LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

( LPLPO ) DANA PKD DAN JKN

PUSKESMAS : MADURAN PELAPORAN BULAN : Maret
SUB UNIT :TURI PERMINTAAN BULAN APRIL
KECAMATAN : MADURAN TAHUN : 2023
KABUPATEN : LAMONGAN
PROPINSI : JAWA TIMUR

STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PEMBERIAN

NO NAMA BARANG KEMASAN PERMINTAAN

PKD JKN PKD JKN PKD JKN PKD JKN PKD JKN PKD JKN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT-OBATAN
1 Acyclovir Cream 5 % 25 tube @ 5 gram 0 5
2 Antamen (Anti Diare) Syr Botol 0 0
3 Alopurinol tablet 100 mg 10 strips @ 10 tabl 90 300 0 390 300 90 200
4 Alopurinol tablet 300 mg 10 blister @ 10 tab 90 50 50 90 30 50 20 40 200
Ambroxol tab 10 strip @ 10 tablet 200 200 180 20 200
5 Ambroxol sirup 15 mg/ml botol 60 ml 0 0
7 Amlodipin tablet 10 mg 3 strip @ 10 tablets 0 0 100
8 Amlodipin tablet 5 mg 3 strip @ 10 tablets 110 0 110 50 60 100
9 Amoksisilin sirup kering 125 mg/ 5 ml btl @ 60 ml 0 0 5
10 Amoksisilin tablet scored 500 mg 10 strip @ 10 tablet 170 100 170 100 170 100 0 - 200
11 Antalgin tablet 500 mg dus 10 x 10 tablet 100 0 100 100 200
13 Antasida DOEN I tablet kunyah, kombinasi : 10 strip @ 10 tablet 200 200 0 200 0 300
Aluminium Hidroksida 200 mg Magnesium Hidroksida
200 mg

14 Antasida DOEN II suspensi, kombinasi : Aluminium botol @ 60 ml 0 0

Hidroksida 200 mg/5 ml Magnesium Hidroksida 200
mg/5ml

15 Anti influenza kaplet (Herbacold) box 150's 0 0 5

16 Anti mikroba + kortikosteroid tetas mata botol @ 5 ml 0 0 5
17 Anti Hemoroid dus/ 3 blister x 10's 0 0
18 Anti Bakteri Topikal Tetes telinga botol @ 10 ml 0 0
19 Antimigren: Ergotamin Tartrat 1 mg + Kofein 50 mg btl 100 tablet 0 0 100
20 Antispasmodik box 100 kaplet 0 0
21 Asam Ascorbat (vitamin C) tablet 50 mg 10 strip x 10 tab 200 0 200 300
22 Asam asetilsalisilat (asetosal) tab 80 mg(MINIASPI) 10 strip x 10 tab 0 0
23 Asam Folat tablet 0,4 mg 10 strip @ 10 tablet 100 0 100 100
24 Asam Mefenamat kaplet 500 mg 10 strip x 10 tab 20 200 20 200 20 200 0 - 300
25 Asam traneksamat tablet 500 mg dus, 10 x 10 tablet 0 0
26 Asiklovir tablet 200 mg 10 strip @ 10 tablet 0 0 50
27 Asiklovir tablet 400 mg 10 strip @ 10 tablet 0 0
28 Atapulgit tablet 600 mg 5 strip @ 10 tablet 0 0
Betametason CR tube 0 0 10
29 Bedak Salisil serbuk 2% dus @ 50 gram 2 2 2 2 10
30 Bisakodil suppositoria 10 mg supp 0 0
31 Bisoprolol tablet 5 mg box 3 x 10 tab 0 0
32 Dexametason 0,5 mg Tablet 100 100 0 100 0 300
34 Dimenhidrinat tablet 50 mg 10 strip @ 10 tablet 100 100 0 50 50
36 Domperidon Tab Tablet 0 0 100
37 Domperidon Syr Botol 0 0
38 Etil Klorida semprot 100 ml btl @ 100 ml 0 0
40 Fitomenadion (vitamin K1) tablet salut gula 10 mg dus@ 10 x 10 's 0 0
41 Fluocinolone Acetonide, Neomycin sulfat cream tube @ 5 g 0 0
42 Furosemid Inj Ampul 0 0
43 Garam Oralit I serbuk ,kombinasi : Natrium Klorida dus @ 100 Sachet 0 0
0,52 g Kalium Klorida 0,30 g Trinatrium sitrat dihidrat
0,58 g Glukosa Anhidrat 2,70 g

