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
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52

NAMA OBAT

SATUAN

Air raksa Dental Use

Alat Suntik 1 ml
Alat Suntik 2,5 ml
Allopurinol 100 mg

Botol
Set
Set
Tablet

Ambroxol syr

Botol

Aminofillin 200 mg
Aminofillin Inj
Amoksillin Sir kering 125 mg/5ml
Amoksisillin 250 mg
Amoksisillin 500 mg
Antalgin 500 mg
Antalgin Injeksi
Antasida DOEN
Anti Fungi doen
Anti Haemoroid
Aqua Pro Injeksi 20 ml
Asam Ascorbat 50 mg
Asam Mefenamat 500 mg
Asetosal 500 mg
Betason cream 5 g
Captropil 25 mg
Catgut 2/0 - 3/0

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

Cefadroxil

Kapsul

Cimetidin
Cyprofloksasin
Deksamethason 0,5 mg
Deksamethason inj 5 mg/ml
Dekstran 70 lar Infus 6%
Dekstromethorfan Sir 10mg/5ml
Dekstrometorfan 15 mg
Diazepam 2 mg
Diazepam Injeksi 5 mg
Difenhidramin inj 10mg/ml-1ml
Digoksin 0,25 mg
Efedrin HCl 25 mg
Epinefrin HCl Injeksi
Etakridini Larutan
Etanol 70 %
Etil Klorida Semprot 100 ml
Extrak Belladon
Fenobarbital 30 mg
Fenobarbital Injeksi 50 mg/ml
Fenoksimetil Penisillin 250 mg
Fenoksimetil Penisillin 500 mg
Fenol Gliserol Tts Telinga 10%
Fitomenadion 10 mg
Fitomenadion Injeksi
Furosemid 40 mg
Gameksan Emulsi 1%
Garam Oralit 200 ml

Tablet
Tablet
Tablet
Ampul
Botol
Botol
Tablet
Tablet
Ampul
Ampul
Tablet
Tablet
Ampul
Botol
Botol
Botol
Tablet
Tablet
Ampul
Tablet
Tablet
Botol
Tablet
Ampul
Tablet
Botol
Sachet

Gentamicin cream

Tube

Gentian Violet 10 ml

Botol

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
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

Glass ionomer Cement

Glibenklamid 5 mg
Gliseril Guayacolat
Gliserin 100 ml
Glucosa Larutan infus 5%
Griseofulvin 125 mg
Haloperidol 1,5 mg
Hidrocortison Cream 2,5%
Hidroklorotiazid 25 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Infus Set Dewasa
Isoniazid 300 mg
Isosorbid Dinitrat 5 mg
Kalsium Hidroksida Pasta
Kalsium Laktas 500 mg
Kapas pembalut 250 gram
Karbamazepin 200 mg
Kasa Pembalut 4m x15 cm
Kloramfenicol 250 mg
Kloramfenicol Salep Mata 1%
Kloramfenicol Tetes telinga 3%
Klorfeniramin Maleat 4 mg
Klorpromazin HCl 100 mg
Klorpromazin HCl 25 mg
Kodein HCl 10 mg
Kotrimoksasol suspensi
Kotrimoksasol tab 400 mg
Lidocain Injeksi
Lisol 100 ml
Magnesium Sulfat Inj[IV] 40%
Mebendazol 100 mg
Methilergometrin 0,125 g
Metilergometrin Inj 0,200 mg/ml
Metronidazole 250 mg

Set
Tablet
Tablet
Botol
Botol
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Set
Tablet
Tablet
Kotak
Tablet
Bks
Tablet
Rol
Kapsul
Tube
Botol
Tablet
Tablet
Tablet
Tablet
Botol
Tablet
Ampul
Botol
Vial
Tablet
Tablet
Ampul
Tablet

Miconazol Cream
Mulsanol Syr

Tube
Botol

Mummifying Pasta
Natrium Bicarbonat 500 mg
Natrium Chlorida Lar Infus 0,9%
Neo Diaform

Botol
Tablet
Botol
Tablet

Nifedipin

Tablet

Nistatin 100000 IU/gram

Obat Batuk Hitam 100 ml
Oksitetracyclin inj 50 mg/ml
Oksitetrasiklin HCl Salep 3%
Oksitetrasiklin HCl Slp Mata 1%
Oksitosin Injeksi 10 IU/ml
Paracetamol 500 mg
Paracetamol Sirup 60 ml

Tablet
Botol
Ampul
Tube
Tube
Ampul
Tablet
Botol

Pehavral

Tablet

Pirantel Pamoat 365 mg

Piridoksin HCl 10 mg

Tablet
Tablet

106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130

Plester 5 yard x 2 inch

Povidon Iodida 10%-30 ml
Povidon Iodida 10%-300 ml
Prednison 5 mg
Propanolol HCl 40 mg
Propil Tiourasil 100 mg

Rol
Botol
Botol
Tablet
Tablet
Tablet

Ranitidine

Tablet

Reserpin 0,25 mg
Rifampisin 450 mg
Ringer Laktas Lar Infus Steril
Salbutamol 2 mg
Salep 24
Salisil Bedak 2 %
Serum anti tetanus 1.500 IU
Sianokobalamin (vit B12) inj
Silk [Benang Bedah Sutra] 3/0
Silver amalgam serbuk 65-75%
Sulfacetamid Tetes Mata 5 ml
Tablet Tambah Darah
Tetrasiklin HCl 250 mg
Tetrasiklin HCl 500 mg
Thiamini HCl 50 mg
Thiamini HCl Injeksi 100mg/ml
Triheksifenidil HCl 2 mg
Vitamin B Complek

Tablet
Kapsul
Botol
Tablet
Pot
Kotak
Ampul
Ampul
Sachet
Botol
Botol
Tablet
Kapsul
Kapsul
Tablet
Ampul
Tablet
Tablet

SURAT BUKTI BARANG KELUAR

NO
DISERAHKAN KEPADA
DARI
TANGGAL

PUSTU BENDA
GUDANG OBAT PKM CICURUG
2 S/D 31 JANUARI 2010

NAMA, BENTUK DAN KADAR

NO

SATUAN

PERMINTAAN

PEMBERIAN

OBAT
1 Air raksa Dental Use

Botol

2 Alat Suntik 1 ml

Set

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

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

Alat Suntik 2,5 ml

Allopurinol 100 mg
Ambroxol syr
Aminofillin 200 mg
Aminofillin Inj
Amoksillin Sir kering 125 mg/5ml
Amoksisillin 250 mg
Amoksisillin 500 mg
Antalgin 500 mg
Antalgin Injeksi
Antasida DOEN
Anti Fungi doen
Anti Haemoroid
Aqua Pro Injeksi 20 ml
Asam Ascorbat 50 mg
Asam Mefenamat 500 mg
Asetosal 500 mg
Betason cream 5 g
Captropil 25 mg
Catgut 2/0 - 3/0
Cefadroxil
Cimetidin
Cyprofloksasin
Deksamethason 0,5 mg
Deksamethason inj 5 mg/ml
Dekstran 70 lar Infus 6%
Dekstromethorfan Sir 10mg/5ml
Dekstrometorfan 15 mg
Diazepam 2 mg
Diazepam Injeksi 5 mg
Difenhidramin inj 10mg/ml-1ml
Digoksin 0,25 mg
Efedrin HCl 25 mg
Epinefrin HCl Injeksi
Etakridini Larutan
Etanol 70 %
Etil Klorida Semprot 100 ml
Extrak Belladon

Set
Tablet
Botol
Tablet
Ampul
Botol
Kapsul
Kaplet
Tablet
Ampul
Tablet
Pot
Supp
Vial
Tablet
Kaplet
Tablet
Tube
Tablet
Sachet
Kapsul
Tablet
Tablet
Tablet
Ampul
Botol
Botol
Tablet
Tablet
Ampul
Ampul
Tablet
Tablet
Ampul
Botol
Botol
Botol
Tablet

KET

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
80
81
82
83
84
85
86
87
88
89
90

Fenobarbital 30 mg
Fenobarbital Injeksi 50 mg/ml
Fenoksimetil Penisillin 250 mg
Fenoksimetil Penisillin 500 mg
Fenol Gliserol Tts Telinga 10%
Fitomenadion 10 mg
Fitomenadion Injeksi
Furosemid 40 mg
Gameksan Emulsi 1%
Garam Oralit 200 ml
Gentamicin cream
Gentian Violet 10 ml
Glass ionomer Cement
Glibenklamid 5 mg
Gliseril Guayacolat
Gliserin 100 ml
Glucosa Larutan infus 5%
Griseofulvin 125 mg
Haloperidol 1,5 mg
Hidrocortison Cream 2,5%
Hidroklorotiazid 25 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Infus Set Dewasa
Isoniazid 300 mg
Isosorbid Dinitrat 5 mg
Kalsium Hidroksida Pasta
Kalsium Laktas 500 mg
Kapas pembalut 250 gram
Karbamazepin 200 mg
Kasa Pembalut 4m x15 cm
Kloramfenicol 250 mg
Kloramfenicol Salep Mata 1%
Kloramfenicol Tetes telinga 3%
Klorfeniramin Maleat 4 mg
Klorpromazin HCl 100 mg
Klorpromazin HCl 25 mg
Kodein HCl 10 mg
Kotrimoksasol suspensi
Kotrimoksasol tab 400 mg
Lidocain Injeksi
Lisol 100 ml
Magnesium Sulfat Inj[IV] 40%
Mebendazol 100 mg
Methilergometrin 0,125 g
Metilergometrin Inj 0,200 mg/ml
Metronidazole 250 mg
Miconazol Cream
Mulsanol Syr
Mummifying Pasta

Tablet
Ampul
Tablet
Tablet
Botol
Tablet
Ampul
Tablet
Botol
Sachet
Tube
Botol
Set
Tablet
Tablet
Botol
Botol
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Set
Tablet
Tablet
Kotak
Tablet
Bks
Tablet
Rol
Kapsul
Tube
Botol
Tablet
Tablet
Tablet
Tablet
Botol
Tablet
Ampul
Botol
Vial
Tablet
Tablet
Ampul
Tablet
Tube
Botol
Botol

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

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

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
124
125
126
127
128
129
130

Natrium Bicarbonat 500 mg

Natrium Chlorida Lar Infus 0,9%
Neo Diaform
Nifedipin
Nistatin 100000 IU/gram
Obat Batuk Hitam 100 ml
Oksitetracyclin inj 50 mg/ml
Oksitetrasiklin HCl Salep 3%
Oksitetrasiklin HCl Slp Mata 1%
Oksitosin Injeksi 10 IU/ml
Paracetamol 500 mg
Paracetamol Sirup 60 ml
Pehavral
Pirantel Pamoat 365 mg
Piridoksin HCl 10 mg
Plester 5 yard x 2 inch
Povidon Iodida 10%-30 ml
Povidon Iodida 10%-300 ml
Prednison 5 mg
Propanolol HCl 40 mg
Propil Tiourasil 100 mg
Ranitidine
Reserpin 0,25 mg
Rifampisin 450 mg
Ringer Laktas Lar Infus Steril
Salbutamol 2 mg
Salep 24
Salisil Bedak 2 %
Serum anti tetanus 1.500 IU
Sianokobalamin (vit B12) inj
Silk [Benang Bedah Sutra] 3/0
Silver amalgam serbuk 65-75%
Sulfacetamid Tetes Mata 5 ml
Tablet Tambah Darah
Tetrasiklin HCl 250 mg
Tetrasiklin HCl 500 mg
Thiamini HCl 50 mg
Thiamini HCl Injeksi 100mg/ml
Triheksifenidil HCl 2 mg
Vitamin B Complek

Tablet
Botol
Tablet
Tablet
Tablet
Botol
Ampul
Tube
Tube
Ampul
Tablet
Botol
Tablet
Tablet
Tablet
Rol
Botol
Botol
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Botol
Tablet
Pot
Kotak
Ampul
Ampul
Sachet
Botol
Botol
Tablet
Kapsul
Kapsul
Tablet
Ampul
Tablet
Tablet

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

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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 memberikan

yg menerima,

drs. Sudarmono, Apt. MARS.

