LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBA

PUSKESMAS KAB. TAPANULI TENGAH

PUSKESMAS : PASARIBUTOBING
KECAMATAN : PASARIBUTOBING
STOK AWAL PENERIMA PERSEDIA PEMAKAI
NO NAMA OBAT SATUAN AN AN AN
1 2 3 4 5 6 = (4 + 5 ) 7
1 AIR UNTUK INJEKSI BOTOL 0 0 0 0
2 ALAT SUNTIK DISP. 1 ML SET 90 0 90 0
3 ALAT SUNTIK DISP. 3 ML SET 141 0 141 21
4 ALAT SUNTIK DISP. 5 ML SET 636 0 636 48
5 ALCOHOL SWAB PCS 119 0 119 21
6 ALKACIDE 1 LITER BOTOL 1 0 1 0
7 ALKAZYME SAK 1 0 1 0
8 ALKOHOL 70% 1 LITER BOTOL 1 1 2 1
9 ALOPURINOL 100 MG TABLET 260 100 360 60
10 AMLODIPIN 5 MG TABLET 240 0 240 35
11 AMOKSISILIN 500 MG KAPLET 1021 1000 2021 617
12 AMOKSISILIN SYRUP KERING FORTE 250MG/5ML BOTOL 44 10 54 24
13 ANTACIDA DOEN I TAB TAB.KUNYAH 474 1200 1674 572
14 ANTACIDA DOEN II SUSPENSI BOTOL 4 10 14 9
15 ANTIHEMMORHOID SUPPOSITORIA SUPP 0 0 0 0
16 ASAM ASKORBAT (VIT C) 250 MG TABLET 7025 0 7025 6364
17 ASAM ASKORBAT (VIT C) 50 MG TABLET 604 0 604 4
18 ASAM FOLAT (A FOLAT) 0,4 MG TABLET 120 100 220 50
19 ASAM MEFENAMAT 500 MG TABLET 759 1000 1759 440
20 ASAM TRANEKSAMAT INJEKSI AMPUL 1 2 3 3
21 ASETIL SISTEIN 200 MG KAPSUL 1050 0 1050 150
22 ASIKLOVIR TABLET 200 MG TABLET 90 0 90 10
23 ASIKLOVIR TABLET 400 MG TABLET 100 0 100 20
24 ATROPIN INJEKSI 0,35 MG/ ML AMPUL 0 0 0 0
25 BETAHISTIN TAB 6 MG TABLET 60 0 60 20
26 BETAMETASON KRIM 0,1% (SBG VALERAT) TUBE 10 0 10 9
27 BISAKODIL 5 MG TABLET (DULCOLAX) TABLET 0 0 0 0
28 BISAKODIL SUSP (DULCOLAX SUPP) SUPP 6 0 6 4
29 BURNAZIN (PERAK SULFADIAZIN KRIM 1%) TUBE 1 0 1 0
30 CAPTOPRIL 12,5 MG TABLET 390 500 890 255
31 CAPTOPRIL 25 MG TABLET 265 300 565 75
32 CAPTOPRIL 50 MG TABLET 45 0 45 0
33 CEFADROXIL FORTE SIRUP BTL 60 ML 0 0 0 0
34 CEFADROXIL KAPSUL 500 MG KAPSUL 390 600 990 470
 STOK AWAL PENERIMA PERSEDIA PEMAKAI
NO NAMA OBAT SATUAN
AN AN AN
1 2 3 4 5 6 = (4 + 5 ) 7
35 CETIRIZINE SYRUP BOTOL 1 5 6 0
36 CETIRIZINE TABLET TABLET 130 200 330 70
37 CHLORAMPHENICOL SALEP KULIT 2% (BUFACETIN)TUBE 71 0 71 36
38 CHLORAMPHENICOL SUSPENSI 125MG/5ML BOTOL 3 0 3 2
39 CHLORPHENIRAMIN MALEAT (CTM) TABLET 269 2000 2269 726
40 CIPROFLOXACIN 500 MG TABLET 125 200 325 140
41 CLINDAMYCIN 300 MG CAPSUL 79 0 79 0
42 CODEIN 10 MG TABLET 0 0 0 0
43 COTRIMOXAZOLE SUSPENSI BOTOL 6 15 21 2
44 COTRIMOXAZOLE TABLET DEWASA 480 mg TABLET 186 300 486 105
45 DARYANT TULE PCS 0 0 0 0
46 DEKSTROFEN SYRUP BOTOL 15 50 65 65
47 DENOMIX CREAM 10 GRAM TUBE 8 0 8 1
48 DEXAMETASONE INJEKSI IV/IM 5MG/ML AMPUL 13 0 13 0
49 DEXAMETASONE TABLET 0,5 MG TABLET 621 1300 1921 764
50 DEXOCORT KRIM TUBE 0 0 0 0
51 DIAZEPAM LAR.REKTAL (STESOLID) 10MG/2,5ML TUBE 2 0 2 0
52 DOMPERIDON SYRUP BOTOL 4 0 4 4
53 DOMPERIDONE TABLET 10 MG TABLET 0 0 0 0
54 EPINEFRIN INJEKSI AMPUL 5 0 5 0
55 EUGENOL BOTOL 2 0 2 0
56 FOLLEY CATHETER SET 0 0 0 0
57 FUROSEMID 40 MG TABLET 170 100 270 45
58 GARAM ORALIT SAK 82 50 132 40
59 GENTAMYCIN TETES MATA 0,3% BOTOL 4 0 4 1
60 GLIMEPIRID 2 MG TABLET 0 0 0 0
61 GLUKOSA LARUTAN INFUS 5% STERIL BOTOL 500ML 3 0 3 0
62 GRISEOFULVIN 125 MG TAB TABLET 157 100 257 80
63 HANDSCHOON NON STERIL L PCS 50 0 50 50
64 HANDSCHOON NON STERIL M PCS 62 0 62 62
65 HANDSCHOON STERIL PASANG 16 20 36 9
66 HIDROKLORTIAZID 25 MG TABLET 45 0 45 15
67 HIDROKORTISON 2,5% KRIM TUBE 0 0 0 0
68 IBUPROFEN 200 MG TABLET TABLET 395 300 695 140
69 IBUPROFEN 400 MG TABLET TABLET 417 300 717 70
70 IBUPROFEN SYR 100MG/5ML BOTOL 10 3 13 2
71 ILLIADIN (OKSIMETAZOLIN) TETES HIDUNG 0,050%BOTOL 2 0 2 1
73 INFUSION SET DEWASA SET 16 0 16 3
74 ISOSORBID DINITRAT 5MG (FASORBID) TAB. SUBLINGUAL 184 0 184 20
75 IV CATHETER (TROVENOCATH) SET 5 0 5 3
76 KALSIUM LAKTAT 500 MG TABLET 2,420 0 2420 0
77 KAPAS PEMBALUT 250 GRAM PCS 1 1 2 1
78 KARBOGLISERIN TETES TELINGA 10% BOTOL - 3 3 3
 STOK AWAL PENERIMA PERSEDIA PEMAKAI
NO NAMA OBAT SATUAN
AN AN AN
1 2 3 4 5 6 = (4 + 5 ) 7
79 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL 14 0 14 4
80 KASSA HIDROFIL STERIL 16X16 KTK 17 10 27 7
81 KETOKONAZOLE 200 MG TABLET 135 100 235 50
82 KETOKONAZOLE KRIM TUBE 0 0 0 0
83 KETOROLAC INJEKSI 30 MG/ML AMPUL 0 0 0 0
84 KLORAMFENIKOL SALEP MATA 1% TUBE 5 GR 8 0 8 0
85 LIDOKAIN 2% + EPINEFRIN 1 : 80.000 AMPUL 0 0 0 0
86 LIDOKAIN INJEKSI 2% (HCL) AMPUL 22 0 22 5
87 LOPERAMIDE TAB 2 MG TABLET 304 0 304 110
88 LORATADINE 10 MG TABLET 227 100 327 60
89 LYSOL 1 LITER BOTOL 1 0 1 0
90 MASKER PCS 10 50 60 15
91 MEBENDAZOLE 500 MG (VERMOX) TABLET 0 0 0 0
92 METFORMIN 500 MG TABLET 200 100 300 50
93 METHYL PREDNISOLON 4 MG TABLET 345 0 345 50
94 METIL ERGOMETRIN INJEKSI 0,2MG/ML AMPUL 14 0 14 7
95 METIL ERGOMETRIN MALEAT 0,175 MG TABLET 80 100 180 70
96 METOKLOPRAMID 5 MG TABLET TABLET 170 100 270 30
97 METOKLOPRAMID SYRUP (LEXAPRAM) BOTOL 2 0 2 2
98 METRONIDAZOLE 500 MG TABLET 255 200 455 130
99 MIKONAZOLE KRIM 2% (SBG NITRAT) TUBE 10 GR 2 0 2 1
100 NACL 0,9% LARUTAN INFUS BOTOL 500ML 12 10 22 4
101 NATRIUM DIKLOFENAK 25 MG TABLET 120 200 320 125
102 NATRIUM DIKLOFENAK 50 MG TABLET 145 200 345 120
103 NIFEDIPIN 10 MG TAB TABLET 465 0 465 0
104 OKSITOSIN INJEKSI AMPUL 7 10 17 7
105 OMEPRAZOLE 20 MG CAPSUL KAPSUL 0 200 200 75
106 ONDANSETRON INJEKSI 2MG/ ML AMPUL 0 0 0 0
107 PARACETAMOL DROP 100MG/ML BOTOL 0 6 6 3
108 PARACETAMOL SYRUP 120MG/5ML BOTOL 39 20 59 24
109 PARASETAMOL TABLET 500 MG TABLET 1087 1000 2087 937
110 PHYTOMENADION INJEKSI AMPUL 10 0 10 0
111 PHYTOMENADION TABLET TABLET 50 100 150 65
112 PIRANTEL PAMOAT SUSPENSI 125 MG BOTOL 5 0 5 0
113 PIRIDOKSIN (VIT B6) INJEKSI AMPUL 4 0 4 3
114 PIRIDOKSIN (VIT B6) TAB 10 MG (HCL) TABLET 517 500 1017 175
115 PLESTER ISOPLAST 5YARD X 2 INCH ROL 0 0 0 0
116 PLESTER PHARMAFIX 10 CM X 500 CM ROL 0 0 0 0
117 PLESTER POLIFIX 5 CM X 1 M ROL 9 5 14 6
118 POVIDON IODIDA 10% 1000 ML BOTOL 1 0 1 0
119 POVIDON IODIDA 10% 300 ML BOTOL 0 0 0 0
120 POVIDONE IODIDA 10% 30 ML BOTOL 3 0 3 0
121 POVIDONE IODIDA 10% 60 ML BOTOL 29 0 29 13
122 PREDNISON 5 MG TABLET 290 500 790 120
123 PULAREX (ATTAPULGIT) TABLET 600 MG TABLET 207 0 207 42
124 PULMICORT TURBUHALER 200 TURB 0 0 0 0
 STOK AWAL PENERIMA PERSEDIA PEMAKAI
NO NAMA OBAT SATUAN
AN AN AN
1 2 3 4 5 6 = (4 + 5 ) 7
125 RANITIDINE TABLET 150 MG TABLET 145 600 745 675
126 RINGER LACTAT LARUTAN INFUS BOTOL 500ML 16 6 22 8
127 SAFETY BOX PCS 0 0 0 0
128 SALBUTAMOL 4 MG TABLET 0 0 0 0
129 SALBUTAMOL SYRUP (SALBRON) BOTOL 6 5 11 6
130 SALISIL BEDAK SERBUK 2% SAK 7 0 7 0
131 SCABIMITE CREAM TUBE 0 0 0 0
132 SIANOKOBALAMIN (VIT B12) 50 MCG TABLET 132 300 432 270
133 SIANOKOBALAMIN (VIT B12) INJ 500MCG AMPUL 7 15 22 2
134 SIMVASTATIN TABLET 10 MG TABLET 120 150 270 85
135 SOFTAMAN HAND 1 LITER BOTOL 1 0 1 0
136 SUCRALFAT SUSPENSI ( ULSAFATE) BOTOL 3 15 18 12
137 SYMBICORT TURBUHALER 180 TURB 0 0 0 0
138 TABLET TAMBAH DARAH TABLET 300 0 300 85
139 TETAGAM P. SYRINGE 1 ML AMPUL 1 0 1 0
140 THIAMIN 50 MG TABLET 424 600 1024 210
141 VITAMIN B KOMPLEKS TABLET 360 1500 1860 895
142 XYLOCAINE JELLY 2% TUBE 5 0 5 0
143 XYLOCAINE SPRAY TUBE 0 0 0 0
144 ZINK TAB DISPERSIBEL 20 MG TABLET 56 100 156 60
lansoprazole 30mg tablet 80 100 180 80

BPJS PUSTU BKIA LANSIA

JUMLAH KUNJUNGAN RESEP
218 26 7 0

DIKETAHUI, YANG MENYERAHKAN

KEPALA DINAS KESEHATAN TAP.TENGAH KEPALA SEKSI KEFARMASIAN

FREDDY L. SITUMEANG, S.Sos, M.Kes. LINNON BASTIAN L.RAJA, S.Farm.,Apt.

NIP. 19640223 198803 1 003 NIP. 19830419 200604 1 005
 PERMINTAAN OBAT
LI TENGAH

LAPORAN BULAN / PERIODE : JANUARI 2018

PERMINTAAN BULAN / PERIODE : FEBRUARI 2018
STOK PERMINTA PEMBERIAN
SISA STOK OPTIMUM KET
AN DAK PROP JUMLAH
8=(6-7) 9 10 11 12 13 14
0 0
90 0
120 0
588 0
98 0
1 0
1 0
1 1
300 0
205 0
1404 0
30 30
1102 600
5 10
0 0
661 0
600 0
170 0
1319 0
0 5
900 0
80 0
80 0
0 0
40 0
1 15
0 10
2 0
1 0
635 300
490 0
45 0
0 5
520 500
 STOK PERMINTA PEMBERIAN
SISA STOK KET
OPTIMUM AN DAK PROP JUMLAH
8=(6-7) 9 10 11 12 13 14
6 0
260 100
35 0
1 3
1543 800
185 200
79 0
0 0
19 0
381 100
0 0
0 100
7 0
13 0
1157 800
0 0
2 0
0 5
0 100
5 0
2 0
0 0
225 0
92 0
3 0
0 0
3 0
177 100
0 100
0 100
27 10
30 0
0 5
555 0
647 0
11 3
1 0
13 0
164 100
2 5
2420 0
1 1
0 5
 STOK PERMINTA PEMBERIAN
SISA STOK KET
OPTIMUM AN DAK PROP JUMLAH
8=(6-7) 9 10 11 12 13 14
10 0
20 10
185 0
0 2
0 0
8 0
0 0
17 0
194 100
267 100
1 0
45 0
0 3
250 0
295 0
7 10
110 100
240 0
0 0
325 100
1 5
18 5
195 100
225 100
465 0
10 10
125 300
0 0
3 10
35 30
1150 1000
10 0
85 100
5 0
1 0
842 0
0 0
0 0
8 10
1 0
0 0
3 0
16 0
670 200
165 100
0 0
 STOK PERMINTA PEMBERIAN
SISA STOK KET
OPTIMUM AN DAK PROP JUMLAH
8=(6-7) 9 10 11 12 13 14
70 1000
14 10
0 0
0 100
5 10
7 0
0 0
162 300
20 0
185 100
1 0
6 15
0 0
215 100
1 0
814 0
965 1000
5 0
0 0
96 100
100 100

TDK ADA KARTUJUMLAH

111 362

NYERAHKAN YANG MEMINTA

KEFARMASIAN PIMPINAN PUSKESMAS

L.RAJA, S.Farm.,Apt. dr. EDWIN N.P. SIANTURI

9 200604 1 005 NIP. 19770620 201001 1 016
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS KAB. TAPANULI TENGAH

