LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (

KODE PUSKESMAS : 3519120101

PUSKESMAS : BALEREJO
KECAMATAN : BALEREJO
KABUPATEN : MADIUN
PROPINSI : JAWA TIMUR

Sumber
No Kode Barang Nama Satuan Penerimaan
Dana Stok Awal
1 127 ACYCLOVIR 400 MG TABLET GFK TABLET 500 0
2 1034 ALAT SUNTIK SEKALI PAKAI 0,5 ML GFK PCS 200 500
3 1049 ALAT SUNTIK SEKALI PAKAI 0.05 ML GFK PCS 200 0
4 3419 ALAT SUNTIK SEKALI PAKAI 0.3 ML GFK PCS 200 0
5 366 ALAT SUNTIK SEKALI PAKAI 1 ML GFK PCS 167 0
6 369 ALAT SUNTIK SEKALI PAKAI 3 ML GFK PCS 712 700
7 370 ALAT SUNTIK SEKALI PAKAI 5 ML GFK PCS 789 700
8 4251 ALAT TEST HEMOGLOBIN SYSTEM GFK KIT 2 0
9 103 ALBENDAZOLE TABLET 400 MG GFK TABLET 92 0
10 478 ALKOHOL 70% 1 LITER GFK BOTOL 80 0
11 371 ALKOHOL SWAB GFK PCS 4600 0
12 542 ALLOPURINOL TABLET 100 MG GFK TABLET 3817 0
13 647 ALPRAZOLAM TABLET 0.5 MG GFK TABLET 475 0
14 305 AMBROXOL TABLET 30 MG GFK TABLET 818 2000
15 108 AMITRIPTYLINE TABLET 25 MG GFK TABLET 500 0
16 109 AMLODIPINE TABLET 10 MG GFK TABLET 13322 0
17 550 AMLODIPINE TABLET 5 MG GFK TABLET 2710 0
18 658 AMOXYCILLIN SIRUP 250 MG/5 ML GFK BOTOL 92 0
19 113 AMOXYCILLIN TABLET 500 MG GFK TABLET 5585 5000
20 114 AMPICILLIN INJEKSI 1 G/VIAL GFK VIAL 70 150
21 115 ANTACIDA SIRUP 400 MG/5 ML GFK BOTOL 52 0
22 116 ANTACIDA TABLET 400 MG GFK TABLET 7360 0
23 4527 ANTI FLU & BATUK FORTE (Kombinasi) GFK TABLET 1000 0
TABLET
24 614 ANTI INFLUENZA TABLET GFK TABLET 1346 0
25 309 ANTIBAKTERI (BACITRACIN POLYMYXIN) GFK TUBE 31 50
SALEP KULIT 5 Gr
26 117 ANTIFUNGI: ASAM SALICYLICUM 30 MG, GFK POT 15 0
ASAM BENZOICUM 60 MG
27 118 ANTIHEMOROID DOEN SUPPOSITORIA 2 gr GFK SUPPO 0 30

28 125 ASAM MEFENAMAT TABLET 500 MG GFK TABLET 9828 0

29 449 ASCORBIC ACID (VITAMIN C) TABLET 250 GFK TABLET 746 0
MG
30 123 ASCORBIC ACID (VITAMIN C) TABLET 50 MG GFK TABLET 6144 0

31 2188 ASEPTIC GEL 5 Lt (Ethyl Alcohol 70% gel) GFK GALON 29 0

32 372 ASEPTIC GEL 500 ML (Ethyl Alcohol 70% gel) GFK BOTOL 38 0

33 312 ASPIRIN (ASETOSAL) TABLET 100 MG GFK TABLET 1560 0

34 129 ATROPINE SULPHATE INJEKSI 0.25 MG/ML GFK AMPUL 5 0

35 2382 ATTAPULGITE 630 MG / PULAREX GFK TABLET 547 0

36 682 ATTAPULGITE|PECTIN TABLET (MOLAGIT) GFK TABLET 3045 0

37 3191 AZITHROMYCIN TABLET 500 MG GFK TABLET 16 0

38 2226 BAJU APD (DISPOSABLE PROTECTIVE COVER GFK PCS 200 0
ALL)/HAZMAT
39 131 BEDAK SALISIL SERBUK 2 % GFK KOTAK 89 50
40 612 BETAHISTINE TABLET 6 MG GFK TABLET 1870 500
41 316 BETAMETHASONE KRIM 0.1% GFK TUBE 144 0
42 133 BISACODYL TABLET 5 MG GFK TABLET 70 0
43 4252 BISOPROLOL 2.5 MG GFK TABLET 465 0
44 722 BLOOD LANCET GFK PCS 300 0
45 414 BLOOD TRANSFUSION SET GFK PACK 48 0
46 336 CALCIUM LACTATE TABLET 500 MG / KALK GFK TABLET 4349 0

