Lplpo Puskesmas 2022

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
KODE PUSKESMAS
NAMA PUSKESMAS DIPERIKSA DISIAPKAN DISERAHKAN PEMAKAIAN LAPORAN
DISTRIK BULAN JANUARI FEBRUARI
KABUPATEN SORONG SELATAN TAHUN 2022 2022
PROVINSI PAPUA BARAT
PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN EXPIRE SISA STOK STOK OPT PERMINTAAN KET
APBD KAB APBD PROV BUFF STOK PROGRAM
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
I OBAT
1 ALLOPURINOL TABLET 100 MG Tablet 1,200 1,200 1,200 -
2 ALLOPURINOL TABLET 300 MG Tablet - - -
3 ALPARA SYRUP Botol - - 300
4 ALPARA TABLET Tablet - - 2,000
5 AMAROPO PLUS TABLET Tablet 300 300 300 500
6 AMBROKSOL SIRUP 15 MG/ML Botol 75 75 75 - 300
7 AMBROKSOL TABLET 30 MG Tablet 2,100 2,100 - 2,100 - 2,000
8 AMINOFILIN INJEKSI 24 MG/ML Ampul 30 30 30 -
9 AMINOFILIN TABLET 150 MG Tablet - - -
10 AMINOFILIN TABLET 200 MG Tablet 200 200 200 -
11 AMITRIPTYLIN TAB 25 MG Tablet 200 200 200 -
12 AMLODIPIN TABLET 10 MG Tablet 1,000 1,000 1,000 -
13 AMLODIPIN TABLET 5 MG Tablet 1,300 1,300 1,300 -
14 AMOKSISILLIN DROPS 15 ML Botol - - 200
15 AMOKSISILLIN KAPLET 250 MG Kapsul - - 6,000
16 AMOKSISILLIN KAPLET 500 MG Tablet - - - 6,000
17 AMOKSISILLIN SIRUP KERING 125 MG/5ML Botol - - - 300
18 AMOKSISILLIN SIRUP KERING FORTE 250 MG/5ML Botol 20 20 4 16 200
19 AMPISILLIN INJEKSI 1 GRAM Vial 20 20 20 -
20 ANTALGIN (METAMIZOL) INJEKSI 250 MG/ML Ampul 120 120 120
21 ANTALGIN (METAMIZOL)TABLET 500 MG Tablet 600 600 300 300 1,000
22 ANTASIDA DOEN SUSPENSI KOMBINASI Botol 275 275 275 200
23 ANTASIDA DOEN TABLET KUNYAH KOMBINASI Tablet 1,300 1,300 100 1,200 300
ANTI BAKTERI SALEP: BASITRASIN 500IU/G + POLIMIKSIN
24 Tube - - -
10.000 IU/G
ANTIFUNGI SALEP, KOMBINASI: ASAM BENZOAT 6% +
25 Pot 96 96 96 -
ASAM SALISILAT 3%
26 ANTIHEMOROID DOEN KOMBINASI Suppo 20 20 20 -
k AQUA PRO INJEKSI STERIL 25 ML Botol 24 24 24 -
28 ASAM ASCORBAT TABLET 250 MG Tablet - - -
29 ASAM ASCORBAT TABLET 50 MG Tablet 1,700 1,700 300 1,400 -
30 ASAM ASETILSALISILAT TABLET 80 MG Tablet 900 900 900 1,000
31 ASAM FOLAT TABLET 0.4 MG Tablet - - -
32 ASAM FOLAT TABLET 1 MG Tablet 800 800 800 500
33 ASAM MEFENAMAT TABLET 500 MG Tablet 200 200 100 100 3,000
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
34 ASAM TRANEXAMAT INJEKSI 100 MG/ML Ampul 60 60 60 -
35 ASAM TRANEXAMAT TABLET 500 MG Tablet - - -
36 ASETYLSISTEIN KAPSUL 200 MG Kapsul - - -
37 ASIFIT TABLET Tablet - - 300
38 ASIKLOVIR KRIM 5% Tube 92 92 92 -
39 ASIKLOVIR TABLET 200 MG Tablet - - -
40 ASIKLOVIR TABLET 400 MG Tablet 1,000 1,000 1,000 -
41 ATROPIN SULFAT INJ. 0,25 MG/ML-1ML Ampul - - -
42 BECEFORT SIRUP Botol 1 1 1 300
43 BECEFORT TABLET Tablet 100 100 100 - 1,000
44 BENZATIN BENSIL PENISILIN 1,2 JT UI/VIAL Vial - - -
45 BENZATIN BENSIL PENISILIN 2,4 JT UI/VIAL Vial 10 10 10 -
46 BETAHISTIN MESILAT TABLET 6 MG Tablet 90 90 90 -
47 BETAMETASON CREAM 0,1% Tube 174 174 174 -
48 BEVALEX KRIM Tube - - 60
49 BIO ATP TABLET Tablet - - 1,000
50 BIORON INJEKSI Ampul - - 100
51 BIORON TABLET Tablet - - 1,000
52 BISOPROLOL TABLET 2,5 MG Tablet - - -
53 BISOPROLOL TABLET 5 MG Tablet - - -
54 CAPTOPRIL TABLET 12,5 MG Tablet 1,300 1,300 1,300 -
55 CAPTOPRIL TABLET 25 MG Tablet 1,400 1,400 1,400
56 CAPTOPRIL TABLET 50 MG Tablet - - -
57 CARBAMAZEPIN TABLET 200 MG Tablet 500 - 500 500 -
58 CEFADROKSIL KAPSUL 250 MG Kapsul - - 4,000
59 CEFADROKSIL KAPSUL 500 MG Kapsul - - 4,000
60 CEFADROKSIL SIRUP 125 MG/60 ML Botol 26 26 26 200
61 CEFOTAXIME INJEKSI 1 GR Vial - - 20
62 CENDO XYTROL TM Botol - - 200
63 CLINDAMISIN KAPSUL 150 MG Kapsul - - 500
64 CLINDAMISIN KAPSUL 300 MG Kapsul - - - 500
65 CLOBAZAM TABLET 10 MG Tablet - - -
66 CLORPROMAZIN INJEKSI 5 mg/ml Ampul 30 30 30 -
67 CLORPROMAZIN TABLET 100 MG Tablet - - -
68 CYANOCOBALAMIN (B-12) INJEKSI 500 MCG/ML Ampul 73 73 73 -
69 CYANOCOBALAMIN (B-12) TABLET 50 MCG Tablet 3,100 3,100 3,100 -
70 DEKSAMETHASON INJEKSI 5 MG/ML-1ML Ampul 43 43 43 -
71 DEKSAMETHASON TABLET 0,5 MG Tablet 200 200 200 - 2,000
72 DESOKSIMETASON SALEP 0,25% Tube - - -
73 DEXTAMIN TABLET Tablet - - 2,000
74 DIAZEPAM INJEKSI 5 MG/ML- 2 ML Ampul - - 20
75 DIAZEPAM TABLET 2 MG Tablet - - 100
76 DIAZEPAM TABLET 5 MG Tablet - - 100
77 DIFENHIDRAMIN HCl INJEKSI 10 MG/ML Ampul 60 60 60 -
78 DIGOKSIN TABLET 0,25 MG Tablet 200 200 200
79 DIMENHIDRINAT TABLET Tablet 200 200 200 -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
80 DOKSISIKLIN TABLET 100 MG Kapsul 400 400 400 -
81 DOMPERIDON DROPS 5 MG/ML Botol 19 19 19 200
82 DOMPERIDON SUSPENSI 5 MG/5ML Botol 80 80 10 70 200
83 DOMPERIDON TABLET 10 MG Tablet 1,100 1,100 1,100 -
84 DULCOLAX SUPPO ANAK Suppo - - 40
85 DULCOLAX SUPPO DEWASA Suppo - - 40
86 DULCOLAX TABLET Tablet - - - 200
87 EFEDRIN INJEKSI 50 MG/ML Ampul - - 40
88 EFEDRIN TABLET 25 MG Tablet - - 200
89 EPINEFRIN HCl (ADRENALIN) INJEKSI 0,1% Ampul 30 30 30 60
90 ERGOTAMIN 1 MG + KAFEIN 50 MG TABLET Tablet 600 600 600 -
91 ERITROMISIN KAPSUL 250 MG Kapsul 400 400 400 1,000
92 ERITROMISIN KAPSUL 500 MG Kapsul 300 300 300 1,000
93 ERITROMISIN SYRUP 200 MG/5 ML Botol - - 400
94 ETAMBUTOL TABLET 250 MG Tablet 400 400 400 -
95 ETAMBUTOL TABLET 500 MG Tablet 300 300 300 -
96 FENITOIN NATRIUM TABLET 100 MG Tablet - - 200
97 FENITOIN NATRIUM TABLET 30 MG Tablet - - 200
98 FENOFIBRAT KAPSUL 100 MG Kapsul - - -
100 FENOKSIMETIL PENISILIN (PENISILIN V) 500 MG Tablet - - 300
101 FENOL GLISEROL TT 10% Botol - - 200
102 FITUNO Tablet - - 1,000
103 FLUKONAZOL KAPSUL 150 MG Kapsul 40 40 40 -
104 FLUSINOLON ASETONID SALEP 0,025% Tube - - -
105 FOLAMIL GENIO KAPSUL Kapsul - - 1,500
106 FUCILEX KRIM Tube - - -
107 FUROSEMID TABLET 40 MG Tablet - - 200
108 GABAPENTIN KAPSUL 300 MG Kapsul 200 200 200 -
109 GEMFIBROZIL 600 MG Tablet - - -
110 GENTALEX KRIM Tube - - 100
111 GENTAMYCIN INJEKSI 40 MG/ML Ampul - - -
112 GENTAMYCIN SALEP KULIT 0.1% Tube 1 1 1 150
113 GENTAMYCIN SALEP MATA 0,3% Tube 60 60 60
114 GENTAMYCIN SULFAT TM 0,3% Botol 62 62 62
