LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

KODE P1702046201 BULAN OKTOBER JML.PUSTU 1 JML.POSKESDES/BIDES 9

PUSKESMAS KAMPUNG DELIMA TAHUN 2020 JML.MELAPOR 1 JML.MELAPOR 9

Kode STOK SISA STOK PERMIN KET

NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
1 Abbocath No. 18 (IV cath No. 18) Pcs 2 50 52 52
2 Abbocath No. 20 (IV cath No. 20) Pcs 1 1 1
3 Abbocath No. 22 (IV cath No. 22) Pcs 2 2 2
4 Abbocath No. 24 (IV cath No. 24) Pcs
1 50 51 51
5 Abbocath no.27 Pcs 0 0 0
6 Alat suntik sekali pakai 1 ml Set 0 0 0
7 Alat suntik sekali pakai 5 ml Set 0 2400 2400 2400
8 Alat Suntik sekali pakai 3 ml Set 0 1600 1600 1600
9 Albendazole 400 Mg Caplet 600 600 100 500
10 Alkohol 70% 100 ml Botol 26 24 50 0 50
11 Alkohol 70% 1000 ml Botol 1 5 6 1 5
12 Alkohol swabs Pcs 300 300 300
13 Allopurinol 100 mg Tablet 0 100 100 100 0
14 Alphamol 600mg Tablet 1800 1500 3300 300 3000
15 Alprazolam tab 0,25 mg Tablet 0 0 0
16 Ambroxol Tablet 30 mg Tablet 0 0 0
17 Aminofilin 200 mg Tablet 0 0 0
18 Amitriptilin Hcl tablet salut 25 mg Tablet 0 0 0
19 Amlodipin tab 5 mg Tablet 0 0 0
20 Amoksisilin 250 mg Botol 6200 6200 6200
21 Amoksisilin 500 mg Tablet 4900 5000 9900 9900
22 Amoksisilin sirup 125 mg / 5 ml Botol 150 150 15 135
23 Antasida DOEN Sirup 60 ml Botol 0 0 0
24 Antasida doen tablet Tablet 0 100 100 100 0
25 Anti hemoroid doen kombinasi Supp 15 15 10 5
26 Anti bakteri doen salep kombinasi : Basitras Tube 6 6 6
27 Anti fungi doen kombinasi : asam benzoat 6% + Pot 0 0 0
28 Anti Malaria DOEN Komb(Sulfadoksin 500 mg Botol 0 0 0
29 Anti migrain doen kombinasi Tablet 100 100 1 99
30 Antiseptik Gell 500 cc galon 1 1 1
31 Antiseptik handrub @ 500 ml (Sky Light Cleaner galon 3 3 1 2
32 Aqua pro injeksi Botol 0 0 0
33 Asam askorbat ( vit.c ) 50 mg Tablet 0 100 100 100 0
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
34 Asam Mefenamat 500 mg /Molasic Kaplet 2700 7000 9700 9700
35 Asam traneksamat injeksi Ampul 0 0 0
36 Asiklovir tablet 200 mg Tablet 0 0 0
37 Asiklovir tablet 400 mg Tablet 300 300 200 100
38 Asiklovir Krim 5 % Tube 0 25 25 25
39 Atropin sulfat 0,5 mg Tablet 0 0 0
40 Atropin Inj 0,25 Mg Ampul 0 0 0
41 Attapulgit 630 mg (pularex) Tablet 400 400 100 300
42 Bedak Salisil 2 % Bungkus 12 36 48 6 42
43 Benecheck Plus Glucose Test Strip 50's Pcs 0 0 0
44 Benecheck Plus Total Cholesterol Test Strip 10's Pcs 0 0 0
45 Benecheck Plus Uric Test Strip 25's Pcs 0 0 0
46 Benechek Asam Urat Pcs 0 0 0
47 Benechek Cholesterol Pcs 0 0 0
48 Benechek GDS Pcs 0 0 0
49 Berotec Fenoterol HBR INH Cairan Botol 0 0 0
50 Betahistin Mesilat tab 6 mg Tablet 1100 300 1400 1400
51 Betametason krim 0,1 % Tube 23 50 73 25 48
52 Bioplacenton Tube 19 19 19
53 Bisakodil supp 10 mg (dulcolax) Supp 0 0 0
54 Bisakodil supp 5 mg (dulcolax infant) Supp 0 0 0
55 Bisoprolol tab 5 mg Tablet 0 0 0
56 Blood Transfusion Set Set 0 50 50 50
57 Burnazine Salep Luka Bakar Tube 2 4 6 6
58 Buscopan injeksi Ampul 0 0 0
59 Captopril 12, 5 mg Tablet 1100 1000 2100 0 2100
60 Captopril 25 mg Tablet 200 1000 1200 0 1200
61 Catgut / benang bedah no.2/0 Set 0 0 0
62 Catgut / benang bedah no.3/0 Set 0 0 0
63 Cefadroxyl 500 mg Capsul 0 0 0
64 Cefadroxyl Syr. Kering Botol 0 0 0
65 Cefixime 100 mg Tablet 1260 0 1260 300 960
66 Ceftriaxone inj Ampul 10 10 10
68 Cetirizine 10mg Tablet 0 0 0
69 Ciprofoxacin 500 mg Tablet 0 0 0
70 Citicolin injeksi Ampul 0 0 0
71 Clobazam Tablet 86.5 86.5 2 84.5
72 Clozapin 100mg Tab Tablet 0 0 0 0
73 Clozapin 25mg Tab Tablet 36.5 100 136.5 136.5
74 Deksametason 0,5 mg Tablet 0 0 0
75 Deksametason inj.5 mg / ml - 1 ml Ampul 0 30 30 30
76 Dermafix T 5x7 c Lembar 0 0 0

Kode STOK SISA STOK PERMIN KET

NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
77 Detol sabun cair Tablet 0 6 6 1 5
78 Dextral tab Tablet 0 0 0
79 Diazepam 2 mg Ampul 0 0 0
80 Diazepam injeksi 5 mg / ml - 2 ml Tablet 0 0 0
81 Diazepam 5 mg tablet Supp 0 0 0
82 Diazepam enema Stesolid 5mg Ampul 0 0 0
83 Difenhidramin hcl inj.10mg/ml-1ml Tablet 21 90 111 111
84 Diltiazem 30 mg Tablet 0 0 0
85 Domperidon tablet Ampul 200 200 200
86 Epinefrin hcl injeksi 0,1 % - 1 ml Tablet 10 10 1 9
87 Eritromisin 500 mg Botol 0 0 0
88 Eritromisin Sirup Botol 0 0 0
89 Etakridin ( rivanol ) larutan 0,1 % Botol 0 10 10 10
90 Etil klorida semprot Botol 5 5 5
91 Eugenol cairan Tablet 1 1 1
92 Fenobarbital 30 mg Ampul 0 0 0
93 Fenobarbital inj 50 mg/ml Botol 0 0 0
94 Fenol gliserol (karbogliserin) tetes telinga 10 Ampul 0 0 0
95 Fitomenadion (vit K1) inj.10mg/ml-1ml Tablet 0 60 60 60
96 Fitomenadion (vit K1)tab.salut 10 mg Ampul 0 200 200 200
97 Fitomenadion injeksi 2 mg / 1 ml set 0 0 0
98 Folley Chateter no 16 set 0 0 0 0
99 Folley Chateter no 18 set 4 4 4
100 Folley Chateter no 22 Tablet 3 3 3
101 Furosemid 40mg sacc 0 0 0
102 Garam oralit untuk 200 ml air Tube 0 1000 1000 100 900
103 Gentamicin Salep Kulit Ampul 12 12 12
104 Gentamisin Inj 40 mg/ml Botol 0 0 0
105 Gentamisin TM Botol 9 9 9
106 Gentian violet larutan 1 % Tablet 0 5 5 5
107 Glibenklamid 5 mg Tablet 700 300 1000 1000
108 Gliseril guayakolat 100 mg Botol 4700 6000 10700 1400 9300
109 Glukosa larutan infus 5 % steril Tablet 0 10 10 10
110 Griseofulvin 125 mg , micronized Tablet 0 0 0
111 Haloperidol 1,5 mg Ampul 0 0 0
112 Haloperidol inj. 50 mg Tablet 0 0 0
113 Haloperidol 0,5 mg Tablet 0 0 0
114 Haloperidol 2 Mg set 0 0 0
115 Hand Schoon M set 0 3 3 3
116 Hand Schoon No. 7,5 set 0 200 200 200
117 Handschoon GynecologiNo. 7 set 0 0 0
118 Handschoon GynecologiNo. 7,5 Tablet 0 0 0 0
119 Hidroklortiazid ( Hct ) 25 mg Tube 400 400 400
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
120 Hidrokortison krim 2,5 % Tablet 0 48 48 24 24
121 Ibuprofen 200 mg Tablet 0 0 0
122 Ibuprofen 400 mg Botol 2300 2000 4300 4300
123 Ibuprofen syrup 100mg/5ml Botol 0 0 0
124 Imersi Oil Set 0 0 0
125 Infusion set anak Set 4 50 54 54
126 Infusion set dewasa set 1 1 1
127 Infusiont Set Y - Type Box 1 50 51 51
128 Iodine Test 10 ml Tablet 0 0 0
129 Isosorbid dinitrat tab.sublungual 5 mg Biji 0 0 0
130 Jarum jahit ( bedah ) no. 11 Biji 0 0 0
131 Jarum jahit ( bedah ) no. 13 Kulit Biji 0 0 0
132 Jarum jahit ( bedah ) no. 13 Otot Biji 0 0 0
133 Jarum jahit ( bedah ) no. 9 Kulit Biji 0 0 0
134 Jarum jahit ( bedah ) no. 9 Otot Botol 0 0 0
135 KAEN 3 B INFUS Tablet 0 0 0
136 Kalsium laktat ( kalk ) 500 mg Gulung 3000 2000 5000 5000
137 Kapas pembalut / absorben 250 gr bks 6 10 16 16
138 Kasa kompres 40 / 40 steril Rol 69 69 69
139 Kasa pembalut 4 m x 10 cm Rol 36 36 36
140 Kasa pembalut hidrofil 4 m x 15 cm Rol 200 200 400 400
141 Kasa pembalut hidrofil 4 m x 3 cm Rol 122 122 122
142 Kasa pembalut hidrofil 4 m x 5 cm Lembar 60 60 60
143 Kasa pembalut hidrofil 16 cm x 16 cm Bungkus 0 0 0
144 Kasa pembalut 2 yard x 80 cm Rol 0 0 0
145 Kasa Hidrofil 40 yard x 80 cm Tube 2 2 2
146 Ketokonazole Cream 2 % Tablet 0 100 100 25 75
147 Ketokonazole tablet 200 mg Ampul 0 0 0
148 Ketorolac injeksi Botol 0 0 0
149 Kloramfenicol Salep mata Kapsul 17 17 17
150 Kloramfenikol 250 mg Kapsul 600 600 600
151 Kloramfenikol 500 mg (Chloramex) Botol 300 300 300
152 Kloramfenikol tetes mata 0,5 % (decacetin) Tube 0 0 0
153 Kloramfenikol Salep Kulit 2 % (Bufacetin Krim) Botol 0 0 0
154 Kloramfenikol Syrup Tablet 0 0 0
155 Klorfeniramin ( ctm ) 4 mg Tablet 6200 10,000 16,200 1400 14,800
156 Kloroquin 150 mg Tablet 0 0 0
157 Klorpromazin hcl 100 mg Tablet 100 100 2 98
158 Kodein hcl 10 mg Tablet 0 0 0
159 Kotrimoksazol dewasa ( 480 mg ) Tablet 0 0 0
160 Kotrimoksazol pediatrik ( 120 mg ) Botol 0 0 0
161 Kotrimoksazol suspensi Kapsul 14 14 14
162 Lansoprazole tablet 30 mg Botol 900 2720 3620 100 3520
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
163 Larutan EDTA 100 ml Botol 0 0 0
164 Larutan Giemsa 100 ml Botol 0 0 0
165 Larutan HCL 0,1 N 100ml Botol 0 0 0
166 Larutan KOH 10% 100 ml Botol 0 0 0
167 Larutan Turk 100 ml Lembar 0 0 0
168 Leukoplast 2.5 cm X 4.5 cm Ampul 0 30 30 1 29
169 Lidocain Combinasi (+epinefrin) Ampul 25 120 145 145
170 Lidokain injeksi 2% Botol 50 100 150 150
171 Lidokain Jel 2 % Botol 0 0 0
172 Lidokain Spray Oral 10 % Botol 0 0 0
173 Lisol 1000 ml Tablet 2 3 5 5
174 Loratadine 10 mg Tablet 0 500 500 500
175 Masker 3 Ply Plus Bh 0 0 0
176 Masker Earloop Bh 0 5 5 5
177 Masker N 95 Bh 0 2 2 2 0
178 Masker particular respirator 9105 Bh 0 0 0
179 Masker tie on Bh 0 0 0
180 Melocid 7.5 mg Tablet 100 100 100 0
181 meloxicam 15 mg Tablet 0 0 0
182 Mersibion kaplet Tablet 0 200 200 200
183 Metformin 500 mg tablet 0 0 0
184 Metformin 850mg tablet 0 0 0
185 Metilergometrin Maleat 0.125 mg Ampul 0 0 0
186 Metilergometrine mal.inj.0,200mg-1ml Tablet 0 0 0
187 Metilprednisolon 4 Mg Tab Tablet 1300 1300 1300
188 Metoklorpamide Tablet Tablet 500 500 500
189 Metronidazol 250 mg Tablet 0 0 0
190 Metronidazol 500 mg Botol 700 700 700
191 Metronidazol sirup Botol 0 0 0
192 Metronidazole Infus 5 Mg Botol 0 0 0
193 MgSo4 Inj Tube 2 2 2 0 ed.11/2020
194 Molacream Botol 15 72 87 2 85
195 Molafate suspensi Botol 0 0 0
196 My Jelly 82 gram Botol 0 0 0
197 Natrium klorida larutan 0,9 % steril tablet 4 23 27 27
198 Natrium Bicarbonat 500 mg Tablet 500 500 500
199 Natrium Diklofenak tab 25 mg Tablet 0 500 500 500
200 Natrium Diklofenak tab 50 mg Ampul 0 0 0
201 Neurobion injeksi / mersibion Supp 10 10 10
202 Nistatin 100.000 iu / g tab. Vaginal Tablet 0 0 0
203 Nistatin 500.000 iu tablet salut paket 0 0 0
204 OAM Program Malaria paket 0 0 0
205 OAT Kategori 1 paket 0 0 0
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
206 OAT Kategori 2 paket 0 0 0
207 OAT Kategori Anak Botol 0 0 0
208 Obat batuk hitam ( o b h ) cairan Tube 5 5 5 0
209 Oksitetrasiklin hcl salep 3 % Tube 0 0 0
210 Oksitetrasiklin hcl salep mata 1% Ampul 23 23 23
211 Oksitosin injeksi 10 iu / ml - 1 ml Ampul 0 25 25 25
212 Ondansentron injeksi 2 mg Botol 0 0 0
213 Paracetamol Drop 100mg/ml Tablet 45 45 20 25
214 Parasetamol 500 mg Botol 0 7000 7000 500 6500
215 Parasetamol sirup 120 mg / 5 ml bh 0 0 0
216 Pehaveral bh 0 0 0
217 Pembalut Elastis 10 cm x 4,55 m Tablet 1 3 4 4
218 Pembalut Elastis 7,5 cm x 4,55 m Tablet 0 3 3 3
219 Pirantel pamoat Tablet 0 0 0
220 Piridoksin hcl ( vit. B 6 ) 10 mg bj 0 300 300 300 0
221 Piroxicam 10 mg rol 300 300 300 0
222 Planotest Kehamilan rol 0 50 50 50
223 Plester 5 yard x 2 inch Tablet 0 0 0
224 Plester e-care surgical tape 2'' Tablet 34 72 106 106
225 Prednison 5 mg Tablet 0 0 0
226 Primaquin Tablet Tablet 0 0 0
227 Pritacort tablet tablet 0 0 0
228 Propanolol hcl 10 mg tablet 0 0 0
229 Propanolol hcl 40 mg Ampul 0 0 0
230 Propiltiourasil ( PTU ) 100 mg Tablet 0 0 0
231 Ranitidin 25 Mh/ML inj tablet 3 300 303 303
232 Ranitidin Tablet tablet 4500 10,000 14,500 1000 13,500
233 Resperidon 1mg Botol 0 0 0
234 Risperidon tablet 2 mg Pc 0 100 100 100
235 RL larutan infus steril tablet 3 60 63 63
236 S i l k (benang bedah sutera) no.3 / 0 Pot 39 24 63 63
237 Salbutamol 2 mg lb 0 0 0
238 Salep 2 - 4 kombinasi : asam salisilat 2% + be tablet 0 48 48 48
239 Salon Pas Jet Spray Tube 0 6 6 6
240 Samcofenac 50 mg pc 0 0 0
241 Scabimite/ Permetrin Krim Vial 0 24 24 24
242 Serenity Twist Blood Lancet Ampul 0 0 0
243 Serum anti bisa ular poli.inj.5 ml (abu I) Ampul 0 0 0
244 Serum anti difteri injeksi 1.500 iu/amp (a.t.s) Ampul 5 5 5
245 Sianokobalamin (vit.b12) inj.500 mcg/ml tablet 40 40 1 39
246 Sikzonoate Inj. Flufenazine Inj. 25mg/ml tablet 0 0 0
247 Simvastatin Tablet Kaplet 2430 2430 2430
248 Tablet Tambah Darah Ampul 500 5600 6100 1000 5100
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
249 Thiamphenicol 500 mg tablet 2000 2000 4000 4000
250 Tiamin hcl (vit.b1) Inj 100mg/1 ml Ampul 0 0 0
251 Tiamin hcl mononitrat(vit.b1) 50mg tablet set 3000 10000 13000 1500 11500
252 Tramadol injeksi 50 mg/ml tablet 0 0 0
254 Trifluoperazine 5mg bh 0 0 0
255 Triheksifenidil hcl 2 mg Ampul 0 0 0
256 Umbilical Cord Klem Steril Nylon Ampul 0 200 200 200
257 Vaksin Rabies Vero (VAR) rabipur kapsul 0 0 0
258 Vaksin Rabies Vero (VAR) verorab Botol 0 0 0
259 Vit. A 100.000 iu kaplet 0 0 0
260 Vit. A 200.000 iu kapsul 0 0 0
261 Vitamin B kompleks Tablet 400 400 400 0
262 Yodium povidon lar.10 % 30 ml Botol 0 30 30 30
263 Yodium povidon lar.10 % 300 ml Botol 9 9 9 0
264 Yodium povidon lar.10 % 60 ml Botol 0 0 0
265 Zinc Dispersible 20 mg Tablet 500 500 500
266 Zinc Sirup Botol 6 72 78 78
267 0 0
268 0 0
269 0 0
270 0 0
271 0 0

