:

:
: 2015

PUSTU/POLINDES
BULAN
TAHUN

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

NAMA OBAT
Alopurinol 100 mg
Alopurinol 300 mg
Ambroxol tablet 30 mg
Amlodipin tab 5 mg
Amoksisilin 500 mg
Amoksisilin SK 125mg/5ml
Antasida DOEN Syrup
Antasida DOEN tab Komb
Antihemoroid DOEN Komb
Asam Askorbat (Vit C) tab 50 mg
Asam folat 1 mg
Asam mefenamat 500 mg
Asiklovir 400 mg
Asiklovir 5 % krim
Betahistin Mesilat tablet 6 mg
Betametason krim 0,1%
Bromheksin tablet 8 mg
Deksametason inj 5 mg/ml-ml
Difenhidramin Hcl Inj 10 mg/ml-1ml
Fenoksimetil penisilin tab 500 mg
Fenol gliserol tetes Telinga 10 %
Fitomenadion (VitK) inj 10mg/ml-1ml
Fitomenadion (VitK) tab 10 mg
Furosemid tab 40 mg
Gentamsin Salep Kulit 0,1%
Glibenklamid 5 mg
Gliseril Guaiyakolat tab 100 mg
Grisiofulvin tab 125 mg
Hidrokortison krim 2.5 %
Hiosin N- Butilbromida Tab 10 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Ichtyol salp
Kalium Diklofenak tab 50 mg
Kalsium Laktas (Kalk) tab 500 mg
Kaptopril 12,5 mg
Kaptopril 25 mg
Kloramphenikol salep mata 1 %
Kloramphenikol tetes telinga 3 %

SATUAN
Tablet
Tablet
Tablet
Tablet
Kaplet
Botol
Botol
Tablet
Suppositoria
Tablet
Tablet
Tablet
Tablet
Tube
Tablet
Tube
Tablet
Ampul
Ampul
Tablet
Botol
Ampul
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Pot
Tablet
Tablet
Tablet
Tablet
Tube
Botol

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
80
81
82
83
84
85
86
87

Klorfeniramin maleat (CTM) tab 4 mg

Kotrimoksazole Susp
Lidokain 2% injeksi
Lidokain Komp Inj
Metil Ergometrin Inj 0,200 mg-1 ml
Metil Ergometrin tab 0.125 mg
Na. Diklofenac 50 mg
Nifedipin tab 10 mg
Obat Batuk hitam (OBH) sirup 100 ml
Oksitetrasiklin SK 3%
Oksitetrasiklin SM 1 %
Oksitosin inj 10 iu/1ml
Parasetamol Drops
Parasetamol sirup 120 mg/5 ml
Piridoksin tab 10 mg
Piroksicam 20 mg
Prednison 5 mg tab
Propiltiourasil 100 mg tab
Ranitidin tab 150 mg
Ringer Laktate lart infus
S. Anti Bisa Ular poli inj 5 ml(ABU I)
S. Anti Tetanus inj 1.500 iu/Amp ( ATS )
Salbutamol 2 mg tab
Salbutamol 4 mg tab
Salep 2-4 komb
Salisil Bedak 2 %
Salisil Spiritus 10 %
Sefadroxil 500 mg kapsul
Sianokobalamin (Vit B12) inj
Siprofloksasin 500 mg tab
Sulfasetamid tts mata 15%
Tetrasiklin 500 mg
Thiamin ( Vit B1 ) 50 mg tab
Thiamphenkol 500 mg cap
Tiamfenikol Suspensi ( Conucol Dry Sirup )
Triheksipenidil Hcl 2 mg tab
Vitamin B Kompleks tab
Yodium povidon 10 % 30 ml
Yodium Povidon 10 % 300 ml
Zink 20 mg Tablet dispersible
Zink Syrup
Bufacom (Triamsinolon in oral base)
Dulcolax tab
Demacolin tab
Fludane Syrup
Fludane Tablet
Lakto B
Lysmin ( Lysin ) Sirup

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

88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108

Multivitamin (Ultravita tab / Kurkumex tab / Lanovit tab)

Neurovit E tablet
Alat Suntik Sekali Pakai 1 ml
Alat Suntik Sekali Pakai 3 ml / 2,5 ml
Alat Suntik Sekali Pakai 5 ml
Catgut/Benang bedah no 3/0 (p&c) dengan jarum bedah
Infusion Set Dewasa
Kapas Pembalut/Absorben 250 gr
Kasa Pembalut 2 X 80 cm
Kasa Kompres 40/40 steril
Kasa Pembalut 4 X 15 cm
Kasa Pembalut 4 X 3 cm
Lisol (Kresol tersaponifikasi 50%) 1 liter
Masker
Sarung Tangan Non Steril
IV. Catheter no. 18
Simvastatin 20 mg tab
Biplacenton
Ventolin Inhalasi
Permetrin Krim 5 %
Metoklopramid tab 5 mg

Tablet
Tablet
Set
Set
Set
Set
Set
Bungkus
Roll
Roll
Roll
Roll
Botol
Set
Set
Set
Tablet
Tube
Amp
Tube
Tablet

LAPORAN PE

Kode
ALP1
ALP2
AMB
AMD2
AMOK5
AMOKS
AND1
AND2
ATM
VITC
AFOL
ASMEF
ASK1
ASK2
BMT
BTM
BRO
DEK1
DIF
FPT2
FGT
VITK1
VITK2
FRO1
GEN1
GLIB
GG
GRI
HDR
HNB1
IBU1
IBU2
ICH
KD
KALK
KAP1
KAP2
KLOSM
KLOTT

Stok Awal Penerimaan Persdiaan

200

200

CTM
KOTS
LIDO1
LIDO2
ME1
ME2
NAD2
NIF
OBH
OKTSK
OKTSM
OTS
PARAD
PARAS
B6
PIK2
PRED
PTU
RAN2
RL
ABU1
ATS1
SAL1
SAL2
S2-4
SB2
SS
SEF
B12
SPRO
SULF
TETR2
VB1
THIA1
THAI2
TPD
VBC
YOD1
YOD2
ZNK1
ZNK2
BUF
DUL2
DEM
FLUD1
FLUD2
LKB
LYS

MULTF
NEUR2
ASS3
ASS4
ASS5
GUT1
ISD
KPA
KP1
KP2
KP3
KP4
LKT
MAS
STN
IV1
SIV
BPL
VNT
Permet
MTK3

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (JKN)

10

11

16

12

13

TANGGAL
15
16
17

14

24

16

GAL
18

19

32

20

21

16

22

23

16

24

16

25

26

56

27

28

29

16

30

31

Pemakaian

Sisa

Permintaa

PELAPOR

:
: JANUARI
: 2015

PUSTU/POLINDES
BULAN
TAHUN

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

NAMA OBAT
Alopurinol 100 mg
Alopurinol 300 mg
Ambroxol tablet 30 mg
Amlodipin tab 5 mg
Amoksisilin 500 mg
Amoksisilin SK 125mg/5ml
Antasida DOEN Syrup
Antasida DOEN tab Komb
Antihemoroid DOEN Komb
Asam Askorbat (Vit C) tab 50 mg
Asam folat 1 mg
Asam mefenamat 500 mg
Asiklovir 400 mg
Asiklovir 5 % krim
Betahistin Mesilat tablet 6 mg
Betametason krim 0,1%
Bromheksin tablet 8 mg
Deksametason inj 5 mg/ml-ml
Difenhidramin Hcl Inj 10 mg/ml-1ml
Fenoksimetil penisilin tab 500 mg
Fenol gliserol tetes Telinga 10 %
Fitomenadion (VitK) inj 10mg/ml-1ml
Fitomenadion (VitK) tab 10 mg
Furosemid tab 40 mg
Gentamsin Salep Kulit 0,1%
Glibenklamid 5 mg
Gliseril Guaiyakolat tab 100 mg
Grisiofulvin tab 125 mg
Hidrokortison krim 2.5 %
Hiosin N- Butilbromida Tab 10 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Ichtyol salp
Kalium Diklofenak tab 50 mg
Kalsium Laktas (Kalk) tab 500 mg
Kaptopril 12,5 mg
Kaptopril 25 mg
Kloramphenikol salep mata 1 %
Kloramphenikol tetes telinga 3 %

SATUAN
Tablet
Tablet
Tablet
Tablet
Kaplet
Botol
Botol
Tablet
Suppositoria
Tablet
Tablet
Tablet
Tablet
Tube
Tablet
Tube
Tablet
Ampul
Ampul
Tablet
Botol
Ampul
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Pot
Tablet
Tablet
Tablet
Tablet
Tube
Botol

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
80
81
82
83
84
85
86
87

Klorfeniramin maleat (CTM) tab 4 mg

Kotrimoksazole Susp
Lidokain 2% injeksi
Lidokain Komp Inj
Metil Ergometrin Inj 0,200 mg-1 ml
Metil Ergometrin tab 0.125 mg
Na. Diklofenac 50 mg
Nifedipin tab 10 mg
Obat Batuk hitam (OBH) sirup 100 ml
Oksitetrasiklin SK 3%
Oksitetrasiklin SM 1 %
Oksitosin inj 10 iu/1ml
Parasetamol Drops
Parasetamol sirup 120 mg/5 ml
Piridoksin tab 10 mg
Piroksicam 20 mg
Prednison 5 mg tab
Propiltiourasil 100 mg tab
Ranitidin tab 150 mg
Ringer Laktate lart infus
S. Anti Bisa Ular poli inj 5 ml(ABU I)
S. Anti Tetanus inj 1.500 iu/Amp ( ATS )
Salbutamol 2 mg tab
Salbutamol 4 mg tab
Salep 2-4 komb
Salisil Bedak 2 %
Salisil Spiritus 10 %
Sefadroxil 500 mg kapsul
Sianokobalamin (Vit B12) inj
Siprofloksasin 500 mg tab
Sulfasetamid tts mata 15%
Tetrasiklin 500 mg
Thiamin ( Vit B1 ) 50 mg tab
Thiamphenkol 500 mg cap
Tiamfenikol Suspensi ( Conucol Dry Sirup )
Triheksipenidil Hcl 2 mg tab
Vitamin B Kompleks tab
Yodium povidon 10 % 30 ml
Yodium Povidon 10 % 300 ml
Zink 20 mg Tablet dispersible
Zink Syrup
Bufacom (Triamsinolon in oral base)
Dulcolax tab
Demacolin tab
Fludane Syrup
Fludane Tablet
Lakto B
Lysmin ( Lysin ) Sirup

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

88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
-

Multivitamin (Ultravita tab / Kurkumex tab / Lanovit tab)

Neurovit E tablet
Alat Suntik Sekali Pakai 1 ml
Alat Suntik Sekali Pakai 3 ml / 2,5 ml
Alat Suntik Sekali Pakai 5 ml
Catgut/Benang bedah no 3/0 (p&c) dengan jarum bedah
Infusion Set Dewasa
Kapas Pembalut/Absorben 250 gr
Kasa Pembalut 2 X 80 cm
Kasa Kompres 40/40 steril
Kasa Pembalut 4 X 15 cm
Kasa Pembalut 4 X 3 cm
Lisol (Kresol tersaponifikasi 50%) 1 liter
Masker
Sarung Tangan Non Steril
IV. Catheter no. 18
Simvastatin 20 mg tab
Biplacenton
Ventolin Inhalasi
Permetrin Krim 5 %
Metoklopramid tab 5 mg
0
0
0

Tablet
Tablet
Set
Set
Set
Set
Set
Bungkus
Roll
Roll
Roll
Roll
Botol
Set
Set
Set
Tablet
Tube
Amp
Tube
Tablet
0
0
0

LAPORAN PE

Kode
ALP1
ALP2
AMB
AMD2
AMOK5
AMOKS
AND1
AND2
ATM
VITC
AFOL
ASMEF
ASK1
ASK2
BMT
BTM
BRO
DEK1
DIF
FPT2
FGT
VITK1
VITK2
FRO1
GEN1
GLIB
GG
GRI
HDR
HNB1
IBU1
IBU2
ICH
KD
KALK
KAP1
KAP2
KLOSM
KLOTT

Stok Awal Penerimaan Persdiaan

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

CTM
KOTS
LIDO1
LIDO2
ME1
ME2
NAD2
NIF
OBH
OKTSK
OKTSM
OTS
PARAD
PARAS
B6
PIK2
PRED
PTU
RAN2
RL
ABU1
ATS1
SAL1
SAL2
S2-4
SB2
SS
SEF
B12
SPRO
SULF
TETR2
VB1
THIA1
THAI2
TPD
VBC
YOD1
YOD2
ZNK1
ZNK2
BUF
DUL2
DEM
FLUD1
FLUD2
LKB
LYS

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

MULTF
NEUR2
ASS3
ASS4
ASS5
GUT1
ISD
KPA
KP1
KP2
KP3
KP4
LKT
MAS
STN
IV1
SIV
BPL
VNT
Permet
MTK3
0
0
0

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 (JKN)

