LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

PUSKESMAS
DOKUMEN NOMOR TANGGAL
PUSKESMAS : PEMBANTU MUNDEH KAUH PELAPORAN BULAN/PERIODE : AGUSTUS 2018 DISKES
KECAMATAN : SELEMADEG BARAT PERMINTAAN BULAN/PERIODE: SEPTEMBER 2018 PUSKESMAS
KABUPATEN : TABANAN
Sumber
Stok Penerima Persedia Pemakai Stok
No Nama Obat Satuan Sisa Stok Permintaan Pemberian Ket
Awal an an an Optimum PKD PPKD Prog/Prov Lain

2 3 4 5 6 7=(5+6) 8 9=(7-8) 10 11=(10-9) 12 13 14 15 16 17

1 Acyclovir Salep Tube 2 2 1 1
2 Acyclovir 400 mg Tab Tablet 90 90 10 80
3 Air raksa dental use Botol - - -
4 Albendazol 400 mg tab Tablet - - -
5 Alprazolam 0.5 mg Tablet - - -
Alupurinol 100 mg tab / Selespurin/
6 Proxuric Tablet - - -
7 Ambroxol syr Botol 2 2 1 1 2
8 Ambroxol tab 30 mg / Promukus Tablet 80 80 10 70
9 Aminofilina injeksi 24 mg/ ml. 10 ml Ampul - - -
10 Aminofilna tablet 200 mg Tablet - - -
11 Amitriptilina hcl tablet salut 25 mg Tablet - - -
Amoksilina kapsul 500 mg
12 Tablet 95 95 85 10 100
Amoksilna sirup kering 125 mg/ 5 mg
13 Botol 1 1 1 2
14 Antasida doen tablet kombinasi Tablet 5 5 5 - 100
15 Anti hemmoroid suppositoria Supp - - -
16 Aqua pro injeksi streril. Bebas priogen Vial - - -
20 ml
17 Aquadest steril 500 ml Botol - - -
As salisilat 2% + belerang endap 4%(2-
18 Pot - - -
4 salep
As. Benzoat 3 % + as salisilat 6%
19 Pot - - -
(whitefield)
20 Asam askorbat (Vit. C) tablet 50 mg Tablet - - -
21 Asam mefenamat 500 mg Tablet 50 50 35 15 100
22 Asetosal 100 mg Tablet - - -
23 Asetosal tablet 500 mg Tablet - - -
24 Atropina sulfat injeksi 0 .25 mg / ml - 1 Ampul - - -
ml
25 Basitrasin Polimiksin Tube - - -
26 Besi (II) sulfat tablet salut .kombinasi Tablet - - -
27 Betahistin tab Tablet - - -
28 Betametazon salep kulit Tube - - - 3
29 Captopril 12.5 mg tablet Tablet - - -
30 Captopril 25 mg tablet Tablet - - - 100
31 Carbamazepina 200 mg talet Tablet - - -
Cefadroxil 125mg/5ml Sirup
32 Botol - - -
Cefadroxill 500 mg tablet
33 Tablet - - -
34 Cefotaxim 1 gr Injeksi Ampul - - -
35 Cetirizin10 mg tab Tablet - - -
36 Cimetidine/Selestidin Tablet - - -
37 Ciprofloxazin tablet 500 mg Tablet - - -
38 Deksametason injeksi 5 mg / ml - 1 ml Ampul - - - 5
39 Deksametason tablet 0.5 mg Tablet 25 100 125 20 105

