LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

NO : PELAPORAN BULAN : APRIL

NAMA PUSKESMAS : PRINGGARATA PENERIMAAN BULAN : MEI
NAMA UNIT : PUSTU PEMEPEK
PENGELOLA OBAT : Ns. BAIQ RETNO, S.Kep

STOK STOK EXPIRED DATE/

No. Nama Obat Satuan PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN PEMBERIAN NO. BATCH
AWAL OPTIMUM KETERANGAN

Tablet/Kapsul/Sachet
1 ACT tablet tablet
2 Acetyl Cystein 200mg tablet 200
3 Acyclovir 200 mg tablet tablet
4 Acyclovir 400 mg tablet tablet 140 140 140
5 Albendazol tablet 400 mg tablet
6 Alopurinol tablet 100 mg tablet 200
7 Alprazolam 0,5 mg tablet tablet
8 Alprazolam 1 mg tablet
9 Ambroxol tablet tablet 200
10 Aminofilina tablet 200 mg tablet
11 Amitriptilina tablet 25 mg tablet
12 Amlodipin 5 mg tablet
13 Amlodipin 10 mg tablet 100 100 40 60
14 Amoksisilina kapsul 500 mg tablet 220 200 420 30 390
15 Antasida DOEN tablet tablet 380 380 110 270 100
16 Asam Askorbat (Vit. C) tablet 50 mg tablet 240 240 40 200
17 Asam Folat tab tablet
18 Asam Mefenamat tablet 500 mg tablet 180 180 40 140 200
19 Asam Tranexamat 500mg tablet
20 Asetosal 80mg (MINIASPI) tablet
21 Attalpulgite 600mg - New Antides tablet 30 30 30 200
22 Azithromycin 500 mg tab tablet
23 Betahistin 6mg tablet 90 90 10 80
24 Captopril 12,5 mg tablet 80 100 180 40 140
25 Captopril tablet 25 mg tablet
26 Captopril tablet 50 mg tablet
27 Cefadroxil 500 mg tablet 90 90 20 70
28 Clozapine 25mg tablet
29 Cyproploxasin tablet tablet 100 100 20 80 100
30 Deksametason tablet 0,5 mg tablet 190 100 290 70 220 200
31 Diazepam tablet 2 mg tablet
32 Digoksin tablet 0,25 mg tablet
33 Domperidon tablet 10 mg tablet 70 70 70
34 Doxycyklin 100 mg tablet capsul
35 Efedrina HCl. tablet 25 mg tablet
36 Ergotamin Caffein tablet tablet
37 Eritromisin kapsul 250 mg tablet
38 Eritromisin kapsul 500 mg tablet
39 Fenobarbital tablet 30 mg tablet
40 Fenofibrate 100 mg tablet
41 Fitomenadion (Vit. K) tablet salut 10 mg tablet
42 Fluoxetin 20mg (NOPRES) tablet
43 Furosemida tablet 40 mg tablet
44 Garam Oralit untuk 200 ml air Sachet 100 100 10 90
45 Gemfibrozil 150 mg tablet
46 Glibenklamida tablet 5 mg tablet 250 250 10 240
47 Glimepiride tablet 1 mg tablet
48 Glimepiride tablet 2 mg tablet
49 Griseofulvin tablet 125 mg Mikronized tablet
50 Guaifenisin tablet tablet 40 40 40 200
51 Haloperidol tablet 1,5 mg tablet
52 Haloperidol tablet 5 mg tablet
53 Hidroklortiazide (HCT) tablet 25 mg tablet
54 Hyoscine N Butilbromide/ SCOPMA tablet 150 150 150 200
55 Ibuprofen tablet 200 mg tablet
56 Ibuprofen tablet 400 mg tablet 20 20 20 200
57 Isoniazid ( INH ) + Pyridoxin (B6) tablet
58 Isoniazid ( INH ) 100mg tablet
59 Isosorbid Dinitrat Sub Lingual tablet 5 mg tablet
60 Kalsium Laktat tablet 500 mg tablet 120 120 120
61 Karbamazepin 200 mg tablet
62 Ketokonazole tablet 200 mg tablet
63 Klindamycin 150 mg tablet
64 Klindamycin 300 mg capsul
65 Kloramfenikol kapsul 250 mg tablet
66 Kloramfenikol kapsul 500 mg tablet 160 160 160 Jun-22
67 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 200 200 100 100 200
68 Klorpromazina tablet 100 mg tablet
69 KOMBIPAK (Azythromycin + Cefixime ) tablet
70 Kotrimoksazol dewasa tablet tablet 80 80 80
71 Kuinin ( Kina ) tablet 200 mg tablet
72 Loperamide 2mg tab tablet 100
73 Loratadin 10mg tablet 200
74 Lorazepam 1 mg (RENAQUIL 1mg) tablet
75 Metformin HCL 500 mg tablet tablet 200 200 190
76 Metilergometrin Maleat tablet 0,125 mg tablet
77 Metilprednisolon 4 mg tablet 200
78 metocloperamide tab 5 mg tablet
79 Metoclopramide 10 mg tablet 150 150 150
80 Metronidazol tablet 500 mg tablet 100 100 100
81 Mineral Mix Sachet Sachet
82 Misoprotol tab 200 mcg tablet
83 Na diklofenak 25mg tablet
 84 Na diklofenak 50mg tablet 20 100 120 50 70 200
85 Nifedipin tablet tablet
86 Nistatin tablet salut 500.000 IU tablet
87 Obat Anti Tuberkulosis FDC kategori 1/3 paket
88 Obat Anti Tuberkulosis FDC kategori 2 paket
89 Obat Anti Tuberkulosis FDC kategori anak paket
90 Obat Anti Tuberkulosis KDT Harian paket
91 Omeprazole kapsul kapsul 100
92 Oseltamivir tablet
93 Parasetamol tablet 500 mg tablet 110 200 310 190 120 200
94 Phenytoin 100 mg capsul
95 Piridoksina HCl. tablet 10 mg tablet 100 100 100
96 Prednison tablet 5 mg tablet
97 Primakuin tablet 15 mg tablet
98 Propiltiourasil tablet 100 mg tablet
99 Ranitidin tablet 150 mg tablet 100 100 10 90 100
100 Retinol (Vitamin A) kapsul 100.000 IU capsul
101 Retinol (Vitamin A) kapsul 200.000 IU capsul
102 Risperidon 2 mg tablet tablet
103 Salbutamol tablet 2 mg tablet
104 Salbutamol tablet 4 mg tablet 240 240 240
105 Simvastatin 10mg tablet 30 100 130 40 90 200
106 Sivit zink tablet tablet
107 Spironolakston 25 mg tablet
108 Striatamin cap capsul
109 Tablet Tambah Darah kombinasi tablet 200 200 50 150
110 Tetrasiklina HCl. kapsul 500 mg capsul
111 Tiamine HCl. Mononitrat (Vit. B-1) tablet 50 mg tablet 310 310 70 240
112 Trifluoperazine 6 mg tablet
113 Triheksifenidil HCl. tablet 2 mg tablet
114 Valproat tab sal 250 mg (Depakote ER) botol
115 Vitamin B Komplek tablet tablet 320 320 40 280 100
116 Zinc tablet 20 mg botol 80 80 80
Syrup/ Suspensi
117 Ambroxol sirup 15mg/ml botol 4 4 4
118 Amoksisilina sirup kering 125 mg/ 5ml botol 8 8 2 6
119 Amoksisilina sirup kering 250 mg/ 5ml botol
120 Amoxicillin drop botol
121 Antasida DOEN suspensi botol 8 8 2 6
122 Cefadroxil sirup 125mg/ml botol
123 Domperidon syrup botol
124 Eritromisin Syrup Kering 200mg/5ml botol
125 Ibuprofen sirup 100mg/5ml botol
126 Kloramfenikol suspensi 125mg/5 ml botol
127 Kotrimoksazol suspensi botol 3 3 2 1 5
128 Multivitamin dan mineral (caviplex) syr botol
129 Parasetamol drop 100 mg/ml @ 15 ml botol
130 Parasetamol sirup 120 mg / 5 ml botol 9 9 3 6
131 Setirizin sir 5 mg/5 ml. botol
132 Valproat syrup 250 mg/ml botol
133 Zinc sir 20 mg/5 ml botol
Injeksi
134 ACT injeksi ampul
135 Aminofilina injeksi 24 mg / ml-10ml ampul
136 Ampisilina injeksi Ampul
137 Aqua Pro injeksi steril bebas pirogen ampul
138 Asam Tranexamat 500mg/5 ml injeksi ampul
139 Atropin Sulfat injeksi 0,25 mg / ml-1 ml ampul
140 Calsium Glukonas Inj ampul
141 Deksametason inj. 5 mg /ml-1 ml Ampul 5 5 5
142 Diazepam injeksi 5 mg/ ml- 2 ml ampul
143 Difenhidramina injeksi 10 mg/ ml- 1 ml ampul
144 Epinefrin injeksi 0,1 % - 1 ml ampul
145 Fenobarbital injeksi 50 mg / ml-1 ml ampul
146 Fitomenadion (Vit. K) injeksi 10 mg / ml-1 ml ampul
147 Haloperidol injeksi 5mg/ml (LODOMER 5) ampul
148 Ketorolac Inj 30 mg/ml ampul
149 Kloramfenikol injeksi Ampul
150 Lidokain 2% injeksi (tunggal) ampul 2 2 1 1
151 Lidokain Kompositum injeksi ampul
152 Magnesium Sulfat injeksiI (IV) 20 %-25 ml Vial
153 Magnesium Sulfat injeksiI (IV) 40 %-25 ml Vial
154 Metilergometrin Maleat injeksi 0,2 mg / ml Ampul
155 Metocloperamide Ampul .5 5 5
156 Nebules kombinasiinj: ipatropium br 0.5 mg+ Vial
157 salbutamol 2.5 mg (COMBIVENT) ampul
Oksitosin injeksi 10 IU / ml - 1 ml
158 Omeprazole 40mg/10 ml injeksi Vial
159 Prokain Benzil Penisilin inj 3jt IU Vial
160 Ranitidine injeksi Pot
161 Sabu Polivalen 5 ml (ABU I) Vial
162 Salbutamol Inj 1 mg/ml Vial
163 Serum Anti Tetanus injeksi 1.500 IU / ampul (ATS) ampul
164 Sianokobalamin (Vit. B 12) injeksi 500 mcg / ml ampul
Obat Luar
165 Acyclovir krim 5% tube
166 Antibakteri DOEN salep kombinasi tube 5
167 Antifungi DOEN kombinasi tube
168 Antihemaroid DOEN kombinasi suppo 5
169 Betametason krim 0,1 % tube 1 1 1
170 Borax Glycerin botol
171 Calamin (Caladin) lotion 60 ml botol 5 5 5
172 Diazepam rectal tube 5 mg (stesolid rectal) tube
173 Diazepam rectal tube 10mg (stesolid rectal) tube
174 Dulcolax 5mg supp (anak) suppo 6 6 6
175 Dulcolax 10mg supp (Dewasa) suppo
176 Etakridina (Rivanol) larutan 0,1 % botol
177 Etanol 70 % botol
178 Fenolgliserol tetes telinga 10 % botol
179 Gentamicin salep mata (GENOINT) 0,3 % tube
180 Gentamicin tetes mata 0,3 % botol
181 Hidrokortison krim 2,5 % tube 6 6 2 4
182 Ketokonazole cream 2% tube
183 Kloramfenikol salep kulit 2% (BUFACETIN) tube
184 Kloramfenikol salep mata 1 % tube 5 5 5
185 Kloramfenikol tetes mata 0,5 % botol
186 Kloramfenikol tetes telinga 3 % botol 3 3 3
187 Miconazol krim tube 5 5 10 1 9
188 Oksitetrasiklin salep mata 1 % tube 6 6 6 May-22
189 Parasetamol / Pamol suppo 125mg suppo 12 12 2 10
190 Perhidrol ( Lar H2O2 ) tube
191 Povidon Iodida 10 % , 30 ml botol
192 Povidon Iodida 10 % , 60 ml botol
193 Povidon Iodida 10 % , 300 ml botol 1 1 1
194 Salep 2-4 Kombinasi Pot
195 Salisil Bedak 2 % botol 8 8 1 7
196 Scabicid/Scabimid cream tube 10
197 Silver sulfadiazin Cream 1% 35 gr tube
Infus dan Cairan
198 Cairan Untuk Irigasi 1000 ml Flash
199 Glukosa infus 5 % Flash
200 Glukosa infus 10 % Flash
201 Glukosa infus 40 % Flash
202 Natrium Klorida infus 0,9 % 500 ml Flash 3 3 3
203 Prontosan Wound Irrigation sol 350ml botol
204 Ringer Laktat larutan infus steril Flash
Bahan Medis Habis Pakai
205 Alat Suntik sekali pakai 1 ml Set
206 Alat Suntik sekali pakai 3 ml Set 20 20 2 18
207 Alat Suntik sekali pakai 5 ml Set 15 15 15
208 Catgut / Benang Bedah No. 2/0 24x70 cm
209 Catgut / Benang Bedah No. 3/0 24x70 cm
210 Cover Glass 20x20 set
211 Dermafix S IV set
212 Feeding Tube 40cm No. 8 set
213 Foley cathether No. 16 set
214 Foley cathether No. 18 set
215 Foley cathether No. 20 set
216 Gown set botol
217 Hand Rub 500ml botol
218 Hand Scrub 500ml botol
219 Handrub refill 5 liter galon
220 Hazmat Size L set
221 Hazmat Size XL set
222 Infusion Set anak-anak set
223 Infusion Set dewasa set
224 IV Cathether No. 18 G set
225 IV Cathether No. 20 G set
226 IV Cathether No. 22 G set
227 IV Cathether No. 24 G set
228 Jarum hecting kombinasi set
229 Jelly Dopler botol
230 Kapas Pembalut / Adsorben 250 gram rol
231 Kasa Pembalut 40 yd x 110 cm rol
232 Kasa Pembalut 4x10 cm rol
233 Kasa Pembalut 4x15 cm rol
234 Kertas EKG 58mm x 25 m rol
235 Kertas EKG 58mm X 30 m rol
236 Kertas EKG 63mm X 30 m rol
237 Kertas EKG 80mm x 20 m rol
238 Lokal kacamata faceshield set
239 Masker Bedah Anak pcs
240 Masker KN 95 pcs
241 Masker N 95 pcs
242 Masker Oxygen (Maxiflow) Anak (Pediatrik) set
243 Masker Oxygen (Maxiflow) Dewasa (Adult) set
244 Masker surgical pcs 20 20 40 18 20
245 Masker surgical Anak pcs
246 Object Glass 20x20 mm pack
247 Oxygen Nasal Adult (Dewasa) set
248 Oxygen Nasal NewNates set
249 Oxygen Nasal Pediatric set
250 Pembalut gibs rol
251 Plester 5 yard x 2 inchi (plester coklat) rol
252 Plester Kertas 1" (surgical tape) rol
253 Regulator Oksigen set
254 Sarung tangan steril no.6,5 pasang
255 Sarung tangan steril NO.7 pasang
256 Sarung tangan steril NO.7,5 pasang
257 Sarung tangan non steril uk L pasang
258 Sarung tangan non steril uk.M pasang 34 34 20
259 Sarung tangan obgin No. 6,5 pasang
260 Sarung tangan obgin No. 7 pasang
261 Sarung tangan obgin No. 7,5 pasang
262 Sarung tangan obgyn no. 8 pasang
263 Silk 2/0 + 1/2 GT 35MM set
264 Silk 3/0 + 1/2 GT 35MM set 34 34 1 33
265 Solida Nurse Cap set
266 Surgical mess 11 pack
267 Surgical mess 20 pack
268 Transparent IV Dressing (with notch) set
269 Umbilical cord klem set
270 Urine bag set
271 Wing Neddle No 21 G set
272 Wing Neddle No 23 G set
273 Wing Neddle No 25 G set
Bahan Gigi
274 Air Raksa dental use 100 gram
275 Cavit botol
276 Cresophene botol
277 Etil klorida semprot 100 ml
278 Euginol cairan dus 12 btl
279 Glass Ionomer cement (GC IX) A2-A3 set
280 Jarum exterpatie set
281 Jarum reaming file set
282 Kalsium Hidroksida pasta 2 tube
283 Klorfenol Kamper Menthol ( CHKM ) 10 ml
284 Mummifying pasta botol
285 Non Arsen Septodont Rapid botol
286 Semen Seng Pospat serbuk dan cairan set @ 30 gr
287 Silver Amalgam 1 oz
288 Spon Gelatin Cubicles 1 x 1 x 1 cm 24 buah
289 Tambalan komposit-solare X (A2-A3) Set
290 Temperory Stoping Fletcher serbuk & cair set @ 100 gr
Tambahan
291 Cetirizine tab tablet 100 100 100
292 Alkohol swab pack
293 Kasa hidrofil steril pack
294 Klip 200

Yang Memberikan, Yang Menerima,

Pengelola Obat Puskesmas Pengelola Obat Unit

Nisa' Amila Rodhiya, S.Farm., Apt Ns. Baiq Retno ,S.Kep

 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPL
NO :
NAMA PUSKESMAS : PRINGGARATA
NAMA UNIT : PUSTU PEMEPEK
PENGELOLA OBAT : Ns. BAIQ R ETNO CESAR MARLANGEN S.Kep

