LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

PUSKESMAS
PUSKESMAS : MENES
KECAMATAN : MENES
KAB / KOTA : PANDEGLANG PELAPORAN BULAN / PERIODE : AGUSTUS 2021
PROVINSI : BANTEN PERMINTAAN BULAN / PERIODE : SEPTEMBER 2021

Jumlah Stok
N0 NAMA OBAT SATUAN Stok Awal Penerimaan Pemakaian
Persediaan Akhir

1 2 3 4 5 6 7 8
A NAMA OBAT ( 4+5 ) (6-7)
1 Alprazolam Tablet - - - - -
2 Albendazol Tablet 400 mg Tablet - - - - -
3 Allopurinol tablet 100 mg Tablet 700 - 700 - 700
4 Ambroxol sirup Botol - - - - -
5 Ambroxol tablet 30 mg Tablet - - - - -
6 Aminofilin Tablet 200 mg Tablet - - - - -
7 Aminofilina injeksi 24 mg/ml - 10 ml Ampul - - - - -
8 Amlodipin 10 mg Tablet 1,510 - 1,510 730 780
9 Amlodipin Besilate 5 mg Tablet - - - - -
10 Amoksisilin Forte sirup kering 250mg Botol - - - - -
11 Amoksisilin Injeksi 1 gr Vial - - - - -
12 Amoksisilin Tablet 500 mg Tablet 9,340 - 9,340 2,340 7,000
13 Amoksisillin kapsul 250 mg Kapsul - - - - -
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol 600 - 600 50 550
15 Ampisilin Injeksi 1 gr Vial - - - - -
16 Analog insulin Long Acting Pen - - - - -
17 Analog insulin Mix Acting Pen - - - - -
18 Antalgin (Metampiron) tablet 500 mg Tablet - - - - -
19 Antalgin (Metampiron) tablet 500 mg Tablet - - - - -
20 Antasida DOEN suspensi Botol 84 - 84 64 20
21 ANTASIDA DOEN Tablet Tablet 8,480 - 8,480 2,580 5,900
22 Anti Bakteri DOEN ( Bacitrasin ) Tube - - - - -
23 anti hemoroid doen kombinasi supp - - - - -
24 Antifungi DOEN Tube - - - - -
25 Antimigren DOEN Kombinasi : Tablet - - - - -
26 Antiparkinson DOEN tablet Kombinasi : Tablet - - - - -
27 Antiparkinson Tablet ( Levopar ) Tablet - - - - -
28 Aqua Pro Injeksi Vial 60 - 60 5 55
29 Artermeter injeksi Ampul - - - - -
30 Artesunate injeksi 60 mg/ml vial - - - - -
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 6,900 - 6,900 2,390 4,510
32 Asam Asetilsalisilat 80mg Tablet 50 - 50 30 20
33 Asam Folat Botol 500 - 500 100 400
34 Asam Fusidat Cream Tube - - - - -
35 Asam Klorida 0,1 N Botol - - - - -
36 Asam Mefenamat 500 mg Tablet 2,400 - 2,400 300 2,100
37 Asam Traneksamat Inj 5% Ampul - - - - -
38 Asering Botol 400 - 400 229 171
39 Asetosal tablet 500 mg Tablet - - - - -
40 Asetyl Cysteine Capsul - 5,280 5,280 4,520 760
41 Asiklovir Cream 5% Tube - - - - -
42 Asiklovir tablet 200 mg Tablet - - - - -
43 Asiklovir tablet 400 mg Tablet 250 - 250 - 250
44 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul 50 - 50 - 50
45 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Vial - - - - -
46 Atropin Sulfat tablet 0,5 mg Tablet - - - - -
47 Berotec Metered Aerosol 100 mg Bok - - - - -
48 Betadine Salep Antiseptik 5 mg Tube - - - - -
49 Betametason krim 0,1 % Tube - - - - -
50 Bisakodil Suppositoria supp - - - - -
51 Bisoprolol 2,5 mg Tablet - - - - -
52 Bisoprolol 5 mg Tablet - - - - -
53 Cairan Infus KN-3B Botol - - - - -
54 Cairan Infus Wida KDN 1 Botol - - - - -
55 Cairan Pembersih ( Protektor ) Botol - - - - -
56 Captopril Tablet 12,5 mg Tablet - - - - -
57 Captopril Tablet 25 mg Tablet - - - - -
58 Cefadroxil Capsul 500 mg Capsul - - - - -
59 Cefixime Capsul 100 mg Capsul - - - - -
60 Cefixime Sirup Botol - - - - -
61 Cefotaksime 1 gr Injeksi Vial - - - - -
62 Cetirizine Capsul 50 mg Capsul - - - - -
63 Cetirizine sirup 5 mg/5 ml Botol - - - - -
64 Ciprofloxcacin 500 mg tablet Tablet - - - - -
65 Combivent UDV 2,5 mg+0,5mg/2,5 ml Ampul - - - - -
66 D-Artepp tablet Tablet - - - - -
67 Deksametason tablet 0,5 mg Tablet 3,360 - 3,360 2,360 1,000
68 Dekstran 70 - larutan infus 6% steril Botol - - - - -
69 Dekstrometorfan sirup Botol - - - - -
70 Dekstrometorfan tablet 15 mg Tablet - - - - -
71 Diazepam Injeksi Ampul - - - - -
72 Diazepam Rektal 0,5 mg / 2 ml supp 36 - 36 16 20
73 Diazepam tablet 2 mg Tablet - - - - -
74 Diazepam tablet 5 mg Tablet 70 - 70 21 49
75 Difenhidramin HCL injeksi 10 mg/ml - 1ml Ampul 18 - 18 16 2
76 Digoksin tablet 0,25 mg Tablet - - - - -
77 Diltiazem Tablet - - - - -
78 Doksisiklin Kapsul 100 mg Capsul - - - - -
79 Domperidon 10mg Tablet Tablet - - - - -
80 Domperidon Suspensi 5 mg/ 5 ml Botol - - - - -
81 Doxicyclin 500mg capsul - - - - -
82 Efedrin HCLTablet 25 mg Tablet - - - - -
83 Epinefrina HCL/Bitartrat Injeksi Ampul 54 - 54 13 41
84 Eritromicyn kapsul 250 mg capsul - - - - -
85 Erytromicin kapsul 500 mg Kapsul - - - - -
86 Erytromicin sirup 125 mg Botol - - - - -
87 Etakridin ( Rivanol ) larutan 0,1% Botol - - - - -
88 Etambutol 500 mg Tablet - - - - -
89 Etanol 70 % Botol - - - - -
90 Etil Klorida Semprot Botol - - - - -
91 Fenitoin Natrium kapsul 30 mg Kapsul - - - - -
92 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul - - - - -
93 Fenobarbital tablet 30 mg Tablet 126 - 126 - 126
94 Fenoksimetil Penisilina tablet 250 mg Tablet - - - - -
95 Fenol Gliserol tetes telinga 10 % Botol - - - - -
96 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul - - - - -
97 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 100 - 100 100 -
98 Flufenazine Deconat Inj 25 mg/ml Ampul - 20 20 5 16
99 Furosemida tablet 40 mg Tablet - - - - -
100 Furosemide Injeksi Ampul - - - - -
101 Garam Oralit Sachet 175 - 175 - 175
102 Gemfibrozil 300 mg Tablet - - - - -
103 Gentamicin Injeksi Ampul - - - - -
104 Gentamicin Salep Kulit Tube - - - - -
105 Gentamicin Salep mata Tube - - - - -
106 Gentamicin Tetes Mata Botol 18 - 18 18 -
107 Gentian Violet 1 % Botol - - - - -
108 Glibenclamid tablet 5 mg Tablet 200 - 200 - 200
109 Glicerin Guaiacolat ( GG ) 100 mg Tablet - - - - -
110 Glikazid 80 mg Tablet Tablet - - - - -
111 Glimepiride 2 mg Tablet 200 500 700 100 600
112 Glukosa larutan infus 10% steril Botol - - - - -
113 Glukosa larutan infus 5 % steril Botol - - - - -
114 Good Life Vit C 1000mg Kotak 37 - 37 1 36
115 Griseofulvin tablet 500 mg, Tablet - - - - -
116 Guaiafenesin 100 mg Tablet - - - - -
117 Hidroklortiniazid ( HCT )Tab.25 mg Tablet 500 - 500 - 500
118 Hidrokortison krim 2,5% Tube 72 48 120 72 48
