LPLPO Juli 2019 (Permintaan)

DOKUMEN RENCANA KEBUTUHAN OBAT PUSKESMAS TAHUN 2019
PUSKESMAS :
KECAMATAN :
KABUPATEN : OGAN KOMERING ILIR
PROPINSI : SUMATERA SELATAN
NO. NAMA OBAT JAN FEB MAR APR MEI JUN JULI AGST SEPT OKT NOP DES TOTAL
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
1 Absorbent tipped applicator (alcohol swab) 52 102 439 91 337 503 480 0 0 0 0 1000 3004
2 Acetylcystein Kapsul 200mg 83 32 279 565 240 380 220 0 0 0 0 0 1799
3 Acyclovir tab 200 mg 80 150 310 630 0 0 0 0 0 0 0 0 1170
4 Acyclovir cream 6 2 0 0 0 0 0 0 0 0 0 0 8
5 Albendazol tab 400 mg 60 0 18 6 34 20 18 0 0 0 0 0 156
6 Alkohol Liquid (etanol) 70%-1000 ml 5 2 7 3 12 6 12 0 0 0 0 0 47
7 Allopurinol 100 mg 60 430 200 340 0 41 89 0 0 0 0 0 1160
8 Aminophylline Inj 24 mg/ml-10 ml 0 0 100 0 0 0 0 0 0 0 0 0 100
9 Aminophylline tab 200 mg 300 240 200 0 260 114 186 0 0 0 0 0 1300
10 Amitriptyline 25 mg tab 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Amlodipine tab 5 mg 720 450 430 905 313 301 466 0 0 0 0 0 3585
12 Amoxycillin Syr 0 0 0 0 0 0 50 0 0 0 0 0 50
13 Amoxycillin 250 mg 140 520 264 396 270 1120 40 0 0 0 0 0 2750
14 Amoxycillin 500 mg 1018 1674 1137 1750 1294 1076 1110 0 0 0 0 0 9059
15 Ampicilin 1 gr Inj 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Antasida Syr DOEN 20 35 10 43 13 39 9 0 0 0 0 0 169
17 Antasida DOEN Kombinasi 1242 1671 1309 1484 1776 1198 462 0 0 0 0 0 9142
18 Anti Bisa Ular 5 ml (ABU I)/ Biosave 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Asam Mefenamat 500 mg tab 0 1091 2433 1476 0 0 0 0 0 0 0 0 5000
20 Ascorbic acid (Vit.C) 50 mg 1001 772 897 933 197 1055 1055 0 0 0 0 0 5910
21 Ascorbic acid |calsium carbonate 500 mg (Pehavral 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Aspirin (miniaspi) 100 mg tab 199 20 40 240 0 0 100 0 0 0 0 0 599
23 Atropine inj 0,25 mg/ml 0 0 15 0 0 0 1 0 0 0 0 0 16
24 Attapulgite Tablet (Pularex) 11 28 32 298 0 30 0 0 0 0 0 0 399
25 Attapulgite Tablet 600 mg (New Antides) 0 0 60 20 0 130 0 0 0 0 0 0 210
26 Automated blood grouping (Tes Gol. Darah) 0 1 0 0 1 0 0 0 0 0 0 0 2
27 Bahan Tambal Gigi Sementara (Fletcher/Caviton) 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Bedak Salisil 2% 5 4 12 3 24 14 40 0 0 0 0 0 102
29 Benzoic acid |salicylic acid salep (anti fungi) 0 2 0 22 0 0 24 0 0 0 0 0 48
30 Betahistine Mesylate 6 mg tab 625 125 160 465 15 65 370 0 0 0 0 0 1825
31 Betamethasone 0,1% krim 12 0 0 0 41 7 26 0 0 0 0 0 86
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
32 Bisacodyl 5mg 15 540 0 0 0 0 0 0 0 0 0 0 555
33 Bismuth subgallas (antihemoroid) 0 0 0 20 10 0 10 0 0 0 0 0 40
34 Calcium chloride lactate infus (RL) 481 647 645 419 706 581 339 0 0 0 0 0 3818
35 Calsium Laktat (Kalk) 500 mg 820 570 810 850 40 0 400 0 0 0 0 0 3490
36 Captopril 12,5 mg 600 184 436 660 1330 445 717 0 0 0 0 0 4372
37 Captopril 25 mg 910 640 170 0 0 0 0 0 0 0 0 0 1720
38 Carbamazepin tab 0 0 0 0 0 0 0 0 0 0 0 0 0
39 Catgut/Benang Chromic Bedah No.2/0-3/0 26 16 3 25 33 37 18 0 0 0 0 0 158
40 Catgut/Benang Plain Bedah No.2/0-3/0 35 4 2 3 30 0 0 0 0 0 0 0 74
41 Cefadroxil 500mg 435 19 0 0 0 0 0 0 0 0 0 0 454
42 Cetirizine 5 mg/5 ml sirup 10 4 5 48 0 21 2 0 0 0 0 0 90
43 Chloramhenicol Salep Mata 1% 0 7 3 13 3 28 1 0 0 0 0 0 55
44 Chloramphenicol Suspensi 125 mg/ml 11 37 27 40 35 20 0 0 0 0 0 0 170
45 Chloramphenicol 250 mg caps 0 12 0 100 10 0 20 0 0 0 0 0 142
46 Chloramphenicol TT 3% 0 0 0 0 0 0 0 0 0 0 0 0 0
47 Chloramphenicol/ Hidrokortison krim 2,5% 33 7 47 24 29 24 25 0 0 0 0 0 189
48 Chlorpheniramine Maleat (CTM) 4 mg 1371 1296 2201 1470 1280 1338 1402 0 0 0 0 0 10358
49 Chlorpromazine HCl 100 mg 0 0 805 0 0 0 0 0 0 0 0 0 805
50 Cimetidin 200 tab 0 0 0 0 0 0 0 0 0 0 0 0 0
51 Ciprofloxacin 500 mg tab 639 811 1710 860 420 230 0 0 0 0 0 0 4670
52 Ciprofloxacin Infus 0 0 0 0 0 0 2 0 0 0 0 0 2
53 Clindamycin 300mg 0 0 0 150 0 450 0 0 0 0 0 0 600
54 Cresol liquid 1 Liter (lysol) 2 1 3 0 2 1 0 0 0 0 0 0 9
55 Cyanocobalamin (Vit B12) inj 500 mcg/ml 10 0 0 16 9 0 0 0 0 0 0 0 35
56 Devitalisasi pasta 0 0 0 0 0 0 0 0 0 0 0 0 0
57 Dexamethasone 0,5 mg 1396 1304 0 0 0 0 0 0 0 0 0 0 2700
58 Dexamethasone inj 5mg/ml-1ml 67 0 0 0 8 30 1 0 0 0 0 0 106
59 Diazepam 5mg/ml-2 ml inj 1 0 0 0 0 0 0 0 0 0 0 0 1
60 Diazepam 2 mg 100 40 145 15 600 0 50 0 0 0 0 0 950
61 Diclofenac sodium 25 mg tab 737 1687 112 0 0 0 270 0 0 0 0 0 2806
62 Digoxin 0,25 mg 0 0 10 81 0 9 0 0 0 0 0 0 100
63 Dimenhydrinate 50mg 100 40 90 190 0 320 0 0 0 0 0 0 740
64 Dipenhidramine HCl inj 10mg/ml 0 30 30 0 60 30 0 0 0 0 0 0 150
65 Domperidone 10 mg 675 964 430 660 100 520 251 0 0 0 0 0 3600
66 Doxycycline 100 mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0
67 Epinephrine HCl/bitartrat inj 0,1% 0 24 0 0 50 0 0 0 0 0 0 0 74
68 Erythromicin Syr 5 1 0 0 0 0 0 0 0 0 0 0 6
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
69 Erythromicin 500 mg capsul 720 631 874 670 0 0 0 0 0 0 0 0 2895
70 Ethacridine (Rivanol) 0,1% 0 0 6 0 0 0 0 0 0 0 0 0 6
71 Ethanol ( Aseptan ) 500 cc+ Pump 7 1 1 4 0 0 0 0 0 0 0 0 13
72 Eugenol cairan 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Ferrous fumarate ( Tab. Tambah Darah ) 1370 25870 1770 1990 8540 3740 270 0 0 0 0 0 43550
74 Folic acid 1mg ( asam folat) 70 0 0 560 0 10 0 0 0 0 0 0 640
75 Folley Catheter No.16 8 16 1 8 9 1 1 0 0 0 0 0 44
76 Furosemida Injeksi 0 0 0 0 10 1 2 0 0 0 0 0 13
77 Furosemida 40 mg 0 274 196 230 40 230 150 0 0 0 0 0 1120
78 Garam Oralit 8 41 8 0 84 50 50 0 0 0 0 0 241
79 Gentamicyn 0,3% TM 0 0 0 0 0 0 0 0 0 0 0 0 0
80 Gentamicyn Inj 40 mg/ml 0 5 12 0 10 2 2 0 0 0 0 0 31
81 Gentamicyn 0,1% SK 6 3 6 0 0 0 0 0 0 0 0 0 15
82 Glass lonomer 0 0 0 0 0 0 0 0 0 0 0 0 0
83 Glibenclamide 5 mg 240 41 0 440 29 70 280 0 0 0 0 0 1100
84 Glimepiride 1 mg 53 27 390 142 224 0 0 0 0 0 0 0 836
85 Glukosa larutan infus 10% 1 4 0 5 3 5 0 0 0 0 0 0 18
86 Glukosa larutan infus 5% 31 96 161 7 172 50 65 0 0 0 0 0 582
87 Griseofulvin 125 mg 0 0 20 70 41 49 2 0 0 0 0 0 182
88 Guaifenesin 100 Tab (GG tab) 1015 452 933 1730 1680 156 574 0 0 0 0 0 6540
89 Haloperidol 0,5 mg tab 0 0 0 0 0 0 0 0 0 0 0 0 0
90 Haloperidol 5 mg tab 0 70 500 0 100 0 0 0 0 0 0 0 670
91 Human chorionic (HCG/Tes kehamilan ) 0 24 31 0 90 0 0 0 0 0 0 0 145
92 Hydrochlorotiazide (HCT) 25 mg 15 10 10 175 0 10 30 0 0 0 0 0 250
93 Ibuprofen sirup 29 11 11 32 0 0 0 0 0 0 0 0 83
94 Ibuprofen 200 mg 49 0 0 0 0 0 0 0 0 0 0 0 49
95 Ibuprofen 400 mg 0 0 0 0 0 0 0 0 0 0 0 0 0
96 Ichthyol salep 10% 0 0 0 0 0 0 0 0 0 0 0 0 0
97 Immunoglobulin human anti-tetanus (Tetagam) 0 10 0 0 10 0 4 0 0 0 0 0 24
98 Infus set dewasa 120 94 120 73 96 114 27 0 0 0 0 0 644
99 Infusi set anak 0 0 17 67 30 28 7 0 0 0 0 0 149
100 Iodium Povidon 10% 30 ml 0 0 37 0 0 0 0 0 0 0 0 0 37
101 Isosorbide tablet 0 127 0 23 0 0 0 0 0 0 0 0 150
102 IV Catheter No.20 61 48 47 8 15 5 0 0 0 0 0 0 184
103 IV Catheter No.22 165 113 179 150 21 158 50 0 0 0 0 0 836
104 IV Catheter No.24 45 46 115 78 30 55 48 0 0 0 0 0 417
105 Jarum Jahit Kulit 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
106 Kalium Permanganat Serbuk 0 0 0 0 0 0 0 0 0 0 0 0 0
107 Kapas pembalut/Absorben 250 g 9 2 0 8 0 7 2 0 0 0 0 0 28
108 Kasa pembalut 2x80 17 4 39 10 7 20 0 0 0 0 0 0 97
109 Kasa pembalut hidrofil 4 m x 15 cm 62 45 194 60 165 116 69 0 0 0 0 0 711
110 Kasa pembalut hidrofil 4 m x 3 cm 0 0 0 0 0 0 0 0 0 0 0 0 0
111 Kasa kompres 40/40 steril 17 6 113 0 16 29 22 0 0 0 0 0 203
112 Ketoconazole 200 mg Cream 22 9 33 18 7 37 1 0 0 0 0 0 127
113 Ketoconazole 200 mg tab 202 188 35 135 20 0 0 0 0 0 0 0 580
114 Klorokina Fosfat 250 mg 0 0 0 0 0 0 0 0 0 0 0 0 0
115 Levertran Salep/ Salep Luka Bakar 0 1 0 1 0 0 10 0 0 0 0 0 12
116 Lidocain 2% 0 0 0 0 0 0 0 0 0 0 0 0 0
117 Lidokain Comp. inj Kombinasi 70 20 11 14 37 91 0 0 0 0 0 0 243
118 Lidocaine spray (Xylocaine spray) 4 1 1 0 4 1 2 0 0 0 0 0 13
119 Liquorice liquid extract (OBH) 100 76 65 0 0 0 0 0 0 0 0 0 241
120 Locoriz Cream 0 0 0 0 0 0 0 0 0 0 0 0 0
121 Loperamid 2 m tab 66 57 0 196 0 0 0 0 0 0 0 0 319
122 Loratadine 10 mg tab 380 690 450 522 998 423 468 0 0 0 0 0 3931
123 Magnesium Sulfat Injeksi 20% (MgSO4) 0 0 0 0 6 0 24 0 0 0 0 0 30
124 Magnesium Sulfat Injeksi 40% (MgSO4) 1 0 0 0 0 0 0 0 0 0 0 0 1
125 Masker 702 587 916 286 724 350 645 0 0 0 0 0 4210
126 Medical adhesive tape (dermafix/leukomed) 0 2 12 2 24 35 0 0 0 0 0 0 75
127 Metamizole injeksi (antalgin 1000) 0 0 0 0 0 0 0 0 0 0 0 0 0
128 Metformin 500mg tab 239 149 480 420 80 400 480 0 0 0 0 0 2248
129 Methyl Ergometrin Maleat inj 0,2 mg/ml 0 0 0 0 0 0 0 0 0 0 0 0 0
130 Methyl Ergometrin Maleat 0,125 mg 0 0 0 100 0 0 20 0 0 0 0 0 120
131 Methyl Prednisolon tab 4 mg 719 374 1381 1270 0 0 0 0 0 0 0 0 3744
132 Methyl Rosanilinium (gentian violet) 4 19 15 4 1 1 2 0 0 0 0 0 46
133 Metronidazol 250 mg tab 240 272 588 170 570 105 125 0 0 0 0 0 2070
134 Metronidazol 500 mg tab 0 0 0 0 0 0 0 0 0 0 0 0 0
135 Metronidazol Infus 0 0 0 0 3 0 0 0 0 0 0 0 3
136 Metronidazol syr 0 3 20 3 0 17 2 0 0 0 0 0 45
137 Miconazole 2% Salep Kulit 14 0 11 6 37 58 5 0 0 0 0 0 131
138 Momilen Baby Gold Sirup 0 0 0 0 0 0 0 0 0 0 0 0 0
139 Natrium Bikarbonat 500 mg 0 0 0 130 0 0 0 0 0 0 0 0 130
140 Nifedipin 10 mg tab 66 120 73 50 10 30 0 0 0 0 0 0 349
141 Nystatin Tab Vag 10.000 iu/g 0 20 0 30 80 0 0 0 0 0 0 0 130
142 Omeprazole inj 48 0 0 0 0 18 15 0 0 0 0 0 81
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
143 Omeprazole kaps 430 235 265 270 150 290 230 0 0 0 0 0 1870
144 Oxytetracycline HCl 1% Salep Mata 15 2 9 0 39 11 0 0 0 0 0 0 76
145 Oxytetracycline HCl 3% Salep Kulit 0 0 0 0 0 0 0 0 0 0 0 0 0
146 Oxytocin inj 10 IU 117 200 0 0 0 0 50 0 0 0 0 0 367
147 Papaverin 40 mg tab 0 0 0 0 0 0 0 0 0 0 0 0 0
148 Papaverin inj 0 0 0 0 0 0 0 0 0 0 0 0 0
149 Paracetamol Drops 15 ml 5 5 8 23 3 0 6 0 0 0 0 0 50
150 Parasetamol 120 mg/5 ml Syr 73 99 108 110 94 60 75 0 0 0 0 0 619
151 Parasetamol 500 mg 4390 3266 5784 3920 3720 420 1790 0 0 0 0 0 23290
152 Patient Lubricant (My Jelly ) 0 0 1 1 0 1 0 0 0 0 0 0 3
153 Permethrin (Scabimite Cream) 10 5 3 10 0 5 6 0 0 0 0 0 39
154 Phenobarbital inj 50mg/ml-2ml 0 0 0 0 0 0 30 0 0 0 0 0 30
155 Phenobarbital 100 mg 0 0 0 0 0 0 0 0 0 0 0 0 0
156 Phenol gliserol 10% TT 9 3 13 9 0 6 31 0 0 0 0 0 71
157 Phytomenadione (Vit.K1) inj 10 mg/ml 11 51 35 30 31 0 60 0 0 0 0 0 218
158 Phytomenadione (Vit.K1) 10 mg 180 0 0 0 0 0 120 0 0 0 0 0 300
159 Piracetam 400 mg 0 0 0 0 0 0 0 0 0 0 0 0 0
160 Piroxicam 20 mg tab 765 910 580 760 1090 481 849 0 0 0 0 0 5435
161 Pisau Disposable (Mess No.14/21) 20 7 37 13 15 0 0 0 0 0 0 0 92
162 Plesterku (Leukoplast) 17 13 19 11 22 24 9 0 0 0 0 0 115
163 Polivalen serum (Anti Tetanus Inj. 1500 iu/Biosat) 0 0 0 0 0 0 0 0 0 0 0 0 0
164 Povidon iodium 10% 300 ml 3 0 6 1 1 3 2 0 0 0 0 0 16
165 Prednison 5 mg 0 0 0 0 0 0 0 0 0 0 0 0 0
166 Primaquin 15 mg tab 0 0 0 0 0 0 0 0 0 0 0 0 0
167 Profolat tab 0 0 0 0 0 0 0 0 0 0 0 0 0
168 Prokaina Penisilin G inj 3.000.000 iu 0 0 0 0 0 0 0 0 0 0 0 0 0
169 Propranolol HCl 10 mg 70 0 0 0 0 0 0 0 0 0 0 0 70
170 Propranolol HCl 40 mg 132 68 700 0 0 210 0 0 0 0 0 0 1110
171 Propylthiouracil 100 mg 55 55 100 190 0 100 50 0 0 0 0 0 550
172 Protein Gluco Test 0 0 10 0 10 10 0 0 0 0 0 0 30
173 Pyrantel Pamoat 125 mg 0 0 0 0 0 0 0 0 0 0 0 0 0
174 Pyridoxine HCl 10 mg 114 560 30 220 20 280 0 0 0 0 0 0 1224
175 Ranitidin 150 mg 1550 1695 1195 1310 1370 853 297 0 0 0 0 0 8270
176 Ranitidin Injeksi 0 0 0 0 0 0 0 0 0 0 0 0 0
177 Retinol (Vit.A) kaps 100.000 iu 0 0 0 0 100 0 0 0 0 0 0 0 100
178 Retinol (Vit.A) kaps 200.000 iu 0 0 0 0 400 100 100 0 0 0 0 0 600
179 Risperidone 2mg 0 0 0 0 0 200 0 0 0 0 0 0 200
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
180 Salbutamol 2 mg 0 0 0 0 0 0 0 0 0 0 0 0 0
181 Salep 2-4 Kombinasi 6 14 0 0 0 0 0 0 0 0 0 0 20
182 Sarung tangan (HandScuun) No.7,5 0 0 0 0 0 0 0 0 0 0 0 0 0
183 Sarung tangan (HandScuun Steril) No. 6,5 0 75 216 9 0 0 0 0 0 0 0 0 300
184 Sarung tangan (HandScuun Steril) No.7 35 0 0 0 0 0 0 0 0 0 0 0 35
185 Sarung tangan (HandScuun Steril) No.7,5 0 0 0 0 0 0 0 0 0 0 0 0 0
186 Semen Seng Fosfat Serbuk & Cairan 0 0 0 0 0 0 0 0 0 0 0 0 0
187 Sianocobalamin (Vit B12) 50 mg tab 383 651 379 498 349 408 222 0 0 0 0 0 2890
188 Silk (Benang Bedah) No. 3/0 3 12 11 0 6 12 9 0 0 0 0 0 53
189 Silver Sulfadiazine 1 0 1 6 1 2 1 0 0 0 0 0 12
190 Simvastatin 10 mg tab 140 357 95 283 55 147 183 0 0 0 0 0 1260
191 Sodium cloride infus 0,9% ( NACL ) 180 76 2 0 101 66 25 0 0 0 0 0 450
192 Spuit 1 ml 584 28 154 153 0 165 43 0 0 0 0 0 1127
193 Spuit 3 ml 839 714 663 410 800 630 20 0 0 0 0 0 4076
194 Spuit 5 ml 277 66 0 51 86 220 193 0 0 0 0 0 893
195 Sulfadoxine | Pyrimethamine Tablet 500mg|25mg 0 0 0 0 0 0 0 0 0 0 0 0 0
196 Sulfamethoxazole | trimethoprim (cotri) syr 64 32 82 40 36 64 12 0 0 0 0 0 330
197 Sulfasetamida 15% TM 0 0 0 0 0 0 0 0 0 0 0 0 0
198 Tetracycline 250 mg 0 0 0 0 0 0 0 0 0 0 0 0 0
199 Tetracycline 500 mg 40 170 30 100 120 520 0 0 0 0 0 0 980
200 Thiamine HCl (Vit B1) inj 100 mg/ml 0 0 0 0 0 0 0 0 0 0 0 0 0
201 Thiamine HCl (Vit B1) 50 mg 20 70 150 30 400 0 0 0 0 0 0 0 670
202 Trihexyphenidyl tab 2 mg 10 90 0 0 0 0 0 0 0 0 0 0 100
203 Trimethoprim (cotrimoxazol 480 mg) tablet 254 666 80 0 0 0 230 0 0 0 0 0 1230
204 Urin Bag 9 4 0 13 0 0 0 0 0 0 0 0 26
205 Usg Gel 0 0 0 0 0 0 0 0 0 0 0 0 0
206 Vaksin Rabies Vero/ Verorab 0 0 0 0 0 0 0 0 0 0 0 0 0
207 Vitamin B Kompleks 2050 2162 1598 1940 470 0 870 0 0 0 0 0 9090
208 Vitamin K Infant Inj 0 0 0 0 0 0 0 0 0 0 0 0 0
209 Water liquid (aqua P,I) 39 7 37 11 27 25 25 0 0 0 0 0 171
210 Wing Needle No.21 0 0 0 0 0 0 0 0 0 0 0 0 0
211 Wing Needle No.27 0 0 0 0 0 0 0 0 0 0 0 0 0
212 Zinc Sulphate Suppositoria (Superhoid) 0 0 0 0 0 0 0 0 0 0 0 0 0
213 Zinc tab 194 30 36 0 0 0 110 0 0 0 0 0 370
214 0 0 0 0 0 0 0 0 0 0 0 0 0
215 0 0 0 0 0 0 0 0 0 0 0 0 0
216 0 0 0 0 0 0 0 0 0 0 0 0 0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
217 0 0 0 0 0 0 0 0 0 0 0 0 0
218 0 0 0 0 0 0 0 0 0 0 0 0 0
219 0 0 0 0 0 0 0 0 0 0 0 0 0
220 0 0 0 0 0 0 0 0 0 0 0 0 0
221 0 0 0 0 0 0 0 0 0 0 0 0 0
222 0 0 0 0 0 0 0 0 0 0 0 0 0
223 0 0 0 0 0 0 0 0 0 0 0 0 0
224 0 0 0 0 0 0 0 0 0 0 0 0 0
225 0 0 0 0 0 0 0 0 0 0 0 0 0
226 0 0 0 0 0 0 0 0 0 0 0 0 0
227 0 0 0 0 0 0 0 0 0 0 0 0 0
228 0 0 0 0 0 0 0 0 0 0 0 0 0
229 0 0 0 0 0 0 0 0 0 0 0 0 0
230 0 0 0 0 0 0 0 0 0 0 0 0 0
231 0 0 0 0 0 0 0 0 0 0 0 0 0
232 0 0 0 0 0 0 0 0 0 0 0 0 0
233 0 0 0 0 0 0 0 0 0 0 0 0 0
234 0 0 0 0 0 0 0 0 0 0 0 0 0
235 0 0 0 0 0 0 0 0 0 0 0 0 0
236 0 0 0 0 0 0 0 0 0 0 0 0 0
237 0 0 0 0 0 0 0 0 0 0 0 0 0
238 0 0 0 0 0 0 0 0 0 0 0 0 0
239 0 0 0 0 0 0 0 0 0 0 0 0 0
240 0 0 0 0 0 0 0 0 0 0 0 0 0
241 0 0 0 0 0 0 0 0 0 0 0 0 0
UMUM JAMSOSKES BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP
0
Mengetahui Mengetahui Mengetahui/ Menyetujui Yang Memb

Kepala Dinas Kesehatan Kab. OKI Kepala Instalasi Farmasi Dinkes OKI Pimpinan Puskesmas Pengelola Obat P
..................................... ..................................... .....................................

NIP. NIP. NIP.
STOK JUMLAH
PENGAMAN RENCANA
16 17
300.4 3304.4
1799
1170
8
156
47
1160
100
1300
0
3585
50
2750
9059
0
169
9142
0
5000
5910
0
599
16
399
210
2
0
102
48
1825
86
STOK JUMLAH
PENGAMAN RENCANA
16 17
555
40
3818
3490
4372
1720
0
158
74
454
90
55
170
142
0
189
10358
805
0
4670
2
600
9
35
0
2700
106
1
950
2806
100
740
150
3600
0
74
6
STOK JUMLAH
PENGAMAN RENCANA
16 17
2895
6
13
0
43550
640
44
13
1120
241
0
31
15
0
1100
836
18
582
182
6540
0
670
145
250
83
49
0
0
24
644
149
37
150
184
836
417
0
STOK JUMLAH
PENGAMAN RENCANA
16 17
0
28
97
711
0
203
127
580
0
12
0
243
13
241
0
319
3931
30
1
4210
75
0
2248
0
120
3744
46
2070
0
3
45
131
0
130
349
130
81
STOK JUMLAH
PENGAMAN RENCANA
16 17
1870
76
0
367
0
0
50
619
23290
3
39
30
0
71
218
300
0
5435
92
115
0
16
0
0
0
0
70
1110
550
30
0
1224
8270
0
100
600
200
STOK JUMLAH
PENGAMAN RENCANA
16 17
0
20
0
300
35
0
0
2890
53
12
1260
450
1127
4076
893
0
330
0
0
980
0
670
100
1230
26
0
0
9090
0
171
0
0
0
370
0
0
0
STOK JUMLAH
PENGAMAN RENCANA
16 17
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
Yang Membuat
Pengelola Obat Puskesmas
.....................................
NIP.
LAMPIRAN BERITA ACARA PENCACAHAN OBAT AKHIR TAHUN PUSKESMAS
PUSKESMAS : TAHUN : 2018
KECAMATAN :
MENURUT PENCATATAN HASIL SELISIH KADALUARSA RUSAK

