LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OB

PUSKESMAS KAB. TAPANULI TENGAH

PUSKESMAS : BARUS UTARA

KECAMATAN : BARUS UTARA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN

1 2 3 4 5 6 = (4 + 5 ) 7
1 AIR UNTUK INJEKSI BOTOL 4 0 4 0
2 ALAT SUNTIK DISP. 3 ML SET 45 100 145 70
3 ALAT SUNTIK DISP. 5 ML SET 0 100 100 0
4 ALCOHOL SWAB PCS 9895 2500 12395 1300
5 ALKACIDE 1 LITER BOTOL 1 0 1 0
6 ALKAZYME SAK 1 0 1 1
7 ALKOHOL 70% 1 LITER BOTOL 1 0 1 0
8 ALOPURINOL 100 MG TABLET 20 800 820 480
9 AMINOFILIN 150 MGTABLET TABLET 100 0 100 0
10 AMLODIPIN 10 MG TABLET TABLET 0 0 0 0
11 AMLODIPIN 5 MG TABLET 0 600 600 565
12 AMOKSISILIN 500 MG KAPLET 804 1000 1804 1032
13 AMOKSISILIN SYRUP KERING FORTE 250MG/5ML BOTOL 99 50 149 86
14 AMPHETAMIN CHECK TEST PCS 0 0 0 0
15 ANTACIDA DOEN I TAB TABLET 395 2000 2395 1531
16 ANTACIDA DOEN II SUSPENSI BOTOL 10 0 10 7
18 ANTIHEMMOROID SUPP SUPP 1 2 3 0
19 ASAM ASKORBAT (VIT C) 250 MG TABLET 0 100 100 90
20 ASAM ASKORBAT (VIT C) 50 MG TABLET 763 1000 1763 942
21 ASAM FOLAT (A FOLAT) 0,4 MG TABLET 196 0 190 20
22 ASAM MEFENAMAT 500 MG TABLET 670 1200 1870 920
23 ASAM TRANEKSAMAT INJEKSI AMPUL 0 0 0 0
24 ASEPTAN BOTOL 0 0 0 0
25 ASERING BOTOL 2 10 12 9
26 ASETIL SISTEIN 200 MG KAPSUL 0 0 0 0
27 ASIKLOVIR TABLET 200 MG TABLET 190 0 190 120
28 ASIKLOVIR TABLET 400 MG TABLET 305 0 305 30
29 ATROPIN INJEKSI 0,35 MG/ ML AMPUL 0 0 0 0
30 BEROTEC INHALER BOTOL 1 0 1 0
31 BETAHISTIN TAB 6 MG TABLET 500 0 500 100
32 BETAMETASON KRIM 0,1% (SBG VALERAT) TUBE 9 5 14 7
33 BISAKODIL 5 MG TABLET (DULCOLAX) TABLET 60 0 60 0
34 BISAKODIL SUSP (DULCOLAX SUPP) SUPP 4 0 4 0
35 BRACKET PCS 0 0 0 0
36 BURNAZIN (PERAK SULFADIAZIN KRIM 1%) TUBE 2 1 3 0
37 OSTOVEL (KALSITROL) TABLET 30 30 60 0
38 CAPTOPRIL 12,5 MG TABLET 0 800 800 510
39 CAPTOPRIL 25 MG TABLET 0 500 500 80
40 CATGUT CHROMIC 2/0 PCS 12 5 17 3
41 CEFADROXIL 250 MG SYRUP SYRUP 0 0 0 0
42 CEFOTAXIM INJ VIAL 4 0 4 0
43 CEFTRIAXONE INJ VIAL 2 0 2 0
44 CETIRIZINE SYRUP BOTOL 26 0 26 0
45 CETIRIZINE TABLET TABLET 717 500 1217 340
46 CHLORAMPHENICOL SALEP KULIT 2% (BUFACETIN) TUBE 0 5 5 0
47 CHLORPHENIRAMIN MALEAT (CTM) TABLET 329 1500 1829 1652
48 CIPROFLOXACIN 500 MG TABLET 250 500 750 440
49 CLINDAMYCIN 300 MG CAPSUL 100 1000 1100 300
50 CLOPIDOGREL TABLET 75 MG TABLET 0 0 0 0
51 CODEIN 10 MG TABLET 95 200 295 0
52 CONCOR (BISOPROLOL) 1,25 MG TABLET 0 0 0 0
53 COTRIMOXAZOLE SUSPENSI BOTOL 39 50 89 34
54 COTRIMOXAZOLE TABLET DEWASA 480 mg TABLET 340 800 1140 470
55 DARYANT TULE PCS 5 3 8 1
56 DEKSTROFEN SYRUP BOTOL 0 25 25 21
57 DENOMIX CREAM 10 GRAM TUBE 0 0 0 0
58 DEXAMETASONE INJEKSI IV/IM 5MG/ML AMPUL 5 0 5 0
59 DEXAMETASONE TABLET 0,5 MG TABLET 230 700 930 574
60 DEXOCORT KRIM TUBE 0 2 2 0
61 DIAZEPAM LAR.REKTAL (STESOLID) 10MG/2,5ML TUBE 0 1 1 0
62 DOMPERIDON 10 MG TABLET TABLET 0 0 0 0
63 DOMPERIDON SYRUP BOTOL 7 0 7 4
64 EPINEFRIN INJEKSI AMPUL 0 10 10 0
65 EUGENOL BOTOL 0 2 2 0
66 FOLLEY CATHETER SET 0 0 0 0
67 FUROSEMID 40 MG TABLET 594 1000 1594 220
68 GARAM ORALIT SAK 50 0 50 5
69 GENTAMYCIN TETES MATA 0,3% BOTOL 32 50 82 33
70 GLIBENKLAMIDE 5 MG TAB TABLET 0 0 0 0
71 GLIMEPIRID 2 MG TABLET 210 0 210 130
72 GLUKOSA LARUTAN INFUS 5% STERIL BOTOL 6 2 8 0
73 GRISEOFULVIN 125 MG TAB TABLET 310 1000 1310 610
74 GRISEOFULVIN 500 MG TABLET 0 0 0 0
75 HANDSCHOON NON STERIL L PCS 40 50 90 10
76 HANDSCHOON NON STERIL M PCS 0 50 50 6
77 HANDSCHOON OBSGYN PCS 4 0 4 0
78 HANDSCHOON STERIL PASANG 3 30 33 17
79 HIDROKLORTIAZID 25 MG TABLET 200 0 200 0
80 HIDROKORTISON 2,5% KRIM TUBE 6 10 16 5
81 HUSTAB SIRUP BOTOL 0 25 25 0
82 HUSTAB TABLET TABLET 77 300 377 377
83 IBUPROFEN 200 MG TABLET TABLET 510 400 910 200
84 IBUPROFEN 400 MG TABLET TABLET 480 1000 1480 830
85 IBUPROFEN SUSPENSI BOTOL 28 50 78 30
86 ILLIADIN (OKSIMETAZOLIN) TETES HIDUNG 0,050% BOTOL 2 3 5 0
87 INFUSION SET ANAK (PEDIATRIC) PCS 0 0 0 0
88 INFUSION SET DEWASA SET 9 20 29 14
89 ISOSORBID DINITRAT 5MG (FASORBID) TABLET 900 0 900 20
90 IV CATH PEN 18 PCS 0 0 0 0
91 IV CATH PEN 20 PCS 0 0 0 0
92 IV TROVENOCATH 18 PCS 7 10 17 6
93 IV TROVENOCATH 20 PCS 2 5 7 0
94 IV TROVENOCATH 22 PCS 6 5 11 3
95 IV TROVENOCATH 24 PCS 9 3 12 3
96 KALSIUM LAKTAT 500 MG TABLET 170 1200 1370 1170
97 KAPAS PEMBALUT 250 GRAM PCS 1 1 2 0
98 KARBOGLISERIN TETES TELINGA 10% BOTOL 7 2 9 2
99 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL 23 20 43 12
100 KASSA HIDROFIL STERIL 16X16 KTK 27 20 47 23
101 KETOKONAZOLE 200 MG TABLET 167 300 467 160
102 KETOKONAZOLE KRIM TUBE 8 2 10 3
103 KETOPROPEN SUPP SUPP 0 0 0 0
104 KETOROLAC INJEKSI 30 MG/ML AMPUL 3 5 8 0
105 LANSOPRAZOLE 30 MG KAPSUL 55 100 155 115
106 LIDOKAIN 2% + EPINEFRIN 1 : 80.000 AMPUL 0 0 0 0
107 LIDOKAIN INJEKSI 2% (HCL) AMPUL 9 10 19 6
108 LOPERAMIDE TAB 2 MG TABLET 190 300 490 163
109 LORATADINE 10 MG TABLET 130 100 230 203
110 LYSOL 1 LITER BOTOL 1 1 2 0
111 MARIYUANA RAPID TEST PCS 0 0 0 0
112 MASKER PCS 46 100 146 56
113 MEBENDAZOLE 500 MG (VERMOX) TABLET 0 0 0 0
114 METFORMIN 500 MG TABLET 0 100 100 100
115 METHYL PREDNISOLON 4 MG TABLET 1680 500 2180 390
116 METIL ERGOMETRIN INJEKSI 0,2MG/ML AMPUL 0 20 20 0
117 METIL ERGOMETRIN MALEAT 0,175 MG TABLET 300 0 300 0
118 METOKLOPAMID DROP BOTOL 10 0 10 0
119 METOKLOPRAMID 5 MG TABLET TABLET 110 0 110 0
120 METRONIDAZOLE 500 MG TABLET 1105 1000 2105 573
121 METRONIDAZOLE OVULA (VAGIZOL) SUPP 2 0 2 0
122 METRONIDAZOLE SUSPENSI BOTOL 0 0 0 0
123 MIKONAZOLE KRIM 2% (SBG NITRAT) TUBE 10 GR 11 25 36 18
124 MINERAL MIX SAK 0 0 0 0
125 NACL 0,9% LARUTAN INFUS BOTOL 5 10 15 3
126 NATRIUM DIKLOFENAK 25 MG TABLET 530 500 1030 870
127 NATRIUM DIKLOFENAK 50 MG TABLET 480 600 1080 440
128 NEW ANTIDWTS (ATAPULGIT) TABLET 60 300 360 10
129 NIFEDIPIN 10 MG TAB TABLET 80 0 80 0
130 OKSITETRASIKLIN SALEP MATA TUBE 0 0 0 0
131 OKSITOSIN INJEKSI AMPUL 11 10 21 1
132 OMEPRAZOLE 20 MG CAPSUL KAPSUL 50 300 350 350
133 ONDANSETRON INJEKSI 2MG/ ML AMPUL 3 2 5 1
134 PARACETAMOL DROP 100MG/ML BOTOL 0 0 0 0
135 PARACETAMOL SYRUP 120MG/5ML BOTOL 19 50 69 57
136 PARASETAMOL TABLET 500 MG TABLET 114 500 614 614
137 PHYTOMENADION INJEKSI AMPUL 14 0 14 0
138 PHYTOMENADION TABLET TABLET 155 0 155 10
139 PIRANTEL PAMOAT 125 MG TABLET TABLET 0 0 0 0
140 PIRANTEL PAMOAT SUSPENSI 125 MG BOTOL 0 5 5 0
141 PIRIDOKSIN (VIT B6) INJEKSI AMPUL 32 30 62 12
142 PIRIDOKSIN (VIT B6) TAB 10 MG (HCL) TABLET 2365 1000 3365 1657
143 PLESTER ISOPLAST 5YARD X 2 INCH ROL 9 6 15 0
144 PLESTER PHARMAFIX 10 CM X 500 CM ROL 0 0 0 0
145 PLESTER POLIFIX 5 CM X 1 M ROL 26 15 41 12
146 POVIDON IODIDA 10% 300 ML BOTOL 0 2 2 0
147 PREDNISON 5 MG TABLET 360 500 860 250
148 PULMICORT TURBUHALER 200 TURB 0 0 0 0
149 RANITIDIN INJEKSI AMPUL 11 10 21 8
150 RISTONAT 35 MG TABLET 0 0 0 0
151 SAFETY BOX PCS 3 0 3 0
152 SALBUTAMOL 4 MG TABLET 0 300 300 70
153 SALBUTAMOL SYRUP BOTOL 8 10 18 4
154 SALEP ANTIFUNGI POT 2 2 4 0
155 SALISIL BEDAK SERBUK 2% SAK 0 10 10 4
156 SCABIMITE CREAM TUBE 3 0 3 0
157 SELANG OKSIGEN M PCS 1 0 1 0
158 SELANG OKSIGEN S PCS 1 0 1 0
159 SIANOKOBALAMIN (VIT B12) 50 MCG TABLET 210 1000 1210 1210
160 SIANOKOBALAMIN (VIT B12) INJ 500MCG AMPUL 14 30 44 24
161 SILK BLACK PCS 3 10 13 6
162 SIMVASTATIN TABLET 10 MG TABLET 440 300 740 380
163 SOFTAMAN HAND 1 LITER BOTOL 0 0 0 0
164 SUCRALFAT SUSPENSI ( ULSAFATE) BOTOL 0 20 20 15
165 SYMBICORT TURBUHALER 180 TURB 0 1 1 0
166 TABLET TAMBAH DARAH TABLET 820 0 820 340
167 TETAGAM P. SYRINGE 1 ML AMPUL 0 1 1 0
168 THIAMIN 50 MG TABLET 767 1000 1767 1610
169 UMBILICAL CORD PCS 11 10 21 0
170 USG GEL BOTOL 0 0 0 0
171 VITAMIN B KOMPLEKS TABLET 512 2000 2512 1813
172 XYLOCAINE SPRAY TUBE 2 0 2 0
173 ZINK TAB DISPERSIBEL 20 MG TABLET 100 0 100 0

BPJS PUSTU BKIA LANSIA

JUMLAH KUNJUNGAN RESEP
 JUMLAH KUNJUNGAN RESEP
201 140 10 350

DIKETAHUI, YANG MENYERAHKAN

KEPALA DINAS KESEHATAN TAP.TENGAH KEPALA SEKSI KEFARMASIAN

NURSYAM, SKM., M.Kes. DESI HOTNIDA, S.Farm.,Apt.

