0 0 0
166 N-ASETIL SISTEIN KAPSUL 200 MG KAP
0 0 0 0 0 0 0 0 0
167 NASALIN SPRAY 100 ML BTL
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

168 NATRIUM BIKARBONAT INJEKSI 8,4 % AMP

0 0 0 0 0 0 0 0 0
169 NATRIUM BIKARBONAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
170 NATRIUM DIKLOFENAK 50 MG TAB
0 0 0 0 0 0 0 0 0
171 NATRIUM FOSFAT ENEMA TUB
0 0 0 0 0 0 0 0 0
172 NATRIUM FUSIDAT SALEP 20 MG / G TUB
0 0 0 0 0 0 0 0 0
173 NATRIUM KLORIDA LARUTAN INFUS 0,9 % BTL
0 0 0 0 0 0 0 0 0
174 NIFEDIPIN TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
175 NIFEDIPIN TABLET 30 MG SR TAB
0 0 0 0 0 0 0 0 0
176 NISTATIN 100.000 IU / G TABLET VAGINA TAB
0 0 0 0 0 0 0 0 0
177 NISTATIN 500.000 IU TABLET SALUT TAB
0 0 0 0 0 0 0 0 0
178 NISTATIN SUSPENSI 100.000 IU / ML BTL
0 20 20 0 0 0 20 20 0
179 NORETISTERON TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
184 OBAT BATUK HITAM SIRUP BTL
0 0 0 0 0 0 0 0 0
185 OKSIMETAZOLIN TETES HIDUNG 0,025 % BTL
0 0 0 0 0 0 0 0 0
186 OKSIMETAZOLIN TETES HIDUNG 0,05 % BTL
0 0 0 0 0 0 0 0 0
187 OKSITETRASIKLIN HCL IM 50 MG / ML - 10 ML AMP
0 0 0 0 0 0 0 0 0
188 OKSITETRASIKLIN HCL SALEP KULIT 3 % TUB
4 0 4 0 0 4 0 4 0
189 OKSITETRASIKLIN HCL SALEP MATA 1 % TUB
0 0 0 0 0 0 0 0 0
190 OKSITOSIN INJEKSI 10 IU / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
191 OMEPRAZOLE INJEKSI 40 MG VIAL
0 0 0 0 0 0 0 0 0
192 OMEPRAZOLE KAPSUL 20 MG KAP
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

195 PARASETAMOL DROPS 100 MG / ML BTL

0 0 0 0 0 0 0 0 0
196 PARASETAMOL INFUS 10 MG / ML BTL
0 0 0 0 0 0 0 0 0
197 PARASETAMOL SIRUP 120 MG / 5 ML BTL
3 0 3 0 0 3 0 3 0
198 PARASETAMOL TABLET 500 MG TAB
390 0 390 0 0 390 0 390 0
199 PERAK SULFADIAZIN KRIM 1% TUB
0 0 0 0 0 0 0 0 0
200 PERMETRIN KRIM 5% TUB
0 0 0 0 0 0 0 0 0
202 PILOKARPIN HCL NITRAT TETES MATA 2 % BTL
0 0 0 0 0 0 0 0 0
204 PIRACETAM TABLET 400 MG TAB
0 0 0 0 0 0 0 0 0
205 PIRANTEL PAMOAT TABLET 125 MG TAB
0 0 0 0 0 0 0 0 0
206 PIRANTEL SUSPENSI 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
207 PIRIDOKSIN HCL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
208 PREDNISON TABLET 5 MG TAB
400 50 450 0 0 400 50 450 0
209 PROKAIN BENZIL PENISILLIN INJEKSI 3 JUTA UI VIAL
0 0 0 0 0 0 0 0 0
210 PROPILTIOURASIL TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0
211 PROPRANOLOL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
212 PROPRANOLOL TABLET 40 MG TAB
0 0 0 0 0 0 0 0 0
213 PSEUDOEFEDRIN SIRUP BTL
0 0 0 0 0 0 0 0 0
215 RANITIDIN TABLET 150 MG TAB
0 0 0 0 0 0 0 0 0
216 RETINOL KAPSUL 100.000 IU KAP
0 0 0 0 0 0 0 0 0
217 RETINOL KAPSUL 200.000 IU KAP
0 0 0 0 0 0 0 0 0
218 RIFAMPISIN TABLET 450 MG TAB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

219 RIFAMPISIN TABLET 600 MG TAB

0 0 0 0 0 0 0 0 0
220 RINGER LAKTAT LARUTAN INFUS STERIL BTL
0 0 0 0 0 0 0 0 0
221 RISPERIDON TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0
222 SALBUTAMOL INHALASI BTL
0 0 0 0 0 0 0 0 0
223 SALBUTAMOL NEBUL AMP
0 0 0 0 0 0 0 0 0
224 SALBUTAMOL TABLET 4 MG TAB
0 0 0 0 0 0 0 0 0
225 SALEP 2 - 4 KOMBINASI TUB
2 0 2 0 0 2 0 2 0
226 SALISIL BEDAK 2 % KTK
0 0 0 0 0 0 0 0 0
227 SALISIL SPIRITUS 10 % BTL
0 0 0 0 0 0 0 0 0
228 SEFADROKSIL KAPSUL 500 MG KAP
0 0 0 0 0 0 0 0 0
229 SEFADROKSIL SIRUP KERING 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
230 SEFOTAKSIM SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0
231 SEFTRIAXON SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0
234 SETIRIZIN SYR 5 MG / 5ML TAB
0 0 0 0 0 0 0 0 0
235 SETIRIZIN TABLET 10 MG BTL
0 0 0 0 0 0 0 0 0
236 SIANOKOBALAMIN INJEKSI 500 MCG / ML AMP
0 0 0 0 0 0 0 0 0
237 SIMVASTATIN TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
238 SIMVASTATIN TABLET 20 MG TAB
0 0 0 0 0 0 0 0 0
239 SIPROFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
240 SPIRONOLAKTON TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0
241 SULFASETAMID NATRIUM TETES MATA 15 % BTL
3 0 3 0 0 3 0 3 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

242 TABLET TAMBAH DARAH KOMBINASI TAB

1,270 0 1,270 0 0 1,270 0 1,270 0
244 TETRAKAIN HCL TETES MATA 0,5% BTL
0 0 0 0 0 0 0 0 0
245 TETRASIKLIN HCL KAPSUL 250 MG KAP
0 0 0 0 0 0 0 0 0
246 TIAMIN HCL INJEKSI 1.000 MCG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
247 TIAMIN HCL MONONITRAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0
250 UREA KRIM 10% TUB
0 0 0 0 0 0 0 0 0
251 VALPROAT SIRUP 250 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
252 VITAMIN B KOMPLEKS TABLET TAB
160 0 160 0 0 160 0 160 0
253 VITAMIN NEUROTROPIK INJEKSI AMP
0 0 0 0 0 0 0 0 0
254 WIDA BES BTL
0 0 0 0 0 0 0 0 0
255 YODIUM POVIDON GARGLE 240 ML BTL
0 0 0 0 0 0 0 0 0
256 YODIUM POVIDON LARUTAN 10 % 30 ML BTL
0 0 0 0 0 0 0 0 0
257 YODIUM POVIDON LARUTAN 10 % 300 ML BTL
0 0 0 0 0 0 0 0 0
258 ZINK DROPS 10 MG / ML BTL
0 0 0 0 0 0 0 0 0
259 ZINK SIRUP 20 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
260 ZINK TABLET 20 MG TAB
0 0 0 0 0 0 0 0 0
390 TEST HAMIL URINE / HCG TEST TEST
0 0 0 0 0 0 0 0 0
D. BAHAN MEDIS PAKAI HABIS
0 0 0
418 ALAT SUNTIK SEKALI PAKAI 0,05 ML SET
0 0 0 0 0 0 0 0 0
419 ALAT SUNTIK SEKALI PAKAI 0,5 ML SET
0 0 0 0 0 0 0 0 0
420 ALAT SUNTIK SEKALI PAKAI 1 ML SET
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

421 ALAT SUNTIK SEKALI PAKAI 10 ML SET

0 0 0 0 0 0 0 0 0
422 ALAT SUNTIK SEKALI PAKAI 3 ML SET
7 0 7 0 0 7 0 7 0
423 ALAT SUNTIK SEKALI PAKAI 5 ML SET
8 0 8 0 0 8 0 8 0
424 ALAT SUNTIK SEKALI PAKAI 20 ML SET
0 0 0 0 0 0 0 0 0
425 ALAT SUNTIK SEKALI PAKAI 50 ML SET
0 0 0 0 0 0 0 0 0
426 ALKOHOL SWAB BJ
0 0 0 0 0 0 0 0 0
427 ANTISEPTIK HANDRUB BTL
0 0 0 0 0 0 0 0 0
428 ANTISEPTIK HANDSCRUB BTL
0 0 0 0 0 0 0 0 0
429 APRON PLASTIK PCS
0 0 0 0 0 0 0 0 0
430 BIST MESS BJ
0 0 0 0 0 0 0 0 0
431 BLOOD LANCET 26 G / 28 G SET
0 0 0 0 0 0 0 0 0
432 BLOOD SET SET
0 0 0 0 0 0 0 0 0
435 CATGUT CHROMIC NO. 3/0 SACHET
0 0 0 0 0 0 0 0 0
436 CATGUT CHROMIC NO. 4/0 SACHET
0 0 0 0 0 0 0 0 0
437 CATGUT PLAIN / BENANG BEDAH NO. 2/0 SACHET
0 0 0 0 0 0 0 0 0
438 CATGUT PLAIN / BENANG BEDAH NO. 3/0 SACHET
3 0 3 0 0 3 0 3 0
441 FOLLEY CATHETER 2 WAY NO. 16 SET
0 0 0 0 0 0 0 0 0
442 FOLLEY CATHETER 2 WAY NO. 18 SET
0 0 0 0 0 0 0 0 0
444 ID BAND PCS
0 0 0 0 0 0 0 0 0
445 INFUS SET ANAK SET
0 0 0 0 0 0 0 0 0
446 INFUS SET DEWASA SET
1 0 1 0 0 1 0 1 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

447 IV CATHETER NO. 18 SET

2 0 2 0 0 2 0 2 0
448 IV CATHETER NO. 20 SET
0 0 0 0 0 0 0 0 0
449 IV CATHETER NO. 22 SET
0 0 0 0 0 0 0 0 0
450 IV CATHETER NO. 24 SET
0 0 0 0 0 0 0 0 0
451 IV CATHETER NO. 26 SET
0 0 0 0 0 0 0 0 0
452 JARUM JAHIT / BEDAH NO. 9 S/D 14 BJ
0 0 0 0 0 0 0 0 0
454 KAPAS BERLEMAK 500 GRAM ROL
0 0 0 0 0 0 0 0 0
455 KAPAS PEMBALUT / ABSORBEN 250 GRAM ROL
1 0 1 0 0 1 0 1 0
457 KASA 16x16 PCS
0 0 0 0 0 0 0 0 0
458 KASA 40X80 ROL
0 0 0 0 0 0 0 0 0
459 KASA HIDROFIL STERIL UKURAN 18 M X22 CM ROL
0 0 0 0 0 0 0 0 0
460 KASA KOMPRES 40/40 STERIL ROL
0 0 0 0 0 0 0 0 0
461 KASA PEMBALUT 2 M X 80 CM ROL
0 0 0 0 0 0 0 0 0
462 KASA PEMBALUT ELASTIS 4 INCI ROL
0 0 0 0 0 0 0 0 0
463 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL
0 0 0 0 0 0 0 0 0
464 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL
0 0 0 0 0 0 0 0 0
465 KASA PEMBALUT HIDROFIL 4 M X 3 CM ROL
0 0 0 0 0 0 0 0 0
466 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL
0 0 0 0 0 0 0 0 0
467 KASA PERAWATAN LUKA LBR
0 0 0 0 0 0 0 0 0
468 KASET WITH SCREEN GREEN PKT
0 0 0 0 0 0 0 0 0
469 KERTAS EKG 80 MM X 30 M ROL
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

470 MASKER PCS

0 0 0 0 0 0 0 0 0
471 MASKER N95 PCS
0 0 0 0 0 0 0 0 0
484 NURSE CAP PCS
0 0 0 0 0 0 0 0 0
485 PEMBALUT GIPS 4 INCI ROL
0 0 0 0 0 0 0 0 0
486 PLESTER 5 CM x 5 M ROL
0 0 0 0 0 0 0 0 0
487 PLESTER 10 CM X 5 M ROL
0 0 0 0 0 0 0 0 0
488 PLESTER 15 CM X 5 M ROL
0 0 0 0 0 0 0 0 0
489 PLESTER BULAT NON WOVEN PCS
0 0 0 0 0 0 0 0 0
490 PLESTER KAIN 7,5 X 4,5 M ROL
0 0 0 0 0 0 0 0 0
491 POT SPUTUM SET
0 0 0 0 0 0 0 0 0
492 POT URINE SET
0 0 0 0 0 0 0 0 0
493 SAFETY BOX 2,5 L KTK
0 0 0 0 0 0 0 0 0
494 SAFETY BOX 5 L KTK
0 0 0 0 0 0 0 0 0
495 SARUNG TANGAN KEBIDANAN (PANJANG) PSG
0 0 0 0 0 0 0 0 0
496 SARUNG TANGAN KERJA (TEBAL) M - L PSG
0 0 0 0 0 0 0 0 0
497 SARUNG TANGAN NON STERIL PSG
0 0 0 0 0 0 0 0 0
498 SARUNG TANGAN STERIL PSG
0 0 0 0 0 0 0 0 0
501 SENDOK SIRUP PCS
0 0 0 0 0 0 0 0 0
502 SILK / BENANG SUTERA NO. 3/0 SACHET
0 0 0 0 0 0 0 0 0
503 SLIM ZUIKER / MUCUS EXTRACTOR SET
0 0 0 0 0 0 0 0 0
508 SURGICAL GOWN PCS
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

516 UNDERPAD LBR

1 0 1 0 0 1 0 1 0
517 URINE BAG STERIL LBR
0 0 0 0 0 0 0 0 0
518 USG GEL TUB
0 0 0 0 0 0 0 0 0

JUMLAH KUNJUNGAN RESEP

KTP

BPJS

TUBAN, 2021

MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MENERIMA/MELAPOR

KEPALA PUSKESMAS PLUMPANG

dr H BOEDI WINOTO LESTI E. P., S.Farm., Apt.

NIP 19640723 199602 1 001 NIP. 199007042019032021

JKN

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

Polindes/ Pustu/ ponkesdes : :

TAHUN :

STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

A. OBAT ESSENSIAL
GFK
1 ALBENDAZOL TABLET 400 MG TAB
0 0 0 0 0 0 0 0 0
2 ALBENDAZOL SUSPENSI 200 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
3 ALOPURINOL TABLET 100 MG TAB
150 0 150 0 0 150 0 150 0
4 AMBROKSOL TABLET 30 MG TAB
0 0 0 0 0 0 0 0 0
6 AMINOFILLIN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
8 AMLODIPIN TABLET 10 MG TAB
70 0 70 0 0 70 0 70 0
9 AMLODIPIN TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
10 AMOKSISILIN KAPLET 500 MG KAPL
200 0 200 0 0 200 0 200 0
11 AMOKSISILIN KAPSUL 250 MG KAP
0 0 0 0 0 0 0 0 0
13 AMOKSISILIN SIRUP KERING 125 MG / 5 ML BTL
3 0 3 0 0 3 0 3 0
16 ANTASIDA DOEN SUSPENSI BTL
4 0 4 0 0 4 0 4 0
17 ANTASIDA DOEN TABLET KOMBINASI TAB
140 0 140 0 0 140 0 140 0
18 ANTI BAKTERI DOEN SALEP KOMBINASI TUB
0 0 0 0 0 0 0 0 0
19 ANTI FUNGI DOEN KOMBINASI POT
0 0 0 0 0 0 0 0 0
21 ANTI INFEKSI KRIM TUB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

22 ANTI MIGRAIN DOEN TABLET KOMBINASI TAB

0 0 0 0 0 0 0 0 0
25 ASAM ASKORBAT TABLET 250 MG TAB
0 0 0 0 0 0 0 0 0
26 ASAM ASKORBAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0
27 ASAM ASKORBAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
28 ASAM FOLAT TABLET 0,4 MG TAB
0 0 0 0 0 0 0 0 0
29 ASAM MEFENAMAT TABLET 500 MG TAB
250 0 250 0 0 250 0 250 0
30 ASAM TRANEKSAMAT INJEKSI 50 MG / ML AMP
0 0 0 0 0 0 0 0 0
31 ASAM TRANEKSAMAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
33 ASIKLOVIR TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
34 ASIKLOVIR TABLET 400 MG TAB
80 0 80 0 0 80 0 80 0
35 ASIKLOVIR KRIM 5 % TUB
3 0 3 0 0 3 0 3 0
36 ATAPULGIT TABLET 600 MG TAB
0 0 0 0 0 0 0 0 0
40 BETAHISTIN MESILAT TABLET 6 MG TAB
0 0 0 0 0 0 0 0 0
41 BETAMETASON KRIM 0,1 % TUB
5 0 5 0 0 5 0 5 0
46 DEKSAMETASON INJEKSI 5 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
47 DEKSAMETASON TABLET 0,5 MG TAB
160 0 160 0 0 160 0 160 0
52 DIFENHIDRAMIN HCL INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
56 DIMENHIDRINAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0
57 DOMPERIDON SIRUP 5 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
58 DOMPERIDON TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
59 EPINEPRIN HCL INJEKSI 0,1 % AMP
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

60 ERITROMISIN KAPSUL 500 MG KAP

0 0 0 0 0 0 0 0 0
61 ERITROMISIN SIRUP KERING 200 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
62 ETAKRIDIN LARUTAN 0,1 % BTL
2 0 2 0 0 2 0 2 0
63 ETANOL 70 % BTL
3 0 3 0 0 3 0 3 0
64 ETIL KLORIDA SEMPROT BTL
0 0 0 0 0 0 0 0 0
69 FENOL GLISEROL TETES TELINGA 10 % BTL
4 0 4 0 0 4 0 4 0
70 FITOMENADION INJEKSI 2 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
71 FITOMENADION INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
72 FITOMENADION TABLET SALUT 10 MG TAB
0 0 0 0 0 0 0 0 0
75 FUROSEMID INJEKSI 10 MG AMP
0 0 0 0 0 0 0 0 0
76 FUROSEMID TABLET 40 MG TAB
0 0 0 0 0 0 0 0 0
77 GARAM ORALIT KOMBINASI SAK
10 0 10 0 0 10 0 10 0
78 GEMFIBROZIL KAPSUL 300 MG KAP
0 0 0 0 0 0 0 0 0
79 GENTAMISIN INJEKSI 40 MG/ML AMP
0 0 0 0 0 0 0 0 0
80 GENTAMISIN TETES MATA 0,3 % BTL
0 0 0 0 0 0 0 0 0
81 GENTAMISIN SALEP KULIT 0,1 % TUB
0 0 0 0 0 0 0 0 0
82 GENTAMISIN SALEP MATA 0,3 % TUB
0 0 0 0 0 0 0 0 0
83 GENTIAN VIOLET LARUTAN 1 % BTL
0 0 0 0 0 0 0 0 0
84 GLIBENKLAMID TABLET 5 MG TAB
70 0 70 0 0 70 0 70 0
85 GLIMEPIRIDE TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0
86 GLUKOSA LARUTAN INFUS 5 % STERIL BTL
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

87 GLUKOSA LARUTAN INFUS 10 % STERIL BTL

0 0 0 0 0 0 0 0 0
88 GLUKOSA LARUTAN INFUS 40 % STERIL AMP
0 0 0 0 0 0 0 0 0
89 GRISEOFULVIN TABLET 125 MG TAB
0 0 0 0 0 0 0 0 0
96 HIDROKLORTIAZID TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0
97 HIDROKORTISON KRIM 2,5 % TUB
3 0 3 0 0 3 0 3 0
99 HIOSIN BUTILBROMIDA TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
100 IBUPROFEN SUSPENSI 100 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
101 IBUPROFEN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
102 IBUPROFEN TABLET 400 MG TAB
150 0 150 0 0 150 0 150 0
103 INSULIN ANALOG LONG ACTING PEN
0 0 0 0 0 0 0 0 0
104 INSULIN ANALOG RAPID ACTING PEN
0 0 0 0 0 0 0 0 0
105 ISONIAZID TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0
106 ISONIAZID TABLET 300 MG TAB
0 0 0 0 0 0 0 0 0
107 ISOSORBID DINITRAT TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
108 KALSIUM GLUKONAT INJEKSI 10 % AMP
0 0 0 0 0 0 0 0 0
109 KALSIUM LAKTAT TABLET 500 MG TAB
30 0 30 0 0 30 0 30 0
111 KAOLIN - PEKTIN SIRUP BTL
0 0 0 0 0 0 0 0 0
112 KAPTOPRIL TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0
113 KARBAMAZEPIN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
114 KETOKONAZOLE KRIM 2 % TUB
3 0 3 0 0 3 0 3 0
115 KETOKONAZOLE TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

