LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

( LPLPO ) DANA PKD DAN JKN

PUSKESMAS : MADURAN PELAPORAN BULAN Mei
SUB UNIT : DURIWETAN PERMINTAAN BULAN Juni
KECAMATAN : MADURAN TAHUN : 2024
KABUPATEN : LAMONGAN
PROPINSI : JAWA TIMUR

STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PEMBERIAN

NO NAMA BARANG KEMASAN PERMINTAAN

PKD JKN PKD JKN PKD JKN PKD JKN PKD JKN PKD JKN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
OBAT-OBATAN
1 Acyclovir Cream 5 % 25 tube @ 5 gram 0 2 0 2 2 05
2 Antamen (Anti Diare) Syr Botol 0 0 5
3 Alopurinol tablet 100 mg 10 strips @ 10 tabl 0 0 0 200
4 Alopurinol tablet 300 mg 10 blister @ 10 tab 0 0 200
Ambroxol tab 10 blister @ 10 tab 0 100 0 100 100 0 200
5 Ambroxol sirup 15 mg/ml botol 60 ml 0 0 10
6 Aminofilin injeksi 24 mg/ml 30 ampul @ 10 ml 0 0
7 Amlodipin tablet 10 mg 3 strip @ 10 tablets 10 100 110 0 110 0 200
8 Amlodipin tablet 5 mg 3 strip @ 10 tablets 0 50 50 0 50 0 200
9 Amoksisilin sirup kering 125 mg/ 5 ml btl @ 60 ml 0 0 0 5
10 Amoksisilin tablet scored 500 mg 10 strip @ 10 tablet 0 100 0 100 100 0 300
11 Antalgin tablet 500 mg dus 10 x 10 tablet 50 0 50 50 0 200
13 Antasida DOEN I tablet kunyah, kombinasi : Aluminium 10 strip @ 10 tablet 10 0 300
Hidroksida 200 mg Magnesium Hidroksida 200 mg 110 0
100 110
14 Antasida DOEN II suspensi, kombinasi : Aluminium botol @ 60 ml 0 1 10
Hidroksida 200 mg/5 ml Magnesium Hidroksida 200 3 3 0 3
mg/5ml
15 Anti influenza kaplet (Herbacold) box 150's 0 0 200
16 Anti mikroba + kortikosteroid tetas mata botol @ 5 ml 0 0 5
17 Anti Hemoroid dus/ 3 blister x 10's 0 0
18 Anti Bakteri Topikal Tetes telinga botol @ 10 ml 0 0 5
19 Antimigren: Ergotamin Tartrat 1 mg + Kofein 50 mg btl 100 tablet
0 0
20 Antispasmodik box 100 kaplet 0 0
21 Asam Ascorbat (vitamin C) tablet 50 mg 10 strip x 10 tab 0 100 0 100 100 0 100
22 Asam asetilsalisilat (asetosal) tab 80 mg(MINIASPI) 10 strip x 10 tab 0 0
23 Asam Folat tablet 0,4 mg 10 strip @ 10 tablet 0 100 0 100 100 0 100
24 Asam Mefenamat kaplet 500 mg 10 strip x 10 tab 0 100 0 100 100 0 300
25 Asam traneksamat tablet 500 mg dus, 10 x 10 tablet 0 0
26 Asiklovir tablet 200 mg 10 strip @ 10 tablet 0 0 100
27 Asiklovir tablet 400 mg 10 strip @ 10 tablet 0 0 100
28 Atapulgit tablet 600 mg 5 strip @ 10 tablet 0 0
Betametason CR tube 0 0
29 Bedak Salisil serbuk 2% dus @ 50 gram 0 0 5
30 Bisakodil suppositoria 10 mg supp 0 0
31 Bisoprolol tablet 5 mg box 3 x 10 tab 0 0
32 Dexametason 0,5 mg Tablet 0 100 0 100 100 0 300
34 Dimenhidrinat tablet 50 mg 10 strip @ 10 tablet 0 0 200
36 Domperidon Tab Tablet 0 0 0 200
37 Domperidon Syr Botol 0 0 5