NO. NAMA OBAT SATUAN SALDO 1 PENERIMAAN 1 PENGELUARAN 1 SALDO 31 DES
JANUARI S/D 31 JANUARI S/D 31 PENCACAHAN
JANUARI 2019 2019
DES 2019 DES 2019
1 2 3 4 5 6 7 8 9 10 11
1 Absorbent tipped applicator (alcohol swab) Pcs 84 3200 2004 1280 1280
2 Acetylcystein Kapsul 200mg Kapsul 419 2000 1799 620 620
3 Acyclovir tab 200 mg Tablet 370 1000 1170 200 200
4 Acyclovir cream Tube 8 0 8 0 0
5 Albendazol tab 400 mg Tablet 318 0 156 162 162
6 Alkohol Liquid (etanol) 70%-1000 ml Btl 19 51 47 23 23
7 Allopurinol 100 mg Tablet 90 3000 1160 1930 1930
8 Aminophylline Inj 24 mg/ml-10 ml Ampul 100 0 100 0 0
9 Aminophylline tab 200 mg Tablet 500 1800 1300 1000 1000
10 Amitriptyline 25 mg tab Tablet 300 0 0 300 300
11 Amlodipine tab 5 mg Tablet 825 8100 3585 5340 5340
12 Amoxycillin Syr Btl 0 420 50 370 370
13 Amoxycillin 250 mg Kapsul 440 9200 2750 6890 6890
14 Amoxycillin 500 mg Kaptab 4179 14000 9059 9120 9120
15 Ampicilin 1 gr Inj Vial 0 10 0 10 10
16 Antasida Syr DOEN Btl 216 700 169 747 747
17 Antasida DOEN Kombinasi Tablet 1242 17000 9142 9100 9100
18 Anti Bisa Ular 5 ml (ABU I)/ Biosave Vial 0 0 0 0 0
19 Asam Mefenamat 500 mg tab Tablet 0 5000 5000 0 0
20 Ascorbic acid (Vit.C) 50 mg Tablet 5490 7000 5910 6580 6580
21 Ascorbic acid |calsium carbonate 500 mg (Pehav Tablet 0 0 0 0 0
22 Aspirin (miniaspi) 100 mg tab Tablet 199 1300 599 900 900
23 Atropine inj 0,25 mg/ml Ampul 16 100 16 100 100
24 Attapulgite Tablet (Pularex) Tablet 378 300 399 279 279
25 Attapulgite Tablet 600 mg (New Antides) Tablet 700 1100 210 1590 1590
26 Automated blood grouping (Tes Gol. Darah) Paket 0 2 2 0 0
27 Bahan Tambal Gigi Sementara (Fletcher/Caviton Pcs 4 2 0 6 6
28 Bedak Salisil 2% Btl 21 244 102 163 163
29 Benzoic acid |salicylic acid salep (anti fungi) pot 48 72 48 72 72
30 Betahistine Mesylate 6 mg tab Tablet 705 2300 1825 1180 1180
31 Betamethasone 0,1% krim Tube 12 100 86 26 26
HALAMAN : 2
NO. NAMA OBAT SATUAN PENERIMAAN 1 PENGELUARAN 1
SALDO 1 SALDO 31 DES
JANUARI 2019 2019
DES 2019 DES 2019
1 2 3 4 5 6 7 8 9 10 11
32 Bisacodyl 5mg Tablet 555 0 555 0 0
33 Bismuth subgallas (antihemoroid) Supp 20 50 40 30 30
34 Calcium chloride lactate infus (RL) Botol 508 5500 3818 2190 2190
35 Calsium Laktat (Kalk) 500 mg Tablet 3090 2400 3490 2000 2000
36 Captopril 12,5 mg Tablet 1250 7000 4372 3878 3878
37 Captopril 25 mg Tablet 1720 0 1720 0 0
38 Carbamazepin tab Tablet 629 200 0 829 829
39 Catgut/Benang Chromic Bedah No.2/0-3/0 Pcs 26 384 158 252 252
40 Catgut/Benang Plain Bedah No.2/0-3/0 Pcs 74 0 74 0 0
41 Cefadroxil 500mg Tablet 454 0 454 0 0
42 Cetirizine 5 mg/5 ml sirup Botol 45 200 90 155 155
43 Chloramhenicol Salep Mata 1% Tube 50 96 55 91 91
44 Chloramphenicol Suspensi 125 mg/ml Btl 48 200 170 78 78
45 Chloramphenicol 250 mg caps Tablet 242 0 142 100 100
46 Chloramphenicol TT 3% Botol 0 0 0 0 0
47 Chloramphenicol/ Hidrokortison krim 2,5% Tube 63 264 189 138 138
48 Chlorpheniramine Maleat (CTM) 4 mg Tablet 2508 20000 10358 12150 12150
49 Chlorpromazine HCl 100 mg Tablet 1005 0 805 200 200
50 Cimetidin 200 tab Tablet 0 0 0 0 0
51 Ciprofloxacin 500 mg tab Tablet 670 4000 4670 0 0
52 Ciprofloxacin Infus Botol 0 10 2 8 8
53 Clindamycin 300mg Kapsul 600 0 600 0 0
54 Cresol liquid 1 Liter (lysol) Botol 9 0 9 0 0
55 Cyanocobalamin (Vit B12) inj 500 mcg/ml Ampul 35 0 35 0 0
56 Devitalisasi pasta pot 0 0 0 0 0
57 Dexamethasone 0,5 mg Tablet 2700 0 2700 0 0
58 Dexamethasone inj 5mg/ml-1ml Ampul 187 110 106 191 191
59 Diazepam 5mg/ml-2 ml inj Ampul 1 0 1 0 0
60 Diazepam 2 mg Tablet 1400 3000 950 3450 3450
61 Diclofenac sodium 25 mg tab Tablet 2536 4000 2806 3730 3730
62 Digoxin 0,25 mg Tablet 100 0 100 0 0
63 Dimenhydrinate 50mg Tablet 420 1300 740 980 980
64 Dipenhidramine HCl inj 10mg/ml Ampul 60 300 150 210 210
65 Domperidone 10 mg Tablet 1089 7000 3600 4489 4489
66 Doxycycline 100 mg Kapsul Kapsul 500 0 0 500 500
67 Epinephrine HCl/bitartrat inj 0,1% Ampul 0 124 74 50 50
68 Erythromicin Syr Btl 6 0 6 0 0
HALAMAN : 3
JANUARI 2019 2019
DES 2019 DES 2019
1 2 3 4 5 6 7 8 9 10 11
69 Erythromicin 500 mg capsul Kapsul 895 2000 2895 0 0
70 Ethacridine (Rivanol) 0,1% Btl 7 0 6 1 1
71 Ethanol ( Aseptan ) 500 cc+ Pump Botol 13 0 13 0 0
72 Eugenol cairan Btl 5 0 0 5 5
73 Ferrous fumarate ( Tab. Tambah Darah ) Tablet 11720 62400 43550 30570 30570
74 Folic acid 1mg ( asam folat) Tablet 1200 2000 640 2560 2560
75 Folley Catheter No.16 Pcs 19 30 44 5 5
76 Furosemida Injeksi Ampul 0 25 13 12 12
77 Furosemida 40 mg Tablet 420 1600 1120 900 900
78 Garam Oralit Sachet 441 200 241 400 400
79 Gentamicyn 0,3% TM Botol 0 0 0 0 0
80 Gentamicyn Inj 40 mg/ml Ampul 29 75 31 73 73
81 Gentamicyn 0,1% SK Tube 15 0 15 0 0
82 Glass lonomer Paket 0 1 0 1 1
83 Glibenclamide 5 mg Tablet 1120 4000 1100 4020 4020
84 Glimepiride 1 mg Tablet 536 4000 836 3700 3700
85 Glukosa larutan infus 10% Botol 70 100 18 152 152
87 Griseofulvin 125 mg Tablet 260 2200 182 2278 2278
88 Guaifenesin 100 Tab (GG tab) Tablet 5780 8000 6540 7240 7240
89 Haloperidol 0,5 mg tab Tablet 0 0 0 0 0
90 Haloperidol 5 mg tab Tablet 970 700 670 1000 1000
91 Human chorionic (HCG/Tes kehamilan ) Strip 145 120 145 120 120
92 Hydrochlorotiazide (HCT) 25 mg Tablet 490 1000 250 1240 1240
93 Ibuprofen sirup Botol 138 0 83 55 55
94 Ibuprofen 200 mg Tablet 49 0 49 0 0
96 Ichthyol salep 10% pot 0 0 0 0 0
97 Immunoglobulin human anti-tetanus (Tetagam) Ampul 0 30 24 6 6
98 Infus set dewasa Pcs 387 1600 644 1343 1343
99 Infusi set anak Pcs 104 750 149 705 705
100 Iodium Povidon 10% 30 ml Botol 37 0 37 0 0
101 Isosorbide tablet Tablet 150 0 150 0 0
102 IV Catheter No.20 Pcs 184 0 184 0 0
105 Jarum Jahit Kulit Pcs 0 0 0 0 0
HALAMAN : 4
JANUARI 2019 2019
DES 2019 DES 2019
1 2 3 4 5 6 7 8 9 10 11
106 Kalium Permanganat Serbuk pot 0 0 0 0 0
107 Kapas pembalut/Absorben 250 g Pcs 28 25 28 25 25
108 Kasa pembalut 2x80 Pcs 20 176 97 99 99
109 Kasa pembalut hidrofil 4 m x 15 cm Pcs 366 700 711 355 355
111 Kasa kompres 40/40 steril Pcs 45 400 203 242 242
112 Ketoconazole 200 mg Cream Tube 22 250 127 145 145
113 Ketoconazole 200 mg tab Tablet 580 0 580 0 0
114 Klorokina Fosfat 250 mg Tablet 0 0 0 0 0
115 Levertran Salep/ Salep Luka Bakar pot 2 24 12 14 14
116 Lidocain 2% Ampul 7 0 0 7 7
117 Lidokain Comp. inj Kombinasi Ampul 180 330 243 267 267
118 Lidocaine spray (Xylocaine spray) Botol 9 5 13 1 1
119 Liquorice liquid extract (OBH) Botol 241 0 241 0 0
120 Locoriz Cream Tube 0 0 0 0 0
121 Loperamid 2 m tab Tablet 319 0 319 0 0
122 Loratadine 10 mg tab Tablet 2310 8000 3931 6379 6379
123 Magnesium Sulfat Injeksi 20% (MgSO4) Ampul 15 15 30 0 0
125 Masker Pcs 1315 5800 4210 2905 2905
126 Medical adhesive tape (dermafix/leukomed) Pcs 48 150 75 123 123
127 Metamizole injeksi (antalgin 1000) Ampul 63 0 0 63 63
128 Metformin 500mg tab Tablet 708 4500 2248 2960 2960
129 Methyl Ergometrin Maleat inj 0,2 mg/ml Ampul 0 0 0 0 0
130 Methyl Ergometrin Maleat 0,125 mg Tab 100 700 120 680 680
131 Methyl Prednisolon tab 4 mg Tablet 2744 1000 3744 0 0
132 Methyl Rosanilinium (gentian violet) Botol 15 96 46 65 65
133 Metronidazol 250 mg tab Tablet 570 1500 2070 0 0
135 Metronidazol Infus Botol 0 10 3 7 7
136 Metronidazol syr Botol 0 150 45 105 105
137 Miconazole 2% Salep Kulit Tube 64 192 131 125 125
138 Momilen Baby Gold Sirup Botol 0 0 0 0 0
139 Natrium Bikarbonat 500 mg Tablet 530 0 130 400 400
140 Nifedipin 10 mg tab Kapsul 349 0 349 0 0
141 Nystatin Tab Vag 10.000 iu/g Tablet 130 200 130 200 200
142 Omeprazole inj Vial 101 150 81 170 170
HALAMAN : 5
JANUARI 2019 2019
DES 2019 DES 2019
1 2 3 4 5 6 7 8 9 10 11
143 Omeprazole kaps Kapsul 1120 2910 1870 2160 2160
144 Oxytetracycline HCl 1% Salep Mata Tube 26 125 76 75 75
145 Oxytetracycline HCl 3% Salep Kulit Tube 0 0 0 0 0
146 Oxytocin inj 10 IU Ampul 117 400 367 150 150
147 Papaverin 40 mg tab Tablet 0 0 0 0 0
148 Papaverin inj Tablet 0 0 0 0 0
149 Paracetamol Drops 15 ml Botol 102 0 50 52 52
150 Parasetamol 120 mg/5 ml Syr Botol 73 1000 619 454 454
151 Parasetamol 500 mg Tablet 6500 21000 23290 4210 4210
152 Patient Lubricant (My Jelly ) Tube 8 5 3 10 10
153 Permethrin (Scabimite Cream) Tube 46 0 39 7 7
154 Phenobarbital inj 50mg/ml-2ml Ampul 30 60 30 60 60
155 Phenobarbital 100 mg Tablet 0 0 0 0 0
156 Phenol gliserol 10% TT Botol 24 120 71 73 73
157 Phytomenadione (Vit.K1) inj 10 mg/ml Ampul 120 600 218 502 502
158 Phytomenadione (Vit.K1) 10 mg Tablet 180 500 300 380 380
159 Piracetam 400 mg Tablet 0 0 0 0 0
160 Piroxicam 20 mg tab Tablet 4425 4000 5435 2990 2990
161 Pisau Disposable (Mess No.14/21) Pcs 92 0 92 0 0
162 Plesterku (Leukoplast) Pcs 32 150 115 67 67
163 Polivalen serum (Anti Tetanus Inj. 1500 iu/Biosa Ampul 0 0 0 0 0
164 Povidon iodium 10% 300 ml Botol 22 5 16 11 11
165 Prednison 5 mg Tablet 0 0 0 0 0
166 Primaquin 15 mg tab Tablet 100 300 0 400 400
167 Profolat tab Tablet 0 0 0 0 0
168 Prokaina Penisilin G inj 3.000.000 iu Ampul 0 0 0 0 0
169 Propranolol HCl 10 mg Tablet 70 0 70 0 0
171 Propylthiouracil 100 mg Tablet 800 0 550 250 250
172 Protein Gluco Test Strip 50 20 30 40 40
173 Pyrantel Pamoat 125 mg Tablet 100 0 0 100 100
174 Pyridoxine HCl 10 mg Tablet 424 3000 1224 2200 2200
175 Ranitidin 150 mg Tablet 2270 6000 8270 0 0
176 Ranitidin Injeksi Ampul 0 0 0 0 0
177 Retinol (Vit.A) kaps 100.000 iu Kapsul 0 1000 100 900 900
179 Risperidone 2mg Tablet 0 1000 200 800 800
HALAMAN : 6
JANUARI 2019 2019
DES 2019 DES 2019
1 2 3 4 5 6 7 8 9 10 11
180 Salbutamol 2 mg Tablet 0 0 0 0 0
181 Salep 2-4 Kombinasi pot 18 2 20 0 0
182 Sarung tangan (HandScuun) No.7,5 Pcs 0 0 0 0 0
183 Sarung tangan (HandScuun Steril) No. 6,5 Pcs 0 300 300 0 0
184 Sarung tangan (HandScuun Steril) No.7 Pcs 35 0 35 0 0
185 Sarung tangan (HandScuun Steril) No.7,5 Pcs 0 0 0 0 0
186 Semen Seng Fosfat Serbuk & Cairan Set 0 0 0 0 0
187 Sianocobalamin (Vit B12) 50 mg tab Tablet 920 5000 2890 3030 3030
188 Silk (Benang Bedah) No. 3/0 Pcs 77 108 53 132 132
189 Silver Sulfadiazine Tube 20 27 12 35 35
190 Simvastatin 10 mg tab Tablet 420 3810 1260 2970 2970
191 Sodium cloride infus 0,9% ( NACL ) Botol 218 740 450 508 508
192 Spuit 1 ml Pcs 584 1300 1127 757 757
193 Spuit 3 ml Pcs 1076 3000 4076 0 0
194 Spuit 5 ml Pcs 410 600 893 117 117
195 Sulfadoxine | Pyrimethamine Tablet 500mg|25 Tablet 0 0 0 0 0
196 Sulfamethoxazole | trimethoprim (cotri) syr Botol 68 600 330 338 338
197 Sulfasetamida 15% TM Botol 0 0 0 0 0
198 Tetracycline 250 mg Tablet 0 0 0 0 0
200 Thiamine HCl (Vit B1) inj 100 mg/ml Ampul 0 0 0 0 0
201 Thiamine HCl (Vit B1) 50 mg Tablet 170 1200 670 700 700
202 Trihexyphenidyl tab 2 mg Tablet 500 0 100 400 400
203 Trimethoprim (cotrimoxazol 480 mg) tablet Tablet 1000 2000 1230 1770 1770
204 Urin Bag Pcs 26 0 26 0 0
205 Usg Gel Botol 0 0 0 0 0
206 Vaksin Rabies Vero/ Verorab Paket 0 0 0 0 0
207 Vitamin B Kompleks Tablet 8220 2000 9090 1130 1130
208 Vitamin K Infant Inj Ampul 0 0 0 0 0
209 Water liquid (aqua P,I) Botol 115 180 171 124 124
210 Wing Needle No.21 Pcs 0 0 0 0 0
212 Zinc Sulphate Suppositoria (Superhoid) Kapsul 0 0 0 0 0
213 Zinc tab Tablet 260 2000 370 1890 1890
214 0 0 0 0 0
215 0 0 0 0 0
216 0 0 0 0 0
HALAMAN : 7
JANUARI 2019 2019
DES 2019 DES 2019
1 2 3 4 5 6 7 8 9 10 11
Mengetahui/ Menyetujui Yang Membuat

Pimpinan Puskesmas SAKSI - SAKSI Pengelola Obat Puskesm
1 2
..................................... ....................................
..................................... .....................................
HILANG
12
HILANG
12
HILANG
12
HILANG
12
HILANG
12
HILANG
12
HILANG
12
Yang Membuat
gelola Obat Puskesmas
..................................
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO) RUMAH S
RS PRATAMA : TUGU JAYA PELAPORAN BULAN : JANUARI 2019
KECAMATAN : LEMPUING PERMINTAAN BULAN : FEBRUARI 2019
STOK
NO. NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL
1 2 3 4 5 6 7
1 Absorbent tipped applicator (alcohol swab) Pcs 84 0 84 52
2 Acetylcystein Kapsul 200mg Kapsul 419 0 419 83
3 Acyclovir tab 200 mg Tablet 370 0 370 80
4 Acyclovir cream Tube 8 0 8 6
5 Albendazol tab 400 mg Tablet 318 0 318 60
6 Alkohol Liquid (etanol) 70%-1000 ml Btl 19 0 19 5
7 Allopurinol 100 mg Tablet 90 0 90 60
8 Aminophylline Inj 24 mg/ml-10 ml Ampul 100 0 100 0
9 Aminophylline tab 200 mg Tablet 500 0 500 300
10 Amitriptyline 25 mg tab Tablet 300 0 300 0
11 Amlodipine tab 5 mg Tablet 825 0 825 720
12 Amoxycillin Syr Btl 0 0 0 0
13 Amoxycillin 250 mg Kapsul 440 0 440 140
14 Amoxycillin 500 mg Kaptab 4179 0 4179 1018
15 Ampicilin 1 gr Inj Vial 0 0 0 0
16 Antasida Syr DOEN Btl 216 0 216 20
17 Antasida DOEN Kombinasi Tablet 1242 0 1242 1242
18 Anti Bisa Ular 5 ml (ABU I)/ Biosave Vial 0 0 0 0
19 Asam Mefenamat 500 mg tab Tablet 0 0 0 0
20 Ascorbic acid (Vit.C) 50 mg Tablet 5490 0 5490 1001
21 Ascorbic acid |calsium carbonate 500 mg (Pehavral) Tablet 0 0 0 0
22 Aspirin (miniaspi) 100 mg tab Tablet 199 0 199 199
23 Atropine inj 0,25 mg/ml Ampul 16 0 16 0
24 Attapulgite Tablet (Pularex) Tablet 378 0 378 11
25 Attapulgite Tablet 600 mg (New Antides) Tablet 700 0 700 0
26 Automated blood grouping (Tes Gol. Darah) Paket 0 0 0 0
27 Bahan Tambal Gigi Sementara (Fletcher/Caviton) Pcs 4 0 4 0
28 Bedak Salisil 2% Btl 21 0 21 5
29 Benzoic acid |salicylic acid salep (anti fungi) pot 48 0 48 0
30 Betahistine Mesylate 6 mg tab Tablet 705 0 705 625
31 Betamethasone 0,1% krim Tube 12 0 12 12
HALAMAN : 2
STOK
AWAL
1 2 3 4 5 6 7
32 Bisacodyl 5mg Tablet 555 0 555 15
33 Bismuth subgallas (antihemoroid) Supp 20 0 20 0
34 Calcium chloride lactate infus (RL) Botol 508 0 508 481
35 Calsium Laktat (Kalk) 500 mg Tablet 3090 0 3090 820
36 Captopril 12,5 mg Tablet 1250 0 1250 600
37 Captopril 25 mg Tablet 1720 0 1720 910
38 Carbamazepin tab Tablet 629 0 629 0
39 Catgut/Benang Chromic Bedah No.2/0-3/0 Pcs 26 0 26 26
40 Catgut/Benang Plain Bedah No.2/0-3/0 Pcs 74 0 74 35
41 Cefadroxil 500mg Tablet 454 0 454 435
42 Cetirizine 5 mg/5 ml sirup Botol 45 0 45 10
43 Chloramhenicol Salep Mata 1% Tube 50 0 50 0
44 Chloramphenicol Suspensi 125 mg/ml Btl 48 0 48 11
45 Chloramphenicol 250 mg caps Tablet 242 0 242 0
46 Chloramphenicol TT 3% Botol 0 0 0 0
47 Chloramphenicol/ Hidrokortison krim 2,5% Tube 63 0 63 33
48 Chlorpheniramine Maleat (CTM) 4 mg Tablet 2508 0 2508 1371
49 Chlorpromazine HCl 100 mg Tablet 1005 0 1005 0
50 Cimetidin 200 tab Tablet 0 0 0 0
51 Ciprofloxacin 500 mg tab Tablet 670 0 670 639
52 Ciprofloxacin Infus Botol 0 0 0 0
53 Clindamycin 300mg Kapsul 600 0 600 0
54 Cresol liquid 1 Liter (lysol) Botol 9 0 9 2
55 Cyanocobalamin (Vit B12) inj 500 mcg/ml Ampul 35 0 35 10
56 Devitalisasi pasta pot 0 0 0 0
57 Dexamethasone 0,5 mg Tablet 2700 0 2700 1396
58 Dexamethasone inj 5mg/ml-1ml Ampul 187 0 187 67
59 Diazepam 5mg/ml-2 ml inj Ampul 1 0 1 1
60 Diazepam 2 mg Tablet 1400 0 1400 100
61 Diclofenac sodium 25 mg tab Tablet 2536 0 2536 737
62 Digoxin 0,25 mg Tablet 100 0 100 0
63 Dimenhydrinate 50mg Tablet 420 0 420 100
64 Dipenhidramine HCl inj 10mg/ml Ampul 60 0 60 0
65 Domperidone 10 mg Tablet 1089 0 1089 675
66 Doxycycline 100 mg Kapsul Kapsul 500 0 500 0
67 Epinephrine HCl/bitartrat inj 0,1% Ampul 0 0 0 0
68 Erythromicin Syr Btl 6 0 6 5
HALAMAN : 3
STOK
AWAL
1 2 3 4 5 6 7
69 Erythromicin 500 mg capsul Kapsul 895 0 895 720
70 Ethacridine (Rivanol) 0,1% Btl 7 0 7 0
71 Ethanol ( Aseptan ) 500 cc+ Pump Botol 13 0 13 7
72 Eugenol cairan Btl 5 0 5 0
73 Ferrous fumarate ( Tab. Tambah Darah ) Tablet 11720 0 11720 1370
74 Folic acid 1mg ( asam folat) Tablet 1200 0 1200 70
75 Folley Catheter No.16 Pcs 19 0 19 8
76 Furosemida Injeksi Ampul 0 0 0 0
77 Furosemida 40 mg Tablet 420 0 420 0
78 Garam Oralit Sachet 441 0 441 8
79 Gentamicyn 0,3% TM Botol 0 0 0 0
80 Gentamicyn Inj 40 mg/ml Ampul 29 0 29 0
81 Gentamicyn 0,1% SK Tube 15 0 15 6
82 Glass lonomer Paket 0 0 0 0
83 Glibenclamide 5 mg Tablet 1120 0 1120 240
84 Glimepiride 1 mg Tablet 536 0 536 53
85 Glukosa larutan infus 10% Botol 70 0 70 1
86 Glukosa larutan infus 5% Botol 181 0 181 31
87 Griseofulvin 125 mg Tablet 260 0 260 0
88 Guaifenesin 100 Tab (GG tab) Tablet 5780 0 5780 1015
89 Haloperidol 0,5 mg tab Tablet 0 0 0 0
90 Haloperidol 5 mg tab Tablet 970 0 970 0
91 Human chorionic (HCG/Tes kehamilan ) Strip 145 0 145 0
92 Hydrochlorotiazide (HCT) 25 mg Tablet 490 0 490 15
93 Ibuprofen sirup Botol 138 0 138 29
94 Ibuprofen 200 mg Tablet 49 0 49 49
96 Ichthyol salep 10% pot 0 0 0 0
97 Immunoglobulin human anti-tetanus (Tetagam) Ampul 0 0 0 0
98 Infus set dewasa Pcs 387 0 387 120
99 Infusi set anak Pcs 104 0 104 0
100 Iodium Povidon 10% 30 ml Botol 37 0 37 0
101 Isosorbide tablet Tablet 150 0 150 0
102 IV Catheter No.20 Pcs 184 0 184 61
105 Jarum Jahit Kulit Pcs 0 0 0 0
HALAMAN : 4
STOK
AWAL
1 2 3 4 5 6 7
106 Kalium Permanganat Serbuk pot 0 0 0 0
107 Kapas pembalut/Absorben 250 g Pcs 28 0 28 9
108 Kasa pembalut 2x80 Pcs 20 0 20 17
109 Kasa pembalut hidrofil 4 m x 15 cm Pcs 366 0 366 62
111 Kasa kompres 40/40 steril Pcs 45 0 45 17
112 Ketoconazole 200 mg Cream Tube 22 0 22 22
113 Ketoconazole 200 mg tab Tablet 580 0 580 202
114 Klorokina Fosfat 250 mg Tablet 0 0 0 0
115 Levertran Salep/ Salep Luka Bakar pot 2 0 2 0
116 Lidocain 2% Ampul 7 0 7 0
117 Lidokain Comp. inj Kombinasi Ampul 180 0 180 70
118 Lidocaine spray (Xylocaine spray) Botol 9 0 9 4
119 Liquorice liquid extract (OBH) Botol 241 0 241 100
120 Locoriz Cream Tube 0 0 0 0
121 Loperamid 2 m tab Tablet 319 0 319 66
122 Loratadine 10 mg tab Tablet 2310 0 2310 380
123 Magnesium Sulfat Injeksi 20% (MgSO4) Ampul 15 0 15 0
125 Masker Pcs 1315 0 1315 702
126 Medical adhesive tape (dermafix/leukomed) Pcs 48 0 48 0
127 Metamizole injeksi (antalgin 1000) Ampul 63 0 63 0
128 Metformin 500mg tab Tablet 708 0 708 239
129 Methyl Ergometrin Maleat inj 0,2 mg/ml Ampul 0 0 0 0
130 Methyl Ergometrin Maleat 0,125 mg Tab 100 0 100 0
131 Methyl Prednisolon tab 4 mg Tablet 2744 0 2744 719
132 Methyl Rosanilinium (gentian violet) Botol 15 0 15 4
133 Metronidazol 250 mg tab Tablet 570 0 570 240
135 Metronidazol Infus Botol 0 0 0 0
136 Metronidazol syr Botol 0 0 0 0
137 Miconazole 2% Salep Kulit Tube 64 0 64 14
138 Momilen Baby Gold Sirup Botol 0 0 0 0
139 Natrium Bikarbonat 500 mg Tablet 530 0 530 0
140 Nifedipin 10 mg tab Kapsul 349 0 349 66
141 Nystatin Tab Vag 10.000 iu/g Tablet 130 0 130 0
142 Omeprazole inj Vial 101 0 101 48
HALAMAN : 5
STOK
AWAL
1 2 3 4 5 6 7
143 Omeprazole kaps Kapsul 1120 0 1120 430
144 Oxytetracycline HCl 1% Salep Mata Tube 26 0 26 15
145 Oxytetracycline HCl 3% Salep Kulit Tube 0 0 0 0
146 Oxytocin inj 10 IU Ampul 117 0 117 117
147 Papaverin 40 mg tab Tablet 0 0 0 0
148 Papaverin inj Tablet 0 0 0 0
149 Paracetamol Drops 15 ml Botol 102 0 102 5
150 Parasetamol 120 mg/5 ml Syr Botol 73 0 73 73
151 Parasetamol 500 mg Tablet 6500 0 6500 4390
152 Patient Lubricant (My Jelly ) Tube 8 0 8 0
153 Permethrin (Scabimite Cream) Tube 46 0 46 10
154 Phenobarbital inj 50mg/ml-2ml Ampul 30 0 30 0
155 Phenobarbital 100 mg Tablet 0 0 0 0
156 Phenol gliserol 10% TT Botol 24 0 24 9
157 Phytomenadione (Vit.K1) inj 10 mg/ml Ampul 120 0 120 11
158 Phytomenadione (Vit.K1) 10 mg Tablet 180 0 180 180
159 Piracetam 400 mg Tablet 0 0 0 0
160 Piroxicam 20 mg tab Tablet 4425 0 4425 765
161 Pisau Disposable (Mess No.14/21) Pcs 92 0 92 20
162 Plesterku (Leukoplast) Pcs 32 0 32 17
163 Polivalen serum (Anti Tetanus Inj. 1500 iu/Biosat) Ampul 0 0 0 0
164 Povidon iodium 10% 300 ml Botol 22 0 22 3
165 Prednison 5 mg Tablet 0 0 0 0
166 Primaquin 15 mg tab Tablet 100 0 100 0
167 Profolat tab Tablet 0 0 0 0
168 Prokaina Penisilin G inj 3.000.000 iu Ampul 0 0 0 0
169 Propranolol HCl 10 mg Tablet 70 0 70 70
171 Propylthiouracil 100 mg Tablet 800 0 800 55
172 Protein Gluco Test Strip 50 0 50 0
173 Pyrantel Pamoat 125 mg Tablet 100 0 100 0
174 Pyridoxine HCl 10 mg Tablet 424 0 424 114
175 Ranitidin 150 mg Tablet 2270 0 2270 1550
176 Ranitidin Injeksi Ampul 0 0 0 0
177 Retinol (Vit.A) kaps 100.000 iu Kapsul 0 0 0 0
178 Retinol (Vit.A) kaps 200.000 iu Kapsul 0 0 0 0
179 Risperidone 2mg Tablet 0 0 0 0
HALAMAN : 6
STOK
AWAL
1 2 3 4 5 6 7
180 Salbutamol 2 mg Tablet 0 0 0 0
181 Salep 2-4 Kombinasi pot 18 0 18 6
182 Sarung tangan (HandScuun) No.7,5 Pcs 0 0 0 0
183 Sarung tangan (HandScuun Steril) No. 6,5 Pcs 0 0 0 0
184 Sarung tangan (HandScuun Steril) No.7 Pcs 35 0 35 35
185 Sarung tangan (HandScuun Steril) No.7,5 Pcs 0 0 0 0
186 Semen Seng Fosfat Serbuk & Cairan Set 0 0 0 0
187 Sianocobalamin (Vit B12) 50 mg tab Tablet 920 0 920 383
188 Silk (Benang Bedah) No. 3/0 Pcs 77 0 77 3
189 Silver Sulfadiazine Tube 20 0 20 1
190 Simvastatin 10 mg tab Tablet 420 0 420 140
191 Sodium cloride infus 0,9% ( NACL ) Botol 218 0 218 180
192 Spuit 1 ml Pcs 584 0 584 584
193 Spuit 3 ml Pcs 1076 0 1076 839
194 Spuit 5 ml Pcs 410 0 410 277
195 Sulfadoxine | Pyrimethamine Tablet 500mg|25mg Tablet 0 0 0 0
196 Sulfamethoxazole | trimethoprim (cotri) syr Botol 68 0 68 64
197 Sulfasetamida 15% TM Botol 0 0 0 0
198 Tetracycline 250 mg Tablet 0 0 0 0
200 Thiamine HCl (Vit B1) inj 100 mg/ml Ampul 0 0 0 0
201 Thiamine HCl (Vit B1) 50 mg Tablet 170 0 170 20
202 Trihexyphenidyl tab 2 mg Tablet 500 0 500 10
203 Trimethoprim (cotrimoxazol 480 mg) tablet Tablet 1000 0 1000 254
204 Urin Bag Pcs 26 0 26 9
205 Usg Gel Botol 0 0 0 0
206 Vaksin Rabies Vero/ Verorab Paket 0 0 0 0
207 Vitamin B Kompleks Tablet 8220 0 8220 2050
208 Vitamin K Infant Inj Ampul 0 0 0 0
209 Water liquid (aqua P,I) Botol 115 0 115 39
210 Wing Needle No.21 Pcs 0 0 0 0
212 Zinc Sulphate Suppositoria (Superhoid) Kapsul 0 0 0 0
213 Zinc tab Tablet 260 0 260 194
214
215
216
HALAMAN : 7
STOK
AWAL
1 2 3 4 5 6 7
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
UMUM BPJS JUMLAH

Mengetahui Mengetahui Mengetahui

Kepala Dinas Kesehatan Kab. OKI Kepala Instalasi Farmasi Dinkes OKI Direktur RS Pra
H. M. Lubis, S.KM., M.Kes Himayanti, S.Si., Apt. Pamuji, S.

