LAPORAN PEMAKAIAN DAN LEMBAR PER

PUSKESMAS
PUSKESMAS KEDAWUNG I
KECAMATAN KEDAWUNG I PELAPORAN BULAN / PERIODE
KABUPATEN : SRAGEN PERMINTAAN BULAN / PERIODE

STOK PENERI PERSE PEMAKAIAN

NO NAMA OBAT SATUAN
AWAL MAAN DIAAN
A Obat Generik
A1 Acetosal 500 mg tab Tablet 0 0 0 0
A2 ACT tab Kotak 24 tab 0 0 0 0
A3 Albendasol Tablet 0 0 0 0
A4 Allopurinol 100 mg tab Tablet 781 0 781 214
A5 Ambroxol sirup Botol 0 0 0 0
A6 Ambroxol tab Tablet 0 0 0 0
A7 Aminofilin inj. Ampul 9 0 9 0
A8 Aminofilin tab 200 mg Tablet 300 0 300 0
A9 Amitriptilin tab 25 mg Tablet 0 0 0 0
A10 Amlodipin 5mg Tablet 144 0 144 127
A11 Amoksisilin + As. Klavunalat 625 mg Tablet 0 0 0 0
A12 Amoksisilin injeksi Vial 67 50 117 35
A13 Amoksisilin kab 500 mg Tablet 4,068 2,000 6,068 2,891
A14 Amoksisilin kap 250 mg Kapsul 0 0 0 0
A15 Amoksisilin Sirup 125 mg Botol 88 60 148 57
A16 Ampisilin injeksi 1 gram Vial 37 50 87 20
A17 Antalgin injeksi Ampul 0 0 0 0
A18 Antalgin tab 500 mg Tablet 829 0 829 173
A19 Antasida Doen tab Tablet 1,730 2,000 3,730 2,002
A20 Antasida sirup Botol 75 0 75 32
A21 Anti Bacteri Doen salep kulit Tube 42 0 42 0
A22 Anti Hemoroid suppo Suppo 10 0 10 0
A23 Antifungi Kombinasi salep kulit Pot 61 0 61 3
A24 Artemeter inj 80 mg Ktk 6 amp 0 0 0 0
A25 Artesunate Inj ktk 8 amp 0 0 0 0
A26 Asam Askorbat tab 50 mg tab Tablet 4,719 0 4,719 380
A27 Asam Mefenamat kap 500 mg Kaplet 2,630 2,000 4,630 1,365
A28 Asam traneksamat inj 250 mg Ampul 0 0 0 0
A29 Asiklovir salep kulit Tube 50 25 75 15
A30 Asiklovir tab 200 mg Tablet 270 500 770 269
A31 Atropin Sulfas inj Ampul 30 0 30 0
A32 Benzatin Benzyl Penisilin Inj 2,4jt UI Flacon 0 0 0 0
A33 Besi II Sulfat Tablet + asam folat Tablet 6,927 0 6,927 1,170
A34 Betahistin mesilat tab Tablet 239 0 239 233
A35 Betamethason salep kulit Tube 46 25 71 16
A36 Bisakodil tab Tablet 143 0 143 6
A37 Deksametason inj Ampul 246 0 246 0
A38 Deksametason tab 0,5 mg Tablet 3,274 3,000 6,274 2,820
A39 Dekstromethorpan sirup Botol 0 0 0 0
A40 Dekstromethorpan tab Tablet 0 0 0 0
A41 Diazepam inj. 5mg/2ml Ampul 0 0 0 0
A42 Diazepam tab 2 mg Tablet 510 0 510 0
A43 Diazepam tab 5 mg Tablet 0 0 0 0
A44 Difenhydramin HCl inj Ampul 390 0 390 0
A45 Digoxin tab 0,25 mg Tablet 0 0 0 0
A46 Dimenhydrinat tab Tablet 83 0 83 32
A47 Doksisiklin 100 Tablet 0 0 0 0
A48 Domperidon suspensi Botol 0 50 50 17
A49 Domperidon tab 10 mg Tablet 319 200 519 5
A50 Efedrin tab 25 mg Tablet 0 0 0 0
A51 Efinefrin ( Adrenalin inj ) Ampul 9 0 9 0
A52 Ekstrak Belladon tab 10 mg Tablet 50 0 50 0
A53 Erytromicin kap 250 mg Kapsul 0 0 0 0
A54 Erytromicin kap 500 mg Kapsul 0 0 0 0
A55 Erytromicin sirup Botol 0 0 0 0