10

11

12

13

14

TANGGAL
15
16
17

GAL
18

19

20

21

22

23

24

25

26

27

28

29

30

31

Pemakaian

Sisa

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

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

Permintaa

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

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

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

PELAPOR

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

:
: PEBRUARI
: 2015

PUSTU/POLINDES
BULAN
TAHUN

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

NAMA OBAT
Alopurinol 100 mg
Alopurinol 300 mg
Ambroxol tablet 30 mg
Amlodipin tab 5 mg
Amoksisilin 500 mg
Amoksisilin SK 125mg/5ml
Antasida DOEN Syrup
Antasida DOEN tab Komb
Antihemoroid DOEN Komb
Asam Askorbat (Vit C) tab 50 mg
Asam folat 1 mg
Asam mefenamat 500 mg
Asiklovir 400 mg
Asiklovir 5 % krim
Betahistin Mesilat tablet 6 mg
Betametason krim 0,1%
Bromheksin tablet 8 mg
Deksametason inj 5 mg/ml-ml
Difenhidramin Hcl Inj 10 mg/ml-1ml
Fenoksimetil penisilin tab 500 mg
Fenol gliserol tetes Telinga 10 %
Fitomenadion (VitK) inj 10mg/ml-1ml
Fitomenadion (VitK) tab 10 mg
Furosemid tab 40 mg
Gentamsin Salep Kulit 0,1%
Glibenklamid 5 mg
Gliseril Guaiyakolat tab 100 mg
Grisiofulvin tab 125 mg
Hidrokortison krim 2.5 %
Hiosin N- Butilbromida Tab 10 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Ichtyol salp
Kalium Diklofenak tab 50 mg
Kalsium Laktas (Kalk) tab 500 mg
Kaptopril 12,5 mg
Kaptopril 25 mg
Kloramphenikol salep mata 1 %
Kloramphenikol tetes telinga 3 %

SATUAN
Tablet
Tablet
Tablet
Tablet
Kaplet
Botol
Botol
Tablet
Suppositoria
Tablet
Tablet
Tablet
Tablet
Tube
Tablet
Tube
Tablet
Ampul
Ampul
Tablet
Botol
Ampul
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Pot
Tablet
Tablet
Tablet
Tablet
Tube
Botol

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
80
81
82
83
84
85
86
87

Klorfeniramin maleat (CTM) tab 4 mg

Kotrimoksazole Susp
Lidokain 2% injeksi
Lidokain Komp Inj
Metil Ergometrin Inj 0,200 mg-1 ml
Metil Ergometrin tab 0.125 mg
Na. Diklofenac 50 mg
Nifedipin tab 10 mg
Obat Batuk hitam (OBH) sirup 100 ml
Oksitetrasiklin SK 3%
Oksitetrasiklin SM 1 %
Oksitosin inj 10 iu/1ml
Parasetamol Drops
Parasetamol sirup 120 mg/5 ml
Piridoksin tab 10 mg
Piroksicam 20 mg
Prednison 5 mg tab
Propiltiourasil 100 mg tab
Ranitidin tab 150 mg
Ringer Laktate lart infus
S. Anti Bisa Ular poli inj 5 ml(ABU I)
S. Anti Tetanus inj 1.500 iu/Amp ( ATS )
Salbutamol 2 mg tab
Salbutamol 4 mg tab
Salep 2-4 komb
Salisil Bedak 2 %
Salisil Spiritus 10 %
Sefadroxil 500 mg kapsul
Sianokobalamin (Vit B12) inj
Siprofloksasin 500 mg tab
Sulfasetamid tts mata 15%
Tetrasiklin 500 mg
Thiamin ( Vit B1 ) 50 mg tab
Thiamphenkol 500 mg cap
Tiamfenikol Suspensi ( Conucol Dry Sirup )
Triheksipenidil Hcl 2 mg tab
Vitamin B Kompleks tab
Yodium povidon 10 % 30 ml
Yodium Povidon 10 % 300 ml
Zink 20 mg Tablet dispersible
Zink Syrup
Bufacom (Triamsinolon in oral base)
Dulcolax tab
Demacolin tab
Fludane Syrup
Fludane Tablet
Lakto B
Lysmin ( Lysin ) Sirup

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

88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
-

Multivitamin (Ultravita tab / Kurkumex tab / Lanovit tab)

Neurovit E tablet
Alat Suntik Sekali Pakai 1 ml
Alat Suntik Sekali Pakai 3 ml / 2,5 ml
Alat Suntik Sekali Pakai 5 ml
Catgut/Benang bedah no 3/0 (p&c) dengan jarum bedah
Infusion Set Dewasa
Kapas Pembalut/Absorben 250 gr
Kasa Pembalut 2 X 80 cm
Kasa Kompres 40/40 steril
Kasa Pembalut 4 X 15 cm
Kasa Pembalut 4 X 3 cm
Lisol (Kresol tersaponifikasi 50%) 1 liter
Masker
Sarung Tangan Non Steril
IV. Catheter no. 18
Simvastatin 20 mg tab
Biplacenton
Ventolin Inhalasi
Permetrin Krim 5 %
Metoklopramid tab 5 mg
0
0
0

Tablet
Tablet
Set
Set
Set
Set
Set
Bungkus
Roll
Roll
Roll
Roll
Botol
Set
Set
Set
Tablet
Tube
Amp
Tube
Tablet
0
0
0

LAPORAN PE

Kode
ALP1
ALP2
AMB
AMD2
AMOK5
AMOKS
AND1
AND2
ATM
VITC
AFOL
ASMEF
ASK1
ASK2
BMT
BTM
BRO
DEK1
DIF
FPT2
FGT
VITK1
VITK2
FRO1
GEN1
GLIB
GG
GRI
HDR
HNB1
IBU1
IBU2
ICH
KD
KALK
KAP1
KAP2
KLOSM
KLOTT

Stok Awal Penerimaan Persdiaan

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

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

CTM
KOTS
LIDO1
LIDO2
ME1
ME2
NAD2
NIF
OBH
OKTSK
OKTSM
OTS
PARAD
PARAS
B6
PIK2
PRED
PTU
RAN2
RL
ABU1
ATS1
SAL1
SAL2
S2-4
SB2
SS
SEF
B12
SPRO
SULF
TETR2
VB1
THIA1
THAI2
TPD
VBC
YOD1
YOD2
ZNK1
ZNK2
BUF
DUL2
DEM
FLUD1
FLUD2
LKB
LYS

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

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

MULTF
NEUR2
ASS3
ASS4
ASS5
GUT1
ISD
KPA
KP1
KP2
KP3
KP4
LKT
MAS
STN
IV1
SIV
BPL
VNT
Permet
MTK3
0
0
0

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

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 (JKN)

10

11

12

13

14

TANGGAL
15
16
17

GAL
18

19

20

21

22

23

24

25

26

27

28

29

30

31

Pemakaian

Sisa

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

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

Permintaa

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

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

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

PELAPOR

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

:
: MARET
: 2015

PUSTU/POLINDES
BULAN
TAHUN

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

NAMA OBAT
Alopurinol 100 mg
Alopurinol 300 mg
Ambroxol tablet 30 mg
Amlodipin tab 5 mg
Amoksisilin 500 mg
Amoksisilin SK 125mg/5ml
Antasida DOEN Syrup
Antasida DOEN tab Komb
Antihemoroid DOEN Komb
Asam Askorbat (Vit C) tab 50 mg
Asam folat 1 mg
Asam mefenamat 500 mg
Asiklovir 400 mg
Asiklovir 5 % krim
Betahistin Mesilat tablet 6 mg
Betametason krim 0,1%
Bromheksin tablet 8 mg
Deksametason inj 5 mg/ml-ml
Difenhidramin Hcl Inj 10 mg/ml-1ml
Fenoksimetil penisilin tab 500 mg
Fenol gliserol tetes Telinga 10 %
Fitomenadion (VitK) inj 10mg/ml-1ml
Fitomenadion (VitK) tab 10 mg
Furosemid tab 40 mg
Gentamsin Salep Kulit 0,1%
Glibenklamid 5 mg
Gliseril Guaiyakolat tab 100 mg
Grisiofulvin tab 125 mg
Hidrokortison krim 2.5 %
Hiosin N- Butilbromida Tab 10 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Ichtyol salp
Kalium Diklofenak tab 50 mg
Kalsium Laktas (Kalk) tab 500 mg
Kaptopril 12,5 mg
Kaptopril 25 mg
Kloramphenikol salep mata 1 %
Kloramphenikol tetes telinga 3 %

SATUAN
Tablet
Tablet
Tablet
Tablet
Kaplet
Botol
Botol
Tablet
Suppositoria
Tablet
Tablet
Tablet
Tablet
Tube
Tablet
Tube
Tablet
Ampul
Ampul
Tablet
Botol
Ampul
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Pot
Tablet
Tablet
Tablet
Tablet
Tube
Botol

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
80
81
82
83
84
85
86
87

Klorfeniramin maleat (CTM) tab 4 mg

Kotrimoksazole Susp
Lidokain 2% injeksi
Lidokain Komp Inj
Metil Ergometrin Inj 0,200 mg-1 ml
Metil Ergometrin tab 0.125 mg
Na. Diklofenac 50 mg
Nifedipin tab 10 mg
Obat Batuk hitam (OBH) sirup 100 ml
Oksitetrasiklin SK 3%
Oksitetrasiklin SM 1 %
Oksitosin inj 10 iu/1ml
Parasetamol Drops
Parasetamol sirup 120 mg/5 ml
Piridoksin tab 10 mg
Piroksicam 20 mg
Prednison 5 mg tab
Propiltiourasil 100 mg tab
Ranitidin tab 150 mg
Ringer Laktate lart infus
S. Anti Bisa Ular poli inj 5 ml(ABU I)
S. Anti Tetanus inj 1.500 iu/Amp ( ATS )
Salbutamol 2 mg tab
Salbutamol 4 mg tab
Salep 2-4 komb
Salisil Bedak 2 %
Salisil Spiritus 10 %
Sefadroxil 500 mg kapsul
Sianokobalamin (Vit B12) inj
Siprofloksasin 500 mg tab
Sulfasetamid tts mata 15%
Tetrasiklin 500 mg
Thiamin ( Vit B1 ) 50 mg tab
Thiamphenkol 500 mg cap
Tiamfenikol Suspensi ( Conucol Dry Sirup )
Triheksipenidil Hcl 2 mg tab
Vitamin B Kompleks tab
Yodium povidon 10 % 30 ml
Yodium Povidon 10 % 300 ml
Zink 20 mg Tablet dispersible
Zink Syrup
Bufacom (Triamsinolon in oral base)
Dulcolax tab
Demacolin tab
Fludane Syrup
Fludane Tablet
Lakto B
Lysmin ( Lysin ) Sirup

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

88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
-

Multivitamin (Ultravita tab / Kurkumex tab / Lanovit tab)

Neurovit E tablet
Alat Suntik Sekali Pakai 1 ml
Alat Suntik Sekali Pakai 3 ml / 2,5 ml
Alat Suntik Sekali Pakai 5 ml
Catgut/Benang bedah no 3/0 (p&c) dengan jarum bedah
Infusion Set Dewasa
Kapas Pembalut/Absorben 250 gr
Kasa Pembalut 2 X 80 cm
Kasa Kompres 40/40 steril
Kasa Pembalut 4 X 15 cm
Kasa Pembalut 4 X 3 cm
Lisol (Kresol tersaponifikasi 50%) 1 liter
Masker
Sarung Tangan Non Steril
IV. Catheter no. 18
Simvastatin 20 mg tab
Biplacenton
Ventolin Inhalasi
Permetrin Krim 5 %
Metoklopramid tab 5 mg
0
0
0

Tablet
Tablet
Set
Set
Set
Set
Set
Bungkus
Roll
Roll
Roll
Roll
Botol
Set
Set
Set
Tablet
Tube
Amp
Tube
Tablet
0
0
0

LAPORAN PE

Kode
ALP1
ALP2
AMB
AMD2
AMOK5
AMOKS
AND1
AND2
ATM
VITC
AFOL
ASMEF
ASK1
ASK2
BMT
BTM
BRO
DEK1
DIF
FPT2
FGT
VITK1
VITK2
FRO1
GEN1
GLIB
GG
GRI
HDR
HNB1
IBU1
IBU2
ICH
KD
KALK
KAP1
KAP2
KLOSM
KLOTT

Stok Awal Penerimaan Persdiaan

0
0
0
0
0
0
0
93
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
74
0
0
0
8
0
0
0
22
0
0
0
0

0
0
0
0
0
0
0
93
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
74
0
0
0
8
0
0
0
22
0
0
0
0

CTM
KOTS
LIDO1
LIDO2
ME1
ME2
NAD2
NIF
OBH
OKTSK
OKTSM
OTS
PARAD
PARAS
B6
PIK2
PRED
PTU
RAN2
RL
ABU1
ATS1
SAL1
SAL2
S2-4
SB2
SS
SEF
B12
SPRO
SULF
TETR2
VB1
THIA1
THAI2
TPD
VBC
YOD1
YOD2
ZNK1
ZNK2
BUF
DUL2
DEM
FLUD1
FLUD2
LKB
LYS