Umum
JKN Jumlah
Kunjungan Resep Bayar Tidak

Mengetahui Yang Menyerahkan Mengetahui : Yang Menerima

Kepala Dinas Kesehatan Kepala IFK Ka. UPT Puskesmas Kampung Delima Petugas Puskesmas
Kabupaten Rejang Lebong
 ........................................................... FRANSISKA PUTRIANI,SSI,Apt JONI,SKM FITRIANI,A.Md.Farm
NIP. NIP.19790817 201001 2 2024 NIP. 19721005 199203 1 006 NIP.19740802 199503 2 002
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

KODE P1702046201 BULAN NOVEMBER JML.PUSTU 1 JML.POSKESDES/BIDES 9

PUSKESMAS KAMPUNG DELIMA TAHUN 2020 JML.MELAPOR 1 JML.MELAPOR 9

Kode STOK SISA STOK PERMIN KET

NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
1 Abbocath No. 18 (IV cath No. 18) Pcs 52 52 37 15
2 Abbocath No. 20 (IV cath No. 20) Pcs 1 1 0 1
3 Abbocath No. 22 (IV cath No. 22) Pcs 2 2 0 2
4 Abbocath No. 24 (IV cath No. 24) Pcs 51 51 27 24
5 Abbocath no.27 Pcs 0 0 0
6 Alat suntik sekali pakai 1 ml Set 0 0 0
7 Alat suntik sekali pakai 5 ml Set 1600 1600 900 700
8 Alat Suntik sekali pakai 3 ml Set 2400 2400 900 1500
9 Albendazole 400 Mg Caplet 500 500 500
10 Alkohol 70% 100 ml Botol 50 50 37 13
11 Alkohol 70% 1000 ml Botol 5 5 5
12 Alkohol swabs Pcs 300 300 300
13 Allopurinol 100 mg Tablet 0 0 0
14 Alphamol 600mg Tablet 3000 3000 150 2850
15 Alprazolam tab 0,25 mg Tablet 0 0 0
16 Ambroxol Tablet 30 mg Tablet 0 0 0
17 Aminofilin 200 mg Tablet 0 0 0
18 Amitriptilin Hcl tablet salut 25 mg Tablet 0 0 0
19 Amlodipin tab 5 mg Tablet 0 0 0
20 Amoksisilin 250 mg Botol 6200 6200 5400 800
21 Amoksisilin 500 mg Tablet 9900 9900 4500 5400
22 Amoksisilin sirup 125 mg / 5 ml Botol 135 135 22 113
23 Antasida DOEN Sirup 60 ml Botol 0 0 0
24 Antasida doen tablet Tablet 0 0 0
25 Anti hemoroid doen kombinasi Supp 5 5 5 0
26 Anti bakteri doen salep kombinasi : Basitras Tube 6 6 6
27 Anti fungi doen kombinasi : asam benzoat 6% + Pot 0 0 0
28 Anti Malaria DOEN Komb(Sulfadoksin 500 mg Botol 0 0 0
29 Anti migrain doen kombinasi Tablet 99 99 99
30 Antiseptik Gell 500 cc galon 1 1 1
31 Antiseptik handrub @ 500 ml (Sky Light Cleaner galon 2 2 0 2
32 Aqua pro injeksi Botol 0 36 36 5 31
33 Asam askorbat ( vit.c ) 50 mg Tablet 0 0 0
 Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
34 Asam Mefenamat 500 mg /Molasic Kaplet 9700 9700 4600 5100
35 Asam traneksamat injeksi Ampul 0 0 0
36 Asiklovir tablet 200 mg Tablet 0 0 0
37 Asiklovir tablet 400 mg Tablet 100 100 100
38 Asiklovir Krim 5 % Tube 25 25 25 0
39 Atropin sulfat 0,5 mg Tablet 0 0 0
40 Atropin Inj 0,25 Mg Ampul 0 0 0
41 Attapulgit 630 mg (pularex) Tablet 300 300 300
42 Bedak Salisil 2 % Bungkus 42 42 30 12
43 Benecheck Plus Glucose Test Strip 50's Pcs 0 0 0
44 Benecheck Plus Total Cholesterol Test Strip 10's Pcs 0 0 0
45 Benecheck Plus Uric Test Strip 25's Pcs 0 0 0
46 Benechek Asam Urat Pcs 0 0 0
47 Benechek Cholesterol Pcs 0 0 0
48 Benechek GDS Pcs 0 0 0
49 Berotec Fenoterol HBR INH Cairan Botol 0 0 0
50 Betahistin Mesilat tab 6 mg Tablet 1400 1400 1400
51 Betametason krim 0,1 % Tube 48 48 3 45
52 Bioplacenton Tube 19 19 19
53 Bisakodil supp 10 mg (dulcolax) Supp 0 0 0
54 Bisakodil supp 5 mg (dulcolax infant) Supp 0 0 0
55 Bisoprolol tab 5 mg Tablet 0 0 0
56 Blood Transfusion Set Set 50 50 27 23
57 Burnazine Salep Luka Bakar Tube 6 6 1 5
58 Buscopan injeksi Ampul 0 0 0
59 Captopril 12, 5 mg Tablet 2100 2100 900 1200
60 Captopril 25 mg Tablet 1200 1200 1200
61 Catgut / benang bedah no.2/0 Set 0 0 0
62 Catgut / benang bedah no.3/0 Set 0 0 0
63 Cefadroxyl 500 mg Capsul 0 0 0
64 Cefadroxyl Syr. Kering Botol 0 0 0
65 Cefixime 100 mg Tablet 960 960 540 420
66 Ceftriaxone inj Ampul 10 10 10
68 Cetirizine 10mg Tablet 0 0 0
69 Ciprofoxacin 500 mg Tablet 0 0 0
70 Citicolin injeksi Ampul 0 0 0
71 Clobazam Tablet 86.5 86.5 2 84.5
72 Clozapin 100mg Tab Tablet 0 0 0
73 Clozapin 25mg Tab Tablet 136.5 136.5 136.5
74 Deksametason 0,5 mg Tablet 0 0 0
75 Deksametason inj.5 mg / ml - 1 ml Ampul 30 30 18 12
76 Dermafix T 5x7 c Lembar 0 0 0
 Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
77 Detol sabun cair Tablet 5 5 3 2
78 Dextral tab Tablet 9900 9900 1950 7950
79 Diazepam 2 mg Ampul 0 0 0
80 Diazepam injeksi 5 mg / ml - 2 ml Tablet 0 0 0
81 Diazepam 5 mg tablet Supp 0 0 0
82 Diazepam enema Stesolid 5mg Ampul 0 0 0
83 Difenhidramin hcl inj.10mg/ml-1ml Tablet 111 111 90 21
84 Diltiazem 30 mg Tablet 0 0 0
85 Domperidon tablet Ampul 200 200 200
86 Epinefrin hcl injeksi 0,1 % - 1 ml Tablet 9 9 3 6
87 Eritromisin 500 mg Botol 0 0 0
88 Eritromisin Sirup Botol 0 0 0
89 Etakridin ( rivanol ) larutan 0,1 % Botol 10 10 3 7
90 Etil klorida semprot Botol 5 5 5
91 Eugenol cairan Tablet 1 1 1
92 Fenobarbital 30 mg Ampul 0 0 0
93 Fenobarbital inj 50 mg/ml Botol 0 0 0
94 Fenol gliserol (karbogliserin) tetes telinga 10 Ampul 0 0 0
95 Fitomenadion (vit K1) inj.10mg/ml-1ml Tablet 60 60 45 15
96 Fitomenadion (vit K1)tab.salut 10 mg Ampul 200 200 180 20
97 Fitomenadion injeksi 2 mg / 1 ml set 0 0 0
98 Folley Chateter no 16 set 0 0 0
99 Folley Chateter no 18 set 4 4 4
100 Folley Chateter no 22 Tablet 3 3 3
101 Furosemid 40mg sacc 0 0 0
102 Garam oralit untuk 200 ml air Tube 900 900 600 300
103 Gentamicin Salep Kulit Ampul 12 12 12
104 Gentamisin Inj 40 mg/ml Botol 0 0 0
105 Gentamisin TM Botol 9 9 9
106 Gentian violet larutan 1 % Tablet 5 5 5 0
107 Glibenklamid 5 mg Tablet 1000 1000 800 200
108 Gliseril guayakolat 100 mg Botol 9300 9300 2700 6600
109 Glukosa larutan infus 5 % steril Tablet 10 10 7 3
110 Griseofulvin 125 mg , micronized Tablet 0 0 0
111 Haloperidol 1,5 mg Ampul 0 0 0
112 Haloperidol inj. 50 mg Tablet 0 0 0
113 Haloperidol 0,5 mg Tablet 0 0 0
114 Haloperidol 2 Mg set 0 0 0
115 Hand Schoon M set 3 3 3 0
116 Hand Schoon No. 7,5 set 200 200 200
117 Handschoon GynecologiNo. 7 set 0 0 0
118 Handschoon GynecologiNo. 7,5 Tablet 0 0 0
119 Hidroklortiazid ( Hct ) 25 mg Tube 400 400 400
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
120 Hidrokortison krim 2,5 % Tablet 24 24 24 0
121 Ibuprofen 200 mg Tablet 0 0 0
122 Ibuprofen 400 mg Botol 4300 4300 1000 3300
123 Ibuprofen syrup 100mg/5ml Botol 0 0 0
124 Imersi Oil Set 0 0 0
125 Infusion set anak Set 54 54 45 9
126 Infusion set dewasa set 1 1 1
127 Infusiont Set Y - Type Box 51 51 45 6
128 Iodine Test 10 ml Tablet 0 0 0
129 Isosorbid dinitrat tab.sublungual 5 mg Biji 0 0 0
130 Jarum jahit ( bedah ) no. 11 Biji 0 0 0
131 Jarum jahit ( bedah ) no. 13 Kulit Biji 0 0 0
132 Jarum jahit ( bedah ) no. 13 Otot Biji 0 0 0
133 Jarum jahit ( bedah ) no. 9 Kulit Biji 0 0 0
134 Jarum jahit ( bedah ) no. 9 Otot Botol 0 0 0
135 KAEN 3 B INFUS Tablet 0 0 0
136 Kalsium laktat ( kalk ) 500 mg Gulung 5000 5000 5000
137 Kapas pembalut / absorben 250 gr bks 16 16 13 3
138 Kasa kompres 40 / 40 steril Rol 69 69 69 0
139 Kasa pembalut 4 m x 10 cm Rol 36 36 20 16
140 Kasa pembalut hidrofil 4 m x 15 cm Rol 200 200 135 65
141 Kasa pembalut hidrofil 4 m x 3 cm Rol 122 122 90 32
142 Kasa pembalut hidrofil 4 m x 5 cm Lembar 60 60 10 50
143 Kasa pembalut hidrofil 16 cm x 16 cm Bungkus 0 0 0
144 Kasa pembalut 2 yard x 80 cm Rol 0 0 0
145 Kasa Hidrofil 40 yard x 80 cm Tube 2 2 2
146 Ketokonazole Cream 2 % Tablet 75 75 27 48
147 Ketokonazole tablet 200 mg Ampul 0 0 0
148 Ketorolac injeksi Botol 0 0 0
149 Kloramfenicol Salep mata Kapsul 17 17 17
150 Kloramfenikol 250 mg Kapsul 600 600 600
151 Kloramfenikol 500 mg (Chloramex) Botol 300 300 300
152 Kloramfenikol tetes mata 0,5 % (decacetin) Tube 0 0 0
153 Kloramfenikol Salep Kulit 2 % (Bufacetin Krim) Botol 0 0 0
154 Kloramfenikol Syrup Tablet 0 0 0
155 Klorfeniramin ( ctm ) 4 mg Tablet 14,800 14,800 3600 11,200
156 Kloroquin 150 mg Tablet 0 0 0
157 Klorpromazin hcl 100 mg Tablet 98 98 98
158 Kodein hcl 10 mg Tablet 0 0 0
159 Kotrimoksazol dewasa ( 480 mg ) Tablet 0 0 0
160 Kotrimoksazol pediatrik ( 120 mg ) Botol 0 0 0
161 Kotrimoksazol suspensi Kapsul 14 14 10 4
162 Lansoprazole tablet 30 mg Botol 3520 3520 3520
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
163 Larutan EDTA 100 ml Botol 0 0 0
164 Larutan Giemsa 100 ml Botol 0 0 0
165 Larutan HCL 0,1 N 100ml Botol 0 0 0
166 Larutan KOH 10% 100 ml Botol 0 0 0
167 Larutan Turk 100 ml Lembar 0 0 0
168 Leukoplast 2.5 cm X 4.5 cm Ampul 29 29 5 24
169 Lidocain Combinasi (+epinefrin) Ampul 145 145 90 55
170 Lidokain injeksi 2% Botol 150 150 135 15
171 Lidokain Jel 2 % Botol 0 0 0
172 Lidokain Spray Oral 10 % Botol 0 0 0
173 Lisol 1000 ml Tablet 5 5 1 4
174 Loratadine 10 mg Tablet 500 500 50 450
175 Masker 3 Ply Plus Bh 0 0 0
176 Masker Earloop Bh 5 5 5 0
177 Masker N 95 Bh 0 0 0
178 Masker particular respirator 9105 Bh 0 0 0
179 Masker tie on Bh 0 0 0
180 Melocid 7.5 mg Tablet 0 0 0
181 Meloxicam 15 mg Tablet 0 600 600 200 400
182 Mersibion kaplet Tablet 200 200 200 0
183 Metformin 500 mg tablet 0 0 0
184 Metformin 850mg tablet 0 0 0
185 Metilergometrin Maleat 0.125 mg Ampul 0 0 0
186 Metilergometrine mal.inj.0,200mg-1ml Tablet 0 0 0
187 Metilprednisolon 4 Mg Tab Tablet 1300 1300 1300
188 Metoklorpamide Tablet Tablet 500 500 500
189 Metronidazol 250 mg Tablet 0 0 0
190 Metronidazol 500 mg Botol 700 700 200 500
191 Metronidazol sirup Botol 0 0 0
192 Metronidazole Infus 5 Mg Botol 0 0 0
193 MgSo4 Inj Tube 0 0 0 ed.11/2020
194 Molacream Botol 85 85 33 52
195 Molafate suspensi Botol 0 0 0
196 My Jelly 82 gram Botol 0 0 0
197 Natrium klorida larutan 0,9 % steril tablet 27 27 23 4
198 Natrium Bicarbonat 500 mg Tablet 500 500 500 0
199 Natrium Diklofenak tab 25 mg Tablet 500 500 250 250
200 Natrium Diklofenak tab 50 mg Ampul 0 0 0
201 Neurobion injeksi / mersibion Supp 10 10 10
202 Nistatin 100.000 iu / g tab. Vaginal Tablet 0 0 0
203 Nistatin 500.000 iu tablet salut paket 0 0 0
204 OAM Program Malaria paket 0 0 0
205 OAT Kategori 1 paket 0 0 0
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
206 OAT Kategori 2 paket 0 0 0
207 OAT Kategori Anak Botol 0 0 0
208 Obat batuk hitam ( o b h ) cairan Tube 0 0 0
209 Oksitetrasiklin hcl salep 3 % Tube 0 0 0
210 Oksitetrasiklin hcl salep mata 1% Ampul 23 23 23
211 Oksitosin injeksi 10 iu / ml - 1 ml Ampul 25 25 23 2
212 Ondansentron injeksi 2 mg Botol 0 0 0
213 Paracetamol Drop 100mg/ml Tablet 25 25 25 0
214 Parasetamol 500 mg Botol 6500 6500 3500 3000
215 Parasetamol sirup 120 mg / 5 ml bh 0 0 0
216 Pehaveral bh 0 0 0
217 Pembalut Elastis 10 cm x 4,55 m Tablet 4 4 4
218 Pembalut Elastis 7,5 cm x 4,55 m Tablet 3 3 3
219 Pirantel pamoat Tablet 0 0 0
220 Piridoksin hcl ( vit. B 6 ) 10 mg bj 0 0 0
221 Piroxicam 10 mg rol 0 0 0
222 Planotest Kehamilan rol 50 50 27 23
223 Plester 5 yard x 2 inch Tablet 0 0 0
224 Plester e-care surgical tape 2'' Tablet 106 106 45 61
225 Prednison 5 mg Tablet 0 0 0
226 Primaquin Tablet Tablet 0 0 0
227 Pritacort tablet tablet 0 0 0
228 Propanolol hcl 10 mg tablet 0 0 0
229 Propanolol hcl 40 mg Ampul 0 0 0
230 Propiltiourasil ( PTU ) 100 mg Tablet 0 0 0
231 Ranitidin 25 Mh/ML inj tablet 303 303 180 123
232 Ranitidin Tablet tablet 13,500 13,500 2,900 10,600
233 Resperidon 1mg Botol 0 0 0
234 Risperidon tablet 2 mg Pc 100 100 20 80
235 RL larutan infus steril tablet 63 63 46 17
236 S i l k (benang bedah sutera) no.3 / 0 Pot 63 63 45 18
237 Salbutamol 2 mg lb 0 0 0
238 Salep 2 - 4 kombinasi : asam salisilat 2% + be tablet 48 48 27 21
239 Salon Pas Jet Spray Tube 6 6 2 4
240 Samcofenac 50 mg pc 0 0 0
241 Scabimite/ Permetrin Krim Vial 24 24 9 15
242 Serenity Twist Blood Lancet Ampul 0 0 0
243 Serum anti bisa ular poli.inj.5 ml (abu I) Ampul 0 0 0
244 Serum anti difteri injeksi 1.500 iu/amp (a.t.s) Ampul 5 5 1 4
245 Sianokobalamin (vit.b12) inj.500 mcg/ml tablet 39 39 39
246 Sikzonoate Inj. Flufenazine Inj. 25mg/ml tablet 0 0 0
247 Simvastatin Tablet Kaplet 2430 2430 2430
248 Tablet Tambah Darah Ampul 5100 5100 600 4500
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
249 Thiamphenicol 500 mg tablet 4000 4000 4000
250 Tiamin hcl (vit.b1) Inj 100mg/1 ml Ampul 0 0 0
251 Tiamin hcl mononitrat(vit.b1) 50mg tablet set 11500 11500 4800 6700
252 Tramadol injeksi 50 mg/ml tablet 0 0 0
254 Trifluoperazine 5mg bh 0 0 0
255 Triheksifenidil hcl 2 mg Ampul 0 0 0
256 Umbilical Cord Klem Steril Nylon Ampul 200 200 135 65
257 Vaksin Rabies Vero (VAR) rabipur kapsul 0 0 0
258 Vaksin Rabies Vero (VAR) verorab Botol 0 0 0
259 Vit. A 100.000 iu kaplet 0 0 0
260 Vit. A 200.000 iu kapsul 0 0 0
261 Vitamin B kompleks Tablet 0 0 0
262 Yodium povidon lar.10 % 30 ml Botol 30 30 27 3
263 Yodium povidon lar.10 % 300 ml Botol 0 0 0
264 Yodium povidon lar.10 % 60 ml Botol 0 0 0
265 Zinc Dispersible 20 mg Tablet 500 500 500
266 Zinc Sirup Botol 78 78 27 51
267 0 0 0
268 0 0 0
269 0 0 0
270 0 0 0
271 0 0 0

