Template Lplpo 2024

KEPALA PUSKESMAS: dr. ENDAH ROSITANINGSIH, SE., MM.
NIP : 19691230 201001 2 002

PENGELOLA OBAT : AINA MUJTAHIDA A S.Farm., Apt NIP : 19861218 201903 2 004
DINAS KESEHATAN KABUPATEN BLITAR
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
KODE : PELAPORAN BULAN : DESEMBER 2023 DOKUMEN NOMOR DOKUMEN TANGGAL
PUSKESMAS : SANANKULON PERMINTAAN BULAN : JANUARI 2024
UPT IFK
KECAMATAN : SANANKULON
KABUPATEN : BLITAR
PUSKESMAS
PROVINSI : JAWA TIMUR
SISA STOK JUMLAH

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PEMBERIAN
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11 12
1 2 WAY FOLEY CATHETER NO.16 PCS 0 0 0 0
2 2 WAY FOLEY CATHETER NO.18 PCS 0 0
3 2 WAY FOLEY CATHETER NO.20 PCS 0 0
4 ACETYLCYSTEINE CAPSULE 200 MG CAPSULE 0 0
5 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0 0
10 ALKOHOL SWAB PCS 0 0
11 ALLOPURINOL TABLET 100 MG TABLET 0 0
12 ALPRAZOLAM 1 MG TABLET TABLET 0 0
13 AMBROXOL SIRUP 5MG/ML BOTOL 0 0
14 AMBROXOL TABLET 30 MG TABLET 0 0

AMINOPHYLLINE INJEKSI 24 MG/ML
15
10 ML
AMPUL 0 0
16 AMITRIPTYLLINE HCL TABLET 25 MG TABLET 0 0
17 AMLODIPINE TABLET 10 MG TABLET 0 0
18 AMLODIPINE TABLET 5 MG TABLET 0 0

AMOKSISILIN DRY SYRUP 125 MG/5
19
ML 60 ML
BOTOL 0 0
AMOKSISILIN SERBUK INJEKSI 1000
20
MG
VIAL 0 0
21 AMOKSISILIN TABLET 500 MG KAPLET 0 0

AMOXCICILIN FORTE SYRUP KERING
22
250MG/5ML
BOTOL 0 0
AMPICILLIN SERBUK INJEKSI 1.000 MG
23
MG/VIAL
VIAL 0 0
ANTALGIN 500 MG TABLET
24
(METAMIZOL)
TABLET 0 0
25 ANTASIDA DOEN TABLET KOMBINASI TABLET 0 0
26 ANTASIDA SUSPENSI 60 ML BOTOL 0 0

ANTI BAKTERI DOEN SALEP
27
KOMBINASI 5 GR
POT 0 0
ANTI FUNGI DOEN SALEP KOMBINASI
28
30 GR
POT 0 0
29 ANTI HAEMOROID DOEN KOMBINASI SUPP. 0 0

ANTI MIGRAIN DOEN TABLET
30
KOMBINASI
TABLET 0 0
ANTI SPASMODIK TABLET
31
(DORMICOMP)
TABLET 0 0
AQUA PRO INJEKSI STERIL BEBAS
32
PIROGEN 20 ML
BOTOL 0 0
ASAM ASKORBAT ( VIT C ) TABLET 50
33
MG
TABLET 0 0
34 ASAM FOLAT 1MG TABLET TABLET 0 0
35 ASAM MEFENAMAT TABLET 500 MG TABLET 0 0

ASAM TRANEKSAMAT 100 MG/ML
36
INJEKSI
AMPUL 0 0
37 ASAM TRANEKSAMAT 500 MG TABLET TABLET 0 0
ASAM VALPROAT 250 MG TABLET /
38
DEPAKOTE ER
TABLET 0 0
39 ASEPTAN 500CC + PUMP BOTOL 0 0
40 ASEPTIC GEL 500CC + DISPENSER BOTOL 0 0
41 ASERING (ASETAT RINGER) SOFT BAG BOTOL 0 0
42 ASETOSAL TABLET 100 (80) MG TABLET 0 0
43 ASIKLOVIR KREAM 5 % 5 GR TUBE 0 0
44 ASIKLOVIR TABLET 400 MG TABLET 0 0

ATROPIN SULFAT INJEKSI 0,25
45
MG/ML 1 ML
AMPUL 0 0
46 ATTAPULGIT + PECTIN TABLET TABLET 0 0
47 BETAHISTINMESILAT 6 MG TABLET TABLET 0 0
48 BETAMETHASONE CREAM 0,1 % 5 GR TUBE 0 0
49 BISAKODIL TABLET 5 MG TABLET 0 0
50 BISAKODIL SUPPOSITORIA 10 MG SUPP. 0 0
51 BISAKODIL SUPPOSITORIA 5 MG SUPP. 0 0

BISOPROLOL 2,5 MG TABLET
52
(CONCOR)
TABLET 0 0
53 BISOPROLOL 5 MG TABLET TABLET 0 0
54 CAT GUT NO. 3/0 CHROMIC PCS 0 0
55 CAT GUT NO. 3/0 PLAIN PCS 0 0
56 CITICHOLIN 250 MG/ML-2ML INJEKSI AMPUL 0 0
57 CLONIDINE 0.15 MG TABLET TABLET 0 0

58 COMBIVENT UDV INHALASI VIAL 0 0
DEKSAMETHASONE INJEKSI 5
59
MG/ML 1 ML
AMPUL 0 0
60 DEKSAMETHASONE TABLET 0,5 MG TABLET 0 0
61 DEVITALISASI PASTA ( NON ARSEN ) POT 0 0
62 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 0 0

DIAZEPAM LARUTAN RECTAL 5MG/
63
2,5ML-STESOLID
TUBE 0 0
64 DIAZEPAM TABLET 2 MG TABLET 0 0
65 DIAZEPAM TABLET 5 MG TABLET 0 0

DIFENHIDRAMINE HCL INJEKSI 10
66
MG/ML 1 ML
AMPUL 0 0
67 DIGOXIN TABLET 0,25 MG TABLET 0 0
68 DIMENHYDRINATE TABLET 50 MG TABLET 0 0
69 DOKSISIKLIN TABLET 100 MG KAPSUL 0 0
70 DOMPERIDON SUSPENSI 5MG/ML BOTOL 0 0
71 DOMPERIDON TABLET 10 MG TABLET 0 0

EKSTRACT PLASENTA + NEOMYSIN
72
SALEP 15 GR
TUBE 0 0
EPINEFRIN (ADRENALIN) HCL INJ.0,1 %
73
1 ML
AMPUL 0 0
74 ERITROMISIN KAPSUL 250 MG KAPSUL 0 0

ERITROMISIN SIRUP KERING 200
75
MG/5ML
BOTOL 0 0
76 ERITROMISIN TABLET 500 MG KAPSUL 0 0

ETAKRIDIN ( RIVANOL ) LARUTAN 0,1 %
77
300 ML
BOTOL 0 0
78 ETANOL [ ALKOHOL ] 70 % 1000 ML BOTOL 0 0

79 ETIL KLORIDA SEMPROT 100 ML BOTOL 0 0
80 EUGENOL CAIRAN 10 ML BOTOL 0 0
81 FENITOIN NATRIUM TABLET 100 MG KAPSUL 0 0

FENOBARBITAL INJEKSI 50 MG/ML 2
82
ML
AMPUL 0 0
83 FENOBARBITAL TABLET 30 MG TABLET 0 0

FENOL GLISEROL TETES TELINGA 10
84
% 5 ML
BOTOL 0 0
FITOMENADION ( VIT K1 ) INJEKSI 10
85
MG/ML 1 ML
AMPUL 0 0
FITOMENADION ( VIT K1 ) TABLET
86
SALUT 10 MG
TABLET 0 0
FITOMENADION (VIT K) INFANT INJ.
87
2MG/ML
AMPUL 0 0
FLUPHENASINE DEKANOAT INJEKSI
88
25 MG 1 ML
AMPUL 0 0
89 FUROSEMID INJEKSI 10 mg VIAL 0 0
90 FUROSEMID TABLET 40 MG TABLET 0 0
91 GEMFIBROZIL 300 MG KAPSUL KAPSUL 0 0
92 GENTAMISIN SALEP KULIT 0,1 % 5 GR TUBE 0 0
93 GENTAMISIN SALEP MATA 0,3% TUBE 0 0
94 GENTAMISIN TETES MATA 0,3% BOTOL 0 0
95 GLASS IONOMER CEMENT ( GC IX ) BOTOL 0 0
96 GLIBENCLAMIDE TABLET 5 MG TABLET 0 0

GLICERIL GUAIACOLAT TABLET 100
97
MG
TABLET 0 0
98 GLIMEPIRIDE 1 MG TABLET TABLET 0 0
99 GLIMEPIRIDE 2 MG TABLET TABLET 0 0

GLUKOSA 40% DEXTROSE
100
INJECTION U.S.P CAIRAN INJEKSI
VIAL 0 0
GLUKOSA LARUTAN INFUS 10 %
101
STERIL
BOTOL 0 0
102
STERIL
BOTOL 0 0
103 GRISEOFULVIN TABLET 125 MG TABLET 0 0
104 HALOPERIDOL 2 MG TABLET 0 0
105 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 0 0

HALOPERIDOL INJ. 5 MG/ML
106
(LODOMER)
AMPUL 0 0
107 HALOPERIDOL TABLET 1,5 MG TABLET 0 0
108 HALOPERIDOL TABLET 5 MG TABLET 0 0
109 HERBAKOF SYRUP 60ML BOTOL 0 0

HES-HYDROXYETHYL STARCH 6
110
%/VOLUVEN INFUS 500 ML
BOTOL 0 0
111 HIDROCORTISON CR 1% TUBE 0 0
112 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 0 0
113 HYDROCHLORTHIAZIDE 25 MG TABLET 0 0

I.V CATHETER NO.16 WITH INJECTION
114
PORT
PCS 0 0
115
PORT
PCS 0 0
I.V CATHETER NO.20 WITH
116
INJECTION PORT
PCS 0 0
117
INJECTION PORT
PCS 0 0
118
INJECTION PORT
PCS 0 0
119
INJECTION PORT
PCS 0 0
IBUPROFEN FORTE SYRUP
120
200MG/5ML
BOTOL 0 0
IBUPROFEN SUSPENSI 100 MG/5 ML
121
60 ML
BOTOL 0 0
122 IBUPROFEN TABLET 400 MG TABLET 0 0
123 INFUSION SET ANAK PCS 0 0
124 INFUSION SET DEWASA PCS 0 0

ISOSORBIDE DINITRATE SUBLINGUAL
125
5 MG
TABLET 0 0
126 KAEN 3B BOTOL 0 0
127 KALIUM DIKLOFENAK 50 MG TABLET TABLET 0 0

KALSIUM GLUCONAS INJEKSI 100
128
MG/ML 10 ML
AMPUL 0 0
KALSIUM LAKTAT (KALK) TABLET 500
129
MG
TABLET 0 0
130 KANTONG URINE DEWASA PCS 0 0
131 KAPAS PEMBALUT/ABSORBEN 250 GR BKS 0 0
132 KAPTOPRIL TABLET 25 MG TABLET 0 0
133 KARBAMAZEPIN TABLET 200 MG TABLET 0 0
134 KASA KOMPRES 40/40 STERIL BKS 0 0

KASA PEMBALUT HIDROFIL 16 X 16 CM
135
STRIL
ROL 0 0
KASA PEMBALUT HIDROFIL 2 M X 80
136
CM
ROL 0 0
137
CM
ROL 0 0
138
CM
ROL 0 0
KASA STERIL (DARYAN TOLLE)YG
139
DIRESAPI FRAMISETIN
PCS 0 0
140 KETOKONAZOLE TABLET 200 MG TABLET 0 0
141 KLINDAMISIN KAPSUL 150 MG TABLET 0 0

142 KLINDAMISIN KAPSUL 300 MG KAPSUL 0 0
143 KLOBAZAM 10 MG TABLET TABLET 0 0
144 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 0 0
145 KLORAMFENIKOL SALEP KULIT 2 % TUBE 0 0
146 KLORAMFENIKOL SALEP MATA 1 % TUBE 0 0

KLORAMFENIKOL SUSPENSI 125 MG/5
147
ML
BOTOL 0 0
148 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 0 0

KLORFENIRAMINE MALEAT (CTM)
149
TABLET 4 MG
TABLET 0 0
KLORPROMAZIN HCL INJEKSI 25
150
MG/ML 1 ML
AMPUL 0 0
151
MG/ML 1 ML
AMPUL 0 0
152 KLORPROMAZIN HCL TABLET 100 MG TABLET 0 0
153 KLOZAPIN 100 MG TABLET TABLET 0 0
154 KLOZAPIN 25 MG TABLET TABLET 0 0
155 KODEIN HCL TABLET 10 MG TABLET 0 0
156 KOTRIMOKSAZOL DEWASA TABLET TABLET 0 0
157 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 0 0
158 LEVOFLOXACIN TABLET 500 MG TABLET 0 0
159 LIDOCAIN 2% INJ AMPUL 0 0

LIDOCAIN COMPOSITUM INJEKSI 2
160
ML
AMPUL 0 0
161 LISOL CONCENTRATE 1000 ML BOTOL 0 0
162 LOPERAMIDE TABLET 2 MG TABLET 0 0

163 LORATADIN TABLET 10 MG TABLET 0 0
164 LORAZEPAM 2 MG TABLET 0 0

MAGNESIUM SULFAT INJEKSI (IV) 40
165
% 25 ML
AMPUL 0 0
166 MASKER EARLOOP PLUS PCS 0 0
167 MASKER KERTAS 3 PLY EAR LOOP PCS 0 0
168 MASKER KERTAS 3 PLY TIE ON PCS 0 0
169 MASKER N95 PCS 0 0

METAMIZOL (NORAGES) INJEKSI 500
170
MG/2ML
AMPUL 0 0
171 METFORMIN TABLET 500 MG TABLET 0 0

METILERGOMETRIN MALEAT INJEKSI
172
0,200 MG 1 ML
AMPUL 0 0
METILERGOMETRIN MALEAT TABLET
173
0,125 MG
TABLET 0 0
174 METILPREDNISOLON TABLET 4 MG TABLET 0 0
175 METOKLOPRAMIDE 10 MG TABLET TABLET 0 0
176 METOKLOPRAMIDE 5 MG TABLET TABLET 0 0

METOKLOPROMIDE (SOTATIC)
177
INJEKSI 5 MG/ML 2 ML
AMPUL 0 0
178 METOKLOPROMIDE SIRUP BOTOL 0 0

METRONIDAZOL + NYSTATIN VAG.
179
(PROVAGIN) OVULA
VIAL 0 0
180 METRONIDAZOL TABLET 250 MG TABLET 0 0
181 METRONIDAZOL TABLET 500 MG TABLET 0 0

METRONIDAZOLE INFUS 5 MG/ML
182
100 ML
BOTOL 0 0
183 MIKONAZOL KREAM 10 GR TUBE 0 0

NATRIUM DIKLOFENAK TABLET 25
184
MG
TABLET 0 0
185
MG
TABLET 0 0
NATRIUM KLORIDA INFUS 0,9 %
186
STERIL
BOTOL 0 0
187 NIFEDIPINE TABLET 10 MG TABLET 0 0
188 NISTATIN TABLET 500.000 UI TABLET 0 0
189 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 0 0

OBAT BATUK HITAM (OBH) CAIRAN
190
100 ML
BOTOL 0 0
191 OKSIGEN NASAL CANNULA ADULT PCS 0 0
192 OKSIGEN NASAL CANNULA INFANT PCS 0 0

OKSITETRACYCLIN SALEP KULIT 3 % 5
193
GR
TUBE 0 0
OKSITETRACYCLIN SALEP MATA 1 %
194
3,5 GR
TUBE 0 0
195 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 0 0
196 OMEPRAZOLE TABLET 20 MG KAPSUL 0 0
197 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 0 0

PARACETAMOL SYRUP 120 MG/5 ML
198
60 ML
BOTOL 0 0
199 PARACETAMOL TABLET 500 MG TABLET 0 0

PARACETAMOL TETES 100 MG/ML 15
200
ML
BOTOL 0 0
201 PEHAVRAL TABLET TABLET 0 0
202 PERAK SULFADIAZIN KRIM 1 % TUBE 0 0
203 PERHYDROL [ H2O2 ] 3 % 800 ML BOTOL 0 0
204 PERMETHRINE 5% CR 15 GRAM TUBE 0 0

205 PIRACETAM TABLET 800 MG TABLET 0 0
206 PIRANTEL PAMOAT TABLET TABLET 0 0

PIRIDOKSIN HCL (VIT B6) TABLET 10
207
MG
TABLET 0 0
208 PIROKSIKAM KAPSUL 10 MG KAPSUL 0 0
209 PLESTER 10 CM X 2 M ROL 0 0
210 PREDNISON TABLET 5 MG TABLET 0 0
211 PROPRANOLOL HCL TABLET 40 MG TABLET 0 0
212 RANITIDIN INJEKSI 25 MG/ ML AMPUL 0 0
213 RISPERIDON 2 MG TABLET TABLET 0 0

RINGER LAKTATE LARUTAN INFUS
214
STERIL
BOTOL 0 0
215 SALBUTAMOL TABLET 2 MG TABLET 0 0
216 SALBUTAMOL TABLET 4 MG TABLET 0 0
217 SALEP 2-4 KOMBINASI 30 GR POT 0 0
218 SALICYL BEDAK 2 % KOTAK 0 0
219 SARUNG TANGAM NON STERIL L PCS 0 0
220 SARUNG TANGAN NON STERIL M PCS 0 0
221 SARUNG TANGAN NON STERIL S PCS 0 0
222 SARUNG TANGAN STERIL NO 6 PSG 0 0
223 SARUNG TANGAN STERIL NO. 7,5 PSG 0 0
224 SARUNG TANGAN STERILE NO.6,5 PSG 0 0
225 SARUNG TANGAN STERILE NO.7 PSG 0 0

226 SEFADROKSIL KAPSUL 500 MG KAPSUL 0 0
SERUM ANTI BISA ULAR POLIVALEN
227
INJ.5 ML (ABU I)
VIAL 0 0
SERUM ANTI TETANUS INJEKSI 1.500
228
IU/AMP (ATS)
VIAL 0 0
229 SETIRIZINE TABLET 10 MG TABLET 0 0

SIANOKOBALAMIN ( VIT B12 ) INJEKSI
230
500 MCG/ML 1 ML
AMPUL 0 0
SIANOKOBALAMIN ( VIT B12 ) TABLET
231
50 MCG
TABLET 0 0
SILK (BENANG BEDAH SUTERA)
232
NO.3/0
PCS 0 0
233 SIMVASTATIN TABLET 10 MG TABLET 0 0
234 SIPROFLOXACIN INFUS 2% BOTOL 0 0
235 SIPROFLOXACIN TABLET 500 MG TABLET 0 0
236 SPONS GELATIN CUBICLES 1x1x1 CM PCS 0 0

SULFASETAMID NATRIUM TETES
237
MATA 15 % 5 ML
BOTOL 0 0
TEMPORARY CAVITY SEALER
238
[TUMPATAN SEMENTARA] (CAVIT G)
PCS 0 0
239 TETRAKAIN HCL TETES MATA 5 ML BOTOL 0 0
240 TETRASIKLIN HCL TABLET 500 MG KAPSUL 0 0

THIAMIN HCL MONONITRAT (VIT B1)
241
TABLET 50 MG
TABLET 0 0
TRANFUSION SET ADULT WITH Y
242
INJECTION
PCS 0 0
243 TRIFLOUPERASIN TABLET 5 MG TABLET 0 0