0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
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
4
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
0
0
0
5
0
0
0
0
0
0
0
0
0
0
0

MULTF
NEUR2
ASS3
ASS4
ASS5
GUT1
ISD
KPA
KP1
KP2
KP3
KP4
LKT
MAS
STN
IV1
SIV
BPL
VNT
Permet
MTK3
0
0
0

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

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 (JKN)

10

11

12

13

14

TANGGAL
15
16
17

GAL
18

19

20

21

22

23

24

25

26

27

28

29

30

31

Pemakaian

Sisa

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

0
0
0
0
0
0
0
93
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
74
0
0
0
8
0
0
0
22
0
0
0
0

Permintaa

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

0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
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

PELAPOR

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

:
: APRIL
: 2015

PUSTU/POLINDES
BULAN
TAHUN

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

NAMA OBAT
Alopurinol 100 mg
Alopurinol 300 mg
Ambroxol tablet 30 mg
Amlodipin tab 5 mg
Amoksisilin 500 mg
Amoksisilin SK 125mg/5ml
Antasida DOEN Syrup
Antasida DOEN tab Komb
Antihemoroid DOEN Komb
Asam Askorbat (Vit C) tab 50 mg
Asam folat 1 mg
Asam mefenamat 500 mg
Asiklovir 400 mg
Asiklovir 5 % krim
Betahistin Mesilat tablet 6 mg
Betametason krim 0,1%
Bromheksin tablet 8 mg
Deksametason inj 5 mg/ml-ml
Difenhidramin Hcl Inj 10 mg/ml-1ml
Fenoksimetil penisilin tab 500 mg
Fenol gliserol tetes Telinga 10 %
Fitomenadion (VitK) inj 10mg/ml-1ml
Fitomenadion (VitK) tab 10 mg
Furosemid tab 40 mg
Gentamsin Salep Kulit 0,1%
Glibenklamid 5 mg
Gliseril Guaiyakolat tab 100 mg
Grisiofulvin tab 125 mg
Hidrokortison krim 2.5 %
Hiosin N- Butilbromida Tab 10 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Ichtyol salp
Kalium Diklofenak tab 50 mg
Kalsium Laktas (Kalk) tab 500 mg
Kaptopril 12,5 mg
Kaptopril 25 mg
Kloramphenikol salep mata 1 %
Kloramphenikol tetes telinga 3 %

SATUAN
Tablet
Tablet
Tablet
Tablet
Kaplet
Botol
Botol
Tablet
Suppositoria
Tablet
Tablet
Tablet
Tablet
Tube
Tablet
Tube
Tablet
Ampul
Ampul
Tablet
Botol
Ampul
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Pot
Tablet
Tablet
Tablet
Tablet
Tube
Botol

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
80
81
82
83
84
85
86
87

Klorfeniramin maleat (CTM) tab 4 mg

Kotrimoksazole Susp
Lidokain 2% injeksi
Lidokain Komp Inj
Metil Ergometrin Inj 0,200 mg-1 ml
Metil Ergometrin tab 0.125 mg
Na. Diklofenac 50 mg
Nifedipin tab 10 mg
Obat Batuk hitam (OBH) sirup 100 ml
Oksitetrasiklin SK 3%
Oksitetrasiklin SM 1 %
Oksitosin inj 10 iu/1ml
Parasetamol Drops
Parasetamol sirup 120 mg/5 ml
Piridoksin tab 10 mg
Piroksicam 20 mg
Prednison 5 mg tab
Propiltiourasil 100 mg tab
Ranitidin tab 150 mg
Ringer Laktate lart infus
S. Anti Bisa Ular poli inj 5 ml(ABU I)
S. Anti Tetanus inj 1.500 iu/Amp ( ATS )
Salbutamol 2 mg tab
Salbutamol 4 mg tab
Salep 2-4 komb
Salisil Bedak 2 %
Salisil Spiritus 10 %
Sefadroxil 500 mg kapsul
Sianokobalamin (Vit B12) inj
Siprofloksasin 500 mg tab
Sulfasetamid tts mata 15%
Tetrasiklin 500 mg
Thiamin ( Vit B1 ) 50 mg tab
Thiamphenkol 500 mg cap
Tiamfenikol Suspensi ( Conucol Dry Sirup )
Triheksipenidil Hcl 2 mg tab
Vitamin B Kompleks tab
Yodium povidon 10 % 30 ml
Yodium Povidon 10 % 300 ml
Zink 20 mg Tablet dispersible
Zink Syrup
Bufacom (Triamsinolon in oral base)
Dulcolax tab
Demacolin tab
Fludane Syrup
Fludane Tablet
Lakto B
Lysmin ( Lysin ) Sirup

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

88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
-

Multivitamin (Ultravita tab / Kurkumex tab / Lanovit tab)

Neurovit E tablet
Alat Suntik Sekali Pakai 1 ml
Alat Suntik Sekali Pakai 3 ml / 2,5 ml
Alat Suntik Sekali Pakai 5 ml
Catgut/Benang bedah no 3/0 (p&c) dengan jarum bedah
Infusion Set Dewasa
Kapas Pembalut/Absorben 250 gr
Kasa Pembalut 2 X 80 cm
Kasa Kompres 40/40 steril
Kasa Pembalut 4 X 15 cm
Kasa Pembalut 4 X 3 cm
Lisol (Kresol tersaponifikasi 50%) 1 liter
Masker
Sarung Tangan Non Steril
IV. Catheter no. 18
Simvastatin 20 mg tab
Biplacenton
Ventolin Inhalasi
Permetrin Krim 5 %
Metoklopramid tab 5 mg
0
0
0

Tablet
Tablet
Set
Set
Set
Set
Set
Bungkus
Roll
Roll
Roll
Roll
Botol
Set
Set
Set
Tablet
Tube
Amp
Tube
Tablet
0
0
0

LAPORAN PE

Kode
ALP1
ALP2
AMB
AMD2
AMOK5
AMOKS
AND1
AND2
ATM
VITC
AFOL
ASMEF
ASK1
ASK2
BMT
BTM
BRO
DEK1
DIF
FPT2
FGT
VITK1
VITK2
FRO1
GEN1
GLIB
GG
GRI
HDR
HNB1
IBU1
IBU2
ICH
KD
KALK
KAP1
KAP2
KLOSM
KLOTT

Stok Awal Penerimaan Persdiaan

0
0
0
0
0
0
0
93
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
74
0
0
0
8
0
0
0
22
0
0
0
0

0
0
0
0
0
0
0

200

293

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

1000

1074
0
0
0

200

208
0
0
0

300

322
0

100

100
0
0

23

18

16

CTM
KOTS
LIDO1
LIDO2
ME1
ME2
NAD2
NIF
OBH
OKTSK
OKTSM
OTS
PARAD
PARAS
B6
PIK2
PRED
PTU
RAN2
RL
ABU1
ATS1
SAL1
SAL2
S2-4
SB2
SS
SEF
B12
SPRO
SULF
TETR2
VB1
THIA1
THAI2
TPD
VBC
YOD1
YOD2
ZNK1
ZNK2
BUF
DUL2
DEM
FLUD1
FLUD2
LKB
LYS

0
0
0
0
0
0
0
0
0
0
0
0
0
0
4
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
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

300

304

200

202

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

50
300

50
306
0
0
0

500

505
0
0
0
0
0
0
0
0
0
0
0

36

40

MULTF
NEUR2
ASS3
ASS4
ASS5
GUT1
ISD
KPA
KP1
KP2
KP3
KP4
LKT
MAS
STN
IV1
SIV
BPL
VNT
Permet
MTK3
0
0
0

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

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 (JKN)

10

24

11

16

32

16

12

13

TANGGAL
15
16
17

14

24

16

19

11

16

16

30
8

20
10

39

15

16
8

40

32

62

24

16

16

24

16

24

45

GAL
18

19

20

21

32

16

16

16

40
24

22

23

16

12

24

25

16

16

10

16

10

27

28

29

56

10

26

80

16

16

46

20

50

20

20

26

12

16

10

10
8

16

10
16

16

16

216
24

21

52

24

24

24

216

16

10
20

16

30

31

16

10

Pemakaian

Sisa

0
0
0
0
0
0
0
248
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
376
0
0
0
146
0
0
0
315
0
86
0
0

0
0
0
0
0
0
0
45
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
698
0
0
0
62
0
0
0
7
0
14
0
0

Permintaa

200

200

500
100

0
0
0
0
0
0
0
0
0
0
0
0
0
0
258
0
120
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
305
0
0
0
475
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
46
0
82
0
0
0
0
0
0
0
0
0
0
0
0
0
0
40
1
0
0
0
30
0
0
0
0
0
0
0
0
0
0
0

300
200

500

500

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

PELAPOR

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

:
: MEI
: 2015

PUSTU/POLINDES
BULAN
TAHUN

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

NAMA OBAT
Alopurinol 100 mg
Alopurinol 300 mg
Ambroxol tablet 30 mg
Amlodipin tab 5 mg
Amoksisilin 500 mg
Amoksisilin SK 125mg/5ml
Antasida DOEN Syrup
Antasida DOEN tab Komb
Antihemoroid DOEN Komb
Asam Askorbat (Vit C) tab 50 mg
Asam folat 1 mg
Asam mefenamat 500 mg
Asiklovir 400 mg
Asiklovir 5 % krim
Betahistin Mesilat tablet 6 mg
Betametason krim 0,1%
Bromheksin tablet 8 mg
Deksametason inj 5 mg/ml-ml
Difenhidramin Hcl Inj 10 mg/ml-1ml
Fenoksimetil penisilin tab 500 mg
Fenol gliserol tetes Telinga 10 %
Fitomenadion (VitK) inj 10mg/ml-1ml
Fitomenadion (VitK) tab 10 mg
Furosemid tab 40 mg
Gentamsin Salep Kulit 0,1%
Glibenklamid 5 mg
Gliseril Guaiyakolat tab 100 mg
Grisiofulvin tab 125 mg
Hidrokortison krim 2.5 %
Hiosin N- Butilbromida Tab 10 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Ichtyol salp
Kalium Diklofenak tab 50 mg
Kalsium Laktas (Kalk) tab 500 mg
Kaptopril 12,5 mg
Kaptopril 25 mg
Kloramphenikol salep mata 1 %
Kloramphenikol tetes telinga 3 %

SATUAN
Tablet
Tablet
Tablet
Tablet
Kaplet
Botol
Botol
Tablet
Suppositoria
Tablet
Tablet
Tablet
Tablet
Tube
Tablet
Tube
Tablet
Ampul
Ampul
Tablet
Botol
Ampul
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Pot
Tablet
Tablet
Tablet
Tablet
Tube
Botol

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
80
81
82
83
84
85
86
87

Klorfeniramin maleat (CTM) tab 4 mg

Kotrimoksazole Susp
Lidokain 2% injeksi
Lidokain Komp Inj
Metil Ergometrin Inj 0,200 mg-1 ml
Metil Ergometrin tab 0.125 mg
Na. Diklofenac 50 mg
Nifedipin tab 10 mg
Obat Batuk hitam (OBH) sirup 100 ml
Oksitetrasiklin SK 3%
Oksitetrasiklin SM 1 %
Oksitosin inj 10 iu/1ml
Parasetamol Drops
Parasetamol sirup 120 mg/5 ml
Piridoksin tab 10 mg
Piroksicam 20 mg
Prednison 5 mg tab
Propiltiourasil 100 mg tab
Ranitidin tab 150 mg
Ringer Laktate lart infus
S. Anti Bisa Ular poli inj 5 ml(ABU I)
S. Anti Tetanus inj 1.500 iu/Amp ( ATS )
Salbutamol 2 mg tab
Salbutamol 4 mg tab
Salep 2-4 komb
Salisil Bedak 2 %
Salisil Spiritus 10 %
Sefadroxil 500 mg kapsul
Sianokobalamin (Vit B12) inj
Siprofloksasin 500 mg tab
Sulfasetamid tts mata 15%
Tetrasiklin 500 mg
Thiamin ( Vit B1 ) 50 mg tab
Thiamphenkol 500 mg cap
Tiamfenikol Suspensi ( Conucol Dry Sirup )
Triheksipenidil Hcl 2 mg tab
Vitamin B Kompleks tab
Yodium povidon 10 % 30 ml
Yodium Povidon 10 % 300 ml
Zink 20 mg Tablet dispersible
Zink Syrup
Bufacom (Triamsinolon in oral base)
Dulcolax tab
Demacolin tab
Fludane Syrup
Fludane Tablet
Lakto B
Lysmin ( Lysin ) Sirup

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

88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
-

Multivitamin (Ultravita tab / Kurkumex tab / Lanovit tab)