47 190 CAPTOPRIL TABLET 12.5 MG GFK TABLET 3098 0

48 191 CAPTOPRIL TABLET 25 MG GFK TABLET 1034 0
49 355 CEFADROXIL TABLET 500 MG GFK KAPSUL 2975 1000
50 810 CHLORAMPHENICOL SALEP KULIT 2% GFK TUBE 5 0
(BUFACETIN SK 15 GR)
51 200 CHLORPHENIRAMINE MALEAT TABLET 4 GFK TABLET 2395 300
MG (CTM)
52 202 CHLORPROMAZINE 25 MG TABLET (CPZ 25 GFK TABLET 10 0
MG)
53 203 CHLORPROMAZINE HCL 100 MG TABLET GFK TABLET 230 400
(CPZ 100 MG)
54 373 CHROMIC CATGUT WITH NEEDLE SURGICAL GFK PCS 12 0
SUTURES 2/0
55 263 CIPROFLOXACIN TABLET 500 MG GFK TABLET 2250 1000
56 650 CLOZAPINE TABLET 25 MG GFK TABLET 200 500
57 206 COTRIMOXAZOLE (DOEN I DEWASA) : GFK TABLET 1730 300
Sulfametoxazole 400 mg + Trimetoprim 80
mg tablet

58 3796 CURCUMA 20 MG TABLET GFK TABLET 4092 0

59 135 DEXAMETHASONE 0.5 MG TABLET GFK TABLET 9996 0
60 134 DEXAMETHASONE INJEKSI 5 MG/ML GFK AMPUL 180 0
61 136 DIAZEPAM RECTAL 5 MG/2,5 ML GFK TUBE 10 0
62 1234 DIAZEPAM TABLET 5 MG GFK TABLET 575 0
63 142 DIMENHYDRINATE TABLET 50 MG GFK TABLET 617 600
64 139 DIPHENHYDRAMINE INJEKSI 10 MG/ML GFK AMPUL 123 90
65 2966 DOLUTEGRAVIR|LAMIVUDINE|TENOFOVIR GFK TABLET 120 0
DISOPROXIL FUMARATE 50MG|300MG|
300MG TABLET (TLD)

66 535 DOMPERIDONE SIRUP 5 MG/5 ML GFK BOTOL 107 0

67 144 DOMPERIDONE TABLET 10 MG GFK TABLET 1383 0
68 2936 DT VACCINE (10 ds) GFK VIAL 25 0
69 150 ETHYL CHLORIDE SPRAY GFK BOTOL 0 3
70 2250 EXAMINATION GLOVES SIZE M GFK PCS 1500 1000
(HANDSCOON NON STERIL FREE POWDER
M)

71 905 EXAMINATION GLOVES SIZE S GFK PCS 1550 0

( HANDSCOON NON STERIL FREE POWDER
S)

72 160 FLUPHENAZINE DECANOATE INJEKSI 25 GFK AMPUL 21 0

MG/ML (i.m.)/SIKZONOATE
73 379 FOLLEY CATHETER 2 WAY NO. 16 GFK PCS 29 0
74 3807 FRAMYCETIN SULFATE TULE GFK LEMBAR 6 0
75 4396 FREEZE-Tag GFK PCS 1 0
76 4395 FRIDGE-Tag 2 GFK PCS 1 0
77 162 FUROSEMIDE TABLET 40 MG GFK TABLET 185 0
78 163 GARAM ORALIT KOMBINASI SERBUK GFK SACHET 897 0
79 910 GENEXPERT MTB/RIF CARTRIDGE GFK KIT 0 100
80 325 GENTAMYCIN SULFAT DROPS 0.3 %( tetes GFK BOTOL 92 48
mata )
81 166 GLIMEPIRIDE TABLET 1 MG GFK TABLET 7245 0
82 167 GLIMEPIRIDE TABLET 2 MG GFK TABLET 6414 3000
83 329 GLUCOSE/DEXTROSE MONOHYDRAT INFUS GFK AMPUL 10 0
40 % (D 40%)
84 327 GUAIFENESIN TABLET 100 MG (Gliseril GFK TABLET 6033 0
Guaiakolat 100 mg)
85 997 HALOPERIDOL DROPS 2 MG/ML (LODOMER GFK BOTOL 2 0
DROP)
86 175 HALOPERIDOL TABLET 2 MG GFK TABLET 1490 0
87 2845 HANDSANITIZER (Handrub) GFK BOTOL 20 0
88 4238 HEMOGLOBIN TEST STRIP GFK TEST 250 0
89 1129 HEPATITIS B IMMUNE GLOBULIN (HUMAN) GFK Syringe 1 0
S/D 220 IU/ML (HYPERHEP 0,5 Ml)(HBIG)

