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Laporan Pemakaian Obat Apotek Januari 2019

This document is a report on the usage and request form for medicine supplies from the sub-unit pharmacy of Marga II District, Tabanan Regency, Bali, Indonesia for the month of February 2019. It includes a table listing 77 different medicines with details on initial stock, additional supplies received, amount used, remaining stock, and requested additional supplies for the next period. The table provides a concise inventory of medicine stocks and needs to help ensure adequate supplies are available.

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69 views144 pages

Laporan Pemakaian Obat Apotek Januari 2019

This document is a report on the usage and request form for medicine supplies from the sub-unit pharmacy of Marga II District, Tabanan Regency, Bali, Indonesia for the month of February 2019. It includes a table listing 77 different medicines with details on initial stock, additional supplies received, amount used, remaining stock, and requested additional supplies for the next period. The table provides a concise inventory of medicine stocks and needs to help ensure adequate supplies are available.

Uploaded by

sastro Backup1
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLS, PDF, TXT or read online on Scribd

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT SUB UNIT

DOKUMEN NOMOR TANGGAL


PUSK
SUB UNIT

SUB UNIT : APOTEK PELAPORAN BULAN / PERIODE : JANUARI 2019


KECAMATAN :MARGA II PERMINTAAN BULAN / PERIODE : FEBRUARI 2019
KABUPATEN : TABANAN

No Nama Obat Satuan STOK PENERI PERSEDIAA PEMAK SISA PERMIN PENERI
AWAL MAAN N AIAN STOK TAAN MAAN KET
1 2 3 4 5 6(4 + 5) 7 8(6-7) 9 10 11
1 Acyclovir Salep Tube 0 10 10 3 7 10 10
2 Acyclovir 400 mg Tab Tablet 11 200 211 60 151
3 Air raksa dental use Botol 0 0 0 0
4 Albendazol 400 mg tab Tablet 29 29 29 0
5 Alprazolam 0.5 mg Tablet 124 600 724 435 289 500 800
6 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 85 150 235 90 145
7 Ambroxol syr Botol 7 55 62 31 31 10 10
8 Ambroxol tab 30 mg / Promukus Tablet 63 500 563 136 427
9 Aminofilina injeksi 24 mg/ ml. 10 ml Ampul 5 5 0 5
10 Aminofilna tablet 200 mg Tablet 0 0 0 0
11 Amitriptilina hcl tablet salut 25 mg Tablet 140 140 45 95
12 Amoksilina kapsul 500 mg Tablet 665 1500 2165 1789 376 500 2100
13 Amoksilna sirup kering 125 mg/ 5 mg Botol 0 0 0 0
14 Antasida doen tablet kombinasi Tablet 461 500 961 614 347 500 500
15 Anti hemmoroid suppositoria Supp 0 0 0 0
16 Aqua pro injeksi streril. Bebas priogen 20 ml Vial 0 0 0 0
17 Aquadest steril 500 ml Botol 0 0 0 0
18 As salisilat 2% + belerang endap 4%(2-4 salep Pot 0 0 0 0
19 As. Benzoat 3 % + as salisilat 6%(whitefield) Pot 0 0 0 0
20 Asam askorbat (Vit. C) tablet 50 mg Tablet 0 0 0 0
21 Asam mefenamat 500 mg Tablet 8 300 308 308 0
22 Asetosal 100 mg Tablet 0 0 0 0
23 Asetosal tablet 500 mg Tablet 0 0 0 0
24 Atropina sulfat injeksi 0 .25 mg / ml - 1 ml Ampul 3 3 0 3
25 Basitrasin Polimiksin Tube 4 50 54 25 29
26 Besi (II) sulfat tablet salut .kombinasi Tablet 24 200 224 185 39 500 800
27 Betahistin tab Tablet 168 300 468 325 143 300 300
28 Betametazon salep kulit Tube 7 4 11 3 8
29 Captopril 12.5 mg tablet Tablet 0 0 0 0
30 Captopril 25 mg tablet Tablet 40 1000 1040 910 130 500 1000
31 Carbamazepina 200 mg talet Tablet 0 0 0 0
32 Cefadroxil 125mg/5ml Sirup Botol 10 50 60 55 5 10 45
33 Cefadroxill 500 mg tablet Tablet 0 0 0 0
34 Cefotaxim 1 gr Injeksi Ampul 0 0 0 0
35 Cetirizin10 mg tab Tablet 141 600 741 474 267 200 400
36 Cimetidine/Selestidin Tablet 0 0 0 0
37 Ciprofloxazin tablet 500 mg Tablet 320 500 820 385 435
38 Deksametason injeksi 5 mg / ml - 1 ml Ampul 14 14 0 14
39 Deksametason tablet 0.5 mg Tablet 203 203 57 146 500 1500
40 Devitalisasi pasta Tube 0 0 0 0
41 Diazepam 5 mg Tablet 0 0 0 0
42 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0 0 0 0
43 Diazepam tablet 2 mg Tablet 0 100 100 75 25 100 100
44 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 2 2 2 0
45 Digoksina tablet 0. 25 mg Tablet 75 100 175 60 115
46 Domperidon tablet 10 mg Tablet 376 500 876 790 86 500 1000
47 Doxycicline 100 mg tab Tablet 0 0 0 0
48 Efedrina HCL (efedrina) tablet 25 mg Tablet 0 0 0 0
49 Epinefrina HCL / bitartat (aderenalina) inj 01% Ampul 13 13 0 13
50 Ergotamina tartrat 1 mg + kofeina 50 mg tab Tablet 0 0 0 0
51 Erytromysin 200mg/5ml Syrup Botol 0 0 0 0
52 Erytromysin tablet 500 mg Tablet 0 0 0 0
53 Etakridina (rivanol) larutan 0.1 % Botol 0 0 0 0
54 Etil klorida semprot Botol 0 0 0 0 1 1
55 Eugenol cairan Botol 0 1 1 0 1
56 Fenobarbital inj 50 mg /ml -2ml Ampul 0 0 0 0
57 Fenobarbital tablet 100mg Tablet 0 0 0 0
58 Fenobarbital tablet 30 mg Tablet 140 140 0 140
59 Fenol gliserol tetes telnga 10% Botol 0 0 0 0
60 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0 0 0 0
61 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0 0 0 0
62 Furosemida tablet 40 mg Tablet 27 100 127 30 97 200 200
63 Garam Oralit untuk 200 ml air Sachet 74 100 174 161 13 100 200
64 Gentamisin Salep Mata Tube 0 0 0 0 10 10
65 Gentamysin SK Tube 0 0 0 0
66 Gentamysin TM/Genoint TM Botol 6 6 3 3
67 Gentian violet larutan 1 % Botol 0 0 0 0
68 Glibenklamida tablet 5 mg Tablet 0 0 0 0
69 Gliseril guayakolat tablet 10 mg Tablet 0 0 0 0
70 Glukosa larutan infus 10 % steril Botol 1 1 0 1
71 Glukosa larutan infus 40 % steril Botol 0 0 0 0
72 Glukosa larutan infus 5 % steril Botol 0 0 0 0
No Nama Obat Satuan STOK PENERI PERSEDIAA PEMAK SISA PERMIN PENERI
AWAL MAAN N AIAN STOK TAAN MAAN KET
73 Griseofulvin tablet 125 mg. Mikronized Tablet 0 0 0 0
74 Haloperidol 0,5 mg. Tablet Tablet 0 0 0 0
75 Haloperidol 1,5 mg tablet Tablet 0 0 0 0
76 Haloperidol 5 mg tablet Tablet 0 0 0 0
77 Hidroklorotiasida (HCT) tablet 25 mg Tablet 199 199 60 139
78 Hidrokortison krim 2.5 % Tube 19 14 33 25 8 24 24
79 Ibuprofen tablet 400 mg Tablet 0 0 0 0
80 Isoniazide 100 mg Tablet 43 43 0 43
81 Isoniazide 300 mg Tablet 0 0 0 0
82 Isosorbid dinitrat Tablet 0 100 100 30 70
83 Kalsium hidroksida pasta Pot 1 1 0 1
84 Kalsium laktat (kalk) tablet 500 mg Tablet 0 0 0 0
85 Ketokonazole 200 mg tablet Tablet 153 100 253 131 122 100 100
86 Kinina dihidroklorida (kinina) inj 25 % - 2 ml Ampul 0 0 0 0
87 Kinina sulfat tablet 222 mg (7 h20 ) Tablet 0 0 0 0
88 Kloramfenicol salep kulit Tube 0 0 0 0
89 Kloramfenikol kapsul 250 mg Tablet 0 0 0 0
90 Kloramfenikol salep mata 1 % Tube 0 0 0 0
91 Kloramfenikol tetes Mata Botol 0 0 0 0
92 Kloramfenikol tetes telinga 3 % Botol 3 3 0 3 5 5
93 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 142 500 642 143 499
94 Klorpromazin 100 mg tablet Tablet 0 0 0 0
95 Klorpromazina Hcl inj 25 mg / ml - 1 ml Ampul 0 0 0 0
96 Klorpromazina Hcl inj 5 mg / ml - 2 ml Ampul 0 0 0 0
97 Klorpromazina hcl tablet salut 25 mg Tablet 34 34 6 28
98 Kodeina Hcl (kodeina) tablet 10 mg Tablet 0 0 0 0
99 Kotrimoksasol suspensi Botol 2 15 17 7 10
100 Kotrimoksasol tablet kombinasi Tablet 0 0 0 0
101 Lidokain inj Ampul 0 100 100 13 87
102 Lidokaina comp inj kombinasi Ampul 0 0 0 0
103 Metakresol sulfonat dan metanol kondensai (AlbotyBotol 0 0 0 0
104 Metformin 500 mg tablet Tablet 320 500 820 770 50 500 1000
105 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0 0 0 0
106 Metilergometrina malet tablet salut 0. 125 mg Tablet 0 0 0 0
107 Metilprednisolon tablet 4 mg Tablet 940 2000 2940 2753 187 200 700
108 Metoklopramide 10 mg tablet/Noristal Tablet 0 0 0 0
109 Metronidazol 500 mg Tablet 0 0 0 0
110 Metronidazol tablet 250 mg Tablet 0 0 0 0
111 Mikonazole salep Tube 12 12 1 11
112 Monoklorkamfer mentolcairan (CHKM) Botol 0 1 1 0 1
113 Mumifyng pasta Botol 1 1 0 1
114 Natrium bikarbonat tablet 500 mg Tablet 0 0 0 0
115 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 320 600 920 920 0 500 500
116 Natrium klorida larutan infus 0. 9 steril Botol 0 3 3 0 3
117 Nifedipin tablet 10 mg Tablet 0 0 0 0
118 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 9 20 29 4 25 20 20
119 Obat batuk hitam (OBH) cairan Botol 100 m 0 0 0 0
120 Ofloxacin tab 400mg Tablet 0 0 0 0
121 Oksigen gas dalam tabung 3 m3 Tabung 0 0 0 0
122 Oksigen gas dalam tabung 6 m3 Tabung 0 0 0 0
123 Oksitetrasiklina hcl salep 3 % Tube 0 0 0 0
124 Oksitetrasiklina hcl salep mata 1 % Tube 0 0 0 0
125 Oksitosina inj 10 iu/ml - 1 ml Ampul 0 0 0 0
126 Parasetamol sirup 120 mg / 5 ml Botol 6 30 36 27 9 10 20
127 Parasetamol tab 100 mg Tablet 0 0 0 0
128 Parasetamol tablet 500mg Tablet 536 1500 2036 1567 469 500 1500
129 Pirantel pamoat (pirantel) tablet 125 mg basa Tablet 0 0 0 0
130 Piroxicam 10 Mg Tablet 0 0 0 0
131 Piroxicam 20 Mg Tablet 0 0 0 0
132 Prednison tablet 5 mgn Tablet 0 0 0 0
133 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0 0 0 0
134 Primakina tablet 15 mg Tablet 0 0 0 0
135 Prokaina penisilina g inj 3 juta iu Vial 0 0 0 0
136 Propiltionurasil tablet 100 mg Tablet 0 0 0 0
137 Propranolol hcl (Propranolol) tablet 40 mg Tablet 0 0 0 0
138 Pyridoxin injeksi Ampul 0 0 0 0
139 Ranitidin inj 25 mg/2 ml Ampul 3 3 2 1
140 Ranitidin tablet 150 mg Tablet 647 647 422 225 500 500
141 Reserpina tablet 0, 10 mg Tablet 0 0 0 0
142 Reserpina tablet 0, 25 mg Tablet 0 0 0 0
143 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0 0 0 0
144 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0 0 0 0
145 Ringer laktat larutan infus steril Botol 3 2 5 0 5 2 2
146 Risperidon Tablet 10 100 110 75 35 100 100
147 Salbutamol tablet 2 mg Tablet 0 0 0 0
148 Salbutamol tablet 4 mg Tablet 365 400 765 477 288 500 500
149 Salisil bedak 2 % Bks 19 19 0 19
150 Salisil spiritus 10 % Botol 0 0 0 0
151 Semen seng fosfat serbuk dan cairan Botol 0 0 0 0
152 Serum anti bisa ular polivalen inj. 5ml Ampul 0 0 0 0
153 Serum anti tetanus inj. 1.500 iu Ampul 0 0 0 0
154 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0 0 0 0
155 Silver amalgam serbuk 65-75% Botol 0 0 0 0
156 Simvastatin tab 10 mg Tablet 150 150 0 150
157 Sulfacetamide tetes mata Botol 0 0 0 0
No Nama Obat Satuan STOK PENERI PERSEDIAA PEMAK SISA PERMIN PENERI
AWAL MAAN N AIAN STOK TAAN MAAN KET
158 Synthetic filing material larutan dan serbuk Set 0 0 0 0
159 Temporary stopping fletcher serbuk dan cairan Set 0 0 0 0
160 Tetrasiklina hcl (tetrasiklina) kapsul 250 mg Tablet 0 0 0 0
161 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 130 130 105 25 200 200
162 Thiamfenikol 500 Tablet 0 0 0 0
163 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0 0 0 0
164 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0 0 0 0
165 Tramadol Tablet 0 0 0 0
166 Trifluoperazine (Stelazin) Tablet 40 40 0 40
167 Triheksfenidil hcl 2 mg tablet Tablet 5 5 0 5
168 Trikresol formalin (tkf) cairan Botol 0 1 1 0 1
169 Vitamin B kompleks tablet Tablet 0 0 0 0
170 Yodium povidan larutan 10% 300 ml Botol 0 0 0 0
171 Yodium povidon larutan 10% 30 ml Botol 0 0 0 0
172 Zink tablet Tablet 70 200 270 116 154 200 200
Amoxcilin syrup 250 mg/ 5 ml botol 35 35 7 28
0
OBAT TAMBAHAN 0 0 0 0
173 Aptil Botol 0 0 0 0
174 (Lopinavir/Ritonavir)Aluvia Botol 0 0 0 0
175 Abacavir Tablet 0 0 0 0
176 Acyclovir tablet 200 mg Tablet 0 0 0 0
177 Aleterol TM Botol 0 0 0 0
178 Amlodipin 10 mg tab Tablet 0 0 0 0
179 Amlodipin 5 mg tab Tablet 533 1800 2333 1935 398 300 1500
180 Amox-clav Tablet 0 0 0 0
181 Ampisilin Serbuk Injeksi i.m/i.v. 1000 mg/ml Ampul 0 0 0 0
182 Ampisillin injeksi i.m/i.v 1000 mg/ml Ampul 0 0 0 0
183 Antalgin injeksi Ampul 0 0 0 0
184 Antasida syr Botol 0 0 0 0
185 Arterakine Tablet 0 0 0 0
186 Artesunat inj Vial 0 0 0 0
187 Asam Folat 1 mg Tablet 0 200 200 55 145 100 100
188 Asam tranexamat 500 mg Tablet 0 0 0 0
189 Asetosal 80/miniaspi tablet 0 0 0 0
190 Atripla(TDF+3TC+EFV) Botol 0 0 0 0
191 Azitromisin+cefixim Tablet 0 0 0 0
192 Azytromisin tablet 500 mg Tablet 0 0 0 0
193 BD Vacuntainer Pcs 0 0 0 0
194 Becefort Tablet 209 500 709 297 412 300 300
195 Benzatin Penisillin Vial 0 0 0 0
196 Bonding Set 1 1 0 1
197 Bufacomb salep Tube 5 5 10 3 7
198 Buscopan inj Ampul 0 0 0 0
199 Caviton Tube 1 1 2 0 2
200 Cefixim syr 100 mg/5 ml Botol 0 0 0 0
201 Cefixim tablet 100 mg Tablet 0 0 0 0
202 Cefixim tablet 200 mg Tablet 0 0 0 0
203 Cefotaxim 0,5 g inj Vial 0 0 0 0
204 Ceftriaxon inj Vial 0 0 0 0
205 Clarithromysin 500 mg Tablet 0 0 0 0
206 Clavamox inj Ampul 0 0 0 0
207 Clindamisin 150 mg Tablet 0 0 0 0
208 Clindamisin 300 mg Tablet 0 0 0 0
209 Clobazam 10 mg Tablet 0 0 0 0
210 Clozapine 25 mg Tablet 350 350 30 320
211 Composite (tumpatan sinar)A3 Set 1 1 0 1
212 Composite (tumpatan sinar)A3.5 Set 1 1 0 1
213 Crofed Tablet 0 0 0 0
214 D1/2 NS botol 0 0 0 0
215 D1/4 NS Botol 0 0 0 0
216 Daryantulle Lembar 0 20 20 0 20
217 Dermazine/Burnazin Tube 0 0 0 0 2 2
218 Dextina / Dextamin/Dextamec/Polofar Plus Tablet 180 500 680 300 380 300 500
219 Dextran 70% Botol 0 0 0 0
220 Dextrofen syr Botol 11 45 56 45 11 10 35
221 Diaform tablet/selesdiar Tablet 0 0 0 0
222 Dormi/Scopma/Spashi tablet Tablet 20 100 120 0 120
223 Dulcolac anak supp Supp 0 0 0 0
224 Dulcolac dewasa supp Supp 0 0 0 0
225 Dulkolak tablet Tablet 0 0 0 0
226 Duviral(Zidovudin 300+Lamivudin 150) Botol 0 0 0 0
227 Efavirenz Botol 0 0 0 0
228 Etambutol Tablet 0 0 0 0
229 ETSA Set 1 1 0 1
230 Euthyrox 100mg Tablet 0 0 0 0
231 Faktu Supp Supp 0 0 0 0
232 Fluconasol tab Tablet 0 0 0 0
233 Fluoxetin Tablet 20 20 0 20
234 Forumen TT Fls 0 0 0 0
235 Gentamisin Injeksi 80 mg/2ml Ampul 0 0 0 0
236 Glass ionomer (Ketac Molar) Tube 1 1 0 1
237 Glimepiride 2 tablet 215 1000 1215 790 425 500 1000
238 Glimepiride 4 tablet 0 0 0 0
239 Glukonas Calcicus 10%- 10ml Ampul 2 2 0 2
No Nama Obat Satuan STOK PENERI PERSEDIAA PEMAK SISA PERMIN PENERI
AWAL MAAN N AIAN STOK TAAN MAAN KET
240 Haldol inj Ampul 0 0 0 0
241 Hiviral (Lamivudin 150) Botol 0 0 0 0
242 Ibuprofen syr btl 0 0 0 0
243 Iliadin TH flesh 0 0 0 0
244 Isotic Neolisin TM Fls 8 10 18 12 6 10 20
245 Kalium Diklovenac tablet 308 308 308 0 500 500
246 Kaltropen supp Supp 2 2 0 2
247 Ketoconazole SK tube 2 15 17 14 3 10 20
248 Ketoprofen inj 10 mg Ampul 0 0 0 0
249 Ketoprofen tablet 100 mg Tablet 0 0 0 0
250 Ketorolac inj Ampul 0 0 0 0
251 Kombipak Anak Paket 0 0 0 0
252 Lodomer 2 Tablet 0 0 0 0
253 Lytamin syr botol 0 0 0 0
254 Magnesium Sulfat 20% - 25 ml Botol 0 0 0 0
255 Magnesium Sulfat 40% - 25 ml Botol 2 2 0 2
256 Metil Prednisolon 16 mg Tablet 0 0 0 0
257 Metil prednisolon inj 500 mg Vial 0 0 0 0
258 Metronidazole 500 mg Infus/100 ml Botol 0 0 0 0
259 Meylon inj Botol 0 0 0 0
260 Microlax Supp 0 2 2 0 2 2 2
261 Miloxicam 7,5 mg tablet 0 150 150 50 100 300 480
262 Molexflu Tablet 0 0 0 0
263 Multivitamin (Livron B plek) Tablet 665 665 125 540
264 Multivitamin sirup( Xanvit syr) Botol 0 0 0 0
265 Neurotropik tablet Tablet 0 0 0 0
266 Neviral (neviravin 200mg) Botol 0 0 0 0
267 New antides tablet 455 455 96 359
268 Nutrifar 5000 Tablet 0 0 0 0
269 Obat anti tuberkulosis FDC katagori I Paket 0 2 2 1 1
270 Obat anti tuberkulosis FDC anak Paket 0 0 0 0
271 Obat anti tuberkulosis FDC katagori II Paket 0 0 0 0
272 Obat anti tuberkulosis FDC sisipan Paket 0 0 0 0
273 Obat anti tuberkulosis kategori I Paket 0 0 0 0
274 Obat Batuk Kombinasi Botol 0 0 0 0
275 Obat Flu kombinasi CTM, PPA (Anaflu), Demacolin Tablet 362 362 155 207
276 Obat Flu Kombinasi/Mecofed/Quantidex Tablet 0 0 0 0
277 OBH plus botol 15 10 25 23 2
278 Omeprasole tablet 20 mg Tablet 350 300 650 410 240 150 150
279 Ondancentron inj Ampul 0 0 0 0
280 Ondancetron 4 mg Tablet 0 96 96 0 96
281 Orpen Tablet 0 0 0 0
282 Oseltamivir Tablet 0 0 0 0
283 Paket bonding Set 0 0 0 0
284 Pamol 125 mg Supp Supp 9 9 4 5
285 Pamol 250 mg Supp Supp 15 15 0 15
286 Pantocain Tetes Mata Botol 0 0 0 0
287 Parasetamol drop Botol 0 0 0 0 10 10
288 Pehacain Injeksi Ampul 0 0 0 0
289 Pehatrim Forte (Kotrimoksasol tab forte 960 mg) Tablet 0 0 0 0
290 Perhidrol (H2O2) Botol 0 0 0 0
291 Phenitoin tab Tablet 100 100 200 60 140
292 Piracetam 400 mg Tablet 0 0 0 0
293 Piracetam inj 200mg/1ml Ampul 0 0 0 0
294 Pirimethamine tablet Tablet 0 0 0 0
295 Prenatin DF Tablet 0 0 0 0
296 Prenatin plus tablet tablet 0 0 0 0
297 Primaquin Tablet 0 0 0 0
298 Primperan inj Ampul 0 0 0 0
299 Procurma sirup botol 4 10 14 5 9 5 5
300 Prokain Benzil Penicillin G Injeksi 3 jt IU/vial Vial 0 0 0 0
301 Proris supp Supp 0 0 0 0
302 Pularex Tablet 0 0 0 0
303 Scabimite cream tube 0 5 5 0 5
304 Sikzonoate inj Ampul 0 0 0 0
305 Simvastatin tab 20 mg Tablet 0 0 0 0
306 Spashi inj Ampul 0 0 0 0
307 Spashi tab Tablet 0 0 0 0
308 Stelosi tab 5 mg Tablet 0 0 0 0
309 Stesolid rectal Supp 0 0 0 0
310 Strop indra Botol 0 0 0 0
311 Sulfadiazin tablet Tablet 0 0 0 0
312 Tenofovir (Tenofovir 300mg) Botol 0 0 0 0
313 Tetagam Ampul 23 20 43 10 33
314 Tramadol inj 50 mg/ml Ampul 0 0 0 0
315 Tranexid inj (Asam tranexamat inj) Ampul 0 0 0 0
316 Urotractin tablet 0 100 100 15 85
317 Ventolin Nebulizer Ampul 6 6 3 3 20 20
318 Vitamin B12 tab Tablet 0 0 0 0
319 Vitamin Neurotropik inj Ampul 0 0 0 0
320 Vitamin Neurotropik tablet (Nutrifar, Sohobion) Tablet 0 0 0 0
321 VitKa infan Ampul 0 0 0 0
322 Xylocain Gel Ampul 0 0 0 0
323 Zidovudine 100 mg Tablet 0 0 0 0
No Nama Obat Satuan STOK PENERI PERSEDIAA PEMAK SISA PERMIN PENERI
AWAL MAAN N AIAN STOK TAAN MAAN KET
Sucralfate syrup botol 9 50 59 59 0
Clopidogrel bisulfate 0 0 0 0
Levofloxacin 500 0 0 0 0
Spironolactone 25 mg 0 0 0 0
Domperidone syr 0 0 0 0
Ceterizine syr 5 mg/5ml 0 0 0 0
Albendazol syr 0 0 0
Zink syr 0 0 0
Cazetin drop 0 0 0
Lacto B 0 0 0
Scopma plus tab 0 0 0
Nebacetin powder 0 0 0
Metronidazol syr 125/5 ml 0 0 0
Salbutamol syr 0 0 0
Furosemida inj 0 0 0
Paracetamol infus 10 mg/ml 0 0 0
Calortusin tab 0 0 0
Coparcetin tab 0 0 0
TB tahap intensif 0 0 0
TB tahap lanjutan 0 0 0
Solathim syr 0 0 0
Antiseptic liquid no 2 0 0 0
Tenofovir + Emtricitabin 0 0 0
Cavit G 0 0 0
Ketros Supp 0 0 0
Harnal 0 0 0
BMHP 0 0 0
1 ADS 0.5 ml Pcs 100 100 0 100
2 ADS 0.05 ml Pcs 105 105 0 105
3 ADS 2 ml Pcs 0 0 0 0
4 ADS 5 ml Pcs 160 160 0 160
5 Alat suntik sekali pakai 1 ml Pcs 0 0 0 0
6 Alat suntik sekali pakai 2,5 ml Pcs 0 0 0 0
7 Alat suntik sekali pakai 5 ml Pcs 0 0 0 0
8 Bisturi no 13 Pcs 0 0 0 0
9 Bisturi no 14 Pcs 0 0 0 0
10 Bisturi no 19/20 Pcs 0 0 0 0
11 Bisturi no 21 Pcs 0 0 0 0
12 Box slide kotak 2 2 0 2
13 Catgut 2/0 plain Sachet 24 24 0 24
14 Catgut / benang bedah no 2/0 chromic Sachet 0 0 0 0
15 Catgut / benang bedah no 3/0 plain Sachet 0 0 0 0
16 Catgut 1/0 Chromic Pcs 0 0 0 0
17 Catgut 2/0 Chromic Roll Roll 0 0 0 0
18 Catgut 3/0 Chromic Roll Roll 0 0 0 0
19 Cutgut Chromic No.1 atraumatik (sachet) Sachet 0 0 0 0
20 Etanol 70 % Botol 0 0 0 0
21 Etanol 70 % Botol 100 m 0 0 0 0
22 Film Rontgen 18 x 24 Set 0 0 0 0
23 Folley catheter Pcs 0 0 0 0
24 Hypavix (Ultrafik) Roll 0 3 3 0 3
25 I.V Catheter 22 Pcs 0 0 0 0
26 I.V Catheter 24 Pcs 0 0 0 0
27 Infusion set anak Set 0 0 0 0
28 Infusion set dewasa Set 0 0 0 0 1 1
29 IV Cath dgn Katup pcs 0 0 0 0 1 1
30 IV Catheter 18 Pcs 0 0 0 0
31 IV Catheter 20 Pcs 0 0 0 0
32 IV Catheter no 18 G Terumo Pcs 0 0 0 0
33 IV Catheter no 20 G Terumo Pcs 0 0 0 0
34 Jarum injeksi Pcs 0 0 0 0
35 Jarum jahit (bedah) no. 9 s/d 14 Set 0 0 0 0
36 Jarum Jahit Bedah no 12 Set 0 0 0 0
37 Jarum Jahit Bedah no 13 Set 0 0 0 0
38 Jarum Jahit Bedah no 14 Set 0 0 0 0
39 Jarum Kulit Set 0 0 0 0
40 Jarum Otot dan Kulit Set 0 0 0 0
41 Jelly RO Tube 0 0 0 0
42 Kantung Puyer Pak 0 0 0 0
43 Kapas pembalut / absorben 250 gram Roll 0 0 0 0
44 Kasa gulung 40 x 80 Roll 0 1 1 0 1
45 Kasa Hidrofil 4 x 10 Roll 0 0 0 0
46 Kasa kompres 40 / 40 steril Roll 0 0 0 0
47 Kasa pembalut 2 x 80 Roll 0 0 0 0
48 Kasa pembalut hidrofil 4 m x 15 cm Roll 0 0 0 0
49 Kasa pembalut hidrofin 4m x 3 cm Roll 0 0 0 0
50 Kasa Steril ( 18 x 22 ) Kotak 4 30 34 0 34
51 Kertas EKG Roll 0 0 0 0
52 Kertas saring Lembar 0 0 0 0
53 Kertas USG Roll 0 0 0 0
54 Klem Tali Pusar pcs 0 0 0 0
55 Klip Kecil Pak 6 6 0 6
56 Klip Tanggung Pak 0 20 20 0 20 10 10
57 Lampu spiritus botol 0 0 0 0
58 Lisol mengandung kresol Botol 19 19 0 19
No Nama Obat Satuan STOK PENERI PERSEDIAA PEMAK SISA PERMIN PENERI
AWAL MAAN N AIAN STOK TAAN MAAN KET
59 Masker Pcs 100 100 0 100
60 Masker Bedah Pcs 0 0 0 0
61 Masker N95 Pcs 0 0 0 0
62 MY Jelly Tube 0 0 0 0
63 Nasal cannula Oksigen pcs 0 0 0 0
64 Pembalut Gips Roll 0 0 0 0
65 Perkamen Pak 0 0 0 0
66 Plester 5 yard x 2 inch Roll 0 0 0 0
67 Pot Salep Pot 0 0 0 0
68 Pot Sputum Pcs 18 140 158 0 158 60 80
69 Safety box Pcs 0 0 0 0
70 Sarung Tangan Gynaecologi pasang 0 0 0 0
71 Sarung Tangan L Pasang 0 0 0 0
72 Sarung Tangan M Pasang 0 0 0 0
73 Sarung Tangan S Pasang 0 0 0 0
74 Sarung Tangan Steril Pasang 0 0 0 0
75 Sarung Tangan Surgiglove Pasang 0 0 0 0
76 Sendok Takar Pcs 35 100 135 0 135
77 Silk 3/0 roll Roll 1 1 0 1
78 Silk (benang bedah sutera) no.3/0 Pcs 5 5 0 5
79 Slide Prosted Pak 0 0 0 0
80 Spalk tungkai atas anak Pcs 0 0 0 0
81 Spalk tungkai atas dewasa Pcs 0 0 0 0
82 Spalk tungkai bawah anak Pcs 0 0 0 0
83 Spalk tungkai bawah dewasa Pcs 0 0 0 0
84 Spuit 10 ml Pcs 0 0 0 0
85 Spuit 2/3 ml Pcs 0 0 0 0
86 Transfusi Set Pcs 0 0 0 0
87 Uji Tuberkulin Vial 0 0 0 0
88 Underpad Pak 0 0 0 0
89 Urinebag Set 0 0 0 0
90 Wing Needle 21 Pcs 0 0 0 0
91 Wing Needle 23 Pcs 0 0 0 0
92 Wing Needle 25 Pcs 0 0 0 0
93 Wing Needle 27 Pcs 0 0 0 0

BAYAR TIDAK BAYAR ( JKN ) JUMLAH


JUMLAH KUNJUNGAN RESEP
152 747 899

Mengetahui Yang Menyerahkan Yang Meminta / pelapor


Kepala Puskesmas Selemadeg Timur II Petugas Gudang Obat Puskesmas Petugas Apotek / Pustu

dr. Ni Putu Partini Ni Kadek Eni Mulyani I Wayan Diatmika


NIP. 196607262002122003 NIP. NIP. 19890909 201101 1 003
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT SUB UNIT