Neurovit E tablet
Alat Suntik Sekali Pakai 1 ml
Alat Suntik Sekali Pakai 3 ml / 2,5 ml
Alat Suntik Sekali Pakai 5 ml
Catgut/Benang bedah no 3/0 (p&c) dengan jarum bedah
Infusion Set Dewasa
Kapas Pembalut/Absorben 250 gr
Kasa Pembalut 2 X 80 cm
Kasa Kompres 40/40 steril
Kasa Pembalut 4 X 15 cm
Kasa Pembalut 4 X 3 cm
Lisol (Kresol tersaponifikasi 50%) 1 liter
Masker
Sarung Tangan Non Steril
IV. Catheter no. 18
Simvastatin 20 mg tab
Biplacenton
Ventolin Inhalasi
Permetrin Krim 5 %
Metoklopramid tab 5 mg
0
0
0

Tablet
Tablet
Set
Set
Set
Set
Set
Bungkus
Roll
Roll
Roll
Roll
Botol
Set
Set
Set
Tablet
Tube
Amp
Tube
Tablet
0
0
0

LAPORAN PE

Kode
ALP1
ALP2
AMB
AMD2
AMOK5
AMOKS
AND1
AND2
ATM
VITC
AFOL
ASMEF
ASK1
ASK2
BMT
BTM
BRO
DEK1
DIF
FPT2
FGT
VITK1
VITK2
FRO1
GEN1
GLIB
GG
GRI
HDR
HNB1
IBU1
IBU2
ICH
KD
KALK
KAP1
KAP2
KLOSM
KLOTT

Stok Awal Penerimaan Persdiaan

0
0
0
0
0
0
0
45
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
698
0
0
0
62
0
0
0
7
0
14
0
0

300

200

500
300

0
0
0
0
0
0
0
345
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
698
0
0
0
262
0
0
0
507
300
14
0
0

40

24

16

16

24

20

CTM
KOTS
LIDO1
LIDO2
ME1
ME2
NAD2
NIF
OBH
OKTSK
OKTSM
OTS
PARAD
PARAS
B6
PIK2
PRED
PTU
RAN2
RL
ABU1
ATS1
SAL1
SAL2
S2-4
SB2
SS
SEF
B12
SPRO
SULF
TETR2
VB1
THIA1
THAI2
TPD
VBC
YOD1
YOD2
ZNK1
ZNK2
BUF
DUL2
DEM
FLUD1
FLUD2
LKB
LYS

0
0
0
0
0
0
0
0
0
0
0
0
0
0
46
0
82
0
0
0
0
0
0
0
0
0
0
0
0
0
0
40
1
0
0
0
30
0
0
0
0
0
0
0
0
0
0
0

500

300
200

500

1000

500
0
0
0
0
0
0
0
0
0
5
0
0
0
346
0
282
0
0
0
0
0
0
0
0
0
0
0
0
0
0
40
501
0
0
0
1030
0
0
0
0
0
0
0
0
0
0
0

8
16

8
16

MULTF
NEUR2
ASS3
ASS4
ASS5
GUT1
ISD
KPA
KP1
KP2
KP3
KP4
LKT
MAS
STN
IV1
SIV
BPL
VNT
Permet
MTK3
0
0
0

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

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 (JKN)

10

24

40

16

11

12

13

64

56

14

TANGGAL
15
16
17

24

16

16

8
8

8
8

30

16

GAL
18

19

20

21

22

23

24

25

26

27

28

29

16

16

32

32

16

32

16

48

24

24

16

24

16

16

16

24

16

16

16

40

60
16

30
16

24
16

40
24

40

50
8

50
16

20
8

24

24

32

20

16

32

24

24
24

16

20

24

32

32

32

20

16

16

20

32

24

32

24

24

40

88

36

56

60

16
50

50

32

40

16

24
40

34

46

32

64

48

46

54

20

24

2
16

24

30

32

24

16

40
24

31

Pemakaian

Sisa

0
0
0
0
0
0
0
256
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
584
0
0
0
164
0
0
0
394
152
0
0
0

0
0
0
0
0
0
0
89
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
114
0
0
0
98
0
0
0
113
148
14
0
0

Permintaa

200

500

300

500

32

36

280
0
0
0
0
0
0
0
0
0
4
0
0
0
240
0
248
0
0
0
0
0
0
0
0
0
0
0
0
0
0
40
416
0
0
0
506
0
0
0
0
0
0
0
0
0
0
0

220
0
0
0
0
0
0
0
0
0
1
0
0
0
106
0
34
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
85
0
0
0
524
0
0
0
0
0
0
0
0
0
0
0

500

500
500

50
500

500

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

PELAPOR

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 (JKN)

PUSTU/POLINDES
BULAN
TAHUN
NO

NAMA OBAT

1
2
3
4
5
6
7
8
9
10
11

Alopurinol 100 mg
Alopurinol 300 mg
Ambroxol tablet 30 mg
Amlodipin tab 5 mg
Amoksisilin 500 mg
Amoksisilin SK 125mg/5ml
Antasida DOEN Syrup
Antasida DOEN tab Komb
Antihemoroid DOEN Komb
Asam Askorbat (Vit C) tab 50 mg
Asam folat 1 mg

12
13
14
15
16
17
18
19
20
21

Asam mefenamat 500 mg

Asiklovir 400 mg
Asiklovir 5 % krim
Betahistin Mesilat tablet 6 mg
Betametason krim 0,1%
Bromheksin tablet 8 mg
Deksametason inj 5 mg/ml-ml
Difenhidramin Hcl Inj 10 mg/ml-1ml
Fenoksimetil penisilin tab 500 mg
Fenol gliserol tetes Telinga 10 %

: Sumberbulu
: JUNI
: 2015
SATUAN

Tablet ALP1
Tablet ALP2
Tablet AMB
Tablet AMD2
Kaplet AMOK5
Botol
AMOKS
Botol
AND1
Tablet AND2
Suppositoria ATM
Tablet VITC
Tablet AFOL
Tablet
Tablet
Tube
Tablet
Tube
Tablet
Ampul
Ampul
Tablet
Botol

22 Fitomenadion (VitK) inj 10mg/ml-1ml Ampul

23
24
25
26
27
28
29
30
31

Fitomenadion (VitK) tab 10 mg

Furosemid tab 40 mg
Gentamsin Salep Kulit 0,1%
Glibenklamid 5 mg
Gliseril Guaiyakolat tab 100 mg
Grisiofulvin tab 125 mg
Hidrokortison krim 2.5 %
Hiosin N- Butilbromida Tab 10 mg
Ibuprofen 200 mg

Kode

Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Tube
Tablet
Tablet

Pene
Stok
Persdiaa
rimaa
Awal
n
n
0
0
0
0
0
0
0
0
0
0
0
0
0
0
89
89
0
0
0
0
0
0

ASMEF
ASK1
ASK2
BMT
BTM
BRO
DEK1
DIF
FPT2
FGT

0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0

VITK1

VITK2
FRO1
GEN1
GLIB
GG
GRI
HDR
HNB1
IBU1

0
0
0
0
114
0
0
0
98

0
0
0
0
114
0
0
0
98

TANGGAL
1

16

24

10

16

11

12

13

14

15

16

17

12

18

19

20

21

22

23

24

25

26

27

16

28

32
33
34
35
36
37
38
39
40
41
42

Ibuprofen 400 mg
Ichtyol salp
Kalium Diklofenak tab 50 mg
Kalsium Laktas (Kalk) tab 500 mg
Kaptopril 12,5 mg
Kaptopril 25 mg
Kloramphenikol salep mata 1 %
Kloramphenikol tetes telinga 3 %
Klorfeniramin maleat (CTM) tab 4 m
Kotrimoksazole Susp
Lidokain 2% injeksi

Tablet
Pot
Tablet
Tablet
Tablet
Tablet
Tube
Botol
Tablet
Botol
Ampul

IBU2
ICH
KD
KALK
KAP1
KAP2
KLOSM
KLOTT
CTM
KOTS
LIDO1

0
0
0
113
148
14
0
0
220
0
0

0
0
0
113
148
14
0
0
220
0
0

43
44
45
46
47
48

Lidokain Komp Inj

Metil Ergometrin Inj 0,200 mg-1 ml
Metil Ergometrin tab 0.125 mg
Na. Diklofenac 50 mg
Nifedipin tab 10 mg
Obat Batuk hitam (OBH) sirup 100 m

Ampul
Ampul
Tablet
Tablet
Tablet
Botol

LIDO2
ME1
ME2
NAD2
NIF
OBH

0
0
0
0
0
0

0
0
0
0
0
0

49 Oksitetrasiklin SK 3%
50 Oksitetrasiklin SM 1 %
51 Oksitosin inj 10 iu/1ml

Tube
Tube
Ampul

OKTSK
OKTSM
OTS

0
1
0

0
1
0

52 Parasetamol Drops

Botol

PARAD

Parasetamol sirup 120 mg/5 ml

Botol
Piridoksin tab 10 mg
Tablet
Piroksicam 20 mg
Tablet
Prednison 5 mg tab
Tablet
Propiltiourasil 100 mg tab
Tablet
Ranitidin tab 150 mg
Tablet
Ringer Laktate lart infus
Botol
S. Anti Bisa Ular poli inj 5 ml(ABU I)
Vial
S. Anti Tetanus inj 1.500 iu/Amp ( AT Ampul
Salbutamol 2 mg tab
Tablet
Salbutamol 4 mg tab
Tablet
Salep 2-4 komb
Pot
Salisil Bedak 2 %
Kotak
Salisil Spiritus 10 %
Botol
Sefadroxil 500 mg kapsul
Tablet
Sianokobalamin (Vit B12) inj
Ampul

PARAS
B6
PIK2
PRED
PTU
RAN2
RL
ABU1
ATS1
SAL1
SAL2
S2-4
SB2
SS
SEF
B12

0
106
0
34
0
0
0
0
0
0
0
0
0
0
0
0

0
106
0
34
0
0
0
0
0
0
0
0
0
0
0
0

53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68

10

10
8

16

24

8
8

10

20

10
8

16

12

10
8

16

10
8

16

8
8

10

10

16

16

69 Siprofloksasin 500 mg tab

Tablet
70 Sulfasetamid tts mata 15%
Botol
71 Tetrasiklin 500 mg
Tablet
72 Thiamin ( Vit B1 ) 50 mg tab
Tablet
73 Thiamphenkol 500 mg cap
Kapsul
74 Tiamfenikol Suspensi ( Conucol Dry Botol
75 Triheksipenidil Hcl 2 mg tab
Tablet
76 Vitamin B Kompleks tab
Tablet
77 Yodium povidon 10 % 30 ml
Botol
78 Yodium Povidon 10 % 300 ml
Botol
79 Zink 20 mg Tablet dispersible
Tablet
80 Zink Syrup
Botol
81 Bufacom (Triamsinolon in oral base) Tube
82 Dulcolax tab
Tablet
83 Demacolin tab
Tablet
84 Fludane Syrup
Botol
85 Fludane Tablet
Tablet
86 Lakto B
Sachet
87 Lysmin ( Lysin ) Sirup
Botol
88 Multivitamin (Ultravita tab / Kurkume Tablet
89 Neurovit E tablet
Tablet
90 Alat Suntik Sekali Pakai 1 ml
Set
91 Alat Suntik Sekali Pakai 3 ml / 2,5 m
Set
92 Alat Suntik Sekali Pakai 5 ml
Set
93 Catgut/Benang bedah no 3/0 (p&c)
Set
94 Infusion Set Dewasa
Set
95 Kapas Pembalut/Absorben 250 gr Bungkus
96 Kasa Pembalut 2 X 80 cm
Roll
97 Kasa Kompres 40/40 steril
Roll
98 Kasa Pembalut 4 X 15 cm
Roll
99 Kasa Pembalut 4 X 3 cm
Roll
100 Lisol (Kresol tersaponifikasi 50%) 1 l Botol
101 Masker
Set
102 Sarung Tangan Non Steril
Set
103 IV. Catheter no. 18
Set
104 Simvastatin 20 mg tab
Tablet
105 Biplacenton
Tube
106 Ventolin Inhalasi
Amp

SPRO
SULF
TETR2
VB1
THIA1
THAI2
TPD
VBC
YOD1
YOD2
ZNK1
ZNK2
BUF
DUL2
DEM
FLUD1
FLUD2
LKB
LYS
MULTF
NEUR2
ASS3
ASS4
ASS5
GUT1
ISD
KPA
KP1
KP2
KP3
KP4
LKT
MAS
STN
IV1
SIV
BPL
VNT

0
0
0
85
0
0
0
524
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
85
0
0
0
524
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

16

16

10

16

16

24

32

24

16

16

24

32

107 Permetrin Krim 5 %

108 Metoklopramid tab 5 mg

Tube
Tablet

Permet
MTK3

0
0

0
0

29

30

31

Pemakai
an

Sisa

0
0
0
0
0
0
0
88
0
0
0

0
0
0
0
0
0
0
1
0
0
0

0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0

0
0
0
0
108
0
0
0
88

0
0
0
0
6
0
0
0
10

Permint
aa

0
0
0
100
104
0
0
0
188
0
0

0
0
0
13
44
14
0
0
32
0
0

0
0
0
0
0
0

0
0
0
0
0
0

0
0
0

0
1
0

0
40
0
16
0
0
0
0
0
0
0
0
0
0
0
0

0
66
0
18
0
0
0
0
0
0
0
0
0
0
0
0

16

24

32

0
0
0
16
0
0
0
342
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
69
0
0
0
182
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0

