FORM DATA SAMPLING KESESUAIAN PERESEPAN DENGAN FORMULARIUM

BULAN : …JANUARI 2019……………………………………………………….

NAMA JENIS OBAT YANG TIDAK TERSEDIA
NO TANGGAL JUMLAH ITEM OBAT
DALAM FORMULARIUM
1 1/2/2019 0
2 1/2/2019 0
3 1/2/2019 0
4 1/2/2019 0
5 1/3/2019 0
6 1/3/2019 0
7 1/3/2019 0
8 1/3/2019 0
9 1/4/2019 0
10 1/4/2019 0
11 1/4/2019 0
12 1/4/2019 0
13 1/5/2019 0
14 1/5/2019 0
15 1/5/2019 0
16 1/5/2019 0
17 1/7/2019 0
18 1/7/2019 0
19 1/7/2019 0
20 1/7/2019 0
21 1/8/2019 0
22 1/8/2019 0
23 1/8/2019 0
24 1/8/2019 0
25 1/9/2019 0
26 1/9/2019 0
27 1/9/2019 0
28 1/9/2019 0
29 1/10/2019 0
30 1/10/2019 0
31 1/10/2019 0
32 1/10/2019 0
33 1/11/2019 Basitracin 1
34 1/11/2019 0
35 1/11/2019 0
36 1/11/2019 0
37 1/12/2019 0
38 1/12/2019 0
39 1/12/2019 0
40 1/12/2019 0
41 1/14/2019 0
42 1/14/2019 0
43 1/14/2019 0
44 1/14/2019 0
45 1/15/2019 0
46 1/15/2019 0
47 1/15/2019 0
48 1/15/2019 0
49 1/16/2019 0
50 1/16/2019 0
51 1/16/2019 0
52 1/16/2019 0
53 1/17/2019 0
54 1/17/2019 0
55 1/17/2019 0
56 1/17/2019 0
57 1/18/2019 0
58 1/18/2019 0
59 1/18/2019 0
60 1/18/2019 0
61 1/19/2019 0
62 1/19/2019 0
63 1/19/2019 0
64 1/19/2019 0
65 1/21/2019 0
66 1/21/2019 0
67 1/21/2019 0
68 1/21/2019 0
69 1/22/2019 0
70 1/22/2019 0
71 1/22/2019 0
72 1/22/2019 0
73 1/23/2019 0
74 1/23/2019 0
75 1/23/2019 0
76 1/23/2019 0
77 1/24/2019 0
78 1/24/2019 0
79 1/24/2019 0
80 1/24/2019 0
81 1/25/2019 0
82 1/25/2019 0
83 1/25/2019 0
84 1/25/2019 0
85 1/26/2019 0
86 1/26/2019 0
87 1/26/2019 0
88 1/26/2019 0
89 1/28/2019 0
90 1/28/2019 0
91 1/28/2019 0
92 1/28/2019 0
93 1/29/2019 0
94 1/29/2019 0
95 1/29/2019 0
96 1/29/2019 0
97 1/29/2019 0
98 1/30/2019 0
99 1/30/2019 0
100 1/30/2019 0
101 1/30/2019 0
102 1/31/2019 0
103 1/31/2019 0
104 1/31/2019 0
105 1/31/2019 0

