LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

(LPLPO)

Unit Penerima : Puskesmas Sukaraja Tiga Bulan : Februari

Kecamatan : Marga Tiga Tahun : 2019
Kabupaten : Lampung Timur
Provinsi : Lampung

Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok

247 ALLOPURINOL TABLET 100 MG TABLET 5,020

415 AMINOPHYLLINE INJEKSI 24 MG/ML AMPUL 0

444 AMITRIPTYLINE TABLET 25 MG TABLET 300

445 AMLODIPINE TABLET 10 MG TABLET 6,000
446 AMLODIPINE TABLET 5 MG TABLET 85

523 AMOXYCILLIN SIRUP 250 MG/5 ML SIRUP 1,311

809 ANTACIDA TABLET 400 MG TABLET 34,400

966 ASAM MEFENAMAT TABLET 500 MG TABLET 22,430

ASCORBIC ACID (VITAMIN C) TABLET

923 TABLET 1,300
250 MG
ASCORBIC ACID (VITAMIN C) TABLET
926 TABLET 8,500
50 MG
1479 BENZOIC ACID SALEP SALEP 0

1690 BISACODYL SUPPOSITORIA 10 MG SUPPOS 214

1691 BISACODYL SUPPOSITORIA 5 MG SUPPOS 117

 BISMUTH SUBGALLATE|ZINC OXIDE|
1702 LIDOCAINE|HEXACHLOROPHENE SUPPOS 0
SUPPOSITORIA 2 G

CALCIUM CHLORIDE DIHYDRATE|

10160 POTASSIUM CHLORIDE|SODIUM INFUS 0
CHLORIDE|SODIUM LACTATE INFUS

2005 CALCIUM LACTATE TABLET 500 MG TABLET 9,300

2084 CARBAMAZEPINE TABLET 200 MG TABLET 200

2518 CETIRIZINE SIRUP 5 MG/ML SIRUP 40

2546 CETIRIZINE TABLET 10 MG TABLET 140
2601 CHLORAMPHENICOL SALEP 2% SALEP 60
CHLORAMPHENICOL SIRUP 125
2593 SIRUP 102
MG/5ML

2745 CHLORPHENIRAMINE TABLET 4 MG TABLET 55,600

2762 CHLORPROMAZINE TABLET 100 MG TABLET 100

2763 CHLORPROMAZINE TABLET 25 MG TABLET 0

2828 CIPROFLOXACIN TABLET 500 MG TABLET 11,200

CLAVULANIC ACID|AMOXICILLIN
2967 TABLET 0
TABLET 500 MG

3202 COTRIMOXAZOLE SIRUP 240 MG/5 ML SIRUP 0

6645 COTRIMOXAZOLE TABLET TABLET 0

3416 DEXAMETHASONE INJEKSI 5 MG/ML INJEKSI 8

3443 DEXAMETHASONE TABLET 0.5 MG TABLET 9,500

3688 DICLOFENAC SODIUM TABLET 25 MG TABLET 9,050

3690 DICLOFENAC SODIUM TABLET 50 MG TABLET 5,450

3983 DOMPERIDONE TABLET 10 MG TABLET 4,100

4306 EPINEPHRINE INJEKSI 1 MG/ML INJEKSI 0

4445 ERYTHROMYCIN SIRUP 200 MG/5 ML SIRUP 32

4458 ERYTHROMYCIN TABLET 250 MG TABLET 2,100

4492 ESOMEPRAZOLE TABLET 20 MG TABLET 0
FENOTEROL HYDROBROMIDE SPRAY
4736 SPRAY 0
100 MCG
945 FOLIC ACID TABLET 400 MCG TABLET 0

5079 FUSIDATE SODIUM SALEP 20 MG/G SALEP 0

5167 GENTAMYCIN SALEP 0.3 % SALEP 0

5266 GLIMEPIRIDE TABLET 2 MG TABLET 3,900
5300 GLUCOSE INFUS 5 % INFUS 0
5843 HYDROCORTISONE SALEP 2.5 % SALEP 262
5964 IBUPROFEN TABLET 200 MG TABLET 700
5966 IBUPROFEN TABLET 400 MG TABLET 0
INTRAVASCULAR ADMINISTRATION
AK0902022 0 0
SET

IPRATROPIUM BROMIDE|
6238 LIQUID 0
SALBUTAMOL SULPHATE LIQUID

AK9005688 IV CATHETER NO 20 0 0
AK9005689 IV CATHETER NO 22 0 0
AK9005690 IV CATHETER NO 24 0 0
6535 KETOCONAZOLE SALEP 2% SALEP 17
 LEVODOPA|BENSERAZIDE TABLET 100
6812 TABLET 0
MG
6887 LIDOCAINE INJEKSI 20 MG/ML INJEKSI 146
6998 LOPERAMIDE TABLET 2 MG TABLET 800
7013 LORATADINE TABLET 10 MG TABLET 1,150
7491 METFORMIN TABLET 500 MG TABLET 3,000
METHYLERGOMETRINE INJEKSI 0.2
7536 INJEKSI 0
MG/ML

7586 METHYLPREDNISOLONE TABLET 8 MG TABLET 0

7651 METOCLOPRAMIDE TABLET 10 MG TABLET 500

7688 METRONIDAZOLE SIRUP 125 MG/5 ML SIRUP 50

7697 METRONIDAZOLE TABLET 500 MG TABLET 200

7727 MICONAZOLE SALEP 2% SALEP 0

8160 NIFEDIPINE TABLET 10 MG TABLET 100
8256 NYSTATIN OVULA 10000 IU OVULA 100

8573 PARACETAMOL DROPS 100 MG/ML DROPS 50

8601 PARACETAMOL SIRUP 120 MG/5 ML SIRUP 1,302

8593 PARACETAMOL TABLET 500 MG TABLET 57,300

9246 PHENYTOIN TABLET 100 MG TABLET 200
AK0902040 PISTON SYRINGE 0 0
9673 PROPANOLOL TABLET 10 MG TABLET 200
PYRAZINAMIDE|ETHAMBUTOL|
9805 TABLET 0
ISONIAZID|RIFAMPICIN TABLET
1684 PYRIDOXINE TABLET 10 MG TABLET 7,600

11896 RETINOL PALMITATE TABLET 100000 IU TABLET 0

 RIFAMPICIN|ISONIAZID TABLET 75 MG|
10128 TABLET 0
50 MG
AK9008969 SARUNG TANGAN STERIL NO 7 0 0
AK9008970 SARUNG TANGAN STERIL NO 7.5 0 0
10482 SIMVASTATIN TABLET 10 MG TABLET 5,980
SULFAMETHOXAZOLE|
10908 TABLET 0
TRIMETHOPRIM TABLET 400 MG|80 MG
SYRINGE ACTUATOR FOR AN
AK0501030 0 0
INJEKTOR
990 TRANEXAMIC ACID INJEKSI 5 ML INJEKSI 50
TUBERCULIN PPD TABLET 10 TU/0.1
11719 TABLET 0
ML
11922 VITAMIN B COMPOUND TABLET TABLET 1,400

12189 ZINC SULPHATE SIRUP 20 MG/5 ML SIRUP 0

Obat Tambahan

Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok

ALAT SUNTIK SEKALI PAKAI 0,5 ML PCS 30

ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0

ALAT SUNTIK SEKALI PAKAI 2,5 ML PCS 0

ALAT SUNTIK SEKALI PAKAI 5 ML PCS 0

ALAT SUNTIK SEKALI PAKAI 3 ML PCS 1,743

ALBENDAZOLE TAB TABLET 390

ANTASID SUSPENSI SIRUP 90
ANTIFUNGI DOEN KOMBINASI SALEP 116
ANTIHEMOROID KOMB. SUPOSOTORIA
SUPPO 8
2 MG
AMOXICILLIN SIRUP KERING 125
BOTOL 642
MG/5ML
AMOXICILLIN TABLET 500 MG TABLET 64,550
AMININOFILIN TABLET 200 MG TABLET 0
ASAM ASETILSALISILAT (ACETOSAL)
TABLET 0
TAB 80 MG
ASAM FOLAT 1 MG TABLET 0
ASIKLOFIR TAB 400 MG TABLET 400
ATAPULGIT TABLET 600 MG TABLET 6,000
BASITRASIN SALEP KULIT TUBE 138

BETAMETASON 0,5 MG/G SALEP KULIT TUBE 125

BISAKODIL TABLET SAL 5 MG TABLET 300

CAPTOPRIL TAB 25 MG TABLET 2,200

CHLORAMFENIKOL SALEP MATA 1 % SALEP 53

CHLORAMEX ( KLORAMFENIKOL )
CAPSUL 0
KAPSUL 500 MG
CYANOCOBALAMIN ( VITAMIN B12)
TABLET 4,800
TAB 50 MG
DEC TABLET 100 MG TABLET 3,300
DHP TAB TABLET 9
ETANOL 70% 100 ML CAIRAN 2
ETANOL 70% 300 ML CAIRAN 3
EUGENOL CAIRAN CAIRAN 16
FITOMENADION ( VIT K ) INJEKSI 2
AMPUL 0
MG/ML

FITOMENADION ( VIT K ) TABLET TABLET 700

FUROSEMID TAB 40 MG TABLET 7,300

GENTAMICIN INJEKSI AMPUL 7

GARAM ORALIT UNTUK 200 ML AIR SACHET 150

GRISEOFULVIN TAB 250 MG TABLET 450

HALOPERIDOL TAB 1,5 MG TABLET 0
ISOSORBID DINITRAT TAB
TABLET 0
SUBLINGUAL 5MG
ISONIAZID TAB 300 MG TABLET 100
KETOCONAZOLE TABLET 200 MG TABLET 650
LEVOTREOKSIN TABLET 0
MAGNESIUM SO4 INJEKSI 40% AMPUL 17
MASKER PCS 0
MEBENDAZOL TABLET 100 MG
TABLET 18
(VERMOX)

METHILPREDNISOLONE TAB 4 MG TABLET 2,400

NACL INFUS INFUS 10

OMEPRAZOLE CAPSUL 20 MG CAPSUL 300
OXYTOSIN INJEKSI AMPUL 10
PERAK SULFADIAZIN KRIM 1 % TUBE 7
PLESTER 5 YARD X 2 INCHI PCS 0
POVIDON IODIDA @ 30 ML LARUTAN 0
POVIDON IODIDA @ 300 ML LARUTAN 2
PREDNISONE TAB 5 MG TABLET 0
PROFYLTHIURACIL TAB 100 MG TABLET 0
RANITIDINE TAB 150 MG TABLET 0
RINGER LAKTAT LARUTAN INFUS
INFUS 30
STERIL
SALBUTAMOL TAB 2 MG TABLET 5,000
SALEP 2-4 KOMBINASI SALEP 104

SIMVASTATIN TABLET 20 MG /TABLET TABLET 240

SPIRONOLACTONE 25 MG TABLET 300
STESOLID ( DIAZEPAM ) LAT REKTAL 5
SUPPO 14
MG/2,5 ML
SULFADOKSIN PYRIMETHAMINE TAB
TABLET 100
5000-25 MG

THIAMIN ( VITAMIN B1) TABLET 50 MG TABLET 4,200

TRIHEKSIFENADIL TAB 2 MG TABLET 700

ZINC TABLET 10 MG TABLET 3,500
CLOBAZAM TAB TABLET 0
DIAZEPAM INJEKSI AMPUL 5
HALOPERIDOL TAB 5 MG TABLET 50
HALOPERIDOL 1,5 MG TABLET 0
HALOPERIDOL INJEKSI 50 MG AMPUL 50
HALOPERIDOL 5 MG AMPUL 7
COPANOL (PARACETAMOL SIRUP) BOTOL 9
GLIBENKLAMIDE TAB 40 MG TABLET 5,800
IREMAX (PCT + IBUPROFEN) TABLET 500
NUFIT SIRUP BOTOL 9

PHENOL GLYCEROL/TETES TELINGA BOTOL 48

AQUAGEL STERIL JELLY 82 GR TUBE 2

CATHEJELL LIDOCAIN 2% & CHG 0,05% TUBE 1

HYDREX SURGICAL SCRUB 500 ML BOTOL 5

KASSA HIDROPKILE 40 YARD X 80 CM ROLL 5

NASSAL OXYGEN SIZE L PCS 10

NASSAL OXYGEN SIZE S PCS 10
SARUNG TANGAN STERIL SIZE 7 PAIR 1
SARUNG TANGAN STERIL SIZE 7,5 PAIR 1
 SILK 3-0,6 CM RESERVE CUTTING 3/8
PCS 1
CICLE 26 MR
UNDERPAD PCS 10
ALKOHOL 70% 1000 ML BOTOL 3
BEDAK SALICIL 50 GR KOTAK 29
NI-ASETIL SISTEIN KAPSUL 200 MG KAPSUL 60

BMHP
ABOCATH NO: 20 PCS 167
AXIMED FACE MASK EAR LOOP DUS 17
AXIMED FACE MASK TIES ON DUS 23
AXIMED SWAB 2-PLY DUS 63
CANNOFIX-PU (6 CM X 8 CM) PCS 5
KASSA BERLEMAK PACK 10
SARUNG TANGAN SIZE M BOX 1
SARUNG TANGAN SIZE L BOX 1

SNA MEDIKA POLIBAN 10 CM X 2.7 M ROLL 3

SPUIT 0,5 ML PCS 1,400

URINE BAG STERIL PCS 20
ALKAZYME SACHET 25 MG PACK 3
DESTRUCT SYIRING WITH NEEDLE 5
PCS 200
ML
 SMTHS MEDICAL JELCO 20/ ABOCATH
PCS 39
20
ESKAMED IV CANNULA (22) PCS 192
ESKAMED IV CANNULA (24) PCS 93
NIPRO INFUS SET DEWASA PCS 76
AXIMED SYRINGE 3 CC SET 5,500
AXIMED INFUS PEDIATRIC SET PCS 93