115 GENTIAN VIOLET Botol 24 24 24
116 GERIAVITA Tablet 420 420 90 330
117 GLIBENKLAMID TABLET 5 MG Tablet 700 700 700
118 GLIMEPIRID TABLET 1 MG Tablet 500 500 500
122 GLUKOSA LARUTAN INFUS 10% STERIL Botol 8 8 8
124 GLYCERIL GUAIACOLAT TABLET 100 MG Tablet 1,200 1,200 1,200
125 GRISEOFULVIN TABLET 125 MG Tablet - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
126 GRISEOFULVIN TABLET 500 MG Tablet - -
127 GRIVIN FORTE Tablet - -
128 GUAIFENESIN TABLET 100 MG Tablet 300 300 300
129 HEMAFORT TABLET Tablet 200 200 100 100
130 HIDROCLOROTIAZID TABLET 25 MG Tablet 300 300 - 300
131 HIDROKORTISON KRIM 2,5% Tube 1 1 1
132 HIDROKSI KLOROKUIN TABLET 200 MG Tablet - - -
133 HUSTAB P 8 MG TABLET Tablet 800 800 800
134 HUSTAB P SYRUP Botol 13 13 6 7 100
135 HUSTAB TABLET Tablet 3,300 3,300 3,300
136 IBUPROFEN SUSPENSI 100 MG/5 ML Botol 221 221 30 191
137 IBUPROFEN TABLET 200 MG Tablet - - -
139 ICHTYOL SALEP Pot - -
140 ISONIAZID TABLET 100 MG Tablet - -
141 ISONIAZID TABLET 300 MG Tablet - -
142 ISOSORBIT DINITRAT INJEKSI 10 MG/10 ML Ampul - -
143 ISOSORBIT DINITRAT TABLET SUB 5 MG Tablet - -
144 KALSIUM LACTAT TABLET 500 MG Tablet 1,200 1,200 1,200 1,000
145 KANAMYCIN SERBUK INJEKSI 1.000 MG Vial 40 40 40
146 KETOCONAZOLE KRIM 2% Tube 100 100 100
147 KETOCONAZOLE TABLET 200 MG Tablet 388 388 388
148 KETOROLAC INJEKSI 30 MG/ML Ampul 20 20 20
149 KLORAMFENIKOL KAPSUL 250 MG Kapsul 700 700 700
151 KLORAMFENIKOL SK 2% Tube 18 18 18
152 KLORAMFENIKOL SM 1% Tube 8 8 8
153 KLORAMFENIKOL TT 3% Botol - - -
154 KLORFENIRAMIN MALEAT (CTM) TABLET 4 MG Tablet 1,100 1,100 1,100 1,000
155 KLOROKUIN TABLET 150 MG Tablet - - 500
KOMPOLAX KOMBINASI :
156 Botol 9 9 9
PARAFIN+GLISERIN+FENOLFTALEIN
157 KOTRIMOKSAZOL SUSPENSI KOMB. 240 MG/5ML Botol 41 41 41
158 KOTRIMOKSAZOL TABLET 120 MG PEDIATRIK Tablet - -
159 KOTRIMOKSAZOL TABLET 480 MG Tablet 3,600 3,600 3,600
161 LAKTULOSA SIRUP 2,335 G/5 ML Botol 26 26 5 21
162 LANSOPRAZOL 30 MG Tablet - - 2,000
163 LEXACROL FORTE SYRUP Botol - - 1,000
164 LIDOCAIN 2% (HCl) + EPINEFRIN INJEKSI 1:80.000-2 ml Ampul 300 300 300 -
165 LIDOCAIN NON EPINEFRIN INJEKSI 2% Ampul 460 460 460 -
166 LIVRON BPLEX Tablet 500 500 300 200 2,000
167 LOPERAMID TABLET Tablet 100 100 100 500
168 LORATADIN TABLET 10 MG Tablet 800 800 800 -
169 MAGNESIUM SUFAT INJEKSI (Mg SO4) 20 % Vial 60 60 60 -
170 MAGNESIUM SUFAT INJEKSI (Mg SO4) 40 % Vial 60 60 60 -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
171 MELOKSIKAM TABLET 15 MG Tablet - - 1,000
172 METANEURON TABLET Tablet - - 1,000
173 METFORMIN TABLET 500 MG Tablet 700 700 700 -
174 METHIL ERGOMETRIN INJEKSI 0,2 MG/ML Ampul - - -
175 METHIL ERGOMETRIN TABLET 0,125 MG Tablet 500 500 500 -
176 METILPREDNISOLON TABLET 16 MG Tablet 700 700 100 600 -
177 METILPREDNISOLON TABLET 4 MG Tablet 400 400 400 -
178 METILPREDNISOLON TABLET 8 MG Tablet - - 1,000
179 METOKLOPRAMIDE DROP 2 MG/ML Botol 23 23 23 100
180 METOKLOPRAMIDE TABLET 10 MG Tablet 200 200 200 -
181 METRONIDAZOL OVULA Suppo 60 60 60 -
182 METRONIDAZOL TABLET 250 MG Tablet - - -
183 METRONIDAZOL TABLET 500 MG Tablet 800 800 800 -
184 MIKONAZOL KRIM 2% Tube 24 24 24 48
185 MINERAL MIX Sachet - - -
186 MOLAKRIM Tube - - 60
187 MOLASIC KAPLET (ASAM MEFENAMAT) Tablet - - 4,000
188 MOLEXFLU KAPLET Tablet - - 4,000
189 NATRIUM DIKLOFENAK TABLET 25 MG Tablet 800 - 200 600 400
190 NATRIUM DIKLOFENAK TABLET 50 MG Tablet 450 450 450 600
191 NATRIUM KLORIDA LARUTAN INFUS 0,9% Botol - - -
192 NIFEDIPIN TABLET 10 MG Tablet 50 50 50 -
193 NISTATIN SUSPENSION 100.000 IU Botol 63 63 63
194 NISTATIN TABLET SALUT 500.000 IU Tablet 100 100 100
195 NISTATIN VAGINAL TABLET 100.000 IU/G Tablet 200 200 200
196 NOZA TABLET Tablet 500 500 300 200 1,000
197 OBAT ANTI TBC FDC KATEGORI ANAK Paket - -
198 OBAT ANTI TBC FDC KATEGORI I Paket - -
199 OBAT ANTI TBC FDC KATEGORI II Paket - -
OBAT KB KOMBINASI: LEVONOGESTREL 150
200 Strip 400 400 400 -
MCG+ETINILESTRADIOL 30 MCG
201 OBH SYRUP Botol - -
202 OKSIMETAZOLIN TETES HIDUNG 0,025% (ANAK) Botol - -
203 OKSIMETAZOLIN TETES HIDUNG 0,050% (DEWASA) Botol - -
204 OKSITETRASIKLIN SALEP KULIT 3% Tube - -
205 OKSITETRASIKLIN SALEP MATA 1% Tube 175 175 175 -
206 OKSITOSIN INJEKSI 10 IU/ML Ampul - - 100
207 OMEPRASOL INJEKSI 40 MG/10 ML Ampul - - -
208 OMEPRASOL KAPSUL 20 MG Kapsul - - 500
209 ORALIT 200 ML Sachet - - -
210 PAPAVERIN HCl TABLET 40 MG Tablet - - 1,000
211 PAPAVERIN INJEKSI 40 MG/ML Ampul - - -
212 PARASETAMOL DROPS 100 MG/ML Botol - - 200
213 PARASETAMOL SYRUP 120 MG/ML Botol 266 266 55 211 200
214 PARASETAMOL TABLET 500 MG Tablet 700 700 400 300 5,000
215 PEHASTAN 500 MG (ASAM MEFENAMAT) Tablet - - 2,000
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
216 PEHAVIT-D3 Kapsul - - 1,000
217 PERIO KIN SPRAY KLORHEKSIDIN Botol - - -
218 PHENOBARBITAL INJEKSI 50 MG/ML Ampul - - -
219 PHENOBARBITAL TABLET 30 MG Tablet - - -
220 PHENYLBUTAZON TABLET 200 MG Tablet - - -
221 PIRACETAM TABLET 400 MG Tablet - - 500
222 PIRANTEL SIRUP 125 MG / 5 ML Botol - - -
223 PIRANTEL TABLET 125 MG Tablet 408 408 408 -
224 PIRANTEL TABLET 250 MG Tablet - - -
225 PIRIMETAMIN+SULFADOKSIN KOMBINASI Tablet - - -
226 PIROKSIKAM TABLET 10 MG Tablet - - 1,000
227 PIROKSIKAM TABLET 20 MG Tablet 800 800 200 600 -
228 PREDNISON TABLET 5 MG Tablet 1,800 1,800 100 1,700 -
229 PRIMAKUIN TABLET 15 MG Tablet 300 300 300 -
230 PROKAIN PENISILLIN INJEKSI 3 JT IU Vial - - 60
231 PROPANOLOL HCl TABLET 40 MG Tablet 500 500 500 -
232 PROPILTIOURASIL TABLET 100 MG Tablet - - -
233 PYRAZINAMID TABLET 500 MG Tablet - - - -
234 QUININ TABLET 222 MG Tablet 600 600 600 -
235 RANITIDIN INJEKSI 25 MG/ML Ampul 10 10 10 40
236 RANITIDIN TABLET 150 MG Tablet 200 200 200 500
237 RIFAMPICIN KAPSUL 300 MG Kapsul - - -
239 RINGER ASETAT LARUTAN INFUS Botol 18 18 18 -
240 RINGER LAKTAT LARUTAN CAIRAN INFUS Botol 16 16 16 -
241 SALBUTAMOL CAIRAN IH 0,1% Botol - - -
242 SALBUTAMOL SIRUP Botol - - 200
243 SALBUTAMOL TABLET 2 MG Tablet - - - - 1,000