A56 Etakridin Lakt. ( Rivanol ) Botol 0 0 0 0
A57 Ethambutol tab 250 mg Tablet 0 0 0 0
A58 Fenitoin Na. kap 100 mg Kapsul 0 0 0 0
A59 Fenobarbital inj 50mg/ml Ampul 0 0 0 0
A60 Fenobarbital tab30 mg Tablet 0 0 0 0
A61 Fenol Gliserol Botol 0 0 0 0
A62 Fitomenadion inj Ampul 30 0 30 0
A63 Fitomenadion tab 10 mg Tablet 388 0 388 42
A64 Furosemide tab 40 mg Tablet 102 0 102 0
A65 Furosemide injeksi Ampul 0 0 0 0
A66 Gameksan salep kulit Tube 0 0 0 0
A67 Garam Oralit 200ml Sak 0 0 0 0
A68 Gentamicin tetes mata 0,3 % Botol 51 0 51 1
A69 Gentamicin injeksi Ampul 0 0 0 0
A70 Gentamisin salep kulit Tube 2 0 2 0
A71 Gentian Violet Botol 6 0 6 6
A72 Glibenklamide tab 5 mg Tablet 1,552 0 1,552 168
A73 Gliseril guaiakolat tab Tablet 3,221 2,500 5,721 1,388
A74 Glukonas kalsikus Ampul 0 0 0 0
A75 Glukose 40 % larutan infus Ampul 0 0 0 0
A76 Glukose 10 % larutan infus Flabot 0 0 0 0
A77 Glukose 5 % larutan infus Flabot 0 0 0 0
A78 Griseofulvin tab 125 mg Tablet 472 0 472 37
A79 Haloperidol tab 0,5 mg Tablet 0 0 0 0
A80 Haloperidol tab 1,5 mg Tablet 0 0 0 0
A81 Hidrokhlorotiazide (HCT) tab 25 mg Tablet 0 0 0 0
A82 Hidrokortison salep kulit Tube 1 24 25 23
A83 Hiosine-N- butilbromide tablet 10 mg Tablet 0 0 0 0
A84 Ibuprofen tab 200 mg Tablet 3,488 1,000 4,488 360
A85 Ibuprofen tab 400 mg Tablet 0 0 0 0
A86 Isoniazide tab ( INH ) Tablet 0 0 0 0
A87 Isosorbid Dinitrat Tablet 440 0 440 30
A88 Kalium Diklofenak 25 mg Tablet 500 0 500 0
A89 Kalium Diklofenak 50 mg Tablet 38 0 38 0
A90 Kalsium Laktat tab 500 mg Tablet 1,915 500 2,415 909
A91 Kaptopril tab 25 mg Tablet 2,812 0 2,812 475
A92 Karbamazepin tab 200 mg Tablet 0 0 0 0
A93 Ketokonazole 200 mg Tablet 294 0 294 24
A94 Ketokonazole krim tube 0 0 0 0
A95 Ketoprofen inj Ampul 0 0 0 0
A96 Kinina Dihydroklorid inj Ampul 0 0 0 0
A97 Kinina HCl. Tab Tablet 0 0 0 0
A98 Klobazam tab Tablet 0 0 0 0
A99 Klonidin tab Tablet 0 0 0 0
A10
Klorafeniramin ( CTM ) tab Tablet 2,892 1,000 3,892 1,730
0
A10
Kloramfenikol inj Vial 0 0 0 0
1
A10
Kloramfenikol salep mata 1 % Tube 68 0 68 1
2
A10
Kloramfenikol sirup Botol 48 0 48 1
3
A10
Kloramfenikol tetes mata 0,5 % Tube 56 0 56 12
4
A10
Kloramfenikol tetes telinga Kapsul 78 0 78 8
5
A10
Kloramfenikol kap 250 mg Botol 543 0 543 0
6
A10
Klorokuin tab 150 mg Tablet 0 0 0 0
7
A10
Klorpromasin injeksi Ampul 0 0 0 0
8
A10
Klorpromasin tab 25 mg Tablet 0 0 0 0
9
A11
Kontrasepsi implant set 0 0 0 0
0
A11
Kontrasepsi inj depo prog 3 bln vial 0 0 0 0
1
A11
Kotrimoksazol suspensi Botol 150 0 150 12
2
A11
Kotrimoksazol tab 120 mg Tablet 0 0 0 0
3
A11
Kotrimoksazol tab 480 mg Tablet 1,049 0 1,049 273
4
A11
