LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

NO : PELAPORAN BULAN : DESEMBER 2022

NAMA PUSKESMAS : PRINGGARATA PENERIMAAN BULAN : JANUARI 2023
NAMA UNIT : POLINDES ARJANGKA
PENGELOLA OBAT : ZAHRUL HAYATI, A.Md.Keb

80

STOK EXPIRED DATE/

No. Nama Obat Satuan STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PEMBERIAN NO. BATCH
OPTIMUM KETERANGAN

Tablet/Kapsul/Sachet
1 ACT tablet tablet - -
2 Acetyl Cystein 200mg tablet - -
3 Acyclovir 200 mg tablet tablet - -
4 Acyclovir 400 mg tablet tablet - -
5 Albendazol tablet 400 mg tablet - -
6 Alopurinol tablet 100 mg tablet - -
7 Alprazolam 0,5 mg tablet tablet - -
8 Alprazolam 1 mg tablet - -
9 Ambroxol tablet tablet - -
10 Aminofilina tablet 200 mg tablet - -
11 Amitriptilina tablet 25 mg tablet - -
12 Amlodipin 5 mg tablet - -
13 Amlodipin 10 mg tablet - -
14 Amoksisilina kapsul 500 mg tablet 80 200 280 280
15 Antasida DOEN tablet tablet 80 100 180 180
16 Asam Askorbat (Vit. C) tablet 50 mg tablet 70 70 70
17 Asam Folat tab tablet - -
18 Asam Mefenamat tablet 500 mg tablet 100 100 100
19 Asam Tranexamat 500mg tablet - -
20 Asetosal 80mg (MINIASPI) tablet - -
21 Attalpulgite 600mg - New Antides tablet - -
22 Azithromycin 500 mg tab tablet - -
23 Betahistin 6mg tablet - -
24 Captopril 12,5 mg tablet - -
25 Captopril tablet 25 mg tablet - -
26 Captopril tablet 50 mg tablet - -
27 Cefadroxil 500 mg tablet - -
28 Clozapine 25mg tablet - -
29 Cyproploxasin tablet tablet - -
 STOK EXPIRED DATE/
No. Nama Obat Satuan STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PEMBERIAN NO. BATCH
OPTIMUM KETERANGAN

30 Deksametason tablet 0,5 mg tablet 100 100 100

31 Diazepam tablet 2 mg tablet - -
32 Digoksin tablet 0,25 mg tablet - -
33 Domperidon tablet 10 mg tablet - -
34 Doxycyklin 100 mg tablet capsul - -
35 Efedrina HCl. tablet 25 mg tablet - -
36 Ergotamin Caffein tablet tablet - -
37 Eritromisin kapsul 250 mg tablet - -
38 Eritromisin kapsul 500 mg tablet - -
39 Fenobarbital tablet 30 mg tablet - -
40 Fenofibrate 100 mg tablet - -
41 Fitomenadion (Vit. K) tablet salut 10 mg tablet - -
42 Fluoxetin 20mg (NOPRES) tablet - -
43 Furosemida tablet 40 mg tablet - -
44 Garam Oralit untuk 200 ml air Sachet 17 17 17
45 Gemfibrozil 150 mg tablet - -
46 Glibenklamida tablet 5 mg tablet - -
47 Glimepiride tablet 1 mg tablet - -
48 Glimepiride tablet 2 mg tablet - -
49 Griseofulvin tablet 125 mg Mikronized tablet - -
50 Guaifenisin tablet tablet - -
51 Haloperidol tablet 1,5 mg tablet - -
52 Haloperidol tablet 5 mg tablet - -
53 Hidroklortiazide (HCT) tablet 25 mg tablet - -
54 Hyoscine N Butilbromide/ SCOPMA tablet - -
55 Ibuprofen tablet 200 mg tablet - -
56 Ibuprofen tablet 400 mg tablet - -
57 Isoniazid ( INH ) + Pyridoxin (B6) tablet - -
58 Isoniazid ( INH ) 100mg tablet - -
59 Isosorbid Dinitrat Sub Lingual tablet 5 mg tablet - -
60 Kalsium Laktat tablet 500 mg tablet 80 100 180 180
61 Karbamazepin 200 mg tablet - -
62 Ketokonazole tablet 200 mg tablet - -
63 Klindamycin 150 mg tablet - -
64 Klindamycin 300 mg capsul - -
65 Kloramfenikol kapsul 250 mg tablet - -
66 Kloramfenikol kapsul 500 mg tablet - -
67 Klorfeniramin Maleat (CTM) tablet 4 mg tablet - -
68 Klorpromazina tablet 100 mg tablet - -
 STOK EXPIRED DATE/
No. Nama Obat Satuan STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PEMBERIAN NO. BATCH
OPTIMUM KETERANGAN

