PUSTU/ PKD :

TANGGAL :

JUMLAH OBAT

NO NAMA OBAT
NAMA PASIEN TOTAL

UMUR
1 allopurinol 100 mg Tablet
2 ambroxol Tablet
3 aminophilin Tablet
4 amlodipin 5 mg Tablet
5 amlodpin 10 mg Tablet
6 Amoksisilin 500 mg Tablet
7 amoxicilin 125 mg/5ml sirup Botol
8 Antalgin Tablet
9 Antasida Tablet
10 antasida sirup Botol
11 Antihemoroid Suppo suppositoria
12 asam folat 400mcg Tablet
13 asam mefenamat Tablet
14 asam tranexamat 500 mg Tablet
15 asiklovir 200 mg Tablet
16 asiklovir 400 mg Tablet
17 attapulgit 650 mg Tablet
18 bedak salisil Botol
19 betahistin 24 mg Tablet
20 betahistin 6 mg Tablet
21 betametason salep kulit Tablet
22 bisakodil /dulcolax Tablet
23 Cetirizin Tablet
24 CTM Tablet
25 Dexa Metason Tablet
26 dextral Tablet
27 digoksin 0.25 mg Tablet
28 dimenhidrinat Tablet
29 domperidom Tablet
30 fenol gliserol tetes telinga Tablet
31 fitomenadion Tablet
32 furosemid 40 mg Tablet
33 gemfibrozil 600 mg Tablet
34 Glibenklamid 5 mg Tablet
35 Glimepirid 2 mg Tablet
36 Gliseril Guaiacolat Tablet
37 hidrokortison salep kulit Tube
38 hustab Tablet
39 Ibuprofen 500 mg Tablet
40 Isosorbid Dinitrat 5 mg Tablet
41 kalk Tablet
42 Kaptopril 12,5 mg Tablet
43 Kaptopril 25 mg Tablet
44 ketokonazole 200 mg Tablet
45 ketokonazole krim Tablet
46 Kloramfenicol 500 mg Tablet
47 kloramfenikol salep kulit Tube
48 kloramfenikol salep mata Tube
49 kloramfenikol tetes mata Fls
50 kloramfenikol tetes telinga Fls
51 Kotrimoksasole 500 mg Tablet
52 metformin 500 mg Tablet
53 metilergometri tablet Tablet
54 metilprednisolon 16 mg Tablet
55 metilprednisolon 4 mg Tablet
56 metronidazole 500 mg Tablet
57 mikonazole kri Tablet
58 Miniaspi Tablet
59 Multivitamin (fervital) Tablet
 PUSTU/ PKD :
TANGGAL :

JUMLAH OBAT

NO NAMA OBAT
NAMA PASIEN TOTAL

60 natrium diklofenak 50 mg Tablet

61 Nifedipin 10 mg Tablet
62 OBH sirup Tablet
63 omeprazole 20 mg Tablet
64 oralit Sachet
65 papaverin Tablet
66 paracetamol 500 mg Tablet
67 paracetamol sirup Botol
68 permetrin salep Tube
69 pirantel Pamoat 125 mg Tablet
70 piroksikam 20 mg Tablet
71 PRAMOLTA Botol
72 prednison Tablet
73 ranitidin Tablet
74 salbutamol 2 mg Tablet
75 salbutamol 4 mg Tablet
76 salep antifungi (whitefield) Tube
77 Salep2-4 Tablet
78 sefadroksil 500 mg Tablet
79 simvastatin 10 mg Tablet
80 simvastatin 20 mg Tablet
81 Siprofloksasin 500 mg Tablet
82 Tablet Tambah darah Tablet
83 vitamin B komplek Tablet
84 vitamin B1 Tablet
86 vitamin b6 Tablet
87 vitamin C Tablet
88 vitamin neurotropik Tablet
89 ZINK Tablet

KB
1 Depo KB vial
2 Spuit KB pcs
3 Implant pcs
4 IUD Coper T pcs
5 Sarung Tangan Steril pasang
6 Lidocain vial
7 Plester Steril/Dermafix pcs
8 spuit implant pcs
9 bisturi pcs
10 PIL KB
11 KONDOM
 PUSTU/ PKD :
TANGGAL :

