LAPORAN PEMAKAIAN dan LEMBAR PERMINTAAN OBAT (LPLPO)

Nama Puskesmas
Kecamatan

NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35

NAMA OBAT / ALAT KESEHATAN HABIS PAKAI

ACYCLOVIR 200 MG TABLET
ACYCLOVIR KRIM 5%
ALBENDAZOLE TABLET 400 MG
ALOPURINOL TABLET 100 MG
AMBROXOL SIRUP
AMBROXOL TAB 10 MG
AMINOFILIN TABLET 200 MG
AMINOFILINA INJEKSI 24 MG/ML - 10 ML
AMITRIPTILIN HCL TABLET SALUT 25 MG
AMOKSISILIN INJ. 1000 MG
AMOKSISILIN KAPLET 500 MG
AMOKSISILIN KAPSUL 250 MG
AMOKSISILIN SIRUP KERING 125 MG/5 ML
AMPISILIN KAPLET 500 MG
ANTALGIN (METAMPIRON) TABLET 500 MG
ANTASIDA DOEN SUSPENSI
ANTASIDA DOEN TABLET KOMBINASI
ANTIFUNGI DOEN KOMB.
ANTIHEMOROID SUPPOSITORIA
AQUA PRO INJEKSI STERIL BEBAS PIROGEN
ASAM ASKORBAT TABLET 50 MG
ASAM FOLAT
ASAM MEFENAMAT KAPLET 500 MG
ATROPIN SULFAT TABLET 0,5 MG
ATROPIN SULFAT INJEKSI 0,25 MG/ML - 1ML
BETAHISTIN MESILATE 6 MG
BETAMETASON KRIM 0,1 %
CAPTOPRIL TABLET 12,5 MG
CARBAMAZEPIN TABLET
CLONIDIN 0,15 MG TABLET
DEKSAMETASON INJEKSI 5 MG/ML 1 ML
DEKSAMETASON TABLET 0,5 MG
DEKSTROMETORPHAN SIRUP 60 ML
DEKSTROMETORPHAN TABLET 15 MG
DIAZEPAM INJEKSI 5 MG/ML - 2 ML

: Puskesmas Punggelan 2
: Punggelan

SATUAN
Tablet
Tube
Tablet
Tablet
Botol
Tablet
Tablet
Ampul
Tablet
Vial
Kaplet
Kapsul
Botol
Kaplet
Tablet
Botol
Tablet
Pot
Supp
Tablet
Tablet
Tablet
Kaplet
Tablet
Ampul
Tablet
Tube
Tablet
Tablet
Tablet
Ampul
Tablet
Botol
Tablet
Ampul

STOK
PENERIMA PERSEDIA
AWAL
AN
AN
250
100
350
0
0
0
450
0
450
700
0
700
64
0
64
500
100
600
380
300
680
2
5
7
180
0
180
0
0
0
6400
1000
7400
420
120
540
110
150
260
750
200
950
1000
3000
4000
96
20
116
4000
1000
5000
5
0
5
0
10
10
0
0
0
5000
1000
6000
2899
0
2899
800
1500
2300
0
0
0
0
0
0
20
0
20
0
50
50
2500
0
2500
0
0
0
590
100
690
0
0
0
2000
3000
5000
106
0
106
7000
1000
8000
0
0
0

Bulan
Tahun

PENGELUARAN
bln lalu
bln ini
134
10
3
0
0
0
0
90
1
0
147
20
60
0
0
0
0
0
0
3000
1389
200
0
54
41
400
100
300
620
5
31
428
509
0
0
0
0
0
0
544
303
60
70
280
500
0
0
0
0
0
0
45
7
803
252
0
0
0
0
0
0
930
947
1
25
0
0

total
144
3
0
90
1
147
80
0
0
0
4389
200
95
500
920
36
937
0
0
0
847
130
780
0
0
0
52
1055
0
0
0
1877
1
25
0

SISA
STOK
STOK
OPTIMAL
106
216
0
4.5
450
0
610
135
63
1.5
343
220.5
300
120
2
0
180
0
0
0
2011
6583.5
220
300
15
142.5
200
750
80
1380
60
54
3063
1405.5
5
0
10
0
0
0
4153
1270.5
2769
195
20
1170
0
0
0
0
20
0
0
78
1445
1582.5
0
0
690
0
0
0
123
2815.5
106
1.5
6975
37.5
0
0