90 3857 HERBACOLD TABLET GFK 250 0

91 3262 HerbaKOF (Reconyl TM, campuran ekstrak GFK BOTOL 2 0
yang setara dengan simplisia: Vitex trifolia
folium 1 GR, Zingiber officinale rhizone 0.25
GR, Abrus precatorius folium 0.25 GR,
Phaleria macrocarpa fructus 0.20 GR) 100
ML

92 178 HIDROKORTISON CREAM 2,5% GFK TUBE 57 0

93 179 HIOSCIN BUTILBROMIDA 10 MG (Tab/Kaps) GFK TABLET 180 0

94 181 IBUPROFEN SIRUP 100 MG/5 ML GFK BOTOL 4 0

95 183 IBUPROFEN TABLET 400 MG GFK TABLET 228 0
96 3806 IMUNOMODULATOR KAPSUL (Stimuno) GFK KAPSUL 60 0

97 2978 INACTIVATED POLIOMYELITIS VACCINE GFK VIAL 0 20

(IPV) 5 DOSIS
98 418 INFUSION SET DEWASA GFK SET 78 100
99 654 IODIN TEST 10 ML GFK BOTOL 2 0
100 1544 IPRATROPIUM BROMIDE|SALBUTAMOL GFK AMPUL 30 0
SULPHATE 0.5 MG|2.5 MG (Cairan Inhalasi)

101 1860 ISONIAZID TABLET 300 MG (INH 300 MG) GFK TABLET 98 112

102 186 ISOSORBIDE DINITRATE TABLET 5 MG GFK TABLET 70 0

(ISDN)
103 387 IV CATHETER NO. 24 GFK PCS 50 0
104 384 IV CATHETER NO.18 GFK PCS 250 0
105 385 IV CATHETER NO.20 GFK PCS 35 0
106 391 Kapas Berlemak 500 gram GFK ROLL 3 0
107 392 KAPAS PUTIH 250 G GFK ROLL 29 0
108 2277 KARBOL LIQUID GFK PCS 68 0
109 397 KASA HYDROFIL 4 M X 15 CM GFK ROLL 60 0
110 396 KASA PEMBALUT HIDROFIL 40 YDS X 80 CM GFK ROLL 3 0

111 393 KASA STERIL 16 X 16 CM (KOTAK) GFK KOTAK 52 0

112 799 Kertas EKG GFK ROLL 5 0
113 194 KETOCONAZOLE SALEP 2% GFK TUBE 2 0
114 195 KETOCONAZOLE TABLET 200 MG GFK TABLET 709 0
115 3257 KIT STOP TB RHZE GFK PAKET 14 0
(150/75/400/275)mg+RH(150/75)mg (OAT
KDT Dosis Harian)

116 196 KLORAMFENIKOL KAPSUL 250 MG GFK KAPSUL 2045 0

117 199 KLORAMFENIKOL TETES TELINGA 1 % GFK BOTOL 45 0
118 4525 KLORAMFENIKOL TETES TELINGA 3 % GFK BOTOL 0 24
119 1253 Kondom GFK PCS 75 0
120 683 LIDOCAINE INJEKSI 2% GFK AMPUL 158 0
121 340 LOPERAMID 2 MG GFK TABLET 450 0
122 209 LORATADINE TABLET 10 MG GFK TABLET 563 0
123 1254 LUBRICANT GFK PCS 15 0
124 210 MAGNESIUM SULFAT INJEKSI 20 % (i.v.) GFK FLACON 2 0
125 211 MAGNESIUM SULFAT INJEKSI 40 % (i.v.) GFK FLACON 5 0
126 1011 MASKER KARET (EARLOOP) GFK PCS 11700 0
127 2599 MASKER N95 GFK PCS 740 0
128 1107 MDT COMBI MB ADULT : RIFAMPICIN 300 GFK BLISTER 2 1
MG, CLOFAZIMINE 100 MG | DAPSON 100
MG

