S s

LAPORAN PEMAKAIAN DAN LEMPAR PERMINTAAN OBAT (LPLPO)

PUSKESMAS FORM : LPLPO

RASIO OBAT : 38036 : 2708 = 27 %

PUSKESMAS : CITAPEN
KECAMATAN : CIAWI PELAPORAN BULAN / PERIODE : Januari 2024 53747 DOKUMEN NOMOR
KABUPATEN : BOGOR PERMINTAAN BULAN / PERIODE : - DINAS KAB
PROPINSI : JAWA BARAT PUSKESMAS

STOCK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOCK AKHIR PENERIMAAN

NO. NAMA OBAT SATUAN PERMINTAAN KETERANGAN
PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM

1 Albendazol sus 200 mg/ml botol 0 0 0 0 0

2 Albendazol tab 400 mg tablet 8300 0 8300 0 8300
3 Allopurinol tab 300 mg tablet 1380 1600 500 0 1880 1600 80 100 1800 1500
4 Ambroksol Syrup botol 0 0 0 0 0 0 0 0 0 0
5 Ambroksol tablet tablet 0 0 0 0 0 0 0 0 0 0
6 Aminofilin tab 200 mg tablet 775 0 100 0 875 0 25 0 850 0
7 Amitriptilin tab tablet 900 100 0 100 900 0 0 100 900
8 Amlodipin tab 10 mg tablet 280 2500 400 0 680 2500 80 0 600 2500
9 Amlodipin tab 5mg tablet 300 9683 400 0 700 9683 0 83 700 9600
10 Amoksisilin 250 mg tab tablet 500 0 300 0 800 0 300 0 500 0
11 Amoksisilin 500 mg tab tablet 1000 33700 400 0 1400 33700 1000 3700 400 30000
12 Amoksisilin sirup kering 250 mg/5 ml botol 0 0 0 0 0 0 0 0 0 0
13 Amoksisilin sirup kering 125 mg/5 ml botol 0 200 0 0 0 200 0 100 0 100
14 Antalgin tab tablet 0 0 0 0 0 0 0 0 0 0
15 Antapulgite tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Antasid DOEN sirup botol 0 0 0 0 0 0 0 0 0 0
17 Antasida kombinasi tab kunyah tablet 0 48378 0 0 0 48378 0 3378 0 45000
18 Anti Bakteri DOEN salep kombinasi tube 0 0 0 0 0 0 0 0 0 0
19 Anti Fungi kombinasi salep tube 30 0 0 0 30 0 12 0 18 0
20 Anti Hemoroid kombinasi sup Supos 14 0 10 0 24 0 14 0 10 0
21 Antimigren DOEN kombinasi tablet 0 0 0
22 Aqua Pro Injeksi Steril, bebas pirogen tablet 2 0 0 0 2 0 0 0 2 0
3 Asam askorbat (vitamin C) tab 50mg tablet 0 0 800 0 800 0 0 0 800 0
23 Asam askorbat (vitamin C) tab 250 mg tablet 9784 18000 0 5400 0 9784 5400 18000 7000 0 2784 5400 18000
24 Asam askorbat (vitamin C) tab 500 mg tablet 0 0 0 0 0 0 0 0 0 0
25 Asam Mefenamat kaps tablet 0 32793 300 0 300 32793 300 793 0 32000
26 Asetosal tab tablet 0 0 0 0 0 0 0 0 0 0
27 Asiklovir tab 200mg tablet 0 0 0 0 0 0 0 0 0 0
28 Asiklovir tab 400mg tablet 440 0 200 0 640 0 40 0 600 0
29 Asiklovir Cream tube 0 0 0 0 0 0 0 0 0 0
30 Atropin Sulfat Injeksi ampul 0 0 0
31 Atropin Sulfat tab tablet 0 0 0
32 Bedak Salisil serb tablet 85 0 80 0 165 0 85 0 80 0
 STOCK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOCK AKHIR PENERIMAAN
NO. NAMA OBAT SATUAN PERMINTAAN KETERANGAN
PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM

33 Betahistin Melistat tab tablet 0 0 0

34 Betametason krim tube 55 0 25 0 80 0 35 0 45 0
35 Cefixime 200mg tablet 0 0 0 0 0 0 0 0 0 0
36 Clozapine 100 mg tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
37 Clozapine 25 mg tablet 1417 0 0 0 1417 0 117 0 1300 0
38 Deksametason Injeksi ampul 17 5 22 7 15
39 Deksametason 0,5 mg tablet 0 0 0 0 0 0 0 0 0 0
40 Diazepam enema 10 mg/2,5 ml suppos 0 0 0 0 0 0 0 0 0 0
41 Diazepam enema 5 mg/2,5 ml suppos 10 0 0 0 10 0 0 0 10 0
42 Diazepam Injeksi ampul 1 0 0 0 1 0 0 0 1 0
43 Diazepam tab tablet 100 0 0 0 100 0 0 0 100 0
44 Difenhidramin HCl Injeksi ampul 0 0 0 0 0 0 0 0 0 0
45 Digoksin tab tablet
0 0 0 0 0 0 0 0 0 0
46 Dimenhidrinat 50 mg tablet
100 0 100 0 200 0 100 0 100 0
47 Domperidone 10 mg tablet
0 0 0 0 0 0 0 0 0 0
48 Efedrin HCl tab tablet
0 0 0
Epinefrin HCl / Bitatrtat (Efinefrin /
49 ampul
Adrenalin Injeksi) 1 mg/ml 0 0 0 0 0 0 0 0 0 0
50 Etanol 70% botol 1 0 0 0 1 0 0 0 1 0
51 Ethambutol tab tablet 0 0 0

52 FDC ANAK paket

0 5 5 1 4

53 FDC BOOKLET OAT DOSIS HARIAN paket

0 6 6 2 4

54 FDC OAT KDT HARIAN paket

0 6 6 2 4

55 FDC Sisipan paket

0 0 0
56 Fenitoin Natrium tab tablet

57 Fenobarbital injeksi ampul

58 Fenobarbital tab tablet 100 0 100 0 200 0 0 0 200 0

59 Fenol glycerol tetes telinga botol 0 0 0 0 0 0 0 0 0 0
60 Fitomenadion (vitamin K 1) injeksi ampul
10 0 0 0 10 0 8 0 2 0
61 Fitomenadion (vitamin K 1) tab tablet 0 272 0 0 0 272 0 72 0 200
62 Flupenazine Deconoate Skizonoat 25 mg ampul 0 0 0 0 0
63 Furosemid tab tablet 0 0 0 0 0 0 0 0 0 0
64 Garam oralit kombinasi serb sachet 1215 3000 4215 215 4000
65 Gentamicin Sulfate 0,1% 5 g tube 0 285 0 0 0 285 0 135 0 150

66 Gigi, Lidokain 2% + epinefrin 1:80.001 ampul

84 0 60 0 144 0 14 0 130 0
Gigi, Bahan tumpatan sementara lar+ serb
67 set 4 0 0 0 4 0 0 0 4 0
(Temporary)
68 Gigi, Bonding buah
 STOCK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOCK AKHIR PENERIMAAN
NO. NAMA OBAT SATUAN PERMINTAAN KETERANGAN
PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM

69 Gigi, Eritromisin kaps tablet 0 0 0 0 0 0 0 0 0 0

70 Gigi, Etil Klorida spray botol 2 0 1 0 3 0 2 0 1 0
71 Gigi, Etsa buah

72 Gigi, Eugenol Cairan botol 3 0 0 0 3 0 0 0 3 0

Gigi, Glass ionomer ART (Atraumatic
73 set 2 0 0 0 2 0 0 0 2 0
Restorative Treatment)
74 Gigi, Kalsium hidroksida bubuk, pasta tube 5 0 0 0 5 0 0 0 5 0
Gigi, Klorfenol kamfer mentol (CHKM)
75 botol 3 0 0 0 3 0 0 0 3 0
cairan
76 Gigi, Komposit resin Set +Bonding + ETSA set 3 0 0 0 3 0 0 0 3 0
77 Gigi, Mummifying Pasta tablet 0 0 0 0 0 0 0 0 0 0
78 Gigi, Pasta devitalisasi (non arsen) tube 3 0 0 0 3 0 0 0 3 0
79 Gigi, Semen Seng Fosfat Serbuk & Cairan set 0 0 0 0 0 0 0 0 0 0
80 Glibenklamid tab tablet 229 0 100 0 329 0 29 0 300 0
81 Glimepiride 2 mg tablet 0 0 0 0 0 0
82 Gliseryl Guayakolat Syrup botol 0 0 0 0 0 0 0 0 0 0
83 Gliseryl Guayakolat tab tablet 0 0 0 0 0 0 0 0 0 0
84 Glukosa Larutan Infus botol