244 SALBUTAMOL TABLET 4 MG Tablet 400 400 400 600
245 SALEP 2-4 KOMBINASI Pot 148 148 148 -
246 SALISIL BEDAK 2% Pot 24 24 5 19 50
247 SEFIKSIM KAPSUL 100 MG Kapsul - - 1,000
248 SEFIKSIM KAPSUL 200 MG Kapsul - - 1,000
249 SEFIKSIM SIRUP KERING 100 MG / 5 ML Botol 28 28 28 200
250 SEFTRIAKSON INJEKSI 1 G Vial - - 20
251 SERUM ABU POLIVALEN INJEKSI Vial - - -
252 SERUM ANTI TETANUS INJEKSI 1.500 IU Ampul - - 100
253 SETIRIZIN SIRUP 5 MG/ML Botol 8 8 8 200
254 SETIRIZIN TABLET 10 MG Tablet - - 1,000
255 SIMVASTATIN TABLET 10 MG Tablet 1,620 1,620 1,620 -
256 SIMVASTATIN TABLET 20 MG Tablet 600 600 600 -
257 SIPROFLOKSACIN TABLET 500 MG Tablet 600 600 600 -
258 SPIRONOLAKTON TABLET 100 MG Tablet 500 500 500 -
259 STESOLID SUPPO 10 MG/2,5 ML Suppo 10 10 10 -
260 STESOLID SUPPO 5 MG/2,5 ML Suppo 10 10 10 -
261 STREPTOMYCIN SULFAT INJEKSI 1 G Vial - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
262 SUKRALFAT SIRUP 500 mg/ 5 ml, 100 ml Botol 162 162 162 100
263 SULFACETAMID TM 15% Botol - - 40
264 SULFADIAZIN KRIM Tube 19 19 19 -
TABLET TAMBAH DARAH KOMBINASI (FE. FUMARAT 60
265 Tablet - - 4,000
MG + AS. FOLAT 0,4 MG)
266 TETRACYCLIN KAPSUL 250 MG Kapsul 600 600 600 -
267 TETRACYCLIN KAPSUL 500 MG Kapsul 500 500 500 -
268 TRAMADOL HCl INJEKSI 50 MG/ML Ampul - - -
269 VALSARTAN TABLET 160 MG Tablet - - -
271 VIPCOL SYRUP 60 ML Botol - - 500
272 VIT. A (RETINOL) 100.000 IU KAPSUL LUNAK Kapsul 500 500 500 -
273 VIT. A (RETINOL) 200.000 IU KAPSUL LUNAK Kapsul 400 400 400 -
274 VIT. B KOMPLEKS TABLET Tablet 3,000 3,000 3,000 -
275 VIT. B1 (THIAMIN) INJEKSI 100 MG/ML-1ML Ampul 2,000 2,000 2,000 -
276 VIT. B1 (THIAMIN) TABLET 50 MG Tablet 2,000 2,000 2,000 -
277 VIT. B6 (PYRIDOKSIN HCl) TABLET 10 MG Tablet 1,200 1,200 1,200 -
278 VIT. K INJ. (PHYTOMENADION) 10 MG/ML Ampul 30 30 30 -
279 VIT. K INJ. (PHYTOMENADION) 2 MG/ML Ampul - - - -
280 VIT. K TAB. SALUT (PHYTOMENADION) 10MG Tablet 400 400 400 -
281 VOMETA DROPS 5 MG/ML Botol 19 19 19 60
282 ZINK DROP 10 MG/ML Botol - - 200
283 ZINK SIRUP 20 MG/5 ML Botol - - 200
284 ZINK TABLET DISPERSIBLE 20 MG Tablet 2,900 2,900 200 2,700 -
285 - -
286 - -
287 - -
288 - -
289 - -
290 - -
II BAHAN MEDIS HABIS PAKAI (BMHP)
1 ABBOCATH (I.V CATHETER) NO. 18 Pcs 45 45 10 35 -
2 ABBOCATH (I.V CATHETER) NO. 20 Pcs 169 169 169 -
6 ALKAZIDE DESINFECTAN Botol - - -
7 ALKAZYME DESINFECTAN Sachet - - -
8 ALKOHOL 70% 100 ML Botol 14 14 14 -
9 ALKOHOL 70% 300 ML Botol - - -
10 ALKOHOL SWAB Sachet 100 100 100 200
11 APRON LENGAN PANJANG Pcs - - 20
12 ASEPTAN LIQUID 500 ML Botol 4 4 4 30
13 ASEPTIC GEL 500 ML Botol 22 22 22 20
14 ASMA MONITOR Pcs - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
15 BIOPLACENTON JELLY Tube - - 50
16 BIOPLACENTON TULLE Pcs - - 50
17 BISTURI Pcs - - 100
18 BLOOD LANCET 21 G x 1,8 mm Pcs - - 2 box
19 BRACKET HAND WASH Pcs - - 10
20 CANNOFIX 6 CM X 8 CM Pcs - - -
21 CATGUT CROMIC 2/0 + JARUM BEDAH Pcs 36 36 36 -
22 CATGUT CROMIC 3/0 + JARUM BEDAH Pcs 60 60 60 -
23 CATGUT PLAIN 2/0 + JARUM BEDAH Pcs 48 48 48 -
24 CATGUT PLAIN 3/0 + JARUM BEDAH Pcs 60 60 60 -
25 CATGUT SILK 2/0 + JARUM BEDAH Pcs 24 24 24 -
26 CATGUT SILK 3/0 + JARUM BEDAH Pcs 5 5 5 20
27 CAVIDAGEL 30 GR Tube - - - -
28 CUVETTES DIASPECT Pcs - - -
29 DECK GLASS 20X20 Kotak - - -
30 DISPOSABLE DENTAL NEEDLE 30 G x 16 mm Pcs - - -
31 ELASTIC BANDAGE 10 CM X 4,5 M Roll 3 3 3 -
34 ELASTIC BANDAGE 7,5 CM X 4,5 M Roll 3 3 3 -
35 ETAKRIDIN (RIVANOL) LARUTAN 0,1% Botol 18 18 18 -
36 ETHYL KLORIDA SEMPROT Botol - - -
37 FOLLEY CATHETER NO. 10 Pcs - - -
43 FOLLEY CATHETER NO.16 Pcs - - -
47 GIEMSA 250 ML Botol - - - 2
48 HAEMOCYTOMETER Pcs - - -
49 HIDROGEN PEROKSIDA (H2O2) 3% 100 ML Botol 5 5 5 -
50 INFUSION SET ANAK Set 36 36 - 36 -
51 INFUSION SET DEWASA Set 24 24 24 -
52 KAPAS PEMBALUT 100 Gr Bungkus 8 8 8
53 KAPAS PEMBALUT 250 Gr Bungkus - - -
54 KAPAS PEMBALUT 50 GR Bungkus 10 10 10
56 KASA HYDROFIL 2 x 80 CM Roll 45 45 45
57 KASA HYDROFIL 3,6 M X 10 CM Roll - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
59 KASA HYDROFIL 3,6 M X 8 CM Roll - -
60 KASA HYDROFIL 4 M X 10 CM Roll 45 45 45
63 KASA HYDROFIL 40 Y X 16 CM Roll - -
67 KASA STERIL HYDROFIL 16 X 16 Kotak - -
68 KASA STERIL HYDROFIL 18 X 22 Kotak - -
69 KLINIPET 100 Unit - - 1 box
70 KLINIPET 1000 Unit - -
73 KONDOM Kotak - -
74 KY JELLY Tube - -
75 LARUTAN HCl 0,1 N 100 ML Botol - -
76 LARUTAN METHANOL 250 ML Botol - - 1
77 LARUTAN TURC Botol - - 1
78 LISOL (DESINFECTAN) 1 LITER Botol - - 1
79 LUMPANG + STAMPER Set - - 2
80 MASKER BEDAH EAR LOOP (CANTOL) Pcs 100 100 100 2,000
81 MASKER BEDAH TIE ON (IKAT) Pcs 200 200 200 -
82 MASKER KN95 Psg - - -
83 MASKER N95 Pcs - - -
84 MY JELLY Tube 5 5 5 -
85 OBJECT GLASS Pcs - - 3 box
86 ONESCRUB 4% Botol 8 8 8 6
87 PIPET TIP BLUE Pcs - - 1 box
88 PIPET TIP YELLOW Pcs - - 1 box
89 PLESTER 1 CM X 5 M Roll - - 20
90 PLESTER 1,25 CM X 4,5 M Roll 24 24 24 -
91 PLESTER 2,5 CM X 1 M Roll 42 42 42 -
92 PLESTER 2,5 CM X 4,5 M Roll - - -
93 PLESTER 5 CM X 4,5 M Roll 8 8 8 -
94 PLESTER 7,5 CM X 4,5 M Roll 32 32 32 -
95 PLESTERIN BULAT T Pcs 450 450 450 3 box
96 PLESTERIN ELASTIS JUMBO Pcs - - 200
97 PLESTERIN FIRST AID Pcs 264 264 264 200
98 POLIFIX/PHARMAFIX 10 CM X 5 M Roll - - -
99 POLIFIX/PHARMAFIX 15 CM X 5 M Roll 26 26 26 -
100 POLIFIX/PHARMAFIX 5 CM X 5 M Roll 26 26 26 -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
101 POT SPUTUM Pcs - - -
102 POT URINE Pcs - - -
103 RAPID COVID-19 ANTIGEN Pcs - - -
104 RDT MALARIA Pcs - - -
105 REAGEN GOLONGAN DARAH A Pcs - - 2 box
106 REAGEN GOLONGAN DARAH AB Pcs - - 2 box
107 REAGEN GOLONGAN DARAH ANTI D RHESUS Pcs - - 2 box
108 REAGEN GOLONGAN DARAH B Pcs - - 2 box
109 REAGEN ZIEHL NEELSEN 3% Kit - - 1
110 SAFETY BOKS Pcs - -
111 SALISIL SPIRITUS ML Botol - -
112 SARUNG TANGAN BLUE NITRIL M Psg - -
113 SARUNG TANGAN BLUE NITRIL S Psg - -
114 SARUNG TANGAN NON STERIL L Psg 700 700 700 200
115 SARUNG TANGAN NON STERIL M Psg 1,000 1,000 300 700
