LAPORAN PEMAKAIAN DAN LEMBAR PERMIN

PUSKESMAS
SUB UNIT : PUSTU PASIR DURUNG
KECAMATAN : SINDANGRESMI
KAB / KOTA : PELAPORAN BULAN / PERIODE : DESEMBER
PROVINSI : PERMINTAAN BULAN / PERIODE : JANUARI

Jumlah
Stok
N0 NAMA OBAT SATUAN Penerimaan Persedia
Awal
an

1 2 3 4 5 6
A NAMA OBAT ( 4+5 )
1 Alprazolam Tablet - -
2 Albendazol Tablet 400 mg Tablet - - -
3 Allopurinol tablet 100 mg Tablet 150 200 350
4 Ambroxol sirup Botol - - -
5 Ambroxol tablet 30 mg Tablet - - -
6 Aminofilin Tablet 200 mg Tablet - - -
7 Aminofilina injeksi 24 mg/ml - 10 ml Ampul - - -
8 Amlodipin 10 mg Tablet 114 150 264
9 Amlodipin Besilate 5 mg Tablet 100 150 250
10 Amoksisilin Forte sirup kering 250mg Botol 10 10 20
11 Amoksisilin Injeksi 1 gr Vial - - -
12 Amoksisilin Tablet 500 mg Tablet 100 300 400
13 Amoksisillin kapsul 250 mg Kapsul - - -
14 Amoksisillin Sirup Kering 125 mg/5 ml Botol - - -
15 Ampisilin Injeksi 1 gr Vial - - -
16 Analog insulin Long Acting Pen - - -
17 Analog insulin Mix Acting Pen - - -
18 Antalgin (Metampiron) tablet 500 mg Tablet - - -
19 Antalgin (Metampiron) tablet 500 mg Tablet - - -
20 Antasida DOEN suspensi Botol (7) - (7)
21 ANTASIDA DOEN Tablet Tablet 100 300 400
22 Anti Bakteri DOEN ( Bacitrasin ) Tube - - -
23 anti hemoroid doen kombinasi supp - - -
24 Antifungi DOEN Tube - - -
25 Antimigren DOEN Kombinasi : Tablet - - -
26 Antiparkinson DOEN tablet Kombinasi : Tablet - - -
27 Antiparkinson Tablet ( Levopar ) Tablet - - -
28 Aqua Pro Injeksi Vial - - -
29 Artermeter injeksi Ampul - - -
30 Artesunate injeksi 60 mg/ml vial - - -
31 Asam Ascorbat ( Vit. C ) 50 MG Tablet 300 200 500
32 Asam Folat Botol 250 200 450
33 Asam Fusidat Cream Tube - - -
34 Asam Klorida 0,1 N Botol - - -
35 Asam Mefenamat 500 mg Tablet - 100 100
36 Asam Traneksamat Inj 5% Ampul - - -
37 Asering Botol 1 - 1
38 Asetosal tablet 500 mg Tablet - - -
39 Asetyl Cysteine Capsul 180 180 360
40 Asiklovir Cream 5% Tube - - -
41 Asiklovir tablet 200 mg Tablet 50 50 100
42 Asiklovir tablet 400 mg Tablet - - -
43 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Ampul - - -
44 Atropin Sulfat injeksi 0,25 mg/ml-1 ml Vial - - -
45 Atropin Sulfat tablet 0,5 mg Tablet - - -
46 Berotec Metered Aerosol 100 mg Bok - - -
47 Betadine Salep Antiseptik 5 mg Tube 6 5 11
48 Betametason krim 0,1 % Tube 20 15 35
49 Bisakodil Suppositoria supp - - -
50 Bisoprolol 2,5 mg Tablet - - -
51 Bisoprolol 5 mg Tablet - - -
52 Cairan Infus KN-3B Botol - - -
53 Cairan Infus Wida KDN 1 Botol - - -
54 Cairan Pembersih ( Protektor ) Botol - - -
55 Captopril Tablet 12,5 mg Tablet 54 100 154
56 Captopril Tablet 25 mg Tablet - - -
57 Cefadroxil Capsul 500 mg Capsul - - -
58 Cefixime Capsul 100 mg Capsul - - -