No. Nama Obat Satuan STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN

Tablet/Kapsul/Sachet
1 ACT tablet tablet
2 Acetyl Cystein 200mg tablet 180 180 50
3 Acyclovir 200 mg tablet tablet
4 Acyclovir 400 mg tablet tablet 140 140 40
5 Albendazol tablet 400 mg tablet 200 200
6 Alopurinol tablet 100 mg tablet
7 Alprazolam 0,5 mg tablet tablet
8 Alprazolam 1 mg tablet
9 Ambroxol tablet tablet
10 Aminofilina tablet 200 mg tablet
11 Amitriptilina tablet 25 mg tablet
12 Amlodipin 5 mg tablet
13 Amlodipin 10 mg tablet 60 60 20
14 Amoksisilina kapsul 500 mg tablet 390 200 590 350
15 Antasida DOEN tablet tablet 270 200 470 170
0 Asam Askorbat (Vit. C) tablet 50 mg tablet 200 200 80
17 Asam Folat tab tablet
18 Asam Mefenamat tablet 500 mg tablet 140 200 340 90
19 Asam Tranexamat 500mg tablet
20 Asetosal 80mg (MINIASPI) tablet
21 Attalpulgite 600mg - New Antides tablet
22 Azithromycin 500 mg tab tablet
23 Betahistin 6mg tablet 80 80 50
24 Captopril 12,5 mg tablet 140 140 70
25 Captopril tablet 25 mg tablet
26 Captopril tablet 50 mg tablet
27 Cefadroxil 500 mg tablet 70 70 70
28 Clozapine 25mg tablet
29 Cyproploxasin tablet tablet 80 100 180 90
30 Deksametason tablet 0,5 mg tablet 220 200 420 160
31 Diazepam tablet 2 mg tablet
32 Digoksin tablet 0,25 mg tablet
33 Domperidon tablet 10 mg tablet 70 70
34 Doxycyklin 100 mg tablet capsul
35 Efedrina HCl. tablet 25 mg tablet
36 Ergotamin Caffein tablet tablet
37 Eritromisin kapsul 250 mg tablet
38 Eritromisin kapsul 500 mg tablet
39 Fenobarbital tablet 30 mg tablet
40 Fenofibrate 100 mg tablet
41 Fitomenadion (Vit. K) tablet salut 10 mg tablet
42 Fluoxetin 20mg (NOPRES) tablet
43 Furosemida tablet 40 mg tablet
44 Garam Oralit untuk 200 ml air Sachet 90 90 50
45 Gemfibrozil 150 mg tablet
46 Glibenklamida tablet 5 mg tablet 240 240 10
47 Glimepiride tablet 1 mg tablet
48 Glimepiride tablet 2 mg tablet
49 Griseofulvin tablet 125 mg Mikronized tablet
50 Guaifenisin tablet tablet
51 Haloperidol tablet 1,5 mg tablet
52 Haloperidol tablet 5 mg tablet
53 Hidroklortiazide (HCT) tablet 25 mg tablet
54 Hyoscine N Butilbromide/ SCOPMA tablet 100 100 50
55 Ibuprofen tablet 200 mg tablet
56 Ibuprofen tablet 400 mg tablet
57 Isoniazid ( INH ) + Pyridoxin (B6) tablet
58 Isoniazid ( INH ) 100mg tablet
59 Isosorbid Dinitrat Sub Lingual tablet 5 m tablet
60 Kalsium Laktat tablet 500 mg tablet 120 120
61 Karbamazepin 200 mg tablet
62 Ketokonazole tablet 200 mg tablet
63 Klindamycin 150 mg tablet
64 Klindamycin 300 mg capsul
65 Kloramfenikol kapsul 250 mg tablet
66 Kloramfenikol kapsul 500 mg tablet 160 160
67 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 100 200 300 120
68 Klorpromazina tablet 100 mg tablet
69 KOMBIPAK (Azythromycin + Cefixime ) tablet
70 Kotrimoksazol dewasa tablet tablet 80 80
71 Kuinin ( Kina ) tablet 200 mg tablet
72 Loperamide 2mg tab tablet
73 Loratadin 10mg tablet
74 Lorazepam 1 mg (RENAQUIL 1mg) tablet
75 Metformin HCL 500 mg tablet tablet 190 190 10
76 Metilergometrin Maleat tablet 0,125 mg tablet
77 Metilprednisolon 4 mg tablet
78 metocloperamide tab 5 mg tablet
79 Metoclopramide 10 mg tablet 150 150 30
80 Metronidazol tablet 500 mg tablet 100 100 80
81 Mineral Mix Sachet Sachet
82 Misoprotol tab 200 mcg tablet
83 Na diklofenak 25mg tablet
84 Na diklofenak 50mg tablet 70 200 270 80
85 Nifedipin tablet tablet
86 Nistatin tablet salut 500.000 IU tablet
87 Obat Anti Tuberkulosis FDC kategori 1/3 paket
88 Obat Anti Tuberkulosis FDC kategori 2 paket
89 Obat Anti Tuberkulosis FDC kategori ana paket
90 Obat Anti Tuberkulosis KDT Harian paket
91 Omeprazole kapsul kapsul
92 Oseltamivir tablet
93 Parasetamol tablet 500 mg tablet 120 200 320 220
94 Phenytoin 100 mg capsul
95 Piridoksina HCl. tablet 10 mg tablet 100 100
96 Prednison tablet 5 mg tablet
97 Primakuin tablet 15 mg tablet
98 Propiltiourasil tablet 100 mg tablet
99 Ranitidin tablet 150 mg tablet 90 90 60
100 Retinol (Vitamin A) kapsul 100.000 IU capsul
101 Retinol (Vitamin A) kapsul 200.000 IU capsul
102 Risperidon 2 mg tablet tablet
103 Salbutamol tablet 2 mg tablet
104 Salbutamol tablet 4 mg tablet 240 240
105 Simvastatin 10mg tablet 90 90 90
106 Sivit zink tablet tablet
107 Spironolakston 25 mg tablet
108 Striatamin cap capsul
109 Tablet Tambah Darah kombinasi tablet 150 150
110 Tetrasiklina HCl. kapsul 500 mg capsul
111 Tiamine HCl. Mononitrat (Vit. B-1) tablet tablet 240 240 160
112 Trifluoperazine 6 mg tablet
113 Triheksifenidil HCl. tablet 2 mg tablet
114 Valproat tab sal 250 mg (Depakote ER) botol
115 Vitamin B Komplek tablet tablet 280 100 380 130
116 Zinc tablet 20 mg botol 80 80 50
Syrup/ Suspensi
117 Ambroxol sirup 15mg/ml botol 4 4 1
118 Amoksisilina sirup kering 125 mg/ 5ml botol 6 6 4
119 Amoksisilina sirup kering 250 mg/ 5ml botol
120 Amoxicillin drop botol
121 Antasida DOEN suspensi botol 6 6 6
122 Cefadroxil sirup 125mg/ml botol
123 Domperidon syrup botol
124 Eritromisin Syrup Kering 200mg/5ml botol
125 Ibuprofen sirup 100mg/5ml botol
126 Kloramfenikol suspensi 125mg/5 ml botol
127 Kotrimoksazol suspensi botol 1 5 6 1
128 Multivitamin dan mineral (caviplex) syr botol
129 Parasetamol drop 100 mg/ml @ 15 ml botol
130 Parasetamol sirup 120 mg / 5 ml botol 6 6 5
131 Setirizin sir 5 mg/5 ml. botol
132 Valproat syrup 250 mg/ml botol
133 Zinc sir 20 mg/5 ml botol
Injeksi
134 ACT injeksi ampul
135 Aminofilina injeksi 24 mg / ml-10ml ampul
136 Ampisilina injeksi Ampul
137 Aqua Pro injeksi steril bebas pirogen ampul
138 Asam Tranexamat 500mg/5 ml injeksi ampul
139 Atropin Sulfat injeksi 0,25 mg / ml-1 ml ampul
140 Calsium Glukonas Inj ampul
141 Deksametason inj. 5 mg /ml-1 ml Ampul 5 5
142 Diazepam injeksi 5 mg/ ml- 2 ml ampul
143 Difenhidramina injeksi 10 mg/ ml- 1 ml ampul
144 Epinefrin injeksi 0,1 % - 1 ml ampul
145 Fenobarbital injeksi 50 mg / ml-1 ml ampul
146 Fitomenadion (Vit. K) injeksi 10 mg / ml- ampul
147 Haloperidol injeksi 5mg/ml (LODOMER 5) ampul
148 Ketorolac Inj 30 mg/ml ampul
149 Kloramfenikol injeksi Ampul
150 Lidokain 2% injeksi (tunggal) ampul 1 1 1
151 Lidokain Kompositum injeksi ampul
152 Magnesium Sulfat injeksiI (IV) 20 %-25 m Vial
153 Magnesium Sulfat injeksiI (IV) 40 %-25 m Vial
154 Metilergometrin Maleat injeksi 0,2 mg / m Ampul
155 Metocloperamide inj Ampul .5 5 1
156 Nebules kombinasi : ipatropium br 0.5 Vial
157 Oksitosin injeksi 10 IU / ml - 1 ml ampul
158 Omeprazole 40mg/10 ml injeksi Vial
159 Prokain Benzil Penisilin inj 3jt IU Vial
160 Ranitidine injeksi Pot
161 Sabu Polivalen 5 ml (ABU I) Vial
162 Salbutamol Inj 1 mg/ml Vial
163 Serum Anti Tetanus injeksi 1.500 IU / am ampul
164 Sianokobalamin (Vit. B 12) injeksi 500 m ampul
Obat Luar
165 Acyclovir krim 5% tube
166 Antibakteri DOEN salep kombinasi tube
167 Antifungi DOEN kombinasi tube
168 Antihemaroid DOEN kombinasi suppo
169 Betametason krim 0,1 % tube
170 Borax Glycerin botol
171 Calamin (Caladin) lotion 60 ml botol 5 5 1
172 Diazepam rectal tube 5 mg (stesolid recta tube
173 Diazepam rectal tube 10mg (stesolid rect tube
174 Dulcolax 5mg supp (anak) suppo 6 6
175 Dulcolax 10mg supp (Dewasa) suppo
176 Etakridina (Rivanol) larutan 0,1 % botol
177 Etanol 70 % botol
178 Fenolgliserol tetes telinga 10 % botol
179 Gentamicin salep mata (GENOINT) 0,3 % tube
180 Gentamicin tetes mata 0,3 % botol
181 Hidrokortison krim 2,5 % tube 4 4 4
182 Ketokonazole cream 2% tube
183 Kloramfenikol salep kulit 2% (BUFACETIN tube
184 Kloramfenikol salep mata 1 % tube 5 5 2
185 Kloramfenikol tetes mata 0,5 % botol
186 Kloramfenikol tetes telinga 3 % botol 3 3
187 Miconazol krim tube 9 9 5
188 Oksitetrasiklin salep mata 1 % tube 6 6 1
189 Parasetamol / Pamol suppo 125mg suppo 10 10
190 Perhidrol ( Lar H2O2 ) tube
191 Povidon Iodida 10 % , 30 ml botol
192 Povidon Iodida 10 % , 60 ml botol
193 Povidon Iodida 10 % , 300 ml botol 1 1
194 Salep 2-4 Kombinasi Pot
195 Salisil Bedak 2 % botol 7 7
196 Scabicid/Scabimid cream tube
197 Silver sulfadiazin Cream 1% 35 gr tube
Infus dan Cairan
198 Cairan Untuk Irigasi 1000 ml Flash
199 Glukosa infus 5 % Flash
200 Glukosa infus 10 % Flash
201 Glukosa infus 40 % Flash
202 Natrium Klorida infus 0,9 % 500 ml Flash 3 3 1
203 Prontosan Wound Irrigation sol 350ml botol
204 Ringer Laktat larutan infus steril Flash
Bahan Medis Habis Pakai
205 Alat Suntik sekali pakai 1 ml Set
206 Alat Suntik sekali pakai 3 ml Set 18 18 12
207 Alat Suntik sekali pakai 5 ml Set 15 15 8
208 Catgut / Benang Bedah No. 2/0 24x70 cm
209 Catgut / Benang Bedah No. 3/0 24x70 cm
210 Cover Glass 20x20 set
211 Dermafix S IV set
212 Feeding Tube 40cm No. 8 set
213 Foley cathether No. 16 set
214 Foley cathether No. 18 set
215 Foley cathether No. 20 set
216 Gown set botol
217 Hand Rub 500ml botol
218 Hand Scrub 500ml botol
219 Handrub refill 5 liter galon
220 Hazmat Size L set
221 Hazmat Size XL set
222 Infusion Set anak-anak set
223 Infusion Set dewasa set
224 IV Cathether No. 18 G set
225 IV Cathether No. 20 G set
226 IV Cathether No. 22 G set
227 IV Cathether No. 24 G set
228 Jarum hecting kombinasi set
229 Jelly Dopler botol
230 Kapas Pembalut / Adsorben 250 gram rol
231 Kasa Pembalut 40 yd x 110 cm rol
232 Kasa Pembalut 4x10 cm rol
233 Kasa Pembalut 4x15 cm rol
234 Kertas EKG 58mm x 25 m rol
235 Kertas EKG 58mm X 30 m rol
236 Kertas EKG 63mm X 30 m rol
237 Kertas EKG 80mm x 20 m rol
238 Lokal kacamata faceshield set
239 Masker Bedah Anak pcs
240 Masker KN 95 pcs
241 Masker N 95 pcs
242 Masker Oxygen (Maxiflow) Anak (Pediatrik) set
243 Masker Oxygen (Maxiflow) Dewasa (Adult) set
244 Masker surgical pcs 18 20 38 23
245 Masker surgical Anak pcs
246 Object Glass 20x20 mm pack
247 Oxygen Nasal Adult (Dewasa) set
248 Oxygen Nasal NewNates set
249 Oxygen Nasal Pediatric set
250 Pembalut gibs rol
251 Plester 5 yard x 2 inchi (plester coklat) rol
252 Plester Kertas 1" (surgical tape) rol
253 Regulator Oksigen set
254 Sarung tangan steril no.6,5 pasang
255 Sarung tangan steril NO.7 pasang
256 Sarung tangan steril NO.7,5 pasang
257 Sarung tangan non steril uk L pasang
258 Sarung tangan non steril uk.M pasang 20 20 8
259 Sarung tangan obgin No. 6,5 pasang
260 Sarung tangan obgin No. 7 pasang
261 Sarung tangan obgin No. 7,5 pasang
262 Sarung tangan obgyn no. 8 pasang
263 Silk 2/0 + 1/2 GT 35MM set
264 Silk 3/0 + 1/2 GT 35MM set 33 34 1
265 Solida Nurse Cap set
266 Surgical mess 11 pack
267 Surgical mess 20 pack
268 Transparent IV Dressing (with notch) set
269 Umbilical cord klem set
270 Urine bag set
271 Wing Neddle No 21 G set
272 Wing Neddle No 23 G set
273 Wing Neddle No 25 G set
Bahan Gigi
274 Air Raksa dental use 100 gram
275 Cavit botol
276 Cresophene botol
277 Etil klorida semprot 100 ml
278 Euginol cairan dus 12 btl
279 Glass Ionomer cement (GC IX) A2-A3 set
280 Jarum exterpatie set
281 Jarum reaming file set
282 Kalsium Hidroksida pasta 2 tube
283 Klorfenol Kamper Menthol ( CHKM ) 10 ml
284 Mummifying pasta botol
285 Non Arsen Septodont Rapid botol
286 Semen Seng Pospat serbuk dan cairan set @ 30 gr
287 Silver Amalgam 1 oz
288 Spon Gelatin Cubicles 1 x 1 x 1 cm 24 buah
289 Tambalan komposit-solare X (A2-A3) Set
290 Temperory Stoping Fletcher serbuk & cair set @ 100 gr
Tambahan
291 Cetirizine tab tablet 100 100
292 Alkohol swab pack
293 Kasa hidrofil steril pack
294 Klip sheet
295 Kertas Puyer sheet

Yang Memberikan,
Pengelola Obat Puskesmas

Nisa' Amila Rodhiya, S.Farm

ERMINTAAN OBAT (LPLPO)
PELAPORAN BULAN: Mei
PENERIMAAN BULAN:Juni

STOK EXPIRED DATE/

SISA STOK PERMINTAAN PEMBERIAN NO. BATCH
OPTIMUM KETERANGAN

130 120

100

200

200

40 100
240 300
300 100
120 200

250 200

200

30 60
70
200

200

90 100
260 200

70
40

230

200

50 200

200

120

160 Jun-22
180 200

80

100
200

180

200

120
20 200
190 200

100

100 400

100

30 200

240
200

150

80 200

250 100
30

3 3
2 5

5 5
1 5

5
5

4
6

3
4
5 5 May-22
10

7
10

6 20
7 20
 1

15 20

12

33
 100

200
200

Yang Memberikan, Yang Menerima,

Pengelola Obat Puskesmas Pengelola Obat Unit

Nisa' Amila Rodhiya, S.Farm., Apt Ns. Baiq Retno ,S.Kep

 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO
NO :
NAMA PUSKESMAS : PRINGGARATA
NAMA UNIT : PUSTU PEMEPEK
PENGELOLA OBAT : Ns. BAIQ RETNO, S.Kep