119 Ibuprofen Suspensi Tablet - - - - -
120 Ibuprofen tablet 200 mg Tablet - - - - -
121 Ibuprofen tablet 400 mg Tablet - - - - -
122 Imunomodulator sirup( STIMUNO) Botol - - - - -
123 Isosorbid Dinitrat tablet sublingual 5 mg Tablet 300 - 300 - 300
124 Kalsium Glukonas Injeksi Ampul 72 - 72 - 72
125 Kalsium Laktat (Kalk) tablet 500 mg Tablet 1,900 1,000 2,900 2,200 700
126 Kapas Berlemak 500 mg Bungkus - - - - -
127 Karbogliserin Tetes Telinga Botol 48 - 48 24 24
128 Ketokonazol Kream Tube - - - - -
129 Ketokonazol Tablet 200 mg Tablet - - - - -
130 Ketorolac inj Ampul 85 - 85 25 60
131 Kifadene tablet 20 mg Tablet - - - - -
132 Kloramfenikol salep kulit Tube 96 48 144 24 120
133 Kloramfenikol salep mata 1 % capsul - - - - -
134 Kloramfenikol suspensi Botol - - - - -
135 Kloramfenikol tetes telinga 3% Tube - - - - -
136 Kloramphenicol 250 mg Capsul - - - - -
137 Kloramphenicol 500 mg capsul 100 - 100 - 100
138 Kloramphenicol Tetes Mata Botol - - - - -
139 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet - - - - -
140 Klorokuin tablet 150 mg Tablet - - - - -
141 Klorpromazin HCL tablet salut 25 mg Tablet - - - - -
142 Kombinasi (Pirimetamin 25 mg + Solfadoxin Tablet - - - - -
143 Kotrimoksazol Dewasa Tablet 480 mg Tablet 1,100 - 1,100 300 800
144 Kotrimoksazol Sirup / Suspensi Botol 98 - 98 36 62
145 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul - - - - -
146 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol - - - - -
147 Lactobacilus serbuk Sachet - - - - -
148 Lidocain 2%+efinefrin injeksi Ampul 200 - 200 - 200
149 Lidocain injeksi 2 ml Ampul 100 - 100 - 100
150 Lisinopril 10 mg tablet Tablet - - - - -
151 Lisinopril 5 mg tablet Tablet - - - - -
152 Loperamid 4 mg tablet Tablet 1,750 - 1,750 210 1,540
153 Lytacur Sirup Botol - - - - -
154 Magnesium Sulfat Inj. 25 ml Ampul - - - - -
155 Metamizol 500 mg Tablet - - - - -
156 Metformin 500 mg Tablet Tablet - - - - -
157 Methilprednisolon tablet 8 mg Tablet - - - - -
158 Metilergometrin Maleat injeksi 1 ml Ampul - - - - -
159 Metilergometrin Maleat Tablet Tablet 90 - 90 - 90
160 Methisoprinol 500mg Phapros Tablet 500 - 500 - 500
161 Metoklopramid Suspensi Botol - - - - -
162 Metoklopramid tablet Tablet - - - - -
163 Metronidazol 500 mg Tablet - - - - -
164 Metronidazol infus / injeksi Botol - - - - -
165 Metronidazol Ovula supp - - - - -
166 Metronidazol suspensi Botol - - - - -
167 Mikonazol kream Tube 56 - 56 10 46
168 Multivitamin Anak Sirup Botol - - - - -
169 Multivitamin Anak Sirup / Stimuno Syr (BANKEU) Botol 80 - 80 21 59
170 Multivitamin Dewasa Antioksidan ( Becom c ) Tablet - - - - -
171 Multivitamin Dewasa (HB Vit) Box 23 - 23 - 23
172 Multivitamin Dewasa / OXYVIT (BANKEU) Box 21 - 21 2 19
173 Natrium Diklofenak 25 mg Tablet Tablet - - - - -
174 Natrium Diklofenak 50 mg Tablet Tablet 4,200 - 4,200 - 4,200
175 Natrium Klorida Cairan Infus ( NaCL ) Botol 300 - 300 170 130
176 Nifedipine Tablet 10 mg Tablet - - - - -
177 Nistatin tablet vaginal 100.000 IU/g Tube 177 - 177 - 177
178 Obat anti Diare suspensi Botol - - - - -
179 Obat Anti Diare Tablet (Akita / Molagit ) Tablet - - - - -
180 Obat Batuk Flu ( Molexflu ) Tablet - - - - -
181 Obat Batuk Hitam (OBH) Botol - - - - -
182 Obat Batuk Sirup Herbal ( Herbacop ) Botol - - - - -
183 Ofloxsacin Tetes Telinga Tube - - - - -
184 Oksitetrasiklin HCL salep mata 1% Botol 418 - 418 49 369
185 Oksitosin injeksi 10 IU/ml - 1 ml Ampul - - - - -
186 Omeprazol injeksi Ampul - - - - -
187 Omeprazol Kapsul 20 mg capsul - - - - -
188 Ondancentron injeksi 4 mg Ampul - - - - -
189 Ondancentron Tablet4 mg Tablet - - - - -
190 Paracetamol Drop 15 ml Botol 43 - 43 19 24
191 Paracetamol Sirup 120 mg/5 ml Botol 661 - 661 184 477
192 Parafin Dresing ( Bioplacenton Tull ) pcs - - - - -
193 Parasetamol tablet 100 mg Tablet - - - - -
194 Parasetamol tablet 500 mg Tablet 5,150 - 5,150 5,150 -
195 Permetrin Krim 5 % Tube - - - - -
196 Pirantel Sirup Botol - - - - -
197 Pirantel tablet 125 mg Tablet - - - - -
198 Pirazinamid Botol - - - - -
199 Piridoksin HCL (VIT B6) tablet 10mg Botol 1,370 1,000 2,370 1,300 1,070
200 Piroksikam tablet 20 mg Tablet - - - - -
201 Polikresulen Tube - - - - -
202 Povidon lodida 10% 300 ml - - - - -
203 Povidon lodida 10% 60 ml Tablet - - - - -
204 Prazikuantel tablet 600 mg Botol - - - - -
205 Prednison Tablet 5 mg Tablet 2,600 - 2,600 300 2,300
206 Primakuin 15 mg Tablet - - - - -
207 Probenesid 500 mg tablet Tablet - - - - -
208 Prokain Benzil Penisilin 3 juta IU/vial injeksi Ampul - - - - -
209 Propanolol HCL tablet 10 mg Tablet - - - - -
210 Ranitidin injeksi Ampul - - - - -
211 Ranitidin tablet Tablet - - - - -
212 Resperidone 2 mg tablet Tablet - - - - -
213 Ringer Laktat cairan infus (Otsuka) Botol - - - - -
214 Ringer Laktat cairan infus (Widatra) Botol - - - - -
215 Ringer Laktat (2020) Botol 400 - 400 320 80
216 Rivanol 300 ml Botol - - - - -
217 Salbutamol Tablet 2 mg Tablet 1,320 - 1,320 220 1,100
218 Salbutamol tablet 4mg Tablet - - - - -
219 Salep 2-4 Tube - - - - -
220 Salep kombinasi cream ( Berloson ) Tube - - - - -
221 Salicil bedak Kotak - - - - -
222 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial 8 - 8 4 4
223 Serum Anti Tetanus inj 1500 IU ( Tetagam ) Vial 10 - 10 7 3
224 Sianokobalamin Injeksi Ampul - - - - -
225 Simvastatin 10 mg tablet Tablet - - - - -
226 Simvastatin 20 mg tablet Tablet 340 - 340 290 50
227 Sukralfat Suspensi Botol - - - - -
228 Sukralfat tablet 500 mg Tablet - - - - -
229 Suspensi Seng Insulin inj.40 IU/ml - 10 ml Tube - - - - -
230 Temporary Stopping Fletcher serbuk & cairan Tablet - - - - -
231 Tetrakain HCL tetes mata 0,5% Tube - - - - -
232 Tetrasiklin 250 mg capsul capsul - - - - -
233 Tetrasiklin 500 mg capsul capsul - - - - -
234 Tiamin Tablet 50 mg ( B1 ) Tablet - - - - -
235 Ventolin Nebulizer Ampul - - - - -
236 Vitamin B komplek Tablet 6,500 3,000 9,500 2,700 6,800
237 Zink sirup Botol - - - - -
238 Zink tablet 20 mg Tablet 970 2,000 2,970 490 2,480