Umum JKN Jumlah

Kunjungan Resep Bayar Tidak

Mengetahui Yang Menyerahkan Mengetahui : Yang Menerima

Kepala Dinas Kesehatan Kepala IFK Ka. UPT Puskesmas Kampung Delima Petugas Puskesmas
Kabupaten Rejang Lebong

........................................................... FRANSISKA PUTRIANI,SSI,Apt JONI,SKM FITRIANI,A.Md.Farm

NIP. NIP.19790817 201001 2 2024 NIP. 19721005 199203 1 006 NIP.19740802 199503 2 002
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

KODE BULAN JANUARI JML.PUSTU 1 JML.POSKESDES/BIDES

PUSKESMAS BANGUN JAYA TAHUN 2021 JML.MELAPOR 1 JML.MELAPOR

Kode STOK SISA STOK PERMIN KET

NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
1 Abbocath No. 18 (IV cath No. 18) Pcs 200 0 200 0 200
2 Abbocath No. 20 (IV cath No. 20) Pcs 10 0 10 0 10
3 Abbocath No. 22 (IV cath No. 22) Pcs 120 0 120 10 110
4 Abbocath No. 24 (IV cath No. 24) Pcs 80 50 130 10 120
5 Abbocath no.27 Pcs 0 0 0 0 0
6 Alat suntik sekali pakai 1 ml Set 1000 0 1000 0 1000
7 Alat suntik sekali pakai 5 ml Set 2000 0 2000 100 1900
8 Alat Suntik sekali pakai 3 ml Set 900 0 900 100 800
9 Albendazole 400 Mg Caplet 0 500 500 100 400
10 Alkohol 70% 100 ml Botol 18 12 30 2 28
11 Alkohol 70% 1000 ml Botol 1 5 6 1 5
12 Alkohol swabs Pcs 150 200 350 50 300
13 Allopurinol 100 mg Tablet 100 500 600 300 300
14 Alphamol 600mg Tablet 1500 3000 4500 300 4200
15 Alprazolam tab 0,25 mg Tablet 0 0 0 0 0
16 Ambroxol Tablet 30 mg Tablet 0 0 0 0 0
17 Aminofilin 200 mg Tablet 800 0 800 200 600
18 Amitriptilin Hcl tablet salut 25 mg Tablet 0 0 0 0 0
19 Amlodipin tab 5 mg Tablet 0 0 0 0 0
20 Amoksisilin 250 mg Botol 3300 2000 5300 0 5300
21 Amoksisilin 500 mg Tablet 9400 10000 19400 2200 17200
22 Amoksisilin sirup 125 mg / 5 ml Botol 180 100 280 61 219
23 Antasida DOEN Sirup 60 ml Botol 0 200 200 42 158
24 Antasida doen tablet Tablet 0 2300 2300 400 1900
25 Anti hemoroid doen kombinasi Supp 70 0 70 0 70
26 Anti bakteri doen salep kombinasi : Basitras Tube 139 0 139 29 110
27 Anti fungi doen kombinasi : asam benzoat 6% + Pot 130 48 178 8 170
28 Anti Malaria DOEN Komb(Sulfadoksin 500 mg Botol 0 0 0 0 0
29 Anti migrain doen kombinasi Tablet 400 0 400 0 400
30 Antiseptik Gell 500 cc galon 0 0 0 0 0
31 Antiseptik handrub @ 500 ml (Sky Light Cleaner galon 0 0 2 2 0
32 Aqua pro injeksi Botol 30 24 54 12 42
33 Asam askorbat ( vit.c ) 50 mg Tablet 0 700 700 400 300
 Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
34 Asam Mefenamat 500 mg /Molasic Kaplet 7100 5000 12100 1700 10400
35 Asam traneksamat injeksi Ampul 0 0 0 0 0
36 Asiklovir tablet 200 mg Tablet 150 200 350 50 300
37 Asiklovir tablet 400 mg Tablet 150 200 350 0 350
38 Asiklovir Krim 5 % Tube 56 0 56 11 45
39 Atropin sulfat 0,5 mg Tablet 0 0 0 0 0
40 Atropin Inj 0,25 Mg Ampul 0 0 0 0 0
41 Attapulgit 630 mg (pularex) Tablet 600 0 600 0 600
42 Bedak Salisil 2 % Bungkus 18 0 18 6 12
43 Benecheck Plus Glucose Test Strip 50's Pcs 0 100 100 100 0
44 Benecheck Plus Total Cholesterol Test Strip 10's Pcs 0 0 0 0 0
45 Benecheck Plus Uric Test Strip 25's Pcs 0 0 0 0 0
46 Benechek Asam Urat Pcs 0 0 0 0 0
47 Benechek Cholesterol Pcs 0 0 0 0 0
48 Benechek GDS Pcs 0 0 0 0 0
49 Berotec Fenoterol HBR INH Cairan Botol 0 0 0 0 0
50 Betahistin Mesilat tab 6 mg Tablet 900 0 900 100 800
51 Betametason krim 0,1 % Tube 15 0 15 5 10
52 Bioplacenton Tube 0 0 0 0 0
53 Bisakodil supp 10 mg (dulcolax) Supp 75 0 75 0 75
54 Bisakodil supp 5 mg (dulcolax infant) Supp 0 48 48 0 48
55 Bisoprolol tab 5 mg Tablet 330 0 330 0 330
56 Blood Transfusion Set Set 0 50 50 0 50
57 Burnazine Salep Luka Bakar Tube 7 3 10 1 9
58 Buscopan injeksi Ampul 20 0 20 10 10
59 Captopril 12, 5 mg Tablet 5900 1000 6900 800 6100
60 Captopril 25 mg Tablet 3000 1000 4000 700 3300
61 Catgut / benang bedah no.2/0 Set 12 36 48 11 37
62 Catgut / benang bedah no.3/0 Set 0 0 0 0 0
63 Cefadroxyl 500 mg Capsul 7800 0 7800 800 7000
64 Cefadroxyl Syr. Kering Botol 70 0 70 9 61
65 Cefixime 100 mg Tablet 0 0 0 0 0
66 Ceftriaxone inj Ampul 0 100 100 30 70
68 Cetirizine 10mg Tablet 0 0 0 0 0
69 Ciprofoxacin 500 mg Tablet 0 400 400 100 300
70 Citicolin injeksi Ampul 80 5 85 20 65
71 Clobazam Tablet 0 0 0 0 0
72 Clozapin 100mg Tab Tablet 0 0 0 0 0
73 Clozapin 25mg Tab Tablet 200 0 200 150 50
74 Deksametason 0,5 mg Tablet 0 500 500 200 300
75 Deksametason inj.5 mg / ml - 1 ml Ampul 0 30 30 16 14
76 Dermafix T 5x7 c Lembar 50 0 50 0 50
 Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
77 Detol sabun cair Tablet 0 0 0 0 0
78 Dextral tab Tablet 0 0 0 0 0
79 Diazepam 2 mg inj Ampul 1 0 1 0 1
80 Diazepam injeksi 5 mg / ml - 2 ml Tablet 0 0 0 0 0
81 Diazepam 5 mg tablet Supp 0 0 0 0 0
82 Diazepam enema Stesolid 5mg Ampul 0 0 0 0 0
83 Difenhidramin hcl inj.10mg/ml-1ml Tablet 240 30 270 257 13 240 ed
84 Diltiazem 30 mg Tablet 300 200 500 0 500
85 Domperidon tablet Ampul 0 500 500 200 300
86 Epinefrin hcl injeksi 0,1 % - 1 ml Tablet 0 0 0 0 0
87 Eritromisin 500 mg Botol 1200 500 1700 200 1500
88 Eritromisin Sirup Botol 0 10 10 3 7
89 Etakridin ( rivanol ) larutan 0,1 % Botol 6 6 12 1 11
90 Etil klorida semprot Botol 0 10 10 0 10
91 Eugenol cairan Tablet 0 0 0 0 0
92 Fenobarbital 30 mg Ampul 0 0 0 0 0
93 Fenobarbital inj 50 mg/ml Botol 10 0 10 0 10
94 Fenol gliserol (karbogliserin) tetes telinga 10 Ampul 0 4 4 0 4
95 Fitomenadion (vit K1) inj.10mg/ml-1ml Tablet 115 115 0 115
96 Fitomenadion (vit K1)tab.salut 10 mg Ampul 500 0 500 0 500
97 Fitomenadion injeksi 2 mg / 1 ml set 90 30 120 8 112
98 Folley Chateter no 16 set 0 30 30 0 30
99 Folley Chateter no 18 set 0 30 30 0 30
100 Folley Chateter no 22 Tablet 0 30 30 0 30
101 Furosemid 40mg sacc 0 0 0 0 0
102 Garam oralit untuk 200 ml air Tube 0 100 100 90 10
103 Gentamicin Salep Kulit Ampul 0 0 0 0 0
104 Gentamisin Inj 40 mg/ml Botol 0 0 0 0 0
105 Gentamisin TM Botol 48 0 48 3 45
106 Gentian violet larutan 1 % Tablet 19 9 28 3 25
107 Glibenklamid 5 mg Tablet 800 0 800 0 800
108 Gliseril guayakolat 100 mg Botol 7100 6800 13900 8700 5200 7100 ed
109 Glukosa larutan infus 5 % steril Tablet 10 0 10 0 10
110 Griseofulvin 125 mg , micronized Tablet 0 0 0 0 0
111 Haloperidol 1,5 mg Ampul 0 0 0 0 0
112 Haloperidol 5 mg Tablet 100 0 100 100 0
113 Haloperidol 0,5 mg Tablet 0 0 0 0 0
114 Haloperidol 2 Mg set 0 0 0 0 0
115 Hand Schoon M set 0 0 0 0 0
116 Hand Schoon No. 7,5 set 50 0 50 50 0
117 Handschoon GynecologiNo. 7 set 0 0 0 0 0
118 Handschoon GynecologiNo. 7,5 Tablet 0 0 0 0 0
119 Hidroklortiazid ( Hct ) 25 mg Tube 3400 1300 4700 0 4700
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
120 Hidrokortison krim 2,5 % Tablet 82 48 130 1 129
121 Ibuprofen 200 mg Tablet 0 0 0 0 0
122 Ibuprofen 400 mg Botol 4300 200 4500 900 3600
123 Ibuprofen syrup 100mg/5ml Botol 0 35 35 13 22
124 Imersi Oil Set 0 0 0 0 0
125 Infusion set anak Set 70 0 70 20 50
126 Infusion set dewasa set 0 0 0 0 0
127 Infusiont Set Y - Type Box 180 0 180 30 150
128 Iodine Test 10 ml Tablet 0 0 0 0 0
129 Isosorbid dinitrat tab.sublungual 5 mg Biji 1000 0 1000 0 1000
130 Jarum jahit ( bedah ) no. 11 Biji 0 0 0 0 0
131 Jarum jahit ( bedah ) no. 13 Kulit Biji 0 0 0 0 0
132 Jarum jahit ( bedah ) no. 13 Otot Biji 24 144 168 0 168
133 Jarum jahit ( bedah ) no. 9 Kulit Biji 0 0 0 0 0
