C 00

0 00
po O
o o

zo
 VI

0 0 0 0
5• 0
또. 별. 2 0
0
0 3
그. 그.Z Z 2
그 0 0 0 0
VI 0
 MONITORING OBAT GADAR PERSEDIAAN UGD VK
UPT PUSKESMAS KRAMATWATU
BULAN:
No Nama Obat Satuan Jumlah Sisa Stok Jumlah
Standar Aktual pengganti
Atro in Sulfat in•eksi 0,25m ml Am ul 5
9
2 Deksamethason in•eksi 5m ml Am ul CD
10

3 E inefrinHCI Am ul 5 S-

4 Fitomenadion in•eksi 2m ml Am ul 10

5 Fitomenadion in•eksi IOm ml Am ul 10

6 Glukosa 40% botol 5

7 Isosorbid dinitrat 5m tablet 30

8 Lidokain in•eksi2% Am ul 30 2
9 Ma nesium Sulfat 20% botol 5

O 10 Ma nesiumSulfat 40% botol 5

II NaCl 0,9% botol 10

12 Nifedi in IOm tablet tablet 20

13 Rin er Lactat botol 30

14 Salbutamol cairan inhalasi lm ml Am ul 10

 MONITORING OBAT DAN BMHP GADAR PERSEDIAAN UGD VK
PUSKESMAS KRAMATWATU
HARIÆANGGAL:
Jumlah Sisa Stok Jumlah
Nama Obat Satuan
Standar Aktual en anti
I Alat Suntik I ml Set 30
2 Alat Suntlk 3 ml Set 30
Set 10 VO
3 Alat Suntik 5 ml
4 Alat Suntik 10 ml Set 10