Juli
: 2012

PERMINTAAN
RUMUS
RIIL

0
0

0
0

PEMBERIAN

KETR

36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79

DIAZEPAM TABLET 2 MG
DIAZEPAM TABLET 5 MG
DIFENHIDRAMIN HCL INJEKSI 10 MG/ML - 1ML
DIGOKSIN TABLET 0,25 MG
DILTIAZEM TABLET
DIMENHIDRINATE 50 MG
DOMPERIDONE SIRUP
DOMPERIDONE TABLET 10 MG
EFEDRIN TABLET 25 MG
EPINEFRINA HCL/ADRENALINA INJEKSI 0,1 % - 1
ERITROMISIN KAPSUL 500 MG
ETAKRIDIN (RIVANOL) LARUTAN
ETIL KLORID SEMPROT
FENILBUTASON TABLET SALUT 200 MG
FENOBARBITAL INJEKSI 50 MG/ML - 2 ML
FENOBARBITAL TABLET 30 MG
FENOKSIMETIL PENISILIN TABLET 500 MG
FENOL GLISEROL TT 10 % 5 ML
FITOMENADION (VIT.K1) INJEKSI 10 MG/ML - 1 ML
FITOMENADION (VIT.K1) TABLET SALUT GULA 10
FUROSEMID TABLET 40 MG
GARAM ORALIT UNTUK 200 ML AIR
GEMFIBROZIL 300 MG
GENTAMICIN 80 MG INJEKSI
GENTAMICIN SALEP KULIT
GENTIAN VIOLET 1 % 10 ML
GLIBENKLAMID TABLET 5 MG
GLISERIL GUAYAKOLAT 100 MG
GLISEROL
GLUKOSA LARUTAN INFUS 5 % STERIL
HALOPERIDOL TABLET 1,5 MG
HALOPERIDOL TABLET 5 MG
HIDROKLOROTIAZID (HCT) TABLET
HIDROKORTISON KREAM 2,5% 5 GR
HYOSIN N BUTILBROMIDA KAPLET
IBUPROFEN TABLET 200 MG
IBUPROFEN TABLET 400 MG
ISOSORBID DINITRAT TABLET SUBLINGUAL 5 MG
KALSIUM LAKTAT TABLET 500 MG
KAPAS BERLEMAK 500 GRAM
KAPAS PEMBALUT/ABSORBEN 250 GR
KETOKONAZOLE 200 MG TABLET
KLORAMFENIKOL SUSPENSI 125 MG/5 ML
KLORAMPENIKOL KAPSUL 250 MG

Tablet
Tablet
Ampul
Tablet
Tablet
Tablet
Botol
Tablet
Tablet
Ampul
Kapsul
Botol
Botol
Tablet
Ampul
Tablet
Tablet
Botol
Ampul
Tablet
Tablet
Saset
Kapsul
Ampul
Tube
Botol
Tablet
Tablet
Botol
Botol
Tablet
Tablet
Tablet
Tube
Kaplet
Tablet
Tablet
Tablet
Tablet
Bungkus
Bungkus
Tablet
Botol
Kapsul

0
0
0
300
0
800
0
50
4050
0
700
98
3
4000
0
0
2000
48
30
500
0
2100
200
0
50
30
0
4000
0
27
0
0
3000
24
74
1200
500
100
0
0
1
420
65
2600

0
0
0
100
0
0
0
200
0
0
200
0
0
0
0
0
0
0
0
0
0
300
100
0
10
0
100
1000
0
20
0
0
0
24
0
200
100
0
3000
0
2
100
0
0

0
0
0
400
0
800
0
250
4050
0
900
98
3
4000
0
0
2000
48
30
500
0
2400
300
0
60
30
100
5000
0
47
0
0
3000
48
74
1400
600
100
3000
0
3
520
65
2600

0
0
0
0
0
60
0
0
19
0
20
1
0
10
0
0
0
5
0
22
0
6
0
0
6
2
0
333
0
0
0
0
12
3
0
101
20
0
529
0
0
6
2
0

20
0
0
0
12
0
0
105
0
70
2
0
70
0
0
10
6
3
42
90
0
0
0
3
4
0
593
0
5
0
0
24
13
0
132
0
0
794
0
50
10
11
12

20
0
0
0
0
72
0
0
124
0
90
3
0
80
0
0
10
11
3
64
90
6
0
0
9
6
0
926
0
5
0
0
36
16
0
233
20
0
1323
0
50
16
13
12