DOKUMEN NOMOR TANGGAL


PUSK
SUB UNIT

SUB UNIT : BERABAN PELAPORAN BULAN / PERIODE : JANUARI 2019


KECAMATAN : SELEMADEG TIMUR PERMINTAAN BULAN / PERIODE : FEBRUARI 2019
KABUPATEN : TABANAN

STOK PENERIMAA PERSEDIA PEMAKA SISA PERMIN PENERI


No Nama Obat Satuan KET
AWAL N AN IAN STOK TAAN MAAN
1 2 3 4 5 6(4 + 5) 7 8(6-7) 9 10 11
1 Acyclovir Salep Tube 8 8 0 8
2 Acyclovir 400 mg Tab Tablet 0 0 0 0
3 Air raksa dental use Botol 0 0 0 0
4 Albendazol 400 mg tab Tablet 0 0 0 0
5 Alprazolam 0.5 mg Tablet 0 0 0 0
6 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0 0 0 0
7 Ambroxol syr Botol 6 6 1 5
8 Ambroxol tab 30 mg / Promukus Tablet 180 180 20 160
9 Aminofilina injeksi 24 mg/ ml. 10 ml Ampul 0 0 0 0
10 Aminofilna tablet 200 mg Tablet 0 0 0 0
11 Amitriptilina hcl tablet salut 25 mg Tablet 0 0 0 0
12 Amoksilina kapsul 500 mg Tablet 130 200 330 50 280
13 Amoksilna sirup kering 125 mg/ 5 mg Botol 0 0 0 0
14 Antasida doen tablet kombinasi Tablet 170 200 370 70 300
15 Anti hemmoroid suppositoria Supp 0 0 0 0
16 Aqua pro injeksi streril. Bebas priogen 20 ml Vial 1 1 0 1
17 Aquadest steril 500 ml Botol 0 0 0 0
18 As salisilat 2% + belerang endap 4%(2-4 salep Pot 0 0 0 0
19 As. Benzoat 3 % + as salisilat 6%(whitefield) Pot 0 0 0 0
20 Asam askorbat (Vit. C) tablet 50 mg Tablet 0 0 0 0
21 Asam mefenamat 500 mg Tablet 280 280 50 230
22 Asetosal 100 mg Tablet 0 0 0 0
23 Asetosal tablet 500 mg Tablet 0 0 0 0
24 Atropina sulfat injeksi 0 .25 mg / ml - 1 ml Ampul 0 0 0 0
25 Basitrasin Polimiksin Tube 0 0 0 0
26 Besi (II) sulfat tablet salut .kombinasi Tablet 0 0 0 0
27 Betahistin tab Tablet 0 0 0 0
28 Betametazon salep kulit Tube 3 5 8 0 8
29 Captopril 12.5 mg tablet Tablet 0 0 0 0
30 Captopril 25 mg tablet Tablet 0 0 0 0
31 Carbamazepina 200 mg talet Tablet 0 0 0 0
32 Cefadroxil 125mg/5ml Sirup Botol 5 5 1 4
33 Cefadroxill 500 mg tablet Tablet 90 90 40 50
34 Cefotaxim 1 gr Injeksi Ampul 0 0 0 0
35 Cetirizin10 mg tab Tablet 0 0 0 0
36 Cimetidine/Selestidin Tablet 0 0 0 0
37 Ciprofloxazin tablet 500 mg Tablet 35 35 0 35
38 Deksametason injeksi 5 mg / ml - 1 ml Ampul 0 0 0 0
39 Deksametason tablet 0.5 mg Tablet 369 369 105 264
40 Devitalisasi pasta Tube 0 0 0 0
41 Diazepam 5 mg Tablet 0 0 0 0
42 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0 0 0 0
43 Diazepam tablet 2 mg Tablet 0 0 0 0
44 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 0 0 0 0
45 Digoksina tablet 0. 25 mg Tablet 0 0 0 0
46 Domperidon tablet 10 mg Tablet 120 120 20 100
47 Doxycicline 100 mg tab Tablet 0 0 0 0
48 Efedrina HCL (efedrina) tablet 25 mg Tablet 0 0 0 0
49 Epinefrina HCL / bitartat (aderenalina) inj 01% Ampul 0 0 0 0
50 Ergotamina tartrat 1 mg + kofeina 50 mg tab Tablet 0 0 0 0
51 Erytromysin 200mg/5ml Syrup Botol 0 0 0 0
52 Erytromysin tablet 500 mg Tablet 0 0 0 0
53 Etakridina (rivanol) larutan 0.1 % Botol 0 0 0 0
54 Etil klorida semprot Botol 0 0 0 0
55 Eugenol cairan Botol 0 0 0 0
56 Fenobarbital inj 50 mg /ml -2ml Ampul 0 0 0 0
57 Fenobarbital tablet 100mg Tablet 0 0 0 0
58 Fenobarbital tablet 30 mg Tablet 0 0 0 0
59 Fenol gliserol tetes telnga 10% Botol 0 0 0 0
60 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0 0 0 0
61 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0 0 0 0
62 Furosemida tablet 40 mg Tablet 0 0 0 0
63 Garam Oralit untuk 200 ml air Sachet 80 80 0 80
STOK PENERIMAA PERSEDIA PEMAKA SISA PERMIN PENERI
No Nama Obat Satuan KET
AWAL N AN IAN STOK TAAN MAAN
64 Gentamisin Salep Mata Tube 0 0 0 0
65 Gentamysin SK Tube 0 0 0 0
66 Gentamysin TM/Genoint TM Botol 0 0 0 0
67 Gentian violet larutan 1 % Botol 0 0 0 0
68 Glibenklamida tablet 5 mg Tablet 0 0 0 0
69 Gliseril guayakolat tablet 10 mg Tablet 0 0 0 0
70 Glukosa larutan infus 10 % steril Botol 0 0 0 0
71 Glukosa larutan infus 40 % steril Botol 0 0 0 0
72 Glukosa larutan infus 5 % steril Botol 0 0 0 0
73 Griseofulvin tablet 125 mg. Mikronized Tablet 0 0 0 0
74 Haloperidol 0,5 mg. Tablet Tablet 0 0 0 0
75 Haloperidol 1,5 mg tablet Tablet 0 0 0 0
76 Haloperidol 5 mg tablet Tablet 0 0 0 0
77 Hidroklorotiasida (HCT) tablet 25 mg Tablet 0 0 0 0
78 Hidrokortison krim 2.5 % Tube 0 0 0 0
79 Ibuprofen tablet 400 mg Tablet 60 60 0 60
80 Isoniazide 100 mg Tablet 0 0 0 0
81 Isoniazide 300 mg Tablet 0 0 0 0
82 Isosorbid dinitrat Tablet 0 0 0 0
83 Kalsium hidroksida pasta Pot 0 0 0 0
84 Kalsium laktat (kalk) tablet 500 mg Tablet 0 0 0 0
85 Ketokonazole 200 mg tablet Tablet 0 0 0 0
86 Kinina dihidroklorida (kinina) inj 25 % - 2 ml Ampul 0 0 0 0
87 Kinina sulfat tablet 222 mg (7 h20 ) Tablet 0 0 0 0
88 Kloramfenicol salep kulit Tube 0 0 0 0
89 Kloramfenikol kapsul 250 mg Tablet 0 0 0 0
90 Kloramfenikol salep mata 1 % Tube 0 0 0 0
91 Kloramfenikol tetes Mata Botol 0 0 0 0
92 Kloramfenikol tetes telinga 3 % Botol 0 0 0 0
93 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 0 0 0 0
94 Klorpromazin 100 mg tablet Tablet 0 0 0 0
95 Klorpromazina Hcl inj 25 mg / ml - 1 ml Ampul 0 0 0 0
96 Klorpromazina Hcl inj 5 mg / ml - 2 ml Ampul 0 0 0 0
97 Klorpromazina hcl tablet salut 25 mg Tablet 0 0 0 0
98 Kodeina Hcl (kodeina) tablet 10 mg Tablet 0 0 0 0
99 Kotrimoksasol suspensi Botol 0 0 0 0
100 Kotrimoksasol tablet kombinasi Tablet 0 0 0 0
101 Lidokain inj Ampul 0 0 0 0
102 Lidokaina comp inj kombinasi Ampul 0 0 0 0
103 Metakresol sulfonat dan metanol kondensai (Al Botol 0 0 0 0
104 Metformin 500 mg tablet Tablet 0 0 0 0
105 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0 0 0 0
106 Metilergometrina malet tablet salut 0. 125 mg Tablet 0 0 0 0
107 Metilprednisolon tablet 4 mg Tablet 0 0 0 0
108 Metoklopramide 10 mg tablet/Noristal Tablet 0 0 0 0
109 Metronidazol 500 mg Tablet 0 0 0 0
110 Metronidazol tablet 250 mg Tablet 0 0 0 0
111 Mikonazole salep Tube 0 0 0 0
112 Monoklorkamfer mentolcairan (CHKM) Botol 0 0 0 0
113 Mumifyng pasta Botol 0 0 0 0
114 Natrium bikarbonat tablet 500 mg Tablet 0 0 0 0
115 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 0 0 0 0
116 Natrium klorida larutan infus 0. 9 steril Botol 0 0 0 0
117 Nifedipin tablet 10 mg Tablet 0 0 0 0
118 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0 0 0 0
119 Obat batuk hitam (OBH) cairan Botol 100 ml 0 0 0 0
120 Ofloxacin tab 400mg Tablet 0 0 0 0
121 Oksigen gas dalam tabung 3 m3 Tabung 0 0 0 0
122 Oksigen gas dalam tabung 6 m3 Tabung 0 0 0 0
123 Oksitetrasiklina hcl salep 3 % Tube 0 0 0 0
124 Oksitetrasiklina hcl salep mata 1 % Tube 0 0 0 0
125 Oksitosina inj 10 iu/ml - 1 ml Ampul 0 0 0 0
126 Parasetamol sirup 120 mg / 5 ml Botol 0 0 0 0
127 Parasetamol tab 100 mg Tablet 0 0 0 0
128 Parasetamol tablet 500mg Tablet 247 200 447 145 302
129 Pirantel pamoat (pirantel) tablet 125 mg basa Tablet 0 0 0 0
130 Piroxicam 10 Mg Tablet 0 0 0 0
131 Piroxicam 20 Mg Tablet 0 0 0 0
132 Prednison tablet 5 mgn Tablet 0 0 0 0
133 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0 0 0 0
134 Primakina tablet 15 mg Tablet 0 0 0 0
135 Prokaina penisilina g inj 3 juta iu Vial 0 0 0 0
136 Propiltionurasil tablet 100 mg Tablet 0 0 0 0
137 Propranolol hcl (Propranolol) tablet 40 mg Tablet 0 0 0 0
138 Pyridoxin injeksi Ampul 0 0 0 0
139 Ranitidin inj 25 mg/2 ml Ampul 0 0 0 0
STOK PENERIMAA PERSEDIA PEMAKA SISA PERMIN PENERI
No Nama Obat Satuan KET
AWAL N AN IAN STOK TAAN MAAN
140 Ranitidin tablet 150 mg Tablet 190 190 20 170
141 Reserpina tablet 0, 10 mg Tablet 0 0 0 0
142 Reserpina tablet 0, 25 mg Tablet 0 0 0 0
143 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0 0 0 0 90 100
144 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0 0 0 0 15 15
145 Ringer laktat larutan infus steril Botol 0 0 0 0
146 Risperidon Tablet 0 0 0 0
147 Salbutamol tablet 2 mg Tablet 0 0 0 0
148 Salbutamol tablet 4 mg Tablet 0 0 0 0
149 Salisil bedak 2 % Bks 0 0 0 0
150 Salisil spiritus 10 % Botol 0 0 0 0
151 Semen seng fosfat serbuk dan cairan Botol 0 0 0 0
152 Serum anti bisa ular polivalen inj. 5ml Ampul 0 0 0 0
153 Serum anti tetanus inj. 1.500 iu Ampul 0 0 0 0
154 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0 0 0 0
155 Silver amalgam serbuk 65-75% Botol 0 0 0 0
156 Simvastatin tab 10 mg Tablet 0 0 0 0
157 Sulfacetamide tetes mata Botol 0 0 0 0
158 Synthetic filing material larutan dan serbuk Set 0 0 0 0
159 Temporary stopping fletcher serbuk dan cairan Set 0 0 0 0
160 Tetrasiklina hcl (tetrasiklina) kapsul 250 mg Tablet 0 0 0 0
161 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0 0 0 0
162 Thiamfenikol 500 Tablet 0 0 0 0
163 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0 0 0 0
164 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0 0 0 0
165 Tramadol Tablet 0 0 0 0
166 Trifluoperazine (Stelazin) Tablet 0 0 0 0
167 Triheksfenidil hcl 2 mg tablet Tablet 0 0 0 0
168 Trikresol formalin (tkf) cairan Botol 0 0 0 0
169 Vitamin B kompleks tablet Tablet 0 0 0 0
170 Yodium povidan larutan 10% 300 ml Botol 0 0 0 0
171 Yodium povidon larutan 10% 30 ml Botol 0 0 0 0
172 Zink tablet Tablet 0 0 0 0
Amoxcilin syrup botol 0 0 0 0
0
OBAT TAMBAHAN 0 0 0 0
173 Aptil Botol 0 0 0 0
174 (Lopinavir/Ritonavir)Aluvia Botol 0 0 0 0
175 Abacavir Tablet 0 0 0 0
176 Acyclovir tablet 200 mg Tablet 0 0 0 0
177 Aleterol TM Botol 0 0 0 0
178 Amlodipin 10 mg tab Tablet 0 0 0 0
179 Amlodipin 5 mg tab Tablet 0 0 0 0
180 Amox-clav Tablet 0 0 0 0
181 Ampisilin Serbuk Injeksi i.m/i.v. 1000 mg/ml Ampul 0 0 0 0
182 Ampisillin injeksi i.m/i.v 1000 mg/ml Ampul 0 0 0 0
183 Antalgin injeksi Ampul 0 0 0 0
184 Antasida syr Botol 12 12 4 8
185 Arterakine Tablet 0 0 0 0
186 Artesunat inj Vial 0 0 0 0
187 Asam Folat 1 mg Tablet 0 0 0 0
188 Asam tranexamat 500 mg Tablet 0 0 0 0
189 Asetosal 80/miniaspi tablet 0 0 0 0
190 Atripla(TDF+3TC+EFV) Botol 0 0 0 0
191 Azitromisin+cefixim Tablet 0 0 0 0
192 Azytromisin tablet 500 mg Tablet 0 0 0 0
193 BD Vacuntainer Pcs 0 0 0 0
194 Becefort Tablet 0 0 0 0
195 Benzatin Penisillin Vial 0 0 0 0
196 Bonding Set 0 0 0 0
197 Bufacomb salep Tube 4 4 0 4
198 Buscopan inj Ampul 0 0 0 0
199 Caviton Tube 0 0 0 0
200 Cefixim syr 100 mg/5 ml Botol 0 0 0 0
201 Cefixim tablet 100 mg Tablet 0 0 0 0
202 Cefixim tablet 200 mg Tablet 0 0 0 0
203 Cefotaxim 0,5 g inj Vial 0 0 0 0
204 Ceftriaxon inj Vial 0 0 0 0
205 Clarithromysin 500 mg Tablet 0 0 0 0
206 Clavamox inj Ampul 0 0 0 0
207 Clindamisin 150 mg Tablet 0 0 0 0
208 Clindamisin 300 mg Tablet 0 0 0 0
209 Clobazam 10 mg Tablet 0 0 0 0
210 Clozapine 25 mg Tablet 0 0 0 0
211 Composite (tumpatan sinar)A3 Set 0 0 0 0
212 Composite (tumpatan sinar)A3.5 Set 0 0 0 0
STOK PENERIMAA PERSEDIA PEMAKA SISA PERMIN PENERI
No Nama Obat Satuan KET
AWAL N AN IAN STOK TAAN MAAN
213 Crofed Tablet 0 0 0 0
214 D1/2 NS botol 0 0 0 0
215 D1/4 NS Botol 0 0 0 0
216 Daryantulle Lembar 0 0 0 0
217 Dermazine/Burnazin Tube 0 0 0 0
218 Dextina / Dextamin/Dextamec/Polofar Plus Tablet 0 0 0 0
219 Dextran 70% Botol 0 0 0 0
220 Dextrofen syr Botol 0 0 0 0
221 Diaform tablet/selesdiar Tablet 0 0 0 0
222 Dormi/Scopma/Spashi tablet Tablet 0 0 0 0
223 Dulcolac anak supp Supp 0 0 0 0
224 Dulcolac dewasa supp Supp 0 0 0 0
225 Dulkolak tablet Tablet 0 0 0 0
226 Duviral(Zidovudin 300+Lamivudin 150) Botol 0 0 0 0
227 Efavirenz Botol 0 0 0 0
228 Etambutol Tablet 0 0 0 0
229 ETSA Set 0 0 0 0
230 Euthyrox 100mg Tablet 0 0 0 0
231 Faktu Supp Supp 0 0 0 0
232 Fluconasol tab Tablet 0 0 0 0
233 Fluoxetin Tablet 0 0 0 0
234 Forumen TT Fls 0 0 0 0
235 Gentamisin Injeksi 80 mg/2ml Ampul 0 0 0 0
236 Glass ionomer (Ketac Molar) Tube 0 0 0 0
237 Glimepiride 2 tablet 0 0 0 0
238 Glimepiride 4 tablet 0 0 0 0
239 Glukonas Calcicus 10%- 10ml Ampul 0 0 0 0
240 Haldol inj Ampul 0 0 0 0
241 Hiviral (Lamivudin 150) Botol 0 0 0 0
242 Ibuprofen syr btl 2 2 0 2
243 Iliadin TH flesh 0 0 0 0
244 Isotic Neolisin TM Fls 5 5 2 3
245 Kalium Diklovenac tablet 130 200 330 100 230
246 Kaltropen supp Supp 0 0 0 0
247 Ketoconazole SK tube 3 3 0 3
248 Ketoprofen inj 10 mg Ampul 0 0 0 0
249 Ketoprofen tablet 100 mg Tablet 0 0 0 0
250 Ketorolac inj Ampul 0 0 0 0
251 Kombipak Anak Paket 0 0 0 0
252 Lodomer 2 Tablet 0 0 0 0
253 Lytamin syr botol 0 0 0 0
254 Magnesium Sulfat 20% - 25 ml Botol 0 0 0 0
255 Magnesium Sulfat 40% - 25 ml Botol 0 0 0 0
256 Metil Prednisolon 16 mg Tablet 0 0 0 0
257 Metil prednisolon inj 500 mg Vial 0 0 0 0
258 Metronidazole 500 mg Infus/100 ml Botol 0 0 0 0
259 Meylon inj Botol 0 0 0 0
260 Microlax Supp 0 0 0 0
261 Miloxicam 7,5 mg tablet 0 0 0 0
262 Molexflu Tablet 0 0 0 0
263 Multivitamin (Livron B plek) Tablet 210 210 20 190
264 Multivitamin sirup( Xanvit syr) Botol 0 0 0 0
265 Neurotropik tablet Tablet 0 0 0 0
266 Neviral (neviravin 200mg) Botol 0 0 0 0
267 New antides tablet 254 254 0 254
268 Nutrifar 5000 Tablet 0 0 0 0
269 Obat anti tuberkulosis FDC katagori I Paket 0 0 0 0
270 Obat anti tuberkulosis FDC anak Paket 0 0 0 0
271 Obat anti tuberkulosis FDC katagori II Paket 0 0 0 0
272 Obat anti tuberkulosis FDC sisipan Paket 0 0 0 0
273 Obat anti tuberkulosis kategori I Paket 0 0 0 0
274 Obat Batuk Kombinasi Botol 0 0 0 0
275 Obat Flu kombinasi CTM, PPA (Anaflu), Demaco Tablet 310 310 30 280
276 Obat Flu Kombinasi/Mecofed/Quantidex Tablet 0 0 0 0
277 OBH plus botol 0 0 0 0
278 Omeprasole tablet 20 mg Tablet 0 0 0 0
279 Ondancentron inj Ampul 0 0 0 0
280 Ondancetron 4 mg Tablet 0 0 0 0
281 Orpen Tablet 259 259 10 249
282 Oseltamivir Tablet 0 0 0 0
283 Paket bonding Set 0 0 0 0
284 Pamol 125 mg Supp Supp 0 0 0 0
285 Pamol 250 mg Supp Supp 0 0 0 0
286 Pantocain Tetes Mata Botol 0 0 0 0
287 Parasetamol drop Botol 10 10 0 10
288 Pehacain Injeksi Ampul 0 0 0 0
STOK PENERIMAA PERSEDIA PEMAKA SISA PERMIN PENERI
No Nama Obat Satuan KET
AWAL N AN IAN STOK TAAN MAAN
289 Pehatrim Forte (Kotrimoksasol tab forte 960 mg Tablet 0 0 0 0
290 Perhidrol (H2O2) Botol 0 0 0 0
291 Phenitoin tab Tablet 0 0 0 0
292 Piracetam 400 mg Tablet 0 0 0 0
293 Piracetam inj 200mg/1ml Ampul 0 0 0 0
294 Pirimethamine tablet Tablet 0 0 0 0
295 Prenatin DF Tablet 0 0 0 0
296 Prenatin plus tablet tablet 0 0 0 0
297 Primaquin Tablet 0 0 0 0
298 Primperan inj Ampul 0 0 0 0
299 Procurma sirup botol 0 0 0 0
300 Prokain Benzil Penicillin G Injeksi 3 jt IU/vial Vial 0 0 0 0
301 Proris supp Supp 0 0 0 0
302 Pularex Tablet 0 0 0 0
303 Scabimite cream tube 0 0 0 0
304 Sikzonoate inj Ampul 0 0 0 0
305 Simvastatin tab 20 mg Tablet 0 0 0 0
306 Spashi inj Ampul 0 0 0 0
307 Spashi tab Tablet 0 0 0 0
308 Stelosi tab 5 mg Tablet 0 0 0 0
309 Stesolid rectal Supp 0 0 0 0
310 Strop indra Botol 0 0 0 0
311 Sulfadiazin tablet Tablet 0 0 0 0
312 Tenofovir (Tenofovir 300mg) Botol 0 0 0 0
313 Tetagam Ampul 0 0 0 0
314 Tramadol inj 50 mg/ml Ampul 0 0 0 0
315 Tranexid inj (Asam tranexamat inj) Ampul 0 0 0 0
316 Urotractin tablet 0 0 0 0
317 Ventolin Nebulizer Ampul 0 0 0 0
318 Vitamin B12 tab Tablet 0 0 0 0
319 Vitamin Neurotropik inj Ampul 0 0 0 0
320 Vitamin Neurotropik tablet (Nutrifar, Sohobion Tablet 0 0 0 0
321 VitKa infan Ampul 0 0 0 0
322 Xylocain Gel Ampul 0 0 0 0
323 Zidovudine 100 mg Tablet 0 0 0 0
Sucralfate syrup botol 0 0 0 0
Clopidogrel bisulfate 0 0 0 0
Levofloxacin 500 0 0 0 0
Spironolactone 25 mg 0 0 0 0
Domperidone syr 0 0 0 0
Ceterizine syr 5 mg/5ml 0 0 0 0
Albendazol syr 0 0 0 0
Zink syr 0 0 0 0
Cazetin drop 0 0 0 0
Lacto B 0 0 0 0
Scopma plus tab 0 0 0 0
Nebacetin powder 0 0 0 0
Metronidazol syr 125/5 ml 0 0 0 0
Salbutamol syr 0 0 0 0
Furosemida inj 0 0 0 0
Paracetamol infus 10 mg/ml 0 0 0 0
Calortusin tab 0 0 0 0
Coparcetin tab 0 0 0 0
TB tahap intensif 0 0 0 0
TB tahap lanjutan 0 0 0 0
Solathim syr 0 0 0 0
Antiseptic liquid no 2 0 0 0 0
Tenofovir + Emtricitabin 0 0 0 0
Cavit G 0 0 0 0
Ketros Supp 0 0 0 0
Harnal 0 0 0 0
BMHP 0 0 0 0
1 ADS 0.5 ml Pcs 0 0 0 0
2 ADS 0.05 ml Pcs 0 0 0 0
3 ADS 2 ml Pcs 0 0 0 0
4 ADS 5 ml Pcs 0 0 0 0
5 Alat suntik sekali pakai 1 ml Pcs 0 0 0 0
6 Alat suntik sekali pakai 2,5 ml Pcs 0 0 0 0
7 Alat suntik sekali pakai 5 ml Pcs 0 0 0 0
8 Bisturi no 13 Pcs 0 0 0 0
9 Bisturi no 14 Pcs 0 0 0 0
10 Bisturi no 19/20 Pcs 0 0 0 0
11 Bisturi no 21 Pcs 0 0 0 0
12 Box slide kotak 0 0 0 0
13 Catgut 2/0 plain Sachet 0 0 0 0
14 Catgut / benang bedah no 2/0 chromic Sachet 0 0 0 0
STOK PENERIMAA PERSEDIA PEMAKA SISA PERMIN PENERI
No Nama Obat Satuan KET
AWAL N AN IAN STOK TAAN MAAN
15 Catgut / benang bedah no 3/0 plain Sachet 0 0 0 0
16 Catgut 1/0 Chromic Pcs 0 0 0 0
17 Catgut 2/0 Chromic Roll Roll 0 0 0 0
18 Catgut 3/0 Chromic Roll Roll 0 0 0 0
19 Cutgut Chromic No.1 atraumatik (sachet) Sachet 0 0 0 0
20 Etanol 70 % Botol 0 0 0 0
21 Etanol 70 % Botol 100 ml 0 0 0 0
22 Film Rontgen 18 x 24 Set 0 0 0 0
23 Folley catheter Pcs 0 0 0 0
24 Hypavix (Ultrafik) Roll 0 0 0 0
25 I.V Catheter 22 Pcs 0 0 0 0
26 I.V Catheter 24 Pcs 0 0 0 0
27 Infusion set anak Set 0 0 0 0
28 Infusion set dewasa Set 0 0 0 0
29 IV Cath dgn Katup pcs 0 0 0 0
30 IV Catheter 18 Pcs 0 0 0 0
31 IV Catheter 20 Pcs 0 0 0 0
32 IV Catheter no 18 G Terumo Pcs 0 0 0 0
33 IV Catheter no 20 G Terumo Pcs 0 0 0 0
34 Jarum injeksi Pcs 0 0 0 0
35 Jarum jahit (bedah) no. 9 s/d 14 Set 0 0 0 0
36 Jarum Jahit Bedah no 12 Set 0 0 0 0
37 Jarum Jahit Bedah no 13 Set 0 0 0 0
38 Jarum Jahit Bedah no 14 Set 0 0 0 0
39 Jarum Kulit Set 0 0 0 0
40 Jarum Otot dan Kulit Set 0 0 0 0
41 Jelly RO Tube 0 0 0 0
42 Kantung Puyer Pak 0 0 0 0
43 Kapas pembalut / absorben 250 gram Roll 0 0 0 0
44 Kasa gulung 40 x 80 Roll 0 0 0 0
45 Kasa Hidrofil 4 x 10 Roll 0 0 0 0
46 Kasa kompres 40 / 40 steril Roll 0 0 0 0
47 Kasa pembalut 2 x 80 Roll 0 0 0 0
48 Kasa pembalut hidrofil 4 m x 15 cm Roll 0 0 0 0
49 Kasa pembalut hidrofin 4m x 3 cm Roll 0 0 0 0
50 Kasa Steril ( 18 x 22 ) Kotak 0 0 0 0
51 Kertas EKG Roll 0 0 0 0
52 Kertas saring Lembar 0 0 0 0
53 Kertas USG Roll 0 0 0 0
54 Klem Tali Pusar pcs 0 0 0 0
55 Klip Kecil Pak 2 2 0 2
56 Klip Tanggung Pak 4 4 0 4
57 Lampu spiritus botol 0 0 0 0
58 Lisol mengandung kresol Botol 0 0 0 0
59 Masker Pcs 40 40 0 40
60 Masker Bedah Pcs 0 0 0 0
61 Masker N95 Pcs 0 0 0 0
62 MY Jelly Tube 0 0 0 0
63 Nasal cannula Oksigen pcs 0 0 0 0
64 Pembalut Gips Roll 0 0 0 0
65 Perkamen Pak 0 0 0 0
66 Plester 5 yard x 2 inch Roll 0 0 0 0
67 Pot Salep Pot 0 0 0 0
68 Pot Sputum Pcs 0 0 0 0
69 Safety box Pcs 0 0 0 0
70 Sarung Tangan Gynaecologi pasang 0 0 0 0
71 Sarung Tangan L Pasang 10 10 0 10
72 Sarung Tangan M Pasang 0 0 0 0
73 Sarung Tangan S Pasang 0 0 0 0
74 Sarung Tangan Steril Pasang 0 0 0 0
75 Sarung Tangan Surgiglove Pasang 0 0 0 0
76 Sendok Takar Pcs 7 7 6 1
77 Silk 3/0 roll Roll 0 0 0 0
78 Silk (benang bedah sutera) no.3/0 Pcs 0 0 0 0
79 Slide Prosted Pak 0 0 0 0
80 Spalk tungkai atas anak Pcs 0 0 0 0
81 Spalk tungkai atas dewasa Pcs 0 0 0 0
82 Spalk tungkai bawah anak Pcs 0 0 0 0
83 Spalk tungkai bawah dewasa Pcs 0 0 0 0
84 Spuit 10 ml Pcs 0 0 0 0
85 Spuit 2/3 ml Pcs 0 0 0 0
86 Transfusi Set Pcs 0 0 0 0
87 Uji Tuberkulin Vial 0 0 0 0
88 Underpad Pak 0 0 0 0
89 Urinebag Set 0 0 0 0
90 Wing Needle 21 Pcs 0 0 0 0
STOK PENERIMAA PERSEDIA PEMAKA SISA PERMIN PENERI
No Nama Obat Satuan KET
AWAL N AN IAN STOK TAAN MAAN
91 Wing Needle 23 Pcs 0 0 0 0
92 Wing Needle 25 Pcs 0 0 0 0
93 Wing Needle 27 Pcs 0 0 0 0

BAYAR TIDAK BAYAR ( JKN ) JUMLAH


JUMLAH KUNJUNGAN RESEP
0 38 38

Mengetahui Yang Menyerahkan Yang Meminta / pelapor


Kepala Puskesmas Selemadeg Timur II Petugas Gudang Obat Puskesmas Petugas Apotek / Pustu

dr. Ni Putu Partini Ni Kadek Eni Mulyani Ni Wayan Yunianti


NIP. 196607262002122003 NIP. NIP.197209041992032006
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT SUB UNIT

DOKUMEN NOMOR TANGGAL


PUSK
SUB UNIT

SUB UNIT : PUSKEL PELAPORAN BULAN / PERIODE : JANUARI 2019


KECAMATAN : SELEMADEG TIMUR PERMINTAAN BULAN / PERIODE : FEBRUARI 2019
KABUPATEN : TABANAN

STOK PENERI PERSEDIA PEMAKA SISA PERMIN PENERI


No Nama Obat Satuan STOK
AWAL MAAN AN IAN TAAN MAAN KET
1 2 3 4 5 6(4 + 5) 7 8(6-7) 9 10 11
1 Acyclovir Salep Tube 2 2 1 1
2 Acyclovir 400 mg Tab Tablet 60 60 30 30
3 Air raksa dental use Botol 0 0 0
4 Albendazol 400 mg tab Tablet 0 0 0 840 840
5 Alprazolam 0.5 mg Tablet 0 0 0
6 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 170 170 170
7 Ambroxol syr Botol 0 0 0
8 Ambroxol tab 30 mg / Promukus Tablet 230 230 30 0 gdo 200
9 Aminofilina injeksi 24 mg/ ml. 10 ml Ampul 0 0 0
10 Aminofilna tablet 200 mg Tablet 0 0 0
11 Amitriptilina hcl tablet salut 25 mg Tablet 0 0 0
12 Amoksilina kapsul 500 mg Tablet 484 484 40 444
13 Amoksilna sirup kering 125 mg/ 5 mg Botol 0 0 0
14 Antasida doen tablet kombinasi Tablet 490 490 90 400
15 Anti hemmoroid suppositoria Supp 0 0 0
16 Aqua pro injeksi streril. Bebas priogen 20 ml Vial 0 0 0
17 Aquadest steril 500 ml Botol 0 0 0
18 As salisilat 2% + belerang endap 4%(2-4 salep Pot 0 0 0
19 As. Benzoat 3 % + as salisilat 6%(whitefield) Pot 0 0 0
20 Asam askorbat (Vit. C) tablet 50 mg Tablet 0 0 0
21 Asam mefenamat 500 mg Tablet 310 310 10 0 gdo 300
22 Asetosal 100 mg Tablet 0 0 0
23 Asetosal tablet 500 mg Tablet 0 0 0
24 Atropina sulfat injeksi 0 .25 mg / ml - 1 ml Ampul 0 0 0
25 Basitrasin Polimiksin Tube 0 0 0
26 Besi (II) sulfat tablet salut .kombinasi Tablet 0 0 0 500 500
27 Betahistin tab Tablet 60 60 40 20
28 Betametazon salep kulit Tube 6 6 1 5
29 Captopril 12.5 mg tablet Tablet 0 0 0
30 Captopril 25 mg tablet Tablet 800 800 120 680
31 Carbamazepina 200 mg talet Tablet 0 0 0
32 Cefadroxil 125mg/5ml Sirup Botol 0 0 0
33 Cefadroxill 500 mg tablet Tablet 130 130 20 110
34 Cefotaxim 1 gr Injeksi Ampul 0 0 0
35 Cetirizin10 mg tab Tablet 40 40 30 10 160 160
36 Cimetidine/Selestidin Tablet 0 0 0
37 Ciprofloxazin tablet 500 mg Tablet 68 68 20 48
38 Deksametason injeksi 5 mg / ml - 1 ml Ampul 0 0 0
39 Deksametason tablet 0.5 mg Tablet 270 270 10 260
40 Devitalisasi pasta Tube 0 0 0
41 Diazepam 5 mg Tablet 0 0 0
42 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0 0 0
43 Diazepam tablet 2 mg Tablet 0 0 0
44 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 0 0 0
45 Digoksina tablet 0. 25 mg Tablet 100 100 10 90
46 Domperidon tablet 10 mg Tablet 250 250 60 190
47 Doxycicline 100 mg tab Tablet 0 0 0
48 Efedrina HCL (efedrina) tablet 25 mg Tablet 0 0 0
49 Epinefrina HCL / bitartat (aderenalina) inj 01% Ampul 0 0 0
50 Ergotamina tartrat 1 mg + kofeina 50 mg tab Tablet 0 0 0
51 Erytromysin 200mg/5ml Syrup Botol 0 0 0
52 Erytromysin tablet 500 mg Tablet 0 0 0
53 Etakridina (rivanol) larutan 0.1 % Botol 0 0 0
54 Etil klorida semprot Botol 0 0 0
55 Eugenol cairan Botol 0 0 0
56 Fenobarbital inj 50 mg /ml -2ml Ampul 0 0 0
57 Fenobarbital tablet 100mg Tablet 0 0 0
58 Fenobarbital tablet 30 mg Tablet 0 0 0
59 Fenol gliserol tetes telnga 10% Botol 0 0 0
60 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0 0 0
61 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0 0 0
62 Furosemida tablet 40 mg Tablet 0 0 0
63 Garam Oralit untuk 200 ml air Sachet 0 100 100 100
64 Gentamisin Salep Mata Tube 0 0 0
65 Gentamysin SK Tube 0 0 0
66 Gentamysin TM/Genoint TM Botol 6 10 16 5 11
67 Gentian violet larutan 1 % Botol 0 0 0
STOK PENERI PERSEDIA PEMAKA SISA PERMIN PENERI
No Nama Obat Satuan STOK
AWAL MAAN AN IAN TAAN MAAN KET
68 Glibenklamida tablet 5 mg Tablet 0 0 0
69 Gliseril guayakolat tablet 10 mg Tablet 0 0 0
70 Glukosa larutan infus 10 % steril Botol 0 0 0
71 Glukosa larutan infus 40 % steril Botol 0 0 0
72 Glukosa larutan infus 5 % steril Botol 0 0 0
73 Griseofulvin tablet 125 mg. Mikronized Tablet 0 0 0
74 Haloperidol 0,5 mg. Tablet Tablet 0 0 0
75 Haloperidol 1,5 mg tablet Tablet 0 0 0
76 Haloperidol 5 mg tablet Tablet 0 0 0
77 Hidroklorotiasida (HCT) tablet 25 mg Tablet 0 0 0
78 Hidrokortison krim 2.5 % Tube 7 7 1 6
79 Ibuprofen tablet 400 mg Tablet 149 149 30 119
80 Isoniazide 100 mg Tablet 0 0 0
81 Isoniazide 300 mg Tablet 0 0 0
82 Isosorbid dinitrat Tablet 0 0 0
83 Kalsium hidroksida pasta Pot 0 0 0
84 Kalsium laktat (kalk) tablet 500 mg Tablet 0 0 0
85 Ketokonazole 200 mg tablet Tablet 90 90 20 70
86 Kinina dihidroklorida (kinina) inj 25 % - 2 ml Ampul 0 0 0
87 Kinina sulfat tablet 222 mg (7 h20 ) Tablet 0 0 0
88 Kloramfenicol salep kulit Tube 0 0 0
89 Kloramfenikol kapsul 250 mg Tablet 0 0 0
90 Kloramfenikol salep mata 1 % Tube 0 0 0
91 Kloramfenikol tetes Mata Botol 0 0 0
92 Kloramfenikol tetes telinga 3 % Botol 0 0 0
93 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 115 115 45 70
94 Klorpromazin 100 mg tablet Tablet 0 0 0
95 Klorpromazina Hcl inj 25 mg / ml - 1 ml Ampul 0 0 0
96 Klorpromazina Hcl inj 5 mg / ml - 2 ml Ampul 0 0 0
97 Klorpromazina hcl tablet salut 25 mg Tablet 0 0 0
98 Kodeina Hcl (kodeina) tablet 10 mg Tablet 0 0 0
99 Kotrimoksasol suspensi Botol 2 2 2
100 Kotrimoksasol tablet kombinasi Tablet 0 0 0
101 Lidokain inj Ampul 0 0 0
102 Lidokaina comp inj kombinasi Ampul 0 0 0
103 Metakresol sulfonat dan metanol kondensai (Albotyl) Botol 0 0 0
104 Metformin 500 mg tablet Tablet 450 450 150 300
105 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0 0 0
106 Metilergometrina malet tablet salut 0. 125 mg Tablet 0 0 0
107 Metilprednisolon tablet 4 mg Tablet 160 300 460 310 150
108 Metoklopramide 10 mg tablet/Noristal Tablet 0 0 0
109 Metronidazol 500 mg Tablet 0 0 0
110 Metronidazol tablet 250 mg Tablet 0 0 0
111 Mikonazole salep Tube 2 2 2
112 Monoklorkamfer mentolcairan (CHKM) Botol 0 0 0
113 Mumifyng pasta Botol 0 0 0
114 Natrium bikarbonat tablet 500 mg Tablet 0 0 0
115 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 0 0 0
116 Natrium klorida larutan infus 0. 9 steril Botol 0 0 0
117 Nifedipin tablet 10 mg Tablet 0 0 0
118 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0 0 0
119 Obat batuk hitam (OBH) cairan Botol 100 ml 0 0 0
120 Ofloxacin tab 400mg Tablet 0 0 0
121 Oksigen gas dalam tabung 3 m3 Tabung 0 0 0
122 Oksigen gas dalam tabung 6 m3 Tabung 0 0 0
123 Oksitetrasiklina hcl salep 3 % Tube 0 0 0
124 Oksitetrasiklina hcl salep mata 1 % Tube 0 0 0
125 Oksitosina inj 10 iu/ml - 1 ml Ampul 0 0 0
126 Parasetamol sirup 120 mg / 5 ml Botol 0 0 0
127 Parasetamol tab 100 mg Tablet 0 0 0
128 Parasetamol tablet 500mg Tablet 455 455 280 175
129 Pirantel pamoat (pirantel) tablet 125 mg basa Tablet 0 0 0
130 Piroxicam 10 Mg Tablet 0 0 0
131 Piroxicam 20 Mg Tablet 0 0 0
132 Prednison tablet 5 mgn Tablet 0 0 0
133 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0 0 0
134 Primakina tablet 15 mg Tablet 0 0 0
135 Prokaina penisilina g inj 3 juta iu Vial 0 0 0
136 Propiltionurasil tablet 100 mg Tablet 0 0 0
137 Propranolol hcl (Propranolol) tablet 40 mg Tablet 0 0 0
138 Pyridoxin injeksi Ampul 0 0 0
139 Ranitidin inj 25 mg/2 ml Ampul 0 0 0
140 Ranitidin tablet 150 mg Tablet 280 280 110 170
141 Reserpina tablet 0, 10 mg Tablet 0 0 0
142 Reserpina tablet 0, 25 mg Tablet 0 0 0
143 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0 0 0
144 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0 0 0
145 Ringer laktat larutan infus steril Botol 0 0 0
146 Risperidon Tablet 0 0 0
147 Salbutamol tablet 2 mg Tablet 0 0 0
STOK PENERI PERSEDIA PEMAKA SISA PERMIN PENERI
No Nama Obat Satuan STOK
AWAL MAAN AN IAN TAAN MAAN KET
148 Salbutamol tablet 4 mg Tablet 180 180 60 120
149 Salisil bedak 2 % Bks 0 0 0
150 Salisil spiritus 10 % Botol 0 0 0
151 Semen seng fosfat serbuk dan cairan Botol 0 0 0
152 Serum anti bisa ular polivalen inj. 5ml Ampul 0 0 0
153 Serum anti tetanus inj. 1.500 iu Ampul 0 0 0
154 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0 0 0
155 Silver amalgam serbuk 65-75% Botol 0 0 0
156 Simvastatin tab 10 mg Tablet 0 0 0
157 Sulfacetamide tetes mata Botol 0 0 0
158 Synthetic filing material larutan dan serbuk Set 0 0 0
159 Temporary stopping fletcher serbuk dan cairan Set 0 0 0
160 Tetrasiklina hcl (tetrasiklina) kapsul 250 mg Tablet 0 0 0
161 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0 0 0
162 Thiamfenikol 500 Tablet 0 0 0
163 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0 0 0
164 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0 0 0
165 Tramadol Tablet 0 0 0
166 Trifluoperazine (Stelazin) Tablet 0 0 0
167 Triheksfenidil hcl 2 mg tablet Tablet 0 0 0
168 Trikresol formalin (tkf) cairan Botol 0 0 0
169 Vitamin B kompleks tablet Tablet 0 0 0
170 Yodium povidan larutan 10% 300 ml Botol 0 0 0
171 Yodium povidon larutan 10% 30 ml Botol 0 0 0
172 Zink tablet Tablet 0 100 100 100
Amoxcilin syrup 250mg botol 0 0 0