116 KLINDAMISIN KAPSUL 300 MG KAP

0 0 0 0 0 0 0 0 0
120 KLORAMFENIKOL INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0
121 KLORAMFENIKOL KAPSUL 250 MG KAP
0 10 10 0 0 0 10 10 0
122 KLORAMFENIKOL SALEP MATA 1% TUB
3 0 3 0 0 3 0 3 0
123 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BTL
0 0 0 0 0 0 0 0 0
124 KLORAMFENIKOL TETES MATA 0,5 % BTL
0 0 0 0 0 0 0 0 0
125 KLORAMFENIKOL TETES TELINGA 3 % BTL
0 0 0 0 0 0 0 0 0
126 KLORFENIRAMIN MALEAT TABLET 4 MG TAB
240 0 240 0 0 240 0 240 0
132 KOTRIMOKSAZOL DEWASA TABLET TAB
0 0 0 0 0 0 0 0 0
133 KOTRIMOKSAZOL PEDIATRIK TABLET TAB
0 0 0 0 0 0 0 0 0
134 KOTRIMOKSAZOL SUSPENSI 240 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
135 KURKUMA SIRUP BTL
0 0 0 0 0 0 0 0 0
136 KURKUMA TABLET TAB
0 0 0 0 0 0 0 0 0
137 LAKTULOSA SIRUP BTL
0 0 0 0 0 0 0 0 0
138 LEVOFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
139 LEVOTIROKSIN TABLET 100 MCG TAB
0 0 0 0 0 0 0 0 0
140 LIDOKAIN KOMPOSITUM INJEKSI AMP
0 0 0 0 0 0 0 0 0
141 LIDOKAIN SPRAY ORAL 10 % BTL
0 0 0 0 0 0 0 0 0
142 LISINOPRIL TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
143 LISINOPRIL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
144 LOPERAMID TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

145 LORATADIN TABLET 10 MG TAB

0 0 0 0 0 0 0 0 0
146 MAGNESIUM SULFAT INJEKSI / IV 20% - 25 ML AMP
0 0 0 0 0 0 0 0 0
147 MAGNESIUM SULFAT INJEKSI / IV 40% - 25 ML AMP
0 0 0 0 0 0 0 0 0
149 MEBENDAZOL TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0
150 MELOKSIKAM TABLET 15 MG TAB
0 0 0 0 0 0 0 0 0
151 METAMIZOL INJEKSI 500 MG / ML AMP
0 0 0 0 0 0 0 0 0
152 METFORMIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
153 METIL ERGOMETRIN INJEKSI 0,2 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
154 METIL ERGOMETRIN TABLET 0,125 MG TAB
0 0 0 0 0 0 0 0 0
155 METIL PREDNISOLON INJEKSI 125 MG AMP
0 0 0 0 0 0 0 0 0
156 METIL PREDNISOLON TABLET 4 MG TAB
0 0 0 0 0 0 0 0 0
157 METOKLOPRAMID INJEKSI 5 MG / ML AMP
0 0 0 0 0 0 0 0 0
158 METOKLOPRAMID TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
159 METRONIDAZOL INFUS 5 MG / ML BTL
0 0 0 0 0 0 0 0 0
160 METRONIDAZOL SIRUP 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
161 METRONIDAZOL TABLET 250 MG TAB
0 0 0 0 0 0 0 0 0
162 METRONIDAZOL TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
163 MIKONAZOL KRIM 2% TUB
0 0 0 0 0 0 0 0 0
165 MOMETASON FUROAT KRIM 0,1 % TUB
0 0 0 0 0 0 0 0 0
166 N-ASETIL SISTEIN KAPSUL 200 MG KAP
0 0 0 0 0 0 0 0 0
167 NASALIN SPRAY 100 ML BTL
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

168 NATRIUM BIKARBONAT INJEKSI 8,4 % AMP

0 0 0 0 0 0 0 0 0
169 NATRIUM BIKARBONAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
170 NATRIUM DIKLOFENAK 50 MG TAB
0 0 0 0 0 0 0 0 0
171 NATRIUM FOSFAT ENEMA TUB
0 0 0 0 0 0 0 0 0
172 NATRIUM FUSIDAT SALEP 20 MG / G TUB
0 0 0 0 0 0 0 0 0
173 NATRIUM KLORIDA LARUTAN INFUS 0,9 % BTL
0 0 0 0 0 0 0 0 0
174 NIFEDIPIN TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
175 NIFEDIPIN TABLET 30 MG SR TAB
0 0 0 0 0 0 0 0 0
176 NISTATIN 100.000 IU / G TABLET VAGINA TAB
0 0 0 0 0 0 0 0 0
177 NISTATIN 500.000 IU TABLET SALUT TAB
0 0 0 0 0 0 0 0 0
178 NISTATIN SUSPENSI 100.000 IU / ML BTL
0 20 20 0 0 0 20 20 0
179 NORETISTERON TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
184 OBAT BATUK HITAM SIRUP BTL
0 0 0 0 0 0 0 0 0
185 OKSIMETAZOLIN TETES HIDUNG 0,025 % BTL
0 0 0 0 0 0 0 0 0
186 OKSIMETAZOLIN TETES HIDUNG 0,05 % BTL
0 0 0 0 0 0 0 0 0
187 OKSITETRASIKLIN HCL IM 50 MG / ML - 10 ML AMP
0 0 0 0 0 0 0 0 0
188 OKSITETRASIKLIN HCL SALEP KULIT 3 % TUB
4 0 4 0 0 4 0 4 0
189 OKSITETRASIKLIN HCL SALEP MATA 1 % TUB
0 0 0 0 0 0 0 0 0
190 OKSITOSIN INJEKSI 10 IU / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
191 OMEPRAZOLE INJEKSI 40 MG VIAL
0 0 0 0 0 0 0 0 0
192 OMEPRAZOLE KAPSUL 20 MG KAP
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

195 PARASETAMOL DROPS 100 MG / ML BTL

0 0 0 0 0 0 0 0 0
196 PARASETAMOL INFUS 10 MG / ML BTL
0 0 0 0 0 0 0 0 0
197 PARASETAMOL SIRUP 120 MG / 5 ML BTL
3 0 3 0 0 3 0 3 0
198 PARASETAMOL TABLET 500 MG TAB
390 0 390 0 0 390 0 390 0
199 PERAK SULFADIAZIN KRIM 1% TUB
0 0 0 0 0 0 0 0 0
200 PERMETRIN KRIM 5% TUB
0 0 0 0 0 0 0 0 0
202 PILOKARPIN HCL NITRAT TETES MATA 2 % BTL
0 0 0 0 0 0 0 0 0
204 PIRACETAM TABLET 400 MG TAB
0 0 0 0 0 0 0 0 0
205 PIRANTEL PAMOAT TABLET 125 MG TAB
0 0 0 0 0 0 0 0 0
206 PIRANTEL SUSPENSI 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
207 PIRIDOKSIN HCL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
208 PREDNISON TABLET 5 MG TAB
400 50 450 0 0 400 50 450 0
209 PROKAIN BENZIL PENISILLIN INJEKSI 3 JUTA UI VIAL
0 0 0 0 0 0 0 0 0
210 PROPILTIOURASIL TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0
211 PROPRANOLOL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
212 PROPRANOLOL TABLET 40 MG TAB
0 0 0 0 0 0 0 0 0
213 PSEUDOEFEDRIN SIRUP BTL
0 0 0 0 0 0 0 0 0
215 RANITIDIN TABLET 150 MG TAB
0 0 0 0 0 0 0 0 0
216 RETINOL KAPSUL 100.000 IU KAP
0 0 0 0 0 0 0 0 0
217 RETINOL KAPSUL 200.000 IU KAP
0 0 0 0 0 0 0 0 0
218 RIFAMPISIN TABLET 450 MG TAB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

219 RIFAMPISIN TABLET 600 MG TAB

0 0 0 0 0 0 0 0 0
220 RINGER LAKTAT LARUTAN INFUS STERIL BTL
0 0 0 0 0 0 0 0 0
221 RISPERIDON TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0
222 SALBUTAMOL INHALASI BTL
0 0 0 0 0 0 0 0 0
223 SALBUTAMOL NEBUL AMP
0 0 0 0 0 0 0 0 0
224 SALBUTAMOL TABLET 4 MG TAB
0 0 0 0 0 0 0 0 0
225 SALEP 2 - 4 KOMBINASI TUB
2 0 2 0 0 2 0 2 0
226 SALISIL BEDAK 2 % KTK
0 0 0 0 0 0 0 0 0
227 SALISIL SPIRITUS 10 % BTL
0 0 0 0 0 0 0 0 0
228 SEFADROKSIL KAPSUL 500 MG KAP
0 0 0 0 0 0 0 0 0
229 SEFADROKSIL SIRUP KERING 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
230 SEFOTAKSIM SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0
231 SEFTRIAXON SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0
234 SETIRIZIN SYR 5 MG / 5ML TAB
0 0 0 0 0 0 0 0 0
235 SETIRIZIN TABLET 10 MG BTL
0 0 0 0 0 0 0 0 0
236 SIANOKOBALAMIN INJEKSI 500 MCG / ML AMP
0 0 0 0 0 0 0 0 0
237 SIMVASTATIN TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
238 SIMVASTATIN TABLET 20 MG TAB
0 0 0 0 0 0 0 0 0
239 SIPROFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
240 SPIRONOLAKTON TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0
241 SULFASETAMID NATRIUM TETES MATA 15 % BTL
3 0 3 0 0 3 0 3 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

242 TABLET TAMBAH DARAH KOMBINASI TAB

1,270 0 1,270 0 0 1,270 0 1,270 0
244 TETRAKAIN HCL TETES MATA 0,5% BTL
0 0 0 0 0 0 0 0 0
245 TETRASIKLIN HCL KAPSUL 250 MG KAP
0 0 0 0 0 0 0 0 0
246 TIAMIN HCL INJEKSI 1.000 MCG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
247 TIAMIN HCL MONONITRAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0
250 UREA KRIM 10% TUB
0 0 0 0 0 0 0 0 0
251 VALPROAT SIRUP 250 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
252 VITAMIN B KOMPLEKS TABLET TAB
160 0 160 0 0 160 0 160 0
253 VITAMIN NEUROTROPIK INJEKSI AMP
0 0 0 0 0 0 0 0 0
254 WIDA BES BTL
0 0 0 0 0 0 0 0 0
255 YODIUM POVIDON GARGLE 240 ML BTL
0 0 0 0 0 0 0 0 0
256 YODIUM POVIDON LARUTAN 10 % 30 ML BTL
0 0 0 0 0 0 0 0 0
257 YODIUM POVIDON LARUTAN 10 % 300 ML BTL
0 0 0 0 0 0 0 0 0
258 ZINK DROPS 10 MG / ML BTL
0 0 0 0 0 0 0 0 0
259 ZINK SIRUP 20 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
260 ZINK TABLET 20 MG TAB
0 0 0 0 0 0 0 0 0
390 TEST HAMIL URINE / HCG TEST TEST
0 0 0 0 0 0 0 0 0
D. BAHAN MEDIS PAKAI HABIS
0 0 0
418 ALAT SUNTIK SEKALI PAKAI 0,05 ML SET
0 0 0 0 0 0 0 0 0
419 ALAT SUNTIK SEKALI PAKAI 0,5 ML SET
0 0 0 0 0 0 0 0 0
420 ALAT SUNTIK SEKALI PAKAI 1 ML SET
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

421 ALAT SUNTIK SEKALI PAKAI 10 ML SET

0 0 0 0 0 0 0 0 0
422 ALAT SUNTIK SEKALI PAKAI 3 ML SET
7 0 7 0 0 7 0 7 0
423 ALAT SUNTIK SEKALI PAKAI 5 ML SET
8 0 8 0 0 8 0 8 0
424 ALAT SUNTIK SEKALI PAKAI 20 ML SET
0 0 0 0 0 0 0 0 0
425 ALAT SUNTIK SEKALI PAKAI 50 ML SET
0 0 0 0 0 0 0 0 0
426 ALKOHOL SWAB BJ
0 0 0 0 0 0 0 0 0
427 ANTISEPTIK HANDRUB BTL
0 0 0 0 0 0 0 0 0
428 ANTISEPTIK HANDSCRUB BTL
0 0 0 0 0 0 0 0 0
429 APRON PLASTIK PCS
0 0 0 0 0 0 0 0 0
430 BIST MESS BJ
0 0 0 0 0 0 0 0 0
431 BLOOD LANCET 26 G / 28 G SET
0 0 0 0 0 0 0 0 0
432 BLOOD SET SET
0 0 0 0 0 0 0 0 0
435 CATGUT CHROMIC NO. 3/0 SACHET
0 0 0 0 0 0 0 0 0
436 CATGUT CHROMIC NO. 4/0 SACHET
0 0 0 0 0 0 0 0 0
437 CATGUT PLAIN / BENANG BEDAH NO. 2/0 SACHET
0 0 0 0 0 0 0 0 0
438 CATGUT PLAIN / BENANG BEDAH NO. 3/0 SACHET
3 0 3 0 0 3 0 3 0
441 FOLLEY CATHETER 2 WAY NO. 16 SET
0 0 0 0 0 0 0 0 0
442 FOLLEY CATHETER 2 WAY NO. 18 SET
0 0 0 0 0 0 0 0 0
444 ID BAND PCS
0 0 0 0 0 0 0 0 0
445 INFUS SET ANAK SET
0 0 0 0 0 0 0 0 0
446 INFUS SET DEWASA SET
1 0 1 0 0 1 0 1 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

447 IV CATHETER NO. 18 SET

2 0 2 0 0 2 0 2 0
448 IV CATHETER NO. 20 SET
0 0 0 0 0 0 0 0 0
449 IV CATHETER NO. 22 SET
0 0 0 0 0 0 0 0 0
450 IV CATHETER NO. 24 SET
0 0 0 0 0 0 0 0 0
451 IV CATHETER NO. 26 SET
0 0 0 0 0 0 0 0 0
452 JARUM JAHIT / BEDAH NO. 9 S/D 14 BJ
0 0 0 0 0 0 0 0 0
454 KAPAS BERLEMAK 500 GRAM ROL
0 0 0 0 0 0 0 0 0
455 KAPAS PEMBALUT / ABSORBEN 250 GRAM ROL
1 0 1 0 0 1 0 1 0
457 KASA 16x16 PCS
0 0 0 0 0 0 0 0 0
458 KASA 40X80 ROL
0 0 0 0 0 0 0 0 0
459 KASA HIDROFIL STERIL UKURAN 18 M X22 CM ROL
0 0 0 0 0 0 0 0 0
460 KASA KOMPRES 40/40 STERIL ROL
0 0 0 0 0 0 0 0 0
461 KASA PEMBALUT 2 M X 80 CM ROL
0 0 0 0 0 0 0 0 0
462 KASA PEMBALUT ELASTIS 4 INCI ROL
0 0 0 0 0 0 0 0 0
463 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL
0 0 0 0 0 0 0 0 0
464 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL
0 0 0 0 0 0 0 0 0
465 KASA PEMBALUT HIDROFIL 4 M X 3 CM ROL
0 0 0 0 0 0 0 0 0
466 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL
0 0 0 0 0 0 0 0 0
467 KASA PERAWATAN LUKA LBR
0 0 0 0 0 0 0 0 0
468 KASET WITH SCREEN GREEN PKT
0 0 0 0 0 0 0 0 0
469 KERTAS EKG 80 MM X 30 M ROL
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

470 MASKER PCS

0 0 0 0 0 0 0 0 0
471 MASKER N95 PCS
0 0 0 0 0 0 0 0 0
484 NURSE CAP PCS
0 0 0 0 0 0 0 0 0
485 PEMBALUT GIPS 4 INCI ROL
0 0 0 0 0 0 0 0 0
486 PLESTER 5 CM x 5 M ROL
0 0 0 0 0 0 0 0 0
487 PLESTER 10 CM X 5 M ROL
0 0 0 0 0 0 0 0 0
488 PLESTER 15 CM X 5 M ROL
0 0 0 0 0 0 0 0 0
489 PLESTER BULAT NON WOVEN PCS
0 0 0 0 0 0 0 0 0
490 PLESTER KAIN 7,5 X 4,5 M ROL
0 0 0 0 0 0 0 0 0
491 POT SPUTUM SET
0 0 0 0 0 0 0 0 0
492 POT URINE SET
0 0 0 0 0 0 0 0 0
493 SAFETY BOX 2,5 L KTK
0 0 0 0 0 0 0 0 0
494 SAFETY BOX 5 L KTK
0 0 0 0 0 0 0 0 0
495 SARUNG TANGAN KEBIDANAN (PANJANG) PSG
0 0 0 0 0 0 0 0 0
496 SARUNG TANGAN KERJA (TEBAL) M - L PSG
0 0 0 0 0 0 0 0 0
497 SARUNG TANGAN NON STERIL PSG
0 0 0 0 0 0 0 0 0
498 SARUNG TANGAN STERIL PSG
0 0 0 0 0 0 0 0 0
501 SENDOK SIRUP PCS
0 0 0 0 0 0 0 0 0
502 SILK / BENANG SUTERA NO. 3/0 SACHET
0 0 0 0 0 0 0 0 0
503 SLIM ZUIKER / MUCUS EXTRACTOR SET
0 0 0 0 0 0 0 0 0
508 SURGICAL GOWN PCS
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

516 UNDERPAD LBR

1 0 1 0 0 1 0 1 0
517 URINE BAG STERIL LBR
0 0 0 0 0 0 0 0 0
518 USG GEL TUB
0 0 0 0 0 0 0 0 0

JUMLAH KUNJUNGAN RESEP

KTP

BPJS

TUBAN, 2021

MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MENERIMA/MELAPOR

KEPALA PUSKESMAS PLUMPANG

dr H BOEDI WINOTO LESTI E. P., S.Farm., Apt.