69 KOMBIPAK (Azythromycin + Cefixime ) tablet - -

70 Kotrimoksazol dewasa tablet tablet - -
71 Kuinin ( Kina ) tablet 200 mg tablet - -
72 Loperamide 2mg tab tablet - -
73 Loratadin 10mg tablet - -
74 Lorazepam 1 mg (RENAQUIL 1mg) tablet - -
75 Metformin HCL 500 mg tablet tablet - -
76 Metilergometrin Maleat tablet 0,125 mg tablet - -
77 Metilprednisolon 4 mg tablet - -
78 metocloperamide tab 5 mg tablet - -
79 Metoclopramide 10 mg tablet - -
80 Metronidazol tablet 500 mg tablet - -
81 Mineral Mix Sachet Sachet - -
82 Misoprotol tab 200 mcg tablet - -
83 Na diklofenak 25mg tablet - -
84 Na diklofenak 50mg tablet - -
85 Nifedipin tablet tablet 40 40 40
86 Nistatin tablet salut 500.000 IU tablet - -
87 Obat Anti Tuberkulosis FDC kategori 1/3 paket - -
88 Obat Anti Tuberkulosis FDC kategori 2 paket - -
89 Obat Anti Tuberkulosis FDC kategori anak paket - -
90 Obat Anti Tuberkulosis KDT Harian paket - -
91 Omeprazole kapsul kapsul - -
92 Oseltamivir tablet - -
93 Parasetamol tablet 500 mg tablet 90 200 290 290
94 Phenytoin 100 mg capsul - -
95 Piridoksina HCl. tablet 10 mg tablet 80 100 180 180
96 Prednison tablet 5 mg tablet - -
97 Primakuin tablet 15 mg tablet - -
98 Propiltiourasil tablet 100 mg tablet - -
99 Ranitidin tablet 150 mg tablet - -
100 Retinol (Vitamin A) kapsul 100.000 IU capsul - -
101 Retinol (Vitamin A) kapsul 200.000 IU capsul 33 33 33
102 Risperidon 2 mg tablet tablet - -
103 Salbutamol tablet 2 mg tablet - -
104 Salbutamol tablet 4 mg tablet - -
105 Simvastatin 10mg tablet - -
106 Sivit zink tablet tablet - -
107 Spironolakston 25 mg tablet - -
 STOK EXPIRED DATE/
No. Nama Obat Satuan STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PEMBERIAN NO. BATCH
OPTIMUM KETERANGAN