44 Gemfibrozil kapsul 300 mg 10 strip@ 10 kapsul 40 10 50 90 10 90 10 0 - 200

45 Gentamisin salep mata 0,3 % tube @ 3,5 gr 0 0 5
46 Glibenklamid tablet 5 mg 10 strip @ 10 tablet 100 100 200 0 120 80 100
47 Glikazid tablet 80mg (GLUCODEX) dus, 100 tablet 0 0
48 Glimepiride tablet 1 mg ktk 10x10 tablet 0 0 100
49 Glimepiride tablet 2 mg 5 strip @ 10 tablet 130 130 0 100
50 Glimepiride tablet 3 mg ktk 5x10 tablet 0 0
51 Griseofulvin tablet 125 mg dus @ 10 x 10's 60 60 0
52 Glyseril Guaiacolat (Batuk Berdahak) botol 100 tab 0 0 200
53 Hidrokortison Salep kulit Tube 3 3 0 3 0 5
54 Hidroklortiazid Tablet 0 0
55 Ibuprofen 200 mg 10 strip @ 10 tablet 20 20 0
56 Ibuprofen Syr Botol 0 0
57 Kalsium laktat (kalk) tab 500 mg 10 strip @ 10 tablet 100 0 100 100 - 200
58 Kaptopril tablet scored 12,5 mg 10 strip @ 10 tablet 50 100 150 0 100 50 100
59 Kaptopril tablet scored 25 mg 10 strip @ 10 tablet 150 150 0 100 50 100
60 Ketokonazol krim 2 % tube 10 gr 4 4 0 4 0 5
61 Ketokonazol tablet 200 mg 5 strip @ 10 tablet 10 50 60 0 60 0 100
Kloramfenikol 500 mg 10 strip @ 10 tablet 0 0 100
62 Kloramfenikol kaplet 250 mg ktk 10 x 10 tablet 0 0 100
63 Kloramfenikol salep kulit (Bufacetin) tube 5 gr 0 0 5
Kloramfenikol tetes telinga botol 2 0 2
64 Kloramfenikol suspensi 125 mg/ 5 ml botol, 60 ml 0 0
65 Klorfeniramina Maleat ( CTM ) tablet 4 mg box 10 x 10 "s 110 100 210 0 100
66 Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg dus, 100 Sachet @ 0 0
Asam Folat 0,25 mg 30 tablet
67 Kotrimoksazol DOEN I (dewasa) 10 strip @ 10 tablet 120 120 0
kombinasi :Sulfametoksazol 400 mg Trimetoprim 80
mg
68 Kotrimoksazol tab 200mg/40 mg dus, 10 strip @ 10 0 0
tablet
69 Kotrimoksazol suspensi komb.: Sulfametoksazol 200 botol, 60 ml 0 0
mg + Trimetoprim 40 mg / 5 ml
70 Lidocain Inj Ampul 0 0 5
72 Loperamid tablet 2 mg 10 strip @ 10 tablet 0 0 100
73 Loratadin tablet 10 mg 5 strip @ 10 tablet 0 0
74 Metformin HCl tablet 500 mg 10 strip@ 10 tablet 90 90 0 90 0 100
75 Metilergometrin Maleat (metilergometrin) tablet salut ktk 10 x 10 tablet 0 0
0,125 mg salut
77 Metilprednisolon tablet 4 mg 10 strip @ 10 tablet 50 50 0 50 0 200
78 Metronidazol tablet 500 mg 11 strip @ 10 tablet 10 10 0 10 0 100
79 Mikonazol krim/salep 2 % (Nitrat) tube 10 gr 0 0 5
80 Mukolitik dan Ekspektoran sirup botol 60 ml 0 0 10
81 Multivitamin sirop botol 60 ml 3 3 0 10
