PEMERINTAH KABUPATEN MURUNG RAYA

DINAS KESEHATAN
UPT PUSKESMAS PURUK CAHU SEBERANG
Jl. Bhayangkara No.53B Kel.Puruk Cahu Seberang Kec. Murung Kode Pos 73912
Telp. 081235382115, email : pkm.purukcahuseberang12@gmail.com

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO

PUSTU PURUK CAHU SEBRANG
PUSKESMAS : PURUK CAHU SEBERANG
KECAMATAN : MURUNG
KABUPATEN : MURUNG RAYA

PROPINSI : KALIMANTAN TENGAH

STOK SISA
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN RUSAK/ED
AWAL STOK

1 2 3 4 5 6 7 8 9
1 ACETYLCYSTEINE TABLET 200 MG TABLET 0 0
2 ACYCLOVIR TABLET 200 MG TABLET 100 0
3 ACYCLOVIR TABLET 400 MG TABLET
4 ALLOPURINOL TABLET 100 MG TABLET 100 100 200 0 200
5 AMOXYCILLIN SIRUP 250 MG\/5 ML SIRUP 5 5 10 1 9
6 AMOXYCILLIN TABLET 500 MG TABLET 130 100 230 180 50
7 ANTACIDA TABLET TABLET 0 0 0

8 ANTI-FUNGI DOEN Kombinasi : ASAM SALEP

9 ASAM FOLAT 400 MCG TABLET 100 100 200 50 150
10 ASAM MEFENAMAT TABLET 500 MG TABLET 100 100 200 180 20
11 ATAPULGIT TABLET 600 MG TABLET
12 BEDAK SALISIL SERBUK 2 % SERBUK 0 5 5 0 5
13 BETAMETHASONE SALEP 0.1% SALEP
14 CALCIUM LACTATE TABLET 500 MG TABLET 0 100 100 80 20
15 CAPTOPRIL TABLET 12.5 MG TABLET 100 100 200 170 30
16 CARBAMAZEPINE TABLET 200 MG TABLET
17 CHLORAMPHENICOL SALEP KULIT 2% SALEP 6 5 11 1 10
18 CHLORPROMAZINE HCL TABLET 100 TABLET
19 CLOZAPINE TABLET 25 MG TABLET
20 COTRIMOXAZOLE TABLET 480 MG TABLET 200 0 200 0 0
21 COTRIMOXAZOLE TABLET 960 MG TABLET 230 0 230 90 140
22 CYANOCOBALAMIN INJEKSI 500 MCG INJEKSI
23 DIAZEPAM ENEMA 5 MG/2.5 ML ENEMA
24 DIAZEPAM TABLET 2 MG TABLET
25 DIAZEPAM TABLET 5 MG TABLET
26 DIMENHYDRINATE TABLET 50 MG TABLET
27 DOMPERIDONE SIRUP 5 MG/5 ML SIRUP 7 0 7 0 7
28 DOMPERIDONE TABLET 10 MG TABLET 800 0 800 10 790
29 DOXYCYCLINE TABLET 100 MG TABLET
30 ERYTHROMYCIN SIRUP 200 MG/5 ML SIRUP 6 0 6 1 5
31 FAVIPIRAVIR 200 MG TABLET TABLET
32 FITOMENADION (VITAMIN K) INJEKSI INJEKSI
33 GARAM ORALIT SERBUK SERBUK 0 100 100 0 100
34 GENTAMYCIN DROPS 0.3 % DROPS 0 5 5 3 2
35 GENTAMYCIN Salep Mata 3.5 G Salep
36 GLIBENCLAMIDE TABLET 5 MG TABLET 100 100 200 120 80
37 HALOPERIDOL TABLET 5 MG TABLET
38 HYDROCORTISONE SALEP 2.5 % SALEP 5 5 10 0 10
39 IBUPROFEN TABLET 200 MG TABLET 200 200 400 40 360
40 ISOSORBIDE DINITRATE TABLET 5 MG TABLET 0 100 100 100

41 KETOCONAZOLE SALEP 2% SALEP

42 LIDOCAINE INJEKSI 2% INJEKSI 10 0 10 0 10
43 LIDOCAINE|EPINEPHRINE INJEKSI INJEKSI
44 LORATADINE TABLET 10 MG TABLET 0 100 100 0 100 100
45 METFORMIN TABLET 850 MG TABLET
46 METHYLPREDNISOLONE TABLET 4 MG TABLET 350 0 350 300 50
47 METRONIDAZOLE TABLET 500 MG TABLET 100 0 100 20 80
48 NYSTATIN OVULA 10000 IU OVULA 70 0 70