TRIHEKSIFENIDIL HIDROKLORIDA
244
TABLET 2 MG
TABLET 0 0
245 VITAMIN B COMPLEX TABLET TABLET 0 0

YODIUM POVIDON LARUTAN 10 % 30
246
ML
BOTOL 0 0
YODIUM POVIDON LARUTAN 10% 60
247
ML
BOTOL 0 0
ZENTRA (TRIPROLIDINE|
248
PSEUDOEPHEDRINE)
TABLET 0 0
249 ZINK 20 MG TABLET TABLET 0 0
250 ALPARA TABLET TABLET 0 0
251 ALPARA SYRUP BOTOL 0 0
252 CURLYSINE SIRUP BOTOL 0 0
253 BUFACOMB CREAM TUBE 0 0
254 SARUNG TANGAN STERIL S PCS 0 0
255 SARUNG TANGAN STERIL M PCS 0 0
256 SARUNG TANGAN STERIL L PCS 0 0
257 SUPRAFENID SUPP BOTOL 0 0
258 FASFIT D 1000 IU TABLET 0 0
259 POLIFIX PLESTER PCS 0 0
260 LEUKOPLAST PLESTER PCS 0 0
261 LISINOPRIL 5 MG TABLET 0 0
262 HERBA ASIMOR BOX 0 0
263 LYTACUR SYRUP 60 ML BOTOL 0 0

HIOPAR (HYOSCINE-N-
264 BUTILBROMIDE 10 MG, BOX 0 0
PARACETAMOL 500 MG)
NOZA (TRIPROLIDIN HCL 2,5 MG,
265 TRIPROLIDINE HCL 30 MG, BOX 0 0
PARACETAMOL 500 MG)
266 IMIBOND F (ZINC PHOSPHATE) BOX 0 0
267 NOVA COMPO C BOX 0 0

268 NOVA COMPO B PLUS BOX 0 0
269 PARAMONOCLOROFENOL BOX 0 0
270 TRICRESOLFORMALINA BOX 0 0
271 ATTAQUE GEL PCS 0 0
272 XIMEX (OPTIXITROL) BOTOL 0 0
273 RANITIDIN TABLET 150 MG TABLET 0 0
RINDOBION 5000 (THIAMIN 100 MG,

274 PYRIDOXIBE 100 MG, TABLET 0 0
CYANOCOBALAMIN 5000 MCG)
275 ZINC SYRUP 20 MG/5MG BOTOL 0 0

276
NO.2/0
PCS 0 0
OBAT PROGRAM / HIBAH
1 KESWA-AMITRIPTYLINE 25 MG TABLET 0 0
2 KESWA-DIAZEPAM 5 MG TABLET 0 0
3 KESWA-DIAZEPAM INJEKSI 5 MG/2ML AMPUL 0 0
4 KESWA-SIKZONOAT 25 MG AMPUL 0 0
5 KESWA-HALOPERIDOL 5 MG TABLET 0 0
6 KESWA-HALDOL DECANOAT INJEKSI AMPUL 0 0
7 KESWA-CLOZAPIN 25 MG TABLET 0 0
8 KESWA-RISPERIDON 2 MG TABLET 0 0
9 KESWA-TRIFLUOPERAZINE 5 MG TABLET 0 0
10 KESWA TRIHEKSIPHENIDIL 2 MG TABLET 0 0
11 DBD-SD BIOLINE CHIKUNGUNYA IgM TEST 0 0

DBD-VIROTEC DENGUE COMBO
12
(IgG\/IgM dan NS1)
TEST 0 0
13 DBD-ABATE POWDER 1 KG KG 0 0
14 DBD-ABATE POWDER SACHET SACHET 0 0
15 DIARE-ORALIT SERBUK SACHET 0 0
16 DIARE-ZINC TABLET 20 MG TABLET 0 0

FILARIASIS-ALBENDAZOLE TABLET
17
400 MG
TABLET 0 0
FILARIASIS-ALBENDAZOLE SYRUP 200
18
MG/5ML
BOTOL 0 0
GIZI-VITAMIN A CAPSUL LUNAK
19
100.000 IU
KAPSUL 0 0
20
200.000 IU
KAPSUL 0 0
21 GIZI-MINERAL MIX SACHET 0 0
22 GIZI-TABLET TAMBAH DARAH TABLET 0 0
23 HEPATITIS-VIROCHECK HBsAG TEST 0 0

HEPATITIS-HYPERHEP B S/D CAIRAN
24
INJEKSI (HBIg)
SYRINGE 0 0
25 HEPATITIS-ANTI HBs HEPATITIS B TEST 0 0
26 HEPATITIS-STARTES HCV TEST 0 0
27 HIV-ABACAVIR TABLET 300 MG BOTOL 0 0
28 HIV-AQUAGEL LUBRICATING JELLY SACHET 0 0

HIV-BENZATIN BENZIL PENICILIN
29
INJEKSI 2.4 UI/ML
VIAL 0 0
HIV-COTRIMOKSAZOLE 800 MG + 160
30
MG
TABLET 0 0
HIV-DETEKSI RAPIDAN TESTER ANTI
31
HIV 1/2 TEST 3 LINES
TEST 0 0
HIV-DIAGNOSTAR HIV 1/2 ONE STEP
32
RAPID DIAGNOSTIC TEST GCHIV-402A
TEST 0 0
33 HIV-DOLUTEGRAVIR CAPLET 50 MG BOTOL 0 0
HIV-DOLUTEGRAVIR 50 MG;
34 LAMIFUDINE 300 MG; TENOFOVIR 300 BOTOL 0 0
MG (TLD)
35 HIV-EVAFIRENZ TABLET 600 MG BOTOL 0 0
36 HIV-FASTCLEAR Q HIV 1/2 TRI-LINE TEST 0 0

HIV-INDEC HIV 1/2 & SYPHILLIS
37
COMBO TEST
TEST 0 0
HIV-KHB DIAGNOSTIC KIT FOR HIV
38 (1+2) ANTIBODY COLLOIDAL GOLD V2 TEST 0 0
RAPID TEST
39 HIV-KONDOM SIMPLEX BOX@144 PIECES 0 0
40 HIV-KONDOM SUTRA ISI 12 PIECES 0 0
41 HIV-LAMIVUDINE TABLET 100 MG BOTOL 0 0
42 HIV-LAMIVUDINE TABLET 150 MG BOTOL 0 0
43 HIV-NEVIRAPINE 200 MG BOTOL 0 0

HIV-RAPIDAN TESTER WB/S/P ANTI
44
HIV 1/2 TEST
TEST 0 0
HIV-STANDARD Q HIV 1/2 AB 3 LINES
45
TEST
TEST 0 0
46 HIV-TENOFOVIR TABLET 300 MG BOTOL 0 0

HIV-TENOFOVIR 300 MG;
47 LAMIVUDINE 300 MG; EVAFIRENS 600 BOTOL 0 0
MG (TLE)
48 HIV-TREPOCHECK SYPHILLIS TEST TEST 0 0
49 HIV-VIROCHECK HIV 1/2 TEST TEST 0 0
HIV-ZIDOVUDINE 300 MG +
50
LAMIVUDINE 150 MG
BOTOL 0 0
51 HIV-ZIDOVUDINE TABLET 150 MG BOTOL 0 0
52 HIV-FOKUS RPR ANTIGEN TEST TEST 0 0

53 IMUN-VAKSIN POLIO (BOPV) VIAL 0 0
IMUN-VAKSIN PENTABIO (DPT-HB-
54
Hib)
VIAL 0 0
55 IMUN-VAKSIN PCV (PREVENAR) VIAL 0 0
56 IMUN-VAKSIN ROTAVIRUS (ROTAVAC) VIAL 0 0
57 IMUN-VAKSIN BCG VIAL 0 0
58 IMUN-VAKSIN HEPATITIS B VIAL 0 0
59 IMUN-VAKSIN IPV CAIRAN INJEKSI VIAL 0 0
60 IMUN-VAKSIN JERAP DT VIAL 0 0
61 IMUN-VAKSIN JERAP Td VIAL 0 0
62 IMUN-VAKSIN MEASLES RUBELLA VIAL 0 0

IMUN-ONEJCT AUTO DISABLE
63
SYRINGE 0,05 ML
SYRINGE 0 0
IMUN-ONEJECT AUTO DISABLE
64
SYRINGE 0,5 ML
SYRINGE 0 0
65
SYRINGE 0,3 ML
SYRINGE 0 0
66
SYRINGE 3 ML
SYRINGE 0 0
IMUN-ONEJECT AUTODISABLE
67
SYRINGE 5 ML
SYRINGE 0 0
IMUN-DISPOSABLE SAFETY BOX 5
68
LITER
PIECES 0 0
69 IMUN-ALCOHOL SWAB PIECES 0 0
70 KIA-AMPICILLIN SERBUK INJEKSI 1 G VIAL 0 0
71 KIA-CA GLUCONAS INJEKSI 10 ML AMPUL 0 0

KIA-GENTAMICIN SULFATE CAIRAN
72
INJEKSI 40 MG
AMPUL 0 0
KIA-MAGNESIUM SULFAT CAIRAN
73
INJEKSI 40%
AMPUL 0 0
KIA-MAGENSIUM SULFAT CAIRAN
74
INJEKSI 20%
AMPUL 0 0
KIA-METRONIDAZOLE INFUS 5
75
MG/ML
BOTOL 0 0
KIA-PYTOMENADION CAIRAN INJEKSI
76
2 MG/ML
AMPUL 0 0
77 KIA-DIAZEPAM INJEKSI 5 MG/2ML AMPUL 0 0

KIA-PHENOBARBITAL INJEKSI 50
78
MG/ML
AMPUL 0 0
79 KIA-OXYTETRACYCLINE SALEP MATA TUBE 0 0
80 KUSTA-MDT MB ADULT (RED) BLISTER 0 0
81 KUSTA-MDA PB ADULT (GREEN) BLISTER 0 0
82 KUSTA-MDT MB CHILD (ORANGE) BLISTER 0 0
83 KUSTA-TREPOCHECK SIPHILIS TEST 0 0
84 MALARIA-DHP FRIMAL TABLET 0 0
85 MALARIA-PRIMAQUIN TABLET 15 MG TABLET 0 0
86 TBC-ISONIAZID TABLET 100 MG TABLET 0 0
87 TBC-ISONIAZID TABLET 300 MG TABLET 0 0
88 TBC-ETHAMBUTOL TABLET 100 MG TABLET 0 0
89 TBC-ETHAMBUTOL TABLET 400 MG TABLET 0 0

TBC-PAKET STOP TB DOSIS HARIAN
90
RHZE 150/75/400/275 + RH 150/75
PAKET 0 0
TBC-PAKET STOP TB KATEGORI I
91
RHZE 150/75/400/175 + RH 150/150
PAKET 0 0
TBC-PAKET STOP TB ANAK RHZ
92
75/50/150 + RH 75/50
PAKET 0 0
93 TBC-LEVOFLOXACIN 100 MG TABLET 0 0
94 TBC-PIRAZINAMIDE 500 MG TABLET 0 0

95 TBC-RIFAMPICIN 600 MG TABLET 0 0
96 TBC-RIFTIN RIFAPENTIN 150 MG TABLET 0 0

TBC-3HP ISONIAZID RIFAPENTIN
97
300/300
PAKET 0 0
98 TBC-3HR ISONIAZID RIFAMPISIN 50/75 PAKET 0 0
99 TBC-PIRIDOKSIN VITAMIN B6 25 MG TABLET 0 0
100 TBC-TUBERCULIN PPD RT 23 SSI VIAL 0 0
101 TBC-REAGEN ZIEHL NEELSEN PAKET 0 0
102 TBC-POT SPUTUM POT 0 0
103 TBC-KACA SLIDE PIECES 0 0
104 TBC-MASKER BEDAH PROGRAM TB PIECES 0 0
105 TBC-MASKER N95 WEGEN PIECES 0 0
106 TBC-MASKER N95 AERO PIECES 0 0
107 TBC-MASKER N95 DREAMCAN PIECES 0 0

TBC-GENEXPERT MTB RIF 50
108
CATRIDGE
PIECES 0 0
TBC-PROTEN GOLD SUMBER
109
PROTEIN
SACHET 0 0
110 SURVEILEN-ANTI DIFTERI SERUM VIAL 0 0
111 SURVEILEN-VAKSIN MENINGITIS VIAL 0 0
112 PTM-STIK GULA DARAH PIECES 0 0
113 PTM-STIK CHOLESTEROL PIECES 0 0
114 PTM-STIK ASAM URAT PIECES 0 0
115 PTM-VAGINAL SPECULUM UKURAN S PIECES 0 0

116 PTM-VAGINAL SPECULUM UKURAN M PIECES 0 0
117 PTM-VAGINAL SPECULUM UKURAN L PIECES 0 0

PTM-OCCULT BLOOD STRIP ONE
118
STEP RAPID TEST
TEST 0 0
119 PTM-ALCOHOL SWAB PIECES 0 0
120 PTM-BLOOD LANCET PIECES 0 0
121 PTM-PROLINE TRIGLISERIDE REAGEN BOTOL 0 0

PTM-PROLINE CHOLESTEROL
122
REAGEN
BOTOL 0 0
123 PTM-SARUNG TANGAN STERIL 6.5 PASANG 0 0
124 PTM-SARUNG TANGAN STERIL 7 PASANG 0 0
125 PTM-SARUNG TANGAN STERIL 7.5 PASANG 0 0

PTM-RAPID DIAGNOSTIC TEST MULTI
126
DRUG 7 IN 1
TEST 0 0
127 PTM-ACON URINALYSIS STRIP BOTOL 0 0
128 PTM-KERTAS EKG 110 X 30 mm ROLL 0 0
131 PTM-MOUTH PIECES PIECES 0 0
132 PTM-D-PIECES PIECES 0 0
133 PTM-SPUIT 5 ML SYRINGE 0 0
134 PTM-STOOL CONTAINER POT 0 0
135 PTM-COTTON SWAB PIECES 0 0

KESGA-STRIP PEMERIKSAAN
136
CHOLESTEROL
PIECES 0 0
137
HEMOGLOBIN
PIECES 0 0
138 KESGA-ALCOHOL SWAB PIECES 0 0
139 KESGA-LANCET PIECES 0 0
OBAT TAMBAHAN
1 ALLOPURINOL (BLUD) TABLET 0 0
2 AMBROXOL TABLET 30 MG (BLUD) TABLET 0 0
3 AMLODIPINE 5MG (BLUD) TABLET 0 0
4 AMLODIPINE 10 MG (BLUD) TABLET 0 0
5 ANTASIDA DOEN TABLET KOMBINASI (BL TABLET 0 0
6 ANTIHEMOROID/BORRAGINOL (BLUD) TABLET 0 0
7 AQUA PRO INJEKSI (BLUD) PIECES 0 0
8 ASAM MEFENAMAT TABLET 500 MG (BLU TABLET 0 0
9 ASAM TRANEKSAMAT (BLUD) TABLET 0 0
10 ASETILSISTEIN (BLUD) KAPSUL 0 0
11 ASETOSAL TABLET 100 (80) MG (BLUD) TABLET 0 0
12 ASIKLOVIR SALEP KULIT (BLUD) TUBE 0 0
13 ASIKLOVIR TABLET (BLUD) TABLET 0 0
14 BATUK FLU SIRUP/ ETAFLUSIN (BLUD) SIRUP 0 0
15 BATUK FLU TABLET/ETAFLUSIN (BLUD) TABLET 0 0
16 BEDAK SALISIL (BLUD) SACHET 0 0
17 BETADINE GARGLE (BLUD) BOTOL 0 0

18 BETAHISTIN TABLET (BLUD) TABLET 0 0
19 BETAMETHASONE SALEP KULIT (BLUD) TUBE 0 0
20 BIOPLACENTON (BLUD) TUBE 0 0
21 BISAKODIL TABLET 5 MG (BLUD) TABLET 0 0
22 BUFACOMB SALEP (BLUD) TUBE 0 0
23 BUFACORT - N (BLUD) TUBE 0 0
24 CIPROFLOXACIN (BLUD) TABLET 0 0
25 CLINDAMISIN KAPS (BLUD) KAPSUL 0 0
26 CTM (BLUD) TABLET 0 0
27 DARYANTULLE (BLUD) PIECES 0 0
28 DEKSAMETHASONE TABLET 0,5 MG ((BLUD TABLET 0 0
29 DIMENHIDRINATE (BLUD) TABLET 0 0
30 DOMPERIDONE TABLET 10 MG ( (BLUD)) TABLET 0 0
31 DUK LUBANG PIECES 0 0
32 EPINEFRIN INJEKSI (BLUD) AMPUL 0 0
33 ETIL KLORIDA SPRAY (BLUD) BOTOL 0 0
35 FITOMENADION INJ (BLUD) AMPUL 0 0
36 FITOMENADION TABLET (BLUD) TABLET 0 0
37 FUROSEMIDE TABLET (BLUD) TABLET 0 0
38 GEMFIBROZIL (BLUD) KAPSUL 0 0
39 GENTAMICIN TETES MATA (BLUD) FLASK 0 0

40 GENTAMISIN SALEP KULIT /GENOINT (BL TUBE 0 0
41 GENTIAN VIOLET LARUTAN 1 % (BLUD) BOTOL 0 0
42 GLIBENCLAMIDE TABLET 5 MG (BLUD) TABLET 0 0
43 GLIMEPIRID 1 MG (BLUD) TABLET 0 0
44 GLIMEPIRIDE 2 MG TABLET (BLUD) TABLET 0 0
45 GLISERIL GUAIKOLAT/GUAIFENESIN BLU TABLET 0 0
46 GLUKOSA INFUS (BLUD) FLASK 0 0
48 HIDROKORTISON CREAM KULIT (BLUD) TUBE 0 0
49 HYOSCINE BUTYLBROMIDE (ANTI SPASM TABLET 0 0
50 HYPAFIX (BLUD) PIECES 0 0
51 IBUPROFEN 4OO MG (TABLET) TABLET 0 0
52 ISDN (BLUD) TABLET 0 0
53 KAOLIN PEKTIN SIRUP (NOVADIAR) BOTOL 0 0
54 KAPTOPRIL TABLET 12,5 MG (BLUD) TABLET 0 0
55 KAPTOPRIL TABLET 25 MG (BLUD) TABLET 0 0
56 KASSA STERIL 16X16 (BLUD) KOTAK 0 0
57 KETOKONAZOLE TABLET 200MG (BLUD) TABLET 0 0
58 KLORAMFENIKOL SIRUP (BLUD) BOTOL 0 0
59 KLORAMFENIKOL TETES TELINGA (BLUD) BOTOL 0 0
60 KOTRIMOKSAZOL TAB (BLUD) TABLET 0 0
61 LOPERAMIDE TABLET 2 MG (BLUD) TABLET 0 0

62 LORATADINE (BLUD) TABLET 0 0
63 METFORMIN (BLUD) TABLET 0 0
64 METILERGOMETRINE INJ (BLUD) AMPUL 0 0
65 METILPREDNISOLON TABLET 4 MG (BLUD TABLET 0 0
66 METRONIDAZOL (BLUD) TABLET 0 0
67 MULTIVITAMIN KOMBINASI TABLET (BLUD TABLET 0 0
68 MULTIVITAMIN KOMBINASI SIRUP (BLUD) BOTOL 0 0
69 NATRIUM DIKLOFENAK 25/50 MG (BLUD) TABLET 0 0
70 NEW DIATABS (BLUD) TABLET 0 0
71 NIFEDIPINE TAB (BLUD) TABLET 0 0
72 OKSITETRASIKLIN SALEP KULIT (BLUD) TUBE 0 0
73 OMEPRAZOLE 20MG (BLUD) KAPSUL 0 0
74 ONDANSETRONE INJEKSI (BLUD) AMPUL 0 0
75 PARACETAMOL TABLET 500 MG (BLUD) TABLET 0 0
76 PIRACETAM KAPSUL (BLUD) TABLET 0 0
77 PIROXICAM (BLUD) TABLET 0 0
78 POVIDONE IODINE 60ML (BLUD) BOTOL 0 0
79 RANITIDIN TABLET (BLUD) TABLET 0 0
80 SALBUTAMOL TABLET 2 MG (BLUD) TABLET 0 0
81 SEFADROKSIL KAPSUL 500 MG (BLUD) KAPSUL 0 0
82 SETERIZIN TABLET (BLUD) TABLET 0 0