PELAPOR

0
0

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (JKN)

PUSTU/POLINDES
BULAN
TAHUN

:
: JULI
: 2015
###

SATUAN Kode

Stok
Awal

1 Alopurinol 100 mg

Tablet ALP1

2 Alopurinol 300 mg

Tablet ALP2

3 Ambroxol tablet 30 mg

Tablet AMB

4 Amlodipin tab 5 mg

6 Amoksisilin SK 125mg/5ml

Tablet AMD2
AMOK
Kaplet 5
AMOK
Botol S

7 Antasida DOEN Syrup

Botol

AND1

8 Antasida DOEN tab Komb

Tablet AND2

NO

NAMA OBAT

5 Amoksisilin 500 mg

9 Antihemoroid DOEN Komb

Peneri Persdia
maan
an

300

301

SuppositoriaATM

10 Asam Askorbat (Vit C) tab 50 mg

Tablet VITC

11 Asam folat 1 mg

Tablet AFOL

12 Asam mefenamat 500 mg

Tablet

ASME
F

200

200

13 Asiklovir 400 mg

Tablet ASK1

14 Asiklovir 5 % krim

Tube

ASK2

TANGGAL
1

10

11

24

40

12

13

24

14

18

15

16

17

18

19

20

21

22

32

40

23

16

50

24

25

24

60

26

27

32

15 Betahistin Mesilat tablet 6 mg

Tablet BMT

16 Betametason krim 0,1%

Tube

BTM

17 Bromheksin tablet 8 mg

Tablet BRO

18 Deksametason inj 5 mg/ml-ml

19 Difenhidramin Hcl Inj 10 mg/ml-1ml

Ampul DEK1
Ampul DIF

0
0

0
0

20 Fenoksimetil penisilin tab 500 mg

21 Fenol gliserol tetes Telinga 10 %

Tablet FPT2
Botol FGT

0
0

0
0

22 Fitomenadion (VitK) inj 10mg/ml-1ml

Ampul VITK1

23 Fitomenadion (VitK) tab 10 mg

Tablet VITK2

24 Furosemid tab 40 mg

Tablet FRO1

25 Gentamsin Salep Kulit 0,1%

Tube

26 Glibenklamid 5 mg
27 Gliseril Guaiyakolat tab 100 mg
28 Grisiofulvin tab 125 mg

Tablet GLIB
Tablet GG
Tablet GRI

0
6
0

0
1006
0

29 Hidrokortison krim 2.5 %

Tube

30 Hiosin N- Butilbromida Tab 10 mg

Tablet HNB1

30

30

31 Ibuprofen 200 mg

Tablet IBU1

10

300

310

32 Ibuprofen 400 mg
33 Ichtyol salp
34 Kalium Diklofenak tab 50 mg

Tablet IBU2
Pot ICH
Tablet KD

0
0
0

35 Kalsium Laktas (Kalk) tab 500 mg

Tablet KALK

13

500

513

36 Kaptopril 12,5 mg

Tablet KAP1

44

100

144

GEN1

HDR

0
5

1000

32

48

24

32

32

0
8
8

16

24

32

24

48

24

0
0
0
10
8

40

40

16

24

50

60
16

16

37 Kaptopril 25 mg

14

38 Kloramphenikol salep mata 1 %

Tablet KAP2
KLOS
Tube M

39 Kloramphenikol tetes telinga 3 %

Botol

40 Klorfeniramin maleat (CTM) tab 4 mg

Tablet CTM

32

41 Kotrimoksazole Susp

Botol

KOTS

42 Lidokain 2% injeksi

Ampul LIDO1

43 Lidokain Komp Inj

44 Metil Ergometrin Inj 0,200 mg-1 ml
45 Metil Ergometrin tab 0.125 mg

Ampul LIDO2
Ampul ME1
Tablet ME2

0
0
0

0
0
0

46 Na. Diklofenac 50 mg
47 Nifedipin tab 10 mg

Tablet NAD2
Tablet NIF

0
0

48 Obat Batuk hitam (OBH) sirup 100 ml

Botol

KLOTT

53 Parasetamol sirup 120 mg/5 ml

54 Piridoksin tab 10 mg

OBH
OKTS
Tube K
OKTS
Tube M
Ampul OTS
PARA
Botol D
PARA
Botol S
Tablet B6

0
66

55 Piroksicam 20 mg

Tablet PIK2

56 Prednison 5 mg tab
57 Propiltiourasil 100 mg tab

Tablet PRED
Tablet PTU

18
0

58 Ranitidin tab 150 mg

59 Ringer Laktate lart infus

Tablet RAN2
Botol RL

0
0

49 Oksitetrasiklin SK 3%
50 Oksitetrasiklin SM 1 %
51 Oksitosin inj 10 iu/1ml
52 Parasetamol Drops

1
0

100

1000

30

114

1032

16

48

16

48

16

32

32

32

30
0

6
0

300

0
366

24

32

16

24

16

20

24

0
300

318
0
0
0

16

24

24

16

60 S. Anti Bisa Ular poli inj 5 ml(ABU I)

ABU1

61 S. Anti Tetanus inj 1.500 iu/Amp ( ATS Ampul ATS1

62 Salbutamol 2 mg tab

Tablet SAL1

63 Salbutamol 4 mg tab

Tablet SAL2

64
65
66
67
68

Pot
Kotak
Botol
Tablet
Ampul

0
0
0
0
0

0
0
0
0
0

Salep 2-4 komb

Salisil Bedak 2 %
Salisil Spiritus 10 %
Sefadroxil 500 mg kapsul
Sianokobalamin (Vit B12) inj

Vial

S2-4
SB2
SS
SEF
B12

69 Siprofloksasin 500 mg tab

Tablet SPRO

70 Sulfasetamid tts mata 15%

Botol

71 Tetrasiklin 500 mg
72 Thiamin ( Vit B1 ) 50 mg tab

Tablet TETR2
Tablet VB1

0
69

0
369

73 Thiamphenkol 500 mg cap

Kapsul THIA1

0
0
182

0
0
1182

SULF

74 Tiamfenikol Suspensi ( Conucol Dry Si Botol THAI2

75 Triheksipenidil Hcl 2 mg tab
Tablet TPD
76 Vitamin B Kompleks tab
Tablet VBC

300

1000

77 Yodium povidon 10 % 30 ml

Botol

YOD1

78 Yodium Povidon 10 % 300 ml

Botol

YOD2

79 Zink 20 mg Tablet dispersible

Tablet ZNK1

80 Zink Syrup
81 Bufacom (Triamsinolon in oral base)

Botol
Tube

ZNK2
BUF

0
0

0
0

82 Dulcolax tab

Tablet DUL2

100

100

24

32

60

16

80

32

24

24

16

60

16

20

16

24

24

32

83 Demacolin tab

Tablet DEM

84 Fludane Syrup

Botol

FLUD1

85 Fludane Tablet

Tablet FLUD2

86 Lakto B
87 Lysmin ( Lysin ) Sirup

Sachet LKB
Botol LYS

0
0

0
0

88 Multivitamin (Ultravita tab / Kurkumex Tablet MULTF

NEUR
89 Neurovit E tablet
Tablet 2

90 Alat Suntik Sekali Pakai 1 ml

Set

ASS3

91 Alat Suntik Sekali Pakai 3 ml / 2,5 ml

Set

ASS4

92 Alat Suntik Sekali Pakai 5 ml

Set

ASS5

93
94
95
96
97
98
99
100

Catgut/Benang bedah no 3/0 (p&c) d

Set GUT1
Infusion Set Dewasa
Set ISD
Kapas Pembalut/Absorben 250 gr
Bungkus KPA
Kasa Pembalut 2 X 80 cm
Roll KP1
Kasa Kompres 40/40 steril
Roll KP2
Kasa Pembalut 4 X 15 cm
Roll KP3
Kasa Pembalut 4 X 3 cm
Roll KP4
Lisol (Kresol tersaponifikasi 50%) 1 lit Botol LKT

0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0

101
102
103
104
105
106

Masker
Sarung Tangan Non Steril
IV. Catheter no. 18
Simvastatin 20 mg tab
Biplacenton
Ventolin Inhalasi

Set
Set
Set
Tablet
Tube
Amp

MAS
STN
IV1
SIV
BPL
VNT

0
0
0
0
0
0

0
0
0
0
0
0

107 Permetrin Krim 5 %

Tube

Permet

108 Metoklopramid tab 5 mg

Tablet MTK3

0
0
0

0
0
0

0 Err:509
0 Err:509
0 Err:509

Err:509
Err:509
Err:509

28

29

30

25

31

24

Pemaka
Sisa
ian
0

219

82

190

10

Permint
aa

200

200

24

48

24

32

16

0
0

0
0

0
0

0
0

0
272
0

0
734
0

22

216

94

0
0
0

0
0
0

200

313

120

24

200

100

24

48

24

32

76

38

336

696

0
0
0

0
0
0

0
0

30
0

4
0

2
0

0
180

0
186

104
0

214
0

0
0

0
0

100

100

50

24

32

32

0
0
0
0
0

0
0
0
0
0

0
180

0
189

50

30

0
0
408

0
0
774

100

0
0

0
0

0
0

0
0

0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0

0
0
0
0
0
0

0
0
0
0
0
0

0
0
0

PELAPOR

Err:509
Err:509
Err:509

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (JKN)

PUSTU/POLINDES
BULAN
TAHUN

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

:
: AGUSTUS
: 2015

SA
TU Kode
AN
Alopurinol 100 mg
TabletALP1
Alopurinol 300 mg
TabletALP2
Ambroxol tablet 30 mg
TabletAMB
Amlodipin tab 5 mg
TabletAMD2
AMOK
Amoksisilin 500 mg
Kaplet
5AMOK
Amoksisilin SK 125mg/5ml
Botol
S
Antasida DOEN Syrup
BotolAND1
Antasida DOEN tab Komb
TabletAND2
Antihemoroid DOEN Komb
Suppositoria
ATM
Asam Askorbat (Vit C) tab 50 mg
TabletVITC
Asam folat 1 mg
TabletAFOL
ASME
Asam mefenamat 500 mg
Tablet
F
Asiklovir 400 mg
TabletASK1
Asiklovir 5 % krim
TubeASK2
Betahistin Mesilat tablet 6 mg
TabletBMT
Betametason krim 0,1%
TubeBTM
Bromheksin tablet 8 mg
TabletBRO
Deksametason inj 5 mg/ml-ml
AmpulDEK1
Difenhidramin Hcl Inj 10 mg/ml-1ml
AmpulDIF
Fenoksimetil penisilin tab 500 mg
TabletFPT2
Fenol gliserol tetes Telinga 10 %
BotolFGT
Fitomenadion (VitK) inj 10mg/ml-1ml AmpulVITK1
Fitomenadion (VitK) tab 10 mg
TabletVITK2
Furosemid tab 40 mg
TabletFRO1
NAMA OBAT

Stok Pener
Persdiaan
Awal imaan
0
0
0
0
0
0
0
82
0
0
10
0
0
0
0
3
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
82
0
0
10
0
0
0
0
3
0
0
0
0
0
0
0
0

TANGGAL
1

10

11

12

13

14

15

16

17

18

19

20

21

10

22

23

24

25

26

27

28

29

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
53
54
55
56
57

Gentamsin Salep Kulit 0,1%

Glibenklamid 5 mg
Gliseril Guaiyakolat tab 100 mg
Grisiofulvin tab 125 mg
Hidrokortison krim 2.5 %
Hiosin N- Butilbromida Tab 10 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Ichtyol salp
Kalium Diklofenak tab 50 mg
Kalsium Laktas (Kalk) tab 500 mg
Kaptopril 12,5 mg
Kaptopril 25 mg
Kloramphenikol salep mata 1 %
Kloramphenikol tetes telinga 3 %
Klorfeniramin maleat (CTM) tab 4 mg
Kotrimoksazole Susp
Lidokain 2% injeksi
Lidokain Komp Inj
Metil Ergometrin Inj 0,200 mg-1 ml
Metil Ergometrin tab 0.125 mg
Na. Diklofenac 50 mg
Nifedipin tab 10 mg
Obat Batuk hitam (OBH) sirup 100 ml
Oksitetrasiklin SK 3%
Oksitetrasiklin SM 1 %
Oksitosin inj 10 iu/1ml
Parasetamol Drops
Parasetamol sirup 120 mg/5 ml
Piridoksin tab 10 mg
Piroksicam 20 mg
Prednison 5 mg tab
Propiltiourasil 100 mg tab