OBAT PROGRAM
1 Albendazol Tablet 400 mg Tablet 6,720 - 6,720 - 6,720
2 Isoniazid Tablet 100 mg Tablet - - - - -
3 Obat Antituberkulosis kategori 1 Paket - 32 32 - 32
4 Obat Antituberkulosis Kategori 2 Paket 2 4 6 - 6
5 Obat Antituberkulosis Kategori Anak Paket - 2 2 - 2
6 Pot Dahak Non Steril Biji - - - - -
7 Pot Dahak Steril Biji - - - - -
8 Reagen Ziehl Neelsen Kit - - - - -
9 MDT MB Anak Tablet Tablet - - - - -
10 MDT MB Dewasa Tablet Tablet - - - - -
11 MDT PB Dewasa Tablet Tablet - - - - -
12 MDT PB Anak Tablet Tablet - - - - -
13 Retinol (Vitamin A) kapsul 200.000 IU capsul - - - - -
14 Retinol (Vitamin A) kapsul 100.000 IU capsul - - - - -
15 Tablet Penambah Darah ( FE ) Tablet 85,000 - 85,000 13,180 71,820
16 Amitriptilin tablet 25 mg Tablet - 300 300 30 270
17 Carbamazepin 200 mg tablet Tablet - - - - -
18 Clobazam 10 mg Tablet Tablet 219 - 219 - 219
19 Clozapine 25 mg Tablet Tablet - 100 100 - 100
20 Fenitoin Natrium kapsul 30 mg capsul - - - - -
21 Haloperidol 1,5 mg Tablet Tablet - - - - -
22 Haloperidol 2 mg tablet Tablet 722 200 922 365 557
23 Haloperidol 5 mg Tablet Tablet 923 500 1,423 670 753
24 Haloperidol Injeksi Ampul - - - - -
25 INH 100mg Tablet 100 - 100 - 100
26 Klorpromazin HCL tablet salut 100 mg Tablet 931 500 1,431 675 756
27 Klorpromazine Tablet 25 mg Tablet - - - - -
28 Triheksilfenidil Hcl 2 mg tablet Tablet 510 1,000 1,510 738 772
29 Resperidone 2mg tablet Tablet 314 300 614 427 187

B NAMA BAHAN MEDIS HABIS PAKAI (BMHP )

1 Alat suntik 1 ml Pcs 373 - 373 343 30

2 Alat suntik 10 ml Pcs - - - - -
3 Alat suntik 2,5 ml Pcs - - - - -
4 Alat suntik 20 ml Pcs - - - - -
5 Alat suntik 3 cc (Remedi) - - - - -
6 Alat suntik 3 ml Pcs 1,404 - 1,404 504 900
7 Alat suntik 3 ml (Program) Box 9 - 9 - 9
8 Alat suntik 5 ml pcs 626 - 626 70 556
9 Alkazide 1 L High Level Desinfectant Botol - - - - -
10 Alkazyme Sachet 25 mg Pack - - - - -
11 Alkohol 70 % 1 L Botol - - - - -
12 Alkohol swab Sachet 9 5 14 5 9
13 Anti Septik Hand Rub Botol - - - - -
14 Anti Septik Surgikal Hand Scrub Botol - - - - -
15 Cat Gut no 2/0 Sachet - - - - -
16 Cat Gut no 3/0 Sachet - - - - -
17 Cat Gut No 3/0 (24 mm) Sachet - - - - -
18 Cat Gut No 3/0 (26 mm) Sachet - - - - -
19 Cathetter Jelly Biji - - - - -
20 Demetech Silk 3/0 Set - - - - -
21 E Care I.V Dresing Pcs 247 - 247 - 247
22 E-Care Surgical Mask Tie On Lembar - - - - -
23 Face Drager (COVID) Pcs 3 - 3 - 3
24 Face Drager (BANKEU) Unit 3 - 3 - 3
25 Face Shielld (BANKEU2) Pcs 40 - 40 - 40
26 Folly No 14 Catether pcs - - - - -
27 Folly No 16 Catether pcs 40 - 40 1 39
28 Forehead Thermometer Microlife (DID) Unit - - - - -
29 Handsanitizer 5L (BANKEU) Galon 14 - 14 - 14
30 Hazmat Protect U Coverall (BANKEU) Pcs 170 - 170 - 170
31 I.V Cathetter No. 20 Set 135 - 135 10 125
32 I.V Cathetter No. 22 Set 155 - 155 61 94
33 I.V Cathetter No. 24 Set 80 - 80 10 70
34 I.V Cathetter No. 26 Set - - - - -
35 Infuset Anak Set 144 - 144 25 119
36 Infuset Dewasa Set 100 50 150 7 143
37 Jarum Insulin Tablet - - - - -
38 Kantong Jenazah (CSR BJB) Buah 3 - 3 - 3
39 Kantong Jenazah (BANKEU) Buah 5 - 5 - 5
40 Kapas Berlemak 250 gr Bungkus 8 - 8 1 7
41 Kapas Berlemak 500 gr Bungkus - - - - -
42 Kasa 4 m x 10 cm Rol - - - - -
43 Kasa 3 m x 15 cm Rol 80 - 80 45 35
44 Kasa Hidrofil 36 x 80 cm Rol - - - - -
45 Kasa Hidrofil 40 x 80 cm Rol 3 - 3 - 3
46 Kasa Pembalut 2 x 80 cm Pack - - - - -
47 Kasa Steril 16 x 16 cm Kotak 60 60 120 70 50
48 Lisol 1 L Botol - - - - -
49 Masker Bedah 3ply (BANKEU) Box - - - - -
50 Masker KN95 (PROV) Pcs 80 - 80 - 80
51 Masker N95 (CSR BJB) Pcs - - - - -
52 Masker N95 (BANKEU) Pcs 30 - 30 - 30
53 Masker N95 (PROV) Pcs 180 - 180 80 100
54 Masker karet Ear Loop Lembar - - - - -
55 Masker tali Tube - - - - -
56 Nasal Canula Oksigen Set - - - - -
57 Nasal Canula Oksigen Anak Pcs 50 - 50 5 45
58 Nasal Canula Oksigen Dewasa Pcs 50 - 50 13 37
59 Plester 1" Rol - - - - -
60 Plester Kertas 2,5 cm Rol - - - - -
61 Plester Kertas 1,25 cm x 9,14 cm Rol 59 12 71 32 39
62 Plester Non Woven 5cm x 5 cm Rol - - - - -
63 Policlean Botol 9 - 9 2 7
64 Polifik Kotak - - - - -
65 Saraya Alsof A 500 ml Botol - - - - -
66 Saraya Alsof Pure 500 ml Botol - - - - -
67 Sarung Tangan Gynecolog No 7 Pasang 50 - 50 6 44
68 Sarung Tangan Gynecolog No 7 (BANKEU) Pasang 16 - 16 10 6
69 Sarung tangan M (Non Steril) Pasang - - - - -
70 Sarung tangan no 6,5 Pasang - - - - -
71 Sarung tangan no 6,5 Steril Gloves Pasang 200 200 400 - 400
72 Sarung tangan no 7,0 Steril Pasang - - - - -
73 Sarung tangan Steril Panjang (CSR BJB) Pasang 8 - 8 - 8
74 Sepatu Boots (CSR BJB) Pasang 10 - 10 - 10
75 Silk Black 3/0 26mm Sachet 96 - 96 18 78
76 Selang Section ( Surgikal Conection Tube with yankauer) Pcs - - - - -
77 Underpad Lembar 140 - 140 - 140
78 Urine Bag Biji 70 - 70 5 65

NAMA OBAT VAKSIN

1 Vaksin Anti Rabies ( VAR ) Vial - - - - -

2 Vaksin BCG Vial - - - - -
3 Vaksin DT Vial - - - - -
4 Vaksin HB 0 Pcs - - - - -
5 Vaksin HBIG Vial - - - - -
6 Vaksin Measless Rubella (MR) Vial - - - - -
7 Vaksin Pentabio ( DPT - HB - Hib ) Vial - - - - -
8 Vaksin Polio B OPV Vial - - - - -
9 Vaksin Polio IPV Vial - - - - -
10 Vaksin TD Vial - - - - -
11 Vaksin Tuberculin Vial - - - - -
12 ADS 0,005 ml Unit - - - - -
13 ADS 0,5 ml Unit - - - - -
14 ADS 5 ml Unit - - - - -
15 Safety Box Unit - - - - -

