LAPORAN OBAT PUSTU/ POSKESDES………………

Laporan Bulan :
Permintaan Bulan :

NO NAMA OBAT Satuan Ukuran Stock awal Penerimaan

1 Allopurinol 100 mg Tablet
2 Amlodipin tablet 5 mg Tablet
3 Amlodipin tablet 10 mg tablet
4 Ambroxol tablet Tablet
5 Aminophylin tablet Tablet
6 Amoksisilin kaplet 500 mg kaplet
7 Amoxcicilin 250 mg Kapsul
8 Antasida DOEN tablet kunyah Tablet
9 Asam asetilsalisilat (asetosal) Tablet
10 Asam Askorbat (Vitamin C) tablet 50 mg Tablet

11 Asam Mefenamat 500 mg kaplet

12 Asiklovir tablet / kapsul / kaplet 400 mg Tablet

13 Asiklovir tablet 200 mg Tablet
14 Attapulgite 600 mg table (New Antides) Tablet
15 Bedak Salicyl Botol
16 Betahistin metasilat 6 mg Tablet
17 Bisoprolol Tablet
18 Bromhexin tablet 8 mg (Bromifar) tablet
19 Captopril 12,5 mg Tablet
20 Captopril 25 mg Tablet
21 Captopril 50 mg tablet
22 Chlorpromazin Tablet
23 Cimetidine tablet tablet
24 Dexamethason 0,5 Mg tablet
25 Domperidon tablet 10 mg Tablet
26 Doxycylin tablet Tablet
27 Eritromisin 500 mg Tablet
28 Eritromisin tablet 250 mg kapsul
29 Furosemid tablet 40 mg Tablet
30 Garam Oralit sachet
31 Glibenklamide 5 mg Tablet
32 Gliseril Guaicolat 100 mg Tablet
33 Griseofulvin tablet 125 mg Tablet
34 Haloperidol tablet 0,5 mg tablet
NO NAMA OBAT Satuan Ukuran Stock awal Penerimaan
35 Hidroklorotiazid tab 25 mg Tablet
36 Hyoscine N Butylbromide (Scopma) kaplet
37 Ibuprofen 400 mg Tablet

38 Isosorbit Dinitrat 5 mg Tablet Sublingual

39 Kalsium Laktat 500 mg Tablet

40 Kalium Diklofenak 25 mg tablet
41 Kalium Diklofenak 50 mg tablet
42 Karbamazepin kaplet 200 mg kaplet
43 Ketokonazole tablet 200 mg Tablet
44 Klindamisin 300 mg kapsul
45 Kloramfenikol 250 mg kapsul
46 Klorpheniramine Maleat 4 mg (CTM) Tablet
47 Kombinasi : Kaolin + Pektin tablet
48 Kotrimoksasol 480 mg Tablet
49 Loperamid Tablet
50 Loratadine 10 mg Tablet
51 Meloxicam tablet 7,5 mg tablet
52 Meloxicam tablet 15 mg Tablet
53 Metampiron 500 mg/Antalgin kaplet
NO NAMA OBAT Satuan Ukuran Stock awal Penerimaan
54 Metformin HCL 500 mg Kaplet
55 Metilprednisolone 4 mg Tablet
56 Metoklopramid 10 mg Tablet
57 Metronidazol tablet 250 mg Tablet
58 Multivitamin (Omegavit) Kapsul
59 Metronidazol tablet 500 mg Tablet
60 N-asetil sistein kapsul 200 mg Tablet
61 Natrium Bikarbonat Tablet
62 Natrium diklofenak 25 mg Tablet
63 Natrium diklofenak 50 mg Tablet
64 Nifedipin tablet tablet
65 Obat Antispasmodik/ Spasminal Tablet
66 Omeprazol kapsul 20 mg kapsul
67 Paracetmol 500 mg Tablet
68 Pirantel tablet score (base) 125 mg tablet
69 Piridoxin (vit B6) Tablet
70 Piroxicam kapsul 20 mg kapsul
71 Prednison tablet 5 mg tablet
72 Propanolol Tablet
73 Ranitidine 150 mg tablet
74 Salbutamol 4 mg Tablet
75 Sianokobalamin Tablet Tablet
76 Simvastatin scored tablet 10 mg Tablet
77 Simvastatin tablet / kaplet / salut 20 mg Tablet
78 Siprofloksasin 500 mg Tablet

