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LAPORAN PEMAKAIAN HARIAN OBAT UMUM MEI 2023

NO NAMA OBAT SATUAN


PEMAKAIAN

1 2
C CAIRAN
1 Natrium Klorida lart.infus 0,9% steril - 500 ml Botol 0 0

D OBAT 0 0
1 Allupurinol 100 mg Tablet Tab 0 0
2 Aminophylin tablet 200mg Tab 0 0
3 Amlodipin 10 mg Tab 0 0
4 Amoksisilin Kaplet 500 mg Kaplet 0 300
5 Amoksisilin Kapsul 250 mg Kapsul 0 0
6 Amoksisilin sirup kering 125 mg/5 ml Botol 0 11
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 0 0
8 Antasida Suspensi 60 ml Botol 0 0
9 Antasida DOEN tablet kombinasi Tab 0 70
10 Anti fungi DOEN komb sk tube 0 0
11 Anti Hemoroid DOEN kombinasi supp 0 0
12 Antimigren DOEN kombinasi Tab 0 0
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab 0 0
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 0 66
15 asam folat tablet 1 mg Tab 0 0
16 Asam mefenamat 500 mg Kaplet 0 205
17 Asetyl sestein 200mg kapsul 0 111
18 Asiklovir Tablet 400 mg Tab 0 0
19 Attalpugite tab 600 mg Tab 0 20
20 Betahistin maleat Tab 0 0
21 Betametasone Krim 0.1% tube 0 0
22 Bisakodil Supp 10 mg supp 0 0
23 bisoprolol tablet tablet 0 0
24 Captopril 12,5 mg Tab 0 0
25 Captopril tablet 25 mg Tab 0 35
26 Deksametasone tablet 0.5mg Tab 0 215
27 Diasepam 2 mg tablet Tab 0 0
28 Diazepam Inj 5 ml/2ml ampul 0 0
29 Diazepam lar rektal 5mg/2,5ml tube 0 0
30 Digoksin tablet 0,25 mg Tab 0 0
31 Doksisiklin 100 mg ampul 0 0
32 Domperidon tablet 10 mg Tab 0 3
33 Erytromycin 250 mg Kapsul 0 0
34 Etambutol HCL 250 mg Tab 0 0
35 Fenitoin Na kaps 100 mg Kapsul 0 0
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul 0 0
37 Fenobarbital tablet 30 mg Tab 0 0
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 0 0
39 Furosemid tablet 40 mg Tab 0 0
40 Gentamisin tetes mata Botol 0 0
41 Glibenklamid tablet 5 mg Tab 0 0
42 Glimepiride tab 0 5
43 Griseofulvin tablet 125 mg, micronized Tab 0 0
44 Hidroklorotiazid (HCT) tablet 25 mg Tab 0 0
45 Hidrokortison krim 2,5 % tube 0 15
46 Ibuprofen Suspensi 100mg 5ml botol 0 0
47 Ibuprofen tablet 400 mg Tab 0 176
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab 0 0
49 Kalsium lakate (kalk) tablet Tab 0 40
50 Karbamazepin tablet 200 mg Tab 0 0
51 Karbogliserin Tetes Telinga 10% Botol 0 0
52 Ketokonazol krim 2 % tube 0 0
53 Ketokonazol Tablet 200 mg Tab 0 30
54 Klindamicin 150 mg Kapsul 0 0
55 Kloramfenikol Kapsul 500 mg Kapsul 0 0
56 Kloramfenikol salep kulit 2% (bufacetin) tube 0 4
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol 0 0
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 0 103
59 Klorpromazin HCL tablet 25 mg Tab 0 0
60 Kodein HCl 10 mg Tab 0 0
61 Kotrimoksazol forte tablet Tab 0 40
62 Kotrimoksazol 480 tablet tab 0 0
63 Kotrimoksazol suspensi kombinasi Botol 0 5
64 Lansoprazol 30 mg Tab 0 0
65 Loratadin tab 10 mg Tab 0 0
66 Metformin tablet 500 mg Tab 0 15
67 metil dopa tab 250 mg Tab 0 0
68 Metilergometrin Maleat tablet salut 0,125 mg Tab 0 0
69 Metronidazol tablet 500 mg Tab 0 10
70 Miconazol SK tube 0 0
71 Natrium bikarbonat tablet 500 mg Tab 0 0
72 Natrium Diklofenac 50 mg Tab 0 110
73 Nifedifin tablet 30 mg Tab 0 0
74 Nistatin 100.000 IU/gram tablet vaginal supp 0 0
75 Nistatin tablet salut gula 500.000 IU/g Tab 0 0
76 Oksitetrasiklin HCl salep 3% - 5 gram tube 0 0
77 Omeprazol 20 mg Tab 0 59
78 Ondansentron tab 8 mg Tab 0 0
79 parasetamol drop Botol 0 0
80 Parasetamol Kaplet 500 mg Tab 0 35
81 Parasetamol sirup Botol 0 14
82 Permetrin/scabimite krim 5 % tube 0 0
83 Pirantel Pamoat tablet 125 mg Tab 0 0
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 0 10
85 Prednison tablet 5 mg Tab 0 12
86 Propranolol HCl tablet 40 mg Tab 0 0
87 Ranitidin tablet 150 mg Tab 0 204
88 Salbutamol tablet 2 mg Tab 0 0
89 Salep 2 - 4 kombinasi tube 0 1
90 Setirizin sir 5 mg/ 5 ml Botol 0 0
91 Sianokobalamin (Vitamin B12) 50 mg Tab 0 10
92 Simvastatin 20 mg Tab 0 5
93 Tetrasiklin HCl Kapsul 500 mg Kapsul 0 0
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 0 10
95 Vitamin B komplek tablet Tab 0 72

G KESEHATAN JIWA 0 0
1 Haloperidol dekanoat inj 50 mg/ml ampul 0 0
2 Klobazam 10 mg tablet tablet 0 0
3 Amitripilin HCL 25 mg tablet tablet 0 0
4 Klorpromazin 100 mg tablet tablet 0 0
5 Risperidon 2 mg Tablet tablet 0 0
6 Klozapin 25 mg tablet tablet 0 0
7 Trifluoperazine HCL 5 mg tablet tablet 0 0
8 Haloperidol inj 5 mg/ml ampul 0 0
9 Imipramin HCL 25 mg tablet tablet 0 0
10 Fluoksetin 10 mg tablet tablet 0 0
11 Triheksifenidil 2 mg tab tablet 0 0
12 Haloperidol 5 mg tablet tablet 0 0

I GIZI
Retinol (Vitamin A) 100.000 IU Kapsul Lunak
Bayi (6 - 11 bulan)
1 kapsul 0 0
Retinol (Vitamin A) 200.000 IU Kapsul Lunak
Balita (11 - 59 bulan)
2 kapsul 0 0
3 Tablet Tambah Darah (Ibu Hamil) tablet 0 270
0 0
A BMHP 0 0
1 Kapas 250 gr Pcs 0 0
2 Masker Pcs 0 0
3 Handscoon non steril ukuran M Pcs 0 0
4 Handscoon non steril ukuran S Pcs 0 0
5 Handscoon steril 7 Pcs 0 0
0 0
B DESINFECTAN 0 0
1 Alkohol 70% - 1000 ml Btl 0 0
2 Antiseptik Hand Rub 500 ml Btl 0 0
3 Rivanol larutan 0,1% - 300 cc Btl 0 0
0 0
C TAMBAHAN OBAT DAN ALKES 0 0
1 Asiklovir krim Tube 0 0
2 Ciprofloksasin 500 mg Tablet 0 0
3 Domperidon sirup Btl 0 0
4 Garam Oralit Sacchet 0 0
5 Gemfibrozil 600 mg Tablet 0 0
6 Haloperidol 1,5 mg Tablet 0 0
7 Klindamicin 300 mg Kapsul 0 0
8 Metoklorpropamid 5 mg Tablet 0 5
9 Multivitamin sirup Btl 0 0
10 Multivitamin tablet/SUPRABION Kapsul 0 0
11 Natrium Diklofenak 25 mg Tablet 0 0
12 Nifedipin 20 mg/adalat oros Tablet 0 0
13 Oksitetrasiklin salep mata 1% Tube 0 0
14 Propiltiourasil 100 mg Tablet 0 0
15 Ramipril 10 mg Tablet 0 0
16 Salisil Bedak Bungkus 0 0
17 Salbutamol 4 mg Tablet 0 0
18 Sefadroksil 500 mg Kapsul 0 0
19 Sefadroksil sirup 250 mg Btl 0 0
20 Sefadroksil sirup 125 mg Btl 0 0
21 Setrizin tablet Tablet 0 21
22 Zink kid 10 mg sirup Btl 0 0
23 Zink sirup 20 mg Btl 0 0
24 Zink tablet 20 mg Tablet 0 60
NO NAMA OBAT SATUAN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet
17 Asetyl sestein 200mg kapsul
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab
95 Vitamin B komplek tablet Tab

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl

C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Haloperidol 1,5 mg Tablet
6 Gemfibrozil 600 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 1
JUMLAH