AXIMED PAPER TAPE/1.25CM X 9.14 M ROLL 39

UTAMA KASSA KOMPRES STERIL 16 X

PACK 2
16 CM
UTAMA KASSA KOMPRES STERIL 4 M
ROLL 2
X 10 CM

EGYPT PHARMAFIX (5 CM X 500 CM ) BOX 4

SKIFA AUTO DISABLE/ SPUIT 0,5 ML PCS 500

BPJS
ALLOPURINOL TABLET 100 MG TABLET 3,300
AMOXICILLIN TABLET 500 MG TABLET 15,300

ANTI FUNGI DOEN SALEF KOMBINASI KRIM 55

BETAMETASON 0,1 % SALEP KULIT KRIM 305

BISOPROLOL TAB SALUT 5 MG TABLET 0

BUFACETIN(KLORAMFENICOL) SALEF
KRIM 140
KULIT 2%
CIPROFLOXACIN TABLET 500 MG TABLET 1,500
CHLORAMEX ( KLORAMFENIKOL )
KAPSUL 1,650
KAPSUL 500 MG

CHLORPHENIRAMINE MALEAT 4 MG TABLET 0

DILTIAZEM TABLET 30 MG TABLET 300

EFINEPRIN 0,1 % INJEKSI 1MG/ ML INJEKSI 70

HIDROCORTISONE 2,5 % SALEP KULIT KRIM 48

HIDROCLOROTIAZID ( HCT ) TABLET

TABLET 0
25 MG
KETOCONAZOLE TABLET 200 MG TABLET 0

KETOCONAZOLE 2 % SALEP KULIT KRIM 39

KLORAMPHENICOL SUSP 125 MG/5 ML SUSPENSI 25

LIDOCAINE COMPOSITUM INJEKSI 2% INJEKSI 440

LEVOFLOXACIN TABLET 2,200

LOPERAMIDE HCL 2 MG TABLET 600
METFORMIN TABLET 0

METTHYLPREDNISOLON TAB 4 MG TABLET 0

NATRIUM DIKLOFENAK TAB 50 MG TABLET 950

NEW ANTIDES TABLET 0

RANITIDINE TAB 150 MG TABLET 7,500

RINGER LACTAT LARUTAN INFUS CAIRAN 50

RISPERIDONE 1 MG TABLET 2,700

SALEP 2-4 KOMBINASI KRIM 60
SIMVASTATIN TABLET 10 MG /TABLET TABLET 330

SPIRONOLACTONE 25 MG TABLET 900

STESOLID ( DIAZEPAM ) LAT REKTAL 5
TUBE 0
MG/2,5 ML
TETRACIKLINE CAPSUL 500 MG KAPSUL 4,600
VITAMIN B1 (TIAMIN) TABLET TABLET 15,100
VENTOLIN NEBULES 2,5 MG AMP 40
VENTOLIN ROTAHALER BOK 15
XYLOCAINE 2% JELLY TUBE 0
BETAHISTINE TAB 6 MG TABLET 2,200
GLIMEPIRIDE TAB 2 MG TABLET 2,300
CLOZAPINE TAB 100 MG TABLET 400
RISPERIDONE 2 MG TABLET 1,800
CETERIZINE TAB 100 MG TABLET 8,800
MICARDIS TAB 40 MG TABLET 340
AMLODIPINE TAB 5 MG TABLET 1,800

Jumlah Umum Jumlah

Mengetahui Tidak Bayar Tidak
Ka.UPTD Puskesmas Sukaraja Tiga Resep

I Nym Dus Arianto

NIP : 19730313 199303 1 006
 Stok
Permintaan Pemberian Keterangan
Optimum
Stok
Permintaan Pemberian Sisa Stok
Optimum
Sukaraja Tiga, 5 Maret 2019
Penanggung Jawab Laporan

Erman Ariyanto,Amd.Kep
NIP.19750419 199502 1 001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

Unit Penerima : Puskesmas Sukaraja Tiga

Kecamatan : Marga Tiga
Kabupaten : Lampung Timur
Provinsi : Lampung

Kode Nama Obat Sediaan Stok Awal Penerimaan

247 ALLOPURINOL TABLET 100 MG TABLET 4,920

415 AMINOPHYLLINE INJEKSI 24 MG/ML AMPUL

0
444 AMITRIPTYLINE TABLET 25 MG TABLET 400
445 AMLODIPINE TABLET 10 MG TABLET 150
446 AMLODIPINE TABLET 5 MG TABLET 25
523 AMOXYCILLIN SIRUP 250 MG/5 ML SIRUP 1,059
809 ANTACIDA TABLET 400 MG TABLET 38,300

966 ASAM MEFENAMAT TABLET 500 MG TABLET

23,030
ASCORBIC ACID (VITAMIN C) TABLET
923 TABLET
250 MG 1,800
ASCORBIC ACID (VITAMIN C) TABLET
926 TABLET
50 MG 6,700
1479 BENZOIC ACID SALEP SALEP 0
1690 BISACODYL SUPPOSITORIA 10 MG SUPPOS 72
1691 BISACODYL SUPPOSITORIA 5 MG SUPPOS 92
BISMUTH SUBGALLATE|ZINC OXIDE|
1702 LIDOCAINE|HEXACHLOROPHENE SUPPOS
SUPPOSITORIA 2 G 0

CALCIUM CHLORIDE DIHYDRATE|

10160 POTASSIUM CHLORIDE|SODIUM INFUS
CHLORIDE|SODIUM LACTATE INFUS
0

2005 CALCIUM LACTATE TABLET 500 MG TABLET

4,900
2084 CARBAMAZEPINE TABLET 200 MG TABLET 400
2518 CETIRIZINE SIRUP 5 MG/ML SIRUP 0
2546 CETIRIZINE TABLET 10 MG TABLET 0
2601 CHLORAMPHENICOL SALEP 2% SALEP 0
CHLORAMPHENICOL SIRUP 125
2593 SIRUP
MG/5ML 62

2745 CHLORPHENIRAMINE TABLET 4 MG TABLET

41,000

2762 CHLORPROMAZINE TABLET 100 MG TABLET

100
 2763 CHLORPROMAZINE TABLET 25 MG TABLET
0
2828 CIPROFLOXACIN TABLET 500 MG TABLET 12,200
CLAVULANIC ACID|AMOXICILLIN
2967 TABLET
TABLET 500 MG 0

3202 COTRIMOXAZOLE SIRUP 240 MG/5 ML SIRUP

0
6645 COTRIMOXAZOLE TABLET TABLET 0

3416 DEXAMETHASONE INJEKSI 5 MG/ML INJEKSI

10
3443 DEXAMETHASONE TABLET 0.5 MG TABLET 0

3688 DICLOFENAC SODIUM TABLET 25 MG TABLET

3,850

3690 DICLOFENAC SODIUM TABLET 50 MG TABLET

300
3983 DOMPERIDONE TABLET 10 MG TABLET 1,300
4306 EPINEPHRINE INJEKSI 1 MG/ML INJEKSI 0

4445 ERYTHROMYCIN SIRUP 200 MG/5 ML SIRUP

40
4458 ERYTHROMYCIN TABLET 250 MG TABLET 900
4492 ESOMEPRAZOLE TABLET 20 MG TABLET 0
FENOTEROL HYDROBROMIDE SPRAY
4736 SPRAY
100 MCG 0
945 FOLIC ACID TABLET 400 MCG TABLET 0

5079 FUSIDATE SODIUM SALEP 20 MG/G SALEP

0
5167 GENTAMYCIN SALEP 0.3 % SALEP 0
5266 GLIMEPIRIDE TABLET 2 MG TABLET 2,400
5300 GLUCOSE INFUS 5 % INFUS 0
5843 HYDROCORTISONE SALEP 2.5 % SALEP 90
5964 IBUPROFEN TABLET 200 MG TABLET 0
5966 IBUPROFEN TABLET 400 MG TABLET 0
INTRAVASCULAR ADMINISTRATION
AK0902022 0
SET 0

IPRATROPIUM BROMIDE|
6238 LIQUID
SALBUTAMOL SULPHATE LIQUID
0
AK9005688 IV CATHETER NO 20 0 0
AK9005689 IV CATHETER NO 22 0 0
AK9005690 IV CATHETER NO 24 0 0
6535 KETOCONAZOLE SALEP 2% SALEP 0
LEVODOPA|BENSERAZIDE TABLET
6812 TABLET
100 MG 0
6887 LIDOCAINE INJEKSI 20 MG/ML INJEKSI 20
6998 LOPERAMIDE TABLET 2 MG TABLET 1,200
7013 LORATADINE TABLET 10 MG TABLET 400
7491 METFORMIN TABLET 500 MG TABLET 3,000
 METHYLERGOMETRINE INJEKSI 0.2
7536 INJEKSI
MG/ML 0
METHYLPREDNISOLONE TABLET 8
7586 TABLET
MG 0

7651 METOCLOPRAMIDE TABLET 10 MG TABLET

500

7688 METRONIDAZOLE SIRUP 125 MG/5 ML SIRUP

0
7697 METRONIDAZOLE TABLET 500 MG TABLET 500
7727 MICONAZOLE SALEP 2% SALEP 0
8160 NIFEDIPINE TABLET 10 MG TABLET 100
8256 NYSTATIN OVULA 10000 IU OVULA 100

8573 PARACETAMOL DROPS 100 MG/ML DROPS

0

8601 PARACETAMOL SIRUP 120 MG/5 ML SIRUP

1,266
8593 PARACETAMOL TABLET 500 MG TABLET 60,900
9246 PHENYTOIN TABLET 100 MG TABLET 200
AK0902040 PISTON SYRINGE 0 0
9673 PROPANOLOL TABLET 10 MG TABLET 200
PYRAZINAMIDE|ETHAMBUTOL|
9805 TABLET
ISONIAZID|RIFAMPICIN TABLET 0
1684 PYRIDOXINE TABLET 10 MG TABLET 4,800
RETINOL PALMITATE TABLET 100000
11896 TABLET
IU 0
RIFAMPICIN|ISONIAZID TABLET 75
10128 TABLET
MG|50 MG 0
AK9008969 SARUNG TANGAN STERIL NO 7 0 0
AK9008970 SARUNG TANGAN STERIL NO 7.5 0 0
10482 SIMVASTATIN TABLET 10 MG TABLET 4,670
SULFAMETHOXAZOLE|
10908 TRIMETHOPRIM TABLET 400 MG|80 TABLET
MG 0
SYRINGE ACTUATOR FOR AN
AK0501030 0
INJEKTOR 0
990 TRANEXAMIC ACID INJEKSI 5 ML INJEKSI 50
TUBERCULIN PPD TABLET 10 TU/0.1
11719 TABLET
ML 0
11922 VITAMIN B COMPOUND TABLET TABLET 3,000

12189 ZINC SULPHATE SIRUP 20 MG/5 ML SIRUP

0

Obat Tambahan
Kode Nama Obat Sediaan Stok Awal Penerimaan
ALAT SUNTIK SEKALI PAKAI 0,5 ML PCS 40
ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0
ALAT SUNTIK SEKALI PAKAI 2,5 ML PCS 0
ALAT SUNTIK SEKALI PAKAI 5 ML PCS 0
ALAT SUNTIK SEKALI PAKAI 3 ML PCS 2,043
ALBENDAZOLE TAB TABLET 420
ANTASID SUSPENSI SIRUP 0
ANTIFUNGI DOEN KOMBINASI SALEP 86
ANTIHEMOROID KOMB. SUPOSOTORIA 2 SUPPO
MG 10
AMOXICILLIN SIRUP KERING 125 MG/5ML BOTOL
688
AMOXICILLIN TABLET 500 MG TABLET 62,250
AMININOFILIN TABLET 200 MG TABLET 0
ASAM ASETILSALISILAT (ACETOSAL) TAB 80 TABLET
MG 0
ASAM FOLAT 1 MG TABLET 0
ASIKLOFIR TAB 400 MG TABLET 200
ATAPULGIT TABLET 600 MG TABLET 0
BASITRASIN SALEP KULIT TUBE 50
BETAMETASON 0,5 MG/G SALEP KULIT TUBE 53
BISAKODIL TABLET SAL 5 MG TABLET 320
CAPTOPRIL TAB 25 MG TABLET 2,600
CHLORAMFENIKOL SALEP MATA 1 % SALEP 76
CHLORAMEX ( KLORAMFENIKOL ) KAPSUL CAPSUL
500 MG 0
CYANOCOBALAMIN ( VITAMIN B12) TAB 50 TABLET
MG 3,200
DEC TABLET 100 MG TABLET 3,300
DHP TAB TABLET 9
ETANOL 70% 100 ML CAIRAN 6
ETANOL 70% 300 ML CAIRAN 4
EUGENOL CAIRAN CAIRAN 18
FITOMENADION ( VIT K ) INJEKSI 2 MG/ML AMPUL
0
FITOMENADION ( VIT K ) TABLET TABLET 800
FUROSEMID TAB 40 MG TABLET 4,300
GENTAMICIN INJEKSI AMPUL 7
GARAM ORALIT UNTUK 200 ML AIR SACHET 200
GRISEOFULVIN TAB 250 MG TABLET 300
HALOPERIDOL TAB 1,5 MG TABLET 0
ISOSORBID DINITRAT TAB SUBLINGUAL 5MG TABLET
0
ISONIAZID TAB 300 MG TABLET 100
KETOCONAZOLE TABLET 200 MG TABLET 400
LEVOTREOKSIN TABLET 0
MAGNESIUM SO4 INJEKSI 40% AMPUL 17
MASKER PCS 0
MEBENDAZOL TABLET 100 MG (VERMOX) TABLET
18
METHILPREDNISOLONE TAB 4 MG TABLET 300
NACL INFUS INFUS 14
OMEPRAZOLE CAPSUL 20 MG CAPSUL 0
 OXYTOSIN INJEKSI AMPUL 20
PERAK SULFADIAZIN KRIM 1 % TUBE 5
PLESTER 5 YARD X 2 INCHI PCS 0
POVIDON IODIDA @ 30 ML LARUTAN 0
POVIDON IODIDA @ 300 ML LARUTAN 2
PREDNISONE TAB 5 MG TABLET 700
PROFYLTHIURACIL TAB 100 MG TABLET 0
RANITIDINE TAB 150 MG TABLET 200
RINGER LAKTAT LARUTAN INFUS STERIL INFUS 40
SALBUTAMOL TAB 2 MG TABLET 3,000
SALEP 2-4 KOMBINASI SALEP 50
SIMVASTATIN TABLET 20 MG /TABLET TABLET 260
SPIRONOLACTONE 25 MG TABLET 300
STESOLID ( DIAZEPAM ) LAT REKTAL 5 SUPPO
MG/2,5 ML 17
SULFADOKSIN PYRIMETHAMINE TAB 5000- TABLET
25 MG 100
THIAMIN ( VITAMIN B1) TABLET 50 MG TABLET 3,000
TRIHEKSIFENADIL TAB 2 MG TABLET 800
ZINC TABLET 10 MG TABLET 0
CLOBAZAM TAB TABLET 0
DIAZEPAM INJEKSI AMPUL 5
HALOPERIDOL TAB 5 MG TABLET 100
HALOPERIDOL 1,5 MG TABLET 0
HALOPERIDOL INJEKSI 50 MG AMPUL 50
HALOPERIDOL 5 MG AMPUL 12

