DINAS KESEHATAN LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LB2) FORM : LPLPO PUSKESMAS

KABUPATEN KEP. ARU PUSKESMAS

PUSKESMAS : Kabalsiang Benjuring

PUSKESMAS PEMBANTU YANG ADA :1 Yang Melapor……… Bulan : Januari
POLINDES YANG ADA : Yang Melapor……… Tahun : 2024
KECAMATAN :
KABUPATEN : KEPULAUAN ARU
PROPINSI : MALUKU

Pemberian
Stock Penerima Persediaa Pemakaia Sisa Stock Perminta
No Nama Obat Satuan
Awal an n n Stock OPT an
Ket
PKD BUFFER APBD Lain JML
1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
1 Acyclovir 200mg Tab 200 0 200 0 200
2 Acyclovir 400mg Tab 700 0 700 0 700
3 Acyclovir Cr Tube 24 0 24 2 22
4 Allupurinol 100mg Tab 300 0 300 0 300
5 Allupurinol 300mg Tab 500 0 500 0 500
6 Ambeven Tab Tab 0 0 0 0 0
7 Ambroxol Syr Botol 0 0 0 0 0
8 Ambroxol 30 mg Tab 1400 0 1400 400 1000
9 Amlodiphin 10 mg Tab 3200 0 3200 0 3200
10 Amlodiphin 5 mg Tab 5000 0 5000 0 5000
11 Amoxycillin 500mg Tab 500 0 500 200 300
12 Amoxycillin Syr Kering Botol 63 0 63 0 63
13 Ampicillin 500 mg Tab 275 0 275 0 275
14 Ampicillin injeksi Ampl 30 0 30 0 30
15 Antasida DOEN Tab 1100 0 1100 0 1100
16 Antasida Sirup Botol 60 0 60 0 60
17 As. Askorbat ( Vit. C ) 50 mg Tab 600 0 600 300 300
18 As. Folat 1 mg Tab 300 0 300 100 200
19 As. Mefenamat 500mg Tab 500 0 500 100 400
20 Asam Asetilsalisilat ( Asetosal ) 80 mg Tab 240 0 240 0 240
21 Asam Traneksamat Tab 100 0 100 0 100
22 Asam Traneksamat Injeksi Ampul 10 0 10 0 10
23 ATS ( Serum Anti Tetanus ) (Biosat) Ampul 0 0 0 0 0
24 Bedak Salisil Serb 2 % Box 80 0 80 10 70
1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
25 Betametason 17 Valerat 0,1% 5gr Tube 50 0 50 20 30
26 Bethahistine 6 mg ( Samcohistin ) Tab 200 0 200 100 100
1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
27 Bromhexin Tab 200 0 200 100 100
28 Captopril 25mg Tab 0 0 0 0 0
29 Captopril 50mg Tab 0 0 0 0 0
30 Cefadroxyl 500 mg Tab 800 0 800 0 800
31 Cefadroxyl sirup kering Botol 0 0 0 0 0
32 Ceterizine Sirup Botol 0 0 0 0 0
33 Cetirizine Tablet 10 mg Tab 900 0 900 200 700
34 Chlorampenicol Palmitat Sirup 125 mg/5ml Botol 4 0 4 0 4
35 Chlorampenicol Tetes Mata (Reco Tetes Mata) Botol 10 0 20 0 20
36 Chlorampenicol Salep Mata Tube 12 0 12 0 12
37 Chlorampenicol Tetes Telinga ( Reco Tetes Telinga ) Botol 38 0 38 0 38
38 Cimetidin 200 mg Tab 600 0 800 0 800
39 Ciprofloxacin 500 mg Tab 1470 0 1470 0 1470
40 Clindamisin 300mg Tab 1700 0 1700 0 1700
41 Clorfeniramin Maleat (CTM ) Tab 2100 0 2100 100 2000
42 Cotrimoxazole Sirup Botol 41 0 41 0 41
43 Cotrimoxazole 480 mg Tab 500 0 500 100 400
44 Dexamethasone 0,5mg Tab 0 0 0 0 0
45 Dexamethasone Inj. Ampl 0 0 0 0 0
46 Digoxin 0,25mg Tab 100 0 100 0 100
47 Diphenhidramin injeksi Ampl 15 0 15 0 15
48 Domperidon 10mg Tab 100 0 100 0 100
49 Domperidon Syr Botol 60 0 60 0 60
50 Doxycyclin 100 mg Tab 775 0 775 0 775
51 Dun Salep Tube 0 0 0 0 0
52 Epinefrin (Adrenalin) Inj. 0.1% Ampl 0 0 0 0 0
53 Eritromicin 500mg Tab 100 0 100 0 100
54 Fitomenadion (Vit. K) 10mg Tab 1500 0 1500 0 1500
55 Fitomenadion (Vit. K) Inj Ampl 0 0 0 0 0
56 Furosemida 40mg Tab 0 0 0 0 0
57 GG Tab 500 0 500 0 500