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Devitalisasi pasta
40 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 - Ampul 2 2 - 5
ml
45 Digoksina tablet 0. 25 mg Tablet - - -
Domperidon tablet 10 mg
46 Tablet - - -
47 Doxycicline 100 mg tab Tablet - - -
48 Efedrina HCL (efedrina) tablet 25 mg Tablet - - -
49 Epinefrina HCL / bitartat (aderenalina) Ampul 2 2 2
inj 01%
50 Ergotamina tartrat 1 mg + kofeina 50 Tablet - - -
mg tab
51 Erytromysin 200mg/5ml Syrup Botol - - -
52 Erytromysin tablet 500 mg Tablet - - -
Etakridina (rivanol) larutan 0.1 %
53 Botol - - -
Etil klorida semprot
54 Botol - - -
55 Eugenol cairan Botol - - -
56 Fenobarbital inj 50 mg /ml -2ml Ampul - - -
57 Fenobarbital tablet 100mg Tablet - - -
58 Fenobarbital tablet 30 mg Tablet - - -
59 Fenol gliserol tetes telnga 10% Botol - - -
60 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul - - -
61 Fitomenadion (vit. K1) tablet salut 10 Tablet - - -
mg
62 Furosemida tablet 40 mg Tablet - - -
63 Garam Oralit untuk 200 ml air Sachet - - -
64 Gentamisin Salep Mata Tube 2 2 2
65 Gentamysin SK Tube - - -
66 Gentamysin TM/Genoint TM Botol - - -
Gentian violet larutan 1 %
67 Botol - - -
Glibenklamida tablet 5 mg
68 Tablet - - -
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 - - -
77 Hidroklorotiasida (HCT) tablet 25 mg Tablet - - -
78 Hidrokortison krim 2.5 % Tube - - -
79 Ibuprofen tablet 400 mg Tablet 120 0 120 120
80 Isoniazide 100 mg Tablet - - -
Isoniazide 300 mg
81 Tablet - - -
Isosorbid dinitrat
82 Tablet - - -
83 Kalsium hidroksida pasta Pot - - -
84 Kalsium laktat (kalk) tablet 500 mg Tablet - - -
85 Ketokonazole 200 mg tablet Tablet - - -
Kinina dihidroklorida (kinina) inj 25 % - 2
86 Ampul - - -
ml

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Kinina sulfat tablet 222 mg (7 h20 )
87 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 % Bot - - -
93 Klorfeniramina maleat (CTM) tablet 4 Tablet 50 50 10 40
mg
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 - - -
Kotrimoksasol tablet kombinasi
100 Tablet - - -
Lidokain inj
101 Ampul 2 2 2 - 2
102 Lidokaina comp inj kombinasi Ampul - - -
103 Metakresol sulfonat dan metanol Botol - - -
kondensai (Albotyl)
104 Metformin 500 mg tablet Tablet - - -
105 Metilergometrina maleat inj 0. 200 g / Ampul - - -
ml- ml
106 Metilergometrina malet tablet salut 0. Tablet - - -
125 mg
107 Metilprednisolon tablet 4 mg Tablet - - -
108 Metoklopramide 10 mg tablet/Noristal Tablet - - -
109 Metronidazol 500 mg Tablet 50 50 50 - 100
110 Metronidazol tablet 250 mg Tablet - - -
111 Mikonazole salep Tube 2 2 2
112 Monoklorkamfer mentolcairan (CHKM) Botol - - -
113 Mumifyng pasta Botol - - -
Natrium bikarbonat tablet 500 mg
114 Tablet - - -
Natrium Diklofenak 50
115 Tablet 90 0 90 20 70
(Nadifen/Prostanac)
116 Natrium klorida larutan infus 0. 9 steril Botol 1 1 1
117 Nifedipin tablet 10 mg Tablet - - -
118 Nistatin 100. 000 iu/g tablet vaginal Tab Vag - - -
119 Obat batuk hitam (OBH) cairan Botol 10 - - -
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 1 1 1
124 Oksitetrasiklina hcl salep mata 1 % Tube - - -
125 Oksitosina inj 10 iu/ml - 1 ml Ampul - - -
126 Parasetamol sirup 120 mg / 5 ml Botol - - - 5
127 Parasetamol tab 100 mg Tablet - - -
Parasetamol tablet 500mg
128 Tablet 115 0 115 80 35 100
Pirantel pamoat (pirantel) tablet 125 mg
129 Tablet - - -
basa
Piroxicam 10 Mg
130 Tablet - - -
131 Piroxicam 20 Mg Tablet - - -
132 Prednison tablet 5 mgn Tablet - - -
133 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet - - -

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Primakina tablet 15 mg
134 Tablet - - -
135 Prokaina penisilina g inj 3 juta iu Vial - - -
136 Propiltionurasil tablet 100 mg Tablet - - -
137 Propranolol hcl (Propranolol) tablet 40 Tablet - - -
mg
138 Pyridoxin injeksi Ampul - - -
139 Ranitidin inj 25 mg/2 ml Ampul - - -
140 Ranitidin tablet 150 mg Tablet 40 100 140 20 120
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 1 1 1
146 Risperidon Tablet - - -
Salbutamol tablet 2 mg
147 Tablet - - -
Salbutamol tablet 4 mg
148 Tablet 80 80 40 40
149 Salisil bedak 2 % Bks 2 2 2 100
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 2 2 2 5
155 Silver amalgam serbuk 65-75% Botol - - -
156 Simvastatin tab 10 mg Tablet - - -
157 Sulfacetamide tetes mata Botol - - -
158 Synthetic filing material larutan dan Set - - -
serbuk
159 Temporary stopping fletcher serbuk dan Set - - -
cairan
160 Tetrasiklina hcl (tetrasiklina) kapsul 250 Tablet - - -
mg
Tetrasiklina hcl (tetrasiklina) kapsul 500
161 Tablet 30 30 0 30
mg
162 Thiamfenikol 500 Tablet - - -
163 Tiamin hcl /mononitrat (vit.b1) tablet 50 Tablet - - -
mg
164 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul - - -
165 Tramadol Tablet - - -
Trifluoperazine (Stelazin)
166 Tablet - - -
Triheksfenidil hcl 2 mg tablet
167 Tablet - - -
168 Trikresol formalin (tkf) cairan Botol - - -
169 Vitamin B kompleks tablet Tablet - - -
170 Yodium povidan larutan 10% 300 ml Botol - - -
171 Yodium povidon larutan 10% 30 ml Botol - - -
172 Zink tablet Tablet - - -
- - -
OBAT TAMBAHAN - - -
173 Aptil Botol - - -
174 (Lopinavir/Ritonavir)Aluvia Botol - - -
175 Abacavir Tablet - - -
176 Acyclovir tablet 200 mg Tablet - - -
177 Aleterol TM Botol - - -
Amlodipin 10 mg tab
178 Tablet - - -

4/8
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2 3 4 5 6 7=(5+6) 8 9=(7-8) 10 11=(10-9) 12 13 14 15 16 17

Amlodipin 5 mg tab
179 Tablet 30 60 90 60 30 100
180 Amox-clav Tablet - - -
181 Ampisilin Serbuk Injeksi i.m/i.v. 1000 Ampul - - -
mg/ml
Ampul
182 Ampisillin injeksi i.m/i.v 1000 mg/ml - - -
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 100 100 20 80
195 Benzatin Penisillin Vial - - -
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 Tablet - - -
Plus
219 Dextran 70% Botol - - -
220 Dextrofen syr Botol - - -
Diaform tablet/selesdiar
221 Tablet - - -
222 Dormi/Scopma/Spashi tablet Tablet - - -
223 Dulcolac anak supp Supp - - -
224 Dulcolac dewasa supp Supp - - -
225 Dulkolak tablet Tablet - - -