PUSKESMAS : PASARIBUTOBING LAPORAN BULAN / PERIODE : FEBRUARI 2018

KECAMATAN : PASARIBUTOBING PERMINTAAN BULAN / PERIODE : MARET 2018
STOK STOK PEMBERIAN
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTA AN KET
AWAL OPTIMUM DAK PROP JUMLAH
1 2 3 4 5 6 = (4 + 5 ) 7 8=(6-7) 9 10 11 12 13 14
1 AIR UNTUK INJEKSI BOTOL 0 0 0 0 0 0
2 ALAT SUNTIK DISP. 1 ML SET 90 0 90 90 0 0
3 ALAT SUNTIK DISP. 3 ML SET 116 0 116 30 86 100
4 ALAT SUNTIK DISP. 5 ML SET 540 0 540 79 461 0
5 ALCOHOL SWAB PCS 77 0 77 30 47 0
6 ALKACIDE 1 LITER BOTOL 1 0 1 0 1 0
7 ALKAZYME SAK 1 0 1 0 1 0
8 ALKOHOL 70% 1 LITER BOTOL 1 1 2 1 1 2
9 ALOPURINOL 100 MG TABLET 340 1000 1340 220 1120 0
10 AMLODIPIN 5 MG TABLET 170 150 320 235 170 500
11 AMOKSISILIN 500 MG KAPLET 1787 1500 3287 3041 246 1000
12 AMOKSISILIN SYRUP KERING FORTE 250MG/5ML BOTOL 16 100 116 75 41 10
13 ANTACIDA DOEN I TAB TAB.KUNYAH 1730 1500 3230 3097 133 3000
14 ANTACIDA DOEN II SUSPENSI BOTOL 6 10 16 7 9 20
15 ANTIHEMMORHOID SUPPOSITORIA SUPP 0 0 0 0 0 5
16 ASAM ASKORBAT (VIT C) 250 MG TABLET 0 0 0 0 0 1000
17 ASAM ASKORBAT (VIT C) 50 MG TABLET 596 0 596 591 5 1000
18 ASAM FOLAT (A FOLAT) 0,4 MG TABLET 220 0 220 135 85 100
19 ASAM MEFENAMAT 500 MG TABLET 1875 2000 3875 3578 297 1000
20 ASAM TRANEKSAMAT INJEKSI AMPUL 0 2 2 2 0 5
21 ASETIL SISTEIN 200 MG KAPSUL 750 0 750 562 188 300
22 ASIKLOVIR TABLET 200 MG TABLET 70 500 570 0 570 0
23 ASIKLOVIR TABLET 400 MG TABLET 60 500 560 0 560 0
24 ATROPIN INJEKSI 0,35 MG/ ML AMPUL 0 0 0 0 0 0
25 BETAHISTIN TAB 6 MG TABLET 20 150 170 0 170 0
26 BETAMETASON KRIM 0,1% (SBG VALERAT) TUBE 1 0 1 9 -8 15
27 BISAKODIL 5 MG TABLET (DULCOLAX) TABLET 0 0 0 0 0 10
28 BISAKODIL SUSP (DULCOLAX SUPP) SUPP 0 6 6 1 5 0
29 BURNAZIN (PERAK SULFADIAZIN KRIM 1%) TUBE 1 2 3 2 1 2
30 CAPTOPRIL 12,5 MG TABLET 300 1000 1300 730 570 1500
31 CAPTOPRIL 25 MG TABLET 470 100 570 290 280 1000
32 CAPTOPRIL 50 MG TABLET 45 100 145 145 0 500
33 CEFADROXIL FORTE SIRUP BTL 60 ML 0 0 0 0 0 20
34 CEFADROXIL KAPSUL 500 MG KAPSUL 650 700 1350 1190 160 1500
35 CETIRIZINE SYRUP BOTOL 6 20 26 1 25 0
36 CETIRIZINE TABLET TABLET 183 1000 1183 479 704 300
37 CHLORAMPHENICOL SALEP KULIT 2% (BUFACETIN) TUBE 35 0 35 36 -1 0
38 CHLORAMPHENICOL SUSPENSI 125MG/5ML BOTOL 0 0 0 0 0 10
39 CHLORPHENIRAMIN MALEAT (CTM) TABLET 1406 500 1906 1396 510 2000
40 CIPROFLOXACIN 500 MG TABLET 245 300 545 446 99 1000
41 CLINDAMYCIN 300 MG CAPSUL 59 100 159 20 139 100
42 CODEIN 10 MG TABLET 0 100 100 0 100 0
43 COTRIMOXAZOLE SUSPENSI BOTOL 14 20 34 6 28 0
44 COTRIMOXAZOLE TABLET DEWASA 480 mg TABLET 1261 500 1761 1384 377 300
45 DARYANT TULE PCS 0 2 2 0 2 0
46 DEKSTROFEN SYRUP BOTOL 63 50 113 93 20 50
47 DENOMIX CREAM 10 GRAM TUBE 30 0 30 28 2 10
48 DEXAMETASONE INJEKSI IV/IM 5MG/ML AMPUL 17 300 317 102 215 0
49 DEXAMETASONE TABLET 0,5 MG TABLET 791 300 1091 1090 1 2000
50 DEXOCORT KRIM TUBE 0 0 0 0 0 0
51 DIAZEPAM LAR.REKTAL (STESOLID) 10MG/2,5ML TUBE 13 10 23 16 7 0
52 DOMPERIDON SYRUP BOTOL 0 0 0 4 -4 5
53 DOMPERIDONE TABLET 10 MG TABLET 0 0 0 0 0 100
54 EPINEFRIN INJEKSI AMPUL 5 0 5 0 5 0
55 EUGENOL BOTOL 2 0 2 0 2 0
56 FOLLEY CATHETER SET 0 0 0 0 0 0
57 FUROSEMID 40 MG TABLET 190 500 690 360 330 1000
58 GARAM ORALIT SAK 42 100 142 0 142 0
59 GENTAMYCIN TETES MATA 0,3% BOTOL 2 0 2 1 1 0
60 GLIMEPIRID 2 MG TABLET 0 100 100 10 90 200
61 GLUKOSA LARUTAN INFUS 5% STERIL BOTOL 500ML 3 0 3 0 3 5
62 GRISEOFULVIN 125 MG TAB TABLET 377 0 377 5 372 100
63 HANDSCHOON NON STERIL L PCS 0 0 0 0 0 100
64 HANDSCHOON NON STERIL M PCS 0 0 0 0 0 100
65 HANDSCHOON STERIL PASANG 107 50 157 15 142 50
66 HIDROKLORTIAZID 25 MG TABLET 30 0 30 0 30 50
67 HIDROKORTISON 2,5% KRIM TUBE 0 0 0 0 0 5
68 IBUPROFEN 200 MG TABLET TABLET 527 100 627 280 347 500
69 IBUPROFEN 400 MG TABLET TABLET 145 100 245 210 35 500
70 IBUPROFEN SYR 100MG/5ML BOTOL 21 10 31 0 31 0
71 ILLIADIN (OKSIMETAZOLIN) TETES HIDUNG 0,050% BOTOL 0 5 5 0 5 0
73 INFUSION SET DEWASA SET 8 10 18 11 7 10
74 ISOSORBID DINITRAT 5MG (FASORBID) TAB. SUBLINGUAL 164 0 0 20 144 100
75 IV CATHETER (TROVENOCATH) SET 2 10 12 0 12 0
76 KALSIUM LAKTAT 500 MG TABLET 0 0 0 0 0 500
77 KAPAS PEMBALUT 250 GRAM PCS 1 1 2 1 1 1
78 KARBOGLISERIN TETES TELINGA 10% BOTOL 0 3 3 3 0 5
79 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL 8 10 18 4 14 10
80 KASSA HIDROFIL STERIL 16X16 KTK 20 20 40 18 22 20
81 KETOKONAZOLE 200 MG TABLET 15 500 515 130 385 300
82 KETOKONAZOLE KRIM TUBE 0 0 0 0 0 2
83 KETOROLAC INJEKSI 30 MG/ML AMPUL 0 0 0 0 0 0
84 KLORAMFENIKOL SALEP MATA 1% TUBE 5 GR 8 0 8 1 7 0
85 LIDOKAIN 2% + EPINEFRIN 1 : 80.000 AMPUL 0 0 0 0 0 0
86 LIDOKAIN INJEKSI 2% (HCL) AMPUL 17 0 17 11 6 20
87 LOPERAMIDE TAB 2 MG TABLET 264 100 364 20 344 100
88 LORATADINE 10 MG TABLET 327 100 427 84 343 100
89 LYSOL 1 LITER BOTOL 1 0 1 0 1 0
90 MASKER PCS 65 0 65 65 0 300
91 MEBENDAZOLE 500 MG (VERMOX) TABLET 4 0 4 4 0 0
92 METFORMIN 500 MG TABLET 200 1000 1200 115 1085 0
93 METHYL PREDNISOLON 4 MG TABLET 215 500 715 130 585 0
94 METIL ERGOMETRIN INJEKSI 0,2MG/ML AMPUL 10 20 30 20 10 10
95 METIL ERGOMETRIN MALEAT 0,175 MG TABLET 210 0 210 100 110 200
96 METOKLOPRAMID 5 MG TABLET TABLET 90 200 290 0 290 0
97 METOKLOPRAMID SYRUP (LEXAPRAM) BOTOL 0 0 0 0 0 5
98 METRONIDAZOLE 500 MG TABLET 197 6000 6197 4315 1882 0
99 MIKONAZOLE KRIM 2% (SBG NITRAT) TUBE 10 GR 15 25 40 6 34 0
100 NACL 0,9% LARUTAN INFUS BOTOL 500ML 11 5 16 2 14 5
101 NATRIUM DIKLOFENAK 25 MG TABLET 125 100 225 160 65 2000
102 NATRIUM DIKLOFENAK 50 MG TABLET 235 100 335 330 5 2000
103 NIFEDIPIN 10 MG TAB TABLET 965 500 1465 900 565 0
104 OKSITOSIN INJEKSI AMPUL 13 5 18 10 8 10
105 OMEPRAZOLE 20 MG CAPSUL KAPSUL 215 300 515 441 74 1000
106 ONDANSETRON INJEKSI 2MG/ ML AMPUL 0 0 0 0 0 0
107 PARACETAMOL DROP 100MG/ML BOTOL 6 10 16 3 13 5
108 PARACETAMOL SYRUP 120MG/5ML BOTOL 69 100 169 31 138 0
109 PARASETAMOL TABLET 500 MG TABLET 1704 1000 2704 1905 799 1000
110 PHYTOMENADION INJEKSI AMPUL 10 0 10 1 9 0
111 PHYTOMENADION TABLET TABLET 110 100 210 130 80 200
112 PIRANTEL PAMOAT SUSPENSI 125 MG BOTOL 5 0 5 0 5 0
113 PIRIDOKSIN (VIT B6) INJEKSI AMPUL 1 5 6 4 2 10
114 PIRIDOKSIN (VIT B6) TAB 10 MG (HCL) TABLET 1006 200 1206 1061 145 2000
115 PLESTER ISOPLAST 5YARD X 2 INCH ROL 0 0 0 0 0 0
116 PLESTER PHARMAFIX 10 CM X 500 CM ROL 0 0 0 0 0 0
117 PLESTER POLIFIX 5 CM X 1 M ROL 21 10 31 9 22 10
118 POVIDON IODIDA 10% 1000 ML BOTOL 1 0 1 0 1 0
119 POVIDON IODIDA 10% 300 ML BOTOL 0 0 0 0 0 0
120 POVIDONE IODIDA 10% 30 ML BOTOL 3 0 3 0 3 0
121 POVIDONE IODIDA 10% 60 ML BOTOL 34 10 44 27 17 0
122 PREDNISON 5 MG TABLET 767 2000 2767 340 2427 0
123 PULAREX (ATTAPULGIT) TABLET 600 MG TABLET 168 300 468 40 428 100
124 PULMICORT TURBUHALER 200 TURB 0 0 0 0 0 0
125 RANITIDINE TABLET 150 MG TABLET 50 200 250 250 0 2000
126 RINGER LACTAT LARUTAN INFUS BOTOL 500ML 12 5 17 12 5 10
127 SAFETY BOX PCS 0 1 1 1 0 0
128 SALBUTAMOL 4 MG TABLET 0 0 0 0 0 100
129 SALBUTAMOL SYRUP (SALBRON) BOTOL 13 10 23 12 11 20
130 SALISIL BEDAK SERBUK 2% SAK 2 0 2 0 2 0
131 SCABIMITE CREAM TUBE 0 0 0 0 0 0
132 SIANOKOBALAMIN (VIT B12) 50 MCG TABLET 152 500 652 670 -18 1000
133 SIANOKOBALAMIN (VIT B12) INJ 500MCG AMPUL 14 10 24 12 12 20
134 SIMVASTATIN TABLET 10 MG TABLET 190 150 340 205 135 200
135 SOFTAMAN HAND 1 LITER BOTOL 1 0 1 1 0 2
136 SUCRALFAT SUSPENSI ( ULSAFATE) BOTOL 12 20 32 8 24 10
137 SYMBICORT TURBUHALER 180 TURB 0 0 0 0 0 0
138 TABLET TAMBAH DARAH TABLET 435 150 585 260 325 100
139 TETAGAM P. SYRINGE 1 ML AMPUL 1 0 1 0 1 0
140 THIAMIN 50 MG TABLET 599 200 799 175 624 300
141 VITAMIN B KOMPLEKS TABLET 555 200 755 755 0 2000
142 XYLOCAINE JELLY 2% TUBE 5 0 5 0 5 0
143 XYLOCAINE SPRAY TUBE 0 2 2 0 2 0
144 ZINK TAB DISPERSIBEL 20 MG TABLET 126 100 226 159 67 500
145 LANSOPRAZOLE 30 MG tablet 150 150 300 302 -2 1000
146 IV CATHETER SET 10 50 60 20 40 0

BPJS PUSTU BKIA LANSIA KK/KTP JUMLAH

JUMLAH KUNJUNGAN RESEP
350 0 0 0 229 579

DIKETAHUI, YANG MENYERAHKAN YANG MEMINTA

KEPALA DINAS KESEHATAN TAP.TENGAH KEPALA SEKSI KEFARMASIAN PIMPINAN PUSKESMAS

NURSYAM,SKM,M.Kes LINNON BASTIAN L.RAJA, S.Farm.,Apt. dr. MARULI SILALAHI

NIP. 19690909 199103 2 005 NIP. 19830419 200604 1 005 NIP. 19830802 201001 1 020
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS KAB. TAPANULI TENGAH

PUSKESMAS : PASARIBUTOBING
KECAMATAN : PASARIBUTOBING
STOK
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL
1 2 3 4 5 6 = (4 + 5 ) 7
1 AIR UNTUK INJEKSI BOTOL 0 0 0 0
2 ALAT SUNTIK DISP. 1 ML SET 90 0 90 90
3 ALAT SUNTIK DISP. 3 ML SET 116 0 116 30
4 ALAT SUNTIK DISP. 5 ML SET 540 0 540 79
5 ALCOHOL SWAB PCS 77 0 77 30
6 ALKACIDE 1 LITER BOTOL 1 0 1 0
7 ALKAZYME SAK 1 0 1 0
8 ALKOHOL 70% 1 LITER BOTOL 1 1 2 1
9 ALOPURINOL 100 MG TABLET 340 1000 1340 220
10 AMLODIPIN 5 MG TABLET 170 150 320 235
11 AMOKSISILIN 500 MG KAPLET 1787 1500 3287 3041
12 AMOKSISILIN SYRUP KERING FORTE 250MG/5ML BOTOL 16 100 116 75
13 ANTACIDA DOEN I TAB TAB.KUNYAH 1730 1500 3230 3097
14 ANTACIDA DOEN II SUSPENSI BOTOL 6 10 16 7
15 ANTIHEMMORHOID SUPPOSITORIA SUPP 0 0 0 0
16 ASAM ASKORBAT (VIT C) 250 MG TABLET 0 0 0 0
17 ASAM ASKORBAT (VIT C) 50 MG TABLET 596 0 596 591
18 ASAM FOLAT (A FOLAT) 0,4 MG TABLET 220 0 220 135
19 ASAM MEFENAMAT 500 MG TABLET 1875 2000 3875 3578
20 ASAM TRANEKSAMAT INJEKSI AMPUL 0 2 2 2
21 ASETIL SISTEIN 200 MG KAPSUL 750 0 750 562
22 ASIKLOVIR TABLET 200 MG TABLET 70 500 570 0
23 ASIKLOVIR TABLET 400 MG TABLET 60 500 560 0
24 ATROPIN INJEKSI 0,35 MG/ ML AMPUL 0 0 0 0
25 BETAHISTIN TAB 6 MG TABLET 20 150 170 0
26 BETAMETASON KRIM 0,1% (SBG VALERAT) TUBE 1 0 1 9
27 BISAKODIL 5 MG TABLET (DULCOLAX) TABLET 0 0 0 0
28 BISAKODIL SUSP (DULCOLAX SUPP) SUPP 0 6 6 1
29 BURNAZIN (PERAK SULFADIAZIN KRIM 1%) TUBE 1 2 3 2
30 CAPTOPRIL 12,5 MG TABLET 300 1000 1300 730
31 CAPTOPRIL 25 MG TABLET 470 100 570 290
32 CAPTOPRIL 50 MG TABLET 45 100 145 145
33 CEFADROXIL FORTE SIRUP BTL 60 ML 0 0 0 0
34 CEFADROXIL KAPSUL 500 MG KAPSUL 650 700 1350 1190
35 CETIRIZINE SYRUP BOTOL 6 20 26 1
36 CETIRIZINE TABLET TABLET 183 1000 1183 479
37 CHLORAMPHENICOL SALEP KULIT 2% (BUFACETIN) TUBE 35 0 35 36
38 CHLORAMPHENICOL SUSPENSI 125MG/5ML BOTOL 0 0 0 0
39 CHLORPHENIRAMIN MALEAT (CTM) TABLET 1406 500 1906 1396
40 CIPROFLOXACIN 500 MG TABLET 245 300 545 446
41 CLINDAMYCIN 300 MG CAPSUL 59 100 159 20
42 CODEIN 10 MG TABLET 0 100 100 0
43 COTRIMOXAZOLE SUSPENSI BOTOL 14 20 34 6
44 COTRIMOXAZOLE TABLET DEWASA 480 mg TABLET 1261 500 1761 1384
45 DARYANT TULE PCS 0 2 2 0
46 DEKSTROFEN SYRUP BOTOL 63 50 113 93
47 DENOMIX CREAM 10 GRAM TUBE 30 0 30 28
48 DEXAMETASONE INJEKSI IV/IM 5MG/ML AMPUL 17 300 317 102
49 DEXAMETASONE TABLET 0,5 MG TABLET 791 300 1091 1090
50 DEXOCORT KRIM TUBE 0 0 0 0
51 DIAZEPAM LAR.REKTAL (STESOLID) 10MG/2,5ML TUBE 13 10 23 16
52 DOMPERIDON SYRUP BOTOL 0 0 0 4
53 DOMPERIDONE TABLET 10 MG TABLET 0 0 0 0
54 EPINEFRIN INJEKSI AMPUL 5 0 5 0
55 EUGENOL BOTOL 2 0 2 0
56 FOLLEY CATHETER SET 0 0 0 0
57 FUROSEMID 40 MG TABLET 190 500 690 360
58 GARAM ORALIT SAK 42 100 142 0
59 GENTAMYCIN TETES MATA 0,3% BOTOL 2 0 2 1
60 GLIMEPIRID 2 MG TABLET 0 100 100 10
61 GLUKOSA LARUTAN INFUS 5% STERIL BOTOL 500ML 3 0 3 0
62 GRISEOFULVIN 125 MG TAB TABLET 377 0 377 5
63 HANDSCHOON NON STERIL L PCS 0 0 0 0
64 HANDSCHOON NON STERIL M PCS 0 0 0 0
65 HANDSCHOON STERIL PASANG 107 50 157 15
66 HIDROKLORTIAZID 25 MG TABLET 30 0 30 0
67 HIDROKORTISON 2,5% KRIM TUBE 0 0 0 0
68 IBUPROFEN 200 MG TABLET TABLET 527 100 627 280
69 IBUPROFEN 400 MG TABLET TABLET 145 100 245 210
70 IBUPROFEN SYR 100MG/5ML BOTOL 21 10 31 0
71 ILLIADIN (OKSIMETAZOLIN) TETES HIDUNG 0,050% BOTOL 0 5 5 0
73 INFUSION SET DEWASA SET 8 10 18 11
74 ISOSORBID DINITRAT 5MG (FASORBID) TAB. SUBLINGUAL 164 0 0 20
75 IV CATHETER (TROVENOCATH) SET 2 10 12 0
76 KALSIUM LAKTAT 500 MG TABLET 0 0 0 0
77 KAPAS PEMBALUT 250 GRAM PCS 1 1 2 1
78 KARBOGLISERIN TETES TELINGA 10% BOTOL 0 3 3 3
79 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL 8 10 18 4
80 KASSA HIDROFIL STERIL 16X16 KTK 20 20 40 18
81 KETOKONAZOLE 200 MG TABLET 15 500 515 130
82 KETOKONAZOLE KRIM TUBE 0 0 0 0
83 KETOROLAC INJEKSI 30 MG/ML AMPUL 0 0 0 0
84 KLORAMFENIKOL SALEP MATA 1% TUBE 5 GR 8 0 8 1
85 LIDOKAIN 2% + EPINEFRIN 1 : 80.000 AMPUL 0 0 0 0
86 LIDOKAIN INJEKSI 2% (HCL) AMPUL 17 0 17 11
87 LOPERAMIDE TAB 2 MG TABLET 264 100 364 20
88 LORATADINE 10 MG TABLET 327 100 427 84
89 LYSOL 1 LITER BOTOL 1 0 1 0
90 MASKER PCS 65 0 65 65
91 MEBENDAZOLE 500 MG (VERMOX) TABLET 4 0 4 4
92 METFORMIN 500 MG TABLET 200 1000 1200 115
93 METHYL PREDNISOLON 4 MG TABLET 215 500 715 130
94 METIL ERGOMETRIN INJEKSI 0,2MG/ML AMPUL 10 20 30 20
95 METIL ERGOMETRIN MALEAT 0,175 MG TABLET 210 0 210 100
96 METOKLOPRAMID 5 MG TABLET TABLET 90 200 290 0
97 METOKLOPRAMID SYRUP (LEXAPRAM) BOTOL 0 0 0 0
98 METRONIDAZOLE 500 MG TABLET 197 6000 6197 4315
99 MIKONAZOLE KRIM 2% (SBG NITRAT) TUBE 10 GR 15 25 40 6
100 NACL 0,9% LARUTAN INFUS BOTOL 500ML 11 5 16 2
101 NATRIUM DIKLOFENAK 25 MG TABLET 125 100 225 160
102 NATRIUM DIKLOFENAK 50 MG TABLET 235 100 335 330
103 NIFEDIPIN 10 MG TAB TABLET 965 500 1465 900
104 OKSITOSIN INJEKSI AMPUL 13 5 18 10
105 OMEPRAZOLE 20 MG CAPSUL KAPSUL 215 300 515 441
106 ONDANSETRON INJEKSI 2MG/ ML AMPUL 0 0 0 0
107 PARACETAMOL DROP 100MG/ML BOTOL 6 10 16 3
108 PARACETAMOL SYRUP 120MG/5ML BOTOL 69 100 169 31
109 PARASETAMOL TABLET 500 MG TABLET 1704 1000 2704 1905
110 PHYTOMENADION INJEKSI AMPUL 10 0 10 1
111 PHYTOMENADION TABLET TABLET 110 100 210 130
112 PIRANTEL PAMOAT SUSPENSI 125 MG BOTOL 5 0 5 0
113 PIRIDOKSIN (VIT B6) INJEKSI AMPUL 1 5 6 4
114 PIRIDOKSIN (VIT B6) TAB 10 MG (HCL) TABLET 1006 200 1206 1061
115 PLESTER ISOPLAST 5YARD X 2 INCH ROL 0 0 0 0
116 PLESTER PHARMAFIX 10 CM X 500 CM ROL 0 0 0 0
117 PLESTER POLIFIX 5 CM X 1 M ROL 21 10 31 9
118 POVIDON IODIDA 10% 1000 ML BOTOL 1 0 1 0
119 POVIDON IODIDA 10% 300 ML BOTOL 0 0 0 0
120 POVIDONE IODIDA 10% 30 ML BOTOL 3 0 3 0
121 POVIDONE IODIDA 10% 60 ML BOTOL 34 10 44 27
122 PREDNISON 5 MG TABLET 767 2000 2767 340
123 PULAREX (ATTAPULGIT) TABLET 600 MG TABLET 168 300 468 40
124 PULMICORT TURBUHALER 200 TURB 0 0 0 0
125 RANITIDINE TABLET 150 MG TABLET 50 200 250 250
126 RINGER LACTAT LARUTAN INFUS BOTOL 500ML 12 5 17 12
127 SAFETY BOX PCS 0 1 1 1
128 SALBUTAMOL 4 MG TABLET 0 0 0 0
129 SALBUTAMOL SYRUP (SALBRON) BOTOL 13 10 23 12
130 SALISIL BEDAK SERBUK 2% SAK 2 0 2 0
131 SCABIMITE CREAM TUBE 0 0 0 0
132 SIANOKOBALAMIN (VIT B12) 50 MCG TABLET 152 500 652 670
133 SIANOKOBALAMIN (VIT B12) INJ 500MCG AMPUL 14 10 24 12
134 SIMVASTATIN TABLET 10 MG TABLET 190 150 340 205
135 SOFTAMAN HAND 1 LITER BOTOL 1 0 1 1
136 SUCRALFAT SUSPENSI ( ULSAFATE) BOTOL 12 20 32 8
137 SYMBICORT TURBUHALER 180 TURB 0 0 0 0
138 TABLET TAMBAH DARAH TABLET 435 150 585 260
139 TETAGAM P. SYRINGE 1 ML AMPUL 1 0 1 0
140 THIAMIN 50 MG TABLET 599 200 799 175
141 VITAMIN B KOMPLEKS TABLET 555 200 755 755
142 XYLOCAINE JELLY 2% TUBE 5 0 5 0
143 XYLOCAINE SPRAY TUBE 0 2 2 0
144 ZINK TAB DISPERSIBEL 20 MG TABLET 126 100 226 159
145 LANSOPRAZOLE 30 MG tablet 150 150 300 302
146 IV CATHETER SET 10 50 60 20