38 Etil Klorida semprot 100 ml btl @ 100 ml 0 0
40 Fitomenadion (vitamin K1) tablet salut gula 10 mg dus@ 10 x 10 's 0 0
41 Fluocinolone Acetonide, Neomycin sulfat cream tube @ 5 g 0 0
43 Garam Oralit I serbuk ,kombinasi : Natrium Klorida 0,52 dus @ 100 Sachet 10
g Kalium Klorida 0,30 g Trinatrium sitrat dihidrat 0,58 g 0 0
Glukosa Anhidrat 2,70 g
44 Gemfibrozil kapsul 300 mg 10 strip@ 10 kapsul 0 0
45 Gentamisin salep mata 0,3 % tube @ 3,5 gr 0 0 5
46 Glibenklamid tablet 5 mg 10 strip @ 10 tablet 10 50 0 60 60 0
47 Glikazid tablet 80mg (GLUCODEX) dus, 100 tablet 0 0
48 Glimepiride tablet 1 mg ktk 10x10 tablet 0 0 100
49 Glimepiride tablet 2 mg 5 strip @ 10 tablet 0 100 0 100 110 0 100
50 Glimepiride tablet 3 mg ktk 5x10 tablet 0 0 100
51 Griseofulvin tablet 125 mg dus @ 10 x 10's 0 0 100
52 Glyseril Guaiacolat (Batuk Berdahak) botol 100 tab 0 0 200
53 Hidrokortison Salep kulit Tube 0 0 10
54 Hidroklortiazid Tablet 0 0
55 Ibuprofen 400 mg 10 strip @ 10 tablet 0 50 0 50 50 0 300
56 Ibuprofen Syr Botol 0 0 10
57 Kalsium laktat (kalk) tab 500 mg 10 strip @ 10 tablet 100 0 100 100 0 200
58 Kaptopril tablet scored 12,5 mg 10 strip @ 10 tablet 0 0 100
59 Kaptopril tablet scored 25 mg 10 strip @ 10 tablet 0 0 100
60 Ketokonazol krim 2 % tube 10 gr 2 0 2 2 0 10
61 Ketokonazol tablet 200 mg 5 strip @ 10 tablet 0 50 50 0 50 0 100
Kloramfenikol 500 mg 10 strip @ 10 tablet 0 0 100
62 Kloramfenikol kaplet 250 mg ktk 10 x 10 tablet 0 0 100
63 Kloramfenikol salep kulit (Bufacetin) tube 5 gr 0 0 5
Kloramfenikol tetes telinga botol 0 0
64 Kloramfenikol suspensi 125 mg/ 5 ml botol, 60 ml 0 0 5
65 Klorfeniramina Maleat ( CTM ) tablet 4 mg box 10 x 10 "s 10 200 210 0 210 0 100
66 Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg dus, 100 Sachet @ 30 20 0
Asam Folat 0,25 mg tablet 200 220 0 220
67 Kotrimoksazol DOEN I (dewasa) 10 strip @ 10 tablet 0 0 200
0 50
kombinasi :Sulfametoksazol 400 mg Trimetoprim 80 mg 50 50
68 Kotrimoksazol tab 200mg/40 mg dus, 10 strip @ 10 200
tablet
0 0
69 Kotrimoksazol suspensi komb.: Sulfametoksazol 200 mg botol, 60 ml
0 0 10
+ Trimetoprim 40 mg / 5 ml
70 Lidocain Inj Ampul 0 0
72 Loperamid tablet 2 mg 10 strip @ 10 tablet 0 100 0 100 100 0 100
73 Loratadin tablet 10 mg 5 strip @ 10 tablet 0 0
74 Metformin HCl tablet 500 mg 10 strip@ 10 tablet 20 100 120 0 120 0 100
75 Metilergometrin Maleat (metilergometrin) tablet salut ktk 10 x 10 tablet salut 100
0,125 mg
0 0
77 Metilprednisolon tablet 4 mg 10 strip @ 10 tablet 0 100 0 100 100 0 200
78 Metronidazol tablet 500 mg 11 strip @ 10 tablet 0 0 100