No. Nama Obat Satuan STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN

Tablet/Kapsul/Sachet
1 ACT tablet tablet
2 Acetyl Cystein 200mg tablet 130 0 130 50
3 Acyclovir 200 mg tablet tablet
4 Acyclovir 400 mg tablet tablet 100 100 -
5 Albendazol tablet 400 mg tablet
6 Alopurinol tablet 100 mg tablet 100 100 -
7 Alprazolam 0,5 mg tablet tablet
8 Alprazolam 1 mg tablet
9 Ambroxol tablet tablet 0
10 Aminofilina tablet 200 mg tablet
11 Amitriptilina tablet 25 mg tablet
12 Amlodipin 5 mg tablet
13 Amlodipin 10 mg tablet 40 100 140 70
14 Amoksisilina kapsul 500 mg tablet 240 200 440 280
15 Antasida DOEN tablet tablet 300 100 400 100
0 Asam Askorbat (Vit. C) tablet 50 mg tablet 120 200 320 110
17 Asam Folat tab tablet
18 Asam Mefenamat tablet 500 mg tablet 250 200 450 180
19 Asam Tranexamat 500mg tablet
20 Asetosal 80mg (MINIASPI) tablet
21 Attalpulgite 600mg - New Antides tablet 0
22 Azithromycin 500 mg tab tablet
23 Betahistin 6mg tablet 30 60 90 40
24 Captopril 12,5 mg tablet 70 70 40
25 Captopril tablet 25 mg tablet 200 200 -
26 Captopril tablet 50 mg tablet
27 Cefadroxil 500 mg tablet 0
28 Clozapine 25mg tablet
29 Cyproploxasin tablet tablet 90 0 90 90
30 Deksametason tablet 0,5 mg tablet 260 200 460 160
31 Diazepam tablet 2 mg tablet
32 Digoksin tablet 0,25 mg tablet
33 Domperidon tablet 10 mg tablet 70 70 -
34 Doxycyklin 100 mg tablet capsul
35 Efedrina HCl. tablet 25 mg tablet
36 Ergotamin Caffein tablet tablet
37 Eritromisin kapsul 250 mg tablet
38 Eritromisin kapsul 500 mg tablet
39 Fenobarbital tablet 30 mg tablet
40 Fenofibrate 100 mg tablet
41 Fitomenadion (Vit. K) tablet salut 10 mg tablet
42 Fluoxetin 20mg (NOPRES) tablet
43 Furosemida tablet 40 mg tablet
44 Garam Oralit untuk 200 ml air Sachet 40 40 40
45 Gemfibrozil 150 mg tablet
46 Glibenklamida tablet 5 mg tablet 230 230 100
47 Glimepiride tablet 1 mg tablet
48 Glimepiride tablet 2 mg tablet
49 Griseofulvin tablet 125 mg Mikronized tablet
50 Guaifenisin tablet tablet 0
51 Haloperidol tablet 1,5 mg tablet
52 Haloperidol tablet 5 mg tablet
53 Hidroklortiazide (HCT) tablet 25 mg tablet
54 Hyoscine N Butilbromide/ SCOPMA tablet 50 100 150 50
55 Ibuprofen tablet 200 mg tablet
56 Ibuprofen tablet 400 mg tablet 200 200 50
57 Isoniazid ( INH ) + Pyridoxin (B6) tablet
58 Isoniazid ( INH ) 100mg tablet
59 Isosorbid Dinitrat Sub Lingual tablet 5 mg tablet
60 Kalsium Laktat tablet 500 mg tablet 120 120 -
61 Karbamazepin 200 mg tablet
62 Ketokonazole tablet 200 mg tablet
63 Klindamycin 150 mg tablet
64 Klindamycin 300 mg capsul
65 Kloramfenikol kapsul 250 mg tablet
66 Kloramfenikol kapsul 500 mg tablet 160 160
67 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 180 200 380 120
68 Klorpromazina tablet 100 mg tablet
69 KOMBIPAK (Azythromycin + Cefixime ) tablet
70 Kotrimoksazol dewasa tablet tablet 80 80 -
71 Kuinin ( Kina ) tablet 200 mg tablet
72 Loperamide 2mg tab tablet 0
73 Loratadin 10mg tablet 100 100 -
74 Lorazepam 1 mg (RENAQUIL 1mg) tablet
75 Metformin HCL 500 mg tablet tablet 180 180 40
76 Metilergometrin Maleat tablet 0,125 mg tablet
77 Metilprednisolon 4 mg tablet 200 200 10
78 metocloperamide tab 5 mg tablet
79 Metoclopramide 10 mg tablet 120 120 20
80 Metronidazol tablet 500 mg tablet 20 200 220 80
81 Mineral Mix Sachet Sachet
82 Misoprotol tab 200 mcg tablet
83 Na diklofenak 25mg tablet
84 Na diklofenak 50mg tablet 190 200 390 60
85 Nifedipin tablet tablet
86 Nistatin tablet salut 500.000 IU tablet
87 Obat Anti Tuberkulosis FDC kategori 1/3 paket
88 Obat Anti Tuberkulosis FDC kategori 2 paket
89 Obat Anti Tuberkulosis FDC kategori anak paket
90 Obat Anti Tuberkulosis KDT Harian paket
91 Omeprazole kapsul kapsul 0
92 Oseltamivir tablet
93 Parasetamol tablet 500 mg tablet 100 300 400 150
94 Phenytoin 100 mg capsul
95 Piridoksina HCl. tablet 10 mg tablet 100 100 50
96 Prednison tablet 5 mg tablet
97 Primakuin tablet 15 mg tablet
98 Propiltiourasil tablet 100 mg tablet
99 Ranitidin tablet 150 mg tablet 30 100 130 30
100 Retinol (Vitamin A) kapsul 100.000 IU capsul
101 Retinol (Vitamin A) kapsul 200.000 IU capsul
102 Risperidon 2 mg tablet tablet
103 Salbutamol tablet 2 mg tablet
104 Salbutamol tablet 4 mg tablet 240 240 110
105 Simvastatin 10mg tablet 0
106 Sivit zink tablet tablet
107 Spironolakston 25 mg tablet
108 Striatamin cap capsul
109 Tablet Tambah Darah kombinasi tablet 150 150 70
110 Tetrasiklina HCl. kapsul 500 mg capsul
111 Tiamine HCl. Mononitrat (Vit. B-1) tablet 50 tablet 80 200 280 80
112 Trifluoperazine 6 mg tablet
113 Triheksifenidil HCl. tablet 2 mg tablet
114 Valproat tab sal 250 mg (Depakote ER) botol
115 Vitamin B Komplek tablet tablet 250 100 350 150
116 Zinc tablet 20 mg botol 30 30 10
Syrup/ Suspensi
117 Ambroxol sirup 15mg/ml botol 3 3 6 2
118 Amoksisilina sirup kering 125 mg/ 5ml botol 2 0 2 1
119 Amoksisilina sirup kering 250 mg/ 5ml botol
120 Amoxicillin drop botol
121 Antasida DOEN suspensi botol 5 5 2
122 Cefadroxil sirup 125mg/ml botol
123 Domperidon syrup botol
124 Eritromisin Syrup Kering 200mg/5ml botol
125 Ibuprofen sirup 100mg/5ml botol
126 Kloramfenikol suspensi 125mg/5 ml botol
127 Kotrimoksazol suspensi botol 5 5 10 2
128 Multivitamin dan mineral (caviplex) syr botol
129 Parasetamol drop 100 mg/ml @ 15 ml botol
130 Parasetamol sirup 120 mg / 5 ml botol 1 5 6 2
131 Setirizin sir 5 mg/5 ml. botol
132 Valproat syrup 250 mg/ml botol
133 Zinc sir 20 mg/5 ml botol
Injeksi
134 ACT injeksi ampul
135 Aminofilina injeksi 24 mg / ml-10ml ampul
136 Ampisilina injeksi Ampul
137 Aqua Pro injeksi steril bebas pirogen ampul
138 Asam Tranexamat 500mg/5 ml injeksi ampul
139 Atropin Sulfat injeksi 0,25 mg / ml-1 ml ampul
140 Calsium Glukonas Inj ampul
141 Deksametason inj. 5 mg /ml-1 ml Ampul 5 5 -
142 Diazepam injeksi 5 mg/ ml- 2 ml ampul
143 Difenhidramina injeksi 10 mg/ ml- 1 ml ampul
144 Epinefrin injeksi 0,1 % - 1 ml ampul
145 Fenobarbital injeksi 50 mg / ml-1 ml ampul
146 Fitomenadion (Vit. K) injeksi 10 mg / ml-1 ml ampul
147 Haloperidol injeksi 5mg/ml (LODOMER 5) ampul
148 Ketorolac Inj 30 mg/ml ampul
149 Kloramfenikol injeksi Ampul
150 Lidokain 2% injeksi (tunggal) ampul 5 5 -
151 Lidokain Kompositum injeksi ampul
152 Magnesium Sulfat injeksiI (IV) 20 %-25 ml Vial
153 Magnesium Sulfat injeksiI (IV) 40 %-25 ml Vial
154 Metilergometrin Maleat injeksi 0,2 mg / ml Ampul
155 Metocloperamide inj Ampul 4 4 4
156 Nebules kombinasi : ipatropium br 0.5 mg+ Vial
157 Oksitosin injeksi 10 IU / ml - 1 ml ampul
158 Omeprazole 40mg/10 ml injeksi Vial
159 Prokain Benzil Penisilin inj 3jt IU Vial
160 Ranitidine injeksi Pot
161 Sabu Polivalen 5 ml (ABU I) Vial
162 Salbutamol Inj 1 mg/ml Vial
163 Serum Anti Tetanus injeksi 1.500 IU / ampul ampul
164 Sianokobalamin (Vit. B 12) injeksi 500 mcg / ampul
Obat Luar
165 Acyclovir krim 5% tube 0
166 Antibakteri DOEN salep kombinasi tube 5 5 1
167 Antifungi DOEN kombinasi tube
168 Antihemaroid DOEN kombinasi suppo 0
169 Betametason krim 0,1 % tube
170 Borax Glycerin botol
171 Calamin (Caladin) lotion 60 ml botol 4 4 1
172 Diazepam rectal tube 5 mg (stesolid rectal) tube
173 Diazepam rectal tube 10mg (stesolid rectal) tube
174 Dulcolax 5mg supp (anak) suppo 6 6
175 Dulcolax 10mg supp (Dewasa) suppo
176 Etakridina (Rivanol) larutan 0,1 % botol
177 Etanol 70 % botol
178 Fenolgliserol tetes telinga 10 % botol
179 Gentamicin salep mata (GENOINT) 0,3 % tube
180 Gentamicin tetes mata 0,3 % botol
181 Hidrokortison krim 2,5 % tube 0
182 Ketokonazole cream 2% tube
183 Kloramfenikol salep kulit 2% (BUFACETIN) tube
184 Kloramfenikol salep mata 1 % tube 3 3 2
185 Kloramfenikol tetes mata 0,5 % botol
186 Kloramfenikol tetes telinga 3 % botol 3 3 1
187 Miconazol krim tube 4 4 2
188 Oksitetrasiklin salep mata 1 % tube 5 0 5 -
189 Parasetamol / Pamol suppo 125mg suppo 10 10 2
190 Perhidrol ( Lar H2O2 ) tube
191 Povidon Iodida 10 % , 30 ml botol
192 Povidon Iodida 10 % , 60 ml botol
193 Povidon Iodida 10 % , 300 ml botol 1 1 -
194 Salep 2-4 Kombinasi Pot
195 Salisil Bedak 2 % botol 7 7 2
196 Scabicid/Scabimid cream tube 0
197 Silver sulfadiazin Cream 1% 35 gr tube
Infus dan Cairan
198 Cairan Untuk Irigasi 1000 ml Flash
199 Glukosa infus 5 % Flash
200 Glukosa infus 10 % Flash
201 Glukosa infus 40 % Flash
202 Natrium Klorida infus 0,9 % 500 ml Flash 2 2 4 1
203 Prontosan Wound Irrigation sol 350ml botol 3 3 1
204 Ringer Laktat larutan infus steril Flash
Bahan Medis Habis Pakai
205 Alat Suntik sekali pakai 1 ml Set
206 Alat Suntik sekali pakai 3 ml Set 6 20 26 6
207 Alat Suntik sekali pakai 5 ml Set 7 20 27 2
208 Catgut / Benang Bedah No. 2/0 24x70 cm
209 Catgut / Benang Bedah No. 3/0 24x70 cm
210 Cover Glass 20x20 set
211 Dermafix S IV set
212 Feeding Tube 40cm No. 8 set
213 Foley cathether No. 16 set
214 Foley cathether No. 18 set
215 Foley cathether No. 20 set
216 Gown set botol
217 Hand Rub 500ml botol
218 Hand Scrub 500ml botol
219 Handrub refill 5 liter galon
220 Hazmat Size L set
221 Hazmat Size XL set
222 Infusion Set anak-anak set
223 Infusion Set dewasa set
224 IV Cathether No. 18 G set
225 IV Cathether No. 20 G set
226 IV Cathether No. 22 G set
227 IV Cathether No. 24 G set
228 Jarum hecting kombinasi set
229 Jelly Dopler botol
230 Kapas Pembalut / Adsorben 250 gram rol
231 Kasa Pembalut 40 yd x 110 cm rol 0
232 Kasa Pembalut 4x10 cm rol
233 Kasa Pembalut 4x15 cm rol
234 Kertas EKG 58mm x 25 m rol
235 Kertas EKG 58mm X 30 m rol
236 Kertas EKG 63mm X 30 m rol
237 Kertas EKG 80mm x 20 m rol
238 Lokal kacamata faceshield set
239 Masker Bedah Anak pcs
240 Masker KN 95 pcs
241 Masker N 95 pcs
242 Masker Oxygen (Maxiflow) Anak (Pediatrik) set
243 Masker Oxygen (Maxiflow) Dewasa (Adult) set
244 Masker surgical pcs 15 50 65 15
245 Masker surgical Anak pcs
246 Object Glass 20x20 mm pack
247 Oxygen Nasal Adult (Dewasa) set
248 Oxygen Nasal NewNates set
249 Oxygen Nasal Pediatric set
250 Pembalut gibs rol
251 Plester 5 yard x 2 inchi (plester coklat) rol 2 2
252 Plester Kertas 1" (surgical tape) rol
253 Regulator Oksigen set
254 Sarung tangan steril no.6,5 pasang
255 Sarung tangan steril NO.7 pasang
256 Sarung tangan steril NO.7,5 pasang
257 Sarung tangan non steril uk L pasang
258 Sarung tangan non steril uk.M pasang 12 12 -
259 Sarung tangan obgin No. 6,5 pasang
260 Sarung tangan obgin No. 7 pasang
261 Sarung tangan obgin No. 7,5 pasang
262 Sarung tangan obgyn no. 8 pasang
263 Silk 2/0 + 1/2 GT 35MM set
264 Silk 3/0 + 1/2 GT 35MM set 33 33 1
265 Solida Nurse Cap set
266 Surgical mess 11 pack
267 Surgical mess 20 pack
268 Transparent IV Dressing (with notch) set
269 Umbilical cord klem set
270 Urine bag set
271 Wing Neddle No 21 G set
272 Wing Neddle No 23 G set
273 Wing Neddle No 25 G set
Tambahan
274 Cetirizine tab tablet 100 100 -
275 Alkohol swab pack
276 Kasa hidrofil steril pack
277 Klip sheet 0 -
278 Kertas Puyer sheet 0

Yang Memberikan,
Pengelola Obat Puskesmas

Nisa' Amila Rodhiya, S.Farm.

RMINTAAN OBAT (LPLPO)
PELAPORAN BULAN : Juni
PENERIMAAN BULAN : Juli

EXPIRED
STOK
SISA STOK PERMINTAAN PEMBERIAN NO. BATCH DATE/
OPTIMUM
KETERANGAN

80 100

100

100

70 100
160 300
300
210

270 200

200

50 90
30
200 100

200

- 200
300 200

70
 - 100

130

100 200

150 200

120

160 100 Jun-22

260 200

80 100

100
100

140
190 200

100 200
140 100

330

200

250 300

50 100
100

100 100

130 100
200

80 100

200 200

200 200
20 100

4
1 5
3 5

4 5

10

- 10

10
4 5

3 5

1 5

2
2 5
5 May-22
8

1
3
2

20 10
25

50
 2

10

32

100

1
200
200

Yang Memberikan, Yang Menerima,

Pengelola Obat Puskesmas Pengelola Obat Unit

Nisa' Amila Rodhiya, S.Farm., Apt Ns. Baiq Retno ,S.Kep

 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
NO : PELAPORAN BULAN : Juli
NAMA PUSKESMAS : PRINGGARATA PENERIMAAN BULAN : A: Agustus
NAMA UNIT : PUSTU PEMEPEK
PENGELOLA OBAT : Ns. BAIQ RETNO, S.Kep