BPJS PUSTU BKIA LANSIA

JUMLAH KUNJUNGAN RESEP
350 0 0 0

DIKETAHUI, YANG MENYERAHKAN

KEPALA DINAS KESEHATAN TAP.TENGAH KEPALA SEKSI KEFARMASIAN

NURSYAM,SKM,M.Kes LINNON BASTIAN L.RAJA, S.Farm.,Apt.

NIP. 19690909 199103 2 005 NIP. 19830419 200604 1 005
ERMINTAAN OBAT
TENGAH

LAPORAN BULAN / PERIODE : MARET 2018

PERMINTAAN BULAN / PERIODE : APRIL 2018
STOK PEMBERIAN
SISA STOK PERMINTA AN KET
OPTIMUM DAK PROP JUMLAH
8=(6-7) 9 10 11 12 13 14
0 0
0 0
86 100
461 0
47 0
1 0
1 0
1 2
1120 0
170 500
246 1000
41 10
133 3000
9 20
0 5
0 1000
5 1000
85 100
297 1000
0 5
188 300
570 0
560 0
0 0
170 0
-8 15
0 10
5 0
1 2
570 1500
280 1000
0 500
0 20
160 1500
25 0
704 300
-1 0
0 10
510 2000
99 1000
139 100
100 0
28 0
377 300
2 0
20 50
2 10
215 0
1 2000
0 0
7 0
-4 5
0 100
5 0
2 0
0 0
330 1000
142 0
1 0
90 200
3 5
372 100
0 100
0 100
142 50
30 50
0 5
347 500
35 500
31 0
5 0
7 10
144 100
12 0
0 500
1 1
0 5
14 10
22 20
385 300
 0 2
0 0
7 0
0 0
6 20
344 100
343 100
1 0
0 300
0 0
1085 0
585 0
10 10
110 200
290 0
0 5
1882 0
34 0
14 5
65 2000
5 2000
565 0
8 10
74 1000
0 0
13 5
138 0
799 1000
9 0
80 200
5 0
2 10
145 2000
0 0
0 0
22 10
1 0
0 0
3 0
17 0
2427 0
428 100
0 0
0 2000
5 10
 0 0
0 100
11 20
2 0
0 0
-18 1000
12 20
135 200
0 2
24 10
0 0
325 100
1 0
624 300
0 2000
5 0
2 0
67 500
-2 1000
40 0

KK/KTP JUMLAH
229 579

G MENYERAHKAN YANG MEMINTA

SEKSI KEFARMASIAN PIMPINAN PUSKESMAS

TIAN L.RAJA, S.Farm.,Apt. dr. MARULI SILALAHI

830419 200604 1 005 NIP. 19830802 201001 1 020
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS KAB. TAPANULI TENGAH

PUSKESMAS : PASARIBUTOBING
KECAMATAN : PASARIBUTOBING
STOK
NO NAMA OBAT SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN
AWAL
1 2 3 4 5 6 = (4 + 5 ) 7
1 AIR UNTUK INJEKSI BOTOL 0 0 0 0
2 ALAT SUNTIK DISP. 1 ML SET 90 0 90 90
3 ALAT SUNTIK DISP. 3 ML SET 86 100 186 15
4 ALAT SUNTIK DISP. 5 ML SET 461 0 461 100
5 ALCOHOL SWAB PCS 47 0 47 15
6 ALKACIDE 1 LITER BOTOL 1 0 1 0
7 ALKAZYME SAK 1 0 1 0
8 ALKOHOL 70% 1 LITER BOTOL 1 1 1 1
9 ALLOPURINOL 100 MG TABLET 1120 0 1120 450
10 AMLODIPIN 5 MG TABLET 170 1500 1670 256
11 AMOKSISILIN 500 MG KAPLET 246 1000 1246 1159
12 AMOKSISILIN SYRUP KERING FORTE 250MG/5ML BOTOL 41 10 51 47
13 ANTACIDA DOEN I TAB TAB.KUNYAH 133 5000 5133 2858
14 ANTACIDA DOEN II SUSPENSI BOTOL 9 20 29 14
15 ANTIHEMMORHOID SUPPOSITORIA SUPP 0 5 5 2
16 ASAM ASKORBAT (VIT C) 250 MG TABLET 0 0 0 0
17 ASAM ASKORBAT (VIT C) 50 MG TABLET 5 1000 1005 569
18 ASAM FOLAT (A FOLAT) 0,4 MG TABLET 85 100 185 90
19 ASAM MEFENAMAT 500 MG TABLET 297 4000 4297 2020
20 ASAM TRANEKSAMAT INJEKSI AMPUL 0 2 2 2
21 ASETIL SISTEIN 200 MG KAPSUL 188 3000 3188 287
22 ASIKLOVIR TABLET 200 MG TABLET 570 0 570 0
23 ASIKLOVIR TABLET 400 MG TABLET 560 0 560 0
24 ATROPIN INJEKSI 0,35 MG/ ML AMPUL 0 0 0 0
25 BETAHISTIN TAB 6 MG TABLET 170 0 170 0
26 BETAMETASON KRIM 0,1% (SBG VALERAT) TUBE 0 0 0 0
27 BISAKODIL 5 MG TABLET (DULCOLAX) TABLET 0 0 0 0
28 BISAKODIL SUSP (DULCOLAX SUPP) SUPP 0 5 5 2
29 BURNAZIN (PERAK SULFADIAZIN KRIM 1%) TUBE 1 5 6 1
30 CAPTOPRIL 12,5 MG TABLET 570 1000 1570 650
31 CAPTOPRIL 25 MG TABLET 280 1000 1280 390
32 CAPTOPRIL 50 MG TABLET 0 1000 1000 380
33 CEFADROXIL FORTE SIRUP BTL 60 ML 0 0 0 0
34 CEFADROXIL KAPSUL 500 MG KAPSUL 160 700 860 887
35 CETIRIZINE SYRUP BOTOL 25 0 25 1
36 CETIRIZINE TABLET TABLET 704 800 1504 747
37 CHLORAMPHENICOL SALEP KULIT 2% (BUFACETIN) TUBE 0 30 30 13
38 CHLORAMPHENICOL SUSPENSI 125MG/5ML BOTOL 0 0 0 0
39 CHLORPHENIRAMIN MALEAT (CTM) TABLET 510 300 810 800
40 CIPROFLOXACIN 500 MG TABLET 0 500 500 450
41 CLINDAMYCIN 300 MG CAPSUL 139 500 639 30
42 CODEIN 10 MG TABLET 100 0 100 10
43 COTRIMOXAZOLE SUSPENSI BOTOL 14 20 34 8
44 COTRIMOXAZOLE TABLET DEWASA 480 mg TABLET 377 1500 1877 193
45 DARYANT TULE PCS 0 2 2 2
46 DEKSTROFEN SYRUP BOTOL 20 50 70 58
47 DENOMIX CREAM 10 GRAM TUBE 2 0 2 2
48 DEXAMETASONE INJEKSI IV/IM 5MG/ML AMPUL 215 0 215 0
49 DEXAMETASONE TABLET 0,5 MG TABLET 1 0 1 0
50 DEXOCORT KRIM TUBE 0 0 0 0
51 DIAZEPAM LAR.REKTAL (STESOLID) 10MG/2,5ML TUBE 7 5 12 1
52 DOMPERIDON SYRUP BOTOL 18 0 18 6
53 DOMPERIDONE TABLET 10 MG TABLET 0 0 0 0
54 EPINEFRIN INJEKSI AMPUL 5 0 5 0
55 EUGENOL BOTOL 2 0 2 0
56 FOLLEY CATHETER SET 0 0 0 0
57 FUROSEMID 40 MG TABLET 330 500 830 320
58 GARAM ORALIT SAK 142 0 142 10
59 GENTAMYCIN TETES MATA 0,3% BOTOL 2 0 2 1
60 GLIMEPIRID 2 MG TABLET 80 0 80 40
61 GLUKOSA LARUTAN INFUS 5% STERIL BOTOL 500ML 3 0 3 0
62 GRISEOFULVIN 125 MG TAB TABLET 372 0 372 0
63 HANDSCHOON NON STERIL L PCS 0 0 0 0
64 HANDSCHOON NON STERIL M PCS 0 0 0 0
65 HANDSCHOON STERIL PASANG 142 0 142 39
66 HIDROKLORTIAZID 25 MG TABLET 30 0 30 0
67 HIDROKORTISON 2,5% KRIM TUBE 0 0 0 0
68 IBUPROFEN 200 MG TABLET TABLET 35 200 235 50
69 IBUPROFEN 400 MG TABLET TABLET 347 200 547 195
70 IBUPROFEN SYR 100MG/5ML BOTOL 31 0 31 0
71 ILLIADIN (OKSIMETAZOLIN) TETES HIDUNG 0,050% BOTOL 5 15 20 6
73 INFUSION SET DEWASA SET 7 10 17 7
74 ISOSORBID DINITRAT 5MG (FASORBID) TAB. SUBLINGUAL 144 0 0 10
75 IV CATHETER (TROVENOCATH) SET 71 0 71 22
76 KALSIUM LAKTAT 500 MG TABLET 0 1000 1000 110
77 KAPAS PEMBALUT 250 GRAM PCS 1 0 1 0
78 KARBOGLISERIN TETES TELINGA 10% BOTOL 5 0 5 3
79 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL 14 10 24 3
80 KASSA HIDROFIL STERIL 16X16 KTK 22 20 42 20
81 KETOKONAZOLE 200 MG TABLET 385 300 685 161
82 KETOKONAZOLE KRIM TUBE 0 0 0 0
83 KETOROLAC INJEKSI 30 MG/ML AMPUL 0 0 0 0
84 KLORAMFENIKOL SALEP MATA 1% TUBE 5 GR 6 0 6 0
85 LIDOKAIN 2% + EPINEFRIN 1 : 80.000 AMPUL 0 0 0 0
86 LIDOKAIN INJEKSI 2% (HCL) AMPUL 6 20 26 12
87 LOPERAMIDE TAB 2 MG TABLET 344 0 344 43
88 LORATADINE 10 MG TABLET 343 0 343 70
89 LYSOL 1 LITER BOTOL 1 0 1 0
90 MASKER PCS 0 50 50 33
91 MEBENDAZOLE 500 MG (VERMOX) TABLET 4 0 4 4
92 METFORMIN 500 MG TABLET 1085 0 1085 125
93 METHYL PREDNISOLON 4 MG TABLET 585 0 585 114
94 METIL ERGOMETRIN INJEKSI 0,2MG/ML AMPUL 10 0 10 10
95 METIL ERGOMETRIN MALEAT 0,175 MG TABLET 110 200 310 100
96 METOKLOPRAMID 5 MG TABLET TABLET 90 200 290 10
97 METOKLOPRAMID SYRUP (LEXAPRAM) BOTOL 0 0 0 0
98 METRONIDAZOLE 500 MG TABLET 1882 0 1882 805
99 MIKONAZOLE KRIM 2% (SBG NITRAT) TUBE 10 GR 34 0 34 10
100 NACL 0,9% LARUTAN INFUS BOTOL 500ML 14 0 14 2
101 NATRIUM DIKLOFENAK 25 MG TABLET 65 100 165 160
102 NATRIUM DIKLOFENAK 50 MG TABLET 5 100 105 120
103 NIFEDIPIN 10 MG TAB TABLET 565 0 565 10
104 OKSITOSIN INJEKSI AMPUL 8 5 13 10
105 OMEPRAZOLE 20 MG CAPSUL KAPSUL 74 300 374 328
106 ONDANSETRON INJEKSI 2MG/ ML AMPUL 0 0 0 0
107 PARACETAMOL DROP 100MG/ML BOTOL 13 0 13 7
108 PARACETAMOL SYRUP 120MG/5ML BOTOL 138 0 138 41
109 PARASETAMOL TABLET 500 MG TABLET 799 1500 2299 998
110 PHYTOMENADION INJEKSI AMPUL 9 30 39 10
111 PHYTOMENADION TABLET TABLET 80 200 280 100
112 PIRANTEL PAMOAT SUSPENSI 125 MG BOTOL 5 0 5 0
113 PIRIDOKSIN (VIT B6) INJEKSI AMPUL 2 0 2 0
114 PIRIDOKSIN (VIT B6) TAB 10 MG (HCL) TABLET 145 1500 1645 735
115 PLESTER ISOPLAST 5YARD X 2 INCH ROL 0 0 0 0
116 PLESTER PHARMAFIX 10 CM X 500 CM ROL 0 0 0 0
117 PLESTER POLIFIX 5 CM X 1 M ROL 22 0 22 19
118 POVIDON IODIDA 10% 1000 ML BOTOL 1 0 1 0
119 POVIDON IODIDA 10% 300 ML BOTOL 0 0 0 0
120 POVIDONE IODIDA 10% 30 ML BOTOL 3 0 3 0
121 POVIDONE IODIDA 10% 60 ML BOTOL 17 10 27 14
122 PREDNISON 5 MG TABLET 2427 0 2427 1376
123 PULAREX (ATTAPULGIT) TABLET 600 MG TABLET 428 0 428 6
124 PULMICORT TURBUHALER 200 TURB 0 0 0 0
125 RANITIDINE TABLET 150 MG TABLET 0 0 0 0
126 RINGER LACTAT LARUTAN INFUS BOTOL 500ML 5 10 17 7
127 SAFETY BOX PCS 0 0 0 0
128 SALBUTAMOL 4 MG TABLET 0 100 100 20
129 SALBUTAMOL SYRUP (SALBRON) BOTOL 11 10 21 22
130 SALISIL BEDAK SERBUK 2% SAK 2 0 2 0
131 SCABIMITE CREAM TUBE 0 0 0 0
132 SIANOKOBALAMIN (VIT B12) 50 MCG TABLET 0 700 700 502
133 SIANOKOBALAMIN (VIT B12) INJ 500MCG AMPUL 12 10 22 21
134 SIMVASTATIN TABLET 10 MG TABLET 135 150 285 35
135 SOFTAMAN HAND 1 LITER BOTOL 0 0 0 1
136 SUCRALFAT SUSPENSI ( ULSAFATE) BOTOL 24 0 24 8
137 SYMBICORT TURBUHALER 180 TURB 0 0 0 0
138 TABLET TAMBAH DARAH TABLET 325 300 625 143
139 TETAGAM P. SYRINGE 1 ML AMPUL 1 0 1 0
140 THIAMIN 50 MG TABLET 624 0 624 364
141 VITAMIN B KOMPLEKS TABLET 0 2000 2000 836
142 XYLOCAINE JELLY 2% TUBE 5 0 5 0
143 XYLOCAINE SPRAY TUBE 0 0 0 0
144 ZINK TAB DISPERSIBEL 20 MG TABLET 67 500 567 220
145 LANSOPRAZOLE 30 MG tablet 0 500 500 413
146 IV CATHETER SET 40 0 40 20
147 SILK 0 0 0 0
146 CAT-GUT 8 0 8 5

BPJS PUSTU BKIA LANSIA

JUMLAH KUNJUNGAN RESEP
350 0 0 0

DIKETAHUI, YANG MENYERAHKAN

KEPALA DINAS KESEHATAN TAP.TENGAH KEPALA SEKSI KEFARMASIAN

NURSYAM,SKM,M.Kes LINNON BASTIAN L.RAJA, S.Farm.,Apt.