83 SIMVASTATIN 10MG (BLUD) TABLET 0 0
84 TIAMFENIKOL KAPSUL (BLUD) KAPSUL 0 0
85 VGEL (BLUD) TUBE 0 0
86 VITAMIN B KOMPLEKS (BLUD) TABLET 0 0
87 VITAMIN B1/THIAMIN (BLUD) TABLET 0 0
88 VITAMIN B6/PIRIDOKSIN HCL10 MG (BLUD TABLET 0 0
89 VITAMIN C/ASAM ASKORBAT 50 MG (BLUD TABLET 0 0
90 ZINK SIRUP (PROGRAM) BOTOL 0 0
91 ZIVIT ZINC (PROGRAM) TABLET 0 0
92 0 0 0
93 0 0 0
94 0 0 0
95 0 0 0
96 0 0 0
97 0 0 0
98 0 0 0
99 0 0 0
100 0 0 0
Blitar ,
Mengetahui / Menyetujui
Mengetahui / Menyetujui Yang Menerima, Yang Menyerahkan,
Kepala Puskesmas Kepala UPT Petugas Petugas Pengelola Obat
SANANKULON Instalasi Farmasi Kabupaten Instalasi Farmasi Kabupaten Puskesmas
dr. ENDAH ROSITANINGSIH, SE., MM. dr. FARUQ AKBAR Al R. Apt. ROMDLON FAUZI, S.Farm. AINA MUJTAHIDA A S.Farm., Apt
NIP. 19691230 201001 2 002 NIP : 19880803 201502 1 001 NIP : 19910317 202012 1 012 NIP. 19861218 201903 2 004
KODE : PELAPORAN BULAN : JANUARI 2024 DOKUMEN NOMOR DOKUMEN TANGGAL
PUSKESMAS : PERMINTAAN BULAN : FEBRUARI 2024
UPT IFK
KECAMATAN :
KABUPATEN : BLITAR
PUSKESMAS
SISA STOK JUMLAH

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11
1 2 WAY FOLEY CATHETER NO.16 PCS 0 0 0
4 ACETYLCYSTEINE CAPSULE 200 MG CAPSULE 0 0 0
5 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0 0 0
10 ALKOHOL SWAB PCS 0 0 0
11 ALLOPURINOL TABLET 100 MG TABLET 0 0 0
12 ALPRAZOLAM 1 MG TABLET TABLET 0 0 0
13 AMBROXOL SIRUP 5MG/ML BOTOL 0 0 0
14 AMBROXOL TABLET 30 MG TABLET 0 0 0

15
10 ML
AMPUL 0 0 0
16 AMITRIPTYLLINE HCL TABLET 25 MG TABLET 0 0 0

AN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
TANGGAL
PEMBERIAN
12
17 AMLODIPINE TABLET 10 MG TABLET 0 0 0

19
ML 60 ML
BOTOL 0 0 0
20
MG
VIAL 0 0 0
21 AMOKSISILIN TABLET 500 MG KAPLET 0 0 0

22
250MG/5ML
BOTOL 0 0 0
23
MG/VIAL
VIAL 0 0 0
24
(METAMIZOL)
TABLET 0 0 0
25 ANTASIDA DOEN TABLET KOMBINASI TABLET 0 0 0
26 ANTASIDA SUSPENSI 60 ML BOTOL 0 0 0

27
KOMBINASI 5 GR
POT 0 0 0
28
30 GR
POT 0 0 0
29 ANTI HAEMOROID DOEN KOMBINASI SUPP. 0 0 0

30
KOMBINASI
TABLET 0 0 0
31
(DORMICOMP)
TABLET 0 0 0
32
PIROGEN 20 ML
BOTOL 0 0 0
33
MG
TABLET 0 0 0
34 ASAM FOLAT 1MG TABLET TABLET 0 0 0
35 ASAM MEFENAMAT TABLET 500 MG TABLET 0 0 0

36
INJEKSI
AMPUL 0 0 0
37 ASAM TRANEKSAMAT 500 MG TABLET TABLET 0 0 0

38
DEPAKOTE ER
TABLET 0 0 0
39 ASEPTAN 500CC + PUMP BOTOL 0 0 0
40 ASEPTIC GEL 500CC + DISPENSER BOTOL 0 0 0
41 ASERING (ASETAT RINGER) SOFT BAG BOTOL 0 0 0
42 ASETOSAL TABLET 100 (80) MG TABLET 0 0 0
43 ASIKLOVIR KREAM 5 % 5 GR TUBE 0 0 0
44 ASIKLOVIR TABLET 400 MG TABLET 0 0 0

45
MG/ML 1 ML
AMPUL 0 0 0
46 ATTAPULGIT + PECTIN TABLET TABLET 0 0 0
47 BETAHISTINMESILAT 6 MG TABLET TABLET 0 0 0
48 BETAMETHASONE CREAM 0,1 % 5 GR TUBE 0 0 0
49 BISAKODIL TABLET 5 MG TABLET 0 0 0
50 BISAKODIL SUPPOSITORIA 10 MG SUPP. 0 0 0

52
(CONCOR)
TABLET 0 0 0
53 BISOPROLOL 5 MG TABLET TABLET 0 0 0
54 CAT GUT NO. 3/0 CHROMIC PCS 0 0 0
55 CAT GUT NO. 3/0 PLAIN PCS 0 0 0
56 CITICHOLIN 250 MG/ML-2ML INJEKSI AMPUL 0 0 0
57 CLONIDINE 0.15 MG TABLET TABLET 0 0 0
58 COMBIVENT UDV INHALASI VIAL 0 0 0

59
MG/ML 1 ML
AMPUL 0 0 0
60 DEKSAMETHASONE TABLET 0,5 MG TABLET 0 0 0

61 DEVITALISASI PASTA ( NON ARSEN ) POT 0 0 0
62 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 0 0 0

63
2,5ML-STESOLID
TUBE 0 0 0
64 DIAZEPAM TABLET 2 MG TABLET 0 0 0

66
MG/ML 1 ML
AMPUL 0 0 0
67 DIGOXIN TABLET 0,25 MG TABLET 0 0 0
68 DIMENHYDRINATE TABLET 50 MG TABLET 0 0 0
69 DOKSISIKLIN TABLET 100 MG KAPSUL 0 0 0
70 DOMPERIDON SUSPENSI 5MG/ML BOTOL 0 0 0
71 DOMPERIDON TABLET 10 MG TABLET 0 0 0

72
SALEP 15 GR
TUBE 0 0 0
73
1 ML
AMPUL 0 0 0
74 ERITROMISIN KAPSUL 250 MG KAPSUL 0 0 0

75
MG/5ML
BOTOL 0 0 0
76 ERITROMISIN TABLET 500 MG KAPSUL 0 0 0

77
300 ML
BOTOL 0 0 0
78 ETANOL [ ALKOHOL ] 70 % 1000 ML BOTOL 0 0 0
79 ETIL KLORIDA SEMPROT 100 ML BOTOL 0 0 0
80 EUGENOL CAIRAN 10 ML BOTOL 0 0 0
81 FENITOIN NATRIUM TABLET 100 MG KAPSUL 0 0 0

82
ML
AMPUL 0 0 0
83 FENOBARBITAL TABLET 30 MG TABLET 0 0 0
84
% 5 ML
BOTOL 0 0 0
85
MG/ML 1 ML
AMPUL 0 0 0
86
SALUT 10 MG
TABLET 0 0 0
87
2MG/ML
AMPUL 0 0 0
88
25 MG 1 ML
AMPUL 0 0 0
89 FUROSEMID INJEKSI 10 mg VIAL 0 0 0
90 FUROSEMID TABLET 40 MG TABLET 0 0 0
91 GEMFIBROZIL 300 MG KAPSUL KAPSUL 0 0 0
92 GENTAMISIN SALEP KULIT 0,1 % 5 GR TUBE 0 0 0
93 GENTAMISIN SALEP MATA 0,3% TUBE 0 0 0
94 GENTAMISIN TETES MATA 0,3% BOTOL 0 0 0
95 GLASS IONOMER CEMENT ( GC IX ) BOTOL 0 0 0
96 GLIBENCLAMIDE TABLET 5 MG TABLET 0 0 0

97
MG
TABLET 0 0 0
98 GLIMEPIRIDE 1 MG TABLET TABLET 0 0 0

100
VIAL 0 0 0
101
STERIL
BOTOL 0 0 0
102
STERIL
BOTOL 0 0 0
103 GRISEOFULVIN TABLET 125 MG TABLET 0 0 0
104 HALOPERIDOL 2 MG TABLET 0 0 0

105 HALOPERIDOL DEKANOAT INJ 50 MG VIAL 0 0 0
106
(LODOMER)
AMPUL 0 0 0
107 HALOPERIDOL TABLET 1,5 MG TABLET 0 0 0
108 HALOPERIDOL TABLET 5 MG TABLET 0 0 0
109 HERBAKOF SYRUP 60ML BOTOL 0 0 0

110
BOTOL 0 0 0
111 HIDROCORTISON CR 1% TUBE 0 0 0
112 HIDROCORTISONE CREAM 2,5 % 5 GR TUBE 0 0 0
113 HYDROCHLORTHIAZIDE 25 MG TABLET 0 0 0

114
PORT
PCS 0 0 0
115
PORT
PCS 0 0 0
116
INJECTION PORT
PCS 0 0 0
117
INJECTION PORT
PCS 0 0 0
118
INJECTION PORT
PCS 0 0 0
119
INJECTION PORT
PCS 0 0 0
120
200MG/5ML
BOTOL 0 0 0
121
60 ML
BOTOL 0 0 0
122 IBUPROFEN TABLET 400 MG TABLET 0 0 0
123 INFUSION SET ANAK PCS 0 0 0
124 INFUSION SET DEWASA PCS 0 0 0

125
5 MG
TABLET 0 0 0
126 KAEN 3B BOTOL 0 0 0

127 KALIUM DIKLOFENAK 50 MG TABLET TABLET 0 0 0
128
MG/ML 10 ML
AMPUL 0 0 0
129
MG
TABLET 0 0 0
130 KANTONG URINE DEWASA PCS 0 0 0
131 KAPAS PEMBALUT/ABSORBEN 250 GR BKS 0 0 0
132 KAPTOPRIL TABLET 25 MG TABLET 0 0 0
133 KARBAMAZEPIN TABLET 200 MG TABLET 0 0 0
134 KASA KOMPRES 40/40 STERIL BKS 0 0 0

135
STRIL
ROL 0 0 0
136
CM
ROL 0 0 0
137
CM
ROL 0 0 0
138
CM
ROL 0 0 0
139
DIRESAPI FRAMISETIN
PCS 0 0 0
140 KETOKONAZOLE TABLET 200 MG TABLET 0 0 0
141 KLINDAMISIN KAPSUL 150 MG TABLET 0 0 0
142 KLINDAMISIN KAPSUL 300 MG KAPSUL 0 0 0
143 KLOBAZAM 10 MG TABLET TABLET 0 0 0
144 KLORAMFENIKOL KAPSUL 500 MG KAPSUL 0 0 0
145 KLORAMFENIKOL SALEP KULIT 2 % TUBE 0 0 0
146 KLORAMFENIKOL SALEP MATA 1 % TUBE 0 0 0

147
ML
BOTOL 0 0 0
148 KLORAMFENIKOL TETES TELINGA 3 % BOTOL 0 0 0

149
TABLET 4 MG
TABLET 0 0 0
150
MG/ML 1 ML
AMPUL 0 0 0
151
MG/ML 1 ML
AMPUL 0 0 0
152 KLORPROMAZIN HCL TABLET 100 MG TABLET 0 0 0
153 KLOZAPIN 100 MG TABLET TABLET 0 0 0
155 KODEIN HCL TABLET 10 MG TABLET 0 0 0
156 KOTRIMOKSAZOL DEWASA TABLET TABLET 0 0 0
157 KOTRIMOKSAZOL SUSPENSI 60 ML BOTOL 0 0 0
158 LEVOFLOXACIN TABLET 500 MG TABLET 0 0 0
159 LIDOCAIN 2% INJ AMPUL 0 0 0

160
ML
AMPUL 0 0 0
161 LISOL CONCENTRATE 1000 ML BOTOL 0 0 0
162 LOPERAMIDE TABLET 2 MG TABLET 0 0 0
163 LORATADIN TABLET 10 MG TABLET 0 0 0
164 LORAZEPAM 2 MG TABLET 0 0 0

165
% 25 ML
AMPUL 0 0 0
166 MASKER EARLOOP PLUS PCS 0 0 0
167 MASKER KERTAS 3 PLY EAR LOOP PCS 0 0 0
168 MASKER KERTAS 3 PLY TIE ON PCS 0 0 0
169 MASKER N95 PCS 0 0 0

170
MG/2ML
AMPUL 0 0 0
171 METFORMIN TABLET 500 MG TABLET 0 0 0
172
0,200 MG 1 ML
AMPUL 0 0 0
173
0,125 MG
TABLET 0 0 0
174 METILPREDNISOLON TABLET 4 MG TABLET 0 0 0
175 METOKLOPRAMIDE 10 MG TABLET TABLET 0 0 0

177
AMPUL 0 0 0
178 METOKLOPROMIDE SIRUP BOTOL 0 0 0

179
(PROVAGIN) OVULA
VIAL 0 0 0
180 METRONIDAZOL TABLET 250 MG TABLET 0 0 0

182
100 ML
BOTOL 0 0 0
183 MIKONAZOL KREAM 10 GR TUBE 0 0 0

184
MG
TABLET 0 0 0
185
MG
TABLET 0 0 0
186
STERIL
BOTOL 0 0 0
187 NIFEDIPINE TABLET 10 MG TABLET 0 0 0
188 NISTATIN TABLET 500.000 UI TABLET 0 0 0
189 NISTATIN VAGINAL TABLET 100.000 UI VAGTAB 0 0 0

190
100 ML
BOTOL 0 0 0
191 OKSIGEN NASAL CANNULA ADULT PCS 0 0 0
192 OKSIGEN NASAL CANNULA INFANT PCS 0 0 0

193
GR
TUBE 0 0 0
194
3,5 GR
TUBE 0 0 0
195 OKSITOSIN INJEKSI 10 IU/ML 1 ML AMPUL 0 0 0
196 OMEPRAZOLE TABLET 20 MG KAPSUL 0 0 0
197 ONDANSENTRON 4 MG/2 ML INJEKSI AMPUL 0 0 0

198
60 ML
BOTOL 0 0 0
199 PARACETAMOL TABLET 500 MG TABLET 0 0 0

200
ML
BOTOL 0 0 0
201 PEHAVRAL TABLET TABLET 0 0 0
202 PERAK SULFADIAZIN KRIM 1 % TUBE 0 0 0
203 PERHYDROL [ H2O2 ] 3 % 800 ML BOTOL 0 0 0
204 PERMETHRINE 5% CR 15 GRAM TUBE 0 0 0
205 PIRACETAM TABLET 800 MG TABLET 0 0 0
206 PIRANTEL PAMOAT TABLET TABLET 0 0 0

207
MG
TABLET 0 0 0
208 PIROKSIKAM KAPSUL 10 MG KAPSUL 0 0 0
209 PLESTER 10 CM X 2 M ROL 0 0 0
210 PREDNISON TABLET 5 MG TABLET 0 0 0
211 PROPRANOLOL HCL TABLET 40 MG TABLET 0 0 0
212 RANITIDIN INJEKSI 25 MG/ ML AMPUL 0 0 0
213 RISPERIDON 2 MG TABLET TABLET 0 0 0

214
STERIL
BOTOL 0 0 0
215 SALBUTAMOL TABLET 2 MG TABLET 0 0 0
217 SALEP 2-4 KOMBINASI 30 GR POT 0 0 0
218 SALICYL BEDAK 2 % KOTAK 0 0 0
219 SARUNG TANGAM NON STERIL L PCS 0 0 0
220 SARUNG TANGAN NON STERIL M PCS 0 0 0
221 SARUNG TANGAN NON STERIL S PCS 0 0 0
222 SARUNG TANGAN STERIL NO 6 PSG 0 0 0
223 SARUNG TANGAN STERIL NO. 7,5 PSG 0 0 0
224 SARUNG TANGAN STERILE NO.6,5 PSG 0 0 0
225 SARUNG TANGAN STERILE NO.7 PSG 0 0 0
226 SEFADROKSIL KAPSUL 500 MG KAPSUL 0 0 0

227
INJ.5 ML (ABU I)
VIAL 0 0 0
228
IU/AMP (ATS)
VIAL 0 0 0
229 SETIRIZINE TABLET 10 MG TABLET 0 0 0

230
500 MCG/ML 1 ML
AMPUL 0 0 0
231
50 MCG
TABLET 0 0 0
232
NO.3/0
PCS 0 0 0
233 SIMVASTATIN TABLET 10 MG TABLET 0 0 0
234 SIPROFLOXACIN INFUS 2% BOTOL 0 0 0
235 SIPROFLOXACIN TABLET 500 MG TABLET 0 0 0
236 SPONS GELATIN CUBICLES 1x1x1 CM PCS 0 0 0

237
MATA 15 % 5 ML
BOTOL 0 0 0
238
PCS 0 0 0
239 TETRAKAIN HCL TETES MATA 5 ML BOTOL 0 0 0
240 TETRASIKLIN HCL TABLET 500 MG KAPSUL 0 0 0

241
TABLET 50 MG
TABLET 0 0 0
242
INJECTION
PCS 0 0 0
243 TRIFLOUPERASIN TABLET 5 MG TABLET 0 0 0

244
TABLET 2 MG
TABLET 0 0 0
245 VITAMIN B COMPLEX TABLET TABLET 0 0 0

246
ML
BOTOL 0 0 0
247
ML
BOTOL 0 0 0
248
PSEUDOEPHEDRINE)
TABLET 0 0 0
249 ZINK 20 MG TABLET TABLET 0 0 0
250 ALPARA TABLET TABLET 0 0 0
251 ALPARA SYRUP BOTOL 0 0 0
252 CURLYSINE SIRUP BOTOL 0 0 0
253 BUFACOMB CREAM TUBE 0 0 0
254 SARUNG TANGAN STERIL S PCS 0 0 0
255 SARUNG TANGAN STERIL M PCS 0 0 0
256 SARUNG TANGAN STERIL L PCS 0 0 0
257 SUPRAFENID SUPP BOTOL 0 0 0
258 FASFIT D 1000 IU TABLET 0 0 0

259 POLIFIX PLESTER PCS 0 0 0
260 LEUKOPLAST PLESTER PCS 0 0 0
261 LISINOPRIL 5 MG TABLET 0 0 0
262 HERBA ASIMOR BOX 0 0 0
263 LYTACUR SYRUP 60 ML BOTOL 0 0 0