85 Griseofulviin (micronized) tab tablet 0 0 0 0 0 0 0 0 0 0

86 Haloperidol 1.5 mg tab tablet

87 Haloperidol 5 mg/ml Decanoas Inj ampul 0 3 0 0 0 0 0 3 0 0 0 0 0 3 0

88 Haloperidol tab 5 mg tab tablet 496 0 0 0 0 0 496 0 0 496 0 0 0 0
89 Hibiscrub sol botol

90 Hidroklorotiazid tab tablet 700 0 400 0 1100 0 20 0 1080 0

91 Hidrokortison krim tube 26 480 120 0 146 480 50 80 96 400
92 Hydroksil Ethyl Starch 200.000(WIDAHES) botol

93 Ibuprofen tab 200mg tablet 0 0 0 0 0 0 0 0 0 0

94 Ibuprofen tab 400mg tablet 0 4775 100 0 100 4775 100 2775 0 2000
95 Isoniazid tab tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
96 Isoniazid 300 mg/ Rifapetin 300 mg box 0 0 0 0
97 Isosorbid dinitrat tab tablet 0 0 0 0 0 0 0 0 0 0
98 Kalium Diklofenak tab tablet 0 0 0 0 0 0 0 0 0 0
99 Kalsium Glukonat injeksi ampul 0 0 0 0 0 0 0 0 0 0
100 Kalsium laktat tab tablet 0 0 0 0 0 0 0 0 0 0
101 Kaptopril tab tablet 1900 0 0 0 1900 0 0 0 1900 0
102 Karbamazepin tab tablet

103 Karbon Aktif tab tablet 74 320 394 80 314 0

104 Ketokonazole 200 mg tablet 80 0 300 0 380 0 40 0 340 0
105 Ketorolac Injeksi ampul

106 Kloramfenikol 250 mg Kapsul 90 0 0 0 90 0 90 0 0 0

107 Kloramfenikol salep Kulit ( Bufacetin ) tube 0 0 0 0 0 0 0 0 0 0
108 Kloramfenikol salep mata tube 0 0 0 0 0 0 0 0 0 0
109 Kloramfenikol Suspensi Suspensi 0 0 0 0 0 0 0 0 0 0
 STOCK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOCK AKHIR PENERIMAAN
NO. NAMA OBAT SATUAN PERMINTAAN KETERANGAN
PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM

110 Klorfeniramin tab ( CTM ) tablet 0 52520 1000 0 1000 52520 1000 2520 0 50000
111 Klorpromazin tab ( CPZ ) 100 mg tablet 891 0 0 0 0 891 0 91 0 800 0
112 Kodein tab tablet 0 0 0 0 0 0 0 0 0 0
113 Kombinasi Ergotamin 1 mg + Kafein 50 mg tablet 0 0 0 0 0
114 KOTRIMOKAZOLE FORTE 960 MG tablet 0 0 0 0 0 0 0 0 0 0
Kotrimoksazol (dewasa) tab 480mg
115 tablet 0 2865 0 0 0 2865 0 665 0 2200
kombinasi
116 Kotrimoksazol anak kombinasi suspensi botol 200 800 0 0 200 800 0 50 200 750
117 Kotrrimoksazol Pedriatik kombinasi tablet tablet
Larutan mengandung elektrolit (Ringer
118 botol 10 20 30 9 21
Laktat)
119 Levertran salep tube

120 Lidokain Injeksi 2% ampul 100 0 0 0 100 0 10 0 90 0

121 Loratadin 10mg tablet 520 0 0 520 20 0 500
122 Magnesium Sulfat inj 20% (i.v.) ampul

123 Magnesium Sulfat inj 40% (i.v.) ampul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

124 Meloksikam tab tablet 0 0 0 0 0 0 0 0 0 0

125 Metformin tab tablet

572 1800 400 0 972 1800 72 0 900 1800

126 Methyl prednisolon tab 4 mg tablet

0 0 0 0 0 0 0 0 0 0
127 Methyldopa tab tablet

128 Metilergometrin inj ampul

129 Metilergometrin 0,125 mg tablet 110 0 0 0 110 0 10 0 100 0

130 Metoklopramid tab tablet 0 0 0 0 0 0 0 0 0 0
131 Metronidazol tab tablet 0 0 0 0 0 0 0 0 0 0
132 Meylon 84-B.P. ampul

133 Mikonazol krim tube 6 168 48 0 54 168 0 48 54 120 EXP

Multivitamin + mineral + ginseng
134 tablet
(Farmaton)
135 Multivitamin +Vitamin C (Enervon C) tablet 0 0 0 0 0 0 0 0 0 0
136 Nacl 500 ml botol 0 10 0 0 0 10 0 4 0 6
137 Nacl 0,9 % 100 ml botol 0 0 0 0 0 0 0 0 0 0
138 N-Asetil Sistein tab Kapsul 5180 27240 2160 0 7340 27240 4340 0 3000 27240
139 Natrium Bikarbonat tab tablet

140 Natrium Diklofenak tab 50 mg tablet 700 3310 100 0 800 3310 300 10 500 3300
141 Neo Diaform tab tablet 152 0 100 0 252 0 252 0 0 0

