LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

(LPLPO)

Kode Puskesmas : 440 Laporan Bulan : Januari 2024

Puskesmas
Sido Mulyo : Permintaan Bulan : Feb-24
Kecamatan
Tungkal Ilir : Nomor :
Kab/ Kodya
Banyuasin : Tanggal : 31 Januari 2024
Propinsi
Sumatera Selatan
:

KOD KELAS SATU STOK PENERI PERSEDI PEMA SISA STOK PERMIN PEMBERIAN
NAMA OBAT KET
E TERAPI AN AWAL MAAN AAN KAIAN STOK OPT TAAN INPRES ASKES APBD LAIN JMLH

OBAT PAJAK ROKOK

1 Acifar Cream tube 0 0 0 24
2 Amoxicilin 125mg Syr Kering botol 0 0 0 20
3 Amlodipin 10 mg tablet tablet 0 0 0 500
4 Akita Tablet tablet 0 0 0 200
5 Azitromycin Kaplet kaplet 0 0 0 200
6 Biomega tablet 0 0 0
7 Bronchitin Expectorant botol 0 0 0 50
8 Calestar Syrup botol 0 0 0 25
9 Citicolin Injeksi ampul 0 0 0 25
10 Citicolin Kaplet kaplet 0 0 0
11 Chloramphenicol Suspensi botol 0 0 0 25
12 Clindamicin Kapsul Kapsul 0 0 0 200
13 CTM tablet 0 0 0 500
14 Dexametason Tablet tablet 0 0 0 2000
15 Elomox Cream tube 0 0 0 50
16 Emturnas Kaplet kaplet 0 0 0 100
17 Erlamycetin Tetes Telinga botol 0 0 0 100
18 Estalex tablet 0 0 0
19 Fimestan Forte tablet 0 0 0
20 Flucadex Kaplet kaplet 0 0 0 2000
21 Hico Gel tube 0 0 0 50
22 Ibuprofen 200mg Tablet tablet 0 0 0 2000
23 Ibuprofen 400mg Tablet tablet 0 0 0 5000
24 Imuco Syrup botol 0 0 0 25
25 Lico-C tablet 0 0 0 1000
26 Licocure Kapsul kapsul 0 0 0
27 Loperamide HCL tablet 0 0 0 500
28 Melosikam Tablet 15mg tablet 0 0 0 3000
29 Metronidazole Tablet tablet 0 0 0 300
30 Mulsanol Syrup botol 0 0 0 50
31 Nifedipin Tablet tablet 0 0 0
32 Nisagon Krim tube 0 0 0 25
33 OBH Rama botol 0 0 0 100
34 Oralit Sachet 0 0 0
KOD KELAS SATU STOK PENERI PERSEDI PEMA SISA STOK PERMIN PEMBERIAN
NAMA OBAT KET
E TERAPI AN AWAL MAAN AAN KAIAN STOK OPT TAAN INPRES ASKES APBD LAIN JMLH
35 Oxytetracyclin Salap Kulit tube 0 0 0 100
36 Pehavral kapsul 0 0 0 1000
37 Prednison Tablet tablet 0 0 0 5000
38 Propiltiouasil Tablet tablet 0 0 0
39 Ranitidin Injeksi ampul 0 0 0 100
40 Ranitidin Tablet tablet 0 0 0 3000
41 Salicyl Bedak zak 0 0 0 100
42 Sefadroxil 500mg kapsul 0 0 0 2000
43 Sefiksim Kapsul kapsul 0 0 0 3000
44 Siprofloksasin 500mg tablet 0 0 0 3000
45 Sukralfat 500mg Syrup botol 0 0 0 50
46 Zecaxol Syrup botol 0 0 0 50
47 Zecaxol Tablet tablet 0 0 0 5000
48 Tablet Tambah Darah tablet 300 300 100 200
0 0
Alat Kesehatan 0 0
1 Acticare Antiseptik Handscrub 5 L Shipment GL 0 0 0
2 Acticare Antiseptik Handscrub 500 ML Shipment botol 0 0 0
3 Acticare Antiseptik Handrub 5 L Shipment GL 0 0 0
4 Acticare Antiseptik Handrub 500 ML Shipment botol 0 0 0
5 Acticare Alcohol Swab CHG 2 % Shipment pcs 0 0 0
6 Cavidagel,15g tube 0 0 0
7 Tro-Sensosurge, Surgical Plus Glove Steril,6.0 pcs 0 0 0
8 Tro-Sensosurge, Surgical plus Glove Steril,6.5 pcs 0 0 0
9 Tro-Sensosurge, Surgical plus Glove Steril,7.5 pcs 0 0 0
10 Tro-Sensosurge, Surgical plus Glove Steril,8.0 pcs 0 0 0
11 Pharmacoll Comport Plus,10 cm x 10 cm pcs 0 0 0
12 Postofix-PU Post Operative Dressing 10 cm x 10 cm pcs 0 0 0
0 0 0
DAK 0 0
0 0
1 Alopurinol tablet 100 mg Box/ tablet 500 500 500 0 500
2 Alphamol Kaplet kaplet 0 0 5000
3 Alprazolam tablet 0,25 mg kapsul 0 0
4 Alprazolam tablet 0,5 mg Box/100 tablet 270 270 0 270 300
5 Alprazolam tablet 1mg kapsul 177 177 0 177 300
6 Amoksisilin Drop 100 mg/ml botol 34 34 14 20 50
7 Amoksisilin sirup kering 125 mg/5ml botol 0 0 0 50
8 Amoksisilin sirup kering 250 mg/5ml botol 165 165 30 135 50
9 Amoksisilin tablet 500 mg Box/ tablet 600 600 600 0 2000
10 Aminofilin Injeksi 24 mg/ml ampul 20 20 0 20
11 Amitriptilin tablet salut 25 mg (HCL) Box/100 tablet 0 0
12 Amlodipin tablet 5 mg Box/ tablet 3900 3900 600 3300 2000
13 Anestetik Lokal Gigi Kombinasi ampul 0 0
14 Miniaspi(Asetosal)tablet 80mg Box/100 tablet 300 300 200 100 300
KOD KELAS SATU STOK PENERI PERSEDI PEMA SISA STOK PERMIN PEMBERIAN
NAMA OBAT KET
E TERAPI AN AWAL MAAN AAN KAIAN STOK OPT TAAN INPRES ASKES APBD LAIN JMLH
15 Asam Mefenamat kapsul/kaplet 500 mg box/ 100 tablet 0 0 0 5000
16 Asam Traneksamat injeksi box/ ampul 0 0 200
17 Asam Traneksmat 500 mg tablet tablet 0 0 500
18 Asiklovir tablet 200 mg Box/100 tablet 0 0
19 Asiklovir tablet 400 mg Box/100 tablet 0 0 1000
Antasida DOEN Tablet Kombinasi Mg Hidroksida 200
20
mg+ Box/100 tablet 6100 6100 800 5300 1000
Al Hidroksida 200 mg 0 0
21 Antasida DOEN II suspensi Botol 60 ml 0 0 100
22 Antifungi DOEN salep, Kombinasi:Asam Benzoat 6% 0 0 50
Asam Salisilat 3% 0 0
23 Antihemoroid,komb bismut subgalat 150mg Box/10 tablet 5 5 5 0 20
heksaklorofen 2,5mg lidokain 10mg seng oksida 120mg 0 0