OBAT TAMBAHAN 0 0 0
173 Aptil Botol 0 0 0
174 (Lopinavir/Ritonavir)Aluvia Botol 0 0 0
175 Abacavir Tablet 0 0 0
176 Acyclovir tablet 200 mg Tablet 0 0 0
177 Aleterol TM Botol 0 0 0
178 Amlodipin 10 mg tab Tablet 0 0 0
179 Amlodipin 5 mg tab Tablet 300 600 900 810 90 300 300
180 Amox-clav Tablet 0 0 0
181 Ampisilin Serbuk Injeksi i.m/i.v. 1000 mg/ml Ampul 0 0 0
182 Ampisillin injeksi i.m/i.v 1000 mg/ml Ampul 0 0 0
183 Antalgin injeksi Ampul 0 0 0
184 Antasida syr Botol 21 21 2 19
185 Arterakine Tablet 0 0 0
186 Artesunat inj Vial 0 0 0
187 Asam Folat 1 mg Tablet 0 0 0
188 Asam tranexamat 500 mg Tablet 0 0 0
189 Asetosal 80/miniaspi tablet 0 0 0
190 Atripla(TDF+3TC+EFV) Botol 0 0 0
191 Azitromisin+cefixim Tablet 0 0 0
192 Azytromisin tablet 500 mg Tablet 0 0 0
193 BD Vacuntainer Pcs 0 0 0
194 Becefort Tablet 130 130 30 100
195 Benzatin Penisillin Vial 0 0 0
196 Bonding Set 0 0 0
197 Bufacomb salep Tube 0 0 0
198 Buscopan inj Ampul 0 0 0
199 Caviton Tube 0 0 0
200 Cefixim syr 100 mg/5 ml Botol 1 1 1
201 Cefixim tablet 100 mg Tablet 0 0 0
202 Cefixim tablet 200 mg Tablet 0 0 0
203 Cefotaxim 0,5 g inj Vial 0 0 0
204 Ceftriaxon inj Vial 0 0 0
205 Clarithromysin 500 mg Tablet 0 0 0
206 Clavamox inj Ampul 0 0 0
207 Clindamisin 150 mg Tablet 0 0 0
208 Clindamisin 300 mg Tablet 0 0 0
209 Clobazam 10 mg Tablet 0 0 0
210 Clozapine 25 mg Tablet 0 0 0
211 Composite (tumpatan sinar)A3 Set 0 0 0
212 Composite (tumpatan sinar)A3.5 Set 0 0 0
213 Crofed Tablet 0 0 0
214 D1/2 NS botol 0 0 0
215 D1/4 NS Botol 0 0 0
216 Daryantulle Lembar 0 0 0
217 Dermazine/Burnazin Tube 0 0 0
218 Dextina / Dextamin/Dextamec/Polofar Plus Tablet 164 164 30 134
219 Dextran 70% Botol 0 0 0
220 Dextrofen syr Botol 4 4 4 0 5 5
221 Diaform tablet/selesdiar Tablet 0 0 0
222 Dormi/Scopma/Spashi tablet Tablet 0 0 0
223 Dulcolac anak supp Supp 0 0 0
224 Dulcolac dewasa supp Supp 0 0 0
STOK PENERI PERSEDIA PEMAKA SISA PERMIN PENERI
No Nama Obat Satuan STOK
AWAL MAAN AN IAN TAAN MAAN KET
225 Dulkolak tablet Tablet 0 0 0
226 Duviral(Zidovudin 300+Lamivudin 150) Botol 0 0 0
227 Efavirenz Botol 0 0 0
228 Etambutol Tablet 0 0 0
229 ETSA Set 0 0 0
230 Euthyrox 100mg Tablet 0 0 0
231 Faktu Supp Supp 0 0 0
232 Fluconasol tab Tablet 0 0 0
233 Fluoxetin Tablet 0 0 0
234 Forumen TT Fls 0 0 0
235 Gentamisin Injeksi 80 mg/2ml Ampul 0 0 0
236 Glass ionomer (Ketac Molar) Tube 0 0 0
237 Glimepiride 2 tablet 410 410 240 170
238 Glimepiride 4 tablet 0 0 0
239 Glukonas Calcicus 10%- 10ml Ampul 0 0 0
240 Haldol inj Ampul 0 0 0
241 Hiviral (Lamivudin 150) Botol 0 0 0
242 Ibuprofen syr btl 3 3 3
243 Iliadin TH flesh 0 0 0
244 Isotic Neolisin TM Fls 0 0 0
245 Kalium Diklovenac tablet 320 320 230 90
246 Kaltropen supp Supp 0 0 0
247 Ketoconazole SK tube 8 8 8
248 Ketoprofen inj 10 mg Ampul 0 0 0
249 Ketoprofen tablet 100 mg Tablet 0 0 0
250 Ketorolac inj Ampul 0 0 0
251 Kombipak Anak Paket 0 0 0
252 Lodomer 2 Tablet 0 0 0
253 Lytamin syr botol 0 0 0
254 Magnesium Sulfat 20% - 25 ml Botol 0 0 0
255 Magnesium Sulfat 40% - 25 ml Botol 0 0 0
256 Metil Prednisolon 16 mg Tablet 0 0 0
257 Metil prednisolon inj 500 mg Vial 0 0 0
258 Metronidazole 500 mg Infus/100 ml Botol 0 0 0
259 Meylon inj Botol 0 0 0
260 Microlax Supp 0 0 0
261 Miloxicam 7,5 mg tablet 0 300 300 60 240
262 Molexflu Tablet 0 0 0
263 Multivitamin (Livron B plek) Tablet 180 180 110 70
264 Multivitamin sirup( Xanvit syr) Botol 0 0 0
265 Neurotropik tablet Tablet 0 0 0
266 Neviral (neviravin 200mg) Botol 0 0 0
267 New antides tablet 55 55 10 45
268 Nutrifar 5000 Tablet 0 0 0
269 Obat anti tuberkulosis FDC katagori I Paket 0 0 0
270 Obat anti tuberkulosis FDC anak Paket 0 0 0
271 Obat anti tuberkulosis FDC katagori II Paket 0 0 0
272 Obat anti tuberkulosis FDC sisipan Paket 0 0 0
273 Obat anti tuberkulosis kategori I Paket 0 0 0
274 Obat Batuk Kombinasi Botol 0 0 0
275 Obat Flu kombinasi CTM, PPA (Anaflu), Demacolin Tablet 261 261 261
276 Obat Flu Kombinasi/Mecofed/Quantidex Tablet 0 0 0
277 OBH plus botol 1 1 1 0
278 Omeprasole tablet 20 mg Tablet 314 314 40 274
279 Ondancentron inj Ampul 0 0 0
280 Ondancetron 4 mg Tablet 0 0 0
281 Orpen Tablet 45 45 45
282 Oseltamivir Tablet 0 0 0
283 Paket bonding Set 0 0 0
284 Pamol 125 mg Supp Supp 0 0 0
285 Pamol 250 mg Supp Supp 0 0 0
286 Pantocain Tetes Mata Botol 0 0 0
287 Parasetamol drop Botol 0 0 0
288 Pehacain Injeksi Ampul 0 0 0
289 Pehatrim Forte (Kotrimoksasol tab forte 960 mg) Tablet 0 0 0
290 Perhidrol (H2O2) Botol 0 0 0
291 Phenitoin tab Tablet 0 0 0
292 Piracetam 400 mg Tablet 0 0 0
293 Piracetam inj 200mg/1ml Ampul 0 0 0
294 Pirimethamine tablet Tablet 0 0 0
295 Prenatin DF Tablet 0 0 0
296 Prenatin plus tablet tablet 0 0 0
297 Primaquin Tablet 0 0 0
298 Primperan inj Ampul 0 0 0
299 Procurma sirup botol 0 0 0
300 Prokain Benzil Penicillin G Injeksi 3 jt IU/vial Vial 0 0 0
301 Proris supp Supp 0 0 0
302 Pularex Tablet 0 0 0
303 Scabimite cream tube 0 0 0
304 Sikzonoate inj Ampul 0 0 0
STOK PENERI PERSEDIA PEMAKA SISA PERMIN PENERI
No Nama Obat Satuan STOK
AWAL MAAN AN IAN TAAN MAAN KET
305 Simvastatin tab 20 mg Tablet 0 0 0
306 Spashi inj Ampul 0 0 0
307 Spashi tab Tablet 0 0 0
308 Stelosi tab 5 mg Tablet 0 0 0
309 Stesolid rectal Supp 0 0 0
310 Strop indra Botol 0 0 0
311 Sulfadiazin tablet Tablet 0 0 0
312 Tenofovir (Tenofovir 300mg) Botol 0 0 0
313 Tetagam Ampul 0 0 0
314 Tramadol inj 50 mg/ml Ampul 0 0 0
315 Tranexid inj (Asam tranexamat inj) Ampul 0 0 0
316 Urotractin tablet 0 0 0
317 Ventolin Nebulizer Ampul 0 0 0
318 Vitamin B12 tab Tablet 0 0 0
319 Vitamin Neurotropik inj Ampul 0 0 0
320 Vitamin Neurotropik tablet (Nutrifar, Sohobion) Tablet 0 0 0
321 VitKa infan Ampul 0 0 0
322 Xylocain Gel Ampul 0 0 0
323 Zidovudine 100 mg Tablet 0 0 0
Sucralfate syrup botol 0 0 0
Clopidogrel bisulfate 0 0 0
Levofloxacin 500 0 0 0
Spironolactone 25 mg 0 0 0
Domperidone syr 0 0 0
Ceterizine syr 5 mg/5ml 0 0 0
Albendazol syr 0 0 0
Zink syr 0 0 0
Cazetin drop 0 0 0
Lacto B 0 0 0
Scopma plus tab 0 0 0
Nebacetin powder 0 0 0
Metronidazol syr 125/5 ml 0 0 0
Salbutamol syr 0 0 0
Furosemida inj 0 0 0
Paracetamol infus 10 mg/ml 0 0 0
Calortusin tab 0 0 0
Coparcetin tab 0 0 0
TB tahap intensif 0 0 0
TB tahap lanjutan 0 0 0
Solathim syr 0 0 0
Antiseptic liquid no 2 0 0 0
Tenofovir + Emtricitabin 0 0 0
Cavit G 0 0 0
Ketros Supp 0 0 0
Harnal 0 0 0
BMHP 0 0 0
1 ADS 0.5 ml Pcs 0 0 0
2 ADS 0.05 ml Pcs 0 0 0
3 ADS 2 ml Pcs 0 0 0
4 ADS 5 ml Pcs 0 0 0
5 Alat suntik sekali pakai 1 ml Pcs 0 0 0
6 Alat suntik sekali pakai 2,5 ml Pcs 0 0 0
7 Alat suntik sekali pakai 5 ml Pcs 0 0 0
8 Bisturi no 13 Pcs 0 0 0
9 Bisturi no 14 Pcs 0 0 0
10 Bisturi no 19/20 Pcs 0 0 0
11 Bisturi no 21 Pcs 0 0 0
12 Box slide kotak 0 0 0
13 Catgut 2/0 plain Sachet 0 0 0
14 Catgut / benang bedah no 2/0 chromic Sachet 0 0 0
15 Catgut / benang bedah no 3/0 plain Sachet 0 0 0
16 Catgut 1/0 Chromic Pcs 0 0 0
17 Catgut 2/0 Chromic Roll Roll 0 0 0
18 Catgut 3/0 Chromic Roll Roll 0 0 0
19 Cutgut Chromic No.1 atraumatik (sachet) Sachet 0 0 0
20 Etanol 70 % Botol 0 0 0
21 Etanol 70 % Botol 100 ml 0 0 0
22 Film Rontgen 18 x 24 Set 0 0 0
23 Folley catheter Pcs 0 0 0
24 Hypavix (Ultrafik) Roll 0 0 0
25 I.V Catheter 22 Pcs 0 0 0
26 I.V Catheter 24 Pcs 0 0 0
27 Infusion set anak Set 0 0 0
28 Infusion set dewasa Set 0 0 0
29 IV Cath dgn Katup pcs 0 0 0
30 IV Catheter 18 Pcs 0 0 0
31 IV Catheter 20 Pcs 0 0 0
32 IV Catheter no 18 G Terumo Pcs 0 0 0
33 IV Catheter no 20 G Terumo Pcs 0 0 0
34 Jarum injeksi Pcs 0 0 0
STOK PENERI PERSEDIA PEMAKA SISA PERMIN PENERI
No Nama Obat Satuan STOK
AWAL MAAN AN IAN TAAN MAAN KET
35 Jarum jahit (bedah) no. 9 s/d 14 Set 0 0 0
36 Jarum Jahit Bedah no 12 Set 0 0 0
37 Jarum Jahit Bedah no 13 Set 0 0 0
38 Jarum Jahit Bedah no 14 Set 0 0 0
39 Jarum Kulit Set 0 0 0
40 Jarum Otot dan Kulit Set 0 0 0
41 Jelly RO Tube 0 0 0
42 Kantung Puyer Pak 0 0 0
43 Kapas pembalut / absorben 250 gram Roll 0 0 0
44 Kasa gulung 40 x 80 Roll 0 0 0
45 Kasa Hidrofil 4 x 10 Roll 0 0 0
46 Kasa kompres 40 / 40 steril Roll 0 0 0
47 Kasa pembalut 2 x 80 Roll 0 0 0
48 Kasa pembalut hidrofil 4 m x 15 cm Roll 5 5 5
49 Kasa pembalut hidrofin 4m x 3 cm Roll 0 0 0
50 Kasa Steril ( 18 x 22 ) Kotak 2 2 2
51 Kertas EKG Roll 0 0 0
52 Kertas saring Lembar 0 0 0
53 Kertas USG Roll 0 0 0
54 Klem Tali Pusar pcs 0 0 0
55 Klip Kecil Pak 0 0 0
56 Klip Tanggung Pak 8 8 3 5
57 Lampu spiritus botol 0 0 0
58 Lisol mengandung kresol Botol 0 0 0
59 Masker Pcs 0 0 0
60 Masker Bedah Pcs 0 0 0
61 Masker N95 Pcs 0 0 0
62 MY Jelly Tube 0 0 0
63 Nasal cannula Oksigen pcs 0 0 0
64 Pembalut Gips Roll 0 0 0
65 Perkamen Pak 0 0 0
66 Plester 5 yard x 2 inch Roll 0 0 0
67 Pot Salep Pot 0 0 0
68 Pot Sputum Pcs 0 0 0
69 Safety box Pcs 0 0 0
70 Sarung Tangan Gynaecologi pasang 0 0 0
71 Sarung Tangan L Pasang 0 0 0
72 Sarung Tangan M Pasang 0 0 0
73 Sarung Tangan S Pasang 0 0 0
74 Sarung Tangan Steril Pasang 0 0 0
75 Sarung Tangan Surgiglove Pasang 0 0 0
76 Sendok Takar Pcs 0 0 0
77 Silk 3/0 roll Roll 0 0 0
78 Silk (benang bedah sutera) no.3/0 Pcs 0 0 0
79 Slide Prosted Pak 0 0 0
80 Spalk tungkai atas anak Pcs 0 0 0
81 Spalk tungkai atas dewasa Pcs 0 0 0
82 Spalk tungkai bawah anak Pcs 0 0 0
83 Spalk tungkai bawah dewasa Pcs 0 0 0
84 Spuit 10 ml Pcs 0 0 0
85 Spuit 2/3 ml Pcs 0 0 0
86 Transfusi Set Pcs 0 0 0
87 Uji Tuberkulin Vial 0 0 0
88 Underpad Pak 0 0 0
89 Urinebag Set 0 0 0
90 Wing Needle 21 Pcs 0 0 0
91 Wing Needle 23 Pcs 0 0 0
92 Wing Needle 25 Pcs 0 0 0
93 Wing Needle 27 Pcs 0 0 0

BAYAR TIDAK BAYAR ( JKN ) JUMLAH


JUMLAH KUNJUNGAN RESEP
3 75 78

Mengetahui Yang Menyerahkan Yang Meminta / pelapor


Kepala Puskesmas Selemadeg Timur II Petugas Gudang Obat Puskesmas Petugas Apotek / Pustu

dr. Ni Putu Partini Ni Kadek Eni Mulyani Ni Wayan Suganti


NIP. 196607262002122003 NIP. NIP. 197603192009022005
gdo 200

gdo 300
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT SUB UNIT

DOKUMEN NOMOR TANGGAL


PUSK
SUB UNIT

SUB UNIT : TEGAL MENGKEB PELAPORAN BULAN / PERIODE : JANUARI 2019


KECAMATAN : SELEMADEG TIMUR PERMINTAAN BULAN / PERIODE : FEBRUARI 2019
KABUPATEN : TABANAN

No Nama Obat Satuan STOK PENERIM PERSEDIA PEMAKAI SISA PERMIN PENERIM KET
AWAL AAN AN AN STOK TAAN AAN
1 2 3 4 5 6(4 + 5) 7 8(6-7) 10 11
1 Acyclovir Salep Tube 2 2 1 1 5 5
2 Acyclovir 400 mg Tab Tablet 105 105 0 105
3 Air raksa dental use Botol 0 0 0 0
4 Albendazol 400 mg tab Tablet 0 0 0 0
5 Alprazolam 0.5 mg Tablet 0 0 0 0
6 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0 0 0 0
7 Ambroxol syr Botol 0 0 0 0
8 Ambroxol tab 30 mg / Promukus Tablet 180 180 35 145
9 Aminofilina injeksi 24 mg/ ml. 10 ml Ampul 0 0 0 0
10 Aminofilna tablet 200 mg Tablet 0 0 0 0
11 Amitriptilina hcl tablet salut 25 mg Tablet 0 0 0 0
12 Amoksilina kapsul 500 mg Tablet 135 200 335 145 190 300 300
13 Amoksilna sirup kering 125 mg/ 5 mg Botol 0 0 0 0
14 Antasida doen tablet kombinasi Tablet 120 200 320 240 80 200 200
15 Anti hemmoroid suppositoria Supp 0 0 0 0
16 Aqua pro injeksi streril. Bebas priogen 20 ml Vial 1 1 0 1
17 Aquadest steril 500 ml Botol 0 0 0 0
18 As salisilat 2% + belerang endap 4%(2-4 salep Pot 0 0 0 0
19 As. Benzoat 3 % + as salisilat 6%(whitefield) Pot 0 0 0 0
20 Asam askorbat (Vit. C) tablet 50 mg Tablet 0 0 0 0
21 Asam mefenamat 500 mg Tablet 100 100 90 10
22 Asetosal 100 mg Tablet 0 0 0 0
23 Asetosal tablet 500 mg Tablet 0 0 0 0
24 Atropina sulfat injeksi 0 .25 mg / ml - 1 ml Ampul 0 0 0 0
25 Basitrasin Polimiksin Tube 2 2 2 0
26 Besi (II) sulfat tablet salut .kombinasi Tablet 115 115 40 75
27 Betahistin tab Tablet 0 0 0 0
28 Betametazon salep kulit Tube 2 5 7 2 5
29 Captopril 12.5 mg tablet Tablet 0 0 0 0
30 Captopril 25 mg tablet Tablet 0 0 0 0
31 Carbamazepina 200 mg talet Tablet 0 0 0 0
32 Cefadroxil 125mg/5ml Sirup Botol 0 0 0 0
33 Cefadroxill 500 mg tablet Tablet 80 80 0 80
34 Cefotaxim 1 gr Injeksi Ampul 0 0 0 0
35 Cetirizin10 mg tab Tablet 97 97 17 80
36 Cimetidine/Selestidin Tablet 0 0 0 0
37 Ciprofloxazin tablet 500 mg Tablet 0 0 0 0
38 Deksametason injeksi 5 mg / ml - 1 ml Ampul 0 0 0 0
39 Deksametason tablet 0.5 mg Tablet 246 246 75 171 200 200
40 Devitalisasi pasta Tube 0 0 0 0
41 Diazepam 5 mg Tablet 0 0 0 0
42 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0 0 0 0
43 Diazepam tablet 2 mg Tablet 0 0 0 0
44 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 8 8 1 7
45 Digoksina tablet 0. 25 mg Tablet 0 0 0 0
46 Domperidon tablet 10 mg Tablet 90 90 15 75
47 Doxycicline 100 mg tab Tablet 0 0 0 0
48 Efedrina HCL (efedrina) tablet 25 mg Tablet 0 0 0 0
49 Epinefrina HCL / bitartat (aderenalina) inj 01% Ampul 0 0 0 0
50 Ergotamina tartrat 1 mg + kofeina 50 mg tab Tablet 0 0 0 0
51 Erytromysin 200mg/5ml Syrup Botol 0 0 0 0
52 Erytromysin tablet 500 mg Tablet 0 0 0 0
53 Etakridina (rivanol) larutan 0.1 % Botol 0 0 0 0
54 Etil klorida semprot Botol 0 0 0 0
55 Eugenol cairan Botol 0 0 0 0
56 Fenobarbital inj 50 mg /ml -2ml Ampul 0 0 0 0
57 Fenobarbital tablet 100mg Tablet 0 0 0 0
58 Fenobarbital tablet 30 mg Tablet 0 0 0 0
59 Fenol gliserol tetes telnga 10% Botol 0 0 0 0
60 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0 0 0 0
61 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0 0 0 0
62 Furosemida tablet 40 mg Tablet 0 0 0 0
63 Garam Oralit untuk 200 ml air Sachet 27 27 27 0
64 Gentamisin Salep Mata Tube 3 3 0 3
65 Gentamysin SK Tube 0 0 0 0
66 Gentamysin TM/Genoint TM Botol 1 5 6 1 5
67 Gentian violet larutan 1 % Botol 0 0 0 0
68 Glibenklamida tablet 5 mg Tablet 0 0 0 0
69 Gliseril guayakolat tablet 10 mg Tablet 0 0 0 0
70 Glukosa larutan infus 10 % steril Botol 0 0 0 0
71 Glukosa larutan infus 40 % steril Botol 0 0 0 0
72 Glukosa larutan infus 5 % steril Botol 0 0 0 0
STOK PENERIM PERSEDIA PEMAKAI SISA PERMIN PENERIM
No Nama Obat Satuan KET
AWAL AAN AN AN STOK TAAN AAN
73 Griseofulvin tablet 125 mg. Mikronized Tablet 0 0 0 0
74 Haloperidol 0,5 mg. Tablet Tablet 0 0 0 0
75 Haloperidol 1,5 mg tablet Tablet 0 0 0 0
76 Haloperidol 5 mg tablet Tablet 0 0 0 0
77 Hidroklorotiasida (HCT) tablet 25 mg Tablet 0 0 0 0
78 Hidrokortison krim 2.5 % Tube 0 0 0 0
79 Ibuprofen tablet 400 mg Tablet 0 0 0 0
80 Isoniazide 100 mg Tablet 0 0 0 0
81 Isoniazide 300 mg Tablet 0 0 0 0
82 Isosorbid dinitrat Tablet 0 0 0 0
83 Kalsium hidroksida pasta Pot 0 0 0 0
84 Kalsium laktat (kalk) tablet 500 mg Tablet 35 35 35 0
85 Ketokonazole 200 mg tablet Tablet 7 7 0 7
86 Kinina dihidroklorida (kinina) inj 25 % - 2 ml Ampul 0 0 0 0
87 Kinina sulfat tablet 222 mg (7 h20 ) Tablet 0 0 0 0
88 Kloramfenicol salep kulit Tube 0 0 0 0
89 Kloramfenikol kapsul 250 mg Tablet 0 0 0 0
90 Kloramfenikol salep mata 1 % Tube 0 0 0 0
91 Kloramfenikol tetes Mata Botol 0 0 0 0
92 Kloramfenikol tetes telinga 3 % Botol 0 0 0 0
93 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 100 200 300 110 190 100 100
94 Klorpromazin 100 mg tablet Tablet 0 0 0 0
95 Klorpromazina Hcl inj 25 mg / ml - 1 ml Ampul 0 0 0 0
96 Klorpromazina Hcl inj 5 mg / ml - 2 ml Ampul 0 0 0 0
97 Klorpromazina hcl tablet salut 25 mg Tablet 0 0 0 0
98 Kodeina Hcl (kodeina) tablet 10 mg Tablet 0 0 0 0
99 Kotrimoksasol suspensi Botol 7 7 0 7
100 Kotrimoksasol tablet kombinasi Tablet 70 70 70 0
101 Lidokain inj Ampul 0 0 0 0
102 Lidokaina comp inj kombinasi Ampul 0 0 0 0
103 Metakresol sulfonat dan metanol kondensai (ABotol 0 0 0 0
104 Metformin 500 mg tablet Tablet 0 0 0 0
105 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0 0 0 0
106 Metilergometrina malet tablet salut 0. 125 mg Tablet 0 0 0 0
107 Metilprednisolon tablet 4 mg Tablet 0 0 0 0
108 Metoklopramide 10 mg tablet/Noristal Tablet 0 0 0 0
109 Metronidazol 500 mg Tablet 60 60 0 0
110 Metronidazol tablet 250 mg Tablet 0 0 0 0
111 Mikonazole salep Tube 0 0 0 0
112 Monoklorkamfer mentolcairan (CHKM) Botol 0 0 0 0
113 Mumifyng pasta Botol 0 0 0 0
114 Natrium bikarbonat tablet 500 mg Tablet 0 0 0 0
115 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 0 0 0 0 200 200
116 Natrium klorida larutan infus 0. 9 steril Botol 1 1 0 1
117 Nifedipin tablet 10 mg Tablet 0 0 0 0
118 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0 0 0 0
119 Obat batuk hitam (OBH) cairan Botol 100 m 0 0 0 0
120 Ofloxacin tab 400mg Tablet 0 0 0 0
121 Oksigen gas dalam tabung 3 m3 Tabung 0 0 0 0
122 Oksigen gas dalam tabung 6 m3 Tabung 0 0 0 0
123 Oksitetrasiklina hcl salep 3 % Tube 0 0 0 0
124 Oksitetrasiklina hcl salep mata 1 % Tube 0 0 0 0
125 Oksitosina inj 10 iu/ml - 1 ml Ampul 0 0 0 0
126 Parasetamol sirup 120 mg / 5 ml Botol 0 0 0 0
127 Parasetamol tab 100 mg Tablet 0 0 0 0
128 Parasetamol tablet 500mg Tablet 185 300 485 315 170 300 300
129 Pirantel pamoat (pirantel) tablet 125 mg basa Tablet 0 0 0 0
130 Piroxicam 10 Mg Tablet 0 0 0 0
131 Piroxicam 20 Mg Tablet 0 0 0 0
132 Prednison tablet 5 mgn Tablet 0 0 0 0
133 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0 0 0 0
134 Primakina tablet 15 mg Tablet 0 0 0 0
135 Prokaina penisilina g inj 3 juta iu Vial 0 0 0 0
136 Propiltionurasil tablet 100 mg Tablet 0 0 0 0
137 Propranolol hcl (Propranolol) tablet 40 mg Tablet 0 0 0 0
138 Pyridoxin injeksi Ampul 0 0 0 0
139 Ranitidin inj 25 mg/2 ml Ampul 0 0 0 0
140 Ranitidin tablet 150 mg Tablet 210 210 160 50 200 200
141 Reserpina tablet 0, 10 mg Tablet 0 0 0 0
142 Reserpina tablet 0, 25 mg Tablet 0 0 0 0
143 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0 0 0 0 100 100
144 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0 0 0 0 20 20
145 Ringer laktat larutan infus steril Botol 0 0 0 0
146 Risperidon Tablet 0 0 0 0
147 Salbutamol tablet 2 mg Tablet 0 0 0 0
148 Salbutamol tablet 4 mg Tablet 0 0 0 0
149 Salisil bedak 2 % Bks 0 0 0 0
150 Salisil spiritus 10 % Botol 0 0 0 0
151 Semen seng fosfat serbuk dan cairan Botol 0 0 0 0
152 Serum anti bisa ular polivalen inj. 5ml Ampul 0 0 0 0
153 Serum anti tetanus inj. 1.500 iu Ampul 0 0 0 0
154 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 11 11 5 6 5 5
155 Silver amalgam serbuk 65-75% Botol 0 0 0 0
156 Simvastatin tab 10 mg Tablet 0 0 0 0
157 Sulfacetamide tetes mata Botol 0 0 0 0
STOK PENERIM PERSEDIA PEMAKAI SISA PERMIN PENERIM
No Nama Obat Satuan KET
AWAL AAN AN AN STOK TAAN AAN
158 Synthetic filing material larutan dan serbuk Set 0 0 0 0
159 Temporary stopping fletcher serbuk dan caira Set 0 0 0 0
160 Tetrasiklina hcl (tetrasiklina) kapsul 250 mg Tablet 0 0 0 0
161 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 70 70 20 50
162 Thiamfenikol 500 Tablet 0 0 0 0
163 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0 0 0 0
164 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0 0 0 0
165 Tramadol Tablet 0 0 0 0
166 Trifluoperazine (Stelazin) Tablet 0 0 0 0
167 Triheksfenidil hcl 2 mg tablet Tablet 0 0 0 0
168 Trikresol formalin (tkf) cairan Botol 0 0 0 0
169 Vitamin B kompleks tablet Tablet 0 0 0 0
170 Yodium povidan larutan 10% 300 ml Botol 0 0 0 0
171 Yodium povidon larutan 10% 30 ml Botol 0 0 0 0
172 Zink tablet Tablet 0 0 0 0
Amoxcilin syrup botol 3 3 0 3
0
OBAT TAMBAHAN 0 0 0 0
173 Aptil Botol 0 0 0 0
174 (Lopinavir/Ritonavir)Aluvia Botol 0 0 0 0
175 Abacavir Tablet 0 0 0 0
176 Acyclovir tablet 200 mg Tablet 0 0 0 0
177 Aleterol TM Botol 0 0 0 0
178 Amlodipin 10 mg tab Tablet 0 0 0 0
179 Amlodipin 5 mg tab Tablet 0 0 0 0
180 Amox-clav Tablet 0 0 0 0
181 Ampisilin Serbuk Injeksi i.m/i.v. 1000 mg/ml Ampul 0 0 0 0
182 Ampisillin injeksi i.m/i.v 1000 mg/ml Ampul 0 0 0 0
183 Antalgin injeksi Ampul 0 0 0 0
184 Antasida syr Botol 0 0 0 0
185 Arterakine Tablet 0 0 0 0
186 Artesunat inj Vial 0 0 0 0
187 Asam Folat 1 mg Tablet 0 0 0 0
188 Asam tranexamat 500 mg Tablet 0 0 0 0
189 Asetosal 80/miniaspi tablet 0 0 0 0
190 Atripla(TDF+3TC+EFV) Botol 0 0 0 0
191 Azitromisin+cefixim Tablet 0 0 0 0
192 Azytromisin tablet 500 mg Tablet 0 0 0 0
193 BD Vacuntainer Pcs 0 0 0 0
194 Becefort Tablet 15 200 215 20 195 100 100
195 Benzatin Penisillin Vial 0 0 0 0
196 Bonding Set 0 0 0 0
197 Bufacomb salep Tube 0 0 0 0
198 Buscopan inj Ampul 0 0 0 0
199 Caviton Tube 0 0 0 0
200 Cefixim syr 100 mg/5 ml Botol 1 1 0 1
201 Cefixim tablet 100 mg Tablet 0 0 0 0
202 Cefixim tablet 200 mg Tablet 0 0 0 0
203 Cefotaxim 0,5 g inj Vial 0 0 0 0
204 Ceftriaxon inj Vial 0 0 0 0
205 Clarithromysin 500 mg Tablet 0 0 0 0
206 Clavamox inj Ampul 0 0 0 0
207 Clindamisin 150 mg Tablet 0 0 0 0
208 Clindamisin 300 mg Tablet 0 0 0 0
209 Clobazam 10 mg Tablet 0 0 0 0
210 Clozapine 25 mg Tablet 0 0 0 0
211 Composite (tumpatan sinar)A3 Set 0 0 0 0
212 Composite (tumpatan sinar)A3.5 Set 0 0 0 0
213 Crofed Tablet 0 0 0 0
214 D1/2 NS botol 0 0 0 0
215 D1/4 NS Botol 0 0 0 0
216 Daryantulle Lembar 0 0 0 0
217 Dermazine/Burnazin Tube 0 0 0 0
218 Dextina / Dextamin/Dextamec/Polofar Plus Tablet 18 18 0 0
219 Dextran 70% Botol 0 0 0 0
220 Dextrofen syr Botol 9 9 8 1 10 10
221 Diaform tablet/selesdiar Tablet 0 0 0 0
222 Dormi/Scopma/Spashi tablet Tablet 0 0 0 0
223 Dulcolac anak supp Supp 0 0 0 0
224 Dulcolac dewasa supp Supp 0 0 0 0
225 Dulkolak tablet Tablet 0 0 0 0
226 Duviral(Zidovudin 300+Lamivudin 150) Botol 0 0 0 0
227 Efavirenz Botol 0 0 0 0
228 Etambutol Tablet 0 0 0 0
229 ETSA Set 0 0 0 0
230 Euthyrox 100mg Tablet 0 0 0 0
231 Faktu Supp Supp 0 0 0 0
232 Fluconasol tab Tablet 0 0 0 0
233 Fluoxetin Tablet 0 0 0 0
234 Forumen TT Fls 0 0 0 0
235 Gentamisin Injeksi 80 mg/2ml Ampul 0 0 0 0
236 Glass ionomer (Ketac Molar) Tube 0 0 0 0
237 Glimepiride 2 tablet 0 0 0 0
238 Glimepiride 4 tablet 0 0 0 0
239 Glukonas Calcicus 10%- 10ml Ampul 0 0 0 0
STOK PENERIM PERSEDIA PEMAKAI SISA PERMIN PENERIM
No Nama Obat Satuan KET
AWAL AAN AN AN STOK TAAN AAN
240 Haldol inj Ampul 0 0 0 0
241 Hiviral (Lamivudin 150) Botol 0 0 0 0
242 Ibuprofen syr btl 0 0 0 0
243 Iliadin TH flesh 0 0 0 0
244 Isotic Neolisin TM Fls 0 0 0 0
245 Kalium Diklovenac tablet 0 200 200 0 200
246 Kaltropen supp Supp 0 0 0 0
247 Ketoconazole SK tube 0 0 0 0
248 Ketoprofen inj 10 mg Ampul 0 0 0 0
249 Ketoprofen tablet 100 mg Tablet 0 0 0 0
250 Ketorolac inj Ampul 0 0 0 0
251 Kombipak Anak Paket 0 0 0 0
252 Lodomer 2 Tablet 0 0 0 0
253 Lytamin syr botol 0 0 0 0
254 Magnesium Sulfat 20% - 25 ml Botol 0 0 0 0
255 Magnesium Sulfat 40% - 25 ml Botol 0 0 0 0
256 Metil Prednisolon 16 mg Tablet 0 0 0 0
257 Metil prednisolon inj 500 mg Vial 0 0 0 0
258 Metronidazole 500 mg Infus/100 ml Botol 0 0 0 0
259 Meylon inj Botol 0 0 0 0
260 Microlax Supp 0 0 0 0
261 Miloxicam 7,5 mg tablet 80 150 230 160 70 150
262 Molexflu Tablet 0 0 0 0
263 Multivitamin (Livron B plek) Tablet 140 140 105 35 200 200
264 Multivitamin sirup( Xanvit syr) Botol 0 0 0 0
265 Neurotropik tablet Tablet 0 0 0 0
266 Neviral (neviravin 200mg) Botol 0 0 0 0
267 New antides tablet 73 73 38 35
268 Nutrifar 5000 Tablet 0 0 0 0
269 Obat anti tuberkulosis FDC katagori I Paket 0 0 0 0
270 Obat anti tuberkulosis FDC anak Paket 0 0 0 0
271 Obat anti tuberkulosis FDC katagori II Paket 0 0 0 0
272 Obat anti tuberkulosis FDC sisipan Paket 0 0 0 0
273 Obat anti tuberkulosis kategori I Paket 0 0 0 0
274 Obat Batuk Kombinasi Botol 0 0 0 0
275 Obat Flu kombinasi CTM, PPA (Anaflu), Demac Tablet 160 160 160 0 200 200
276 Obat Flu Kombinasi/Mecofed/Quantidex Tablet 0 0 0 0
277 OBH plus botol 8 8 7 1 5 5
278 Omeprasole tablet 20 mg Tablet 90 90 70 20
279 Ondancentron inj Ampul 0 0 0 0
280 Ondancetron 4 mg Tablet 0 0 0 0
281 Orpen Tablet 0 0 0 0
282 Oseltamivir Tablet 0 0 0 0
283 Paket bonding Set 0 0 0 0
284 Pamol 125 mg Supp Supp 0 0 0 0
285 Pamol 250 mg Supp Supp 0 0 0 0
286 Pantocain Tetes Mata Botol 0 0 0 0
287 Parasetamol drop Botol 6 6 5 1 5 5
288 Pehacain Injeksi Ampul 0 0 0 0
289 Pehatrim Forte (Kotrimoksasol tab forte 960 m Tablet 0 0 0 0
290 Perhidrol (H2O2) Botol 0 0 0 0
291 Phenitoin tab Tablet 0 0 0 0
292 Piracetam 400 mg Tablet 0 0 0 0
293 Piracetam inj 200mg/1ml Ampul 0 0 0 0
294 Pirimethamine tablet Tablet 0 0 0 0
295 Prenatin DF Tablet 0 0 0 0
296 Prenatin plus tablet tablet 0 0 0 0
297 Primaquin Tablet 0 0 0 0
298 Primperan inj Ampul 0 0 0 0
299 Procurma sirup botol 0 0 0 0
300 Prokain Benzil Penicillin G Injeksi 3 jt IU/vial Vial 0 0 0 0
301 Proris supp Supp 0 0 0 0
302 Pularex Tablet 0 0 0 0
303 Scabimite cream tube 0 0 0 0
304 Sikzonoate inj Ampul 0 0 0 0
305 Simvastatin tab 20 mg Tablet 0 0 0 0
306 Spashi inj Ampul 0 0 0 0
307 Spashi tab Tablet 0 0 0 0
308 Stelosi tab 5 mg Tablet 0 0 0 0
309 Stesolid rectal Supp 0 0 0 0
310 Strop indra Botol 0 0 0 0
311 Sulfadiazin tablet Tablet 0 0 0 0
312 Tenofovir (Tenofovir 300mg) Botol 0 0 0 0
313 Tetagam Ampul 0 0 0 0
314 Tramadol inj 50 mg/ml Ampul 0 0 0 0
315 Tranexid inj (Asam tranexamat inj) Ampul 0 0 0 0
316 Urotractin tablet 0 0 0 0
317 Ventolin Nebulizer Ampul 0 0 0 0
318 Vitamin B12 tab Tablet 0 0 0 0
319 Vitamin Neurotropik inj Ampul 0 0 0 0
320 Vitamin Neurotropik tablet (Nutrifar, Sohobio Tablet 0 0 0 0
321 VitKa infan Ampul 0 0 0 0
322 Xylocain Gel Ampul 0 0 0 0
323 Zidovudine 100 mg Tablet 0 0 0 0
Sucralfate syrup botol 0 0 0 0
STOK PENERIM PERSEDIA PEMAKAI SISA PERMIN PENERIM
No Nama Obat Satuan KET
AWAL AAN AN AN STOK TAAN AAN
Clopidogrel bisulfate 0 0 0 0
Levofloxacin 500 0 0 0 0
Spironolactone 25 mg 0 0 0 0
Domperidone syr 0 0 0 0
Ceterizine syr 5 mg/5ml 0 0 0 0
Albendazol syr 0 0 0 0
Zink syr 0 0 0 0
Cazetin drop 0 0 0 0
Lacto B 0 0 0 0
Scopma plus tab 0 0 0 0
Nebacetin powder 0 0 0 0
Metronidazol syr 125/5 ml 0 0 0 0
Salbutamol syr 0 0 0 0
Furosemida inj 0 0 0 0
Paracetamol infus 10 mg/ml 0 0 0 0
Calortusin tab 0 0 0 0
Coparcetin tab 0 0 0 0
TB tahap intensif 0 0 0 0
TB tahap lanjutan 0 0 0 0
Solathim syr 0 0 0 0
Antiseptic liquid no 2 0 0 0 0
Tenofovir + Emtricitabin 0 0 0 0
Cavit G 0 0 0 0
Ketros Supp 0 0 0 0
Harnal 0 0 0 0
BMHP 0 0 0 0
1 ADS 0.5 ml Pcs 0 0 0 0
2 ADS 0.05 ml Pcs 0 0 0 0
3 ADS 2 ml Pcs 0 0 0 0
4 ADS 5 ml Pcs 0 0 0 0
5 Alat suntik sekali pakai 1 ml Pcs 0 0 0 0
6 Alat suntik sekali pakai 2,5 ml Pcs 0 0 0 0
7 Alat suntik sekali pakai 5 ml Pcs 0 0 0 0
8 Bisturi no 13 Pcs 0 0 0 0
9 Bisturi no 14 Pcs 0 0 0 0
10 Bisturi no 19/20 Pcs 0 0 0 0
11 Bisturi no 21 Pcs 0 0 0 0
12 Box slide kotak 0 0 0 0
13 Catgut 2/0 plain Sachet 0 0 0 0
14 Catgut / benang bedah no 2/0 chromic Sachet 0 0 0 0
15 Catgut / benang bedah no 3/0 plain Sachet 0 0 0 0
16 Catgut 1/0 Chromic Pcs 0 0 0 0
17 Catgut 2/0 Chromic Roll Roll 0 0 0 0
18 Catgut 3/0 Chromic Roll Roll 0 0 0 0
19 Cutgut Chromic No.1 atraumatik (sachet) Sachet 0 0 0 0
20 Etanol 70 % Botol 0 0 0 0
21 Etanol 70 % Botol 100 m 0 0 0 0
22 Film Rontgen 18 x 24 Set 0 0 0 0
23 Folley catheter Pcs 0 0 0 0
24 Hypavix (Ultrafik) Roll 0 0 0 0
25 I.V Catheter 22 Pcs 0 0 0 0
26 I.V Catheter 24 Pcs 0 0 0 0
27 Infusion set anak Set 0 0 0 0
28 Infusion set dewasa Set 0 0 0 0
29 IV Cath dgn Katup pcs 0 0 0 0
30 IV Catheter 18 Pcs 0 0 0 0
31 IV Catheter 20 Pcs 0 0 0 0
32 IV Catheter no 18 G Terumo Pcs 0 0 0 0
33 IV Catheter no 20 G Terumo Pcs 0 0 0 0
34 Jarum injeksi Pcs 0 0 0 0
35 Jarum jahit (bedah) no. 9 s/d 14 Set 0 0 0 0
36 Jarum Jahit Bedah no 12 Set 0 0 0 0
37 Jarum Jahit Bedah no 13 Set 0 0 0 0
38 Jarum Jahit Bedah no 14 Set 0 0 0 0
39 Jarum Kulit Set 0 0 0 0
40 Jarum Otot dan Kulit Set 0 0 0 0
41 Jelly RO Tube 0 0 0 0
42 Kantung Puyer Pak 0 0 0 0
43 Kapas pembalut / absorben 250 gram Roll 0 0 0 0
44 Kasa gulung 40 x 80 Roll 0 0 0 0
45 Kasa Hidrofil 4 x 10 Roll 0 0 0 0
46 Kasa kompres 40 / 40 steril Roll 1 1 0 1
47 Kasa pembalut 2 x 80 Roll 0 0 0 0
48 Kasa pembalut hidrofil 4 m x 15 cm Roll 1 1 0 1
49 Kasa pembalut hidrofin 4m x 3 cm Roll 0 0 0 0
50 Kasa Steril ( 18 x 22 ) Kotak 0 0 0 0
51 Kertas EKG Roll 0 0 0 0
52 Kertas saring Lembar 0 0 0 0
53 Kertas USG Roll 0 0 0 0
54 Klem Tali Pusar pcs 0 0 0 0
55 Klip Kecil Pak 1 3 4 2 2 2 2
56 Klip Tanggung Pak 1 3 4 2 2 2 2
57 Lampu spiritus botol 0 0 0 0
58 Lisol mengandung kresol Botol 0 0 0 0
59 Masker Pcs 45 45 45 0
STOK PENERIM PERSEDIA PEMAKAI SISA PERMIN PENERIM
No Nama Obat Satuan KET
AWAL AAN AN AN STOK TAAN AAN
60 Masker Bedah Pcs 0 0 0 0
61 Masker N95 Pcs 0 0 0 0
62 MY Jelly Tube 0 0 0 0
63 Nasal cannula Oksigen pcs 0 0 0 0
64 Pembalut Gips Roll 0 0 0 0
65 Perkamen Pak 0 0 0 0
66 Plester 5 yard x 2 inch Roll 0 0 0 0
67 Pot Salep Pot 0 0 0 0
68 Pot Sputum Pcs 0 0 0 0
69 Safety box Pcs 0 0 0 0
70 Sarung Tangan Gynaecologi pasang 0 0 0 0
71 Sarung Tangan L Pasang 0 0 0 0
72 Sarung Tangan M Pasang 0 0 0 0
73 Sarung Tangan S Pasang 0 0 0 0
74 Sarung Tangan Steril Pasang 0 0 0 0
75 Sarung Tangan Surgiglove Pasang 0 0 0 0
76 Sendok Takar Pcs 10 10 0 10
77 Silk 3/0 roll Roll 0 0 0 0
78 Silk (benang bedah sutera) no.3/0 Pcs 0 0 0 0
79 Slide Prosted Pak 0 0 0 0
80 Spalk tungkai atas anak Pcs 0 0 0 0
81 Spalk tungkai atas dewasa Pcs 0 0 0 0
82 Spalk tungkai bawah anak Pcs 0 0 0 0
83 Spalk tungkai bawah dewasa Pcs 0 0 0 0
84 Spuit 10 ml Pcs 0 0 0 0
85 Spuit 2/3 ml Pcs 0 0 0 0
86 Transfusi Set Pcs 0 0 0 0
87 Uji Tuberkulin Vial 0 0 0 0
88 Underpad Pak 0 0 0 0
89 Urinebag Set 0 0 0 0
90 Wing Needle 21 Pcs 0 0 0 0
91 Wing Needle 23 Pcs 0 0 0 0
92 Wing Needle 25 Pcs 0 0 0 0
93 Wing Needle 27 Pcs 0 0 0 0