108 Striatamin cap capsul - -

109 Tablet Tambah Darah kombinasi tablet 360 900 1,260 1,260
110 Tetrasiklina HCl. kapsul 500 mg capsul - -
111 Tiamine HCl. Mononitrat (Vit. B-1) tablet 50 mg tablet - -
112 Trifluoperazine 6 mg tablet - -
113 Triheksifenidil HCl. tablet 2 mg tablet - -
114 Valproat tab sal 250 mg (Depakote ER) botol - -
115 Vitamin B Komplek tablet tablet 100 100 200 200
116 Zinc tablet 20 mg botol - -
Syrup/ Suspensi - -
117 Ambroxol sirup 15mg/ml botol - -
118 Amoksisilina sirup kering 125 mg/ 5ml botol - -
119 Amoksisilina sirup kering 250 mg/ 5ml botol - -
120 Amoxicillin drop botol - -
121 Antasida DOEN suspensi botol - -
122 Cefadroxil sirup 125mg/ml botol - -
123 Domperidon syrup botol - -
124 Eritromisin Syrup Kering 200mg/5ml botol - -
125 Ibuprofen sirup 100mg/5ml botol - -
126 Kloramfenikol suspensi 125mg/5 ml botol - -
127 Kotrimoksazol suspensi botol - -
128 Multivitamin dan mineral (caviplex) syr botol - -
129 Parasetamol drop 100 mg/ml @ 15 ml botol - -
130 Parasetamol sirup 120 mg / 5 ml botol - -
131 Setirizin sir 5 mg/5 ml. botol - -
132 Valproat syrup 250 mg/ml botol - -
133 Zinc sir 20 mg/5 ml botol - -
Injeksi - -
134 ACT injeksi ampul - -
135 Aminofilina injeksi 24 mg / ml-10ml ampul - -
136 Ampisilina injeksi Ampul 2 3 5 5
137 Aqua Pro injeksi steril bebas pirogen ampul 5 2 7 7
138 Asam Tranexamat 500mg/5 ml injeksi ampul - -
139 Atropin Sulfat injeksi 0,25 mg / ml-1 ml ampul - -
140 Calsium Glukonas Inj ampul - -
141 Deksametason inj. 5 mg /ml-1 ml Ampul - -
142 Diazepam injeksi 5 mg/ ml- 2 ml ampul - -
143 Difenhidramina injeksi 10 mg/ ml- 1 ml ampul - -
144 Epinefrin injeksi 0,1 % - 1 ml ampul - -
 STOK EXPIRED DATE/
No. Nama Obat Satuan STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PEMBERIAN NO. BATCH
OPTIMUM KETERANGAN

145 Fenobarbital injeksi 50 mg / ml-1 ml ampul - -

146 Fitomenadion (Vit. K) injeksi 10 mg / ml-1 ml ampul 9 5 14 14
147 Haloperidol injeksi 5mg/ml (LODOMER 5) ampul - -
148 Ketorolac Inj 30 mg/ml ampul - -
149 Kloramfenikol injeksi Ampul - -
150 Lidokain 2% injeksi (tunggal) ampul - -
151 Lidokain Kompositum injeksi ampul - -
152 Magnesium Sulfat injeksiI (IV) 20 %-25 ml Vial - -
153 Magnesium Sulfat injeksiI (IV) 40 %-25 ml Vial 2 2 2
154 Metilergometrin Maleat injeksi 0,2 mg / ml Ampul - -
155 Metocloperamide inj Ampul - -
Nebules kombinasi : ipatropium br 0.5 mg+
156 salbutamol 2.5 mg (COMBIVENT) Vial - -
157 Oksitosin injeksi 10 IU / ml - 1 ml ampul 24 10 34 34
158 Omeprazole 40mg/10 ml injeksi Vial - -
159 Prokain Benzil Penisilin inj 3jt IU Vial - -
160 Ranitidine injeksi Pot - -
161 Sabu Polivalen 5 ml (ABU I) Vial - -
162 Salbutamol Inj 1 mg/ml Vial - -
163 Serum Anti Tetanus injeksi 1.500 IU / ampul (ATS) ampul - -
164 Sianokobalamin (Vit. B 12) injeksi 500 mcg / ml ampul - -
Obat Luar - -
165 Acyclovir krim 5% tube - -
166 Antibakteri DOEN salep kombinasi tube - -
167 Antifungi DOEN kombinasi tube - -
168 Antihemaroid DOEN kombinasi suppo - -
169 Betametason krim 0,1 % tube - -
170 Borax Glycerin botol - -
171 Calamin (Caladin) lotion 60 ml botol - -
172 Diazepam rectal tube 5 mg (stesolid rectal) tube - -
173 Diazepam rectal tube 10mg (stesolid rectal) tube - -
174 Dulcolax 5mg supp (anak) suppo - -
175 Dulcolax 10mg supp (Dewasa) suppo - -
176 Etakridina (Rivanol) larutan 0,1 % botol - -
177 Etanol 70 % botol 1 1 1
178 Fenolgliserol tetes telinga 10 % botol - -
179 Gentamicin salep mata (GENOINT) 0,3 % tube - -
180 Gentamicin tetes mata 0,3 % botol - -
181 Hidrokortison krim 2,5 % tube - -
 STOK EXPIRED DATE/
No. Nama Obat Satuan STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PEMBERIAN NO. BATCH
OPTIMUM KETERANGAN