5/8
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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 Folley catheter Pcs - - -
235 Forumen TT Fls - - -
236 Gentamisin Injeksi 80 mg/2ml Ampul - - -
237 Glass ionomer (Ketac Molar) Tube - - -
238 Glimepiride 2 tablet 50 50 50
239 Glimepiride 4 tablet - - -
Ampul
240 Glukonas Calcicus 10%- 10ml - - -
241 Haldol inj Ampul - - -
242 Hiviral (Lamivudin 150) Botol - - -
243 Ibuprofen syr btl - - -
244 Iliadin TH flesh - - -
245 Isotic Neolisin TM Fls - - -
246 Kalium Diklovenac tablet - - -
247 Kaltropen supp Supp - - -
248 Ketoconazole SK tube - - -
249 Ketoprofen inj 10 mg Ampul - - -
250 Ketoprofen tablet 100 mg Tablet - - -
251 Ketorolac inj Ampul - - -
252 Kombipak Anak Paket - - -
253 Lodomer 2 Tablet - - -
Lytamin syr
254 botol - - -
Magnesium Sulfat 20% - 25 ml Botol
255 - - -
Botol
256 Magnesium Sulfat 40% - 25 ml - - -
257 Metil Prednisolon 16 mg Tablet - - -
258 Metil prednisolon inj 500 mg Vial - - -
259 Metronidazole 500 mg Infus/100 ml Botol - - -
260 Meylon inj Botol - - -
261 Microlax Supp - - -
262 Miloxicam 7,5 mg tablet - - -
263 Molexflu Tablet - - -
264 Multivitamin (Livron B plek) Tablet - - -
265 Multivitamin sirup( Xanvit syr) Botol - - -
266 Neurotropik tablet Tablet - - -
267 Neviral (neviravin 200mg) Botol - - -
268 New antides tablet 20 20 0 20
269 Nutrifar 5000 Tablet - - -
270 Obat anti tuberkulosis FDC katagori I Paket - - -
271 Obat anti tuberkulosis FDC anak Paket - - -
272 Obat anti tuberkulosis FDC katagori II Paket - - -

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Obat anti tuberkulosis FDC sisipan
273 Paket - - -
274 Obat anti tuberkulosis kategori I Paket - - -
275 Obat Batuk Kombinasi Botol - - -
276 Obat Flu kombinasi CTM, PPA (Anaflu), Tablet 20 100 120 65 55 100
Demacolin
277 Obat Flu Kombinasi/Mecofed/Quantidex Tablet - - -
278 OBH plus botol - - -
279 Omeprasole tablet 20 mg Tablet - - -
280 Ondancentron inj Ampul - - -
281 Ondancetron 4 mg Tablet - - -
282 Orpen Tablet - - -
283 Oseltamivir Tablet - - -
284 Paket bonding Set - - -
285 Pamol 125 mg Supp Supp - - -
286 Pamol 250 mg Supp Supp - - -
Pantocain Tetes Mata
287 Botol - - -
288 Parasetamol drop Botol - - -
289 Pehacain Injeksi Ampul - - -
Pehatrim Forte (Kotrimoksasol tab forte
290 Tablet - - -
960 mg)

291 Perhidrol (H2O2) Botol - - -

292 Phenitoin tab Tablet - - -
Piracetam 400 mg
293 Tablet - - -
Piracetam inj 200mg/1ml
294 Ampul - - -
295 Pirimethamine tablet Tablet - - -
296 Prenatin DF Tablet 40 40 10 30 100
297 Prenatin plus tablet tablet - - -
298 Primaquin Tablet - - -
299 Primperan inj Ampul - - -
300 Procurma sirup botol 2 2 2
301 Prokain Benzil Penicillin G Injeksi 3 jt Vial - - -
IU/vial
302 Proris supp Supp - - -
303 Pularex Tablet - - -
304 Scabimite cream tube - - -
305 Sikzonoate inj Ampul - - -
306 Simvastatin tab 20 mg Tablet - - -
Spashi inj
307 Ampul - - -
Spashi tab
308 Tablet - - -
309 Stelosi tab 5 mg Tablet - - -
310 Stesolid rectal Supp - - -
311 Strop indra Botol - - -
312 Sulfadiazin tablet Tablet - - -
313 Tenofovir (Tenofovir 300mg) Botol - - -
314 Tetagam Ampul - - -
315 Tramadol inj 50 mg/ml Ampul - - -
316 Tranexid inj (Asam tranexamat inj) Ampul - - -
317 Urotractin tablet - - -
318 Ventolin Nebulizer Ampul - - -

7/8
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Vitamin B12 tab
319 Tablet - - -
320 Vitamin Neurotropik inj Ampul - - -
321 Vitamin Neurotropik tablet (Nutrifar, Tablet - - -
Sohobion)
322 VitKa infan Ampul - - -
323 Xylocain Gel Ampul - - -
324 Zidovudine 100 mg Tablet - - -
- - -

