LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

( LPLPO ) DANA PKD DAN JKN

PUSKESMAS : MADURAN
SUB UNIT : SIWURAN
KECAMATAN : MADURAN
KABUPATEN : LAMONGAN
PROPINSI : JAWA TIMUR

STOK AWAL PENERIMAAN PERSEDIAAN

NO NAMA BARANG KEMASAN

PKD JKN PKD JKN PKD

1 2 3 4 5 6 7 8
OBAT-OBATAN
1 Acyclovir Cream 5 % 25 tube @ 5 2 0
gram
2 Antamen (Anti Diare) Syr Botol 0
3 Alopurinol tablet 100 mg 10 strips @ 10 0 0 0
tabl
4 Alopurinol tablet 300 mg 10 blister @ 10 0 30
tab
Ambroxol tab 10 blister @ 10 0 0 0
tab
5 Ambroxol sirup 15 mg/ml botol 60 ml 0
6 Aminofilin injeksi 24 mg/ml 30 ampul @ 10 0
ml
7 Amlodipin tablet 10 mg 3 strip @ 10 0 100
tablets
8 Amlodipin tablet 5 mg 3 strip @ 10 0 0 100
tablets
9 Amoksisilin sirup kering 12 btl @ 60 ml 0 0
10 Amoksisilin tablet scored 10 strip @ 10 0 0
tablet
11 Antalgin tablet 500 mg dus 10 x 10 0 0 0
tablet
12 Antalgin/metamizol Inj Ampul 0
13 Antasida DOEN I tablet 10 strip @ 10 0 0 0
kunyah, kombinasi : tablet
Aluminium Hidroksida 200
mg Magnesium Hidroksida
200 mg
14 Antasida DOEN II botol @ 60 ml 0 0
suspensi, kombinasi :
Aluminium Hidroksida 200
mg/5 ml Magnesium
Hidroksida 200 mg/5ml

15 Anti influenza kaplet (Herb box 150's 0 0

16 Anti mikroba + botol @ 5 ml 0
kortikosteroid tetas mata
17 Anti Hemoroid dus/ 3 blister x 0
10's
18 Anti Bakteri Topikal Tetes t botol @ 10 ml 0

19 Antimigren: Ergotamin btl 100 tablet 0

Tartrat 1 mg + Kofein 50
mg

20 Antispasmodik box 100 kaplet 0

21 Asam Ascorbat (vitamin C) 10 strip x 10 tab 0

22 Asam asetilsalisilat (aseto 10 strip x 10 tab 0

23 Asam Folat tablet 0,4 mg 10 strip @ 10 0 100 0

tablet
24 Asam Mefenamat kaplet 5010 strip x 10 tab 0 0

25 Asam traneksamat tablet 5 dus, 10 x 10 0

tablet
26 Asiklovir tablet 200 mg 10 strip @ 10 0
tablet
27 Asiklovir tablet 400 mg 10 strip @ 10 0
tablet
28 Atapulgit tablet 600 mg 5 strip @ 10 0
tablet
Betametason CR tube 0 0
29 Bedak Salisil serbuk 2% dus @ 50 gram 0 0 0
30 Bisakodil suppositoria 10 m supp 0
31 Bisoprolol tablet 5 mg box 3 x 10 tab 0

32 Dexametason 0,5 mg Tablet 0 0 0

33 Dexametason inj Ampul 0
34 Dimenhidrinat tablet 50 mg 10 strip @ 10 100
tablet
35 Diphenhidramin Inj Ampul 0
36 Domperidon Tab Tablet 50
37 Domperidon Syr Botol 0
38 Etil Klorida semprot 100 ml btl @ 100 ml 0
39 Fitomenadion (vitamin K1) i dus @ 30 0
ampul
40 Fitomenadion (vitamin K1) tabl dus@ 10 x 10 's 0

41 Fluocinolone Acetonide, Neomy tube @ 5 g 0

42 Furosemid Inj Ampul 0
43 Garam Oralit I dus @ 100 50
serbuk ,kombinasi : Sachet
Natrium Klorida 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 0

kapsul
45 Gentamisin salep mata 0,3 tube @ 3,5 gr 0
46 Glibenklamid tablet 5 mg 10 strip @ 10
tablet
47 Glikazid tablet 80mg (GL dus, 100 tablet 0

48 Glimepiride tablet 1 mg ktk 10x10 tablet 0

49 Glimepiride tablet 2 mg 5 strip @ 10 0

tablet
50 Glimepiride tablet 3 mg ktk 5x10 tablet 0

51 Griseofulvin tablet 125 mg dus @ 10 x 10's 0

52 Glyseril Guaiacolat (Batuk botol 100 tab 0

53 Hidrokortison Salep kulit Tube 0
54 Hidroklortiazid Tablet 0
Ibuprofen 400 mg 10 strip @ 10 0 0
tablet
55 Ibuprofen 200 mg 10 strip @ 10 0 0
tablet
56 Ibuprofen Syr Botol 0
57 Kalsium laktat (kalk) tab 510 strip @ 10 0 0 0
tablet
58 Kaptopril tablet scored 12 10 strip @ 10 0
tablet
59 Kaptopril tablet scored 25 10 strip @ 10 100 0
tablet
60 Ketokonazol krim 2 % tube 10 gr 3
61 Ketokonazol tablet 200 mg 5 strip @ 10 50
tablet
Kloramfenikol 500 mg 10 strip @ 10 0
tablet
62 Kloramfenikol kaplet 250 m ktk 10 x 10 0
tablet
63 Kloramfenikol salep kulit (B tube 5 gr 0
Kloramfenikol tetes telinga botol 0
64 Kloramfenikol suspensi 125 botol, 60 ml 0
65 Klorfeniramina Maleat ( CT box 10 x 10 "s 0
66 Kombinasi tablet salut : dus, 100 0
Besi (II) sulfat 7H2O 200 Sachet @ 30
mg Asam Folat 0,25 mg tablet
67 Kotrimoksazol DOEN I 10 strip @ 10 0
(dewasa) tablet
kombinasi :Sulfametoksaz
ol 400 mg Trimetoprim 80
mg
68 Kotrimoksazol tab dus, 10 strip @ 0
200mg/40 mg 10 tablet
69 Kotrimoksazol suspensi botol, 60 ml 0
komb.: Sulfametoksazol
200 mg + Trimetoprim 40
mg / 5 ml