58 Garam Oralit ( Ramolit ) Sach 500 0 500 100 400
59 Gentamicin Salep Kulit Tube 0 0 0 0 0
60 Glibenclamide 5mg Tab 500 0 500 0 500
61 Glimepirid 2 mg Tab 400 0 400 0 400
62 Glukosa Larutan Infus 5% Botol 20 0 20 5 15
1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
63 Griseovulvin 125 mg Tab 30 0 30 0 30
64 Holi Vitamin B Comp + Vit C Tab 300 0 300 100 200
1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
65 Hydroklortiazid 25 mg Tab 0 0 0 0 0
66 Hydrokortison Cream Tube 0 0 0 0 0
67 Ibuprofen 200mg Tab 300 0 300 200 100
68 Ibuprofen 400mg Tab 500 0 500 100 400
69 Ibuprofen Sirup Botol 5 0 5 1 4
70 Isosorbit Dinitrat Tab 5 mg Tab 480 0 480 0 480
71 Kalium Diklofenak 50 mg Tab 0 0 0 0 0
72 Kalsium Laktat ( Kalk ) 500 mg Tab 0 0 0 0 0
73 Ketoconazole 200 mg Tab 100 0 100 0 100
74 Kombinasi Batuk Pilek ( Flutamol ) Capsule 0 0 0 0 0
75 Kombinasi Flu dan alergi ( Quantidex/Eflin ) Tab 0 0 0 0 0
76 Kombinasi Kaolin 550 mg + Pektin 20 mg ( Selesdiar Licopec ) Tab 200 0 200 0 200
77 Lacto B Sachet 0 0 0 0 0
78 Lanzoprazole Caps 150 0 150 60 90
79 Lidocain 2 % Ampl 25 0 25 0 25
80 Lidocain Comb Inj Ampl 25 0 25 0 25
81 Lisinopril 10 mg Tab 200 0 200 0 200
82 Loratadin Tab 10 mg Tab 0 0 0 0 0
83 Meloxicam 15 mg Tab 400 0 400 100 300
84 Meloxicam 7,5 mg Tab 400 0 400 0 400
85 Metformin 500mg Tab 1300 0 1300 0 1300
86 Metilergometrin Inj Ampl 0 0 0 0 0
87 Metilergometrin 0,125 mg Tab 200 0 200 0 200
88 Metilprednison 4mg Tab 600 0 600 100 500
89 Metoklopramid 5mg Tab 1130 0 1130 0 1130
90 Metronidazole 500mg Tab 600 0 600 0 600
91 Miconazole Nitrate 10gr Tube 0 0 0 0 0
92 Natrium Diklofenak 25mg Tab 500 0 500 0 500
93 Natrium Diklofenak 50mg ( Prostanac ) Tab 800 0 800 200 600
94 Natrium Klortida Larutan Infus 0,9% Botol 35 0 35 5 30
95 New Antides Tab 0 0 0 0 0
96 Nistatin Vaginal Tab 0 0 0 0 0
97 Novadium/bidium (Loperamid 2 mg) Tab 400 0 400 0 400
98 OBH Sirup Botol 0 0 0 0 0
99 Oksitoksin Injk Ampl 29 0 29 0 29
 1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
100 Omeprazol 20mg Tab 160 0 160 30 130
101 Ondansetron Inj Ampl 55 0 55 0 55
 1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
102 Oxitetracyclin Salep Kulit Tube 0 0 0 0 0
103 Paracetamol 500mg Tab 900 0 900 0 900
104 Paracetamol Syr Botol 30 0 30 15 15
105 Paracetamol Infus Botol 0 0 0 0 0
106 Pirantel Pamoat Tab 484 0 484 0 484
107 Piroksikam 20mg Tab 500 0 500 0 500
108 Prednison 5mg Tab 600 0 600 200 400
109 Pro Curma plus Suspensi Botol 4 0 4 0 4
110 Propanolol 10 mg Tab 100 0 200 0 200
111 Ranitidin 150mg Tab 400 0 400 0 400
112 Ranitidin Injk Ampl 45 0 45 0 45
113 Ringer Laktat Botol 25 0 25 6 19
114 Salap Luka Bakar (Neocenta Gel) Tube 0 0 0 0 0
115 Salbutamol 2 mg Tab 400 0 400 100 300
116 Salbutamol 4 mg Tab 100 0 100 100 0
117 Scabimite 5% Tube 0 0 0 0 0
118 Simvastatin 10mg Tab 700 0 700 0 700
119 Simvastatin 20 mg Tab 400 0 400 100 300
120 Sucralfat Sirup Botol 28 0 28 23 5
121 Thiamin HCL (Vit. B1) 50mg Tab 200 0 200 100 100
122 Vitamin B12 Inj ( Cyanocobalamin ) Vial 50 0 50 3 47
123 Vitamin B6 Tab 900 0 900 100 800
124 Zink Tablet Tab 1200 0 1200 100 1100