BMHP
ABOCATH NO: 20 PCS 169
AXIMED FACE MASK EAR LOOP DUS 25
AXIMED FACE MASK TIES ON DUS 31
AXIMED SWAB 2-PLY DUS 73
CANNOFIX-PU (6 CM X 8 CM) PCS 5
KASSA BERLEMAK PACK 13
SARUNG TANGAN SIZE M BOX 2
SARUNG TANGAN SIZE L BOX 2
SNA MEDIKA POLIBAN 10 CM X 2.7 M ROLL 3
SPUIT 0,5 ML PCS 1,500
URINE BAG STERIL PCS 24
ALKAZYME SACHET 25 MG PACK 2
DESTRUCT SYIRING WITH NEEDLE 5 ML PCS 200
SMTHS MEDICAL JELCO 20/ ABOCATH 20 PCS 41
ESKAMED IV CANNULA (22) PCS 194
ESKAMED IV CANNULA (24) PCS 94
NIPRO INFUS SET DEWASA PCS 78
AXIMED SYRINGE 3 CC SET 5,700
 AXIMED INFUS PEDIATRIC SET PCS 94
AXIMED PAPER TAPE/1.25CM X 9.14 M ROLL 42
UTAMA KASSA KOMPRES STERIL 16 X 16 CM PACK
4
UTAMA KASSA KOMPRES STERIL 4 M X 10 ROLL
CM 3
EGYPT PHARMAFIX (5 CM X 500 CM ) BOX 5
SKIFA AUTO DISABLE/ SPUIT 0,5 ML PCS 500

BPJS
ALLOPURINOL TABLET 100 MG TABLET 3,500
AMOXICILLIN TABLET 500 MG TABLET 15,500
ANTI FUNGI DOEN SALEF KOMBINASI KRIM 60
BETAMETASON 0,1 % SALEP KULIT KRIM 325
BISOPROLOL TAB SALUT 5 MG TABLET 0
BUFACETIN(KLORAMFENICOL) SALEF KULIT KRIM
2% 158
CIPROFLOXACIN TABLET 500 MG TABLET 1,700
CHLORAMEX ( KLORAMFENIKOL ) KAPSUL KAPSUL
500 MG 1,950
CHLORPHENIRAMINE MALEAT 4 MG TABLET 0
DILTIAZEM TABLET 30 MG TABLET 300
EFINEPRIN 0,1 % INJEKSI 1MG/ ML INJEKSI 70
HIDROCORTISONE 2,5 % SALEP KULIT KRIM 48
HIDROCLOROTIAZID ( HCT ) TABLET 25 MG TABLET
0
KETOCONAZOLE TABLET 200 MG TABLET 0
KETOCONAZOLE 2 % SALEP KULIT KRIM 44
KLORAMPHENICOL SUSP 125 MG/5 ML SUSPENSI 30
LIDOCAINE COMPOSITUM INJEKSI 2% INJEKSI 470
LEVOFLOXACIN TABLET 2,500
LOPERAMIDE HCL 2 MG TABLET 800
METFORMIN TABLET 0
METTHYLPREDNISOLON TAB 4 MG TABLET 0
NATRIUM DIKLOFENAK TAB 50 MG TABLET 1,350
NEW ANTIDES TABLET 0
RANITIDINE TAB 150 MG TABLET 8,000
RINGER LACTAT LARUTAN INFUS CAIRAN 54
RISPERIDONE 1 MG TABLET 2,800
SALEP 2-4 KOMBINASI KRIM 60
SIMVASTATIN TABLET 10 MG /TABLET TABLET 360
SPIRONOLACTONE 25 MG TABLET 900
STESOLID ( DIAZEPAM ) LAT REKTAL 5 TUBE
MG/2,5 ML 0
TETRACIKLINE CAPSUL 500 MG KAPSUL 5,000
VITAMIN B1 (TIAMIN) TABLET TABLET 15,500
VENTOLIN NEBULES 2,5 MG AMP 40
VENTOLIN ROTAHALER BOK 15
XYLOCAINE 2% JELLY TUBE 0
BETAHISTINE TAB 6 MG TABLET 2,400
GLIMEPIRIDE TAB 2 MG TABLET 2,500
CLOZAPINE TAB 100 MG TABLET 400
RISPERIDONE 2 MG TABLET 1,900
CETERIZINE TAB 100 MG TABLET 9,000
MICARDIS TAB 40 MG TABLET 360
AMLODIPINE TAB 5 MG TABLET 240
 Bulan : Maret
Tahun : 2019

Persediaan Pemakaian Rusak/Ed Sisa Stok Stok Optimum Permintaan Pemberian

Persediaan Pemakaian Rusak/Ed Sisa Stok Stok Optimum Permintaan Pemberian
Keterangan
Sisa Stok
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

Unit Penerima : Puskesmas Sukaraja Tiga Bulan : Februari

Kecamatan : Marga Tiga Tahun : 2019
Kabupaten : Lampung Timur
Provinsi : Lampung

Stok
Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Permintaan
Optimum
247 ALLOPURINOL TABLET 100 MG TABLET 5,620 0 5,620 700 4,920
415 AMINOPHYLLINE INJEKSI 24 MG/ML AMPUL 0 0 0 0 0
444 AMITRIPTYLINE TABLET 25 MG TABLET 500 0 500 100 400
445 AMLODIPINE TABLET 10 MG TABLET 510 0 510 360 150
446 AMLODIPINE TABLET 5 MG TABLET 145 0 145 120 25
523 AMOXYCILLIN SIRUP 250 MG/5 ML SIRUP 1,119 0 1,119 60 1,059
809 ANTACIDA TABLET 400 MG TABLET 41,300 0 41,300 3,000 38,300
966 ASAM MEFENAMAT TABLET 500 MG TABLET 26,430 0 26,430 3,400 23,030
923 ASCORBIC ACID (VITAMIN C) TABLET 250 MG TABLET 2,100 0 2,100 300 1,800
926 ASCORBIC ACID (VITAMIN C) TABLET 50 MG TABLET 8,100 0 8,100 1,400 6,700
1479 BENZOIC ACID SALEP SALEP 0 0 0 0 0
1690 BISACODYL SUPPOSITORIA 10 MG SUPPOS 78 0 78 6 72
1691 BISACODYL SUPPOSITORIA 5 MG SUPPOS 98 0 98 6 92
1702 BISMUTH SUBGALLATE|ZINC OXIDE|LIDOCAINE| SUPPOS
HEXACHLOROPHENE SUPPOSITORIA 2 G 0 0 0 0 0
10160 CALCIUM CHLORIDE DIHYDRATE|POTASSIUM CHLORIDE|SODIUM INFUS
CHLORIDE|SODIUM LACTATE INFUS 0 0 0 0 0
2005 CALCIUM LACTATE TABLET 500 MG TABLET 5,400 0 5,400 500 4,900
2084 CARBAMAZEPINE TABLET 200 MG TABLET 500 0 500 100 400
2518 CETIRIZINE SIRUP 5 MG/ML SIRUP 0 0 0 0 0
2546 CETIRIZINE TABLET 10 MG TABLET 0 0 0 0 0
2601 CHLORAMPHENICOL SALEP 2% SALEP 0 0 0 0 0
 2593 CHLORAMPHENICOL SIRUP 125 MG/5ML SIRUP 67 0 67 5 62
2745 CHLORPHENIRAMINE TABLET 4 MG TABLET 44,200 0 44,200 3,200 41,000
2762 CHLORPROMAZINE TABLET 100 MG TABLET 200 0 200 100 100
2763 CHLORPROMAZINE TABLET 25 MG TABLET 0 0 0 0 0
2828 CIPROFLOXACIN TABLET 500 MG TABLET 13,400 0 13,400 1,200 12,200
2967 CLAVULANIC ACID|AMOXICILLIN TABLET 500 MG TABLET 0 0 0 0 0
3202 COTRIMOXAZOLE SIRUP 240 MG/5 ML SIRUP 0 0 0 0 0
6645 COTRIMOXAZOLE TABLET TABLET 0 0 0 0 0
3416 DEXAMETHASONE INJEKSI 5 MG/ML INJEKSI 10 0 10 0 10
3443 DEXAMETHASONE TABLET 0.5 MG TABLET 0 0 0 0 0
3688 DICLOFENAC SODIUM TABLET 25 MG TABLET 4,150 0 4,150 300 3,850
3690 DICLOFENAC SODIUM TABLET 50 MG TABLET 600 0 600 300 300
3983 DOMPERIDONE TABLET 10 MG TABLET 1,700 0 1,700 400 1,300
4306 EPINEPHRINE INJEKSI 1 MG/ML INJEKSI 0 0 0 0 0
4445 ERYTHROMYCIN SIRUP 200 MG/5 ML SIRUP 50 0 50 10 40
4458 ERYTHROMYCIN TABLET 250 MG TABLET 1,200 0 1,200 300 900
4492 ESOMEPRAZOLE TABLET 20 MG TABLET 0 0 0 0 0
4736 FENOTEROL HYDROBROMIDE SPRAY 100 MCG SPRAY 0 0 0 0 0
945 FOLIC ACID TABLET 400 MCG TABLET 0 0 0 0 0
5079 FUSIDATE SODIUM SALEP 20 MG/G SALEP 0 0 0 0 0
5167 GENTAMYCIN SALEP 0.3 % SALEP 0 0 0 0 0
5266 GLIMEPIRIDE TABLET 2 MG TABLET 2,650 0 2,650 250 2,400
5300 GLUCOSE INFUS 5 % INFUS 0 0 0 0 0
5843 HYDROCORTISONE SALEP 2.5 % SALEP 110 0 110 20 90
5964 IBUPROFEN TABLET 200 MG TABLET 0 0 0 0 0
5966 IBUPROFEN TABLET 400 MG TABLET 0 0 0 0 0
AK0902022 INTRAVASCULAR ADMINISTRATION SET 0 0 0 0 0 0
6238 IPRATROPIUM BROMIDE|SALBUTAMOL SULPHATE LIQUID LIQUID 0 0 0 0 0
AK9005688 IV CATHETER NO 20 0 0 0 0 0 0
AK9005689 IV CATHETER NO 22 0 0 0 0 0 0
AK9005690 IV CATHETER NO 24 0 0 0 0 0 0
6535 KETOCONAZOLE SALEP 2% SALEP 0 0 0 0 0
6812 LEVODOPA|BENSERAZIDE TABLET 100 MG TABLET 0 0 0 0 0
6887 LIDOCAINE INJEKSI 20 MG/ML INJEKSI 20 0 20 0 20
 6998 LOPERAMIDE TABLET 2 MG TABLET 1,500 0 1,500 300 1,200
7013 LORATADINE TABLET 10 MG TABLET 1,200 0 1,200 800 400
7491 METFORMIN TABLET 500 MG TABLET 3,400 0 3,400 400 3,000
7536 METHYLERGOMETRINE INJEKSI 0.2 MG/ML INJEKSI 30 0 30 30 0
7586 METHYLPREDNISOLONE TABLET 8 MG TABLET 0 0 0 0 0
7651 METOCLOPRAMIDE TABLET 10 MG TABLET 550 0 550 50 500
7688 METRONIDAZOLE SIRUP 125 MG/5 ML SIRUP 0 0 0 0 0
7697 METRONIDAZOLE TABLET 500 MG TABLET 900 0 900 400 500
7727 MICONAZOLE SALEP 2% SALEP 0 0 0 0 0
8160 NIFEDIPINE TABLET 10 MG TABLET 150 0 150 50 100
8256 NYSTATIN OVULA 10000 IU OVULA 100 0 100 0 100
8573 PARACETAMOL DROPS 100 MG/ML DROPS 0 0 0 0 0
8601 PARACETAMOL SIRUP 120 MG/5 ML SIRUP 1,506 0 1,506 240 1,266
8593 PARACETAMOL TABLET 500 MG TABLET 67,900 0 67,900 7,000 60,900
9246 PHENYTOIN TABLET 100 MG TABLET 200 0 200 0 200
AK0902040 PISTON SYRINGE 0 0 0 0 0 0
9673 PROPANOLOL TABLET 10 MG TABLET 200 0 200 0 200
9805 PYRAZINAMIDE|ETHAMBUTOL|ISONIAZID|RIFAMPICIN TABLET TABLET 0 0 0 0 0
1684 PYRIDOXINE TABLET 10 MG TABLET 5,800 0 5,800 1,000 4,800
11896 RETINOL PALMITATE TABLET 100000 IU TABLET 0 0 0 0 0
10128 RIFAMPICIN|ISONIAZID TABLET 75 MG|50 MG TABLET 0 0 0 0 0
AK9008969 SARUNG TANGAN STERIL NO 7 0 0 0 0 0 0
AK9008970 SARUNG TANGAN STERIL NO 7.5 0 0 0 0 0 0
10482 SIMVASTATIN TABLET 10 MG TABLET 5,000 0 5,000 330 4,670
10908 SULFAMETHOXAZOLE|TRIMETHOPRIM TABLET 400 MG|80 MG TABLET 0 0 0 0 0
AK0501030 SYRINGE ACTUATOR FOR AN INJEKTOR 0 0 0 0 0 0
990 TRANEXAMIC ACID INJEKSI 5 ML INJEKSI 50 0 50 0 50
11719 TUBERCULIN PPD TABLET 10 TU/0.1 ML TABLET 0 0 0 0 0
11922 VITAMIN B COMPOUND TABLET TABLET 4,000 0 4,000 1,000 3,000
12189 ZINC SULPHATE SIRUP 20 MG/5 ML SIRUP 0 0 0 0 0