EXPIRED
STOK
No. Nama Obat Satuan STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
OPTIMUM
PERMINTAAN PEMBERIAN NO. BATCH DATE/
KETERANGAN
Tablet/Kapsul/Sachet
1 ACT tablet tablet
2 Acetyl Cystein 200mg tablet 80 60 140 110 30 60
3 Acyclovir 200 mg tablet tablet
4 Acyclovir 400 mg tablet tablet 100 100 - 100
5 Albendazol tablet 400 mg tablet
6 Alopurinol tablet 100 mg tablet 100 0 100 100 - 100
7 Alprazolam 0,5 mg tablet tablet
8 Alprazolam 1 mg tablet
9 Ambroxol tablet tablet 0
10 Aminofilina tablet 200 mg tablet
11 Amitriptilina tablet 25 mg tablet
12 Amlodipin 5 mg tablet 100
13 Amlodipin 10 mg tablet 70 0 70 - -
14 Amoksisilina kapsul 500 mg tablet 160 200 360 360 - 300
15 Antasida DOEN tablet tablet 300 0 300 200 100 100
0 Asam Askorbat (Vit. C) tablet 50 mg tablet 210 0 210 160 50 100
17 Asam Folat tab tablet
18 Asam Mefenamat tablet 500 mg tablet 270 200 470 400 70 200
19 Asam Tranexamat 500mg tablet
20 Asetosal 80mg (MINIASPI) tablet
21 Attalpulgite 600mg - New Antides tablet 100 100 50 50 100
22 Azithromycin 500 mg tab tablet
23 Betahistin 6mg tablet 50 90 140 80 60 90
24 Captopril 12,5 mg tablet 200 100 300 150 150
25 Captopril tablet 25 mg tablet 100
26 Captopril tablet 50 mg tablet
27 Cefadroxil 500 mg tablet 0
28 Clozapine 25mg tablet
29 Cyproploxasin tablet tablet - 100 100 80 20 100
30 Deksametason tablet 0,5 mg tablet 300 100 400 300 100 300
31 Diazepam tablet 2 mg tablet
32 Digoksin tablet 0,25 mg tablet
33 Domperidon tablet 10 mg tablet 70 70 70 - 100
34 Doxycyklin 100 mg tablet capsul
35 Efedrina HCl. tablet 25 mg tablet
36 Ergotamin Caffein tablet tablet
37 Eritromisin kapsul 250 mg tablet
38 Eritromisin kapsul 500 mg tablet
39 Fenobarbital tablet 30 mg tablet
40 Fenofibrate 100 mg tablet
41 Fitomenadion (Vit. K) tablet salut 10 mg tablet
42 Fluoxetin 20mg (NOPRES) tablet
43 Furosemida tablet 40 mg tablet
44 Garam Oralit untuk 200 ml air Sachet - 25 25 25 - 100
45 Gemfibrozil 150 mg tablet
46 Glibenklamida tablet 5 mg tablet 130 130 30 100
47 Glimepiride tablet 1 mg tablet
48 Glimepiride tablet 2 mg tablet
49 Griseofulvin tablet 125 mg Mikronized tablet
50 Guaifenisin tablet tablet 0
51 Haloperidol tablet 1,5 mg tablet
52 Haloperidol tablet 5 mg tablet
53 Hidroklortiazide (HCT) tablet 25 mg tablet
54 Hyoscine N Butilbromide/ SCOPMA tablet 100 0 100 100 - 200
55 Ibuprofen tablet 200 mg tablet
56 Ibuprofen tablet 400 mg tablet 150 200 350 300 50 200
57 Isoniazid ( INH ) + Pyridoxin (B6) tablet
58 Isoniazid ( INH ) 100mg tablet
59 Isosorbid Dinitrat Sub Lingual tablet 5 mg tablet
60 Kalsium Laktat tablet 500 mg tablet 120 120 20 100
61 Karbamazepin 200 mg tablet
62 Ketokonazole tablet 200 mg tablet
63 Klindamycin 150 mg tablet
64 Klindamycin 300 mg capsul
65 Kloramfenikol kapsul 250 mg tablet 100 100 20 80 100
66 Kloramfenikol kapsul 500 mg tablet - 0 - - Jun-22
67 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 200 200 400 200 200 200
68 Klorpromazina tablet 100 mg tablet
69 KOMBIPAK (Azythromycin + Cefixime ) tablet
70 Kotrimoksazol dewasa tablet tablet 80 100 180 80 100 200
71 Kuinin ( Kina ) tablet 200 mg tablet
72 Loperamide 2mg tab tablet 100 100 50 50 100
73 Loratadin 10mg tablet 100 100 200 110 90 100
74 Lorazepam 1 mg (RENAQUIL 1mg) tablet
75 Metformin HCL 500 mg tablet tablet 140 140 100 40 100
76 Metilergometrin Maleat tablet 0,125 mg tablet
77 Metilprednisolon 4 mg tablet 190 0 190 140 50 200
78 metocloperamide tab 5 mg tablet
79 Metoclopramide 10 mg tablet 100 100 200 110 90 200
80 Metronidazol tablet 500 mg tablet 140 100 240 160 80 100
81 Mineral Mix Sachet Sachet
82 Misoprotol tab 200 mcg tablet
83 Na diklofenak 25mg tablet
84 Na diklofenak 50mg tablet 330 0 330 230 100 100
85 Nifedipin tablet tablet
86 Nistatin tablet salut 500.000 IU tablet
87 Obat Anti Tuberkulosis FDC kategori 1/3 paket
88 Obat Anti Tuberkulosis FDC kategori 2 paket
89 Obat Anti Tuberkulosis FDC kategori anak paket
90 Obat Anti Tuberkulosis KDT Harian paket
91 Omeprazole kapsul kapsul 100 100 50 50 100
92 Oseltamivir tablet
93 Parasetamol tablet 500 mg tablet 250 200 450 370 80 300
94 Phenytoin 100 mg capsul
95 Piridoksina HCl. tablet 10 mg tablet 50 100 150 100 50
96 Prednison tablet 5 mg tablet 0 100
97 Primakuin tablet 15 mg tablet
98 Propiltiourasil tablet 100 mg tablet
99 Ranitidin tablet 150 mg tablet 100 0 100 100 - 200
100 Retinol (Vitamin A) kapsul 100.000 IU capsul
101 Retinol (Vitamin A) kapsul 200.000 IU capsul
102 Risperidon 2 mg tablet tablet
103 Salbutamol tablet 2 mg tablet 130 100 230 150 80
104 Salbutamol tablet 4 mg tablet 100
105 Simvastatin 10mg tablet 100 100 60 40 100
106 Sivit zink tablet tablet
107 Spironolakston 25 mg tablet
108 Striatamin cap capsul
109 Tablet Tambah Darah kombinasi tablet 80 90 150 100 50 100
110 Tetrasiklina HCl. kapsul 500 mg capsul
111 Tiamine HCl. Mononitrat (Vit. B-1) tablet 50 tablet 200 200 400 340 60 200
112 Trifluoperazine 6 mg tablet
113 Triheksifenidil HCl. tablet 2 mg tablet
114 Valproat tab sal 250 mg (Depakote ER) botol
115 Vitamin B Komplek tablet tablet 200 200 400 330 70 200
116 Zinc tablet 20 mg botol 20 100 120 40 80
Syrup/ Suspensi
117 Ambroxol sirup 15mg/ml botol 4 0 4 - 4 5
118 Amoksisilina sirup kering 125 mg/ 5ml botol 1 5 6 1 5
119 Amoksisilina sirup kering 250 mg/ 5ml botol
120 Amoxicillin drop botol
121 Antasida DOEN suspensi botol 3 5 8 3 5
122 Cefadroxil sirup 125mg/ml botol
123 Domperidon syrup botol
124 Eritromisin Syrup Kering 200mg/5ml botol
125 Ibuprofen sirup 100mg/5ml botol
126 Kloramfenikol suspensi 125mg/5 ml botol
127 Kotrimoksazol suspensi botol 8 5 13 8 5
128 Multivitamin dan mineral (caviplex) syr botol
129 Parasetamol drop 100 mg/ml @ 15 ml botol
130 Parasetamol sirup 120 mg / 5 ml botol 4 5 9 3 6
131 Setirizin sir 5 mg/5 ml. botol
132 Valproat syrup 250 mg/ml botol
133 Zinc sir 20 mg/5 ml botol
Injeksi
134 ACT injeksi ampul
135 Aminofilina injeksi 24 mg / ml-10ml ampul
136 Ampisilina injeksi Ampul
137 Aqua Pro injeksi steril bebas pirogen ampul
138 Asam Tranexamat 500mg/5 ml injeksi ampul
139 Atropin Sulfat injeksi 0,25 mg / ml-1 ml ampul
140 Calsium Glukonas Inj ampul
141 Deksametason inj. 5 mg /ml-1 ml Ampul 5 5 - 5
142 Diazepam injeksi 5 mg/ ml- 2 ml ampul
143 Difenhidramina injeksi 10 mg/ ml- 1 ml ampul
144 Epinefrin injeksi 0,1 % - 1 ml ampul
145 Fenobarbital injeksi 50 mg / ml-1 ml ampul
146 Fitomenadion (Vit. K) injeksi 10 mg / ml-1 ml ampul
147 Haloperidol injeksi 5mg/ml (LODOMER 5) ampul
148 Ketorolac Inj 30 mg/ml ampul 5 5 5 - 10
149 Kloramfenikol injeksi Ampul
150 Lidokain 2% injeksi (tunggal) ampul 5 5 10 2 8
151 Lidokain Kompositum injeksi ampul
152 Magnesium Sulfat injeksiI (IV) 20 %-25 ml Vial
153 Magnesium Sulfat injeksiI (IV) 40 %-25 ml Vial
154 Metilergometrin Maleat injeksi 0,2 mg / ml Ampul
155 Metocloperamide inj Ampul 4 10 14 14 - 10
156 Nebules kombinasi : ipatropium br 0.5 mg+ Vial
157 Oksitosin injeksi 10 IU / ml - 1 ml ampul
158 Omeprazole 40mg/10 ml injeksi Vial
159 Prokain Benzil Penisilin inj 3jt IU Vial
160 Ranitidine injeksi Pot 0 10
161 Sabu Polivalen 5 ml (ABU I) Vial
162 Salbutamol Inj 1 mg/ml Vial
163 Serum Anti Tetanus injeksi 1.500 IU / ampul ampul
164 Sianokobalamin (Vit. B 12) injeksi 500 mcg / ampul
Obat Luar
165 Acyclovir krim 5% tube 0
166 Antibakteri DOEN salep kombinasi tube 4 5 9 4 5 5
167 Antifungi DOEN kombinasi tube
168 Antihemaroid DOEN kombinasi suppo 0
169 Betametason krim 0,1 % tube 5 5 2 3 8
170 Borax Glycerin botol
171 Calamin (Caladin) lotion 60 ml botol 3 0 3 3 - 5
172 Diazepam rectal tube 5 mg (stesolid rectal) tube
173 Diazepam rectal tube 10mg (stesolid rectal) tube
174 Dulcolax 5mg supp (anak) suppo 6 6 - 6
175 Dulcolax 10mg supp (Dewasa) suppo
176 Etakridina (Rivanol) larutan 0,1 % botol
177 Etanol 70 % botol
178 Fenolgliserol tetes telinga 10 % botol
179 Gentamicin salep mata (GENOINT) 0,3 % tube
180 Gentamicin tetes mata 0,3 % botol
181 Hidrokortison krim 2,5 % tube 5 5 3 2 8
182 Ketokonazole cream 2% tube
183 Kloramfenikol salep kulit 2% (BUFACETIN) tube
184 Kloramfenikol salep mata 1 % tube 1 5 6 4 2 5
185 Kloramfenikol tetes mata 0,5 % botol 5
186 Kloramfenikol tetes telinga 3 % botol 2 2 2 - 5
187 Miconazol krim tube 2 5 7 4 3 8
188 Oksitetrasiklin salep mata 1 % tube - 0 - May-22
189 Parasetamol / Pamol suppo 125mg suppo 8 8 3 5
190 Perhidrol ( Lar H2O2 ) tube
191 Povidon Iodida 10 % , 30 ml botol
192 Povidon Iodida 10 % , 60 ml botol
193 Povidon Iodida 10 % , 300 ml botol 1 1 1 -
194 Salep 2-4 Kombinasi Pot
195 Salisil Bedak 2 % botol 5 5 1 4
196 Scabicid/Scabimid cream tube 0 5
197 Silver sulfadiazin Cream 1% 35 gr tube 5
Infus dan Cairan
198 Cairan Untuk Irigasi 1000 ml Flash
199 Glukosa infus 5 % Flash
200 Glukosa infus 10 % Flash
201 Alkohol 70% Flash 1
202 Natrium Klorida infus 0,9 % 500 ml Flash 3 2 5 5 - 5
203 Prontosan Wound Irrigation sol 350ml botol 2 0 2 2 -
204 Ringer Laktat larutan infus steril Flash
Bahan Medis Habis Pakai
205 Alat Suntik sekali pakai 1 ml Set
206 Alat Suntik sekali pakai 3 ml Set 20 10 30 15 15
207 Alat Suntik sekali pakai 5 ml Set 25 0 25 5 20
208 Catgut / Benang Bedah No. 2/0 24x70 cm
209 Catgut / Benang Bedah No. 3/0 24x70 cm
210 Cover Glass 20x20 set
211 Dermafix S IV set
212 Feeding Tube 40cm No. 8 set
213 Foley cathether No. 16 set
214 Foley cathether No. 18 set
215 Foley cathether No. 20 set
216 Gown set botol
217 Hand Rub 500ml botol
218 Hand Scrub 500ml botol
219 Handrub refill 5 liter galon
220 Hazmat Size L set
221 Hazmat Size XL set
222 Infusion Set anak-anak set
223 Infusion Set dewasa set
224 IV Cathether No. 18 G set
225 IV Cathether No. 20 G set
226 IV Cathether No. 22 G set
227 IV Cathether No. 24 G set
228 Jarum hecting kombinasi set
229 Jelly Dopler botol
230 Kapas Pembalut / Adsorben 250 gram rol
231 Kasa Pembalut 40 yd x 110 cm rol 1 1 1 -
232 Kasa Pembalut 4x10 cm rol
233 Kasa Pembalut 4x15 cm rol
234 Kertas EKG 58mm x 25 m rol
235 Kertas EKG 58mm X 30 m rol
236 Kertas EKG 63mm X 30 m rol
237 Kertas EKG 80mm x 20 m rol
238 Lokal kacamata faceshield set
239 Masker Bedah Anak pcs
240 Masker KN 95 pcs
241 Masker N 95 pcs
242 Masker Oxygen (Maxiflow) Anak (Pediatrik) set
243 Masker Oxygen (Maxiflow) Dewasa (Adult) set
244 Masker surgical pcs 50 0 50 25 25
245 Masker surgical Anak pcs
246 Object Glass 20x20 mm pack
247 Oxygen Nasal Adult (Dewasa) set
248 Oxygen Nasal NewNates set
249 Oxygen Nasal Pediatric set
250 Pembalut gibs rol
251 Plester 5 yard x 2 inchi (plester coklat) rol 2 0 2 1 1
252 Plester Kertas 1" (surgical tape) rol
253 Regulator Oksigen set
254 Sarung tangan steril no.6,5 pasang
255 Sarung tangan steril NO.7 pasang
256 Sarung tangan steril NO.7,5 pasang
257 Sarung tangan non steril uk. S pasang 50 50 10 40
258 Sarung tangan non steril uk.M pasang 10 0 10 10 - 50
259 Sarung tangan obgin No. 6,5 pasang
260 Sarung tangan obgin No. 7 pasang
261 Sarung tangan obgin No. 7,5 pasang
262 Sarung tangan obgyn no. 8 pasang
263 Silk 2/0 + 1/2 GT 35MM set
264 Silk 3/0 + 1/2 GT 35MM set 32 32 2 30
265 Solida Nurse Cap set
266 Surgical mess 11 pack
267 Surgical mess 20 pack
268 Transparent IV Dressing (with notch) set 5
269 Umbilical cord klem set
270 Urine bag set
271 Wing Neddle No 21 G set
272 Wing Neddle No 23 G set
273 Wing Neddle No 25 G set
Tambahan
274 Cetirizine tab tablet 100 100 20 80
275 Alkohol swab pack
276 Kasa hidrofil steril pack
277 Klip sheet 200 200 200 - 200
278 Kertas Puyer sheet 200 200 200 -

