LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT OTSUS

( LPLPO ) OTSUS

UPT PKM : SUNGAI RAYA BULAN : JANUARI

KECAMATAN : SUNGAI RAYA TAHUN : 2023

KABUPATEN : ACEH TIMUR

PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN

KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir 200 mg Tablet 0 0 0

2 Acyclovir Cream Tube 33 33 3 30
3 Ambroxol Tab 30 mg Tablet 0 0 0
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 36 0 36
syr)
5 Asam Folat Tablet 2950 2950 76 2874
6 Attapulgite 630 mg Tablet 0 0 0
7 Bedak Salisil 2% Serbuk Kotak 1 50 51 23 28 100
8 Betahistin Tablet 0 0 0
9 Betametason Tube 0 0 0
10 Bisacodil supp 5 mg Supp 6 6 0 6
11 Bisacodil supp 10 mg Supp 20 20 2 18
12 Bromhexin HCL Syrup Botol 0 0 0
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0
14 Clobazam 10 mg Tablet 63 63 0 63
15 Curcuma Force Tablet 0 0 0
16 Dexamethason Tab 0,5 mg Tablet 5147 5147 1301 3846 1000
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 13 13 0 13
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0
20 Digoksin 0.25 mg Tablet 100 100 0 100
21 Diphenhidramin Inj Ampul 0 0 0
22 Erytromicin 500 mg Tablet 79 79 10 69
23 Furosemid 40 mg Tablet 133 133 0 133
24 Furosemid Inj 10 mg/ml Ampul 10 10 0 10
25 Gentamisin Salep Mata Tube 1 1 0 1
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0
27 Griseofulvin Tablet 34 34 34 0
28 Hidroklorotiazid 25 mg Tablet 97 97 0 97 100
29 Ibuprofen Tab 200 mg Tablet 214 214 0 214
30 Ibuprofen Tab 400 mg Tablet 0 0 0
31 Isosorbid Dinitrat 5 mg Tablet 209 200 409 167 242
32 Kalium Diclofenac 50 mg Tablet 420 420 384 36
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0
34 Kaptopril 25 mg Tablet 0 0 0
35 kalium Permanganat 5 gr Pot 25 25 20 5
36 Ketokonazole 2 % Tube 0 0 0 100
37 Klindamicin 150 mg Kapsul 72 72 0 72
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0
39 Kloramphenicol Salep Mata 1 % Tube 24 24 0 24 100
40 Kloramphenicol tetes Mata 0.5% Botol 62 62 1 61
41 Kloramphenicol tetes telinga Botol 5 5 0 5
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0
43 Klorpromazin 100 mg Tablet 21 21 0 21
44 Lansoprazole 30 mg Kapsul 0 0 0 600
45 Levofloxacin 500 mg Tablet 0 0 0
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

46 Lidocain inj 2 % Ampul 0 0 0

47 Loperamid 2 mg Tablet 196 500 696 20 676
48 Meloxicam 15 mg Tablet 0 0 0
49 Methisoprinol Tablet 0 0 0
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0
51 Metronidazol 500 mg Tablet 990 990 343 647
52 Mikonazol krim 2 % Tube 26 26 0 26
53 Multivitamin Dewasa Komb (Geriavita) Tablet 9 9 9 0
54 Multivitamin Syr Anak (Becefort syr) Botol 25 25 0 25
55 Natrium Bicarbonat 500 mg Tablet 0 0 0
56 Nistatin drop Botol 3 3 0 3
57 Oksitetrasiklin Salep Kulit Tube 0 0 0
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0
60 Piridoksin Tablet 0 0 0
61 Piroxicam 10 mg Tablet 755 755 755 0
62 Risperidon 2 mg Tablet 0 0 0
63 Salbutamol 4 mg Tablet 100 100 82 18
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0
65 Sefadroksil 500 mg Kapsul 0 0 0
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0
67 Sianocobalamin inj Ampul 100 100 0 100
68 Thiamin Inj Ampul 0 0 0
69 Thiamin 50 mg Tablet 3000 3000 0 3000
70 Thiamphenicol 500 mg Kapsul 0 0 0
71 Ventolin Nebule Vial 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
OBAT GIGI 0 0 0
72 Master Bond Botol 0 0 0
73 Orafil Plus Temporary Botol 0 0 0
74 Absorbent Paper Point Box 0 0 0
75 Root Canal Sealer Box 0 0 0
76 Zinc F+ Box 0 0 0
77 Antiseptic Liquid No. 2 Botol 0 0 0
78 Cresotin Paste Pot 0 0 0
79 Iodotin Paste Pot 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
BMHP 0 0 0
80 Alat Suntik 1 cc Pcs 100 100 15 85
81 Alat Suntik 3 cc Pcs 200 300 500 71 429 100
82 Alat Suntik 5 cc Pcs 0 0 0 100
83 Alat Suntik 10 cc Pcs 0 0 0
84 Alkohol 70 % 300 ml Botol 0 0 0
85 Alkohol 70 % 1000 ml Botol 0 0 0
86 Blood Lancet Pcs 300 300 0 300 100
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

87 Cavida Gel Tube 18 18 2 16

88 Desinfectan Spray ( Baymed ) 750 ml Botol 11 11 1 10
89 Etil Klorida Semprot Botol 0 0 0
90 Fresco Hand Rub 500 ml Botol 0 0 0
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 5 5 0 5
92 Hand Scrub 4 % 500 ml ( Baymed ) 5 5 0 5
93 High Elastic Bandage Roll 8 8 0 8
94 HCG Strip Strip 0 0 0
95 Infusion Set Anak Pcs 100 50 150 0 150
96 I.V. Insert 6 x 7 Pcs 100 100 0 100
97 Jelco No.18 G I.V Catheter Pcs 150 150 100 50 100
98 Jelco No.20 G I.V Catheter Pcs 0 0 0
99 Jelco No.22 G I.V Catheter Pcs 200 200 62 138
100 Jelco No.24 G I.V Catheter Pcs 222 222 101 121 100
101 Jelco No.26 G I.V Catheter Pcs 0 0 0 100
102 Kapas 100 gr Bungkus 12 12 0 12
103 Kapas 500 gr Bungkus 5 5 0 5
104 Kasa Hidrofil 16 cm x 16 cm Kotak 414 414 0 414
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0
106 Nasal Canula Neonate Pcs 30 30 0 30
107 Nasal Canula (Child, Adult ) Pcs 0 0 0
108 Nebulizer Mask Child Pcs 70 70 0 70
109 Nebulizer Mask Adult Pcs 40 40 0 40 10
110 Povidone Iodine 10% 60 ml Botol 25 25 0 25
111 Pot Dahak Pot 0 0 0
112 Pot Urine Pot 0 0 0
113 Rivanol 300 ml Botol 0 0 0
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0
115 Sarung Tangan Non steril Pcs 0 0 0
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0
118 Sarung Tangan Steril No. 7.0 Pair 200 200 110 90 50
119 Sarung Tangan Steril No. 7.5 Pair 100 100 0 100
120 Surgical Gloves Steril Gynecolog Pair 52 52 0 52
121 Surgical Gown ( Apron ) Pcs 0 0 0
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0
123 Underpad Pcs 30 30 0 30
Masker N95 10 10 0 10
0 0 0
0 0 0
0 0 0
0 0 0
OBAT LABORATORIUM 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0
127 Anti-D Duoclone Golongan Darah Vial 0 0 0
128 Antigen H Vial 0 0 0
129 Antigen H-A Vial 0 0 0
130 Antigen H-B Vial 0 0 0
131 Antigen H-C Vial 0 0 0
132 Antigen O-A Vial 0 0 0
133 Antigen O-B Vial 0 0 0
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

134 Antigen O-C Vial 0 0 0

135 Antigen O Vial 0 0 0
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0
137 Barium Clorida 10% 100 ml Botol 0 0 0
138 Barium Clorida 10% 500 ml Botol 0 0 0
139 Benedict 100mL Botol 0 0 0
140 EDTA 10% 100mL Botol 0 0 0
141 Ehrlich 100 ml Botol 0 0 0
142 Eosin 2% 100 ml Botol 0 0 0
143 HCl 0,1N 100mL Botol 0 0 0
144 Hemoglobin C 500mL Botol 0 0 0
145 Immersion Oil 50 ml Botol 0 0 0
146 KOH 10% 500 ml Botol 0 0 0
147 Na Citrate 3,13% 100ml Botol 0 0 0
148 Pewarna Giemsa 100 ml Botol 0 0 0
149 Pewarna MDT 3x500mL Botol 0 0 0
150 Rees Ecker 100 ml Botol 0 0 0
151 SM Sedimen 500mL Botol 0 0 0
152 Turk 500 ml Botol 0 0 0
153 Wright 100 ml Botol 0 0 0
154 SD Bioline HbSAg Kotak 0 0 0
155 SD Syphillis 3.0 Kotak 0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

dr Dewi Suryati HERAWATI A.Md.Farm

NIP.198101162009122001 NIP,197112291993032002
 LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) OTSUS
BULAN JANUARI 2023
PUSKESMAS : SUNGAI RAYA
Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
1 Acyclovir 200 mg Tablet 0 0 0 0 0
2 Acyclovir Cream Tube 33 0 33 2 1 3 30
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 0
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 0 36 0 36
syr)
5 Asam Folat Tablet 2950 0 2950 30 10 10 10 6 10 76 2874
6 Attapulgite 630 mg Tablet 0 0 0 0 0
7 Bedak Salisil 2% Serbuk Kotak 1 50 51 5 1 3 3 4 1 2 3 1 23 28
8 Betahistin Tablet 0 0 0 0 0
9 Betametason Tube 0 0 0 0 0
10 Bisacodil supp 5 mg Supp 6 0 6 0 6
11 Bisacodil supp 10 mg Supp 20 0 20 2 2 18
12 Bromhexin HCL Syrup Botol 0 0 0 0 0
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 0
14 Clobazam 10 mg Tablet 63 0 63 0 63
15 Curcuma Force Tablet 0 0 0 0 0
16 Dexamethason Tab 0,5 mg Tablet 5147 0 5147 93 65 17 4 153 49 30 34 20 20 120 20 133 20 104 73 12 78 203 23 30 1301 3846
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 0
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 13 0 13 0 13
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 0
20 Digoksin 0.25 mg Tablet 100 0 100 0 100
21 Diphenhidramin Inj Ampul 0 0 0 0 0
22 Erytromicin 500 mg Tablet 79 0 79 10 10 69
23 Furosemid 40 mg Tablet 133 0 133 0 133
24 Furosemid Inj 10 mg/ml Ampul 10 0 10 0 10
25 Gentamisin Salep Mata Tube 1 0 1 0 1
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 0
27 Griseofulvin Tablet 34 0 34 10 12 12 34 0
28 Hidroklorotiazid 25 mg Tablet 97 0 97 0 97
29 Ibuprofen Tab 200 mg Tablet 214 0 214 0 214
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 0
31 Isosorbid Dinitrat 5 mg Tablet 209 200 409 15 5 5 25 6 10 5 10 16 40 10 10 10 167 242
32 Kalium Diclofenac 50 mg Tablet 420 0 420 111 6 6 6 10 17 4 21 10 45 19 37 35 20 16 10 5 6 384 36
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 0
34 Kaptopril 25 mg Tablet 0 0 0 0 0
35 kalium Permanganat 5 gr Pot 25 0 25 2 4 1 1 1 1 2 1 2 3 2 20 5
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
36 Ketokonazole 2 % Tube 0 0 0 0 0
37 Klindamicin 150 mg Kapsul 72 0 72 0 72
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 0
39 Kloramphenicol Salep Mata 1 % Tube 0 24 24 0 24
40 Kloramphenicol tetes Mata 0.5% Botol 62 0 62 1 1 61
41 Kloramphenicol tetes telinga Botol 5 0 5 0 5
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 0
43 Klorpromazin 100 mg Tablet 21 0 21 0 21
44 Lansoprazole 30 mg Kapsul 0 0 0 0 0
45 Levofloxacin 500 mg Tablet 0 0 0 0 0
46 Lidocain inj 2 % Ampul 0 0 0 0 0
47 Loperamid 2 mg/bidium Tablet 196 500 696 10 10 20 676
48 Meloxicam 15 mg Tablet 0 0 0 0 0
49 Methisoprinol Tablet 0 0 0 0 0
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 0
51 Metronidazol 500 mg Tablet 990 0 990 10 30 10 20 100 10 10 10 10 20 16 20 22 20 5 30 343 647
52 Mikonazol krim 2 % Tube 26 0 26 0 26
53 Multivitamin Dewasa Komb (Geriavita) Tablet 9 0 9 9 9 0
54 Multivitamin Syr Anak (Becefort syr) Botol 25 0 25 0 25
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 0
56 Nistatin drop Botol 3 0 3 0 3
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 0
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0 0 0
60 Piridoksin Tablet 0 0 0 0 0
61 Piroxicam 10 mg Tablet 755 0 755 116 6 20 6 27 10 42 3 18 32 60 78 65 68 76 46 20 56 6 755 0
62 Risperidon 2 mg Tablet 0 0 0 0 0
63 Salbutamol 4 mg Tablet 100 0 100 10 10 20 10 6 10 6 10 82 18
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 0
65 Sefadroksil 500 mg Kapsul 0 0 0 0 0
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0
67 Sianocobalamin inj Ampul 0 100 100 0 100
68 Thiamin Inj Ampul 0 0 0 0 0
69 Thiamin 50 mg Tablet 3000 0 3000 0 3000
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 0
71 Ventolin Nebule Vial 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0
72 Master Bond Botol 0 0 0 0 0
73 Orafil Plus Temporary Botol 0 0 0 0 0
74 Absorbent Paper Point Box 0 0 0 0 0
75 Root Canal Sealer Box 0 0 0 0 0
76 Zinc F+ Box 0 0 0 0 0
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 0
78 Cresotin Paste Pot 0 0 0 0 0
79 Iodotin Paste Pot 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
BMHP 0 0 0 0 0
80 Alat Suntik 1 cc Pcs 100 0 100 15 15 85
81 Alat Suntik 3 cc Pcs 200 300 500 5 5 3 2 30 1 15 10 71 429
82 Alat Suntik 5 cc Pcs 0 0 0 0 0
83 Alat Suntik 10 cc Pcs 0 0 0 0 0
84 Alkohol 70 % 300 ml Botol 0 0 0 0 0
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 0
86 Blood Lancet Pcs 0 300 300 0 300
87 Cavida Gel Tube 18 0 18 2 2 16
88 Desinfectan Spray ( Baymed ) 750 ml Botol 11 0 11 1 1 10
89 Etil Klorida Semprot Botol 0 0 0 0 0
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 0
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 5 0 5 0 5
92 Hand Scrub 4 % 500 ml ( Baymed ) 0 5 5 0 5
93 High Elastic Bandage Roll 8 0 8 0 8
94 HCG Strip Strip 0 0 0 0 0
95 Infusion Set Anak Pcs 100 50 150 0 150
96 I.V. Insert 6 x 7 Pcs 100 0 100 0 100
97 Jelco No.18 G I.V Catheter Pcs 150 0 150 100 100 50
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 0
99 Jelco No.22 G I.V Catheter Pcs 200 0 200 50 2 10 62 138
100 Jelco No.24 G I.V Catheter Pcs 222 0 222 1 100 101 121
101 Jelco No.26 G I.V Catheter Pcs 0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
102 Kapas 100 gr Bungkus 0 12 12 0 12
103 Kapas 500 gr Bungkus 0 5 5 0 5
104 Kasa Hidrofil 16 cm x 16 cm Kotak 414 0 414 0 414
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 0
106 Nasal Canula Neonate Pcs 30 0 30 0 30
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 0
108 Nebulizer Mask Child Pcs 70 0 70 0 70
109 Nebulizer Mask Adult Pcs 40 0 40 0 40
110 Povidone Iodine 10% 60 ml Botol 25 0 25 0 25
111 Pot Dahak Pot 0 0 0 0 0
112 Pot Urine Pot 0 0 0 0 0
113 Rivanol 300 ml Botol 0 0 0 0 0
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 0
115 Sarung Tangan Non steril Pcs 0 0 0 0 0
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 0
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 0
118 Sarung Tangan Steril No. 7.0 Pair 200 0 200 50 10 50 110 90
119 Sarung Tangan Steril No. 7.5 Pair 100 0 100 0 100
120 Surgical Gloves Steril Gynecolog Pair 52 0 52 0 52
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 0
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 0
123 Underpad Pcs 30 0 30 0 30
Masker N95 10 0 10 0 10
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT LABORATORIUM 0 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 0
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 0
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 0
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 0
128 Antigen H Vial 0 0 0 0 0
129 Antigen H-A Vial 0 0 0 0 0
130 Antigen H-B Vial 0 0 0 0 0
131 Antigen H-C Vial 0 0 0 0 0
132 Antigen O-A Vial 0 0 0 0 0
133 Antigen O-B Vial 0 0 0 0 0
134 Antigen O-C Vial 0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
135 Antigen O Vial 0 0 0 0 0
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 0
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 0
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 0
139 Benedict 100mL Botol 0 0 0 0 0
140 EDTA 10% 100mL Botol 0 0 0 0 0
141 Ehrlich 100 ml Botol 0 0 0 0 0
142 Eosin 2% 100 ml Botol 0 0 0 0 0
143 HCl 0,1N 100mL Botol 0 0 0 0 0
144 Hemoglobin C 500mL Botol 0 0 0 0 0
145 Immersion Oil 50 ml Botol 0 0 0 0 0
146 KOH 10% 500 ml Botol 0 0 0 0 0
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 0
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 0
149 Pewarna MDT 3x500mL Botol 0 0 0 0 0
150 Rees Ecker 100 ml Botol 0 0 0 0 0
151 SM Sedimen 500mL Botol 0 0 0 0 0
152 Turk 500 ml Botol 0 0 0 0 0
153 Wright 100 ml Botol 0 0 0 0 0
154 SD Bioline HbSAg Kotak 0 0 0 0 0
155 SD Syphillis 3.0 Kotak 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

dr Dewi Suryati HERAWATI A.Md.Farm

Nip.197112291993032001
NIP.198101162009122001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT OTSUS
( LPLPO ) OTSUS

UPT PKM : SUNGAI RAYA BULAN : FEBRUARI

KECAMATAN : SUNGAI RAYA TAHUN : 2023

KABUPATEN : ACEH TIMUR

PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN

KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir 200 mg Tablet 0 0 0 0

2 Acyclovir Cream Tube 30 30 0 30
3 Ambroxol Tab 30 mg Tablet 0 0 0 0
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 36 0 36
syr)
5 Asam Folat Tablet 2874 2874 1780 1094
6 Attapulgite 630 mg Tablet 0 0 0 0
7 Bedak Salisil 2% Serbuk Kotak 28 50 78 14 64
8 Betahistin Tablet 0 0 0 0
9 Betametason Tube 0 0 0 0
10 Bisacodil supp 5 mg Supp 6 6 0 6
11 Bisacodil supp 10 mg Supp 18 18 0 18
12 Bromhexin HCL Syrup Botol 0 0 0 0
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0
14 Clobazam 10 mg Tablet 63 63 0 63
15 Curcuma Force Tablet 0 0 0 0
16 Dexamethason Tab 0,5 mg Tablet 3846 1000 4846 1703 3143
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 13 13 0 13
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0
20 Digoksin 0.25 mg Tablet 100 100 0 100
21 Diphenhidramin Inj Ampul 0 0 0 0
22 Erytromicin 500 mg Tablet 69 69 10 59
23 Furosemid 40 mg Tablet 133 133 10 123
24 Furosemid Inj 10 mg/ml Ampul 10 10 0 10
25 Gentamisin Salep Mata Tube 1 1 0 1
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0
27 Griseofulvin Tablet 0 0 0 0
28 Hidroklorotiazid 25 mg Tablet 97 50 147 50 97
29 Ibuprofen Tab 200 mg Tablet 214 214 0 214
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0
31 Isosorbid Dinitrat 5 mg Tablet 242 242 43 199
32 Kalium Diclofenac 50 mg Tablet 36 36 0 36
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0
34 Kaptopril 25 mg Tablet 0 0 0 0
35 kalium Permanganat 5 gr Pot 5 5 0 5
36 Ketokonazole 2 % Tube 0 50 50 0 50
37 Klindamicin 150 mg Kapsul 72 72 16 56
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0
39 Kloramphenicol Salep Mata 1 % Tube 24 48 72 12 60
40 Kloramphenicol tetes Mata 0.5% Botol 61 61 10 51
41 Kloramphenicol tetes telinga Botol 5 5 5 0
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0
43 Klorpromazin 100 mg Tablet 21 21 0 21
44 Lansoprazole 30 mg Kapsul 0 600 600 343 257
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

45 Levofloxacin 500 mg Tablet 0 0 0 0

46 Lidocain inj 2 % Ampul 0 0 0 0
47 Loperamid 2 mg Tablet 676 676 50 626
48 Meloxicam 15 mg Tablet 0 0 0 0
49 Methisoprinol Tablet 0 0 0 0
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0
51 Metronidazol 500 mg Tablet 647 647 647 0
52 Mikonazol krim 2 % Tube 26 26 26 0
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0
54 Multivitamin Syr Anak (Becefort syr) Botol 25 25 0 25
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0
56 Nistatin drop Botol 3 3 0 3
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0 0
60 Piridoksin Tablet 0 0 0 0
61 Piroxicam 10 mg Tablet 0 0 0 0
62 Risperidon 2 mg Tablet 0 0 0 0
63 Salbutamol 4 mg Tablet 18 18 18 0
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0
65 Sefadroksil 500 mg Kapsul 0 0 0 0
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0
67 Sianocobalamin inj Ampul 100 100 25 75
68 Thiamin Inj Ampul 0 0 0 0
69 Thiamin 50 mg Tablet 3000 3000 100 2900
70 Thiamphenicol 500 mg Kapsul 0 0 0 0
71 Ventolin Nebule Vial 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0 0 0
72 Master Bond Botol 0 0 0 0
73 Orafil Plus Temporary Botol 0 0 0 0
74 Absorbent Paper Point Box 0 0 0 0
75 Root Canal Sealer Box 0 0 0 0
76 Zinc F+ Box 0 0 0 0
77 Antiseptic Liquid No. 2 Botol 0 0 0 0
78 Cresotin Paste Pot 0 0 0 0
79 Iodotin Paste Pot 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BMHP 0 0 0 0
80 Alat Suntik 1 cc Pcs 85 85 6 79
81 Alat Suntik 3 cc Pcs 429 100 529 330 199
82 Alat Suntik 5 cc Pcs 0 100 100 100 0
83 Alat Suntik 10 cc Pcs 0 0 0 0
84 Alkohol 70 % 300 ml Botol 0 0 0 0
85 Alkohol 70 % 1000 ml Botol 0 0 0 0
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

86 Blood Lancet Pcs 300 100 400 200 200

87 Cavida Gel Tube 16 16 6 10
88 Desinfectan Spray ( Baymed ) 750 ml Botol 10 10 1 9
89 Etil Klorida Semprot Botol 0 0 0 0
90 Fresco Hand Rub 500 ml Botol 0 0 0 0
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 5 5 5 0
92 Hand Scrub 4 % 500 ml ( Baymed ) 5 5 5 0
93 High Elastic Bandage Roll 8 8 0 8
94 HCG Strip Strip 0 0 0 0
95 Infusion Set Anak Pcs 150 150 0 150
96 I.V. Insert 6 x 7 Pcs 100 100 0 100
97 Jelco No.18 G I.V Catheter Pcs 50 100 150 0 150
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0
99 Jelco No.22 G I.V Catheter Pcs 138 138 9 129
100 Jelco No.24 G I.V Catheter Pcs 121 100 221 2 219
101 Jelco No.26 G I.V Catheter Pcs 0 100 100 0 100
102 Kapas 100 gr Bungkus 12 12 12 0
103 Kapas 500 gr Bungkus 5 5 0 5
104 Kasa Hidrofil 16 cm x 16 cm Kotak 414 414 0 414
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0
106 Nasal Canula Neonate Pcs 30 30 0 30
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0
108 Nebulizer Mask Child Pcs 70 70 0 70
109 Nebulizer Mask Adult Pcs 40 10 50 0 50
110 Povidone Iodine 10% 60 ml Botol 25 25 10 15
111 Pot Dahak Pot 0 0 0 0
112 Pot Urine Pot 0 0 0 0
113 Rivanol 300 ml Botol 0 0 0 0
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0
115 Sarung Tangan Non steril Pcs 0 0 0 0
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0
118 Sarung Tangan Steril No. 7.0 Pair 90 50 140 140 0
119 Sarung Tangan Steril No. 7.5 Pair 100 100 0 100
120 Surgical Gloves Steril Gynecolog Pair 52 52 0 52
121 Surgical Gown ( Apron ) Pcs 0 0 0 0
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0
123 Underpad Pcs 30 30 0 30
Masker N95 10 10 0 10
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT LABORATORIUM 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0
128 Antigen H Vial 0 0 0 0
129 Antigen H-A Vial 0 0 0 0
130 Antigen H-B Vial 0 0 0 0
131 Antigen H-C Vial 0 0 0 0
132 Antigen O-A Vial 0 0 0 0
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

133 Antigen O-B Vial 0 0 0 0

134 Antigen O-C Vial 0 0 0 0
135 Antigen O Vial 0 0 0 0
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0
137 Barium Clorida 10% 100 ml Botol 0 0 0 0
138 Barium Clorida 10% 500 ml Botol 0 0 0 0
139 Benedict 100mL Botol 0 0 0 0
140 EDTA 10% 100mL Botol 0 0 0 0
141 Ehrlich 100 ml Botol 0 0 0 0
142 Eosin 2% 100 ml Botol 0 0 0 0
143 HCl 0,1N 100mL Botol 0 0 0 0
144 Hemoglobin C 500mL Botol 0 0 0 0
145 Immersion Oil 50 ml Botol 0 0 0 0
146 KOH 10% 500 ml Botol 0 0 0 0
147 Na Citrate 3,13% 100ml Botol 0 0 0 0
148 Pewarna Giemsa 100 ml Botol 0 0 0 0
149 Pewarna MDT 3x500mL Botol 0 0 0 0
150 Rees Ecker 100 ml Botol 0 0 0 0
151 SM Sedimen 500mL Botol 0 0 0 0
152 Turk 500 ml Botol 0 0 0 0
153 Wright 100 ml Botol 0 0 0 0
154 SD Bioline HbSAg Kotak 0 0 0 0
155 SD Syphillis 3.0 Kotak 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat

dr Dewi Suryati Herawati Amd Farm

NIP.198101162009122001 NIP.197112291993032002
 LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) OTSUS
BULAN FEBRUARI 2023
PUSKESMAS : SUNGAI RAYA
Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
1 Acyclovir 200 mg Tablet 0 0 0 0 0
2 Acyclovir Cream Tube 30 0 30 0 30
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 0
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 0 36 0 36
syr)
5 Asam Folat Tablet 2874 0 2874 300 10 20 10 1010 300 30 100 1780 1094
6 Attapulgite 630 mg Tablet 0 0 0 0 0
7 Bedak Salisil 2% Serbuk Kotak 28 50 78 1 1 1 2 3 1 3 1 1 14 64
8 Betahistin Tablet 0 0 0 0 0
9 Betametason Tube 0 0 0 0 0
10 Bisacodil supp 5 mg Supp 6 0 6 0 6
11 Bisacodil supp 10 mg Supp 18 0 18 0 18
12 Bromhexin HCL Syrup Botol 0 0 0 0 0
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 0
14 Clobazam 10 mg Tablet 63 0 63 0 63
15 Curcuma Force Tablet 0 0 0 0 0
16 Dexamethason Tab 0,5 mg Tablet 3846 1000 4846 139 30 39 60 86 16 66 6 200 58 405 67 80 107 14 140 30 39 25 96 1703 3143
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 0
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 13 0 13 0 13
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 0
20 Digoksin 0.25 mg Tablet 100 0 100 0 100
21 Diphenhidramin Inj Ampul 0 0 0 0 0
22 Erytromicin 500 mg Tablet 69 0 69 10 10 59
23 Furosemid 40 mg Tablet 133 0 133 10 10 123
24 Furosemid Inj 10 mg/ml Ampul 10 0 10 0 10
25 Gentamisin Salep Mata Tube 1 0 1 0 1
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 0
27 Griseofulvin Tablet 0 0 0 0 0
28 Hidroklorotiazid 25 mg Tablet 97 100 147 50 50 97
29 Ibuprofen Tab 200 mg Tablet 214 0 214 0 214
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 0
31 Isosorbid Dinitrat 5 mg Tablet 242 0 242 13 20 10 43 199
32 Kalium Diclofenac 50 mg Tablet 36 0 36 0 36
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
34 Kaptopril 25 mg Tablet 0 0 0 0 0
35 kalium Permanganat 5 gr Pot 5 0 5 0 5
36 Ketokonazole 2 % Tube 0 50 50 0 50
37 Klindamicin 150 mg Kapsul 72 0 72 16 16 56
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 0
39 Kloramphenicol Salep Mata 1 % Tube 24 48 72 1 3 3 2 2 1 12 60
40 Kloramphenicol tetes Mata 0.5% Botol 61 0 61 10 10 51
41 Kloramphenicol tetes telinga Botol 5 0 5 1 3 1 5 0
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 0
43 Klorpromazin 100 mg Tablet 21 0 21 0 21
44 Lansoprazole 30 mg Kapsul 0 600 600 10 10 22 16 20 10 10 23 30 32 30 66 20 44 343 257
45 Levofloxacin 500 mg Tablet 0 0 0 0 0
46 Lidocain inj 2 % Ampul 0 0 0 0 0
47 Loperamid 2 mg Tablet 676 0 676 50 50 626
48 Meloxicam 15 mg Tablet 0 0 0 0 0
49 Methisoprinol Tablet 0 0 0 0 0
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 0
51 Metronidazol 500 mg Tablet 647 0 647 10 20 20 10 40 10 10 3 20 200 244 30 10 10 10 647 0
52 Mikonazol krim 2 % Tube 26 0 26 1 1 2 2 20 26 0
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 0
54 Multivitamin Syr Anak (Becefort syr) Botol 25 0 25 0 25
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 0
56 Nistatin drop Botol 3 0 3 0 3
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 0
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0 0 0
60 Piridoksin Tablet 0 0 0 0 0
61 Piroxicam 10 mg Tablet 0 0 0 0 0
62 Risperidon 2 mg Tablet 0 0 0 0 0
63 Salbutamol 4 mg Tablet 18 0 18 6 12 18 0
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 0
65 Sefadroksil 500 mg Kapsul 0 0 0 0 0
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0
67 Sianocobalamin inj Ampul 100 0 100 2 10 3 10 25 75
68 Thiamin Inj Ampul 0 0 0 0 0
69 Thiamin 50 mg Tablet 3000 0 3000 100 100 2900
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 0
71 Ventolin Nebule Vial 0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0
72 Master Bond Botol 0 0 0 0 0
73 Orafil Plus Temporary Botol 0 0 0 0 0
74 Absorbent Paper Point Box 0 0 0 0 0
75 Root Canal Sealer Box 0 0 0 0 0
76 Zinc F+ Box 0 0 0 0 0
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 0
78 Cresotin Paste Pot 0 0 0 0 0
79 Iodotin Paste Pot 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
BMHP 0 0 0 0 0
80 Alat Suntik 1 cc Pcs 85 0 85 5 1 6 79
81 Alat Suntik 3 cc Pcs 429 100 529 10 20 300 330 199
82 Alat Suntik 5 cc Pcs 0 100 100 100 100 0
83 Alat Suntik 10 cc Pcs 0 0 0 0 0
84 Alkohol 70 % 300 ml Botol 0 0 0 0 0
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 0
86 Blood Lancet Pcs 300 100 400 200 200 200
87 Cavida Gel Tube 16 0 16 1 1 3 1 6 10
88 Desinfectan Spray ( Baymed ) 750 ml Botol 10 0 10 1 1 9
89 Etil Klorida Semprot Botol 0 0 0 0 0
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 0
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 5 0 5 2 1 2 5 0
92 Hand Scrub 4 % 500 ml ( Baymed ) 5 0 5 1 1 1 1 1 5 0
93 High Elastic Bandage Roll 8 0 8 0 8
94 HCG Strip Strip 0 0 0 0 0
95 Infusion Set Anak Pcs 150 0 150 0 150
96 I.V. Insert 6 x 7 Pcs 100 0 100 0 100
97 Jelco No.18 G I.V Catheter Pcs 50 100 150 0 150
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 0
99 Jelco No.22 G I.V Catheter Pcs 138 0 138 5 4 9 129
100 Jelco No.24 G I.V Catheter Pcs 121 100 221 1 1 2 219
101 Jelco No.26 G I.V Catheter Pcs 0 100 100 0 100
102 Kapas 100 gr Bungkus 12 0 12 1 1 1 3 1 2 1 1 1 12 0
103 Kapas 500 gr Bungkus 5 0 5 0 5
104 Kasa Hidrofil 16 cm x 16 cm Kotak 414 0 414 0 414
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 0
106 Nasal Canula Neonate Pcs 30 0 30 0 30
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 0
108 Nebulizer Mask Child Pcs 70 0 70 0 70
109 Nebulizer Mask Adult Pcs 40 10 50 0 50
110 Povidone Iodine 10% 60 ml (BETADIN) Botol 25 0 25 6 3 1 10 15
111 Pot Dahak Pot 0 0 0 0 0
112 Pot Urine Pot 0 0 0 0 0
113 Rivanol 300 ml Botol 0 0 0 0 0
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 0
115 Sarung Tangan Non steril Pcs 0 0 0 0 0
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 0
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 0
118 Sarung Tangan Steril No. 7.0 Pair 90 50 140 50 90 140 0
119 Sarung Tangan Steril No. 7.5 Pair 100 0 100 0 100
120 Surgical Gloves Steril Gynecolog Pair 52 0 52 0 52
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 0
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 0
123 Underpad Pcs 30 0 30 0 30
Masker N95 10 0 10 0 10
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT LABORATORIUM 0 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 0
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 0
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 0
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 0
128 Antigen H Vial 0 0 0 0 0
129 Antigen H-A Vial 0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
130 Antigen H-B Vial 0 0 0 0 0
131 Antigen H-C Vial 0 0 0 0 0
132 Antigen O-A Vial 0 0 0 0 0
133 Antigen O-B Vial 0 0 0 0 0
134 Antigen O-C Vial 0 0 0 0 0
135 Antigen O Vial 0 0 0 0 0
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 0
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 0
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 0
139 Benedict 100mL Botol 0 0 0 0 0
140 EDTA 10% 100mL Botol 0 0 0 0 0
141 Ehrlich 100 ml Botol 0 0 0 0 0
142 Eosin 2% 100 ml Botol 0 0 0 0 0
143 HCl 0,1N 100mL Botol 0 0 0 0 0
144 Hemoglobin C 500mL Botol 0 0 0 0 0
145 Immersion Oil 50 ml Botol 0 0 0 0 0
146 KOH 10% 500 ml Botol 0 0 0 0 0
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 0
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 0
149 Pewarna MDT 3x500mL Botol 0 0 0 0 0
150 Rees Ecker 100 ml Botol 0 0 0 0 0
151 SM Sedimen 500mL Botol 0 0 0 0 0
152 Turk 500 ml Botol 0 0 0 0 0
153 Wright 100 ml Botol 0 0 0 0 0
154 SD Bioline HbSAg Kotak 0 0 0 0 0
155 SD Syphillis 3.0 Kotak 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

dr Dewi Suryati HERAWATI A.Md.Farm

 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
Nip.197112291993032001
NIP.198101162009122001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT OTSUS
( LPLPO ) OTSUS