0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0

0
0
0
0
0

0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 5 10 10 10 10 5 5 5 5 10 10 10 10 5 10 10 5 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol 1 1 1 1 1 1 1 1 1 1 1
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 6 10 20 20
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 5 10 10 10 10 10 10 10 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 5 6 5 6 6 6 6 6 6 6 6 6 1 1 2
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab 10 10 10 5
26 Deksametasone tablet 0.5mg Tab 6 5 5 5 6 6 6 6 6 6 6 6 6 6 1 2 2 1
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 3
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab 5
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 6 10 10 10 10 10 10 10 10 10 10 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab 5 10 10 5
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 5 6 6 6 6 5 6 6 6 6 6 1 2 2 3 1 1 2
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 5 10 10 10 5
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1 1 1 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 15
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab 10
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 10 10 10 10 10 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6 6 6 6 6 6 6 5
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 5 5 5 10 10
81 Parasetamol sirup Botol 1 1 1 1 1 1 1 1 1 1 1 1 1 1
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 10
85 Prednison tablet 5 mg Tab 6 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 6 6 10 10 10 10 10 10 6 10 10 10 10 10 10 10 10 10
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10
92 Simvastatin 20 mg Tab 5
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10
95 Vitamin B komplek tablet Tab 5 6 5 10 10 10 10 6 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 30 30 30 30 30 30 30 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet 5
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 10 10 10 10 10 10
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet 6 10 5 10 10
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet 3 3 3
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 2

10 5 10 5 10 10 10 5 10 10 10 10 10 10 10 10 10

10 10 10
3 2 2 2 1 2 2 2 3

2 2 3 2 2 2 2 1 3 2 2 2 3 10 10 10 10 10 10 10 10 10 10
3 2 2 2 2 3 1 3 2 2 2 3
6 10 10 10
JUMLAH

0
0

0
0
0
300
0
11
0
0
70
0
0
0
0
66
0
205
111
0
20
0
0
0
0
0
35
215
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
5
0
0
15
0
176
0
40
0
0
0
30
0
0
4
0
103
0
0
40
0
5
0
0
15
0
0
10
0
0
110
0
0
0
0
59
0
0
35
14
0
0
10
12
0
204
0
1
0
10
5
0
10
72

0
0
0
0
0
0
0
0
0
0
0
0

0
0
270

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
0
0
0
0
21
0
0
60
0
0
0
0
0
0
0
0
0
0
0
0
41
0
0
0
0
0
0
0
0
9
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol 2

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 5 10 10 10 5 10 5 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1 1 1 1 1 1 1 1 1 1 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 3 20 20 20 5 3 3 5 3 1 2
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 1 6 6 6 6 6 6 6 6 6 1 3 2 1 1 2
18 Asiklovir Tablet 400 mg Tab 15
19 Attalpugite tab 600 mg Tab 10 5
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 6 6 6 6 6 6 2 5 2 5 2
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 5 3
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3 8
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 20
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube 1 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6 6 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 10 4 10 10 3 5 10 10 10
81 Parasetamol sirup Botol 1 1 1
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 10
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 10 10 10 10 6 10 10 10 10 10 10 10 10 10 6 10 10
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1 1 1 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1 1 1 1 1 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10
92 Simvastatin 20 mg Tab 10
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10
95 Vitamin B komplek tablet Tab 3 3 10 6 10 2

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 10 10 30 30 30 30 30 30 30 30 30 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 10
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 5 3
25 Kapas 500 gr Pcs
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc 50 50 50
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc 50 50 50
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet 1
45 Neocenta gel Tube
46 Methil prednisolone Tablet 3 3 1 10
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 3

10 10 10 10 5 10 5 10 5 10 10 10 10 4 3 5

2 2 1 1
10
JUMLAH

2
0

0
0
0
292
0
0
13
0
50
0
0
0
0
85
0
70
83
15
15
0
0
0
0
0
0
82
0
0
0
0
0
8
0
0
0
0
0
0
0
0
0
0
0
0
2
0
80
0
30
0
0
0
0
0
0
0
0
0
0
0
11
0
2
0
0
20
0
0
0
2
0
40
0
0
0
0
42
0
0
102
3
0
0
10
0
0
182
0
5
9
20
10
0
30
34

0
0
0
0
0
0
0
0
0
0
0
0

0
0
320

0
0
0
0
0

0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
46
0
0
8
0
0
150
0
0
150
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
17
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 5 10 10 5 10 5 10 10 10 10 10 10 10 10 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol 1 1 1 1 1 1
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 10 10 10 5 10 20 3 2 2
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 5 6 6 6 6 6 6 6 6 5 6 6 6 6 1 5
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 5 6 6 6 6 6 5 2 2
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul 10
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab 10
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1 1 1 1 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube 1
53 Ketokonazol Tablet 200 mg Tab 10 10
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1
64 Lansoprazol 30 mg Tab 3
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 10
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 6 10 6 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10
81 Parasetamol sirup Botol 1 1 1 1 1 1 1 1 1
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 10 10
85 Prednison tablet 5 mg Tab 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 6 10 6 6 6 10 10 10 10 10 10 10 10
88 Salbutamol tablet 2 mg Tab 10 10 10 10 10 10 10 10 10
89 Salep 2 - 4 kombinasi tube 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 10 40
92 Simvastatin 20 mg Tab 5
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10 10 10 10 10 10 10 10 10 10
95 Vitamin B komplek tablet Tab 10 10 10 10 10 10 6 10 10 10 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet 20 20 30
12 Haloperidol 5 mg tablet tablet 10

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 20 30 30 30 30 30 30 30 30 30 30 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 15
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 10 10
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet 5
45 Neocenta gel Tube
46 Methil prednisolone Tablet 3
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 4

10 10 5

2 1 1 1 2 2 1 1 1 2
10 3 3 1
JUMLAH

0
0

0
0
0
190
0
6
0
0
30
0
0
0
0
0
0
80
114
0
0
0
0
0
0
0
0
62
0
0
0
0
10
0
0
0
0
0
0
0
0
0
10
0
0
0
7
0
40
0
30
0
0
1
20
0
0
4
0
0
0
0
0
0
1
3
0
10
0
0
0
1
0
32
0
0
0
0
18
0
0
20
9
0
0
20
6
0
114
90
2
3
80
5
0
130
116

0
0
0
0
0
0
0
0
0
0
70
10

0
0
380

0
0
0
0
0

0
0
0
0
0
0
0
0
0
15
0
0
0
0
0
0
0
0
0
0
0
0
0
71
0
0
20
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 5
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 10 5
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 10 10 5 10 10 10 10 10 20 20 20 20
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 6 6 6 6 6 6 6 6 2 1 1 1 2 2
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 6 6 6 6 6 6 6 5 6 5 2 3
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 10
39 Furosemid tablet 40 mg Tab 6
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 5
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 4
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1 1 1 1 1 1 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 12
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 10 5
81 Parasetamol sirup Botol 1 1
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 10 10 5
85 Prednison tablet 5 mg Tab 10
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 6 10 6 10 10 6 10 10 10 10 10
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1 1 1 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1 1 1 1 1 1 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 10 6 10 10 10
92 Simvastatin 20 mg Tab 3 3
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10
95 Vitamin B komplek tablet Tab 10 12 5 10 2 3 3

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 10 30 30 20 30 30 30 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs 10 10 10 10
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl

C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet 10
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 5 3
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet 2
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof syr Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 5

1 2 1 5

5
JUMLAH

0
0

0
0
0
15
0
0
0
0
85
0
0
0
0
60
0
90
84
0
0
0
0
0
0
0
0
98
0
0
0
0
0
0
0
0
0
0
0
10
6
0
0
0
0
0
3
0
60
0
25
0
0
0
0
0
0
3
0
0
0
0
4
0
8
0
0
12
0
0
0
0
0
50
0
0
0
0
18
0
0
45
2
0
0
25
10
0
98
0
5
10
76
6
0
10
45

0
0
0
0
0
0
0
0
0
0
0
0

0
0
240

0
0
40
0
0

0
0
0

0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
39
0
0
8
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 5 10 10 10 5 10 10 5 5 10 10 10 15
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 10 10 10 4 10 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 2 4 2 2 3 4 10 10 10 10 10 10 10 10 10 10 4
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 6 5 6 6 6 3 5 6 3 6 6 6 6 6 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 5 6 6 6 6 6 5 6 1 3 4
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 10
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3 3 3
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1 1 1 1 1 1 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 6 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 5 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 14 3 10 6 10
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 10 10 10 10 6 10 10 10 10 10 10 10 10 10 6 10 10
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10 10
95 Vitamin B komplek tablet Tab 3 2 10 3 10 10 3

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 30 30 30 30 20 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 10
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 5 3 3
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet 3 3 3 2
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 6

1 1 1

10 4

10 10 10 10 10 10 10 10

6 2 2 2 2 3 1 2 2 1 1 2
10
JUMLAH

0
0

0
0
0
155
0
0
21
0
188
0
0
0
0
211
0
60
126
0
10
0
0
0
0
0
0
54
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
30
0
0
0
0
0
0
6
0
0
0
0
9
0
8
0
0
0
0
0
0
0
0
56
0
0
0
0
18
0
0
45
0
0
0
43
0
0
182
0
3
2
10
0
0
50
41

0
0
0
0
0
0
0
0
0
0
0
0

0
0
200

0
0
0
0
0

0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
51
0
0
11
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
11
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet
17 Asetyl sestein 200mg kapsul
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab
95 Vitamin B komplek tablet Tab