Yang Memberikan, Yang Menerima,

Pengelola Obat Puskesmas Pengelola Obat Unit

Nisa' Amila Rodhiya, S.Farm., Apt Ns. Baiq Retno ,S.Kep

 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
NO : PELAPORAN BULAN : Agustus
NAMA PUSKESMAS : PRINGGARATA PENERIMAAN BULAN : AgSeptember
NAMA UNIT : PUSTU PEMEPEK
PENGELOLA OBAT : Ns. BAIQ RETNO, S.Kep
EXPIRED
STOK
No. Nama Obat Satuan STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
OPTIMUM
PERMINTAAN PEMBERIAN NO. BATCH DATE/
KETERANGAN
Tablet/Kapsul/Sachet
1 ACT tablet tablet
2 Acetyl Cystein 200mg tablet 30 30 30 0
3 Acyclovir 200 mg tablet tablet
4 Acyclovir 400 mg tablet tablet 100 100 10 90
5 Albendazol tablet 400 mg tablet
6 Alopurinol tablet 100 mg tablet - 100 100 20 80 100
7 Alprazolam 0,5 mg tablet tablet
8 Alprazolam 1 mg tablet
9 Ambroxol tablet tablet 200
10 Aminofilina tablet 200 mg tablet
11 Amitriptilina tablet 25 mg tablet
12 Amlodipin 5 mg tablet
13 Amlodipin 10 mg tablet - 100
14 Amoksisilina kapsul 500 mg tablet - 200 200 100 100 200
15 Antasida DOEN tablet tablet 100 100 200 20 180 100
0 Asam Askorbat (Vit. C) tablet 50 mg tablet 50 100 150 50 100 100
17 Asam Folat tab tablet 100
18 Asam Mefenamat tablet 500 mg tablet 70 100 170 70 100 200
19 Asam Tranexamat 500mg tablet
20 Asetosal 80mg (MINIASPI) tablet
21 Attalpulgite 600mg - New Antides tablet 50 100 150 100 50 200
22 Azithromycin 500 mg tab tablet `
23 Betahistin 6mg tablet 60 90 150 90 60 90
24 Captopril 12,5 mg tablet 150 100 250 100 150
25 Captopril tablet 25 mg tablet 100
26 Captopril tablet 50 mg tablet
27 Cefadroxil 500 mg tablet
28 Clozapine 25mg tablet
29 Cyproploxasin tablet tablet 20 20 20 0 200
30 Deksametason tablet 0,5 mg tablet 100 200 300 200 100 200
31 Diazepam tablet 2 mg tablet
32 Digoksin tablet 0,25 mg tablet
33 Domperidon tablet 10 mg tablet -
34 Doxycyklin 100 mg tablet capsul
35 Efedrina HCl. tablet 25 mg tablet
36 Ergotamin Caffein tablet tablet
37 Eritromisin kapsul 250 mg tablet
38 Eritromisin kapsul 500 mg tablet
39 Fenobarbital tablet 30 mg tablet
40 Fenofibrate 100 mg tablet
41 Fitomenadion (Vit. K) tablet salut 10 mg tablet
42 Fluoxetin 20mg (NOPRES) tablet
43 Furosemida tablet 40 mg tablet
44 Garam Oralit untuk 200 ml air Sachet - 10 10 10 0 100
45 Gemfibrozil 150 mg tablet
46 Glibenklamida tablet 5 mg tablet 100 100 0 100
47 Glimepiride tablet 1 mg tablet
48 Glimepiride tablet 2 mg tablet
49 Griseofulvin tablet 125 mg Mikronized tablet
50 Guaifenisin tablet tablet
51 Haloperidol tablet 1,5 mg tablet
52 Haloperidol tablet 5 mg tablet
53 Hidroklortiazide (HCT) tablet 25 mg tablet
54 Hyoscine N Butilbromide/ SCOPMA tablet - 200
55 Ibuprofen tablet 200 mg tablet
56 Ibuprofen tablet 400 mg tablet 50 50 50 0 200
57 Isoniazid ( INH ) + Pyridoxin (B6) tablet
58 Isoniazid ( INH ) 100mg tablet
59 Isosorbid Dinitrat Sub Lingual tablet 5 mg tablet
60 Kalsium Laktat tablet 500 mg tablet 100 100 0 100
61 Karbamazepin 200 mg tablet
62 Ketokonazole tablet 200 mg tablet
63 Klindamycin 150 mg tablet
64 Klindamycin 300 mg capsul
65 Kloramfenikol kapsul 250 mg tablet 80 100 180 30 150
66 Kloramfenikol kapsul 500 mg tablet - 100
67 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 200 100 300 100 200 200
68 Klorpromazina tablet 100 mg tablet
69 KOMBIPAK (Azythromycin + Cefixime ) tablet
70 Kotrimoksazol dewasa tablet tablet 100 100 0 100 100
71 Kuinin ( Kina ) tablet 200 mg tablet
72 Loperamide 2mg tab tablet 50 100 150 100 50 100
73 Loratadin 10mg tablet 90 100 190 110 80 100
74 Lorazepam 1 mg (RENAQUIL 1mg) tablet
75 Metformin HCL 500 mg tablet tablet 40 100 140 40 100 100
76 Metilergometrin Maleat tablet 0,125 mg tablet
77 Metilprednisolon 4 mg tablet 50 50 50 0 200
78 metocloperamide tab 5 mg tablet
79 Metoclopramide 10 mg tablet 90 100 190 40 150 100
80 Metronidazol tablet 500 mg tablet 80 100 180 30 150 100
81 Mineral Mix Sachet Sachet
82 Misoprotol tab 200 mcg tablet
83 Na diklofenak 25mg tablet
84 Na diklofenak 50mg tablet 100 100 50 50 100
85 Nifedipin tablet tablet
86 Nistatin tablet salut 500.000 IU tablet
87 Obat Anti Tuberkulosis FDC kategori 1/3 paket
88 Obat Anti Tuberkulosis FDC kategori 2 paket
89 Obat Anti Tuberkulosis FDC kategori anak paket
90 Obat Anti Tuberkulosis KDT Harian paket
91 Omeprazole kapsul kapsul 50 50 50 0 100
92 Oseltamivir tablet
93 Parasetamol tablet 500 mg tablet 80 300 380 330 50 300
94 Phenytoin 100 mg capsul
95 Piridoksina HCl. tablet 10 mg tablet 50 50 50 0 200
96 Prednison tablet 5 mg tablet 100
97 Primakuin tablet 15 mg tablet
98 Propiltiourasil tablet 100 mg tablet
99 Ranitidin tablet 150 mg tablet - 100 100 20 80 200
100 Retinol (Vitamin A) kapsul 100.000 IU capsul
101 Retinol (Vitamin A) kapsul 200.000 IU capsul
102 Risperidon 2 mg tablet tablet
103 Salbutamol tablet 2 mg tablet 80 80 30 50
104 Salbutamol tablet 4 mg tablet 100 100 0 100 100
105 Simvastatin 10mg tablet 40 100 140 60 80 200
106 Sivit zink tablet tablet
107 Spironolakston 25 mg tablet
108 Striatamin cap capsul
109 Tablet Tambah Darah kombinasi tablet 50 90 140 50 90 100
110 Tetrasiklina HCl. kapsul 500 mg capsul
111 Tiamine HCl. Mononitrat (Vit. B-1) tablet 50 mg tablet 60 100 150 150 0 200
112 Trifluoperazine 6 mg tablet
113 Triheksifenidil HCl. tablet 2 mg tablet
114 Valproat tab sal 250 mg (Depakote ER) botol
115 Vitamin B Komplek tablet tablet 70 70 70 0 300
116 Zinc tablet 20 mg botol 80 80 0 80
Syrup/ Suspensi
117 Ambroxol sirup 15mg/ml botol 4 4 0 4
118 Amoksisilina sirup kering 125 mg/ 5ml botol 5 5 1 4
119 Amoksisilina sirup kering 250 mg/ 5ml botol
120 Amoxicillin drop botol
121 Antasida DOEN suspensi botol 5 5 0 5
122 Cefadroxil sirup 125mg/ml botol
123 Domperidon syrup botol
124 Eritromisin Syrup Kering 200mg/5ml botol
125 Ibuprofen sirup 100mg/5ml botol
126 Kloramfenikol suspensi 125mg/5 ml botol
127 Kotrimoksazol suspensi botol 5 5 0 5
128 Multivitamin dan mineral (caviplex) syr botol
129 Parasetamol drop 100 mg/ml @ 15 ml botol
130 Parasetamol sirup 120 mg / 5 ml botol 6 6 3 3
131 Setirizin sir 5 mg/5 ml. botol
132 Valproat syrup 250 mg/ml botol
133 Zinc sir 20 mg/5 ml botol
Injeksi
134 ACT injeksi ampul
135 Aminofilina injeksi 24 mg / ml-10ml ampul
136 Ampisilina injeksi Ampul
137 Aqua Pro injeksi steril bebas pirogen ampul
138 Asam Tranexamat 500mg/5 ml injeksi ampul
139 Atropin Sulfat injeksi 0,25 mg / ml-1 ml ampul
140 Calsium Glukonas Inj ampul
141 Deksametason inj. 5 mg /ml-1 ml Ampul 5 5 0 5
142 Diazepam injeksi 5 mg/ ml- 2 ml ampul
143 Difenhidramina injeksi 10 mg/ ml- 1 ml ampul
144 Epinefrin injeksi 0,1 % - 1 ml ampul
145 Fenobarbital injeksi 50 mg / ml-1 ml ampul
146 Fitomenadion (Vit. K) injeksi 10 mg / ml-1 ml ampul
147 Haloperidol injeksi 5mg/ml (LODOMER 5) ampul
148 Ketorolac Inj 30 mg/ml ampul - 10 10 5 5 10
149 Kloramfenikol injeksi Ampul
150 Lidokain 2% injeksi (tunggal) ampul 8 8 0 8
151 Lidokain Kompositum injeksi ampul
152 Magnesium Sulfat injeksiI (IV) 20 %-25 ml Vial
153 Magnesium Sulfat injeksiI (IV) 40 %-25 ml Vial
154 Metilergometrin Maleat injeksi 0,2 mg / ml Ampul
155 Metocloperamide inj Ampul - 10 10 5 5 10
156 Nebules kombinasi : ipatropium br 0.5 mg+ salbutamol 2.5 m Vial
157 Oksitosin injeksi 10 IU / ml - 1 ml ampul
158 Omeprazole 40mg/10 ml injeksi Vial
159 Prokain Benzil Penisilin inj 3jt IU Vial
160 Ranitidine injeksi Pot
161 Sabu Polivalen 5 ml (ABU I) Vial
162 Salbutamol Inj 1 mg/ml Vial
163 Serum Anti Tetanus injeksi 1.500 IU / ampul (ATS) ampul
164 Sianokobalamin (Vit. B 12) injeksi 500 mcg / ml ampul
Obat Luar
165 Acyclovir krim 5% tube 5
166 Antibakteri DOEN salep kombinasi tube 5 5 5 2 3 5
167 Antifungi DOEN kombinasi tube
168 Antihemaroid DOEN kombinasi suppo
169 Betametason krim 0,1 % tube 3 3 2 1 5
170 Borax Glycerin botol
171 Calamin (Caladin) lotion 60 ml botol - 5 5 5
172 Diazepam rectal tube 5 mg (stesolid rectal) tube
173 Diazepam rectal tube 10mg (stesolid rectal) tube
174 Dulcolax 5mg supp (anak) suppo 6 6 0 6
175 Dulcolax 10mg supp (Dewasa) suppo
176 Etakridina (Rivanol) larutan 0,1 % botol
177 Etanol 70 % botol
178 Fenolgliserol tetes telinga 10 % botol
179 Gentamicin salep mata (GENOINT) 0,3 % tube
180 Gentamicin tetes mata 0,3 % botol
181 Hidrokortison krim 2,5 % tube 2 2 4 2 2 5
182 Ketokonazole cream 2% tube
183 Kloramfenikol salep kulit 2% (BUFACETIN) tube
184 Kloramfenikol salep mata 1 % tube 2 2 0 2 5
185 Kloramfenikol tetes mata 0,5 % botol 5
186 Kloramfenikol tetes telinga 3 % botol - 5
187 Miconazol krim tube 3 8 11 3 8
188 Oksitetrasiklin salep mata 1 % tube
189 Parasetamol / Pamol suppo 125mg suppo 5 5 0 5
190 Perhidrol ( Lar H2O2 ) tube
191 Povidon Iodida 10 % , 30 ml botol
192 Povidon Iodida 10 % , 60 ml botol
193 Povidon Iodida 10 % , 300 ml botol -
194 Salep 2-4 Kombinasi Pot
195 Salisil Bedak 2 % botol 4 4 0 4
196 Scabicid/Scabimid cream tube
197 Silver sulfadiazin Cream 1% 35 gr tube 2
Infus dan Cairan
198 Cairan Untuk Irigasi 1000 ml Flash
199 Glukosa infus 5 % Flash
200 Glukosa infus 10 % Flash
201 Alkohol 70% Flash
202 Natrium Klorida infus 0,9 % 500 ml Flash - 3
203 Prontosan Wound Irrigation sol 350ml botol -
204 Ringer Laktat larutan infus steril Flash
Bahan Medis Habis Pakai
205 Alat Suntik sekali pakai 1 ml Set
206 Alat Suntik sekali pakai 3 ml Set 15 15 7 8 10
207 Alat Suntik sekali pakai 5 ml Set 20 20 10 10
208 Catgut / Benang Bedah No. 2/0 24x70 cm
209 Catgut / Benang Bedah No. 3/0 24x70 cm
210 Cover Glass 20x20 set
211 Dermafix S IV set 3
212 Feeding Tube 40cm No. 8 set
213 Foley cathether No. 16 set
214 Foley cathether No. 18 set
215 Foley cathether No. 20 set
216 Gown set botol
217 Hand Rub 500ml botol
218 Hand Scrub 500ml botol
219 Handrub refill 5 liter galon
220 Hazmat Size L set
221 Hazmat Size XL set
222 Infusion Set anak-anak set
223 Infusion Set dewasa set
224 IV Cathether No. 18 G set
225 IV Cathether No. 20 G set
226 IV Cathether No. 22 G set
227 IV Cathether No. 24 G set
228 Jarum hecting kombinasi set
229 Jelly Dopler botol
230 Kapas Pembalut / Adsorben 250 gram rol
231 Kasa Pembalut 40 yd x 110 cm rol -
232 Kasa Pembalut 4x10 cm rol
233 Kasa Pembalut 4x15 cm rol
234 Kertas EKG 58mm x 25 m rol
235 Kertas EKG 58mm X 30 m rol
236 Kertas EKG 63mm X 30 m rol
237 Kertas EKG 80mm x 20 m rol
238 Lokal kacamata faceshield set
239 Masker Bedah Anak pcs
240 Masker KN 95 pcs
241 Masker N 95 pcs
242 Masker Oxygen (Maxiflow) Anak (Pediatrik) set
243 Masker Oxygen (Maxiflow) Dewasa (Adult) set
244 Masker surgical pcs 25 25 20 5 25
245 Masker surgical Anak pcs
246 Object Glass 20x20 mm pack
247 Oxygen Nasal Adult (Dewasa) set
248 Oxygen Nasal NewNates set
249 Oxygen Nasal Pediatric set
250 Pembalut gibs rol
251 Plester 5 yard x 2 inchi (plester coklat) rol 1 1 1
252 Plester Kertas 1" (surgical tape) rol
253 Regulator Oksigen set
254 Sarung tangan steril no.6,5 pasang
255 Sarung tangan steril NO.7 pasang
256 Sarung tangan steril NO.7,5 pasang
257 Sarung tangan non steril uk. S pasang 40 40 40 0
258 Sarung tangan non steril uk.M pasang - 50 50 50
259 Sarung tangan obgin No. 6,5 pasang
260 Sarung tangan obgin No. 7 pasang
261 Sarung tangan obgin No. 7,5 pasang
262 Sarung tangan obgyn no. 8 pasang
263 Silk 2/0 + 1/2 GT 35MM set
264 Silk 3/0 + 1/2 GT 35MM set 30 30 30
265 Solida Nurse Cap set
266 Surgical mess 11 pack
267 Surgical mess 20 pack
268 Transparent IV Dressing (with notch) set
269 Umbilical cord klem set
270 Urine bag set
271 Wing Neddle No 21 G set
272 Wing Neddle No 23 G set
273 Wing Neddle No 25 G set
Tambahan
274 Cetirizine tab tablet 80 80 10 70
275 Alkohol swab pack
276 Kasa hidrofil steril pack
277 Klip sheet - 200 200 100 100 200
278 Kertas Puyer sheet - 200

Yang Memberikan, Yang Menerima,

Pengelola Obat Puskesmas Pengelola Obat Unit

Nisa' Amila Rodhiya, S.Farm., Apt Ns. Baiq Retno ,S.Kep

 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
NO : PELAPORAN BULAN : September
NAMA PUSKESMAS : PRINGGARATA PENERIMAAN BULAN : Oktober
NAMA UNIT : PUSTU PEMEPEK
PENGELOLA OBAT : Ns. BAIQ RETNO, S.Kep
EXPIRED
STOK
No. Nama Obat Satuan STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
OPTIMUM
PERMINTAAN PEMBERIAN NO. BATCH DATE/
KETERANGAN
Tablet/Kapsul/Sachet
1 ACT tablet tablet
2 Acetyl Cystein 200mg tablet 0 100
3 Acyclovir 200 mg tablet tablet
4 Acyclovir 400 mg tablet tablet 90 90 50 40
5 Albendazol tablet 400 mg tablet
6 Alopurinol tablet 100 mg tablet 80 100 180 80 100 100
7 Alprazolam 0,5 mg tablet tablet
8 Alprazolam 1 mg tablet
9 Ambroxol tablet tablet 200 200 100 100 200
10 Aminofilina tablet 200 mg tablet
11 Amitriptilina tablet 25 mg tablet
12 Amlodipin 5 mg tablet
13 Amlodipin 10 mg tablet 100 100 30 70 100
14 Amoksisilina kapsul 500 mg tablet 100 200 300 150 150 400
15 Antasida DOEN tablet tablet 180 100 280 80 200
16 Asam Askorbat (Vit. C) tablet 50 mg tablet 100 100 200 100 100 100
17 Asam Folat tab tablet
18 Asam Mefenamat tablet 500 mg tablet 100 200 300 150 150 200
19 Asam Tranexamat 500mg tablet
20 Asetosal 80mg (MINIASPI) tablet
21 Attalpulgite 600mg - New Antides tablet 50 100 150 100 50 100
22 Azithromycin 500 mg tab tablet
23 Betahistin 6mg tablet 60 90 150 50 100
24 Captopril 12,5 mg tablet 150 150 0 150
25 Captopril tablet 25 mg tablet 100 100 100 0 200
26 Captopril tablet 50 mg tablet
27 Cefadroxil 500 mg tablet 200
28 Clozapine 25mg tablet
29 Cyproploxasin tablet tablet 0 100 100 80 30 200
30 Deksametason tablet 0,5 mg tablet 100 200 300 150 150 200
31 Diazepam tablet 2 mg tablet
32 Digoksin tablet 0,25 mg tablet
33 Domperidon tablet 10 mg tablet
34 Doxycyklin 100 mg tablet capsul
35 Efedrina HCl. tablet 25 mg tablet
36 Ergotamin Caffein tablet tablet
37 Eritromisin kapsul 250 mg tablet
38 Eritromisin kapsul 500 mg tablet
39 Fenobarbital tablet 30 mg tablet
40 Fenofibrate 100 mg tablet
41 Fitomenadion (Vit. K) tablet salut 10 mg tablet
42 Fluoxetin 20mg (NOPRES) tablet
43 Furosemida tablet 40 mg tablet
44 Garam Oralit untuk 200 ml air Sachet 0 20 20 10 10 100
45 Gemfibrozil 150 mg tablet
46 Glibenklamida tablet 5 mg tablet 100 100 100
47 Glimepiride tablet 1 mg tablet
48 Glimepiride tablet 2 mg tablet
49 Griseofulvin tablet 125 mg Mikronized tablet
50 Guaifenisin tablet tablet 100
51 Haloperidol tablet 1,5 mg tablet
52 Haloperidol tablet 5 mg tablet
53 Hidroklortiazide (HCT) tablet 25 mg tablet
54 Hyoscine N Butilbromide/ SCOPMA tablet 100 100 50 50 100
55 Ibuprofen tablet 200 mg tablet
56 Ibuprofen tablet 400 mg tablet 0 100 100 50 50 300
57 Isoniazid ( INH ) + Pyridoxin (B6) tablet
58 Isoniazid ( INH ) 100mg tablet
59 Isosorbid Dinitrat Sub Lingual tablet 5 mg tablet
60 Kalsium Laktat tablet 500 mg tablet 100 100 10 90
61 Karbamazepin 200 mg tablet
62 Ketokonazole tablet 200 mg tablet
63 Klindamycin 150 mg tablet
64 Klindamycin 300 mg capsul
65 Kloramfenikol kapsul 250 mg tablet 150 100 250 50 200
66 Kloramfenikol kapsul 500 mg tablet 100
67 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 200 200 400 150 250 200
68 Klorpromazina tablet 100 mg tablet
69 KOMBIPAK (Azythromycin + Cefixime ) tablet
70 Kotrimoksazol dewasa tablet tablet 0 100 100 100 200
71 Kuinin ( Kina ) tablet 200 mg tablet
72 Loperamide 2mg tab tablet 50 100 150 50 100 200
73 Loratadin 10mg tablet 80 80 80 100
74 Lorazepam 1 mg (RENAQUIL 1mg) tablet
75 Metformin HCL 500 mg tablet tablet 100 100 200 100 100
76 Metilergometrin Maleat tablet 0,125 mg tablet
77 Metilprednisolon 4 mg tablet 0 100 100 50 50 200
78 metocloperamide tab 5 mg tablet
79 Metoclopramide 10 mg tablet 150 100 250 100 150 100
80 Metronidazol tablet 500 mg tablet 150 100 150 50 100 100
81 Mineral Mix Sachet Sachet
82 Misoprotol tab 200 mcg tablet
83 Na diklofenak 25mg tablet
84 Na diklofenak 50mg tablet 50 100 150 70 80 100
85 Nifedipin tablet tablet
86 Nistatin tablet salut 500.000 IU tablet
87 Obat Anti Tuberkulosis FDC kategori 1/3 paket
88 Obat Anti Tuberkulosis FDC kategori 2 paket
89 Obat Anti Tuberkulosis FDC kategori anak paket
90 Obat Anti Tuberkulosis KDT Harian paket
91 Omeprazole kapsul kapsul 0 100 100 50 50 100
92 Oseltamivir tablet
93 Parasetamol tablet 500 mg tablet 50 300 350 150 200 400
94 Phenytoin 100 mg capsul
95 Piridoksina HCl. tablet 10 mg tablet 0
96 Prednison tablet 5 mg tablet
 97 Primakuin tablet 15 mg tablet
98 Propiltiourasil tablet 100 mg tablet
99 Ranitidin tablet 150 mg tablet 80 200 280 100 180 100
100 Retinol (Vitamin A) kapsul 100.000 IU capsul
101 Retinol (Vitamin A) kapsul 200.000 IU capsul
102 Risperidon 2 mg tablet tablet
103 Salbutamol tablet 2 mg tablet 50 50 50 0
104 Salbutamol tablet 4 mg tablet 100 100 200 50 150 100
105 Simvastatin 10mg tablet 80 80 30 50 200
106 Sivit zink tablet tablet
107 Spironolakston 25 mg tablet
108 Striatamin cap capsul
109 Tablet Tambah Darah kombinasi tablet 90 90 180 30 150 100
110 Tetrasiklina HCl. kapsul 500 mg capsul
111 Tiamine HCl. Mononitrat (Vit. B-1) tablet 50 mg tablet 0
112 Trifluoperazine 6 mg tablet 300
113 Triheksifenidil HCl. tablet 2 mg tablet
114 Valproat tab sal 250 mg (Depakote ER) botol
115 Vitamin B Komplek tablet tablet 0 300 300 150 150 300
116 Zinc tablet 20 mg botol 80 80 80
Syrup/ Suspensi
117 Ambroxol sirup 15mg/ml botol 4 4 4
118 Amoksisilina sirup kering 125 mg/ 5ml botol 4 4 4
119 Amoksisilina sirup kering 250 mg/ 5ml botol
120 Amoxicillin drop botol
121 Antasida DOEN suspensi botol 5 5 5
122 Cefadroxil sirup 125mg/ml botol
123 Domperidon syrup botol
124 Eritromisin Syrup Kering 200mg/5ml botol
125 Ibuprofen sirup 100mg/5ml botol
126 Kloramfenikol suspensi 125mg/5 ml botol
127 Kotrimoksazol suspensi botol 5 5 3 2
128 Multivitamin dan mineral (caviplex) syr botol
129 Parasetamol drop 100 mg/ml @ 15 ml botol
130 Parasetamol sirup 120 mg / 5 ml botol 3 3 1 2
131 Setirizin sir 5 mg/5 ml. botol
132 Valproat syrup 250 mg/ml botol
133 Zinc sir 20 mg/5 ml botol
Injeksi
134 ACT injeksi ampul
135 Aminofilina injeksi 24 mg / ml-10ml ampul
136 Ampisilina injeksi Ampul
137 Aqua Pro injeksi steril bebas pirogen ampul
138 Asam Tranexamat 500mg/5 ml injeksi ampul
139 Atropin Sulfat injeksi 0,25 mg / ml-1 ml ampul
140 Calsium Glukonas Inj ampul
141 Deksametason inj. 5 mg /ml-1 ml Ampul 5 5 0 5
142 Diazepam injeksi 5 mg/ ml- 2 ml ampul
143 Difenhidramina injeksi 10 mg/ ml- 1 ml ampul
144 Epinefrin injeksi 0,1 % - 1 ml ampul
145 Fenobarbital injeksi 50 mg / ml-1 ml ampul
146 Fitomenadion (Vit. K) injeksi 10 mg / ml-1 ml ampul
147 Haloperidol injeksi 5mg/ml (LODOMER 5) ampul
148 Ketorolac Inj 30 mg/ml ampul 5 10 15 5 10
149 Kloramfenikol injeksi Ampul
150 Lidokain 2% injeksi (tunggal) ampul 8 8 3 5 5
151 Lidokain Kompositum injeksi ampul
152 Magnesium Sulfat injeksiI (IV) 20 %-25 ml Vial
153 Magnesium Sulfat injeksiI (IV) 40 %-25 ml Vial
154 Metilergometrin Maleat injeksi 0,2 mg / ml Ampul
155 Metocloperamide inj Ampul 5 10 15 10 10
156 Nebules kombinasi : ipatropium br 0.5 mg+ salbutamo Vial
157 Oksitosin injeksi 10 IU / ml - 1 ml ampul
158 Omeprazole 40mg/10 ml injeksi Vial
159 Prokain Benzil Penisilin inj 3jt IU Vial
160 Ranitidine injeksi Pot 10
161 Sabu Polivalen 5 ml (ABU I) Vial
162 Salbutamol Inj 1 mg/ml Vial
163 Serum Anti Tetanus injeksi 1.500 IU / ampul (ATS) ampul
164 Sianokobalamin (Vit. B 12) injeksi 500 mcg / ml ampul
Obat Luar
165 Acyclovir krim 5% tube 3 3 0 3 5
166 Antibakteri DOEN salep kombinasi tube 3 3 6 3 3 5
167 Antifungi DOEN kombinasi tube
168 Antihemaroid DOEN kombinasi suppo
169 Betametason krim 0,1 % tube 1 3 4 2 2 5
170 Borax Glycerin botol
171 Calamin (Caladin) lotion 60 ml botol 5 5 1 4
172 Diazepam rectal tube 5 mg (stesolid rectal) tube
173 Diazepam rectal tube 10mg (stesolid rectal) tube
174 Dulcolax 5mg supp (anak) suppo 6 6 0 6
175 Dulcolax 10mg supp (Dewasa) suppo
176 Etakridina (Rivanol) larutan 0,1 % botol
177 Etanol 70 % botol
178 Fenolgliserol tetes telinga 10 % botol
179 Gentamicin salep mata (GENOINT) 0,3 % tube
180 Gentamicin tetes mata 0,3 % botol
181 Hidrokortison krim 2,5 % tube 2 2 2 2 0 5
182 Ketokonazole cream 2% tube
183 Kloramfenikol salep kulit 2% (BUFACETIN) tube
184 Kloramfenikol salep mata 1 % tube 2 5 7 2 5 5
185 Kloramfenikol tetes mata 0,5 % botol
186 Kloramfenikol tetes telinga 3 % botol 5
187 Miconazol krim tube 8 8 4 4 5
188 Oksitetrasiklin salep mata 1 % tube
189 Parasetamol / Pamol suppo 125mg suppo 5 5 0 5
190 Perhidrol ( Lar H2O2 ) tube
191 Povidon Iodida 10 % , 30 ml botol
192 Povidon Iodida 10 % , 60 ml botol
193 Povidon Iodida 10 % , 300 ml botol
194 Salep 2-4 Kombinasi Pot
195 Salisil Bedak 2 % botol 4 4 2 2 5
196 Scabicid/Scabimid cream tube
197 Silver sulfadiazin Cream 1% 35 gr tube
Infus dan Cairan
198 Cairan Untuk Irigasi 1000 ml Flash
199 Glukosa infus 5 % Flash
200 Glukosa infus 10 % Flash
201 Alkohol 70% Flash
202 Natrium Klorida infus 0,9 % 500 ml Flash 2 2 0 2
203 Prontosan Wound Irrigation sol 350ml botol
204 Ringer Laktat larutan infus steril Flash
Bahan Medis Habis Pakai
205 Alat Suntik sekali pakai 1 ml Set
206 Alat Suntik sekali pakai 3 ml Set 8 10 18 8 10 20
207 Alat Suntik sekali pakai 5 ml Set 10 10 2 8 15
208 Catgut / Benang Bedah No. 2/0 24x70 cm `
209 Catgut / Benang Bedah No. 3/0 24x70 cm
210 Cover Glass 20x20 set
211 Dermafix S IV set
212 Feeding Tube 40cm No. 8 set
213 Foley cathether No. 16 set
214 Foley cathether No. 18 set
215 Foley cathether No. 20 set
216 Gown set botol
217 Hand Rub 500ml botol
218 Hand Scrub 500ml botol
219 Handrub refill 5 liter galon
220 Hazmat Size L set
221 Hazmat Size XL set
222 Infusion Set anak-anak set
223 Infusion Set dewasa set
224 IV Cathether No. 18 G set
225 IV Cathether No. 20 G set
226 IV Cathether No. 22 G set
227 IV Cathether No. 24 G set
228 Jarum hecting kombinasi set
229 Jelly Dopler botol
230 Kapas Pembalut / Adsorben 250 gram rol
231 Kasa Pembalut 40 yd x 110 cm rol
232 Kasa Pembalut 4x10 cm rol
233 Kasa Pembalut 4x15 cm rol
234 Kertas EKG 58mm x 25 m rol
235 Kertas EKG 58mm X 30 m rol
236 Kertas EKG 63mm X 30 m rol
237 Kertas EKG 80mm x 20 m rol
238 Lokal kacamata faceshield set
239 Masker Bedah Anak pcs
240 Masker KN 95 pcs
241 Masker N 95 pcs
242 Masker Oxygen (Maxiflow) Anak (Pediatrik) set
243 Masker Oxygen (Maxiflow) Dewasa (Adult) set
244 Masker surgical pcs 5 25 30 10 20 25
245 Masker surgical Anak pcs
246 Object Glass 20x20 mm pack
247 Oxygen Nasal Adult (Dewasa) set
248 Oxygen Nasal NewNates set
249 Oxygen Nasal Pediatric set
250 Pembalut gibs rol
251 Plester 5 yard x 2 inchi (plester coklat) rol 1 1 1 0 1
252 Plester Kertas 1" (surgical tape) rol
253 Regulator Oksigen set
254 Sarung tangan steril no.6,5 pasang
255 Sarung tangan steril NO.7 pasang
256 Sarung tangan steril NO.7,5 pasang
257 Sarung tangan non steril uk. S pasang 0
258 Sarung tangan non steril uk.M pasang 50 50 20 30 50
259 Sarung tangan obgin No. 6,5 pasang
260 Sarung tangan obgin No. 7 pasang
261 Sarung tangan obgin No. 7,5 pasang
262 Sarung tangan obgyn no. 8 pasang
263 Silk 2/0 + 1/2 GT 35MM set
264 Silk 3/0 + 1/2 GT 35MM set 30 30 2 28
265 Solida Nurse Cap set
266 Surgical mess 11 pack
267 Surgical mess 20 pack
268 Transparent IV Dressing (with notch) set
269 Umbilical cord klem set
270 Urine bag set
271 Wing Neddle No 21 G set
272 Wing Neddle No 23 G set
273 Wing Neddle No 25 G set
Tambahan
274 Cetirizine tab tablet 70 70 70 100
275 Alkohol swab pack
276 Kasa hidrofil steril pack
277 Klip sheet 100 200 300 200 200
278 Kertas Puyer sheet 200 200 100 100