142 Nifedipin tab 10 mg tablet

0 0 0 0 0 0 0 0 0 0
143 Nistatin tab sal gula 500.000 IU tablet 0 0 0 0 0 0 0 0 0 0
144 Nistatin tab vaginal 100.000 IU tablet 5 0 0 0 5 0 5 0 0 0
145 Obat Herbal Tradisional (HERBAKOF) sachet 0 0 0 0 0 0 0 0 0 0
146 Oksigen ih, gas dalam tabung botol 0 0 4 0 4 0 4 0 0 0
147 Oksitetrasiklin HCl Salep Kulit tube

148 Oksitetrasiklin HCl Salep Mata tube 0 0 0 0 0

149 Oksitosin injeksi ampul 0 0 0 0 0 0 0 0 0 0
 STOCK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOCK AKHIR PENERIMAAN
NO. NAMA OBAT SATUAN PERMINTAAN KETERANGAN
PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM

150 Omeprazole 20 mg capsul 0 3600 100 0 100 3600 100 600 0 3000
151 Ondansentron injeksi ampul

152 Papaverin tab tablet

153 Parasetamol sirup 120 mg/ml botol 300 1656 0 0 300 1656 300 56 0 1600
154 Parasetamol tab 100 mg tablet

155 Parasetamol tab 500 mg tablet 0 64670 0 0 0 64670 0 4670 0 60000

156 Piracetam Injeksi ampul

157 Piridoksin (vitamin B6) tab tablet 0 15370 1000 0 1000 15370 1000 3370 0 12000
158 Piroksikam tab tablet 0 0 0 0 0 0 0 0 0 0
159 Povidon Iodida larutan 60 ml botol 20 16 0 0 20 16 0 0 20 16
160 Prednison tab tablet 0 37572 0 0 0 37572 0 5572 0 32000
161 Proparonol tab tablet

162 Propiltiourasil tab 100 mg tablet 0 0 0 0 0 0 0 0 0 0

163 Pyrantel l syrup botol

164 Pyrazinamid tab tablet

165 Ranitidin tab 150 mg tablet 224 0 0 0 224 0 224 0 0 0

166 Reserpin tab tablet

167 Retinol (vitamin A) kaps lunak 100.000 IU tablet 0 700 700 0 700
168 Retinol (vitamin A) kaps lunak 200.000 IU tablet 3680 4050 4050 0 4050
Rifampicin/Isoniazid Disposible 75 mg/50
169 tablet
mg 0
170 Risperidone 1 mg tablet 0 0 0 0 0 0 0
171 Risperidone 2 mg tablet 400 100 0 0 0 0 400 100 0 400 100 0 0 0 0
172 Salbutamol + Nacl injeksi ampul

173 Salbutamol 2 mg tablet 122 0 200 0 322 0 222 0 100 0

174 Salbutamol Nebules tablet 0 0 0 0 0 0 0 0 0 0
175 Salbutamol tab 4 mg tablet 0 0 0 0 0 0 0 0 0 0
176 Salep 2-4 kombinasi tube 0 582 48 0 48 582 48 82 0 500
177 Sefadroksil kaps Kapsul 0 0 0 0 0 0 0 0 0 0
178 Sefadroksil syrup botol 0 0 0 0 0 0 0 0 0 0
179 Seftriaxon injeksi ampul

180 Serum anti bisa ular I inj (i.m./i.v.) ampul 0 0 0 0 0 0 0 0 0 0

181 Serum antitetanus (A.T.S) ampul

182 Sianokobalamin (Vit B 12) tablet 0 19500 0 0 0 19500 0 0 0 19500

183 Simetidin tab tablet 0 0 0 0 0 0 0 0 0 0
184 Simvastatin 10 mg tablet 0 0 0 0 0 0 0 0 0 0
185 Simvastatin 20 mg tablet 374 2000 100 0 474 2000 174 0 300 2000
186 Siproploxacin tab 500 mg tablet 0 910 100 0 100 910 100 410 0 500
187 Streptomicin Injeksi ampul

188 Tablet Tambah Darah Kombinasi tab tablet 89585 0 89585 1585 88000
189 Taburia sachet 0 0 0 0 0
190 TEST PECT ( hcg ) pcs
 STOCK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOCK AKHIR PENERIMAAN
NO. NAMA OBAT SATUAN PERMINTAAN KETERANGAN
PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM

191 Tetes mata deksametason phosphat botol

192 Tetes mata Kloramfenikol botol 40 0 10 0 50 0 40 0 10 0

193 Tetes Mata Levofloksaxin botol

194 Tetes Mata Sulfasetamid Natrium botol

195 Tetes mata Tetrakain Hydroklorida botol

196 Tetes mata Tropikamid botol

197 Tetes telinga Kloramphenikol 3 % botol 7 0 10 0 17 0 17 0 0 0

198 Tetrasiklin HCl 250 mg tab tablet 0 0 0 0 0 0 0 0 0 0
199 Tetrasiklin kaps 500 mg tab tablet 91 0 100 0 191 0 0 0 191 0
200 Tiamin (vitamin B1) tab tablet 0 0 0 0 0 0 0 0 0 0
201 Tramadol injeksi ampul

202 Tramadol tab tablet 0 0 0 0 0 0 0 0 0 0

203 Triheksifenidyl 2 mg tab tablet 0 2655 0 5000 0 7655 655 0 7000
204 Vitamin B kompleks tab tablet 400 10179 800 0 1200 10179 1200 3179 0 7000
205 Zinc tab tablet 3 8500 8503 503 8000
PROGRAM HEPATITIS

1 HBSAg test 0 275 0 0 550 0 0 825 0 0 25 0 0 800 0

BAHAN MEDIS HABIS PAKAI

1 ADS 0.05 ml buah 0 0 0 0 0 0 0 0 0 0

2 ADS 0.5 ml buah 0 0 0 0 0 0 0 0 0 0

3 Alat suntik sekali pakai 1 ml + jarum buah 0 0 0 0 0 0 0 0 0 0

4 Alat suntik sekali pakai 3 ml + jarum buah 100 0 0 0 0 0 100 0 0 0 0 0 100 0 0

5 Alat suntik sekali pakai 5 ml + jarum buah 480 0 0 0 0 0 480 0 0 0 0 0 480 0 0

6 Alkohol 70% buah 0 0 0 0 0 0 0 0 0 0

7 Alkohol swab kotak 0 0 265 0 0 0 0 0 265 0 0 0 0 0 265

8 Ballon Cateter No. 16 pcs 0 0 0 0 0 0 0 0 0 0

9 Ballon Cateter No. 18 pcs 0 0 0 0 0 0 0 0 0 0

10 Benang, PGA 8/0 US IOL Assorbable buah

11 Benang, Poliglactin 9108-0 suture buah

12 Bisturi (Surgical Blade) buah 0 0 0 0 0 0 0 0 0 0

13 Blood Lancete buah

14 Box Slide buah

Catgut Chromic/benang bedah no. 2/0 +
15 buah 0 0 0 0 0 0 0 0 0 0
jarum
Catgut Chromic/benang bedah no. 3/0 +
16 buah 0 0 0 0 0 0 0 0 0 0
jarum
Catgut Plain / benang bedah no. 2/0 +
17 buah 0 0 12 0 12 0 0 0 12 0
jarum
Catgut Plain / benang bedah no. 3/0 +
18 buah 0 0 12 0 12 0 5 0 7 0
jarum
19 Cup Disposible buah

20 Developer buah 0 0 0 0 0 0 0 0 0 0

21 Film Rontgen 18 x 23 buah

22 Film Rontgen 24 x 29 buah

23 Film Rontgen 30 x 39 buah

24 Film Rontgen 35 x 34 buah

 STOCK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOCK AKHIR PENERIMAAN
NO. NAMA OBAT SATUAN PERMINTAAN KETERANGAN
PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM

25 Fixer buah

26 Foley Catheter 2 way No. 12 buah

27 Foley Catheter 2 way No. 14 buah

28 Foley Catheter 2 way No. 16 buah

29 Foley Catheter 2 way No. 18 buah

30 Hanger 24 x 29 buah

31 Hanger 18 x 23 buah

32 Hanger 30 x 39 buah

33 Hanger 35 x 34 buah

34 Hecting needle (tanpa benang) untuk kulit buah

35 Hecting needle (tanpa benang) untuk otot buah

36 Infusion set anak buah 0 0 0 0 0 0 0 0 0 0

37 Infusion set dewasa buah 50 0 0 0 50 0 50 0 0 0

38 IV catheter no 18 G buah 0 0 2 0 2 0 2 0 0 0

39 IV catheter no 20 G buah 0 0 5 0 5 0 0 0 5 0

40 IV catheter no 22 G buah 0 0 5 0 5 0 0 0 5 0

41 IV catheter no 24 G buah 40 0 0 0 40 0 0 0 40 0

42 Kaca Slide buah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

43 Kapas pembalut / absorben buah 2 0 0 0 2 0 0 0 2 0

44 kasa hidrophil buah

45 Kasa Steril 16 x 16 buah 0 130 4 0 4 130 4 0 0 130

46 Kassa Gulung Hidrofil ( 4x15 cm ) pcs 320 0 0 0 320 0 0 0 320 0

47 Kassa Hidrrofil ( 2x80 cm ) pcs 0 0 0 0 0 0 0 0 0 0

48 Kertas EKG buah

49 Kertas Saring buah

50 Lubricating Jelly buah

51 Masker Disposible box 0 0 100 0 0 0 0 0 0 100 0 0 0 0 0 100

52 Masker N95 buah 0 0 0 0 0 0 0 0 0 0 0 0 0 0

53 Ose buah

54 Plester Besar buah 50 12 0 0 50 12 5 0 45 12

55 Plester Kecil buah 0 0 1 0 1 0 1 0 0 0

56 Pot Dahak buah 0 60 0 0 0 0 60 0 0 0 0 0 60 0

5 Plesterin Roll non woven 5cm x 5mm buah 0 7 7

57 Pot Urine buah

58 Safety Box buah 0 0 0 0 0

59 Sarung tangan bedah steril buah

60 Sarung tangan Obgyn buah 4 0 0 0 4 0 0 0 4 0

61 Sarung Tangan Pendek non steril ukuran L buah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Sarung Tangan Pendek non steril ukuran
62 box 0 0 61 70 0 0 0 0 0 61 70 0 0 0 0 0 0 61 70
M
63 Sarung Tangan Pendek non steril ukuran S buah 0 0 67 0 0 0 0 67 0 0 0 0 0 67

64 Selang Oksigen Anak pcs 0 0 0 0 0 0 0 0 0 0

 STOCK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOCK AKHIR PENERIMAAN
NO. NAMA OBAT SATUAN PERMINTAAN KETERANGAN
PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM

65 Selang Oksigen buah

66 Selang Oksigen Dewasa pcs 0 0 0 0 0 0 0 0 0 0

67 Silk (Benang bedah sutera) No. 3/0 buah 13 0 4 0 17 0 0 0 17 0

68 Silk( Benang Bedah Sutera) No 2/0 buah 12 0 1 0 13 0 0 0 13 0

69 Sopratulle buah 0 0 0 0 0 0 0 0 0 0

70 Strip Test Hemoglobin box 0 0 10 0 0 0 0 0 10 0 0 1 0 0 9

71 Strip Test Asam Urat box 0 0 15 0 0 0 0 0 0 15 0 0 1 0 0 14

72 Strip Test Kolesterol box 0 0 29 0 0 0 0 0 29 0 0 2 0 0 27

72 Strip Test Gula Darah box 0 0 9 0 0 0 0 0 9 0 0 1 0 0 8

70 Tabung EDTA buah

71 Tip Blue 500-1000 ul buah

72 Tip White 10-20 ul buah

73 Tip Yellow 50 ul buah

74 Torniquet buah

75 Urine bag steril buah

76 Ziel Nelsen Set 0 0 0 0 0 0 0 0 0 0 0 0 0 0

PROGRAM HIV & TB

1 Acon HB Hemoglobin 50 Test Mission Box 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2 Alkohol Swab box 0 0 0 0 0

3 Masker bedah box 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

4 Masker N95 kotak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 Parafilm Roll 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

6 Plastik Medis Pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

7 Plesterin Bulat Box 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8 Rapid Test S Test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

9 RAPID TEST HIV (VIROCHECK HIV 1/2) Test 0 200 0 0 0 0 0 200 0 0 0 0 0 200 0

10 Rapid Duo 1/2 HIV SYPHILIS COMBO Test 0 200 0 0 0 0 0 200 0 0 0 0 0 200 0

11 Sarung Tangan Nitril Kotak 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

12 VACUTAINER CLOT ACTIVATOR pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 VACUTAINER EDTA pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

PROGRAM COVID-19

1 Alat pelindung diri survailance set 0 0 0 0 0

2 Antiseptik Tangan 100 ml pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

3 APD pcs 0 84 0 0 0 0 0 84 0 0 0 0 0 84 0

4 Apron pcs 0 28 0 0 0 0 0 28 0 0 0 0 0 28 0

5 Azitromicin tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
BAJU HAMZAT & SHOES COVER
6 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
(HEIGEN)
7 BAJU HAMZAT (BOHO) pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

8 Blood Lancet pcs 100 0 0 0 0 0 100 0 0 100 0 0 0 0 0

9 Epinefrin inj 1 mg/ml ampul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

 STOCK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOCK AKHIR PENERIMAAN
NO. NAMA OBAT SATUAN PERMINTAAN KETERANGAN
PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM

10 FACE SHIELD pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

11 Favipiravir 200 mg tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

12 GOOGLE (SAFETY VENTILATOR) pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

13 Gown Reuseble Full Set Set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

14 Hand Sanititizer 250 ml botol 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 Hand Sanititizer 500 ml botol 0 0 54 0 0 0 0 0 54 0 0 0 0 0 54

16 Hand Satitizer 5 Liter Gallon 0 1 0 0 0 0 0 1 0 0 0 0 0 1 0

17 IV CATH No. 22 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

18 Kantung Jenazah buah 0 2 0 0 0 0 0 2 0 0 0 0 0 2 0

19 Kertas EKG buah 5 0 0 0 0 0 5 0 0 0 0 0 5 0 0

20 Masker Disposible Box 0 0 0 27 0 0 0 0 0 0 27 0 0 0 7 0 0 0 20

21 Masker Earloop kotak 0 0 0 0 0

22 Masker FFP2 NR pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

23 Masker Headloop (Hijab) kotak 0 0 0 0 0 0 0
24 Masker Kain pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
25 Masker N95 kotak 0 5 0 12 0 0 0 0 0 5 0 12 0 0 0 0 5 0 12
26 Multivitamin Syrup pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

27
Multivit-Zinc Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28
Nurse Cup kotak 2 0 2 0 2
29 Oseltamivir tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

30 Rapid Test Covid-19 ANTIGEN test 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Sarung tangan glove powder free sterile
31 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6,5
32 Sarung tangan glove powder free sterile 7 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Sarung tangan glove powder free sterile
33 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7,5
34 Sarung Tangan Nitril L Kotak 0

35 Sarung Tangan Nitril M Kotak 0 0 0 0 0

36 Sarung Tangan Nitril S Kotak 0

37 Sarung Tangan Non Steril Box 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

38 Vitamin E 200 IU Kapsul 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
39 Vitamin-C 500 mg tablet 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
40 Vitamin-D3 1000 IU tablet 0 0 0 0 0
41 VTM pcs 0 0 0 0
PROGRAM IMUNISASI
1 ADS 0,3 ml pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 ADS 0.5 ml pcs 0 7600 0 0 0 0 0 7600 0 0 0 0 0 7600 0
3 ADS 0,05 pcs 0 0 0 0 0
4 ADS 5 ml pcs 0 300 0 0 0 0 0 300 0 0 0 0 0 300 0
5 Alkohol swab pcs 0 3000 0 0 0 0 0 3000 0 0 0 0 0 3000 0
6 APD (vaksin covid) set 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
7 Buku Juknis Covid-19 buah 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 Disposable Syringe 3 ml pcs 0 90 0 0 0 0 0 90 0 0 0 0 0 90 0
9 Dropper Polio pcs 90 50 140 30 90
10 Dropper Rotavac pcs 0 0 0 0 0
11 Kartu Vaksinasi Covid-19 pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
12 Nacl 10 ml botol 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
 STOCK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOCK AKHIR PENERIMAAN
NO. NAMA OBAT SATUAN PERMINTAAN KETERANGAN
PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM

13 Pelarut MR ampul 150 50 200 50 150

14 Pelarut BCG ampul 160 50 210 50 160
15 Rompi Vaksinator pcs 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
16 Safety Box pcs 0 175 0 0 0 0 0 175 0 0 0 0 0 175 0
17 Vaksin BCG @20 vial 136 50 186 50 136
18 Vaksin Covid-19 PFIZER @6 vial 0 0 0 0 0

19
VAKSIN COVID-19 (INOVAC 10 DOSE) vial 0 5 5 0 5
20 Vaksin DIPHTHERIA ANTITOXIN vial
21 Vaksin DT vial 35 0 35 0 35
22 Vaksin Hb0 pcs 273 100 373 50 323
23 Vaksin IPV @5 vial 50 50 100 50 50
24 Vaksin MENINGITIS vial
25 Vaksin MR @20 vial 176 50 226 50 176
26 Vaksin PCV @4 vial 153 50 203 50 153
27 Vaksin PENTABIO DPT-HB-HIB @5 vial 0 0 0 0 0
28 Vaksin Polio Oral @10 vial 109 50 169 60 109
29 Vaksin Td vial 145 50 195 50 145