NIP. 19660603 198703 1 003 NIP. 19770221 200501 2 005 Nip.19751122
AN OBAT (LPLPO) RUMAH SAKIT PRATAMA TUGU JAYA
: JANUARI 2019 DOKUMEN NOMOR TANGGAL
: FEBRUARI 2019 DINKES KAB/KOTA
IFK KAB/KOTA
PUSKESMAS 01
STOK STOK
PERMINTAAN PEMBERIAAN KET
AKHIR OPTIMUM
8 9 10 11 12
32 598 600
336 1001 1000
290 515 1000
2 51 48
258 283 0
14 17 10
30 412 1000
100 1 0
200 383 300
300 0 0
105 2752 3000
0 300 300
300 1175 1000
3161 6434 4000
0 10 10
196 300 100
0 5000 5000
0 3 3
0 5000 5000
4489 3206 2000
0 1000 1000
0 345 300
16 4 0
367 14 300
700 0 300
0 1 1
4 0 5
16 41 100
48 0 0
80 1136 1000
0 134 134
LPLPO No: 01 LAPORAN BULAN : JANUARI 2019
STOK STOK
AKHIR OPTIMUM
8 9 10 11 12
540 19 0
20 0 0
27 1458 2500
2270 4048 3000
650 2030 2000
810 3346 3500
629 38 200
0 200 400
39 200 200
19 1946 2500
35 36 50
50 23 48
37 14 200
242 419 500
0 48 48
30 64 50
1137 7619 10000
1005 0 0
0 0 2000
31 3109 4000
0 0 0
600 0 0
7 6 10
25 134 200
0 1 1
1304 7298 7000
120 148 100
0 100 100
1300 255 0
1799 1419 1000
100 200 200
320 358 300
60 38 100
414 3081 3000
500 0 0
0 13 24
1 206 300
STOK STOK
AKHIR OPTIMUM
8 9 10 11 12
175 1539 2000
7 1 5
6 18 12
5 10 0
10350 7202 0
1130 168 500
11 24 30
0 0 0
420 741 500
433 254 200
0 0 24
29 1 24
9 139 150
0 1 1
880 664 1000
483 819 1000
69 26 100
150 98 500
260 179 200
4765 2854 2000
0 0 200
970 0 200
145 0 100
475 716 500
109 38 100
0 1903 3000
0 0 2000
0 0 24
0 10 10
267 600 600
104 300 300
37 0 0
150 358 500
123 158 200
271 478 400
182 207 200
0 0 0
STOK STOK
AKHIR OPTIMUM
8 9 10 11 12
0 0 48
19 41 25
3 96 100
304 186 100
20 56 100
28 43 100
0 119 150
378 1101 2000
0 0 200
2 0 0
7 0 10
110 189 150
5 10 4.6
141 260 200
0 0 12
253 771 1000
1930 1175 1000
15 0 15
0 13 15
613 2416 3000
48 2 50
63 0 0
469 2369 2500
0 0 0
100 0 500
2025 2522 1000
11 17 48
330 651 1500
0 255 1500
0 10 10
0 100 100
50 37 12
0 0 200
530 200 200
283 613 500
130 89 100
53 100 100
STOK STOK
AKHIR OPTIMUM
8 9 10 11 12
690 784 900
11 65 72
0 48 48
0 220 200
0 0 500
0 0 12
97 11 50
0 553 600
2110 15861 15000
8 1 0
36 33 24
30 60 60
0 100 100
15 47 48
109 91 100
0 638 1000
0 24 200
3660 2988 1000
72 26 200
15 46 50
0 10 10
19 8 5
0 1000 1000
100 200 100
0 0 0
0 12 12
0 166 500
268 169 500
745 389 500
50 51 0
100 0 0
310 401 500
720 6040 6000
0 0 200
0 0 0
0 2000 2000
0 0 500
STOK STOK
AKHIR OPTIMUM
8 9 10 11 12
0 511 1500
12 40 24
0 2608 3000
0 300 300
0 300 300
0 300 300
0 0 5
537 2462 3000
74 17 24
19 8 0
280 1053 1200
38 558 1000
0 1320 500
237 2703 3000
133 664 600
0 0 0
4 176 300
0 0 48
0 500 500
880 500 500
0 0 0
150 255 200
490 200 0
746 707 1000
17 20 20
0 3 3
0 1 1
6170 8139 5000
0 0 0
76 82 30
0 0 0
0 0 0
0 0 20
66 419 1000
STOK STOK
AKHIR OPTIMUM
8 9 10 11 12

Direktur RS Pratama Tugu Jaya Pengelola Gudang Obat
Pamuji, S.KM.,M.Si. Kartini Wiati,SKM

Nip.19751122 199503 1 002 NIP. 19750806 200501 2 009
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O
RS PRATAMA : TUGU JAYA PELAPORAN BULAN

KECAMATAN : LEMPUING PERMINTAAN BULAN
STOK
NO. NAMA OBAT SATUAN PENERIMAAN
AWAL
1 2 3 4 5
1 Absorbent tipped applicator (alcohol swab) Pcs 32 600

2 Acetylcystein Kapsul 200mg Kapsul 336 1000
3 Acyclovir tab 200 mg Tablet 290 1000
4 Acyclovir cream Tube 2 0
5 Albendazol tab 400 mg Tablet 258 0
6 Alkohol Liquid (etanol) 70%-1000 ml Btl 14 10
7 Allopurinol 100 mg Tablet 30 1000
8 Aminophylline Inj 24 mg/ml-10 ml Ampul 100 0
9 Aminophylline tab 200 mg Tablet 200 300
10 Amitriptyline 25 mg tab Tablet 300 0
11 Amlodipine tab 5 mg Tablet 105 3000
12 Amoxycillin Syr Btl 0 0
13 Amoxycillin 250 mg Kapsul 300 1000
14 Amoxycillin 500 mg Kaptab 3161 4000
15 Ampicilin 1 gr Inj Vial 0 10
16 Antasida Syr DOEN Btl 196 100
17 Antasida DOEN Kombinasi Tablet 0 5000
18 Anti Bisa Ular 5 ml (ABU I)/ Biosave Vial 0 0
19 Asam Mefenamat 500 mg tab Tablet 0 5000
20 Ascorbic acid (Vit.C) 50 mg Tablet 4489 2000
21 Ascorbic acid |calsium carbonate 500 mg (Pehavral) Tablet 0 0
22 Aspirin (miniaspi) 100 mg tab Tablet 0 300
23 Atropine inj 0,25 mg/ml Ampul 16 0
24 Attapulgite Tablet (Pularex) Tablet 367 300
25 Attapulgite Tablet 600 mg (New Antides) Tablet 700 300
26 Automated blood grouping (Tes Gol. Darah) Paket 0 1
27 Bahan Tambal Gigi Sementara (Fletcher/Caviton) Pcs 4 2
28 Bedak Salisil 2% Btl 16 100
29 Benzoic acid |salicylic acid salep (anti fungi) pot 48 0
30 Betahistine Mesylate 6 mg tab Tablet 80 1000
31 Betamethasone 0,1% krim Tube 0 0
STOK
AWAL
1 2 3 4 5
32 Bisacodyl 5mg Tablet 540 0

33 Bismuth subgallas (antihemoroid) Supp 20 0
34 Calcium chloride lactate infus (RL) Botol 27 2500
35 Calsium Laktat (Kalk) 500 mg Tablet 2270 0
36 Captopril 12,5 mg Tablet 650 2000
37 Captopril 25 mg Tablet 810 0
38 Carbamazepin tab Tablet 629 200
39 Catgut/Benang Chromic Bedah No.2/0-3/0 Pcs 0 384
40 Catgut/Benang Plain Bedah No.2/0-3/0 Pcs 39 0
41 Cefadroxil 500mg Tablet 19 0
42 Cetirizine 5 mg/5 ml sirup Botol 35 50
43 Chloramhenicol Salep Mata 1% Tube 50 48
44 Chloramphenicol Suspensi 125 mg/ml Btl 37 200
45 Chloramphenicol 250 mg caps Tablet 242 0
46 Chloramphenicol TT 3% Botol 0 0
47 Chloramphenicol/ Hidrokortison krim 2,5% Tube 30 48
48 Chlorpheniramine Maleat (CTM) 4 mg Tablet 1137 10000
49 Chlorpromazine HCl 100 mg Tablet 1005 0
50 Cimetidin 200 tab Tablet 0 0
51 Ciprofloxacin 500 mg tab Tablet 31 4000
52 Ciprofloxacin Infus Botol 0 0
53 Clindamycin 300mg Kapsul 600 0
54 Cresol liquid 1 Liter (lysol) Botol 7 0
55 Cyanocobalamin (Vit B12) inj 500 mcg/ml Ampul 25 0
56 Devitalisasi pasta pot 0 0
57 Dexamethasone 0,5 mg Tablet 1304 0
58 Dexamethasone inj 5mg/ml-1ml Ampul 120 10
59 Diazepam 5mg/ml-2 ml inj Ampul 0 0
60 Diazepam 2 mg Tablet 1300 0
61 Diclofenac sodium 25 mg tab Tablet 1799 0
62 Digoxin 0,25 mg Tablet 100 0
63 Dimenhydrinate 50mg Tablet 320 300
64 Dipenhidramine HCl inj 10mg/ml Ampul 60 120
65 Domperidone 10 mg Tablet 414 3000
66 Doxycycline 100 mg Kapsul Kapsul 500 0
67 Epinephrine HCl/bitartrat inj 0,1% Ampul 0 24
68 Erythromicin Syr Btl 1 0
STOK
AKHIR
1 2 3 8 5
69 Erythromicin 500 mg capsul Kapsul 175 2000

70 Ethacridine (Rivanol) 0,1% Btl 7 0
71 Ethanol ( Aseptan ) 500 cc+ Pump Botol 6 0
72 Eugenol cairan Btl 5 0
73 Ferrous fumarate ( Tab. Tambah Darah ) Tablet 10350 22400
74 Folic acid 1mg ( asam folat) Tablet 1130 500
75 Folley Catheter No.16 Pcs 11 30
76 Furosemida Injeksi Ampul 0 0
77 Furosemida 40 mg Tablet 420 400
78 Garam Oralit Sachet 433 200
79 Gentamicyn 0,3% TM Botol 0 0
80 Gentamicyn Inj 40 mg/ml Ampul 29 25
81 Gentamicyn 0,1% SK Tube 9 0
82 Glass lonomer Paket 0 1
83 Glibenclamide 5 mg Tablet 880 1000
84 Glimepiride 1 mg Tablet 483 1000
85 Glukosa larutan infus 10% Botol 69 100
87 Griseofulvin 125 mg Tablet 260 200
88 Guaifenesin 100 Tab (GG tab) Tablet 4765 2000
89 Haloperidol 0,5 mg tab Tablet 0 0
90 Haloperidol 5 mg tab Tablet 970 200
91 Human chorionic (HCG/Tes kehamilan ) Strip 145 120
92 Hydrochlorotiazide (HCT) 25 mg Tablet 475 500
93 Ibuprofen sirup Botol 109 0
94 Ibuprofen 200 mg Tablet 0 0
96 Ichthyol salep 10% pot 0 0
97 Immunoglobulin human anti-tetanus (Tetagam) Ampul 0 10
98 Infus set dewasa Pcs 267 600
99 Infusi set anak Pcs 104 300
100 Iodium Povidon 10% 30 ml Botol 37 0
101 Isosorbide tablet Tablet 150 0
102 IV Catheter No.20 Pcs 123 0
105 Jarum Jahit Kulit Pcs 0 0
STOK
AWAL
1 2 3 4 5
106 Kalium Permanganat Serbuk pot 0 0

107 Kapas pembalut/Absorben 250 g Pcs 19 25
108 Kasa pembalut 2x80 Pcs 3 100
109 Kasa pembalut hidrofil 4 m x 15 cm Pcs 304 100
111 Kasa kompres 40/40 steril Pcs 28 100
112 Ketoconazole 200 mg Cream Tube 0 150
113 Ketoconazole 200 mg tab Tablet 378 0
114 Klorokina Fosfat 250 mg Tablet 0 0
115 Levertran Salep/ Salep Luka Bakar pot 2 0
116 Lidocain 2% Ampul 7 0
117 Lidokain Comp. inj Kombinasi Ampul 110 150
118 Lidocaine spray (Xylocaine spray) Botol 5 5
119 Liquorice liquid extract (OBH) Botol 141 0
120 Locoriz Cream Tube 0 0
121 Loperamid 2 m tab Tablet 253 0
122 Loratadine 10 mg tab Tablet 1930 1000
123 Magnesium Sulfat Injeksi 20% (MgSO4) Ampul 15 15
125 Masker Pcs 613 3000
126 Medical adhesive tape (dermafix/leukomed) Pcs 48 0
127 Metamizole injeksi (antalgin 1000) Ampul 63 0
128 Metformin 500mg tab Tablet 469 2500
129 Methyl Ergometrin Maleat inj 0,2 mg/ml Ampul 0 0
130 Methyl Ergometrin Maleat 0,125 mg Tab 100 500
131 Methyl Prednisolon tab 4 mg Tablet 2025 1000
132 Methyl Rosanilinium (gentian violet) Botol 11 48
133 Metronidazol 250 mg tab Tablet 330 1500
135 Metronidazol Infus Botol 0 10
136 Metronidazol syr Botol 0 100
137 Miconazole 2% Salep Kulit Tube 50 24
138 Momilen Baby Gold Sirup Botol 0 0
139 Natrium Bikarbonat 500 mg Tablet 530 0
140 Nifedipin 10 mg tab Kapsul 283 0
141 Nystatin Tab Vag 10.000 iu/g Tablet 130 100
142 Omeprazole inj Vial 53 100
STOK
AWAL
1 2 3 4 5
143 Omeprazole kaps Kapsul 690 900

144 Oxytetracycline HCl 1% Salep Mata Tube 11 0
145 Oxytetracycline HCl 3% Salep Kulit Tube 0 0
146 Oxytocin inj 10 IU Ampul 0 200
147 Papaverin 40 mg tab Tablet 0 0
148 Papaverin inj Tablet 0 0
149 Paracetamol Drops 15 ml Botol 97 0
150 Parasetamol 120 mg/5 ml Syr Botol 0 600
151 Parasetamol 500 mg Tablet 2110 15000
152 Patient Lubricant (My Jelly ) Tube 8 0
153 Permethrin (Scabimite Cream) Tube 36 0
154 Phenobarbital inj 50mg/ml-2ml Ampul 30 60
155 Phenobarbital 100 mg Tablet 0 0
156 Phenol gliserol 10% TT Botol 15 48
157 Phytomenadione (Vit.K1) inj 10 mg/ml Ampul 109 120
158 Phytomenadione (Vit.K1) 10 mg Tablet 0 0
159 Piracetam 400 mg Tablet 0 0
160 Piroxicam 20 mg tab Tablet 3660 1000
161 Pisau Disposable (Mess No.14/21) Pcs 72 0
162 Plesterku (Leukoplast) Pcs 15 50
163 Polivalen serum (Anti Tetanus Inj. 1500 iu/Biosat) Ampul 0 0
164 Povidon iodium 10% 300 ml Botol 19 5
165 Prednison 5 mg Tablet 0 0
166 Primaquin 15 mg tab Tablet 100 100
167 Profolat tab Tablet 0 0
168 Prokaina Penisilin G inj 3.000.000 iu Ampul 0 0
169 Propranolol HCl 10 mg Tablet 0 0
171 Propylthiouracil 100 mg Tablet 745 0
172 Protein Gluco Test Strip 50 0
173 Pyrantel Pamoat 125 mg Tablet 100 0
174 Pyridoxine HCl 10 mg Tablet 310 500
175 Ranitidin 150 mg Tablet 720 6000
176 Ranitidin Injeksi Ampul 0 0
177 Retinol (Vit.A) kaps 100.000 iu Kapsul 0 0
179 Risperidone 2mg Tablet 0 0
STOK
AWAL
1 2 3 4 5
180 Salbutamol 2 mg Tablet 0 0

181 Salep 2-4 Kombinasi pot 12 2
182 Sarung tangan (HandScuun) No.7,5 Pcs 0 0
183 Sarung tangan (HandScuun Steril) No. 6,5 Pcs 0 300
184 Sarung tangan (HandScuun Steril) No.7 Pcs 0 0
185 Sarung tangan (HandScuun Steril) No.7,5 Pcs 0 0
186 Semen Seng Fosfat Serbuk & Cairan Set 0 0
187 Sianocobalamin (Vit B12) 50 mg tab Tablet 537 3000
188 Silk (Benang Bedah) No. 3/0 Pcs 74 36
189 Silver Sulfadiazine Tube 19 0
190 Simvastatin 10 mg tab Tablet 280 1200
191 Sodium cloride infus 0,9% ( NACL ) Botol 38 40
192 Spuit 1 ml Pcs 0 500
193 Spuit 3 ml Pcs 237 3000
194 Spuit 5 ml Pcs 133 600
195 Sulfadoxine | Pyrimethamine Tablet 500mg|25mg Tablet 0 0
196 Sulfamethoxazole | trimethoprim (cotri) syr Botol 4 300
197 Sulfasetamida 15% TM Botol 0 0
198 Tetracycline 250 mg Tablet 0 0
200 Thiamine HCl (Vit B1) inj 100 mg/ml Ampul 0 0
201 Thiamine HCl (Vit B1) 50 mg Tablet 150 200
202 Trihexyphenidyl tab 2 mg Tablet 490 0
203 Trimethoprim (cotrimoxazol 480 mg) tablet Tablet 746 0
204 Urin Bag Pcs 17 0
205 Usg Gel Botol 0 0
206 Vaksin Rabies Vero/ Verorab Paket 0 0
207 Vitamin B Kompleks Tablet 6170 0
208 Vitamin K Infant Inj Ampul 0 0
209 Water liquid (aqua P,I) Botol 76 30
210 Wing Needle No.21 Pcs 0 0
212 Zinc Sulphate Suppositoria (Superhoid) Kapsul 0 0
213 Zinc tab Tablet 66 0
214
215
216
STOK
AWAL
1 2 3 4 5
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
UMUM BPJS
Mengetahui Mengetahui
Kepala Dinas Kesehatan Kab. OKI Kepala Instalasi Farmasi Dinkes OKI
H. M. Lubis, S.KM., M.Kes Himayanti, S.Si., Apt.

NIP. 19660603 198703 1 003 NIP. 19770221 200501 2 005
MBAR PERMINTAAN OBAT (LPLPO) PUSKESMAS
ORAN BULAN : FEBRUARI 2019 DOKUMEN NOMOR TANGGAL

NTAAN BULAN : DINKES KAB/KOTA
IFK KAB/KOTA
PUSKESMAS 02
STOK STOK
PERSEDIAAN PEMAKAIAN PERMINTAAN PEMBERIAAN KET
AKHIR OPTIMUM
6 7 8 9 10 11 12
632 102 530
1336 32 1304
1290 150 1140
2 2 0
258 0 258
24 2 22
1030 430 600
100 0 100
500 240 260
300 0 300
3105 450 2655
0 0 0
1300 520 780
7161 1674 5487
10 0 10
296 35 261
5000 1671 3329
0 0 0
5000 1091 3909
6489 772 5717
0 0 0
300 20 280
16 0 16
667 28 639
1000 0 1000
1 1 0
6 0 6
116 4 112
48 2 46
1080 125 955
0 0 0
HALAMAN : 2 LPLPO No : 02 LAPORAN BULAN : FEBRUARI 2019
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
540 540 0
20 0 20
2527 647 1880
2270 570 1700
2650 184 2466
810 640 170
829 0 829
384 16 368
39 4 35
19 19 0
85 4 81
98 7 91
237 37 200
242 12 230
0 0 0
78 7 71
11137 1296 9841
1005 0 1005
0 0 0
4031 811 3220
0 0 0
600 0 600
7 1 6
25 0 25
0 0 0
1304 1304 0
130 0 130
0 0 0
1300 40 1260
1799 1687 112
100 0 100
620 40 580
180 30 150
3414 964 2450
500 0 500
24 24 0
1 1
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
2175 631 1544
7 0 7
6 1 5
5 0 5
32750 25870 6880
1630 0 1630
41 16 25
0 0 0
820 274 546
633 41 592
0 0 0
54 5 49
9 3 6
1 0 1
1880 41 1839
1483 27 1456
169 4 165
650 96 554
460 0 460
6765 452 6313
0 0 0
1170 70 1100
265 24 241
975 10 965
109 11 98
0 0 0
0 0 0
0 0 0
10 10 0
867 94 773
404 0 404
37 0 37
150 127 23
123 48 75
671 113 558
382 46 336
0 0 0
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
0 0 0
44 2 42
103 4 99
404 45 359
20 0 20
128 6 122
150 9 141
378 188 190
0 0 0
2 1 1
7 0 7
260 20 240
10 1 9
141 76 65
0 0 0
253 57 196
2930 690 2240
30 0 30
0 0 0
3613 587 3026
48 2 46
63 0 63
2969 149 2820
0 0 0
600 0 600
3025 374 2651
59 19 40
1830 272 1558
0 0 0
10 0 10
100 3 97
74 0 74
0 0 0
530 0 530
283 120 163
230 20 210
153 0 153
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
1590 235 1355
11 2 9
0 0 0
200 200 0
0 0 0
0 0 0
97 5 92
600 99 501
17110 3266 13844
8 0 8
36 5 31
90 0 90
0 0 0
63 3 60
229 51 178
0 0 0
0 0 0
4660 910 3750
72 7 65
65 13 52
0 0 0
24 0 24
0 0 0
200 0 200
0 0 0
0 0 0
0 0 0
768 68 700
745 55 690
50 0 50
100 0 100
810 560 250
6720 1695 5025
0 0 0
0 0 0
0 0 0
0 0 0
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
0 0 0
14 14 0
0 0 0
300 75 225
0 0 0
0 0 0
0 0 0
3537 651 2886
110 12 98
19 0 19
1480 357 1123
78 76 2
500 28 472
3237 714 2523
733 66 667
0 0 0
304 32 272
0 0 0
0 0 0
1380 170 1210
0 0 0
350 70 280
490 90 400
746 666 80
17 4 13
0 0 0
0 0 0
6170 2162 4008
0 0 0
106 7 99
0 0 0
0 0 0
0 0 0
66 30 36
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
JUMLAH


Nip.19751122 199503 1 002 NIP. 19750806 200501 2 009
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O

STOK
AWAL
1 2 3 4 5

STOK
AWAL
1 2 3 4 5

STOK
AWAL
1 2 3 4 5

STOK
AWAL
1 2 3 4 5

125 Masker Pcs 3026 0
STOK
AWAL
1 2 3 4 5

STOK
AWAL
1 2 3 4 5

214
215
216
STOK
AWAL
1 2 3 4 5
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
UMUM BPJS JUMLAH


NIP. 19660603 198703 1 003 NIP. 19770221 200501 2 005
LEMBAR PERMINTAAN OBAT (LPLPO) PUSKESMAS
ORAN BULAN : MARET 2019 DOKUMEN NOMOR TANGGAL

INTAAN BULAN : DINKES KAB/KOTA
IFK KAB/KOTA
PUSKESMAS
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
530 439 91
1304 279 1025
1140 310 830
0 0 0
258 18 240
22 7 15
600 200 400
100 100 0
260 200 60
300 0 300
2655 430 2225
0 0 0
780 264 516
5487 1137 4350
10 0 10
261 10 251
3329 1309 2020
0 0 0
3909 2433 1476
5717 897 4820
0 0 0
280 40 240
16 15 1
639 32 607
1000 60 940
0 0 0
6 0 6
112 12 100
46 0 46
955 160 795
0 0 0
HALAMAN : 2 LPLPO No: 3 LAPORAN BULAN : MARET 2019
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
0 0 0
20 0 20
1880 645 1235
1700 810 890
2466 436 2030
170 170 0
829 0 829
368 3 365
35 2 33
0 0 0
81 5 76
91 3 88
200 27 173
230 0 230
0 0 0
71 47 24
9841 2201 7640
1005 805 200
0 0 0
3220 1710 1510
0 0 0
600 0 600
6 3 3
25 0 25
0 0 0
0 0 0
130 0 130
0 0 0
1260 145 1115
112 112 0
100 10 90
580 90 490
150 30 120
2450 430 2020
500 0 500
0 0 0
0 0 0
HALAMAN : 3 LPLPO No : 03 LAPORAN BULAN : MARET 2019
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
1544 874 670
7 6 1
5 1 4
5 0 5
6880 1770 5110
1630 0 1630
25 1 24
0 0 0
546 196 350
592 8 584
0 0 0
49 12 37
6 6 0
1 0 1
1839 0 1839
1456 390 1066
165 0 165
554 161 393
460 20 440
6313 933 5380
0 0 0
1100 500 600
241 31 210
965 10 955
98 11 87
0 0 0
0 0 0
0 0 0
0 0 0
773 120 653
404 17 387
37 37 0
23 0 23
75 47 28
558 179 379
336 115 221
0 0 0
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
0 0 0
42 0 42
99 39 60
359 194 165
20 0 20
122 113 9
141 33 108
190 35 155
0 0 0
1 0 1
7 0 7
240 11 229
9 1 8
65 65 0
0 0 0
196 0 196
2240 450 1790
30 0 30
0 0 0
3026 916 2110
46 12 34
63 0 63
2820 480 2340
0 0 0
600 0 600
2651 1381 1270
40 15 25
1558 588 970
0 0 0
10 0 10
97 20 77
74 11 63
0 0 0
530 0 530
163 73 90
210 0 210
153 0 153
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
1355 265 1090
9 9 0
0 0 0
0 0 0
0 0 0
0 0 0
92 8 84
501 108 393
13844 5784 8060
8 1 7
31 3 28
90 0 90
0 0 0
60 13 47
178 35 143
0 0 0
0 0 0
3750 580 3170
65 37 28
52 19 33
0 0 0
24 6 18
0 0 0
200 0 200
0 0 0
0 0 0
0 0 0
700 700 0
690 100 590
50 10 40
100 0 100
250 30 220
5025 1195 3830
0 0 0
0 0 0
0 0 0
0 0 0
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
0 0 0
0 0 0
0 0 0
225 216 9
0 0 0
0 0 0
0 0 0
2886 379 2507
98 11 87
19 1 18
1123 95 1028
2 2 0
472 154 318
2523 663 1860
667 0 667
0 0 0
272 82 190
0 0 0
0 0 0
1210 30 1180
0 0 0
280 150 130
400 0 400
80 80 0
13 0 13
0 0 0
0 0 0
4008 1598 2410
0 0 0
99 37 62
0 0 0
0 0 0
0 0 0
36 36 0
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12


NIP.19751122 199503 1 002 NIP. 19750806 200501 2 009
STOK
AWAL
1 2 3 4 5

STOK
AWAL
1 2 3 4 5

STOK
AWAL
1 2 3 4 5

STOK
AWAL
1 2 3 4 5

STOK
AWAL
1 2 3 4 5

STOK
AWAL
1 2 3 4 5

214
215
216
STOK
AWAL
1 2 3 4 5
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
UMUM BPJS JUMLAH


NIP. 19660603 198703 1 003 NIP. 19770221 200501 2 005
N BULAN : APRIL 2019 DOKUMEN NOMOR TANGGAL
AN BULAN : MEI 2019 DINKES KAB/KOTA
IFK KAB/KOTA
PUSKESMAS 4
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
91 91 0 904 900
1025 565 460 1253 1000
830 630 200 1560 2500
0 0 0 3 48
240 6 234 34 0
15 3 12 17 20
400 340 60 1388 2500
0 0 0 143 200
60 0 60 630 1000
300 0 300 0 200
2225 905 1320 2554 2000
0 0 0 0 500
516 396 120 1688 2500
4350 1750 2600 6526 10000
10 0 10 0 0
251 43 208 126 300
2020 1484 536 6387 8000
0 0 0 0 5
1476 1476 0 11769 10000
4820 933 3887 3723 3000
0 0 0 0 1000
240 240 0 429 1000
1 0 1 21 100
607 298 309 512 500
940 20 920 114 500
0 0 0 1 1
6 0 6 0 0
100 3 97 27 100
46 22 24 34 48
795 465 330 1073 800
0 0 0 0 48
HALAMAN : 2 LPLPO No : 4 LAPORAN BULAN : APRIL 2019
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
0 0 0 773 1000
20 20 0 29 50
1235 419 816 2448 2000
890 850 40 3191 5000
2030 660 1370 1831 1500
0 0 0 1159 3000
829 0 829 0 500
365 25 340 63 72
33 3 30 13 72
0 0 0 27 5000
76 48 28 82 100
88 13 75 33 24
173 40 133 149 100
230 100 130 0 2000
0 0 0 0 100
24 24 0 112 150
7640 1470 6170 7107 5000
200 0 200 1152 2000
0 0 0 0 3000
1510 860 650 4837 5000
0 0 0 0 10
600 150 450 215 0
3 0 3 6 10
25 16 9 23 200
0 0 0 0 0
0 0 0 3671 10000
130 0 130 200 200
0 0 0 0 100
1115 15 1100 286 500
0 0 0 2574 5000
90 81 9 130 500
490 190 300 458 500
120 0 120 86 50
2020 660 1360 2939 3000
500 0 500 0 0
0 0 0 34 50
0 0 0 1 300
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
670 670 0 3112 4000
1 0 1 9 10
4 4 0 9 20
5 0 5 0 0
5110 1990 3120 42394 40000
1630 560 1070 801 500
24 8 16 36 20
0 0 0 0 10
350 230 120 1002 1000
584 0 584 70 1000
0 0 0 0 24
37 0 37 24 48
0 0 0 13 48
1 0 1 0 0
1839 440 1399 688 1000
1066 142 924 800 1000
165 5 160 13 0
393 7 386 378 100
440 70 370 129 500
5380 1730 3650 4457 1000
0 0 0 0 500
600 0 600 816 500
210 0 210 79 200
955 175 780 279 500
87 32 55 77 100
0 0 0 0 5000
0 0 0 0 5000
0 0 0 0 24
0 0 0 14 10
653 73 580 411 500
387 67 320 120 250
0 0 0 53 0
23 23 0 215 1000
28 8 20 147 200
379 150 229 632 500
221 78 143 342 300
0 0 0 0 0
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
0 0 0 0 48
42 8 34 14 20
60 10 50 76 50
165 60 105 428 400
20 0 20 0 50
9 0 9 170 200
108 18 90 86 50
155 135 20 512 1000
0 0 0 0 100
1 1 0 3 0
7 0 7 0 25
229 14 215 64 100
8 0 8 3 5
0 0 0 202 500
0 0 0 0 24
196 196 0 362 500
1790 522 1268 2378 2000
30 0 30 0 0
0 0 0 0 30
2110 286 1824 2560 800
34 2 32 23 100
63 0 63 0 0
2340 420 1920 1501 2000
0 0 0 0 0
600 100 500 143 200
1270 1270 0 5026 6000
25 4 21 54 48
970 170 800 1474 700
0 0 0 0 1000
10 0 10 0 0
77 3 74 37 50
63 6 57 24 48
0 0 0 0 100
530 130 400 186 500
90 50 40 348 500
210 30 180 72 50
153 0 153 200 50
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
1090 270 820 1102 2000
0 0 0 16 50
0 0 0 0 50
0 0 0 286 300
0 0 0 0 500
0 0 0 0 100
84 23 61 52 100
393 110 283 454 300
8060 3920 4140 18557 15000
7 1 6 3 5
28 10 18 26 24
90 0 90 0 0
0 0 0 0 100
47 9 38 36 50
143 30 113 166 300
0 0 0 0 2000
0 0 0 0 500
3170 760 2410 3219 3000
28 13 15 82 200
33 11 22 62 50
0 0 0 0 10
18 1 17 10 20
0 0 0 0 5000
200 0 200 0 200
0 0 0 0 1000
0 0 0 0 0
0 0 0 0 2000
0 0 0 1099 2000
590 190 400 494 2000
40 0 40 14 0
100 0 100 0 500
220 220 0 1159 2000
3830 1310 2520 6009 5000
0 0 0 0 500
0 0 0 0 1000
0 0 0 0 1000
0 0 0 0 1000
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
0 0 0 0 2000
0 0 0 20 48
0 0 0 0 8000
9 9 0 429 500
0 0 0 0 500
0 0 0 0 500
0 0 0 0 0
2507 498 2009 2186 1000
87 0 87 33 24
18 6 12 10 15
1028 283 745 1052 2100
0 0 0 220 500
318 153 165 479 500
1860 410 1450 2557 2000
667 51 616 167 300
0 0 0 0 0
190 40 150 362 400
0 0 0 0 48
0 0 0 0 500
1180 100 1080 429 2000
0 0 0 0 30
130 30 100 358 1000
400 0 400 129 200
0 0 0 1756 5000
13 13 0 24 24
0 0 0 0 8
0 0 0 0 0
2410 1940 470 8155 10000
0 0 0 0 50
62 11 51 79 50
0 0 0 0 0
0 0 0 0 0
0 0 0 0 20
0 0 0 2000 2000
HALAMAN : 7 LPLPO No: 4 LAPORAN BULAN : APRIL 2019
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12