NIP. 140 278 442

Hasim
NIP. 140 309 073
mengetahui/menyetujui
Ka PKM Cicurug

dr. TeddyMulyadi S
NIP 480 132 468

SURAT BUKTI BARANG KELUAR

NO
DISERAHKAN KEPADA
DARI
TANGGAL

PUSTU BENDA
GUDANG OBAT PKM CICURUG
2 S/D 31FEBRUARI 2010

NAMA, BENTUK DAN KADAR

NO

SATUAN

PERMINTAAN

PEMBERIAN

OBAT
1 Air raksa Dental Use

Botol

2 Alat Suntik 1 ml

Set

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

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

Alat Suntik 2,5 ml

Allopurinol 100 mg
Ambroxol syr
Aminofillin 200 mg
Aminofillin Inj
Amoksillin Sir kering 125 mg/5ml
Amoksisillin 250 mg
Amoksisillin 500 mg
Antalgin 500 mg
Antalgin Injeksi
Antasida DOEN
Anti Fungi doen
Anti Haemoroid
Aqua Pro Injeksi 20 ml
Asam Ascorbat 50 mg
Asam Mefenamat 500 mg
Asetosal 500 mg
Betason cream 5 g
Captropil 25 mg
Catgut 2/0 - 3/0
Cefadroxil
Cimetidin
Cyprofloksasin
Deksamethason 0,5 mg
Deksamethason inj 5 mg/ml
Dekstran 70 lar Infus 6%
Dekstromethorfan Sir 10mg/5ml
Dekstrometorfan 15 mg
Diazepam 2 mg
Diazepam Injeksi 5 mg
Difenhidramin inj 10mg/ml-1ml
Digoksin 0,25 mg
Efedrin HCl 25 mg
Epinefrin HCl Injeksi
Etakridini Larutan
Etanol 70 %
Etil Klorida Semprot 100 ml
Extrak Belladon

Set
Tablet
Botol
Tablet
Ampul
Botol
Kapsul
Kaplet
Tablet
Ampul
Tablet
Pot
Supp
Vial
Tablet
Kaplet
Tablet
Tube
Tablet
Sachet
Kapsul
Tablet
Tablet
Tablet
Ampul
Botol
Botol
Tablet
Tablet
Ampul
Ampul
Tablet
Tablet
Ampul
Botol
Botol
Botol
Tablet

KET

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
80
81
82
83
84
85
86
87
88
89
90

Fenobarbital 30 mg
Fenobarbital Injeksi 50 mg/ml
Fenoksimetil Penisillin 250 mg
Fenoksimetil Penisillin 500 mg
Fenol Gliserol Tts Telinga 10%
Fitomenadion 10 mg
Fitomenadion Injeksi
Furosemid 40 mg
Gameksan Emulsi 1%
Garam Oralit 200 ml
Gentamicin cream
Gentian Violet 10 ml
Glass ionomer Cement
Glibenklamid 5 mg
Gliseril Guayacolat
Gliserin 100 ml
Glucosa Larutan infus 5%
Griseofulvin 125 mg
Haloperidol 1,5 mg
Hidrocortison Cream 2,5%
Hidroklorotiazid 25 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Infus Set Dewasa
Isoniazid 300 mg
Isosorbid Dinitrat 5 mg
Kalsium Hidroksida Pasta
Kalsium Laktas 500 mg
Kapas pembalut 250 gram
Karbamazepin 200 mg
Kasa Pembalut 4m x15 cm
Kloramfenicol 250 mg
Kloramfenicol Salep Mata 1%
Kloramfenicol Tetes telinga 3%
Klorfeniramin Maleat 4 mg
Klorpromazin HCl 100 mg
Klorpromazin HCl 25 mg
Kodein HCl 10 mg
Kotrimoksasol suspensi
Kotrimoksasol tab 400 mg
Lidocain Injeksi
Lisol 100 ml
Magnesium Sulfat Inj[IV] 40%
Mebendazol 100 mg
Methilergometrin 0,125 g
Metilergometrin Inj 0,200 mg/ml
Metronidazole 250 mg
Miconazol Cream
Mulsanol Syr
Mummifying Pasta

Tablet
Ampul
Tablet
Tablet
Botol
Tablet
Ampul
Tablet
Botol
Sachet
Tube
Botol
Set
Tablet
Tablet
Botol
Botol
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Set
Tablet
Tablet
Kotak
Tablet
Bks
Tablet
Rol
Kapsul
Tube
Botol
Tablet
Tablet
Tablet
Tablet
Botol
Tablet
Ampul
Botol
Vial
Tablet
Tablet
Ampul
Tablet
Tube
Botol
Botol

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

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

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
124
125
126
127
128
129
130

Natrium Bicarbonat 500 mg

Natrium Chlorida Lar Infus 0,9%
Neo Diaform
Nifedipin
Nistatin 100000 IU/gram
Obat Batuk Hitam 100 ml
Oksitetracyclin inj 50 mg/ml
Oksitetrasiklin HCl Salep 3%
Oksitetrasiklin HCl Slp Mata 1%
Oksitosin Injeksi 10 IU/ml
Paracetamol 500 mg
Paracetamol Sirup 60 ml
Pehavral
Pirantel Pamoat 365 mg
Piridoksin HCl 10 mg
Plester 5 yard x 2 inch
Povidon Iodida 10%-30 ml
Povidon Iodida 10%-300 ml
Prednison 5 mg
Propanolol HCl 40 mg
Propil Tiourasil 100 mg
Ranitidine
Reserpin 0,25 mg
Rifampisin 450 mg
Ringer Laktas Lar Infus Steril
Salbutamol 2 mg
Salep 24
Salisil Bedak 2 %
Serum anti tetanus 1.500 IU
Sianokobalamin (vit B12) inj
Silk [Benang Bedah Sutra] 3/0
Silver amalgam serbuk 65-75%
Sulfacetamid Tetes Mata 5 ml
Tablet Tambah Darah
Tetrasiklin HCl 250 mg
Tetrasiklin HCl 500 mg
Thiamini HCl 50 mg
Thiamini HCl Injeksi 100mg/ml
Triheksifenidil HCl 2 mg
Vitamin B Complek

Tablet
Botol
Tablet
Tablet
Tablet
Botol
Ampul
Tube
Tube
Ampul
Tablet
Botol
Tablet
Tablet
Tablet
Rol
Botol
Botol
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Botol
Tablet
Pot
Kotak
Ampul
Ampul
Sachet
Botol
Botol
Tablet
Kapsul
Kapsul
Tablet
Ampul
Tablet
Tablet

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

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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 memberikan

yg menerima,

drs. Sudarmono, Apt. MARS.

NIP. 140 278 442

Hasim
NIP. 140 309 073
mengetahui/menyetujui
Ka PKM Cicurug

dr. TeddyMulyadi S
NIP 480 132 468

SURAT BUKTI BARANG KELUAR

NO
DISERAHKAN KEPADA
DARI
TANGGAL

PUSTU BENDA
GUDANG OBAT PKM CICURUG
2 S/D 31 MARET 2010

NAMA, BENTUK DAN KADAR

NO

SATUAN

PERMINTAAN

PEMBERIAN

OBAT
1 Air raksa Dental Use

Botol

2 Alat Suntik 1 ml

Set

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

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

Alat Suntik 2,5 ml

Allopurinol 100 mg
Ambroxol syr
Aminofillin 200 mg
Aminofillin Inj
Amoksillin Sir kering 125 mg/5ml
Amoksisillin 250 mg
Amoksisillin 500 mg
Antalgin 500 mg
Antalgin Injeksi
Antasida DOEN
Anti Fungi doen
Anti Haemoroid
Aqua Pro Injeksi 20 ml
Asam Ascorbat 50 mg
Asam Mefenamat 500 mg
Asetosal 500 mg
Betason cream 5 g
Captropil 25 mg
Catgut 2/0 - 3/0
Cefadroxil
Cimetidin
Cyprofloksasin
Deksamethason 0,5 mg
Deksamethason inj 5 mg/ml
Dekstran 70 lar Infus 6%
Dekstromethorfan Sir 10mg/5ml
Dekstrometorfan 15 mg
Diazepam 2 mg
Diazepam Injeksi 5 mg
Difenhidramin inj 10mg/ml-1ml
Digoksin 0,25 mg
Efedrin HCl 25 mg
Epinefrin HCl Injeksi
Etakridini Larutan
Etanol 70 %
Etil Klorida Semprot 100 ml
Extrak Belladon

Set
Tablet
Botol
Tablet
Ampul
Botol
Kapsul
Kaplet
Tablet
Ampul
Tablet
Pot
Supp
Vial
Tablet
Kaplet
Tablet
Tube
Tablet
Sachet
Kapsul
Tablet
Tablet
Tablet
Ampul
Botol
Botol
Tablet
Tablet
Ampul
Ampul
Tablet
Tablet
Ampul
Botol
Botol
Botol
Tablet

KET

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
80
81
82
83
84
85
86
87
88
89
90