UPT PKM : SUNGAI RAYA BULAN : MARET

KECAMATAN : SUNGAI RAYA TAHUN : 2023

KABUPATEN : ACEH TIMUR

PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN

KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir 200 mg Tablet 0 0 0 0

2 Acyclovir Cream Tube 30 30 0 30
3 Ambroxol Tab 30 mg Tablet 0 0 0 0
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 36 0 36
syr)
5 Asam Folat Tablet 1094 1094 1094 0
6 Attapulgite 630 mg Tablet 0 0 0 0
7 Bedak Salisil 2% Serbuk Kotak 64 30 94 39 55
8 Betahistin Tablet 0 0 0 0
9 Betametason Tube 0 0 0 0
10 Bisacodil supp 5 mg Supp 6 6 0 6
11 Bisacodil supp 10 mg Supp 18 18 0 18
12 Bromhexin HCL Syrup Botol 0 0 0 0
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0
14 Clobazam 10 mg Tablet 63 63 60 3
15 Curcuma Force Tablet 0 0 0 0
16 Dexamethason Tab 0,5 mg Tablet 3143 1000 4143 1020 3123
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 13 13 3 10
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0
20 Digoksin 0.25 mg Tablet 100 100 0 100
21 Diphenhidramin Inj Ampul 0 0 0 0
22 Erytromicin 500 mg Tablet 59 59 40 19
23 Furosemid 40 mg Tablet 123 123 0 123
24 Furosemid Inj 10 mg/ml Ampul 10 10 0 10
25 Gentamisin Salep Mata Tube 1 1 0 1
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0
27 Griseofulvin Tablet 0 0 0 0
28 Hidroklorotiazid 25 mg Tablet 97 97 13 84
29 Ibuprofen Tab 200 mg Tablet 214 214 210 4
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0
31 Isosorbid Dinitrat 5 mg Tablet 199 199 93 106
32 Kalium Diclofenac 50 mg Tablet 36 36 0 36
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0
34 Kaptopril 25 mg Tablet 0 0 0 0
35 kalium Permanganat 5 gr Pot 5 5 2 3
36 Ketokonazole 2 % Tube 50 25 75 0 75
37 Klindamicin 150 mg Kapsul 56 56 40 16
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0
39 Kloramphenicol Salep Mata 1 % Tube 60 24 84 28 56
40 Kloramphenicol tetes Mata 0.5% Botol 51 51 1 50
41 Kloramphenicol tetes telinga Botol 0 0 0 0
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0
43 Klorpromazin 100 mg Tablet 21 21 21 0
44 Lansoprazole 30 mg Kapsul 257 500 757 309 448
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

45 Levofloxacin 500 mg Tablet 0 0 0 0

46 Lidocain inj 2 % Ampul 0 0 0 0
47 Loperamid 2 mg Tablet 626 626 10 616
48 Meloxicam 15 mg Tablet 0 0 0 0
49 Methisoprinol Tablet 0 0 0 0
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0
51 Metronidazol 500 mg Tablet 0 500 500 256 244
52 Mikonazol krim 2 % Tube 0 0 0 0
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0
54 Multivitamin Syr Anak (Becefort syr) Botol 25 25 25 0
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0
56 Nistatin drop Botol 3 3 2 1
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0 0
60 Piridoksin Tablet 0 0 0 0
61 Piroxicam 10 mg Tablet 0 0 0 0
62 Risperidon 2 mg Tablet 0 0 0 0
63 Salbutamol 4 mg Tablet 0 0 0 0
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0
65 Sefadroksil 500 mg Kapsul 0 0 0 0
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0
67 Sianocobalamin inj Ampul 75 75 0 75
68 Thiamin Inj Ampul 0 0 0 0
69 Thiamin 50 mg Tablet 2900 1000 3900 1546 2354
70 Thiamphenicol 500 mg Kapsul 0 0 0 0
71 Ventolin Nebule Vial 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0 0 0
72 Master Bond Botol 0 0 0 0
73 Orafil Plus Temporary Botol 0 0 0 0
74 Absorbent Paper Point Box 0 0 0 0
75 Root Canal Sealer Box 0 0 0 0
76 Zinc F+ Box 0 0 0 0
77 Antiseptic Liquid No. 2 Botol 0 0 0 0
78 Cresotin Paste Pot 0 0 0 0
79 Iodotin Paste Pot 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BMHP 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 79 0 79
81 Alat Suntik 3 cc Pcs 199 100 299 12 287
82 Alat Suntik 5 cc Pcs 0 0 0 0
83 Alat Suntik 10 cc Pcs 0 0 0 0
84 Alkohol 70 % 300 ml Botol 0 0 0 0
85 Alkohol 70 % 1000 ml Botol 0 0 0 0
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

86 Blood Lancet Pcs 200 200 400 300 100

87 Cavida Gel Tube 10 10 0 10
88 Desinfectan Spray ( Baymed ) 750 ml Botol 9 9 2 7
89 Etil Klorida Semprot Botol 0 0 0 0
90 Fresco Hand Rub 500 ml Botol 0 0 0 0
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0
92 Hand Scrub 4 % 500 ml ( Baymed ) 0 0 0 0
93 High Elastic Bandage Roll 8 8 0 8
94 HCG Strip Strip 0 0 0 0
95 Infusion Set Anak Pcs 150 150 6 144
96 I.V. Insert 6 x 7 Pcs 100 100 0 100
97 Jelco No.18 G I.V Catheter Pcs 150 100 250 10 240
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0
99 Jelco No.22 G I.V Catheter Pcs 129 100 229 0 229
100 Jelco No.24 G I.V Catheter Pcs 219 219 8 211
101 Jelco No.26 G I.V Catheter Pcs 100 100 0 100
102 Kapas 100 gr Bungkus 0 0 0 0
103 Kapas 500 gr Bungkus 5 5 5 0
104 Kasa Hidrofil 16 cm x 16 cm Kotak 414 414 10 404
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0
106 Nasal Canula Neonate Pcs 30 30 0 30
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0
108 Nebulizer Mask Child Pcs 70 70 7 63
109 Nebulizer Mask Adult Pcs 50 50 7 43
110 Povidone Iodine 10% 60 ml Botol 15 15 1 14
111 Pot Dahak Pot 0 0 0 0
112 Pot Urine Pot 0 0 0 0
113 Rivanol 300 ml Botol 0 0 0 0
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0
115 Sarung Tangan Non steril Pcs 0 0 0 0
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0
118 Sarung Tangan Steril No. 7.0 Pair 0 100 100 0 100
119 Sarung Tangan Steril No. 7.5 Pair 100 100 0 100
120 Surgical Gloves Steril Gynecolog Pair 52 52 0 52
121 Surgical Gown ( Apron ) Pcs 0 0 0 0
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0
123 Underpad Pcs 30 30 0 30
10 10 0 10
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT LABORATORIUM 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0
128 Antigen H Vial 0 0 0 0
129 Antigen H-A Vial 0 0 0 0
130 Antigen H-B Vial 0 0 0 0
131 Antigen H-C Vial 0 0 0 0
132 Antigen O-A Vial 0 0 0 0
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

133 Antigen O-B Vial 0 0 0 0

134 Antigen O-C Vial 0 0 0 0
135 Antigen O Vial 0 0 0 0
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0
137 Barium Clorida 10% 100 ml Botol 0 0 0 0
138 Barium Clorida 10% 500 ml Botol 0 0 0 0
139 Benedict 100mL Botol 0 0 0 0
140 EDTA 10% 100mL Botol 0 0 0 0
141 Ehrlich 100 ml Botol 0 0 0 0
142 Eosin 2% 100 ml Botol 0 0 0 0
143 HCl 0,1N 100mL Botol 0 0 0 0
144 Hemoglobin C 500mL Botol 0 0 0 0
145 Immersion Oil 50 ml Botol 0 0 0 0
146 KOH 10% 500 ml Botol 0 0 0 0
147 Na Citrate 3,13% 100ml Botol 0 0 0 0
148 Pewarna Giemsa 100 ml Botol 0 0 0 0
149 Pewarna MDT 3x500mL Botol 0 0 0 0
150 Rees Ecker 100 ml Botol 0 0 0 0
151 SM Sedimen 500mL Botol 0 0 0 0
152 Turk 500 ml Botol 0 0 0 0
153 Wright 100 ml Botol 0 0 0 0
154 SD Bioline HbSAg Kotak 0 0 0 0
155 SD Syphillis 3.0 Kotak 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

dr Dewi Suryati Herawati Amd Farm

NIP.198101162009122001 NIP.197112291993032002
 LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) OTSUS
BULAN MARET 2023
PUSKESMAS : SUNGAI RAYA
Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
1 Acyclovir 200 mg Tablet 0 0 0 0 0
2 Acyclovir Cream Tube 30 0 30 0 30
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 0
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 0 36 0 36
syr)
5 Asam Folat Tablet 1094 0 1094 10 20 300 10 300 300 154 1094 0
6 Attapulgite 630 mg Tablet 0 0 0 0 0
7 Bedak Salisil 2% Serbuk Kotak 64 30 94 2 3 3 1 2 15 1 10 1 1 39 55
8 Betahistin Tablet 0 0 0 0 0
9 Betametason Tube 0 0 0 0 0
10 Bisacodil supp 5 mg Supp 6 0 6 0 6
11 Bisacodil supp 10 mg Supp 18 0 18 0 18
12 Bromhexin HCL Syrup Botol 0 0 0 0 0
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 0
14 Clobazam 10 mg Tablet 63 0 63 20 20 20 60 3
15 Curcuma Force Tablet 0 0 0 0 0
16 Dexamethason Tab 0,5 mg Tablet 3143 1000 4143 30 60 58 54 10 22 30 26 21 6 204 30 40 46 66 200 31 44 42 1020 3123
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 0
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 13 0 13 3 3 10
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 0
20 Digoksin 0.25 mg Tablet 100 0 100 0 100
21 Diphenhidramin Inj Ampul 0 0 0 0 0
22 Erytromicin 500 mg Tablet 59 0 59 10 20 10 40 19
23 Furosemid 40 mg Tablet 123 0 123 0 123
24 Furosemid Inj 10 mg/ml Ampul 10 0 10 0 10
25 Gentamisin Salep Mata Tube 1 0 1 0 1
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 0
27 Griseofulvin Tablet 0 0 0 0 0
28 Hidroklorotiazid 25 mg Tablet 97 0 97 3 10 13 84
29 Ibuprofen Tab 200 mg Tablet 214 0 214 20 190 210 4
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 0
31 Isosorbid Dinitrat 5 mg Tablet 199 0 199 10 29 20 12 10 12 93 106
32 Kalium Diclofenac 50 mg Tablet 36 0 36 0 36
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 0
34 Kaptopril 25 mg Tablet 0 0 0 0 0
35 kalium Permanganat 5 gr Pot 5 0 5 1 1 2 3
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
36 Ketokonazole 2 % Tube 50 25 75 0 75
37 Klindamicin 150 mg Kapsul 56 0 56 10 10 20 40 16
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 0
39 Kloramphenicol Salep Mata 1 % Tube 60 24 84 1 1 10 15 1 28 56
40 Kloramphenicol tetes Mata 0.5% Botol 51 0 51 1 1 50
41 Kloramphenicol tetes telinga Botol 0 0 0 0 0
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 0
43 Klorpromazin 100 mg Tablet 21 0 21 21 21 0
44 Lansoprazole 30 mg Kapsul 257 500 757 6 20 16 37 55 4 49 22 70 30 309 448
45 Levofloxacin 500 mg Tablet 0 0 0 0 0
46 Lidocain inj 2 % Ampul 0 0 0 0 0
47 Loperamid 2 mg Tablet 626 0 626 10 10 616
48 Meloxicam 15 mg Tablet 0 0 0 0 0
49 Methisoprinol Tablet 0 0 0 0 0
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 0
51 Metronidazol 500 mg Tablet 0 500 500 7 10 20 6 3 100 10 100 256 244
52 Mikonazol krim 2 % Tube 0 0 0 0 0
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 0
54 Multivitamin Syr Anak (Becefort syr) Botol 25 0 25 3 6 3 5 8 25 0
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 0
56 Nistatin drop Botol 3 0 3 1 1 2 1
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 0
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0 0 0
60 Piridoksin Tablet 0 0 0 0 0
61 Piroxicam 10 mg Tablet 0 0 0 0 0
62 Risperidon 2 mg Tablet 0 0 0 0 0
63 Salbutamol 4 mg Tablet 0 0 0 0 0
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 0
65 Sefadroksil 500 mg Kapsul 0 0 0 0 0
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0
67 Sianocobalamin inj Ampul 75 0 75 0 75
68 Thiamin Inj Ampul 0 0 0 0 0
69 Thiamin 50 mg Tablet 2900 1000 3900 40 5 70 70 156 35 20 66 101 5 282 22 61 18 120 310 145 20 1546 2354
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 0
71 Ventolin Nebule Vial 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0
72 Master Bond Botol 0 0 0 0 0
73 Orafil Plus Temporary Botol 0 0 0 0 0
74 Absorbent Paper Point Box 0 0 0 0 0
75 Root Canal Sealer Box 0 0 0 0 0
76 Zinc F+ Box 0 0 0 0 0
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 0
78 Cresotin Paste Pot 0 0 0 0 0
79 Iodotin Paste Pot 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
BMHP 0 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 0 79 0 79
81 Alat Suntik 3 cc Pcs 199 100 299 10 2 12 287
82 Alat Suntik 5 cc Pcs 0 0 0 0 0
83 Alat Suntik 10 cc Pcs 0 0 0 0 0
84 Alkohol 70 % 300 ml Botol 0 0 0 0 0
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 0
86 Blood Lancet Pcs 200 200 400 100 200 300 100
87 Cavida Gel Tube 10 0 10 0 10
88 Desinfectan Spray ( Baymed ) 750 ml Botol 9 0 9 2 2 7
89 Etil Klorida Semprot Botol 0 0 0 0 0
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 0
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 0
92 Hand Scrub 4 % 500 ml ( Baymed ) 0 0 0 0 0
93 High Elastic Bandage Roll 8 0 8 0 8
94 HCG Strip Strip 0 0 0 0 0
95 Infusion Set Anak Pcs 150 0 150 6 6 144
96 I.V. Insert 6 x 7 Pcs 100 0 100 0 100
97 Jelco No.18 G I.V Catheter Pcs 150 100 250 10 10 240
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 0
99 Jelco No.22 G I.V Catheter Pcs 129 100 229 0 229
100 Jelco No.24 G I.V Catheter Pcs 219 0 219 1 1 2 1 2 1 8 211
101 Jelco No.26 G I.V Catheter Pcs 100 0 100 0 100
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
102 Kapas 100 gr Bungkus 0 0 0 0 0
103 Kapas 500 gr Bungkus 5 0 5 1 2 2 5 0
104 Kasa Hidrofil 16 cm x 16 cm Kotak 414 0 414 10 10 404
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 0
106 Nasal Canula Neonate Pcs 30 0 30 0 30
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 0
108 Nebulizer Mask Child Pcs 70 0 70 7 7 63
109 Nebulizer Mask Adult Pcs 50 0 50 7 7 43
110 Povidone Iodine 10% 60 ml Botol 15 0 15 1 1 14
111 Pot Dahak Pot 0 0 0 0 0
112 Pot Urine Pot 0 0 0 0 0
113 Rivanol 300 ml Botol 0 0 0 0 0
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 0
115 Sarung Tangan Non steril Pcs 0 0 0 0 0
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 0
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 0
118 Sarung Tangan Steril No. 7.0 Pair 0 100 100 0 100
119 Sarung Tangan Steril No. 7.5 Pair 100 0 100 0 100
120 Surgical Gloves Steril Gynecolog Pair 52 0 52 0 52
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 0
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 0
123 Underpad Pcs 30 0 30 0 30
Masker N95 10 0 10 0 10
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT LABORATORIUM 0 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 0
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 0
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 0
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 0
128 Antigen H Vial 0 0 0 0 0
129 Antigen H-A Vial 0 0 0 0 0
130 Antigen H-B Vial 0 0 0 0 0
131 Antigen H-C Vial 0 0 0 0 0
132 Antigen O-A Vial 0 0 0 0 0
133 Antigen O-B Vial 0 0 0 0 0
134 Antigen O-C Vial 0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
135 Antigen O Vial 0 0 0 0 0
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 0
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 0
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 0
139 Benedict 100mL Botol 0 0 0 0 0
140 EDTA 10% 100mL Botol 0 0 0 0 0
141 Ehrlich 100 ml Botol 0 0 0 0 0
142 Eosin 2% 100 ml Botol 0 0 0 0 0
143 HCl 0,1N 100mL Botol 0 0 0 0 0
144 Hemoglobin C 500mL Botol 0 0 0 0 0
145 Immersion Oil 50 ml Botol 0 0 0 0 0
146 KOH 10% 500 ml Botol 0 0 0 0 0
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 0
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 0
149 Pewarna MDT 3x500mL Botol 0 0 0 0 0
150 Rees Ecker 100 ml Botol 0 0 0 0 0
151 SM Sedimen 500mL Botol 0 0 0 0 0
152 Turk 500 ml Botol 0 0 0 0 0
153 Wright 100 ml Botol 0 0 0 0 0
154 SD Bioline HbSAg Kotak 0 0 0 0 0
155 SD Syphillis 3.0 Kotak 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

dr Dewi Suryati HERAWATI A.Md.Farm

Nip.197112291993032001
NIP.198101162009122001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT OTSUS
( LPLPO ) OTSUS

UPT PKM : SUNGAI RAYA BULAN : APRIL

KECAMATAN : SUNGAI RAYA TAHUN : 2023

KABUPATEN : ACEH TIMUR

PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN

KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir 200 mg Tablet 0 0 0 0 tlg diisi

2 Acyclovir Cream Tube 30 30 0 30 tlg diisi
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 tlg diisi
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 36 0 36 tlg diisi
syr)
5 Asam Folat Tablet 0 0 0 0 tlg diisi
6 Attapulgite 630 mg Tablet 0 0 0 0 tlg diisi
7 Bedak Salisil 2% Serbuk Kotak 55 55 41 14 tlg diisi
8 Betahistin Tablet 0 0 0 0 tlg diisi
9 Betametason Tube 0 0 0 0 tlg diisi
10 Bisacodil supp 5 mg Supp 6 6 0 6 tlg diisi
11 Bisacodil supp 10 mg Supp 18 18 0 18 tlg diisi
12 Bromhexin HCL Syrup Botol 0 0 0 0 tlg diisi
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 tlg diisi
14 Clobazam 10 mg Tablet 3 3 0 3 tlg diisi
15 Curcuma Force Tablet 0 360 360 265 95 tlg diisi
16 Dexamethason Tab 0,5 mg Tablet 3123 2000 5123 1171 3952 tlg diisi
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 tlg diisi
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 10 10 5 5 tlg diisi
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 tlg diisi
20 Digoksin 0.25 mg Tablet 100 100 0 100 tlg diisi
21 Diphenhidramin Inj Ampul 0 0 0 0 tlg diisi
22 Erytromicin 500 mg Tablet 19 19 0 19 tlg diisi
23 Furosemid 40 mg Tablet 123 123 0 123 tlg diisi
24 Furosemid Inj 10 mg/ml Ampul 10 10 0 10 tlg diisi
25 Gentamisin Salep Mata Tube 1 1 0 1 tlg diisi
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 tlg diisi
27 Griseofulvin Tablet 0 0 0 0 tlg diisi
28 Hidroklorotiazid 25 mg Tablet 84 84 83 1 tlg diisi
29 Ibuprofen Tab 200 mg Tablet 4 4 0 4 tlg diisi
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 tlg diisi
31 Isosorbid Dinitrat 5 mg Tablet 106 300 406 105 301 tlg diisi
32 Kalium Diclofenac 50 mg Tablet 36 36 0 36 tlg diisi
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 tlg diisi
34 Kaptopril 25 mg Tablet 0 0 0 0 tlg diisi
35 kalium Permanganat 5 gr Pot 3 3 0 3 tlg diisi
36 Ketokonazole 2 % Tube 75 75 0 75 tlg diisi
37 Klindamicin 150 mg Kapsul 16 16 0 16 tlg diisi
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 tlg diisi
39 Kloramphenicol Salep Mata 1 % Tube 56 56 28 28 tlg diisi
40 Kloramphenicol tetes Mata 0.5% Botol 50 50 10 40 tlg diisi
41 Kloramphenicol tetes telinga Botol 0 0 0 0 tlg diisi
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 tlg diisi
43 Klorpromazin 100 mg Tablet 0 0 0 0 tlg diisi
44 Lansoprazole 30 mg Kapsul 448 500 948 792 156 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

45 Levofloxacin 500 mg Tablet 0 0 0 0 tlg diisi

46 Lidocain inj 2 % Ampul 0 0 0 0 tlg diisi
47 Loperamid 2 mg Tablet 616 616 10 606 tlg diisi
48 Meloxicam 15 mg Tablet 0 0 0 0 tlg diisi
49 Methisoprinol Tablet 0 0 0 0 tlg diisi
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 tlg diisi
51 Metronidazol 500 mg Tablet 244 1000 1244 169 1075 tlg diisi
52 Mikonazol krim 2 % Tube 0 0 0 0 tlg diisi
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 tlg diisi
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 0 0 tlg diisi
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 tlg diisi
56 Nistatin drop Botol 1 1 0 1 tlg diisi
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 tlg diisi
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 tlg diisi
59 Paracetamol 500 mg Tablet 0 0 0 0 tlg diisi
60 Piridoksin Tablet 0 0 0 0 tlg diisi
61 Piroxicam 10 mg Tablet 0 0 0 0 tlg diisi
62 Risperidon 2 mg Tablet 0 0 0 0 tlg diisi
63 Salbutamol 4 mg Tablet 0 0 0 0 tlg diisi
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 tlg diisi
65 Sefadroksil 500 mg Kapsul 0 0 0 0 tlg diisi
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 tlg diisi
67 Sianocobalamin inj Ampul 75 75 0 75 tlg diisi
68 Thiamin Inj Ampul 0 0 0 0 tlg diisi
69 Thiamin 50 mg Tablet 2354 1000 3354 1392 1962 tlg diisi
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 tlg diisi
71 Ventolin Nebule Vial 0 0 0 0 tlg diisi
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0 0 0
72 Master Bond Botol 0 0 0 0 tlg diisi
73 Orafil Plus Temporary Botol 0 0 0 0 tlg diisi
74 Absorbent Paper Point Box 0 0 0 0 tlg diisi
75 Root Canal Sealer Box 0 0 0 0 tlg diisi
76 Zinc F+ Box 0 0 0 0 tlg diisi
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 tlg diisi
78 Cresotin Paste Pot 0 0 0 0 tlg diisi
79 Iodotin Paste Pot 0 0 0 0 tlg diisi
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BMHP 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 79 0 79 tlg diisi
81 Alat Suntik 3 cc Pcs 287 287 104 183 tlg diisi
82 Alat Suntik 5 cc Pcs 0 100 100 10 90 tlg diisi
83 Alat Suntik 10 cc Pcs 0 0 0 0 tlg diisi
84 Alkohol 70 % 300 ml Botol 0 0 0 0 tlg diisi
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

86 Blood Lancet Pcs 100 200 300 0 300 tlg diisi

87 Cavida Gel Tube 10 10 0 10 tlg diisi
88 Desinfectan Spray ( Baymed ) 750 ml Botol 7 7 0 7 tlg diisi
89 Etil Klorida Semprot Botol 0 0 0 0 tlg diisi
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 tlg diisi
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 tlg diisi
92 Hand Scrub 4 % 500 ml ( Baymed ) 0 5 5 1 4 tlg diisi
93 High Elastic Bandage Roll 8 8 0 8 tlg diisi
94 HCG Strip Strip 0 0 0 0 tlg diisi
95 Infusion Set Anak Pcs 144 144 0 144 tlg diisi
96 I.V. Insert 6 x 7 Pcs 100 100 0 100 tlg diisi
97 Jelco No.18 G I.V Catheter Pcs 240 240 0 240 tlg diisi
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 tlg diisi
99 Jelco No.22 G I.V Catheter Pcs 229 229 0 229 tlg diisi
100 Jelco No.24 G I.V Catheter Pcs 211 211 4 207 tlg diisi
101 Jelco No.26 G I.V Catheter Pcs 100 100 0 100 tlg diisi
102 Kapas 100 gr Bungkus 0 12 12 3 9 tlg diisi
103 Kapas 500 gr Bungkus 0 0 0 0 tlg diisi
104 Kasa Hidrofil 16 cm x 16 cm Kotak 404 404 83 321 tlg diisi
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 tlg diisi
106 Nasal Canula Neonate Pcs 30 30 0 30 tlg diisi
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 tlg diisi
108 Nebulizer Mask Child Pcs 63 63 0 63 tlg diisi
109 Nebulizer Mask Adult Pcs 43 43 0 43 tlg diisi
110 Povidone Iodine 10% 60 ml Botol 14 14 3 11 tlg diisi
111 Pot Dahak Pot 0 0 0 0 tlg diisi
112 Pot Urine Pot 0 0 0 0 tlg diisi
113 Rivanol 300 ml Botol 0 0 0 0 tlg diisi
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 tlg diisi
115 Sarung Tangan Non steril Pcs 0 0 0 0 tlg diisi
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 tlg diisi
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 tlg diisi
118 Sarung Tangan Steril No. 7.0 Pair 100 100 200 150 50 tlg diisi
119 Sarung Tangan Steril No. 7.5 Pair 100 100 0 100 tlg diisi
120 Surgical Gloves Steril Gynecolog Pair 52 52 0 52 tlg diisi
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 tlg diisi
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 tlg diisi
123 Underpad Pcs 30 30 0 30 tlg diisi
10 10 0 10
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT LABORATORIUM 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 tlg diisi
128 Antigen H Vial 0 0 0 0 tlg diisi
129 Antigen H-A Vial 0 0 0 0 tlg diisi
130 Antigen H-B Vial 0 0 0 0 tlg diisi
131 Antigen H-C Vial 0 0 0 0 tlg diisi
132 Antigen O-A Vial 0 0 0 0 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