59 Cefixime Sirup Botol - - -
60 Cefotaksime 1 gr Injeksi Vial - - -
61 Cetirizine Capsul 50 mg Capsul - 100 100
62 Cetirizine sirup 5 mg/5 ml Botol - - -
63 Ciprofloxcacin 500 mg tablet Tablet 170 200 370
64 Combivent UDV 2,5 mg+0,5mg/2,5 ml Ampul - - -
65 D-Artepp tablet Tablet - - -
66 Deksametason tablet 0,5 mg Tablet 100 100 200
67 Dekstran 70 - larutan infus 6% steril Botol - - -
68 Dekstrometorfan sirup Botol - - -
69 Dekstrometorfan tablet 15 mg Tablet - - -
70 Diazepam Rektal 0,5 mg / 2 ml supp - - -
71 Diazepam tablet 2 mg Tablet - - -
72 Diazepam tablet 5 mg Tablet - - -
73 Difenhidramin HCL injeksi 10 mg/ml - 1ml Ampul - - -
74 Digoksin tablet 0,25 mg Tablet - - -
75 Diltiazem Tablet - - -
76 Doksisiklin Kapsul 100 mg Capsul - - -
 77 Domperidon 10mg Tablet Tablet 100 100 200
78 Domperidon Suspensi 5 mg/ 5 ml Botol 10 10 20
79 Doxicyclin 500mg capsul - - -
80 Efedrin HCLTablet 25 mg Tablet - - -
81 Epinefrina HCL/Bitartrat Injeksi Ampul - - -
82 Eritromicyn kapsul 250 mg capsul - - -
83 Erytromicin kapsul 500 mg Kapsul - - -
84 Erytromicin sirup 125 mg Botol - - -
85 Etakridin ( Rivanol ) larutan 0,1% Botol - - -
86 Etambutol 500 mg Tablet - - -
87 Etanol 70 % Botol - - -
88 Etil Klorida Semprot Botol - - -
89 Fenitoin Natrium kapsul 30 mg Kapsul - - -
90 Fenobarbital injeksi 50 mg/ml - 2 ml Ampul - - -
91 Fenobarbital tablet 30 mg Tablet - - -
92 Fenoksimetil Penisilina tablet 250 mg Tablet - - -
93 Fenol Gliserol tetes telinga 10 % Botol (5) - (5)
94 Fitomenadion (Vit.K1) Injeksi 10 mg/ml-1 Ampul - - -
95 Fitomenadion (Vit.K1) tab salut gula 10 m Tablet - - -
96 Flufenazine Deconat Inj 25 mg/ml Ampul - - -
97 Furosemida tablet 40 mg Tablet 50 50 100
98 Furosemide Injeksi Ampul - - -
99 Garam Oralit Sachet 95 - 95
100 Gemfibrozil 300 mg Tablet - - -
101 Gentamicin Injeksi Ampul - - -
102 Gentamicin Salep Kulit Tube - - -
103 Gentamicin Salep mata Tube - - -
104 Gentamicin Tetes Mata Botol 6 5 11
105 Gentian Violet 1 % Botol - - -
106 Glibenclamid tablet 5 mg Tablet - - -
107 Glicerin Guaiacolat ( GG ) 100 mg Tablet - - -
108 Glikazid 80 mg Tablet Tablet - - -
109 Glimepiride 2 mg Tablet - - -
110 Glukosa larutan infus 10% steril Botol - - -
111 Glukosa larutan infus 5 % steril Botol - - -
112 Griseofulvin tablet 500 mg, Tablet - - -
113 Guaiafenesin 100 mg Tablet - - -
114 Hidroklortiniazid ( HCT )Tab.25 mg Tablet - - -
115 Hidrokortison krim 2,5% Tube 14 24 38
116 Ibuprofen Suspensi Tablet - - -
117 Ibuprofen tablet 200 mg Tablet - - -
118 Ibuprofen tablet 400 mg Tablet - - -
119 Imunomodulator sirup( STIMUNO) Botol - - -
120 Isosorbid Dinitrat tablet sublingual 5 mg Tablet - - -
121 Kalsium Glukonas Injeksi Ampul - - -