Fenobarbital 30 mg
Fenobarbital Injeksi 50 mg/ml
Fenoksimetil Penisillin 250 mg
Fenoksimetil Penisillin 500 mg
Fenol Gliserol Tts Telinga 10%
Fitomenadion 10 mg
Fitomenadion Injeksi
Furosemid 40 mg
Gameksan Emulsi 1%
Garam Oralit 200 ml
Gentamicin cream
Gentian Violet 10 ml
Glass ionomer Cement
Glibenklamid 5 mg
Gliseril Guayacolat
Gliserin 100 ml
Glucosa Larutan infus 5%
Griseofulvin 125 mg
Haloperidol 1,5 mg
Hidrocortison Cream 2,5%
Hidroklorotiazid 25 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Infus Set Dewasa
Isoniazid 300 mg
Isosorbid Dinitrat 5 mg
Kalsium Hidroksida Pasta
Kalsium Laktas 500 mg
Kapas pembalut 250 gram
Karbamazepin 200 mg
Kasa Pembalut 4m x15 cm
Kloramfenicol 250 mg
Kloramfenicol Salep Mata 1%
Kloramfenicol Tetes telinga 3%
Klorfeniramin Maleat 4 mg
Klorpromazin HCl 100 mg
Klorpromazin HCl 25 mg
Kodein HCl 10 mg
Kotrimoksasol suspensi
Kotrimoksasol tab 400 mg
Lidocain Injeksi
Lisol 100 ml
Magnesium Sulfat Inj[IV] 40%
Mebendazol 100 mg
Methilergometrin 0,125 g
Metilergometrin Inj 0,200 mg/ml
Metronidazole 250 mg
Miconazol Cream
Mulsanol Syr
Mummifying Pasta

Tablet
Ampul
Tablet
Tablet
Botol
Tablet
Ampul
Tablet
Botol
Sachet
Tube
Botol
Set
Tablet
Tablet
Botol
Botol
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Set
Tablet
Tablet
Kotak
Tablet
Bks
Tablet
Rol
Kapsul
Tube
Botol
Tablet
Tablet
Tablet
Tablet
Botol
Tablet
Ampul
Botol
Vial
Tablet
Tablet
Ampul
Tablet
Tube
Botol
Botol

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

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

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
124
125
126
127
128
129
130

Natrium Bicarbonat 500 mg

Natrium Chlorida Lar Infus 0,9%
Neo Diaform
Nifedipin
Nistatin 100000 IU/gram
Obat Batuk Hitam 100 ml
Oksitetracyclin inj 50 mg/ml
Oksitetrasiklin HCl Salep 3%
Oksitetrasiklin HCl Slp Mata 1%
Oksitosin Injeksi 10 IU/ml
Paracetamol 500 mg
Paracetamol Sirup 60 ml
Pehavral
Pirantel Pamoat 365 mg
Piridoksin HCl 10 mg
Plester 5 yard x 2 inch
Povidon Iodida 10%-30 ml
Povidon Iodida 10%-300 ml
Prednison 5 mg
Propanolol HCl 40 mg
Propil Tiourasil 100 mg
Ranitidine
Reserpin 0,25 mg
Rifampisin 450 mg
Ringer Laktas Lar Infus Steril
Salbutamol 2 mg
Salep 24
Salisil Bedak 2 %
Serum anti tetanus 1.500 IU
Sianokobalamin (vit B12) inj
Silk [Benang Bedah Sutra] 3/0
Silver amalgam serbuk 65-75%
Sulfacetamid Tetes Mata 5 ml
Tablet Tambah Darah
Tetrasiklin HCl 250 mg
Tetrasiklin HCl 500 mg
Thiamini HCl 50 mg
Thiamini HCl Injeksi 100mg/ml
Triheksifenidil HCl 2 mg
Vitamin B Complek

Tablet
Botol
Tablet
Tablet
Tablet
Botol
Ampul
Tube
Tube
Ampul
Tablet
Botol
Tablet
Tablet
Tablet
Rol
Botol
Botol
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Botol
Tablet
Pot
Kotak
Ampul
Ampul
Sachet
Botol
Botol
Tablet
Kapsul
Kapsul
Tablet
Ampul
Tablet
Tablet

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

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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 memberikan

yg menerima,

drs. Sudarmono, Apt. MARS.

NIP. 140 278 442

Hasim
NIP. 140 309 073
mengetahui/menyetujui
Ka PKM Cicurug

dr. TeddyMulyadi S
NIP 480 132 468

SURAT BUKTI BARANG KELUAR

NO
DISERAHKAN KEPADA
DARI
TANGGAL

PUSTU BENDA
GUDANG OBAT PKM CICURUG
2 S/D 31 APRIL 2010

NAMA, BENTUK DAN KADAR

NO

SATUAN

PERMINTAAN

PEMBERIAN

OBAT
1 Air raksa Dental Use

Botol

2 Alat Suntik 1 ml

Set

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

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

Alat Suntik 2,5 ml

Allopurinol 100 mg
Ambroxol syr
Aminofillin 200 mg
Aminofillin Inj
Amoksillin Sir kering 125 mg/5ml
Amoksisillin 250 mg
Amoksisillin 500 mg
Antalgin 500 mg
Antalgin Injeksi
Antasida DOEN
Anti Fungi doen
Anti Haemoroid
Aqua Pro Injeksi 20 ml
Asam Ascorbat 50 mg
Asam Mefenamat 500 mg
Asetosal 500 mg
Betason cream 5 g
Captropil 25 mg
Catgut 2/0 - 3/0
Cefadroxil
Cimetidin
Cyprofloksasin
Deksamethason 0,5 mg
Deksamethason inj 5 mg/ml
Dekstran 70 lar Infus 6%
Dekstromethorfan Sir 10mg/5ml
Dekstrometorfan 15 mg
Diazepam 2 mg
Diazepam Injeksi 5 mg
Difenhidramin inj 10mg/ml-1ml
Digoksin 0,25 mg
Efedrin HCl 25 mg
Epinefrin HCl Injeksi
Etakridini Larutan
Etanol 70 %
Etil Klorida Semprot 100 ml
Extrak Belladon

Set
Tablet
Botol
Tablet
Ampul
Botol
Kapsul
Kaplet
Tablet
Ampul
Tablet
Pot
Supp
Vial
Tablet
Kaplet
Tablet
Tube
Tablet
Sachet
Kapsul
Tablet
Tablet
Tablet
Ampul
Botol
Botol
Tablet
Tablet
Ampul
Ampul
Tablet
Tablet
Ampul
Botol
Botol
Botol
Tablet

KET

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
80
81
82
83
84
85
86
87
88
89
90

Fenobarbital 30 mg
Fenobarbital Injeksi 50 mg/ml
Fenoksimetil Penisillin 250 mg
Fenoksimetil Penisillin 500 mg
Fenol Gliserol Tts Telinga 10%
Fitomenadion 10 mg
Fitomenadion Injeksi
Furosemid 40 mg
Gameksan Emulsi 1%
Garam Oralit 200 ml
Gentamicin cream
Gentian Violet 10 ml
Glass ionomer Cement
Glibenklamid 5 mg
Gliseril Guayacolat
Gliserin 100 ml
Glucosa Larutan infus 5%
Griseofulvin 125 mg
Haloperidol 1,5 mg
Hidrocortison Cream 2,5%
Hidroklorotiazid 25 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Infus Set Dewasa
Isoniazid 300 mg
Isosorbid Dinitrat 5 mg
Kalsium Hidroksida Pasta
Kalsium Laktas 500 mg
Kapas pembalut 250 gram
Karbamazepin 200 mg
Kasa Pembalut 4m x15 cm
Kloramfenicol 250 mg
Kloramfenicol Salep Mata 1%
Kloramfenicol Tetes telinga 3%
Klorfeniramin Maleat 4 mg
Klorpromazin HCl 100 mg
Klorpromazin HCl 25 mg
Kodein HCl 10 mg
Kotrimoksasol suspensi
Kotrimoksasol tab 400 mg
Lidocain Injeksi
Lisol 100 ml
Magnesium Sulfat Inj[IV] 40%
Mebendazol 100 mg
Methilergometrin 0,125 g
Metilergometrin Inj 0,200 mg/ml
Metronidazole 250 mg
Miconazol Cream
Mulsanol Syr
Mummifying Pasta

Tablet
Ampul
Tablet
Tablet
Botol
Tablet
Ampul
Tablet
Botol
Sachet
Tube
Botol
Set
Tablet
Tablet
Botol
Botol
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Set
Tablet
Tablet
Kotak
Tablet
Bks
Tablet
Rol
Kapsul
Tube
Botol
Tablet
Tablet
Tablet
Tablet
Botol
Tablet
Ampul
Botol
Vial
Tablet
Tablet
Ampul
Tablet
Tube
Botol
Botol

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

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

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
124
125
126
127
128
129
130

Natrium Bicarbonat 500 mg

Natrium Chlorida Lar Infus 0,9%
Neo Diaform
Nifedipin
Nistatin 100000 IU/gram
Obat Batuk Hitam 100 ml
Oksitetracyclin inj 50 mg/ml
Oksitetrasiklin HCl Salep 3%
Oksitetrasiklin HCl Slp Mata 1%
Oksitosin Injeksi 10 IU/ml
Paracetamol 500 mg
Paracetamol Sirup 60 ml
Pehavral
Pirantel Pamoat 365 mg
Piridoksin HCl 10 mg
Plester 5 yard x 2 inch
Povidon Iodida 10%-30 ml
Povidon Iodida 10%-300 ml
Prednison 5 mg
Propanolol HCl 40 mg
Propil Tiourasil 100 mg
Ranitidine
Reserpin 0,25 mg
Rifampisin 450 mg
Ringer Laktas Lar Infus Steril
Salbutamol 2 mg
Salep 24
Salisil Bedak 2 %
Serum anti tetanus 1.500 IU
Sianokobalamin (vit B12) inj
Silk [Benang Bedah Sutra] 3/0
Silver amalgam serbuk 65-75%
Sulfacetamid Tetes Mata 5 ml
Tablet Tambah Darah
Tetrasiklin HCl 250 mg
Tetrasiklin HCl 500 mg
Thiamini HCl 50 mg
Thiamini HCl Injeksi 100mg/ml
Triheksifenidil HCl 2 mg
Vitamin B Complek

Tablet
Botol
Tablet
Tablet
Tablet
Botol
Ampul
Tube
Tube
Ampul
Tablet
Botol
Tablet
Tablet
Tablet
Rol
Botol
Botol
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Botol
Tablet
Pot
Kotak
Ampul
Ampul
Sachet
Botol
Botol
Tablet
Kapsul
Kapsul
Tablet
Ampul
Tablet
Tablet

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

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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 memberikan

yg menerima,

drs. Sudarmono, Apt. MARS.