116 SARUNG TANGAN NON STERIL S Psg - -
117 SARUNG TANGAN OBGYN L Psg 100 100 100
118 SARUNG TANGAN OBGYN M Psg - -
119 SARUNG TANGAN OBGYN S Psg - -
120 SARUNG TANGAN STERIL 6,5 Psg 500 500 500
121 SARUNG TANGAN STERIL 7 Psg - -
122 SARUNG TANGAN STERIL 8 Psg - - 50
123 SEPTALKAN Botol 3 3 3
124 SPIRITUS Botol - -
125 SPOIT (ALAT SUNTIK SEKALI PAKAI) 1 ML Pcs 900 900 900 -
130 STICK TEST ASAM URAT Pcs - - 10
131 STICK TEST GLUKOSA Pcs - - 10
132 STICK TEST KOLESTEROL Pcs - - 10
133 TABUNG DARAH 10 ML Pcs - -
136 TABUNG EDTA Pcs - - 3 pak
137 TABUNG MICRO Pcs - - 3 pak
138 TABUNG PLN PLH 13X100 6.0 Pcs - -
139 TES KEHAMILAN Test - -
140 TES KIT HEPATITIS C Test - -
141 TES KIT HIV INTEC 1&2 Test - -
142 TES KIT HIV ONCOPROBE Test - -
143 TES KIT HIV VIKIA Test - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
144 TES KIT SYPHYLIS Test - -
145 TEST DRUGS AMPHETAMIN Test - -
146 TEST DRUGS BENZODIAZEPINE Test - -
147 TEST DRUGS ECSTACY (MDMA) Test - -
148 TEST DRUGS MARIJUANA (HC) Test - -
149 TEST DRUGS METHAMPHETAMINE Test - -
150 TEST DRUGS MORPHINE Test - -
TEST DRUGS MORPHINE / METAHAMPHETAMINE /
151 Test - -
ECSTACY (MOPMETMDMA) Panel 3
152 TEST DRUGS MULTY 6 TEST PANEL Test - -
153 TEST HBsAg Test - -
154 TEST URIN CYBOW Pcs - -
155 TISSU DESINFEKTAN (ONE WIPE) Pcs - -
156 TP RAPID SYPHILIS (SD BIOLINE SYPHILIS) Pcs - -
157 UMBILICAL CORD KLEM Pcs - -
158 URINE BAG STERIL Pcs - -
159 YODIUM POVIDON LAR. 10% 300 ML Botol - -
160 YODIUM POVIDON LAR. 10% 60 ML Botol 79 79 3 76
161 - -
162 - -
163 - -
164 - -
165 - -
III PROGRAM
1 ALBENDAZOL TABLET Tablet 600 600 600
2 ALKOHOL SWAB Sachet - - -
3 AQUA PRO INJEKSI STERIL 20 ML Vial 24 24 24 100
4 ARTESUNAT INJEKSI Vial - - 200
5 ARTHEMETER INJEKSI Ampul - - 2,000
6 AZITROMISIN TABLET 500 MG Tablet - - 1,000
7 BENZATIN BENSIL PENISILIN 1,2 JT UI/VIAL Botol - - 50
8 BENZATIN BENSIL PENISILIN 2,4 JT UI/VIAL Botol - - 100
9 BLOOD LANCET Pcs - - -
10 BOX SLIDE Pcs - - -
11 CATRIDGE XPERT MTB/RIF Kit - - -
12 DIETIL CARBAMAZIN TABLET Tablet - - -
13 DOKSISIKLIN KAPSUL 100 MG Kapsul - - -
14 ETHAMBUTOL TABLET 400 MG Tablet - - -
15 ETHIONAMIDE TABLET 250 MG Tablet - - 100
16 FORMULA 100 Sachet - - 5,000
17 FORMULA 75 Sachet - - 5,000
18 FORMULA MIX Sachet - - 400
19 GIEMSA 250 ML Botol - - 200
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
20 HCL Botol - - -
21 HEPATITIS B IMUNOGLOBIN (HUMAN) Pcs - - -
22 HUMAN HEXAGON SYPHILIS Pcs - - 1,000
23 IMERSION OIL Botol - - 200
24 KOH 10% Botol - - 800
25 KOTRIMOKSAZOL TABLET 480 MG Tablet - - -
27 KUININ DIHIDROKLORIDA INJEKSI Ampul - - 30
28 KUININ TABLET 222 MG Tablet 600 600 600 30
29 KY JELLY Tube - - 1,000
31 MDT MULTI BACILLARY (MB) ANAK Blist - - -
32 MDT MULTI BACILLARY (MB) DEWASA Blist - - -
33 MDT PAUCI BACILLARY (PB) ANAK Blist - - 500
34 MDT PAUCI BACILLARY (PB) DEWASA Blist - - 3,000
35 METHYLEN BLUE 0,3% Botol - - -
36 MINERAL MIX Paket - - -
37 NaCl 0,9% Botol - - -
38 OAT KATEGORI ANAK Paket - - 400
39 OAT KATEGORI I-FDC Paket - - -
40 OAT KATEGORI II-FDC Paket - - -
41 OBAT ANTI MALARIA Tablet - - -
42 OBJECT GLASS Pcs - - -
43 POT SPUTUM Pcs - - 300
44 POT URINE Pcs - - 2,000
45 PRIMAKUIN TABLET 15 MG Tablet - - -
46 PYRAZINAMID TABLET 500 MG Tablet - - 40
47 RAPID 1 RDT HIV (VEROCHECK) Test - - -
48 RAPID TEST HIV 2 DIAGNOSTAR Test - - -
49 RAPID TEST HIV 2 KHB DIAGNOSTIC Test - - 100
50 RAPID TEST SYPHILIS RB-TS Test - - 1,000
51 RDT MALARIA Pcs - - 100
52 REAGEN CD4 TYPE I Pcs - - 500
53 REAGEN ZHEL NEILSEN Kit - - -
56 RPR ANTIGEN Pcs - - -
57 SAFETY BOX Pcs - - -
58 SARUNG TANGAN BLUE NITRIL Psg - - -
59 STANDAR Q HIV 1/2 Ab 3 LINE Vial - - 3,000
60 STOP TB KIT Kit - - 3,000
61 TES KIT HIV INTEC 1&2 Test - - 200
62 TES KIT HIV ONCOPROBE Test - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
63 TES KIT HIV VIKIA Test - - 50
64 TEST HBsAg Set - - -
65 TP RAPID HIV (SD BIOLINE HIV) Pcs - - -
66 TP RAPID SYPHILIS (SD BIOLINE SYPHILIS) Pcs - - -
67 TUBERKULIN PPD RT 23 SSI Vial - - -
68 VIT. A (RETINOL) 100.000 IU KAPSUL LUNAK Kapsul - -
69 VIT. A (RETINOL) 200.000 IU KAPSUL LUNAK Kapsul - - -
70 VIT. B6 (PYRIDOKSIN HCl) TABLET 10 MG Tablet - - -
71 - - -
72 - - 1,000
73 - - -
IV LOGISTIK COVID-19 1,000
1 AZITROMICIN TAB 500 MG Tablet - - 50
2 CHOLOROKUIN 150 MG TAB Tablet - - 200
3 FAVIPIRAVIR 200 MG TAB Tablet - - 200
4 HYDROXYCHOLOQUINE SULFAT 200 MG Tablet - - -
5 OSELTAMIVIR KAPSUL 75 MG Tablet - - -
6 APD COVER ALL SUIT (LEVEL 3) -
- APRON Pcs - - -
- BAJU APD Pcs - - 60
- FACE SHIELD Pcs - - 100
- KACA MATA GOOGLE Pcs - - -
- MASKER KN95/N95 Pcs - - 40
- NURSE CAP Pcs - - 40
- SARUNG TANGAN STERIL Pcs - - -
- SEPATU BOOTS Pcs - - 40
7 APD DISPOSABLE GOWN (LEVEL 2) 200
- BAJU APD Pcs - - -
- KACAMATA GOOGLE Pcs - - -
- MASKER BEDAH Pcs - - 1,000
- NURSE CAP Pcs - - 1,000
- SARUNG TANGAN STERIL Pcs - - 200
8 CATRIDGE COVID Test - - -
9 HAND SANITIZER Botol - - -
10 HEAD CUP / NURSE CUP Pcs - - -
11 MASKER BEDAH EARLOOP (CANTOL) Pcs - - 1,000
12 MASKER BEDAH TIE ON (IKAT) Pcs - - -
13 MASKER KN95 Pcs - - -
14 MASKER N95 Pcs 60 60 60 40
15 RAPID COVID-19 (SARS-CoV-2 Antibody Test) Test - - 100
16 RAPID COVID-19 ANTIGEN Test - - 1,000
17 SARUNG TANGAN NON STERIL L Psg - - -
18 SARUNG TANGAN NON STERIL M Psg - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
19 SARUNG TANGAN NON STERIL S Psg - - 600
20 SARUNG TANGAN OBGYN L Psg - - -
21 SARUNG TANGAN OBGYN M Psg - - -
22 SARUNG TANGAN OBGYN S Psg - - -
23 SARUNG TANGAN STERIL 6,5 Psg - - -
24 SARUNG TANGAN STERIL 7 Psg - - -
26 TABUNG EDTA Pcs - - 100
27 VTM Pcs - -
28 Pcs - -
29 - -
30 - -
31 - -
32 - -
33 - -
34 - -
Mengetahui,
Kepala Dinas Kesehatan Yang Menyerahkan, Yang Meminta, Pengelola Obat Puskesmas
Kabupaten Sorong Selatan Kepala Seksi Kefarmasian Kepala Puskesmas
Marthina Atanay, SKM., M.Kes. Endiyonarsi, S.Farm., Apt Nama Kapus Nama Pengelola Obat
Nip. 19750512 200003 2 006 Nip. 19820313 201201 1 001 Nip. Nip.