122 Kalsium Laktat (Kalk) tablet 500 mg Tablet 220 200 420
123 Kapas Berlemak 500 mg Bungkus - - -
124 Ketokonazol Kream Tube 14 - 14
125 Ketokonazol Tablet 200 mg Tablet 50 50 100
126 Ketorolac inj Ampul 10 10 20
127 Kifadene tablet 20 mg Tablet - - -
128 Kloramfenikol salep mata 1 % capsul 12 10 22
129 Kloramfenikol suspensi Botol - - -
130 Kloramfenikol tetes telinga 3% Tube - - -
131 Kloramphenicol 250 mg Capsul 100 100 200
132 Kloramphenicol 500 mg capsul - - -
133 Kloramphenicol Tetes Mata Botol - - -
134 Klorfeniramin Maleat (CTM) tablet 4 mg Tablet - 200 200
135 Klorokuin tablet 150 mg Tablet - - -
136 Klorpromazin HCL tablet salut 25 mg Tablet - - -
137 Kombinasi (Pirimetamin 25 mg + SolfadoxiTablet - - -
138 Kotrimoksazol Dewasa Tablet 480 mg Tablet 480 400 880
139 Kotrimoksazol Sirup / Suspensi Botol 10 10 20
140 Kuinin Dihidroklorida injeksi 25% - 2 ml Ampul - - -
141 Kuinin Dihidroklorida injeksi 25% - 2 ml Botol - - -
142 Lactobacilus serbuk Sachet - - -
143 Lidocain 2%+efinefrin injeksi Ampul - - -
144 Lidocain injeksi 2 ml Ampul - - -
145 Lisinopril 10 mg tablet Tablet - - -
146 Lisinopril 5 mg tablet Tablet - - -
147 Loperamid 4 mg tablet Tablet - - -
148 Lytacur Sirup Botol - - -
149 Magnesium Sulfat Inj. 25 ml Ampul - - -
150 Metamizol 500 mg Tablet - - -
151 Metformin 500 mg Tablet Tablet - - -
152 Methilprednisolon tablet 8 mg Tablet - - -
153 Metilergometrin Maleat injeksi 1 ml Ampul - - -
154 Metilergometrin Maleat Tablet Tablet - - -
155 Metoklopramid Suspensi Botol - - -
156 Metoklopramid tablet Tablet - - -
157 Metronidazol 500 mg Tablet - - -
158 Metronidazol infus / injeksi Botol - - -
159 Metronidazol Ovula supp - - -
160 Metronidazol suspensi Botol - - -
161 Mikonazol kream Tube - - -
162 Multivitamin Anak Sirup Botol 10 10 20
163 Multivitamin Dewasa Antioksidan ( BecomTablet - - -
164 Natrium Diklofenak 25 mg Tablet Tablet - - -
165 Natrium Diklofenak 50 mg Tablet Tablet 200 100 300
166 Natrium Klorida Cairan Infus ( NaCL ) Botol 4 - 4
167 Nifedipine Tablet 10 mg Tablet - - -
168 Nistatin tablet vaginal 100.000 IU/g Tube - - -
169 Obat anti Diare suspensi Botol - - -
170 Obat Anti Diare Tablet (Akita / Molagit ) Tablet 90 100 190
171 Obat Batuk Flu ( Molexflu ) Tablet - - -
172 Obat Batuk Hitam (OBH) Botol - - -
173 Obat Batuk Sirup Herbal ( Herbacop ) Botol - - -
174 Ofloxsacin Tetes Telinga Tube - - -
175 Oksitetrasiklin HCL salep mata 1% Botol - - -
176 Oksitosin injeksi 10 IU/ml - 1 ml Ampul - - -
177 Omeprazol injeksi Ampul - - -
178 Omeprazol Kapsul 20 mg capsul (30) - (30)
179 Ondancentron injeksi 4 mg Ampul - 5 5
180 Ondancentron Tablet4 mg Tablet 30 60 90
181 Paracetamol Drop 15 ml Botol 11 15 26