BAYAR TIDAK BAYAR ( JKN ) JUMLAH


JUMLAH KUNJUNGAN RESEP
18 90 108

Mengetahui Yang Menyerahkan Yang Meminta / pelapor


Kepala Puskesmas Selemadeg Timur II Petugas Gudang Obat Puskesmas Petugas Apotek / Pustu

dr. Ni Putu Partini Ni Kadek Eni Mulyani Ni Putu Sri Wahyuni, A.Md.Keb
NIP. 196607262002122003 NIP. NIP. 19680420 199001 1 002
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT SUB UNIT

DOKUMEN NOMOR TANGGAL


PUSK
SUB UNIT

SUB UNIT : TANGGUNTITI PELAPORAN BULAN / PERIODE : JANUARI 2019


KECAMATAN : SELEMADEG TIMUR PERMINTAAN BULAN / PERIODE : FEBRUARI 2019
KABUPATEN : TABANAN

No Nama Obat Satuan PENERIMAA PERSEDI PEMAKA SISA PERMINT PENERI


STOK AWAL N AAN IAN STOK AAN MAAN KET
1 2 3 4 5 6(4 + 5) 7 8(6-7) 9 10 11
1 Acyclovir Salep Tube 4 4 1 3
2 Acyclovir 400 mg Tab Tablet 0 0 0 0
3 Air raksa dental use Botol 0 0 0 0
4 Albendazol 400 mg tab Tablet 0 0 0 0
5 Alprazolam 0.5 mg Tablet 0 0 0 0
6 Alupurinol 100 mg tab / Selespurin/ Proxu Tablet 0 0 0 0
7 Ambroxol syr Botol 9 9 3 6
8 Ambroxol tab 30 mg / Promukus Tablet 116 116 10 106
9 Aminofilina injeksi 24 mg/ ml. 10 ml Ampul 0 0 0 0
10 Aminofilna tablet 200 mg Tablet 0 0 0 0
11 Amitriptilina hcl tablet salut 25 mg Tablet 0 0 0 0
12 Amoksilina kapsul 500 mg Tablet 166 166 10 156
13 Amoksilna sirup kering 125 mg/ 5 mg Botol 0 0 0 0
14 Antasida doen tablet kombinasi Tablet 100 100 100 0
15 Anti hemmoroid suppositoria Supp 0 0 0 0
16 Aqua pro injeksi streril. Bebas priogen 20 Vial 1 1 0 1
17 Aquadest steril 500 ml Botol 0 0 0 0
18 As salisilat 2% + belerang endap 4%(2-4 sa Pot 0 0 0 0
19 As. Benzoat 3 % + as salisilat 6%(whitefield Pot 0 0 0 0
20 Asam askorbat (Vit. C) tablet 50 mg Tablet 0 0 0 0
21 Asam mefenamat 500 mg Tablet 80 80 20 60
22 Asetosal 100 mg Tablet 0 0 0 0
23 Asetosal tablet 500 mg Tablet 0 0 0 0
24 Atropina sulfat injeksi 0 .25 mg / ml - 1 ml Ampul 0 0 0 0
25 Basitrasin Polimiksin Tube 4 4 1 3
26 Besi (II) sulfat tablet salut .kombinasi Tablet 0 0 0 0
27 Betahistin tab Tablet 0 0 0 0
28 Betametazon salep kulit Tube 4 4 1 3
29 Captopril 12.5 mg tablet Tablet 0 0 0 0
30 Captopril 25 mg tablet Tablet 0 0 0 0
31 Carbamazepina 200 mg talet Tablet 0 0 0 0
32 Cefadroxil 125mg/5ml Sirup Botol 3 3 0 3
33 Cefadroxill 500 mg tablet Tablet 0 0 0 0
34 Cefotaxim 1 gr Injeksi Ampul 0 0 0 0
35 Cetirizin10 mg tab Tablet 0 0 0 0
36 Cimetidine/Selestidin Tablet 0 0 0 0
37 Ciprofloxazin tablet 500 mg Tablet 0 0 0 0
38 Deksametason injeksi 5 mg / ml - 1 ml Ampul 0 0 0 0
39 Deksametason tablet 0.5 mg Tablet 64 100 164 64 100
40 Devitalisasi pasta Tube 0 0 0 0
41 Diazepam 5 mg Tablet 0 0 0 0
42 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0 0 0 0
43 Diazepam tablet 2 mg Tablet 0 0 0 0
44 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 6 6 2 4 5 5
45 Digoksina tablet 0. 25 mg Tablet 0 0 0 0
46 Domperidon tablet 10 mg Tablet 0 0 0 0
47 Doxycicline 100 mg tab Tablet 0 0 0 0
48 Efedrina HCL (efedrina) tablet 25 mg Tablet 0 0 0 0
49 Epinefrina HCL / bitartat (aderenalina) inj Ampul 0 0 0 0
50 Ergotamina tartrat 1 mg + kofeina 50 mg t Tablet 0 0 0 0
51 Erytromysin 200mg/5ml Syrup Botol 0 0 0 0
52 Erytromysin tablet 500 mg Tablet 0 0 0 0
53 Etakridina (rivanol) larutan 0.1 % Botol 0 0 0 0
54 Etil klorida semprot Botol 0 0 0 0
55 Eugenol cairan Botol 0 0 0 0
56 Fenobarbital inj 50 mg /ml -2ml Ampul 0 0 0 0
57 Fenobarbital tablet 100mg Tablet 0 0 0 0
58 Fenobarbital tablet 30 mg Tablet 0 0 0 0
59 Fenol gliserol tetes telnga 10% Botol 0 0 0 0
60 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0 0 0 0
61 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0 0 0 0
62 Furosemida tablet 40 mg Tablet 0 0 0 0
63 Garam Oralit untuk 200 ml air Sachet 0 0 0 0
64 Gentamisin Salep Mata Tube 0 0 0 0
65 Gentamysin SK Tube 0 0 0 0
66 Gentamysin TM/Genoint TM Botol 0 0 0 0
67 Gentian violet larutan 1 % Botol 0 0 0 0
68 Glibenklamida tablet 5 mg Tablet 0 0 0 0
69 Gliseril guayakolat tablet 10 mg Tablet 0 0 0 0
70 Glukosa larutan infus 10 % steril Botol 0 0 0 0
PENERIMAA PERSEDI PEMAKA SISA PERMINT PENERI
No Nama Obat Satuan
STOK AWAL N AAN IAN STOK AAN MAAN KET
71 Glukosa larutan infus 40 % steril Botol 0 0 0 0
72 Glukosa larutan infus 5 % steril Botol 0 0 0 0
73 Griseofulvin tablet 125 mg. Mikronized Tablet 0 0 0 0
74 Haloperidol 0,5 mg. Tablet Tablet 0 0 0 0
75 Haloperidol 1,5 mg tablet Tablet 0 0 0 0
76 Haloperidol 5 mg tablet Tablet 0 0 0 0
77 Hidroklorotiasida (HCT) tablet 25 mg Tablet 0 0 0 0
78 Hidrokortison krim 2.5 % Tube 5 5 1 4
79 Ibuprofen tablet 400 mg Tablet 10 10 0 10
80 Isoniazide 100 mg Tablet 0 0 0 0
81 Isoniazide 300 mg Tablet 0 0 0 0
82 Isosorbid dinitrat Tablet 0 0 0 0
83 Kalsium hidroksida pasta Pot 0 0 0 0
84 Kalsium laktat (kalk) tablet 500 mg Tablet 0 0 0 0
85 Ketokonazole 200 mg tablet Tablet 0 0 0 0
86 Kinina dihidroklorida (kinina) inj 25 % - 2 Ampul 0 0 0 0
87 Kinina sulfat tablet 222 mg (7 h20 ) Tablet 0 0 0 0
88 Kloramfenicol salep kulit Tube 0 0 0 0
89 Kloramfenikol kapsul 250 mg Tablet 0 0 0 0
90 Kloramfenikol salep mata 1 % Tube 0 0 0 0
91 Kloramfenikol tetes Mata Botol 0 0 0 0
92 Kloramfenikol tetes telinga 3 % Botol 0 0 0 0
93 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 168 168 30 138
94 Klorpromazin 100 mg tablet Tablet 0 0 0 0
95 Klorpromazina Hcl inj 25 mg / ml - 1 ml Ampul 0 0 0 0
96 Klorpromazina Hcl inj 5 mg / ml - 2 ml Ampul 0 0 0 0
97 Klorpromazina hcl tablet salut 25 mg Tablet 0 0 0 0
98 Kodeina Hcl (kodeina) tablet 10 mg Tablet 0 0 0 0
99 Kotrimoksasol suspensi Botol 0 0 0 0
100 Kotrimoksasol tablet kombinasi Tablet 0 0 0 0
101 Lidokain inj Ampul 0 0 0 0
102 Lidokaina comp inj kombinasi Ampul 0 0 0 0
103 Metakresol sulfonat dan metanol kondensaBotol 0 0 0 0
104 Metformin 500 mg tablet Tablet 0 0 0 0
105 Metilergometrina maleat inj 0. 200 g / ml- Ampul 0 0 0 0
106 Metilergometrina malet tablet salut 0. 12 Tablet 0 0 0 0
107 Metilprednisolon tablet 4 mg Tablet 0 0 0 0
108 Metoklopramide 10 mg tablet/Noristal Tablet 0 0 0 0
109 Metronidazol 500 mg Tablet 0 0 0 0
110 Metronidazol tablet 250 mg Tablet 0 0 0 0
111 Mikonazole salep Tube 0 0 0 0
112 Monoklorkamfer mentolcairan (CHKM) Botol 0 0 0 0
113 Mumifyng pasta Botol 0 0 0 0
114 Natrium bikarbonat tablet 500 mg Tablet 0 0 0 0
115 Natrium Diklofenak 50 (Nadifen/Prostanac Tablet 0 0 0 0
116 Natrium klorida larutan infus 0. 9 steril Botol 0 0 0 0
117 Nifedipin tablet 10 mg Tablet 0 0 0 0
118 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0 0 0 0
119 Obat batuk hitam (OBH) cairan Botol 100 ml 0 0 0 0
120 Ofloxacin tab 400mg Tablet 0 0 0 0
121 Oksigen gas dalam tabung 3 m3 Tabung 0 0 0 0
122 Oksigen gas dalam tabung 6 m3 Tabung 0 0 0 0
123 Oksitetrasiklina hcl salep 3 % Tube 0 0 0 0
124 Oksitetrasiklina hcl salep mata 1 % Tube 0 0 0 0
125 Oksitosina inj 10 iu/ml - 1 ml Ampul 0 0 0 0
126 Parasetamol sirup 120 mg / 5 ml Botol 0 0 0 0
127 Parasetamol tab 100 mg Tablet 0 0 0 0
128 Parasetamol tablet 500mg Tablet 130 100 230 40 190
129 Pirantel pamoat (pirantel) tablet 125 mg Tablet 0 0 0 0
130 Piroxicam 10 Mg Tablet 0 0 0 0
131 Piroxicam 20 Mg Tablet 0 0 0 0
132 Prednison tablet 5 mgn Tablet 0 0 0 0
133 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0 0 0 0
134 Primakina tablet 15 mg Tablet 0 0 0 0
135 Prokaina penisilina g inj 3 juta iu Vial 0 0 0 0
136 Propiltionurasil tablet 100 mg Tablet 0 0 0 0
137 Propranolol hcl (Propranolol) tablet 40 mg Tablet 0 0 0 0
138 Pyridoxin injeksi Ampul 0 0 0 0
139 Ranitidin inj 25 mg/2 ml Ampul 0 0 0 0
140 Ranitidin tablet 150 mg Tablet 100 100 10 90
141 Reserpina tablet 0, 10 mg Tablet 0 0 0 0
142 Reserpina tablet 0, 25 mg Tablet 0 0 0 0
143 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0 0 0 0 95 100
144 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0 0 0 0 15 15
145 Ringer laktat larutan infus steril Botol 0 0 0 0
146 Risperidon Tablet 0 0 0 0
147 Salbutamol tablet 2 mg Tablet 0 0 0 0
148 Salbutamol tablet 4 mg Tablet 0 0 0 0
149 Salisil bedak 2 % Bks 0 0 0 0
150 Salisil spiritus 10 % Botol 0 0 0 0
151 Semen seng fosfat serbuk dan cairan Botol 0 0 0 0
152 Serum anti bisa ular polivalen inj. 5ml Ampul 0 0 0 0
153 Serum anti tetanus inj. 1.500 iu Ampul 0 0 0 0
154 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 10 10 3 7 10 10
PENERIMAA PERSEDI PEMAKA SISA PERMINT PENERI
No Nama Obat Satuan
STOK AWAL N AAN IAN STOK AAN MAAN KET
155 Silver amalgam serbuk 65-75% Botol 0 0 0 0
156 Simvastatin tab 10 mg Tablet 0 0 0 0
157 Sulfacetamide tetes mata Botol 0 0 0 0
158 Synthetic filing material larutan dan serb Set 0 0 0 0
159 Temporary stopping fletcher serbuk dan c Set 0 0 0 0
160 Tetrasiklina hcl (tetrasiklina) kapsul 250 Tablet 0 0 0 0
161 Tetrasiklina hcl (tetrasiklina) kapsul 500 m Tablet 0 0 0 0
162 Thiamfenikol 500 Tablet 0 0 0 0
163 Tiamin hcl /mononitrat (vit.b1) tablet 50 Tablet 0 0 0 0
164 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0 0 0 0
165 Tramadol Tablet 0 0 0 0
166 Trifluoperazine (Stelazin) Tablet 0 0 0 0
167 Triheksfenidil hcl 2 mg tablet Tablet 0 0 0 0
168 Trikresol formalin (tkf) cairan Botol 0 0 0 0
169 Vitamin B kompleks tablet Tablet 0 0 0 0
170 Yodium povidan larutan 10% 300 ml Botol 0 0 0 0
171 Yodium povidon larutan 10% 30 ml Botol 0 0 0 0
172 Zink tablet Tablet 90 90 10 80
Amoxcilin syrup botol 0 0 0 0
0
OBAT TAMBAHAN 0 0 0 0
173 Aptil Botol 0 0 0 0
174 (Lopinavir/Ritonavir)Aluvia Botol 0 0 0 0
175 Abacavir Tablet 0 0 0 0
176 Acyclovir tablet 200 mg Tablet 0 0 0 0
177 Aleterol TM Botol 0 0 0 0
178 Amlodipin 10 mg tab Tablet 0 0 0 0
179 Amlodipin 5 mg tab Tablet 0 0 0 0
180 Amox-clav Tablet 0 0 0 0
181 Ampisilin Serbuk Injeksi i.m/i.v. 1000 mg/ Ampul 0 0 0 0
182 Ampisillin injeksi i.m/i.v 1000 mg/ml Ampul 0 0 0 0
183 Antalgin injeksi Ampul 0 0 0 0
184 Antasida syr Botol 0 0 0 0
185 Arterakine Tablet 0 0 0 0
186 Artesunat inj Vial 0 0 0 0
187 Asam Folat 1 mg Tablet 0 0 0 0
188 Asam tranexamat 500 mg Tablet 0 0 0 0
189 Asetosal 80/miniaspi tablet 0 0 0 0
190 Atripla(TDF+3TC+EFV) Botol 0 0 0 0
191 Azitromisin+cefixim Tablet 0 0 0 0
192 Azytromisin tablet 500 mg Tablet 0 0 0 0
193 BD Vacuntainer Pcs 0 0 0 0
194 Becefort Tablet 150 150 50 100
195 Benzatin Penisillin Vial 0 0 0 0
196 Bonding Set 0 0 0 0
197 Bufacomb salep Tube 0 0 0 0
198 Buscopan inj Ampul 0 0 0 0
199 Caviton Tube 0 0 0 0
200 Cefixim syr 100 mg/5 ml Botol 0 0 0 0
201 Cefixim tablet 100 mg Tablet 0 0 0 0
202 Cefixim tablet 200 mg Tablet 0 0 0 0
203 Cefotaxim 0,5 g inj Vial 0 0 0 0
204 Ceftriaxon inj Vial 0 0 0 0
205 Clarithromysin 500 mg Tablet 0 0 0 0
206 Clavamox inj Ampul 0 0 0 0
207 Clindamisin 150 mg Tablet 0 0 0 0
208 Clindamisin 300 mg Tablet 0 0 0 0
209 Clobazam 10 mg Tablet 0 0 0 0
210 Clozapine 25 mg Tablet 0 0 0 0
211 Composite (tumpatan sinar)A3 Set 0 0 0 0
212 Composite (tumpatan sinar)A3.5 Set 0 0 0 0
213 Crofed Tablet 0 0 0 0
214 D1/2 NS botol 0 0 0 0
215 D1/4 NS Botol 0 0 0 0
216 Daryantulle Lembar 0 0 0 0
217 Dermazine/Burnazin Tube 0 0 0 0
218 Dextina / Dextamin/Dextamec/Polofar Plu Tablet 0 0 0 0
219 Dextran 70% Botol 0 0 0 0
220 Dextrofen syr Botol 0 0 0 0
221 Diaform tablet/selesdiar Tablet 0 0 0 0
222 Dormi/Scopma/Spashi tablet Tablet 0 0 0 0
223 Dulcolac anak supp Supp 0 0 0 0
224 Dulcolac dewasa supp Supp 0 0 0 0
225 Dulkolak tablet Tablet 0 0 0 0
226 Duviral(Zidovudin 300+Lamivudin 150) Botol 0 0 0 0
227 Efavirenz Botol 0 0 0 0
228 Etambutol Tablet 0 0 0 0
229 ETSA Set 0 0 0 0
230 Euthyrox 100mg Tablet 0 0 0 0
231 Faktu Supp Supp 0 0 0 0
232 Fluconasol tab Tablet 0 0 0 0
233 Fluoxetin Tablet 0 0 0 0
234 Forumen TT Fls 0 0 0 0
235 Gentamisin Injeksi 80 mg/2ml Ampul 0 0 0 0
PENERIMAA PERSEDI PEMAKA SISA PERMINT PENERI
No Nama Obat Satuan
STOK AWAL N AAN IAN STOK AAN MAAN KET
236 Glass ionomer (Ketac Molar) Tube 0 0 0 0
237 Glimepiride 2 tablet 0 0 0 0
238 Glimepiride 4 tablet 0 0 0 0
239 Glukonas Calcicus 10%- 10ml Ampul 0 0 0 0
240 Haldol inj Ampul 0 0 0 0
241 Hiviral (Lamivudin 150) Botol 0 0 0 0
242 Ibuprofen syr btl 0 0 0 0
243 Iliadin TH flesh 0 0 0 0
244 Isotic Neolisin TM Fls 7 7 1 6
245 Kalium Diklovenac tablet 170 170 110 60 200 200
246 Kaltropen supp Supp 0 0 0 0
247 Ketoconazole SK tube 0 0 0 0
248 Ketoprofen inj 10 mg Ampul 0 0 0 0
249 Ketoprofen tablet 100 mg Tablet 0 0 0 0
250 Ketorolac inj Ampul 0 0 0 0
251 Kombipak Anak Paket 0 0 0 0
252 Lodomer 2 Tablet 0 0 0 0
253 Lytamin syr botol 0 0 0 0
254 Magnesium Sulfat 20% - 25 ml Botol 0 0 0 0
255 Magnesium Sulfat 40% - 25 ml Botol 0 0 0 0
256 Metil Prednisolon 16 mg Tablet 0 0 0 0
257 Metil prednisolon inj 500 mg Vial 0 0 0 0
258 Metronidazole 500 mg Infus/100 ml Botol 0 0 0 0
259 Meylon inj Botol 0 0 0 0
260 Microlax Supp 0 0 0 0
261 Miloxicam 7,5 mg tablet 0 0 0 0
262 Molexflu Tablet 0 0 0 0
263 Multivitamin (Livron B plek) Tablet 60 200 260 50 210
264 Multivitamin sirup( Xanvit syr) Botol 0 0 0 0
265 Neurotropik tablet Tablet 0 0 0 0
266 Neviral (neviravin 200mg) Botol 0 0 0 0
267 New antides tablet 130 130 0 130
268 Nutrifar 5000 Tablet 0 0 0 0
269 Obat anti tuberkulosis FDC katagori I Paket 0 0 0 0
270 Obat anti tuberkulosis FDC anak Paket 0 0 0 0
271 Obat anti tuberkulosis FDC katagori II Paket 0 0 0 0
272 Obat anti tuberkulosis FDC sisipan Paket 0 0 0 0
273 Obat anti tuberkulosis kategori I Paket 0 0 0 0
274 Obat Batuk Kombinasi Botol 0 0 0 0
275 Obat Flu kombinasi CTM, PPA (Anaflu), D Tablet 160 160 40 120
276 Obat Flu Kombinasi/Mecofed/Quantidex Tablet 0 0 0 0
277 OBH plus botol 5 5 0 5
278 Omeprasole tablet 20 mg Tablet 0 0 0 0
279 Ondancentron inj Ampul 0 0 0 0
280 Ondancetron 4 mg Tablet 0 0 0 0
281 Orpen Tablet 8 8 8 0
282 Oseltamivir Tablet 0 0 0 0
283 Paket bonding Set 0 0 0 0
284 Pamol 125 mg Supp Supp 0 0 0 0
285 Pamol 250 mg Supp Supp 0 0 0 0
286 Pantocain Tetes Mata Botol 0 0 0 0
287 Parasetamol drop Botol 0 0 0 0
288 Pehacain Injeksi Ampul 0 0 0 0
289 Pehatrim Forte (Kotrimoksasol tab forte 9 Tablet 0 0 0 0
290 Perhidrol (H2O2) Botol 0 0 0 0
291 Phenitoin tab Tablet 0 0 0 0
292 Piracetam 400 mg Tablet 0 0 0 0
293 Piracetam inj 200mg/1ml Ampul 0 0 0 0
294 Pirimethamine tablet Tablet 0 0 0 0
295 Prenatin DF Tablet 0 0 0 0
296 Prenatin plus tablet tablet 0 0 0 0
297 Primaquin Tablet 0 0 0 0
298 Primperan inj Ampul 0 0 0 0
299 Procurma sirup botol 5 5 1 4
300 Prokain Benzil Penicillin G Injeksi 3 jt IU/vi Vial 0 0 0 0
301 Proris supp Supp 0 0 0 0
302 Pularex Tablet 0 0 0 0
303 Scabimite cream tube 0 0 0 0
304 Sikzonoate inj Ampul 0 0 0 0
305 Simvastatin tab 20 mg Tablet 0 0 0 0
306 Spashi inj Ampul 0 0 0 0
307 Spashi tab Tablet 0 0 0 0
308 Stelosi tab 5 mg Tablet 0 0 0 0
309 Stesolid rectal Supp 0 0 0 0
310 Strop indra Botol 0 0 0 0
311 Sulfadiazin tablet Tablet 0 0 0 0
312 Tenofovir (Tenofovir 300mg) Botol 0 0 0 0
313 Tetagam Ampul 0 0 0 0
314 Tramadol inj 50 mg/ml Ampul 0 0 0 0
315 Tranexid inj (Asam tranexamat inj) Ampul 0 0 0 0
316 Urotractin tablet 0 0 0 0
317 Ventolin Nebulizer Ampul 0 0 0 0
318 Vitamin B12 tab Tablet 0 0 0 0
319 Vitamin Neurotropik inj Ampul 0 0 0 0
PENERIMAA PERSEDI PEMAKA SISA PERMINT PENERI
No Nama Obat Satuan
STOK AWAL N AAN IAN STOK AAN MAAN KET
320 Vitamin Neurotropik tablet (Nutrifar, Soh Tablet 0 0 0 0
321 VitKa infan Ampul 0 0 0 0
322 Xylocain Gel Ampul 0 0 0 0
323 Zidovudine 100 mg Tablet 0 0 0 0
Sucralfate syrup botol 0 0 0 0
Clopidogrel bisulfate 0 0 0 0
Levofloxacin 500 0 0 0 0
Spironolactone 25 mg 0 0 0 0
Domperidone syr 0 0 0 0
Ceterizine syr 5 mg/5ml 0 0 0 0
Albendazol syr 0 0 0 0
Zink syr 0 0 0 0
Cazetin drop 0 0 0 0
Lacto B 0 0 0 0
Scopma plus tab 0 0 0 0
Nebacetin powder 0 0 0 0
Metronidazol syr 125/5 ml 0 0 0 0
Salbutamol syr 0 0 0 0
Furosemida inj 0 0 0 0
Paracetamol infus 10 mg/ml 0 0 0 0
Calortusin tab 0 0 0 0
Coparcetin tab 0 0 0 0
TB tahap intensif 0 0 0 0
TB tahap lanjutan 0 0 0 0
Solathim syr 0 0 0 0
Antiseptic liquid no 2 0 0 0 0
Tenofovir + Emtricitabin 0 0 0 0
Cavit G 0 0 0 0
Ketros Supp 0 0 0 0
Harnal 0 0 0 0
BMHP 0 0 0 0
1 ADS 0.5 ml Pcs 0 0 0 0
2 ADS 0.05 ml Pcs 0 0 0 0
3 ADS 2 ml Pcs 0 0 0 0
4 ADS 5 ml Pcs 0 0 0 0
5 Alat suntik sekali pakai 1 ml Pcs 0 0 0 0
6 Alat suntik sekali pakai 2,5 ml Pcs 0 0 0 0
7 Alat suntik sekali pakai 5 ml Pcs 0 0 0 0
8 Bisturi no 13 Pcs 0 0 0 0
9 Bisturi no 14 Pcs 0 0 0 0
10 Bisturi no 19/20 Pcs 0 0 0 0
11 Bisturi no 21 Pcs 0 0 0 0
12 Box slide kotak 0 0 0 0
13 Catgut 2/0 plain Sachet 0 0 0 0
14 Catgut / benang bedah no 2/0 chromic Sachet 0 0 0 0
15 Catgut / benang bedah no 3/0 plain Sachet 0 0 0 0
16 Catgut 1/0 Chromic Pcs 0 0 0 0
17 Catgut 2/0 Chromic Roll Roll 0 0 0 0
18 Catgut 3/0 Chromic Roll Roll 0 0 0 0
19 Cutgut Chromic No.1 atraumatik (sachet) Sachet 0 0 0 0
20 Etanol 70 % Botol 0 0 0 0
21 Etanol 70 % Botol 100 ml 0 0 0 0
22 Film Rontgen 18 x 24 Set 0 0 0 0
23 Folley catheter Pcs 0 0 0 0
24 Hypavix (Ultrafik) Roll 0 0 0 0
25 I.V Catheter 22 Pcs 0 0 0 0
26 I.V Catheter 24 Pcs 0 0 0 0
27 Infusion set anak Set 0 0 0 0
28 Infusion set dewasa Set 0 0 0 0
29 IV Cath dgn Katup pcs 0 0 0 0
30 IV Catheter 18 Pcs 0 0 0 0
31 IV Catheter 20 Pcs 0 0 0 0
32 IV Catheter no 18 G Terumo Pcs 0 0 0 0
33 IV Catheter no 20 G Terumo Pcs 0 0 0 0
34 Jarum injeksi Pcs 0 0 0 0
35 Jarum jahit (bedah) no. 9 s/d 14 Set 0 0 0 0
36 Jarum Jahit Bedah no 12 Set 0 0 0 0
37 Jarum Jahit Bedah no 13 Set 0 0 0 0
38 Jarum Jahit Bedah no 14 Set 0 0 0 0
39 Jarum Kulit Set 0 0 0 0
40 Jarum Otot dan Kulit Set 0 0 0 0
41 Jelly RO Tube 0 0 0 0
42 Kantung Puyer Pak 0 0 0 0
PENERIMAA PERSEDI PEMAKA SISA PERMINT PENERI
No Nama Obat Satuan
STOK AWAL N AAN IAN STOK AAN MAAN KET
43 Kapas pembalut / absorben 250 gram Roll 0 0 0 0
44 Kasa gulung 40 x 80 Roll 0 0 0 0
45 Kasa Hidrofil 4 x 10 Roll 0 0 0 0
46 Kasa kompres 40 / 40 steril Roll 0 0 0 0
47 Kasa pembalut 2 x 80 Roll 0 0 0 0
48 Kasa pembalut hidrofil 4 m x 15 cm Roll 0 0 0 0
49 Kasa pembalut hidrofin 4m x 3 cm Roll 0 0 0 0
50 Kasa Steril ( 18 x 22 ) Kotak 0 0 0 0
51 Kertas EKG Roll 0 0 0 0
52 Kertas saring Lembar 0 0 0 0
53 Kertas USG Roll 0 0 0 0
54 Klem Tali Pusar pcs 0 0 0 0
55 Klip Kecil Pak 5 5 1 4
56 Klip Tanggung Pak 5 5 1 4
57 Lampu spiritus botol 0 0 0 0
58 Lisol mengandung kresol Botol 0 0 0 0
59 Masker Pcs 0 0 0 0
60 Masker Bedah Pcs 0 0 0 0
61 Masker N95 Pcs 0 0 0 0
62 MY Jelly Tube 0 0 0 0
63 Nasal cannula Oksigen pcs 0 0 0 0
64 Pembalut Gips Roll 0 0 0 0
65 Perkamen Pak 0 0 0 0
66 Plester 5 yard x 2 inch Roll 0 0 0 0
67 Pot Salep Pot 0 0 0 0
68 Pot Sputum Pcs 0 0 0 0
69 Safety box Pcs 0 0 0 0
70 Sarung Tangan Gynaecologi pasang 0 0 0 0
71 Sarung Tangan L Pasang 0 0 0 0
72 Sarung Tangan M Pasang 0 0 0 0
73 Sarung Tangan S Pasang 0 0 0 0
74 Sarung Tangan Steril Pasang 0 0 0 0
75 Sarung Tangan Surgiglove Pasang 0 0 0 0
76 Sendok Takar Pcs 0 0 0 0
77 Silk 3/0 roll Roll 0 0 0 0
78 Silk (benang bedah sutera) no.3/0 Pcs 0 0 0 0
79 Slide Prosted Pak 0 0 0 0
80 Spalk tungkai atas anak Pcs 0 0 0 0
81 Spalk tungkai atas dewasa Pcs 0 0 0 0
82 Spalk tungkai bawah anak Pcs 0 0 0 0
83 Spalk tungkai bawah dewasa Pcs 0 0 0 0
84 Spuit 10 ml Pcs 0 0 0 0
85 Spuit 2/3 ml Pcs 0 0 0 0
86 Transfusi Set Pcs 0 0 0 0
87 Uji Tuberkulin Vial 0 0 0 0
88 Underpad Pak 0 0 0 0
89 Urinebag Set 0 0 0 0
90 Wing Needle 21 Pcs 0 0 0 0
91 Wing Needle 23 Pcs 0 0 0 0
92 Wing Needle 25 Pcs 0 0 0 0
93 Wing Needle 27 Pcs 0 0 0 0

BAYAR TIDAK BAYAR ( JKN ) JUMLAH


JUMLAH KUNJUNGAN RESEP
28 28

Mengetahui Yang Menyerahkan Yang Meminta / pelapor


Kepala Puskesmas Selemadeg Timur II Petugas Gudang Obat Puskesmas Petugas Apotek / Pustu

dr. Ni Putu Partini Ni Kadek Eni Mulyani Ni Luh Putu Ika Wahyu Cahyani
NIP. 196607262002122003 NIP. NIP. 198908112017052001
REKAP PEMAKAIAN PUSTU PUSKESMAS MARGA II
BULAN MARET 2019