HIOPAR (HYOSCINE-N-
264 BUTILBROMIDE 10 MG, BOX 0 0 0
PARACETAMOL 500 MG)
265 TRIPROLIDINE HCL 30 MG, BOX 0 0 0
PARACETAMOL 500 MG)
266 IMIBOND F (ZINC PHOSPHATE) BOX 0 0 0
267 NOVA COMPO C BOX 0 0 0
268 NOVA COMPO B PLUS BOX 0 0 0
269 PARAMONOCLOROFENOL BOX 0 0 0
270 TRICRESOLFORMALINA BOX 0 0 0
271 ATTAQUE GEL PCS 0 0 0
272 XIMEX (OPTIXITROL) BOTOL 0 0 0
273 RANITIDIN TABLET 150 MG TABLET 0 0 0

274 PYRIDOXIBE 100 MG, TABLET 0 0 0
275 ZINC SYRUP 20 MG/5MG BOTOL 0 0 0
276
NO.2/0
PCS 0 0 0
1 KESWA-AMITRIPTYLINE 25 MG TABLET 0 0 0
2 KESWA-DIAZEPAM 5 MG TABLET 0 0 0
3 KESWA-DIAZEPAM INJEKSI 5 MG/2ML AMPUL 0 0 0

4 KESWA-SIKZONOAT 25 MG AMPUL 0 0 0
5 KESWA-HALOPERIDOL 5 MG TABLET 0 0 0
6 KESWA-HALDOL DECANOAT INJEKSI AMPUL 0 0 0
7 KESWA-CLOZAPIN 25 MG TABLET 0 0 0
8 KESWA-RISPERIDON 2 MG TABLET 0 0 0
9 KESWA-TRIFLUOPERAZINE 5 MG TABLET 0 0 0
10 KESWA TRIHEKSIPHENIDIL 2 MG TABLET 0 0 0
11 DBD-SD BIOLINE CHIKUNGUNYA IgM TEST 0 0 0

12
(IgG\/IgM dan NS1)
TEST 0 0 0
13 DBD-ABATE POWDER 1 KG KG 0 0 0
14 DBD-ABATE POWDER SACHET SACHET 0 0 0
15 DIARE-ORALIT SERBUK SACHET 0 0 0
16 DIARE-ZINC TABLET 20 MG TABLET 0 0 0

17
400 MG
TABLET 0 0 0
18
MG/5ML
BOTOL 0 0 0
19
100.000 IU
KAPSUL 0 0 0
20
200.000 IU
KAPSUL 0 0 0
21 GIZI-MINERAL MIX SACHET 0 0 0
22 GIZI-TABLET TAMBAH DARAH TABLET 0 0 0
23 HEPATITIS-VIROCHECK HBsAG TEST 0 0 0

24
INJEKSI (HBIg)
SYRINGE 0 0 0
25 HEPATITIS-ANTI HBs HEPATITIS B TEST 0 0 0

26 HEPATITIS-STARTES HCV TEST 0 0 0
27 HIV-ABACAVIR TABLET 300 MG BOTOL 0 0 0
28 HIV-AQUAGEL LUBRICATING JELLY SACHET 0 0 0

29
INJEKSI 2.4 UI/ML
VIAL 0 0 0
30
MG
TABLET 0 0 0
31
TEST 0 0 0
32
TEST 0 0 0
33 HIV-DOLUTEGRAVIR CAPLET 50 MG BOTOL 0 0 0

34 LAMIFUDINE 300 MG; TENOFOVIR 300 BOTOL 0 0 0
MG (TLD)
35 HIV-EVAFIRENZ TABLET 600 MG BOTOL 0 0 0
36 HIV-FASTCLEAR Q HIV 1/2 TRI-LINE TEST 0 0 0
37
COMBO TEST
TEST 0 0 0
38 (1+2) ANTIBODY COLLOIDAL GOLD V2 TEST 0 0 0
RAPID TEST
39 HIV-KONDOM SIMPLEX BOX@144 PIECES 0 0 0
40 HIV-KONDOM SUTRA ISI 12 PIECES 0 0 0
41 HIV-LAMIVUDINE TABLET 100 MG BOTOL 0 0 0
43 HIV-NEVIRAPINE 200 MG BOTOL 0 0 0

44
HIV 1/2 TEST
TEST 0 0 0
45
TEST
TEST 0 0 0
46 HIV-TENOFOVIR TABLET 300 MG BOTOL 0 0 0

47 LAMIVUDINE 300 MG; EVAFIRENS 600 BOTOL 0 0 0
MG (TLE)
48 HIV-TREPOCHECK SYPHILLIS TEST TEST 0 0 0
49 HIV-VIROCHECK HIV 1/2 TEST TEST 0 0 0

50
LAMIVUDINE 150 MG
BOTOL 0 0 0
51 HIV-ZIDOVUDINE TABLET 150 MG BOTOL 0 0 0
52 HIV-FOKUS RPR ANTIGEN TEST TEST 0 0 0
53 IMUN-VAKSIN POLIO (BOPV) VIAL 0 0 0

54
Hib)
VIAL 0 0 0
55 IMUN-VAKSIN PCV (PREVENAR) VIAL 0 0 0
56 IMUN-VAKSIN ROTAVIRUS (ROTAVAC) VIAL 0 0 0
57 IMUN-VAKSIN BCG VIAL 0 0 0
58 IMUN-VAKSIN HEPATITIS B VIAL 0 0 0
59 IMUN-VAKSIN IPV CAIRAN INJEKSI VIAL 0 0 0

60 IMUN-VAKSIN JERAP DT VIAL 0 0 0
61 IMUN-VAKSIN JERAP Td VIAL 0 0 0
62 IMUN-VAKSIN MEASLES RUBELLA VIAL 0 0 0

63
SYRINGE 0,05 ML
SYRINGE 0 0 0
64
SYRINGE 0,5 ML
SYRINGE 0 0 0
65
SYRINGE 0,3 ML
SYRINGE 0 0 0
66
SYRINGE 3 ML
SYRINGE 0 0 0
67
SYRINGE 5 ML
SYRINGE 0 0 0
68
LITER
PIECES 0 0 0
69 IMUN-ALCOHOL SWAB PIECES 0 0 0

70 KIA-AMPICILLIN SERBUK INJEKSI 1 G VIAL 0 0 0
71 KIA-CA GLUCONAS INJEKSI 10 ML AMPUL 0 0 0

72
INJEKSI 40 MG
AMPUL 0 0 0
73
INJEKSI 40%
AMPUL 0 0 0
74
INJEKSI 20%
AMPUL 0 0 0
75
MG/ML
BOTOL 0 0 0
76
2 MG/ML
AMPUL 0 0 0
77 KIA-DIAZEPAM INJEKSI 5 MG/2ML AMPUL 0 0 0

78
MG/ML
AMPUL 0 0 0
79 KIA-OXYTETRACYCLINE SALEP MATA TUBE 0 0 0
80 KUSTA-MDT MB ADULT (RED) BLISTER 0 0 0
81 KUSTA-MDA PB ADULT (GREEN) BLISTER 0 0 0
82 KUSTA-MDT MB CHILD (ORANGE) BLISTER 0 0 0
83 KUSTA-TREPOCHECK SIPHILIS TEST 0 0 0
84 MALARIA-DHP FRIMAL TABLET 0 0 0
85 MALARIA-PRIMAQUIN TABLET 15 MG TABLET 0 0 0
86 TBC-ISONIAZID TABLET 100 MG TABLET 0 0 0
88 TBC-ETHAMBUTOL TABLET 100 MG TABLET 0 0 0

90
RHZE 150/75/400/275 + RH 150/75
PAKET 0 0 0
91
RHZE 150/75/400/175 + RH 150/150
PAKET 0 0 0
92
75/50/150 + RH 75/50
PAKET 0 0 0
93 TBC-LEVOFLOXACIN 100 MG TABLET 0 0 0
94 TBC-PIRAZINAMIDE 500 MG TABLET 0 0 0
95 TBC-RIFAMPICIN 600 MG TABLET 0 0 0
96 TBC-RIFTIN RIFAPENTIN 150 MG TABLET 0 0 0

97
300/300
PAKET 0 0 0
98 TBC-3HR ISONIAZID RIFAMPISIN 50/75 PAKET 0 0 0
99 TBC-PIRIDOKSIN VITAMIN B6 25 MG TABLET 0 0 0
100 TBC-TUBERCULIN PPD RT 23 SSI VIAL 0 0 0
101 TBC-REAGEN ZIEHL NEELSEN PAKET 0 0 0
102 TBC-POT SPUTUM POT 0 0 0
103 TBC-KACA SLIDE PIECES 0 0 0
104 TBC-MASKER BEDAH PROGRAM TB PIECES 0 0 0
105 TBC-MASKER N95 WEGEN PIECES 0 0 0
106 TBC-MASKER N95 AERO PIECES 0 0 0
107 TBC-MASKER N95 DREAMCAN PIECES 0 0 0

108
CATRIDGE
PIECES 0 0 0
109
PROTEIN
SACHET 0 0 0
110 SURVEILEN-ANTI DIFTERI SERUM VIAL 0 0 0
111 SURVEILEN-VAKSIN MENINGITIS VIAL 0 0 0
112 PTM-STIK GULA DARAH PIECES 0 0 0
113 PTM-STIK CHOLESTEROL PIECES 0 0 0
114 PTM-STIK ASAM URAT PIECES 0 0 0

115 PTM-VAGINAL SPECULUM UKURAN S PIECES 0 0 0
116 PTM-VAGINAL SPECULUM UKURAN M PIECES 0 0 0
117 PTM-VAGINAL SPECULUM UKURAN L PIECES 0 0 0

118
STEP RAPID TEST
TEST 0 0 0
119 PTM-ALCOHOL SWAB PIECES 0 0 0
120 PTM-BLOOD LANCET PIECES 0 0 0
121 PTM-PROLINE TRIGLISERIDE REAGEN BOTOL 0 0 0

122
REAGEN
BOTOL 0 0 0
123 PTM-SARUNG TANGAN STERIL 6.5 PASANG 0 0 0
124 PTM-SARUNG TANGAN STERIL 7 PASANG 0 0 0

126
DRUG 7 IN 1
TEST 0 0 0
127 PTM-ACON URINALYSIS STRIP BOTOL 0 0 0
128 PTM-KERTAS EKG 110 X 30 mm ROLL 0 0 0
131 PTM-MOUTH PIECES PIECES 0 0 0
132 PTM-D-PIECES PIECES 0 0 0
133 PTM-SPUIT 5 ML SYRINGE 0 0 0
134 PTM-STOOL CONTAINER POT 0 0 0
135 PTM-COTTON SWAB PIECES 0 0 0

136
CHOLESTEROL
PIECES 0 0 0
137
HEMOGLOBIN
PIECES 0 0 0
138 KESGA-ALCOHOL SWAB PIECES 0 0 0
139 KESGA-LANCET PIECES 0 0 0
OBAT TAMBAHAN
1 ALLOPURINOL (BLUD) TABLET 0 0 0
2 AMBROXOL TABLET 30 MG (BLUD) TABLET 0 0 0
3 AMLODIPINE 5MG (BLUD) TABLET 0 0 0
4 AMLODIPINE 10 MG (BLUD) TABLET 0 0 0
5 ANTASIDA DOEN TABLET KOMBINASI (BL TABLET 0 0 0
6 ANTIHEMOROID/BORRAGINOL (BLUD) TABLET 0 0 0
7 AQUA PRO INJEKSI (BLUD) PIECES 0 0 0
8 ASAM MEFENAMAT TABLET 500 MG (BLU TABLET 0 0 0
9 ASAM TRANEKSAMAT (BLUD) TABLET 0 0 0
10 ASETILSISTEIN (BLUD) KAPSUL 0 0 0
11 ASETOSAL TABLET 100 (80) MG (BLUD) TABLET 0 0 0
12 ASIKLOVIR SALEP KULIT (BLUD) TUBE 0 0 0
13 ASIKLOVIR TABLET (BLUD) TABLET 0 0 0
14 BATUK FLU SIRUP/ ETAFLUSIN (BLUD) SIRUP 0 0 0
15 BATUK FLU TABLET/ETAFLUSIN (BLUD) TABLET 0 0 0
16 BEDAK SALISIL (BLUD) SACHET 0 0 0
17 BETADINE GARGLE (BLUD) BOTOL 0 0 0
18 BETAHISTIN TABLET (BLUD) TABLET 0 0 0
19 BETAMETHASONE SALEP KULIT (BLUD) TUBE 0 0 0

OBAT TAMBAHAN
20 BIOPLACENTON (BLUD) TUBE 0 0 0
21 BISAKODIL TABLET 5 MG (BLUD) TABLET 0 0 0
22 BUFACOMB SALEP (BLUD) TUBE 0 0 0
23 BUFACORT - N (BLUD) TUBE 0 0 0
24 CIPROFLOXACIN (BLUD) TABLET 0 0 0
25 CLINDAMISIN KAPS (BLUD) KAPSUL 0 0 0
26 CTM (BLUD) TABLET 0 0 0
27 DARYANTULLE (BLUD) PIECES 0 0 0
28 DEKSAMETHASONE TABLET 0,5 MG ((BLUDTABLET 0 0 0
29 DIMENHIDRINATE (BLUD) TABLET 0 0 0
30 DOMPERIDONE TABLET 10 MG ( (BLUD)) TABLET 0 0 0
31 DUK LUBANG PIECES 0 0 0
32 EPINEFRIN INJEKSI (BLUD) AMPUL 0 0 0
33 ETIL KLORIDA SPRAY (BLUD) BOTOL 0 0 0
35 FITOMENADION INJ (BLUD) AMPUL 0 0 0
36 FITOMENADION TABLET (BLUD) TABLET 0 0 0
37 FUROSEMIDE TABLET (BLUD) TABLET 0 0 0
38 GEMFIBROZIL (BLUD) KAPSUL 0 0 0
39 GENTAMICIN TETES MATA (BLUD) FLASK 0 0 0
40 GENTAMISIN SALEP KULIT /GENOINT (BL TUBE 0 0 0
41 GENTIAN VIOLET LARUTAN 1 % (BLUD) BOTOL 0 0 0
42 GLIBENCLAMIDE TABLET 5 MG (BLUD) TABLET 0 0 0

43 GLIMEPIRID 1 MG (BLUD) TABLET 0 0 0
44 GLIMEPIRIDE 2 MG TABLET (BLUD) TABLET 0 0 0
45 GLISERIL GUAIKOLAT/GUAIFENESIN BLU TABLET 0 0 0
46 GLUKOSA INFUS (BLUD) FLASK 0 0 0
48 HIDROKORTISON CREAM KULIT (BLUD) TUBE 0 0 0
49 HYOSCINE BUTYLBROMIDE (ANTI SPASM TABLET 0 0 0
50 HYPAFIX (BLUD) PIECES 0 0 0
51 IBUPROFEN 4OO MG (TABLET) TABLET 0 0 0
52 ISDN (BLUD) TABLET 0 0 0
53 KAOLIN PEKTIN SIRUP (NOVADIAR) BOTOL 0 0 0
54 KAPTOPRIL TABLET 12,5 MG (BLUD) TABLET 0 0 0
55 KAPTOPRIL TABLET 25 MG (BLUD) TABLET 0 0 0
56 KASSA STERIL 16X16 (BLUD) KOTAK 0 0 0
57 KETOKONAZOLE TABLET 200MG (BLUD) TABLET 0 0 0
58 KLORAMFENIKOL SIRUP (BLUD) BOTOL 0 0 0
59 KLORAMFENIKOL TETES TELINGA (BLUD) BOTOL 0 0 0
60 KOTRIMOKSAZOL TAB (BLUD) TABLET 0 0 0
61 LOPERAMIDE TABLET 2 MG (BLUD) TABLET 0 0 0
62 LORATADINE (BLUD) TABLET 0 0 0
63 METFORMIN (BLUD) TABLET 0 0 0
64 METILERGOMETRINE INJ (BLUD) AMPUL 0 0 0
65 METILPREDNISOLON TABLET 4 MG (BLUD TABLET 0 0 0

66 METRONIDAZOL (BLUD) TABLET 0 0 0
67 MULTIVITAMIN KOMBINASI TABLET (BLUD TABLET 0 0 0
68 MULTIVITAMIN KOMBINASI SIRUP (BLUD) BOTOL 0 0 0
69 NATRIUM DIKLOFENAK 25/50 MG (BLUD) TABLET 0 0 0
70 NEW DIATABS (BLUD) TABLET 0 0 0
71 NIFEDIPINE TAB (BLUD) TABLET 0 0 0
72 OKSITETRASIKLIN SALEP KULIT (BLUD) TUBE 0 0 0
73 OMEPRAZOLE 20MG (BLUD) KAPSUL 0 0 0
74 ONDANSETRONE INJEKSI (BLUD) AMPUL 0 0 0
75 PARACETAMOL TABLET 500 MG (BLUD) TABLET 0 0 0
76 PIRACETAM KAPSUL (BLUD) TABLET 0 0 0
77 PIROXICAM (BLUD) TABLET 0 0 0
78 POVIDONE IODINE 60ML (BLUD) BOTOL 0 0 0
79 RANITIDIN TABLET (BLUD) TABLET 0 0 0
80 SALBUTAMOL TABLET 2 MG (BLUD) TABLET 0 0 0
81 SEFADROKSIL KAPSUL 500 MG (BLUD) KAPSUL 0 0 0
82 SETERIZIN TABLET (BLUD) TABLET 0 0 0
83 SIMVASTATIN 10MG (BLUD) TABLET 0 0 0
84 TIAMFENIKOL KAPSUL (BLUD) KAPSUL 0 0 0
85 VGEL (BLUD) TUBE 0 0 0
86 VITAMIN B KOMPLEKS (BLUD) TABLET 0 0 0
87 VITAMIN B1/THIAMIN (BLUD) TABLET 0 0 0

88 VITAMIN B6/PIRIDOKSIN HCL10 MG (BLUD TABLET 0 0 0
89 VITAMIN C/ASAM ASKORBAT 50 MG (BLUD TABLET 0 0 0
90 ZINK SIRUP (PROGRAM) BOTOL 0 0 0
91 ZIVIT ZINC (PROGRAM) TABLET 0 0 0
92 0 0 0 0
93 0 0 0 0
94 0 0 0 0
95 0 0 0 0
96 0 0 0 0
97 0 0 0 0
98 0 0 0 0
99 0 0 0 0
100 0 0 0 0
Blitar ,
0 Instalasi Farmasi Kabupaten Instalasi Farmasi Kabupaten Puskesmas
NIP. 19691230 201001 2 002 NIP : 19880803 201502 1 001 NIP : 19910317 202012 1 012 NIP. 19861218 201903 2 004
Yang Menyerahkan,
Petugas Pengelola Obat
Puskesmas
AINA MUJTAHIDA A S.Farm., Apt

19861218 201903 2 004
KODE : PELAPORAN BULAN : FEBRUARI 2024 DOKUMEN NOMOR DOKUMEN TANGGAL
PUSKESMAS : PERMINTAAN BULAN : MARET 2024
UPT IFK
KECAMATAN :
KABUPATEN : BLITAR
PUSKESMAS
SISA STOK JUMLAH

GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

15
10 ML
AMPUL 0 0 0

TANGGAL
PEMBERIAN
12

19
ML 60 ML
BOTOL 0 0 0
20
MG
VIAL 0 0 0

22
250MG/5ML
BOTOL 0 0 0
23
MG/VIAL
VIAL 0 0 0
24
(METAMIZOL)
TABLET 0 0 0

27
KOMBINASI 5 GR
POT 0 0 0
28
30 GR
POT 0 0 0

30
KOMBINASI
TABLET 0 0 0
31
(DORMICOMP)
TABLET 0 0 0
32
PIROGEN 20 ML
BOTOL 0 0 0
33
MG
TABLET 0 0 0

36
INJEKSI
AMPUL 0 0 0

38
DEPAKOTE ER
TABLET 0 0 0

45
MG/ML 1 ML
AMPUL 0 0 0

52
(CONCOR)
TABLET 0 0 0

59
MG/ML 1 ML
AMPUL 0 0 0


63
2,5ML-STESOLID
TUBE 0 0 0

66
MG/ML 1 ML
AMPUL 0 0 0

72
SALEP 15 GR
TUBE 0 0 0
73
1 ML
AMPUL 0 0 0

75
MG/5ML
BOTOL 0 0 0

77
300 ML
BOTOL 0 0 0

82
ML
AMPUL 0 0 0
84
% 5 ML
BOTOL 0 0 0
85
MG/ML 1 ML
AMPUL 0 0 0
86
SALUT 10 MG
TABLET 0 0 0
87
2MG/ML
AMPUL 0 0 0
88
25 MG 1 ML
AMPUL 0 0 0