Obat Tambahan
 Stok
Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Optimum Permintaan

ALAT SUNTIK SEKALI PAKAI 0,5 ML PCS 40 0 40 0 40

ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0 0 0 0 0
ALAT SUNTIK SEKALI PAKAI 2,5 ML PCS 0 0 0 0 0
ALAT SUNTIK SEKALI PAKAI 5 ML PCS 0 0 0 0 0
ALAT SUNTIK SEKALI PAKAI 3 ML PCS 2,243 0 2,243 200 2,043
ALBENDAZOLE TAB TABLET 420 0 420 0 420
ANTASID SUSPENSI SIRUP 0 0 0 0 0
ANTIFUNGI DOEN KOMBINASI SALEP 86 0 86 0 86
ANTIHEMOROID KOMB. SUPOSOTORIA 2 MG SUPPO 10 0 10 0 10
AMOXICILLIN SIRUP KERING 125 MG/5ML BOTOL 838 0 838 150 688
AMOXICILLIN TABLET 500 MG TABLET 65,150 0 65,150 2,900 62,250
AMININOFILIN TABLET 200 MG TABLET 0 0 0 0 0
ASAM ASETILSALISILAT (ACETOSAL) TAB 80 MG TABLET 0 0 0 0 0
ASAM FOLAT 1 MG TABLET 0 0 0 0 0
ASIKLOFIR TAB 400 MG TABLET 200 0 200 0 200
ATAPULGIT TABLET 600 MG TABLET 0 0 0 0 0
BASITRASIN SALEP KULIT TUBE 50 0 50 0 50
BETAMETASON 0,5 MG/G SALEP KULIT TUBE 59 0 59 6 53
BISAKODIL TABLET SAL 5 MG TABLET 320 0 320 0 320
CAPTOPRIL TAB 25 MG TABLET 3,100 0 3,100 500 2,600
CHLORAMFENIKOL SALEP MATA 1 % SALEP 100 0 100 24 76
CHLORAMEX ( KLORAMFENIKOL ) KAPSUL 500 MG CAPSUL 100 0 100 100 0
CYANOCOBALAMIN ( VITAMIN B12) TAB 50 MG TABLET 3,200 0 3,200 0 3,200
DEC TABLET 100 MG TABLET 3,300 0 3,300 0 3,300
DHP TAB TABLET 9 0 9 0 9
ETANOL 70% 100 ML CAIRAN 9 0 9 3 6
ETANOL 70% 300 ML CAIRAN 5 0 5 1 4
EUGENOL CAIRAN CAIRAN 18 0 18 0 18
FITOMENADION ( VIT K ) INJEKSI 2 MG/ML AMPUL 0 0 0 0 0
FITOMENADION ( VIT K ) TABLET TABLET 800 0 800 0 800
FUROSEMID TAB 40 MG TABLET 4,800 0 4,800 500 4,300
GENTAMICIN INJEKSI AMPUL 7 0 7 0 7
GARAM ORALIT UNTUK 200 ML AIR SACHET 200 0 200 0 200
GRISEOFULVIN TAB 250 MG TABLET 300 0 300 0 300
HALOPERIDOL TAB 1,5 MG TABLET 0 0 0 0 0
ISOSORBID DINITRAT TAB SUBLINGUAL 5MG TABLET 0 0 0 0 0
ISONIAZID TAB 300 MG TABLET 100 0 100 0 100
KETOCONAZOLE TABLET 200 MG TABLET 500 0 500 100 400
LEVOTREOKSIN TABLET 0 0 0 0 0
MAGNESIUM SO4 INJEKSI 40% AMPUL 17 0 17 0 17
MASKER PCS 0 0 0 0 0
MEBENDAZOL TABLET 100 MG (VERMOX) TABLET 18 0 18 0 18
METHILPREDNISOLONE TAB 4 MG TABLET 400 0 400 100 300
NACL INFUS INFUS 14 0 14 0 14
OMEPRAZOLE CAPSUL 20 MG CAPSUL 0 0 0 0 0
OXYTOSIN INJEKSI AMPUL 30 0 30 10 20
PERAK SULFADIAZIN KRIM 1 % TUBE 6 0 6 1 5
PLESTER 5 YARD X 2 INCHI PCS 0 0 0 0 0
POVIDON IODIDA @ 30 ML LARUTAN 0 0 0 0 0
POVIDON IODIDA @ 300 ML LARUTAN 3 0 3 1 2
PREDNISONE TAB 5 MG TABLET 1,700 0 1,700 1,000 700
PROFYLTHIURACIL TAB 100 MG TABLET 0 0 0 0 0
RANITIDINE TAB 150 MG TABLET 400 0 400 200 200
RINGER LAKTAT LARUTAN INFUS STERIL INFUS 40 0 40 0 40
SALBUTAMOL TAB 2 MG TABLET 3,400 0 3,400 400 3,000
SALEP 2-4 KOMBINASI SALEP 65 0 65 15 50
SIMVASTATIN TABLET 20 MG /TABLET TABLET 260 0 260 0 260
SPIRONOLACTONE 25 MG TABLET 300 0 300 0 300
STESOLID ( DIAZEPAM ) LAT REKTAL 5 MG/2,5 ML SUPPO 20 0 20 3 17
SULFADOKSIN PYRIMETHAMINE TAB 5000-25 MG TABLET 100 0 100 0 100
THIAMIN ( VITAMIN B1) TABLET 50 MG TABLET 4,200 0 4,200 1,200 3,000
TRIHEKSIFENADIL TAB 2 MG TABLET 1,600 0 1,600 800 800
ZINC TABLET 10 MG TABLET 0 0 0 0 0
CLOBAZAM TAB TABLET 10 0 10 10 0
 DIAZEPAM INJEKSI AMPUL 5 0 5 0 5
HALOPERIDOL TAB 5 MG TABLET 200 0 200 100 100
HALOPERIDOL 1,5 MG TABLET 30 0 30 30 0
HALOPERIDOL INJEKSI 50 MG AMPUL 50 0 50 0 50
HALOPERIDOL 5 MG AMPUL 12 0 12 0 12

BMHP
ABOCATH NO: 20 PCS 171 0 171 2 169
AXIMED FACE MASK EAR LOOP DUS 30 0 30 5 25
AXIMED FACE MASK TIES ON DUS 36 0 36 5 31
AXIMED SWAB 2-PLY DUS 81 0 81 8 73
CANNOFIX-PU (6 CM X 8 CM) PCS 6 0 6 1 5
KASSA BERLEMAK PACK 17 0 17 4 13
SARUNG TANGAN SIZE M BOX 3 0 3 1 2
SARUNG TANGAN SIZE L BOX 3 0 3 1 2
SNA MEDIKA POLIBAN 10 CM X 2.7 M ROLL 3 0 3 0 3
SPUIT 0,5 ML PCS 1,550 0 1,550 50 1,500
URINE BAG STERIL PCS 28 0 28 4 24
ALKAZYME SACHET 25 MG PACK 2 0 2 0 2
DESTRUCT SYIRING WITH NEEDLE 5 ML PCS 200 0 200 0 200
SMTHS MEDICAL JELCO 20/ ABOCATH 20 PCS 43 0 43 2 41
ESKAMED IV CANNULA (22) PCS 196 0 196 2 194
ESKAMED IV CANNULA (24) PCS 96 0 96 2 94
NIPRO INFUS SET DEWASA PCS 81 0 81 3 78
AXIMED SYRINGE 3 CC SET 5,700 0 5,700 0 5,700
AXIMED INFUS PEDIATRIC SET PCS 96 0 96 2 94
AXIMED PAPER TAPE/1.25CM X 9.14 M ROLL 44 0 44 2 42
UTAMA KASSA KOMPRES STERIL 16 X 16 CM PACK 9 0 9 5 4
UTAMA KASSA KOMPRES STERIL 4 M X 10 CM ROLL 5 0 5 2 3
EGYPT PHARMAFIX (5 CM X 500 CM ) BOX 5 0 5 0 5
SKIFA AUTO DISABLE/ SPUIT 0,5 ML PCS 500 0 500 0 500
BPJS
ALLOPURINOL TABLET 100 MG TABLET 3,700 0 3,700 200 3,500
AMOXICILLIN TABLET 500 MG TABLET 15,700 0 15,700 200 15,500
ANTI FUNGI DOEN SALEF KOMBINASI KRIM 64 0 64 4 60
BETAMETASON 0,1 % SALEP KULIT KRIM 350 0 350 25 325
BISOPROLOL TAB SALUT 5 MG TABLET 0 0 0 0 0
BUFACETIN(KLORAMFENICOL) SALEF KULIT 2% KRIM 166 0 166 8 158
CIPROFLOXACIN TABLET 500 MG TABLET 2,000 0 2,000 300 1,700
CHLORAMEX ( KLORAMFENIKOL ) KAPSUL 500 MG KAPSUL 2,350 0 2,350 400 1,950
CHLORPHENIRAMINE MALEAT 4 MG TABLET 0 0 0 0 0
DILTIAZEM TABLET 30 MG TABLET 300 0 300 0 300
EFINEPRIN 0,1 % INJEKSI 1MG/ ML INJEKSI 70 0 70 0 70
HIDROCORTISONE 2,5 % SALEP KULIT KRIM 48 0 48 0 48
HIDROCLOROTIAZID ( HCT ) TABLET 25 MG TABLET 0 0 0 0 0
KETOCONAZOLE TABLET 200 MG TABLET 0 0 0 0 0
KETOCONAZOLE 2 % SALEP KULIT KRIM 50 0 50 6 44
KLORAMPHENICOL SUSP 125 MG/5 ML SUSPENSI 35 0 35 5 30
LIDOCAINE COMPOSITUM INJEKSI 2% INJEKSI 500 0 500 30 470
LEVOFLOXACIN TABLET 2,900 0 2,900 400 2,500
LOPERAMIDE HCL 2 MG TABLET 800 0 800 0 800
METFORMIN TABLET 0 0 0 0 0
METTHYLPREDNISOLON TAB 4 MG TABLET 0 0 0 0 0
NATRIUM DIKLOFENAK TAB 50 MG TABLET 1,350 0 1,350 0 1,350
NEW ANTIDES TABLET 0 0 0 0 0
RANITIDINE TAB 150 MG TABLET 8,500 0 8,500 500 8,000
RINGER LACTAT LARUTAN INFUS CAIRAN 54 0 54 0 54
RISPERIDONE 1 MG TABLET 3,000 0 3,000 200 2,800
SALEP 2-4 KOMBINASI KRIM 60 0 60 0 60
SIMVASTATIN TABLET 10 MG /TABLET TABLET 390 0 390 30 360
SPIRONOLACTONE 25 MG TABLET 1,000 0 1,000 100 900
STESOLID ( DIAZEPAM ) LAT REKTAL 5 MG/2,5 ML TUBE 0 0 0 0 0
TETRACIKLINE CAPSUL 500 MG KAPSUL 5,400 0 5,400 400 5,000
VITAMIN B1 (TIAMIN) TABLET TABLET 16,100 0 16,100 600 15,500
VENTOLIN NEBULES 2,5 MG AMP 40 0 40 0 40
VENTOLIN ROTAHALER BOK 15 0 15 0 15
XYLOCAINE 2% JELLY TUBE 0 0 0 0 0
BETAHISTINE TAB 6 MG TABLET 2,400 0 2,400 0 2,400
GLIMEPIRIDE TAB 2 MG TABLET 2,500 0 2,500 0 2,500
CLOZAPINE TAB 100 MG TABLET 450 0 450 50 400
RISPERIDONE 2 MG TABLET 2,000 0 2,000 100 1,900
CETERIZINE TAB 100 MG TABLET 9,000 0 9,000 0 9,000
MICARDIS TAB 40 MG TABLET 400 0 400 40 360
AMLODIPINE TAB 5 MG TABLET 240 0 240 0 240