NIP 19640723 199602 1 001 NIP. 199007042019032021

JKN

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

Polindes/ Pustu/ ponkesdes : :

TAHUN :

STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

A. OBAT ESSENSIAL
GFK
1 ALBENDAZOL TABLET 400 MG TAB
0 0 0 0 0 0 0 0 0 0
2 ALBENDAZOL SUSPENSI 200 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
3 ALOPURINOL TABLET 100 MG TAB
150 0 150 0 0 150 0 150 0 0
4 AMBROKSOL TABLET 30 MG TAB
0 0 0 0 0 0 0 0 0 0
6 AMINOFILLIN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0 0
8 AMLODIPIN TABLET 10 MG TAB
70 0 70 0 0 70 0 70 0 0
9 AMLODIPIN TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0 0
10 AMOKSISILIN KAPLET 500 MG KAPL
200 0 200 0 0 200 0 200 0 0
11 AMOKSISILIN KAPSUL 250 MG KAP
0 0 0 0 0 0 0 0 0 0
13 AMOKSISILIN SIRUP KERING 125 MG / 5 ML BTL
3 0 3 0 0 3 0 3 0 0
16 ANTASIDA DOEN SUSPENSI BTL
4 0 4 0 0 4 0 4 0 0
17 ANTASIDA DOEN TABLET KOMBINASI TAB
140 0 140 0 0 140 0 140 0 0
18 ANTI BAKTERI DOEN SALEP KOMBINASI TUB
0 0 0 0 0 0 0 0 0 0
19 ANTI FUNGI DOEN KOMBINASI POT
0 0 0 0 0 0 0 0 0 0
21 ANTI INFEKSI KRIM TUB
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

22 ANTI MIGRAIN DOEN TABLET KOMBINASI TAB

0 0 0 0 0 0 0 0 0 0
25 ASAM ASKORBAT TABLET 250 MG TAB
0 0 0 0 0 0 0 0 0 0
26 ASAM ASKORBAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0 0
27 ASAM ASKORBAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
28 ASAM FOLAT TABLET 0,4 MG TAB
0 0 0 0 0 0 0 0 0 0
29 ASAM MEFENAMAT TABLET 500 MG TAB
250 0 250 0 0 250 0 250 0 0
30 ASAM TRANEKSAMAT INJEKSI 50 MG / ML AMP
0 0 0 0 0 0 0 0 0 0
31 ASAM TRANEKSAMAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
33 ASIKLOVIR TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0 0
34 ASIKLOVIR TABLET 400 MG TAB
80 0 80 0 0 80 0 80 0 0
35 ASIKLOVIR KRIM 5 % TUB
3 0 3 0 0 3 0 3 0 0
36 ATAPULGIT TABLET 600 MG TAB
0 0 0 0 0 0 0 0 0 0
40 BETAHISTIN MESILAT TABLET 6 MG TAB
0 0 0 0 0 0 0 0 0 0
41 BETAMETASON KRIM 0,1 % TUB
5 0 5 0 0 5 0 5 0 0
46 DEKSAMETASON INJEKSI 5 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
47 DEKSAMETASON TABLET 0,5 MG TAB
160 0 160 0 0 160 0 160 0 0
52 DIFENHIDRAMIN HCL INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
56 DIMENHIDRINAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0 0
57 DOMPERIDON SIRUP 5 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
58 DOMPERIDON TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
59 EPINEPRIN HCL INJEKSI 0,1 % AMP
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

60 ERITROMISIN KAPSUL 500 MG KAP

0 0 0 0 0 0 0 0 0 0
61 ERITROMISIN SIRUP KERING 200 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
62 ETAKRIDIN LARUTAN 0,1 % BTL
2 0 2 0 0 2 0 2 0 0
63 ETANOL 70 % BTL
3 0 3 0 0 3 0 3 0 0
64 ETIL KLORIDA SEMPROT BTL
0 0 0 0 0 0 0 0 0 0
69 FENOL GLISEROL TETES TELINGA 10 % BTL
4 0 4 0 0 4 0 4 0 0
70 FITOMENADION INJEKSI 2 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
71 FITOMENADION INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
72 FITOMENADION TABLET SALUT 10 MG TAB
0 0 0 0 0 0 0 0 0 0
75 FUROSEMID INJEKSI 10 MG AMP
0 0 0 0 0 0 0 0 0 0
76 FUROSEMID TABLET 40 MG TAB
0 0 0 0 0 0 0 0 0 0
77 GARAM ORALIT KOMBINASI SAK
10 0 10 0 0 10 0 10 0 0
78 GEMFIBROZIL KAPSUL 300 MG KAP
0 0 0 0 0 0 0 0 0 0
79 GENTAMISIN INJEKSI 40 MG/ML AMP
0 0 0 0 0 0 0 0 0 0
80 GENTAMISIN TETES MATA 0,3 % BTL
0 0 0 0 0 0 0 0 0 0
81 GENTAMISIN SALEP KULIT 0,1 % TUB
0 0 0 0 0 0 0 0 0 0
82 GENTAMISIN SALEP MATA 0,3 % TUB
0 0 0 0 0 0 0 0 0 0
83 GENTIAN VIOLET LARUTAN 1 % BTL
0 0 0 0 0 0 0 0 0 0
84 GLIBENKLAMID TABLET 5 MG TAB
70 0 70 0 0 70 0 70 0 0
85 GLIMEPIRIDE TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0 0
86 GLUKOSA LARUTAN INFUS 5 % STERIL BTL
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

87 GLUKOSA LARUTAN INFUS 10 % STERIL BTL

0 0 0 0 0 0 0 0 0 0
88 GLUKOSA LARUTAN INFUS 40 % STERIL AMP
0 0 0 0 0 0 0 0 0 0
89 GRISEOFULVIN TABLET 125 MG TAB
0 0 0 0 0 0 0 0 0 0
96 HIDROKLORTIAZID TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0 0
97 HIDROKORTISON KRIM 2,5 % TUB
3 0 3 0 0 3 0 3 0 0
99 HIOSIN BUTILBROMIDA TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
100 IBUPROFEN SUSPENSI 100 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
101 IBUPROFEN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0 0
102 IBUPROFEN TABLET 400 MG TAB
150 0 150 0 0 150 0 150 0 0
103 INSULIN ANALOG LONG ACTING PEN
0 0 0 0 0 0 0 0 0 0
104 INSULIN ANALOG RAPID ACTING PEN
0 0 0 0 0 0 0 0 0 0
105 ISONIAZID TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0 0
106 ISONIAZID TABLET 300 MG TAB
0 0 0 0 0 0 0 0 0 0
107 ISOSORBID DINITRAT TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0 0
108 KALSIUM GLUKONAT INJEKSI 10 % AMP
0 0 0 0 0 0 0 0 0 0
109 KALSIUM LAKTAT TABLET 500 MG TAB
30 0 30 0 0 30 0 30 0 0
111 KAOLIN - PEKTIN SIRUP BTL
0 0 0 0 0 0 0 0 0 0
112 KAPTOPRIL TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0 0
113 KARBAMAZEPIN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0 0
114 KETOKONAZOLE KRIM 2 % TUB
3 0 3 0 0 3 0 3 0 0
115 KETOKONAZOLE TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

116 KLINDAMISIN KAPSUL 300 MG KAP

0 0 0 0 0 0 0 0 0 0
120 KLORAMFENIKOL INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0 0
121 KLORAMFENIKOL KAPSUL 250 MG KAP
0 10 10 0 0 0 10 10 0 0
122 KLORAMFENIKOL SALEP MATA 1% TUB
3 0 3 0 0 3 0 3 0 0
123 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BTL
0 0 0 0 0 0 0 0 0 0
124 KLORAMFENIKOL TETES MATA 0,5 % BTL
0 0 0 0 0 0 0 0 0 0
125 KLORAMFENIKOL TETES TELINGA 3 % BTL
0 0 0 0 0 0 0 0 0 0
126 KLORFENIRAMIN MALEAT TABLET 4 MG TAB
240 0 240 0 0 240 0 240 0 0
132 KOTRIMOKSAZOL DEWASA TABLET TAB
0 0 0 0 0 0 0 0 0 0
133 KOTRIMOKSAZOL PEDIATRIK TABLET TAB
0 0 0 0 0 0 0 0 0 0
134 KOTRIMOKSAZOL SUSPENSI 240 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
135 KURKUMA SIRUP BTL
0 0 0 0 0 0 0 0 0 0
136 KURKUMA TABLET TAB
0 0 0 0 0 0 0 0 0 0
137 LAKTULOSA SIRUP BTL
0 0 0 0 0 0 0 0 0 0
138 LEVOFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
139 LEVOTIROKSIN TABLET 100 MCG TAB
0 0 0 0 0 0 0 0 0 0
140 LIDOKAIN KOMPOSITUM INJEKSI AMP
0 0 0 0 0 0 0 0 0 0
141 LIDOKAIN SPRAY ORAL 10 % BTL
0 0 0 0 0 0 0 0 0 0
142 LISINOPRIL TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0 0
143 LISINOPRIL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
144 LOPERAMID TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

145 LORATADIN TABLET 10 MG TAB

0 0 0 0 0 0 0 0 0 0
146 MAGNESIUM SULFAT INJEKSI / IV 20% - 25 ML AMP
0 0 0 0 0 0 0 0 0 0
147 MAGNESIUM SULFAT INJEKSI / IV 40% - 25 ML AMP
0 0 0 0 0 0 0 0 0 0
149 MEBENDAZOL TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0 0
150 MELOKSIKAM TABLET 15 MG TAB
0 0 0 0 0 0 0 0 0 0
151 METAMIZOL INJEKSI 500 MG / ML AMP
0 0 0 0 0 0 0 0 0 0
152 METFORMIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
153 METIL ERGOMETRIN INJEKSI 0,2 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
154 METIL ERGOMETRIN TABLET 0,125 MG TAB
0 0 0 0 0 0 0 0 0 0
155 METIL PREDNISOLON INJEKSI 125 MG AMP
0 0 0 0 0 0 0 0 0 0
156 METIL PREDNISOLON TABLET 4 MG TAB
0 0 0 0 0 0 0 0 0 0
157 METOKLOPRAMID INJEKSI 5 MG / ML AMP
0 0 0 0 0 0 0 0 0 0
158 METOKLOPRAMID TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
159 METRONIDAZOL INFUS 5 MG / ML BTL
0 0 0 0 0 0 0 0 0 0
160 METRONIDAZOL SIRUP 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
161 METRONIDAZOL TABLET 250 MG TAB
0 0 0 0 0 0 0 0 0 0
162 METRONIDAZOL TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
163 MIKONAZOL KRIM 2% TUB
0 0 0 0 0 0 0 0 0 0
165 MOMETASON FUROAT KRIM 0,1 % TUB
0 0 0 0 0 0 0 0 0 0
166 N-ASETIL SISTEIN KAPSUL 200 MG KAP
0 0 0 0 0 0 0 0 0 0
167 NASALIN SPRAY 100 ML BTL
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

168 NATRIUM BIKARBONAT INJEKSI 8,4 % AMP

0 0 0 0 0 0 0 0 0 0
169 NATRIUM BIKARBONAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
170 NATRIUM DIKLOFENAK 50 MG TAB
0 0 0 0 0 0 0 0 0 0
171 NATRIUM FOSFAT ENEMA TUB
0 0 0 0 0 0 0 0 0 0
172 NATRIUM FUSIDAT SALEP 20 MG / G TUB
0 0 0 0 0 0 0 0 0 0
173 NATRIUM KLORIDA LARUTAN INFUS 0,9 % BTL
0 0 0 0 0 0 0 0 0 0
174 NIFEDIPIN TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
175 NIFEDIPIN TABLET 30 MG SR TAB
0 0 0 0 0 0 0 0 0 0
176 NISTATIN 100.000 IU / G TABLET VAGINA TAB
0 0 0 0 0 0 0 0 0 0
177 NISTATIN 500.000 IU TABLET SALUT TAB
0 0 0 0 0 0 0 0 0 0
178 NISTATIN SUSPENSI 100.000 IU / ML BTL
0 20 20 0 0 0 20 20 0 0
179 NORETISTERON TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0 0
184 OBAT BATUK HITAM SIRUP BTL
0 0 0 0 0 0 0 0 0 0
185 OKSIMETAZOLIN TETES HIDUNG 0,025 % BTL
0 0 0 0 0 0 0 0 0 0
186 OKSIMETAZOLIN TETES HIDUNG 0,05 % BTL
0 0 0 0 0 0 0 0 0 0
187 OKSITETRASIKLIN HCL IM 50 MG / ML - 10 ML AMP
0 0 0 0 0 0 0 0 0 0
188 OKSITETRASIKLIN HCL SALEP KULIT 3 % TUB
4 0 4 0 0 4 0 4 0 0
189 OKSITETRASIKLIN HCL SALEP MATA 1 % TUB
0 0 0 0 0 0 0 0 0 0
190 OKSITOSIN INJEKSI 10 IU / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
191 OMEPRAZOLE INJEKSI 40 MG VIAL
0 0 0 0 0 0 0 0 0 0
192 OMEPRAZOLE KAPSUL 20 MG KAP
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

195 PARASETAMOL DROPS 100 MG / ML BTL

0 0 0 0 0 0 0 0 0 0
196 PARASETAMOL INFUS 10 MG / ML BTL
0 0 0 0 0 0 0 0 0 0
197 PARASETAMOL SIRUP 120 MG / 5 ML BTL
3 0 3 0 0 3 0 3 0 0
198 PARASETAMOL TABLET 500 MG TAB
390 0 390 0 0 390 0 390 0 0
199 PERAK SULFADIAZIN KRIM 1% TUB
0 0 0 0 0 0 0 0 0 0
200 PERMETRIN KRIM 5% TUB
0 0 0 0 0 0 0 0 0 0
202 PILOKARPIN HCL NITRAT TETES MATA 2 % BTL
0 0 0 0 0 0 0 0 0 0
204 PIRACETAM TABLET 400 MG TAB
0 0 0 0 0 0 0 0 0 0
205 PIRANTEL PAMOAT TABLET 125 MG TAB
0 0 0 0 0 0 0 0 0 0
206 PIRANTEL SUSPENSI 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
207 PIRIDOKSIN HCL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
208 PREDNISON TABLET 5 MG TAB
400 50 450 0 0 400 50 450 0 0
209 PROKAIN BENZIL PENISILLIN INJEKSI 3 JUTA UI VIAL
0 0 0 0 0 0 0 0 0 0
210 PROPILTIOURASIL TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0 0
211 PROPRANOLOL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
212 PROPRANOLOL TABLET 40 MG TAB
0 0 0 0 0 0 0 0 0 0
213 PSEUDOEFEDRIN SIRUP BTL
0 0 0 0 0 0 0 0 0 0
215 RANITIDIN TABLET 150 MG TAB
0 0 0 0 0 0 0 0 0 0
216 RETINOL KAPSUL 100.000 IU KAP
0 0 0 0 0 0 0 0 0 0
217 RETINOL KAPSUL 200.000 IU KAP
0 0 0 0 0 0 0 0 0 0
218 RIFAMPISIN TABLET 450 MG TAB
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

219 RIFAMPISIN TABLET 600 MG TAB

0 0 0 0 0 0 0 0 0 0
220 RINGER LAKTAT LARUTAN INFUS STERIL BTL
0 0 0 0 0 0 0 0 0 0
221 RISPERIDON TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0 0
222 SALBUTAMOL INHALASI BTL
0 0 0 0 0 0 0 0 0 0
223 SALBUTAMOL NEBUL AMP
0 0 0 0 0 0 0 0 0 0
224 SALBUTAMOL TABLET 4 MG TAB
0 0 0 0 0 0 0 0 0 0
225 SALEP 2 - 4 KOMBINASI TUB
2 0 2 0 0 2 0 2 0 0
226 SALISIL BEDAK 2 % KTK
0 0 0 0 0 0 0 0 0 0
227 SALISIL SPIRITUS 10 % BTL
0 0 0 0 0 0 0 0 0 0
228 SEFADROKSIL KAPSUL 500 MG KAP
0 0 0 0 0 0 0 0 0 0
229 SEFADROKSIL SIRUP KERING 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
230 SEFOTAKSIM SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0 0
231 SEFTRIAXON SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0 0
234 SETIRIZIN SYR 5 MG / 5ML TAB
0 0 0 0 0 0 0 0 0 0
235 SETIRIZIN TABLET 10 MG BTL
0 0 0 0 0 0 0 0 0 0
236 SIANOKOBALAMIN INJEKSI 500 MCG / ML AMP
0 0 0 0 0 0 0 0 0 0
237 SIMVASTATIN TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
238 SIMVASTATIN TABLET 20 MG TAB
0 0 0 0 0 0 0 0 0 0
239 SIPROFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
240 SPIRONOLAKTON TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0 0
241 SULFASETAMID NATRIUM TETES MATA 15 % BTL
3 0 3 0 0 3 0 3 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

242 TABLET TAMBAH DARAH KOMBINASI TAB

1,270 0 1,270 0 0 1,270 0 1,270 0 0
244 TETRAKAIN HCL TETES MATA 0,5% BTL
0 0 0 0 0 0 0 0 0 0
245 TETRASIKLIN HCL KAPSUL 250 MG KAP
0 0 0 0 0 0 0 0 0 0
246 TIAMIN HCL INJEKSI 1.000 MCG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
247 TIAMIN HCL MONONITRAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0 0
250 UREA KRIM 10% TUB
0 0 0 0 0 0 0 0 0 0
251 VALPROAT SIRUP 250 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
252 VITAMIN B KOMPLEKS TABLET TAB
160 0 160 0 0 160 0 160 0 0
253 VITAMIN NEUROTROPIK INJEKSI AMP
0 0 0 0 0 0 0 0 0 0
254 WIDA BES BTL
0 0 0 0 0 0 0 0 0 0
255 YODIUM POVIDON GARGLE 240 ML BTL
0 0 0 0 0 0 0 0 0 0
256 YODIUM POVIDON LARUTAN 10 % 30 ML BTL
0 0 0 0 0 0 0 0 0 0
257 YODIUM POVIDON LARUTAN 10 % 300 ML BTL
0 0 0 0 0 0 0 0 0 0
258 ZINK DROPS 10 MG / ML BTL
0 0 0 0 0 0 0 0 0 0
259 ZINK SIRUP 20 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
260 ZINK TABLET 20 MG TAB
0 0 0 0 0 0 0 0 0 0
390 TEST HAMIL URINE / HCG TEST TEST
0 0 0 0 0 0 0 0 0 0
D. BAHAN MEDIS PAKAI HABIS
0 0 0 0
418 ALAT SUNTIK SEKALI PAKAI 0,05 ML SET
0 0 0 0 0 0 0 0 0 0
419 ALAT SUNTIK SEKALI PAKAI 0,5 ML SET
0 0 0 0 0 0 0 0 0 0
420 ALAT SUNTIK SEKALI PAKAI 1 ML SET
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

421 ALAT SUNTIK SEKALI PAKAI 10 ML SET

0 0 0 0 0 0 0 0 0 0
422 ALAT SUNTIK SEKALI PAKAI 3 ML SET
7 0 7 0 0 7 0 7 0 0
423 ALAT SUNTIK SEKALI PAKAI 5 ML SET
8 0 8 0 0 8 0 8 0 0
424 ALAT SUNTIK SEKALI PAKAI 20 ML SET
0 0 0 0 0 0 0 0 0 0
425 ALAT SUNTIK SEKALI PAKAI 50 ML SET
0 0 0 0 0 0 0 0 0 0
426 ALKOHOL SWAB BJ
0 0 0 0 0 0 0 0 0 0
427 ANTISEPTIK HANDRUB BTL
0 0 0 0 0 0 0 0 0 0
428 ANTISEPTIK HANDSCRUB BTL
0 0 0 0 0 0 0 0 0 0
429 APRON PLASTIK PCS
0 0 0 0 0 0 0 0 0 0
430 BIST MESS BJ
0 0 0 0 0 0 0 0 0 0
431 BLOOD LANCET 26 G / 28 G SET
0 0 0 0 0 0 0 0 0 0
432 BLOOD SET SET
0 0 0 0 0 0 0 0 0 0
435 CATGUT CHROMIC NO. 3/0 SACHET
0 0 0 0 0 0 0 0 0 0
436 CATGUT CHROMIC NO. 4/0 SACHET
0 0 0 0 0 0 0 0 0 0
437 CATGUT PLAIN / BENANG BEDAH NO. 2/0 SACHET
0 0 0 0 0 0 0 0 0 0
438 CATGUT PLAIN / BENANG BEDAH NO. 3/0 SACHET
3 0 3 0 0 3 0 3 0 0
441 FOLLEY CATHETER 2 WAY NO. 16 SET
0 0 0 0 0 0 0 0 0 0
442 FOLLEY CATHETER 2 WAY NO. 18 SET
0 0 0 0 0 0 0 0 0 0
444 ID BAND PCS
0 0 0 0 0 0 0 0 0 0
445 INFUS SET ANAK SET
0 0 0 0 0 0 0 0 0 0
446 INFUS SET DEWASA SET
1 0 1 0 0 1 0 1 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

447 IV CATHETER NO. 18 SET

2 0 2 0 0 2 0 2 0 0
448 IV CATHETER NO. 20 SET
0 0 0 0 0 0 0 0 0 0
449 IV CATHETER NO. 22 SET
0 0 0 0 0 0 0 0 0 0
450 IV CATHETER NO. 24 SET
0 0 0 0 0 0 0 0 0 0
451 IV CATHETER NO. 26 SET
0 0 0 0 0 0 0 0 0 0
452 JARUM JAHIT / BEDAH NO. 9 S/D 14 BJ
0 0 0 0 0 0 0 0 0 0
454 KAPAS BERLEMAK 500 GRAM ROL
0 0 0 0 0 0 0 0 0 0
455 KAPAS PEMBALUT / ABSORBEN 250 GRAM ROL
1 0 1 0 0 1 0 1 0 0
457 KASA 16x16 PCS
0 0 0 0 0 0 0 0 0 0
458 KASA 40X80 ROL
0 0 0 0 0 0 0 0 0 0
459 KASA HIDROFIL STERIL UKURAN 18 M X22 CM ROL
0 0 0 0 0 0 0 0 0 0
460 KASA KOMPRES 40/40 STERIL ROL
0 0 0 0 0 0 0 0 0 0
461 KASA PEMBALUT 2 M X 80 CM ROL
0 0 0 0 0 0 0 0 0 0
462 KASA PEMBALUT ELASTIS 4 INCI ROL
0 0 0 0 0 0 0 0 0 0
463 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL
0 0 0 0 0 0 0 0 0 0
464 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL
0 0 0 0 0 0 0 0 0 0
465 KASA PEMBALUT HIDROFIL 4 M X 3 CM ROL
0 0 0 0 0 0 0 0 0 0
466 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL
0 0 0 0 0 0 0 0 0 0
467 KASA PERAWATAN LUKA LBR
0 0 0 0 0 0 0 0 0 0
468 KASET WITH SCREEN GREEN PKT
0 0 0 0 0 0 0 0 0 0
469 KERTAS EKG 80 MM X 30 M ROL
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

