BULAN : 26 MEI 2024 - 25 JUNI 2024

LAPORAN JUMLAH PEMERIKSAAN

No Jenis Pemeriksaan
26 27 28 29
1 Hb/Rutin Ibu hamil 0 0 0 0
2 Laju Endap Darah / LED 0 1 0 0
3 Darah Rutin /Dift 0 1 0 0
4 Golongan Darah 0 0 0 0

1 Gula darah puasa (BPU) 0 0 0 0

2 Gula darah puasa (Lansia) 0 0 0 0
3 Gula darah puasa (KI) 0 0 0 0
4 Gula darah sewaktu (Gigi) 0 0 0 0
5 Gula darah sewaktu (KI) 0 0 0 0
6 Gula darah sewaktu (BPU, PKPR, MTBS dll) 0 0 0 0
7 Gula darah post prandial / Gdpp 0 0 0 0
8 Gula darah sewaktu (Screening PTM) 0 0 0 0
9 Gula darah sewaktu (Screening Lansia) 0 0 0 0
10 Cholesterol (Screening PTM) 0 0 0 0
11 Cholesterol (Screening Lansia) 0 0 0 0
12 Asam Urat (Screening PTM) 0 0 0 0
13 Asam Urat (Screening Lansia) 0 0 0 0

1 Widal 0 1 0 0
2 Rapid test HIV 0 0 0 0
3 RPR test / Sifilis 0 0 0 0
4 HbsAg 0 0 0 0
5 NS1/IgG-igM 0 1 0 0

1 Urine 3 pm 0 0 0 0
2 Urine 10 pm 0 0 0 0
3 Test Kehamilan /Hcg 0 0 0 0

1 Faeces Lengkap 0 0 0 0

1 Bakteri tahan asam / BTA diagnosa 0 0 0 0

2 Bakteri tahan asam / BTA Follow up 0 0 0 0

1 BPJS / JKN 0 1 0 0
2 Gratis / Free 0 0 0 0
3 Bayar 0 0 0 0

1 Cito 0 0 0 0
 2 Sesuai 0 1 0 0
Jumlah Slide
Pasien BTA Positif (Jumlah slide) 0
Pasien BTA Negatif (Jumlah slide) 0
All BTA (Jumlah Sample) 0

Mengetahui,

Ket:
Tanggal Merah
Cuti
Dinas Luar
 LAPORAN BULANAN LABORATORIUM
PUSKESMAS PEMBANTU PESANGGRAHAN

TANGGAL
30 31 1 2 3 4 5 6 7 8
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
Pemeriksaan Kimia Klinik
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
Pemeriksaan Imunoserologi
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
Pemeriksaan Urinalisa
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
Pemeriksaan Lain-lain
0 0 0 0 0 0 0 0 0 0
Pemeriksaan BTA
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
Total Pemeriksaan Laboratorium
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
Total Pasien
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
BORATORIUM
PESANGGRAHAN

TANGGAL
9 10 11 12 13 14 15 16 17 18
0 0 0 0 0 0 0 0 0 0
0 0 0 1 0 0 0 0 0 0
0 0 0 1 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
ik
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
ogi
0 0 0 1 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
a
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
orium
0 0 0 1 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 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 0 0 0 0
 TOTAL
19 20 21 22 23 24 25
0 0 0 0 0 0 0 0
1 0 0 0 0 1 0 4
1 0 0 0 0 1 0 4
0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
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 0 0 1 0 4
0 0 0 0 0 0 0 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 0 0 0 0 0 0
0 0 0 0 0 1 0 1
0 0 0 0 0 0 0 0

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 0 0 1 0 4
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 0 0 1 0 4
BULAN : 26 MEI 2024 - 25 JUNI 2024
Laporan Jumlah Poli

No Jenis Pemeriksaan 26 27 28 29 30
1 Poli Lansia 0 0 0 0 0
2 Poli Paru 0 0 0 0 0
3 Poli MTBS 0 0 0 0 0
4 Poli KIA 0 0 0 0 0
5 Poli PTM 0 0 0 0 0
6 Poli Umum 0 1 0 0 0
7 Poli PKPR 0 0 0 0 0
8 Poli Gigi 0 0 0 0 0
Jumlah Pasien Poli
A
1 BPJS/JKN 0 1 0 0 0
2 Gratis / free 0 0 0 0 0
3 Bayar 0 0 0 0 0
Jumlah

1 Pasien CITO 0 0 0 0 0
2 Pasien sesuai 0 1 0 0 0

Ket:
Tanggal Merah
Cuti
Dinas Luar
 LAPORAN JUMLAH PASIEN LABORATORIUM
PUSKESMAS PEMBANTU PESANGGRAHAN

TANGGAL
31 1 2 3 4 5 6 7 8 9
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0

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

JUMLAH PEMBAYARAN
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
Jumlah Pasien Cito
ORATORIUM
NGGRAHAN

TANGGAL
10 11 12 13 14 15 16 17 18 19
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 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 0 0 0 0 1
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 0 0 0 0 1
0 0 0 0 0 0 0 0 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 0 0 0 0 1
 TOTAL
20 21 22 23 24 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 1 0 4
0 0 0 0 0 0 0
0 0 0 0 0 0 0
4