NIP. 19690909 199103 2 005 NIP. 19830419 200604 1 005
ERMINTAAN OBAT
TENGAH

LAPORAN BULAN / PERIODE : APRIL 2018

PERMINTAAN BULAN / PERIODE : MEI 2018
STOK PEMBERIAN
SISA STOK PERMINTA AN KET
OPTIMUM DAK PROP JUMLAH
8=(6-7) 9 10 11 12 13 14
0 0
0 50
171 100
361 0
32 100
1 0
1 0
0 2
670 300
1414 0
87 2000
4 20
2275 2000
15 20
3 5
0 1000
436 1000
95 100
2277 1000
0 5
2901 0
570 0
560 0
0 0
170 0
0 15
0 10
3 5
5 0
920 1000
890 800
620 800
0 20
-27 1500
24 0
757 500
17 0
0 10
10 1000
50 1000
609 0
90 0
26 0
1684 0
0 5
12 50
0 10
215 0
1 2000
0 2
11 0
12 10
0 100
5 0
2 0
0 0
510 500
132 0
1 5
40 200
3 5
372 0
0 100
0 100
103 50
30 50
0 5
185 500
352 500
31 0
14 0
10 10
144 100
49 0
890 500
1 2
2 5
21 10
22 20
524 400
 0 2
0 5
6 0
0 0
14 20
301 100
273 100
1 0
17 100
0 5
960 0
471 0
0 20
210 200
290 0
0 5
1077 0
24 10
12 5
5 2000
-15 2000
555 0
3 10
46 1000
0 0
6 5
97 0
1301 500
29 0
180 100
5 0
2 10
910 1000
0 2
0 1
3 20
1 0
0 0
3 0
13 0
1051 0
422 100
0 0
0 2000
10 10
 0 0
80 100
-1 20
2 0
0 0
198 1000
1 20
250 100
0 2
16 10
0 0
482 100
1 0
260 500
1164 1000
5 0
0 0
347 500
87 1000
20 10
0 10
3 20

KK/KTP JUMLAH
229 579

G MENYERAHKAN YANG MEMINTA

SEKSI KEFARMASIAN PIMPINAN PUSKESMAS

TIAN L.RAJA, S.Farm.,Apt. dr. MARULI SILALAHI

830419 200604 1 005 NIP. 19830802 201001 1 020
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS KAB. TAPANULI TENGAH

PUSKESMAS : PASARIBUTOBING LAPORAN BULAN / PERIODE

KECAMATAN : PASARIBUTOBING PERMINTAAN BULAN / PERIODE
PENERIMAA PERSEDIAA
NO NAMA OBAT SATUAN STOK AWAL PEMAKAIAN SISA STOK
N N
1 2 3 4 5 6 = (4 + 5 ) 7 8=(6-7)
1 AIR UNTUK INJEKSI BOTOL 0 0 0 0 0
2 ALAT SUNTIK DISP. 1 ML SET 0 0 0 0 0
3 ALAT SUNTIK DISP. 3 ML SET 171 100 271 151 120
4 ALAT SUNTIK DISP. 5 ML SET 361 0 361 20 341
5 ALCOHOL SWAB PCS 32 5000 5032 35 4997
6 ALKACIDE 1 LITER BOTOL 1 0 1 0 1
7 ALKAZYME SAK 1 0 1 0 1
8 ALKOHOL 70% 1 LITER BOTOL 1 1 1 1 0
9 ALLOPURINOL 100 MG TABLET 670 300 970 370 600
10 AMLODIPIN 5 MG TABLET 1414 900 2314 256 1414
11 AMOKSISILIN 500 MG KAPLET 87 2000 2087 520 1567
12 AMOKSISILIN SYRUP KERING FORTE 250MG/ BOTOL 4 50 54 25 29
13 ANTACIDA DOEN I TAB TAB.KUNYAH 2275 1000 3275 3055 220
14 ANTACIDA DOEN II SUSPENSI BOTOL 15 5 20 5 15
15 ANTIHEMMORHOID SUPPOSITORIA SUPP 0 0 0 0 0
16 ASAM ASKORBAT (VIT C) 250 MG TABLET 0 0 0 0 0
17 ASAM ASKORBAT (VIT C) 50 MG TABLET 439 1000 1439 1166 273
18 ASAM FOLAT (A FOLAT) 0,4 MG TABLET 95 100 195 195 0
19 ASAM MEFENAMAT 500 MG TABLET 2277 5000 7277 2015 5262
20 ASAM TRANEKSAMAT INJEKSI AMPUL 0 2 2 2 0
21 ASETIL SISTEIN 200 MG KAPSUL 2901 6000 8901 393 8508
22 ASIKLOVIR TABLET 200 MG TABLET 570 0 570 0 570
23 ASIKLOVIR TABLET 400 MG TABLET 560 0 560 0 560
24 CATGUT 0 0 0 0 0
25 BETAHISTIN TAB 6 MG TABLET 170 0 170 50 120
26 BETAMETASON KRIM 0,1% (SBG VALERAT) TUBE 0 15 15 8 7
27 BISAKODIL 5 MG TABLET (DULCOLAX) TABLET 0 0 0 0 0
28 BISAKODIL SUSP (DULCOLAX SUPP) SUPP 3 6 9 1 8
29 BURNAZIN (PERAK SULFADIAZIN KRIM 1%) TUBE 5 0 5 3 2
30 CAPTOPRIL 12,5 MG TABLET 920 500 1420 1125 295
31 CAPTOPRIL 25 MG TABLET 890 1500 2390 930 1460
32 CAPTOPRIL 50 MG TABLET 620 1000 1620 390 1230
33 CEFADROXIL FORTE SIRUP BTL 60 ML 0 0 0 0 0
34 CEFADROXIL KAPSUL 500 MG KAPSUL -27 1000 973 618 355
35 CETIRIZINE SYRUP BOTOL 24 0 24 4 20
36 CETIRIZINE TABLET TABLET 757 1000 1757 792 965
37 CHLORAMPHENICOL SALEP KULIT 2% (BUFA TUBE 0 50 50 4 46
38 CHLORAMPHENICOL SUSPENSI 125MG/5ML BOTOL 0 0 0 0 0
39 CHLORPHENIRAMIN MALEAT (CTM) TABLET 10 500 510 510 0
40 CIPROFLOXACIN 500 MG TABLET 50 500 550 549 1
41 CLINDAMYCIN 300 MG CAPSUL 1079 500 1579 60 1519
42 CODEIN 10 MG TABLET 100 0 100 10 80
43 COTRIMOXAZOLE SUSPENSI BOTOL 26 0 26 10 16
44 COTRIMOXAZOLE TABLET DEWASA 480 mg TABLET 1684 0 1684 984 700
45 DARYANT TULE PCS 0 5 5 2 3
46 DEKSTROFEN SYRUP BOTOL 12 50 62 39 23
47 DENOMIX CREAM 10 GRAM TUBE 0 0 0 0 0
48 DEXAMETASONE INJEKSI IV/IM 5MG/ML AMPUL 215 0 215 0 215
49 DEXAMETASONE TABLET 0,5 MG TABLET 1 200 201 201 0
50 DEXOCORT KRIM TUBE 0 0 0 0 0
51 DIAZEPAM LAR.REKTAL (STESOLID) 10MG/2, TUBE 11 0 11 0 11
52 DOMPERIDON SYRUP BOTOL 12 0 12 3 9
53 DOMPERIDONE TABLET 10 MG TABLET 0 0 0 0 0
54 EPINEFRIN INJEKSI AMPUL 5 0 5 0 5
55 EUGENOL BOTOL 2 0 2 0 2
56 FOLLEY CATHETER SET 0 0 0 0 0
57 FUROSEMID 40 MG TABLET 510 500 1010 725 285
58 GARAM ORALIT SAK 132 0 132 10 122
59 GENTAMYCIN TETES MATA 0,3% BOTOL 1 10 11 6 5
60 GLIMEPIRID 2 MG TABLET 40 200 240 10 230
61 GLUKOSA LARUTAN INFUS 5% STERIL BOTOL 500ML 3 0 3 3 0
62 GRISEOFULVIN 125 MG TAB TABLET 212 0 212 0 212
63 HANDSCHOON NON STERIL L PCS 0 0 0 0 0
64 HANDSCHOON NON STERIL M PCS 0 0 0 0 0
65 HANDSCHOON STERIL PASANG 103 50 153 103 50
66 HIDROKLORTIAZID 25 MG TABLET 30 0 30 0 30
67 HIDROKORTISON 2,5% KRIM TUBE 0 0 0 0 0
68 IBUPROFEN 200 MG TABLET TABLET 185 300 485 280 205
69 IBUPROFEN 400 MG TABLET TABLET 352 300 652 252 400
70 IBUPROFEN SYR 100MG/5ML BOTOL 31 0 31 13 18
71 ILLIADIN (OKSIMETAZOLIN) TETES HIDUNG 0 BOTOL 14 20 34 0 34
73 INFUSION SET DEWASA SET 10 10 20 10 10
74 ISOSORBID DINITRAT 5MG (FASORBID) TAB. SUBLINGUAL 144 100 244 10 234
75 IV CATHETER (TROVENOCATH) SET 27 0 27 0 27
76 KALSIUM LAKTAT 500 MG TABLET 890 100 990 363 627
77 KAPAS PEMBALUT 250 GRAM PCS 1 0 1 0 1
78 KARBOGLISERIN TETES TELINGA 10% BOTOL 4 0 4 0 4
79 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL 21 10 31 13 18
80 KASSA HIDROFIL STERIL 16X16 KTK 22 15 37 22 15
81 KETOKONAZOLE 200 MG TABLET 524 200 724 215 509
82 KETOKONAZOLE KRIM TUBE 0 0 0 0 0
83 KETOROLAC INJEKSI 30 MG/ML AMPUL 10 0 10 2 8
84 KLORAMFENIKOL SALEP MATA 1% TUBE 5 GR 6 0 6 0 6
85 LIDOKAIN 2% + EPINEFRIN 1 : 80.000 AMPUL 0 0 0 0 0
86 LIDOKAIN INJEKSI 2% (HCL) AMPUL 14 20 34 18 16
87 LOPERAMIDE TAB 2 MG TABLET 268 0 268 0 268
88 LORATADINE 10 MG TABLET 273 100 373 373 0
89 LYSOL 1 LITER BOTOL 1 0 1 0 1
90 MASKER PCS 17 50 67 37 30
91 MEBENDAZOLE 500 MG (VERMOX) TABLET 0 5 5 2 3
92 METFORMIN 500 MG TABLET 960 500 1460 80 1380
93 METHYL PREDNISOLON 4 MG TABLET 471 0 471 271 200
94 METIL ERGOMETRIN INJEKSI 0,2MG/ML AMPUL 0 20 20 20 0
95 METIL ERGOMETRIN MALEAT 0,175 MG TABLET 310 200 510 300 210
96 METOKLOPRAMID 5 MG TABLET TABLET 290 0 290 30 260
97 METOKLOPRAMID SYRUP (LEXAPRAM) BOTOL 0 0 0 0 0
98 METRONIDAZOLE 500 MG TABLET 1882 0 1882 1479 403
99 MIKONAZOLE KRIM 2% (SBG NITRAT) TUBE 10 GR 24 25 49 23 26
100 NACL 0,9% LARUTAN INFUS BOTOL 500ML 10 2 12 2 12
101 NATRIUM DIKLOFENAK 25 MG TABLET 5 300 305 255 50
102 NATRIUM DIKLOFENAK 50 MG TABLET -15 300 285 265 20
103 NIFEDIPIN 10 MG TAB TABLET 555 0 555 0 555
104 OKSITOSIN INJEKSI AMPUL 3 10 13 10 3
105 OMEPRAZOLE 20 MG CAPSUL KAPSUL 46 600 646 599 47
106 ONDANSETRON INJEKSI 2MG/ ML AMPUL 0 0 0 0 0
107 PARACETAMOL DROP 100MG/ML BOTOL 6 5 11 3 8
108 PARACETAMOL SYRUP 120MG/5ML BOTOL 97 20 117 30 87
109 PARASETAMOL TABLET 500 MG TABLET 1301 5000 6301 1124 5177
110 PHYTOMENADION INJEKSI AMPUL 49 0 49 19 30
111 PHYTOMENADION TABLET TABLET 180 100 280 130 150
112 PIRANTEL PAMOAT SUSPENSI 125 MG BOTOL 5 0 5 0 5
113 PIRIDOKSIN (VIT B6) INJEKSI AMPUL 2 10 12 1 11
114 PIRIDOKSIN (VIT B6) TAB 10 MG (HCL) TABLET 910 1000 1910 860 1050
115 PLESTER ISOPLAST 5YARD X 2 INCH ROL 0 0 0 0 0
116 PLESTER PHARMAFIX 10 CM X 500 CM ROL 0 0 0 0 0
117 PLESTER POLIFIX 5 CM X 1 M ROL 3 25 28 10 18
118 POVIDON IODIDA 10% 1000 ML BOTOL 1 0 1 0 1
119 POVIDON IODIDA 10% 300 ML BOTOL 0 0 0 0 0
120 POVIDONE IODIDA 10% 30 ML BOTOL 3 0 3 0 3
121 POVIDONE IODIDA 10% 60 ML BOTOL 10 0 10 0 10
122 PREDNISON 5 MG TABLET 1051 1000 2051 1029 1022
123 PULAREX (ATTAPULGIT) TABLET 600 MG TABLET 422 0 422 82 340
124 PULMICORT TURBUHALER 200 TURB 0 0 0 0 0
125 RANITIDINE TABLET 150 MG TABLET 0 100 100 100 0
126 RINGER LACTAT LARUTAN INFUS BOTOL 500ML 10 10 20 10 10
127 SAFETY BOX PCS 0 0 0 0 0
128 SALBUTAMOL 4 MG TABLET 80 400 480 255 225
129 SALBUTAMOL SYRUP (SALBRON) BOTOL -1 0 0 0 -1
130 SALISIL BEDAK SERBUK 2% SAK 2 0 2 0 2
131 SCABIMITE CREAM TUBE 0 0 0 0 0
132 SIANOKOBALAMIN (VIT B12) 50 MCG TABLET 198 1000 1198 373 825
133 SIANOKOBALAMIN (VIT B12) INJ 500MCG AMPUL 1 20 21 16 5
134 SIMVASTATIN TABLET 10 MG TABLET 250 30 280 55 225
135 SOFTAMAN HAND 1 LITER BOTOL 0 0 0 1 0
136 SUCRALFAT SUSPENSI ( ULSAFATE) BOTOL 16 10 26 8 16
137 SYMBICORT TURBUHALER 180 TURB 0 0 0 0 0
138 TABLET TAMBAH DARAH TABLET 482 150 632 360 272
139 SLIK SET 0 0 0 0 0
140 THIAMIN 50 MG TABLET 260 500 760 180 580
141 VITAMIN B KOMPLEKS TABLET 1164 1000 2164 1402 762
142 XYLOCAINE JELLY 2% TUBE 0 0 0 0 0
143 XYLOCAINE SPRAY SPRAY 2 0 2 0 2
144 ZINK TAB DISPERSIBEL 20 MG TABLET 67 500 567 220 347
145 LANSOPRAZOLE 30 MG TABLET 0 500 500 413 87
146 IV CATHETER SET 20 0 40 20 20

BPJS PUSTU BKIA LANSIA KK/KTP

JUMLAH KUNJUNGAN RESEP
267 35 0 0 337

DIKETAHUI, YANG MENYERAHKAN

KEPALA DINAS KESEHATAN TAP.TENGAH KEPALA SEKSI KEFARMASIAN

NURSYAM,SKM,M.Kes LINNON BASTIAN L.RAJA, S.Farm.,Apt.