182 Paracetamol Sirup 120 mg/5 ml Botol - - -
183 Parafin Dresing ( Bioplacenton Tull ) pcs - - -
184 Parasetamol tablet 100 mg Tablet - - -
185 Parasetamol tablet 500 mg Tablet 250 400 650
186 Permetrin Krim 5 % Tube - - -
187 Pirantel Sirup Botol - - -
188 Pirantel tablet 125 mg Tablet - - -
189 Pirazinamid Botol - - -
190 Piridoksin HCL (VIT B6) tablet 10mg Botol 250 200 450
191 Piroksikam tablet 20 mg Tablet - - -
192 Polikresulen Tube - - -
193 Povidon lodida 10% 300 ml - 1 1
194 Povidon lodida 10% 60 ml Tablet - - -
195 Prazikuantel tablet 600 mg Botol - - -
196 Prednison Tablet 5 mg Tablet 200 200 400
197 Primakuin 15 mg Tablet - - -
198 Probenesid 500 mg tablet Tablet - - -
199 Prokain Benzil Penisilin 3 juta IU/vial injeksAmpul - - -
200 Propanolol HCL tablet 10 mg Tablet - - -
201 Ranitidin injeksi Ampul (4) - (4)
202 Ranitidin tablet Tablet (200) - (200)
203 Resperidone 2 mg tablet Tablet - - -
204 Ringer Laktat cairan infus (Otsuka) - - -
205 Ringer Laktat cairan infus (Widatra) Botol 15 20 35
206 Rivanol 300 ml Botol - - -
207 Salbutamol Tablet 2 mg Tablet (10) - (10)
208 Salbutamol tablet 4mg Tablet 100 100 200
209 Salep 2-4 Tube 24 24 48
210 Salep kombinasi cream ( Berloson ) Tube - - -
211 Salicil bedak Kotak - - -
212 Serum Anti Bisa Ular Polivalen Inj 50 ml Vial - - -
213 Serum Anti Tetanus inj 1500 IU ( TetagamVial - - -
214 Sianokobalamin Injeksi Ampul - - -
215 Simvastatin 10 mg tablet Tablet 30 60 90
216 Simvastatin 20 mg tablet Tablet 40 - 40
217 Sukralfat Suspensi Botol 5 5 10
218 Sukralfat tablet 500 mg Tablet - - -
219 Suspensi Seng Insulin inj.40 IU/ml - 10 ml Tube - - -
220 Temporary Stopping Fletcher serbuk & caiTablet - - -
221 Tetrakain HCL tetes mata 0,5% Tube - - -
222 Tetrasiklin 250 mg capsul capsul - - -
223 Tetrasiklin 500 mg capsul capsul - - -
224 Tiamin Tablet 50 mg ( B1 ) Tablet 170 100 270
225 Ventolin Nebulizer Ampul - - -
226 Vitamin B komplek Tablet (10) 100 90
227 Zink sirup Botol - - -
228 Zink tablet 20 mg Tablet - - -
229 Diazepam injeksi 2 ml Ampul - - -
230 Nystatin Tablet 500.000 IU Tablet - - -
231 Deksametason Injek I.V./I.M 5Mg/Ml Ampul - - -
232 Griseofulvin tablet 125 mg Tablet - - -
233 Kloramfenikol S.K Tube 12 - 12
234 - - -
235 - - -
- - -
OBAT PROGRAM - - -
1 Albendazol Tablet 400 mg Tablet - - -
2 Isoniazid Tablet 100 mg Tablet - - -
3 Obat Antituberkulosis kategori 1 Paket - - -
4 Obat Antituberkulosis Kategori 2 Paket - - -
5 Obat Antituberkulosis Kategori Anak Paket - - -
6 Pot Dahak Non Steril Biji - - -
7 Pot Dahak Steril Biji - - -
8 Reagen Ziehl Neelsen Kit - - -
9 MDT MB Anak Tablet Tablet - - -
10 MDT MB Dewasa Tablet Tablet 100 - 100
11 MDT PB Dewasa Tablet Tablet - - -
12 MDT PB Anak Tablet Tablet - - -