97
MG
TABLET 0 0 0

100
VIAL 0 0 0
101
STERIL
BOTOL 0 0 0
102
STERIL
BOTOL 0 0 0

106
(LODOMER)
AMPUL 0 0 0

110
BOTOL 0 0 0

114
PORT
PCS 0 0 0
115
PORT
PCS 0 0 0
116
INJECTION PORT
PCS 0 0 0
117
INJECTION PORT
PCS 0 0 0
118
INJECTION PORT
PCS 0 0 0
119
INJECTION PORT
PCS 0 0 0
120
200MG/5ML
BOTOL 0 0 0
121
60 ML
BOTOL 0 0 0

125
5 MG
TABLET 0 0 0

128
MG/ML 10 ML
AMPUL 0 0 0
129
MG
TABLET 0 0 0

135
STRIL
ROL 0 0 0
136
CM
ROL 0 0 0
137
CM
ROL 0 0 0
138
CM
ROL 0 0 0
139
DIRESAPI FRAMISETIN
PCS 0 0 0

147
ML
BOTOL 0 0 0

149
TABLET 4 MG
TABLET 0 0 0
150
MG/ML 1 ML
AMPUL 0 0 0
151
MG/ML 1 ML
AMPUL 0 0 0

160
ML
AMPUL 0 0 0

165
% 25 ML
AMPUL 0 0 0

170
MG/2ML
AMPUL 0 0 0
172
0,200 MG 1 ML
AMPUL 0 0 0
173
0,125 MG
TABLET 0 0 0

177
AMPUL 0 0 0

179
(PROVAGIN) OVULA
VIAL 0 0 0

182
100 ML
BOTOL 0 0 0

184
MG
TABLET 0 0 0
185
MG
TABLET 0 0 0
186
STERIL
BOTOL 0 0 0

190
100 ML
BOTOL 0 0 0

193
GR
TUBE 0 0 0
194
3,5 GR
TUBE 0 0 0

198
60 ML
BOTOL 0 0 0

200
ML
BOTOL 0 0 0

207
MG
TABLET 0 0 0

214
STERIL
BOTOL 0 0 0

227
INJ.5 ML (ABU I)
VIAL 0 0 0
228
IU/AMP (ATS)
VIAL 0 0 0

230
500 MCG/ML 1 ML
AMPUL 0 0 0
231
50 MCG
TABLET 0 0 0
232
NO.3/0
PCS 0 0 0

237
MATA 15 % 5 ML
BOTOL 0 0 0
238
PCS 0 0 0

241
TABLET 50 MG
TABLET 0 0 0
242
INJECTION
PCS 0 0 0

244
TABLET 2 MG
TABLET 0 0 0

246
ML
BOTOL 0 0 0
247
ML
BOTOL 0 0 0
248
PSEUDOEPHEDRINE)
TABLET 0 0 0


HIOPAR (HYOSCINE-N-
PARACETAMOL 500 MG)
PARACETAMOL 500 MG)

276
NO.2/0
PCS 0 0 0


12
(IgG\/IgM dan NS1)
TEST 0 0 0

17
400 MG
TABLET 0 0 0
18
MG/5ML
BOTOL 0 0 0
19
100.000 IU
KAPSUL 0 0 0
20
200.000 IU
KAPSUL 0 0 0

24
INJEKSI (HBIg)
SYRINGE 0 0 0


29
INJEKSI 2.4 UI/ML
VIAL 0 0 0
30
MG
TABLET 0 0 0
31
TEST 0 0 0
32
TEST 0 0 0

MG (TLD)
37
COMBO TEST
TEST 0 0 0
RAPID TEST

44
HIV 1/2 TEST
TEST 0 0 0
45
TEST
TEST 0 0 0

MG (TLE)

50
LAMIVUDINE 150 MG
BOTOL 0 0 0

54
Hib)
VIAL 0 0 0


63
SYRINGE 0,05 ML
SYRINGE 0 0 0
64
SYRINGE 0,5 ML
SYRINGE 0 0 0
65
SYRINGE 0,3 ML
SYRINGE 0 0 0
66
SYRINGE 3 ML
SYRINGE 0 0 0
67
SYRINGE 5 ML
SYRINGE 0 0 0
68
LITER
PIECES 0 0 0


72
INJEKSI 40 MG
AMPUL 0 0 0
73
INJEKSI 40%
AMPUL 0 0 0
74
INJEKSI 20%
AMPUL 0 0 0
75
MG/ML
BOTOL 0 0 0
76
2 MG/ML
AMPUL 0 0 0

78
MG/ML
AMPUL 0 0 0

90
RHZE 150/75/400/275 + RH 150/75
PAKET 0 0 0
91
RHZE 150/75/400/175 + RH 150/150
PAKET 0 0 0
92
75/50/150 + RH 75/50
PAKET 0 0 0

97
300/300
PAKET 0 0 0

108
CATRIDGE
PIECES 0 0 0

109
PROTEIN
SACHET 0 0 0


118
STEP RAPID TEST
TEST 0 0 0
122
REAGEN
BOTOL 0 0 0

126
DRUG 7 IN 1
TEST 0 0 0

136
CHOLESTEROL
PIECES 0 0 0
137
HEMOGLOBIN
PIECES 0 0 0

OBAT TAMBAHAN

OBAT TAMBAHAN



92 0 0 0 0
93 0 0 0 0
94 0 0 0 0
95 0 0 0 0
96 0 0 0 0
97 0 0 0 0
98 0 0 0 0
99 0 0 0 0
100 0 0 0 0
Blitar ,
Yang Menyerahkan,
Puskesmas
NIP. 19691230 201001 2 002 NIP : 19880803 201502 1 001 NIP : 19910317 202012 1 012 NIP. 19861218 201903 2 004
19861218 201903 2 004
KODE : PELAPORAN BULAN : MARET 2024 DOKUMEN NOMOR DOKUMEN TANGGAL
PUSKESMAS : PERMINTAAN BULAN : Apr-24
UPT IFK
KECAMATAN :
KABUPATEN : BLITAR
PUSKESMAS
SISA STOK JUMLAH

GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

15
10 ML
AMPUL 0 0 0

TANGGAL
PEMBERIAN
12

19
ML 60 ML
BOTOL 0 0 0
20
MG
VIAL 0 0 0

22
250MG/5ML
BOTOL 0 0 0
23
MG/VIAL
VIAL 0 0 0
24
(METAMIZOL)
TABLET 0 0 0

27
KOMBINASI 5 GR
POT 0 0 0
28
30 GR
POT 0 0 0

30
KOMBINASI
TABLET 0 0 0
31
(DORMICOMP)
TABLET 0 0 0
32
PIROGEN 20 ML
BOTOL 0 0 0
33
MG
TABLET 0 0 0

36
INJEKSI
AMPUL 0 0 0

38
DEPAKOTE ER
TABLET 0 0 0

45
MG/ML 1 ML
AMPUL 0 0 0

52
(CONCOR)
TABLET 0 0 0

59
MG/ML 1 ML
AMPUL 0 0 0


63
2,5ML-STESOLID
TUBE 0 0 0

66
MG/ML 1 ML
AMPUL 0 0 0

72
SALEP 15 GR
TUBE 0 0 0
73
1 ML
AMPUL 0 0 0

75
MG/5ML
BOTOL 0 0 0

77
300 ML
BOTOL 0 0 0

82
ML
AMPUL 0 0 0
84
% 5 ML
BOTOL 0 0 0
85
MG/ML 1 ML
AMPUL 0 0 0
86
SALUT 10 MG
TABLET 0 0 0
87
2MG/ML
AMPUL 0 0 0
88
25 MG 1 ML
AMPUL 0 0 0

97
MG
TABLET 0 0 0

100
VIAL 0 0 0
101
STERIL
BOTOL 0 0 0
102
STERIL
BOTOL 0 0 0

106
(LODOMER)
AMPUL 0 0 0

110
BOTOL 0 0 0

114
PORT
PCS 0 0 0
115
PORT
PCS 0 0 0
116
INJECTION PORT
PCS 0 0 0
117
INJECTION PORT
PCS 0 0 0
118
INJECTION PORT
PCS 0 0 0
119
INJECTION PORT
PCS 0 0 0
120
200MG/5ML
BOTOL 0 0 0
121
60 ML
BOTOL 0 0 0

125
5 MG
TABLET 0 0 0

128
MG/ML 10 ML
AMPUL 0 0 0
129
MG
TABLET 0 0 0

135
STRIL
ROL 0 0 0
136
CM
ROL 0 0 0
137
CM
ROL 0 0 0
138
CM
ROL 0 0 0
139
DIRESAPI FRAMISETIN
PCS 0 0 0

147
ML
BOTOL 0 0 0

149
TABLET 4 MG
TABLET 0 0 0
150
MG/ML 1 ML
AMPUL 0 0 0
151
MG/ML 1 ML
AMPUL 0 0 0

160
ML
AMPUL 0 0 0

165
% 25 ML
AMPUL 0 0 0

170
MG/2ML
AMPUL 0 0 0
172
0,200 MG 1 ML
AMPUL 0 0 0
173
0,125 MG
TABLET 0 0 0

177
AMPUL 0 0 0

179
(PROVAGIN) OVULA
VIAL 0 0 0

182
100 ML
BOTOL 0 0 0

184
MG
TABLET 0 0 0
185
MG
TABLET 0 0 0
186
STERIL
BOTOL 0 0 0

190
100 ML
BOTOL 0 0 0

193
GR
TUBE 0 0 0
194
3,5 GR
TUBE 0 0 0

198
60 ML
BOTOL 0 0 0

200
ML
BOTOL 0 0 0

207
MG
TABLET 0 0 0

214
STERIL
BOTOL 0 0 0

227
INJ.5 ML (ABU I)
VIAL 0 0 0
228
IU/AMP (ATS)
VIAL 0 0 0

230
500 MCG/ML 1 ML
AMPUL 0 0 0
231
50 MCG
TABLET 0 0 0
232
NO.3/0
PCS 0 0 0

237
MATA 15 % 5 ML
BOTOL 0 0 0
238
PCS 0 0 0

241
TABLET 50 MG
TABLET 0 0 0
242
INJECTION
PCS 0 0 0

244
TABLET 2 MG
TABLET 0 0 0

246
ML
BOTOL 0 0 0
247
ML
BOTOL 0 0 0
248
PSEUDOEPHEDRINE)
TABLET 0 0 0


HIOPAR (HYOSCINE-N-
PARACETAMOL 500 MG)
PARACETAMOL 500 MG)

276
NO.2/0
PCS 0 0 0


12
(IgG\/IgM dan NS1)
TEST 0 0 0

17
400 MG
TABLET 0 0 0
18
MG/5ML
BOTOL 0 0 0
19
100.000 IU
KAPSUL 0 0 0
20
200.000 IU
KAPSUL 0 0 0

24
INJEKSI (HBIg)
SYRINGE 0 0 0


29
INJEKSI 2.4 UI/ML
VIAL 0 0 0
30
MG
TABLET 0 0 0
31
TEST 0 0 0
32
TEST 0 0 0

MG (TLD)
37
COMBO TEST
TEST 0 0 0
RAPID TEST

44
HIV 1/2 TEST
TEST 0 0 0
45
TEST
TEST 0 0 0

MG (TLE)

50
LAMIVUDINE 150 MG
BOTOL 0 0 0

54
Hib)
VIAL 0 0 0


63
SYRINGE 0,05 ML
SYRINGE 0 0 0
64
SYRINGE 0,5 ML
SYRINGE 0 0 0
65
SYRINGE 0,3 ML
SYRINGE 0 0 0
66
SYRINGE 3 ML
SYRINGE 0 0 0
67
SYRINGE 5 ML
SYRINGE 0 0 0
68
LITER
PIECES 0 0 0


72
INJEKSI 40 MG
AMPUL 0 0 0
73
INJEKSI 40%
AMPUL 0 0 0
74
INJEKSI 20%
AMPUL 0 0 0
75
MG/ML
BOTOL 0 0 0
76
2 MG/ML
AMPUL 0 0 0

78
MG/ML
AMPUL 0 0 0

90
RHZE 150/75/400/275 + RH 150/75
PAKET 0 0 0
91
RHZE 150/75/400/175 + RH 150/150
PAKET 0 0 0
92
75/50/150 + RH 75/50
PAKET 0 0 0

97
300/300
PAKET 0 0 0

108
CATRIDGE
PIECES 0 0 0

109
PROTEIN
SACHET 0 0 0


118
STEP RAPID TEST
TEST 0 0 0
122
REAGEN
BOTOL 0 0 0

126
DRUG 7 IN 1
TEST 0 0 0

136
CHOLESTEROL
PIECES 0 0 0
137
HEMOGLOBIN
PIECES 0 0 0

OBAT TAMBAHAN

OBAT TAMBAHAN



92 0 0 0 0
93 0 0 0 0
94 0 0 0 0
95 0 0 0 0
96 0 0 0 0
97 0 0 0 0
98 0 0 0 0
99 0 0 0 0
100 0 0 0 0
Blitar ,
Yang Menyerahkan,
Puskesmas
NIP. 19691230 201001 2 002 NIP : 19880803 201502 1 001 NIP : 19910317 202012 1 012 NIP. 19861218 201903 2 004
19861218 201903 2 004
KODE : PELAPORAN BULAN : APRIL 2024 DOKUMEN NOMOR DOKUMEN TANGGAL
PUSKESMAS : PERMINTAAN BULAN : MEI 2024
UPT IFK
KECAMATAN :
KABUPATEN : BLITAR
PUSKESMAS
SISA STOK JUMLAH

GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

15
10 ML
AMPUL 0 0 0

TANGGAL
PEMBERIAN
12

19
ML 60 ML
BOTOL 0 0 0
20
MG
VIAL 0 0 0

22
250MG/5ML
BOTOL 0 0 0
23
MG/VIAL
VIAL 0 0 0
24
(METAMIZOL)
TABLET 0 0 0

27
KOMBINASI 5 GR
POT 0 0 0
28
30 GR
POT 0 0 0

30
KOMBINASI
TABLET 0 0 0
31
(DORMICOMP)
TABLET 0 0 0
32
PIROGEN 20 ML
BOTOL 0 0 0
33
MG
TABLET 0 0 0

36
INJEKSI
AMPUL 0 0 0

38
DEPAKOTE ER
TABLET 0 0 0

45
MG/ML 1 ML
AMPUL 0 0 0

52
(CONCOR)
TABLET 0 0 0

59
MG/ML 1 ML
AMPUL 0 0 0


63
2,5ML-STESOLID
TUBE 0 0 0

66
MG/ML 1 ML
AMPUL 0 0 0

72
SALEP 15 GR
TUBE 0 0 0
73
1 ML
AMPUL 0 0 0

75
MG/5ML
BOTOL 0 0 0

77
300 ML
BOTOL 0 0 0

82
ML
AMPUL 0 0 0
84
% 5 ML
BOTOL 0 0 0
85
MG/ML 1 ML
AMPUL 0 0 0
86
SALUT 10 MG
TABLET 0 0 0
87
2MG/ML
AMPUL 0 0 0
88
25 MG 1 ML
AMPUL 0 0 0

97
MG
TABLET 0 0 0

100
VIAL 0 0 0
101
STERIL
BOTOL 0 0 0
102
STERIL
BOTOL 0 0 0

106
(LODOMER)
AMPUL 0 0 0

110
BOTOL 0 0 0

114
PORT
PCS 0 0 0
115
PORT
PCS 0 0 0
116
INJECTION PORT
PCS 0 0 0
117
INJECTION PORT
PCS 0 0 0
118
INJECTION PORT
PCS 0 0 0
119
INJECTION PORT
PCS 0 0 0
120
200MG/5ML
BOTOL 0 0 0
121
60 ML
BOTOL 0 0 0

125
5 MG
TABLET 0 0 0

128
MG/ML 10 ML
AMPUL 0 0 0
129
MG
TABLET 0 0 0

135
STRIL
ROL 0 0 0
136
CM
ROL 0 0 0
137
CM
ROL 0 0 0
138
CM
ROL 0 0 0
139
DIRESAPI FRAMISETIN
PCS 0 0 0

147
ML
BOTOL 0 0 0

149
TABLET 4 MG
TABLET 0 0 0
150
MG/ML 1 ML
AMPUL 0 0 0
151
MG/ML 1 ML
AMPUL 0 0 0

160
ML
AMPUL 0 0 0

165
% 25 ML
AMPUL 0 0 0

170
MG/2ML
AMPUL 0 0 0
172
0,200 MG 1 ML
AMPUL 0 0 0
173
0,125 MG
TABLET 0 0 0

177
AMPUL 0 0 0

179
(PROVAGIN) OVULA
VIAL 0 0 0

182
100 ML
BOTOL 0 0 0

184
MG
TABLET 0 0 0
185
MG
TABLET 0 0 0
186
STERIL
BOTOL 0 0 0

190
100 ML
BOTOL 0 0 0

193
GR
TUBE 0 0 0
194
3,5 GR
TUBE 0 0 0

198
60 ML
BOTOL 0 0 0

200
ML
BOTOL 0 0 0

207
MG
TABLET 0 0 0

214
STERIL
BOTOL 0 0 0

227
INJ.5 ML (ABU I)
VIAL 0 0 0
228
IU/AMP (ATS)
VIAL 0 0 0

230
500 MCG/ML 1 ML
AMPUL 0 0 0
231
50 MCG
TABLET 0 0 0
232
NO.3/0
PCS 0 0 0

237
MATA 15 % 5 ML
BOTOL 0 0 0
238
PCS 0 0 0

241
TABLET 50 MG
TABLET 0 0 0
242
INJECTION
PCS 0 0 0

244
TABLET 2 MG
TABLET 0 0 0

246
ML
BOTOL 0 0 0
247
ML
BOTOL 0 0 0
248
PSEUDOEPHEDRINE)
TABLET 0 0 0


HIOPAR (HYOSCINE-N-
PARACETAMOL 500 MG)
PARACETAMOL 500 MG)

276
NO.2/0
PCS 0 0 0


12
(IgG\/IgM dan NS1)
TEST 0 0 0

17
400 MG
TABLET 0 0 0
18
MG/5ML
BOTOL 0 0 0
19
100.000 IU
KAPSUL 0 0 0
20
200.000 IU
KAPSUL 0 0 0

24
INJEKSI (HBIg)
SYRINGE 0 0 0


29
INJEKSI 2.4 UI/ML
VIAL 0 0 0
30
MG
TABLET 0 0 0
31
TEST 0 0 0
32
TEST 0 0 0

MG (TLD)
37
COMBO TEST
TEST 0 0 0
RAPID TEST

44
HIV 1/2 TEST
TEST 0 0 0
45
TEST
TEST 0 0 0

MG (TLE)

50
LAMIVUDINE 150 MG
BOTOL 0 0 0

54
Hib)
VIAL 0 0 0


63
SYRINGE 0,05 ML
SYRINGE 0 0 0
64
SYRINGE 0,5 ML
SYRINGE 0 0 0
65
SYRINGE 0,3 ML
SYRINGE 0 0 0
66
SYRINGE 3 ML
SYRINGE 0 0 0
67
SYRINGE 5 ML
SYRINGE 0 0 0
68
LITER
PIECES 0 0 0