BMHP - - -
325 ADS 0.5 ml Pcs - - -
ADS 0.05 ml
326 Pcs - - -
327 ADS 2 ml Pcs - - -
328 ADS 5 ml Pcs - - -
329 Alat suntik sekali pakai 1 ml Pcs - - -
330 Alat suntik sekali pakai 2,5 ml Pcs - - -
Alat suntik sekali pakai 5 ml
331 Pcs - - -
Bisturi no 13
332 Pcs - - -
333 Bisturi no 14 Pcs - - -
334 Bisturi no 19/20 Pcs - - -
335 Bisturi no 21 Pcs - - -
336 Box slide kotak - - -
337 Catgut 2/0 plain Sachet - - -
338 Catgut / benang bedah no 2/0 chromic Sachet - - -
339 Catgut / benang bedah no 3/0 plain Sachet 2 2 2
340 Catgut 1/0 Chromic Pcs - - -
341 Catgut 2/0 Chromic Roll Roll - - -
342 Catgut 3/0 Chromic Roll Roll - - -
343 Cutgut Chromic No.1 atraumatik (sachet) Sachet - - -
344 Etanol 70 % Botol - - -
345 Etanol 70 % Botol 10 - - -
Film Rontgen 18 x 24
346 Set - - -
347 Hypavix (Ultrafik) Roll - - -
348 I.V Catheter 22 Pcs - - -
349 I.V Catheter 24 Pcs - - -
350 Infusion set anak Set - - -
351 Infusion set dewasa Set - - -
352 IV Cath dgn Katup pcs - - -
353 IV Catheter 18 Pcs - - -
354 IV Catheter 20 Pcs - - -
355 IV Catheter no 18 G Terumo Pcs - - -
356 IV Catheter no 20 G Terumo Pcs - - -
357 Jarum injeksi Pcs - - -
358 Jarum jahit (bedah) no. 9 s/d 14 Set - - -
Jarum Jahit Bedah no 12
359 Set - - -
Jarum Jahit Bedah no 13
360 Set - - -
361 Jarum Jahit Bedah no 14 Set - - -
362 Jarum Kulit Set - - -

8/8
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Jarum Otot dan Kulit
363 Set - - -
364 Jelly RO Tube - - -
365 Kantung Puyer Pak - - -
366 Kapas pembalut / absorben 250 gram Roll - - -
367 Kasa gulung 40 x 80 Roll - - -
368 Kasa Hidrofil 4 x 10 Roll 2 2 2
369 Kasa kompres 40 / 40 steril Roll - - -
370 Kasa pembalut 2 x 80 Roll - - -
371 Kasa pembalut hidrofil 4 m x 15 cm Roll - - -
372 Kasa pembalut hidrofin 4m x 3 cm Roll 4 4 3 1
373 Kasa Steril ( 18 x 22 ) Kotak 6 6 1 5
374 Kertas EKG Roll - - -
Lembar
375 Kertas saring - - -
Kertas USG
376 Roll - - -
Klem Tali Pusar
377 pcs - - -
Klip Kecil
378 Pak - - -
379 Klip Tanggung Pak - - -
380 Lampu spiritus botol - - -
381 Lisol mengandung kresol Botol - - -
382 Masker Pcs - - - 1 BOX
383 Masker Bedah Pcs - - -
384 Masker N95 Pcs - - -
385 MY Jelly Tube - - -
386 Nasal cannula Oksigen pcs - - -
387 Pembalut Gips Roll - - -
388 Perkamen Pak - - -
389 Plester 5 yard x 2 inch Roll - - -
390 Pot Salep Pot - - -
Pot Sputum
391 Pcs - - -
392 Safety box Pcs - - -
393 Sarung Tangan Gynaecologi pasang - - -
394 Sarung Tangan L Pasang - - -
395 Sarung Tangan M Pasang - - -
396 Sarung Tangan S Pasang - - -
397 Sarung Tangan Steril Pasang - - -
398 Sarung Tangan Surgiglove Pasang - - -
399 Sendok Takar Pcs - - -
400 Silk 3/0 roll Roll - - -
401 Silk (benang bedah sutera) no.3/0 Pcs - - -
402 Slide Prosted Pak - - -
403 Spalk tungkai atas anak Pcs - - -
Spalk tungkai atas dewasa
404 Pcs - - -
Spalk tungkai bawah anak
405 Pcs - - -
406 Spalk tungkai bawah dewasa Pcs - - -
407 Spuit 10 ml Pcs - - -
408 Spuit 2/3 ml Pcs - - -
409 Transfusi Set Pcs - - -