NAMA OBAT REAGEN

1 Albumin (Reagen) Kotak - - - - -

2 anti A Monoclonal ( GolDar 10 ml) Vial - - - - -
3 Anti A-B Monoclonal ( GolDar 10 ml) Vial - - - - -
4 Anti B Monoclonal ( GolDar 10ml) Vial - - - - -
5 Anti D Monoclonal ( GolGar 10ml) Vial - - - - -
6 Benecheck Plus Cholesterol Test Strip - - - - -
7 Benecheck Plus Glukosa Test Strip - - - - -
8 Benecheck Plus Uric Test Strip - - - - -
9 Bilirubin T/D (Reagen) Kotak - - - - -
10 Brilian Green Bile Broth Kotak - - - - -
11 Cellclean (CL-50) (Reagen) Kotak - - - - -
12 Cellpack (PK-30L) (Reagen) Kotak - - - - -
13 Chikungunya IgM (Reagen) Kotak - - - - -
14 Cholesterol (Reagen) Kotak - - - - -
15 Cholesterol Stik (Reagen) Kotak - - - - -
16 CK-MB (Reagen) Kotak - - - - -
17 Creatinin Reagen Kit - - - - -
18 Dengue IgM / IgM ( Reagen ) Kotak - - - - -
19 Eight Check ( LNH ) Serial - - - - -
20 Febrile Antingen H Parathpy Vial - - - - -
21 Febrile Antingen H-A Parathpy Vial - - - - -
22 Febrile Antingen H-B Parathpy Vial - - - - -
23 Febrile Antingen H-C Parathpy Vial - - - - -
24 Febrile Antingen O Parathpy Vial - - - - -
25 Febrile Antingen O-A Parathpy Vial - - - - -
26 Febrile Antingen O-B Parathpy Vial - - - - -
27 Febrile Antingen O-C Parathpy Vial - - - - -
28 Glukosa Reagen Kotak - - - - -
29 GOT ( ALAT ) Kotak - - - - -
30 GPT ( ALAT ) Kotak - - - - -
31 HBSAG Reagen Box - - - - -
32 HCG Strip Vial - - - - -
33 HDL Cholesterol ( Precipitan ) Kotak - - - - -
34 Hematologi Calibrator (Nscs 1000 ) Botol - - - - -
35 Hemoglobin Reagen Kotak - - - - -
36 Lactose Broth 500 mg Botol - - - - -
37 LDL Cholesterol Kotak - - - - -
38 Leptospira IgM (Reagen) Kotak - - - - -
39 Micropippets MT-1-up to 200 ui Pcs - - - - -
40 MIcropippets MT-up to 1 ml Pcs - - - - -
41 NS1 Antigen Test (Reagen) Kotak - - - - -
42 Pipet Ukur 10 ml biji - - - - -
43 Poch Pack D (II) Reagen Kotak - - - - -
44 Poch Pack L (II) Reagen Kotak - - - - -
45 Stik Uric Acid Kotak - - - - -
46 Strip Narkoba 3 Parameter Kotak - - - - -
47 Strip Narkoba 5 Parameter Kotak - - - - -
48 Strip Narkoba 6 Parameter Kotak - - - - -
49 Total Protein Kotak - - - - -
50 Trigleserida Kotak - - - - -
51 Urea Kotak - - - - -
52 Uric Acid Kotak - - - - -

NAMA OBAT REAGEN PROGRAM HIV

1 Rapid 1 HIV (SD Bioline ) Tes - - - - -
2 Rapid 2 HIV (Fokus ) Tes - - - - -
3 Rapid 3 HIV (Biomeriux Vikia ) Tes - - - - -
4 SD Biosensore Standart Q Syphlis Tes - - - - -
5 RPR Syphlis ( Fokus ) Tes - - - - -
6 Reagen CD4 Control Tes - - - - -
7 Reagen CD4 Mobile Tes - - - - -
8 RPR Syphlis Komponen Kit - - - - -
9 Anuscopy Buah - - - - -
10 Kertas PH Indikator Buah - - - - -
11 Rotator Buah - - - - -
12 Tip. Uk.60 Bks - - - - -
13 Tip. Uk.61 Bks - - - - -
14 Pronto / Holder Buah - - - - -

NAMA OBAT GIGI

1 Anastesi Citojek Box - - - - -

 2 Articulating Paper (Kertas warna penanda oklusi) Kotak - - - - -
3 Bahan Tumpatan sementara Botol - - - - -
4 Bonding Syringe 2 - 2 - 2
5 Cairan Desinfectan ( Perendaman Instrumen Gigi ) Botol - - - - -
6 Cairan untuk desinfectan pembersih permukaan Botol - - - - -
7 Carpule Citojek Kotak 4 - 4 - 4
8 Chlorfeson Kamfer menthol ( CHKM ) Cairan Botol - - - - -
9 Composite Nanohibrid A1 Tube 1 - 1 - 1
10 Composite Nanohibrid A2 Tube - - - - -
11 Composite Nanohibrid A3 Tube - - - - -
12 Composite Nanohibrid A3,5 Tube - - - - -
13 Devitalisasi Pasta Pot - - - - -
14 Devitalisasi Pulpa Pak 1 - 1 - 1
15 Disclosing Solution Botol - - - - -
16 Etcing Gel Pcs - - - - -
17 Etil Klorida Semprot Botol - - - - -
18 Eugenol Cairan Botol - - - - -
19 Formokesol Botol - - - - -
20 Gas Powred Jet Injector Botol 8 - 8 - 8
21 Glass Ionomer Cement ART Pot - - - - -
22 Glass Ionomer Cement Fuji 9 Pak 2 - 2 - 2
23 Jarum citojek uk 16 mm Box - - - - -
24 Kalsium Hidroksida pasta Botol - - - - -
25 Klorhekdidin Larutan 2 % Botol - - - - -
26 Mummifiying Fasta Botol - - - - -
27 Natrium Hipoklorit airan konsentrat 5% Botol - - - - -
28 Paper Points 15-40 mm Box - - - - -
29 Pasta Devitalisasi ( Non Arsen ) Tube - - - - -
30 Pasta Pengisi Saluran Akar Syringe - - - - -
31 Semen seng Fosfat serbuk Set - - - - -
32 Spon Gelatin Cubicis 1x1x1 cm (Spongostan) Botol - - - - -
33 Temporary Filling Fasta Set - - - - -
34 Temporary Restorative Hydraulic CAVITON white Pak 2 - 2 - 2
35 Tooth Stain Remover ( TSR ) Botol - - - - -
36 Wipes Desinfektan Botol - - - - -
 RAWAT
JUMLAH KUNJUNGAN PUSKESMAS JALAN
RAWAT INAP JUMLAH

UMUM / BAYAR 0
UMUM / TIDAK BAYAR 0
JKN 0
TOTAL KUNJUNGAN 0

Mengetahui / Menyetujui
KEPALA DINAS KESEHATAN YANG MENYERAHKAN YANG MEMINTA
KABUPATEN PANDEGLANG KEPALA UPT. GUDANG FARMASI KEPALA PUSKESMAS

………………………………………… …………………………………………………… Hj. NONOK NATAESAH,

NIP. NIP. NIP. 19680508 198703
PERMINTAAN OBAT ( LPLPO )
S
DOKUMEN NOMOR TANGGAL
DINKES KAB/KOTA
GFK KAB/KOTA
PUSKESMAS

Jumlah PEMBERIAN
Stok
Perminta BUFFER JUMLAH
Optimum APBD II JKN PROG LAIN LAIN
an STOK

9 10 11 12 13 14 15 16

-
-
-
-
-
-
-
876
- 1200
-
-
2,808
-
60
-
-
-
-
-
77
3,096
-
-
-
-
-
-
6
-
-
2,868
36 100
120
-
-
360
- 10
275
-
5,424 2640
-
-
-
-
-
-
-
 - 10
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
2,832 1000
-
-
-
- 50
19
-
25
19 20
-
-
-
-
-
-
-
16 100
-
-
-
-
-
-
-
-
-
-
-
-
-
120 200
6
-
-
-
-
-
-
-
22 24
-
 -
-
-
120
-
-
1
-
-
-
86 48
-
-
-
-
-
-
2,640 3000
-
29
-
-
30 100
-
29
-
-
-
-
-
-
-
-
-
-
360
43
-
-
-
-
-
-
-
252
-
-
-
- 2000
-
-
-
-
-
-
-
-
-
-
12
 - 50
25 50
-
-
2
-
-
204
-
-
-
-
-
-
-
-
59
-
-
-
-
-
23 100
221
-
-
6,180
-
-
-
-
1,560 1000
-
-
-
-
-
360
-
-
-
-
-
-
-
-
-
384 100
-
264
-
-
-
-
5 10
8 10
-
- 500
348 500
-
 -
-
-
-
-
-
-
-
3,240
-
588