NIP. 19690909 199103 2 005 NIP. 19830419 200604 1 005
 PERMINTAAN OBAT
LI TENGAH

LAPORAN BULAN / PERIODE : MEI 2018

PERMINTAAN BULAN / PERIODE : JUNI 2018
STOK PERMINTA PEMBERIAN
KET
OPTIMUM AN DAK PROP JUMLAH
9 10 11 12 13 14
0
50
200
0
0
0
0
3
500
1000
1000
20
3000
20
10
1000
2000
500
0
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0
0
20
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2
2000
1500
500
20
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1000
10
10
2000
2000
0
0
10
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5
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2
0
10
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0
0
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0
20
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100
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10
5
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 0
100
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10
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50
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500
1000
0
0
500
2000
10

JUMLAH
639

YANG MEMINTA
PIMPINAN PUSKESMAS

dr. MARULI SILALAHI

NIP. 19830802 201001 1 020
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS KAB. TAPANULI TENGAH

PUSKESMAS : PASARIBUTOBING LAPORAN BULAN / PERIODE :JUNI 2018

KECAMATAN : PASARIBUTOBING PERMINTAAN BULAN / PERIODE : JULI 2018
PENERIMAA PERSEDIAA STOK PERMINTA PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PEMAKAIAN SISA STOK KET
N N OPTIMUM AN DAK PROP JUMLAH
1 2 3 4 5 6 = (4 + 5 ) 7 8=(6-7) 9 10 11 12 13 14
1 AIR UNTUK IN BOTOL 0 0 0 0 0 0
2 ALAT SUNTIK SET 0 0 0 0 0 0
3 ALAT SUNTIK SET 120 100 220 50 170 100
4 ALAT SUNTIK SET 341 0 341 50 291 0
5 ALCOHOL SW PCS 4997 0 4997 50 4947 0
6 ALKACIDE 1 L BOTOL 1 0 1 0 1 0
7 ALKAZYME SAK 1 0 1 0 1 0
8 ALKOHOL 70% BOTOL 0 1 1 1 0 2
9 ALLOPURINOL TABLET 600 300 900 310 590 500
10 AMLODIPIN 5 TABLET 230 900 1130 605 525 500
11 AMOKSISILIN KAPLET 1567 1500 3067 437 2630 0
12 AMOKSISILIN BOTOL 29 50 79 34 45 30
13 ANTACIDA DOTAB.KUNYAH 220 1800 2020 2130 -110 3000
14 ANTACIDA DO BOTOL 15 0 15 15 0 50
15 ANTIHEMMOR SUPP 0 0 0 0 0 10
16 ASAM ASKORB TABLET 0 700 700 115 585 1000
17 ASAM ASKORB TABLET 273 1100 1373 1092 281 1000
18 ASAM FOLAT ( TABLET 0 100 100 110 -10 500
19 ASAM MEFEN TABLET 5262 3000 8262 1419 6843 0
20 ASAM TRANEK AMPUL 0 0 0 0 0 5
21 ASETIL SISTE KAPSUL 8508 600 9108 326 8782 0
22 ASIKLOVIR T TABLET 570 0 570 20 550 0
23 ASIKLOVIR T TABLET 560 0 560 0 560 0
24 CATGUT 0 7 7 2 5 20
25 BETAHISTIN TABLET 120 0 120 70 50 100
26 BETAMETASON TUBE 7 10 17 5 12 10
27 BISAKODIL 5 TABLET 0 0 0 0 0 10
28 BISAKODIL S SUPP 8 0 8 1 7 0
29 BURNAZIN (P TUBE 2 0 2 0 2 2
30 CAPTOPRIL 1 TABLET 295 100 395 390 5 1000
31 CAPTOPRIL 2 TABLET 1460 1500 2960 1079 1881 500
32 CAPTOPRIL 5 TABLET 1230 1000 2230 180 2050 0
33 CEFADROXIL BTL 60 ML 0 0 0 0 0 20
34 CEFADROXIL KAPSUL 355 600 955 753 202 2000
35 CETIRIZINE BOTOL 20 0 20 0 20 0
36 CETIRIZINE TABLET 965 300 1265 788 477 1000
37 CHLORAMPHEN TUBE 46 25 71 3 68 0
38 CHLORAMPHE BOTOL 0 0 0 0 0 10
39 CHLORPHENIR TABLET 0 800 800 564 236 2000
40 CIPROFLOXAC TABLET 549 1200 1749 952 797 2000
41 CLINDAMYCIN CAPSUL 1519 100 1619 969 650 0
42 CODEIN 10 M TABLET 100 0 100 10 80 0
43 COTRIMOXAZ BOTOL 16 0 16 12 4 30
44 COTRIMOXAZO TABLET 700 0 700 387 313 1000
45 DARYANT TU PCS 3 2 5 2 3 5
46 DEKSTROFEN BOTOL 23 50 73 51 22 50
47 DENOMIX CR TUBE 0 0 0 0 0 30
48 DEXAMETASON AMPUL 215 0 215 0 215 0
49 DEXAMETASONTABLET 0 1200 1200 743 457 2000
50 DEXOCORT K TUBE 0 0 0 0 0 9
51 DIAZEPAM LA TUBE 11 0 11 0 11 0
52 DOMPERIDON BOTOL 9 5 14 0 14 0
53 DOMPERIDON TABLET 0 0 0 0 0 100
54 EPINEFRIN IN AMPUL 5 0 5 0 5 0
55 EUGENOL BOTOL 2 0 2 0 2 0
56 FOLLEY CAT SET 0 0 0 0 0 0
57 FUROSEMID TABLET 285 500 785 222 563 1000
58 GARAM ORAL SAK 122 0 122 0 122 0
59 GENTAMYCIN BOTOL 5 10 15 10 5 20
60 GLIMEPIRID TABLET 230 100 330 155 175 500
61 GLUKOSA LAR
BOTOL 500ML 0 0 0 0 0 10
62 GRISEOFULVI TABLET 212 0 212 0 212 0
63 HANDSCHOON PCS 0 100 100 100 0 100
64 HANDSCHOON PCS 0 100 100 50 50 100
65 HANDSCHOON PASANG 50 10 60 20 40 100
66 HIDROKLORTI TABLET 30 0 30 0 30 50
67 HIDROKORTIS TUBE 0 0 0 0 0 5
68 IBUPROFEN 2 TABLET 205 100 305 20 285 500
69 IBUPROFEN 4 TABLET 400 200 600 288 312 300
70 IBUPROFEN S BOTOL 18 0 18 0 18 0
71 ILLIADIN (OK BOTOL 34 0 34 0 34 0
73 INFUSION SE SET 10 0 10 10 0 10
74 ISOSORBIDTAB.
D SUBLINGUAL 234 100 334 0 334 0
75 IV CATHETER SET 27 0 27 15 12 20
76 KALSIUM LAK TABLET 627 200 827 379 448 500
77 KAPAS PEMBA PCS 1 0 1 1 0 2
78 KARBOGLISER BOTOL 4 0 4 0 4 5
79 KASA PEMBAL ROL 18 10 28 5 23 0
80 KASSA HIDRO KTK 15 15 30 25 5 50
81 KETOKONAZO TABLET 508 100 608 179 429 500
82 KETOKONAZO TUBE 0 0 0 0 0 10
83 KETOROLAC I AMPUL 8 0 8 0 8 5
84 KLORAMFENIKTUBE 5 GR 6 0 6 0 6 0
85 LIDOKAIN 2% AMPUL 0 0 0 0 0 0
86 LIDOKAIN INJ AMPUL 16 20 36 15 21 20
87 LOPERAMIDE TABLET 268 0 268 27 241 100
88 LORATADINE TABLET 0 100 100 97 3 500
89 LYSOL 1 LITE BOTOL 1 0 1 1 0 2
90 MASKER PCS 30 50 80 50 30 100
91 MEBENDAZOL TABLET 3 0 3 3 0 5
92 METFORMIN TABLET 1380 500 1880 140 1740 0
93 METHYL PRE TABLET 200 300 500 205 295 500
94 METIL ERGOM AMPUL 0 20 20 20 0 20
95 METIL ERGOM TABLET 210 100 310 100 210 100
96 METOKLOPRA TABLET 260 0 260 20 240 0
97 METOKLOPRA BOTOL 0 0 0 0 0 5
98 METRONIDAZ TABLET 403 800 1203 441 762 1000
99 MIKONAZOLETUBE 10 GR 26 24 50 6 42 10
100 NACL 0,9% L BOTOL 500ML 12 2 12 5 7 10
101 NATRIUM DIK TABLET 50 100 150 150 0 2000
102 NATRIUM DIK TABLET 20 100 120 120 0 2000
103 NIFEDIPIN 10 TABLET 555 2000 2555 30 2525 0
104 OKSITOSIN I AMPUL 3 10 13 10 3 10
105 OMEPRAZOLE KAPSUL 47 500 547 545 2 1000
106 ONDANSETRONAMPUL 0 0 0 0 0 0
107 PARACETAMO BOTOL 8 5 13 5 8 20
108 PARACETAMO BOTOL 87 20 107 28 79 0
109 PARASETAMOL TABLET 5177 1500 6677 974 5703 0
110 PHYTOMENADI AMPUL 30 30 60 20 40 0
111 PHYTOMENAD TABLET 150 100 250 100 150 100
112 PIRANTEL PA BOTOL 5 0 5 0 5 0
113 PIRIDOKSIN ( AMPUL 11 10 21 0 21 0
114 PIRIDOKSIN ( TABLET 1050 1000 2050 764 1286 500
115 PLESTER ISO ROL 0 0 0 0 0 2
116 PLESTER PHA ROL 0 0 0 0 0 2
117 PLESTER POLI ROL 18 20 38 20 18 20
118 POVIDON IOD BOTOL 1 0 1 0 1 0
119 POVIDON IOD BOTOL 0 0 0 0 0 0
120 POVIDONE IO BOTOL 3 0 3 2 1 5
121 POVIDONE IO BOTOL 10 0 10 0 10 0
122 PREDNISON TABLET 1022 1000 2022 459 1563 1000
123 PULAREX (AT TABLET 340 0 340 58 282 100
124 PULMICORT TURB 0 0 0 0 0 0
125 RANITIDINE TABLET 0 0 0 0 0 2000
126 RINGER LACTBOTOL 500ML 10 10 20 10 10 20
127 SAFETY BOX PCS 0 0 0 0 0 0
128 SALBUTAMOL TABLET 225 400 625 254 371 200
129 SALBUTAMOL BOTOL 0 0 0 0 0 50
130 SALISIL BED SAK 2 0 2 0 2 0
131 SCABIMITE TUBE 0 0 0 0 0 10
132 SIANOKOBALA TABLET 825 600 1425 290 1135 500
133 SIANOKOBALA AMPUL 5 20 25 11 14 20
134 SIMVASTATIN TABLET 225 30 255 55 200 100
135 SOFTAMAN HA BOTOL 0 0 0 1 0 2
136 SUCRALFAT S BOTOL 16 20 36 6 30 10
137 SYMBICORT TURB 0 0 0 0 0 0
138 TABLET TAM TABLET 272 300 572 130 442 100
139 SLIK SET 0 0 0 0 0 10
140 THIAMIN 50 TABLET 580 500 1080 150 930 500
141 VITAMIN B K TABLET 762 1000 1762 1446 316 1000
142 XYLOCAINE J TUBE 0 0 0 0 0 0
143 XYLOCAINE SPRAY 2 0 2 0 2 0
144 ZINK TAB DIS TABLET 347 500 847 100 747 500
145 LANSOPRAZO TABLET 87 350 437 285 152 1000
146 IV CATHETER SET 20 0 20 10 10 10

BPJS PUSTU BKIA LANSIA KK/KTP JUMLAH

JUMLAH KUNJUNGAN RESEP
285 10 0 15 175 485
 DIKETAHUI, YANG MENYERAHKAN YANG MEMINTA
KEPALA DINAS KESEHATAN TAP.TENGAH KEPALA SEKSI KEFARMASIAN PIMPINAN PUSKESMAS

NURSYAM,SKM,M.Kes LINNON BASTIAN L.RAJA, S.Farm.,Apt. dr. MARULI SILALAHI

NIP. 19690909 199103 2 005 NIP. 19830419 200604 1 005 NIP. 19830802 201001 1 020
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS KAB. TAPANULI TENGAH

PUSKESMAS : PASARIBUTOBING LAPORAN BULAN / PERIODE

KECAMATAN : PASARIBUTOBING PERMINTAAN BULAN / PERIODE
PENERIMAA PERSEDIAA STOK PERMINTA
NO NAMA OBAT SATUAN STOK AWAL PEMAKAIAN SISA STOK
N N OPTIMUM AN
1 2 3 4 5 6 = (4 + 5 ) 7 8=(6-7) 9 10
1 AIR UNTUK IN BOTOL 0 0 0 0 0 0
2 ALAT SUNTIK SET 0 0 0 0 0 50
3 ALAT SUNTIK SET 171 100 271 151 120 200
4 ALAT SUNTIK SET 361 0 361 20 341 0
5 ALCOHOL SW PCS 32 5000 5032 35 4997 0
6 ALKACIDE 1 L BOTOL 1 0 1 0 1 0
7 ALKAZYME SAK 1 0 1 0 1 0
8 ALKOHOL 70% BOTOL 1 1 1 1 0 3
9 ALLOPURINOL TABLET 670 300 970 370 600 500
10 AMLODIPIN 5 TABLET 1414 900 2314 256 1414 1000
11 AMOKSISILIN KAPLET 87 2000 2087 520 1567 1000
12 AMOKSISILIN BOTOL 4 50 54 25 29 20
13 ANTACIDA DOTAB.KUNYAH 2275 1000 3275 3055 220 3000
14 ANTACIDA DO BOTOL 15 5 20 5 15 20
15 ANTIHEMMOR SUPP 0 0 0 0 0 10
16 ASAM ASKORB TABLET 0 0 0 0 0 1000
17 ASAM ASKORB TABLET 439 1000 1439 1166 273 2000
18 ASAM FOLAT ( TABLET 95 100 195 195 0 500
19 ASAM MEFEN TABLET 2277 5000 7277 2015 5262 0
20 ASAM TRANEK AMPUL 0 2 2 2 0 5
21 ASETIL SISTE KAPSUL 2901 6000 8901 393 8508 0
22 ASIKLOVIR T TABLET 570 0 570 0 570 0
23 ASIKLOVIR T TABLET 560 0 560 0 560 0
24 CATGUT 0 0 0 0 0 20
25 BETAHISTIN TABLET 170 0 170 50 120 100
26 BETAMETASON TUBE 0 15 15 8 7 10
27 BISAKODIL 5 TABLET 0 0 0 0 0 10
28 BISAKODIL S SUPP 3 6 9 1 8 0
29 BURNAZIN (P TUBE 5 0 5 3 2 2
30 CAPTOPRIL 1 TABLET 920 500 1420 1125 295 2000
31 CAPTOPRIL 2 TABLET 890 1500 2390 930 1460 1500
32 CAPTOPRIL 5 TABLET 620 1000 1620 390 1230 500
33 CEFADROXIL BTL 60 ML 0 0 0 0 0 20
34 CEFADROXIL KAPSUL -27 1000 973 618 355 2000
35 CETIRIZINE BOTOL 24 0 24 4 20 0
36 CETIRIZINE TABLET 757 1000 1757 792 965 1000
37 CHLORAMPHEN TUBE 0 50 50 4 46 10
38 CHLORAMPHE BOTOL 0 0 0 0 0 10
39 CHLORPHENIR TABLET 10 500 510 510 0 2000
40 CIPROFLOXAC TABLET 50 500 550 549 1 2000
41 CLINDAMYCIN CAPSUL 1079 500 1579 60 1519 0
42 CODEIN 10 M TABLET 100 0 100 10 80 0
43 COTRIMOXAZ BOTOL 26 0 26 10 16 10
44 COTRIMOXAZO TABLET 1684 0 1684 984 700 1000
45 DARYANT TU PCS 0 5 5 2 3 5
46 DEKSTROFEN BOTOL 12 50 62 39 23 50
47 DENOMIX CR TUBE 0 0 0 0 0 30
48 DEXAMETASON AMPUL 215 0 215 0 215 0
49 DEXAMETASONTABLET 1 200 201 201 0 2000
50 DEXOCORT K TUBE 0 0 0 0 0 2
51 DIAZEPAM LA TUBE 11 0 11 0 11 0
52 DOMPERIDON BOTOL 12 0 12 3 9 10
53 DOMPERIDON TABLET 0 0 0 0 0 100
54 EPINEFRIN IN AMPUL 5 0 5 0 5 0
55 EUGENOL BOTOL 2 0 2 0 2 0
56 FOLLEY CAT SET 0 0 0 0 0 0
57 FUROSEMID TABLET 510 500 1010 725 285 1000
58 GARAM ORAL SAK 132 0 132 10 122 0
59 GENTAMYCIN BOTOL 1 10 11 6 5 20
60 GLIMEPIRID TABLET 40 200 240 10 230 200
61 GLUKOSA LAR
BOTOL 500ML 3 0 3 3 0 20
62 GRISEOFULVI TABLET 212 0 212 0 212 0
63 HANDSCHOON PCS 0 0 0 0 0 100
64 HANDSCHOON PCS 0 0 0 0 0 100
65 HANDSCHOON PASANG 103 50 153 103 50 200
66 HIDROKLORTI TABLET 30 0 30 0 30 50
67 HIDROKORTIS TUBE 0 0 0 0 0 5
68 IBUPROFEN 2 TABLET 185 300 485 280 205 800
69 IBUPROFEN 4 TABLET 352 300 652 252 400 300
70 IBUPROFEN S BOTOL 31 0 31 13 18 0
71 ILLIADIN (OK BOTOL 14 20 34 0 34 0
73 INFUSION SE SET 10 10 20 10 10 10
74 ISOSORBIDTAB.
D SUBLINGUAL 144 100 244 10 234 100
75 IV CATHETER SET 27 0 27 0 27 0
76 KALSIUM LAK TABLET 890 100 990 363 627 500
77 KAPAS PEMBA PCS 1 0 1 0 1 2
78 KARBOGLISER BOTOL 4 0 4 0 4 5
79 KASA PEMBAL ROL 21 10 31 13 18 10
80 KASSA HIDRO KTK 22 15 37 22 15 30
81 KETOKONAZO TABLET 524 200 724 215 509 500
82 KETOKONAZO TUBE 0 0 0 0 0 10
83 KETOROLAC I AMPUL 10 0 10 2 8 5
84 KLORAMFENIKTUBE 5 GR 6 0 6 0 6 0
85 LIDOKAIN 2% AMPUL 0 0 0 0 0 0
86 LIDOKAIN INJ AMPUL 14 20 34 18 16 20
87 LOPERAMIDE TABLET 268 0 268 0 268 100
88 LORATADINE TABLET 273 100 373 373 0 1000
89 LYSOL 1 LITE BOTOL 1 0 1 0 1 0
90 MASKER PCS 17 50 67 37 30 200
91 MEBENDAZOL TABLET 0 5 5 2 3 5
92 METFORMIN TABLET 960 500 1460 80 1380 0
93 METHYL PRE TABLET 471 0 471 271 200 500
94 METIL ERGOM AMPUL 0 20 20 20 0 20
95 METIL ERGOM TABLET 310 200 510 300 210 200
96 METOKLOPRA TABLET 290 0 290 30 260 0
97 METOKLOPRA BOTOL 0 0 0 0 0 5
98 METRONIDAZ TABLET 1882 0 1882 1479 403 1000
99 MIKONAZOLETUBE 10 GR 24 25 49 23 26 10
100 NACL 0,9% L BOTOL 500ML 10 2 12 2 12 10
101 NATRIUM DIK TABLET 5 300 305 255 50 2000
102 NATRIUM DIK TABLET -15 300 285 265 20 2000
103 NIFEDIPIN 10 TABLET 555 0 555 0 555 0
104 OKSITOSIN I AMPUL 3 10 13 10 3 10
105 OMEPRAZOLE KAPSUL 46 600 646 599 47 1000
106 ONDANSETRONAMPUL 0 0 0 0 0 0
107 PARACETAMO BOTOL 6 5 11 3 8 20
108 PARACETAMO BOTOL 97 20 117 30 87 0
109 PARASETAMOL TABLET 1301 5000 6301 1124 5177 0
110 PHYTOMENADI AMPUL 49 0 49 19 30 10
111 PHYTOMENAD TABLET 180 100 280 130 150 200
112 PIRANTEL PA BOTOL 5 0 5 0 5 0
113 PIRIDOKSIN ( AMPUL 2 10 12 1 11 10
114 PIRIDOKSIN ( TABLET 910 1000 1910 860 1050 1000
115 PLESTER ISO ROL 0 0 0 0 0 2
116 PLESTER PHA ROL 0 0 0 0 0 2
117 PLESTER POLI ROL 3 25 28 10 18 20
118 POVIDON IOD BOTOL 1 0 1 0 1 0
119 POVIDON IOD BOTOL 0 0 0 0 0 0
120 POVIDONE IO BOTOL 3 0 3 0 3 0
121 POVIDONE IO BOTOL 10 0 10 0 10 0
122 PREDNISON TABLET 1051 1000 2051 1029 1022 1000
123 PULAREX (AT TABLET 422 0 422 82 340 100
124 PULMICORT TURB 0 0 0 0 0 0
125 RANITIDINE TABLET 0 100 100 100 0 2000
126 RINGER LACTBOTOL 500ML 10 10 20 10 10 20
 127 SAFETY BOX PCS 0 0 0 0 0 0
128 SALBUTAMOL TABLET 80 400 480 255 225 100
129 SALBUTAMOL BOTOL -1 0 0 0 -1 30
130 SALISIL BED SAK 2 0 2 0 2 0
131 SCABIMITE TUBE 0 0 0 0 0 10
132 SIANOKOBALA TABLET 198 1000 1198 373 825 1000
133 SIANOKOBALA AMPUL 1 20 21 16 5 50
134 SIMVASTATIN TABLET 250 30 280 55 225 100
135 SOFTAMAN HA BOTOL 0 0 0 1 0 2
136 SUCRALFAT S BOTOL 16 10 26 8 16 10
137 SYMBICORT TURB 0 0 0 0 0 0
138 TABLET TAM TABLET 482 150 632 360 272 100
139 SLIK SET 0 0 0 0 0 10
140 THIAMIN 50 TABLET 260 500 760 180 580 500
141 VITAMIN B K TABLET 1164 1000 2164 1402 762 1000
142 XYLOCAINE J TUBE 0 0 0 0 0 0
143 XYLOCAINE SPRAY 2 0 2 0 2 0
144 ZINK TAB DIS TABLET 67 500 567 220 347 500
145 LANSOPRAZO TABLET 0 500 500 413 87 2000
146 IV CATHETER SET 20 0 40 20 20 10