NIP. 19690909 199103 2 005 NIP. 19831109 20101 2 028
MINTAAN OBAT
NGAH

LAPORAN BULAN / PERIODE : MARET 2019

PERMINTAAN BULAN / PERIODE : APRIL 2019
STOK PEMBERIAN
SISA STOK PERMINTAAN KET
OPTIMUM DAK PROP JUMLAH
8=(6-7) 9 10 11 12 13 14
4 0
75 100
100 0
11095 0
1 0
0 1
1 0
340 800
100 0
0 300
35 600
772 1000
63 50
0 0
864 2000
3 15
3 2
10 100
821 1000
170 0
950 1500
0 2
0 0
3 10
0 0
70 100
275 100
0 0
1 0
400 200
7 10
60 0
4 0
0 0
3 2
60 30
290 800
420 500
14 5
0 25
4 0
2 0
26 0
877 500
5 5
177 1800
310 500
800 300
0 0
295 0
0 0
55 50
670 800
7 3
4 50
0 10
5 5
356 700
2 0
1 1
0 100
3 10
10 0
2 0
0 2
1374 0
45 100
49 0
0 100
80 400
8 0
700 1000
0 500
80 50
44 50
4 0
16 50
200 0
11 10
25 30
0 600
710 400
650 1000
48 0
5 0
0 0
15 20
880 0
0 0
0 0
11 10
7 5
8 5
9 5
200 3
2 0
7 4
31 20
24 30
307 300
7 5
0 0
8 0
40 300
0 0
13 10
327 300
27 200
2 0
0 0
90 100
0 5
0 200
1790 100
20 0
300 0
10 0
110 0
1532 0
2 0
0 10
18 25
0 0
12 10
160 500
640 600
350 100
80 100
 0 10
20 0
0 500
4 1
0 0
12 50
0 1000
14 0
145 0
0 0
5 0
50 0
1708 1000
15 0
0 0
29 20
2 1
610 100
0 0
13 10
0 0
3 0
230 300
14 10
4 0
6 10
3 0
1 0
1 0
0 1500
20 30
7 10
360 300
0 0
5 30
1 0
480 0
1 0
157 1500
21 0
0 1
699 2000
2 0
100 0

TDK ADA KARTU JUMLAH

 10 711

RAHKAN YANG MEMINTA

ARMASIAN PIMPINAN PUSKESMAS

Farm.,Apt. dr. Marwati

0101 2 028 Nip. 19691221 200212 2 002
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAA
PUSKESMAS KAB. TAPANULI TENGAH

PUSKESMAS : BARUS UTARA

KECAMATAN : BARUS UTARA
NO NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN
AWAL
1 2 3 4 5 6 = (4 + 5 )
1 AIR UNTUK INJEKSI BOTOL 4 0 4
2 ALAT SUNTIK DISP. 3 ML SET 75 100 175
3 ALAT SUNTIK DISP. 5 ML SET 100 100 200
4 ALCOHOL SWAB PCS 11095 5000 16095
5 ALKACIDE 1 LITER BOTOL 1 0 1
6 ALKAZYME SAK 0 0 0
7 ALKOHOL 70% 1 LITER BOTOL 1 0 1
8 ALOPURINOL 100 MG TABLET 340 1000 1340
9 AMINOFILIN 150 MGTABLET TABLET 100 0 100
10 AMLODIPIN 10 MG TABLET TABLET 0 100 100
11 AMLODIPIN 5 MG TABLET 35 600 635
12 AMOKSISILIN 500 MG KAPLET 772 900 1672
13 AMOKSISILIN SYRUP KERING FORTE 250MG/5ML BOTOL 63 0 63
14 AMPHETAMIN CHECK TEST PCS 0 0 0
15 ANTACIDA DOEN I TAB TABLET 864 1500 2364
16 ANTACIDA DOEN II SUSPENSI BOTOL 3 0 3
18 ANTIHEMMOROID SUPP SUPP 3 2 5
19 ASAM ASKORBAT (VIT C) 250 MG TABLET 90 100 190
20 ASAM ASKORBAT (VIT C) 50 MG TABLET 821 600 1421
21 ASAM FOLAT (A FOLAT) 0,4 MG TABLET 170 0 170
22 ASAM MEFENAMAT 500 MG TABLET 950 1100 2050
23 ASAM TRANEKSAMAT INJEKSI AMPUL 0 2 2
24 ASEPTAN BOTOL 0 0 0
25 ASERING BOTOL 3 24 27
26 ASETIL SISTEIN 200 MG KAPSUL 0 0 0
27 ASIKLOVIR TABLET 200 MG TABLET 70 0 70
28 ASIKLOVIR TABLET 400 MG TABLET 275 500 775
29 ATROPIN INJEKSI 0,35 MG/ ML AMPUL 0 0 0
30 BEROTEC INHALER BOTOL 1 0 1
31 BETAHISTIN TAB 6 MG TABLET 400 150 550
32 BETAMETASON KRIM 0,1% (SBG VALERAT) TUBE 7 5 12
33 BISAKODIL 5 MG TABLET (DULCOLAX) TABLET 60 0 60
34 BISAKODIL SUSP (DULCOLAX SUPP) SUPP 4 0 4
35 BRACKET PCS 0 0 0
36 BURNAZIN (PERAK SULFADIAZIN KRIM 1%) TUBE 2 2 4
37 OSTOVEL (KALSITROL) TABLET 60 0 60
38 CAPTOPRIL 12,5 MG TABLET 290 500 790
39 CAPTOPRIL 25 MG TABLET 420 300 720
40 CATGUT CHROMIC 2/0 PCS 14 10 24
41 CEFADROXIL 250 MG SYRUP SYRUP 0 10 10
42 CEFOTAXIM INJ VIAL 4 0 4
43 CEFTRIAXONE INJ VIAL 2 0 2
44 CETIRIZINE SYRUP BOTOL 26 0 26
45 CETIRIZINE TABLET TABLET 877 500 1377
46 CHLORAMPHENICOL SALEP KULIT 2% (BUFACETIN) TUBE 5 4 9
47 CHLORPHENIRAMIN MALEAT (CTM) TABLET 177 2000 2177
48 CIPROFLOXACIN 500 MG TABLET 310 500 810
49 CLINDAMYCIN 300 MG CAPSUL 800 100 900
50 CLOPIDOGREL TABLET 75 MG TABLET 0 0 0
51 CODEIN 10 MG TABLET 295 0 295
52 CONCOR (BISOPROLOL) 1,25 MG TABLET 0 0 0
53 COTRIMOXAZOLE SUSPENSI BOTOL 55 0 55
54 COTRIMOXAZOLE TABLET DEWASA 480 mg TABLET 670 800 1470
55 DARYANT TULE PCS 7 4 11
56 DEKSTROFEN SYRUP BOTOL 4 25 29
57 DENOMIX CREAM 10 GRAM TUBE 0 0 0
58 DEXAMETASONE INJEKSI IV/IM 5MG/ML AMPUL 5 5 10
59 DEXAMETASONE TABLET 0,5 MG TABLET 356 3000 3356
60 DEXOCORT KRIM TUBE 2 0 2
61 DIAZEPAM LAR.REKTAL (STESOLID) 10MG/2,5ML TUBE 1 1 2
62 DOMPERIDON 10 MG TABLET TABLET 0 100 100
63 DOMPERIDON SYRUP BOTOL 3 0 3
64 EPINEFRIN INJEKSI AMPUL 10 0 10
65 EUGENOL BOTOL 2 0 2
66 FOLLEY CATHETER SET 0 2 2
67 FUROSEMID 40 MG TABLET 1374 200 1574
68 GARAM ORALIT SAK 45 100 145
69 GENTAMYCIN TETES MATA 0,3% BOTOL 49 0 49
70 GLIBENKLAMIDE 5 MG TAB TABLET 0 100 100
71 GLIMEPIRID 2 MG TABLET 80 100 180
72 GLUKOSA LARUTAN INFUS 5% STERIL BOTOL 6 2 8
73 GRISEOFULVIN 125 MG TAB TABLET 700 1000 1700
74 GRISEOFULVIN 500 MG TABLET 0 200 200
75 HANDSCHOON NON STERIL L PCS 80 50 130
76 HANDSCHOON NON STERIL M PCS 44 50 94
77 HANDSCHOON OBSGYN PCS 4 0 4
78 HANDSCHOON STERIL PASANG 16 20 36
79 HIDROKLORTIAZID 25 MG TABLET 200 0 200
80 HIDROKORTISON 2,5% KRIM TUBE 11 10 21
81 HUSTAB SIRUP BOTOL 0 25 25
82 HUSTAB TABLET TABLET 0 900 900
83 IBUPROFEN 200 MG TABLET TABLET 710 400 1110
84 IBUPROFEN 400 MG TABLET TABLET 650 1000 1650
85 IBUPROFEN SUSPENSI BOTOL 48 0 48
86 ILLIADIN (OKSIMETAZOLIN) TETES HIDUNG 0,050% BOTOL 5 0 5
87 INFUSION SET ANAK (PEDIATRIC) PCS 0 0 0
88 INFUSION SET DEWASA SET 15 20 35
89 ISOSORBID DINITRAT 5MG (FASORBID) TABLET 880 0 880
90 IV CATH PEN 18 PCS 0 0 0
91 IV CATH PEN 20 PCS 0 0 0
92 IV TROVENOCATH 18 PCS 11 10 21
93 IV TROVENOCATH 20 PCS 7 5 12
94 IV TROVENOCATH 22 PCS 8 5 13
95 IV TROVENOCATH 24 PCS 9 0 9
96 KALSIUM LAKTAT 500 MG TABLET 200 1500 1700
97 KAPAS PEMBALUT 250 GRAM PCS 2 1 3
98 KARBOGLISERIN TETES TELINGA 10% BOTOL 7 2 9
99 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL 31 20 51
100 KASSA HIDROFIL STERIL 16X16 KTK 24 20 44
101 KETOKONAZOLE 200 MG TABLET 307 300 607
102 KETOKONAZOLE KRIM TUBE 7 4 11
103 KETOPROPEN SUPP SUPP 0 0 0
104 KETOROLAC INJEKSI 30 MG/ML AMPUL 8 0 8
105 LANSOPRAZOLE 30 MG KAPSUL 40 300 340
106 LIDOKAIN 2% + EPINEFRIN 1 : 80.000 AMPUL 0 0 0
107 LIDOKAIN INJEKSI 2% (HCL) AMPUL 13 30 43
108 LOPERAMIDE TAB 2 MG TABLET 327 500 827
109 LORATADINE 10 MG TABLET 27 0 27
110 LYSOL 1 LITER BOTOL 2 0 2
111 MARIYUANA RAPID TEST PCS 0 0 0
112 MASKER PCS 90 50 140
113 MEBENDAZOLE 500 MG (VERMOX) TABLET 0 5 5
114 METFORMIN 500 MG TABLET 0 200 200
115 METHYL PREDNISOLON 4 MG TABLET 1790 2000 3790
116 METIL ERGOMETRIN INJEKSI 0,2MG/ML AMPUL 20 0 20
117 METIL ERGOMETRIN MALEAT 0,175 MG TABLET 300 0 300
118 METOKLOPAMID DROP BOTOL 10 0 10
119 METOKLOPRAMID 5 MG TABLET TABLET 110 0 110
120 METRONIDAZOLE 500 MG TABLET 1532 0 1532
121 METRONIDAZOLE OVULA (VAGIZOL) SUPP 2 0 2
122 METRONIDAZOLE SUSPENSI BOTOL 0 2 2
123 MIKONAZOLE KRIM 2% (SBG NITRAT) TUBE 10 GR 18 25 43
124 MINERAL MIX SAK 0 0 0
125 NACL 0,9% LARUTAN INFUS BOTOL 12 10 22
126 NATRIUM DIKLOFENAK 25 MG TABLET 160 500 660
127 NATRIUM DIKLOFENAK 50 MG TABLET 640 600 1240
128 NEW ANTIDWTS (ATAPULGIT) TABLET 350 100 450
129 NIFEDIPIN 10 MG TAB TABLET 80 0 80
130 OKSITETRASIKLIN SALEP MATA TUBE 0 3 3
131 OKSITOSIN INJEKSI AMPUL 30 0 30
132 OMEPRAZOLE 20 MG CAPSUL KAPSUL 0 500 500
133 ONDANSETRON INJEKSI 2MG/ ML AMPUL 4 2 6
134 PARACETAMOL DROP 100MG/ML BOTOL 0 0 0
135 PARACETAMOL SYRUP 120MG/5ML BOTOL 12 50 62
136 PARASETAMOL TABLET 500 MG TABLET 0 500 500
137 PHYTOMENADION INJEKSI AMPUL 14 0 14
138 PHYTOMENADION TABLET TABLET 145 0 145
139 PIRANTEL PAMOAT 125 MG TABLET TABLET 0 0 0
140 PIRANTEL PAMOAT SUSPENSI 125 MG BOTOL 5 0 5
141 PIRIDOKSIN (VIT B6) INJEKSI AMPUL 50 50 100
142 PIRIDOKSIN (VIT B6) TAB 10 MG (HCL) TABLET 1708 1000 2708
143 PLESTER ISOPLAST 5YARD X 2 INCH ROL 29 15 44
144 PLESTER PHARMAFIX 10 CM X 500 CM ROL 0 0 0
145 PLESTER POLIFIX 5 CM X 1 M ROL 29 15 44
146 POVIDON IODIDA 10% 300 ML BOTOL 2 1 3
147 PREDNISON 5 MG TABLET 610 1500 2110
148 PULMICORT TURBUHALER 200 TURB 0 0 0
149 RANITIDIN INJEKSI AMPUL 13 10 23
150 RISTONAT 35 MG TABLET 0 0 0
151 SAFETY BOX PCS 3 0 3
152 SALBUTAMOL 4 MG TABLET 230 300 530
153 SALBUTAMOL SYRUP BOTOL 14 10 24
154 SALEP ANTIFUNGI POT 4 0 4
155 SALISIL BEDAK SERBUK 2% SAK 6 10 16
156 SCABIMITE CREAM TUBE 3 0 3
157 SELANG OKSIGEN M PCS 1 0 1
158 SELANG OKSIGEN S PCS 1 0 1
159 SIANOKOBALAMIN (VIT B12) 50 MCG TABLET 0 1500 1500
160 SIANOKOBALAMIN (VIT B12) INJ 500MCG AMPUL 20 50 70
161 SILK BLACK PCS 7 10 17
162 SIMVASTATIN TABLET 10 MG TABLET 360 600 960
163 SOFTAMAN HAND 1 LITER BOTOL 0 0 0
164 SUCRALFAT SUSPENSI ( ULSAFATE) BOTOL 5 25 30
165 SYMBICORT TURBUHALER 180 TURB 1 0 1
166 TABLET TAMBAH DARAH TABLET 480 300 780
167 TETAGAM P. SYRINGE 1 ML AMPUL 1 0 1
168 THIAMIN 50 MG TABLET 157 1600 1757
169 UMBILICAL CORD PCS 21 50 71
170 USG GEL BOTOL 0 1 1
171 VITAMIN B KOMPLEKS TABLET 699 3000 3699
172 XYLOCAINE SPRAY TUBE 2 0 2
173 ZINK TAB DISPERSIBEL 20 MG TABLET 100 0 100