82 Natrium Diklofenak tablet 25 mg dus @ 5 x 10's 0 0 200
83 Natrium Diklofenak tablet 50 mg dus @ 5 x 10's 60 100 60 100 60 100 0 - 200
84 Nifedipin tablet 10 mg 10 strip @ 10 tablet 0 0
85 Nistatin vaginal tablet 100.000 IU/g dus @ 10 x 10's 0 0
86 Obat Sariawan (gom) box 24 tube @ 5 gr 2 2 0
87 OBH sirup botol 60 ml 3 3 0 3 0 10
88 Oksitetrasiklin salep mata 1 % steril tube @ 5 g 0 0 5
89 Omeprazol kaps 20 mg strip 3 x 10 kapsul 0 0 200
91 Parasetamol Sirup 120 mg / 5 ml botol 60 ml 0 0
92 Parasetamol tablet 500 mg 10 strip @ 10 kss 200 0 200 200 - 300
93 Piridoksin (vitamin B6) tab 10 mg botol@ 100 tablet 0 0 100
94 Piroxicam 10 mg kapsul 0 0 200
95 Prednison tab 5 mg kotak @ 10 x 10 tab 0 0 200
96 Propiltourasil tb 100 mg kotak @ 10 x 10 tab 0 0
97 Ranitidin Tablet 0 0 200
98 Ranitidin Inj Ampul 0 0
99 Salbutamol tablet 2 mg ( sebagai sulfat ) strip @ 10 tablet 100 100 0 50 50 100
100 Salbutamol tablet 4 mg ( sebagai sulfat ) ktk 10 x 10 tablet 0 0
101 Salep 2-4 , Kombinasi : Asam Salisilat 2 % + Belerang Pot @ 30 gram 3 3 0 2 1 5
endap 4 %
102 Sefadroksil kapsul 500 mg 10 strip@ 10 kapsul 0 0 100
103 Sefadroksil sir kering 250 mg/5 ml dus, botol 60 ml 0 0
104 Sefotaksim injeksi 1 gram dus, 10 vial @ 1g 0 0
105 Setirizin tablet 10 mg 10 strips @ 10 kap 100 0 100 50 50 50
106 Sianokobalamin (vitamin B12) injeksi 500 mcg ampul @ 1 ml 0 0
107 Simvastatin tablet 10 mg 10 strip @ 10 kss 0 0 100
Simvastatin tablet 20 mg 10 strip @ 10 kss 0 0 100
108 Siprofloksasin tablet 500 mg (sebagai HCl) 10 blister @ 10 tab 0 0
109 Tetes Telinga Antibiotik ( Kloramfenikol 1 % ) botol @ 10 ml 0 0
110 Terra F (Batuk Pilek) 10 strip @ 10 tablet 50 0 50 50 - 100
111 Tetrasiklin kapsul 500 mg 10 strip @ 10 kapsul 0 0
112 Tiamin ( Vitamin B1 ) tablet 50 mg 10 strip @ 10 tablet 100 0 100 100 - 200
113 Multivitamin (Recovit tetes) vial @ 20 ml 0 0 5
114 Vitamin B-Complex Tab botol @ 100 tablet 200 200 0 100 100 100
116 Zink 10 mg/5 ml sirup botol @ 100 ml 0 0
117 Zink tablet dispesible 20 mg 10 strip @ 10 tablet 0 0

Mengetahui,
Yang Menyerahkan,
Kepala Puskesmas Maduran
Petugas pengelola gudang obat Yang Menerima,

Petugas sub unit

Nur Faizah

..
dr. Ema Vika Pratiwi ..................................................
apt. Zumatul Amilin, S.Farm NIP.197707282008012022
NIP. 198604282014122001
NIP. 199510232020122016
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