TubeGEN1
TabletGLIB
TabletGG
TabletGRI
TubeHDR
TabletHNB1
TabletIBU1
TabletIBU2
Pot ICH
TabletKD
TabletKALK
TabletKAP1
TabletKAP2
KLOS
Tube
M
BotolKLOTT
TabletCTM
BotolKOTS
AmpulLIDO1
AmpulLIDO2
AmpulME1
TabletME2
TabletNAD2
TabletNIF
BotolOBH
OKTS
Tube
K
OKTS
Tube
M
AmpulOTS
PARA
Botol
D
PARA
Botol
S
TabletB6
TabletPIK2
TabletPRED
TabletPTU

0
0
734
0
0
22
94
0
0
0
313
24
38
0
0
696
0
0
0
0
0
30
0
0
0
2
0
0
0
186
0
214
0

0
0
734
0
0
22
94
0
0
0
313
24
38
0
0
696
0
0
0
0
0
30
0
0
0
2
0
0
0
186
0
214
0

32

24

16

24

16

24

24

32

16

24

24

24

6
8

20
6

24

24

24

32

16

20

30

20

16

32

16

20

6
8

20

20
6

24

24

24

32

16

16

32

16

16

32

32

32

32

16

16

8
8

20

20
8

8
8

8
8

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

Ranitidin tab 150 mg

TabletRAN2
Ringer Laktate lart infus
BotolRL
S. Anti Bisa Ular poli inj 5 ml(ABU I)
Vial ABU1
S. Anti Tetanus inj 1.500 iu/Amp ( ATS )AmpulATS1
Salbutamol 2 mg tab
TabletSAL1
Salbutamol 4 mg tab
TabletSAL2
Salep 2-4 komb
Pot S2-4
Salisil Bedak 2 %
KotakSB2
Salisil Spiritus 10 %
BotolSS
Sefadroxil 500 mg kapsul
TabletSEF
Sianokobalamin (Vit B12) inj
AmpulB12
Siprofloksasin 500 mg tab
TabletSPRO
Sulfasetamid tts mata 15%
BotolSULF
Tetrasiklin 500 mg
TabletTETR2
Thiamin ( Vit B1 ) 50 mg tab
TabletVB1
Thiamphenkol 500 mg cap
KapsulTHIA1
Tiamfenikol Suspensi ( Conucol Dry SiruBotolTHAI2
Triheksipenidil Hcl 2 mg tab
TabletTPD
Vitamin B Kompleks tab
TabletVBC
Yodium povidon 10 % 30 ml
BotolYOD1
Yodium Povidon 10 % 300 ml
BotolYOD2
Zink 20 mg Tablet dispersible
TabletZNK1
Zink Syrup
BotolZNK2
Bufacom (Triamsinolon in oral base) TubeBUF
Dulcolax tab
TabletDUL2
Demacolin tab
TabletDEM
Fludane Syrup
BotolFLUD1
Fludane Tablet
TabletFLUD2
Lakto B
SachetLKB
Lysmin ( Lysin ) Sirup
BotolLYS
Multivitamin (Ultravita tab / Kurkumex tab
TabletMULTF
NEUR
Neurovit E tablet
Tablet
2
Alat Suntik Sekali Pakai 1 ml
Set ASS3

0
0
0
0
0
0
0
0
0
0
0
0
0
0
189
0
0
0
774
0
0
100
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
189
0
0
0
774
0
0
100
0
0
0
0
0
0
0
0
0
0
0

16

32

24

16

24

32

16

24

32

24

16

24

16

32

10

24

32

16

10

24

50

24

16

24

24

38

10

24

24

32

32

91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108

Alat Suntik Sekali Pakai 3 ml / 2,5 ml Set ASS4

Alat Suntik Sekali Pakai 5 ml
Set ASS5
Catgut/Benang bedah no 3/0 (p&c) den Set GUT1
Infusion Set Dewasa
Set ISD
Kapas Pembalut/Absorben 250 gr Bungkus
KPA
Kasa Pembalut 2 X 80 cm
Roll KP1
Kasa Kompres 40/40 steril
Roll KP2
Kasa Pembalut 4 X 15 cm
Roll KP3
Kasa Pembalut 4 X 3 cm
Roll KP4
Lisol (Kresol tersaponifikasi 50%) 1 liter BotolLKT
Masker
Set MAS
Sarung Tangan Non Steril
Set STN
IV. Catheter no. 18
Set IV1
Simvastatin 20 mg tab
TabletSIV
Biplacenton
TubeBPL
Ventolin Inhalasi
Amp VNT
Permetrin Krim 5 %
TubePermet
Metoklopramid tab 5 mg
TabletMTK3

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

31

Pemakaian

Sisa

0
0
0
0
0
0
0
80
0
0
10
0
0
0
0
3
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Perminta
a

0
0
368
0
0
18
88
0
0
0
150
24
24
0
0
368
0
0
0
0
0
30
0
0
0
2
0
0
0
112
0
56
0

0
0
366
0
0
4
6
0
0
0
163
0
14
0
0
328
0
0
0
0
0
0
0
0
0
0
0
0
0
74
0
158
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
184
0
0
0
528
0
0
30
0
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
246
0
0
70
0
0
0
0
0
0
0
0
0
0
0

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

PELAPOR

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

:
: SEPTEMBER
: 2015

PUSTU/POLINDES
BULAN
TAHUN

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

NAMA OBAT
Alopurinol 100 mg
Alopurinol 300 mg
Ambroxol tablet 30 mg
Amlodipin tab 5 mg
Amoksisilin 500 mg
Amoksisilin SK 125mg/5ml
Antasida DOEN Syrup
Antasida DOEN tab Komb
Antihemoroid DOEN Komb
Asam Askorbat (Vit C) tab 50 mg
Asam folat 1 mg
Asam mefenamat 500 mg
Asiklovir 400 mg
Asiklovir 5 % krim
Betahistin Mesilat tablet 6 mg
Betametason krim 0,1%
Bromheksin tablet 8 mg
Deksametason inj 5 mg/ml-ml
Difenhidramin Hcl Inj 10 mg/ml-1ml
Fenoksimetil penisilin tab 500 mg
Fenol gliserol tetes Telinga 10 %
Fitomenadion (VitK) inj 10mg/ml-1ml
Fitomenadion (VitK) tab 10 mg
Furosemid tab 40 mg
Gentamsin Salep Kulit 0,1%
Glibenklamid 5 mg
Gliseril Guaiyakolat tab 100 mg
Grisiofulvin tab 125 mg
Hidrokortison krim 2.5 %
Hiosin N- Butilbromida Tab 10 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Ichtyol salp
Kalium Diklofenak tab 50 mg
Kalsium Laktas (Kalk) tab 500 mg
Kaptopril 12,5 mg
Kaptopril 25 mg
Kloramphenikol salep mata 1 %
Kloramphenikol tetes telinga 3 %

SATUAN
Tablet
Tablet
Tablet
Tablet
Kaplet
Botol
Botol
Tablet
Suppositoria
Tablet
Tablet
Tablet
Tablet
Tube
Tablet
Tube
Tablet
Ampul
Ampul
Tablet
Botol
Ampul
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Pot
Tablet
Tablet
Tablet
Tablet
Tube
Botol

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
80
81
82
83
84
85
86
87

Klorfeniramin maleat (CTM) tab 4 mg

Kotrimoksazole Susp
Lidokain 2% injeksi
Lidokain Komp Inj
Metil Ergometrin Inj 0,200 mg-1 ml
Metil Ergometrin tab 0.125 mg
Na. Diklofenac 50 mg
Nifedipin tab 10 mg
Obat Batuk hitam (OBH) sirup 100 ml
Oksitetrasiklin SK 3%
Oksitetrasiklin SM 1 %
Oksitosin inj 10 iu/1ml
Parasetamol Drops
Parasetamol sirup 120 mg/5 ml
Piridoksin tab 10 mg
Piroksicam 20 mg
Prednison 5 mg tab
Propiltiourasil 100 mg tab
Ranitidin tab 150 mg
Ringer Laktate lart infus
S. Anti Bisa Ular poli inj 5 ml(ABU I)
S. Anti Tetanus inj 1.500 iu/Amp ( ATS )
Salbutamol 2 mg tab
Salbutamol 4 mg tab
Salep 2-4 komb
Salisil Bedak 2 %
Salisil Spiritus 10 %
Sefadroxil 500 mg kapsul
Sianokobalamin (Vit B12) inj
Siprofloksasin 500 mg tab
Sulfasetamid tts mata 15%
Tetrasiklin 500 mg
Thiamin ( Vit B1 ) 50 mg tab
Thiamphenkol 500 mg cap
Tiamfenikol Suspensi ( Conucol Dry Sirup )
Triheksipenidil Hcl 2 mg tab
Vitamin B Kompleks tab
Yodium povidon 10 % 30 ml
Yodium Povidon 10 % 300 ml
Zink 20 mg Tablet dispersible
Zink Syrup
Bufacom (Triamsinolon in oral base)
Dulcolax tab
Demacolin tab
Fludane Syrup
Fludane Tablet
Lakto B
Lysmin ( Lysin ) Sirup

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

88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
-

Multivitamin (Ultravita tab / Kurkumex tab / Lanovit tab)

Neurovit E tablet
Alat Suntik Sekali Pakai 1 ml
Alat Suntik Sekali Pakai 3 ml / 2,5 ml
Alat Suntik Sekali Pakai 5 ml
Catgut/Benang bedah no 3/0 (p&c) dengan jarum bedah
Infusion Set Dewasa
Kapas Pembalut/Absorben 250 gr
Kasa Pembalut 2 X 80 cm
Kasa Kompres 40/40 steril
Kasa Pembalut 4 X 15 cm
Kasa Pembalut 4 X 3 cm
Lisol (Kresol tersaponifikasi 50%) 1 liter
Masker
Sarung Tangan Non Steril
IV. Catheter no. 18
Simvastatin 20 mg tab
Biplacenton
Ventolin Inhalasi
Permetrin Krim 5 %
Metoklopramid tab 5 mg
Parasetamol
akotrimoksa dewasa
0

Tablet
Tablet
Set
Set
Set
Set
Set
Bungkus
Roll
Roll
Roll
Roll
Botol
Set
Set
Set
Tablet
Tube
Amp
Tube
Tablet
0
0
0

LAPORAN PEM

Kode
ALP1
ALP2
AMB
AMD2
AMOK5
AMOKS
AND1
AND2
ATM
VITC
AFOL
ASMEF
ASK1
ASK2
BMT
BTM
BRO
DEK1
DIF
FPT2
FGT
VITK1
VITK2
FRO1
GEN1
GLIB
GG
GRI
HDR
HNB1
IBU1
IBU2
ICH
KD
KALK
KAP1
KAP2
KLOSM
KLOTT

Stok Awal Penerimaan Persdiaan

0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
366
0
0
4
6
0
0
0
163
0
14
0
0

300
1000
200

3
100
100

300

300
100
100

0
0
0
0
0
0
0
302
0
1000
200
0
0
0
0
0
0
0
0
0
0
0
0
0
3
100
366
100
0
4
306
0
0
0
463
100
114
0
0

24

20

16

20

CTM
KOTS
LIDO1
LIDO2
ME1
ME2
NAD2
NIF
OBH
OKTSK
OKTSM
OTS
PARAD
PARAS
B6
PIK2
PRED
PTU
RAN2
RL
ABU1
ATS1
SAL1
SAL2
S2-4
SB2
SS
SEF
B12
SPRO
SULF
TETR2
VB1
THIA1
THAI2
TPD
VBC
YOD1
YOD2
ZNK1
ZNK2
BUF
DUL2
DEM
FLUD1
FLUD2
LKB
LYS

328
0
0
0
0
0
0
0
0
0
0
0
0
0
74
0
158
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
246
0
0
70
0
0
0
0
0
0
0
0

50

5
5

5
200

20
50

1000

328
0
0
0
0
0
50
0
0
5
5
0
0
5
274
0
158
0
0
0
0
0
0
0
3
0
0
0
20
50
0
0
5
0
0
0
1246
0
0
70
0
0
0
0
0
0
0
0

24

24

32

32

10

10

24

MULTF
NEUR2
ASS3
ASS4
ASS5
GUT1
ISD
KPA
KP1
KP2
KP3
KP4
LKT
MAS
STN
IV1
SIV
BPL
VNT
Permet
MTK3
0
0
0

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

50

500
200

0
0
0
50
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
500
200
0

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (JKN)

10

11

12

13

14

TANGGAL
15
16
17

18

24

16

45
20

32

24

16

16

20

16

48

30

32

32

20

16
16
6

1
1

16

24

20

32

10

24

10

10

24

48
20

19

20

21

16
54

48
20

20
43

24

22

24

25

26

27

28

24

16

32

24

43

48

54
20

48

24

24

20
16

16

29

16

30

24
56

20

24

16

30
12

23

16

16

16
16

24

16

30
16

1
1

1
26

16

10

16

16

24

26
10

32

48
10

10

24
30

16

24
10

48
20

31

24

24

24

Pemakaian

Sisa

0
0
0
0
0
0
0
216
0
396
80
0
0
0
0
0
0
0
0
0
0
0
0
0
0
40
343
0
0
0
200
0
0
0
182
88
18
0
0