Direktur Rumah Sakit Pengelola Obat
dr. Muhammad Tito Aristian Kartini Wiati,SKM

NIP. 19850421 2014081 001 NIP. 19750806 200501 2 009
variabel Variabel
waktu Hari
waktu Waktu
tunggu Kosong
Kosong
tunggu
15 121.53846 0 0
15 168.46154 0 0
15 209.61538 0 0
15 0.3846154 0 0
15 4.6153846 0 0
15 2.3076923 0 0
15 186.53846 0 0
15 19.230769 0 0
15 84.615385 0 0
15 0 0 0
15 343.26923 0 0
15 0 0 0
15 226.92308 0 0
15 877.11538 0 0
15 0 0 0
15 16.923077 0 0
15 858.46154 0 0
15 0 0 0
15 961.53846 60 3846.1538
15 500.38462 0 0
15 0 0 0
15 57.692308 0 0
15 2.8846154 0 0
15 68.846154 0 0
15 15.384615 0 0
15 0.1923077 0 0
15 0 0 0
15 3.6538462 0 0
15 4.6153846 0 0
15 144.23077 0 0
15 0 0 0
variabel Variabel
waktu Hari
waktu Waktu
tunggu Kosong
Kosong
tunggu
15 103.84615 0 0
15 3.8461538 0 0
15 329.03846 0 0
15 428.84615 0 0
15 246.15385 0 0
15 155.76923 0 0
15 0 0 0
15 8.4615385 0 0
15 1.7307692 0 0
15 3.6538462 0 0
15 10.961538 0 0
15 4.4230769 0 0
15 20 0 0
15 21.538462 0 0
15 0 0 0
15 15 0 0
15 955.19231 0 0
15 154.80769 0 0
15 0 0 0
15 650.19231 0 0
15 0 0 0
15 28.846154 0 0
15 0.7692308 0 0
15 3.0769231 0 0
15 0 0 0
15 250.76923 90 1504.6154
15 0 0 0
15 0 0 0
15 38.461538 0 0
15 345.96154 0 0
15 17.5 0 0
15 61.538462 0 0
15 11.538462 0 0
15 395 0 0
15 0 0 0
15 4.6153846 0 0
15 0.1923077 0 0
15 0 0 0
variabel Variabel
waktu Hari
waktu Waktu
tunggu Kosong
Kosong
tunggu
15 418.26923 0 0
15 1.1538462 0 0
15 1.1538462 0 0
15 0 0 0
15 5698.0769 0 0
15 107.69231 0 0
15 4.8076923 0 0
15 0 0 0
15 134.61538 0 0
15 9.4230769 0 0
15 0 0 0
15 3.2692308 0 0
15 1.7307692 0 0
15 0 0 0
15 92.5 0 0
15 107.5 0 0
15 1.7307692 0 0
15 50.769231 0 0
15 17.307692 0 0
15 599.03846 0 0
15 0 0 0
15 109.61538 0 0
15 10.576923 0 0
15 37.5 0 0
15 10.384615 0 0
15 0 0 0
15 0 0 0
15 0 0 0
15 1.9230769 0 0
15 55.192308 0 0
15 16.153846 0 0
15 7.1153846 0 0
15 28.846154 0 0
15 19.807692 0 0
15 85 0 0
15 45.961538 0 0
15 0 0 0
15 0 0 0
variabel Variabel
waktu Hari
waktu Waktu
tunggu Kosong
Kosong
tunggu
15 0 0 0
15 1.9230769 0 0
15 10.192308 0 0
15 57.5 0 0
15 0 0 0
15 22.884615 0 0
15 11.538462 0 0
15 68.846154 0 0
15 0 0 0
15 0.3846154 0 0
15 0 0 0
15 8.6538462 0 0
15 0.3846154 0 0
15 27.115385 0 0
15 0 0 0
15 48.653846 0 0
15 319.61538 0 0
15 0 0 0
15 0 0 0
15 344.03846 0 0
15 3.0769231 0 0
15 0 0 0
15 201.73077 0 0
15 0 0 0
15 19.230769 0 0
15 581.73077 15 581.73077
15 7.3076923 0 0
15 198.07692 0 0
15 0 0 0
15 0 0 0
15 5 0 0
15 3.2692308 0 0
15 0 0 0
15 25 0 0
15 46.730769 0 0
15 9.6153846 0 0
15 0 0 0
15 0 0 0
variabel Variabel
waktu Hari
waktu Waktu
tunggu Kosong
Kosong
tunggu
15 148.07692 0 0
15 2.1153846 0 0
15 0 0 0
15 38.461538 0 0
15 0 0 0
15 0 0 0
15 6.9230769 0 0
15 60.961538 0 0
15 2494.2308 0 0
15 0.3846154 0 0
15 3.4615385 0 0
15 0 0 0
15 0 0 0
15 4.8076923 0 0
15 22.307692 0 0
15 0 0 0
15 0 0 0
15 432.69231 0 0
15 10.961538 0 0
15 8.2692308 0 0
15 0 0 0
15 1.3461538 0 0
15 0 0 0
15 0 0 0
15 0 0 0
15 0 0 0
15 0 0 0
15 147.69231 0 0
15 66.346154 0 0
15 1.9230769 0 0
15 0 0 0
15 155.76923 0 0
15 807.69231 0 0
15 0 0 0
15 0 0 0
15 0 0 0
15 0 0 0
15 0 0 0
variabel Variabel
waktu Hari
waktu Waktu
tunggu Kosong
Kosong
tunggu
15 0 0 0
15 2.6923077 0 0
15 0 0 0
15 57.692308 0 0
15 0 0 0
15 0 0 0
15 0 0 0
15 293.84615 0 0
15 4.4230769 0 0
15 1.3461538 0 0
15 141.34615 0 0
15 15 90 90
15 64.423077 0 0
15 343.65385 0 0
15 22.5 0 0
15 0 0 0
15 29.615385 60 118.46154
15 0 0 0
15 0 0 0
15 57.692308 0 0
15 0 0 0
15 48.076923 0 0
15 17.307692 0 0
15 143.46154 60 573.84615
15 3.2692308 0 0
15 0 0 0
15 0 0 0
15 1096.1538 0 0
15 0 0 0
15 10.576923 0 0
15 0 0 0
15 0 0 0
15 0 0 0
15 12.692308 30 25.384615
15 0 0 0
15 0 0 0
15 0 0 0
0 0 0
variabel Variabel
waktu Hari
waktu Waktu
tunggu Kosong
Kosong
tunggu
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
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
RS PRATAMA : TUGU JAYA PELAPORAN BULAN : MEI 2019 DOKUMEN

KECAMATAN : LEMPUING PERMINTAAN BULAN :- DINKES KAB/KOTA
KABUPATEN : OGAN KOMERING ILIR IFK KAB/KOTA
PROPINSI : SUMATERA SELATAN PUSKESMAS
STOK STOK STOK

NO. NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10
1 Absorbent tipped applicator (alcohol swab) Pcs 0 900 900 337 563
2 Acetylcystein Kapsul 200mg Kapsul 460 1000 1460 240 1220
3 Acyclovir tab 200 mg Tablet 200 0 200 0 200
4 Acyclovir cream Tube 0 0 0 0 0
5 Albendazol tab 400 mg Tablet 234 0 234 34 200
6 Alkohol Liquid (etanol) 70%-1000 ml Btl 12 20 32 12 20
7 Allopurinol 100 mg Tablet 60 0 60 0 60
8 Aminophylline Inj 24 mg/ml-10 ml Ampul 0 0 0 0 0
9 Aminophylline tab 200 mg Tablet 60 1000 1060 260 800
10 Amitriptyline 25 mg tab Tablet 300 0 300 0 300
11 Amlodipine tab 5 mg Tablet 1320 2100 3420 313 3107
12 Amoxycillin Syr Btl 0 0 0 0 0
13 Amoxycillin 250 mg Kapsul 120 5000 5120 270 4850
14 Amoxycillin 500 mg Kaptab 2600 0 2600 1294 1306
15 Ampicilin 1 gr Inj Vial 10 0 10 0 10
16 Antasida Syr DOEN Btl 208 300 508 13 495
17 Antasida DOEN Kombinasi Tablet 536 8000 8536 1776 6760
18 Anti Bisa Ular 5 ml (ABU I)/ Biosave Vial 0 0 0 0 0
19 Asam Mefenamat 500 mg tab Tablet 0 0 0 0 0
20 Ascorbic acid (Vit.C) 50 mg Tablet 3887 3000 6887 197 6690
21 Ascorbic acid |calsium carbonate 500 mg (Pehavral) Tablet 0 0 0 0 0
22 Aspirin (miniaspi) 100 mg tab Tablet 0 1000 1000 0 1000
23 Atropine inj 0,25 mg/ml Ampul 1 100 101 0 101
24 Attapulgite Tablet (Pularex) Tablet 309 0 309 0 309
25 Attapulgite Tablet 600 mg (New Antides) Tablet 920 500 1420 0 1420
26 Automated blood grouping (Tes Gol. Darah) Paket 0 1 1 1 0
27 Bahan Tambal Gigi Sementara (Fletcher/Caviton) Pcs 6 0 6 0 6
28 Bedak Salisil 2% Btl 97 96 193 24 169
29 Benzoic acid |salicylic acid salep (anti fungi) pot 24 48 72 0 72
30 Betahistine Mesylate 6 mg tab Tablet 330 800 1130 15 1115
31 Betamethasone 0,1% krim Tube 0 50 50 41 9
HALAMAN : 2 LPLPO No : 05 LAPORAN BULAN
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10
32 Bisacodyl 5mg Tablet 0 0 0 0 0

33 Bismuth subgallas (antihemoroid) Supp 0 50 50 10 40
34 Calcium chloride lactate infus (RL) Botol 816 2000 2816 706 2110
35 Calsium Laktat (Kalk) 500 mg Tablet 40 0 40 40 0
36 Captopril 12,5 mg Tablet 1370 2000 3370 1330 2040
37 Captopril 25 mg Tablet 0 0 0 0 0
38 Carbamazepin tab Tablet 829 0 829 0 829
39 Catgut/Benang Chromic Bedah No.2/0-3/0 Pcs 340 0 340 33 307
40 Catgut/Benang Plain Bedah No.2/0-3/0 Pcs 30 0 30 30 0
41 Cefadroxil 500mg Tablet 0 0 0 0 0
42 Cetirizine 5 mg/5 ml sirup Botol 28 100 128 0 128
43 Chloramhenicol Salep Mata 1% Tube 75 24 99 3 96
44 Chloramphenicol Suspensi 125 mg/ml Btl 133 0 133 35 98
45 Chloramphenicol 250 mg caps Tablet 130 0 130 10 120
46 Chloramphenicol TT 3% Botol 0 0 0 0 0
47 Chloramphenicol/ Hidrokortison krim 2,5% Tube 0 144 144 29 115
48 Chlorpheniramine Maleat (CTM) 4 mg Tablet 6170 5000 11170 1280 9890
49 Chlorpromazine HCl 100 mg Tablet 200 0 200 0 200
50 Cimetidin 200 tab Tablet 0 0 0 0 0
51 Ciprofloxacin 500 mg tab Tablet 650 0 650 420 230
52 Ciprofloxacin Infus Botol 0 10 10 0 10
53 Clindamycin 300mg Kapsul 450 0 450 0 450
54 Cresol liquid 1 Liter (lysol) Botol 3 0 3 2 1
55 Cyanocobalamin (Vit B12) inj 500 mcg/ml Ampul 9 0 9 9 0
56 Devitalisasi pasta pot 0 0 0 0 0
57 Dexamethasone 0,5 mg Tablet 0 0 0 0 0
58 Dexamethasone inj 5mg/ml-1ml Ampul 130 0 130 8 122
59 Diazepam 5mg/ml-2 ml inj Ampul 0 0 0 0 0
60 Diazepam 2 mg Tablet 1100 3000 4100 600 3500
61 Diclofenac sodium 25 mg tab Tablet 0 0 0 0 0
62 Digoxin 0,25 mg Tablet 9 0 9 0 9
63 Dimenhydrinate 50mg Tablet 300 500 800 0 800
64 Dipenhidramine HCl inj 10mg/ml Ampul 120 60 180 60 120
65 Domperidone 10 mg Tablet 1360 3000 4360 100 4260
66 Doxycycline 100 mg Kapsul Kapsul 500 0 500 0 500
67 Epinephrine HCl/bitartrat inj 0,1% Ampul 0 50 50 50 0
68 Erythromicin Syr Btl 0 0 0 0 0
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10
69 Erythromicin 500 mg capsul Kapsul 0 0 0 0 0

70 Ethacridine (Rivanol) 0,1% Btl 1 0 1 0 1
71 Ethanol ( Aseptan ) 500 cc+ Pump Botol 0 0 0 0 0
72 Eugenol cairan Btl 5 0 5 0 5
73 Ferrous fumarate ( Tab. Tambah Darah ) Tablet 3120 40000 43120 8540 34580
74 Folic acid 1mg ( asam folat) Tablet 1070 500 1570 0 1570
75 Folley Catheter No.16 Pcs 16 0 16 9 7
76 Furosemida Injeksi Ampul 0 25 25 10 15
77 Furosemida 40 mg Tablet 120 1000 1120 40 1080
78 Garam Oralit Sachet 584 0 584 84 500
79 Gentamicyn 0,3% TM Botol 0 0 0 0 0
80 Gentamicyn Inj 40 mg/ml Ampul 37 50 87 10 77
81 Gentamicyn 0,1% SK Tube 0 0 0 0 0
82 Glass lonomer Paket 1 0 1 0 1
83 Glibenclamide 5 mg Tablet 1399 1000 2399 29 2370
84 Glimepiride 1 mg Tablet 924 1000 1924 224 1700
87 Griseofulvin 125 mg Tablet 370 500 870 41 829
88 Guaifenesin 100 Tab (GG tab) Tablet 3650 1000 4650 1680 2970
89 Haloperidol 0,5 mg tab Tablet 0 0 0 0 0
90 Haloperidol 5 mg tab Tablet 600 500 1100 100 1000
91 Human chorionic (HCG/Tes kehamilan ) Strip 210 0 210 90 120
92 Hydrochlorotiazide (HCT) 25 mg Tablet 780 500 1280 0 1280
93 Ibuprofen sirup Botol 55 0 55 0 55
96 Ichthyol salep 10% pot 0 0 0 0 0
97 Immunoglobulin human anti-tetanus (Tetagam) Ampul 0 10 10 10 0
98 Infus set dewasa Pcs 580 500 1080 96 984
99 Infusi set anak Pcs 320 250 570 30 540
100 Iodium Povidon 10% 30 ml Botol 0 0 0 0 0
101 Isosorbide tablet Tablet 0 0 0 0 0
105 Jarum Jahit Kulit Pcs 0 0 0 0 0
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10
106 Kalium Permanganat Serbuk pot 0 0 0 0 0

107 Kapas pembalut/Absorben 250 g Pcs 34 0 34 0 34
108 Kasa pembalut 2x80 Pcs 50 50 100 7 93
111 Kasa kompres 40/40 steril Pcs 9 200 209 16 193
112 Ketoconazole 200 mg Cream Tube 90 50 140 7 133
113 Ketoconazole 200 mg tab Tablet 20 0 20 20 0
114 Klorokina Fosfat 250 mg Tablet 0 0 0 0 0
115 Levertran Salep/ Salep Luka Bakar pot 0 0 0 0 0
116 Lidocain 2% Ampul 7 0 7 0 7
117 Lidokain Comp. inj Kombinasi Ampul 215 120 335 37 298
118 Lidocaine spray (Xylocaine spray) Botol 8 0 8 4 4
119 Liquorice liquid extract (OBH) Botol 0 0 0 0 0
120 Locoriz Cream Tube 0 0 0 0 0
121 Loperamid 2 m tab Tablet 0 0 0 0 0
122 Loratadine 10 mg tab Tablet 1268 2000 3268 998 2270
125 Masker Pcs 1824 800 2624 724 1900
126 Medical adhesive tape (dermafix/leukomed) Pcs 32 100 132 24 108
127 Metamizole injeksi (antalgin 1000) Ampul 63 0 63 0 63
128 Metformin 500mg tab Tablet 1920 0 1920 80 1840
129 Methyl Ergometrin Maleat inj 0,2 mg/ml Ampul 0 0 0 0 0
130 Methyl Ergometrin Maleat 0,125 mg Tab 500 200 700 0 700
131 Methyl Prednisolon tab 4 mg Tablet 0 0 0 0 0
132 Methyl Rosanilinium (gentian violet) Botol 21 48 69 1 68
135 Metronidazol Infus Botol 10 0 10 3 7
136 Metronidazol syr Botol 74 50 124 0 124
137 Miconazole 2% Salep Kulit Tube 57 48 105 37 68
138 Momilen Baby Gold Sirup Botol 0 0 0 0 0
139 Natrium Bikarbonat 500 mg Tablet 400 0 400 0 400
140 Nifedipin 10 mg tab Kapsul 40 0 40 10 30
141 Nystatin Tab Vag 10.000 iu/g Tablet 180 100 280 80 200
142 Omeprazole inj Vial 153 50 203 0 203
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10
143 Omeprazole kaps Kapsul 820 2010 2830 150 2680

144 Oxytetracycline HCl 1% Salep Mata Tube 0 50 50 39 11
145 Oxytetracycline HCl 3% Salep Kulit Tube 0 0 0 0 0
146 Oxytocin inj 10 IU Ampul 0 0 0 0 0
147 Papaverin 40 mg tab Tablet 0 0 0 0 0
148 Papaverin inj Tablet 0 0 0 0 0
149 Paracetamol Drops 15 ml Botol 61 0 61 3 58
150 Parasetamol 120 mg/5 ml Syr Botol 283 0 283 94 189
151 Parasetamol 500 mg Tablet 4140 0 4140 3720 420
152 Patient Lubricant (My Jelly ) Tube 6 5 11 0 11
153 Permethrin (Scabimite Cream) Tube 18 0 18 0 18
154 Phenobarbital inj 50mg/ml-2ml Ampul 90 0 90 0 90
155 Phenobarbital 100 mg Tablet 0 0 0 0 0
156 Phenol gliserol 10% TT Botol 38 48 86 0 86
157 Phytomenadione (Vit.K1) inj 10 mg/ml Ampul 113 300 413 31 382
158 Phytomenadione (Vit.K1) 10 mg Tablet 0 0 0 0 0
159 Piracetam 400 mg Tablet 0 0 0 0 0
160 Piroxicam 20 mg tab Tablet 2410 3000 5410 1090 4320
161 Pisau Disposable (Mess No.14/21) Pcs 15 0 15 15 0
162 Plesterku (Leukoplast) Pcs 22 50 72 22 50
163 Polivalen serum (Anti Tetanus Inj. 1500 iu/Biosat) Ampul 0 0 0 0 0
164 Povidon iodium 10% 300 ml Botol 17 0 17 1 16
165 Prednison 5 mg Tablet 0 0 0 0 0
166 Primaquin 15 mg tab Tablet 200 200 400 0 400
167 Profolat tab Tablet 0 0 0 0 0
168 Prokaina Penisilin G inj 3.000.000 iu Ampul 0 0 0 0 0
171 Propylthiouracil 100 mg Tablet 400 0 400 0 400
172 Protein Gluco Test Strip 40 0 40 10 30
173 Pyrantel Pamoat 125 mg Tablet 100 0 100 0 100
174 Pyridoxine HCl 10 mg Tablet 0 2000 2000 20 1980
175 Ranitidin 150 mg Tablet 2520 0 2520 1370 1150
176 Ranitidin Injeksi Ampul 0 0 0 0 0
179 Risperidone 2mg Tablet 0 1000 1000 0 1000
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10
180 Salbutamol 2 mg Tablet 0 0 0 0 0

181 Salep 2-4 Kombinasi pot 0 0 0 0 0
182 Sarung tangan (HandScuun) No.7,5 Pcs 0 0 0 0 0
183 Sarung tangan (HandScuun Steril) No. 6,5 Pcs 0 0 0 0 0
184 Sarung tangan (HandScuun Steril) No.7 Pcs 0 0 0 0 0
185 Sarung tangan (HandScuun Steril) No.7,5 Pcs 0 0 0 0 0
186 Semen Seng Fosfat Serbuk & Cairan Set 0 0 0 0 0
187 Sianocobalamin (Vit B12) 50 mg tab Tablet 2009 1000 3009 349 2660
188 Silk (Benang Bedah) No. 3/0 Pcs 87 36 123 6 117
189 Silver Sulfadiazine Tube 12 15 27 1 26
190 Simvastatin 10 mg tab Tablet 745 2100 2845 55 2790
191 Sodium cloride infus 0,9% ( NACL ) Botol 0 500 500 101 399
192 Spuit 1 ml Pcs 165 500 665 0 665
193 Spuit 3 ml Pcs 1450 0 1450 800 650
194 Spuit 5 ml Pcs 616 0 616 86 530
195 Sulfadoxine | Pyrimethamine Tablet 500mg|25mg Tablet 0 0 0 0 0
196 Sulfamethoxazole | trimethoprim (cotri) syr Botol 150 0 150 36 114
197 Sulfasetamida 15% TM Botol 0 0 0 0 0
200 Thiamine HCl (Vit B1) inj 100 mg/ml Ampul 0 0 0 0 0
201 Thiamine HCl (Vit B1) 50 mg Tablet 100 1000 1100 400 700
202 Trihexyphenidyl tab 2 mg Tablet 400 0 400 0 400
203 Trimethoprim (cotrimoxazol 480 mg) tablet Tablet 0 0 0 0 0
204 Urin Bag Pcs 0 0 0 0 0
205 Usg Gel Botol 0 0 0 0 0
206 Vaksin Rabies Vero/ Verorab Paket 0 0 0 0 0
207 Vitamin B Kompleks Tablet 470 0 470 470 0
208 Vitamin K Infant Inj Ampul 0 0 0 0 0
209 Water liquid (aqua P,I) Botol 51 50 101 27 74
212 Zinc Sulphate Suppositoria (Superhoid) Kapsul 0 0 0 0 0
213 Zinc tab Tablet 0 0 0 0 0
214
215
216
HALAMAN : 7 LPLPO No: 05 LAPORAN BULAN
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
UMUM BPJS JUMLAH

Mengetahui Mengetahui Mengetahui/ Menyetujui Yang Membuat
Kepala Dinas Kesehatan Kab. OKI Kepala Instalasi Farmasi Dinkes OKI Direktur Rumah Sakit Pengelola Obat
H. M. Lubis, S.KM., M.Kes Himayanti, S.Si., Apt. dr. Muhammad Tito Aristian Kartini Wiati,SKM
NIP. 19660603 198703 1 003 NIP. 19770221 200501 2 005 NIP. 19850421 2014081 001 NIP. 19750806 200501 2 009
NOMOR TANGGAL
05
PEMBERIAAN KET
11 12
LAPORAN BULAN : MEI 2019
PEMBERIAAN KET
11 12
PEMBERIAAN KET
11 12
PEMBERIAAN KET
11 12
PEMBERIAAN KET
11 12
PEMBERIAAN KET
11 12
PEMBERIAAN KET
11 12
Yang Membuat
Pengelola Obat
Kartini Wiati,SKM
NIP. 19750806 200501 2 009
variabel Variabel
waktu Hari
waktu Waktu
tunggu Kosong
Kosong
tunggu
15 121.53846 0 0
15 168.46154 0 0
15 209.61538 0 0
15 0.3846154 0 0
15 4.6153846 0 0
15 2.3076923 0 0
15 186.53846 0 0
15 19.230769 0 0
15 84.615385 0 0
15 0 0 0
15 343.26923 0 0
15 0 0 0
15 226.92308 0 0
15 877.11538 0 0
15 0 0 0
15 16.923077 0 0
15 858.46154 0 0
15 0 0 0
15 961.53846 60 3846.1538
15 500.38462 0 0
15 0 0 0
15 57.692308 0 0
15 2.8846154 0 0
15 68.846154 0 0
15 15.384615 0 0
15 0.1923077 0 0
15 0 0 0
15 3.6538462 0 0
15 4.6153846 0 0
15 144.23077 0 0
15 0 0 0
variabel Variabel
waktu Hari
waktu Waktu
tunggu Kosong
Kosong
tunggu
15 103.84615 0 0
15 3.8461538 0 0
15 329.03846 0 0
15 428.84615 0 0
15 246.15385 0 0
15 155.76923 0 0
15 0 0 0
15 8.4615385 0 0
15 1.7307692 0 0
15 3.6538462 0 0
15 10.961538 0 0
15 4.4230769 0 0
15 20 0 0
15 21.538462 0 0
15 0 0 0
15 15 0 0
15 955.19231 0 0
15 154.80769 0 0
15 0 0 0
15 650.19231 0 0
15 0 0 0
15 28.846154 0 0
15 0.7692308 0 0
15 3.0769231 0 0
15 0 0 0
15 250.76923 90 1504.6154
15 0 0 0
15 0 0 0
15 38.461538 0 0
15 345.96154 0 0
15 17.5 0 0
15 61.538462 0 0
15 11.538462 0 0
15 395 0 0
15 0 0 0
15 4.6153846 0 0
15 0.1923077 0 0
15 0 0 0
variabel Variabel
waktu Hari
waktu Waktu
tunggu Kosong
Kosong
tunggu
15 418.26923 0 0
15 1.1538462 0 0
15 1.1538462 0 0
15 0 0 0
15 5698.0769 0 0
15 107.69231 0 0
15 4.8076923 0 0
15 0 0 0
15 134.61538 0 0
15 9.4230769 0 0
15 0 0 0
15 3.2692308 0 0
15 1.7307692 0 0
15 0 0 0
15 92.5 0 0
15 107.5 0 0
15 1.7307692 0 0
15 50.769231 0 0
15 17.307692 0 0
15 599.03846 0 0
15 0 0 0
15 109.61538 0 0
15 10.576923 0 0
15 37.5 0 0
15 10.384615 0 0
15 0 0 0
15 0 0 0
15 0 0 0
15 1.9230769 0 0
15 55.192308 0 0
15 16.153846 0 0
15 7.1153846 0 0
15 28.846154 0 0
15 19.807692 0 0
15 85 0 0
15 45.961538 0 0
15 0 0 0
15 0 0 0
variabel Variabel
waktu Hari
waktu Waktu
tunggu Kosong
Kosong
tunggu
15 0 0 0
15 1.9230769 0 0
15 10.192308 0 0
15 57.5 0 0
15 0 0 0
15 22.884615 0 0
15 11.538462 0 0
15 68.846154 0 0
15 0 0 0
15 0.3846154 0 0
15 0 0 0
15 8.6538462 0 0
15 0.3846154 0 0
15 27.115385 0 0
15 0 0 0
15 48.653846 0 0
15 319.61538 0 0
15 0 0 0
15 0 0 0
15 344.03846 0 0
15 3.0769231 0 0
15 0 0 0
15 201.73077 0 0
15 0 0 0
15 19.230769 0 0
15 581.73077 15 581.73077
15 7.3076923 0 0
15 198.07692 0 0
15 0 0 0
15 0 0 0
15 5 0 0
15 3.2692308 0 0
15 0 0 0
15 25 0 0
15 46.730769 0 0
15 9.6153846 0 0
15 0 0 0
15 0 0 0
variabel Variabel
waktu Hari
waktu Waktu
tunggu Kosong
Kosong
tunggu
15 148.07692 0 0
15 2.1153846 0 0
15 0 0 0
15 38.461538 0 0
15 0 0 0
15 0 0 0
15 6.9230769 0 0
15 60.961538 0 0
15 2494.2308 0 0
15 0.3846154 0 0
15 3.4615385 0 0
15 0 0 0
15 0 0 0
15 4.8076923 0 0
15 22.307692 0 0
15 0 0 0
15 0 0 0
15 432.69231 0 0
15 10.961538 0 0
15 8.2692308 0 0
15 0 0 0
15 1.3461538 0 0
15 0 0 0
15 0 0 0
15 0 0 0
15 0 0 0
15 0 0 0
15 147.69231 0 0
15 66.346154 0 0
15 1.9230769 0 0
15 0 0 0
15 155.76923 0 0
15 807.69231 0 0
15 0 0 0
15 0 0 0
15 0 0 0
15 0 0 0
15 0 0 0
variabel Variabel
waktu Hari
waktu Waktu
tunggu Kosong
Kosong
tunggu
15 0 0 0
15 2.6923077 0 0
15 0 0 0
15 57.692308 0 0
15 0 0 0
15 0 0 0
15 0 0 0
15 293.84615 0 0
15 4.4230769 0 0
15 1.3461538 0 0
15 141.34615 0 0
15 15 90 90
15 64.423077 0 0
15 343.65385 0 0
15 22.5 0 0
15 0 0 0
15 29.615385 60 118.46154
15 0 0 0
15 0 0 0
15 57.692308 0 0
15 0 0 0
15 48.076923 0 0
15 17.307692 0 0
15 143.46154 60 573.84615
15 3.2692308 0 0
15 0 0 0
15 0 0 0
15 1096.1538 0 0
15 0 0 0
15 10.576923 0 0
15 0 0 0
15 0 0 0
15 0 0 0
15 12.692308 30 25.384615
15 0 0 0
15 0 0 0
15 0 0 0
0 0 0
variabel Variabel
waktu Hari
waktu Waktu
tunggu Kosong
Kosong
tunggu
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
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN
RS PRATAMA TUGU JAYA PELAPORAN BULAN

KECAMATAN : LEMPUING PERMINTAAS BULAN
STOK
AWAL
1 2 3 4 5
STOK
AWAL
1 2 3 4 5
STOK
AWAL
1 2 3 4 5
STOK
AWAL
1 2 3 4 5
STOK
AWAL
1 2 3 4 5
171 Propylthiouracil 100 mg Tablet 400
STOK
AWAL
1 2 3 4 5
214
215
216
STOK
AWAL
1 2 3 4 5
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
UMUM JAMSOSKES BPJS


NIP. 19660603 198703 1 003 NIP. 19770221 200501 2 005
MBAR PERMINTAAN OBAT (LPLPO) PUSKESMAS
ORAN BULAN : JUNI 2019 DOKUMEN NOMOR TANGGAL

