LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : SEDADAP PELAPORAN BULAN : Agustus 2010 NO./[Link]:

KECAMATAN : NUNUKAN SELATAN PERMINTAAN BULAN/PERIODE : September 2010 - Nopember 2010 GFK
KABUPATEN : NUNUKAN PUSK
DINKES

PENERIMA PERSEDIA PEMAKAI SISA STOK PERMINTA PEMBERIAN KETERANG

NO NAMA OBAT SATUAN STOK AWAL
AN AN AN STOK OPT AN
JUMLAH
AN
INPRES ASKES APBD I APBD II LAIN2
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet 930 930 930
2 Ambeven tablet 0 0
3 Albendazole tablet 60 60 60
4 Allopurinol 100 mg tablet 600 600 600
5 Ambroksol 30 mg tablet 20 20 20
6 Amoxicillin 250 mg tablet 0 0
7 Amoxicillin 500 mg tablet 2400 2400 2400
8 Ampisilin 500 mg tablet 1800 1800 1800
9 Antalgin 500 mg tablet 5000 5000 5000
10 Antasida DOEN tablet 100 100 100
11 Asam Folat tablet 0 0
12 Asam Mefenamat 500 mg tablet 3800 3800 3800
13 Atropin Sulfat 0,5 mg tablet 500 500 500
14 Acyclovir 200 mg tablet 200 200 200
15 Acyclovir 400 mg tablet 640 640 640
16 Besi sulfat tablet 0 0
17 Bisacodyl (Laxana) tablet 0 0
18 Buscopan tablet 0 0
19 Captopril 25 mg tablet 90 90 90
20 Captopril 12,5 mg tablet 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDIA PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
21 Cefadroxil 500 mg tablet 0 0
22 Chloramphenicol 250 mg tablet 800 800 800
23 Chloroquin 250 mg tablet 0 0
24 Cimetidine 200 mg tablet 0 0
25 Ciprofloxacin 500 mg tablet 380 380 380
26 CTM 4 mg tablet 10500 10500 10500
27 Deksametasone 0,5 mg tablet 0 0
28 Dekstrometorfan 15 mg tablet 4150 4150 4150
29 Digoksin 0,25 mg tablet 100 100 100
30 Dimenhidrinat 50 mg tablet 0 0
31 Domperidone 10 mg tablet 750 750 750
32 Efedrin 25 mg tablet 1800 1800 1800
33 Ergotamine Kafein tablet 275 275 275
34 Erythromycin 250 mg tablet 600 600 600
35 Erythromycin 500 mg tablet 1070 1070 1070
36 Famotidine 20 mg tablet 0 0
37 Furosemide 40 mg tablet 560 560 560
38 Glibenklamide 5 mg tablet 710 710 710
39 Gliseril Guayakolat 100 mg tablet 8150 8150 8150
40 Griseofulvin 125 mg tablet 1460 1460 1460
41 H C T 25 mg tablet 0 0
42 Ibuprofen 200 mg tablet 0 0
43 Ibuprofen 400 mg tablet 390 390 390
44 Isosorbit Dinitrat 5 mg tablet 0 0
45 Kalnex 500 mg tablet 0 0
46 Kalsium Laktat 500 mg tablet 7300 7300 7300
47 Ketokonazole 200 mg tablet 0 0
48 Komp Pirimetamin Sulfadoksin tablet 87 87 87
49 Kotrimoksazol 120 mg tablet 300 300 300
50 Kotrimoksazol 480 mg tablet 1690 1690 1690
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDIA PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
51 Mebendazol tablet 0 0
52 Methylergometrin 0,125 mg tablet 440 440 440
53 Metoklopramide 10 mg tablet 0 0
54 Metronidazol 500 mg tablet 800 800 800
55 Metronidazol 250 mg tablet 300 300 300
56 Multivitamin (Wishen) kaplet 10 10 10
57 New Diatabs tablet 0 0
58 Nifedipin 10 mg tablet 0 0
59 Nystatin 500.000 IU tablet 100 100 100
60 Oralit 200 ml sachet 370 370 370
61 Papaverin 40 mg tablet 1600 1600 1600
62 Parasetamol 100 mg tablet 0 0
63 Parasetamol 500 mg tablet 8300 8300 8300
64 Parasetamol tab tablet 0 0
65 Phenitoin 30 mg tablet 250 250 250
66 Phenylbutazone 200 mg tablet 0 0
67 Pirantel Pamoat 125 mg tablet 0 0
68 Piroksikam 10 mg tablet 136 136 136
69 Piroksikam 20 mg tablet 0 0
70 Prednison 5 mg tablet 4000 4000 4000
71 Propanolol 10 mg tablet 0 0
72 Propanolol 40 mg tablet 90 90 90
73 PTU 100 mg tablet 200 200 200
74 Ranitidine 150 mg tablet 0 0
75 Reserpin 0,10 mg tablet 280 280 280
76 Reserpin 0,25 mg tablet 1000 1000 1000
77 Salbutamol 2 mg tablet 690 690 690
78 Salbutamol 4 mg tablet 0 0
79 Sulfadimidin 500 mg tablet 0 0
80 Tetrasiklin 250 mg kapsul 1000 1000 1000
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDIA PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
81 Tetrasiklin 500 mg tablet 0 0
82 Thiamphenicol 500 mg tablet 0 0
83 Vitamin B Kompleks tablet 0 0
84 Vitamin B6 10 mg tablet 5500 5500 5500
85 Vitamin B1 50 mg tablet 5800 5800 5800
86 Vitamin B12 tablet 0 0
87 Vitamin C 50 mg tablet 7800 7800 7800
88 Vitamin K 10 mg tablet 300 300 300
OBAT JENIS SIRUP
89 Ambroksol sirup btl 93 93 93
90 Amoxicillin SK 125 mg/ 5 ml btl @ 60 ml 101 101 101
91 Amoxicillin SK 250 mg/ 5 ml btl @ 60 ml 26 26 26
92 Ampisilin Sirup Kering btl 25 25 25
93 Antasida suspensi btl 0 0
94 Besi Sulfat Syrup btl 174 174 174
95 Cefadroxil Syrup Kering btl 0 0
96 Chloramphenicol Syrup btl 60 60 60
97 Dekstrometorfan sirup btl 60 ml 96 96 96
98 Erythromycin Syrup Kering Botol 0 0
99 Kotrimoksazol suspensi btl 60 ml 135 135 135
100 Multivitamin Syrup (Pediagrow) btl 11 11 11
101 OBH Sirup btl 88 88 88
102 Parasetamol Sirup btl 60 ml 0 0
OBAT NAPZA
103 Diazepam 2 mg tablet 2609 2609 2609
104 Diazepam 5 mg tablet 0 0
105 Diazepam Inj amp 17 17 17 0 ED
106 Fenobarbital 30 mg tablet 800 800 800
107 Fenobarbital Injeksi amp 25 25 0 25
108 Fenitoin inj amp 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDIA PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
109 Haloperidol 5 mg tablet 0 0
110 Klorpromazin 100 mg tablet 0 0
111 Klorpromazin 25 mg tablet 980 980 980
112 Kodein 10 mg tablet 221 221 11 210
OBAT TB PARU 0 0
113 Ethambutol 250 mg tablet 0 0
114 I N H 100 mg tablet 0 0
115 I N H 300 mg tablet 1842 1842 1842
116 Pirazinamid 500 mg tablet 52 52 52
117 Rifampisin 450 mg tablet 73 73 73
OBAT LUAR
118 Aqudes Steril 500 ml btl 0 0
119 Alkohol 70 % 1000 ml Btl 5 5 5
120 Acyclovir Cream Tube 23 23 23
121 Anti Hemoroid Supp 45 45 45
122 Bacid Racin Salep Tube 0 0
123 Betametasone Krim Tube 0 0
124 Borax Gliserin sol Btl 0 0
125 Etil Klorida Spray Btl 100 ml 0 0
126 Fenol Gliserol Tts Telinga Btl 0 0
127 Formalin tab 1 Gram btl/ 100 tab 0 0
128 Gentamycin Salep Kulit Tube 25 25 25
129 Gentamycin Tetes Mata Steril 0,3 % Botol 20 20 20
130 Gentian Violet Sol Btl 37 37 37
131 Gliserin Btl @ 10 ml 0 0
132 Hydrocortisone Cream 2,5% tube 54 54 54
133 Ichtyol Salep 10 gr Pot 5 5 5
134 Kalium Permanganat Pot 9 9 9
135 Kloramfenikol Salep Kulit (Farsycol) Tube @ 10 gr 0 0
136 Kloramfenikol Salep Mata 1 % Tube 20 20 20
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDIA PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
137 Kloramfenikol tetes Mata btl 0 0
138 Kloramfenikol Tetes Telinga Btl 0 0
139 Lisol 1000 ml Btl 4 4 4
140 Mikonazole Krim Tube 0 0
141 Oksitetrasiklin Salep Kulit 3 % Tube 35 35 35
142 Oksitetrasiklin Salep Mata 1 % Tube 27 27 27
143 Rivanol 1 % 300 ml Btl 5 5 5
144 Salisil Bedak kotak 21 21 21
145 Salisilat Belerang Salep box/pot 39 39 39
146 Yodium Povidone Sol 1000 ml Btl 0 0
147 Yodium Povidone Sol 300 ml Btl 0 0
148 Yodium Povidone Sol 30 ml Btl 0 0
149 Yodium Povidon Sol 10 ml Btl 1 1 1
OBAT SUNTIK
150 Adidryl Injeksi vial 13 13 13
151 Adimidon Injeksi vial 18 18 18
152 Aqua Pro Inj amp 3 3 3
153 Aminofilin inj amp 50 50 50
154 Antalgin inj amp 0 0
155 Cefotaxim inj amp 6 6 6
156 Cortison inj amp 0 0
157 Deksametasone Inj amp 80 80 80
158 Dextrose 5 % - Nacl 0,45 % kolf 0 0
159 Dextrose 5 % - Nacl 1/4 kolf 0 0
160 Dextrose 5 % kolf 31 31 31
161 Dextrose 10 % kolf 10 10 10
162 Difenhidramin Inj amp 25 25 25
163 Ephinephrin Injeksi amp 0 0
164 Ketorolac Injeksi amp 15 15 15
165 Lidokain Inj amp 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDIA PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
166 Lidokain comp amp 135 135 135
167 Metil ergometrin inj amp 20 20 20
168 Natrium Klorida Infus kolf 14 14 14
169 Natrium Tiosulfat Injeksi amp 0 0
170 Oxytetracyclin Injeksi vial 0 0
171 Oxytocin Injeksi amp 35 35 35
172 Papaverin inj amp 0 0
173 Ranitidine Injeksi amp 25 25 25
174 Ringer Laktat Infus kolf 44 44 44
175 Sabu 5 ml Injeksi vial 0 0
176 Streptomycin Injeksi vial 0 0
177 Vitamin B1 inj amp 0 0
178 Vitamin B 12 inj amp 68 68 68
179 Vitamin K Injeksi Amp 0 0
180 Vitamin C Inj Amp 0 0
ALKES HABIS PAKAI
181 Abbocath No.18 Pcs 48 48 48
182 Abbocath No. 20 Pcs 24 24 24
183 Abbocath No. 22 Pcs 73 73 73
184 Abbocath No.24 Pcs 60 60 60
185 Alat Suntik 1 ml Pcs 150 150 150
186 Alat Suntik 2,5 ml Pcs 100 100 100
187 Alat Suntik 3 ml Pcs 0 0
188 Alat Suntik 5 ml Pcs 120 120 120
189 Alat Suntik 10 ml Pcs 0 0
190 Alat Suntik 20 ml Pcs 0 0
191 Blood Set Set 0 0
192 Cat/Gut 2/0 150 cm Pcs 0 0
193 Catgut 3/0 150 cm Pcs 0 0
194 Catgut Chromic No.3/0 100 meter Pcs 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDIA PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
195 Hand Schoen No 7 Pasang 0 0
196 Hand Schoen No 7,5 Pasang 0 0
197 Hand Schoen No 8 Pasang 0 0
198 Hypafix 5 cm Roll 0 0
199 Infus Set Anak Pcs 0 0
200 Infus Set Dewasa Pcs 61 61 61
201 Jarum Bedah Pcs 20 20 20
202 Kapas Pembalut 250 gram Bks 7 7 7
203 Kasa 2 y x 80 cm Roll 0 0
204 Kasa 5 cm x 80 cm Roll 0 0
205 Kasa Kompres 40 x40 Roll 6 6 6
206 Kasa Pemb 40 x 80 cm Roll 0 0
207 Kasa Steril 16 x 16 Ktk 13 13 13
208 Kasa Hidrofil 4 x 15 cm Roll 0 0
209 Kasa Pembalut 4 x 3 cm Roll 0 0
210 Masker Box/50 Pcs 0 0
211 Nald Hecting Otot (Jarum Kulit) Set/12 pcs 0 0
212 Nald Hecting Kulit No 11 pcs 0 0
213 Nald Hecting No 13 Set 0 0
214 Nald Hecting No 15 Set 0 0
215 NGT No. 12 (Feeding Tube) Set 0 0
216 NGT No. 16 (Feeding Tube) Set 0 0
217 Nald No. 26 Pcs 0 0
218 Nald No. 25 Pcs 0 0
219 Nald No. 24 Pcs 0 0
220 Scalvein No. 23 Pcs 0 0
221 Silk 3/0 500 cm Pcs 0 0
222 Silk 3/0 75 cm Pcs 0 0
223 Silk Black 3/0 100 meter box 0 0
224 Plester 5 Yard x 2 Inch Roll 4 4 4
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDIA PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
TAMBAHAN
225 0 0
226 0 0
227 0 0
228 0 0
229 0 0
230 0 0
231 0 0
232 0 0
233 0 0
234 0 0
235 0 0
236 0 0
237 0 0
238 0 0
239 0 0

Umum
ASKES Jumlah
Jumlah Kunjungan Resep Bayar Tidak Bayar

Yang Meminta Mengetahui/Menyetujui Yang Menyerahkan Yang Menerima

Pimpinan Puskesmas Kepala Dinkes II / GFK Petugas GFK Petugas Puskesmas

Dr. Herlina Barends (…………………………………………) (………………………………….) Hj. Badariah

NIP. 19670726 199903 2 003 NIP. NIP. NIP. 19580612 197712 2 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : SEDADAP PELAPORAN BULAN : Agustus 2010 NO./[Link]:

KECAMATAN : NUNUKAN SELATAN PERMINTAAN BULAN/PERIODE : September 2010 - Nopember 2010 GFK
KABUPATEN : NUNUKAN PUSK
DINKES