470 MASKER PCS

0 0 0 0 0 0 0 0 0 0
471 MASKER N95 PCS
0 0 0 0 0 0 0 0 0 0
484 NURSE CAP PCS
0 0 0 0 0 0 0 0 0 0
485 PEMBALUT GIPS 4 INCI ROL
0 0 0 0 0 0 0 0 0 0
486 PLESTER 5 CM x 5 M ROL
0 0 0 0 0 0 0 0 0 0
487 PLESTER 10 CM X 5 M ROL
0 0 0 0 0 0 0 0 0 0
488 PLESTER 15 CM X 5 M ROL
0 0 0 0 0 0 0 0 0 0
489 PLESTER BULAT NON WOVEN PCS
0 0 0 0 0 0 0 0 0 0
490 PLESTER KAIN 7,5 X 4,5 M ROL
0 0 0 0 0 0 0 0 0 0
491 POT SPUTUM SET
0 0 0 0 0 0 0 0 0 0
492 POT URINE SET
0 0 0 0 0 0 0 0 0 0
493 SAFETY BOX 2,5 L KTK
0 0 0 0 0 0 0 0 0 0
494 SAFETY BOX 5 L KTK
0 0 0 0 0 0 0 0 0 0
495 SARUNG TANGAN KEBIDANAN (PANJANG) PSG
0 0 0 0 0 0 0 0 0 0
496 SARUNG TANGAN KERJA (TEBAL) M - L PSG
0 0 0 0 0 0 0 0 0 0
497 SARUNG TANGAN NON STERIL PSG
0 0 0 0 0 0 0 0 0 0
498 SARUNG TANGAN STERIL PSG
0 0 0 0 0 0 0 0 0 0
501 SENDOK SIRUP PCS
0 0 0 0 0 0 0 0 0 0
502 SILK / BENANG SUTERA NO. 3/0 SACHET
0 0 0 0 0 0 0 0 0 0
503 SLIM ZUIKER / MUCUS EXTRACTOR SET
0 0 0 0 0 0 0 0 0 0
508 SURGICAL GOWN PCS
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

516 UNDERPAD LBR

1 0 1 0 0 1 0 1 0 0
517 URINE BAG STERIL LBR
0 0 0 0 0 0 0 0 0 0
518 USG GEL TUB
0 0 0 0 0 0 0 0 0 0

JUMLAH KUNJUNGAN RESEP

KTP

BPJS

TUBAN, 2021

MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MENERIMA/MELAPOR

KEPALA PUSKESMAS PLUMPANG

dr H BOEDI WINOTO LESTI E. P., S.Farm., Apt.

NIP 19640723 199602 1 001 NIP. 199007042019032021

JKN

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

Polindes/ Pustu/ ponkesdes : :

TAHUN :

STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

A. OBAT ESSENSIAL
GFK
1 ALBENDAZOL TABLET 400 MG TAB
0 0 0 0 0 0 0 0 0
2 ALBENDAZOL SUSPENSI 200 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
3 ALOPURINOL TABLET 100 MG TAB
150 0 150 0 0 150 0 150 0
4 AMBROKSOL TABLET 30 MG TAB
0 0 0 0 0 0 0 0 0
6 AMINOFILLIN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
8 AMLODIPIN TABLET 10 MG TAB
70 0 70 0 0 70 0 70 0
9 AMLODIPIN TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
10 AMOKSISILIN KAPLET 500 MG KAPL
200 0 200 0 0 200 0 200 0
11 AMOKSISILIN KAPSUL 250 MG KAP
0 0 0 0 0 0 0 0 0
13 AMOKSISILIN SIRUP KERING 125 MG / 5 ML BTL
3 0 3 0 0 3 0 3 0
16 ANTASIDA DOEN SUSPENSI BTL
4 0 4 0 0 4 0 4 0
17 ANTASIDA DOEN TABLET KOMBINASI TAB
140 0 140 0 0 140 0 140 0
18 ANTI BAKTERI DOEN SALEP KOMBINASI TUB
0 0 0 0 0 0 0 0 0
19 ANTI FUNGI DOEN KOMBINASI POT
0 0 0 0 0 0 0 0 0
21 ANTI INFEKSI KRIM TUB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

22 ANTI MIGRAIN DOEN TABLET KOMBINASI TAB

0 0 0 0 0 0 0 0 0
25 ASAM ASKORBAT TABLET 250 MG TAB
0 0 0 0 0 0 0 0 0
26 ASAM ASKORBAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0
27 ASAM ASKORBAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
28 ASAM FOLAT TABLET 0,4 MG TAB
0 0 0 0 0 0 0 0 0
29 ASAM MEFENAMAT TABLET 500 MG TAB
250 0 250 0 0 250 0 250 0
30 ASAM TRANEKSAMAT INJEKSI 50 MG / ML AMP
0 0 0 0 0 0 0 0 0
31 ASAM TRANEKSAMAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
33 ASIKLOVIR TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
34 ASIKLOVIR TABLET 400 MG TAB
80 0 80 0 0 80 0 80 0
35 ASIKLOVIR KRIM 5 % TUB
3 0 3 0 0 3 0 3 0
36 ATAPULGIT TABLET 600 MG TAB
0 0 0 0 0 0 0 0 0
40 BETAHISTIN MESILAT TABLET 6 MG TAB
0 0 0 0 0 0 0 0 0
41 BETAMETASON KRIM 0,1 % TUB
5 0 5 0 0 5 0 5 0
46 DEKSAMETASON INJEKSI 5 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
47 DEKSAMETASON TABLET 0,5 MG TAB
160 0 160 0 0 160 0 160 0
52 DIFENHIDRAMIN HCL INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
56 DIMENHIDRINAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0
57 DOMPERIDON SIRUP 5 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
58 DOMPERIDON TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
59 EPINEPRIN HCL INJEKSI 0,1 % AMP
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

60 ERITROMISIN KAPSUL 500 MG KAP

0 0 0 0 0 0 0 0 0
61 ERITROMISIN SIRUP KERING 200 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
62 ETAKRIDIN LARUTAN 0,1 % BTL
2 0 2 0 0 2 0 2 0
63 ETANOL 70 % BTL
3 0 3 0 0 3 0 3 0
64 ETIL KLORIDA SEMPROT BTL
0 0 0 0 0 0 0 0 0
69 FENOL GLISEROL TETES TELINGA 10 % BTL
4 0 4 0 0 4 0 4 0
70 FITOMENADION INJEKSI 2 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
71 FITOMENADION INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
72 FITOMENADION TABLET SALUT 10 MG TAB
0 0 0 0 0 0 0 0 0
75 FUROSEMID INJEKSI 10 MG AMP
0 0 0 0 0 0 0 0 0
76 FUROSEMID TABLET 40 MG TAB
0 0 0 0 0 0 0 0 0
77 GARAM ORALIT KOMBINASI SAK
10 0 10 0 0 10 0 10 0
78 GEMFIBROZIL KAPSUL 300 MG KAP
0 0 0 0 0 0 0 0 0
79 GENTAMISIN INJEKSI 40 MG/ML AMP
0 0 0 0 0 0 0 0 0
80 GENTAMISIN TETES MATA 0,3 % BTL
0 0 0 0 0 0 0 0 0
81 GENTAMISIN SALEP KULIT 0,1 % TUB
0 0 0 0 0 0 0 0 0
82 GENTAMISIN SALEP MATA 0,3 % TUB
0 0 0 0 0 0 0 0 0
83 GENTIAN VIOLET LARUTAN 1 % BTL
0 0 0 0 0 0 0 0 0
84 GLIBENKLAMID TABLET 5 MG TAB
70 0 70 0 0 70 0 70 0
85 GLIMEPIRIDE TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0
86 GLUKOSA LARUTAN INFUS 5 % STERIL BTL
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

87 GLUKOSA LARUTAN INFUS 10 % STERIL BTL

0 0 0 0 0 0 0 0 0
88 GLUKOSA LARUTAN INFUS 40 % STERIL AMP
0 0 0 0 0 0 0 0 0
89 GRISEOFULVIN TABLET 125 MG TAB
0 0 0 0 0 0 0 0 0
96 HIDROKLORTIAZID TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0
97 HIDROKORTISON KRIM 2,5 % TUB
3 0 3 0 0 3 0 3 0
99 HIOSIN BUTILBROMIDA TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
100 IBUPROFEN SUSPENSI 100 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
101 IBUPROFEN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
102 IBUPROFEN TABLET 400 MG TAB
150 0 150 0 0 150 0 150 0
103 INSULIN ANALOG LONG ACTING PEN
0 0 0 0 0 0 0 0 0
104 INSULIN ANALOG RAPID ACTING PEN
0 0 0 0 0 0 0 0 0
105 ISONIAZID TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0
106 ISONIAZID TABLET 300 MG TAB
0 0 0 0 0 0 0 0 0
107 ISOSORBID DINITRAT TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
108 KALSIUM GLUKONAT INJEKSI 10 % AMP
0 0 0 0 0 0 0 0 0
109 KALSIUM LAKTAT TABLET 500 MG TAB
30 0 30 0 0 30 0 30 0
111 KAOLIN - PEKTIN SIRUP BTL
0 0 0 0 0 0 0 0 0
112 KAPTOPRIL TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0
113 KARBAMAZEPIN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
114 KETOKONAZOLE KRIM 2 % TUB
3 0 3 0 0 3 0 3 0
115 KETOKONAZOLE TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

116 KLINDAMISIN KAPSUL 300 MG KAP

0 0 0 0 0 0 0 0 0
120 KLORAMFENIKOL INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0
121 KLORAMFENIKOL KAPSUL 250 MG KAP
0 10 10 0 0 0 10 10 0
122 KLORAMFENIKOL SALEP MATA 1% TUB
3 0 3 0 0 3 0 3 0
123 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BTL
0 0 0 0 0 0 0 0 0
124 KLORAMFENIKOL TETES MATA 0,5 % BTL
0 0 0 0 0 0 0 0 0
125 KLORAMFENIKOL TETES TELINGA 3 % BTL
0 0 0 0 0 0 0 0 0
126 KLORFENIRAMIN MALEAT TABLET 4 MG TAB
240 0 240 0 0 240 0 240 0
132 KOTRIMOKSAZOL DEWASA TABLET TAB
0 0 0 0 0 0 0 0 0
133 KOTRIMOKSAZOL PEDIATRIK TABLET TAB
0 0 0 0 0 0 0 0 0
134 KOTRIMOKSAZOL SUSPENSI 240 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
135 KURKUMA SIRUP BTL
0 0 0 0 0 0 0 0 0
136 KURKUMA TABLET TAB
0 0 0 0 0 0 0 0 0
137 LAKTULOSA SIRUP BTL
0 0 0 0 0 0 0 0 0
138 LEVOFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
139 LEVOTIROKSIN TABLET 100 MCG TAB
0 0 0 0 0 0 0 0 0
140 LIDOKAIN KOMPOSITUM INJEKSI AMP
0 0 0 0 0 0 0 0 0
141 LIDOKAIN SPRAY ORAL 10 % BTL
0 0 0 0 0 0 0 0 0
142 LISINOPRIL TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
143 LISINOPRIL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
144 LOPERAMID TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

145 LORATADIN TABLET 10 MG TAB

0 0 0 0 0 0 0 0 0
146 MAGNESIUM SULFAT INJEKSI / IV 20% - 25 ML AMP
0 0 0 0 0 0 0 0 0
147 MAGNESIUM SULFAT INJEKSI / IV 40% - 25 ML AMP
0 0 0 0 0 0 0 0 0
149 MEBENDAZOL TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0
150 MELOKSIKAM TABLET 15 MG TAB
0 0 0 0 0 0 0 0 0
151 METAMIZOL INJEKSI 500 MG / ML AMP
0 0 0 0 0 0 0 0 0
152 METFORMIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
153 METIL ERGOMETRIN INJEKSI 0,2 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
154 METIL ERGOMETRIN TABLET 0,125 MG TAB
0 0 0 0 0 0 0 0 0
155 METIL PREDNISOLON INJEKSI 125 MG AMP
0 0 0 0 0 0 0 0 0
156 METIL PREDNISOLON TABLET 4 MG TAB
0 0 0 0 0 0 0 0 0
157 METOKLOPRAMID INJEKSI 5 MG / ML AMP
0 0 0 0 0 0 0 0 0
158 METOKLOPRAMID TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
159 METRONIDAZOL INFUS 5 MG / ML BTL
0 0 0 0 0 0 0 0 0
160 METRONIDAZOL SIRUP 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
161 METRONIDAZOL TABLET 250 MG TAB
0 0 0 0 0 0 0 0 0
162 METRONIDAZOL TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
163 MIKONAZOL KRIM 2% TUB
0 0 0 0 0 0 0 0 0
165 MOMETASON FUROAT KRIM 0,1 % TUB
0 0 0 0 0 0 0 0 0
166 N-ASETIL SISTEIN KAPSUL 200 MG KAP
0 0 0 0 0 0 0 0 0
167 NASALIN SPRAY 100 ML BTL
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

168 NATRIUM BIKARBONAT INJEKSI 8,4 % AMP

0 0 0 0 0 0 0 0 0
169 NATRIUM BIKARBONAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
170 NATRIUM DIKLOFENAK 50 MG TAB
0 0 0 0 0 0 0 0 0
171 NATRIUM FOSFAT ENEMA TUB
0 0 0 0 0 0 0 0 0
172 NATRIUM FUSIDAT SALEP 20 MG / G TUB
0 0 0 0 0 0 0 0 0
173 NATRIUM KLORIDA LARUTAN INFUS 0,9 % BTL
0 0 0 0 0 0 0 0 0
174 NIFEDIPIN TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
175 NIFEDIPIN TABLET 30 MG SR TAB
0 0 0 0 0 0 0 0 0
176 NISTATIN 100.000 IU / G TABLET VAGINA TAB
0 0 0 0 0 0 0 0 0
177 NISTATIN 500.000 IU TABLET SALUT TAB
0 0 0 0 0 0 0 0 0
178 NISTATIN SUSPENSI 100.000 IU / ML BTL
0 20 20 0 0 0 20 20 0
179 NORETISTERON TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
184 OBAT BATUK HITAM SIRUP BTL
0 0 0 0 0 0 0 0 0
185 OKSIMETAZOLIN TETES HIDUNG 0,025 % BTL
0 0 0 0 0 0 0 0 0
186 OKSIMETAZOLIN TETES HIDUNG 0,05 % BTL
0 0 0 0 0 0 0 0 0
187 OKSITETRASIKLIN HCL IM 50 MG / ML - 10 ML AMP
0 0 0 0 0 0 0 0 0
188 OKSITETRASIKLIN HCL SALEP KULIT 3 % TUB
4 0 4 0 0 4 0 4 0
189 OKSITETRASIKLIN HCL SALEP MATA 1 % TUB
0 0 0 0 0 0 0 0 0
190 OKSITOSIN INJEKSI 10 IU / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
191 OMEPRAZOLE INJEKSI 40 MG VIAL
0 0 0 0 0 0 0 0 0
192 OMEPRAZOLE KAPSUL 20 MG KAP
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

195 PARASETAMOL DROPS 100 MG / ML BTL

0 0 0 0 0 0 0 0 0
196 PARASETAMOL INFUS 10 MG / ML BTL
0 0 0 0 0 0 0 0 0
197 PARASETAMOL SIRUP 120 MG / 5 ML BTL
3 0 3 0 0 3 0 3 0
198 PARASETAMOL TABLET 500 MG TAB
390 0 390 0 0 390 0 390 0
199 PERAK SULFADIAZIN KRIM 1% TUB
0 0 0 0 0 0 0 0 0
200 PERMETRIN KRIM 5% TUB
0 0 0 0 0 0 0 0 0
202 PILOKARPIN HCL NITRAT TETES MATA 2 % BTL
0 0 0 0 0 0 0 0 0
204 PIRACETAM TABLET 400 MG TAB
0 0 0 0 0 0 0 0 0
205 PIRANTEL PAMOAT TABLET 125 MG TAB
0 0 0 0 0 0 0 0 0
206 PIRANTEL SUSPENSI 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
207 PIRIDOKSIN HCL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
208 PREDNISON TABLET 5 MG TAB
400 50 450 0 0 400 50 450 0
209 PROKAIN BENZIL PENISILLIN INJEKSI 3 JUTA UI VIAL
0 0 0 0 0 0 0 0 0
210 PROPILTIOURASIL TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0
211 PROPRANOLOL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
212 PROPRANOLOL TABLET 40 MG TAB
0 0 0 0 0 0 0 0 0
213 PSEUDOEFEDRIN SIRUP BTL
0 0 0 0 0 0 0 0 0
215 RANITIDIN TABLET 150 MG TAB
0 0 0 0 0 0 0 0 0
216 RETINOL KAPSUL 100.000 IU KAP
0 0 0 0 0 0 0 0 0
217 RETINOL KAPSUL 200.000 IU KAP
0 0 0 0 0 0 0 0 0
218 RIFAMPISIN TABLET 450 MG TAB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

219 RIFAMPISIN TABLET 600 MG TAB

0 0 0 0 0 0 0 0 0
220 RINGER LAKTAT LARUTAN INFUS STERIL BTL
0 0 0 0 0 0 0 0 0
221 RISPERIDON TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0
222 SALBUTAMOL INHALASI BTL
0 0 0 0 0 0 0 0 0
223 SALBUTAMOL NEBUL AMP
0 0 0 0 0 0 0 0 0
224 SALBUTAMOL TABLET 4 MG TAB
0 0 0 0 0 0 0 0 0
225 SALEP 2 - 4 KOMBINASI TUB
2 0 2 0 0 2 0 2 0
226 SALISIL BEDAK 2 % KTK
0 0 0 0 0 0 0 0 0
227 SALISIL SPIRITUS 10 % BTL
0 0 0 0 0 0 0 0 0
228 SEFADROKSIL KAPSUL 500 MG KAP
0 0 0 0 0 0 0 0 0
229 SEFADROKSIL SIRUP KERING 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
230 SEFOTAKSIM SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0
231 SEFTRIAXON SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0
234 SETIRIZIN SYR 5 MG / 5ML TAB
0 0 0 0 0 0 0 0 0
235 SETIRIZIN TABLET 10 MG BTL
0 0 0 0 0 0 0 0 0
236 SIANOKOBALAMIN INJEKSI 500 MCG / ML AMP
0 0 0 0 0 0 0 0 0
237 SIMVASTATIN TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
238 SIMVASTATIN TABLET 20 MG TAB
0 0 0 0 0 0 0 0 0
239 SIPROFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
240 SPIRONOLAKTON TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0
241 SULFASETAMID NATRIUM TETES MATA 15 % BTL
3 0 3 0 0 3 0 3 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

242 TABLET TAMBAH DARAH KOMBINASI TAB

1,270 0 1,270 0 0 1,270 0 1,270 0
244 TETRAKAIN HCL TETES MATA 0,5% BTL
0 0 0 0 0 0 0 0 0
245 TETRASIKLIN HCL KAPSUL 250 MG KAP
0 0 0 0 0 0 0 0 0
246 TIAMIN HCL INJEKSI 1.000 MCG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
247 TIAMIN HCL MONONITRAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0
250 UREA KRIM 10% TUB
0 0 0 0 0 0 0 0 0
251 VALPROAT SIRUP 250 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
252 VITAMIN B KOMPLEKS TABLET TAB
160 0 160 0 0 160 0 160 0
253 VITAMIN NEUROTROPIK INJEKSI AMP
0 0 0 0 0 0 0 0 0
254 WIDA BES BTL
0 0 0 0 0 0 0 0 0
255 YODIUM POVIDON GARGLE 240 ML BTL
0 0 0 0 0 0 0 0 0
256 YODIUM POVIDON LARUTAN 10 % 30 ML BTL
0 0 0 0 0 0 0 0 0
257 YODIUM POVIDON LARUTAN 10 % 300 ML BTL
0 0 0 0 0 0 0 0 0
258 ZINK DROPS 10 MG / ML BTL
0 0 0 0 0 0 0 0 0
259 ZINK SIRUP 20 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
260 ZINK TABLET 20 MG TAB
0 0 0 0 0 0 0 0 0
390 TEST HAMIL URINE / HCG TEST TEST
0 0 0 0 0 0 0 0 0
D. BAHAN MEDIS PAKAI HABIS
0 0 0
418 ALAT SUNTIK SEKALI PAKAI 0,05 ML SET
0 0 0 0 0 0 0 0 0
419 ALAT SUNTIK SEKALI PAKAI 0,5 ML SET
0 0 0 0 0 0 0 0 0
420 ALAT SUNTIK SEKALI PAKAI 1 ML SET
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