NTAAS BULAN : JULI 2019 DINKES KAB/KOTA
IFK KAB/KOTA
PUSKESMAS 06
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
563 503 60 1741 1681
1220 380 840 1892 1200
200 0 200 1296 500
0 0 0 48 48
200 20 180 97 0
20 6 14 35 21
60 41 19 2000 2000
0 0 0 135 100
800 114 686 756 500
300 0 300 500 200
3107 301 2806 5000 3000
0 0 0 400 400
4850 1120 3730 2642 5000
1306 1076 230 7010 10000
10 0 10 0 0
495 39 456 140 300
6760 1198 5562 7607 4000
0 0 0 2 2
0 0 0 10000 10000
6690 1055 5635 4099 2000
0 0 0 3000 3000
1000 0 1000 382 0
101 0 101 20 0
309 30 279 487 300
1420 130 1290 264 300
0 0 0 1 0
6 0 6 0 0
169 14 155 67 50
72 0 72 30 24
1115 65 1050 961 500
9 7 2 58 56
HALAMAN : 2 LPLPO No : 06 LAPORAN BULAN : JUNI 2019
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
0 0 0 500 500
40 0 40 39 0
2110 581 1529 3084 1555
0 0 0 2383 2383
2040 445 1595 3642 3000
0 0 0 5000 5000
829 0 829 0 0
307 37 270 124 100
0 0 0 100 150
0 0 0 2000 2000
128 21 107 98 50
96 28 68 60 24
98 20 78 162 100
120 0 120 149 200
0 0 0 24 24
115 24 91 161 70
9890 1338 8552 8311 5000
200 0 200 1090 500
0 0 0 2000 2000
230 230 0 5000 5000
10 0 10 0 0
450 450 0 500 500
1 1 0 10 10
0 0 0 200 200
0 0 0 0 0
0 0 0 8000 8000
122 30 92 200 100
0 0 0 100 100
3500 0 3500 943 0
0 0 0 4000 4000
9 9 0 200 200
800 320 480 769 500
120 30 90 153 100
4260 520 3740 2368 1000
500 0 500 0 0
0 0 0 64 50
0 0 0 200 200
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
0 0 0 2187 2500
1 0 1 10 10
0 0 0 20 20
5 0 5 0 0
34580 3740 30840 23806 0
1570 10 1560 770 1000
7 1 6 27 21
15 1 14 13 50
1080 230 850 943 200
500 50 450 1000 550
0 0 0 24 24
77 2 75 31 0
0 0 0 96 96
1 0 1 0 0
2370 70 2300 721 2000
1700 0 1700 993 2000
157 5 152 17 0
314 50 264 509 260
829 49 780 2000 1500
2970 156 2814 5878 5000
0 0 0 500 500
1000 0 1000 808 0
120 0 120 154 100
1280 10 1270 264 0
55 0 55 60 50
0 0 0 2000 2000
0 0 0 2000 2000
0 0 0 48 48
0 0 0 14 10
984 114 870 528 500
540 28 512 183 200
0 0 0 24 24
0 0 0 51 51
5 5 0 400 400
208 158 50 678 700
113 55 58 370 400
0 0 0 0 0
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
0 0 0 24 24
34 7 27 20 20
93 20 73 99 26
340 116 224 688 500
20 0 20 100 100
193 29 164 208 50
133 37 96 123 48
0 0 0 2000 2000
0 0 0 100 100
0 0 0 2 12
7 0 7 48 48
298 91 207 191 50
4 1 3 8 5
0 0 0 500 500
0 0 0 12 12
0 0 0 274 500
2270 423 1847 5000 5000
24 0 24 7 10
0 0 0 12 12
1900 350 1550 3006 2000
108 35 73 90 50
63 0 63 0 0
1840 400 1440 1817 5000
0 0 0 100 100
700 0 700 135 0
0 0 0 5000 5000
68 1 67 31 0
230 105 125 1878 2000
0 0 0 1000 1000
7 0 7 4 0
124 17 107 52 0
68 58 10 137 127
0 0 0 100 100
400 0 400 1000 600
30 30 0 1000 1000
200 0 200 140 0
203 18 185 25 0
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
2680 290 2390 2500 1000
11 11 0 72 72
0 0 0 48 48
0 0 0 200 200
0 0 0 200 200
0 0 0 24 24
58 0 58 100 50
189 60 129 495 400
420 420 0 18608 20000
11 1 10 4 0
18 5 13 24 24
90 0 90 0 0
0 0 0 0 0
86 6 80 37 12
382 0 382 133 200
0 0 0 500 500
0 0 0 500 500
4320 481 3839 3839 3000
0 0 0 200 200
50 24 26 98 100
0 0 0 5 5
16 3 13 14 12
0 0 0 5000 5000
400 0 400 0 0
0 0 0 1000 1000
0 0 0 24 24
0 0 0 500 500
2000 210 1790 1210 500
400 100 300 521 500
30 10 20 38 18
100 0 100 100 0
1980 280 1700 785 500
1150 853 297 6320 6000
0 0 0 100 100
900 0 900 120 0
600 100 500 600 100
1000 200 800 240 0
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
0 0 0 1000 1000
0 0 0 24 24
0 0 0 2000 2000
0 0 0 500 500
0 0 0 500 500
0 0 0 500 500
0 0 0 24 24
2660 408 2252 2196 1000
117 12 105 38 24
26 2 24 13 12
2790 147 2643 809 500
399 66 333 215 200
665 165 500 618 300
650 630 20 3279 5000
530 220 310 446 300
0 0 0 0 0
114 64 50 290 300
0 0 0 24 24
0 0 0 1000 1000
2960 520 2440 970 0
0 0 0 0 0
700 0 700 734 0
400 0 400 14 0
0 0 0 2000 2000
0 0 0 18 20
0 0 0 2 2
0 0 0 0 0
0 0 0 10000 10000
0 0 0 0 0
74 25 49 128 100
0 0 0 0 0
0 0 0 0 0
0 0 0 24 24
0 0 0 2000 2000
STOK STOK
AKHIR OPTIMUM
6 7 8 9 10 11 12
JUMLAH
getahui Mengetahui/ Menyetujui Yang Membuat

Farmasi Dinkes OKI Pimpinan Puskesmas Pengelola Obat Puskesmas
ti, S.Si., Apt. dr. Muhammad Tito Aristian Kartini Wiati,SKM

21 200501 2 005 NIP. 19850421 2014081 001 NIP. 19750806 200501 2 009
variabel Variabel
waktu Hari
waktu Kosong Waktu
tunggu Kosong
tunggu
10 81.02564 0 0
10 112.3077 0 0
10 139.7436 0 0
10 0.25641 0 0
10 3.076923 0 0
10 1.538462 0 0
10 124.359 0 0
10 12.82051 0 0
10 56.41026 0 0
10 0 0 0
10 228.8462 0 0
10 0 0 0
10 151.2821 0 0
10 584.7436 0 0
10 0 0 0
10 11.28205 0 0
10 572.3077 0 0
10 0 0 0
10 641.0256 0 0
10 333.5897 0 0
10 0 0 0
10 38.46154 0 0
10 1.923077 0 0
10 45.89744 0 0
10 10.25641 0 0
10 0.128205 0 0
10 0 0 0
10 2.435897 0 0
10 3.076923 0 0
10 96.15385 0 0
10 0 0 0
variabel Variabel
waktu Hari
waktu Kosong Waktu
tunggu Kosong
tunggu
10 69.23077 0 0
10 2.564103 0 0
10 219.359 0 0
10 285.8974 0 0
10 164.1026 0 0
10 103.8462 0 0
10 0 0 0
10 5.641026 0 0
10 1.153846 0 0
10 2.435897 0 0
10 7.307692 0 0
10 2.948718 0 0
10 13.33333 0 0
10 14.35897 0 0
10 0 0 0
10 10 0 0
10 636.7949 0 0
10 103.2051 0 0
10 0 0 0
10 433.4615 0 0
10 0 0 0
10 19.23077 0 0
10 0.512821 0 0
10 2.051282 0 0
10 0 0 0
10 167.1795 0 0
10 0 0 0
10 0 0 0
10 25.64103 0 0
10 230.641 0 0
10 11.66667 0 0
10 41.02564 0 0
10 7.692308 0 0
10 263.3333 0 0
10 0 0 0
10 3.076923 0 0
10 0.128205 0 0
0 0 0
variabel Variabel
waktu Hari
waktu Kosong Waktu
tunggu Kosong
tunggu
10 278.8462 0 0
10 0.769231 0 0
10 0.769231 0 0
10 0 0 0
10 3798.718 0 0
10 71.79487 0 0
10 3.205128 0 0
10 0 0 0
10 89.74359 0 0
10 6.282051 0 0
10 0 0 0
10 2.179487 0 0
10 1.153846 0 0
10 0 0 0
10 61.66667 0 0
10 71.66667 0 0
10 1.153846 0 0
10 33.84615 0 0
10 11.53846 0 0
10 399.359 0 0
10 0 0 0
10 73.07692 0 0
10 7.051282 0 0
10 25 0 0
10 6.923077 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 1.282051 0 0
10 36.79487 0 0
10 10.76923 0 0
10 4.74359 0 0
10 19.23077 0 0
10 13.20513 0 0
10 56.66667 0 0
10 30.64103 0 0
10 0 0 0
0 0 0
variabel Variabel
waktu Hari
waktu Kosong Waktu
tunggu Kosong
tunggu
10 0 0 0
10 1.282051 0 0
10 6.794872 0 0
10 38.33333 0 0
10 0 0 0
10 15.25641 0 0
10 7.692308 0 0
10 45.89744 0 0
10 0 0 0
10 0.25641 0 0
10 0 0 0
10 5.769231 0 0
10 0.25641 0 0
10 18.07692 0 0
10 0 0 0
10 32.4359 0 0
10 213.0769 0 0
10 0 0 0
10 0 0 0
10 229.359 0 0
10 2.051282 0 0
10 0 0 0
10 134.4872 0 0
10 0 0 0
10 12.82051 0 0
10 387.8205 0 0
10 4.871795 0 0
10 132.0513 0 0
10 0 0 0
10 0 0 0
10 3.333333 0 0
10 2.179487 0 0
10 0 0 0
10 16.66667 0 0
10 31.15385 0 0
10 6.410256 0 0
10 0 0 0
0 0 0
variabel Variabel
waktu Hari
waktu Kosong Waktu
tunggu Kosong
tunggu
10 98.71795 0 0
10 1.410256 0 0
10 0 0 0
10 25.64103 0 0
10 0 0 0
10 0 0 0
10 4.615385 0 0
10 40.64103 0 0
10 1662.821 0 0
10 0.25641 0 0
10 2.307692 0 0
10 0 0 0
10 0 0 0
10 3.205128 0 0
10 14.87179 0 0
10 0 0 0
10 0 0 0
10 288.4615 0 0
10 7.307692 0 0
10 5.512821 0 0
10 0 0 0
10 0.897436 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 98.46154 0 0
10 44.23077 0 0
10 1.282051 0 0
10 0 0 0
10 103.8462 0 0
10 538.4615 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 0 0 0
0 0 0
variabel Variabel
waktu Hari
waktu Kosong Waktu
tunggu Kosong
tunggu
10 0 0 0
10 1.794872 0 0
10 0 0 0
10 38.46154 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 195.8974 0 0
10 2.948718 0 0
10 0.897436 0 0
10 94.23077 0 0
10 10 0 0
10 42.94872 0 0
10 229.1026 0 0
10 15 0 0
10 0 0 0
10 19.74359 0 0
10 0 0 0
10 0 0 0
10 38.46154 0 0
10 0 0 0
10 32.05128 0 0
10 11.53846 0 0
10 95.64103 0 0
10 2.179487 0 0
10 0 0 0
10 0 0 0
10 730.7692 0 0
10 0 0 0
10 7.051282 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 8.461538 0 0
10 0 0 0
10 0 0 0
10 0 0 0
0 0 0
variabel Variabel
waktu Hari
waktu Kosong Waktu
tunggu Kosong
tunggu
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
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO) PUSKESMAS
RS PRATAMA TUGU JAYA PELAPORAN BULAN : JULI 2019 DOKUMEN NOMOR

KECAMATAN : LEMPUING PERMINTAAN BULAN : AGUSTUS 2019 DINKES KAB/KOTA
PROPINSI : SUMATERA SELATAN RS PRATAMA 07
STOK STOK STOK

NO. NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN PERMINTAAN PEMBERIAAN
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
1 Absorbent tipped applicator (alcohol swab) Pcs 60 1700 1760 480 1280 1787 500
2 Acetylcystein Kapsul 200mg Kapsul 840 0 840 220 620 1137 500
3 Acyclovir tab 200 mg Tablet 200 0 200 0 200 1000 1000
4 Acyclovir cream Tube 0 0 0 0 0 100 100
5 Albendazol tab 400 mg Tablet 180 0 180 18 162 600 600
6 Alkohol Liquid (etanol) 70%-1000 ml Btl 14 21 35 12 23 41 20
7 Allopurinol 100 mg Tablet 19 2000 2019 89 1930 176 0
8 Aminophylline Inj 24 mg/ml-10 ml Ampul 0 0 0 0 0 0 0
9 Aminophylline tab 200 mg Tablet 686 500 1186 186 1000 758 0
10 Amitriptyline 25 mg tab Tablet 300 0 300 0 300 500 500
11 Amlodipine tab 5 mg Tablet 2806 3000 5806 466 5340 1462 0
12 Amoxycillin Syr Btl 0 420 420 50 370 68 0
13 Amoxycillin 250 mg Kapsul 3730 3200 6930 40 6890 1936 0
14 Amoxycillin 500 mg Kaptab 230 10000 10230 1110 9120 4711 0
15 Ampicilin 1 gr Inj Vial 10 0 10 0 10 0 0
16 Antasida Syr DOEN Btl 456 300 756 9 747 83 0
17 Antasida DOEN Kombinasi Tablet 5562 4000 9562 462 9100 4652 0
18 Anti Bisa Ular 5 ml (ABU I)/ Biosave Vial 0 0 0 0 0 0 2
19 Asam Mefenamat 500 mg tab Tablet 0 0 0 0 0 6000 6000
20 Ascorbic acid (Vit.C) 50 mg Tablet 5635 2000 7635 1055 6580 3123 0
21 Ascorbic acid |calsium carbonate 500 mg (Pehav Tablet 0 0 0 0 0 0 0
22 Aspirin (miniaspi) 100 mg tab Tablet 1000 0 1000 100 900 135 0
23 Atropine inj 0,25 mg/ml Ampul 101 0 101 1 100 1 0
24 Attapulgite Tablet (Pularex) Tablet 279 0 279 0 279 41 0
25 Attapulgite Tablet 600 mg (New Antides) Tablet 1290 300 1590 0 1590 176 0
26 Automated blood grouping (Tes Gol. Darah) Paket 0 0 0 0 0 1 0
27 Bahan Tambal Gigi Sementara (Fletcher/Caviton Pcs 6 0 6 0 6 0 0
28 Bedak Salisil 2% Btl 155 48 203 40 163 106 0
29 Benzoic acid |salicylic acid salep (anti fungi) pot 72 24 96 24 72 32 0
30 Betahistine Mesylate 6 mg tab Tablet 1050 500 1550 370 1180 609 0
31 Betamethasone 0,1% krim Tube 2 50 52 26 26 100 100
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
32 Bisacodyl 5mg Tablet 0 0 0 0 0 500 500

33 Bismuth subgallas (antihemoroid) Supp 40 0 40 10 30 27 0
34 Calcium chloride lactate infus (RL) Botol 1529 1000 2529 339 2190 2201 0
35 Calsium Laktat (Kalk) 500 mg Tablet 0 2400 2400 400 2000 596 1000
36 Captopril 12,5 mg Tablet 1595 3000 4595 717 3878 3374 0
37 Captopril 25 mg Tablet 0 0 0 0 0 2000 2000
38 Carbamazepin tab Tablet 829 0 829 0 829 0 0
39 Catgut/Benang Chromic Bedah No.2/0-3/0 Pcs 270 0 270 18 252 119 120
40 Catgut/Benang Plain Bedah No.2/0-3/0 Pcs 0 0 0 0 0 41 72
41 Cefadroxil 500mg Tablet 0 0 0 0 0 1000 1000
42 Cetirizine 5 mg/5 ml sirup Botol 107 50 157 2 155 31 0
43 Chloramhenicol Salep Mata 1% Tube 68 24 92 1 91 43 0
44 Chloramphenicol Suspensi 125 mg/ml Btl 78 0 78 0 78 74 0
45 Chloramphenicol 250 mg caps Tablet 120 0 120 20 100 41 0
46 Chloramphenicol TT 3% Botol 0 0 0 0 0 24 24
47 Chloramphenicol/ Hidrokortison krim 2,5% Tube 91 72 163 25 138 106 0
48 Chlorpheniramine Maleat (CTM) 4 mg Tablet 8552 5000 13552 1402 12150 5442 0
49 Chlorpromazine HCl 100 mg Tablet 200 0 200 0 200 1000 1000
50 Cimetidin 200 tab Tablet 0 0 0 0 0 2000 2000
51 Ciprofloxacin 500 mg tab Tablet 0 0 0 0 0 5000 5000
52 Ciprofloxacin Infus Botol 10 0 10 2 8 3 0
53 Clindamycin 300mg Kapsul 0 0 0 0 0 609 600
54 Cresol liquid 1 Liter (lysol) Botol 0 0 0 0 0 24 24
55 Cyanocobalamin (Vit B12) inj 500 mcg/ml Ampul 0 0 0 0 0 24 24
56 Devitalisasi pasta pot 0 0 0 0 0 0 0
57 Dexamethasone 0,5 mg Tablet 0 0 0 0 0 5000 5000
58 Dexamethasone inj 5mg/ml-1ml Ampul 92 100 192 1 191 53 0
59 Diazepam 5mg/ml-2 ml inj Ampul 0 0 0 0 0 100 100
60 Diazepam 2 mg Tablet 3500 0 3500 50 3450 880 0
61 Diclofenac sodium 25 mg tab Tablet 0 4000 4000 270 3730 366 0
62 Digoxin 0,25 mg Tablet 0 0 0 0 0 12 200
63 Dimenhydrinate 50mg Tablet 480 500 980 0 980 433 0
64 Dipenhidramine HCl inj 10mg/ml Ampul 90 120 210 0 210 122 0
65 Domperidone 10 mg Tablet 3740 1000 4740 251 4489 1179 0
66 Doxycycline 100 mg Kapsul Kapsul 500 0 500 0 500 0 0
67 Epinephrine HCl/bitartrat inj 0,1% Ampul 0 50 50 0 50 68 0
68 Erythromicin Syr Btl 0 0 0 0 0 100 100
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
69 Erythromicin 500 mg capsul Kapsul 0 0 0 0 0 2000 2000

70 Ethacridine (Rivanol) 0,1% Btl 1 0 1 0 1 10 10
71 Ethanol ( Aseptan ) 500 cc+ Pump Botol 0 0 0 0 0 10 10
72 Eugenol cairan Btl 5 0 5 0 5 0 0
73 Ferrous fumarate ( Tab. Tambah Darah ) Tablet 30840 0 30840 270 30570 16991 0
74 Folic acid 1mg ( asam folat) Tablet 1560 1000 2560 0 2560 14 0
75 Folley Catheter No.16 Pcs 6 0 6 1 5 15 10
76 Furosemida Injeksi Ampul 14 0 14 2 12 18 6
77 Furosemida 40 mg Tablet 850 200 1050 150 900 569 0
78 Garam Oralit Sachet 450 0 450 50 400 400 0
79 Gentamicyn 0,3% TM Botol 0 0 0 0 0 48 48
80 Gentamicyn Inj 40 mg/ml Ampul 75 0 75 2 73 19 0
81 Gentamicyn 0,1% SK Tube 0 0 0 0 0 100 100
82 Glass lonomer Paket 1 0 1 0 1 0 0
83 Glibenclamide 5 mg Tablet 2300 2000 4300 280 4020 513 0
84 Glimepiride 1 mg Tablet 1700 2000 3700 0 3700 303 0
85 Glukosa larutan infus 10% Botol 152 0 152 0 152 11 0
86 Glukosa larutan infus 5% Botol 264 260 524 65 459 389 0
87 Griseofulvin 125 mg Tablet 780 1500 2280 2 2278 125 0
88 Guaifenesin 100 Tab (GG tab) Tablet 2814 5000 7814 574 7240 3263 0
89 Haloperidol 0,5 mg tab Tablet 0 0 0 0 0 0 0
90 Haloperidol 5 mg tab Tablet 1000 0 1000 0 1000 135 0
91 Human chorionic (HCG/Tes kehamilan ) Strip 120 0 120 0 120 122 50
92 Hydrochlorotiazide (HCT) 25 mg Tablet 1270 0 1270 30 1240 54 0
93 Ibuprofen sirup Botol 55 0 55 0 55 50 50
94 Ibuprofen 200 mg Tablet 0 0 0 0 0 2000 2000
95 Ibuprofen 400 mg Tablet 0 0 0 0 0 2000 2000
96 Ichthyol salep 10% pot 0 0 0 0 0 0 24
97 Immunoglobulin human anti-tetanus (Tetagam) Ampul 0 10 10 4 6 19 13
98 Infus set dewasa Pcs 870 500 1370 27 1343 321 0
99 Infusi set anak Pcs 512 200 712 7 705 88 0
100 Iodium Povidon 10% 30 ml Botol 0 0 0 0 0 30 30
101 Isosorbide tablet Tablet 0 0 0 0 0 1000 1000
102 IV Catheter No.20 Pcs 0 0 0 0 0 27 100
105 Jarum Jahit Kulit Pcs 0 0 0 0 0 0 0
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
106 Kalium Permanganat Serbuk pot 0 0 0 0 0 0 24

107 Kapas pembalut/Absorben 250 g Pcs 27 0 27 2 25 12 0
108 Kasa pembalut 2x80 Pcs 73 26 99 0 99 37 0
109 Kasa pembalut hidrofil 4 m x 15 cm Pcs 224 200 424 69 355 474 0
110 Kasa pembalut hidrofil 4 m x 3 cm Pcs 20 0 20 0 20 200 200
111 Kasa kompres 40/40 steril Pcs 164 100 264 22 242 91 0
112 Ketoconazole 200 mg Cream Tube 96 50 146 1 145 61 0
113 Ketoconazole 200 mg tab Tablet 0 0 0 0 0 3000 3000
114 Klorokina Fosfat 250 mg Tablet 0 0 0 0 0 0 0
115 Levertran Salep/ Salep Luka Bakar pot 0 24 24 10 14 14 0
116 Lidocain 2% Ampul 7 0 7 0 7 0 0
117 Lidokain Comp. inj Kombinasi Ampul 207 60 267 0 267 173 0
118 Lidocaine spray (Xylocaine spray) Botol 3 0 3 2 1 9 8
119 Liquorice liquid extract (OBH) Botol 0 0 0 0 0 0 0
120 Locoriz Cream Tube 0 0 0 0 0 0 0
121 Loperamid 2 m tab Tablet 0 0 0 0 0 2000 2000
122 Loratadine 10 mg tab Tablet 1847 5000 6847 468 6379 2557 0
123 Magnesium Sulfat Injeksi 20% (MgSO4) Ampul 24 0 24 24 0 41 40
124 Magnesium Sulfat Injeksi 40% (MgSO4) Ampul 0 0 0 0 0 0 20
125 Masker Pcs 1550 2000 3550 645 2905 2327 0
126 Medical adhesive tape (dermafix/leukomed) Pcs 73 50 123 0 123 80 0
127 Metamizole injeksi (antalgin 1000) Ampul 63 0 63 0 63 0 0
128 Metformin 500mg tab Tablet 1440 2000 3440 480 2960 1300 1000
129 Methyl Ergometrin Maleat inj 0,2 mg/ml Ampul 0 0 0 0 0 0 0
130 Methyl Ergometrin Maleat 0,125 mg Tab 700 0 700 20 680 27 0
131 Methyl Prednisolon tab 4 mg Tablet 0 0 0 0 0 0 4000
132 Methyl Rosanilinium (gentian violet) Botol 67 0 67 2 65 5 0
133 Metronidazol 250 mg tab Tablet 125 0 125 125 0 1083 1083
134 Metronidazol 500 mg tab Tablet 0 0 0 0 0 1000 1000
135 Metronidazol Infus Botol 7 0 7 0 7 4 0
136 Metronidazol syr Botol 107 0 107 2 105 26 0
137 Miconazole 2% Salep Kulit Tube 10 120 130 5 125 135 24
138 Momilen Baby Gold Sirup Botol 0 0 0 0 0 0 0
139 Natrium Bikarbonat 500 mg Tablet 400 0 400 0 400 500 500
140 Nifedipin 10 mg tab Kapsul 0 0 0 0 0 54 500
141 Nystatin Tab Vag 10.000 iu/g Tablet 200 0 200 0 200 108 0
142 Omeprazole inj Vial 185 0 185 15 170 45 0
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
143 Omeprazole kaps Kapsul 2390 0 2390 230 2160 907 0

144 Oxytetracycline HCl 1% Salep Mata Tube 0 75 75 0 75 68 0
145 Oxytetracycline HCl 3% Salep Kulit Tube 0 0 0 0 0 100 100
146 Oxytocin inj 10 IU Ampul 0 200 200 50 150 68 0
147 Papaverin 40 mg tab Tablet 0 0 0 0 0 0 0
148 Papaverin inj Tablet 0 0 0 0 0 0 0
149 Paracetamol Drops 15 ml Botol 58 0 58 6 52 12 0
150 Parasetamol 120 mg/5 ml Syr Botol 129 400 529 75 454 310 0
151 Parasetamol 500 mg Tablet 0 6000 6000 1790 4210 8028 5000
152 Patient Lubricant (My Jelly ) Tube 10 0 10 0 10 1 0
153 Permethrin (Scabimite Cream) Tube 13 0 13 6 7 15 8
154 Phenobarbital inj 50mg/ml-2ml Ampul 90 0 90 30 60 41 0
155 Phenobarbital 100 mg Tablet 0 0 0 0 0 0 0
156 Phenol gliserol 10% TT Botol 80 24 104 31 73 50 0
157 Phytomenadione (Vit.K1) inj 10 mg/ml Ampul 382 180 562 60 502 123 0
158 Phytomenadione (Vit.K1) 10 mg Tablet 0 500 500 120 380 162 0
159 Piracetam 400 mg Tablet 0 0 0 0 0 500 500
160 Piroxicam 20 mg tab Tablet 3839 0 3839 849 2990 3276 2000
161 Pisau Disposable (Mess No.14/21) Pcs 0 0 0 0 0 20 200
162 Plesterku (Leukoplast) Pcs 26 50 76 9 67 74 20
163 Polivalen serum (Anti Tetanus Inj. 1500 iu/Biosat Ampul 0 0 0 0 0 0 0
164 Povidon iodium 10% 300 ml Botol 13 0 13 2 11 8 5
165 Prednison 5 mg Tablet 0 0 0 0 0 4000 4000
166 Primaquin 15 mg tab Tablet 400 0 400 0 400 0 0
167 Profolat tab Tablet 0 0 0 0 0 0 0
168 Prokaina Penisilin G inj 3.000.000 iu Ampul 0 0 0 0 0 0 0
169 Propranolol HCl 10 mg Tablet 0 0 0 0 0 1000 1000
170 Propranolol HCl 40 mg Tablet 1790 500 2290 0 2290 284 0
171 Propylthiouracil 100 mg Tablet 300 0 300 50 250 203 200
172 Protein Gluco Test Strip 20 20 40 0 40 27 0
173 Pyrantel Pamoat 125 mg Tablet 100 0 100 0 100 0 0
174 Pyridoxine HCl 10 mg Tablet 1700 500 2200 0 2200 406 0
175 Ranitidin 150 mg Tablet 297 0 297 297 0 3412 5000
176 Ranitidin Injeksi Ampul 0 0 0 0 0 0 0
177 Retinol (Vit.A) kaps 100.000 iu Kapsul 900 0 900 0 900 135 0
178 Retinol (Vit.A) kaps 200.000 iu Kapsul 500 100 600 100 500 812 500
179 Risperidone 2mg Tablet 800 0 800 0 800 271 0
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
180 Salbutamol 2 mg Tablet 0 0 0 0 0 3000 3000

181 Salep 2-4 Kombinasi pot 0 0 0 0 0 24 24
182 Sarung tangan (HandScuun) No.7,5 Pcs 0 0 0 0 0 3000 3000
183 Sarung tangan (HandScuun Steril) No. 6,5 Pcs 0 0 0 0 0 500 500
184 Sarung tangan (HandScuun Steril) No.7 Pcs 0 0 0 0 0 500 500
185 Sarung tangan (HandScuun Steril) No.7,5 Pcs 0 0 0 0 0 500 500
186 Semen Seng Fosfat Serbuk & Cairan Set 0 0 0 0 0 0 0
187 Sianocobalamin (Vit B12) 50 mg tab Tablet 2252 1000 3252 222 3030 1325 0
188 Silk (Benang Bedah) No. 3/0 Pcs 105 36 141 9 132 37 0
189 Silver Sulfadiazine Tube 24 12 36 1 35 5 0
190 Simvastatin 10 mg tab Tablet 2643 510 3153 183 2970 521 0
191 Sodium cloride infus 0,9% ( NACL ) Botol 333 200 533 25 508 260 0
192 Spuit 1 ml Pcs 500 300 800 43 757 282 0
193 Spuit 3 ml Pcs 20 0 20 20 0 2632 3000
194 Spuit 5 ml Pcs 310 0 310 193 117 676 600
195 Sulfadoxine | Pyrimethamine Tablet 500mg|25 Tablet 0 0 0 0 0 0 0
196 Sulfamethoxazole | trimethoprim (cotri) syr Botol 50 300 350 12 338 152 0
197 Sulfasetamida 15% TM Botol 0 0 0 0 0 0 0
198 Tetracycline 250 mg Tablet 0 0 0 0 0 500 500
199 Tetracycline 500 mg Tablet 2440 0 2440 0 2440 866 0
200 Thiamine HCl (Vit B1) inj 100 mg/ml Ampul 0 0 0 0 0 0 0
201 Thiamine HCl (Vit B1) 50 mg Tablet 700 0 700 0 700 542 0
202 Trihexyphenidyl tab 2 mg Tablet 400 0 400 0 400 0 0
203 Trimethoprim (cotrimoxazol 480 mg) tablet Tablet 0 2000 2000 230 1770 311 0
204 Urin Bag Pcs 0 0 0 0 0 15 15
205 Usg Gel Botol 0 0 0 0 0 2 2
206 Vaksin Rabies Vero/ Verorab Paket 0 0 0 0 0 0 0
207 Vitamin B Kompleks Tablet 0 2000 2000 870 1130 5000 5000
208 Vitamin K Infant Inj Ampul 0 0 0 0 0 0 0
209 Water liquid (aqua P,I) Botol 49 100 149 25 124 104 0
210 Wing Needle No.21 Pcs 0 0 0 0 0 0 0
211 Wing Needle No.27 Pcs 0 0 0 0 0 0 0
212 Zinc Sulphate Suppositoria (Superhoid) Kapsul 0 0 0 0 0 0 0
213 Zinc tab Tablet 0 2000 2000 110 1890 149 0
214 Cefotaxim Inj Vial 0 0 0 0 0 100 100
215
216
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241