0 0 0 0 1 0 4
0 0 0 0 0 0 0
0 0 0 0 0 0 0
4

0 0 0 0 0 0 0
0 0 0 0 1 0 4

Dibuat oleh

Rizki Saputra
NIP 19980521202204159

D
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
( LPLPO / B2 )
LABORATORIUM PUSKESMAS PEMBANTU PESANGGRAHAN

KODE PUSKESMAS : P3171040203

PUSKESMAS : PEMBANTU PESANGGRAHAN
KECAMATAN : PESANGGRAHAN
KAB/KODYA : SUKU DINAS KESEHATAN KODYA JAKARTA SELATAN
BULAN : JUNI 2024

STOK PENERIMAA PERSEDIAA

KODE NAMA OBAT SATUAN Pem
AWAL N N
LAB

1 2 3 4 5 6
Alkes Habis Pakai
1 Alat Suntik Sekali Pakai 1 ml (spuit) Pcs 0 0 0 0
2 Alat Suntik Sekali Pakai 3 ml (spuit) Pcs 0 0 0 0
3 Blood Lancet Box 10 0 10 1
4 Tabung EDTA Pcs 100 0 100 8
5 Mikrotube EDTA Pcs 0 0 0 0
6 Tabung Beku / SST Vacutainer Pcs 100 0 100 60
7 Mikropore Pcs 0 0 0 0
8 Kapas Alkohol Box 3 0 3 3
9 Pot Urin / Sputum Pcs 180 0 180 100
10 Objek Glass Box 3 0 3 1
11 Masker Box 0 0 0 0
12 Thermal Paper Pcs 0 0 0 0
13 Kartu Golongan darah Pcs 1 2 1 0
14 Tabung Centrifuge Urin Pcs 50 0 50 20
15 Blue tip Pack 1 0 1 1
16 Yellow Tip Pack 1 0 1 1
0 0 0 0
Reagensia Hematologi 0 0 0 0
1 Cell Pack Box 1 0 1 1
2 Cell Clean Btl 1 0 1 1
3 Sulfolyser 500 ml Btl 0 0 0 0
4 Stromatolyser-WH Btl 2 0 2 1
5 Stromatolyser 4 Ds Pack 0 0 0 0
6 E-Check XS 500 Set 0 0 0 0
0 0 0 0
Reagensia Kimia Darah 0 0 0 0
1 Accu Check / Strip Gula Darah Box 2 1 1 0
2 Benecheck Box 0 0 0 0
0 0 0 0
Reagensia Serologi 0 0 0 0
 1 Widal Set 1 0 1 1
2 Golongan Darah Set 1 0 1 1
3 SD HIV Pcs 0 25 25 0
4 Syphilis Rapid Pcs 0 20 20 0
5 Syphilis RPR Box 0 0 0 0
6 HbsAg Pcs 0 25 25 0
0 0 0 0
Reagensia Urinalisa + Feces 0 0 0 0
1 Stik Urin 3 PM Btl 0 1 1 0
2 Stik Urin 10 PM Btl 0 1 1 0
3 Tes Kehamilan Pcs 10 50 60 0
0 0 0 0
Reagensia Mikrobiologi 0 0 0 0
1 Ziehl Neelsen (6x100 ml) Btl 4 0 4 2
0 0 0 0
Lain - Lain 0 0 0 0
1 Alkohol 70 % Btl 0 0 0 0
2 Nacl 0.9 % Btl 0 0 0 0
3 Aquabidest Btl 0 0 0 0
4 Spiritus Btl 0 0 0 0
5 Immersion Oil Btl 0 0 0 0
6 Lisol Btl 0 0 0 0
7 Giemsa Btl 0 0 0 0
8 Eter Alkohol Btl 0 0 0 0
9 Methanol Btl 0 0 0 0
10 Tissue Lensa Buku 12 0 12 1
11 Kotak Slide BTA PCS 1 0 1 0
12 Tissue Gulung Roll 2 0 1 0

Ket : Reagen masih ada setengah

1 Bulan mau EXP
MBAR PERMINTAAN OBAT
B2 )
MBANTU PESANGGRAHAN

Pemakaian Total SISA KETERANGAN

SCREENING SCREENING LAIN PEMAKAIAN STOK 10
PTM LANSIA LAIN
7 8 9 10

0 0 0 0 0
0 0 0 0 0
1 1 0 3 7 30/06/2025
0 0 0 22 78
0 0 0 0 0
0 0 0 60 40
0 0 0 0 0
0 0 0 3 0
0 0 0 100 80
0 0 0 1 2
0 0 0 0 0
0 0 0 0 0
0 0 0 0 1
0 0 0 20 30
0 0 0 1 0
0 0 0 1 0
0 0 0 0 0
0 0 0 0 0
0 0 0 1 0
0 0 0 1 0
0 0 0 0 0
0 0 0 1 1
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 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 1 0
0 0 0 1 0
0 0 0 0 25
0 0 0 0 20
0 0 0 0 0
0 0 0 0 25
0 0 0 0 0
0 0 0 0 0
0 0 0 0 1
0 0 0 0 1
0 0 0 0 60
0 0 0 0 0
0 0 0 0 0
0 0 0 2 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
0 0 0 0 0
0 0 0 0 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 11
0 0 0 0 1
0 0 0 0 1