24 Anti Bakteri DOEN salep Box/25 tube 0 0
25 Anti Malaria Doen komb pirimetamin 25mg tablet 0 0
sulfadoksin 500mg 0 0
26 Atropin Injeksi 2,5 mg/ml Box/ ampul 48 48 0 48
27 Asam Askorbat (Vit C) tablet 50 mg box/ 100 tablet 7100 7100 200 6900 1000
28 Betahistin tablet 6 mg tablet 0 0 2000
29 Betametason krim 0,1 % box/25 tube 0 0 0 100
30 Candesartan 8 mg tablet 0 0 500
31 Clobazam tablet 10 mg Box/100 tablet 0 0
32 Clopidogrel tablet salut selaput 75 mg tablet 0 0 1000
33 Curcuma Forte tablet 0 0 500
34 Deksametason tablet 0,5 mg Box/100 tablet 0 0 5000
35 Deksametason injeksi 5 mg/ml Box/100 0 0 0 100
36 Desoksimetason krim 0,25% tube 0 0 100
37 Dextral Syrup botol 0 0 50
38 Diazepam injeksi 5 mg/ml ampul 30 30 0 30
39 Diazepam Tablet 2 mg tablet 0 0 500
40 Diazepam tablet 5 mg tablet 222 222 7 215 100
41 Digoksin Tablet 0,25 mg Box/100 tablet 0 0
42 Difenhidramin injeksi 10 mg/ml Box/30 ampul 240 240 20 220 100
43 Domperidon Drops 5 mg/ml botol 0 0
44 Domperidon Suspensi 5 mg/ 5 ml Botol/60 ml 0 0 100
45 Domperidon Tablet 10 mg Box/100 tablet 0 0 1000
46 Dulcolax Bisacodil Suppos 10 mg suppos 0 0 50
47 Efedrin HCL Inj 50 mg/ml ampul 10 10 0 10 200
48 Epinefrin (Adrenalin) injeksi 1mg/ml ampul 0 0 200
49 Erythromycin sirup kering 200 mg/5ml botol 0 0 100
50 Eritromicin Sterate Tablet 500 mg tablet 100 100 100 0 500
51 Etil Klorida Spray 100 ml botol 4 4 1 3 10
52 Fenitoin/ Phenytoin Sodium Kapsul 30 mg tablet 0 0 0
53 Fenobarbital injeksi 50 mg/5ml box/ampul 150 150 0 150
KOD KELAS SATU STOK PENERI PERSEDI PEMA SISA STOK PERMIN PEMBERIAN
NAMA OBAT KET
E TERAPI AN AWAL MAAN AAN KAIAN STOK OPT TAAN INPRES ASKES APBD LAIN JMLH
54 Fenobarbital Tablet 30 mg tablet 0 0
55 Fentanil Injeksi 0,05 mg/ml ampul 0 0
56 Fenofibrat kaps 100 mg tablet 350 350 50 300
57 Ferro Fumarat 60 mg+as. Folat 0,4 mg (TTD) tablet 0 0
58 Fitomenadion (Vit. K 1) Tablet 10 mg kapsul 0 0 1000
59 Fitomenadion (Vit. K 1) Injeksi 10 mg/ml-1 ml ampul 0 0
60 Fitomenadion (Vit. K 1) Injeksi 2 mg/ml-1 ml Box/30 ampul 0 0
61 Furosemid tablet 40 mg box/20x10 tab 0 0 500
62 Garam Oralit serbuk kombinasi sachet 2000 2000 1000 1000
63 Glukosa Larutan Infus 5% Steril Botol/500 ml 100 100 0 100 40
64 Glibenklamid Tablet 5 mg Box/100 tablet 0 0 0
65 Glimepiride Tablet 1 mg Box/ tablet 400 400 300 100 5000
0 0
66 Haloperidol Drop 2 mg/ml botol 0 0
67 Haloperidol tablet 0,5 mg Box/100 tablet 0 0 300
68 Haloperidol tablet 2 mg Box/100 tablet 180 180 0 180 300
69 Haloperidol tablet 5 mg Box/100
box/12tablet 0 0 300
70 Haloperidol injeksi 50 mg/ml ampul@1ml 0 0
71 Hidrokortison krim 2,5% tube 5 gr 7 7 7 0 100
72 Hidroklorotiazid 25 mg tablet 300 300 100 200 500
73 Human tetanus Imunoglobulin 250 IU ampul 0 0
74 Ibuprofen Suspensi 100mg/5ml botol 0 0 200
75 Ibuprofen tablet 200 mg box/ 100 tablet 0 0 2000
76 Imboost Forcees tablet 0 0 500
77 Isosorbid Dinitrat 5 mg tablet 600 600 100 500
78 Kalsium Laktat (Kalk) 500 mg tablet 100 100 100 0 2000
79 Kaptopril 12,5 mg tablet 1800 1800 300 1500 2000
80 Kaptopril 25 mg Box/100 tablet 1500 1500 400 1100 2000
81 Ketokonazol krim 2% tube 10 gram 0 0 100
82 Ketokonazol Tablet 200 mg Box/50 tablet 100 100 100 0 1000
83 Ketoprofen Supositoria 100 mg suppos 0 0
84 Ketorolac injeksi 30 mg box/ ampul 10 10 10 0 100
85 Klindamisin Kapsul Box/ kapsul 0 0 500
86 Kloramfenikol salep mata 1% tube 5gram 0 0 200
87 Kloramfenikol suspensi 125 mg/5ml botol 0 0 50
88 kloramfenikol tablet 500 mg tablet 0 0 100
89 Klopromazin tablet salut 100mg (HCl) tablet 600 600 0 600
90 Klozapin 25 mg Box/50 tablet 0 0
91 Klorfeniramina Maleat (CTM) 4 mg tablet Box/100 tablet 0 0 5000
92 Kombinasi KDT/FDC Mengandung: Parafin+ botol 0 0
93 Kotrimoksazol Suspensi Kombinasi Sulfametoksazol Botol/60 ml 32 32 0 32 50
200 mg+Trimetroprin 40 mg/5 ml 0 0
94 Kotrimoksazol Tablet Kombinasi Sulfametoksazol Box/100 tablet 1400 1400 100 1300 500
KOD KELAS SATU STOK PENERI PERSEDI PEMA SISA STOK PERMIN PEMBERIAN
NAMA OBAT KET
E TERAPI AN AWAL MAAN AAN KAIAN STOK OPT TAAN INPRES ASKES APBD LAIN JMLH
400 mg+Trimetropin 80 mg 0 0
95 Lanzoprazol kapsul 30 mg tablet 0 0 5000
96 Levofloksasin tablet 500 mg tablet 0 0
97 Lidokain injeksi 2% (HCL)+epinefrin 1:800 Box/ampul 88 88 5 83 200
000-2ml 0 0
98 Loperamid tablet 2 mg Box/100 tablet 0 0 500
99 Loratadin tablet 10 mg tablet 0 0 1000
100 Lorazepam tablet 0,5 mg tablet 0 0
101 Lorazepam tablet 2 mg box/ 100 tablet 0 0
102 Magnesium Sulfat Injeksi 20% PE@25ml 0 0 30
103 Magnesium Sulfat Injeksi 40% Dus 120 ml 0 0 30