Lidokain comp injeksi Ampul 95 60 155 -30
5
A11
Loperamid Tablet 255 0 255 0
6
A11
Mebendazol tab100 mg Tablet 0 0 0 0
7
A11
Metformin 500 Tablet 248 500 748 170
8
A11
Methoklopramide injeksi Ampul 50 0 50 0
9
A12
Methoklopramide sirup Botol 0 0 0 0
0
A12
Methoklopramide tab10 mg Tablet 2,990 0 2,990 349
1
A12
Metilergomet injeksi 0,2 mg Ampul 0 0 0 0
2
A12
Metilergomet tab 0,125 mg Tablet 0 0 0 0
3
A12
Metilprednisolon 4 Tablet 2,233 0 2,233 350
4
A12
Metronidazol inf Ampul 0 0 0 0
5
A12
Metronidazol tab 250 mg Tablet 0 0 0 0
6
A12
Metronidazol tab 500 mg Tablet 308 0 308 117
7
A12
MgSO4 20 % Vial 0 0 0 0
8
A12
MgSO4 40 % Vial 0 0 0 0
9
A13
Mineral mix Sak 0 0 0 0
0
A13
Misoprostol Tablet 0 0 0 0
1
A13
Myconazol salep kulit Tube 77 0 77 8
2
A13
Na tiroksin Tablet 0 0 0 0
3
A13
Na. Bic. Tab 500 mg Tablet 0 0 0 0
4
A13
Na. Cl. Infus Flabot 0 0 0 0
5
A13
Natrium Dikofenak 50 Tablet 2,031 500 2,531 532
6
A13
Natrium Tiosulfas inj Ampul 0 0 0 0
7
A13
Nifedipin Tablet 0 0 0 0
8
A13
O A T Anak Paket 0 0 0 0
9
A14
O A T - FDC anak Paket 0 0 0 0
0
A14
O A T - FDC kat 1 & 3 Paket 10 0 10 0
1
A14
O A T - FDC kat 2 Paket 1 0 1 0
2
A14
O A T - FDC sisipan Paket 0 0 0 0
3
A14
O A T Katagori - 1 Paket 0 0 0 0
4
A14
O A T Katagori - 2 Paket 0 0 0 0
5
A14
O A T Katagori - 3 Paket 0 0 0 0
6
A14
O A T Sisipan Paket 0 0 0 0
7
A14
Obat Batuk Hitam sirup Botol 13 0 13 1
8
A14
Oksitetrasiklin salep kulit 3 % Tube 0 0 0 0
9
A15
Oksitetrasiklin salep mata Tube 0 0 0 0
0
A15
Oksitetrasiklin 50mg/ml inj Flacon 0 0 0 0
1
A15
Oksitocin 10mg/ml inj Ampul 20 0 20 0
2
A15
Omeprazol kaps Kapsul 0 0 0 0
3
A15
Papaverin inj Ampul 0 0 0 0
4
A15
Papaverin tab 40 mg Tablet 3,406 0 3,406 28
5
A15
Parasetamol sirup Botol 80 0 80 64
6
A15
Parasetamol tab 100 mg Tablet 0 0 0 0
7
A15
Parasetamol tab 500 mg Tablet 2,220 5,000 7,220 4,994
8
A15
Perhidrol 2 % Botol 0 0 0 0
9
A16
Piracetam 400 Kapsul 0 0 0 0
0
A16
Pirazinamid tab 500 mg Tablet 0 0 0 0
1
A16
Piridoksin tab 10 mg Tablet 1,792 0 1,792 24
2
A16
Piroksikam tab 10 mg Kapsul 1,884 0 1,884 509
3
A16
Piroksikam tab 20 mg Kapsul 0 0 0 0
4
A16
Polykrusulen ( Albothyl ) Botol 0 0 0 0
5
A16
Povidon Iodium 10% 30 ml Botol 10 0 10 0
6
A16
Povidon Iodium 10% 300 ml Botol 4 0 4 0
7
A16
Prednison tab 5 mg Tablet 1,041 0 1,041 7
8
A16
Primakuin tab 15 mg Tablet 0 0 0 0
9
A17
Proc. Pen. 3 juta inj Vial 0 0 0 0
0
A17
Prokain Benzil Penisilin Vial 0 0 0 0
1
A17
Propanolol tab 40 mg Tablet 0 0 0 0
2
A17
Propylthioracil ( PTU ) tab 100 mg Tablet 0 0 0 0
3
A17
Pyrantel tab 125 mg Tablet 0 0 0 0
4
A17
Ranitidine 150 mg Tablet 820 0 820 191
5
A17
Ranitidine inj ampul 107 0 107 6