0
0
0
0
0
0
0
86
0
604
120
0
0
0
0
0
0
0
0
0
0
0
0
0
3
60
23
100
0
4
106
0
0
0
281
12
96
0
0

Permintaa

300
5
300

300
50
2

30

1000

300

0
0
0
0
0
0
24
0
0
2
2
0
0
2
86
0
0
0
0
0
0
0
0
0
0
0
0
0
7
8
0
0
0
0
0
0
288
0
0
60
0
0
0
0
0
0
0
0

328
0
0
0
0
0
26
0
0
3
3
0
0
3
188
0
158
0
0
0
0
0
0
0
3
0
0
0
13
42
0
0
5
0
0
0
958
0
0
10
0
0
0
0
0
0
0
0

5
5

50

50
5

100

50
1
50
5

24
10

0
0
0
43
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
290
120
0

PELAPOR

0
0
0
7
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
210
80
0

100
2
4
2
2

5
5
3

500
200

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (JKN)

:
: OKTOBER
: 2015

PUSTU/POLINDES
BULAN
TAHUN

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

NAMA OBAT
Alopurinol 100 mg
Alopurinol 300 mg
Ambroxol tablet 30 mg
Amlodipin tab 5 mg
Amoksisilin 500 mg
Amoksisilin SK 125mg/5ml
Antasida DOEN Syrup
Antasida DOEN tab Komb
Antihemoroid DOEN Komb
Asam Askorbat (Vit C) tab 50 mg
Asam folat 1 mg
Asam mefenamat 500 mg
Asiklovir 400 mg
Asiklovir 5 % krim
Betahistin Mesilat tablet 6 mg
Betametason krim 0,1%
Bromheksin tablet 8 mg
Deksametason inj 5 mg/ml-ml
Difenhidramin Hcl Inj 10 mg/ml-1ml
Fenoksimetil penisilin tab 500 mg
Fenol gliserol tetes Telinga 10 %
Fitomenadion (VitK) inj 10mg/ml-1ml
Fitomenadion (VitK) tab 10 mg
Furosemid tab 40 mg

SATUAN
Tablet
Tablet
Tablet
Tablet
Kaplet
Botol
Botol
Tablet
Suppositoria
Tablet
Tablet
Tablet
Tablet
Tube
Tablet
Tube
Tablet
Ampul
Ampul
Tablet
Botol
Ampul
Tablet
Tablet

Kode
ALP1
ALP2
AMB
AMD2
AMOK5
AMOKS
AND1
AND2
ATM
VITC
AFOL
ASMEF
ASK1
ASK2
BMT
BTM
BRO
DEK1
DIF
FPT2
FGT
VITK1
VITK2
FRO1

Stok Awal Penerimaan Persdiaan

0
0
0
0
0
0
0
86
0
604
120
0
0
0
0
0
0
0
0
0
0
0
0
0

50

300
5
100

600
5
30

50
0
0
0
300
5
0
186
0
604
120
0
0
0
0
0
0
0
0
600
0
5
30
0

TANG
1

16

19

19

10 11
8

32

64

24

12

27

16

16

16

13

35

43

16

25
26
27

Gentamsin Salep Kulit 0,1%

Glibenklamid 5 mg
Gliseril Guaiyakolat tab 100 mg

Tube
Tablet
Tablet

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
53
54
55
56
57

Grisiofulvin tab 125 mg

Hidrokortison krim 2.5 %
Hiosin N- Butilbromida Tab 10 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Ichtyol salp
Kalium Diklofenak tab 50 mg
Kalsium Laktas (Kalk) tab 500 mg
Kaptopril 12,5 mg
Kaptopril 25 mg
Kloramphenikol salep mata 1 %
Kloramphenikol tetes telinga 3 %
Klorfeniramin maleat (CTM) tab 4 mg
Kotrimoksazole Susp
Lidokain 2% injeksi
Lidokain Komp Inj
Metil Ergometrin Inj 0,200 mg-1 ml
Metil Ergometrin tab 0.125 mg
Na. Diklofenac 50 mg
Nifedipin tab 10 mg
Obat Batuk hitam (OBH) sirup 100 ml
Oksitetrasiklin SK 3%
Oksitetrasiklin SM 1 %
Oksitosin inj 10 iu/1ml
Parasetamol Drops
Parasetamol sirup 120 mg/5 ml
Piridoksin tab 10 mg
Piroksicam 20 mg
Prednison 5 mg tab
Propiltiourasil 100 mg tab

Tablet
Tube
Tablet
Tablet
Tablet
Pot
Tablet
Tablet
Tablet
Tablet
Tube
Botol
Tablet
Botol
Ampul
Ampul
Ampul
Tablet
Tablet
Tablet
Botol
Tube
Tube
Ampul
Botol
Botol
Tablet
Tablet
Tablet
Tablet

GEN1
GLIB
GG
GRI
HDR
HNB1
IBU1
IBU2
ICH
KD
KALK
KAP1
KAP2
KLOSM
KLOTT
CTM
KOTS
LIDO1
LIDO2
ME1
ME2
NAD2
NIF
OBH
OKTSK
OKTSM
OTS
PARAD
PARAS
B6
PIK2
PRED
PTU

3
60
23
100
0
4
106
0
0
0
281
12
96
0
0
328
0
0
0
0
0
26
0
0
3
3
0
0
3
188
0
158
0

3
100
500

100

100
100

500

10

6
160
523
100
0
4
206
0
0
0
281
112
196
0
0
828
0
0
0
0
0
26
0
0
3
3
10
0
3
188
0
158
0

8
11

8
8

27

64

3
8

8
16

3
8

8
8

88
11

8
8

8
8

24

8
8

46

58
59
60

Ranitidin tab 150 mg

Ringer Laktate lart infus
S. Anti Bisa Ular poli inj 5 ml(ABU I)

Tablet
Botol
Vial

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

S. Anti Tetanus inj 1.500 iu/Amp ( ATS )

Salbutamol 2 mg tab
Salbutamol 4 mg tab
Salep 2-4 komb
Salisil Bedak 2 %
Salisil Spiritus 10 %
Sefadroxil 500 mg kapsul
Sianokobalamin (Vit B12) inj
Siprofloksasin 500 mg tab
Sulfasetamid tts mata 15%
Tetrasiklin 500 mg
Thiamin ( Vit B1 ) 50 mg tab
Thiamphenkol 500 mg cap
Tiamfenikol Suspensi ( Conucol Dry Sirup )
Triheksipenidil Hcl 2 mg tab
Vitamin B Kompleks tab
Yodium povidon 10 % 30 ml
Yodium Povidon 10 % 300 ml
Zink 20 mg Tablet dispersible
Zink Syrup
Bufacom (Triamsinolon in oral base)
Dulcolax tab
Demacolin tab
Fludane Syrup
Fludane Tablet
Lakto B
Lysmin ( Lysin ) Sirup
Multivitamin (Ultravita tab / Kurkumex tab / La
Neurovit E tablet
Alat Suntik Sekali Pakai 1 ml

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

RAN2
RL
ABU1
ATS1
SAL1
SAL2
S2-4
SB2
SS
SEF
B12
SPRO
SULF
TETR2
VB1
THIA1
THAI2
TPD
VBC
YOD1
YOD2
ZNK1
ZNK2
BUF
DUL2
DEM
FLUD1
FLUD2
LKB
LYS
MULTF
NEUR2
ASS3

0
0
0
0
0
0
3
0
0
0
13
42
0
0
5
0
0
0
958
0
0
10
0
0
0
0
0
0
0
0
0
0
0

30
5

50

1000

30
5
0
0
0
0
3
0
0
0
63
42
0
0
5
0
0
0
1958
0
0
10
0
0
0
0
0
0
0
0
0
0
0

19

16

16

32

16

24

16

91
92
93

Alat Suntik Sekali Pakai 3 ml / 2,5 ml

Alat Suntik Sekali Pakai 5 ml
Catgut/Benang bedah no 3/0 (p&c) dengan j

94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
-

Infusion Set Dewasa

Kapas Pembalut/Absorben 250 gr
Kasa Pembalut 2 X 80 cm
Kasa Kompres 40/40 steril
Kasa Pembalut 4 X 15 cm
Kasa Pembalut 4 X 3 cm
Lisol (Kresol tersaponifikasi 50%) 1 liter
Masker
Sarung Tangan Non Steril
IV. Catheter no. 18
Simvastatin 20 mg tab
Biplacenton
Ventolin Inhalasi
Permetrin Krim 5 %
Metoklopramid tab 5 mg
Parasetamol
kotrimoksasol dewasa
fe

Set
Set
Set
Set
Bungkus
Roll
Roll
Roll
Roll
Botol
Set
Set
Set
Tablet
Tube
Amp
Tube
Tablet
0
0
0

ASS4
ASS5
GUT1
ISD
KPA
KP1
KP2
KP3
KP4
LKT
MAS
STN
IV1
SIV
BPL
VNT
Permet
MTK3
0
0
0

7
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
210
80
0

100
600

7
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
210
180
600

16

8
10

28

8
10

30

60

16
10
60

16

TAAN OBAT (JKN)

14

TANGGAL
15 16 17
8

16

18

19

20

21

22 23
8

24

25

26

27 28
8

16

29

16

30

16

31

16

Pemakaian

Sisa

40
0
0
0
217
0
0
0
0
265
0
0
0
0
0
0
0
0
0
80
0
0
0
0

10
0
0
0
83
5
0
186
0
339
120
0
0
0
0
0
0
0
0
520
0
5
30
0

Permintaa

16
3

8
8

3
16

8
8

8
16

8
8

16

11

8
8

16

8
8

8
8

0
144
84
0
0
0
200
0
0
0
8
108
168
0
0
167
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

6
16
439
100
0
4
6
0
0
0
273
4
28
0
0
661
0
0
0
0
0
26
0
0
3
3
10
0
3
188
0
158
0

24

16

0
0
0
0
0
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
0

30
5
0
0
0
0
3
0
0
0
63
42
0
0
5
0
0
0
1723
0
0
10
0
0
0
0
0
0
0
0
0
0
0

16
10

10
240

8
10

8
60

8
10

8
10

8
10

7
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
180
90
450

PELAPOR

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
30
90
150

:
: NOPEMBER
: 2015

PUSTU/POLINDES
BULAN
TAHUN

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

NAMA OBAT
Alopurinol 100 mg
Alopurinol 300 mg
Ambroxol tablet 30 mg
Amlodipin tab 5 mg
Amoksisilin 500 mg
Amoksisilin SK 125mg/5ml
Antasida DOEN Syrup
Antasida DOEN tab Komb
Antihemoroid DOEN Komb
Asam Askorbat (Vit C) tab 50 mg
Asam folat 1 mg
Asam mefenamat 500 mg
Asiklovir 400 mg
Asiklovir 5 % krim
Betahistin Mesilat tablet 6 mg
Betametason krim 0,1%
Bromheksin tablet 8 mg
Deksametason inj 5 mg/ml-ml
Difenhidramin Hcl Inj 10 mg/ml-1ml
Fenoksimetil penisilin tab 500 mg
Fenol gliserol tetes Telinga 10 %
Fitomenadion (VitK) inj 10mg/ml-1ml
Fitomenadion (VitK) tab 10 mg
Furosemid tab 40 mg
Gentamsin Salep Kulit 0,1%
Glibenklamid 5 mg
Gliseril Guaiyakolat tab 100 mg
Grisiofulvin tab 125 mg
Hidrokortison krim 2.5 %
Hiosin N- Butilbromida Tab 10 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Ichtyol salp
Kalium Diklofenak tab 50 mg
Kalsium Laktas (Kalk) tab 500 mg
Kaptopril 12,5 mg
Kaptopril 25 mg
Kloramphenikol salep mata 1 %
Kloramphenikol tetes telinga 3 %

SATUAN
Tablet
Tablet
Tablet
Tablet
Kaplet
Botol
Botol
Tablet
Suppositoria
Tablet
Tablet
Tablet
Tablet
Tube
Tablet
Tube
Tablet
Ampul
Ampul
Tablet
Botol
Ampul
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Pot
Tablet
Tablet
Tablet
Tablet
Tube
Botol