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 7
JUMLAH

0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab 5


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 5 10 10 10 5 10 10 5 10 10 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1 1 1 1 1 1 1 1 1 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 10 10 10 10 10 10 5 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 20 3 1 5 10 10 10 10 10 10 10 10 10 10 4 10
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 5 6 6 6 6 5 6 6 6 6 6 6 6 6 6 5 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10 5
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 6 6 6 6 6 6 6 6
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 5 5 5
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol 1 1
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3 3 5
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1 1 1 1 1 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube 1 1 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10
81 Parasetamol sirup Botol 1 1 1 1 1 1 1 1
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 10 10 10
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 10 mg Tab
87 Ranitidin tablet 150 mg Tab 10 10 10 10 10 6 10 10 10 10 10 10 10 10 10 6 10
88 Salbutamol tablet 2 mg Tab 10 10
89 Salep 2 - 4 kombinasi tube 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 10 10
92 Simvastatin 20 mg Tab 3
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10
95 Vitamin B komplek tablet Tab 10 3 3 3 6 10 3 2 3

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 30 10

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl

C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet 5
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 2
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 3 1 5
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet 2
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul 5
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 8

10 10 5 10 5 10 5 10 10 10 10 10 5 5 5 5 4

10 10 5 10

10 10 10 10 10 10 10 20 4

2 1 2 1 5 2 4 1 1 1 1 1 1 2 2 2 1 1 1 1 4
10 10
JUMLAH

0
0

5
0
0
284
0
0
12
0
200
0
0
0
0
208
0
70
136
0
15
0
0
0
0
0
0
78
0
0
0
0
0
15
0
0
0
0
0
0
0
0
0
0
0
0
4
0
10
0
20
0
2
0
0
0
0
3
0
0
0
0
11
0
7
0
0
0
0
0
0
3
0
30
0
0
0
0
24
0
0
10
8
0
0
30
0
0
182
20
1
2
50
3
0
10
43

0
0
0
0
0
0
0
0
0
0
0
0

0
0
70

0
0
0
0
0

0
0
0

0
0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
0
0
0
0
29
0
0
9
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
0
0
NO NAMA OBAT SATUAN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 5
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1 1 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 10 10 5
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 10 10 10 10 20 2
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 5
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10 10 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 6 6 6 6 6 6 2 6 6 6 6
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 10 5
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1 1 1 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 5
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol 1 1
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3 3
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 mg Tab
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube 1 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 6 6 6 6 10
85 Prednison tablet 5 mg Tab 6 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 6 6 10 10 10 10 10 6 10 10 10 10 6 10 10
88 Salbutamol tablet 2 mg Tab 10 10
89 Salep 2 - 4 kombinasi tube 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1 1 1 1 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
95 Vitamin B komplek tablet Tab 10 10 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 20 20 30 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran L Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 6,5 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl

C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 5 10 10 10 10 5 5
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet 3
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 9

5 3 5

5 10 10
2 1 1 1 1 2 2 1 1 1 1 1 1

1 2 1 2 3 1 1 2
10 10 10

10 10 10
JUMLAH

0
0

0
0
0
168
0
0
5
0
95
0
0
0
0
72
0
185
111
0
30
0
0
0
0
0
0
105
0
0
0
0
0
15
0
0
0
0
0
0
0
0
0
0
0
0
6
0
45
0
50
0
2
0
0
0
0
0
0
0
0
0
6
0
0
0
0
0
0
0
0
2
0
190
0
0
0
0
12
0
0
0
0
0
0
34
12
0
40
20
1
8
0
0
0
150
40

0
0
0
0
0
0
0
0
0
0
0
0

0
0
130

0
0
0
0
0

0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
43
0
0
55
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 5 5 10 10 10 10 5 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 10 10 10 10 10 10 5
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 5 5 3 2 5 3 2 4
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 6 6 6 6 6 6 2 2 1 3 1 1 4 3 5
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 5 5 6 2 5
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 5
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab 3
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 6
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 15
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube 1 1 1 1 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 10 10 10 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 5 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 14
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 6 10 10 10 10 10 10 10 6 10
88 Salbutamol tablet 2 mg Tab 10
89 Salep 2 - 4 kombinasi tube 1 1 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10
92 Simvastatin 20 mg Tab 5
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10
95 Vitamin B komplek tablet Tab 3 10 10 3 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 20 30 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 5 10
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Zink multivitamin kaplet
46 Methil prednisolone Tablet 3
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 10
JUMLAH

0
0

0
0
0
65
0
0
4
0
135
0
0
0
0
29
0
40
76
0
10
0
0
0
0
0
0
29
0
0
0
0
0
5
0
0
0
0
0
0
0
0
0
0
0
0
3
0
20
0
0
0
0
0
3
0
0
0
0
0
0
0
6
0
3
0
0
15
0
0
0
5
0
90
0
0
0
0
30
0
0
15
0
0
0
14
0
0
102
10
4
5
10
5
0
30
36

0
0
0
0
0
0
0
0
0
0
0
0

0
0
110

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
42
0
0
15
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab 10 10


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 5 10 10 5 10 10 5 10 5 10 5 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1 1 1 1 1 1 1 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 5 10 5 5 5 10 5 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp 3
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 2 10 2 2 1
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 1 6 6 6 6 5 6 6 6 6 5 6 1 1 5 5 6 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10 2 5 10 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 10 10 6 5 10 6 6 5 6 5 6 6 6 6 6 3 10
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg Tab
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab 10 3
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1 1 1 1 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3 3
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 10 10 10 10 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 3 5 5 10 10 5 5
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 10 10 10
85 Prednison tablet 5 mg Tab 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 10 10 10
88 Salbutamol tablet 2 mg Tab 10
89 Salep 2 - 4 kombinasi tube 1 1 1
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10
92 Simvastatin 20 mg Tab 5
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10 10 10 10 10
95 Vitamin B komplek tablet Tab 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 20 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 10 10
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 1 1 3 3 1 1 2
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 10
25 Kapas 500 gr Pcs
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 11

1 1 1 2

4
JUMLAH

0
0

20
0
0
125
0
0
10
0
105
0
3
0
0
27
0
120
94
0
37
0
0
0
0
0
0
122
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
30
0
40
0
0
0
13
0
0
9
0
0
0
0
6
0
2
0
0
0
0
0
0
1
0
100
0
0
0
0
18
0
0
43
0
0
0
30
6
0
40
10
3
0
30
5
0
80
150

0
0
0
0
0
0
0
0
0
0
0
0

0
0
50

0
0
0
0
0

0
0
0
0
0
0
0
0
0
20
0
0
0
0
0
0
0
0
0
0
0
0
0
33
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 5 5 10 10 5 5
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 6 6 10 10 10 10 10 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 6 10 3 3 3
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 6 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 6 6 6 6 6 6 6 6 1 1 1 1 1 4
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 3 6 6 6 3 6 5 6 6 6 3 6 5 1 2 2 1 1
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab 5
42 Glimepiride tab 10
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10 10 10 10 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 15 15 15 10
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab 10
70 Miconazol SK tube 1 1 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 10 10 10 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6 6 6 6 6 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 5 10 10 5 10 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 4 10 10 10 10 10 10 10 6 6 10
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 6 10 10 6 6 6 6
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10 10 10
95 Vitamin B komplek tablet Tab 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 30 30 30 30 20 20 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 10
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3 3 3 3 1 1
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc 50 50
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Zink multivitamin kaplet
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 12

2 2
10 10
JUMLAH

0
0

0
0
0
90
0
0
4
0
122
0
0
0
0
35
0
46
75
0
20
0
1
0
0
0
0
78
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
10
0
0
4
0
40
0
90
0
0
0
0
0
0
0
0
0
0
0
3
0
3
0
0
55
0
0
10
3
0
90
0
0
0
0
60
0
0
60
0
0
0
96
0
0
50
0
2
3
10
0
0
60
200

0
0
0
0
0
0
0
0
0
0
0
0

0
0
220

0
0
0
0
0

0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
29
0
0
0
0
0
0
0
0
100
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol 1

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 2 3 10 10 10 10 2 2 4 3 4 2 2 2 4 4 3
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 3 6 6 6 5 4 6 1 2 2 1 1 1 1 1
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10 10 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 5 6 5 4 1 3 2 3 4 3 6 10 10 10 10 10
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg Kapsul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab 5
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3 3 3
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 15
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 6 10 10 10 10 10 10 10 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 2 5 5
81 Parasetamol sirup Botol 1 1 1 1 1 1 1 1 1
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 6 14 6 6 6 3 6 6 6 14
85 Prednison tablet 5 mg Tab 6 6 6 3
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1 1 1 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab
95 Vitamin B komplek tablet Tab 10 6 4 10 10 3 3 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 6 30 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet 10 10 10 10
7 Klindamicin 300 mg Kapsul 10 10 4
8 Metoklorpropamid 5 mg Tablet 10 10 10
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 10
25 Kapas 500 gr Pcs
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Botol
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet 10 10 3 3 3 3
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 13

3 3

2 1 2 6

10 10 10 10 4
JUMLAH

1
0

0
0
0
60
0
0
16
0
80
0
0
0
0
93
0
50
75
0
30
0
0
0
0
0
0
148
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
0
40
0
0
0
0
0
0
0
0
0
0
0
0
0
9
0
1
0
0
15
0
0
0
1
0
106
0
0
0
0
36
0
0
32
9
0
0
73
21
0
0
0
3
7
0
0
0
0
56