-20
0
0
300
0
728
0
50
3926
0
700
95
3
3920
0
0
1990
37
27
436
0
2094
300
0
41
24
0
3074
0
22
0
0
2964
8
74
967
480
100
0
0
1
404
52
2588

30
0
0
0
0
108
0
0
186
0
135
4.5
0
120
0
0
15
16.5
4.5
96
135
9
0
0
13.5
9
0
1389
0
7.5
0
0
54
24
0
349.5
30
0
1984.5
0
75
24
19.5
18

0
0
0
0

0
0

0
0
0
0
16

80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123

KLORAMPENIKOL SALEP MATA 1%

KLORAMPENIKOL TETES TELINGA 3 %
KLORFENERAMIN MALEAT (CTM) TABLET 4 MG
KOTRIMOKSAZOL SUSPENSI 240MG/5ML KOMB.
KOTRIMOKSAZOL TABLET 480 MG. KOMBINASI
LIDOCAIN 2% INJEKSI
LIDOKAIN COMP. INJEKSI 2 %
LOPERAMID HCL TABLET 2 MG
LORATADIN 10 MG
MEBENDAZOL TABLET 100 MG
METFORMIN 500 MG TABLET
METILERGOMETRIN MALEAT TAB. SLT.0,125 MG
METILERGOMETRIN MALEAT INJEKSI 0,2 MG-1ML
METILPREDNISOLON TABLET 4 MG
METRONIDAZOL TABLET 500 MG
MIKONAZOL KRIM/SALEP 2%
NATRIUM BIKARBONAT TABLET
NATRIUM DIKLOFENAK 50 MG TABLET
NATRIUM FENITOIN KAPSUL 100 MG
NATRIUM KLORIDA LARUTAN INFUS 0,9 % STERIL
NIFEDIPIN TABLET
NISTATIN TABLET VAGINAL 100.000 IU/G
OBAT BATUK HITAM (OBH) CAIRAN
OKSITETRASIKLIN HCL SALEP KULIT 3 %
OKSITETRASIKLIN HCL SALEP MATA 1 %
OKSITOSIN INJEKSI 10 IU/ML - 1 ML
OMEPRAZOLE 30 MG KAPSUL
PAPAVERIN INJEKSI
PAPAVERIN TABLET 40 MG
PARASETAMOL SIRUP 120 MG/5 ML 60 ML
PARASETAMOL TABLET 500 MG
PIRACETAM 400 MG TABLET
PIRACETAM INJ
PIRANTEL TABLET 125 MG
PIRIDOKSIN (VIT B6) INJEKSI
PIRIDOKSIN (VIT B6) TABLET 10 MG
PIROKSIKAM TABLET 10 MG
POVIDON IODIDA 10 % 30 ML
POVIDON IODIDA 10 % 300 ML
PREDNISON TABLET 5 MG
PROPILTIOURASIL TABLET 100 MG
PROPRANOLOL HCL TABLET 40 MG
RANITIDIN INJEKSI
RANITIDIN TABLET 150 MG

Tube
Botol
Tablet
Botol
Tablet
Ampul
Ampul
Tablet
Tablet
Tablet
Tablet
Tablet
Ampul
Tablet
Tablet
Tube
Tablet
Tablet
Kapsul
Botol
Tablet
Tablet
Botol
Tube
Tube
Ampul
Kapsul
Ampul
Tablet
Botol
Tablet
Tablet
Ampul
Tablet
Ampul
Tablet
Tablet
Botol
Botol
Tablet
Tablet
Tablet
Ampul
Tablet

92
71
1886
167
3700
20
30
130
100
0
400
400
0
270
2070
22
2800
902
0
34
600
300
229
111
75
40
20
0
950
340
9837
100
0
532
0
2739
1848
18
3
4750
0
0
25
900

24
0
5000
200
100
0
0
0
0
0
100
0
0
0
24
0
100
0
20
100
0
0
24
25
20
0
0
0
200
3000
0
0
0
0
0
200
20
0
1000
0
0
0
600

116
71
6886
367
3800
20
30
130
100
0
400
500
0
270
2070
46
2800
1002
0
54
700
300
229
135
100
60
20
0
950
540
12837
100
0
532
0
2739
2048
38
3
5750
0
0
25
1500

