LAPORAN PERMINTAAN OBAT JKN

UPTD. PUSKESMAS TABANAN I

SUB UNIT : POSKESDES SUDIMARA

KODE NO NAMA OBAT SATUAN JANUARI FEBRUARI MARET APRIL MEI JUNI TOTAL

A1 1 Acyclovir Salep Tube 5 5 0

A2 2 Acyclovir 400 mg Tab Tablet 0 0
A3 3 Albendazol 400 mg tab Tablet 0 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0 0
A5 5 Ambroxol syr Botol 10 5 5 20 15
A6 6 Ambroxol tab 30 mg / Promukus Tablet 0 0
A7 7 Amoksilina kapsul 500 mg Tablet 0 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 0 0
A9 9 Antasida doen tablet kombinasi Tablet 100 200 100 400 300
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0 0
A11 11 Asam mefenamat 500 mg Tablet 0 0
A12 12 Basitrasin Polimiksin Tube 0 0
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0 0
A14 14 Betahistin tab Tablet 0 0
A15 15 Betametazon salep kulit Tube 0 0
A16 16 Captopril 12.5 mg tablet Tablet 0 0
A17 17 Captopril 25 mg tablet Tablet 0 0
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0 0
A19 19 Cefadroxill 500 mg tablet Tablet 0 0
A20 20 Cetirizin10 mg tab Tablet 0 0
A21 21 Ciprofloxazin tablet 500 mg Tablet 0 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 0 0
A23 23 Deksametason tablet 0.5 mg Tablet 200 100 300 200
A24 24 Diazepam 5 mg Tablet 0 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0 0
A26 26 Diazepam tablet 2 mg Tablet 0 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 0 0
A28 28 Domperidon tablet 10 mg Tablet 0 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0 0
A30 30 Erytromysin tablet 500 mg Tablet 0 0
A31 31 Etil klorida semprot Botol 0 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0 0
A35 35 Furosemida tablet 40 mg Tablet 0 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0 0
A37 37 Gentamisin Salep Mata Tube 0 0
A38 38 Gentamysin SK Tube 0 0
A39 39 Gentamysin TM/Genoint TM Botol 0 0
A40 40 Gentian violet larutan 1 % Botol 0 0
A41 41 Glibenklamida tablet 5 mg Tablet 0 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0 0
A43 43 Glukosa larutan infus 10 % steril Botol 0 0
A44 44 Glukosa larutan infus 40 % steril Botol 0 0
A45 45 Glukosa larutan infus 5 % steril Botol 0 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0 0
A47 47 Hidrokortison krim 2.5 % Tube 5 5 0
A48 48 Ibuprofen tablet 400 mg Tablet 0 0
 KODE NO NAMA OBAT SATUAN JANUARI FEBRUARI MARET APRIL MEI JUNI TOTAL

A49 49 Isoniazide 100 mg Tablet 0 0

A50 50 Isoniazide 300 mg Tablet 0 0
A51 51 Isosorbid dinitrat Tablet 0 0
A52 52 Kalsium hidroksida pasta Pot 0 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 100 100 0
A54 54 Ketokonazole 200 mg tablet Tablet 0 0
A55 55 Kloramfenicol salep kulit Tube 0 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0 0
A57 57 Kloramfenikol salep mata 1 % Tube 0 0
A58 58 Kloramfenikol tetes Mata Botol 0 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 100 100 0
A61 61 Kotrimoksasol suspensi Botol 0 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0 0
A63 63 Lidokain inj Ampul 0 0
A64 64 Lidokaina comp inj kombinasi Ampul 0 0
A65 65 Metformin 500 mg tablet Tablet 0 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0 0
A70 70 Metronidazol 500 mg Tablet 0 0
A71 71 Metronidazol tablet 250 mg Tablet 0 0
A72 72 Mikonazole salep Tube 0 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 100 100 0
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0 0
A75 75 Nifedipin tablet 10 mg Tablet 0 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0 0
A82 82 Parasetamol tablet 500mg Tablet 0 0
A83 83 Prednison tablet 5 mgn Tablet 0 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0 0
A85 85 Ranitidin tablet 150 mg Tablet 0 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0 0
A90 90 Ringer laktat larutan infus steril Botol 0 0
A91 91 Risperidon Tablet 0 0
A92 92 Salbutamol tablet 2 mg Tablet 0 0
A93 93 Salbutamol tablet 4 mg Tablet 0 0
A94 94 Salisil bedak 2 % Bks 0 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0 0
A96 96 Silver amalgam serbuk 65-75% Botol 0 0
A97 97 Simvastatin tab 10 mg Tablet 0 0
A98 98 Sulfacetamide tetes mata Botol 0 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0 0
A100 100 Thiamfenikol 500 Tablet 0 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0 0
 KODE NO NAMA OBAT SATUAN JANUARI FEBRUARI MARET APRIL MEI JUNI TOTAL

A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0 0

A103 103 Trifluoperazine (Stelazin) Tablet 0 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0 0
A105 105 Vitamin B kompleks tablet Tablet 100 100 100
A106 106 Zink tablet Tablet 0 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0 0
0 0
OBAT TAMBAHAN 0 0
A108 108 Amlodipin 10 mg tab Tablet 0 0
A109 109 Amlodipin 5 mg tab Tablet 0 0
A110 110 Antasida syr Tablet 0 0
A111 111 Asam Folat 1 mg Tablet 0 0
A112 112 Becefort Vial 0 0
A113 113 Benzatin Penisillin Set 0 0
A114 114 Bonding Tube 0 0
A115 115 Bufacomb salep Ampul 0 0
A116 116 Daryantulle Tube 0 0
A117 117 Dermazine/Burnazin Tablet 0 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0 0
A119 119 Dextrofen syr Tablet 0 0
A120 120 Dormi/Scopma/Spashi tablet Supp 0 0
A121 121 Dulcolac anak supp Supp 0 0
A122 122 Dulcolac dewasa supp Tablet 0 0
A123 123 Dulkolak tablet Botol 0 0
A124 124 Euthyrox 100mg Supp 0 0
A125 125 Glimepiride 2 tablet 0 0
A126 126 Glimepiride 4 Ampul 0 0
A127 127 Ibuprofen syr flesh 0 0
A128 128 Kalium Diklovenac Supp 0 0
A129 129 Kaltropen supp tube 0 0
A130 130 Ketoconazole SK Ampul 0 0
A131 131 Microlax tablet 0 0
A132 132 Miloxicam 7,5 mg Tablet 0 0
A133 133 Multivitamin (Livron B plek) Botol 200 200 400 200
A134 134 Multivitamin sirup (caviplex) Tablet 0 0
A135 135 New antides Tablet 0 0
A136 136 OBH plus Tablet 0 0
A137 137 Omeprasole tablet 20 mg Ampul 0 0
A138 138 Parasetamol drop Ampul 0 0
A139 139 Pehacain Injeksi Tablet 0 0
A140 140 Prenatin DF tablet 0 0
A141 141 Ventolin Nebulizer Tablet 0 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0 0
0 0
BMHP 0 0
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 0 0
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0 0
B5 5 Alkohol 1 Liter Botol 0 0
B64 64 Alkohol swab Box 0 0
B6 6 Bactigrass Box 0 0
B8 8 Betadine 1 L Botol 0 0
 KODE NO NAMA OBAT SATUAN JANUARI FEBRUARI MARET APRIL MEI JUNI TOTAL

B59 59 Betadine 30 ml Botol 0 0

B7 7 Betadine 300 ml Botol 0 0
B9 9 Bisturi No 10 Pcs 0 0
B10 10 Bisturi No 11 Pcs 0 0
B11 11 Bisturi No 20 Pcs 0 0
B12 12 Bisturi No 21 Pcs 0 0
B13 13 Bisturi No 22 Pcs 0 0
B65 65 Blood lancet Box 0 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0 0
B67 67 CE Botol 0 0
B16 16 Daryantulle Box 0 0
B69 69 Folley Cathteter G18 pcs 0 0
B17 17 H2O2 Botol 0 0
B18 18 Hand sanitizer Botol 0 0
B19 19 Hyfafik 5x5 Roll 0 0
B61 61 Hypapix 15 x 5 Roll 0 0
B20 20 Infusion Set dewasa Pcs 0 0
B21 21 IV cath no .18 Pcs 0 0
B22 22 IV cath no .20 Pcs 0 0
B23 23 IV cath no .22 Pcs 0 0
B24 24 IV cath no .24 Roll 0 0
B25 25 IV cath no.16 Pcs 0 0
B26 26 Jarum heacting Pcs 0 0
B27 27 Jarum Injeksi Pcs 0 0
B28 28 Jarum Onemed set Pcs 0 0
B29 29 Jarum Otot -Kulit Set 0 0
B30 30 Jelly Botol 0 0
B31 31 Kantong Puyer Pack 0 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0 0
B63 63 Kapas pembalut 1000g Roll 0 0
B33 33 Kasa Gulung Roll 0 0
B34 34 Kasa hidrofil 18 x 22 Roll 0 0
B35 35 Kasa hidrofil 4 x 10 Roll 0 0
B66 66 Kasa hidrofil 5 x 4 Roll 0 0
B36 36 Kasa pembalut 2 x 80 Roll 0 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 0 0
B38 38 Kertas Perkamen Pack 0 0
B39 39 Klem tali Pusar Pcs 0 0
B40 40 Klip Plastik Obat 10X7 cm Pack 10 10 0
B41 41 KlipPlastik Obat 13X8,7 cm Pack 10 10 0
B42 42 Lisol Botol 0 0
B43 43 Masker Box 50 50 100 100 300 200
B68 68 Masker N95 Pcs 0 0
B55 55 Nylon 5/0 Pcs 0 0
B57 57 Pot Dahak Pcs 0 0
B44 44 Sarung Tangan L Pasang 0 0
B45 45 Sarung Tangan M Pasang 0 50
B46 46 Sarung Tangan S Pasang 0 0
B47 47 Sarung Tangan Steril M Pasang 0 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0 0
B56 56 Slide prosted Pack 0 0
 KODE NO NAMA OBAT SATUAN JANUARI FEBRUARI MARET APRIL MEI JUNI TOTAL

B60 60 Spiritus Pcs 0 0

B62 62 Spuit 10 cc Pcs 0 0
B58 58 Tabung EDTA Box 0 0
B50 50 Urinbag Pcs 0 0
B51 51 Venflon No 20 Pcs 0 0
B52 52 Wing Needle 21 Pcs 0 0
B53 53 Wing Needle 23 Pcs 0 0
B54 54 Wing Needle 25 Pcs 0 0
 LAPORAN PEMAKAIAN OBAT JKN
UPTD. PUSKESMAS TABANAN I

SUB UNIT : POSKESDES SUDIMARA

KOD JANUARI FEBRUARI MARET APRIL MEI JUNI TOTAL

NO NAMA OBAT SATUAN
E
A1 1 Acyclovir Salep Tube 0 0
A2 2 Acyclovir 400 mg Tab Tablet 0 0
A3 3 Albendazol 400 mg tab Tablet 0 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0 0
A5 5 Ambroxol syr Botol 6 3 9 9
A6 6 Ambroxol tab 30 mg / Promukus Tablet 0 0
A7 7 Amoksilina kapsul 500 mg Tablet 0 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 0 0
A9 9 Antasida doen tablet kombinasi Tablet 100 30 50 180 180
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0 0
A11 11 Asam mefenamat 500 mg Tablet 0 0
A12 12 Basitrasin Polimiksin Tube 0 0
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0 0
A14 14 Betahistin tab Tablet 0 0
A15 15 Betametazon salep kulit Tube 0 0
A16 16 Captopril 12.5 mg tablet Tablet 0 0
A17 17 Captopril 25 mg tablet Tablet 0 0
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0 0
A19 19 Cefadroxill 500 mg tablet Tablet 0 0
A20 20 Cetirizin10 mg tab Tablet 0 0
A21 21 Ciprofloxazin tablet 500 mg Tablet 0 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 0 0
A23 23 Deksametason tablet 0.5 mg Tablet 28 28 28
A24 24 Diazepam 5 mg Tablet 0 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0 0
A26 26 Diazepam tablet 2 mg Tablet 0 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 0 0
A28 28 Domperidon tablet 10 mg Tablet 0 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0 0
A30 30 Erytromysin tablet 500 mg Tablet 0 0
A31 31 Etil klorida semprot Botol 0 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0 0
A35 35 Furosemida tablet 40 mg Tablet 0 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0 0
A37 37 Gentamisin Salep Mata Tube 0 0
A38 38 Gentamysin SK Tube 0 0
A39 39 Gentamysin TM/Genoint TM Botol 0 0
A40 40 Gentian violet larutan 1 % Botol 0 0
A41 41 Glibenklamida tablet 5 mg Tablet 0 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0 0
A43 43 Glukosa larutan infus 10 % steril Botol 0 0
A44 44 Glukosa larutan infus 40 % steril Botol 0 0
KOD JANUARI FEBRUARI MARET APRIL MEI JUNI TOTAL
NO NAMA OBAT SATUAN
E
A45 45 Glukosa larutan infus 5 % steril Botol 0 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0 0
A47 47 Hidrokortison krim 2.5 % Tube 0 0
A48 48 Ibuprofen tablet 400 mg Tablet 0 0
A49 49 Isoniazide 100 mg Tablet 0 0
A50 50 Isoniazide 300 mg Tablet 0 0
A51 51 Isosorbid dinitrat Tablet 0 0
A52 52 Kalsium hidroksida pasta Pot 0 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 0 0
A54 54 Ketokonazole 200 mg tablet Tablet 0 0
A55 55 Kloramfenicol salep kulit Tube 0 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0 0
A57 57 Kloramfenikol salep mata 1 % Tube 0 0
A58 58 Kloramfenikol tetes Mata Botol 0 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 0 0
A61 61 Kotrimoksasol suspensi Botol 0 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0 0
A63 63 Lidokain inj Ampul 0 0
A64 64 Lidokaina comp inj kombinasi Ampul 0 0
A65 65 Metformin 500 mg tablet Tablet 0 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0 0
A70 70 Metronidazol 500 mg Tablet 0 0
A71 71 Metronidazol tablet 250 mg Tablet 0 0
A72 72 Mikonazole salep Tube 0 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 0 0
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0 0
A75 75 Nifedipin tablet 10 mg Tablet 0 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0 0
A82 82 Parasetamol tablet 500mg Tablet 0 0
A83 83 Prednison tablet 5 mgn Tablet 0 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0 0
A85 85 Ranitidin tablet 150 mg Tablet 0 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0 0
A90 90 Ringer laktat larutan infus steril Botol 0 0
A91 91 Risperidon Tablet 0 0
A92 92 Salbutamol tablet 2 mg Tablet 0 0
A93 93 Salbutamol tablet 4 mg Tablet 0 0
KOD JANUARI FEBRUARI MARET APRIL MEI JUNI TOTAL
NO NAMA OBAT SATUAN
E
A94 94 Salisil bedak 2 % Bks 0 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0 0
A96 96 Silver amalgam serbuk 65-75% Botol 0 0
A97 97 Simvastatin tab 10 mg Tablet 0 0
A98 98 Sulfacetamide tetes mata Botol 0 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0 0
A100 100 Thiamfenikol 500 Tablet 0 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0 0
A103 103 Trifluoperazine (Stelazin) Tablet 0 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0 0
A105 105 Vitamin B kompleks tablet Tablet 18 18 18
A106 106 Zink tablet Tablet 0 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0 0
0 0
OBAT TAMBAHAN 0 0
A108 108 Amlodipin 10 mg tab Tablet 0 0
A109 109 Amlodipin 5 mg tab Tablet 0 0
A110 110 Antasida syr Tablet 0 0
A111 111 Asam Folat 1 mg Tablet 0 0
A112 112 Becefort Vial 0 0
A113 113 Benzatin Penisillin Set 0 0
A114 114 Bonding Tube 0 0
A115 115 Bufacomb salep Ampul 0 0
A116 116 Daryantulle Tube 0 0
A117 117 Dermazine/Burnazin Tablet 0 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0 0
A119 119 Dextrofen syr Tablet 0 0
A120 120 Dormi/Scopma/Spashi tablet Supp 0 0
A121 121 Dulcolac anak supp Supp 0 0
A122 122 Dulcolac dewasa supp Tablet 0 0
A123 123 Dulkolak tablet Botol 0 0
A124 124 Euthyrox 100mg Supp 0 0
A125 125 Glimepiride 2 tablet 0 0
A126 126 Glimepiride 4 Ampul 0 0
A127 127 Ibuprofen syr flesh 0 0
A128 128 Kalium Diklovenac Supp 0 0
A129 129 Kaltropen supp tube 0 0
A130 130 Ketoconazole SK Ampul 0 0
A131 131 Microlax tablet 0 0
A132 132 Miloxicam 7,5 mg Tablet 50 100 150 150
A133 133 Multivitamin (Livron B plek) Botol 0 0
A134 134 Multivitamin sirup (caviplex) Tablet 0 0
A135 135 New antides Tablet 0 0
A136 136 OBH plus Tablet 0 0
A137 137 Omeprasole tablet 20 mg Ampul 0 0
A138 138 Parasetamol drop Ampul 0 0
A139 139 Pehacain Injeksi Tablet 0 0
A140 140 Prenatin DF tablet 0 0
KOD JANUARI FEBRUARI MARET APRIL MEI JUNI TOTAL
NO NAMA OBAT SATUAN
E
A141 141 Ventolin Nebulizer Tablet 0 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0 0
0 0
BMHP 0 0
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 0 0
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0 0
B5 5 Alkohol 1 Liter Botol 0 0
B64 64 Alkohol swab Box 0 0
B6 6 Bactigrass Box 0 0
B8 8 Betadine 1 L Botol 0 0
B59 59 Betadine 30 ml Botol 0 0
B7 7 Betadine 300 ml Botol 0 0
B9 9 Bisturi No 10 Pcs 0 0
B10 10 Bisturi No 11 Pcs 0 0
B11 11 Bisturi No 20 Pcs 0 0
B12 12 Bisturi No 21 Pcs 0 0
B13 13 Bisturi No 22 Pcs 0 0
B65 65 Blood lancet Box 0 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0 0
B67 67 CE Botol 0 0
B16 16 Daryantulle Box 0 0
B69 69 Folley Cathteter G18 pcs 0 0
B17 17 H2O2 Botol 0 0
B18 18 Hand sanitizer Botol 0 0
B19 19 Hyfafik 5x5 Roll 0 0
B61 61 Hypapix 15 x 5 Roll 0 0
B20 20 Infusion Set dewasa Pcs 0 0
B21 21 IV cath no .18 Pcs 0 0
B22 22 IV cath no .20 Pcs 0 0
B23 23 IV cath no .22 Pcs 0 0
B24 24 IV cath no .24 Roll 0 0
B25 25 IV cath no.16 Pcs 0 0
B26 26 Jarum heacting Pcs 0 0
B27 27 Jarum Injeksi Pcs 0 0
B28 28 Jarum Onemed set Pcs 0 0
B29 29 Jarum Otot -Kulit Set 0 0
B30 30 Jelly Botol 0 0
B31 31 Kantong Puyer Pack 0 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0 0
B63 63 Kapas pembalut 1000g Roll 0 0
B33 33 Kasa Gulung Roll 0 0
B34 34 Kasa hidrofil 18 x 22 Roll 0 0
B35 35 Kasa hidrofil 4 x 10 Roll 0 0
B66 66 Kasa hidrofil 5 x 4 Roll 0 0
B36 36 Kasa pembalut 2 x 80 Roll 0 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 0 0
KOD JANUARI FEBRUARI MARET APRIL MEI JUNI TOTAL
NO NAMA OBAT SATUAN
E
B38 38 Kertas Perkamen Pack 0 0
B39 39 Klem tali Pusar Pcs 0 0
B40 40 Klip Plastik Obat 10X7 cm Pack 0 0
B41 41 KlipPlastik Obat 13X8,7 cm Pack 0 0
B42 42 Lisol Botol 0 0
B43 43 Masker Box 25 60 60 145 145
B68 68 Masker N95 Pcs 0 0
B55 55 Nylon 5/0 Pcs 0 0
B57 57 Pot Dahak Pcs 0 0
B44 44 Sarung Tangan L Pasang 0 0
B45 45 Sarung Tangan M Pasang 0 0
B46 46 Sarung Tangan S Pasang 0 0
B47 47 Sarung Tangan Steril M Pasang 0 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0 0
B56 56 Slide prosted Pack 0 0
B60 60 Spiritus Pcs 0 0
B62 62 Spuit 10 cc Pcs 0 0
B58 58 Tabung EDTA Box 0 0
B50 50 Urinbag Pcs 0 0
B51 51 Venflon No 20 Pcs 0 0
B52 52 Wing Needle 21 Pcs 0 0
B53 53 Wing Needle 23 Pcs 0 0
B54 54 Wing Needle 25 Pcs 0 0
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT JKN
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA

PELAPORAN : MARET 2021

PERMINTAAN : APRIL 2021

STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN
AWAL
A1 1 Acyclovir Salep Tube 0 0
A2 2 Acyclovir 400 mg Tab Tablet 0 0
A3 3 Albendazol 400 mg tab Tablet 0 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0 0
A5 5 Ambroxol syr Botol 0 0
A6 6 Ambroxol tab 30 mg / Promukus Tablet 0 0
A7 7 Amoksilina kapsul 500 mg Tablet 0 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 0 0
A9 9 Antasida doen tablet kombinasi Tablet 100 100 100 0 200
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0 0
A11 11 Asam mefenamat 500 mg Tablet 0 0
A12 12 Basitrasin Polimiksin Tube 0 0
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0 0
A14 14 Betahistin tab Tablet 0 0
A15 15 Betametazon salep kulit Tube 0 0
A16 16 Captopril 12.5 mg tablet Tablet 0 0
A17 17 Captopril 25 mg tablet Tablet 0 0
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0 0
A19 19 Cefadroxill 500 mg tablet Tablet 0 0
A20 20 Cetirizin10 mg tab Tablet 0 0
A21 21 Ciprofloxazin tablet 500 mg Tablet 0 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 0 0
A23 23 Deksametason tablet 0.5 mg Tablet 0 0
A24 24 Diazepam 5 mg Tablet 0 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0 0
A26 26 Diazepam tablet 2 mg Tablet 0 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 0 0
A28 28 Domperidon tablet 10 mg Tablet 0 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0 0
A30 30 Erytromysin tablet 500 mg Tablet 0 0
A31 31 Etil klorida semprot Botol 0 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0 0
A35 35 Furosemida tablet 40 mg Tablet 0 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN
AWAL
A37 37 Gentamisin Salep Mata Tube 0 0
A38 38 Gentamysin SK Tube 0 0
A39 39 Gentamysin TM/Genoint TM Botol 0 0
A40 40 Gentian violet larutan 1 % Botol 0 0
A41 41 Glibenklamida tablet 5 mg Tablet 0 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0 0
A43 43 Glukosa larutan infus 10 % steril Botol 0 0
A44 44 Glukosa larutan infus 40 % steril Botol 0 0
A45 45 Glukosa larutan infus 5 % steril Botol 0 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0 0
A47 47 Hidrokortison krim 2.5 % Tube 0 0
A48 48 Ibuprofen tablet 400 mg Tablet 0 0
A49 49 Isoniazide 100 mg Tablet 0 0
A50 50 Isoniazide 300 mg Tablet 0 0
A51 51 Isosorbid dinitrat Tablet 0 0
A52 52 Kalsium hidroksida pasta Pot 0 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 0 0
A54 54 Ketokonazole 200 mg tablet Tablet 0 0
A55 55 Kloramfenicol salep kulit Tube 0 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0 0
A57 57 Kloramfenikol salep mata 1 % Tube 0 0
A58 58 Kloramfenikol tetes Mata Botol 0 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 0 0
A61 61 Kotrimoksasol suspensi Botol 0 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0 0
A63 63 Lidokain inj Ampul 0 0
A64 64 Lidokaina comp inj kombinasi Ampul 0 0
A65 65 Metformin 500 mg tablet Tablet 0 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0 0
A70 70 Metronidazol 500 mg Tablet 0 0
A71 71 Metronidazol tablet 250 mg Tablet 0 0
A72 72 Mikonazole salep Tube 0 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 0 0
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0 0
A75 75 Nifedipin tablet 10 mg Tablet 0 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN
AWAL
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0 0
A82 82 Parasetamol tablet 500mg Tablet 0 0
A83 83 Prednison tablet 5 mgn Tablet 0 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0 0
A85 85 Ranitidin tablet 150 mg Tablet 0 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0 0
A90 90 Ringer laktat larutan infus steril Botol 0 0
A91 91 Risperidon Tablet 0 0
A92 92 Salbutamol tablet 2 mg Tablet 0 0
A93 93 Salbutamol tablet 4 mg Tablet 0 0
A94 94 Salisil bedak 2 % Bks 0 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0 0
A96 96 Silver amalgam serbuk 65-75% Botol 0 0
A97 97 Simvastatin tab 10 mg Tablet 0 0
A98 98 Sulfacetamide tetes mata Botol 0 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0 0
A100 100 Thiamfenikol 500 Tablet 0 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0 0
A103 103 Trifluoperazine (Stelazin) Tablet 0 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0 0
A105 105 Vitamin B kompleks tablet Tablet 0 0
A106 106 Zink tablet Tablet 0 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0 0

OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0 0
A109 109 Amlodipin 5 mg tab Tablet 0 0
A110 110 Antasida syr Tablet 0 0
A111 111 Asam Folat 1 mg Tablet 0 0
A112 112 Becefort Vial 0 0
A113 113 Benzatin Penisillin Set 0 0
A114 114 Bonding Tube 0 0
A115 115 Bufacomb salep Ampul 0 0
A116 116 Daryantulle Tube 0 0
A117 117 Dermazine/Burnazin Tablet 0 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0 0
A119 119 Dextrofen syr Tablet 0 0
A120 120 Dormi/Scopma/Spashi tablet Supp 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN
AWAL
A121 121 Dulcolac anak supp Supp 0 0
A122 122 Dulcolac dewasa supp Tablet 0 0
A123 123 Dulkolak tablet Botol 0 0
A124 124 Euthyrox 100mg Supp 0 0
A125 125 Glimepiride 2 tablet 0 0
A126 126 Glimepiride 4 Ampul 0 0
A127 127 Ibuprofen syr flesh 0 0
A128 128 Kalium Diklovenac Supp 0 0
A129 129 Kaltropen supp tube 0 0
A130 130 Ketoconazole SK Ampul 0 0
A131 131 Microlax tablet 0 0
A132 132 Miloxicam 7,5 mg Tablet 0 0
A133 133 Multivitamin (Livron B plek) Botol 0 0
A134 134 Multivitamin sirup (caviplex) Tablet 0 0
A135 135 New antides Tablet 0 0
A136 136 OBH plus Tablet 0 0
A137 137 Omeprasole tablet 20 mg Ampul 0 0
A138 138 Parasetamol drop Ampul 0 0
A139 139 Pehacain Injeksi Tablet 0 0
A140 140 Prenatin DF tablet 0 0
A141 141 Ventolin Nebulizer Tablet 0 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0 0

BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 0 0
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0 0
B5 5 Alkohol 1 Liter Botol 0 0
B64 64 Alkohol swab Box 0 0
B6 6 Bactigrass Box 0 0
B8 8 Betadine 1 L Botol 0 0
B59 59 Betadine 30 ml Botol 0 0
B7 7 Betadine 300 ml Botol 0 0
B9 9 Bisturi No 10 Pcs 0 0
B10 10 Bisturi No 11 Pcs 0 0
B11 11 Bisturi No 20 Pcs 0 0
B12 12 Bisturi No 21 Pcs 0 0
B13 13 Bisturi No 22 Pcs 0 0
B65 65 Blood lancet Box 0 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0 0
B67 67 CE Botol 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN
AWAL
B16 16 Daryantulle Box 0 0
B69 69 Folley Cathteter G18 pcs 0 0
B17 17 H2O2 Botol 0 0
B18 18 Hand sanitizer Botol 0 0
B19 19 Hyfafik 5x5 Roll 0 0
B61 61 Hypapix 15 x 5 Roll 0 0
B20 20 Infusion Set dewasa Pcs 0 0
B21 21 IV cath no .18 Pcs 0 0
B22 22 IV cath no .20 Pcs 0 0
B23 23 IV cath no .22 Pcs 0 0
B24 24 IV cath no .24 Roll 0 0
B25 25 IV cath no.16 Pcs 0 0
B26 26 Jarum heacting Pcs 0 0
B27 27 Jarum Injeksi Pcs 0 0
B28 28 Jarum Onemed set Pcs 0 0
B29 29 Jarum Otot -Kulit Set 0 0
B30 30 Jelly Botol 0 0
B31 31 Kantong Puyer Pack 0 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0 0
B63 63 Kapas pembalut 1000g Roll 0 0
B33 33 Kasa Gulung Roll 0 0
B34 34 Kasa hidrofil 18 x 22 Roll 0 0
B35 35 Kasa hidrofil 4 x 10 Roll 0 0
B66 66 Kasa hidrofil 5 x 4 Roll 0 0
B36 36 Kasa pembalut 2 x 80 Roll 0 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 0 0
B38 38 Kertas Perkamen Pack 0 0
B39 39 Klem tali Pusar Pcs 0 0
B40 40 Klip Plastik Obat 10X7 cm Pack 0 0
B41 41 KlipPlastik Obat 13X8,7 cm Pack 0 0
B42 42 Lisol Botol 0 0
B43 43 Masker Box 50 50 25 25 50
B68 68 Masker N95 Pcs 0 0
B55 55 Nylon 5/0 Pcs 0 0
B57 57 Pot Dahak Pcs 0 0
B44 44 Sarung Tangan L Pasang 0 0
B45 45 Sarung Tangan M Pasang 0 0
B46 46 Sarung Tangan S Pasang 0 0
B47 47 Sarung Tangan Steril M Pasang 0 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0 0
B56 56 Slide prosted Pack 0 0
B60 60 Spiritus Pcs 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN
AWAL
B62 62 Spuit 10 cc Pcs 0 0
B58 58 Tabung EDTA Box 0 0
B50 50 Urinbag Pcs 0 0
B51 51 Venflon No 20 Pcs 0 0
B52 52 Wing Needle 21 Pcs 0 0
B53 53 Wing Needle 23 Pcs 0 0
B54 54 Wing Needle 25 Pcs 0 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat Penanggungjawab Sub Unit

dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018 NIP.197608142006042014

Mengetahui/Menyetujui Yang Menyerahkan Yang Menerima

Pimpinan Puskesmas Tabanan I Petugas Gudang Obat Petugas Puskesmas Tabanan I

dr. I KETUT SERINATA Ni Md Ayu Yuliani Putri H,A.Md.Farm GST.A.P. YULIANINGSIH A.Md.Keb
NIP.19660616 200212 1 002 NIP. 19930719 201903 2 018 NIP.197608142006042014
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT JKN
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : APRIL 2021
PERMINTAAN : MEI 2021
STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN
AWAL
A1 1 Acyclovir Salep Tube 0 0
A2 2 Acyclovir 400 mg Tab Tablet 0 0
A3 3 Albendazol 400 mg tab Tablet 0 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0 0
A5 5 Ambroxol syr Botol 10 10 6 4 5
A6 6 Ambroxol tab 30 mg / Promukus Tablet 0 0
A7 7 Amoksilina kapsul 500 mg Tablet 0 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 0 0
A9 9 Antasida doen tablet kombinasi Tablet 200 200 30 170
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0 0
A11 11 Asam mefenamat 500 mg Tablet 0 0
A12 12 Basitrasin Polimiksin Tube 0 0
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0 0
A14 14 Betahistin tab Tablet 0 0
A15 15 Betametazon salep kulit Tube 0 0
A16 16 Captopril 12.5 mg tablet Tablet 0 0
A17 17 Captopril 25 mg tablet Tablet 0 0
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0 0
A19 19 Cefadroxill 500 mg tablet Tablet 0 0
A20 20 Cetirizin10 mg tab Tablet 0 0
A21 21 Ciprofloxazin tablet 500 mg Tablet 0 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 0 0
A23 23 Deksametason tablet 0.5 mg Tablet 200 200 200
A24 24 Diazepam 5 mg Tablet 0 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0 0
A26 26 Diazepam tablet 2 mg Tablet 0 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 0 0
A28 28 Domperidon tablet 10 mg Tablet 0 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0 0
A30 30 Erytromysin tablet 500 mg Tablet 0 0
A31 31 Etil klorida semprot Botol 0 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN
AWAL
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0 0
A35 35 Furosemida tablet 40 mg Tablet 0 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0 0
A37 37 Gentamisin Salep Mata Tube 0 0
A38 38 Gentamysin SK Tube 0 0
A39 39 Gentamysin TM/Genoint TM Botol 0 0
A40 40 Gentian violet larutan 1 % Botol 0 0
A41 41 Glibenklamida tablet 5 mg Tablet 0 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0 0
A43 43 Glukosa larutan infus 10 % steril Botol 0 0
A44 44 Glukosa larutan infus 40 % steril Botol 0 0
A45 45 Glukosa larutan infus 5 % steril Botol 0 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0 0
A47 47 Hidrokortison krim 2.5 % Tube 0 0
A48 48 Ibuprofen tablet 400 mg Tablet 0 0
A49 49 Isoniazide 100 mg Tablet 0 0
A50 50 Isoniazide 300 mg Tablet 0 0
A51 51 Isosorbid dinitrat Tablet 0 0
A52 52 Kalsium hidroksida pasta Pot 0 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 0 0
A54 54 Ketokonazole 200 mg tablet Tablet 0 0
A55 55 Kloramfenicol salep kulit Tube 0 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0 0
A57 57 Kloramfenikol salep mata 1 % Tube 0 0
A58 58 Kloramfenikol tetes Mata Botol 0 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 0 0
A61 61 Kotrimoksasol suspensi Botol 0 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0 0
A63 63 Lidokain inj Ampul 0 0
A64 64 Lidokaina comp inj kombinasi Ampul 0 0
A65 65 Metformin 500 mg tablet Tablet 0 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN
AWAL
A70 70 Metronidazol 500 mg Tablet 0 0
A71 71 Metronidazol tablet 250 mg Tablet 0 0
A72 72 Mikonazole salep Tube 0 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 0 0
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0 0
A75 75 Nifedipin tablet 10 mg Tablet 0 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0 0
A82 82 Parasetamol tablet 500mg Tablet 0 0
A83 83 Prednison tablet 5 mgn Tablet 0 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0 0
A85 85 Ranitidin tablet 150 mg Tablet 0 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0 0
A90 90 Ringer laktat larutan infus steril Botol 0 0
A91 91 Risperidon Tablet 0 0
A92 92 Salbutamol tablet 2 mg Tablet 0 0
A93 93 Salbutamol tablet 4 mg Tablet 0 0
A94 94 Salisil bedak 2 % Bks 0 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0 0
A96 96 Silver amalgam serbuk 65-75% Botol 0 0
A97 97 Simvastatin tab 10 mg Tablet 0 0
A98 98 Sulfacetamide tetes mata Botol 0 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0 0
A100 100 Thiamfenikol 500 Tablet 0 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0 0
A103 103 Trifluoperazine (Stelazin) Tablet 0 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0 0
A105 105 Vitamin B kompleks tablet Tablet 0 0
A106 106 Zink tablet Tablet 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN
AWAL
A107 107 Amoxicillin syr 250 / 5 mg Botol 0 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0 0
A109 109 Amlodipin 5 mg tab Tablet 0 0
A110 110 Antasida syr Tablet 0 0
A111 111 Asam Folat 1 mg Tablet 0 0
A112 112 Becefort Vial 0 0
A113 113 Benzatin Penisillin Set 0 0
A114 114 Bonding Tube 0 0
A115 115 Bufacomb salep Ampul 0 0
A116 116 Daryantulle Tube 0 0
A117 117 Dermazine/Burnazin Tablet 0 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0 0
A119 119 Dextrofen syr Tablet 0 0
A120 120 Dormi/Scopma/Spashi tablet Supp 0 0
A121 121 Dulcolac anak supp Supp 0 0
A122 122 Dulcolac dewasa supp Tablet 0 0
A123 123 Dulkolak tablet Botol 0 0
A124 124 Euthyrox 100mg Supp 0 0
A125 125 Glimepiride 2 tablet 0 0
A126 126 Glimepiride 4 Ampul 0 0
A127 127 Ibuprofen syr flesh 0 0
A128 128 Kalium Diklovenac Supp 0 0
A129 129 Kaltropen supp tube 0 0
A130 130 Ketoconazole SK Ampul 0 0
A131 131 Microlax tablet 0 0
A132 132 Miloxicam 7,5 mg Tablet 0 0
A133 133 Multivitamin (Livron B plek) Botol 200 200 50 150
A134 134 Multivitamin sirup (caviplex) Tablet 0 0
A135 135 New antides Tablet 0 0
A136 136 OBH plus Tablet 0 0
A137 137 Omeprasole tablet 20 mg Ampul 0 0
A138 138 Parasetamol drop Ampul 0 0
A139 139 Pehacain Injeksi Tablet 0 0
A140 140 Prenatin DF tablet 0 0
A141 141 Ventolin Nebulizer Tablet 0 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN
AWAL
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 0 0
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0 0
B5 5 Alkohol 1 Liter Botol 0 0
B64 64 Alkohol swab Box 0 0
B6 6 Bactigrass Box 0 0
B8 8 Betadine 1 L Botol 0 0
B59 59 Betadine 30 ml Botol 0 0
B7 7 Betadine 300 ml Botol 0 0
B9 9 Bisturi No 10 Pcs 0 0
B10 10 Bisturi No 11 Pcs 0 0
B11 11 Bisturi No 20 Pcs 0 0
B12 12 Bisturi No 21 Pcs 0 0
B13 13 Bisturi No 22 Pcs 0 0
B65 65 Blood lancet Box 0 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0 0
B67 67 CE Botol 0 0
B16 16 Daryantulle Box 0 0
B69 69 Folley Cathteter G18 pcs 0 0
B17 17 H2O2 Botol 0 0
B18 18 Hand sanitizer Botol 0 0
B19 19 Hyfafik 5x5 Roll 0 0
B61 61 Hypapix 15 x 5 Roll 0 0
B20 20 Infusion Set dewasa Pcs 0 0
B21 21 IV cath no .18 Pcs 0 0
B22 22 IV cath no .20 Pcs 0 0
B23 23 IV cath no .22 Pcs 0 0
B24 24 IV cath no .24 Roll 0 0
B25 25 IV cath no.16 Pcs 0 0
B26 26 Jarum heacting Pcs 0 0
B27 27 Jarum Injeksi Pcs 0 0
B28 28 Jarum Onemed set Pcs 0 0
B29 29 Jarum Otot -Kulit Set 0 0
B30 30 Jelly Botol 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN
AWAL
B31 31 Kantong Puyer Pack 0 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0 0
B63 63 Kapas pembalut 1000g Roll 0 0
B33 33 Kasa Gulung Roll 0 0
B34 34 Kasa hidrofil 18 x 22 Roll 0 0
B35 35 Kasa hidrofil 4 x 10 Roll 0 0
B66 66 Kasa hidrofil 5 x 4 Roll 0 0
B36 36 Kasa pembalut 2 x 80 Roll 0 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 0 0
B38 38 Kertas Perkamen Pack 0 0
B39 39 Klem tali Pusar Pcs 0 0
B40 40 Klip Plastik Obat 10X7 cm Pack 0 0
B41 41 KlipPlastik Obat 13X8,7 cm Pack 0 0
B42 42 Lisol Botol 0 0
B43 43 Masker Box 25 50 75 60 15 100
B68 68 Masker N95 Pcs 0 0
B55 55 Nylon 5/0 Pcs 0 0
B57 57 Pot Dahak Pcs 0 0
B44 44 Sarung Tangan L Pasang 0 0
B45 45 Sarung Tangan M Pasang 0 0
B46 46 Sarung Tangan S Pasang 0 0
B47 47 Sarung Tangan Steril M Pasang 0 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0 0
B56 56 Slide prosted Pack 0 0
B60 60 Spiritus Pcs 0 0
B62 62 Spuit 10 cc Pcs 0 0
B58 58 Tabung EDTA Box 0 0
B50 50 Urinbag Pcs 0 0
B51 51 Venflon No 20 Pcs 0 0
B52 52 Wing Needle 21 Pcs 0 0
B53 53 Wing Needle 23 Pcs 0 0
B54 54 Wing Needle 25 Pcs 0 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat Penanggungjawab Sub Unit
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN
AWAL

dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018 NIP.197608142006042014
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : MEI 2021
PERMINTAAN : JUNI 2021
STOK
KODE NO NAMA OBAT SATUAN
AWAL
A1 1 Acyclovir Salep Tube 0
A2 2 Acyclovir 400 mg Tab Tablet 0
A3 3 Albendazol 400 mg tab Tablet 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0
A5 5 Ambroxol syr Botol 4
A6 6 Ambroxol tab 30 mg / Promukus Tablet 0
A7 7 Amoksilina kapsul 500 mg Tablet 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 0
A9 9 Antasida doen tablet kombinasi Tablet 170
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0
A11 11 Asam mefenamat 500 mg Tablet 0
A12 12 Basitrasin Polimiksin Tube 0
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0
A14 14 Betahistin tab Tablet 0
A15 15 Betametazon salep kulit Tube 0
A16 16 Captopril 12.5 mg tablet Tablet 0
A17 17 Captopril 25 mg tablet Tablet 0
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0
A19 19 Cefadroxill 500 mg tablet Tablet 0
A20 20 Cetirizin10 mg tab Tablet 0
A21 21 Ciprofloxazin tablet 500 mg Tablet 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 0
A23 23 Deksametason tablet 0.5 mg Tablet 200
A24 24 Diazepam 5 mg Tablet 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0
A26 26 Diazepam tablet 2 mg Tablet 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 0
A28 28 Domperidon tablet 10 mg Tablet 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0
A30 30 Erytromysin tablet 500 mg Tablet 0
A31 31 Etil klorida semprot Botol 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0
A35 35 Furosemida tablet 40 mg Tablet 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0
A37 37 Gentamisin Salep Mata Tube 0
A38 38 Gentamysin SK Tube 0
A39 39 Gentamysin TM/Genoint TM Botol 0
A40 40 Gentian violet larutan 1 % Botol 0
A41 41 Glibenklamida tablet 5 mg Tablet 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0
A43 43 Glukosa larutan infus 10 % steril Botol 0
A44 44 Glukosa larutan infus 40 % steril Botol 0
A45 45 Glukosa larutan infus 5 % steril Botol 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0
A47 47 Hidrokortison krim 2.5 % Tube 0
A48 48 Ibuprofen tablet 400 mg Tablet 0
A49 49 Isoniazide 100 mg Tablet 0
A50 50 Isoniazide 300 mg Tablet 0
A51 51 Isosorbid dinitrat Tablet 0
A52 52 Kalsium hidroksida pasta Pot 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 0
A54 54 Ketokonazole 200 mg tablet Tablet 0
A55 55 Kloramfenicol salep kulit Tube 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0
A57 57 Kloramfenikol salep mata 1 % Tube 0
A58 58 Kloramfenikol tetes Mata Botol 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 0
A61 61 Kotrimoksasol suspensi Botol 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0
A63 63 Lidokain inj Ampul 0
A64 64 Lidokaina comp inj kombinasi Ampul 0
A65 65 Metformin 500 mg tablet Tablet 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0
A70 70 Metronidazol 500 mg Tablet 0
A71 71 Metronidazol tablet 250 mg Tablet 0
A72 72 Mikonazole salep Tube 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 0
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0
A75 75 Nifedipin tablet 10 mg Tablet 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0
A82 82 Parasetamol tablet 500mg Tablet 0
A83 83 Prednison tablet 5 mgn Tablet 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0
A85 85 Ranitidin tablet 150 mg Tablet 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0
A90 90 Ringer laktat larutan infus steril Botol 0
A91 91 Risperidon Tablet 0
A92 92 Salbutamol tablet 2 mg Tablet 0
A93 93 Salbutamol tablet 4 mg Tablet 0
A94 94 Salisil bedak 2 % Bks 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0
A96 96 Silver amalgam serbuk 65-75% Botol 0
A97 97 Simvastatin tab 10 mg Tablet 0
A98 98 Sulfacetamide tetes mata Botol 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0
A100 100 Thiamfenikol 500 Tablet 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0
A103 103 Trifluoperazine (Stelazin) Tablet 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0
A105 105 Vitamin B kompleks tablet Tablet 0
A106 106 Zink tablet Tablet 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0
A109 109 Amlodipin 5 mg tab Tablet 0
A110 110 Antasida syr Tablet 0
A111 111 Asam Folat 1 mg Tablet 0
A112 112 Becefort Vial 0
A113 113 Benzatin Penisillin Set 0
A114 114 Bonding Tube 0
A115 115 Bufacomb salep Ampul 0
A116 116 Daryantulle Tube 0
A117 117 Dermazine/Burnazin Tablet 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0
A119 119 Dextrofen syr Tablet 0
A120 120 Dormi/Scopma/Spashi tablet Supp 0
A121 121 Dulcolac anak supp Supp 0
A122 122 Dulcolac dewasa supp Tablet 0
A123 123 Dulkolak tablet Botol 0
A124 124 Euthyrox 100mg Supp 0
A125 125 Glimepiride 2 tablet 0
A126 126 Glimepiride 4 Ampul 0
A127 127 Ibuprofen syr flesh 0
A128 128 Kalium Diklovenac Supp 0
A129 129 Kaltropen supp tube 0
A130 130 Ketoconazole SK Ampul 0
A131 131 Microlax tablet 0
A132 132 Miloxicam 7,5 mg Tablet 0
A133 133 Multivitamin (Livron B plek) Botol 150
A134 134 Multivitamin sirup (caviplex) Tablet 0
A135 135 New antides Tablet 0
A136 136 OBH plus Tablet 0
A137 137 Omeprasole tablet 20 mg Ampul 0
A138 138 Parasetamol drop Ampul 0
A139 139 Pehacain Injeksi Tablet 0
A140 140 Prenatin DF tablet 0
A141 141 Ventolin Nebulizer Tablet 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 0
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0
B5 5 Alkohol 1 Liter Botol 0
B64 64 Alkohol swab Box 0
B6 6 Bactigrass Box 0
B8 8 Betadine 1 L Botol 0
B59 59 Betadine 30 ml Botol 0
B7 7 Betadine 300 ml Botol 0
B9 9 Bisturi No 10 Pcs 0
B10 10 Bisturi No 11 Pcs 0
B11 11 Bisturi No 20 Pcs 0
B12 12 Bisturi No 21 Pcs 0
B13 13 Bisturi No 22 Pcs 0
B65 65 Blood lancet Box 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0
B67 67 CE Botol 0
B16 16 Daryantulle Box 0
B69 69 Folley Cathteter G18 pcs 0
B17 17 H2O2 Botol 0
B18 18 Hand sanitizer Botol 0
B19 19 Hyfafik 5x5 Roll 0
B61 61 Hypapix 15 x 5 Roll 0
B20 20 Infusion Set dewasa Pcs 0
B21 21 IV cath no .18 Pcs 0
B22 22 IV cath no .20 Pcs 0
B23 23 IV cath no .22 Pcs 0
B24 24 IV cath no .24 Roll 0
B25 25 IV cath no.16 Pcs 0
B26 26 Jarum heacting Pcs 0
B27 27 Jarum Injeksi Pcs 0
B28 28 Jarum Onemed set Pcs 0
B29 29 Jarum Otot -Kulit Set 0
B30 30 Jelly Botol 0
B31 31 Kantong Puyer Pack 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0
B63 63 Kapas pembalut 1000g Roll 0
B33 33 Kasa Gulung Roll 0
B34 34 Kasa hidrofil 18 x 22 Roll 0
B35 35 Kasa hidrofil 4 x 10 Roll 0
B66 66 Kasa hidrofil 5 x 4 Roll 0
B36 36 Kasa pembalut 2 x 80 Roll 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 0
B38 38 Kertas Perkamen Pack 0
B39 39 Klem tali Pusar Pcs 0
B40 40 Klip Plastik Obat 10X7 cm Pack 0
B41 41 KlipPlastik Obat 13X8,7 cm Pack 0
B42 42 Lisol Botol 0
B43 43 Masker Box 15
B68 68 Masker N95 Pcs 0
B55 55 Nylon 5/0 Pcs 0
B57 57 Pot Dahak Pcs 0
B44 44 Sarung Tangan L Pasang 0
B45 45 Sarung Tangan M Pasang 0
B46 46 Sarung Tangan S Pasang 0
B47 47 Sarung Tangan Steril M Pasang 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0
B56 56 Slide prosted Pack 0
B60 60 Spiritus Pcs 0
B62 62 Spuit 10 cc Pcs 0
B58 58 Tabung EDTA Box 0
B50 50 Urinbag Pcs 0
B51 51 Venflon No 20 Pcs 0
B52 52 Wing Needle 21 Pcs 0
B53 53 Wing Needle 23 Pcs 0
B54 54 Wing Needle 25 Pcs 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat
dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A.Md
NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018

Mengetahui/Menyetujui
Pimpinan Puskesmas Tabanan I

dr. I KETUT SERINATA

NIP.19660616 200212 1 002
 AN DAN LEMBAR PERMINTAAN OBAT JKN
D. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
ELAPORAN : MEI 2021
ERMINTAAN : JUNI 2021

PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

0 0
0 0
0 0
0 0
5 9 3 6 5
0 0
0 0
0 0
170 50 120 100
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
200 28 172 100
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
100 100 18 82 200
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
150 100 50 200
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
100 115 60 55 100
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

nanggunjawab Gudang Obat Penanggungjawab Sub Unit

Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
P. 19930719 201903 2 018 NIP.197608142006042014

Yang Menyerahkan Yang Menerima

Petugas Gudang Obat Petugas Puskesmas Tabanan I

Ni Md Ayu Yuliani Putri H,A.Md.Farm GST.A.P. YULIANINGSIH A.Md.Keb

NIP. 19930719 201903 2 018 NIP.197608142006042014
PENERIMAAN
Puskesmas Tabanan I

. YULIANINGSIH A.Md.Keb
08142006042014
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAA
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : JUNI 2021
PERMINTAAN : JULI 2021
STOK
KODE NO NAMA OBAT SATUAN
AWAL
A1 1 Acyclovir Salep Tube 0
A2 2 Acyclovir 400 mg Tab Tablet 0
A3 3 Albendazol 400 mg tab Tablet 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0
A5 5 Ambroxol syr Botol 6
A6 6 Ambroxol tab 30 mg / Promukus Tablet 0
A7 7 Amoksilina kapsul 500 mg Tablet 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 0
A9 9 Antasida doen tablet kombinasi Tablet 120
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0
A11 11 Asam mefenamat 500 mg Tablet 0
A12 12 Basitrasin Polimiksin Tube 0
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0
A14 14 Betahistin tab Tablet 0
A15 15 Betametazon salep kulit Tube 0
A16 16 Captopril 12.5 mg tablet Tablet 0
A17 17 Captopril 25 mg tablet Tablet 0
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0
A19 19 Cefadroxill 500 mg tablet Tablet 0
A20 20 Cetirizin10 mg tab Tablet 0
A21 21 Ciprofloxazin tablet 500 mg Tablet 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 0
A23 23 Deksametason tablet 0.5 mg Tablet 172
A24 24 Diazepam 5 mg Tablet 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0
A26 26 Diazepam tablet 2 mg Tablet 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 0
A28 28 Domperidon tablet 10 mg Tablet 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0
A30 30 Erytromysin tablet 500 mg Tablet 0
A31 31 Etil klorida semprot Botol 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0
A35 35 Furosemida tablet 40 mg Tablet 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0
A37 37 Gentamisin Salep Mata Tube 0
A38 38 Gentamysin SK Tube 0
A39 39 Gentamysin TM/Genoint TM Botol 0
A40 40 Gentian violet larutan 1 % Botol 0
A41 41 Glibenklamida tablet 5 mg Tablet 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0
A43 43 Glukosa larutan infus 10 % steril Botol 0
A44 44 Glukosa larutan infus 40 % steril Botol 0
A45 45 Glukosa larutan infus 5 % steril Botol 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0
A47 47 Hidrokortison krim 2.5 % Tube 0
A48 48 Ibuprofen tablet 400 mg Tablet 0
A49 49 Isoniazide 100 mg Tablet 0
A50 50 Isoniazide 300 mg Tablet 0
A51 51 Isosorbid dinitrat Tablet 0
A52 52 Kalsium hidroksida pasta Pot 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 0
A54 54 Ketokonazole 200 mg tablet Tablet 0
A55 55 Kloramfenicol salep kulit Tube 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0
A57 57 Kloramfenikol salep mata 1 % Tube 0
A58 58 Kloramfenikol tetes Mata Botol 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 0
A61 61 Kotrimoksasol suspensi Botol 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0
A63 63 Lidokain inj Ampul 0
A64 64 Lidokaina comp inj kombinasi Ampul 0
A65 65 Metformin 500 mg tablet Tablet 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0
A70 70 Metronidazol 500 mg Tablet 0
A71 71 Metronidazol tablet 250 mg Tablet 0
A72 72 Mikonazole salep Tube 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 0
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0
A75 75 Nifedipin tablet 10 mg Tablet 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0
A82 82 Parasetamol tablet 500mg Tablet 0
A83 83 Prednison tablet 5 mgn Tablet 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0
A85 85 Ranitidin tablet 150 mg Tablet 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0
A90 90 Ringer laktat larutan infus steril Botol 0
A91 91 Risperidon Tablet 0
A92 92 Salbutamol tablet 2 mg Tablet 0
A93 93 Salbutamol tablet 4 mg Tablet 0
A94 94 Salisil bedak 2 % Bks 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0
A96 96 Silver amalgam serbuk 65-75% Botol 0
A97 97 Simvastatin tab 10 mg Tablet 0
A98 98 Sulfacetamide tetes mata Botol 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0
A100 100 Thiamfenikol 500 Tablet 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0
A103 103 Trifluoperazine (Stelazin) Tablet 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0
A105 105 Vitamin B kompleks tablet Tablet 82
A106 106 Zink tablet Tablet 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0
A109 109 Amlodipin 5 mg tab Tablet 0
A110 110 Antasida syr Tablet 0
A111 111 Asam Folat 1 mg Tablet 0
A112 112 Becefort Vial 0
A113 113 Benzatin Penisillin Set 0
A114 114 Bonding Tube 0
A115 115 Bufacomb salep Ampul 0
A116 116 Daryantulle Tube 0
A117 117 Dermazine/Burnazin Tablet 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0
A119 119 Dextrofen syr Tablet 0
A120 120 Dormi/Scopma/Spashi tablet Supp 0
A121 121 Dulcolac anak supp Supp 0
A122 122 Dulcolac dewasa supp Tablet 0
A123 123 Dulkolak tablet Botol 0
A124 124 Euthyrox 100mg Supp 0
A125 125 Glimepiride 2 tablet 0
A126 126 Glimepiride 4 Ampul 0
A127 127 Ibuprofen syr flesh 0
A128 128 Kalium Diklovenac Supp 0
A129 129 Kaltropen supp tube 0
A130 130 Ketoconazole SK Ampul 0
A131 131 Microlax tablet 0
A132 132 Miloxicam 7,5 mg Tablet 0
A133 133 Multivitamin (Livron B plek) Botol 50
A134 134 Multivitamin sirup (caviplex) Tablet 0
A135 135 New antides Tablet 0
A136 136 OBH plus Tablet 0
A137 137 Omeprasole tablet 20 mg Ampul 0
A138 138 Parasetamol drop Ampul 0
A139 139 Pehacain Injeksi Tablet 0
A140 140 Prenatin DF tablet 0
A141 141 Ventolin Nebulizer Tablet 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 0
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0
B5 5 Alkohol 1 Liter Botol 0
B64 64 Alkohol swab Box 0
B6 6 Bactigrass Box 0
B8 8 Betadine 1 L Botol 0
B59 59 Betadine 30 ml Botol 0
B7 7 Betadine 300 ml Botol 0
B9 9 Bisturi No 10 Pcs 0
B10 10 Bisturi No 11 Pcs 0
B11 11 Bisturi No 20 Pcs 0
B12 12 Bisturi No 21 Pcs 0
B13 13 Bisturi No 22 Pcs 0
B65 65 Blood lancet Box 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0
B67 67 CE Botol 0
B16 16 Daryantulle Box 0
B69 69 Folley Cathteter G18 pcs 0
B17 17 H2O2 Botol 0
B18 18 Hand sanitizer Botol 0
B19 19 Hyfafik 5x5 Roll 0
B61 61 Hypapix 15 x 5 Roll 0
B20 20 Infusion Set dewasa Pcs 0
B21 21 IV cath no .18 Pcs 0
B22 22 IV cath no .20 Pcs 0
B23 23 IV cath no .22 Pcs 0
B24 24 IV cath no .24 Roll 0
B25 25 IV cath no.16 Pcs 0
B26 26 Jarum heacting Pcs 0
B27 27 Jarum Injeksi Pcs 0
B28 28 Jarum Onemed set Pcs 0
B29 29 Jarum Otot -Kulit Set 0
B30 30 Jelly Botol 0
B31 31 Kantong Puyer Pack 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0
B63 63 Kapas pembalut 1000g Roll 0
B33 33 Kasa Gulung Roll 0
B34 34 Kasa hidrofil 18 x 22 Roll 0
B35 35 Kasa hidrofil 4 x 10 Roll 0
B66 66 Kasa hidrofil 5 x 4 Roll 0
B36 36 Kasa pembalut 2 x 80 Roll 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 0
B38 38 Kertas Perkamen Pack 0
B39 39 Klem tali Pusar Pcs 0
B40 40 Klip Plastik Obat 10X7 cm Pack 0
B41 41 KlipPlastik Obat 13X8,7 cm Pack 0
B42 42 Lisol Botol 0
B43 43 Masker Box 55
B68 68 Masker N95 Pcs 0
B55 55 Nylon 5/0 Pcs 0
B57 57 Pot Dahak Pcs 0
B44 44 Sarung Tangan L Pasang 0
B45 45 Sarung Tangan M Pasang 0
B46 46 Sarung Tangan S Pasang 0
B47 47 Sarung Tangan Steril M Pasang 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0
B56 56 Slide prosted Pack 0
B60 60 Spiritus Pcs 0
B62 62 Spuit 10 cc Pcs 0
B58 58 Tabung EDTA Box 0
B50 50 Urinbag Pcs 0
B51 51 Venflon No 20 Pcs 0
B52 52 Wing Needle 21 Pcs 0
B53 53 Wing Needle 23 Pcs 0
B54 54 Wing Needle 25 Pcs 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat

dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A

NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018
Mengetahui/Menyetujui
Pimpinan Puskesmas Tabanan I

dr. I KETUT SERINATA

NIP.19660616 200212 1 002
 AN DAN LEMBAR PERMINTAAN OBAT JKN
D. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
ELAPORAN : JUNI 2021
ERMINTAAN : JULI 2021

PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

5 5 5
0 0
0 0
0 0
5 11 8 3 5
0 0
0 0
0 0
100 220 110 110 100
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
100 272 96 176 100
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
5 5 5
0 0
0 0
0 0
0 0
0 0
100 100 100
0 0
0 0
0 0
0 0
0 0
0 0
100 100 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 100 20 80 200
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
82 82 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
200 250 170 80 200
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 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 2
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
10 10 1 9
10 10 1 9
0 0
100 155 100 55 100
0 0 50
0 0
0 0
0 0
0 0
0 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

nanggunjawab Gudang Obat Penanggungjawab Sub Unit

Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
P. 19930719 201903 2 018 NIP.197608142006042014
Yang Menyerahkan Yang Menerima
Petugas Gudang Obat Petugas Puskesmas Tabanan I

Ni Md Ayu Yuliani Putri H,A.Md.Farm GST.A.P. YULIANINGSIH A.Md.Keb

NIP. 19930719 201903 2 018 NIP.197608142006042014
PENERIMAAN
Puskesmas Tabanan I

. YULIANINGSIH A.Md.Keb
08142006042014
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : JULI 2021
PERMINTAAN : AGUSTUS 2021
STOK
KODE NO NAMA OBAT SATUAN
AWAL
A1 1 Acyclovir Salep Tube 5
A2 2 Acyclovir 400 mg Tab Tablet 0
A3 3 Albendazol 400 mg tab Tablet 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0
A5 5 Ambroxol syr Botol 3
A6 6 Ambroxol tab 30 mg / Promukus Tablet 0
A7 7 Amoksilina kapsul 500 mg Tablet 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 0
A9 9 Antasida doen tablet kombinasi Tablet 110
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0
A11 11 Asam mefenamat 500 mg Tablet 0
A12 12 Basitrasin Polimiksin Tube 0
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0
A14 14 Betahistin tab Tablet 0
A15 15 Betametazon salep kulit Tube 0
A16 16 Captopril 12.5 mg tablet Tablet 0
A17 17 Captopril 25 mg tablet Tablet 0
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0
A19 19 Cefadroxill 500 mg tablet Tablet 0
A20 20 Cetirizin10 mg tab Tablet 0
A21 21 Ciprofloxazin tablet 500 mg Tablet 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 0
A23 23 Deksametason tablet 0.5 mg Tablet 176
A24 24 Diazepam 5 mg Tablet 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0
A26 26 Diazepam tablet 2 mg Tablet 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 0
A28 28 Domperidon tablet 10 mg Tablet 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0
A30 30 Erytromysin tablet 500 mg Tablet 0
A31 31 Etil klorida semprot Botol 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0
A35 35 Furosemida tablet 40 mg Tablet 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0
A37 37 Gentamisin Salep Mata Tube 0
A38 38 Gentamysin SK Tube 0
A39 39 Gentamysin TM/Genoint TM Botol 0
A40 40 Gentian violet larutan 1 % Botol 0
A41 41 Glibenklamida tablet 5 mg Tablet 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0
A43 43 Glukosa larutan infus 10 % steril Botol 0
A44 44 Glukosa larutan infus 40 % steril Botol 0
A45 45 Glukosa larutan infus 5 % steril Botol 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0
A47 47 Hidrokortison krim 2.5 % Tube 5
A48 48 Ibuprofen tablet 400 mg Tablet 0
A49 49 Isoniazide 100 mg Tablet 0
A50 50 Isoniazide 300 mg Tablet 0
A51 51 Isosorbid dinitrat Tablet 0
A52 52 Kalsium hidroksida pasta Pot 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 100
A54 54 Ketokonazole 200 mg tablet Tablet 0
A55 55 Kloramfenicol salep kulit Tube 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0
A57 57 Kloramfenikol salep mata 1 % Tube 0
A58 58 Kloramfenikol tetes Mata Botol 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 100
A61 61 Kotrimoksasol suspensi Botol 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0
A63 63 Lidokain inj Ampul 0
A64 64 Lidokaina comp inj kombinasi Ampul 0
A65 65 Metformin 500 mg tablet Tablet 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0
A70 70 Metronidazol 500 mg Tablet 0
A71 71 Metronidazol tablet 250 mg Tablet 0
A72 72 Mikonazole salep Tube 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 80
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0
A75 75 Nifedipin tablet 10 mg Tablet 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0
A82 82 Parasetamol tablet 500mg Tablet 0
A83 83 Prednison tablet 5 mgn Tablet 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0
A85 85 Ranitidin tablet 150 mg Tablet 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0
A90 90 Ringer laktat larutan infus steril Botol 0
A91 91 Risperidon Tablet 0
A92 92 Salbutamol tablet 2 mg Tablet 0
A93 93 Salbutamol tablet 4 mg Tablet 0
A94 94 Salisil bedak 2 % Bks 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0
A96 96 Silver amalgam serbuk 65-75% Botol 0
A97 97 Simvastatin tab 10 mg Tablet 0
A98 98 Sulfacetamide tetes mata Botol 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0
A100 100 Thiamfenikol 500 Tablet 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0
A103 103 Trifluoperazine (Stelazin) Tablet 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0
A105 105 Vitamin B kompleks tablet Tablet 0
A106 106 Zink tablet Tablet 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0
A109 109 Amlodipin 5 mg tab Tablet 0
A110 110 Antasida syr Tablet 0
A111 111 Asam Folat 1 mg Tablet 0
A112 112 Becefort Vial 0
A113 113 Benzatin Penisillin Set 0
A114 114 Bonding Tube 0
A115 115 Bufacomb salep Ampul 0
A116 116 Daryantulle Tube 0
A117 117 Dermazine/Burnazin Tablet 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0
A119 119 Dextrofen syr Tablet 0
A120 120 Dormi/Scopma/Spashi tablet Supp 0
A121 121 Dulcolac anak supp Supp 0
A122 122 Dulcolac dewasa supp Tablet 0
A123 123 Dulkolak tablet Botol 0
A124 124 Euthyrox 100mg Supp 0
A125 125 Glimepiride 2 tablet 0
A126 126 Glimepiride 4 Ampul 0
A127 127 Ibuprofen syr flesh 0
A128 128 Kalium Diklovenac Supp 0
A129 129 Kaltropen supp tube 0
A130 130 Ketoconazole SK Ampul 0
A131 131 Microlax tablet 0
A132 132 Miloxicam 7,5 mg Tablet 0
A133 133 Multivitamin (Livron B plek) Botol 80
A134 134 Multivitamin sirup (caviplex) Tablet 0
A135 135 New antides Tablet 0
A136 136 OBH plus Tablet 0
A137 137 Omeprasole tablet 20 mg Ampul 0
A138 138 Parasetamol drop Ampul 0
A139 139 Pehacain Injeksi Tablet 0
A140 140 Prenatin DF tablet 0
A141 141 Ventolin Nebulizer Tablet 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 0
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0
B5 5 Alkohol 1 Liter Botol 0
B64 64 Alkohol swab Box 0
B6 6 Bactigrass Box 0
B8 8 Betadine 1 L Botol 0
B59 59 Betadine 30 ml Botol 0
B7 7 Betadine 300 ml Botol 0
B9 9 Bisturi No 10 Pcs 0
B10 10 Bisturi No 11 Pcs 0
B11 11 Bisturi No 20 Pcs 0
B12 12 Bisturi No 21 Pcs 0
B13 13 Bisturi No 22 Pcs 0
B65 65 Blood lancet Box 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0
B67 67 CE Botol 0
B16 16 Daryantulle Box 0
B69 69 Folley Cathteter G18 pcs 0
B17 17 H2O2 Botol 0
B18 18 Hand sanitizer Botol 0
B19 19 Hyfafik 5x5 Roll 0
B61 61 Hypapix 15 x 5 Roll 0
B20 20 Infusion Set dewasa Pcs 0
B21 21 IV cath no .18 Pcs 0
B22 22 IV cath no .20 Pcs 0
B23 23 IV cath no .22 Pcs 0
B24 24 IV cath no .24 Roll 0
B25 25 IV cath no.16 Pcs 0
B26 26 Jarum heacting Pcs 0
B27 27 Jarum Injeksi Pcs 0
B28 28 Jarum Onemed set Pcs 0
B29 29 Jarum Otot -Kulit Set 0
B30 30 Jelly Botol 0
B31 31 Kantong Puyer Pack 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0
B63 63 Kapas pembalut 1000g Roll 0
B33 33 Kasa Gulung Roll 0
B34 34 Kasa hidrofil 18 x 22 Roll 0
B35 35 Kasa hidrofil 4 x 10 Roll 0
B66 66 Kasa hidrofil 5 x 4 Roll 0
B36 36 Kasa pembalut 2 x 80 Roll 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 0
B38 38 Kertas Perkamen Pack 0
B39 39 Klem tali Pusar Pcs 0
B40 40 Klip Plastik Obat 10X7 cm Pack 9
B41 41 KlipPlastik Obat 13X8,7 cm Pack 9
B42 42 Lisol Botol 0
B43 43 Masker Box 55
B68 68 Masker N95 Pcs 0
B55 55 Nylon 5/0 Pcs 0
B57 57 Pot Dahak Pcs 0
B44 44 Sarung Tangan L Pasang 0
B45 45 Sarung Tangan M Pasang 0
B46 46 Sarung Tangan S Pasang 0
B47 47 Sarung Tangan Steril M Pasang 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0
B56 56 Slide prosted Pack 0
B60 60 Spiritus Pcs 0
B62 62 Spuit 10 cc Pcs 0
B58 58 Tabung EDTA Box 0
B50 50 Urinbag Pcs 0
B51 51 Venflon No 20 Pcs 0
B52 52 Wing Needle 21 Pcs 0
B53 53 Wing Needle 23 Pcs 0
B54 54 Wing Needle 25 Pcs 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat
dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A.Md
NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018

Mengetahui/Menyetujui
Pimpinan Puskesmas Tabanan I

dr. I KETUT SERINATA

NIP.19660616 200212 1 002
 AN DAN LEMBAR PERMINTAAN OBAT JKN
D. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
ELAPORAN : JULI 2021
MINTAAN : AGUSTUS 2021

PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

5 5
0 0
0 0
0 0
5 8 3 5
0 0
0 0
0 0
110 40 70 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 100 100
0 0
10 10 10
90 266 137 129 100
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
5 1 4
0 0
0 0
0 0
0 0
0 0
100 100
0 0
0 0
0 0
0 0
0 0
0 0
100 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 280 110 170 100
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
5 5 5
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
80 80 0 200
0 0
0 0
10 10 1 9
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
1 1 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
2 2 1 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
9 1 8
9 1 8
0 0
100 155 75 80 100
0 0 50
0 0
0 0
0 0
0 0
50 50 30 20 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

nanggunjawab Gudang Obat Penanggungjawab Sub Unit

Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
P. 19930719 201903 2 018 NIP.197608142006042014

Yang Menyerahkan Yang Menerima

Petugas Gudang Obat Petugas Puskesmas Tabanan I

Ni Md Ayu Yuliani Putri H,A.Md.Farm GST.A.P. YULIANINGSIH A.Md.Keb

NIP. 19930719 201903 2 018 NIP.197608142006042014
PENERIMAAN
Puskesmas Tabanan I

. YULIANINGSIH A.Md.Keb
08142006042014
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAA
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : AGUSTUS 2021
PERMINTAAN : SEPTEMBER 2021
STOK
KODE NO NAMA OBAT SATUAN
AWAL
A1 1 Acyclovir Salep Tube 5
A2 2 Acyclovir 400 mg Tab Tablet 0
A3 3 Albendazol 400 mg tab Tablet 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0
A5 5 Ambroxol syr Botol 5
A6 6 Ambroxol tab 30 mg / Promukus Tablet 0
A7 7 Amoksilina kapsul 500 mg Tablet 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 0
A9 9 Antasida doen tablet kombinasi Tablet 70
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0
A11 11 Asam mefenamat 500 mg Tablet 0
A12 12 Basitrasin Polimiksin Tube 0
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0
A14 14 Betahistin tab Tablet 0
A15 15 Betametazon salep kulit Tube 0
A16 16 Captopril 12.5 mg tablet Tablet 0
A17 17 Captopril 25 mg tablet Tablet 0
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0
A19 19 Cefadroxill 500 mg tablet Tablet 0
A20 20 Cetirizin10 mg tab Tablet 100
A21 21 Ciprofloxazin tablet 500 mg Tablet 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 10
A23 23 Deksametason tablet 0.5 mg Tablet 129
A24 24 Diazepam 5 mg Tablet 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0
A26 26 Diazepam tablet 2 mg Tablet 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 0
A28 28 Domperidon tablet 10 mg Tablet 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0
A30 30 Erytromysin tablet 500 mg Tablet 0
A31 31 Etil klorida semprot Botol 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0
A35 35 Furosemida tablet 40 mg Tablet 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0
A37 37 Gentamisin Salep Mata Tube 0
A38 38 Gentamysin SK Tube 0
A39 39 Gentamysin TM/Genoint TM Botol 0
A40 40 Gentian violet larutan 1 % Botol 0
A41 41 Glibenklamida tablet 5 mg Tablet 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0
A43 43 Glukosa larutan infus 10 % steril Botol 0
A44 44 Glukosa larutan infus 40 % steril Botol 0
A45 45 Glukosa larutan infus 5 % steril Botol 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0
A47 47 Hidrokortison krim 2.5 % Tube 4
A48 48 Ibuprofen tablet 400 mg Tablet 0
A49 49 Isoniazide 100 mg Tablet 0
A50 50 Isoniazide 300 mg Tablet 0
A51 51 Isosorbid dinitrat Tablet 0
A52 52 Kalsium hidroksida pasta Pot 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 100
A54 54 Ketokonazole 200 mg tablet Tablet 0
A55 55 Kloramfenicol salep kulit Tube 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0
A57 57 Kloramfenikol salep mata 1 % Tube 0
A58 58 Kloramfenikol tetes Mata Botol 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 100
A61 61 Kotrimoksasol suspensi Botol 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0
A63 63 Lidokain inj Ampul 0
A64 64 Lidokaina comp inj kombinasi Ampul 0
A65 65 Metformin 500 mg tablet Tablet 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0
A70 70 Metronidazol 500 mg Tablet 0
A71 71 Metronidazol tablet 250 mg Tablet 0
A72 72 Mikonazole salep Tube 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 170
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0
A75 75 Nifedipin tablet 10 mg Tablet 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0
A82 82 Parasetamol tablet 500mg Tablet 0
A83 83 Prednison tablet 5 mgn Tablet 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0
A85 85 Ranitidin tablet 150 mg Tablet 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0
A90 90 Ringer laktat larutan infus steril Botol 0
A91 91 Risperidon Tablet 0
A92 92 Salbutamol tablet 2 mg Tablet 0
A93 93 Salbutamol tablet 4 mg Tablet 0
A94 94 Salisil bedak 2 % Bks 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0
A96 96 Silver amalgam serbuk 65-75% Botol 0
A97 97 Simvastatin tab 10 mg Tablet 0
A98 98 Sulfacetamide tetes mata Botol 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0
A100 100 Thiamfenikol 500 Tablet 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0
A103 103 Trifluoperazine (Stelazin) Tablet 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0
A105 105 Vitamin B kompleks tablet Tablet 0
A106 106 Zink tablet Tablet 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0
A109 109 Amlodipin 5 mg tab Tablet 0
A110 110 Antasida syr Tablet 0
A111 111 Asam Folat 1 mg Tablet 0
A112 112 Becefort Vial 0
A113 113 Benzatin Penisillin Set 0
A114 114 Bonding Tube 0
A115 115 Bufacomb salep Ampul 0
A116 116 Daryantulle Tube 0
A117 117 Dermazine/Burnazin Tablet 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0
A119 119 Dextrofen syr Tablet 5
A120 120 Dormi/Scopma/Spashi tablet Supp 0
A121 121 Dulcolac anak supp Supp 0
A122 122 Dulcolac dewasa supp Tablet 0
A123 123 Dulkolak tablet Botol 0
A124 124 Euthyrox 100mg Supp 0
A125 125 Glimepiride 2 tablet 0
A126 126 Glimepiride 4 Ampul 0
A127 127 Ibuprofen syr flesh 0
A128 128 Kalium Diklovenac Supp 0
A129 129 Kaltropen supp tube 0
A130 130 Ketoconazole SK Ampul 0
A131 131 Microlax tablet 0
A132 132 Miloxicam 7,5 mg Tablet 0
A133 133 Multivitamin (Livron B plek) Botol 0
A134 134 Multivitamin sirup (caviplex) Tablet 0
A135 135 New antides Tablet 0
A136 136 OBH plus Tablet 9
A137 137 Omeprasole tablet 20 mg Ampul 0
A138 138 Parasetamol drop Ampul 0
A139 139 Pehacain Injeksi Tablet 0
A140 140 Prenatin DF tablet 0
A141 141 Ventolin Nebulizer Tablet 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 0
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0
B5 5 Alkohol 1 Liter Botol 1
B64 64 Alkohol swab Box 0
B6 6 Bactigrass Box 0
B8 8 Betadine 1 L Botol 0
B59 59 Betadine 30 ml Botol 0
B7 7 Betadine 300 ml Botol 0
B9 9 Bisturi No 10 Pcs 0
B10 10 Bisturi No 11 Pcs 0
B11 11 Bisturi No 20 Pcs 0
B12 12 Bisturi No 21 Pcs 0
B13 13 Bisturi No 22 Pcs 0
B65 65 Blood lancet Box 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0
B67 67 CE Botol 0
B16 16 Daryantulle Box 0
B69 69 Folley Cathteter G18 pcs 0
B17 17 H2O2 Botol 0
B18 18 Hand sanitizer Botol 1
B19 19 Hyfafik 5x5 Roll 0
B61 61 Hypapix 15 x 5 Roll 0
B20 20 Infusion Set dewasa Pcs 0
B21 21 IV cath no .18 Pcs 0
B22 22 IV cath no .20 Pcs 0
B23 23 IV cath no .22 Pcs 0
B24 24 IV cath no .24 Roll 0
B25 25 IV cath no.16 Pcs 0
B26 26 Jarum heacting Pcs 0
B27 27 Jarum Injeksi Pcs 0
B28 28 Jarum Onemed set Pcs 0
B29 29 Jarum Otot -Kulit Set 0
B30 30 Jelly Botol 0
B31 31 Kantong Puyer Pack 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0
B63 63 Kapas pembalut 1000g Roll 0
B33 33 Kasa Gulung Roll 0
B34 34 Kasa hidrofil 18 x 22 Roll 0
B35 35 Kasa hidrofil 4 x 10 Roll 0
B66 66 Kasa hidrofil 5 x 4 Roll 0
B36 36 Kasa pembalut 2 x 80 Roll 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 0
B38 38 Kertas Perkamen Pack 0
B39 39 Klem tali Pusar Pcs 0
B40 40 Klip Plastik Obat 10X7 cm Pack 8
B41 41 KlipPlastik Obat 13X8,7 cm Pack 8
B42 42 Lisol Botol 0
B43 43 Masker Box 80
B68 68 Masker N95 Pcs 0
B55 55 Nylon 5/0 Pcs 0
B57 57 Pot Dahak Pcs 0
B44 44 Sarung Tangan L Pasang 0
B45 45 Sarung Tangan M Pasang 0
B46 46 Sarung Tangan S Pasang 20
B47 47 Sarung Tangan Steril M Pasang 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0
B56 56 Slide prosted Pack 0
B60 60 Spiritus Pcs 0
B62 62 Spuit 10 cc Pcs 0
B58 58 Tabung EDTA Box 0
B50 50 Urinbag Pcs 0
B51 51 Venflon No 20 Pcs 0
B52 52 Wing Needle 21 Pcs 0
B53 53 Wing Needle 23 Pcs 0
B54 54 Wing Needle 25 Pcs 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat

dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A

NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018
Mengetahui/Menyetujui
Pimpinan Puskesmas Tabanan I

dr. I KETUT SERINATA

NIP.19660616 200212 1 002
 AN DAN LEMBAR PERMINTAAN OBAT JKN
D. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
APORAN : AGUSTUS 2021
MINTAAN : SEPTEMBER 2021

PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

5 1 4 5
0 0
0 0
0 0
5 5 0 5
0 0
0 0
5 5 5
70 40 30 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 100 100
0 0
0 0
100 100
0 0
10 10
129 28 101 100
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
4 1 3 5
0 0
0 0
0 0
0 0
0 0
100 100
0 0
0 0
0 0
0 0
0 0
0 0
100 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 270 20 250
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 100 2 98 200
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 0 200
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
5 2 3 5
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 0 200
0 0
0 0
9 9 0 10
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
1 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
1 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
8 1 7
8 2 6 1
0 0
100 180 80 100 50
0 0
0 0
0 0
0 0
0 0
50 70 50 20 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

nanggunjawab Gudang Obat Penanggungjawab Sub Unit

Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
P. 19930719 201903 2 018 NIP.197608142006042014
Yang Menyerahkan Yang Menerima
Petugas Gudang Obat Petugas Puskesmas Tabanan I

Ni Md Ayu Yuliani Putri H,A.Md.Farm GST.A.P. YULIANINGSIH A.Md.Keb

NIP. 19930719 201903 2 018 NIP.197608142006042014
PENERIMAAN
Puskesmas Tabanan I

. YULIANINGSIH A.Md.Keb
08142006042014
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : SEPTEMBER 2021
PERMINTAAN : OKTOBER 2021
STOK
KODE NO NAMA OBAT SATUAN
AWAL
A1 1 Acyclovir Salep Tube 4
A2 2 Acyclovir 400 mg Tab Tablet 0
A3 3 Albendazol 400 mg tab Tablet 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0
A5 5 Ambroxol syr Botol 0
A6 6 Ambroxol tab 30 mg / Promukus Tablet 0
A7 7 Amoksilina kapsul 500 mg Tablet 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 5
A9 9 Antasida doen tablet kombinasi Tablet 30
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0
A11 11 Asam mefenamat 500 mg Tablet 0
A12 12 Basitrasin Polimiksin Tube 0
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0
A14 14 Betahistin tab Tablet 0
A15 15 Betametazon salep kulit Tube 0
A16 16 Captopril 12.5 mg tablet Tablet 0
A17 17 Captopril 25 mg tablet Tablet 100
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0
A19 19 Cefadroxill 500 mg tablet Tablet 0
A20 20 Cetirizin10 mg tab Tablet 100
A21 21 Ciprofloxazin tablet 500 mg Tablet 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 10
A23 23 Deksametason tablet 0.5 mg Tablet 101
A24 24 Diazepam 5 mg Tablet 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0
A26 26 Diazepam tablet 2 mg Tablet 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 0
A28 28 Domperidon tablet 10 mg Tablet 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0
A30 30 Erytromysin tablet 500 mg Tablet 0
A31 31 Etil klorida semprot Botol 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0
A35 35 Furosemida tablet 40 mg Tablet 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0
A37 37 Gentamisin Salep Mata Tube 0
A38 38 Gentamysin SK Tube 0
A39 39 Gentamysin TM/Genoint TM Botol 0
A40 40 Gentian violet larutan 1 % Botol 0
A41 41 Glibenklamida tablet 5 mg Tablet 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0
A43 43 Glukosa larutan infus 10 % steril Botol 0
A44 44 Glukosa larutan infus 40 % steril Botol 0
A45 45 Glukosa larutan infus 5 % steril Botol 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0
A47 47 Hidrokortison krim 2.5 % Tube 3
A48 48 Ibuprofen tablet 400 mg Tablet 0
A49 49 Isoniazide 100 mg Tablet 0
A50 50 Isoniazide 300 mg Tablet 0
A51 51 Isosorbid dinitrat Tablet 0
A52 52 Kalsium hidroksida pasta Pot 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 100
A54 54 Ketokonazole 200 mg tablet Tablet 0
A55 55 Kloramfenicol salep kulit Tube 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0
A57 57 Kloramfenikol salep mata 1 % Tube 0
A58 58 Kloramfenikol tetes Mata Botol 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 100
A61 61 Kotrimoksasol suspensi Botol 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0
A63 63 Lidokain inj Ampul 0
A64 64 Lidokaina comp inj kombinasi Ampul 0
A65 65 Metformin 500 mg tablet Tablet 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0
A70 70 Metronidazol 500 mg Tablet 0
A71 71 Metronidazol tablet 250 mg Tablet 0
A72 72 Mikonazole salep Tube 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 250
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0
A75 75 Nifedipin tablet 10 mg Tablet 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0
A82 82 Parasetamol tablet 500mg Tablet 98
A83 83 Prednison tablet 5 mgn Tablet 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0
A85 85 Ranitidin tablet 150 mg Tablet 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0
A90 90 Ringer laktat larutan infus steril Botol 0
A91 91 Risperidon Tablet 0
A92 92 Salbutamol tablet 2 mg Tablet 0
A93 93 Salbutamol tablet 4 mg Tablet 0
A94 94 Salisil bedak 2 % Bks 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0
A96 96 Silver amalgam serbuk 65-75% Botol 0
A97 97 Simvastatin tab 10 mg Tablet 0
A98 98 Sulfacetamide tetes mata Botol 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0
A100 100 Thiamfenikol 500 Tablet 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0
A103 103 Trifluoperazine (Stelazin) Tablet 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0
A105 105 Vitamin B kompleks tablet Tablet 0
A106 106 Zink tablet Tablet 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0
A109 109 Amlodipin 5 mg tab Tablet 0
A110 110 Antasida syr Tablet 0
A111 111 Asam Folat 1 mg Tablet 0
A112 112 Becefort Vial 0
A113 113 Benzatin Penisillin Set 0
A114 114 Bonding Tube 0
A115 115 Bufacomb salep Ampul 0
A116 116 Daryantulle Tube 0
A117 117 Dermazine/Burnazin Tablet 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0
A119 119 Dextrofen syr Tablet 3
A120 120 Dormi/Scopma/Spashi tablet Supp 0
A121 121 Dulcolac anak supp Supp 0
A122 122 Dulcolac dewasa supp Tablet 0
A123 123 Dulkolak tablet Botol 0
A124 124 Euthyrox 100mg Supp 0
A125 125 Glimepiride 2 tablet 0
A126 126 Glimepiride 4 Ampul 0
A127 127 Ibuprofen syr flesh 0
A128 128 Kalium Diklovenac Supp 0
A129 129 Kaltropen supp tube 0
A130 130 Ketoconazole SK Ampul 0
A131 131 Microlax tablet 0
A132 132 Miloxicam 7,5 mg Tablet 0
A133 133 Multivitamin (Livron B plek) Botol 0
A134 134 Multivitamin sirup (caviplex) Tablet 0
A135 135 New antides Tablet 0
A136 136 OBH plus Tablet 0
A137 137 Omeprasole tablet 20 mg Ampul 0
A138 138 Parasetamol drop Ampul 0
A139 139 Pehacain Injeksi Tablet 0
A140 140 Prenatin DF tablet 0
A141 141 Ventolin Nebulizer Tablet 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 0
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0
B5 5 Alkohol 1 Liter Botol 1
B64 64 Alkohol swab Box 0
B6 6 Bactigrass Box 0
B8 8 Betadine 1 L Botol 0
B59 59 Betadine 30 ml Botol 0
B7 7 Betadine 300 ml Botol 0
B9 9 Bisturi No 10 Pcs 0
B10 10 Bisturi No 11 Pcs 0
B11 11 Bisturi No 20 Pcs 0
B12 12 Bisturi No 21 Pcs 0
B13 13 Bisturi No 22 Pcs 0
B65 65 Blood lancet Box 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0
B67 67 CE Botol 0
B16 16 Daryantulle Box 0
B69 69 Folley Cathteter G18 pcs 0
B17 17 H2O2 Botol 0
B18 18 Hand sanitizer Botol 1
B19 19 Hyfafik 5x5 Roll 0
B61 61 Hypapix 15 x 5 Roll 0
B20 20 Infusion Set dewasa Pcs 0
B21 21 IV cath no .18 Pcs 0
B22 22 IV cath no .20 Pcs 0
B23 23 IV cath no .22 Pcs 0
B24 24 IV cath no .24 Roll 0
B25 25 IV cath no.16 Pcs 0
B26 26 Jarum heacting Pcs 0
B27 27 Jarum Injeksi Pcs 0
B28 28 Jarum Onemed set Pcs 0
B29 29 Jarum Otot -Kulit Set 0
B30 30 Jelly Botol 0
B31 31 Kantong Puyer Pack 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0
B63 63 Kapas pembalut 1000g Roll 0
B33 33 Kasa Gulung Roll 0
B34 34 Kasa hidrofil 18 x 22 Roll 0
B35 35 Kasa hidrofil 4 x 10 Roll 0
B66 66 Kasa hidrofil 5 x 4 Roll 0
B36 36 Kasa pembalut 2 x 80 Roll 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 0
B38 38 Kertas Perkamen Pack 0
B39 39 Klem tali Pusar Pcs 0
B40 40 Klip Plastik Obat 10X7 cm Pack 7
B41 41 KlipPlastik Obat 13X8,7 cm Pack 6
B42 42 Lisol Botol 0
B43 43 Masker Box 100
B68 68 Masker N95 Pcs 0
B55 55 Nylon 5/0 Pcs 0
B57 57 Pot Dahak Pcs 0
B44 44 Sarung Tangan L Pasang 0
B45 45 Sarung Tangan M Pasang 0
B46 46 Sarung Tangan S Pasang 20
B47 47 Sarung Tangan Steril M Pasang 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0
B56 56 Slide prosted Pack 0
B60 60 Spiritus Pcs 0
B62 62 Spuit 10 cc Pcs 0
B58 58 Tabung EDTA Box 0
B50 50 Urinbag Pcs 0
B51 51 Venflon No 20 Pcs 0
B52 52 Wing Needle 21 Pcs 0
B53 53 Wing Needle 23 Pcs 0
B54 54 Wing Needle 25 Pcs 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat
dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A.Md
NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018