182 Ketokonazole cream 2% tube - -

183 Kloramfenikol salep kulit 2% (BUFACETIN) tube - -
184 Kloramfenikol salep mata 1 % tube - -
185 Kloramfenikol tetes mata 0,5 % botol - -
186 Kloramfenikol tetes telinga 3 % botol - -
187 Miconazol krim tube - -
188 Oksitetrasiklin salep mata 1 % tube 2 2 2
189 Parasetamol / Pamol suppo 125mg suppo - -
190 Perhidrol ( Lar H2O2 ) tube - -
191 Povidon Iodida 10 % , 30 ml botol - -
192 Povidon Iodida 10 % , 60 ml botol 2 2 2
193 Povidon Iodida 10 % , 300 ml botol - -
194 Salep 2-4 Kombinasi Pot - -
195 Salisil Bedak 2 % botol - -
196 Scabicid/Scabimid cream tube - -
197 Silver sulfadiazin Cream 1% 35 gr tube - -
Infus dan Cairan - -
198 Cairan Untuk Irigasi 1000 ml Flash - -
199 Glukosa infus 5 % Flash - -
200 Glukosa infus 10 % Flash - -
201 Glukosa infus 40 % Flash - -
202 Natrium Klorida infus 0,9 % 500 ml Flash - -
203 Prontosan Wound Irrigation sol 350ml botol - -
204 Ringer Laktat larutan infus steril Flash 10 9 19 19
Bahan Medis Habis Pakai - -
205 Alat Suntik sekali pakai 1 ml Set 16 16 16
206 Alat Suntik sekali pakai 3 ml Set 15 15 30 30
207 Alat Suntik sekali pakai 5 ml Set 13 13 13
208 Catgut / Benang Bedah No. 2/0 24x70 cm - -
209 Catgut / Benang Bedah No. 3/0 24x70 cm 8 24 32 32
210 Cover Glass 20x20 set - -
211 Dermafix S IV set - -
212 Feeding Tube 40cm No. 8 set - -
213 Foley cathether No. 16 set - -
214 Foley cathether No. 18 set - -
215 Foley cathether No. 20 set - -
216 Gown set botol - -
217 Hand Rub 500ml botol - -
 STOK EXPIRED DATE/
No. Nama Obat Satuan STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PEMBERIAN NO. BATCH
OPTIMUM KETERANGAN