6
A17
Reserpin tab 0,25 mg Tablet 0 0 0 0
7
A17
Retinol 100.000 iu Kab Btl @50 0 0 0 0
8
A17
Retinol 200.000 iu Kab Btl @50 0 0 0 0
9
A18
Rifampisin kap 300 mg Kapsul 0 0 0 0
0
A18
Ringer Laktat Infus Flabot 237 140 377 143
1
A18
Salbutamol tab 2 mg Tablet 1,634 0 1,634 84
2
A18
Salep 2 - 4 kombinasi Pot 22 0 22 0
3
A18
Salysil bedak 2 % Botol 22 0 22 10
4
A18
Sefadroksil 500 cps Kapsul 936 0 936 102
5
A18
Sefotaxim 1g inj Vial 39 0 39 9
6
A18
Seftriaxon inj Vial 30 0 30 1
7
A18
Serum ABU 5 ml inj. Flacon 1 0 1 0
8
A18
Serum ATS 1.500 iu inj Ampul 7 0 7 0
9
A19
Sianokobalamin inj ( Vit. B12 ) inj Ampul 0 0 0 0
0
A19
Sianokobalamin tab ( Vit. B12 ) tab Tablet 1,299 500 1,799 544
1
A19
Simetidin tab Tablet 0 0 0 0
2
A19
Simvastatin 10 Tablet 1,278 0 1,278 110
3
A19
Siprofloxacin tab 500 mg Tablet 648 0 648 60
4
A19
Streptomicin 1.500 mg inj Vial 0 0 0 0
5
A19
Sulfacetamid tetes mata Botol 0 0 0 0
6
A19
Sulfadimidin 500 mg tab Tablet 0 0 0 0
7
A19
Sulfadoksin + Piritamin tab Tablet 0 0 0 0
8
A19
Tetracyklin kap 250 mg Kapsul 0 0 0 0
9
A20
Tetracyklin kap 500 mg Kapsul 0 0 0 0
0
A20
Thiamin HCl / B1 tab 100 mg Tablet 0 0 0 9
1
A20
Tiamfenikol kap 500 mg Kapsul 1,000 0 1,000 46
2
A20
Tiamin HCl / B1 injeksi 100mg /ml Ampul 0 0 0 0
3
A20
Tiamin HCl / B1 Tab 50 mg Tablet 2,360 0 2,360 54
4
A20
Triheksifenidil tab 2 mg Tablet 0 0 0 0
5
A20
Vitamin B Komplek tab Tablet 499 1,500 1,999 165
6
A20
Zink Tablet 133 0 133 133
7
B Obat Non Generik
B1 Antasida + Simetikon Tablet 969 0 969 0
B2 Antasida + simetikon sirup Botol 31 0 31 0
B3 Anti Diare kombinasi ( Dewasa ) Tablet 597 0 597 400
B4 Anti Diare kombinasi sirup ( Anak ) Botol 50 0 50 12
B5 Anti hemorhoid kapsul Kapsul 0 0 0 0
B6 Anti radang topikal mengandung Tube 0 0 0 0
triamsinolon acetonide 1 mg
B7 Anti spasmodik inj / spasi inj Ampul 0 0 0 0
B8 Asam Askorbat tab 500 + Vitamin Tablet 746 0 746 217
B9 Asering infus Flabot 63 0 67 8
B10 Asifit Kapsul 0 0 0 0
B11 Batugin eliksir Botol 0 0 0 0
B12 Betamethason + Antibiotik salep kulit Tube 4 0 4 0
B13 Bioprost Kapsul 0 0 0 0
B14 D 1/2NS Flabot 0 0 0 0
B15 Diazepam rectal Tube 6 0 6 0
B16 Flunarizin 5 mg Tablet 0 0 0 0
B17 Mecobalamin 500 Kapsul 0 0 0 0
B18 Minyak kayu putih Botol 0 0 0 0
B19 Minyak telon Botol 0 0 0 0
B20 Multivitamin sirup ( Anak ) Botol 63 0 63 40
B21 Multivitamin tab ( Dewasa ) Tablet 122 0 122 0
B22 Neprolit Kapsul 0 0 0 0
B23 Salep Luka Bakar Tube 13 10 23 8
B24 Simetidin inj Ampul 0 0 0 0
B25 Tablet Tambah Darah + Vitamin Tablet 629 500 1,129 629
B26 Tensigard Kapsul 0 0 0 0
B27 Vitamin neurotropik inj Ampul 42 30 72 12
B28 Xylomidon inj Vial 0 0 0 0