PENERIMA PERSEDIA PEMAKAI SISA STOK PERMINTA PEMBERIAN KETERANG

NO NAMA OBAT SATUAN STOK AWAL
AN AN AN STOK OPT AN
JUMLAH
AN
INPRES ASKES APBD I APBD II LAIN2
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet 930 930 0 930 0
2 Ambeven tablet 0 0 0 0
3 Albendazole tablet 60 60 60 0 120
4 Allopurinol 100 mg tablet 600 600 300 300 1000
5 Ambroksol 30 mg tablet 20 500 520 320 200 1000
6 Amoxicillin 250 mg tablet 600 600 360 240 2400
7 Amoxicillin 500 mg tablet 2400 1000 3400 3200 200 15000
8 Ampisilin 500 mg tablet 1800 1800 1800 0 6000
9 Antalgin 500 mg tablet 5000 5000 0 5000 0
10 Antasida DOEN tablet 100 900 1000 1000 0 5000
11 Asam Folat tablet 0 0 0 0
12 Asam Mefenamat 500 mg tablet 3800 3800 1700 2100 10000
13 Atropin Sulfat 0,5 mg tablet 500 500 0 500 0
14 Acyclovir 200 mg tablet 200 200 0 200 0
15 Acyclovir 400 mg tablet 700 700 0 700 0
16 Besi sulfat tablet 1000 1000 300 700 5000
17 Bisacodyl (Laxana) tablet 0 0 0
18 Buscopan tablet 0 0 0
19 Captopril 25 mg tablet 90 90 90 0 3000
20 Captopril 12,5 mg tablet 0 0 3000
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDIA PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
21 Cefadroxil 500 mg tablet 0 0 0
22 Chloramphenicol 250 mg tablet 800 800 800 3000
23 Chloroquin 250 mg tablet 0 0 0
24 Cimetidine 200 mg tablet 0 0 0
25 Ciprofloxacin 500 mg tablet 380 380 80 300 1000
26 CTM 4 mg tablet 10500 10500 4500 6000 20000
27 Deksametasone 0,5 mg tablet 5000 5000 4000 1000 20000
28 Dekstrometorfan 15 mg tablet 4150 4150 1150 3000 2000
29 Digoksin 0,25 mg tablet 100 100 10 90 0
30 Dimenhidrinat 50 mg tablet 100 100 0 100 0
31 Domperidone 10 mg tablet 750 750 150 600 600
32 Efedrin 25 mg tablet 1800 1800 1800 0 3000
33 Ergotamine Kafein tablet 275 275 175 100 0
34 Erythromycin 250 mg tablet 600 600 0 600 0
35 Erythromycin 500 mg tablet 1070 1070 1070 0 3000
36 Famotidine 20 mg tablet 500 500 150 350 1000
37 Furosemide 40 mg tablet 560 560 160 400 0
38 Glibenklamide 5 mg tablet 710 710 110 600 400
39 Gliseril Guayakolat 100 mg tablet 8150 8150 4150 4000 13000
40 Griseofulvin 125 mg tablet 1460 1460 460 1000 1500
41 H C T 25 mg tablet 1000 1000 0 1000 2000
42 Ibuprofen 200 mg tablet 0 0 0 4500
43 Ibuprofen 400 mg tablet 390 1000 1390 590 800 3000
44 Isosorbit Dinitrat 5 mg tablet 0 0 0
45 Kalnex 500 mg tablet 0 0 0
46 Kalsium Laktat 500 mg tablet 7300 7300 1300 6000 4000
47 Ketokonazole 200 mg tablet 0 0 0
48 Komp Pirimetamin Sulfadoksin tablet 88 88 0 88 0
49 Kotrimoksazol 120 mg tablet 300 300 100 200 300
50 Kotrimoksazol 480 mg tablet 1690 1690 1690 0 7000
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDIA PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
51 Loperamid HCL 2 mg (Novadium) tablet 500 500 200 300 600
52 Mebendazol tablet 0 0 0 0
53 Methylergometrin 0,125 mg tablet 440 440 40 400 0
54 Metoklopramide 10 mg tablet 0 0 0
55 Metronidazol 500 mg tablet 800 800 10 790 0
56 Metronidazol 250 mg tablet 300 300 0 300 0
57 Multivitamin (Wishen) kaplet 10 300 310 70 240 0
58 New Diatabs tablet 0 0 0
59 Nifedipin 10 mg tablet 0 0 0
60 Nystatin 500.000 IU tablet 100 100 0 100 0
61 Oralit 200 ml sachet 370 370 270 100 600
62 Papaverin 40 mg tablet 1600 1600 600 1000 3000
63 Parasetamol 100 mg tablet 0 0 0 0
64 Parasetamol 500 mg tablet 8300 8300 5300 3000 20000
65 Parasetamol tab tablet 0 0 0
66 Phenitoin 30 mg tablet 250 250 0 250 0
67 Phenylbutazone 200 mg tablet 0 0 0
68 Pirantel Pamoat 125 mg tablet 0 0 0
69 Piroksikam 10 mg tablet 136 300 436 136 300 2000
70 Piroksikam 20 mg tablet 300 300 200 100 2000
71 Prednison 5 mg tablet 4000 1000 5000 4000 1000 12000
72 Propanolol 10 mg tablet 0 0 0
73 Propanolol 40 mg tablet 100 100 0 100 0
74 PTU 100 mg tablet 200 200 0 200 0
75 Ranitidine 150 mg tablet 0 0 3000
76 Reserpin 0,10 mg tablet 280 280 280 0 500
77 Reserpin 0,25 mg tablet 1000 1000 0 1000 1000
78 Salbutamol 2 mg tablet 690 690 90 600 0
79 Salbutamol 4 mg tablet 0 0 0
80 Sulfadimidin 500 mg tablet 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDIA PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
81 Tetrasiklin 250 mg kapsul 1000 1000 0 1000 0
82 Tetrasiklin 500 mg tablet 0 0 0
83 Thiamphenicol 500 mg tablet 0 0 0
84 Vitamin B Kompleks tablet 5000 5000 3000 2000 10000
85 Vitamin B6 10 mg tablet 5500 5500 2500 3000 8000
86 Vitamin B1 50 mg tablet 5800 5800 2800 3000 9000
87 Vitamin B12 tablet 0 0 0
88 Vitamin C 50 mg tablet 7800 7800 2800 5000 9000
89 Vitamin K 10 mg tablet 300 300 100 200 300
OBAT JENIS SIRUP
90 Ambroksol sirup btl 93 93 6 87 0
91 Amoxicillin SK 125 mg/ 5 ml btl @ 60 ml 101 101 101 0 500
92 Amoxicillin SK 250 mg/ 5 ml btl @ 60 ml 26 26 26 0 100
93 Ampisilin Sirup Kering btl 25 25 25 0 100
94 Antasida suspensi btl 0 0 0 200
95 Besi Sulfat Syrup btl 174 174 174 0 0
96 Cefadroxil Syrup Kering btl 0 0 0 0
97 Chloramphenicol Syrup btl 60 60 0 60 0 ED
98 Dekstrometorfan sirup btl 60 ml 96 97 0 97 0
99 Ibuprofen Syrup Botol 50 50 0 50 0
100 Kotrimoksazol suspensi btl 60 ml 135 135 41 94 250
101 Multivitamin Syrup (Pediagrow) btl 11 25 36 14 22 50
102 OBH Sirup btl 88 10 98 30 68 100
103 Parasetamol Sirup btl 60 ml 0 0 450
OBAT NAPZA
104 Diazepam 2 mg tablet 2609 2609 236 2373 0
105 Diazepam 5 mg tablet 0 0 0 0
106 Diazepam Inj amp 17 17 17 0 0 ED
107 Fenobarbital 30 mg tablet 800 800 225 575 0
108 Fenobarbital Injeksi amp 25 25 0 25 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDIA PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
109 Fenitoin inj amp 0 0 0
110 Haloperidol 5 mg tablet 0 0 0
111 Klorpromazin 100 mg tablet 0 0 0
112 Klorpromazin 25 mg tablet 980 980 80 900 0
113 Kodein 10 mg tablet 221 221 11 210 0
OBAT TB PARU 0 0
114 Ethambutol 250 mg tablet 0 0 0
115 I N H 100 mg tablet 0 0 0
116 I N H 300 mg tablet 1842 1842 842 1000 0
117 Pirazinamid 500 mg tablet 60 60 0 60 0
118 Rifampisin 450 mg tablet 73 73 6 67 0
OBAT LUAR
119 Aqudes Steril 500 ml btl 0 0 0
120 Alkohol 70 % 1000 ml Btl 5 5 3 2 10
121 Acyclovir Cream Tube 23 23 4 19 50
122 Anti Hemoroid Supp 45 45 20 25 60
123 Bacid Racin Salep Tube 0 0 0
124 Betametasone Krim Tube 25 25 3 22 100
125 Borax Gliserin sol Btl 0 0 0
126 Etil Klorida Spray Btl 100 ml 5 5 1 4 0
127 Fenol Gliserol Tts Telinga Btl 0 0 0
128 Formalin tab 1 Gram btl/ 100 tab 0 0 0
129 Gentamycin Salep Kulit Tube 25 25 10 15 25
130 Gentamycin Tetes Mata Steril 0,3 % botol 20 20 4 16 20
131 Gentian Violet Sol Btl 37 37 1 36 0
132 Gliserin Btl @ 10 ml 0 0 0
133 Hydrocortisone Cream 2,5% tube 54 24 78 69 9 200
134 Ichtyol Salep 10 gr Pot 5 5 5 0 20
135 Kalium Permanganat Pot 9 9 0 9 10
136 Kloramfenikol Salep Kulit (Farsycol) Tube @ 10 gr 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDIA PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
137 Kloramfenikol Salep Mata 1 % Tube 20 20 20 0 50
138 Kloramfenikol tetes Mata btl 0 0 0
139 Kloramfenikol Tetes Telinga Btl 0 0 50
140 Lisol 1000 ml Btl 4 4 0 4 0
141 Mikonazole Krim Tube 24 24 4 20 120
142 Oksitetrasiklin Salep Kulit 3 % Tube 35 25 60 40 20 125
143 Oksitetrasiklin Salep Mata 1 % Tube 27 125 152 25 127 0
144 Rivanol 1 % 300 ml Btl 5 5 0 5 0
145 Salisil Bedak kotak 21 21 21 0 30
146 Salisilat Belerang Salep box/pot 39 39 6 33 24
147 Yodium Povidone Sol 1000 ml Btl 0 0 0
148 Yodium Povidone Sol 300 ml Btl 0 0 0
149 Yodium Povidone Sol 30 ml Btl 0 0 10
150 Yodium Povidon Sol 10 ml Btl 1 1 1 0 5
OBAT SUNTIK
151 Adidryl Injeksi vial 13 13 12 1 0
152 Adimidon Injeksi vial 18 25 43 18 25 0
153 Aqua Pro Inj amp 3 3 3 0 10 ED
154 Aminofilin inj amp 50 50 20 30 0
155 Antalgin inj amp 0 0 0
156 Buscopan Injeksi amp 5 5 0 5 0
157 Cefotaxim inj amp 6 6 0 6 0
158 Cortison inj amp 0 0 0
159 Deksametasone Inj amp 80 80 8 72 100
160 Dextrose 5 % - Nacl 0,45 % kolf 0 0 0
161 Dextrose 5 % - Nacl 1/4 kolf 0 0 0
162 Dextrose 5 % kolf 31 31 0 31 0
163 Dextrose 10 % kolf 10 10 4 6 15
164 Difenhidramin Inj amp 25 25 5 20 0
165 Ephinephrin Injeksi amp 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDIA PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
166 Ketorolac Injeksi amp 15 15 0 15 0
167 Lidokain Inj amp 150 150 0 150 0
168 Lidokain comp amp 0 0 0
169 Metil ergometrin inj amp 20 20 10 10 0
170 Natrium Klorida Infus kolf 14 14 2 12 20
171 Natrium Tiosulfat Injeksi amp 0 0 0
172 Oxytetracyclin Injeksi vial 0 0 0
173 Oxytocin Injeksi amp 35 35 35 0 120
174 Papaverin inj amp 30 30 0 30 0
175 Ranitidine Injeksi amp 25 25 5 20 0
176 Ringer Laktat Infus kolf 44 44 8 36 20
177 Sabu 5 ml Injeksi vial 0 0 0
178 Streptomycin Injeksi vial 0 0 0
179 Vitamin B1 inj amp 10 10 0 10 0
180 Vitamin B 12 inj amp 68 68 0 68 0
181 Vitamin K Injeksi Amp 25 25 0 25 0
182 Vitamin C Inj Amp 0 0 0
ALKES HABIS PAKAI
183 Abbocath No.18 Pcs 48 48 0 48 0
184 Abbocath No. 20 Pcs 24 24 1 23 0
185 Abbocath No. 22 Pcs 74 74 0 74 0
186 Abbocath No.24 Pcs 72 72 0 72 0
187 Alat Suntik 1 ml Pcs 150 1600 1750 150 1600 500
188 Alat Suntik 2,5 ml Pcs 100 100 100 0 300
189 Alat Suntik 3 ml Pcs 100 100 54 46 300
190 Alat Suntik 5 ml Pcs 120 500 620 120 500 400
191 Alat Suntik 10 ml Pcs 0 0 0
192 Alat Suntik 20 ml Pcs 0 0 0
193 Blood Set Set 0 0 0
194 Cat/Gut 2/0 150 cm Pcs 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDIA PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
195 Catgut No. 3/0 75 cm Pcs 1 1 1 0 0
196 Catgut Chromic No. 4/0 150 cm Pcs 6 6 0 6 0
197 Hand Schoen No 7 Pasang 23 23 0 23 0
198 Hand Schoen No 7,5 Pasang 0 0 0
199 Hand Schoen No 8 Pasang 0 0 0
200 Hypafix 5 cm Roll 0 0 0
201 Infus Set Anak Pcs 14 14 0 14 0
202 Infus Set Dewasa Pcs 72 72 0 72 0
203 Jarum Bedah Pcs 20 20 20 0 0
204 Kapas Pembalut 250 gram Bks 7 7 2 5 10
205 Kasa 2 y x 80 cm Roll 0 0 0
206 Kasa 5 cm x 80 cm Roll 0 0 0
207 Kasa Kompres 40 x40 Roll 6 6 0 6 0
208 Kasa Pemb 40 x 80 cm Roll 0 0 0
209 Kasa Steril 16 x 16 Ktk 13 13 13 0 40
210 Kasa Hidrofil 4 x 15 cm Roll 0 0 0
211 Kasa Pembalut 4 x 3 cm Roll 0 0 0
212 Masker Box/50 Pcs 0 0 0
213 Nald Hecting Otot (Jarum Kulit) Set/12 pcs 0 0 0
214 Nald Hecting No. 9 pcs 12 12 0 12 0
215 Nald Hecting No 13 Pcs 12 12 0 12 0
216 Nald Hecting No 15 Pcs 0 0 0
217 NGT No. 3,5 (Feeding Tube) Set 10 10 0 10 0 ED
218 NGT No. 16 (Feeding Tube) Set 0 0 0
219 Nald No. 23 Pcs 0 0 300
220 Nald No. 24 Pcs 0 0 0
221 Scalvein No. 23 Pcs 0 0 0
222 Silk No. 3/0 150 cm0 Pcs 1 1 0 1 0
223 Silk Black No. 3/0 75 cm (35 mm) Pcs 12 12 0 12 0
224 Silk Black No. 3/0 75 cm (26 mm) Pcs 22 22 0 22 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDIA PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
225 Plester 5 Yard x 2 Inch Roll 4 4 4 0 12
TAMBAHAN
226 Alkohol Swab ktk/100 paket 3 3 0 3 0
227 Pharmafix 2,5 cm x 5 mtr Roll 10 10 3 7 0
228 Pharmafix 5 cm x 5 mtr Roll 10 10 1 9 0
229 Pharmafix 10 cm x 5 mtr Roll 10 10 2 8 0
230 Indo Obat Flu tablet 54 54 0 54 0
231 Indo Obat Cacing (Mebendazole) tablet 3 3 0 3 0
232 Indo Obat Penurun Panas tablet 48 48 0 48 0
233 0 0 0
234 0 0 0
235 0 0 0
236 0 0 0
237 0 0 0
238 0 0 0
239 0 0 0
240 0 0 0

Umum
ASKES Jumlah
Jumlah Kunjungan Resep Bayar Tidak Bayar

395 470 96 961

Yang Meminta Mengetahui/Menyetujui Yang Menyerahkan Yang Menerima

Pimpinan Puskesmas Kepala Dinkes II / GFK Petugas GFK Petugas Puskesmas

Dr. Herlina Barends (…………………………………………) (………………………………….) Hj. Badariah

NIP. 19670726 199903 2 003 NIP. NIP. NIP. 19580612 197712 2 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : SEDADAP PELAPORAN BULAN : Agustus 2010 NO./[Link]:

KECAMATAN : NUNUKAN SELATAN PERMINTAAN BULAN/PERIODE : September 2010 - Nopember 2010 GFK
KABUPATEN : NUNUKAN PUSK
DINKES

PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA PEMBERIAN KETERANG

NO NAMA OBAT SATUAN STOK AWAL
AN AAN AN STOK OPT AN
JUMLAH
AN
INPRES ASKES APBD I APBD II LAIN2
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet 930 930 0 930
2 Ambeven tablet 0 0 0
3 Albendazole tablet 60 60 60 0
4 Allopurinol 100 mg tablet 600 600 300 300
5 Ambroksol 30 mg tablet 20 500 520 320 200
6 Amoxicillin 250 mg tablet 600 600 360 240
7 Amoxicillin 500 mg tablet 2400 1000 3400 3200 200
8 Ampisilin 500 mg tablet 1800 1800 1800 0
9 Antalgin 500 mg tablet 5000 5000 0 5000
10 Antasida DOEN tablet 100 900 1000 1000 0
11 Asam Folat tablet 0 0 0
12 Asam Mefenamat 500 mg tablet 3800 3800 1700 2100
13 Atropin Sulfat 0,5 mg tablet 500 500 0 500
14 Acyclovir 200 mg tablet 200 200 0 200
15 Acyclovir 400 mg tablet 700 700 0 700
16 Besi sulfat tablet 1000 1000 300 700
17 Bisacodyl (Laxana) tablet 0 0
18 Buscopan tablet 0 0
19 Captopril 25 mg tablet 90 90 90 0
20 Captopril 12,5 mg tablet 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
21 Cefadroxil 500 mg tablet 0 0
22 Chloramphenicol 250 mg tablet 800 800 800
23 Chloroquin 250 mg tablet 0 0
24 Cimetidine 200 mg tablet 0 0
25 Ciprofloxacin 500 mg tablet 380 380 80 300
26 CTM 4 mg tablet 10500 10500 4500 6000
27 Deksametasone 0,5 mg tablet 5000 5000 4000 1000
28 Dekstrometorfan 15 mg tablet 4150 4150 1150 3000
29 Digoksin 0,25 mg tablet 100 100 10 90
30 Dimenhidrinat 50 mg tablet 100 100 0 100
31 Domperidone 10 mg tablet 750 750 150 600
32 Efedrin 25 mg tablet 1800 1800 1800 0
33 Ergotamine Kafein tablet 275 275 175 100
34 Erythromycin 250 mg tablet 600 600 0 600
35 Erythromycin 500 mg tablet 1070 1070 1070 0
36 Famotidine 20 mg tablet 500 500 150 350
37 Furosemide 40 mg tablet 560 560 160 400
38 Glibenklamide 5 mg tablet 710 710 110 600
39 Gliseril Guayakolat 100 mg tablet 8150 8150 4150 4000
40 Griseofulvin 125 mg tablet 1460 1460 460 1000
41 H C T 25 mg tablet 1000 1000 0 1000
42 Ibuprofen 200 mg tablet 0 0 0
43 Ibuprofen 400 mg tablet 390 1000 1390 590 800
44 Isosorbit Dinitrat 5 mg tablet 0 0
45 Kalnex 500 mg tablet 0 0
46 Kalsium Laktat 500 mg tablet 7300 7300 1300 6000
47 Ketokonazole 200 mg tablet 0 0
48 Komp Pirimetamin Sulfadoksin tablet 88 88 0 88
49 Kotrimoksazol 120 mg tablet 300 300 100 200
50 Kotrimoksazol 480 mg tablet 1690 1690 1690 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
51 Loperamid HCL 2 mg (Novadium) tablet 500 500 200 300
52 Mebendazol tablet 0 0 0
53 Methylergometrin 0,125 mg tablet 440 440 40 400
54 Metoklopramide 10 mg tablet 0 0
55 Metronidazol 500 mg tablet 800 800 10 790
56 Metronidazol 250 mg tablet 300 300 0 300
57 Multivitamin (Wishen) kaplet 10 300 310 70 240
58 New Diatabs tablet 0 0
59 Nifedipin 10 mg tablet 0 0
60 Nystatin 500.000 IU tablet 100 100 0 100
61 Oralit 200 ml sachet 370 370 270 100
62 Papaverin 40 mg tablet 1600 1600 600 1000
63 Parasetamol 100 mg tablet 0 0 0
64 Parasetamol 500 mg tablet 8300 8300 5300 3000
65 Parasetamol tab tablet 0 0
66 Phenitoin 30 mg tablet 250 250 0 250
67 Phenylbutazone 200 mg tablet 0 0
68 Pirantel Pamoat 125 mg tablet 0 0
69 Piroksikam 10 mg tablet 136 300 436 136 300
70 Piroksikam 20 mg tablet 300 300 200 100
71 Prednison 5 mg tablet 4000 1000 5000 4000 1000
72 Propanolol 10 mg tablet 0 0
73 Propanolol 40 mg tablet 100 100 0 100
74 PTU 100 mg tablet 200 200 0 200
75 Ranitidine 150 mg tablet 0 0
76 Reserpin 0,10 mg tablet 280 280 280 0
77 Reserpin 0,25 mg tablet 1000 1000 0 1000
78 Salbutamol 2 mg tablet 690 690 90 600
79 Salbutamol 4 mg tablet 0 0
80 Sulfadimidin 500 mg tablet 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
81 Tetrasiklin 250 mg kapsul 1000 1000 0 1000
82 Tetrasiklin 500 mg tablet 0 0
83 Thiamphenicol 500 mg tablet 0 0
84 Vitamin B Kompleks tablet 5000 5000 3000 2000
85 Vitamin B6 10 mg tablet 5500 5500 2500 3000
86 Vitamin B1 50 mg tablet 5800 5800 2800 3000
87 Vitamin B12 tablet 0 0
88 Vitamin C 50 mg tablet 7800 7800 2800 5000
89 Vitamin K 10 mg tablet 300 300 100 200
OBAT JENIS SIRUP
90 Ambroksol sirup btl 93 93 6 87
91 Amoxicillin SK 125 mg/ 5 ml btl @ 60 ml 101 101 101 0
92 Amoxicillin SK 250 mg/ 5 ml btl @ 60 ml 26 26 26 0
93 Ampisilin Sirup Kering btl 25 25 25 0
94 Antasida suspensi btl 0 0 0
95 Besi Sulfat Syrup btl 174 174 174 0
96 Cefadroxil Syrup Kering btl 0 0 0
97 Chloramphenicol Syrup btl 60 60 0 60 ED
98 Dekstrometorfan sirup btl 60 ml 96 97 0 97
99 Ibuprofen Syrup Botol 50 50 0 50
100 Kotrimoksazol suspensi btl 60 ml 135 135 41 94
101 Multivitamin Syrup (Pediagrow) btl 11 25 36 14 22
102 OBH Sirup btl 88 10 98 30 68
103 Parasetamol Sirup btl 60 ml 0 0
OBAT NAPZA
104 Diazepam 2 mg tablet 2609 2609 236 2373
105 Diazepam 5 mg tablet 0 0 0
106 Diazepam Inj amp 17 17 17 0 ED
107 Fenobarbital 30 mg tablet 800 800 225 575
108 Fenobarbital Injeksi amp 25 25 0 25
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
109 Fenitoin inj amp 0 0
110 Haloperidol 5 mg tablet 0 0
111 Klorpromazin 100 mg tablet 0 0
112 Klorpromazin 25 mg tablet 980 980 80 900
113 Kodein 10 mg tablet 221 221 11 210
OBAT TB PARU 0 0
114 Ethambutol 250 mg tablet 0 0
115 I N H 100 mg tablet 0 0
116 I N H 300 mg tablet 1842 1842 842 1000
117 Pirazinamid 500 mg tablet 60 60 0 60
118 Rifampisin 450 mg tablet 73 73 6 67
OBAT LUAR
119 Aqudes Steril 500 ml btl 0 0
120 Alkohol 70 % 1000 ml Btl 5 5 3 2
121 Acyclovir Cream Tube 23 23 4 19
122 Anti Hemoroid Supp 45 45 20 25
123 Bacid Racin Salep Tube 0 0
124 Betametasone Krim Tube 25 25 3 22
125 Borax Gliserin sol Btl 0 0
126 Etil Klorida Spray Btl 100 ml 5 5 1 4
127 Fenol Gliserol Tts Telinga Btl 0 0
128 Formalin tab 1 Gram tablet 4 4 0 4
129 Gentamycin Salep Kulit Tube 25 25 10 15
130 Gentamycin Tetes Mata Steril 0,3 % botol 20 20 4 16
131 Gentian Violet Sol Btl 37 37 1 36
132 Gliserin Btl @ 10 ml 0 0
133 Hydrocortisone Cream 2,5% tube 54 24 78 69 9
134 Ichtyol Salep 10 gr Pot 5 5 5 0
135 Kalium Permanganat Pot 9 9 0 9
136 Kloramfenikol Salep Kulit (Farsycol) Tube @ 10 gr 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
137 Kloramfenikol Salep Mata 1 % Tube 20 20 20 0
138 Kloramfenikol tetes Mata btl 0 0
139 Kloramfenikol Tetes Telinga Btl 0 0
140 Lisol 1000 ml Btl 4 4 0 4
141 Mikonazole Krim Tube 24 24 4 20
142 Oksitetrasiklin Salep Kulit 3 % Tube 35 25 60 40 20
143 Oksitetrasiklin Salep Mata 1 % Tube 27 125 152 25 127
144 Rivanol 1 % 300 ml Btl 5 5 0 5
145 Salisil Bedak kotak 21 21 21 0
146 Salisilat Belerang Salep box/pot 39 39 6 33
147 Yodium Povidone Sol 1000 ml Btl 0 0
148 Yodium Povidone Sol 300 ml Btl 0 0
149 Yodium Povidone Sol 30 ml Btl 0 0
150 Yodium Povidon Sol 10 ml Btl 1 1 1 0
OBAT SUNTIK
151 Adidryl Injeksi vial 9 9 1 8
152 Adimidon Injeksi vial 17 17 1 16
153 Aqua Pro Inj amp 3 3 3 0 ED
154 Aminofilin inj amp 50 50 20 30
155 Antalgin inj amp 0 0
156 Buscopan Injeksi amp 5 5 0 5
157 Cefotaxim inj amp 6 6 0 6
158 Cortison inj amp 7 7 0 7
159 Deksametasone Inj amp 80 80 8 72
160 Dextrose 5 % - Nacl 0,45 % kolf 0 0
161 Dextrose 5 % - Nacl 1/4 kolf 0 0
162 Dextrose 5 % kolf 31 31 0 31
163 Dextrose 10 % kolf 10 10 4 6
164 Difenhidramin Inj amp 25 25 5 20
165 Ephinephrin Injeksi amp 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
166 Ketorolac Injeksi amp 15 15 0 15
167 Lidokain Inj amp 150 150 0 150
168 Lidokain comp amp 0 0
169 Metil ergometrin inj amp 20 20 10 10
170 Natrium Klorida Infus kolf 14 14 2 12
171 Natrium Tiosulfat Injeksi amp 0 0
172 Oxytetracyclin Injeksi vial 0 0
173 Oxytocin Injeksi amp 35 35 35 0
174 Papaverin inj amp 30 30 0 30
175 Ranitidine Injeksi amp 25 25 5 20
176 Ringer Laktat Infus kolf 44 44 8 36
177 Sabu 5 ml Injeksi vial 0 0
178 Streptomycin Injeksi vial 0 0
179 Vitamin B1 inj amp 10 10 0 10
180 Vitamin B 12 inj amp 68 68 0 68
181 Vitamin K Injeksi Amp 25 25 0 25
182 Vitamin C Inj Amp 0 0
ALKES HABIS PAKAI
183 Abbocath No.18 Pcs 48 48 0 48
184 Abbocath No. 20 Pcs 24 24 1 23
185 Abbocath No. 22 Pcs 74 74 0 74
186 Abbocath No.24 Pcs 72 72 0 72
187 Alat Suntik 1 ml Pcs 150 1600 1750 150 1600
188 Alat Suntik 2,5 ml Pcs 100 100 100 0
189 Alat Suntik 3 ml Pcs 100 100 54 46
190 Alat Suntik 5 ml Pcs 120 500 620 120 500
191 Alat Suntik 10 ml Pcs 0 0
192 Alat Suntik 20 ml Pcs 0 0
193 Blood Set Set 0 0
194 Cat/Gut 2/0 150 cm Pcs 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
195 Catgut No. 3/0 75 cm Pcs 1 1 1 0
196 Catgut Chromic No. 4/0 150 cm Pcs 6 6 0 6
197 Hand Schoen No 7 Pasang 23 23 0 23
198 Hand Schoen No 7,5 Pasang 0 0
199 Hand Schoen No 8 Pasang 0 0
200 Hypafix 5 cm Roll 0 0
201 Infus Set Anak Pcs 14 14 0 14
202 Infus Set Dewasa Pcs 72 72 0 72
203 Jarum Bedah Pcs 20 20 20 0
204 Kapas Pembalut 250 gram Bks 7 7 2 5
205 Kasa 2 y x 80 cm Roll 0 0
206 Kasa 5 cm x 80 cm Roll 0 0
207 Kasa Kompres 40 x40 Roll 6 6 0 6
208 Kasa Pemb 40 x 80 cm Roll 0 0
209 Kasa Steril 16 x 16 Ktk 13 13 5 8
210 Kasa Hidrofil 4 x 15 cm Roll 0 0
211 Kasa Pembalut 4 x 3 cm Roll 0 0
212 Masker Box/50 Pcs 0 0
213 Nald Hecting Otot (Jarum Kulit) Set/12 pcs 0 0
214 Nald Hecting No. 9 pcs 12 12 0 12
215 Nald Hecting No 13 Pcs 12 12 0 12
216 Nald Hecting No 15 Pcs 0 0
217 NGT No. 3,5 (Feeding Tube) Set 10 10 0 10 ED
218 NGT No. 16 (Feeding Tube) Set 0 0
219 Nald No. 23 Pcs 0 0
220 Nald No. 24 Pcs 0 0
221 Scalvein No. 23 Pcs 0 0
222 Silk No. 3/0 150 cm0 Pcs 1 1 0 1
223 Silk Black No. 3/0 75 cm (35 mm) Pcs 12 12 0 12
224 Silk Black No. 3/0 75 cm (26 mm) Pcs 22 22 0 22
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
225 Plester 5 Yard x 2 Inch Roll 4 4 4 0
TAMBAHAN
226 Alkohol Swab ktk/100 paket 3 3 0 3
227 Pharmafix 2,5 cm x 5 mtr Roll 10 10 3 7
228 Pharmafix 5 cm x 5 mtr Roll 10 10 1 9
229 Pharmafix 10 cm x 5 mtr Roll 10 10 2 8
230 Indo Obat Flu tablet 54 54 0 54
231 Indo Obat Cacing (Mebendazole) tablet 3 3 0 3
232 Indo Obat Penurun Panas tablet 48 48 0 48
233 0 0
234 0 0
235 0 0
236 0 0
237 0 0
238 0 0
239 0 0
240 0 0