79 Tablet Tambah Darah Ibu Hamil (Fe tablet

Fumarat 60 mg +Asam folat 0.400 mg)
80 Tetrasiklin kapsul 250 mg kapsul
81 Tiamfenikol 500 mg kapsul
82 Thiamin HCl tablet 50 mg ( Vitamin B1) tablet
83 Vitamin B Kompleks tablet
84 Zinc tablet Tablet
SIRUP
1 Ambroxol syrup 15mg botol 60 ml
2 Kombinasi : Kaolin + Pektin suspensi botol 60 ml
3 Kotrimoksasol sirup Botol
4 Multivitamin Anak Botol
5 Parasetamol sirup 120 mg / ml Botol
6 SALEP / CREM & OBAT TETES
NO NAMA OBAT Satuan Ukuran Stock awal Penerimaan
7 Acyclovir krim Tube
8 Betametason salep Tube
9 Gentamicin salep kulit Tube
10 Ketokenazol krim Tube
11 Kloramfenikol tetes mata Botol
12 Kloramfenikol tetes telinga botol 5 ml

13 Kombinasi : Asam Silisilat 2 % + Belerang pot

endap 4 % (Salep 2-4)
14 Mikonazol krim / salep 2 % Tube
15 Oksiterasiklin salep kulit Tube
16 Oksitetrasiklin HCl salep 3% mata Tube
INJEKSI / SUPPOSITORIA / JELLY
1 Lidocain Inj (Lidocain HCL 2%) Ampul
CAIRAN
1 Glukosa larutan infus 5 % Steril botol
2 Nacl 0,9% botol
3 Ringer Laktat botol
BAHAN MEDIS HABIS PAKAI

1 Alat suntik 1 ml pcs

2 Alat suntik 2,5 ml pcs
3 Alat suntik 3 ml pcs
4 Alat suntik 5 ml pcs
5 Alat suntik 10 ml pcs
6 Alcohol swab pcs
7 Alkohol 70 % 100 ml Botol
8 Alkohol 70 % 1000 ml Botol
NO NAMA OBAT Satuan Ukuran Stock awal Penerimaan
9 Alkohol 70 % 300 ml Botol
10 Catgut chromic 2/0 + jarum pcs
11 Catgut chromic 3/0 + jarum pcs
12 Folly catheter 2 way No 16 pcs
13 Folly catheter 2 way No 18 pcs
14 Folly catheter 2 way No 20 pcs
15 Folly catheter 2 way No 22 pcs
16 Folly catheter 2 way No 24 pcs
17 Folly catheter ped no. 6 pcs
18 Folly catheter ped no. 8 pcs
19 Folly catheter ped no. 10 pcs
20 Venflon pcs
21 Hanscun steril No.6,5 pcs
22 Hanscun steril No.7 pcs
23 Hanscun steril No.7,5 pcs
24 Hanscun steril No.8 pcs
25 Hanscun Non steril No.7 pcs
26 Hanscun Non steril pcs
27 Infusion Set Anak Pcs
28 Infusion Set Dewasa Pcs
29 IV Catheter No.18 Pcs
30 IV Catheter 20G x 1/4" Pcs
31 IV Catheter No.22 Pcs
32 IV Catheter 24G x 3/4" Pcs
33 Kasa hidrofil 36 x 80 cm Roll
34 Kapas Pembalut 250 g Roll
35 Kasa Pembalut 2m x 80cm Roll
36 Kasa Pembalut Hidrofil 4 X 5 cm Roll
37 Kasa Pembalut Hidrofil 4 X 10 cm Roll
38 Kasa Pembalut Hidrofil 4 X 15 cm Roll
39 Kasa steril 16 x 16 cm kotak
40 Lisol 1 L Botol

41 Plester 5 yeard X 2 Inchi Roll

42 Povidon Iodin 30 ml Botol

43 Povidon Iodin 500 ml Botol
44 Povidon lodida larutan 10 % 60 ml Botol
45 Povidon iodida larutan 10% botol 1000 ml
46 Povidon iodida larutan 10% botol 300 ml
NO NAMA OBAT Satuan Ukuran Stock awal Penerimaan
47 Rivanol 300 cc Botol
48 Scalpel Blades No. 10 pcs
49 Scalpel Blades No. 11 pcs
50 Scalpel Blades No. 15 pcs
51 Surgical blade no. 21 pcs
52 Semen seng fosfat serbuk dan cairan botol
53 Silk 2/0 + Jarum 1/2 GT 35 mm pcs
54 Silk 3/0 + Jarum 1/2 GT 35 mm pcs
55 Surgical Mask Earloop pcs
56 Test Hamil Pcs
UMUM
BAYAR TIDAK BAYAR
JUMLAH KUNJUNGAN RESEP
DES………………………………

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JKN TOTAL

Penanggung Jawab Pustu / Poskesdes

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NIP………………………………………………………………………………….