133 Antigen O-B Vial 0 0 0 0 tlg diisi

134 Antigen O-C Vial 0 0 0 0 tlg diisi
135 Antigen O Vial 0 0 0 0 tlg diisi
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 tlg diisi
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 tlg diisi
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 tlg diisi
139 Benedict 100mL Botol 0 0 0 0 tlg diisi
140 EDTA 10% 100mL Botol 0 0 0 0 tlg diisi
141 Ehrlich 100 ml Botol 0 0 0 0 tlg diisi
142 Eosin 2% 100 ml Botol 0 0 0 0 tlg diisi
143 HCl 0,1N 100mL Botol 0 0 0 0 tlg diisi
144 Hemoglobin C 500mL Botol 0 0 0 0 tlg diisi
145 Immersion Oil 50 ml Botol 0 0 0 0 tlg diisi
146 KOH 10% 500 ml Botol 0 0 0 0 tlg diisi
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 tlg diisi
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 tlg diisi
149 Pewarna MDT 3x500mL Botol 0 0 0 0 tlg diisi
150 Rees Ecker 100 ml Botol 0 0 0 0 tlg diisi
151 SM Sedimen 500mL Botol 0 0 0 0 tlg diisi
152 Turk 500 ml Botol 0 0 0 0 tlg diisi
153 Wright 100 ml Botol 0 0 0 0 tlg diisi
154 SD Bioline HbSAg Kotak 0 0 0 0 tlg diisi
155 SD Syphillis 3.0 Kotak 0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

dr Dewi Suryati Herawati Amd Farm

NIP.198101162009122001 NIP.197112291993032002
 LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) OTSUS
BULAN APRIL 2023
PUSKESMAS : SUNGAI RAYA
Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
1 Acyclovir 200 mg Tablet 0 0 0 0 0
2 Acyclovir Cream Tube 30 0 30 0 30
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 0
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 0 36 0 36
syr)
5 Asam Folat Tablet 0 0 0 0 0
6 Attapulgite 630 mg Tablet 0 0 0 0 0
7 Bedak Salisil 2% Serbuk Kotak 55 0 55 3 1 1 1 1 15 7 10 1 1 41 14
8 Betahistin Tablet 0 0 0 0 0
9 Betametason Tube 0 0 0 0 0
10 Bisacodil supp 5 mg Supp 6 0 6 0 6
11 Bisacodil supp 10 mg Supp 18 0 18 0 18
12 Bromhexin HCL Syrup Botol 0 0 0 0 0
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 0
14 Clobazam 10 mg Tablet 3 0 3 0 3
15 Curcuma Force Tablet 0 360 360 106 5 10 34 40 70 265 95
16 Dexamethason Tab 0,5 mg Tablet 3123 2000 5123 20 37 48 45 89 90 36 40 21 6 204 88 40 46 82 200 36 43 1171 3952
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 0
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 10 0 10 2 3 5 5
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 0
20 Digoksin 0.25 mg Tablet 100 0 100 0 100
21 Diphenhidramin Inj Ampul 0 0 0 0 0
22 Erytromicin 500 mg Tablet 19 0 19 0 19
23 Furosemid 40 mg Tablet 123 0 123 0 123
24 Furosemid Inj 10 mg/ml Ampul 10 0 10 0 10
25 Gentamisin Salep Mata Tube 1 0 1 0 1
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 0
27 Griseofulvin Tablet 0 0 0 0 0
28 Hidroklorotiazid 25 mg Tablet 84 0 84 10 60 3 10 83 1
29 Ibuprofen Tab 200 mg Tablet 4 0 4 0 4
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 0
31 Isosorbid Dinitrat 5 mg Tablet 106 300 406 20 1 20 12 10 30 12 105 301
32 Kalium Diclofenac 50 mg Tablet 36 0 36 0 36
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 0
34 Kaptopril 25 mg Tablet 0 0 0 0 0
35 kalium Permanganat 5 gr Pot 3 0 3 0 3
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
36 Ketokonazole 2 % Tube 75 0 75 0 75
37 Klindamicin 150 mg Kapsul 16 0 16 0 16
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 0
39 Kloramphenicol Salep Mata 1 % Tube 56 0 56 5 2 10 10 1 28 28
40 Kloramphenicol tetes Mata 0.5% Botol 50 0 50 10 10 40
41 Kloramphenicol tetes telinga Botol 0 0 0 0 0
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 0
43 Klorpromazin 100 mg Tablet 0 0 0 0 0
44 Lansoprazole 30 mg Kapsul 448 500 948 58 21 28 26 72 30 40 78 22 20 75 37 55 4 39 21 84 42 40 792 156
45 Levofloxacin 500 mg Tablet 0 0 0 0 0
46 Lidocain inj 2 % Ampul 0 0 0 0 0
47 Loperamid 2 mg Tablet 616 0 616 10 10 606
48 Meloxicam 15 mg Tablet 0 0 0 0 0
49 Methisoprinol Tablet 0 0 0 0 0
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 0
51 Metronidazol 500 mg Tablet 244 1000 1244 10 20 10 6 3 10 100 10 169 1075
52 Mikonazol krim 2 % Tube 0 0 0 0 0
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 0
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 0 0 0
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 0
56 Nistatin drop Botol 1 0 1 0 1
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 0
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0 0 0
60 Piridoksin Tablet 0 0 0 0 0
61 Piroxicam 10 mg Tablet 0 0 0 0 0
62 Risperidon 2 mg Tablet 0 0 0 0 0
63 Salbutamol 4 mg Tablet 0 0 0 0 0
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 0
65 Sefadroksil 500 mg Kapsul 0 0 0 0 0
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0
67 Sianocobalamin inj Ampul 75 0 75 0 75
68 Thiamin Inj Ampul 0 0 0 0 0
69 Thiamin 50 mg Tablet 2354 1000 3354 45 30 75 45 83 33 40 5 282 83 61 30 120 305 135 20 1392 1962
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 0
71 Ventolin Nebule Vial 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0
72 Master Bond Botol 0 0 0 0 0
73 Orafil Plus Temporary Botol 0 0 0 0 0
74 Absorbent Paper Point Box 0 0 0 0 0
75 Root Canal Sealer Box 0 0 0 0 0
76 Zinc F+ Box 0 0 0 0 0
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 0
78 Cresotin Paste Pot 0 0 0 0 0
79 Iodotin Paste Pot 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
BMHP 0 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 0 79 0 79
81 Alat Suntik 3 cc Pcs 287 0 287 100 2 2 104 183
82 Alat Suntik 5 cc Pcs 0 100 100 10 10 90
83 Alat Suntik 10 cc Pcs 0 0 0 0 0
84 Alkohol 70 % 300 ml Botol 0 0 0 0 0
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 0
86 Blood Lancet Pcs 100 200 300 0 300
87 Cavida Gel Tube 10 0 10 0 10
88 Desinfectan Spray ( Baymed ) 750 ml Botol 7 0 7 0 7
89 Etil Klorida Semprot Botol 0 0 0 0 0
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 0
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 0
92 Hand Scrub 4 % 500 ml ( Baymed ) 0 5 5 1 1 4
93 High Elastic Bandage Roll 8 0 8 0 8
94 HCG Strip Strip 0 0 0 0 0
95 Infusion Set Anak Pcs 144 0 144 0 144
96 I.V. Insert 6 x 7 Pcs 100 0 100 0 100
97 Jelco No.18 G I.V Catheter Pcs 240 0 240 0 240
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 0
99 Jelco No.22 G I.V Catheter Pcs 229 0 229 0 229
100 Jelco No.24 G I.V Catheter Pcs 211 0 211 1 2 1 4 207
101 Jelco No.26 G I.V Catheter Pcs 100 0 100 0 100
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
102 Kapas 100 gr Bungkus 0 12 12 2 1 3 9
103 Kapas 500 gr Bungkus 0 0 0 0 0
104 Kasa Hidrofil 16 cm x 16 cm Kotak 404 0 404 50 33 83 321
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 0
106 Nasal Canula Neonate Pcs 30 0 30 0 30
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 0
108 Nebulizer Mask Child Pcs 63 0 63 0 63
109 Nebulizer Mask Adult Pcs 43 0 43 0 43
110 Povidone Iodine 10% 60 ml Botol 14 0 14 1 1 1 3 11
111 Pot Dahak Pot 0 0 0 0 0
112 Pot Urine Pot 0 0 0 0 0
113 Rivanol 300 ml Botol 0 0 0 0 0
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 0
115 Sarung Tangan Non steril Pcs 0 0 0 0 0
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 0
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 0
118 Sarung Tangan Steril No. 7.0 Pair 100 100 200 50 100 150 50
119 Sarung Tangan Steril No. 7.5 Pair 100 0 100 0 100
120 Surgical Gloves Steril Gynecolog Pair 52 0 52 0 52
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 0
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 0
123 Underpad Pcs 30 0 30 0 30
Masker N95 10 0 10 0 10
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT LABORATORIUM 0 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 0
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 0
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 0
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 0
128 Antigen H Vial 0 0 0 0 0
129 Antigen H-A Vial 0 0 0 0 0
130 Antigen H-B Vial 0 0 0 0 0
131 Antigen H-C Vial 0 0 0 0 0
132 Antigen O-A Vial 0 0 0 0 0
133 Antigen O-B Vial 0 0 0 0 0
134 Antigen O-C Vial 0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
135 Antigen O Vial 0 0 0 0 0
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 0
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 0
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 0
139 Benedict 100mL Botol 0 0 0 0 0
140 EDTA 10% 100mL Botol 0 0 0 0 0
141 Ehrlich 100 ml Botol 0 0 0 0 0
142 Eosin 2% 100 ml Botol 0 0 0 0 0
143 HCl 0,1N 100mL Botol 0 0 0 0 0
144 Hemoglobin C 500mL Botol 0 0 0 0 0
145 Immersion Oil 50 ml Botol 0 0 0 0 0
146 KOH 10% 500 ml Botol 0 0 0 0 0
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 0
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 0
149 Pewarna MDT 3x500mL Botol 0 0 0 0 0
150 Rees Ecker 100 ml Botol 0 0 0 0 0
151 SM Sedimen 500mL Botol 0 0 0 0 0
152 Turk 500 ml Botol 0 0 0 0 0
153 Wright 100 ml Botol 0 0 0 0 0
154 SD Bioline HbSAg Kotak 0 0 0 0 0
155 SD Syphillis 3.0 Kotak 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

dr Dewi Suryati HERAWATI A.Md.Farm

Nip.197112291993032001
NIP.198101162009122001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT OTSUS
( LPLPO ) OTSUS

UPT PKM : (TOLONG DIISI YA NAMANYA) BULAN : MAI

KECAMATAN : (TOLONG DIISI YA NAMANYA) TAHUN : 2023

KABUPATEN : ACEH TIMUR

PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN

KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir 200 mg Tablet 0 0 0 0 tlg diisi

2 Acyclovir Cream Tube 30 30 0 30 tlg diisi
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 tlg diisi
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 36 0 36 tlg diisi
syr)
5 Asam Folat Tablet 0 0 0 0 tlg diisi
6 Attapulgite 630 mg Tablet 0 0 0 0 tlg diisi
7 Bedak Salisil 2% Serbuk Kotak 14 14 0 14 tlg diisi
8 Betahistin Tablet 0 0 0 0 tlg diisi
9 Betametason Tube 0 0 0 0 tlg diisi
10 Bisacodil supp 5 mg Supp 6 6 0 6 tlg diisi
11 Bisacodil supp 10 mg Supp 18 18 0 18 tlg diisi
12 Bromhexin HCL Syrup Botol 0 0 0 0 tlg diisi
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 tlg diisi
14 Clobazam 10 mg Tablet 3 3 0 3 tlg diisi
15 Curcuma Force Tablet 95 95 0 95 tlg diisi
16 Dexamethason Tab 0,5 mg Tablet 3952 3952 0 3952 tlg diisi
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 tlg diisi
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 5 5 0 5 tlg diisi
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 tlg diisi
20 Digoksin 0.25 mg Tablet 100 100 0 100 tlg diisi
21 Diphenhidramin Inj Ampul 0 0 0 0 tlg diisi
22 Erytromicin 500 mg Tablet 19 19 0 19 tlg diisi
23 Furosemid 40 mg Tablet 123 123 0 123 tlg diisi
24 Furosemid Inj 10 mg/ml Ampul 10 10 0 10 tlg diisi
25 Gentamisin Salep Mata Tube 1 1 0 1 tlg diisi
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 tlg diisi
27 Griseofulvin Tablet 0 0 0 0 tlg diisi
28 Hidroklorotiazid 25 mg Tablet 1 1 0 1 tlg diisi
29 Ibuprofen Tab 200 mg Tablet 4 4 0 4 tlg diisi
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 tlg diisi
31 Isosorbid Dinitrat 5 mg Tablet 301 301 0 301 tlg diisi
32 Kalium Diclofenac 50 mg Tablet 36 36 0 36 tlg diisi
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 tlg diisi
34 Kaptopril 25 mg Tablet 0 0 0 0 tlg diisi
35 kalium Permanganat 5 gr Pot 3 3 0 3 tlg diisi
36 Ketokonazole 2 % Tube 75 75 0 75 tlg diisi
37 Klindamicin 150 mg Kapsul 16 16 0 16 tlg diisi
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 tlg diisi
39 Kloramphenicol Salep Mata 1 % Tube 28 28 0 28 tlg diisi
40 Kloramphenicol tetes Mata 0.5% Botol 40 40 0 40 tlg diisi
41 Kloramphenicol tetes telinga Botol 0 0 0 0 tlg diisi
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 tlg diisi
43 Klorpromazin 100 mg Tablet 0 0 0 0 tlg diisi
44 Lansoprazole 30 mg Kapsul 156 156 0 156 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

45 Levofloxacin 500 mg Tablet 0 0 0 0 tlg diisi

46 Lidocain inj 2 % Ampul 0 0 0 0 tlg diisi
47 Loperamid 2 mg Tablet 606 606 0 606 tlg diisi
48 Meloxicam 15 mg Tablet 0 0 0 0 tlg diisi
49 Methisoprinol Tablet 0 0 0 0 tlg diisi
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 tlg diisi
51 Metronidazol 500 mg Tablet 1075 1075 0 1075 tlg diisi
52 Mikonazol krim 2 % Tube 0 0 0 0 tlg diisi
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 tlg diisi
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 0 0 tlg diisi
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 tlg diisi
56 Nistatin drop Botol 1 1 0 1 tlg diisi
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 tlg diisi
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 tlg diisi
59 Paracetamol 500 mg Tablet 0 0 0 0 tlg diisi
60 Piridoksin Tablet 0 0 0 0 tlg diisi
61 Piroxicam 10 mg Tablet 0 0 0 0 tlg diisi
62 Risperidon 2 mg Tablet 0 0 0 0 tlg diisi
63 Salbutamol 4 mg Tablet 0 0 0 0 tlg diisi
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 tlg diisi
65 Sefadroksil 500 mg Kapsul 0 0 0 0 tlg diisi
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 tlg diisi
67 Sianocobalamin inj Ampul 75 75 0 75 tlg diisi
68 Thiamin Inj Ampul 0 0 0 0 tlg diisi
69 Thiamin 50 mg Tablet 1962 1962 0 1962 tlg diisi
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 tlg diisi
71 Ventolin Nebule Vial 0 0 0 0 tlg diisi
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0 0 0
72 Master Bond Botol 0 0 0 0 tlg diisi
73 Orafil Plus Temporary Botol 0 0 0 0 tlg diisi
74 Absorbent Paper Point Box 0 0 0 0 tlg diisi
75 Root Canal Sealer Box 0 0 0 0 tlg diisi
76 Zinc F+ Box 0 0 0 0 tlg diisi
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 tlg diisi
78 Cresotin Paste Pot 0 0 0 0 tlg diisi
79 Iodotin Paste Pot 0 0 0 0 tlg diisi
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BMHP 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 79 0 79 tlg diisi
81 Alat Suntik 3 cc Pcs 183 183 0 183 tlg diisi
82 Alat Suntik 5 cc Pcs 90 90 0 90 tlg diisi
83 Alat Suntik 10 cc Pcs 0 0 0 0 tlg diisi
84 Alkohol 70 % 300 ml Botol 0 0 0 0 tlg diisi
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

86 Blood Lancet Pcs 300 300 0 300 tlg diisi

87 Cavida Gel Tube 10 10 0 10 tlg diisi
88 Desinfectan Spray ( Baymed ) 750 ml Botol 7 7 0 7 tlg diisi
89 Etil Klorida Semprot Botol 0 0 0 0 tlg diisi
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 tlg diisi
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 tlg diisi
92 Hand Scrub 4 % 500 ml ( Baymed ) 4 4 0 4 tlg diisi
93 High Elastic Bandage Roll 8 8 0 8 tlg diisi
94 HCG Strip Strip 0 0 0 0 tlg diisi
95 Infusion Set Anak Pcs 144 144 0 144 tlg diisi
96 I.V. Insert 6 x 7 Pcs 100 100 0 100 tlg diisi
97 Jelco No.18 G I.V Catheter Pcs 240 240 0 240 tlg diisi
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 tlg diisi
99 Jelco No.22 G I.V Catheter Pcs 229 229 0 229 tlg diisi
100 Jelco No.24 G I.V Catheter Pcs 207 207 0 207 tlg diisi
101 Jelco No.26 G I.V Catheter Pcs 100 100 0 100 tlg diisi
102 Kapas 100 gr Bungkus 9 9 0 9 tlg diisi
103 Kapas 500 gr Bungkus 0 0 0 0 tlg diisi
104 Kasa Hidrofil 16 cm x 16 cm Kotak 321 321 0 321 tlg diisi
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 tlg diisi
106 Nasal Canula Neonate Pcs 30 30 0 30 tlg diisi
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 tlg diisi
108 Nebulizer Mask Child Pcs 63 63 0 63 tlg diisi
109 Nebulizer Mask Adult Pcs 43 43 0 43 tlg diisi
110 Povidone Iodine 10% 60 ml Botol 11 11 0 11 tlg diisi
111 Pot Dahak Pot 0 0 0 0 tlg diisi
112 Pot Urine Pot 0 0 0 0 tlg diisi
113 Rivanol 300 ml Botol 0 0 0 0 tlg diisi
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 tlg diisi
115 Sarung Tangan Non steril Pcs 0 0 0 0 tlg diisi
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 tlg diisi
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 tlg diisi
118 Sarung Tangan Steril No. 7.0 Pair 50 50 0 50 tlg diisi
119 Sarung Tangan Steril No. 7.5 Pair 100 100 0 100 tlg diisi
120 Surgical Gloves Steril Gynecolog Pair 52 52 0 52 tlg diisi
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 tlg diisi
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 tlg diisi
123 Underpad Pcs 30 30 0 30 tlg diisi
10 10 0 10
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT LABORATORIUM 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 tlg diisi
128 Antigen H Vial 0 0 0 0 tlg diisi
129 Antigen H-A Vial 0 0 0 0 tlg diisi
130 Antigen H-B Vial 0 0 0 0 tlg diisi
131 Antigen H-C Vial 0 0 0 0 tlg diisi
132 Antigen O-A Vial 0 0 0 0 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

133 Antigen O-B Vial 0 0 0 0 tlg diisi

134 Antigen O-C Vial 0 0 0 0 tlg diisi
135 Antigen O Vial 0 0 0 0 tlg diisi
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 tlg diisi
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 tlg diisi
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 tlg diisi
139 Benedict 100mL Botol 0 0 0 0 tlg diisi
140 EDTA 10% 100mL Botol 0 0 0 0 tlg diisi
141 Ehrlich 100 ml Botol 0 0 0 0 tlg diisi
142 Eosin 2% 100 ml Botol 0 0 0 0 tlg diisi
143 HCl 0,1N 100mL Botol 0 0 0 0 tlg diisi
144 Hemoglobin C 500mL Botol 0 0 0 0 tlg diisi
145 Immersion Oil 50 ml Botol 0 0 0 0 tlg diisi
146 KOH 10% 500 ml Botol 0 0 0 0 tlg diisi
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 tlg diisi
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 tlg diisi
149 Pewarna MDT 3x500mL Botol 0 0 0 0 tlg diisi
150 Rees Ecker 100 ml Botol 0 0 0 0 tlg diisi
151 SM Sedimen 500mL Botol 0 0 0 0 tlg diisi
152 Turk 500 ml Botol 0 0 0 0 tlg diisi
153 Wright 100 ml Botol 0 0 0 0 tlg diisi
154 SD Bioline HbSAg Kotak 0 0 0 0 tlg diisi
155 SD Syphillis 3.0 Kotak 0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

( ) ( )
Nip Nip
 LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) OTSUS
BULAN MAI 2023
PUSKESMAS : ( tlg diisi )
Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
1 Acyclovir 200 mg Tablet 0 0 0 0 0
2 Acyclovir Cream Tube 30 0 30 0 30
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 0
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 0 36 0 36
syr)
5 Asam Folat Tablet 0 0 0 0 0
6 Attapulgite 630 mg Tablet 0 0 0 0 0
7 Bedak Salisil 2% Serbuk Kotak 14 0 14 0 14
8 Betahistin Tablet 0 0 0 0 0
9 Betametason Tube 0 0 0 0 0
10 Bisacodil supp 5 mg Supp 6 0 6 0 6
11 Bisacodil supp 10 mg Supp 18 0 18 0 18
12 Bromhexin HCL Syrup Botol 0 0 0 0 0
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 0
14 Clobazam 10 mg Tablet 3 0 3 0 3
15 Curcuma Force Tablet 95 0 95 0 95
16 Dexamethason Tab 0,5 mg Tablet 3952 0 3952 0 3952
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 0
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 5 0 5 0 5
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 0
20 Digoksin 0.25 mg Tablet 100 0 100 0 100
21 Diphenhidramin Inj Ampul 0 0 0 0 0
22 Erytromicin 500 mg Tablet 19 0 19 0 19
23 Furosemid 40 mg Tablet 123 0 123 0 123
24 Furosemid Inj 10 mg/ml Ampul 10 0 10 0 10
25 Gentamisin Salep Mata Tube 1 0 1 0 1
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 0
27 Griseofulvin Tablet 0 0 0 0 0
28 Hidroklorotiazid 25 mg Tablet 1 0 1 0 1
29 Ibuprofen Tab 200 mg Tablet 4 0 4 0 4
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 0
31 Isosorbid Dinitrat 5 mg Tablet 301 0 301 0 301
32 Kalium Diclofenac 50 mg Tablet 36 0 36 0 36
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 0
34 Kaptopril 25 mg Tablet 0 0 0 0 0
35 kalium Permanganat 5 gr Pot 3 0 3 0 3
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
36 Ketokonazole 2 % Tube 75 0 75 0 75
37 Klindamicin 150 mg Kapsul 16 0 16 0 16
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 0
39 Kloramphenicol Salep Mata 1 % Tube 28 0 28 0 28
40 Kloramphenicol tetes Mata 0.5% Botol 40 0 40 0 40
41 Kloramphenicol tetes telinga Botol 0 0 0 0 0
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 0
43 Klorpromazin 100 mg Tablet 0 0 0 0 0
44 Lansoprazole 30 mg Kapsul 156 0 156 0 156
45 Levofloxacin 500 mg Tablet 0 0 0 0 0
46 Lidocain inj 2 % Ampul 0 0 0 0 0
47 Loperamid 2 mg Tablet 606 0 606 0 606
48 Meloxicam 15 mg Tablet 0 0 0 0 0
49 Methisoprinol Tablet 0 0 0 0 0
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 0
51 Metronidazol 500 mg Tablet 1075 0 1075 0 1075
52 Mikonazol krim 2 % Tube 0 0 0 0 0
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 0
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 0 0 0
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 0
56 Nistatin drop Botol 1 0 1 0 1
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 0
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0 0 0
60 Piridoksin Tablet 0 0 0 0 0
61 Piroxicam 10 mg Tablet 0 0 0 0 0
62 Risperidon 2 mg Tablet 0 0 0 0 0
63 Salbutamol 4 mg Tablet 0 0 0 0 0
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 0
65 Sefadroksil 500 mg Kapsul 0 0 0 0 0
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0
67 Sianocobalamin inj Ampul 75 0 75 0 75
68 Thiamin Inj Ampul 0 0 0 0 0
69 Thiamin 50 mg Tablet 1962 0 1962 0 1962
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 0
71 Ventolin Nebule Vial 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0
72 Master Bond Botol 0 0 0 0 0
73 Orafil Plus Temporary Botol 0 0 0 0 0
74 Absorbent Paper Point Box 0 0 0 0 0
75 Root Canal Sealer Box 0 0 0 0 0
76 Zinc F+ Box 0 0 0 0 0
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 0
78 Cresotin Paste Pot 0 0 0 0 0
79 Iodotin Paste Pot 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
BMHP 0 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 0 79 0 79
81 Alat Suntik 3 cc Pcs 183 0 183 0 183
82 Alat Suntik 5 cc Pcs 90 0 90 0 90
83 Alat Suntik 10 cc Pcs 0 0 0 0 0
84 Alkohol 70 % 300 ml Botol 0 0 0 0 0
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 0
86 Blood Lancet Pcs 300 0 300 0 300
87 Cavida Gel Tube 10 0 10 0 10
88 Desinfectan Spray ( Baymed ) 750 ml Botol 7 0 7 0 7
89 Etil Klorida Semprot Botol 0 0 0 0 0
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 0
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 0
92 Hand Scrub 4 % 500 ml ( Baymed ) 4 0 4 0 4
93 High Elastic Bandage Roll 8 0 8 0 8
94 HCG Strip Strip 0 0 0 0 0
95 Infusion Set Anak Pcs 144 0 144 0 144
96 I.V. Insert 6 x 7 Pcs 100 0 100 0 100
97 Jelco No.18 G I.V Catheter Pcs 240 0 240 0 240
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 0
99 Jelco No.22 G I.V Catheter Pcs 229 0 229 0 229
100 Jelco No.24 G I.V Catheter Pcs 207 0 207 0 207
101 Jelco No.26 G I.V Catheter Pcs 100 0 100 0 100
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
102 Kapas 100 gr Bungkus 9 0 9 0 9
103 Kapas 500 gr Bungkus 0 0 0 0 0
104 Kasa Hidrofil 16 cm x 16 cm Kotak 321 0 321 0 321
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 0
106 Nasal Canula Neonate Pcs 30 0 30 0 30
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 0
108 Nebulizer Mask Child Pcs 63 0 63 0 63
109 Nebulizer Mask Adult Pcs 43 0 43 0 43
110 Povidone Iodine 10% 60 ml Botol 11 0 11 0 11
111 Pot Dahak Pot 0 0 0 0 0
112 Pot Urine Pot 0 0 0 0 0
113 Rivanol 300 ml Botol 0 0 0 0 0
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 0
115 Sarung Tangan Non steril Pcs 0 0 0 0 0
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 0
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 0
118 Sarung Tangan Steril No. 7.0 Pair 50 0 50 0 50
119 Sarung Tangan Steril No. 7.5 Pair 100 0 100 0 100
120 Surgical Gloves Steril Gynecolog Pair 52 0 52 0 52
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 0
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 0
123 Underpad Pcs 30 0 30 0 30
10 0 10 0 10
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT LABORATORIUM 0 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 0
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 0
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 0
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 0
128 Antigen H Vial 0 0 0 0 0
129 Antigen H-A Vial 0 0 0 0 0
130 Antigen H-B Vial 0 0 0 0 0
131 Antigen H-C Vial 0 0 0 0 0
132 Antigen O-A Vial 0 0 0 0 0
133 Antigen O-B Vial 0 0 0 0 0
134 Antigen O-C Vial 0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
135 Antigen O Vial 0 0 0 0 0
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 0
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 0
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 0
139 Benedict 100mL Botol 0 0 0 0 0
140 EDTA 10% 100mL Botol 0 0 0 0 0
141 Ehrlich 100 ml Botol 0 0 0 0 0
142 Eosin 2% 100 ml Botol 0 0 0 0 0
143 HCl 0,1N 100mL Botol 0 0 0 0 0
144 Hemoglobin C 500mL Botol 0 0 0 0 0
145 Immersion Oil 50 ml Botol 0 0 0 0 0
146 KOH 10% 500 ml Botol 0 0 0 0 0
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 0
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 0
149 Pewarna MDT 3x500mL Botol 0 0 0 0 0
150 Rees Ecker 100 ml Botol 0 0 0 0 0
151 SM Sedimen 500mL Botol 0 0 0 0 0
152 Turk 500 ml Botol 0 0 0 0 0
153 Wright 100 ml Botol 0 0 0 0 0
154 SD Bioline HbSAg Kotak 0 0 0 0 0
155 SD Syphillis 3.0 Kotak 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

( ) ( )
Nip. Nip.
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT OTSUS
( LPLPO ) OTSUS

UPT PKM : (TOLONG DIISI YA NAMANYA) BULAN : JUNI

KECAMATAN : (TOLONG DIISI YA NAMANYA) TAHUN : 2023

KABUPATEN : ACEH TIMUR

PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN

KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir 200 mg Tablet 0 0 0 0 tlg diisi

2 Acyclovir Cream Tube 30 30 0 30 tlg diisi
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 tlg diisi
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 36 0 36 tlg diisi
syr)
5 Asam Folat Tablet 0 0 0 0 tlg diisi
6 Attapulgite 630 mg Tablet 0 0 0 0 tlg diisi
7 Bedak Salisil 2% Serbuk Kotak 14 14 0 14 tlg diisi
8 Betahistin Tablet 0 0 0 0 tlg diisi
9 Betametason Tube 0 0 0 0 tlg diisi
10 Bisacodil supp 5 mg Supp 6 6 0 6 tlg diisi
11 Bisacodil supp 10 mg Supp 18 18 0 18 tlg diisi
12 Bromhexin HCL Syrup Botol 0 0 0 0 tlg diisi
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 tlg diisi
14 Clobazam 10 mg Tablet 3 3 0 3 tlg diisi
15 Curcuma Force Tablet 95 95 0 95 tlg diisi
16 Dexamethason Tab 0,5 mg Tablet 3952 3952 0 3952 tlg diisi
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 tlg diisi
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 5 5 0 5 tlg diisi
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 tlg diisi
20 Digoksin 0.25 mg Tablet 100 100 0 100 tlg diisi
21 Diphenhidramin Inj Ampul 0 0 0 0 tlg diisi
22 Erytromicin 500 mg Tablet 19 19 0 19 tlg diisi
23 Furosemid 40 mg Tablet 123 123 0 123 tlg diisi
24 Furosemid Inj 10 mg/ml Ampul 10 10 0 10 tlg diisi
25 Gentamisin Salep Mata Tube 1 1 0 1 tlg diisi
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 tlg diisi
27 Griseofulvin Tablet 0 0 0 0 tlg diisi
28 Hidroklorotiazid 25 mg Tablet 1 1 0 1 tlg diisi
29 Ibuprofen Tab 200 mg Tablet 4 4 0 4 tlg diisi
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 tlg diisi
31 Isosorbid Dinitrat 5 mg Tablet 301 301 0 301 tlg diisi
32 Kalium Diclofenac 50 mg Tablet 36 36 0 36 tlg diisi
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 tlg diisi
34 Kaptopril 25 mg Tablet 0 0 0 0 tlg diisi
35 kalium Permanganat 5 gr Pot 3 3 0 3 tlg diisi
36 Ketokonazole 2 % Tube 75 75 0 75 tlg diisi
37 Klindamicin 150 mg Kapsul 16 16 0 16 tlg diisi
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 tlg diisi
39 Kloramphenicol Salep Mata 1 % Tube 28 28 0 28 tlg diisi
40 Kloramphenicol tetes Mata 0.5% Botol 40 40 0 40 tlg diisi
41 Kloramphenicol tetes telinga Botol 0 0 0 0 tlg diisi
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 tlg diisi
43 Klorpromazin 100 mg Tablet 0 0 0 0 tlg diisi
44 Lansoprazole 30 mg Kapsul 156 156 0 156 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