104 Metamizol sodium monohydrate injeksi ampul 13 13 3 10
105 Metformin HCL tablet 500 mg Box/100 tablet 600 600 600 0 5000
106 Methylergometrin injeksi 0,2 mg/ml ampul 0 0 100
107 Methylergometrin Maleat tablet 0,125 mg tablet 300 300 0 300
108 Metilprednisolon injeksi 125 mg ampul 29 29 2 27 100
109 Metilprednisolon tablet 4 mg Box/100 tablet 0 0 0 3000
110 Metoklopramide 5mg tablet 0 0
111 Metoklopramide 10mg Box/100 tablet 0 0
112 Metronidazol Ovula 500 mg box/5 supp 0 0 100
113 Metronidazol Sirup 125 mg/5ml botol 26 26 1 25 100
114 Metronidazol tablet tablet 0 0 1000
115 Momethasone Furoate 0,1%krim tube 0 0 50
116 N-Asetil Sistein tablet 200 mg tablet 900 900 180 720 1000
117 Natrium Klorida Larutan Infus 0,9% Steril Botol/500 ml 120 120 20 100 100
118 Natrium Diklofenak tablet 25 mg Box/50 tablet 50 50 50 0 3000
119 Natrium Diklofenak tablet 50 mg Box/50 tablet 100 100 100 0 3000
120 Nifedipin 10 mg tablet tablet 0 0
121 Nistatin tablet salut 500.000 iu/g Box/100 tablet 300 300 0 300
122 Nistatin Vaginal tablet 100.000 iu/g Box/100 tablet 100 100 0 100
123 Obat Batuk Hitam (OBH) botol 0 0 200
124 Oksitetrasiklin 1% salap mata tube 0 0 100
125 Oksitosin injeksi 10 IU/ml box/10 ampul 31 31 4 27 100
126 Omeprazol injeksi 40 mg ampul 0 0 100
127 Omeprazol Kapsul 20 mg Box/30 kapsul 0 0 2000
128 Ondansetron Hydrochloride Injeksi 4 mg/ml ampul 141 141 11 130 100
129 Ondansetron kaplet 8 mg tablet 0 0 2000
130 Oxyvit C+ tablet 0 0 500
131 Parasetamol drops botol 15 ml 0 0 50
132 Parasetamol infus 10 mg/ml botol 0 0
133 Parasetamol Sirup 120 mg/5ml botol 60 ml 118 118 18 100 100
134 Parasetamol tablet 500 mg box/ 100 tablet 1400 1400 1100 300 5000
135 Pirantel Pamoat Susp 125 mg/5ml botol 0 0
136 Pirantel tablet score (base) 125 mg tablet 0 0 200
KOD KELAS SATU STOK PENERI PERSEDI PEMA SISA STOK PERMIN PEMBERIAN
NAMA OBAT KET
E TERAPI AN AWAL MAAN AAN KAIAN STOK OPT TAAN INPRES ASKES APBD LAIN JMLH
137 Prednison tablet 5 mg Box/100 tablet 0 0 5000
138 Prenatin-DF tablet 0 0 0 2000
139 Propiltiourasil tablet 100 mg tablet 300 300 0 300 500
140 Ranitidin Injeksi 25 mg/ 2 ml Box/25 ampul 50 50 10 40 50
141 Ranitidin tablet 150 mg Box/100 tablet 0 0 3000
142 Ringer Laktat Larutan Infus Steril botol 100 100 20 80 100
143 Risperidon tablet 1 mg box/100 tablet 0 0 0 200
144 Risperidon tablet 2 mg box/100 tablet 0 0 0 200
145 Salbutamol tablet 2 mg tablet 200 200 200 0 1000
146 Salbutamol Sirup 2mg/5ml botol 4 4 4 0 50
147 Sefadroksil Sirup Kering 60 btl/ml 0 0 100
148 Sefadroksil kapsul 500 mg Box/100 tablet 0 0 3000
149 Sefiksim Kapsul 200 mg tablet 0 0 5000
150 Sefiksim sirup kering 100 mg/5ml botol 60 ml 13 13 6 7 100
151 Sefotaksim serbuk injeksi 1000mg vial 23 23 6 17 25
152 Seftriakson Serbuk Injeksi 1000mg vial 1 1 1 0 25
153 Serum Anti bisa Ular (A.B.U) Vial 1 1 0 1 10
154 Setirizin sirup 5mg/5ml botol 7 7 4 3 100
155 Setirizine Tablet 10 mg Box/tablet 0 0
156 Sikzonoate Injeksi ampul 0 0
157 Simvastatin Tablet 10 mg Box/30 tablet 200 200 200 0 2000
158 Siprofloksasin tablet 500 mg Box/100 tablet 0 0 3000
159 Spironolakton 25 mg kaplet kaplet 0 0 500
160 Sukralfat susp 500 mg/5ml, 100 ml botol 0 0 50
161 Sukralfat tablet 500 mg tablet 1600 1600 400 1200 2000
162 Suplemen lytacur Rasa botol 14 14 14 0 100
163 Stimuno Fitofarmaka botol 21 21 16 5 50
164 Terbutaline sulfate kaplet 2,5 mg kaplet 400 400 0 400 100
165 Triheksifenidil 2 mg tablet 370 370 0 370
166 Valsartan tab 80 mg Box/30 tablet 0 0 200
167 Zincpro drops 10 mg/ml botol 90 90 0 90
168 Zinc syrup 10 mg/ml botol 0 0 50
169 Zinc syrup 20 mg/ml botol 54 54 4 50 50
170 Zinc tablet 20 mg box/10x10 tab 0 0 0 2000
0 0
Obat Gigi 0 0
1 Bur Carbide Highspeed Round Box 0 0 0
2 Bur DiamondSet FG Box 0 0 0
3 Cavit G RF 28G Bottle Dus 0 0 0
4 Composit Finishing Kit Box 0 0 0
5 Fluoride Varnish Box 0 0 0
6 Ketac Universal HM Intro Kit A3 Dus 0 0 0
7 Micro Brush Box 0 0 0
8 Paramono Clorofenol Dus 0 0 0
KOD KELAS SATU STOK PENERI PERSEDI PEMA SISA STOK PERMIN PEMBERIAN
NAMA OBAT KET
E TERAPI AN AWAL MAAN AAN KAIAN STOK OPT TAAN INPRES ASKES APBD LAIN JMLH
9 Saliva Ejector Kantong 0 0 0
10 Tricresolformalina Dus 0 0 0
11 Orafil Plus Temporary Filling Box 0 0 0
12 61108 Ketac Universal Box 0 0 0
13 61111 Ketac Universal Box 0 0 0
14 12247BL ESPE CLINPRO White Box 0 0 0
15 Z250 XT Syr Intro Kit LA/APAC/MEA Kit 0 0 0
16 Z250 Syringe Intro Kit LA/APAC Kit 0 0 0
0 0
Alat Kesehatan 0 0
1 Alat Suntik Sekali Pakai 1 ml Box/ set 600 400 1000 100 900 100
2 Alat Suntik Sekali Pakai 3 ml Box/ set 400 400 0 400