(LPLPO)
KODE PUSKESMAS 0
NAMA PUSKESMAS 0 DIPERIKSA DISIAPKAN DISERAHKAN PEMAKAIAN LAPORAN
DISTRIK 0 BULAN FEBRUARI MARET
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
I OBAT
1 ALLOPURINOL TABLET 100 MG Tablet 1,200 1,200 1,200
3 ALPARA SYRUP Botol - - -
4 ALPARA TABLET Tablet - - -
5 AMAROPO PLUS TABLET Tablet 300 300 300
6 AMBROKSOL SIRUP 15 MG/ML Botol - - -
7 AMBROKSOL TABLET 30 MG Tablet - - - -
8 AMINOFILIN INJEKSI 24 MG/ML Ampul 30 30
10 AMINOFILIN TABLET 200 MG Tablet 200 200 200
11 AMITRIPTYLIN TAB 25 MG Tablet 200 200 200
12 AMLODIPIN TABLET 10 MG Tablet 1,000 1,000 1,000
14 AMOKSISILLIN DROPS 15 ML Botol - - -
15 AMOKSISILLIN KAPLET 250 MG Kapsul - - -
16 AMOKSISILLIN KAPLET 500 MG Tablet - - -
17 AMOKSISILLIN SIRUP KERING 125 MG/5ML Botol - - -
18 AMOKSISILLIN SIRUP KERING FORTE 250 MG/5ML Botol 16 16 5 11
19 AMPISILLIN INJEKSI 1 GRAM Vial 20 20 20
21 ANTALGIN (METAMIZOL)TABLET 500 MG Tablet 300 300 300
22 ANTASIDA DOEN SUSPENSI KOMBINASI Botol 275 275 10 265
23 ANTASIDA DOEN TABLET KUNYAH KOMBINASI Tablet 1,200 1,200 200 1,000 1,000
24 Tube - - -
10.000 IU/G
25 Pot 96 96 96
ASAM SALISILAT 3%
26 ANTIHEMOROID DOEN KOMBINASI Suppo 20 20 20
27 AQUA PRO INJEKSI STERIL 25 ML Botol 24 24 24
29 ASAM ASCORBAT TABLET 50 MG Tablet 1,400 1,400 200 1,200
30 ASAM ASETILSALISILAT TABLET 80 MG Tablet 900 900 900
32 ASAM FOLAT TABLET 1 MG Tablet 800 800 800
33 ASAM MEFENAMAT TABLET 500 MG Tablet 100 100 100
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
34 ASAM TRANEXAMAT INJEKSI 100 MG/ML Ampul 60 60 60
37 ASIFIT TABLET Tablet - - -
38 ASIKLOVIR KRIM 5% Tube 92 92 92
40 ASIKLOVIR TABLET 400 MG Tablet 1,000 1,000 1,000
42 BECEFORT SIRUP Botol 1 1 1
43 BECEFORT TABLET Tablet - - -
45 BENZATIN BENSIL PENISILIN 2,4 JT UI/VIAL Vial 10 10 10
46 BETAHISTIN MESILAT TABLET 6 MG Tablet 90 90 90
47 BETAMETASON CREAM 0,1% Tube 174 174 5 169
48 BEVALEX KRIM Tube - - -
49 BIO ATP TABLET Tablet - - -
50 BIORON INJEKSI Ampul - - -
51 BIORON TABLET Tablet - - -
54 CAPTOPRIL TABLET 12,5 MG Tablet 1,300 1,300 1,300
57 CARBAMAZEPIN TABLET 200 MG Tablet 500 500 500
58 CEFADROKSIL KAPSUL 250 MG Kapsul - - -
60 CEFADROKSIL SIRUP 125 MG/60 ML Botol 26 26 10 16
61 CEFOTAXIME INJEKSI 1 GR Vial - - -
62 CENDO XYTROL TM Botol - - -
63 CLINDAMISIN KAPSUL 150 MG Kapsul - - -
66 CLORPROMAZIN INJEKSI 5 mg/ml Ampul 30 30 30
68 CYANOCOBALAMIN (B-12) INJEKSI 500 MCG/ML Ampul 73 73 73
69 CYANOCOBALAMIN (B-12) TABLET 50 MCG Tablet 3,100 3,100 3,100
70 DEKSAMETHASON INJEKSI 5 MG/ML-1ML Ampul 43 43 43
71 DEKSAMETHASON TABLET 0,5 MG Tablet - - -
73 DEXTAMIN TABLET Tablet - - -
74 DIAZEPAM INJEKSI 5 MG/ML- 2 ML Ampul - - -
75 DIAZEPAM TABLET 2 MG Tablet - - -
77 DIFENHIDRAMIN HCl INJEKSI 10 MG/ML Ampul 60 60 60
79 DIMENHIDRINAT TABLET Tablet 200 200 200
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
80 DOKSISIKLIN TABLET 100 MG Kapsul 400 400 400
81 DOMPERIDON DROPS 5 MG/ML Botol 19 19 19
82 DOMPERIDON SUSPENSI 5 MG/5ML Botol 70 70 70
83 DOMPERIDON TABLET 10 MG Tablet 1,100 1,100 1,100
84 DULCOLAX SUPPO ANAK Suppo - - -
85 DULCOLAX SUPPO DEWASA Suppo - - -
86 DULCOLAX TABLET Tablet - - -
87 EFEDRIN INJEKSI 50 MG/ML Ampul - - -
88 EFEDRIN TABLET 25 MG Tablet - - -
89 EPINEFRIN HCl (ADRENALIN) INJEKSI 0,1% Ampul 30 30 30
90 ERGOTAMIN 1 MG + KAFEIN 50 MG TABLET Tablet 600 600 600
91 ERITROMISIN KAPSUL 250 MG Kapsul 400 400 400
92 ERITROMISIN KAPSUL 500 MG Kapsul 300 300 100 200 1,000
93 ERITROMISIN SYRUP 200 MG/5 ML Botol - - -
94 ETAMBUTOL TABLET 250 MG Tablet 400 400 400
96 FENITOIN NATRIUM TABLET 100 MG Tablet - - -
100 FENOKSIMETIL PENISILIN (PENISILIN V) 500 MG Tablet - - -
101 FENOL GLISEROL TT 10% Botol - - -
102 FITUNO Tablet - - -
103 FLUKONAZOL KAPSUL 150 MG Kapsul 40 40 40
105 FOLAMIL GENIO KAPSUL Kapsul - - -
107 FUROSEMID TABLET 40 MG Tablet - - -
108 GABAPENTIN KAPSUL 300 MG Kapsul 200 200 200
110 GENTALEX KRIM Tube - - -
112 GENTAMYCIN SALEP KULIT 0.1% Tube 1 1 1
116 GERIAVITA Tablet 330 330 330
124 GLYCERIL GUAIACOLAT TABLET 100 MG Tablet 1,200 1,200 200 1,000
125 GRISEOFULVIN TABLET 125 MG Tablet - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
127 GRIVIN FORTE Tablet - - -
129 HEMAFORT TABLET Tablet 100 100 100
130 HIDROCLOROTIAZID TABLET 25 MG Tablet 300 300 300
134 HUSTAB P SYRUP Botol 7 7 7 -
136 IBUPROFEN SUSPENSI 100 MG/5 ML Botol 191 191 191
139 ICHTYOL SALEP Pot - - -
140 ISONIAZID TABLET 100 MG Tablet - - -
142 ISOSORBIT DINITRAT INJEKSI 10 MG/10 ML Ampul - - -
143 ISOSORBIT DINITRAT TABLET SUB 5 MG Tablet - - -
144 KALSIUM LACTAT TABLET 500 MG Tablet 1,200 1,200 200 1,000
146 KETOCONAZOLE KRIM 2% Tube 100 100 25 75
154 KLORFENIRAMIN MALEAT (CTM) TABLET 4 MG Tablet 1,100 1,100 100 1,000
155 KLOROKUIN TABLET 150 MG Tablet - - -
156 Botol 9 9 9
158 KOTRIMOKSAZOL TABLET 120 MG PEDIATRIK Tablet - - -
159 KOTRIMOKSAZOL TABLET 480 MG Tablet 3,600 3,600 200 3,400
161 LAKTULOSA SIRUP 2,335 G/5 ML Botol 21 21 21
162 LANSOPRAZOL 30 MG Tablet - - -
163 LEXACROL FORTE SYRUP Botol - - -
164 LIDOCAIN 2% (HCl) + EPINEFRIN INJEKSI 1:80.000-2 ml Ampul 300 300 300
165 LIDOCAIN NON EPINEFRIN INJEKSI 2% Ampul 460 460 460
166 LIVRON BPLEX Tablet 200 200 200 -
167 LOPERAMID TABLET Tablet 100 100 100
168 LORATADIN TABLET 10 MG Tablet 800 800 800
169 MAGNESIUM SUFAT INJEKSI (Mg SO4) 20 % Vial 60 60 60
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
171 MELOKSIKAM TABLET 15 MG Tablet - - -
172 METANEURON TABLET Tablet - - -
173 METFORMIN TABLET 500 MG Tablet 700 700 700
175 METHIL ERGOMETRIN TABLET 0,125 MG Tablet 500 500 500
176 METILPREDNISOLON TABLET 16 MG Tablet 600 600 600