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
80
81
82
83
84
85
86
87

Klorfeniramin maleat (CTM) tab 4 mg

Kotrimoksazole Susp
Lidokain 2% injeksi
Lidokain Komp Inj
Metil Ergometrin Inj 0,200 mg-1 ml
Metil Ergometrin tab 0.125 mg
Na. Diklofenac 50 mg
Nifedipin tab 10 mg
Obat Batuk hitam (OBH) sirup 100 ml
Oksitetrasiklin SK 3%
Oksitetrasiklin SM 1 %
Oksitosin inj 10 iu/1ml
Parasetamol Drops
Parasetamol sirup 120 mg/5 ml
Piridoksin tab 10 mg
Piroksicam 20 mg
Prednison 5 mg tab
Propiltiourasil 100 mg tab
Ranitidin tab 150 mg
Ringer Laktate lart infus
S. Anti Bisa Ular poli inj 5 ml(ABU I)
S. Anti Tetanus inj 1.500 iu/Amp ( ATS )
Salbutamol 2 mg tab
Salbutamol 4 mg tab
Salep 2-4 komb
Salisil Bedak 2 %
Salisil Spiritus 10 %
Sefadroxil 500 mg kapsul
Sianokobalamin (Vit B12) inj
Siprofloksasin 500 mg tab
Sulfasetamid tts mata 15%
Tetrasiklin 500 mg
Thiamin ( Vit B1 ) 50 mg tab
Thiamphenkol 500 mg cap
Tiamfenikol Suspensi ( Conucol Dry Sirup )
Triheksipenidil Hcl 2 mg tab
Vitamin B Kompleks tab
Yodium povidon 10 % 30 ml
Yodium Povidon 10 % 300 ml
Zink 20 mg Tablet dispersible
Zink Syrup
Bufacom (Triamsinolon in oral base)
Dulcolax tab
Demacolin tab
Fludane Syrup
Fludane Tablet
Lakto B
Lysmin ( Lysin ) Sirup

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

88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
-

Multivitamin (Ultravita tab / Kurkumex tab / Lanovit tab)

Neurovit E tablet
Alat Suntik Sekali Pakai 1 ml
Alat Suntik Sekali Pakai 3 ml / 2,5 ml
Alat Suntik Sekali Pakai 5 ml
Catgut/Benang bedah no 3/0 (p&c) dengan jarum bedah
Infusion Set Dewasa
Kapas Pembalut/Absorben 250 gr
Kasa Pembalut 2 X 80 cm
Kasa Kompres 40/40 steril
Kasa Pembalut 4 X 15 cm
Kasa Pembalut 4 X 3 cm
Lisol (Kresol tersaponifikasi 50%) 1 liter
Masker
Sarung Tangan Non Steril
IV. Catheter no. 18
Simvastatin 20 mg tab
Biplacenton
Ventolin Inhalasi
Permetrin Krim 5 %
Metoklopramid tab 5 mg
0
0
0

Tablet
Tablet
Set
Set
Set
Set
Set
Bungkus
Roll
Roll
Roll
Roll
Botol
Set
Set
Set
Tablet
Tube
Amp
Tube
Tablet
0
0
0

LAPORAN PE

Kode
ALP1
ALP2
AMB
AMD2
AMOK5
AMOKS
AND1
AND2
ATM
VITC
AFOL
ASMEF
ASK1
ASK2
BMT
BTM
BRO
DEK1
DIF
FPT2
FGT
VITK1
VITK2
FRO1
GEN1
GLIB
GG
GRI
HDR
HNB1
IBU1
IBU2
ICH
KD
KALK
KAP1
KAP2
KLOSM
KLOTT

Stok Awal Penerimaan Persdiaan

10
0
0
0
83
5
0
186
0
339
120
0
0
0
0
0
0
0
0
520
0
5
30
0
6
16
439
100
0
4
6
0
0
0
273
4
28
0
0

10
0
0
0
83
5
0
186
0
339
120
0
0
0
0
0
0
0
0
520
0
5
30
0
6
16
439
100
0
4
6
0
0
0
273
4
28
0
0

CTM
KOTS
LIDO1
LIDO2
ME1
ME2
NAD2
NIF
OBH
OKTSK
OKTSM
OTS
PARAD
PARAS
B6
PIK2
PRED
PTU
RAN2
RL
ABU1
ATS1
SAL1
SAL2
S2-4
SB2
SS
SEF
B12
SPRO
SULF
TETR2
VB1
THIA1
THAI2
TPD
VBC
YOD1
YOD2
ZNK1
ZNK2
BUF
DUL2
DEM
FLUD1
FLUD2
LKB
LYS

661
0
0
0
0
0
26
0
0
3
3
10
0
3
188
0
158
0
30
5
0
0
0
0
3
0
0
0
63
42
0
0
5
0
0
0
1723
0
0
10
0
0
0
0
0
0
0
0

661
0
0
0
0
0
26
0
0
3
3
10
0
3
188
0
158
0
30
5
0
0
0
0
3
0
0
0
63
42
0
0
5
0
0
0
1723
0
0
10
0
0
0
0
0
0
0
0

MULTF
NEUR2
ASS3
ASS4
ASS5
GUT1
ISD
KPA
KP1
KP2
KP3
KP4
LKT
MAS
STN
IV1
SIV
BPL
VNT
Permet
MTK3
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
90
150

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
30
90
150

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (JKN)

10

11

12

13

14

TANGGAL
15
16
17

GAL
18

19

20

21

22

23

24

25

26

27

28

29

30

31

Pemakaian

Sisa

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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
0
0
0
83
5
0
186
0
339
120
0
0
0
0
0
0
0
0
520
0
5
30
0
6
16
439
100
0
4
6
0
0
0
273
4
28
0
0

Permintaa

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

661
0
0
0
0
0
26
0
0
3
3
10
0
3
188
0
158
0
30
5
0
0
0
0
3
0
0
0
63
42
0
0
5
0
0
0
1723
0
0
10
0
0
0
0
0
0
0
0

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

PELAPOR

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
30
90
150

:
: DESEMBER
: 2015

PUSTU/POLINDES
BULAN
TAHUN

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

NAMA OBAT
Alopurinol 100 mg
Alopurinol 300 mg
Ambroxol tablet 30 mg
Amlodipin tab 5 mg
Amoksisilin 500 mg
Amoksisilin SK 125mg/5ml
Antasida DOEN Syrup
Antasida DOEN tab Komb
Antihemoroid DOEN Komb
Asam Askorbat (Vit C) tab 50 mg
Asam folat 1 mg
Asam mefenamat 500 mg
Asiklovir 400 mg
Asiklovir 5 % krim
Betahistin Mesilat tablet 6 mg
Betametason krim 0,1%
Bromheksin tablet 8 mg
Deksametason inj 5 mg/ml-ml
Difenhidramin Hcl Inj 10 mg/ml-1ml
Fenoksimetil penisilin tab 500 mg
Fenol gliserol tetes Telinga 10 %
Fitomenadion (VitK) inj 10mg/ml-1ml
Fitomenadion (VitK) tab 10 mg
Furosemid tab 40 mg
Gentamsin Salep Kulit 0,1%
Glibenklamid 5 mg
Gliseril Guaiyakolat tab 100 mg
Grisiofulvin tab 125 mg
Hidrokortison krim 2.5 %
Hiosin N- Butilbromida Tab 10 mg
Ibuprofen 200 mg
Ibuprofen 400 mg
Ichtyol salp
Kalium Diklofenak tab 50 mg
Kalsium Laktas (Kalk) tab 500 mg
Kaptopril 12,5 mg
Kaptopril 25 mg
Kloramphenikol salep mata 1 %
Kloramphenikol tetes telinga 3 %

SATUAN
Tablet
Tablet
Tablet
Tablet
Kaplet
Botol
Botol
Tablet
Suppositoria
Tablet
Tablet
Tablet
Tablet
Tube
Tablet
Tube
Tablet
Ampul
Ampul
Tablet
Botol
Ampul
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Tube
Tablet
Tablet
Tablet
Pot
Tablet
Tablet
Tablet
Tablet
Tube
Botol

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
80
81
82
83
84
85
86
87

Klorfeniramin maleat (CTM) tab 4 mg

Kotrimoksazole Susp
Lidokain 2% injeksi
Lidokain Komp Inj
Metil Ergometrin Inj 0,200 mg-1 ml
Metil Ergometrin tab 0.125 mg
Na. Diklofenac 50 mg
Nifedipin tab 10 mg
Obat Batuk hitam (OBH) sirup 100 ml
Oksitetrasiklin SK 3%
Oksitetrasiklin SM 1 %
Oksitosin inj 10 iu/1ml
Parasetamol Drops
Parasetamol sirup 120 mg/5 ml
Piridoksin tab 10 mg
Piroksicam 20 mg
Prednison 5 mg tab
Propiltiourasil 100 mg tab
Ranitidin tab 150 mg
Ringer Laktate lart infus
S. Anti Bisa Ular poli inj 5 ml(ABU I)
S. Anti Tetanus inj 1.500 iu/Amp ( ATS )
Salbutamol 2 mg tab
Salbutamol 4 mg tab
Salep 2-4 komb
Salisil Bedak 2 %
Salisil Spiritus 10 %
Sefadroxil 500 mg kapsul
Sianokobalamin (Vit B12) inj
Siprofloksasin 500 mg tab
Sulfasetamid tts mata 15%
Tetrasiklin 500 mg
Thiamin ( Vit B1 ) 50 mg tab
Thiamphenkol 500 mg cap
Tiamfenikol Suspensi ( Conucol Dry Sirup )
Triheksipenidil Hcl 2 mg tab
Vitamin B Kompleks tab
Yodium povidon 10 % 30 ml
Yodium Povidon 10 % 300 ml
Zink 20 mg Tablet dispersible
Zink Syrup
Bufacom (Triamsinolon in oral base)
Dulcolax tab
Demacolin tab
Fludane Syrup
Fludane Tablet
Lakto B
Lysmin ( Lysin ) Sirup

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

88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
-

Multivitamin (Ultravita tab / Kurkumex tab / Lanovit tab)

Neurovit E tablet
Alat Suntik Sekali Pakai 1 ml
Alat Suntik Sekali Pakai 3 ml / 2,5 ml
Alat Suntik Sekali Pakai 5 ml
Catgut/Benang bedah no 3/0 (p&c) dengan jarum bedah
Infusion Set Dewasa
Kapas Pembalut/Absorben 250 gr
Kasa Pembalut 2 X 80 cm
Kasa Kompres 40/40 steril
Kasa Pembalut 4 X 15 cm
Kasa Pembalut 4 X 3 cm
Lisol (Kresol tersaponifikasi 50%) 1 liter
Masker
Sarung Tangan Non Steril
IV. Catheter no. 18
Simvastatin 20 mg tab
Biplacenton
Ventolin Inhalasi
Permetrin Krim 5 %
Metoklopramid tab 5 mg
0
0
0

Tablet
Tablet
Set
Set
Set
Set
Set
Bungkus
Roll
Roll
Roll
Roll
Botol
Set
Set
Set
Tablet
Tube
Amp
Tube
Tablet
0
0
0

LAPORAN PE

Kode
ALP1
ALP2
AMB
AMD2
AMOK5
AMOKS
AND1
AND2
ATM
VITC
AFOL
ASMEF
ASK1
ASK2
BMT
BTM
BRO
DEK1
DIF
FPT2
FGT
VITK1
VITK2
FRO1
GEN1
GLIB
GG
GRI
HDR
HNB1
IBU1
IBU2
ICH
KD
KALK
KAP1
KAP2
KLOSM
KLOTT

Stok Awal Penerimaan Persdiaan

10
0
0
0
83
5
0
186
0
339
120
0
0
0
0
0
0
0
0
520
0
5
30
0
6
16
439
100
0
4
6
0
0
0
273
4
28
0
0

10
0
0
0
83
5
0
186
0
339
120
0
0
0
0
0
0
0
0
520
0
5
30
0
6
16
439
100
0
4
6
0
0
0
273
4
28
0
0

CTM
KOTS
LIDO1
LIDO2
ME1
ME2
NAD2
NIF
OBH
OKTSK
OKTSM
OTS
PARAD
PARAS
B6
PIK2
PRED
PTU
RAN2
RL
ABU1
ATS1
SAL1
SAL2
S2-4
SB2
SS
SEF
B12
SPRO
SULF
TETR2
VB1
THIA1
THAI2
TPD
VBC
YOD1
YOD2
ZNK1
ZNK2
BUF
DUL2
DEM
FLUD1
FLUD2
LKB
LYS

661
0
0
0
0
0
26
0
0
3
3
10
0
3
188
0
158
0
30
5
0
0
0
0
3
0
0
0
63
42
0
0
5
0
0
0
1723
0
0
10
0
0
0
0
0
0
0
0

661
0
0
0
0
0
26
0
0
3
3
10
0
3
188
0
158
0
30
5
0
0
0
0
3
0
0
0
63
42
0
0
5
0
0
0
1723
0
0
10
0
0
0
0
0
0
0
0

MULTF
NEUR2
ASS3
ASS4
ASS5
GUT1
ISD
KPA
KP1
KP2
KP3
KP4
LKT
MAS
STN
IV1
SIV
BPL
VNT
Permet
MTK3
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
90
150

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
30
90
150

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (JKN)

10

11

12

13

14

TANGGAL
15
16
17

GAL
18

19

20

21

22

23

24

25

26

27

28

29

30

31

Pemakaian

Sisa

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
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
0
0
0
83
5
0
186
0
339
120
0
0
0
0
0
0
0
0
520
0
5
30
0
6
16
439
100
0
4
6
0
0
0
273
4
28
0
0

Permintaa

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

661
0
0
0
0
0
26
0
0
3
3
10
0
3
188
0
158
0
30
5
0
0
0
0
3
0
0
0
63
42
0
0
5
0
0
0
1723
0
0
10
0
0
0
0
0
0
0
0

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

PELAPOR

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
30
90
150