1
3
980
34
131
0
0
0
0
0
0
30
0
0
30
1
36
88
0
0
8
0
11
9
9
0
0
0
32
14
755
0
0
6
0
136
3
0
140
0
0
0
206

5
2
1269
50
282
2
0
0
0
0
0
40
10
20
90
19
50
116
0
3
48
10
12
15
9
0
0
0
46
20
1201
0
0
66
0
174
146
4
0
140
0
0
0
172

6
5
2249
84
413
2
0
0
0
0
0
70
10
20
120
20
86
204
0
3
56
10
23
24
18
0
0
0
78
34
1956
0
0
72
0
174
282
7
0
280
0
0
0
378

86
66
5617
83
9
18
30
130
100
0
400
460
-10
250
1980
27
2750
886
0
51
652
290
217
120
91
60
20
0
904
520
11636
100
0
466
0
2565
1902
34
3
5610
0
0
25
1328

9
7.5
3373.5
126
619.5
3
0
0
0
0
0
105
15
30
180
30
129
306
0
4.5
84
15
34.5
36
27
0
0
0
117
51
2934
0
0
108
0
261
423
10.5
0
420
0
0
0
567

0
0

0
0

124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160

1
2

RINGER LAKTAT LARUTAN INFUS STERIL

SALBUTAMOL TABLET 2 MG
SALEP 2 - 4 KOMB.(As.Salisilat&Belerang endap)
SALISIL BEDAK 50 GR
SEFADROKSIL 500 MG
SERUM ANTI BISA ULAR INJEKSI 5 ML (ABU I)
SERUM ANTI TETANUS INJEKSI 1.500 IU/AMPUL
SIANOKOBALAMIN (VIT.B12) INJEKSI 500
SIMVASTATIN TABLET 10 MG
SIPROFLOKSASIN TABLET 500 MG
SULFASETAMID TETES MATA 15 %
THIAMFENIKOL KAPSUL 500 MG
THIAMIN HCL (VIT. B1) INJEKSI 100 MG/ML - 1 ML
THIAMIN HCL/MONONITRAT (VIT. B1) TABLET 50
TRAMADOL INJEKSI
TRAMADOL TABLET 50 MG
TRIHEKSIFENIDIL TABLET 2 MG
VITAMIN B KOMPLEKS TABLET
ZINK TABLET 20 MG
ALAT SUNTIK SEKALI PAKAI 1 ML
ALAT SUNTIK SEKALI PAKAI 2,5 ML
ALAT SUNTIK SEKALI PAKAI 5 ML
CAT GUT NO. 2/0 - 3/0 DNG. JARUM BEDAH
FOLLEY CATH NO. 16
FOLLEY CATH NO. 18
HAND SCHOON NO.7,5
INFUSION SET ANAK
INFUSION SET DEWASA
I V CATHETER NO. 22
I V CATHETER NO. 24
MASKER
PLESTER 5 YARD X 2 INCHI
SILK (BENANG BEDAH SUTERA) NO. 3/0
URIN BAG
WING NEEDLE NO.21
WING NEEDLE NO.23
WING NEEDLE NO.25

Botol
Tablet
Pot
Kotak
Kapsul
Vial
Ampul
Ampul
Tablet
Tablet
Botol
Kapsul
Ampul
Tablet
Ampul
Tablet
Tablet
Tablet
Tablet
Buah
Buah
Buah
Kotak
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Buah
Roll
Kotak
Buah
Buah
Buah
Buah

14
1780
31
128
130
0
0
0
20
1452
95
470
0
5600
0
100
0
5800
469
0
0
0
0
0
0
30
0
0
0
0
0
0
2
0
0
0
0

20
200
24
0
50
0
0
0
0
200
24
100
0
0
0
0
0
5000
200
0
55
0
1
0
9
14
0
0
25
0
0
3
0
3
0
0
0

PERBEKALAN KESEHATAN/ PENUNJANG

ANTALGIN INJEKSI 250 MG/ML
ASAM TRANEKSAMAT 500 MG

Vial
Tablet

0
0

34
1980
55
128
180
0
0
0
20
1652
119
570
0
5600
0
100
0
10800
669
0
55
0
1
0
9
44
0
0
25
0
0
3
2
3
0
0
0
0
0
0
0
0
0
0

0
122
2
7
0
0
0
0
0
142
1
10
0
120
0
0
0
39
8
0
0
0
0
0
0
5
0
0
0
0
5
2
0
0
0
0
0