Jumlah Umum Jumlah

Mengetahui Tidak Bayar Tidak Sukaraja Tiga, 5 Maret 2019
Ka.UPTD Puskesmas Sukaraja Tiga Resep 500 465 965 Penanggung Jawab Laporan

I Nym Dus Arianto Erman Ariyanto,Amd.Kep

NIP : 19730313 199303 1 006 NIP.19750419 199502 1 001
Pemberian Keterangan
Pemberian Sisa Stok
, 5 Maret 2019
Jawab Laporan

to,Amd.Kep
9 199502 1 001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

Unit Penerima : Puskesmas Sukaraja Tiga Bulan : Januari

Kecamatan : Marga Tiga Tahun : 2019
Kabupaten : Lampung Timur
Provinsi : Lampung

Stok
Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Permintaan
Optimum
247 ALLOPURINOL TABLET 100 MG TABLET 6,020 0 6,020 400 5,620
415 AMINOPHYLLINE INJEKSI 24 MG/ML AMPUL 0 0 0 0 0
444 AMITRIPTYLINE TABLET 25 MG TABLET 100 500 600 100 500
445 AMLODIPINE TABLET 10 MG TABLET 600 0 600 90 510
446 AMLODIPINE TABLET 5 MG TABLET 360 0 360 215 145
523 AMOXYCILLIN SIRUP 250 MG/5 ML SIRUP 1,192 0 1,192 73 1,119
809 ANTACIDA TABLET 400 MG TABLET 44,400 0 44,400 3,100 41,300
966 ASAM MEFENAMAT TABLET 500 MG TABLET 30,530 0 30,530 4,100 26,430
923 ASCORBIC ACID (VITAMIN C) TABLET 250 MG TABLET 2,900 0 2,900 800 2,100
926 ASCORBIC ACID (VITAMIN C) TABLET 50 MG TABLET 9,200 0 9,200 1,100 8,100
1479 BENZOIC ACID SALEP SALEP 0 0 0 0 0
1690 BISACODYL SUPPOSITORIA 10 MG SUPPOS 90 0 90 12 78
1691 BISACODYL SUPPOSITORIA 5 MG SUPPOS 103 0 103 5 98
1702 BISMUTH SUBGALLATE|ZINC OXIDE|LIDOCAINE| SUPPOS
HEXACHLOROPHENE SUPPOSITORIA 2 G 0 0 0 0 0
10160 CALCIUM CHLORIDE DIHYDRATE|POTASSIUM CHLORIDE|SODIUM INFUS
CHLORIDE|SODIUM LACTATE INFUS 0 0 0 0 0
2005 CALCIUM LACTATE TABLET 500 MG TABLET 6,600 0 6,600 1,200 5,400
2084 CARBAMAZEPINE TABLET 200 MG TABLET 600 0 600 100 500
2518 CETIRIZINE SIRUP 5 MG/ML SIRUP 10 0 10 10 0
2546 CETIRIZINE TABLET 10 MG TABLET 0 0 0 0 0
2601 CHLORAMPHENICOL SALEP 2% SALEP 0 0 0 0 0
 2593 CHLORAMPHENICOL SIRUP 125 MG/5ML SIRUP 79 0 79 12 67
2745 CHLORPHENIRAMINE TABLET 4 MG TABLET 48,800 0 48,800 4,600 44,200
2762 CHLORPROMAZINE TABLET 100 MG TABLET 0 300 300 100 200
2763 CHLORPROMAZINE TABLET 25 MG TABLET 100 0 100 100 0
2828 CIPROFLOXACIN TABLET 500 MG TABLET 14,500 0 14,500 1,100 13,400
2967 CLAVULANIC ACID|AMOXICILLIN TABLET 500 MG TABLET 0 0 0 0 0
3202 COTRIMOXAZOLE SIRUP 240 MG/5 ML SIRUP 0 0 0 0 0
6645 COTRIMOXAZOLE TABLET TABLET 0 0 0 0 0
3416 DEXAMETHASONE INJEKSI 5 MG/ML INJEKSI 17 0 17 7 10
3443 DEXAMETHASONE TABLET 0.5 MG TABLET 0 0 0 0 0
3688 DICLOFENAC SODIUM TABLET 25 MG TABLET 4,900 0 4,900 750 4,150
3690 DICLOFENAC SODIUM TABLET 50 MG TABLET 1,400 0 1,400 800 600
3983 DOMPERIDONE TABLET 10 MG TABLET 2,550 0 2,550 850 1,700
4306 EPINEPHRINE INJEKSI 1 MG/ML INJEKSI 0 0 0 0 0
4445 ERYTHROMYCIN SIRUP 200 MG/5 ML SIRUP 56 0 56 6 50
4458 ERYTHROMYCIN TABLET 250 MG TABLET 1,300 0 1,300 100 1,200
4492 ESOMEPRAZOLE TABLET 20 MG TABLET 0 0 0 0 0
4736 FENOTEROL HYDROBROMIDE SPRAY 100 MCG SPRAY 5 0 5 5 0
945 FOLIC ACID TABLET 400 MCG TABLET 0 0 0 0
5079 FUSIDATE SODIUM SALEP 20 MG/G SALEP 0 0 0 0 0
5167 GENTAMYCIN SALEP 0.3 % SALEP 0 0 0 0 0
5266 GLIMEPIRIDE TABLET 2 MG TABLET 3,350 0 3,350 700 2,650
5300 GLUCOSE INFUS 5 % INFUS 0 0 0 0 0
5843 HYDROCORTISONE SALEP 2.5 % SALEP 120 0 120 10 110
5964 IBUPROFEN TABLET 200 MG TABLET 0 0 0 0 0
5966 IBUPROFEN TABLET 400 MG TABLET 0 0 0 0 0
AK0902022 INTRAVASCULAR ADMINISTRATION SET 0 0 0 0 0 0
6238 IPRATROPIUM BROMIDE|SALBUTAMOL SULPHATE LIQUID LIQUID 0 0 0 0 0
AK9005688 IV CATHETER NO 20 0 0 0 0 0 0
AK9005689 IV CATHETER NO 22 0 0 0 0 0 0
AK9005690 IV CATHETER NO 24 0 0 0 0 0 0
6535 KETOCONAZOLE SALEP 2% SALEP 0 0 0 0 0
6812 LEVODOPA|BENSERAZIDE TABLET 100 MG TABLET 0 0 0 0 0
6887 LIDOCAINE INJEKSI 20 MG/ML INJEKSI 30 0 30 10 20
 6998 LOPERAMIDE TABLET 2 MG TABLET 2,000 0 2,000 500 1,500
7013 LORATADINE TABLET 10 MG TABLET 1,800 0 1,800 600 1,200
7491 METFORMIN TABLET 500 MG TABLET 4,000 0 4,000 600 3,400
7536 METHYLERGOMETRINE INJEKSI 0.2 MG/ML INJEKSI 60 0 60 30 30
7586 METHYLPREDNISOLONE TABLET 8 MG TABLET 0 0 0 0 0
7651 METOCLOPRAMIDE TABLET 10 MG TABLET 600 0 600 50 550
7688 METRONIDAZOLE SIRUP 125 MG/5 ML SIRUP 0 0 0 0 0
7697 METRONIDAZOLE TABLET 500 MG TABLET 1,300 0 1,300 400 900
7727 MICONAZOLE SALEP 2% SALEP 8 0 8 8 0
8160 NIFEDIPINE TABLET 10 MG TABLET 250 0 250 100 150
8256 NYSTATIN OVULA 10000 IU OVULA 100 0 100 0 100
8573 PARACETAMOL DROPS 100 MG/ML DROPS 14 0 14 14 0
8601 PARACETAMOL SIRUP 120 MG/5 ML SIRUP 1,698 0 1,698 192 1,506
8593 PARACETAMOL TABLET 500 MG TABLET 74,700 0 74,700 6,800 67,900
9246 PHENYTOIN TABLET 100 MG TABLET 200 0 200 0 200
AK0902040 PISTON SYRINGE 0 0 0 0 0 0
9673 PROPANOLOL TABLET 10 MG TABLET 200 0 200 0 200
9805 PYRAZINAMIDE|ETHAMBUTOL|ISONIAZID|RIFAMPICIN TABLET TABLET 0 0 0 0 0
1684 PYRIDOXINE TABLET 10 MG TABLET 6,800 0 6,800 1,000 5,800
11896 RETINOL PALMITATE TABLET 100000 IU TABLET 0 0 0 0 0
10128 RIFAMPICIN|ISONIAZID TABLET 75 MG|50 MG TABLET 0 0 0 0 0
AK9008969 SARUNG TANGAN STERIL NO 7 0 0 0 0 0 0
AK9008970 SARUNG TANGAN STERIL NO 7.5 0 0 0 0 0 0
10482 SIMVASTATIN TABLET 10 MG TABLET 5,450 0 5,450 450 5,000
10908 SULFAMETHOXAZOLE|TRIMETHOPRIM TABLET 400 MG|80 MG TABLET 0 0 0 0 0
AK0501030 SYRINGE ACTUATOR FOR AN INJEKTOR 0 0 0 0 0 0
990 TRANEXAMIC ACID INJEKSI 5 ML INJEKSI 50 0 50 0 50
11719 TUBERCULIN PPD TABLET 10 TU/0.1 ML TABLET 0 0 0 0 0
11922 VITAMIN B COMPOUND TABLET TABLET 4,300 0 4,300 300 4,000
12189 ZINC SULPHATE SIRUP 20 MG/5 ML SIRUP 0 0 0 0 0

Obat Tambahan
 Stok
Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Optimum Permintaan

ALAT SUNTIK SEKALI PAKAI 0,5 ML PCS 60 0 60 20 40

ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0 0 0 0 0
ALAT SUNTIK SEKALI PAKAI 2,5 ML PCS 0 0 0 0 0
ALAT SUNTIK SEKALI PAKAI 5 ML PCS 15 0 15 15 0
ALAT SUNTIK SEKALI PAKAI 3 ML PCS 2,543 0 2,543 300 2,243
ALBENDAZOLE TAB TABLET 450 0 450 30 420
ANTASID SUSPENSI SIRUP 0 0 0 0 0
ANTIFUNGI DOEN KOMBINASI SALEP 98 0 98 12 86
ANTIHEMOROID KOMB. SUPOSOTORIA 2 MG SUPPO 20 0 20 10 10
AMOXICILLIN SIRUP KERING 125 MG/5ML BOTOL 988 0 988 150 838
AMOXICILLIN TABLET 500 MG TABLET 68,150 0 68,150 3,000 65,150
AMININOFILIN TABLET 200 MG TABLET 0 0 0 0 0
ASAM ASETILSALISILAT (ACETOSAL) TAB 80 MG TABLET 0 0 0 0 0
ASAM FOLAT 1 MG TABLET 2,900 0 2,900 2,900 0
ASIKLOFIR TAB 400 MG TABLET 200 0 200 0 200
ATAPULGIT TABLET 600 MG TABLET 0 0 0 0 0
BASITRASIN SALEP KULIT TUBE 72 0 72 22 50
BETAMETASON 0,5 MG/G SALEP KULIT TUBE 75 0 75 16 59
BISAKODIL TABLET SAL 5 MG TABLET 370 0 370 50 320
CAPTOPRIL TAB 25 MG TABLET 4,100 0 4,100 1,000 3,100
CHLORAMFENIKOL SALEP MATA 1 % SALEP 126 0 126 26 100
CHLORAMEX ( KLORAMFENIKOL ) KAPSUL 500 MG CAPSUL 300 0 300 200 100
CYANOCOBALAMIN ( VITAMIN B12) TAB 50 MG TABLET 3,900 0 3,900 700 3,200
DEC TABLET 100 MG TABLET 3,300 0 3,300 0 3,300
DHP TAB TABLET 9 0 9 0 9
ETANOL 70% 100 ML CAIRAN 10 0 10 1 9
ETANOL 70% 300 ML CAIRAN 5 0 5 0 5
EUGENOL CAIRAN CAIRAN 18 0 18 0 18
FITOMENADION ( VIT K ) INJEKSI 2 MG/ML AMPUL 0 0 0 0 0
FITOMENADION ( VIT K ) TABLET TABLET 900 0 900 100 800
FUROSEMID TAB 40 MG TABLET 5,600 0 5,600 800 4,800
GENTAMICIN INJEKSI AMPUL 7 0 7 0 7
GARAM ORALIT UNTUK 200 ML AIR SACHET 250 0 250 50 200
GRISEOFULVIN TAB 250 MG TABLET 300 0 300 0 300
HALOPERIDOL TAB 1,5 MG TABLET 0 0 0 0 0
ISOSORBID DINITRAT TAB SUBLINGUAL 5MG TABLET 0 0 0 0 0
ISONIAZID TAB 300 MG TABLET 100 0 100 0 100
KETOCONAZOLE TABLET 200 MG TABLET 700 0 700 200 500
LEVOTREOKSIN TABLET 0 0 0 0 0
MAGNESIUM SO4 INJEKSI 40% AMPUL 17 0 17 0 17
MASKER PCS 0 0 0 0 0
MEBENDAZOL TABLET 100 MG (VERMOX) TABLET 18 0 18 0 18
METHILPREDNISOLONE TAB 4 MG TABLET 500 0 500 100 400
NACL INFUS INFUS 16 0 16 2 14
OMEPRAZOLE CAPSUL 20 MG CAPSUL 0 0 0 0 0
OXYTOSIN INJEKSI AMPUL 35 0 35 5 30
PERAK SULFADIAZIN KRIM 1 % TUBE 6 0 6 0 6
PLESTER 5 YARD X 2 INCHI PCS 0 0 0 0 0
POVIDON IODIDA @ 30 ML LARUTAN 0 0 0 0 0
POVIDON IODIDA @ 300 ML LARUTAN 3 0 3 0 3
PREDNISONE TAB 5 MG TABLET 1,900 0 1,900 200 1,700
PROFYLTHIURACIL TAB 100 MG TABLET 0 0 0 0 0
RANITIDINE TAB 150 MG TABLET 1,000 0 1,000 600 400
RINGER LAKTAT LARUTAN INFUS STERIL INFUS 40 0 40 0 40
SALBUTAMOL TAB 2 MG TABLET 3,700 0 3,700 300 3,400
SALEP 2-4 KOMBINASI SALEP 71 0 71 6 65
SIMVASTATIN TABLET 20 MG /TABLET TABLET 280 0 280 20 260
SPIRONOLACTONE 25 MG TABLET 350 0 350 50 300
STESOLID ( DIAZEPAM ) LAT REKTAL 5 MG/2,5 ML SUPPO 22 0 22 2 20
SULFADOKSIN PYRIMETHAMINE TAB 5000-25 MG TABLET 100 0 100 0 100
THIAMIN ( VITAMIN B1) TABLET 50 MG TABLET 4,800 0 4,800 600 4,200
TRIHEKSIFENADIL TAB 2 MG TABLET 1,600 200 1,800 200 1,600
ZINC TABLET 10 MG TABLET 0 0 0 0 0
CLOBAZAM TAB TABLET 0 10 10 0 10
 DIAZEPAM INJEKSI AMPUL 0 5 5 0 5
HALOPERIDOL TAB 5 MG TABLET 0 300 300 100 200
HALOPERIDOL 1,5 MG TABLET 0 30 30 0 30
HALOPERIDOL INJEKSI 50 MG AMPUL 0 50 50 0 50
HALOPERIDOL 5 MG AMPUL 0 12 12 0 12