45 Levofloxacin 500 mg Tablet 0 0 0 0 tlg diisi

46 Lidocain inj 2 % Ampul 0 0 0 0 tlg diisi
47 Loperamid 2 mg Tablet 606 606 0 606 tlg diisi
48 Meloxicam 15 mg Tablet 0 0 0 0 tlg diisi
49 Methisoprinol Tablet 0 0 0 0 tlg diisi
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 tlg diisi
51 Metronidazol 500 mg Tablet 1075 1075 0 1075 tlg diisi
52 Mikonazol krim 2 % Tube 0 0 0 0 tlg diisi
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 tlg diisi
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 0 0 tlg diisi
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 tlg diisi
56 Nistatin drop Botol 1 1 0 1 tlg diisi
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 tlg diisi
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 tlg diisi
59 Paracetamol 500 mg Tablet 0 0 0 0 tlg diisi
60 Piridoksin Tablet 0 0 0 0 tlg diisi
61 Piroxicam 10 mg Tablet 0 0 0 0 tlg diisi
62 Risperidon 2 mg Tablet 0 0 0 0 tlg diisi
63 Salbutamol 4 mg Tablet 0 0 0 0 tlg diisi
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 tlg diisi
65 Sefadroksil 500 mg Kapsul 0 0 0 0 tlg diisi
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 tlg diisi
67 Sianocobalamin inj Ampul 75 75 0 75 tlg diisi
68 Thiamin Inj Ampul 0 0 0 0 tlg diisi
69 Thiamin 50 mg Tablet 1962 1962 0 1962 tlg diisi
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 tlg diisi
71 Ventolin Nebule Vial 0 0 0 0 tlg diisi
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0 0 0
72 Master Bond Botol 0 0 0 0 tlg diisi
73 Orafil Plus Temporary Botol 0 0 0 0 tlg diisi
74 Absorbent Paper Point Box 0 0 0 0 tlg diisi
75 Root Canal Sealer Box 0 0 0 0 tlg diisi
76 Zinc F+ Box 0 0 0 0 tlg diisi
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 tlg diisi
78 Cresotin Paste Pot 0 0 0 0 tlg diisi
79 Iodotin Paste Pot 0 0 0 0 tlg diisi
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BMHP 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 79 0 79 tlg diisi
81 Alat Suntik 3 cc Pcs 183 183 0 183 tlg diisi
82 Alat Suntik 5 cc Pcs 90 90 0 90 tlg diisi
83 Alat Suntik 10 cc Pcs 0 0 0 0 tlg diisi
84 Alkohol 70 % 300 ml Botol 0 0 0 0 tlg diisi
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

86 Blood Lancet Pcs 300 300 0 300 tlg diisi

87 Cavida Gel Tube 10 10 0 10 tlg diisi
88 Desinfectan Spray ( Baymed ) 750 ml Botol 7 7 0 7 tlg diisi
89 Etil Klorida Semprot Botol 0 0 0 0 tlg diisi
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 tlg diisi
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 tlg diisi
92 Hand Scrub 4 % 500 ml ( Baymed ) 4 4 0 4 tlg diisi
93 High Elastic Bandage Roll 8 8 0 8 tlg diisi
94 HCG Strip Strip 0 0 0 0 tlg diisi
95 Infusion Set Anak Pcs 144 144 0 144 tlg diisi
96 I.V. Insert 6 x 7 Pcs 100 100 0 100 tlg diisi
97 Jelco No.18 G I.V Catheter Pcs 240 240 0 240 tlg diisi
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 tlg diisi
99 Jelco No.22 G I.V Catheter Pcs 229 229 0 229 tlg diisi
100 Jelco No.24 G I.V Catheter Pcs 207 207 0 207 tlg diisi
101 Jelco No.26 G I.V Catheter Pcs 100 100 0 100 tlg diisi
102 Kapas 100 gr Bungkus 9 9 0 9 tlg diisi
103 Kapas 500 gr Bungkus 0 0 0 0 tlg diisi
104 Kasa Hidrofil 16 cm x 16 cm Kotak 321 321 0 321 tlg diisi
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 tlg diisi
106 Nasal Canula Neonate Pcs 30 30 0 30 tlg diisi
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 tlg diisi
108 Nebulizer Mask Child Pcs 63 63 0 63 tlg diisi
109 Nebulizer Mask Adult Pcs 43 43 0 43 tlg diisi
110 Povidone Iodine 10% 60 ml Botol 11 11 0 11 tlg diisi
111 Pot Dahak Pot 0 0 0 0 tlg diisi
112 Pot Urine Pot 0 0 0 0 tlg diisi
113 Rivanol 300 ml Botol 0 0 0 0 tlg diisi
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 tlg diisi
115 Sarung Tangan Non steril Pcs 0 0 0 0 tlg diisi
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 tlg diisi
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 tlg diisi
118 Sarung Tangan Steril No. 7.0 Pair 50 50 0 50 tlg diisi
119 Sarung Tangan Steril No. 7.5 Pair 100 100 0 100 tlg diisi
120 Surgical Gloves Steril Gynecolog Pair 52 52 0 52 tlg diisi
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 tlg diisi
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 tlg diisi
123 Underpad Pcs 30 30 0 30 tlg diisi
10 10 0 10
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT LABORATORIUM 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 tlg diisi
128 Antigen H Vial 0 0 0 0 tlg diisi
129 Antigen H-A Vial 0 0 0 0 tlg diisi
130 Antigen H-B Vial 0 0 0 0 tlg diisi
131 Antigen H-C Vial 0 0 0 0 tlg diisi
132 Antigen O-A Vial 0 0 0 0 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

133 Antigen O-B Vial 0 0 0 0 tlg diisi

134 Antigen O-C Vial 0 0 0 0 tlg diisi
135 Antigen O Vial 0 0 0 0 tlg diisi
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 tlg diisi
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 tlg diisi
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 tlg diisi
139 Benedict 100mL Botol 0 0 0 0 tlg diisi
140 EDTA 10% 100mL Botol 0 0 0 0 tlg diisi
141 Ehrlich 100 ml Botol 0 0 0 0 tlg diisi
142 Eosin 2% 100 ml Botol 0 0 0 0 tlg diisi
143 HCl 0,1N 100mL Botol 0 0 0 0 tlg diisi
144 Hemoglobin C 500mL Botol 0 0 0 0 tlg diisi
145 Immersion Oil 50 ml Botol 0 0 0 0 tlg diisi
146 KOH 10% 500 ml Botol 0 0 0 0 tlg diisi
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 tlg diisi
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 tlg diisi
149 Pewarna MDT 3x500mL Botol 0 0 0 0 tlg diisi
150 Rees Ecker 100 ml Botol 0 0 0 0 tlg diisi
151 SM Sedimen 500mL Botol 0 0 0 0 tlg diisi
152 Turk 500 ml Botol 0 0 0 0 tlg diisi
153 Wright 100 ml Botol 0 0 0 0 tlg diisi
154 SD Bioline HbSAg Kotak 0 0 0 0 tlg diisi
155 SD Syphillis 3.0 Kotak 0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

( ) ( )
Nip Nip
 LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) OTSUS
BULAN JUNI 2023
PUSKESMAS : ( tlg diisi )
Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
1 Acyclovir 200 mg Tablet 0 0 0 0 0
2 Acyclovir Cream Tube 30 0 30 0 30
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 0
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 0 36 0 36
syr)
5 Asam Folat Tablet 0 0 0 0 0
6 Attapulgite 630 mg Tablet 0 0 0 0 0
7 Bedak Salisil 2% Serbuk Kotak 14 0 14 0 14
8 Betahistin Tablet 0 0 0 0 0
9 Betametason Tube 0 0 0 0 0
10 Bisacodil supp 5 mg Supp 6 0 6 0 6
11 Bisacodil supp 10 mg Supp 18 0 18 0 18
12 Bromhexin HCL Syrup Botol 0 0 0 0 0
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 0
14 Clobazam 10 mg Tablet 3 0 3 0 3
15 Curcuma Force Tablet 95 0 95 0 95
16 Dexamethason Tab 0,5 mg Tablet 3952 0 3952 0 3952
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 0
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 5 0 5 0 5
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 0
20 Digoksin 0.25 mg Tablet 100 0 100 0 100
21 Diphenhidramin Inj Ampul 0 0 0 0 0
22 Erytromicin 500 mg Tablet 19 0 19 0 19
23 Furosemid 40 mg Tablet 123 0 123 0 123
24 Furosemid Inj 10 mg/ml Ampul 10 0 10 0 10
25 Gentamisin Salep Mata Tube 1 0 1 0 1
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 0
27 Griseofulvin Tablet 0 0 0 0 0
28 Hidroklorotiazid 25 mg Tablet 1 0 1 0 1
29 Ibuprofen Tab 200 mg Tablet 4 0 4 0 4
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 0
31 Isosorbid Dinitrat 5 mg Tablet 301 0 301 0 301
32 Kalium Diclofenac 50 mg Tablet 36 0 36 0 36
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 0
34 Kaptopril 25 mg Tablet 0 0 0 0 0
35 kalium Permanganat 5 gr Pot 3 0 3 0 3
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
36 Ketokonazole 2 % Tube 75 0 75 0 75
37 Klindamicin 150 mg Kapsul 16 0 16 0 16
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 0
39 Kloramphenicol Salep Mata 1 % Tube 28 0 28 0 28
40 Kloramphenicol tetes Mata 0.5% Botol 40 0 40 0 40
41 Kloramphenicol tetes telinga Botol 0 0 0 0 0
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 0
43 Klorpromazin 100 mg Tablet 0 0 0 0 0
44 Lansoprazole 30 mg Kapsul 156 0 156 0 156
45 Levofloxacin 500 mg Tablet 0 0 0 0 0
46 Lidocain inj 2 % Ampul 0 0 0 0 0
47 Loperamid 2 mg Tablet 606 0 606 0 606
48 Meloxicam 15 mg Tablet 0 0 0 0 0
49 Methisoprinol Tablet 0 0 0 0 0
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 0
51 Metronidazol 500 mg Tablet 1075 0 1075 0 1075
52 Mikonazol krim 2 % Tube 0 0 0 0 0
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 0
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 0 0 0
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 0
56 Nistatin drop Botol 1 0 1 0 1
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 0
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0 0 0
60 Piridoksin Tablet 0 0 0 0 0
61 Piroxicam 10 mg Tablet 0 0 0 0 0
62 Risperidon 2 mg Tablet 0 0 0 0 0
63 Salbutamol 4 mg Tablet 0 0 0 0 0
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 0
65 Sefadroksil 500 mg Kapsul 0 0 0 0 0
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0
67 Sianocobalamin inj Ampul 75 0 75 0 75
68 Thiamin Inj Ampul 0 0 0 0 0
69 Thiamin 50 mg Tablet 1962 0 1962 0 1962
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 0
71 Ventolin Nebule Vial 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0
72 Master Bond Botol 0 0 0 0 0
73 Orafil Plus Temporary Botol 0 0 0 0 0
74 Absorbent Paper Point Box 0 0 0 0 0
75 Root Canal Sealer Box 0 0 0 0 0
76 Zinc F+ Box 0 0 0 0 0
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 0
78 Cresotin Paste Pot 0 0 0 0 0
79 Iodotin Paste Pot 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
BMHP 0 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 0 79 0 79
81 Alat Suntik 3 cc Pcs 183 0 183 0 183
82 Alat Suntik 5 cc Pcs 90 0 90 0 90
83 Alat Suntik 10 cc Pcs 0 0 0 0 0
84 Alkohol 70 % 300 ml Botol 0 0 0 0 0
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 0
86 Blood Lancet Pcs 300 0 300 0 300
87 Cavida Gel Tube 10 0 10 0 10
88 Desinfectan Spray ( Baymed ) 750 ml Botol 7 0 7 0 7
89 Etil Klorida Semprot Botol 0 0 0 0 0
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 0
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 0
92 Hand Scrub 4 % 500 ml ( Baymed ) 4 0 4 0 4
93 High Elastic Bandage Roll 8 0 8 0 8
94 HCG Strip Strip 0 0 0 0 0
95 Infusion Set Anak Pcs 144 0 144 0 144
96 I.V. Insert 6 x 7 Pcs 100 0 100 0 100
97 Jelco No.18 G I.V Catheter Pcs 240 0 240 0 240
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 0
99 Jelco No.22 G I.V Catheter Pcs 229 0 229 0 229
100 Jelco No.24 G I.V Catheter Pcs 207 0 207 0 207
101 Jelco No.26 G I.V Catheter Pcs 100 0 100 0 100
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
102 Kapas 100 gr Bungkus 9 0 9 0 9
103 Kapas 500 gr Bungkus 0 0 0 0 0
104 Kasa Hidrofil 16 cm x 16 cm Kotak 321 0 321 0 321
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 0
106 Nasal Canula Neonate Pcs 30 0 30 0 30
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 0
108 Nebulizer Mask Child Pcs 63 0 63 0 63
109 Nebulizer Mask Adult Pcs 43 0 43 0 43
110 Povidone Iodine 10% 60 ml Botol 11 0 11 0 11
111 Pot Dahak Pot 0 0 0 0 0
112 Pot Urine Pot 0 0 0 0 0
113 Rivanol 300 ml Botol 0 0 0 0 0
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 0
115 Sarung Tangan Non steril Pcs 0 0 0 0 0
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 0
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 0
118 Sarung Tangan Steril No. 7.0 Pair 50 0 50 0 50
119 Sarung Tangan Steril No. 7.5 Pair 100 0 100 0 100
120 Surgical Gloves Steril Gynecolog Pair 52 0 52 0 52
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 0
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 0
123 Underpad Pcs 30 0 30 0 30
10 0 10 0 10
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT LABORATORIUM 0 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 0
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 0
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 0
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 0
128 Antigen H Vial 0 0 0 0 0
129 Antigen H-A Vial 0 0 0 0 0
130 Antigen H-B Vial 0 0 0 0 0
131 Antigen H-C Vial 0 0 0 0 0
132 Antigen O-A Vial 0 0 0 0 0
133 Antigen O-B Vial 0 0 0 0 0
134 Antigen O-C Vial 0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
135 Antigen O Vial 0 0 0 0 0
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 0
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 0
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 0
139 Benedict 100mL Botol 0 0 0 0 0
140 EDTA 10% 100mL Botol 0 0 0 0 0
141 Ehrlich 100 ml Botol 0 0 0 0 0
142 Eosin 2% 100 ml Botol 0 0 0 0 0
143 HCl 0,1N 100mL Botol 0 0 0 0 0
144 Hemoglobin C 500mL Botol 0 0 0 0 0
145 Immersion Oil 50 ml Botol 0 0 0 0 0
146 KOH 10% 500 ml Botol 0 0 0 0 0
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 0
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 0
149 Pewarna MDT 3x500mL Botol 0 0 0 0 0
150 Rees Ecker 100 ml Botol 0 0 0 0 0
151 SM Sedimen 500mL Botol 0 0 0 0 0
152 Turk 500 ml Botol 0 0 0 0 0
153 Wright 100 ml Botol 0 0 0 0 0
154 SD Bioline HbSAg Kotak 0 0 0 0 0
155 SD Syphillis 3.0 Kotak 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

( ) ( )
Nip. Nip.
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT OTSUS
( LPLPO ) OTSUS

UPT PKM : (TOLONG DIISI YA NAMANYA) BULAN : JULI

KECAMATAN : (TOLONG DIISI YA NAMANYA) TAHUN : 2023

KABUPATEN : ACEH TIMUR

PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN

KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir 200 mg Tablet 0 0 0 0 tlg diisi

2 Acyclovir Cream Tube 30 30 0 30 tlg diisi
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 tlg diisi
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 36 0 36 tlg diisi
syr)
5 Asam Folat Tablet 0 0 0 0 tlg diisi
6 Attapulgite 630 mg Tablet 0 0 0 0 tlg diisi
7 Bedak Salisil 2% Serbuk Kotak 14 14 0 14 tlg diisi
8 Betahistin Tablet 0 0 0 0 tlg diisi
9 Betametason Tube 0 0 0 0 tlg diisi
10 Bisacodil supp 5 mg Supp 6 6 0 6 tlg diisi
11 Bisacodil supp 10 mg Supp 18 18 0 18 tlg diisi
12 Bromhexin HCL Syrup Botol 0 0 0 0 tlg diisi
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 tlg diisi
14 Clobazam 10 mg Tablet 3 3 0 3 tlg diisi
15 Curcuma Force Tablet 95 95 0 95 tlg diisi
16 Dexamethason Tab 0,5 mg Tablet 3952 3952 0 3952 tlg diisi
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 tlg diisi
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 5 5 0 5 tlg diisi
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 tlg diisi
20 Digoksin 0.25 mg Tablet 100 100 0 100 tlg diisi
21 Diphenhidramin Inj Ampul 0 0 0 0 tlg diisi
22 Erytromicin 500 mg Tablet 19 19 0 19 tlg diisi
23 Furosemid 40 mg Tablet 123 123 0 123 tlg diisi
24 Furosemid Inj 10 mg/ml Ampul 10 10 0 10 tlg diisi
25 Gentamisin Salep Mata Tube 1 1 0 1 tlg diisi
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 tlg diisi
27 Griseofulvin Tablet 0 0 0 0 tlg diisi
28 Hidroklorotiazid 25 mg Tablet 1 1 0 1 tlg diisi
29 Ibuprofen Tab 200 mg Tablet 4 4 0 4 tlg diisi
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 tlg diisi
31 Isosorbid Dinitrat 5 mg Tablet 301 301 0 301 tlg diisi
32 Kalium Diclofenac 50 mg Tablet 36 36 0 36 tlg diisi
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 tlg diisi
34 Kaptopril 25 mg Tablet 0 0 0 0 tlg diisi
35 kalium Permanganat 5 gr Pot 3 3 0 3 tlg diisi
36 Ketokonazole 2 % Tube 75 75 0 75 tlg diisi
37 Klindamicin 150 mg Kapsul 16 16 0 16 tlg diisi
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 tlg diisi
39 Kloramphenicol Salep Mata 1 % Tube 28 28 0 28 tlg diisi
40 Kloramphenicol tetes Mata 0.5% Botol 40 40 0 40 tlg diisi
41 Kloramphenicol tetes telinga Botol 0 0 0 0 tlg diisi
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 tlg diisi
43 Klorpromazin 100 mg Tablet 0 0 0 0 tlg diisi
44 Lansoprazole 30 mg Kapsul 156 156 0 156 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

45 Levofloxacin 500 mg Tablet 0 0 0 0 tlg diisi

46 Lidocain inj 2 % Ampul 0 0 0 0 tlg diisi
47 Loperamid 2 mg Tablet 606 606 0 606 tlg diisi
48 Meloxicam 15 mg Tablet 0 0 0 0 tlg diisi
49 Methisoprinol Tablet 0 0 0 0 tlg diisi
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 tlg diisi
51 Metronidazol 500 mg Tablet 1075 1075 0 1075 tlg diisi
52 Mikonazol krim 2 % Tube 0 0 0 0 tlg diisi
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 tlg diisi
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 0 0 tlg diisi
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 tlg diisi
56 Nistatin drop Botol 1 1 0 1 tlg diisi
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 tlg diisi
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 tlg diisi
59 Paracetamol 500 mg Tablet 0 0 0 0 tlg diisi
60 Piridoksin Tablet 0 0 0 0 tlg diisi
61 Piroxicam 10 mg Tablet 0 0 0 0 tlg diisi
62 Risperidon 2 mg Tablet 0 0 0 0 tlg diisi
63 Salbutamol 4 mg Tablet 0 0 0 0 tlg diisi
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 tlg diisi
65 Sefadroksil 500 mg Kapsul 0 0 0 0 tlg diisi
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 tlg diisi
67 Sianocobalamin inj Ampul 75 75 0 75 tlg diisi
68 Thiamin Inj Ampul 0 0 0 0 tlg diisi
69 Thiamin 50 mg Tablet 1962 1962 0 1962 tlg diisi
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 tlg diisi
71 Ventolin Nebule Vial 0 0 0 0 tlg diisi
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0 0 0
72 Master Bond Botol 0 0 0 0 tlg diisi
73 Orafil Plus Temporary Botol 0 0 0 0 tlg diisi
74 Absorbent Paper Point Box 0 0 0 0 tlg diisi
75 Root Canal Sealer Box 0 0 0 0 tlg diisi
76 Zinc F+ Box 0 0 0 0 tlg diisi
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 tlg diisi
78 Cresotin Paste Pot 0 0 0 0 tlg diisi
79 Iodotin Paste Pot 0 0 0 0 tlg diisi
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BMHP 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 79 0 79 tlg diisi
81 Alat Suntik 3 cc Pcs 183 183 0 183 tlg diisi
82 Alat Suntik 5 cc Pcs 90 90 0 90 tlg diisi
83 Alat Suntik 10 cc Pcs 0 0 0 0 tlg diisi
84 Alkohol 70 % 300 ml Botol 0 0 0 0 tlg diisi
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

86 Blood Lancet Pcs 300 300 0 300 tlg diisi

87 Cavida Gel Tube 10 10 0 10 tlg diisi
88 Desinfectan Spray ( Baymed ) 750 ml Botol 7 7 0 7 tlg diisi
89 Etil Klorida Semprot Botol 0 0 0 0 tlg diisi
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 tlg diisi
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 tlg diisi
92 Hand Scrub 4 % 500 ml ( Baymed ) 4 4 0 4 tlg diisi
93 High Elastic Bandage Roll 8 8 0 8 tlg diisi
94 HCG Strip Strip 0 0 0 0 tlg diisi
95 Infusion Set Anak Pcs 144 144 0 144 tlg diisi
96 I.V. Insert 6 x 7 Pcs 100 100 0 100 tlg diisi
97 Jelco No.18 G I.V Catheter Pcs 240 240 0 240 tlg diisi
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 tlg diisi
99 Jelco No.22 G I.V Catheter Pcs 229 229 0 229 tlg diisi
100 Jelco No.24 G I.V Catheter Pcs 207 207 0 207 tlg diisi
101 Jelco No.26 G I.V Catheter Pcs 100 100 0 100 tlg diisi
102 Kapas 100 gr Bungkus 9 9 0 9 tlg diisi
103 Kapas 500 gr Bungkus 0 0 0 0 tlg diisi
104 Kasa Hidrofil 16 cm x 16 cm Kotak 321 321 0 321 tlg diisi
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 tlg diisi
106 Nasal Canula Neonate Pcs 30 30 0 30 tlg diisi
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 tlg diisi
108 Nebulizer Mask Child Pcs 63 63 0 63 tlg diisi
109 Nebulizer Mask Adult Pcs 43 43 0 43 tlg diisi
110 Povidone Iodine 10% 60 ml Botol 11 11 0 11 tlg diisi
111 Pot Dahak Pot 0 0 0 0 tlg diisi
112 Pot Urine Pot 0 0 0 0 tlg diisi
113 Rivanol 300 ml Botol 0 0 0 0 tlg diisi
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 tlg diisi
115 Sarung Tangan Non steril Pcs 0 0 0 0 tlg diisi
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 tlg diisi
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 tlg diisi
118 Sarung Tangan Steril No. 7.0 Pair 50 50 0 50 tlg diisi
119 Sarung Tangan Steril No. 7.5 Pair 100 100 0 100 tlg diisi
120 Surgical Gloves Steril Gynecolog Pair 52 52 0 52 tlg diisi
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 tlg diisi
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 tlg diisi
123 Underpad Pcs 30 30 0 30 tlg diisi
10 10 0 10
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT LABORATORIUM 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 tlg diisi
128 Antigen H Vial 0 0 0 0 tlg diisi
129 Antigen H-A Vial 0 0 0 0 tlg diisi
130 Antigen H-B Vial 0 0 0 0 tlg diisi
131 Antigen H-C Vial 0 0 0 0 tlg diisi
132 Antigen O-A Vial 0 0 0 0 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

133 Antigen O-B Vial 0 0 0 0 tlg diisi

134 Antigen O-C Vial 0 0 0 0 tlg diisi
135 Antigen O Vial 0 0 0 0 tlg diisi
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 tlg diisi
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 tlg diisi
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 tlg diisi
139 Benedict 100mL Botol 0 0 0 0 tlg diisi
140 EDTA 10% 100mL Botol 0 0 0 0 tlg diisi
141 Ehrlich 100 ml Botol 0 0 0 0 tlg diisi
142 Eosin 2% 100 ml Botol 0 0 0 0 tlg diisi
143 HCl 0,1N 100mL Botol 0 0 0 0 tlg diisi
144 Hemoglobin C 500mL Botol 0 0 0 0 tlg diisi
145 Immersion Oil 50 ml Botol 0 0 0 0 tlg diisi
146 KOH 10% 500 ml Botol 0 0 0 0 tlg diisi
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 tlg diisi
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 tlg diisi
149 Pewarna MDT 3x500mL Botol 0 0 0 0 tlg diisi
150 Rees Ecker 100 ml Botol 0 0 0 0 tlg diisi
151 SM Sedimen 500mL Botol 0 0 0 0 tlg diisi
152 Turk 500 ml Botol 0 0 0 0 tlg diisi
153 Wright 100 ml Botol 0 0 0 0 tlg diisi
154 SD Bioline HbSAg Kotak 0 0 0 0 tlg diisi
155 SD Syphillis 3.0 Kotak 0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

( ) ( )
Nip Nip
 LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) OTSUS
BULAN JULI 2023
PUSKESMAS : ( tlg diisi )
Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
1 Acyclovir 200 mg Tablet 0 0 0 0 0
2 Acyclovir Cream Tube 30 0 30 0 30
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 0
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 0 36 0 36
syr)
5 Asam Folat Tablet 0 0 0 0 0
6 Attapulgite 630 mg Tablet 0 0 0 0 0
7 Bedak Salisil 2% Serbuk Kotak 14 0 14 0 14
8 Betahistin Tablet 0 0 0 0 0
9 Betametason Tube 0 0 0 0 0
10 Bisacodil supp 5 mg Supp 6 0 6 0 6
11 Bisacodil supp 10 mg Supp 18 0 18 0 18
12 Bromhexin HCL Syrup Botol 0 0 0 0 0
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 0
14 Clobazam 10 mg Tablet 3 0 3 0 3
15 Curcuma Force Tablet 95 0 95 0 95
16 Dexamethason Tab 0,5 mg Tablet 3952 0 3952 0 3952
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 0
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 5 0 5 0 5
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 0
20 Digoksin 0.25 mg Tablet 100 0 100 0 100
21 Diphenhidramin Inj Ampul 0 0 0 0 0
22 Erytromicin 500 mg Tablet 19 0 19 0 19
23 Furosemid 40 mg Tablet 123 0 123 0 123
24 Furosemid Inj 10 mg/ml Ampul 10 0 10 0 10
25 Gentamisin Salep Mata Tube 1 0 1 0 1
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 0
27 Griseofulvin Tablet 0 0 0 0 0
28 Hidroklorotiazid 25 mg Tablet 1 0 1 0 1
29 Ibuprofen Tab 200 mg Tablet 4 0 4 0 4
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 0
31 Isosorbid Dinitrat 5 mg Tablet 301 0 301 0 301
32 Kalium Diclofenac 50 mg Tablet 36 0 36 0 36
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 0
34 Kaptopril 25 mg Tablet 0 0 0 0 0
35 kalium Permanganat 5 gr Pot 3 0 3 0 3
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
36 Ketokonazole 2 % Tube 75 0 75 0 75
37 Klindamicin 150 mg Kapsul 16 0 16 0 16
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 0
39 Kloramphenicol Salep Mata 1 % Tube 28 0 28 0 28
40 Kloramphenicol tetes Mata 0.5% Botol 40 0 40 0 40
41 Kloramphenicol tetes telinga Botol 0 0 0 0 0
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 0
43 Klorpromazin 100 mg Tablet 0 0 0 0 0
44 Lansoprazole 30 mg Kapsul 156 0 156 0 156
45 Levofloxacin 500 mg Tablet 0 0 0 0 0
46 Lidocain inj 2 % Ampul 0 0 0 0 0
47 Loperamid 2 mg Tablet 606 0 606 0 606
48 Meloxicam 15 mg Tablet 0 0 0 0 0
49 Methisoprinol Tablet 0 0 0 0 0
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 0
51 Metronidazol 500 mg Tablet 1075 0 1075 0 1075
52 Mikonazol krim 2 % Tube 0 0 0 0 0
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 0
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 0 0 0
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 0
56 Nistatin drop Botol 1 0 1 0 1
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 0
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0 0 0
60 Piridoksin Tablet 0 0 0 0 0
61 Piroxicam 10 mg Tablet 0 0 0 0 0
62 Risperidon 2 mg Tablet 0 0 0 0 0
63 Salbutamol 4 mg Tablet 0 0 0 0 0
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 0
65 Sefadroksil 500 mg Kapsul 0 0 0 0 0
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0
67 Sianocobalamin inj Ampul 75 0 75 0 75
68 Thiamin Inj Ampul 0 0 0 0 0
69 Thiamin 50 mg Tablet 1962 0 1962 0 1962
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 0
71 Ventolin Nebule Vial 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0
72 Master Bond Botol 0 0 0 0 0
73 Orafil Plus Temporary Botol 0 0 0 0 0
74 Absorbent Paper Point Box 0 0 0 0 0
75 Root Canal Sealer Box 0 0 0 0 0
76 Zinc F+ Box 0 0 0 0 0
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 0
78 Cresotin Paste Pot 0 0 0 0 0
79 Iodotin Paste Pot 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
BMHP 0 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 0 79 0 79
81 Alat Suntik 3 cc Pcs 183 0 183 0 183
82 Alat Suntik 5 cc Pcs 90 0 90 0 90
83 Alat Suntik 10 cc Pcs 0 0 0 0 0
84 Alkohol 70 % 300 ml Botol 0 0 0 0 0
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 0
86 Blood Lancet Pcs 300 0 300 0 300
87 Cavida Gel Tube 10 0 10 0 10
88 Desinfectan Spray ( Baymed ) 750 ml Botol 7 0 7 0 7
89 Etil Klorida Semprot Botol 0 0 0 0 0
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 0
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 0
92 Hand Scrub 4 % 500 ml ( Baymed ) 4 0 4 0 4
93 High Elastic Bandage Roll 8 0 8 0 8
94 HCG Strip Strip 0 0 0 0 0
95 Infusion Set Anak Pcs 144 0 144 0 144
96 I.V. Insert 6 x 7 Pcs 100 0 100 0 100
97 Jelco No.18 G I.V Catheter Pcs 240 0 240 0 240
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 0
99 Jelco No.22 G I.V Catheter Pcs 229 0 229 0 229
100 Jelco No.24 G I.V Catheter Pcs 207 0 207 0 207
101 Jelco No.26 G I.V Catheter Pcs 100 0 100 0 100
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
102 Kapas 100 gr Bungkus 9 0 9 0 9
103 Kapas 500 gr Bungkus 0 0 0 0 0
104 Kasa Hidrofil 16 cm x 16 cm Kotak 321 0 321 0 321
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 0
106 Nasal Canula Neonate Pcs 30 0 30 0 30
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 0
108 Nebulizer Mask Child Pcs 63 0 63 0 63
109 Nebulizer Mask Adult Pcs 43 0 43 0 43
110 Povidone Iodine 10% 60 ml Botol 11 0 11 0 11
111 Pot Dahak Pot 0 0 0 0 0
112 Pot Urine Pot 0 0 0 0 0
113 Rivanol 300 ml Botol 0 0 0 0 0
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 0
115 Sarung Tangan Non steril Pcs 0 0 0 0 0
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 0
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 0
118 Sarung Tangan Steril No. 7.0 Pair 50 0 50 0 50
119 Sarung Tangan Steril No. 7.5 Pair 100 0 100 0 100
120 Surgical Gloves Steril Gynecolog Pair 52 0 52 0 52
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 0
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 0
123 Underpad Pcs 30 0 30 0 30
10 0 10 0 10
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT LABORATORIUM 0 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 0
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 0
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 0
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 0
128 Antigen H Vial 0 0 0 0 0
129 Antigen H-A Vial 0 0 0 0 0
130 Antigen H-B Vial 0 0 0 0 0
131 Antigen H-C Vial 0 0 0 0 0
132 Antigen O-A Vial 0 0 0 0 0
133 Antigen O-B Vial 0 0 0 0 0
134 Antigen O-C Vial 0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
135 Antigen O Vial 0 0 0 0 0
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 0
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 0
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 0
139 Benedict 100mL Botol 0 0 0 0 0
140 EDTA 10% 100mL Botol 0 0 0 0 0
141 Ehrlich 100 ml Botol 0 0 0 0 0
142 Eosin 2% 100 ml Botol 0 0 0 0 0
143 HCl 0,1N 100mL Botol 0 0 0 0 0
144 Hemoglobin C 500mL Botol 0 0 0 0 0
145 Immersion Oil 50 ml Botol 0 0 0 0 0
146 KOH 10% 500 ml Botol 0 0 0 0 0
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 0
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 0
149 Pewarna MDT 3x500mL Botol 0 0 0 0 0
150 Rees Ecker 100 ml Botol 0 0 0 0 0
151 SM Sedimen 500mL Botol 0 0 0 0 0
152 Turk 500 ml Botol 0 0 0 0 0
153 Wright 100 ml Botol 0 0 0 0 0
154 SD Bioline HbSAg Kotak 0 0 0 0 0
155 SD Syphillis 3.0 Kotak 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