C Obat Gigi
C1 Air raksa dental use Botol 0 0 0 0
C2 Bahan bonding botol 0 0 0 0
C3 Bahan Etsa botol 0 0 0 0
C4 Devitalisasi Pasta Botol 0 0 0 0
C5 Etil Klorida semprot Botol 3 0 3 0
C6 Eugenol sol Pot 0 0 0 0
C7 Flour tablet Tablet 0 0 0 0
C8 Glass Ionomer Cement Pot 3 0 3 0
C9 Kalsium hydroksi pasta dos 1 0 1 0
C10 Monokror Kamfer Menthol ( CHKM ) Pot 0 0 0 0
C11 Mumiying Pasta Biji 0 0 0 0
C12 Semen Seng Fosfat p+liq Botol 0 0 0 0
C13 Silver Amalgam Botol 0 0 0 0
C14 Solare Tube 0 0 0 0
C15 Spons Gelatin Cubices Dos 0 0 0 0
C16 Temp+Stopp Fletc p+liq Set 0 0 0 0
C17 Trikresol Formalin ( TKF ) Botol 0 0 0 0
C18 Yodium Gliserin Cc 0 0 0 0

D Alkes Pakai Habis

D1 ADS 0,05 ml Biji 30 0 30 10
D2 ADS 0,5 ml Biji 2,500 0 2,500 0
D3 ADS 5 ml Biji 100 0 100 0
D4 Alat suntik 1 ml Biji 0 0 0 0
D5 Alat suntik 2,5 ml / 3ml Biji 1,275 0 1,275 18
D6 Alat Suntik 5 ml Biji 490 0 490 0
D7 Antiseptik/Bayclin Botol 0 0 0 0
D8 Aqua Pro injeksi Flacon 60 0 60 0
D9 Aquadest steril 500ml Botol 0 0 0 0
D10 Cat Gut Biji 0 0 0 0
D11 Etanol 70 % Botol 3 3 6 0
D12 Hand Scoen Biji 291 0 291 8
D13 Infus Set anak Biji 50 0 50 0
D14 Infus Set dewasa Biji 250 100 350 50
D15 IV Cateter No. 18 Biji 0 0 0 0
D16 IV Cateter No. 20 ( Dewasa ) Biji 0 0 0 0
D17 IV Cateter No. 22 ( Dewasa ) Biji 136 0 136 0
D18 IV Cateter No. 24 ( Anak ) Biji 50 0 50 0
D19 Jarum Bengkok / Jahit Biji 0 0 0 0
D20 Jarum Suntik Biji 10 0 10 0
D21 Kapas Adsorben 250 gr Roll 3 3 6 3
D22 Kasa panjang 40 cmx80 yard Roll 0 0 0 0
D23 Kasa Pemb 4 m x 10 cm Roll 0 0 0 0
D24 Kasa Pemb Hydro 4 m x 15 cm Roll 100 0 100 50
D25 Kasa Pemb Hydro 4 x 80 cm Biji 0 0 0 0
D26 Kasa Steril 16 x 16 ( 16 lmb ) Dos 65 0 65 0
D27 Kasa steril mengand:Framasetin 10% Biji 0 0 0 0
D28 Kasa uk 36 m x 80 cm Roll 0 0 0 0
D29 Kertas Puyer Pak 0 0 0 0
D30 Lisol Botol 0 0 0 0
D31 Masker Biji 200 0 200 100
D32 Masker N 95 Biji 20 0 20 0
D33 Mess Biji 0 0 0 0
D34 Penjernih Air Cepat ( PAC ) Set 0 0 0 0
D35 Plastik obat pak 0 0 0 0
D36 Plester 5 yardx2inch Roll -2 0 -2 2
D37 Poly Cateter No. 14 Biji 5 0 5 0
D38 Poly Cateter No. 16 Biji 0 0 0 0
D39 Poly Cateter No. 18 Biji 5 0 5 0
D40 Selang oksigen anak Biji 0 0 0 0
D41 Selang Oksigen dws Biji 5 0 5 0
D42 Silk Biji 0 0 0 0
D43 Tranfusi set Biji 0 0 0 0
D44 Urine Bag Biji 12 0 12 2
D45 Wing Needle No 23 Biji 0 0 0 0
D46 Wing Needle No 25 Biji 0 0 0 0
D47 Pot dahak Biji 0 0 0 0

