LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

Laporan bulan/periode :
Permintaan bulan/periode :

No. Nama Barang Obat dan BMHP Satuan Stok Awal PenerimaanPersediaan Pemakaian Stok Akhir Permintaan Pemberian Keterangan
APBD APBN
1 Alopurinol tablet 100 mg tablet 550
2 Asetilsistein 200 mg tablet -
3 Amlodipine Tab 10 mg tablet 560 exp 200
4 Amlodipine Tab 5 mg tablet 600 -
5 Amoksisilin Kaplet 500 mg tablet 150 100
6 Amoksisilin kapsul 250 mg tablet 0
7 Amoksisilin Sirup Forte 250 mg / 5 ml fls 0
8 Amoksisilin Sirup 125 mg / 5 ml fls 48
9 Aminofilin Injeksi 24 mg/ml ampul _
10 Antasida DOEN suspensi fls 24
11 Antasida DOEN tablet tablet 370
12 Antifungi Doen pot -
13 Antihemoroid supp tablet 10
14 Asam Askorbat (Vit. C) tablet 50 mg tablet 0 200
Asam Askorbat (Vit. C) tablet 500 mg
15 Ramivit tablet 190 0
16 Asam Mefenamat tablet 500 mg tablet 180
Asam Asetil Salilislat (Asetosal) Tablet 80
17 mg tablet -
18 Asam Folat Tablet 1 mg tablet 0 exp 100
19 Asiklovir tablet 400 mg tablet 130 0
20 Azitromisin tablet 500 mg tablet 20
21 Bedak Salisil botol
22 Bedak Salisil 2% - 50 Gram botol
23 Betametason krim 0.1 % tube 0 20
24 Cefadroxil syr kering 125 mg fls 0 exp 10
25 Cetirizine 10 mg tablet 230 0
26 Cotrimoxazole 480 tablet 400 0
27 Deksametason injeksi 5mg/ml ampul 13 0
28 Deksametason injeksi 5mg/ml ampul -
29 Deksametason tablet 0,5 mg tablet 180 0
30 Diazepam injeksi 5 mg/ml-2 ml ampul -
31 Diazepam Rectal 5 mg tube -
32 Diazepam Rectal 10 mg tube -
33 Diazepam tablet 2 mg tablet -
34 Dipenhydramoin HCl tablet -
35 Domperidone Tablet 10 mg tablet 190 0
36 Ephinephrine Injeksi ampul -
37 Eritromisin kapsul 500 mg kapsul -
38 Etakridin larutan 0,1% - 300 ml fls -
39 Etanol larutan 70 % - 1000 ml fls -
40 Favipiravir tablet -
41 Fenobarbital tablet 30 mg tablet ?

42 Fenol gliserol Tetes Telinga 10% fls 21 Reco tetes mata

43 Fitomenadion ( Vit K) injeksi 2 mg/ml ampul 0

44 Fitomenadion (Vit. K) tablet 10 mg tablet 100
45 Fludane Capsul kapsul 0
46 Furosemid 40 mg tablet 200 0
47 Flutamol Tablet tablet 100 ed 8 100 colartusin

48 Garam Oralit Serbuk sachet 68 0

49 Gentamisin SM tube 16 0 erlamycetin

50 Gentamisin salep kulit tube 3 10

51 Glibenclamide tablet 400 0
52 Glimepiride tablet 200
53 Gluconas calcicus 10% - 10 ml botol
54 Glukosa larutan steril (infus)10% botol
55 Glukosa larutan steril (infus)5 % botol
56 Griseofulvin tablet
57 Haloperidol tablet 1.5 mg tablet
58 Haloperidol tablet 5 mg tablet
59 Hidrocortisone Cream 2,5% tube 32 0
60 Hidroklortiazid tablet 25 mg tablet 100
61 Hidrokortison krim 2,5% tube
62 Ibuprofen Suspensi 200 mg/ 5 ml 60 ml fls 12
63 Kalsium Laktat (Kalk) tablet 500 mg tablet 4 200
64 Kaptopril tablet 12.5 mg tablet 160
65 Kaptopril tablet 25 mg tablet 190
66 Karbamazepine tablet 200 mg tablet 100
67 Ketokonazole tablet 200 mg tablet 0 100
68 klindamisin kapsul 150 mg kapsul ?