0
0
0
0
0
0
0
0
0
0
0
0

0
0
66

0
0
0
0
0

0
0
0
0
0
0
0
0
40
24
30
0
0
0
0
0
0
0
0
0
0
0
0
18
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
32
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet
17 Asetyl sestein 200mg kapsul
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab
95 Vitamin B komplek tablet Tab

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 14
JUMLAH

0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 5 10 10 10 10 10 10 10 10 5 5 5 10 10 10 5 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 10 10 10 10 10 5 10 6 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 10 3 3 3 4 2 2
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 3 3 6 5 6 6 6 6 6 6 6 6 6 6 6 6 6 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10 6 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 5 6 6 4 3 2 6 6 2 3 3 2
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 5
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1 1 1 1 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1 1 1 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 3 3 3 3 3 3 3 3 6 3 3 3 3 3 3 3 3 3
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3 8 3 3
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1 1 1 1 1 1 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 10 20
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 6 10 10 3
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 5 5 5 10 10 10 10 10 10
81 Parasetamol sirup Botol 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 10 10
85 Prednison tablet 5 mg Tab 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 6 6 10 10 6 6 6 10 6 10 6
88 Salbutamol tablet 2 mg Tab 2
89 Salep 2 - 4 kombinasi tube 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 6 6 10
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10 10 10
95 Vitamin B komplek tablet Tab 3 10 6 6 6 10 10 10 4 10 3 10 10 10 1

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet 10 3
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet 30 30 30 30
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 10 30 30 30 30 30 30 30 30 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 10
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3 3 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 10 10 10 3 10 10 5 5
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc 50 50
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet 3
45 Neocenta gel Tube
46 Methil prednisolone Tablet 3 3 3 3 3 3 3
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj ampul
65 Amoksisilin drops Botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 15

10 10 10 10 10 10 5 5 10 5 15 10 15 10 15 5

1 1 1 1 1 1 1 1 1 1 1

10 5 10 5

5 6 2 4 1 1 1 1 1 6 1 1 1 1 6 1
3 3 3 5 3 2 1 1 2 1 1 3 3 2 2 1 1 1 1 1

1
JUMLAH

0
0

0
0
0
310
0
0
29
0
201
0
0
0
0
37
0
130
140
0
26
0
0
0
0
0
0
78
0
0
0
0
0
5
0
0
0
0
0
0
0
0
0
0
0
0
7
0
60
0
10
0
0
0
0
0
0
8
0
97
0
0
17
0
8
0
0
30
0
0
0
1
0
29
0
0
0
0
0
0
0
95
19
0
0
20
6
0
92
2
2
5
42
0
0
60
109

0
0
0
0
13
0
0
0
0
0
120
0

0
0
280

0
0
0
0
0

0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
9
0
0
63
0
0
0
0
0
100
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
21
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol 2

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 10 5 10 10 5 10 10 10 6 5
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1 1 1 1 1 1 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 10 10 10 10 10 5 6 6
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp 3
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 3 5 10 10 10 10 10 3 3 3 3
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 3 3 6 6 6 6 4 1 4 1 1 1 3 1 1 1
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 6 6 6 6 6 5 6 6 6 6 6 6 6
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 5 10
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 5
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 30
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 10 8
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 10
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab 10 10
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 10 10 10 10 10 10 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6 6 6 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 10 5 10 10 10
81 Parasetamol sirup Botol 1 1 1 1 1 1 1 1 1 1 1 1 1
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 10 10 10 3 2
85 Prednison tablet 5 mg Tab 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 6
88 Salbutamol tablet 2 mg Tab 5
89 Salep 2 - 4 kombinasi tube 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1 1 1 1 1 1 1 1 1 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 6 10 10 10 10 10 4
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10 2
95 Vitamin B komplek tablet Tab 10 10 10 10 10 10 5 10 10 3 10 10 10 10 10 10 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 30 30 30 30 30 30 20 20 20 30 30 30 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 10
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 10
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 10 10 5
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc 50 50 50 50 50
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 16

1 1 1

4 4 2 5 2 2
2 2 3 1 1 3 2 1 1 1 1 1
1

10 10 10 10 10 10 10
JUMLAH

2
0

0
0
0
131
0
0
9
0
137
0
3
0
0
70
0
80
63
0
10
0
0
0
0
0
0
126
0
0
0
0
0
15
0
0
0
0
0
5
0
0
0
0
0
0
3
0
20
0
50
0
0
0
0
0
0
4
0
73
0
0
18
0
1
0
0
10
0
0
20
1
0
120
0
0
0
0
48
0
0
75
13
0
0
35
6
0
6
5
2
14
70
0
0
42
238

0
0
0
0
0
0
0
0
0
0
0
0

0
0
390

0
0
0
0
0

0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
25
0
0
250
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab 3


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 5 10 10 5 10 10 5 10 10 5 10 5 5
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1 1 1 1 1 1 1 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 3 2 3 2 4 4 2 2 1 3 2 2 5
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 5 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 3 6 6 6 6 5 6 3 3 6 5 6 2 1 1 1
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 6 5 6 6 5 5 6 2 4 5 2 10
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol 1
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab 5
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1 1 1 1 1 1 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3 3 3 3
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab 10 10
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 10 10 10 10 10 10 10 10 10 10 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 10 10 10 10 10 10 10 10 10 10
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 6 6
88 Salbutamol tablet 2 mg Tab 10 6 4
89 Salep 2 - 4 kombinasi tube 1
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10
92 Simvastatin 20 mg Tab 3 5
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10
95 Vitamin B komplek tablet Tab 6 6 10 3 5 10 3 1

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 30 30 20 20 20 30 30 30 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 10 10
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc 50 50
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet 3
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul 10 10 10 4
RINCIAN PEMAKAIAN OBAT
TANGGAL 17

5 5 5 10 10 10 5 10 5 10 10 10 5 5 10 5 10 10 10

10
3 1 1 1 1 1 3 1
JUMLAH

0
0
0
3
0
0
300
0
0
10
0
60
0
0
0
0
45
0
185
90
0
10
0
0
0
0
0
0
92
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
0
0
10
0
1
0
5
0
0
11
0
0
0
0
12
0
1
0
0
0
0
0
20
0
0
30
0
0
0
0
36
0
0
140
0
0
0
100
0
0
12
20
1
0
30
8
0
30
44
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
270
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
20
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
100
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
34
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet
17 Asetyl sestein 200mg kapsul
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab
95 Vitamin B komplek tablet Tab

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 18
JUMLAH

0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN

C CAIRAN

1 Natrium Klorida Botol 2

D OBAT

1 Allupurinol 100 mg Tablet Tab 10


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 10 10 5 5 5 10 10 5 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol 1 1 1 1 1 1
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1 1 1 1 1 1 1 1 1 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 6 10 10 10 10 10 10 10 10 5 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 10 10 20 10 10 10 10 10
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 4 6 6 6 6 6 6 6 6 6 6 6 6 1
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube 1
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 5 5 6 6 6 6 6 6 6 3 3 2 5
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 6 10 10 10 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1 1 1 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3 5 15
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 10 10 10
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 6 10 10 10 10 10 6
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6 6 6 6 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10
81 Parasetamol sirup Botol 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 6 6 6 10 10 10
88 Salbutamol tablet 2 mg Tab 10
89 Salep 2 - 4 kombinasi tube 1 1 1 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1 1 1 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 10 10
92 Simvastatin 20 mg Tab 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10 10 10 10 10 10 10 10
95 Vitamin B komplek tablet Tab 10 10 10 10 6 6 10 10 10 10 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 30 10 10 10 7

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl

C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 15 10
8 Metoklorpropamid 5 mg Tablet 10
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 5 5
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet 3
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 19

10 5 10 10 10 10 10 10 10 10 10 5 10 5

1 1 1 1 1 1 1 5
3 1 3 3 1 1 1 1 3 1 1 1 1 1 1 3 5 3
1
JUMLAH

2
0

10
0
0
275
0
6
12
0
131
0
0
0
0
100
0
140
107
0
20
0
1
0
0
0
0
89
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
60
0
66
0
0
0
0
0
0
8
0
85
0
0
23
0
1
0
0
30
0
0
0
0
0
82
0
0
0
0
54
0
0
10
16
0
0
0
6
0
58
10
5
7
50
171
0
110
112

0
0
0
0
0
0
0
0
0
0
0
0

0
0
97

0
0
0
0
0

0
0
0

0
0
0
0
0
0
25
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN

C CAIRAN

1 Natrium Klorida Botol 1

D OBAT

1 Allupurinol 100 mg Tablet Tab 10


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 2 2 2 2 4
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 1 6 6 6 5 6 2 1 1 1 1 1 1
18 Asiklovir Tablet 400 mg Tab 4
10 Attalpugite tab 600 mg Tab 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 10 6 6 6 6 6 6 6 6 3 2
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 10 10
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1 1 1 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1 1 1 1 1 1 1 1 1
64 Lansoprazol 30 mg Tab 10 10 10 10 10 10
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 10
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 10 10 10 10 10 10 10 10 5 10 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6 6 6 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 10 10 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 10
85 Prednison tablet 5 mg Tab 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 10 6
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 10
92 Simvastatin 20 mg Tab 5
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10
95 Vitamin B komplek tablet Tab 10 10 3 6 6 10 10 10 3 10 10 6 3