421 ALAT SUNTIK SEKALI PAKAI 10 ML SET

0 0 0 0 0 0 0 0 0
422 ALAT SUNTIK SEKALI PAKAI 3 ML SET
7 0 7 0 0 7 0 7 0
423 ALAT SUNTIK SEKALI PAKAI 5 ML SET
8 0 8 0 0 8 0 8 0
424 ALAT SUNTIK SEKALI PAKAI 20 ML SET
0 0 0 0 0 0 0 0 0
425 ALAT SUNTIK SEKALI PAKAI 50 ML SET
0 0 0 0 0 0 0 0 0
426 ALKOHOL SWAB BJ
0 0 0 0 0 0 0 0 0
427 ANTISEPTIK HANDRUB BTL
0 0 0 0 0 0 0 0 0
428 ANTISEPTIK HANDSCRUB BTL
0 0 0 0 0 0 0 0 0
429 APRON PLASTIK PCS
0 0 0 0 0 0 0 0 0
430 BIST MESS BJ
0 0 0 0 0 0 0 0 0
431 BLOOD LANCET 26 G / 28 G SET
0 0 0 0 0 0 0 0 0
432 BLOOD SET SET
0 0 0 0 0 0 0 0 0
435 CATGUT CHROMIC NO. 3/0 SACHET
0 0 0 0 0 0 0 0 0
436 CATGUT CHROMIC NO. 4/0 SACHET
0 0 0 0 0 0 0 0 0
437 CATGUT PLAIN / BENANG BEDAH NO. 2/0 SACHET
0 0 0 0 0 0 0 0 0
438 CATGUT PLAIN / BENANG BEDAH NO. 3/0 SACHET
3 0 3 0 0 3 0 3 0
441 FOLLEY CATHETER 2 WAY NO. 16 SET
0 0 0 0 0 0 0 0 0
442 FOLLEY CATHETER 2 WAY NO. 18 SET
0 0 0 0 0 0 0 0 0
444 ID BAND PCS
0 0 0 0 0 0 0 0 0
445 INFUS SET ANAK SET
0 0 0 0 0 0 0 0 0
446 INFUS SET DEWASA SET
1 0 1 0 0 1 0 1 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

447 IV CATHETER NO. 18 SET

2 0 2 0 0 2 0 2 0
448 IV CATHETER NO. 20 SET
0 0 0 0 0 0 0 0 0
449 IV CATHETER NO. 22 SET
0 0 0 0 0 0 0 0 0
450 IV CATHETER NO. 24 SET
0 0 0 0 0 0 0 0 0
451 IV CATHETER NO. 26 SET
0 0 0 0 0 0 0 0 0
452 JARUM JAHIT / BEDAH NO. 9 S/D 14 BJ
0 0 0 0 0 0 0 0 0
454 KAPAS BERLEMAK 500 GRAM ROL
0 0 0 0 0 0 0 0 0
455 KAPAS PEMBALUT / ABSORBEN 250 GRAM ROL
1 0 1 0 0 1 0 1 0
457 KASA 16x16 PCS
0 0 0 0 0 0 0 0 0
458 KASA 40X80 ROL
0 0 0 0 0 0 0 0 0
459 KASA HIDROFIL STERIL UKURAN 18 M X22 CM ROL
0 0 0 0 0 0 0 0 0
460 KASA KOMPRES 40/40 STERIL ROL
0 0 0 0 0 0 0 0 0
461 KASA PEMBALUT 2 M X 80 CM ROL
0 0 0 0 0 0 0 0 0
462 KASA PEMBALUT ELASTIS 4 INCI ROL
0 0 0 0 0 0 0 0 0
463 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL
0 0 0 0 0 0 0 0 0
464 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL
0 0 0 0 0 0 0 0 0
465 KASA PEMBALUT HIDROFIL 4 M X 3 CM ROL
0 0 0 0 0 0 0 0 0
466 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL
0 0 0 0 0 0 0 0 0
467 KASA PERAWATAN LUKA LBR
0 0 0 0 0 0 0 0 0
468 KASET WITH SCREEN GREEN PKT
0 0 0 0 0 0 0 0 0
469 KERTAS EKG 80 MM X 30 M ROL
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

470 MASKER PCS

0 0 0 0 0 0 0 0 0
471 MASKER N95 PCS
0 0 0 0 0 0 0 0 0
484 NURSE CAP PCS
0 0 0 0 0 0 0 0 0
485 PEMBALUT GIPS 4 INCI ROL
0 0 0 0 0 0 0 0 0
486 PLESTER 5 CM x 5 M ROL
0 0 0 0 0 0 0 0 0
487 PLESTER 10 CM X 5 M ROL
0 0 0 0 0 0 0 0 0
488 PLESTER 15 CM X 5 M ROL
0 0 0 0 0 0 0 0 0
489 PLESTER BULAT NON WOVEN PCS
0 0 0 0 0 0 0 0 0
490 PLESTER KAIN 7,5 X 4,5 M ROL
0 0 0 0 0 0 0 0 0
491 POT SPUTUM SET
0 0 0 0 0 0 0 0 0
492 POT URINE SET
0 0 0 0 0 0 0 0 0
493 SAFETY BOX 2,5 L KTK
0 0 0 0 0 0 0 0 0
494 SAFETY BOX 5 L KTK
0 0 0 0 0 0 0 0 0
495 SARUNG TANGAN KEBIDANAN (PANJANG) PSG
0 0 0 0 0 0 0 0 0
496 SARUNG TANGAN KERJA (TEBAL) M - L PSG
0 0 0 0 0 0 0 0 0
497 SARUNG TANGAN NON STERIL PSG
0 0 0 0 0 0 0 0 0
498 SARUNG TANGAN STERIL PSG
0 0 0 0 0 0 0 0 0
501 SENDOK SIRUP PCS
0 0 0 0 0 0 0 0 0
502 SILK / BENANG SUTERA NO. 3/0 SACHET
0 0 0 0 0 0 0 0 0
503 SLIM ZUIKER / MUCUS EXTRACTOR SET
0 0 0 0 0 0 0 0 0
508 SURGICAL GOWN PCS
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

516 UNDERPAD LBR

1 0 1 0 0 1 0 1 0
517 URINE BAG STERIL LBR
0 0 0 0 0 0 0 0 0
518 USG GEL TUB
0 0 0 0 0 0 0 0 0

JUMLAH KUNJUNGAN RESEP

KTP

BPJS

TUBAN, 2021

MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MENERIMA/MELAPOR

KEPALA PUSKESMAS PLUMPANG

dr H BOEDI WINOTO LESTI E. P., S.Farm., Apt.

NIP 19640723 199602 1 001 NIP. 199007042019032021

JKN

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

Polindes/ Pustu/ ponkesdes : :

TAHUN :

STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

A. OBAT ESSENSIAL
GFK
1 ALBENDAZOL TABLET 400 MG TAB
0 0 0 0 0 0 0 0 0
2 ALBENDAZOL SUSPENSI 200 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
3 ALOPURINOL TABLET 100 MG TAB
150 0 150 0 0 150 0 150 0
4 AMBROKSOL TABLET 30 MG TAB
0 0 0 0 0 0 0 0 0
6 AMINOFILLIN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
8 AMLODIPIN TABLET 10 MG TAB
70 0 70 0 0 70 0 70 0
9 AMLODIPIN TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
10 AMOKSISILIN KAPLET 500 MG KAPL
200 0 200 0 0 200 0 200 0
11 AMOKSISILIN KAPSUL 250 MG KAP
0 0 0 0 0 0 0 0 0
13 AMOKSISILIN SIRUP KERING 125 MG / 5 ML BTL
3 0 3 0 0 3 0 3 0
16 ANTASIDA DOEN SUSPENSI BTL
4 0 4 0 0 4 0 4 0
17 ANTASIDA DOEN TABLET KOMBINASI TAB
140 0 140 0 0 140 0 140 0
18 ANTI BAKTERI DOEN SALEP KOMBINASI TUB
0 0 0 0 0 0 0 0 0
19 ANTI FUNGI DOEN KOMBINASI POT
0 0 0 0 0 0 0 0 0
21 ANTI INFEKSI KRIM TUB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

22 ANTI MIGRAIN DOEN TABLET KOMBINASI TAB

0 0 0 0 0 0 0 0 0
25 ASAM ASKORBAT TABLET 250 MG TAB
0 0 0 0 0 0 0 0 0
26 ASAM ASKORBAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0
27 ASAM ASKORBAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
28 ASAM FOLAT TABLET 0,4 MG TAB
0 0 0 0 0 0 0 0 0
29 ASAM MEFENAMAT TABLET 500 MG TAB
250 0 250 0 0 250 0 250 0
30 ASAM TRANEKSAMAT INJEKSI 50 MG / ML AMP
0 0 0 0 0 0 0 0 0
31 ASAM TRANEKSAMAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
33 ASIKLOVIR TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
34 ASIKLOVIR TABLET 400 MG TAB
80 0 80 0 0 80 0 80 0
35 ASIKLOVIR KRIM 5 % TUB
3 0 3 0 0 3 0 3 0
36 ATAPULGIT TABLET 600 MG TAB
0 0 0 0 0 0 0 0 0
40 BETAHISTIN MESILAT TABLET 6 MG TAB
0 0 0 0 0 0 0 0 0
41 BETAMETASON KRIM 0,1 % TUB
5 0 5 0 0 5 0 5 0
46 DEKSAMETASON INJEKSI 5 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
47 DEKSAMETASON TABLET 0,5 MG TAB
160 0 160 0 0 160 0 160 0
52 DIFENHIDRAMIN HCL INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
56 DIMENHIDRINAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0
57 DOMPERIDON SIRUP 5 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
58 DOMPERIDON TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
59 EPINEPRIN HCL INJEKSI 0,1 % AMP
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

60 ERITROMISIN KAPSUL 500 MG KAP

0 0 0 0 0 0 0 0 0
61 ERITROMISIN SIRUP KERING 200 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
62 ETAKRIDIN LARUTAN 0,1 % BTL
2 0 2 0 0 2 0 2 0
63 ETANOL 70 % BTL
3 0 3 0 0 3 0 3 0
64 ETIL KLORIDA SEMPROT BTL
0 0 0 0 0 0 0 0 0
69 FENOL GLISEROL TETES TELINGA 10 % BTL
4 0 4 0 0 4 0 4 0
70 FITOMENADION INJEKSI 2 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
71 FITOMENADION INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
72 FITOMENADION TABLET SALUT 10 MG TAB
0 0 0 0 0 0 0 0 0
75 FUROSEMID INJEKSI 10 MG AMP
0 0 0 0 0 0 0 0 0
76 FUROSEMID TABLET 40 MG TAB
0 0 0 0 0 0 0 0 0
77 GARAM ORALIT KOMBINASI SAK
10 0 10 0 0 10 0 10 0
78 GEMFIBROZIL KAPSUL 300 MG KAP
0 0 0 0 0 0 0 0 0
79 GENTAMISIN INJEKSI 40 MG/ML AMP
0 0 0 0 0 0 0 0 0
80 GENTAMISIN TETES MATA 0,3 % BTL
0 0 0 0 0 0 0 0 0
81 GENTAMISIN SALEP KULIT 0,1 % TUB
0 0 0 0 0 0 0 0 0
82 GENTAMISIN SALEP MATA 0,3 % TUB
0 0 0 0 0 0 0 0 0
83 GENTIAN VIOLET LARUTAN 1 % BTL
0 0 0 0 0 0 0 0 0
84 GLIBENKLAMID TABLET 5 MG TAB
70 0 70 0 0 70 0 70 0
85 GLIMEPIRIDE TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0
86 GLUKOSA LARUTAN INFUS 5 % STERIL BTL
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

87 GLUKOSA LARUTAN INFUS 10 % STERIL BTL

0 0 0 0 0 0 0 0 0
88 GLUKOSA LARUTAN INFUS 40 % STERIL AMP
0 0 0 0 0 0 0 0 0
89 GRISEOFULVIN TABLET 125 MG TAB
0 0 0 0 0 0 0 0 0
96 HIDROKLORTIAZID TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0
97 HIDROKORTISON KRIM 2,5 % TUB
3 0 3 0 0 3 0 3 0
99 HIOSIN BUTILBROMIDA TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
100 IBUPROFEN SUSPENSI 100 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
101 IBUPROFEN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
102 IBUPROFEN TABLET 400 MG TAB
150 0 150 0 0 150 0 150 0
103 INSULIN ANALOG LONG ACTING PEN
0 0 0 0 0 0 0 0 0
104 INSULIN ANALOG RAPID ACTING PEN
0 0 0 0 0 0 0 0 0
105 ISONIAZID TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0
106 ISONIAZID TABLET 300 MG TAB
0 0 0 0 0 0 0 0 0
107 ISOSORBID DINITRAT TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
108 KALSIUM GLUKONAT INJEKSI 10 % AMP
0 0 0 0 0 0 0 0 0
109 KALSIUM LAKTAT TABLET 500 MG TAB
30 0 30 0 0 30 0 30 0
111 KAOLIN - PEKTIN SIRUP BTL
0 0 0 0 0 0 0 0 0
112 KAPTOPRIL TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0
113 KARBAMAZEPIN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
114 KETOKONAZOLE KRIM 2 % TUB
3 0 3 0 0 3 0 3 0
115 KETOKONAZOLE TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

116 KLINDAMISIN KAPSUL 300 MG KAP

0 0 0 0 0 0 0 0 0
120 KLORAMFENIKOL INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0
121 KLORAMFENIKOL KAPSUL 250 MG KAP
0 10 10 0 0 0 10 10 0
122 KLORAMFENIKOL SALEP MATA 1% TUB
3 0 3 0 0 3 0 3 0
123 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BTL
0 0 0 0 0 0 0 0 0
124 KLORAMFENIKOL TETES MATA 0,5 % BTL
0 0 0 0 0 0 0 0 0
125 KLORAMFENIKOL TETES TELINGA 3 % BTL
0 0 0 0 0 0 0 0 0
126 KLORFENIRAMIN MALEAT TABLET 4 MG TAB
240 0 240 0 0 240 0 240 0
132 KOTRIMOKSAZOL DEWASA TABLET TAB
0 0 0 0 0 0 0 0 0
133 KOTRIMOKSAZOL PEDIATRIK TABLET TAB
0 0 0 0 0 0 0 0 0
134 KOTRIMOKSAZOL SUSPENSI 240 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
135 KURKUMA SIRUP BTL
0 0 0 0 0 0 0 0 0
136 KURKUMA TABLET TAB
0 0 0 0 0 0 0 0 0
137 LAKTULOSA SIRUP BTL
0 0 0 0 0 0 0 0 0
138 LEVOFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
139 LEVOTIROKSIN TABLET 100 MCG TAB
0 0 0 0 0 0 0 0 0
140 LIDOKAIN KOMPOSITUM INJEKSI AMP
0 0 0 0 0 0 0 0 0
141 LIDOKAIN SPRAY ORAL 10 % BTL
0 0 0 0 0 0 0 0 0
142 LISINOPRIL TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
143 LISINOPRIL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
144 LOPERAMID TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

145 LORATADIN TABLET 10 MG TAB

0 0 0 0 0 0 0 0 0
146 MAGNESIUM SULFAT INJEKSI / IV 20% - 25 ML AMP
0 0 0 0 0 0 0 0 0
147 MAGNESIUM SULFAT INJEKSI / IV 40% - 25 ML AMP
0 0 0 0 0 0 0 0 0
149 MEBENDAZOL TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0
150 MELOKSIKAM TABLET 15 MG TAB
0 0 0 0 0 0 0 0 0
151 METAMIZOL INJEKSI 500 MG / ML AMP
0 0 0 0 0 0 0 0 0
152 METFORMIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
153 METIL ERGOMETRIN INJEKSI 0,2 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
154 METIL ERGOMETRIN TABLET 0,125 MG TAB
0 0 0 0 0 0 0 0 0
155 METIL PREDNISOLON INJEKSI 125 MG AMP
0 0 0 0 0 0 0 0 0
156 METIL PREDNISOLON TABLET 4 MG TAB
0 0 0 0 0 0 0 0 0
157 METOKLOPRAMID INJEKSI 5 MG / ML AMP
0 0 0 0 0 0 0 0 0
158 METOKLOPRAMID TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
159 METRONIDAZOL INFUS 5 MG / ML BTL
0 0 0 0 0 0 0 0 0
160 METRONIDAZOL SIRUP 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
161 METRONIDAZOL TABLET 250 MG TAB
0 0 0 0 0 0 0 0 0
162 METRONIDAZOL TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
163 MIKONAZOL KRIM 2% TUB
0 0 0 0 0 0 0 0 0
165 MOMETASON FUROAT KRIM 0,1 % TUB
0 0 0 0 0 0 0 0 0
166 N-ASETIL SISTEIN KAPSUL 200 MG KAP
0 0 0 0 0 0 0 0 0
167 NASALIN SPRAY 100 ML BTL
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

168 NATRIUM BIKARBONAT INJEKSI 8,4 % AMP

0 0 0 0 0 0 0 0 0
169 NATRIUM BIKARBONAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
170 NATRIUM DIKLOFENAK 50 MG TAB
0 0 0 0 0 0 0 0 0
171 NATRIUM FOSFAT ENEMA TUB
0 0 0 0 0 0 0 0 0
172 NATRIUM FUSIDAT SALEP 20 MG / G TUB
0 0 0 0 0 0 0 0 0
173 NATRIUM KLORIDA LARUTAN INFUS 0,9 % BTL
0 0 0 0 0 0 0 0 0
174 NIFEDIPIN TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
175 NIFEDIPIN TABLET 30 MG SR TAB
0 0 0 0 0 0 0 0 0
176 NISTATIN 100.000 IU / G TABLET VAGINA TAB
0 0 0 0 0 0 0 0 0
177 NISTATIN 500.000 IU TABLET SALUT TAB
0 0 0 0 0 0 0 0 0
178 NISTATIN SUSPENSI 100.000 IU / ML BTL
0 20 20 0 0 0 20 20 0
179 NORETISTERON TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0
184 OBAT BATUK HITAM SIRUP BTL
0 0 0 0 0 0 0 0 0
185 OKSIMETAZOLIN TETES HIDUNG 0,025 % BTL
0 0 0 0 0 0 0 0 0
186 OKSIMETAZOLIN TETES HIDUNG 0,05 % BTL
0 0 0 0 0 0 0 0 0
187 OKSITETRASIKLIN HCL IM 50 MG / ML - 10 ML AMP
0 0 0 0 0 0 0 0 0
188 OKSITETRASIKLIN HCL SALEP KULIT 3 % TUB
4 0 4 0 0 4 0 4 0
189 OKSITETRASIKLIN HCL SALEP MATA 1 % TUB
0 0 0 0 0 0 0 0 0
190 OKSITOSIN INJEKSI 10 IU / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
191 OMEPRAZOLE INJEKSI 40 MG VIAL
0 0 0 0 0 0 0 0 0
192 OMEPRAZOLE KAPSUL 20 MG KAP
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