NIP. 140 278 442

Hasim
NIP. 140 309 073
mengetahui/menyetujui
Ka PKM Cicurug

dr. TeddyMulyadi S
NIP 480 132 468

SURAT BUKTI BARANG KELUAR

NO
DISERAHKAN KEPADA
DARI
TANGGAL

PUSTU BENDA
GUDANG OBAT PKM CICURUG
2 S/D 31 MEI 2010

NAMA, BENTUK DAN KADAR

NO

SATUAN

PERMINTAAN

PEMBERIAN

OBAT
1 Air raksa Dental Use

Botol

2 Alat Suntik 1 ml

Set

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

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

Alat Suntik 2,5 ml

Allopurinol 100 mg
Ambroxol syr
Aminofillin 200 mg
Aminofillin Inj
Amoksillin Sir kering 125 mg/5ml
Amoksisillin 250 mg
Amoksisillin 500 mg
Antalgin 500 mg
Antalgin Injeksi
Antasida DOEN
Anti Fungi doen
Anti Haemoroid
Aqua Pro Injeksi 20 ml
Asam Ascorbat 50 mg
Asam Mefenamat 500 mg
Asetosal 500 mg
Betason cream 5 g
Captropil 25 mg
Catgut 2/0 - 3/0
Cefadroxil
Cimetidin
Cyprofloksasin
Deksamethason 0,5 mg
Deksamethason inj 5 mg/ml
Dekstran 70 lar Infus 6%
Dekstromethorfan Sir 10mg/5ml
Dekstrometorfan 15 mg
Diazepam 2 mg
Diazepam Injeksi 5 mg
Difenhidramin inj 10mg/ml-1ml
Digoksin 0,25 mg
Efedrin HCl 25 mg
Epinefrin HCl Injeksi
Etakridini Larutan
Etanol 70 %
Etil Klorida Semprot 100 ml
Extrak Belladon

Set
Tablet
Botol
Tablet
Ampul
Botol
Kapsul
Kaplet
Tablet
Ampul
Tablet
Pot
Supp
Vial
Tablet
Kaplet
Tablet
Tube
Tablet
Sachet
Kapsul
Tablet
Tablet
Tablet
Ampul
Botol
Botol
Tablet
Tablet
Ampul
Ampul
Tablet
Tablet
Ampul
Botol
Botol
Botol
Tablet

KET

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
80
81
82
83
84
85
86
87
88
89
90

Fenobarbital 30 mg
Fenobarbital Injeksi 50 mg/ml
Fenoksimetil Penisillin 250 mg
Fenoksimetil Penisillin 500 mg
Fenol Gliserol Tts Telinga 10%
Fitomenadion 10 mg
Fitomenadion Injeksi
Furosemid 40 mg
Gameksan Emulsi 1%
Garam Oralit 200 ml
Gentamicin cream
Gentian Violet 10 ml
Glass ionomer Cement
Glibenklamid 5 mg
Gliseril Guayacolat
Gliserin 100 ml
Glucosa Larutan infus 5%
Griseofulvin 125 mg
Haloperidol 1,5 mg
Hidrocortison Cream 2,5%
Hidroklorotiazid 25 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Infus Set Dewasa
Isoniazid 300 mg
Isosorbid Dinitrat 5 mg
Kalsium Hidroksida Pasta
Kalsium Laktas 500 mg
Kapas pembalut 250 gram
Karbamazepin 200 mg
Kasa Pembalut 4m x15 cm
Kloramfenicol 250 mg
Kloramfenicol Salep Mata 1%
Kloramfenicol Tetes telinga 3%
Klorfeniramin Maleat 4 mg
Klorpromazin HCl 100 mg
Klorpromazin HCl 25 mg
Kodein HCl 10 mg
Kotrimoksasol suspensi
Kotrimoksasol tab 400 mg
Lidocain Injeksi
Lisol 100 ml
Magnesium Sulfat Inj[IV] 40%
Mebendazol 100 mg
Methilergometrin 0,125 g
Metilergometrin Inj 0,200 mg/ml
Metronidazole 250 mg
Miconazol Cream
Mulsanol Syr
Mummifying Pasta

Tablet
Ampul
Tablet
Tablet
Botol
Tablet
Ampul
Tablet
Botol
Sachet
Tube
Botol
Set
Tablet
Tablet
Botol
Botol
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Set
Tablet
Tablet
Kotak
Tablet
Bks
Tablet
Rol
Kapsul
Tube
Botol
Tablet
Tablet
Tablet
Tablet
Botol
Tablet
Ampul
Botol
Vial
Tablet
Tablet
Ampul
Tablet
Tube
Botol
Botol

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

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

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
124
125
126
127
128
129
130

Natrium Bicarbonat 500 mg

Natrium Chlorida Lar Infus 0,9%
Neo Diaform
Nifedipin
Nistatin 100000 IU/gram
Obat Batuk Hitam 100 ml
Oksitetracyclin inj 50 mg/ml
Oksitetrasiklin HCl Salep 3%
Oksitetrasiklin HCl Slp Mata 1%
Oksitosin Injeksi 10 IU/ml
Paracetamol 500 mg
Paracetamol Sirup 60 ml
Pehavral
Pirantel Pamoat 365 mg
Piridoksin HCl 10 mg
Plester 5 yard x 2 inch
Povidon Iodida 10%-30 ml
Povidon Iodida 10%-300 ml
Prednison 5 mg
Propanolol HCl 40 mg
Propil Tiourasil 100 mg
Ranitidine
Reserpin 0,25 mg
Rifampisin 450 mg
Ringer Laktas Lar Infus Steril
Salbutamol 2 mg
Salep 24
Salisil Bedak 2 %
Serum anti tetanus 1.500 IU
Sianokobalamin (vit B12) inj
Silk [Benang Bedah Sutra] 3/0
Silver amalgam serbuk 65-75%
Sulfacetamid Tetes Mata 5 ml
Tablet Tambah Darah
Tetrasiklin HCl 250 mg
Tetrasiklin HCl 500 mg
Thiamini HCl 50 mg
Thiamini HCl Injeksi 100mg/ml
Triheksifenidil HCl 2 mg
Vitamin B Complek

Tablet
Botol
Tablet
Tablet
Tablet
Botol
Ampul
Tube
Tube
Ampul
Tablet
Botol
Tablet
Tablet
Tablet
Rol
Botol
Botol
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Botol
Tablet
Pot
Kotak
Ampul
Ampul
Sachet
Botol
Botol
Tablet
Kapsul
Kapsul
Tablet
Ampul
Tablet
Tablet

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

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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 memberikan

yg menerima,

drs. Sudarmono, Apt. MARS.

NIP. 140 278 442

Hasim
NIP. 140 309 073
mengetahui/menyetujui
Ka PKM Cicurug

dr. TeddyMulyadi S
NIP 480 132 468

SURAT BUKTI BARANG KELUAR

NO
DISERAHKAN KEPADA
DARI
TANGGAL

PUSTU BENDA
GUDANG OBAT PKM CICURUG
2 S/D 31 JUNI 2010

NAMA, BENTUK DAN KADAR

NO

SATUAN

PERMINTAAN

PEMBERIAN

OBAT
1 Air raksa Dental Use

Botol

2 Alat Suntik 1 ml

Set

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

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

Alat Suntik 2,5 ml

Allopurinol 100 mg
Ambroxol syr
Aminofillin 200 mg
Aminofillin Inj
Amoksillin Sir kering 125 mg/5ml
Amoksisillin 250 mg
Amoksisillin 500 mg
Antalgin 500 mg
Antalgin Injeksi
Antasida DOEN
Anti Fungi doen
Anti Haemoroid
Aqua Pro Injeksi 20 ml
Asam Ascorbat 50 mg
Asam Mefenamat 500 mg
Asetosal 500 mg
Betason cream 5 g
Captropil 25 mg
Catgut 2/0 - 3/0
Cefadroxil
Cimetidin
Cyprofloksasin
Deksamethason 0,5 mg
Deksamethason inj 5 mg/ml
Dekstran 70 lar Infus 6%
Dekstromethorfan Sir 10mg/5ml
Dekstrometorfan 15 mg
Diazepam 2 mg
Diazepam Injeksi 5 mg
Difenhidramin inj 10mg/ml-1ml
Digoksin 0,25 mg
Efedrin HCl 25 mg
Epinefrin HCl Injeksi
Etakridini Larutan
Etanol 70 %
Etil Klorida Semprot 100 ml
Extrak Belladon

Set
Tablet
Botol
Tablet
Ampul
Botol
Kapsul
Kaplet
Tablet
Ampul
Tablet
Pot
Supp
Vial
Tablet
Kaplet
Tablet
Tube
Tablet
Sachet
Kapsul
Tablet
Tablet
Tablet
Ampul
Botol
Botol
Tablet
Tablet
Ampul
Ampul
Tablet
Tablet
Ampul
Botol
Botol
Botol
Tablet

KET

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
80
81
82
83
84
85
86
87
88
89
90

Fenobarbital 30 mg
Fenobarbital Injeksi 50 mg/ml
Fenoksimetil Penisillin 250 mg
Fenoksimetil Penisillin 500 mg
Fenol Gliserol Tts Telinga 10%
Fitomenadion 10 mg
Fitomenadion Injeksi
Furosemid 40 mg
Gameksan Emulsi 1%
Garam Oralit 200 ml
Gentamicin cream
Gentian Violet 10 ml
Glass ionomer Cement
Glibenklamid 5 mg
Gliseril Guayacolat
Gliserin 100 ml
Glucosa Larutan infus 5%
Griseofulvin 125 mg
Haloperidol 1,5 mg
Hidrocortison Cream 2,5%
Hidroklorotiazid 25 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Infus Set Dewasa
Isoniazid 300 mg
Isosorbid Dinitrat 5 mg
Kalsium Hidroksida Pasta
Kalsium Laktas 500 mg
Kapas pembalut 250 gram
Karbamazepin 200 mg
Kasa Pembalut 4m x15 cm
Kloramfenicol 250 mg
Kloramfenicol Salep Mata 1%
Kloramfenicol Tetes telinga 3%
Klorfeniramin Maleat 4 mg
Klorpromazin HCl 100 mg
Klorpromazin HCl 25 mg
Kodein HCl 10 mg
Kotrimoksasol suspensi
Kotrimoksasol tab 400 mg
Lidocain Injeksi
Lisol 100 ml
Magnesium Sulfat Inj[IV] 40%
Mebendazol 100 mg
Methilergometrin 0,125 g
Metilergometrin Inj 0,200 mg/ml
Metronidazole 250 mg
Miconazol Cream
Mulsanol Syr
Mummifying Pasta