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 30 30 30 20 20 20 30 30 30 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl

C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 10 15
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 5 5 3 3 5
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet 2
45 Neocenta gel Tube
46 Methil prednisolone Tablet 3
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 20

5 10 5 5 5 10 10 10 10

1 1 1 1 1 1
8

3 3 3 3 3 3 1 1 1 1 1 1 1 1 1 1 1 1 1 10 10 2

10 10
JUMLAH

1
0

10
0
0
230
0
15
0
0
60
0
0
0
0
22
0
70
62
4
10
0
0
0
0
0
0
75
0
0
0
0
0
20
0
0
0
0
0
0
0
0
0
0
0
0
1
0
168
0
10
0
0
0
0
0
0
8
0
101
0
0
3
0
10
60
0
10
0
0
0
1
0
175
0
0
0
0
48
0
0
60
0
0
0
10
6
0
26
0
2
5
40
5
0
40
97

0
0
0
0
0
0
0
0
0
0
0
0

0
0
300

0
0
0
0
0

0
0
0

0
0
0
0
0
0
25
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
21
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet
17 Asetyl sestein 200mg kapsul
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
2 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab
95 Vitamin B komplek tablet Tab

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Kapsul
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 21
JUMLAH

0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 15 10 15 10 10 10 10 10 5 10 5 10 10 5 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 5 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 10 10 3 5 4 2 5 2 3 4 3
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 6 6 6 6 6 6 6 6 1 1 1 1 1
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab 10
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 6 5 6 6 6 6 6 6 4 2 5
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 5 10
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 3
39 Furosemid tablet 40 mg Tab 5
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab 10
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube 1 1 1 1 1 1 1
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 3 3 3 3 3 3 3 3 3 3 3 3 1 1 1 1
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 10
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1 1 1 1 1 1 1 1 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 10 20
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 mg Tab
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 10 10 10 10 10 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6 6 6 6 6 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10
81 Parasetamol sirup Botol 1 1 1 1
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 10
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 10 6 10 10 10 10 10 10 10
88 Salbutamol tablet 2 mg Tab 5
89 Salep 2 - 4 kombinasi tube 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1 1 1 1 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 6 12 6
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10
95 Vitamin B komplek tablet Tab 6 6 8 3 3 6 4

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet 4 4
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 15 10
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet 3
45 Neocenta gel Tube
46 Methil prednisolone Tablet 3 3 3 3 3 3 3
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester
68 Stimuno forte
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 22

10 5 10 5 10 10 10 10 10 10 5 4 5 5

1 1 1 1 1 1 1 5 1 1 1 4

3 5
1 1 1 1 1 1 1 1 10 10 10 3
JUMLAH

0
0

0
0
0
264
0
0
0
0
55
0
0
0
0
61
0
90
90
0
20
0
0
0
0
0
10
96
0
0
0
0
0
15
0
0
0
0
0
3
5
0
0
10
0
0
1
0
30
0
0
0
0
0
0
0
0
7
0
81
0
0
10
0
10
0
0
30
0
0
0
1
0
110
0
0
0
0
60
0
0
10
4
0
0
10
0
0
96
5
1
8
24
0
0
40
36

0
0
0
0
0
0
0
0
0
0
0
0

0
0
60

0
0
0
0
0

0
0
0
0
0
0
8
0
0
25
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
21
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 15 10 10 10 5 10 5
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol 1 1 1 1 1 1 1 1
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 1 1 1 1 1 1 1 1
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 5 5 10 10 5 5 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 20 20 20 10 10 10 5 10 10 10 10 3 3 3 2 2 3
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 6 3 1 6 3 6 6 6 6 6 6 3 3 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 2 6 6 6 6 6 6 4 3 3 1 2
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul 15
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 10
39 Furosemid tablet 40 mg Tab 10 10 1
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab 10
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 5 3
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1 1 1 1 1
64 Lansoprazol 30 mg Tab 3
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab 10
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 5 10 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 10
85 Prednison tablet 5 mg Tab 3 2 2 2
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 10 6 10 6 5 6 10
88 Salbutamol tablet 2 mg Tab 6
89 Salep 2 - 4 kombinasi tube 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 5 10 10 10 10 10 10 10 10 10 2 3 3 2
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10
95 Vitamin B komplek tablet Tab 10 10 10 3

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl

C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 1
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 10 5 5 10 5
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc 50 50 50
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester
68 Stimuno forte
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 23

2 2 2 2 2 2 3 2 3 2

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 3 1
JUMLAH

0
0

0
0
0
95
0
8
8
0
50
0
0
0
0
173
0
160
106
0
20
0
0
0
0
0
0
63
0
0
0
0
15
0
0
0
0
0
0
10
21
0
10
0
0
0
4
0
10
0
60
0
0
0
0
0
0
0
0
0
0
0
8
0
6
3
0
0
0
0
10
1
0
40
0
0
0
0
12
0
0
25
0
0
0
10
9
0
63
6
1
2
115
0
0
30
33

0
0
0
0
0
0
0
0
0
0
0
0

0
0
30

0
0
0
0
0

0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
35
0
0
150
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 5 1 10 1 10 10 10 10 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol 1 1 1 1 1 1 1 1 1 1 1
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 20 10 10 2 2 4 3 3 2 10
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 1 1 6 1 6 6 6 6 6 6 1 1
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 4 10 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 5 6 6 6 6 6 2 6 6 2
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 5
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 10 10
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 10
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 2
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 mg Tab
69 Metronidazol tablet 500 mg Tab 10 2
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6 6 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 5 3 2 5 2 3 4 10 10 2
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 14
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 10 6 10 10 10 10 10 10 10 6
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 6 10 10
92 Simvastatin 20 mg Tab 5 5 5
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab
95 Vitamin B komplek tablet Tab 10 6 6 6 3 10 6 6 3 10 3 6 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet 30 30
12 Haloperidol 5 mg tablet tablet 10 10

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet 5 5 5 5
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 6
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 5
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet 3 3
45 Neocenta gel Tube
46 Methil prednisolone Tablet 3 3
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester
68 Stimuno forte
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 24

10 10 5 10 5 10

6 6 6 1 1 5 6
JUMLAH

0
0

0
0
0
177
0
11
0
0
0
0
0
0
0
66
0
80
96
0
24
0
0
0
0
0
0
51
0
0
0
0
0
5
0
0
0
0
0
20
0
0
0
0
0
0
1
0
20
0
10
0
0
0
0
0
0
0
0
0
0
0
10
0
3
0
0
2
0
0
12
0
0
30
0
0
0
0
42
0
0
76
0
0
0
14
0
0
102
0
0
1
36
15
0
0
95

0
0
0
0
0
0
0
0
0
0
60
20

0
0
0

0
0
0
0
0

0
0
0
0
0
0
20
0
0
6
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
6
0
6
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol 1

D OBAT

1 Allupurinol 100 mg Tablet Tab 3


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 10 10 10 10 5 5 5 10 10 5 10 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 6 10 10 10 2 3 3
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10 10 5 10 10 5 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 1 5 6 6 4 6 6 5 6 6 6 6 1 1 1 1
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 5 6 5 5 5 6 6 6 6 6 10 6 3 3 3 3 4
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg Tab
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 10
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10 10 5 10 6
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1 1 1 1 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 6 10 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6 6 6 6 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 10 10 10 2 5 5 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 14 10 1
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 6 10 10 6 10 6
88 Salbutamol tablet 2 mg Tab 10
89 Salep 2 - 4 kombinasi tube 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 10 10 10
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10 10 10 10 10 10 10 10 10
95 Vitamin B komplek tablet Tab 10 10 10 5 10 10 10 10 10 10 10 10 10 10 10 2 4 3

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30 30 30 6

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 15 10 10
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 10 6 3 3 3
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester
68 Stimuno forte
69 Kloramfenikol Kapsul 250 mg Kapsul 10
RINCIAN PEMAKAIAN OBAT
TANGGAL 25

5 10 10 10 10 10 10 10 10 10 5 10

1 1 1 1 1 1 1 1 1 1 2 1

3 3 3 3
2 2 2 3 2
JUMLAH

1
0

3
0
0
270
0
17
0
0
40
0
0
0
0
54
0
160
92
0
0
0
0
0
0
0
0
106
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
1
0
40
0
61
0
0
0
0
0
0
0
0
0
0
0
0
0
6
0
0
0
0
0
0
0
0
66
0
0
0
0
54
0
0
82
0
0
0
25
0
0
48
10
2
5
60
0
0
120
165

0
0
0
0
0
0
0
0
0
0
0
0

0
0
96

0
0
0
0
0

0
0
0
0
0
0
0
0
0
35
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
25
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RI