178 METILPREDNISOLON TABLET 8 MG Tablet - - -
179 METOKLOPRAMIDE DROP 2 MG/ML Botol 23 23 23
180 METOKLOPRAMIDE TABLET 10 MG Tablet 200 200 200
181 METRONIDAZOL OVULA Suppo 60 60 60
183 METRONIDAZOL TABLET 500 MG Tablet 800 800 800
184 MIKONAZOL KRIM 2% Tube 24 24 24 -
186 MOLAKRIM Tube - - -
187 MOLASIC KAPLET (ASAM MEFENAMAT) Tablet - - -
188 MOLEXFLU KAPLET Tablet - - -
189 NATRIUM DIKLOFENAK TABLET 25 MG Tablet 600 600 600
192 NIFEDIPIN TABLET 10 MG Tablet 50 50 50
196 NOZA TABLET Tablet 200 200 100 100
197 OBAT ANTI TBC FDC KATEGORI ANAK Paket - - -
198 OBAT ANTI TBC FDC KATEGORI I Paket - - -
199 OBAT ANTI TBC FDC KATEGORI II Paket - - -
200 Strip 400 400 400
201 OBH SYRUP Botol - - -
202 OKSIMETAZOLIN TETES HIDUNG 0,025% (ANAK) Botol - - -
203 OKSIMETAZOLIN TETES HIDUNG 0,050% (DEWASA) Botol - - -
204 OKSITETRASIKLIN SALEP KULIT 3% Tube - - -
205 OKSITETRASIKLIN SALEP MATA 1% Tube 175 175 175
206 OKSITOSIN INJEKSI 10 IU/ML Ampul - - -
208 OMEPRASOL KAPSUL 20 MG Kapsul - - -
210 PAPAVERIN HCl TABLET 40 MG Tablet - - -
212 PARASETAMOL DROPS 100 MG/ML Botol - - -
213 PARASETAMOL SYRUP 120 MG/ML Botol 211 211 10 201
214 PARASETAMOL TABLET 500 MG Tablet 300 300 200 100 -
215 PEHASTAN 500 MG (ASAM MEFENAMAT) Tablet - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
216 PEHAVIT-D3 Kapsul - - -
221 PIRACETAM TABLET 400 MG Tablet - - -
223 PIRANTEL TABLET 125 MG Tablet 408 408 408
226 PIROKSIKAM TABLET 10 MG Tablet - - -
227 PIROKSIKAM TABLET 20 MG Tablet 600 600 600
228 PREDNISON TABLET 5 MG Tablet 1,700 1,700 100 1,600
229 PRIMAKUIN TABLET 15 MG Tablet 300 300 300
230 PROKAIN PENISILLIN INJEKSI 3 JT IU Vial - - -
231 PROPANOLOL HCl TABLET 40 MG Tablet 500 500 500
233 PYRAZINAMID TABLET 500 MG Tablet - - -
234 QUININ TABLET 222 MG Tablet 600 600 600
235 RANITIDIN INJEKSI 25 MG/ML Ampul 10 10 10
236 RANITIDIN TABLET 150 MG Tablet 200 200 200
239 RINGER ASETAT LARUTAN INFUS Botol 18 18 18
240 RINGER LAKTAT LARUTAN CAIRAN INFUS Botol 16 16 16
242 SALBUTAMOL SIRUP Botol - - -
243 SALBUTAMOL TABLET 2 MG Tablet - - -
244 SALBUTAMOL TABLET 4 MG Tablet 400 400 400
245 SALEP 2-4 KOMBINASI Pot 148 148 148
246 SALISIL BEDAK 2% Pot 19 19 19
247 SEFIKSIM KAPSUL 100 MG Kapsul - - -
249 SEFIKSIM SIRUP KERING 100 MG / 5 ML Botol 28 28 28
250 SEFTRIAKSON INJEKSI 1 G Vial - - -
252 SERUM ANTI TETANUS INJEKSI 1.500 IU Ampul - - -
253 SETIRIZIN SIRUP 5 MG/ML Botol 8 8 8 -
254 SETIRIZIN TABLET 10 MG Tablet - - -
255 SIMVASTATIN TABLET 10 MG Tablet 1,620 1,620 1,620
256 SIMVASTATIN TABLET 20 MG Tablet 600 600 600
257 SIPROFLOKSACIN TABLET 500 MG Tablet 600 600 600
258 SPIRONOLAKTON TABLET 100 MG Tablet 500 500 500
259 STESOLID SUPPO 10 MG/2,5 ML Suppo 10 10 10
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
262 SUKRALFAT SIRUP 500 mg/ 5 ml, 100 ml Botol 162 10 - 10
263 SULFACETAMID TM 15% Botol - - -
264 SULFADIAZIN KRIM Tube 19 19 19
265 Tablet - - -
266 TETRACYCLIN KAPSUL 250 MG Kapsul 600 600 600
271 VIPCOL SYRUP 60 ML Botol - - -
272 VIT. A (RETINOL) 100.000 IU KAPSUL LUNAK Kapsul 500 500 500
274 VIT. B KOMPLEKS TABLET Tablet 3,000 3,000 200 2,800
275 VIT. B1 (THIAMIN) INJEKSI 100 MG/ML-1ML Ampul 2,000 2,000 2,000
276 VIT. B1 (THIAMIN) TABLET 50 MG Tablet 2,000 2,000 2,000
277 VIT. B6 (PYRIDOKSIN HCl) TABLET 10 MG Tablet 1,200 1,200 1,200
278 VIT. K INJ. (PHYTOMENADION) 10 MG/ML Ampul 30 30 30
279 VIT. K INJ. (PHYTOMENADION) 2 MG/ML Ampul - - -
280 VIT. K TAB. SALUT (PHYTOMENADION) 10MG Tablet 400 400 400
281 VOMETA DROPS 5 MG/ML Botol 19 19 19
282 ZINK DROP 10 MG/ML Botol - - -
283 ZINK SIRUP 20 MG/5 ML Botol - - -
284 ZINK TABLET DISPERSIBLE 20 MG Tablet 2,700 2,700 2,700
285 - - -
286 - - -
287 - - -
288 - - -
289 - - -
290 - - -
1 ABBOCATH (I.V CATHETER) NO. 18 Pcs 35 35 35
8 ALKOHOL 70% 100 ML Botol 14 14 14
10 ALKOHOL SWAB Sachet 100 100 100
11 APRON LENGAN PANJANG Pcs - - -
12 ASEPTAN LIQUID 500 ML Botol 4 4 4
13 ASEPTIC GEL 500 ML Botol 22 22 22
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
15 BIOPLACENTON JELLY Tube - - -
16 BIOPLACENTON TULLE Pcs - - -
17 BISTURI Pcs - - -
18 BLOOD LANCET 21 G x 1,8 mm Pcs - - -
19 BRACKET HAND WASH Pcs - - -
21 CATGUT CROMIC 2/0 + JARUM BEDAH Pcs 36 36 36
23 CATGUT PLAIN 2/0 + JARUM BEDAH Pcs 48 48 48
25 CATGUT SILK 2/0 + JARUM BEDAH Pcs 24 24 24
27 CAVIDAGEL 30 GR Tube - - -
31 ELASTIC BANDAGE 10 CM X 4,5 M Roll 3 3 3
34 ELASTIC BANDAGE 7,5 CM X 4,5 M Roll 3 3 3
35 ETAKRIDIN (RIVANOL) LARUTAN 0,1% Botol 18 18 18
47 GIEMSA 250 ML Botol - - -
49 HIDROGEN PEROKSIDA (H2O2) 3% 100 ML Botol 5 5 5
50 INFUSION SET ANAK Set 36 36 36
51 INFUSION SET DEWASA Set 24 24 24
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
63 KASA HYDROFIL 40 Y X 16 CM Roll - - -
67 KASA STERIL HYDROFIL 16 X 16 Kotak - - -
69 KLINIPET 100 Unit - - -
73 KONDOM Kotak - - -
74 KY JELLY Tube - - -
75 LARUTAN HCl 0,1 N 100 ML Botol - - -
76 LARUTAN METHANOL 250 ML Botol - - -
77 LARUTAN TURC Botol - - -
78 LISOL (DESINFECTAN) 1 LITER Botol - - -
79 LUMPANG + STAMPER Set - - -
80 MASKER BEDAH EAR LOOP (CANTOL) Pcs - - -
84 MY JELLY Tube 5 5 5
86 ONESCRUB 4% Botol 8 8 8
87 PIPET TIP BLUE Pcs - - -
88 PIPET TIP YELLOW Pcs - - -
89 PLESTER 1 CM X 5 M Roll - - -
90 PLESTER 1,25 CM X 4,5 M Roll 24 24 24
91 PLESTER 2,5 CM X 1 M Roll 42 42 42
93 PLESTER 5 CM X 4,5 M Roll 8 8 8
95 PLESTERIN BULAT T Pcs 450 450 450
96 PLESTERIN ELASTIS JUMBO Pcs - - -
97 PLESTERIN FIRST AID Pcs 264 264 264
99 POLIFIX/PHARMAFIX 15 CM X 5 M Roll 26 26 26
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
105 REAGEN GOLONGAN DARAH A Pcs - - -
106 REAGEN GOLONGAN DARAH AB Pcs - - -
107 REAGEN GOLONGAN DARAH ANTI D RHESUS Pcs - - -