Umum
ASKES Jumlah
Jumlah Kunjungan Resep Bayar Tidak Bayar

395 470 96 961

Yang Meminta Mengetahui/Menyetujui Yang Menyerahkan Yang Menerima

Pimpinan Puskesmas Kepala Dinkes II / GFK Petugas GFK Petugas Puskesmas

Dr. Herlina Barends (…………………………………………) (………………………………….) Hj. Badariah

NIP. 19670726 199903 2 003 NIP. NIP. NIP. 19580612 197712 2 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : SEDADAP PELAPORAN BULAN : September 2010 NO./[Link]:

KECAMATAN : NUNUKAN SELATAN PERMINTAAN BULAN/PERIODE : GFK
KABUPATEN : NUNUKAN PUSK
DINKES

PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA PEMBERIAN KETERANG

NO NAMA OBAT SATUAN STOK AWAL
AN AAN AN STOK OPT AN
JUMLAH
AN
INPRES ASKES APBD I APBD II LAIN2
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet 930 930 140 790
2 Ambeven tablet 0 0 0 0
3 Albendazole tablet 0 120 120 30 90
4 Allopurinol 100 mg tablet 300 1000 1300 0 1300
5 Ambroksol 30 mg tablet 200 500 700 400 300
6 Amoxicillin 250 mg tablet 240 1800 2040 360 1680
7 Amoxicillin 500 mg tablet 200 14000 14200 2300 11900
8 Ampisilin 500 mg tablet 0 3000 3000 300 2700
9 Antalgin 500 mg tablet 5000 5000 1000 4000
10 Antasida DOEN tablet 0 900 900 900 0
11 Asam Folat tablet 0 0 0 0
12 Asam Mefenamat 500 mg tablet 2100 6000 8100 1100 7000
13 Atropin Sulfat 0,5 mg tablet 500 500 0 500
14 Acyclovir 200 mg tablet 200 200 0 200
15 Acyclovir 400 mg tablet 700 700 100 600
16 Besi sulfat tablet 700 4000 4700 900 3800
17 Bisacodyl (Laxana) tablet 0 0
18 Buscopan tablet 0 0
19 Captopril 25 mg tablet 0 3000 3000 200 2800
20 Captopril 12,5 mg tablet 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
21 Cefadroxil 500 mg tablet 0 0
22 Chloramphenicol 250 mg tablet 3000 3000 1000 2000
23 Chloroquin 250 mg tablet 0 0
24 Cimetidine 200 mg tablet 0 0
25 Ciprofloxacin 500 mg tablet 300 1000 1300 50 1250
26 CTM 4 mg tablet 6000 5000 11000 4000 7000
27 Deksametasone 0,5 mg tablet 1000 15000 16000 4000 12000
28 Dekstrometorfan 15 mg tablet 3000 2000 5000 0 5000
29 Digoksin 0,25 mg tablet 90 90 90 0 ED
30 Dimenhidrinat 50 mg tablet 100 100 0 100
31 Domperidone 10 mg tablet 600 600 1200 100 1100
32 Efedrin 25 mg tablet 0 3000 3000 0 3000
33 Ergotamine Kafein tablet 100 100 0 100
34 Erythromycin 250 mg tablet 600 600 120 480
35 Erythromycin 500 mg tablet 0 3000 3000 1200 1800
36 Famotidine 20 mg tablet 350 500 850 250 600
37 Furosemide 40 mg tablet 400 400 0 400
38 Glibenklamide 5 mg tablet 600 400 1000 200 800
39 Gliseril Guayakolat 100 mg tablet 4000 10000 14000 2000 12000
40 Griseofulvin 125 mg tablet 1000 1500 2500 0 2500
41 H C T 25 mg tablet 1000 1000 2000 1000 1000
42 Ibuprofen 200 mg tablet 0 0 0 0
43 Ibuprofen 400 mg tablet 800 1000 1800 400 1400
44 Isosorbit Dinitrat 5 mg tablet 0 0
45 Kalnex 500 mg tablet 0 0
46 Kalsium Laktat 500 mg tablet 6000 4000 10000 1000 9000
47 Ketokonazole 200 mg tablet 0 0
48 Komp Pirimetamin Sulfadoksin tablet 88 88 0 88
49 Kotrimoksazol 120 mg tablet 200 300 500 0 500
50 Kotrimoksazol 480 mg tablet 0 2000 2000 500 1500
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
51 Loperamid HCL 2 mg (Novadium) tablet 300 100 400 0 400
52 Mebendazol tablet 0 0 0 0
53 Methylergometrin 0,125 mg tablet 400 400 0 400
54 Metoklopramide 10 mg tablet 0 0
55 Metronidazol 500 mg tablet 790 790 100 690
56 Metronidazol 250 mg tablet 300 300 0 300
57 Multivitamin (Wishen) kaplet 240 240 240 0 ED
58 New Diatabs tablet 0 0
59 Nifedipin 10 mg tablet 0 0
60 Nystatin 500.000 IU tablet 100 100 0 100
61 Oralit 200 ml sachet 100 600 700 200 500
62 Papaverin 40 mg tablet 1000 1000 0 1000
63 Parasetamol 100 mg tablet 0 0 0 0
64 Parasetamol 500 mg tablet 3000 20000 23000 3000 20000
65 Parasetamol tab tablet 0 0
66 Phenitoin 30 mg tablet 250 250 0 250
67 Phenylbutazone 200 mg tablet 0 0
68 Pirantel Pamoat 125 mg tablet 0 0
69 Piroksikam 10 mg tablet 300 1000 1300 400 900
70 Piroksikam 20 mg tablet 100 1000 1100 0 1100
71 Prednison 5 mg tablet 1000 10000 11000 1000 10000
72 Propanolol 10 mg tablet 0 0
73 Propanolol 40 mg tablet 100 100 0 100
74 PTU 100 mg tablet 200 200 0 200
75 Ranitidine 150 mg tablet 500 500 200 300
76 Reserpin 0,10 mg tablet 0 500 500 0 500
77 Reserpin 0,25 mg tablet 1000 1000 2000 0 2000
78 Salbutamol 2 mg tablet 600 600 0 600
79 Salbutamol 4 mg tablet 0 0
80 Sulfadimidin 500 mg tablet 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
81 Tetrasiklin 250 mg kapsul 1000 1000 0 1000
82 Tetrasiklin 500 mg tablet 0 0
83 Thiamphenicol 500 mg tablet 0 0
84 Vitamin B Kompleks tablet 2000 5000 7000 2000 5000
85 Vitamin B6 10 mg tablet 3000 8000 11000 2000 9000
86 Vitamin B1 50 mg tablet 3000 9000 12000 2000 10000
87 Vitamin B12 tablet 0 0
88 Vitamin C 50 mg tablet 5000 9000 14000 3000 11000
89 Vitamin K 10 mg tablet 200 300 500 0 500
OBAT JENIS SIRUP
90 Ambroksol sirup btl 87 87 10 77
91 Amoxicillin SK 125 mg/ 5 ml btl @ 60 ml 0 300 300 100 200
92 Amoxicillin SK 250 mg/ 5 ml btl @ 60 ml 0 100 100 27 73
93 Ampisilin Sirup Kering btl 0 0 0 0
94 Antasida suspensi btl 0 0 0 0
95 Besi Sulfat Syrup btl 0 0 0 0
96 Cefadroxil Syrup Kering btl 0 0 0 0
97 Chloramphenicol Syrup btl 60 60 0 60 ED
98 Dekstrometorfan sirup btl 60 ml 97 97 5 92
99 Ibuprofen Syrup Botol 50 50 1 49
100 Kotrimoksazol suspensi btl 60 ml 94 250 344 53 291
101 Multivitamin Syrup (Pediagrow) btl 22 22 3 19
102 OBH Sirup btl 68 68 11 57
103 Parasetamol Sirup btl 60 ml 300 300 100 200
OBAT NAPZA
104 Diazepam 2 mg tablet 2373 2373 20 2353
105 Diazepam 5 mg tablet 0 0 0 0
106 Diazepam Inj amp 0 0 0 0 ED
107 Fenobarbital 30 mg tablet 575 575 10 565
108 Fenobarbital Injeksi amp 25 25 25 0 ED
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
109 Fenitoin inj amp 0 0
110 Haloperidol 5 mg tablet 0 0
111 Klorpromazin 100 mg tablet 0 0
112 Klorpromazin 25 mg tablet 900 900 0 900
113 Kodein 10 mg tablet 210 210 0 210
OBAT TB PARU 0 0
114 Ethambutol 250 mg tablet 0 0
115 I N H 100 mg tablet 0 0
116 I N H 300 mg tablet 1000 1000 0 1000
117 Pirazinamid 500 mg tablet 60 60 0 60
118 Rifampisin 450 mg tablet 67 67 6 61
OBAT LUAR
119 Aqudes Steril 500 ml btl 0 0
120 Alkohol 70 % 1000 ml Btl 2 5 7 2 5
121 Acyclovir Cream Tube 19 50 69 19 50
122 Anti Hemoroid Supp 25 60 85 25 60
123 Bacid Racin Salep Tube 0 0
124 Betametasone Krim Tube 22 75 97 72 25
125 Borax Gliserin sol Btl 0 0
126 Etil Klorida Spray Btl 100 ml 4 4 1 3
127 Fenol Gliserol Tts Telinga Btl 0 0
128 Formalin tab 1 Gram tablet 4 4 0 4
129 Gentamycin Salep Kulit Tube 15 50 65 15 50
130 Gentamycin Tetes Mata Steril 0,3 % botol 16 20 36 6 30
131 Gentian Violet Sol Btl 36 36 0 36
132 Gliserin Btl @ 10 ml 0 0
133 Hydrocortisone Cream 2,5% tube 9 168 177 81 96
134 Ichtyol Salep 10 gr Pot 0 0 0 0
135 Kalium Permanganat Pot 9 9 1 8
136 Kloramfenikol Salep Kulit (Farsycol) Tube @ 10 gr 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
137 Kloramfenikol Salep Mata 1 % Tube 0 0 0 0
138 Kloramfenikol tetes Mata btl 0 0
139 Kloramfenikol Tetes Telinga Btl 48 48 2 46
140 Lisol 1000 ml Btl 4 4 1 3
141 Mikonazole Krim Tube 20 96 116 20 96
142 Oksitetrasiklin Salep Kulit 3 % Tube 20 100 120 70 50
143 Oksitetrasiklin Salep Mata 1 % Tube 127 127 27 100
144 Rivanol 1 % 300 ml Btl 5 5 1 4
145 Salisil Bedak kotak 0 30 30 10 20
146 Salisilat Belerang Salep pot 33 24 57 0 57
147 Yodium Povidone Sol 1000 ml Btl 0 0
148 Yodium Povidone Sol 300 ml Btl 0 0
149 Yodium Povidone Sol 30 ml Btl 10 10 1 9
150 Yodium Povidon Sol 10 ml Btl 0 0 0 0
OBAT SUNTIK
151 Adidryl Injeksi vial 8 8 0 8
152 Adimidon Injeksi vial 16 16 0 16
153 Aqua Pro Inj amp 0 0 0 0 ED
154 Aminofilin inj amp 30 30 0 30
155 Antalgin inj amp 0 0
156 Buscopan Injeksi amp 5 5 0 5
157 Cefotaxim inj amp 6 6 0 6
158 Cortison inj amp 7 7 7 0 ED
159 Deksametasone Inj amp 72 100 172 0 172
160 Dextrose 5 % - Nacl 0,45 % kolf 0 0
161 Dextrose 5 % - Nacl 1/4 kolf 0 0
162 Dextrose 5 % kolf 31 31 3 28
163 Dextrose 10 % kolf 6 25 31 0 31
164 Difenhidramin Inj amp 20 20 0 20
165 Ephinephrin Injeksi amp 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
166 Ketorolac Injeksi amp 15 15 0 15
167 Lidokain Inj amp 0 0 0 0
168 Lidokain comp amp 150 150 0 150
169 Metil ergometrin inj amp 10 10 0 10
170 Natrium Klorida Infus kolf 12 20 32 3 29
171 Natrium Tiosulfat Injeksi amp 0 0
172 Oxytetracyclin Injeksi vial 0 0
173 Oxytocin Injeksi amp 0 0 0 0
174 Papaverin inj amp 30 30 0 30
175 Ranitidine Injeksi amp 20 20 0 20
176 Ringer Laktat Infus kolf 36 20 56 30 26
177 Sabu 5 ml Injeksi vial 0 0
178 Streptomycin Injeksi vial 0 0
179 Vitamin B1 inj amp 10 10 0 10
180 Vitamin B 12 inj amp 68 68 0 68
181 Vitamin K Injeksi Amp 25 24 49 0 49 dari KIA
182 Vitamin C Inj Amp 0 0
ALKES HABIS PAKAI
183 Abbocath No.18 Pcs 48 48 0 48
184 Abbocath No. 20 Pcs 23 23 8 15
185 Abbocath No. 22 Pcs 74 74 13 61
186 Abbocath No.24 Pcs 72 72 5 67
187 Alat Suntik 1 ml Pcs 1600 500 2100 0 2100
188 Alat Suntik 2,5 ml Pcs 0 0 0 0
189 Alat Suntik 3 ml Pcs 46 300 346 46 300
190 Alat Suntik 5 ml Pcs 500 400 900 100 800
191 Alat Suntik 10 ml Pcs 0 0
192 Alat Suntik 20 ml Pcs 0 0
193 Blood Set Set 0 0
194 Cat/Gut 2/0 150 cm Pcs 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
195 Catgut No. 3/0 75 cm Pcs 0 0 0 0
196 Catgut Chromic No. 4/0 150 cm Pcs 6 6 6 0
197 Hand Schoen No 7 Pasang 23 23 23 0
198 Hand Schoen No 7,5 Pasang 0 0
199 Hand Schoen No 8 Pasang 0 0
200 Hypafix 5 cm Roll 0 0
201 Infus Set Anak Pcs 14 14 1 13
202 Infus Set Dewasa Pcs 72 72 23 49
203 Jarum Bedah Pcs 0 0 0 0
204 Kapas Pembalut 250 gram Bks 5 10 15 2 13
205 Kasa 2 y x 80 cm Roll 0 0
206 Kasa 5 cm x 80 cm Roll 0 0
207 Kasa Kompres 40 x40 Roll 6 6 6 0
208 Kasa Pemb 40 x 80 cm Roll 0 0
209 Kasa Steril 16 x 16 ktk/100 lbr 8 40 48 15 33
210 Kasa Hidrofil 4 x 15 cm Roll 0 0
211 Kasa Pembalut 4 x 3 cm Roll 0 0
212 Masker Box/50 Pcs 0 0
213 Nald Hecting Otot (Jarum Kulit) Set/12 pcs 0 0
214 Nald Hecting No. 9 pcs 12 12 0 12
215 Nald Hecting No 13 Pcs 12 12 0 12
216 Nald Hecting No 15 Pcs 0 0
217 NGT No. 3,5 (Feeding Tube) Set 10 10 10 0 ED
218 NGT No. 16 (Feeding Tube) Set 0 0
219 Nald No. 23 Pcs 300 300 200 100
220 Nald No. 24 Pcs 0 0
221 Scalvein No. 23 Pcs 0 0
222 Silk No. 3/0 150 cm Pcs 1 1 1 0
223 Silk Black No. 3/0 75 cm (35 mm) Pcs 12 12 12 0
224 Silk Black No. 3/0 75 cm (26 mm) Pcs 22 22 0 22
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
225 Plester 5 Yard x 2 Inch Roll 0 12 12 1 11
TAMBAHAN
226 Alkohol Swab ktk/100 paket 3 3 0 3
227 Pharmafix 2,5 cm x 5 mtr Roll 7 7 4 3
228 Pharmafix 5 cm x 5 mtr Roll 9 9 0 9
229 Pharmafix 10 cm x 5 mtr Roll 8 8 0 8
230 Indo Obat Flu tablet 54 54 12 42
231 Indo Obat Cacing (Mebendazole) tablet 3 3 2 1
232 Indo Obat Penurun Panas tablet 48 48 0 48
233 0 0
234 0 0
235 0 0
236 0 0
237 0 0
238 0 0
239 0 0
240 0 0

Umum
ASKES Jumlah
Jumlah Kunjungan Resep Bayar Tidak Bayar

435 313 94 842

Yang Meminta Mengetahui/Menyetujui Yang Menyerahkan Yang Menerima

Pimpinan Puskesmas Kepala Dinkes II / GFK Petugas GFK Petugas Puskesmas

Dr. Herlina Barends (…………………………………………) (………………………………….) Hj. Badariah

NIP. 19670726 199903 2 003 NIP. NIP. NIP. 19580612 197712 2 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : SEDADAP PELAPORAN BULAN : Oktober 2010 NO./[Link]:

KECAMATAN : NUNUKAN SELATAN PERMINTAAN BULAN/PERIODE : GFK
KABUPATEN : NUNUKAN PUSK
DINKES

PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA PEMBERIAN KETERANG

NO NAMA OBAT SATUAN STOK AWAL
AN AAN AN STOK OPT AN
JUMLAH
AN
INPRES ASKES APBD I APBD II LAIN2
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet 790 790 0 790
2 Ambeven tablet 0 0 0 0
3 Albendazole tablet 90 90 30 60
4 Allopurinol 100 mg tablet 1300 1300 200 1100
5 Ambroksol 30 mg tablet 300 500 800 400 400
6 Amoxicillin 250 mg tablet 1680 1680 1080 600
7 Amoxicillin 500 mg tablet 11900 11900 4300 7600
8 Ampisilin 500 mg tablet 2700 2700 100 2600
9 Antalgin 500 mg tablet 4000 4000 0 4000
10 Antasida DOEN tablet 0 3000 3000 1000 2000
11 Asam Folat tablet 0 0 0 0
12 Asam Mefenamat 500 mg tablet 7000 7000 2300 4700
13 Atropin Sulfat 0,5 mg tablet 500 500 0 500
14 Acyclovir 200 mg tablet 200 200 0 200
15 Acyclovir 400 mg tablet 600 600 100 500
16 Besi sulfat tablet 3800 3800 1100 2700
17 Bisacodyl (Laxana) tablet 0 0 0
18 Buscopan tablet 0 0 0
19 Captopril 25 mg tablet 2800 2800 400 2400
20 Captopril 12,5 mg tablet 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
21 Cefadroxil 500 mg tablet 0 0 0
22 Chloramphenicol 250 mg tablet 2000 2000 0 2000
23 Chloroquin 250 mg tablet 0 0 0
24 Cimetidine 200 mg tablet 0 0 0
25 Ciprofloxacin 500 mg tablet 1250 1250 100 1150
26 CTM 4 mg tablet 7000 7000 5000 2000
27 Deksametasone 0,5 mg tablet 12000 12000 6000 6000
28 Dekstrometorfan 15 mg tablet 5000 5000 0 5000
29 Digoksin 0,25 mg tablet 0 0 0 0
30 Dimenhidrinat 50 mg tablet 100 100 0 100
31 Domperidone 10 mg tablet 1100 1100 200 900
32 Efedrin 25 mg tablet 3000 3000 0 3000
33 Ergotamine Kafein tablet 100 100 0 100
34 Erythromycin 250 mg tablet 480 480 0 480
35 Erythromycin 500 mg tablet 1800 1800 1500 300
36 Famotidine 20 mg tablet 600 600 0 600
37 Furosemide 40 mg tablet 400 400 200 200
38 Glibenklamide 5 mg tablet 800 800 0 800
39 Gliseril Guayakolat 100 mg tablet 12000 12000 2000 10000
40 Griseofulvin 125 mg tablet 2500 2500 300 2200
41 H C T 25 mg tablet 1000 1000 0 1000
42 Ibuprofen 200 mg tablet 0 0 0 0
43 Ibuprofen 400 mg tablet 1400 1400 600 800
44 Isosorbit Dinitrat 5 mg tablet 0 0 0
45 Kalnex 500 mg tablet 0 0 0
46 Kalsium Laktat 500 mg tablet 9000 9000 2000 7000
47 Ketokonazole 200 mg tablet 0 0 0
48 Komp Pirimetamin Sulfadoksin tablet 88 88 0 88
49 Kotrimoksazol 120 mg tablet 500 500 0 500
50 Kotrimoksazol 480 mg tablet 1500 1500 1300 200
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
51 Loperamid HCL 2 mg (Novadium) tablet 400 400 100 300
52 Mebendazol tablet 0 0 0 0
53 Methylergometrin 0,125 mg tablet 400 400 0 400
54 Metoklopramide 10 mg tablet 0 0 0
55 Metronidazol 500 mg tablet 690 690 0 690
56 Metronidazol 250 mg tablet 300 300 100 200
57 Multivitamin (Wishen) kaplet 0 0 0 0
58 New Diatabs tablet 0 0 0
59 Nifedipin 10 mg tablet 0 0 0
60 Nystatin 500.000 IU tablet 100 100 0 100
61 Oralit 200 ml sachet 500 500 400 100
62 Papaverin 40 mg tablet 1000 1000 0 1000
63 Parasetamol 100 mg tablet 0 0 0 0
64 Parasetamol 500 mg tablet 20000 20000 5000 15000
65 Parasetamol tab tablet 0 0 0
66 Phenitoin 30 mg tablet 250 250 0 250
67 Phenylbutazone 200 mg tablet 0 0 0
68 Pirantel Pamoat 125 mg tablet 0 0 0
69 Piroksikam 10 mg tablet 900 900 200 700
70 Piroksikam 20 mg tablet 1100 1100 400 700
71 Prednison 5 mg tablet 10000 10000 1000 9000
72 Propanolol 10 mg tablet 0 0 0
73 Propanolol 40 mg tablet 100 100 0 100
74 PTU 100 mg tablet 200 200 0 200
75 Ranitidine 150 mg tablet 300 500 800 600 200
76 Reserpin 0,10 mg tablet 500 250 750 500 250
77 Reserpin 0,25 mg tablet 2000 2000 1000 1000
78 Salbutamol 2 mg tablet 600 600 0 600
79 Salbutamol 4 mg tablet 0 0 0
80 Sulfadimidin 500 mg tablet 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
81 Tetrasiklin 250 mg kapsul 1000 1000 0 1000
82 Tetrasiklin 500 mg tablet 0 0 0
83 Thiamphenicol 500 mg tablet 0 0 0
84 Vitamin B Kompleks tablet 5000 5000 2000 3000
85 Vitamin B6 10 mg tablet 9000 9000 1000 8000
86 Vitamin B1 50 mg tablet 10000 10000 1000 9000
87 Vitamin B12 tablet 0 0 0
88 Vitamin C 50 mg tablet 11000 11000 3000 8000
89 Vitamin K 10 mg tablet 500 500 300 200
OBAT JENIS SIRUP
90 Ambroksol sirup btl 77 77 10 67
91 Amoxicillin SK 125 mg/ 5 ml btl @ 60 ml 200 200 70 130
92 Amoxicillin SK 250 mg/ 5 ml btl @ 60 ml 73 73 27 46
93 Ampisilin Sirup Kering btl 0 0 0 0
94 Antasida suspensi btl 0 0 0 0
95 Besi Sulfat Syrup btl 0 0 0 0
96 Cefadroxil Syrup Kering btl 0 0 0 0
97 Chloramphenicol Syrup btl 0 0 0 0
98 Dekstrometorfan sirup btl 60 ml 92 97 7 90
99 Ibuprofen Syrup Botol 49 49 5 44
100 Kotrimoksazol suspensi btl 60 ml 291 291 78 213
101 Multivitamin Syrup (Pediagrow) btl 19 19 9 10
102 OBH Sirup btl 57 57 24 33
103 Parasetamol Sirup btl 60 ml 200 200 73 127
OBAT NAPZA
104 Diazepam 2 mg tablet 2353 2353 0 2353
105 Diazepam 5 mg tablet 0 0 0 0
106 Diazepam Inj amp 0 0 0 0
107 Fenobarbital 30 mg tablet 565 565 4 561
108 Fenobarbital Injeksi amp 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
109 Fenitoin inj amp 0 0 0
110 Haloperidol 5 mg tablet 0 0 0
111 Klorpromazin 100 mg tablet 0 0 0
112 Klorpromazin 25 mg tablet 900 900 0 900
113 Kodein 10 mg tablet 210 210 0 210
OBAT TB PARU 0 0
114 Ethambutol 250 mg tablet 0 0 0
115 I N H 100 mg tablet 0 0 0
116 I N H 300 mg tablet 1000 1000 0 1000
117 Pirazinamid 500 mg tablet 60 60 0 60
118 Rifampisin 450 mg tablet 61 61 6 55
OBAT LUAR
119 Aqudes Steril 500 ml btl 0 0 0 0
120 Alkohol 70 % 1000 ml Btl 5 5 1 4
121 Acyclovir Cream Tube 50 50 0 50
122 Anti Hemoroid Supp 60 60 25 35
123 Bacid Racin Salep Tube 0 0 0 0
124 Betametasone Krim Tube 25 50 75 50 25
125 Borax Gliserin sol Btl 0 0 0 0
126 Etil Klorida Spray Btl 100 ml 3 3 0 3
127 Fenol Gliserol Tts Telinga Btl 0 0 0 0
128 Formalin tab 1 Gram tablet 4 4 0 4
129 Gentamycin Salep Kulit Tube 50 50 0 50
130 Gentamycin Tetes Mata Steril 0,3 % botol 30 30 20 10
131 Gentian Violet Sol Btl 36 36 10 26
132 Gliserin Btl @ 10 ml 0 0 0 0
133 Hydrocortisone Cream 2,5% tube 96 96 48 48
134 Ichtyol Salep 10 gr Pot 0 0 0 0
135 Kalium Permanganat Pot 8 8 1 7
136 Kloramfenikol Salep Kulit (Farsycol) Tube @ 10 gr 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
137 Kloramfenikol Salep Mata 1 % Tube 0 0 0 0
138 Kloramfenikol tetes Mata btl 0 0 0 0
139 Kloramfenikol Tetes Telinga Btl 46 46 13 33
140 Lisol 1000 ml Btl 3 3 0 3
141 Mikonazole Krim Tube 96 96 48 48
142 Oksitetrasiklin Salep Kulit 3 % Tube 50 50 100 50 50
143 Oksitetrasiklin Salep Mata 1 % Tube 100 100 0 100
144 Rivanol 1 % 300 ml Btl 4 4 2 2
145 Salisil Bedak kotak 20 20 10 10
146 Salisilat Belerang Salep pot 57 57 10 47
147 Yodium Povidone Sol 1000 ml Btl 0 0 0 0
148 Yodium Povidone Sol 300 ml Btl 0 0 0 0
149 Yodium Povidone Sol 30 ml Btl 9 9 0 9
150 Yodium Povidon Sol 10 ml Btl 0 0 0 0
OBAT SUNTIK
151 Adidryl Injeksi vial 8 8 0 8
152 Adimidon Injeksi vial 16 16 0 16
153 Aqua Pro Inj amp 0 0 0 0
154 Aminofilin inj amp 30 30 0 30
155 Antalgin inj amp 0 0 0
156 Buscopan Injeksi amp 5 5 0 5
157 Cefotaxim inj amp 6 6 0 6
158 Cortison inj amp 0 0 0 0
159 Deksametasone Inj amp 172 172 35 137
160 Dextrose 5 % - Nacl 0,45 % kolf 0 0 0
161 Dextrose 5 % - Nacl 1/4 kolf 0 0 0
162 Dextrose 5 % kolf 28 28 3 25
163 Dextrose 10 % kolf 31 31 25 6 ED
164 Difenhidramin Inj amp 20 20 0 20
165 Ephinephrin Injeksi amp 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
166 Ketorolac Injeksi amp 15 15 5 10
167 Lidokain Inj amp 0 0 0 0
168 Lidokain comp amp 150 150 15 135
169 Metil ergometrin inj amp 10 10 0 10
170 Natrium Klorida Infus kolf 29 29 0 29
171 Natrium Tiosulfat Injeksi amp 0 0 0
172 Oxytetracyclin Injeksi vial 0 0 0
173 Oxytocin Injeksi amp 0 0 0 0
174 Papaverin inj amp 30 30 1 29
175 Ranitidine Injeksi amp 20 20 0 20
176 Ringer Laktat Infus kolf 26 26 14 12
177 Sabu 5 ml Injeksi vial 0 0 0
178 Streptomycin Injeksi vial 0 0 0
179 Vitamin B1 inj amp 10 10 0 10
180 Vitamin B 12 inj amp 68 68 20 48
181 Vitamin K Injeksi Amp 49 49 0 49
182 Vitamin C Inj Amp 0 0 0
ALKES HABIS PAKAI
183 Abbocath No.18 Pcs 48 48 0 48
184 Abbocath No. 20 Pcs 15 15 0 15
185 Abbocath No. 22 Pcs 61 61 0 61
186 Abbocath No.24 Pcs 67 67 11 56
187 Alat Suntik 1 ml Pcs 2100 2100 251 1849
188 Alat Suntik 2,5 ml Pcs 0 0 0 0
189 Alat Suntik 3 ml Pcs 46 46 9 37
190 Alat Suntik 5 ml Pcs 800 800 0 800
191 Alat Suntik 10 ml Pcs 0 0 0
192 Alat Suntik 20 ml Pcs 0 0 0
193 Blood Set Set 0 0 0
194 Cat/Gut 2/0 150 cm Pcs 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
195 Catgut No. 3/0 75 cm Pcs 0 0 0 0
196 Catgut Chromic No. 4/0 150 cm Pcs 0 0 0 0
197 Hand Schoen No 7 Pasang 0 0 0 0
198 Hand Schoen No 7,5 Pasang 0 0 0
199 Hand Schoen No 8 Pasang 0 0 0
200 Hypafix 5 cm Roll 0 0 0
201 Infus Set Anak Pcs 13 13 0 13
202 Infus Set Dewasa Pcs 49 49 5 44
203 Jarum Bedah Pcs 0 0 0 0
204 Kapas Pembalut 250 gram Bks 13 13 1 12
205 Kasa 2 y x 80 cm Roll 0 0 0
206 Kasa 5 cm x 80 cm Roll 0 0 0
207 Kasa Kompres 40 x40 Roll 0 0 0 0
208 Kasa Pemb 40 x 80 cm Roll 0 0 0
209 Kasa Steril 16 x 16 ktk/100 lbr 33 33 7 26
210 Kasa Hidrofil 4 x 15 cm Roll 0 0 0
211 Kasa Pembalut 4 x 3 cm Roll 0 0 0
212 Masker Box/50 Pcs 0 0 0
213 Nald Hecting Otot (Jarum Kulit) Set/12 pcs 0 0 0
214 Nald Hecting No. 9 pcs 12 12 0 12
215 Nald Hecting No 13 Pcs 12 12 12 0
216 Nald Hecting No 15 Pcs 0 0 0
217 NGT No. 3,5 (Feeding Tube) Set 0 0 0 0
218 NGT No. 16 (Feeding Tube) Set 0 0 0
219 Nald No. 23 Pcs 100 100 100 0
220 Nald No. 24 Pcs 0 0 0
221 Scalvein No. 23 Pcs 0 0 0
222 Silk No. 3/0 150 cm Pcs 0 0 0 0
223 Silk Black No. 3/0 75 cm (35 mm) Pcs 0 0 0 0
224 Silk Black No. 3/0 75 cm (26 mm) Pcs 22 22 0 22
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
225 Plester 5 Yard x 2 Inch Roll 11 11 2 9
TAMBAHAN
226 Alkohol Swab ktk/100 paket 3 3 0 3
227 Pharmafix 2,5 cm x 5 mtr Roll 3 3 0 3
228 Pharmafix 5 cm x 5 mtr Roll 9 9 0 9
229 Pharmafix 10 cm x 5 mtr Roll 8 8 1 7
230 Indo Obat Flu tablet 42 42 12 30
231 Indo Obat Cacing (Mebendazole) tablet 1 1 0 1
232 Indo Obat Penurun Panas tablet 48 48 0 48
233 Ampicillin Injeksi (Vicillin) vial 110 110 0 110 dari KIA
234 Gentamycin Injeksi amp 140 140 0 140 dari KIA
235 0 0
236 0 0
237 0 0
238 0 0
239 0 0
240 0 0

Umum
ASKES Jumlah
Jumlah Kunjungan Resep Bayar Tidak Bayar

431 609 122 1162

Yang Meminta Mengetahui/Menyetujui Yang Menyerahkan Yang Menerima

Pimpinan Puskesmas Kepala Dinkes II / GFK Petugas GFK Petugas Puskesmas

Dr. Herlina Barends (…………………………………………) (………………………………….) Hj. Badariah

NIP. 19670726 199903 2 003 NIP. NIP. NIP. 19580612 197712 2 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : SEDADAP PELAPORAN BULAN : Nopember 2010 NO./[Link]:

KECAMATAN : NUNUKAN SELATAN PERMINTAAN BULAN/PERIODE : GFK
KABUPATEN : NUNUKAN PUSK
DINKES

PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA PEMBERIAN KETERANG

NO NAMA OBAT SATUAN STOK AWAL
AN AAN AN STOK OPT AN
JUMLAH
AN
INPRES ASKES APBD I APBD II LAIN2
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet 790 790 0 790
2 Ambeven tablet 0 0 0 0
3 Albendazole tablet 60 60 30 30
4 Allopurinol 100 mg tablet 1100 1100 300 800
5 Ambroksol 30 mg tablet 400 400 300 100
6 Amoxicillin 250 mg tablet 600 600 600 0
7 Amoxicillin 500 mg tablet 7600 7600 4300 3300
8 Ampisilin 500 mg tablet 2600 2600 300 2300
9 Antalgin 500 mg tablet 4000 4000 1000 3000
10 Antasida DOEN tablet 2000 2000 1000 1000
11 Asam Folat tablet 0 0 0 0
12 Asam Mefenamat 500 mg tablet 4700 4700 2300 2400
13 Atropin Sulfat 0,5 mg tablet 500 500 0 500
14 Acyclovir 200 mg tablet 200 200 0 200
15 Acyclovir 400 mg tablet 500 500 100 400
16 Besi sulfat tablet 2700 2700 1600 1100
17 Bisacodyl (Laxana) tablet 0 0 0 0
18 Buscopan tablet 0 0 0 0
19 Captopril 25 mg tablet 2400 2400 500 1900
20 Captopril 12,5 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
21 Cefadroxil 500 mg tablet 0 0 0 0
22 Chloramphenicol 250 mg tablet 2000 2000 0 2000
23 Chloroquin 250 mg tablet 0 0 0 0
24 Cimetidine 200 mg tablet 0 0 0 0
25 Ciprofloxacin 500 mg tablet 1150 1150 250 900
26 CTM 4 mg tablet 2000 7000 9000 8000 1000
27 Deksametasone 0,5 mg tablet 6000 6000 5000 1000
28 Dekstrometorfan 15 mg tablet 5000 5000 1000 4000
29 Digoksin 0,25 mg tablet 0 0 0 0
30 Dimenhidrinat 50 mg tablet 100 100 100 0
31 Domperidone 10 mg tablet 900 900 300 600
32 Efedrin 25 mg tablet 3000 3000 1000 2000
33 Ergotamine Kafein tablet 100 100 0 100
34 Erythromycin 250 mg tablet 480 480 360 120
35 Erythromycin 500 mg tablet 300 500 800 400 400
36 Famotidine 20 mg tablet 600 600 600 0
37 Furosemide 40 mg tablet 200 200 0 200
38 Glibenklamide 5 mg tablet 800 800 200 600
39 Gliseril Guayakolat 100 mg tablet 10000 10000 4000 6000
40 Griseofulvin 125 mg tablet 2200 2200 100 2100
41 H C T 25 mg tablet 1000 1000 0 1000
42 Ibuprofen 200 mg tablet 0 300 300 100 200
43 Ibuprofen 400 mg tablet 800 800 800 0
44 Isosorbit Dinitrat 5 mg tablet 0 0 0 0
45 Kalnex 500 mg tablet 0 0 0 0
46 Kalsium Laktat 500 mg tablet 7000 7000 2000 5000
47 Ketokonazole 200 mg tablet 0 100 100 50 50
48 Komp Pirimetamin Sulfadoksin tablet 88 88 0 88
49 Kotrimoksazol 120 mg tablet 500 500 400 100
50 Kotrimoksazol 480 mg tablet 200 200 200 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
51 Loperamid HCL 2 mg (Novadium) tablet 300 300 200 100
52 Mebendazol tablet 0 0 0 0
53 Methylergometrin 0,125 mg tablet 400 400 0 400
54 Metoklopramide 10 mg tablet 0 0 0 0
55 Metronidazol 500 mg tablet 690 690 190 500
56 Metronidazol 250 mg tablet 200 200 0 200
57 Multivitamin (Wishen) kaplet 0 0 0 0
58 New Diatabs tablet 0 0 0 0
59 Nifedipin 10 mg tablet 0 0 0 0
60 Nystatin 500.000 IU tablet 100 100 10 90
61 Oralit 200 ml sachet 100 300 400 200 200
62 Papaverin 40 mg tablet 1000 1000 1000 0
63 Parasetamol 100 mg tablet 0 0 0 0
64 Parasetamol 500 mg tablet 15000 15000 5000 10000
65 Parasetamol tab tablet 0 0 0 0
66 Phenitoin 30 mg tablet 250 250 0 250
67 Phenylbutazone 200 mg tablet 0 0 0 0
68 Pirantel Pamoat 125 mg tablet 0 0 0 0
69 Piroksikam 10 mg tablet 700 700 200 500
70 Piroksikam 20 mg tablet 700 700 100 600
71 Prednison 5 mg tablet 9000 9000 2000 7000
72 Propanolol 10 mg tablet 0 0 0 0
73 Propanolol 40 mg tablet 100 100 0 100
74 PTU 100 mg tablet 200 200 0 200
75 Ranitidine 150 mg tablet 200 300 500 500 0
76 Reserpin 0,10 mg tablet 250 250 500 500 0 ED = 250 tab
77 Reserpin 0,25 mg tablet 1000 1000 0 1000
78 Salbutamol 2 mg tablet 600 600 0 600
79 Salbutamol 4 mg tablet 0 0 0 0
80 Sulfadimidin 500 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
81 Tetrasiklin 250 mg kapsul 1000 1000 0 1000
82 Tetrasiklin 500 mg tablet 0 0 0 0
83 Thiamphenicol 500 mg tablet 0 0 0 0
84 Vitamin B Kompleks tablet 3000 3000 3000 0
85 Vitamin B6 10 mg tablet 8000 8000 2000 6000
86 Vitamin B1 50 mg tablet 9000 9000 3000 6000
87 Vitamin B12 tablet 0 1000 1000 1000 0
88 Vitamin C 50 mg tablet 8000 8000 4000 4000
89 Vitamin K 10 mg tablet 200 200 100 100
OBAT JENIS SIRUP
90 Ambroksol sirup btl 67 67 29 38
91 Amoxicillin SK 125 mg/ 5 ml btl @ 60 ml 130 130 82 48
92 Amoxicillin SK 250 mg/ 5 ml btl @ 60 ml 46 46 17 29
93 Ampisilin Sirup Kering btl 0 0 0 0
94 Antasida suspensi btl 0 0 0 0
95 Besi Sulfat Syrup btl 0 0 0 0
96 Cefadroxil Syrup Kering btl 0 0 0 0
97 Chloramphenicol Syrup btl 0 0 0 0
98 Dekstrometorfan sirup btl 60 ml 90 97 13 84
99 Ibuprofen Syrup Botol 44 44 4 40
100 Kotrimoksazol suspensi btl 60 ml 213 213 72 141
101 Multivitamin Syrup (Pediagrow) btl 10 10 10 0
102 OBH Sirup btl 33 20 53 39 14
103 Parasetamol Sirup btl 60 ml 127 127 116 11
OBAT NAPZA
104 Diazepam 2 mg tablet 2353 2353 25 2328
105 Diazepam 5 mg tablet 0 0 0 0
106 Diazepam Inj amp 0 0 0 0
107 Fenobarbital 30 mg tablet 561 561 29.5 531.5
108 Fenobarbital Injeksi amp 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
109 Fenitoin inj amp 0 0 0 0
110 Haloperidol 5 mg tablet 0 0 0 0
111 Klorpromazin 100 mg tablet 0 0 0 0
112 Klorpromazin 25 mg tablet 900 900 0 900
113 Kodein 10 mg tablet 210 210 210 0 Rusak
OBAT TB PARU
114 Ethambutol 250 mg tablet 0 0 0 0
115 I N H 100 mg tablet 0 0 0 0
116 I N H 300 mg tablet 1000 1000 0 1000
117 Pirazinamid 500 mg tablet 60 60 0 60
118 Rifampisin 450 mg tablet 55 55 26 29
OBAT LUAR
119 Aqudes Steril 500 ml btl 0 0 0 0
120 Alkohol 70 % 1000 ml Btl 4 4 2 2
121 Acyclovir Cream Tube 50 50 0 50
122 Anti Hemoroid Supp 35 35 15 20
123 Bacid Racin Salep Tube 0 0 0 0
124 Betametasone Krim Tube 25 75 100 50 50
125 Borax Gliserin sol Btl 0 0 0 0
126 Etil Klorida Spray Btl 100 ml 3 3 1 2
127 Fenol Gliserol Tts Telinga Btl 0 0 0 0
128 Formalin tab 1 Gram tablet 4 4 0 4
129 Gentamycin Salep Kulit Tube 50 50 0 50
130 Gentamycin Tetes Mata Steril 0,3 % botol 10 20 30 18 12
131 Gentian Violet Sol Btl 26 26 7 19
132 Gliserin Btl @ 10 ml 0 0 0 0
133 Hydrocortisone Cream 2,5% tube 48 48 96 72 24
134 Ichtyol Salep 10 gr Pot 0 0 0 0
135 Kalium Permanganat Pot 7 7 4 3
136 Kloramfenikol Salep Kulit (Farsycol) Tube @ 10 gr 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
137 Kloramfenikol Salep Mata 1 % Tube 0 0 0 0
138 Kloramfenikol tetes Mata btl 0 0 0 0
139 Kloramfenikol Tetes Telinga Btl 33 33 9 24
140 Lisol 1000 ml Btl 3 3 1 2
141 Mikonazole Krim Tube 48 48 24 24
142 Oksitetrasiklin Salep Kulit 3 % Tube 50 50 50 0
143 Oksitetrasiklin Salep Mata 1 % Tube 100 100 5 95
144 Rivanol 1 % 300 ml Btl 2 5 7 3 4
145 Salisil Bedak kotak 10 10 10 0
146 Salisilat Belerang Salep pot 47 47 8 39
147 Yodium Povidone Sol 1000 ml Btl 0 0 0 0
148 Yodium Povidone Sol 300 ml Btl 9 9 3 6
149 Yodium Povidon Sol 10 ml Btl 0 0 0 0
OBAT SUNTIK
150 Adidryl Injeksi vial 8 8 3 5
151 Adimidon Injeksi vial 16 16 3 13
152 Aqua Pro Inj amp 0 0 0 0
153 Aminofilin inj amp 30 30 0 30
154 Antalgin inj amp 0 0 0 0
155 Buscopan Injeksi amp 5 5 0 5
156 Cefotaxim inj amp 6 6 6 0 ED
157 Cortison inj amp 0 0 0 0
158 Deksametasone Inj amp 137 137 10 127
159 Dextrose 5 % - Nacl 0,45 % kolf 0 0 0 0
160 Dextrose 5 % - Nacl 1/4 kolf 0 0 0 0
161 Dextrose 5 % kolf 25 25 4 21
162 Dextrose 10 % kolf 6 6 2 4
163 Difenhidramin Inj amp 20 20 5 15
164 Ephinephrin Injeksi amp 0 0 0 0
165 Ketorolac Injeksi amp 10 10 0 10
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
166 Lidokain Inj amp 0 0 0 0
167 Lidokain comp amp 135 135 35 100
168 Metil ergometrin inj amp 10 10 0 10
169 Natrium Klorida Infus kolf 29 29 8 21
170 Natrium Tiosulfat Injeksi amp 0 0 0 0
171 Oxytetracyclin Injeksi vial 0 0 0 0
172 Oxytocin Injeksi amp 0 0 0 0
173 Papaverin inj amp 29 29 5 24
174 Ranitidine Injeksi amp 20 20 5 15
175 Ringer Laktat Infus kolf 12 60 72 22 50
176 Sabu 5 ml Injeksi vial 0 0 0 0
177 Streptomycin Injeksi vial 0 0 0 0
178 Vitamin B1 inj amp 10 10 10 0 ED
179 Vitamin B 12 inj amp 48 48 15 33
180 Vitamin K Injeksi Amp 49 49 15 34
181 Vitamin C Inj Amp 0 0 0 0
ALKES HABIS PAKAI
182 Abbocath No.18 Pcs 48 48 0 48
183 Abbocath No. 20 Pcs 15 15 15 0
184 Abbocath No. 22 Pcs 61 61 18 43
185 Abbocath No.24 Pcs 56 56 8 48
186 Alat Suntik 1 ml Pcs 1849 1849 300 1549
187 Alat Suntik 2,5 ml Pcs 0 0 0 0
188 Alat Suntik 3 ml Pcs 37 300 337 310 27
189 Alat Suntik 5 ml Pcs 800 800 200 600
190 Alat Suntik 10 ml Pcs 0 0 0 0
191 Alat Suntik 20 ml Pcs 0 0 0 0
192 Blood Set Set 0 0 0 0
193 Cat/Gut 2/0 150 cm Pcs 0 0 0 0
194 Catgut Chromic No. 3/0 75 cm Pcs 0 48 48 34 14
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
195 Catgut Chromic No. 4/0 150 cm Pcs 0 0 0 0
196 Hand Schoen No 7 Pasang 0 0 0 0
197 Hand Schoen No 7,5 Pasang 0 0 0 0
198 Hand Schoen No 8 Pasang 0 0 0 0
199 Hypafix 5 cm Roll 0 0 0 0
200 Infus Set Anak Pcs 13 13 5 8
201 Infus Set Dewasa Pcs 44 44 28 16
202 Jarum Bedah Pcs 0 0 0 0
203 Kapas Pembalut 250 gram Bks 12 12 1 11
204 Kasa 2 y x 80 cm Roll 0 10 10 4 6
205 Kasa 5 cm x 80 cm Roll 0 0 0 0
206 Kasa Kompres 40 x40 Roll 0 25 25 5 20
207 Kasa Pemb 40 x 80 cm Roll 0 0 0 0
208 Kasa Steril 16 x 16 ktk/100 lbr 26 10 36 26 10
209 Kasa Hidrofil 4 x 15 cm Roll 0 30 30 24 6
210 Kasa Pembalut 4 x 3 cm Roll 0 0 0 0
211 Masker Box/50 Pcs 0 0 0 0
212 Nald Hecting Otot (Jarum Kulit) Set/12 pcs 0 0 0 0
213 Nald Hecting No. 9 pcs 12 12 0 12
214 Nald Hecting No 13 Pcs 0 0 0 0
215 Nald Hecting No 15 Pcs 0 0 0 0
216 NGT No. 3,5 (Feeding Tube) Set 0 0 0 0
217 NGT No. 16 (Feeding Tube) Set 0 0 0 0
218 Nald No. 23 Pcs 0 0 0 0
219 Nald No. 24 Pcs 0 300 300 100 200
220 Scalvein No. 23 Pcs 0 0 0 0
221 Silk No. 3/0 150 cm Pcs 0 0 0 0
222 Silk Black No. 3/0 75 cm (35 mm) Pcs 0 0 0 0
223 Silk Black No. 3/0 75 cm (26 mm) Pcs 22 22 0 22
224 Plester 5 Yard x 2 Inch Roll 9 9 5 4
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
TAMBAHAN
225 Alkohol Swab ktk/100 paket 3 3 0 3
226 Pharmafix 2,5 cm x 5 mtr Roll 3 3 0 3
227 Pharmafix 5 cm x 5 mtr Roll 9 9 1 8
228 Pharmafix 10 cm x 5 mtr Roll 7 7 1 6
229 Indo Obat Flu tablet 30 30 30 0
230 Indo Obat Cacing (Mebendazole) tablet 1 1 1 0
231 Indo Obat Penurun Panas tablet 48 48 48 0
232 Ampicillin Injeksi (Vicillin) vial 110 110 0 110 dari KIA
233 Gentamycin Injeksi amp 140 140 0 140 dari KIA
234 0 0
235 0 0
236 0 0
237 0 0
238 0 0
239 0 0