BPJS PUSTU BKIA

JUMLAH KUNJUNGAN RESEP
200 140 10

DIKETAHUI, YANG MENYERAHKA

KEPALA DINAS KESEHATAN TAP.TENGAH KEPALA SEKSI KEFARMA

NURSYAM, SKM., M.Kes. DESI HOTNIDA, S.Farm.,

NIP. 19690909 199103 2 005 NIP. 19831109 20101 2
LEMBAR PERMINTAAN OBAT
TAPANULI TENGAH

LAPORAN BULAN / PERIODE : APRIL 19

PERMINTAAN BULAN / PERIODE : MEI 2019
STOK PERMINTA PEMBERIAN
PEMAKAIAN SISA STOK KET
OPTIMUM AN DAK PROP JUMLAH
7 8=(6-7) 9 10 11 12 13 14
1 3 0
110 65 100
0 200 0
1300 14795 0
0 1 0
0 0 1
0 1 0
560 780 800
0 100 0
0 100 300
215 420 600
1070 602 1000
17 46 50
0 0 0
1494 870 2000
0 0 15
0 5 2
90 100 100
848 573 1000
0 170 0
1262 788 1500
0 2 2
0 0 0
18 9 10
0 0 0
0 70 100
200 575 100
0 0 0
0 1 0
240 310 200
4 8 10
0 60 0
0 4 0
0 0 0
1 3 2
60 0 30
580 210 800
80 640 500
13 11 5
3 7 25
0 4 0
0 2 0
12 14 0
480 897 500
2 7 5
1244 933 1800
530 280 500
330 570 300
0 0 0
0 295 0
0 0 0
19 36 50
250 1220 800
3 8 3
14 15 50
0 0 10
0 10 5
813 2543 700
0 2 0
0 2 1
20 80 100
1 2 10
0 10 0
0 2 0
0 2 2
60 1514 0
0 145 100
21 28 0
100 0 100
180 0 400
0 8 0
830 870 1000
0 200 500
50 80 50
40 54 50
0 4 0
31 5 50
0 200 0
6 15 10
13 12 30
220 680 600
360 750 400
470 1180 1000
3 45 0
1 4 0
0 0 0
10 25 20
10 870 0
0 0 0
0 0 0
6 15 10
5 7 5
0 13 5
0 9 5
1191 509 3
1 2 0
1 8 4
28 23 20
35 9 30
320 287 300
4 7 5
0 0 0
0 8 0
200 140 300
0 0 0
5 38 10
180 647 300
27 0 200
0 2 0
0 0 0
88 52 100
0 5 5
200 0 200
950 2840 100
0 20 0
80 220 0
0 10 0
0 110 0
1000 532 0
0 2 0
0 2 10
16 27 25
0 0 0
2 20 10
310 350 500
800 440 600
10 440 100
80 0 100
3 0 10
10 20 0
290 210 500
0 6 1
0 0 0
37 25 50
171 329 1000
14 0 0
35 110 0
0 0 0
0 5 0
0 100 0
1743 965 1000
26 18 0
0 0 0
26 18 20
1 2 1
103 2007 100
0 0 0
2 21 10
0 0 0
0 3 0
110 420 300
2 22 10
0 4 0
4 12 10
0 3 0
0 1 0
1 0 0
1040 460 1500
23 47 30
7 10 10
460 500 300
0 0 0
12 18 30
0 1 0
460 320 0
0 1 0
1417 340 1500
6 65 0
0 1 1
2312 1387 2000
 0 2 0
0 100 0

LANSIA TDK ADA KARTU JUMLAH

350 10 711

YANG MENYERAHKAN YANG MEMINTA

KEPALA SEKSI KEFARMASIAN PIMPINAN PUSKESMAS

DESI HOTNIDA, S.Farm.,Apt. dr. Marwati

NIP. 19831109 20101 2 028 Nip. 19691221 200212 2 002
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAA
PUSKESMAS KAB. TAPANULI TENGAH

PUSKESMAS : BARUS UTARA

KECAMATAN : BARUS UTARA
NO NAMA OBAT SATUAN STOK PENERIMAAN PERSEDIAAN
AWAL
1 2 3 4 5 6 = (4 + 5 )
1 AIR UNTUK INJEKSI BOTOL 3 0 3
2 ALAT SUNTIK DISP. 3 ML SET 65 100 165
3 ALAT SUNTIK DISP. 5 ML SET 200 0 200
4 ALCOHOL SWAB PCS 14795 0 14795
5 ALKACIDE 1 LITER BOTOL 1 0 1
6 ALKAZYME SAK 0 1 1
7 ALKOHOL 70% 1 LITER BOTOL 1 0 1
8 ALOPURINOL 100 MG TABLET 780 1000 1780
9 AMINOFILIN 150 MGTABLET TABLET 100 0 100
10 AMLODIPIN 10 MG TABLET TABLET 100 0 100
11 AMLODIPIN 5 MG TABLET 420 0 420
12 AMOKSISILIN 500 MG KAPLET 602 800 1402
13 AMOKSISILIN SYRUP KERING FORTE 250MG/5ML BOTOL 46 0 46
14 AMPHETAMIN CHECK TEST PCS 0 0 0
15 ANTACIDA DOEN I TAB TABLET 870 1000 1870
16 ANTACIDA DOEN II SUSPENSI BOTOL 0 0 0
18 ANTIHEMMOROID SUPP SUPP 5 0 5
19 ASAM ASKORBAT (VIT C) 250 MG TABLET 100 0 100
20 ASAM ASKORBAT (VIT C) 50 MG TABLET 573 400 973
21 ASAM FOLAT (A FOLAT) 0,4 MG TABLET 170 0 170
22 ASAM MEFENAMAT 500 MG TABLET 788 800 1588
23 ASAM TRANEKSAMAT INJEKSI AMPUL 2 0 2
24 ASEPTAN BOTOL 0 0 0
25 ASERING BOTOL 9 24 33
26 ASETIL SISTEIN 200 MG KAPSUL 0 0 0
27 ASIKLOVIR TABLET 200 MG TABLET 70 0 70
28 ASIKLOVIR TABLET 400 MG TABLET 575 500 1075
29 ATROPIN INJEKSI 0,35 MG/ ML AMPUL 0 0 0
30 BEROTEC INHALER BOTOL 1 0 1
31 BETAHISTIN TAB 6 MG TABLET 310 90 400
32 BETAMETASON KRIM 0,1% (SBG VALERAT) TUBE 8 0 8
33 BISAKODIL 5 MG TABLET (DULCOLAX) TABLET 60 0 60
34 BISAKODIL SUSP (DULCOLAX SUPP) SUPP 4 0 4
35 BRACKET PCS 0 0 0
36 BURNAZIN (PERAK SULFADIAZIN KRIM 1%) TUBE 3 0 3
37 OSTOVEL (KALSITROL) TABLET 0 30 30
38 CAPTOPRIL 12,5 MG TABLET 210 500 710
39 CAPTOPRIL 25 MG TABLET 240 0 240
40 CATGUT CHROMIC 2/0 PCS 11 5 16
41 CEFADROXIL 250 MG SYRUP SYRUP 7 0 7
42 CEFOTAXIM INJ VIAL 4 0 4
43 CEFTRIAXONE INJ VIAL 2 0 2
44 CETIRIZINE SYRUP BOTOL 14 0 14
45 CETIRIZINE TABLET TABLET 897 200 1097
46 CHLORAMPHENICOL SALEP KULIT 2% (BUFACETIN) TUBE 7 0 7
47 CHLORPHENIRAMIN MALEAT (CTM) TABLET 933 1000 1933
48 CIPROFLOXACIN 500 MG TABLET 280 500 780
49 CLINDAMYCIN 300 MG CAPSUL 570 100 670
50 CLOPIDOGREL TABLET 75 MG TABLET 0 0 0
51 CODEIN 10 MG TABLET 295 0 295
52 CONCOR (BISOPROLOL) 1,25 MG TABLET 0 0 0
53 COTRIMOXAZOLE SUSPENSI BOTOL 36 50 86
54 COTRIMOXAZOLE TABLET DEWASA 480 mg TABLET 1220 800 2020
55 DARYANT TULE PCS 8 0 8
56 DEKSTROFEN SYRUP BOTOL 15 15 30
57 DENOMIX CREAM 10 GRAM TUBE 0 0 0
58 DEXAMETASONE INJEKSI IV/IM 5MG/ML AMPUL 10 0 10
59 DEXAMETASONE TABLET 0,5 MG TABLET 2543 2000 4543
60 DEXOCORT KRIM TUBE 2 0 2
61 DIAZEPAM LAR.REKTAL (STESOLID) 10MG/2,5ML TUBE 2 0 2
62 DOMPERIDON 10 MG TABLET TABLET 80 0 80
63 DOMPERIDON SYRUP BOTOL 2 0 2
64 EPINEFRIN INJEKSI AMPUL 10 0 10
65 EUGENOL BOTOL 2 0 2
66 FOLLEY CATHETER SET 2 2 4
67 FUROSEMID 40 MG TABLET 1514 0 1514
68 GARAM ORALIT SAK 145 100 245
69 GENTAMYCIN TETES MATA 0,3% BOTOL 28 0 28
70 GLIBENKLAMIDE 5 MG TAB TABLET 0 100 100
71 GLIMEPIRID 2 MG TABLET 0 100 100
72 GLUKOSA LARUTAN INFUS 5% STERIL BOTOL 8 0 8
73 GRISEOFULVIN 125 MG TAB TABLET 870 1000 1870
74 GRISEOFULVIN 500 MG TABLET 200 0 200
75 HANDSCHOON NON STERIL L PCS 80 50 130
76 HANDSCHOON NON STERIL M PCS 54 50 104
77 HANDSCHOON OBSGYN PCS 4 0 4
78 HANDSCHOON STERIL PASANG 5 50 55
79 HIDROKLORTIAZID 25 MG TABLET 200 0 200
80 HIDROKORTISON 2,5% KRIM TUBE 15 0 15
81 HUSTAB SIRUP BOTOL 12 15 27
82 HUSTAB TABLET TABLET 680 600 1280
83 IBUPROFEN 200 MG TABLET TABLET 750 300 1050
84 IBUPROFEN 400 MG TABLET TABLET 1180 0 1180
85 IBUPROFEN SUSPENSI BOTOL 45 0 45
86 ILLIADIN (OKSIMETAZOLIN) TETES HIDUNG 0,050% BOTOL 4 0 4
87 INFUSION SET ANAK (PEDIATRIC) PCS 0 0 0
88 INFUSION SET DEWASA SET 25 10 35
89 ISOSORBID DINITRAT 5MG (FASORBID) TABLET 870 0 870
90 IV CATH PEN 18 PCS 0 0 0
91 IV CATH PEN 20 PCS 0 0 0
92 IV TROVENOCATH 18 PCS 15 10 25
93 IV TROVENOCATH 20 PCS 7 5 12
94 IV TROVENOCATH 22 PCS 13 5 18
95 IV TROVENOCATH 24 PCS 9 0 9
96 KALSIUM LAKTAT 500 MG TABLET 509 500 1009
97 KAPAS PEMBALUT 250 GRAM PCS 1 0 1
98 KARBOGLISERIN TETES TELINGA 10% BOTOL 8 0 8
99 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL 23 10 33
100 KASSA HIDROFIL STERIL 16X16 KTK 9 20 29
101 KETOKONAZOLE 200 MG TABLET 287 0 287
102 KETOKONAZOLE KRIM TUBE 7 2 9
103 KETOPROPEN SUPP SUPP 0 0 0
104 KETOROLAC INJEKSI 30 MG/ML AMPUL 8 0 8
105 LANSOPRAZOLE 30 MG KAPSUL 140 300 440
106 LIDOKAIN 2% + EPINEFRIN 1 : 80.000 AMPUL 0 0 0
107 LIDOKAIN INJEKSI 2% (HCL) AMPUL 38 0 38
108 LOPERAMIDE TAB 2 MG TABLET 647 300 947
109 LORATADINE 10 MG TABLET 0 0 0
110 LYSOL 1 LITER BOTOL 2 0 2
111 MARIYUANA RAPID TEST PCS 0 0 0
112 MASKER PCS 52 100 152
113 MEBENDAZOLE 500 MG (VERMOX) TABLET 5 0 5
114 METFORMIN 500 MG TABLET 0 100 100
115 METHYL PREDNISOLON 4 MG TABLET 2840 1000 3840
116 METIL ERGOMETRIN INJEKSI 0,2MG/ML AMPUL 20 10 30
117 METIL ERGOMETRIN MALEAT 0,175 MG TABLET 220 0 220
118 METOKLOPAMID DROP BOTOL 10 0 10
119 METOKLOPRAMID 5 MG TABLET TABLET 110 0 110
120 METRONIDAZOLE 500 MG TABLET 532 1000 1532
121 METRONIDAZOLE OVULA (VAGIZOL) SUPP 2 0 2
122 METRONIDAZOLE SUSPENSI BOTOL 2 0 2
123 MIKONAZOLE KRIM 2% (SBG NITRAT) TUBE 10 GR 27 10 37
124 MINERAL MIX SAK 0 0 0
125 NACL 0,9% LARUTAN INFUS BOTOL 20 10 30
126 NATRIUM DIKLOFENAK 25 MG TABLET 350 200 550
127 NATRIUM DIKLOFENAK 50 MG TABLET 440 400 840
128 NEW ANTIDWTS (ATAPULGIT) TABLET 440 0 440
129 NIFEDIPIN 10 MG TAB TABLET 0 0 0
130 OKSITETRASIKLIN SALEP MATA TUBE 0 0 0
131 OKSITOSIN INJEKSI AMPUL 20 30 50
132 OMEPRAZOLE 20 MG CAPSUL KAPSUL 210 300 510
133 ONDANSETRON INJEKSI 2MG/ ML AMPUL 6 0 6
134 PARACETAMOL DROP 100MG/ML BOTOL 0 0 0
135 PARACETAMOL SYRUP 120MG/5ML BOTOL 25 10 35
136 PARASETAMOL TABLET 500 MG TABLET 329 300 629
137 PHYTOMENADION INJEKSI AMPUL 0 0 0
138 PHYTOMENADION TABLET TABLET 110 0 110
139 PIRANTEL PAMOAT 125 MG TABLET TABLET 0 0 0
140 PIRANTEL PAMOAT SUSPENSI 125 MG BOTOL 5 0 5
141 PIRIDOKSIN (VIT B6) INJEKSI AMPUL 100 50 150
142 PIRIDOKSIN (VIT B6) TAB 10 MG (HCL) TABLET 965 1000 1965
143 PLESTER ISOPLAST 5YARD X 2 INCH ROL 9 0 9
144 PLESTER PHARMAFIX 10 CM X 500 CM ROL 0 0 0
145 PLESTER POLIFIX 5 CM X 1 M ROL 18 10 28
146 POVIDON IODIDA 10% 300 ML BOTOL 2 1 3
147 PREDNISON 5 MG TABLET 2007 500 2507
148 PULMICORT TURBUHALER 200 TURB 0 0 0
149 RANITIDIN INJEKSI AMPUL 21 10 31
150 RISTONAT 35 MG TABLET 0 0 0
151 SAFETY BOX PCS 3 0 3
152 SALBUTAMOL 4 MG TABLET 420 100 520
153 SALBUTAMOL SYRUP BOTOL 22 0 22
154 SALEP ANTIFUNGI POT 4 0 4
155 SALISIL BEDAK SERBUK 2% SAK 12 10 22
156 SCABIMITE CREAM TUBE 3 0 3
157 SELANG OKSIGEN M PCS 1 0 1
158 SELANG OKSIGEN S PCS 0 0 0
159 SIANOKOBALAMIN (VIT B12) 50 MCG TABLET 460 1000 1460
160 SIANOKOBALAMIN (VIT B12) INJ 500MCG AMPUL 47 30 77
161 SILK BLACK PCS 10 5 15
162 SIMVASTATIN TABLET 10 MG TABLET 500 300 800
163 SOFTAMAN HAND 1 LITER BOTOL 0 0 0
164 SUCRALFAT SUSPENSI ( ULSAFATE) BOTOL 18 10 28
165 SYMBICORT TURBUHALER 180 TURB 1 0 1
166 TABLET TAMBAH DARAH TABLET 320 0 320
167 TETAGAM P. SYRINGE 1 ML AMPUL 1 0 1
168 THIAMIN 50 MG TABLET 340 1400 1740
169 UMBILICAL CORD PCS 65 0 65
170 USG GEL BOTOL 1 0 1
171 VITAMIN B KOMPLEKS TABLET 1387 3000 4387
172 XYLOCAINE SPRAY TUBE 2 0 2
173 ZINK TAB DISPERSIBEL 20 MG TABLET 100 500 600

BPJS PUSTU BKIA

JUMLAH KUNJUNGAN RESEP
204 140 10

DIKETAHUI, YANG MENYERAHKA

KEPALA DINAS KESEHATAN TAP.TENGAH KEPALA SEKSI KEFARMA

NURSYAM, SKM., M.Kes. DESI HOTNIDA, S.Farm.