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 5 10 10 10 10 10 5 10 10 10 10 10 5 5 10 10 5 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol 1 1 1 1 1 1
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 6 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 5 5 5
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 5 6 2 6 6 6 6 6 6 6 6 5 6 6 5 6 6
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 4 6 6 3 2 3 5 3 3 2 2
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg Kapsul
32 Domperidon tablet 10 mg Tab 10
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab 10
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 10 10 7
67 metil dopa tab 250 mg Tab 1
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab 10 10 10 10
70 Miconazol SK tube 1 1 1 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 6 6 10 10 10 10 10 10 10 10 10 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6 6 6 6 6 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 5 10 5 10 5 10 10 5 10 10 5 10 10 10 3 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 6 6
85 Prednison tablet 5 mg Tab 6 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 6 3 4 6 6 6 6 6
88 Salbutamol tablet 2 mg Tab 5
89 Salep 2 - 4 kombinasi tube 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1 1 1 1 1 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10
92 Simvastatin 20 mg Tab 5 3 3
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab
95 Vitamin B komplek tablet Tab 10 10 6 10 10 10 5 3

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 10 30 20

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet 5
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 3 5
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet 5
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet 1
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet 3 3 3
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester
68 Stimuno forte
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 26

10 10 5 5 4 2 2

6 1 1 1 1 2 1 1 1
JUMLAH

0
0

0
0
0
193
0
6
0
0
86
0
0
0
0
0
0
40
116
0
0
0
0
0
0
0
0
45
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
10
0
0
4
0
70
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
27
1
0
40
4
0
162
0
0
0
0
60
0
0
128
0
0
0
12
12
0
43
5
2
9
20
11
0
0
64

0
0
0
0
0
0
0
0
0
0
0
0

0
0
60

0
0
0
0
0

0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
8
0
0
0
0
0
0
0
0
0
0
0
0
5
0
0
0
0
1
0
0
0
9
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RI

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab 10


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 5 10 10 10 10 10 5 10 10 10 3 4 5 5
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 6 5 10 5
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 20 5 5 3 5 3 4 3 2 2 3 3 4 2 2
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 6 2 2 6 6 2 6 1 1 1 1 1 1 1 1
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10 10 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 6 3 3 4 4 2
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab 3
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab 10
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube 1
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1 1 1 1 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 30
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab 10
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 6 6 10 10 10
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 10 10 10 10 10 10 10 10 10 5 5 5 10 10
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 6 10 6 6 6 4
85 Prednison tablet 5 mg Tab 6 5 3 3 2 2 3 3
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 10 10 10 10 10 6 10 10 10 10 10 10 10 10 10 6 10
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 10 10 2 3 3 2
92 Simvastatin 20 mg Tab 5 5
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10 10
95 Vitamin B komplek tablet Tab 6 6 3

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet 5 5
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 10 15 10
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet 3
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 3 10 5 10 10 5 3
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc 50 50 50
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester
68 Stimuno forte
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 27

1 1 1 5
10 10
JUMLAH

0
0

10
0
0
137
0
0
0
0
36
0
0
0
0
76
0
70
64
0
30
0
0
0
0
0
0
52
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
10
0
0
3
0
40
0
30
0
0
1
0
0
0
0
0
0
0
0
0
0
6
0
0
30
0
0
10
0
0
42
0
0
0
0
18
0
0
155
0
0
0
38
27
0
192
0
2
1
60
10
0
50
15

0
0
0
0
0
0
0
0
0
0
0
0

0
0
30

0
0
0
0
0

0
0
0
0
0
0
10
0
0
35
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
0
46
0
0
150
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RIN

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet
17 Asetyl sestein 200mg kapsul
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
10 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab
88 Salbutamol tablet 2 mg Tab
89 Salep 2 - 4 kombinasi tube
90 Setirizin sir 5 mg/ 5 ml Botol
91 Sianokobalamin (Vitamin B12) 50 mg Tab
92 Simvastatin 20 mg Tab
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab
95 Vitamin B komplek tablet Tab

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
68 Stimuno forte Tablet
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 28
JUMLAH

0
0

0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0

0
0
0

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT SATUAN RINCIAN PEMAKAIAN OBAT
JUMLAH
TANGGAL 29

C CAIRAN

1 Natrium Klorida Botol 0


0
D OBAT

1 Allupurinol 100 mg Tablet Tab 6 6


2 Aminophylin tablet 200mg Tab 0
3 Amlodipin 10 mg Tab 0
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 5 10 5 10 10 10 10 10 5 10 5 10 10 10 10 5 10 3 5 10 10 10 10 15 15 2 2 2 2 5 2 2 2 2 5 2 2 2 1 276
5 Amoksisilin Kapsul 250 mg Kapsul 0
6 Amoksisilin sirup kering 125 mg/5 ml Botol 0
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol 0
8 Antasida Suspensi 60 ml Botol 0
9 Antasida DOEN tablet kombinasi Tab 10 10 10 5 10 10 10 10 10 10 10 105
10 Anti fungi DOEN komb sk tube 0
11 Anti Hemoroid DOEN kombinasi supp 0
12 Antimigren DOEN kombinasi Tab 0
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab 0
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 20 2 3 2 2 2 2 43
15 asam folat tablet 1 mg Tab 0
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 210
17 Asetyl sestein 200mg kapsul 6 6 6 6 6 6 5 6 6 6 6 6 6 5 6 6 1 1 6 1 1 1 1 1 1 1 1 6 1 2 1 2 122
18 Asiklovir Tablet 400 mg Tab 40 40
19 Attalpugite tab 600 mg Tab 10 10 20
20 Betahistin maleat Tab 0
21 Betametasone Krim 0.1% tube 0
22 Bisakodil Supp 10 mg supp 0
23 bisoprolol tablet tablet 0
24 Captopril 12,5 mg Tab 0
25 Captopril tablet 25 mg Tab 0
26 Deksametasone tablet 0.5mg Tab 5 6 6 6 5 6 5 6 3 6 6 6 6 2 4 2 1 2 1 5 1 6 2 4 2 3 4 111
27 Diasepam 2 mg tablet Tab 0
28 Diazepam Inj 5 ml/2ml ampul 0
29 Diazepam lar rektal 5mg/2,5ml tube 0
30 Digoksin tablet 0,25 mg Tab 0
31 Doksisiklin 100 mg ampul 0
32 Domperidon tablet 10 mg Tab 0
33 Erytromycin 250 mg Kapsul 0
34 Etambutol HCL 250 mg Tab 0
35 Fenitoin Na kaps 100 mg Kapsul 0
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul 0
37 Fenobarbital tablet 30 mg Tab 0
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab 0
39 Furosemid tablet 40 mg Tab 0
40 Gentamisin tetes mata Botol 0
41 Glibenklamid tablet 5 mg Tab 0
42 Glimepiride tab 0
43 Griseofulvin tablet 125 mg, micronized Tab 0
NO NAMA OBAT SATUAN RINCIAN PEMAKAIAN OBAT
JUMLAH
TANGGAL 29
44 Hidroklorotiazid (HCT) tablet 25 mg Tab 0
45 Hidrokortison krim 2,5 % tube 0
46 Ibuprofen Suspensi 100mg 5ml botol 0
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 10 10 10 10 10 90
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab 0
49 Kalsium lakate (kalk) tablet Tab 10 10
50 Karbamazepin tablet 200 mg Tab 0
51 Karbogliserin Tetes Telinga 10% Botol 0
52 Ketokonazol krim 2 % tube 0
53 Ketokonazol Tablet 200 mg Tab 0
54 Klindamicin 150 mg Kapsul 0
55 Kloramfenikol Kapsul 500 mg Kapsul 0
56 Kloramfenikol salep kulit 2% (bufacetin) tube 0
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol 0
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab 0
59 Klorpromazin HCL tablet 25 mg Tab 0
60 Kodein HCl 10 mg Tab 0
61 Kotrimoksazol forte tablet Tab 5 3 8
62 Kotrimoksazol 480 tablet tab 0
63 Kotrimoksazol suspensi kombinasi Botol 1 1 1 1 4
64 Lansoprazol 30 mg Tab 0
65 Loratadin tab 10 mg Tab 0
66 Metformin tablet 500 mg Tab 20 10 30
67 metil dopa tab 250 mg Tab 0
68 Metilergometrin Maleat tablet salut 0,125 Tab 0
mg
69 Metronidazol tablet 500 mg Tab 0
70 Miconazol SK tube 1 1 2
71 Natrium bikarbonat tablet 500 mg Tab 0
72 Natrium Diklofenac 50 mg Tab 10 10 6 10 10 10 10 66
73 Nifedifin tablet 30 mg Tab 0
74 Nistatin 100.000 IU/gram tablet vaginal supp 0
75 Nistatin tablet salut gula 500.000 IU/g Tab 0
76 Oksitetrasiklin HCl salep 3% - 5 gram tube 0
77 Omeprazol 20 mg Tab 6 6 6 6 6 6 10 10 10 10 10 10 10 10 5 121
78 Ondansentron tab 8 mg Tab 0
79 parasetamol drop Botol 0
80 Parasetamol Kaplet 500 mg Tab 5 5
81 Parasetamol sirup Botol 1 1 1 3
82 Permetrin/scabimite krim 5 % tube 0
83 Pirantel Pamoat tablet 125 mg Tab 0
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 10 10
85 Prednison tablet 5 mg Tab 0
86 Propranolol HCl tablet 40 mg Tab 0
87 Ranitidin tablet 150 mg Tab 10 10 10 10 6 46
88 Salbutamol tablet 2 mg Tab 5 10 1 16
89 Salep 2 - 4 kombinasi tube 1 1 1 1 4
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1 1 1 1 1 1 8
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10 10 30
92 Simvastatin 20 mg Tab 0
NO NAMA OBAT SATUAN RINCIAN PEMAKAIAN OBAT
JUMLAH
TANGGAL 29
93 Tetrasiklin HCl Kapsul 500 mg Kapsul 0
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10 40
95 Vitamin B komplek tablet Tab 6 3 10 3 10 10 10 10 10 10 3 10 10 10 10 3 3 131