72
INJEKSI 40 MG
AMPUL 0 0 0
73
INJEKSI 40%
AMPUL 0 0 0
74
INJEKSI 20%
AMPUL 0 0 0
75
MG/ML
BOTOL 0 0 0
76
2 MG/ML
AMPUL 0 0 0

78
MG/ML
AMPUL 0 0 0

90
RHZE 150/75/400/275 + RH 150/75
PAKET 0 0 0
91
RHZE 150/75/400/175 + RH 150/150
PAKET 0 0 0
92
75/50/150 + RH 75/50
PAKET 0 0 0

97
300/300
PAKET 0 0 0

108
CATRIDGE
PIECES 0 0 0

109
PROTEIN
SACHET 0 0 0


118
STEP RAPID TEST
TEST 0 0 0
122
REAGEN
BOTOL 0 0 0

126
DRUG 7 IN 1
TEST 0 0 0

136
CHOLESTEROL
PIECES 0 0 0
137
HEMOGLOBIN
PIECES 0 0 0

OBAT TAMBAHAN

OBAT TAMBAHAN



92 0 0 0 0
93 0 0 0 0
94 0 0 0 0
95 0 0 0 0
96 0 0 0 0
97 0 0 0 0
98 0 0 0 0
99 0 0 0 0
100 0 0 0 0
Blitar ,
Yang Menyerahkan,
NIP. 19691230 201001 2 002 NIP : 19880803 201502 1 001 NIP : 19910317 202012 1 012 NIP. 19861218 201903 2 004
Puskesmas

19861218 201903 2 004
KODE : PELAPORAN BULAN : MEI 2024 DOKUMEN NOMOR DOKUMEN TANGGAL
PUSKESMAS : PERMINTAAN BULAN : JUNI 2024
UPT IFK
KECAMATAN :
KABUPATEN : BLITAR
PUSKESMAS
SISA STOK JUMLAH

GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

15
10 ML
AMPUL 0 0 0

TANGGAL
PEMBERIAN
12

19
ML 60 ML
BOTOL 0 0 0
20
MG
VIAL 0 0 0

22
250MG/5ML
BOTOL 0 0 0
23
MG/VIAL
VIAL 0 0 0
24
(METAMIZOL)
TABLET 0 0 0

27
KOMBINASI 5 GR
POT 0 0 0
28
30 GR
POT 0 0 0

30
KOMBINASI
TABLET 0 0 0
31
(DORMICOMP)
TABLET 0 0 0
32
PIROGEN 20 ML
BOTOL 0 0 0
33
MG
TABLET 0 0 0

36
INJEKSI
AMPUL 0 0 0

38
DEPAKOTE ER
TABLET 0 0 0

45
MG/ML 1 ML
AMPUL 0 0 0

52
(CONCOR)
TABLET 0 0 0

59
MG/ML 1 ML
AMPUL 0 0 0


63
2,5ML-STESOLID
TUBE 0 0 0

66
MG/ML 1 ML
AMPUL 0 0 0

72
SALEP 15 GR
TUBE 0 0 0
73
1 ML
AMPUL 0 0 0

75
MG/5ML
BOTOL 0 0 0

77
300 ML
BOTOL 0 0 0

82
ML
AMPUL 0 0 0
84
% 5 ML
BOTOL 0 0 0
85
MG/ML 1 ML
AMPUL 0 0 0
86
SALUT 10 MG
TABLET 0 0 0
87
2MG/ML
AMPUL 0 0 0
88
25 MG 1 ML
AMPUL 0 0 0

97
MG
TABLET 0 0 0

100
VIAL 0 0 0
101
STERIL
BOTOL 0 0 0
102
STERIL
BOTOL 0 0 0

106
(LODOMER)
AMPUL 0 0 0

110
BOTOL 0 0 0

114
PORT
PCS 0 0 0
115
PORT
PCS 0 0 0
116
INJECTION PORT
PCS 0 0 0
117
INJECTION PORT
PCS 0 0 0
118
INJECTION PORT
PCS 0 0 0
119
INJECTION PORT
PCS 0 0 0
120
200MG/5ML
BOTOL 0 0 0
121
60 ML
BOTOL 0 0 0

125
5 MG
TABLET 0 0 0

128
MG/ML 10 ML
AMPUL 0 0 0
129
MG
TABLET 0 0 0

135
STRIL
ROL 0 0 0
136
CM
ROL 0 0 0
137
CM
ROL 0 0 0
138
CM
ROL 0 0 0
139
DIRESAPI FRAMISETIN
PCS 0 0 0

147
ML
BOTOL 0 0 0

149
TABLET 4 MG
TABLET 0 0 0
150
MG/ML 1 ML
AMPUL 0 0 0
151
MG/ML 1 ML
AMPUL 0 0 0

160
ML
AMPUL 0 0 0

165
% 25 ML
AMPUL 0 0 0

170
MG/2ML
AMPUL 0 0 0
172
0,200 MG 1 ML
AMPUL 0 0 0
173
0,125 MG
TABLET 0 0 0

177
AMPUL 0 0 0

179
(PROVAGIN) OVULA
VIAL 0 0 0

182
100 ML
BOTOL 0 0 0

184
MG
TABLET 0 0 0
185
MG
TABLET 0 0 0
186
STERIL
BOTOL 0 0 0

190
100 ML
BOTOL 0 0 0

193
GR
TUBE 0 0 0
194
3,5 GR
TUBE 0 0 0

198
60 ML
BOTOL 0 0 0

200
ML
BOTOL 0 0 0

207
MG
TABLET 0 0 0

214
STERIL
BOTOL 0 0 0

227
INJ.5 ML (ABU I)
VIAL 0 0 0
228
IU/AMP (ATS)
VIAL 0 0 0

230
500 MCG/ML 1 ML
AMPUL 0 0 0
231
50 MCG
TABLET 0 0 0
232
NO.3/0
PCS 0 0 0

237
MATA 15 % 5 ML
BOTOL 0 0 0
238
PCS 0 0 0

241
TABLET 50 MG
TABLET 0 0 0
242
INJECTION
PCS 0 0 0

244
TABLET 2 MG
TABLET 0 0 0

246
ML
BOTOL 0 0 0
247
ML
BOTOL 0 0 0
248
PSEUDOEPHEDRINE)
TABLET 0 0 0


HIOPAR (HYOSCINE-N-
PARACETAMOL 500 MG)
PARACETAMOL 500 MG)

276
NO.2/0
PCS 0 0 0


12
(IgG\/IgM dan NS1)
TEST 0 0 0

17
400 MG
TABLET 0 0 0
18
MG/5ML
BOTOL 0 0 0
19
100.000 IU
KAPSUL 0 0 0
20
200.000 IU
KAPSUL 0 0 0

24
INJEKSI (HBIg)
SYRINGE 0 0 0


29
INJEKSI 2.4 UI/ML
VIAL 0 0 0
30
MG
TABLET 0 0 0
31
TEST 0 0 0
32
TEST 0 0 0

MG (TLD)
37
COMBO TEST
TEST 0 0 0
RAPID TEST

44
HIV 1/2 TEST
TEST 0 0 0
45
TEST
TEST 0 0 0

MG (TLE)

50
LAMIVUDINE 150 MG
BOTOL 0 0 0

54
Hib)
VIAL 0 0 0


63
SYRINGE 0,05 ML
SYRINGE 0 0 0
64
SYRINGE 0,5 ML
SYRINGE 0 0 0
65
SYRINGE 0,3 ML
SYRINGE 0 0 0
66
SYRINGE 3 ML
SYRINGE 0 0 0
67
SYRINGE 5 ML
SYRINGE 0 0 0
68
LITER
PIECES 0 0 0


72
INJEKSI 40 MG
AMPUL 0 0 0
73
INJEKSI 40%
AMPUL 0 0 0
74
INJEKSI 20%
AMPUL 0 0 0
75
MG/ML
BOTOL 0 0 0
76
2 MG/ML
AMPUL 0 0 0

78
MG/ML
AMPUL 0 0 0

90
RHZE 150/75/400/275 + RH 150/75
PAKET 0 0 0
91
RHZE 150/75/400/175 + RH 150/150
PAKET 0 0 0
92
75/50/150 + RH 75/50
PAKET 0 0 0

97
300/300
PAKET 0 0 0

108
CATRIDGE
PIECES 0 0 0

109
PROTEIN
SACHET 0 0 0


118
STEP RAPID TEST
TEST 0 0 0
122
REAGEN
BOTOL 0 0 0

126
DRUG 7 IN 1
TEST 0 0 0

136
CHOLESTEROL
PIECES 0 0 0
137
HEMOGLOBIN
PIECES 0 0 0

OBAT TAMBAHAN

OBAT TAMBAHAN



92 0 0 0 0
93 0 0 0 0
94 0 0 0 0
95 0 0 0 0
96 0 0 0 0
97 0 0 0 0
98 0 0 0 0
99 0 0 0 0
100 0 0 0 0
Blitar ,
Yang Menyerahkan,
Puskesmas
NIP. 19691230 201001 2 002 NIP : 19880803 201502 1 001 NIP : 19910317 202012 1 012 NIP. 19861218 201903 2 004
19861218 201903 2 004
PUSKESMAS : PERMINTAAN BULAN : JANUARI 2024
UPT IFK
KECAMATAN :
KABUPATEN : BLITAR
PUSKESMAS
SISA STOK JUMLAH

GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

15
10 ML
AMPUL 0 0 0

TANGGAL
PEMBERIAN
12

19
ML 60 ML
BOTOL 0 0 0
20
MG
VIAL 0 0 0

22
250MG/5ML
BOTOL 0 0 0
23
MG/VIAL
VIAL 0 0 0
24
(METAMIZOL)
TABLET 0 0 0

27
KOMBINASI 5 GR
POT 0 0 0
28
30 GR
POT 0 0 0

30
KOMBINASI
TABLET 0 0 0
31
(DORMICOMP)
TABLET 0 0 0
32
PIROGEN 20 ML
BOTOL 0 0 0
33
MG
TABLET 0 0 0

36
INJEKSI
AMPUL 0 0 0

38
DEPAKOTE ER
TABLET 0 0 0

45
MG/ML 1 ML
AMPUL 0 0 0

52
(CONCOR)
TABLET 0 0 0

59
MG/ML 1 ML
AMPUL 0 0 0


63
2,5ML-STESOLID
TUBE 0 0 0

66
MG/ML 1 ML
AMPUL 0 0 0

72
SALEP 15 GR
TUBE 0 0 0
73
1 ML
AMPUL 0 0 0

75
MG/5ML
BOTOL 0 0 0

77
300 ML
BOTOL 0 0 0

82
ML
AMPUL 0 0 0
84
% 5 ML
BOTOL 0 0 0
85
MG/ML 1 ML
AMPUL 0 0 0
86
SALUT 10 MG
TABLET 0 0 0
87
2MG/ML
AMPUL 0 0 0
88
25 MG 1 ML
AMPUL 0 0 0

97
MG
TABLET 0 0 0

100
VIAL 0 0 0
101
STERIL
BOTOL 0 0 0
102
STERIL
BOTOL 0 0 0

106
(LODOMER)
AMPUL 0 0 0

110
BOTOL 0 0 0

114
PORT
PCS 0 0 0
115
PORT
PCS 0 0 0
116
INJECTION PORT
PCS 0 0 0
117
INJECTION PORT
PCS 0 0 0
118
INJECTION PORT
PCS 0 0 0
119
INJECTION PORT
PCS 0 0 0
120
200MG/5ML
BOTOL 0 0 0
121
60 ML
BOTOL 0 0 0

125
5 MG
TABLET 0 0 0

128
MG/ML 10 ML
AMPUL 0 0 0
129
MG
TABLET 0 0 0

135
STRIL
ROL 0 0 0
136
CM
ROL 0 0 0
137
CM
ROL 0 0 0
138
CM
ROL 0 0 0
139
DIRESAPI FRAMISETIN
PCS 0 0 0

147
ML
BOTOL 0 0 0

149
TABLET 4 MG
TABLET 0 0 0
150
MG/ML 1 ML
AMPUL 0 0 0
151
MG/ML 1 ML
AMPUL 0 0 0

160
ML
AMPUL 0 0 0

165
% 25 ML
AMPUL 0 0 0

170
MG/2ML
AMPUL 0 0 0
172
0,200 MG 1 ML
AMPUL 0 0 0
173
0,125 MG
TABLET 0 0 0

177
AMPUL 0 0 0

179
(PROVAGIN) OVULA
VIAL 0 0 0

182
100 ML
BOTOL 0 0 0

184
MG
TABLET 0 0 0
185
MG
TABLET 0 0 0
186
STERIL
BOTOL 0 0 0

190
100 ML
BOTOL 0 0 0

193
GR
TUBE 0 0 0
194
3,5 GR
TUBE 0 0 0

198
60 ML
BOTOL 0 0 0

200
ML
BOTOL 0 0 0

207
MG
TABLET 0 0 0

214
STERIL
BOTOL 0 0 0

227
INJ.5 ML (ABU I)
VIAL 0 0 0
228
IU/AMP (ATS)
VIAL 0 0 0

230
500 MCG/ML 1 ML
AMPUL 0 0 0
231
50 MCG
TABLET 0 0 0
232
NO.3/0
PCS 0 0 0

237
MATA 15 % 5 ML
BOTOL 0 0 0
238
PCS 0 0 0

241
TABLET 50 MG
TABLET 0 0 0
242
INJECTION
PCS 0 0 0

244
TABLET 2 MG
TABLET 0 0 0

246
ML
BOTOL 0 0 0
247
ML
BOTOL 0 0 0
248
PSEUDOEPHEDRINE)
TABLET 0 0 0


HIOPAR (HYOSCINE-N-
PARACETAMOL 500 MG)
PARACETAMOL 500 MG)

276
NO.2/0
PCS 0 0 0


12
(IgG\/IgM dan NS1)
TEST 0 0 0

17
400 MG
TABLET 0 0 0
18
MG/5ML
BOTOL 0 0 0
19
100.000 IU
KAPSUL 0 0 0
20
200.000 IU
KAPSUL 0 0 0

24
INJEKSI (HBIg)
SYRINGE 0 0 0


29
INJEKSI 2.4 UI/ML
VIAL 0 0 0
30
MG
TABLET 0 0 0
31
TEST 0 0 0
32
TEST 0 0 0

MG (TLD)
37
COMBO TEST
TEST 0 0 0
RAPID TEST

44
HIV 1/2 TEST
TEST 0 0 0
45
TEST
TEST 0 0 0

MG (TLE)

50
LAMIVUDINE 150 MG
BOTOL 0 0 0

54
Hib)
VIAL 0 0 0


63
SYRINGE 0,05 ML
SYRINGE 0 0 0
64
SYRINGE 0,5 ML
SYRINGE 0 0 0
65
SYRINGE 0,3 ML
SYRINGE 0 0 0
66
SYRINGE 3 ML
SYRINGE 0 0 0
67
SYRINGE 5 ML
SYRINGE 0 0 0
68
LITER
PIECES 0 0 0


72
INJEKSI 40 MG
AMPUL 0 0 0
73
INJEKSI 40%
AMPUL 0 0 0
74
INJEKSI 20%
AMPUL 0 0 0
75
MG/ML
BOTOL 0 0 0
76
2 MG/ML
AMPUL 0 0 0

78
MG/ML
AMPUL 0 0 0

90
RHZE 150/75/400/275 + RH 150/75
PAKET 0 0 0
91
RHZE 150/75/400/175 + RH 150/150
PAKET 0 0 0
92
75/50/150 + RH 75/50
PAKET 0 0 0

97
300/300
PAKET 0 0 0

108
CATRIDGE
PIECES 0 0 0

109
PROTEIN
SACHET 0 0 0


118
STEP RAPID TEST
TEST 0 0 0
122
REAGEN
BOTOL 0 0 0

126
DRUG 7 IN 1
TEST 0 0 0

136
CHOLESTEROL
PIECES 0 0 0
137
HEMOGLOBIN
PIECES 0 0 0

OBAT TAMBAHAN

OBAT TAMBAHAN



92 0 0 0 0
93 0 0 0 0
94 0 0 0 0
95 0 0 0 0
96 0 0 0 0
97 0 0 0 0
98 0 0 0 0
99 0 0 0 0
100 0 0 0 0
Blitar ,
Yang Menyerahkan,
Puskesmas
NIP. 19691230 201001 2 002 NIP : 19880803 201502 1 001 NIP : 19910317 202012 1 012 NIP. 19861218 201903 2 004
19861218 201903 2 004
KODE : PELAPORAN BULAN : JULI 2024 DOKUMEN NOMOR DOKUMEN TANGGAL
PUSKESMAS : PERMINTAAN BULAN : AGUSTUS 2024
UPT IFK
KECAMATAN :
KABUPATEN : BLITAR
PUSKESMAS
SISA STOK JUMLAH

GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

15
10 ML
AMPUL 0 0 0

TANGGAL
PEMBERIAN
12

19
ML 60 ML
BOTOL 0 0 0
20
MG
VIAL 0 0 0

22
250MG/5ML
BOTOL 0 0 0
23
MG/VIAL
VIAL 0 0 0
24
(METAMIZOL)
TABLET 0 0 0

27
KOMBINASI 5 GR
POT 0 0 0
28
30 GR
POT 0 0 0

30
KOMBINASI
TABLET 0 0 0
31
(DORMICOMP)
TABLET 0 0 0
32
PIROGEN 20 ML
BOTOL 0 0 0
33
MG
TABLET 0 0 0

36
INJEKSI
AMPUL 0 0 0

38
DEPAKOTE ER
TABLET 0 0 0

45
MG/ML 1 ML
AMPUL 0 0 0

52
(CONCOR)
TABLET 0 0 0

59
MG/ML 1 ML
AMPUL 0 0 0


63
2,5ML-STESOLID
TUBE 0 0 0

66
MG/ML 1 ML
AMPUL 0 0 0

72
SALEP 15 GR
TUBE 0 0 0
73
1 ML
AMPUL 0 0 0

75
MG/5ML
BOTOL 0 0 0

77
300 ML
BOTOL 0 0 0

82
ML
AMPUL 0 0 0
84
% 5 ML
BOTOL 0 0 0
85
MG/ML 1 ML
AMPUL 0 0 0
86
SALUT 10 MG
TABLET 0 0 0
87
2MG/ML
AMPUL 0 0 0
88
25 MG 1 ML
AMPUL 0 0 0

97
MG
TABLET 0 0 0

100
VIAL 0 0 0
101
STERIL
BOTOL 0 0 0
102
STERIL
BOTOL 0 0 0

106
(LODOMER)
AMPUL 0 0 0

110
BOTOL 0 0 0

114
PORT
PCS 0 0 0
115
PORT
PCS 0 0 0
116
INJECTION PORT
PCS 0 0 0
117
INJECTION PORT
PCS 0 0 0
118
INJECTION PORT
PCS 0 0 0
119
INJECTION PORT
PCS 0 0 0
120
200MG/5ML
BOTOL 0 0 0
121
60 ML
BOTOL 0 0 0