5 Alat Suntlk 20 ml Set 10

6 Aminophilin in eksi Ampul 3

7 Am icillin I gram Vial 10

8 Aqua pro inj 20 ml Vial 10

9 Bisturi Set 10

10 Ca Gluconas injeksi Ampul 3 3

Il Cat ut chromic 2/0 Set 3

12 Cat ut chromic 3/0 Set 3 2

13 Cat ut Iain 2/0 Set 3

14 Cat t Plain 3/0 Set 3

15 Difenhidramin Injeksi Ampul 3 3

16 Etakndin Rivanol % Botol
17 Etanol 70% Botol
18 ETT No 2 PCS 2

19 ETT No.3 PCS 2 2

20 Furosemide Injeksi Ampul 4

21 Folley Catheter No. 16 PCS 3

22 Folley Catheter No. 18 PCS 3

23 Gelang Anak Perempuan PCS 5

24 Gelang Dewasa Perem uan PCS 5

25 Gelan Anak Laki-laki PCS 5

26 Gelang Dewasa Laki-laki PCS 5

27 Glucosa Botol 5

28 Glucosa 5% Botol 5

29 Handscoon S Box

30 Handscoon M Box 1

31 HandscoonL Box

32 Handscoon Steril Protos PCS 15

33 Handscoon Steril Obgyn Pcs 7

34 Infuset Anak Set 10

35 Infuset Dewasa Set 15

36 IV Catheter 18 Set 20
 Jumlah Sisa Stok jumlah
No Nama Obat Satuan
Standar Aktual en anti
37 IV Catheter 20 Set 10

38 IV Catheter 22 Set 10

39 IV Catheter 24 Set 10

40 IV Catheter 26 Set 10

41 Ka as Pcs
42 Kassa 36.x80 Rol 1

43 Kassa Elastis 4 Inch Rol 2

44 Kassa Pembalut 4x15cm Rol 10

45 Kassa Steril 16x16 Box 5

46 Nasal Canul Anak Set 3 3

47 Nasal Canul Bayi Set 3

48 Nasal Canul Dewasa Set 3 3

49 Oxygen Mask Nasal Anak Set 3

50 Oxygen Mask Nasal Dewasa Set 3

2-
51 Oksitosrn Injeksi Ampul 30

52 Omeprazole Injeksi Vial 8

53 Plester Rol 2

54 Povidon 00 n! Botol 1

55 Serum ATS Am ul 5 3
56 Serum ABU Vial 2
22
57 Silk Benan Sutra Set 10

58 Suction No.8 Set

59 Suction No 10 Set

60 Umbilical Cord Set 10

61 Urine Ba Set 5
5
62 Vaksin VAR Vial
 MONITORING OBAT GAI)AR PERSEDIAAN UC,D VK

IIARI"I'ANGGAL: 2-9
Jumlah Sisa Stok Jumlah
Nama Obat Satuan
Standar Aktual pengganti
00
Tablet
2 Amoxicillin Siru Botol 5

3 Aminofillin 200 m ' Tablet 30

4 Amlodi in 10 m Tablet 50
5 Antasida tablet Tablet 100 90 31)
6 Antasida Siru Botol 5

7 AntihemoroidSu os Su o 5

8 Asam Asetilsalisilat 80 m Tablet 30

9 Asam Mefenamat 500 m Tablet 100
10 Acetylcystein200 m Kapsul 0
II Asiclovir400 m Tablet 30
1.10
12 Attalpu ite tablet Tablet 50 lo
13 Betahistin Tablet 20
14 BetamethasonSale Kulit Tube 5

15 Captopril 25 m Tablet 50
16 Cetirinn 5mg/5ml Siru Botol 5
17 Deksamethason 0,5 m Tablet 100
18 Dom eridon Sus ensi Botol 5

19 Dom eridon 10 m Tablet 50

20 Gentamicin Salep Mata Tube 5

21 H osin 10 m Tablet 50 D
22 ISDN Tablet 30
23 Kalsium (Kalk) Tablet 100
24 Kotrimoxazole 480 m Tablet 20
25 Kloramfenikol250 m Ka sul 20
26 Klorfemramin Maleat Tablet 100 00
27 Metformin 500 m Tablet 10
28 Metronidazole 500 m Tablet 30
29 Nifedipin 10 m Tablet 20
30 Oralit Sachet 30
31 Ome razole Kapsul 30
32 Parasetamol 500 m Tablet 00
33 Parasetamol Siru Botol 5

34 Parasetamol drop Botol 5

35 Perak Sulfadiazin Tube 1

36 Piridoksin itamin B6 Botol 50 D

37 Ranitidin Tablet 100
38 Retinol 200.000 1U Tablet 10
39 Salbutamol 2 m Tablet
40 Si rofloxacin 500 m Tablet 20
41 Tablet Tambah Darah Tablet 100
42 Thiamin 50 m Tablet 50
43 Vitamin b-kom lek Tablet 100
44 Zinc Tablet 50 D
 MONITORING OBAT GADAR PERSEDIAAN UGD VK
UPT PUSKESMASKRAMATWATU
BULAN: Setm t
Jumlah Sisa Stok Jumlah
No Nama Obat Satuan
Standar Aktual n anti
5
Atro in Sulfat in•eksi 0,25m ml Am ul 5

to
2 Deksamethason in•eksi 5m ml Am ul 10

3 E inefrin HCI Am ul 5

10
4 Fitomenadion in•eksi 2m ml Am ul 10

5 Fitomenadion in'eksi 10m ml Am ul 10

6 Glukosa 40% botol 5

7 Isosorbid dinitrat Sm tablet 30

2-
8 Lidokain in•eksi 2% Am ul 30

9 Ma nesium Sulfat 20% botol 5

10 Ma esium Sulfat 40% botol 5

0
NaCl 0,9% botol 10

12 Nifedi in I Om tablet tablet 20

3
13 Rin er Lactat botol 30

14 Salbutamol cairan inhalasi lm ml Am ul 10

 MONITORING OBAT DAN BMHP GADAR PERSEDIAAN UGD VK
Urr PUSKESMASKRAMANATU
HARI/TANGGAL:
Jumlah Sisa Stok Jumlah
NamaObat Satuan
Standar Aktual en anti
I Alat Suntik I ml Set 30