Total Item Obat Yang Tidak Tersedia Dalam Formularium 1

Kepala Puskesmas Parenggean I Penanggung Jawab UKP Pengelola Obat Puskesmas

dr. Mustafa P dr. Atma Antariksa Tiara Febriani, Amd. Farm

NIP. 19760809 200604 1 010 NIP. 19850710 201412 1 001 NIP. 19980203 201903 2 001
 FORM DATA SAMPLING KESESUAIAN PERESEPAN DENGAN FORMULARIUM
BULAN : FEBRUARI 2019………………………………………………………….
NAMA JENIS OBAT YANG TIDAK TERSEDIA
NO TANGGAL JUMLAH ITEM OBAT
DALAM FORMULARIUM
1 2/1/2019 0
2 2/1/2019 0
3 2/1/2019 0
4 2/1/2019 0
5 2/2/2019 0
6 2/2/2019 0
7 2/2/2019 0
8 1/2/2019 0
9 2/4/2019 0
10 2/4/2019 0
11 2/4/2019 0
12 2/4/2019 0
13 2/6/2019 0
14 2/6/2019 0
15 2/6/2019 0
16 2/6/2019 0
17 2/7/2019 0
18 2/7/2019 0
19 2/7/2019 0
20 2/7/2019 0
21 2/8/2019 0
22 2/8/2019 0
23 2/8/2019 0
24 2/8/2019 0
25 2/9/2019 0
26 2/9/2019 0
27 2/9/2019 0
28 2/9/2019 0
29 2/11/2019 0
30 2/11/2019 0
31 2/11/2019 0
32 2/11/2019 0
33 2/12/2019 0
34 2/12/2019 0
35 2/12/2019 0
36 2/12/2019 0
37 13-02-109 0
38 2/13/2019 0
39 2/13/2019 0
40 2/13/2019 0
41 2/14/2019 0
42 2/14/2019 0
43 2/14/2019 0
44 2/14/2019 0
45 2/15/2019 0
46 2/15/2019 0
47 2/15/2019 0
48 2/15/2019 0
49 2/16/2019 0
50 2/16/2019 0
51 2/16/2019 0
52 2/16/2019 0
53 2/18/2019 0
54 2/18/2019 0
55 2/18/2019 0
56 2/18/2019 0
57 2/19/2019 0
58 2/19/2019 0
59 2/19/2019 0
60 2/19/2019 0
61 2/20/2019 0
62 2/20/2019 0
63 2/20/2019 0
64 2/20/2019 0
65 2/21/2019 0
66 2/21/2019 0
67 2/21/2019 0
68 2/21/2019 0
69 2/22/2019 0
70 2/22/2019 0
71 2/22/2019 0
72 2/22/2019 0
73 2/23/2019 0
74 2/23/2019 0
75 2/23/2019 0
76 2/23/2019 0
77 2/25/2019 0
78 2/25/2019 0
79 2/25/2019 0
80 2/25/2019 0
81 2/26/2019 0
82 2/26/2019 0
83 2/26/2019 0
84 2/26/2019 0
85 2/27/2019 0
86 2/27/2019 0
87 2/27/2019 0
88 2/27/2019 0
89 2/28/2019 0
90 2/28/2019 0
91 2/28/2019 0
92 2/28/2019 0

Total Item Obat Yang Tidak Tersedia Dalam Formularium 0

Kepala Puskesmas Parenggean I Penanggung Jawab UKP Pengelola Obat Puskesmas

dr. Mustafa P dr. Atma Antariksa Tiara Febriani, Amd. Farm

NIP. 19760809 200604 1 010 NIP. 19850710 201412 1 001 NIP. 19980203 201903 2 001
 FORM DATA SAMPLING KESESUAIAN PERESEPAN DENGAN FORMULARIUM
BULAN : MARET 2019………………………………………………………….
NAMA JENIS OBAT YANG TIDAK TERSEDIA
NO TANGGAL JUMLAH ITEM OBAT
DALAM FORMULARIUM
1 3/1/2019 0
2 3/1/2019 0
3 3/1/2019 0
4 3/1/2019 0
5 3/2/2019 0
6 3/2/2019 0
7 3/2/2019 0
8 3/2/2019 0
9 3/4/2019 0
10 3/4/2019 0
11 3/4/2019 0
12 3/4/2019 0
13 3/5/2019 0
14 3/5/2019 0
15 3/5/2019 0
16 3/5/2019 0
17 3/6/2019 0
18 3/6/2019 0
19 3/6/2019 0
20 3/6/2019 0
21 3/8/2019 0
22 3/8/2019 0
23 3/8/2019 0
24 3/8/2019 0
25 3/9/2019 0
26 3/9/2019 0
27 3/9/2019 0
28 3/9/2019 0
29 3/11/2019 0
30 3/11/2019 0
31 3/11/2019 0
32 3/11/2019 0
33 3/12/2019 Basitracin 1
34 3/12/2019 0
35 3/12/2019 0
36 3/12/2019 0
37 3/13/2019 0
38 3/13/2019 0
39 3/13/2019 0
40 3/13/2019 0
41 3/14/2019 0
42 3/14/2019 0
43 3/14/2019 0
44 3/14/2019 0
45 3/15/2019 0
46 3/15/2019 0
47 3/15/2019 0
48 3/15/2019 0
49 3/16/2019 0
50 3/16/2019 0
51 3/16/2019 0
52 3/16/2019 0
53 3/18/2019 0
54 3/18/2019 0
55 3/18/2019 0
56 3/18/2019 0
57 3/19/2019 0
58 3/19/2019 0
59 3/19/2019 0
60 3/19/2019 0
61 3/20/2019 0
62 3/20/2019 0
63 3/20/2019 0
64 3/20/2019 0
65 3/21/2019 0
66 3/21/2019 0
67 3/21/2019 0
68 3/21/2019 0
69 3/22/2019 0
70 3/22/2019 0
71 3/22/2019 0
72 3/22/2019 0
73 3/23/2019 0
74 3/23/2019 0
75 3/23/2019 0
76 3/23/2019 0
77 3/25/2019 0
78 3/25/2019 0
79 3/25/2019 0
80 25-03--2019 0
81 3/26/2019 0
82 3/26/2019 0
83 3/26/2019 0
 84 3/26/2019 0
85 3/27/2019 0
86 3/27/2019 0
87 3/27/2019 0
88 3/27/2019 0
89 3/28/2019 0
90 3/28/2019 0
91 3/28/2019 0
92 3/28/2019 0
93 3/29/2019 0
94 3/29/2019 0
95 3/29/2019 0
96 3/29/2019 0
97 3/29/2019 0
98 3/30/2019 0
99 3/30/2019 0
100 3/30/2019 0
101 3/30/2019 0