BPJS PUSTU BKIA LANSIA KK/KTP JUMLAH

JUMLAH KUNJUNGAN RESEP
267 35 0 0 337 639

DIKETAHUI, YANG MENYERAHKAN

KEPALA DINAS KESEHATAN TAP.TENGAH KEPALA SEKSI KEFARMASIAN

NURSYAM,SKM,M.Kes LINNON BASTIAN L.RAJA, S.Farm.,Apt.

NIP. 19690909 199103 2 005 NIP. 19830419 200604 1 005
AN OBAT

: MEI 2018
: JUNI 2018
PEMBERIAN
KET
DAK PROP JUMLAH
11 12 13 14
 YANG MEMINTA
PIMPINAN PUSKESMAS

dr. MARULI SILALAHI

NIP. 19830802 201001 1 020
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN
PUSKESMAS KAB. TAPANULI TENGAH

PUSKESMAS :PASARIBUTOBING
KECAMATAN :PASARIBUTOBING

NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDIA PEMAKAI

AN AN AN
1 2 3 4 5 6 = (4 + 5 ) 7
1 AIR UNTUK INJEKSI BOTOL 0 0 0 0
2 ALAT SUNTIK DISP. 3 ML SET 150 100 250 120
3 ALAT SUNTIK DISP. 5 ML SET 291 0 291 130
4 ALCOHOL SWAB PCS 4947 0 4947 1300
5 ALKACIDE 1 LITER BOTOL 1 0 1 0
6 ALKAZYME SAK 1 0 1 0
7 ALKOHOL 70% 1 LITER BOTOL 0 1 1 1
8 ALOPURINOL 100 MG TABLET 590 500 1090 270
9 AMLODIPIN 5 MG TABLET 525 1500 2025 1085
10 AMOKSISILIN 500 MG KAPLET 2630 0 2630 879
11 AMOKSISILIN SYRUP KERING FORTE 250MG/5ML BOTOL 45 50 95 42
12 ANTACIDA DOEN I TAB TAB.KUNYAH -110 3600 3490 1977
13 ANTACIDA DOEN II SUSPENSI BOTOL 0 0 0 0
14 ASAM ASKORBAT (VIT C) 250 MG TABLET 585 0 585 358
15 ASAM ASKORBAT (VIT C) 50 MG TABLET 281 1000 1281 1001
16 ASAM FOLAT (A FOLAT) 0,4 MG TABLET -10 300 290 110
17 ASAM MEFENAMAT 500 MG TABLET 6843 6843
18 ASEPTAN BOTOL 0 0 0 0
19 ASERING BOTOL 0 0 0 0
20 ASETIL SISTEIN 200 MG KAPSUL 8782 0 8782 1397
21 ASIKLOVIR TABLET 200 MG TABLET 550 0 550 0
22 ASIKLOVIR TABLET 400 MG TABLET 560 0 560 0
23 ATROPIN INJEKSI 0,35 MG/ ML AMPUL 0 0 0 0
24 BEROTEC INHALER BOTOL 0 0 0 0
25 BETAHISTIN TAB 6 MG TABLET 50 300 350 30
26 BETAMETASON KRIM 0,1% (SBG VALERAT) TUBE 12 0 12 3
27 BISAKODIL 5 MG TABLET (DULCOLAX) TABLET 0 30 30 0
28 BISAKODIL SUSP (DULCOLAX SUPP) SUPP 7 0 7 2
29 BRACKET PCS 0 0 0 0
30 BURNAZIN (PERAK SULFADIAZIN KRIM 1%) TUBE 2 5 7 2
31 CAPTOPRIL 12,5 MG TABLET 5 300 305 200
32 CAPTOPRIL 25 MG TABLET 1881 0 1881 1225
33 CAPTOPRIL 50 MG TABLET 2050 0 2050 370
34 CATGUT ADVANTIME PCS 5 5 10 7
35 CEFADROXIL KAPSUL 500 MG KAPSUL 202 800 1002 736
36 CETIRIZINE SYRUP BOTOL 20 0 20 0
37 CETIRIZINE TABLET TABLET 477 477
38 CHLORAMPHENICOL SALEP KULIT 2% (BUFACETIN)TUBE 68 0 68 18
39 CHLORPHENIRAMIN MALEAT (CTM) TABLET 236 1500 1736 1067
40 CIPROFLOXACIN 500 MG TABLET 797 500 1297 1074
41 CLINDAMYCIN 300 MG CAPSUL 650 500 1150 240
42 CODEIN 10 MG TABLET 80 0 80 0
43 COTRIMOXAZOLE SUSPENSI BOTOL 4 50 54 25
44 COTRIMOXAZOLE TABLET DEWASA 480 mg TABLET 313 500 813 484
45 DARYANT TULE PCS 3 2 5 2
46 DEKSTROFEN SYRUP BOTOL 22 50 72 55
47 DENOMIX CREAM 10 GRAM TUBE 0 0 0 0
48 DEXAMETASONE INJEKSI IV/IM 5MG/ML AMPUL 215 0 215 0
49 DEXAMETASONE TABLET 0,5 MG TABLET 457 300 757 755
50 DEXOCORT KRIM TUBE 0 0 0 0
51 DIAZEPAM 2 MG TABLET 0 0 0 0
52 DIAZEPAM LAR.REKTAL (STESOLID) 10MG/2,5ML TUBE 7 0 7 2
53 DOMPERIDON SYRUP BOTOL 14 0 14 5
54 EPINEFRIN INJEKSI AMPUL 5 0 5 0
55 EUGENOL BOTOL 2 0 2 0
56 FOLLEY CATHETER SET 0 0 0 0
57 FUROSEMID 40 MG TABLET 563 1000 1563 511
58 GARAM ORALIT SAK 122 0 122 0
59 GENTAMYCIN TETES MATA 0,3% BOTOL 5 25 30 2
60 GLIMEPIRID 2 MG TABLET 175 200 375 40
61 GLUKOSA LARUTAN INFUS 5% STERIL BOTOL 500ML 0 5 5 5
62 GRISEOFULVIN 125 MG TAB TABLET 212 0 212 0
63 HANDSCHOON NON STERIL L PCS 0 100 100 100
64 HANDSCHOON NON STERIL M PCS 50 100 150 100
65 HANDSCHOON OBSGYN PCS 0 0 0 0
66 HANDSCHOON STERIL PASANG 40 40
67 HIDROKLORTIAZID 25 MG TABLET 30 30
68 HIDROKORTISON 2,5% KRIM TUBE - 0 0 0
69 IBUPROFEN 200 MG TABLET TABLET 285 100 385 290
70 IBUPROFEN 400 MG TABLET TABLET 312 100 412 306
71 IBUPROFEN SYR 100MG/5ML BOTOL 18 0 18 0
72 ILLIADIN (OKSIMETAZOLIN) TETES HIDUNG 0,050%BOTOL 34 0 34 0
73 INFUSION SET DEWASA SET 5 0 5 5
74 ISOSORBID DINITRAT 5MG (FASORBID) TAB. SUBLINGUAL 334 0 334 0
75 IV TROVENOCATH 18 PCS 3 0 3 3
76 IV TROVENOCATH 20 PCS 9 0 9 5
77 IV TROVENOCATH 22 PCS 25 0 25 10
78 IV TROVENOCATH 24 PCS 17 0 17 0
79 KALSIUM LAKTAT 500 MG TABLET 448 400 848 395
80 KAPAS PEMBALUT 250 GRAM PCS 0 0
81 KARBOGLISERIN TETES TELINGA 10% BOTOL 4 0 4 2
82 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL 23 0 23 0
83 KASSA HIDROFIL STERIL 16X16 KTK 23 20 43 25
84 KETOKONAZOLE 200 MG TABLET 429 0 429 175
85 KETOKONAZOLE KRIM TUBE 0 0 0 0
86 KETOROLAC INJEKSI 30 MG/ML AMPUL 9 0 9 0
87 KLORAMFENIKOL SALEP MATA 1% TUBE 5 GR 6 0 6 0
88 LANSOPRAZOLE 30 MG KAPSUL 152 350 502 502
89 LIDOKAIN 2% + EPINEFRIN 1 : 80.000 AMPUL 0 0 0 0
90 LIDOKAIN INJEKSI 2% (HCL) AMPUL 21 10 31 10
91 LOPERAMIDE TAB 2 MG TABLET 241 0 241 94
92 LORATADINE 10 MG TABLET 3 200 203 50
93 LYSOL 1 LITER BOTOL 0 1 1 0
94 MASKER PCS 30 50 80 50
95 MEBENDAZOLE 500 MG (VERMOX) TABLET 0 2 2 1
96 METFORMIN 500 MG TABLET 1740 3000 4740 630
97 METHYL PREDNISOLON 4 MG TABLET 295 500 795 572
98 METIL ERGOMETRIN INJEKSI 0,2MG/ML AMPUL 0 50 50 50
99 METIL ERGOMETRIN MALEAT 0,175 MG TABLET 210 100 310 100
100 METOKLOPRAMID 5 MG TABLET TABLET 240 0 240 50
101 METRONIDAZOLE 500 MG TABLET 752 3000 3752 939
102 MIKONAZOLE KRIM 2% (SBG NITRAT) TUBE 10 GR 42 25 67 21
103 NACL 0,9% LARUTAN INFUS BOTOL 500ML 7 10 17 5
104 NATRIUM DIKLOFENAK 25 MG TABLET 0 300 300 300
105 NATRIUM DIKLOFENAK 50 MG TABLET 150 300 450 450
106 NIFEDIPIN 10 MG TAB TABLET 2525 0 2525 520
107 OKSITOSIN INJEKSI AMPUL 3 10 13 10
108 OMEPRAZOLE 20 MG CAPSUL KAPSUL 2 500 502 496
109 ONDANSETRON INJEKSI 2MG/ ML AMPUL 0 0 0 0
110 PARACETAMOL DROP 100MG/ML BOTOL 11 5 16 5
111 PARACETAMOL SYRUP 120MG/5ML BOTOL 79 0 79 36
112 PARASETAMOL TABLET 500 MG TABLET 5703 3000 8703 563
113 PHYTOMENADION INJEKSI AMPUL 40 30 70 30
114 PHYTOMENADION TABLET TABLET 150 100 250 100
115 PIRANTEL PAMOAT SUSPENSI 125 MG BOTOL 5 0 5 0
116 PIRIDOKSIN (VIT B6) INJEKSI AMPUL 21 0 21 0
117 PIRIDOKSIN (VIT B6) TAB 10 MG (HCL) TABLET 1286 500 1786 964
118 PLESTER ISOPLAST 5YARD X 2 INCH ROL 0 6 6 1
119 PLESTER PHARMAFIX 10 CM X 500 CM ROL 0 0 0 0
120 PLESTER POLIFIX 5 CM X 1 M ROL 18 18
121 POVIDON IODIDA 10% 300 ML BOTOL 1 0 1 1
122 POVIDONE IODIDA 10% 60 ML BOTOL 6 0 6 0
123 PREDNISON 5 MG TABLET 1563 3000 4563 1550
124 NEW DIATABS(ATTAPULGIT) TABLET 600 MG TABLET 282 0 282 73
125 PULMICORT TURBUHALER 200 TURB 0 0 0 0
126 RANITIDINE TABLET 150 MG TABLET 0 0 0 0
127 RINGER LACTAT LARUTAN INFUS BOTOL 500ML 10 10 20 10
128 SAFETY BOX PCS 0 1 1 0
129 SALBUTAMOL 4 MG TABLET 371 200 571 434
130 SALBUTAMOL SYRUP (SALBRON) BOTOL 0 0 0 0
131 SALISIL BEDAK SERBUK 2% SAK 2 0 2 1
132 SCABIMITE CREAM TUBE 0 0 0 0
133 SIANOKOBALAMIN (VIT B12) 50 MCG TABLET 1135 0 1135 750
134 SIANOKOBALAMIN (VIT B12) INJ 500MCG AMPUL 14 10 24 13
135 SIMVASTATIN TABLET 10 MG TABLET 200 100 300 60
136 SOFTAMAN HAND 1 LITER BOTOL 0 1 1 1
137 SUCRALFAT SUSPENSI ( ULSAFATE) BOTOL 30 0 30 13
138 SYMBICORT TURBUHALER 180 TURB 0 0 0 0
139 TABLET TAMBAH DARAH TABLET 442 150 592 310
140 TETAGAM P. SYRINGE 1 ML AMPUL 0 0 0 0
141 THIAMIN 50 MG TABLET 930 0 930 320
142 UMBILICAL CORD PCS 0 0 0 0
143 USG GEL BOTOL 0 0 0 0
144 VITAMIN B KOMPLEKS TABLET 316 316
145 XYLOCAINE JELLY 2% TUBE 0 0 0 0
146 XYLOCAINE SPRAY TUBE 2 0 2 0
147 ZINK TAB DISPERSIBEL 20 MG TABLET 910 0 910 126

BPJS PUSTU BKIA LANSIA

JUMLAH KUNJUNGAN RESEP
283 15 0 20

DIKETAHUI, YANG MENYERAHKAN

KEPALA DINAS KESEHATAN TAP.TENGAH KEPALA SEKSI KEFARMASIAN

NURSYAM, SKM., M.Kes. LINNON BASTIAN L.RAJA, S.Farm.,Apt.