9/8
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410 Uji Tuberkulin Vial - - -
411 Underpad Pak - - -
412 Urinebag Set - - -
413 Wing Needle 21 Pcs - - -
414 Wing Needle 23 Pcs - - -
415 Wing Needle 25 Pcs - - -
416 Wing Needle 27 Pcs - - -

Mengetahui/Menyetujui Yang Meyerahkan Yang Meminta/Melapor

Kepala Puskesmas Selemadeg Barat Petugas Pustu

dr. Wayan Arya Putra Manuaba Ni Made Nuartini I.A.Pt Ekawiyadnyani, A.Md.Keb
NIP. 197211072005011008 NIP.196412311990032079 NIP.198305262017052001

10/8
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO) BMHP
PUSTU MUNDEH KAUH

PUSKESMAS : SELEMADEG BARAT

KECAMATAN : SELEMADEG BARAT PELAPORAN BULAN/PERIODE : AGUSTUS 2018
KABUPATEN : TABANAN PERMINTAAN BULAN/PERIODE SEPTEMBER

Stok Stok Ket/

KODE NO NAMA BAHAN MEDIS HABIS PAKAI Satuan Penerimaan Persediaan Pemakaian Sisa Stok Permintaan Penerimaan
Awal Opt Exp.
1 2 3 4 5 6=(4+5) 7 8 9 10=(9-8) 11
B1 1 Alat suntik sekali pakai 2,5 ml Pcs 39 39 3 36 4
B2 2 Alat suntik sekali pakai 5 ml Pcs - - -
B3 3 Catgut / benang bedah no 2/0 chromic Sachet - - -
B4 4 Catgut / benang bedah no 3/0 chromic Sachet - - -
B5 5 Catgut / benang bedah no 2/0 plain Sachet - - -
B6 6 Catgut / benang bedah no 3/0 plain Sachet - - -
B7 7 Kapas pembalut / absorben 250 gram Roll 1 1 1 -
B8 8 Kasa gulung Roll - - -
B9 9 Kasa pembalut hidrofil 4 m x 15 cm Roll -
B10 10 Silk (benang bedah sutera) no.3/0 Pcs - - -
B11 11 Folley catheter Pcs - - -
B12 12 IV Catheter 24 Pcs - - -
B13 13 IV Catheter 20 Pcs - - -
B14 14 Sarung Tangan M Pasang 24 24 15 9 21
B15 15 Sarung Tangan S Pasang - - -
B16 16 Sarung Tangan L pasang - - -
B17 17 Urinebag Set - - -
B18 18 Jarum Injeksi Pcs - - -
B19 19 Sarung Tangan Steril M Pcs - - -
B20 20 Jarum Otot Kulit Set - - -
B21 21 Bisturi 11 Pcs - - -
B22 22 Bisturi 21 Pcs - - -
B23 23 Bisturi 20 Pcs - - -
B24 24 Jelly Tube - - -
B25 25 Perkamen Pak - - -
B26 26 Klip Plastik 10x7 Pak - - -
B27 27 Klip Plastik 13x8,7 Pak - - -
B28 28 Daryantul Lembar - - - 1
B29 29 Hypafix Pak - - - 5
B30 30 Alkohol 70 % 1 liter Brataco btl - - - 1
B31 31 IV cath no .22 Pcs - - -
B32 32 IV cath no .18 Pcs - - -
B33 33 Lisol Botol - - -
B34 34 H2O2 Onemed Botol - - -
B35 35 Alat suntik sekali pakai 3cc TOP pcs - - -
 Stok Stok Ket/
KODE NO NAMA BAHAN MEDIS HABIS PAKAI Satuan Penerimaan Persediaan Pemakaian Sisa Stok Permintaan Penerimaan
Awal Opt Exp.
1 2 3 4 5 6=(4+5) 7 8 9 10=(9-8) 11