3 Alat Suntik Sekali Pakai 5 ml Box/ set 300 300 0 300
4 Alkohol 70 % 1 L botol 19 10 29 3 26 10
5 Alkohol Peroxide + Pump 500 ml botol 0 0 10
6 Aseptan 2% Sol 100 ML BH botol 4 4 2 2
7 Acticare Alkohol Swab box 11 11 3 8 500
8 Acticare Alkohol Swab Plus CHG box 2 2 1 1
0 0
9 Alkohol Swab box 0 0 10
10 Alkazyme Sachet 25 mg Sachet 0 0
11 Alkacide 1 L High Level Diksinfektant botol 0 0 5
12 Aseptic Gel Anti Septik Pembersih tangan botol 0 0
13 Aseptik Handrub 500 ml botol 0 0 0
14 Aseptik Liquid botol 0 0
15 Benecheck Plus Glucose test box 36 36 0 36
16 Botol Kimiawi Plastik 1 L botol 0 0
17 Catgut chromic 2/0 +jarum, 75 cm set 2 2 0 2 24
18 Catgut chromic 3/0 +jarum,75 cm set 0 0 24
19 Catgut chromic steril suture wih needle 2/0 box 0 0 0 1
20 Catgut chromic steril suture wih needle 3/0 box 3 3 3 0 1
21 Catgut Plain Steril Suture With Needle 3/0 box 1 1 1 0 1
22 Catgut Plain 3/0 +jarum,75 cm set 0 0 0 24
23 Catgut Plain 2/0 +jarum,75 cm set 0 0 0 24
24 Catgut Plain Steril Suture With Needle 2/0 box 3 3 3 0
25 Catgut Plain Steril Suture With Needle 75 cm box 0 0
26 Steril suture silk braided with needle 3/0 box 3 3 3 0
27 Endotracheal tube with cuffed 3 pcs 2 2 0 2
28 Endotracheal tube with cuffed 4 pcs 2 2 0 2
29 ECG Paper 50MM X 30 MT roll 0 0
30 Vagion Steril S pcs 0 0
31 Vagion Steril M pcs 0 0
32 Vagion Steril L pcs 0 0
33 Catheter 2 way no. 08 set 2 2 2 0 20
KOD KELAS SATU STOK PENERI PERSEDI PEMA SISA STOK PERMIN PEMBERIAN
NAMA OBAT KET
E TERAPI AN AWAL MAAN AAN KAIAN STOK OPT TAAN INPRES ASKES APBD LAIN JMLH
34 Catheter 2 Way no.16 set 0 0 0 50
35 Catheter 2 Way no.18 set 0 0 0 50
36 Dermafix S IV Advance 9 x 7 cm buah 0 0
37 Dermafix T 10x8 cm pcs 14 14 4 10
38 Dermafix T 10x20 cm pcs 27 27 7 20
39 Disposible Blood Transfusion Sets pcs 15 15 13 2 25
40 Disposible Nasal Oxygen Cannula Neonata pcs 80 80 47 33
41 Disposible Nasal Oxygen Cannula Child pcs 80 80 45 35
42 Disposible Nasal Oxygen Cannula Adult pcs 80 80 53 27
43 Duk Lubang Steril 25 x 30 cm pcs 5 5 0 5
44 One Closan scrub 4 %,500cc + Dispenser botol 0 0 0
45 Powder Free Latex Medical Examination Gloves M Box 0 0 5
46 Powder Free Latex Medical Examination Gloves L box 0 0 5
47 Powder Free Latex Medical Examination Gloves XL box 0 0 5
48 Handsanitizer AH80 500 ml botol 0 0 0
49 Infus Set Anak Box/100 set 0 0 0 50
50 Infus Set Dewasa Box/100 set 0 0 0 50
51 I.V Cannula with Teflon Catheter 1 22 buah 0 0 0 50
52 I.V Cannula with Teflon Catheter 1 24 buah 0 0 0 50
53 Mucus Extractor pcs 0 0 0
54 Steracath 20 set 0 0 50
55 Steracath 22 set 0 0 50
56 Steracath 24 set 0 0 50
57 Kassa Kompres Steril 40 x 40 cm buah 0 0
58 Kassa hidrofil 40 y x 40 cm roll 0 0
59 Kassa Pembalut 2 x 80 cm roll 1 1 0 1
60 Kassa Steril Cuplik 16 cm x 16 cm box 0 0 0
61 Kassa Hidrofil 4 y x 15 cm roll 75 75 15 60
62 Kassa Steril 10 x 10 cm, 8 ply 1x5's Buah 0 0
63 Kapas Pembalut OM 250 GR BH roll 1 1 0 1
64 Leukomed IV Film 6 x 8 cm Sachet 20 20 2 18
65 Lancets box 12 12 12 0 10
66 lysol botol 0 0 0 3
67 One Cleane 1 lt botol 1 1 0 1 5
68 One Wipe box 1 1 0 1 5
69 Steril One Wipe box 0 0 0
70 Plesterin Roll 5 cmx x 5 M New roll 0 0 5
71 Plesterin Roll 10 cm x 10 M roll 0 0 5
72 Plesterin roll 15 cmx x 15 M roll 1 1 0 1 5
73 Plesterin Bulat Nonwoven box 2 2 0 2 5
74 Plesterin Elastis Jumbo box 0 0 0 5
75 PHARMAFIX Wound Dressing 10 cm x 500 cm roll 0 0
76 PHARMAFIX Wound Dressing 15 cm x 500 cm roll 0 0
77 Povidine 10% 300 ml botol 8 8 1 7
KOD KELAS SATU STOK PENERI PERSEDI PEMA SISA STOK PERMIN PEMBERIAN
NAMA OBAT KET
E TERAPI AN AWAL MAAN AAN KAIAN STOK OPT TAAN INPRES ASKES APBD LAIN JMLH
78 Rivanol 300ml botol 28 6 34 4 30
79 Safety box 5L box 2 2 0 2 10
80 safety box 12,5L box 2 2 0 2 10
81 Shield Hospital Disinfektan 1L borol 0 0
82 Sabun Anti Bakteri 5 liter GL 0 0
83 Sabun Anti Bakteri 500 ml + Disp botol 0 0
84 Suction Connecting Tube pcs 2 2 0 2
85 Surgical Mask - 3ply Earloop + S Shock box 0 0 0
86 Surgical Mask - 3ply tie on pcs 0 0 2
87 Surgical Mask - 3ply Hijab pcs 0 0 2
88 Surgcal Face Mask, Motif Anak box 0 0 10
89 ST. Gnaecolog Steril OM pcs 0 0 0
90 Elbow length Latex Powdered 6,5 pcs 0 0
91 Elbow length Latex Powdered 7,5 pcs 0 0
92 Sterile powdered latex Surgical Gloves Size 6,5 pcs 0 0 5
93 Sterile powdered latex Surgical Gloves Size 7 pcs 0 0 5
94 Virusan AS Teather Grad Antin Microbal Scrub 500 ml botol 0 0
Virusolve+For Madical Devices And Any Surface
95
trigger 750 ml botol 0 0
96 Umibilical Cord Clamp box 0 0
97 Urine Bag pcs 2 2 2 0