Kepala Dinas Kesehatan Kab. OKI Kepala Instalasi Farmasi Dinkes OKI Direktur RS Pratama Pengelola Obat RS Pratama
H. M. Lubis, S.KM., M.Kes Himayanti, S.Si., Apt. dr. Muhammad Tito Aristian Kartini Wiati,SKM
NIP. 19660603 198703 1 003 NIP. 19770221 200501 2 005 NIP. 19850421 2014081 001 NIP. 19750806 200501 2 009
TANGGAL
KET
12
: JULI 2019
KET
12
: JULI 2019
KET
12
: JULI 2019
KET
12
: JULI 2019
KET
12
: JULI 2019
KET
12
: JULI 2019
KET
12
ang Membuat
ola Obat RS Pratama
artini Wiati,SKM
750806 200501 2 009
variabel Variabel
waktu Hari
waktu Waktu
tunggu Kosong
Kosong
tunggu
10 169.23077 0 0
10 107.69231 0 0
10 0 0 0
10 0 0 0
10 9.2307692 0 0
10 3.8461538 0 0
10 16.666667 0 0
10 0 0 0
10 71.794872 0 0
10 0 0 0
10 138.46154 0 0
10 6.4102564 0 0
10 183.33333 0 0
10 446.15385 0 0
10 0 0 0
10 7.8205128 0 0
10 440.51282 0 0
10 0 0 0
10 0 0 0
10 295.76923 0 0
10 0 0 0
10 12.820513 0 0
10 0.1282051 0 0
10 3.8461538 0 0
10 16.666667 0 0
10 0.1282051 0 0
10 0 0 0
10 10 0 0
10 3.0769231 0 0
10 57.692308 0 0
10 9.4871795 0 0
10 0 0 0
10 #VALUE! 0 #VALUE!
10 0 0 0
10 2.6923077 0 0
10 0 0 0
10 2.5641026 0 0
10 208.46154 0 0
10 56.410256 0 0
10 319.48718 0 0
10 0 0 0
10 0 0 0
10 11.282051 0 0
10 3.8461538 0 0
10 0 0 0
10 2.9487179 0 0
10 4.1025641 0 0
10 7.0512821 0 0
10 3.8461538 0 0
10 0 0 0
10 10 0 0
10 515.38462 0 0
10 0 0 0
10 0 0 0
10 83.333333 0 0
10 0.2564103 0 0
10 57.692308 0 0
10 0.3846154 30 1.1538462
10 1.1538462 0 0
10 0 0 0
10 0 0 0
10 5 0 0
10 0 0 0
10 83.333333 0 0
10 34.615385 0 0
10 1.1538462 0 0
10 41.025641 0 0
10 11.538462 0 0
10 111.66667 0 0
10 0 0 0
10 6.4102564 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 2.6923077 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 1608.9744 0 0
10 1.2820513 0 0
10 1.4102564 0 0
10 1.6666667 0 0
10 53.846154 0 0
10 23.589744 0 0
10 0 0 0
10 1.7948718 0 0
10 0 0 0
10 0 0 0
10 48.589744 0 0
10 28.717949 0 0
10 1.025641 0 0
10 36.794872 0 0
10 11.794872 0 0
10 308.97436 0 0
10 0 0 0
10 12.820513 0 0
10 11.538462 0 0
10 5.1282051 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 1.7948718 0 0
10 30.384615 0 0
10 8.3333333 0 0
10 0 0 0
10 0 0 0
10 2.5641026 0 0
10 29.358974 0 0
10 17.051282 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 2.6923077 0 0
10 0 0 0
10 1.1538462 0 0
10 3.4615385 0 0
10 44.871795 0 0
10 0 0 0
10 8.5897436 0 0
10 5.7692308 0 0
10 2.5641026 0 0
10 0 0 0
10 1.2820513 0 0
10 0 0 0
10 16.410256 0 0
10 0.8974359 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 242.17949 0 0
10 3.8461538 0 0
10 0 0 0
10 220.38462 0 0
10 7.5641026 0 0
10 0 0 0
10 123.07692 0 0
10 0 0 0
10 2.5641026 0 0
10 0 0 0
10 0.5128205 0 0
10 102.5641 0 0
10 0 0 0
10 0.3846154 0 0
10 2.4358974 0 0
10 12.820513 0 0
10 0 0 0
10 0 0 0
10 5.1282051 0 0
10 10.25641 0 0
10 4.2307692 0 0
10 0 0 0
10 0 0 0
10 2.6923077 0 0
10 85.897436 0 0
10 6.4102564 0 0
10 0 0 0
10 6.4102564 0 0
10 0 0 0
10 0 0 0
10 1.1538462 0 0
10 29.358974 0 0
10 760.25641 0 0
10 0.1282051 0 0
10 1.4102564 0 0
10 3.8461538 0 0
10 0 0 0
10 4.7435897 0 0
10 11.666667 0 0
10 15.384615 0 0
10 0 0 0
10 310.25641 0 0
10 1.9230769 0 0
10 7.0512821 0 0
10 0 0 0
10 0.7692308 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 26.923077 0 0
10 19.230769 0 0
10 2.5641026 0 0
10 0 0 0
10 38.461538 0 0
10 323.07692 0 0
10 0 0 0
10 12.820513 0 0
10 76.923077 0 0
10 25.641026 0 0
10 0 0 0
10 0 0 0
10 2.6923077 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 125.51282 0 0
10 3.4615385 0 0
10 0.5128205 0 0
10 49.358974 0 0
10 24.615385 0 0
10 26.666667 0 0
10 185.89744 30 557.69231
10 63.974359 0 0
10 0 0 0
10 14.358974 0 0
10 0 0 0
10 0 0 0
10 82.051282 0 0
10 0 0 0
10 51.282051 0 0
10 0 0 0
10 29.487179 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 171.79487 0 0
10 0 0 0
10 9.8717949 0 0
10 0 0 0
10 0 0 0
10 0 0 0
10 14.102564 0 0
10 0 0 0
10 0 0 0
RS PRATAMA TUGU JAYA PELAPORAN BULAN : AGUSTUS 2019 DOKUMEN NOMOR

KECAMATAN : LEMPUING PERMINTAAN BULAN : DINKES KAB/KOTA
PROPINSI : SUMATERA SELATAN RS PRATAMA 07
STOK STOK STOK

AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
1 Absorbent tipped applicator (alcohol swab) Pcs 1280 1280 1280

2 Acetylcystein Kapsul 200mg Kapsul 620 620 620
3 Acyclovir tab 200 mg Tablet 200 200 200
4 Acyclovir cream Tube 0 0 0
5 Albendazol tab 400 mg Tablet 162 162 162
6 Alkohol Liquid (etanol) 70%-1000 ml Btl 23 23 23
7 Allopurinol 100 mg Tablet 1930 1930 1930
8 Aminophylline Inj 24 mg/ml-10 ml Ampul 0 0 0
9 Aminophylline tab 200 mg Tablet 1000 1000 1000
10 Amitriptyline 25 mg tab Tablet 300 300 300
11 Amlodipine tab 5 mg Tablet 5340 5340 5340
12 Amoxycillin Syr Btl 370 370 370
13 Amoxycillin 250 mg Kapsul 6890 6890 6890
14 Amoxycillin 500 mg Kaptab 9120 9120 9120
15 Ampicilin 1 gr Inj Vial 10 10 10
16 Antasida Syr DOEN Btl 747 747 747
17 Antasida DOEN Kombinasi Tablet 9100 9100 9100
18 Anti Bisa Ular 5 ml (ABU I)/ Biosave Vial 0 0 0
19 Asam Mefenamat 500 mg tab Tablet 0 0 0
20 Ascorbic acid (Vit.C) 50 mg Tablet 6580 6580 6580
21 Ascorbic acid |calsium carbonate 500 mg (Pehavr Tablet 0 0 0
22 Aspirin (miniaspi) 100 mg tab Tablet 900 900 900
23 Atropine inj 0,25 mg/ml Ampul 100 100 100
24 Attapulgite Tablet (Pularex) Tablet 279 279 279
25 Attapulgite Tablet 600 mg (New Antides) Tablet 1590 1590 1590
26 Automated blood grouping (Tes Gol. Darah) Paket 0 0 0
27 Bahan Tambal Gigi Sementara (Fletcher/Caviton) Pcs 6 6 6
28 Bedak Salisil 2% Btl 163 163 163
29 Benzoic acid |salicylic acid salep (anti fungi) pot 72 72 72
30 Betahistine Mesylate 6 mg tab Tablet 1180 1180 1180
31 Betamethasone 0,1% krim Tube 26 26 26
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
32 Bisacodyl 5mg Tablet 0 0 0

33 Bismuth subgallas (antihemoroid) Supp 30 30 30
34 Calcium chloride lactate infus (RL) Botol 2190 2190 2190
35 Calsium Laktat (Kalk) 500 mg Tablet 2000 2000 2000
36 Captopril 12,5 mg Tablet 3878 3878 3878
37 Captopril 25 mg Tablet 0 0 0
38 Carbamazepin tab Tablet 829 829 829
39 Catgut/Benang Chromic Bedah No.2/0-3/0 Pcs 252 252 252
40 Catgut/Benang Plain Bedah No.2/0-3/0 Pcs 0 0 0
41 Cefadroxil 500mg Tablet 0 0 0
42 Cetirizine 5 mg/5 ml sirup Botol 155 155 155
43 Chloramhenicol Salep Mata 1% Tube 91 91 91
44 Chloramphenicol Suspensi 125 mg/ml Btl 78 78 78
45 Chloramphenicol 250 mg caps Tablet 100 100 100
46 Chloramphenicol TT 3% Botol 0 0 0
47 Chloramphenicol/ Hidrokortison krim 2,5% Tube 138 138 138
48 Chlorpheniramine Maleat (CTM) 4 mg Tablet 12150 12150 12150
49 Chlorpromazine HCl 100 mg Tablet 200 200 200
50 Cimetidin 200 tab Tablet 0 0 0
51 Ciprofloxacin 500 mg tab Tablet 0 0 0
52 Ciprofloxacin Infus Botol 8 8 8
53 Clindamycin 300mg Kapsul 0 0 0
54 Cresol liquid 1 Liter (lysol) Botol 0 0 0
55 Cyanocobalamin (Vit B12) inj 500 mcg/ml Ampul 0 0 0
56 Devitalisasi pasta pot 0 0 0
57 Dexamethasone 0,5 mg Tablet 0 0 0
58 Dexamethasone inj 5mg/ml-1ml Ampul 191 191 191
59 Diazepam 5mg/ml-2 ml inj Ampul 0 0 0
60 Diazepam 2 mg Tablet 3450 3450 3450
61 Diclofenac sodium 25 mg tab Tablet 3730 3730 3730
62 Digoxin 0,25 mg Tablet 0 0 0
63 Dimenhydrinate 50mg Tablet 980 980 980
64 Dipenhidramine HCl inj 10mg/ml Ampul 210 210 210
65 Domperidone 10 mg Tablet 4489 4489 4489
66 Doxycycline 100 mg Kapsul Kapsul 500 500 500
67 Epinephrine HCl/bitartrat inj 0,1% Ampul 50 50 50
68 Erythromicin Syr Btl 0 0 0
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
69 Erythromicin 500 mg capsul Kapsul 0 0 0

70 Ethacridine (Rivanol) 0,1% Btl 1 1 1
71 Ethanol ( Aseptan ) 500 cc+ Pump Botol 0 0 0
72 Eugenol cairan Btl 5 5 5
73 Ferrous fumarate ( Tab. Tambah Darah ) Tablet 30570 30570 30570
74 Folic acid 1mg ( asam folat) Tablet 2560 2560 2560
75 Folley Catheter No.16 Pcs 5 5 5
76 Furosemida Injeksi Ampul 12 12 12
77 Furosemida 40 mg Tablet 900 900 900
78 Garam Oralit Sachet 400 400 400
79 Gentamicyn 0,3% TM Botol 0 0 0
80 Gentamicyn Inj 40 mg/ml Ampul 73 73 73
81 Gentamicyn 0,1% SK Tube 0 0 0
82 Glass lonomer Paket 1 1 1
83 Glibenclamide 5 mg Tablet 4020 4020 4020
84 Glimepiride 1 mg Tablet 3700 3700 3700
85 Glukosa larutan infus 10% Botol 152 152 152
86 Glukosa larutan infus 5% Botol 459 459 459
87 Griseofulvin 125 mg Tablet 2278 2278 2278
88 Guaifenesin 100 Tab (GG tab) Tablet 7240 7240 7240
89 Haloperidol 0,5 mg tab Tablet 0 0 0
90 Haloperidol 5 mg tab Tablet 1000 1000 1000
91 Human chorionic (HCG/Tes kehamilan ) Strip 120 120 120
92 Hydrochlorotiazide (HCT) 25 mg Tablet 1240 1240 1240
93 Ibuprofen sirup Botol 55 55 55
94 Ibuprofen 200 mg Tablet 0 0 0
95 Ibuprofen 400 mg Tablet 0 0 0
96 Ichthyol salep 10% pot 0 0 0
97 Immunoglobulin human anti-tetanus (Tetagam) Ampul 6 6 6
98 Infus set dewasa Pcs 1343 1343 1343
99 Infusi set anak Pcs 705 705 705
100 Iodium Povidon 10% 30 ml Botol 0 0 0
101 Isosorbide tablet Tablet 0 0 0
102 IV Catheter No.20 Pcs 0 0 0
105 Jarum Jahit Kulit Pcs 0 0 0
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
106 Kalium Permanganat Serbuk pot 0 0 0

107 Kapas pembalut/Absorben 250 g Pcs 25 25 25
108 Kasa pembalut 2x80 Pcs 99 99 99
109 Kasa pembalut hidrofil 4 m x 15 cm Pcs 355 355 355
110 Kasa pembalut hidrofil 4 m x 3 cm Pcs 20 20 20
111 Kasa kompres 40/40 steril Pcs 242 242 242
112 Ketoconazole 200 mg Cream Tube 145 145 145
113 Ketoconazole 200 mg tab Tablet 0 0 0
114 Klorokina Fosfat 250 mg Tablet 0 0 0
115 Levertran Salep/ Salep Luka Bakar pot 14 14 14
116 Lidocain 2% Ampul 7 7 7
117 Lidokain Comp. inj Kombinasi Ampul 267 267 267
118 Lidocaine spray (Xylocaine spray) Botol 1 1 1
119 Liquorice liquid extract (OBH) Botol 0 0 0
120 Locoriz Cream Tube 0 0 0
121 Loperamid 2 m tab Tablet 0 0 0
122 Loratadine 10 mg tab Tablet 6379 6379 6379
123 Magnesium Sulfat Injeksi 20% (MgSO4) Ampul 0 0 0
124 Magnesium Sulfat Injeksi 40% (MgSO4) Ampul 0 0 0
125 Masker Pcs 2905 2905 2905
126 Medical adhesive tape (dermafix/leukomed) Pcs 123 123 123
127 Metamizole injeksi (antalgin 1000) Ampul 63 63 63
128 Metformin 500mg tab Tablet 2960 2960 2960
129 Methyl Ergometrin Maleat inj 0,2 mg/ml Ampul 0 0 0
130 Methyl Ergometrin Maleat 0,125 mg Tab 680 680 680
131 Methyl Prednisolon tab 4 mg Tablet 0 0 0
132 Methyl Rosanilinium (gentian violet) Botol 65 65 65
133 Metronidazol 250 mg tab Tablet 0 0 0
134 Metronidazol 500 mg tab Tablet 0 0 0
135 Metronidazol Infus Botol 7 7 7
136 Metronidazol syr Botol 105 105 105
137 Miconazole 2% Salep Kulit Tube 125 125 125
138 Momilen Baby Gold Sirup Botol 0 0 0
139 Natrium Bikarbonat 500 mg Tablet 400 400 400
140 Nifedipin 10 mg tab Kapsul 0 0 0
141 Nystatin Tab Vag 10.000 iu/g Tablet 200 200 200
142 Omeprazole inj Vial 170 170 170
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
143 Omeprazole kaps Kapsul 2160 2160 2160

144 Oxytetracycline HCl 1% Salep Mata Tube 75 75 75
145 Oxytetracycline HCl 3% Salep Kulit Tube 0 0 0
146 Oxytocin inj 10 IU Ampul 150 150 150
147 Papaverin 40 mg tab Tablet 0 0 0
148 Papaverin inj Tablet 0 0 0
149 Paracetamol Drops 15 ml Botol 52 52 52
150 Parasetamol 120 mg/5 ml Syr Botol 454 454 454
151 Parasetamol 500 mg Tablet 4210 4210 4210
152 Patient Lubricant (My Jelly ) Tube 10 10 10
153 Permethrin (Scabimite Cream) Tube 7 7 7
154 Phenobarbital inj 50mg/ml-2ml Ampul 60 60 60
155 Phenobarbital 100 mg Tablet 0 0 0
156 Phenol gliserol 10% TT Botol 73 73 73
157 Phytomenadione (Vit.K1) inj 10 mg/ml Ampul 502 502 502
158 Phytomenadione (Vit.K1) 10 mg Tablet 380 380 380
159 Piracetam 400 mg Tablet 0 0 0
160 Piroxicam 20 mg tab Tablet 2990 2990 2990
161 Pisau Disposable (Mess No.14/21) Pcs 0 0 0
162 Plesterku (Leukoplast) Pcs 67 67 67
163 Polivalen serum (Anti Tetanus Inj. 1500 iu/Biosat Ampul 0 0 0
164 Povidon iodium 10% 300 ml Botol 11 11 11
165 Prednison 5 mg Tablet 0 0 0
166 Primaquin 15 mg tab Tablet 400 400 400
167 Profolat tab Tablet 0 0 0
168 Prokaina Penisilin G inj 3.000.000 iu Ampul 0 0 0
169 Propranolol HCl 10 mg Tablet 0 0 0
170 Propranolol HCl 40 mg Tablet 2290 2290 2290
171 Propylthiouracil 100 mg Tablet 250 250 250
172 Protein Gluco Test Strip 40 40 40
173 Pyrantel Pamoat 125 mg Tablet 100 100 100
174 Pyridoxine HCl 10 mg Tablet 2200 2200 2200
175 Ranitidin 150 mg Tablet 0 0 0
176 Ranitidin Injeksi Ampul 0 0 0
177 Retinol (Vit.A) kaps 100.000 iu Kapsul 900 900 900
178 Retinol (Vit.A) kaps 200.000 iu Kapsul 500 500 500
179 Risperidone 2mg Tablet 800 800 800
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
180 Salbutamol 2 mg Tablet 0 0 0

181 Salep 2-4 Kombinasi pot 0 0 0
182 Sarung tangan (HandScuun) No.7,5 Pcs 0 0 0
183 Sarung tangan (HandScuun Steril) No. 6,5 Pcs 0 0 0
184 Sarung tangan (HandScuun Steril) No.7 Pcs 0 0 0
185 Sarung tangan (HandScuun Steril) No.7,5 Pcs 0 0 0
186 Semen Seng Fosfat Serbuk & Cairan Set 0 0 0
187 Sianocobalamin (Vit B12) 50 mg tab Tablet 3030 3030 3030
188 Silk (Benang Bedah) No. 3/0 Pcs 132 132 132
189 Silver Sulfadiazine Tube 35 35 35
190 Simvastatin 10 mg tab Tablet 2970 2970 2970
191 Sodium cloride infus 0,9% ( NACL ) Botol 508 508 508
192 Spuit 1 ml Pcs 757 757 757
193 Spuit 3 ml Pcs 0 0 0
194 Spuit 5 ml Pcs 117 117 117
195 Sulfadoxine | Pyrimethamine Tablet 500mg|25 Tablet 0 0 0
196 Sulfamethoxazole | trimethoprim (cotri) syr Botol 338 338 338
197 Sulfasetamida 15% TM Botol 0 0 0
198 Tetracycline 250 mg Tablet 0 0 0
199 Tetracycline 500 mg Tablet 2440 2440 2440
200 Thiamine HCl (Vit B1) inj 100 mg/ml Ampul 0 0 0
201 Thiamine HCl (Vit B1) 50 mg Tablet 700 700 700
202 Trihexyphenidyl tab 2 mg Tablet 400 400 400
203 Trimethoprim (cotrimoxazol 480 mg) tablet Tablet 1770 1770 1770
204 Urin Bag Pcs 0 0 0
205 Usg Gel Botol 0 0 0
206 Vaksin Rabies Vero/ Verorab Paket 0 0 0
207 Vitamin B Kompleks Tablet 1130 1130 1130
208 Vitamin K Infant Inj Ampul 0 0 0
209 Water liquid (aqua P,I) Botol 124 124 124
210 Wing Needle No.21 Pcs 0 0 0
211 Wing Needle No.27 Pcs 0 0 0
212 Zinc Sulphate Suppositoria (Superhoid) Kapsul 0 0 0
213 Zinc tab Tablet 1890 1890 1890
214 0 0 0
215 0 0 0
216 0 0 0
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
217 0 0 0
218 0 0 0
219 0 0 0
220 0 0 0
221 0 0 0
222 0 0 0
223 0 0 0
224 0 0 0
225 0 0 0
226 0 0 0
227 0 0 0
228 0 0 0
229 0 0 0
230 0 0 0
231 0 0 0
232 0 0 0
233 0 0 0
234 0 0 0
235 0 0 0
236 0 0 0
237 0 0 0
238 0 0 0
239 0 0 0
240 0 0 0
241 0 0 0

0
Kepala Dinas Kesehatan Kab. OKI Kepala Instalasi Farmasi Dinkes OKI Pimpinan Puskesmas Pengelola Obat Puskesmas
..................................... ..................................... ..................................... .....................................

TANGGAL
KET
12
: AGUSTUS 2019
KET
12
: AGUSTUS 2019
KET
12
: AGUSTUS 2019
KET
12
: AGUSTUS 2019
KET
12
: AGUSTUS 2019
KET
12
: AGUSTUS 2019
KET
12
Yang Membuat
gelola Obat Puskesmas
..................................
STUS 2019
STUS 2019
STUS 2019
STUS 2019
STUS 2019
STUS 2019
KETERSEDIAAN OBAT RS PRATAMA TUGU JAYA
PERIODE JULI AGUSTUS SEPTEMBER 2019
ANTIBIOTIK / ANTIVIRUS/ANTIFUNGI ANTIPIRETIK/ANALGESIK/ANTIINFLAMASI

Amox 250 Ada Antalgin Tab Tidak Ada
Amox 500 ADA Antalgin Inj Ada
Amox Syr ADA Asetosal Ada
Cefadroxil 500 Tidak Ada Asam Mefenamat Tidak Ada
CiproTab Tidak Ada Ibuprofen 200 Tidak Ada
Cipro Infus Ada Ibuprofen 400 Tidak Ada
Clindamisin Tidak Ada Ibuprofen Syr Ada
Doksisiklin Ada PCT Drop Ada
Eritro 500 Tidak Ada PCT Syr Ada
Eritro Syr Tidak Ada PCT 500 Ada
Genta Inj Ada Piroksikam Ada
Kloram 250 Ada Na Diklofenak 25 Ada
Kloram Syr Ada
Kotri Tab Ada
Kotri Syr Ada
Tetra 250 Tidak Ada EXPECTORANT
Tetra 500 Ada ASETILSISTEIN Ada
GG/Guaifenesin Ada
Griseofulvin Ada OBH Tidak Ada
Ketoconazol 200 Tidak Ada
Metro Syr Ada ANTIALERGI/KORTIKOSTEROID
Metro 250 Ada Cetirizin Syr Ada
Metro 500 Tidak Ada Loratadine Tab Ada
Nistatin Ovula Ada Dexa Tab Tidak Ada
Dexa Inj Ada
Acyclovir 200, Kaps Ada Difenhidramin Inj Ada
CTM Ada
Antihipertensi/Diuretik/Angina Metil Prednisolon Tidak Ada
Amlodipin Ada
Captopril 12,5 mg Ada
Captoprl 25 Tidak Ada ANTIDIABETES
Furosemid Tab Ada Glibenklamid Ada
Furosemid Inj Ada Glimepirid 1, Ada
HCT Ada Metformin Ada
ISDN Tidak Ada
Digoksin Tidak Ada Antikolesterol
Nifedipin Ada Simvastatin Ada
Obat-obat Jiwa Anti Magh

Amitriptilin Ada Antasida Tab Ada
Diazepam Tab Ada Antasida Syr Ada
Diazepam inj Tidak Ada Omeprazol Ada
Fenobarbital Tab Tidak Ada Omeprazol Inj Ada
Fenobarbital Inj Ada Ranitidin Tab Ada
Haloperidol 0,5 Tidak Ada Cimetidin Ada
Haloperidol 5 Ada Na Bicarbonat Ada
CPZ Ada
Piracetam Tidak Ada Antidiare
Risperidon Ada Attagipe/Pularex/Antides Ada
Triheksipenidil Ada Zink Ada
Loperamid Tidak Ada
Oralit Ada
Vitamin Antiemetik
Vit B1 Ada Dimenhidrinat Ada
Vit B1 Inj Tidak Ada Dom Ada
Vit B6 Ada
Vit B12 Ada Antelmintik
Vit B12 Inj Tidak Ada Albendazol Tab Ada
Vit B-Kompleks Ada Pirantel Tab Ada
Vit C Ada
Vit K Tab Tidak Ada
Vit K Inj Ada Bronkodilator
Fe Ada Aminofillin Ada
Asam Folat Ada Aminofillin Inj Tidak Ada
Salbutamol Tidak Ada
DLL
Allupurinol Ada
Betahistin Ada
PTU Ada
Gentian Vioelet Ada
Bisacodyl Tidak Ada
Antihemoroid Ada
Superoid Tidak Ada
Kalium Permanganat Tidak Ada
Bedak Salisil Ada
Salep Kulit Tetes Telinga

Betametason cr Ada Kloram Tetes Telinga Tidak Ada
Gentamisin cr Tidak Ada Fenol Gliserol TT Ada
Hidrokortison cr Ada
Ichtiyol Tidak Ada
Acyclovir cr Tidak Ada Salep/Tetes Mata
Keto cr Ada Gentamisin TM Tidak Ada
Levertran Ada Kloramfenikol SM Ada
Sulfadiazin Ada Oksitetrasiklin SM Ada
Miconazol cr Ada
Oksi Sk Tidak Ada
Salep 24 Tidak Ada
Scabimite Ada
Bennzoat Salep Ada
betadin terpisah
kotri tablet dan syr terpisah
kloram/hidro krim?
Siano injeksi dan tablet terpisah
PUSKESMAS : PELAPORAN BULAN : OKTOBER 2018 DOKUMEN NOMOR
KECAMATAN : PERMINTAAS BULAN : DINKES KAB/KOTA

STOK STOK STOK

AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
1 Absorbent tipped applicator (alcohol swab) Pcs 1280 1280 1280 -1280
2 Acetylcystein Kapsul 200mg Kapsul 620 620 620 -620
3 Acyclovir tab 200 mg Tablet 200 200 200 -200
5 Albendazol tab 400 mg Tablet 162 162 162 -162
6 Alkohol Liquid (etanol) 70%-1000 ml Btl 23 23 23 -23
7 Allopurinol 100 mg Tablet 1930 1930 1930 -1930
9 Aminophylline tab 200 mg Tablet 1000 1000 1000 -1000
10 Amitriptyline 25 mg tab Tablet 300 300 300 -300
11 Amlodipine tab 5 mg Tablet 5340 5340 5340 -5340
12 Amoxycillin Syr Btl 370 370 370 -370
13 Amoxycillin 250 mg Kapsul 6890 6890 6890 -6890
14 Amoxycillin 500 mg Kaptab 9120 9120 9120 -9120
15 Ampicilin 1 gr Inj Vial 10 10 10 -10
16 Antasida Syr DOEN Btl 747 747 747 -747
17 Antasida DOEN Kombinasi Tablet 9100 9100 9100 -9100
20 Ascorbic acid (Vit.C) 50 mg Tablet 6580 6580 6580 -6580
21 Ascorbic acid |calsium carbonate 500 mg (Pe Tablet 0 0 0 0
22 Aspirin (miniaspi) 100 mg tab Tablet 900 900 900 -900
23 Atropine inj 0,25 mg/ml Ampul 100 100 100 -100
24 Attapulgite Tablet (Pularex) Tablet 279 279 279 -279
25 Attapulgite Tablet 600 mg (New Antides) Tablet 1590 1590 1590 -1590
27 Bahan Tambal Gigi Sementara (Fletcher/Cavi Pcs 6 6 6 -6
28 Bedak Salisil 2% Btl 163 163 163 -163
29 Benzoic acid |salicylic acid salep (anti fungi) pot 72 72 72 -72
30 Betahistine Mesylate 6 mg tab Tablet 1180 1180 1180 -1180
31 Betamethasone 0,1% krim Tube 26 26 26 -26
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
33 Bismuth subgallas (antihemoroid) Supp 30 30 30 -30
34 Calcium chloride lactate infus (RL) Botol 2190 2190 2190 -2190
35 Calsium Laktat (Kalk) 500 mg Tablet 2000 2000 2000 -2000
36 Captopril 12,5 mg Tablet 3878 3878 3878 -3878
38 Carbamazepin tab Tablet 829 829 829 -829
39 Catgut/Benang Chromic Bedah No.2/0-3/0 Pcs 252 252 252 -252
42 Cetirizine 5 mg/5 ml sirup Botol 155 155 155 -155
43 Chloramhenicol Salep Mata 1% Tube 91 91 91 -91
44 Chloramphenicol Suspensi 125 mg/ml Btl 78 78 78 -78
45 Chloramphenicol 250 mg caps Tablet 100 100 100 -100
47 Chloramphenicol/ Hidrokortison krim 2,5% Tube 138 138 138 -138
48 Chlorpheniramine Maleat (CTM) 4 mg Tablet 12150 12150 12150 -12150
49 Chlorpromazine HCl 100 mg Tablet 200 200 200 -200
52 Ciprofloxacin Infus Botol 8 8 8 -8
58 Dexamethasone inj 5mg/ml-1ml Ampul 191 191 191 -191
60 Diazepam 2 mg Tablet 3450 3450 3450 -3450
61 Diclofenac sodium 25 mg tab Tablet 3730 3730 3730 -3730
63 Dimenhydrinate 50mg Tablet 980 980 980 -980
64 Dipenhidramine HCl inj 10mg/ml Ampul 210 210 210 -210
65 Domperidone 10 mg Tablet 4489 4489 4489 -4489
66 Doxycycline 100 mg Kapsul Kapsul 500 500 500 -500
67 Epinephrine HCl/bitartrat inj 0,1% Ampul 50 50 50 -50
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
70 Ethacridine (Rivanol) 0,1% Btl 1 1 1 -1
72 Eugenol cairan Btl 5 5 5 -5
73 Ferrous fumarate ( Tab. Tambah Darah ) Tablet 30570 30570 30570 -30570
74 Folic acid 1mg ( asam folat) Tablet 2560 2560 2560 -2560
75 Folley Catheter No.16 Pcs 5 5 5 -5
76 Furosemida Injeksi Ampul 12 12 12 -12
77 Furosemida 40 mg Tablet 900 900 900 -900
78 Garam Oralit Sachet 400 400 400 -400
80 Gentamicyn Inj 40 mg/ml Ampul 73 73 73 -73
82 Glass lonomer Paket 1 1 1 -1
83 Glibenclamide 5 mg Tablet 4020 4020 4020 -4020
84 Glimepiride 1 mg Tablet 3700 3700 3700 -3700
85 Glukosa larutan infus 10% Botol 152 152 152 -152
87 Griseofulvin 125 mg Tablet 2278 2278 2278 -2278
88 Guaifenesin 100 Tab (GG tab) Tablet 7240 7240 7240 -7240
90 Haloperidol 5 mg tab Tablet 1000 1000 1000 -1000
91 Human chorionic (HCG/Tes kehamilan ) Strip 120 120 120 -120
92 Hydrochlorotiazide (HCT) 25 mg Tablet 1240 1240 1240 -1240
93 Ibuprofen sirup Botol 55 55 55 -55
97 Immunoglobulin human anti-tetanus (Tetaga Ampul 6 6 6 -6
98 Infus set dewasa Pcs 1343 1343 1343 -1343
99 Infusi set anak Pcs 705 705 705 -705
104 IV Catheter No.24 Pcs 10 10 10 -10
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
107 Kapas pembalut/Absorben 250 g Pcs 25 25 25 -25
108 Kasa pembalut 2x80 Pcs 99 99 99 -99
109 Kasa pembalut hidrofil 4 m x 15 cm Pcs 355 355 355 -355
111 Kasa kompres 40/40 steril Pcs 242 242 242 -242
112 Ketoconazole 200 mg Cream Tube 145 145 145 -145
115 Levertran Salep/ Salep Luka Bakar pot 14 14 14 -14
116 Lidocain 2% Ampul 7 7 7 -7
117 Lidokain Comp. inj Kombinasi Ampul 267 267 267 -267
118 Lidocaine spray (Xylocaine spray) Botol 1 1 1 -1
122 Loratadine 10 mg tab Tablet 6379 6379 6379 -6379
125 Masker Pcs 2905 2905 2905 -2905
126 Medical adhesive tape (dermafix/leukomed) Pcs 123 123 123 -123
127 Metamizole injeksi (antalgin 1000) Ampul 63 63 63 -63
128 Metformin 500mg tab Tablet 2960 2960 2960 -2960
130 Methyl Ergometrin Maleat 0,125 mg Tab 680 680 680 -680
132 Methyl Rosanilinium (gentian violet) Botol 65 65 65 -65
135 Metronidazol Infus Botol 7 7 7 -7
136 Metronidazol syr Botol 105 105 105 -105
137 Miconazole 2% Salep Kulit Tube 125 125 125 -125
139 Natrium Bikarbonat 500 mg Tablet 400 400 400 -400
141 Nystatin Tab Vag 10.000 iu/g Tablet 200 200 200 -200
142 Omeprazole inj Vial 170 170 170 -170
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
143 Omeprazole kaps Kapsul 2160 2160 2160 -2160
144 Oxytetracycline HCl 1% Salep Mata Tube 75 75 75 -75
146 Oxytocin inj 10 IU Ampul 150 150 150 -150
149 Paracetamol Drops 15 ml Botol 52 52 52 -52
150 Parasetamol 120 mg/5 ml Syr Botol 454 454 454 -454
151 Parasetamol 500 mg Tablet 4210 4210 4210 -4210
152 Patient Lubricant (My Jelly ) Tube 10 10 10 -10
153 Permethrin (Scabimite Cream) Tube 7 7 7 -7
154 Phenobarbital inj 50mg/ml-2ml Ampul 60 60 60 -60
156 Phenol gliserol 10% TT Botol 73 73 73 -73
157 Phytomenadione (Vit.K1) inj 10 mg/ml Ampul 502 502 502 -502
158 Phytomenadione (Vit.K1) 10 mg Tablet 380 380 380 -380
160 Piroxicam 20 mg tab Tablet 2990 2990 2990 -2990
162 Plesterku (Leukoplast) Pcs 67 67 67 -67
163 Polivalen serum (Anti Tetanus Inj. 1500 iu/Bio Ampul 0 0 0 0
164 Povidon iodium 10% 300 ml Botol 11 11 11 -11
166 Primaquin 15 mg tab Tablet 400 400 400 -400
170 Propranolol HCl 40 mg Tablet 2290 2290 2290 -2290
171 Propylthiouracil 100 mg Tablet 250 250 250 -250
172 Protein Gluco Test Strip 40 40 40 -40
173 Pyrantel Pamoat 125 mg Tablet 100 100 100 -100
174 Pyridoxine HCl 10 mg Tablet 2200 2200 2200 -2200
177 Retinol (Vit.A) kaps 100.000 iu Kapsul 900 900 900 -900
179 Risperidone 2mg Tablet 800 800 800 -800
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
187 Sianocobalamin (Vit B12) 50 mg tab Tablet 3030 3030 3030 -3030
188 Silk (Benang Bedah) No. 3/0 Pcs 132 132 132 -132
189 Silver Sulfadiazine Tube 35 35 35 -35
190 Simvastatin 10 mg tab Tablet 2970 2970 2970 -2970
191 Sodium cloride infus 0,9% ( NACL ) Botol 508 508 508 -508
192 Spuit 1 ml Pcs 757 757 757 -757
193 Spuit 3 ml Pcs 0 0 0 0
194 Spuit 5 ml Pcs 117 117 117 -117
195 Sulfadoxine | Pyrimethamine Tablet 500mg Tablet 0 0 0 0
196 Sulfamethoxazole | trimethoprim (cotri) syr Botol 338 338 338 -338
199 Tetracycline 500 mg Tablet 2440 2440 2440 -2440
201 Thiamine HCl (Vit B1) 50 mg Tablet 700 700 700 -700
202 Trihexyphenidyl tab 2 mg Tablet 400 400 400 -400
203 Trimethoprim (cotrimoxazol 480 mg) tablet Tablet 1770 1770 1770 -1770
204 Urin Bag Pcs 0 0 0 0
207 Vitamin B Kompleks Tablet 1130 1130 1130 -1130
209 Water liquid (aqua P,I) Botol 124 124 124 -124
213 Zinc tab Tablet 1890 1890 1890 -1890
214 0 0 0 0
215 0 0 0 0
216 0 0 0 0
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
217 0 0 0 0
218 0 0 0 0
219 0 0 0 0
220 0 0 0 0
221 0 0 0 0
222 0 0 0 0
223 0 0 0 0
224 0 0 0 0
225 0 0 0 0
226 0 0 0 0
227 0 0 0 0
228 0 0 0 0
229 0 0 0 0
230 0 0 0 0
231 0 0 0 0
232 0 0 0 0
233 0 0 0 0
234 0 0 0 0
235 0 0 0 0
236 0 0 0 0
237 0 0 0 0
238 0 0 0 0
239 0 0 0 0
240 0 0 0 0
241 0 0 0 0

0
Kepala Dinas Kesehatan Kab. OKI Kepala Instalasi Farmasi Dinkes OKI Pimpinan Puskesmas Pengelola Obat Puskesma
..................................... ..................................... ..................................... .....................................