-
-
-
-
-
-
-
-
-
-
-
-
-
-
15,816
36
-
-
-
-
-
438
804
-
-
810
-
886
512

412 500
-
-
-
-
605 600
-
84
-
-
-
6 10
 -
-
-
-
-
-
-
-
-
-
-
-
-
- 20
1
- 2
-
-
12
73 100
12 100
-
30
8
-
-
-
1
-
-
54 100
-
-
-
84 100
-
-
-
-
-
96
-
-
-
6
16
-
-
38 36
-
2 5
-
-
-
7
12
-
-
- 300
-
 -
-
22
-
-
6

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-

-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
 Harap Dilampirkan : 1. LB 1

2. Lap. Psikotropika & Narkotika

3. Lap. Pemakaian Serum ABU
4. Lap. 20 Pemakaian Obat Terbanyak

YANG MEMINTA YANG MEMINTA :

KEPALA PUSKESMAS PETUGAS OBAT PUSKESMAS

Hj. NONOK NATAESAH, SKM RD. ISTI YULISTINA, S.Far Apt

NIP. 19680508 198703 2 001 NIP. 19840717 200604 2 017
 LAPORAN PEMAKAIAN DAN LEMBA
PUSKES
PUSKESMAS : MENES
KECAMATAN : MENES
KAB / KOTA : MENES PELAPORAN BULAN / PERIODE
PROVINSI : MENES

Penerimaan
Stok
N0 NAMA OBAT SATUAN
Awal DAK
1 2 3 4 5

1 Alprazolam Tablet
2 Albendazol Tablet 400 mg Tablet
3 Allopurinol tablet 100 mg Tablet 700
4 Ambroxol sirup Botol
5 Ambroxol tablet 30 mg Tablet
6 Aminofilin Tablet 200 mg Tablet
7 Aminofilina injeksi 24 mg/ml - 10 ml Ampul
8 Amlodipin 10 mg Tablet 1,510
9 Amlodipin Besilate 5 mg Tablet
10 Amoksisilin Forte sirup kering 250mg Botol
11 Amoksisilin Injeksi 1 gr Vial
12 Amoksisilin Tablet 500 mg Tablet 9,340
13 Amoksisillin kapsul 250 mg Kapsul
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol 600
15 Ampisilin Injeksi 1 gr Vial
16 Analog insulin Long Acting Pen
17 Analog insulin Mix Acting Pen
18 Antalgin (Metampiron) tablet 500 mg Tablet
19 Antalgin (Metampiron) tablet 500 mg Tablet
20 Antasida DOEN suspensi Botol 84
21 ANTASIDA DOEN Tablet Tablet 8,480
22 Anti Bakteri DOEN ( Bacitrasin ) Tube
23 anti hemoroid doen kombinasi supp
24 Antifungi DOEN Tube
25 Antimigren DOEN Kombinasi : Tablet
26 Antiparkinson DOEN tablet Kombinasi : Tablet
27 Antiparkinson Tablet ( Levopar ) Tablet
28 Aqua Pro Injeksi Vial 60
29 Artermeter injeksi Ampul
30 Artesunate injeksi 60 mg/ml vial
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 6,900
32 Asam Asetilsalisilat 80mg Tablet 50
33 Asam Folat Botol 500
34 Asam Fusidat Cream Tube
35 Asam Klorida 0,1 N Botol
36 Asam Mefenamat 500 mg Tablet 2,400
37 Asam Traneksamat Inj 5% Ampul
38 Asering Botol 400
39 Asetosal tablet 500 mg Tablet
40 Asetyl Cysteine Capsul 5,280
41 Asiklovir Cream 5% Tube
42 Asiklovir tablet 200 mg Tablet
43 Asiklovir tablet 400 mg Tablet 250
44 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul 50
45 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Vial
46 Atropin Sulfat tablet 0,5 mg Tablet
47 Berotec Metered Aerosol 100 mg Bok
48 Betadine Salep Antiseptik 5 mg Tube
49 Betametason krim 0,1 % Tube
50 Bisakodil Suppositoria supp
51 Bisoprolol 2,5 mg Tablet
52 Bisoprolol 5 mg Tablet
53 Cairan Infus KN-3B Botol
54 Cairan Infus Wida KDN 1 Botol
55 Cairan Pembersih ( Protektor ) Botol
56 Captopril Tablet 12,5 mg Tablet
57 Captopril Tablet 25 mg Tablet
58 Cefadroxil Capsul 500 mg Capsul
59 Cefixime Capsul 100 mg Capsul
60 Cefixime Sirup Botol
61 Cefotaksime 1 gr Injeksi Vial
62 Cetirizine Capsul 50 mg Capsul
63 Cetirizine sirup 5 mg/5 ml Botol
64 Ciprofloxcacin 500 mg tablet Tablet
65 Combivent UDV 2,5 mg+0,5mg/2,5 ml Ampul
66 D-Artepp tablet Tablet
67 Deksametason tablet 0,5 mg Tablet 3,360
68 Dekstran 70 - larutan infus 6% steril Botol
69 Dekstrometorfan sirup Botol
70 Dekstrometorfan tablet 15 mg Tablet
71 Diazepam Injeksi Ampul
72 Diazepam Rektal 0,5 mg / 2 ml supp 36
73 Diazepam tablet 2 mg Tablet
74 Diazepam tablet 5 mg Tablet 70
75 Difenhidramin HCL injeksi 10 mg/ml - 1ml Ampul 18
76 Digoksin tablet 0,25 mg Tablet
77 Diltiazem Tablet
78 Doksisiklin Kapsul 100 mg Capsul
79 Domperidon 10mg Tablet Tablet
80 Domperidon Suspensi 5 mg/ 5 ml Botol
81 Doxicyclin 500mg capsul
82 Efedrin HCLTablet 25 mg Tablet
83 Epinefrina HCL/Bitartrat Injeksi Ampul 54
84 Eritromicyn kapsul 250 mg capsul
85 Erytromicin kapsul 500 mg Kapsul
86 Erytromicin sirup 125 mg Botol
87 Etakridin ( Rivanol ) larutan 0,1% Botol
88 Etambutol 500 mg Tablet
89 Etanol 70 % Botol
90 Etil Klorida Semprot Botol
91 Fenitoin Natrium kapsul 30 mg Kapsul
92 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul
93 Fenobarbital tablet 30 mg Tablet 126
94 Fenoksimetil Penisilina tablet 250 mg Tablet
95 Fenol Gliserol tetes telinga 10 % Botol
96 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 ml Ampul
97 Fitomenadion (Vit.K1) tab salut gula 10 mg Tablet 100
98 Flufenazine Deconat Inj 25 mg/ml Ampul
99 Furosemida tablet 40 mg Tablet
100 Furosemide Injeksi Ampul
101 Garam Oralit Sachet 175
102 Gemfibrozil 300 mg Tablet
103 Gentamicin Injeksi Ampul
104 Gentamicin Salep Kulit Tube
105 Gentamicin Salep mata Tube
106 Gentamicin Tetes Mata Botol 18
107 Gentian Violet 1 % Botol
108 Glibenclamid tablet 5 mg Tablet 200
109 Glicerin Guaiacolat ( GG ) 100 mg Tablet
110 Glikazid 80 mg Tablet Tablet
111 Glimepiride 2 mg Tablet 200 500
112 Glukosa larutan infus 10% steril Botol
113 Glukosa larutan infus 5 % steril Botol
114 Good Life Vit C 1000mg Kotak 37
115 Griseofulvin tablet 500 mg, Tablet
116 Guaiafenesin 100 mg Tablet
117 Hidroklortiniazid ( HCT )Tab.25 mg Tablet 500
118 Hidrokortison krim 2,5% Tube 72 48
119 Ibuprofen Suspensi Tablet
120 Ibuprofen tablet 200 mg Tablet
121 Ibuprofen tablet 400 mg Tablet
122 Imunomodulator sirup( STIMUNO) Botol
123 Isosorbid Dinitrat tablet sublingual 5 mg Tablet 300
124 Kalsium Glukonas Injeksi Ampul 72
125 Kalsium Laktat (Kalk) tablet 500 mg Tablet 1,900 1,000
126 Kapas Berlemak 500 mg Bungkus
127 Karbogliserin Tetes Telinga Botol 48
128 Ketokonazol Kream Tube
129 Ketokonazol Tablet 200 mg Tablet
130 Ketorolac inj Ampul 85
131 Kifadene tablet 20 mg Tablet
132 Kloramfenikol salep kulit Tube 96 48
133 Kloramfenikol salep mata 1 % capsul
134 Kloramfenikol suspensi Botol
135 Kloramfenikol tetes telinga 3% Tube
136 Kloramphenicol 250 mg Capsul
137 Kloramphenicol 500 mg capsul 100
138 Kloramphenicol Tetes Mata Botol
139 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet
140 Klorokuin tablet 150 mg Tablet
141 Klorpromazin HCL tablet salut 25 mg Tablet
142 Kombinasi (Pirimetamin 25 mg + Solfadoxin Tablet
143 Kotrimoksazol Dewasa Tablet 480 mg Tablet 1,100
144 Kotrimoksazol Sirup / Suspensi Botol 98
145 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul
146 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol
147 Lactobacilus serbuk Sachet
148 Lidocain 2%+efinefrin injeksi Ampul 200
149 Lidocain injeksi 2 ml Ampul 100
150 Lisinopril 10 mg tablet Tablet
151 Lisinopril 5 mg tablet Tablet
152 Loperamid 4 mg tablet Tablet 1,750
153 Lytacur Sirup Botol
154 Magnesium Sulfat Inj. 25 ml Ampul
155 Metamizol 500 mg Tablet
156 Metformin 500 mg Tablet Tablet
157 Methilprednisolon tablet 8 mg Tablet
158 Metilergometrin Maleat injeksi 1 ml Ampul
159 Metilergometrin Maleat Tablet Tablet 90
160 Methisoprinol 500mg Phapros Tablet 500
161 Metoklopramid Suspensi Botol
162 Metoklopramid tablet Tablet
163 Metronidazol 500 mg Tablet
164 Metronidazol infus / injeksi Botol
165 Metronidazol Ovula supp
166 Metronidazol suspensi Botol
167 Mikonazol kream Tube 56
168 Multivitamin Anak Sirup Botol
169 Multivitamin Anak Sirup / Stimuno Syr (BANKEU) Botol 80
170 Multivitamin Dewasa Antioksidan ( Becom c ) Tablet
171 Multivitamin Dewasa (HB Vit) Box 23
172 Multivitamin Dewasa / OXYVIT (BANKEU) Box 21
173 Natrium Diklofenak 25 mg Tablet Tablet
174 Natrium Diklofenak 50 mg Tablet Tablet 4,200
175 Natrium Klorida Cairan Infus ( NaCL ) Botol 300
176 Nifedipine Tablet 10 mg Tablet
177 Nistatin tablet vaginal 100.000 IU/g Tube 177
178 Obat anti Diare suspensi Botol
179 Obat Anti Diare Tablet (Akita / Molagit ) Tablet
180 Obat Batuk Flu ( Molexflu ) Tablet
181 Obat Batuk Hitam (OBH) Botol
182 Obat Batuk Sirup Herbal ( Herbacop ) Botol
183 Ofloxsacin Tetes Telinga Tube
184 Oksitetrasiklin HCL salep mata 1% Botol 418
185 Oksitosin injeksi 10 IU/ml - 1 ml Ampul
186 Omeprazol injeksi Ampul
187 Omeprazol Kapsul 20 mg capsul
188 Ondancentron injeksi 4 mg Ampul
189 Ondancentron Tablet4 mg Tablet
190 Paracetamol Drop 15 ml Botol 43
191 Paracetamol Sirup 120 mg/5 ml Botol 661
192 Parafin Dresing ( Bioplacenton Tull ) pcs
193 Parasetamol tablet 100 mg Tablet
194 Parasetamol tablet 500 mg Tablet 5,150
195 Permetrin Krim 5 % Tube
196 Pirantel Sirup Botol
197 Pirantel tablet 125 mg Tablet
198 Pirazinamid Botol
199 Piridoksin HCL (VIT B6) tablet 10mg Botol 1,370 1,000
200 Piroksikam tablet 20 mg Tablet
201 Polikresulen Tube
202 Povidon lodida 10% 300 ml 0
203 Povidon lodida 10% 60 ml Tablet
204 Prazikuantel tablet 600 mg Botol
205 Prednison Tablet 5 mg Tablet 2,600
206 Primakuin 15 mg Tablet
207 Probenesid 500 mg tablet Tablet
208 Prokain Benzil Penisilin 3 juta IU/vial injeksi Ampul
209 Propanolol HCL tablet 10 mg Tablet
210 Ranitidin injeksi Ampul
211 Ranitidin tablet Tablet
212 Resperidone 2 mg tablet Tablet
213 Ringer Laktat cairan infus (Otsuka) Botol
214 Ringer Laktat cairan infus (Widatra) Botol
215 Ringer Laktat (2020) Botol 400
216 Rivanol 300 ml Botol
217 Salbutamol Tablet 2 mg Tablet 1,320
218 Salbutamol tablet 4mg Tablet
219 Salep 2-4 Tube
220 Salep kombinasi cream ( Berloson ) Tube
221 Salicil bedak Kotak
222 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial 8
223 Serum Anti Tetanus inj 1500 IU ( Tetagam ) Vial 10
224 Sianokobalamin Injeksi Ampul
225 Simvastatin 10 mg tablet Tablet
226 Simvastatin 20 mg tablet Tablet 340
227 Sukralfat Suspensi Botol
228 Sukralfat tablet 500 mg Tablet
229 Suspensi Seng Insulin inj.40 IU/ml - 10 ml Tube
230 Temporary Stopping Fletcher serbuk & cairan Tablet
231 Tetrakain HCL tetes mata 0,5% Tube
232 Tetrasiklin 250 mg capsul capsul
233 Tetrasiklin 500 mg capsul capsul
234 Tiamin Tablet 50 mg ( B1 ) Tablet
235 Ventolin Nebulizer Ampul
236 Vitamin B komplek Tablet 6,500 3,000
237 Zink sirup Botol
238 Zink tablet 20 mg Tablet 970 2,000