Umum
ASKES Jumlah
Jumlah Kunjungan Resep Bayar Tidak Bayar

470 663 150 1283

Yang Meminta Mengetahui/Menyetujui Yang Menyerahkan Yang Menerima

Pimpinan Puskesmas Kepala Dinkes II / GFK Petugas GFK Petugas Puskesmas

Dr. Herlina Barends (…………………………………………) (………………………………….) Hj. Badariah

NIP. 19670726 199903 2 003 NIP. NIP. NIP. 19580612 197712 2 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : SEDADAP PELAPORAN BULAN : Nopember 2010 NO./[Link]:

KECAMATAN : NUNUKAN SELATAN PERMINTAAN BULAN/PERIODE : Desember 2010 - Februari 2011 GFK
KABUPATEN : NUNUKAN PUSK
DINKES

PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA PEMBERIAN KETERANG

NO NAMA OBAT SATUAN STOK AWAL
AN AAN AN STOK OPT AN
JUMLAH
AN
INPRES ASKES APBD I APBD II LAIN2
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet 790 790 0 790 0
2 Ambeven tablet 0 0 0 0 0
3 Albendazole tablet 60 60 30 30 120
4 Allopurinol 100 mg tablet 1100 1100 300 800 0
5 Ambroksol 30 mg tablet 400 400 300 100 1200
6 Amoxicillin 250 mg tablet 600 600 600 0 2400
7 Amoxicillin 500 mg tablet 7600 7600 4300 3300 20000
8 Ampisilin 500 mg tablet 2600 2600 300 2300 0
9 Antalgin 500 mg tablet 4000 4000 1000 3000 0
10 Antasida DOEN tablet 2000 2000 1000 1000 6000
11 Asam Folat tablet 0 0 0 0 0
12 Asam Mefenamat 500 mg tablet 4700 4700 2300 2400 10000
13 Atropin Sulfat 0,5 mg tablet 500 500 0 500 0
14 Acyclovir 200 mg tablet 200 200 0 200 0
15 Acyclovir 400 mg tablet 500 500 100 400 0
16 Besi sulfat tablet 2700 2700 1600 1100 7000
17 Bisacodyl (Laxana) tablet 0 0 0 0 0
18 Buscopan tablet 0 0 0 0 0
19 Captopril 25 mg tablet 2400 2400 500 1900 1000
20 Captopril 12,5 mg tablet 0 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
21 Cefadroxil 500 mg tablet 0 0 0 0 0
22 Chloramphenicol 250 mg tablet 2000 2000 0 2000 0
23 Chloroquin 250 mg tablet 0 0 0 0 0
24 Cimetidine 200 mg tablet 0 0 0 0 5000
25 Ciprofloxacin 500 mg tablet 1150 1150 250 900 1000
26 CTM 4 mg tablet 2000 7000 9000 8000 1000 32000
27 Deksametasone 0,5 mg tablet 6000 6000 5000 1000 20000
28 Dekstrometorfan 15 mg tablet 5000 5000 1000 4000 0
29 Digoksin 0,25 mg tablet 0 0 0 0 0
30 Dimenhidrinat 50 mg tablet 100 100 100 0 600
31 Domperidone 10 mg tablet 900 900 300 600 1200
32 Efedrin 25 mg tablet 3000 3000 1000 2000 4000
33 Ergotamine Kafein tablet 100 100 0 100 0
34 Erythromycin 250 mg tablet 480 480 360 120 1200
35 Erythromycin 500 mg tablet 300 500 800 400 400 5000
36 Famotidine 20 mg tablet 600 600 600 0 2400
37 Furosemide 40 mg tablet 200 200 0 200 0
38 Glibenklamide 5 mg tablet 800 800 200 600 800
39 Gliseril Guayakolat 100 mg tablet 10000 10000 4000 6000 16000
40 Griseofulvin 125 mg tablet 2200 2200 100 2100 0
41 H C T 25 mg tablet 1000 1000 0 1000 0
42 Ibuprofen 200 mg tablet 0 300 300 100 200 1000
43 Ibuprofen 400 mg tablet 800 800 800 0 3000
44 Isosorbit Dinitrat 5 mg tablet 0 0 0 0 500
45 Kalnex 500 mg tablet 0 0 0 0 0
46 Kalsium Laktat 500 mg tablet 7000 7000 2000 5000 8000
47 Ketokonazole 200 mg tablet 0 100 100 50 50 500
48 Komp Pirimetamin Sulfadoksin tablet 88 88 0 88 0
49 Kotrimoksazol 120 mg tablet 500 500 400 100 1000
50 Kotrimoksazol 480 mg tablet 200 200 200 0 10000
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
51 Loperamid HCL 2 mg (Novadium) tablet 300 300 200 100 500
52 Mebendazol tablet 0 0 0 0 0
53 Methylergometrin 0,125 mg tablet 400 400 0 400 0
54 Metoklopramide 10 mg tablet 0 0 0 0 0
55 Metronidazol 500 mg tablet 690 690 190 500 0
56 Metronidazol 250 mg tablet 200 200 0 200 0
57 Multivitamin (Wishen) kaplet 0 0 0 0 0
58 New Diatabs tablet 0 0 0 0 0
59 Nifedipin 10 mg tablet 0 0 0 0 1000
60 Nystatin 500.000 IU tablet 100 100 10 90 0
61 Oralit 200 ml sachet 100 300 400 200 200 3000
62 Papaverin 40 mg tablet 1000 1000 1000 0 4000
63 Parasetamol 100 mg tablet 0 0 0 0 5000
64 Parasetamol 500 mg tablet 15000 15000 5000 10000 20000
65 Parasetamol tab tablet 0 0 0 0 0
66 Phenitoin 30 mg tablet 250 250 0 250 0
67 Phenylbutazone 200 mg tablet 0 0 0 0 0
68 Pirantel Pamoat 125 mg tablet 0 0 0 0 500
69 Piroksikam 10 mg tablet 700 700 200 500 800
70 Piroksikam 20 mg tablet 700 700 100 600 400
71 Prednison 5 mg tablet 9000 9000 2000 7000 8000
72 Propanolol 10 mg tablet 0 0 0 0 0
73 Propanolol 40 mg tablet 100 100 0 100 0
74 PTU 100 mg tablet 200 200 0 200 0
75 Ranitidine 150 mg tablet 200 300 500 500 0 5000
76 Reserpin 0,10 mg tablet 250 250 500 500 0 2000 ED = 250 tab
77 Reserpin 0,25 mg tablet 1000 1000 0 1000 1000
78 Salbutamol 2 mg tablet 600 600 0 600 0
79 Salbutamol 4 mg tablet 0 0 0 0 0
80 Sulfadimidin 500 mg tablet 0 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
81 Tetrasiklin 250 mg kapsul 1000 1000 0 1000 0
82 Tetrasiklin 500 mg tablet 0 0 0 0 0
83 Thiamphenicol 500 mg tablet 0 0 0 0 0
84 Vitamin B Kompleks tablet 3000 3000 3000 0 12000
85 Vitamin B6 10 mg tablet 8000 8000 2000 6000 8000
86 Vitamin B1 50 mg tablet 9000 9000 3000 6000 12000
87 Vitamin B12 tablet 0 1000 1000 1000 0 6000
88 Vitamin C 50 mg tablet 8000 8000 4000 4000 16000
89 Vitamin K 10 mg tablet 200 200 100 100 400
OBAT JENIS SIRUP
90 Ambroksol sirup btl 67 67 29 38 116
91 Amoxicillin SK 125 mg/ 5 ml btl @ 60 ml 130 130 82 48 500
92 Amoxicillin SK 250 mg/ 5 ml btl @ 60 ml 46 46 17 29 150
93 Ampisilin Sirup Kering btl 0 0 0 0 0
94 Antasida suspensi btl 0 0 0 0 100
95 Besi Sulfat Syrup btl 0 0 0 0 0
96 Cefadroxil Syrup Kering btl 0 0 0 0 0
97 Chloramphenicol Syrup btl 0 0 0 0 0
98 Dekstrometorfan sirup btl 60 ml 90 97 13 84 0
99 Ibuprofen Syrup Botol 44 44 4 40 0
100 Kotrimoksazol suspensi btl 60 ml 213 213 72 141 400
101 Multivitamin Syrup (Pediagrow) btl 10 10 10 0 50
102 OBH Sirup btl 33 20 53 39 14 300
103 Parasetamol Sirup btl 60 ml 127 127 116 11 600
OBAT NAPZA
104 Diazepam 2 mg tablet 2353 2353 25 2328 0
105 Diazepam 5 mg tablet 0 0 0 0 0
106 Diazepam Inj amp 0 0 0 0 0
107 Fenobarbital 30 mg tablet 561 561 29.5 531.5 0
108 Fenobarbital Injeksi amp 0 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
109 Fenitoin inj amp 0 0 0 0 0
110 Haloperidol 5 mg tablet 0 0 0 0 0
111 Klorpromazin 100 mg tablet 0 0 0 0 0
112 Klorpromazin 25 mg tablet 900 900 0 900 0
113 Kodein 10 mg tablet 210 210 210 0 0 Rusak
OBAT TB PARU
114 Ethambutol 250 mg tablet 0 0 0 0 0
115 I N H 100 mg tablet 0 0 0 0 0
116 I N H 300 mg tablet 1000 1000 0 1000 0
117 Pirazinamid 500 mg tablet 60 60 0 60 0
118 Rifampisin 450 mg tablet 55 55 26 29 100
OBAT LUAR
119 Aqudes Steril 500 ml btl 0 0 0 0 0
120 Alkohol 70 % 1000 ml Btl 4 4 2 2 8
121 Acyclovir Cream Tube 50 50 0 50 0
122 Anti Hemoroid Supp 35 35 15 20 60
123 Bacid Racin Salep Tube 0 0 0 0 200
124 Betametasone Krim Tube 25 75 100 50 50 200
125 Borax Gliserin sol Btl 0 0 0 0 0
126 Etil Klorida Spray Btl 100 ml 3 3 1 2 4
127 Fenol Gliserol Tts Telinga Btl 0 0 0 0 0
128 Formalin tab 1 Gram tablet 4 4 0 4 0
129 Gentamycin Salep Kulit Tube 50 50 0 50 50
130 Gentamycin Tetes Mata Steril 0,3 % botol 10 20 30 18 12 50
131 Gentian Violet Sol Btl 26 26 7 19 24
132 Gliserin Btl @ 10 ml 0 0 0 0 0
133 Hydrocortisone Cream 2,5% tube 48 48 96 72 24 288
134 Ichtyol Salep 10 gr Pot 0 0 0 0 0
135 Kalium Permanganat Pot 7 7 4 3 15
136 Kloramfenikol Salep Kulit (Farsycol) Tube @ 10 gr 0 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
137 Kloramfenikol Salep Mata 1 % Tube 0 0 0 0 0
138 Kloramfenikol tetes Mata btl 0 0 0 0 0
139 Kloramfenikol Tetes Telinga Btl 33 33 9 24 36
140 Lisol 1000 ml Btl 3 3 1 2 5
141 Mikonazole Krim Tube 48 48 24 24 96
142 Oksitetrasiklin Salep Kulit 3 % Tube 50 50 50 0 500
143 Oksitetrasiklin Salep Mata 1 % Tube 100 100 5 95 0
144 Rivanol 1 % 300 ml Btl 2 5 7 3 4 6
145 Salisil Bedak kotak 10 10 10 0 60
146 Salisilat Belerang Salep pot 47 47 8 39 24
147 Yodium Povidone Sol 1000 ml Btl 0 0 0 0 0
148 Yodium Povidone Sol 300 ml Btl 9 9 3 6 12
149 Yodium Povidon Sol 10 ml Btl 0 0 0 0 0
OBAT SUNTIK
150 Adidryl Injeksi vial 8 8 3 5 0
151 Adimidon Injeksi vial 16 16 3 13 0
152 Aqua Pro Inj amp 0 0 0 0 0
153 Aminofilin inj amp 30 30 0 30 0
154 Antalgin inj amp 0 0 0 0 0
155 Buscopan Injeksi amp 5 5 0 5 0
156 Cefotaxim inj amp 6 6 6 0 0 ED
157 Cortison inj amp 0 0 0 0 0
158 Deksametasone Inj amp 137 137 10 127 0
159 Dextrose 5 % - Nacl 0,45 % kolf 0 0 0 0 0
160 Dextrose 5 % - Nacl 1/4 kolf 0 0 0 0 0
161 Dextrose 5 % kolf 25 25 4 21 20
162 Dextrose 10 % kolf 6 6 2 4 0
163 Difenhidramin Inj amp 20 20 5 15 0
164 Ephinephrin Injeksi amp 0 0 0 0 0
165 Ketorolac Injeksi amp 10 10 0 10 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
166 Lidokain Inj amp 0 0 0 0 0
167 Lidokain comp amp 135 135 35 100 0
168 Metil ergometrin inj amp 10 10 0 10 0
169 Natrium Klorida Infus kolf 29 29 8 21 100
170 Neurobion Injeksi amp 0 0 0 0 50
171 Oxytetracyclin Injeksi vial 0 0 0 0 0
172 Oxytocin Injeksi amp 0 0 0 0 0
173 Papaverin inj amp 29 29 5 24 0
174 Ranitidine Injeksi amp 20 20 5 15 20
175 Ringer Laktat Infus kolf 12 60 72 22 50 120
176 Sabu 5 ml Injeksi vial 0 0 0 0 0
177 Streptomycin Injeksi vial 0 0 0 0 0
178 Vitamin B1 inj amp 10 10 10 0 60 ED
179 Vitamin B 12 inj amp 48 48 15 33 30
180 Vitamin K Injeksi Amp 49 49 15 34 0
181 Vitamin C Inj Amp 0 0 0 0 0
ALKES HABIS PAKAI
182 Abbocath No.18 Pcs 48 48 0 48 0
183 Abbocath No. 20 Pcs 15 15 15 0 200
184 Abbocath No. 22 Pcs 61 61 18 43 100
185 Abbocath No.24 Pcs 56 56 8 48 100
186 Alat Suntik 1 ml Pcs 1849 1849 300 1549 0
187 Alat Suntik 2,5 ml Pcs 0 0 0 0 0
188 Alat Suntik 3 ml Pcs 37 300 337 310 27 1000
189 Alat Suntik 5 ml Pcs 800 800 200 600 0
190 Alat Suntik 10 ml Pcs 0 0 0 0 0
191 Alat Suntik 20 ml Pcs 0 0 0 0 0
192 Blood Set Set 0 0 0 0 0
193 Cat/Gut 2/0 150 cm Pcs 0 0 0 0 0
194 Catgut Chromic No. 3/0 75 cm Pcs 0 48 48 34 14 100
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
195 Catgut Chromic No. 4/0 150 cm Pcs 0 0 0 0 0
196 Hand Schoen No 7 Pasang 0 0 0 0 500
197 Hand Schoen No 7,5 Pasang 0 0 0 0 500
198 Hand Schoen No 8 Pasang 0 0 0 0 0
199 Hypafix 5 cm Roll 0 0 0 0 50
200 Infus Set Anak Pcs 13 13 5 8 50
201 Infus Set Dewasa Pcs 44 44 28 16 120
202 Jarum Bedah Pcs 0 0 0 0 0
203 Kapas Pembalut 250 gram Bks 12 12 1 11 5
204 Kasa 2 y x 80 cm Roll 0 10 10 4 6 200
205 Kasa 5 cm x 80 cm Roll 0 0 0 0 0
206 Kasa Kompres 40 x40 Roll 0 25 25 5 20 250
207 Kasa Pemb 40 x 80 cm Roll 0 0 0 0 0
208 Kasa Steril 16 x 16 ktk/100 lbr 26 10 36 26 10 100
209 Kasa Hidrofil 4 x 15 cm Roll 0 30 30 24 6 800
210 Kasa Pembalut 4 x 3 cm Roll 0 0 0 0 0
211 Masker Box/50 Pcs 0 0 0 0 10
212 Nald Hecting Otot (Jarum Kulit) Set/12 pcs 0 0 0 0 0
213 Nald Hecting No. 9 pcs 12 12 0 12 0
214 Nald Hecting No 13 Pcs 0 0 0 0 100
215 Nald Hecting No 15 Pcs 0 0 0 0 0
216 NGT No. 3,5 (Feeding Tube) Set 0 0 0 0 0
217 NGT No. 16 (Feeding Tube) Set 0 0 0 0 0
218 Nald No. 23 Pcs 0 0 0 0 300
219 Nald No. 24 Pcs 0 300 300 100 200 800
220 Scalvein No. 23 Pcs 0 0 0 0 0
221 Silk No. 3/0 150 cm Pcs 0 0 0 0 0
222 Silk Black No. 3/0 75 cm (35 mm) Pcs 0 0 0 0 0
223 Silk Black No. 3/0 75 cm (26 mm) Pcs 22 22 0 22 0
224 Plester 5 Yard x 2 Inch Roll 9 9 5 4 20
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
TAMBAHAN
225 Alkohol Swab ktk/100 paket 3 3 0 3 0
226 Pharmafix 2,5 cm x 5 mtr Roll 3 3 0 3 0
227 Pharmafix 5 cm x 5 mtr Roll 9 9 1 8 0
228 Pharmafix 10 cm x 5 mtr Roll 7 7 1 6 0
229 Indo Obat Flu tablet 30 30 30 0 0
230 Indo Obat Cacing (Mebendazole) tablet 1 1 1 0 0
231 Indo Obat Penurun Panas tablet 48 48 48 0 0
232 Ampicillin Injeksi (Vicillin) vial 110 110 0 110 0 dari KIA
233 Gentamycin Injeksi amp 140 140 0 140 0 dari KIA
234 Bisturi Pcs 0 0 300
235 Gaas Roll Roll 0 0 10
236 Larutan H2O2 3 % 800 ml botol 0 0 5
237 0 0
238 0 0
239 0 0