BMHP
ABOCATH NO: 20 PCS 171 0 171 0 171
AXIMED FACE MASK EAR LOOP DUS 35 0 35 5 30
AXIMED FACE MASK TIES ON DUS 41 0 41 5 36
AXIMED SWAB 2-PLY DUS 87 0 87 6 81
CANNOFIX-PU (6 CM X 8 CM) PCS 7 0 7 1 6
KASSA BERLEMAK PACK 19 0 19 2 17
SARUNG TANGAN SIZE M BOX 5 0 5 2 3
SARUNG TANGAN SIZE L BOX 6 0 6 3 3
SNA MEDIKA POLIBAN 10 CM X 2.7 M ROLL 3 0 3 0 3
SPUIT 0,5 ML PCS 1,650 0 1,650 100 1,550
URINE BAG STERIL PCS 28 0 28 0 28
ALKAZYME SACHET 25 MG PACK 2 0 2 0 2
DESTRUCT SYIRING WITH NEEDLE 5 ML PCS 200 0 200 0 200
SMTHS MEDICAL JELCO 20/ ABOCATH 20 PCS 43 0 43 0 43
ESKAMED IV CANNULA (22) PCS 196 0 196 0 196
ESKAMED IV CANNULA (24) PCS 96 0 96 0 96
NIPRO INFUS SET DEWASA PCS 81 0 81 0 81
AXIMED SYRINGE 3 CC SET 5,900 0 5,900 200 5,700
AXIMED INFUS PEDIATRIC SET PCS 96 0 96 0 96
AXIMED PAPER TAPE/1.25CM X 9.14 M ROLL 45 0 45 1 44
UTAMA KASSA KOMPRES STERIL 16 X 16 CM PACK 14 0 14 5 9
UTAMA KASSA KOMPRES STERIL 4 M X 10 CM ROLL 7 0 7 2 5
EGYPT PHARMAFIX (5 CM X 500 CM ) BOX 6 0 6 1 5
SKIFA AUTO DISABLE/ SPUIT 0,5 ML PCS 500 0 500 0 500
BPJS
ALLOPURINOL TABLET 100 MG TABLET 3,900 0 3,900 200 3,700
AMOXICILLIN TABLET 500 MG TABLET 15,900 0 15,900 200 15,700
ANTI FUNGI DOEN SALEF KOMBINASI KRIM 64 0 64 0 64
BETAMETASON 0,1 % SALEP KULIT KRIM 350 0 350 0 350
BISOPROLOL TAB SALUT 5 MG TABLET 0 0 0 0 0
BUFACETIN(KLORAMFENICOL) SALEF KULIT 2% KRIM 166 0 166 0 166
CIPROFLOXACIN TABLET 500 MG TABLET 2,200 0 2,200 200 2,000
CHLORAMEX ( KLORAMFENIKOL ) KAPSUL 500 MG KAPSUL 2,550 0 2,550 200 2,350
CHLORPHENIRAMINE MALEAT 4 MG TABLET 0 0 0 0 0
DILTIAZEM TABLET 30 MG TABLET 300 0 300 0 300
EFINEPRIN 0,1 % INJEKSI 1MG/ ML INJEKSI 70 0 70 0 70
HIDROCORTISONE 2,5 % SALEP KULIT KRIM 60 0 60 12 48
HIDROCLOROTIAZID ( HCT ) TABLET 25 MG TABLET 2,100 0 2,100 200 1,900
KETOCONAZOLE TABLET 200 MG TABLET 0 0 0 0 0
KETOCONAZOLE 2 % SALEP KULIT KRIM 52 0 52 2 50
KLORAMPHENICOL SUSP 125 MG/5 ML SUSPENSI 35 0 35 0 35
LIDOCAINE COMPOSITUM INJEKSI 2% INJEKSI 530 0 530 30 500
LEVOFLOXACIN TABLET 3,100 0 3,100 200 2,900
LOPERAMIDE HCL 2 MG TABLET 800 0 800 0 800
METFORMIN TABLET 0 0 0 0 0
METTHYLPREDNISOLON TAB 4 MG TABLET 0 0 0 0 0
NATRIUM DIKLOFENAK TAB 50 MG TABLET 1,350 0 1,350 0 1,350
NEW ANTIDES TABLET 0 0 0 0 0
RANITIDINE TAB 150 MG TABLET 10,500 0 10,500 2,000 8,500
RINGER LACTAT LARUTAN INFUS CAIRAN 54 0 54 0 54
RISPERIDONE 1 MG TABLET 3,100 0 3,100 100 3,000
SALEP 2-4 KOMBINASI KRIM 62 0 62 2 60
SIMVASTATIN TABLET 10 MG /TABLET TABLET 480 0 480 90 390
SPIRONOLACTONE 25 MG TABLET 1,100 0 1,100 100 1,000
STESOLID ( DIAZEPAM ) LAT REKTAL 5 MG/2,5 ML TUBE 0 0 0 0 0
TETRACIKLINE CAPSUL 500 MG KAPSUL 5,800 0 5,800 400 5,400
VITAMIN B1 (TIAMIN) TABLET TABLET 16,100 0 16,100 0 16,100
VENTOLIN NEBULES 2,5 MG AMP 40 0 40 0 40
VENTOLIN ROTAHALER BOK 15 0 15 0 15
XYLOCAINE 2% JELLY TUBE 0 0 0 0 0
BETAHISTINE TAB 6 MG TABLET 2,400 0 2,400 0 2,400
GLIMEPIRIDE TAB 2 MG TABLET 2,500 0 2,500 0 2,500
CLOZAPINE TAB 100 MG TABLET 500 0 500 50 450
RISPERIDONE 2 MG TABLET 2,000 0 2,000 0 2,000
CETERIZINE TAB 100 MG TABLET 9,000 0 9,000 0 9,000
MICARDIS TAB 40 MG TABLET 400 0 400 0 400
AMLODIPINE TAB 5 MG TABLET 240 0 240 0 240

Jumlah Umum Jumlah

Mengetahui Tidak Bayar Tidak Sukaraja Tiga, 4 Februari 2019
Ka.UPTD Puskesmas Sukaraja Tiga Resep 467 396 863 Penanggung Jawab Laporan

I NYM DUA ARIANTO Erman Ariyanto,Amd.Kep

NIP : 19730313 199303 1 006 NIP.19750419 199502 1 001
Pemberian Keterangan
Pemberian Sisa Stok
, 4 Februari 2019
Jawab Laporan

to,Amd.Kep
9 199502 1 001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

Unit Penerima : Puskesmas Sukaraja Tiga Bulan : Desember

Kecamatan : Marga Tiga Tahun : 2018
Kabupaten : Lampung Timur
Provinsi : Lampung

Stok
Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Permintaan
Optimum
247 ALLOPURINOL TABLET 100 MG TABLET 5,020 1,400 6,420 400 6,020
415 AMINOPHYLLINE INJEKSI 24 MG/ML AMPUL 0 0 0 0 0
444 AMITRIPTYLINE TABLET 25 MG TABLET 100 0 100 0 100
445 AMLODIPINE TABLET 10 MG TABLET 180 450 630 30 600
446 AMLODIPINE TABLET 5 MG TABLET 690 150 840 480 360
523 AMOXYCILLIN SIRUP 250 MG/5 ML SIRUP 859 400 1,259 67 1,192
809 ANTACIDA TABLET 400 MG TABLET 46,900 6,700 53,600 9,200 44,400
966 ASAM MEFENAMAT TABLET 500 MG TABLET 38,730 2,000 40,730 10,200 30,530
923 ASCORBIC ACID (VITAMIN C) TABLET 250 MG TABLET 1,900 1,800 3,700 800 2,900
926 ASCORBIC ACID (VITAMIN C) TABLET 50 MG TABLET 2,500 7,900 10,400 1,200 9,200
1479 BENZOIC ACID SALEP SALEP 0 0 0 0 0
1690 BISACODYL SUPPOSITORIA 10 MG SUPPOS 90 0 90 0 90
1691 BISACODYL SUPPOSITORIA 5 MG SUPPOS 108 0 108 5 103
1702 BISMUTH SUBGALLATE|ZINC OXIDE|LIDOCAINE| SUPPOS
HEXACHLOROPHENE SUPPOSITORIA 2 G 0 0 0 0 0
10160 CALCIUM CHLORIDE DIHYDRATE|POTASSIUM CHLORIDE|SODIUM INFUS
CHLORIDE|SODIUM LACTATE INFUS 0 0 0 0 0
2005 CALCIUM LACTATE TABLET 500 MG TABLET 3,500 4,000 7,500 900 6,600
2084 CARBAMAZEPINE TABLET 200 MG TABLET 300 300 600 0 600
2518 CETIRIZINE SIRUP 5 MG/ML SIRUP 22 0 22 12 10
2546 CETIRIZINE TABLET 10 MG TABLET 0 0 0 0 0
2601 CHLORAMPHENICOL SALEP 2% SALEP 0 0 0 0 0
 2593 CHLORAMPHENICOL SIRUP 125 MG/5ML SIRUP 84 0 84 5 79
2745 CHLORPHENIRAMINE TABLET 4 MG TABLET 12,800 40,000 52,800 4,000 48,800
2762 CHLORPROMAZINE TABLET 100 MG TABLET 0 0 0 0 0
2763 CHLORPROMAZINE TABLET 25 MG TABLET 100 0 100 0 100
2828 CIPROFLOXACIN TABLET 500 MG TABLET 12,200 3,300 15,500 1,000 14,500
2967 CLAVULANIC ACID|AMOXICILLIN TABLET 500 MG TABLET 0 0 0 0 0
3202 COTRIMOXAZOLE SIRUP 240 MG/5 ML SIRUP 15 0 15 15 0
6645 COTRIMOXAZOLE TABLET TABLET 100 0 100 100 0
3416 DEXAMETHASONE INJEKSI 5 MG/ML INJEKSI 17 0 17 0 17
3443 DEXAMETHASONE TABLET 0.5 MG TABLET 0 0 0 0 0
3688 DICLOFENAC SODIUM TABLET 25 MG TABLET 2,400 2,700 5,100 200 4,900
3690 DICLOFENAC SODIUM TABLET 50 MG TABLET 1,650 0 1,650 250 1,400
3983 DOMPERIDONE TABLET 10 MG TABLET 1,500 1,300 2,800 250 2,550
4306 EPINEPHRINE INJEKSI 1 MG/ML INJEKSI 0 0 0 0 0
4445 ERYTHROMYCIN SIRUP 200 MG/5 ML SIRUP 60 0 60 4 56
4458 ERYTHROMYCIN TABLET 250 MG TABLET 1,100 300 1,400 100 1,300
4492 ESOMEPRAZOLE TABLET 20 MG TABLET 0 0 0 0 0
4736 FENOTEROL HYDROBROMIDE SPRAY 100 MCG SPRAY 16 0 16 11 5
945 FOLIC ACID TABLET 400 MCG TABLET 0 0 0 0 0
5079 FUSIDATE SODIUM SALEP 20 MG/G SALEP 0 0 0 0 0
5167 GENTAMYCIN SALEP 0.3 % SALEP 0 0 0 0 0
5266 GLIMEPIRIDE TABLET 2 MG TABLET 1,800 1,950 3,750 400 3,350
5300 GLUCOSE INFUS 5 % INFUS 0 0 0 0 0
5843 HYDROCORTISONE SALEP 2.5 % SALEP 0 120 120 0 120
5964 IBUPROFEN TABLET 200 MG TABLET 0 0 0 0 0
5966 IBUPROFEN TABLET 400 MG TABLET 0 0 0 0 0
AK0902022 INTRAVASCULAR ADMINISTRATION SET 0 0 0 0 0 0
6238 IPRATROPIUM BROMIDE|SALBUTAMOL SULPHATE LIQUID LIQUID 0 0 0 0 0
AK9005688 IV CATHETER NO 20 0 0 0 0 0 0
AK9005689 IV CATHETER NO 22 0 0 0 0 0 0
AK9005690 IV CATHETER NO 24 0 0 0 0 0 0
6535 KETOCONAZOLE SALEP 2% SALEP 0 0 0 0 0
6812 LEVODOPA|BENSERAZIDE TABLET 100 MG TABLET 0 0 0 0 0
6887 LIDOCAINE INJEKSI 20 MG/ML INJEKSI 24 30 54 24 30
 6998 LOPERAMIDE TABLET 2 MG TABLET 2,290 800 3,090 1,090 2,000
7013 LORATADINE TABLET 10 MG TABLET 1,000 1,600 2,600 800 1,800
7491 METFORMIN TABLET 500 MG TABLET 3,000 1,200 4,200 200 4,000
7536 METHYLERGOMETRINE INJEKSI 0.2 MG/ML INJEKSI 70 0 70 10 60
7586 METHYLPREDNISOLONE TABLET 8 MG TABLET 0 0 0 0 0
7651 METOCLOPRAMIDE TABLET 10 MG TABLET 600 0 600 0 600
7688 METRONIDAZOLE SIRUP 125 MG/5 ML SIRUP 5 0 5 5 0
7697 METRONIDAZOLE TABLET 500 MG TABLET 700 900 1,600 300 1,300
7727 MICONAZOLE SALEP 2% SALEP 17 0 17 9 8
8160 NIFEDIPINE TABLET 10 MG TABLET 300 0 300 50 250
8256 NYSTATIN OVULA 10000 IU OVULA 100 0 100 0 100
8573 PARACETAMOL DROPS 100 MG/ML DROPS 25 0 25 11 14
8601 PARACETAMOL SIRUP 120 MG/5 ML SIRUP 1,712 150 1,862 164 1,698
8593 PARACETAMOL TABLET 500 MG TABLET 96,800 0 96,800 22,100 74,700
9246 PHENYTOIN TABLET 100 MG TABLET 200 0 200 0 200
AK0902040 PISTON SYRINGE 0 0 0 0 0 0
9673 PROPANOLOL TABLET 10 MG TABLET 200 0 200 0 200
9805 PYRAZINAMIDE|ETHAMBUTOL|ISONIAZID|RIFAMPICIN TABLET TABLET 0 0 0 0 0
1684 PYRIDOXINE TABLET 10 MG TABLET 3,500 4,100 7,600 800 6,800
11896 RETINOL PALMITATE TABLET 100000 IU TABLET 0 0 0 0 0
10128 RIFAMPICIN|ISONIAZID TABLET 75 MG|50 MG TABLET 0 0 0 0 0
AK9008969 SARUNG TANGAN STERIL NO 7 0 0 0 0 0 0
AK9008970 SARUNG TANGAN STERIL NO 7.5 0 0 0 0 0 0
10482 SIMVASTATIN TABLET 10 MG TABLET 3,410 2,280 5,690 240 5,450
10908 SULFAMETHOXAZOLE|TRIMETHOPRIM TABLET 400 MG|80 MG TABLET 0 0 0 0 0
AK0501030 SYRINGE ACTUATOR FOR AN INJEKTOR 0 0 0 0 0 0
990 TRANEXAMIC ACID INJEKSI 5 ML INJEKSI 80 0 80 30 50
11719 TUBERCULIN PPD TABLET 10 TU/0.1 ML TABLET 0 0 0 0 0
11922 VITAMIN B COMPOUND TABLET TABLET 500 4,300 4,800 500 4,300
12189 ZINC SULPHATE SIRUP 20 MG/5 ML SIRUP 0 0 0 0 0