134 Jarum jahit ( bedah ) no. 9 Otot Botol 12 0 12 0 12
135 KAEN 3 B INFUS gulung 0 0 0 0 0
136 Kalsium laktat ( kalk ) 500 mg tablet 3600 2000 5600 500 5100
137 Kapas pembalut / absorben 250 gr bks 2 10 12 3 9
138 Kasa kompres 40 / 40 steril Rol 0 100 100 20 80
139 Kasa pembalut 4 m x 10 cm Rol 0 0 0 0 0
140 Kasa pembalut hidrofil 4 m x 15 cm Rol 0 0 0 0 0
141 Kasa pembalut hidrofil 4 m x 3 cm Rol 80 0 80 0 80
142 Kasa pembalut hidrofil 4 m x 5 cm Lembar 270 0 270 70 200
143 Kasa pembalut hidrofil 16 cm x 16 cm Bungkus 450 0 450 50 400
144 Kasa pembalut 2 yard x 80 cm Rol 0 0 0 0 0
145 Kasa Hidrofil 40 yard x 80 cm Tube 0 10 10 2 8
146 Ketokonazole Cream 2 % Tablet 78 25 103 9 94
147 Ketokonazole tablet 200 mg Ampul 800 200 1000 350 650
148 Ketorolac injeksi Botol 0 0 0 0 0
149 Kloramfenicol Salep mata Kapsul 17 0 17 7 10
150 Kloramfenikol 250 mg Kapsul 6200 0 6200 0 6200
151 Kloramfenikol 500 mg (Chloramex) Botol 2100 4000 6100 100 6000
152 Kloramfenikol tetes mata 0,5 % (decacetin) Tube 0 2 2 0 2
153 Kloramfenikol Salep Kulit 2 % (Bufacetin Krim) Botol 0 0 0 0 0
154 Kloramfenikol Syrup Tablet 0 0 0 0 0
155 Klorfeniramin ( ctm ) 4 mg Tablet 6,000 10000 16000 0 16,000
156 Kloroquin 150 mg Tablet 0 0 0 0 0
157 Klorpromazin hcl 100 mg Tablet 0 0 0 0 0
158 Kodein hcl 10 mg Tablet 0 0 0 0 0
159 Kotrimoksazol dewasa ( 480 mg ) Tablet 0 300 300 100 200
160 Kotrimoksazol pediatrik ( 120 mg ) Botol 0 0 0 0 0
161 Kotrimoksazol suspensi Kapsul 0 50 50 12 38
162 Lansoprazole tablet 30 mg Botol 1260 1360 2620 320 2300
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
163 Larutan EDTA 100 ml Botol 0 0 0 0 0
164 Larutan Giemsa 100 ml Botol 0 0 0 0 0
165 Larutan HCL 0,1 N 100ml Botol 0 0 0 0 0
166 Larutan KOH 10% 100 ml Botol 0 0 0 0 0
167 Larutan Turk 100 ml Lembar 0 0 0 0 0
168 Leukoplast 2.5 cm X 4.5 cm Ampul 0 0 0 0 0
169 Lidocain Combinasi (+epinefrin) Ampul 40 90 130 50 80
170 Lidokain injeksi 2% Botol 68 0 68 0 68
171 Lidokain Jel 2 % Botol 0 0 0 0 0
172 Lidokain Spray Oral 10 % Botol 0 0 0 0 0
173 Lisol 1000 ml Tablet 0 5 5 2 3
174 Loratadine 10 mg Tablet 0 0 0 0 0
175 Masker 3 Ply Plus Bh 0 0 0 0 0
176 Masker Earloop Bh 0 0 0 0 0
177 Masker N 95 Bh 0 20 20 5 15
178 Masker particular respirator 9105 Bh 0 0 0 0 0
179 Masker tie on Bh 100 500 600 150 450
180 Melocid 7.5 mg Tablet 0 0 0 0 0
181 Meloxicam 7,5 mg Tablet 920 700 1620 260 1360
182 Mersibion kaplet Tablet 0 100 100 0 100
183 Metformin 500 mg tablet 0 0 0 0 0
184 Metformin 850mg tablet 0 700 700 100 600
185 Metilergometrin Maleat 0.125 mg Ampul 0 0 0 0 0
186 Metilergometrine mal.inj.0,200mg-1ml Tablet 0 0 0 0 0
187 Metilprednisolon 4 Mg Tab Tablet 2100 400 2500 300 2200
188 Metoklorpamide Tablet Tablet 400 400 800 0 800
189 Metronidazol 250 mg Tablet 4700 1000 5700 300 5400
190 Metronidazol 500 mg Botol 0 0 0 0 0
191 Metronidazol sirup Botol 0 0 0 0 0
192 Metronidazole Infus 5 Mg Botol 0 0 0 0 0
193 MgSo4 Inj Tube 0 0 0 0 0
194 Molacream Botol 25 0 25 1 24
195 Molafate suspensi Botol 0 0 0 0 0
196 My Jelly 82 gram Botol 0 0 0 0 0
197 Natrium klorida larutan 0,9 % steril tablet 0 20 20 20 0
198 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 0
199 Natrium Diklofenak tab 25 mg Tablet 1000 500 1500 1050 450
200 Natrium Diklofenak tab 50 mg Ampul 0 500 500 150 350
201 Neurobion injeksi / mersibion Supp 30 0 30 0 30
202 Nistatin 100.000 iu / g tab. Vaginal Tablet 400 0 400 0 400
203 Nistatin 500.000 iu tablet salut paket 0 100 100 0 100
204 OAM Program Malaria paket 0 0 0 0 0
205 OAT Kategori 1 paket 0 0 0 0 0
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
206 OAT Kategori 2 paket 0 0 0 0 0
207 OAT Kategori Anak Botol 0 0 0 0 0
208 Obat batuk hitam ( o b h ) cairan Tube 0 10 10 6 4
209 Oksitetrasiklin hcl salep 3 % Tube 38 0 38 8 30
210 Oksitetrasiklin hcl salep mata 1% Ampul 19 5 24 4 20
211 Oksitosin injeksi 10 iu / ml - 1 ml Ampul 3 10 13 0 13
212 Ondansentron injeksi 2 mg Botol 0 0 0 0 0
213 Paracetamol Drop 100mg/ml Tablet 0 20 20 7 13
214 Parasetamol 500 mg Botol 6800 7000 13800 2100 11700
215 Parasetamol sirup 120 mg / 5 ml bh 0 100 100 30 70
216 Pehaveral bh 0 0 0 0 0
217 Pembalut Elastis 10 cm x 4,55 m Tablet 0 0 0 0 0
218 Pembalut Elastis 7,5 cm x 4,55 m Tablet 20 0 20 0 20
219 Pirantel pamoat Tablet 0 0 0 0 0
220 Piridoksin hcl ( vit. B 6 ) 10 mg bj 0 600 600 100 500
221 Piroxicam 10 mg rol 0 0 0 0 0
222 Planotest Kehamilan rol 160 0 160 10 150
223 Plester 5 yard x 2 inch Tablet 0 0 0 0 0
224 Plester e-care surgical tape 2'' Tablet 34 30 64 4 60
225 Prednison 5 mg Tablet 0 300 300 100 200
226 Primaquin Tablet Tablet 0 0 0 0 0
227 Pritacort tablet tablet 0 0 0 0 0
228 Propanolol hcl 10 mg tablet 500 0 500 0 500
229 Propanolol hcl 40 mg Ampul 0 0 0 0 0
230 Propiltiourasil ( PTU ) 100 mg Tablet 550 0 550 0 550
231 Ranitidin 25 Mh/ML inj tablet 144 100 244 64 180
232 Ranitidin Tablet tablet 2000 3000 5000 0 5000
233 Resperidon 1mg Botol 0 0 0 0 0
234 Risperidon tablet 2 mg Pc 300 0 300 200 100
235 RL larutan infus steril tablet 142 60 202 62 140
236 S i l k (benang bedah sutera) no.3 / 0 Pot 33 24 57 7 50
237 Salbutamol 2 mg lb 0 0 400 200 200
238 Salep 2 - 4 kombinasi : asam salisilat 2% + be tablet 44 0 44 4 40
239 Salon Pas Jet Spray Tube 4 0 4 1 3
240 Samcofenac 50 mg pc 0 0 0 0 0
241 Scabimite/ Permetrin Krim Vial 23 60 83 11 72
242 Serenity Twist Blood Lancet Ampul 0 0 0 0 0
243 Serum anti bisa ular poli.inj.5 ml (abu I) Ampul 0 0 0 0 0
244 Serum anti difteri injeksi 1.500 iu/amp (a.t.s) Ampul 0 0 0 0 0
245 Sianokobalamin (vit.b12) inj.500 mcg/ml tablet 412 200 612 217 395 150 ed
246 Sikzonoate Inj. Flufenazine Inj. 25mg/ml tablet 0 0 0 0 0
247 Simvastatin Tablet Kaplet 1540 1680 3220 30 3190
248 Tablet Tambah Darah Ampul 6800 5600 12400 4900 7500
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
249 Thiamphenicol 500 mg tablet 0 0 0 0 0
250 Tiamin hcl (vit.b1) Inj 100mg/1 ml Ampul 0 0 0 0 0
251 Tiamin hcl mononitrat(vit.b1) 50mg tablet set 6300 600 6900 1500 5400
252 Tramadol injeksi 50 mg/ml tablet 0 0 0 0 0
254 Trifluoperazine 5mg bh 0 0 0 0 0
255 Triheksifenidil hcl 2 mg Ampul 100 0 100 100 0
256 Umbilical Cord Klem Steril Nylon Ampul 80 0 80 20 60
257 Vaksin Rabies Vero (VAR) rabipur kapsul 0 0 0 0 0
258 Vaksin Rabies Vero (VAR) verorab Botol 0 0 0 0 0
259 Vit. A 100.000 iu kaplet 0 0 0 0 0
260 Vit. A 200.000 iu kapsul 0 0 0 0 0
261 Vitamin B kompleks Tablet 0 200 200 100 100
262 Yodium povidon lar.10 % 30 ml Botol 5 0 5 1 4
263 Yodium povidon lar.10 % 300 ml Botol 0 0 0 0 0
264 Yodium povidon lar.10 % 60 ml Botol 0 10 10 2 8
265 Zinc Dispersible 20 mg Tablet 1300 0 1300 100 1200
266 Zinc Sirup Botol 24 108 132 12 120
267
268
269
270
271

Umum JKN Jumlah

Kunjungan Resep Bayar Tidak
60 5 115 180

Mengetahui Yang Menyerahkan Mengetahui : Yang Menerima

Kepala Dinas Kesehatan Kepala IFK Ka. UPT Puskesmas Kampung Delima Petugas Puskesmas
Kabupaten Rejang Lebong

........................................................... FRANSISKA PUTRIANI,SSI,Apt M.NASIR MAULUDDIN,SKM EVRIZA GUSDWIYANTI,Am.Rad

NIP. NIP.19790817 201001 2 2024 NIP. 19690528 199001 1 001 NIP.19880809 201001 2 011
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