E Laboratorium Dan Reagen

E1 Alkohol swab 100pcs/box 0 0 0 0
E2 Amphetamin dos 50 test dus 50 0 0 0 0
E3 Asam urat Kit 4 x 30 ml 0 0 0 0
E4 Benzodiazepin dos 50 test dus 50 0 0 0 0
E5 Blue tips set @100 0 0 0 0
E6 BOD Nutrient Mixture Botol 0 0 0 0
E7 BOD Standart Botol 0 0 0 0
E8 Briliant green 2% Bile Broth (BGLB) Btl dlm dus 0 0 0 0
E9 Cannabinoides dos 50 test dus 50 0 0 0 0
E10 Cell clean Btl 50 ml 0 0 0 0
E11 Cellpack (PK-30 ) box 20 lt 0 0 0 0
E12 Cholinesterase botol 0 0 0 0
E13 Cocain dos 50 test dus 50 0 0 0 0
E14 COD cell test Botol 0 0 0 0
E15 COD sol A Refil Botol 0 0 0 0
E16 Combur test kit 100test Kit 100 test 0 0 0 0
E17 Deck glass box 100 biji 0 0 0 0
E18 EDTA 10 % btl 250 ml 0 0 0 0
E19 Eight check ( L,N,H ) serial 3x1.5ml 0 0 0 0
E20 Glukosa Botol 5 x 100 ml 0 0 0 0
E21 HbsAg test Dus 50 pcs 0 0 0 0
E22 Iodida Test Botol 0 0 0 0
E23 Kertas ECG lembar 0 0 0 0
E24 Kolesterol Botol 5 x 100 ml 0 0 0 0
E25 Kreatinin Botol 2 x 125 ml 0 0 0 0
E26 Lactosa Broth Botol 0 0 0 0
E27 Larutan Asam Klorida 1 % Botol 0 0 0 0
E28 Larutan Asam Sulfosalisilat Botol 0 0 0 0
E29 Larutan Benedick Botol 0 0 0 0
E30 Larutan Eosin Botol 0 0 0 0
E31 Larutan Etanol Asam Botol 0 0 0 0
E32 Larutan Gabbet Botol 0 0 0 0
E33 Larutan Giemsa Botol 0 0 0 0
E34 Larutan Hayem Botol 0 0 0 0
E35 Larutan Karbol Fuksin Botol 0 0 0 0
E36 Larutan Kinyoun Botol 0 0 0 0
E37 Larutan Metanol Botol 0 0 0 0
E38 Larutan Metilen Biru Botol 0 0 0 0
E39 Larutan Turk Botol 0 0 0 0
E40 Larutan Drabkin Botol 500 ml 0 0 0 0
E41 Larutan Rees Ecker Botol 100 ml 0 0 0 0
E42 LDL kit 0 0 0 0
E43 Minyak emersi botol 0 0 0 0
E44 Morphines dos 50 test dus 50 0 0 0 0
E45 Needle boorner dus 100 0 0 0 0
E46 Obyek glass set 0 0 0 0
E47 Oksigen m3 0 0 0 0
E48 Poch-D box 5 lt 0 0 0 0
E49 Poch-L box 500ml 0 0 0 0
E50 Reagen A/B ( GOLDA ) Set 0 0 0 0
E51 Reagen amonium Botol 0 0 0 0
E52 Reagen Cu Btl dlm dus 0 0 0 0
E53 Reagen Fe ( Iron ) Btl dlm dus 0 0 0 0
E54 Reagen Mn Btl dlm dus 0 0 0 0
E55 Reagen Nitrat Btl dlm dus 0 0 0 0
E56 Reagen Nitrit Btl dlm dus 0 0 0 0
E57 Reagen Phospat Botol 0 0 0 0
E58 Reagen Zn Botol 0 0 0 0
E59 Reagen Cyanmet kit/500ml Kit 500ml 0 0 0 0
E60 Serum Widal AO Vial 5 ml 0 0 0 0
E61 Serum Widal H Vial 5 ml 0 0 0 0
E62 Serum Widal O Vial 5 ml 0 0 0 0
E63 Serum widal S thypi H parathyphi AH vial 5 ml 0 0 0 0
E64 SGOT Botol 2 x 62,5 ml 0 0 0 0
E65 SGPT Botol 2 x 62,5 ml 0 0 0 0
E66 Stromatolyser-WH Btl 500 ml 0 0 0 0
E67 Tabung EDTA 3 ml dus 100 0 0 0 0
E68 Tabung EDTA 5 ml dus 100 0 0 0 0
E69 Test Gula Darah Biji 0 0 0 0
E70 Test hematokrit/asisten Tube 100 biji 0 0 0 0
E71 Thermal roll paper roll 0 0 0 0
E72 Tissue lensa biji 0 0 0 0
E73 Trigliserida Botol 6 x 50 ml 0 0 0 0
E74 Ultrasonic gel set 0 0 0 0
E75 Ureum Kit 2 x 100 ml 0 0 0 0
E76 Urine Test Biji 0 0 0 0
E77 Vacum tainer dus 100 0 0 0 0
E78 Yellow tips set @1000 0 0 0 0
0
F Obat Tambahan 0
F3 Aminofluid infus 0 0 0 0
F35 Ventolin ampul