TANGGAL
KET
12
: OKTOBER 2018
KET
12
: OKTOBER 2018
KET
12
: OKTOBER 2018
KET
12
: OKTOBER 2018
KET
12
: OKTOBER 2018
KET
12
: OKTOBER 2018
KET
12
Yang Membuat
.....................................
PUSKESMAS : PELAPORAN BULAN : NOPEMBER 2018 DOKUMEN NOMOR

STOK STOK STOK

AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
125 Masker Pcs 2905 2905 2905 -2905
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
192 Spuit 1 ml Pcs 757 757 757 -757
193 Spuit 3 ml Pcs 0 0 0 0
194 Spuit 5 ml Pcs 117 117 117 -117
213 Zinc tab Tablet 1890 1890 1890 -1890
214 0 0 0 0
215 0 0 0 0
216 0 0 0 0
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
217 0 0 0 0
218 0 0 0 0
219 0 0 0 0
220 0 0 0 0
221 0 0 0 0
222 0 0 0 0
223 0 0 0 0
224 0 0 0 0
225 0 0 0 0
226 0 0 0 0
227 0 0 0 0
228 0 0 0 0
229 0 0 0 0
230 0 0 0 0
231 0 0 0 0
232 0 0 0 0
233 0 0 0 0
234 0 0 0 0
235 0 0 0 0
236 0 0 0 0
237 0 0 0 0
238 0 0 0 0
239 0 0 0 0
240 0 0 0 0
241 0 0 0 0

0
..................................... ..................................... ..................................... .....................................

TANGGAL
KET
12
: NOPEMBER 2018
KET
12
: NOPEMBER 2018
KET
12
: NOPEMBER 2018
KET
12
: NOPEMBER 2018
KET
12
: NOPEMBER 2018
KET
12
: NOPEMBER 2018
KET
12
Yang Membuat
.....................................
PUSKESMAS : PELAPORAN BULAN : SEPTEMBER 2018 DOKUMEN NOMOR

STOK STOK STOK

AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
125 Masker Pcs 2905 2905 2905 -2905
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
192 Spuit 1 ml Pcs 757 757 757 -757
193 Spuit 3 ml Pcs 0 0 0 0
194 Spuit 5 ml Pcs 117 117 117 -117
213 Zinc tab Tablet 1890 1890 1890 -1890
214 0 0 0 0
215 0 0 0 0
216 0 0 0 0
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10 11
217 0 0 0 0
218 0 0 0 0
219 0 0 0 0
220 0 0 0 0
221 0 0 0 0
222 0 0 0 0
223 0 0 0 0
224 0 0 0 0
225 0 0 0 0
226 0 0 0 0
227 0 0 0 0
228 0 0 0 0
229 0 0 0 0
230 0 0 0 0
231 0 0 0 0
232 0 0 0 0
233 0 0 0 0
234 0 0 0 0
235 0 0 0 0
236 0 0 0 0
237 0 0 0 0
238 0 0 0 0
239 0 0 0 0
240 0 0 0 0
241 0 0 0 0

0
..................................... ..................................... ..................................... .....................................

TANGGAL
KET
12
: SEPTEMBER 2018
KET
12
: SEPTEMBER 2018
KET
12
: SEPTEMBER 2018
KET
12
: SEPTEMBER 2018
KET
12
: SEPTEMBER 2018
KET
12
: SEPTEMBER 2018
KET
12
Yang Membuat
.....................................
PUSKESMAS : PELAPORAN BULAN : DESEMBER 2018 DOKUMEN

STOK STOK STOK

AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10
21 Ascorbic acid |calsium carbonate 500 mg (Pehavral Tablet 0 0 0 0
27 Bahan Tambal Gigi Sementara (Fletcher/Caviton) Pcs 6 6 6 -6
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10
97 Immunoglobulin human anti-tetanus (Tetagam) Ampul 6 6 6 -6
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10
125 Masker Pcs 2905 2905 2905 -2905
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10
163 Polivalen serum (Anti Tetanus Inj. 1500 iu/Biosat) Ampul 0 0 0 0
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10
192 Spuit 1 ml Pcs 757 757 757 -757
193 Spuit 3 ml Pcs 0 0 0 0
194 Spuit 5 ml Pcs 117 117 117 -117
195 Sulfadoxine | Pyrimethamine Tablet 500mg|25mg Tablet 0 0 0 0
213 Zinc tab Tablet 1890 1890 1890 -1890
214 0 0 0 0
215 0 0 0 0
216 0 0 0 0
STOK STOK STOK
AWAL AKHIR OPTIMUM
1 2 3 4 5 6 7 8 9 10
217 0 0 0 0
218 0 0 0 0
219 0 0 0 0
220 0 0 0 0
221 0 0 0 0
222 0 0 0 0
223 0 0 0 0
224 0 0 0 0
225 0 0 0 0
226 0 0 0 0
227 0 0 0 0
228 0 0 0 0
229 0 0 0 0
230 0 0 0 0
231 0 0 0 0
232 0 0 0 0
233 0 0 0 0
234 0 0 0 0
235 0 0 0 0
236 0 0 0 0
237 0 0 0 0
238 0 0 0 0
239 0 0 0 0
240 0 0 0 0
241 0 0 0 0

0
Mengetahui Mengetahui Mengetahui/ Menyetujui
Kepala Dinas Kesehatan Kab. OKI Kepala Instalasi Farmasi Dinkes OKI Pimpinan Puskesmas
..................................... ..................................... .....................................

NOMOR TANGGAL
PEMBERIAAN KET
11 12
AN BULAN : DESEMBER 2018
PEMBERIAAN KET
11 12
PEMBERIAAN KET
11 12
PEMBERIAAN KET
11 12
PEMBERIAAN KET
11 12
PEMBERIAAN KET
11 12
PEMBERIAAN KET
11 12
Yang Membuat
.....................................
PUSKESMAS : TUGU JAYA PELAPORAN BULAN : Januari 2019

KECAMATAN : LEMPUING PERMINTAAN BULAN : Februari 2019
PROPINSI : SUMETERA SELATAN
NO. NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN PEMAKAIAN

AWAL
1 2 3 4 5 6 7
1 Acetylcystein Kapsul 200mg Kapsul 419 0 419 83
2 Acyclovir 200 mg tab Tablet 370 0 370 80
4 Air Raksa Dental Btl 0 0 0 0
5 Alat Suntik Sekali Pakai 1 ml Pcs 584 0 584 584
8 Albendazol 400 mg tab Tablet 318 0 318 60
9 Alcohol Swab Pcs 84 0 84 52
10 Allopurinol 100 mg Tablet 90 0 90 60
11 Aminofillin 200 mg Tablet 500 0 500 300
12 Aminofillin Inj 24 mg/ml-10 ml Ampul 100 0 100 0
13 Amitriptylin 25 mg tb Tablet 300 0 300 0
14 Amlodipin tab 5 mg Tablet 825 0 825 720
15 Amoksisilin 250 mg Kapsul 440 0 440 140
16 Amoksisilin 500 mg Tablet 4179 0 4179 1018
17 Amoksisilin Syr Btl 0 0 0 0
18 Ampisilin 1 gr Inj Vial 0 0 0 0
19 Ampisilin 500 mg Tablet 0 0 0 0
20 Antalgin 1000mg/2ml Ampul 63 0 63 0
21 Antalgin 500 mg Tablet 0 0 0 0
22 Antalgin inj. Ampul 0 0 0 0
23 Antasida DOEN Kombinasi Tablet 1242 0 1242 1242
24 Antasida Syr DOEN Btl 216 0 216 20
25 Anti Haemoroid Suppos Suppo 20 0 20 0
26 Antifungi DOEN Kombinasi Salep Pot 48 0 48 0
27 Antithrom/ Heparin Na. Krim/ Hico Tube 0 0 0 0
28 Aqua Pro Inj. Steril 20 ml Ampul 115 0 115 39
29 Asam Asetilsalisilat 100 mg tab Tablet 199 0 199 199
30 Asam Askorbat (Vit.C) 50 mg Tablet 5490 0 5490 1001
HALAMAN : 2 LPLPO No :
AWAL
1 2 3 4 5 6 7
32 Aseptan 500 cc+ Pump Btl 13 0 13 7
33 Atagip tab Tablet 0 0 0 0
34 Atropine inj 0,25 mg/ml Ampul 16 0 16 0
35 Betahistin Mesylate 6 mg tab Tablet 705 0 705 625
36 Betametason 0,1% krim Tube 12 0 12 12
37 Bisakodil 5mg Tablet 555 0 555 15
38 Calortusin tab Tablet 0 0 0 0
39 Captopril 12,5 mg Tablet 1250 0 1250 600
41 Catgut/Benang Chromic Bedah No.2/ Pcs 26 0 26 26
42 Catgut/Benang Plain Bedah No.2/0-3 Pcs 74 0 74 35
44 Cetirizine 5 mg/5 ml sirup Btl 45 0 45 10
47 Ciprofloxacin Infus Btl 0 0 0 0
48 Clindamyacin 300mg Kapsul 600 0 600 0
49 Coparcetin tab Tablet 0 0 0 0
50 Deksametason 0,5 mg Tablet 2700 0 2700 1396
51 Deksametason inj 5mg/ml-1ml Ampul 187 0 187 67
52 Dermafix S IV Pcs 0 0 0 0
53 Devitalisasi pasta Pot 0 0 0 0
54 Diazepam 2 mg Tablet 1400 0 1400 100
55 Diazepam inj 5mg/ml-2 ml Ampul 1 0 1 1
56 Difenhidramin HCl inj 10mg/ml Ampul 60 0 60 0
57 Digoksin 0,25 mg Tablet 100 0 100 0
58 Dimenhydrinat 50mg Tablet 420 0 420 100
59 Domperidone 10 mg Tablet 1089 0 1089 675
60 Doxycycline 100 mg Kapsul Kapsul 500 0 500 0
61 Epinefrin HCl/bitartrat inj 0,1% Ampul 0 0 0 0
62 Erlamycetin Tetes Telinga btl 0 0 0 0
63 Eryra Forte tab Tablet 0 0 0 0
66 Etakridina (Rivanol) 0,1% Btl 7 0 7 0
67 Etanol 70%-100 ml Btl 0 0 0 0
68 Etanol 70%-1000 ml Btl 19 0 19 5
AWAL
1 2 3 4 5 6 7
69 Etil klorida semprot Btl 0 0 0 0
70 Eugenol cairan Btl 5 0 5 0
71 Fenobarbital 100 mg Tablet 0 0 0 0
72 Fenobarbital 30 mg Tablet 0 0 0 0
73 Fenobarbital inj 50mg/ml-2ml Ampul 30 0 30 0
74 Fenol gliserol 10% TT Btl 24 0 24 9
75 Fitomenadion (Vit.K1) 10 mg Tablet 180 0 180 180
76 Fitomenadion (Vit.K1) inj 10 mg/ml Ampul 120 0 120 11
77 Folley Catheter No.16 Pcs 19 0 19 8
78 Furosemida 40 mg Tablet 420 0 420 0
79 Furosemida Injeksi Ampul 0 0 0 0
80 Garam Oralit Sachet 441 0 441 8
81 Gentamicin 0,1% SK Tube 15 0 15 6
82 Gentamicin 0,3% TM Btl 0 0 0 0
83 Gentamicin Inj 40 mg/ml Ampul 29 0 29 0
84 Gentian Violet 1% larutan Btl 15 0 15 4
85 Glass lonomerlement set 0 0 0 0
86 Glibenklamid 5 mg Tablet 1120 0 1120 240
87 Glimepiride 1 mg Tablet 536 0 536 53
88 Gliseril Guaikolat 100 mg Tablet 5780 0 5780 1015
89 Gluco Protein Pcs 50 0 50 0
90 Glukosa larutan infus 10% Btl 70 0 70 1
91 Glukosa larutan infus 5% Btl 181 0 181 31
92 Griseofulvin 125 mg Tablet 260 0 260 0
93 Guaifenesin 100 Tab Tablet 0 0 0 0
95 Haloperidol 5 mg tab Tablet 970 0 970 0
96 HandScuun No.7,5 Pcs 0 0 0 0
97 HandScuun Steril No.7 Pcs 35 0 35 35
98 HandScuun Steril No.7,5 Pcs 0 0 0 0
99 Hemafort Tablet 0 0 0 0
100 Hexymer tab Tablet 0 0 0 0
101 Hidroklorotiazida (HCT) 25 mg Tablet 490 0 490 15
102 Hidrokortison krim 2,5% Tube 63 0 63 33
105 Ibuprofen susp btl 138 0 138 29
AWAL
1 2 3 4 5 6 7
106 Ichtiol salep Pot 0 0 0 0
107 Infusion set anak ppc 104 0 104 0
108 Infusion set dewasa Pcs 387 0 387 120
109 Isosorbid tablet Tablet 150 0 150 0
113 Jarum Jahit Kulit Sutra Pcs 0 0 0 0
114 Kalium Permanganat Serbuk Pcs 0 0 0 0
115 Kalsium Laktat (Kalk) 500 mg Tablet 3090 0 3090 820
116 Kapas pembalut/Absorben 250 g Pcs 28 0 28 9
117 Karbamazepin Tablet 629 0 629 0
118 Kasa kompres 40/40 steril Pcs 45 0 45 17
119 Kasa pembalut 2x80 Pcs 20 0 20 17
122 Ketokonazol 200 mg Cream Tube 22 0 22 22
123 Ketokonazol 200 mg tab Tablet 580 0 580 202
124 Kloramfenicol 250 mg tab Tablet 242 0 242 0
125 Kloramfenicol 3% TT Tube 0 0 0 0
126 Kloramfenicol Suspensi 125 mg/ml Btl 48 0 48 11
127 Kloramfenikol 1% Salep Mata Tube 50 0 50 0
128 Klorfeniramin Maleat (CTM) 4 mg Tablet 2508 0 2508 1371
130 Klorpromazin HCl 100 mg Tablet 1005 0 1005 0
131 Komb. Pirimet 2 mg + Sulfadox 500 Tablet 0 0 0 0
132 Kotrimoksazol Kombinasi 120 mg Tablet 0 0 0 0
133 Kotrimoksazol Kombinasi 480 mg Tablet 1000 0 1000 254
134 Kotrimoksazol Suspensi Btl 68 0 68 64
135 Leukoplast Pcs 32 0 32 17
136 Levertran Salep/ Salep Luka Bakar Pot 2 0 2 0
137 Lidocain 2% Ampul 7 0 7 0
138 Lidokain Comp. inj Kombinasi Ampul 180 0 180 70
141 Loratadine 10 mg tab Tablet 2310 0 2310 380
142 Lysol 1 Liter Btl 9 0 9 2
AWAL
1 2 3 4 5 6 7
143 Magnesium Sulfat Injeksi 20% (MgSO Ampul 15 0 15 0
144 Magnesium Sulfat Injeksi 40% (MgSO Ampul 1 0 1 1
145 Masker Pcs 1315 0 1315 702
146 Mess No.14/21 Pcs 92 0 92 20
147 Metformin 500mg tab Tablet 708 0 708 239
148 Metil Ergometrin Maleat 0,125 mg Tablet 100 0 100 0
149 Metil Ergometrin Maleat inj 0,2 mg/ Ampul 0 0 0 0
150 Metil Prednisolon Tablet 2744 0 2744 719
151 Metronidazol 250 mg Tablet 570 0 570 240
152 Metronidazol 500 mg Tablet 0 0 0 0
153 Metronidazol Infus Btl 0 0 0 0
154 Metronidazol syr Btl 0 0 0 0
155 Miconazole 2% Salep Kulit Tube 64 0 64 14
156 Momilen Baby Gold Sirup Btl 0 0 0 0
157 My Jelly 82 gram Tube 8 0 8 0
158 Natrium Bikarbonat 500 mg Tablet 530 0 530 0
159 Natrium Diclofenac 25 mg tab Tablet 2536 0 2536 737
160 Natrium Klorida larutan infus 0,9% Btl 218 0 218 180
161 New Antides Tablet Tablet 700 0 700 0
162 Nifedipin 10 mg tab Tablet 349 0 349 66
163 Nistatin Tab Vag 100.000 iu/g Tablet 130 0 130 0
164 Novachlor kapsul Kapsul 0 0 0 0
165 Nutrifar tab Tablet 0 0 0 0
166 Obat Batuk Hitam Btl 241 0 241 100
167 OBH FM Btl 0 0 0 0
168 Oksitetrasiklin HCl 1% Salep Mata Tube 26 0 26 15
169 Oksitetrasiklin HCl 3% Salep Kulit Tube 0 0 0 0
170 Omeprazole inj Ampul 101 0 101 48
171 Omeprazole kaps Kapsul 1120 0 1120 430
172 Oxytocin inj 10 IU Ampul 117 0 117 117
174 Papaverin inj Ampul 0 0 0 0
175 Paracetamol Drops 15 ml Btl 102 0 102 5
177 Parasetamol 120 mg/5 ml Syr Btl 73 0 73 73
179 Pehavral Tablet 0 0 0 0
AWAL
1 2 3 4 5 6 7
181 Pirantel Pamoat 125 mg Tablet 100 0 100 0
182 Piridoksina HCl 10 mg Tablet 424 0 424 114
183 Piroksikam 20 mg tab Tablet 4425 0 4425 765
184 Pitogin inj 10 iu/ml Ampul 0 0 0 0
185 Plester 5 yard x 2 inch Pcs 0 0 0 0
187 Primaquin 15 mg tab Tablet 100 0 100 0
190 Propil Tio Urasil 100 mg Tablet 800 0 800 55
193 Pularex Tablet Tablet 378 0 378 11
196 Retinol(Vit.A) kaps 100.000 iu Kapsul 0 0 0 0
197 Retinol(Vit.A) kaps 200.000 iu Kapsul 0 0 0 0
198 Ringer Laktat larutan Infus steril Btl 508 0 508 481
199 Risperidone 2mg Tablet 0 0 0 0
201 Salep 2-4 Kombinasi Pot 18 0 18 6
202 Salisil Bedak 2% Pot 21 0 21 5
203 ScabimIte Cream Tube 46 0 46 10
204 Scopma tab Tablet 0 0 0 0
206 Serum Anti Bisa Ular 5 ml (ABU I)/ Bi Ampul 0 0 0 0
207 Serum Anti Tetanus Inj. 1500 iu Ampul 0 0 0 0
208 Sianocobalamin (Vit B12) 50 mg tab Tablet 920 0 920 383
209 Sianocobalamin (Vit B12) inj 500 mc Ampul 35 0 35 10
210 Silk (Benang Bedah) No. 3/0 Pcs 77 0 77 3
211 Silver Amalgam Serbuk Btl 0 0 0 0
212 Simvastatin 10 mg tab Tablet 420 0 420 140
213 Strip asam urat Pcs 0 0 0 0
214 Strip gula darah Pcs 0 0 0 0
215 Strip Kolestrol Pcs 0 0 0 0
216 Sulfadiazine Silver Tube 20 0 20 1
AWAL
1 2 3 4 5 6 7
217 Sulfasetamida 15% TM Btl 0 0 0 0
218 Superhoid Supp Suppo 0 0 0 0
219 Tablet tambah darah Tablet 11720 0 11720 1370
220 Temporary stopping Fletcher Btl 4 0 4 0
221 Tes Golongan Darah Anti A Pcs 0 0 0 0
222 Tes Golongan Darah Anti AB Pcs 0 0 0 0
223 Tes Golongan Darah Anti B Pcs 0 0 0 0
224 Tes Golongan Darah Anti D Pcs 0 0 0 0
225 Tes Kehamilan Pcs 145 0 145 0
226 Tetagam Ampul 0 0 0 0
227 Tetrasiklin 250 mg Kapsul 0 0 0 0
228 Tetrasiklin 500 mg Kapsul 920 0 920 40
229 Tiacinon inj Ampul 0 0 0 0
230 Tiamfenikol 500 mg Kapsul 0 0 0 0
231 Tiamin HCl (Vit B1) 50 mg Kapsul 170 0 170 20
232 Tiamin HCl (Vit B1) inj 100 mg/ml Ampul 0 0 0 0
233 Trihexyphenidyl tab 2 mg Tablet 500 0 500 10
234 Truvit Sirup Btl 0 0 0 0
235 Urin Bag Pcs 26 0 26 9
236 Usg Gel Btl 0 0 0 0
237 Vaksin Rabies Vero/ Verorab Ampul 0 0 0 0
238 Vigel 30 gram Tube 0 0 0 0
239 Vit K Infant Inj Ampul 0 0 0 0
240 Vitamin B Kompleks Tablet 8220 0 8220 2050
243 Xylocaine 10 Spray Btl 9 0 9 4
244 Yodium Povidon 10% 30 ml Btl 37 0 37 0
245 Yodium Povidon 10% 300 ml Btl 22 0 22 3
246 Zinc tab Tablet 260 0 260 194
247 Leukomed-IV Pcs 48 0 48 0
248 Miniaspi Tablet 0 0 0 0
249 Asam Folat 1mg Tablet 1200 0 1200 70
250 Handschoon steril No. 6,5 Pcs 0 0 0 0
JUMLAH KUNJUNGAN RESEP UMUM JAMSOSKEBPJS JUMLAH
Mengetahui Mengetahui Mengetahui/ Menyetujui

Kepala Dinas Kesehatan Kab. OKI
Kepala Instalasi Farmasi Dinkes OKI Pimpinan Puskesmas
H. M. Lubis, S.KM., M.Kes Himayanti, S.Si., Apt. Pamuji, S.KM.,M.Si.

NIP. 19660603 198703 1 003 NIP. 19770221 200501 2 005 Nip.19751122 199503 1 00
JUDUL 14,5
BAWAH JUDUL 13
anuari 2019 DOKUMEN NOMOR TANGGAL BARIS 7 DAN 8 : 6,5
ebruari 2019 DINKES KAB/KOTA JUDUL : 18 18
GFK KAB/KOTA TABEL : 13
PUSKESMAS JUDUL 2 17,5 17,5
STOK STOK OPTIMUM PERMINTAAN PEMBERIAAN KET waktu tun variabel w

AKHIR
8 9 10 11 12
336 1001 1000 5 50
290 515 1000 5 26
2 51 48 5 3
0 0 2 5 0
0 1320 500 5 66
237 2703 3000 5 136
133 664 600 5 33
258 283 0 5 14
32 598 600 5 30
30 412 1000 5 21
200 383 300 5 19
100 1 0 5 0
300 0 0 5 0
105 2752 3000 5 138
300 1175 1000 5 59
3161 6434 4000 5 323
0 300 300 5 0
0 10 10 5 0
0 500 500 5 0
63 0 0 5 0
0 5000 5000 5 0
0 0 0 5 0
0 5000 5000 5 224
196 300 100 5 10
20 0 0 5 0
48 0 0 5 0
0 0 0 5 0
76 82 30 5 4
0 345 300 5 17
4489 3206 2000 5 161
0 5000 5000 5 146
1 LAPORAN BULAN : Januari 2019
AKHIR
8 9 10 11 12
6 18 12 5 1
0 300 300 5 0
16 4 0 5 0
80 1136 1000 5 57
0 134 134 5 7
540 19 0 5 1
0 0 500 5 0
650 2030 2000 5 102
810 3346 3500 5 168
0 200 400 5 4
39 200 200 5 4
19 1946 2500 5 98
35 36 50 5 2
0 0 2000 5 0
31 3109 4000 5 156
0 0 0 5 0
600 0 0 5 0
0 0 500 5 0
1304 7298 7000 5 366
120 148 100 5 7
0 10 10 5 0
0 1 1 5 0
1300 255 0 5 13
0 100 100 5 1
60 38 100 5 2
100 200 200 5 0
320 358 300 5 18
414 3081 3000 5 155
500 0 0 5 0
0 13 24 5 1
0 0 48 5 0
0 2000 2000 5 0
175 1539 2000 5 77
1 206 300 5 10
7 1 5 5 0
0 100 100 5 0
14 17 10 5 1
AKHIR
8 9 10 11 12
0 10 10 5 0
5 10 0 5 0
0 100 100 5 0
0 100 100 5 0
30 60 60 5 0
15 47 48 5 2
0 638 1000 5 32
109 91 100 5 5
11 24 30 5 1
420 741 500 5 37
0 0 0 5 0
433 254 200 5 13
9 139 150 5 7
0 0 24 5 0
29 1 24 5 0
11 17 48 5 1
0 1 1 5 0
880 664 1000 5 33
483 819 1000 5 41
4765 2854 2000 5 143
50 51 0 5 3
69 26 100 5 1
150 98 500 5 5
260 179 200 5 9
0 0 2000 5 0
0 0 200 5 0
970 0 200 5 0
0 2608 3000 5 96
0 300 300 5 6
0 300 300 5 0
0 0 1000 5 0
0 0 200 5 0
475 716 500 5 36
30 64 50 5 3
0 1903 3000 5 96
0 0 2000 5 0
109 38 100 5 2
AKHIR
8 9 10 11 12
0 0 24 5 0
104 300 300 5 0
267 600 600 5 16
150 358 500 5 13
123 158 200 5 8
271 478 400 5 24
182 207 200 5 10
0 0 0 5 0
0 0 48 5 0
2270 4048 3000 5 203
19 41 25 5 2
629 38 200 5 2
28 43 100 5 2
3 96 100 5 5
304 186 100 5 9
20 56 100 5 3
0 119 150 5 6
378 1101 2000 5 55
242 419 500 5 21
0 48 48 5 0
37 14 200 5 1
50 23 48 5 1
1137 7619 10000 5 383
0 0 200 5 0
1005 0 0 5 0
0 0 0 5 0
0 0 0 5 0
746 707 1000 5 36
4 176 300 5 9
15 46 50 5 2
2 0 0 5 0
7 0 10 5 0
110 189 150 5 9
0 0 12 5 0
253 771 1000 5 39
1930 1175 1000 5 59
7 6 10 5 0
AKHIR
8 9 10 11 12
15 0 15 5 0
0 13 15 5 1
613 2416 3000 5 121
72 26 200 5 1
469 2369 2500 5 119
100 0 500 5 0
0 0 0 5 0
2025 2522 1000 5 127
330 651 1500 5 33
0 255 1500 5 13
0 10 10 5 0
0 100 100 5 0
50 37 12 5 2
0 0 200 5 0
8 1 0 5 0
530 200 200 5 0
1799 1419 1000 5 71
38 558 1000 5 28
700 0 300 5 0
283 613 500 5 31
130 89 100 5 4
0 0 500 5 0
0 0 500 5 0
141 260 200 5 13
0 0 200 5 0
11 65 72 5 3
0 0 48 5 0
53 100 100 5 5
690 784 900 5 39
0 220 200 5 11
0 0 500 5 0
0 0 12 5 0
97 11 50 5 1
0 0 200 5 0
0 553 600 5 24
2110 15861 15000 5 796
0 0 500 5 0
AKHIR
8 9 10 11 12
0 24 200 5 1
100 0 0 5 0
310 401 500 5 20
3660 2988 1000 5 150
0 0 200 5 0
0 50 50 5 0
0 1000 1000 5 0
100 200 100 5 0
0 0 0 5 0
0 12 12 5 0
745 389 500 5 20
0 166 500 5 8
268 169 500 5 8
367 14 300 5 1
720 6040 6000 5 303
0 0 200 5 0
0 0 0 5 0
0 0 0 5 0
27 1458 2500 5 68
0 0 500 5 0
0 511 1500 5 26
12 40 24 5 2
16 41 100 5 2
36 33 24 5 2
0 500 500 5 0
0 0 5 5 0
0 3 3 5 0
0 10 10 5 0
537 2462 3000 5 124
25 134 200 5 7
74 17 24 5 1
0 0 2 5 0
280 1053 1200 5 53
0 0 200 5 0
0 0 200 5 0
0 0 200 5 0
19 8 0 5 0
AKHIR
8 9 10 11 12
0 0 48 5 0
0 0 20 5 0
10350 7202 0 5 362
4 0 5 5 0
0 1 1 5 0
0 1 1 5 0
0 1 1 5 0
0 1 1 5 0
145 0 100 5 0
0 10 10 5 1
0 500 500 5 0
880 500 500 5 8
0 200 200 5 0
0 1000 1000 5 0
150 255 200 5 13
0 0 0 5 0
490 200 0 5 1
0 100 100 5 0
17 20 20 5 1
0 3 3 5 0
0 1 1 5 0
0 0 0 5 0
0 0 0 5 0
6170 8139 5000 5 409
0 0 0 5 0
0 0 0
5 10 5
37 0 0
19 8 5
66 419 1000
48 2 50
0 200 300
1130 168 500
0 300 300
engetahui/ Menyetujui Yang Membuat

mpinan Puskesmas Pengelola Obat Puskesmas
muji, S.KM.,M.Si. Kartini Wiati,SKM

p.19751122 199503 1 002 NIP. 19750806 200501 2 009
Hari KosonVariabel Waktu Kosong
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
10 448.2051
0 0
0 0
0 0
15 0
0 0
0 0
0 0
60 1750.769