Total Item Obat Yang Tidak Tersedia Dalam Formularium 1

Kepala Puskesmas Parenggean I Penanggung Jawab UKP Pengelola Obat Puskesmas

dr. Mustafa P dr. Atma Antariksa Tiara Febriani, Amd. Farm

NIP. 19760809 200604 1 010 NIP. 19850710 201412 1 001 NIP. 19980203 201903 2 001
 FORM DATA SAMPLING KESESUAIAN PERESEPAN DENGAN FORMULARIUM
BULAN : APRIL 2019………………………………………………………….
NAMA JENIS OBAT YANG TIDAK TERSEDIA
NO TANGGAL
DALAM FORMULARIUM
1 4/1/2019
2 4/1/2019
3 4/1/2019
4 4/1/2019
5 4/2/2019
6 4/2/2019
7 4/2/2019
8 4/2/2019
9 4/4/2019
10 4/4/2019
11 4/4/2019
12 4/4/2019
13 4/5/2019
14 4/5/2019
15 4/5/2019
16 4/5/2019 Dextrofren sirup
17 4/6/2019
18 4/6/2019
19 4/6/2019
20 4/6/2019
21 4/8/2019
22 4/8/2019
23 4/8/2019
24 4/8/2019
25 4/9/2019
26 4/9/2019
27 4/9/2019
28 4/9/2019
29 4/10/2019
30 4/10/2019
31 4/10/2019
32 4/10/2019
33 4/11/2019 Basitracin
34 4/11/2019
35 4/11/2019
36 4/11/2019
37 4/12/2019
38 4/12/2019
39 4/12/2019
40 4/12/2019
41 4/13/2019
42 4/13/2019
43 4/13/2019
44 4/13/2019
45 4/15/2019 Curbeplex
46 4/15/2019
47 4/15/2019
48 4/15/2019
49 4/16/2019
50 4/16/2019
51 4/16/2019
52 4/16/2019
53 3/17/2019
54 3/17/2019
55 3/17/2019
56 3/17/2019
57 3/18/2019
58 3/18/2019
59 3/18/2019
60 3/18/2019
61 4/20/2019
62 4/20/2019
63 4/20/2019
64 4/20/2019
65 4/22/2019
66 4/22/2019
67 4/22/2019
68 4/22/2019
69 4/23/2019
70 4/23/2019
71 4/23/2019
72 4/23/2019
73 4/24/2019
74 4/24/2019
75 4/24/2019
76 4/24/2019
77 4/25/2019
78 4/25/2019
79 4/25/2019
80 4/25/2019
81 4/26/2019
82 4/26/2019
83 4/26/2019
84 4/26/2019
85 4/27/2019
86 4/27/2019
87 4/27/2019
88 4/27/2019
89 4/29/2019
90 4/29/2019
91 4/29/2019
92 4/29/2019
93 4/30/2019
94 4/30/2019
95 4/30/2019
96 4/30/2019
Total Item Obat Yang Tidak Tersedia Dalam Formularium

Kepala Puskesmas Parenggean I Penanggung Jawab UKP Pengelola Obat Puskesmas

dr. Mustafa P dr. Atma Antariksa Tiara Febriani, Amd. Farm

NIP. 19760809 200604 1 010 NIP. 19850710 201412 1 001 NIP. 19980203 201903 2 001
DENGAN FORMULARIUM
………………………….