195 PARASETAMOL DROPS 100 MG / ML BTL

0 0 0 0 0 0 0 0 0
196 PARASETAMOL INFUS 10 MG / ML BTL
0 0 0 0 0 0 0 0 0
197 PARASETAMOL SIRUP 120 MG / 5 ML BTL
3 0 3 0 0 3 0 3 0
198 PARASETAMOL TABLET 500 MG TAB
390 0 390 0 0 390 0 390 0
199 PERAK SULFADIAZIN KRIM 1% TUB
0 0 0 0 0 0 0 0 0
200 PERMETRIN KRIM 5% TUB
0 0 0 0 0 0 0 0 0
202 PILOKARPIN HCL NITRAT TETES MATA 2 % BTL
0 0 0 0 0 0 0 0 0
204 PIRACETAM TABLET 400 MG TAB
0 0 0 0 0 0 0 0 0
205 PIRANTEL PAMOAT TABLET 125 MG TAB
0 0 0 0 0 0 0 0 0
206 PIRANTEL SUSPENSI 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
207 PIRIDOKSIN HCL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
208 PREDNISON TABLET 5 MG TAB
400 50 450 0 0 400 50 450 0
209 PROKAIN BENZIL PENISILLIN INJEKSI 3 JUTA UI VIAL
0 0 0 0 0 0 0 0 0
210 PROPILTIOURASIL TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0
211 PROPRANOLOL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
212 PROPRANOLOL TABLET 40 MG TAB
0 0 0 0 0 0 0 0 0
213 PSEUDOEFEDRIN SIRUP BTL
0 0 0 0 0 0 0 0 0
215 RANITIDIN TABLET 150 MG TAB
0 0 0 0 0 0 0 0 0
216 RETINOL KAPSUL 100.000 IU KAP
0 0 0 0 0 0 0 0 0
217 RETINOL KAPSUL 200.000 IU KAP
0 0 0 0 0 0 0 0 0
218 RIFAMPISIN TABLET 450 MG TAB
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

219 RIFAMPISIN TABLET 600 MG TAB

0 0 0 0 0 0 0 0 0
220 RINGER LAKTAT LARUTAN INFUS STERIL BTL
0 0 0 0 0 0 0 0 0
221 RISPERIDON TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0
222 SALBUTAMOL INHALASI BTL
0 0 0 0 0 0 0 0 0
223 SALBUTAMOL NEBUL AMP
0 0 0 0 0 0 0 0 0
224 SALBUTAMOL TABLET 4 MG TAB
0 0 0 0 0 0 0 0 0
225 SALEP 2 - 4 KOMBINASI TUB
2 0 2 0 0 2 0 2 0
226 SALISIL BEDAK 2 % KTK
0 0 0 0 0 0 0 0 0
227 SALISIL SPIRITUS 10 % BTL
0 0 0 0 0 0 0 0 0
228 SEFADROKSIL KAPSUL 500 MG KAP
0 0 0 0 0 0 0 0 0
229 SEFADROKSIL SIRUP KERING 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
230 SEFOTAKSIM SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0
231 SEFTRIAXON SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0
234 SETIRIZIN SYR 5 MG / 5ML TAB
0 0 0 0 0 0 0 0 0
235 SETIRIZIN TABLET 10 MG BTL
0 0 0 0 0 0 0 0 0
236 SIANOKOBALAMIN INJEKSI 500 MCG / ML AMP
0 0 0 0 0 0 0 0 0
237 SIMVASTATIN TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0
238 SIMVASTATIN TABLET 20 MG TAB
0 0 0 0 0 0 0 0 0
239 SIPROFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0
240 SPIRONOLAKTON TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0
241 SULFASETAMID NATRIUM TETES MATA 15 % BTL
3 0 3 0 0 3 0 3 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

242 TABLET TAMBAH DARAH KOMBINASI TAB

1,270 0 1,270 0 0 1,270 0 1,270 0
244 TETRAKAIN HCL TETES MATA 0,5% BTL
0 0 0 0 0 0 0 0 0
245 TETRASIKLIN HCL KAPSUL 250 MG KAP
0 0 0 0 0 0 0 0 0
246 TIAMIN HCL INJEKSI 1.000 MCG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0
247 TIAMIN HCL MONONITRAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0
250 UREA KRIM 10% TUB
0 0 0 0 0 0 0 0 0
251 VALPROAT SIRUP 250 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
252 VITAMIN B KOMPLEKS TABLET TAB
160 0 160 0 0 160 0 160 0
253 VITAMIN NEUROTROPIK INJEKSI AMP
0 0 0 0 0 0 0 0 0
254 WIDA BES BTL
0 0 0 0 0 0 0 0 0
255 YODIUM POVIDON GARGLE 240 ML BTL
0 0 0 0 0 0 0 0 0
256 YODIUM POVIDON LARUTAN 10 % 30 ML BTL
0 0 0 0 0 0 0 0 0
257 YODIUM POVIDON LARUTAN 10 % 300 ML BTL
0 0 0 0 0 0 0 0 0
258 ZINK DROPS 10 MG / ML BTL
0 0 0 0 0 0 0 0 0
259 ZINK SIRUP 20 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0
260 ZINK TABLET 20 MG TAB
0 0 0 0 0 0 0 0 0
390 TEST HAMIL URINE / HCG TEST TEST
0 0 0 0 0 0 0 0 0
D. BAHAN MEDIS PAKAI HABIS
0 0 0
418 ALAT SUNTIK SEKALI PAKAI 0,05 ML SET
0 0 0 0 0 0 0 0 0
419 ALAT SUNTIK SEKALI PAKAI 0,5 ML SET
0 0 0 0 0 0 0 0 0
420 ALAT SUNTIK SEKALI PAKAI 1 ML SET
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

421 ALAT SUNTIK SEKALI PAKAI 10 ML SET

0 0 0 0 0 0 0 0 0
422 ALAT SUNTIK SEKALI PAKAI 3 ML SET
7 0 7 0 0 7 0 7 0
423 ALAT SUNTIK SEKALI PAKAI 5 ML SET
8 0 8 0 0 8 0 8 0
424 ALAT SUNTIK SEKALI PAKAI 20 ML SET
0 0 0 0 0 0 0 0 0
425 ALAT SUNTIK SEKALI PAKAI 50 ML SET
0 0 0 0 0 0 0 0 0
426 ALKOHOL SWAB BJ
0 0 0 0 0 0 0 0 0
427 ANTISEPTIK HANDRUB BTL
0 0 0 0 0 0 0 0 0
428 ANTISEPTIK HANDSCRUB BTL
0 0 0 0 0 0 0 0 0
429 APRON PLASTIK PCS
0 0 0 0 0 0 0 0 0
430 BIST MESS BJ
0 0 0 0 0 0 0 0 0
431 BLOOD LANCET 26 G / 28 G SET
0 0 0 0 0 0 0 0 0
432 BLOOD SET SET
0 0 0 0 0 0 0 0 0
435 CATGUT CHROMIC NO. 3/0 SACHET
0 0 0 0 0 0 0 0 0
436 CATGUT CHROMIC NO. 4/0 SACHET
0 0 0 0 0 0 0 0 0
437 CATGUT PLAIN / BENANG BEDAH NO. 2/0 SACHET
0 0 0 0 0 0 0 0 0
438 CATGUT PLAIN / BENANG BEDAH NO. 3/0 SACHET
3 0 3 0 0 3 0 3 0
441 FOLLEY CATHETER 2 WAY NO. 16 SET
0 0 0 0 0 0 0 0 0
442 FOLLEY CATHETER 2 WAY NO. 18 SET
0 0 0 0 0 0 0 0 0
444 ID BAND PCS
0 0 0 0 0 0 0 0 0
445 INFUS SET ANAK SET
0 0 0 0 0 0 0 0 0
446 INFUS SET DEWASA SET
1 0 1 0 0 1 0 1 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

447 IV CATHETER NO. 18 SET

2 0 2 0 0 2 0 2 0
448 IV CATHETER NO. 20 SET
0 0 0 0 0 0 0 0 0
449 IV CATHETER NO. 22 SET
0 0 0 0 0 0 0 0 0
450 IV CATHETER NO. 24 SET
0 0 0 0 0 0 0 0 0
451 IV CATHETER NO. 26 SET
0 0 0 0 0 0 0 0 0
452 JARUM JAHIT / BEDAH NO. 9 S/D 14 BJ
0 0 0 0 0 0 0 0 0
454 KAPAS BERLEMAK 500 GRAM ROL
0 0 0 0 0 0 0 0 0
455 KAPAS PEMBALUT / ABSORBEN 250 GRAM ROL
1 0 1 0 0 1 0 1 0
457 KASA 16x16 PCS
0 0 0 0 0 0 0 0 0
458 KASA 40X80 ROL
0 0 0 0 0 0 0 0 0
459 KASA HIDROFIL STERIL UKURAN 18 M X22 CM ROL
0 0 0 0 0 0 0 0 0
460 KASA KOMPRES 40/40 STERIL ROL
0 0 0 0 0 0 0 0 0
461 KASA PEMBALUT 2 M X 80 CM ROL
0 0 0 0 0 0 0 0 0
462 KASA PEMBALUT ELASTIS 4 INCI ROL
0 0 0 0 0 0 0 0 0
463 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL
0 0 0 0 0 0 0 0 0
464 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL
0 0 0 0 0 0 0 0 0
465 KASA PEMBALUT HIDROFIL 4 M X 3 CM ROL
0 0 0 0 0 0 0 0 0
466 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL
0 0 0 0 0 0 0 0 0
467 KASA PERAWATAN LUKA LBR
0 0 0 0 0 0 0 0 0
468 KASET WITH SCREEN GREEN PKT
0 0 0 0 0 0 0 0 0
469 KERTAS EKG 80 MM X 30 M ROL
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

470 MASKER PCS

0 0 0 0 0 0 0 0 0
471 MASKER N95 PCS
0 0 0 0 0 0 0 0 0
484 NURSE CAP PCS
0 0 0 0 0 0 0 0 0
485 PEMBALUT GIPS 4 INCI ROL
0 0 0 0 0 0 0 0 0
486 PLESTER 5 CM x 5 M ROL
0 0 0 0 0 0 0 0 0
487 PLESTER 10 CM X 5 M ROL
0 0 0 0 0 0 0 0 0
488 PLESTER 15 CM X 5 M ROL
0 0 0 0 0 0 0 0 0
489 PLESTER BULAT NON WOVEN PCS
0 0 0 0 0 0 0 0 0
490 PLESTER KAIN 7,5 X 4,5 M ROL
0 0 0 0 0 0 0 0 0
491 POT SPUTUM SET
0 0 0 0 0 0 0 0 0
492 POT URINE SET
0 0 0 0 0 0 0 0 0
493 SAFETY BOX 2,5 L KTK
0 0 0 0 0 0 0 0 0
494 SAFETY BOX 5 L KTK
0 0 0 0 0 0 0 0 0
495 SARUNG TANGAN KEBIDANAN (PANJANG) PSG
0 0 0 0 0 0 0 0 0
496 SARUNG TANGAN KERJA (TEBAL) M - L PSG
0 0 0 0 0 0 0 0 0
497 SARUNG TANGAN NON STERIL PSG
0 0 0 0 0 0 0 0 0
498 SARUNG TANGAN STERIL PSG
0 0 0 0 0 0 0 0 0
501 SENDOK SIRUP PCS
0 0 0 0 0 0 0 0 0
502 SILK / BENANG SUTERA NO. 3/0 SACHET
0 0 0 0 0 0 0 0 0
503 SLIM ZUIKER / MUCUS EXTRACTOR SET
0 0 0 0 0 0 0 0 0
508 SURGICAL GOWN PCS
0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

516 UNDERPAD LBR

1 0 1 0 0 1 0 1 0
517 URINE BAG STERIL LBR
0 0 0 0 0 0 0 0 0
518 USG GEL TUB
0 0 0 0 0 0 0 0 0

JUMLAH KUNJUNGAN RESEP

KTP

BPJS

TUBAN, 2021

MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MENERIMA/MELAPOR

KEPALA PUSKESMAS PLUMPANG

dr H BOEDI WINOTO LESTI E. P., S.Farm., Apt.

NIP 19640723 199602 1 001 NIP. 199007042019032021

JKN

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

Polindes/ Pustu/ ponkesdes : :

TAHUN :

STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

A. OBAT ESSENSIAL
GFK
1 ALBENDAZOL TABLET 400 MG TAB
0 0 0 0 0 0 0 0 0 0
2 ALBENDAZOL SUSPENSI 200 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
3 ALOPURINOL TABLET 100 MG TAB
150 0 150 0 0 150 0 150 0 0
4 AMBROKSOL TABLET 30 MG TAB
0 0 0 0 0 0 0 0 0 0
6 AMINOFILLIN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0 0
8 AMLODIPIN TABLET 10 MG TAB
70 0 70 0 0 70 0 70 0 0
9 AMLODIPIN TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0 0
10 AMOKSISILIN KAPLET 500 MG KAPL
200 0 200 0 0 200 0 200 0 0
11 AMOKSISILIN KAPSUL 250 MG KAP
0 0 0 0 0 0 0 0 0 0
13 AMOKSISILIN SIRUP KERING 125 MG / 5 ML BTL
3 0 3 0 0 3 0 3 0 0
16 ANTASIDA DOEN SUSPENSI BTL
4 0 4 0 0 4 0 4 0 0
17 ANTASIDA DOEN TABLET KOMBINASI TAB
140 0 140 0 0 140 0 140 0 0
18 ANTI BAKTERI DOEN SALEP KOMBINASI TUB
0 0 0 0 0 0 0 0 0 0
19 ANTI FUNGI DOEN KOMBINASI POT
0 0 0 0 0 0 0 0 0 0
21 ANTI INFEKSI KRIM TUB
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

22 ANTI MIGRAIN DOEN TABLET KOMBINASI TAB

0 0 0 0 0 0 0 0 0 0
25 ASAM ASKORBAT TABLET 250 MG TAB
0 0 0 0 0 0 0 0 0 0
26 ASAM ASKORBAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0 0
27 ASAM ASKORBAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
28 ASAM FOLAT TABLET 0,4 MG TAB
0 0 0 0 0 0 0 0 0 0
29 ASAM MEFENAMAT TABLET 500 MG TAB
250 0 250 0 0 250 0 250 0 0
30 ASAM TRANEKSAMAT INJEKSI 50 MG / ML AMP
0 0 0 0 0 0 0 0 0 0
31 ASAM TRANEKSAMAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
33 ASIKLOVIR TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0 0
34 ASIKLOVIR TABLET 400 MG TAB
80 0 80 0 0 80 0 80 0 0
35 ASIKLOVIR KRIM 5 % TUB
3 0 3 0 0 3 0 3 0 0
36 ATAPULGIT TABLET 600 MG TAB
0 0 0 0 0 0 0 0 0 0
40 BETAHISTIN MESILAT TABLET 6 MG TAB
0 0 0 0 0 0 0 0 0 0
41 BETAMETASON KRIM 0,1 % TUB
5 0 5 0 0 5 0 5 0 0
46 DEKSAMETASON INJEKSI 5 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
47 DEKSAMETASON TABLET 0,5 MG TAB
160 0 160 0 0 160 0 160 0 0
52 DIFENHIDRAMIN HCL INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
56 DIMENHIDRINAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0 0
57 DOMPERIDON SIRUP 5 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
58 DOMPERIDON TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
59 EPINEPRIN HCL INJEKSI 0,1 % AMP
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

60 ERITROMISIN KAPSUL 500 MG KAP

0 0 0 0 0 0 0 0 0 0
61 ERITROMISIN SIRUP KERING 200 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
62 ETAKRIDIN LARUTAN 0,1 % BTL
2 0 2 0 0 2 0 2 0 0
63 ETANOL 70 % BTL
3 0 3 0 0 3 0 3 0 0
64 ETIL KLORIDA SEMPROT BTL
0 0 0 0 0 0 0 0 0 0
69 FENOL GLISEROL TETES TELINGA 10 % BTL
4 0 4 0 0 4 0 4 0 0
70 FITOMENADION INJEKSI 2 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
71 FITOMENADION INJEKSI 10 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
72 FITOMENADION TABLET SALUT 10 MG TAB
0 0 0 0 0 0 0 0 0 0
75 FUROSEMID INJEKSI 10 MG AMP
0 0 0 0 0 0 0 0 0 0
76 FUROSEMID TABLET 40 MG TAB
0 0 0 0 0 0 0 0 0 0
77 GARAM ORALIT KOMBINASI SAK
10 0 10 0 0 10 0 10 0 0
78 GEMFIBROZIL KAPSUL 300 MG KAP
0 0 0 0 0 0 0 0 0 0
79 GENTAMISIN INJEKSI 40 MG/ML AMP
0 0 0 0 0 0 0 0 0 0
80 GENTAMISIN TETES MATA 0,3 % BTL
0 0 0 0 0 0 0 0 0 0
81 GENTAMISIN SALEP KULIT 0,1 % TUB
0 0 0 0 0 0 0 0 0 0
82 GENTAMISIN SALEP MATA 0,3 % TUB
0 0 0 0 0 0 0 0 0 0
83 GENTIAN VIOLET LARUTAN 1 % BTL
0 0 0 0 0 0 0 0 0 0
84 GLIBENKLAMID TABLET 5 MG TAB
70 0 70 0 0 70 0 70 0 0
85 GLIMEPIRIDE TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0 0
86 GLUKOSA LARUTAN INFUS 5 % STERIL BTL
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

87 GLUKOSA LARUTAN INFUS 10 % STERIL BTL

0 0 0 0 0 0 0 0 0 0
88 GLUKOSA LARUTAN INFUS 40 % STERIL AMP
0 0 0 0 0 0 0 0 0 0
89 GRISEOFULVIN TABLET 125 MG TAB
0 0 0 0 0 0 0 0 0 0
96 HIDROKLORTIAZID TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0 0
97 HIDROKORTISON KRIM 2,5 % TUB
3 0 3 0 0 3 0 3 0 0
99 HIOSIN BUTILBROMIDA TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
100 IBUPROFEN SUSPENSI 100 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
101 IBUPROFEN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0 0
102 IBUPROFEN TABLET 400 MG TAB
150 0 150 0 0 150 0 150 0 0
103 INSULIN ANALOG LONG ACTING PEN
0 0 0 0 0 0 0 0 0 0
104 INSULIN ANALOG RAPID ACTING PEN
0 0 0 0 0 0 0 0 0 0
105 ISONIAZID TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0 0
106 ISONIAZID TABLET 300 MG TAB
0 0 0 0 0 0 0 0 0 0
107 ISOSORBID DINITRAT TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0 0
108 KALSIUM GLUKONAT INJEKSI 10 % AMP
0 0 0 0 0 0 0 0 0 0
109 KALSIUM LAKTAT TABLET 500 MG TAB
30 0 30 0 0 30 0 30 0 0
111 KAOLIN - PEKTIN SIRUP BTL
0 0 0 0 0 0 0 0 0 0
112 KAPTOPRIL TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0 0
113 KARBAMAZEPIN TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0 0
114 KETOKONAZOLE KRIM 2 % TUB
3 0 3 0 0 3 0 3 0 0
115 KETOKONAZOLE TABLET 200 MG TAB
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

116 KLINDAMISIN KAPSUL 300 MG KAP

0 0 0 0 0 0 0 0 0 0
120 KLORAMFENIKOL INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0 0
121 KLORAMFENIKOL KAPSUL 250 MG KAP
0 10 10 0 0 0 10 10 0 0
122 KLORAMFENIKOL SALEP MATA 1% TUB
3 0 3 0 0 3 0 3 0 0
123 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BTL
0 0 0 0 0 0 0 0 0 0
124 KLORAMFENIKOL TETES MATA 0,5 % BTL
0 0 0 0 0 0 0 0 0 0
125 KLORAMFENIKOL TETES TELINGA 3 % BTL
0 0 0 0 0 0 0 0 0 0
126 KLORFENIRAMIN MALEAT TABLET 4 MG TAB
240 0 240 0 0 240 0 240 0 0
132 KOTRIMOKSAZOL DEWASA TABLET TAB
0 0 0 0 0 0 0 0 0 0
133 KOTRIMOKSAZOL PEDIATRIK TABLET TAB
0 0 0 0 0 0 0 0 0 0
134 KOTRIMOKSAZOL SUSPENSI 240 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
135 KURKUMA SIRUP BTL
0 0 0 0 0 0 0 0 0 0
136 KURKUMA TABLET TAB
0 0 0 0 0 0 0 0 0 0
137 LAKTULOSA SIRUP BTL
0 0 0 0 0 0 0 0 0 0
138 LEVOFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
139 LEVOTIROKSIN TABLET 100 MCG TAB
0 0 0 0 0 0 0 0 0 0
140 LIDOKAIN KOMPOSITUM INJEKSI AMP
0 0 0 0 0 0 0 0 0 0
141 LIDOKAIN SPRAY ORAL 10 % BTL
0 0 0 0 0 0 0 0 0 0
142 LISINOPRIL TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0 0
143 LISINOPRIL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
144 LOPERAMID TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