NIP. 19690909 199103 2 005 NIP. 19831109 20101 2
LEMBAR PERMINTAAN OBAT
TAPANULI TENGAH

LAPORAN BULAN / PERIODE : MEI 19

PERMINTAAN BULAN / PERIODE : JUNI 2019
STOK PERMINTA PEMBERIAN
PEMAKAIAN SISA STOK KET
OPTIMUM AN DAK PROP JUMLAH
7 8=(6-7) 9 10 11 12 13 14
0 3 0
75 90 100
0 200 0
1500 13295 0
0 1 0
0 0 1
0 1 0
820 960 800
0 100 0
100 0 300
420 0 600
760 642 1000
10 36 50
0 0 0
1360 510 2000
0 0 15
0 5 2
90 10 100
487 486 1000
30 140 0
690 898 1500
0 2 2
0 0 0
10 23 10
0 0 0
0 70 100
340 735 100
0 0 0
0 1 0
140 260 200
4 4 10
0 60 0
0 4 0
0 0 0
1 2 2
10 20 30
470 240 800
60 180 500
5 11 5
2 5 25
0 4 0
0 2 0
0 14 0
410 687 500
3 4 5
1432 501 1800
450 330 500
330 340 300
0 0 0
0 295 0
0 0 0
31 55 50
650 1370 800
1 7 3
20 10 50
0 0 10
1 9 5
1729 2814 700
0 2 0
1 1 1
30 50 100
2 0 10
0 10 0
0 2 0
0 4 2
20 1494 0
25 220 100
6 22 0
100 0 100
100 0 400
0 8 0
670 1200 1000
0 200 500
30 100 50
16 88 50
0 4 0
23 32 50
10 190 0
8 7 10
6 21 30
740 540 600
600 450 400
770 410 1000
45 0 0
1 4 0
0 0 0
14 21 20
10 870 0
0 0 0
0 0 0
9 16 10
2 10 5
4 14 5
0 9 5
840 169 3
1 0 0
4 4 4
9 24 20
16 13 30
60 227 300
5 4 5
0 0 0
0 8 0
140 300 300
0 0 0
12 26 10
750 197 300
27 0 200
0 2 0
0 0 0
85 67 100
0 5 5
60 40 200
1380 2460 100
0 30 0
0 220 0
0 10 0
0 110 0
792 740 0
0 2 0
0 2 10
17 20 25
0 0 0
1 29 10
430 120 500
660 180 600
140 300 100
80 0 100
0 0 10
10 40 0
480 30 500
2 4 1
0 0 0
8 27 50
629 0 1000
0 0 0
10 100 0
0 0 0
0 5 0
36 114 0
1060 905 1000
0 9 0
0 0 0
16 12 20
1 2 1
630 1877 100
0 0 0
28 3 10
0 0 0
0 3 0
140 380 300
2 20 10
0 4 0
12 10 10
0 3 0
0 1 0
0 0 0
980 480 1500
24 53 30
0 15 10
300 500 300
0 0 0
8 20 30
0 1 0
100 220 0
0 1 0
1380 360 1500
5 60 0
0 1 1
2260 2127 2000
 0 2 0
0 600 0

LANSIA TDK ADA KARTU JUMLAH

350 10 714

YANG MENYERAHKAN YANG MEMINTA

KEPALA SEKSI KEFARMASIAN PIMPINAN PUSKESMAS

DESI HOTNIDA, S.Farm.,Apt. dr. Marwati

NIP. 19831109 20101 2 028 Nip. 19691221 200212 2 002
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O
PUSKESMAS KAB. TAPANULI TENGAH

PUSKESMAS : BARUS UTARA

KECAMATAN : BARUS UTARA
NO NAMA OBAT SATUAN STOK PENERIMA PERSEDIAA PEMAKAIA
AWAL AN N N
1 2 3 4 5 6 = (4 + 5 ) 7
1 AIR UNTUK INJEKSI BOTOL 3 0 3 0
2 ALAT SUNTIK DISP. 3 ML SET 90 100 190 95
3 ALAT SUNTIK DISP. 5 ML SET 200 0 200 0
4 ALCOHOL SWAB PCS 13295 0 13295 1500
5 ALKACIDE 1 LITER BOTOL 1 0 1 0
6 ALKAZYME SAK 1 1 2 0
7 ALKOHOL 70% 1 LITER BOTOL 1 0 1 1
8 ALOPURINOL 100 MG TABLET 960 800 1760 470
9 AMINOFILIN 150 MGTABLET TABLET 100 0 100 10
10 AMLODIPIN 10 MG TABLET TABLET 0 100 100 45
11 AMLODIPIN 5 MG TABLET 0 300 300 285
12 AMOKSISILIN 500 MG KAPLET 642 1000 1642 930
13 AMOKSISILIN SYRUP KERING FORTE 250MG/5ML BOTOL 0 0 0 0
14 AMPHETAMIN CHECK TEST PCS 0 0 0 0
15 ANTACIDA DOEN I TAB TABLET 510 1200 1710 940
16 ANTACIDA DOEN II SUSPENSI BOTOL 0 5 5 5
18 ANTIHEMMOROID SUPP SUPP 5 2 7 0
19 ASAM ASKORBAT (VIT C) 250 MG TABLET 10 100 110 30
20 ASAM ASKORBAT (VIT C) 50 MG TABLET 486 200 686 516
21 ASAM FOLAT (A FOLAT) 0,4 MG TABLET 140 0 140 40
22 ASAM MEFENAMAT 500 MG TABLET 898 1500 2398 1190
23 ASAM TRANEKSAMAT INJEKSI AMPUL 2 2 4 2
24 ASEPTAN BOTOL 0 0 0 0
25 ASERING BOTOL 23 24 47 22
26 ASETIL SISTEIN 200 MG KAPSUL 0 0 0 0
27 ASIKLOVIR TABLET 200 MG TABLET 70 0 70 0
28 ASIKLOVIR TABLET 400 MG TABLET 735 200 935 359
29 ATROPIN INJEKSI 0,35 MG/ ML AMPUL 0 0 0 0
30 BEROTEC INHALER BOTOL 1 0 1 0
31 BETAHISTIN TAB 6 MG TABLET 260 150 410 90
32 BETAMETASON KRIM 0,1% (SBG VALERAT) TUBE 4 0 4 2
33 BISAKODIL 5 MG TABLET (DULCOLAX) TABLET 90 0 90 0
34 BISAKODIL SUSP (DULCOLAX SUPP) SUPP 4 0 4 0
35 BRACKET PCS 0 0 0 0
36 BURNAZIN (PERAK SULFADIAZIN KRIM 1%) TUBE 2 1 3 1
37 OSTOVEL (KALSITROL) TABLET 20 0 20 0
38 CAPTOPRIL 12,5 MG TABLET 240 500 740 240
39 CAPTOPRIL 25 MG TABLET 180 200 380 140
40 CATGUT CHROMIC 2/0 PCS 11 5 16 8
41 CEFADROXIL 250 MG SYRUP SYRUP 5 5 10 2
42 CEFOTAXIM INJ VIAL 4 0 4 0
43 CEFTRIAXONE INJ VIAL 2 0 2 0
44 CETIRIZINE SYRUP BOTOL 0 0 0 0
45 CETIRIZINE TABLET TABLET 687 300 987 400
46 CHLORAMPHENICOL SALEP KULIT 2% (BUFACETIN) TUBE 4 2 6 2
47 CHLORPHENIRAMIN MALEAT (CTM) TABLET 501 1200 1701 976
48 CIPROFLOXACIN 500 MG TABLET 330 300 630 340
49 CLINDAMYCIN 300 MG CAPSUL 340 100 440 0
50 CLOPIDOGREL TABLET 75 MG TABLET 0 0 0 0
51 CODEIN 10 MG TABLET 300 0 300 20
52 CONCOR (BISOPROLOL) 1,25 MG TABLET 0 0 0 0
53 COTRIMOXAZOLE SUSPENSI BOTOL 55 50 105 36
54 COTRIMOXAZOLE TABLET DEWASA 480 mg TABLET 0 0 0 0
55 DARYANT TULE PCS 7 0 7 0
56 DEKSTROFEN SYRUP BOTOL 10 15 25 18
57 DENOMIX CREAM 10 GRAM TUBE 0 0 0 0
58 DEXAMETASONE INJEKSI IV/IM 5MG/ML AMPUL 9 0 9 6
59 DEXAMETASONE TABLET 0,5 MG TABLET 2994 1000 3994 725
60 DEXOCORT KRIM TUBE 2 0 2 1
61 DIAZEPAM LAR.REKTAL (STESOLID) 10MG/2,5ML TUBE 1 0 1 0
62 DOMPERIDON 10 MG TABLET TABLET 50 100 150 90
63 DOMPERIDON SYRUP BOTOL 0 0 0 0
64 EPINEFRIN INJEKSI AMPUL 10 0 10 5
65 EUGENOL BOTOL 4 2 6 1
66 FOLLEY CATHETER SET 4 2 6 0
67 FUROSEMID 40 MG TABLET 1494 0 1494 356
68 GARAM ORALIT SAK 220 100 320 90
69 GENTAMYCIN TETES MATA 0,3% BOTOL 0 0 0 0
70 GLIBENKLAMIDE 5 MG TAB TABLET 0 100 100 50
71 GLIMEPIRID 2 MG TABLET 0 0 0 0
72 GLUKOSA LARUTAN INFUS 5% STERIL BOTOL 8 0 8 0
73 GRISEOFULVIN 125 MG TAB TABLET 0 0 0 0
74 GRISEOFULVIN 500 MG TABLET 200 0 200 0
75 HANDSCHOON NON STERIL L PCS 100 0 100 76
76 HANDSCHOON NON STERIL M PCS 88 0 88 10
77 HANDSCHOON OBSGYN PCS 4 0 4 0
78 HANDSCHOON STERIL PASANG 32 100 132 41
79 HIDROKLORTIAZID 25 MG TABLET 190 0 190 40
80 HIDROKORTISON 2,5% KRIM TUBE 7 24 31 13
81 HUSTAB SIRUP BOTOL 21 5 26 12
82 HUSTAB TABLET TABLET 540 900 1440 570
83 IBUPROFEN 200 MG TABLET TABLET 450 400 850 280
84 IBUPROFEN 400 MG TABLET TABLET 410 600 1010 770
85 IBUPROFEN SUSPENSI BOTOL 0 0 0 0
86 ILLIADIN (OKSIMETAZOLIN) TETES HIDUNG 0,050% BOTOL 4 0 4 0
87 INFUSION SET ANAK (PEDIATRIC) PCS 0 0 0 0
88 INFUSION SET DEWASA SET 21 10 31 16
89 ISOSORBID DINITRAT 5MG (FASORBID) TABLET 0 0 0 0
90 IV CATH PEN 18 PCS 0 0 0 0
91 IV CATH PEN 20 PCS 0 0 0 0
92 IV TROVENOCATH 18 PCS 16 5 21 15
93 IV TROVENOCATH 20 PCS 10 5 15 12
94 IV TROVENOCATH 22 PCS 14 0 14 8
95 IV TROVENOCATH 24 PCS 9 0 9 4
96 KALSIUM LAKTAT 500 MG TABLET 169 800 969 590
97 KAPAS PEMBALUT 250 GRAM PCS 0 1 1 0
98 KARBOGLISERIN TETES TELINGA 10% BOTOL 4 0 4 2
99 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL 24 10 34 19
100 KASSA HIDROFIL STERIL 16X16 KTK 13 10 23 20
101 KETOKONAZOLE 200 MG TABLET 227 200 427 202
102 KETOKONAZOLE KRIM TUBE 4 4 8 5
103 KETOPROPEN SUPP SUPP 0 0 0 0
104 KETOROLAC INJEKSI 30 MG/ML AMPUL 6 0 6 0
105 LANSOPRAZOLE 30 MG KAPSUL 300 300 600 450
106 LIDOKAIN 2% + EPINEFRIN 1 : 80.000 AMPUL 0 0 0 0
107 LIDOKAIN INJEKSI 2% (HCL) AMPUL 26 20 46 30
108 LOPERAMIDE TAB 2 MG TABLET 0 0 0 0
109 LORATADINE 10 MG TABLET 0 0 0 27
110 LYSOL 1 LITER BOTOL 2 0 2 0
111 MARIYUANA RAPID TEST PCS 0 0 0 0
112 MASKER PCS 67 50 117 87
113 MEBENDAZOLE 500 MG (VERMOX) TABLET 5 5 10 1
114 METFORMIN 500 MG TABLET 40 100 140 60
115 METHYL PREDNISOLON 4 MG TABLET 2460 500 2960 1730
116 METIL ERGOMETRIN INJEKSI 0,2MG/ML AMPUL 30 0 30 0
117 METIL ERGOMETRIN MALEAT 0,175 MG TABLET 220 0 220 0
118 METOKLOPAMID DROP BOTOL 10 0 10 1
119 METOKLOPRAMID 5 MG TABLET TABLET 110 0 110 0
120 METRONIDAZOLE 500 MG TABLET 740 1000 1740 1200
121 METRONIDAZOLE OVULA (VAGIZOL) SUPP 2 0 2 0
122 METRONIDAZOLE SUSPENSI BOTOL 2 0 2 2
123 MIKONAZOLE KRIM 2% (SBG NITRAT) TUBE 10 GR 20 10 30 7
124 MINERAL MIX SAK 0 0 0 0
125 NACL 0,9% LARUTAN INFUS BOTOL 29 5 34 13
126 NATRIUM DIKLOFENAK 25 MG TABLET 120 500 620 340
127 NATRIUM DIKLOFENAK 50 MG TABLET 180 500 680 430
128 NEW ANTIDWTS (ATAPULGIT) TABLET 300 100 400 170
129 NIFEDIPIN 10 MG TAB TABLET 0 0 0 0
130 OKSITETRASIKLIN SALEP MATA TUBE 0 2 2 0
131 OKSITOSIN INJEKSI AMPUL 40 0 40 0
132 OMEPRAZOLE 20 MG CAPSUL KAPSUL 30 300 330 40
133 ONDANSETRON INJEKSI 2MG/ ML AMPUL 4 2 6 0
134 PARACETAMOL DROP 100MG/ML BOTOL 0 0 0 0
135 PARACETAMOL SYRUP 120MG/5ML BOTOL 27 20 47 34
136 PARASETAMOL TABLET 500 MG TABLET 0 500 500 253
137 PHYTOMENADION INJEKSI AMPUL 0 0 0 0
138 PHYTOMENADION TABLET TABLET 100 0 100 10
139 PIRANTEL PAMOAT 125 MG TABLET TABLET 0 0 0 0
140 PIRANTEL PAMOAT SUSPENSI 125 MG BOTOL 5 0 5 1
141 PIRIDOKSIN (VIT B6) INJEKSI AMPUL 114 0 114 36
142 PIRIDOKSIN (VIT B6) TAB 10 MG (HCL) TABLET 905 2000 2905 730
143 PLESTER ISOPLAST 5YARD X 2 INCH ROL 9 0 9 0
144 PLESTER PHARMAFIX 10 CM X 500 CM ROL 0 1 1 0
145 PLESTER POLIFIX 5 CM X 1 M ROL 12 0 12 11
146 POVIDON IODIDA 10% 300 ML BOTOL 2 0 2 2
147 PREDNISON 5 MG TABLET 1877 0 1877 30
148 PULMICORT TURBUHALER 200 TURB 0 0 0 0
149 RANITIDIN INJEKSI AMPUL 29 10 39 8
150 RISTONAT 35 MG TABLET 0 0 0 0
151 SAFETY BOX PCS 3 0 3 0
152 SALBUTAMOL 4 MG TABLET 380 300 680 160
153 SALBUTAMOL SYRUP BOTOL 20 0 20 2
154 SALEP ANTIFUNGI POT 4 0 4 0
155 SALISIL BEDAK SERBUK 2% SAK 10 0 10 2
156 SCABIMITE CREAM TUBE 3 0 3 0
157 SELANG OKSIGEN M PCS 1 0 1 0
158 SELANG OKSIGEN S PCS 0 0 0 0
159 SIANOKOBALAMIN (VIT B12) 50 MCG TABLET 480 1500 1980 540
160 SIANOKOBALAMIN (VIT B12) INJ 500MCG AMPUL 53 30 83 31
161 SILK BLACK PCS 15 10 25 7
162 SIMVASTATIN TABLET 10 MG TABLET 500 300 800 270
163 SOFTAMAN HAND 1 LITER BOTOL 0 0 0 0
164 SUCRALFAT SUSPENSI ( ULSAFATE) BOTOL 20 0 20 9
165 SYMBICORT TURBUHALER 180 TURB 1 0 1 0
166 TABLET TAMBAH DARAH TABLET 220 0 220 50
167 TETAGAM P. SYRINGE 1 ML AMPUL 1 0 1 0
168 THIAMIN 50 MG TABLET 360 800 1160 540
169 UMBILICAL CORD PCS 60 0 60 10
170 USG GEL BOTOL 1 0 1 0
171 VITAMIN B KOMPLEKS TABLET 2127 1000 3127 1300
172 XYLOCAINE SPRAY TUBE 2 0 2 0
173 ZINK TAB DISPERSIBEL 20 MG TABLET 600 0 600 20
174 CHLORAMPHENICOL SUSPENSI BOTOL 0 2 2 0