( ) ( )
Nip. Nip.
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT OTSUS
( LPLPO ) OTSUS

UPT PKM : (TOLONG DIISI YA NAMANYA) BULAN : AGUSTUS

KECAMATAN : (TOLONG DIISI YA NAMANYA) TAHUN : 2023

KABUPATEN : ACEH TIMUR

PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN

KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir 200 mg Tablet 0 0 0 0 tlg diisi

2 Acyclovir Cream Tube 30 30 0 30 tlg diisi
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 tlg diisi
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 36 0 36 tlg diisi
syr)
5 Asam Folat Tablet 0 0 0 0 tlg diisi
6 Attapulgite 630 mg Tablet 0 0 0 0 tlg diisi
7 Bedak Salisil 2% Serbuk Kotak 14 14 0 14 tlg diisi
8 Betahistin Tablet 0 0 0 0 tlg diisi
9 Betametason Tube 0 0 0 0 tlg diisi
10 Bisacodil supp 5 mg Supp 6 6 0 6 tlg diisi
11 Bisacodil supp 10 mg Supp 18 18 0 18 tlg diisi
12 Bromhexin HCL Syrup Botol 0 0 0 0 tlg diisi
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 tlg diisi
14 Clobazam 10 mg Tablet 3 3 0 3 tlg diisi
15 Curcuma Force Tablet 95 95 0 95 tlg diisi
16 Dexamethason Tab 0,5 mg Tablet 3952 3952 0 3952 tlg diisi
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 tlg diisi
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 5 5 0 5 tlg diisi
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 tlg diisi
20 Digoksin 0.25 mg Tablet 100 100 0 100 tlg diisi
21 Diphenhidramin Inj Ampul 0 0 0 0 tlg diisi
22 Erytromicin 500 mg Tablet 19 19 0 19 tlg diisi
23 Furosemid 40 mg Tablet 123 123 0 123 tlg diisi
24 Furosemid Inj 10 mg/ml Ampul 10 10 0 10 tlg diisi
25 Gentamisin Salep Mata Tube 1 1 0 1 tlg diisi
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 tlg diisi
27 Griseofulvin Tablet 0 0 0 0 tlg diisi
28 Hidroklorotiazid 25 mg Tablet 1 1 0 1 tlg diisi
29 Ibuprofen Tab 200 mg Tablet 4 4 0 4 tlg diisi
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 tlg diisi
31 Isosorbid Dinitrat 5 mg Tablet 301 301 0 301 tlg diisi
32 Kalium Diclofenac 50 mg Tablet 36 36 0 36 tlg diisi
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 tlg diisi
34 Kaptopril 25 mg Tablet 0 0 0 0 tlg diisi
35 kalium Permanganat 5 gr Pot 3 3 0 3 tlg diisi
36 Ketokonazole 2 % Tube 75 75 0 75 tlg diisi
37 Klindamicin 150 mg Kapsul 16 16 0 16 tlg diisi
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 tlg diisi
39 Kloramphenicol Salep Mata 1 % Tube 28 28 0 28 tlg diisi
40 Kloramphenicol tetes Mata 0.5% Botol 40 40 0 40 tlg diisi
41 Kloramphenicol tetes telinga Botol 0 0 0 0 tlg diisi
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 tlg diisi
43 Klorpromazin 100 mg Tablet 0 0 0 0 tlg diisi
44 Lansoprazole 30 mg Kapsul 156 156 0 156 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

45 Levofloxacin 500 mg Tablet 0 0 0 0 tlg diisi

46 Lidocain inj 2 % Ampul 0 0 0 0 tlg diisi
47 Loperamid 2 mg Tablet 606 606 0 606 tlg diisi
48 Meloxicam 15 mg Tablet 0 0 0 0 tlg diisi
49 Methisoprinol Tablet 0 0 0 0 tlg diisi
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 tlg diisi
51 Metronidazol 500 mg Tablet 1075 1075 0 1075 tlg diisi
52 Mikonazol krim 2 % Tube 0 0 0 0 tlg diisi
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 tlg diisi
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 0 0 tlg diisi
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 tlg diisi
56 Nistatin drop Botol 1 1 0 1 tlg diisi
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 tlg diisi
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 tlg diisi
59 Paracetamol 500 mg Tablet 0 0 0 0 tlg diisi
60 Piridoksin Tablet 0 0 0 0 tlg diisi
61 Piroxicam 10 mg Tablet 0 0 0 0 tlg diisi
62 Risperidon 2 mg Tablet 0 0 0 0 tlg diisi
63 Salbutamol 4 mg Tablet 0 0 0 0 tlg diisi
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 tlg diisi
65 Sefadroksil 500 mg Kapsul 0 0 0 0 tlg diisi
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 tlg diisi
67 Sianocobalamin inj Ampul 75 75 0 75 tlg diisi
68 Thiamin Inj Ampul 0 0 0 0 tlg diisi
69 Thiamin 50 mg Tablet 1962 1962 0 1962 tlg diisi
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 tlg diisi
71 Ventolin Nebule Vial 0 0 0 0 tlg diisi
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0 0 0
72 Master Bond Botol 0 0 0 0 tlg diisi
73 Orafil Plus Temporary Botol 0 0 0 0 tlg diisi
74 Absorbent Paper Point Box 0 0 0 0 tlg diisi
75 Root Canal Sealer Box 0 0 0 0 tlg diisi
76 Zinc F+ Box 0 0 0 0 tlg diisi
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 tlg diisi
78 Cresotin Paste Pot 0 0 0 0 tlg diisi
79 Iodotin Paste Pot 0 0 0 0 tlg diisi
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BMHP 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 79 0 79 tlg diisi
81 Alat Suntik 3 cc Pcs 183 183 0 183 tlg diisi
82 Alat Suntik 5 cc Pcs 90 90 0 90 tlg diisi
83 Alat Suntik 10 cc Pcs 0 0 0 0 tlg diisi
84 Alkohol 70 % 300 ml Botol 0 0 0 0 tlg diisi
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

86 Blood Lancet Pcs 300 300 0 300 tlg diisi

87 Cavida Gel Tube 10 10 0 10 tlg diisi
88 Desinfectan Spray ( Baymed ) 750 ml Botol 7 7 0 7 tlg diisi
89 Etil Klorida Semprot Botol 0 0 0 0 tlg diisi
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 tlg diisi
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 tlg diisi
92 Hand Scrub 4 % 500 ml ( Baymed ) 4 4 0 4 tlg diisi
93 High Elastic Bandage Roll 8 8 0 8 tlg diisi
94 HCG Strip Strip 0 0 0 0 tlg diisi
95 Infusion Set Anak Pcs 144 144 0 144 tlg diisi
96 I.V. Insert 6 x 7 Pcs 100 100 0 100 tlg diisi
97 Jelco No.18 G I.V Catheter Pcs 240 240 0 240 tlg diisi
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 tlg diisi
99 Jelco No.22 G I.V Catheter Pcs 229 229 0 229 tlg diisi
100 Jelco No.24 G I.V Catheter Pcs 207 207 0 207 tlg diisi
101 Jelco No.26 G I.V Catheter Pcs 100 100 0 100 tlg diisi
102 Kapas 100 gr Bungkus 9 9 0 9 tlg diisi
103 Kapas 500 gr Bungkus 0 0 0 0 tlg diisi
104 Kasa Hidrofil 16 cm x 16 cm Kotak 321 321 0 321 tlg diisi
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 tlg diisi
106 Nasal Canula Neonate Pcs 30 30 0 30 tlg diisi
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 tlg diisi
108 Nebulizer Mask Child Pcs 63 63 0 63 tlg diisi
109 Nebulizer Mask Adult Pcs 43 43 0 43 tlg diisi
110 Povidone Iodine 10% 60 ml Botol 11 11 0 11 tlg diisi
111 Pot Dahak Pot 0 0 0 0 tlg diisi
112 Pot Urine Pot 0 0 0 0 tlg diisi
113 Rivanol 300 ml Botol 0 0 0 0 tlg diisi
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 tlg diisi
115 Sarung Tangan Non steril Pcs 0 0 0 0 tlg diisi
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 tlg diisi
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 tlg diisi
118 Sarung Tangan Steril No. 7.0 Pair 50 50 0 50 tlg diisi
119 Sarung Tangan Steril No. 7.5 Pair 100 100 0 100 tlg diisi
120 Surgical Gloves Steril Gynecolog Pair 52 52 0 52 tlg diisi
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 tlg diisi
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 tlg diisi
123 Underpad Pcs 30 30 0 30 tlg diisi
10 10 0 10
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT LABORATORIUM 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 tlg diisi
128 Antigen H Vial 0 0 0 0 tlg diisi
129 Antigen H-A Vial 0 0 0 0 tlg diisi
130 Antigen H-B Vial 0 0 0 0 tlg diisi
131 Antigen H-C Vial 0 0 0 0 tlg diisi
132 Antigen O-A Vial 0 0 0 0 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

133 Antigen O-B Vial 0 0 0 0 tlg diisi

134 Antigen O-C Vial 0 0 0 0 tlg diisi
135 Antigen O Vial 0 0 0 0 tlg diisi
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 tlg diisi
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 tlg diisi
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 tlg diisi
139 Benedict 100mL Botol 0 0 0 0 tlg diisi
140 EDTA 10% 100mL Botol 0 0 0 0 tlg diisi
141 Ehrlich 100 ml Botol 0 0 0 0 tlg diisi
142 Eosin 2% 100 ml Botol 0 0 0 0 tlg diisi
143 HCl 0,1N 100mL Botol 0 0 0 0 tlg diisi
144 Hemoglobin C 500mL Botol 0 0 0 0 tlg diisi
145 Immersion Oil 50 ml Botol 0 0 0 0 tlg diisi
146 KOH 10% 500 ml Botol 0 0 0 0 tlg diisi
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 tlg diisi
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 tlg diisi
149 Pewarna MDT 3x500mL Botol 0 0 0 0 tlg diisi
150 Rees Ecker 100 ml Botol 0 0 0 0 tlg diisi
151 SM Sedimen 500mL Botol 0 0 0 0 tlg diisi
152 Turk 500 ml Botol 0 0 0 0 tlg diisi
153 Wright 100 ml Botol 0 0 0 0 tlg diisi
154 SD Bioline HbSAg Kotak 0 0 0 0 tlg diisi
155 SD Syphillis 3.0 Kotak 0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

( ) ( )
Nip Nip
 LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) OTSUS
BULAN AGUSTUS 2023
PUSKESMAS : ( tlg diisi )
Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
1 Acyclovir 200 mg Tablet 0 0 0 0 0
2 Acyclovir Cream Tube 30 0 30 0 30
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 0
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 0 36 0 36
syr)
5 Asam Folat Tablet 0 0 0 0 0
6 Attapulgite 630 mg Tablet 0 0 0 0 0
7 Bedak Salisil 2% Serbuk Kotak 14 0 14 0 14
8 Betahistin Tablet 0 0 0 0 0
9 Betametason Tube 0 0 0 0 0
10 Bisacodil supp 5 mg Supp 6 0 6 0 6
11 Bisacodil supp 10 mg Supp 18 0 18 0 18
12 Bromhexin HCL Syrup Botol 0 0 0 0 0
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 0
14 Clobazam 10 mg Tablet 3 0 3 0 3
15 Curcuma Force Tablet 95 0 95 0 95
16 Dexamethason Tab 0,5 mg Tablet 3952 0 3952 0 3952
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 0
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 5 0 5 0 5
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 0
20 Digoksin 0.25 mg Tablet 100 0 100 0 100
21 Diphenhidramin Inj Ampul 0 0 0 0 0
22 Erytromicin 500 mg Tablet 19 0 19 0 19
23 Furosemid 40 mg Tablet 123 0 123 0 123
24 Furosemid Inj 10 mg/ml Ampul 10 0 10 0 10
25 Gentamisin Salep Mata Tube 1 0 1 0 1
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 0
27 Griseofulvin Tablet 0 0 0 0 0
28 Hidroklorotiazid 25 mg Tablet 1 0 1 0 1
29 Ibuprofen Tab 200 mg Tablet 4 0 4 0 4
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 0
31 Isosorbid Dinitrat 5 mg Tablet 301 0 301 0 301
32 Kalium Diclofenac 50 mg Tablet 36 0 36 0 36
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 0
34 Kaptopril 25 mg Tablet 0 0 0 0 0
35 kalium Permanganat 5 gr Pot 3 0 3 0 3
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
36 Ketokonazole 2 % Tube 75 0 75 0 75
37 Klindamicin 150 mg Kapsul 16 0 16 0 16
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 0
39 Kloramphenicol Salep Mata 1 % Tube 28 0 28 0 28
40 Kloramphenicol tetes Mata 0.5% Botol 40 0 40 0 40
41 Kloramphenicol tetes telinga Botol 0 0 0 0 0
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 0
43 Klorpromazin 100 mg Tablet 0 0 0 0 0
44 Lansoprazole 30 mg Kapsul 156 0 156 0 156
45 Levofloxacin 500 mg Tablet 0 0 0 0 0
46 Lidocain inj 2 % Ampul 0 0 0 0 0
47 Loperamid 2 mg Tablet 606 0 606 0 606
48 Meloxicam 15 mg Tablet 0 0 0 0 0
49 Methisoprinol Tablet 0 0 0 0 0
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 0
51 Metronidazol 500 mg Tablet 1075 0 1075 0 1075
52 Mikonazol krim 2 % Tube 0 0 0 0 0
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 0
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 0 0 0
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 0
56 Nistatin drop Botol 1 0 1 0 1
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 0
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0 0 0
60 Piridoksin Tablet 0 0 0 0 0
61 Piroxicam 10 mg Tablet 0 0 0 0 0
62 Risperidon 2 mg Tablet 0 0 0 0 0
63 Salbutamol 4 mg Tablet 0 0 0 0 0
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 0
65 Sefadroksil 500 mg Kapsul 0 0 0 0 0
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0
67 Sianocobalamin inj Ampul 75 0 75 0 75
68 Thiamin Inj Ampul 0 0 0 0 0
69 Thiamin 50 mg Tablet 1962 0 1962 0 1962
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 0
71 Ventolin Nebule Vial 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0
72 Master Bond Botol 0 0 0 0 0
73 Orafil Plus Temporary Botol 0 0 0 0 0
74 Absorbent Paper Point Box 0 0 0 0 0
75 Root Canal Sealer Box 0 0 0 0 0
76 Zinc F+ Box 0 0 0 0 0
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 0
78 Cresotin Paste Pot 0 0 0 0 0
79 Iodotin Paste Pot 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
BMHP 0 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 0 79 0 79
81 Alat Suntik 3 cc Pcs 183 0 183 0 183
82 Alat Suntik 5 cc Pcs 90 0 90 0 90
83 Alat Suntik 10 cc Pcs 0 0 0 0 0
84 Alkohol 70 % 300 ml Botol 0 0 0 0 0
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 0
86 Blood Lancet Pcs 300 0 300 0 300
87 Cavida Gel Tube 10 0 10 0 10
88 Desinfectan Spray ( Baymed ) 750 ml Botol 7 0 7 0 7
89 Etil Klorida Semprot Botol 0 0 0 0 0
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 0
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 0
92 Hand Scrub 4 % 500 ml ( Baymed ) 4 0 4 0 4
93 High Elastic Bandage Roll 8 0 8 0 8
94 HCG Strip Strip 0 0 0 0 0
95 Infusion Set Anak Pcs 144 0 144 0 144
96 I.V. Insert 6 x 7 Pcs 100 0 100 0 100
97 Jelco No.18 G I.V Catheter Pcs 240 0 240 0 240
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 0
99 Jelco No.22 G I.V Catheter Pcs 229 0 229 0 229
100 Jelco No.24 G I.V Catheter Pcs 207 0 207 0 207
101 Jelco No.26 G I.V Catheter Pcs 100 0 100 0 100
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
102 Kapas 100 gr Bungkus 9 0 9 0 9
103 Kapas 500 gr Bungkus 0 0 0 0 0
104 Kasa Hidrofil 16 cm x 16 cm Kotak 321 0 321 0 321
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 0
106 Nasal Canula Neonate Pcs 30 0 30 0 30
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 0
108 Nebulizer Mask Child Pcs 63 0 63 0 63
109 Nebulizer Mask Adult Pcs 43 0 43 0 43
110 Povidone Iodine 10% 60 ml Botol 11 0 11 0 11
111 Pot Dahak Pot 0 0 0 0 0
112 Pot Urine Pot 0 0 0 0 0
113 Rivanol 300 ml Botol 0 0 0 0 0
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 0
115 Sarung Tangan Non steril Pcs 0 0 0 0 0
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 0
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 0
118 Sarung Tangan Steril No. 7.0 Pair 50 0 50 0 50
119 Sarung Tangan Steril No. 7.5 Pair 100 0 100 0 100
120 Surgical Gloves Steril Gynecolog Pair 52 0 52 0 52
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 0
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 0
123 Underpad Pcs 30 0 30 0 30
10 0 10 0 10
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT LABORATORIUM 0 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 0
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 0
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 0
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 0
128 Antigen H Vial 0 0 0 0 0
129 Antigen H-A Vial 0 0 0 0 0
130 Antigen H-B Vial 0 0 0 0 0
131 Antigen H-C Vial 0 0 0 0 0
132 Antigen O-A Vial 0 0 0 0 0
133 Antigen O-B Vial 0 0 0 0 0
134 Antigen O-C Vial 0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
135 Antigen O Vial 0 0 0 0 0
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 0
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 0
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 0
139 Benedict 100mL Botol 0 0 0 0 0
140 EDTA 10% 100mL Botol 0 0 0 0 0
141 Ehrlich 100 ml Botol 0 0 0 0 0
142 Eosin 2% 100 ml Botol 0 0 0 0 0
143 HCl 0,1N 100mL Botol 0 0 0 0 0
144 Hemoglobin C 500mL Botol 0 0 0 0 0
145 Immersion Oil 50 ml Botol 0 0 0 0 0
146 KOH 10% 500 ml Botol 0 0 0 0 0
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 0
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 0
149 Pewarna MDT 3x500mL Botol 0 0 0 0 0
150 Rees Ecker 100 ml Botol 0 0 0 0 0
151 SM Sedimen 500mL Botol 0 0 0 0 0
152 Turk 500 ml Botol 0 0 0 0 0
153 Wright 100 ml Botol 0 0 0 0 0
154 SD Bioline HbSAg Kotak 0 0 0 0 0
155 SD Syphillis 3.0 Kotak 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

( ) ( )
Nip. Nip.
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT OTSUS
( LPLPO ) OTSUS

UPT PKM : (TOLONG DIISI YA NAMANYA) BULAN : SEPTEMBER

KECAMATAN : (TOLONG DIISI YA NAMANYA) TAHUN : 2023

KABUPATEN : ACEH TIMUR

PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN

KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir 200 mg Tablet 0 0 0 0 tlg diisi

2 Acyclovir Cream Tube 30 30 0 30 tlg diisi
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 tlg diisi
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 36 0 36 tlg diisi
syr)
5 Asam Folat Tablet 0 0 0 0 tlg diisi
6 Attapulgite 630 mg Tablet 0 0 0 0 tlg diisi
7 Bedak Salisil 2% Serbuk Kotak 14 14 0 14 tlg diisi
8 Betahistin Tablet 0 0 0 0 tlg diisi
9 Betametason Tube 0 0 0 0 tlg diisi
10 Bisacodil supp 5 mg Supp 6 6 0 6 tlg diisi
11 Bisacodil supp 10 mg Supp 18 18 0 18 tlg diisi
12 Bromhexin HCL Syrup Botol 0 0 0 0 tlg diisi
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 tlg diisi
14 Clobazam 10 mg Tablet 3 3 0 3 tlg diisi
15 Curcuma Force Tablet 95 95 0 95 tlg diisi
16 Dexamethason Tab 0,5 mg Tablet 3952 3952 0 3952 tlg diisi
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 tlg diisi
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 5 5 0 5 tlg diisi
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 tlg diisi
20 Digoksin 0.25 mg Tablet 100 100 0 100 tlg diisi
21 Diphenhidramin Inj Ampul 0 0 0 0 tlg diisi
22 Erytromicin 500 mg Tablet 19 19 0 19 tlg diisi
23 Furosemid 40 mg Tablet 123 123 0 123 tlg diisi
24 Furosemid Inj 10 mg/ml Ampul 10 10 0 10 tlg diisi
25 Gentamisin Salep Mata Tube 1 1 0 1 tlg diisi
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 tlg diisi
27 Griseofulvin Tablet 0 0 0 0 tlg diisi
28 Hidroklorotiazid 25 mg Tablet 1 1 0 1 tlg diisi
29 Ibuprofen Tab 200 mg Tablet 4 4 0 4 tlg diisi
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 tlg diisi
31 Isosorbid Dinitrat 5 mg Tablet 301 301 0 301 tlg diisi
32 Kalium Diclofenac 50 mg Tablet 36 36 0 36 tlg diisi
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 tlg diisi
34 Kaptopril 25 mg Tablet 0 0 0 0 tlg diisi
35 kalium Permanganat 5 gr Pot 3 3 0 3 tlg diisi
36 Ketokonazole 2 % Tube 75 75 0 75 tlg diisi
37 Klindamicin 150 mg Kapsul 16 16 0 16 tlg diisi
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 tlg diisi
39 Kloramphenicol Salep Mata 1 % Tube 28 28 0 28 tlg diisi
40 Kloramphenicol tetes Mata 0.5% Botol 40 40 0 40 tlg diisi
41 Kloramphenicol tetes telinga Botol 0 0 0 0 tlg diisi
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 tlg diisi
43 Klorpromazin 100 mg Tablet 0 0 0 0 tlg diisi
44 Lansoprazole 30 mg Kapsul 156 156 0 156 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

45 Levofloxacin 500 mg Tablet 0 0 0 0 tlg diisi

46 Lidocain inj 2 % Ampul 0 0 0 0 tlg diisi
47 Loperamid 2 mg Tablet 606 606 0 606 tlg diisi
48 Meloxicam 15 mg Tablet 0 0 0 0 tlg diisi
49 Methisoprinol Tablet 0 0 0 0 tlg diisi
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 tlg diisi
51 Metronidazol 500 mg Tablet 1075 1075 0 1075 tlg diisi
52 Mikonazol krim 2 % Tube 0 0 0 0 tlg diisi
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 tlg diisi
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 0 0 tlg diisi
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 tlg diisi
56 Nistatin drop Botol 1 1 0 1 tlg diisi
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 tlg diisi
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 tlg diisi
59 Paracetamol 500 mg Tablet 0 0 0 0 tlg diisi
60 Piridoksin Tablet 0 0 0 0 tlg diisi
61 Piroxicam 10 mg Tablet 0 0 0 0 tlg diisi
62 Risperidon 2 mg Tablet 0 0 0 0 tlg diisi
63 Salbutamol 4 mg Tablet 0 0 0 0 tlg diisi
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 tlg diisi
65 Sefadroksil 500 mg Kapsul 0 0 0 0 tlg diisi
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 tlg diisi
67 Sianocobalamin inj Ampul 75 75 0 75 tlg diisi
68 Thiamin Inj Ampul 0 0 0 0 tlg diisi
69 Thiamin 50 mg Tablet 1962 1962 0 1962 tlg diisi
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 tlg diisi
71 Ventolin Nebule Vial 0 0 0 0 tlg diisi
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0 0 0
72 Master Bond Botol 0 0 0 0 tlg diisi
73 Orafil Plus Temporary Botol 0 0 0 0 tlg diisi
74 Absorbent Paper Point Box 0 0 0 0 tlg diisi
75 Root Canal Sealer Box 0 0 0 0 tlg diisi
76 Zinc F+ Box 0 0 0 0 tlg diisi
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 tlg diisi
78 Cresotin Paste Pot 0 0 0 0 tlg diisi
79 Iodotin Paste Pot 0 0 0 0 tlg diisi
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BMHP 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 79 0 79 tlg diisi
81 Alat Suntik 3 cc Pcs 183 183 0 183 tlg diisi
82 Alat Suntik 5 cc Pcs 90 90 0 90 tlg diisi
83 Alat Suntik 10 cc Pcs 0 0 0 0 tlg diisi
84 Alkohol 70 % 300 ml Botol 0 0 0 0 tlg diisi
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

86 Blood Lancet Pcs 300 300 0 300 tlg diisi

87 Cavida Gel Tube 10 10 0 10 tlg diisi
88 Desinfectan Spray ( Baymed ) 750 ml Botol 7 7 0 7 tlg diisi
89 Etil Klorida Semprot Botol 0 0 0 0 tlg diisi
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 tlg diisi
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 tlg diisi
92 Hand Scrub 4 % 500 ml ( Baymed ) 4 4 0 4 tlg diisi
93 High Elastic Bandage Roll 8 8 0 8 tlg diisi
94 HCG Strip Strip 0 0 0 0 tlg diisi
95 Infusion Set Anak Pcs 144 144 0 144 tlg diisi
96 I.V. Insert 6 x 7 Pcs 100 100 0 100 tlg diisi
97 Jelco No.18 G I.V Catheter Pcs 240 240 0 240 tlg diisi
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 tlg diisi
99 Jelco No.22 G I.V Catheter Pcs 229 229 0 229 tlg diisi
100 Jelco No.24 G I.V Catheter Pcs 207 207 0 207 tlg diisi
101 Jelco No.26 G I.V Catheter Pcs 100 100 0 100 tlg diisi
102 Kapas 100 gr Bungkus 9 9 0 9 tlg diisi
103 Kapas 500 gr Bungkus 0 0 0 0 tlg diisi
104 Kasa Hidrofil 16 cm x 16 cm Kotak 321 321 0 321 tlg diisi
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 tlg diisi
106 Nasal Canula Neonate Pcs 30 30 0 30 tlg diisi
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 tlg diisi
108 Nebulizer Mask Child Pcs 63 63 0 63 tlg diisi
109 Nebulizer Mask Adult Pcs 43 43 0 43 tlg diisi
110 Povidone Iodine 10% 60 ml Botol 11 11 0 11 tlg diisi
111 Pot Dahak Pot 0 0 0 0 tlg diisi
112 Pot Urine Pot 0 0 0 0 tlg diisi
113 Rivanol 300 ml Botol 0 0 0 0 tlg diisi
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 tlg diisi
115 Sarung Tangan Non steril Pcs 0 0 0 0 tlg diisi
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 tlg diisi
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 tlg diisi
118 Sarung Tangan Steril No. 7.0 Pair 50 50 0 50 tlg diisi
119 Sarung Tangan Steril No. 7.5 Pair 100 100 0 100 tlg diisi
120 Surgical Gloves Steril Gynecolog Pair 52 52 0 52 tlg diisi
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 tlg diisi
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 tlg diisi
123 Underpad Pcs 30 30 0 30 tlg diisi
10 10 0 10
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT LABORATORIUM 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 tlg diisi
128 Antigen H Vial 0 0 0 0 tlg diisi
129 Antigen H-A Vial 0 0 0 0 tlg diisi
130 Antigen H-B Vial 0 0 0 0 tlg diisi
131 Antigen H-C Vial 0 0 0 0 tlg diisi
132 Antigen O-A Vial 0 0 0 0 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

133 Antigen O-B Vial 0 0 0 0 tlg diisi

134 Antigen O-C Vial 0 0 0 0 tlg diisi
135 Antigen O Vial 0 0 0 0 tlg diisi
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 tlg diisi
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 tlg diisi
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 tlg diisi
139 Benedict 100mL Botol 0 0 0 0 tlg diisi
140 EDTA 10% 100mL Botol 0 0 0 0 tlg diisi
141 Ehrlich 100 ml Botol 0 0 0 0 tlg diisi
142 Eosin 2% 100 ml Botol 0 0 0 0 tlg diisi
143 HCl 0,1N 100mL Botol 0 0 0 0 tlg diisi
144 Hemoglobin C 500mL Botol 0 0 0 0 tlg diisi
145 Immersion Oil 50 ml Botol 0 0 0 0 tlg diisi
146 KOH 10% 500 ml Botol 0 0 0 0 tlg diisi
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 tlg diisi
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 tlg diisi
149 Pewarna MDT 3x500mL Botol 0 0 0 0 tlg diisi
150 Rees Ecker 100 ml Botol 0 0 0 0 tlg diisi
151 SM Sedimen 500mL Botol 0 0 0 0 tlg diisi
152 Turk 500 ml Botol 0 0 0 0 tlg diisi
153 Wright 100 ml Botol 0 0 0 0 tlg diisi
154 SD Bioline HbSAg Kotak 0 0 0 0 tlg diisi
155 SD Syphillis 3.0 Kotak 0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