69 Klindamisin kapsul 300 mg kapsul ?

70 Kloramfenicol salep mata tube 23 ed 10

Kloramfenicol salep kulit (Bufacetine)2
71 % tube
72 Klorfeniramin maleat (CTM) tablet 4 mg tablet 0 300
73 Klorpromazin 100 mg tablet 0
74 Kolekalsiferol (Vit D3) 400 tablet tablet 0
75 Kolekalsiferol (Vit D3) 400 Sirup fls 0
76 Kotrimoksazol susp. 120 mg/5 ml - 60ml fls 100 exp 11
77 Kotrimosazol tablet 480 mg tablet 400
78 Lidocain komp. injeksi 2 % - ml ampul 0
79 Lidocain+EphInephrine ampul 0
80 Loratadin tablet 200
81 Magnesium sulfat injeksi 20% - 25 ml botol 0
82 Magnesium sulfat injeksi 40% - 25 ml botol 6
83 Metformin tablet 500 mg tablet 390
84 Metildopa(dopamet) tablet 250mg tablet 170
metiilergometrin maleat (Metergin)
85 tablet salut 0,125 mg tablet 0 100
Metilergometrin maleat injeksi 0,2
86 mg/ml ampul 0
87 Metilprednisolon 4 mg tablet 0 100
88 Metoklorpramid tablet tablet 100
89 Metronidazol 500mg tablet 160 0
90 Metronidazole Syr fl 0
91 Mikonazol krim 2% tube 22
92 Natrium Diklofenak Tablet 50 mg tablet 200
Natrium Klorida larutan infus 0,9% - 500
93 ml botol
94 New Antidest (Attapulgite 600 mg) tablet 100
95 Nifedipin tablet 10 mg tablet 100
96 Nistatin tablet vaginal 100.000 IU tablet 200
97 Nistatin tablet vaginal 500.000 IU tablet 100 exp
98 Oksitetrasiklin SM tube 0
99 Oksitetrasiklin Salep kulit tube 0
100 Oksitosin injeksi 10 IU/ml ampul 0
Obat antidiare non spesifik tablet 600
101 mg tablet 0
102 Omeprazol 30 mg kapsul 0
103 Omeprazol 20 mg kapsul 210
104 Oseltamivir 75 mg kapsul 0
105 Parasetamol drops 100mg/ml fls 0 10
106 Parasetamol sirup 120 mg/ 5 ml fls 2 20
107 Parasetamol tablet 500 mg tablet 240 exp 200
108 Periokin Spray botol
109 Piridoksin VIT b6 10 mg tablet 8 exp 100
110 Povidon iodida 10% larutan - 60 ml botol
111 Povidon iodida 1% larutan-30ml botol
112 Povidon iodida 10% larutan - 300 ml botol
113 Prednisone 5 mg tablet tablet 0 100
114 Pritavit multivitamin tablet 0 100
115 Propanolol tablet 10 mg tablet 80
116 Ranitidine tablet 150 mg tablet
117 Retinol Kapsul 100000 IU kapsul
118 Retinol Kapsul 200000 IU kapsul
119 Ringer Laktat larutan infus - 500 ml botol
120 Salbutamol 2mg tablet tablet
121 Salbutamol 4 mg tablet tablet 100
Salep 2-4 kombinasi : Asam Salisilat 2% +
122 Belerang endap 4% pot 23
123 Sanvita Syrup fls 0 20
124 Scabimite Cream (Premetrin 5% krim) tube 20 ex 8 5
125 Sianokobalamin (Vit B12) Tablet 50mg tablet 0 100