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
5 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
30 576.9231
30 33.46154
30 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
30 79.23077
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
15 70.57692
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
7 94.5
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
STOK OPNAME GUDANG OBAT DAN UGD
RUMAH SAKIT PRATAMA TUGU JAYA
KECAMATAN : LEMPUING
SO TOTAL SO
NO. NAMA OBAT SATUAN SO UGD
GUDANG FEBRUARI GUDANG
1 2 3 4 5 6 7
1 Absorbent tipped applicator (alcohol swab) Pcs
2 Acetylcystein Kapsul 200mg Kapsul
3 Acyclovir tab 200 mg Tablet
4 Acyclovir cream Tube
5 Albendazol tab 400 mg Tablet
6 Alkohol Liquid (etanol) 70%-1000 ml Btl
7 Allopurinol 100 mg Tablet
8 Aminophylline Inj 24 mg/ml-10 ml Ampul
9 Aminophylline tab 200 mg Tablet
10 Amitriptyline 25 mg tab Tablet
11 Amlodipine tab 5 mg Tablet
12 Amoxycillin Syr Btl
13 Amoxycillin 250 mg Kapsul
14 Amoxycillin 500 mg Kaptab
15 Ampicilin 1 gr Inj Vial
16 Antasida Syr DOEN Btl
17 Antasida DOEN Kombinasi Tablet
18 Anti Bisa Ular 5 ml (ABU I)/ Biosave Vial
19 Asam Mefenamat 500 mg tab Tablet
20 Ascorbic acid (Vit.C) 50 mg Tablet
21 Ascorbic acid |calsium carbonate 500 mg (Pehavral) Tablet
22 Aspirin (miniaspi) 100 mg tab Tablet
23 Atropine inj 0,25 mg/ml Ampul
24 Attapulgite Tablet (Pularex) Tablet
25 Attapulgite Tablet 600 mg (New Antides) Tablet
26 Automated blood grouping (Tes Gol. Darah) Paket
27 Bahan Tambal Gigi Sementara (Fletcher/Caviton) Pcs
28 Bedak Salisil 2% Btl
29 Benzoic acid |salicylic acid salep (anti fungi) pot
30 Betahistine Mesylate 6 mg tab Tablet
31 Betamethasone 0,1% krim Tube
HALAMAN : 2
NAMA OBAT SO TOTAL SO
NO. SATUAN SO UGD
1 2 3 4 5 6 7
32 Bisacodyl 5mg Tablet
33 Bismuth subgallas (antihemoroid) Supp
34 Calcium chloride lactate infus (RL) Botol
35 Calsium Laktat (Kalk) 500 mg Tablet
36 Captopril 12,5 mg Tablet
37 Captopril 25 mg Tablet
38 Carbamazepin tab Tablet
39 Catgut/Benang Chromic Bedah No.2/0-3/0 Pcs
40 Catgut/Benang Plain Bedah No.2/0-3/0 Pcs
41 Cefadroxil 500mg Tablet
42 Cetirizine 5 mg/5 ml sirup Botol
43 Chloramhenicol Salep Mata 1% Tube
44 Chloramphenicol Suspensi 125 mg/ml Btl
45 Chloramphenicol 250 mg caps Tablet
46 Chloramphenicol TT 3% Botol
47 Chloramphenicol/ Hidrokortison krim 2,5% Tube
48 Chlorpheniramine Maleat (CTM) 4 mg Tablet
49 Chlorpromazine HCl 100 mg Tablet
50 Cimetidin 200 tab Tablet
51 Ciprofloxacin 500 mg tab Tablet
52 Ciprofloxacin Infus Botol
53 Clindamycin 300mg Kapsul
54 Cresol liquid 1 Liter (lysol) Botol
55 Cyanocobalamin (Vit B12) inj 500 mcg/ml Ampul
56 Devitalisasi pasta pot
57 Dexamethasone 0,5 mg Tablet
58 Dexamethasone inj 5mg/ml-1ml Ampul
59 Diazepam 5mg/ml-2 ml inj Ampul
60 Diazepam 2 mg Tablet
61 Diclofenac sodium 25 mg tab Tablet
62 Digoxin 0,25 mg Tablet
63 Dimenhydrinate 50mg Tablet
64 Dipenhidramine HCl inj 10mg/ml Ampul
65 Domperidone 10 mg Tablet
66 Doxycycline 100 mg Kapsul Kapsul
67 Epinephrine HCl/bitartrat inj 0,1% Ampul
68 Erythromicin Syr Btl

NO. SATUAN SO UGD
1 2 3 4 5 6 7
69 Erythromicin 500 mg capsul Kapsul
70 Ethacridine (Rivanol) 0,1% Btl
71 Ethanol ( Aseptan ) 500 cc+ Pump Botol
72 Eugenol cairan Btl
73 Ferrous fumarate ( Tab. Tambah Darah ) Tablet
74 Folic acid 1mg ( asam folat) Tablet
75 Folley Catheter No.16 Pcs
76 Furosemida Injeksi Ampul
77 Furosemida 40 mg Tablet
78 Garam Oralit Sachet
79 Gentamicyn 0,3% TM Botol
80 Gentamicyn Inj 40 mg/ml Ampul
81 Gentamicyn 0,1% SK Tube
82 Glass lonomer Paket
83 Glibenclamide 5 mg Tablet
84 Glimepiride 1 mg Tablet
85 Glukosa larutan infus 10% Botol
86 Glukosa larutan infus 5% Botol
87 Griseofulvin 125 mg Tablet
88 Guaifenesin 100 Tab (GG tab) Tablet
89 Haloperidol 0,5 mg tab Tablet
90 Haloperidol 5 mg tab Tablet
91 Human chorionic (HCG/Tes kehamilan ) Strip
92 Hydrochlorotiazide (HCT) 25 mg Tablet
93 Ibuprofen sirup Botol
94 Ibuprofen 200 mg Tablet
95 Ibuprofen 400 mg Tablet
96 Ichthyol salep 10% pot
97 Immunoglobulin human anti-tetanus (Tetagam) Ampul
98 Infus set dewasa Pcs
99 Infusi set anak Pcs
100 Iodium Povidon 10% 30 ml Botol
101 Isosorbide tablet Tablet
102 IV Catheter No.20 Pcs
105 Jarum Jahit Kulit Pcs

NO. SATUAN SO UGD
1 2 3 4 5 6 7
106 Kalium Permanganat Serbuk pot
107 Kapas pembalut/Absorben 250 g Pcs
108 Kasa pembalut 2x80 Pcs
109 Kasa pembalut hidrofil 4 m x 15 cm Pcs
110 Kasa pembalut hidrofil 4 m x 3 cm Pcs
111 Kasa kompres 40/40 steril Pcs
112 Ketoconazole 200 mg Cream Tube
113 Ketoconazole 200 mg tab Tablet
114 Klorokina Fosfat 250 mg Tablet
115 Levertran Salep/ Salep Luka Bakar pot
116 Lidocain 2% Ampul
117 Lidokain Comp. inj Kombinasi Ampul
118 Lidocaine spray (Xylocaine spray) Botol
119 Liquorice liquid extract (OBH) Botol
120 Locoriz Cream Tube
121 Loperamid 2 m tab Tablet
122 Loratadine 10 mg tab Tablet
123 Magnesium Sulfat Injeksi 20% (MgSO4) Ampul
124 Magnesium Sulfat Injeksi 40% (MgSO4) Ampul
125 Masker Pcs
126 Medical adhesive tape (dermafix/leukomed) Pcs
127 Metamizole injeksi (antalgin 1000) Ampul
128 Metformin 500mg tab Tablet
129 Methyl Ergometrin Maleat inj 0,2 mg/ml Ampul
130 Methyl Ergometrin Maleat 0,125 mg Tab
131 Methyl Prednisolon tab 4 mg Tablet
132 Methyl Rosanilinium (gentian violet) Botol
133 Metronidazol 250 mg tab Tablet
134 Metronidazol 500 mg tab Tablet
135 Metronidazol Infus Botol
136 Metronidazol syr Botol
137 Miconazole 2% Salep Kulit Tube
138 Momilen Baby Gold Sirup Botol
139 Natrium Bikarbonat 500 mg Tablet
140 Nifedipin 10 mg tab Kapsul
141 Nystatin Tab Vag 10.000 iu/g Tablet
142 Omeprazole inj Vial

NO. SATUAN SO UGD
1 2 3 4 5 6 7
143 Omeprazole kaps Kapsul
144 Oxytetracycline HCl 1% Salep Mata Tube
145 Oxytetracycline HCl 3% Salep Kulit Tube
146 Oxytocin inj 10 IU Ampul
147 Papaverin 40 mg tab Tablet
148 Papaverin inj Tablet
149 Paracetamol Drops 15 ml Botol
150 Parasetamol 120 mg/5 ml Syr Botol
151 Parasetamol 500 mg Tablet
152 Patient Lubricant (My Jelly ) Tube
153 Permethrin (Scabimite Cream) Tube
154 Phenobarbital inj 50mg/ml-2ml Ampul
155 Phenobarbital 100 mg Tablet
156 Phenol gliserol 10% TT Botol
157 Phytomenadione (Vit.K1) inj 10 mg/ml Ampul
158 Phytomenadione (Vit.K1) 10 mg Tablet
159 Piracetam 400 mg Tablet
160 Piroxicam 20 mg tab Tablet
161 Pisau Disposable (Mess No.14/21) Pcs
162 Plesterku (Leukoplast) Pcs
163 Polivalen serum (Anti Tetanus Inj. 1500 iu/Biosat) Ampul
164 Povidon iodium 10% 300 ml Botol
165 Prednison 5 mg Tablet
166 Primaquin 15 mg tab Tablet
167 Profolat tab Tablet
168 Prokaina Penisilin G inj 3.000.000 iu Ampul
169 Propranolol HCl 10 mg Tablet
170 Propranolol HCl 40 mg Tablet
171 Propylthiouracil 100 mg Tablet
172 Protein Gluco Test Strip
173 Pyrantel Pamoat 125 mg Tablet
174 Pyridoxine HCl 10 mg Tablet
175 Ranitidin 150 mg Tablet
176 Ranitidin Injeksi Ampul
177 Retinol (Vit.A) kaps 100.000 iu Kapsul
179 Risperidone 2mg Tablet

NO. SATUAN SO UGD
180 Salbutamol 2 mg Tablet
181 Salep 2-4 Kombinasi pot
182 Sarung tangan (HandScuun) No.7,5 Pcs
183 Sarung tangan (HandScuun Steril) No. 6,5 Pcs
184 Sarung tangan (HandScuun Steril) No.7 Pcs
185 Sarung tangan (HandScuun Steril) No.7,5 Pcs
186 Semen Seng Fosfat Serbuk & Cairan Set
187 Sianocobalamin (Vit B12) 50 mg tab Tablet
188 Silk (Benang Bedah) No. 3/0 Pcs
189 Silver Sulfadiazine Tube
190 Simvastatin 10 mg tab Tablet
191 Sodium cloride infus 0,9% ( NACL ) Botol
192 Spuit 1 ml Pcs
193 Spuit 3 ml Pcs
194 Spuit 5 ml Pcs
195 Sulfadoxine | Pyrimethamine Tablet 500mg|25mg Tablet
196 Sulfamethoxazole | trimethoprim (cotri) syr Botol
197 Sulfasetamida 15% TM Botol
198 Tetracycline 250 mg Tablet
199 Tetracycline 500 mg Tablet
200 Thiamine HCl (Vit B1) inj 100 mg/ml Ampul
201 Thiamine HCl (Vit B1) 50 mg Tablet
202 Trihexyphenidyl tab 2 mg Tablet
203 Trimethoprim (cotrimoxazol 480 mg) tablet Tablet
204 Urin Bag Pcs
205 Usg Gel Botol
206 Vaksin Rabies Vero/ Verorab Paket
207 Vitamin B Kompleks Tablet
208 Vitamin K Infant Inj Ampul
209 Water liquid (aqua P,I) Botol
210 Wing Needle No.21 Pcs
211 Wing Needle No.27 Pcs
212 Zinc Sulphate Suppositoria (Superhoid) Kapsul
213 Zinc tab Tablet
214
Mengetahui/
Direktur RS Prata
dr. Muhammad
Nip.19850421 2
GD
A
PELAPORAN BULAN : MEI 2019
: JUNI 2019
: JULI 2019
TOTAL SO TOTAL
SO UGD SO UGD
MARET GUDANG APRIL
8 9 10 11 12
TOTAL SO TOTAL
SO UGD SO UGD
MARET GUDANG APRIL
8 9 10 11 12
TOTAL SO TOTAL
SO UGD SO UGD
MARET GUDANG APRIL
8 9 10 11 12
TOTAL SO TOTAL
SO UGD SO UGD
MARET GUDANG APRIL
8 9 10 11 12
TOTAL SO TOTAL
SO UGD SO UGD
MARET GUDANG APRIL
8 9 10 11 12
TOTAL SO TOTAL
SO UGD SO UGD
MARET GUDANG APRIL
engetahui/ Menyetujui Yang Membuat
ktur RS Pratama Tugu Jaya Pengelola Gudang Obat
Muhammad Tito Aristian Kartini Wiati,SKM

19850421 201408 1 001 NIP. 19750806 200501 2 009
STOK OPNAME APOTEK NO.
RUMAH SAKIT PRATAMA TUGU JAYA 32
33
PELAPORAN BULAN : 34
35
36
NO. NAMA OBAT SATUAN
37
1 Absorbent tipped applicator (alcohol swab) Pcs 38
2 Acetylcystein Kapsul 200mg Kapsul 39
3 Acyclovir tab 200 mg Tablet 40
4 Acyclovir cream Tube 41
5 Albendazol tab 400 mg Tablet 42
6 Alkohol Liquid (etanol) 70%-1000 ml Btl 43
7 Allopurinol 100 mg Tablet 44
8 Aminophylline Inj 24 mg/ml-10 ml Ampul 45
9 Aminophylline tab 200 mg Tablet 46
10 Amitriptyline 25 mg tab Tablet 47
11 Amlodipine tab 5 mg Tablet 48
12 Amoxycillin Syr Btl 49
13 Amoxycillin 250 mg Kapsul 50
14 Amoxycillin 500 mg Kaptab 51
15 Ampicilin 1 gr Inj Vial 52
16 Antasida Syr DOEN Btl 53
17 Antasida DOEN Kombinasi Tablet 54
18 Anti Bisa Ular 5 ml (ABU I)/ Biosave Vial 55
19 Asam Mefenamat 500 mg tab Tablet 56
20 Ascorbic acid (Vit.C) 50 mg Tablet 57
21 Ascorbic acid |calsium carbonate 500 mg (Pehavra Tablet 58
22 Aspirin (miniaspi) 100 mg tab Tablet 59
23 Atropine inj 0,25 mg/ml Ampul 60
24 Attapulgite Tablet (Pularex) Tablet 61
25 Attapulgite Tablet 600 mg (New Antides) Tablet 62
26 Automated blood grouping (Tes Gol. Darah) Paket 63
27 Bahan Tambal Gigi Sementara (Fletcher/Cavi Pcs 64
28 Bedak Salisil 2% Btl 65
29 Benzoic acid |salicylic acid salep (anti fungi) pot 66
30 Betahistine Mesylate 6 mg tab Tablet 67
31 Betamethasone 0,1% krim Tube 68
NO. NAMA OBAT SATUAN NO.

69 Erythromicin 500 mg capsul Kapsul 106
70 Ethacridine (Rivanol) 0,1% Btl 107
71 Ethanol ( Aseptan ) 500 cc+ Pump Botol 108
72 Eugenol cairan Btl 109
73 Ferrous fumarate ( Tab. Tambah Darah ) Tablet 110
74 Folic acid 1mg ( asam folat) Tablet 111
75 Folley Catheter No.16 Pcs 112
76 Furosemida Injeksi Ampul 113
77 Furosemida 40 mg Tablet 114
78 Garam Oralit Sachet 115
79 Gentamicyn 0,3% TM Botol 116
80 Gentamicyn Inj 40 mg/ml Ampul 117
81 Gentamicyn 0,1% SK Tube 118
82 Glass lonomer Paket 119
83 Glibenclamide 5 mg Tablet 120
84 Glimepiride 1 mg Tablet 121
85 Glukosa larutan infus 10% Botol 122
86 Glukosa larutan infus 5% Botol 123
87 Griseofulvin 125 mg Tablet 124
88 Guaifenesin 100 Tab (GG tab) Tablet 125
89 Haloperidol 0,5 mg tab Tablet 126
90 Haloperidol 5 mg tab Tablet 127
91 Human chorionic (HCG/Tes kehamilan ) Strip 128
92 Hydrochlorotiazide (HCT) 25 mg Tablet 129
93 Ibuprofen sirup Botol 130
94 Ibuprofen 200 mg Tablet 131
95 Ibuprofen 400 mg Tablet 132
96 Ichthyol salep 10% pot 133
97 Immunoglobulin human anti-tetanus (Tetaga Ampul 134
98 Infus set dewasa Pcs 135
99 Infusi set anak Pcs 136
100 Iodium Povidon 10% 30 ml Botol 137
101 Isosorbide tablet Tablet 138
102 IV Catheter No.20 Pcs 139
105 Jarum Jahit Kulit Pcs 142
NO. NAMA OBAT SATUAN NO.

143 Omeprazole kaps Kapsul 180
144 Oxytetracycline HCl 1% Salep Mata Tube 181
145 Oxytetracycline HCl 3% Salep Kulit Tube 182
146 Oxytocin inj 10 IU Ampul 183
147 Papaverin 40 mg tab Tablet 184
148 Papaverin inj Tablet 185
149 Paracetamol Drops 15 ml Botol 186
150 Parasetamol 120 mg/5 ml Syr Botol 187
151 Parasetamol 500 mg Tablet 188
152 Patient Lubricant (My Jelly ) Tube 189
153 Permethrin (Scabimite Cream) Tube 190
154 Phenobarbital inj 50mg/ml-2ml Ampul 191
155 Phenobarbital 100 mg Tablet 192
156 Phenol gliserol 10% TT Botol 193
157 Phytomenadione (Vit.K1) inj 10 mg/ml Ampul 194
158 Phytomenadione (Vit.K1) 10 mg Tablet 195
159 Piracetam 400 mg Tablet 196
160 Piroxicam 20 mg tab Tablet 197
161 Pisau Disposable (Mess No.14/21) Pcs 198
162 Plesterku (Leukoplast) Pcs 199
163 Polivalen serum (Anti Tetanus Inj. 1500 iu/Biosat) Ampul 200
164 Povidon iodium 10% 300 ml Botol 201
165 Prednison 5 mg Tablet 202
166 Primaquin 15 mg tab Tablet 203
167 Profolat tab Tablet 204
168 Prokaina Penisilin G inj 3.000.000 iu Ampul 205
169 Propranolol HCl 10 mg Tablet 206
170 Propranolol HCl 40 mg Tablet 207
171 Propylthiouracil 100 mg Tablet 208
172 Protein Gluco Test Strip 209
173 Pyrantel Pamoat 125 mg Tablet 210
174 Pyridoxine HCl 10 mg Tablet 211
175 Ranitidin 150 mg Tablet 212
176 Ranitidin Injeksi Ampul 213
177 Retinol (Vit.A) kaps 100.000 iu Kapsul 214
179 Risperidone 2mg Tablet
NAMA OBAT SATUAN
Bisacodyl 5mg Tablet
Bismuth subgallas (antihemoroid) Supp
Calcium chloride lactate infus (RL) Botol
Calsium Laktat (Kalk) 500 mg Tablet
Captopril 12,5 mg Tablet
Captopril 25 mg Tablet
Carbamazepin tab Tablet
Catgut/Benang Chromic Bedah No.2/0-3/0 Pcs
Catgut/Benang Plain Bedah No.2/0-3/0 Pcs
Cefadroxil 500mg Tablet
Cetirizine 5 mg/5 ml sirup Botol
Chloramhenicol Salep Mata 1% Tube
Chloramphenicol Suspensi 125 mg/ml Btl
Chloramphenicol 250 mg caps Tablet
Chloramphenicol TT 3% Botol
Chloramphenicol/ Hidrokortison krim 2,5% Tube
Chlorpheniramine Maleat (CTM) 4 mg Tablet
Chlorpromazine HCl 100 mg Tablet
Cimetidin 200 tab Tablet
Ciprofloxacin 500 mg tab Tablet
Ciprofloxacin Infus Botol
Clindamycin 300mg Kapsul
Cresol liquid 1 Liter (lysol) Botol
Cyanocobalamin (Vit B12) inj 500 mcg/ml Ampul
Devitalisasi pasta pot
Dexamethasone 0,5 mg Tablet
Dexamethasone inj 5mg/ml-1ml Ampul
Diazepam 5mg/ml-2 ml inj Ampul
Diazepam 2 mg Tablet
Diclofenac sodium 25 mg tab Tablet
Digoxin 0,25 mg Tablet
Dimenhydrinate 50mg Tablet
Dipenhidramine HCl inj 10mg/ml Ampul
Domperidone 10 mg Tablet
Doxycycline 100 mg Kapsul Kapsul
Epinephrine HCl/bitartrat inj 0,1% Ampul
Erythromicin Syr Btl
NAMA OBAT SATUAN

Kalium Permanganat Serbuk pot
Kapas pembalut/Absorben 250 g Pcs
Kasa pembalut 2x80 Pcs
Kasa pembalut hidrofil 4 m x 15 cm Pcs
Kasa pembalut hidrofil 4 m x 3 cm Pcs
Kasa kompres 40/40 steril Pcs
Ketoconazole 200 mg Cream Tube
Ketoconazole 200 mg tab Tablet
Klorokina Fosfat 250 mg Tablet
Levertran Salep/ Salep Luka Bakar pot
Lidocain 2% Ampul
Lidokain Comp. inj Kombinasi Ampul
Lidocaine spray (Xylocaine spray) Botol
Liquorice liquid extract (OBH) Botol
Locoriz Cream Tube
Loperamid 2 m tab Tablet
Loratadine 10 mg tab Tablet
Magnesium Sulfat Injeksi 20% (MgSO4) Ampul
Magnesium Sulfat Injeksi 40% (MgSO4) Ampul
Masker Pcs
Medical adhesive tape (dermafix/leukomed) Pcs
Metamizole injeksi (antalgin 1000) Ampul
Metformin 500mg tab Tablet
Methyl Ergometrin Maleat inj 0,2 mg/ml Ampul
Methyl Ergometrin Maleat 0,125 mg Tab
Methyl Prednisolon tab 4 mg Tablet
Methyl Rosanilinium (gentian violet) Botol
Metronidazol 250 mg tab Tablet
Metronidazol 500 mg tab Tablet
Metronidazol Infus Botol
Metronidazol syr Botol
Miconazole 2% Salep Kulit Tube
Momilen Baby Gold Sirup Botol
Natrium Bikarbonat 500 mg Tablet
Nifedipin 10 mg tab Kapsul
Nystatin Tab Vag 10.000 iu/g Tablet
Omeprazole inj Vial
NAMA OBAT SATUAN

Salbutamol 2 mg Tablet
Salep 2-4 Kombinasi pot
Sarung tangan (HandScuun) No.7,5 Pcs
Sarung tangan (HandScuun Steril) No. 6,5 Pcs
Sarung tangan (HandScuun Steril) No.7 Pcs
Sarung tangan (HandScuun Steril) No.7,5 Pcs
Semen Seng Fosfat Serbuk & Cairan Set
Sianocobalamin (Vit B12) 50 mg tab Tablet
Silk (Benang Bedah) No. 3/0 Pcs
Silver Sulfadiazine Tube
Simvastatin 10 mg tab Tablet
Sodium cloride infus 0,9% ( NACL ) Botol
Spuit 1 ml Pcs
Spuit 3 ml Pcs
Spuit 5 ml Pcs
Sulfadoxine | Pyrimethamine Tablet 500mg|25m Tablet
Sulfamethoxazole | trimethoprim (cotri) syr Botol
Sulfasetamida 15% TM Botol
Tetracycline 250 mg Tablet
Tetracycline 500 mg Tablet
Thiamine HCl (Vit B1) inj 100 mg/ml Ampul
Thiamine HCl (Vit B1) 50 mg Tablet
Trihexyphenidyl tab 2 mg Tablet
Trimethoprim (cotrimoxazol 480 mg) tablet Tablet
Urin Bag Pcs
Usg Gel Botol
Vaksin Rabies Vero/ Verorab Paket
Vitamin B Kompleks Tablet
Vitamin K Infant Inj Ampul
Water liquid (aqua P,I) Botol
Wing Needle No.21 Pcs
Wing Needle No.27 Pcs
Zinc Sulphate Suppositoria (Superhoid) Kapsul
Zinc tab Tablet
Yang Melaporkan
Column2
No. Nama Item Kosong
1 Abocath 18
2 Abocath 20
3 ABOCATH 22
4 Abocath 24
5 Acyclovir cr
6 Asam Mefenamat
7 Captopril 25
8 Cat Gut Plain
9 Cefadroxil
10 Cimetidin
11 Ciprofloxacin
12 Dexa Tab
13 Diazepam Inj
14 Eritro 500
15 Genta SK
16 handschoon
17 Ibuprofen 200
18 Ibuprofen 400
19 ISDN
20 Ketoconazol Tab
21 Kloram Tetes Telinga
22 Loperamid
23 Mess
24 Metil Prednisolon
25 Metronidazol 250
26 Metronidazol 500
27 MgSo4 40%
28 Nifedipin
29 Prednison
30 Ranitidin Inj
31 Ranitidin Tab
32 Rivanol
33 Salbutamol 2 mg
34 spuit 3 cc
35 Transfusi Set

LPLPO Juli 2019 (Permintaan)

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DOKUMEN RENCANA KEBUTUHAN OBAT PUSKESMAS TAHUN 2019

UMUM JAMSOSKES BPJS JUMLAH

Mengetahui Mengetahui Mengetahui/ Menyetujui Yang Memb

..................................... ..................................... .....................................

MENURUT PENCATATAN HASIL SELISIH KADALUARSA RUSAK

Mengetahui/ Menyetujui Yang Membuat

UMUM BPJS JUMLAH

Mengetahui Mengetahui Mengetahui

H. M. Lubis, S.KM., M.Kes Himayanti, S.Si., Apt. Pamuji, S.

Mengetahui/ Menyetujui Yang Membuat

Pamuji, S.KM.,M.Si. Kartini Wiati,SKM

RS PRATAMA : TUGU JAYA PELAPORAN BULAN

1 Absorbent tipped applicator (alcohol swab) Pcs 32 600

32 Bisacodyl 5mg Tablet 540 0

69 Erythromicin 500 mg capsul Kapsul 175 2000

106 Kalium Permanganat Serbuk pot 0 0

143 Omeprazole kaps Kapsul 690 900

180 Salbutamol 2 mg Tablet 0 0

H. M. Lubis, S.KM., M.Kes Himayanti, S.Si., Apt.

ORAN BULAN : FEBRUARI 2019 DOKUMEN NOMOR TANGGAL

Mengetahui/ Menyetujui Yang Membuat

Pamuji, S.KM.,M.Si. Kartini Wiati,SKM

RS PRATAMA : TUGU JAYA PELAPORAN BULAN

1 Absorbent tipped applicator (alcohol swab) Pcs 530 0

32 Bisacodyl 5mg Tablet 0 0

69 Erythromicin 500 mg capsul Kapsul 1544 0

106 Kalium Permanganat Serbuk pot 0 0

143 Omeprazole kaps Kapsul 1355 0

180 Salbutamol 2 mg Tablet 0 0

UMUM BPJS JUMLAH

H. M. Lubis, S.KM., M.Kes Himayanti, S.Si., Apt.

ORAN BULAN : MARET 2019 DOKUMEN NOMOR TANGGAL

Mengetahui/ Menyetujui Yang Membuat

Pamuji, S.KM.,M.Si. Kartini Wiati,SKM

1 Absorbent tipped applicator (alcohol swab) Pcs 91 0

32 Bisacodyl 5mg Tablet 0 0

69 Erythromicin 500 mg capsul Kapsul 670 0

106 Kalium Permanganat Serbuk pot 0 0

143 Omeprazole kaps Kapsul 1090 0

180 Salbutamol 2 mg Tablet 0 0

UMUM BPJS JUMLAH

H. M. Lubis, S.KM., M.Kes Himayanti, S.Si., Apt.

Mengetahui/ Menyetujui Yang Membuat

dr. Muhammad Tito Aristian Kartini Wiati,SKM

RS PRATAMA : TUGU JAYA PELAPORAN BULAN : MEI 2019 DOKUMEN

STOK STOK STOK

32 Bisacodyl 5mg Tablet 0 0 0 0 0

69 Erythromicin 500 mg capsul Kapsul 0 0 0 0 0

106 Kalium Permanganat Serbuk pot 0 0 0 0 0

143 Omeprazole kaps Kapsul 820 2010 2830 150 2680

180 Salbutamol 2 mg Tablet 0 0 0 0 0

UMUM BPJS JUMLAH

RS PRATAMA TUGU JAYA PELAPORAN BULAN

UMUM JAMSOSKES BPJS

H. M. Lubis, S.KM., M.Kes Himayanti, S.Si., Apt.

ORAN BULAN : JUNI 2019 DOKUMEN NOMOR TANGGAL

getahui Mengetahui/ Menyetujui Yang Membuat

ti, S.Si., Apt. dr. Muhammad Tito Aristian Kartini Wiati,SKM

RS PRATAMA TUGU JAYA PELAPORAN BULAN : JULI 2019 DOKUMEN NOMOR

STOK STOK STOK

32 Bisacodyl 5mg Tablet 0 0 0 0 0 500 500

69 Erythromicin 500 mg capsul Kapsul 0 0 0 0 0 2000 2000

106 Kalium Permanganat Serbuk pot 0 0 0 0 0 0 24