13 Retinol (Vitamin A) kapsul 200.000 IU capsul - - -
14 Retinol (Vitamin A) kapsul 100.000 IU capsul - - -
15 Tablet Penambah Darah ( FE ) Tablet - - -
16 Amitriptilin tablet 25 mg Tablet - - -
17 Carbamazepin 200 mg tablet Tablet - - -
18 Clobazam 10 mg Tablet Tablet - - -
19 Clozapine 25 mg Tablet Tablet - - -
 20 Fenitoin Natrium kapsul 30 mg capsul - - -
21 Haloperidol 1,5 mg Tablet Tablet - - -
22 Haloperidol 2 mg tablet Tablet - - -
23 Haloperidol 5 mg Tablet Tablet - - -
24 Haloperidol Injeksi Ampul - - -
25 Klorpromazin HCL tablet salut 100 mg Tablet - - -
26 Klorpromazine Tablet 25 mg Tablet - - -
27 Triheksilfenidil Hcl 2 mg tablet Tablet - - -
- - -
- - -
- - -
NAMA BAHAN MEDIS HABIS PAKAI -
B
(BMHP ) -
1 Alat suntik 1 ml Pcs 10 10 20
2 Alat suntik 10 ml Pcs - - -
3 Alat suntik 2,5 ml Pcs 109 10 119
4 Alat suntik 20 ml Pcs - - -
5 Alat suntik 3 cc (Remedi) - - -
6 Alat suntik 3 ml Pcs 33 20 53
7 Alat suntik 5 ml pcs 16 5 21
8 Alkazide 1 L High Level Desinfectant Botol - - -
9 Alkazyme Sachet 25 mg Pack - - -
10 Alkohol 70 % 1 L Botol - - -
11 Alkohol swab Sachet - 1 1
12 Anti Septik Hand Rub Botol - - -
13 Anti Septik Surgikal Hand Scrub Botol - - -
14 Cat Gut no 2/0 Sachet - - -
15 Cat Gut no 3/0 Sachet 14 10 24
16 Cat Gut No 3/0 (24 mm) Sachet - - -
17 Cat Gut No 3/0 (26 mm) Sachet - - -
18 Cathetter Jelly Biji 2 5 7
19 Demetech Silk 3/0 Set - - -
20 E Care I.V Dresing Pcs - - -
21 E-Care Surgical Mask Tie On Lembar 15 50 65
22 Folly No 14 Catether pcs - - -
23 Folly No 16 Catether pcs 8 5 13
24 I.V Cathetter No. 20 Set 2 10 12
25 I.V Cathetter No. 22 Set 5 10 15
26 I.V Cathetter No. 24 Set 5 5 10
27 I.V Cathetter No. 26 Set 10 10 20
28 Infuset Anak Set 6 10 16
29 Infuset Dewasa Set 4 10 14
30 Jarum Insulin Tablet - - -
31 Kapas Berlemak 250 gr Bungkus - - -
32 Kapas Berlemak 500 gr Bungkus - - -
33 Kasa 4 m x 10 cm Rol - - -
34 Kasa Hidrofil 36 x 80 cm Rol - - -
35 Kasa Pembalut 2 x 80 cm Pack 3 3 6
36 Kasa Steril 16 x 16 cm Kotak - 3 3
37 Lisol 1 L Botol - - -
38 Masker karet Ear Loop Lembar - - -
39 Masker tali Tube - - -
40 Nasal Canula Oksigen Set - - -
41 Plester 1" Rol - - -
42 Plester Kertas 2,5 cm Rol - - -
43 Plester Non Woven 5cm x 5 cm Rol 4 5 9
44 Policlean Botol - - -
45 Polifik Kotak - - -
46 Saraya Alsof A 500 ml Botol - - -
47 Saraya Alsof Pure 500 ml Botol - - -
48 Sarung Tangan Gynecolog No 7 Pasang - - -
49 Sarung tangan M (Non Steril) Pasang - - -
50 Sarung tangan no 6,5 Pasang 45 20 65
51 Sarung tangan no 6,5 Steril Gloves Pasang - - -
52 Sarung tangan no 7,0 Steril Pasang - - -
Selang Section ( Surgikal Conection
53 Tube with yankauer) Pcs - - -
54 Underpad Lembar 4 10 14
55 Urine Bag Biji - - -