2 Alat Suntlk 3 ml Set 30

3 Alat Suntik 5 ml Set 10 10

4 Alat Suntik 10 ml Set 10 10

5 Alat Suntik 20 ml Set 10 10

6 Aminophilin injeksi Ampul 3

7 Ampicillin 1 gram Vial 10 10

8 Aqua pro inj 20 ml Vial 10

9 Bisturi Set 10

10 Ca Gluconas injeksi Ampul 3

Il Cat ut chromic 2/0 Set 3

12 Cat gut chromic 3/0 Set 3

13 Cat ut Iain 2/0 Set 3

14 Cat gut Plain 3/0 Set 3

15 Difenhldramin In eksi Am ul 3

16 Etakndin Rivanol 0,1% Botol

17 Etanol 70% Botol

18 ETT No 2 Pcs 2 2

19 ETT No.3 PCS 2

Ampul 4 4
20 Furosemide Injeksi
21 Folley Catheter No. 16 PCS 3

22 Folle Catheter No. 18 PCS 3 3

23 Gelan Anak Perem uan PCS 5

24 Gelan Dewasa Perem uan PCS 5

25 Gelang Anak Laki-laki Pcs 5

26 Gelang Dewasa Laki-laki PCS 5

27 Glucosa 10% Botol 5

28 Glucosa 5% Botol 5

29 Handscoon S BOX

30 Handscoon M Box
31 Handscoon L Box O o

32 Handscoon Steril Protos Pcs 15

33 Handscoon Steril Obgyn Pcs 7 2-

34 Infuset Anak Set 10 10

35 Infuset Dewasa Set 15 12 3

36 IV Catheter 18 Set 20
 Jumlah Sisa Stok Jumlah
No Nama Obat Satuan anti
Standar Aktual
37 IV Catheter 20 Set 10 (0

38 IV Catheter 22 Set 10

39 IV Catheter 24 Set 10 to

40 IV Catheter 26 Set 10

41 Ka as Pcs
42 Kassa 3600 Rol 1

43 Kassa Elastis 4 Inch Rol

44 Kassa Pembalut 4x15cm Rol
45 Kassa Steril 16x16 Box 5

46 Nasal Canul Anak Set 3 3

47 Nasal Canul Bayi Set 3 3
48 Nasal Canul Dewasa Set 3 -3
49 Oxygen Mask Nasal Anak Set 3

50 Oxygen Mask Nasal Dewasa Set 3

51 Oksitosrn Injeksi Am ul
52 Ome razole Injeksi Vial

53 Plester Rol 2

54 Povidon Botol 1

55 Serum ATS Ampul

56 Serum ABU Vial 2
4
57 Silk Bethan Sutra Set 10

58 Suction No .8 Set
59 Suction No 10 Set

60 Umbilical Cord Set 10

61 Urine Ba Set 5

62 Vaksin VAR Vial

 MONITORING OBAT GADAR PERSEDIAAN UGD VK

HARI,TANGGAL :
Jurnlah Sisa Stok Jumlah
Nama Obat Satuan
Standar Aktual penggnnti
I Amoxiclllin 500 m Tablet 200
2 Amoxicilhn Si Botol 5
3 Aminofillin 200 m Tablet 30
4 Amlodi in 10 m Tablet 50
5 Antasida tablet Tablet 100
6 Antasida Siru Botol 5
7 AntihemoroidSu Su 5
8 Asam Asetilsalisilat 80 m Tablet 30
9 Asam Mefenamat 500 Tablet 100
10 Ac I ein200 K sul 100
II Asic10S'1r400 m Tablet 30
12 Attal u te tablet Tablet 50 10
13 Betahistin Tablet 20
14 Sal Kuht
€1 15 C t ril 25 m
Tube 5
90
Tablet 50
16 Cetiriu.n 5 '5ml S Botol 5
17 Deksarnetiusca Tablet 100
18 Do doaS Botol 5
19 don 10 Tablet 50
20 Gentarrucm Mata Tube 5
21 H •osin 10 Tablet 50
22 ISDN Tablet 30
23 Kalslutn (Kalk) Tablet 100
24 Kotnrno.xazo{e
480 Tablet 20
25 Kloramfenikol 2 SO ul 20
26 Klorferuramin Maleat (CV}, 4 Tablet 100