Bahan Habis Pakai

125 Abocath 18 Pcs 10 0 10 0 10
126 Abocath 20 Pcs 22 0 22 4 18
127 Abocath 22 Pcs 9 0 9 0 9
128 Abocath 24 Pcs 15 0 15 0 15
129 Abocath 26 Pcs 0 0 0 0 0
130 Alkohol Swab Box 15 0 15 1 14
131 Bethadine 300 ml Botol 14 0 14 0 14
132 Bisturi Mess No 22 Pcs 0 0 0 0 0
133 Blood Lancets Pcs 13 0 13 0 13
 1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
134 Chlodin Hand Rab 0,5 % 5L Gen 4 0 4 0 4
135 Chlodin Hand Scrub 4% 5L Gen 0 0 0 0 0
136 Demegut Chromic 2/0 Pcs 12 0 12 0 12
137 Demegut Chromic 3/0 Pcs 12 0 12 0 12
138 Demegut Plain 2/0 Pcs 12 0 12 0 12
139 Demegut Plain 3/0 Pcs 12 0 12 0 12
140 Demisilk 2/0 Pcs 12 0 12 0 12
141 Demisilk 3/0 Pcs 12 0 12 0 12
142 Dermafis Silicon 10 x 20 cm Pcs 0 0 0 0 0
143 Dispo 1 ml Pcs 630 0 630 0 630
144 Dispo 3 ml Pcs 300 0 300 0 300
145 Dispo 5 ml Pcs 500 0 500 100 400
146 Ecodin 1 L Botol 4 0 4 0 4
147 Etanol 70% Cairan 1000 ml Botol 7 0 7 0 7
148 Foley Catheter FR 16 Pcs 0 0 0 0 0
149 Foley Catheter FR 18 Pcs 0 0 0 0 0
150 Golden Gloves (Handscoon On) Pcs 100 0 100 0 100
151 Infusion Set Anak Pcs 20 0 20 0 20
152 Infusion Set Dewasa Pcs 13 0 13 2 11
153 Kapas 250 gram Pcs 10 0 10 0 10
154 Kassa Pembalut 100 gram Pcs 11 0 11 0 11
155 Kasa Hidrofil 40 x 80 Roll 0 0 0 0 0
156 Kasa Steril 5 x 5 cm Pcs 20 0 20 0 20
157 Lisol (antiseptik) Gen 0 0 0 0 0
158 Masker Surgical 3 Ply Pcs 2400 0 2400 100 2300
159 Nurse Cup Pcs 400 0 400 0 400
 1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
160 Plester Roll 19 0 19 5 14
161 Sarung Tangan Obgyn Pasang 10 0 10 2 8
162 Ultrasonic Gel 250 ml Botol 2 0 2 0 2
163 Under Pad Steril Pcs 2 0 10 8 2
164 Urin Bag Pcs 5 0 5 5 0