Yang Memberikan, Yang Menerima,

Pengelola Obat Puskesmas Pengelola Obat Unit

Nisa' Amila Rodhiya, S.Farm., Apt Ns. Baiq Retno.C.M ,S.Kep

 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
NO : PELAPORAN BULAN : Oktober
NAMA PUSKESMAS : PRINGGARATA PENERIMAAN BULAN : November
NAMA UNIT : PUSTU PEMEPEK
PENGELOLA OBAT : Ns. BAIQ RETNO, S.Kep
EXPIRED
STOK
No. Nama Obat Satuan STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
OPTIMUM
PERMINTAAN PEMBERIAN NO. BATCH DATE/
KETERANGAN
Tablet/Kapsul/Sachet
1 ACT tablet tablet
2 Acetyl Cystein 200mg tablet 200
3 Acyclovir 200 mg tablet tablet
4 Acyclovir 400 mg tablet tablet 40 40 0 40 100 Oct-22
5 Albendazol tablet 400 mg tablet
6 Alopurinol tablet 100 mg tablet 100 100 200 120 80 200
7 Alprazolam 0,5 mg tablet tablet
8 Alprazolam 1 mg tablet
9 Ambroxol tablet tablet 100 200 300 220 80 300
10 Aminofilina tablet 200 mg tablet
11 Amitriptilina tablet 25 mg tablet
12 Amlodipin 5 mg tablet
13 Amlodipin 10 mg tablet 70 100 170 100 70 200
14 Amoksisilina kapsul 500 mg tablet 150 400 550 350 200 400
15 Antasida DOEN tablet tablet 200 200 200 0 200
16 Asam Askorbat (Vit. C) tablet 50 mg tablet 100 100 200 100 100 100
17 Asam Folat tab tablet
18 Asam Mefenamat tablet 500 mg tablet 150 200 350 200 150 200
19 Asam Tranexamat 500mg tablet
20 Asetosal 80mg (MINIASPI) tablet
21 Attalpulgite 600mg - New Antides tablet 50 100 150 50 100 100
22 Azithromycin 500 mg tab tablet
23 Betahistin 6mg tablet 100 100 70 30 100
24 Captopril 12,5 mg tablet 150 150 150 0
25 Captopril tablet 25 mg tablet 0 100 100 50 50 200
26 Captopril tablet 50 mg tablet
27 Cefadroxil 500 mg tablet 200 200 80 120 200
28 Clozapine 25mg tablet
29 Cyproploxasin tablet tablet 30 30 30 0 200
30 Deksametason tablet 0,5 mg tablet 150 200 350 250 100 400
31 Diazepam tablet 2 mg tablet
32 Digoksin tablet 0,25 mg tablet
33 Domperidon tablet 10 mg tablet 100 100 50 50
34 Doxycyklin 100 mg tablet capsul
35 Efedrina HCl. tablet 25 mg tablet
36 Ergotamin Caffein tablet tablet
37 Eritromisin kapsul 250 mg tablet
38 Eritromisin kapsul 500 mg tablet
39 Fenobarbital tablet 30 mg tablet
40 Fenofibrate 100 mg tablet
41 Fitomenadion (Vit. K) tablet salut 10 mg tablet
42 Fluoxetin 20mg (NOPRES) tablet
43 Furosemida tablet 40 mg tablet
44 Garam Oralit untuk 200 ml air Sachet 10 100 110 60 50 50
45 Gemfibrozil 150 mg tablet
46 Glibenklamida tablet 5 mg tablet 100 100 50 50 100
47 Glimepiride tablet 1 mg tablet
48 Glimepiride tablet 2 mg tablet
49 Griseofulvin tablet 125 mg Mikronized tablet 100
50 Guaifenisin tablet tablet 100 100 50 50 200
51 Haloperidol tablet 1,5 mg tablet
52 Haloperidol tablet 5 mg tablet
53 Hidroklortiazide (HCT) tablet 25 mg tablet
54 Hyoscine N Butilbromide/ SCOPMA tablet 50 50 50 0 200
55 Ibuprofen tablet 200 mg tablet
56 Ibuprofen tablet 400 mg tablet 50 100 150 100 50 300
57 Isoniazid ( INH ) + Pyridoxin (B6) tablet
58 Isoniazid ( INH ) 100mg tablet
59 Isosorbid Dinitrat Sub Lingual tablet 5 mg tablet
60 Kalsium Laktat tablet 500 mg tablet 90 90 20 70
61 Karbamazepin 200 mg tablet
62 Ketokonazole tablet 200 mg tablet
63 Klindamycin 150 mg tablet
64 Klindamycin 300 mg capsul
65 Kloramfenikol kapsul 250 mg tablet 100 100 100
66 Kloramfenikol kapsul 500 mg tablet
67 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 250 200 450 250 200 400
68 Klorpromazina tablet 100 mg tablet
69 KOMBIPAK (Azythromycin + Cefixime ) tablet
70 Kotrimoksazol dewasa tablet tablet 100 200 300 150 150 300
71 Kuinin ( Kina ) tablet 200 mg tablet
72 Loperamide 2mg tab tablet 100 200 300 150 150 200
73 Loratadin 10mg tablet 80 80 30 50 100
74 Lorazepam 1 mg (RENAQUIL 1mg) tablet
75 Metformin HCL 500 mg tablet tablet 100 100 20 80 100
76 Metilergometrin Maleat tablet 0,125 mg tablet
77 Metilprednisolon 4 mg tablet 50 50 50 0 200
78 metocloperamide tab 5 mg tablet
79 Metoclopramide 10 mg tablet 150 150 100 50 200
80 Metronidazol tablet 500 mg tablet 100 100 200 50 150 100
81 Mineral Mix Sachet Sachet
82 Misoprotol tab 200 mcg tablet
83 Na diklofenak 25mg tablet
84 Na diklofenak 50mg tablet 80 100 180 80 100 300
85 Nifedipin tablet tablet
86 Nistatin tablet salut 500.000 IU tablet
87 Obat Anti Tuberkulosis FDC kategori 1/3 paket
88 Obat Anti Tuberkulosis FDC kategori 2 paket
89 Obat Anti Tuberkulosis FDC kategori anak paket
90 Obat Anti Tuberkulosis KDT Harian paket
91 Omeprazole kapsul kapsul 50 100 50 200
92 Oseltamivir tablet
93 Parasetamol tablet 500 mg tablet 200 200 100 400
94 Phenytoin 100 mg capsul
95 Piridoksina HCl. tablet 10 mg tablet 200
96 Prednison tablet 5 mg tablet 200
97 Primakuin tablet 15 mg tablet
98 Propiltiourasil tablet 100 mg tablet
99 Ranitidin tablet 150 mg tablet 180 100 280 180 100 200
100 Retinol (Vitamin A) kapsul 100.000 IU capsul
101 Retinol (Vitamin A) kapsul 200.000 IU capsul
102 Risperidon 2 mg tablet tablet
103 Salbutamol tablet 2 mg tablet 0
104 Salbutamol tablet 4 mg tablet 150 100 250 100 150 200
105 Simvastatin 10mg tablet 50 50 50 0 200
106 Sivit zink tablet tablet
107 Spironolakston 25 mg tablet
108 Striatamin cap capsul
109 Tablet Tambah Darah kombinasi tablet 150 150 300 200 100
110 Tetrasiklina HCl. kapsul 500 mg capsul
111 Tiamine HCl. Mononitrat (Vit. B-1) tablet 50 mg tablet 300
112 Trifluoperazine 6 mg tablet
113 Triheksifenidil HCl. tablet 2 mg tablet
114 Valproat tab sal 250 mg (Depakote ER) botol
115 Vitamin B Komplek tablet tablet 150 200 350 270 80 400
116 Zinc tablet 20 mg botol 80 80 30 50 100
Syrup/ Suspensi
117 Ambroxol sirup 15mg/ml botol 4 4 1 3
118 Amoksisilina sirup kering 125 mg/ 5ml botol 4 4 1 3
119 Amoksisilina sirup kering 250 mg/ 5ml botol
120 Amoxicillin drop botol
121 Antasida DOEN suspensi botol 5 5 0 5
122 Cefadroxil sirup 125mg/ml botol
123 Domperidon syrup botol
124 Eritromisin Syrup Kering 200mg/5ml botol
125 Ibuprofen sirup 100mg/5ml botol
126 Kloramfenikol suspensi 125mg/5 ml botol
127 Kotrimoksazol suspensi botol 2 2 2 0
128 Multivitamin dan mineral (caviplex) syr botol
129 Parasetamol drop 100 mg/ml @ 15 ml botol
130 Parasetamol sirup 120 mg / 5 ml botol 2 2 0 2
131 Setirizin sir 5 mg/5 ml. botol
132 Valproat syrup 250 mg/ml botol
133 Zinc sir 20 mg/5 ml botol
Injeksi
134 ACT injeksi ampul
135 Aminofilina injeksi 24 mg / ml-10ml ampul
136 Ampisilina injeksi Ampul
137 Aqua Pro injeksi steril bebas pirogen ampul
138 Asam Tranexamat 500mg/5 ml injeksi ampul
139 Atropin Sulfat injeksi 0,25 mg / ml-1 ml ampul
140 Calsium Glukonas Inj ampul
141 Deksametason inj. 5 mg /ml-1 ml Ampul 5 5 0 5
142 Diazepam injeksi 5 mg/ ml- 2 ml ampul
143 Difenhidramina injeksi 10 mg/ ml- 1 ml ampul
144 Epinefrin injeksi 0,1 % - 1 ml ampul
145 Fenobarbital injeksi 50 mg / ml-1 ml ampul
146 Fitomenadion (Vit. K) injeksi 10 mg / ml-1 ml ampul
147 Haloperidol injeksi 5mg/ml (LODOMER 5) ampul
148 Ketorolac Inj 30 mg/ml ampul 10 10 5 5 10
149 Kloramfenikol injeksi Ampul
150 Lidokain 2% injeksi (tunggal) ampul 5 5 3 2 10
151 Lidokain Kompositum injeksi ampul
152 Magnesium Sulfat injeksiI (IV) 20 %-25 ml Vial
153 Magnesium Sulfat injeksiI (IV) 40 %-25 ml Vial
154 Metilergometrin Maleat injeksi 0,2 mg / ml Ampul
155 Metocloperamide inj Ampul 10 10 20 15 5 10
156 Nebules kombinasi : ipatropium br 0.5 mg+ salbutamo Vial 10
157 Oksitosin injeksi 10 IU / ml - 1 ml ampul
158 Omeprazole 40mg/10 ml injeksi Vial
159 Prokain Benzil Penisilin inj 3jt IU Vial
160 Ranitidine injeksi Pot 10
161 Sabu Polivalen 5 ml (ABU I) Vial
162 Salbutamol Inj 1 mg/ml Vial
163 Serum Anti Tetanus injeksi 1.500 IU / ampul (ATS) ampul
164 Sianokobalamin (Vit. B 12) injeksi 500 mcg / ml ampul
Obat Luar
165 Acyclovir krim 5% tube 3 5 8 3 5 5
166 Antibakteri DOEN salep kombinasi tube 3 5 8 4 4 5
167 Antifungi DOEN kombinasi tube
168 Antihemaroid DOEN kombinasi suppo
169 Betametason krim 0,1 % tube 2 5 7 4 3 5
170 Borax Glycerin botol
171 Calamin (Caladin) lotion 60 ml botol 4 4 1 3 5
172 Diazepam rectal tube 5 mg (stesolid rectal) tube
173 Diazepam rectal tube 10mg (stesolid rectal) tube
174 Dulcolax 5mg supp (anak) suppo 6 6 0 6
175 Dulcolax 10mg supp (Dewasa) suppo
176 Etakridina (Rivanol) larutan 0,1 % botol
177 Etanol 70 % botol
178 Fenolgliserol tetes telinga 10 % botol
179 Gentamicin salep mata (GENOINT) 0,3 % tube
180 Gentamicin tetes mata 0,3 % botol
181 Hidrokortison krim 2,5 % tube 0 5
182 Ketokonazole cream 2% tube
183 Kloramfenikol salep kulit 2% (BUFACETIN) tube
184 Kloramfenikol salep mata 1 % tube 5 5 10 3 7 5
185 Kloramfenikol tetes mata 0,5 % botol
186 Kloramfenikol tetes telinga 3 % botol
187 Miconazol krim tube 4 5 9 4 5 5
188 Oksitetrasiklin salep mata 1 % tube
189 Parasetamol / Pamol suppo 125mg suppo 5 5 0 5 10
190 Perhidrol ( Lar H2O2 ) tube
191 Povidon Iodida 10 % , 30 ml botol
192 Povidon Iodida 10 % , 60 ml botol
193 Povidon Iodida 10 % , 300 ml botol
194 Salep 2-4 Kombinasi Pot 5
195 Salisil Bedak 2 % botol 2 5 7 2 5 5
196 Scabicid/Scabimid cream tube 5
197 Silver sulfadiazin Cream 1% 35 gr tube 1
Infus dan Cairan
198 Cairan Untuk Irigasi 1000 ml Flash
199 Glukosa infus 5 % Flash
200 Glukosa infus 10 % Flash
201 Alkohol 70% Flash 1
202 Natrium Klorida infus 0,9 % 500 ml Flash 2 2 2 0 3
203 Prontosan Wound Irrigation sol 350ml botol
204 Ringer Laktat larutan infus steril Flash
Bahan Medis Habis Pakai
205 Alat Suntik sekali pakai 1 ml Set
206 Alat Suntik sekali pakai 3 ml Set 10 20 30 15 15 20
207 Alat Suntik sekali pakai 5 ml Set 8 15 23 8 15 10
208 Catgut / Benang Bedah No. 2/0 24x70 cm `
209 Catgut / Benang Bedah No. 3/0 24x70 cm
210 Cover Glass 20x20 set
211 Dermafix S IV set
212 Feeding Tube 40cm No. 8 set
213 Foley cathether No. 16 set
214 Foley cathether No. 18 set
215 Foley cathether No. 20 set
216 Gown set botol
217 Hand Rub 500ml botol
218 Hand Scrub 500ml botol
219 Handrub refill 5 liter galon
220 Hazmat Size L set
221 Hazmat Size XL set
222 Infusion Set anak-anak set
223 Infusion Set dewasa set
224 IV Cathether No. 18 G set
225 IV Cathether No. 20 G set
226 IV Cathether No. 22 G set
227 IV Cathether No. 24 G set
228 Jarum hecting kombinasi set
229 Jelly Dopler botol
230 Kapas Pembalut / Adsorben 250 gram rol 1
231 Kasa Pembalut 40 yd x 110 cm rol
232 Kasa Pembalut 4x10 cm rol
233 Kasa Pembalut 4x15 cm rol
234 Kertas EKG 58mm x 25 m rol
235 Kertas EKG 58mm X 30 m rol
236 Kertas EKG 63mm X 30 m rol
237 Kertas EKG 80mm x 20 m rol
238 Lokal kacamata faceshield set
239 Masker Bedah Anak pcs
240 Masker KN 95 pcs
241 Masker N 95 pcs
242 Masker Oxygen (Maxiflow) Anak (Pediatrik) set
243 Masker Oxygen (Maxiflow) Dewasa (Adult) set
244 Masker surgical pcs 20 25 45 20 25 25
245 Masker surgical Anak pcs
246 Object Glass 20x20 mm pack
247 Oxygen Nasal Adult (Dewasa) set
248 Oxygen Nasal NewNates set
249 Oxygen Nasal Pediatric set
250 Pembalut gibs rol
251 Plester 5 yard x 2 inchi (plester coklat) rol 0 1 1 0 1 2
252 Plester Kertas 1" (surgical tape) rol
253 Regulator Oksigen set
254 Sarung tangan steril no.6,5 pasang
255 Sarung tangan steril NO.7 pasang
256 Sarung tangan steril NO.7,5 pasang
257 Sarung tangan non steril uk. S pasang
258 Sarung tangan non steril uk.M pasang 30 50 80 30 50
259 Sarung tangan obgin No. 6,5 pasang
260 Sarung tangan obgin No. 7 pasang
261 Sarung tangan obgin No. 7,5 pasang
262 Sarung tangan obgyn no. 8 pasang
263 Silk 2/0 + 1/2 GT 35MM set
264 Silk 3/0 + 1/2 GT 35MM set
265 Solida Nurse Cap set
266 Surgical mess 11 pack
267 Surgical mess 20 pack
268 Transparent IV Dressing (with notch) set
269 Umbilical cord klem set
270 Urine bag set
271 Wing Neddle No 21 G set
272 Wing Neddle No 23 G set
273 Wing Neddle No 25 G set
Tambahan
274 Cetirizine tab tablet 70 100 170 100 70 200
275 Alkohol swab pack
276 Kasa hidrofil steril pack
277 Klip sheet 200 200 400 30 100 300
278 Kertas Puyer sheet 100 0 200