NAMA OBAT VAKSIN

1 Vaksin Anti Rabies ( VAR ) Vial

2 Vaksin BCG Vial
3 Vaksin DT Vial
4 Vaksin HB 0 Pcs
5 Vaksin HBIG Vial
6 Vaksin Measless Rubella (MR) Vial
7 Vaksin Pentabio ( DPT - HB - Hib ) Vial
8 Vaksin Polio B OPV Vial
9 Vaksin Polio IPV Vial
10 Vaksin TD Vial
11 Vaksin Tuberculin Vial
12 ADS 0,005 ml Unit
13 ADS 0,5 ml Unit
14 ADS 5 ml Unit
15 Safety Box Unit

NAMA OBAT REAGEN

 NAMA OBAT REAGEN

1 Albumin (Reagen) Kotak

2 anti A Monoclonal ( GolDar 10 ml) Vial
3 Anti A-B Monoclonal ( GolDar 10 ml) Vial
4 Anti B Monoclonal ( GolDar 10ml) Vial
5 Anti D Monoclonal ( GolGar 10ml) Vial
6 Benecheck Plus Cholesterol Test Strip
7 Benecheck Plus Glukosa Test Strip
8 Benecheck Plus Uric Test Strip
9 Bilirubin T/D (Reagen) Kotak
10 Brilian Green Bile Broth Kotak
11 Cellclean (CL-50) (Reagen) Kotak
12 Cellpack (PK-30L) (Reagen) Kotak
13 Chikungunya IgM (Reagen) Kotak
14 Cholesterol (Reagen) Kotak
15 Cholesterol Stik (Reagen) Kotak
16 CK-MB (Reagen) Kotak
17 Creatinin Reagen Kit
18 Dengue IgM / IgM ( Reagen ) Kotak
19 Eight Check ( LNH ) Serial
20 Febrile Antingen H Parathpy Vial
21 Febrile Antingen H-A Parathpy Vial
22 Febrile Antingen H-B Parathpy Vial
23 Febrile Antingen H-C Parathpy Vial
24 Febrile Antingen O Parathpy Vial
25 Febrile Antingen O-A Parathpy Vial
26 Febrile Antingen O-B Parathpy Vial
27 Febrile Antingen O-C Parathpy Vial
28 Glukosa Reagen Kotak
29 GOT ( ALAT ) Kotak
30 GPT ( ALAT ) Kotak
31 HBSAG Reagen Box
32 HCG Strip Vial
33 HDL Cholesterol ( Precipitan ) Kotak
34 Hematologi Calibrator (Nscs 1000 ) Botol
35 Hemoglobin Reagen Kotak
36 Lactose Broth 500 mg Botol
37 LDL Cholesterol Kotak
38 Leptospira IgM (Reagen) Kotak
39 Micropippets MT-1-up to 200 ui Pcs
40 MIcropippets MT-up to 1 ml Pcs
41 NS1 Antigen Test (Reagen) Kotak
42 Pipet Ukur 10 ml biji
43 Poch Pack D (II) Reagen Kotak
44 Poch Pack L (II) Reagen Kotak
45 Stik Uric Acid Kotak
46 Strip Narkoba 3 Parameter Kotak
47 Strip Narkoba 5 Parameter Kotak
48 Strip Narkoba 6 Parameter Kotak
49 Total Protein Kotak
50 Trigleserida Kotak
51 Urea Kotak
52 Uric Acid Kotak

NAMA OBAT REAGEN PROGRAM HIV

1 Rapid 1 HIV (SD Bioline ) Tes
2 Rapid 2 HIV (Fokus ) Tes
3 Rapid 3 HIV (Biomeriux Vikia ) Tes
4 SD Biosensore Standart Q Syphlis Tes
5 RPR Syphlis ( Fokus ) Tes
6 Reagen CD4 Control Tes
7 Reagen CD4 Mobile Tes
8 RPR Syphlis Komponen Kit
9 Anuscopy Buah
10 Kertas PH Indikator Buah
11 Rotator Buah
12 Tip. Uk.60 Bks
13 Tip. Uk.61 Bks
14 Pronto / Holder Buah