KODE BULAN FEBRUARI JML.PUSTU 1 JML.POSKESDES/BIDES

PUSKESMAS BANGUN JAYA TAHUN 2021 JML.MELAPOR 1 JML.MELAPOR

Kode STOK SISA STOK PERMIN KET

NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
1 Abbocath No. 18 (IV cath No. 18) Pcs 200 0 200 0 200
2 Abbocath No. 20 (IV cath No. 20) Pcs 10 0 10 0 10
3 Abbocath No. 22 (IV cath No. 22) Pcs 110 0 110 10 100
4 Abbocath No. 24 (IV cath No. 24) Pcs 120 0 120 15 105
5 Abbocath no.27 Pcs 0 0 0 0 0
6 Alat suntik sekali pakai 1 ml Set 1000 0 1000 0 1000
7 Alat suntik sekali pakai 5 ml Set 1900 0 1900 50 1850
8 Alat Suntik sekali pakai 3 ml Set 800 0 800 0 800
9 Albendazole 400 Mg Caplet 400 0 400 0 400
10 Alkohol 70% 100 ml Botol 28 0 28 1 27
11 Alkohol 70% 1000 ml Botol 5 0 5 0 5
12 Alkohol swabs Pcs 300 0 300 0 300
13 Allopurinol 100 mg Tablet 300 0 300 200 100
14 Alphamol 600mg Tablet 4200 0 4200 200 4000
15 Alprazolam tab 0,25 mg Tablet 0 0 0 0 0
16 Ambroxol Tablet 30 mg Tablet 0 0 0 0 0
17 Aminofilin 200 mg Tablet 600 0 600 0 600
18 Amitriptilin Hcl tablet salut 25 mg Tablet 0 0 0 0 0
19 Amlodipin tab 5 mg Tablet 0 0 0 0 0
20 Amoksisilin 250 mg Botol 5300 0 5300 0 5300
21 Amoksisilin 500 mg Tablet 17200 0 17200 100 17100
22 Amoksisilin sirup 125 mg / 5 ml Botol 219 0 219 0 219
23 Antasida DOEN Sirup 60 ml Botol 158 0 158 38 120
24 Antasida doen tablet Tablet 1900 0 1900 400 1500
25 Anti hemoroid doen kombinasi Supp 70 0 70 0 70
26 Anti bakteri doen salep kombinasi : Basitras Tube 110 0 110 0 110
27 Anti fungi doen kombinasi : asam benzoat 6% + Pot 170 0 170 25 145
28 Anti Malaria DOEN Komb(Sulfadoksin 500 mg Botol 0 0 0 0 0
29 Anti migrain doen kombinasi Tablet 400 0 400 0 400
30 Antiseptik Gell 500 cc galon 0 0 0 0 0
31 Antiseptik handrub @ 500 ml (Sky Light Cleaner galon 0 0 2 1 1
32 Aqua pro injeksi Botol 42 0 42 0 42
33 Asam askorbat ( vit.c ) 50 mg Tablet 300 0 300 100 200
 Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
34 Asam Mefenamat 500 mg /Molasic Kaplet 10400 10400 1300 9100
35 Asam traneksamat injeksi Ampul 0 0 0 0
36 Asiklovir tablet 200 mg Tablet 300 300 0 300
37 Asiklovir tablet 400 mg Tablet 350 350 50 300
38 Asiklovir Krim 5 % Tube 45 45 11 34
39 Atropin sulfat 0,5 mg Tablet 0 0 0 0
40 Atropin Inj 0,25 Mg Ampul 0 0 0 0
41 Attapulgit 630 mg (pularex) Tablet 600 600 0 600
42 Bedak Salisil 2 % Bungkus 12 12 0 12
43 Benecheck Plus Glucose Test Strip 50's Pcs 0 0 0 0
44 Benecheck Plus Total Cholesterol Test Strip 10's Pcs 0 0 0 0
45 Benecheck Plus Uric Test Strip 25's Pcs 0 0 0 0
46 Benechek Asam Urat Pcs 0 0 0 0
47 Benechek Cholesterol Pcs 0 0 0 0
48 Benechek GDS Pcs 0 0 0 0
49 Berotec Fenoterol HBR INH Cairan Botol 0 0 0 0
50 Betahistin Mesilat tab 6 mg Tablet 800 800 0 800
51 Betametason krim 0,1 % Tube 10 10 6 4
52 Bioplacenton Tube 0 0 0 0
53 Bisakodil supp 10 mg (dulcolax) Supp 75 75 5 70
54 Bisakodil supp 5 mg (dulcolax infant) Supp 48 48 6 42
55 Bisoprolol tab 5 mg Tablet 330 330 0 330
56 Blood Transfusion Set Set 50 50 6 44
57 Burnazine Salep Luka Bakar Tube 9 9 1 8
58 Buscopan injeksi Ampul 10 10 0 10
59 Captopril 12, 5 mg Tablet 6100 6100 100 6000
60 Captopril 25 mg Tablet 3300 3300 600 2700
61 Catgut / benang bedah no.2/0 Set 37 37 6 31
62 Catgut / benang bedah no.3/0 Set 0 0 0 0
63 Cefadroxyl 500 mg Capsul 7000 7000 200 6800
64 Cefadroxyl Syr. Kering Botol 61 61 0 61
65 Cefixime 100 mg Tablet 0 0 0 0
66 Ceftriaxone inj Ampul 70 70 0 70
68 Cetirizine 10mg Tablet 0 0 0 0
69 Ciprofoxacin 500 mg Tablet 300 300 0 300
70 Citicolin injeksi Ampul 65 65 0 65
71 Clobazam Tablet 0 0 0 0
72 Clozapin 100mg Tab Tablet 0 0 0 0
73 Clozapin 25mg Tab Tablet 50 50 50 0
74 Deksametason 0,5 mg Tablet 300 300 200 100
75 Deksametason inj.5 mg / ml - 1 ml Ampul 14 14 0 14
76 Dermafix T 5x7 c Lembar 50 50 0 50
 Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
77 Detol sabun cair Tablet 0 0 0 0
78 Dextral tab Tablet 0 0 0 0
79 Diazepam 2 mg inj Ampul 1 1 0 1
80 Diazepam injeksi 5 mg / ml - 2 ml Tablet 0 0 0 0
81 Diazepam 5 mg tablet Supp 0 0 0 0
82 Diazepam enema Stesolid 5mg Ampul 0 0 0 0
83 Difenhidramin hcl inj.10mg/ml-1ml Tablet 13 13 0 13
84 Diltiazem 30 mg Tablet 500 500 0 500
85 Domperidon tablet Ampul 300 300 100 200
86 Epinefrin hcl injeksi 0,1 % - 1 ml Tablet 0 0 0 0
87 Eritromisin 500 mg Botol 1500 1500 0 1500
88 Eritromisin Sirup Botol 7 7 0 7
89 Etakridin ( rivanol ) larutan 0,1 % Botol 11 11 1 10
90 Etil klorida semprot Botol 10 10 0 10
91 Eugenol cairan Tablet 0 0 0 0
92 Fenobarbital 30 mg Ampul 0 0 0 0
93 Fenobarbital inj 50 mg/ml Botol 10 10 0 10
94 Fenol gliserol (karbogliserin) tetes telinga 10 Ampul 4 4 2 2
95 Fitomenadion (vit K1) inj.10mg/ml-1ml Tablet 115 115 0 115
96 Fitomenadion (vit K1)tab.salut 10 mg Ampul 500 500 0 500
97 Fitomenadion injeksi 2 mg / 1 ml set 112 112 0 112
98 Folley Chateter no 16 set 30 30 0 30
99 Folley Chateter no 18 set 100 100 0 100
100 Folley Chateter no 22 Tablet 30 30 0 30
101 Furosemid 40mg sacc 0 0 0 0
102 Garam oralit untuk 200 ml air Tube 10 10 10 0
103 Gentamicin Salep Kulit Ampul 0 0 0 0
104 Gentamisin Inj 40 mg/ml Botol 0 0 0 0
105 Gentamisin TM Botol 45 45 4 41
106 Gentian violet larutan 1 % Tablet 25 25 0 25
107 Glibenklamid 5 mg Tablet 800 800 0 800
108 Gliseril guayakolat 100 mg Botol 5200 5200 1000 4200
109 Glukosa larutan infus 5 % steril Tablet 10 10 2 8
110 Griseofulvin 125 mg , micronized Tablet 0 0 0 0
111 Haloperidol 1,5 mg Ampul 0 0 0 0
112 Haloperidol 5 mg Tablet 0 0 0 0
113 Haloperidol 0,5 mg Tablet 0 0 0 0
114 Haloperidol 2 Mg set 0 0 0 0
115 Hand Schoon M set 0 0 0 0
116 Hand Schoon No. 7,5 set 0 0 0 0
117 Handschoon GynecologiNo. 7 set 0 0 0 0
118 Handschoon GynecologiNo. 7,5 Tablet 0 0 0 0
119 Hidroklortiazid ( Hct ) 25 mg Tube 4700 4700 0 4700
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
120 Hidrokortison krim 2,5 % Tablet 129 129 9 120
121 Ibuprofen 200 mg Tablet 0 0 0 0
122 Ibuprofen 400 mg Botol 3600 3600 500 3100
123 Ibuprofen syrup 100mg/5ml Botol 22 22 0 22
124 Imersi Oil Set 0 0 0 0
125 Infusion set anak Set 50 50 0 50
126 Infusion set dewasa set 0 0 0 0
127 Infusiont Set Y - Type Box 150 150 0 150
128 Iodine Test 10 ml Tablet 0 0 0 0
129 Isosorbid dinitrat tab.sublungual 5 mg Biji 1000 1000 0 1000
130 Jarum jahit ( bedah ) no. 11 Biji 0 0 0 0
131 Jarum jahit ( bedah ) no. 13 Kulit Biji 0 0 0 0
132 Jarum jahit ( bedah ) no. 13 Otot Biji 168 168 0 168
133 Jarum jahit ( bedah ) no. 9 Kulit Biji 0 0 0 0
134 Jarum jahit ( bedah ) no. 9 Otot Botol 12 12 0 12
135 KAEN 3 B INFUS gulung 0 0 0 0
136 Kalsium laktat ( kalk ) 500 mg tablet 5100 5100 1000 4100
137 Kapas pembalut / absorben 250 gr bks 9 9 0 9
138 Kasa kompres 40 / 40 steril Rol 80 80 0 80
139 Kasa pembalut 4 m x 10 cm Rol 0 0 0 0
140 Kasa pembalut hidrofil 4 m x 15 cm Rol 0 0 0 0
141 Kasa pembalut hidrofil 4 m x 3 cm Rol 80 80 0 80
142 Kasa pembalut hidrofil 4 m x 5 cm Lembar 200 200 0 200
143 Kasa pembalut hidrofil 16 cm x 16 cm Bungkus 400 400 0 400
144 Kasa pembalut 2 yard x 80 cm Rol 0 0 0 0
145 Kasa Hidrofil 40 yard x 80 cm Tube 8 8 0 8
146 Ketokonazole Cream 2 % Tablet 94 94 5 89
147 Ketokonazole tablet 200 mg Ampul 650 650 0 650
148 Ketorolac injeksi Botol 0 0 0 0
149 Kloramfenicol Salep mata Kapsul 10 10 0 10 10 ed
150 Kloramfenikol 250 mg Kapsul 6200 6200 0 6200
151 Kloramfenikol 500 mg (Chloramex) Botol 6000 6000 100 5900
152 Kloramfenikol tetes mata 0,5 % (decacetin) Tube 2 2 0 2
153 Kloramfenikol Salep Kulit 2 % (Bufacetin Krim) Botol 0 0 0 0
154 Kloramfenikol Syrup Tablet 0 0 0 0
155 Klorfeniramin ( ctm ) 4 mg Tablet 16,000 16000 5700 10,300
156 Kloroquin 150 mg Tablet 0 0 0 0
157 Klorpromazin hcl 100 mg Tablet 0 0 0 0
158 Kodein hcl 10 mg Tablet 0 0 0 0
159 Kotrimoksazol dewasa ( 480 mg ) Tablet 200 200 0 200
160 Kotrimoksazol pediatrik ( 120 mg ) Botol 0 0 0 0
161 Kotrimoksazol suspensi Kapsul 38 38 5 33
162 Lansoprazole tablet 30 mg Botol 2300 2300 0 2300
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
163 Larutan EDTA 100 ml Botol 0 0 0 0
164 Larutan Giemsa 100 ml Botol 0 0 0 0
165 Larutan HCL 0,1 N 100ml Botol 0 0 0 0
166 Larutan KOH 10% 100 ml Botol 0 0 0 0
167 Larutan Turk 100 ml Lembar 0 0 0 0
168 Leukoplast 2.5 cm X 4.5 cm Ampul 0 0 0 0
169 Lidocain Combinasi (+epinefrin) Ampul 80 80 0 80
170 Lidokain injeksi 2% Botol 68 68 8 60
171 Lidokain Jel 2 % Botol 0 0 0 0
172 Lidokain Spray Oral 10 % Botol 0 0 0 0
173 Lisol 1000 ml Tablet 3 3 0 3
174 Loratadine 10 mg Tablet 0 0 0 0
175 Masker 3 Ply Plus Bh 0 0 0 0
176 Masker Earloop Bh 0 0 0 0
177 Masker N 95 Bh 15 15 0 15
178 Masker particular respirator 9105 Bh 0 0 0 0
179 Masker tie on Bh 450 450 250 200
180 Melocid 7.5 mg Tablet 0 0 0 0
181 Meloxicam 7,5 mg Tablet 1360 1360 340 1020
182 Mersibion kaplet Tablet 100 100 0 100
183 Metformin 500 mg tablet 0 0 0 0
184 Metformin 850mg tablet 600 600 0 600
185 Metilergometrin Maleat 0.125 mg Ampul 0 0 0 0
186 Metilergometrine mal.inj.0,200mg-1ml Tablet 0 0 0 0
187 Metilprednisolon 4 Mg Tab Tablet 2200 2200 300 1900
188 Metoklorpamide Tablet Tablet 800 800 0 800
189 Metronidazol 250 mg Tablet 5400 5400 100 5300
190 Metronidazol 500 mg Botol 0 0 0 0
191 Metronidazol sirup Botol 0 0 0 0
192 Metronidazole Infus 5 Mg Botol 0 0 0 0
193 MgSo4 Inj Tube 0 0 0 0
194 Molacream Botol 24 24 8 16
195 Molafate suspensi Botol 0 0 0 0
196 My Jelly 82 gram Botol 0 0 0 0
197 Natrium klorida larutan 0,9 % steril tablet 0 0 0 0
198 Natrium Bicarbonat 500 mg Tablet 0 0 0 0
199 Natrium Diklofenak tab 25 mg Tablet 450 450 250 200
200 Natrium Diklofenak tab 50 mg Ampul 350 350 50 300
201 Neurobion injeksi / mersibion Supp 30 30 3 27
202 Nistatin 100.000 iu / g tab. Vaginal Tablet 400 400 0 400
203 Nistatin 500.000 iu tablet salut paket 100 100 0 100
204 OAM Program Malaria paket 0 0 0 0
205 OAT Kategori 1 paket 0 0 0 0
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
206 OAT Kategori 2 paket 0 0 0 0
207 OAT Kategori Anak Botol 0 0 0 0
208 Obat batuk hitam ( o b h ) cairan Tube 4 4 3 1
209 Oksitetrasiklin hcl salep 3 % Tube 30 30 0 30 18 ed
210 Oksitetrasiklin hcl salep mata 1% Ampul 20 20 0 20
211 Oksitosin injeksi 10 iu / ml - 1 ml Ampul 13 13 13 0
212 Ondansentron injeksi 2 mg Botol 0 0 0 0
213 Paracetamol Drop 100mg/ml Tablet 13 13 4 9
214 Parasetamol 500 mg Botol 11700 11700 3600 8100
215 Parasetamol sirup 120 mg / 5 ml bh 70 70 0 70
216 Pehaveral bh 0 0 0 0
217 Pembalut Elastis 10 cm x 4,55 m Tablet 0 0 0 0
218 Pembalut Elastis 7,5 cm x 4,55 m Tablet 20 20 0 20
219 Pirantel pamoat Tablet 0 0 0 0
220 Piridoksin hcl ( vit. B 6 ) 10 mg bj 500 500 150 350
221 Piroxicam 10 mg rol 0 0 0 0
222 Planotest Kehamilan rol 150 150 10 140
223 Plester 5 yard x 2 inch Tablet 0 0 0 0
224 Plester e-care surgical tape 2'' Tablet 60 60 0 60
225 Prednison 5 mg Tablet 200 200 100 100
226 Primaquin Tablet Tablet 0 0 0 0
227 Pritacort tablet tablet 0 0 0 0
228 Propanolol hcl 10 mg tablet 500 500 100 400
229 Propanolol hcl 40 mg Ampul 0 0 0 0
230 Propiltiourasil ( PTU ) 100 mg Tablet 550 550 0 550
231 Ranitidin 25 Mh/ML inj tablet 180 180 0 180
232 Ranitidin Tablet tablet 5000 5000 100 4900
233 Resperidon 1mg Botol 0 0 0 0
234 Risperidon tablet 2 mg Pc 100 100 100 0
235 RL larutan infus steril tablet 140 140 0 140
236 S i l k (benang bedah sutera) no.3 / 0 Pot 50 50 0 50
237 Salbutamol 2 mg lb 200 400 300 100
238 Salep 2 - 4 kombinasi : asam salisilat 2% + be tablet 40 40 6 34
239 Salon Pas Jet Spray Tube 3 3 0 3
240 Samcofenac 50 mg pc 0 0 0 0
241 Scabimite/ Permetrin Krim Vial 72 72 14 58
242 Serenity Twist Blood Lancet Ampul 0 0 0 0
243 Serum anti bisa ular poli.inj.5 ml (abu I) Ampul 0 0 0 0
244 Serum anti difteri injeksi 1.500 iu/amp (a.t.s) Ampul 0 0 0 0
245 Sianokobalamin (vit.b12) inj.500 mcg/ml tablet 395 395 0 395 150 ed
246 Sikzonoate Inj. Flufenazine Inj. 25mg/ml tablet 0 0 0 0
247 Simvastatin Tablet Kaplet 3190 3190 0 3190
248 Tablet Tambah Darah Ampul 7500 7500 3700 3800 3700 ed
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
249 Thiamphenicol 500 mg tablet 0 0 0 0
250 Tiamin hcl (vit.b1) Inj 100mg/1 ml Ampul 0 0 0 0
251 Tiamin hcl mononitrat(vit.b1) 50mg tablet set 5400 5400 500 4900
252 Tramadol injeksi 50 mg/ml tablet 0 0 0 0
254 Trifluoperazine 5mg bh 0 0 0 0
255 Triheksifenidil hcl 2 mg Ampul 0 0 0 0
256 Umbilical Cord Klem Steril Nylon Ampul 60 60 0 60
257 Vaksin Rabies Vero (VAR) rabipur kapsul 0 0 0 0
258 Vaksin Rabies Vero (VAR) verorab Botol 0 0 0 0
259 Vit. A 100.000 iu kaplet 0 0 0 0
260 Vit. A 200.000 iu kapsul 0 0 0 0
261 Vitamin B kompleks Tablet 100 100 100 0
262 Yodium povidon lar.10 % 30 ml Botol 4 4 4 0
263 Yodium povidon lar.10 % 300 ml Botol 0 0 0 0
264 Yodium povidon lar.10 % 60 ml Botol 8 8 6 2
265 Zinc Dispersible 20 mg Tablet 1200 1200 0 1200
266 Zinc Sirup Botol 120 120 0 120
267
268
269
270
271

Umum JKN Jumlah

Kunjungan Resep Bayar Tidak
38 - 430 468

Mengetahui Yang Menyerahkan Mengetahui : Yang Menerima

Kepala Dinas Kesehatan Kepala IFK Ka. UPT Puskesmas Kampung Delima Petugas Puskesmas
Kabupaten Rejang Lebong

........................................................... FRANSISKA PUTRIANI,SSI,Apt M.NASIR MAULUDDIN,SKM EVRIZA GUSDWIYANTI,Am.Rad

NIP. NIP.19790817 201001 2 2024 NIP. 19690528 199001 1 001 NIP.19880809 201001 2 011
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