49 OMEPRAZOLE KAPSUL 20 MG KAPSUL 100 100 200 180 20

50 OXYTOCIN INJEKSI 10 IU\/ML INJEKSI 0 5 5 2 3
51 PARACETAMOL DROPS 100 MG/ML DROPS 13 7 20 9 11
52 PARACETAMOL SIRUP 120 MG\/5 ML SIRUP 15 0 15 7 8
53 PARACETAMOL TABLET 500 MG TABLET 160 200 360 160 200
54 PARACETAMOL|PHENYLPROPANOLAM TABLET
55 PHYTOMENADIONE (VITAMIN K) TABL TABLET
56 PREDNISONE TABLET 5 MG TABLET 240 0 240 40 200
57 PRIMAQUINE TABLET 15 MG TABLET
58 PROPANOLOL TABLET 10 MG TABLET 100 0 100 100
59 RANITIDINE TABLET 150 MG TABLET 10 50 60 50 10
60 RETINOL ACETATE TABLET 20000 IU TABLET
61 RETINOL ACETATE TABLET 20000 IU TABLET
62 RETINOL PALMITATE TABLET 100000 TABLET
63 RINGER LAKTAT 500 ML BOTOL 2 2 4 1 3
64 RISPERIDONE TABLET 2 MG TABLET
65 RIVANOL \/ ETAKRIDIN 300 ML BOTOL
66 SALBUTAMOL TABLET 2 MG (SEBAGAI TABLET 500 0 500 0 500
67 SALBUTAMOL TABLET 4 MG (SEBAGAI TABLET 0 0
68 SALEP 2-4 KOMBINASI: ASAM SALISI TUBE 4 2 6 6 0
69 SODIUM CHLORIDE INFUS INFUS
70 TABLET TAMBAH DARAH KOMBINASI F TABLET 100 200 300 260 40
71 TRIHEXYPHENIDYL TABLET 2 MG TABLET
72 VIT A|VIT D3|VIT B1|RIBOFLAVIN|NI SIRUP
73 VITAMIN B COMPOUND TABLET TABLET 120 200 320 190 130
74 ZINC SULPHATE TABLET 20 MG TABLET 0 100 100 0 100
75 BISACODYL TABLET 5 MG TABLET
76 KETOCONAZOLE TABLET 200 MG TABLET
77 NATRIUM DIKLOFENAK 50 MG TABLET 0 0
78 OXYTETRACYCLINE SALEP MATA 1% SALEP
79 PIROXICAM TABLET 20 MG TABLET 0 100 100 70 30
80

81

82
 83

84

85

86

87

88

89

90

91
92
93

95

96

BAHAN MEDIS HABIS PAKAI

STOK SISA
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN RUSAK/ED
AWAL STOK