27 Metforrnir:500 Tablet 10 vo
28 Metrorudazole SOO Tablet 30
29 Ntfedl In 10 m Tablet 20
30 Oralit Sachet 30
31 Om razole K ui 30
32 Parasetamol 500 m Tablet 200
33 Parasetamol S Botol 5

34 Parasetamol Botol 5

35 Perak Sulfadiazin Tube

36 Pindokstn itamin B6) 50
37 Ranitidin Tablet
100 70
38 Retinol200.0001U Tablet 10
39 Salbutamol 2 m Tablet 1

40 S' rofloxacin 500 Tablet 20

41 Tablet Tambah Darah Tablet 100
42 ftiamin 50 m Tablet 50
43 Vitamin b-ko lek Tablet 100
44 Zinc Tablet 50
 MONITORING OBAT GADAR PERSEDIAAN UGD VK
UPT PUSKESMAS KRAMATWATU
BULAN: a -9
No Nama Obat Jumlah Sisa Stok Jumlah
Satuan
Standar Aktual ngganti
Atro in Sulfat in•eksi 0,25m ml Am ul

2 Deksamethason in•eksi 5m ml Am ul 10

3 E inefrin HCI Am ul 5

4 Fitomenadion in•eksi 2m ml 2-
Am ul 10

5 Fitomenadion in•eksi IOm ml Am ul 10

6 Glukosa 40% botol 5

7 Isosorbid dinitrat 5m tablet 30 30

8 Lidokain in•eksi2% Am ul 30 920

9 Ma nesium Sulfat 20% botol 5

10 Ma esium Sulfat 40% botol 5

11 NaCl 0,9% botol 10

12 Nifedi in IOm tablet tablet 20

13 Rin er Lactat botol 30

2-

14 Salbutamolcairan inhalasi lm ml Am ul 10

6
 MONITORING OBAT DAN BMHP GADAR PERSEDIAAN UGD VK
Urr PUSKESMASKRAMATWATU
HARI/TANGGAL:
Jumlah Sisa Stok Jumlah
Nama Obat Satuan
Standar Aktual en anti
Alat Suntik I ml Set 30 21- 4
2 Alat Suntik 3 ml Set 30
3 Alat Suntik 5 ml Set 10 (0

4 Alat Suntik 10 ml Set 10

5 Alat Suntlk 20 ml Set 10 10

6 Aminophilin injeksi Ampul 3 3

7 Ampicillin I gram Vial 10

8 Aqua pro inj 20 ml Vial 10

9 Bistum Set 10

10 Ca Gluconas injeksi Ampul 3 3

Il Cat ut chromic 2/0 Set 3
3
12 Cat gut chromic 3/0 Set 3 -3
13 Cat ut Iain 2/0 Set 3