( ) ( )
Nip Nip
 LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) OTSUS
BULAN SEPTEMBER 2023
PUSKESMAS : ( tlg diisi )
Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
1 Acyclovir 200 mg Tablet 0 0 0 0 0
2 Acyclovir Cream Tube 30 0 30 0 30
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 0
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 0 36 0 36
syr)
5 Asam Folat Tablet 0 0 0 0 0
6 Attapulgite 630 mg Tablet 0 0 0 0 0
7 Bedak Salisil 2% Serbuk Kotak 14 0 14 0 14
8 Betahistin Tablet 0 0 0 0 0
9 Betametason Tube 0 0 0 0 0
10 Bisacodil supp 5 mg Supp 6 0 6 0 6
11 Bisacodil supp 10 mg Supp 18 0 18 0 18
12 Bromhexin HCL Syrup Botol 0 0 0 0 0
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 0
14 Clobazam 10 mg Tablet 3 0 3 0 3
15 Curcuma Force Tablet 95 0 95 0 95
16 Dexamethason Tab 0,5 mg Tablet 3952 0 3952 0 3952
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 0
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 5 0 5 0 5
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 0
20 Digoksin 0.25 mg Tablet 100 0 100 0 100
21 Diphenhidramin Inj Ampul 0 0 0 0 0
22 Erytromicin 500 mg Tablet 19 0 19 0 19
23 Furosemid 40 mg Tablet 123 0 123 0 123
24 Furosemid Inj 10 mg/ml Ampul 10 0 10 0 10
25 Gentamisin Salep Mata Tube 1 0 1 0 1
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 0
27 Griseofulvin Tablet 0 0 0 0 0
28 Hidroklorotiazid 25 mg Tablet 1 0 1 0 1
29 Ibuprofen Tab 200 mg Tablet 4 0 4 0 4
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 0
31 Isosorbid Dinitrat 5 mg Tablet 301 0 301 0 301
32 Kalium Diclofenac 50 mg Tablet 36 0 36 0 36
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 0
34 Kaptopril 25 mg Tablet 0 0 0 0 0
35 kalium Permanganat 5 gr Pot 3 0 3 0 3
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
36 Ketokonazole 2 % Tube 75 0 75 0 75
37 Klindamicin 150 mg Kapsul 16 0 16 0 16
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 0
39 Kloramphenicol Salep Mata 1 % Tube 28 0 28 0 28
40 Kloramphenicol tetes Mata 0.5% Botol 40 0 40 0 40
41 Kloramphenicol tetes telinga Botol 0 0 0 0 0
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 0
43 Klorpromazin 100 mg Tablet 0 0 0 0 0
44 Lansoprazole 30 mg Kapsul 156 0 156 0 156
45 Levofloxacin 500 mg Tablet 0 0 0 0 0
46 Lidocain inj 2 % Ampul 0 0 0 0 0
47 Loperamid 2 mg Tablet 606 0 606 0 606
48 Meloxicam 15 mg Tablet 0 0 0 0 0
49 Methisoprinol Tablet 0 0 0 0 0
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 0
51 Metronidazol 500 mg Tablet 1075 0 1075 0 1075
52 Mikonazol krim 2 % Tube 0 0 0 0 0
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 0
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 0 0 0
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 0
56 Nistatin drop Botol 1 0 1 0 1
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 0
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0 0 0
60 Piridoksin Tablet 0 0 0 0 0
61 Piroxicam 10 mg Tablet 0 0 0 0 0
62 Risperidon 2 mg Tablet 0 0 0 0 0
63 Salbutamol 4 mg Tablet 0 0 0 0 0
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 0
65 Sefadroksil 500 mg Kapsul 0 0 0 0 0
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0
67 Sianocobalamin inj Ampul 75 0 75 0 75
68 Thiamin Inj Ampul 0 0 0 0 0
69 Thiamin 50 mg Tablet 1962 0 1962 0 1962
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 0
71 Ventolin Nebule Vial 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0
72 Master Bond Botol 0 0 0 0 0
73 Orafil Plus Temporary Botol 0 0 0 0 0
74 Absorbent Paper Point Box 0 0 0 0 0
75 Root Canal Sealer Box 0 0 0 0 0
76 Zinc F+ Box 0 0 0 0 0
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 0
78 Cresotin Paste Pot 0 0 0 0 0
79 Iodotin Paste Pot 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
BMHP 0 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 0 79 0 79
81 Alat Suntik 3 cc Pcs 183 0 183 0 183
82 Alat Suntik 5 cc Pcs 90 0 90 0 90
83 Alat Suntik 10 cc Pcs 0 0 0 0 0
84 Alkohol 70 % 300 ml Botol 0 0 0 0 0
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 0
86 Blood Lancet Pcs 300 0 300 0 300
87 Cavida Gel Tube 10 0 10 0 10
88 Desinfectan Spray ( Baymed ) 750 ml Botol 7 0 7 0 7
89 Etil Klorida Semprot Botol 0 0 0 0 0
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 0
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 0
92 Hand Scrub 4 % 500 ml ( Baymed ) 4 0 4 0 4
93 High Elastic Bandage Roll 8 0 8 0 8
94 HCG Strip Strip 0 0 0 0 0
95 Infusion Set Anak Pcs 144 0 144 0 144
96 I.V. Insert 6 x 7 Pcs 100 0 100 0 100
97 Jelco No.18 G I.V Catheter Pcs 240 0 240 0 240
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 0
99 Jelco No.22 G I.V Catheter Pcs 229 0 229 0 229
100 Jelco No.24 G I.V Catheter Pcs 207 0 207 0 207
101 Jelco No.26 G I.V Catheter Pcs 100 0 100 0 100
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
102 Kapas 100 gr Bungkus 9 0 9 0 9
103 Kapas 500 gr Bungkus 0 0 0 0 0
104 Kasa Hidrofil 16 cm x 16 cm Kotak 321 0 321 0 321
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 0
106 Nasal Canula Neonate Pcs 30 0 30 0 30
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 0
108 Nebulizer Mask Child Pcs 63 0 63 0 63
109 Nebulizer Mask Adult Pcs 43 0 43 0 43
110 Povidone Iodine 10% 60 ml Botol 11 0 11 0 11
111 Pot Dahak Pot 0 0 0 0 0
112 Pot Urine Pot 0 0 0 0 0
113 Rivanol 300 ml Botol 0 0 0 0 0
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 0
115 Sarung Tangan Non steril Pcs 0 0 0 0 0
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 0
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 0
118 Sarung Tangan Steril No. 7.0 Pair 50 0 50 0 50
119 Sarung Tangan Steril No. 7.5 Pair 100 0 100 0 100
120 Surgical Gloves Steril Gynecolog Pair 52 0 52 0 52
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 0
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 0
123 Underpad Pcs 30 0 30 0 30
10 0 10 0 10
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT LABORATORIUM 0 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 0
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 0
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 0
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 0
128 Antigen H Vial 0 0 0 0 0
129 Antigen H-A Vial 0 0 0 0 0
130 Antigen H-B Vial 0 0 0 0 0
131 Antigen H-C Vial 0 0 0 0 0
132 Antigen O-A Vial 0 0 0 0 0
133 Antigen O-B Vial 0 0 0 0 0
134 Antigen O-C Vial 0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
135 Antigen O Vial 0 0 0 0 0
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 0
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 0
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 0
139 Benedict 100mL Botol 0 0 0 0 0
140 EDTA 10% 100mL Botol 0 0 0 0 0
141 Ehrlich 100 ml Botol 0 0 0 0 0
142 Eosin 2% 100 ml Botol 0 0 0 0 0
143 HCl 0,1N 100mL Botol 0 0 0 0 0
144 Hemoglobin C 500mL Botol 0 0 0 0 0
145 Immersion Oil 50 ml Botol 0 0 0 0 0
146 KOH 10% 500 ml Botol 0 0 0 0 0
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 0
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 0
149 Pewarna MDT 3x500mL Botol 0 0 0 0 0
150 Rees Ecker 100 ml Botol 0 0 0 0 0
151 SM Sedimen 500mL Botol 0 0 0 0 0
152 Turk 500 ml Botol 0 0 0 0 0
153 Wright 100 ml Botol 0 0 0 0 0
154 SD Bioline HbSAg Kotak 0 0 0 0 0
155 SD Syphillis 3.0 Kotak 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

( ) ( )
Nip. Nip.
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT OTSUS
( LPLPO ) OTSUS

UPT PKM : (TOLONG DIISI YA NAMANYA) BULAN : OKTOBER

KECAMATAN : (TOLONG DIISI YA NAMANYA) TAHUN : 2023

KABUPATEN : ACEH TIMUR

PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN

KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir 200 mg Tablet 0 0 0 0 tlg diisi

2 Acyclovir Cream Tube 30 30 0 30 tlg diisi
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 tlg diisi
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 36 0 36 tlg diisi
syr)
5 Asam Folat Tablet 0 0 0 0 tlg diisi
6 Attapulgite 630 mg Tablet 0 0 0 0 tlg diisi
7 Bedak Salisil 2% Serbuk Kotak 14 14 0 14 tlg diisi
8 Betahistin Tablet 0 0 0 0 tlg diisi
9 Betametason Tube 0 0 0 0 tlg diisi
10 Bisacodil supp 5 mg Supp 6 6 0 6 tlg diisi
11 Bisacodil supp 10 mg Supp 18 18 0 18 tlg diisi
12 Bromhexin HCL Syrup Botol 0 0 0 0 tlg diisi
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 tlg diisi
14 Clobazam 10 mg Tablet 3 3 0 3 tlg diisi
15 Curcuma Force Tablet 95 95 0 95 tlg diisi
16 Dexamethason Tab 0,5 mg Tablet 3952 3952 0 3952 tlg diisi
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 tlg diisi
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 5 5 0 5 tlg diisi
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 tlg diisi
20 Digoksin 0.25 mg Tablet 100 100 0 100 tlg diisi
21 Diphenhidramin Inj Ampul 0 0 0 0 tlg diisi
22 Erytromicin 500 mg Tablet 19 19 0 19 tlg diisi
23 Furosemid 40 mg Tablet 123 123 0 123 tlg diisi
24 Furosemid Inj 10 mg/ml Ampul 10 10 0 10 tlg diisi
25 Gentamisin Salep Mata Tube 1 1 0 1 tlg diisi
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 tlg diisi
27 Griseofulvin Tablet 0 0 0 0 tlg diisi
28 Hidroklorotiazid 25 mg Tablet 1 1 0 1 tlg diisi
29 Ibuprofen Tab 200 mg Tablet 4 4 0 4 tlg diisi
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 tlg diisi
31 Isosorbid Dinitrat 5 mg Tablet 301 301 0 301 tlg diisi
32 Kalium Diclofenac 50 mg Tablet 36 36 0 36 tlg diisi
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 tlg diisi
34 Kaptopril 25 mg Tablet 0 0 0 0 tlg diisi
35 kalium Permanganat 5 gr Pot 3 3 0 3 tlg diisi
36 Ketokonazole 2 % Tube 75 75 0 75 tlg diisi
37 Klindamicin 150 mg Kapsul 16 16 0 16 tlg diisi
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 tlg diisi
39 Kloramphenicol Salep Mata 1 % Tube 28 28 0 28 tlg diisi
40 Kloramphenicol tetes Mata 0.5% Botol 40 40 0 40 tlg diisi
41 Kloramphenicol tetes telinga Botol 0 0 0 0 tlg diisi
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 tlg diisi
43 Klorpromazin 100 mg Tablet 0 0 0 0 tlg diisi
44 Lansoprazole 30 mg Kapsul 156 156 0 156 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

45 Levofloxacin 500 mg Tablet 0 0 0 0 tlg diisi

46 Lidocain inj 2 % Ampul 0 0 0 0 tlg diisi
47 Loperamid 2 mg Tablet 606 606 0 606 tlg diisi
48 Meloxicam 15 mg Tablet 0 0 0 0 tlg diisi
49 Methisoprinol Tablet 0 0 0 0 tlg diisi
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 tlg diisi
51 Metronidazol 500 mg Tablet 1075 1075 0 1075 tlg diisi
52 Mikonazol krim 2 % Tube 0 0 0 0 tlg diisi
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 tlg diisi
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 0 0 tlg diisi
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 tlg diisi
56 Nistatin drop Botol 1 1 0 1 tlg diisi
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 tlg diisi
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 tlg diisi
59 Paracetamol 500 mg Tablet 0 0 0 0 tlg diisi
60 Piridoksin Tablet 0 0 0 0 tlg diisi
61 Piroxicam 10 mg Tablet 0 0 0 0 tlg diisi
62 Risperidon 2 mg Tablet 0 0 0 0 tlg diisi
63 Salbutamol 4 mg Tablet 0 0 0 0 tlg diisi
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 tlg diisi
65 Sefadroksil 500 mg Kapsul 0 0 0 0 tlg diisi
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 tlg diisi
67 Sianocobalamin inj Ampul 75 75 0 75 tlg diisi
68 Thiamin Inj Ampul 0 0 0 0 tlg diisi
69 Thiamin 50 mg Tablet 1962 1962 0 1962 tlg diisi
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 tlg diisi
71 Ventolin Nebule Vial 0 0 0 0 tlg diisi
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0 0 0
72 Master Bond Botol 0 0 0 0 tlg diisi
73 Orafil Plus Temporary Botol 0 0 0 0 tlg diisi
74 Absorbent Paper Point Box 0 0 0 0 tlg diisi
75 Root Canal Sealer Box 0 0 0 0 tlg diisi
76 Zinc F+ Box 0 0 0 0 tlg diisi
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 tlg diisi
78 Cresotin Paste Pot 0 0 0 0 tlg diisi
79 Iodotin Paste Pot 0 0 0 0 tlg diisi
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BMHP 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 79 0 79 tlg diisi
81 Alat Suntik 3 cc Pcs 183 183 0 183 tlg diisi
82 Alat Suntik 5 cc Pcs 90 90 0 90 tlg diisi
83 Alat Suntik 10 cc Pcs 0 0 0 0 tlg diisi
84 Alkohol 70 % 300 ml Botol 0 0 0 0 tlg diisi
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

86 Blood Lancet Pcs 300 300 0 300 tlg diisi

87 Cavida Gel Tube 10 10 0 10 tlg diisi
88 Desinfectan Spray ( Baymed ) 750 ml Botol 7 7 0 7 tlg diisi
89 Etil Klorida Semprot Botol 0 0 0 0 tlg diisi
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 tlg diisi
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 tlg diisi
92 Hand Scrub 4 % 500 ml ( Baymed ) 4 4 0 4 tlg diisi
93 High Elastic Bandage Roll 8 8 0 8 tlg diisi
94 HCG Strip Strip 0 0 0 0 tlg diisi
95 Infusion Set Anak Pcs 144 144 0 144 tlg diisi
96 I.V. Insert 6 x 7 Pcs 100 100 0 100 tlg diisi
97 Jelco No.18 G I.V Catheter Pcs 240 240 0 240 tlg diisi
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 tlg diisi
99 Jelco No.22 G I.V Catheter Pcs 229 229 0 229 tlg diisi
100 Jelco No.24 G I.V Catheter Pcs 207 207 0 207 tlg diisi
101 Jelco No.26 G I.V Catheter Pcs 100 100 0 100 tlg diisi
102 Kapas 100 gr Bungkus 9 9 0 9 tlg diisi
103 Kapas 500 gr Bungkus 0 0 0 0 tlg diisi
104 Kasa Hidrofil 16 cm x 16 cm Kotak 321 321 0 321 tlg diisi
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 tlg diisi
106 Nasal Canula Neonate Pcs 30 30 0 30 tlg diisi
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 tlg diisi
108 Nebulizer Mask Child Pcs 63 63 0 63 tlg diisi
109 Nebulizer Mask Adult Pcs 43 43 0 43 tlg diisi
110 Povidone Iodine 10% 60 ml Botol 11 11 0 11 tlg diisi
111 Pot Dahak Pot 0 0 0 0 tlg diisi
112 Pot Urine Pot 0 0 0 0 tlg diisi
113 Rivanol 300 ml Botol 0 0 0 0 tlg diisi
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 tlg diisi
115 Sarung Tangan Non steril Pcs 0 0 0 0 tlg diisi
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 tlg diisi
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 tlg diisi
118 Sarung Tangan Steril No. 7.0 Pair 50 50 0 50 tlg diisi
119 Sarung Tangan Steril No. 7.5 Pair 100 100 0 100 tlg diisi
120 Surgical Gloves Steril Gynecolog Pair 52 52 0 52 tlg diisi
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 tlg diisi
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 tlg diisi
123 Underpad Pcs 30 30 0 30 tlg diisi
10 10 0 10
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT LABORATORIUM 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 tlg diisi
128 Antigen H Vial 0 0 0 0 tlg diisi
129 Antigen H-A Vial 0 0 0 0 tlg diisi
130 Antigen H-B Vial 0 0 0 0 tlg diisi
131 Antigen H-C Vial 0 0 0 0 tlg diisi
132 Antigen O-A Vial 0 0 0 0 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

133 Antigen O-B Vial 0 0 0 0 tlg diisi

134 Antigen O-C Vial 0 0 0 0 tlg diisi
135 Antigen O Vial 0 0 0 0 tlg diisi
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 tlg diisi
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 tlg diisi
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 tlg diisi
139 Benedict 100mL Botol 0 0 0 0 tlg diisi
140 EDTA 10% 100mL Botol 0 0 0 0 tlg diisi
141 Ehrlich 100 ml Botol 0 0 0 0 tlg diisi
142 Eosin 2% 100 ml Botol 0 0 0 0 tlg diisi
143 HCl 0,1N 100mL Botol 0 0 0 0 tlg diisi
144 Hemoglobin C 500mL Botol 0 0 0 0 tlg diisi
145 Immersion Oil 50 ml Botol 0 0 0 0 tlg diisi
146 KOH 10% 500 ml Botol 0 0 0 0 tlg diisi
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 tlg diisi
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 tlg diisi
149 Pewarna MDT 3x500mL Botol 0 0 0 0 tlg diisi
150 Rees Ecker 100 ml Botol 0 0 0 0 tlg diisi
151 SM Sedimen 500mL Botol 0 0 0 0 tlg diisi
152 Turk 500 ml Botol 0 0 0 0 tlg diisi
153 Wright 100 ml Botol 0 0 0 0 tlg diisi
154 SD Bioline HbSAg Kotak 0 0 0 0 tlg diisi
155 SD Syphillis 3.0 Kotak 0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

( ) ( )
Nip Nip
 LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) OTSUS
BULAN OKTOBER 2023
PUSKESMAS : ( tlg diisi )
Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
1 Acyclovir 200 mg Tablet 0 0 0 0 0
2 Acyclovir Cream Tube 30 0 30 0 30
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 0
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 0 36 0 36
syr)
5 Asam Folat Tablet 0 0 0 0 0
6 Attapulgite 630 mg Tablet 0 0 0 0 0
7 Bedak Salisil 2% Serbuk Kotak 14 0 14 0 14
8 Betahistin Tablet 0 0 0 0 0
9 Betametason Tube 0 0 0 0 0
10 Bisacodil supp 5 mg Supp 6 0 6 0 6
11 Bisacodil supp 10 mg Supp 18 0 18 0 18
12 Bromhexin HCL Syrup Botol 0 0 0 0 0
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 0
14 Clobazam 10 mg Tablet 3 0 3 0 3
15 Curcuma Force Tablet 95 0 95 0 95
16 Dexamethason Tab 0,5 mg Tablet 3952 0 3952 0 3952
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 0
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 5 0 5 0 5
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 0
20 Digoksin 0.25 mg Tablet 100 0 100 0 100
21 Diphenhidramin Inj Ampul 0 0 0 0 0
22 Erytromicin 500 mg Tablet 19 0 19 0 19
23 Furosemid 40 mg Tablet 123 0 123 0 123
24 Furosemid Inj 10 mg/ml Ampul 10 0 10 0 10
25 Gentamisin Salep Mata Tube 1 0 1 0 1
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 0
27 Griseofulvin Tablet 0 0 0 0 0
28 Hidroklorotiazid 25 mg Tablet 1 0 1 0 1
29 Ibuprofen Tab 200 mg Tablet 4 0 4 0 4
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 0
31 Isosorbid Dinitrat 5 mg Tablet 301 0 301 0 301
32 Kalium Diclofenac 50 mg Tablet 36 0 36 0 36
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 0
34 Kaptopril 25 mg Tablet 0 0 0 0 0
35 kalium Permanganat 5 gr Pot 3 0 3 0 3
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
36 Ketokonazole 2 % Tube 75 0 75 0 75
37 Klindamicin 150 mg Kapsul 16 0 16 0 16
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 0
39 Kloramphenicol Salep Mata 1 % Tube 28 0 28 0 28
40 Kloramphenicol tetes Mata 0.5% Botol 40 0 40 0 40
41 Kloramphenicol tetes telinga Botol 0 0 0 0 0
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 0
43 Klorpromazin 100 mg Tablet 0 0 0 0 0
44 Lansoprazole 30 mg Kapsul 156 0 156 0 156
45 Levofloxacin 500 mg Tablet 0 0 0 0 0
46 Lidocain inj 2 % Ampul 0 0 0 0 0
47 Loperamid 2 mg Tablet 606 0 606 0 606
48 Meloxicam 15 mg Tablet 0 0 0 0 0
49 Methisoprinol Tablet 0 0 0 0 0
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 0
51 Metronidazol 500 mg Tablet 1075 0 1075 0 1075
52 Mikonazol krim 2 % Tube 0 0 0 0 0
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 0
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 0 0 0
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 0
56 Nistatin drop Botol 1 0 1 0 1
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 0
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0 0 0
60 Piridoksin Tablet 0 0 0 0 0
61 Piroxicam 10 mg Tablet 0 0 0 0 0
62 Risperidon 2 mg Tablet 0 0 0 0 0
63 Salbutamol 4 mg Tablet 0 0 0 0 0
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 0
65 Sefadroksil 500 mg Kapsul 0 0 0 0 0
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0
67 Sianocobalamin inj Ampul 75 0 75 0 75
68 Thiamin Inj Ampul 0 0 0 0 0
69 Thiamin 50 mg Tablet 1962 0 1962 0 1962
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 0
71 Ventolin Nebule Vial 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0
72 Master Bond Botol 0 0 0 0 0
73 Orafil Plus Temporary Botol 0 0 0 0 0
74 Absorbent Paper Point Box 0 0 0 0 0
75 Root Canal Sealer Box 0 0 0 0 0
76 Zinc F+ Box 0 0 0 0 0
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 0
78 Cresotin Paste Pot 0 0 0 0 0
79 Iodotin Paste Pot 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
BMHP 0 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 0 79 0 79
81 Alat Suntik 3 cc Pcs 183 0 183 0 183
82 Alat Suntik 5 cc Pcs 90 0 90 0 90
83 Alat Suntik 10 cc Pcs 0 0 0 0 0
84 Alkohol 70 % 300 ml Botol 0 0 0 0 0
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 0
86 Blood Lancet Pcs 300 0 300 0 300
87 Cavida Gel Tube 10 0 10 0 10
88 Desinfectan Spray ( Baymed ) 750 ml Botol 7 0 7 0 7
89 Etil Klorida Semprot Botol 0 0 0 0 0
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 0
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 0
92 Hand Scrub 4 % 500 ml ( Baymed ) 4 0 4 0 4
93 High Elastic Bandage Roll 8 0 8 0 8
94 HCG Strip Strip 0 0 0 0 0
95 Infusion Set Anak Pcs 144 0 144 0 144
96 I.V. Insert 6 x 7 Pcs 100 0 100 0 100
97 Jelco No.18 G I.V Catheter Pcs 240 0 240 0 240
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 0
99 Jelco No.22 G I.V Catheter Pcs 229 0 229 0 229
100 Jelco No.24 G I.V Catheter Pcs 207 0 207 0 207
101 Jelco No.26 G I.V Catheter Pcs 100 0 100 0 100
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
102 Kapas 100 gr Bungkus 9 0 9 0 9
103 Kapas 500 gr Bungkus 0 0 0 0 0
104 Kasa Hidrofil 16 cm x 16 cm Kotak 321 0 321 0 321
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 0
106 Nasal Canula Neonate Pcs 30 0 30 0 30
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 0
108 Nebulizer Mask Child Pcs 63 0 63 0 63
109 Nebulizer Mask Adult Pcs 43 0 43 0 43
110 Povidone Iodine 10% 60 ml Botol 11 0 11 0 11
111 Pot Dahak Pot 0 0 0 0 0
112 Pot Urine Pot 0 0 0 0 0
113 Rivanol 300 ml Botol 0 0 0 0 0
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 0
115 Sarung Tangan Non steril Pcs 0 0 0 0 0
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 0
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 0
118 Sarung Tangan Steril No. 7.0 Pair 50 0 50 0 50
119 Sarung Tangan Steril No. 7.5 Pair 100 0 100 0 100
120 Surgical Gloves Steril Gynecolog Pair 52 0 52 0 52
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 0
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 0
123 Underpad Pcs 30 0 30 0 30
10 0 10 0 10
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT LABORATORIUM 0 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 0
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 0
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 0
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 0
128 Antigen H Vial 0 0 0 0 0
129 Antigen H-A Vial 0 0 0 0 0
130 Antigen H-B Vial 0 0 0 0 0
131 Antigen H-C Vial 0 0 0 0 0
132 Antigen O-A Vial 0 0 0 0 0
133 Antigen O-B Vial 0 0 0 0 0
134 Antigen O-C Vial 0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
135 Antigen O Vial 0 0 0 0 0
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 0
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 0
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 0
139 Benedict 100mL Botol 0 0 0 0 0
140 EDTA 10% 100mL Botol 0 0 0 0 0
141 Ehrlich 100 ml Botol 0 0 0 0 0
142 Eosin 2% 100 ml Botol 0 0 0 0 0
143 HCl 0,1N 100mL Botol 0 0 0 0 0
144 Hemoglobin C 500mL Botol 0 0 0 0 0
145 Immersion Oil 50 ml Botol 0 0 0 0 0
146 KOH 10% 500 ml Botol 0 0 0 0 0
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 0
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 0
149 Pewarna MDT 3x500mL Botol 0 0 0 0 0
150 Rees Ecker 100 ml Botol 0 0 0 0 0
151 SM Sedimen 500mL Botol 0 0 0 0 0
152 Turk 500 ml Botol 0 0 0 0 0
153 Wright 100 ml Botol 0 0 0 0 0
154 SD Bioline HbSAg Kotak 0 0 0 0 0
155 SD Syphillis 3.0 Kotak 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

( ) ( )
Nip. Nip.
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT OTSUS
( LPLPO ) OTSUS

UPT PKM : (TOLONG DIISI YA NAMANYA) BULAN : NOVEMBER

KECAMATAN : (TOLONG DIISI YA NAMANYA) TAHUN : 2023

KABUPATEN : ACEH TIMUR

PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN

KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir 200 mg Tablet 0 0 0 0 tlg diisi

2 Acyclovir Cream Tube 30 30 0 30 tlg diisi
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 tlg diisi
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 36 0 36 tlg diisi
syr)
5 Asam Folat Tablet 0 0 0 0 tlg diisi
6 Attapulgite 630 mg Tablet 0 0 0 0 tlg diisi
7 Bedak Salisil 2% Serbuk Kotak 14 14 0 14 tlg diisi
8 Betahistin Tablet 0 0 0 0 tlg diisi
9 Betametason Tube 0 0 0 0 tlg diisi
10 Bisacodil supp 5 mg Supp 6 6 0 6 tlg diisi
11 Bisacodil supp 10 mg Supp 18 18 0 18 tlg diisi
12 Bromhexin HCL Syrup Botol 0 0 0 0 tlg diisi
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 tlg diisi
14 Clobazam 10 mg Tablet 3 3 0 3 tlg diisi
15 Curcuma Force Tablet 95 95 0 95 tlg diisi
16 Dexamethason Tab 0,5 mg Tablet 3952 3952 0 3952 tlg diisi
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 tlg diisi
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 5 5 0 5 tlg diisi
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 tlg diisi
20 Digoksin 0.25 mg Tablet 100 100 0 100 tlg diisi
21 Diphenhidramin Inj Ampul 0 0 0 0 tlg diisi
22 Erytromicin 500 mg Tablet 19 19 0 19 tlg diisi
23 Furosemid 40 mg Tablet 123 123 0 123 tlg diisi
24 Furosemid Inj 10 mg/ml Ampul 10 10 0 10 tlg diisi
25 Gentamisin Salep Mata Tube 1 1 0 1 tlg diisi
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 tlg diisi
27 Griseofulvin Tablet 0 0 0 0 tlg diisi
28 Hidroklorotiazid 25 mg Tablet 1 1 0 1 tlg diisi
29 Ibuprofen Tab 200 mg Tablet 4 4 0 4 tlg diisi
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 tlg diisi
31 Isosorbid Dinitrat 5 mg Tablet 301 301 0 301 tlg diisi
32 Kalium Diclofenac 50 mg Tablet 36 36 0 36 tlg diisi
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 tlg diisi
34 Kaptopril 25 mg Tablet 0 0 0 0 tlg diisi
35 kalium Permanganat 5 gr Pot 3 3 0 3 tlg diisi
36 Ketokonazole 2 % Tube 75 75 0 75 tlg diisi
37 Klindamicin 150 mg Kapsul 16 16 0 16 tlg diisi
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 tlg diisi
39 Kloramphenicol Salep Mata 1 % Tube 28 28 0 28 tlg diisi
40 Kloramphenicol tetes Mata 0.5% Botol 40 40 0 40 tlg diisi
41 Kloramphenicol tetes telinga Botol 0 0 0 0 tlg diisi
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 tlg diisi
43 Klorpromazin 100 mg Tablet 0 0 0 0 tlg diisi
44 Lansoprazole 30 mg Kapsul 156 156 0 156 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

45 Levofloxacin 500 mg Tablet 0 0 0 0 tlg diisi

46 Lidocain inj 2 % Ampul 0 0 0 0 tlg diisi
47 Loperamid 2 mg Tablet 606 606 0 606 tlg diisi
48 Meloxicam 15 mg Tablet 0 0 0 0 tlg diisi
49 Methisoprinol Tablet 0 0 0 0 tlg diisi
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 tlg diisi
51 Metronidazol 500 mg Tablet 1075 1075 0 1075 tlg diisi
52 Mikonazol krim 2 % Tube 0 0 0 0 tlg diisi
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 tlg diisi
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 0 0 tlg diisi
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 tlg diisi
56 Nistatin drop Botol 1 1 0 1 tlg diisi
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 tlg diisi
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 tlg diisi
59 Paracetamol 500 mg Tablet 0 0 0 0 tlg diisi
60 Piridoksin Tablet 0 0 0 0 tlg diisi
61 Piroxicam 10 mg Tablet 0 0 0 0 tlg diisi
62 Risperidon 2 mg Tablet 0 0 0 0 tlg diisi
63 Salbutamol 4 mg Tablet 0 0 0 0 tlg diisi
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 tlg diisi
65 Sefadroksil 500 mg Kapsul 0 0 0 0 tlg diisi
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 tlg diisi
67 Sianocobalamin inj Ampul 75 75 0 75 tlg diisi
68 Thiamin Inj Ampul 0 0 0 0 tlg diisi
69 Thiamin 50 mg Tablet 1962 1962 0 1962 tlg diisi
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 tlg diisi
71 Ventolin Nebule Vial 0 0 0 0 tlg diisi
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0 0 0
72 Master Bond Botol 0 0 0 0 tlg diisi
73 Orafil Plus Temporary Botol 0 0 0 0 tlg diisi
74 Absorbent Paper Point Box 0 0 0 0 tlg diisi
75 Root Canal Sealer Box 0 0 0 0 tlg diisi
76 Zinc F+ Box 0 0 0 0 tlg diisi
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 tlg diisi
78 Cresotin Paste Pot 0 0 0 0 tlg diisi
79 Iodotin Paste Pot 0 0 0 0 tlg diisi
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BMHP 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 79 0 79 tlg diisi
81 Alat Suntik 3 cc Pcs 183 183 0 183 tlg diisi
82 Alat Suntik 5 cc Pcs 90 90 0 90 tlg diisi
83 Alat Suntik 10 cc Pcs 0 0 0 0 tlg diisi
84 Alkohol 70 % 300 ml Botol 0 0 0 0 tlg diisi
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