BPJS PUSTU BKIA LANSIA

JUMLAH KUNJUNGAN RESEP
203 140 10 350

DIKETAHUI, YANG MENYERAHKAN

KEPALA DINAS KESEHATAN TAP.TENGAH KEPALA SEKSI KEFARMASIAN

NURSYAM, SKM., M.Kes. DESI HOTNIDA, S.Farm.,Apt.

NIP. 19690909 199103 2 005 NIP. 19831109 20101 2 028
AR PERMINTAAN OBAT
NULI TENGAH

LAPORAN BULAN / PERIODE : JUNI 2019

PERMINTAAN BULAN / PERIODE : JULI 2019
STOK PERMINTA PEMBERIAN
SISA STOK KET
OPTIMUM AN DAK PROP JUMLAH
8=(6-7) 9 10 11 12 13 14
3 0
95 100
200 0
12495 0
1 0
2 1
0 0
1290 800
90 0
55 300
15 600
712 1000
0 50
0 0
770 2000
0 15
7 2
80 100
170 1000
100 0
1208 1500
2 2
0 0
25 10
0 0
70 100
576 100
0 0
1 0
320 200
2 10
90 0
4 0
0 0
2 2
 20 30
500 800
240 500
8 5
8 25
4 0
2 0
0 0
587 500
4 5
725 1800
290 500
440 300
0 0
280 0
0 0
69 50
0 800
7 3
7 50
0 10
3 5
3269 700
1 0
1 1
60 100
0 10
5 0
5 0
6 2
1138 0
230 100
0 0
50 100
0 400
8 0
0 1000
200 500
24 50
78 50
4 0
91 50
150 0
18 10
14 30
870 600
570 400
190 1000
0 0
4 0
0 0
15 20
0 0
0 0
0 0
6 10
3 5
6 5
5 5
379 3
1 0
2 4
15 20
3 30
225 300
4 5
0 0
6 0
150 300
0 0
16 10
0 300
0 200
2 0
0 0
30 100
9 5
80 200
1230 100
30 0
220 0
9 0
110 0
540 0
2 0
0 10
23 25
0 0
21 10
280 500
250 600
230 100
0 100
2 10
40 0
290 500
6 1
0 0
13 50
247 1000
0 0
100 0
0 0
4 0
114 0
2175 1000
9 0
1 0
1 20
0 1
1847 100
0 0
31 10
0 0
3 0
520 300
18 10
4 0
8 10
3 0
1 0
0 0
1440 1500
52 30
18 10
530 300
0 0
11 30
1 0
170 0
1 0
620 1500
50 0
1 1
1827 2000
 2 0
580 0
2 2

TDK ADA KARTU JUMLAH

10 713

G MENYERAHKAN YANG MEMINTA

SEKSI KEFARMASIAN PIMPINAN PUSKESMAS

OTNIDA, S.Farm.,Apt. dr. Marwati

831109 20101 2 028 Nip. 19691221 200212 2 002
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN
PUSKESMAS KAB. TAPANULI TENGAH

PUSKESMAS : BARUS UTARA

KECAMATAN : BARUS UTARA
NO NAMA OBAT SATUAN STOK PENERIMA PERSEDIAA
AWAL AN N
1 2 3 4 5 6 = (4 + 5 )
1 AIR UNTUK INJEKSI BOTOL 3 0 3
2 ALAT SUNTIK DISP. 3 ML SET 95 100 195
3 ALAT SUNTIK DISP. 5 ML SET 200 0 200
4 ALCOHOL SWAB PCS 12495 0 12495
5 ALKACIDE 1 LITER BOTOL 1 0 1
6 ALKAZYME SAK 2 0 2
7 ALKOHOL 70% 1 LITER BOTOL 0 0 0
8 ALOPURINOL 100 MG TABLET 1290 300 1590
9 AMINOFILIN 150 MGTABLET TABLET 90 0 90
10 AMLODIPIN 10 MG TABLET TABLET 0 100 100
11 AMLODIPIN 5 MG TABLET 15 300 315
12 AMOKSISILIN 500 MG KAPLET 712 500 1212
13 AMOKSISILIN SYRUP KERING FORTE 250MG/5ML BOTOL 0 5 5
14 AMPHETAMIN CHECK TEST PCS 0 0 0
15 ANTACIDA DOEN I TAB TABLET 770 700 1470
16 ANTACIDA DOEN II SUSPENSI BOTOL 0 5 5
18 ANTIHEMMOROID SUPP SUPP 5 2 7
19 ASAM ASKORBAT (VIT C) 250 MG TABLET 80 0 80
20 ASAM ASKORBAT (VIT C) 50 MG TABLET 170 400 570
21 ASAM FOLAT (A FOLAT) 0,4 MG TABLET 0 0 0
22 ASAM MEFENAMAT 500 MG TABLET 1208 800 2008
23 ASAM TRANEKSAMAT INJEKSI AMPUL 2 2 4
24 ASEPTAN BOTOL 0 0 0
25 ASERING BOTOL 25 10 35
26 ASETIL SISTEIN 200 MG KAPSUL 0 0 0
27 ASIKLOVIR TABLET 200 MG TABLET 70 0 70
28 ASIKLOVIR TABLET 400 MG TABLET 576 100 676
29 ATROPIN INJEKSI 0,35 MG/ ML AMPUL 0 0 0
30 BEROTEC INHALER BOTOL 1 0 1
31 BETAHISTIN TAB 6 MG TABLET 260 0 260
32 BETAMETASON KRIM 0,1% (SBG VALERAT) TUBE 4 0 4
33 BISAKODIL 5 MG TABLET (DULCOLAX) TABLET 0 0 0
34 BISAKODIL SUSP (DULCOLAX SUPP) SUPP 4 0 4
35 BRACKET PCS 0 0 0
36 BURNAZIN (PERAK SULFADIAZIN KRIM 1%) TUBE 2 2 4
37 OSTOVEL (KALSITROL) TABLET 20 0 20
38 CAPTOPRIL 12,5 MG TABLET 500 0 500
39 CAPTOPRIL 25 MG TABLET 240 100 340
40 CATGUT CHROMIC 2/0 PCS 8 5 13
41 CEFADROXIL 250 MG SYRUP SYRUP 8 0 8
42 CEFOTAXIM INJ VIAL 4 0 4
43 CEFTRIAXONE INJ VIAL 2 0 2
44 CETIRIZINE SYRUP BOTOL 0 0 0
45 CETIRIZINE TABLET TABLET 587 500 1087
46 CHLORAMPHENICOL SALEP KULIT 2% (BUFACETIN) TUBE 4 2 6
47 CHLORPHENIRAMIN MALEAT (CTM) TABLET 725 500 1225
48 CIPROFLOXACIN 500 MG TABLET 290 300 590
49 CLINDAMYCIN 300 MG CAPSUL 440 300 740
50 CLOPIDOGREL TABLET 75 MG TABLET 0 0 0
51 CODEIN 10 MG TABLET 280 0 280
52 CONCOR (BISOPROLOL) 1,25 MG TABLET 0 0 0
53 COTRIMOXAZOLE SUSPENSI BOTOL 69 0 69
54 COTRIMOXAZOLE TABLET DEWASA 480 mg TABLET 0 0 0
55 DARYANT TULE PCS 7 0 7
56 DEKSTROFEN SYRUP BOTOL 7 15 22
57 DENOMIX CREAM 10 GRAM TUBE 0 0 0
58 DEXAMETASONE INJEKSI IV/IM 5MG/ML AMPUL 3 5 8
59 DEXAMETASONE TABLET 0,5 MG TABLET 3269 700 3969
60 DEXOCORT KRIM TUBE 2 0 2
61 DIAZEPAM LAR.REKTAL (STESOLID) 10MG/2,5ML TUBE 1 0 1
62 DOMPERIDON 10 MG TABLET TABLET 60 100 160
63 DOMPERIDON SYRUP BOTOL 0 0 0
64 EPINEFRIN INJEKSI AMPUL 5 0 5
65 EUGENOL BOTOL 2 0 2
66 FOLLEY CATHETER SET 3 2 5
67 FUROSEMID 40 MG TABLET 1138 0 1138
68 GARAM ORALIT SAK 230 0 230
69 GENTAMYCIN TETES MATA 0,3% BOTOL 0 0 0
70 GLIBENKLAMIDE 5 MG TAB TABLET 50 100 150
71 GLIMEPIRID 2 MG TABLET 0 0 0
72 GLUKOSA LARUTAN INFUS 5% STERIL BOTOL 8 0 8
73 GRISEOFULVIN 125 MG TAB TABLET 0 0 0
74 GRISEOFULVIN 500 MG TABLET 200 200 400
75 HANDSCHOON NON STERIL L PCS 24 50 74
76 HANDSCHOON NON STERIL M PCS 78 0 78
77 HANDSCHOON OBSGYN PCS 4 0 4
78 HANDSCHOON STERIL PASANG 91 20 111
79 HIDROKLORTIAZID 25 MG TABLET 150 0 150
80 HIDROKORTISON 2,5% KRIM TUBE 18 5 23
81 HUSTAB SIRUP BOTOL 14 10 24
82 HUSTAB TABLET TABLET 870 0 870
83 IBUPROFEN 200 MG TABLET TABLET 570 200 770
84 IBUPROFEN 400 MG TABLET TABLET 190 800 990
85 IBUPROFEN SUSPENSI BOTOL 0 50 50
86 ILLIADIN (OKSIMETAZOLIN) TETES HIDUNG 0,050% BOTOL 4 0 4
87 INFUSION SET ANAK (PEDIATRIC) PCS 0 0 0
88 INFUSION SET DEWASA SET 21 12 33
89 ISOSORBID DINITRAT 5MG (FASORBID) TABLET 0 0 0
90 IV CATH PEN 18 PCS 0 0 0
91 IV CATH PEN 20 PCS 0 0 0
92 IV TROVENOCATH 18 PCS 6 10 16
93 IV TROVENOCATH 20 PCS 3 5 8
94 IV TROVENOCATH 22 PCS 6 5 11
95 IV TROVENOCATH 24 PCS 5 2 7
96 KALSIUM LAKTAT 500 MG TABLET 379 1000 1379
97 KAPAS PEMBALUT 250 GRAM PCS 0 1 1
98 KARBOGLISERIN TETES TELINGA 10% BOTOL 2 0 2
99 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL 15 10 25
100 KASSA HIDROFIL STERIL 16X16 KTK 3 20 23
101 KETOKONAZOLE 200 MG TABLET 225 300 525
102 KETOKONAZOLE KRIM TUBE 4 5 9
103 KETOPROPEN SUPP SUPP 0 0 0
104 KETOROLAC INJEKSI 30 MG/ML AMPUL 6 0 6
105 LANSOPRAZOLE 30 MG KAPSUL 150 300 450
106 LIDOKAIN 2% + EPINEFRIN 1 : 80.000 AMPUL 0 0 0
107 LIDOKAIN INJEKSI 2% (HCL) AMPUL 16 10 26
108 LOPERAMIDE TAB 2 MG TABLET 0 100 100
109 LORATADINE 10 MG TABLET 0 200 200
110 LYSOL 1 LITER BOTOL 2 0 2
111 MARIYUANA RAPID TEST PCS 0 0 0
112 MASKER PCS 30 50 80
113 MEBENDAZOLE 500 MG (VERMOX) TABLET 9 5 14
114 METFORMIN 500 MG TABLET 80 100 180
115 METHYL PREDNISOLON 4 MG TABLET 1230 1000 2230
116 METIL ERGOMETRIN INJEKSI 0,2MG/ML AMPUL 30 0 30
117 METIL ERGOMETRIN MALEAT 0,175 MG TABLET 0 0 0
118 METOKLOPAMID DROP BOTOL 9 0 9
119 METOKLOPRAMID 5 MG TABLET TABLET 110 0 110
120 METRONIDAZOLE 500 MG TABLET 0 0 0
121 METRONIDAZOLE OVULA (VAGIZOL) SUPP 2 0 2
122 METRONIDAZOLE SUSPENSI BOTOL 0 2 2
123 MIKONAZOLE KRIM 2% (SBG NITRAT) TUBE 10 GR 23 10 33
124 MINERAL MIX SAK 0 0 0
125 NACL 0,9% LARUTAN INFUS BOTOL 21 10 31
126 NATRIUM DIKLOFENAK 25 MG TABLET 280 500 780
127 NATRIUM DIKLOFENAK 50 MG TABLET 250 200 450
128 NEW ANTIDWTS (ATAPULGIT) TABLET 230 100 330
129 NIFEDIPIN 10 MG TAB TABLET 0 0 0
130 OKSITETRASIKLIN SALEP MATA TUBE 2 2 4
131 OKSITOSIN INJEKSI AMPUL 40 0 40
132 OMEPRAZOLE 20 MG CAPSUL KAPSUL 290 150 440
133 ONDANSETRON INJEKSI 2MG/ ML AMPUL 6 0 6
134 PARACETAMOL DROP 100MG/ML BOTOL 0 0 0
135 PARACETAMOL SYRUP 120MG/5ML BOTOL 13 25 38
136 PARASETAMOL TABLET 500 MG TABLET 247 300 547
137 PHYTOMENADION INJEKSI AMPUL 0 0 0
138 PHYTOMENADION TABLET TABLET 90 100 190
139 PIRANTEL PAMOAT 125 MG TABLET TABLET 0 0 0
140 PIRANTEL PAMOAT SUSPENSI 125 MG BOTOL 4 0 4
141 PIRIDOKSIN (VIT B6) INJEKSI AMPUL 84 0 84
142 PIRIDOKSIN (VIT B6) TAB 10 MG (HCL) TABLET 2175 1000 3175
143 PLESTER ISOPLAST 5YARD X 2 INCH ROL 9 0 9
144 PLESTER PHARMAFIX 10 CM X 500 CM ROL 1 1 2
145 PLESTER POLIFIX 5 CM X 1 M ROL 1 0 1
146 POVIDON IODIDA 10% 300 ML BOTOL 0 1 1
147 PREDNISON 5 MG TABLET 0 0 0
148 PULMICORT TURBUHALER 200 TURB 0 0 0
149 RANITIDIN INJEKSI AMPUL 31 0 31
150 RISTONAT 35 MG TABLET 1 0 1
151 SAFETY BOX PCS 3 2 5
152 SALBUTAMOL 4 MG TABLET 520 200 720
153 SALBUTAMOL SYRUP BOTOL 18 0 18
154 SALEP ANTIFUNGI POT 4 0 4
155 SALISIL BEDAK SERBUK 2% SAK 8 0 8
156 SCABIMITE CREAM TUBE 3 0 3
157 SELANG OKSIGEN M PCS 1 0 1
158 SELANG OKSIGEN S PCS 0 0 0
159 SIANOKOBALAMIN (VIT B12) 50 MCG TABLET 1440 700 2140
160 SIANOKOBALAMIN (VIT B12) INJ 500MCG AMPUL 52 30 82
161 SILK BLACK PCS 18 5 23
162 SIMVASTATIN TABLET 10 MG TABLET 530 150 680
163 SOFTAMAN HAND 1 LITER BOTOL 0 0 0
164 SUCRALFAT SUSPENSI ( ULSAFATE) BOTOL 11 10 21
165 SYMBICORT TURBUHALER 180 TURB 1 0 1
166 TABLET TAMBAH DARAH TABLET 170 0 170
167 TETAGAM P. SYRINGE 1 ML AMPUL 1 0 1
168 THIAMIN 50 MG TABLET 620 1000 1620
169 UMBILICAL CORD PCS 50 0 50
170 USG GEL BOTOL 1 0 1
171 VITAMIN B KOMPLEKS TABLET 1827 400 2227
172 XYLOCAINE SPRAY TUBE 2 0 2
173 ZINK TAB DISPERSIBEL 20 MG TABLET 0 0 0
174 CHLORAMPHENICOL SUSPENSI BOTOL 2 0 2