1 Abocath 18 Pcs 1 0 1
2 Abocath 20 Pcs 0 3 3
3 Abocath 22 Pcs 7 0 7
4 Abocath 24 Pcs 10 0 10
5 Abocath 26 Pcs
6 Alkohol Swab Pcs 40 0 40
7 Alkohol 1000ml Botol
8 Alkohol 100ml Botol
 9 AquaPro Injeksi Steril Flabot
10 Aseptan Liquid Botol
11 Bisturi no.12 Pcs
12 Bisturi no.15 Pcs
13 Bracket Handwash Pcs
14 Catgut Chromic 3/0 100m Pcs 2 2
15 Catgut Chromic 2/0 (3.5 Metric) Pcs 2 2
16 Catgut Chromic 3/0 HR-37 Pcs
17 Catgut Chromic 3/0 (3 Metric) Pcs
18 Catgut Plain 2/0 (3.5M) Pcs
19 Chateter No.18 Pcs
20 Chateter no. 14 Pcs
21 Chateter no. 16 Pcs
22 Dermafix 10 x 25 Pcs
23 Fixomull 10 x 5 Pcs
24 Fixomull 5 x 5 Pcs
25 Glukosa Larutan Infus 10% Fls
26 Glukosa Larutan Infus 5% Fls 5 3 8 3 5
27 Handscoon Steril No 7 Pasang
28 Handscon Sterill No. 7 1/2 Pasang
29 Handscoon L Box
30 Handscoon M Box
31 Handscoon S Box
32 Hidrogen Peroksida Botol
33 Infuset Anak Pcs
34 Infuset Dewasa Pcs 0 10 10 2 8
35 Isopalster roll
36 Jarum Kulit No 12 Pcs
37 Jarum Kulit No 13 Pcs
38 Kapas 1000g Gulung
39 Kapas 250 gram Gulung
40 Kapas 500 gram roll
41 Kasa Kotak steril 16 x 16 pcs/kotak
42 Kasa Kotak steril 18 x 22 pcs/kotak 2 2 1 1
43 Kasa 4m x 5cm roll 2 2 1 1
44 Kasa 4m x 10cm roll
45 Kasa 4m x 15cm roll
46 Kasa Hidrofil 2m x 80 cm roll
47 Kasa Hidrofil 40yard x 80 cm roll
48 Kasa Kompres 40cmx 40cm lembar
49 Kertas Puyer lembar
50 Leukoplast 2.5 x 4.5 roll
51 Leukoplast 7.5 x 4.5 roll
52 Lisol 1 L Botol
53 Masker Karet Pcs
54 Masker Tali Pcs
55 Masker Oksigen Dws Pcs
56 Masker Oksigen anak Pcs
57 Masker Oksigen Neonatus (Bayi) Pcs
58 Medical regulator Pcs
59 Mucus Extractor Pcs
60 Natrium Klorida Larutan Infus 0,9% Fls 2 2 2
61 Needle 23 Pcs
62 Needle 25 Pcs
63 NGT 14 Pcs
64 NGT 16 Pcs
65 NGT 18 Pcs
66 NGT 20 Pcs
67 Oxyflow Dewasa Pcs
68 Oxyflow Anak Pcs
69 Plesterin bulat Pcs
70 Policlean Botol
71 Polifix 5cm x 1m Pcs
72 Povidone Lodida 300ml Larutan Botol
73 Povidone Lodida 30ml Larutan Botol
74 PP tes Pcs
75 Ringer Lactat Larutan Infus Flabot
76 Rivanol 300ml Botol
77 Signa gel Pcs
78 Silk Braided 2/0 H-R 37mm/2/0( 3M ) Pcs
79 Silk Braided 3/0 H-R 30mm/3/0( 2 M pcs
80 Spuit 1 cc pcs
81 Spuit 2,5cc pcs
82 Spuit 3cc pcs 15 20 35 21 14
83 Spuit 5cc Pcs 13 0 13 3 10
84 Spuit 10cc pcs
85 Spuit 50cc Pcs
86 Threeway Infus Pcs
87 Tabung Oksigen Besar tabung
88 Tabung Oksigen Sedang tabung
89 Tabung Oksigen Kecil tabung
90 Ultra Fix Pcs
91 UnderPad pcs
92 Urine Bag pcs
93 Wida DS 5% Fls
94
95
96
97
98
99
100

JUMLAH KUNJUNGAN PASIEN BPJS/KIS/KMS UMUM JUMLAH

82 0 82
 Yang Menyerahkan, Mengetahui, Yang Menerima,
s Gudang/Apoteker Penanggung Jawab Kepala Puskesmas Puskesmas Puruk Cahu Seberang Petugas Pustu

apt. Mutiara Yunita, S.Farm Yessi Ira Nova, S.Kep Sri Herlina, Amd.K
NRPK. 15.7.0514787 NIP. 19831128 201101 2 003 NIP. 19780524 200501 2
AYA

NG
Pos 73912
l.com

N OBAT ( LPLPO )

PERMINTAAN BULAN/PERIODE : APRIL 2022

PERMINTAAN BULAN/PERIODE :

STOK
PERMINTAAN PEMBERIAN KET
OPTIMAL

10 11 12 13

0 0
0 0
200 200
200 0

100 100
200 100
 0
5 5
200 200
200 0

0
0
10 10

0
0

0
0
 5 5
100 100

0
0
100 100
5 5
0

100 0

200 100
0

200 0
5 0
0
10 5
200 200

100 100
100 100

5 3

0
0
5 5

200 200

100 100
0

200 0

200 100
 STOK
PERMINTAAN PEMBERIAN KET
OPTIMAL

0
0

0
5 0
5 0

5 0

1 1
1 0
1 1

0
3 3
3

2 0
2 0

5 3

1 0
5 3

10 10

20 20
20 20
 Kepala Puskesmas Long Hubung

Yang Menerima,
Petugas Pustu

dr. Yohanes Adam Elsoin

NIP. 19850522 201505 1 001
Sri Herlina, Amd.Kep
NIP. 19780524 200501 2 011
Mengetahui : Yang Menerima,
Kepala Puskesmas Long Hubung Petugas Pustu

dr. Yohanes Adam Elsoin ………………………………….

NIP. 19850522 201505 1 001