NAMA OBAT GIGI

1 Anastesi Citojek Box

2 Articulating Paper (Kertas warna penanda Kotak
3 Bahan Tumpatan sementara Botol
4 Bonding Syringe
5 Cairan Desinfectan ( Perendaman Instrume Botol
6 Cairan untuk desinfectan pembersih permBotol
7 Carpule Citojek Kotak
8 Chlorfeson Kamfer menthol ( CHKM ) CaiBotol
9 Composite Nanohibrid A1 Tube
10 Composite Nanohibrid A2 Tube
11 Composite Nanohibrid A3 Tube
12 Composite Nanohibrid A3,5 Tube
13 Devitalisasi Pasta Pot
14 Disclosing Solution Botol
15 Etcing Gel Pcs
16 Etil Klorida Semprot Botol
17 Eugenol Cairan Botol
18 Formokesol Botol
19 Gas Powred Jet Injector Botol
20 Glass Ionomer Cement ART Pot
21 Jarum citojek uk 16 mm Box
22 Kalsium Hidroksida pasta Botol
23 Klorhekdidin Larutan 2 % Botol
24 Mummifiying Fasta Botol
25 Natrium Hipoklorit airan konsentrat 5% Botol
26 Paper Points 15-40 mm Box
27 Pasta Devitalisasi ( Non Arsen ) Tube
28 Pasta Pengisi Saluran Akar Syringe
29 Semen seng Fosfat serbuk Set
30 Spon Gelatin Cubicis 1x1x1 cm (SpongostBotol
31 Temporary Filling Fasta Set
32 Tooth Stain Remover ( TSR ) Botol
33 Wipes Desinfektan Botol

RAWAT JUMLAH
INAP
0
0
0

RAWAT
JUMLAH KUNJUNGAN PUSKESMAS JALAN
UMUM / BAYAR
UMUM / TIDAK BAYAR
JKN
TOTAL KUNJUNGAN

Mengetahui / Menyetujui
KEPALA DINAS KESEHATAN YANG MENYERAHKAN
KABUPATEN PANDEGLANG KEPALA UPT. GUDANG FARMASI

………………………………………… ……………………………………………………
NIP. NIP.
AN LEMBAR PERMINTAAN OBAT ( LPLPO )
PUSKESMAS
DOKUMEN NOMOR TANGGAL
DINKES KAB/KOTA
: DESEMBER GFK KAB/KOTA
: JANUARI PUSKESMAS

PEMBERIAN
Jumlah
Pemakai Stok Stok
Perminta BUFFER JUMLAH
an Akhir Optimum APBD II JKN PROG LAIN LAIN
an STOK

7 8 9 10 11 12 13 14 15 16
(6-7)
-
-
100 250 100
-
-
-
-
50 214 50
50 200 50
20 15
-
200 200 300
-
-
-
-
-
-
-
9 (16) 25
200 200 300
-
-
-
-
-
-
-
-
-
100 400 150
50 400
-
-
100 - 200
-
3 (2) 5
-
120 240 120
-
100 100
- 100
-
-
-
-
3 8 5
15 20 10
-
-
-
-
-
-
98 56 200
-
-
-
-
-
100 - 100
-
30 340 100
-
-
200 100
-
-
-
-
-
-
-
- 0
-
-
 200
20
-
-
-
-
-
-
-
-
-
-
-
-
-
-
5 (10) 10
-
- 100
-
100 0
-
35 60
-
-
-
-
3 8 8
-
-
-
-
-
-
-
-
-
-
10 28 10
-
-
-
-
-
-
60 360 100
-
12 2 10
100
20 20
-
6 16 15
-
-
200
-
-
200 - 300
-
-
-
40 840 100
20 10
-
-
-
-
-
-
-
-
-
- 15
-
- 100
-
-
-
-
-
-
-
-
-
- 5
20
-
-
100 200 200
2 2 6
 -
-
-
70 120 100
-
-
-
-
-
-
-
30 (60) 120
5 - 10
30 60 60
4 22 5
-
-
-
330 320 400
-
-
-
-
50 400 100
-
-
1 - 1
-
-
200 200 100
-
-
-
-
8 (12)
200 (400) 100
-
-
15 20 15
-
70 (80) 100
200
48
-
-
 -
-
-
30 60 100
20 20 100
10
- 5
-
-
-
-
-
110 160 200
-
170 (80) 100
- 5
-
-
-
-
- 100
12 - 12
-
-
-
-
-
-
-
-
-
-
-
-
-
100
-
-
-
-
-
-
-
-
-
 -
-
-
-
-
-
-
-
-
-
-