Sianokobalamin (Vit B12) injeksi
126 500mcg/ml ampul
127 Simvastatin tablet 10 mg tablet 440
128 Simvastatin tablet 20mg tablet
129 Siprofloksasin tablet 500 mg tablet
130 Stesolid Enema 10 mg/2,5 ml tube
131 Stesolid Enema 5 mg/2,5 ml tube
132 Tetrasiklin kapsul 500 mg kapsul
133 Thiamin Hcl (Vit B1) 50 mg tablet 0 100
Trihexifenidil hidroksida tablet 2 mg
134 tablet
135 Viorex 2% 500 Ml botol
136 Vitamin B Kompleks tablet tablet 0 100
137 Zinc Syr fls 0 10
138 Zink tablet 200 mg dispersible tablet 100
139 Zink tablet Syr 60ml fls
Aqua Pro Injeksi steril bebas pirogen 20
140 ml ampul 10
141 Steryzime 5 Liter botol
142 Stericide 500 ml botol
143 Albendazol 400 mg tablet kaplet
144 Besi kombinasi asam folat tablet tablet
145 Benzatin Penisilin injeksi 2,4 mg ampul
146 Asam Folat 1mg tablet 0 100
BLUD
147 Caviplex Syrup fls
148 ERlamycetin SM tube
149 Gliseril guaikolat 100 mg tablet
151 Gralixa (Furosemida 40 mg) tablet
152 Hicogel tube
153 ISDN tablet
154 Neo Diaform( Kaolin Pektin) tablet
155 OBH Syrup fls 20
156 Sodium Bikarbonat tablet 200 ed 8
157 Reco TT(Kloramfenikol TT) fls 23
158 Gentian Violet botol
159 Etafen/Ibu Profen 400 mg tablet 200
160 Pehacain ampul
161 Winatin/Loratadin tablet
162 Zendalat/Nifedipine tablet
163 OBH/Itrasal fls ed
164 Amoxicillin Syr 125mg/HOLI fls 0
165 Scabimite Salep Kulit tube 20
166 antasida Doen Tablet/ Triman tablet 370
167 Rosidon Syr fls 7
168 Novadiar suspensi fls
169 Salep 2-4 pot 23
170 Acyclovir 400/ Sampharindo kapsul 130
171 Eryra Forte Kaplet kaplet
172 Zinc Syr/ Mepro fls
173 Methylergometrin 0.125 tablet
174 Triolax suppo
175 Piracetam 800mg kaplet
176 Misoprostol tablet
177 Helixim kapsul 100 mg kapsul 150
178 Daryantulle sachet
179 Dohixat kaplet
180 Flutamol kaplet kaplet 0 100
181 Hicogel tube
182 Hufabion tablet 0 100
183 Farsycol (Kloramfenikol Salep Kulit) tube
184 Laxana tablet tablet
185 Zidalev tablet
186 Neocenta Gel tube 1 10
187 Nisagon Salep Kulit tube 0 10
188 odanostin 4 mg tablet
189 Scabimite Salep Kulit tube
190 Calortusin kaplet
191 Captopril 25 mg tablet 19
192 Cazetin Drop fls 19 ed 7 10
193 Cetirizine tablet PIM tablet 230
194 Digoxin tablet
195 Erlamycetin Plus Tetes Mata fls
196 Erlamycetin Tetes Telinga fls
197 Etafen/Ibu Profen 400 mg tablet 220
198 Tibigon tablet
199 ketoconazole krim tube
200 Klorfeson cream tube
201 Meloxicam 15 mg tablet 200 ed 50 ?