145 LORATADIN TABLET 10 MG TAB

0 0 0 0 0 0 0 0 0 0
146 MAGNESIUM SULFAT INJEKSI / IV 20% - 25 ML AMP
0 0 0 0 0 0 0 0 0 0
147 MAGNESIUM SULFAT INJEKSI / IV 40% - 25 ML AMP
0 0 0 0 0 0 0 0 0 0
149 MEBENDAZOL TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0 0
150 MELOKSIKAM TABLET 15 MG TAB
0 0 0 0 0 0 0 0 0 0
151 METAMIZOL INJEKSI 500 MG / ML AMP
0 0 0 0 0 0 0 0 0 0
152 METFORMIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
153 METIL ERGOMETRIN INJEKSI 0,2 MG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
154 METIL ERGOMETRIN TABLET 0,125 MG TAB
0 0 0 0 0 0 0 0 0 0
155 METIL PREDNISOLON INJEKSI 125 MG AMP
0 0 0 0 0 0 0 0 0 0
156 METIL PREDNISOLON TABLET 4 MG TAB
0 0 0 0 0 0 0 0 0 0
157 METOKLOPRAMID INJEKSI 5 MG / ML AMP
0 0 0 0 0 0 0 0 0 0
158 METOKLOPRAMID TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
159 METRONIDAZOL INFUS 5 MG / ML BTL
0 0 0 0 0 0 0 0 0 0
160 METRONIDAZOL SIRUP 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
161 METRONIDAZOL TABLET 250 MG TAB
0 0 0 0 0 0 0 0 0 0
162 METRONIDAZOL TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
163 MIKONAZOL KRIM 2% TUB
0 0 0 0 0 0 0 0 0 0
165 MOMETASON FUROAT KRIM 0,1 % TUB
0 0 0 0 0 0 0 0 0 0
166 N-ASETIL SISTEIN KAPSUL 200 MG KAP
0 0 0 0 0 0 0 0 0 0
167 NASALIN SPRAY 100 ML BTL
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

168 NATRIUM BIKARBONAT INJEKSI 8,4 % AMP

0 0 0 0 0 0 0 0 0 0
169 NATRIUM BIKARBONAT TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
170 NATRIUM DIKLOFENAK 50 MG TAB
0 0 0 0 0 0 0 0 0 0
171 NATRIUM FOSFAT ENEMA TUB
0 0 0 0 0 0 0 0 0 0
172 NATRIUM FUSIDAT SALEP 20 MG / G TUB
0 0 0 0 0 0 0 0 0 0
173 NATRIUM KLORIDA LARUTAN INFUS 0,9 % BTL
0 0 0 0 0 0 0 0 0 0
174 NIFEDIPIN TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
175 NIFEDIPIN TABLET 30 MG SR TAB
0 0 0 0 0 0 0 0 0 0
176 NISTATIN 100.000 IU / G TABLET VAGINA TAB
0 0 0 0 0 0 0 0 0 0
177 NISTATIN 500.000 IU TABLET SALUT TAB
0 0 0 0 0 0 0 0 0 0
178 NISTATIN SUSPENSI 100.000 IU / ML BTL
0 20 20 0 0 0 20 20 0 0
179 NORETISTERON TABLET 5 MG TAB
0 0 0 0 0 0 0 0 0 0
184 OBAT BATUK HITAM SIRUP BTL
0 0 0 0 0 0 0 0 0 0
185 OKSIMETAZOLIN TETES HIDUNG 0,025 % BTL
0 0 0 0 0 0 0 0 0 0
186 OKSIMETAZOLIN TETES HIDUNG 0,05 % BTL
0 0 0 0 0 0 0 0 0 0
187 OKSITETRASIKLIN HCL IM 50 MG / ML - 10 ML AMP
0 0 0 0 0 0 0 0 0 0
188 OKSITETRASIKLIN HCL SALEP KULIT 3 % TUB
4 0 4 0 0 4 0 4 0 0
189 OKSITETRASIKLIN HCL SALEP MATA 1 % TUB
0 0 0 0 0 0 0 0 0 0
190 OKSITOSIN INJEKSI 10 IU / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
191 OMEPRAZOLE INJEKSI 40 MG VIAL
0 0 0 0 0 0 0 0 0 0
192 OMEPRAZOLE KAPSUL 20 MG KAP
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

195 PARASETAMOL DROPS 100 MG / ML BTL

0 0 0 0 0 0 0 0 0 0
196 PARASETAMOL INFUS 10 MG / ML BTL
0 0 0 0 0 0 0 0 0 0
197 PARASETAMOL SIRUP 120 MG / 5 ML BTL
3 0 3 0 0 3 0 3 0 0
198 PARASETAMOL TABLET 500 MG TAB
390 0 390 0 0 390 0 390 0 0
199 PERAK SULFADIAZIN KRIM 1% TUB
0 0 0 0 0 0 0 0 0 0
200 PERMETRIN KRIM 5% TUB
0 0 0 0 0 0 0 0 0 0
202 PILOKARPIN HCL NITRAT TETES MATA 2 % BTL
0 0 0 0 0 0 0 0 0 0
204 PIRACETAM TABLET 400 MG TAB
0 0 0 0 0 0 0 0 0 0
205 PIRANTEL PAMOAT TABLET 125 MG TAB
0 0 0 0 0 0 0 0 0 0
206 PIRANTEL SUSPENSI 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
207 PIRIDOKSIN HCL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
208 PREDNISON TABLET 5 MG TAB
400 50 450 0 0 400 50 450 0 0
209 PROKAIN BENZIL PENISILLIN INJEKSI 3 JUTA UI VIAL
0 0 0 0 0 0 0 0 0 0
210 PROPILTIOURASIL TABLET 100 MG TAB
0 0 0 0 0 0 0 0 0 0
211 PROPRANOLOL TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
212 PROPRANOLOL TABLET 40 MG TAB
0 0 0 0 0 0 0 0 0 0
213 PSEUDOEFEDRIN SIRUP BTL
0 0 0 0 0 0 0 0 0 0
215 RANITIDIN TABLET 150 MG TAB
0 0 0 0 0 0 0 0 0 0
216 RETINOL KAPSUL 100.000 IU KAP
0 0 0 0 0 0 0 0 0 0
217 RETINOL KAPSUL 200.000 IU KAP
0 0 0 0 0 0 0 0 0 0
218 RIFAMPISIN TABLET 450 MG TAB
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

219 RIFAMPISIN TABLET 600 MG TAB

0 0 0 0 0 0 0 0 0 0
220 RINGER LAKTAT LARUTAN INFUS STERIL BTL
0 0 0 0 0 0 0 0 0 0
221 RISPERIDON TABLET 2 MG TAB
0 0 0 0 0 0 0 0 0 0
222 SALBUTAMOL INHALASI BTL
0 0 0 0 0 0 0 0 0 0
223 SALBUTAMOL NEBUL AMP
0 0 0 0 0 0 0 0 0 0
224 SALBUTAMOL TABLET 4 MG TAB
0 0 0 0 0 0 0 0 0 0
225 SALEP 2 - 4 KOMBINASI TUB
2 0 2 0 0 2 0 2 0 0
226 SALISIL BEDAK 2 % KTK
0 0 0 0 0 0 0 0 0 0
227 SALISIL SPIRITUS 10 % BTL
0 0 0 0 0 0 0 0 0 0
228 SEFADROKSIL KAPSUL 500 MG KAP
0 0 0 0 0 0 0 0 0 0
229 SEFADROKSIL SIRUP KERING 125 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
230 SEFOTAKSIM SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0 0
231 SEFTRIAXON SERBUK INJEKSI 1000 MG VIAL
0 0 0 0 0 0 0 0 0 0
234 SETIRIZIN SYR 5 MG / 5ML TAB
0 0 0 0 0 0 0 0 0 0
235 SETIRIZIN TABLET 10 MG BTL
0 0 0 0 0 0 0 0 0 0
236 SIANOKOBALAMIN INJEKSI 500 MCG / ML AMP
0 0 0 0 0 0 0 0 0 0
237 SIMVASTATIN TABLET 10 MG TAB
0 0 0 0 0 0 0 0 0 0
238 SIMVASTATIN TABLET 20 MG TAB
0 0 0 0 0 0 0 0 0 0
239 SIPROFLOKSASIN TABLET 500 MG TAB
0 0 0 0 0 0 0 0 0 0
240 SPIRONOLAKTON TABLET 25 MG TAB
0 0 0 0 0 0 0 0 0 0
241 SULFASETAMID NATRIUM TETES MATA 15 % BTL
3 0 3 0 0 3 0 3 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

242 TABLET TAMBAH DARAH KOMBINASI TAB

1,270 0 1,270 0 0 1,270 0 1,270 0 0
244 TETRAKAIN HCL TETES MATA 0,5% BTL
0 0 0 0 0 0 0 0 0 0
245 TETRASIKLIN HCL KAPSUL 250 MG KAP
0 0 0 0 0 0 0 0 0 0
246 TIAMIN HCL INJEKSI 1.000 MCG / ML - 1 ML AMP
0 0 0 0 0 0 0 0 0 0
247 TIAMIN HCL MONONITRAT TABLET 50 MG TAB
0 0 0 0 0 0 0 0 0 0
250 UREA KRIM 10% TUB
0 0 0 0 0 0 0 0 0 0
251 VALPROAT SIRUP 250 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
252 VITAMIN B KOMPLEKS TABLET TAB
160 0 160 0 0 160 0 160 0 0
253 VITAMIN NEUROTROPIK INJEKSI AMP
0 0 0 0 0 0 0 0 0 0
254 WIDA BES BTL
0 0 0 0 0 0 0 0 0 0
255 YODIUM POVIDON GARGLE 240 ML BTL
0 0 0 0 0 0 0 0 0 0
256 YODIUM POVIDON LARUTAN 10 % 30 ML BTL
0 0 0 0 0 0 0 0 0 0
257 YODIUM POVIDON LARUTAN 10 % 300 ML BTL
0 0 0 0 0 0 0 0 0 0
258 ZINK DROPS 10 MG / ML BTL
0 0 0 0 0 0 0 0 0 0
259 ZINK SIRUP 20 MG / 5 ML BTL
0 0 0 0 0 0 0 0 0 0
260 ZINK TABLET 20 MG TAB
0 0 0 0 0 0 0 0 0 0
390 TEST HAMIL URINE / HCG TEST TEST
0 0 0 0 0 0 0 0 0 0
D. BAHAN MEDIS PAKAI HABIS
0 0 0 0
418 ALAT SUNTIK SEKALI PAKAI 0,05 ML SET
0 0 0 0 0 0 0 0 0 0
419 ALAT SUNTIK SEKALI PAKAI 0,5 ML SET
0 0 0 0 0 0 0 0 0 0
420 ALAT SUNTIK SEKALI PAKAI 1 ML SET
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

421 ALAT SUNTIK SEKALI PAKAI 10 ML SET

0 0 0 0 0 0 0 0 0 0
422 ALAT SUNTIK SEKALI PAKAI 3 ML SET
7 0 7 0 0 7 0 7 0 0
423 ALAT SUNTIK SEKALI PAKAI 5 ML SET
8 0 8 0 0 8 0 8 0 0
424 ALAT SUNTIK SEKALI PAKAI 20 ML SET
0 0 0 0 0 0 0 0 0 0
425 ALAT SUNTIK SEKALI PAKAI 50 ML SET
0 0 0 0 0 0 0 0 0 0
426 ALKOHOL SWAB BJ
0 0 0 0 0 0 0 0 0 0
427 ANTISEPTIK HANDRUB BTL
0 0 0 0 0 0 0 0 0 0
428 ANTISEPTIK HANDSCRUB BTL
0 0 0 0 0 0 0 0 0 0
429 APRON PLASTIK PCS
0 0 0 0 0 0 0 0 0 0
430 BIST MESS BJ
0 0 0 0 0 0 0 0 0 0
431 BLOOD LANCET 26 G / 28 G SET
0 0 0 0 0 0 0 0 0 0
432 BLOOD SET SET
0 0 0 0 0 0 0 0 0 0
435 CATGUT CHROMIC NO. 3/0 SACHET
0 0 0 0 0 0 0 0 0 0
436 CATGUT CHROMIC NO. 4/0 SACHET
0 0 0 0 0 0 0 0 0 0
437 CATGUT PLAIN / BENANG BEDAH NO. 2/0 SACHET
0 0 0 0 0 0 0 0 0 0
438 CATGUT PLAIN / BENANG BEDAH NO. 3/0 SACHET
3 0 3 0 0 3 0 3 0 0
441 FOLLEY CATHETER 2 WAY NO. 16 SET
0 0 0 0 0 0 0 0 0 0
442 FOLLEY CATHETER 2 WAY NO. 18 SET
0 0 0 0 0 0 0 0 0 0
444 ID BAND PCS
0 0 0 0 0 0 0 0 0 0
445 INFUS SET ANAK SET
0 0 0 0 0 0 0 0 0 0
446 INFUS SET DEWASA SET
1 0 1 0 0 1 0 1 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

447 IV CATHETER NO. 18 SET

2 0 2 0 0 2 0 2 0 0
448 IV CATHETER NO. 20 SET
0 0 0 0 0 0 0 0 0 0
449 IV CATHETER NO. 22 SET
0 0 0 0 0 0 0 0 0 0
450 IV CATHETER NO. 24 SET
0 0 0 0 0 0 0 0 0 0
451 IV CATHETER NO. 26 SET
0 0 0 0 0 0 0 0 0 0
452 JARUM JAHIT / BEDAH NO. 9 S/D 14 BJ
0 0 0 0 0 0 0 0 0 0
454 KAPAS BERLEMAK 500 GRAM ROL
0 0 0 0 0 0 0 0 0 0
455 KAPAS PEMBALUT / ABSORBEN 250 GRAM ROL
1 0 1 0 0 1 0 1 0 0
457 KASA 16x16 PCS
0 0 0 0 0 0 0 0 0 0
458 KASA 40X80 ROL
0 0 0 0 0 0 0 0 0 0
459 KASA HIDROFIL STERIL UKURAN 18 M X22 CM ROL
0 0 0 0 0 0 0 0 0 0
460 KASA KOMPRES 40/40 STERIL ROL
0 0 0 0 0 0 0 0 0 0
461 KASA PEMBALUT 2 M X 80 CM ROL
0 0 0 0 0 0 0 0 0 0
462 KASA PEMBALUT ELASTIS 4 INCI ROL
0 0 0 0 0 0 0 0 0 0
463 KASA PEMBALUT HIDROFIL 4 M X 10 CM ROL
0 0 0 0 0 0 0 0 0 0
464 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL
0 0 0 0 0 0 0 0 0 0
465 KASA PEMBALUT HIDROFIL 4 M X 3 CM ROL
0 0 0 0 0 0 0 0 0 0
466 KASA PEMBALUT HIDROFIL 4 M X 5 CM ROL
0 0 0 0 0 0 0 0 0 0
467 KASA PERAWATAN LUKA LBR
0 0 0 0 0 0 0 0 0 0
468 KASET WITH SCREEN GREEN PKT
0 0 0 0 0 0 0 0 0 0
469 KERTAS EKG 80 MM X 30 M ROL
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

470 MASKER PCS

0 0 0 0 0 0 0 0 0 0
471 MASKER N95 PCS
0 0 0 0 0 0 0 0 0 0
484 NURSE CAP PCS
0 0 0 0 0 0 0 0 0 0
485 PEMBALUT GIPS 4 INCI ROL
0 0 0 0 0 0 0 0 0 0
486 PLESTER 5 CM x 5 M ROL
0 0 0 0 0 0 0 0 0 0
487 PLESTER 10 CM X 5 M ROL
0 0 0 0 0 0 0 0 0 0
488 PLESTER 15 CM X 5 M ROL
0 0 0 0 0 0 0 0 0 0
489 PLESTER BULAT NON WOVEN PCS
0 0 0 0 0 0 0 0 0 0
490 PLESTER KAIN 7,5 X 4,5 M ROL
0 0 0 0 0 0 0 0 0 0
491 POT SPUTUM SET
0 0 0 0 0 0 0 0 0 0
492 POT URINE SET
0 0 0 0 0 0 0 0 0 0
493 SAFETY BOX 2,5 L KTK
0 0 0 0 0 0 0 0 0 0
494 SAFETY BOX 5 L KTK
0 0 0 0 0 0 0 0 0 0
495 SARUNG TANGAN KEBIDANAN (PANJANG) PSG
0 0 0 0 0 0 0 0 0 0
496 SARUNG TANGAN KERJA (TEBAL) M - L PSG
0 0 0 0 0 0 0 0 0 0
497 SARUNG TANGAN NON STERIL PSG
0 0 0 0 0 0 0 0 0 0
498 SARUNG TANGAN STERIL PSG
0 0 0 0 0 0 0 0 0 0
501 SENDOK SIRUP PCS
0 0 0 0 0 0 0 0 0 0
502 SILK / BENANG SUTERA NO. 3/0 SACHET
0 0 0 0 0 0 0 0 0 0
503 SLIM ZUIKER / MUCUS EXTRACTOR SET
0 0 0 0 0 0 0 0 0 0
508 SURGICAL GOWN PCS
0 0 0 0 0 0 0 0 0 0
 STOK AWAL PENERIMAAN PEMAKAIAN STOK AKHIR

STOK PERMINT PEMBERI

NO. NAMA OBAT SATUAN KETR.
OPT AAN AN
APBD APBD JKN
APBD JKN TOTAL JKN TOTAL TOTAL APBD JKN TOTAL
PELAYAN PELAYAN
IFK EXPIRED EXPIRED
AN AN

1 2 3 4 5 6=4+5 7 10 11=9+10 12 14 16 17 19=15+18 20 21 22=20+21 23 24 25 26

516 UNDERPAD LBR

1 0 1 0 0 1 0 1 0 0
517 URINE BAG STERIL LBR
0 0 0 0 0 0 0 0 0 0
518 USG GEL TUB
0 0 0 0 0 0 0 0 0 0

JUMLAH KUNJUNGAN RESEP

KTP

BPJS

TUBAN, 2021

MENGETAHUI / MENYETUJUI : YANG MENYERAHKAN YANG MENERIMA/MELAPOR

KEPALA PUSKESMAS PLUMPANG

dr H BOEDI WINOTO LESTI E. P., S.Farm., Apt.