UMUM
ASKES JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR
32 187 134 353

Mengetahui/ Menyetujui Yang Menyerahkan Pimpinan Puskesmas Yang Menerima

Kasi Kefarmasian Petugas Puskesmas

Iwan Afriansyah, S. Farm Reni Anggraini, S. Farm Aminah, S.KM Zhenda Kurniati, A.Md.Farm
NIP. 19870405 201001 1 002 NIP. 19840306 201001 2 006 NIP. 19700723 200604 2 002 NIP. 19991010 202203 2 014
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

Kode Puskesmas
440 : Laporan Bulan : Februari 2024
Puskesmas
Sido Mulyo : Permintaan Bulan : Mar-24
Kecamatan
Tungkal Ilir : Nomor :
Kab/ Kodya
Banyuasin : Tanggal : 28 Februari 2024
Propinsi
Sumatera Selatan
:

KOD KELAS SATU STOK PENERI PERSEDI PEMA SISA STOK PERMIN PEMBERIAN
NAMA OBAT KET
E TERAPI AN AWAL MAAN AAN KAIAN STOK OPT TAAN INPRES ASKES APBD LAIN JMLH

OBAT PAJAK ROKOK

1 Acifar Cream tube 0 0 0 0 24
2 Amoxicilin 125mg Syr Kering botol 0 0 0 20
3 Amlodipin 10 mg tablet tablet 0 0 0 500
4 Akita Tablet tablet 0 0 0 200
5 Azitromycin Kaplet kaplet 0 0 0 200
6 Biomega tablet 0 0 0
7 Bronchitin Expectorant botol 0 0 0 50
8 Calestar Syrup botol 0 0 0 25
9 Citicolin Injeksi ampul 0 0 0 25
10 Citicolin Kaplet kaplet 0 0 0
11 Chloramphenicol Suspensi botol 0 0 0 25
12 Clindamicin Kapsul Kapsul 0 0 0 200
13 CTM tablet 0 0 0 500
14 Dexametason Tablet tablet 0 0 0 2000
15 Elomox Cream tube 0 0 0 50
16 Emturnas Kaplet kaplet 0 0 0 100
17 Erlamycetin Tetes Telinga botol 0 0 0 100
18 Estalex tablet 0 0 0
19 Fimestan Forte tablet 0 0 0
20 Flucadex Kaplet kaplet 0 0 0 2000
21 Hico Gel tube 0 0 0 50
22 Ibuprofen 200mg Tablet tablet 0 0 0 2000
23 Ibuprofen 400mg Tablet tablet 0 0 0 5000
24 Imuco Syrup botol 0 0 0 25
25 Lico-C tablet 0 0 0 1000
26 Licocure Kapsul kapsul 0 0 0
27 Loperamide HCL tablet 0 0 0 500
28 Melosikam Tablet 15mg tablet 0 0 0 3000
29 Metronidazole Tablet tablet 0 0 0 300
30 Mulsanol Syrup botol 0 0 0 50
31 Nifedipin Tablet tablet 0 0 0
32 Nisagon Krim tube 0 0 0 25
33 OBH Rama botol 0 0 0 100
34 Oralit Sachet 0 0 0
KOD KELAS SATU STOK PENERI PERSEDI PEMA SISA STOK PERMIN PEMBERIAN
NAMA OBAT KET
E TERAPI AN AWAL MAAN AAN KAIAN STOK OPT TAAN INPRES ASKES APBD LAIN JMLH
35 Oxytetracyclin Salap Kulit tube 0 0 0 100
36 Pehavral kapsul 0 0 0 1000
37 Prednison Tablet tablet 0 0 0 5000
38 Propiltiouasil Tablet tablet 0 0 0
39 Ranitidin Injeksi ampul 0 0 0 100
40 Ranitidin Tablet tablet 0 0 0 3000
41 Salicyl Bedak zak 0 0 0 100
42 Sefadroxil 500mg kapsul 0 0 0 2000
43 Sefiksim Kapsul kapsul 0 0 0 3000
44 Siprofloksasin 500mg tablet 0 0 0 3000
45 Sukralfat 500mg Syrup botol 0 0 0 50
46 Zecaxol Syrup botol 0 0 0 50
47 Zecaxol Tablet tablet 0 0 0 5000
48 Tablet Tambah Darah tablet 200 0 200 200 0
0 0 0
Alat Kesehatan 0 0 0
1 Acticare Antiseptik Handscrub 5 L Shipment GL 0 0 0
2 Acticare Antiseptik Handscrub 500 ML Shipment botol 0 0 0
3 Acticare Antiseptik Handrub 5 L Shipment GL 0 0 0
4 Acticare Antiseptik Handrub 500 ML Shipment botol 0 0 0
5 Acticare Alcohol Swab CHG 2 % Shipment pcs 0 0 0
6 Cavidagel,15g tube 0 0 0
7 Tro-Sensosurge, Surgical Plus Glove Steril,6.0 pcs 0 0 0
8 Tro-Sensosurge, Surgical plus Glove Steril,6.5 pcs 0 0 0
9 Tro-Sensosurge, Surgical plus Glove Steril,7.5 pcs 0 0 0
10 Tro-Sensosurge, Surgical plus Glove Steril,8.0 pcs 0 0 0
11 Pharmacoll Comport Plus,10 cm x 10 cm pcs 0 0 0
12 Postofix-PU Post Operative Dressing 10 cm x 10 cm pcs 0 0 0
0 0 0
DAK 0 0 0
0 0 0
1 Alopurinol tablet 100 mg Box/ tablet 0 0 0 0 0 500
2 Alphamol Kaplet kaplet 0 0 0 5000
3 Alprazolam tablet 0,25 mg kapsul 0 0 0
4 Alprazolam tablet 0,5 mg Box/100 tablet 270 0 270 4 266 300
5 Alprazolam tablet 1mg kapsul 177 0 177 0 177 300
6 Amoksisilin Drop 100 mg/ml botol 20 0 20 10 10 50
7 Amoksisilin sirup kering 125 mg/5ml botol 0 0 0 50
8 Amoksisilin sirup kering 250 mg/5ml botol 135 0 135 35 100 50
9 Amoksisilin tablet 500 mg Box/ tablet 0 0 0 0 0 2000
10 Aminofilin Injeksi 24 mg/ml ampul 20 0 20 0 20
11 Amitriptilin tablet salut 25 mg (HCL) Box/100 tablet 0 0 0
12 Amlodipin tablet 5 mg Box/ tablet 3300 0 3300 1500 1800 2000
13 Anestetik Lokal Gigi Kombinasi ampul 0 0 0
14 Miniaspi(Asetosal)tablet 80mg Box/100 tablet 100 0 100 100 0 300
KOD KELAS SATU STOK PENERI PERSEDI PEMA SISA STOK PERMIN PEMBERIAN
NAMA OBAT KET
E TERAPI AN AWAL MAAN AAN KAIAN STOK OPT TAAN INPRES ASKES APBD LAIN JMLH
15 Asam Mefenamat kapsul/kaplet 500 mg box/ 100 tablet 0 0 0 5000
16 Asam Traneksamat injeksi box/ ampul 0 0 0 200
17 Asam Traneksmat 500 mg tablet tablet 0 0 0 500
18 Asiklovir tablet 200 mg Box/100 tablet 0 0 0
19 Asiklovir tablet 400 mg Box/100 tablet 0 0 0 1000
Antasida DOEN Tablet Kombinasi Mg Hidroksida 200
20
mg+ Box/100 tablet 5300 0 5300 2300 3000 1000
Al Hidroksida 200 mg 0 0 0
21 Antasida DOEN II suspensi Botol 60 ml 0 0 0 100