129 214 METFORMIN HCL TABLET 500 MG GFK TABLET 11222 0

130 215 METHYLERGOMETRINE INJEKSI 0.2 MG/ML GFK AMPUL 175 0

131 216 METHYLERGOMETRINE TABLET 0.125 MG GFK TABLET 80 0

132 217 METHYLPREDNISOLONE TABLET 4 MG GFK TABLET 1135 1000

133 222 METRONIDAZOLE TABLET 500 MG GFK TABLET 1774 0
134 223 MICONAZOLE SALEP 2% GFK TUBE 92 48
135 2979 MULTIVITAMIN DAN ZINC (CAVIPLEX CDEZ) GFK TABLET 20 0

136 3839 MULTIVITAMIN SYRUP GFK BOTOL 68 10

137 3334 MULTIVITAMIN TABLET MG GFK TABLET 350 0
138 696 NASAL CANNULA ANAK GFK PACK 15 0
139 225 NATRIUM DIKLOFENAK TABLET 50 MG GFK TABLET 12556 0
140 226 NIFEDIPINE TABLET 10 MG GFK TABLET 90 0
141 528 OBAT BATUK HITAM (OBH) SIRUP GFK BOTOL 122 0
142 232 OMEPRAZOLE KAPSUL 20 MG GFK KAPSUL 1200 0
143 604 ONDANSETRON INJEKSI (2 MG/ML)/(4 GFK AMPUL 200 0
MG/2 ML)
144 1831 OXYTETRACYCLINE SALEP MATA 1 % (HCL) GFK TUBE 51 0

145 231 OXYTOCIN INJEKSI 10 IU/ML GFK AMPUL 100 0

146 509 PAKET STOP TB KATEGORI 1 GFK KIT 10 0
147 508 PAKET STOP TB OAT ANAK GFK PAKET 1 0
148 237 PARACETAMOL 500 MG TABLET GFK TABLET 8005 5000
149 688 PARACETAMOL SIRUP 120 MG/5 ML GFK BOTOL 114 0
150 239 PERMETHRIN KRIM 5 % 10 GR GFK TUBE 23 0
151 193 PHENOL GLYCEROL (TETES TELINGA) 10% GFK BOTOL 10 24

152 243 PIRIDOKSIN HCL ( VIT. B6 ) 10 MG GFK TABLET 2688 0

153 1071 PLESTER ADHESIVE NON WOVEN FABRIC GFK ROLL 6 30
10CM X 5M
154 408 POVIDONE IODINE 10% 300ML GFK BOTOL 5 0
155 353 RANITIDINE INJEKSI 25 MG/ML GFK AMPUL 350 300
156 247 RANITIDINE TABLET 150 MG GFK TABLET 7649 0
157 662 RAPID DIAGNOSTIC SYPHILIS TEST GFK TEST 0 100
158 4590 RAPID TEST ANTI HBs GFK BOX 0 2
159 1128 RAPID TEST HbsAg GFK PCS 0 200
160 3439 RAPID TEST MALARIA GFK TEST 25 0
161 434 REAGENT KIMIA KLINIK TRIGLISERIDA GFK KIT 5 0
162 430 REAGENT UJI CHOLESTEROL GFK KIT 5 0
163 1157 REAGENT WIDAL O-D GFK BOTOL 2 0
164 354 RINGER LAKTAT 500 ML (RL Infus) GFK BOTOL 0 200
165 470 RISPERIDONE TABLET 2 MG GFK TABLET 102 500
166 1050 SAFETY BOX 5 LITER GFK PCS 35 0
167 252 SALBUTAMOL TABLET 2 MG GFK TABLET 1815 0
168 382 SARUNG TANGAN STERIL NO. 7 GFK PASANG 100 100
169 258 SETIRIZINE SIRUP 5 MG/5ML GFK BOTOL 0 10
170 260 SIANOKOBALAMIN (VITAMIN B12) INJEKSI GFK AMPUL 100 0
500 MCG
171 259 SIANOKOBALAMIN TABLET 50 MCG GFK TABLET 10780 0
172 261 SIMVASTATIN TABLET 10 MG GFK TABLET 140 0
173 262 SIMVASTATIN TABLET 20 MG GFK TABLET 2040 0
174 346 SODIUM CHLORIDE INFUS 0.9 % (NaCl Infus GFK BOTOL 40 100
0,9%) (500 ml)
175 730 TABLET TAMBAH DARAH KOMBINASI Fe + GFK TABLET 8004 6000
ASAM FOLAT
176 2937 Td VACCIN (10 ds) GFK VIAL 75 0
177 1104 TENOFOVIR/TDF(300)+LAMIVUDIN/ GFK TABLET 170 0
3TC(300)+EFAVIRENZ/EFV(600) (TLE)
178 180 TETAGAM CAIRAN INJEKSI 250 IU/ML(DUS, GFK VIAL 3 0
1 PREFILLED SYRINGE @ 1 ML)