B36 36 Alat suntik sekali pakai 5cc TOP pcs - - -
B37 37 Kasa pembalut 2 x 80 Bunda Biru Bungkus - - -
B38 38 Kasa gulung anugrah Roll - - - 1
B39 39 Kasa hidrofil 4 x 10 Bunda Biru pcs - - -
B40 40 Kasa hidrofil 18 x 22 anugrah pack - - -
B41 41 Sarung tangan nitril L Pasang - - -
B42 42 Sarung tangan nitril M Pasang - - -
B43 43 Silk no.3/0 pcs 2 2 1 1 1
B44 44 Masker Jeva pcs - - - 1
B45 45 Jarum Otot Kulit Onemed set - - -
B46 46 Jelly ultrasonic tube - - -
B47 47 Klip plastik obat 10 x 7 pack 1 1 1 -
B48 48 Klip plastik obat 13 x 8,7 pack 1 1 1 - 1 1
B49 49 Daryantule (Vaseline Swab) lembar - - -
B50 50 Hypafix 5 x 5 roll - - -
B51 51 Infuset dewasa pcs 1 1 1 -
B52 52 Blood Set OM pcs - - -
B53 53 Jarum injeksi needle 23 OM pcs - - -
B54 54 Kasa Gulung 4 x 15 m bunda biru roll 3 3 2 1 3 5
B55 55 Nitrile Gloves White M Supercare Pasang - - -
B56 56 Nitrile Glove White L Supercare pasang - - -
B57 57 Strip Glucose Supersensor @ 50 GlucoDR box - - -
B58 58 Golda Anti A Monoclonal 10 ml J.Mitra vial - - -
B59 59 Golda Anti B Monoclonal 10 ml J.Mitra vial - - -
B60 60 Strip Cholesterol Benecheck @10 pcs box - - -
B61 61 Strip Asam Urat Benecheck box - - -
B62 62 Strip Hemoglobin Mission Plus box - - -
B63 63 Tes Kehamilan Onemed box - - - 2
B64 64 Hypapix 15cm X 5m BSN Roll - - -
B65 65 Strip Glucose Active @50 Accu Check box - - -
B66 66 Selang Oxygen Anak GEA pcs - - -
B67 67 Selang Oxygen Dewasa GEA Pcs - - -
B68 68 Matabur Type Fissure High pcs - - -
B69 69 Komposit A3 (Estelite Quick) pcs - - -
B70 70 Bonding Te-Econom Bond botol - - -
B71 71 ETSA (Opal Etch) botol - - -
B72 72 Carviton (Cervitron White) botol - - -
B73 73 Urinalysis 10 SG 100 Test Insight Expert Acon pcs - - -
B74 74 Calsidor Dorident pcs - - -
B75 75 Matabor Mani Set 6 set - - -
B76 76 Matapex Metabiomed pcs - - -
B77 77 Multifix (Elite Cement) set - - -
 Stok Stok Ket/
KODE NO NAMA BAHAN MEDIS HABIS PAKAI Satuan Penerimaan Persediaan Pemakaian Sisa Stok Permintaan Penerimaan
Awal Opt Exp.
1 2 3 4 5 6=(4+5) 7 8 9 10=(9-8) 11
B78 78 TKF (Cresoformalin) pcs - - -
B79 79 Calcium Hydroxit (Calcidor) pcs - - -
B80 80 Articulating Paper pcs - - -
B81 81 Ruwa Matrix Strip Camden pcs - - -
B82 82 Pipet 1 ml Plastik Biomedika pcs - - -
B83 83 Golda Anti B Monoclonal 10 ml J.Mitra vial - - -
B84 84 Infuset Dewasa Remidi pcs - - -
B85 85 Inflo IV Catheter No. 18 Onemed pcs 1 1 1 -
B86 86 Inflo IV Catheter No. 20 Onemed pcs - - -