22 Antifungi DOEN salep, Kombinasi:Asam Benzoat 6% 0 0 0 50
Asam Salisilat 3% 0 0 0
23 Antihemoroid,komb bismut subgalat 150mg Box/10 tablet 0 0 0 0 0 20
heksaklorofen 2,5mg lidokain 10mg seng oksida 120mg 0 0 0
24 Anti Bakteri DOEN salep Box/25 tube 0 0 0
25 Anti Malaria Doen komb pirimetamin 25mg tablet 0 0 #VALUE!
sulfadoksin 500mg 0 0 0
26 Atropin Injeksi 2,5 mg/ml Box/ ampul 48 0 48 0 48
27 Asam Askorbat (Vit C) tablet 50 mg box/ 100 tablet 6900 0 6900 1900 5000 1000
28 Betahistin tablet 6 mg tablet 0 0 0 2000
29 Betametason krim 0,1 % box/25 tube 0 0 0 100
30 Candesartan 8 mg tablet 0 0 0 500
31 Clobazam tablet 10 mg Box/100 tablet 0 0 0
32 Clopidogrel tablet salut selaput 75 mg tablet 0 0 0 1000
33 Curcuma Forte tablet 0 0 0 500
34 Deksametason tablet 0,5 mg Box/100 tablet 0 0 0 5000
35 Deksametason injeksi 5 mg/ml Box/100 0 0 0 100
36 Desoksimetason krim 0,25% tube 0 0 0 100
37 Dextral Syrup botol 0 0 0 50
38 Diazepam injeksi 5 mg/ml ampul 30 0 30 0 30
39 Diazepam Tablet 2 mg tablet 0 0 0 500
40 Diazepam tablet 5 mg tablet 215 0 215 -7 222 100
41 Digoksin Tablet 0,25 mg Box/100 tablet 0 0 0
42 Difenhidramin injeksi 10 mg/ml Box/30 ampul 220 0 220 130 90 100
43 Domperidon Drops 5 mg/ml botol 0 0 0
44 Domperidon Suspensi 5 mg/ 5 ml Botol/60 ml 0 0 0 100
45 Domperidon Tablet 10 mg Box/100 tablet 0 0 0 1000
46 Dulcolax Bisacodil Suppos 10 mg suppos 0 0 0 50
47 Efedrin HCL Inj 50 mg/ml ampul 10 0 10 0 10 200
48 Epinefrin (Adrenalin) injeksi 1mg/ml ampul 0 0 0 200
49 Erythromycin sirup kering 200 mg/5ml botol 0 0 0 100
50 Eritromicin Sterate Tablet 500 mg tablet 0 0 0 0 0 500
51 Etil Klorida Spray 100 ml botol 3 0 3 1 2 10
52 Fenitoin/ Phenytoin Sodium Kapsul 30 mg tablet 0 0 0
53 Fenobarbital injeksi 50 mg/5ml box/ampul 150 0 150 0 150
KOD KELAS SATU STOK PENERI PERSEDI PEMA SISA STOK PERMIN PEMBERIAN
NAMA OBAT KET
E TERAPI AN AWAL MAAN AAN KAIAN STOK OPT TAAN INPRES ASKES APBD LAIN JMLH
54 Fenobarbital Tablet 30 mg tablet 0 0 0
55 Fentanil Injeksi 0,05 mg/ml ampul 0 0 0
56 Fenofibrat kaps 100 mg tablet 300 0 300 100 200
57 Ferro Fumarat 60 mg+as. Folat 0,4 mg (TTD) tablet 0 0 0
58 Fitomenadion (Vit. K 1) Tablet 10 mg kapsul 0 0 0 1000
59 Fitomenadion (Vit. K 1) Injeksi 10 mg/ml-1 ml ampul 0 0 0
60 Fitomenadion (Vit. K 1) Injeksi 2 mg/ml-1 ml Box/30 ampul 0 0 0
61 Furosemid tablet 40 mg box/20x10 tab 0 0 0 500
62 Garam Oralit serbuk kombinasi sachet 1000 0 1000 300 700
63 Glukosa Larutan Infus 5% Steril Botol/500 ml 100 0 100 0 100 40
64 Glibenklamid Tablet 5 mg Box/100 tablet 0 0 0
65 Glimepiride Tablet 1 mg Box/ tablet 100 0 100 100 0 5000
0 0 0
66 Haloperidol Drop 2 mg/ml botol 0 0 0
67 Haloperidol tablet 0,5 mg Box/100 tablet 0 0 0 300
68 Haloperidol tablet 2 mg Box/100 tablet 180 0 180 0 180 300
69 Haloperidol tablet 5 mg Box/100
box/12tablet 0 0 0 300
70 Haloperidol injeksi 50 mg/ml ampul@1ml 0 0 0
71 Hidrokortison krim 2,5% tube 5 gr 0 0 0 0 0 100
72 Hidroklorotiazid 25 mg tablet 200 0 200 100 100 500
73 Human tetanus Imunoglobulin 250 IU ampul 0 0 0
74 Ibuprofen Suspensi 100mg/5ml botol 0 0 0 200
75 Ibuprofen tablet 200 mg box/ 100 tablet 0 0 0 2000
76 Imboost Forcees tablet 0 0 0 500
77 Isosorbid Dinitrat 5 mg tablet 500 0 500 200 300
78 Kalsium Laktat (Kalk) 500 mg tablet 0 0 0 0 0 2000
79 Kaptopril 12,5 mg tablet 1500 0 1500 500 1000 2000
80 Kaptopril 25 mg Box/100 tablet 1100 0 1100 200 900 2000
81 Ketokonazol krim 2% tube 10 gram 0 0 0 100
82 Ketokonazol Tablet 200 mg Box/50 tablet 0 0 0 0 0 1000
83 Ketoprofen Supositoria 100 mg suppos 0 0 0
84 Ketorolac injeksi 30 mg box/ ampul 0 0 0 0 0 100
85 Klindamisin Kapsul Box/ kapsul 0 0 0 500
86 Kloramfenikol salep mata 1% tube 5gram 0 0 0 200
87 Kloramfenikol suspensi 125 mg/5ml botol 0 0 0 50
88 kloramfenikol tablet 500 mg tablet 0 0 0 100
89 Klopromazin tablet salut 100mg (HCl) tablet 600 0 600 0 600
90 Klozapin 25 mg Box/50 tablet 0 0 0
91 Klorfeniramina Maleat (CTM) 4 mg tablet Box/100 tablet 0 0 0 5000
92 Kombinasi KDT/FDC Mengandung: Parafin+ botol 0 0 0
93 Kotrimoksazol Suspensi Kombinasi Sulfametoksazol Botol/60 ml 32 0 32 12 20 50
200 mg+Trimetroprin 40 mg/5 ml 0 0 0
94 Kotrimoksazol Tablet Kombinasi Sulfametoksazol Box/100 tablet 1300 0 1300 300 1000 500
KOD KELAS SATU STOK PENERI PERSEDI PEMA SISA STOK PERMIN PEMBERIAN
NAMA OBAT KET
E TERAPI AN AWAL MAAN AAN KAIAN STOK OPT TAAN INPRES ASKES APBD LAIN JMLH
400 mg+Trimetropin 80 mg 0 0 0
95 Lanzoprazol kapsul 30 mg tablet 0 0 0 5000
96 Levofloksasin tablet 500 mg tablet 0 0 0
97 Lidokain injeksi 2% (HCL)+epinefrin 1:800 Box/ampul 83 0 83 53 30 200
000-2ml 0 0 0
98 Loperamid tablet 2 mg Box/100 tablet 0 0 0 500
99 Loratadin tablet 10 mg tablet 0 0 0 1000
100 Lorazepam tablet 0,5 mg tablet 0 0 0
101 Lorazepam tablet 2 mg box/ 100 tablet 0 0 0