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul 0
2 Klobazam 10 mg tablet tablet 0
3 Amitripilin HCL 25 mg tablet tablet 0
4 Klorpromazin 100 mg tablet tablet 0
5 Risperidon 2 mg Tablet tablet 0
6 Klozapin 25 mg tablet tablet 0
7 Trifluoperazine HCL 5 mg tablet tablet 0
8 Haloperidol inj 5 mg/ml ampul 0
9 Imipramin HCL 25 mg tablet tablet 0
10 Fluoksetin 10 mg tablet tablet 0
11 Triheksifenidil 2 mg tab tablet 0
12 Haloperidol 5 mg tablet tablet 0

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul 0


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul 0
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 20 10 20 50

A BMHP

1 Kapas 250 gr Pcs 0


2 Masker Pcs 0
3 Handscoon non steril ukuran M Pcs 0
4 Handscoon non steril ukuran S Pcs 0
5 Handscoon steril 7 Pcs 0

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl 0


2 Antiseptik Hand Rub 500 ml Btl 0
3 Rivanol larutan 0,1% - 300 cc Btl 0

C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube 0


2 Ciprofloksasin 500 mg Tablet 0
3 Domperidon sirup Btl 0
4 Garam Oralit Sacchet 0
5 Gemfibrozil 600 mg Tablet 0
6 Haloperidol 1,5 mg Tablet 0
7 Klindamicin 300 mg Kapsul 10 15 10 35
8 Metoklorpropamid 5 mg Tablet 0
9 Multivitamin sirup Btl 0
10 Multivitamin tablet/SUPRABION Kapsul 0
11 Natrium Diklofenak 25 mg Tablet 0
12 Nifedipin 20 mg/adalat oros Tablet 0
13 Oksitetrasiklin salep mata 1% Tube 0
NO NAMA OBAT SATUAN RINCIAN PEMAKAIAN OBAT
JUMLAH
TANGGAL 29
14 Propiltiourasil 100 mg Tablet 0
15 Ramipril 10 mg Tablet 0
16 Salisil Bedak Bungkus 0
17 Salbutamol 4 mg Tablet 0
18 Sefadroksil 500 mg Kapsul 0
19 Sefadroksil sirup 250 mg Btl 0
20 Sefadroksil sirup 125 mg Btl 0
21 Setrizin tablet Tablet 0
22 Zink kid 10 mg sirup Btl 0
23 Zink sirup 20 mg Btl 0
24 Zink tablet 20 mg Tablet 5 5 10
25 Kapas 500 gr Psc 0
26 Sikzonoate 25 mg/ml Ampul 0
27 Masker earloop Psc 0
28 Hazmat Psc 0
29 Sanitizer Botol 0
30 Masker hijab Psc 0
31 Kloramfenicol Syr Botol 0
32 Akilen tetes telinga Botol 0
33 Eutyrox 50 µg Tablet 0
34 Ristonat Tablet 0
35 Pot obat Pcs 0
36 Albendazol 400 mg Tablet 0
37 Amlodipin 5 mg Tablet 0
38 Simvastatin 10 mg Tablet 0
39 Kloramfenicol tetes telinga Btl 0
40 Gliseril Guaiacolate 100 mg Tablet 0
41 Klorpromazin 100 mg tablet Tablet 0
42 Nifedipin tablet 10 mg Tablet 0
43 Propranolol HCl tablet 10 mg Tablet 0
44 Diazepam 5 mg Tablet 0
45 Neocenta gel Tube 0
46 Methil prednisolone Tablet 0
47 Plester roll 0
48 Kasa steril pcs 0
49 Kasa 2x80cm roll 0
50 Betadine 30 ml Botol 0
51 Diazepam Inj 5 ml/2ml (program) Botol 0
52 Infus set dewasa Set 0
53 Infus set anak Set 0
54 Epinefrin injeksi Ampul 0
55 Difenhidramin injeksi Ampul 0
56 Abocath no.20 Pcs 0
57 Abocath no.22 Pcs 0
58 Abocath n0,24 Pcs 0
59 Aqua pro injek Vial 0
60 Micropore 1/2 inch Pcs 0
61 Nasal oksigen anak Pcs 0
62 Metronidazol sirup Botol 0
NO NAMA OBAT SATUAN RINCIAN PEMAKAIAN OBAT
JUMLAH
TANGGAL 29
63 Herbacof Botol 0
64 Ranitidine inj Ampul 0
65 Amoksisilin drops botol 0
66 Gentamisin salep mata 0,3% Tube 0
67 Plester 0
68 Stimuno forte 0
69 Kloramfenikol Kapsul 250 mg Kapsul 0
NO NAMA OBAT SATUAN R

C CAIRAN

1 Natrium Klorida Botol

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 5 10 10 10 10 10 5 10 5 5 10 10 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 10 10 10 10 10 10 10 10 10 10 6 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 5 10 10 10 20 3 3 3 3 3
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 5 3 6 6 6 4 5 6 4 6 6 6 6 1 1 1
18 Asiklovir Tablet 400 mg Tab
19 Attalpugite tab 600 mg Tab 10
20 Betahistin maleat Tab
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab 6
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 5 5 6 6 6 6 6 6 6 5 5 6 6
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg kapsul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab 10 10
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10 10 10 10 10 10 10 10 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol
52 Ketokonazol krim 2 % tube 1
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 3
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1 1 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab 10 10 15 10
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab 10
70 Miconazol SK tube 1
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 10 10 10 10 6 6
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 5 5 10 10 10 10 10 10 10 6 10 5 5 10 5
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 6 10 10 6 10 3 3 3
85 Prednison tablet 5 mg Tab 6
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 6 6 6 6 6 10
88 Salbutamol tablet 2 mg Tab 10
89 Salep 2 - 4 kombinasi tube 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1 1 1 1 1 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 5 10 10 6 6
92 Simvastatin 20 mg Tab 5
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 6 10 10 10
95 Vitamin B komplek tablet Tab 10 10 6 10 6 10 10 10 10 6 10 6 10 10

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 20 10 10 30 30 30 30

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 10
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet 3 3 3 3 3 3 3 3 3
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester
68 Stimuno forte Kapsul 30
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 30

5 15 10 15 2 4 4 3 2

1 1 1 1 1 1 1 1 1 1 1 1 1 1

5 6 6 6 6 6 2 1 2 3 3 2 2 2 2 2 2 3 4 1 1 1 2 3
10 10 10 10 10 10 10 10 10 3 1 3 1 2 2 3 4 2 3 4 3 2 3 3 2 2 4 2 3 2 4 5 4
JUMLAH

0
0

0
0
0
210
0
0
0
0
126
0
0
0
0
70
0
70
92
0
10
0
0
0
0
0
6
171
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
20
0
0
2
0
90
0
40
0
0
1
0
0
0
0
0
0
0
0
3
0
4
0
0
45
0
0
10
1
0
52
0
0
0
0
30
0
0
298
0
0
0
51
6
0
40
10
2
6
47
5
0
36
124

0
0
0
0
0
0
0
0
0
0
0
0

0
0
160

0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
27
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
30
0
NO NAMA OBAT SATUAN RI