86 Blood Lancet Pcs 300 300 0 300 tlg diisi

87 Cavida Gel Tube 10 10 0 10 tlg diisi
88 Desinfectan Spray ( Baymed ) 750 ml Botol 7 7 0 7 tlg diisi
89 Etil Klorida Semprot Botol 0 0 0 0 tlg diisi
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 tlg diisi
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 tlg diisi
92 Hand Scrub 4 % 500 ml ( Baymed ) 4 4 0 4 tlg diisi
93 High Elastic Bandage Roll 8 8 0 8 tlg diisi
94 HCG Strip Strip 0 0 0 0 tlg diisi
95 Infusion Set Anak Pcs 144 144 0 144 tlg diisi
96 I.V. Insert 6 x 7 Pcs 100 100 0 100 tlg diisi
97 Jelco No.18 G I.V Catheter Pcs 240 240 0 240 tlg diisi
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 tlg diisi
99 Jelco No.22 G I.V Catheter Pcs 229 229 0 229 tlg diisi
100 Jelco No.24 G I.V Catheter Pcs 207 207 0 207 tlg diisi
101 Jelco No.26 G I.V Catheter Pcs 100 100 0 100 tlg diisi
102 Kapas 100 gr Bungkus 9 9 0 9 tlg diisi
103 Kapas 500 gr Bungkus 0 0 0 0 tlg diisi
104 Kasa Hidrofil 16 cm x 16 cm Kotak 321 321 0 321 tlg diisi
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 tlg diisi
106 Nasal Canula Neonate Pcs 30 30 0 30 tlg diisi
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 tlg diisi
108 Nebulizer Mask Child Pcs 63 63 0 63 tlg diisi
109 Nebulizer Mask Adult Pcs 43 43 0 43 tlg diisi
110 Povidone Iodine 10% 60 ml Botol 11 11 0 11 tlg diisi
111 Pot Dahak Pot 0 0 0 0 tlg diisi
112 Pot Urine Pot 0 0 0 0 tlg diisi
113 Rivanol 300 ml Botol 0 0 0 0 tlg diisi
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 tlg diisi
115 Sarung Tangan Non steril Pcs 0 0 0 0 tlg diisi
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 tlg diisi
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 tlg diisi
118 Sarung Tangan Steril No. 7.0 Pair 50 50 0 50 tlg diisi
119 Sarung Tangan Steril No. 7.5 Pair 100 100 0 100 tlg diisi
120 Surgical Gloves Steril Gynecolog Pair 52 52 0 52 tlg diisi
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 tlg diisi
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 tlg diisi
123 Underpad Pcs 30 30 0 30 tlg diisi
10 10 0 10
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT LABORATORIUM 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 tlg diisi
128 Antigen H Vial 0 0 0 0 tlg diisi
129 Antigen H-A Vial 0 0 0 0 tlg diisi
130 Antigen H-B Vial 0 0 0 0 tlg diisi
131 Antigen H-C Vial 0 0 0 0 tlg diisi
132 Antigen O-A Vial 0 0 0 0 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

133 Antigen O-B Vial 0 0 0 0 tlg diisi

134 Antigen O-C Vial 0 0 0 0 tlg diisi
135 Antigen O Vial 0 0 0 0 tlg diisi
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 tlg diisi
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 tlg diisi
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 tlg diisi
139 Benedict 100mL Botol 0 0 0 0 tlg diisi
140 EDTA 10% 100mL Botol 0 0 0 0 tlg diisi
141 Ehrlich 100 ml Botol 0 0 0 0 tlg diisi
142 Eosin 2% 100 ml Botol 0 0 0 0 tlg diisi
143 HCl 0,1N 100mL Botol 0 0 0 0 tlg diisi
144 Hemoglobin C 500mL Botol 0 0 0 0 tlg diisi
145 Immersion Oil 50 ml Botol 0 0 0 0 tlg diisi
146 KOH 10% 500 ml Botol 0 0 0 0 tlg diisi
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 tlg diisi
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 tlg diisi
149 Pewarna MDT 3x500mL Botol 0 0 0 0 tlg diisi
150 Rees Ecker 100 ml Botol 0 0 0 0 tlg diisi
151 SM Sedimen 500mL Botol 0 0 0 0 tlg diisi
152 Turk 500 ml Botol 0 0 0 0 tlg diisi
153 Wright 100 ml Botol 0 0 0 0 tlg diisi
154 SD Bioline HbSAg Kotak 0 0 0 0 tlg diisi
155 SD Syphillis 3.0 Kotak 0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

( ) ( )
Nip Nip
 LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) OTSUS
BULAN NOVEMBER 2023
PUSKESMAS : ( tlg diisi )
Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
1 Acyclovir 200 mg Tablet 0 0 0 0 0
2 Acyclovir Cream Tube 30 0 30 0 30
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 0
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 0 36 0 36
syr)
5 Asam Folat Tablet 0 0 0 0 0
6 Attapulgite 630 mg Tablet 0 0 0 0 0
7 Bedak Salisil 2% Serbuk Kotak 14 0 14 0 14
8 Betahistin Tablet 0 0 0 0 0
9 Betametason Tube 0 0 0 0 0
10 Bisacodil supp 5 mg Supp 6 0 6 0 6
11 Bisacodil supp 10 mg Supp 18 0 18 0 18
12 Bromhexin HCL Syrup Botol 0 0 0 0 0
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 0
14 Clobazam 10 mg Tablet 3 0 3 0 3
15 Curcuma Force Tablet 95 0 95 0 95
16 Dexamethason Tab 0,5 mg Tablet 3952 0 3952 0 3952
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 0
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 5 0 5 0 5
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 0
20 Digoksin 0.25 mg Tablet 100 0 100 0 100
21 Diphenhidramin Inj Ampul 0 0 0 0 0
22 Erytromicin 500 mg Tablet 19 0 19 0 19
23 Furosemid 40 mg Tablet 123 0 123 0 123
24 Furosemid Inj 10 mg/ml Ampul 10 0 10 0 10
25 Gentamisin Salep Mata Tube 1 0 1 0 1
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 0
27 Griseofulvin Tablet 0 0 0 0 0
28 Hidroklorotiazid 25 mg Tablet 1 0 1 0 1
29 Ibuprofen Tab 200 mg Tablet 4 0 4 0 4
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 0
31 Isosorbid Dinitrat 5 mg Tablet 301 0 301 0 301
32 Kalium Diclofenac 50 mg Tablet 36 0 36 0 36
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 0
34 Kaptopril 25 mg Tablet 0 0 0 0 0
35 kalium Permanganat 5 gr Pot 3 0 3 0 3
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
36 Ketokonazole 2 % Tube 75 0 75 0 75
37 Klindamicin 150 mg Kapsul 16 0 16 0 16
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 0
39 Kloramphenicol Salep Mata 1 % Tube 28 0 28 0 28
40 Kloramphenicol tetes Mata 0.5% Botol 40 0 40 0 40
41 Kloramphenicol tetes telinga Botol 0 0 0 0 0
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 0
43 Klorpromazin 100 mg Tablet 0 0 0 0 0
44 Lansoprazole 30 mg Kapsul 156 0 156 0 156
45 Levofloxacin 500 mg Tablet 0 0 0 0 0
46 Lidocain inj 2 % Ampul 0 0 0 0 0
47 Loperamid 2 mg Tablet 606 0 606 0 606
48 Meloxicam 15 mg Tablet 0 0 0 0 0
49 Methisoprinol Tablet 0 0 0 0 0
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 0
51 Metronidazol 500 mg Tablet 1075 0 1075 0 1075
52 Mikonazol krim 2 % Tube 0 0 0 0 0
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 0
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 0 0 0
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 0
56 Nistatin drop Botol 1 0 1 0 1
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 0
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0 0 0
60 Piridoksin Tablet 0 0 0 0 0
61 Piroxicam 10 mg Tablet 0 0 0 0 0
62 Risperidon 2 mg Tablet 0 0 0 0 0
63 Salbutamol 4 mg Tablet 0 0 0 0 0
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 0
65 Sefadroksil 500 mg Kapsul 0 0 0 0 0
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0
67 Sianocobalamin inj Ampul 75 0 75 0 75
68 Thiamin Inj Ampul 0 0 0 0 0
69 Thiamin 50 mg Tablet 1962 0 1962 0 1962
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 0
71 Ventolin Nebule Vial 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0
72 Master Bond Botol 0 0 0 0 0
73 Orafil Plus Temporary Botol 0 0 0 0 0
74 Absorbent Paper Point Box 0 0 0 0 0
75 Root Canal Sealer Box 0 0 0 0 0
76 Zinc F+ Box 0 0 0 0 0
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 0
78 Cresotin Paste Pot 0 0 0 0 0
79 Iodotin Paste Pot 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
BMHP 0 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 0 79 0 79
81 Alat Suntik 3 cc Pcs 183 0 183 0 183
82 Alat Suntik 5 cc Pcs 90 0 90 0 90
83 Alat Suntik 10 cc Pcs 0 0 0 0 0
84 Alkohol 70 % 300 ml Botol 0 0 0 0 0
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 0
86 Blood Lancet Pcs 300 0 300 0 300
87 Cavida Gel Tube 10 0 10 0 10
88 Desinfectan Spray ( Baymed ) 750 ml Botol 7 0 7 0 7
89 Etil Klorida Semprot Botol 0 0 0 0 0
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 0
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 0
92 Hand Scrub 4 % 500 ml ( Baymed ) 4 0 4 0 4
93 High Elastic Bandage Roll 8 0 8 0 8
94 HCG Strip Strip 0 0 0 0 0
95 Infusion Set Anak Pcs 144 0 144 0 144
96 I.V. Insert 6 x 7 Pcs 100 0 100 0 100
97 Jelco No.18 G I.V Catheter Pcs 240 0 240 0 240
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 0
99 Jelco No.22 G I.V Catheter Pcs 229 0 229 0 229
100 Jelco No.24 G I.V Catheter Pcs 207 0 207 0 207
101 Jelco No.26 G I.V Catheter Pcs 100 0 100 0 100
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
102 Kapas 100 gr Bungkus 9 0 9 0 9
103 Kapas 500 gr Bungkus 0 0 0 0 0
104 Kasa Hidrofil 16 cm x 16 cm Kotak 321 0 321 0 321
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 0
106 Nasal Canula Neonate Pcs 30 0 30 0 30
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 0
108 Nebulizer Mask Child Pcs 63 0 63 0 63
109 Nebulizer Mask Adult Pcs 43 0 43 0 43
110 Povidone Iodine 10% 60 ml Botol 11 0 11 0 11
111 Pot Dahak Pot 0 0 0 0 0
112 Pot Urine Pot 0 0 0 0 0
113 Rivanol 300 ml Botol 0 0 0 0 0
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 0
115 Sarung Tangan Non steril Pcs 0 0 0 0 0
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 0
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 0
118 Sarung Tangan Steril No. 7.0 Pair 50 0 50 0 50
119 Sarung Tangan Steril No. 7.5 Pair 100 0 100 0 100
120 Surgical Gloves Steril Gynecolog Pair 52 0 52 0 52
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 0
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 0
123 Underpad Pcs 30 0 30 0 30
10 0 10 0 10
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT LABORATORIUM 0 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 0
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 0
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 0
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 0
128 Antigen H Vial 0 0 0 0 0
129 Antigen H-A Vial 0 0 0 0 0
130 Antigen H-B Vial 0 0 0 0 0
131 Antigen H-C Vial 0 0 0 0 0
132 Antigen O-A Vial 0 0 0 0 0
133 Antigen O-B Vial 0 0 0 0 0
134 Antigen O-C Vial 0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
135 Antigen O Vial 0 0 0 0 0
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 0
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 0
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 0
139 Benedict 100mL Botol 0 0 0 0 0
140 EDTA 10% 100mL Botol 0 0 0 0 0
141 Ehrlich 100 ml Botol 0 0 0 0 0
142 Eosin 2% 100 ml Botol 0 0 0 0 0
143 HCl 0,1N 100mL Botol 0 0 0 0 0
144 Hemoglobin C 500mL Botol 0 0 0 0 0
145 Immersion Oil 50 ml Botol 0 0 0 0 0
146 KOH 10% 500 ml Botol 0 0 0 0 0
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 0
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 0
149 Pewarna MDT 3x500mL Botol 0 0 0 0 0
150 Rees Ecker 100 ml Botol 0 0 0 0 0
151 SM Sedimen 500mL Botol 0 0 0 0 0
152 Turk 500 ml Botol 0 0 0 0 0
153 Wright 100 ml Botol 0 0 0 0 0
154 SD Bioline HbSAg Kotak 0 0 0 0 0
155 SD Syphillis 3.0 Kotak 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

( ) ( )
Nip. Nip.
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT OTSUS
( LPLPO ) OTSUS

UPT PKM : (TOLONG DIISI YA NAMANYA) BULAN : DESEMBER

KECAMATAN : (TOLONG DIISI YA NAMANYA) TAHUN : 2023

KABUPATEN : ACEH TIMUR

PROPINSI : PEMERINTAH ACEH

NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN

KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
1 2 3 4 5 6 7 8 9 10

1 Acyclovir 200 mg Tablet 0 0 0 0 tlg diisi

2 Acyclovir Cream Tube 30 30 0 30 tlg diisi
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 tlg diisi
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 36 0 36 tlg diisi
syr)
5 Asam Folat Tablet 0 0 0 0 tlg diisi
6 Attapulgite 630 mg Tablet 0 0 0 0 tlg diisi
7 Bedak Salisil 2% Serbuk Kotak 14 14 0 14 tlg diisi
8 Betahistin Tablet 0 0 0 0 tlg diisi
9 Betametason Tube 0 0 0 0 tlg diisi
10 Bisacodil supp 5 mg Supp 6 6 0 6 tlg diisi
11 Bisacodil supp 10 mg Supp 18 18 0 18 tlg diisi
12 Bromhexin HCL Syrup Botol 0 0 0 0 tlg diisi
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 tlg diisi
14 Clobazam 10 mg Tablet 3 3 0 3 tlg diisi
15 Curcuma Force Tablet 95 95 0 95 tlg diisi
16 Dexamethason Tab 0,5 mg Tablet 3952 3952 0 3952 tlg diisi
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 tlg diisi
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 5 5 0 5 tlg diisi
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 tlg diisi
20 Digoksin 0.25 mg Tablet 100 100 0 100 tlg diisi
21 Diphenhidramin Inj Ampul 0 0 0 0 tlg diisi
22 Erytromicin 500 mg Tablet 19 19 0 19 tlg diisi
23 Furosemid 40 mg Tablet 123 123 0 123 tlg diisi
24 Furosemid Inj 10 mg/ml Ampul 10 10 0 10 tlg diisi
25 Gentamisin Salep Mata Tube 1 1 0 1 tlg diisi
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 tlg diisi
27 Griseofulvin Tablet 0 0 0 0 tlg diisi
28 Hidroklorotiazid 25 mg Tablet 1 1 0 1 tlg diisi
29 Ibuprofen Tab 200 mg Tablet 4 4 0 4 tlg diisi
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 tlg diisi
31 Isosorbid Dinitrat 5 mg Tablet 301 301 0 301 tlg diisi
32 Kalium Diclofenac 50 mg Tablet 36 36 0 36 tlg diisi
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 tlg diisi
34 Kaptopril 25 mg Tablet 0 0 0 0 tlg diisi
35 kalium Permanganat 5 gr Pot 3 3 0 3 tlg diisi
36 Ketokonazole 2 % Tube 75 75 0 75 tlg diisi
37 Klindamicin 150 mg Kapsul 16 16 0 16 tlg diisi
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 tlg diisi
39 Kloramphenicol Salep Mata 1 % Tube 28 28 0 28 tlg diisi
40 Kloramphenicol tetes Mata 0.5% Botol 40 40 0 40 tlg diisi
41 Kloramphenicol tetes telinga Botol 0 0 0 0 tlg diisi
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 tlg diisi
43 Klorpromazin 100 mg Tablet 0 0 0 0 tlg diisi
44 Lansoprazole 30 mg Kapsul 156 156 0 156 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
45 Levofloxacin 500 mg Tablet 0 0 0 0 tlg diisi
46 Lidocain inj 2 % Ampul 0 0 0 0 tlg diisi
47 Loperamid 2 mg Tablet 606 606 0 606 tlg diisi
48 Meloxicam 15 mg Tablet 0 0 0 0 tlg diisi
49 Methisoprinol Tablet 0 0 0 0 tlg diisi
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 tlg diisi
51 Metronidazol 500 mg Tablet 1075 1075 0 1075 tlg diisi
52 Mikonazol krim 2 % Tube 0 0 0 0 tlg diisi
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 tlg diisi
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 0 0 tlg diisi
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 tlg diisi
56 Nistatin drop Botol 1 1 0 1 tlg diisi
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 tlg diisi
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 tlg diisi
59 Paracetamol 500 mg Tablet 0 0 0 0 tlg diisi
60 Piridoksin Tablet 0 0 0 0 tlg diisi
61 Piroxicam 10 mg Tablet 0 0 0 0 tlg diisi
62 Risperidon 2 mg Tablet 0 0 0 0 tlg diisi
63 Salbutamol 4 mg Tablet 0 0 0 0 tlg diisi
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 tlg diisi
65 Sefadroksil 500 mg Kapsul 0 0 0 0 tlg diisi
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 tlg diisi
67 Sianocobalamin inj Ampul 75 75 0 75 tlg diisi
68 Thiamin Inj Ampul 0 0 0 0 tlg diisi
69 Thiamin 50 mg Tablet 1962 1962 0 1962 tlg diisi
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 tlg diisi
71 Ventolin Nebule Vial 0 0 0 0 tlg diisi
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0 0 0
72 Master Bond Botol 0 0 0 0 tlg diisi
73 Orafil Plus Temporary Botol 0 0 0 0 tlg diisi
74 Absorbent Paper Point Box 0 0 0 0 tlg diisi
75 Root Canal Sealer Box 0 0 0 0 tlg diisi
76 Zinc F+ Box 0 0 0 0 tlg diisi
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 tlg diisi
78 Cresotin Paste Pot 0 0 0 0 tlg diisi
79 Iodotin Paste Pot 0 0 0 0 tlg diisi
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BMHP 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 79 0 79 tlg diisi
81 Alat Suntik 3 cc Pcs 183 183 0 183 tlg diisi
82 Alat Suntik 5 cc Pcs 90 90 0 90 tlg diisi
83 Alat Suntik 10 cc Pcs 0 0 0 0 tlg diisi
84 Alkohol 70 % 300 ml Botol 0 0 0 0 tlg diisi
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 tlg diisi
86 Blood Lancet Pcs 300 300 0 300 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
87 Cavida Gel Tube 10 10 0 10 tlg diisi
88 Desinfectan Spray ( Baymed ) 750 ml Botol 7 7 0 7 tlg diisi
89 Etil Klorida Semprot Botol 0 0 0 0 tlg diisi
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 tlg diisi
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 tlg diisi
92 Hand Scrub 4 % 500 ml ( Baymed ) 4 4 0 4 tlg diisi
93 High Elastic Bandage Roll 8 8 0 8 tlg diisi
94 HCG Strip Strip 0 0 0 0 tlg diisi
95 Infusion Set Anak Pcs 144 144 0 144 tlg diisi
96 I.V. Insert 6 x 7 Pcs 100 100 0 100 tlg diisi
97 Jelco No.18 G I.V Catheter Pcs 240 240 0 240 tlg diisi
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 tlg diisi
99 Jelco No.22 G I.V Catheter Pcs 229 229 0 229 tlg diisi
100 Jelco No.24 G I.V Catheter Pcs 207 207 0 207 tlg diisi
101 Jelco No.26 G I.V Catheter Pcs 100 100 0 100 tlg diisi
102 Kapas 100 gr Bungkus 9 9 0 9 tlg diisi
103 Kapas 500 gr Bungkus 0 0 0 0 tlg diisi
104 Kasa Hidrofil 16 cm x 16 cm Kotak 321 321 0 321 tlg diisi
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 tlg diisi
106 Nasal Canula Neonate Pcs 30 30 0 30 tlg diisi
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 tlg diisi
108 Nebulizer Mask Child Pcs 63 63 0 63 tlg diisi
109 Nebulizer Mask Adult Pcs 43 43 0 43 tlg diisi
110 Povidone Iodine 10% 60 ml Botol 11 11 0 11 tlg diisi
111 Pot Dahak Pot 0 0 0 0 tlg diisi
112 Pot Urine Pot 0 0 0 0 tlg diisi
113 Rivanol 300 ml Botol 0 0 0 0 tlg diisi
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 tlg diisi
115 Sarung Tangan Non steril Pcs 0 0 0 0 tlg diisi
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 tlg diisi
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 tlg diisi
118 Sarung Tangan Steril No. 7.0 Pair 50 50 0 50 tlg diisi
119 Sarung Tangan Steril No. 7.5 Pair 100 100 0 100 tlg diisi
120 Surgical Gloves Steril Gynecolog Pair 52 52 0 52 tlg diisi
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 tlg diisi
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 tlg diisi
123 Underpad Pcs 30 30 0 30 tlg diisi
10 10 0 10
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT LABORATORIUM 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 tlg diisi
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 tlg diisi
128 Antigen H Vial 0 0 0 0 tlg diisi
129 Antigen H-A Vial 0 0 0 0 tlg diisi
130 Antigen H-B Vial 0 0 0 0 tlg diisi
131 Antigen H-C Vial 0 0 0 0 tlg diisi
132 Antigen O-A Vial 0 0 0 0 tlg diisi
133 Antigen O-B Vial 0 0 0 0 tlg diisi
134 Antigen O-C Vial 0 0 0 0 tlg diisi
NO NAMA OBAT SATUAN STOK PENERI PERSE PEMA STOK PERMIN
KET
AWAL MAAN DIAAN KAIAN AKHIR TAAN
135 Antigen O Vial 0 0 0 0 tlg diisi
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 tlg diisi
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 tlg diisi
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 tlg diisi
139 Benedict 100mL Botol 0 0 0 0 tlg diisi
140 EDTA 10% 100mL Botol 0 0 0 0 tlg diisi
141 Ehrlich 100 ml Botol 0 0 0 0 tlg diisi
142 Eosin 2% 100 ml Botol 0 0 0 0 tlg diisi
143 HCl 0,1N 100mL Botol 0 0 0 0 tlg diisi
144 Hemoglobin C 500mL Botol 0 0 0 0 tlg diisi
145 Immersion Oil 50 ml Botol 0 0 0 0 tlg diisi
146 KOH 10% 500 ml Botol 0 0 0 0 tlg diisi
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 tlg diisi
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 tlg diisi
149 Pewarna MDT 3x500mL Botol 0 0 0 0 tlg diisi
150 Rees Ecker 100 ml Botol 0 0 0 0 tlg diisi
151 SM Sedimen 500mL Botol 0 0 0 0 tlg diisi
152 Turk 500 ml Botol 0 0 0 0 tlg diisi
153 Wright 100 ml Botol 0 0 0 0 tlg diisi
154 SD Bioline HbSAg Kotak 0 0 0 0 tlg diisi
155 SD Syphillis 3.0 Kotak 0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi
0 0 0 0 tlg diisi

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

( ) ( )
Nip Nip
 LAPORAN PENGGUNAAN OBAT HARIAN ( LPOH ) OTSUS
BULAN DESEMBER 2023
PUSKESMAS : ( tlg diisi )
Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
1 Acyclovir 200 mg Tablet 0 0 0 0 0
2 Acyclovir Cream Tube 30 0 30 0 30
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 0
Anti Alergi Kombinasi Micronized (Dextamin
4 Botol 36 0 36 0 36
syr)
5 Asam Folat Tablet 0 0 0 0 0
6 Attapulgite 630 mg Tablet 0 0 0 0 0
7 Bedak Salisil 2% Serbuk Kotak 14 0 14 0 14
8 Betahistin Tablet 0 0 0 0 0
9 Betametason Tube 0 0 0 0 0
10 Bisacodil supp 5 mg Supp 6 0 6 0 6
11 Bisacodil supp 10 mg Supp 18 0 18 0 18
12 Bromhexin HCL Syrup Botol 0 0 0 0 0
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 0
14 Clobazam 10 mg Tablet 3 0 3 0 3
15 Curcuma Force Tablet 95 0 95 0 95
16 Dexamethason Tab 0,5 mg Tablet 3952 0 3952 0 3952
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Botol 0 0 0 0 0
Phenylphrine Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 5 0 5 0 5
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 0
20 Digoksin 0.25 mg Tablet 100 0 100 0 100
21 Diphenhidramin Inj Ampul 0 0 0 0 0
22 Erytromicin 500 mg Tablet 19 0 19 0 19
23 Furosemid 40 mg Tablet 123 0 123 0 123
24 Furosemid Inj 10 mg/ml Ampul 10 0 10 0 10
25 Gentamisin Salep Mata Tube 1 0 1 0 1
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 0
27 Griseofulvin Tablet 0 0 0 0 0
28 Hidroklorotiazid 25 mg Tablet 1 0 1 0 1
29 Ibuprofen Tab 200 mg Tablet 4 0 4 0 4
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 0
31 Isosorbid Dinitrat 5 mg Tablet 301 0 301 0 301
32 Kalium Diclofenac 50 mg Tablet 36 0 36 0 36
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 0
34 Kaptopril 25 mg Tablet 0 0 0 0 0
35 kalium Permanganat 5 gr Pot 3 0 3 0 3
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
36 Ketokonazole 2 % Tube 75 0 75 0 75
37 Klindamicin 150 mg Kapsul 16 0 16 0 16
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 0
39 Kloramphenicol Salep Mata 1 % Tube 28 0 28 0 28
40 Kloramphenicol tetes Mata 0.5% Botol 40 0 40 0 40
41 Kloramphenicol tetes telinga Botol 0 0 0 0 0
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 0
43 Klorpromazin 100 mg Tablet 0 0 0 0 0
44 Lansoprazole 30 mg Kapsul 156 0 156 0 156
45 Levofloxacin 500 mg Tablet 0 0 0 0 0
46 Lidocain inj 2 % Ampul 0 0 0 0 0
47 Loperamid 2 mg Tablet 606 0 606 0 606
48 Meloxicam 15 mg Tablet 0 0 0 0 0
49 Methisoprinol Tablet 0 0 0 0 0
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 0
51 Metronidazol 500 mg Tablet 1075 0 1075 0 1075
52 Mikonazol krim 2 % Tube 0 0 0 0 0
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 0
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 0 0 0
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 0
56 Nistatin drop Botol 1 0 1 0 1
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 0
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0 0 0
60 Piridoksin Tablet 0 0 0 0 0
61 Piroxicam 10 mg Tablet 0 0 0 0 0
62 Risperidon 2 mg Tablet 0 0 0 0 0
63 Salbutamol 4 mg Tablet 0 0 0 0 0
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 0
65 Sefadroksil 500 mg Kapsul 0 0 0 0 0
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0
67 Sianocobalamin inj Ampul 75 0 75 0 75
68 Thiamin Inj Ampul 0 0 0 0 0
69 Thiamin 50 mg Tablet 1962 0 1962 0 1962
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 0
71 Ventolin Nebule Vial 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
0 0 0 0 0
0 0 0 0 0
OBAT GIGI 0 0 0 0 0
72 Master Bond Botol 0 0 0 0 0
73 Orafil Plus Temporary Botol 0 0 0 0 0
74 Absorbent Paper Point Box 0 0 0 0 0
75 Root Canal Sealer Box 0 0 0 0 0
76 Zinc F+ Box 0 0 0 0 0
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 0
78 Cresotin Paste Pot 0 0 0 0 0
79 Iodotin Paste Pot 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
BMHP 0 0 0 0 0
80 Alat Suntik 1 cc Pcs 79 0 79 0 79
81 Alat Suntik 3 cc Pcs 183 0 183 0 183
82 Alat Suntik 5 cc Pcs 90 0 90 0 90
83 Alat Suntik 10 cc Pcs 0 0 0 0 0
84 Alkohol 70 % 300 ml Botol 0 0 0 0 0
85 Alkohol 70 % 1000 ml Botol 0 0 0 0 0
86 Blood Lancet Pcs 300 0 300 0 300
87 Cavida Gel Tube 10 0 10 0 10
88 Desinfectan Spray ( Baymed ) 750 ml Botol 7 0 7 0 7
89 Etil Klorida Semprot Botol 0 0 0 0 0
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 0
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 0
92 Hand Scrub 4 % 500 ml ( Baymed ) 4 0 4 0 4
93 High Elastic Bandage Roll 8 0 8 0 8
94 HCG Strip Strip 0 0 0 0 0
95 Infusion Set Anak Pcs 144 0 144 0 144
96 I.V. Insert 6 x 7 Pcs 100 0 100 0 100
97 Jelco No.18 G I.V Catheter Pcs 240 0 240 0 240
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 0
99 Jelco No.22 G I.V Catheter Pcs 229 0 229 0 229
100 Jelco No.24 G I.V Catheter Pcs 207 0 207 0 207
101 Jelco No.26 G I.V Catheter Pcs 100 0 100 0 100
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
102 Kapas 100 gr Bungkus 9 0 9 0 9
103 Kapas 500 gr Bungkus 0 0 0 0 0
104 Kasa Hidrofil 16 cm x 16 cm Kotak 321 0 321 0 321
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 0
106 Nasal Canula Neonate Pcs 30 0 30 0 30
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 0
108 Nebulizer Mask Child Pcs 63 0 63 0 63
109 Nebulizer Mask Adult Pcs 43 0 43 0 43
110 Povidone Iodine 10% 60 ml Botol 11 0 11 0 11
111 Pot Dahak Pot 0 0 0 0 0
112 Pot Urine Pot 0 0 0 0 0
113 Rivanol 300 ml Botol 0 0 0 0 0
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 0
115 Sarung Tangan Non steril Pcs 0 0 0 0 0
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 0
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 0
118 Sarung Tangan Steril No. 7.0 Pair 50 0 50 0 50
119 Sarung Tangan Steril No. 7.5 Pair 100 0 100 0 100
120 Surgical Gloves Steril Gynecolog Pair 52 0 52 0 52
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 0
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 0
123 Underpad Pcs 30 0 30 0 30
10 0 10 0 10
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
OBAT LABORATORIUM 0 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 0
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 0
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 0
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 0
128 Antigen H Vial 0 0 0 0 0
129 Antigen H-A Vial 0 0 0 0 0
130 Antigen H-B Vial 0 0 0 0 0
131 Antigen H-C Vial 0 0 0 0 0
132 Antigen O-A Vial 0 0 0 0 0
133 Antigen O-B Vial 0 0 0 0 0
134 Antigen O-C Vial 0 0 0 0 0
 Persediaan Tanggal Pema Stok Ket
NO NAMA OBAT SATUAN
Awal Terima Jumlah 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 kaian Akhir
135 Antigen O Vial 0 0 0 0 0
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 0
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 0
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 0
139 Benedict 100mL Botol 0 0 0 0 0
140 EDTA 10% 100mL Botol 0 0 0 0 0
141 Ehrlich 100 ml Botol 0 0 0 0 0
142 Eosin 2% 100 ml Botol 0 0 0 0 0
143 HCl 0,1N 100mL Botol 0 0 0 0 0
144 Hemoglobin C 500mL Botol 0 0 0 0 0
145 Immersion Oil 50 ml Botol 0 0 0 0 0
146 KOH 10% 500 ml Botol 0 0 0 0 0
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 0
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 0
149 Pewarna MDT 3x500mL Botol 0 0 0 0 0
150 Rees Ecker 100 ml Botol 0 0 0 0 0
151 SM Sedimen 500mL Botol 0 0 0 0 0
152 Turk 500 ml Botol 0 0 0 0 0
153 Wright 100 ml Botol 0 0 0 0 0
154 SD Bioline HbSAg Kotak 0 0 0 0 0
155 SD Syphillis 3.0 Kotak 0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

( ) ( )
Nip. Nip.
 LAPORAN PENERIMAAN OBAT SUMBER DANA OTSUS
TAHUN 2023

PENERIMAAN BULAN JUMLAH

NO NAMA OBAT SATUAN PENERIMAA
JAN FEB MAR APR MAI JUNI JULI AGUST SEPT OKT NOV DES N
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