11 9
-
40 79
-
-
2 51 15
4 17 10
-
-
- 1
1 - 50
-
-
-
6 18 10
-
-
3 4
-
-
55 10 50
-
3 10 3
8 4 10
5 10 10
10 10
20 10
4 12 12
16 (2) 12
-
-
-
 -
-
5 1 5
3 - 10
-
12 (12) 50
-
-
-
-
4 5 2
-
-
-
-
-
- 20
35 30 20
-
-

-
8 6 10
-
 Harap Dilampirkan : 1. LB 1

2. Lap. Psikotropika & Narkotika

3. Lap. Pemakaian Serum ABU
4. Lap. 20 Pemakaian Obat Terbanyak

YANG MEMINTA YANG MEMINTA :

KEPALA PUSKESMAS PETUGAS OBAT PUSKESMAS

………………………………………… ……………………………………..
NIP. NIP.
TANGGAL

Pemakaia
Perhitungan
n Rata Stok Optimum
rata Bufer 10 %

0 0
0 0
33.33333 35
0 0
0 0
0 0
0 0
16.66667 26.4
16.66667 25
0 2
0 0
66.66667 40
0 0
0 0
0 0
0 0
0 0
0 0
0 0
3 -0.7
66.66667 40
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
33.33333 50
16.66667 45
0 0
0 0
33.33333 10
0 0
1 0.1
0 0
40 36
0 0
0 10
0 0
0 0
0 0
0 0
0 0
1 1.1
5 3.5
0 0
0 0
0 0
0 0
0 0
0 0
32.66667 15.4
0 0
0 0
0 0
0 0
0 0
33.33333 10
0 0
10 37
0 0
0 0
0 20
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 0 20
0 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1.666667 -0.5
0 0
0 0
0 0
0 10
0 0
11.66667 9.5
0 0
0 0
0 0
0 0
1 1.1
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
3.333333 3.8
0 0
0 0
0 0
0 0
0 0
0 0
 20 42
0 0
4 1.4
0 10
0 2
0 0
2 2.2
0 0
0 0
0 20
0 0
0 0
66.66667 20
0 0
0 0
0 0
13.33333 88
0 2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 2
0 0
0 0
33.33333 30
0.666667 0.4
 0 0
0 0
0 0
23.33333 19
0 0
0 0
0 0
0 0
0 0
0 0
0 0
10 -3
1.666667 0.5
10 9
1.333333 2.6
0 0
0 0
0 0
110 65
0 0
0 0
0 0
0 0
16.66667 45
0 0
0 0
0.333333 0.1
0 0
0 0
66.66667 40
0 0
0 0
0 0
0 0
2.666667 -0.4
66.66667 -20
0 0
0 0
5 3.5
0 0
23.33333 -1
0 20
0 4.8
0 0
0 0
 0 0
0 0
0 0
10 9
6.666667 4
0 1
0 0
0 0
0 0
0 0
0 0
0 0
36.66667 27
0 0
56.66667 9
0 0
0 0
0 0
0 0
0 0
0 0
4 1.2
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 10
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
 0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
3.666667 2
0 0
13.33333 11.9
0 0
0 0
0.666667 5.3
1.333333 2.1
0 0
0 0
0 0
0.333333 0.1
0 0
0 0
0 0
2 2.4
0 0
0 0
1 0.7
0 0
0 0
18.33333 6.5
0 0
1 1.3
2.666667 1.2
1.666667 1.5
0 1
0 2
1.333333 1.6
5.333333 1.4
0 0
0 0
0 0
 0 0
0 0
1.666667 0.6
1 0.3
0 0
4 0
0 0
0 0
0 0
0 0
1.333333 0.9
0 0
0 0
0 0
0 0
0 0

0 0
0 0

0 0
2.666667 1.4
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0
0 0