108 REAGEN GOLONGAN DARAH B Pcs - - -
109 REAGEN ZIEHL NEELSEN 3% Kit - - -
110 SAFETY BOKS Pcs - - -
111 SALISIL SPIRITUS ML Botol - - -
112 SARUNG TANGAN BLUE NITRIL M Psg - - -
113 SARUNG TANGAN BLUE NITRIL S Psg - - -
114 SARUNG TANGAN NON STERIL L Psg 700 700 700
115 SARUNG TANGAN NON STERIL M Psg 700 700 700
116 SARUNG TANGAN NON STERIL S Psg - - -
124 SPIRITUS Botol - - - 1
125 SPOIT (ALAT SUNTIK SEKALI PAKAI) 1 ML Pcs 900 900 900
130 STICK TEST ASAM URAT Pcs - - -
131 STICK TEST GLUKOSA Pcs - - -
132 STICK TEST KOLESTEROL Pcs - - -
133 TABUNG DARAH 10 ML Pcs - - -
136 TABUNG EDTA Pcs - - -
137 TABUNG MICRO Pcs - - -
138 TABUNG PLN PLH 13X100 6.0 Pcs - - -
139 TES KEHAMILAN Test - - -
140 TES KIT HEPATITIS C Test - - -
141 TES KIT HIV INTEC 1&2 Test - - -
143 TES KIT HIV VIKIA Test - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
144 TES KIT SYPHYLIS Test - - -
145 TEST DRUGS AMPHETAMIN Test - - -
146 TEST DRUGS BENZODIAZEPINE Test - - -
147 TEST DRUGS ECSTACY (MDMA) Test - - -
148 TEST DRUGS MARIJUANA (HC) Test - - -
149 TEST DRUGS METHAMPHETAMINE Test - - -
150 TEST DRUGS MORPHINE Test - - -
151 Test - - -
152 TEST DRUGS MULTY 6 TEST PANEL Test - - -
153 TEST HBsAg Test - - -
154 TEST URIN CYBOW Pcs - - -
155 TISSU DESINFEKTAN (ONE WIPE) Pcs - - -
157 UMBILICAL CORD KLEM Pcs - - -
158 URINE BAG STERIL Pcs - - -
159 YODIUM POVIDON LAR. 10% 300 ML Botol - - -
160 YODIUM POVIDON LAR. 10% 60 ML Botol 76 76 76
161 - - -
162 - - -
163 - - -
164 - - -
165 - - -
III PROGRAM
3 AQUA PRO INJEKSI STERIL 20 ML Vial 24 24 24
4 ARTESUNAT INJEKSI Vial - - -
5 ARTHEMETER INJEKSI Ampul - - -
6 AZITROMISIN TABLET 500 MG Tablet - - -
7 BENZATIN BENSIL PENISILIN 1,2 JT UI/VIAL Botol - - -
15 ETHIONAMIDE TABLET 250 MG Tablet - - -
16 FORMULA 100 Sachet - - -
18 FORMULA MIX Sachet - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
20 HCL Botol - - -
21 HEPATITIS B IMUNOGLOBIN (HUMAN) Pcs - - - -
22 HUMAN HEXAGON SYPHILIS Pcs - - - -
23 IMERSION OIL Botol - - -
24 KOH 10% Botol - - -
27 KUININ DIHIDROKLORIDA INJEKSI Ampul - - -
28 KUININ TABLET 222 MG Tablet 600 600 600
33 MDT PAUCI BACILLARY (PB) ANAK Blist - - -
34 MDT PAUCI BACILLARY (PB) DEWASA Blist - - -
37 NaCl 0,9% Botol - - -
38 OAT KATEGORI ANAK Paket - - -
42 OBJECT GLASS Pcs - - - 2
49 RAPID TEST HIV 2 KHB DIAGNOSTIC Test - - -
50 RAPID TEST SYPHILIS RB-TS Test - - -
52 REAGEN CD4 TYPE I Pcs - - -
59 STANDAR Q HIV 1/2 Ab 3 LINE Vial - -
60 STOP TB KIT Kit - - -
61 TES KIT HIV INTEC 1&2 Test 60 60 60
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
64 TEST HBsAg Set 175 175 175
71 - - -
72 - - -
73 - - -
IV LOGISTIK COVID-19
1 AZITROMICIN TAB 500 MG Tablet - - -
2 CHOLOROKUIN 150 MG TAB Tablet - - -
3 FAVIPIRAVIR 200 MG TAB Tablet - - -
6 APD COVER ALL SUIT (LEVEL 3)
- APRON Pcs - - -
- FACE SHIELD Pcs - - -
- MASKER KN95/N95 Pcs - - -
- NURSE CAP Pcs - - -
- SEPATU BOOTS Pcs - - -
7 APD DISPOSABLE GOWN (LEVEL 2)
- MASKER BEDAH Pcs - - -
11 MASKER BEDAH EARLOOP (CANTOL) Pcs - - -
14 MASKER N95 Pcs 60 60 60
15 RAPID COVID-19 (SARS-CoV-2 Antibody Test) Test - - -
16 RAPID COVID-19 ANTIGEN Test - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
27 VTM Pcs - - -
28 Pcs - - -
29 - - -
30 - - -
31 - - -
32 - - -
33 - - -
34 - - -
Mengetahui,
Nip. 19750512 200003 2 006 Nip. 19820313 201201 1 001 Nip. Nip.
(LPLPO)
KODE PUSKESMAS 0
DISTRIK 0 BULAN MARET APRIL
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
I OBAT
7 AMBROKSOL TABLET 30 MG Tablet - - -
8 AMINOFILIN INJEKSI 24 MG/ML Ampul #VALUE! #VALUE!
18 AMOKSISILLIN SIRUP KERING FORTE 250 MG/5ML Botol 11 11 11
22 ANTASIDA DOEN SUSPENSI KOMBINASI Botol 265 265 265
23 ANTASIDA DOEN TABLET KUNYAH KOMBINASI Tablet 1,000 1,000 1,000
24 Tube - - -
10.000 IU/G
25 Pot 96 96 96
ASAM SALISILAT 3%
29 ASAM ASCORBAT TABLET 50 MG Tablet 1,200 1,200 1,200
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
47 BETAMETASON CREAM 0,1% Tube 169 169 169
60 CEFADROKSIL SIRUP 125 MG/60 ML Botol 16 16 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
134 HUSTAB P SYRUP Botol - - -
144 KALSIUM LACTAT TABLET 500 MG Tablet 1,000 1,000 1,000
154 KLORFENIRAMIN MALEAT (CTM) TABLET 4 MG Tablet 1,000 1,000 1,000
156 Botol 9 9 9
166 LIVRON BPLEX Tablet - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
184 MIKONAZOL KRIM 2% Tube - - -
196 NOZA TABLET Tablet 100 100 100
200 Strip 400 400 400
213 PARASETAMOL SYRUP 120 MG/ML Botol 201 201 201
214 PARASETAMOL TABLET 500 MG Tablet 100 100 100
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
228 PREDNISON TABLET 5 MG Tablet 1,600 1,600 1,600
253 SETIRIZIN SIRUP 5 MG/ML Botol - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
262 SUKRALFAT SIRUP 500 mg/ 5 ml, 100 ml Botol - 10 - 10 - 10
265 Tablet - - -
274 VIT. B KOMPLEKS TABLET Tablet 2,800 2,800 2,800
285 - - -
286 - - -
287 - - -
288 - - -
289 - - -
290 - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
124 SPIRITUS Botol - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
151 Test - - -
161 - - -
162 - - -
163 - - -
164 - - -
165 - - -
III PROGRAM
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
20 HCL Botol - - -
22 HUMAN HEXAGON SYPHILIS Pcs - - -
24 KOH 10% Botol - - -
37 NaCl 0,9% Botol - - -
59 STANDAR Q HIV 1/2 Ab 3 LINE Vial - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
71 - - -
72 - - -
73 - - -
- APRON Pcs - - -
14 MASKER N95 Pcs 60 60 60
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
27 VTM Pcs - - -
28 Pcs - - -
29 - - -
30 - - -
31 - - -
32 - - -
33 - - -
34 - - -
Mengetahui,
Nip. 19750512 200003 2 006 Nip. 19820313 201201 1 001 Nip. Nip.