TOTAL
No Nama Obat Satuan APOTEK PUSKEL P.T JADI P.PEKEN POS.B PEMAKAI
P.S POL.S P.CAU AN
1 2 3 4 5 6 7 8 9 10 11 12
1 Acyclovir Salep Tube 85 4 1 4 94 94
2 Acyclovir 400 mg Tab Tablet 30 30 40 100 100
3 Air raksa dental use Botol 0
4 Albendazol 400 mg tab Tablet 0
5 Alprazolam 0.5 mg Tablet 0
6 Alupurinol 100 mg tab / Selespurin/ Pro Tablet 80 40 10 130 130
7 Ambroxol syr Botol 50 5 2 1 10 68 68
8 Ambroxol tab 30 mg / Promukus Tablet 969 20 20 70 20 40 245 1384 1384
9 Aminofilina injeksi 24 mg/ ml. 10 ml Ampul 0
10 Aminofilna tablet 200 mg Tablet 0
11 Amitriptilina hcl tablet salut 25 mg Tablet 0
12 Amoksilina kapsul 500 mg Tablet 706 20 150 70 30 50 345 1371 1371
13 Amoksilna sirup kering 125 mg/ 5 mg Botol 1 1 1
14 Antasida doen tablet kombinasi Tablet 630 25 160 130 40 80 140 1205 1205
15 Anti hemmoroid suppositoria Supp 0
16 Aqua pro injeksi streril. Bebas priogen Vial 0
17 Aquadest steril 500 ml Botol 0
18 As salisilat 2% + belerang endap 4%(2-4 Pot 0
19 As. Benzoat 3 % + as salisilat 6%(whitef Pot 0
20 Asam askorbat (Vit. C) tablet 50 mg Tablet 0
21 Asam mefenamat 500 mg Tablet 510 10 10 530 530
22 Asetosal 100 mg Tablet 0
23 Asetosal tablet 500 mg Tablet 0
24 Atropina sulfat injeksi 0 .25 mg / ml - 1 Ampul 0
25 Basitrasin Polimiksin Tube 0
26 Besi (II) sulfat tablet salut .kombinasi Tablet 2034 30 2064 2064
27 Betahistin tab Tablet 180 52 30 262 262
28 Betametazon salep kulit Tube 2 2 1 10 15 15
29 Captopril 12.5 mg tablet Tablet 0
30 Captopril 25 mg tablet Tablet 680 10 50 60 110 60 970 970
31 Carbamazepina 200 mg talet Tablet 0
32 Cefadroxil 125mg/5ml Sirup Botol 4 4 4
33 Cefadroxill 500 mg tablet Tablet 20 20 20
34 Cefotaxim 1 gr Injeksi Ampul 0
35 Cetirizin10 mg tab Tablet 340 340 340
36 Cimetidine/Selestidin Tablet 0
37 Ciprofloxazin tablet 500 mg Tablet 540 30 90 110 30 800 800
38 Deksametason injeksi 5 mg / ml - 1 ml Ampul 0
39 Deksametason tablet 0.5 mg Tablet 1680 196 150 80 20 90 435 2651 2651
40 Devitalisasi pasta Tube 0
41 Diazepam 5 mg Tablet 0
42 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0
43 Diazepam tablet 2 mg Tablet 0
44 Difenhidramin HCL injeksi 10 mg / ml - Ampul 0
45 Digoksina tablet 0. 25 mg Tablet 0
46 Domperidon tablet 10 mg Tablet 0
47 Doxycicline 100 mg tab Tablet 0
48 Efedrina HCL (efedrina) tablet 25 mg Tablet 0
49 Epinefrina HCL / bitartat (aderenalina) Ampul 0
50 Ergotamina tartrat 1 mg + kofeina 50 m Tablet 0
51 Erytromysin 200mg/5ml Syrup Botol 0
52 Erytromysin tablet 500 mg Tablet 0
53 Etakridina (rivanol) larutan 0.1 % Botol 0
54 Etil klorida semprot Botol 0
55 Eugenol cairan Botol 0
56 Fenobarbital inj 50 mg /ml -2ml Ampul 0
57 Fenobarbital tablet 100mg Tablet 0
58 Fenobarbital tablet 30 mg Tablet 120 120 120
59 Fenol gliserol tetes telnga 10% Botol 0
60 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0
61 Fitomenadion (vit. K1) tablet salut 10 Tablet 0
62 Furosemida tablet 40 mg Tablet 0
63 Garam Oralit untuk 200 ml air Sachet 51 5 20 15 91 91
64 Gentamisin Salep Mata Tube 2 2 4 4
65 Gentamysin SK Tube 0
66 Gentamysin TM/Genoint TM Botol 7 3 10 10
67 Gentian violet larutan 1 % Botol 0
68 Glibenklamida tablet 5 mg Tablet 570 570 570
69 Gliseril guayakolat tablet 10 mg Tablet 0
70 Glukosa larutan infus 10 % steril Botol 1 1 1
71 Glukosa larutan infus 40 % steril Botol 0
72 Glukosa larutan infus 5 % steril Botol 0
73 Griseofulvin tablet 125 mg. Mikronized Tablet 0
74 Haloperidol 0,5 mg. Tablet Tablet 60 60 60
75 Haloperidol 1,5 mg tablet Tablet 0
76 Haloperidol 5 mg tablet Tablet 0
77 Hidroklorotiasida (HCT) tablet 25 mg Tablet 0
78 Hidrokortison krim 2.5 % Tube 5 1 5 5 1 3 8 28 28
79 Ibuprofen tablet 400 mg Tablet 32 10 10 52 52
80 Isoniazide 100 mg Tablet 28 28 28
81 Isoniazide 300 mg Tablet 0
82 Isosorbid dinitrat Tablet 0
83 Kalsium hidroksida pasta Pot 0
84 Kalsium laktat (kalk) tablet 500 mg Tablet 394 40 5 439 439
85 Ketokonazole 200 mg tablet Tablet 0
86 Kinina dihidroklorida (kinina) inj 25 % - Ampul 0
87 Kinina sulfat tablet 222 mg (7 h20 ) Tablet 0
88 Kloramfenicol salep kulit Tube 0
89 Kloramfenikol kapsul 250 mg Tablet 0
90 Kloramfenikol salep mata 1 % Tube 0
91 Kloramfenikol tetes Mata Botol 0
92 Kloramfenikol tetes telinga 3 % Botol 8 8
93 Klorfeniramina maleat (CTM) tablet 4 Tablet 464 40 170 90 116 40 265 1185 1185
94 Klorpromazin 100 mg tablet Tablet 0
95 Klorpromazina Hcl inj 25 mg / ml - 1 ml Ampul 0
96 Klorpromazina Hcl inj 5 mg / ml - 2 ml Ampul 0
97 Klorpromazina hcl tablet salut 25 mg Tablet 0
98 Kodeina Hcl (kodeina) tablet 10 mg Tablet 0
99 Kotrimoksasol suspensi Botol 2 2 1 5 5
100 Kotrimoksasol tablet kombinasi Tablet 42 12 20 74 74
101 Lidokain inj Ampul 0
102 Lidokaina comp inj kombinasi Ampul 0
103 Metakresol sulfonat dan metanol kondeBotol 0
104 Metformin 500 mg tablet Tablet 520 50 570 570
105 Metilergometrina maleat inj 0. 200 g / Ampul 0
106 Metilergometrina malet tablet salut 0. Tablet 0
107 Metilprednisolon tablet 4 mg Tablet 411 10 90 511 511
108 Metoklopramide 10 mg tablet/Noristal Tablet 34 10 44 44
109 Metronidazol 500 mg Tablet 0
110 Metronidazol tablet 250 mg Tablet 0
111 Mikonazole salep Tube 2 1 2 5 5
112 Monoklorkamfer mentolcairan (CHKM) Botol 0
113 Mumifyng pasta Botol 0
114 Natrium bikarbonat tablet 500 mg Tablet 0
115 Natrium Diklofenak 50 (Nadifen/Prosta Tablet 0
116 Natrium klorida larutan infus 0. 9 steril Botol 5 5 5
117 Nifedipin tablet 10 mg Tablet 0
118 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0
119 Obat batuk hitam (OBH) cairan Botol 100 ml 0
120 Ofloxacin tab 400mg Tablet 0
121 Oksigen gas dalam tabung 3 m3 Tabung 0
122 Oksigen gas dalam tabung 6 m3 Tabung 0
123 Oksitetrasiklina hcl salep 3 % Tube 0
124 Oksitetrasiklina hcl salep mata 1 % Tube 0
125 Oksitosina inj 10 iu/ml - 1 ml Ampul 0
126 Parasetamol sirup 120 mg / 5 ml Botol 57 1 8 66 66
127 Parasetamol tab 100 mg Tablet 0
128 Parasetamol tablet 500mg Tablet 2402 110 180 155 10 170 160 628 3815 3815
129 Pirantel pamoat (pirantel) tablet 125 Tablet 0
130 Piroxicam 10 Mg Tablet 0
131 Piroxicam 20 Mg Tablet 0
132 Prednison tablet 5 mgn Tablet 0
133 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0
134 Primakina tablet 15 mg Tablet 0
135 Prokaina penisilina g inj 3 juta iu Vial 0
136 Propiltionurasil tablet 100 mg Tablet 0
137 Propranolol hcl (Propranolol) tablet 40 Tablet 0
138 Pyridoxin injeksi Ampul 0
139 Ranitidin inj 25 mg/2 ml Ampul 0
140 Ranitidin tablet 150 mg Tablet 700 40 100 50 50 50 990 990
141 Reserpina tablet 0, 10 mg Tablet 0
142 Reserpina tablet 0, 25 mg Tablet 0
143 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0
144 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0
145 Ringer laktat larutan infus steril Botol 1 1 1
146 Risperidon Tablet 0
147 Salbutamol tablet 2 mg Tablet 0
148 Salbutamol tablet 4 mg Tablet 420 20 80 60 35 615 615
149 Salisil bedak 2 % Bks 11 11 11
150 Salisil spiritus 10 % Botol 0
151 Semen seng fosfat serbuk dan cairan Botol 0
152 Serum anti bisa ular polivalen inj. 5ml Ampul 0
153 Serum anti tetanus inj. 1.500 iu Ampul 0
154 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0
155 Silver amalgam serbuk 65-75% Botol 0
156 Simvastatin tab 10 mg Tablet 10 10 10
157 Sulfacetamide tetes mata Botol 0
158 Synthetic filing material larutan dan s Set 0
159 Temporary stopping fletcher serbuk da Set 0
160 Tetrasiklina hcl (tetrasiklina) kapsul 2 Tablet 0
161 Tetrasiklina hcl (tetrasiklina) kapsul 50 Tablet 50 50 30 20 20 170 170
162 Thiamfenikol 500 Tablet 0
163 Tiamin hcl /mononitrat (vit.b1) tablet Tablet 90 90 90
164 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0
165 Tramadol Tablet 0
166 Trifluoperazine (Stelazin) Tablet 0
167 Triheksfenidil hcl 2 mg tablet Tablet 0
168 Trikresol formalin (tkf) cairan Botol 0
169 Vitamin B kompleks tablet Tablet 633 196 40 90 90 190 1239 1239
170 Yodium povidan larutan 10% 300 ml Botol 0
171 Yodium povidon larutan 10% 30 ml Botol 0
172 Zink tablet Tablet 55 55 55
Amoxcilin syrup botol 21 1 8 30 30
0
OBAT TAMBAHAN 0
173 Aptil Botol 0
174 (Lopinavir/Ritonavir)Aluvia Botol 0
175 Abacavir Tablet 0
176 Acyclovir tablet 200 mg Tablet 0
177 Aleterol TM Botol 0
178 Amlodipin 10 mg tab Tablet 0
179 Amlodipin 5 mg tab Tablet 950 170 1120 1120
180 Amox-clav Tablet 0
181 Ampisilin Serbuk Injeksi i.m/i.v. 1000 Ampul 0
182 Ampisillin injeksi i.m/i.v 1000 mg/ml Ampul 0
183 Antalgin injeksi Ampul 0
184 Antasida syr Botol 0
185 Arterakine Tablet 0
186 Artesunat inj Vial 0
187 Asam Folat 1 mg Tablet 0
188 Asam tranexamat 500 mg Tablet 0
189 Asetosal 80/miniaspi tablet 0
190 Atripla(TDF+3TC+EFV) Botol 0
191 Azitromisin+cefixim Tablet 0
192 Azytromisin tablet 500 mg Tablet 0
193 BD Vacuntainer Pcs 0
194 Becefort Tablet 804 130 10 80 60 1084 1084
195 Benzatin Penisillin Vial 0
196 Bonding Set 0
197 Bufacomb salep Tube 0
198 Buscopan inj Ampul 0
199 Caviton Tube 0
200 Cefixim syr 100 mg/5 ml Botol 0
201 Cefixim tablet 100 mg Tablet 0
202 Cefixim tablet 200 mg Tablet 0
203 Cefotaxim 0,5 g inj Vial 0
204 Ceftriaxon inj Vial 0
205 Clarithromysin 500 mg Tablet 0
206 Clavamox inj Ampul 0
207 Clindamisin 150 mg Tablet 0
208 Clindamisin 300 mg Tablet 0
209 Clobazam 10 mg Tablet 0
210 Clozapine 25 mg Tablet 0
211 Composite (tumpatan sinar)A3 Set 0
212 Composite (tumpatan sinar)A3.5 Set 0
213 Crofed Tablet 0
214 D1/2 NS botol 0
215 D1/4 NS Botol 0
216 Daryantulle Lembar 0
217 Dermazine/Burnazin Tube 0
218 Dextina / Dextamin/Dextamec/Polofar Tablet 0
219 Dextran 70% Botol 0
220 Dextrofen syr Botol 17 2 3 10 32 32
221 Diaform tablet/selesdiar Tablet 0
222 Dormi/Scopma/Spashi tablet Tablet 0
223 Dulcolac anak supp Supp 0
224 Dulcolac dewasa supp Supp 0
225 Dulkolak tablet Tablet 0
226 Duviral(Zidovudin 300+Lamivudin 150) Botol 0
227 Efavirenz Botol 0
228 Etambutol Tablet 0
229 ETSA Set 0
230 Euthyrox 100mg Tablet 0
231 Faktu Supp Supp 0
232 Fluconasol tab Tablet 0
233 Fluoxetin Tablet 0
234 Forumen TT Fls 0
235 Gentamisin Injeksi 80 mg/2ml Ampul 0
236 Glass ionomer (Ketac Molar) Tube 0
237 Glimepiride 2 tablet 0
238 Glimepiride 4 tablet 0
239 Glukonas Calcicus 10%- 10ml Ampul 0
240 Haldol inj Ampul 0
241 Hiviral (Lamivudin 150) Botol 0
242 Ibuprofen syr btl 0
243 Iliadin TH flesh 0
244 Isotic Neolisin TM Fls 1 1 1
245 Kalium Diklovenac tablet 450 70 70 90 180 860 860
246 Kaltropen supp Supp 0
247 Ketoconazole SK tube 5 5 5
248 Ketoprofen inj 10 mg Ampul 0
249 Ketoprofen tablet 100 mg Tablet 0
250 Ketorolac inj Ampul 0
251 Kombipak Anak Paket 0
252 Lodomer 2 Tablet 0
253 Lytamin syr botol 0
254 Magnesium Sulfat 20% - 25 ml Botol 0
255 Magnesium Sulfat 40% - 25 ml Botol 0
256 Metil Prednisolon 16 mg Tablet 0
257 Metil prednisolon inj 500 mg Vial 0
258 Metronidazole 500 mg Infus/100 ml Botol 0
259 Meylon inj Botol 0
260 Microlax Supp 0
261 Miloxicam 7,5 mg tablet 640 110 40 790 790
262 Molexflu Tablet 0
263 Multivitamin (Livron B plek) Tablet 1430 184 80 90 170 1954 1954
264 Multivitamin sirup( Xanvit syr) Botol 0
265 Neurotropik tablet Tablet 0
266 Neviral (neviravin 200mg) Botol 0
267 New antides tablet 90 10 60 40 30 20 20 270 270
268 Nutrifar 5000 Tablet 0
269 Obat anti tuberkulosis FDC katagori I Paket 1 1 1
270 Obat anti tuberkulosis FDC anak Paket 0
271 Obat anti tuberkulosis FDC katagori II Paket 0
272 Obat anti tuberkulosis FDC sisipan Paket 0
273 Obat anti tuberkulosis kategori I Paket 0
274 Obat Batuk Kombinasi Botol 0
275 Obat Flu kombinasi CTM, PPA (Anaflu), Tablet 689 20 40 50 30 10 120 959 959
276 Obat Flu Kombinasi/Mecofed/Quantide Tablet 0
277 OBH plus botol 19 1 4 24 24
278 Omeprasole tablet 20 mg Tablet 0
279 Ondancentron inj Ampul 0
280 Ondancetron 4 mg Tablet 0
281 Orpen Tablet 0
282 Oseltamivir Tablet 0
283 Paket bonding Set 0
284 Pamol 125 mg Supp Supp 0
285 Pamol 250 mg Supp Supp 0
286 Pantocain Tetes Mata Botol 0
287 Parasetamol drop Botol 0
288 Pehacain Injeksi Ampul 0
289 Pehatrim Forte (Kotrimoksasol tab fort Tablet 0
290 Perhidrol (H2O2) Botol 0
291 Phenitoin tab Tablet 0
292 Piracetam 400 mg Tablet 0
293 Piracetam inj 200mg/1ml Ampul 0
294 Pirimethamine tablet Tablet 0
295 Prenatin DF Tablet 350 350 350
296 Prenatin plus tablet tablet 0
297 Primaquin Tablet 0
298 Primperan inj Ampul 0
299 Procurma sirup botol 39 1 40 40
300 Prokain Benzil Penicillin G Injeksi 3 jt IU Vial 0
301 Proris supp Supp 0
302 Pularex Tablet 0
303 Scabimite cream tube 0
304 Sikzonoate inj Ampul 0
305 Simvastatin tab 20 mg Tablet 0
306 Spashi inj Ampul 0
307 Spashi tab Tablet 0
308 Stelosi tab 5 mg Tablet 0
309 Stesolid rectal Supp 0
310 Strop indra Botol 0
311 Sulfadiazin tablet Tablet 0
312 Tenofovir (Tenofovir 300mg) Botol 0
313 Tetagam Ampul 0
314 Tramadol inj 50 mg/ml Ampul 0
315 Tranexid inj (Asam tranexamat inj) Ampul 0
316 Urotractin tablet 0
317 Ventolin Nebulizer Ampul 2 2 2
318 Vitamin B12 tab Tablet 0
319 Vitamin Neurotropik inj Ampul 0
320 Vitamin Neurotropik tablet (Nutrifar, Tablet 0
321 VitKa infan Ampul 0
322 Xylocain Gel Ampul 0
323 Zidovudine 100 mg Tablet 0
Sucralfate syrup botol 0
Clopidogrel bisulfate 0
Levofloxacin 500 0
Spironolactone 25 mg 0
Domperidone syr 0
Ceterizine syr 0
Albendazol syr 0
Zink syr 0
Cazetin drop 0
Lacto B 0
Scopma plus 0
Nebacetin powder 0
Metronidazol syr 125 0
Salbutamol syr 0
Furosemida inj 0
Paracetamol inj 0
Colortusin tab 60 60 60
Coparcetin tab 0
TB tahap intensif 0
TB tahap lanjutan 0
Solathim syr 0
Antiseptic liq 0
Tenofovir + Emtricitabin 0
Cavit G 0
Ketros Supp 0
Harnal 0
BMHP 0
1 ADS 0.5 ml Pcs 0
2 ADS 0.05 ml Pcs 0
3 ADS 2 ml Pcs 0
4 ADS 5 ml Pcs 0
5 Alat suntik sekali pakai 1 ml Pcs 0
6 Alat suntik sekali pakai 2,5 ml Pcs 0
7 Alat suntik sekali pakai 5 ml Pcs 0
8 Bisturi no 13 Pcs 0
9 Bisturi no 14 Pcs 0
10 Bisturi no 19/20 Pcs 0
11 Bisturi no 21 Pcs 0
12 Box slide kotak 0
13 Catgut 2/0 plain Sachet 0
14 Catgut / benang bedah no 2/0 chromic Sachet 0
15 Catgut / benang bedah no 3/0 plain Sachet 0
16 Catgut 1/0 Chromic Pcs 0
17 Catgut 2/0 Chromic Roll Roll 0
18 Catgut 3/0 Chromic Roll Roll 0
19 Cutgut Chromic No.1 atraumatik (sache Sachet 0
20 Etanol 70 % Botol 0
21 Etanol 70 % Botol 100 ml 0
22 Film Rontgen 18 x 24 Set 0
23 Folley catheter Pcs 0
24 Hypavix (Ultrafik) Roll 0
25 I.V Catheter 22 Pcs 0
26 I.V Catheter 24 Pcs 0
27 Infusion set anak Set 0
28 Infusion set dewasa Set 0
29 IV Cath dgn Katup pcs 0
30 IV Catheter 18 Pcs 0
31 IV Catheter 20 Pcs 0
32 IV Catheter no 18 G Terumo Pcs 0
33 IV Catheter no 20 G Terumo Pcs 0
34 Jarum injeksi Pcs 0
35 Jarum jahit (bedah) no. 9 s/d 14 Set 0
36 Jarum Jahit Bedah no 12 Set 0
37 Jarum Jahit Bedah no 13 Set 0
38 Jarum Jahit Bedah no 14 Set 0
39 Jarum Kulit Set 0
40 Jarum Otot dan Kulit Set 0
41 Jelly RO Tube 0
42 Kantung Puyer Pak 0
43 Kapas pembalut / absorben 250 gram Roll 0
44 Kasa gulung 40 x 80 Roll 0
45 Kasa Hidrofil 4 x 10 Roll 0
46 Kasa kompres 40 / 40 steril Roll 0
47 Kasa pembalut 2 x 80 Roll 0
48 Kasa pembalut hidrofil 4 m x 15 cm Roll 0
49 Kasa pembalut hidrofin 4m x 3 cm Roll 0
50 Kasa Steril ( 18 x 22 ) Kotak 0
51 Kertas EKG Roll 0
52 Kertas saring Lembar 0
53 Kertas USG Roll 0
54 Klem Tali Pusar pcs 0
55 Klip Kecil Pak 0
56 Klip Tanggung Pak 0
57 Lampu spiritus botol 0
58 Lisol mengandung kresol Botol 0
59 Masker Pcs 0
60 Masker Bedah Pcs 0
61 Masker N95 Pcs 0
62 MY Jelly Tube 0
63 Nasal cannula Oksigen pcs 0
64 Pembalut Gips Roll 0
65 Perkamen Pak 0
66 Plester 5 yard x 2 inch Roll 0
67 Pot Salep Pot 0
68 Pot Sputum Pcs 0
69 Safety box Pcs 0
70 Sarung Tangan Gynaecologi pasang 0
71 Sarung Tangan L Pasang 0
72 Sarung Tangan M Pasang 0
73 Sarung Tangan S Pasang 0
74 Sarung Tangan Steril Pasang 0
75 Sarung Tangan Surgiglove Pasang 0
76 Sendok Takar Pcs 0
77 Silk 3/0 roll Roll 0
78 Silk (benang bedah sutera) no.3/0 Pcs 0
79 Slide Prosted Pak 0
80 Spalk tungkai atas anak Pcs 0
81 Spalk tungkai atas dewasa Pcs 0
82 Spalk tungkai bawah anak Pcs 0
83 Spalk tungkai bawah dewasa Pcs 0
84 Spuit 10 ml Pcs 0
85 Spuit 2/3 ml Pcs 0
86 Transfusi Set Pcs 0
87 Uji Tuberkulin Vial 0
88 Underpad Pak 0
89 Urinebag Set 0
90 Wing Needle 21 Pcs 0
91 Wing Needle 23 Pcs 0
92 Wing Needle 25 Pcs 0
93 Wing Needle 27 Pcs 0
REKAP PENERIMAAN PUSTU PUSKESMAS MARGA II
BULANMARET APRIL 2019

No Nama Obat Satuan APOTEK PUSKEL P.T JADI P.PEKEN POS. B

1 Acyclovir Salep Tube 10


2 Acyclovir 400 mg Tab Tablet 100
3 Air raksa dental use Botol
4 Albendazol 400 mg tab Tablet
5 Alprazolam 0.5 mg Tablet
6 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet
7 Ambroxol syr Botol 3
8 Ambroxol tab 30 mg / Promukus Tablet 500 100
9 Aminofilina injeksi 24 mg/ ml. 10 ml Ampul
10 Aminofilna tablet 200 mg Tablet
11 Amitriptilina hcl tablet salut 25 mg Tablet
12 Amoksilina kapsul 500 mg Tablet 800 100
13 Amoksilna sirup kering 125 mg/ 5 mg Botol
14 Antasida doen tablet kombinasi Tablet 200 200 100
15 Anti hemmoroid suppositoria Supp
16 Aqua pro injeksi streril. Bebas priogen 20 ml Vial
17 Aquadest steril 500 ml Botol
18 As salisilat 2% + belerang endap 4%(2-4 salep Pot
19 As. Benzoat 3 % + as salisilat 6%(whitefield) Pot
20 Asam askorbat (Vit. C) tablet 50 mg Tablet
21 Asam mefenamat 500 mg Tablet 500 100
22 Asetosal 100 mg Tablet
23 Asetosal tablet 500 mg Tablet
24 Atropina sulfat injeksi 0 .25 mg / ml - 1 ml Ampul
25 Basitrasin Polimiksin Tube
26 Besi (II) sulfat tablet salut .kombinasi Tablet 1800
27 Betahistin tab Tablet 500 60 90
28 Betametazon salep kulit Tube
29 Captopril 12.5 mg tablet Tablet
30 Captopril 25 mg tablet Tablet 500
31 Carbamazepina 200 mg talet Tablet
32 Cefadroxil 125mg/5ml Sirup Botol 5
33 Cefadroxill 500 mg tablet Tablet 100
34 Cefotaxim 1 gr Injeksi Ampul
35 Cetirizin10 mg tab Tablet 500
36 Cimetidine/Selestidin Tablet
37 Ciprofloxazin tablet 500 mg Tablet 500 100 100
38 Deksametason injeksi 5 mg / ml - 1 ml Ampul
39 Deksametason tablet 0.5 mg Tablet 1500 100 100 100
40 Devitalisasi pasta Tube
41 Diazepam 5 mg Tablet
42 Diazepam injeksi 5 mg / ml - 2 ml Ampul
43 Diazepam tablet 2 mg Tablet
44 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul
45 Digoksina tablet 0. 25 mg Tablet
46 Domperidon tablet 10 mg Tablet
47 Doxycicline 100 mg tab Tablet
48 Efedrina HCL (efedrina) tablet 25 mg Tablet
49 Epinefrina HCL / bitartat (aderenalina) inj 01% Ampul
50 Ergotamina tartrat 1 mg + kofeina 50 mg tab Tablet
51 Erytromysin 200mg/5ml Syrup Botol
52 Erytromysin tablet 500 mg Tablet
53 Etakridina (rivanol) larutan 0.1 % Botol
54 Etil klorida semprot Botol
55 Eugenol cairan Botol
56 Fenobarbital inj 50 mg /ml -2ml Ampul
57 Fenobarbital tablet 100mg Tablet
58 Fenobarbital tablet 30 mg Tablet 1000
59 Fenol gliserol tetes telnga 10% Botol
60 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul
61 Fitomenadion (vit. K1) tablet salut 10 mg Tablet
62 Furosemida tablet 40 mg Tablet
63 Garam Oralit untuk 200 ml air Sachet 100 10
64 Gentamisin Salep Mata Tube
65 Gentamysin SK Tube
66 Gentamysin TM/Genoint TM Botol 24 6
67 Gentian violet larutan 1 % Botol
68 Glibenklamida tablet 5 mg Tablet 500
69 Gliseril guayakolat tablet 10 mg Tablet
70 Glukosa larutan infus 10 % steril Botol
71 Glukosa larutan infus 40 % steril Botol
72 Glukosa larutan infus 5 % steril Botol
73 Griseofulvin tablet 125 mg. Mikronized Tablet
74 Haloperidol 0,5 mg. Tablet Tablet
75 Haloperidol 1,5 mg tablet Tablet
76 Haloperidol 5 mg tablet Tablet 100
77 Hidroklorotiasida (HCT) tablet 25 mg Tablet
78 Hidrokortison krim 2.5 % Tube 24 3 5
79 Ibuprofen tablet 400 mg Tablet
80 Isoniazide 100 mg Tablet 200
81 Isoniazide 300 mg Tablet
82 Isosorbid dinitrat Tablet
83 Kalsium hidroksida pasta Pot
84 Kalsium laktat (kalk) tablet 500 mg Tablet
85 Ketokonazole 200 mg tablet Tablet
86 Kinina dihidroklorida (kinina) inj 25 % - 2 ml Ampul
87 Kinina sulfat tablet 222 mg (7 h20 ) Tablet
88 Kloramfenicol salep kulit Tube
89 Kloramfenikol kapsul 250 mg Tablet
90 Kloramfenikol salep mata 1 % Tube
91 Kloramfenikol tetes Mata Botol
92 Kloramfenikol tetes telinga 3 % Botol
93 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 500 100 200 100 100
94 Klorpromazin 100 mg tablet Tablet
95 Klorpromazina Hcl inj 25 mg / ml - 1 ml Ampul
96 Klorpromazina Hcl inj 5 mg / ml - 2 ml Ampul
97 Klorpromazina hcl tablet salut 25 mg Tablet
98 Kodeina Hcl (kodeina) tablet 10 mg Tablet
99 Kotrimoksasol suspensi Botol 2 5
100 Kotrimoksasol tablet kombinasi Tablet
101 Lidokain inj Ampul 5
102 Lidokaina comp inj kombinasi Ampul
103 Metakresol sulfonat dan metanol kondensai (AlboBotol
104 Metformin 500 mg tablet Tablet 500
105 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul
106 Metilergometrina malet tablet salut 0. 125 mg Tablet
107 Metilprednisolon tablet 4 mg Tablet 100
108 Metoklopramide 10 mg tablet/Noristal Tablet 500
109 Metronidazol 500 mg Tablet
110 Metronidazol tablet 250 mg Tablet
111 Mikonazole salep Tube
112 Monoklorkamfer mentolcairan (CHKM) Botol
113 Mumifyng pasta Botol
114 Natrium bikarbonat tablet 500 mg Tablet
115 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet
116 Natrium klorida larutan infus 0. 9 steril Botol 5 1
117 Nifedipin tablet 10 mg Tablet
118 Nistatin 100. 000 iu/g tablet vaginal Tab Vag
119 Obat batuk hitam (OBH) cairan Botol 100 ml
120 Ofloxacin tab 400mg Tablet
121 Oksigen gas dalam tabung 3 m3 Tabung
122 Oksigen gas dalam tabung 6 m3 Tabung
123 Oksitetrasiklina hcl salep 3 % Tube
124 Oksitetrasiklina hcl salep mata 1 % Tube
125 Oksitosina inj 10 iu/ml - 1 ml Ampul
126 Parasetamol sirup 120 mg / 5 ml Botol
127 Parasetamol tab 100 mg Tablet
128 Parasetamol tablet 500mg Tablet 1500 200 200 100 200
129 Pirantel pamoat (pirantel) tablet 125 mg basa Tablet
130 Piroxicam 10 Mg Tablet
131 Piroxicam 20 Mg Tablet
132 Prednison tablet 5 mgn Tablet
133 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet
134 Primakina tablet 15 mg Tablet
135 Prokaina penisilina g inj 3 juta iu Vial
136 Propiltionurasil tablet 100 mg Tablet
137 Propranolol hcl (Propranolol) tablet 40 mg Tablet
138 Pyridoxin injeksi Ampul
139 Ranitidin inj 25 mg/2 ml Ampul
140 Ranitidin tablet 150 mg Tablet 300
141 Reserpina tablet 0, 10 mg Tablet
142 Reserpina tablet 0, 25 mg Tablet
143 Retinol (vit. A) kapsul lunak 200.000 iu Tablet
144 Retinol (vit. A) tablet salut 100. 000 iu Tablet
145 Ringer laktat larutan infus steril Botol
146 Risperidon Tablet
147 Salbutamol tablet 2 mg Tablet
148 Salbutamol tablet 4 mg Tablet 400 100
149 Salisil bedak 2 % Bks
150 Salisil spiritus 10 % Botol
151 Semen seng fosfat serbuk dan cairan Botol
152 Serum anti bisa ular polivalen inj. 5ml Ampul
153 Serum anti tetanus inj. 1.500 iu Ampul
154 Sianokobalamina (vit.b12) inj. 500 mcg Ampul
155 Silver amalgam serbuk 65-75% Botol
156 Simvastatin tab 10 mg Tablet
157 Sulfacetamide tetes mata Botol
158 Synthetic filing material larutan dan serbuk Set
159 Temporary stopping fletcher serbuk dan cairan Set
160 Tetrasiklina hcl (tetrasiklina) kapsul 250 mg Tablet
161 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 100 100
162 Thiamfenikol 500 Tablet
163 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet
164 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul
165 Tramadol Tablet
166 Trifluoperazine (Stelazin) Tablet
167 Triheksfenidil hcl 2 mg tablet Tablet
168 Trikresol formalin (tkf) cairan Botol
169 Vitamin B kompleks tablet Tablet 600 200 100
170 Yodium povidan larutan 10% 300 ml Botol
171 Yodium povidon larutan 10% 30 ml Botol
172 Zink tablet Tablet 100
5
OBAT TAMBAHAN
173 Aptil Botol
174 (Lopinavir/Ritonavir)Aluvia Botol
175 Abacavir Tablet
176 Acyclovir tablet 200 mg Tablet
177 Aleterol TM Botol
178 Amlodipin 10 mg tab Tablet
179 Amlodipin 5 mg tab Tablet
180 Amox-clav Tablet 990 180
181 Ampisilin Serbuk Injeksi i.m/i.v. 1000 mg/ml Ampul
182 Ampisillin injeksi i.m/i.v 1000 mg/ml Ampul
183 Antalgin injeksi Ampul
184 Antasida syr Botol
185 Arterakine Tablet
186 Artesunat inj Vial
187 Asam Folat 1 mg Tablet
188 Asam tranexamat 500 mg Tablet
189 Asetosal 80/miniaspi tablet
190 Atripla(TDF+3TC+EFV) Botol
191 Azitromisin+cefixim Tablet
192 Azytromisin tablet 500 mg Tablet
193 BD Vacuntainer Pcs
194 Becefort Tablet
195 Benzatin Penisillin Vial 500 200
196 Bonding Set
197 Bufacomb salep Tube
198 Buscopan inj Ampul
199 Caviton Tube
200 Cefixim syr 100 mg/5 ml Botol
201 Cefixim tablet 100 mg Tablet
202 Cefixim tablet 200 mg Tablet
203 Cefotaxim 0,5 g inj Vial
204 Ceftriaxon inj Vial
205 Clarithromysin 500 mg Tablet
206 Clavamox inj Ampul
207 Clindamisin 150 mg Tablet
208 Clindamisin 300 mg Tablet
209 Clobazam 10 mg Tablet
210 Clozapine 25 mg Tablet
211 Composite (tumpatan sinar)A3 Set
212 Composite (tumpatan sinar)A3.5 Set
213 Crofed Tablet
214 D1/2 NS botol
215 D1/4 NS Botol
216 Daryantulle Lembar
217 Dermazine/Burnazin Tube
218 Dextina / Dextamin/Dextamec/Polofar Plus Tablet
219 Dextran 70% Botol
220 Dextrofen syr Botol
221 Diaform tablet/selesdiar Tablet 5 5
222 Dormi/Scopma/Spashi tablet Tablet
223 Dulcolac anak supp Supp
224 Dulcolac dewasa supp Supp
225 Dulkolak tablet Tablet
226 Duviral(Zidovudin 300+Lamivudin 150) Botol
227 Efavirenz Botol
228 Etambutol Tablet
229 ETSA Set
230 Euthyrox 100mg Tablet
231 Faktu Supp Supp
232 Fluconasol tab Tablet
233 Fluoxetin Tablet
234 Forumen TT Fls
235 Gentamisin Injeksi 80 mg/2ml Ampul
236 Glass ionomer (Ketac Molar) Tube
237 Glimepiride 2 tablet
238 Glimepiride 4 tablet
239 Glukonas Calcicus 10%- 10ml Ampul
240 Haldol inj Ampul
241 Hiviral (Lamivudin 150) Botol
242 Ibuprofen syr btl
243 Iliadin TH flesh
244 Isotic Neolisin TM Fls
245 Kalium Diklovenac tablet
246 Kaltropen supp Supp 500 100 100
247 Ketoconazole SK tube
248 Ketoprofen inj 10 mg Ampul 18
249 Ketoprofen tablet 100 mg Tablet
250 Ketorolac inj Ampul
251 Kombipak Anak Paket
252 Lodomer 2 Tablet
253 Lytamin syr botol
254 Magnesium Sulfat 20% - 25 ml Botol
255 Magnesium Sulfat 40% - 25 ml Botol
256 Metil Prednisolon 16 mg Tablet
257 Metil prednisolon inj 500 mg Vial
258 Metronidazole 500 mg Infus/100 ml Botol
259 Meylon inj Botol
260 Microlax Supp
261 Miloxicam 7,5 mg tablet
262 Molexflu Tablet 150
263 Multivitamin (Livron B plek) Tablet
264 Multivitamin sirup( Xanvit syr) Botol 1400 200 100 100
265 Neurotropik tablet Tablet
266 Neviral (neviravin 200mg) Botol
267 New antides tablet
268 Nutrifar 5000 Tablet 100 100
269 Obat anti tuberkulosis FDC katagori I Paket
270 Obat anti tuberkulosis FDC anak Paket 1
271 Obat anti tuberkulosis FDC katagori II Paket
272 Obat anti tuberkulosis FDC sisipan Paket
273 Obat anti tuberkulosis kategori I Paket
274 Obat Batuk Kombinasi Botol
275 Obat Flu kombinasi CTM, PPA (Anaflu), Demacoli Tablet
276 Obat Flu Kombinasi/Mecofed/Quantidex Tablet 169
277 OBH plus botol
278 Omeprasole tablet 20 mg Tablet 30 3 5 5
279 Ondancentron inj Ampul
280 Ondancetron 4 mg Tablet
281 Orpen Tablet
282 Oseltamivir Tablet
283 Paket bonding Set
284 Pamol 125 mg Supp Supp
285 Pamol 250 mg Supp Supp
286 Pantocain Tetes Mata Botol
287 Parasetamol drop Botol
288 Pehacain Injeksi Ampul
289 Pehatrim Forte (Kotrimoksasol tab forte 960 mg) Tablet
290 Perhidrol (H2O2) Botol
291 Phenitoin tab Tablet
292 Piracetam 400 mg Tablet
293 Piracetam inj 200mg/1ml Ampul
294 Pirimethamine tablet Tablet
295 Prenatin DF Tablet
296 Prenatin plus tablet tablet 420
297 Primaquin Tablet
298 Primperan inj Ampul
299 Procurma sirup botol
300 Prokain Benzil Penicillin G Injeksi 3 jt IU/vial Vial
301 Proris supp Supp
302 Pularex Tablet
303 Scabimite cream tube
304 Sikzonoate inj Ampul
305 Simvastatin tab 20 mg Tablet
306 Spashi inj Ampul
307 Spashi tab Tablet
308 Stelosi tab 5 mg Tablet
309 Stesolid rectal Supp
310 Strop indra Botol
311 Sulfadiazin tablet Tablet
312 Tenofovir (Tenofovir 300mg) Botol
313 Tetagam Ampul
314 Tramadol inj 50 mg/ml Ampul
315 Tranexid inj (Asam tranexamat inj) Ampul
316 Urotractin tablet
317 Ventolin Nebulizer Ampul
318 Vitamin B12 tab Tablet 5
319 Vitamin Neurotropik inj Ampul
320 Vitamin Neurotropik tablet (Nutrifar, Sohobion) Tablet
321 VitKa infan Ampul
322 Xylocain Gel Ampul
323 Zidovudine 100 mg Tablet

BMHP
1 ADS 0.5 ml Pcs
2 ADS 0.05 ml Pcs
3 ADS 2 ml Pcs
4 ADS 5 ml Pcs
5 Alat suntik sekali pakai 1 ml Pcs
6 Alat suntik sekali pakai 2,5 ml Pcs
7 Alat suntik sekali pakai 5 ml Pcs
8 Bisturi no 13 Pcs
9 Bisturi no 14 Pcs
10 Bisturi no 19/20 Pcs
11 Bisturi no 21 Pcs
12 Box slide kotak
13 Catgut 2/0 plain Sachet
14 Catgut / benang bedah no 2/0 chromic Sachet
15 Catgut / benang bedah no 3/0 plain Sachet
16 Catgut 1/0 Chromic Pcs 200
17 Catgut 2/0 Chromic Roll Roll
18 Catgut 3/0 Chromic Roll Roll
19 Cutgut Chromic No.1 atraumatik (sachet) Sachet
20 Etanol 70 % Botol
21 Etanol 70 % Botol 100 ml
22 Film Rontgen 18 x 24 Set
23 Folley catheter Pcs
24 Hypavix (Ultrafik) Roll
25 I.V Catheter 22 Pcs
26 I.V Catheter 24 Pcs
27 Infusion set anak Set
28 Infusion set dewasa Set
29 IV Cath dgn Katup pcs
30 IV Catheter 18 Pcs
31 IV Catheter 20 Pcs
32 IV Catheter no 18 G Terumo Pcs
33 IV Catheter no 20 G Terumo Pcs
34 Jarum injeksi Pcs
35 Jarum jahit (bedah) no. 9 s/d 14 Set
36 Jarum Jahit Bedah no 12 Set
37 Jarum Jahit Bedah no 13 Set
38 Jarum Jahit Bedah no 14 Set
39 Jarum Kulit Set
40 Jarum Otot dan Kulit Set
41 Jelly RO Tube
42 Kantung Puyer Pak
43 Kapas pembalut / absorben 250 gram Roll
44 Kasa gulung 40 x 80 Roll
45 Kasa Hidrofil 4 x 10 Roll
46 Kasa kompres 40 / 40 steril Roll
47 Kasa pembalut 2 x 80 Roll
48 Kasa pembalut hidrofil 4 m x 15 cm Roll
49 Kasa pembalut hidrofin 4m x 3 cm Roll
50 Kasa Steril ( 18 x 22 ) Kotak
51 Kertas EKG Roll
52 Kertas saring Lembar
53 Kertas USG Roll
54 Klem Tali Pusar pcs
55 Klip Kecil Pak
56 Klip Tanggung Pak
57 Lampu spiritus botol
58 Lisol mengandung kresol Botol
59 Masker Pcs
60 Masker Bedah Pcs
61 Masker N95 Pcs
62 MY Jelly Tube
63 Nasal cannula Oksigen pcs
64 Pembalut Gips Roll
65 Perkamen Pak
66 Plester 5 yard x 2 inch Roll
67 Pot Salep Pot
68 Pot Sputum Pcs
69 Safety box Pcs
70 Sarung Tangan Gynaecologi pasang
71 Sarung Tangan L Pasang
72 Sarung Tangan M Pasang
73 Sarung Tangan S Pasang
74 Sarung Tangan Steril Pasang
75 Sarung Tangan Surgiglove Pasang
76 Sendok Takar Pcs
77 Silk 3/0 roll Roll
78 Silk (benang bedah sutera) no.3/0 Pcs
79 Slide Prosted Pak
80 Spalk tungkai atas anak Pcs
81 Spalk tungkai atas dewasa Pcs
82 Spalk tungkai bawah anak Pcs
83 Spalk tungkai bawah dewasa Pcs
84 Spuit 10 ml Pcs
85 Spuit 2/3 ml Pcs
86 Transfusi Set Pcs
87 Uji Tuberkulin Vial
88 Underpad Pak
89 Urinebag Set
90 Wing Needle 21 Pcs
91 Wing Needle 23 Pcs
92 Wing Needle 25 Pcs
93 Wing Needle 27 Pcs
P.S POL.S P.CAU JML

10
100
0
0
0
0
5 5 10 23
100 300 1000
0
0
0
200 1100
0
200 700
0
0
0
0
0
0
600
0
0
0
0
1800
650
0
0
500
0
5
100
0
500
0
700
0
100 1900
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1000
0
0
0
0
110
0
0
30
0
500
0
0
0
0
0
0
0
100
0
5 37
0
200
0
0
0
100 100
0
0
0
0
0
0
0
0
200 1200
0
0
0
0
0
7
100 100
5
0
0
500
0
0
100
500
0
0
0
0
0
0
0
6
0
0
0
0
0
0
0
0
0
10 10 20
0
700 2900
0
0
0
0
0
0
0
0
0
0
0
100 400
0
0
0
0
0
0
0
100 600
0
0
0
0
0
0
0
0
0
0
0
0
100 300
0
0
0
0
0
0
0
900
0
0
100
10 10 25
0
0
0
0
0
0
0
0
1170
0
0
0
0
0
0
0
0
0
0
0
0
0
0
100 800
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
15 25
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
100 800
0
18
0
0
0
0
0
0
0
0
0
0
0
0
0
150
0
100 1900
0
0
0
200
0
1
0
0
0
0
0
169
0
43
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
420
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
200
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
REKAP PENERIMAAN DAN PENGELUARAN GUDANG OBAT
PUSKESMAS MARGA II
BULAN Mar-19