Tablet
Ampul
Tablet
Tablet
Botol
Tablet
Ampul
Tablet
Botol
Sachet
Tube
Botol
Set
Tablet
Tablet
Botol
Botol
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Set
Tablet
Tablet
Kotak
Tablet
Bks
Tablet
Rol
Kapsul
Tube
Botol
Tablet
Tablet
Tablet
Tablet
Botol
Tablet
Ampul
Botol
Vial
Tablet
Tablet
Ampul
Tablet
Tube
Botol
Botol

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

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

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
124
125
126
127
128
129
130

Natrium Bicarbonat 500 mg

Natrium Chlorida Lar Infus 0,9%
Neo Diaform
Nifedipin
Nistatin 100000 IU/gram
Obat Batuk Hitam 100 ml
Oksitetracyclin inj 50 mg/ml
Oksitetrasiklin HCl Salep 3%
Oksitetrasiklin HCl Slp Mata 1%
Oksitosin Injeksi 10 IU/ml
Paracetamol 500 mg
Paracetamol Sirup 60 ml
Pehavral
Pirantel Pamoat 365 mg
Piridoksin HCl 10 mg
Plester 5 yard x 2 inch
Povidon Iodida 10%-30 ml
Povidon Iodida 10%-300 ml
Prednison 5 mg
Propanolol HCl 40 mg
Propil Tiourasil 100 mg
Ranitidine
Reserpin 0,25 mg
Rifampisin 450 mg
Ringer Laktas Lar Infus Steril
Salbutamol 2 mg
Salep 24
Salisil Bedak 2 %
Serum anti tetanus 1.500 IU
Sianokobalamin (vit B12) inj
Silk [Benang Bedah Sutra] 3/0
Silver amalgam serbuk 65-75%
Sulfacetamid Tetes Mata 5 ml
Tablet Tambah Darah
Tetrasiklin HCl 250 mg
Tetrasiklin HCl 500 mg
Thiamini HCl 50 mg
Thiamini HCl Injeksi 100mg/ml
Triheksifenidil HCl 2 mg
Vitamin B Complek

Tablet
Botol
Tablet
Tablet
Tablet
Botol
Ampul
Tube
Tube
Ampul
Tablet
Botol
Tablet
Tablet
Tablet
Rol
Botol
Botol
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Botol
Tablet
Pot
Kotak
Ampul
Ampul
Sachet
Botol
Botol
Tablet
Kapsul
Kapsul
Tablet
Ampul
Tablet
Tablet

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

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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 memberikan

yg menerima,

drs. Sudarmono, Apt. MARS.

NIP. 140 278 442

Hasim
NIP. 140 309 073
mengetahui/menyetujui
Ka PKM Cicurug

dr. TeddyMulyadi S
NIP 480 132 468

SURAT BUKTI BARANG KELUAR

NO
DISERAHKAN KEPADA
DARI
TANGGAL

PUSTU BENDA
GUDANG OBAT PKM CICURUG
2 S/D 31 JULI 2010

NAMA, BENTUK DAN KADAR

NO

SATUAN

PERMINTAAN

PEMBERIAN

OBAT
1 Air raksa Dental Use

Botol

2 Alat Suntik 1 ml

Set

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

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

Alat Suntik 2,5 ml

Allopurinol 100 mg
Ambroxol syr
Aminofillin 200 mg
Aminofillin Inj
Amoksillin Sir kering 125 mg/5ml
Amoksisillin 250 mg
Amoksisillin 500 mg
Antalgin 500 mg
Antalgin Injeksi
Antasida DOEN
Anti Fungi doen
Anti Haemoroid
Aqua Pro Injeksi 20 ml
Asam Ascorbat 50 mg
Asam Mefenamat 500 mg
Asetosal 500 mg
Betason cream 5 g
Captropil 25 mg
Catgut 2/0 - 3/0
Cefadroxil
Cimetidin
Cyprofloksasin
Deksamethason 0,5 mg
Deksamethason inj 5 mg/ml
Dekstran 70 lar Infus 6%
Dekstromethorfan Sir 10mg/5ml
Dekstrometorfan 15 mg
Diazepam 2 mg
Diazepam Injeksi 5 mg
Difenhidramin inj 10mg/ml-1ml
Digoksin 0,25 mg
Efedrin HCl 25 mg
Epinefrin HCl Injeksi
Etakridini Larutan
Etanol 70 %
Etil Klorida Semprot 100 ml
Extrak Belladon

Set
Tablet
Botol
Tablet
Ampul
Botol
Kapsul
Kaplet
Tablet
Ampul
Tablet
Pot
Supp
Vial
Tablet
Kaplet
Tablet
Tube
Tablet
Sachet
Kapsul
Tablet
Tablet
Tablet
Ampul
Botol
Botol
Tablet
Tablet
Ampul
Ampul
Tablet
Tablet
Ampul
Botol
Botol
Botol
Tablet

KET

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
80
81
82
83
84
85
86
87
88
89
90

Fenobarbital 30 mg
Fenobarbital Injeksi 50 mg/ml
Fenoksimetil Penisillin 250 mg
Fenoksimetil Penisillin 500 mg
Fenol Gliserol Tts Telinga 10%
Fitomenadion 10 mg
Fitomenadion Injeksi
Furosemid 40 mg
Gameksan Emulsi 1%
Garam Oralit 200 ml
Gentamicin cream
Gentian Violet 10 ml
Glass ionomer Cement
Glibenklamid 5 mg
Gliseril Guayacolat
Gliserin 100 ml
Glucosa Larutan infus 5%
Griseofulvin 125 mg
Haloperidol 1,5 mg
Hidrocortison Cream 2,5%
Hidroklorotiazid 25 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Infus Set Dewasa
Isoniazid 300 mg
Isosorbid Dinitrat 5 mg
Kalsium Hidroksida Pasta
Kalsium Laktas 500 mg
Kapas pembalut 250 gram
Karbamazepin 200 mg
Kasa Pembalut 4m x15 cm
Kloramfenicol 250 mg
Kloramfenicol Salep Mata 1%
Kloramfenicol Tetes telinga 3%
Klorfeniramin Maleat 4 mg
Klorpromazin HCl 100 mg
Klorpromazin HCl 25 mg
Kodein HCl 10 mg
Kotrimoksasol suspensi
Kotrimoksasol tab 400 mg
Lidocain Injeksi
Lisol 100 ml
Magnesium Sulfat Inj[IV] 40%
Mebendazol 100 mg
Methilergometrin 0,125 g
Metilergometrin Inj 0,200 mg/ml
Metronidazole 250 mg
Miconazol Cream
Mulsanol Syr
Mummifying Pasta

Tablet
Ampul
Tablet
Tablet
Botol
Tablet
Ampul
Tablet
Botol
Sachet
Tube
Botol
Set
Tablet
Tablet
Botol
Botol
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Set
Tablet
Tablet
Kotak
Tablet
Bks
Tablet
Rol
Kapsul
Tube
Botol
Tablet
Tablet
Tablet
Tablet
Botol
Tablet
Ampul
Botol
Vial
Tablet
Tablet
Ampul
Tablet
Tube
Botol
Botol

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

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

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
124
125
126
127
128
129
130

Natrium Bicarbonat 500 mg

Natrium Chlorida Lar Infus 0,9%
Neo Diaform
Nifedipin
Nistatin 100000 IU/gram
Obat Batuk Hitam 100 ml
Oksitetracyclin inj 50 mg/ml
Oksitetrasiklin HCl Salep 3%
Oksitetrasiklin HCl Slp Mata 1%
Oksitosin Injeksi 10 IU/ml
Paracetamol 500 mg
Paracetamol Sirup 60 ml
Pehavral
Pirantel Pamoat 365 mg
Piridoksin HCl 10 mg
Plester 5 yard x 2 inch
Povidon Iodida 10%-30 ml
Povidon Iodida 10%-300 ml
Prednison 5 mg
Propanolol HCl 40 mg
Propil Tiourasil 100 mg
Ranitidine
Reserpin 0,25 mg
Rifampisin 450 mg
Ringer Laktas Lar Infus Steril
Salbutamol 2 mg
Salep 24
Salisil Bedak 2 %
Serum anti tetanus 1.500 IU
Sianokobalamin (vit B12) inj
Silk [Benang Bedah Sutra] 3/0
Silver amalgam serbuk 65-75%
Sulfacetamid Tetes Mata 5 ml
Tablet Tambah Darah
Tetrasiklin HCl 250 mg
Tetrasiklin HCl 500 mg
Thiamini HCl 50 mg
Thiamini HCl Injeksi 100mg/ml
Triheksifenidil HCl 2 mg
Vitamin B Complek

Tablet
Botol
Tablet
Tablet
Tablet
Botol
Ampul
Tube
Tube
Ampul
Tablet
Botol
Tablet
Tablet
Tablet
Rol
Botol
Botol
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Botol
Tablet
Pot
Kotak
Ampul
Ampul
Sachet
Botol
Botol
Tablet
Kapsul
Kapsul
Tablet
Ampul
Tablet
Tablet

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

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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 memberikan

yg menerima,

drs. Sudarmono, Apt. MARS.