JUMLAH ITEM OBAT

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
 0
0
0
0
0
0
0

Pengelola Obat Puskesmas

Tiara Febriani, Amd. Farm

NIP. 19980203 201903 2 001
 FORM DATA SAMPLING KESESUAIAN PERESEPAN DENGAN FORMULARIUM
BULAN : MEI 2019………………………………………………………….
NAMA JENIS OBAT YANG TIDAK TERSEDIA
NO TANGGAL JUMLAH ITEM OBAT
DALAM FORMULARIUM
1 5/2/2019 0
2 5/2/2019 0
3 5/2/2019 0
4 5/2/2019 0
5 5/3/2019 0
6 5/3/2019 0
7 5/3/2019 0
8 5/3/2019 0
9 5/4/2019 0
10 5/4/2019 0
11 5/4/2019 0
12 5/4/2019 0
13 5/6/2019 0
14 5/6/2019 0
15 5/6/2019 0
16 5/6/2019 0
17 5/7/2019 0
18 5/7/2019 0
19 5/7/2019 0
20 5/7/2019 0
21 5/8/2019 0
22 5/8/2019 0
23 5/8/2019 0
24 5/8/2019 0
25 5/9/2019 0
26 5/9/2019 0
27 5/9/2019 0
28 5/9/2019 0
29 5/10/2019 0
30 5/10/2019 0
31 5/10/2019 0
32 5/10/2019 0
33 5/11/2019 Basitracin 1
34 5/11/2019 0
35 5/11/2019 0
36 5/11/2019 0
37 5/13/2019 0
38 5/13/2019 0
39 5/13/2019 0
40 5/13/2019 0
41 5/14/2019 0
42 5/14/2019 0
43 5/14/2019 0
44 5/14/2019 0
45 5/15/2019 0
46 5/15/2019 0
47 5/15/2019 0
48 5/15/2019 0
49 5/16/2019 0
50 5/16/2019 Curbiplex 1
51 5/16/2019 0
52 5/16/2019 0
53 5/17/2019 0
54 5/17/2019 0
55 5/17/2019 0
56 5/17/2019 0
57 5/18/2019 0
58 5/18/2019 0
59 5/18/2019 0
60 5/18/2019 0
61 5/20/2019 0
62 5/20/2019 0
63 5/20/2019 0
64 5/20/2019 0
65 5/21/2019 0
66 5/21/2019 0
67 5/21/2019 0
68 5/21/2019 0
69 5/22/2019 0
70 5/22/2019 0
71 5/22/2019 0
72 5/22/2019 0
73 5/23/2019 0
74 5/23/2019 0
75 5/23/2019 0
76 5/23/2019 0
77 5/24/2019 0
78 5/24/2019 0
79 5/24/2019 0
80 5/24/2019 0
81 5/25/2019 0
82 5/25/2019 0
83 5/25/2019 0
 84 5/25/2019 0
85 5/27/2019 0
86 5/27/2019 0
87 5/27/2019 0
88 5/27/2019 0
89 5/28/2019 0
90 5/28/2019 0
91 5/28/2019 0
92 5/28/2019 0
93 5/29/2019 0
94 5/29/2019 0
95 5/29/2019 0
96 5/29/2019 0
97 5/31/2019 0
98 5/31/2019 0
99 5/31/2019 0
100 5/31/2019 0

Total Item Obat Yang Tidak Tersedia Dalam Formularium 2

Kepala Puskesmas Parenggean I Penanggung Jawab UKP Pengelola Obat Puskesmas

dr. Mustafa P dr. Atma Antariksa Tiara Febriani, Amd. Farm

NIP. 19760809 200604 1 010 NIP. 19850710 201412 1 001 NIP. 19980203 201903 2 001