125
5 MG
TABLET 0 0 0

128
MG/ML 10 ML
AMPUL 0 0 0
129
MG
TABLET 0 0 0

135
STRIL
ROL 0 0 0
136
CM
ROL 0 0 0
137
CM
ROL 0 0 0
138
CM
ROL 0 0 0
139
DIRESAPI FRAMISETIN
PCS 0 0 0

147
ML
BOTOL 0 0 0

149
TABLET 4 MG
TABLET 0 0 0
150
MG/ML 1 ML
AMPUL 0 0 0
151
MG/ML 1 ML
AMPUL 0 0 0

160
ML
AMPUL 0 0 0

165
% 25 ML
AMPUL 0 0 0

170
MG/2ML
AMPUL 0 0 0
172
0,200 MG 1 ML
AMPUL 0 0 0
173
0,125 MG
TABLET 0 0 0

177
AMPUL 0 0 0

179
(PROVAGIN) OVULA
VIAL 0 0 0

182
100 ML
BOTOL 0 0 0

184
MG
TABLET 0 0 0
185
MG
TABLET 0 0 0
186
STERIL
BOTOL 0 0 0

190
100 ML
BOTOL 0 0 0

193
GR
TUBE 0 0 0
194
3,5 GR
TUBE 0 0 0

198
60 ML
BOTOL 0 0 0

200
ML
BOTOL 0 0 0

207
MG
TABLET 0 0 0

214
STERIL
BOTOL 0 0 0

227
INJ.5 ML (ABU I)
VIAL 0 0 0
228
IU/AMP (ATS)
VIAL 0 0 0

230
500 MCG/ML 1 ML
AMPUL 0 0 0
231
50 MCG
TABLET 0 0 0
232
NO.3/0
PCS 0 0 0

237
MATA 15 % 5 ML
BOTOL 0 0 0
238
PCS 0 0 0

241
TABLET 50 MG
TABLET 0 0 0
242
INJECTION
PCS 0 0 0

244
TABLET 2 MG
TABLET 0 0 0

246
ML
BOTOL 0 0 0
247
ML
BOTOL 0 0 0
248
PSEUDOEPHEDRINE)
TABLET 0 0 0


HIOPAR (HYOSCINE-N-
PARACETAMOL 500 MG)
PARACETAMOL 500 MG)

276
NO.2/0
PCS 0 0 0


12
(IgG\/IgM dan NS1)
TEST 0 0 0

17
400 MG
TABLET 0 0 0
18
MG/5ML
BOTOL 0 0 0
19
100.000 IU
KAPSUL 0 0 0
20
200.000 IU
KAPSUL 0 0 0

24
INJEKSI (HBIg)
SYRINGE 0 0 0


29
INJEKSI 2.4 UI/ML
VIAL 0 0 0
30
MG
TABLET 0 0 0
31
TEST 0 0 0
32
TEST 0 0 0

MG (TLD)
37
COMBO TEST
TEST 0 0 0
RAPID TEST

44
HIV 1/2 TEST
TEST 0 0 0
45
TEST
TEST 0 0 0

MG (TLE)

50
LAMIVUDINE 150 MG
BOTOL 0 0 0

54
Hib)
VIAL 0 0 0


63
SYRINGE 0,05 ML
SYRINGE 0 0 0
64
SYRINGE 0,5 ML
SYRINGE 0 0 0
65
SYRINGE 0,3 ML
SYRINGE 0 0 0
66
SYRINGE 3 ML
SYRINGE 0 0 0
67
SYRINGE 5 ML
SYRINGE 0 0 0
68
LITER
PIECES 0 0 0


72
INJEKSI 40 MG
AMPUL 0 0 0
73
INJEKSI 40%
AMPUL 0 0 0
74
INJEKSI 20%
AMPUL 0 0 0
75
MG/ML
BOTOL 0 0 0
76
2 MG/ML
AMPUL 0 0 0

78
MG/ML
AMPUL 0 0 0

90
RHZE 150/75/400/275 + RH 150/75
PAKET 0 0 0
91
RHZE 150/75/400/175 + RH 150/150
PAKET 0 0 0
92
75/50/150 + RH 75/50
PAKET 0 0 0

97
300/300
PAKET 0 0 0

108
CATRIDGE
PIECES 0 0 0

109
PROTEIN
SACHET 0 0 0


118
STEP RAPID TEST
TEST 0 0 0
122
REAGEN
BOTOL 0 0 0

126
DRUG 7 IN 1
TEST 0 0 0

136
CHOLESTEROL
PIECES 0 0 0
137
HEMOGLOBIN
PIECES 0 0 0

OBAT TAMBAHAN

OBAT TAMBAHAN



92 0 0 0 0
93 0 0 0 0
94 0 0 0 0
95 0 0 0 0
96 0 0 0 0
97 0 0 0 0
98 0 0 0 0
99 0 0 0 0
100 0 0 0 0
Blitar ,
Yang Menyerahkan,
Puskesmas
NIP. 19691230 201001 2 002 NIP : 19880803 201502 1 001 NIP : 19910317 202012 1 012 NIP. 19861218 201903 2 004
19861218 201903 2 004
KODE : PELAPORAN BULAN : AGUSTUS 2024 DOKUMEN NOMOR DOKUMEN TANGGAL
PUSKESMAS : PERMINTAAN BULAN : SEPTEMBER 2024
UPT IFK
KECAMATAN :
KABUPATEN : BLITAR
PUSKESMAS
SISA STOK JUMLAH

GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

15
10 ML
AMPUL 0 0 0

TANGGAL
PEMBERIAN
12

19
ML 60 ML
BOTOL 0 0 0
20
MG
VIAL 0 0 0

22
250MG/5ML
BOTOL 0 0 0
23
MG/VIAL
VIAL 0 0 0
24
(METAMIZOL)
TABLET 0 0 0

27
KOMBINASI 5 GR
POT 0 0 0
28
30 GR
POT 0 0 0

30
KOMBINASI
TABLET 0 0 0
31
(DORMICOMP)
TABLET 0 0 0
32
PIROGEN 20 ML
BOTOL 0 0 0
33
MG
TABLET 0 0 0

36
INJEKSI
AMPUL 0 0 0

38
DEPAKOTE ER
TABLET 0 0 0

45
MG/ML 1 ML
AMPUL 0 0 0

52
(CONCOR)
TABLET 0 0 0

59
MG/ML 1 ML
AMPUL 0 0 0


63
2,5ML-STESOLID
TUBE 0 0 0

66
MG/ML 1 ML
AMPUL 0 0 0

72
SALEP 15 GR
TUBE 0 0 0
73
1 ML
AMPUL 0 0 0

75
MG/5ML
BOTOL 0 0 0

77
300 ML
BOTOL 0 0 0

82
ML
AMPUL 0 0 0
84
% 5 ML
BOTOL 0 0 0
85
MG/ML 1 ML
AMPUL 0 0 0
86
SALUT 10 MG
TABLET 0 0 0
87
2MG/ML
AMPUL 0 0 0
88
25 MG 1 ML
AMPUL 0 0 0

97
MG
TABLET 0 0 0

100
VIAL 0 0 0
101
STERIL
BOTOL 0 0 0
102
STERIL
BOTOL 0 0 0

106
(LODOMER)
AMPUL 0 0 0

110
BOTOL 0 0 0

114
PORT
PCS 0 0 0
115
PORT
PCS 0 0 0
116
INJECTION PORT
PCS 0 0 0
117
INJECTION PORT
PCS 0 0 0
118
INJECTION PORT
PCS 0 0 0
119
INJECTION PORT
PCS 0 0 0
120
200MG/5ML
BOTOL 0 0 0
121
60 ML
BOTOL 0 0 0

125
5 MG
TABLET 0 0 0

128
MG/ML 10 ML
AMPUL 0 0 0
129
MG
TABLET 0 0 0

135
STRIL
ROL 0 0 0
136
CM
ROL 0 0 0
137
CM
ROL 0 0 0
138
CM
ROL 0 0 0
139
DIRESAPI FRAMISETIN
PCS 0 0 0

147
ML
BOTOL 0 0 0

149
TABLET 4 MG
TABLET 0 0 0
150
MG/ML 1 ML
AMPUL 0 0 0
151
MG/ML 1 ML
AMPUL 0 0 0

160
ML
AMPUL 0 0 0

165
% 25 ML
AMPUL 0 0 0

170
MG/2ML
AMPUL 0 0 0
172
0,200 MG 1 ML
AMPUL 0 0 0
173
0,125 MG
TABLET 0 0 0

177
AMPUL 0 0 0

179
(PROVAGIN) OVULA
VIAL 0 0 0

182
100 ML
BOTOL 0 0 0

184
MG
TABLET 0 0 0
185
MG
TABLET 0 0 0
186
STERIL
BOTOL 0 0 0

190
100 ML
BOTOL 0 0 0

193
GR
TUBE 0 0 0
194
3,5 GR
TUBE 0 0 0

198
60 ML
BOTOL 0 0 0

200
ML
BOTOL 0 0 0

207
MG
TABLET 0 0 0

214
STERIL
BOTOL 0 0 0

227
INJ.5 ML (ABU I)
VIAL 0 0 0
228
IU/AMP (ATS)
VIAL 0 0 0

230
500 MCG/ML 1 ML
AMPUL 0 0 0
231
50 MCG
TABLET 0 0 0
232
NO.3/0
PCS 0 0 0

237
MATA 15 % 5 ML
BOTOL 0 0 0
238
PCS 0 0 0

241
TABLET 50 MG
TABLET 0 0 0
242
INJECTION
PCS 0 0 0

244
TABLET 2 MG
TABLET 0 0 0

246
ML
BOTOL 0 0 0
247
ML
BOTOL 0 0 0
248
PSEUDOEPHEDRINE)
TABLET 0 0 0


HIOPAR (HYOSCINE-N-
PARACETAMOL 500 MG)
PARACETAMOL 500 MG)

276
NO.2/0
PCS 0 0 0


12
(IgG\/IgM dan NS1)
TEST 0 0 0

17
400 MG
TABLET 0 0 0
18
MG/5ML
BOTOL 0 0 0
19
100.000 IU
KAPSUL 0 0 0
20
200.000 IU
KAPSUL 0 0 0

24
INJEKSI (HBIg)
SYRINGE 0 0 0


29
INJEKSI 2.4 UI/ML
VIAL 0 0 0
30
MG
TABLET 0 0 0
31
TEST 0 0 0
32
TEST 0 0 0

MG (TLD)
37
COMBO TEST
TEST 0 0 0
RAPID TEST

44
HIV 1/2 TEST
TEST 0 0 0
45
TEST
TEST 0 0 0

MG (TLE)

50
LAMIVUDINE 150 MG
BOTOL 0 0 0

54
Hib)
VIAL 0 0 0


63
SYRINGE 0,05 ML
SYRINGE 0 0 0
64
SYRINGE 0,5 ML
SYRINGE 0 0 0
65
SYRINGE 0,3 ML
SYRINGE 0 0 0
66
SYRINGE 3 ML
SYRINGE 0 0 0
67
SYRINGE 5 ML
SYRINGE 0 0 0
68
LITER
PIECES 0 0 0


72
INJEKSI 40 MG
AMPUL 0 0 0
73
INJEKSI 40%
AMPUL 0 0 0
74
INJEKSI 20%
AMPUL 0 0 0
75
MG/ML
BOTOL 0 0 0
76
2 MG/ML
AMPUL 0 0 0

78
MG/ML
AMPUL 0 0 0

90
RHZE 150/75/400/275 + RH 150/75
PAKET 0 0 0
91
RHZE 150/75/400/175 + RH 150/150
PAKET 0 0 0
92
75/50/150 + RH 75/50
PAKET 0 0 0

97
300/300
PAKET 0 0 0

108
CATRIDGE
PIECES 0 0 0

109
PROTEIN
SACHET 0 0 0


118
STEP RAPID TEST
TEST 0 0 0
122
REAGEN
BOTOL 0 0 0

126
DRUG 7 IN 1
TEST 0 0 0

136
CHOLESTEROL
PIECES 0 0 0
137
HEMOGLOBIN
PIECES 0 0 0

OBAT TAMBAHAN

OBAT TAMBAHAN



92 0 0 0 0
93 0 0 0 0
94 0 0 0 0
95 0 0 0 0
96 0 0 0 0
97 0 0 0 0
98 0 0 0 0
99 0 0 0 0
100 0 0 0 0
Blitar ,
Yang Menyerahkan,
Puskesmas
NIP. 19691230 201001 2 002 NIP : 19880803 201502 1 001 NIP : 19910317 202012 1 012 NIP. 19861218 201903 2 004
19861218 201903 2 004
KODE : PELAPORAN BULAN : SEPTEMBER 2024 DOKUMEN NOMOR DOKUMEN TANGGAL
PUSKESMAS : PERMINTAAN BULAN : OKTOBER 2024
UPT IFK
KECAMATAN :
KABUPATEN : BLITAR
PUSKESMAS
SISA STOK JUMLAH

GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

15
10 ML
AMPUL 0 0 0

TANGGAL
PEMBERIAN
12

19
ML 60 ML
BOTOL 0 0 0
20
MG
VIAL 0 0 0

22
250MG/5ML
BOTOL 0 0 0
23
MG/VIAL
VIAL 0 0 0
24
(METAMIZOL)
TABLET 0 0 0

27
KOMBINASI 5 GR
POT 0 0 0
28
30 GR
POT 0 0 0

30
KOMBINASI
TABLET 0 0 0
31
(DORMICOMP)
TABLET 0 0 0
32
PIROGEN 20 ML
BOTOL 0 0 0
33
MG
TABLET 0 0 0

36
INJEKSI
AMPUL 0 0 0

38
DEPAKOTE ER
TABLET 0 0 0

45
MG/ML 1 ML
AMPUL 0 0 0

52
(CONCOR)
TABLET 0 0 0

59
MG/ML 1 ML
AMPUL 0 0 0


63
2,5ML-STESOLID
TUBE 0 0 0

66
MG/ML 1 ML
AMPUL 0 0 0

72
SALEP 15 GR
TUBE 0 0 0
73
1 ML
AMPUL 0 0 0

75
MG/5ML
BOTOL 0 0 0

77
300 ML
BOTOL 0 0 0

82
ML
AMPUL 0 0 0
84
% 5 ML
BOTOL 0 0 0
85
MG/ML 1 ML
AMPUL 0 0 0
86
SALUT 10 MG
TABLET 0 0 0
87
2MG/ML
AMPUL 0 0 0
88
25 MG 1 ML
AMPUL 0 0 0

97
MG
TABLET 0 0 0

100
VIAL 0 0 0
101
STERIL
BOTOL 0 0 0
102
STERIL
BOTOL 0 0 0

106
(LODOMER)
AMPUL 0 0 0

110
BOTOL 0 0 0

114
PORT
PCS 0 0 0
115
PORT
PCS 0 0 0
116
INJECTION PORT
PCS 0 0 0
117
INJECTION PORT
PCS 0 0 0
118
INJECTION PORT
PCS 0 0 0
119
INJECTION PORT
PCS 0 0 0
120
200MG/5ML
BOTOL 0 0 0
121
60 ML
BOTOL 0 0 0

125
5 MG
TABLET 0 0 0

128
MG/ML 10 ML
AMPUL 0 0 0
129
MG
TABLET 0 0 0

135
STRIL
ROL 0 0 0
136
CM
ROL 0 0 0
137
CM
ROL 0 0 0
138
CM
ROL 0 0 0
139
DIRESAPI FRAMISETIN
PCS 0 0 0

147
ML
BOTOL 0 0 0

149
TABLET 4 MG
TABLET 0 0 0
150
MG/ML 1 ML
AMPUL 0 0 0
151
MG/ML 1 ML
AMPUL 0 0 0

160
ML
AMPUL 0 0 0

165
% 25 ML
AMPUL 0 0 0

170
MG/2ML
AMPUL 0 0 0
172
0,200 MG 1 ML
AMPUL 0 0 0
173
0,125 MG
TABLET 0 0 0

177
AMPUL 0 0 0

179
(PROVAGIN) OVULA
VIAL 0 0 0

182
100 ML
BOTOL 0 0 0

184
MG
TABLET 0 0 0
185
MG
TABLET 0 0 0
186
STERIL
BOTOL 0 0 0

190
100 ML
BOTOL 0 0 0

193
GR
TUBE 0 0 0
194
3,5 GR
TUBE 0 0 0

198
60 ML
BOTOL 0 0 0

200
ML
BOTOL 0 0 0

207
MG
TABLET 0 0 0

214
STERIL
BOTOL 0 0 0

227
INJ.5 ML (ABU I)
VIAL 0 0 0
228
IU/AMP (ATS)
VIAL 0 0 0

230
500 MCG/ML 1 ML
AMPUL 0 0 0
231
50 MCG
TABLET 0 0 0
232
NO.3/0
PCS 0 0 0

237
MATA 15 % 5 ML
BOTOL 0 0 0
238
PCS 0 0 0

241
TABLET 50 MG
TABLET 0 0 0
242
INJECTION
PCS 0 0 0

244
TABLET 2 MG
TABLET 0 0 0

246
ML
BOTOL 0 0 0
247
ML
BOTOL 0 0 0
248
PSEUDOEPHEDRINE)
TABLET 0 0 0


HIOPAR (HYOSCINE-N-
PARACETAMOL 500 MG)
PARACETAMOL 500 MG)

276
NO.2/0
PCS 0 0 0


12
(IgG\/IgM dan NS1)
TEST 0 0 0

17
400 MG
TABLET 0 0 0
18
MG/5ML
BOTOL 0 0 0
19
100.000 IU
KAPSUL 0 0 0
20
200.000 IU
KAPSUL 0 0 0

24
INJEKSI (HBIg)
SYRINGE 0 0 0


29
INJEKSI 2.4 UI/ML
VIAL 0 0 0
30
MG
TABLET 0 0 0
31
TEST 0 0 0
32
TEST 0 0 0

MG (TLD)
37
COMBO TEST
TEST 0 0 0
RAPID TEST

44
HIV 1/2 TEST
TEST 0 0 0
45
TEST
TEST 0 0 0

MG (TLE)

50
LAMIVUDINE 150 MG
BOTOL 0 0 0

54
Hib)
VIAL 0 0 0


63
SYRINGE 0,05 ML
SYRINGE 0 0 0
64
SYRINGE 0,5 ML
SYRINGE 0 0 0
65
SYRINGE 0,3 ML
SYRINGE 0 0 0
66
SYRINGE 3 ML
SYRINGE 0 0 0
67
SYRINGE 5 ML
SYRINGE 0 0 0
68
LITER
PIECES 0 0 0


72
INJEKSI 40 MG
AMPUL 0 0 0
73
INJEKSI 40%
AMPUL 0 0 0
74
INJEKSI 20%
AMPUL 0 0 0
75
MG/ML
BOTOL 0 0 0
76
2 MG/ML
AMPUL 0 0 0

78
MG/ML
AMPUL 0 0 0

90
RHZE 150/75/400/275 + RH 150/75
PAKET 0 0 0
91
RHZE 150/75/400/175 + RH 150/150
PAKET 0 0 0
92
75/50/150 + RH 75/50
PAKET 0 0 0

97
300/300
PAKET 0 0 0

108
CATRIDGE
PIECES 0 0 0
109
PROTEIN
SACHET 0 0 0


118
STEP RAPID TEST
TEST 0 0 0

122
REAGEN
BOTOL 0 0 0

126
DRUG 7 IN 1
TEST 0 0 0

136
CHOLESTEROL
PIECES 0 0 0
137
HEMOGLOBIN
PIECES 0 0 0

OBAT TAMBAHAN

OBAT TAMBAHAN



92 0 0 0 0
93 0 0 0 0
94 0 0 0 0
95 0 0 0 0
96 0 0 0 0
97 0 0 0 0
98 0 0 0 0
99 0 0 0 0
100 0 0 0 0
Blitar ,
NIP. 19691230 201001 2 002 NIP : 19880803 201502 1 001 NIP : 19910317 202012 1 012 NIP. 19861218 201903 2 004
Yang Menyerahkan,
Puskesmas