NIP. 140 278 442

Hasim
NIP. 140 309 073
mengetahui/menyetujui
Ka PKM Cicurug

dr. TeddyMulyadi S
NIP 480 132 468

SURAT BUKTI BARANG KELUAR

NO
DISERAHKAN KEPADA
DARI
TANGGAL

PUSTU BENDA
GUDANG OBAT PKM CICURUG
2 S/D 31 AGUSTUS 2010

NAMA, BENTUK DAN KADAR

NO

SATUAN

PERMINTAAN

PEMBERIAN

OBAT
1 Air raksa Dental Use

Botol

2 Alat Suntik 1 ml

Set

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

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

Alat Suntik 2,5 ml

Allopurinol 100 mg
Ambroxol syr
Aminofillin 200 mg
Aminofillin Inj
Amoksillin Sir kering 125 mg/5ml
Amoksisillin 250 mg
Amoksisillin 500 mg
Antalgin 500 mg
Antalgin Injeksi
Antasida DOEN
Anti Fungi doen
Anti Haemoroid
Aqua Pro Injeksi 20 ml
Asam Ascorbat 50 mg
Asam Mefenamat 500 mg
Asetosal 500 mg
Betason cream 5 g
Captropil 25 mg
Catgut 2/0 - 3/0
Cefadroxil
Cimetidin
Cyprofloksasin
Deksamethason 0,5 mg
Deksamethason inj 5 mg/ml
Dekstran 70 lar Infus 6%
Dekstromethorfan Sir 10mg/5ml
Dekstrometorfan 15 mg
Diazepam 2 mg
Diazepam Injeksi 5 mg
Difenhidramin inj 10mg/ml-1ml
Digoksin 0,25 mg
Efedrin HCl 25 mg
Epinefrin HCl Injeksi
Etakridini Larutan
Etanol 70 %
Etil Klorida Semprot 100 ml
Extrak Belladon

Set
Tablet
Botol
Tablet
Ampul
Botol
Kapsul
Kaplet
Tablet
Ampul
Tablet
Pot
Supp
Vial
Tablet
Kaplet
Tablet
Tube
Tablet
Sachet
Kapsul
Tablet
Tablet
Tablet
Ampul
Botol
Botol
Tablet
Tablet
Ampul
Ampul
Tablet
Tablet
Ampul
Botol
Botol
Botol
Tablet

KET

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
80
81
82
83
84
85
86
87
88
89
90

Fenobarbital 30 mg
Fenobarbital Injeksi 50 mg/ml
Fenoksimetil Penisillin 250 mg
Fenoksimetil Penisillin 500 mg
Fenol Gliserol Tts Telinga 10%
Fitomenadion 10 mg
Fitomenadion Injeksi
Furosemid 40 mg
Gameksan Emulsi 1%
Garam Oralit 200 ml
Gentamicin cream
Gentian Violet 10 ml
Glass ionomer Cement
Glibenklamid 5 mg
Gliseril Guayacolat
Gliserin 100 ml
Glucosa Larutan infus 5%
Griseofulvin 125 mg
Haloperidol 1,5 mg
Hidrocortison Cream 2,5%
Hidroklorotiazid 25 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Infus Set Dewasa
Isoniazid 300 mg
Isosorbid Dinitrat 5 mg
Kalsium Hidroksida Pasta
Kalsium Laktas 500 mg
Kapas pembalut 250 gram
Karbamazepin 200 mg
Kasa Pembalut 4m x15 cm
Kloramfenicol 250 mg
Kloramfenicol Salep Mata 1%
Kloramfenicol Tetes telinga 3%
Klorfeniramin Maleat 4 mg
Klorpromazin HCl 100 mg
Klorpromazin HCl 25 mg
Kodein HCl 10 mg
Kotrimoksasol suspensi
Kotrimoksasol tab 400 mg
Lidocain Injeksi
Lisol 100 ml
Magnesium Sulfat Inj[IV] 40%
Mebendazol 100 mg
Methilergometrin 0,125 g
Metilergometrin Inj 0,200 mg/ml
Metronidazole 250 mg
Miconazol Cream
Mulsanol Syr
Mummifying Pasta

Tablet
Ampul
Tablet
Tablet
Botol
Tablet
Ampul
Tablet
Botol
Sachet
Tube
Botol
Set
Tablet
Tablet
Botol
Botol
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Set
Tablet
Tablet
Kotak
Tablet
Bks
Tablet
Rol
Kapsul
Tube
Botol
Tablet
Tablet
Tablet
Tablet
Botol
Tablet
Ampul
Botol
Vial
Tablet
Tablet
Ampul
Tablet
Tube
Botol
Botol

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

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

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
124
125
126
127
128
129
130

Natrium Bicarbonat 500 mg

Natrium Chlorida Lar Infus 0,9%
Neo Diaform
Nifedipin
Nistatin 100000 IU/gram
Obat Batuk Hitam 100 ml
Oksitetracyclin inj 50 mg/ml
Oksitetrasiklin HCl Salep 3%
Oksitetrasiklin HCl Slp Mata 1%
Oksitosin Injeksi 10 IU/ml
Paracetamol 500 mg
Paracetamol Sirup 60 ml
Pehavral
Pirantel Pamoat 365 mg
Piridoksin HCl 10 mg
Plester 5 yard x 2 inch
Povidon Iodida 10%-30 ml
Povidon Iodida 10%-300 ml
Prednison 5 mg
Propanolol HCl 40 mg
Propil Tiourasil 100 mg
Ranitidine
Reserpin 0,25 mg
Rifampisin 450 mg
Ringer Laktas Lar Infus Steril
Salbutamol 2 mg
Salep 24
Salisil Bedak 2 %
Serum anti tetanus 1.500 IU
Sianokobalamin (vit B12) inj
Silk [Benang Bedah Sutra] 3/0
Silver amalgam serbuk 65-75%
Sulfacetamid Tetes Mata 5 ml
Tablet Tambah Darah
Tetrasiklin HCl 250 mg
Tetrasiklin HCl 500 mg
Thiamini HCl 50 mg
Thiamini HCl Injeksi 100mg/ml
Triheksifenidil HCl 2 mg
Vitamin B Complek

Tablet
Botol
Tablet
Tablet
Tablet
Botol
Ampul
Tube
Tube
Ampul
Tablet
Botol
Tablet
Tablet
Tablet
Rol
Botol
Botol
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Botol
Tablet
Pot
Kotak
Ampul
Ampul
Sachet
Botol
Botol
Tablet
Kapsul
Kapsul
Tablet
Ampul
Tablet
Tablet

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

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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 memberikan

yg menerima,

drs. Sudarmono, Apt. MARS.

NIP. 140 278 442

Hasim
NIP. 140 309 073
mengetahui/menyetujui
Ka PKM Cicurug

dr. TeddyMulyadi S
NIP 480 132 468

SURAT BUKTI BARANG KELUAR

NO
DISERAHKAN KEPADA
DARI
TANGGAL

PUSTU BENDA
GUDANG OBAT PKM CICURUG
2 S/D 31 SEPTEMBER 2010

NAMA, BENTUK DAN KADAR

NO

SATUAN

PERMINTAAN

PEMBERIAN

OBAT
1 Air raksa Dental Use

Botol

2 Alat Suntik 1 ml

Set

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

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

Alat Suntik 2,5 ml

Allopurinol 100 mg
Ambroxol syr
Aminofillin 200 mg
Aminofillin Inj
Amoksillin Sir kering 125 mg/5ml
Amoksisillin 250 mg
Amoksisillin 500 mg
Antalgin 500 mg
Antalgin Injeksi
Antasida DOEN
Anti Fungi doen
Anti Haemoroid
Aqua Pro Injeksi 20 ml
Asam Ascorbat 50 mg
Asam Mefenamat 500 mg
Asetosal 500 mg
Betason cream 5 g
Captropil 25 mg
Catgut 2/0 - 3/0
Cefadroxil
Cimetidin
Cyprofloksasin
Deksamethason 0,5 mg
Deksamethason inj 5 mg/ml
Dekstran 70 lar Infus 6%
Dekstromethorfan Sir 10mg/5ml
Dekstrometorfan 15 mg
Diazepam 2 mg
Diazepam Injeksi 5 mg
Difenhidramin inj 10mg/ml-1ml
Digoksin 0,25 mg
Efedrin HCl 25 mg
Epinefrin HCl Injeksi
Etakridini Larutan
Etanol 70 %
Etil Klorida Semprot 100 ml
Extrak Belladon

Set
Tablet
Botol
Tablet
Ampul
Botol
Kapsul
Kaplet
Tablet
Ampul
Tablet
Pot
Supp
Vial
Tablet
Kaplet
Tablet
Tube
Tablet
Sachet
Kapsul
Tablet
Tablet
Tablet
Ampul
Botol
Botol
Tablet
Tablet
Ampul
Ampul
Tablet
Tablet
Ampul
Botol
Botol
Botol
Tablet

KET

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
80
81
82
83
84
85
86
87
88
89
90

Fenobarbital 30 mg
Fenobarbital Injeksi 50 mg/ml
Fenoksimetil Penisillin 250 mg
Fenoksimetil Penisillin 500 mg
Fenol Gliserol Tts Telinga 10%
Fitomenadion 10 mg
Fitomenadion Injeksi
Furosemid 40 mg
Gameksan Emulsi 1%
Garam Oralit 200 ml
Gentamicin cream
Gentian Violet 10 ml
Glass ionomer Cement
Glibenklamid 5 mg
Gliseril Guayacolat
Gliserin 100 ml
Glucosa Larutan infus 5%
Griseofulvin 125 mg
Haloperidol 1,5 mg
Hidrocortison Cream 2,5%
Hidroklorotiazid 25 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Infus Set Dewasa
Isoniazid 300 mg
Isosorbid Dinitrat 5 mg
Kalsium Hidroksida Pasta
Kalsium Laktas 500 mg
Kapas pembalut 250 gram
Karbamazepin 200 mg
Kasa Pembalut 4m x15 cm
Kloramfenicol 250 mg
Kloramfenicol Salep Mata 1%
Kloramfenicol Tetes telinga 3%
Klorfeniramin Maleat 4 mg
Klorpromazin HCl 100 mg
Klorpromazin HCl 25 mg
Kodein HCl 10 mg
Kotrimoksasol suspensi
Kotrimoksasol tab 400 mg
Lidocain Injeksi
Lisol 100 ml
Magnesium Sulfat Inj[IV] 40%
Mebendazol 100 mg
Methilergometrin 0,125 g
Metilergometrin Inj 0,200 mg/ml
Metronidazole 250 mg
Miconazol Cream
Mulsanol Syr
Mummifying Pasta

Tablet
Ampul
Tablet
Tablet
Botol
Tablet
Ampul
Tablet
Botol
Sachet
Tube
Botol
Set
Tablet
Tablet
Botol
Botol
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Set
Tablet
Tablet
Kotak
Tablet
Bks
Tablet
Rol
Kapsul
Tube
Botol
Tablet
Tablet
Tablet
Tablet
Botol
Tablet
Ampul
Botol
Vial
Tablet
Tablet
Ampul
Tablet
Tube
Botol
Botol

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

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

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
124
125
126
127
128
129
130

Natrium Bicarbonat 500 mg

Natrium Chlorida Lar Infus 0,9%
Neo Diaform
Nifedipin
Nistatin 100000 IU/gram
Obat Batuk Hitam 100 ml
Oksitetracyclin inj 50 mg/ml
Oksitetrasiklin HCl Salep 3%
Oksitetrasiklin HCl Slp Mata 1%
Oksitosin Injeksi 10 IU/ml
Paracetamol 500 mg
Paracetamol Sirup 60 ml
Pehavral
Pirantel Pamoat 365 mg
Piridoksin HCl 10 mg
Plester 5 yard x 2 inch
Povidon Iodida 10%-30 ml
Povidon Iodida 10%-300 ml
Prednison 5 mg
Propanolol HCl 40 mg
Propil Tiourasil 100 mg
Ranitidine
Reserpin 0,25 mg
Rifampisin 450 mg
Ringer Laktas Lar Infus Steril
Salbutamol 2 mg
Salep 24
Salisil Bedak 2 %
Serum anti tetanus 1.500 IU
Sianokobalamin (vit B12) inj
Silk [Benang Bedah Sutra] 3/0
Silver amalgam serbuk 65-75%
Sulfacetamid Tetes Mata 5 ml
Tablet Tambah Darah
Tetrasiklin HCl 250 mg
Tetrasiklin HCl 500 mg
Thiamini HCl 50 mg
Thiamini HCl Injeksi 100mg/ml
Triheksifenidil HCl 2 mg
Vitamin B Complek

Tablet
Botol
Tablet
Tablet
Tablet
Botol
Ampul
Tube
Tube
Ampul
Tablet
Botol
Tablet
Tablet
Tablet
Rol
Botol
Botol
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Botol
Tablet
Pot
Kotak
Ampul
Ampul
Sachet
Botol
Botol
Tablet
Kapsul
Kapsul
Tablet
Ampul
Tablet
Tablet

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

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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 memberikan

yg menerima,

drs. Sudarmono, Apt. MARS.