BPJS PUSTU BKIA

JUMLAH KUNJUNGAN RESEP
202 140 10

DIKETAHUI, YANG MENYERAHKAN

KEPALA DINAS KESEHATAN TAP.TENGAH KEPALA SEKSI KEFARMASIA

NURSYAM, SKM., M.Kes. DESI HOTNIDA, S.Farm.,Ap

NIP. 19690909 199103 2 005 NIP. 19831109 20101 2 02
LEMBAR PERMINTAAN OBAT
TAPANULI TENGAH

LAPORAN BULAN / PERIODE : JULI 2019

PERMINTAAN BULAN / PERIODE : AGUSTUS 2019
PEMAKAIA SISA STOK STOK PERMINTA PEMBERIAN
KET
N OPTIMUM AN DAK PROP JUMLAH
7 8=(6-7) 9 10 11 12 13 14
3 0 0
10 185 100
10 190 0
100 12395 0
0 1 0
0 2 1
0 0 0
310 1280 800
0 90 0
100 0 600
315 0 600
724 488 1500
5 0 100
0 0 0
1470 0 4000
5 0 50
0 7 2
60 20 300
527 43 1500
0 0 200
740 1268 3000
2 2 2
0 0 0
0 35 10
0 0 0
0 70 100
0 676 100
0 0 0
0 1 0
260 0 500
4 0 50
0 0 0
0 4 0
0 0 0
1 3 10
 0 20 30
250 250 200
90 250 200
0 13 10
0 8 50
0 4 0
0 2 0
0 0 100
480 607 1000
6 0 50
945 280 3500
100 490 1000
0 740 100
0 0 0
30 250 0
0 0 0
7 62 50
0 0 1000
0 7 5
22 0 100
0 0 10
6 3 5
468 3501 1000
2 0 50
0 1 2
160 0 1000
0 0 50
0 5 5
1 1 2
0 5 2
220 918 0
230 0 500
0 0 10
130 20 500
0 0 700
0 8 2
0 0 500
95 305 1500
19 55 50
20 58 50
2 2 0
46 86 50
150 0 500
23 0 100
24 0 100
870 0 1500
250 520 400
990 0 1500
0 0 0
0 4 0
0 0 15
13 20 30
0 0 100
0 0 0
0 0 0
0 16 10
2 6 10
0 11 10
3 4 15
750 629 1200
0 1 1
1 1 2
5 20 50
14 9 60
80 445 300
7 2 15
0 0 0
0 6 0
450 0 1000
0 0 0
2 24 10
100 0 500
30 170 300
0 2 0
0 0 0
80 0 300
7 7 10
180 0 300
260 1970 300
5 25 0
0 0 100
6 3 10
0 110 300
0 0 1000
1 1 0
1 1 30
9 24 50
0 0 0
5 26 15
590 190 600
280 170 700
140 190 200
0 0 100
2 2 15
3 37 0
440 0 1000
0 6 2
0 0 0
31 7 100
547 0 2000
0 0 10
30 160 100
0 0 0
1 3 5
0 84 0
814 2361 1000
0 9 0
1 1 3
1 0 30
0 1 2
0 0 200
0 0 0
0 31 10
0 1 0
0 5 0
80 640 200
0 18 15
0 4 0
6 2 50
0 3 0
0 1 5
0 0 5
1494 646 2000
2 80 35
0 23 10
480 200 1000
0 0 0
21 0 60
0 1 0
40 130 0
0 1 0
756 864 2000
0 50 0
0 1 1
1360 867 2500
 0 2 0
0 0 500
0 2 5

LANSIA TDK ADA KARTU JUMLAH

350 10 712

YANG MENYERAHKAN YANG MEMINTA

KEPALA SEKSI KEFARMASIAN PIMPINAN PUSKESMAS

DESI HOTNIDA, S.Farm.,Apt. dr. Marwati

NIP. 19831109 20101 2 028 Nip. 19691221 200212 2 002
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O
PUSKESMAS KAB. TAPANULI TENGAH