C CAIRAN

1 Natrium Klorida Botol 1

D OBAT

1 Allupurinol 100 mg Tablet Tab


2 Aminophylin tablet 200mg Tab
3 Amlodipin 10 mg Tab
4 Amoksisilin Kaplet 500 mg Kaplet 10 10 10 5 10 10 10 10 10 10 10 10 10 10 10
5 Amoksisilin Kapsul 250 mg Kapsul
6 Amoksisilin sirup kering 125 mg/5 ml Botol
7 Amoksisilin sirup kering Forte 250 mg/5 ml Botol
8 Antasida Suspensi 60 ml Botol
9 Antasida DOEN tablet kombinasi Tab 5 10 10 10 10 10 5 10 10 10 10 10
10 Anti fungi DOEN komb sk tube
11 Anti Hemoroid DOEN kombinasi supp
12 Antimigren DOEN kombinasi Tab
13 Asam Asetil Salisilat (Asetosal) tablet 80 mg Tab
14 Asam Askorbat (Vit.C) tablet 50 mg Tab 10 10 10 10 10 10
15 asam folat tablet 1 mg Tab
16 Asam mefenamat 500 mg Kaplet 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
17 Asetyl sestein 200mg kapsul 6 6 6 6 6 6 6 6 2 1 2 2 1 1 2 1 1
18 Asiklovir Tablet 400 mg Tab 10
19 Attalpugite tab 600 mg Tab 10 2 5 10 10 10
20 Betahistin maleat Tab 10
21 Betametasone Krim 0.1% tube
22 Bisakodil Supp 10 mg supp
23 bisoprolol tablet tablet
24 Captopril 12,5 mg Tab
25 Captopril tablet 25 mg Tab
26 Deksametasone tablet 0.5mg Tab 6 6 6 6 6 6 6 6 2 2 2 2
27 Diasepam 2 mg tablet Tab
28 Diazepam Inj 5 ml/2ml ampul
29 Diazepam lar rektal 5mg/2,5ml tube
30 Digoksin tablet 0,25 mg Tab
31 Doksisiklin 100 mg ampul
32 Domperidon tablet 10 mg Tab
33 Erytromycin 250 mg Kapsul
34 Etambutol HCL 250 mg Tab
35 Fenitoin Na kaps 100 mg Kapsul
36 Fenobarbital injeksi 50 mg/ml - 2 ml ampul
37 Fenobarbital tablet 30 mg Tab
38 Fitomenadion (Vit.K1) tablet salut 10 mg Tab
39 Furosemid tablet 40 mg Tab
40 Gentamisin tetes mata Botol
41 Glibenklamid tablet 5 mg Tab
42 Glimepiride tab
43 Griseofulvin tablet 125 mg, micronized Tab
44 Hidroklorotiazid (HCT) tablet 25 mg Tab
45 Hidrokortison krim 2,5 % tube 1 1 1
46 Ibuprofen Suspensi 100mg 5ml botol
47 Ibuprofen tablet 400 mg Tab 10
48 Isosorbid Dinitrat 5 mg tablet sublingual Tab
49 Kalsium lakate (kalk) tablet Tab 10 10
50 Karbamazepin tablet 200 mg Tab
51 Karbogliserin Tetes Telinga 10% Botol 1
52 Ketokonazol krim 2 % tube 1
53 Ketokonazol Tablet 200 mg Tab
54 Klindamicin 150 mg Kapsul
55 Kloramfenikol Kapsul 500 mg Kapsul
56 Kloramfenikol salep kulit 2% (bufacetin) tube
57 Kloramfenikol Salep Mata 1% - 3,5 gr Botol
58 Klorfeniramin Maleat (CTM) tablet 4 mg Tab
59 Klorpromazin HCL tablet 25 mg Tab
60 Kodein HCl 10 mg Tab
61 Kotrimoksazol forte tablet Tab 10 3
62 Kotrimoksazol 480 tablet tab
63 Kotrimoksazol suspensi kombinasi Botol 1 1 1 1 1 1 1 1 1
64 Lansoprazol 30 mg Tab
65 Loratadin tab 10 mg Tab
66 Metformin tablet 500 mg Tab
67 metil dopa tab 250 mg Tab
68 Metilergometrin Maleat tablet salut 0,125 Tab
mg
69 Metronidazol tablet 500 mg Tab 10
70 Miconazol SK tube
71 Natrium bikarbonat tablet 500 mg Tab
72 Natrium Diklofenac 50 mg Tab 6 6
73 Nifedifin tablet 30 mg Tab
74 Nistatin 100.000 IU/gram tablet vaginal supp
75 Nistatin tablet salut gula 500.000 IU/g Tab
76 Oksitetrasiklin HCl salep 3% - 5 gram tube
77 Omeprazol 20 mg Tab 6 6 6
78 Ondansentron tab 8 mg Tab
79 parasetamol drop Botol
80 Parasetamol Kaplet 500 mg Tab 10 10 10 10 10 10 10 10 10 10 2 2 2 2 2 2 2
81 Parasetamol sirup Botol
82 Permetrin/scabimite krim 5 % tube
83 Pirantel Pamoat tablet 125 mg Tab
84 Piridoksin HCl (Vit.B6) tablet 10 mg Tab 10 14 10 2
85 Prednison tablet 5 mg Tab
86 Propranolol HCl tablet 40 mg Tab
87 Ranitidin tablet 150 mg Tab 10 10 10 10 10 10 10 10 10 10
88 Salbutamol tablet 2 mg Tab 10
89 Salep 2 - 4 kombinasi tube 1 1 1 1
90 Setirizin sir 5 mg/ 5 ml Botol 1
91 Sianokobalamin (Vitamin B12) 50 mg Tab 10 10
92 Simvastatin 20 mg Tab 5
93 Tetrasiklin HCl Kapsul 500 mg Kapsul
94 Tiamin HCl/Mononitrat (Vit.B1) tablet 50 mg Tab 10 10 10 10 10 10 10 10 10
95 Vitamin B komplek tablet Tab 10 10 10 10 10 10 2

G KESEHATAN JIWA
1 Haloperidol dekanoat inj 50 mg/ml ampul
2 Klobazam 10 mg tablet tablet
3 Amitripilin HCL 25 mg tablet tablet
4 Klorpromazin 100 mg tablet tablet
5 Risperidon 2 mg Tablet tablet
6 Klozapin 25 mg tablet tablet
7 Trifluoperazine HCL 5 mg tablet tablet
8 Haloperidol inj 5 mg/ml ampul
9 Imipramin HCL 25 mg tablet tablet
10 Fluoksetin 10 mg tablet tablet
11 Triheksifenidil 2 mg tab tablet
12 Haloperidol 5 mg tablet tablet

I GIZI

1 Retinol (Vitamin A) 100.000 IU Kapsul Lunak kapsul


Bayi (6 - 11 bulan)
2 Retinol (Vitamin A) 200.000 IU Kapsul Lunak kapsul
Balita (11 - 59 bulan)
3 Tablet Tambah Darah (Ibu Hamil) tablet 20 20 30 20

A BMHP

1 Kapas 250 gr Pcs


2 Masker Pcs
3 Handscoon non steril ukuran M Pcs
4 Handscoon non steril ukuran S Pcs
5 Handscoon steril 7 Pcs

B DESINFECTAN

1 Alkohol 70% - 1000 ml Btl


2 Antiseptik Hand Rub 500 ml Btl
3 Rivanol larutan 0,1% - 300 cc Btl
C TAMBAHAN OBAT DAN ALKES

1 Asiklovir krim Tube


2 Ciprofloksasin 500 mg Tablet
3 Domperidon sirup Btl
4 Garam Oralit Sacchet 5 5
5 Gemfibrozil 600 mg Tablet
6 Haloperidol 1,5 mg Tablet
7 Klindamicin 300 mg Kapsul 10 10
8 Metoklorpropamid 5 mg Tablet
9 Multivitamin sirup Btl
10 Multivitamin tablet/SUPRABION Kapsul
11 Natrium Diklofenak 25 mg Tablet
12 Nifedipin 20 mg/adalat oros Tablet
13 Oksitetrasiklin salep mata 1% Tube
14 Propiltiourasil 100 mg Tablet
15 Ramipril 10 mg Tablet
16 Salisil Bedak Bungkus
17 Salbutamol 4 mg Tablet
18 Sefadroksil 500 mg Kapsul
19 Sefadroksil sirup 250 mg Btl
20 Sefadroksil sirup 125 mg Btl
21 Setrizin tablet Tablet
22 Zink kid 10 mg sirup Btl
23 Zink sirup 20 mg Btl
24 Zink tablet 20 mg Tablet 10 10 10 10 10 10 10 10 3 10 10 5
25 Kapas 500 gr Psc
26 Sikzonoate 25 mg/ml Ampul
27 Masker earloop Psc
28 Hazmat Psc
29 Sanitizer Botol
30 Masker hijab Psc
31 Kloramfenicol Syr Botol
32 Akilen tetes telinga Botol
33 Eutyrox 50 µg Tablet
34 Ristonat Tablet
35 Pot obat Pcs
36 Albendazol 400 mg Tablet
37 Amlodipin 5 mg Tablet 10
38 Simvastatin 10 mg Tablet
39 Kloramfenicol tetes telinga Btl
40 Gliseril Guaiacolate 100 mg Tablet
41 Klorpromazin 100 mg tablet Tablet
42 Nifedipin tablet 10 mg Tablet
43 Propranolol HCl tablet 10 mg Tablet
44 Diazepam 5 mg Tablet
45 Neocenta gel Tube
46 Methil prednisolone Tablet 3
47 Plester roll
48 Kasa steril pcs
49 Kasa 2x80cm roll
50 Betadine 30 ml Botol
51 Diazepam Inj 5 ml/2ml (program) Botol
52 Infus set dewasa Set
53 Infus set anak Set
54 Epinefrin injeksi Ampul
55 Difenhidramin injeksi Ampul
56 Abocath no.20 Pcs
57 Abocath no.22 Pcs
58 Abocath n0,24 Pcs
59 Aqua pro injek Vial
60 Micropore 1/2 inch Pcs
61 Nasal oksigen anak Pcs
62 Metronidazol sirup Botol
63 Herbacof Botol
64 Ranitidine inj Ampul
65 Amoksisilin drops botol
66 Gentamisin salep mata 0,3% Tube
67 Plester Pcs
67 Plester
68 Stimuno forte
69 Kloramfenikol Kapsul 250 mg Kapsul
RINCIAN PEMAKAIAN OBAT
TANGGAL 31

2 1
2 2 1 2 1 2 10
JUMLAH

1
0

0
0
0
145
0
0
0
0
110
0
0
0
0
60
0
150
64
10
47
10
0
0
0
0
0
56
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
10
0
20
0
1
1
0
0
0
0
0
0
0
0
13
0
9
0
0
0
0
0
10
0
0
12
0
0
0
0
18
0
0
134
0
0
0
36
0
0
100
10
4
1
20
5
0
90
62

0
0
0
0
0
0
0
0
0
0
0
0

0
0
90

0
0
0
0
0

0
0
0
0
0
0
10
0
0
20
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
108
0
0
0
0
0
0
0
0
0
0
0
0
10
0
0
0
0
0
0
0
0
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

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