KODE BULAN Maret JML.PUSTU 1 JML.POSKESDES/BIDES

PUSKESMAS BANGUN JAYA TAHUN 2021 JML.MELAPOR 1 JML.MELAPOR

Kode STOK SISA STOK PERMIN KET

NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
1 Abbocath No. 18 (IV cath No. 18) Pcs 200 0 200 20 180 0
2 Abbocath No. 20 (IV cath No. 20) Pcs 10 0 10 10 0 200
3 Abbocath No. 22 (IV cath No. 22) Pcs 100 0 100 30 70 50
4 Abbocath No. 24 (IV cath No. 24) Pcs 105 0 105 25 80 50
5 Abbocath no.27 Pcs 0 0 0 0 0 0
6 Alat suntik sekali pakai 1 ml Set 1000 0 1000 100 900 0
7 Alat suntik sekali pakai 5 ml Set 1850 0 1850 150 1700 0
8 Alat Suntik sekali pakai 3 ml Set 800 0 800 300 500 2000
9 Albendazole 400 Mg Caplet 400 0 400 0 400 0
10 Alkohol 70% 100 ml Botol 27 0 27 15 12 24
11 Alkohol 70% 1000 ml Botol 5 0 5 4 1 5
12 Alkohol swabs Pcs 300 0 300 200 100 100
13 Allopurinol 100 mg Tablet 100 0 100 100 0 2500
14 Alphamol 600mg Tablet 4000 0 4000 0 4000 0
15 Alprazolam tab 0,25 mg Tablet 0 0 0 0 0 0
16 Ambroxol Tablet 30 mg Tablet 0 0 0 0 0 3000
17 Aminofilin 200 mg Tablet 600 0 600 0 600 300
18 Amitriptilin Hcl tablet salut 25 mg Tablet 0 0 0 0 0 0
19 Amlodipin tab 5 mg Tablet 0 0 0 0 0 3500
20 Amoksisilin 250 mg Botol 5300 0 5300 600 4700 0
21 Amoksisilin 500 mg Tablet 17100 0 17100 1100 16000 0
22 Amoksisilin sirup 125 mg / 5 ml Botol 219 0 219 19 200 0
23 Antasida DOEN Sirup 60 ml Botol 120 0 120 40 80 150
24 Antasida doen tablet Tablet 1500 0 1500 300 1200 4000
25 Anti hemoroid doen kombinasi Supp 70 0 70 0 70 0
26 Anti bakteri doen salep kombinasi : Basitras Tube 110 0 110 10 100 0
27 Anti fungi doen kombinasi : asam benzoat 6% + Pot 145 0 145 5 140 0
28 Anti Malaria DOEN Komb(Sulfadoksin 500 mg Botol 0 0 0 0 0 500
29 Anti migrain doen kombinasi Tablet 400 0 400 0 400 0
30 Antiseptik Gell 500 cc galon 0 0 0 0 0 2
31 Antiseptik handrub @ 500 ml (Sky Light Cleaner galon 1 0 2 2 0 4
32 Aqua pro injeksi Botol 42 0 42 6 36 0
33 Asam askorbat ( vit.c ) 50 mg Tablet 200 0 200 200 0 3000
 Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
34 Asam Mefenamat 500 mg /Molasic Kaplet 9100 9100 500 8600 1500
35 Asam traneksamat injeksi Ampul 0 0 0 0 10
36 Asiklovir tablet 200 mg Tablet 300 300 0 300 200
37 Asiklovir tablet 400 mg Tablet 300 300 100 200 200
38 Asiklovir Krim 5 % Tube 34 34 9 25 25
39 Atropin sulfat 0,5 mg Tablet 0 0 0 0 0
40 Atropin Inj 0,25 Mg Ampul 0 0 0 0 0
41 Attapulgit 630 mg (pularex) Tablet 600 600 0 600 0
42 Bedak Salisil 2 % Bungkus 12 12 0 12 6
43 Benecheck Plus Glucose Test Strip 50's Pcs 0 0 0 0
44 Benecheck Plus Total Cholesterol Test Strip 10's Pcs 0 0 0 0
45 Benecheck Plus Uric Test Strip 25's Pcs 0 0 0 0
46 Benechek Asam Urat Pcs 0 0 0 0
47 Benechek Cholesterol Pcs 0 0 0 0
48 Benechek GDS Pcs 0 0 0 0
49 Berotec Fenoterol HBR INH Cairan Botol 0 0 0 0
50 Betahistin Mesilat tab 6 mg Tablet 800 800 200 600 0
51 Betametason krim 0,1 % Tube 4 4 4 0 50
52 Bioplacenton Tube 0 0 0 0 5
53 Bisakodil supp 10 mg (dulcolax) Supp 70 70 0 70 0
54 Bisakodil supp 5 mg (dulcolax infant) Supp 42 42 0 42 0
55 Bisoprolol tab 5 mg Tablet 330 330 0 330 0
56 Blood Transfusion Set Set 44 44 4 40 0
57 Burnazine Salep Luka Bakar Tube 8 8 3 5 2
58 Buscopan injeksi Ampul 10 10 0 10 20
59 Captopril 12, 5 mg Tablet 6000 6000 200 5800 2000
60 Captopril 25 mg Tablet 2700 2700 600 2100 3000
61 Catgut / benang bedah no.2/0 Set 31 31 25 6 36
62 Catgut / benang bedah no.3/0 Set 0 0 0 0 36
63 Cefadroxyl 500 mg Capsul 6800 6800 700 6100 0
64 Cefadroxyl Syr. Kering Botol 61 61 6 55 50
65 Cefixime 100 mg Tablet 0 0 0 0 1000
66 Ceftriaxone inj Ampul 70 70 0 70 20
68 Cetirizine 10mg Tablet 0 0 0 0 2000
69 Ciprofoxacin 500 mg Tablet 300 300 200 100 4000
70 Citicolin injeksi Ampul 65 65 0 65 0
71 Clobazam Tablet 0 0 0 0 0
72 Clozapin 100mg Tab Tablet 0 0 0 0 0
73 Clozapin 25mg Tab Tablet 0 0 0 0 0
74 Deksametason 0,5 mg Tablet 100 100 100 0 5000
75 Deksametason inj.5 mg / ml - 1 ml Ampul 14 14 9 5 100
76 Dermafix T 5x7 c Lembar 50 50 0 50 25
 Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
77 Detol sabun cair Tablet 0 0 0 0 12
78 Dextral tab Tablet 0 0 0 0 0
79 Diazepam 2 mg inj Ampul 1 1 0 1 0
80 Diazepam injeksi 5 mg / ml - 2 ml Tablet 0 0 0 0 0
81 Diazepam 5 mg tablet Supp 0 0 0 0 0
82 Diazepam enema Stesolid 5mg Ampul 0 0 0 0 0
83 Difenhidramin hcl inj.10mg/ml-1ml Tablet 13 13 9 4 100
84 Diltiazem 30 mg Tablet 500 500 0 500 0
85 Domperidon tablet Ampul 200 200 200 0 3000
86 Epinefrin hcl injeksi 0,1 % - 1 ml Tablet 0 0 0 0 10
87 Eritromisin 500 mg Botol 1500 1500 1500 0 1000 ed 1500
88 Eritromisin Sirup Botol 7 7 0 7 10
89 Etakridin ( rivanol ) larutan 0,1 % Botol 10 10 6 4 5
90 Etil klorida semprot Botol 10 10 5 5 6
91 Eugenol cairan Tablet 0 0 0 0 0
92 Fenobarbital 30 mg Ampul 0 0 0 0 0
93 Fenobarbital inj 50 mg/ml Botol 10 10 0 10 0
94 Fenol gliserol (karbogliserin) tetes telinga 10 Ampul 2 2 2 0 15
95 Fitomenadion (vit K1) inj.10mg/ml-1ml Tablet 115 115 15 100 0
96 Fitomenadion (vit K1)tab.salut 10 mg Ampul 500 500 0 500 0
97 Fitomenadion injeksi 2 mg / 1 ml set 112 112 12 100 0
98 Folley Chateter no 16 set 30 30 5 25 0
99 Folley Chateter no 18 set 100 100 5 95 0
100 Folley Chateter no 22 Tablet 30 30 5 25 0
101 Furosemid 40mg sacc 0 0 0 0 0
102 Garam oralit untuk 200 ml air Tube 0 0 0 0 100
103 Gentamicin Salep Kulit Ampul 0 0 0 0 25
104 Gentamisin Inj 40 mg/ml Botol 0 0 0 0 10
105 Gentamisin TM Botol 41 41 3 38 0
106 Gentian violet larutan 1 % Tablet 25 25 0 25 0
107 Glibenklamid 5 mg Tablet 800 800 300 500 300
108 Gliseril guayakolat 100 mg Botol 4200 4200 200 4000 2000
109 Glukosa larutan infus 5 % steril Tablet 8 8 0 8 20
110 Griseofulvin 125 mg , micronized Tablet 0 0 0 0 200
111 Haloperidol 1,5 mg Ampul 0 0 0 0 0
112 Haloperidol 5 mg Tablet 0 0 0 0 0
113 Haloperidol 0,5 mg Tablet 0 0 0 0 0
114 Haloperidol 2 Mg set 0 0 0 0 0
115 Hand Schoon M set 0 800 800 300 500 200
116 Hand Schoon No. 7,5 set 0 0 0 0 200
117 Handschoon GynecologiNo. 7 set 0 0 0 0 100
118 Handschoon GynecologiNo. 7,5 Tablet 0 0 0 0 100
119 Hidroklortiazid ( Hct ) 25 mg Tube 4700 4700 400 4300 0
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
120 Hidrokortison krim 2,5 % Tablet 120 120 10 110 25
121 Ibuprofen 200 mg Tablet 0 0 0 0 2000
122 Ibuprofen 400 mg Botol 3100 3100 700 2400 2000
123 Ibuprofen syrup 100mg/5ml Botol 22 22 7 15 50
124 Imersi Oil Set 0 0 0 0 0
125 Infusion set anak Set 50 50 5 45 0
126 Infusion set dewasa set 0 0 0 0 50
127 Infusiont Set Y - Type Box 150 150 20 130 0
128 Iodine Test 10 ml Tablet 0 0 0 0 0
129 Isosorbid dinitrat tab.sublungual 5 mg Biji 1000 1000 200 800 0
130 Jarum jahit ( bedah ) no. 11 Biji 0 0 0 0 12
131 Jarum jahit ( bedah ) no. 13 Kulit Biji 0 0 0 0 12
132 Jarum jahit ( bedah ) no. 13 Otot Biji 168 168 0 168 0
133 Jarum jahit ( bedah ) no. 9 Kulit Biji 0 0 0 0 24
134 Jarum jahit ( bedah ) no. 9 Otot Botol 12 12 0 12 24
135 KAEN 3 B INFUS gulung 0 0 0 0 2
136 Kalsium laktat ( kalk ) 500 mg tablet 4100 4100 1000 3100 2000
137 Kapas pembalut / absorben 250 gr bks 9 9 4 5 5
138 Kasa kompres 40 / 40 steril Rol 80 80 10 70 0
139 Kasa pembalut 4 m x 10 cm Rol 0 0 0 0 0
140 Kasa pembalut hidrofil 4 m x 15 cm Rol 0 0 0 0 0
141 Kasa pembalut hidrofil 4 m x 3 cm Rol 80 80 0 80 0
142 Kasa pembalut hidrofil 4 m x 5 cm Lembar 200 200 0 200 0
143 Kasa pembalut hidrofil 16 cm x 16 cm Bungkus 400 400 0 400 0
144 Kasa pembalut 2 yard x 80 cm Rol 0 0 0 0 0
145 Kasa Hidrofil 40 yard x 80 cm Tube 8 8 0 8 0
146 Ketokonazole Cream 2 % Tablet 89 89 14 75 25
147 Ketokonazole tablet 200 mg Ampul 650 650 0 650 500
148 Ketorolac injeksi Botol 0 0 0 0 100
149 Kloramfenicol Salep mata Kapsul 0 0 0 0 25
150 Kloramfenikol 250 mg Kapsul 6200 6200 100 6100 0
151 Kloramfenikol 500 mg (Chloramex) Botol 5900 5900 600 5300 0
152 Kloramfenikol tetes mata 0,5 % (decacetin) Tube 2 2 2 0 20
153 Kloramfenikol Salep Kulit 2 % (Bufacetin Krim) Botol 0 0 0 0 25
154 Kloramfenikol Syrup Tablet 0 0 0 0 50
155 Klorfeniramin ( ctm ) 4 mg Tablet 15,000 15000 1000 14,000 0
156 Kloroquin 150 mg Tablet 0 0 0 0 0
157 Klorpromazin hcl 100 mg Tablet 0 0 0 0 0
158 Kodein hcl 10 mg Tablet 0 0 0 0 0
159 Kotrimoksazol dewasa ( 480 mg ) Tablet 200 200 200 0 4000
160 Kotrimoksazol pediatrik ( 120 mg ) Botol 0 0 0 0 25
161 Kotrimoksazol suspensi Kapsul 33 33 8 25 50
162 Lansoprazole tablet 30 mg Botol 2300 2300 60 2240 0
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
163 Larutan EDTA 100 ml Botol 0 0 0 0 0
164 Larutan Giemsa 100 ml Botol 0 0 0 0 0
165 Larutan HCL 0,1 N 100ml Botol 0 0 0 0 0
166 Larutan KOH 10% 100 ml Botol 0 0 0 0 0
167 Larutan Turk 100 ml Lembar 0 0 0 0 0
168 Leukoplast 2.5 cm X 4.5 cm Ampul 0 0 0 0 0
169 Lidocain Combinasi (+epinefrin) Ampul 80 80 10 70 100
170 Lidokain injeksi 2% Botol 60 60 0 60 100
171 Lidokain Jel 2 % Botol 0 0 0 0 0
172 Lidokain Spray Oral 10 % Botol 0 0 0 0 0
173 Lisol 1000 ml Tablet 3 3 3 0 7
174 Loratadine 10 mg Tablet 0 0 0 0 0
175 Masker 3 Ply Plus Bh 0 0 0 0 0
176 Masker Earloop Bh 0 0 0 0 0
177 Masker N 95 Bh 15 15 5 10 5
178 Masker particular respirator 9105 Bh 0 0 0 0 0
179 Masker tie on Bh 200 200 400 200 200 200
180 Melocid 7.5 mg Tablet 0 0 0 0 0
181 Meloxicam 7,5 mg Tablet 1020 1020 60 960 1020
182 Mersibion kaplet Tablet 100 100 100 0 1000
183 Metformin 500 mg tablet 0 0 0 0 500
184 Metformin 850mg tablet 600 600 0 600 500
185 Metilergometrin Maleat 0.125 mg Ampul 0 0 0 0 0
186 Metilergometrine mal.inj.0,200mg-1ml Tablet 0 0 0 0 0
187 Metilprednisolon 4 Mg Tab Tablet 1900 1900 1900 0 3000 ed 1900
188 Metoklorpamide Tablet Tablet 800 800 0 800 0
189 Metronidazol 250 mg Tablet 5300 5300 0 5300 0
190 Metronidazol 500 mg Botol 0 0 0 0 3000
191 Metronidazol sirup Botol 0 0 0 0 100
192 Metronidazole Infus 5 Mg Botol 0 0 0 0 0
193 MgSo4 Inj Tube 0 0 0 0 5
194 Molacream Botol 16 16 4 12 12
195 Molafate suspensi Botol 0 0 0 0 0
196 My Jelly 82 gram Botol 0 0 0 0 5
197 Natrium klorida larutan 0,9 % steril botol 0 0 0 0 120
198 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 0
199 Natrium Diklofenak tab 25 mg Tablet 200 200 100 100 2500
200 Natrium Diklofenak tab 50 mg Ampul 300 300 200 100 2500
201 Neurobion injeksi / mersibion Supp 27 27 7 20 30
202 Nistatin 100.000 iu / g tab. Vaginal Tablet 400 400 0 400 0
203 Nistatin 500.000 iu tablet salut paket 100 100 0 100 500
204 OAM Program Malaria paket 0 0 0 0 0
205 OAT Kategori 1 paket 0 0 0 0 0
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
206 OAT Kategori 2 paket 0 0 0 0 0
207 OAT Kategori Anak Botol 0 0 0 0 0
208 Obat batuk hitam ( o b h ) cairan Tube 1 1 1 0 30
209 Oksitetrasiklin hcl salep 3 % Tube 30 30 5 25 25
210 Oksitetrasiklin hcl salep mata 1% Ampul 20 20 5 15 25
211 Oksitosin injeksi 10 iu / ml - 1 ml Ampul 0 0 0 0 50
212 Ondansentron injeksi 2 mg Botol 0 0 0 0 100
213 Paracetamol Drop 100mg/ml Tablet 9 9 2 7 15
214 Parasetamol 500 mg Botol 9300 9300 300 9000 0
215 Parasetamol sirup 120 mg / 5 ml bh 70 70 25 45 100
216 Pehaveral bh 0 0 0 0 0
217 Pembalut Elastis 10 cm x 4,55 m Tablet 0 0 0 0 0
218 Pembalut Elastis 7,5 cm x 4,55 m Tablet 20 20 0 20 0
219 Pirantel pamoat Tablet 0 0 0 0 0
220 Piridoksin hcl ( vit. B 6 ) 10 mg bj 350 350 250 100 3000
221 Piroxicam 10 mg rol 0 0 0 0 0
222 Planotest Kehamilan rol 140 140 0 140 0
223 Plester 5 yard x 2 inch Tablet 0 0 0 0 0
224 Plester e-care surgical tape 2'' Tablet 60 60 10 50 0
225 Prednison 5 mg Tablet 100 100 100 0 5000
226 Primaquin Tablet Tablet 0 0 0 0 0
227 Pritacort tablet tablet 0 0 0 0 0
228 Propanolol hcl 10 mg tablet 400 400 0 400 0
229 Propanolol hcl 40 mg Ampul 0 0 0 0 0
230 Propiltiourasil ( PTU ) 100 mg Tablet 550 550 50 500 0
231 Ranitidin 25 Mh/ML inj tablet 180 180 80 100 100
232 Ranitidin Tablet tablet 4900 4900 400 4500 0
233 Resperidon 1mg Botol 0 0 0 0 0
234 Risperidon tablet 2 mg Pc 0 0 0 0 0
235 RL larutan infus steril tablet 140 140 60 80 80
236 S i l k (benang bedah sutera) no.3 / 0 Pot 50 50 0 50 0
237 Salbutamol 2 mg lb 100 400 400 0 2000
238 Salep 2 - 4 kombinasi : asam salisilat 2% + be tablet 34 34 10 24 0
239 Salon Pas Jet Spray Tube 3 3 0 3 0
240 Samcofenac 50 mg pc 0 0 0 0 0
241 Scabimite/ Permetrin Krim Vial 58 58 8 50 0
242 Serenity Twist Blood Lancet Ampul 0 0 0 0 0
243 Serum anti bisa ular poli.inj.5 ml (abu I) Ampul 0 0 0 0 0
244 Serum anti difteri injeksi 1.500 iu/amp (a.t.s) Ampul 0 0 0 0 0
245 Sianokobalamin (vit.b12) inj.500 mcg/ml tablet 395 395 15 380 100
246 Sikzonoate Inj. Flufenazine Inj. 25mg/ml tablet 0 0 0 0 0
247 Simvastatin Tablet Kaplet 3190 3190 160 3030 1680
248 Tablet Tambah Darah Ampul 3800 3800 1000 2800 5600
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
249 Thiamphenicol 500 mg tablet 0 0 0 0 0
250 Tiamin hcl (vit.b1) Inj 100mg/1 ml Ampul 0 0 0 0 20
251 Tiamin hcl mononitrat(vit.b1) 50mg tablet set 4900 4900 1000 3900 0
252 Tramadol injeksi 50 mg/ml tablet 0 0 0 0 20
254 Trifluoperazine 5mg bh 0 0 0 0 0
255 Triheksifenidil hcl 2 mg Ampul 0 0 0 0 0
256 Umbilical Cord Klem Steril Nylon Ampul 60 60 10 50 100
257 Vaksin Rabies Vero (VAR) rabipur kapsul 0 0 0 0 0
258 Vaksin Rabies Vero (VAR) verorab Botol 0 0 0 0 0
259 Vit. A 100.000 iu kaplet 0 0 0 0 0
260 Vit. A 200.000 iu kapsul 0 0 0 0 0
261 Vitamin B kompleks Tablet 0 0 0 0 5000
262 Yodium povidon lar.10 % 30 ml Botol 0 0 0 0 20
263 Yodium povidon lar.10 % 300 ml Botol 0 0 0 0 0
264 Yodium povidon lar.10 % 60 ml Botol 2 2 2 0 25
265 Zinc Dispersible 20 mg Tablet 1200 1200 100 1100 0
266 Zinc Sirup Botol 120 120 0 120 0
267
268
269
270
271