102 Magnesium Sulfat Injeksi 20% PE@25ml 0 0 0 30
103 Magnesium Sulfat Injeksi 40% Dus 120 ml 0 0 0 30
104 Metamizol sodium monohydrate injeksi ampul 10 0 10 10 0
105 Metformin HCL tablet 500 mg Box/100 tablet 0 0 0 0 0 5000
106 Methylergometrin injeksi 0,2 mg/ml ampul 0 0 0 100
107 Methylergometrin Maleat tablet 0,125 mg tablet 300 0 300 0 300
108 Metilprednisolon injeksi 125 mg ampul 27 0 27 18 9 100
109 Metilprednisolon tablet 4 mg Box/100 tablet 0 0 0 3000
110 Metoklopramide 5mg tablet 0 0 0
111 Metoklopramide 10mg Box/100 tablet 0 0 0
112 Metronidazol Ovula 500 mg box/5 supp 0 0 0 100
113 Metronidazol Sirup 125 mg/5ml botol 25 0 25 5 20 100
114 Metronidazol tablet tablet 0 0 0 1000
115 Momethasone Furoate 0,1%krim tube 0 0 0 50
116 N-Asetil Sistein tablet 200 mg tablet 720 0 720 600 120 1000
117 Natrium Klorida Larutan Infus 0,9% Steril Botol/500 ml 100 0 100 40 60 100
118 Natrium Diklofenak tablet 25 mg Box/50 tablet 0 0 0 0 0 3000
119 Natrium Diklofenak tablet 50 mg Box/50 tablet 0 0 0 0 0 3000
120 Nifedipin 10 mg tablet tablet 0 0 0
121 Nistatin tablet salut 500.000 iu/g Box/100 tablet 300 0 300 100 200
122 Nistatin Vaginal tablet 100.000 iu/g Box/100 tablet 100 0 100 100 0
123 Obat Batuk Hitam (OBH) botol 0 0 0 200
124 Oksitetrasiklin 1% salap mata tube 0 0 0 100
125 Oksitosin injeksi 10 IU/ml box/10 ampul 27 0 27 27 0 100
126 Omeprazol injeksi 40 mg ampul 0 0 0 100
127 Omeprazol Kapsul 20 mg Box/30 kapsul 0 0 0 2000
128 Ondansetron Hydrochloride Injeksi 4 mg/ml ampul 130 0 130 70 60 100
129 Ondansetron kaplet 8 mg tablet 0 0 0 2000
130 Oxyvit C+ tablet 0 0 0 500
131 Parasetamol drops botol 15 ml 0 0 0 50
132 Parasetamol infus 10 mg/ml botol 0 0 0
133 Parasetamol Sirup 120 mg/5ml botol 60 ml 100 0 100 65 35 100
134 Parasetamol tablet 500 mg box/ 100 tablet 300 0 300 300 0 5000
135 Pirantel Pamoat Susp 125 mg/5ml botol 0 0 0
136 Pirantel tablet score (base) 125 mg tablet 0 0 0 200
KOD KELAS SATU STOK PENERI PERSEDI PEMA SISA STOK PERMIN PEMBERIAN
NAMA OBAT KET
E TERAPI AN AWAL MAAN AAN KAIAN STOK OPT TAAN INPRES ASKES APBD LAIN JMLH
137 Prednison tablet 5 mg Box/100 tablet 0 0 0 5000
138 Prenatin-DF tablet 0 0 0 2000
139 Propiltiourasil tablet 100 mg tablet 300 0 300 100 200 500
140 Ranitidin Injeksi 25 mg/ 2 ml Box/25 ampul 40 0 40 10 30 50
141 Ranitidin tablet 150 mg Box/100 tablet 0 0 0 3000
142 Ringer Laktat Larutan Infus Steril botol 80 0 80 60 20 100
143 Risperidon tablet 1 mg box/100 tablet 0 0 0 200
144 Risperidon tablet 2 mg box/100 tablet 0 0 0 200
145 Salbutamol tablet 2 mg tablet 0 0 0 0 0 1000
146 Salbutamol Sirup 2mg/5ml botol 0 0 0 0 0 50
147 Sefadroksil Sirup Kering 60 btl/ml 0 0 0 100
148 Sefadroksil kapsul 500 mg Box/100 tablet 0 0 0 3000
149 Sefiksim Kapsul 200 mg tablet 0 0 0 5000
150 Sefiksim sirup kering 100 mg/5ml botol 60 ml 7 0 7 0 7 100
151 Sefotaksim serbuk injeksi 1000mg vial 17 0 17 9 8 25
152 Seftriakson Serbuk Injeksi 1000mg vial 0 0 0 0 0 25
153 Serum Anti bisa Ular (A.B.U) Vial 1 0 1 0 1 10
154 Setirizin sirup 5mg/5ml botol 3 0 3 3 0 100
155 Setirizine Tablet 10 mg Box/tablet 0 0 0
156 Sikzonoate Injeksi ampul 0 0 0
157 Simvastatin Tablet 10 mg Box/30 tablet 0 0 0 0 0 2000
158 Siprofloksasin tablet 500 mg Box/100 tablet 0 0 0 3000
159 Spironolakton 25 mg kaplet kaplet 0 0 0 500
160 Sukralfat susp 500 mg/5ml, 100 ml botol 0 0 0 50
161 Sukralfat tablet 500 mg tablet 1200 0 1200 800 400 2000
162 Suplemen lytacur Rasa botol 0 0 0 0 0 100
163 Stimuno Fitofarmaka botol 5 0 5 5 0 50
164 Terbutaline sulfate kaplet 2,5 mg kaplet 400 0 400 200 200 100
165 Triheksifenidil 2 mg tablet 370 0 370 0 370
166 Valsartan tab 80 mg Box/30 tablet 0 0 0 200
167 Zincpro drops 10 mg/ml botol 90 0 90 25 65
168 Zinc syrup 10 mg/ml botol 0 0 0 50
169 Zinc syrup 20 mg/ml botol 50 0 50 20 30 50
170 Zinc tablet 20 mg box/10x10 tab 0 0 0 0 2000
0 0 0
Obat Gigi 0 0 0
1 Bur Carbide Highspeed Round Box 0 0 0
2 Bur DiamondSet FG Box 0 0 0
3 Cavit G RF 28G Bottle Dus 0 0 0
4 Composit Finishing Kit Box 0 0 0
5 Fluoride Varnish Box 0 0 0
6 Ketac Universal HM Intro Kit A3 Dus 0 0 0
7 Micro Brush Box 0 0 0
8 Paramono Clorofenol Dus 0 0 0
KOD KELAS SATU STOK PENERI PERSEDI PEMA SISA STOK PERMIN PEMBERIAN
NAMA OBAT KET
E TERAPI AN AWAL MAAN AAN KAIAN STOK OPT TAAN INPRES ASKES APBD LAIN JMLH
9 Saliva Ejector Kantong 0 0 0
10 Tricresolformalina Dus 0 0 0
11 Orafil Plus Temporary Filling Box 0 0 0
12 61108 Ketac Universal Box 0 0 0
13 61111 Ketac Universal Box 0 0 0
14 12247BL ESPE CLINPRO White Box 0 0 0
15 Z250 XT Syr Intro Kit LA/APAC/MEA Kit 0 0 0
16 Z250 Syringe Intro Kit LA/APAC Kit 0 0 0
0 0 0
Alat Kesehatan 0 0 0
1 Alat Suntik Sekali Pakai 1 ml Box/ set 900 0 900 300 600 100
2 Alat Suntik Sekali Pakai 3 ml Box/ set 400 0 400 100 300