NIP. 140 278 442

Hasim
NIP. 140 309 073
mengetahui/menyetujui
Ka PKM Cicurug

dr. TeddyMulyadi S
NIP 480 132 468

SURAT BUKTI BARANG KELUAR

NO
DISERAHKAN KEPADA
DARI
TANGGAL

PUSTU BENDA
GUDANG OBAT PKM CICURUG
2 S/D 31 OKTOBER 2010

NAMA, BENTUK DAN KADAR

NO

SATUAN

PERMINTAAN

PEMBERIAN

OBAT
1 Air raksa Dental Use

Botol

2 Alat Suntik 1 ml

Set

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

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

Alat Suntik 2,5 ml

Allopurinol 100 mg
Ambroxol syr
Aminofillin 200 mg
Aminofillin Inj
Amoksillin Sir kering 125 mg/5ml
Amoksisillin 250 mg
Amoksisillin 500 mg
Antalgin 500 mg
Antalgin Injeksi
Antasida DOEN
Anti Fungi doen
Anti Haemoroid
Aqua Pro Injeksi 20 ml
Asam Ascorbat 50 mg
Asam Mefenamat 500 mg
Asetosal 500 mg
Betason cream 5 g
Captropil 25 mg
Catgut 2/0 - 3/0
Cefadroxil
Cimetidin
Cyprofloksasin
Deksamethason 0,5 mg
Deksamethason inj 5 mg/ml
Dekstran 70 lar Infus 6%
Dekstromethorfan Sir 10mg/5ml
Dekstrometorfan 15 mg
Diazepam 2 mg
Diazepam Injeksi 5 mg
Difenhidramin inj 10mg/ml-1ml
Digoksin 0,25 mg
Efedrin HCl 25 mg
Epinefrin HCl Injeksi
Etakridini Larutan
Etanol 70 %
Etil Klorida Semprot 100 ml
Extrak Belladon

Set
Tablet
Botol
Tablet
Ampul
Botol
Kapsul
Kaplet
Tablet
Ampul
Tablet
Pot
Supp
Vial
Tablet
Kaplet
Tablet
Tube
Tablet
Sachet
Kapsul
Tablet
Tablet
Tablet
Ampul
Botol
Botol
Tablet
Tablet
Ampul
Ampul
Tablet
Tablet
Ampul
Botol
Botol
Botol
Tablet

KET

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
80
81
82
83
84
85
86
87
88
89
90

Fenobarbital 30 mg
Fenobarbital Injeksi 50 mg/ml
Fenoksimetil Penisillin 250 mg
Fenoksimetil Penisillin 500 mg
Fenol Gliserol Tts Telinga 10%
Fitomenadion 10 mg
Fitomenadion Injeksi
Furosemid 40 mg
Gameksan Emulsi 1%
Garam Oralit 200 ml
Gentamicin cream
Gentian Violet 10 ml
Glass ionomer Cement
Glibenklamid 5 mg
Gliseril Guayacolat
Gliserin 100 ml
Glucosa Larutan infus 5%
Griseofulvin 125 mg
Haloperidol 1,5 mg
Hidrocortison Cream 2,5%
Hidroklorotiazid 25 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Infus Set Dewasa
Isoniazid 300 mg
Isosorbid Dinitrat 5 mg
Kalsium Hidroksida Pasta
Kalsium Laktas 500 mg
Kapas pembalut 250 gram
Karbamazepin 200 mg
Kasa Pembalut 4m x15 cm
Kloramfenicol 250 mg
Kloramfenicol Salep Mata 1%
Kloramfenicol Tetes telinga 3%
Klorfeniramin Maleat 4 mg
Klorpromazin HCl 100 mg
Klorpromazin HCl 25 mg
Kodein HCl 10 mg
Kotrimoksasol suspensi
Kotrimoksasol tab 400 mg
Lidocain Injeksi
Lisol 100 ml
Magnesium Sulfat Inj[IV] 40%
Mebendazol 100 mg
Methilergometrin 0,125 g
Metilergometrin Inj 0,200 mg/ml
Metronidazole 250 mg
Miconazol Cream
Mulsanol Syr
Mummifying Pasta

Tablet
Ampul
Tablet
Tablet
Botol
Tablet
Ampul
Tablet
Botol
Sachet
Tube
Botol
Set
Tablet
Tablet
Botol
Botol
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Set
Tablet
Tablet
Kotak
Tablet
Bks
Tablet
Rol
Kapsul
Tube
Botol
Tablet
Tablet
Tablet
Tablet
Botol
Tablet
Ampul
Botol
Vial
Tablet
Tablet
Ampul
Tablet
Tube
Botol
Botol

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

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

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
124
125
126
127
128
129
130

Natrium Bicarbonat 500 mg

Natrium Chlorida Lar Infus 0,9%
Neo Diaform
Nifedipin
Nistatin 100000 IU/gram
Obat Batuk Hitam 100 ml
Oksitetracyclin inj 50 mg/ml
Oksitetrasiklin HCl Salep 3%
Oksitetrasiklin HCl Slp Mata 1%
Oksitosin Injeksi 10 IU/ml
Paracetamol 500 mg
Paracetamol Sirup 60 ml
Pehavral
Pirantel Pamoat 365 mg
Piridoksin HCl 10 mg
Plester 5 yard x 2 inch
Povidon Iodida 10%-30 ml
Povidon Iodida 10%-300 ml
Prednison 5 mg
Propanolol HCl 40 mg
Propil Tiourasil 100 mg
Ranitidine
Reserpin 0,25 mg
Rifampisin 450 mg
Ringer Laktas Lar Infus Steril
Salbutamol 2 mg
Salep 24
Salisil Bedak 2 %
Serum anti tetanus 1.500 IU
Sianokobalamin (vit B12) inj
Silk [Benang Bedah Sutra] 3/0
Silver amalgam serbuk 65-75%
Sulfacetamid Tetes Mata 5 ml
Tablet Tambah Darah
Tetrasiklin HCl 250 mg
Tetrasiklin HCl 500 mg
Thiamini HCl 50 mg
Thiamini HCl Injeksi 100mg/ml
Triheksifenidil HCl 2 mg
Vitamin B Complek

Tablet
Botol
Tablet
Tablet
Tablet
Botol
Ampul
Tube
Tube
Ampul
Tablet
Botol
Tablet
Tablet
Tablet
Rol
Botol
Botol
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Botol
Tablet
Pot
Kotak
Ampul
Ampul
Sachet
Botol
Botol
Tablet
Kapsul
Kapsul
Tablet
Ampul
Tablet
Tablet

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

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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 memberikan

yg menerima,

drs. Sudarmono, Apt. MARS.

NIP. 140 278 442

Hasim
NIP. 140 309 073
mengetahui/menyetujui
Ka PKM Cicurug

dr. TeddyMulyadi S
NIP 480 132 468

SURAT BUKTI BARANG KELUAR

NO
DISERAHKAN KEPADA
DARI
TANGGAL

PUSTU BENDA
GUDANG OBAT PKM CICURUG
2 S/D 31 NOVEMBER 2010

NAMA, BENTUK DAN KADAR

NO

SATUAN

PERMINTAAN

PEMBERIAN

OBAT
1 Air raksa Dental Use

Botol

2 Alat Suntik 1 ml

Set

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

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

Alat Suntik 2,5 ml

Allopurinol 100 mg
Ambroxol syr
Aminofillin 200 mg
Aminofillin Inj
Amoksillin Sir kering 125 mg/5ml
Amoksisillin 250 mg
Amoksisillin 500 mg
Antalgin 500 mg
Antalgin Injeksi
Antasida DOEN
Anti Fungi doen
Anti Haemoroid
Aqua Pro Injeksi 20 ml
Asam Ascorbat 50 mg
Asam Mefenamat 500 mg
Asetosal 500 mg
Betason cream 5 g
Captropil 25 mg
Catgut 2/0 - 3/0
Cefadroxil
Cimetidin
Cyprofloksasin
Deksamethason 0,5 mg
Deksamethason inj 5 mg/ml
Dekstran 70 lar Infus 6%
Dekstromethorfan Sir 10mg/5ml
Dekstrometorfan 15 mg
Diazepam 2 mg
Diazepam Injeksi 5 mg
Difenhidramin inj 10mg/ml-1ml
Digoksin 0,25 mg
Efedrin HCl 25 mg
Epinefrin HCl Injeksi
Etakridini Larutan
Etanol 70 %
Etil Klorida Semprot 100 ml
Extrak Belladon

Set
Tablet
Botol
Tablet
Ampul
Botol
Kapsul
Kaplet
Tablet
Ampul
Tablet
Pot
Supp
Vial
Tablet
Kaplet
Tablet
Tube
Tablet
Sachet
Kapsul
Tablet
Tablet
Tablet
Ampul
Botol
Botol
Tablet
Tablet
Ampul
Ampul
Tablet
Tablet
Ampul
Botol
Botol
Botol
Tablet

KET

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
80
81
82
83
84
85
86
87
88
89
90