Psikotopika
165 Halloperidol 1,5 mg Tab 500 0 500 0 500

UMUM PHB JUMLAH

JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR

Mengetahui/Menyetujui Yang Menyerahkan Yang Meminta Yang Menerima

Sekretaris Petugas IFK Pimpinan Puskesmas Petugas Puskesmas

(Ronald A. Letelay, SE) (....................................................) (Ns. Makdalena Ilely., S.Kep) (apt. Sri Adhayani, S.Farm)
NIP. 197406193006041015 NIP 19830405 200406 2 022 NRPK 25.6.0505870

Proyek PSIK 1993 / 1994

DINAS KESEHATAN LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LB2) FORM : LPLPO PUSKESMAS
KABUPATEN KEP. ARU PUSKESMAS

PUSKESMAS : Kabalsiang Benjuring

PUSKESMAS PEMBANTU YANG ADA :1 Yang Melapor……… Bulan : Januari
POLINDES YANG ADA : Yang Melapor……… Tahun : 2024
KECAMATAN :
KABUPATEN : KEPULAUAN ARU
PROPINSI : MALUKU

Pemberian
Stock Penerima Persediaa Pemakaia Sisa Stock Perminta
No Nama Obat Satuan
Awal an n n Stock OPT an
Ket
PKD BUFFER APBD Lain JML
1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
1 Acyclovir 200mg Tab 200 0 200 0 200
2 Acyclovir 400mg Tab 700 0 700 0 700
3 Acyclovir Cr Tube 24 0 24 2 22 10
4 Allupurinol 100mg Tab 300 0 300 0 300 500
5 Allupurinol 300mg Tab 500 0 500 0 500
6 Ambeven Tab Tab 0 0 0 0 0 500
7 Ambroxol Syr Botol 0 0 0 0 0 20
8 Ambroxol 30 mg Tab 1400 0 1400 400 1000
9 Amlodiphin 10 mg Tab 3200 0 3200 0 3200
10 Amlodiphin 5 mg Tab 5000 0 5000 0 5000
11 Amoxycillin 500mg Tab 500 0 500 200 300 500
12 Amoxycillin Syr Kering Botol 63 0 63 0 63
13 Ampicillin 500 mg Tab 275 0 275 0 275
14 Ampicillin injeksi Ampl 30 0 30 0 30
15 Antasida DOEN Tab 1100 0 1100 0 1100
16 Antasida Sirup Botol 60 0 60 0 60
17 As. Askorbat ( Vit. C ) 50 mg Tab 600 0 600 300 300 1000
18 As. Folat 1 mg Tab 300 0 300 100 200 2000
19 As. Mefenamat 500mg Tab 500 0 500 100 400 500
20 Asam Asetilsalisilat ( Asetosal ) 80 mg Tab 240 0 240 0 240
21 Asam Traneksamat Tab 100 0 100 0 100 100
22 Asam Traneksamat Injeksi Ampul 10 0 10 0 10 30
23 ATS ( Serum Anti Tetanus ) (Biosat) Ampul 0 0 0 0 0 10
24 Bedak Salisil Serb 2 % Box 80 0 80 10 70
1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
25 Betametason 17 Valerat 0,1% 5gr Tube 50 0 50 20 30 50
26 Bethahistine 6 mg ( Samcohistin ) Tab 200 0 200 100 100 500
1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