3 Alat Suntik Sekali Pakai 5 ml Box/ set 300 0 300 0 300
4 Alkohol 70 % 1 L botol 26 0 26 6 20 10
5 Alkohol Peroxide + Pump 500 ml botol 0 0 0 10
6 Aseptan 2% Sol 100 ML BH botol 2 0 2 0 2
7 Acticare Alkohol Swab box 8 0 8 4 4 500
8 Acticare Alkohol Swab Plus CHG box 1 0 1 0 1
0 0 0
9 Alkohol Swab box 0 0 0 10
10 Alkazyme Sachet 25 mg Sachet 0 0 0
11 Alkacide 1 L High Level Diksinfektant botol 0 0 0 5
12 Aseptic Gel Anti Septik Pembersih tangan botol 0 0 0
13 Aseptik Handrub 500 ml botol 0 0 0
14 Aseptik Liquid botol 0 0 0
15 Benecheck Plus Glucose test box 36 0 36 0 36
16 Botol Kimiawi Plastik 1 L botol 0 0 0
17 Catgut chromic 2/0 +jarum, 75 cm set 2 0 2 2 0 24
18 Catgut chromic 3/0 +jarum,75 cm set 0 0 0 24
19 Catgut chromic steril suture wih needle 2/0 box 0 0 0 1
20 Catgut chromic steril suture wih needle 3/0 box 0 0 0 0 0 1
21 Catgut Plain Steril Suture With Needle 3/0 box 0 0 0 0 0 1
22 Catgut Plain 3/0 +jarum,75 cm set 0 0 0 24
23 Catgut Plain 2/0 +jarum,75 cm set 0 0 0 24
24 Catgut Plain Steril Suture With Needle 2/0 box 0 0 0 0 0
25 Catgut Plain Steril Suture With Needle 75 cm box 0 0 0
26 Steril suture silk braided with needle 3/0 box 0 0 0 0 0
27 Endotracheal tube with cuffed 3 pcs 2 0 2 0 2
28 Endotracheal tube with cuffed 4 pcs 2 0 2 0 2
29 ECG Paper 50MM X 30 MT roll 0 0 0
30 Vagion Steril S pcs 0 0 0
31 Vagion Steril M pcs 0 0 0
32 Vagion Steril L pcs 0 0 0
33 Catheter 2 way no. 08 set 0 0 0 0 0 20
KOD KELAS SATU STOK PENERI PERSEDI PEMA SISA STOK PERMIN PEMBERIAN
NAMA OBAT KET
E TERAPI AN AWAL MAAN AAN KAIAN STOK OPT TAAN INPRES ASKES APBD LAIN JMLH
34 Catheter 2 Way no.16 set 0 0 0 50
35 Catheter 2 Way no.18 set 0 0 0 50
36 Dermafix S IV Advance 9 x 7 cm buah 0 0 0
37 Dermafix T 10x8 cm pcs 10 0 10 2 8
38 Dermafix T 10x20 cm pcs 20 0 20 7 13
39 Disposible Blood Transfusion Sets pcs 2 0 2 1 1 25
40 Disposible Nasal Oxygen Cannula Neonata pcs 33 0 33 0 33
41 Disposible Nasal Oxygen Cannula Child pcs 35 0 35 0 35
42 Disposible Nasal Oxygen Cannula Adult pcs 27 0 27 0 27
43 Duk Lubang Steril 25 x 30 cm pcs 5 0 5 5 0
44 One Closan scrub 4 %,500cc + Dispenser botol 0 0 0
45 Powder Free Latex Medical Examination Gloves M Box 0 0 0 5
46 Powder Free Latex Medical Examination Gloves L box 0 0 0 5
47 Powder Free Latex Medical Examination Gloves XL box 0 0 0 5
48 Handsanitizer AH80 500 ml botol 0 0 0
49 Infus Set Anak Box/100 set 0 0 0 50
50 Infus Set Dewasa Box/100 set 0 0 0 50
51 I.V Cannula with Teflon Catheter 1 22 buah 0 0 0 50
52 I.V Cannula with Teflon Catheter 1 24 buah 0 0 0 50
53 Mucus Extractor pcs 0 0 0
54 Steracath 20 set 0 0 0 50
55 Steracath 22 set 0 0 0 50
56 Steracath 24 set 0 0 0 50
57 Kassa Kompres Steril 40 x 40 cm buah 0 0 0
58 Kassa hidrofil 40 y x 40 cm roll 0 0 0
59 Kassa Pembalut 2 x 80 cm roll 1 0 1 0 1
60 Kassa Steril Cuplik 16 cm x 16 cm box 0 0 0
61 Kassa Hidrofil 4 y x 15 cm roll 60 0 60 30 30
62 Kassa Steril 10 x 10 cm, 8 ply 1x5's Buah 0 0 0
63 Kapas Pembalut OM 250 GR BH roll 1 0 1 0 1
64 Leukomed IV Film 6 x 8 cm Sachet 18 0 18 6 12
65 Lancets box 0 0 0 0 0 10
66 lysol botol 0 0 0 3
67 One Cleane 1 lt botol 1 0 1 0 1 5
68 One Wipe box 1 0 1 0 1 5
69 Steril One Wipe box 0 0 0
70 Plesterin Roll 5 cmx x 5 M New roll 0 0 0 5
71 Plesterin Roll 10 cm x 10 M roll 0 0 0 5
72 Plesterin roll 15 cmx x 15 M roll 1 0 1 0 1 5
73 Plesterin Bulat Nonwoven box 2 0 2 1 1 5
74 Plesterin Elastis Jumbo box 0 0 0 5
75 PHARMAFIX Wound Dressing 10 cm x 500 cm roll 0 0 0
76 PHARMAFIX Wound Dressing 15 cm x 500 cm roll 0 0 0
77 Povidine 10% 300 ml botol 7 0 7 3 4
KOD KELAS SATU STOK PENERI PERSEDI PEMA SISA STOK PERMIN PEMBERIAN
NAMA OBAT KET
E TERAPI AN AWAL MAAN AAN KAIAN STOK OPT TAAN INPRES ASKES APBD LAIN JMLH
78 Rivanol 300ml botol 30 0 30 8 22
79 Safety box 5L box 2 0 2 0 2 10
80 safety box 12,5L box 2 0 2 0 2 10
81 Shield Hospital Disinfektan 1L borol 0 0 0
82 Sabun Anti Bakteri 5 liter GL 0 0 0
83 Sabun Anti Bakteri 500 ml + Disp botol 0 0 0
84 Suction Connecting Tube pcs 2 0 2 0 2
85 Surgical Mask - 3ply Earloop + S Shock box 0 0 0
86 Surgical Mask - 3ply tie on pcs 0 0 0 2
87 Surgical Mask - 3ply Hijab pcs 0 0 0 2
88 Surgcal Face Mask, Motif Anak box 0 0 0 10
89 ST. Gnaecolog Steril OM pcs 0 0 0
90 Elbow length Latex Powdered 6,5 pcs 0 0 0
91 Elbow length Latex Powdered 7,5 pcs 0 0 0
92 Sterile powdered latex Surgical Gloves Size 6,5 pcs 0 0 0 5
93 Sterile powdered latex Surgical Gloves Size 7 pcs 0 0 0 5
94 Virusan AS Teather Grad Antin Microbal Scrub 500 ml botol 0 0 0
Virusolve+For Madical Devices And Any Surface
95
trigger 750 ml botol 0 0 0
96 Umibilical Cord Clamp box 0 0 0
97 Urine Bag pcs 0 0 0 0 0

UMUM
ASKES JUMLAH
JUMLAH KUNJUNGAN RESEP BAYAR TIDAK BAYAR
29 164 78 271

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