Obat Tambahan
 Stok
Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Optimum Permintaan

ALAT SUNTIK SEKALI PAKAI 0,5 ML PCS 160 0 160 100 60

ALAT SUNTIK SEKALI PAKAI 1 ML PCS 0 0 0 0 0
ALAT SUNTIK SEKALI PAKAI 2,5 ML PCS 0 0 0 0 0
ALAT SUNTIK SEKALI PAKAI 5 ML PCS 25 0 25 10 15
ALAT SUNTIK SEKALI PAKAI 3 ML PCS 2,823 0 2,823 280 2,543
ALBENDAZOLE TAB TABLET 360 120 480 30 450
ANTASID SUSPENSI SIRUP 0 0 0 0 0
ANTIFUNGI DOEN KOMBINASI SALEP 86 48 134 36 98
ANTIHEMOROID KOMB. SUPOSOTORIA 2 MG SUPPO 30 0 30 10 20
AMOXICILLIN SIRUP KERING 125 MG/5ML BOTOL 632 450 1,082 94 988
AMOXICILLIN TABLET 500 MG TABLET 64,150 6,400 70,550 2,400 68,150
AMININOFILIN TABLET 200 MG TABLET 0 0 0 0 0
ASAM ASETILSALISILAT (ACETOSAL) TAB 80 MG TABLET 0 0 0 0 0
ASAM FOLAT 1 MG TABLET 1,500 1,700 3,200 300 2,900
ASIKLOFIR TAB 400 MG TABLET 400 0 400 200 200
ATAPULGIT TABLET 600 MG TABLET 0 0 0 0 0
BASITRASIN SALEP KULIT TUBE 52 24 76 4 72
BETAMETASON 0,5 MG/G SALEP KULIT TUBE 61 25 86 11 75
BISAKODIL TABLET SAL 5 MG TABLET 400 0 400 30 370
CAPTOPRIL TAB 25 MG TABLET 4,600 0 4,600 500 4,100
CHLORAMFENIKOL SALEP MATA 1 % SALEP 142 0 142 16 126
CHLORAMEX ( KLORAMFENIKOL ) KAPSUL 500 MG CAPSUL 400 0 400 100 300
CYANOCOBALAMIN ( VITAMIN B12) TAB 50 MG TABLET 2,700 1,500 4,200 300 3,900
DEC TABLET 100 MG TABLET 3,300 0 3,300 0 3,300
DHP TAB TABLET 9 0 9 0 9
ETANOL 70% 100 ML CAIRAN 13 0 13 3 10
ETANOL 70% 300 ML CAIRAN 6 0 6 1 5
EUGENOL CAIRAN CAIRAN 18 0 18 0 18
FITOMENADION ( VIT K ) INJEKSI 2 MG/ML AMPUL 0 0 0 0 0
FITOMENADION ( VIT K ) TABLET TABLET 700 300 1,000 100 900
FUROSEMID TAB 40 MG TABLET 2,000 3,800 5,800 200 5,600
GENTAMICIN INJEKSI AMPUL 17 0 17 10 7
GARAM ORALIT UNTUK 200 ML AIR SACHET 330 0 330 80 250
GRISEOFULVIN TAB 250 MG TABLET 300 0 300 0 300
HALOPERIDOL TAB 1,5 MG TABLET 0 0 0 0 0
ISOSORBID DINITRAT TAB SUBLINGUAL 5MG TABLET 0 0 0 0 0
ISONIAZID TAB 300 MG TABLET 100 0 100 0 100
KETOCONAZOLE TABLET 200 MG TABLET 150 600 750 50 700
LEVOTREOKSIN TABLET 0 0 0 0 0
MAGNESIUM SO4 INJEKSI 40% AMPUL 17 0 17 0 17
MASKER PCS 0 0 0 0 0
MEBENDAZOL TABLET 100 MG (VERMOX) TABLET 18 0 18 0 18
METHILPREDNISOLONE TAB 4 MG TABLET 0 500 500 0 500
NACL INFUS INFUS 18 0 18 2 16
OMEPRAZOLE CAPSUL 20 MG CAPSUL 0 0 0 0 0
OXYTOSIN INJEKSI AMPUL 50 0 50 15 35
PERAK SULFADIAZIN KRIM 1 % TUBE 7 0 7 1 6
PLESTER 5 YARD X 2 INCHI PCS 0 0 0 0 0
POVIDON IODIDA @ 30 ML LARUTAN 0 0 0 0 0
POVIDON IODIDA @ 300 ML LARUTAN 4 0 4 1 3
PREDNISONE TAB 5 MG TABLET 0 1,900 1,900 0 1,900
PROFYLTHIURACIL TAB 100 MG TABLET 0 0 0 0 0
RANITIDINE TAB 150 MG TABLET 1,500 0 1,500 500 1,000
RINGER LAKTAT LARUTAN INFUS STERIL INFUS 80 0 80 40 40
SALBUTAMOL TAB 2 MG TABLET 2,200 1,600 3,800 100 3,700
SALEP 2-4 KOMBINASI SALEP 82 0 82 11 71
SIMVASTATIN TABLET 20 MG /TABLET TABLET 300 0 300 20 280
SPIRONOLACTONE 25 MG TABLET 350 0 350 0 350
STESOLID ( DIAZEPAM ) LAT REKTAL 5 MG/2,5 ML SUPPO 15 10 25 3 22
SULFADOKSIN PYRIMETHAMINE TAB 5000-25 MG TABLET 100 0 100 0 100
THIAMIN ( VITAMIN B1) TABLET 50 MG TABLET 3,000 2,400 5,400 600 4,800
TRIHEKSIFENADIL TAB 2 MG TABLET 1,000 700 1,700 100 1,600
ZINC TABLET 10 MG TABLET 0 0 0 0 0
BMHP
ABOCATH NO: 20 PCS 175 0 175 4 171
AXIMED FACE MASK EAR LOOP DUS 53 0 53 18 35
AXIMED FACE MASK TIES ON DUS 40 3 43 2 41
AXIMED SWAB 2-PLY DUS 46 45 91 4 87
CANNOFIX-PU (6 CM X 8 CM) PCS 7 0 7 0 7
KASSA BERLEMAK PACK 20 5 25 6 19
SARUNG TANGAN SIZE M BOX 3 3 6 1 5
SARUNG TANGAN SIZE L BOX 4 3 7 1 6
SNA MEDIKA POLIBAN 10 CM X 2.7 M ROLL 3 0 3 0 3
SPUIT 0,5 ML PCS 1,700 0 1,700 50 1,650
URINE BAG STERIL PCS 38 10 48 20 28
ALKAZYME SACHET 25 MG PACK 2 0 2 0 2
DESTRUCT SYIRING WITH NEEDLE 5 ML PCS 100 100 200 0 200
SMTHS MEDICAL JELCO 20/ ABOCATH 20 PCS 93 0 93 50 43
ESKAMED IV CANNULA (22) PCS 198 0 198 2 196
ESKAMED IV CANNULA (24) PCS 99 0 99 3 96
NIPRO INFUS SET DEWASA PCS 91 0 91 10 81
AXIMED SYRINGE 3 CC SET 3,800 2,200 6,000 100 5,900
AXIMED INFUS PEDIATRIC SET PCS 98 0 98 2 96
AXIMED PAPER TAPE/1.25CM X 9.14 M ROLL 45 0 45 0 45
UTAMA KASSA KOMPRES STERIL 16 X 16 CM PACK 6 11 17 3 14
UTAMA KASSA KOMPRES STERIL 4 M X 10 CM ROLL 3 4 7 0 7
EGYPT PHARMAFIX (5 CM X 500 CM ) BOX 4 3 7 1 6
SKIFA AUTO DISABLE/ SPUIT 0,5 ML PCS 500 0 500 0 500

BPJS
ALLOPURINOL TABLET 100 MG TABLET 4,100 0 4,100 200 3,900
AMOXICILLIN TABLET 500 MG TABLET 16,200 0 16,200 300 15,900
ANTI FUNGI DOEN SALEF KOMBINASI KRIM 70 0 70 6 64
BETAMETASON 0,1 % SALEP KULIT KRIM 375 0 375 25 350
BISOPROLOL TAB SALUT 5 MG TABLET 0 0 0 0 0
BUFACETIN(KLORAMFENICOL) SALEF KULIT 2% KRIM 176 0 176 10 166
CIPROFLOXACIN TABLET 500 MG TABLET 2,300 0 2,300 100 2,200
CHLORAMEX ( KLORAMFENIKOL ) KAPSUL 500 MG KAPSUL 3,050 0 3,050 500 2,550
CHLORPHENIRAMINE MALEAT 4 MG TABLET 0 0 0 0 0
DILTIAZEM TABLET 30 MG TABLET 300 0 300 0 300
EFINEPRIN 0,1 % INJEKSI 1MG/ ML INJEKSI 70 0 70 0 70
HIDROCORTISONE 2,5 % SALEP KULIT KRIM 90 0 90 30 60
HIDROCLOROTIAZID ( HCT ) TABLET 25 MG TABLET 2,700 0 2,700 600 2,100
KETOCONAZOLE TABLET 200 MG TABLET 0 0 0 0 0
KETOCONAZOLE 2 % SALEP KULIT KRIM 57 0 57 5 52
KLORAMPHENICOL SUSP 125 MG/5 ML SUSPENSI 40 0 40 5 35
LIDOCAINE COMPOSITUM INJEKSI 2% INJEKSI 590 0 590 60 530
LEVOFLOXACIN TABLET 3,400 0 3,400 300 3,100
LOPERAMIDE HCL 2 MG TABLET 800 0 800 0 800
METFORMIN TABLET 0 0 0 0 0
METTHYLPREDNISOLON TAB 4 MG TABLET 0 0 0 0 0
NATRIUM DIKLOFENAK TAB 50 MG TABLET 1,450 0 1,450 100 1,350
NEW ANTIDES TABLET 0 0 0 0 0
RANITIDINE TAB 150 MG TABLET 11,000 0 11,000 500 10,500
RINGER LACTAT LARUTAN INFUS CAIRAN 54 0 54 0 54
RISPERIDONE 1 MG TABLET 3,400 0 3,400 300 3,100
SALEP 2-4 KOMBINASI KRIM 67 0 67 5 62
SIMVASTATIN TABLET 10 MG /TABLET TABLET 510 0 510 30 480
SPIRONOLACTONE 25 MG TABLET 1,100 0 1,100 0 1,100
STESOLID ( DIAZEPAM ) LAT REKTAL 5 MG/2,5 ML TUBE 0 0 0 0 0
TETRACIKLINE CAPSUL 500 MG KAPSUL 7,000 0 7,000 1,200 5,800
VITAMIN B1 (TIAMIN) TABLET TABLET 17,400 0 17,400 1,300 16,100
VENTOLIN NEBULES 2,5 MG AMP 40 0 40 0 40
VENTOLIN ROTAHALER BOK 15 0 15 0 15
XYLOCAINE 2% JELLY TUBE 0 0 0 0 0
BETAHISTINE TAB 6 MG TABLET 0 2,400 2,400 0 2,400
GLIMEPIRIDE TAB 2 MG TABLET 0 2,500 2,500 0 2,500
CLOZAPINE TAB 100 MG TABLET 0 500 500 0 500
RISPERIDONE 2 MG TABLET 0 2,000 2,000 0 2,000
CETERIZINE TAB 100 MG TABLET 0 9,000 9,000 0 9,000
MICARDIS TAB 40 MG TABLET 0 400 400 0 400
AMLODIPINE TAB 5 MG TABLET 0 240 240 0 240