Umum JKN Jumlah

Kunjungan Resep Bayar Tidak

Mengetahui Yang Menyerahkan Mengetahui : Yang Menerima

Kepala Dinas Kesehatan Kepala IFK Ka. UPT Puskesmas Kampung Delima Petugas Puskesmas
Kabupaten Rejang Lebong

........................................................... FRANSISKA PUTRIANI,SSI,Apt M.NASIR MAULUDDIN,SKM EVRIZA GUSDWIYANTI,Am.Rad

NIP. NIP.19790817 201001 2 2024 NIP. 19690528 199001 1 001 NIP.19880809 201001 2 011
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

KODE BULAN April JML.PUSTU 1 JML.POSKESDES/BIDES

PUSKESMAS BANGUN JAYA TAHUN 2021 JML.MELAPOR 1 JML.MELAPOR

Kode STOK SISA STOK PERMIN KET

NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
1 Abbocath No. 18 (IV cath No. 18) Pcs 180 0 180 10 170
2 Abbocath No. 20 (IV cath No. 20) Pcs 0 50 50 20 30
3 Abbocath No. 22 (IV cath No. 22) Pcs 70 50 120 20 100
4 Abbocath No. 24 (IV cath No. 24) Pcs 80 50 130 30 100
5 Abbocath no.27 Pcs 0 0 0 0 0
6 Alat suntik sekali pakai 1 ml Set 900 0 900 900 0 ed 900
7 Alat suntik sekali pakai 5 ml Set 1700 0 1700 200 1500 ed1500
8 Alat Suntik sekali pakai 3 ml Set 500 2400 2900 400 2500
9 Albendazole 400 Mg Caplet 400 0 400 100 300
10 Alkohol 70% 100 ml Botol 12 0 12 0 12
11 Alkohol 70% 1000 ml Botol 1 5 6 0 6
12 Alkohol swabs Pcs 100 100 200 0 200
13 Allopurinol 100 mg Tablet 0 700 700 100 600
14 Alphamol 600mg Tablet 4000 0 4000 600 3400
15 Alprazolam tab 0,25 mg Tablet 0 0 0 0 0
16 Ambroxol Tablet 30 mg Tablet 0 0 0 0 0
17 Aminofilin 200 mg Tablet 600 100 700 200 500
18 Amitriptilin Hcl tablet salut 25 mg Tablet 0 0 0 0 0
19 Amlodipin tab 5 mg Tablet 0 2100 2100 0 2100
20 Amoksisilin 250 mg Botol 4700 0 4700 200 4500
21 Amoksisilin 500 mg Tablet 16000 0 16000 1000 15000
22 Amoksisilin sirup 125 mg / 5 ml Botol 200 0 200 0 200
23 Antasida DOEN Sirup 60 ml Botol 80 50 130 30 100
24 Antasida doen tablet Tablet 1200 2300 3500 500 3000
25 Anti hemoroid doen kombinasi Supp 70 0 70 0 70
26 Anti bakteri doen salep kombinasi : Basitras Tube 100 0 100 10 90
27 Anti fungi doen kombinasi : asam benzoat 6% + Pot 140 0 140 0 140
28 Anti Malaria DOEN Komb(Sulfadoksin 500 mg Botol 0 0 0 0 0
29 Anti migrain doen kombinasi Tablet 400 0 400 0 400
30 Antiseptik Gell 500 cc galon 0 0 0 0 0
31 Antiseptik handrub @ 500 ml (Sky Light Cleaner galon 0 0 2 2 0
32 Aqua pro injeksi Botol 36 0 36 0 36
33 Asam askorbat ( vit.c ) 50 mg Tablet 0 700 700 200 500
 Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
34 Asam Mefenamat 500 mg /Molasic Kaplet 8600 5000 13600 600 13000
35 Asam traneksamat injeksi Ampul 0 0 0 0 0
36 Asiklovir tablet 200 mg Tablet 300 200 500 100 400
37 Asiklovir tablet 400 mg Tablet 200 200 400 50 350
38 Asiklovir Krim 5 % Tube 25 0 25 5 20
39 Atropin sulfat 0,5 mg Tablet 0 0 0 0 0
40 Atropin Inj 0,25 Mg Ampul 0 0 0 0 0
41 Attapulgit 630 mg (pularex) Tablet 600 0 600 100 500
42 Bedak Salisil 2 % Bungkus 12 0 12 0 12
43 Benecheck Plus Glucose Test Strip 50's Pcs 0 0 0 0 0
44 Benecheck Plus Total Cholesterol Test Strip 10's Pcs 0 0 0 0 0
45 Benecheck Plus Uric Test Strip 25's Pcs 0 0 0 0 0
46 Benechek Asam Urat Pcs 0 0 0 0 0
47 Benechek Cholesterol Pcs 0 0 0 0 0
48 Benechek GDS Pcs 0 0 0 0 0
49 Berotec Fenoterol HBR INH Cairan Botol 0 0 0 0 0
50 Betahistin Mesilat tab 6 mg Tablet 600 0 600 100 500
51 Betametason krim 0,1 % Tube 0 50 50 10 40
52 Bioplacenton Tube 0 0 0 0 0
53 Bisakodil supp 10 mg (dulcolax) Supp 70 0 70 10 60
54 Bisakodil supp 5 mg (dulcolax infant) Supp 42 0 42 7 35
55 Bisoprolol tab 5 mg Tablet 330 0 330 0 330
56 Blood Transfusion Set Set 40 0 40 5 35
57 Burnazine Salep Luka Bakar Tube 5 2 7 2 5
58 Buscopan injeksi Ampul 10 0 10 0 10
59 Captopril 12, 5 mg Tablet 5800 1400 7200 700 6500
60 Captopril 25 mg Tablet 2100 500 2600 800 1800
61 Catgut / benang bedah no.2/0 Set 6 0 6 0 6
62 Catgut / benang bedah no.3/0 Set 0 0 0 0 0
63 Cefadroxyl 500 mg Capsul 6100 0 6100 900 5200
64 Cefadroxyl Syr. Kering Botol 55 0 55 10 45
65 Cefixime 100 mg Tablet 0 990 990 0 990
66 Ceftriaxone inj Ampul 70 0 70 0 70
68 Cetirizine 10mg Tablet 0 0 0 0 0
69 Ciprofoxacin 500 mg Tablet 100 400 500 200 300
70 Citicolin injeksi Ampul 65 0 65 5 60
71 Clobazam Tablet 0 0 0 0 0
72 Clozapin 100mg Tab Tablet 0 0 0 0 0
73 Clozapin 25mg Tab Tablet 0 200 200 100 100
74 Deksametason 0,5 mg Tablet 0 500 500 200 300
75 Deksametason inj.5 mg / ml - 1 ml Ampul 5 30 35 15 20
76 Dermafix T 5x7 c Lembar 50 25 75 25 50
 Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
77 Detol sabun cair Tablet 0 6 6 6 0
78 Dextral tab Tablet 0 0 0 0 0
79 Diazepam 2 mg inj Ampul 1 3 4 0 4
80 Diazepam injeksi 5 mg / ml - 2 ml Tablet 0 0 0 0 0
81 Diazepam 5 mg tablet Supp 0 0 0 0 0
82 Diazepam enema Stesolid 5mg Ampul 0 0 0 0 0
83 Difenhidramin hcl inj.10mg/ml-1ml Tablet 4 30 34 14 20
84 Diltiazem 30 mg Tablet 500 0 500 0 500
85 Domperidon tablet Ampul 0 400 400 300 100
86 Epinefrin hcl injeksi 0,1 % - 1 ml Tablet 0 0 0 0 0
87 Eritromisin 500 mg Botol 0 200 200 100 100
88 Eritromisin Sirup Botol 7 10 17 5 12
89 Etakridin ( rivanol ) larutan 0,1 % Botol 4 5 9 4 5
90 Etil klorida semprot Botol 5 6 11 2 9
91 Eugenol cairan Tablet 0 0 0 0 0
92 Fenobarbital 30 mg Ampul 0 0 0 0 0
93 Fenobarbital inj 50 mg/ml Botol 10 0 10 5 5
94 Fenol gliserol (karbogliserin) tetes telinga 10 Ampul 0 10 10 0 10
95 Fitomenadion (vit K1) inj.10mg/ml-1ml Tablet 100 0 100 10 90
96 Fitomenadion (vit K1)tab.salut 10 mg Ampul 500 0 500 0 500
97 Fitomenadion injeksi 2 mg / 1 ml set 100 0 100 20 80
98 Folley Chateter no 16 set 25 0 25 0 25
99 Folley Chateter no 18 set 95 0 95 12 83
100 Folley Chateter no 22 Tablet 25 0 25 0 25
101 Furosemid 40mg sacc 0 0 0 0 0
102 Garam oralit untuk 200 ml air Tube 0 100 100 0 100
103 Gentamicin Salep Kulit Ampul 0 24 24 4 20
104 Gentamisin Inj 40 mg/ml Botol 0 0 0 0 0
105 Gentamisin TM Botol 38 0 38 8 30
106 Gentian violet larutan 1 % Tablet 25 0 25 5 20
107 Glibenklamid 5 mg Tablet 500 300 800 200 600
108 Gliseril guayakolat 100 mg Botol 4000 2000 6000 1000 5000
109 Glukosa larutan infus 5 % steril Tablet 8 5 13 0 13
110 Griseofulvin 125 mg , micronized Tablet 0 200 200 0 200
111 Haloperidol 1,5 mg Ampul 0 0 0 0 0
112 Haloperidol 5 mg Tablet 0 0 0 0 0
113 Haloperidol 0,5 mg Tablet 0 0 0 0 0
114 Haloperidol 2 Mg set 0 400 400 0 400
115 Hand Schoon M set 500 10 510 210 300
116 Hand Schoon No. 7,5 set 0 0 0 0 0
117 Handschoon GynecologiNo. 7 set 0 0 0 0 0
118 Handschoon GynecologiNo. 7,5 Tablet 0 0 0 0 0
119 Hidroklortiazid ( Hct ) 25 mg Tube 4300 0 4300 300 4000
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
120 Hidrokortison krim 2,5 % Tablet 110 24 134 10 124
121 Ibuprofen 200 mg Tablet 0 200 200 200 0
122 Ibuprofen 400 mg Botol 2400 200 2600 600 2000
123 Ibuprofen syrup 100mg/5ml Botol 15 50 65 15 50
124 Imersi Oil Set 0 0 0 0 0
125 Infusion set anak Set 45 0 45 5 40
126 Infusion set dewasa set 0 0 0 0 0
127 Infusiont Set Y - Type Box 130 0 130 0 130
128 Iodine Test 10 ml Tablet 0 0 0 0 0
129 Isosorbid dinitrat tab.sublungual 5 mg Biji 800 0 800 0 800
130 Jarum jahit ( bedah ) no. 11 Biji 0 0 0 0 0
131 Jarum jahit ( bedah ) no. 13 Kulit Biji 0 12 12 0 12
132 Jarum jahit ( bedah ) no. 13 Otot Biji 168 0 168 12 156
133 Jarum jahit ( bedah ) no. 9 Kulit Biji 0 24 24 12 12
134 Jarum jahit ( bedah ) no. 9 Otot Botol 12 24 36 0 36
135 KAEN 3 B INFUS gulung 0 20 20 20 0
136 Kalsium laktat ( kalk ) 500 mg tablet 3100 500 3600 600 3000
137 Kapas pembalut / absorben 250 gr bks 5 10 15 5 10
138 Kasa kompres 40 / 40 steril Rol 70 0 70 0 70
139 Kasa pembalut 4 m x 10 cm Rol 0 0 0 0 0
140 Kasa pembalut hidrofil 4 m x 15 cm Rol 0 0 0 0 0
141 Kasa pembalut hidrofil 4 m x 3 cm Rol 80 0 80 0 80
142 Kasa pembalut hidrofil 4 m x 5 cm Lembar 200 0 200 0 200
143 Kasa pembalut hidrofil 16 cm x 16 cm Bungkus 400 0 400 0 400
144 Kasa pembalut 2 yard x 80 cm Rol 0 0 0 0 0
145 Kasa Hidrofil 40 yard x 80 cm Tube 8 0 8 0 8
146 Ketokonazole Cream 2 % Tablet 75 25 100 20 80
147 Ketokonazole tablet 200 mg Ampul 650 200 850 150 700
148 Ketorolac injeksi Botol 0 0 0 0 0
149 Kloramfenicol Salep mata Kapsul 0 0 0 0 0
150 Kloramfenikol 250 mg Kapsul 6100 0 6100 100 6000
151 Kloramfenikol 500 mg (Chloramex) Botol 5300 0 5300 800 4500
152 Kloramfenikol tetes mata 0,5 % (decacetin) Tube 0 0 0 0 0
153 Kloramfenikol Salep Kulit 2 % (Bufacetin Krim) Botol 0 5 5 5 0
154 Kloramfenikol Syrup Tablet 0 48 48 0 48
155 Klorfeniramin ( ctm ) 4 mg Tablet 14,000 0 14000 1500 12,500
156 Kloroquin 150 mg Tablet 0 0 0 0 0
157 Klorpromazin hcl 100 mg Tablet 0 0 0 0 0
158 Kodein hcl 10 mg Tablet 0 0 0 0 0
159 Kotrimoksazol dewasa ( 480 mg ) Tablet 0 400 400 200 200
160 Kotrimoksazol pediatrik ( 120 mg ) Botol 0 0 0 0 0
161 Kotrimoksazol suspensi Kapsul 25 50 75 0 75
162 Lansoprazole tablet 30 mg Botol 2240 0 2240 240 2000
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
163 Larutan EDTA 100 ml Botol 0 0 0 0 0
164 Larutan Giemsa 100 ml Botol 0 0 0 0 0
165 Larutan HCL 0,1 N 100ml Botol 0 0 0 0 0
166 Larutan KOH 10% 100 ml Botol 0 0 0 0 0
167 Larutan Turk 100 ml Lembar 0 0 0 0 0
168 Leukoplast 2.5 cm X 4.5 cm Ampul 0 0 0 0 0
169 Lidocain Combinasi (+epinefrin) Ampul 70 60 130 30 100
170 Lidokain injeksi 2% Botol 60 0 60 10 50
171 Lidokain Jel 2 % Botol 0 0 0 0 0
172 Lidokain Spray Oral 10 % Botol 0 0 0 0 0
173 Lisol 1000 ml Tablet 0 0 0 0 0
174 Loratadine 10 mg Tablet 0 0 0 0 0
175 Masker 3 Ply Plus Bh 0 0 0 0 0
176 Masker Earloop Bh 0 0 0 0 0
177 Masker N 95 Bh 10 20 30 10 20
178 Masker particular respirator 9105 Bh 0 0 0 0 0
179 Masker tie on Bh 200 250 450 300 150
180 Melocid 7.5 mg Tablet 0 0 0 0 0
181 Meloxicam 7,5 mg Tablet 960 0 960 210 750
182 Mersibion kaplet Tablet 0 100 100 100 0
183 Metformin 500 mg tablet 0 400 400 0 400
184 Metformin 850mg tablet 600 400 1000 200 800
185 Metilergometrin Maleat 0.125 mg Ampul 0 0 0 0 0
186 Metilergometrine mal.inj.0,200mg-1ml Tablet 0 0 0 0 0
187 Metilprednisolon 4 Mg Tab Tablet 0 400 400 400 0
188 Metoklorpamide Tablet Tablet 800 0 800 0 800
189 Metronidazol 250 mg Tablet 5300 0 5300 300 5000
190 Metronidazol 500 mg Botol 0 100 100 100 0
191 Metronidazol sirup Botol 0 0 0 0 0
192 Metronidazole Infus 5 Mg Botol 0 0 0 0 0
193 MgSo4 Inj Tube 0 6 6 0 6
194 Molacream Botol 12 12 24 4 20
195 Molafate suspensi Botol 0 0 0 0 0
196 My Jelly 82 gram Botol 0 2 2 1 1
197 Natrium klorida larutan 0,9 % steril botol 0 20 20 20 0
198 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 0
199 Natrium Diklofenak tab 25 mg Tablet 100 500 600 200 400
200 Natrium Diklofenak tab 50 mg Ampul 100 500 600 200 400
201 Neurobion injeksi / mersibion Supp 20 0 20 20 0
202 Nistatin 100.000 iu / g tab. Vaginal Tablet 400 0 400 100 300
203 Nistatin 500.000 iu tablet salut paket 100 0 100 100 0
204 OAM Program Malaria paket 0 0 0 0 0
205 OAT Kategori 1 paket 0 0 0 0 0
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
206 OAT Kategori 2 paket 0 0 0 0
207 OAT Kategori Anak Botol 0 0 0 0 0
208 Obat batuk hitam ( o b h ) cairan Tube 0 10 10 2 8
209 Oksitetrasiklin hcl salep 3 % Tube 25 0 25 5 20
210 Oksitetrasiklin hcl salep mata 1% Ampul 15 5 20 5 15
211 Oksitosin injeksi 10 iu / ml - 1 ml Ampul 0 10 10 10 0
212 Ondansentron injeksi 2 mg Botol 0 0 0 0 0
213 Paracetamol Drop 100mg/ml Tablet 7 60 67 7 60
214 Parasetamol 500 mg Botol 9000 0 9000 1500 7500
215 Parasetamol sirup 120 mg / 5 ml bh 45 100 145 25 120
216 Pehaveral bh 0 0 0 0 0
217 Pembalut Elastis 10 cm x 4,55 m Tablet 0 0 0 0 0
218 Pembalut Elastis 7,5 cm x 4,55 m Tablet 20 0 20 0 20
219 Pirantel pamoat Tablet 0 0 0 0 0
220 Piridoksin hcl ( vit. B 6 ) 10 mg bj 100 400 500 300 200
221 Piroxicam 10 mg rol 0 0 0 0 0
222 Planotest Kehamilan rol 140 0 140 0 140
223 Plester 5 yard x 2 inch Tablet 0 0 0 0 0
224 Plester e-care surgical tape 2'' Tablet 50 0 50 5 45
225 Prednison 5 mg Tablet 0 400 400 300 100
226 Primaquin Tablet Tablet 0 0 0 0 0
227 Pritacort tablet tablet 0 0 0 0 0
228 Propanolol hcl 10 mg tablet 400 0 400 0 400
229 Propanolol hcl 40 mg Ampul 0 0 0 0 0
230 Propiltiourasil ( PTU ) 100 mg Tablet 500 0 500 200 300
231 Ranitidin 25 Mh/ML inj tablet 100 0 100 20 80
232 Ranitidin Tablet tablet 4500 0 4500 700 3800
233 Resperidon 1mg Botol 0 0 0 0 0
234 Risperidon tablet 2 mg Pc 0 400 400 100 300
235 RL larutan infus steril tablet 80 80 160 20 140
236 S i l k (benang bedah sutera) no.3 / 0 Pot 50 0 50 8 42
237 Salbutamol 2 mg lb 0 400 400 200 200
238 Salep 2 - 4 kombinasi : asam salisilat 2% + be tablet 24 0 24 0 24
239 Salon Pas Jet Spray Tube 3 0 3 0 3
240 Samcofenac 50 mg pc 0 0 0 0 0
241 Scabimite/ Permetrin Krim Vial 50 0 50 10 40
242 Serenity Twist Blood Lancet Ampul 0 0 0 0 0
243 Serum anti bisa ular poli.inj.5 ml (abu I) Ampul 0 0 0 0 0
244 Serum anti difteri injeksi 1.500 iu/amp (a.t.s) Ampul 0 0 0 0 0
245 Sianokobalamin (vit.b12) inj.500 mcg/ml tablet 380 100 480 380 100 380 ed
246 Sikzonoate Inj. Flufenazine Inj. 25mg/ml tablet 0 0 0 0 0
247 Simvastatin Tablet Kaplet 3030 1680 4710 3030 1680 3030 ed
248 Tablet Tambah Darah Ampul 2800 22400 25200 1200 24000
Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
249 Thiamphenicol 500 mg tablet 0 0 0 0 0
250 Tiamin hcl (vit.b1) Inj 100mg/1 ml Ampul 0 0 0 0 0
251 Tiamin hcl mononitrat(vit.b1) 50mg tablet set 3900 0 3900 1400 2500
252 Tramadol injeksi 50 mg/ml tablet 0 0 0 0 0
254 Trifluoperazine 5mg bh 0 0 0 0 0
255 Triheksifenidil hcl 2 mg Ampul 0 200 200 100 100
256 Umbilical Cord Klem Steril Nylon Ampul 50 100 150 30 120
257 Vaksin Rabies Vero (VAR) rabipur kapsul 0 0 0 0 0
258 Vaksin Rabies Vero (VAR) verorab Botol 0 0 0 0 0
259 Vit. A 100.000 iu kaplet 0 0 0 0 0
260 Vit. A 200.000 iu kapsul 0 0 0 0 0
261 Vitamin B kompleks Tablet 0 200 200 200 0
262 Yodium povidon lar.10 % 30 ml Botol 0 10 10 2 8
263 Yodium povidon lar.10 % 300 ml Botol 0 0 0 0 0
264 Yodium povidon lar.10 % 60 ml Botol 0 10 10 5 5
265 Zinc Dispersible 20 mg Tablet 1100 0 1100 300 800
266 Zinc Sirup Botol 120 0 120 12 108
267
268
269
270
271