PUSKESMAS : BARUS UTARA

KECAMATAN : BARUS UTARA
NO NAMA OBAT SATUAN STOK PENERIMA PERSEDIAA
AWAL AN N
1 2 3 4 5 6 = (4 + 5 )
1 AIR UNTUK INJEKSI BOTOL 0 0 0
2 ALAT SUNTIK DISP. 3 ML SET 185 200 385
3 ALAT SUNTIK DISP. 5 ML SET 190 0 190
4 ALCOHOL SWAB PCS 12395 0 12395
5 ALKACIDE 1 LITER BOTOL 1 0 1
6 ALKAZYME SAK 2 0 2
7 ALKOHOL 70% 1 LITER BOTOL 0 1 1
8 ALOPURINOL 100 MG TABLET 1280 1100 2380
9 AMINOFILIN 150 MGTABLET TABLET 90 0 90
10 AMLODIPIN 10 MG TABLET TABLET 0 0 0
11 AMLODIPIN 5 MG TABLET 0 900 900
12 AMOKSISILIN 500 MG KAPLET 488 2000 2488
13 AMOKSISILIN SYRUP KERING FORTE 250MG/5ML BOTOL 0 0 0
14 AMPHETAMIN CHECK TEST PCS 0 0 0
15 ANTACIDA DOEN I TAB TABLET 0 4000 4000
16 ANTACIDA DOEN II SUSPENSI BOTOL 0 10 10
18 ANTIHEMMOROID SUPP SUPP 7 2 9
19 ASAM ASKORBAT (VIT C) 250 MG TABLET 20 100 120
20 ASAM ASKORBAT (VIT C) 50 MG TABLET 43 600 643
21 ASAM FOLAT (A FOLAT) 0,4 MG TABLET 0 100 100
22 ASAM MEFENAMAT 500 MG TABLET 1268 2500 3768
23 ASAM TRANEKSAMAT INJEKSI AMPUL 2 7 9
24 ASEPTAN BOTOL 0 0 0
25 ASERING BOTOL 35 10 45
26 ASETIL SISTEIN 200 MG KAPSUL 0 0 0
27 ASIKLOVIR TABLET 200 MG TABLET 70 0 70
28 ASIKLOVIR TABLET 400 MG TABLET 676 600 1276
29 ATROPIN INJEKSI 0,35 MG/ ML AMPUL 0 0 0
30 BEROTEC INHALER BOTOL 1 5 6
31 BETAHISTIN TAB 6 MG TABLET 0 300 300
32 BETAMETASON KRIM 0,1% (SBG VALERAT) TUBE 0 0 0
33 BISAKODIL 5 MG TABLET (DULCOLAX) TABLET 0 0 0
34 BISAKODIL SUSP (DULCOLAX SUPP) SUPP 4 0 4
35 BRACKET PCS 0 0 0
36 BURNAZIN (PERAK SULFADIAZIN KRIM 1%) TUBE 3 2 5
37 OSTOVEL (KALSITROL) TABLET 20 30 50
38 CAPTOPRIL 12,5 MG TABLET 250 400 650
39 CAPTOPRIL 25 MG TABLET 250 400 650
40 CATGUT CHROMIC 2/0 PCS 13 5 18
41 CEFADROXIL 250 MG SYRUP SYRUP 8 10 18
42 CEFOTAXIM INJ VIAL 4 0 4
43 CEFTRIAXONE INJ VIAL 2 0 2
44 CETIRIZINE SYRUP BOTOL 0 0 0
45 CETIRIZINE TABLET TABLET 607 500 1107
46 CHLORAMPHENICOL SALEP KULIT 2% (BUFACETIN) TUBE 0 5 5
47 CHLORPHENIRAMIN MALEAT (CTM) TABLET 280 2800 3080
48 CIPROFLOXACIN 500 MG TABLET 490 500 990
49 CLINDAMYCIN 300 MG CAPSUL 740 0 740
50 CLOPIDOGREL TABLET 75 MG TABLET 0 0 0
51 CODEIN 10 MG TABLET 250 0 250
52 CONCOR (BISOPROLOL) 1,25 MG TABLET 0 0 0
53 COTRIMOXAZOLE SUSPENSI BOTOL 62 0 62
54 COTRIMOXAZOLE TABLET DEWASA 480 mg TABLET 0 0 0
55 DARYANT TULE PCS 7 3 10
56 DEKSTROFEN SYRUP BOTOL 0 30 30
57 DENOMIX CREAM 10 GRAM TUBE 0 0 0
58 DEXAMETASONE INJEKSI IV/IM 5MG/ML AMPUL 6 5 11
59 DEXAMETASONE TABLET 0,5 MG TABLET 3501 1000 4501
60 DEXOCORT KRIM TUBE 0 10 10
61 DIAZEPAM LAR.REKTAL (STESOLID) 10MG/2,5ML TUBE 1 0 1
62 DOMPERIDON 10 MG TABLET TABLET 0 300 300
63 DOMPERIDON SYRUP BOTOL 0 0 0
64 EPINEFRIN INJEKSI AMPUL 5 0 5
65 EUGENOL BOTOL 1 2 3
66 FOLLEY CATHETER SET 3 2 5
67 FUROSEMID 40 MG TABLET 918 0 918
68 GARAM ORALIT SAK 0 300 300
69 GENTAMYCIN TETES MATA 0,3% BOTOL 0 0 0
70 GLIBENKLAMIDE 5 MG TAB TABLET 20 200 220
71 GLIMEPIRID 2 MG TABLET 0 0 0
72 GLUKOSA LARUTAN INFUS 5% STERIL BOTOL 5 0 5
73 GRISEOFULVIN 125 MG TAB TABLET 0 700 700
74 GRISEOFULVIN 500 MG TABLET 305 0 305
75 HANDSCHOON NON STERIL L PCS 55 50 105
76 HANDSCHOON NON STERIL M PCS 58 50 108
77 HANDSCHOON OBSGYN PCS 2 2 4
78 HANDSCHOON STERIL PASANG 86 50 136
79 HIDROKLORTIAZID 25 MG TABLET 0 200 200
80 HIDROKORTISON 2,5% KRIM TUBE 0 25 25
81 HUSTAB SIRUP BOTOL 0 40 40
82 HUSTAB TABLET TABLET 0 2400 2400
83 IBUPROFEN 200 MG TABLET TABLET 520 200 720
84 IBUPROFEN 400 MG TABLET TABLET 0 1300 1300
85 IBUPROFEN SUSPENSI BOTOL 50 25 75
86 ILLIADIN (OKSIMETAZOLIN) TETES HIDUNG 0,050% BOTOL 4 2 6
87 INFUSION SET ANAK (PEDIATRIC) PCS 0 0 0
88 INFUSION SET DEWASA SET 20 22 42
89 ISOSORBID DINITRAT 5MG (FASORBID) TABLET 0 0 0
90 IV CATH PEN 18 PCS 0 0 0
91 IV CATH PEN 20 PCS 0 0 0
92 IV TROVENOCATH 18 PCS 16 5 21
93 IV TROVENOCATH 20 PCS 6 5 11
94 IV TROVENOCATH 22 PCS 11 0 11
95 IV TROVENOCATH 24 PCS 4 5 9
96 KALSIUM LAKTAT 500 MG TABLET 0 0 0
97 KAPAS PEMBALUT 250 GRAM PCS 1 1 2
98 KARBOGLISERIN TETES TELINGA 10% BOTOL 1 2 3
99 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL 20 20 40
100 KASSA HIDROFIL STERIL 16X16 KTK 9 20 29
101 KETOKONAZOLE 200 MG TABLET 445 600 1045
102 KETOKONAZOLE KRIM TUBE 2 20 22
103 KETOPROPEN SUPP SUPP 0 0 0
104 KETOROLAC INJEKSI 30 MG/ML AMPUL 6 0 6
105 LANSOPRAZOLE 30 MG KAPSUL 0 800 800
106 LIDOKAIN 2% + EPINEFRIN 1 : 80.000 AMPUL 0 0 0
107 LIDOKAIN INJEKSI 2% (HCL) AMPUL 24 10 34
108 LOPERAMIDE TAB 2 MG TABLET 0 200 200
109 LORATADINE 10 MG TABLET 170 0 170
110 LYSOL 1 LITER BOTOL 2 0 2
111 MARIYUANA RAPID TEST PCS 0 0 0
112 MASKER PCS 0 100 100
113 MEBENDAZOLE 500 MG (VERMOX) TABLET 8 10 18
114 METFORMIN 500 MG TABLET 0 200 200
115 METHYL PREDNISOLON 4 MG TABLET 1970 100 2070
116 METIL ERGOMETRIN INJEKSI 0,2MG/ML AMPUL 25 0 25
117 METIL ERGOMETRIN MALEAT 0,175 MG TABLET 0 100 100
118 METOKLOPAMID DROP BOTOL 3 3 6
119 METOKLOPRAMID 5 MG TABLET TABLET 110 0 110
120 METRONIDAZOLE 500 MG TABLET 0 0 0
121 METRONIDAZOLE OVULA (VAGIZOL) SUPP 2 0 2
122 METRONIDAZOLE SUSPENSI BOTOL 1 2 3
123 MIKONAZOLE KRIM 2% (SBG NITRAT) TUBE 10 GR 24 0 24
124 MINERAL MIX SAK 0 0 0
125 NACL 0,9% LARUTAN INFUS BOTOL 26 10 36
126 NATRIUM DIKLOFENAK 25 MG TABLET 190 500 690
127 NATRIUM DIKLOFENAK 50 MG TABLET 170 200 370
128 NEW ANTIDWTS (ATAPULGIT) TABLET 190 100 290
129 NIFEDIPIN 10 MG TAB TABLET 0 0 0
130 OKSITETRASIKLIN SALEP MATA TUBE 2 2 4
131 OKSITOSIN INJEKSI AMPUL 37 0 37
132 OMEPRAZOLE 20 MG CAPSUL KAPSUL 0 800 800
133 ONDANSETRON INJEKSI 2MG/ ML AMPUL 6 0 6
134 PARACETAMOL DROP 100MG/ML BOTOL 0 2 2
135 PARACETAMOL SYRUP 120MG/5ML BOTOL 7 70 77
136 PARASETAMOL TABLET 500 MG TABLET 0 1100 1100
137 PHYTOMENADION INJEKSI AMPUL 0 0 0
138 PHYTOMENADION TABLET TABLET 160 100 260
139 PIRANTEL PAMOAT 125 MG TABLET TABLET 0 20 20
140 PIRANTEL PAMOAT SUSPENSI 125 MG BOTOL 3 0 3
141 PIRIDOKSIN (VIT B6) INJEKSI AMPUL 84 0 84
142 PIRIDOKSIN (VIT B6) TAB 10 MG (HCL) TABLET 2361 8000 10361
143 PLESTER ISOPLAST 5YARD X 2 INCH ROL 9 0 9
144 PLESTER PHARMAFIX 10 CM X 500 CM ROL 1 1 2
145 PLESTER POLIFIX 5 CM X 1 M ROL 0 0 0
146 POVIDON IODIDA 10% 300 ML BOTOL 1 2 3
147 PREDNISON 5 MG TABLET 0 0 0
148 PULMICORT TURBUHALER 200 TURB 0 0 0
149 RANITIDIN INJEKSI AMPUL 31 10 41
150 RISTONAT 35 MG TABLET 1 0 1
151 SAFETY BOX PCS 5 3 8
152 SALBUTAMOL 4 MG TABLET 640 300 940
153 SALBUTAMOL SYRUP BOTOL 18 0 18
154 SALEP ANTIFUNGI POT 4 2 6
155 SALISIL BEDAK SERBUK 2% SAK 2 2 4
156 SCABIMITE CREAM TUBE 3 0 3
157 SELANG OKSIGEN M PCS 1 0 1
158 SELANG OKSIGEN S PCS 0 0 0
159 SIANOKOBALAMIN (VIT B12) 50 MCG TABLET 646 1500 2146
160 SIANOKOBALAMIN (VIT B12) INJ 500MCG AMPUL 80 30 110
161 SILK BLACK PCS 23 10 33
162 SIMVASTATIN TABLET 10 MG TABLET 200 600 800
163 SOFTAMAN HAND 1 LITER BOTOL 0 0 0
164 SUCRALFAT SUSPENSI ( ULSAFATE) BOTOL 0 40 40
165 SYMBICORT TURBUHALER 180 TURB 1 0 1
166 TABLET TAMBAH DARAH TABLET 130 600 730
167 TETAGAM P. SYRINGE 1 ML AMPUL 1 0 1
168 THIAMIN 50 MG TABLET 864 1500 2364
169 UMBILICAL CORD PCS 50 0 50
170 USG GEL BOTOL 1 1 2
171 VITAMIN B KOMPLEKS TABLET 867 3000 3867
172 XYLOCAINE SPRAY TUBE 2 0 2
173 ZINK TAB DISPERSIBEL 20 MG TABLET 0 0 0
174 CHLORAMPHENICOL SUSPENSI BOTOL 0 0 0

BPJS PUSTU BKIA

JUMLAH KUNJUNGAN RESEP
210 140 10

DIKETAHUI, YANG MENYERAHKAN

KEPALA DINAS KESEHATAN TAP.TENGAH KEPALA SEKSI KEFARMASIAN

NURSYAM, SKM., M.Kes. DESI HOTNIDA, S.Farm.,Apt.

NIP. 19690909 199103 2 005 NIP. 19831109 20101 2 028
N LEMBAR PERMINTAAN OBAT
B. TAPANULI TENGAH

LAPORAN BULAN / PERIODE : AGUSTUS 2019

PERMINTAAN BULAN / PERIODE : SEPTEMBER 2019
PEMAKAIA SISA STOK STOK PERMINTA PEMBERIAN
KET
N OPTIMUM AN DAK PROP JUMLAH
7 8=(6-7) 9 10 11 12 13 14
0 0 0
76 309 100
0 190 0
700 11695 0
1 0 0
0 2 1
0 1 0
2190 190 800
10 80 0
0 0 600
865 35 600
1337 1151 1500
0 0 100
0 0 0
2249 1751 4000
10 0 50
0 9 2
40 80 300
643 0 1500
30 70 200
1460 2308 3000
2 7 2
0 0 0
3 42 10
0 0 0
50 20 100
326 950 100
0 0 0
4 2 0
270 30 500
4 0 50
0 0 0
0 4 0
0 0 0
0 5 10
 0 50 30
480 170 200
330 320 200
0 18 10
10 8 50
0 4 0
0 2 0
0 0 100
1053 54 1000
5 0 50
1656 1424 3500
470 520 1000
300 440 100
0 0 0
0 250 0
0 0 0
27 35 50
0 0 1000
4 6 5
23 7 100
0 0 10
1 10 5
844 3657 1000
5 5 50
0 1 2
300 0 1000
0 0 50
0 5 5
0 3 2
0 5 2
918 0 0
165 135 500
0 0 10
220 0 500
0 0 700
2 3 2
250 450 500
50 255 1500
80 25 50
90 18 50
0 4 0
26 110 50
200 0 500
19 6 100
39 1 100
1328 1072 1500
0 720 400
850 450 1500
49 26 0
0 6 0
0 0 15
14 28 30
0 0 100
0 0 0
0 0 0
0 21 10
0 11 10
11 0 10
8 1 15
0 0 1200
1 1 1
1 2 2
0 40 50
23 6 60
20 1025 300
11 11 15
0 0 0
1 5 0
585 215 1000
0 0 0
1 34 10
190 10 500
100 70 300
0 2 0
0 0 0
100 0 300
1 17 10
200 0 300
1970 100 300
1 24 0
20 80 100
1 5 10
10 100 300
0 0 1000
0 2 0
0 3 30
24 0 50
0 0 0
8 28 15
640 50 600
290 80 700
130 160 200
0 0 100
4 0 15
2 35 0
480 320 1000
2 4 2
2 0 0
34 43 100
1100 0 2000
0 0 10
120 140 100
0 20 0
0 3 5
0 84 0
2922 7439 1000
1 8 0
1 1 3
1 0 30
0 3 2
0 0 200
0 0 0
4 37 10
0 1 0
0 8 0
240 700 200
2 16 15
1 5 0
4 0 50
0 3 0
1 0 5
0 0 5
1280 866 2000
13 97 35
0 33 10
550 250 1000
0 0 0
24 16 60
0 1 0
260 470 0
0 1 0
1644 720 2000
0 50 0
1 1 1
1789 2078 2500
 0 2 0
0 0 500
0 0 5

LANSIA TDK ADA KARTU JUMLAH

350 10 720

YANG MENYERAHKAN YANG MEMINTA

KEPALA SEKSI KEFARMASIAN PIMPINAN PUSKESMAS

DESI HOTNIDA, S.Farm.,Apt. dr. Marwati

NIP. 19831109 20101 2 028 Nip. 19691221 200212 2 002
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS KAB. TAPANULI TENGAH