27 Bromhexin Tab 200 0 200 100 100 1000
28 Captopril 25mg Tab 0 0 0 0 0 500
29 Captopril 50mg Tab 0 0 0 0 0 500
30 Cefadroxyl 500 mg Tab 800 0 800 0 800
31 Cefadroxyl sirup kering Botol 0 0 0 0 0
32 Ceterizine Sirup Botol 0 0 0 0 0 20
33 Cetirizine Tablet 10 mg Tab 900 0 900 200 700 300
34 Chlorampenicol Palmitat Sirup 125 mg/5ml Botol 4 0 4 0 4
35 Chlorampenicol Tetes Mata (Reco Tetes Mata) Botol 10 0 20 0 20 10
36 Chlorampenicol Salep Mata Tube 12 0 12 0 12 10
37 Chlorampenicol Tetes Telinga ( Reco Tetes Telinga ) Botol 38 0 38 0 38
38 Cimetidin 200 mg Tab 600 0 800 0 800
39 Ciprofloxacin 500 mg Tab 1470 0 1470 0 1470
40 Clindamisin 300mg Tab 1700 0 1700 0 1700
41 Clorfeniramin Maleat (CTM ) Tab 2100 0 2100 100 2000
42 Cotrimoxazole Sirup Botol 41 0 41 0 41
43 Cotrimoxazole 480 mg Tab 500 0 500 100 400
44 Dexamethasone 0,5mg Tab 0 0 0 0 0 1000
45 Dexamethasone Inj. Ampl 0 0 0 0 0 30
46 Digoxin 0,25mg Tab 100 0 100 0 100
47 Diphenhidramin injeksi Ampl 15 0 15 0 15
48 Domperidon 10mg Tab 100 0 100 0 100 200
49 Domperidon Syr Botol 60 0 60 0 60
50 Doxycyclin 100 mg Tab 775 0 775 0 775
51 Dun Salep Tube 0 0 0 0 0 30
52 Epinefrin (Adrenalin) Inj. 0.1% Ampl 0 0 0 0 0
53 Eritromicin 500mg Tab 100 0 100 0 100
54 Fitomenadion (Vit. K) 10mg Tab 1500 0 1500 0 1500
55 Fitomenadion (Vit. K) Inj Ampl 0 0 0 0 0 20
56 Furosemida 40mg Tab 0 0 0 0 0 500
57 GG Tab 500 0 500 0 500
58 Garam Oralit ( Ramolit ) Sach 500 0 500 100 400
59 Gentamicin Salep Kulit Tube 0 0 0 0 0 50
60 Glibenclamide 5mg Tab 500 0 500 0 500
61 Glimepirid 2 mg Tab 400 0 400 0 400
62 Glukosa Larutan Infus 5% Botol 20 0 20 5 15
1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
63 Griseovulvin 125 mg Tab 30 0 30 0 30
64 Holi Vitamin B Comp + Vit C Tab 300 0 300 100 200 500
1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
65 Hydroklortiazid 25 mg Tab 0 0 0 0 0 500
66 Hydrokortison Cream Tube 0 0 0 0 0 50
67 Ibuprofen 200mg Tab 300 0 300 200 100 500
68 Ibuprofen 400mg Tab 500 0 500 100 400 500
69 Ibuprofen Sirup Botol 5 0 5 1 4 10
70 Isosorbit Dinitrat Tab 5 mg Tab 480 0 480 0 480
71 Kalium Diklofenak 50 mg Tab 0 0 0 0 0 300
72 Kalsium Laktat ( Kalk ) 500 mg Tab 0 0 0 0 0 1000
73 Ketoconazole 200 mg Tab 100 0 100 0 100
74 Kombinasi Batuk Pilek ( Flutamol ) Capsule 0 0 0 0 0 500