Fenobarbital 30 mg
Fenobarbital Injeksi 50 mg/ml
Fenoksimetil Penisillin 250 mg
Fenoksimetil Penisillin 500 mg
Fenol Gliserol Tts Telinga 10%
Fitomenadion 10 mg
Fitomenadion Injeksi
Furosemid 40 mg
Gameksan Emulsi 1%
Garam Oralit 200 ml
Gentamicin cream
Gentian Violet 10 ml
Glass ionomer Cement
Glibenklamid 5 mg
Gliseril Guayacolat
Gliserin 100 ml
Glucosa Larutan infus 5%
Griseofulvin 125 mg
Haloperidol 1,5 mg
Hidrocortison Cream 2,5%
Hidroklorotiazid 25 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Infus Set Dewasa
Isoniazid 300 mg
Isosorbid Dinitrat 5 mg
Kalsium Hidroksida Pasta
Kalsium Laktas 500 mg
Kapas pembalut 250 gram
Karbamazepin 200 mg
Kasa Pembalut 4m x15 cm
Kloramfenicol 250 mg
Kloramfenicol Salep Mata 1%
Kloramfenicol Tetes telinga 3%
Klorfeniramin Maleat 4 mg
Klorpromazin HCl 100 mg
Klorpromazin HCl 25 mg
Kodein HCl 10 mg
Kotrimoksasol suspensi
Kotrimoksasol tab 400 mg
Lidocain Injeksi
Lisol 100 ml
Magnesium Sulfat Inj[IV] 40%
Mebendazol 100 mg
Methilergometrin 0,125 g
Metilergometrin Inj 0,200 mg/ml
Metronidazole 250 mg
Miconazol Cream
Mulsanol Syr
Mummifying Pasta

Tablet
Ampul
Tablet
Tablet
Botol
Tablet
Ampul
Tablet
Botol
Sachet
Tube
Botol
Set
Tablet
Tablet
Botol
Botol
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Set
Tablet
Tablet
Kotak
Tablet
Bks
Tablet
Rol
Kapsul
Tube
Botol
Tablet
Tablet
Tablet
Tablet
Botol
Tablet
Ampul
Botol
Vial
Tablet
Tablet
Ampul
Tablet
Tube
Botol
Botol

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

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

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
124
125
126
127
128
129
130

Natrium Bicarbonat 500 mg

Natrium Chlorida Lar Infus 0,9%
Neo Diaform
Nifedipin
Nistatin 100000 IU/gram
Obat Batuk Hitam 100 ml
Oksitetracyclin inj 50 mg/ml
Oksitetrasiklin HCl Salep 3%
Oksitetrasiklin HCl Slp Mata 1%
Oksitosin Injeksi 10 IU/ml
Paracetamol 500 mg
Paracetamol Sirup 60 ml
Pehavral
Pirantel Pamoat 365 mg
Piridoksin HCl 10 mg
Plester 5 yard x 2 inch
Povidon Iodida 10%-30 ml
Povidon Iodida 10%-300 ml
Prednison 5 mg
Propanolol HCl 40 mg
Propil Tiourasil 100 mg
Ranitidine
Reserpin 0,25 mg
Rifampisin 450 mg
Ringer Laktas Lar Infus Steril
Salbutamol 2 mg
Salep 24
Salisil Bedak 2 %
Serum anti tetanus 1.500 IU
Sianokobalamin (vit B12) inj
Silk [Benang Bedah Sutra] 3/0
Silver amalgam serbuk 65-75%
Sulfacetamid Tetes Mata 5 ml
Tablet Tambah Darah
Tetrasiklin HCl 250 mg
Tetrasiklin HCl 500 mg
Thiamini HCl 50 mg
Thiamini HCl Injeksi 100mg/ml
Triheksifenidil HCl 2 mg
Vitamin B Complek

Tablet
Botol
Tablet
Tablet
Tablet
Botol
Ampul
Tube
Tube
Ampul
Tablet
Botol
Tablet
Tablet
Tablet
Rol
Botol
Botol
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Botol
Tablet
Pot
Kotak
Ampul
Ampul
Sachet
Botol
Botol
Tablet
Kapsul
Kapsul
Tablet
Ampul
Tablet
Tablet

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

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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 memberikan

yg menerima,

drs. Sudarmono, Apt. MARS.

NIP. 140 278 442

Hasim
NIP. 140 309 073
mengetahui/menyetujui
Ka PKM Cicurug

dr. TeddyMulyadi S
NIP 480 132 468

SURAT BUKTI BARANG KELUAR

NO
DISERAHKAN KEPADA
DARI
TANGGAL

PUSTU BENDA
GUDANG OBAT PKM CICURUG
2 S/D 31 DESEMBER 2010

NAMA, BENTUK DAN KADAR

NO

SATUAN

PERMINTAAN

PEMBERIAN

OBAT
1 Air raksa Dental Use

Botol

2 Alat Suntik 1 ml

Set

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

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

Alat Suntik 2,5 ml

Allopurinol 100 mg
Ambroxol syr
Aminofillin 200 mg
Aminofillin Inj
Amoksillin Sir kering 125 mg/5ml
Amoksisillin 250 mg
Amoksisillin 500 mg
Antalgin 500 mg
Antalgin Injeksi
Antasida DOEN
Anti Fungi doen
Anti Haemoroid
Aqua Pro Injeksi 20 ml
Asam Ascorbat 50 mg
Asam Mefenamat 500 mg
Asetosal 500 mg
Betason cream 5 g
Captropil 25 mg
Catgut 2/0 - 3/0
Cefadroxil
Cimetidin
Cyprofloksasin
Deksamethason 0,5 mg
Deksamethason inj 5 mg/ml
Dekstran 70 lar Infus 6%
Dekstromethorfan Sir 10mg/5ml
Dekstrometorfan 15 mg
Diazepam 2 mg
Diazepam Injeksi 5 mg
Difenhidramin inj 10mg/ml-1ml
Digoksin 0,25 mg
Efedrin HCl 25 mg
Epinefrin HCl Injeksi
Etakridini Larutan
Etanol 70 %
Etil Klorida Semprot 100 ml
Extrak Belladon

Set
Tablet
Botol
Tablet
Ampul
Botol
Kapsul
Kaplet
Tablet
Ampul
Tablet
Pot
Supp
Vial
Tablet
Kaplet
Tablet
Tube
Tablet
Sachet
Kapsul
Tablet
Tablet
Tablet
Ampul
Botol
Botol
Tablet
Tablet
Ampul
Ampul
Tablet
Tablet
Ampul
Botol
Botol
Botol
Tablet

KET

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
80
81
82
83
84
85
86
87
88
89
90

Fenobarbital 30 mg
Fenobarbital Injeksi 50 mg/ml
Fenoksimetil Penisillin 250 mg
Fenoksimetil Penisillin 500 mg
Fenol Gliserol Tts Telinga 10%
Fitomenadion 10 mg
Fitomenadion Injeksi
Furosemid 40 mg
Gameksan Emulsi 1%
Garam Oralit 200 ml
Gentamicin cream
Gentian Violet 10 ml
Glass ionomer Cement
Glibenklamid 5 mg
Gliseril Guayacolat
Gliserin 100 ml
Glucosa Larutan infus 5%
Griseofulvin 125 mg
Haloperidol 1,5 mg
Hidrocortison Cream 2,5%
Hidroklorotiazid 25 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Infus Set Dewasa
Isoniazid 300 mg
Isosorbid Dinitrat 5 mg
Kalsium Hidroksida Pasta
Kalsium Laktas 500 mg
Kapas pembalut 250 gram
Karbamazepin 200 mg
Kasa Pembalut 4m x15 cm
Kloramfenicol 250 mg
Kloramfenicol Salep Mata 1%
Kloramfenicol Tetes telinga 3%
Klorfeniramin Maleat 4 mg
Klorpromazin HCl 100 mg
Klorpromazin HCl 25 mg
Kodein HCl 10 mg
Kotrimoksasol suspensi
Kotrimoksasol tab 400 mg
Lidocain Injeksi
Lisol 100 ml
Magnesium Sulfat Inj[IV] 40%
Mebendazol 100 mg
Methilergometrin 0,125 g
Metilergometrin Inj 0,200 mg/ml
Metronidazole 250 mg
Miconazol Cream
Mulsanol Syr
Mummifying Pasta

Tablet
Ampul
Tablet
Tablet
Botol
Tablet
Ampul
Tablet
Botol
Sachet
Tube
Botol
Set
Tablet
Tablet
Botol
Botol
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Set
Tablet
Tablet
Kotak
Tablet
Bks
Tablet
Rol
Kapsul
Tube
Botol
Tablet
Tablet
Tablet
Tablet
Botol
Tablet
Ampul
Botol
Vial
Tablet
Tablet
Ampul
Tablet
Tube
Botol
Botol

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

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

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
124
125
126
127
128
129
130

Natrium Bicarbonat 500 mg

Natrium Chlorida Lar Infus 0,9%
Neo Diaform
Nifedipin
Nistatin 100000 IU/gram
Obat Batuk Hitam 100 ml
Oksitetracyclin inj 50 mg/ml
Oksitetrasiklin HCl Salep 3%
Oksitetrasiklin HCl Slp Mata 1%
Oksitosin Injeksi 10 IU/ml
Paracetamol 500 mg
Paracetamol Sirup 60 ml
Pehavral
Pirantel Pamoat 365 mg
Piridoksin HCl 10 mg
Plester 5 yard x 2 inch
Povidon Iodida 10%-30 ml
Povidon Iodida 10%-300 ml
Prednison 5 mg
Propanolol HCl 40 mg
Propil Tiourasil 100 mg
Ranitidine
Reserpin 0,25 mg
Rifampisin 450 mg
Ringer Laktas Lar Infus Steril
Salbutamol 2 mg
Salep 24
Salisil Bedak 2 %
Serum anti tetanus 1.500 IU
Sianokobalamin (vit B12) inj
Silk [Benang Bedah Sutra] 3/0
Silver amalgam serbuk 65-75%
Sulfacetamid Tetes Mata 5 ml
Tablet Tambah Darah
Tetrasiklin HCl 250 mg
Tetrasiklin HCl 500 mg
Thiamini HCl 50 mg
Thiamini HCl Injeksi 100mg/ml
Triheksifenidil HCl 2 mg
Vitamin B Complek

Tablet
Botol
Tablet
Tablet
Tablet
Botol
Ampul
Tube
Tube
Ampul
Tablet
Botol
Tablet
Tablet
Tablet
Rol
Botol
Botol
Tablet
Tablet
Tablet
Tablet
Tablet
Kapsul
Botol
Tablet
Pot
Kotak
Ampul
Ampul
Sachet
Botol
Botol
Tablet
Kapsul
Kapsul
Tablet
Ampul
Tablet
Tablet

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

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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 memberikan

yg menerima,

drs. Sudarmono, Apt. MARS.

NIP. 140 278 442

Hasim
NIP. 140 309 073
mengetahui/menyetujui
Ka PKM Cicurug

dr. TeddyMulyadi S
NIP 480 132 468