218 Hand Scrub 500ml botol - -

219 Handrub refill 5 liter galon - -
220 Hazmat Size L set - -
221 Hazmat Size XL set - -
222 Infusion Set anak-anak set - -
223 Infusion Set dewasa set 8 6 14 14
224 IV Cathether No. 18 G set 9 5 14 14
225 IV Cathether No. 20 G set 7 7 7
226 IV Cathether No. 22 G set - -
227 IV Cathether No. 24 G set - -
228 Jarum hecting kombinasi set - -
229 Jelly Dopler botol - -
230 Kapas Pembalut / Adsorben 250 gram rol 1 1 1
231 Kasa Pembalut 40 yd x 110 cm rol 1/2 1 2 2
232 Kasa Pembalut 4x10 cm rol - -
233 Kasa Pembalut 4x15 cm rol - -
234 Kertas EKG 58mm x 25 m rol - -
235 Kertas EKG 58mm X 30 m rol - -
236 Kertas EKG 63mm X 30 m rol - -
237 Kertas EKG 80mm x 20 m rol - -
238 Lokal kacamata faceshield set - -
239 Masker Bedah Anak pcs - -
240 Masker KN 95 pcs - -
241 Masker N 95 pcs 10 10 10
242 Masker Oxygen (Maxiflow) Anak (Pediatrik) set - -
243 Masker Oxygen (Maxiflow) Dewasa (Adult) set - -
244 Masker surgical pcs 30 30 30
245 Masker surgical Anak pcs - -
246 Object Glass 20x20 mm pack - -
247 Oxygen Nasal Adult (Dewasa) set - -
248 Oxygen Nasal NewNates set - -
249 Oxygen Nasal Pediatric set - -
250 Pembalut gibs rol - -
251 Plester 5 yard x 2 inchi (plester coklat) rol 1 1 1
252 Plester Kertas 1" (surgical tape) rol - -
253 Regulator Oksigen set - -
254 Sarung tangan steril no.6,5 pasang - -
255 Sarung tangan steril NO.7 pasang 10 10 10
256 Sarung tangan steril NO.7,5 pasang - -
 STOK EXPIRED DATE/
No. Nama Obat Satuan STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PEMBERIAN NO. BATCH
OPTIMUM KETERANGAN

257 Sarung tangan non steril uk L pasang - -

258 Sarung tangan non steril uk.M pasang 90 100 190 190
259 Sarung tangan obgin No. 6,5 pasang - -
260 Sarung tangan obgin No. 7 pasang - -
261 Sarung tangan obgin No. 7,5 pasang - -
262 Sarung tangan obgyn no. 8 pasang - -
263 Silk 2/0 + 1/2 GT 35MM set - -
264 Silk 3/0 + 1/2 GT 35MM set - -
 STOK EXPIRED DATE/
No. Nama Obat Satuan STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PEMBERIAN NO. BATCH
OPTIMUM KETERANGAN

265 Solida Nurse Cap set - -

266 Surgical mess 11 pack - -
267 Surgical mess 20 pack - -
268 Transparent IV Dressing (with notch) set - -
269 Umbilical cord klem set 16 16 16
270 Urine bag set - -
271 Wing Neddle No 21 G set - -
272 Wing Neddle No 23 G set - -
273 Wing Neddle No 25 G set - -
Bahan Gigi - -
274 Air Raksa dental use 100 gram - -
275 Cavit botol - -
276 Cresophene botol - -
277 Etil klorida semprot 100 ml - -
278 Euginol cairan dus 12 btl - -
279 Glass Ionomer cement (GC IX) A2-A3 set - -
280 Jarum exterpatie set - -
281 Jarum reaming file set - -
282 Kalsium Hidroksida pasta 2 tube - -
283 Klorfenol Kamper Menthol ( CHKM ) 10 ml - -
284 Mummifying pasta botol - -
285 Non Arsen Septodont Rapid botol - -
286 Semen Seng Pospat serbuk dan cairan set @ 30 gr - -
287 Silver Amalgam 1 oz - -
288 Spon Gelatin Cubicles 1 x 1 x 1 cm 24 buah - -
289 Tambalan komposit-solare X (A2-A3) Set - -
290 Temperory Stoping Fletcher serbuk & cair set @ 100 gr - -
Tambahan - -
291 Cetirizine tab tablet 20 20 20
292 Alkohol swab pack 100 100 200 200
293 kasa hidrofil steril pack - -

Yang Memberikan, Yang Menerima,

Pengelola Obat Puskesmas Pengelola Obat Unit

Nisa' Amila Rodhiya, S.Farm., Apt .........................................