OBAT PROGRAM
1 Albendazol Tablet 400 mg Tablet 6,720
2 Isoniazid Tablet 100 mg Tablet
3 Obat Antituberkulosis kategori 1 Paket
4 Obat Antituberkulosis Kategori 2 Paket 2
5 Obat Antituberkulosis Kategori Anak Paket
6 Pot Dahak Non Steril Biji
7 Pot Dahak Steril Biji
8 Reagen Ziehl Neelsen Kit
9 MDT MB Anak Tablet Tablet
10 MDT MB Dewasa Tablet Tablet
11 MDT PB Dewasa Tablet Tablet
12 MDT PB Anak Tablet Tablet
13 Retinol (Vitamin A) kapsul 200.000 IU capsul
14 Retinol (Vitamin A) kapsul 100.000 IU capsul
15 Tablet Penambah Darah ( FE ) Tablet 85,000
16 Amitriptilin tablet 25 mg Tablet
17 Carbamazepin 200 mg tablet Tablet
18 Clobazam 10 mg Tablet Tablet 219
19 Clozapine 25 mg Tablet Tablet
20 Fenitoin Natrium kapsul 30 mg capsul
21 Haloperidol 1,5 mg Tablet Tablet
22 Haloperidol 2 mg tablet Tablet 722
23 Haloperidol 5 mg Tablet Tablet 923
24 Haloperidol Injeksi Ampul
25 INH 100mg Tablet 100
26 Klorpromazin HCL tablet salut 100 mg Tablet 931
27 Klorpromazine Tablet 25 mg Tablet
28 Triheksilfenidil Hcl 2 mg tablet Tablet 510
29 Resperidone 2mg tablet Tablet 314

B NAMA BAHAN MEDIS HABIS PAKAI (BMHP )