Yang Memberikan, Yang Menerima,

Pengelola Obat Puskesmas Pengelola Obat Unit

Nisa' Amila Rodhiya, S.Farm., Apt Ns. Baiq Retno.C.M ,S.Kep

 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
NO : PELAPORAN BULAN : November
NAMA PUSKESMAS : PRINGGARATA PENERIMAAN BULAN : Desember
NAMA UNIT : PUSTU PEMEPEK
PENGELOLA OBAT : Ns. BAIQ RETNO, S.Kep
EXPIRED
STOK
No. Nama Obat Satuan STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
OPTIMUM
PERMINTAAN PEMBERIAN NO. BATCH DATE/
KETERANGAN
Tablet/Kapsul/Sachet
1 ACT tablet tablet
2 Acetyl Cystein 200mg tablet 120 120 40 80 100
3 Acyclovir 200 mg tablet tablet
4 Acyclovir 400 mg tablet tablet 40 100 140 40 100
5 Albendazol tablet 400 mg tablet 0
6 Alopurinol tablet 100 mg tablet 80 200 280 130 150 200
7 Alprazolam 0,5 mg tablet tablet
8 Alprazolam 1 mg tablet
9 Ambroxol tablet tablet 80 300 380 230 150 300
10 Aminofilina tablet 200 mg tablet
11 Amitriptilina tablet 25 mg tablet
12 Amlodipin 5 mg tablet
13 Amlodipin 10 mg tablet 70 100 170 60 110 200
14 Amoksisilina kapsul 500 mg tablet 200 400 600 370 230 400
15 Antasida DOEN tablet tablet 0 200 200 50 150 300
16 Asam Askorbat (Vit. C) tablet 50 mg tablet 100 100 200 100 100 300
17 Asam Folat tab tablet
18 Asam Mefenamat tablet 500 mg tablet 150 100 250 150 100 300
19 Asam Tranexamat 500mg tablet
20 Asetosal 80mg (MINIASPI) tablet
21 Attalpulgite 600mg - New Antides tablet 100 100 200 100 100 200
22 Azithromycin 500 mg tab tablet
23 Betahistin 6mg tablet 30 90 120 30 90 120
24 Captopril 12,5 mg tablet 0
25 Captopril tablet 25 mg tablet 50 200 250 100 150 300
26 Captopril tablet 50 mg tablet
27 Cefadroxil 500 mg tablet 120 100 220 120 100 200
28 Clozapine 25mg tablet
29 Cyproploxasin tablet tablet 0 100 100 50 50 200
30 Deksametason tablet 0,5 mg tablet 100 300 400 250 150 400
31 Diazepam tablet 2 mg tablet
32 Digoksin tablet 0,25 mg tablet
33 Domperidon tablet 10 mg tablet 50 50 0 50
34 Doxycyklin 100 mg tablet capsul
35 Efedrina HCl. tablet 25 mg tablet
36 Ergotamin Caffein tablet tablet
37 Eritromisin kapsul 250 mg tablet
38 Eritromisin kapsul 500 mg tablet
39 Fenobarbital tablet 30 mg tablet
40 Fenofibrate 100 mg tablet
41 Fitomenadion (Vit. K) tablet salut 10 mg tablet
42 Fluoxetin 20mg (NOPRES) tablet
43 Furosemida tablet 40 mg tablet
44 Garam Oralit untuk 200 ml air Sachet 50 50 100 50 50 100
45 Gemfibrozil 150 mg tablet
46 Glibenklamida tablet 5 mg tablet 50 100 150 0 150 200
47 Glimepiride tablet 1 mg tablet
48 Glimepiride tablet 2 mg tablet
49 Griseofulvin tablet 125 mg Mikronized tablet 100 100 0 100
50 Guaifenisin tablet tablet 50 200 250 100 150 300
51 Haloperidol tablet 1,5 mg tablet
52 Haloperidol tablet 5 mg tablet
53 Hidroklortiazide (HCT) tablet 25 mg tablet
54 Hyoscine N Butilbromide/ SCOPMA tablet 0 100 100 50 50 200
55 Ibuprofen tablet 200 mg tablet
56 Ibuprofen tablet 400 mg tablet 50 200 250 100 150 400
57 Isoniazid ( INH ) + Pyridoxin (B6) tablet
58 Isoniazid ( INH ) 100mg tablet
59 Isosorbid Dinitrat Sub Lingual tablet 5 mg tablet
60 Kalsium Laktat tablet 500 mg tablet 70 70 0 70
61 Karbamazepin 200 mg tablet
62 Ketokonazole tablet 200 mg tablet
63 Klindamycin 150 mg tablet
64 Klindamycin 300 mg capsul
65 Kloramfenikol kapsul 250 mg tablet 100 100 50 50 100
66 Kloramfenikol kapsul 500 mg tablet
67 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 200 300 500 250 250 400
68 Klorpromazina tablet 100 mg tablet
69 KOMBIPAK (Azythromycin + Cefixime ) tablet
70 Kotrimoksazol dewasa tablet tablet 150 200 350 250 100 300
71 Kuinin ( Kina ) tablet 200 mg tablet
72 Loperamide 2mg tab tablet 150 200 350 100 250 200
73 Loratadin 10mg tablet 50 50 50 0 300
74 Lorazepam 1 mg (RENAQUIL 1mg) tablet
75 Metformin HCL 500 mg tablet tablet 80 200 280 30 250 200
76 Metilergometrin Maleat tablet 0,125 mg tablet
77 Metilprednisolon 4 mg tablet 0
78 Metocloperamide tab 5 mg tablet
79 Metoclopramide 10 mg tablet 50 50 50 0 300
80 Metronidazol tablet 500 mg tablet 150 100 250 150 150 200
81 Mineral Mix Sachet Sachet
82 Misoprotol tab 200 mcg tablet
83 Na diklofenak 25mg tablet
84 Na diklofenak 50mg tablet 100 100 200 80 120 300
85 Nifedipin tablet tablet
86 Nistatin tablet salut 500.000 IU tablet
87 Obat Anti Tuberkulosis FDC kategori 1/3 paket
88 Obat Anti Tuberkulosis FDC kategori 2 paket
89 Obat Anti Tuberkulosis FDC kategori anak paket
90 Obat Anti Tuberkulosis KDT Harian paket
91 Omeprazole kapsul kapsul 50 120 170 70 100 200
92 Oseltamivir tablet
93 Parasetamol tablet 500 mg tablet 100 300 400 200 200 500
94 Phenytoin 100 mg capsul
95 Piridoksina HCl. tablet 10 mg tablet 200 200 0 200 300
96 Prednison tablet 5 mg tablet
97 Primakuin tablet 15 mg tablet
98 Propiltiourasil tablet 100 mg tablet
99 Ranitidin tablet 150 mg tablet 100 100 200 100 100 300
100 Retinol (Vitamin A) kapsul 100.000 IU capsul
101 Retinol (Vitamin A) kapsul 200.000 IU capsul
102 Risperidon 2 mg tablet tablet
103 Salbutamol tablet 2 mg tablet
104 Salbutamol tablet 4 mg tablet 150 200 350 100 250 200
105 Simvastatin 10mg tablet 0 100 100 30 70 200
106 Sivit zink tablet tablet
107 Spironolakston 25 mg tablet
108 Striatamin cap capsul
109 Tablet Tambah Darah kombinasi tablet 100 100 30 70 200
110 Tetrasiklina HCl. kapsul 500 mg capsul
111 Tiamine HCl. Mononitrat (Vit. B-1) tablet 50 tablet 200 200 100 100 300
112 Trifluoperazine 6 mg tablet
113 Triheksifenidil HCl. tablet 2 mg tablet
114 Valproat tab sal 250 mg (Depakote ER) botol
115 Vitamin B Komplek tablet tablet 80 200 280 130 150 300
116 Zinc tablet 20 mg botol 50 100 150 80 70 200
Syrup/ Suspensi
117 Ambroxol sirup 15mg/ml botol
118 Amoksisilina sirup kering 125 mg/ 5ml botol
119 Amoksisilina sirup kering 250 mg/ 5ml botol
120 Amoxicillin drop botol
121 Antasida DOEN suspensi botol
122 Cefadroxil sirup 125mg/ml botol
123 Domperidon syrup botol
124 Eritromisin Syrup Kering 200mg/5ml botol
125 Ibuprofen sirup 100mg/5ml botol
126 Kloramfenikol suspensi 125mg/5 ml botol
127 Kotrimoksazol suspensi botol
128 Multivitamin dan mineral (caviplex) syr botol
129 Parasetamol drop 100 mg/ml @ 15 ml botol
130 Parasetamol sirup 120 mg / 5 ml botol
131 Setirizin sir 5 mg/5 ml. botol
132 Valproat syrup 250 mg/ml botol
133 Zinc sir 20 mg/5 ml botol
Injeksi
134 ACT injeksi ampul
135 Aminofilina injeksi 24 mg / ml-10ml ampul
136 Ampisilina injeksi Ampul
137 Aqua Pro injeksi steril bebas pirogen ampul
138 Asam Tranexamat 500mg/5 ml injeksi ampul
139 Atropin Sulfat injeksi 0,25 mg / ml-1 ml ampul
140 Calsium Glukonas Inj ampul
141 Deksametason inj. 5 mg /ml-1 ml Ampul 5 5 0 5
142 Diazepam injeksi 5 mg/ ml- 2 ml ampul
143 Difenhidramina injeksi 10 mg/ ml- 1 ml ampul
144 Epinefrin injeksi 0,1 % - 1 ml ampul
145 Fenobarbital injeksi 50 mg / ml-1 ml ampul
146 Fitomenadion (Vit. K) injeksi 10 mg / ml-1 ml ampul
147 Haloperidol injeksi 5mg/ml (LODOMER 5) ampul
148 Ketorolac Inj 30 mg/ml ampul 5 10 15 5 10
149 Kloramfenikol injeksi Ampul
150 Lidokain 2% injeksi (tunggal) ampul 2 10 12 2 10
151 Lidokain Kompositum injeksi ampul
152 Magnesium Sulfat injeksiI (IV) 20 %-25 ml Vial
153 Magnesium Sulfat injeksiI (IV) 40 %-25 ml Vial
154 Metilergometrin Maleat injeksi 0,2 mg / ml Ampul
155 Metocloperamide inj Ampul 5 10 15 5 10
156 Nebules kombinasi : ipatropium br 0.5 mg Vial 5 5 0 5
157 Oksitosin injeksi 10 IU / ml - 1 ml ampul
158 Omeprazole 40mg/10 ml injeksi Vial
159 Prokain Benzil Penisilin inj 3jt IU Vial
160 Ranitidine injeksi Pot
161 Sabu Polivalen 5 ml (ABU I) Vial
162 Salbutamol Inj 1 mg/ml Vial
163 Serum Anti Tetanus injeksi 1.500 IU / ampul ampul
164 Sianokobalamin (Vit. B 12) injeksi 500 mcg / ampul
Obat Luar
165 Acyclovir krim 5% tube 5 5 10 3 7 10
166 Antibakteri DOEN salep kombinasi tube 4 5 9 5 4 10
167 Antifungi DOEN kombinasi tube
168 Antihemaroid DOEN kombinasi suppo
169 Betametason krim 0,1 % tube 3 5 8 3 5 10
170 Borax Glycerin botol
171 Calamin (Caladin) lotion 60 ml botol 3 5 8 1 7 10
172 Diazepam rectal tube 5 mg (stesolid rectal) tube
173 Diazepam rectal tube 10mg (stesolid rectal) tube
174 Dulcolax 5mg supp (anak) suppo 6 6 0 6
175 Dulcolax 10mg supp (Dewasa) suppo
176 Etakridina (Rivanol) larutan 0,1 % botol
177 Etanol 70 % botol
178 Fenolgliserol tetes telinga 10 % botol
179 Gentamicin salep mata (GENOINT) 0,3 % tube
180 Gentamicin tetes mata 0,3 % botol
181 Hidrokortison krim 2,5 % tube 5 5 1 4 10
182 Ketokonazole cream 2% tube
183 Kloramfenikol salep kulit 2% (BUFACETIN) tube
184 Kloramfenikol salep mata 1 % tube 7 5 12 2 10 10
185 Kloramfenikol tetes mata 0,5 % botol
186 Kloramfenikol tetes telinga 3 % botol
187 Miconazol krim tube 5 5 1 4 10
188 Oksitetrasiklin salep mata 1 % tube
189 Parasetamol / Pamol suppo 125mg suppo 5 6 11 5 6 10
190 Perhidrol ( Lar H2O2 ) tube
191 Povidon Iodida 10 % , 30 ml botol
192 Povidon Iodida 10 % , 60 ml botol
193 Povidon Iodida 10 % , 300 ml botol
194 Salep 2-4 Kombinasi Pot
195 Salisil Bedak 2 % botol 5 5 10 0 10 10
196 Scabicid/Scabimid cream tube
197 Silver sulfadiazin Cream 1% 35 gr tube
Infus dan Cairan
198 Cairan Untuk Irigasi 1000 ml Flash
199 Glukosa infus 5 % Flash
200 Glukosa infus 10 % Flash
201 Alkohol 70% Flash 1 1 0 1
202 Natrium Klorida infus 0,9 % 500 ml Flash 0 3
203 Prontosan Wound Irrigation sol 350ml botol
204 Ringer Laktat larutan infus steril Flash
Bahan Medis Habis Pakai
205 Alat Suntik sekali pakai 1 ml Set
206 Alat Suntik sekali pakai 3 ml Set 15 20 35 7 28
207 Alat Suntik sekali pakai 5 ml Set 15 10 25 5 20
208 Catgut / Benang Bedah No. 2/0 24x70 cm
209 Catgut / Benang Bedah No. 3/0 24x70 cm
210 Cover Glass 20x20 set
211 Dermafix S IV set
212 Feeding Tube 40cm No. 8 set
213 Foley cathether No. 16 set
214 Foley cathether No. 18 set
215 Foley cathether No. 20 set
216 Gown set botol
217 Hand Rub 500ml botol
218 Hand Scrub 500ml botol
219 Handrub refill 5 liter galon
220 Hazmat Size L set
221 Hazmat Size XL set
222 Infusion Set anak-anak set
223 Infusion Set dewasa set
224 IV Cathether No. 18 G set
225 IV Cathether No. 20 G set
226 IV Cathether No. 22 G set
227 IV Cathether No. 24 G set
228 Jarum hecting kombinasi set
229 Jelly Dopler botol
230 Kapas Pembalut / Adsorben 250 gram rol
231 Kasa Pembalut 40 yd x 110 cm rol
232 Kasa Pembalut 4x10 cm rol
233 Kasa Pembalut 4x15 cm rol
234 Kertas EKG 58mm x 25 m rol
235 Kertas EKG 58mm X 30 m rol
236 Kertas EKG 63mm X 30 m rol
237 Kertas EKG 80mm x 20 m rol
238 Lokal kacamata faceshield set
239 Masker Bedah Anak pcs
240 Masker KN 95 pcs
241 Masker N 95 pcs
242 Masker Oxygen (Maxiflow) Anak (Pediatrik) set
243 Masker Oxygen (Maxiflow) Dewasa (Adult) set
244 Masker surgical pcs 25 25 50 25 25 25
245 Masker surgical Anak pcs
246 Object Glass 20x20 mm pack
247 Oxygen Nasal Adult (Dewasa) set
248 Oxygen Nasal NewNates set
249 Oxygen Nasal Pediatric set
250 Pembalut gibs rol
251 Plester 5 yard x 2 inchi (plester coklat) rol 1 2 3 1 2
252 Plester Kertas 1" (surgical tape) rol
253 Regulator Oksigen set
254 Sarung tangan steril no.6,5 pasang
255 Sarung tangan steril NO.7 pasang
256 Sarung tangan steril NO.7,5 pasang
257 Sarung tangan non steril uk. S pasang
258 Sarung tangan non steril uk.M pasang 50 50 20 30
259 Sarung tangan obgin No. 6,5 pasang
260 Sarung tangan obgin No. 7 pasang
261 Sarung tangan obgin No. 7,5 pasang
262 Sarung tangan obgyn no. 8 pasang
263 Silk 2/0 + 1/2 GT 35MM set
264 Silk 3/0 + 1/2 GT 35MM set
265 Solida Nurse Cap set
266 Surgical mess 11 pack
267 Surgical mess 20 pack
268 Transparent IV Dressing (with notch) set
269 Umbilical cord klem set
270 Urine bag set
271 Wing Neddle No 21 G set
272 Wing Neddle No 23 G set
273 Wing Neddle No 25 G set
Tambahan
274 Cetirizine tab tablet 70 70 70 0 300
275 Alkohol swab pack
276 Kasa hidrofil steril pack
277 Klip sheet 100 300 400 100 200 400
278 Kertas Puyer sheet 0 200 200 0 200 200