STOK PENERIM PERSEDIA PENGELUARAN


No Nama Obat Satuan JML
AWAL AAN AN APT PUSKEL P.T.JADI P.PEKEN POS.B P.S POL.S P.CAU EXP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1 Acyclovir Salep Tube 0 0 0
2 Acyclovir 400 mg Tab Tablet 0 0 0
3 Air raksa dental use Botol 0 0 0
4 Albendazol 400 mg tab Tablet 0 0 0
5 Alprazolam 0.5 mg Tablet 0 0 0
6 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0 0 0
7 Ambroxol syr Botol 0 0 0
8 Ambroxol tab 30 mg / Promukus Tablet 0 0 0
9 Aminofilina injeksi 24 mg/ ml. 10 ml Ampul 0 0 0
10 Aminofilna tablet 200 mg Tablet 0 0 0
11 Amitriptilina hcl tablet salut 25 mg Tablet 0 0 0
12 Amoksilina kapsul 500 mg Tablet 0 0 0
13 Amoksilna sirup kering 125 mg/ 5 mg Botol 0 0 0
14 Antasida doen tablet kombinasi Tablet 0 0 0
15 Anti hemmoroid suppositoria Supp 0 0 0
16 Aqua pro injeksi streril. Bebas priogen 20 ml Vial 0 0 0
17 Aquadest steril 500 ml Botol 0 0 0
18 As salisilat 2% + belerang endap 4%(2-4 salep Pot 0 0 0
19 As. Benzoat 3 % + as salisilat 6%(whitefield) Pot 0 0 0
20 Asam askorbat (Vit. C) tablet 50 mg Tablet 0 0 0
21 Asam mefenamat 500 mg Tablet 0 0 0
22 Asetosal 100 mg Tablet 0 0 0
23 Asetosal tablet 500 mg Tablet 0 0 0
24 Atropina sulfat injeksi 0 .25 mg / ml - 1 ml Ampul 0 0 0
25 Basitrasin Polimiksin Tube 0 0 0
26 Besi (II) sulfat tablet salut .kombinasi Tablet 0 0 0
27 Betahistin tab Tablet 0 0 0
28 Betametazon salep kulit Tube 0 0 0
29 Captopril 12.5 mg tablet Tablet 0 0 0
30 Captopril 25 mg tablet Tablet 0 0 0
31 Carbamazepina 200 mg talet Tablet 0 0 0
32 Cefadroxil 125mg/5ml Sirup Botol 0 0 0
33 Cefadroxill 500 mg tablet Tablet 0 0 0
34 Cefotaxim 1 gr Injeksi Ampul 0 0 0
35 Cetirizin10 mg tab Tablet 0 0 0
36 Cimetidine/Selestidin Tablet 0 0 0
37 Ciprofloxazin tablet 500 mg Tablet 0 0 0
38 Deksametason injeksi 5 mg / ml - 1 ml Ampul 0 0 0
39 Deksametason tablet 0.5 mg Tablet 0 0 0
40 Devitalisasi pasta Tube 0 0 0
41 Diazepam 5 mg Tablet 0 0 0
42 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0 0 0
43 Diazepam tablet 2 mg Tablet 0 0 0
44 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 0 0 0
45 Digoksina tablet 0. 25 mg Tablet 0 0 0
46 Domperidon tablet 10 mg Tablet 0 0 0
47 Doxycicline 100 mg tab Tablet 0 0 0
48 Efedrina HCL (efedrina) tablet 25 mg Tablet 0 0 0
49 Epinefrina HCL / bitartat (aderenalina) inj 01% Ampul 0 0 0
50 Ergotamina tartrat 1 mg + kofeina 50 mg tab Tablet 0 0 0
51 Erytromysin 200mg/5ml Syrup Botol 0 0 0
52 Erytromysin tablet 500 mg Tablet 0 0 0
53 Etakridina (rivanol) larutan 0.1 % Botol 0 0 0
54 Etil klorida semprot Botol 0 0 0
55 Eugenol cairan Botol 0 0 0
56 Fenobarbital inj 50 mg /ml -2ml Ampul 0 0 0
57 Fenobarbital tablet 100mg Tablet 0 0 0
58 Fenobarbital tablet 30 mg Tablet 0 0 0
59 Fenol gliserol tetes telnga 10% Botol 0 0 0
60 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0 0 0
61 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0 0 0
62 Furosemida tablet 40 mg Tablet 0 0 0
63 Garam Oralit untuk 200 ml air Sachet 0 0 0
64 Gentamisin Salep Mata Tube 0 0 0
65 Gentamysin SK Tube 0 0 0
66 Gentamysin TM/Genoint TM Botol 0 0 0
67 Gentian violet larutan 1 % Botol 0 0 0
68 Glibenklamida tablet 5 mg Tablet 0 0 0
69 Gliseril guayakolat tablet 10 mg Tablet 0 0 0
70 Glukosa larutan infus 10 % steril Botol 0 0 0
71 Glukosa larutan infus 40 % steril Botol 0 0 0
72 Glukosa larutan infus 5 % steril Botol 0 0 0
73 Griseofulvin tablet 125 mg. Mikronized Tablet 0 0 0
74 Haloperidol 0,5 mg. Tablet Tablet 0 0 0
75 Haloperidol 1,5 mg tablet Tablet 0 0 0
76 Haloperidol 5 mg tablet Tablet 0 0 0
77 Hidroklorotiasida (HCT) tablet 25 mg Tablet 0 0 0
78 Hidrokortison krim 2.5 % Tube 0 0 0
79 Ibuprofen tablet 400 mg Tablet 0 0 0
80 Isoniazide 100 mg Tablet 0 0 0
81 Isoniazide 300 mg Tablet 0 0 0
82 Isosorbid dinitrat Tablet 0 0 0
83 Kalsium hidroksida pasta Pot 0 0 0
84 Kalsium laktat (kalk) tablet 500 mg Tablet 0 0 0
85 Ketokonazole 200 mg tablet Tablet 0 0 0
86 Kinina dihidroklorida (kinina) inj 25 % - 2 ml Ampul 0 0 0
87 Kinina sulfat tablet 222 mg (7 h20 ) Tablet 0 0 0
88 Kloramfenicol salep kulit Tube 0 0 0
89 Kloramfenikol kapsul 250 mg Tablet 0 0 0
90 Kloramfenikol salep mata 1 % Tube 0 0 0
91 Kloramfenikol tetes Mata Botol 0 0 0
92 Kloramfenikol tetes telinga 3 % Botol 0 0 0
93 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 0 0 0
94 Klorpromazin 100 mg tablet Tablet 0 0 0
95 Klorpromazina Hcl inj 25 mg / ml - 1 ml Ampul 0 0 0
96 Klorpromazina Hcl inj 5 mg / ml - 2 ml Ampul 0 0 0
97 Klorpromazina hcl tablet salut 25 mg Tablet 0 0 0
98 Kodeina Hcl (kodeina) tablet 10 mg Tablet 0 0 0
99 Kotrimoksasol suspensi Botol 0 0 0
100 Kotrimoksasol tablet kombinasi Tablet 0 0 0
101 Lidokain inj Ampul 0 0 0
102 Lidokaina comp inj kombinasi Ampul 0 0 0
103 Metakresol sulfonat dan metanol kondensai (Albotyl) Botol 0 0 0
104 Metformin 500 mg tablet Tablet 0 0 0
105 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0 0 0
106 Metilergometrina malet tablet salut 0. 125 mg Tablet 0 0 0
107 Metilprednisolon tablet 4 mg Tablet 0 0 0
108 Metoklopramide 10 mg tablet/Noristal Tablet 0 0 0
109 Metronidazol 500 mg Tablet 0 0 0
110 Metronidazol tablet 250 mg Tablet 0 0 0
111 Mikonazole salep Tube 0 0 0
112 Monoklorkamfer mentolcairan (CHKM) Botol 0 0 0
113 Mumifyng pasta Botol 0 0 0
114 Natrium bikarbonat tablet 500 mg Tablet 0 0 0
115 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 0 0 0
116 Natrium klorida larutan infus 0. 9 steril Botol 0 0 0
117 Nifedipin tablet 10 mg Tablet 0 0 0
118 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0 0 0
119 Obat batuk hitam (OBH) cairan Botol 100 ml 0 0 0
120 Ofloxacin tab 400mg Tablet 0 0 0
121 Oksigen gas dalam tabung 3 m3 Tabung 0 0 0
122 Oksigen gas dalam tabung 6 m3 Tabung 0 0 0
123 Oksitetrasiklina hcl salep 3 % Tube 0 0 0
124 Oksitetrasiklina hcl salep mata 1 % Tube 0 0 0
125 Oksitosina inj 10 iu/ml - 1 ml Ampul 0 0 0
126 Parasetamol sirup 120 mg / 5 ml Botol 0 0 0
127 Parasetamol tab 100 mg Tablet 0 0 0
128 Parasetamol tablet 500mg Tablet 0 0 0
129 Pirantel pamoat (pirantel) tablet 125 mg basa Tablet 0 0 0
130 Piroxicam 10 Mg Tablet 0 0 0
131 Piroxicam 20 Mg Tablet 0 0 0
132 Prednison tablet 5 mgn Tablet 0 0 0
133 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0 0 0
134 Primakina tablet 15 mg Tablet 0 0 0
135 Prokaina penisilina g inj 3 juta iu Vial 0 0 0
136 Propiltionurasil tablet 100 mg Tablet 0 0 0
137 Propranolol hcl (Propranolol) tablet 40 mg Tablet 0 0 0
138 Pyridoxin injeksi Ampul 0 0 0
139 Ranitidin inj 25 mg/2 ml Ampul 0 0 0
140 Ranitidin tablet 150 mg Tablet 0 0 0
141 Reserpina tablet 0, 10 mg Tablet 0 0 0
142 Reserpina tablet 0, 25 mg Tablet 0 0 0
143 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0 0 0
144 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0 0 0
145 Ringer laktat larutan infus steril Botol 0 0 0
146 Risperidon Tablet 0 0 0
147 Salbutamol tablet 2 mg Tablet 0 0 0
148 Salbutamol tablet 4 mg Tablet 0 0 0
149 Salisil bedak 2 % Bks 0 0 0
150 Salisil spiritus 10 % Botol 0 0 0
151 Semen seng fosfat serbuk dan cairan Botol 0 0 0
152 Serum anti bisa ular polivalen inj. 5ml Ampul 0 0 0
153 Serum anti tetanus inj. 1.500 iu Ampul 0 0 0
154 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0 0 0
155 Silver amalgam serbuk 65-75% Botol 0 0 0
156 Simvastatin tab 10 mg Tablet 0 0 0
157 Sulfacetamide tetes mata Botol 0 0 0
158 Synthetic filing material larutan dan serbuk Set 0 0 0
159 Temporary stopping fletcher serbuk dan cairan Set 0 0 0
160 Tetrasiklina hcl (tetrasiklina) kapsul 250 mg Tablet 0 0 0
161 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0 0 0
162 Thiamfenikol 500 Tablet 0 0 0
163 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0 0 0
164 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0 0 0
165 Tramadol Tablet 0 0 0
166 Trifluoperazine (Stelazin) Tablet 0 0 0
167 Triheksfenidil hcl 2 mg tablet Tablet 0 0 0
168 Trikresol formalin (tkf) cairan Botol 0 0 0
169 Vitamin B kompleks tablet Tablet 0 0 0
170 Yodium povidan larutan 10% 300 ml Botol 0 0 0
171 Yodium povidon larutan 10% 30 ml Botol 0 0 0
172 Zink tablet Tablet 0 0 0
- Amoxcilin syrup 250 mg/ 5 ml botol 0 0 0
- 0 - 0 0 0
- OBAT TAMBAHAN - 0 0 0
173 Aptil Botol 0 0 0
174 (Lopinavir/Ritonavir)Aluvia Botol 0 0 0
175 Abacavir Tablet 0 0 0
176 Acyclovir tablet 200 mg Tablet 0 0 0
177 Aleterol TM Botol 0 0 0
178 Amlodipin 10 mg tab Tablet 0 0 0
179 Amlodipin 5 mg tab Tablet 0 0 0
180 Amox-clav Tablet 0 0 0
181 Ampisilin Serbuk Injeksi i.m/i.v. 1000 mg/ml Ampul 0 0 0
182 Ampisillin injeksi i.m/i.v 1000 mg/ml Ampul 0 0 0
183 Antalgin injeksi Ampul 0 0 0
184 Antasida syr Botol 0 0 0
185 Arterakine Tablet 0 0 0
186 Artesunat inj Vial 0 0 0
187 Asam Folat 1 mg Tablet 0 0 0
188 Asam tranexamat 500 mg Tablet 0 0 0
189 Asetosal 80/miniaspi tablet 0 0 0
190 Atripla(TDF+3TC+EFV) Botol 0 0 0
191 Azitromisin+cefixim Tablet 0 0 0
192 Azytromisin tablet 500 mg Tablet 0 0 0
193 BD Vacuntainer Pcs 0 0 0
194 Becefort Tablet 0 0 0
195 Benzatin Penisillin Vial 0 0 0
196 Bonding Set 0 0 0
197 Bufacomb salep Tube 0 0 0
198 Buscopan inj Ampul 0 0 0
199 Caviton Tube 0 0 0
200 Cefixim syr 100 mg/5 ml Botol 0 0 0
201 Cefixim tablet 100 mg Tablet 0 0 0
202 Cefixim tablet 200 mg Tablet 0 0 0
203 Cefotaxim 0,5 g inj Vial 0 0 0
204 Ceftriaxon inj Vial 0 0 0
205 Clarithromysin 500 mg Tablet 0 0 0
206 Clavamox inj Ampul 0 0 0
207 Clindamisin 150 mg Tablet 0 0 0
208 Clindamisin 300 mg Tablet 0 0 0
209 Clobazam 10 mg Tablet 0 0 0
210 Clozapine 25 mg Tablet 0 0 0
211 Composite (tumpatan sinar)A3 Set 0 0 0
212 Composite (tumpatan sinar)A3.5 Set 0 0 0
213 Crofed Tablet 0 0 0
214 D1/2 NS botol 0 0 0
215 D1/4 NS Botol 0 0 0
216 Daryantulle Lembar 0 0 0
217 Dermazine/Burnazin Tube 0 0 0
218 Dextina / Dextamin/Dextamec/Polofar Plus Tablet 0 0 0
219 Dextran 70% Botol 0 0 0
220 Dextrofen syr Botol 0 0 0
221 Diaform tablet/selesdiar Tablet 0 0 0
222 Dormi/Scopma/Spashi tablet Tablet 0 0 0
223 Dulcolac anak supp Supp 0 0 0
224 Dulcolac dewasa supp Supp 0 0 0
225 Dulkolak tablet Tablet 0 0 0
226 Duviral(Zidovudin 300+Lamivudin 150) Botol 0 0 0
227 Efavirenz Botol 0 0 0
228 Etambutol Tablet 0 0 0
229 ETSA Set 0 0 0
230 Euthyrox 100mg Tablet 0 0 0
231 Faktu Supp Supp 0 0 0
232 Fluconasol tab Tablet 0 0 0
233 Fluoxetin Tablet 0 0 0
234 Forumen TT Fls 0 0 0
235 Gentamisin Injeksi 80 mg/2ml Ampul 0 0 0
236 Glass ionomer (Ketac Molar) Tube 0 0 0
237 Glimepiride 2 tablet 0 0 0
238 Glimepiride 4 tablet 0 0 0
239 Glukonas Calcicus 10%- 10ml Ampul 0 0 0
240 Haldol inj Ampul 0 0 0
241 Hiviral (Lamivudin 150) Botol 0 0 0
242 Ibuprofen syr btl 0 0 0
243 Iliadin TH flesh 0 0 0
244 Isotic Neolisin TM Fls 0 0 0
245 Kalium Diklovenac tablet 0 0 0
246 Kaltropen supp Supp 0 0 0
247 Ketoconazole SK tube 0 0 0
248 Ketoprofen inj 10 mg Ampul 0 0 0
249 Ketoprofen tablet 100 mg Tablet 0 0 0
250 Ketorolac inj Ampul 0 0 0
251 Kombipak Anak Paket 0 0 0
252 Lodomer 2 Tablet 0 0 0
253 Lytamin syr botol 0 0 0
254 Magnesium Sulfat 20% - 25 ml Botol 0 0 0
255 Magnesium Sulfat 40% - 25 ml Botol 0 0 0
256 Metil Prednisolon 16 mg Tablet 0 0 0
257 Metil prednisolon inj 500 mg Vial 0 0 0
258 Metronidazole 500 mg Infus/100 ml Botol 0 0 0
259 Meylon inj Botol 0 0 0
260 Microlax Supp 0 0 0
261 Miloxicam 7,5 mg tablet 0 0 0
262 Molexflu Tablet 0 0 0
263 Multivitamin (Livron B plek) Tablet 0 0 0
264 Multivitamin sirup( Xanvit syr) Botol 0 0 0
265 Neurotropik tablet Tablet 0 0 0
266 Neviral (neviravin 200mg) Botol 0 0 0
267 New antides tablet 0 0 0
268 Nutrifar 5000 Tablet 0 0 0
269 Obat anti tuberkulosis FDC katagori I Paket 0 0 0
270 Obat anti tuberkulosis FDC anak Paket 0 0 0
271 Obat anti tuberkulosis FDC katagori II Paket 0 0 0
272 Obat anti tuberkulosis FDC sisipan Paket 0 0 0
273 Obat anti tuberkulosis kategori I Paket 0 0 0
274 Obat Batuk Kombinasi Botol 0 0 0
275 Obat Flu kombinasi CTM, PPA (Anaflu), Demacolin Tablet 0 0 0
276 Obat Flu Kombinasi/Mecofed/Quantidex Tablet 0 0 0
277 OBH plus botol 0 0 0
278 Omeprasole tablet 20 mg Tablet 0 0 0
279 Ondancentron inj Ampul 0 0 0
280 Ondancetron 4 mg Tablet 0 0 0
281 Orpen Tablet 0 0 0
282 Oseltamivir Tablet 0 0 0
283 Paket bonding Set 0 0 0
284 Pamol 125 mg Supp Supp 0 0 0
285 Pamol 250 mg Supp Supp 0 0 0
286 Pantocain Tetes Mata Botol 0 0 0
287 Parasetamol drop Botol 0 0 0
288 Pehacain Injeksi Ampul 0 0 0
289 Pehatrim Forte (Kotrimoksasol tab forte 960 mg) Tablet 0 0 0
290 Perhidrol (H2O2) Botol 0 0 0
291 Phenitoin tab Tablet 0 0 0
292 Piracetam 400 mg Tablet 0 0 0
293 Piracetam inj 200mg/1ml Ampul 0 0 0
294 Pirimethamine tablet Tablet 0 0 0
295 Prenatin DF Tablet 0 0 0
296 Prenatin plus tablet tablet 0 0 0
297 Primaquin Tablet 0 0 0
298 Primperan inj Ampul 0 0 0
299 Procurma sirup botol 0 0 0
300 Prokain Benzil Penicillin G Injeksi 3 jt IU/vial Vial 0 0 0
301 Proris supp Supp 0 0 0
302 Pularex Tablet 0 0 0
303 Scabimite cream tube 0 0 0
304 Sikzonoate inj Ampul 0 0 0
305 Simvastatin tab 20 mg Tablet 0 0 0
306 Spashi inj Ampul 0 0 0
307 Spashi tab Tablet 0 0 0
308 Stelosi tab 5 mg Tablet 0 0 0
309 Stesolid rectal Supp 0 0 0
310 Strop indra Botol 0 0 0
311 Sulfadiazin tablet Tablet 0 0 0
312 Tenofovir (Tenofovir 300mg) Botol 0 0 0
313 Tetagam Ampul 0 0 0
314 Tramadol inj 50 mg/ml Ampul 0 0 0
315 Tranexid inj (Asam tranexamat inj) Ampul 0 0 0
316 Urotractin tablet 0 0 0
317 Ventolin Nebulizer Ampul 0 0 0
318 Vitamin B12 tab Tablet 0 0 0
319 Vitamin Neurotropik inj Ampul 0 0 0
320 Vitamin Neurotropik tablet (Nutrifar, Sohobion) Tablet 0 0 0
321 VitKa infan Ampul 0 0 0
322 Xylocain Gel Ampul 0 0 0
323 Zidovudine 100 mg Tablet 0 0 0
- Sucralfate syrup botol 0 0 0
- Clopidogrel bisulfate - 0 0 0
- Levofloxacin 500 - 0 0 0
- Spironolactone 25 mg - 0 0 0
- Domperidone syr - 0 0 0
- Ceterizine syr 5 mg/5ml - 0 0 0
Albendazol syr 0 0 0
Zink syr 0 0 0
Cazetin drop 0 0 0
Lacto B 0 0 0
Scopma plus 0 0 0
Nebacetin powder 0 0 0
Metronidazol syr 125 0 0 0
Salbutamol syr 0 0 0
Furosemida inj 0 0 0
Paracetamol inj 0 0 0
Colortusin tab 0 0 0
Coparcetin tab 0 0 0
TB tahap intensif 0 0 0
TB tahap lanjutan 0 0 0
Solathim syr 0 0 0
Antiseptic liq 0 0 0
Tenofovir + Emtricitabin 0 0 0
Cavit G 0 0 0
Ketros Supp 0 0 0
Harnal 0 0 0
- BMHP - 0 0 0
1 ADS 0.5 ml Pcs 0 0 0
2 ADS 0.05 ml Pcs 0 0 0
3 ADS 2 ml Pcs 0 0 0
4 ADS 5 ml Pcs 0 0 0
5 Alat suntik sekali pakai 1 ml Pcs 0 0 0
6 Alat suntik sekali pakai 2,5 ml Pcs 0 0 0
7 Alat suntik sekali pakai 5 ml Pcs 0 0 0
8 Bisturi no 13 Pcs 0 0 0
9 Bisturi no 14 Pcs 0 0 0
10 Bisturi no 19/20 Pcs 0 0 0
11 Bisturi no 21 Pcs 0 0 0
12 Box slide kotak 0 0 0
13 Catgut 2/0 plain Sachet 0 0 0
14 Catgut / benang bedah no 2/0 chromic Sachet 0 0 0
15 Catgut / benang bedah no 3/0 plain Sachet 0 0 0
16 Catgut 1/0 Chromic Pcs 0 0 0
17 Catgut 2/0 Chromic Roll Roll 0 0 0
18 Catgut 3/0 Chromic Roll Roll 0 0 0
19 Cutgut Chromic No.1 atraumatik (sachet) Sachet 0 0 0
20 Etanol 70 % Botol 0 0 0
21 Etanol 70 % Botol 100 ml 0 0 0
22 Film Rontgen 18 x 24 Set 0 0 0
23 Folley catheter Pcs 0 0 0
24 Hypavix (Ultrafik) Roll 0 0 0
25 I.V Catheter 22 Pcs 0 0 0
26 I.V Catheter 24 Pcs 0 0 0
27 Infusion set anak Set 0 0 0
28 Infusion set dewasa Set 0 0 0
29 IV Cath dgn Katup pcs 0 0 0
30 IV Catheter 18 Pcs 0 0 0
31 IV Catheter 20 Pcs 0 0 0
32 IV Catheter no 18 G Terumo Pcs 0 0 0
33 IV Catheter no 20 G Terumo Pcs 0 0 0
34 Jarum injeksi Pcs 0 0 0
35 Jarum jahit (bedah) no. 9 s/d 14 Set 0 0 0
36 Jarum Jahit Bedah no 12 Set 0 0 0
37 Jarum Jahit Bedah no 13 Set 0 0 0
38 Jarum Jahit Bedah no 14 Set 0 0 0
39 Jarum Kulit Set 0 0 0
40 Jarum Otot dan Kulit Set 0 0 0
41 Jelly RO Tube 0 0 0
42 Kantung Puyer Pak 0 0 0
43 Kapas pembalut / absorben 250 gram Roll 0 0 0
44 Kasa gulung 40 x 80 Roll 0 0 0
45 Kasa Hidrofil 4 x 10 Roll 0 0 0
46 Kasa kompres 40 / 40 steril Roll 0 0 0
47 Kasa pembalut 2 x 80 Roll 0 0 0
48 Kasa pembalut hidrofil 4 m x 15 cm Roll 0 0 0
49 Kasa pembalut hidrofin 4m x 3 cm Roll 0 0 0
50 Kasa Steril ( 18 x 22 ) Kotak 0 0 0
51 Kertas EKG Roll 0 0 0
52 Kertas saring Lembar 0 0 0
53 Kertas USG Roll 0 0 0
54 Klem Tali Pusar pcs 0 0 0
55 Klip Kecil Pak 0 0 0
56 Klip Tanggung Pak 0 0 0
57 Lampu spiritus botol 0 0 0
58 Lisol mengandung kresol Botol 0 0 0
59 Masker Pcs 0 0 0
60 Masker Bedah Pcs 0 0 0
61 Masker N95 Pcs 0 0 0
62 MY Jelly Tube 0 0 0
63 Nasal cannula Oksigen pcs 0 0 0
64 Pembalut Gips Roll 0 0 0
65 Perkamen Pak 0 0 0
66 Plester 5 yard x 2 inch Roll 0 0 0
67 Pot Salep Pot 0 0 0
68 Pot Sputum Pcs 0 0 0
69 Safety box Pcs 0 0 0
70 Sarung Tangan Gynaecologi pasang 0 0 0
71 Sarung Tangan L Pasang 0 0 0
72 Sarung Tangan M Pasang 0 0 0
73 Sarung Tangan S Pasang 0 0 0
74 Sarung Tangan Steril Pasang 0 0 0
75 Sarung Tangan Surgiglove Pasang 0 0 0
76 Sendok Takar Pcs 0 0 0
77 Silk 3/0 roll Roll 0 0 0
78 Silk (benang bedah sutera) no.3/0 Pcs 0 0 0
79 Slide Prosted Pak 0 0 0
80 Spalk tungkai atas anak Pcs 0 0 0
81 Spalk tungkai atas dewasa Pcs 0 0 0
82 Spalk tungkai bawah anak Pcs 0 0 0
83 Spalk tungkai bawah dewasa Pcs 0 0 0
84 Spuit 10 ml Pcs 0 0 0
85 Spuit 2/3 ml Pcs 0 0 0
86 Transfusi Set Pcs 0 0 0
87 Uji Tuberkulin Vial 0 0 0
88 Underpad Pak 0 0 0
89 Urinebag Set 0 0 0
90 Wing Needle 21 Pcs 0 0 0
91 Wing Needle 23 Pcs 0 0 0
92 Wing Needle 25 Pcs 0 0 0
93 Wing Needle 27 Pcs 0 0 0
STOK
AKHIR
17
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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0
0
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PUSKESMAS MARGA II
BULAN MARET -APRIL 2019
REKAP PENERIMAAN DAN PENGELUARAN GUDANG OBAT
STOK PENERIM PERSEDIA PENGELUARAN
No Nama Obat Satuan JML
AWAL AAN AN APT PUSKEL P.T.JADI P.PEKEN POS.B P.S POL.S P.CSU EXP
1 2 3 4 5 6 7 8 9 10 11 12 13
1 Acyclovir Salep Tube 380 380 10 10
2 Acyclovir 400 mg Tab Tablet 760 760 100 100
3 Air raksa dental use Botol - 0
4 Albendazol 400 mg tab Tablet 210 210 0
5 Alprazolam 0.5 mg Tablet - 0
6 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 898 898 0
7 Ambroxol syr Botol 1048 100 1,148 3 5 5 10 23
8 Ambroxol tab 30 mg / Promukus Tablet 5442 2,000 7,442 500 100 100 300 1000
9 Aminofilina injeksi 24 mg/ ml. 10 ml Ampul - 0
10 Aminofilna tablet 200 mg Tablet - 0
11 Amitriptilina hcl tablet salut 25 mg Tablet - 0
12 Amoksilina kapsul 500 mg Tablet 2753 1,000 3,753 800 100 200 1100
13 Amoksilna sirup kering 125 mg/ 5 mg Botol - 0
14 Antasida doen tablet kombinasi Tablet 7431 7,431 200 200 100 200 700
15 Anti hemmoroid suppositoria Supp 32 32 0
16 Aqua pro injeksi streril. Bebas priogen 20 ml Vial - 0
17 Aquadest steril 500 ml Botol - 0
18 As salisilat 2% + belerang endap 4%(2-4 salep Pot - 0
19 As. Benzoat 3 % + as salisilat 6%(whitefield) Pot - 0
20 Asam askorbat (Vit. C) tablet 50 mg Tablet - 0
21 Asam mefenamat 500 mg Tablet 1,000 1,000 500 100 600
22 Asetosal 100 mg Tablet - 0
23 Asetosal tablet 500 mg Tablet - 0
24 Atropina sulfat injeksi 0 .25 mg / ml - 1 ml Ampul - 0
25 Basitrasin Polimiksin Tube - 0
26 Besi (II) sulfat tablet salut .kombinasi Tablet 7181 7,181 1800 1800
27 Betahistin tab Tablet 1759 1,759 500 60 90 650
28 Betametazon salep kulit Tube 78 78 0
29 Captopril 12.5 mg tablet Tablet - 0
30 Captopril 25 mg tablet Tablet 3274 500 3,774 500 500
31 Carbamazepina 200 mg talet Tablet - 0
32 Cefadroxil 125mg/5ml Sirup Botol 139 139 5 5
33 Cefadroxill 500 mg tablet Tablet 1528 1,528 100 100
34 Cefotaxim 1 gr Injeksi Ampul - 0
35 Cetirizin10 mg tab Tablet 1025 1,500 2,525 500 500
STOK PENERIM PERSEDIA PENGELUARAN
No Nama Obat Satuan JML
AWAL AAN AN APT PUSKEL P.T.JADI P.PEKEN POS.B P.S POL.S P.CSU EXP
1 2 3 4 5 6 7 8 9 10 11 12 13
36 Cimetidine/Selestidin Tablet - 0
37 Ciprofloxazin tablet 500 mg Tablet 933 933 500 100 100 700
38 Deksametason injeksi 5 mg / ml - 1 ml Ampul - 0
39 Deksametason tablet 0.5 mg Tablet 7900 7,900 1500 100 100 100 100 1900
40 Devitalisasi pasta Tube 2 2 0
41 Diazepam 5 mg Tablet - 0
42 Diazepam injeksi 5 mg / ml - 2 ml Ampul 15 15 0
43 Diazepam tablet 2 mg Tablet - 0
44 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul - 0
45 Digoksina tablet 0. 25 mg Tablet 90 90 0
46 Domperidon tablet 10 mg Tablet - 0
47 Doxycicline 100 mg tab Tablet - 0
48 Efedrina HCL (efedrina) tablet 25 mg Tablet - 0
49 Epinefrina HCL / bitartat (aderenalina) inj 01% Ampul 17 17 0
50 Ergotamina tartrat 1 mg + kofeina 50 mg tab Tablet - 0
51 Erytromysin 200mg/5ml Syrup Botol - 0
52 Erytromysin tablet 500 mg Tablet 500 500 0
53 Etakridina (rivanol) larutan 0.1 % Botol - 0
54 Etil klorida semprot Botol 18 18 0
55 Eugenol cairan Botol - 0
56 Fenobarbital inj 50 mg /ml -2ml Ampul - 0
57 Fenobarbital tablet 100mg Tablet - 0
58 Fenobarbital tablet 30 mg Tablet 5027 1,000 6,027 1000 1000
59 Fenol gliserol tetes telnga 10% Botol - 0
60 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul - 0
61 Fitomenadion (vit. K1) tablet salut 10 mg Tablet - 0
62 Furosemida tablet 40 mg Tablet 440 440 0
63 Garam Oralit untuk 200 ml air Sachet 162 100 262 100 10 110
64 Gentamisin Salep Mata Tube 39 39 0
65 Gentamysin SK Tube - 0
66 Gentamysin TM/Genoint TM Botol 244 244 24 6 30
67 Gentian violet larutan 1 % Botol - 0
68 Glibenklamida tablet 5 mg Tablet 1470 500 1,970 500 500
69 Gliseril guayakolat tablet 10 mg Tablet 1421 1,421 0
70 Glukosa larutan infus 10 % steril Botol - 0
71 Glukosa larutan infus 40 % steril Botol - 0
72 Glukosa larutan infus 5 % steril Botol 16 16 0
73 Griseofulvin tablet 125 mg. Mikronized Tablet - 0
74 Haloperidol 0,5 mg. Tablet Tablet - 0
STOK PENERIM PERSEDIA PENGELUARAN
No Nama Obat Satuan JML
AWAL AAN AN APT PUSKEL P.T.JADI P.PEKEN POS.B P.S POL.S P.CSU EXP
1 2 3 4 5 6 7 8 9 10 11 12 13
75 Haloperidol 1,5 mg tablet Tablet 200 200 0
76 Haloperidol 5 mg tablet Tablet 200 200 100 100
77 Hidroklorotiasida (HCT) tablet 25 mg Tablet 994 994 0
78 Hidrokortison krim 2.5 % Tube 196 196 24 3 5 5 37
79 Ibuprofen tablet 400 mg Tablet - 0
80 Isoniazide 100 mg Tablet 200 200 200 200
81 Isoniazide 300 mg Tablet - 0
82 Isosorbid dinitrat Tablet 28 28 0
83 Kalsium hidroksida pasta Pot - 0
84 Kalsium laktat (kalk) tablet 500 mg Tablet 3417 3,417 100 100
85 Ketokonazole 200 mg tablet Tablet - 0
86 Kinina dihidroklorida (kinina) inj 25 % - 2 ml Ampul - 0
87 Kinina sulfat tablet 222 mg (7 h20 ) Tablet - 0
88 Kloramfenicol salep kulit Tube - 0
89 Kloramfenikol kapsul 250 mg Tablet - 0
90 Kloramfenikol salep mata 1 % Tube - 0
91 Kloramfenikol tetes Mata Botol - 0
92 Kloramfenikol tetes telinga 3 % Botol 73 30 103 0
93 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 6152 6,152 500 100 200 100 100 200 1200
94 Klorpromazin 100 mg tablet Tablet - 0
95 Klorpromazina Hcl inj 25 mg / ml - 1 ml Ampul - 0
96 Klorpromazina Hcl inj 5 mg / ml - 2 ml Ampul - 0
97 Klorpromazina hcl tablet salut 25 mg Tablet - 0
98 Kodeina Hcl (kodeina) tablet 10 mg Tablet - 0
99 Kotrimoksasol suspensi Botol 140 140 2 5 7
100 Kotrimoksasol tablet kombinasi Tablet 1220 1,000 2,220 100 100
101 Lidokain inj Ampul 99 99 5 5
102 Lidokaina comp inj kombinasi Ampul - 0
103 Metakresol sulfonat dan metanol kondensai (Albotyl) Botol - 0
104 Metformin 500 mg tablet Tablet 2090 1,000 3,090 500 500
105 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 25 25 0
106 Metilergometrina malet tablet salut 0. 125 mg Tablet - 0
107 Metilprednisolon tablet 4 mg Tablet 3577 3,577 100 100
108 Metoklopramide 10 mg tablet/Noristal Tablet 1431 1,431 500 500
109 Metronidazol 500 mg Tablet 659 659 0
110 Metronidazol tablet 250 mg Tablet - 0
111 Mikonazole salep Tube 40 24 64 0
112 Monoklorkamfer mentolcairan (CHKM) Botol - 0
113 Mumifyng pasta Botol - 0
STOK PENERIM PERSEDIA PENGELUARAN
No Nama Obat Satuan JML
AWAL AAN AN APT PUSKEL P.T.JADI P.PEKEN POS.B P.S POL.S P.CSU EXP
1 2 3 4 5 6 7 8 9 10 11 12 13
114 Natrium bikarbonat tablet 500 mg Tablet - 0
115 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet - 0
116 Natrium klorida larutan infus 0. 9 steril Botol 79 79 5 1 6
117 Nifedipin tablet 10 mg Tablet 480 480 0
118 Nistatin 100. 000 iu/g tablet vaginal Tab Vag - 0
119 Obat batuk hitam (OBH) cairan Botol 100 ml - 0
120 Ofloxacin tab 400mg Tablet - 0
121 Oksigen gas dalam tabung 3 m3 Tabung - 0
122 Oksigen gas dalam tabung 6 m3 Tabung - 0
123 Oksitetrasiklina hcl salep 3 % Tube - 0
124 Oksitetrasiklina hcl salep mata 1 % Tube - 0
125 Oksitosina inj 10 iu/ml - 1 ml Ampul 10 10 0
126 Parasetamol sirup 120 mg / 5 ml Botol 176 100 276 10 10 20
127 Parasetamol tab 100 mg Tablet - 0
128 Parasetamol tablet 500mg Tablet 11292 5,000 16,292 1500 200 200 100 200 700 2900
129 Pirantel pamoat (pirantel) tablet 125 mg basa Tablet - 0
130 Piroxicam 10 Mg Tablet - 0
131 Piroxicam 20 Mg Tablet - 0
132 Prednison tablet 5 mgn Tablet - 0
133 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet - 0
134 Primakina tablet 15 mg Tablet - 0
135 Prokaina penisilina g inj 3 juta iu Vial - 0
136 Propiltionurasil tablet 100 mg Tablet - 0
137 Propranolol hcl (Propranolol) tablet 40 mg Tablet - 0
138 Pyridoxin injeksi Ampul - 0
139 Ranitidin inj 25 mg/2 ml Ampul - 0
140 Ranitidin tablet 150 mg Tablet 4174 4,174 300 100 400
141 Reserpina tablet 0, 10 mg Tablet - 0
142 Reserpina tablet 0, 25 mg Tablet - 0
143 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 1008 1,008 0
144 Retinol (vit. A) tablet salut 100. 000 iu Tablet 271 271 0
145 Ringer laktat larutan infus steril Botol 18 18 0
146 Risperidon Tablet - 0
147 Salbutamol tablet 2 mg Tablet - 0
148 Salbutamol tablet 4 mg Tablet 3511 3,511 400 100 100 600
149 Salisil bedak 2 % Bks - 0
150 Salisil spiritus 10 % Botol - 0
151 Semen seng fosfat serbuk dan cairan Botol 4 4 0
152 Serum anti bisa ular polivalen inj. 5ml Ampul - 0
STOK PENERIM PERSEDIA PENGELUARAN
No Nama Obat Satuan JML
AWAL AAN AN APT PUSKEL P.T.JADI P.PEKEN POS.B P.S POL.S P.CSU EXP
1 2 3 4 5 6 7 8 9 10 11 12 13
153 Serum anti tetanus inj. 1.500 iu Ampul - 0
154 Sianokobalamina (vit.b12) inj. 500 mcg Ampul - 0
155 Silver amalgam serbuk 65-75% Botol 1 1 0
156 Simvastatin tab 10 mg Tablet 755 755 0
157 Sulfacetamide tetes mata Botol - 0
158 Synthetic filing material larutan dan serbuk Set - 0
159 Temporary stopping fletcher serbuk dan cairan Set 1 1 0
160 Tetrasiklina hcl (tetrasiklina) kapsul 250 mg Tablet - 0
161 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 1105 1,105 100 100 100 300
162 Thiamfenikol 500 Tablet - 0
163 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 147 147 0
164 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul - 0
165 Tramadol Tablet - 0
166 Trifluoperazine (Stelazin) Tablet - 0
167 Triheksfenidil hcl 2 mg tablet Tablet - 0
168 Trikresol formalin (tkf) cairan Botol 4 4 0
169 Vitamin B kompleks tablet Tablet 3332 3,000 6,332 600 200 100 900
170 Yodium povidan larutan 10% 300 ml Botol 2 2 0
171 Yodium povidon larutan 10% 30 ml Botol 14 14 0
172 Zink tablet Tablet 1476 1,476 100 100
0 Amoxcilin syrup 250 mg/ 5 ml botol 145 60 205 5 10 10 25
0 - 0
0 OBAT TAMBAHAN - 0
173 Aptil Botol - 0
174 (Lopinavir/Ritonavir)Aluvia Botol - 0
175 Abacavir Tablet - 0
176 Acyclovir tablet 200 mg Tablet - 0
177 Aleterol TM Botol - 0
178 Amlodipin 10 mg tab Tablet - 0
179 Amlodipin 5 mg tab Tablet 1688 3,000 4,688 990 180 1170
180 Amox-clav Tablet - 0
181 Ampisilin Serbuk Injeksi i.m/i.v. 1000 mg/ml Ampul - 0
182 Ampisillin injeksi i.m/i.v 1000 mg/ml Ampul - 0
183 Antalgin injeksi Ampul - 0
184 Antasida syr Botol - 0
185 Arterakine Tablet - 0
186 Artesunat inj Vial - 0
187 Asam Folat 1 mg Tablet - 0
188 Asam tranexamat 500 mg Tablet - 0
STOK PENERIM PERSEDIA PENGELUARAN
No Nama Obat Satuan JML
AWAL AAN AN APT PUSKEL P.T.JADI P.PEKEN POS.B P.S POL.S P.CSU EXP
1 2 3 4 5 6 7 8 9 10 11 12 13
189 Asetosal 80/miniaspi tablet - 0
190 Atripla(TDF+3TC+EFV) Botol - 0
191 Azitromisin+cefixim Tablet - 0
192 Azytromisin tablet 500 mg Tablet - 0
193 BD Vacuntainer Pcs - 0
194 Becefort Tablet 5611 5,611 500 200 100 800
195 Benzatin Penisillin Vial - 0
196 Bonding Set - 0
197 Bufacomb salep Tube - 0
198 Buscopan inj Ampul - 0
199 Caviton Tube 1 1 0
200 Cefixim syr 100 mg/5 ml Botol - 0
201 Cefixim tablet 100 mg Tablet - 0
202 Cefixim tablet 200 mg Tablet - 0
203 Cefotaxim 0,5 g inj Vial - 0
204 Ceftriaxon inj Vial - 0
205 Clarithromysin 500 mg Tablet - 0
206 Clavamox inj Ampul - 0
207 Clindamisin 150 mg Tablet - 0
208 Clindamisin 300 mg Tablet - 0
209 Clobazam 10 mg Tablet - 0
210 Clozapine 25 mg Tablet - 0
211 Composite (tumpatan sinar)A3 Set - 0
212 Composite (tumpatan sinar)A3.5 Set - 0
213 Crofed Tablet 1760 1,760 0
214 D1/2 NS botol - 0
215 D1/4 NS Botol - 0
216 Daryantulle Lembar - 0
217 Dermazine/Burnazin Tube - 0
218 Dextina / Dextamin/Dextamec/Polofar Plus Tablet - 0
219 Dextran 70% Botol - 0
220 Dextrofen syr Botol 141 141 5 5 15 25
221 Diaform tablet/selesdiar Tablet - 0
222 Dormi/Scopma/Spashi tablet Tablet - 0
223 Dulcolac anak supp Supp 12 12 0
224 Dulcolac dewasa supp Supp 10 10 0
225 Dulkolak tablet Tablet - 0
226 Duviral(Zidovudin 300+Lamivudin 150) Botol - 0
227 Efavirenz Botol - 0
STOK PENERIM PERSEDIA PENGELUARAN
No Nama Obat Satuan JML
AWAL AAN AN APT PUSKEL P.T.JADI P.PEKEN POS.B P.S POL.S P.CSU EXP
1 2 3 4 5 6 7 8 9 10 11 12 13
228 Etambutol Tablet - 0
229 ETSA Set - 0
230 Euthyrox 100mg Tablet - 0
231 Faktu Supp Supp - 0
232 Fluconasol tab Tablet - 0
233 Fluoxetin Tablet - 0
234 Forumen TT Fls 10 20 30 0
235 Gentamisin Injeksi 80 mg/2ml Ampul - 0
236 Glass ionomer (Ketac Molar) Tube - 0
237 Glimepiride 2 tablet - 0
238 Glimepiride 4 tablet - 0
239 Glukonas Calcicus 10%- 10ml Ampul 10 10 0
240 Haldol inj Ampul - 0
241 Hiviral (Lamivudin 150) Botol - 0
242 Ibuprofen syr btl - 0
243 Iliadin TH flesh - 0
244 Isotic Neolisin TM Fls 68 68 0
245 Kalium Diklovenac tablet 3053 3,053 500 100 100 100 800
246 Kaltropen supp Supp - 0
247 Ketoconazole SK tube 18 18 18 18
248 Ketoprofen inj 10 mg Ampul - 0
249 Ketoprofen tablet 100 mg Tablet - 0
250 Ketorolac inj Ampul - 0
251 Kombipak Anak Paket - 0
252 Lodomer 2 Tablet - 0
253 Lytamin syr botol - 0
254 Magnesium Sulfat 20% - 25 ml Botol 2 2 0
255 Magnesium Sulfat 40% - 25 ml Botol 16 16 0
256 Metil Prednisolon 16 mg Tablet - 0
257 Metil prednisolon inj 500 mg Vial - 0
258 Metronidazole 500 mg Infus/100 ml Botol - 0
259 Meylon inj Botol 5 5 0
260 Microlax Supp - 0
261 Miloxicam 7,5 mg tablet 2660 2,660 150 150
262 Molexflu Tablet - 0
263 Multivitamin (Livron B plek) Tablet 5257 5,257 1400 200 100 100 100 1900
264 Multivitamin sirup( Xanvit syr) Botol - 0
265 Neurotropik tablet Tablet - 0
266 Neviral (neviravin 200mg) Botol - 0
STOK PENERIM PERSEDIA PENGELUARAN
No Nama Obat Satuan JML
AWAL AAN AN APT PUSKEL P.T.JADI P.PEKEN POS.B P.S POL.S P.CSU EXP
1 2 3 4 5 6 7 8 9 10 11 12 13
267 New antides tablet 2726 2,726 100 100 200
268 Nutrifar 5000 Tablet - 0
269 Obat anti tuberkulosis FDC katagori I Paket 3 3 1 1
270 Obat anti tuberkulosis FDC anak Paket - 0
271 Obat anti tuberkulosis FDC katagori II Paket - 0
272 Obat anti tuberkulosis FDC sisipan Paket - 0
273 Obat anti tuberkulosis kategori I Paket - 0
274 Obat Batuk Kombinasi Botol - 0
275 Obat Flu kombinasi CTM, PPA (Anaflu), Demacolin Tablet 169 169 169 169
276 Obat Flu Kombinasi/Mecofed/Quantidex Tablet - 0
277 OBH plus botol 130 130 30 3 5 5 43
278 Omeprasole tablet 20 mg Tablet - 0
279 Ondancentron inj Ampul - 0
280 Ondancetron 4 mg Tablet 24 24 0
281 Orpen Tablet - 0
282 Oseltamivir Tablet - 0
283 Paket bonding Set - 0
284 Pamol 125 mg Supp Supp 12 12 0
285 Pamol 250 mg Supp Supp 12 12 0
286 Pantocain Tetes Mata Botol - 0
287 Parasetamol drop Botol 2 2 0
288 Pehacain Injeksi Ampul 115 115 0
289 Pehatrim Forte (Kotrimoksasol tab forte 960 mg) Tablet - 0
290 Perhidrol (H2O2) Botol - 0
291 Phenitoin tab Tablet - 0
292 Piracetam 400 mg Tablet - 0
293 Piracetam inj 200mg/1ml Ampul - 0
294 Pirimethamine tablet Tablet - 0
295 Prenatin DF Tablet 2942 2,942 420 420
296 Prenatin plus tablet tablet - 0
297 Primaquin Tablet - 0
298 Primperan inj Ampul - 0
299 Procurma sirup botol 140 140 0
300 Prokain Benzil Penicillin G Injeksi 3 jt IU/vial Vial - 0
301 Proris supp Supp - 0
302 Pularex Tablet - 0
303 Scabimite cream tube - 0
304 Sikzonoate inj Ampul - 0
305 Simvastatin tab 20 mg Tablet - 0
STOK PENERIM PERSEDIA PENGELUARAN
No Nama Obat Satuan JML
AWAL AAN AN APT PUSKEL P.T.JADI P.PEKEN POS.B P.S POL.S P.CSU EXP
1 2 3 4 5 6 7 8 9 10 11 12 13
306 Spashi inj Ampul - 0
307 Spashi tab Tablet - 0
308 Stelosi tab 5 mg Tablet - 0
309 Stesolid rectal Supp - 0
310 Strop indra Botol - 0
311 Sulfadiazin tablet Tablet - 0
312 Tenofovir (Tenofovir 300mg) Botol - 0
313 Tetagam Ampul 66 66 0
314 Tramadol inj 50 mg/ml Ampul - 0
315 Tranexid inj (Asam tranexamat inj) Ampul - 0
316 Urotractin tablet - 0
317 Ventolin Nebulizer Ampul 34 34 5 5
318 Vitamin B12 tab Tablet - 0
319 Vitamin Neurotropik inj Ampul - 0
320 Vitamin Neurotropik tablet (Nutrifar, Sohobion) Tablet - 0
321 VitKa infan Ampul - 0
322 Xylocain Gel Ampul - 0
323 Zidovudine 100 mg Tablet - 0
Sucralfate syrup botol - 0
Clopidogrel bisulfate 0 - 0
Levofloxacin 500 0 - 0
Spironolactone 25 mg 0 - 0
Domperidone syr 0 - 0
Ceterizine syr 5 mg/5ml 0 - 0
Albendazol syr 0 1348 1,348 0
Zink syr 0 - 0
Cazetin drop 0 - 0
Lacto B 0 - 0
Scopma plus 0 - 0
Nebacetin powder 0 - 0
Metronidazol syr 125 0 - 0
Salbutamol syr 0 - 0
Furosemida inj 0 - 0
Paracetamol inj 0 - 0
Colortusin tab 0 1,000 1,000 200 200
Coparcetin tab 0 - 0
TB tahap intensif 0 - 0
TB tahap lanjutan 0 - 0
Solathim syr 0 - 0
STOK PENERIM PERSEDIA PENGELUARAN
No Nama Obat Satuan JML
AWAL AAN AN APT PUSKEL P.T.JADI P.PEKEN POS.B P.S POL.S P.CSU EXP
1 2 3 4 5 6 7 8 9 10 11 12 13
Antiseptic liq 0 - 0
Tenofovir + Emtricitabin 0 - 0
Cavit G 0 - 0
Ketros Supp 0 - 0
Harnal 0 - 0
BMHP 0 - 0
1 ADS 0.5 ml Pcs - 0
2 ADS 0.05 ml Pcs - 0
3 ADS 2 ml Pcs - 0
4 ADS 5 ml Pcs - 0
5 Alat suntik sekali pakai 1 ml Pcs - 0
6 Alat suntik sekali pakai 2,5 ml Pcs - 0
7 Alat suntik sekali pakai 5 ml Pcs - 0
8 Bisturi no 13 Pcs - 0
9 Bisturi no 14 Pcs - 0
10 Bisturi no 19/20 Pcs - 0
11 Bisturi no 21 Pcs - 0
12 Box slide kotak - 0
13 Catgut 2/0 plain Sachet - 0
14 Catgut / benang bedah no 2/0 chromic Sachet - 0
15 Catgut / benang bedah no 3/0 plain Sachet - 0
16 Catgut 1/0 Chromic Pcs - 0
17 Catgut 2/0 Chromic Roll Roll - 0
18 Catgut 3/0 Chromic Roll Roll - 0
19 Cutgut Chromic No.1 atraumatik (sachet) Sachet - 0
20 Etanol 70 % Botol - 0
21 Etanol 70 % Botol 100 ml - 0
22 Film Rontgen 18 x 24 Set - 0
23 Folley catheter Pcs - 0
24 Hypavix (Ultrafik) Roll - 0
25 I.V Catheter 22 Pcs - 0
26 I.V Catheter 24 Pcs - 0
27 Infusion set anak Set - 0
28 Infusion set dewasa Set - 0
29 IV Cath dgn Katup pcs - 0
30 IV Catheter 18 Pcs - 0
31 IV Catheter 20 Pcs - 0
32 IV Catheter no 18 G Terumo Pcs - 0
33 IV Catheter no 20 G Terumo Pcs - 0
STOK PENERIM PERSEDIA PENGELUARAN
No Nama Obat Satuan JML
AWAL AAN AN APT PUSKEL P.T.JADI P.PEKEN POS.B P.S POL.S P.CSU EXP
1 2 3 4 5 6 7 8 9 10 11 12 13
34 Jarum injeksi Pcs - 0
35 Jarum jahit (bedah) no. 9 s/d 14 Set - 0
36 Jarum Jahit Bedah no 12 Set - 0
37 Jarum Jahit Bedah no 13 Set - 0
38 Jarum Jahit Bedah no 14 Set - 0
39 Jarum Kulit Set - 0
40 Jarum Otot dan Kulit Set - 0
41 Jelly RO Tube - 0
42 Kantung Puyer Pak - 0
43 Kapas pembalut / absorben 250 gram Roll - 0
44 Kasa gulung 40 x 80 Roll - 0
45 Kasa Hidrofil 4 x 10 Roll - 0
46 Kasa kompres 40 / 40 steril Roll - 0
47 Kasa pembalut 2 x 80 Roll - 0
48 Kasa pembalut hidrofil 4 m x 15 cm Roll - 0
49 Kasa pembalut hidrofin 4m x 3 cm Roll - 0
50 Kasa Steril ( 18 x 22 ) Kotak - 0
51 Kertas EKG Roll - 0
52 Kertas saring Lembar - 0
53 Kertas USG Roll - 0
54 Klem Tali Pusar pcs - 0
55 Klip Kecil Pak - 0
56 Klip Tanggung Pak - 0
57 Lampu spiritus botol - 0
58 Lisol mengandung kresol Botol - 0
59 Masker Pcs 1000 1,000 0
60 Masker Bedah Pcs - 0
61 Masker N95 Pcs 60 60 0
62 MY Jelly Tube - 0
63 Nasal cannula Oksigen pcs - 0
64 Pembalut Gips Roll - 0
65 Perkamen Pak 10 10 0
66 Plester 5 yard x 2 inch Roll - 0
67 Pot Salep Pot - 0
68 Pot Sputum Pcs - 0
69 Safety box Pcs - 0
70 Sarung Tangan Gynaecologi pasang - 0
71 Sarung Tangan L Pasang - 0
72 Sarung Tangan M Pasang - 0
STOK PENERIM PERSEDIA PENGELUARAN
No Nama Obat Satuan JML
AWAL AAN AN APT PUSKEL P.T.JADI P.PEKEN POS.B P.S POL.S P.CSU EXP
1 2 3 4 5 6 7 8 9 10 11 12 13
73 Sarung Tangan S Pasang - 0
74 Sarung Tangan Steril Pasang - 0
75 Sarung Tangan Surgiglove Pasang - 0
76 Sendok Takar Pcs - 0
77 Silk 3/0 roll Roll - 0
78 Silk (benang bedah sutera) no.3/0 Pcs - 0
79 Slide Prosted Pak - 0
80 Spalk tungkai atas anak Pcs - 0
81 Spalk tungkai atas dewasa Pcs - 0
82 Spalk tungkai bawah anak Pcs - 0
83 Spalk tungkai bawah dewasa Pcs - 0
84 Spuit 10 ml Pcs - 0
85 Spuit 2/3 ml Pcs - 0
86 Transfusi Set Pcs - 0
87 Uji Tuberkulin Vial - 0
88 Underpad Pak - 0
89 Urinebag Set - 0
90 Wing Needle 21 Pcs - 0
91 Wing Needle 23 Pcs - 0
92 Wing Needle 25 Pcs - 0
93 Wing Needle 27 Pcs - 0
STOK
AKHIR
14
370 10
660 100
-
210
-
898
1,125 23
6,442 1000
-
-
-
2,653 1100
-
6,731 700
32
-
-
-
-
-
400 600
-
-
-
-
5,381 1800
1,109 650
78
-
3,274 500
-
134 5
1,428 100
-
2,025 500
STOK
AKHIR
14
-
233 700
-
6,000 1900
2
-
15
-
-
90
-
-
-
17
-
-
500
-
18
-
-
-
5,027 1000
-
-
-
440
152 110
39
-
214 30
-
1,470 500
1,421
-
-
16
-
-
STOK
AKHIR
14
200
100 100
994
159 37
-
- 200
-
28
-
3,317 100
-
-
-
-
-
-
-
103
4,952 1200
-
-
-
-
-
133 7
2,120 100
94 5
-
-
2,590 500
25
-
3,477 100
931 500
659
-
64
-
-
STOK
AKHIR
14
-
-
73 6
480
-
-
-
-
-
-
-
10
256 20
-
13,392 2900
-
-
-
-
-
-
-
-
-
-
-
3,774 400
-
-
1,008
271
18
-
-
2,911 600
-
-
4
-
STOK
AKHIR
14
-
-
1
755
-
-
1
-
805 300
-
147
-
-
-
-
4
5,432 900
2
14
1,376 100
180 25
-
-
-
-
-
-
-
-
3,518 1170
-
-
-
-
-
-
-
-
-
STOK
AKHIR
14
-
-
-
-
-
4,811 800
-
-
-
-
1
-
-
-
-
-
-
-
-
-
-
-
-
-
1,760
-
-
-
-
-
-
116 25
-
-
12
10
-
-
-
STOK
AKHIR
14
-
-
-
-
-
-
30
-
-
-
-
10
-
-
-
-
68
2,253 800
-
-
-
-
-
-
-
-
2
16
-
-
-
5
-
2,510 150
-
3,357 1900
-
-
-
STOK
AKHIR
14
2,526 200
-
2
-
-
-
-
-
- 169
-
87 43
-
-
24
-
-
-
12
12
-
2
115
-
-
-
-
-
-
2,522 420
-
-
-
140
-
-
-
-
-
-
STOK
AKHIR
14
-
-
-
-
-
-
-
66
-
-
-
29 5
-
-
-
-
-
-
-
-
-
-
-
-
1,348
-
-
-
-
-
-
-
-
-
800 200
-
-
-
-
STOK
AKHIR
14
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
STOK
AKHIR
14
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
1,000
-
60
-
-
-
10
-
-
-
-
-
-
-
STOK
AKHIR
14
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
FORM : LPLPO PUSKEL
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKEL

PUSKESMAS : MARGA II DOKUMEN NOMOR TANGGAL


KECAMATAN : MARGA PELAPORAN BULAN/PERIODE Apr-19 DIKES
KABUPATEN : Tabanan PERMINTAAN BULAN/PERIODE May-19 PUSKESMAS

Peneri Permintaa Pemberia Sumber


Kode No Nama Obat Satuan Stok Awal maan Persediaan Pemakaian Sisa Stok Stok Opt n n Ket
PKD PPKD Prog/Prov Lain
1 2 3 4 5.00 6 7=(5+6) 8.00 9=(7-8) 10.00 11=(10-9) 12 13 14 15 16 17

A1 1 Acyclovir Salep Tube 6 6.00 1 5.00 1.50


A2 2 Acyclovir 400 mg Tab Tablet 100 100.00 100.00 -
A3 3 Air raksa dental use Botol - - -
A4 4 Albendazol 400 mg tab Tablet - - -
A5 5 Alprazolam 0.5 mg Tablet - - -
A6 6 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 110 110.00 70 40.00 105.00
A7 7 Ambroxol syr Botol 2 5 7.00 7.00 -
A8 8 Ambroxol tab 30 mg / Promukus Tablet 280 280.00 90 190.00 135.00
A9 9 Aminofilina injeksi 24 mg/ ml. 10 ml Ampul - - -
A10 10 Aminofilna tablet 200 mg Tablet - - -
A11 11 Amitriptilina hcl tablet salut 25 mg Tablet - - -
A12 12 Amoksilina kapsul 500 mg Tablet 390 390.00 20 370.00 30.00
A13 13 Amoksilna sirup kering 125 mg/ 5 mg Botol - - -
A14 14 Antasida doen tablet kombinasi Tablet 270 100 370.00 220 150.00 330.00
A15 15 Anti hemmoroid suppositoria Supp - - -
A16 16 Aqua pro injeksi streril. Bebas priogen 20 ml Vial - - -
A17 17 Aquadest steril 500 ml Botol - - -
A18 18 As salisilat 2% + belerang endap 4%(2-4 salep Pot - - -
A19 19 As. Benzoat 3 % + as salisilat 6%(whitefield) Pot - - -
A20 20 Asam askorbat (Vit. C) tablet 50 mg Tablet 50 50.00 50.00 -
A21 21 Asam mefenamat 500 mg Tablet 194 100 294.00 294 - 441.00
A22 22 Asetosal 100 mg Tablet - - -
A23 23 Asetosal tablet 500 mg Tablet - - -
A24 24 Atropina sulfat injeksi 0 .25 mg / ml - 1 ml Ampul - - -
A25 25 Basitrasin Polimiksin Tube - - -
Peneri Permintaa Pemberia Sumber
Kode No Nama Obat Satuan Stok Awal maan Persediaan Pemakaian Sisa Stok Stok Opt n n Ket
PKD PPKD Prog/Prov Lain
A26 26 Besi (II) sulfat tablet salut .kombinasi Tablet 300 300.00 20 280.00 30.00
A27 27 Betahistin tab Tablet 160 160.00 18 142.00 27.00
A28 28 Betametazon salep kulit Tube 11 11.00 11.00 - ED
A29 29 Captopril 12.5 mg tablet Tablet - - -
A30 30 Captopril 25 mg tablet Tablet 336 336.00 79 257.00 118.50
A31 31 Carbamazepina 200 mg talet Tablet - - -
A32 32 Cefadroxil 125mg/5ml Sirup Botol - - -
A33 33 Cefadroxill 500 mg tablet Tablet 80 80.00 30 50.00 45.00
A34 34 Cefotaxim 1 gr Injeksi Ampul - - -
A35 35 Cetirizin10 mg tab Tablet 210 210.00 210.00 -
A36 36 Cimetidine/Selestidin Tablet - - -
A37 37 Ciprofloxazin tablet 500 mg Tablet 114 114.00 54 60.00 81.00
A38 38 Deksametason injeksi 5 mg / ml - 1 ml Ampul - - -
A39 39 Deksametason tablet 0.5 mg Tablet 180 200 380.00 100 280.00 150.00
A40 40 Devitalisasi pasta Tube - - -
A41 41 Diazepam 5 mg Tablet - - -
A42 42 Diazepam injeksi 5 mg / ml - 2 ml Ampul - - -
A43 43 Diazepam tablet 2 mg Tablet - - -
A44 44 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul - - -
A45 45 Digoksina tablet 0. 25 mg Tablet - - -
A46 46 Domperidon tablet 10 mg Tablet - - -
A47 47 Doxycicline 100 mg tab Tablet - - -
A48 48 Efedrina HCL (efedrina) tablet 25 mg Tablet - - -
A49 49 Epinefrina HCL / bitartat (aderenalina) inj 01% Ampul - - -
A50 50 Ergotamina tartrat 1 mg + kofeina 50 mg tab Tablet - - -
A51 51 Erytromysin 200mg/5ml Syrup Botol - - -
A52 52 Erytromysin tablet 500 mg Tablet - - -
A53 53 Etakridina (rivanol) larutan 0.1 % Botol - - -
A54 54 Etil klorida semprot Botol - - -
A55 55 Eugenol cairan Botol - - -
A56 56 Fenobarbital inj 50 mg /ml -2ml Ampul - - -
A57 57 Fenobarbital tablet 100mg Tablet - - -
A58 58 Fenobarbital tablet 30 mg Tablet - - -
A59 59 Fenol gliserol tetes telnga 10% Botol - - -
A60 60 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul - - -
Peneri Permintaa Pemberia Sumber
Kode No Nama Obat Satuan Stok Awal maan Persediaan Pemakaian Sisa Stok Stok Opt n n Ket
PKD PPKD Prog/Prov Lain
A61 61 Fitomenadion (vit. K1) tablet salut 10 mg Tablet - - -
A62 62 Furosemida tablet 40 mg Tablet - - -
A63 63 Garam Oralit untuk 200 ml air Sachet 3 10 13.00 13.00 -
A64 64 Gentamisin Salep Mata Tube 0 - - -
A65 65 Gentamysin SK Tube - - -
A66 66 Gentamysin TM/Genoint TM Botol 4 11 15.00 5 10.00 7.50
A67 67 Gentian violet larutan 1 % Botol - - -
A68 68 Glibenklamida tablet 5 mg Tablet - - -
A69 69 Gliseril guayakolat tablet 10 mg Tablet - - -
A70 70 Glukosa larutan infus 10 % steril Botol - - -
A71 71 Glukosa larutan infus 40 % steril Botol - - -
A72 72 Glukosa larutan infus 5 % steril Botol - - -
A73 73 Griseofulvin tablet 125 mg. Mikronized Tablet - - -
A74 74 Haloperidol 0,5 mg. Tablet Tablet - - -
A75 75 Haloperidol 1,5 mg tablet Tablet - - -
A76 76 Haloperidol 5 mg tablet Tablet - - -
A77 77 Hidroklorotiasida (HCT) tablet 25 mg Tablet - - -
A78 78 Hidrokortison krim 2.5 % Tube 9 9.00 4 5.00 6.00
A79 79 Ibuprofen tablet 400 mg Tablet 30 30.00 30 - 45.00
A80 80 Isoniazide 100 mg Tablet - - -
A81 81 Isoniazide 300 mg Tablet - - -
A82 82 Isosorbid dinitrat Tablet - - -
A83 83 Kalsium hidroksida pasta Pot - - -
A84 84 Kalsium laktat (kalk) tablet 500 mg Tablet - - -
A85 85 Ketokonazole 200 mg tablet Tablet - - -
A86 86 Kinina dihidroklorida (kinina) inj 25 % - 2 ml Ampul - - -
A87 87 Kinina sulfat tablet 222 mg (7 h20 ) Tablet - - -
A88 88 Kloramfenicol salep kulit Tube - - -
A89 89 Kloramfenikol kapsul 250 mg Tablet - - -
A90 90 Kloramfenikol salep mata 1 % Tube - - -
A91 91 Kloramfenikol tetes Mata Botol - - -
A92 92 Kloramfenikol tetes telinga 3 % Botol 5 5.00 2 3.00 3.00
A93 93 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 217 217.00 175 42.00 262.50
A94 94 Klorpromazin 100 mg tablet Tablet - - -
A95 95 Klorpromazina Hcl inj 25 mg / ml - 1 ml Ampul - - -
Peneri Permintaa Pemberia Sumber
Kode No Nama Obat Satuan Stok Awal maan Persediaan Pemakaian Sisa Stok Stok Opt n n Ket
PKD PPKD Prog/Prov Lain
A96 96 Klorpromazina Hcl inj 5 mg / ml - 2 ml Ampul - - -
A97 97 Klorpromazina hcl tablet salut 25 mg Tablet - - -
A98 98 Kodeina Hcl (kodeina) tablet 10 mg Tablet - - -
A99 99 Kotrimoksasol suspensi Botol 11 11.00 11.00 - ED
A100 100 Kotrimoksasol tablet kombinasi Tablet 76 76.00 76.00 -
A101 101 Lidokain inj Ampul - - -
A102 102 Lidokaina comp inj kombinasi Ampul - - -
A103 103 Metakresol sulfonat dan metanol kondensai Botol - - -
A104 104 (Albotyl)
Metformin 500 mg tablet Tablet - - -
A105 105 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul - - -
A106 106 Metilergometrina malet tablet salut 0. 125 mg Tablet - - -
A107 107 Metilprednisolon tablet 4 mg Tablet 246 246.00 246.00 - ED
A108 108 Metoklopramide 10 mg tablet/Noristal Tablet 220 220.00 220.00 -
A109 109 Metronidazol 500 mg Tablet - - -
A110 110 Metronidazol tablet 250 mg Tablet - - -
A111 111 Mikonazole salep Tube 2 2.00 2.00 -
A112 112 Monoklorkamfer mentolcairan (CHKM) Botol - - -
A113 113 Mumifyng pasta Botol - - -
A114 114 Natrium bikarbonat tablet 500 mg Tablet - - -
A115 115 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet - - -
A116 116 Natrium klorida larutan infus 0. 9 steril Botol - - -
A117 117 Nifedipin tablet 10 mg Tablet - - -
A118 118 Nistatin 100. 000 iu/g tablet vaginal Tab Vag - - -
A119 119 Obat batuk hitam (OBH) cairan Botol 100 ml - - -
A120 120 Ofloxacin tab 400mg Tablet - - -
A121 121 Oksigen gas dalam tabung 3 m3 Tabung - - -
A122 122 Oksigen gas dalam tabung 6 m3 Tabung - - -
A123 123 Oksitetrasiklina hcl salep 3 % Tube - - -
A124 124 Oksitetrasiklina hcl salep mata 1 % Tube - - -
A125 125 Oksitosina inj 10 iu/ml - 1 ml Ampul - - -
A126 126 Parasetamol sirup 120 mg / 5 ml Botol 1 4 5.00 5.00 -
A127 127 Parasetamol tab 100 mg Tablet - - -
A128 128 Parasetamol tablet 500mg Tablet 315 200 515.00 210 305.00 315.00
A129 129 Pirantel pamoat (pirantel) tablet 125 mg basa Tablet - - -
A130 130 Piroxicam 10 Mg Tablet - - -
Peneri Permintaa Pemberia Sumber
Kode No Nama Obat Satuan Stok Awal maan Persediaan Pemakaian Sisa Stok Stok Opt n n Ket
PKD PPKD Prog/Prov Lain
A131 131 Piroxicam 20 Mg Tablet - - -
A132 132 Prednison tablet 5 mgn Tablet - - -
A133 133 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet - - -
A134 134 Primakina tablet 15 mg Tablet - - -
A135 135 Prokaina penisilina g inj 3 juta iu Vial - - -
A136 136 Propiltionurasil tablet 100 mg Tablet - - -
A137 137 Propranolol hcl (Propranolol) tablet 40 mg Tablet - - -
A138 138 Pyridoxin injeksi Ampul - - -
A139 139 Ranitidin inj 25 mg/2 ml Ampul - - -
A140 140 Ranitidin tablet 150 mg Tablet 344 344.00 20 324.00 30.00 ED
A141 141 Reserpina tablet 0, 10 mg Tablet - - -
A142 142 Reserpina tablet 0, 25 mg Tablet - - -
A143 143 Retinol (vit. A) kapsul lunak 200.000 iu Tablet - - -
A144 144 Retinol (vit. A) tablet salut 100. 000 iu Tablet - - -
A145 145 Ringer laktat larutan infus steril Botol - - -
A146 146 Risperidon Tablet - - -
A147 147 Salbutamol tablet 2 mg Tablet - - -
A148 148 Salbutamol tablet 4 mg Tablet 224 224.00 44 180.00 66.00
A149 149 Salisil bedak 2 % Bks - - -
A150 150 Salisil spiritus 10 % Botol - - -
A151 151 Semen seng fosfat serbuk dan cairan Botol - - -
A152 152 Serum anti bisa ular polivalen inj. 5ml Ampul - - -
A153 153 Serum anti tetanus inj. 1.500 iu Ampul - - -
A154 154 Sianokobalamina (vit.b12) inj. 500 mcg Ampul - - -
A155 155 Silver amalgam serbuk 65-75% Botol - - -
A156 156 Simvastatin tab 10 mg Tablet - - -
A157 157 Sulfacetamide tetes mata Botol - - -
A158 158 Synthetic filing material larutan dan serbuk Set - - -
A159 159 Temporary stopping fletcher serbuk dan cairan Set - - -
A160 160 Tetrasiklina hcl (tetrasiklina) kapsul 250 mg Tablet - - -
A161 161 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet - - -
A162 162 Thiamfenikol 500 Tablet - - -
A163 163 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0 - - -
A164 164 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul - - -
A165 165 Tramadol Tablet - - -
Peneri Permintaa Pemberia Sumber
Kode No Nama Obat Satuan Stok Awal maan Persediaan Pemakaian Sisa Stok Stok Opt n n Ket
PKD PPKD Prog/Prov Lain
A166 166 Trifluoperazine (Stelazin) Tablet - - -
A167 167 Triheksfenidil hcl 2 mg tablet Tablet - - -
A168 168 Trikresol formalin (tkf) cairan Botol - - -
A169 169 Vitamin B kompleks tablet Tablet 270 200 470.00 214 256.00 321.00
A170 170 Yodium povidan larutan 10% 300 ml Botol - - -
A171 171 Yodium povidon larutan 10% 30 ml Botol - - -
A172 172 Zink tablet Tablet - - -
Amoxcilin syrup 250 mg/5ml boto 2 2.00 2.00 -
-
OBAT TAMBAHAN - -
A173 173 Aptil Botol - - -
A174 174 (Lopinavir/Ritonavir)Aluvia Botol - -
A175 175 Abacavir Tablet - -
A176 176 Acyclovir tablet 200 mg Tablet - -
A177 177 Aleterol TM Botol - -
A178 178 Amlodipin 10 mg tab Tablet - -
A179 179 Amlodipin 5 mg tab Tablet 130 360 490.00 430 60.00 645.00
A180 180 Amox-clav Tablet - -
A181 181 Ampisilin Serbuk Injeksi i.m/i.v. 1000 mg/ml Ampul - -
A182 182 Ampisillin injeksi i.m/i.v 1000 mg/ml Ampul - -
A183 183 Antalgin injeksi Ampul - -
A184 184 Antasida syr Botol - - -
A185 185 Arterakine Tablet - -
A186 186 Artesunat inj Vial - -
A187 187 Asam Folat 1 mg Tablet - - -
A188 188 Asam tranexamat 500 mg Tablet - -
A189 189 Asetosal 80/miniaspi tablet - - -
A190 190 Atripla(TDF+3TC+EFV) Botol - -
A191 191 Azitromisin+cefixim Tablet - -
A192 192 Azytromisin tablet 500 mg Tablet - -
A193 193 BD Vacuntainer Pcs - -
A194 194 Becefort Tablet 265 265.00 34 231.00 51.00
A195 195 Benzatin Penisillin Vial - - -
A196 196 Bonding Set - - -
A197 197 Bufacomb salep Tube - - -
Peneri Permintaa Pemberia Sumber
Kode No Nama Obat Satuan Stok Awal maan Persediaan Pemakaian Sisa Stok Stok Opt n n Ket
PKD PPKD Prog/Prov Lain
A198 198 Buscopan inj Ampul - - -
A199 199 Caviton Tube - - -
A200 200 Cefixim syr 100 mg/5 ml Botol - - -
A201 201 Cefixim tablet 100 mg Tablet - -
A202 202 Cefixim tablet 200 mg Tablet - -
A203 203 Cefotaxim 0,5 g inj Vial - -
A204 204 Ceftriaxon inj Vial - -
A205 205 Clarithromysin 500 mg Tablet - -
A206 206 Clavamox inj Ampul - -
A207 207 Clindamisin 150 mg Tablet - -
A208 208 Clindamisin 300 mg Tablet - -
A209 209 Clobazam 10 mg Tablet - - -
A210 210 Clozapine 25 mg Tablet - - -
A211 211 Composite (tumpatan sinar)A3 Set - - -
A212 212 Composite (tumpatan sinar)A3.5 Set - - -
A213 213 Crofed Tablet - - -
A214 214 D1/2 NS botol - - -
A215 215 D1/4 NS Botol - - -
A216 216 Daryantulle Lembar - - -
A217 217 Dermazine/Burnazin Tube - - -
A218 218 Dextina / Dextamin/Dextamec/Polofar Plus Tablet - - -
A219 219 Dextran 70% Botol - -
A220 220 Dextrofen syr Botol 7 7.00 1 6.00 1.50
A221 221 Diaform tablet/selesdiar Tablet - -
A222 222 Dormi/Scopma/Spashi tablet Tablet - - -
A223 223 Dulcolac anak supp Supp - -
A224 224 Dulcolac dewasa supp Supp - -
A225 225 Dulkolak tablet Tablet - -
A226 226 Duviral(Zidovudin 300+Lamivudin 150) Botol - -
A227 227 Efavirenz Botol - -
A228 228 Etambutol Tablet - -
A229 229 ETSA Set - -
A230 230 Euthyrox 100mg Tablet - -
A231 231 Faktu Supp Supp - -
A232 232 Fluconasol tab Tablet - -
Peneri Permintaa Pemberia Sumber
Kode No Nama Obat Satuan Stok Awal maan Persediaan Pemakaian Sisa Stok Stok Opt n n Ket
PKD PPKD Prog/Prov Lain
A233 233 Fluoxetin Tablet - -
A234 234 Forumen TT Fls - - -
A235 235 Gentamisin Injeksi 80 mg/2ml Ampul - -
A236 236 Glass ionomer (Ketac Molar) Tube - - -
A237 237 Glimepiride 2 tablet - - -
A238 238 Glimepiride 4 tablet - -
A239 239 Glukonas Calcicus 10%- 10ml Ampul - -
A240 240 Haldol inj Ampul - -
A241 241 Hiviral (Lamivudin 150) Botol - -
A242 242 Ibuprofen syr btl - - -
A243 243 Iliadin TH flesh - - -
A244 244 Isotic Neolisin TM Fls 1 5 6.00 5 1.00 7.50
A245 245 Kalium Diklovenac tablet 254 100 354.00 354 - 531.00
A246 246 Kaltropen supp Supp - - -
A247 247 Ketoconazole SK tube 3 3.00 3.00 -
A248 248 Ketoprofen inj 10 mg Ampul - -
A249 249 Ketoprofen tablet 100 mg Tablet - -
A250 250 Ketorolac inj Ampul - -
A251 251 Kombipak Anak Paket - -
A252 252 Lodomer 2 Tablet - -
A253 253 Lytamin syr botol - -
A254 254 Magnesium Sulfat 20% - 25 ml Botol - -
A255 255 Magnesium Sulfat 40% - 25 ml Botol - - -
A256 256 Metil Prednisolon 16 mg Tablet - -
A257 257 Metil prednisolon inj 500 mg Vial - -
A258 258 Metronidazole 500 mg Infus/100 ml Botol - -
A259 259 Meylon inj Botol - -
A260 260 Microlax Supp - - -
A261 261 Miloxicam 7,5 mg tablet 130 130.00 92 38.00 138.00
A262 262 Molexflu Tablet - -
A263 263 Multivitamin (Livron B plek) Tablet 146 300 446.00 306 140.00 459.00
A264 264 Multivitamin sirup( Xanvit syr) Botol - -
A265 265 Neurotropik tablet Tablet - -
A266 266 Neviral (neviravin 200mg) Botol - -
A267 267 New antides tablet 180 180.00 6 174.00 9.00
Peneri Permintaa Pemberia Sumber
Kode No Nama Obat Satuan Stok Awal maan Persediaan Pemakaian Sisa Stok Stok Opt n n Ket
PKD PPKD Prog/Prov Lain
A268 268 Nutrifar 5000 Tablet - -
A269 269 Obat anti tuberkulosis FDC katagori I Paket - - -
A270 270 Obat anti tuberkulosis FDC anak Paket - - -
A271 271 Obat anti tuberkulosis FDC katagori II Paket - -
A272 272 Obat anti tuberkulosis FDC sisipan Paket - -
A273 273 Obat anti tuberkulosis kategori I Paket - -
A274 274 Obat Batuk Kombinasi Botol - -
A275 275 Obat Flu kombinasi CTM, PPA (Anaflu), Tablet 204 204.00 80 124.00 120.00
A276 276 Demacolin
Obat Flu Kombinasi/Mecofed/Quantidex Tablet - -
A277 277 OBH plus botol 2 3 5.00 1 4.00 1.50
A278 278 Omeprasole tablet 20 mg Tablet - - -
A279 279 Ondancentron inj Ampul - -
A280 280 Ondancetron 4 mg Tablet - - -
A281 281 Orpen Tablet - - -
A282 282 Oseltamivir Tablet - -
A283 283 Paket bonding Set - -
A284 284 Pamol 125 mg Supp Supp - - -
A285 285 Pamol 250 mg Supp Supp - - -
A286 286 Pantocain Tetes Mata Botol - -
A287 287 Parasetamol drop Botol - - -
A288 288 Pehacain Injeksi Ampul - - -
A289 289 Pehatrim Forte (Kotrimoksasol tab forte 960 mg) Tablet - -
A290 290 Perhidrol (H2O2) Botol - -
A291 291 Phenitoin tab Tablet - - -
A292 292 Piracetam 400 mg Tablet - -
A293 293 Piracetam inj 200mg/1ml Ampul - -
A294 294 Pirimethamine tablet Tablet - -
A295 295 Prenatin DF Tablet 172 172.00 172.00 - ED
A296 296 Prenatin plus tablet tablet - -
A297 297 Primaquin Tablet - -
A298 298 Primperan inj Ampul - -
A299 299 Procurma sirup botol 4 4.00 1 3.00
A300 300 Prokain Benzil Penicillin G Injeksi 3 jt IU/vial Vial - -
A301 301 Proris supp Supp - -
A302 302 Pularex Tablet - -
Peneri Permintaa Pemberia Sumber
Kode No Nama Obat Satuan Stok Awal maan Persediaan Pemakaian Sisa Stok Stok Opt n n Ket
PKD PPKD Prog/Prov Lain
A303 303 Scabimite cream tube - - -
A304 304 Sikzonoate inj Ampul - -
A305 305 Simvastatin tab 20 mg Tablet - - -
A306 306 Spashi inj Ampul - -
A307 307 Spashi tab Tablet - -
A308 308 Stelosi tab 5 mg Tablet - -
A309 309 Stesolid rectal Supp - - -
A310 310 Strop indra Botol - - -
A311 311 Sulfadiazin tablet Tablet - -
A312 312 Tenofovir (Tenofovir 300mg) Botol - -
A313 313 Tetagam Ampul - - -
A314 314 Tramadol inj 50 mg/ml Ampul - -
A315 315 Tranexid inj (Asam tranexamat inj) Ampul - - -
A316 316 Urotractin tablet - - -
A317 317 Ventolin Nebulizer Ampul - - -
A318 318 Vitamin B12 tab Tablet - - -
A319 319 Vitamin Neurotropik inj Ampul - - -
A320 320 Vitamin Neurotropik tablet (Nutrifar, Sohobion) Tablet - - -
A321 321 VitKa infan Ampul - - -
A322 322 Xylocain Gel Ampul - - -
A323 323 Zidovudine 100 mg Tablet - - -
Sucralfate syrup botol - - -
Clopidogrel bisulfate - - -
Levofloxacin 500 - - -
Spironolactone 25 mg - - -
Domperidone syr - - -
Ceterizine syr 5 mg/5 ml - - -
Albendazol syr - - -
Zink syr - - -
Cazetin drop - - -
Lacto B - - -
Scopma plus tab - - -
Nebacetin powder - - -
Metronidazol syr 125 mg/5ml - - -
Salbutamol syr - - -
Peneri Permintaa Pemberia Sumber
Kode No Nama Obat Satuan Stok Awal maan Persediaan Pemakaian Sisa Stok Stok Opt n n Ket
PKD PPKD Prog/Prov Lain
Furosemida inj - - -
Paracetamol infus 10 mg/ml - - -
Calortusin tab - - -
Coparcetin tab - - -
TB tahap intensif - - -
TB tahap lanjutan - - -
Solathim syr - - -
Antiseptic liquid no 2 - - -
Tenofovir (Tenofovir 300 mg) + Emtricitabin - - -
Cavit G - - -
Ketros Supp - - -
Harnal - - -
BMHP - - -
B1 1 ADS 0.5 ml Pcs - - -
B2 2 ADS 0.05 ml Pcs - - -
B3 3 ADS 2 ml Pcs - -
B4 4 ADS 5 ml Pcs - - -
B5 5 Alat suntik sekali pakai 1 ml Pcs - -
B6 6 Alat suntik sekali pakai 2,5 ml Pcs - -
B7 7 Alat suntik sekali pakai 5 ml Pcs - -
B8 8 Bisturi no 13 Pcs - -
B9 9 Bisturi no 14 Pcs - -
B10 10 Bisturi no 19/20 Pcs - -
B11 11 Bisturi no 21 Pcs - -
B12 12 Box slide kotak - - -
B13 13 Catgut 2/0 plain Sachet - -
B14 14 Catgut / benang bedah no 2/0 chromic Sachet - -
B15 15 Catgut / benang bedah no 3/0 plain Sachet - - -
B16 16 Catgut 1/0 Chromic Pcs - -
B17 17 Catgut 2/0 Chromic Roll Roll - -
B18 18 Catgut 3/0 Chromic Roll Roll - -
B19 19 Cutgut Chromic No.1 atraumatik (sachet) Sachet - -
B20 20 Etanol 70 % Botol - - -
B21 21 Etanol 70 % Botol 100 ml - -
B22 22 Film Rontgen 18 x 24 Set - -
Peneri Permintaa Pemberia Sumber
Kode No Nama Obat Satuan Stok Awal maan Persediaan Pemakaian Sisa Stok Stok Opt n n Ket
PKD PPKD Prog/Prov Lain
B23 23 Folley catheter Pcs - -
B24 24 Hypavix (Ultrafik) Roll - - -
B25 25 I.V Catheter 22 Pcs - -
B26 26 I.V Catheter 24 Pcs - -
B27 27 Infusion set anak Set - -
B28 28 Infusion set dewasa Set - - -
B29 29 IV Cath dgn Katup pcs - - -
B30 30 IV Catheter 18 Pcs - -
B31 31 IV Catheter 20 Pcs - -
B32 32 IV Catheter no 18 G Terumo Pcs - -
B33 33 IV Catheter no 20 G Terumo Pcs - -
B34 34 Jarum injeksi Pcs - -
B35 35 Jarum jahit (bedah) no. 9 s/d 14 Set - -
B36 36 Jarum Jahit Bedah no 12 Set - -
B37 37 Jarum Jahit Bedah no 13 Set - -
B38 38 Jarum Jahit Bedah no 14 Set - -
B39 39 Jarum Kulit Set - -
B40 40 Jarum Otot dan Kulit Set - -
B41 41 Jelly RO Tube - -
B42 42 Kantung Puyer Pak - -
B43 43 Kapas pembalut / absorben 250 gram Roll - - -
B44 44 Kasa gulung 40 x 80 Roll - - -
B45 45 Kasa Hidrofil 4 x 10 Roll - - -
B46 46 Kasa kompres 40 / 40 steril Roll - - -
B47 47 Kasa pembalut 2 x 80 Roll - - -
B48 48 Kasa pembalut hidrofil 4 m x 15 cm Roll - - -
B49 49 Kasa pembalut hidrofin 4m x 3 cm Roll - - -
B50 50 Kasa Steril ( 18 x 22 ) Kotak - - -
B51 51 Kertas EKG Roll - - -
B52 52 Kertas saring Lembar - - -
B53 53 Kertas USG Roll - - -
B54 54 Klem Tali Pusar pcs - - -
B55 55 Klip Kecil Pak - - -
B56 56 Klip Tanggung Pak - - -
B57 57 Lampu spiritus botol - - -
Peneri Permintaa Pemberia Sumber
Kode No Nama Obat Satuan Stok Awal maan Persediaan Pemakaian Sisa Stok Stok Opt n n Ket
PKD PPKD Prog/Prov Lain
B58 58 Lisol mengandung kresol Botol - - -
B59 59 Masker Pcs - - -
B60 60 Masker Bedah Pcs - - -
B61 61 Masker N95 Pcs - - -
B62 62 MY Jelly Tube - - -
B63 63 Nasal cannula Oksigen pcs - - -
B64 64 Pembalut Gips Roll - - -
B65 65 Perkamen Pak - - -
B66 66 Plester 5 yard x 2 inch Roll - - -
B67 67 Pot Salep Pot - - -
B68 68 Pot Sputum Pcs - - -
B69 69 Safety box Pcs - - -
B70 70 Sarung Tangan Gynaecologi pasang - - -
B71 71 Sarung Tangan L Pasang - - -
B72 72 Sarung Tangan M Pasang - - -
B73 73 Sarung Tangan S Pasang - - -
B74 74 Sarung Tangan Steril Pasang - - -
B75 75 Sarung Tangan Surgiglove Pasang - - -
B76 76 Sendok Takar Pcs - - -
B77 77 Silk 3/0 roll Roll - - -
B78 78 Silk (benang bedah sutera) no.3/0 Pcs - - -
B79 79 Slide Prosted Pak - -
B80 80 Spalk tungkai atas anak Pcs - -
B81 81 Spalk tungkai atas dewasa Pcs - -
B82 82 Spalk tungkai bawah anak Pcs - -
B83 83 Spalk tungkai bawah dewasa Pcs - -
B84 84 Spuit 10 ml Pcs - -
B85 85 Spuit 2/3 ml Pcs - -
B86 86 Transfusi Set Pcs - -
B87 87 Uji Tuberkulin Vial - -
B88 88 Underpad Pak - -
B89 89 Urinebag Set - -
B90 90 Wing Needle 21 Pcs - -
B91 91 Wing Needle 23 Pcs - -
B92 92 Wing Needle 25 Pcs - -
Peneri Permintaa Pemberia Sumber
Kode No Nama Obat Satuan Stok Awal maan Persediaan Pemakaian Sisa Stok Stok Opt n n Ket
PKD PPKD Prog/Prov Lain
B93 93 Wing Needle 27 Pcs -