JUMLAH OBAT

NO NAMA OBAT
NAMA PASIEN TOTAL

10

11

12

13

14

15
1

9
UMUR
1 allopurinol 100 mg Tablet
2 ambroxol Tablet
3 aminophilin Tablet
4 amlodipin 5 mg Tablet
5 amlodpin 10 mg Tablet
6 Amoksisilin 500 mg Tablet
7 amoxicilin 125 mg/5ml sirup Botol
8 Antalgin Tablet
9 Antasida Tablet
10 antasida sirup Botol
11 Antihemoroid Suppo suppositoria
12 asam folat 400mcg Tablet
13 asam mefenamat Tablet
14 asam tranexamat 500 mg Tablet
15 asiklovir 200 mg Tablet
16 asiklovir 400 mg Tablet
17 attapulgit 650 mg Tablet
18 bedak salisil Botol
19 betahistin 24 mg Tablet
20 betahistin 6 mg Tablet
21 betametason salep kulit Tablet
22 bisakodil /dulcolax Tablet
23 Cetirizin Tablet
24 CTM Tablet
25 Dexa Metason Tablet
26 dextral Tablet
27 digoksin 0.25 mg Tablet
28 dimenhidrinat Tablet
29 domperidom Tablet
30 fenol gliserol tetes telinga Tablet
31 fitomenadion Tablet
32 furosemid 40 mg Tablet
33 gemfibrozil 600 mg Tablet
34 Glibenklamid 5 mg Tablet
35 Glimepirid 2 mg Tablet
36 Gliseril Guaiacolat Tablet
37 hidrokortison salep kulit Tube
38 hustab Tablet
39 Ibuprofen 500 mg Tablet
40 Isosorbid Dinitrat 5 mg Tablet
41 kalk Tablet
42 Kaptopril 12,5 mg Tablet
43 Kaptopril 25 mg Tablet
44 ketokonazole 200 mg Tablet
45 ketokonazole krim Tablet
46 Kloramfenicol 500 mg Tablet
47 kloramfenikol salep kulit Tube
48 kloramfenikol salep mata Tube
49 kloramfenikol tetes mata Fls
50 kloramfenikol tetes telinga Fls
51 Kotrimoksasole 500 mg Tablet
52 metformin 500 mg Tablet
53 metilergometri tablet Tablet
54 metilprednisolon 16 mg Tablet
 JUMLAH OBAT

NO NAMA OBAT
NAMA PASIEN TOTAL

10

11

12

13

14

15
1

9
55 metilprednisolon 4 mg Tablet
56 metronidazole 500 mg Tablet
57 mikonazole kri Tablet
58 Miniaspi Tablet
59 Multivitamin (fervital) Tablet
60 natrium diklofenak 50 mg Tablet
61 Nifedipin 10 mg Tablet
62 OBH sirup Tablet
63 omeprazole 20 mg Tablet
64 oralit Sachet
65 papaverin Tablet
66 paracetamol 500 mg Tablet
67 paracetamol sirup Botol
68 permetrin salep Tube
69 pirantel Pamoat 125 mg Tablet
70 piroksikam 20 mg Tablet
71 PRAMOLTA Botol
72 prednison Tablet
73 ranitidin Tablet
74 salbutamol 2 mg Tablet
75 salbutamol 4 mg Tablet
76 salep antifungi (whitefield) Tube
77 Salep2-4 Tablet
78 sefadroksil 500 mg Tablet
79 simvastatin 10 mg Tablet
80 simvastatin 20 mg Tablet
81 Siprofloksasin 500 mg Tablet
82 Tablet Tambah darah Tablet
83 vitamin B komplek Tablet
84 vitamin B1 Tablet
86 vitamin b6 Tablet
87 vitamin C Tablet
88 vitamin neurotropik Tablet
89 ZINK Tablet

KB
1 Depo KB vial
2 Spuit KB pcs
3 Implant pcs
4 IUD Coper T pcs
5 Sarung Tangan Steril pasang
6 Lidocain vial
7 Plester Steril/Dermafix pcs
8 spuit implant pcs
9 bisturi pcs
10 PIL KB
11 KONDOM