Mengetahui/Menyetujui
Pimpinan Puskesmas Tabanan I

dr. I KETUT SERINATA

NIP.19660616 200212 1 002
 AN DAN LEMBAR PERMINTAAN OBAT JKN
D. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PORAN : SEPTEMBER 2021
MINTAAN : OKTOBER 2021

PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

5 9 9
0 0
0 0
0 0
5 5 5
0 0
0 0
5 10 10
30 30 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 200 10 190
0 0
0 0
100 100
0 0
10 10
101 42 59
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
3 2 1 5
0 0
0 0
0 0
0 0
0 0
100 200 200
0 0
0 0
0 0
0 0
0 0
0 0
100 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
250 30 220
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 298 128 170 100
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 0 200
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
5 8 4 4
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 0 200
0 0
0 0
10 10 10
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
1 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
1 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
7 7
10 16 2 14
0 0
50 150 70 80 50
0 0
0 0
0 0
0 0
0 0
50 70 40 30 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

nanggunjawab Gudang Obat Penanggungjawab Sub Unit

Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
P. 19930719 201903 2 018 NIP.197608142006042014

Yang Menyerahkan Yang Menerima

Petugas Gudang Obat Petugas Puskesmas Tabanan I

Ni Md Ayu Yuliani Putri H,A.Md.Farm GST.A.P. YULIANINGSIH A.Md.Keb

NIP. 19930719 201903 2 018 NIP.197608142006042014
PENERIMAAN
Puskesmas Tabanan I

. YULIANINGSIH A.Md.Keb
08142006042014
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : OKTOBER 2021
PERMINTAAN : NOVEMBER 2021
STOK
KODE NO NAMA OBAT SATUAN
AWAL
A1 1 Acyclovir Salep Tube 9
A2 2 Acyclovir 400 mg Tab Tablet 0
A3 3 Albendazol 400 mg tab Tablet 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0
A5 5 Ambroxol syr Botol 5
A6 6 Ambroxol tab 30 mg / Promukus Tablet 0
A7 7 Amoksilina kapsul 500 mg Tablet 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 10
A9 9 Antasida doen tablet kombinasi Tablet 0
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0
A11 11 Asam mefenamat 500 mg Tablet 0
A12 12 Basitrasin Polimiksin Tube 0
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0
A14 14 Betahistin tab Tablet 0
A15 15 Betametazon salep kulit Tube 0
A16 16 Captopril 12.5 mg tablet Tablet 0
A17 17 Captopril 25 mg tablet Tablet 190
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0
A19 19 Cefadroxill 500 mg tablet Tablet 0
A20 20 Cetirizin10 mg tab Tablet 100
A21 21 Ciprofloxazin tablet 500 mg Tablet 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 10
A23 23 Deksametason tablet 0.5 mg Tablet 59
A24 24 Diazepam 5 mg Tablet 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0
A26 26 Diazepam tablet 2 mg Tablet 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 0
A28 28 Domperidon tablet 10 mg Tablet 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0
A30 30 Erytromysin tablet 500 mg Tablet 0
A31 31 Etil klorida semprot Botol 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0
A35 35 Furosemida tablet 40 mg Tablet 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0
A37 37 Gentamisin Salep Mata Tube 0
A38 38 Gentamysin SK Tube 0
A39 39 Gentamysin TM/Genoint TM Botol 0
A40 40 Gentian violet larutan 1 % Botol 0
A41 41 Glibenklamida tablet 5 mg Tablet 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0
A43 43 Glukosa larutan infus 10 % steril Botol 0
A44 44 Glukosa larutan infus 40 % steril Botol 0
A45 45 Glukosa larutan infus 5 % steril Botol 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0
A47 47 Hidrokortison krim 2.5 % Tube 1
A48 48 Ibuprofen tablet 400 mg Tablet 0
A49 49 Isoniazide 100 mg Tablet 0
A50 50 Isoniazide 300 mg Tablet 0
A51 51 Isosorbid dinitrat Tablet 0
A52 52 Kalsium hidroksida pasta Pot 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 200
A54 54 Ketokonazole 200 mg tablet Tablet 0
A55 55 Kloramfenicol salep kulit Tube 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0
A57 57 Kloramfenikol salep mata 1 % Tube 0
A58 58 Kloramfenikol tetes Mata Botol 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 100
A61 61 Kotrimoksasol suspensi Botol 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0
A63 63 Lidokain inj Ampul 0
A64 64 Lidokaina comp inj kombinasi Ampul 0
A65 65 Metformin 500 mg tablet Tablet 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0
A70 70 Metronidazol 500 mg Tablet 0
A71 71 Metronidazol tablet 250 mg Tablet 0
A72 72 Mikonazole salep Tube 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 220
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0
A75 75 Nifedipin tablet 10 mg Tablet 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0
A82 82 Parasetamol tablet 500mg Tablet 170
A83 83 Prednison tablet 5 mgn Tablet 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0
A85 85 Ranitidin tablet 150 mg Tablet 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0
A90 90 Ringer laktat larutan infus steril Botol 0
A91 91 Risperidon Tablet 0
A92 92 Salbutamol tablet 2 mg Tablet 0
A93 93 Salbutamol tablet 4 mg Tablet 0
A94 94 Salisil bedak 2 % Bks 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0
A96 96 Silver amalgam serbuk 65-75% Botol 0
A97 97 Simvastatin tab 10 mg Tablet 0
A98 98 Sulfacetamide tetes mata Botol 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0
A100 100 Thiamfenikol 500 Tablet 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0
A103 103 Trifluoperazine (Stelazin) Tablet 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0
A105 105 Vitamin B kompleks tablet Tablet 0
A106 106 Zink tablet Tablet 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0
A109 109 Amlodipin 5 mg tab Tablet 0
A110 110 Antasida syr Tablet 0
A111 111 Asam Folat 1 mg Tablet 0
A112 112 Becefort Vial 0
A113 113 Benzatin Penisillin Set 0
A114 114 Bonding Tube 0
A115 115 Bufacomb salep Ampul 0
A116 116 Daryantulle Tube 0
A117 117 Dermazine/Burnazin Tablet 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0
A119 119 Dextrofen syr Tablet 4
A120 120 Dormi/Scopma/Spashi tablet Supp 0
A121 121 Dulcolac anak supp Supp 0
A122 122 Dulcolac dewasa supp Tablet 0
A123 123 Dulkolak tablet Botol 0
A124 124 Euthyrox 100mg Supp 0
A125 125 Glimepiride 2 tablet 0
A126 126 Glimepiride 4 Ampul 0
A127 127 Ibuprofen syr flesh 0
A128 128 Kalium Diklovenac Supp 0
A129 129 Kaltropen supp tube 0
A130 130 Ketoconazole SK Ampul 0
A131 131 Microlax tablet 0
A132 132 Miloxicam 7,5 mg Tablet 0
A133 133 Multivitamin (Livron B plek) Botol 0
A134 134 Multivitamin sirup (caviplex) Tablet 0
A135 135 New antides Tablet 0
A136 136 OBH plus Tablet 10
A137 137 Omeprasole tablet 20 mg Ampul 0
A138 138 Parasetamol drop Ampul 0
A139 139 Pehacain Injeksi Tablet 0
A140 140 Prenatin DF tablet 0
A141 141 Ventolin Nebulizer Tablet 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 0
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0
B5 5 Alkohol 1 Liter Botol 1
B64 64 Alkohol swab Box 0
B6 6 Bactigrass Box 0
B8 8 Betadine 1 L Botol 0
B59 59 Betadine 30 ml Botol 0
B7 7 Betadine 300 ml Botol 0
B9 9 Bisturi No 10 Pcs 0
B10 10 Bisturi No 11 Pcs 0
B11 11 Bisturi No 20 Pcs 0
B12 12 Bisturi No 21 Pcs 0
B13 13 Bisturi No 22 Pcs 0
B65 65 Blood lancet Box 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0
B67 67 CE Botol 0
B16 16 Daryantulle Box 0
B69 69 Folley Cathteter G18 pcs 0
B17 17 H2O2 Botol 0
B18 18 Hand sanitizer Botol 1
B19 19 Hyfafik 5x5 Roll 0
B61 61 Hypapix 15 x 5 Roll 0
B20 20 Infusion Set dewasa Pcs 0
B21 21 IV cath no .18 Pcs 0
B22 22 IV cath no .20 Pcs 0
B23 23 IV cath no .22 Pcs 0
B24 24 IV cath no .24 Roll 0
B25 25 IV cath no.16 Pcs 0
B26 26 Jarum heacting Pcs 0
B27 27 Jarum Injeksi Pcs 0
B28 28 Jarum Onemed set Pcs 0
B29 29 Jarum Otot -Kulit Set 0
B30 30 Jelly Botol 0
B31 31 Kantong Puyer Pack 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0
B63 63 Kapas pembalut 1000g Roll 0
B33 33 Kasa Gulung Roll 0
B34 34 Kasa hidrofil 18 x 22 Roll 0
B35 35 Kasa hidrofil 4 x 10 Roll 0
B66 66 Kasa hidrofil 5 x 4 Roll 0
B36 36 Kasa pembalut 2 x 80 Roll 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 0
B38 38 Kertas Perkamen Pack 0
B39 39 Klem tali Pusar Pcs 0
B40 40 Klip Plastik Obat 10X7 cm Pack 7
B41 41 KlipPlastik Obat 13X8,7 cm Pack 14
B42 42 Lisol Botol 0
B43 43 Masker Box 80
B68 68 Masker N95 Pcs 0
B55 55 Nylon 5/0 Pcs 0
B57 57 Pot Dahak Pcs 0
B44 44 Sarung Tangan L Pasang 0
B45 45 Sarung Tangan M Pasang 0
B46 46 Sarung Tangan S Pasang 30
B47 47 Sarung Tangan Steril M Pasang 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0
B56 56 Slide prosted Pack 0
B60 60 Spiritus Pcs 0
B62 62 Spuit 10 cc Pcs 0
B58 58 Tabung EDTA Box 0
B50 50 Urinbag Pcs 0
B51 51 Venflon No 20 Pcs 0
B52 52 Wing Needle 21 Pcs 0
B53 53 Wing Needle 23 Pcs 0
B54 54 Wing Needle 25 Pcs 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat
dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A.Md
NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018

Mengetahui/Menyetujui
Pimpinan Puskesmas Tabanan I

dr. I KETUT SERINATA

NIP.19660616 200212 1 002
 AN DAN LEMBAR PERMINTAAN OBAT JKN
D. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
APORAN : OKTOBER 2021
MINTAAN : NOVEMBER 2021

PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

9 1 8
0 0
0 0
0 0
5 5 0 5
100 100 100
0 0
10 10
0 0
0 0
100 100 100
0 0
0 0
0 0
0 0
0 0
100 290 70 220
0 0
0 0
100 100
0 0
10 1 9
59 59 0 100
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
1 1 0
0 0
0 0
0 0
0 0
0 0
200 10 190
0 0
0 0
0 0
0 0
0 0
0 0
100 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
220 120 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
300 470 222 248
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 0 200
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
4 4 0 5
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 0 200
0 0
0 0
10 6 4 5
0 0
0 0
0 0
0 0
0 0
0 0

0 0
0 0
0 0
0 0
1 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
1 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
7 7
14 2 12
0 0
50 130 80 50 50
0 0
0 0
0 0
0 0
0 0
50 80 40 40 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

nanggunjawab Gudang Obat Penanggungjawab Sub Unit

Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
P. 19930719 201903 2 018 NIP.197608142006042014

Yang Menyerahkan Yang Menerima

Petugas Gudang Obat Petugas Puskesmas Tabanan I

Ni Md Ayu Yuliani Putri H,A.Md.Farm GST.A.P. YULIANINGSIH A.Md.Keb

NIP. 19930719 201903 2 018 NIP.197608142006042014
PENERIMAAN
Puskesmas Tabanan I

. YULIANINGSIH A.Md.Keb
08142006042014
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : NOVEMBER 2021
PERMINTAAN : DESEMBER 2021
STOK
KODE NO NAMA OBAT SATUAN
AWAL
A1 1 Acyclovir Salep Tube 8
A2 2 Acyclovir 400 mg Tab Tablet 0
A3 3 Albendazol 400 mg tab Tablet 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0
A5 5 Ambroxol syr Botol 0
A6 6 Ambroxol tab 30 mg / Promukus Tablet 100
A7 7 Amoksilina kapsul 500 mg Tablet 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 10
A9 9 Antasida doen tablet kombinasi Tablet 0
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0
A11 11 Asam mefenamat 500 mg Tablet 100
A12 12 Basitrasin Polimiksin Tube 0
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0
A14 14 Betahistin tab Tablet 0
A15 15 Betametazon salep kulit Tube 0
A16 16 Captopril 12.5 mg tablet Tablet 0
A17 17 Captopril 25 mg tablet Tablet 220
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0
A19 19 Cefadroxill 500 mg tablet Tablet 0
A20 20 Cetirizin10 mg tab Tablet 100
A21 21 Ciprofloxazin tablet 500 mg Tablet 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 9
A23 23 Deksametason tablet 0.5 mg Tablet 0
A24 24 Diazepam 5 mg Tablet 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0
A26 26 Diazepam tablet 2 mg Tablet 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 0
A28 28 Domperidon tablet 10 mg Tablet 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0
A30 30 Erytromysin tablet 500 mg Tablet 0
A31 31 Etil klorida semprot Botol 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0
A35 35 Furosemida tablet 40 mg Tablet 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0
A37 37 Gentamisin Salep Mata Tube 0
A38 38 Gentamysin SK Tube 0
A39 39 Gentamysin TM/Genoint TM Botol 0
A40 40 Gentian violet larutan 1 % Botol 0
A41 41 Glibenklamida tablet 5 mg Tablet 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0
A43 43 Glukosa larutan infus 10 % steril Botol 0
A44 44 Glukosa larutan infus 40 % steril Botol 0
A45 45 Glukosa larutan infus 5 % steril Botol 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0
A47 47 Hidrokortison krim 2.5 % Tube 0
A48 48 Ibuprofen tablet 400 mg Tablet 0
A49 49 Isoniazide 100 mg Tablet 0
A50 50 Isoniazide 300 mg Tablet 0
A51 51 Isosorbid dinitrat Tablet 0
A52 52 Kalsium hidroksida pasta Pot 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 190
A54 54 Ketokonazole 200 mg tablet Tablet 0
A55 55 Kloramfenicol salep kulit Tube 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0
A57 57 Kloramfenikol salep mata 1 % Tube 0
A58 58 Kloramfenikol tetes Mata Botol 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 100
A61 61 Kotrimoksasol suspensi Botol 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0
A63 63 Lidokain inj Ampul 0
A64 64 Lidokaina comp inj kombinasi Ampul 0
A65 65 Metformin 500 mg tablet Tablet 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0
A70 70 Metronidazol 500 mg Tablet 0
A71 71 Metronidazol tablet 250 mg Tablet 0
A72 72 Mikonazole salep Tube 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 100
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0
A75 75 Nifedipin tablet 10 mg Tablet 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0
A82 82 Parasetamol tablet 500mg Tablet 248
A83 83 Prednison tablet 5 mgn Tablet 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0
A85 85 Ranitidin tablet 150 mg Tablet 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0
A90 90 Ringer laktat larutan infus steril Botol 0
A91 91 Risperidon Tablet 0
A92 92 Salbutamol tablet 2 mg Tablet 0
A93 93 Salbutamol tablet 4 mg Tablet 0
A94 94 Salisil bedak 2 % Bks 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0
A96 96 Silver amalgam serbuk 65-75% Botol 0
A97 97 Simvastatin tab 10 mg Tablet 0
A98 98 Sulfacetamide tetes mata Botol 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0
A100 100 Thiamfenikol 500 Tablet 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0
A103 103 Trifluoperazine (Stelazin) Tablet 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0
A105 105 Vitamin B kompleks tablet Tablet 0
A106 106 Zink tablet Tablet 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0
A109 109 Amlodipin 5 mg tab Tablet 0
A110 110 Antasida syr Tablet 0
A111 111 Asam Folat 1 mg Tablet 0
A112 112 Becefort Vial 0
A113 113 Benzatin Penisillin Set 0
A114 114 Bonding Tube 0
A115 115 Bufacomb salep Ampul 0
A116 116 Daryantulle Tube 0
A117 117 Dermazine/Burnazin Tablet 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0
A119 119 Dextrofen syr Tablet 0
A120 120 Dormi/Scopma/Spashi tablet Supp 0
A121 121 Dulcolac anak supp Supp 0
A122 122 Dulcolac dewasa supp Tablet 0
A123 123 Dulkolak tablet Botol 0
A124 124 Euthyrox 100mg Supp 0
A125 125 Glimepiride 2 tablet 0
A126 126 Glimepiride 4 Ampul 0
A127 127 Ibuprofen syr flesh 0
A128 128 Kalium Diklovenac Supp 0
A129 129 Kaltropen supp tube 0
A130 130 Ketoconazole SK Ampul 0
A131 131 Microlax tablet 0
A132 132 Miloxicam 7,5 mg Tablet 0
A133 133 Multivitamin (Livron B plek) Botol 0
A134 134 Multivitamin sirup (caviplex) Tablet 0
A135 135 New antides Tablet 0
A136 136 OBH plus Tablet 4
A137 137 Omeprasole tablet 20 mg Ampul 0
A138 138 Parasetamol drop Ampul 0
A139 139 Pehacain Injeksi Tablet 0
A140 140 Prenatin DF tablet 0
A141 141 Ventolin Nebulizer Tablet 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 0
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0
B5 5 Alkohol 1 Liter Botol 0
B64 64 Alkohol swab Box 0
B6 6 Bactigrass Box 0
B8 8 Betadine 1 L Botol 0
B59 59 Betadine 30 ml Botol 0
B7 7 Betadine 300 ml Botol 0
B9 9 Bisturi No 10 Pcs 0
B10 10 Bisturi No 11 Pcs 0
B11 11 Bisturi No 20 Pcs 0
B12 12 Bisturi No 21 Pcs 0
B13 13 Bisturi No 22 Pcs 0
B65 65 Blood lancet Box 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0
B67 67 CE Botol 0
B16 16 Daryantulle Box 0
B69 69 Folley Cathteter G18 pcs 0
B17 17 H2O2 Botol 0
B18 18 Hand sanitizer Botol 0
B19 19 Hyfafik 5x5 Roll 0
B61 61 Hypapix 15 x 5 Roll 0
B20 20 Infusion Set dewasa Pcs 0
B21 21 IV cath no .18 Pcs 0
B22 22 IV cath no .20 Pcs 0
B23 23 IV cath no .22 Pcs 0
B24 24 IV cath no .24 Roll 0
B25 25 IV cath no.16 Pcs 0
B26 26 Jarum heacting Pcs 0
B27 27 Jarum Injeksi Pcs 0
B28 28 Jarum Onemed set Pcs 0
B29 29 Jarum Otot -Kulit Set 0
B30 30 Jelly Botol 0
B31 31 Kantong Puyer Pack 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0
B63 63 Kapas pembalut 1000g Roll 0
B33 33 Kasa Gulung Roll 0
B34 34 Kasa hidrofil 18 x 22 Roll 0
B35 35 Kasa hidrofil 4 x 10 Roll 0
B66 66 Kasa hidrofil 5 x 4 Roll 0
B36 36 Kasa pembalut 2 x 80 Roll 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 0
B38 38 Kertas Perkamen Pack 0
B39 39 Klem tali Pusar Pcs 0
B40 40 Klip Plastik Obat 10X7 cm Pack 7
B41 41 KlipPlastik Obat 13X8,7 cm Pack 12
B42 42 Lisol Botol 0
B43 43 Masker Box 50
B68 68 Masker N95 Pcs 0
B55 55 Nylon 5/0 Pcs 0
B57 57 Pot Dahak Pcs 0
B44 44 Sarung Tangan L Pasang 0
B45 45 Sarung Tangan M Pasang 0
B46 46 Sarung Tangan S Pasang 40
B47 47 Sarung Tangan Steril M Pasang 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0
B56 56 Slide prosted Pack 0
B60 60 Spiritus Pcs 0
B62 62 Spuit 10 cc Pcs 0
B58 58 Tabung EDTA Box 0
B50 50 Urinbag Pcs 0
B51 51 Venflon No 20 Pcs 0
B52 52 Wing Needle 21 Pcs 0
B53 53 Wing Needle 23 Pcs 0
B54 54 Wing Needle 25 Pcs 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat
dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A.Md
NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018

Mengetahui/Menyetujui
Pimpinan Puskesmas Tabanan I

dr. I KETUT SERINATA

NIP.19660616 200212 1 002
 AN DAN LEMBAR PERMINTAAN OBAT JKN
D. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PORAN : NOVEMBER 2021
MINTAAN : DESEMBER 2021

PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

8 2 6
0 0
0 0
0 0
5 5 5
100 10 90 100
0 0
10 2 8
0 0
0 0
100 100
0 0
0 0
0 0
0 0
0 0
220 60 160 100
0 0
0 0
100 100
0 0
9 2 7
0 0 100
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
100 290 190 100 100
0 0
0 0
0 0
0 0
0 0
0 0
100 100 0 200
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 100 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 348 198 150 100
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 0 100
0 0
0 0
0 0
0 0 200
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
5 5 5
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 0 200
0 0
0 0
5 9 4 5
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
7 1 6
12 1 11
0 0
50 50 0 100
0 0
0 0
0 0
0 0
0 0
50 90 40 50 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

nanggunjawab Gudang Obat Penanggungjawab Sub Unit

Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
P. 19930719 201903 2 018 NIP.197608142006042014

Yang Menyerahkan Yang Menerima

Petugas Gudang Obat Petugas Puskesmas Tabanan I

Ni Md Ayu Yuliani Putri H,A.Md.Farm GST.A.P. YULIANINGSIH A.Md.Keb

NIP. 19930719 201903 2 018 NIP.197608142006042014
PENERIMAAN
Puskesmas Tabanan I

. YULIANINGSIH A.Md.Keb
08142006042014
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : DESEMBER 2021
PERMINTAAN : JANUARI 2022
STOK
KODE NO NAMA OBAT SATUAN
AWAL
A1 1 Acyclovir Salep Tube 6
A2 2 Acyclovir 400 mg Tab Tablet 0
A3 3 Albendazol 400 mg tab Tablet 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0
A5 5 Ambroxol syr Botol 5
A6 6 Ambroxol tab 30 mg / Promukus Tablet 90
A7 7 Amoksilina kapsul 500 mg Tablet 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 8
A9 9 Antasida doen tablet kombinasi Tablet 0
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0
A11 11 Asam mefenamat 500 mg Tablet 100
A12 12 Basitrasin Polimiksin Tube 0
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0
A14 14 Betahistin tab Tablet 0
A15 15 Betametazon salep kulit Tube 0
A16 16 Captopril 12.5 mg tablet Tablet 0
A17 17 Captopril 25 mg tablet Tablet 160
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0
A19 19 Cefadroxill 500 mg tablet Tablet 0
A20 20 Cetirizin10 mg tab Tablet 100
A21 21 Ciprofloxazin tablet 500 mg Tablet 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 7
A23 23 Deksametason tablet 0.5 mg Tablet 0
A24 24 Diazepam 5 mg Tablet 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0
A26 26 Diazepam tablet 2 mg Tablet 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 0
A28 28 Domperidon tablet 10 mg Tablet 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0
A30 30 Erytromysin tablet 500 mg Tablet 0
A31 31 Etil klorida semprot Botol 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0
A35 35 Furosemida tablet 40 mg Tablet 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0
A37 37 Gentamisin Salep Mata Tube 0
A38 38 Gentamysin SK Tube 0
A39 39 Gentamysin TM/Genoint TM Botol 0
A40 40 Gentian violet larutan 1 % Botol 0
A41 41 Glibenklamida tablet 5 mg Tablet 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0
A43 43 Glukosa larutan infus 10 % steril Botol 0
A44 44 Glukosa larutan infus 40 % steril Botol 0
A45 45 Glukosa larutan infus 5 % steril Botol 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0
A47 47 Hidrokortison krim 2.5 % Tube 0
A48 48 Ibuprofen tablet 400 mg Tablet 0
A49 49 Isoniazide 100 mg Tablet 0
A50 50 Isoniazide 300 mg Tablet 0
A51 51 Isosorbid dinitrat Tablet 0
A52 52 Kalsium hidroksida pasta Pot 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 100
A54 54 Ketokonazole 200 mg tablet Tablet 0
A55 55 Kloramfenicol salep kulit Tube 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0
A57 57 Kloramfenikol salep mata 1 % Tube 0
A58 58 Kloramfenikol tetes Mata Botol 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 0
A61 61 Kotrimoksasol suspensi Botol 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0
A63 63 Lidokain inj Ampul 0
A64 64 Lidokaina comp inj kombinasi Ampul 0
A65 65 Metformin 500 mg tablet Tablet 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0
A70 70 Metronidazol 500 mg Tablet 0
A71 71 Metronidazol tablet 250 mg Tablet 0
A72 72 Mikonazole salep Tube 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 100
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0
A75 75 Nifedipin tablet 10 mg Tablet 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0
A82 82 Parasetamol tablet 500mg Tablet 150
A83 83 Prednison tablet 5 mgn Tablet 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0
A85 85 Ranitidin tablet 150 mg Tablet 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0
A90 90 Ringer laktat larutan infus steril Botol 0
A91 91 Risperidon Tablet 0
A92 92 Salbutamol tablet 2 mg Tablet 0
A93 93 Salbutamol tablet 4 mg Tablet 0
A94 94 Salisil bedak 2 % Bks 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0
A96 96 Silver amalgam serbuk 65-75% Botol 0
A97 97 Simvastatin tab 10 mg Tablet 0
A98 98 Sulfacetamide tetes mata Botol 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0
A100 100 Thiamfenikol 500 Tablet 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0
A103 103 Trifluoperazine (Stelazin) Tablet 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0
A105 105 Vitamin B kompleks tablet Tablet 0
A106 106 Zink tablet Tablet 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0
A109 109 Amlodipin 5 mg tab Tablet 0
A110 110 Antasida syr Tablet 0
A111 111 Asam Folat 1 mg Tablet 0
A112 112 Becefort Vial 0
A113 113 Benzatin Penisillin Set 0
A114 114 Bonding Tube 0
A115 115 Bufacomb salep Ampul 0
A116 116 Daryantulle Tube 0
A117 117 Dermazine/Burnazin Tablet 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0
A119 119 Dextrofen syr Tablet 5
A120 120 Dormi/Scopma/Spashi tablet Supp 0
A121 121 Dulcolac anak supp Supp 0
A122 122 Dulcolac dewasa supp Tablet 0
A123 123 Dulkolak tablet Botol 0
A124 124 Euthyrox 100mg Supp 0
A125 125 Glimepiride 2 tablet 0
A126 126 Glimepiride 4 Ampul 0
A127 127 Ibuprofen syr flesh 0
A128 128 Kalium Diklovenac Supp 0
A129 129 Kaltropen supp tube 0
A130 130 Ketoconazole SK Ampul 0
A131 131 Microlax tablet 0
A132 132 Miloxicam 7,5 mg Tablet 0
A133 133 Multivitamin (Livron B plek) Botol 0
A134 134 Multivitamin sirup (caviplex) Tablet 0
A135 135 New antides Tablet 0
A136 136 OBH plus Tablet 5
A137 137 Omeprasole tablet 20 mg Ampul 0
A138 138 Parasetamol drop Ampul 0
A139 139 Pehacain Injeksi Tablet 0
A140 140 Prenatin DF tablet 0
A141 141 Ventolin Nebulizer Tablet 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 0
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0
B5 5 Alkohol 1 Liter Botol 0
B64 64 Alkohol swab Box 0
B6 6 Bactigrass Box 0
B8 8 Betadine 1 L Botol 0
B59 59 Betadine 30 ml Botol 0
B7 7 Betadine 300 ml Botol 0
B9 9 Bisturi No 10 Pcs 0
B10 10 Bisturi No 11 Pcs 0
B11 11 Bisturi No 20 Pcs 0
B12 12 Bisturi No 21 Pcs 0
B13 13 Bisturi No 22 Pcs 0
B65 65 Blood lancet Box 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0
B67 67 CE Botol 0
B16 16 Daryantulle Box 0
B69 69 Folley Cathteter G18 pcs 0
B17 17 H2O2 Botol 0
B18 18 Hand sanitizer Botol 0
B19 19 Hyfafik 5x5 Roll 0
B61 61 Hypapix 15 x 5 Roll 0
B20 20 Infusion Set dewasa Pcs 0
B21 21 IV cath no .18 Pcs 0
B22 22 IV cath no .20 Pcs 0
B23 23 IV cath no .22 Pcs 0
B24 24 IV cath no .24 Roll 0
B25 25 IV cath no.16 Pcs 0
B26 26 Jarum heacting Pcs 0
B27 27 Jarum Injeksi Pcs 0
B28 28 Jarum Onemed set Pcs 0
B29 29 Jarum Otot -Kulit Set 0
B30 30 Jelly Botol 0
B31 31 Kantong Puyer Pack 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0
B63 63 Kapas pembalut 1000g Roll 0
B33 33 Kasa Gulung Roll 0
B34 34 Kasa hidrofil 18 x 22 Roll 0
B35 35 Kasa hidrofil 4 x 10 Roll 0
B66 66 Kasa hidrofil 5 x 4 Roll 0
B36 36 Kasa pembalut 2 x 80 Roll 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 0
B38 38 Kertas Perkamen Pack 0
B39 39 Klem tali Pusar Pcs 0
B40 40 Klip Plastik Obat 10X7 cm Pack 6
B41 41 KlipPlastik Obat 13X8,7 cm Pack 11
B42 42 Lisol Botol 0
B43 43 Masker Box 0
B68 68 Masker N95 Pcs 0
B55 55 Nylon 5/0 Pcs 0
B57 57 Pot Dahak Pcs 0
B44 44 Sarung Tangan L Pasang 0
B45 45 Sarung Tangan M Pasang 0
B46 46 Sarung Tangan S Pasang 50
B47 47 Sarung Tangan Steril M Pasang 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0
B56 56 Slide prosted Pack 0
B60 60 Spiritus Pcs 0
B62 62 Spuit 10 cc Pcs 0
B58 58 Tabung EDTA Box 0
B50 50 Urinbag Pcs 0
B51 51 Venflon No 20 Pcs 0
B52 52 Wing Needle 21 Pcs 0
B53 53 Wing Needle 23 Pcs 0
B54 54 Wing Needle 25 Pcs 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat
dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A.Md
NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018
 AN DAN LEMBAR PERMINTAAN OBAT JKN
D. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
APORAN : DESEMBER 2021
MINTAAN : JANUARI 2022

PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

6 6
0 0
0 0
0 0
5 10 4 6
90 43 47 100
0 0
8 3 5
0 0
0 0
100 200 50 150
0 0
0 0
0 0
0 0
0 0
100 260 30 230
0 0
0 0
100 100
0 0
7 1 6
0 0 100
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
100 200 100 100 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0 200
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 100 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 250 148 102 100
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 0 100
0 0
0 0
0 0
0 0 200
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
5 5 0 10
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 0 200
0 0
0 0
5 5 0 10
0 0
0 0
0 0
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 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 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
6 1 5 10
11 1 10
0 0
0 0 100
0 0
0 0
0 0
0 0
0 0
50 100 50 50 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

nanggunjawab Gudang Obat Penanggungjawab Sub Unit

Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
P. 19930719 201903 2 018 NIP.197608142006042014
 PENERIMAAN

ED 150
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : JANUARI 2022
PERMINTAAN : FEBRUARI 2022
STOK
KODE NO NAMA OBAT SATUAN
AWAL
A1 1 Acyclovir Salep Tube 6
A2 2 Acyclovir 400 mg Tab Tablet 0
A3 3 Albendazol 400 mg tab Tablet 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0
A5 5 Ambroxol syr Botol 6
A6 6 Ambroxol tab 30 mg / Promukus Tablet 47
A7 7 Amoksilina kapsul 500 mg Tablet 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 5
A9 9 Antasida doen tablet kombinasi Tablet 0
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0
A11 11 Asam mefenamat 500 mg Tablet 150
A12 12 Basitrasin Polimiksin Tube 0
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0
A14 14 Betahistin tab Tablet 0
A15 15 Betametazon salep kulit Tube 0
A16 16 Captopril 12.5 mg tablet Tablet 0
A17 17 Captopril 25 mg tablet Tablet 230
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0
A19 19 Cefadroxill 500 mg tablet Tablet 0
A20 20 Cetirizin10 mg tab Tablet 100
A21 21 Ciprofloxazin tablet 500 mg Tablet 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 6
A23 23 Deksametason tablet 0.5 mg Tablet 0
A24 24 Diazepam 5 mg Tablet 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0
A26 26 Diazepam tablet 2 mg Tablet 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 0
A28 28 Domperidon tablet 10 mg Tablet 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0
A30 30 Erytromysin tablet 500 mg Tablet 0
A31 31 Etil klorida semprot Botol 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0
A35 35 Furosemida tablet 40 mg Tablet 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0
A37 37 Gentamisin Salep Mata Tube 0
A38 38 Gentamysin SK Tube 0
A39 39 Gentamysin TM/Genoint TM Botol 0
A40 40 Gentian violet larutan 1 % Botol 0
A41 41 Glibenklamida tablet 5 mg Tablet 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0
A43 43 Glukosa larutan infus 10 % steril Botol 0
A44 44 Glukosa larutan infus 40 % steril Botol 0
A45 45 Glukosa larutan infus 5 % steril Botol 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0
A47 47 Hidrokortison krim 2.5 % Tube 0
A48 48 Ibuprofen tablet 400 mg Tablet 0
A49 49 Isoniazide 100 mg Tablet 0
A50 50 Isoniazide 300 mg Tablet 0
A51 51 Isosorbid dinitrat Tablet 0
A52 52 Kalsium hidroksida pasta Pot 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 100
A54 54 Ketokonazole 200 mg tablet Tablet 0
A55 55 Kloramfenicol salep kulit Tube 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0
A57 57 Kloramfenikol salep mata 1 % Tube 0
A58 58 Kloramfenikol tetes Mata Botol 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 0
A61 61 Kotrimoksasol suspensi Botol 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0
A63 63 Lidokain inj Ampul 0
A64 64 Lidokaina comp inj kombinasi Ampul 0
A65 65 Metformin 500 mg tablet Tablet 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0
A70 70 Metronidazol 500 mg Tablet 0
A71 71 Metronidazol tablet 250 mg Tablet 0
A72 72 Mikonazole salep Tube 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 100
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0
A75 75 Nifedipin tablet 10 mg Tablet 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0
A82 82 Parasetamol tablet 500mg Tablet 102
A83 83 Prednison tablet 5 mgn Tablet 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0
A85 85 Ranitidin tablet 150 mg Tablet 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0
A90 90 Ringer laktat larutan infus steril Botol 0
A91 91 Risperidon Tablet 0
A92 92 Salbutamol tablet 2 mg Tablet 0
A93 93 Salbutamol tablet 4 mg Tablet 0
A94 94 Salisil bedak 2 % Bks 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0
A96 96 Silver amalgam serbuk 65-75% Botol 0
A97 97 Simvastatin tab 10 mg Tablet 0
A98 98 Sulfacetamide tetes mata Botol 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0
A100 100 Thiamfenikol 500 Tablet 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0
A103 103 Trifluoperazine (Stelazin) Tablet 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0
A105 105 Vitamin B kompleks tablet Tablet 0
A106 106 Zink tablet Tablet 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0
A109 109 Amlodipin 5 mg tab Tablet 0
A110 110 Antasida syr Tablet 0
A111 111 Asam Folat 1 mg Tablet 0
A112 112 Becefort Vial 0
A113 113 Benzatin Penisillin Set 0
A114 114 Bonding Tube 0
A115 115 Bufacomb salep Ampul 0
A116 116 Daryantulle Tube 0
A117 117 Dermazine/Burnazin Tablet 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0
A119 119 Dextrofen syr Tablet 0
A120 120 Dormi/Scopma/Spashi tablet Supp 0
A121 121 Dulcolac anak supp Supp 0
A122 122 Dulcolac dewasa supp Tablet 0
A123 123 Dulkolak tablet Botol 0
A124 124 Euthyrox 100mg Supp 0
A125 125 Glimepiride 2 tablet 0
A126 126 Glimepiride 4 Ampul 0
A127 127 Ibuprofen syr flesh 0
A128 128 Kalium Diklovenac Supp 0
A129 129 Kaltropen supp tube 0
A130 130 Ketoconazole SK Ampul 0
A131 131 Microlax tablet 0
A132 132 Miloxicam 7,5 mg Tablet 0
A133 133 Multivitamin (Livron B plek) Botol 0
A134 134 Multivitamin sirup (caviplex) Tablet 0
A135 135 New antides Tablet 0
A136 136 OBH plus Tablet 0
A137 137 Omeprasole tablet 20 mg Ampul 0
A138 138 Parasetamol drop Ampul 0
A139 139 Pehacain Injeksi Tablet 0
A140 140 Prenatin DF tablet 0
A141 141 Ventolin Nebulizer Tablet 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0
Caviplex syrup Botol 0
Calortusin Tablet 0
Demacolin Tablet 0
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 73
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0
B5 5 Alkohol 1 Liter Botol 0
B64 64 Alkohol swab Box 0
B6 6 Bactigrass Box 0
B8 8 Betadine 1 L Botol 0
B59 59 Betadine 30 ml Botol 0
B7 7 Betadine 300 ml Botol 0
B9 9 Bisturi No 10 Pcs 0
B10 10 Bisturi No 11 Pcs 0
B11 11 Bisturi No 20 Pcs 0
B12 12 Bisturi No 21 Pcs 0
B13 13 Bisturi No 22 Pcs 0
B65 65 Blood lancet Box 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0
B67 67 CE Botol 0
B16 16 Daryantulle Box 9
B69 69 Folley Cathteter G18 pcs 0
B17 17 H2O2 Botol 0
B18 18 Hand sanitizer Botol 0
B19 19 Hyfafik 5x5 Roll 0
B61 61 Hypapix 15 x 5 Roll 0
B20 20 Infusion Set dewasa Pcs 0
B21 21 IV cath no .18 Pcs 0
B22 22 IV cath no .20 Pcs 0
B23 23 IV cath no .22 Pcs 0
B24 24 IV cath no .24 Roll 0
B25 25 IV cath no.16 Pcs 0
B26 26 Jarum heacting Pcs 0
B27 27 Jarum Injeksi Pcs 0
B28 28 Jarum Onemed set Pcs 0
B29 29 Jarum Otot -Kulit Set 0
B30 30 Jelly Botol 0
B31 31 Kantong Puyer Pack 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0
B63 63 Kapas pembalut 1000g Roll 0
B33 33 Kasa Gulung Roll 0
B34 34 Kasa hidrofil 18 x 22 Roll 0
B35 35 Kasa hidrofil 4 x 10 Roll 0
B66 66 Kasa hidrofil 5 x 4 Roll 8
B36 36 Kasa pembalut 2 x 80 Roll 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 0
B38 38 Kertas Perkamen Pack 0
B39 39 Klem tali Pusar Pcs 0
B40 40 Klip Plastik Obat 10X7 cm Pack 5
B41 41 KlipPlastik Obat 13X8,7 cm Pack 10
B42 42 Lisol Botol 0
B43 43 Masker Box 0
B68 68 Masker N95 Pcs 0
B55 55 Nylon 5/0 Pcs 0
B57 57 Pot Dahak Pcs 0
B44 44 Sarung Tangan L Pasang 0
B45 45 Sarung Tangan M Pasang 0
B46 46 Sarung Tangan S Pasang 50
B47 47 Sarung Tangan Steril M Pasang 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0
B56 56 Slide prosted Pack 0
B60 60 Spiritus Pcs 0
B62 62 Spuit 10 cc Pcs 0
B58 58 Tabung EDTA Box 0
B50 50 Urinbag Pcs 0
B51 51 Venflon No 20 Pcs 0
B52 52 Wing Needle 21 Pcs 0
B53 53 Wing Needle 23 Pcs 0
B54 54 Wing Needle 25 Pcs 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat

dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A.Md

NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018
 AN DAN LEMBAR PERMINTAAN OBAT JKN
D. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
APORAN : JANUARI 2022
MINTAAN : FEBRUARI 2022

PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

5 11 1 10
0 0
0 0
0 0
5 11 7 4 10
47 26 21 100
0 0
5 5
0 0
0 0
150 150 200
5 5 2 3 5
0 0
0 0
0 0
0 0
230 60 170 100
0 0
0 0
100 100
0 0
6 1 5
100 100 100 100
0 0
0 0
0 0
5 5 5
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
100 200 60 140 100
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 0 100
0 0
0 0
100 60 40 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 10
100 202 155 47 200
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 0 100
0 0
0 0
0 0
0 0 200
0 0
0 0

0 0
0 0
0 0
0 0
100 100 90 10 200
0 0
0 0
5 5 1 4
0 0
0 0
0 0
0 0 10
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 0 200
0 0
0 0
3 3 3 0 10
0 0
0 0
0 0
0 0
0 0
0 0
5 5 5 0 10
100 100 50 50 200
100 100 30 70 200

0 0
0 0
73 2 71
0 0
0 0 1
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
9 1 8
0 0
0 0
1 1 1 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 5
0 0 5
8 2 6
0 0
0 0 5
0 0 1
0 0
10 15 1 14
10 1 9
0 0 1
0 0 100
0 0
0 0
0 0
0 0
0 0
50 100 50 50 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
nanggunjawab Gudang Obat Penanggungjawab Sub Unit

Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
P. 19930719 201903 2 018 NIP.197608142006042014
 PENERIMAAN

ED 1

ED 150
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAA
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : FEBRUARI 2022
PERMINTAAN : MARET 2022
STOK
KODE NO NAMA OBAT SATUAN
AWAL
A1 1 Acyclovir Salep Tube 10
A2 2 Acyclovir 400 mg Tab Tablet 0
A3 3 Albendazol 400 mg tab Tablet 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0
A5 5 Ambroxol syr Botol 4
A6 6 Ambroxol tab 30 mg / Promukus Tablet 21
A7 7 Amoksilina kapsul 500 mg Tablet 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 5
A9 9 Antasida doen tablet kombinasi Tablet 0
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0
A11 11 Asam mefenamat 500 mg Tablet 150
A12 12 Basitrasin Polimiksin Tube 3
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0
A14 14 Betahistin tab Tablet 0
A15 15 Betametazon salep kulit Tube 0
A16 16 Captopril 12.5 mg tablet Tablet 0
A17 17 Captopril 25 mg tablet Tablet 170
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0
A19 19 Cefadroxill 500 mg tablet Tablet 0
A20 20 Cetirizin10 mg tab Tablet 100
A21 21 Ciprofloxazin tablet 500 mg Tablet 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 5
A23 23 Deksametason tablet 0.5 mg Tablet 100
A24 24 Diazepam 5 mg Tablet 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0
A26 26 Diazepam tablet 2 mg Tablet 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 5
A28 28 Domperidon tablet 10 mg Tablet 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0
A30 30 Erytromysin tablet 500 mg Tablet 0
A31 31 Etil klorida semprot Botol 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0
A35 35 Furosemida tablet 40 mg Tablet 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0
A37 37 Gentamisin Salep Mata Tube 0
A38 38 Gentamysin SK Tube 0
A39 39 Gentamysin TM/Genoint TM Botol 0
A40 40 Gentian violet larutan 1 % Botol 0
A41 41 Glibenklamida tablet 5 mg Tablet 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0
A43 43 Glukosa larutan infus 10 % steril Botol 0
A44 44 Glukosa larutan infus 40 % steril Botol 0
A45 45 Glukosa larutan infus 5 % steril Botol 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0
A47 47 Hidrokortison krim 2.5 % Tube 0
A48 48 Ibuprofen tablet 400 mg Tablet 0
A49 49 Isoniazide 100 mg Tablet 0
A50 50 Isoniazide 300 mg Tablet 0
A51 51 Isosorbid dinitrat Tablet 0
A52 52 Kalsium hidroksida pasta Pot 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 140
A54 54 Ketokonazole 200 mg tablet Tablet 0
A55 55 Kloramfenicol salep kulit Tube 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0
A57 57 Kloramfenikol salep mata 1 % Tube 0
A58 58 Kloramfenikol tetes Mata Botol 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 0
A61 61 Kotrimoksasol suspensi Botol 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0
A63 63 Lidokain inj Ampul 0
A64 64 Lidokaina comp inj kombinasi Ampul 0
A65 65 Metformin 500 mg tablet Tablet 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0
A70 70 Metronidazol 500 mg Tablet 0
A71 71 Metronidazol tablet 250 mg Tablet 0
A72 72 Mikonazole salep Tube 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 40
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0
A75 75 Nifedipin tablet 10 mg Tablet 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0
A82 82 Parasetamol tablet 500mg Tablet 47
A83 83 Prednison tablet 5 mgn Tablet 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0
A85 85 Ranitidin tablet 150 mg Tablet 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0
A90 90 Ringer laktat larutan infus steril Botol 0
A91 91 Risperidon Tablet 0
A92 92 Salbutamol tablet 2 mg Tablet 0
A93 93 Salbutamol tablet 4 mg Tablet 0
A94 94 Salisil bedak 2 % Bks 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0
A96 96 Silver amalgam serbuk 65-75% Botol 0
A97 97 Simvastatin tab 10 mg Tablet 0
A98 98 Sulfacetamide tetes mata Botol 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0
A100 100 Thiamfenikol 500 Tablet 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0
A103 103 Trifluoperazine (Stelazin) Tablet 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0
A105 105 Vitamin B kompleks tablet Tablet 0
A106 106 Zink tablet Tablet 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0
A109 109 Amlodipin 5 mg tab Tablet 0
A110 110 Antasida syr Tablet 0
A111 111 Asam Folat 1 mg Tablet 0
A112 112 Becefort Vial 10
A113 113 Benzatin Penisillin Set 0
A114 114 Bonding Tube 0
A115 115 Bufacomb salep Ampul 4
A116 116 Daryantulle Tube 0
A117 117 Dermazine/Burnazin Tablet 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0
A119 119 Dextrofen syr Tablet 0
A120 120 Dormi/Scopma/Spashi tablet Supp 0
A121 121 Dulcolac anak supp Supp 0
A122 122 Dulcolac dewasa supp Tablet 0
A123 123 Dulkolak tablet Botol 0
A124 124 Euthyrox 100mg Supp 0
A125 125 Glimepiride 2 tablet 0
A126 126 Glimepiride 4 Ampul 0
A127 127 Ibuprofen syr flesh 0
A128 128 Kalium Diklovenac Supp 0
A129 129 Kaltropen supp tube 0
A130 130 Ketoconazole SK Ampul 0
A131 131 Microlax tablet 0
A132 132 Miloxicam 7,5 mg Tablet 0
A133 133 Multivitamin (Livron B plek) Botol 0
A134 134 Multivitamin sirup (caviplex) Tablet 0
A135 135 New antides Tablet 0
A136 136 OBH plus Tablet 0
A137 137 Omeprasole tablet 20 mg Ampul 0
A138 138 Parasetamol drop Ampul 0
A139 139 Pehacain Injeksi Tablet 0
A140 140 Prenatin DF tablet 0
A141 141 Ventolin Nebulizer Tablet 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0
Caviplex syrup Botol 0
Calortusin Tablet 50
Demacolin Tablet 70
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 71
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0
B5 5 Alkohol 1 Liter Botol 0
B64 64 Alkohol swab Box 0
B6 6 Bactigrass Box 0
B8 8 Betadine 1 L Botol 0
B59 59 Betadine 30 ml Botol 0
B7 7 Betadine 300 ml Botol 0
B9 9 Bisturi No 10 Pcs 0
B10 10 Bisturi No 11 Pcs 0
B11 11 Bisturi No 20 Pcs 0
B12 12 Bisturi No 21 Pcs 0
B13 13 Bisturi No 22 Pcs 0
B65 65 Blood lancet Box 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0
B67 67 CE Botol 0
B16 16 Daryantulle Box 8
B69 69 Folley Cathteter G18 pcs 0
B17 17 H2O2 Botol 0
B18 18 Hand sanitizer Botol 0
B19 19 Hyfafik 5x5 Roll 0
B61 61 Hypapix 15 x 5 Roll 0
B20 20 Infusion Set dewasa Pcs 0
B21 21 IV cath no .18 Pcs 0
B22 22 IV cath no .20 Pcs 0
B23 23 IV cath no .22 Pcs 0
B24 24 IV cath no .24 Roll 0
B25 25 IV cath no.16 Pcs 0
B26 26 Jarum heacting Pcs 0
B27 27 Jarum Injeksi Pcs 0
B28 28 Jarum Onemed set Pcs 0
B29 29 Jarum Otot -Kulit Set 0
B30 30 Jelly Botol 0
B31 31 Kantong Puyer Pack 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0
B63 63 Kapas pembalut 1000g Roll 0
B33 33 Kasa Gulung Roll 0
B34 34 Kasa hidrofil 18 x 22 Roll 0
B35 35 Kasa hidrofil 4 x 10 Roll 0
B66 66 Kasa hidrofil 5 x 4 Roll 6
B36 36 Kasa pembalut 2 x 80 Roll 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 0
B38 38 Kertas Perkamen Pack 0
B39 39 Klem tali Pusar Pcs 0
B40 40 Klip Plastik Obat 10X7 cm Pack 14
B41 41 KlipPlastik Obat 13X8,7 cm Pack 9
B42 42 Lisol Botol 0
B43 43 Masker Box 0
B68 68 Masker N95 Pcs 0
B55 55 Nylon 5/0 Pcs 0
B57 57 Pot Dahak Pcs 0
B44 44 Sarung Tangan L Pasang 0
B45 45 Sarung Tangan M Pasang 0
B46 46 Sarung Tangan S Pasang 50
B47 47 Sarung Tangan Steril M Pasang 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0
B56 56 Slide prosted Pack 0
B60 60 Spiritus Pcs 0
B62 62 Spuit 10 cc Pcs 0
B58 58 Tabung EDTA Box 0
B50 50 Urinbag Pcs 0
B51 51 Venflon No 20 Pcs 0
B52 52 Wing Needle 21 Pcs 0
B53 53 Wing Needle 23 Pcs 0
B54 54 Wing Needle 25 Pcs 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat

dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A

NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018
 AN DAN LEMBAR PERMINTAAN OBAT JKN
D. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
APORAN : FEBRUARI 2022
RMINTAAN : MARET 2022

PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

10 1 9
0 0
0 0
0 0
8 12 7 5
21 21 0
0 0
5 3 2 5
0 0
0 0
150 150
5 8 8
0 0
0 0
0 0
0 0
100 270 60 210
0 0
0 0
100 100
0 0
5 1 4 5
100 200 200
0 0
0 0
0 0
5 10 10
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
140 30 110
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
40 30 10
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
200 247 117 130 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 0 0
0 0
0 0
100 100 100
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
200 210 44 166
0 0
0 0
4 2 2 5
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
10 10 7 3 10
200 250 70 180
200 270 70 200

0 0
0 0
71 1 70
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
8 1 7
0 0
0 0
0 0
0 0
1 1 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
5 5 5
6 1 5
0 0
5 5 5
1 1 1 0
0 0
14 1 13
9 1 8
1 1 1 0
0 0
0 0
0 0
0 0
0 0
0 0
50 100 50 50 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

nanggunjawab Gudang Obat Penanggungjawab Sub Unit

Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
P. 19930719 201903 2 018 NIP.197608142006042014
PENERIMAAN KET

ED 1

ED 150
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : MARET 2022
PERMINTAAN : APRIL 2022
STOK
KODE NO NAMA OBAT SATUAN
AWAL
A1 1 Acyclovir Salep Tube 9
A2 2 Acyclovir 400 mg Tab Tablet 0
A3 3 Albendazol 400 mg tab Tablet 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0
A5 5 Ambroxol syr Botol 5
A6 6 Ambroxol tab 30 mg / Promukus Tablet 0
A7 7 Amoksilina kapsul 500 mg Tablet 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 2
A9 9 Antasida doen tablet kombinasi Tablet 0
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0
A11 11 Asam mefenamat 500 mg Tablet 150
A12 12 Basitrasin Polimiksin Tube 8
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0
A14 14 Betahistin tab Tablet 0
A15 15 Betametazon salep kulit Tube 0
A16 16 Captopril 12.5 mg tablet Tablet 0
A17 17 Captopril 25 mg tablet Tablet 210
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0
A19 19 Cefadroxill 500 mg tablet Tablet 0
A20 20 Cetirizin10 mg tab Tablet 100
A21 21 Ciprofloxazin tablet 500 mg Tablet 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 4
A23 23 Deksametason tablet 0.5 mg Tablet 200
A24 24 Diazepam 5 mg Tablet 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0
A26 26 Diazepam tablet 2 mg Tablet 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 10
A28 28 Domperidon tablet 10 mg Tablet 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0
A30 30 Erytromysin tablet 500 mg Tablet 0
A31 31 Etil klorida semprot Botol 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0
A35 35 Furosemida tablet 40 mg Tablet 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0
A37 37 Gentamisin Salep Mata Tube 0
A38 38 Gentamysin SK Tube 0
A39 39 Gentamysin TM/Genoint TM Botol 0
A40 40 Gentian violet larutan 1 % Botol 0
A41 41 Glibenklamida tablet 5 mg Tablet 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0
A43 43 Glukosa larutan infus 10 % steril Botol 0
A44 44 Glukosa larutan infus 40 % steril Botol 0
A45 45 Glukosa larutan infus 5 % steril Botol 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0
A47 47 Hidrokortison krim 2.5 % Tube 0
A48 48 Ibuprofen tablet 400 mg Tablet 0
A49 49 Isoniazide 100 mg Tablet 0
A50 50 Isoniazide 300 mg Tablet 0
A51 51 Isosorbid dinitrat Tablet 0
A52 52 Kalsium hidroksida pasta Pot 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 110
A54 54 Ketokonazole 200 mg tablet Tablet 0
A55 55 Kloramfenicol salep kulit Tube 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0
A57 57 Kloramfenikol salep mata 1 % Tube 0
A58 58 Kloramfenikol tetes Mata Botol 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 0
A61 61 Kotrimoksasol suspensi Botol 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0
A63 63 Lidokain inj Ampul 0
A64 64 Lidokaina comp inj kombinasi Ampul 0
A65 65 Metformin 500 mg tablet Tablet 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0
A70 70 Metronidazol 500 mg Tablet 0
A71 71 Metronidazol tablet 250 mg Tablet 0
A72 72 Mikonazole salep Tube 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 10
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0
A75 75 Nifedipin tablet 10 mg Tablet 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0
A82 82 Parasetamol tablet 500mg Tablet 130
A83 83 Prednison tablet 5 mgn Tablet 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0
A85 85 Ranitidin tablet 150 mg Tablet 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0
A90 90 Ringer laktat larutan infus steril Botol 0
A91 91 Risperidon Tablet 0
A92 92 Salbutamol tablet 2 mg Tablet 0
A93 93 Salbutamol tablet 4 mg Tablet 100
A94 94 Salisil bedak 2 % Bks 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0
A96 96 Silver amalgam serbuk 65-75% Botol 0
A97 97 Simvastatin tab 10 mg Tablet 0
A98 98 Sulfacetamide tetes mata Botol 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0
A100 100 Thiamfenikol 500 Tablet 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0
A103 103 Trifluoperazine (Stelazin) Tablet 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0
A105 105 Vitamin B kompleks tablet Tablet 0
A106 106 Zink tablet Tablet 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0
A109 109 Amlodipin 5 mg tab Tablet 0
A110 110 Antasida syr Tablet 0
A111 111 Asam Folat 1 mg Tablet 0
A112 112 Becefort Vial 166
A113 113 Benzatin Penisillin Set 0
A114 114 Bonding Tube 0
A115 115 Bufacomb salep Ampul 2
A116 116 Daryantulle Tube 0
A117 117 Dermazine/Burnazin Tablet 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0
A119 119 Dextrofen syr Tablet 0
A120 120 Dormi/Scopma/Spashi tablet Supp 0
A121 121 Dulcolac anak supp Supp 0
A122 122 Dulcolac dewasa supp Tablet 0
A123 123 Dulkolak tablet Botol 0
A124 124 Euthyrox 100mg Supp 0
A125 125 Glimepiride 2 tablet 0
A126 126 Glimepiride 4 Ampul 0
A127 127 Ibuprofen syr flesh 0
A128 128 Kalium Diklovenac Supp 0
A129 129 Kaltropen supp tube 0
A130 130 Ketoconazole SK Ampul 0
A131 131 Microlax tablet 0
A132 132 Miloxicam 7,5 mg Tablet 0
A133 133 Multivitamin (Livron B plek) Botol 0
A134 134 Multivitamin sirup (caviplex) Tablet 0
A135 135 New antides Tablet 0
A136 136 OBH plus Tablet 0
A137 137 Omeprasole tablet 20 mg Ampul 0
A138 138 Parasetamol drop Ampul 0
A139 139 Pehacain Injeksi Tablet 0
A140 140 Prenatin DF tablet 0
A141 141 Ventolin Nebulizer Tablet 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0
Caviplex syrup Botol 3
Calortusin Tablet 180
Demacolin Tablet 200
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 70
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0
B5 5 Alkohol 1 Liter Botol 0
B64 64 Alkohol swab Box 0
B6 6 Bactigrass Box 0
B8 8 Betadine 1 L Botol 0
B59 59 Betadine 30 ml Botol 0
B7 7 Betadine 300 ml Botol 0
B9 9 Bisturi No 10 Pcs 0
B10 10 Bisturi No 11 Pcs 0
B11 11 Bisturi No 20 Pcs 0
B12 12 Bisturi No 21 Pcs 0
B13 13 Bisturi No 22 Pcs 0
B65 65 Blood lancet Box 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0
B67 67 CE Botol 0
B16 16 Daryantulle Box 7
B69 69 Folley Cathteter G18 pcs 0
B17 17 H2O2 Botol 0
B18 18 Hand sanitizer Botol 0
B19 19 Hyfafik 5x5 Roll 0
B61 61 Hypapix 15 x 5 Roll 0
B20 20 Infusion Set dewasa Pcs 0
B21 21 IV cath no .18 Pcs 0
B22 22 IV cath no .20 Pcs 0
B23 23 IV cath no .22 Pcs 0
B24 24 IV cath no .24 Roll 0
B25 25 IV cath no.16 Pcs 0
B26 26 Jarum heacting Pcs 0
B27 27 Jarum Injeksi Pcs 0
B28 28 Jarum Onemed set Pcs 0
B29 29 Jarum Otot -Kulit Set 0
B30 30 Jelly Botol 0
B31 31 Kantong Puyer Pack 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0
B63 63 Kapas pembalut 1000g Roll 0
B33 33 Kasa Gulung Roll 0
B34 34 Kasa hidrofil 18 x 22 Roll 0
B35 35 Kasa hidrofil 4 x 10 Roll 5
B66 66 Kasa hidrofil 5 x 4 Roll 5
B36 36 Kasa pembalut 2 x 80 Roll 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 5
B38 38 Kertas Perkamen Pack 0
B39 39 Klem tali Pusar Pcs 0
B40 40 Klip Plastik Obat 10X7 cm Pack 13
B41 41 KlipPlastik Obat 13X8,7 cm Pack 8
B42 42 Lisol Botol 0
B43 43 Masker Box 0
B68 68 Masker N95 Pcs 0
B55 55 Nylon 5/0 Pcs 0
B57 57 Pot Dahak Pcs 0
B44 44 Sarung Tangan L Pasang 0
B45 45 Sarung Tangan M Pasang 0
B46 46 Sarung Tangan S Pasang 50
B47 47 Sarung Tangan Steril M Pasang 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0
B56 56 Slide prosted Pack 0
B60 60 Spiritus Pcs 0
B62 62 Spuit 10 cc Pcs 0
B58 58 Tabung EDTA Box 0
B50 50 Urinbag Pcs 0
B51 51 Venflon No 20 Pcs 0
B52 52 Wing Needle 21 Pcs 0
B53 53 Wing Needle 23 Pcs 0
B54 54 Wing Needle 25 Pcs 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat

dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A.Md

NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018
 AN DAN LEMBAR PERMINTAAN OBAT JKN
D. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
LAPORAN : MARET 2022
RMINTAAN : APRIL 2022

PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

9 1 8
0 0
0 0
0 0
5 5 0 10
0 0
0 0
5 7 4 3 5
0 0
0 0
150 150
8 4 4 5
0 0
0 0
0 0
0 0
210 40 170
0 0
0 0
100 100
0 0
5 9 1 8
200 108 92 100
0 0
0 0
0 0
10 10
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
110 60 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
10 10 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 230 118 112 100
0 0
 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 100
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
166 42 124
0 0
0 0
5 7 7
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
10 13 9 4 5
180 36 144
200 20 180

0 0
0 0
70 4 66
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
7 2 5
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
5 1 4
5 1 4
0 0
5 1 4
0 0
0 0
13 1 12
8 1 7
0 0
0 0 100
0 0
0 0
0 0
0 0
0 0
50 100 50 50 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
nanggunjawab Gudang Obat Penanggungjawab Sub Unit

Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
P. 19930719 201903 2 018 NIP.197608142006042014
PENERIMAAN KET

ED 1

ED 150
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : APRIL 2022
PERMINTAAN : MEI 2022
STOK
KODE NO NAMA OBAT SATUAN
AWAL
A1 1 Acyclovir Salep Tube 8
A2 2 Acyclovir 400 mg Tab Tablet 0
A3 3 Albendazol 400 mg tab Tablet 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0
A5 5 Ambroxol syr Botol 0
A6 6 Ambroxol tab 30 mg / Promukus Tablet 0
A7 7 Amoksilina kapsul 500 mg Tablet 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 3
A9 9 Antasida doen tablet kombinasi Tablet 0
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0
A11 11 Asam mefenamat 500 mg Tablet 150
A12 12 Basitrasin Polimiksin Tube 4
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0
A14 14 Betahistin tab Tablet 0
A15 15 Betametazon salep kulit Tube 0
A16 16 Captopril 12.5 mg tablet Tablet 0
A17 17 Captopril 25 mg tablet Tablet 170
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0
A19 19 Cefadroxill 500 mg tablet Tablet 0
A20 20 Cetirizin10 mg tab Tablet 100
A21 21 Ciprofloxazin tablet 500 mg Tablet 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 8
A23 23 Deksametason tablet 0.5 mg Tablet 92
A24 24 Diazepam 5 mg Tablet 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0
A26 26 Diazepam tablet 2 mg Tablet 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 10
A28 28 Domperidon tablet 10 mg Tablet 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0
A30 30 Erytromysin tablet 500 mg Tablet 0
A31 31 Etil klorida semprot Botol 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0
A35 35 Furosemida tablet 40 mg Tablet 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0
A37 37 Gentamisin Salep Mata Tube 0
A38 38 Gentamysin SK Tube 0
A39 39 Gentamysin TM/Genoint TM Botol 0
A40 40 Gentian violet larutan 1 % Botol 0
A41 41 Glibenklamida tablet 5 mg Tablet 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0
A43 43 Glukosa larutan infus 10 % steril Botol 0
A44 44 Glukosa larutan infus 40 % steril Botol 0
A45 45 Glukosa larutan infus 5 % steril Botol 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0
A47 47 Hidrokortison krim 2.5 % Tube 0
A48 48 Ibuprofen tablet 400 mg Tablet 0
A49 49 Isoniazide 100 mg Tablet 0
A50 50 Isoniazide 300 mg Tablet 0
A51 51 Isosorbid dinitrat Tablet 0
A52 52 Kalsium hidroksida pasta Pot 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 50
A54 54 Ketokonazole 200 mg tablet Tablet 0
A55 55 Kloramfenicol salep kulit Tube 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0
A57 57 Kloramfenikol salep mata 1 % Tube 0
A58 58 Kloramfenikol tetes Mata Botol 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 0
A61 61 Kotrimoksasol suspensi Botol 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0
A63 63 Lidokain inj Ampul 0
A64 64 Lidokaina comp inj kombinasi Ampul 0
A65 65 Metformin 500 mg tablet Tablet 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0
A70 70 Metronidazol 500 mg Tablet 0
A71 71 Metronidazol tablet 250 mg Tablet 0
A72 72 Mikonazole salep Tube 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 0
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0
A75 75 Nifedipin tablet 10 mg Tablet 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0
A82 82 Parasetamol tablet 500mg Tablet 112
A83 83 Prednison tablet 5 mgn Tablet 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0
A85 85 Ranitidin tablet 150 mg Tablet 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0
A90 90 Ringer laktat larutan infus steril Botol 0
A91 91 Risperidon Tablet 0
A92 92 Salbutamol tablet 2 mg Tablet 0
A93 93 Salbutamol tablet 4 mg Tablet 100
A94 94 Salisil bedak 2 % Bks 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0
A96 96 Silver amalgam serbuk 65-75% Botol 0
A97 97 Simvastatin tab 10 mg Tablet 0
A98 98 Sulfacetamide tetes mata Botol 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0
A100 100 Thiamfenikol 500 Tablet 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0
A103 103 Trifluoperazine (Stelazin) Tablet 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0
A105 105 Vitamin B kompleks tablet Tablet 0
A106 106 Zink tablet Tablet 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0
A109 109 Amlodipin 5 mg tab Tablet 0
A110 110 Antasida syr Tablet 0
A111 111 Asam Folat 1 mg Tablet 0
A112 112 Becefort Vial 124
A113 113 Benzatin Penisillin Set 0
A114 114 Bonding Tube 0
A115 115 Bufacomb salep Ampul 7
A116 116 Daryantulle Tube 0
A117 117 Dermazine/Burnazin Tablet 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0
A119 119 Dextrofen syr Tablet 0
A120 120 Dormi/Scopma/Spashi tablet Supp 0
A121 121 Dulcolac anak supp Supp 0
A122 122 Dulcolac dewasa supp Tablet 0
A123 123 Dulkolak tablet Botol 0
A124 124 Euthyrox 100mg Supp 0
A125 125 Glimepiride 2 tablet 0
A126 126 Glimepiride 4 Ampul 0
A127 127 Ibuprofen syr flesh 0
A128 128 Kalium Diklovenac Supp 0
A129 129 Kaltropen supp tube 0
A130 130 Ketoconazole SK Ampul 0
A131 131 Microlax tablet 0
A132 132 Miloxicam 7,5 mg Tablet 0
A133 133 Multivitamin (Livron B plek) Botol 0
A134 134 Multivitamin sirup (caviplex) Tablet 0
A135 135 New antides Tablet 0
A136 136 OBH plus Tablet 0
A137 137 Omeprasole tablet 20 mg Ampul 0
A138 138 Parasetamol drop Ampul 0
A139 139 Pehacain Injeksi Tablet 0
A140 140 Prenatin DF tablet 0
A141 141 Ventolin Nebulizer Tablet 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0
Caviplex syrup Botol 4
Calortusin Tablet 144
Demacolin Tablet 180
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 66
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0
B5 5 Alkohol 1 Liter Botol 0
B64 64 Alkohol swab Box 0
B6 6 Bactigrass Box 0
B8 8 Betadine 1 L Botol 0
B59 59 Betadine 30 ml Botol 0
B7 7 Betadine 300 ml Botol 0
B9 9 Bisturi No 10 Pcs 0
B10 10 Bisturi No 11 Pcs 0
B11 11 Bisturi No 20 Pcs 0
B12 12 Bisturi No 21 Pcs 0
B13 13 Bisturi No 22 Pcs 0
B65 65 Blood lancet Box 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0
B67 67 CE Botol 0
B16 16 Daryantulle Box 5
B69 69 Folley Cathteter G18 pcs 0
B17 17 H2O2 Botol 0
B18 18 Hand sanitizer Botol 0
B19 19 Hyfafik 5x5 Roll 0
B61 61 Hypapix 15 x 5 Roll 0
B20 20 Infusion Set dewasa Pcs 0
B21 21 IV cath no .18 Pcs 0
B22 22 IV cath no .20 Pcs 0
B23 23 IV cath no .22 Pcs 0
B24 24 IV cath no .24 Roll 0
B25 25 IV cath no.16 Pcs 0
B26 26 Jarum heacting Pcs 0
B27 27 Jarum Injeksi Pcs 0
B28 28 Jarum Onemed set Pcs 0
B29 29 Jarum Otot -Kulit Set 0
B30 30 Jelly Botol 0
B31 31 Kantong Puyer Pack 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0
B63 63 Kapas pembalut 1000g Roll 0
B33 33 Kasa Gulung Roll 0
B34 34 Kasa hidrofil 18 x 22 Roll 0
B35 35 Kasa hidrofil 4 x 10 Roll 4
B66 66 Kasa hidrofil 5 x 4 Roll 4
B36 36 Kasa pembalut 2 x 80 Roll 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 4
B38 38 Kertas Perkamen Pack 0
B39 39 Klem tali Pusar Pcs 0
B40 40 Klip Plastik Obat 10X7 cm Pack 12
B41 41 KlipPlastik Obat 13X8,7 cm Pack 7
B42 42 Lisol Botol 0
B43 43 Masker Box 0
B68 68 Masker N95 Pcs 0
B55 55 Nylon 5/0 Pcs 0
B57 57 Pot Dahak Pcs 0
B44 44 Sarung Tangan L Pasang 0
B45 45 Sarung Tangan M Pasang 0
B46 46 Sarung Tangan S Pasang 50
B47 47 Sarung Tangan Steril M Pasang 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0
B56 56 Slide prosted Pack 0
B60 60 Spiritus Pcs 0
B62 62 Spuit 10 cc Pcs 0
B58 58 Tabung EDTA Box 0
B50 50 Urinbag Pcs 0
B51 51 Venflon No 20 Pcs 0
B52 52 Wing Needle 21 Pcs 0
B53 53 Wing Needle 23 Pcs 0
B54 54 Wing Needle 25 Pcs 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat

dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A.Md

NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018
 AN DAN LEMBAR PERMINTAAN OBAT JKN
D. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
LAPORAN : APRIL 2022
ERMINTAAN : MEI 2022

PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

8 8
0 0
0 0
0 0
0 0 10
0 0
0 0
5 8 7 1 10
0 0
0 0
150 150
5 9 2 7
0 0
0 0
0 0
0 0
170 50 120 100
0 0
0 0
100 100
0 0
8 1 7
100 192 58 134 100
0 0
0 0
0 0
10 10
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
50 20 30 100
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
100 212 200 12 200
0 0
 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 100
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
124 94 30 200
0 0
0 0
7 2 5
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
5 9 2 7 5
144 32 112 100
180 36 144 100

0 0
0 0
66 4 62
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
5 1 4
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
4 1 3
4 1 3
0 0
4 1 3
0 0
0 0
12 1 11
7 1 6
0 0
0 0 100
0 0
0 0
0 0
0 0
0 0
50 100 50 50 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
nanggunjawab Gudang Obat Penanggungjawab Sub Unit

Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
P. 19930719 201903 2 018 NIP.197608142006042014
PENERIMAAN KET

ED 1

ED 150
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT JKN
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : MEI 2022
PERMINTAAN : JUNI 2022
STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN KET
AWAL
A1 1 Acyclovir Salep Tube 8 8 1 7 ED 1
A2 2 Acyclovir 400 mg Tab Tablet 0 0 0
A3 3 Albendazol 400 mg tab Tablet 0 0 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0 0 0
A5 5 Ambroxol syr Botol 0 0 0 10
A6 6 Ambroxol tab 30 mg / Promukus Tablet 0 0 0
A7 7 Amoksilina kapsul 500 mg Tablet 0 0 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 1 10 11 4 7
A9 9 Antasida doen tablet kombinasi Tablet 0 0 0
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0 0 0
A11 11 Asam mefenamat 500 mg Tablet 150 150 150 ED 150
A12 12 Basitrasin Polimiksin Tube 7 7 1 6
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0 0 0
A14 14 Betahistin tab Tablet 0 0 0
A15 15 Betametazon salep kulit Tube 0 0 0
A16 16 Captopril 12.5 mg tablet Tablet 0 0 0
A17 17 Captopril 25 mg tablet Tablet 120 120 110 10
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0 0 0
A19 19 Cefadroxill 500 mg tablet Tablet 0 100 100 100
A20 20 Cetirizin10 mg tab Tablet 100 100 100
A21 21 Ciprofloxazin tablet 500 mg Tablet 0 0 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 7 7 1 6
A23 23 Deksametason tablet 0.5 mg Tablet 134 100 234 62 172
A24 24 Diazepam 5 mg Tablet 0 0 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0 0 0
A26 26 Diazepam tablet 2 mg Tablet 0 0 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 10 10 10
A28 28 Domperidon tablet 10 mg Tablet 0 0 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0 0 0
A30 30 Erytromysin tablet 500 mg Tablet 0 0 0
A31 31 Etil klorida semprot Botol 0 0 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0 0 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0 0 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN KET
AWAL
A35 35 Furosemida tablet 40 mg Tablet 0 0 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0 0 0
A37 37 Gentamisin Salep Mata Tube 0 0 0
A38 38 Gentamysin SK Tube 0 0 0
A39 39 Gentamysin TM/Genoint TM Botol 0 0 0
A40 40 Gentian violet larutan 1 % Botol 0 0 0
A41 41 Glibenklamida tablet 5 mg Tablet 0 0 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0 0 0
A43 43 Glukosa larutan infus 10 % steril Botol 0 0 0
A44 44 Glukosa larutan infus 40 % steril Botol 0 0 0
A45 45 Glukosa larutan infus 5 % steril Botol 0 0 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0 0 0
A47 47 Hidrokortison krim 2.5 % Tube 0 0 0
A48 48 Ibuprofen tablet 400 mg Tablet 0 0 0
A49 49 Isoniazide 100 mg Tablet 0 0 0
A50 50 Isoniazide 300 mg Tablet 0 0 0
A51 51 Isosorbid dinitrat Tablet 0 0 0
A52 52 Kalsium hidroksida pasta Pot 0 0 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 30 30 30
A54 54 Ketokonazole 200 mg tablet Tablet 0 0 0
A55 55 Kloramfenicol salep kulit Tube 0 0 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0 0 0
A57 57 Kloramfenikol salep mata 1 % Tube 0 0 0
A58 58 Kloramfenikol tetes Mata Botol 0 0 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0 0 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 0 0 0
A61 61 Kotrimoksasol suspensi Botol 0 0 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0 0 0
A63 63 Lidokain inj Ampul 0 0 0
A64 64 Lidokaina comp inj kombinasi Ampul 0 0 0
A65 65 Metformin 500 mg tablet Tablet 0 0 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0 0 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0 0 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0 0 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0 0 0
A70 70 Metronidazol 500 mg Tablet 0 0 0
A71 71 Metronidazol tablet 250 mg Tablet 0 0 0
A72 72 Mikonazole salep Tube 0 0 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 0 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN KET
AWAL
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0 0 0
A75 75 Nifedipin tablet 10 mg Tablet 0 0 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0 0 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0 0 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0 0 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0 0 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0 0 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0 0 0
A82 82 Parasetamol tablet 500mg Tablet 12 200 212 92 120 100
A83 83 Prednison tablet 5 mgn Tablet 0 0 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0 0 0
A85 85 Ranitidin tablet 150 mg Tablet 0 0 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0 0 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0 0 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0 0 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0 0 0
A90 90 Ringer laktat larutan infus steril Botol 0 0 0
A91 91 Risperidon Tablet 0 0 0
A92 92 Salbutamol tablet 2 mg Tablet 0 0 0
A93 93 Salbutamol tablet 4 mg Tablet 100 100 100
A94 94 Salisil bedak 2 % Bks 0 0 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0 0 0
A96 96 Silver amalgam serbuk 65-75% Botol 0 0 0
A97 97 Simvastatin tab 10 mg Tablet 0 0 0
A98 98 Sulfacetamide tetes mata Botol 0 0 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0 0 0
A100 100 Thiamfenikol 500 Tablet 0 0 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0 0 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0 0 0
A103 103 Trifluoperazine (Stelazin) Tablet 0 0 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0 0 0
A105 105 Vitamin B kompleks tablet Tablet 0 0 0
A106 106 Zink tablet Tablet 0 0 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0 0 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0 0 0
A109 109 Amlodipin 5 mg tab Tablet 0 0 0
A110 110 Antasida syr Tablet 0 0 0
A111 111 Asam Folat 1 mg Tablet 0 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN KET
AWAL
A112 112 Becefort Vial 30 200 230 80 150
A113 113 Benzatin Penisillin Set 0 0 0
A114 114 Bonding Tube 0 0 0
A115 115 Bufacomb salep Ampul 5 5 5
A116 116 Daryantulle Tube 0 0 0
A117 117 Dermazine/Burnazin Tablet 0 0 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0 0 0
A119 119 Dextrofen syr Tablet 0 0 0
A120 120 Dormi/Scopma/Spashi tablet Supp 0 0 0
A121 121 Dulcolac anak supp Supp 0 0 0
A122 122 Dulcolac dewasa supp Tablet 0 0 0
A123 123 Dulkolak tablet Botol 0 0 0
A124 124 Euthyrox 100mg Supp 0 0 0
A125 125 Glimepiride 2 tablet 0 0 0
A126 126 Glimepiride 4 Ampul 0 0 0
A127 127 Ibuprofen syr flesh 0 0 0
A128 128 Kalium Diklovenac Supp 0 0 0
A129 129 Kaltropen supp tube 0 0 0
A130 130 Ketoconazole SK Ampul 0 0 0
A131 131 Microlax tablet 0 0 0
A132 132 Miloxicam 7,5 mg Tablet 0 0 0
A133 133 Multivitamin (Livron B plek) Botol 0 0 0
A134 134 Multivitamin sirup (caviplex) Tablet 0 0 0
A135 135 New antides Tablet 0 0 0
A136 136 OBH plus Tablet 0 0 0
A137 137 Omeprasole tablet 20 mg Ampul 0 0 0
A138 138 Parasetamol drop Ampul 0 0 0
A139 139 Pehacain Injeksi Tablet 0 0 0
A140 140 Prenatin DF tablet 0 0 0
A141 141 Ventolin Nebulizer Tablet 0 0 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0 0 0
Caviplex syrup Botol 7 5 12 6 6
Calortusin Tablet 112 100 212 40 172
Demacolin Tablet 144 100 244 56 188
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0 0 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0 0 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 62 62 5 57
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN KET
AWAL
B5 5 Alkohol 1 Liter Botol 0 0 0
B64 64 Alkohol swab Box 0 0 0
B6 6 Bactigrass Box 0 0 0
B8 8 Betadine 1 L Botol 0 0 0
B59 59 Betadine 30 ml Botol 0 0 0
B7 7 Betadine 300 ml Botol 0 0 0
B9 9 Bisturi No 10 Pcs 0 0 0
B10 10 Bisturi No 11 Pcs 0 0 0
B11 11 Bisturi No 20 Pcs 0 0 0
B12 12 Bisturi No 21 Pcs 0 0 0
B13 13 Bisturi No 22 Pcs 0 0 0
B65 65 Blood lancet Box 0 0 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0 0 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0 0 0
B67 67 CE Botol 0 0 0
B16 16 Daryantulle Box 4 4 1 3
B69 69 Folley Cathteter G18 pcs 0 0 0
B17 17 H2O2 Botol 0 0 0
B18 18 Hand sanitizer Botol 0 0 0
B19 19 Hyfafik 5x5 Roll 0 0 0
B61 61 Hypapix 15 x 5 Roll 0 0 0
B20 20 Infusion Set dewasa Pcs 0 0 0
B21 21 IV cath no .18 Pcs 0 0 0
B22 22 IV cath no .20 Pcs 0 0 0
B23 23 IV cath no .22 Pcs 0 0 0
B24 24 IV cath no .24 Roll 0 0 0
B25 25 IV cath no.16 Pcs 0 0 0
B26 26 Jarum heacting Pcs 0 0 0
B27 27 Jarum Injeksi Pcs 0 0 0
B28 28 Jarum Onemed set Pcs 0 0 0
B29 29 Jarum Otot -Kulit Set 0 0 0
B30 30 Jelly Botol 0 0 0
B31 31 Kantong Puyer Pack 0 0 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0 0 0
B63 63 Kapas pembalut 1000g Roll 0 0 0
B33 33 Kasa Gulung Roll 0 0 0
B34 34 Kasa hidrofil 18 x 22 Roll 0 0 0
B35 35 Kasa hidrofil 4 x 10 Roll 3 3 1 2
B66 66 Kasa hidrofil 5 x 4 Roll 3 3 1 2
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN KET
AWAL
B36 36 Kasa pembalut 2 x 80 Roll 0 0 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 3 3 1 2
B38 38 Kertas Perkamen Pack 0 0 0
B39 39 Klem tali Pusar Pcs 0 0 0
B40 40 Klip Plastik Obat 10X7 cm Pack 11 11 1 10
B41 41 KlipPlastik Obat 13X8,7 cm Pack 6 6 1 5
B42 42 Lisol Botol 0 0 0
B43 43 Masker Box 0 0 0 100
B68 68 Masker N95 Pcs 0 0 0
B55 55 Nylon 5/0 Pcs 0 0 0
B57 57 Pot Dahak Pcs 0 0 0
B44 44 Sarung Tangan L Pasang 0 0 0
B45 45 Sarung Tangan M Pasang 0 0 0
B46 46 Sarung Tangan S Pasang 50 50 100 50 50 50
B47 47 Sarung Tangan Steril M Pasang 0 0 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0 0 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0 0 0
B56 56 Slide prosted Pack 0 0 0
B60 60 Spiritus Pcs 0 0 0
B62 62 Spuit 10 cc Pcs 0 0 0
B58 58 Tabung EDTA Box 0 0 0
B50 50 Urinbag Pcs 0 0 0
B51 51 Venflon No 20 Pcs 0 0 0
B52 52 Wing Needle 21 Pcs 0 0 0
B53 53 Wing Needle 23 Pcs 0 0 0
B54 54 Wing Needle 25 Pcs 0 0 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat Penanggungjawab Sub Unit

dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018 NIP.197608142006042014
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : JUNI 2022
PERMINTAAN : JULI 2022
STOK
KODE NO NAMA OBAT SATUAN
AWAL
A1 1 Acyclovir Salep Tube 7
A2 2 Acyclovir 400 mg Tab Tablet 0
A3 3 Albendazol 400 mg tab Tablet 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0
A5 5 Ambroxol syr Botol 0
A6 6 Ambroxol tab 30 mg / Promukus Tablet 0
A7 7 Amoksilina kapsul 500 mg Tablet 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 7
A9 9 Antasida doen tablet kombinasi Tablet 0
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0
A11 11 Asam mefenamat 500 mg Tablet 150
A12 12 Basitrasin Polimiksin Tube 6
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0
A14 14 Betahistin tab Tablet 0
A15 15 Betametazon salep kulit Tube 0
A16 16 Captopril 12.5 mg tablet Tablet 0
A17 17 Captopril 25 mg tablet Tablet 10
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0
A19 19 Cefadroxill 500 mg tablet Tablet 100
A20 20 Cetirizin10 mg tab Tablet 100
A21 21 Ciprofloxazin tablet 500 mg Tablet 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 6
A23 23 Deksametason tablet 0.5 mg Tablet 172
A24 24 Diazepam 5 mg Tablet 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0
A26 26 Diazepam tablet 2 mg Tablet 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 10
A28 28 Domperidon tablet 10 mg Tablet 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0
A30 30 Erytromysin tablet 500 mg Tablet 0
A31 31 Etil klorida semprot Botol 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0
A35 35 Furosemida tablet 40 mg Tablet 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0
A37 37 Gentamisin Salep Mata Tube 0
A38 38 Gentamysin SK Tube 0
A39 39 Gentamysin TM/Genoint TM Botol 0
A40 40 Gentian violet larutan 1 % Botol 0
A41 41 Glibenklamida tablet 5 mg Tablet 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0
A43 43 Glukosa larutan infus 10 % steril Botol 0
A44 44 Glukosa larutan infus 40 % steril Botol 0
A45 45 Glukosa larutan infus 5 % steril Botol 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0
A47 47 Hidrokortison krim 2.5 % Tube 0
A48 48 Ibuprofen tablet 400 mg Tablet 0
A49 49 Isoniazide 100 mg Tablet 0
A50 50 Isoniazide 300 mg Tablet 0
A51 51 Isosorbid dinitrat Tablet 0
A52 52 Kalsium hidroksida pasta Pot 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 30
A54 54 Ketokonazole 200 mg tablet Tablet 0
A55 55 Kloramfenicol salep kulit Tube 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0
A57 57 Kloramfenikol salep mata 1 % Tube 0
A58 58 Kloramfenikol tetes Mata Botol 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 0
A61 61 Kotrimoksasol suspensi Botol 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0
A63 63 Lidokain inj Ampul 0
A64 64 Lidokaina comp inj kombinasi Ampul 0
A65 65 Metformin 500 mg tablet Tablet 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0
A70 70 Metronidazol 500 mg Tablet 0
A71 71 Metronidazol tablet 250 mg Tablet 0
A72 72 Mikonazole salep Tube 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 0
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0
A75 75 Nifedipin tablet 10 mg Tablet 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0
A82 82 Parasetamol tablet 500mg Tablet 120
A83 83 Prednison tablet 5 mgn Tablet 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0
A85 85 Ranitidin tablet 150 mg Tablet 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0
A90 90 Ringer laktat larutan infus steril Botol 0
A91 91 Risperidon Tablet 0
A92 92 Salbutamol tablet 2 mg Tablet 0
A93 93 Salbutamol tablet 4 mg Tablet 100
A94 94 Salisil bedak 2 % Bks 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0
A96 96 Silver amalgam serbuk 65-75% Botol 0
A97 97 Simvastatin tab 10 mg Tablet 0
A98 98 Sulfacetamide tetes mata Botol 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0
A100 100 Thiamfenikol 500 Tablet 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0
A103 103 Trifluoperazine (Stelazin) Tablet 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0
A105 105 Vitamin B kompleks tablet Tablet 0
A106 106 Zink tablet Tablet 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0
A109 109 Amlodipin 5 mg tab Tablet 0
A110 110 Antasida syr Tablet 0
A111 111 Asam Folat 1 mg Tablet 0
A112 112 Becefort Vial 150
A113 113 Benzatin Penisillin Set 0
A114 114 Bonding Tube 0
A115 115 Bufacomb salep Ampul 5
A116 116 Daryantulle Tube 0
A117 117 Dermazine/Burnazin Tablet 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0
A119 119 Dextrofen syr Tablet 0
A120 120 Dormi/Scopma/Spashi tablet Supp 0
A121 121 Dulcolac anak supp Supp 0
A122 122 Dulcolac dewasa supp Tablet 0
A123 123 Dulkolak tablet Botol 0
A124 124 Euthyrox 100mg Supp 0
A125 125 Glimepiride 2 tablet 0
A126 126 Glimepiride 4 Ampul 0
A127 127 Ibuprofen syr flesh 0
A128 128 Kalium Diklovenac Supp 0
A129 129 Kaltropen supp tube 0
A130 130 Ketoconazole SK Ampul 0
A131 131 Microlax tablet 0
A132 132 Miloxicam 7,5 mg Tablet 0
A133 133 Multivitamin (Livron B plek) Botol 0
A134 134 Multivitamin sirup (caviplex) Tablet 0
A135 135 New antides Tablet 0
A136 136 OBH plus Tablet 0
A137 137 Omeprasole tablet 20 mg Ampul 0
A138 138 Parasetamol drop Ampul 0
A139 139 Pehacain Injeksi Tablet 0
A140 140 Prenatin DF tablet 0
A141 141 Ventolin Nebulizer Tablet 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0
Caviplex syrup Botol 6
Calortusin Tablet 172
Demacolin Tablet 188
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 57
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0
B5 5 Alkohol 1 Liter Botol 0
B64 64 Alkohol swab Box 0
B6 6 Bactigrass Box 0
B8 8 Betadine 1 L Botol 0
B59 59 Betadine 30 ml Botol 0
B7 7 Betadine 300 ml Botol 0
B9 9 Bisturi No 10 Pcs 0
B10 10 Bisturi No 11 Pcs 0
B11 11 Bisturi No 20 Pcs 0
B12 12 Bisturi No 21 Pcs 0
B13 13 Bisturi No 22 Pcs 0
B65 65 Blood lancet Box 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0
B67 67 CE Botol 0
B16 16 Daryantulle Box 3
B69 69 Folley Cathteter G18 pcs 0
B17 17 H2O2 Botol 0
B18 18 Hand sanitizer Botol 0
B19 19 Hyfafik 5x5 Roll 0
B61 61 Hypapix 15 x 5 Roll 0
B20 20 Infusion Set dewasa Pcs 0
B21 21 IV cath no .18 Pcs 0
B22 22 IV cath no .20 Pcs 0
B23 23 IV cath no .22 Pcs 0
B24 24 IV cath no .24 Roll 0
B25 25 IV cath no.16 Pcs 0
B26 26 Jarum heacting Pcs 0
B27 27 Jarum Injeksi Pcs 0
B28 28 Jarum Onemed set Pcs 0
B29 29 Jarum Otot -Kulit Set 0
B30 30 Jelly Botol 0
B31 31 Kantong Puyer Pack 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0
B63 63 Kapas pembalut 1000g Roll 0
B33 33 Kasa Gulung Roll 0
B34 34 Kasa hidrofil 18 x 22 Roll 0
B35 35 Kasa hidrofil 4 x 10 Roll 2
B66 66 Kasa hidrofil 5 x 4 Roll 2
B36 36 Kasa pembalut 2 x 80 Roll 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 2
B38 38 Kertas Perkamen Pack 0
B39 39 Klem tali Pusar Pcs 0
B40 40 Klip Plastik Obat 10X7 cm Pack 10
B41 41 KlipPlastik Obat 13X8,7 cm Pack 5
B42 42 Lisol Botol 0
B43 43 Masker Box 0
B68 68 Masker N95 Pcs 0
B55 55 Nylon 5/0 Pcs 0
B57 57 Pot Dahak Pcs 0
B44 44 Sarung Tangan L Pasang 0
B45 45 Sarung Tangan M Pasang 0
B46 46 Sarung Tangan S Pasang 50
B47 47 Sarung Tangan Steril M Pasang 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0
B56 56 Slide prosted Pack 0
B60 60 Spiritus Pcs 0
B62 62 Spuit 10 cc Pcs 0
B58 58 Tabung EDTA Box 0
B50 50 Urinbag Pcs 0
B51 51 Venflon No 20 Pcs 0
B52 52 Wing Needle 21 Pcs 0
B53 53 Wing Needle 23 Pcs 0
B54 54 Wing Needle 25 Pcs 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat

dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A.Md

NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018
 AN DAN LEMBAR PERMINTAAN OBAT JKN
D. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
ELAPORAN : JUNI 2022
ERMINTAAN : JULI 2022

PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

7 2 5
0 0
0 0
0 0
0 0 10
0 0
0 0
7 4 3 5
0 0
0 0
150 150
6 2 4
0 0
0 0
0 0
0 0
10 10 0
0 0
100 100
100 100
0 0
6 6
172 62 110 100
0 0
0 0
0 0
10 10
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
30 20 10
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
120 86 34 100
0 0
 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 100
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
150 80 70 100
0 0
0 0
5 1 4
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
6 1 5
172 145 27 100
188 30 158

0 0
0 0
57 57
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
3 1 2
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 1 1
2 1 1
0 0
2 1 1
0 0
0 0
10 1 9
5 1 4
0 0
0 0 100
0 0
0 0
0 0
0 0
0 0
50 100 50 50 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
nanggunjawab Gudang Obat Penanggungjawab Sub Unit

Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
P. 19930719 201903 2 018 NIP.197608142006042014
PENERIMAAN KET

ED 1

ED 150
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : JULI 2022
PERMINTAAN : AGUSTUS 2022
STOK
KODE NO NAMA OBAT SATUAN
AWAL
A1 1 Acyclovir Salep Tube 5
A2 2 Acyclovir 400 mg Tab Tablet 0
A3 3 Albendazol 400 mg tab Tablet 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0
A5 5 Ambroxol syr Botol 0
A6 6 Ambroxol tab 30 mg / Promukus Tablet 0
A7 7 Amoksilina kapsul 500 mg Tablet 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 3
A9 9 Antasida doen tablet kombinasi Tablet 0
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0
A11 11 Asam mefenamat 500 mg Tablet 150
A12 12 Basitrasin Polimiksin Tube 4
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0
A14 14 Betahistin tab Tablet 0
A15 15 Betametazon salep kulit Tube 0
A16 16 Captopril 12.5 mg tablet Tablet 0
A17 17 Captopril 25 mg tablet Tablet 0
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0
A19 19 Cefadroxill 500 mg tablet Tablet 100
A20 20 Cetirizin10 mg tab Tablet 100
A21 21 Ciprofloxazin tablet 500 mg Tablet 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 6
A23 23 Deksametason tablet 0.5 mg Tablet 110
A24 24 Diazepam 5 mg Tablet 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0
A26 26 Diazepam tablet 2 mg Tablet 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 10
A28 28 Domperidon tablet 10 mg Tablet 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0
A30 30 Erytromysin tablet 500 mg Tablet 0
A31 31 Etil klorida semprot Botol 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0
A35 35 Furosemida tablet 40 mg Tablet 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0
A37 37 Gentamisin Salep Mata Tube 0
A38 38 Gentamysin SK Tube 0
A39 39 Gentamysin TM/Genoint TM Botol 0
A40 40 Gentian violet larutan 1 % Botol 0
A41 41 Glibenklamida tablet 5 mg Tablet 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0
A43 43 Glukosa larutan infus 10 % steril Botol 0
A44 44 Glukosa larutan infus 40 % steril Botol 0
A45 45 Glukosa larutan infus 5 % steril Botol 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0
A47 47 Hidrokortison krim 2.5 % Tube 0
A48 48 Ibuprofen tablet 400 mg Tablet 0
A49 49 Isoniazide 100 mg Tablet 0
A50 50 Isoniazide 300 mg Tablet 0
A51 51 Isosorbid dinitrat Tablet 0
A52 52 Kalsium hidroksida pasta Pot 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 10
A54 54 Ketokonazole 200 mg tablet Tablet 0
A55 55 Kloramfenicol salep kulit Tube 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0
A57 57 Kloramfenikol salep mata 1 % Tube 0
A58 58 Kloramfenikol tetes Mata Botol 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 0
A61 61 Kotrimoksasol suspensi Botol 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0
A63 63 Lidokain inj Ampul 0
A64 64 Lidokaina comp inj kombinasi Ampul 0
A65 65 Metformin 500 mg tablet Tablet 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0
A70 70 Metronidazol 500 mg Tablet 0
A71 71 Metronidazol tablet 250 mg Tablet 0
A72 72 Mikonazole salep Tube 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 0
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0
A75 75 Nifedipin tablet 10 mg Tablet 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0
A82 82 Parasetamol tablet 500mg Tablet 34
A83 83 Prednison tablet 5 mgn Tablet 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0
A85 85 Ranitidin tablet 150 mg Tablet 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0
A90 90 Ringer laktat larutan infus steril Botol 0
A91 91 Risperidon Tablet 0
A92 92 Salbutamol tablet 2 mg Tablet 0
A93 93 Salbutamol tablet 4 mg Tablet 100
A94 94 Salisil bedak 2 % Bks 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0
A96 96 Silver amalgam serbuk 65-75% Botol 0
A97 97 Simvastatin tab 10 mg Tablet 0
A98 98 Sulfacetamide tetes mata Botol 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0
A100 100 Thiamfenikol 500 Tablet 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0
A103 103 Trifluoperazine (Stelazin) Tablet 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0
A105 105 Vitamin B kompleks tablet Tablet 0
A106 106 Zink tablet Tablet 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0
A109 109 Amlodipin 5 mg tab Tablet 0
A110 110 Antasida syr Tablet 0
A111 111 Asam Folat 1 mg Tablet 0
A112 112 Becefort Vial 70
A113 113 Benzatin Penisillin Set 0
A114 114 Bonding Tube 0
A115 115 Bufacomb salep Ampul 4
A116 116 Daryantulle Tube 0
A117 117 Dermazine/Burnazin Tablet 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0
A119 119 Dextrofen syr Tablet 0
A120 120 Dormi/Scopma/Spashi tablet Supp 0
A121 121 Dulcolac anak supp Supp 0
A122 122 Dulcolac dewasa supp Tablet 0
A123 123 Dulkolak tablet Botol 0
A124 124 Euthyrox 100mg Supp 0
A125 125 Glimepiride 2 tablet 0
A126 126 Glimepiride 4 Ampul 0
A127 127 Ibuprofen syr flesh 0
A128 128 Kalium Diklovenac Supp 0
A129 129 Kaltropen supp tube 0
A130 130 Ketoconazole SK Ampul 0
A131 131 Microlax tablet 0
A132 132 Miloxicam 7,5 mg Tablet 0
A133 133 Multivitamin (Livron B plek) Botol 0
A134 134 Multivitamin sirup (caviplex) Tablet 0
A135 135 New antides Tablet 0
A136 136 OBH plus Tablet 0
A137 137 Omeprasole tablet 20 mg Ampul 0
A138 138 Parasetamol drop Ampul 0
A139 139 Pehacain Injeksi Tablet 0
A140 140 Prenatin DF tablet 0
A141 141 Ventolin Nebulizer Tablet 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0
Caviplex syrup Botol 5
Calortusin Tablet 27
Demacolin Tablet 158
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 57
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0
B5 5 Alkohol 1 Liter Botol 0
B64 64 Alkohol swab Box 0
B6 6 Bactigrass Box 0
B8 8 Betadine 1 L Botol 0
B59 59 Betadine 30 ml Botol 0
B7 7 Betadine 300 ml Botol 0
B9 9 Bisturi No 10 Pcs 0
B10 10 Bisturi No 11 Pcs 0
B11 11 Bisturi No 20 Pcs 0
B12 12 Bisturi No 21 Pcs 0
B13 13 Bisturi No 22 Pcs 0
B65 65 Blood lancet Box 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0
B67 67 CE Botol 0
B16 16 Daryantulle Box 2
B69 69 Folley Cathteter G18 pcs 0
B17 17 H2O2 Botol 0
B18 18 Hand sanitizer Botol 0
B19 19 Hyfafik 5x5 Roll 0
B61 61 Hypapix 15 x 5 Roll 0
B20 20 Infusion Set dewasa Pcs 0
B21 21 IV cath no .18 Pcs 0
B22 22 IV cath no .20 Pcs 0
B23 23 IV cath no .22 Pcs 0
B24 24 IV cath no .24 Roll 0
B25 25 IV cath no.16 Pcs 0
B26 26 Jarum heacting Pcs 0
B27 27 Jarum Injeksi Pcs 0
B28 28 Jarum Onemed set Pcs 0
B29 29 Jarum Otot -Kulit Set 0
B30 30 Jelly Botol 0
B31 31 Kantong Puyer Pack 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0
B63 63 Kapas pembalut 1000g Roll 0
B33 33 Kasa Gulung Roll 0
B34 34 Kasa hidrofil 18 x 22 Roll 0
B35 35 Kasa hidrofil 4 x 10 Roll 1
B66 66 Kasa hidrofil 5 x 4 Roll 1
B36 36 Kasa pembalut 2 x 80 Roll 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 1
B38 38 Kertas Perkamen Pack 0
B39 39 Klem tali Pusar Pcs 0
B40 40 Klip Plastik Obat 10X7 cm Pack 9
B41 41 KlipPlastik Obat 13X8,7 cm Pack 4
B42 42 Lisol Botol 0
B43 43 Masker Box 0
B68 68 Masker N95 Pcs 0
B55 55 Nylon 5/0 Pcs 0
B57 57 Pot Dahak Pcs 0
B44 44 Sarung Tangan L Pasang 0
B45 45 Sarung Tangan M Pasang 0
B46 46 Sarung Tangan S Pasang 50
B47 47 Sarung Tangan Steril M Pasang 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0
B56 56 Slide prosted Pack 0
B60 60 Spiritus Pcs 0
B62 62 Spuit 10 cc Pcs 0
B58 58 Tabung EDTA Box 0
B50 50 Urinbag Pcs 0
B51 51 Venflon No 20 Pcs 0
B52 52 Wing Needle 21 Pcs 0
B53 53 Wing Needle 23 Pcs 0
B54 54 Wing Needle 25 Pcs 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat

dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A.Md

NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018
 AN DAN LEMBAR PERMINTAAN OBAT JKN
D. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
ELAPORAN : JULI 2022
MINTAAN : AGUSTUS 2022

PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

5 5
0 0
0 0
0 0
0 0
0 0
0 0
3 3 0 10
0 0
0 0
150 150
4 2 2 5
0 0
0 0
0 0
0 0
0 0
0 0
100 100
100 100
0 0
6 1 5
110 17 93 200
0 0
0 0
0 0
10 10
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0 3
 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
10 10 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
34 34 0
0 0
 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 100
0 0 6
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
70 68 2 100
0 0
0 0
4 4 5
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
5 2 3
27 6 21
158 74 84 200

0 0
0 0
57 9 48
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 2 10
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
1 1 5
1 1 5
0 0
1 1 5
0 0
0 0
9 1 8
4 1 3 10
0 0
0 0
0 0
0 0
0 0
0 0
0 0
50 35 15 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
nanggunjawab Gudang Obat Penanggungjawab Sub Unit

Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
P. 19930719 201903 2 018 NIP.197608142006042014
PENERIMAAN KET

ED 1

10

ED 150
5

200

3
 6

100

5
200
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAA
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : AGUSTUS 2022
PERMINTAAN : SEPTEMBER 2022
STOK
KODE NO NAMA OBAT SATUAN
AWAL
A1 1 Acyclovir Salep Tube 5
A2 2 Acyclovir 400 mg Tab Tablet 0
A3 3 Albendazol 400 mg tab Tablet 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0
A5 5 Ambroxol syr Botol 0
A6 6 Ambroxol tab 30 mg / Promukus Tablet 0
A7 7 Amoksilina kapsul 500 mg Tablet 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 0
A9 9 Antasida doen tablet kombinasi Tablet 0
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0
A11 11 Asam mefenamat 500 mg Tablet 150
A12 12 Basitrasin Polimiksin Tube 2
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0
A14 14 Betahistin tab Tablet 0
A15 15 Betametazon salep kulit Tube 0
A16 16 Captopril 12.5 mg tablet Tablet 0
A17 17 Captopril 25 mg tablet Tablet 0
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0
A19 19 Cefadroxill 500 mg tablet Tablet 100
A20 20 Cetirizin10 mg tab Tablet 100
A21 21 Ciprofloxazin tablet 500 mg Tablet 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 5
A23 23 Deksametason tablet 0.5 mg Tablet 93
A24 24 Diazepam 5 mg Tablet 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0
A26 26 Diazepam tablet 2 mg Tablet 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 10
A28 28 Domperidon tablet 10 mg Tablet 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0
A30 30 Erytromysin tablet 500 mg Tablet 0
A31 31 Etil klorida semprot Botol 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0
A35 35 Furosemida tablet 40 mg Tablet 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0
A37 37 Gentamisin Salep Mata Tube 0
A38 38 Gentamysin SK Tube 0
A39 39 Gentamysin TM/Genoint TM Botol 0
A40 40 Gentian violet larutan 1 % Botol 0
A41 41 Glibenklamida tablet 5 mg Tablet 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0
A43 43 Glukosa larutan infus 10 % steril Botol 0
A44 44 Glukosa larutan infus 40 % steril Botol 0
A45 45 Glukosa larutan infus 5 % steril Botol 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0
A47 47 Hidrokortison krim 2.5 % Tube 0
A48 48 Ibuprofen tablet 400 mg Tablet 0
A49 49 Isoniazide 100 mg Tablet 0
A50 50 Isoniazide 300 mg Tablet 0
A51 51 Isosorbid dinitrat Tablet 0
A52 52 Kalsium hidroksida pasta Pot 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 0
A54 54 Ketokonazole 200 mg tablet Tablet 0
A55 55 Kloramfenicol salep kulit Tube 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0
A57 57 Kloramfenikol salep mata 1 % Tube 0
A58 58 Kloramfenikol tetes Mata Botol 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 0
A61 61 Kotrimoksasol suspensi Botol 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0
A63 63 Lidokain inj Ampul 0
A64 64 Lidokaina comp inj kombinasi Ampul 0
A65 65 Metformin 500 mg tablet Tablet 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0
A70 70 Metronidazol 500 mg Tablet 0
A71 71 Metronidazol tablet 250 mg Tablet 0
A72 72 Mikonazole salep Tube 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 0
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0
A75 75 Nifedipin tablet 10 mg Tablet 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0
A82 82 Parasetamol tablet 500mg Tablet 0
A83 83 Prednison tablet 5 mgn Tablet 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0
A85 85 Ranitidin tablet 150 mg Tablet 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0
A90 90 Ringer laktat larutan infus steril Botol 0
A91 91 Risperidon Tablet 0
A92 92 Salbutamol tablet 2 mg Tablet 0
A93 93 Salbutamol tablet 4 mg Tablet 100
A94 94 Salisil bedak 2 % Bks 0
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0
A96 96 Silver amalgam serbuk 65-75% Botol 0
A97 97 Simvastatin tab 10 mg Tablet 0
A98 98 Sulfacetamide tetes mata Botol 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0
A100 100 Thiamfenikol 500 Tablet 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0
A103 103 Trifluoperazine (Stelazin) Tablet 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0
A105 105 Vitamin B kompleks tablet Tablet 0
A106 106 Zink tablet Tablet 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0
A109 109 Amlodipin 5 mg tab Tablet 0
A110 110 Antasida syr Tablet 0
A111 111 Asam Folat 1 mg Tablet 0
A112 112 Becefort Vial 2
A113 113 Benzatin Penisillin Set 0
A114 114 Bonding Tube 0
A115 115 Bufacomb salep Ampul 4
A116 116 Daryantulle Tube 0
A117 117 Dermazine/Burnazin Tablet 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0
A119 119 Dextrofen syr Tablet 0
A120 120 Dormi/Scopma/Spashi tablet Supp 0
A121 121 Dulcolac anak supp Supp 0
A122 122 Dulcolac dewasa supp Tablet 0
A123 123 Dulkolak tablet Botol 0
A124 124 Euthyrox 100mg Supp 0
A125 125 Glimepiride 2 tablet 0
A126 126 Glimepiride 4 Ampul 0
A127 127 Ibuprofen syr flesh 0
A128 128 Kalium Diklovenac Supp 0
A129 129 Kaltropen supp tube 0
A130 130 Ketoconazole SK Ampul 0
A131 131 Microlax tablet 0
A132 132 Miloxicam 7,5 mg Tablet 0
A133 133 Multivitamin (Livron B plek) Botol 0
A134 134 Multivitamin sirup (caviplex) Tablet 0
A135 135 New antides Tablet 0
A136 136 OBH plus Tablet 0
A137 137 Omeprasole tablet 20 mg Ampul 0
A138 138 Parasetamol drop Ampul 0
A139 139 Pehacain Injeksi Tablet 0
A140 140 Prenatin DF tablet 0
A141 141 Ventolin Nebulizer Tablet 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0
Caviplex syrup Botol 3
Calortusin Tablet 21
Demacolin Tablet 84
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 48
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0
B5 5 Alkohol 1 Liter Botol 0
B64 64 Alkohol swab Box 0
B6 6 Bactigrass Box 0
B8 8 Betadine 1 L Botol 0
B59 59 Betadine 30 ml Botol 0
B7 7 Betadine 300 ml Botol 0
B9 9 Bisturi No 10 Pcs 0
B10 10 Bisturi No 11 Pcs 0
B11 11 Bisturi No 20 Pcs 0
B12 12 Bisturi No 21 Pcs 0
B13 13 Bisturi No 22 Pcs 0
B65 65 Blood lancet Box 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0
B67 67 CE Botol 0
B16 16 Daryantulle Box 2
B69 69 Folley Cathteter G18 pcs 0
B17 17 H2O2 Botol 0
B18 18 Hand sanitizer Botol 0
B19 19 Hyfafik 5x5 Roll 0
B61 61 Hypapix 15 x 5 Roll 0
B20 20 Infusion Set dewasa Pcs 0
B21 21 IV cath no .18 Pcs 0
B22 22 IV cath no .20 Pcs 0
B23 23 IV cath no .22 Pcs 0
B24 24 IV cath no .24 Roll 0
B25 25 IV cath no.16 Pcs 0
B26 26 Jarum heacting Pcs 0
B27 27 Jarum Injeksi Pcs 0
B28 28 Jarum Onemed set Pcs 0
B29 29 Jarum Otot -Kulit Set 0
B30 30 Jelly Botol 0
B31 31 Kantong Puyer Pack 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0
B63 63 Kapas pembalut 1000g Roll 0
B33 33 Kasa Gulung Roll 0
B34 34 Kasa hidrofil 18 x 22 Roll 0
B35 35 Kasa hidrofil 4 x 10 Roll 1
B66 66 Kasa hidrofil 5 x 4 Roll 1
B36 36 Kasa pembalut 2 x 80 Roll 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 1
B38 38 Kertas Perkamen Pack 0
B39 39 Klem tali Pusar Pcs 0
B40 40 Klip Plastik Obat 10X7 cm Pack 8
B41 41 KlipPlastik Obat 13X8,7 cm Pack 3
B42 42 Lisol Botol 0
B43 43 Masker Box 0
B68 68 Masker N95 Pcs 0
B55 55 Nylon 5/0 Pcs 0
B57 57 Pot Dahak Pcs 0
B44 44 Sarung Tangan L Pasang 0
B45 45 Sarung Tangan M Pasang 0
B46 46 Sarung Tangan S Pasang 15
B47 47 Sarung Tangan Steril M Pasang 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0
B56 56 Slide prosted Pack 0
B60 60 Spiritus Pcs 0
B62 62 Spuit 10 cc Pcs 0
B58 58 Tabung EDTA Box 0
B50 50 Urinbag Pcs 0
B51 51 Venflon No 20 Pcs 0
B52 52 Wing Needle 21 Pcs 0
B53 53 Wing Needle 23 Pcs 0
B54 54 Wing Needle 25 Pcs 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat

dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A

NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018
 AN DAN LEMBAR PERMINTAAN OBAT JKN
D. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
APORAN : AGUSTUS 2022
MINTAAN : SEPTEMBER 2022

PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

5 1 4
0 0
0 0
0 0
0 0
0 0
0 0
10 10 5 5
0 0
0 0
150 150
5 7 2 5
0 0
0 0
0 0
0 0
0 0
0 0
100 100
100 100
0 0
5 1 4
200 293 130 163
0 0
0 0
0 0
10 3 7
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
3 3 3
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
100 100
6 6 6
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
100 102 44 58 200
0 0
0 0
5 9 3 6
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
3 3 0 10
21 4 17 200
200 284 134 150 100

0 0
0 0
48 6 42
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 1 1 10
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
1 1 0 5
1 1 0 5
0 0
1 1 0 5
0 0
0 0
8 8
3 1 2 10
0 0
0 0 100
0 0
0 0
0 0
0 0
0 0
15 15 0 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0

nanggunjawab Gudang Obat Penanggungjawab Sub Unit

Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
P. 19930719 201903 2 018 NIP.197608142006042014
PENERIMAAN KET

ED 1

ED 150
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT JKN
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : SEPTEMBER 2022
PERMINTAAN : OKTOBER 2022
STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN
AWAL
A1 1 Acyclovir Salep Tube 4 4
A2 2 Acyclovir 400 mg Tab Tablet 0 0
A3 3 Albendazol 400 mg tab Tablet 0 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0 0
A5 5 Ambroxol syr Botol 0 0
A6 6 Ambroxol tab 30 mg / Promukus Tablet 0 0
A7 7 Amoksilina kapsul 500 mg Tablet 0 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 5 5
A9 9 Antasida doen tablet kombinasi Tablet 0 0
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0 0
A11 11 Asam mefenamat 500 mg Tablet 150 150
A12 12 Basitrasin Polimiksin Tube 5 5
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0 0
A14 14 Betahistin tab Tablet 0 0
A15 15 Betametazon salep kulit Tube 0 0
A16 16 Captopril 12.5 mg tablet Tablet 0 0
A17 17 Captopril 25 mg tablet Tablet 0 0
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0 0
A19 19 Cefadroxill 500 mg tablet Tablet 100 100
A20 20 Cetirizin10 mg tab Tablet 100 100
A21 21 Ciprofloxazin tablet 500 mg Tablet 0 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 4 4
A23 23 Deksametason tablet 0.5 mg Tablet 163 163
A24 24 Diazepam 5 mg Tablet 0 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0 0
A26 26 Diazepam tablet 2 mg Tablet 0 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 7 7
A28 28 Domperidon tablet 10 mg Tablet 0 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0 0
A30 30 Erytromysin tablet 500 mg Tablet 0 0
A31 31 Etil klorida semprot Botol 0 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0 0
A35 35 Furosemida tablet 40 mg Tablet 0 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0 0
A37 37 Gentamisin Salep Mata Tube 0 0
A38 38 Gentamysin SK Tube 3 3
A39 39 Gentamysin TM/Genoint TM Botol 0 0
A40 40 Gentian violet larutan 1 % Botol 0 0
A41 41 Glibenklamida tablet 5 mg Tablet 0 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0 0
A43 43 Glukosa larutan infus 10 % steril Botol 0 0
A44 44 Glukosa larutan infus 40 % steril Botol 0 0
A45 45 Glukosa larutan infus 5 % steril Botol 0 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0 0
A47 47 Hidrokortison krim 2.5 % Tube 0 0
A48 48 Ibuprofen tablet 400 mg Tablet 0 0
A49 49 Isoniazide 100 mg Tablet 0 0
A50 50 Isoniazide 300 mg Tablet 0 0
A51 51 Isosorbid dinitrat Tablet 0 0
A52 52 Kalsium hidroksida pasta Pot 0 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN
AWAL
A54 54 Ketokonazole 200 mg tablet Tablet 0 0
A55 55 Kloramfenicol salep kulit Tube 0 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0 0
A57 57 Kloramfenikol salep mata 1 % Tube 0 0
A58 58 Kloramfenikol tetes Mata Botol 0 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 0 0
A61 61 Kotrimoksasol suspensi Botol 0 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0 0
A63 63 Lidokain inj Ampul 0 0
A64 64 Lidokaina comp inj kombinasi Ampul 0 0
A65 65 Metformin 500 mg tablet Tablet 0 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0 0
A70 70 Metronidazol 500 mg Tablet 0 0
A71 71 Metronidazol tablet 250 mg Tablet 0 0
A72 72 Mikonazole salep Tube 0 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 0 0
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0 0
A75 75 Nifedipin tablet 10 mg Tablet 0 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0 0
A82 82 Parasetamol tablet 500mg Tablet 0 0
A83 83 Prednison tablet 5 mgn Tablet 0 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0 0
A85 85 Ranitidin tablet 150 mg Tablet 0 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0 0
A90 90 Ringer laktat larutan infus steril Botol 0 0
A91 91 Risperidon Tablet 0 0
A92 92 Salbutamol tablet 2 mg Tablet 0 0
A93 93 Salbutamol tablet 4 mg Tablet 100 100
A94 94 Salisil bedak 2 % Bks 6 6
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0 0
A96 96 Silver amalgam serbuk 65-75% Botol 0 0
A97 97 Simvastatin tab 10 mg Tablet 0 0
A98 98 Sulfacetamide tetes mata Botol 0 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0 0
A100 100 Thiamfenikol 500 Tablet 0 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0 0
A103 103 Trifluoperazine (Stelazin) Tablet 0 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0 0
A105 105 Vitamin B kompleks tablet Tablet 0 0
A106 106 Zink tablet Tablet 0 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0 0
A109 109 Amlodipin 5 mg tab Tablet 0 0
A110 110 Antasida syr Tablet 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN
AWAL
A111 111 Asam Folat 1 mg Tablet 0 0
A112 112 Becefort Vial 58 200 258
A113 113 Benzatin Penisillin Set 0 0
A114 114 Bonding Tube 0 0
A115 115 Bufacomb salep Ampul 6 6
A116 116 Daryantulle Tube 0 0
A117 117 Dermazine/Burnazin Tablet 0 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0 0
A119 119 Dextrofen syr Tablet 0 0
A120 120 Dormi/Scopma/Spashi tablet Supp 0 0
A121 121 Dulcolac anak supp Supp 0 0
A122 122 Dulcolac dewasa supp Tablet 0 0
A123 123 Dulkolak tablet Botol 0 0
A124 124 Euthyrox 100mg Supp 0 0
A125 125 Glimepiride 2 tablet 0 0
A126 126 Glimepiride 4 Ampul 0 0
A127 127 Ibuprofen syr flesh 0 0
A128 128 Kalium Diklovenac Supp 0 0
A129 129 Kaltropen supp tube 0 0
A130 130 Ketoconazole SK Ampul 0 0
A131 131 Microlax tablet 0 0
A132 132 Miloxicam 7,5 mg Tablet 0 0
A133 133 Multivitamin (Livron B plek) Botol 0 0
A134 134 Multivitamin sirup (caviplex) Tablet 0 0
A135 135 New antides Tablet 0 0
A136 136 OBH plus Tablet 0 0
A137 137 Omeprasole tablet 20 mg Ampul 0 0
A138 138 Parasetamol drop Ampul 0 0
A139 139 Pehacain Injeksi Tablet 0 0
A140 140 Prenatin DF tablet 0 0
A141 141 Ventolin Nebulizer Tablet 0 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0 0
Caviplex syrup Botol 0 0
Calortusin Tablet 17 17
Demacolin Tablet 150 150
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 42 42
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0 0
B5 5 Alkohol 1 Liter Botol 0 0
B64 64 Alkohol swab Box 0 0
B6 6 Bactigrass Box 0 0
B8 8 Betadine 1 L Botol 0 0
B59 59 Betadine 30 ml Botol 0 0
B7 7 Betadine 300 ml Botol 0 0
B9 9 Bisturi No 10 Pcs 0 0
B10 10 Bisturi No 11 Pcs 0 0
B11 11 Bisturi No 20 Pcs 0 0
B12 12 Bisturi No 21 Pcs 0 0
B13 13 Bisturi No 22 Pcs 0 0
B65 65 Blood lancet Box 0 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0 0
B67 67 CE Botol 0 0
B16 16 Daryantulle Box 1 10 11
B69 69 Folley Cathteter G18 pcs 0 0
B17 17 H2O2 Botol 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN
AWAL
B18 18 Hand sanitizer Botol 0 0
B19 19 Hyfafik 5x5 Roll 0 0
B61 61 Hypapix 15 x 5 Roll 0 0
B20 20 Infusion Set dewasa Pcs 0 0
B21 21 IV cath no .18 Pcs 0 0
B22 22 IV cath no .20 Pcs 0 0
B23 23 IV cath no .22 Pcs 0 0
B24 24 IV cath no .24 Roll 0 0
B25 25 IV cath no.16 Pcs 0 0
B26 26 Jarum heacting Pcs 0 0
B27 27 Jarum Injeksi Pcs 0 0
B28 28 Jarum Onemed set Pcs 0 0
B29 29 Jarum Otot -Kulit Set 0 0
B30 30 Jelly Botol 0 0
B31 31 Kantong Puyer Pack 0 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0 0
B63 63 Kapas pembalut 1000g Roll 0 0
B33 33 Kasa Gulung Roll 0 0
B34 34 Kasa hidrofil 18 x 22 Roll 0 0
B35 35 Kasa hidrofil 4 x 10 Roll 0 5 5
B66 66 Kasa hidrofil 5 x 4 Roll 0 0
B36 36 Kasa pembalut 2 x 80 Roll 0 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 0 5 5
B38 38 Kertas Perkamen Pack 0 0
B39 39 Klem tali Pusar Pcs 0 0
B40 40 Klip Plastik Obat 10X7 cm Pack 8 8
B41 41 KlipPlastik Obat 13X8,7 cm Pack 2 10 12
B42 42 Lisol Botol 0 0
B43 43 Masker Box 0 0
B68 68 Masker N95 Pcs 0 0
B55 55 Nylon 5/0 Pcs 0 0
B57 57 Pot Dahak Pcs 0 0
B44 44 Sarung Tangan L Pasang 0 0
B45 45 Sarung Tangan M Pasang 0 0
B46 46 Sarung Tangan S Pasang 0 100 100
B47 47 Sarung Tangan Steril M Pasang 0 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0 0
B56 56 Slide prosted Pack 0 0
B60 60 Spiritus Pcs 0 0
B62 62 Spuit 10 cc Pcs 0 0
B58 58 Tabung EDTA Box 0 0
B50 50 Urinbag Pcs 0 0
B51 51 Venflon No 20 Pcs 0 0
B52 52 Wing Needle 21 Pcs 0 0
B53 53 Wing Needle 23 Pcs 0 0
B54 54 Wing Needle 25 Pcs 0 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat

dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm

NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018
AAN OBAT JKN

PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN KET

4 5 ED 1
0
0
0
0
0
0
1 4 10
0
0
150 ED 150
1 4 5
0
0
0
0
0
0
100
100
0
4 0 10
59 104 100
0
0
0
7 5
0
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN KET