19861218 201903 2 004
KODE : PELAPORAN BULAN : OKTOBER 2024 DOKUMEN NOMOR DOKUMEN TANGGAL
PUSKESMAS : PERMINTAAN BULAN : NOVEMBER 2024
UPT IFK
KECAMATAN :
KABUPATEN : BLITAR
PUSKESMAS
SISA STOK JUMLAH

GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

15
10 ML
AMPUL 0 0 0

TANGGAL
PEMBERIAN
12

19
ML 60 ML
BOTOL 0 0 0
20
MG
VIAL 0 0 0

22
250MG/5ML
BOTOL 0 0 0
23
MG/VIAL
VIAL 0 0 0
24
(METAMIZOL)
TABLET 0 0 0

27
KOMBINASI 5 GR
POT 0 0 0
28
30 GR
POT 0 0 0

30
KOMBINASI
TABLET 0 0 0
31
(DORMICOMP)
TABLET 0 0 0
32
PIROGEN 20 ML
BOTOL 0 0 0
33
MG
TABLET 0 0 0

36
INJEKSI
AMPUL 0 0 0

38
DEPAKOTE ER
TABLET 0 0 0

45
MG/ML 1 ML
AMPUL 0 0 0

52
(CONCOR)
TABLET 0 0 0

59
MG/ML 1 ML
AMPUL 0 0 0


63
2,5ML-STESOLID
TUBE 0 0 0

66
MG/ML 1 ML
AMPUL 0 0 0

72
SALEP 15 GR
TUBE 0 0 0
73
1 ML
AMPUL 0 0 0

75
MG/5ML
BOTOL 0 0 0

77
300 ML
BOTOL 0 0 0

82
ML
AMPUL 0 0 0
84
% 5 ML
BOTOL 0 0 0
85
MG/ML 1 ML
AMPUL 0 0 0
86
SALUT 10 MG
TABLET 0 0 0
87
2MG/ML
AMPUL 0 0 0
88
25 MG 1 ML
AMPUL 0 0 0

97
MG
TABLET 0 0 0

100
VIAL 0 0 0
101
STERIL
BOTOL 0 0 0
102
STERIL
BOTOL 0 0 0

106
(LODOMER)
AMPUL 0 0 0

110
BOTOL 0 0 0

114
PORT
PCS 0 0 0
115
PORT
PCS 0 0 0
116
INJECTION PORT
PCS 0 0 0
117
INJECTION PORT
PCS 0 0 0
118
INJECTION PORT
PCS 0 0 0
119
INJECTION PORT
PCS 0 0 0
120
200MG/5ML
BOTOL 0 0 0
121
60 ML
BOTOL 0 0 0

125
5 MG
TABLET 0 0 0

128
MG/ML 10 ML
AMPUL 0 0 0
129
MG
TABLET 0 0 0

135
STRIL
ROL 0 0 0
136
CM
ROL 0 0 0
137
CM
ROL 0 0 0
138
CM
ROL 0 0 0
139
DIRESAPI FRAMISETIN
PCS 0 0 0

147
ML
BOTOL 0 0 0

149
TABLET 4 MG
TABLET 0 0 0
150
MG/ML 1 ML
AMPUL 0 0 0
151
MG/ML 1 ML
AMPUL 0 0 0

160
ML
AMPUL 0 0 0

165
% 25 ML
AMPUL 0 0 0

170
MG/2ML
AMPUL 0 0 0
172
0,200 MG 1 ML
AMPUL 0 0 0
173
0,125 MG
TABLET 0 0 0

177
AMPUL 0 0 0

179
(PROVAGIN) OVULA
VIAL 0 0 0

182
100 ML
BOTOL 0 0 0

184
MG
TABLET 0 0 0
185
MG
TABLET 0 0 0
186
STERIL
BOTOL 0 0 0

190
100 ML
BOTOL 0 0 0

193
GR
TUBE 0 0 0
194
3,5 GR
TUBE 0 0 0

198
60 ML
BOTOL 0 0 0

200
ML
BOTOL 0 0 0

207
MG
TABLET 0 0 0

214
STERIL
BOTOL 0 0 0

227
INJ.5 ML (ABU I)
VIAL 0 0 0
228
IU/AMP (ATS)
VIAL 0 0 0

230
500 MCG/ML 1 ML
AMPUL 0 0 0
231
50 MCG
TABLET 0 0 0
232
NO.3/0
PCS 0 0 0

237
MATA 15 % 5 ML
BOTOL 0 0 0
238
PCS 0 0 0

241
TABLET 50 MG
TABLET 0 0 0
242
INJECTION
PCS 0 0 0

244
TABLET 2 MG
TABLET 0 0 0

246
ML
BOTOL 0 0 0
247
ML
BOTOL 0 0 0
248
PSEUDOEPHEDRINE)
TABLET 0 0 0


HIOPAR (HYOSCINE-N-
PARACETAMOL 500 MG)
PARACETAMOL 500 MG)

276
NO.2/0
PCS 0 0 0


12
(IgG\/IgM dan NS1)
TEST 0 0 0

17
400 MG
TABLET 0 0 0
18
MG/5ML
BOTOL 0 0 0
19
100.000 IU
KAPSUL 0 0 0
20
200.000 IU
KAPSUL 0 0 0

24
INJEKSI (HBIg)
SYRINGE 0 0 0


29
INJEKSI 2.4 UI/ML
VIAL 0 0 0
30
MG
TABLET 0 0 0
31
TEST 0 0 0
32
TEST 0 0 0

MG (TLD)
37
COMBO TEST
TEST 0 0 0
RAPID TEST

44
HIV 1/2 TEST
TEST 0 0 0
45
TEST
TEST 0 0 0

MG (TLE)

50
LAMIVUDINE 150 MG
BOTOL 0 0 0

54
Hib)
VIAL 0 0 0


63
SYRINGE 0,05 ML
SYRINGE 0 0 0
64
SYRINGE 0,5 ML
SYRINGE 0 0 0
65
SYRINGE 0,3 ML
SYRINGE 0 0 0
66
SYRINGE 3 ML
SYRINGE 0 0 0
67
SYRINGE 5 ML
SYRINGE 0 0 0
68
LITER
PIECES 0 0 0


72
INJEKSI 40 MG
AMPUL 0 0 0
73
INJEKSI 40%
AMPUL 0 0 0
74
INJEKSI 20%
AMPUL 0 0 0
75
MG/ML
BOTOL 0 0 0
76
2 MG/ML
AMPUL 0 0 0

78
MG/ML
AMPUL 0 0 0

90
RHZE 150/75/400/275 + RH 150/75
PAKET 0 0 0
91
RHZE 150/75/400/175 + RH 150/150
PAKET 0 0 0
92
75/50/150 + RH 75/50
PAKET 0 0 0

97
300/300
PAKET 0 0 0

108
CATRIDGE
PIECES 0 0 0

109
PROTEIN
SACHET 0 0 0


118
STEP RAPID TEST
TEST 0 0 0
122
REAGEN
BOTOL 0 0 0

126
DRUG 7 IN 1
TEST 0 0 0

136
CHOLESTEROL
PIECES 0 0 0
137
HEMOGLOBIN
PIECES 0 0 0

OBAT TAMBAHAN

OBAT TAMBAHAN



92 0 0 0 0
93 0 0 0 0
94 0 0 0 0
95 0 0 0 0
96 0 0 0 0
97 0 0 0 0
98 0 0 0 0
99 0 0 0 0
100 0 0 0 0
Blitar ,
Yang Menyerahkan,
Puskesmas
NIP. 19691230 201001 2 002 NIP : 19880803 201502 1 001 NIP : 19910317 202012 1 012 NIP. 19861218 201903 2 004
19861218 201903 2 004
PUSKESMAS : PERMINTAAN BULAN : JANUARI 2024
UPT IFK
KECAMATAN :
KABUPATEN : BLITAR
PUSKESMAS
SISA STOK JUMLAH

GUDANG OBAT ED
1 2 3 4 5 6 = 4+5 7 8 = (6-7)-10 9 10 11

15
10 ML
AMPUL 0 0 0

TANGGAL
PEMBERIAN
12

19
ML 60 ML
BOTOL 0 0 0
20
MG
VIAL 0 0 0

22
250MG/5ML
BOTOL 0 0 0
23
MG/VIAL
VIAL 0 0 0
24
(METAMIZOL)
TABLET 0 0 0

27
KOMBINASI 5 GR
POT 0 0 0
28
30 GR
POT 0 0 0

30
KOMBINASI
TABLET 0 0 0
31
(DORMICOMP)
TABLET 0 0 0
32
PIROGEN 20 ML
BOTOL 0 0 0
33
MG
TABLET 0 0 0

36
INJEKSI
AMPUL 0 0 0

38
DEPAKOTE ER
TABLET 0 0 0

45
MG/ML 1 ML
AMPUL 0 0 0

52
(CONCOR)
TABLET 0 0 0

59
MG/ML 1 ML
AMPUL 0 0 0


63
2,5ML-STESOLID
TUBE 0 0 0

66
MG/ML 1 ML
AMPUL 0 0 0

72
SALEP 15 GR
TUBE 0 0 0
73
1 ML
AMPUL 0 0 0

75
MG/5ML
BOTOL 0 0 0

77
300 ML
BOTOL 0 0 0

82
ML
AMPUL 0 0 0
84
% 5 ML
BOTOL 0 0 0
85
MG/ML 1 ML
AMPUL 0 0 0
86
SALUT 10 MG
TABLET 0 0 0
87
2MG/ML
AMPUL 0 0 0
88
25 MG 1 ML
AMPUL 0 0 0

97
MG
TABLET 0 0 0

100
VIAL 0 0 0
101
STERIL
BOTOL 0 0 0
102
STERIL
BOTOL 0 0 0

106
(LODOMER)
AMPUL 0 0 0

110
BOTOL 0 0 0

114
PORT
PCS 0 0 0
115
PORT
PCS 0 0 0
116
INJECTION PORT
PCS 0 0 0
117
INJECTION PORT
PCS 0 0 0
118
INJECTION PORT
PCS 0 0 0
119
INJECTION PORT
PCS 0 0 0
120
200MG/5ML
BOTOL 0 0 0
121
60 ML
BOTOL 0 0 0

125
5 MG
TABLET 0 0 0

128
MG/ML 10 ML
AMPUL 0 0 0
129
MG
TABLET 0 0 0

135
STRIL
ROL 0 0 0
136
CM
ROL 0 0 0
137
CM
ROL 0 0 0
138
CM
ROL 0 0 0
139
DIRESAPI FRAMISETIN
PCS 0 0 0

147
ML
BOTOL 0 0 0

149
TABLET 4 MG
TABLET 0 0 0
150
MG/ML 1 ML
AMPUL 0 0 0
151
MG/ML 1 ML
AMPUL 0 0 0

160
ML
AMPUL 0 0 0

165
% 25 ML
AMPUL 0 0 0

170
MG/2ML
AMPUL 0 0 0
172
0,200 MG 1 ML
AMPUL 0 0 0
173
0,125 MG
TABLET 0 0 0

177
AMPUL 0 0 0

179
(PROVAGIN) OVULA
VIAL 0 0 0

182
100 ML
BOTOL 0 0 0

184
MG
TABLET 0 0 0
185
MG
TABLET 0 0 0
186
STERIL
BOTOL 0 0 0

190
100 ML
BOTOL 0 0 0

193
GR
TUBE 0 0 0
194
3,5 GR
TUBE 0 0 0

198
60 ML
BOTOL 0 0 0

200
ML
BOTOL 0 0 0

207
MG
TABLET 0 0 0

214
STERIL
BOTOL 0 0 0

227
INJ.5 ML (ABU I)
VIAL 0 0 0
228
IU/AMP (ATS)
VIAL 0 0 0

230
500 MCG/ML 1 ML
AMPUL 0 0 0
231
50 MCG
TABLET 0 0 0
232
NO.3/0
PCS 0 0 0

237
MATA 15 % 5 ML
BOTOL 0 0 0
238
PCS 0 0 0

241
TABLET 50 MG
TABLET 0 0 0
242
INJECTION
PCS 0 0 0

244
TABLET 2 MG
TABLET 0 0 0

246
ML
BOTOL 0 0 0
247
ML
BOTOL 0 0 0
248
PSEUDOEPHEDRINE)
TABLET 0 0 0


HIOPAR (HYOSCINE-N-
PARACETAMOL 500 MG)
PARACETAMOL 500 MG)

276
NO.2/0
PCS 0 0 0


12
(IgG\/IgM dan NS1)
TEST 0 0 0

17
400 MG
TABLET 0 0 0
18
MG/5ML
BOTOL 0 0 0
19
100.000 IU
KAPSUL 0 0 0
20
200.000 IU
KAPSUL 0 0 0

24
INJEKSI (HBIg)
SYRINGE 0 0 0


29
INJEKSI 2.4 UI/ML
VIAL 0 0 0
30
MG
TABLET 0 0 0
31
TEST 0 0 0
32
TEST 0 0 0

MG (TLD)
37
COMBO TEST
TEST 0 0 0
RAPID TEST

44
HIV 1/2 TEST
TEST 0 0 0
45
TEST
TEST 0 0 0

MG (TLE)

50
LAMIVUDINE 150 MG
BOTOL 0 0 0

54
Hib)
VIAL 0 0 0


63
SYRINGE 0,05 ML
SYRINGE 0 0 0
64
SYRINGE 0,5 ML
SYRINGE 0 0 0
65
SYRINGE 0,3 ML
SYRINGE 0 0 0
66
SYRINGE 3 ML
SYRINGE 0 0 0
67
SYRINGE 5 ML
SYRINGE 0 0 0
68
LITER
PIECES 0 0 0


72
INJEKSI 40 MG
AMPUL 0 0 0
73
INJEKSI 40%
AMPUL 0 0 0
74
INJEKSI 20%
AMPUL 0 0 0
75
MG/ML
BOTOL 0 0 0
76
2 MG/ML
AMPUL 0 0 0

78
MG/ML
AMPUL 0 0 0

90
RHZE 150/75/400/275 + RH 150/75
PAKET 0 0 0
91
RHZE 150/75/400/175 + RH 150/150
PAKET 0 0 0
92
75/50/150 + RH 75/50
PAKET 0 0 0

97
300/300
PAKET 0 0 0

108
CATRIDGE
PIECES 0 0 0
109
PROTEIN
SACHET 0 0 0


118
STEP RAPID TEST
TEST 0 0 0

122
REAGEN
BOTOL 0 0 0

126
DRUG 7 IN 1
TEST 0 0 0

136
CHOLESTEROL
PIECES 0 0 0
137
HEMOGLOBIN
PIECES 0 0 0

OBAT TAMBAHAN

OBAT TAMBAHAN



92 0 0 0 0
93 0 0 0 0
94 0 0 0 0
95 0 0 0 0
96 0 0 0 0
97 0 0 0 0
98 0 0 0 0
99 0 0 0 0
100 0 0 0 0
Blitar ,
NIP. 19691230 201001 2 002 NIP : 19880803 201502 1 001 NIP : 19910317 202012 1 012 NIP. 19861218 201903 2 004
Yang Menyerahkan,
Puskesmas

19861218 201903 2 004

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KEPALA PUSKESMAS: dr. ENDAH ROSITANINGSIH, SE., MM.

NIP : 19691230 201001 2 002

SISA STOK JUMLAH

1 2 WAY FOLEY CATHETER NO.16 PCS 0 0 0 0

2 2 WAY FOLEY CATHETER NO.18 PCS 0 0

3 2 WAY FOLEY CATHETER NO.20 PCS 0 0

4 ACETYLCYSTEINE CAPSULE 200 MG CAPSULE 0 0

5 ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0 0

6 ALAT SUNTIK SEKALI PAKAI 10 ML PCS 0 0

7 ALAT SUNTIK SEKALI PAKAI 20 ML PCS 0 0

8 ALAT SUNTIK SEKALI PAKAI 3 ML PCS 0 0

9 ALAT SUNTIK SEKALI PAKAI 5 ML PCS 0 0

10 ALKOHOL SWAB PCS 0 0

11 ALLOPURINOL TABLET 100 MG TABLET 0 0

12 ALPRAZOLAM 1 MG TABLET TABLET 0 0

13 AMBROXOL SIRUP 5MG/ML BOTOL 0 0

14 AMBROXOL TABLET 30 MG TABLET 0 0

17 AMLODIPINE TABLET 10 MG TABLET 0 0

18 AMLODIPINE TABLET 5 MG TABLET 0 0

21 AMOKSISILIN TABLET 500 MG KAPLET 0 0

25 ANTASIDA DOEN TABLET KOMBINASI TABLET 0 0

26 ANTASIDA SUSPENSI 60 ML BOTOL 0 0

29 ANTI HAEMOROID DOEN KOMBINASI SUPP. 0 0

34 ASAM FOLAT 1MG TABLET TABLET 0 0

35 ASAM MEFENAMAT TABLET 500 MG TABLET 0 0

39 ASEPTAN 500CC + PUMP BOTOL 0 0

40 ASEPTIC GEL 500CC + DISPENSER BOTOL 0 0

41 ASERING (ASETAT RINGER) SOFT BAG BOTOL 0 0

42 ASETOSAL TABLET 100 (80) MG TABLET 0 0

43 ASIKLOVIR KREAM 5 % 5 GR TUBE 0 0

44 ASIKLOVIR TABLET 400 MG TABLET 0 0

46 ATTAPULGIT + PECTIN TABLET TABLET 0 0

47 BETAHISTINMESILAT 6 MG TABLET TABLET 0 0

48 BETAMETHASONE CREAM 0,1 % 5 GR TUBE 0 0

49 BISAKODIL TABLET 5 MG TABLET 0 0

50 BISAKODIL SUPPOSITORIA 10 MG SUPP. 0 0

51 BISAKODIL SUPPOSITORIA 5 MG SUPP. 0 0

53 BISOPROLOL 5 MG TABLET TABLET 0 0

54 CAT GUT NO. 3/0 CHROMIC PCS 0 0

55 CAT GUT NO. 3/0 PLAIN PCS 0 0

56 CITICHOLIN 250 MG/ML-2ML INJEKSI AMPUL 0 0

57 CLONIDINE 0.15 MG TABLET TABLET 0 0

60 DEKSAMETHASONE TABLET 0,5 MG TABLET 0 0

61 DEVITALISASI PASTA ( NON ARSEN ) POT 0 0

62 DIAZEPAM INJEKSI 5 MG/ML 2 ML AMPUL 0 0

64 DIAZEPAM TABLET 2 MG TABLET 0 0

65 DIAZEPAM TABLET 5 MG TABLET 0 0

67 DIGOXIN TABLET 0,25 MG TABLET 0 0

68 DIMENHYDRINATE TABLET 50 MG TABLET 0 0

69 DOKSISIKLIN TABLET 100 MG KAPSUL 0 0

70 DOMPERIDON SUSPENSI 5MG/ML BOTOL 0 0

71 DOMPERIDON TABLET 10 MG TABLET 0 0

74 ERITROMISIN KAPSUL 250 MG KAPSUL 0 0

76 ERITROMISIN TABLET 500 MG KAPSUL 0 0

78 ETANOL [ ALKOHOL ] 70 % 1000 ML BOTOL 0 0

80 EUGENOL CAIRAN 10 ML BOTOL 0 0

81 FENITOIN NATRIUM TABLET 100 MG KAPSUL 0 0

83 FENOBARBITAL TABLET 30 MG TABLET 0 0

89 FUROSEMID INJEKSI 10 mg VIAL 0 0

90 FUROSEMID TABLET 40 MG TABLET 0 0

91 GEMFIBROZIL 300 MG KAPSUL KAPSUL 0 0

92 GENTAMISIN SALEP KULIT 0,1 % 5 GR TUBE 0 0

93 GENTAMISIN SALEP MATA 0,3% TUBE 0 0