179 270 THIAMINE (VITAMIN B1) 50 MG GFK TABLET 1567 1000

180 271 TRIHEXYPHENIDYL TABLET 2 MG (THP 2 GFK TABLET 1200 2000
MG)
181 1216 TUBERCULIN PPDRT (tes Mantoux) GFK VIAL 1 0
182 4263 ULTRASONIC GEL GFK BOTOL 4 0
183 882 UNDERPAD GFK PCS 100 0
184 415 URINE BAG steril GFK PACK 5 0
185 2245 VAKSIN DPT-HB-Hib (PENTABIO) (5 ds) GFK VIAL 0 13
186 2247 VAKSIN HEPATITIS B REKOMBINAN 0,5 GFK Pouches 40 20
ML(HEPATITIS B1) (HB Unijeck) (Bayi)
187 4579 VAKSIN HEPATITIS B REKOMBINAN 1,0 ML GFK Pouches 0 47
(Dewasa/Adult)
188 3884 VAKSIN HUMAN PAPILOMA VIRUS (HPV) GFK VIAL 296 0

189 4429 VAKSIN INAVAC SARS Cov-2 (5 ug) (5 ds) GFK VIAL 0 2
190 3921 VAKSIN PCV MDV 4 DOSIS (Pneumococcal GFK VIAL 0 15
Conjugate Vaccine)
191 2248 VAKSIN POLIO (BIVALENT ORAL GFK VIAL 0 20
POLIOMYELITIS VACCINE)(BOPV)
192 4015 VAKSIN ROTAVIRUS 2,5 ML (5 Ds) GFK VIAL 0 10
193 273 VITAMIN B KOMPLEKS: VITAMIN B1 2 MG, GFK TABLET 4672 0
VITAMIN B2 2 MG, VITAMIN B6 2 MG,
NICOTINAMIDE 20 MG, Ca PANTOTHENATE
10 MG

194 3283 VITAMIN D3 CHOLECALCIFEROL 1000 IU GFK TABLET 30 0

TABLET
195 364 VITAMIN NEUROTROPIK (B1.B6.B12) GFK TABLET 150 0
TABLET
196 1077 ZIDOVUDINE 300 MG + LAMIVUDINE 150 GFK TABLET 150 0
MG(DUVIRAL)
197 4365 ZIFIVAX @1 DS VACCINE GFK VIAL 20 0
198 274 ZINC SULPHATE TABLET 20 MG GFK TABLET 3236 0

KEPALA PUSKESMAS PENANGGUNGJAWAB YANFAR PUSKESMAS

dr. RETNOWULAN PRAWITOSARI apt. DEWI PERMANASARI, S.Farm

NIP 19691002 200212 2 002 NIP 19920801 202012 2 012

MENGETAHUI/MENYETUJUI
a/n KADINKES KABUPATEN MADIUN
KABID SUMBER DAYA KESEHATAN

Dr. SOELAIMAN, S.Kep.Ners., M.Kes

NIP 19720303 199312 1 003
ERMINTAAN OBAT (LPLPO)

BULAN : NOVEMBER
TAHUN : 2023

Pengeluar Stok
Persediaan Stok Akhir Permintaan Pemberian
an Optimum
500 100 400 0 0
700 0 700 0 0
200 200 0 0
200 200 0 0
167 10 157 0 0
1412 412 1000 0 0
1489 600 889 0 0
2 2 0 0 0
92 92 0 0 0
80 1 79 0 0
4600 600 4000 0 0
3817 1229 2588 0 0
475 30 445 0 0
2818 146 2672 0 0
500 0 500 0 0
13322 2185 11137 0 0
2710 2130 580 0 0
92 23 69 0 0
10585 2265 8320 0 0
220 200 20 0 0
52 52 0 0
7360 1656 5704 0 0
1000 500 500 0 0