(LPLPO)
KODE PUSKESMAS 0
DISTRIK 0 BULAN APRIL MEI
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
I OBAT
8 AMINOFILIN INJEKSI 24 MG/ML Ampul #VALUE! #VALUE! #VALUE!
24 Tube - - -
10.000 IU/G
25 Pot 96 96 96
ASAM SALISILAT 3%
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
156 Botol 9 9 9
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
200 Strip 400 400 400
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
265 Tablet - - -
285 - - -
286 - - -
287 - - -
288 - - -
289 - - -
290 - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
151 Test - - -
161 - - -
162 - - -
163 - - -
164 - - -
165 - - -
III PROGRAM
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
20 HCL Botol - - -
24 KOH 10% Botol - - -
37 NaCl 0,9% Botol - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
71 - - -
72 - - -
73 - - -
- APRON Pcs - - -
14 MASKER N95 Pcs 60 60 60
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
27 VTM Pcs - - -
28 Pcs - - -
29 - - -
30 - - -
31 - - -
32 - - -
33 - - -
34 - - -
Mengetahui,
Nip. 19750512 200003 2 006 Nip. 19820313 201201 1 001 Nip. Nip.
(LPLPO)
KODE PUSKESMAS 0
DISTRIK 0 BULAN MEI JUNI
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
I OBAT
24 Tube - - -
10.000 IU/G
25 Pot 96 96 96
ASAM SALISILAT 3%
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
156 Botol 9 9 9
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
200 Strip 400 400 400
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
265 Tablet - - -
285 - - -
286 - - -
287 - - -
288 - - -
289 - - -
290 - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
151 Test - - -
161 - - -
162 - - -
163 - - -
164 - - -
165 - - -
III PROGRAM
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
20 HCL Botol - - -
24 KOH 10% Botol - - -
37 NaCl 0,9% Botol - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
71 - - -
72 - - -
73 - - -
- APRON Pcs - - -
14 MASKER N95 Pcs 60 60 60
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
27 VTM Pcs - - -
28 Pcs - - -
29 - - -
30 - - -
31 - - -
32 - - -
33 - - -
34 - - -
Mengetahui,
Nip. 19750512 200003 2 006 Nip. 19820313 201201 1 001 Nip. Nip.
(LPLPO)
KODE PUSKESMAS 0
DISTRIK 0 BULAN JUNI JULI
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
I OBAT
24 Tube - - -
10.000 IU/G
25 Pot 96 96 96
ASAM SALISILAT 3%
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
156 Botol 9 9 9
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
200 Strip 400 400 400
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
265 Tablet - - -
285 - - -
286 - - -
287 - - -
288 - - -
289 - - -
290 - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
151 Test - - -
161 - - -
162 - - -
163 - - -
164 - - -
165 - - -
III PROGRAM
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
20 HCL Botol - - -
24 KOH 10% Botol - - -
37 NaCl 0,9% Botol - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
71 - - -
72 - - -
73 - - -
- APRON Pcs - - -
14 MASKER N95 Pcs 60 60 60
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
27 VTM Pcs - - -
28 Pcs - - -
29 - - -
30 - - -
31 - - -
32 - - -
33 - - -
34 - - -
Mengetahui,
Nip. 19750512 200003 2 006 Nip. 19820313 201201 1 001 Nip. Nip.
(LPLPO)
KODE PUSKESMAS 0
DISTRIK 0 BULAN JULI AGUSTUS
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
I OBAT
24 Tube - - -
10.000 IU/G
25 Pot 96 96 96
ASAM SALISILAT 3%
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
156 Botol 9 9 9
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
200 Strip 400 400 400
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
265 Tablet - - -
285 - - -
286 - - -
287 - - -
288 - - -
289 - - -
290 - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
151 Test - - -
161 - - -
162 - - -
163 - - -
164 - - -
165 - - -
III PROGRAM
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
20 HCL Botol - - -
24 KOH 10% Botol - - -
37 NaCl 0,9% Botol - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
71 - - -
72 - - -
73 - - -
- APRON Pcs - - -
14 MASKER N95 Pcs 60 60 60
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
27 VTM Pcs - - -
28 Pcs - - -
29 - - -
30 - - -
31 - - -
32 - - -
33 - - -
34 - - -
Mengetahui,
Nip. 19750512 200003 2 006 Nip. 19820313 201201 1 001 Nip. Nip.
(LPLPO)
KODE PUSKESMAS 0
DISTRIK 0 BULAN AGUSTUS SEPTEMBER
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
I OBAT
24 Tube - - -
10.000 IU/G
25 Pot 96 96 96
ASAM SALISILAT 3%
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
156 Botol 9 9 9
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
200 Strip 400 400 400
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
265 Tablet - - -
285 - - -
286 - - -
287 - - -
288 - - -
289 - - -
290 - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
151 Test - - -
161 - - -
162 - - -
163 - - -
164 - - -
165 - - -
III PROGRAM
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
20 HCL Botol - - -
24 KOH 10% Botol - - -
37 NaCl 0,9% Botol - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
71 - - -
72 - - -
73 - - -
- APRON Pcs - - -
14 MASKER N95 Pcs 60 60 60
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
27 VTM Pcs - - -
28 Pcs - - -
29 - - -
30 - - -
31 - - -
32 - - -
33 - - -
34 - - -
Mengetahui,
Nip. 19750512 200003 2 006 Nip. 19820313 201201 1 001 Nip. Nip.
(LPLPO)
KODE PUSKESMAS 0
DISTRIK 0 BULAN SEPTEMBER OKTOBER
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
I OBAT
24 Tube - - -
10.000 IU/G
25 Pot 96 96 96
ASAM SALISILAT 3%
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
156 Botol 9 9 9
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
200 Strip 400 400 400
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
265 Tablet - - -
285 - - -
286 - - -
287 - - -
288 - - -
289 - - -
290 - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
151 Test - - -
161 - - -
162 - - -
163 - - -
164 - - -
165 - - -
III PROGRAM
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
20 HCL Botol - - -
24 KOH 10% Botol - - -
37 NaCl 0,9% Botol - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
71 - - -
72 - - -
73 - - -
- APRON Pcs - - -
14 MASKER N95 Pcs 60 60 60
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
27 VTM Pcs - - -
28 Pcs - - -
29 - - -
30 - - -
31 - - -
32 - - -
33 - - -
34 - - -
Mengetahui,
Nip. 19750512 200003 2 006 Nip. 19820313 201201 1 001 Nip. Nip.
(LPLPO)
KODE PUSKESMAS 0
DISTRIK 0 BULAN OKTOBER NOVEMBER
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
I OBAT
24 Tube - - -
10.000 IU/G
25 Pot 96 96 96
ASAM SALISILAT 3%
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
156 Botol 9 9 9
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
200 Strip 400 400 400
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
265 Tablet - - -
285 - - -
286 - - -
287 - - -
288 - - -
289 - - -
290 - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
151 Test - - -
161 - - -
162 - - -
163 - - -
164 - - -
165 - - -
III PROGRAM
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
20 HCL Botol - - -
24 KOH 10% Botol - - -
37 NaCl 0,9% Botol - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
71 - - -
72 - - -
73 - - -
- APRON Pcs - - -
14 MASKER N95 Pcs 60 60 60
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
27 VTM Pcs - - -
28 Pcs - - -
29 - - -
30 - - -
31 - - -
32 - - -
33 - - -
34 - - -
Mengetahui,
Nip. 19750512 200003 2 006 Nip. 19820313 201201 1 001 Nip. Nip.
(LPLPO)
KODE PUSKESMAS 0
DISTRIK 0 BULAN NOVEMBER DESEMBER
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
I OBAT
24 Tube - - -
10.000 IU/G
25 Pot 96 96 96
ASAM SALISILAT 3%
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
156 Botol 9 9 9
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
200 Strip 400 400 400
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
265 Tablet - - -
285 - - -
286 - - -
287 - - -
288 - - -
289 - - -
290 - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
151 Test - - -
161 - - -
162 - - -
163 - - -
164 - - -
165 - - -
III PROGRAM
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
20 HCL Botol - - -
24 KOH 10% Botol - - -
37 NaCl 0,9% Botol - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
71 - - -
72 - - -
73 - - -
- APRON Pcs - - -
14 MASKER N95 Pcs 60 60 60
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
27 VTM Pcs - - -
28 Pcs - - -
29 - - -
30 - - -
31 - - -
32 - - -
33 - - -
34 - - -
Mengetahui,
Nip. 19750512 200003 2 006 Nip. 19820313 201201 1 001 Nip. Nip.
(LPLPO)
KODE PUSKESMAS 0
DISTRIK 0 BULAN DESEMBER JANUARI
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
I OBAT
24 Tube - - -
10.000 IU/G
25 Pot 96 96 96
ASAM SALISILAT 3%
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
156 Botol 9 9 9
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
200 Strip 400 400 400
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
265 Tablet - - -
285 - - -
286 - - -
287 - - -
288 - - -
289 - - -
290 - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
151 Test - - -
161 - - -
162 - - -
163 - - -
164 - - -
165 - - -
III PROGRAM
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
20 HCL Botol - - -
24 KOH 10% Botol - - -
37 NaCl 0,9% Botol - - -
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
71 - - -
72 - - -
73 - - -
- APRON Pcs - - -
14 MASKER N95 Pcs 60 60 60
PEMBERIAN
1 2 3 4 5 6 = (4+5) 7 8 9 = (6-7-8) 10 11 12 13 14 15 16
27 VTM Pcs - - -
28 Pcs - - -
29 - - -
30 - - -
31 - - -
32 - - -
33 - - -
34 - - -
Mengetahui,
Nip. 19750512 200003 2 006 Nip. 19820313 201201 1 001 Nip. Nip.

Lplpo Puskesmas 2022

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