30
ORAL POLIO VACCINE (N-OPV) PIN vial 0 0 0 0 0
31 Vaksin Pentavac vial 0 10 10 4 0
32 HPV vial 0 0 0 0 0
PROGRAM PTM
1 Alcohol Swab Kotak 140 0 140 0 140
2 Asam Acetat 5 % 100 ml botol 19 0 19 0 19
3 Blood Lancet Kotak 90 0 90 0 90
4 Carik Celup Urinalisa @10 Kotak 5 0 5 0 5
5 Desinfektan 5 L galon 4 0 4 0 4
6 Disposable Spuit 3 ml kotak 4 0 4 0 4
6 Kertas EKG 110/112 MM buah 0 25 25
7 Kapas Lidi Jumbo kotak 23 0 23 0 23
8 Kapas pembalut 500 g Pcs 13 0 13 0 13
9 Plesterin Bulat kotak 2 0 2 0 2
10 Pot Urine pot 450 0 450 0 450
11 Glucose Test Strip Kotak 180 0 180 0 180
11 REAGEN CHOLESTROL 0 7 7
12 REAGEN KONTROL KIMIA 0 1 1
13 REAGEN TRIGLISERID 0 23 23
12 Safety Box pcs 0 0 0 0 0
SARUNG TANGAN LATEX POWDER
13
FREE SIZE M kotak 57 0 57 0 57
14 Tabung Reaksi 5ml Without R/M
pcs 225 0 225 0 225
15 Ultrasound Gel 250ml
botol 19 0 19 0 19
16 Vacutainer Clot Activator
pack 3 0 3 0 3
17 Yellow TIP box 1 0 1 0 1
PROGRAM KIA 0
1 Ampisilin serb Inj 1000 mg/vial vial 2 2 4 0 4
2 Diazepam inj 5 mg/ml ampul 0 2 2 0 2
3 Fenobarbital injeksi ampul 2 2 4 0 4
4 Vit.K Inj vial 30 30 60 0 60
5 Gentamisin cairan inj 40 mg/ml ampul 0 0 0 0 0
 STOCK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOCK AKHIR PENERIMAAN
NO. NAMA OBAT SATUAN PERMINTAAN KETERANGAN
PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM JKN BOK PKD PROGRAM

6 Metronidazole Infus 5 mg/ml botol 0 0 0 0 0

7 Oksitetrasiklin Hcl Salep Mata 1% tube 0 25 25 5 20
8 Oksitosin Injeksi 10 IU/ML ampul 30 20 50 0 50
PROGRAM MALARIA
1 Rapid Tes Malaria kotak 1 0 1 0 1
PROGRAM DBD
1 RDT DBD Combo (IGG & NS1) kotak 1 0 1 0 1

Jumlah Kunjungan Bulan

Tunai : 1395
BPJS : 1304
PBI : Mengetahui, Bogor, 31 Januari 2024
Gratis : KEPALA PUSKESMAS CITAPEN PENGELOLA OBAT PUSKESMAS CITAPEN
Poned :
Anak : 514
Dewasa : 2193
Rawat Inap :
Pasien Gigi : 106 dr. Tuniroh
Pasien Jiwa : 59 NIP. 198511272014122001 Dinda Rania A.Md.Farm
Pasien TB : 38
VAKSIN BCG
VAKSIN COVID-19 (ASTRAZENECA MULTIDOSE-10)
VAKSIN COVID-19 (COVOVAX 10-DOSE)
VAKSIN COVID-19 (JANSSEN 5-DOSE)
VAKSIN COVID-19 (MODERNA)
VAKSIN COVID-19 (MODERNA)
VAKSIN COVID-19 (PFIZER)
VAKSIN COVID-19 (SINOFARM)
VAKSIN COVID-19 (SINOVAC 2 DS)
VAKSIN COVID-19 (SINOVAC MULTIDOSE-10)
VAKSIN COVID-19 (SINOVAC)
VAKSIN DIPHTHERIA ANTITOXIN
VAKSIN DT
VAKSIN Hb0
VAKSIN IPV
VAKSIN MENINGITIS
VAKSIN MR
VAKSIN PCV
VAKSIN PENTABIO DPT-HB-HIB
VAKSIN POLIO ORAL
VAKSIN Td
VAKSIN BCG
VAKSIN COVID-19 (ASTRAZENECA MULTIDOSE-10)
VAKSIN COVID-19 (COVOVAX 10-DOSE)
VAKSIN COVID-19 (JANSSEN 5-DOSE)
VAKSIN COVID-19 (MODERNA)
VAKSIN COVID-19 (MODERNA)
VAKSIN COVID-19 (PFIZER)
VAKSIN COVID-19 (SINOFARM)
VAKSIN COVID-19 (SINOVAC 2 DS)
VAKSIN COVID-19 (SINOVAC MULTIDOSE-10)
VAKSIN COVID-19 (SINOVAC)
VAKSIN DIPHTHERIA ANTITOXIN
VAKSIN DT
VAKSIN Hb0
VAKSIN IPV
VAKSIN MENINGITIS
VAKSIN MR
VAKSIN PCV
VAKSIN PENTABIO DPT-HB-HIB
VAKSIN POLIO ORAL
VAKSIN Td