14 Cat gut Plain 3/0 Set 3

15 Difenhldramin Injeksi Am ul 3

16 Etakndin Rivanol 0,1% Botol

17 Etanol 70% Botol
18 ETT No 2 PCS 2 2
19 No.3 PCS 2

20 Furosemide Injeksi Ampul 4

21 Folley Catheter No. 16 PCS 3 3

22 Folley Catheter No. 18 PCS 3

23 Gelang Anak Perempuan PCS 5 S

24 Gelang Dewasa Perempuan 5

25 Gelang Anak Laki-laki PCS 5

26 Gelang Dewasa Laki-laki PCS 5

27 Glucosa 10% Botol 5

28 Glucosa 5% Botol 5

29 Handscoon S BOX

30 Handscoon M Box
31 HandscoOn L Box
32 Handscoön Steril Protos PCS 15

33 Handscoon Steril Obgyn Pcs 7

34 Infuset Anak Set 10 10

35 Infuset Dewasa Set 15

36 IV Catheter 18 Set 20
No Jumlah Sisa Stok Jumlah
Nama Obat Satuan
Standar Aktual en anti
37 IV Catheter 20 Set 10
38 IV Catheter 22 Set 10

39 IV Catheter 24 Set 10

40 IV Catheter 26 Set 10
41 Ka as Pcs
42 Kassa 36.x80 Rol

43 Kassa Elastis 4 Inch Rol 2

44 Kassa Pembalut 4x15cm Rol 10 (0

45 Kassa Steril 16x16 Box 5

46 Nasal Canul Anak Set 3 1)

47 Nasal Canul Bayi Set 3 3

48 Nasal Canul Dewasa Set 3 3
49 O en Mask Nasal Anak Set 3

50 Oxygen Mask Nasal Dewasa Set 3

51 Oksitosin Injeksi Am ul
52 Ome razole Injeksi Vial

53 Plester Rol 2

54 Povidon Botol 1

55 Serum ÅTS Ampul 2

56 Serum ABU Vial 2
57 Silk Benan Sutra Set 10

58 Suction No.8 Set

59 Suction No. 10 Set

60 Umbilical Cord Set 10 (o

61 Urine Ba Set 5

62 Vaksin VAR Vial

 MONITORING OBAT GADAR PERSEDIAAN UGD VK

11AR1rrANGGAL:
Jumlah Sisa Stok Jumlah
Nama Obat Satuan
Standar Aktual pengganti
I Amoxicillin 500 m Tablet 200
2 Amoxicillin Siru Botol 5

3 Aminofillin 200 m Tablet 30

4 Amlodi in 10 Tablet 50
5 Antasida tablet Tablet 100
6 Antasida Siru Botol 5

7 AntihemoroidSu os Su o 5

8 Asam Asetilsalisilat 80 m Tablet 30

9 Asam Mefenamat 500 m Tablet 100
10 Ace I tein 200 m Ka sul 100
90
II Asiclovir 400 m Tablet 30
12 Attal u 'te tablet Tablet 50
13 Betahistin Tablet 20
14 Betamethason Sal Kulit Tube 5

15 Ca to ril 25 m Tablet 50
16 Cetirizin Sm 5ml Siru Botol 5

17 Deksamethason 0,5 m Tablet 100

18 Dom ridon Sus ensi Botol 5

19 Dom ridon 10 m Tablet 50

20 GentamicinSale Mata Tube 5

21 H osin 10 m Tablet 50
'2 ISDN Tablet 30
23 Kalsium (Kalk) Tablet 100 160
24 Kotrimoxazole 480 m Tablet 20
25 Kloramfenikol 250 m Ka sul 20
26 Klorfeniramin Maleat (CTM) 4 m Tablet 100

27 Metformin 500 m Tablet 10

28 Metronidazole 500 m Tablet 30

29 Nifedipln 10 m Tablet 20

30 Oralit Sachet 30
31 Ome razole K sul 30

32 Parasetamol 500 m Tablet 200

33 Parasetamol Siru Botol 5

34 Parasetamol dro Botol 5

35 Perak Sulfadiazin Tube 1

36 Piridoksln itamin B6) Botol 50

37 Ranitidin Tablet 100
38 Retinol 200.000 1U Tablet 10
39 Salbutamol 2 m Tablet 100
40 Siprofloxacin 500 mg Tablet 20
41 Tablet Tambah Darah (FE) Tablet
42 Thiamin 50 m Tablet 50
43 Vitamin b-kom lek Tablet 100
44 Zinc Tablet 50