202 Meloxicam 7,5 mg tablet 50 ed 50

203 Farizol tablet 160
204 Piroxicam 10 mg Trifa tablet 380 ed 8 50
205 Piroxicam 20 mg Balatif tablet 0 50
206 Pantocain 2.5 % fls
207 Supramox Drops fs
208 Cetirizine syr Erita fls
209 Ondansetron 4mg/2 ml inject ampul
210 Omeprazol 20 mg kaplet
211 Cefadroxil 500 mg kaplet 30 100
212 Caviplex CDEZ kaplet 250
213 Pacdin Baby cought fls 4 15
214 Hyperchol 300 tablet
215 Selvim 20 mg tablet
216 Atorvastatin 20 Mg tablet
217 Lipepsa Syr fls
218 Rosidon Sirup fls
219 Helixim Syr fls 10
220 Dobrizol Kaplet kaplet
221 Lostacef Dry Syr 250 mg/5ml fls
222 Reco Tetes Mata fls
223 Neocenta Gel tube
224 Hico gel tube 100
225 Quantidex Kaplet tablet
226 Mirasic 650 Kaplet tablet 100
227 Allopurinol 100 tablet
228 Dexametason 0,5 mg tablet
229 Holicos Tablet tablet
230 Odanostin 4 mg tablet
231 Ranitidine Inj ampul
232 Ketorolac Inj ampul
233 10% Glucose Unicap ampul
234 Zidalev 500 mg tablet
235 Holicos Sirup fls
236 Lexigo tablet
237 Flutamol Syrup fls 0 10
238 Gregorix 100 mg tablet
239 Piracetam 800 tablet
240 Scopma Plus tablet 100
241 Nemic ( Asam Mefenamat 500mg ) tablet 200
242 Nocovir 75 mg tablet
243 Zithloric tablet
BMHP
245 Alat Suntik sekali pakai 1 ml pcs
246 Alat Suntik sekali pakai 3 ml pcs
247 Alat Suntik sekali pakai 0,05 ml pcs
248 Alkohol Swab pcs
249 Benecheck Plus Glucose Test Strip strip
250 Benecheck Plus total Cholesterol Test S strip
251 Catgut 2/0 Pcs
252 Catgut 3/0 pcs
253 Etil klorida spray 100 ml botol
254 Fixomul 5 cm pcs
255 Folley Cath No 16 Pcs
256 Folley Cath No 18 Pcs
257 I.V CHAT 20GX 1 1/4 pcs
258 I.V CHAT 24G X 3/4 pcs
259 Infusion Adult PCS
260 IV Cath no 16 PCS
261 IV Cath No 18 PCS
262 IV Cath 20 pcs
263 IV Cath 18 pcs
264 IV Cath 22 pcs
265 IV Cath 24 pcs
266 IV Cath 26
267 Kapas Pembalut/Absorben 250 gram bks
268 Kasa 16 x 16 cm kotak
269 Kasa 40 x 80 roll
270 Kasa Pembalut Hidrofil 4 m x 10 cm bks
271 Kasa Pembalut Hidrofil 4 m x 5 cm bks
272 Lisol botol
273 Masker 3 ply pcs
274 Masker N 95 pcs
275 Plester 2, 5 yards x 4,5 inch (Besar) roll
276 Plester 5 yards x 2 inch (Besar) roll
277 Plester 7, 5 yards x 5 inch (Besar)
278 RAPID HIV 2 TEST TEST
279 Reagen Rapid Test HBsAg WB pcs
280 Sarung tangan non 6,5 Pcs
281 Sarung tangan non 7 Pcs
282 Sarung tangan non 8
283 Sarung tangan non steril uk.M psg
284 Sarung tangan non steril uk.S psg
285 Silk 3/0 pcs
286 Umbilical Clamp pcs
287 Underpad Pcs
288 Urine bag steril 2 L pcs
289 VIKIA HIV 1/2 TEST 1X R1 TEST
290 Etakridine Rivanol 0,1% botol
291 Infusion Pediatric pcs
292 Blood Lancet pcs
293 OXYCAN botol
294 Benecheck Plus Total Cholesterol Test pcs
295 Sarung Tangan Obgyn Steril pasang
296 softanol 500ml botol
297 Stericide 500 ml botol
298 Benecheck Test System pcs
299 Alat Kolesterol Acon pcs
300 Auto Lancet pcs
301 Periokin spray fls
302 Flashback blood colection needle 21x pcs
303 Reagen Ziehl neelsen pcs
304 Sarung tangan ukuran M pasang
305 Sarung tangan ukuran S pasang
306 Sabun Cuci Tangan 500 ml botol
307 Verband elastis besar ukuran 15cmx4 roll
308 Verband elastis kecil ukuran 7,5cmx4 roll
309 Verband Elastis sedang 10 cm x 4,55 roll
310 Benecheck plus total cholesterol test st pcs
311 blood glucose on call meter only pre pcs
312 blood glucose on call strip test acon pcs
313 blood lancet pcs
314 cholesterol on call strip test acon pcs
315 humasens plus glucose strip pcs
316 humasens starter pack pcs
317 multivitamin tablet imusive cd zinc pcs
318 alat cholesterol acon pcs
319 COVERALL/HAZMAT pcs
320 GOWN DISPOSIBLE pcs

Pengelola Obat pustu/poskesdes Rancabali,

Apoteker Puskesmas Rancabali

( ) ( apt. Lianda Rosmawati, S.Farm)

NRP. NRP. 873.3204.04.02.010

Mengetahui,
Kepala Puskesmas

dr HJ. Yuniar Sri Maulani

NIP. 19710603 200212 2 006

vit syrp
lerizine syrp