NIP. 19690909 199103 2 005 NIP. 19830419 200604 1 005
BAR PERMINTAAN OBAT
NULI TENGAH

LAPORAN BULAN / PERIODE JULI

PERMINTAAN BULAN / PERIODE :AGUSTUS
STOK PERMINTA PEMBERIAN
SISA STOK KET
OPTIMUM AN DAK PROP JUMLAH
8=(6-7) 9 10 11 12 13 14
0
130 100
161 100
3647 0
1 0
1 0
0 3
820 500
940 200
1751 500
53 50
1513 2000
0 50
227 1000
280 1000
180 500
6843 0
0 10
0 10
7385 0
550 0
560 0
0 0
0 5
320 300
9 10
30 0
5 0
0 2
5 0
105 1000
656 1000
1680 0
3 20
 266 2000
20 0
477 1000
50 0
669 1000
223 2000
910 0
80 50
29 20
329 1000
3 5
17 100
0 20
215 0
2 1000
0 2
0 1000
5 0
9 0
5 5
2 0
0 2
1052 0
122 0
28 0
335 500
0 10
212 200
0 200
50 200
0 30
40 10
30 0
0 10
95 1000
106 1000
18 0
34 0
0 30
334 0
0 20
4 10
15 0
17 0
453 500
 0 0
2 10
23 0
18 50
254 200
0 10
9 0
6 0
0 1000
0 0
21 10
147 500
153 500
1 1
30 100
1 10
4110 0
223 500
0 20
210 300
190 200
2813 0
46 0
12 10
0 2000
0 2000
2005 0
3 10
6 1000
0 0
11 5
43 50
8140 0
40 0
150 200
5 0
21 10
822 1000
5 0
0 5
18 50
0 5
6 5
3013 0
209 500
 0 2
0 1000
10 10
1 0
137 500
0 50
1 10
0 10
385 1000
11 50
240 100
0 3
17 20
0 0
282 500
0 0
610 200
0 20
0 2
316 2000
0 0
2 0
784 500

TDK ADA KARTU JUMLAH

220 538

G MENYERAHKAN YANG MEMINTA

SEKSI KEFARMASIAN PIMPINAN PUSKESMAS

TIAN L.RAJA, S.Farm.,Apt. dr. MARULI SILALAHI

830419 200604 1 005 NIP. 19830802 201001 1 020
AKAIAN DAN LEMBAR PERMINTAAN OBAT
ESMAS KAB. TAPANULI TENGAH

PUSKESMAS :PASARIBUTOBING LAPORAN BULAN / PERIODE

KECAMATAN :PASARIBUTOBING PERMINTAAN BULAN / PERIODE
NAMA STOK PENERIMA PERSEDIA PEMAKAI STOK PERMINTA
NO SATUAN SISA STOK OPTIMUM
OBAT AWAL AN AN AN AN

1 2 3 4 5 6 = (4 + 5 ) 7 8=(6-7) 9 10
1 AIR UNTUK BOTOL 0 0 0 0 0
2 ALAT SUNTIK SET 150 100 250 120 130 100
3 ALAT SUNTIK SET 161 100 261 50 211 0
4 ALCOHOL S PCS 3647 0 3647 400 3247 0
5 ALKACIDE 1BOTOL 1 0 1 0 1 0
6 ALKAZYME SAK 1 0 1 0 1 0
7 ALKOHOL 70BOTOL 0 1 1 1 0 1
8 ALOPURINOL TABLET 820 0 820 330 490 500
9 AMLODIPINTABLET 940 1500 2440 1100 1340 0
10 AMOKSISILIKAPLET 1751 500 2251 1688 563 1000
11 AMOKSISILIBOTOL 53 50 103 32 71 20
12 ANTACIDA DTAB.KUNYA 1513 1500 3013 1940 1073 2000
13 ANTACIDA DBOTOL 0 0 0 0 0 50
14 ASAM ASKOR TABLET 227 200 427 346 81 1000
15 ASAM ASKOR TABLET 280 300 580 395 185 1000
16 ASAM FOLATTABLET 180 0 180 100 80 200
17 ASAM MEFETABLET 6380 0 6380 3140 3240 0
18 ASEPTAN BOTOL 0 0 0 0 0 10
19 ASERING BOTOL 0 10 10 1 9 5
20 ASETIL SIST KAPSUL 7385 0 7385 1393 5992 0
21 ASIKLOVIR TABLET 468 0 468 0 468 0
22 ASIKLOVIR TABLET 450 0 450 10 440 0
23 ATROPIN INAMPUL 0 0 0 0 0 0
24 BEROTEC INBOTOL 0 1 1 0 1 2
25 BETAHISTINTABLET 320 300 620 0 620 0
26 BETAMETASO TUBE 9 0 9 7 2 10
27 BISAKODIL TABLET 0 30 30 0 30 0
28 BISAKODIL SUPP 5 0 5 1 4 0
29 BRACKET PCS 0 0 0 0 0 2
30 BURNAZIN (TUBE 5 0 5 0 5 0
31 CAPTOPRIL TABLET 105 500 605 270 335 1000
32 CAPTOPRIL TABLET 656 500 1156 520 636 1000
33 CAPTOPRIL TABLET 1680 0 1680 160 1520 0
34 CATGUT ADPCS 3 0 3 1 2 10
35 CEFADROXILKAPSUL 266 300 566 450 116 1000
36 CETIRIZINE BOTOL 20 0 20 0 20 0
37 CETIRIZINE TABLET 477 0 477 613 -136 1000
38 CHLORAMPHE TUBE 50 0 50 0 50 0
39 CHLORPHENTABLET 669 800 1469 1014 455 1000
40 CIPROFLOXATABLET 223 500 723 662 61 2000
41 CLINDAMYCCAPSUL 910 0 910 460 450 500
42 CODEIN 10 TABLET 80 0 80 0 80 0
43 COTRIMOXABOTOL 29 10 39 18 21 20
44 COTRIMOXATABLET 329 500 829 233 596 500
45 DARYANT T PCS 3 0 3 1 2 5
46 DEKSTROFEBOTOL 17 50 67 54 13 100
47 DENOMIX CTUBE 0 2 2 0 2 10
48 DEXAMETASO AMPUL 215 0 215 0 215 100
49 DEXAMETASTABLET 2 300 302 302 0 1000
50 DEXOCORT TUBE 0 0 0 0 0 2
51 DIAZEPAM TABLET 0 0 0 0 0 100
52 DIAZEPAM LTUBE 7 0 7 2 5 0
53 DOMPERIDOBOTOL 9 0 9 5 4 0
54 EPINEFRIN IAMPUL 5 20 25 0 25 0
55 EUGENOL BOTOL 2 0 2 0 2 0
56 FOLLEY CATSET 0 0 0 0 0 2
57 FUROSEMIDTABLET 1052 0 1052 105 947 0
58 GARAM ORASAK 122 0 122 0 122 0
59 GENTAMYCIN BOTOL 28 0 28 10 18 10
60 GLIMEPIRIDTABLET 335 500 835 15 820 0
61 GLUKOSA LABOTOL 500 0 3 3 0 3 10
62 GRISEOFULVTABLET 202 0 202 0 202 200
63 HANDSCHOON PCS 0 100 100 100 0 100
64 HANDSCHOO PCS 50 100 150 50 100 100
65 HANDSCHOPCS 0 5 5 5 0 10
66 HANDSCHOO PASANG 40 0 40 10 30 10
67 HIDROKLORT TABLET 230 0 230 0 230 0
68 HIDROKORTITUBE - 10 10 0 10 0
69 IBUPROFENTABLET 95 400 495 140 355 1000
70 IBUPROFENTABLET 106 400 506 60 446 500
71 IBUPROFENBOTOL 18 0 18 4 14 10
72 ILLIADIN ( BOTOL 34 0 34 0 34 0
73 INFUSION SSET 5 0 5 5 0 50
74 ISOSORBID TAB. SUBLI 334 0 334 0 334 0
75 IV TROVENOPCS 3 10 13 10 3 20
76 IV TROVENOPCS 9 5 14 5 9 10
77 IV TROVENOPCS 25 0 25 10 15 0
78 IV TROVENOPCS 17 0 17 1 16 0
79 KALSIUM LATABLET 453 300 753 140 613 500
80 KAPAS PEMPCS 1 1 1 0 2
81 KARBOGLISEBOTOL 2 0 2 2 0 10
82 KASA PEMBA ROL 23 0 23 1 22 0
83 KASSA HIDRKTK 23 20 43 20 23 50
84 KETOKONAZTABLET 254 200 454 124 330 200
85 KETOKONAZTUBE 0 0 0 0 0 10
86 KETOROLACAMPUL 9 0 9 4 5 10
87 KLORAMFENTUBE 5 GR 6 0 6 0 6 0
88 LANSOPRAZKAPSUL 152 550 702 277 425 500
89 LIDOKAIN 2% AMPUL 0 0 0 0 0 0
90 LIDOKAIN INAMPUL 21 0 21 10 11 10
91 LOPERAMIDTABLET 147 100 247 53 194 500
92 LORATADIN TABLET 153 100 253 54 199 500
93 LYSOL 1 LIT BOTOL 0 1 1 0 1 1
94 MASKER PCS 30 50 80 50 30 100
95 MEBENDAZO TABLET 0 2 2 1 1 10
96 METFORMIN TABLET 4110 0 4110 910 3200 0
97 METHYL PRTABLET 223 500 723 181 542 500
98 METIL ERGOAMPUL 0 50 50 50 0 0
99 METIL ERG TABLET 210 0 210 100 110 300
100 METOKLOPRTABLET 240 0 240 50 190 200
101 METRONIDATABLET 2813 0 2813 1603 1210 0
102 MIKONAZOLE TUBE 10 GR 46 0 46 10 36 0
103 NACL 0,9% BOTOL 500 12 10 22 0 22 10
104 NATRIUM DTABLET 0 200 200 200 0 2000
105 NATRIUM DTABLET 0 200 200 200 0 2000
106 NIFEDIPIN TABLET 2005 0 2005 820 1185 0
107 OKSITOSIN IAMPUL 3 10 13 13 0 10
108 OMEPRAZOLKAPSUL 6 650 656 317 339 500
109 ONDANSETRAMPUL 0 0 0 0 0 0
110 PARACETAMBOTOL 11 0 11 10 1 5
111 PARACETAMBOTOL 43 50 93 22 71 20
112 PARASETAMO TABLET 8140 0 8140 2795 5345 0
113 PHYTOMENA AMPUL 40 0 40 0 40 0
114 PHYTOMENA TABLET 150 200 350 100 250 100
115 PIRANTEL PBOTOL 5 0 5 0 5 0
116 PIRIDOKSINAMPUL 21 0 21 0 21 10
117 PIRIDOKSINTABLET 822 1000 1822 402 1420 200
118 PLESTER IS ROL 5 0 5 1 4 0
119 PLESTER PHROL 0 0 0 0 0 5
120 PLESTER POLROL 18 0 18 10 8 50
121 POVIDON IOBOTOL 1 1 2 1 1 5
122 POVIDONE IBOTOL 6 0 6 0 6 5
123 PREDNISONTABLET 3013 1000 4013 2885 1128 0
124 NEW DIATABTABLET 209 0 209 29 180 500
125 PULMICORTTURB 0 0 0 0 0 2
 126 RANITIDINETABLET 0 0 0 0 0 1000
127 RINGER LACBOTOL 500 10 5 15 6 9 10
128 SAFETY BOXPCS 0 1 1 0 1 0
129 SALBUTAMOTABLET 137 800 937 250 687 500
130 SALBUTAMOBOTOL 0 0 0 0 0 50
131 SALISIL BE SAK 1 0 1 0 1 10
132 SCABIMITE TUBE 0 2 2 0 2 10
133 SIANOKOBAL TABLET 385 800 1185 1130 55 1000
134 SIANOKOBAL AMPUL 11 20 31 4 27 20
135 SIMVASTATITABLET 240 0 240 60 180 100
136 SOFTAMAN BOTOL
H 0 3 3 2 1 3
137 SUCRALFAT BOTOL 30 0 30 13 17 20
138 SYMBICORTTURB 0 1 1 0 1 0
139 TABLET TA TABLET 282 900 1182 180 1002 0
140 TETAGAM P.AMPUL 0 0 0 0 0 0
141 THIAMIN 5 TABLET 610 500 1110 230 880 0
142 UMBILICAL PCS 0 10 10 10 0 10
143 USG GEL BOTOL 0 1 1 1 0 2
144 VITAMIN B TABLET 316 0 316 672 -356 2000
145 XYLOCAINE TUBE 0 0 0 0 0 0
146 XYLOCAINE TUBE 2 0 2 0 2 0
147 ZINK TAB D TABLET 784 0 784 50 734 500

JUMLAH KUNJUNGAN RESEP BPJS PUSTU BKIA LANSIA TDK ADA KART JUMLAH
207 20 0 25 220 472

DIKETAHUI, YANG MENYERAHKAN

KEPALA DINAS KESEHATAN TAP.TENGAH KEPALA SEKSI KEFARMASIAN

NURSYAM, SKM., M.Kes. LINNON BASTIAN L.RAJA, S.Farm.,Apt.

NIP. 19690909 199103 2 005 NIP. 19830419 200604 1 005 NIP. 19830802 201001 1 020
AGUSTUS
SEPTEMBER
PEMBERIA KET
N
DAK PROP JUMLAH
11 12 13 14
 YANG MEMINTA
PIMPINAN PUSKESMAS

dr. MARULI SILALAHI

NIP. 19830802 201001 1 020
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS KAB. TAPANULI TENGAH

PUSKESMAS :PASARIBUTOBING LAPORAN BULAN / PERIO

KECAMATAN :PASARIBUTOBING PERMINTAAN BULAN / P
STOK PENERIMA PERSEDIA PEMAKAI SISA STOK
NO NAMA OBAT SATUAN AWAL AN AN AN

1 2 3 4 5 6 = (4 + 5 ) 7 8=(6-7)
1 AIR UNTUK INJEKSI BOTOL 0 0 0 0 0
2 ALAT SUNTIK DISP. 3 ML SET 130 100 230 0 230
3 ALAT SUNTIK DISP. 5 ML SET 161 0 161 50 111
4 ALCOHOL SWAB PCS 4747 1000 5747 5481 266
5 ALKACIDE 1 LITER BOTOL 1 0 1 1 0
6 ALKAZYME SAK 1 0 1 0 1
7 ALKOHOL 70% 1 LITER BOTOL 0 1 1 0 1
8 ALOPURINOL 100 MG TABLET 470 300 790 430 360
9 AMLODIPIN 5 MG TABLET 2050 0 2050 1280 770
10 AMOKSISILIN 500 MG KAPLET 808 1000 1808 1079 729
11 AMOKSISILIN SYRUP KERING FORTE 250MG BOTOL 24 100 124 50 74
12 ANTACIDA DOEN I TAB TAB.KUNYA -40 3000 2960 1828 1132
13 ANTACIDA DOEN II SUSPENSI BOTOL 0 0 0 0 0
14 ASAM ASKORBAT (VIT C) 250 MG TABLET 128 300 381 381 0
15 ASAM ASKORBAT (VIT C) 50 MG TABLET 3 800 803 437 366
16 ASAM FOLAT (A FOLAT) 0,4 MG TABLET 60 200 260 210 50
17 ASAM MEFENAMAT 500 MG TABLET 2005 0 2005 2005 0
18 ASEPTAN BOTOL 0 0 0 0 0
19 ASERING BOTOL 6 10 16 11 5
20 ASETIL SISTEIN 200 MG KAPSUL 8157 0 8157 7692 465
21 ASIKLOVIR TABLET 200 MG TABLET 468 0 468 100 368
22 ASIKLOVIR TABLET 400 MG TABLET 420 0 420 120 300
23 ATROPIN INJEKSI 0,35 MG/ ML AMPUL 0 0 0 0 0
24 BEROTEC INHALER BOTOL 0 1 1 0 1
25 BETAHISTIN TAB 6 MG TABLET 320 180 500 140 360
26 BETAMETASON KRIM 0,1% (SBG VALERAT) TUBE 2 0 2 2 0
27 BISAKODIL 5 MG TABLET (DULCOLAX) TABLET 30 0 30 0 30
28 BISAKODIL SUSP (DULCOLAX SUPP) SUPP 4 0 4 2 2
29 BRACKET PCS 0 0 0 0 0
30 BURNAZIN (PERAK SULFADIAZIN KRIM 1%) TUBE 4 0 4 4 0
31 CAPTOPRIL 12,5 MG TABLET 5 0 5 0 5
32 CAPTOPRIL 25 MG TABLET 416 500 916 806 110
33 CAPTOPRIL 50 MG TABLET 1300 1000 2300 780 1520
34 CATGUT ADVANTIME PCS 5 5 10 7 3
35 CEFADROXIL KAPSUL 500 MG KAPSUL 6 200 206 204 2
36 CETIRIZINE SYRUP BOTOL 19 0 19 16 3
37 CETIRIZINE TABLET TABLET 70 0 70 70 0
38 CHLORAMPHENICOL SALEP KULIT 2% (BUFACTUBE 48 0 48 36 12
39 CHLORPHENIRAMIN MALEAT (CTM) TABLET 565 1700 2265 1590 675
40 CIPROFLOXACIN 500 MG TABLET 100 1100 1200 960 240
41 CLINDAMYCIN 300 MG CAPSUL 420 100 520 350 170
42 CODEIN 10 MG TABLET 80 0 80 0 80
43 COTRIMOXAZOLE SUSPENSI BOTOL 16 20 36 8 28
44 COTRIMOXAZOLE TABLET DEWASA 480 mg TABLET 388 200 588 413 175
45 DARYANT TULE PCS 1 2 3 1 2
46 DEKSTROFEN SYRUP BOTOL 36 20 56 47 9
47 DENOMIX CREAM 10 GRAM TUBE 0 0 0 0 0
48 DEXAMETASONE INJEKSI IV/IM 5MG/ML AMPUL 215 10 225 216 9
49 DEXAMETASONE TABLET 0,5 MG TABLET 0 0 0 0 0
50 DEXOCORT KRIM TUBE 0 0 0 0 0
51 DIAZEPAM 2 MG TABLET 0 0 0 0 0
52 DIAZEPAM LAR.REKTAL (STESOLID) 10MG/2 TUBE 0 1 1 1 1
53 DOMPERIDON SYRUP BOTOL 14 0 14 3 11
54 EPINEFRIN INJEKSI AMPUL 25 0 25 0 25
55 EUGENOL BOTOL 2 0 2 0 2
56 FOLLEY CATHETER SET 0 0 0 0 0
57 FUROSEMID 40 MG TABLET 862 0 862 410 452
58 GARAM ORALIT SAK 122 0 122 122 0
59 GENTAMYCIN TETES MATA 0,3% BOTOL 23 25 48 23 25
60 GLIMEPIRID 2 MG TABLET 555 0 555 290 265
61 GLUKOSA LARUTAN INFUS 5% STERIL BOTOL 500 0 0 0 2 -2
62 GRISEOFULVIN 125 MG TAB TABLET 182 0 182 30 152
63 HANDSCHOON NON STERIL L PCS 50 0 50 20 30
64 HANDSCHOON NON STERIL M PCS 100 0 100 50 50
65 HANDSCHOON OBSGYN PCS 0 5 5 5 0
66 HANDSCHOON STERIL PASANG 30 0 30 10 20
67 HIDROKLORTIAZID 25 MG TABLET 230 0 230 0 230
68 HIDROKORTISON 2,5% KRIM TUBE 10 0 10 10 0
69 IBUPROFEN 200 MG TABLET TABLET 452 300 752 410 342
70 IBUPROFEN 400 MG TABLET TABLET 446 300 746 350 396
71 IBUPROFEN SYR 100MG/5ML BOTOL 13 0 13 1 12
72 ILLIADIN (OKSIMETAZOLIN) TETES HIDUNG 0BOTOL 34 0 34 21 13
73 INFUSION SET DEWASA SET 8 20 28 13 15
74 ISOSORBID DINITRAT 5MG (FASORBID) TAB. SUBLI 334 0 334 120 214
75 IV TROVENOCATH 18 PCS 3 5 8 5 3
76 IV TROVENOCATH 20 PCS 9 5 14 10 4
77 IV TROVENOCATH 22 PCS 15 5 20 11 9
78 IV TROVENOCATH 24 PCS 16 0 16 1 15
79 KALSIUM LAKTAT 500 MG TABLET 491 500 991 487 504
80 KAPAS PEMBALUT 250 GRAM PCS 0 3 3 1 2
81 KARBOGLISERIN TETES TELINGA 10% BOTOL 1 2 3 0 3
82 KASA PEMBALUT HIDROFIL 4 M X 15 CM ROL 17 0 17 5 12
83 KASSA HIDROFIL STERIL 16X16 KTK 23 30 53 25 28
84 KETOKONAZOLE 200 MG TABLET 310 200 510 300 210
85 KETOKONAZOLE KRIM TUBE 0 0 0 0 0
86 KETOROLAC INJEKSI 30 MG/ML AMPUL 9 0 9 0 9
87 KLORAMFENIKOL SALEP MATA 1% TUBE 5 GR 6 0 6 0 6
88 LANSOPRAZOLE 30 MG KAPSUL 150 250 400 400 0
89 LIDOKAIN 2% + EPINEFRIN 1 : 80.000 AMPUL 0 0 0 0 0
90 LIDOKAIN INJEKSI 2% (HCL) AMPUL 11 10 21 10 11
91 LOPERAMIDE TAB 2 MG TABLET 322 100 422 145 277
92 LORATADINE 10 MG TABLET 19 100 119 119 0
93 LYSOL 1 LITER BOTOL 2 0 2 1 1
94 MASKER PCS 30 50 80 50 30
95 MEBENDAZOLE 500 MG (VERMOX) TABLET 1 0 1 0 1
96 METFORMIN 500 MG TABLET 3060 0 3060 670 2390
97 METHYL PREDNISOLON 4 MG TABLET 351 0 351 220 131
98 METIL ERGOMETRIN INJEKSI 0,2MG/ML AMPUL 10 10 20 20 0
99 METIL ERGOMETRIN MALEAT 0,175 MG TABLET 110 0 110 100 10
100 METOKLOPRAMID 5 MG TABLET TABLET 170 0 170 30 140
101 METRONIDAZOLE 500 MG TABLET 3538 0 3538 1663 1875
102 MIKONAZOLE KRIM 2% (SBG NITRAT) TUBE 10 GR 18 0 18 14 4
103 NACL 0,9% LARUTAN INFUS BOTOL 500 9 7 16 6 10
104 NATRIUM DIKLOFENAK 25 MG TABLET 150 500 650 380 270
105 NATRIUM DIKLOFENAK 50 MG TABLET 20 500 520 480 40
106 NIFEDIPIN 10 MG TAB TABLET 2185 0 2185 1000 1185
107 OKSITOSIN INJEKSI AMPUL 0 10 10 10 0
108 OMEPRAZOLE 20 MG CAPSUL KAPSUL 199 250 449 389 60
109 ONDANSETRON INJEKSI 2MG/ ML AMPUL 0 0 0 0 0
110 PARACETAMOL DROP 100MG/ML BOTOL 10 0 10 10 0
111 PARACETAMOL SYRUP 120MG/5ML BOTOL 29 50 79 54 25
112 PARASETAMOL TABLET 500 MG TABLET 3992 0 3992 3304 688
113 PHYTOMENADION INJEKSI AMPUL 40 0 40 30 10
114 PHYTOMENADION TABLET TABLET 250 0 250 130 120
115 PIRANTEL PAMOAT SUSPENSI 125 MG BOTOL 5 0 5 0 5
116 PIRIDOKSIN (VIT B6) INJEKSI AMPUL 20 0 20 3 17
117 PIRIDOKSIN (VIT B6) TAB 10 MG (HCL) TABLET 861 2000 2861 973 1888
118 PLESTER ISOPLAST 5YARD X 2 INCH ROL 4 0 4 0 4
119 PLESTER PHARMAFIX 10 CM X 500 CM ROL 0 0 0 0 0
120 PLESTER POLIFIX 5 CM X 1 M ROL 18 10 28 13 15
121 POVIDON IODIDA 10% 300 ML BOTOL 1 1 2 1 1
122 POVIDONE IODIDA 10% 60 ML BOTOL 4 0 4 4 0
123 PREDNISON 5 MG TABLET 1503 2000 3503 1960 1543
124 NEW DIATABS(ATTAPULGIT) TABLET 600 MG TABLET 177 0 177 22 155
125 PULMICORT TURBUHALER 200 TURB 0 0 0 0 0
126 RANITIDINE TABLET 150 MG TABLET 0 0 0 0 0
127 RINGER LACTAT LARUTAN INFUS BOTOL 500 1 0 1 1 0
128 SAFETY BOX PCS 1 1 2 2 0
129 SALBUTAMOL 4 MG TABLET 667 500 1167 345 822
130 SALBUTAMOL SYRUP (SALBRON) BOTOL 0 0 0 0 0
131 SALISIL BEDAK SERBUK 2% SAK 10 5 15 0 15
132 SCABIMITE CREAM TUBE 2 0 2 0 2
133 SIANOKOBALAMIN (VIT B12) 50 MCG TABLET 5 500 505 310 195
134 SIANOKOBALAMIN (VIT B12) INJ 500MCG AMPUL 3 10 13 13 0
 135 SIMVASTATIN TABLET 10 MG TABLET 180 100 280 50 230
136 SOFTAMAN HAND 1 LITER BOTOL 1 1 2 1 1
137 SUCRALFAT SUSPENSI ( ULSAFATE) BOTOL 12 20 32 8 24
138 SYMBICORT TURBUHALER 180 TURB 0 0 0 0 0
0 TABLET TAMBAH DARAH TABLET 670 600 1270 538 732
140 TETAGAM P. SYRINGE 1 ML AMPUL 0 0 0 0 0
141 THIAMIN 50 MG TABLET 700 0 700 310 390
142 UMBILICAL CORD PCS 0 10 10 10 0
143 USG GEL BOTOL 0 0 0 0 0
144 VITAMIN B KOMPLEKS TABLET -40 1000 960 686 274
145 XYLOCAINE JELLY 2% TUBE 0 0 0 0 0
146 XYLOCAINE SPRAY TUBE 2 0 2 0 2
147 ZINK TAB DISPERSIBEL 20 MG TABLET 669 0 669 73 596
148 ANTIHEMOROID SUPP 0 2 2 0 2
149 KETOPROPEN SUPP 0 2 2 0 2
150 KALSITROL(OSTOVEL MK) KAPSUL 0 30 30 7 23
151 METOKLOPRAMID 2MG DROP 0 2 2 0 2
152 RISTONATE TABLET 0 8 8 3 5
153 RANITIDINE INJ 4 10 14 6 8
154 SILK BLACK PCS 8 0 8 3 5