0
0

5
152
7
10
0
0
0
0
0
150
5
20
0
190
0
18
0
73
10
0
0
0
0
0
0
6
0
0
0
0
10
2
0
0
0
0
0

5
274
9
17
0
0
0
0
0
292
6
30
0
310
0
18
0
112
18
0
0
0
0
0
0
11
0
0
0
0
15
4
0
0
0
0
0
0
0
0
0
0
0
0

29
1828
48
118
180
0
0
0
20
1502
114
550
0
5410
0
82
0
10727
659
0
55
0
1
0
9
38
0
0
25
0
-10
1
2
3
0
0
0
0
0
0
0
0
0
0

7.5
411
13.5
25.5
0
0
0
0
0
438
9
45
0
465
0
27
0
168
27
0
0
0
0
0
0
16.5
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0

0
0
0

0
-55
0
-1
0
-9
0
0
-25
0

-3
0
0
0
0
0
0
0
0
0
0

3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46

BISAKODIL SUPP 10 MG
BISAKODIL SUPP 5 MG
BISAKODIL TABLET
CAIRAN INFUS UTK TERAPI RESUSITASI
DIAZEPAM RECTAL TUBE 5 MG
ETANOL 70 % 1000 ML
GAMEKSAN KRIM
ICHTYOL SALEP
JELLY DOPLER
KALIUM L ASPARTAT 300 MG
KLORAMFENIKOL 1G INJEKSI
KLORAMFENIKOL TETES MATA 0,5 %
KOMB.DIARE SUSPENSI
KOMB.DIARE TABLET
KOMB.ENZIM PENCERNAAN (VITAZYM)
KOMB.FLU SIRUP
KOMB.FLU TABLET
KOMB.LUKA BAKAR GELL (BISMECON)
KOMB.OAI ANTI HIPERTENSI (TENSIGARD)
KOMB.OAI ANTIHEMOROID KAPSUL (HEMOROGARD)
KOMB.OAI HEPATOPROTEKTOR KAPSUL (HEPAGARD)
KOMB.OAI IMUNOSUPRESAN KAPSUL (IMULAN)
KOMB.OAI IMUNOSUPRESAN SIRUP (IMULAN)
KOMB.OAI KUMUR MULUT (ENKASARI)
KOMB.OAI NAFSU MAKAN KAPLET (XANVIT)
KOMB.OAI NAFSU MAKAN SIRUP (XANVIT)
KOMB.VITAMIN B1B6B12
KOMB.VITAMIN KAPLET
KOMB.VITAMIN SIRUP
LARUTAN DESINFEKTAN RUANGAN
LARUTAN KLORIN 5.25%
METOKLOPRAMID HCL INJEKSI 5 MG/ML
POLIKRESULEN 360MG/G (Albothyl)
SIRUP TAMBAH DARAH
TABLET TAMBAH DARAH (BESI FUMARAT)
BISTURI
HAND SCHOON PANJANG
JARUM BEDAH segitiga
I V CATHETER NO.18
KASA PEMBALUT 40 M X 80 CM
KASA PEMBALUT HIDROFIL 4 M X 15 CM
PLESTER DNG FRAMISETIN SULFAT
PP TEST
SELANG O2 BAYI

Supp
Supp
Tablet
Botol
Tube
Botol
Tube
Pot
Botol
Tablet
Vial
Botol
Botol
Tablet
Tablet
Botol
Tablet
Tube
Kapsul
Kapsul
Kapsul
Kapsul
Botol
Botol
Kaplet
Botol
Tablet
Kaplet
Botol
Pouch
Botol
Ampul
Botol
Botol
Tablet
Buah
Buah
Bungkus
Buah
Roll
Roll
Lembar
Buah
Buah

0
0
0
0
0
10
48
96
0
0
0
48
149
5900
0
84
2610
7
120
0
0
0
0
1
0
0
1000
1350
145
0
0
0
10
0
6790
0
0
0
0
0
400
0
44
0

0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
24
300
0
0
0
0
0
0
0
0
0
500
1000
24
0
0
0
3
0
0
0
0
1
0
0
50
0

0
0
0
0
0
12
48
96
0
0
0
48
149
5900
0
108
2910
7
120
0
0
0
0
1
0
0
1500
2350
169
0
0
0
13
0
6790
0
0
0
0
1
400
0
94
0