NIP 19640723 199602 1 001 NIP. 199007042019032021

JKN

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
TAHUN 2021

NON
NO. NAMA OBAT SATUAN FORNAS KETERANGAN
FORNAS

1 2 3 4 5 6
A. OBAT ESSENSIAL
1 ALBENDAZOL TABLET 400 MG TAB 1
2 ALBENDAZOL SUSPENSI 200 MG / 5 ML BTL 1
3 ALOPURINOL TABLET 100 MG TAB 1
4 AMBROKSOL TABLET 30 MG TAB 1
5 AMINOFILLIN INJEKSI 24 MG / ML - 10 ML AMP 1 PP
6 AMINOFILLIN TABLET 200 MG TAB 1
7 AMITRIPTILIN TABLET SALUT 25 MG TAB 1
8 AMLODIPIN TABLET 10 MG TAB 1
9 AMLODIPIN TABLET 5 MG TAB 1
10 AMOKSISILIN KAPLET 500 MG KAPL 1
11 AMOKSISILIN KAPSUL 250 MG KAP 1
12 AMOKSISILIN SERBUK INJEKSI 1 GRAM VIAL 1
13 AMOKSISILIN SIRUP KERING 125 MG / 5 ML BTL 1
14 AMPISILIN SERBUK INJEKSI 1 GRAM VIAL 1 PP
15 AMPISILIN SIRUP KERING 125 MG / 5 ML BTL 1
16 ANTASIDA DOEN SUSPENSI BTL 1
17 ANTASIDA DOEN TABLET KOMBINASI TAB 1
18 ANTI BAKTERI DOEN SALEP KOMBINASI TUB 1
19 ANTI FUNGI DOEN KOMBINASI POT 1
20 ANTI HEMORRHOID SUPPOSUTORIA SUPP 1
21 ANTI INFEKSI KRIM TUB 1
22 ANTI MIGRAIN DOEN TABLET KOMBINASI TAB 1
23 AQUA PRO INJEKSI STERIL BEBAS PIROGEN AMP 1
24 ASAM ASETIL SALISILAT TABLET 80 MG TAB 1
25 ASAM ASKORBAT TABLET 250 MG TAB 1
26 ASAM ASKORBAT TABLET 50 MG TAB 1
27 ASAM ASKORBAT TABLET 500 MG TAB 1
28 ASAM FOLAT TABLET 0,4 MG TAB 1
29 ASAM MEFENAMAT TABLET 500 MG TAB 1
30 ASAM TRANEKSAMAT INJEKSI 50 MG / ML AMP 1 23
31 ASAM TRANEKSAMAT TABLET 500 MG TAB 1 23
32 ASERING INFUS BTL 1
33 ASIKLOVIR TABLET 200 MG TAB 1
34 ASIKLOVIR TABLET 400 MG TAB 1
35 ASIKLOVIR KRIM 5 % TUB 1
36 ATAPULGIT TABLET 600 MG TAB 1
37 ATROPIN SULFAT INJEKSI 0,25 MG / ML - 1 ML AMP 1
38 ATROPIN SULFAT TABLET 0,5 MG TAB 1
39 AZITROMISIN TABLET 500 MG TAB 1 23
40 BETAHISTIN MESILAT TABLET 6 MG TAB 1
41 BETAMETASON KRIM 0,1 % TUB 1
42 BISAKODIL SUPPOSUTORIA 10 MG SUPP 1
43 BISAKODIL TABLET 5 MG TAB 1
44 BISOPROLOL TABLET 2,5 MG TAB 1 23 RB
45 BISOPROLOLTABLET 5 MG TAB 1 23 RB
46 DEKSAMETASON INJEKSI 5 MG / ML - 1 ML AMP 1
47 DEKSAMETASON TABLET 0,5 MG TAB 1
48 DEKSTRAN 70 LARUTAN INFUS STERIL BTL 1
49 DIAZEPAM ENEMA 5 MG / 2,5 ML TUB 1
50 DIAZEPAM INJEKSI 5 MG / ML - 2 ML AMP 1
51 DIAZEPAM TABLET 2 MG TAB 1
52 DIFENHIDRAMIN HCL INJEKSI 10 MG / ML - 1 ML AMP 1
53 DIGOKSIN TABLET 0,25 MG TAB 1 23 RB
54 DILTIAZEM KAPSUL 100 MG SR KAP 1 23 RB
55 DILTIAZEM TABLET 30 MG TAB 1 23 RB
56 DIMENHIDRINAT TABLET 50 MG TAB 1
57 DOMPERIDON SIRUP 5 MG / 5 ML BTL 1
58 DOMPERIDON TABLET 10 MG TAB 1
59 EPINEPRIN HCL INJEKSI 0,1 % AMP 1
60 ERITROMISIN KAPSUL 500 MG KAP 1
61 ERITROMISIN SIRUP KERING 200 MG / 5 ML BTL 1
62 ETAKRIDIN LARUTAN 0,1 % BTL 1
63 ETANOL 70 % BTL 1
64 ETIL KLORIDA SEMPROT BTL 1
65 FENITOIN NATRIUM KAPSUL 100 MG KAP 1
66 FENITOIN INJEKSI 50 MG / ML AMP 1
67 FENOBARBITAL INJEKSI 50 MG / ML - 2 ML AMP 1
68 FENOBARBITAL TABLET 30 MG TAB 1
69 FENOL GLISEROL TETES TELINGA 10 % BTL 1
70 FITOMENADION INJEKSI 2 MG / ML - 1 ML AMP 1
71 FITOMENADION INJEKSI 10 MG / ML - 1 ML AMP 1
72 FITOMENADION TABLET SALUT 10 MG TAB 1
73 FLUFENAZIN INJEKSI 25 MG / ML AMP 1 23 RB
74 FLUOKSETIN KAPSUL 10 MG KAP 1
75 FUROSEMID INJEKSI 10 MG AMP 1
76 FUROSEMID TABLET 40 MG TAB 1
77 GARAM ORALIT KOMBINASI SAK 1
78 GEMFIBROZIL KAPSUL 300 MG KAP 1 23
79 GENTAMISIN INJEKSI 40 MG/ML AMP 1 23
80 GENTAMISIN TETES MATA 0,3 % BTL 1
81 GENTAMISIN SALEP KULIT 0,1 % TUB 1
82 GENTAMISIN SALEP MATA 0,3 % TUB 1
83 GENTIAN VIOLET LARUTAN 1 % BTL 1
84 GLIBENKLAMID TABLET 5 MG TAB 1
85 GLIMEPIRIDE TABLET 2 MG TAB 1
86 GLUKOSA LARUTAN INFUS 5 % STERIL BTL 1
87 GLUKOSA LARUTAN INFUS 10 % STERIL BTL 1
88 GLUKOSA LARUTAN INFUS 40 % STERIL AMP 1
89 GRISEOFULVIN TABLET 125 MG TAB 1
90 HALOPERIDOL DROPS 2 MG / ML BTL 1
91 HALOPERIDOL INJEKSI 5 MG / ML AMP 1
92 HALOPERIDOL INJEKSI 50 MG / ML AMP 1 23 RB
93 HALOPERIDOL TABLET 0,5 MG TAB 1 23 RB
94 HALOPERIDOL TABLET 1,5 MG TAB 1
95 HALOPERIDOL TABLET 5 MG TAB 1
96 HIDROKLORTIAZID TABLET 25 MG TAB 1
97 HIDROKORTISON KRIM 2,5 % TUB 1
98 HIOSIN BUTILBROMIDA INJEKSI 20 MG / ML AMP 1 23
99 HIOSIN BUTILBROMIDA TABLET 10 MG TAB 1
100 IBUPROFEN SUSPENSI 100 MG / 5 ML BTL 1
101 IBUPROFEN TABLET 200 MG TAB 1
102 IBUPROFEN TABLET 400 MG TAB 1
103 INSULIN ANALOG LONG ACTING PEN 1 23 RB
104 INSULIN ANALOG RAPID ACTING PEN 1 23 RB
105 ISONIAZID TABLET 100 MG TAB 1
106 ISONIAZID TABLET 300 MG TAB 1
107 ISOSORBID DINITRAT TABLET 5 MG TAB 1
108 KALSIUM GLUKONAT INJEKSI 10 % AMP 1
109 KALSIUM LAKTAT TABLET 500 MG TAB 1
110 KANAMISIN INJEKSI 1000 MG VIAL 1 23
111 KAOLIN - PEKTIN SIRUP BTL 1
112 KAPTOPRIL TABLET 25 MG TAB 1
113 KARBAMAZEPIN TABLET 200 MG TAB 1
114 KETOKONAZOLE KRIM 2 % TUB 1
115 KETOKONAZOLE TABLET 200 MG TAB 1
116 KLINDAMISIN KAPSUL 300 MG KAP 1
117 KLOBAZAM TABLET 10 MG TAB 1 23
118 KLONIDIN INJEKSI 0,15 MG / ML AMP 1 23
119 KLONIDIN TABLET 0,15 MG TAB 1 23 RB
120 KLORAMFENIKOL INJEKSI 1000 MG VIAL 1 PP
121 KLORAMFENIKOL KAPSUL 250 MG KAP 1
122 KLORAMFENIKOL SALEP MATA 1% TUB 1
123 KLORAMFENIKOL SUSPENSI 125 MG/5 ML BTL 1
124 KLORAMFENIKOL TETES MATA 0,5 % BTL 1
125 KLORAMFENIKOL TETES TELINGA 3 % BTL 1
126 KLORFENIRAMIN MALEAT TABLET 4 MG TAB 1
127 KLORPROMAZIN HCL INJEKSI 25 MG / ML - 1 ML AMP 1
128 KLORPROMAZIN HCL TABLET SALUT 100 MG TAB 1 23 RB
129 KLORPROMAZIN HCL TABLET SALUT 25 MG TAB 1
130 KLOZAPIN TABLET 25 MG TAB 1 23
131 KODEIN HCL TABLET 10 MG TAB 1
132 KOTRIMOKSAZOL DEWASA TABLET TAB 1
133 KOTRIMOKSAZOL PEDIATRIK TABLET TAB 1
134 KOTRIMOKSAZOL SUSPENSI 240 MG / 5 ML BTL 1
135 KURKUMA SIRUP BTL 1
136 KURKUMA TABLET TAB 1
137 LAKTULOSA SIRUP BTL 1
138 LEVOFLOKSASIN TABLET 500 MG TAB 1 23
139 LEVOTIROKSIN TABLET 100 MCG TAB 1 23
140 LIDOKAIN KOMPOSITUM INJEKSI AMP 1
141 LIDOKAIN SPRAY ORAL 10 % BTL 1
142 LISINOPRIL TABLET 5 MG TAB 1
143 LISINOPRIL TABLET 10 MG TAB 1
144 LOPERAMID TABLET 2 MG TAB 1 23
145 LORATADIN TABLET 10 MG TAB 1
146 MAGNESIUM SULFAT INJEKSI / IV 20% - 25 ML AMP 1
147 MAGNESIUM SULFAT INJEKSI / IV 40% - 25 ML AMP 1
148 MANITOL INFUS BTL 1
149 MEBENDAZOL TABLET 100 MG TAB 1
150 MELOKSIKAM TABLET 15 MG TAB 1
151 METAMIZOL INJEKSI 500 MG / ML AMP 1 23
152 METFORMIN TABLET 500 MG TAB 1
153 METIL ERGOMETRIN INJEKSI 0,2 MG / ML - 1 ML AMP 1
154 METIL ERGOMETRIN TABLET 0,125 MG TAB 1
155 METIL PREDNISOLON INJEKSI 125 MG AMP 1 PP
156 METIL PREDNISOLON TABLET 4 MG TAB 1 23 RB
157 METOKLOPRAMID INJEKSI 5 MG / ML AMP 1
158 METOKLOPRAMID TABLET 10 MG TAB 1
159 METRONIDAZOL INFUS 5 MG / ML BTL 1 23
160 METRONIDAZOL SIRUP 125 MG / 5 ML BTL 1
161 METRONIDAZOL TABLET 250 MG TAB 1
162 METRONIDAZOL TABLET 500 MG TAB 1
163 MIKONAZOL KRIM 2% TUB 1
164 MINERAL MIXTURE SACHET 1
165 MOMETASON FUROAT KRIM 0,1 % TUB 1
166 N-ASETIL SISTEIN KAPSUL 200 MG KAP 1
167 NASALIN SPRAY 100 ML BTL 1
168 NATRIUM BIKARBONAT INJEKSI 8,4 % AMP 1 23
169 NATRIUM BIKARBONAT TABLET 500 MG TAB 1
170 NATRIUM DIKLOFENAK 50 MG TAB 1
171 NATRIUM FOSFAT ENEMA TUB 1
172 NATRIUM FUSIDAT SALEP 20 MG / G TUB 1 23
173 NATRIUM KLORIDA LARUTAN INFUS 0,9 % BTL 1
174 NIFEDIPIN TABLET 10 MG TAB 1 23 RB
175 NIFEDIPIN TABLET 30 MG SR TAB 1 23 RB
176 NISTATIN 100.000 IU / G TABLET VAGINA TAB 1
177 NISTATIN 500.000 IU TABLET SALUT TAB 1
178 NISTATIN SUSPENSI 100.000 IU / ML BTL 1
179 NORETISTERON TABLET 5 MG TAB 1 23
180 OBAT ANTI TUBERKULOSIS ANAK PKT 1
181 OBAT ANTI TUBERKULOSIS KATEGORI 1 PKT 1
182 OBAT ANTI TUBERKULOSIS KATEGORI 2 PKT 1
183 OBAT ANTI TUBERKULOSIS KOMBIPAK PKT 1
184 OBAT BATUK HITAM SIRUP BTL 1
185 OKSIMETAZOLIN TETES HIDUNG 0,025 % BTL 1
186 OKSIMETAZOLIN TETES HIDUNG 0,05 % BTL 1
187 OKSITETRASIKLIN HCL IM 50 MG / ML - 10 ML AMP 1 23
188 OKSITETRASIKLIN HCL SALEP KULIT 3 % TUB 1
189 OKSITETRASIKLIN HCL SALEP MATA 1 % TUB 1
190 OKSITOSIN INJEKSI 10 IU / ML - 1 ML AMP 1
191 OMEPRAZOLE INJEKSI 40 MG VIAL 1
192 OMEPRAZOLE KAPSUL 20 MG KAP 1
193 PAN AMIN G SOFTBAG 1 23
194 PARAFORMALDEHIDA TABLET 1 G TAB 1
195 PARASETAMOL DROPS 100 MG / ML BTL 1
196 PARASETAMOL INFUS 10 MG / ML BTL 1 3
197 PARASETAMOL SIRUP 120 MG / 5 ML BTL 1
198 PARASETAMOL TABLET 500 MG TAB 1
199 PERAK SULFADIAZIN KRIM 1% TUB 1
200 PERMETRIN KRIM 5% TUB 1
201 PETIDIN INJEKSI 50 MG / ML - 2 ML AMP 1 23
202 PILOKARPIN HCL NITRAT TETES MATA 2 % BTL 1
203 PIRACETAM INJEKSI 1 GR / 5 ML AMP 1
204 PIRACETAM TABLET 400 MG TAB 1
205 PIRANTEL PAMOAT TABLET 125 MG TAB 1
206 PIRANTEL SUSPENSI 125 MG / 5 ML BTL 1
207 PIRIDOKSIN HCL TABLET 10 MG TAB 1
208 PREDNISON TABLET 5 MG TAB 1
209 PROKAIN BENZIL PENISILLIN INJEKSI 3 JUTA UI VIAL 1
210 PROPILTIOURASIL TABLET 100 MG TAB 1 23
211 PROPRANOLOL TABLET 10 MG TAB 1
212 PROPRANOLOL TABLET 40 MG TAB 1 23
213 PSEUDOEFEDRIN SIRUP BTL 1
214 RANITIDIN INJEKSI 25 MG / ML AMP 1 23
215 RANITIDIN TABLET 150 MG TAB 1
216 RETINOL KAPSUL 100.000 IU KAP 1
217 RETINOL KAPSUL 200.000 IU KAP 1
218 RIFAMPISIN TABLET 450 MG TAB 1 23
219 RIFAMPISIN TABLET 600 MG TAB 1 23
220 RINGER LAKTAT LARUTAN INFUS STERIL BTL 1
221 RISPERIDON TABLET 2 MG TAB 1 23 RB
222 SALBUTAMOL INHALASI BTL 1 23
223 SALBUTAMOL NEBUL AMP 1
224 SALBUTAMOL TABLET 4 MG TAB 1
225 SALEP 2 - 4 KOMBINASI TUB 1
226 SALISIL BEDAK 2 % KTK 1
227 SALISIL SPIRITUS 10 % BTL 1
228 SEFADROKSIL KAPSUL 500 MG KAP 1 PP
229 SEFADROKSIL SIRUP KERING 125 MG / 5 ML BTL 1 PP
230 SEFOTAKSIM SERBUK INJEKSI 1000 MG VIAL 1 23
231 SEFTRIAXON SERBUK INJEKSI 1000 MG VIAL 1 23
232 SERUM ANTI BISA ULAR INJEKSI 5 ML VIAL 1
233 SERUM ANTI TETANUS INJEKSI 1.500 IU / ML AMP 1
234 SETIRIZIN SYR 5 MG / 5ML TAB 1
235 SETIRIZIN TABLET 10 MG BTL 1
236 SIANOKOBALAMIN INJEKSI 500 MCG / ML AMP 1
237 SIMVASTATIN TABLET 10 MG TAB 1
238 SIMVASTATIN TABLET 20 MG TAB 1
239 SIPROFLOKSASIN TABLET 500 MG TAB 1
240 SPIRONOLAKTON TABLET 25 MG TAB 1
241 SULFASETAMID NATRIUM TETES MATA 15 % BTL 1
242 TABLET TAMBAH DARAH KOMBINASI TAB 1
243 TABURIA 1 GRAM SACHET 1
244 TETRAKAIN HCL TETES MATA 0,5% BTL 1
245 TETRASIKLIN HCL KAPSUL 250 MG KAP 1
246 TIAMIN HCL INJEKSI 1.000 MCG / ML - 1 ML AMP 1
247 TIAMIN HCL MONONITRAT TABLET 50 MG TAB 1
248 TRIFLUOPERAZIN TABLET 5 MG TAB 1 23 RB
249 TRIHEKSIFENIDIL HCL TABLET 2 MG TAB 1 23 RB
250 UREA KRIM 10% TUB 1
251 VALPROAT SIRUP 250 MG / 5 ML BTL 1
252 VITAMIN B KOMPLEKS TABLET TAB 1
253 VITAMIN NEUROTROPIK INJEKSI AMP 1
254 WIDA BES BTL 1
255 YODIUM POVIDON GARGLE 240 ML BTL 1
256 YODIUM POVIDON LARUTAN 10 % 30 ML BTL 1
257 YODIUM POVIDON LARUTAN 10 % 300 ML BTL 1
258 ZINK DROPS 10 MG / ML BTL 1
259 ZINK SIRUP 20 MG / 5 ML BTL 1
260 ZINK TABLET 20 MG TAB 1
261 AIR RAKSA DENTAL USE BTL 1
262 CHLORPHENOL KAMFER MENTHOL (CHKM) BTL 1
263 DEVITALISASI PASTA ( NON ARSEN ) BTL 1
264 EUGENOL CAIRAN BTL 1
265 FORMOKRESOL CAIRAN BTL 1
266 GLASS IONOMER ART BTL 1
267 KALSIUM HIDROKSIDA PASTA BTL 1
268 MUMMIFYING PASTA BTL 1
269 SEMEN SENG FOSFAT SERBUK DAN CAIRAN BTL 1
270 TEMPORARY STOPPING FLETCHER SET 1
271 TUMPATAN SEMENTARA BTL 1
272 ABACAVIR 300 MG TAB 1
273 DOLUTEGAVIR 50 MG TAB 1
274 EFAVIRENZ 600 MG TAB 1
275 LAMIVUDINE 150 MG TAB 1
276 LOPINAVIR 200 MG + RITONAVIR 50 MG TAB 1
277 NEVIRAPINE 200 MG TAB 1
278 TENOFOVIR 300 MG TAB 1
279 TENOVOFIR 300 MG + EMTRICITABINE 200 MG TAB 1
TENOFOVIR 300 MG + LAMIVUDIN 300 MG +
280
DOLUTEGAVIR 50 MG TAB 1
TENOFOVIR 300 MG + LAMIVUDIN 300 MG +
281 EFAVIRENZ 600 MG (TRIPLE FDC) TAB
DEWASA 1
282 ZIDOFUDINE 100 MG TAB 1
283 ZIDOFUDINE SIRUP BTL 1
284 ZIDOFUDINE 300 MG + LAMIVUDINE 150 MG TAB 1
ZIDOFUDINE 60 MG + LAMIVUDINE 30 MG +
285 TAB
NEVIRAPINE 50 MG (TRIPLE FDC) ANAK 1
286 LAMPRENE TABLET 100 MG TAB 1
287 MB ANAK BLISTER 1
288 MB DEWASA BLISTER 1
289 PB ANAK BLISTER 1
290 PB DEWASA BLISTER 1
291 ANTI DIFTERI SERUM 10.000 IU VIAL 1
292 BCG 20 DOSIS VIAL 1
293 CAMPAK 10 DOSIS VIAL 1
294 CORONAVAC VIAL 1
295 DPT-HB-Hib 5 DOSIS VIAL 1
296 DT 10 DOSIS VIAL 1
297 HEPATITIS B VIAL 1
298 HEPATITIS B IMUNOGLOBULIN (Hbig) VIAL 1
299 IPV 10 DOSIS VIAL 1
300 MEASLES RUBELLA (MR) VIAL 1
301 MENINGITIS VIAL 1
302 POLIO b-OPV 10 DOSIS VIAL 1
303 POLIO t-OPV 10 DOSIS VIAL 1
304 POLIO t-OPV 20 DOSIS VIAL 1
305 Td 10 DOSIS VIAL 1
306 TT 10 DOSIS VIAL 1
307 ARTESUNATE INJEKSI 60 MG VIAL 1
308 DIHIDROARTEMISIN 40 MG + PIPERAKUIN 320 MG TAB 1
309 KUININ 222 MG TAB 1
310 PRIMAKUIN 15 MG TAB 1
% KESESUAIAN FORNAS 226 84 72.90

KETERANGAN :
PP = Puskesmas Perawatan
3 = Faskes Tingkat 3
23 = Faskes Tingkat 2 dan 3
RB = Rujuk Balik