Jumlah Umum Jumlah

Mengetahui Tidak Bayar Tidak Sukaraja Tiga, 03 Januari 2019
Ka.UPTD Puskesmas Sukaraja Tiga Resep Penanggung Jawab Laporan

Hj. Emyatun , SKM Erman Ariyanto,Amd.Kep

NIP.19660411 198603 2 004 NIP.19750419 199502 1 001
Pemberian Keterangan
Pemberian Sisa Stok
, 03 Januari 2019
Jawab Laporan

to,Amd.Kep
9 199502 1 001
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

Unit Penerima Bulan

Kecamatan : Marga Tiga Tahun
Kabupaten : Lampung Timur
Provinsi : Lampung

Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Stok Optimum Permintaan
247 ALLOPURINOL TABLET 100 MG TABLET
415 AMINOPHYLLINE INJEKSI 24 MG/ML AMPUL
444 AMITRIPTYLINE TABLET 25 MG TABLET
445 AMLODIPINE TABLET 10 MG TABLET
446 AMLODIPINE TABLET 5 MG TABLET
523 AMOXYCILLIN SIRUP 250 MG/5 ML SIRUP
809 ANTACIDA TABLET 400 MG TABLET
966 ASAM MEFENAMAT TABLET 500 MG TABLET
923 ASCORBIC ACID (VITAMIN C) TABLET 250 MG TABLET
926 ASCORBIC ACID (VITAMIN C) TABLET 50 MG TABLET
1479 BENZOIC ACID SALEP SALEP
1690 BISACODYL SUPPOSITORIA 10 MG SUPPOS
1691 BISACODYL SUPPOSITORIA 5 MG SUPPOS

1702 BISMUTH SUBGALLATE|ZINC OXIDE|LIDOCAINE| SUPPOS

HEXACHLOROPHENE SUPPOSITORIA 2 G
10160 CALCIUM CHLORIDE DIHYDRATE|POTASSIUM CHLORIDE| INFUS
SODIUM CHLORIDE|SODIUM LACTATE INFUS
2005 CALCIUM LACTATE TABLET 500 MG TABLET
2084 CARBAMAZEPINE TABLET 200 MG TABLET
2518 CETIRIZINE SIRUP 5 MG/ML SIRUP
2546 CETIRIZINE TABLET 10 MG TABLET
2601 CHLORAMPHENICOL SALEP 2% SALEP
 2593 CHLORAMPHENICOL SIRUP 125 MG/5ML SIRUP
2745 CHLORPHENIRAMINE TABLET 4 MG TABLET
2762 CHLORPROMAZINE TABLET 100 MG TABLET
2763 CHLORPROMAZINE TABLET 25 MG TABLET
2828 CIPROFLOXACIN TABLET 500 MG TABLET
2967 CLAVULANIC ACID|AMOXICILLIN TABLET 500 MG TABLET
3202 COTRIMOXAZOLE SIRUP 240 MG/5 ML SIRUP
6645 COTRIMOXAZOLE TABLET TABLET
3416 DEXAMETHASONE INJEKSI 5 MG/ML INJEKSI
3443 DEXAMETHASONE TABLET 0.5 MG TABLET
3688 DICLOFENAC SODIUM TABLET 25 MG TABLET
3690 DICLOFENAC SODIUM TABLET 50 MG TABLET
3983 DOMPERIDONE TABLET 10 MG TABLET
4306 EPINEPHRINE INJEKSI 1 MG/ML INJEKSI
4445 ERYTHROMYCIN SIRUP 200 MG/5 ML SIRUP
4458 ERYTHROMYCIN TABLET 250 MG TABLET
4492 ESOMEPRAZOLE TABLET 20 MG TABLET
4736 FENOTEROL HYDROBROMIDE SPRAY 100 MCG SPRAY
945 FOLIC ACID TABLET 400 MCG TABLET
5079 FUSIDATE SODIUM SALEP 20 MG/G SALEP
5167 GENTAMYCIN SALEP 0.3 % SALEP
5266 GLIMEPIRIDE TABLET 2 MG TABLET
5300 GLUCOSE INFUS 5 % INFUS
5843 HYDROCORTISONE SALEP 2.5 % SALEP
5964 IBUPROFEN TABLET 200 MG TABLET
5966 IBUPROFEN TABLET 400 MG TABLET
AK0902022 INTRAVASCULAR ADMINISTRATION SET 0
6238 IPRATROPIUM BROMIDE|SALBUTAMOL SULPHATE LIQUID LIQUID
AK9005688 IV CATHETER NO 20 0
AK9005689 IV CATHETER NO 22 0
AK9005690 IV CATHETER NO 24 0
6535 KETOCONAZOLE SALEP 2% SALEP
6812 LEVODOPA|BENSERAZIDE TABLET 100 MG TABLET
6887 LIDOCAINE INJEKSI 20 MG/ML INJEKSI
 6998 LOPERAMIDE TABLET 2 MG TABLET
7013 LORATADINE TABLET 10 MG TABLET
7491 METFORMIN TABLET 500 MG TABLET
7536 METHYLERGOMETRINE INJEKSI 0.2 MG/ML INJEKSI
7586 METHYLPREDNISOLONE TABLET 8 MG TABLET
7651 METOCLOPRAMIDE TABLET 10 MG TABLET
7688 METRONIDAZOLE SIRUP 125 MG/5 ML SIRUP
7697 METRONIDAZOLE TABLET 500 MG TABLET
7727 MICONAZOLE SALEP 2% SALEP
8160 NIFEDIPINE TABLET 10 MG TABLET
8256 NYSTATIN OVULA 10000 IU OVULA
8573 PARACETAMOL DROPS 100 MG/ML DROPS
8601 PARACETAMOL SIRUP 120 MG/5 ML SIRUP
8593 PARACETAMOL TABLET 500 MG TABLET
9246 PHENYTOIN TABLET 100 MG TABLET
AK0902040 PISTON SYRINGE 0
9673 PROPANOL TABLET 10 MG TABLET
9805 PYRAZINAMIDE|ETHAMBUTOL|ISONIAZID|RIFAMPICIN TABLET TABLET
1684 PYRIDOXINE TABLET 10 MG TABLET
11896 RETINOL PALMITATE TABLET 100000 IU TABLET
10128 RIFAMPICIN|ISONIAZID TABLET 75 MG|50 MG TABLET
AK9008969 SARUNG TANGAN STERIL NO 7 0
AK9008970 SARUNG TANGAN STERIL NO 7.5 0
10482 SIMVASTATIN TABLET 10 MG TABLET
10908 SULFAMETHOXAZOLE|TRIMETHOPRIM TABLET 400 MG|80 MG TABLET
AK0501030 SYRINGE ACTUATOR FOR AN INJEKTOR 0
990 TRANEXAMIC ACID INJEKSI 5 ML INJEKSI
11719 TUBERCULIN PPD TABLET 10 TU/0.1 ML TABLET
11922 VITAMIN B COMPOUND TABLET TABLET
12189 ZINC SULPHATE SIRUP 20 MG/5 ML SIRUP

Obat Tambahan
Kode Nama Obat Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Stok Optimum Permintaan

ACT (ARTESUNAT+AMODIAQUIN) TABLET TABLET

ALAT SUNTIK SEKALI PAKAI 0,5 ML PCS
ALAT SUNTIK SEKALI PAKAI 1 ML PCS
ALAT SUNTIK SEKALI PAKAI 2,5 ML PCS
ALAT SUNTIK SEKALI PAKAI 3 ML PCS
ANTASID SUSPENSI SIRUP
ANTI FUNGI DOIN SALEP POT
ASAM ASETILSALISILAT (ACETOSAL) TAB 80 MG TABLET
ASAM FOLAT TAB 0,4 MG TABLET
ATAPULGIT TABLET 600 MG TABLET
BEDAK SALISILAT SERBUK 2% SERBUK
BETAMETASON TETES MATA 1 MG/ML CAIRAN
DEC TABLET 100 MG TABLET
ETANOL 70% CAIRAN
EUGENOL CAIRAN CAIRAN
FITOMENADION ( VIT K ) INJEKSI 2 MG/ML AMPUL
FENITOIN NATRIUM KAPSUL 100 MG KAPSUL
GARAM ORALIT UNTUK 200 ML AIR SACHET
GLUKONAS KALSIKUS 10% AMPUL
GRISEOFULVIN TAB 125 MG TABLET
HALOPERIDOL TAB 1,5 MG TABLET
HALOPERIDOL TAB 5 MG TABLET
IBUPROFEN SIRUP 100 MG/5ML SIRUP
IBUPROFEN SIRUP 200 MG/5ML SIRUP
INFUSET DEWASA PCS
INFUSET ANAK PCS
ISOSORBID DINITRAT TAB SUBLINGUAL 5MG TABLET
KAPAS ABSORBEN 250 G PCS
KASA HIDROFIL STERIL 16 X 16 CM PCS
KASA PEMBALUT ELASTIS 3 INCHI PCS
KASA PEMBALUT ELASTIS 4 INCHI PCS
 KETOKENAZOLE TABLET 200 MG TABLET
KETOROLAK INJEKSI 30 MG/ML INJEKSI
LEVOTREOKSIN TABLET
MAGNESIUM SO4 INJEKSI 40% AMPUL
MASKER PCS
MEBENDAZOL TABLET 100 MG (VERMOX) TABLET
NACL INFUS INFUS
OMEPRAZOLE CAPSUL 20 MG CAPSUL
OXYTOSIN INJEKSI AMPUL
PLESTER 5 YARD X 2 INCHI PCS
POVIDON IODIDA @ 30 ML LARUTAN
POVIDON IODIDA @300 ML LARUTAN
POVIDON IODIDA @ 1000 ML LARUTAN
PROFYLTHIURACIL TAB 100 MG TABLET
PREDNISON KAPLET 8 MG KAPLET
RANITIDINE TAB 150 MG TABLET
RINGER LAKTAT LARUTAN INFUS STERIL INFUS
SALEP 2-4 KOMBINASI KREM
SILK NO 3/0 DENGAN JARUM BEDAH PCS
SIPROFLOKSASIN 500 MG TABLET
SULFADOKSIN PYRIMETHAMINE TAB 5000-25 MG TABLET
TETRASIKLIN HCL KAPSUL 250 MG KAPSUL
TETRASIKLIN HCL KAPSUL 500 MG KAPSUL
TIAMIN HCL (VIT B1) INJ 100MG/ML-1ML INJEKSI
TIAMIN HCL (VIT B1) TABLET 50 MG TABLET
TRIFLUOPERAZINE TABLET
URINE BAG PCS
ZINC TABLET 10 MG TABLET

BPJS
AMOXICILLIN TABLET 500 MG TABLET
BISOPROLOL TAB SALUT 5 MG TABLET
CHLORAMEX ( KLORAMFENIKOL ) KAPSUL 500 MG KAPSUL
FITOMENADION ( VIT K ) INJEKSI INJEKSI
GLIMEPIRIDE 2 MG TABLET
LEVOFLOXACIN TABLET
METFORMIN TABLET
METTHYLPREDNISOLON TAB 4 MG TABLET
NATRIUM DIKLOFENAK TAB 25 MG TABLET
NATRIUM DIKLOFENAK TAB 50 MG TABLET
NEW ANTIDES TABLET
RINGER LACTAT LARUTAN INFUS CAIRAN
SALBUTAMOL TAB 2 MG TABLET
STESOLID ( DIAZEPAM ) LAT REKTAL 5 MG/2,5 ML TUBE
VENTOLIN NEBULES 2,5 MG AMP
VENTOLIN ROTAHALER BOK
XYLOCAINE 2% JELLY TUBE

Jumlah Umum Jumlah

Mengetahui Tidak Bayar Tidak ,
Ka.UPTD Puskesmas Sukaraja Tiga Resep Penanggung Jawab Laporan

Hj. Emyatun , SKM

NIP.19660411 198603 2 004 NIP.
Pemberian Keterangan
Pemberian Keterangan