1 Acyclovir 200 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0

2 Acyclovir Cream Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Anti Alergi Kombinasi Micronized (Dextamin syr) Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Asam Folat Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
6 Attapulgite 630 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Bedak Salisil 2% Serbuk Kotak 50 50 30 0 0 0 0 0 0 0 0 0 130
8 Betahistin Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Betametason Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Bisacodil supp 5 mg Supp 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Bisacodil supp 10 mg Supp 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Bromhexin HCL Syrup Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Clobazam 10 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
15 Curcuma Force Tablet 0 0 0 360 0 0 0 0 0 0 0 0 360
16 Dexamethason Tab 0,5 mg Tablet 0 1000 1000 2000 0 0 0 0 0 0 0 0 4000
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Phenylphrine Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 0 0 0 0 0 0 0 0 0 0 0 0 0
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Digoksin 0.25 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Diphenhidramin Inj Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Erytromicin 500 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
23 Furosemid 40 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
24 Furosemid Inj 10 mg/ml Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Gentamisin Salep Mata Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
 PENERIMAAN BULAN JUMLAH
NO NAMA OBAT SATUAN PENERIMAA
JAN FEB MAR APR MAI JUNI JULI AGUST SEPT OKT NOV DES N
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Griseofulvin Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
28 Hidroklorotiazid 25 mg Tablet 0 50 0 0 0 0 0 0 0 0 0 0 50
29 Ibuprofen Tab 200 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
31 Isosorbid Dinitrat 5 mg Tablet 200 0 0 300 0 0 0 0 0 0 0 0 500
32 Kalium Diclofenac 50 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Kaptopril 25 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
35 kalium Permanganat 5 gr Pot 0 0 0 0 0 0 0 0 0 0 0 0 0
36 Ketokonazole 2 % Tube 0 50 25 0 0 0 0 0 0 0 0 0 75
37 Klindamicin 150 mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0
39 Kloramphenicol Salep Mata 1 % Tube 24 48 24 0 0 0 0 0 0 0 0 0 96
40 Kloramphenicol tetes Mata 0.5% Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
41 Kloramphenicol tetes telinga Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
43 Klorpromazin 100 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
44 Lansoprazole 30 mg Kapsul 0 600 500 500 0 0 0 0 0 0 0 0 1600
45 Levofloxacin 500 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
46 Lidocain inj 2 % Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
47 Loperamid 2 mg Tablet 500 0 0 0 0 0 0 0 0 0 0 0 500
48 Meloxicam 15 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
49 Methisoprinol Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
51 Metronidazol 500 mg Tablet 0 0 500 1000 0 0 0 0 0 0 0 0 1500
52 Mikonazol krim 2 % Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
53 Multivitamin Dewasa Komb (Geriavita) Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
 PENERIMAAN BULAN JUMLAH
NO NAMA OBAT SATUAN PENERIMAA
JAN FEB MAR APR MAI JUNI JULI AGUST SEPT OKT NOV DES N
56 Nistatin drop Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
60 Piridoksin Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
61 Piroxicam 10 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
62 Risperidon 2 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
63 Salbutamol 4 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Sefadroksil 500 mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
67 Sianocobalamin inj Ampul 100 0 0 0 0 0 0 0 0 0 0 0 100
68 Thiamin Inj Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Thiamin 50 mg Tablet 0 0 1000 1000 0 0 0 0 0 0 0 0 2000
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Ventolin Nebule Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
OBAT GIGI 0 0 0 0 0 0 0 0 0 0 0 0 0
72 Master Bond Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Orafil Plus Temporary Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
74 Absorbent Paper Point Box 0 0 0 0 0 0 0 0 0 0 0 0 0
75 Root Canal Sealer Box 0 0 0 0 0 0 0 0 0 0 0 0 0
76 Zinc F+ Box 0 0 0 0 0 0 0 0 0 0 0 0 0
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
78 Cresotin Paste Pot 0 0 0 0 0 0 0 0 0 0 0 0 0
79 Iodotin Paste Pot 0 0 0 0 0 0 0 0 0 0 0 0 0
 PENERIMAAN BULAN JUMLAH
NO NAMA OBAT SATUAN PENERIMAA
JAN FEB MAR APR MAI JUNI JULI AGUST SEPT OKT NOV DES N
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
BMHP 0 0 0 0 0 0 0 0 0 0 0 0 0
80 Alat Suntik 1 cc Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
81 Alat Suntik 3 cc Pcs 300 100 100 0 0 0 0 0 0 0 0 0 500
82 Alat Suntik 5 cc Pcs 0 100 0 100 0 0 0 0 0 0 0 0 200

83 Alat Suntik 10 cc Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0

84 Alkohol 70 % 300 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0

85 Alkohol 70 % 1000 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0

86 Blood Lancet Pcs 300 100 200 200 0 0 0 0 0 0 0 0 800

87 Cavida Gel Tube 0 0 0 0 0 0 0 0 0 0 0 0 0

88 Desinfectan Spray ( Baymed ) 750 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
89 Etil Klorida Semprot Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
92 Hand Scrub 4 % 500 ml ( Baymed ) 5 0 0 5 0 0 0 0 0 0 0 0 10
93 High Elastic Bandage Roll 0 0 0 0 0 0 0 0 0 0 0 0 0
94 HCG Strip Strip 0 0 0 0 0 0 0 0 0 0 0 0 0
95 Infusion Set Anak Pcs 50 0 0 0 0 0 0 0 0 0 0 0 50
96 I.V. Insert 6 x 7 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
97 Jelco No.18 G I.V Catheter Pcs 0 100 100 0 0 0 0 0 0 0 0 0 200
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
99 Jelco No.22 G I.V Catheter Pcs 0 0 100 0 0 0 0 0 0 0 0 0 100
100 Jelco No.24 G I.V Catheter Pcs 0 100 0 0 0 0 0 0 0 0 0 0 100
 PENERIMAAN BULAN JUMLAH
NO NAMA OBAT SATUAN PENERIMAA
JAN FEB MAR APR MAI JUNI JULI AGUST SEPT OKT NOV DES N
101 Jelco No.26 G I.V Catheter Pcs 0 100 0 0 0 0 0 0 0 0 0 0 100
102 Kapas 100 gr Bungkus 12 0 0 12 0 0 0 0 0 0 0 0 24
103 Kapas 500 gr Bungkus 5 0 0 0 0 0 0 0 0 0 0 0 5
104 Kasa Hidrofil 16 cm x 16 cm Kotak 0 0 0 0 0 0 0 0 0 0 0 0 0
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0
106 Nasal Canula Neonate Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
108 Nebulizer Mask Child Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
109 Nebulizer Mask Adult Pcs 0 10 0 0 0 0 0 0 0 0 0 0 10
110 Povidone Iodine 10% 60 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
111 Pot Dahak Pot 0 0 0 0 0 0 0 0 0 0 0 0 0
112 Pot Urine Pot 0 0 0 0 0 0 0 0 0 0 0 0 0
113 Rivanol 300 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
115 Sarung Tangan Non steril Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 0 0 0 0 0 0 0 0 0
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 0 0 0 0 0 0 0 0 0
118 Sarung Tangan Steril No. 7.0 Pair 0 50 100 100 0 0 0 0 0 0 0 0 250
119 Sarung Tangan Steril No. 7.5 Pair 0 0 0 0 0 0 0 0 0 0 0 0 0
120 Surgical Gloves Steril Gynecolog Pair 0 0 0 0 0 0 0 0 0 0 0 0 0
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
123 Underpad Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
OBAT LABORATORIUM 0 0 0 0 0 0 0 0 0 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
 PENERIMAAN BULAN JUMLAH
NO NAMA OBAT SATUAN PENERIMAA
JAN FEB MAR APR MAI JUNI JULI AGUST SEPT OKT NOV DES N
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
128 Antigen H Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
129 Antigen H-A Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
130 Antigen H-B Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
131 Antigen H-C Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
132 Antigen O-A Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
133 Antigen O-B Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
134 Antigen O-C Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
135 Antigen O Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
139 Benedict 100mL Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
140 EDTA 10% 100mL Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
141 Ehrlich 100 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
142 Eosin 2% 100 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
143 HCl 0,1N 100mL Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
144 Hemoglobin C 500mL Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
145 Immersion Oil 50 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
146 KOH 10% 500 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
149 Pewarna MDT 3x500mL Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
150 Rees Ecker 100 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
151 SM Sedimen 500mL Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
152 Turk 500 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
153 Wright 100 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
154 SD Bioline HbSAg Kotak 0 0 0 0 0 0 0 0 0 0 0 0 0
 PENERIMAAN BULAN JUMLAH
NO NAMA OBAT SATUAN PENERIMAA
JAN FEB MAR APR MAI JUNI JULI AGUST SEPT OKT NOV DES N
155 SD Syphillis 3.0 Kotak 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

( ) ( )
Nip. Nip.
 LAPORAN PEMAKAIAN OBAT SUMBER DANA OTSUS
TAHUN 2023

PEMAKAIAN BULAN JUMLAH

NO NAMA OBAT SATUAN
JAN FEB MAR APR MAI JUNI JULI AGUST SEPT OKT NOV DES PENERIMAAN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

1 Acyclovir 200 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0

2 Acyclovir Cream Tube 3 0 0 0 0 0 0 0 0 0 0 0 3
3 Ambroxol Tab 30 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
4 Anti Alergi Kombinasi Micronized (Dextamin syr) Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
5 Asam Folat Tablet 76 1780 1094 0 0 0 0 0 0 0 0 0 2950
6 Attapulgite 630 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Bedak Salisil 2% Serbuk Kotak 23 14 39 41 0 0 0 0 0 0 0 0 117
8 Betahistin Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
9 Betametason Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
10 Bisacodil supp 5 mg Supp 0 0 0 0 0 0 0 0 0 0 0 0 0
11 Bisacodil supp 10 mg Supp 2 0 0 0 0 0 0 0 0 0 0 0 2
12 Bromhexin HCL Syrup Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
14 Clobazam 10 mg Tablet 0 0 60 0 0 0 0 0 0 0 0 0 60
15 Curcuma Force Tablet 0 0 0 265 0 0 0 0 0 0 0 0 265
16 Dexamethason Tab 0,5 mg Tablet 1301 1703 1020 1171 0 0 0 0 0 0 0 0 5195
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Phenylphrine Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 0 0 3 5 0 0 0 0 0 0 0 0 8
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0 0 0 0 0 0 0 0 0 0
20 Digoksin 0.25 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
21 Diphenhidramin Inj Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
22 Erytromicin 500 mg Tablet 10 10 40 0 0 0 0 0 0 0 0 0 60
23 Furosemid 40 mg Tablet 0 10 0 0 0 0 0 0 0 0 0 0 10
24 Furosemid Inj 10 mg/ml Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Gentamisin Salep Mata Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
 PEMAKAIAN BULAN JUMLAH
NO NAMA OBAT SATUAN
JAN FEB MAR APR MAI JUNI JULI AGUST SEPT OKT NOV DES PENERIMAAN
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
27 Griseofulvin Tablet 34 0 0 0 0 0 0 0 0 0 0 0 34
28 Hidroklorotiazid 25 mg Tablet 0 50 13 83 0 0 0 0 0 0 0 0 146
29 Ibuprofen Tab 200 mg Tablet 0 0 210 0 0 0 0 0 0 0 0 0 210
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
31 Isosorbid Dinitrat 5 mg Tablet 167 43 93 105 0 0 0 0 0 0 0 0 408
32 Kalium Diclofenac 50 mg Tablet 384 0 0 0 0 0 0 0 0 0 0 0 384
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
34 Kaptopril 25 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
35 kalium Permanganat 5 gr Pot 20 0 2 0 0 0 0 0 0 0 0 0 22
36 Ketokonazole 2 % Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Klindamicin 150 mg Kapsul 0 16 40 0 0 0 0 0 0 0 0 0 56
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0
39 Kloramphenicol Salep Mata 1 % Tube 0 12 28 28 0 0 0 0 0 0 0 0 68
40 Kloramphenicol tetes Mata 0.5% Botol 1 10 1 10 0 0 0 0 0 0 0 0 22
41 Kloramphenicol tetes telinga Botol 0 5 0 0 0 0 0 0 0 0 0 0 5
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
43 Klorpromazin 100 mg Tablet 0 0 21 0 0 0 0 0 0 0 0 0 21
44 Lansoprazole 30 mg Kapsul 0 343 309 792 0 0 0 0 0 0 0 0 1444
45 Levofloxacin 500 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
46 Lidocain inj 2 % Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
47 Loperamid 2 mg Tablet 20 50 10 10 0 0 0 0 0 0 0 0 90
48 Meloxicam 15 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
49 Methisoprinol Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
51 Metronidazol 500 mg Tablet 343 647 256 169 0 0 0 0 0 0 0 0 1415
52 Mikonazol krim 2 % Tube 0 26 0 0 0 0 0 0 0 0 0 0 26
53 Multivitamin Dewasa Komb (Geriavita) Tablet 9 0 0 0 0 0 0 0 0 0 0 0 9
54 Multivitamin Syr Anak (Becefort syr) Botol 0 0 25 0 0 0 0 0 0 0 0 0 25
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
 PEMAKAIAN BULAN JUMLAH
NO NAMA OBAT SATUAN
JAN FEB MAR APR MAI JUNI JULI AGUST SEPT OKT NOV DES PENERIMAAN
56 Nistatin drop Botol 0 0 2 0 0 0 0 0 0 0 0 0 2
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
60 Piridoksin Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
61 Piroxicam 10 mg Tablet 755 0 0 0 0 0 0 0 0 0 0 0 755
62 Risperidon 2 mg Tablet 0 0 0 0 0 0 0 0 0 0 0 0 0
63 Salbutamol 4 mg Tablet 82 18 0 0 0 0 0 0 0 0 0 0 100
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0 0 0 0 0 0 0 0 0 0
65 Sefadroksil 500 mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
67 Sianocobalamin inj Ampul 0 25 0 0 0 0 0 0 0 0 0 0 25
68 Thiamin Inj Ampul 0 0 0 0 0 0 0 0 0 0 0 0 0
69 Thiamin 50 mg Tablet 0 100 1546 1392 0 0 0 0 0 0 0 0 3038
70 Thiamphenicol 500 mg Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0
71 Ventolin Nebule Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
OBAT GIGI 0 0 0 0 0 0 0 0 0 0 0 0 0
72 Master Bond Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
73 Orafil Plus Temporary Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
74 Absorbent Paper Point Box 0 0 0 0 0 0 0 0 0 0 0 0 0
75 Root Canal Sealer Box 0 0 0 0 0 0 0 0 0 0 0 0 0
76 Zinc F+ Box 0 0 0 0 0 0 0 0 0 0 0 0 0
77 Antiseptic Liquid No. 2 Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
78 Cresotin Paste Pot 0 0 0 0 0 0 0 0 0 0 0 0 0
79 Iodotin Paste Pot 0 0 0 0 0 0 0 0 0 0 0 0 0
 PEMAKAIAN BULAN JUMLAH
NO NAMA OBAT SATUAN
JAN FEB MAR APR MAI JUNI JULI AGUST SEPT OKT NOV DES PENERIMAAN
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
BMHP 0 0 0 0 0 0 0 0 0 0 0 0 0
80 Alat Suntik 1 cc Pcs 15 6 0 0 0 0 0 0 0 0 0 0 21
81 Alat Suntik 3 cc Pcs 71 330 12 104 0 0 0 0 0 0 0 0 517
82 Alat Suntik 5 cc Pcs 0 100 0 10 0 0 0 0 0 0 0 0 110

83 Alat Suntik 10 cc Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0

84 Alkohol 70 % 300 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0

85 Alkohol 70 % 1000 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0

86 Blood Lancet Pcs 0 200 300 0 0 0 0 0 0 0 0 0 500

87 Cavida Gel Tube 2 6 0 0 0 0 0 0 0 0 0 0 8

88 Desinfectan Spray ( Baymed ) 750 ml Botol 1 1 2 0 0 0 0 0 0 0 0 0 4
89 Etil Klorida Semprot Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
90 Fresco Hand Rub 500 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 0 5 0 0 0 0 0 0 0 0 0 0 5
92 Hand Scrub 4 % 500 ml ( Baymed ) 0 5 0 1 0 0 0 0 0 0 0 0 6
93 High Elastic Bandage Roll 0 0 0 0 0 0 0 0 0 0 0 0 0
94 HCG Strip Strip 0 0 0 0 0 0 0 0 0 0 0 0 0
95 Infusion Set Anak Pcs 0 0 6 0 0 0 0 0 0 0 0 0 6
96 I.V. Insert 6 x 7 Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
97 Jelco No.18 G I.V Catheter Pcs 100 0 10 0 0 0 0 0 0 0 0 0 110
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
99 Jelco No.22 G I.V Catheter Pcs 62 9 0 0 0 0 0 0 0 0 0 0 71
100 Jelco No.24 G I.V Catheter Pcs 101 2 8 4 0 0 0 0 0 0 0 0 115
101 Jelco No.26 G I.V Catheter Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
 PEMAKAIAN BULAN JUMLAH
NO NAMA OBAT SATUAN
JAN FEB MAR APR MAI JUNI JULI AGUST SEPT OKT NOV DES PENERIMAAN
102 Kapas 100 gr Bungkus 0 12 0 3 0 0 0 0 0 0 0 0 15
103 Kapas 500 gr Bungkus 0 0 5 0 0 0 0 0 0 0 0 0 5
104 Kasa Hidrofil 16 cm x 16 cm Kotak 0 0 10 83 0 0 0 0 0 0 0 0 93
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0
106 Nasal Canula Neonate Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
108 Nebulizer Mask Child Pcs 0 0 7 0 0 0 0 0 0 0 0 0 7
109 Nebulizer Mask Adult Pcs 0 0 7 0 0 0 0 0 0 0 0 0 7
110 Povidone Iodine 10% 60 ml Botol 0 10 1 3 0 0 0 0 0 0 0 0 14
111 Pot Dahak Pot 0 0 0 0 0 0 0 0 0 0 0 0 0
112 Pot Urine Pot 0 0 0 0 0 0 0 0 0 0 0 0 0
113 Rivanol 300 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
115 Sarung Tangan Non steril Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0 0 0 0 0 0 0 0 0 0
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0 0 0 0 0 0 0 0 0 0
118 Sarung Tangan Steril No. 7.0 Pair 110 140 0 150 0 0 0 0 0 0 0 0 400
119 Sarung Tangan Steril No. 7.5 Pair 0 0 0 0 0 0 0 0 0 0 0 0 0
120 Surgical Gloves Steril Gynecolog Pair 0 0 0 0 0 0 0 0 0 0 0 0 0
121 Surgical Gown ( Apron ) Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
123 Underpad Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
OBAT LABORATORIUM 0 0 0 0 0 0 0 0 0 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
 PEMAKAIAN BULAN JUMLAH
NO NAMA OBAT SATUAN
JAN FEB MAR APR MAI JUNI JULI AGUST SEPT OKT NOV DES PENERIMAAN
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
128 Antigen H Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
129 Antigen H-A Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
130 Antigen H-B Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
131 Antigen H-C Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
132 Antigen O-A Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
133 Antigen O-B Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
134 Antigen O-C Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
135 Antigen O Vial 0 0 0 0 0 0 0 0 0 0 0 0 0
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
137 Barium Clorida 10% 100 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
138 Barium Clorida 10% 500 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
139 Benedict 100mL Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
140 EDTA 10% 100mL Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
141 Ehrlich 100 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
142 Eosin 2% 100 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
143 HCl 0,1N 100mL Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
144 Hemoglobin C 500mL Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
145 Immersion Oil 50 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
146 KOH 10% 500 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
147 Na Citrate 3,13% 100ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
148 Pewarna Giemsa 100 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
149 Pewarna MDT 3x500mL Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
150 Rees Ecker 100 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
151 SM Sedimen 500mL Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
152 Turk 500 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
153 Wright 100 ml Botol 0 0 0 0 0 0 0 0 0 0 0 0 0
154 SD Bioline HbSAg Kotak 0 0 0 0 0 0 0 0 0 0 0 0 0
155 SD Syphillis 3.0 Kotak 0 0 0 0 0 0 0 0 0 0 0 0 0
 PEMAKAIAN BULAN JUMLAH
NO NAMA OBAT SATUAN
JAN FEB MAR APR MAI JUNI JULI AGUST SEPT OKT NOV DES PENERIMAAN
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

( ) ( )
Nip Nip
 LAPORAN TAHUNAN KETERSEDIAAN OBAT SUMBER DANA OTSUS
TAHUN 2023

SALDO SALDO
PENERIMAAN PEMAKAIAN
NO NAMA OBAT SATUAN 01 JAN 31 DES KET
2023 2023
2023 2023
1 2 3 4 5 6 7 8

1 Acyclovir 200 mg Tablet 0 0 0 0

2 Acyclovir Cream Tube 33 0 3 0
3 Ambroxol Tab 30 mg Tablet 0 0 0 0
4 Anti Alergi Kombinasi Micronized (Dextamin syr) Botol 36 0 0 0
5 Asam Folat Tablet 2950 0 2950 0
6 Attapulgite 630 mg Tablet 0 0 0 0
7 Bedak Salisil 2% Serbuk Kotak 1 130 117 0
8 Betahistin Tablet 0 0 0 0
9 Betametason Tube 0 0 0 0
10 Bisacodil supp 5 mg Supp 6 0 0 0
11 Bisacodil supp 10 mg Supp 20 0 2 0
12 Bromhexin HCL Syrup Botol 0 0 0 0
13 Bromhexin HCL Tablet 8 mg Tablet 0 0 0 0
14 Clobazam 10 mg Tablet 63 0 60 0
15 Curcuma Force Tablet 0 360 265 0
16 Dexamethason Tab 0,5 mg Tablet 5147 4000 5195 0
Dextromethorph HBr 7.5 mg,
17 Dexchlopheniramine Maleat 1 mg, Phenylphrine Botol 0 0 0 0
Syr ( Dextrofen )
18 Diazepam Enema 5mg/25ml (Stesolit) Supp 13 0 8 0
19 Diazepam Enema 10mg/25ml (Stesolit) Supp 0 0 0 0
20 Digoksin 0.25 mg Tablet 100 0 0 0
21 Diphenhidramin Inj Ampul 0 0 0 0
22 Erytromicin 500 mg Tablet 79 0 60 0
23 Furosemid 40 mg Tablet 133 0 10 0
24 Furosemid Inj 10 mg/ml Ampul 10 0 0 0
25 Gentamisin Salep Mata Tube 1 0 0 0
26 Gliseril Guayakolat tab 100 mg Tablet 0 0 0 0
27 Griseofulvin Tablet 34 0 34 0
28 Hidroklorotiazid 25 mg Tablet 97 50 146 0
29 Ibuprofen Tab 200 mg Tablet 214 0 210 0
30 Ibuprofen Tab 400 mg Tablet 0 0 0 0
31 Isosorbid Dinitrat 5 mg Tablet 209 500 408 0
32 Kalium Diclofenac 50 mg Tablet 420 0 384 0
33 Kaolin 550 mg,pectin 20 mg (neo diaform) Tablet 0 0 0 0
34 Kaptopril 25 mg Tablet 0 0 0 0
35 kalium Permanganat 5 gr Pot 25 0 22 0
36 Ketokonazole 2 % Tube 0 75 0 0
37 Klindamicin 150 mg Kapsul 72 0 56 0
38 Kloramfenikol kaps 250 mg Kapsul 0 0 0 0
39 Kloramphenicol Salep Mata 1 % Tube 0 96 68 0
40 Kloramphenicol tetes Mata 0.5% Botol 62 0 22 0
41 Kloramphenicol tetes telinga Botol 5 0 5 0
42 Klorfeniramin maleat 4 mg (CTM ) Tablet 0 0 0 0
43 Klorpromazin 100 mg Tablet 21 0 21 0
44 Lansoprazole 30 mg Kapsul 0 1600 1444 0
45 Levofloxacin 500 mg Tablet 0 0 0 0
46 Lidocain inj 2 % Ampul 0 0 0 0
 SALDO SALDO
PENERIMAAN PEMAKAIAN
NO NAMA OBAT SATUAN 01 JAN 31 DES KET
2023 2023
2023 2023
47 Loperamid 2 mg Tablet 196 500 90 0
48 Meloxicam 15 mg Tablet 0 0 0 0
49 Methisoprinol Tablet 0 0 0 0
50 Metoclopramid inj 5 mg/ml Ampul 0 0 0 0
51 Metronidazol 500 mg Tablet 990 1500 1415 0
52 Mikonazol krim 2 % Tube 26 0 26 0
53 Multivitamin Dewasa Komb (Geriavita) Tablet 9 0 9 0
54 Multivitamin Syr Anak (Becefort syr) Botol 25 0 25 0
55 Natrium Bicarbonat 500 mg Tablet 0 0 0 0
56 Nistatin drop Botol 3 0 2 0
57 Oksitetrasiklin Salep Kulit Tube 0 0 0 0
58 Omeprazole inj 40 mg/10 ml Ampul 0 0 0 0
59 Paracetamol 500 mg Tablet 0 0 0 0
60 Piridoksin Tablet 0 0 0 0
61 Piroxicam 10 mg Tablet 755 0 755 0
62 Risperidon 2 mg Tablet 0 0 0 0
63 Salbutamol 4 mg Tablet 100 0 100 0
64 Salep Infeksi Kulit Kombinasi (Flucort N ) Tube 0 0 0 0
65 Sefadroksil 500 mg Kapsul 0 0 0 0
66 Serum Anti Tetanus 1.500 UI / ml Ampul 0 0 0 0
67 Sianocobalamin inj Ampul 0 100 25 0
68 Thiamin Inj Ampul 0 0 0 0
69 Thiamin 50 mg Tablet 3000 2000 3038 0
70 Thiamphenicol 500 mg Kapsul 0 0 0 0
71 Ventolin Nebule Vial 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT GIGI 0 0 0 0
72 Master Bond Botol 0 0 0 0
73 Orafil Plus Temporary Botol 0 0 0 0
74 Absorbent Paper Point Box 0 0 0 0
75 Root Canal Sealer Box 0 0 0 0
76 Zinc F+ Box 0 0 0 0
77 Antiseptic Liquid No. 2 Botol 0 0 0 0
78 Cresotin Paste Pot 0 0 0 0
79 Iodotin Paste Pot 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
BMHP 0 0 0 0
80 Alat Suntik 1 cc Pcs 100 0 21 0
81 Alat Suntik 3 cc Pcs 200 500 517 0
82 Alat Suntik 5 cc Pcs 0 200 110 0
83 Alat Suntik 10 cc Pcs 0 0 0 0
84 Alkohol 70 % 300 ml Botol 0 0 0 0
85 Alkohol 70 % 1000 ml Botol 0 0 0 0
 SALDO SALDO
PENERIMAAN PEMAKAIAN
NO NAMA OBAT SATUAN 01 JAN 31 DES KET
2023 2023
2023 2023
86 Blood Lancet Pcs 0 800 500 0
87 Cavida Gel Tube 18 0 8 0
88 Desinfectan Spray ( Baymed ) 750 ml Botol 11 0 4 0
89 Etil Klorida Semprot Botol 0 0 0 0
90 Fresco Hand Rub 500 ml Botol 0 0 0 0
91 Hand Rub 0,5 % 500 ml ( Baymed ) Botol 5 0 5 0
92 Hand Scrub 4 % 500 ml ( Baymed ) 0 10 6 0
93 High Elastic Bandage Roll 8 0 0 0
94 HCG Strip Strip 0 0 0 0
95 Infusion Set Anak Pcs 100 50 6 0
96 I.V. Insert 6 x 7 Pcs 100 0 0 0
97 Jelco No.18 G I.V Catheter Pcs 150 200 110 0
98 Jelco No.20 G I.V Catheter Pcs 0 0 0 0
99 Jelco No.22 G I.V Catheter Pcs 200 100 71 0
100 Jelco No.24 G I.V Catheter Pcs 222 100 115 0
101 Jelco No.26 G I.V Catheter Pcs 0 100 0 0
102 Kapas 100 gr Bungkus 0 24 15 0
103 Kapas 500 gr Bungkus 0 5 5 0
104 Kasa Hidrofil 16 cm x 16 cm Kotak 414 0 93 0
105 Kasa Hidrofil 4 Yard x 15 cm Roll 0 0 0 0
106 Nasal Canula Neonate Pcs 30 0 0 0
107 Nasal Canula (Child, Adult ) Pcs 0 0 0 0
108 Nebulizer Mask Child Pcs 70 0 7 0
109 Nebulizer Mask Adult Pcs 40 10 7 0
110 Povidone Iodine 10% 60 ml Botol 25 0 14 0
111 Pot Dahak Pot 0 0 0 0
112 Pot Urine Pot 0 0 0 0
113 Rivanol 300 ml Botol 0 0 0 0
114 Safety Box 12,5 L ( Baymed ) Pcs 0 0 0 0
115 Sarung Tangan Non steril Pcs 0 0 0 0
116 Sarung Tangan Steril No. 6.0 Pair 0 0 0 0
117 Sarung Tangan Steril No. 6.5 Pair 0 0 0 0
118 Sarung Tangan Steril No. 7.0 Pair 200 250 400 0
119 Sarung Tangan Steril No. 7.5 Pair 100 0 0 0
120 Surgical Gloves Steril Gynecolog Pair 52 0 0 0
121 Surgical Gown ( Apron ) Pcs 0 0 0 0
122 Uro Catether ( 8,14,16,20 ) Pcs 0 0 0 0
123 Underpad Pcs 30 0 0 0
10 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
OBAT LABORATORIUM 0 0 0 0
124 Anti-A Monoclonal Golongan Darah Vial 0 0 0 0
125 Anti-B Monoclonal Golongan Darah Vial 0 0 0 0
126 Anti-A,B Monoclonal Golongan Darah Vial 0 0 0 0
127 Anti-D Duoclone Golongan Darah Vial 0 0 0 0
128 Antigen H Vial 0 0 0 0
129 Antigen H-A Vial 0 0 0 0
130 Antigen H-B Vial 0 0 0 0
 SALDO SALDO
PENERIMAAN PEMAKAIAN
NO NAMA OBAT SATUAN 01 JAN 31 DES KET
2023 2023
2023 2023
131 Antigen H-C Vial 0 0 0 0
132 Antigen O-A Vial 0 0 0 0
133 Antigen O-B Vial 0 0 0 0
134 Antigen O-C Vial 0 0 0 0
135 Antigen O Vial 0 0 0 0
136 Asam Sulfosalisilat 20% 100 ml Botol 0 0 0 0
137 Barium Clorida 10% 100 ml Botol 0 0 0 0
138 Barium Clorida 10% 500 ml Botol 0 0 0 0
139 Benedict 100mL Botol 0 0 0 0
140 EDTA 10% 100mL Botol 0 0 0 0
141 Ehrlich 100 ml Botol 0 0 0 0
142 Eosin 2% 100 ml Botol 0 0 0 0
143 HCl 0,1N 100mL Botol 0 0 0 0
144 Hemoglobin C 500mL Botol 0 0 0 0
145 Immersion Oil 50 ml Botol 0 0 0 0
146 KOH 10% 500 ml Botol 0 0 0 0
147 Na Citrate 3,13% 100ml Botol 0 0 0 0
148 Pewarna Giemsa 100 ml Botol 0 0 0 0
149 Pewarna MDT 3x500mL Botol 0 0 0 0
150 Rees Ecker 100 ml Botol 0 0 0 0
151 SM Sedimen 500mL Botol 0 0 0 0
152 Turk 500 ml Botol 0 0 0 0
153 Wright 100 ml Botol 0 0 0 0
154 SD Bioline HbSAg Kotak 0 0 0 0
155 SD Syphillis 3.0 Kotak 0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0
0 0 0 0

Mengetahui
Kepala UPTD Puskesmas Pengelola Obat PKM

( ) ( )
Nip Nip