BPJS
Jumlah Kunjungan Resep Bayar Gratis Saraswati
Askes & JPS
Rawat Jalan 1,420 0 831 82
Rawat Inap 162 0 182 31
UGD 218 0 131 27
TOTAL 1,800 0 1,144 140

Mengetahui / menyetujui Yang Menyerahkan

Kepala Dinas Kesehatan Kepala UPTD Instalasi Farmasi
Kabupaten Sragen Kabupaten Sragen

dr H Hargiyanto M Kes Erna Setyowati ,S.Si,Apt

NIP.19680309 199803 1 010 NIP 19760802 200604 2 024
AN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS
Dokumen Nomor Tanggal
N / PERIODE IFK : :
N / PERIODE DESEMBER 2018 Puskesmas

SISA PERMIN Harga Jumlah

KET
STOK TAAN APBD JKN DAK Lain2 Jumlah Satuan(Rp) Harga(Rp)

0 0
0 0
0 0
567 0
0 0
0 0
9 0
300 0
0 0
17 0
0 0
82 50 50 50
3,177 2,500 2,500 2,500
0 0
91 50 60 60
67 50 50 50
0 0
656 1,000 1,000 1,000
1,728 2,000 2,000 2,000
43 0
42 0
10 0
58 0
0 0
0 0
4,339 0
3,265 2,500 2,500 2,500
0 0
60 24 25 25
501 500 0
30 0
0 0
5,757 0
6 300 300 300
55 24 25 25
 137 0
246 0
3,454 3,000 3,000 3,000
0 0
0 0
0 0
510 0
0 0
390 0
0 0
51 0
0 0
33 0
514 300 300 300
0 0
9 0
50 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
30 0 0
346 200 200 200
102 0
0 0
0 0
0 0
50 24 24 24
0 0
2 24 0
0 24 0
1,384 0
4,333 2,500 2,500 2,500
0 0
0 0
0 0
0 0
435 0
0 0
0 0
 0 0
2 24 24 24
0 0
4,128 1,000 1,000 1,000
0 0
0 0
410 0
500 0
38 500 500 500
1,506 1,000 1,000 1,000
2,337 500 0
0 0
270 0
0 0
0 0
0 0
0 0
0 0
0 0
2,162 2,000 2,000 2,000
0 0
67 24 24 24
47 0
44 24 30 30
70 0
543 200 200 200
0 0
0 0
0 0
0 0
0 0
138 50 50 50
0 0
776 1,000 1,000 1,000
185 60 60 60
255 200 0
0 0
578 300 300 300
50 0
0 0
2,641 1,000 1,000 1,000
0 0
0 0
1,883 500 0
0 0
 0 0
191 300 0 0
0 0
0 0
0 0
0 0
69 24 24 24
0 0
0 0
0 0
1,999 500 500 500
0 0
0 0
0 0
0 0
10 0
1 0
0 0
0 0
0 0
0 0
0 0
12 50 50 50
0 24 0
0 24 0
0 0
20 0
0 150 150 150
0 0
3,378 0
16 50 96 96
0 0
2,226 6,000 6,000 6,000
0 0
0 0
0 0
1,768 0
1,375 1,000 1,000 1,000
0 0
0 0
10 0
4 2 2 2
1,034 1,000 1,000 1,000
0 0
0 0
 0 0
0 0
0 0
0 0
629 500 500 500
101 30 30 30
0 0
0 0
0 0
0 0
234 200 200 200
1,550 0
22 0
12 50 50 50
834 300 300 300
30 0
29 0
1 0
7 0
0 0
1,255 500 500 500
0 1,000 0
1,168 500 500 500
588 0
0 0
0 0
0 0
0 0
0 0
0 0
-9 0
954 0
0 0
2,306 1,000 1,000 1,000
0 0
1,834 1,500 1,500 1,500
0 1,000 500 500
0
0
969 0
31 0
197 500 500 500
38 0
0 0
0 0
 0 0
529 0
59 0
0 0
0 0
4 24 0
0 0
0 0
6 0
0 0
0 0
0 0
0 0
23 0
122 1,000 0
0 0
15 10 10 10
0 0
500 500 500 500
0 0
60 30 30 30
0 0
0
0
0 0
0 0
0 0
0 0
3 5 0
0 0
0 0
3 0
1 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0
0
20 0
2,500 0
100 0
0 0
1,257 300 300 300
490 0
0 0
60 0
0 0
0 0
6 3 3 3
283 0
50 50 50 50
300 0
0 0
0 0
136 50 50 50
50 50 50 50
0 0
10 0
3 3 3 3
0 0
0 0
50 100 100 100
0 0
65 10 10 10
0 0
0 0
0 0
0 0
100 0
20 0
0 0
0 0
0 0
-4 0
5 0
0 0
5 0
0 0
5 0
0 0
0 0
10 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
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 0
0 0
0 0
0 0
0 0
0 0
0
0
0 30 30 30
15 10 10
0
0