Umum JKN Jumlah

Kunjungan Resep Bayar Tidak

Mengetahui Yang Menyerahkan Mengetahui : Yang Menerima

Kepala Dinas Kesehatan Kepala IFK Ka. UPT Puskesmas Kampung Delima Petugas Puskesmas
Kabupaten Rejang Lebong

........................................................... FRANSISKA PUTRIANI,SSI,Apt M.NASIR MAULUDDIN,SKM EVRIZA GUSDWIYANTI,Am.Rad

NIP. NIP.19790817 201001 2 2024 NIP. 19690528 199001 1 001 NIP.19880809 201001 2 011
 Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
249 Thiamphenicol 500 mg tablet 0 0 0 0
250 Tiamin hcl (vit.b1) Inj 100mg/1 ml Ampul 0 0 0 0
251 Tiamin hcl mononitrat(vit.b1) 50mg tablet set 2500 2500 500 2000
252 Tramadol injeksi 50 mg/ml tablet 0 0 0 0
254 Trifluoperazine 5mg bh 0 0 0 0
255 Triheksifenidil hcl 2 mg Ampul 100 100 0 100
256 Umbilical Cord Klem Steril Nylon Ampul 120 120 10 110
257 Vaksin Rabies Vero (VAR) rabipur kapsul 0 0 0 0
258 Vaksin Rabies Vero (VAR) verorab Botol 0 0 0 0
259 Vit. A 100.000 iu kaplet 0 0 0 0
260 Vit. A 200.000 iu kapsul 0 0 0 0
261 Vitamin B kompleks Tablet 0 500 500 500 0
262 Yodium povidon lar.10 % 30 ml Botol 8 30 38 7 29
263 Yodium povidon lar.10 % 300 ml Botol 0 0 0 0
264 Yodium povidon lar.10 % 60 ml Botol 5 5 3 2
265 Zinc Dispersible 20 mg Tablet 800 800 0 800
266 Zinc Sirup Botol 108 108 0 108
267
268
269
270
271

Umum JKN Jumlah

Kunjungan Resep Bayar Tidak

Mengetahui Yang Menyerahkan Mengetahui : Yang Menerima

Kepala Dinas Kesehatan Kepala IFK Ka. UPT Puskesmas Bangun Jaya Petugas Puskesmas
Kabupaten Rejang Lebong

........................................................... FRANSISKA PUTRIANI,SSI,Apt M.NASIR MAULUDDIN,SKM SENDI ANDREAS,S.Kep

NIP. NIP.19790817 201001 2 2024 NIP. 19690528 199001 1 001 NIP.198702102009031001
 Kode STOK SISA STOK PERMIN KET
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PEMBERIAN
Obat AWAL STOK OPTIMUM TAAN (RUSAK,ED,EFEKSAMPING,DLL
1 2 3 5 7 8 = (4+5) 9 10 =(6-7) 11 12 13 17
206 OAT Kategori 2 paket 0 0 0 0
207 OAT Kategori Anak Botol 0 0 0 0
208 Obat batuk hitam ( o b h ) cairan Tube 3 3 1 2 100
209 Oksitetrasiklin hcl salep 3 % Tube 20 20 0 20 100
210 Oksitetrasiklin hcl salep mata 1% Ampul 7 7 0 7 100
211 Oksitosin injeksi 10 iu / ml - 1 ml Ampul 0 0 0 0 100
212 Ondansentron injeksi 2 mg Botol 0 0 0 0 100
213 Paracetamol Drop 100mg/ml Tablet 60 60 10 50 100
214 Parasetamol 500 mg Botol 5500 5500 1900 3600 10000
215 Parasetamol sirup 120 mg / 5 ml bh 115 115 19 96 200
216 Pehaveral bh 0 0 0 0
217 Pembalut Elastis 10 cm x 4,55 m Tablet 0 0 0 0 30
218 Pembalut Elastis 7,5 cm x 4,55 m Tablet 20 20 0 20
219 Pirantel pamoat Tablet 0 0 0 0 1000
220 Piridoksin hcl ( vit. B 6 ) 10 mg bj 0 0 0 0 5000
221 Piroxicam 10 mg rol 0 0 0 0 2000
222 Planotest Kehamilan rol 140 140 0 140
223 Plester 5 yard x 2 inch Tablet 0 0 0 0 50
224 Plester e-care surgical tape 2'' Tablet 39 39 1 38 100
225 Prednison 5 mg Tablet 150 150 150 0 2000
226 Primaquin Tablet Tablet 0 0 0 0 1000
227 Pritacort tablet tablet 0 0 0 0
228 Propanolol hcl 10 mg tablet 400 400 0 400 500
229 Propanolol hcl 40 mg Ampul 0 0 0 0 500
230 Propiltiourasil ( PTU ) 100 mg Tablet 300 300 0 300
231 Ranitidin 25 Mh/ML inj Ampul 70 70 0 70 150
232 Ranitidin Tablet tablet 3200 3200 0 0 3000 expire 3200
233 Resperidon 1mg Botol 0 0 0 0
234 Risperidon tablet 2 mg Pc 200 200 100 100
235 RL larutan infus steril tablet 180 180 42 138 300
236 S i l k (benang bedah sutera) no.3 / 0 Pot 37 37 0 37 100
237 Salbutamol 2 mg lb 200 200 30 170 2000
238 Salep 2 - 4 kombinasi : asam salisilat 2% + be tablet 38 38 0 38 50
239 Salon Pas Jet Spray Tube 3 3 0 3 10
240 Samcofenac 50 mg pc 0 0 0 0
241 Scabimite/ Permetrin Krim Vial 33 33 0 33 50
242 Serenity Twist Blood Lancet Ampul 0 0 0 0
243 Serum anti bisa ular poli.inj.5 ml (abu I) Ampul 0 0 0 0
244 Serum anti difteri injeksi 1.500 iu/amp (a.t.s) Ampul 0 0 0 0
245 Sianokobalamin (vit.b12) inj.500 mcg/ml tablet 100 100 0 100 5000
246 Sikzonoate Inj. Flufenazine Inj. 25mg/ml tablet 0 0 0 0
247 Simvastatin Tablet Kaplet 1680 1680 120 1560 3000
248 Tablet Tambah Darah Ampul 22400 22400 1100 21300 3000