79 Mikonazol krim/salep 2 % (Nitrat) tube 10 gr 0 0 5
80 Mukolitik dan Ekspektoran sirup botol 60 ml 0 0
81 Multivitamin sirop botol 60 ml 0 0 5
82 Natrium Diklofenak tablet 25 mg dus @ 5 x 10's 0 0 100
83 Natrium Diklofenak tablet 50 mg dus @ 5 x 10's 0 100 0 100 100 0 100
84 Nifedipin tablet 10 mg 10 strip @ 10 tablet 0 0 200
85 Nistatin vaginal tablet 100.000 IU/g dus @ 10 x 10's 0 0
86 Obat Sariawan (gom) box 24 tube @ 5 gr 0 0 5
87 OBH SIRUP BATUK botol 60 ml 3 3 0 5
88 Oksitetrasiklin salep mata 1 % steril tube @ 5 g 0 0 5
89 Omeprazol kaps 20 mg strip 3 x 10 kapsul 0 0 200
91 Parasetamol Sirup 120 mg / 5 ml botol 60 ml 5 0 5 5 0 10
92 Parasetamol tablet 500 mg 10 strip @ 10 kss 0 200 0 200 200 0 300
93 Piridoksin (vitamin B6) tab 10 mg botol@ 100 tablet 0 0 100
94 Piroxicam 10 mg kapsul 50 0 50 50 0 200
95 Prednison tab 5 mg kotak @ 10 x 10 tab 0 0 100
96 Propiltourasil tb 100 mg kotak @ 10 x 10 tab 0 0
97 Ranitidin Tablet 0 100 100 0 100 0 200
99 Salbutamol tablet 2 mg ( sebagai sulfat ) strip @ 10 tablet 0 50 0 50 50 0 100
100 Salbutamol tablet 4 mg ( sebagai sulfat ) ktk 10 x 10 tablet 0 0 100
101 Salep 2-4 , Kombinasi : Asam Salisilat 2 % + Belerang Pot @ 30 gram 10
endap 4 %
0 0
102 Sefadroksil kapsul 500 mg 10 strip@ 10 kapsul 0 0 0 200
103 Sefadroksil sir kering 250 mg/5 ml dus, botol 60 ml 0 0 5
105 Setirizin tablet 10 mg 10 strips @ 10 kap 0 100 0 100 100 0 200
107 Simvastatin tablet 10 mg 10 strip @ 10 kss 0 100 0 100 100 0 200
Simvastatin tablet 20 mg 10 strip @ 10 kss 0 0 0 200
108 Siprofloksasin tablet 500 mg (sebagai HCl) 10 blister @ 10 tab 0 0 200
109 Tetes Telinga Antibiotik ( Kloramfenikol 1 % ) botol @ 10 ml 0 0 100
110 Terra F (Batuk Pilek) 10 strip @ 10 tablet 0 0 0 300
111 Tetrasiklin kapsul 500 mg 10 strip @ 10 kapsul 0 0 200
Mengetahui, 100
112 Tiamin ( Vitamin B1 ) tablet 50 mg 10 strip @ 10 tablet
Yang Menyerahkan, 0 0
113 Multivitamin SYR BOTOL 0 0 10
Kepala Puskesmas Maduran
114 Vitamin B-Complex Tab botol @ 100 tablet Petugas
0 pengelola
100 gudang obat
0 100 100 Yang Menerima,
0 100
116 Zink 10 mg/5 ml sirup botol @ 100 ml 0 0 5
Petugas sub unit
117 Zink tablet dispesible 20 mg 10 strip @ 10 tablet 0 100 100 0 100 0 100

dr. Ema Vika Pratiwi

apt. Zumatul Amilin, S.Farm
NIP. 198604282014122001 ..................................................
NIP. 199510232020122016 NIP.
 Mengetahui,
Yang Menyerahkan,
Kepala Puskesmas Maduran
Petugas pengelola gudang obat Yang Menerima,
Petugas sub unit

dr. Ema Vika Pratiwi apt. Zumatul Amilin, S.Farm

..................................................
NIP. 198604282014122001
NIP. 199510232020122016 NIP.