1346 1316 30 0 0
81 19 62 0 0

15 1 14 0 0

30 30 0 0

9828 1380 8448 0 0

746 746 0 0
6144 3334 2810 0 0

29 1 28 0 0

38 38 0 0

1560 420 1140 0 0

5 5 0 0

547 507 40 0 0
3045 852 2193 0 0

16 16 0 0 0
200 200 0 0

139 65 74 0 0
2370 290 2080 0 0
144 78 66 0 0
70 70 0 0 0
465 40 425 0 0
300 300 0 0 0
48 48 0 0
4349 1902 2447 0 0

3098 1080 2018 0 0

1034 410 624 0 0
3975 1791 2184 0 0
5 5 0 0 0

2695 1114 1581 0 0

10 10 0 0

630 250 380 0 0

12 12 0 0

3250 120 3130 0 0

700 300 400 0 0
2030 222 1808 0 0

4092 2542 1550 0 0

9996 5734 4262 0 0
180 100 80 0 0
 10 10 0 0
575 170 405 0 0
1217 541 676 0 0
213 118 95 0 0
120 60 60 0 0

107 107 0 0
1383 178 1205 0 0
25 25 0 0 0
3 3 0 0
2500 2400 100 0 0

1550 750 800 0 0

21 5 16 0 0

29 0 29 0 0
6 6 0 0
1 1 0 0
1 1 0 0
185 70 115 0 0
897 76 821 0 0
100 50 50 0 0
140 38 102 0 0

7245 400 6845 0 0

9414 3660 5754 0 0
10 10 0 0

6033 1765 4268 0 0

2 2 0 0

1490 630 860 0 0

20 20 0 0
250 250 0 0 0
1 1 0 0

250 140 110 0 0

 2 2 0 0 0

57 56 1 0 0
180 180 0 0 0

4 4 0 0
228 30 198 0 0
60 60 0 0

20 20 0 0

178 98 80 0 0
2 2 0 0 0
30 10 20 0 0

210 124 86 0 0

70 70 0 0

50 50 0 0 0
250 0 250 0 0
35 35 0 0
3 3 0 0
29 2 27 0 0
68 11 57 0 0
60 60 0 0
3 3 0 0

52 15 37 0 0
5 5 0 0
2 2 0 0 0
709 18 691 0 0
14 14 0 0

2045 50 1995 0 0
45 22 23 0 0
24 24 0 0
75 75 0 0
158 0 158 0 0
 450 450 0 0
563 453 110 0 0
15 15 0 0
2 2 0 0 0
5 5 0 0
11700 11700 0 0
740 300 440 0 0
3 2 1 0 0

11222 7822 3400 0 0

175 25 150 0 0

80 80 0 0

2135 458 1677 0 0

1774 215 1559 0 0
140 48 92 0 0
20 20 0 0 0

78 3 75 0 0
350 300 50 0 0
15 15 0 0
12556 6464 6092 0 0
90 90 0 0
122 57 65 0 0
1200 160 1040 0 0
200 135 65 0 0

51 36 15 0 0

100 100 0 0
10 3 7 0 0
1 1 0 0
13005 6931 6074 0 0
114 41 73 0 0
23 23 0 0
34 3 31 0 0

2688 2050 638 0 0

36 3 33 0 0

5 2 3 0 0
650 350 300 0 0
7649 2391 5258 0 0
 100 100 0 0 0
2 1 1 0 0
200 200 0 0 0
25 25 0 0
5 5 0 0
5 5 0 0
2 2 0 0
200 120 80 0 0
602 270 332 0 0
35 10 25 0 0
1815 845 970 0 0
200 50 150 0 0
10 10 0 0
100 85 15 0 0

10780 8084 2696 0 0

140 90 50 0 0
2040 363 1677 0 0
140 100 40 0 0

14004 6402 7602 0 0

75 75 0 0 0
170 30 140 0 0

3 3 0 0

2567 1151 1416 0 0

3200 1200 2000 0 0

1 1 0 0 0
4 4 0 0
100 20 80 0 0
5 0 5 0 0
13 13 0 0
60 40 20 0 0

47 47 0 0

296 296 0 0 0

2 2 0 0
 15 15 0 0

20 20 0 0

10 10 0 0
4672 3836 836 0 0

30 30 0 0 0

150 130 20 0 0

150 30 120 0 0

20 20 0 0 0
3236 866 2370 0 0

B YANFAR PUSKESMAS PETUGAS YANFAR PUSKESMAS

ANASARI, S.Farm MARTINI, A.Md,Farm

202012 2 012 NIP 19770409 200501 2 010

YANG MENYERAHKAN
KEPALA GFK

apt. INDRIANI, S.Farm

NIP 19850527 201101 2 025