Yang Memberikan, Yang Menerima,

Pengelola Obat Puskesmas Pengelola Obat Unit

Nisa' Amila Rodhiya, S.Farm., Apt Ns. Baiq Retno.C.M ,S.Kep

 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
NO :
NAMA PUSKESMAS : PRINGGARATA
NAMA UNIT : PUSTU PEMEPEK
PENGELOLA OBAT : Ns. BAIQ RETNO, S.Kep

No. Nama Obat Satuan STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN

Tablet/Kapsul/Sachet
1 ACT tablet tablet
2 Acetyl Cystein 200mg tablet 80 60 140 60
3 Acyclovir 200 mg tablet tablet
4 Acyclovir 400 mg tablet tablet 100 100
5 Albendazol tablet 400 mg tablet 0
6 Alopurinol tablet 100 mg tablet 150 150 100
7 Alprazolam 0,5 mg tablet tablet
8 Alprazolam 1 mg tablet
9 Ambroxol tablet tablet 150 300 450 200
10 Aminofilina tablet 200 mg tablet
11 Amitriptilina tablet 25 mg tablet
12 Amlodipin 5 mg tablet
13 Amlodipin 10 mg tablet 110 100 210 110
14 Amoksisilina kapsul 500 mg tablet 230 400 630 430
15 Antasida DOEN tablet tablet 150 300 450 200
16 Asam Askorbat (Vit. C) tablet 50 mg tablet 100 100 50
17 Asam Folat tab tablet
18 Asam Mefenamat tablet 500 mg tablet 100 100 40
19 Asam Tranexamat 500mg tablet
20 Asetosal 80mg (MINIASPI) tablet
21 Attalpulgite 600mg - New Antides tablet 100 200 300 200
22 Azithromycin 500 mg tab tablet
23 Betahistin 6mg tablet 90 120 210 120
24 Captopril 12,5 mg tablet
25 Captopril tablet 25 mg tablet 150 200 350 200
26 Captopril tablet 50 mg tablet
27 Cefadroxil 500 mg tablet 100 100 100
28 Clozapine 25mg tablet
29 Cyproploxasin tablet tablet 50 200 250 100
30 Deksametason tablet 0,5 mg tablet 150 400 550 300
31 Diazepam tablet 2 mg tablet
32 Digoksin tablet 0,25 mg tablet
33 Domperidon tablet 10 mg tablet 50 50 50
34 Doxycyklin 100 mg tablet capsul
35 Efedrina HCl. tablet 25 mg tablet
36 Ergotamin Caffein tablet tablet
37 Eritromisin kapsul 250 mg tablet
38 Eritromisin kapsul 500 mg tablet
39 Fenobarbital tablet 30 mg tablet
40 Fenofibrate 100 mg tablet
41 Fitomenadion (Vit. K) tablet salut 10 mg tablet
42 Fluoxetin 20mg (NOPRES) tablet
43 Furosemida tablet 40 mg tablet
44 Garam Oralit untuk 200 ml air Sachet 50 50 100 20
45 Gemfibrozil 150 mg tablet
46 Glibenklamida tablet 5 mg tablet 150 200 350 200
47 Glimepiride tablet 1 mg tablet
48 Glimepiride tablet 2 mg tablet
49 Griseofulvin tablet 125 mg Mikronized tablet 100 100 0
50 Guaifenisin tablet tablet 150 200 350 150
51 Haloperidol tablet 1,5 mg tablet
52 Haloperidol tablet 5 mg tablet
53 Hidroklortiazide (HCT) tablet 25 mg tablet
54 Hyoscine N Butilbromide/ SCOPMA tablet 50 50 50
55 Ibuprofen tablet 200 mg tablet
56 Ibuprofen tablet 400 mg tablet 150 200 350 180
57 Isoniazid ( INH ) + Pyridoxin (B6) tablet
58 Isoniazid ( INH ) 100mg tablet
59 Isosorbid Dinitrat Sub Lingual tablet 5 mg tablet
60 Kalsium Laktat tablet 500 mg tablet 70 70 0
61 Karbamazepin 200 mg tablet
62 Ketokonazole tablet 200 mg tablet
63 Klindamycin 150 mg tablet
64 Klindamycin 300 mg capsul
65 Kloramfenikol kapsul 250 mg tablet 50 100 150 100
66 Kloramfenikol kapsul 500 mg tablet
67 Klorfeniramin Maleat (CTM) tablet 4 mg tablet 250 200 450 250
68 Klorpromazina tablet 100 mg tablet
69 KOMBIPAK (Azythromycin + Cefixime ) tablet
70 Kotrimoksazol dewasa tablet tablet 100 200 300 130
71 Kuinin ( Kina ) tablet 200 mg tablet
72 Loperamide 2mg tab tablet 250 200 450 250
73 Loratadin 10mg tablet 0
74 Lorazepam 1 mg (RENAQUIL 1mg) tablet
75 Metformin HCL 500 mg tablet tablet 250 200 450 250
76 Metilergometrin Maleat tablet 0,125 mg tablet
77 Metilprednisolon 4 mg tablet
78 Metocloperamide tab 5 mg tablet
79 Metoclopramide 10 mg tablet 0
80 Metronidazol tablet 500 mg tablet 150 200 350 150
81 Mineral Mix Sachet Sachet
82 Misoprotol tab 200 mcg tablet
83 Na diklofenak 25mg tablet
84 Na diklofenak 50mg tablet 120 100 220 120
85 Nifedipin tablet tablet
86 Nistatin tablet salut 500.000 IU tablet
87 Obat Anti Tuberkulosis FDC kategori 1/3 paket
88 Obat Anti Tuberkulosis FDC kategori 2 paket
89 Obat Anti Tuberkulosis FDC kategori anak paket
90 Obat Anti Tuberkulosis KDT Harian paket
91 Omeprazole kapsul kapsul 100 120 220 140
92 Oseltamivir tablet
93 Parasetamol tablet 500 mg tablet 200 300 500 360
94 Phenytoin 100 mg capsul
95 Piridoksina HCl. tablet 10 mg tablet 200 200 400 250
96 Prednison tablet 5 mg tablet
97 Primakuin tablet 15 mg tablet
98 Propiltiourasil tablet 100 mg tablet
99 Ranitidin tablet 150 mg tablet 100 200 300 150
100 Retinol (Vitamin A) kapsul 100.000 IU capsul
101 Retinol (Vitamin A) kapsul 200.000 IU capsul
102 Risperidon 2 mg tablet tablet
103 Salbutamol tablet 2 mg tablet
104 Salbutamol tablet 4 mg tablet 250 200 450 200
105 Simvastatin 10mg tablet 70 200 270 170
106 Sivit zink tablet tablet
107 Spironolakston 25 mg tablet
108 Striatamin cap capsul
109 Tablet Tambah Darah kombinasi tablet 70 210 280 180
110 Tetrasiklina HCl. kapsul 500 mg capsul
111 Tiamine HCl. Mononitrat (Vit. B-1) tablet 50 mg tablet 100 100 100
112 Trifluoperazine 6 mg tablet
113 Triheksifenidil HCl. tablet 2 mg tablet
114 Valproat tab sal 250 mg (Depakote ER) botol
115 Vitamin B Komplek tablet tablet 150 300 450 350
116 Zinc tablet 20 mg botol 70 200 270 90
Syrup/ Suspensi
117 Ambroxol sirup 15mg/ml botol
118 Amoksisilina sirup kering 125 mg/ 5ml botol
119 Amoksisilina sirup kering 250 mg/ 5ml botol
120 Amoxicillin drop botol
121 Antasida DOEN suspensi botol
122 Cefadroxil sirup 125mg/ml botol
123 Domperidon syrup botol
124 Eritromisin Syrup Kering 200mg/5ml botol
125 Ibuprofen sirup 100mg/5ml botol
126 Kloramfenikol suspensi 125mg/5 ml botol
127 Kotrimoksazol suspensi botol
128 Multivitamin dan mineral (caviplex) syr botol
129 Parasetamol drop 100 mg/ml @ 15 ml botol
130 Parasetamol sirup 120 mg / 5 ml botol
131 Setirizin sir 5 mg/5 ml. botol
132 Valproat syrup 250 mg/ml botol
133 Zinc sir 20 mg/5 ml botol
 Injeksi
134 ACT injeksi ampul
135 Aminofilina injeksi 24 mg / ml-10ml ampul
136 Ampisilina injeksi Ampul
137 Aqua Pro injeksi steril bebas pirogen ampul
138 Asam Tranexamat 500mg/5 ml injeksi ampul
139 Atropin Sulfat injeksi 0,25 mg / ml-1 ml ampul
140 Calsium Glukonas Inj ampul
141 Deksametason inj. 5 mg /ml-1 ml Ampul 5 5 0
142 Diazepam injeksi 5 mg/ ml- 2 ml ampul
143 Difenhidramina injeksi 10 mg/ ml- 1 ml ampul
144 Epinefrin injeksi 0,1 % - 1 ml ampul
145 Fenobarbital injeksi 50 mg / ml-1 ml ampul
146 Fitomenadion (Vit. K) injeksi 10 mg / ml-1 ml ampul
147 Haloperidol injeksi 5mg/ml (LODOMER 5) ampul
148 Ketorolac Inj 30 mg/ml ampul 10 10 0
149 Kloramfenikol injeksi Ampul
150 Lidokain 2% injeksi (tunggal) ampul 10 10 1
151 Lidokain Kompositum injeksi ampul
152 Magnesium Sulfat injeksiI (IV) 20 %-25 ml Vial
153 Magnesium Sulfat injeksiI (IV) 40 %-25 ml Vial
154 Metilergometrin Maleat injeksi 0,2 mg / ml Ampul
155 Metocloperamide inj Ampul 10 10 0
156 Nebules kombinasi : ipatropium br 0.5 mg+ s Vial 5 5 0
157 Oksitosin injeksi 10 IU / ml - 1 ml ampul
158 Omeprazole 40mg/10 ml injeksi Vial
159 Prokain Benzil Penisilin inj 3jt IU Vial
160 Ranitidine injeksi Pot
161 Sabu Polivalen 5 ml (ABU I) Vial
162 Salbutamol Inj 1 mg/ml Vial
163 Serum Anti Tetanus injeksi 1.500 IU / ampul (A ampul
164 Sianokobalamin (Vit. B 12) injeksi 500 mcg / m ampul
Obat Luar
165 Acyclovir krim 5% tube 7 5 12 5
166 Antibakteri DOEN salep kombinasi tube 4 5 9 5
167 Antifungi DOEN kombinasi tube
168 Antihemaroid DOEN kombinasi suppo
169 Betametason krim 0,1 % tube 5 5 10 6
170 Borax Glycerin botol
171 Calamin (Caladin) lotion 60 ml botol 7 10 17 5
172 Diazepam rectal tube 5 mg (stesolid rectal) tube
173 Diazepam rectal tube 10mg (stesolid rectal) tube
174 Dulcolax 5mg supp (anak) suppo 6 6 0
175 Dulcolax 10mg supp (Dewasa) suppo
176 Etakridina (Rivanol) larutan 0,1 % botol
177 Etanol 70 % botol
178 Fenolgliserol tetes telinga 10 % botol
179 Gentamicin salep mata (GENOINT) 0,3 % tube
180 Gentamicin tetes mata 0,3 % botol
181 Hidrokortison krim 2,5 % tube 4 4 4
182 Ketokonazole cream 2% tube
183 Kloramfenikol salep kulit 2% (BUFACETIN) tube
184 Kloramfenikol salep mata 1 % tube 10 10 20 1
185 Kloramfenikol tetes mata 0,5 % botol
186 Kloramfenikol tetes telinga 3 % botol
187 Miconazol krim tube 4 4 4
188 Oksitetrasiklin salep mata 1 % tube
189 Parasetamol / Pamol suppo 125mg suppo 6 5 11 3
190 Perhidrol ( Lar H2O2 ) tube
191 Povidon Iodida 10 % , 30 ml botol
192 Povidon Iodida 10 % , 60 ml botol
193 Povidon Iodida 10 % , 300 ml botol
194 Salep 2-4 Kombinasi Pot
195 Salisil Bedak 2 % botol 10 10 20 2
196 Scabicid/Scabimid cream tube
197 Silver sulfadiazin Cream 1% 35 gr tube
Infus dan Cairan
198 Cairan Untuk Irigasi 1000 ml Flash
199 Glukosa infus 5 % Flash
200 Glukosa infus 10 % Flash
201 Alkohol 70% Flash 1 1 0
202 Natrium Klorida infus 0,9 % 500 ml Flash 3 3 0
203 Prontosan Wound Irrigation sol 350ml botol
204 Ringer Laktat larutan infus steril Flash
Bahan Medis Habis Pakai
205 Alat Suntik sekali pakai 1 ml Set
206 Alat Suntik sekali pakai 3 ml Set 28 28 28
207 Alat Suntik sekali pakai 5 ml Set 20 20 5
208 Catgut / Benang Bedah No. 2/0 24x70 cm
209 Catgut / Benang Bedah No. 3/0 24x70 cm
210 Cover Glass 20x20 set
211 Dermafix S IV set
212 Feeding Tube 40cm No. 8 set
213 Foley cathether No. 16 set
214 Foley cathether No. 18 set
215 Foley cathether No. 20 set
216 Gown set botol
217 Hand Rub 500ml botol
218 Hand Scrub 500ml botol
219 Handrub refill 5 liter galon
220 Hazmat Size L set
221 Hazmat Size XL set
222 Infusion Set anak-anak set
223 Infusion Set dewasa set
224 IV Cathether No. 18 G set
225 IV Cathether No. 20 G set
226 IV Cathether No. 22 G set
227 IV Cathether No. 24 G set
228 Jarum hecting kombinasi set
229 Jelly Dopler botol
230 Kapas Pembalut / Adsorben 250 gram rol
231 Kasa Pembalut 40 yd x 110 cm rol
232 Kasa Pembalut 4x10 cm rol
233 Kasa Pembalut 4x15 cm rol
234 Kertas EKG 58mm x 25 m rol
235 Kertas EKG 58mm X 30 m rol
236 Kertas EKG 63mm X 30 m rol
237 Kertas EKG 80mm x 20 m rol
238 Lokal kacamata faceshield set
239 Masker Bedah Anak pcs
240 Masker KN 95 pcs
241 Masker N 95 pcs
242 Masker Oxygen (Maxiflow) Anak (Pediatrik) set
243 Masker Oxygen (Maxiflow) Dewasa (Adult) set
244 Masker surgical pcs 25 25 50 30
245 Masker surgical Anak pcs
246 Object Glass 20x20 mm pack
247 Oxygen Nasal Adult (Dewasa) set
248 Oxygen Nasal NewNates set
249 Oxygen Nasal Pediatric set
250 Pembalut gibs rol
251 Plester 5 yard x 2 inchi (plester coklat) rol 2 2 1
252 Plester Kertas 1" (surgical tape) rol
253 Regulator Oksigen set
254 Sarung tangan steril no.6,5 pasang
255 Sarung tangan steril NO.7 pasang
256 Sarung tangan steril NO.7,5 pasang
257 Sarung tangan non steril uk. S pasang
258 Sarung tangan non steril uk.M pasang 30 30 10
259 Sarung tangan obgin No. 6,5 pasang
260 Sarung tangan obgin No. 7 pasang
261 Sarung tangan obgin No. 7,5 pasang
262 Sarung tangan obgyn no. 8 pasang
263 Silk 2/0 + 1/2 GT 35MM set
264 Silk 3/0 + 1/2 GT 35MM set
265 Solida Nurse Cap set
266 Surgical mess 11 pack
267 Surgical mess 20 pack
268 Transparent IV Dressing (with notch) set
269 Umbilical cord klem set
270 Urine bag set
271 Wing Neddle No 21 G set
272 Wing Neddle No 23 G set
273 Wing Neddle No 25 G set
Tambahan
274 Cetirizine tab tablet 0
275 Alkohol swab pack
276 Kasa hidrofil steril pack
277 Klip sheet 200 400 600 400
278 Kertas Puyer sheet 200 200 400 200

Yang Memberikan,
Pengelola Obat Puskesmas

Nisa' Amila Rodhiya, S.Farm.,

RMINTAAN OBAT (LPLPO)
PELAPORAN BULAN : Desember
PENERIMAAN BULAN : Januari

EXPIRED
STOK
SISA STOK PERMINTAAN PEMBERIAN NO. BATCH DATE/
OPTIMUM
KETERANGAN

80

Oct-22

50

250

100
200
250
50

60

150

90

150

150
250

0
80

150

100
200

170

70

50

200

170

200

200

200

100
80

140

150

150

250
100

100

100
180
5

10

10
5

7
4

12

6
0

19

18

1
3

20
15
20

20
 200
200

Yang Memberikan, Yang Menerima,

Pengelola Obat Puskesmas Pengelola Obat Unit

Nisa' Amila Rodhiya, S.Farm., Apt Ns. Baiq Retno.C.M ,S.Kep