0
0
0
0
0
0
0
1
0
0
0
1
4
88
0
4
335
1
0
0
0
0
0
0
0
0
500
850
35
0
0
0
2
0
4190
0
0
0
0
0
0
0
8
0

1
0
5
1
0
0
3
18
184
0
10
475
4
10
0
0
0
0

600
308
15
0

1
0
204

15

0
0
0
0
0
1
0
6
1
0
0
4
22
272
0
14
810
5
10
0
0
0
0
0
0
0
1100
1158
50
0
0
0
3
0
4394
0
0
0
0
0
0
0
23
0

0
0
0
0
0
9
48
90
-1
0
0
44
127
5628
0
70
1800
2
110
0
0
0
0
1
0
0
900
192
95
0
0
0
12
0
2396
0
0
0
0
1
400
0
21
0

0
0
0
0
0
1.5
0

0
0
0
0
0

1.5
0
0
6

0
0

0
0
0
0
0
0
0

0
0
0
0

0
0
0
4.5
0
6591
0
0
0
0
0
0
0
34.5
0

0
0
0

0
0

0
0
0
0
0
-1
0
0

47 SELANG O2 DEWASA
48 TRANFUSI SET/ BLOOD ADM SET
49 UNDERPAD

1
2
3
4
5
6
7
8
9
10
11
12
13

OBAT GIGI
CAVITON/ DENTORIT
COTTON ROLL UTK GIGI
DENTIN CONDITIONER
DEVITALISASI PASTA (NON ARSEN)
EUGENOL
GLASS CEMENT 2
GLASS IONOMER CEMENT (FUJI IX)
KALSIUM HIDROKSID PASTA
KLORFENOL KAMFER MENTOL (CHKM)
MUMMIFYING PASTA
SEMEN SENG FOSFAT SERBUK DAN CAIRAN
SPON GELATIN CUBICLES 1 X 1 X 1 CM
TEMPORARY STOPING FLETCHER

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

OBAT PROGRAM
DOKSISIKLIN TABLET 100 MG
ETAMBUTOL TABLET 500 MG
EVAVIRENZ
KLOROKUIN TABLET 150 MG
KOMB. ARTESUNATE 50 MG + AMODIAQUIN 150
KOMB.ZIDOVUDIN+LAMIVUDIN
KUININ (KINA) INJEKSI
KUININ (KINA) TABLET 200 MG
LEVOTHYROXINE 100
OAT FDC I
OAT FDC II
OAT Kombipak Kategori I
OBAT ANTI TUBERKOLOSIS ANAK
PRIMAQUIN 15 MG TABLET
PROKAIN PENISILIN FORTIFIEE 4 MUI
RETINOL (VIT.A) KAPSUL LUNAK 100.000 IU
RETINOL (VIT.A) KAPSUL LUNAK 200.000 IU
RIFAMPISIN KAPSUL 300 MG
RIFAMPISIN KAPSUL 450 MG
STREPTOMYCIN INJEKSI

Buah
Buah
Buah

Botol
Bungkus
Botol
Botol
Botol
Set
Set
Tube
Botol
Set
Set
Kotak
Set

Tablet
Tablet
Tablet
Tablet
Kotak
Kotak
Ampul
Tablet
Tablet
Paket
Paket
Paket
Paket
Tablet
Vial
Kapsul
Kapsul
Kapsul
Kapsul
Vial

0
0
0

0
0

0
0
0
0
0
0
0
0
0
0
0
0
0

296

300
1350

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
596
1350
0
0
0

0
0
5

20

0
0
25
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
-20
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
596
1350
0
0
0

0
0
37.5
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
-1350
0
0
0

OBAT LAIN
B.COM.INJEKSI
PLESTER HIPAVIK

KUNJUNGAN RESEP
BAYAR
TIDAK BAYAR
ASKES
TOTAL

0
0

0
0

0
0
0
0
0

0
0

0
0

0
0
0
0
0

0
0
0
0
0

0
0
0
0
0

490
853
10
1353

Mengetahui/ Menyetujui
Kepala Dinas Kesehatan Kab. Banjarnegara

Yang Menyerahkan
Kepala UPOPPK

Yang Meminta
Kepala Puskesmas

Yang Menerima
Petugas Puskesmas

.......................................
NIP.

..............................
NIP.

AGUS SAPTA EKA WALUYA,S.KM

...........................
NIP.197108181996031003

SUSANTI TRIWIYANTI
...........................
NIP.197703052008012009

0
0
0
0
0