75 Kombinasi Flu dan alergi ( Quantidex/Eflin ) Tab 0 0 0 0 0 500
76 Kombinasi Kaolin 550 mg + Pektin 20 mg ( Selesdiar Licopec ) Tab 200 0 200 0 200
77 Lacto B Sachet 0 0 0 0 0 50
78 Lanzoprazole Caps 150 0 150 60 90 300
79 Lidocain 2 % Ampl 25 0 25 0 25
80 Lidocain Comb Inj Ampl 25 0 25 0 25
81 Lisinopril 10 mg Tab 200 0 200 0 200
82 Loratadin Tab 10 mg Tab 0 0 0 0 0 500
83 Meloxicam 15 mg Tab 400 0 400 100 300 500
84 Meloxicam 7,5 mg Tab 400 0 400 0 400
85 Metformin 500mg Tab 1300 0 1300 0 1300
86 Metilergometrin Inj Ampl 0 0 0 0 0
87 Metilergometrin 0,125 mg Tab 200 0 200 0 200
88 Metilprednison 4mg Tab 600 0 600 100 500
89 Metoklopramid 5mg Tab 1130 0 1130 0 1130
90 Metronidazole 500mg Tab 600 0 600 0 600
91 Miconazole Nitrate 10gr Tube 0 0 0 0 0 100
92 Natrium Diklofenak 25mg Tab 500 0 500 0 500
93 Natrium Diklofenak 50mg ( Prostanac ) Tab 800 0 800 200 600
94 Natrium Klortida Larutan Infus 0,9% Botol 35 0 35 5 30
95 New Antides Tab 0 0 0 0 0
96 Nistatin Vaginal Tab 0 0 0 0 0
97 Novadium/bidium (Loperamid 2 mg) Tab 400 0 400 0 400
98 OBH Sirup Botol 0 0 0 0 0 20
99 Oksitoksin Injk Ampl 29 0 29 0 29
 1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
100 Omeprazol 20mg Tab 160 0 160 30 130
101 Ondansetron Inj Ampl 55 0 55 0 55
 1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
102 Oxitetracyclin Salep Kulit Tube 0 0 0 0 0 50
103 Paracetamol 500mg Tab 900 0 900 0 900
104 Paracetamol Syr Botol 30 0 30 15 15 10
105 Paracetamol Infus Botol 0 0 0 0 0 10
106 Pirantel Pamoat Tab 484 0 484 0 484
107 Piroksikam 20mg Tab 500 0 500 0 500
108 Prednison 5mg Tab 600 0 600 200 400 200
109 Pro Curma plus Suspensi Botol 4 0 4 0 4 20
110 Propanolol 10 mg Tab 100 0 200 0 200
111 Ranitidin 150mg Tab 400 0 400 0 400
112 Ranitidin Injk Ampl 45 0 45 0 45
113 Ringer Laktat Botol 25 0 25 6 19
114 Salap Luka Bakar (Neocenta Gel) Tube 0 0 0 0 0 50
115 Salbutamol 2 mg Tab 400 0 400 100 300 500
116 Salbutamol 4 mg Tab 100 0 100 100 0 300
117 Scabimite 5% Tube 0 0 0 0 0 50
118 Simvastatin 10mg Tab 700 0 700 0 700
119 Simvastatin 20 mg Tab 400 0 400 100 300 500
120 Sucralfat Sirup Botol 28 0 28 23 5 20
121 Thiamin HCL (Vit. B1) 50mg Tab 200 0 200 100 100 500
122 Vitamin B12 Inj ( Cyanocobalamin ) Vial 50 0 50 3 47
123 Vitamin B6 Tab 900 0 900 100 800 200
124 Zink Tablet Tab 1200 0 1200 100 1100