B87 87 Inflo IV Catheter No. 22 G Onemed pcs - - -
B88 88 Inflo IV Catheter No. 24 G Onemed pcs - - -
B89 89 Foley Catheter 2 Way FR 20 Remidi pcs - - -
B90 90 Foley Catheter 2 Way FR 16 GEA pcs - - -
B91 91 Glove Surgical Sterile No 7,5 Latex Powered Eu Pasang - - -
B92 92 Latex Glove L Supercare Pasang - - -
B93 93 Latex Glove M Supercare Pasang - - -
B94 94 Disposible Syring 3cc TP pcs - - -
B95 95 Masker 3 ply Karet Remidi pcs - - -
B96 96 Jarum Hecting Nald Combi Onemed set - - -
B97 97 Perhidrol 3 % Onemed botol - - -
B98 98 Strip Glucose Active @50 Accu Check box - - -
B99 99 Strip Glucose @25 easy touch box - - -
B100 100 Alkohol Swab pack - - - 1 kotak
B101 101 Underpad onemad pack - - -
B102 102 Rivanol 0,1% 300ml onemed botol - - -
B103 103 Vasofix IV G18X33 mm Green Bbraun pcs - - -
B104 104 Vasofix IV G20X33 mm Green Bbraun pcs - - -
B105 105 Vasofix IV G22X33 mm Green Bbraun pcs - - -
B106 106 Mess no.11 @100 Aesculap Bbraun pack - - -
B107 107 Stip HB Family Dr @25 box - - -
B108 108 GC-Fuji IX 1-1 #Extra A2 buah - - -
B109 109 GC-Fuji VII 1-1 White buah - - -
B110 110 GC-Caviton Pink buah - - -
B111 111 Biodinamica-Eugenol 20ml botol - - -
B112 112 Devitec PD-Non Arsen botol - - -
B113 113 Vitapex syringe - - -
B114 114 Septodont-Rolde's botol : 13ml botol - - -
B115 115 Svenska-saliva ejector : 100pcs Bungkus - - -
B116 116 Folley catheter no 24 buah - - -
B117 117 Onemed/GT9-Jarum Jahit Kulit No.9 pck : 12 pc pack - - -
B118 118 Onemed/GT10-Jarum Jahit Kulit No.10 pck : 12 pack - - -
B119 119 Onemed/GT11-Jarum Jahit Kulit No.11 pck : 12 pack - - -
 Stok Stok Ket/
KODE NO NAMA BAHAN MEDIS HABIS PAKAI Satuan Penerimaan Persediaan Pemakaian Sisa Stok Permintaan Penerimaan
Awal Opt Exp.
1 2 3 4 5 6=(4+5) 7 8 9 10=(9-8) 11
B120 120 Onemed/GT12-Jarum Jahit Kulit No.12 pck : 12 pack - - -
B121 121 Onemed/GT13-Jarum Jahit Kulit No.13 pck : 12 pack - - -
B122 122 Onemed/GT14-Jarum Jahit Kulit No.14 pck : 12 pack - - -
B123 123 Onemed-Wing Needle No. 23 buah - - -
B124 124 Onemed-Wing Needle No. 27 buah - - -
B125 125 Bene Check - Strip Uric Acid box : 25's box - - -
B126 126 Bene Check - Strip Cholesterol box : 10's box - - -

Mengetahui/Menyetujui Yang Meyerahkan Yang Meminta/Melapor

Kepala Puskesmas Selemadeg Barat Petugas Pustu

dr. Wayan Arya Putra Manuaba Ni Made Nuartini Ni Made Ayu Adiani,A.Md.Keb
NIP. 197211072005011008 NIP.196412311990032079 Nip 198510182017052001