70 Lidocain Inj Ampul 0

71 Lidocain + Epinefrin Inj Ampul 0
72 Loperamid tablet 2 mg 10 strip @ 10 0
tablet
73 Loratadin tablet 10 mg 5 strip @ 10 0
tablet
74 Metformin HCl tablet 500 m 10 strip@ 10 0
tablet
75 Metilergometrin Maleat ktk 10 x 10 0
(metilergometrin) tablet tablet salut
salut 0,125 mg

76 Metilergometrin inj 0,2 mg/ 100 ampul @ 0

1ml
77 Metilprednisolon tablet 4 m 10 strip @ 10 50
tablet
78 Metronidazol tablet 500 mg 11 strip @ 10 0
tablet
79 Mikonazol krim/salep 2 % ( tube 10 gr 0
80 Mukolitik dan Ekspektoran botol 60 ml 0
81 Multivitamin sirop botol 60 ml 0
82 Natrium Diklofenak tablet dus @ 5 x 10's 0
83 Natrium Diklofenak tablet dus @ 5 x 10's 20 0 0
84 Nifedipin tablet 10 mg 10 strip @ 10 0
tablet
85 Nistatin vaginal tablet 100. dus @ 10 x 10's 0

86 Obat Sariawan (gom) box 24 tube @ 0

5 gr
87 OBH SIRUP BATUK botol 60 ml 1 3 0
88 Oksitetrasiklin salep mata 1 tube @ 5 g 0
89 Omeprazol kaps 20 mg strip 3 x 10 0
kapsul
90 Ondansetron inj. 4 mg/ 2 m5 ampul @ 2 ml 0

91 Parasetamol Sirup 120 mg / botol 60 ml 5

92 Parasetamol tablet 500 mg 10 strip @ 10 0 0 0
kss
93 Piridoksin (vitamin B6) tab botol@ 100 tablet 0

94 Piroxicam 10 mg kapsul 0
95 Prednison tab 5 mg kotak @ 10 x 0 0
10 tab
96 Propiltourasil tb 100 mg kotak @ 10 x 0
10 tab
97 Ranitidin Tablet 0 0
98 Ranitidin Inj Ampul 0
99 Salbutamol tablet 2 mg strip @ 10 0 0 0
( sebagai sulfat ) tablet
100 Salbutamol tablet 4 mg ktk 10 x 10 200 0
( sebagai sulfat ) tablet
101 Salep 2-4 , Kombinasi : Pot @ 30 gram 3 3
Asam Salisilat 2 % +
Belerang endap 4 %

102 Sefadroksil kapsul 500 mg 10 strip@ 10 0 0 0

kapsul
103 Sefadroksil sir kering 250 dus, botol 60 ml 0

104 Sefotaksim injeksi 1 gram dus, 10 vial @ 0

1g
105 Setirizin tablet 10 mg 10 strips @ 10 0
kap
106 Sianokobalamin (vitamin B1 ampul @ 1 ml 0

107 Simvastatin tablet 10 mg 10 strip @ 10 0 0 0

kss
Simvastatin tablet 20 mg 10 strip @ 10 0 0
kss
108 Siprofloksasin tablet 500 m 10 blister @ 10 0
tab
109 Tetes Telinga Antibiotik ( botol @ 10 ml 0 0

110 Terra F (Batuk Pilek) 10 strip @ 10 0 0 0

tablet
111 Tetrasiklin kapsul 500 mg10 strip @ 10 kapsul 0
112 Tiamin ( Vitamin B1 ) table 10 strip @ 10 0 0
tablet
113 Multivitamin (Recovit tetes) vial @ 20 ml 0
114 Vitamin B-Complex Tab botol @ 100 0 0
tablet
116 Zink 10 mg/5 ml sirup botol @ 100 ml 0

117 Zink tablet dispesible 20 m 10 strip @ 10 0

tablet
IAN DAN LEMBAR PERMINTAAN OBAT
PO ) DANA PKD DAN JKN
PELAPORAN BULAN JUNI
PERMINTAAN BULAN JUNI
TAHUN 2024

PERSEDIAAN PEMAKAIAN SISA STOK PEMBERIAN

PERMINTAAN

JKN PKD JKN PKD JKN PKD JKN

9 10 11 12 13 14 15 16

0
10 0 150 0 0 300

0 20 20 200

50 50 20 200

0
0

0 100 50 250

0 100 50 250

0
0 100 50 300

0 100 100 200

0
0 200

0 20 100
0

0
 0

100

0 10 200

0 200

0
0 0 3
0
0

0 50 100
0
0

0
0
0
0
0

0
0
0

0
0
0

0 0 200

0 0 200

0
0
0
0 50 200

0 50 200

0
0

0
0

0
0
0
0
0

0
 0
0

0 300

0
0
0
0 250
0
0

0
0
0

0
0 200

100

0
0 100

100
0
0

0
0

0 100

0 200

0 200

100

0
0 200

0
0 200