PUSKESMAS : KALANGAN LAPORAN BULA

KECAMATAN : PANDAN PERMINTAAN B
NO NAMA OBAT SATUAN STOK PENERIMA PERSEDIAAN PEMAKAIAN SISA STOK
AWAL AN
1 2 3 4 5 6 = (4 + 5 ) 7 8=(6-7)
1 AIR UNTUK INJEKSI BOTOL 5 0 5 0 5
2 ALAT SUNTIK DISP. 3 ML SET 113 0 113 37 76
3 ALAT SUNTIK DISP. 5 ML SET 146 0 146 0 146
4 ALCOHOL SWAB PCS 384 0 384 134 250
5 ALKAZYME SAK 1 0 1 0 1
6 ALKOHOL 70% 1 LITER BOTOL 9 0 9 1 8
7 ALOPURINOL 100 MG TABLET 946 0 946 70 876
8 AMINOFILIN 150 MGTABLET TABLET 100 0 100 0 100
9 AMLODIPIN 10 MG TABLET TABLET 384 0 384 70 314
10 AMLODIPIN 5 MG TABLET 738 0 738 147 591
11 AMOKSISILIN 500 MG KAPLET 1645 1000 2645 1098 1547
12 AMOKSISILIN SYRUP KERING FORTE 250MG/5ML BOTOL 48 0 48 12 36
13 ANTACIDA DOEN I TAB TABLET 372 2100 2472 472 2000
14 ANTACIDA DOEN II SUSPENSI BOTOL 29 0 29 18 11
15 ANTIHEMMOROID SUPP SUPP 10 0 10 0 10
16 ASAM ASKORBAT (VIT C) 250 MG TABLET 0 0 0 0 0
17 ASAM ASKORBAT (VIT C) 50 MG TABLET 810 1000 1810 1099 711
18 ASAM FOLAT (A FOLAT) 0,4 MG TABLET 610 0 610 210 400
19 ASAM MEFENAMAT 500 MG TABLET 685 0 685 685 0
20 ASAM TRANEKSAMAT INJEKSI AMPUL 0 0 0 0 0
21 ASEPTAN BOTOL 0 5 5 2 3
22 ASERING BOTOL 7 0 7 0 7
23 ASETIL SISTEIN 200 MG KAPSUL 0 0 0 0 0
24 ASIKLOVIR TABLET 400 MG TABLET 0 0 0 0 0
25 BEROTEC INHALER BOTOL 0 0 0 0 0
26 BETAHISTIN TAB 6 MG TABLET 0 0 0 0 0
27 BETAMETASON KRIM 0,1% (SBG VALERAT) TUBE 0 0 0 0 0
28 BRACKET PCS 0 0 0 0 0
29 BURNAZIN (PERAK SULFADIAZIN KRIM 1%) TUBE 0 0 0 0 0
30 CAPTOPRIL 12,5 MG TABLET 965 0 965 110 855
31 CAPTOPRIL 25 MG TABLET 10 0 10 10 0
32 CATGUT CHROMIC 2/0 PCS 9 0 9 0 9
33 CEFADROXIL 250 MG SYRUP SYRUP 0 0 0 0 0
34 CEFOTAXIM INJ VIAL 0 0 0 0 0
35 CEFTRIAXONE INJ VIAL 0 0 0 0 0
36 CETIRIZINE SYRUP BOTOL 21 0 21 1 20
37 CHLORAMPHENICOL SALEP KULIT 2% (BUFACETIN) TUBE 7 0 7 6 1
38 CHLORPHENIRAMIN MALEAT (CTM) TABLET 518 2000 2518 635 1883
NO NAMA OBAT SATUAN STOK PENERIMA PERSEDIAAN PEMAKAIAN SISA STOK
AWAL AN
1 2 3 4 5 6 = (4 + 5 ) 7 8=(6-7)
39 CIPROFLOXACIN 500 MG TABLET 0 0 0 0 0
40 CLINDAMYCIN 300 MG CAPSUL 20 300 320 50 270
41 CLOPIDOGREL TABLET 75 MG TABLET 0 0 0 0 0
42 CONCOR (BISOPROLOL) 1,25 MG TABLET 0 0 0 0 0
43 COTRIMOXAZOLE SUSPENSI BOTOL 23 0 23 1 22
44 COTRIMOXAZOLE TABLET DEWASA 480 mg TABLET 117 300 417 34 383
45 DEKSTROFEN SYRUP BOTOL 0 0 0 0 0
46 DESOKSIMETASON KRIM TUBE 0 1 1 1 0
47 DEXAMETASONE INJEKSI IV/IM 5MG/ML AMPUL 0 0 0 0 0
48 DEXAMETASONE TABLET 0,5 MG TABLET 0 0 0 0 0
49 DIAZEPAM 4 mg TUBE 10 0 10 0 10
50 DIFENHIDRAMIN INJEKSI AMPUL 2 0 2 2 0
51 DOMPERIDON 10 MG TABLET TABLET 530 0 530 174 356
52 DOMPERIDON SYRUP BOTOL 9 0 9 9 0
53 EPINEFRIN INJEKSI AMPUL 15 0 15 0 15
54 EUGENOL BOTOL 0 0 0 0 0
55 FOLLEY CATHETER SET 0 0 0 0 0
56 FUROSEMID 40 MG TABLET 78 0 78 0 78
57 GARAM ORALIT SAK 77 1800 1877 0 1877
58 GLIBENKLAMIDE 5 MG TAB TABLET 550 0 550 0 550
59 GLIMEPIRID 2 MG TABLET 353 0 353 10 343
60 GLUKOSA LARUTAN INFUS 5% STERIL BOTOL 20 0 20 0 20
61 GRISEOFULVIN 125 MG TAB TABLET 0 0 0 0 0
62 GRISEOFULVIN 500 MG TABLET 0 0 0 0 0
63 HANDSCHOON NON STERIL L PCS 0 500 500 500 0
64 HANDSCHOON NON STERIL M PCS 0 0 0 0 0
65 HANDSCHOON OBSGYN PCS 13 0 13 0 13
66 HANDSCHOON STERIL PASANG 68 0 68 16 52
67 HIDROKLORTIAZID 25 MG TABLET 200 0 200 0 200
68 HIDROKORTISON 2,5% KRIM TUBE 0 0 0 0 0
69 HUSTAB SIRUP BOTOL 0 0 0 0 0
70 HUSTAB TABLET TABLET 0 1200 1200 300 900
71 IBUPROFEN 200 MG TABLET TABLET 0 0 0 0 0
72 IBUPROFEN 400 MG TABLET TABLET 1534 0 1534 316 1218
73 IBUPROFEN SUSPENSI BOTOL 25 0 25 1 24
74 ILLIADIN (OKSIMETAZOLIN) TETES HIDUNG 0,050% BOTOL 0 0 0 0 0
75 INFUSION SET ANAK (PEDIATRIC) PCS 12 0 12 1 11
76 INFUSION SET DEWASA SET 63 0 63 2 61
77 ISOSORBID DINITRAT 5MG (FASORBID) TABLET 0 0 0 0 0
78 IV CATH PEN 18 PCS 9 0 9 0 9
79 IV CATH PEN 20 PCS 8 0 8 0 8
80 IV TROVENOCATH 18 PCS 25 0 25 0 25
81 IV TROVENOCATH 20 PCS 19 0 19 0 19
82 IV TROVENOCATH 22 PCS 26 0 26 0 26
83 IV TROVENOCATH 24 PCS 29 0 29 0 29
84 KALSIUM LAKTAT 500 MG TABLET 587 0 587 250 337
NO NAMA OBAT SATUAN STOK PENERIMA PERSEDIAAN PEMAKAIAN SISA STOK
AWAL AN
1 2 3 4 5 6 = (4 + 5 ) 7 8=(6-7)
85 KAPAS PEMBALUT 250 GRAM PCS 9 0 9 0 9
86 KARBOGLISERIN TETES TELINGA 10% BOTOL 5 0 5 2 3
87 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL 36 0 36 5 31
88 KASSA HIDROFIL STERIL 16X16 KTK 18 20 38 14 24
89 KETOKONAZOLE 200 MG TABLET 0 0 0 0 0
90 KETOKONAZOLE KRIM TUBE 0 0 0 0 0
91 KETOPROPEN SUPP SUPP 0 0 0 0 0
92 KETOROLAC INJEKSI 30 MG/ML AMPUL 0 0 0 0 0
93 KLORAMFENIKOL SALEP MATA TUBE 7 10 17 0 17
94 LANSOPRAZOLE 30 MG KAPSUL 76 0 76 76 0
95 LIDOKAIN 2% + EPINEFRIN 1 : 80.000 AMPUL 30 0 30 0 30
96 LIDOKAIN INJEKSI 2% (HCL) AMPUL 23 0 23 7 16
97 LOPERAMIDE TAB 2 MG TABLET 0 0 0 0 0
98 LORATADINE 10 MG TABLET 184 200 384 81 303
99 LYSOL 1 LITER BOTOL 6 0 6 0 6
100 MASKER PCS 0 0 0 0 0
101 MEBENDAZOLE 500 MG (VERMOX) TABLET 0 0 0 0 0
102 METFORMIN 500 MG TABLET 1713 0 1713 302 1411
103 METHYL PREDNISOLON 4 MG TABLET 330 0 330 247 83
104 METIL ERGOMETRIN INJEKSI 0,2MG/ML AMPUL 0 0 0 0 0
105 METIL ERGOMETRIN MALEAT 0,175 MG TABLET 300 0 300 200 100
106 METOKLOPAMID DROP BOTOL 0 0 0 0 0
107 METOKLOPRAMID 5 MG TABLET TABLET 0 0 0 0 0
108 METRONIDAZOLE 500 MG TABLET 399 0 399 54 345
109 METRONIDAZOLE OVULA (VAGIZOL) SUPP 0 0 0 0 0
110 METRONIDAZOLE SUSPENSI BOTOL 0 0 0 0 0
111 MIKONAZOLE KRIM 2% (SBG NITRAT) TUBE 10 GR 14 0 14 12 2
112 MINERAL MIX SAK 0 0 0 0 0
113 NACL 0,9% LARUTAN INFUS BOTOL 9 0 9 0 9
114 NATRIUM DIKLOFENAK 25 MG TABLET 117 1000 1117 117 1000
115 NATRIUM DIKLOFENAK 50 MG TABLET 0 0 0 0 0
116 NEW ANTIDETS (ATAPULGIT) TABLET 307 0 307 50 257
117 NIFEDIPIN 10 MG TAB/ ADALAT OROS TABLET 0 0 0 0 0
118 OKSITOSIN INJEKSI AMPUL 0 0 0 0 0
119 OMEPRAZOLE 20 MG CAPSUL KAPSUL 0 0 0 0 0
120 ONDANSETRON INJEKSI 2MG/ ML AMPUL 0 0 0 0 0
121 OSTOVEL (KALSITROL) TABLET 0 0 0 0 0
122 PARACETAMOL DROP 100MG/ML BOTOL 0 10 10 7 3
123 PARACETAMOL SYRUP 120MG/5ML BOTOL 19 100 119 59 60
124 PARASETAMOL TABLET 500 MG TABLET 847 2000 2847 993 1854
125 PHYTOMENADION INJEKSI AMPUL 80 0 80 30 50
126 PHYTOMENADION TABLET TABLET 167 0 167 20 147
127 PIRANTEL PAMOAT 125 MG TABLET TABLET 0 0 0 0 0
128 PIRANTEL PAMOAT SUSPENSI 125 MG BOTOL 0 0 0 0 0
129 PIRIDOKSIN (VIT B6) TAB 10 MG (HCL) TABLET 2155 0 2155 177 1978
130 PLESTER ISOPLAST 5YARD X 2 INCH ROL 1 0 1 0 1
NO NAMA OBAT SATUAN STOK PENERIMA PERSEDIAAN PEMAKAIAN SISA STOK
AWAL AN
1 2 3 4 5 6 = (4 + 5 ) 7 8=(6-7)
131 PLESTER PHARMAFIX 10 CM X 500 CM ROL 5 0 5 2 3
132 POVIDON IODIDA 10% 300 ML BOTOL 0 0 0 0 0
133 PREDNISON 5 MG TABLET 0 1000 1000 0 1000
134 RANITIDIN INJEKSI AMPUL 0 0 0 0 0
135 RINGER LAKTAT INFUS BOTOL 15 20 35 2 33
136 RISTONAT 35 MG TABLET 0 0 0 0 0
137 SAFETY BOX PCS 0 0 0 0 0
138 SALBUTAMOL 4 MG TABLET 954 0 954 0 954
139 SALBUTAMOL SYRUP BOTOL 0 0 0 0 0
140 SALEP ANTIFUNGI POT 29 0 29 0 29
141 SCABIMITE CREAM TUBE 0 0 0 0 0
142 SELANG OKSIGEN M PCS 1 0 1 1 0
143 SELANG OKSIGEN S PCS 5 0 5 0 5
144 SIANOKOBALAMIN (VIT B12) 50 MCG TABLET 548 2000 2548 483 2065
145 SIANOKOBALAMIN (VIT B12) INJ 500MCG AMPUL 91 0 91 13 78
146 SILK BLACK PCS 27 0 27 8 19
147 SIMVASTATIN TABLET 10 MG TABLET 0 0 0 0 0
148 SUCRALFAT SUSPENSI ( ULSAFATE) BOTOL 0 0 0 0 0
149 TABLET TAMBAH DARAH TABLET 74 0 74 74 0
150 TETAGAM P. SYRINGE 1 ML AMPUL 3 0 3 0 3
151 THIAMIN 50 MG TABLET 672 0 672 391 281
152 UMBILICAL CORD PCS 630 0 630 0 630
153 USG GEL BOTOL 3 0 3 0 3
154 VITAMIN B KOMPLEKS TABLET 0 3000 3000 800 2200
155 XYLOCAINE SPRAY TUBE 3 0 3 0 3
156 ZINK TAB DISPERSIBEL 20 MG TABLET 324 1000 1324 10 1314
157 ASEPTAN 5 LITER DIRIGEN 1 0 1 0 1
158 KASA PEMBALUT HIDROFIL 4 YARD X 80 CM ROL 2 0 2 0 2
159 DIAZEPAM LAR.REKTAL (STESOLID) 10MG/2,5ML TUBE 12 0 12 0 12
160 MINIASPI/ASETOSAL TABLET 200 0 200 0 200
161 ALKACIDE BOTOL 4 0 4 0 4
162 CETERIZINE TABLET TABLET 561 1000 1561 301 1260
163 MOLAVIR KRIM TUBE 3 3 6 3 3
164 GENTAMISIN TETES MATA BOTOL 1 10 11 2 9
165 OKSITETRASIKLIN SALEP MATA TUBE 24 0 24 0 24

BPJS PUSTU BKIA LANSIA TDK ADA KARTU

JUMLAH KUNJUNGAN RESEP
310 0 0 76 70

DIKETAHUI, YANG MENYERAHKAN

KEPALA DINAS KESEHATAN TAP.TENGAH KEPALA SEKSI KEFARMASIAN

dto
NO NAMA OBAT SATUAN STOK PENERIMA PERSEDIAAN PEMAKAIAN SISA STOK
AWAL AN
1 2 3 4 5 6 = (4 + 5 ) 7 8=(6-7)

NURSYAM, SKM., M.Kes. DESI HOTNIDA, S.Farm.,Apt.

NIP. 19690909 199103 2 005 NIP. 19831109 20101 2 028
N OBAT

AN BULAN / PERIODE : AGUSTUS 2021

NTAAN BULAN / PERIODE : SEPTEMBER 2021
STOK PERMINTA PEMBERIAN
KET
OPTIMUM AN DAK PROP JUMLAH
9 10 11 12 13 14
0 0
44.4 0
0 0
160.8 0
0 0
1.2 0
84 0
0 0
84 0
176.4 0
1317.6 1000
14.4 0
566.4 0
21.6 0
0 0
0 0
1318.8 600
252 0
822 1000
0 10
2.4 5
0 0
0 0
0 200
0 0
0 0
0 10
0 0
0 1
132 0
12 200
0 0
0 0
0 2
0 2
1.2 0
7.2 6
762 1000
 STOK PERMINTA PEMBERIAN
OPTIMUM AN KET
DAK PROP JUMLAH
9 10 11 12 13 14
0 0
60 0
0 0
0 0
1.2 0
40.8 0
0 30
1.2 2
0 0
0 500
0 0
2.4 0
208.8 0
10.8 0 E.D 09/21
0 0
0 0
0 0
0 0
0 0
0 0
12 0
0 0
0 200
0 200
600 600
0 0
0 0
19.2 0
0 0
0 10
0 30
360 0
0 0
379.2 0
1.2 0
0 0
1.2 0
2.4 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
300 500
 STOK PERMINTA PEMBERIAN
OPTIMUM AN KET
DAK PROP JUMLAH
9 10 11 12 13 14
0 0
2.4 0
6 0
16.8 0
0 200
0 10
0 0
0 0
0 0
91.2 500
0 0
8.4 0
0 0
97.2 0
0 0
0 50
0 0
362.4 0
296.4 0
0 0
240 0
0 0
0 0
64.8 0
0 0
0 0
14.4 0
0 0
0 0
140.4 0
0 500
60 0
0 0
0 10
0 0
0 0
0 0
8.4 5
70.8 50
1191.6 700
36 0
24 0
0 0
0 0
212.4 0
0 0
 STOK PERMINTA PEMBERIAN
OPTIMUM AN KET
DAK PROP JUMLAH
9 10 11 12 13 14
2.4 0
0 3
0 0
0 0
2.4 0
0 0
0 0
0 0
0 0
0 0
0 2
1.2 5
0 0
579.6 0
15.6 0
9.6 0
0 500
0 0
88.8 0
0 0
469.2 500
0 0
0 0
960 1000
0 0
12 0
0 0
0 0
0 0
0 0
0 0
361.2 0
3.6 5
2.4 0
0 0

PENGOBATAN LU JUMLAH
20 476

YANG MEMINTA
PIMPINAN PUSKESMAS
 STOK PERMINTA PEMBERIAN
OPTIMUM AN KET
DAK PROP JUMLAH
9 10 11 12 13 14

dr. SYARIFAH SORAYA LUBIS, M.Kes

NIP. 19810930 201001 2 015