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
100
6
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN KET

0
60 198 200
0
0
1 5
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 10
17 0 200
90 60 200

0
0
11 31
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1 10
0
0
PEMAKAIAN SISA STOK PERMINTAAN PENERIMAAN KET

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
0
0
5
0
0
1 7
1 11
0
0 100
0
0
0
0
0
50 50 100
0
0
0
0
0
0
0
0
0
0
0
0

Penanggungjawab Sub Unit

Gusti Ayu Putu Yulianingsih, A.Md.keb

NIP.197608142006042014
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : OKTOBER 2022
PERMINTAAN : NOVEMBER 2022
STOK
KODE NO NAMA OBAT SATUAN
AWAL
A1 1 Acyclovir Salep Tube 4
A2 2 Acyclovir 400 mg Tab Tablet 0
A3 3 Albendazol 400 mg tab Tablet 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0
A5 5 Ambroxol syr Botol 0
A6 6 Ambroxol tab 30 mg / Promukus Tablet 0
A7 7 Amoksilina kapsul 500 mg Tablet 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 4
A9 9 Antasida doen tablet kombinasi Tablet 0
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0
A11 11 Asam mefenamat 500 mg Tablet 150
A12 12 Basitrasin Polimiksin Tube 4
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0
A14 14 Betahistin tab Tablet 0
A15 15 Betametazon salep kulit Tube 0
A16 16 Captopril 12.5 mg tablet Tablet 0
A17 17 Captopril 25 mg tablet Tablet 0
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0
A19 19 Cefadroxill 500 mg tablet Tablet 100
A20 20 Cetirizin10 mg tab Tablet 100
A21 21 Ciprofloxazin tablet 500 mg Tablet 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 0
A23 23 Deksametason tablet 0.5 mg Tablet 104
A24 24 Diazepam 5 mg Tablet 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0
A26 26 Diazepam tablet 2 mg Tablet 0
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 7
A28 28 Domperidon tablet 10 mg Tablet 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0
A30 30 Erytromysin tablet 500 mg Tablet 0
A31 31 Etil klorida semprot Botol 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0
A35 35 Furosemida tablet 40 mg Tablet 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0
A37 37 Gentamisin Salep Mata Tube 0
A38 38 Gentamysin SK Tube 3
A39 39 Gentamysin TM/Genoint TM Botol 0
A40 40 Gentian violet larutan 1 % Botol 0
A41 41 Glibenklamida tablet 5 mg Tablet 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0
A43 43 Glukosa larutan infus 10 % steril Botol 0
A44 44 Glukosa larutan infus 40 % steril Botol 0
A45 45 Glukosa larutan infus 5 % steril Botol 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0
A47 47 Hidrokortison krim 2.5 % Tube 0
A48 48 Ibuprofen tablet 400 mg Tablet 0
A49 49 Isoniazide 100 mg Tablet 0
A50 50 Isoniazide 300 mg Tablet 0
A51 51 Isosorbid dinitrat Tablet 0
A52 52 Kalsium hidroksida pasta Pot 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 0
A54 54 Ketokonazole 200 mg tablet Tablet 0
A55 55 Kloramfenicol salep kulit Tube 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0
A57 57 Kloramfenikol salep mata 1 % Tube 0
A58 58 Kloramfenikol tetes Mata Botol 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 0
A61 61 Kotrimoksasol suspensi Botol 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0
A63 63 Lidokain inj Ampul 0
A64 64 Lidokaina comp inj kombinasi Ampul 0
A65 65 Metformin 500 mg tablet Tablet 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0
A70 70 Metronidazol 500 mg Tablet 0
A71 71 Metronidazol tablet 250 mg Tablet 0
A72 72 Mikonazole salep Tube 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 0
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0
A75 75 Nifedipin tablet 10 mg Tablet 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0
A82 82 Parasetamol tablet 500mg Tablet 0
A83 83 Prednison tablet 5 mgn Tablet 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0
A85 85 Ranitidin tablet 150 mg Tablet 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0
A90 90 Ringer laktat larutan infus steril Botol 0
A91 91 Risperidon Tablet 0
A92 92 Salbutamol tablet 2 mg Tablet 0
A93 93 Salbutamol tablet 4 mg Tablet 100
A94 94 Salisil bedak 2 % Bks 6
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0
A96 96 Silver amalgam serbuk 65-75% Botol 0
A97 97 Simvastatin tab 10 mg Tablet 0
A98 98 Sulfacetamide tetes mata Botol 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0
A100 100 Thiamfenikol 500 Tablet 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0
A103 103 Trifluoperazine (Stelazin) Tablet 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0
A105 105 Vitamin B kompleks tablet Tablet 0
A106 106 Zink tablet Tablet 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0
A109 109 Amlodipin 5 mg tab Tablet 0
A110 110 Antasida syr Tablet 0
A111 111 Asam Folat 1 mg Tablet 0
A112 112 Becefort Vial 198
A113 113 Benzatin Penisillin Set 0
A114 114 Bonding Tube 0
A115 115 Bufacomb salep Ampul 5
A116 116 Daryantulle Tube 0
A117 117 Dermazine/Burnazin Tablet 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0
A119 119 Dextrofen syr Tablet 0
A120 120 Dormi/Scopma/Spashi tablet Supp 0
A121 121 Dulcolac anak supp Supp 0
A122 122 Dulcolac dewasa supp Tablet 0
A123 123 Dulkolak tablet Botol 0
A124 124 Euthyrox 100mg Supp 0
A125 125 Glimepiride 2 tablet 0
A126 126 Glimepiride 4 Ampul 0
A127 127 Ibuprofen syr flesh 0
A128 128 Kalium Diklovenac Supp 0
A129 129 Kaltropen supp tube 0
A130 130 Ketoconazole SK Ampul 0
A131 131 Microlax tablet 0
A132 132 Miloxicam 7,5 mg Tablet 0
A133 133 Multivitamin (Livron B plek) Botol 0
A134 134 Multivitamin sirup (caviplex) Tablet 0
A135 135 New antides Tablet 0
A136 136 OBH plus Tablet 0
A137 137 Omeprasole tablet 20 mg Ampul 0
A138 138 Parasetamol drop Ampul 0
A139 139 Pehacain Injeksi Tablet 0
A140 140 Prenatin DF tablet 0
A141 141 Ventolin Nebulizer Tablet 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0
Caviplex syrup Botol 0
Calortusin Tablet 0
Demacolin Tablet 60
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 31
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0
B5 5 Alkohol 1 Liter Botol 0
B64 64 Alkohol swab Box 0
B6 6 Bactigrass Box 0
B8 8 Betadine 1 L Botol 0
B59 59 Betadine 30 ml Botol 0
B7 7 Betadine 300 ml Botol 0
B9 9 Bisturi No 10 Pcs 0
B10 10 Bisturi No 11 Pcs 0
B11 11 Bisturi No 20 Pcs 0
B12 12 Bisturi No 21 Pcs 0
B13 13 Bisturi No 22 Pcs 0
B65 65 Blood lancet Box 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0
B67 67 CE Botol 0
B16 16 Daryantulle Box 10
B69 69 Folley Cathteter G18 pcs 0
B17 17 H2O2 Botol 0
B18 18 Hand sanitizer Botol 0
B19 19 Hyfafik 5x5 Roll 0
B61 61 Hypapix 15 x 5 Roll 0
B20 20 Infusion Set dewasa Pcs 0
B21 21 IV cath no .18 Pcs 0
B22 22 IV cath no .20 Pcs 0
B23 23 IV cath no .22 Pcs 0
B24 24 IV cath no .24 Roll 0
B25 25 IV cath no.16 Pcs 0
B26 26 Jarum heacting Pcs 0
B27 27 Jarum Injeksi Pcs 0
B28 28 Jarum Onemed set Pcs 0
B29 29 Jarum Otot -Kulit Set 0
B30 30 Jelly Botol 0
B31 31 Kantong Puyer Pack 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0
B63 63 Kapas pembalut 1000g Roll 0
B33 33 Kasa Gulung Roll 0
B34 34 Kasa hidrofil 18 x 22 Roll 0
B35 35 Kasa hidrofil 4 x 10 Roll 5
B66 66 Kasa hidrofil 5 x 4 Roll 0
B36 36 Kasa pembalut 2 x 80 Roll 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 5
B38 38 Kertas Perkamen Pack 0
B39 39 Klem tali Pusar Pcs 0
B40 40 Klip Plastik Obat 10X7 cm Pack 7
B41 41 KlipPlastik Obat 13X8,7 cm Pack 11
B42 42 Lisol Botol 0
B43 43 Masker Box 0
B68 68 Masker N95 Pcs 0
B55 55 Nylon 5/0 Pcs 0
B57 57 Pot Dahak Pcs 0
B44 44 Sarung Tangan L Pasang 0
B45 45 Sarung Tangan M Pasang 0
B46 46 Sarung Tangan S Pasang 50
B47 47 Sarung Tangan Steril M Pasang 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0
B56 56 Slide prosted Pack 0
B60 60 Spiritus Pcs 0
B62 62 Spuit 10 cc Pcs 0
B58 58 Tabung EDTA Box 0
B50 50 Urinbag Pcs 0
B51 51 Venflon No 20 Pcs 0
B52 52 Wing Needle 21 Pcs 0
B53 53 Wing Needle 23 Pcs 0
B54 54 Wing Needle 25 Pcs 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat

dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A.Md

NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018
 AN DAN LEMBAR PERMINTAAN OBAT JKN
D. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
APORAN : OKTOBER 2022
MINTAAN : NOVEMBER 2022

PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN

4 1 3 5
0 0
0 0
0 0
0 0
0 0
0 0
4 4 0
0 0
0 0
150 150 0
4 2 2 5
0 0
0 0
0 0
0 0
0 0
0 0
100 100
100 100
0 0
0 0
104 84 20 100
0 0
0 0
0 0
7 7 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
3 3
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
100 100 0
6 1 5
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
200 398 70 328
0 0
0 0
5 5
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 10
0 0 100
60 60 0 100

0 0
0 0
31 2 29
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
10 10
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
5 5
0 0
0 0
5 5
1 1 1 0
0 0
7 1 6
11 1 10
0 0
0 0
0 0
0 0
0 0
0 0
0 0
100 150 50 100
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
nanggunjawab Gudang Obat Penanggungjawab Sub Unit

Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
P. 19930719 201903 2 018 NIP.197608142006042014
PENERIMAAN KET

ED 1

ED 4

ED 150

ED 7
ED 100
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT JKN
UPTD. PUSKESMAS TABANAN I
POSKESDES SUDIMARA
PELAPORAN : NOVEMBER 2022
PERMINTAAN : DESEMBER 2022
STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL
A1 1 Acyclovir Salep Tube 3 5 8 8
A2 2 Acyclovir 400 mg Tab Tablet 0 0 0
A3 3 Albendazol 400 mg tab Tablet 0 0 0
A4 4 Alupurinol 100 mg tab / Selespurin/ Proxuric Tablet 0 0 0
A5 5 Ambroxol syr Botol 0 0 0
A6 6 Ambroxol tab 30 mg / Promukus Tablet 0 200 200 105 95 100
A7 7 Amoksilina kapsul 500 mg Tablet 0 0 0
A8 8 Amoksilna sirup kering 125 mg/ 5 mg Botol 0 0 0
A9 9 Antasida doen tablet kombinasi Tablet 0 0 0
A10 10 Asam askorbat (Vit. C) tablet 50 mg Tablet 0 0 0
A11 11 Asam mefenamat 500 mg Tablet 0 0 0
A12 12 Basitrasin Polimiksin Tube 2 5 7 7
A13 13 Besi (II) sulfat tablet salut .kombinasi Tablet 0 0 0
A14 14 Betahistin tab Tablet 0 0 0
A15 15 Betametazon salep kulit Tube 0 0 0
A16 16 Captopril 12.5 mg tablet Tablet 0 0 0
A17 17 Captopril 25 mg tablet Tablet 0 0 0
A18 18 Cefadroxil 125mg/5ml Sirup Botol 0 0 0
A19 19 Cefadroxill 500 mg tablet Tablet 100 100 100
A20 20 Cetirizin10 mg tab Tablet 100 100 100
A21 21 Ciprofloxazin tablet 500 mg Tablet 0 0 0
A22 22 Deksametason injeksi 5 mg / ml - 1 ml Ampul 0 0 0
A23 23 Deksametason tablet 0.5 mg Tablet 20 200 220 31 189
A24 24 Diazepam 5 mg Tablet 0 0 0
A25 25 Diazepam injeksi 5 mg / ml - 2 ml Ampul 0 0 0
A26 26 Diazepam tablet 2 mg Tablet 0 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL
A27 27 Difenhidramin HCL injeksi 10 mg / ml - ml Ampul 0 0 0
A28 28 Domperidon tablet 10 mg Tablet 0 0 0
A29 29 Erytromysin 200mg/5ml Syrup Botol 0 0 0
A30 30 Erytromysin tablet 500 mg Tablet 0 0 0
A31 31 Etil klorida semprot Botol 0 0 0
A32 32 Fenol gliserol tetes telnga 10% Botol 0 0 0
A33 33 Fitomenadion (vit. K1) inj 10 / ml 1 ml Ampul 0 0 0
A34 34 Fitomenadion (vit. K1) tablet salut 10 mg Tablet 0 0 0
A35 35 Furosemida tablet 40 mg Tablet 0 0 0
A36 36 Garam Oralit untuk 200 ml air Sachet 0 0 0
A37 37 Gentamisin Salep Mata Tube 0 0 0
A38 38 Gentamysin SK Tube 3 3 3
A39 39 Gentamysin TM/Genoint TM Botol 0 0 0
A40 40 Gentian violet larutan 1 % Botol 0 0 0
A41 41 Glibenklamida tablet 5 mg Tablet 0 0 0
A42 42 Gliseril guayakolat tablet 10 mg Tablet 0 0 0
A43 43 Glukosa larutan infus 10 % steril Botol 0 0 0
A44 44 Glukosa larutan infus 40 % steril Botol 0 0 0
A45 45 Glukosa larutan infus 5 % steril Botol 0 0 0
A46 46 Griseofulvin tablet 125 mg. Mikronized Tablet 0 0 0
A47 47 Hidrokortison krim 2.5 % Tube 0 0 0
A48 48 Ibuprofen tablet 400 mg Tablet 0 0 0
A49 49 Isoniazide 100 mg Tablet 0 0 0
A50 50 Isoniazide 300 mg Tablet 0 0 0
A51 51 Isosorbid dinitrat Tablet 0 0 0
A52 52 Kalsium hidroksida pasta Pot 0 0 0
A53 53 Kalsium laktat (kalk) tablet 500 mg Tablet 0 0 0
A54 54 Ketokonazole 200 mg tablet Tablet 0 0 0
A55 55 Kloramfenicol salep kulit Tube 0 0 0
A56 56 Kloramfenikol kapsul 250 mg Tablet 0 0 0
A57 57 Kloramfenikol salep mata 1 % Tube 0 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL
A58 58 Kloramfenikol tetes Mata Botol 0 0 0
A59 59 Kloramfenikol tetes telinga 3 % Botol 0 0 0
A60 60 Klorfeniramina maleat (CTM) tablet 4 mg Tablet 0 0 0
A61 61 Kotrimoksasol suspensi Botol 0 0 0
A62 62 Kotrimoksasol tablet kombinasi Tablet 0 0 0
A63 63 Lidokain inj Ampul 0 0 0
A64 64 Lidokaina comp inj kombinasi Ampul 0 0 0
A65 65 Metformin 500 mg tablet Tablet 0 0 0
A66 66 Metilergometrina maleat inj 0. 200 g / ml- ml Ampul 0 0 0
A67 67 Metilergometrina malet tablet salut 0. 125 mg Tablet 0 0 0
A68 68 Metilprednisolon tablet 4 mg Tablet 0 0 0 100
A69 69 Metoklopramide 10 mg tablet/Noristal Tablet 0 0 0
A70 70 Metronidazol 500 mg Tablet 0 0 0
A71 71 Metronidazol tablet 250 mg Tablet 0 0 0
A72 72 Mikonazole salep Tube 0 0 0
A73 73 Natrium Diklofenak 50 (Nadifen/Prostanac) Tablet 0 0 0
A74 74 Natrium klorida larutan infus 0. 9 steril Botol 0 0 0
A75 75 Nifedipin tablet 10 mg Tablet 0 0 0
A76 76 Nistatin 100. 000 iu/g tablet vaginal Tab Vag 0 0 0
A77 77 Obat batuk hitam (OBH) cairan Botol 100 ml 0 0 0
A78 78 Oksitetrasiklina hcl salep 3 % Tube 0 0 0
A79 79 Oksitetrasiklina hcl salep mata 1 % Tube 0 0 0
A80 80 Oksitosina inj 10 iu/ml - 1 ml Ampul 0 0 0
A81 81 Parasetamol sirup 120 mg / 5 ml Botol 0 0 0
A82 82 Parasetamol tablet 500mg Tablet 0 0 0
A83 83 Prednison tablet 5 mgn Tablet 0 0 0
A84 84 Pridoksina hcl (vit. B 6) tablet 10 mg Tablet 0 0 0
A85 85 Ranitidin tablet 150 mg Tablet 0 0 0
A86 86 Reserpina tablet 0, 10 mg Tablet 0 0 0
A87 87 Reserpina tablet 0, 25 mg Tablet 0 0 0
A88 88 Retinol (vit. A) kapsul lunak 200.000 iu Tablet 0 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL
A89 89 Retinol (vit. A) tablet salut 100. 000 iu Tablet 0 0 0
A90 90 Ringer laktat larutan infus steril Botol 0 0 0
A91 91 Risperidon Tablet 0 0 0
A92 92 Salbutamol tablet 2 mg Tablet 0 0 0
A93 93 Salbutamol tablet 4 mg Tablet 0 0 0
A94 94 Salisil bedak 2 % Bks 5 5 5
A95 95 Sianokobalamina (vit.b12) inj. 500 mcg Ampul 0 0 0
A96 96 Silver amalgam serbuk 65-75% Botol 0 0 0
A97 97 Simvastatin tab 10 mg Tablet 0 0 0
A98 98 Sulfacetamide tetes mata Botol 0 0 0
A99 99 Tetrasiklina hcl (tetrasiklina) kapsul 500 mg Tablet 0 0 0
A100 100 Thiamfenikol 500 Tablet 0 0 0
A101 101 Tiamin hcl /mononitrat (vit.b1) tablet 50 mg Tablet 0 0 0
A102 102 Tiamina hcl (vit.b1) inj. 100 mg/ml Ampul 0 0 0
A103 103 Trifluoperazine (Stelazin) Tablet 0 0 0
A104 104 Triheksfenidil hcl 2 mg tablet Tablet 0 0 0
A105 105 Vitamin B kompleks tablet Tablet 0 0 0
A106 106 Zink tablet Tablet 0 0 0
A107 107 Amoxicillin syr 250 / 5 mg Botol 0 0 0
OBAT TAMBAHAN
A108 108 Amlodipin 10 mg tab Tablet 0 0 0
A109 109 Amlodipin 5 mg tab Tablet 0 0 0
A110 110 Antasida syr Tablet 0 0 0
A111 111 Asam Folat 1 mg Tablet 0 0 0
A112 112 Becefort Vial 328 328 62 266
A113 113 Benzatin Penisillin Set 0 0 0
A114 114 Bonding Tube 0 0 0
A115 115 Bufacomb salep Ampul 5 5 5
A116 116 Daryantulle Tube 0 0 0
A117 117 Dermazine/Burnazin Tablet 0 0 0
A118 118 Dextina / Dextamin/Dextamec/Polofar Plus Botol 0 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL
A119 119 Dextrofen syr Tablet 0 0 0
A120 120 Dormi/Scopma/Spashi tablet Supp 0 0 0
A121 121 Dulcolac anak supp Supp 0 0 0
A122 122 Dulcolac dewasa supp Tablet 0 0 0
A123 123 Dulkolak tablet Botol 0 0 0
A124 124 Euthyrox 100mg Supp 0 0 0
A125 125 Glimepiride 2 tablet 0 0 0
A126 126 Glimepiride 4 Ampul 0 0 0
A127 127 Ibuprofen syr flesh 0 0 0
A128 128 Kalium Diklovenac Supp 0 0 0
A129 129 Kaltropen supp tube 0 0 0
A130 130 Ketoconazole SK Ampul 0 0 0
A131 131 Microlax tablet 0 0 0
A132 132 Miloxicam 7,5 mg Tablet 0 0 0
A133 133 Multivitamin (Livron B plek) Botol 0 0 0
A134 134 Multivitamin sirup (caviplex) Tablet 0 0 0
A135 135 New antides Tablet 0 0 0
A136 136 OBH plus Tablet 0 0 0
A137 137 Omeprasole tablet 20 mg Ampul 0 0 0
A138 138 Parasetamol drop Ampul 0 0 0
A139 139 Pehacain Injeksi Tablet 0 0 0
A140 140 Prenatin DF tablet 0 0 0
A141 141 Ventolin Nebulizer Tablet 0 0 0
A142 142 Cefadroksil syrup 250 mg/5ml Botol 0 0 0
Caviplex syrup Botol 0 0 0
Calortusin Tablet 0 0 0
Demacolin Tablet 0 100 100 56 44 100
Livron b plex Tablet 0 100 100 40 60 100
Caviplex tab Tablet 0 100 100 10 90
BMHP
B1 1 Alat Suntik sekali pakai 1 ml Pcs 0 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL
B2 2 Alat Suntik sekali pakai 2.5 ml Pcs 0 0 0
B3 3 Alat suntik sekali pakai 3 cc Pcs 29 29 12 17
B4 4 Alat Suntik sekali pakai 5 ml Pcs 0 0 0
B5 5 Alkohol 1 Liter Botol 0 0 0
B64 64 Alkohol swab Box 0 0 0
B6 6 Bactigrass Box 0 0 0
B8 8 Betadine 1 L Botol 0 0 0
B59 59 Betadine 30 ml Botol 0 0 0
B7 7 Betadine 300 ml Botol 0 0 0
B9 9 Bisturi No 10 Pcs 0 0 0
B10 10 Bisturi No 11 Pcs 0 0 0
B11 11 Bisturi No 20 Pcs 0 0 0
B12 12 Bisturi No 21 Pcs 0 0 0
B13 13 Bisturi No 22 Pcs 0 0 0
B65 65 Blood lancet Box 0 0 0
B14 14 Catgut /benang bedah no 2/0 Pcs 0 0 0
B15 15 Catgut /benang bedah no 3/0 Pcs 0 0 0
B67 67 CE Botol 0 0 0
B16 16 Daryantulle Box 10 10 10
B69 69 Folley Cathteter G18 pcs 0 0 0
B17 17 H2O2 Botol 0 0 0
B18 18 Hand sanitizer Botol 0 0 0
B19 19 Hyfafik 5x5 Roll 0 0 0
B61 61 Hypapix 15 x 5 Roll 0 0 0
B20 20 Infusion Set dewasa Pcs 0 0 0
B21 21 IV cath no .18 Pcs 0 0 0
B22 22 IV cath no .20 Pcs 0 0 0
B23 23 IV cath no .22 Pcs 0 0 0
B24 24 IV cath no .24 Roll 0 0 0
B25 25 IV cath no.16 Pcs 0 0 0
B26 26 Jarum heacting Pcs 0 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL
B27 27 Jarum Injeksi Pcs 0 0 0
B28 28 Jarum Onemed set Pcs 0 0 0
B29 29 Jarum Otot -Kulit Set 0 0 0
B30 30 Jelly Botol 0 0 0
B31 31 Kantong Puyer Pack 0 0 0
B32 32 Kapas pembalut /Absorben 250 gram Roll 0 0 0
B63 63 Kapas pembalut 1000g Roll 0 1 1 1 0
B33 33 Kasa Gulung Roll 0 0 0
B34 34 Kasa hidrofil 18 x 22 Roll 0 0 0
B35 35 Kasa hidrofil 4 x 10 Roll 5 5 5
B66 66 Kasa hidrofil 5 x 4 Roll 0 0 0
B36 36 Kasa pembalut 2 x 80 Roll 0 0 0
B37 37 Kasa Pembalut Hidrofil 4x15 cm Roll 5 5 5
B38 38 Kertas Perkamen Pack 0 0 0
B39 39 Klem tali Pusar Pcs 0 0 0
B40 40 Klip Plastik Obat 10X7 cm Pack 6 6 2 4
B41 41 KlipPlastik Obat 13X8,7 cm Pack 10 10 2 8
B42 42 Lisol Botol 0 0 0
B43 43 Masker Box 0 0 0
B68 68 Masker N95 Pcs 0 0 0
B55 55 Nylon 5/0 Pcs 0 0 0
B57 57 Pot Dahak Pcs 0 0 0
B44 44 Sarung Tangan L Pasang 0 0 0
B45 45 Sarung Tangan M Pasang 0 0 0
B46 46 Sarung Tangan S Pasang 100 100 100
B47 47 Sarung Tangan Steril M Pasang 0 0 0
B48 48 Silk (benang bedah sutera)no 2/0 Pcs 0 0 0
B49 49 Silk (benang bedah sutera)no 3/0 Pcs 0 0 0
B56 56 Slide prosted Pack 0 0 0
B60 60 Spiritus Pcs 0 0 0
B62 62 Spuit 10 cc Pcs 0 0 0
 STOK
KODE NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN
AWAL
B58 58 Tabung EDTA Box 0 0 0
B50 50 Urinbag Pcs 0 0 0
B51 51 Venflon No 20 Pcs 0 0 0
B52 52 Wing Needle 21 Pcs 0 0 0
B53 53 Wing Needle 23 Pcs 0 0 0
B54 54 Wing Needle 25 Pcs 0 0 0

Mengetahui,
Kepala UPTD. Puskesmas Tabanan I Penanggunjawab Gudang Obat Penanggungjawab Sub Unit

dr. I Ketut Serinata Ni Md. Ayu Yuliani Putri Hendrawan,A.Md.Farm Gusti Ayu Putu Yulianingsih, A.Md.keb
NIP. 19660616 200212 1 002 NIP. 19930719 201903 2 018 NIP.197608142006042014
PENERIMAAN KET

ED 1

100

ED 4

ED 150
PENERIMAAN KET

ED 7
PENERIMAAN KET

100
PENERIMAAN KET

ED 100
PENERIMAAN KET

100
100
PENERIMAAN KET
PENERIMAAN KET
PENERIMAAN KET