Bahan Habis Pakai

125 Abocath 18 Pcs 10 0 10 0 10 10
126 Abocath 20 Pcs 22 0 22 4 18 10
127 Abocath 22 Pcs 9 0 9 0 9 10
128 Abocath 24 Pcs 15 0 15 0 15
129 Abocath 26 Pcs 0 0 0 0 0
130 Alkohol Swab Box 15 0 15 1 14
131 Bethadine 300 ml Botol 14 0 14 0 14
132 Bisturi Mess No 22 Pcs 0 0 0 0 0 2
133 Blood Lancets Pcs 13 0 13 0 13
 1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
134 Chlodin Hand Rab 0,5 % 5L Gen 4 0 4 0 4
135 Chlodin Hand Scrub 4% 5L Gen 0 0 0 0 0
136 Demegut Chromic 2/0 Pcs 12 0 12 0 12
137 Demegut Chromic 3/0 Pcs 12 0 12 0 12
138 Demegut Plain 2/0 Pcs 12 0 12 0 12
139 Demegut Plain 3/0 Pcs 12 0 12 0 12
140 Demisilk 2/0 Pcs 12 0 12 0 12
141 Demisilk 3/0 Pcs 12 0 12 0 12
142 Dermafis Silicon 10 x 20 cm Pcs 0 0 0 0 0 10
143 Dispo 1 ml Pcs 630 0 630 0 630
144 Dispo 3 ml Pcs 300 0 300 0 300
145 Dispo 5 ml Pcs 500 0 500 100 400
146 Ecodin 1 L Botol 4 0 4 0 4
147 Etanol 70% Cairan 1000 ml Botol 7 0 7 0 7
148 Foley Catheter FR 16 Pcs 0 0 0 0 0 5
149 Foley Catheter FR 18 Pcs 0 0 0 0 0 5
150 Golden Gloves (Handscoon On) Pcs 100 0 100 0 100 500
151 Infusion Set Anak Pcs 20 0 20 0 20
152 Infusion Set Dewasa Pcs 13 0 13 2 11 20
153 Kapas 250 gram Pcs 10 0 10 0 10
154 Kassa Pembalut 100 gram Pcs 11 0 11 0 11
155 Kasa Hidrofil 40 x 80 Roll 0 0 0 0 0 2
156 Kasa Steril 5 x 5 cm Pcs 20 0 20 0 20 10
157 Lisol (antiseptik) Gen 0 0 0 0 0
158 Masker Surgical 3 Ply Pcs 2400 0 2400 100 2300
159 Nurse Cup Pcs 400 0 400 0 400
 1 2 3 4 5 7 8 9 10 12 13 14 15 16 17 18
160 Plester Roll 19 0 19 5 14 1
161 Sarung Tangan Obgyn Pasang 10 0 10 2 8 10
162 Ultrasonic Gel 250 ml Botol 2 0 2 0 2
163 Under Pad Steril Pcs 2 0 10 8 2 10
164 Urin Bag Pcs 5 0 5 5 0 5

Psikotopika
165 Halloperidol 1,5 mg Tab 500 0 500 0 500

UMUM PHB JUMLAH

JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR

Mengetahui/Menyetujui Yang Menyerahkan Yang Meminta Yang Menerima

Sekretaris Petugas IFK Pimpinan Puskesmas Petugas Puskesmas

(Ronald A. Letelay, SE) (....................................................) (Ns. Makdalena Ilely., S.Kep) (apt. Sri Adhayani, S.Farm)
NIP. 197406193006041015 NIP 19830405 200406 2 022 NRPK 25.6.0505870

Proyek PSIK 1993 / 1994