 1 Alat suntik 1 ml Pcs 373
2 Alat suntik 10 ml Pcs
3 Alat suntik 2,5 ml Pcs
4 Alat suntik 20 ml Pcs
5 Alat suntik 3 cc (Remedi) 0
6 Alat suntik 3 ml Pcs 1,404
7 Alat suntik 3 ml (Program) Box 9
8 Alat suntik 5 ml pcs 626
9 Alkazide 1 L High Level Desinfectant Botol
10 Alkazyme Sachet 25 mg Pack
11 Alkohol 70 % 1 L Botol
12 Alkohol swab Sachet 9 5
13 Anti Septik Hand Rub Botol
14 Anti Septik Surgikal Hand Scrub Botol
15 Cat Gut no 2/0 Sachet
16 Cat Gut no 3/0 Sachet
17 Cat Gut No 3/0 (24 mm) Sachet
18 Cat Gut No 3/0 (26 mm) Sachet
19 Cathetter Jelly Biji
20 Demetech Silk 3/0 Set
21 E Care I.V Dresing Pcs 247
22 E-Care Surgical Mask Tie On Lembar
23 Face Drager (COVID) Pcs 3
24 Face Drager (BANKEU) Unit 3
25 Face Shielld (BANKEU2) Pcs 40
26 Folly No 14 Catether pcs
27 Folly No 16 Catether pcs 40
28 Forehead Thermometer Microlife (DID) Unit
29 Handsanitizer 5L (BANKEU) Galon 14
30 Hazmat Protect U Coverall (BANKEU) Pcs 170
31 I.V Cathetter No. 20 Set 135
32 I.V Cathetter No. 22 Set 155
33 I.V Cathetter No. 24 Set 80
34 I.V Cathetter No. 26 Set
35 Infuset Anak Set 144
36 Infuset Dewasa Set 100 50
37 Jarum Insulin Tablet
38 Kantong Jenazah (CSR BJB) Buah 3
39 Kantong Jenazah (BANKEU) Buah 5
40 Kapas Berlemak 250 gr Bungkus 8
41 Kapas Berlemak 500 gr Bungkus
42 Kasa 4 m x 10 cm Rol
43 Kasa 3 m x 15 cm Rol 80
44 Kasa Hidrofil 36 x 80 cm Rol
45 Kasa Hidrofil 40 x 80 cm Rol 3
46 Kasa Pembalut 2 x 80 cm Pack
47 Kasa Steril 16 x 16 cm Kotak 60 60
48 Lisol 1 L Botol
49 Masker Bedah 3ply (BANKEU) Box
50 Masker KN95 (PROV) Pcs 80
51 Masker N95 (CSR BJB) Pcs
52 Masker N95 (BANKEU) Pcs 30
53 Masker N95 (PROV) Pcs 180
54 Masker karet Ear Loop Lembar
55 Masker tali Tube
56 Nasal Canula Oksigen Set
57 Nasal Canula Oksigen Anak Pcs 50
58 Nasal Canula Oksigen Dewasa Pcs 50
59 Plester 1" Rol
60 Plester Kertas 2,5 cm Rol
61 Plester Kertas 1,25 cm x 9,14 cm Rol 59 12
62 Plester Non Woven 5cm x 5 cm Rol
63 Policlean Botol 9
64 Polifik Kotak
65 Saraya Alsof A 500 ml Botol
66 Saraya Alsof Pure 500 ml Botol
67 Sarung Tangan Gynecolog No 7 Pasang 50
68 Sarung Tangan Gynecolog No 7 (BANKEU) Pasang 16
69 Sarung tangan M (Non Steril) Pasang
70 Sarung tangan no 6,5 Pasang
71 Sarung tangan no 6,5 Steril Gloves Pasang 200
72 Sarung tangan no 7,0 Steril Pasang
73 Sarung tangan Steril Panjang (CSR BJB) Pasang 8
74 Sepatu Boots (CSR BJB) Pasang 10
75 Silk Black 3/0 26mm Sachet 96
76 Selang Section ( Surgikal Conection Tube with yankauer)Pcs
77 Underpad Lembar 140
78 Urine Bag Biji 70

NAMA OBAT VAKSIN

1 Vaksin Anti Rabies ( VAR ) Vial

2 Vaksin BCG Vial
3 Vaksin DT Vial
4 Vaksin HB 0 Pcs
5 Vaksin HBIG Vial
6 Vaksin Measless Rubella (MR) Vial
7 Vaksin Pentabio ( DPT - HB - Hib ) Vial
8 Vaksin Polio B OPV Vial
9 Vaksin Polio IPV Vial
10 Vaksin TD Vial
11 Vaksin Tuberculin Vial
12 ADS 0,005 ml Unit
13 ADS 0,5 ml Unit
14 ADS 5 ml Unit
15 Safety Box Unit
 NAMA OBAT REAGEN

1 Albumin (Reagen) Kotak

2 anti A Monoclonal ( GolDar 10 ml) Vial
3 Anti A-B Monoclonal ( GolDar 10 ml) Vial
4 Anti B Monoclonal ( GolDar 10ml) Vial
5 Anti D Monoclonal ( GolGar 10ml) Vial
6 Benecheck Plus Cholesterol Test Strip
7 Benecheck Plus Glukosa Test Strip
8 Benecheck Plus Uric Test Strip
9 Bilirubin T/D (Reagen) Kotak
10 Brilian Green Bile Broth Kotak
11 Cellclean (CL-50) (Reagen) Kotak
12 Cellpack (PK-30L) (Reagen) Kotak
13 Chikungunya IgM (Reagen) Kotak
14 Cholesterol (Reagen) Kotak
15 Cholesterol Stik (Reagen) Kotak
16 CK-MB (Reagen) Kotak
17 Creatinin Reagen Kit
18 Dengue IgM / IgM ( Reagen ) Kotak
19 Eight Check ( LNH ) Serial
20 Febrile Antingen H Parathpy Vial
21 Febrile Antingen H-A Parathpy Vial
22 Febrile Antingen H-B Parathpy Vial
23 Febrile Antingen H-C Parathpy Vial
24 Febrile Antingen O Parathpy Vial
25 Febrile Antingen O-A Parathpy Vial
26 Febrile Antingen O-B Parathpy Vial
27 Febrile Antingen O-C Parathpy Vial
28 Glukosa Reagen Kotak
29 GOT ( ALAT ) Kotak
30 GPT ( ALAT ) Kotak
31 HBSAG Reagen Box
32 HCG Strip Vial
33 HDL Cholesterol ( Precipitan ) Kotak
34 Hematologi Calibrator (Nscs 1000 ) Botol
35 Hemoglobin Reagen Kotak
36 Lactose Broth 500 mg Botol
37 LDL Cholesterol Kotak
38 Leptospira IgM (Reagen) Kotak
39 Micropippets MT-1-up to 200 ui Pcs
40 MIcropippets MT-up to 1 ml Pcs
41 NS1 Antigen Test (Reagen) Kotak
42 Pipet Ukur 10 ml biji
43 Poch Pack D (II) Reagen Kotak
44 Poch Pack L (II) Reagen Kotak
45 Stik Uric Acid Kotak
46 Strip Narkoba 3 Parameter Kotak
47 Strip Narkoba 5 Parameter Kotak
48 Strip Narkoba 6 Parameter Kotak
49 Total Protein Kotak
50 Trigleserida Kotak
51 Urea Kotak
52 Uric Acid Kotak

NAMA OBAT REAGEN PROGRAM HIV

1 Rapid 1 HIV (SD Bioline ) Tes
2 Rapid 2 HIV (Fokus ) Tes
3 Rapid 3 HIV (Biomeriux Vikia ) Tes
4 SD Biosensore Standart Q Syphlis Tes
5 RPR Syphlis ( Fokus ) Tes
6 Reagen CD4 Control Tes
7 Reagen CD4 Mobile Tes
8 RPR Syphlis Komponen Kit
9 Anuscopy Buah
10 Kertas PH Indikator Buah
11 Rotator Buah
12 Tip. Uk.60 Bks
13 Tip. Uk.61 Bks
14 Pronto / Holder Buah
NAMA OBAT GIGI

1 Anastesi Citojek Box

2 Articulating Paper (Kertas warna penanda oklusi) Kotak
3 Bahan Tumpatan sementara Botol
4 Bonding Syringe 2
5 Cairan Desinfectan ( Perendaman Instrumen Gigi ) Botol
6 Cairan untuk desinfectan pembersih permukaan Botol
7 Carpule Citojek Kotak 4
8 Chlorfeson Kamfer menthol ( CHKM ) Cairan Botol
9 Composite Nanohibrid A1 Tube 1
10 Composite Nanohibrid A2 Tube
11 Composite Nanohibrid A3 Tube
12 Composite Nanohibrid A3,5 Tube
13 Devitalisasi Pasta Pot
14 Devitalisasi Pulpa Pak 1
15 Disclosing Solution Botol
16 Etcing Gel Pcs
17 Etil Klorida Semprot Botol
18 Eugenol Cairan Botol
19 Formokesol Botol
20 Gas Powred Jet Injector Botol 8
21 Glass Ionomer Cement ART Pot
22 Glass Ionomer Cement Fuji 9 Pak 2
23 Jarum citojek uk 16 mm Box
24 Kalsium Hidroksida pasta Botol
25 Klorhekdidin Larutan 2 % Botol
26 Mummifiying Fasta Botol
27 Natrium Hipoklorit airan konsentrat 5% Botol
28 Paper Points 15-40 mm Box
29 Pasta Devitalisasi ( Non Arsen ) Tube
30 Pasta Pengisi Saluran Akar Syringe
31 Semen seng Fosfat serbuk Set
32 Spon Gelatin Cubicis 1x1x1 cm (Spongostan) Botol
33 Temporary Filling Fasta Set
34 Temporary Restorative Hydraulic CAVITON white Pak 2
35 Tooth Stain Remover ( TSR ) Botol
36 Wipes Desinfektan Botol
KAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO )
PUSKESMAS
DOKUMEN
DINKES KAB/KOTA
AN / PERIODE : SEPTEMBER 2021 GFK KAB/KOTA
PUSKESMAS