Kunjungan Pasien
a. Bayar 18 152 0 3 18 0
b. JKN 127 747 38 75 90 28
Jumlah 145

Mengetahui/Menyetujui Yang Meyerahkan Yang Meminta Yang Menerima


Kepala Dinkes. Kabupaten Tabanan Pimpinan Puskesmas Petugas Puskel

…………………………………………. ( dr. I Ketut Indra wiguna cakera ) NI MADE SRI WAHYUNI


NIP. 197710032006041002 NIP.
FORM : LPLPO PUSKEL
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
PUSKEL

PUSKESMAS : MARGA II DOKUMEN NOMOR TANGGAL


KECAMATAN : MARGA PELAPORAN BULAN/PERIODE May-19 DIKES
KABUPATEN : Tabanan PERMINTAAN BULAN/PERIODE Jun-19 PUSKESMAS

Peneri Sumber
Kode No Nama Obat Satuan Stok Awal Persediaan Pemakaian Sisa Stok Stok Opt Permintaa Pemberia Ket
maan n n PKD PPKD Prog/Prov Lain
1 2 3 4 5.00 6 7=(5+6) 8.00 9=(7-8) 10.00 11=(10-9) 12 13 14 15 16 17

A1 1 Acyclovir Salep Tube 5 5.00 5.00 -


A2 2 Acyclovir 400 mg Tab Tablet 100 100.00 100.00 -
A3 3 Air raksa dental use Botol - - -
A4 4 Albendazol 400 mg tab Tablet - - -
A5 5 Alprazolam 0.5 mg Tablet - - -
A6 6 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 40 100 140.00 60 80.00 90.00
A7 7 Ambroxol syr Botol 7 7.00 3 4.00 4.50
A8 8 Ambroxol tab 30 mg / Promukus Tablet 190 190.00 20 170.00 30.00
A9 9 Aminofilina injeksi 24 mg/ ml. 10 ml Ampul - - -
A10 10 Aminofilna tablet 200 mg Tablet - - -
A11 11 Amitriptilina hcl tablet salut 25 mg Tablet - - -
A12 12 Amoksilina kapsul 500 mg Tablet 370 370.00 31 339.00 46.50
A13 13 Amoksilna sirup kering 125 mg/ 5 mg Botol - - -
A14 14 Antasida doen tablet kombinasi Tablet 150 200 350.00 64 286.00 96.00
A15 15 Anti hemmoroid suppositoria Supp - - -
A16 16 Aqua pro injeksi streril. Bebas priogen 20 ml Vial - - -
A17 17 Aquadest steril 500 ml Botol - - -
A18 18 As salisilat 2% + belerang endap 4%(2-4 salep Pot - - -
A19 19 As. Benzoat 3 % + as salisilat 6%(whitefield) Pot - - -
A20 20 Asam askorbat (Vit. C) tablet 50 mg Tablet 50 50.00 50.00 -
A21 21 Asam mefenamat 500 mg Tablet 0 - - -
A22 22 Asetosal 100 mg Tablet - - -
A23 23 Asetosal tablet 500 mg Tablet - - -
A24 24 Atropina sulfat injeksi 0 .25 mg / ml - 1 ml Ampul - - -
A25 25 Basitrasin Polimiksin Tube - - -
A26 26 Besi (II) sulfat tablet salut .kombinasi Tablet 280 280.00 280.00 -
A27 27 Betahistin tab Tablet 142 142.00 40 102.00 60.00
A28 28 Betametazon salep kulit Tube 11 11.00 11.00 - ED(11)
A29 29 Captopril 12.5 mg tablet Tablet - - -
A30 30 Captopril 25 mg tablet Tablet 257 257.00 100 157.00 150.00
A31 31 Carbamazepina 200 mg talet Tablet - - -
A32 32 Cefadroxil 125mg/5ml Sirup Botol - - -
A33 33 Cefadroxill 500 mg tablet Tablet 50 50.00 50.00 -
A34 34 Cefotaxim 1 gr Injeksi Ampul - - -
A35 35 Cetirizin10 mg tab Tablet 210 210.00 44 166.00 66.00
A36 36 Cimetidine/Selestidin Tablet - - -
A37 37 Ciprofloxazin tablet 500 mg Tablet 60 100 160.00 16 144.00 24.00
A38 38 Deksametason injeksi 5 mg / ml - 1 ml Ampul - - -
A39 39 Deksametason tablet 0.5 mg Tablet 280 280.00 54 226.00 81.00
A40 40 Devitalisasi pasta Tube - - -
A41 41 Diazepam 5 mg Tablet - - -
A42 42 Diazepam injeksi 5 mg / ml - 2 ml Ampul - - -
A43 43 Diazepam tablet 2 mg Tablet - - -
Difenhidramin HCL injeksi 10 mg / ml - ml
A44 44 Ampul
- - -

A45 45 Digoksina tablet 0. 25 mg Tablet - - -


A46 46 Domperidon tablet 10 mg Tablet - - -
A47 47 Doxycicline 100 mg tab Tablet - - -
A48 48 Efedrina HCL (efedrina) tablet 25 mg Tablet - - -
Epinefrina HCL / bitartat (aderenalina) inj 01%
A49 49 - - -
Ampul
Ergotamina tartrat 1 mg + kofeina 50 mg tab
A50 50 Tablet
- - -

A51 51 Erytromysin 200mg/5ml Syrup Botol - - -


A52 52 Erytromysin tablet 500 mg Tablet - - -
A53 53 Etakridina (rivanol) larutan 0.1 % Botol - - -
A54 54 Etil klorida semprot Botol - - -
A55 55 Eugenol cairan Botol - - -
A56 56 Fenobarbital inj 50 mg /ml -2ml Ampul - - -
A57 57 Fenobarbital tablet 100mg Tablet - - -
A58 58 Fenobarbital tablet 30 mg Tablet - - -
A59 59 Fenol gliserol tetes telnga 10% Botol - - -
A60 60 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul - - -
A61 61 Fitomenadion (vit. K1) tablet salut 10 mg Tablet - - -
A62 62 Furosemida tablet 40 mg Tablet - - -
A63 63 Garam Oralit untuk 200 ml air Sachet 13 13.00 2 11.00 3.00
A64 64 Gentamisin Salep Mata Tube 0 - - -
A65 65 Gentamysin SK Tube - - -
A66 66 Gentamysin TM/Genoint TM Botol 10 10.00 10.00 -
A67 67 Gentian violet larutan 1 % Botol - - -
A68 68 Glibenklamida tablet 5 mg Tablet - - -
A69 69 Gliseril guayakolat tablet 10 mg Tablet - - -
A70 70 Glukosa larutan infus 10 % steril Botol - - -
A71 71 Glukosa larutan infus 40 % steril Botol - - -
A72 72 Glukosa larutan infus 5 % steril Botol - - -
A73 73 Griseofulvin tablet 125 mg. Mikronized Tablet - - -
A74 74 Haloperidol 0,5 mg. Tablet Tablet - - -
A75 75 Haloperidol 1,5 mg tablet Tablet - - -
A76 76 Haloperidol 5 mg tablet Tablet - - -
A77 77 Hidroklorotiasida (HCT) tablet 25 mg Tablet - - -
A78 78 Hidrokortison krim 2.5 % Tube 5 10 15.00 6 9.00 9.00
A79 79 Ibuprofen tablet 400 mg Tablet 0 - - -
A80 80 Isoniazide 100 mg Tablet - - -
A81 81 Isoniazide 300 mg Tablet - - -
A82 82 Isosorbid dinitrat Tablet - - -
A83 83 Kalsium hidroksida pasta Pot - - -
A84 84 Kalsium laktat (kalk) tablet 500 mg Tablet - - -
A85 85 Ketokonazole 200 mg tablet Tablet - - -
Kinina dihidroklorida (kinina) inj 25 % - 2 ml
A86 86 Ampul
- - -
A87 87 Kinina sulfat tablet 222 mg (7 h20 ) Tablet - - -
A88 88 Kloramfenicol salep kulit Tube - - -
A89 89 Kloramfenikol kapsul 250 mg Tablet - - -
A90 90 Kloramfenikol salep mata 1 % Tube - - -
A91 91 Kloramfenikol tetes Mata Botol - - -
A92 92 Kloramfenikol tetes telinga 3 % Botol 3 3 6.00 1 5.00 1.50
A93 93 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 42 300 342.00 5 319.00 7.50
A94 94 Klorpromazin 100 mg tablet Tablet - - -
A95 95 Klorpromazina Hcl inj 25 mg / ml - 1 ml Ampul - - -
A96 96 Klorpromazina Hcl inj 5 mg / ml - 2 ml Ampul - - -
A97 97 Klorpromazina hcl tablet salut 25 mg Tablet - - -
A98 98 Kodeina Hcl (kodeina) tablet 10 mg Tablet - - -
A99 99 Kotrimoksasol suspensi Botol 11 11.00 1 10.00 1.50 ED(8)
A100 100 Kotrimoksasol tablet kombinasi Tablet 76 100 176.00 176.00 -
A101 101 Lidokain inj Ampul - - -
A102 102 Lidokaina comp inj kombinasi Ampul - - -
Metakresol sulfonat dan metanol kondensai
A103 103 (Albotyl) Botol
- - -

A104 104 Metformin 500 mg tablet Tablet - - -


Metilergometrina maleat inj 0. 200 g / ml- ml
A105 105 - - -
Ampul
Metilergometrina malet tablet salut 0. 125 mg
A106 106 Tablet
- - -

A107 107 Metilprednisolon tablet 4 mg Tablet 246 200 446.00 20 426.00 30.00 ED(246)
A108 108 Metoklopramide 10 mg tablet/Noristal Tablet 220 220.00 220.00 -
A109 109 Metronidazol 500 mg Tablet - - -
A110 110 Metronidazol tablet 250 mg Tablet - - -
A111 111 Mikonazole salep Tube 2 2.00 2.00 -
A112 112 Monoklorkamfer mentolcairan (CHKM) Botol - - -
A113 113 Mumifyng pasta Botol - - -
A114 114 Natrium bikarbonat tablet 500 mg Tablet - - -
Natrium Diklofenak 50 (Nadifen/Prostanac)
A115 115 - - -
Tablet
A116 116 Natrium klorida larutan infus 0. 9 steril Botol - - -
A117 117 Nifedipin tablet 10 mg Tablet - - -
A118 118 Nistatin 100. 000 iu/g tablet vaginal Tab Vag - - -
A119 119 Obat batuk hitam (OBH) cairan Botol 100 ml - - -
A120 120 Ofloxacin tab 400mg Tablet - - -
A121 121 Oksigen gas dalam tabung 3 m3 Tabung - - -
A122 122 Oksigen gas dalam tabung 6 m3 Tabung - - -
A123 123 Oksitetrasiklina hcl salep 3 % Tube - - -
A124 124 Oksitetrasiklina hcl salep mata 1 % Tube - - -
A125 125 Oksitosina inj 10 iu/ml - 1 ml Ampul - - -
A126 126 Parasetamol sirup 120 mg / 5 ml Botol 5 5.00 1 4.00 1.50
A127 127 Parasetamol tab 100 mg Tablet - - -
A128 128 Parasetamol tablet 500mg Tablet 305 300 605.00 300 305.00 450.00
Pirantel pamoat (pirantel) tablet 125 mg basa
A129 129 - - -
Tablet
A130 130 Piroxicam 10 Mg Tablet - - -
A131 131 Piroxicam 20 Mg Tablet - - -
A132 132 Prednison tablet 5 mgn Tablet - - -
A133 133 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet - - -
A134 134 Primakina tablet 15 mg Tablet - - -
A135 135 Prokaina penisilina g inj 3 juta iu Vial - - -
A136 136 Propiltionurasil tablet 100 mg Tablet - - -
A137 137 Propranolol hcl (Propranolol) tablet 40 mg Tablet - - -
A138 138 Pyridoxin injeksi Ampul - - -
A139 139 Ranitidin inj 25 mg/2 ml Ampul - - -
A140 140 Ranitidin tablet 150 mg Tablet 324 400 724.00 195 529.00 292.50 ED(324)
A141 141 Reserpina tablet 0, 10 mg Tablet - - -
A142 142 Reserpina tablet 0, 25 mg Tablet - - -
A143 143 Retinol (vit. A) kapsul lunak 200.000 iu Tablet - - -
A144 144 Retinol (vit. A) tablet salut 100. 000 iu Tablet - - -
A145 145 Ringer laktat larutan infus steril Botol - - -
A146 146 Risperidon Tablet - - -
A147 147 Salbutamol tablet 2 mg Tablet - - -
A148 148 Salbutamol tablet 4 mg Tablet 180 100 280.00 10 270.00 15.00
A149 149 Salisil bedak 2 % Bks 5 5.00 5.00 -
A150 150 Salisil spiritus 10 % Botol - - -
A151 151 Semen seng fosfat serbuk dan cairan Botol - - -
A152 152 Serum anti bisa ular polivalen inj. 5ml Ampul - - -
A153 153 Serum anti tetanus inj. 1.500 iu Ampul - - -
A154 154 Sianokobalamina (vit.b12) inj. 500 mcg Ampul - - -
A155 155 Silver amalgam serbuk 65-75% Botol - - -
A156 156 Simvastatin tab 10 mg Tablet - - -
A157 157 Sulfacetamide tetes mata Botol - - -
A158 158 Synthetic filing material larutan dan serbuk Set - - -
Temporary stopping fletcher serbuk dan cairan
A159 159 - - -
Set
Tetrasiklina hcl (tetrasiklina) kapsul 250 mg
A160 160 Tablet
- - -
Tetrasiklina hcl (tetrasiklina) kapsul 500 mg
A161 161 Tablet
- - -

A162 162 Thiamfenikol 500 Tablet - - -


Tiamin hcl /mononitrat (vit.b1) tablet 50 mg
A163 163 Tablet 0 - - -

A164 164 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul - - -


A165 165 Tramadol Tablet - - -
A166 166 Trifluoperazine (Stelazin) Tablet - - -
A167 167 Triheksfenidil hcl 2 mg tablet Tablet - - -
A168 168 Trikresol formalin (tkf) cairan Botol - - -
A169 169 Vitamin B kompleks tablet Tablet 256 256.00 57 199.00 85.50
A170 170 Yodium povidan larutan 10% 300 ml Botol - - -
A171 171 Yodium povidon larutan 10% 30 ml Botol - - -
A172 172 Zink tablet Tablet 100 100.00 10 90.00 15.00
Amoxcilin syrup 250 mg/5ml boto 2 2.00 2.00 -
-
OBAT TAMBAHAN - -
A173 173 Aptil Botol - - -
A174 174 (Lopinavir/Ritonavir)Aluvia Botol - -
A175 175 Abacavir Tablet - -
A176 176 Acyclovir tablet 200 mg Tablet - -
A177 177 Aleterol TM Botol - -
A178 178 Amlodipin 10 mg tab Tablet - -
A179 179 Amlodipin 5 mg tab Tablet 60 450 510.00 122 388.00 183.00
A180 180 Amox-clav Tablet - -
Ampisilin Serbuk Injeksi i.m/i.v. 1000 mg/ml Ampul
A181 181 - -

A182 182 Ampisillin injeksi i.m/i.v 1000 mg/ml Ampul - -


A183 183 Antalgin injeksi Ampul - -
A184 184 Antasida syr Botol - - -
A185 185 Arterakine Tablet - -
A186 186 Artesunat inj Vial - -
A187 187 Asam Folat 1 mg Tablet - - -
A188 188 Asam tranexamat 500 mg Tablet - -
A189 189 Asetosal 80/miniaspi tablet - - -
A190 190 Atripla(TDF+3TC+EFV) Botol - -
A191 191 Azitromisin+cefixim Tablet - -
A192 192 Azytromisin tablet 500 mg Tablet - -
A193 193 BD Vacuntainer Pcs - -
A194 194 Becefort Tablet 231 200 431.00 141 290.00 211.50
A195 195 Benzatin Penisillin Vial - - -
A196 196 Bonding Set - - -
A197 197 Bufacomb salep Tube - - -
A198 198 Buscopan inj Ampul - - -
A199 199 Caviton Tube - - -
A200 200 Cefixim syr 100 mg/5 ml Botol - - -
A201 201 Cefixim tablet 100 mg Tablet - -
A202 202 Cefixim tablet 200 mg Tablet - -
A203 203 Cefotaxim 0,5 g inj Vial - -
A204 204 Ceftriaxon inj Vial - -
A205 205 Clarithromysin 500 mg Tablet - -
A206 206 Clavamox inj Ampul - -
A207 207 Clindamisin 150 mg Tablet - -
A208 208 Clindamisin 300 mg Tablet - -
A209 209 Clobazam 10 mg Tablet - - -
A210 210 Clozapine 25 mg Tablet - - -
A211 211 Composite (tumpatan sinar)A3 Set - - -
A212 212 Composite (tumpatan sinar)A3.5 Set - - -
A213 213 Crofed Tablet - - -
A214 214 D1/2 NS botol - - -
A215 215 D1/4 NS Botol - - -
A216 216 Daryantulle Lembar - - -
A217 217 Dermazine/Burnazin Tube - - -
A218 218 Dextina / Dextamin/Dextamec/Polofar Plus Tablet - - -
A219 219 Dextran 70% Botol - -
A220 220 Dextrofen syr Botol 6 6.00 6.00 -
A221 221 Diaform tablet/selesdiar Tablet - -
A222 222 Dormi/Scopma/Spashi tablet Tablet - - -
A223 223 Dulcolac anak supp Supp - -
A224 224 Dulcolac dewasa supp Supp - -
A225 225 Dulkolak tablet Tablet - -
A226 226 Duviral(Zidovudin 300+Lamivudin 150) Botol - -
A227 227 Efavirenz Botol - -
A228 228 Etambutol Tablet - -
A229 229 ETSA Set - -
A230 230 Euthyrox 100mg Tablet - -
A231 231 Faktu Supp Supp - -
A232 232 Fluconasol tab Tablet - -
A233 233 Fluoxetin Tablet - -
A234 234 Forumen TT Fls - - -
A235 235 Gentamisin Injeksi 80 mg/2ml Ampul - -
A236 236 Glass ionomer (Ketac Molar) Tube - - -
A237 237 Glimepiride 2 tablet - - -
A238 238 Glimepiride 4 tablet - -
A239 239 Glukonas Calcicus 10%- 10ml Ampul - -
A240 240 Haldol inj Ampul - -
A241 241 Hiviral (Lamivudin 150) Botol - -
A242 242 Ibuprofen syr btl - - -
A243 243 Iliadin TH flesh - - -
A244 244 Isotic Neolisin TM Fls 1 5 6.00 6.00 -
A245 245 Kalium Diklovenac tablet 0 600 600.00 262 338.00 393.00
A246 246 Kaltropen supp Supp - - -
A247 247 Ketoconazole SK tube 3 3.00 3.00 -
A248 248 Ketoprofen inj 10 mg Ampul - -
A249 249 Ketoprofen tablet 100 mg Tablet - -
A250 250 Ketorolac inj Ampul - -
A251 251 Kombipak Anak Paket - -
A252 252 Lodomer 2 Tablet - -
A253 253 Lytamin syr botol - -
A254 254 Magnesium Sulfat 20% - 25 ml Botol - -
A255 255 Magnesium Sulfat 40% - 25 ml Botol - - -
A256 256 Metil Prednisolon 16 mg Tablet - -
A257 257 Metil prednisolon inj 500 mg Vial - -
A258 258 Metronidazole 500 mg Infus/100 ml Botol - -
A259 259 Meylon inj Botol - -
A260 260 Microlax Supp - - -
A261 261 Miloxicam 7,5 mg tablet 38 270 308.00 246 62.00 369.00
A262 262 Molexflu Tablet - -
A263 263 Multivitamin (Livron B plek) Tablet 140 500 640.00 508 132.00 762.00
A264 264 Multivitamin sirup( Xanvit syr) Botol - -
A265 265 Neurotropik tablet Tablet - -
A266 266 Neviral (neviravin 200mg) Botol - -
A267 267 New antides tablet 174 174.00 174.00 -
A268 268 Nutrifar 5000 Tablet - -
A269 269 Obat anti tuberkulosis FDC katagori I Paket - - -
A270 270 Obat anti tuberkulosis FDC anak Paket - - -
A271 271 Obat anti tuberkulosis FDC katagori II Paket - -
A272 272 Obat anti tuberkulosis FDC sisipan Paket - -
A273 273 Obat anti tuberkulosis kategori I Paket - -
A274 274 Obat Batuk Kombinasi Botol - -
Obat Flu kombinasi CTM, PPA (Anaflu),
A275 275 Demacolin 124 124.00 84 40.00 126.00
Tablet
A276 276 Obat Flu Kombinasi/Mecofed/Quantidex Tablet - -
A277 277 OBH plus botol 4 4.00 1 3.00 1.50
A278 278 Omeprasole tablet 20 mg Tablet - - -
A279 279 Ondancentron inj Ampul - -
A280 280 Ondancetron 4 mg Tablet - - -
A281 281 Orpen Tablet - - -
A282 282 Oseltamivir Tablet - -
A283 283 Paket bonding Set - -
A284 284 Pamol 125 mg Supp Supp - - -
A285 285 Pamol 250 mg Supp Supp - - -
A286 286 Pantocain Tetes Mata Botol - -
A287 287 Parasetamol drop Botol - - -
A288 288 Pehacain Injeksi Ampul - - -
Pehatrim Forte (Kotrimoksasol tab forte 960 mg) Tablet
A289 289 - -

A290 290 Perhidrol (H2O2) Botol - -


A291 291 Phenitoin tab Tablet - - -
A292 292 Piracetam 400 mg Tablet - -
A293 293 Piracetam inj 200mg/1ml Ampul - -
A294 294 Pirimethamine tablet Tablet - -
A295 295 Prenatin DF Tablet 172 172.00 172.00 - ED(172)
A296 296 Prenatin plus tablet tablet - -
A297 297 Primaquin Tablet - -
A298 298 Primperan inj Ampul - -
A299 299 Procurma sirup botol 4 4.00 4.00
Prokain Benzil Penicillin G Injeksi 3 jt IU/vial Vial
A300 300 - -

A301 301 Proris supp Supp - -


A302 302 Pularex Tablet - -
A303 303 Scabimite cream tube - - -
A304 304 Sikzonoate inj Ampul - -
A305 305 Simvastatin tab 20 mg Tablet - - -
A306 306 Spashi inj Ampul - -
A307 307 Spashi tab Tablet - -
A308 308 Stelosi tab 5 mg Tablet - -
A309 309 Stesolid rectal Supp - - -
A310 310 Strop indra Botol - - -
A311 311 Sulfadiazin tablet Tablet - -
A312 312 Tenofovir (Tenofovir 300mg) Botol - -
A313 313 Tetagam Ampul - - -
A314 314 Tramadol inj 50 mg/ml Ampul - -
A315 315 Tranexid inj (Asam tranexamat inj) Ampul - - -
A316 316 Urotractin tablet - - -
A317 317 Ventolin Nebulizer Ampul - - -
A318 318 Vitamin B12 tab Tablet - - -
A319 319 Vitamin Neurotropik inj Ampul - - -
Vitamin Neurotropik tablet (Nutrifar, Sohobion)
A320 320 - - -
Tablet
A321 321 VitKa infan Ampul - - -
A322 322 Xylocain Gel Ampul - - -
A323 323 Zidovudine 100 mg Tablet - - -
Sucralfate syrup botol - - -
Clopidogrel bisulfate - - -
Levofloxacin 500 - - -
Spironolactone 25 mg - - -
Domperidone syr - - -
Ceterizine syr 5 mg/5 ml - - -
Albendazol syr - - -
Zink syr - - -
Cazetin drop - - -
Lacto B - - -
Scopma plus tab - - -
Nebacetin powder - - -
Metronidazol syr 125 mg/5ml - - -
Salbutamol syr - - -
Furosemida inj - - -
Paracetamol infus 10 mg/ml - - -
Calortusin tab 100 100.00 100.00 -
Coparcetin tab - - -
TB tahap intensif - - -
TB tahap lanjutan - - -
Solathim syr - - -
Antiseptic liquid no 2 - - -
Tenofovir (Tenofovir 300 mg) + Emtricitabin - - -
Cavit G - - -
Ketros Supp - - -
Harnal - - -
BMHP - - -
B1 1 ADS 0.5 ml Pcs - - -
B2 2 ADS 0.05 ml Pcs - - -
B3 3 ADS 2 ml Pcs - -
B4 4 ADS 5 ml Pcs - - -
B5 5 Alat suntik sekali pakai 1 ml Pcs - -
B6 6 Alat suntik sekali pakai 2,5 ml Pcs - -
B7 7 Alat suntik sekali pakai 5 ml Pcs - -
B8 8 Bisturi no 13 Pcs - -
B9 9 Bisturi no 14 Pcs - -
B10 10 Bisturi no 19/20 Pcs - -
B11 11 Bisturi no 21 Pcs - -
B12 12 Box slide kotak - - -
B13 13 Catgut 2/0 plain Sachet - -
B14 14 Catgut / benang bedah no 2/0 chromic Sachet - -
B15 15 Catgut / benang bedah no 3/0 plain Sachet - - -
B16 16 Catgut 1/0 Chromic Pcs - -
B17 17 Catgut 2/0 Chromic Roll Roll - -
B18 18 Catgut 3/0 Chromic Roll Roll - -
B19 19 Cutgut Chromic No.1 atraumatik (sachet) Sachet - -
B20 20 Etanol 70 % Botol - - -
B21 21 Etanol 70 % Botol 100 ml - -
B22 22 Film Rontgen 18 x 24 Set - -
B23 23 Folley catheter Pcs - -
B24 24 Hypavix (Ultrafik) Roll - - -
B25 25 I.V Catheter 22 Pcs - -
B26 26 I.V Catheter 24 Pcs - -
B27 27 Infusion set anak Set - -
B28 28 Infusion set dewasa Set - - -
B29 29 IV Cath dgn Katup pcs - - -
B30 30 IV Catheter 18 Pcs - -
B31 31 IV Catheter 20 Pcs - -
B32 32 IV Catheter no 18 G Terumo Pcs - -
B33 33 IV Catheter no 20 G Terumo Pcs - -
B34 34 Jarum injeksi Pcs - -
B35 35 Jarum jahit (bedah) no. 9 s/d 14 Set - -
B36 36 Jarum Jahit Bedah no 12 Set - -
B37 37 Jarum Jahit Bedah no 13 Set - -
B38 38 Jarum Jahit Bedah no 14 Set - -
B39 39 Jarum Kulit Set - -
B40 40 Jarum Otot dan Kulit Set - -
B41 41 Jelly RO Tube - -
B42 42 Kantung Puyer Pak - -
B43 43 Kapas pembalut / absorben 250 gram Roll - - -
B44 44 Kasa gulung 40 x 80 Roll - - -
B45 45 Kasa Hidrofil 4 x 10 Roll - - -
B46 46 Kasa kompres 40 / 40 steril Roll - - -
B47 47 Kasa pembalut 2 x 80 Roll - - -
B48 48 Kasa pembalut hidrofil 4 m x 15 cm Roll - - -
B49 49 Kasa pembalut hidrofin 4m x 3 cm Roll - - -
B50 50 Kasa Steril ( 18 x 22 ) Kotak - - -
B51 51 Kertas EKG Roll - - -
B52 52 Kertas saring Lembar - - -
B53 53 Kertas USG Roll - - -
B54 54 Klem Tali Pusar pcs - - -
B55 55 Klip Kecil Pak - - -
B56 56 Klip Tanggung Pak - - -
B57 57 Lampu spiritus botol - - -
B58 58 Lisol mengandung kresol Botol - - -
B59 59 Masker Pcs - - -
B60 60 Masker Bedah Pcs - - -
B61 61 Masker N95 Pcs - - -
B62 62 MY Jelly Tube - - -
B63 63 Nasal cannula Oksigen pcs - - -
B64 64 Pembalut Gips Roll - - -
B65 65 Perkamen Pak - - -
B66 66 Plester 5 yard x 2 inch Roll - - -
B67 67 Pot Salep Pot - - -
B68 68 Pot Sputum Pcs - - -
B69 69 Safety box Pcs - - -
B70 70 Sarung Tangan Gynaecologi pasang - - -
B71 71 Sarung Tangan L Pasang - - -
B72 72 Sarung Tangan M Pasang - - -
B73 73 Sarung Tangan S Pasang - - -
B74 74 Sarung Tangan Steril Pasang - - -
B75 75 Sarung Tangan Surgiglove Pasang - - -
B76 76 Sendok Takar Pcs - - -
B77 77 Silk 3/0 roll Roll - - -
B78 78 Silk (benang bedah sutera) no.3/0 Pcs - - -
B79 79 Slide Prosted Pak - -
B80 80 Spalk tungkai atas anak Pcs - -
B81 81 Spalk tungkai atas dewasa Pcs - -
B82 82 Spalk tungkai bawah anak Pcs - -
B83 83 Spalk tungkai bawah dewasa Pcs - -
B84 84 Spuit 10 ml Pcs - -
B85 85 Spuit 2/3 ml Pcs - -
B86 86 Transfusi Set Pcs - -
B87 87 Uji Tuberkulin Vial - -
B88 88 Underpad Pak - -
B89 89 Urinebag Set - -
B90 90 Wing Needle 21 Pcs - -
B91 91 Wing Needle 23 Pcs - -
B92 92 Wing Needle 25 Pcs - -
B93 93 Wing Needle 27 Pcs -

Kunjungan Pasien
a. Bayar 11 152 0 3 18 0
b. JKN 112 747 38 75 90 28
Jumlah 123

Mengetahui/Menyetujui Yang Meyerahkan Yang Meminta Yang Menerima


Kepala Dinkes. Kabupaten Tabanan Pimpinan Puskesmas Petugas Puskel

…………………………………………. ( dr. I Ketut Indra wiguna cakera ) NI MADE SRI WAHYUNI


NIP. 197710032006041002 NIP.

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