Jumlah
 2,333
375
376
3,084

Yang Meminta Yang Menerima

Kepala UPTD Puskesmas Petugas Puskesmas

.Si,Apt Retno Wulandari Amd

04 2 024 NIP 19711223 199503 2 002
PUSKESMAS KEDAWUNG 1
PERMINTAAN BULAN DESEMBER 2018

NO NAMA JUMLAH NO NAMA JUMLAH

1 Amoksisilin injeksi 50 49 Anti Diare kombinasi ( Dewasa ) 500
2 Amoksisilin kab 500 mg 2500 50 Salep Luka Bakar 10
3 Amoksisilin Sirup 125 mg 60 51 Tablet Tambah Darah + Vitamin 500
4 Ampisilin injeksi 1 gram 50 52 Vitamin neurotropik inj 30
5 Antalgin tab 500 mg 1000 53 Alat suntik 2,5 ml / 3ml 300
6 Antasida Doen tab 2000 54 Etanol 70 % 3
7 Asam Mefenamat kap 500 mg 2500 55 Infus Set anak 50
8 Asiklovir salep kulit 25 56 IV Cateter No. 22 ( Dewasa ) 50
9 Betahistin mesilat tab 300 57 IV Cateter No. 24 ( Anak ) 50
10 Betamethason salep kulit 25 58 Kapas Adsorben 250 gr 3
11 Deksametason tab 0,5 mg 3000 59 Kasa Pemb Hydro 4 m x 15 cm 100
12 Domperidon tab 10 mg 300 60 Kasa Steril 16 x 16 ( 16 lmb ) 10
13 Fitomenadion tab 10 mg 200 61 Aminofluid infus 30
14 Gentamicin tetes mata 0,3 % 24 62 Ventolin ampul 10
15 Gliseril guaiakolat tab 2500
16 Hidrokortison salep kulit 24
17 Ibuprofen tab 200 mg 1000
18 Kalium Diklofenak 50 mg 500
19 Kalsium Laktat tab 500 mg 1000
20 Klorafeniramin ( CTM ) tab 2000
21 Kloramfenikol salep mata 1 % 24
22 Kloramfenikol tetes mata 0,5 % 30
23 Kloramfenikol kap 250 mg 200
24 Kotrimoksazol suspensi 50
25 Kotrimoksazol tab 480 mg 1000
26 Lidokain comp injeksi 60
27 Metformin 500 300
28 Methoklopramide tab10 mg 1000
29 Metronidazol tab 500 mg 0
30 Myconazol salep kulit 24
31 Natrium Dikofenak 50 500
32 Obat Batuk Hitam sirup 50
33 Omeprazol kaps 150
34 Parasetamol sirup 96
35 Parasetamol tab 500 mg 6000
36 Piroksikam tab 10 mg 1000
37 Povidon Iodium 10% 300 ml 2
38 Prednison tab 5 mg 1000
39 Ranitidine 150 mg 500
40 Ranitidine inj 30
41 Ringer Laktat Infus 200
42 Salysil bedak 2 % 50
43 Sefadroksil 500 cps 300
44 Sianokobalamin tab ( Vit. B12 ) tab 500
45 Simvastatin 10 500
46 Tiamin HCl / B1 Tab 50 mg 1000
47 Vitamin B Komplek tab 1500
48 Zink 500