JUMLAH KUNJUNGAN RESEP BPJS PUSTU BKIA LANSIA TDK ADA KART

230 20 0 25 227

DIKETAHUI, YANG MENYERAHKAN

KEPALA DINAS KESEHATAN TAP.TENGAH KEPALA SEKSI KEFARMASIAN

NURSYAM, SKM., M.Kes. LINNON BASTIAN L.RAJA, S.Farm.,Apt.

NIP. 19690909 199103 2 005 NIP. 19830419 200604 1 005
RMINTAAN OBAT

LAPORAN BULAN / PERIODE OKTOBER

PERMINTAAN BULAN / PERIODE NOVEMBER
STOK PERMINTA PEMBERIA KET
OPTIMUM AN N
DAK PROP JUMLAH
9 10 11 12 13 14

0
0
0
0
0
1
500
0
1000
25
2000
50
1000
800
300
2000
10
10
1000
0
0
0
2
0
10
0
0
5
10
1000
1000
0
10
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10
1000
10
1000
1500
200
0
10
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2
50
10
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1000
2
100
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0
0
2
100
100
10
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0
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20
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10
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 0
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 100
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1
0
0
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0
0
2000
0
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0
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0
0
0
10
0

JUMLAH
502

YANG MEMINTA
PIMPINAN PUSKESMAS

A, S.Farm.,Apt. dr. MARULI SILALAHI

NIP. 19830802 201001 1 020
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
PUSKESMAS KAB. TAPANULI TENGAH

PUSKESMAS :PASARIBUTOBING LAPORAN BULAN / PERIODE

KECAMATAN :PASARIBUTOBING PERMINTAAN BULAN / PERIODE
NAMA STOK PENERIMA PERSEDIA PEMAKAI SISA STOK STOK PERMINTA
NO SATUAN
OBAT AWAL AN AN AN OPTIMUM AN

1 2 3 4 5 6 = (4 + 5 ) 7 8=(6-7) 9 10
1 AIR UNTUK BOTOL 0 0 0 0 0
2 ALAT SUNTIK SET 130 100 230 0 230 0
3 ALAT SUNTIK SET 161 0 161 50 111 0
4 ALCOHOL S PCS 4747 1000 5747 5481 266 0
5 ALKACIDE 1BOTOL 1 0 1 1 0 0
6 ALKAZYME SAK 1 0 1 0 1 0
7 ALKOHOL 70BOTOL 0 1 1 0 1 1
8 ALOPURINOL TABLET 470 300 790 430 360 500
9 AMLODIPINTABLET 2050 0 2050 1280 770 0
10 AMOKSISILIKAPLET 808 1000 1808 1079 729 1000
11 AMOKSISILIBOTOL 24 100 124 50 74 25
12 ANTACIDA DTAB.KUNYA -40 3000 2960 1828 1132 2000
13 ANTACIDA DBOTOL 0 0 0 0 0 50
14 ASAM ASKOR TABLET 128 300 381 381 0 1000
15 ASAM ASKOR TABLET 3 800 803 437 366 800
16 ASAM FOLATTABLET 60 200 260 210 50 300
17 ASAM MEFETABLET 2005 0 2005 2005 0 2000
18 ASEPTAN BOTOL 0 0 0 0 0 10
19 ASERING BOTOL 6 10 16 11 5 10
20 ASETIL SIST KAPSUL 8157 0 8157 7692 465 1000
21 ASIKLOVIR TABLET 468 0 468 100 368 0
22 ASIKLOVIR TABLET 420 0 420 120 300 0
23 ATROPIN INAMPUL 0 0 0 0 0 0
24 BEROTEC INBOTOL 0 1 1 0 1 2
25 BETAHISTINTABLET 320 180 500 140 360 0
26 BETAMETASO TUBE 2 0 2 2 0 10
27 BISAKODIL TABLET 30 0 30 0 30 0
28 BISAKODIL SUPP 4 0 4 2 2 0
29 BRACKET PCS 0 0 0 0 0 5
30 BURNAZIN (TUBE 4 0 4 4 0 10
31 CAPTOPRIL TABLET 5 0 5 0 5 1000
32 CAPTOPRIL TABLET 416 500 916 806 110 1000
33 CAPTOPRIL TABLET 1300 1000 2300 780 1520 0
34 CATGUT ADPCS 5 5 10 7 3 10
35 CEFADROXILKAPSUL 6 200 206 204 2 1000
36 CETIRIZINE BOTOL 19 0 19 16 3 10
37 CETIRIZINE TABLET 70 0 70 70 0 1000
38 CHLORAMPHE TUBE 48 0 48 36 12 10
39 CHLORPHENTABLET 565 1700 2265 1590 675 1000
40 CIPROFLOXATABLET 100 1100 1200 960 240 1500
41 CLINDAMYCCAPSUL 420 100 520 350 170 200
42 CODEIN 10 TABLET 80 0 80 0 80 0
43 COTRIMOXABOTOL 16 20 36 8 28 10
44 COTRIMOXATABLET 388 200 588 413 175 500
45 DARYANT T PCS 1 2 3 1 2 2
46 DEKSTROFEBOTOL 36 20 56 47 9 50
47 DENOMIX CTUBE 0 0 0 0 0 10
48 DEXAMETASO AMPUL 215 10 225 216 9 10
49 DEXAMETASTABLET 0 0 0 0 0 1000
50 DEXOCORT TUBE 0 0 0 0 0 2
51 DIAZEPAM TABLET 0 0 0 0 0 100
52 DIAZEPAM LTUBE 0 1 1 1 1 0
53 DOMPERIDOBOTOL 14 0 14 3 11 5
54 EPINEFRIN IAMPUL 25 0 25 0 25 0
55 EUGENOL BOTOL 2 0 2 0 2 0
56 FOLLEY CATSET 0 0 0 0 0 2
57 FUROSEMIDTABLET 862 0 862 410 452 100
58 GARAM ORASAK 122 0 122 122 0 100
59 GENTAMYCIN BOTOL 23 25 48 23 25 10
60 GLIMEPIRIDTABLET 555 0 555 290 265 0
61 GLUKOSA LABOTOL 500 0 0 0 2 -2 10
62 GRISEOFULVTABLET 182 0 182 30 152 200
63 HANDSCHOON PCS 50 0 50 20 30 50
64 HANDSCHOO PCS 100 0 100 50 50 0
65 HANDSCHOPCS 0 5 5 5 0 5
66 HANDSCHOO PASANG 30 0 30 10 20 0
67 HIDROKLORT TABLET 230 0 230 0 230 0
68 HIDROKORTITUBE 10 0 10 10 0 20
69 IBUPROFENTABLET 452 300 752 410 342 500
70 IBUPROFENTABLET 446 300 746 350 396 500
71 IBUPROFENBOTOL 13 0 13 1 12 10
72 ILLIADIN ( BOTOL 34 0 34 21 13 5
73 INFUSION SSET 8 20 28 13 15 0
74 ISOSORBID TAB. SUBLI 334 0 334 120 214 0
75 IV TROVENOPCS 3 5 8 5 3 10
76 IV TROVENOPCS 9 5 14 10 4 10
77 IV TROVENOPCS 15 5 20 11 9 10
78 IV TROVENOPCS 16 0 16 1 15 0
79 KALSIUM LATABLET 491 500 991 487 504 500
80 KAPAS PEMPCS 0 3 3 1 2 2
81 KARBOGLISEBOTOL 1 2 3 0 3 5
82 KASA PEMBA ROL 17 0 17 5 12 0
83 KASSA HIDRKTK 23 30 53 25 28 50
84 KETOKONAZTABLET 310 200 510 300 210 200
85 KETOKONAZTUBE 0 0 0 0 0 10
86 KETOROLACAMPUL 9 0 9 0 9 10
87 KLORAMFENTUBE 5 GR 6 0 6 0 6 0
88 LANSOPRAZKAPSUL 150 250 400 400 0 1000
89 LIDOKAIN 2% AMPUL 0 0 0 0 0 0
90 LIDOKAIN INAMPUL 11 10 21 10 11 10
91 LOPERAMIDTABLET 322 100 422 145 277 200
92 LORATADIN TABLET 19 100 119 119 0 500
93 LYSOL 1 LIT BOTOL 2 0 2 1 1 1
94 MASKER PCS 30 50 80 50 30 0
95 MEBENDAZO TABLET 1 0 1 0 1 10
96 METFORMIN TABLET 3060 0 3060 670 2390 0
97 METHYL PRTABLET 351 0 351 220 131 500
98 METIL ERGOAMPUL 10 10 20 20 0 5
99 METIL ERG TABLET 110 0 110 100 10 300
100 METOKLOPRTABLET 170 0 170 30 140 200
101 METRONIDATABLET 3538 0 3538 1663 1875 0
102 MIKONAZOLE TUBE 10 GR 18 0 18 14 4 10
103 NACL 0,9% BOTOL 500 9 7 16 6 10 10
104 NATRIUM DTABLET 150 500 650 380 270 1000
105 NATRIUM DTABLET 20 500 520 480 40 2000
106 NIFEDIPIN TABLET 2185 0 2185 1000 1185 0
107 OKSITOSIN IAMPUL 0 10 10 10 0 10
108 OMEPRAZOLKAPSUL 199 250 449 389 60 500
109 ONDANSETRAMPUL 0 0 0 0 0 0
110 PARACETAMBOTOL 10 0 10 10 0 5
111 PARACETAMBOTOL 29 50 79 54 25 50
112 PARASETAMO TABLET 3992 0 3992 3304 688 1000
113 PHYTOMENA AMPUL 40 0 40 30 10 0
114 PHYTOMENA TABLET 250 0 250 130 120 0
115 PIRANTEL PBOTOL 5 0 5 0 5 0
116 PIRIDOKSINAMPUL 20 0 20 3 17 10
117 PIRIDOKSINTABLET 861 2000 2861 973 1888 0
118 PLESTER IS ROL 4 0 4 0 4 0
119 PLESTER PHROL 0 0 0 0 0 5
120 PLESTER POLROL 18 10 28 13 15 20
121 POVIDON IOBOTOL 1 1 2 1 1 2
122 POVIDONE IBOTOL 4 0 4 4 0 5
123 PREDNISONTABLET 1503 2000 3503 1960 1543 0
124 NEW DIATABTABLET 177 0 177 22 155 200
 125 PULMICORTTURB 0 0 0 0 0 2
126 RANITIDINETABLET 0 0 0 0 0 1000
127 RINGER LACBOTOL 500 1 0 1 1 0 20
128 SAFETY BOXPCS 1 1 2 2 0 2
129 SALBUTAMOTABLET 667 500 1167 345 822 500
130 SALBUTAMOBOTOL 0 0 0 0 0 50
131 SALISIL BE SAK 10 5 15 0 15 0
132 SCABIMITE TUBE 2 0 2 0 2 5
133 SIANOKOBAL TABLET 5 500 505 310 195 1000
134 SIANOKOBAL AMPUL 3 10 13 13 0 50
135 SIMVASTATITABLET 180 100 280 50 230 100
136 SOFTAMAN BOTOL
H 1 1 2 1 1 1
137 SUCRALFAT BOTOL 12 20 32 8 24 20
138 SYMBICORTTURB 0 0 0 0 0 1
0 TABLET TA TABLET 670 600 1270 538 732 0
140 TETAGAM P.AMPUL 0 0 0 0 0 0
141 THIAMIN 5 TABLET 700 0 700 310 390 500
142 UMBILICAL PCS 0 10 10 10 0 0
143 USG GEL BOTOL 0 0 0 0 0 0
144 VITAMIN B TABLET -40 1000 960 686 274 2000
145 XYLOCAINE TUBE 0 0 0 0 0 0
146 XYLOCAINE TUBE 2 0 2 0 2 0
147 ZINK TAB D TABLET 669 0 669 73 596 100
148 ANTIHEMORSUPP 0 2 2 0 2 0
149 KETOPROPESUPP 0 2 2 0 2 0
150 KALSITROL(KAPSUL 0 30 30 7 23 0
151 METOKLOP DROP 0 2 2 0 2 0
152 RISTONATE TABLET 0 8 8 3 5 0
153 RANITIDINEINJ 4 10 14 6 8 10
154 SILK BLACK PCS 8 0 8 3 5 0

JUMLAH KUNJUNGAN RESEP BPJS PUSTU BKIA LANSIA TDK ADA KART JUMLAH
230 20 0 25 227 502

DIKETAHUI, YANG MENYERAHKAN

KEPALA DINAS KESEHATAN TAP.TENGAH KEPALA SEKSI KEFARMASIAN

NURSYAM, SKM., M.Kes. LINNON BASTIAN L.RAJA, S.Farm.,Apt.

NIP. 19690909 199103 2 005 NIP. 19830419 200604 1 005
NOVEMBER
DESEMBER
PEMBERIA KET
N
DAK PROP JUMLAH
11 12 13 14
 YANG MEMINTA
PIMPINAN PUSKESMAS

dr. MARULI SILALAHI

NIP. 19830802 201001 1 020