Penerimaan
Jumlah Jumlah
APBD PROG LAIN 2 Penerimaan Persediaan

5 6
( 4+5 ) 1 2 3 4 5 6
- -
- -
- 700
- -
- -
- -
- -
- 1,510 50 50 70 100
- -
- -
- -
- 9,340 200
- -
- 600
- -
- -
- -
- -
- -
- 84 34
- 8,480 200 200 100
- -
- -
- -
- -
- -
- -
- 60
- -
- -
- 6,900 200 100
- 50
- 500
- -
- -
 - 2,400 100
- -
- 400
- -
5,280 5,280 120 180 240 180 120
- -
- -
- 250
- 50
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 3,360
- -
- -
- -
- -
- 36
- -
- 70
- 18
- -
- -
- -
- -
- -
- -
- -
- 54
 - -
- -
- -
- -
- -
- -
- -
- -
- -
- 126
- -
- -
- -
- 100
20 20 20
- -
- -
- 175
- -
- -
- -
- -
- 18 18
- -
- 200
- -
- -
500 700
- -
- -
- 37
- -
- -
- 500
48 120
- -
- -
- -
- -
- 300
- 72
1,000 2,900 100 400 200
- -
- 48 24
- -
- -
- 85
- -
48 144
- -
- -
- -
- -
- 100
- -
- -
- -
- -
- -
- 1,100
- 98
- -
- -
- -
- 200
- 100
- -
- -
- 1,750
- -
- -
- -
- -
- -
- -
- 90
- 500
- -
- -
- -
- -
- -
- -
- 56 8
- -
- 80
- -
- 23
- 21
- -
- 4,200
- 300
- -
- 177
- -
- -
 - -
- -
- -
- -
- 418
- -
- -
- -
- -
- -
- 43
- 661 10 10
- -
- -
- 5,150 200 200 300
- -
- -
- -
- -
1,000 2,370 100
- -
- -
- -
- -
- -
- 2,600
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 400
- -
- 1,320
- -
- -
- -
- -
- 8
- 10
- -
- -
- 340 30
- -
 - -
- -
- -
- -
- -
- -
- -
- -
3,000 9,500 100 200
- -
2,000 2,970

- 6,720
- -
32 32 32
4 4 6
2 2 2
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 85,000
300 300 300
- -
- 219
100 100 100
- -
- -
200 200 922
500 500 1,423
- -
100
500 500 1,431
- -
1,000 1,000 1,510
300 300 614
 - 373
- -
- -
- -
- -
- 1,404
- 9
- 626
- -
- -
- -
5 14
- -
- -
- -
- -
- -
- -
- -
- -
- 247
- -
- 3
- 3
- 40
- -
- 40
- -
- 14
- 170
- 135
- 155
- 80
- -
- 144
50 150
- -
- 3
- 5
- 8
- -
- -
- 80
- -
- 3
- -
60 120
- -
 - -
- 80
- -
- 30
- 180
- -
- -
- -
- 50
- 50
- -
- -
12 71
- -
- 9
- -
- -
- -
- 50
- 16
- -
- -
200 200 400
- -
- 8
- 10
- 96
- -
- 140
- 70

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -

- -
- -
- -
- 2
- -
- -
- 4
- -
- 1
- -
- -
- -
- -
- 1
- -
- -
- -
- -
- -
- 8
- -
- 2
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- 2
- -
- -
 DOKUMEN NOMOR TANGGAL
NKES KAB/KOTA
FK KAB/KOTA
USKESMAS

Pemakaian Perhari / Tanggal diloket

7
7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

200 100

200 200 200

10 10

100 200 100 200 200 200 200

200 200 200 600

240 120 120 120 120 240 120 120 180 240 240

100 200
 100

24 24

200 400 300 100

 24

100
10 10

100

5 5

1 1
 24

6
10 10 50 20 10

200 200 200 300 200 200 200 200 300 400

100 100 100

100

100

100 60
200 300 300 200 200 100

90 200
 Pengeluaran Sub Unit

22 23 24 25 26 27 28 29 30 31 UGD PONED POSKES KP

100 60

200 100 100 840 200 100

10 10 10

30
400 200 280

200 200 200 100 190

30
100
 100 100

229

180 180 240 240 200 120 240 120 300

100 1800 160

16

21
16

13
 4

100

24

200 100 200

25
100 100
10 6

110

6 5

170
 25

10 3
10 10 10 10 24

200 400 200 200 200 200 450 100 100

400 200 100 200

100 100

320

120

4
7

100
200 200 200 100 400

100 100

13180
30

365
670

675

738
427
343

504

70

10
61
10

25
7

45

50 20
80

5
13

30 2

6
10

18

5
aran Sub Unit Jumlah Stok
Pengeluaran AkhirBulan
8 9
Dll (1+ s.d31 + sub unit) (6-8)
0 0
0 0
0 700
0 0
0 0
0 0
0 0
730 780
0 0
0 0
0 0
2340 7000
0 0
50 550
0 0
0 0
0 0
0 0
0 0
64 20
2580 5900
0 0
0 0
0 0
0 0
0 0
0 0
5 55
0 0
0 0
2390 4510
30 20
100 400
0 0
0 0
 300 2100
0 0
229 171
0 0
4520 760
0 0
0 0
0 250
0 50
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
2360 1000
0 0
0 0
0 0
0 0
16 20
0 0
21 49
16 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
13 41
 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 126
0 0
0 0
0 0
100 0
4 16
0 0
0 0
0 175
0 0
0 0
0 0
0 0
18 0
0 0
0 200
0 0
0 0
100 600
0 0
0 0
1 36
0 0
0 0
0 500
72 48
0 0
0 0
0 0
0 0
0 300
0 72
2200 700
0 0
24 24
0 0
0 0
25 60
0 0
 24 120
0 0
0 0
0 0
0 0
0 100
0 0
0 0
0 0
0 0
0 0
300 800
36 62
0 0
0 0
0 0
0 200
0 100
0 0
0 0
210 1540
0 0
0 0
0 0
0 0
0 0
0 0
0 90
0 500
0 0
0 0
0 0
0 0
0 0
0 0
10 46
0 0
21 59
0 0
0 23
2 19
0 0
0 4200
170 130
0 0
0 177
0 0
0 0
 0 0
0 0
0 0
0 0
49 369
0 0
0 0
0 0
0 0
0 0
19 24
184 477
0 0
0 0
5150 0
0 0
0 0
0 0
0 0
1300 1070
0 0
0 0
0 0
0 0
0 0
300 2300
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
320 80
0 0
220 1100
0 0
0 0
0 0
0 0
4 4
7 3
0 0
0 0
290 50
0 0
 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
2700 6800
0 0
490 2480

0 6720
0 0
0 32
0 6
0 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
13180 71820
30 270
0 0
0 219
0 100
0 0
0 0
365 557
670 753
0 0
0 100
675 756
0 0
738 772
427 187
343 30
0 0
0 0
0 0
0 0
504 900
0 9
70 556
0 0
0 0
0 0
5 9
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 247
0 0
0 3
0 3
0 40
0 0
1 39
0 0
0 14
0 170
10 125
61 94
10 70
0 0
25 119
7 143
0 0
0 3
0 5
1 7
0 0
0 0
45 35
0 0
0 3
0 0
70 50
0 0
 0 0
0 80
0 0
0 30
80 100
0 0
0 0
0 0
5 45
13 37
0 0
0 0
32 39
0 0
2 7
0 0
0 0
0 0
6 44
10 6
0 0
0 0
0 400
0 0
0 8
0 10
18 78
0 0
0 140
5 65

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

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

0 0
0 0
0 0
0 2
0 0
0 0
0 4
0 0
0 1
0 0
0 0
0 0
0 0
0 1
0 0
0 0
0 0
0 0
0 0
0 8
0 0
0 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 2
0 0
0 0