Umum
ASKES Jumlah
Jumlah Kunjungan Resep Bayar Tidak Bayar

470 663 150 1283

Yang Meminta Mengetahui/Menyetujui Yang Menyerahkan Yang Menerima

Pimpinan Puskesmas Kepala Dinkes II / GFK Petugas GFK Petugas Puskesmas

Dr. Herlina Barends (…………………………………………) (………………………………….) Hj. Badariah

NIP. 19670726 199903 2 003 NIP. NIP. NIP. 19580612 197712 2 001
 PERSEDIAAN OBAT & ALKES PUSKESMAS SEDADAP

PUSKESMAS : SEDADAP
KECAMATAN : NUNUKAN SELATAN
KABUPATEN : NUNUKAN
PERIODE : DESEMBER 2010

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN

1 2 3 4 5 6
JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet 790 0 790
2 Ambeven tablet 0 0 0
3 Albendazole tablet 30 120 150
4 Allopurinol 100 mg tablet 800 0 800
5 Ambroksol 30 mg tablet 100 1200 1300
6 Amoxicillin 250 mg tablet 0 2400 2400
7 Amoxicillin 500 mg tablet 3300 20000 23300
8 Ampisilin 500 mg tablet 2300 0 2300
9 Antalgin 500 mg tablet 3000 0 3000
10 Antasida DOEN tablet 1000 3000 4000
11 Asam Folat tablet 0 0 0
12 Asam Mefenamat 500 mg tablet 2400 10000 12400
13 Atropin Sulfat 0,5 mg tablet 500 0 500
14 Acyclovir 200 mg tablet 200 0 200
15 Acyclovir 400 mg tablet 400 0 400
16 Besi sulfat tablet 1100 6000 7100
17 Bisacodyl (Laxana) tablet 0 0 0
18 Buscopan tablet 0 0 0
19 Captopril 25 mg tablet 1900 1000 2900
20 Captopril 12,5 mg tablet 0 0 0
21 Cefadroxil 500 mg tablet 0 0 0
22 Chloramphenicol 250 mg tablet 2000 0 2000
23 Chloroquin 250 mg tablet 0 0 0
24 Cimetidine 200 mg tablet 0 0 0
25 Ciprofloxacin 500 mg tablet 900 1000 1900
26 CTM 4 mg tablet 1000 24000 25000
27 Deksametasone 0,5 mg tablet 1000 15000 16000
28 Dekstrometorfan 15 mg tablet 4000 0 4000
29 Digoksin 0,25 mg tablet 0 0 0
30 Dimenhidrinat 50 mg tablet 0 600 600
31 Domperidone 10 mg tablet 600 1200 1800
32 Efedrin 25 mg tablet 2000 4000 6000
33 Ergotamine Kafein tablet 100 0 100
34 Erythromycin 250 mg tablet 120 1200 1320
35 Erythromycin 500 mg tablet 400 0 400
36 Famotidine 20 mg tablet 0 1400 1400
37 Furosemide 40 mg tablet 200 0 200
38 Glibenklamide 5 mg tablet 600 800 1400
39 Gliseril Guayakolat 100 mg tablet 6000 5000 11000
40 Griseofulvin 125 mg tablet 2100 0 2100
41 H C T 25 mg tablet 1000 0 1000
42 Ibuprofen 200 mg tablet 200 1000 1200
43 Ibuprofen 400 mg tablet 0 1500 1500
44 Isosorbit Dinitrat 5 mg tablet 0 500 500
45 Kalnex 500 mg tablet 0 0 0
46 Kalsium Laktat 500 mg tablet 5000 8000 13000
47 Ketokonazole 200 mg tablet 50 500 550
48 Komp Pirimetamin Sulfadoksin tablet 88 0 88
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN

1 2 3 4 5 6
49 Kotrimoksazol 120 mg tablet 100 1000 1100
50 Kotrimoksazol 480 mg tablet 0 0 0
51 Loperamid HCL 2 mg (Novadium) tablet 100 500 600
52 Mebendazol tablet 0 0 0
53 Methylergometrin 0,125 mg tablet 400 0 400
54 Metoklopramide 10 mg tablet 0 0 0
55 Metronidazol 500 mg tablet 500 0 500
56 Metronidazol 250 mg tablet 200 0 200
57 Multivitamin (Wishen) kaplet 0 0 0
58 New Diatabs tablet 0 0 0
59 Nifedipin 10 mg tablet 0 1000 1000
60 Nystatin 500.000 IU tablet 90 0 90
61 Oralit 200 ml sachet 200 3000 3200
62 Papaverin 40 mg tablet 0 0 0
63 Parasetamol 100 mg tablet 0 0 0
64 Parasetamol 500 mg tablet 10000 8000 18000
65 Parasetamol tab tablet 0 0 0
66 Phenitoin 30 mg tablet 250 0 250
67 Phenylbutazone 200 mg tablet 0 0 0
68 Pirantel Pamoat 125 mg tablet 0 0 0
69 Piroksikam 10 mg tablet 500 840 1340
70 Piroksikam 20 mg tablet 600 400 1000
71 Prednison 5 mg tablet 7000 5000 12000
72 Propanolol 10 mg tablet 0 0 0
73 Propanolol 40 mg tablet 100 0 100
74 PTU 100 mg tablet 200 0 200
75 Ranitidine 150 mg tablet 0 2500 2500
76 Reserpin 0,10 mg tablet 0 2000 2000
77 Reserpin 0,25 mg tablet 1000 1000 2000
78 Salbutamol 2 mg tablet 600 0 600
79 Salbutamol 4 mg tablet 0 0 0
80 Sulfadimidin 500 mg tablet 0 0 0
81 Tetrasiklin 250 mg kapsul 1000 0 1000
82 Tetrasiklin 500 mg tablet 0 0 0
83 Thiamphenicol 500 mg tablet 0 0 0
84 Vitamin B Kompleks tablet 0 13000 13000
85 Vitamin B6 10 mg tablet 6000 8000 14000
86 Vitamin B1 50 mg tablet 6000 12000 18000
87 Vitamin B12 tablet 0 6000 6000
88 Vitamin C 50 mg tablet 4000 16000 20000
89 Vitamin K 10 mg tablet 100 400 500
OBAT JENIS SIRUP
90 Ambroksol sirup btl 38 100 138
91 Amoxicillin SK 125 mg/ 5 ml btl @ 60 ml 48 180 228
92 Amoxicillin SK 250 mg/ 5 ml btl @ 60 ml 29 50 79
93 Ampisilin Sirup Kering btl 0 0 0
94 Antasida suspensi btl 0 72 72
95 Besi Sulfat Syrup btl 0 0 0
96 Cefadroxil Syrup Kering btl 0 0 0
97 Chloramphenicol Syrup btl 0 0 0
98 Dekstrometorfan sirup btl 60 ml 84 0 97
99 Ibuprofen Syrup Botol 40 0 40
100 Kotrimoksazol suspensi btl 60 ml 141 400 541
101 Multivitamin Syrup (Pediagrow) btl 0 0 0
102 OBH Sirup btl 14 150 164
103 Parasetamol Sirup btl 60 ml 11 300 311
OBAT NAPZA
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN

1 2 3 4 5 6
104 Diazepam 2 mg tablet 2328 0 2328
105 Diazepam 5 mg tablet 0 0 0
106 Diazepam Inj amp 0 0 0
107 Fenobarbital 30 mg tablet 531.5 0 531.5
108 Fenobarbital Injeksi amp 0 0 0
109 Fenitoin inj amp 0 0 0
110 Haloperidol 5 mg tablet 0 0 0
111 Klorpromazin 100 mg tablet 0 0 0
112 Klorpromazin 25 mg tablet 900 0 900
113 Kodein 10 mg tablet 0 0 0
OBAT TB PARU
114 Ethambutol 250 mg tablet 0 0 0
115 I N H 100 mg tablet 0 0 0
116 I N H 300 mg tablet 1000 0 1000
117 Pirazinamid 500 mg tablet 60 0 60
118 Rifampisin 450 mg tablet 29 0 29
OBAT LUAR
119 Aqudes Steril 500 ml btl 0 0 0
120 Alkohol 70 % 1000 ml Btl 2 6 8
121 Acyclovir Cream Tube 50 0 50
122 Anti Hemoroid Supp 20 60 80
123 Bacitrasin-Polymyxin B Tube 0 200 200
124 Betametasone Krim Tube 50 200 250
125 Borax Gliserin sol Btl 0 0 0
126 Etil Klorida Spray Btl 100 ml 2 2 4
127 Fenol Gliserol Tts Telinga Btl 0 0 0
128 Formalin tab 1 Gram tablet 4 0 4
129 Gentamycin Salep Kulit Tube 50 50 100
130 Gentamycin Tetes Mata Steril 0,3 % botol 12 50 62
131 Gentian Violet Sol Btl 19 0 19
132 Gliserin Btl @ 10 ml 0 0 0
133 Hydrocortisone Cream 2,5% tube 24 288 312
134 Ichtyol Salep 10 gr Pot 0 0 0
135 Kalium Permanganat Pot 3 0 3
136 Kloramfenikol Salep Kulit (Farsycol) Tube @ 10 gr 0 0 0
137 Kloramfenikol Salep Mata 1 % Tube 0 0 0
138 Kloramfenikol tetes Mata btl 0 0 0
139 Kloramfenikol Tetes Telinga Btl 24 24 48
140 Lisol 1000 ml Btl 2 5 7
141 Mikonazole Krim Tube 24 0 24
142 Oksitetrasiklin Salep Kulit 3 % Tube 0 250 250
143 Oksitetrasiklin Salep Mata 1 % Tube 95 0 95
144 Rivanol 1 % 300 ml Btl 4 6 10
145 Salisil Bedak kotak 0 60 60
146 Salisilat Belerang Salep pot 39 24 63
147 Yodium Povidone Sol 1000 ml Btl 0 0 0
148 Yodium povidone Sol 300 ml Btl 6 0 6
149 Yodium Povidon Sol 10 ml Btl 0 0 0
OBAT SUNTIK
150 Adidryl Injeksi vial 5 0 5
151 Adimidon Injeksi vial 13 0 13
152 Aqua Pro Inj amp 0 0 0
153 Aminofilin inj amp 30 0 30
154 Antalgin inj amp 0 0 0
155 Buscopan Injeksi amp 5 0 5
156 Cefotaxim inj amp 0 0 0
157 Cortison inj amp 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN

1 2 3 4 5 6
158 Deksametasone Inj amp 127 0 127
159 Dextrose 5 % - Nacl 0,45 % kolf 0 0 0
160 Dextrose 5 % - Nacl 1/4 kolf 0 0 0
161 Dextrose 5 % kolf 21 20 41
162 Dextrose 10 % kolf 4 0 4
163 Difenhidramin Inj amp 15 0 15
164 Ephinephrin Injeksi amp 0 0 0
165 Ketorolac Injeksi amp 10 0 10
166 Lidokain Inj amp 0 0 0
167 Lidokain comp amp 100 0 100
168 Metil ergometrin inj amp 10 0 10
169 Natrium Klorida Infus kolf 21 100 121
170 Neurophil 5000 Injeksi amp 0 10 10
171 Oxytetracyclin Injeksi vial 0 0 0
172 Oxytocin Injeksi amp 0 0 0
173 Papaverin inj amp 24 0 24
174 Ranitidine Injeksi amp 15 20 35
175 Ringer Laktat Infus kolf 50 120 170
176 Sabu 5 ml Injeksi vial 0 0 0
177 Streptomycin Injeksi vial 0 0 0
178 Vitamin B1 inj amp 0 0 0
179 Vitamin B 12 inj amp 33 100 133
180 Vitamin K Injeksi Amp 34 0 34
181 Vitamin C Inj Amp 0 0 0
ALKES HABIS PAKAI
182 Abbocath No.18 Pcs 48 0 48
183 Abbocath No. 20 Pcs 0 200 200
184 Abbocath No. 22 Pcs 43 100 143
185 Abbocath No.24 Pcs 48 100 148
186 Alat Suntik 1 ml Pcs 1549 0 1549
187 Alat Suntik 2,5 ml Pcs 0 0 0
188 Alat Suntik 3 ml Pcs 27 1000 1027
189 Alat Suntik 5 ml Pcs 600 0 600
190 Alat Suntik 10 ml Pcs 0 0 0
191 Alat Suntik 20 ml Pcs 0 0 0
192 Blood Set Set 0 0 0
193 Cat/Gut 2/0 150 cm Pcs 0 0 0
194 Catgut Chromic No. 3/0 70 cm Pcs 0 120 120
195 Catgut Chromic No. 3/0 75 cm Pcs 14 48 62
196 Catgut Chromic No. 4/0 150 cm Pcs 0 0 0
197 Hand Schoen No 7 Pasang 0 50 50
198 Hand Schoen No 7,5 Pasang 0 0 0
199 Hand Schoen No 8 Pasang 0 0 0
200 Hypafix 5 cm Roll 0 0 0
201 Infus Set Anak Pcs 8 50 58
202 Infus Set Dewasa Pcs 16 100 116
203 Jarum Bedah Pcs 0 0 0
204 Kapas Pembalut 250 gram Bks 11 5 16
205 Kasa 2 y x 80 cm Roll 6 10 16
206 Kasa 5 cm x 80 cm Roll 0 100 100
207 Kasa Kompres 40 x40 Roll 20 100 120
208 Kasa Pemb 40 x 80 cm Roll 0 0 0
209 Kasa Steril 16 x 16 ktk/100 lbr 10 0 10
210 Kasa Hidrofil 4 x 15 cm Roll 6 150 156
211 Kasa Pembalut 4 x 3 cm Roll 0 0 0
212 Masker Box/50 Pcs 0 0 0
213 Nald Hecting Otot (Jarum Kulit) Set/12 pcs 0 0 0
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN

1 2 3 4 5 6
214 Nald Hecting No. 9 pcs 12 0 12
215 Nald Hecting No 13 Pcs 0 0 0
216 Nald Hecting No 15 Pcs 0 0 0
217 NGT No. 3,5 (Feeding Tube) Set 0 0 0
218 NGT No. 16 (Feeding Tube) Set 0 0 0
219 Nald No. 23 Pcs 0 300 300
220 Nald No. 24 Pcs 200 800 1000
221 Scalvein No. 23 Pcs 0 0 0
222 Silk No. 3/0 150 cm Pcs 0 0 0
223 Silk Black No. 3/0 75 cm (35 mm) Pcs 0 0 0
224 Silk Black No. 3/0 75 cm (26 mm) Pcs 22 0 22
225 Plester 5 Yard x 2 Inch Roll 4 12 16
TAMBAHAN
226 Alkohol Swab ktk/100 paket 3 0 3
227 Pharmafix 2,5 cm x 5 mtr Roll 3 0 3
228 Pharmafix 5 cm x 5 mtr Roll 8 0 8
229 Pharmafix 10 cm x 5 mtr Roll 6 0 6
230 Indo Obat Flu tablet 0 0 0
231 Indo Obat Cacing (Mebendazole) tablet 0 0 0
232 Indo Obat Penurun Panas tablet 0 0 0
233 Ampicillin Injeksi (Vicillin) vial 110 0 110
234 Gentamycin Injeksi amp 140 0 140
235 Urine Bag Set 10 10
236 Elastic Verband 7,5 cm x 4,5 M Roll 5 5
237 Foley Catheter No. 16 Pcs 10 10
238 Foley Catheter No. 18 Pcs 10 10
239 Kanamycin 1 gr Injeksi vial 10 10
240 0
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : SEDADAP PELAPORAN BULAN : Desember 2010 NO./[Link]:

KECAMATAN : NUNUKAN SELATAN PERMINTAAN BULAN/PERIODE : GFK
KABUPATEN : NUNUKAN PUSK
DINKES

PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA PEMBERIAN KETERANG

NO NAMA OBAT SATUAN STOK AWAL
AN AAN AN STOK OPT AN
JUMLAH
AN
INPRES ASKES APBD I APBD II LAIN2
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet 790 0 790 130 660
2 Ambeven tablet 0 0 0 0 0
3 Albendazole tablet 30 120 150 30 120
4 Allopurinol 100 mg tablet 800 0 800 100 700
5 Ambroksol 30 mg tablet 100 1200 1300 400 900
6 Amoxicillin 250 mg tablet 0 2400 2400 600 1800
7 Amoxicillin 500 mg tablet 3300 20000 23300 2300 21000
8 Ampisilin 500 mg tablet 2300 0 2300 100 2200
9 Antalgin 500 mg tablet 3000 0 3000 0 3000
10 Antasida DOEN tablet 1000 3000 4000 1300 2700
11 Asam Folat tablet 0 0 0 0 0
12 Asam Mefenamat 500 mg tablet 2400 10000 12400 1200 11200
13 Atropin Sulfat 0,5 mg tablet 500 0 500 0 500
14 Acyclovir 200 mg tablet 200 0 200 0 200
15 Acyclovir 400 mg tablet 400 0 400 0 400
16 Besi sulfat tablet 1100 6000 7100 1500 5600
17 Bisacodyl (Laxana) tablet 0 0 0 0 0
18 Buscopan tablet 0 0 0 0 0
19 Captopril 25 mg tablet 1900 1000 2900 100 2800
20 Captopril 12,5 mg tablet 0 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
21 Cefadroxil 500 mg tablet 0 0 0 0 0
22 Chloramphenicol 250 mg tablet 2000 0 2000 1000 1000
23 Chloroquin 250 mg tablet 0 0 0 0 0
24 Cimetidine 200 mg tablet 0 0 0 0 0
25 Ciprofloxacin 500 mg tablet 900 1000 1900 100 1800
26 CTM 4 mg tablet 1000 24000 25000 5000 20000
27 Deksametasone 0,5 mg tablet 1000 15000 16000 6000 10000
28 Dekstrometorfan 15 mg tablet 4000 0 4000 0 4000
29 Digoksin 0,25 mg tablet 0 0 0 0 0
30 Dimenhidrinat 50 mg tablet 0 600 600 0 600
31 Domperidone 10 mg tablet 600 1200 1800 200 1600
32 Efedrin 25 mg tablet 2000 4000 6000 1000 5000
33 Ergotamine Kafein tablet 100 0 100 0 100
34 Erythromycin 250 mg tablet 120 1200 1320 0 1320
35 Erythromycin 500 mg tablet 400 0 400 300 100
36 Famotidine 20 mg tablet 0 1400 1400 0 1400
37 Furosemide 40 mg tablet 200 0 200 0 200
38 Glibenklamide 5 mg tablet 600 800 1400 0 1400
39 Gliseril Guayakolat 100 mg tablet 6000 5000 11000 2000 9000
40 Griseofulvin 125 mg tablet 2100 0 2100 200 1900
41 H C T 25 mg tablet 1000 0 1000 0 1000
42 Ibuprofen 200 mg tablet 200 1000 1200 500 700
43 Ibuprofen 400 mg tablet 0 1500 1500 400 1100
44 Isosorbit Dinitrat 5 mg tablet 0 500 500 0 500
45 Kalnex 500 mg tablet 0 0 0 0 0
46 Kalsium Laktat 500 mg tablet 5000 8000 13000 1000 12000
47 Ketokonazole 200 mg tablet 50 500 550 0 550
48 Komp Pirimetamin Sulfadoksin tablet 88 0 88 0 88
49 Kotrimoksazol 120 mg tablet 100 1000 1100 0 1100
50 Kotrimoksazol 480 mg tablet 0 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
51 Loperamid HCL 2 mg (Novadium) tablet 100 500 600 200 400
52 Mebendazol tablet 0 0 0 0 0
53 Methylergometrin 0,125 mg tablet 400 0 400 0 400
54 Metoklopramide 10 mg tablet 0 0 0 0 0
55 Metronidazol 500 mg tablet 500 0 500 0 500
56 Metronidazol 250 mg tablet 200 0 200 0 200
57 Multivitamin (Wishen) kaplet 0 0 0 0 0
58 New Diatabs tablet 0 0 0 0 0
59 Nifedipin 10 mg tablet 0 1000 1000 100 900
60 Nystatin 500.000 IU tablet 90 0 90 0 90
61 Oralit 200 ml sachet 200 3000 3200 200 3000
62 Papaverin 40 mg tablet 0 0 0 0 0
63 Parasetamol 100 mg tablet 0 0 0 0 0
64 Parasetamol 500 mg tablet 10000 8000 18000 4000 14000
65 Parasetamol tab tablet 0 0 0 0 0
66 Phenitoin 30 mg tablet 250 0 250 0 250
67 Phenylbutazone 200 mg tablet 0 0 0 0 0
68 Pirantel Pamoat 125 mg tablet 0 0 0 0 0
69 Piroksikam 10 mg tablet 500 840 1340 220 1120
70 Piroksikam 20 mg tablet 600 400 1000 100 900
71 Prednison 5 mg tablet 7000 5000 12000 3000 9000
72 Propanolol 10 mg tablet 0 0 0 0 0
73 Propanolol 40 mg tablet 100 0 100 0 100
74 PTU 100 mg tablet 200 0 200 0 200
75 Ranitidine 150 mg tablet 0 2500 2500 400 2100
76 Reserpin 0,10 mg tablet 0 2000 2000 1000 1000
77 Reserpin 0,25 mg tablet 1000 1000 2000 0 2000
78 Salbutamol 2 mg tablet 600 0 600 100 500
79 Salbutamol 4 mg tablet 0 0 0 0 0
80 Sulfadimidin 500 mg tablet 0 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
81 Tetrasiklin 250 mg kapsul 1000 0 1000 0 1000
82 Tetrasiklin 500 mg tablet 0 0 0 0 0
83 Thiamphenicol 500 mg tablet 0 0 0 0 0
84 Vitamin B Kompleks tablet 0 13000 13000 3000 10000
85 Vitamin B6 10 mg tablet 6000 8000 14000 1000 13000
86 Vitamin B1 50 mg tablet 6000 12000 18000 1000 17000
87 Vitamin B12 tablet 0 6000 6000 0 6000
88 Vitamin C 50 mg tablet 4000 16000 20000 4000 16000
89 Vitamin K 10 mg tablet 100 400 500 0 500
OBAT JENIS SIRUP
90 Ambroksol sirup btl 38 100 138 38 100
91 Amoxicillin SK 125 mg/ 5 ml btl @ 60 ml 48 180 228 67 161
92 Amoxicillin SK 250 mg/ 5 ml btl @ 60 ml 29 50 79 8 71
93 Ampisilin Sirup Kering btl 0 0 0 0 0
94 Antasida suspensi btl 0 72 72 15 57
95 Besi Sulfat Syrup btl 0 0 0 0 0
96 Cefadroxil Syrup Kering btl 0 0 0 0 0
97 Chloramphenicol Syrup btl 0 0 0 0 0
98 Dekstrometorfan sirup btl 60 ml 84 0 84 3 81
99 Ibuprofen Syrup Botol 40 0 40 26 14
100 Kotrimoksazol suspensi btl 60 ml 141 400 541 46 495
101 Multivitamin Syrup (Pediagrow) btl 0 0 0 0 0
102 OBH Sirup btl 14 150 164 49 115
103 Parasetamol Sirup btl 60 ml 11 300 311 86 225
OBAT NAPZA
104 Diazepam 2 mg tablet 2328 0 2328 22 2306
105 Diazepam 5 mg tablet 0 0 0 0 0
106 Diazepam Inj amp 0 0 0 0 0
107 Fenobarbital 30 mg tablet 531.5 0 531.5 57.5 474
108 Fenobarbital Injeksi amp 0 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
109 Fenitoin inj amp 0 0 0 0 0
110 Haloperidol 5 mg tablet 0 0 0 0 0
111 Klorpromazin 100 mg tablet 0 0 0 0 0
112 Klorpromazin 25 mg tablet 900 0 900 0 900
113 Kodein 10 mg tablet 0 0 0 0 0
OBAT TB PARU
114 Ethambutol 250 mg tablet 0 0 0 0 0
115 I N H 100 mg tablet 0 0 0 0 0
116 I N H 300 mg tablet 1000 0 1000 0 1000
117 Pirazinamid 500 mg tablet 60 0 60 0 60
118 Rifampisin 450 mg tablet 29 0 29 10 19
OBAT LUAR
119 Aqudes Steril 500 ml btl 0 0 0 0 0
120 Alkohol 70 % 1000 ml Btl 2 6 8 3 5
121 Acyclovir Cream Tube 50 0 50 0 50
122 Anti Hemoroid Supp 20 60 80 18 62
123 Bacitracin-Polymyxin B Tube 0 200 200 0 200
124 Betametasone Krim Tube 50 200 250 100 150
125 Borax Gliserin sol Btl 0 0 0 0 0
126 Etil Klorida Spray Btl 100 ml 2 2 4 2 2
127 Fenol Gliserol Tts Telinga Btl 0 0 0 0 0
128 Formalin tab 1 Gram tablet 4 0 4 0 4
129 Gentamycin Salep Kulit Tube 50 50 100 0 100
130 Gentamycin Tetes Mata Steril 0,3 % botol 12 50 62 37 25
131 Gentian Violet Sol Btl 19 0 19 7 12
132 Gliserin Btl @ 10 ml 0 0 0 0 0
133 Hydrocortisone Cream 2,5% tube 24 288 312 120 192
134 Ichtyol Salep 10 gr Pot 0 0 0 0 0
135 Kalium Permanganat Pot 3 0 3 3 0
136 Kloramfenikol Salep Kulit (Farsycol) Tube @ 10 gr 0 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
137 Kloramfenikol Salep Mata 1 % Tube 0 0 0 0 0
138 Kloramfenikol tetes Mata btl 0 0 0 0 0
139 Kloramfenikol Tetes Telinga Btl 24 24 48 10 38
140 Lisol 1000 ml Btl 2 5 7 1 6
141 Mikonazole Krim Tube 24 0 24 5 19
142 Oksitetrasiklin Salep Kulit 3 % Tube 0 250 250 50 200
143 Oksitetrasiklin Salep Mata 1 % Tube 95 0 95 10 85
144 Rivanol 1 % 300 ml Btl 4 6 10 1 9
145 Salisil Bedak kotak 0 60 60 3 57
146 Salisilat Belerang Salep pot 39 24 63 15 48
147 Yodium Povidone Sol 1000 ml Btl 0 0 0 0 0
148 Yodium Povidone Sol 300 ml Btl 6 0 6 2 4
149 Yodium Povidon Sol 10 ml Btl 0 0 0 0 0
OBAT SUNTIK
150 Adidryl Injeksi vial 5 0 5 1 4
151 Adimidon Injeksi vial 13 0 13 1 12
152 Aqua Pro Inj amp 0 0 0 0 0
153 Aminofilin inj amp 30 0 30 0 30
154 Antalgin inj amp 0 0 0 0 0
155 Buscopan Injeksi amp 5 0 5 5 0
156 Cefotaxim inj amp 0 0 0 0 0
157 Cortison inj amp 0 0 0 0 0
158 Deksametasone Inj amp 127 0 127 37 90
159 Dextrose 5 % - Nacl 0,45 % kolf 0 0 0 0 0
160 Dextrose 5 % - Nacl 1/4 kolf 0 0 0 0 0
161 Dextrose 5 % kolf 21 20 41 0 41
162 Dextrose 10 % kolf 4 0 4 0 4
163 Difenhidramin Inj amp 15 0 15 0 15
164 Ephinephrin Injeksi amp 0 0 0 0 0
165 Ketorolac Injeksi amp 10 0 10 0 10
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
166 Lidokain Inj amp 0 0 0 0 0
167 Lidokain comp amp 100 0 100 0 100
168 Metil ergometrin inj amp 10 0 10 0 10
169 Natrium Klorida Infus kolf 21 100 121 7 114
170 Natrium Tiosulfat Injeksi amp 0 0 0 0
171 Neurobion Injeksi amp 0 10 10 5 5
172 Oxytetracyclin Injeksi vial 0 0 0 0 0
173 Oxytocin Injeksi amp 0 0 0 0 0
174 Papaverin inj amp 24 0 24 5 19
175 Ranitidine Injeksi amp 15 20 35 0 35
176 Ringer Laktat Infus kolf 50 120 170 17 153
177 Sabu 5 ml Injeksi vial 0 0 0 0 0
178 Streptomycin Injeksi vial 0 0 0 0 0
179 Vitamin B1 inj amp 0 0 0 0 0
180 Vitamin B 12 inj amp 33 100 133 5 128
181 Vitamin K Injeksi Amp 34 0 34 5 29
182 Vitamin C Inj Amp 0 0 0 0 0
ALKES HABIS PAKAI
183 Abbocath No.18 Pcs 48 0 48 5 43
184 Abbocath No. 20 Pcs 0 200 200 0 200
185 Abbocath No. 22 Pcs 43 100 143 10 133
186 Abbocath No.24 Pcs 48 100 148 0 148
187 Alat Suntik 1 ml Pcs 1549 0 1549 0 1549
188 Alat Suntik 2,5 ml Pcs 0 0 0 0 0
189 Alat Suntik 3 ml Pcs 27 1000 1027 210 817
190 Alat Suntik 5 ml Pcs 600 0 600 5 595
191 Alat Suntik 10 ml Pcs 0 0 0 0 0
192 Alat Suntik 20 ml Pcs 0 0 0 0 0
193 Blood Set Set 0 0 0 0 0
194 Cat/Gut 2/0 150 cm Pcs 0 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
195 Catgut Chromic No. 3/0 70 cm Pcs 0 120 120 0 120
196 Catgut Chromic No. 3/0 75 cm Pcs 14 0 14 0 14
197 Catgut Chromic No. 4/0 150 cm Pcs 0 0 0 0 0
198 Hand Schoen No 7 Pasang 0 50 50 10 40
199 Hand Schoen No 7,5 Pasang 0 0 0 0 0
200 Hand Schoen No 8 Pasang 0 0 0 0 0
201 Hypafix 5 cm Roll 0 0 0 0 0
202 Infus Set Anak Pcs 8 50 58 0 58
203 Infus Set Dewasa Pcs 16 100 116 15 101
204 Jarum Bedah Pcs 0 0 0 0 0
205 Kapas Pembalut 250 gram Bks 11 5 16 0 16
206 Kasa 2 y x 80 cm Roll 6 100 106 12 94
207 Kasa 5 cm x 80 cm Roll 0 0 0 0 0
208 Kasa Kompres 40 x40 Roll 20 100 120 10 110
209 Kasa Pemb 40 x 80 cm Roll 0 0 0 0 0
210 Kasa Steril 16 x 16 ktk/100 lbr 10 0 10 7 3
211 Kasa Hidrofil 4 x 15 cm Roll 6 150 156 6 150
212 Kasa Pembalut 4 x 3 cm Roll 0 0 0 0 0
213 Masker Box/50 Pcs 0 0 0 0 0
214 Nald Hecting Otot (Jarum Kulit) Set/12 pcs 0 0 0 0 0
215 Nald Hecting No. 9 pcs 12 0 12 0 12
216 Nald Hecting No 13 Pcs 0 0 0 0 0
217 Nald Hecting No 15 Pcs 0 0 0 0 0
218 NGT No. 3,5 (Feeding Tube) Set 0 0 0 0 0
219 NGT No. 16 (Feeding Tube) Set 0 0 0 0 0
220 Nald No. 23 Pcs 0 300 300 0 300
221 Nald No. 24 Pcs 200 800 1000 0 1000
222 Scalvein No. 23 Pcs 0 0 0 0 0
223 Silk No. 3/0 150 cm Pcs 0 0 0 0 0
224 Silk Black No. 3/0 75 cm (35 mm) Pcs 0 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
225 Silk Black No. 3/0 75 cm (26 mm) Pcs 22 0 22 10 12
226 Plester 5 Yard x 2 Inch Roll 4 12 16 0 16
TAMBAHAN
227 Alkohol Swab ktk/100 paket 3 0 3 0 3
228 Pharmafix 2,5 cm x 5 mtr Roll 3 0 3 0 3
229 Pharmafix 5 cm x 5 mtr Roll 8 0 8 0 8
230 Pharmafix 10 cm x 5 mtr Roll 6 0 6 0 6
231 Indo Obat Flu tablet 0 0 0 0 0
232 Indo Obat Cacing (Mebendazole) tablet 0 0 0 0 0
233 Indo Obat Penurun Panas tablet 0 0 0 0 0
234 Ampicillin Injeksi (Vicillin) vial 110 0 110 0 110 dari KIA
235 Gentamycin Injeksi amp 140 0 140 0 140 dari KIA
236 Urine Bag Set 0 10 10 2 8
237 Elastic Verban 7,5 cm x 4,5 M Roll 0 5 5 2 3
238 Foley Catheter No.16 pcs 0 10 10 1 9
239 Foley Catheter No.18 pcs 0 10 10 2 8
240 Kanamycin 1 gr Injeksi vial 0 10 10 5 5
241 0 0

Umum
ASKES Jumlah
Jumlah Kunjungan Resep Bayar Tidak Bayar

394 544 111 1049

Yang Meminta Mengetahui/Menyetujui Yang Menyerahkan Yang Menerima

Pimpinan Puskesmas Kepala Dinkes II / GFK Petugas GFK Petugas Puskesmas

Dr. Herlina Barends (…………………………………………) (………………………………….) Hj. Badariah

 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
NIP. 19670726 199903 2 003 NIP. NIP. NIP. 19580612 197712 2 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : SEDADAP PELAPORAN BULAN : Januari 2011 NO./[Link]:

KECAMATAN : NUNUKAN SELATAN PERMINTAAN BULAN/PERIODE : GFK
KABUPATEN : NUNUKAN PUSK
DINKES

PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA PEMBERIAN KETERANG

NO NAMA OBAT SATUAN STOK AWAL
AN AAN AN STOK OPT AN
JUMLAH
AN
INPRES ASKES APBD I APBD II LAIN2
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet 660 660 0 660
2 Ambeven tablet 0 0 0 0
3 Albendazole tablet 120 120 30 90
4 Allopurinol 100 mg tablet 700 700 100 600
5 Ambroksol 30 mg tablet 900 900 900 0
6 Amoxicillin 250 mg tablet 1800 1800 360 1440
7 Amoxicillin 500 mg tablet 21000 21000 3400 17600
8 Ampisilin 500 mg tablet 2200 2200 800 1400
9 Antalgin 500 mg tablet 3000 3000 0 3000
10 Antasida DOEN tablet 2700 2700 1100 1600
11 Asam Folat tablet 0 0 0 0
12 Asam Mefenamat 500 mg tablet 11200 11200 2600 8600
13 Atropin Sulfat 0,5 mg tablet 500 500 0 500
14 Acyclovir 200 mg tablet 200 200 100 100
15 Acyclovir 400 mg tablet 400 400 0 400
16 Besi sulfat tablet 5600 5600 800 4800
17 Bisacodyl (Laxana) tablet 0 0 0 0
18 Buscopan tablet 0 0 0 0
19 Captopril 25 mg tablet 2800 2800 600 2200
20 Captopril 12,5 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
21 Cefadroxil 500 mg tablet 0 0 0 0
22 Chloramphenicol 250 mg tablet 1000 1000 0 1000
23 Chloroquin 250 mg tablet 0 0 0 0
24 Cimetidine 200 mg tablet 0 0 0 0
25 Ciprofloxacin 500 mg tablet 1800 1800 0 1800
26 CTM 4 mg tablet 20000 20000 6000 14000
27 Deksametasone 0,5 mg tablet 10000 10000 3000 7000
28 Dekstrometorfan 15 mg tablet 4000 4000 0 4000
29 Digoksin 0,25 mg tablet 0 0 0 0
30 Dimenhidrinat 50 mg tablet 600 600 0 600
31 Domperidone 10 mg tablet 1600 1600 200 1400
32 Efedrin 25 mg tablet 5000 5000 1000 4000
33 Ergotamine Kafein tablet 100 100 0 100
34 Erythromycin 250 mg tablet 1320 1320 240 1080
35 Erythromycin 500 mg tablet 100 100 100 0
36 Famotidine 20 mg tablet 1400 1400 100 1300
37 Furosemide 40 mg tablet 200 200 0 200
38 Glibenklamide 5 mg tablet 1400 1400 0 1400
39 Gliseril Guayakolat 100 mg tablet 9000 9000 3000 6000
40 Griseofulvin 125 mg tablet 1900 1900 700 1200
41 H C T 25 mg tablet 1000 1000 0 1000
42 Ibuprofen 200 mg tablet 700 700 500 200
43 Ibuprofen 400 mg tablet 1100 1100 200 900
44 Isosorbit Dinitrat 5 mg tablet 500 500 0 500
45 Kalnex 500 mg tablet 0 0 0 0
46 Kalsium Laktat 500 mg tablet 12000 12000 1000 11000
47 Ketokonazole 200 mg tablet 550 550 50 500
48 Komp Pirimetamin Sulfadoksin tablet 88 88 0 88
49 Kotrimoksazol 120 mg tablet 1100 1100 0 1100
50 Kotrimoksazol 480 mg tablet 0 5000 5000 700 4300
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
51 Loperamid HCL 2 mg (Novadium) tablet 400 400 200 200
52 Mebendazol tablet 0 0 0 0
53 Methylergometrin 0,125 mg tablet 400 400 0 400
54 Metoklopramide 10 mg tablet 0 0 0 0
55 Metronidazol 500 mg tablet 500 500 100 400
56 Metronidazol 250 mg tablet 200 200 0 200
57 Multivitamin (Wishen) kaplet 0 0 0 0
58 New Diatabs tablet 0 0 0 0
59 Nifedipin 10 mg tablet 900 900 400 500
60 Nystatin 500.000 IU tablet 90 90 0 90
61 Oralit 200 ml sachet 3000 3000 400 2600
62 Papaverin 40 mg tablet 0 0 0 0
63 Parasetamol 100 mg tablet 0 0 0 0
64 Parasetamol 500 mg tablet 14000 14000 3000 11000
65 Parasetamol tab tablet 0 0 0 0
66 Phenitoin 30 mg tablet 250 250 0 250
67 Phenylbutazone 200 mg tablet 0 0 0 0
68 Pirantel Pamoat 125 mg tablet 0 0 0 0
69 Piroksikam 10 mg tablet 1120 1120 120 1000
70 Piroksikam 20 mg tablet 900 900 300 600
71 Prednison 5 mg tablet 9000 9000 2000 7000
72 Propanolol 10 mg tablet 0 0 0 0
73 Propanolol 40 mg tablet 100 100 0 100
74 PTU 100 mg tablet 200 200 100 100
75 Ranitidine 150 mg tablet 2100 2100 900 1200
76 Reserpin 0,10 mg tablet 1000 1000 250 750
77 Reserpin 0,25 mg tablet 2000 2000 1800 200
78 Salbutamol 2 mg tablet 500 500 0 500
79 Salbutamol 4 mg tablet 0 0 0 0
80 Sulfadimidin 500 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
81 Tetrasiklin 250 mg kapsul 1000 1000 0 1000
82 Tetrasiklin 500 mg tablet 0 0 0 0
83 Thiamphenicol 500 mg tablet 0 0 0 0
84 Vitamin B Kompleks tablet 10000 10000 4000 6000
85 Vitamin B6 10 mg tablet 13000 13000 2000 11000
86 Vitamin B1 50 mg tablet 17000 17000 3000 14000
87 Vitamin B12 tablet 6000 6000 1000 5000
88 Vitamin C 50 mg tablet 16000 16000 4000 12000
89 Vitamin K 10 mg tablet 500 500 0 500
OBAT JENIS SIRUP
90 Ambroksol sirup btl 100 100 25 75
91 Amoxicillin SK 125 mg/ 5 ml btl @ 60 ml 161 161 63 98
92 Amoxicillin SK 250 mg/ 5 ml btl @ 60 ml 71 71 25 46
93 Ampisilin Sirup Kering btl 0 0 0 0
94 Antasida suspensi btl 57 57 10 47
95 Besi Sulfat Syrup btl 0 0 0 0
96 Cefadroxil Syrup Kering btl 0 0 0 0
97 Chloramphenicol Syrup btl 0 0 0 0
98 Dekstrometorfan sirup btl 60 ml 81 81 4 77
99 Ibuprofen Syrup Botol 14 14 0 14
100 Kotrimoksazol suspensi btl 60 ml 495 495 60 435
101 Multivitamin Syrup (Pediagrow) btl 0 0 0 0
102 OBH Sirup btl 115 115 44 71
103 Parasetamol Sirup btl 60 ml 225 225 109 116
OBAT NAPZA
104 Diazepam 2 mg tablet 2306 2306 16 2290
105 Diazepam 5 mg tablet 0 0 0 0
106 Diazepam Inj amp 0 0 0 0
107 Fenobarbital 30 mg tablet 474 474 5.5 468.5
108 Fenobarbital Injeksi amp 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
109 Fenitoin inj amp 0 0 0 0
110 Haloperidol 5 mg tablet 0 0 0 0
111 Klorpromazin 100 mg tablet 0 0 0 0
112 Klorpromazin 25 mg tablet 900 900 0 900
113 Kodein 10 mg tablet 0 0 0 0
OBAT TB PARU
114 Ethambutol 250 mg tablet 0 0 0 0
115 I N H 100 mg tablet 0 0 0 0
116 I N H 300 mg tablet 1000 1000 0 1000
117 Pirazinamid 500 mg tablet 60 60 0 60
118 Rifampisin 450 mg tablet 19 19 19 0 ED
OBAT LUAR
119 Aqudes Steril 500 ml btl 0 0 0 0
120 Alkohol 70 % 1000 ml Btl 5 5 1 4
121 Acyclovir Cream Tube 50 50 5 45
122 Anti Hemoroid Supp 62 62 16 46
123 Bacitracin-Polymyxin B Tube 200 200 0 200
124 Betametasone Krim Tube 150 150 50 100
125 Borax Gliserin sol Btl 0 0 0 0
126 Etil Klorida Spray Btl 100 ml 2 2 0 2
127 Fenol Gliserol Tts Telinga Btl 0 0 0 0
128 Formalin tab 1 Gram tablet 4 4 2 2
129 Gentamycin Salep Kulit Tube 100 100 0 100
130 Gentamycin Tetes Mata Steril 0,3 % botol 25 25 10 15
131 Gentian Violet Sol Btl 12 12 5 7
132 Gliserin Btl @ 10 ml 0 0 0 0
133 Hydrocortisone Cream 2,5% tube 192 192 96 96
134 Ichtyol Salep 10 gr Pot 0 0 0 0
135 Kalium Permanganat Pot 0 0 0 0
136 Kloramfenikol Salep Kulit (Farsycol) Tube @ 10 gr 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
137 Kloramfenikol Salep Mata 1 % Tube 0 0 0 0
138 Kloramfenikol tetes Mata btl 0 0 0 0
139 Kloramfenikol Tetes Telinga Btl 38 38 14 24
140 Lisol 1000 ml Btl 6 6 2 4
141 Mikonazole Krim Tube 19 19 19 0
142 Oksitetrasiklin Salep Kulit 3 % Tube 200 200 25 175
143 Oksitetrasiklin Salep Mata 1 % Tube 85 85 25 60
144 Rivanol 1 % 300 ml Btl 9 9 1 8
145 Salisil Bedak kotak 57 57 17 40
146 Salisilat Belerang Salep pot 48 48 7 41
147 Yodium Povidone Sol 1000 ml Btl 0 0 0 0
148 Yodium Povidone Sol 300 ml Btl 4 4 2 2
149 Yodium Povidon Sol 10 ml Btl 0 0 0 0
OBAT SUNTIK
150 Adidryl Injeksi vial 4 4 0 4
151 Adimidon Injeksi vial 12 12 0 12
152 Aqua Pro Inj amp 0 10 10 6 4
153 Aminofilin inj amp 30 30 0 30
154 Antalgin inj amp 0 0 0 0
155 Buscopan Injeksi amp 0 0 0 0
156 Cefotaxim inj amp 0 0 0 0
157 Cortison inj amp 0 0 0 0
158 Deksametasone Inj amp 90 90 5 85
159 Dextrose 5 % - Nacl 0,45 % kolf 0 0 0 0
160 Dextrose 5 % - Nacl 1/4 kolf 0 0 0 0
161 Dextrose 5 % kolf 41 41 0 41
162 Dextrose 10 % kolf 4 4 0 4
163 Difenhidramin Inj amp 15 15 0 15
164 Ephinephrin Injeksi amp 0 0 0 0
165 Ketorolac Injeksi amp 10 10 0 10
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
166 Lidokain Inj amp 0 0 0 0
167 Lidokain comp amp 100 100 0 100
168 Metil ergometrin inj amp 10 10 5 5
169 Natrium Klorida Infus kolf 114 114 7 107
170 Natrium Tiosulfat Injeksi amp 0 0 0 0
171 Neurobion Injeksi amp 5 5 0 5
172 Oxytetracyclin Injeksi vial 0 0 0 0
173 Oxytocin Injeksi amp 0 0 0 0
174 Papaverin inj amp 19 19 0 19
175 Ranitidine Injeksi amp 35 35 0 35
176 Ringer Laktat Infus kolf 153 153 15 138
177 Sabu 5 ml Injeksi vial 0 0 0 0
178 Streptomycin Injeksi vial 0 0 0 0
179 Vitamin B1 inj amp 0 0 0 0
180 Vitamin B 12 inj amp 128 128 5 123
181 Vitamin K Injeksi Amp 29 29 0 29
182 Vitamin C Inj Amp 0 0 0 0
ALKES HABIS PAKAI
183 Abbocath No.18 Pcs 43 43 1 42
184 Abbocath No. 20 Pcs 200 200 10 190
185 Abbocath No. 22 Pcs 133 133 0 133
186 Abbocath No.24 Pcs 148 148 0 148
187 Alat Suntik 1 ml Pcs 1549 1549 1397 152
188 Alat Suntik 2,5 ml Pcs 0 0 0 0
189 Alat Suntik 3 ml Pcs 817 817 115 702
190 Alat Suntik 5 ml Pcs 595 595 20 575
191 Alat Suntik 10 ml Pcs 0 0 0 0
192 Alat Suntik 20 ml Pcs 0 0 0 0
193 Blood Set Set 0 0 0 0
194 Cat/Gut 2/0 150 cm Pcs 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
195 Catgut Chromic No. 3/0 70 cm Pcs 120 120 0 120
196 Catgut Chromic No. 3/0 75 cm Pcs 14 14 0 14
197 Catgut Chromic No. 4/0 150 cm Pcs 0 0 0 0
198 Hand Schoen No 7 Pasang 40 40 20 20
199 Hand Schoen No 7,5 Pasang 0 200 200 100 100
200 Hand Schoen No 8 Pasang 0 0 0 0
201 Hypafix 5 cm Roll 0 0 0 0
202 Infus Set Anak Pcs 58 58 0 58
203 Infus Set Dewasa Pcs 101 101 15 86
204 Jarum Bedah Pcs 0 0 0 0
205 Kapas Pembalut 250 gram Bks 16 16 2 14
206 Kasa 2 y x 80 cm Roll 94 94 30 64
207 Kasa 5 cm x 80 cm Roll 0 0 0 0
208 Kasa Kompres 40 x40 Roll 110 110 0 110
209 Kasa Pemb 40 x 80 cm Roll 0 0 0 0
210 Kasa Steril 16 x 16 ktk/100 lbr 3 3 3 0
211 Kasa Hidrofil 4 x 15 cm Roll 150 150 0 150
212 Kasa Pembalut 4 x 3 cm Roll 0 0 0 0
213 Masker Box/50 Pcs 0 0 0 0
214 Nald Hecting Otot (Jarum Kulit) Set/12 pcs 0 0 0 0
215 Nald Hecting No. 9 pcs 12 12 0 12
216 Nald Hecting No 13 Pcs 0 0 0 0
217 Nald Hecting No 15 Pcs 0 0 0 0
218 NGT No. 3,5 (Feeding Tube) Set 0 0 0 0
219 NGT No. 16 (Feeding Tube) Set 0 0 0 0
220 Nald No. 23 Pcs 300 300 100 200
221 Nald No. 24 Pcs 1000 1000 0 1000
222 Scalvein No. 23 Pcs 0 0 0 0
223 Silk No. 3/0 150 cm Pcs 0 0 0 0
224 Silk Black No. 3/0 75 cm (35 mm) Pcs 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
225 Silk Black No. 3/0 75 cm (26 mm) Pcs 12 12 0 12
226 Plester 5 Yard x 2 Inch Roll 16 16 4 12
TAMBAHAN
227 Alkohol Swab ktk/100 paket 3 3 0 3
228 Pharmafix 2,5 cm x 5 mtr Roll 3 3 0 3
229 Pharmafix 5 cm x 5 mtr Roll 8 8 0 8
230 Pharmafix 10 cm x 5 mtr Roll 6 6 0 6
231 Indo Obat Flu tablet 0 0 0 0
232 Indo Obat Cacing (Mebendazole) tablet 0 0 0 0
233 Indo Obat Penurun Panas tablet 0 0 0 0
234 Ampicillin Injeksi (Vicillin) vial 110 110 0 110 dari KIA
235 Gentamycin Injeksi amp 140 140 0 140 dari KIA
236 Urine Bag Set 8 8 0 8
237 Elastic Verban 7,5 cm x 4,5 M Roll 3 3 0 3
238 Foley Catheter No.16 pcs 9 9 0 9
239 Foley Catheter No.18 pcs 8 8 0 8
240 Kanamycin 1 gr Injeksi vial 5 5 2 3
241 handscoen No.6 1/2 Pasang 50 50 0 50

Umum
ASKES Jumlah
Jumlah Kunjungan Resep Bayar Tidak Bayar

Yang Meminta Mengetahui/Menyetujui Yang Menyerahkan Yang Menerima

Pimpinan Puskesmas Kepala Dinkes II / GFK Petugas GFK Petugas Puskesmas

Dr. Herlina Barends (…………………………………………) (………………………………….) Hj. Badariah

 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
NIP. 19670726 199903 2 003 NIP. NIP. NIP. 19580612 197712 2 001
 LAPORAN PEMAKAIAN OBAT SETIAP HARI
PUSKESMAS SEDADAP
BULAN : MEI 2011

NO NAMA OBAT SATUAN 2/5/2011 3/5/2011 4/5/2011 5/5/2011 6/5/2011 7/5/2011 9/5/2011 10/5/2011 11/5/2011 12/5/2011 13/5/2011 14/5/2011 16/5/2011 18/5/2011 19/5/2011 20/5/2011 21/5/2011 23/5/2011 24/5/2011 25/5/2011 26/5/2011 27/5/2011 28/5/2011 30/5/2011 31/5/2011

JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet
2 Ambeven tablet
3 Albendazole tablet
4 Allopurinol 100 mg tablet
5 Ambroksol 30 mg tablet
6 Amoxicillin 250 mg tablet
7 Amoxicillin 500 mg tablet
8 Ampisilin 500 mg tablet
9 Antalgin 500 mg tablet
10 Antasida DOEN tablet
11 Asam Folat tablet
12 Asam Mefenamat 500 mg tablet
13 Atropin Sulfat 0,5 mg tablet
14 Acyclovir 200 mg tablet
15 Acyclovir 400 mg tablet
16 Besi sulfat tablet
17 Bisacodyl (Laxana) tablet
18 Buscopan tablet
19 Captopril 25 mg tablet
20 Captopril 12,5 mg tablet
21 Cefadroxil 500 mg tablet
22 Chloramphenicol 250 mg tablet
23 Chloroquin 250 mg tablet
24 Cimetidine 200 mg tablet
25 Ciprofloxacin 500 mg tablet
26 CTM 4 mg tablet
27 Deksametasone 0,5 mg tablet
28 Dekstrometorfan 15 mg tablet
29 Digoksin 0,25 mg tablet
30 Dimenhidrinat 50 mg tablet
31 Domperidone 10 mg tablet
32 Efedrin 25 mg tablet
33 Ergotamine Kafein tablet
34 Erythromycin 250 mg tablet
35 Erythromycin 500 mg tablet
36 Famotidine 20 mg tablet
37 Furosemide 40 mg tablet
38 Glibenklamide 5 mg tablet
39 Gliseril Guayakolat 100 mg tablet
40 Griseofulvin 125 mg tablet
41 H C T 25 mg tablet
42 Ibuprofen 200 mg tablet
43 Ibuprofen 400 mg tablet
44 Isosorbit Dinitrat 5 mg tablet
45 Kalnex 500 mg tablet
46 Kalsium Laktat 500 mg tablet
NO NAMA OBAT SATUAN 2/5/2011 3/5/2011 4/5/2011 5/5/2011 6/5/2011 7/5/2011 9/5/2011 10/5/2011 11/5/2011 12/5/2011 13/5/2011 14/5/2011 16/5/2011 18/5/2011 19/5/2011 20/5/2011 21/5/2011 23/5/2011 24/5/2011 25/5/2011 26/5/2011 27/5/2011 28/5/2011 30/5/2011 31/5/2011

47 Ketokonazole 200 mg tablet

48 Komp Pirimetamin Sulfadoksin tablet
49 Kotrimoksazol 120 mg tablet
50 Kotrimoksazol 480 mg tablet
51 Loperamid HCL 2 mg (Novadium) tablet
52 Mebendazol tablet
53 Methylergometrin 0,125 mg tablet
54 Metoklopramide 10 mg tablet
55 Metronidazol 500 mg tablet
56 Metronidazol 250 mg tablet
57 Multivitamin (Wishen) kaplet
58 New Diatabs tablet
59 Nifedipin 10 mg tablet
60 Nystatin 500.000 IU tablet
61 Oralit 200 ml sachet
62 Papaverin 40 mg tablet
63 Parasetamol 100 mg tablet
64 Parasetamol 500 mg tablet
65 Parasetamol tab tablet
66 Phenitoin 30 mg tablet
67 Phenylbutazone 200 mg tablet
68 Pirantel Pamoat 125 mg tablet
69 Piroksikam 10 mg tablet
70 Piroksikam 20 mg tablet
71 Prednison 5 mg tablet
72 Propanolol 10 mg tablet
73 Propanolol 40 mg tablet
74 PTU 100 mg tablet
75 Ranitidine 150 mg tablet
76 Reserpin 0,10 mg tablet
77 Reserpin 0,25 mg tablet
78 Salbutamol 2 mg tablet
79 Salbutamol 4 mg tablet
80 Sulfadimidin 500 mg tablet
81 Tetrasiklin 250 mg kapsul
82 Tetrasiklin 500 mg tablet
83 Thiamphenicol 500 mg tablet
84 Vitamin B Kompleks tablet
85 Vitamin B6 10 mg tablet
86 Vitamin B1 50 mg tablet
87 Vitamin B12 tablet
88 Vitamin C 50 mg tablet
89 Vitamin K 10 mg tablet
OBAT JENIS SIRUP
90 Ambroksol sirup btl
91 Amoxicillin SK 125 mg/ 5 ml btl
92 Amoxicillin SK 250 mg/ 5 ml btl
93 Ampisilin Sirup Kering btl
94 Antasida suspensi btl
95 Besi Sulfat Syrup btl
96 Cefadroxil Syrup Kering btl
97 Chloramphenicol Syrup btl
NO NAMA OBAT SATUAN 2/5/2011 3/5/2011 4/5/2011 5/5/2011 6/5/2011 7/5/2011 9/5/2011 10/5/2011 11/5/2011 12/5/2011 13/5/2011 14/5/2011 16/5/2011 18/5/2011 19/5/2011 20/5/2011 21/5/2011 23/5/2011 24/5/2011 25/5/2011 26/5/2011 27/5/2011 28/5/2011 30/5/2011 31/5/2011

98 Dekstrometorfan sirup btl

99 Ibuprofen Syrup btl
100 Kotrimoksazol suspensi btl
101 Multivitamin Syrup (Pediagrow) btl
102 OBH Sirup btl
103 Parasetamol Sirup btl
OBAT NAPZA
104 Diazepam 2 mg tablet
105 Diazepam 5 mg tablet
106 Diazepam Inj amp
107 Fenobarbital 30 mg tablet
108 Fenobarbital Injeksi amp
109 Fenitoin inj amp
110 Haloperidol 5 mg tablet
111 Klorpromazin 100 mg tablet
112 Klorpromazin 25 mg tablet
113 Kodein 10 mg tablet
OBAT TB PARU
114 Ethambutol 250 mg tablet
115 I N H 100 mg tablet
116 I N H 300 mg tablet
117 Pirazinamid 500 mg tablet
118 Rifampisin 450 mg tablet
OBAT LUAR
119 Aqudes Steril 500 ml btl
120 Alkohol 70 % 1000 ml Btl
121 Acyclovir Cream Tube
122 Anti Hemoroid Supp
123 Bacitracin-Polymyxin B Tube
124 Betametasone Krim Tube
125 Borax Gliserin sol Btl
126 Etil Klorida Spray Btl 100 ml
127 Fenol Gliserol Tts Telinga Btl
128 Formalin tab 1 Gram tablet
129 Gentamycin Salep Kulit Tube
130 Gentamycin Tetes Mata Steril 0,3 % botol
131 Gentian Violet Sol Btl
132 Gliserin Btl @ 10 ml
133 Hydrocortisone Cream 2,5% tube
134 Ichtyol Salep 10 gr Pot
135 Kalium Permanganat Pot
136 Kloramfenikol Salep Kulit (Farsycol) Tube
137 Kloramfenikol Salep Mata 1 % Tube
138 Kloramfenikol tetes Mata btl
139 Kloramfenikol Tetes Telinga Btl
140 Lisol 1000 ml Btl
141 Mikonazole Krim Tube
142 Oksitetrasiklin Salep Kulit 3 % Tube
143 Oksitetrasiklin Salep Mata 1 % Tube
144 Rivanol 1 % 300 ml Btl
145 Salisil Bedak kotak
146 Salisilat Belerang Salep pot
NO NAMA OBAT SATUAN 2/5/2011 3/5/2011 4/5/2011 5/5/2011 6/5/2011 7/5/2011 9/5/2011 10/5/2011 11/5/2011 12/5/2011 13/5/2011 14/5/2011 16/5/2011 18/5/2011 19/5/2011 20/5/2011 21/5/2011 23/5/2011 24/5/2011 25/5/2011 26/5/2011 27/5/2011 28/5/2011 30/5/2011 31/5/2011

147 Yodium Povidone Sol 1000 ml Btl

148 Yodium Povidone Sol 300 ml Btl
149 Yodium Povidon Sol 10 ml Btl
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : SEDADAP PELAPORAN BULAN : Februari 2011 NO./[Link]:

KECAMATAN : NUNUKAN SELATAN PERMINTAAN BULAN/PERIODE : GFK
KABUPATEN : NUNUKAN PUSK
DINKES

PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA PEMBERIAN KETERANG

NO NAMA OBAT SATUAN STOK AWAL
AN AAN AN STOK OPT AN
JUMLAH
AN
INPRES ASKES APBD I APBD II LAIN2
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet 660 660 660 0 ED
2 Ambeven tablet 0 0 0 0
3 Albendazole tablet 90 90 0 90
4 Allopurinol 100 mg tablet 600 600 100 500
5 Ambroksol 30 mg tablet 0 0 0 0
6 Amoxicillin 250 mg tablet 1440 1440 240 1200
7 Amoxicillin 500 mg tablet 17600 17600 2500 15100
8 Ampisilin 500 mg tablet 1400 1400 0 1400
9 Antalgin 500 mg tablet 3000 3000 0 3000
10 Antasida DOEN tablet 1600 1600 700 900
11 Asam Folat tablet 0 0 0 0
12 Asam Mefenamat 500 mg tablet 8600 8600 1900 6700
13 Atropin Sulfat 0,5 mg tablet 500 500 0 500
14 Acyclovir 200 mg tablet 100 100 0 100
15 Acyclovir 400 mg tablet 400 400 0 400
16 Besi sulfat tablet 4800 4800 600 4200
17 Bisacodyl (Laxana) tablet 0 0 0 0
18 Buscopan tablet 0 0 0 0
19 Captopril 25 mg tablet 2200 2200 400 1800
20 Captopril 12,5 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
21 Cefadroxil 500 mg tablet 0 0 0 0
22 Chloramphenicol 250 mg tablet 1000 1000 1000 0 ED
23 Chloroquin 250 mg tablet 0 0 0 0
24 Cimetidine 200 mg tablet 0 0 0 0
25 Ciprofloxacin 500 mg tablet 1800 1800 150 1650
26 CTM 4 mg tablet 14000 14000 2000 12000
27 Deksametasone 0,5 mg tablet 7000 7000 3000 4000
28 Dekstrometorfan 15 mg tablet 4000 4000 0 4000
29 Digoksin 0,25 mg tablet 0 0 0 0
30 Dimenhidrinat 50 mg tablet 600 600 0 600
31 Domperidone 10 mg tablet 1400 1400 200 1200
32 Efedrin 25 mg tablet 4000 4000 0 4000
33 Ergotamine Kafein tablet 100 100 100 0 ED
34 Erythromycin 250 mg tablet 1080 1080 240 840
35 Erythromycin 500 mg tablet 0 0 0 0
36 Famotidine 20 mg tablet 1300 1300 50 1250
37 Furosemide 40 mg tablet 200 200 0 200
38 Glibenklamide 5 mg tablet 1400 1400 100 1300
39 Gliseril Guayakolat 100 mg tablet 6000 6000 1000 5000
40 Griseofulvin 125 mg tablet 1200 1200 100 1100
41 H C T 25 mg tablet 1000 1000 0 1000
42 Ibuprofen 200 mg tablet 200 200 100 100
43 Ibuprofen 400 mg tablet 900 900 100 800
44 Isosorbit Dinitrat 5 mg tablet 500 500 500 0
45 Kalnex 500 mg tablet 0 0 0 0
46 Kalsium Laktat 500 mg tablet 11000 11000 1000 10000
47 Ketokonazole 200 mg tablet 500 500 0 500
48 Komp Pirimetamin Sulfadoksin tablet 88 88 0 88
49 Kotrimoksazol 120 mg tablet 1100 1100 0 1100
50 Kotrimoksazol 480 mg tablet 4300 5000 9300 5500 3800
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
51 Loperamid HCL 2 mg (Novadium) tablet 200 200 100 100
52 Mebendazol tablet 0 0 0 0
53 Methylergometrin 0,125 mg tablet 400 400 0 400
54 Metoklopramide 10 mg tablet 0 0 0 0
55 Metronidazol 500 mg tablet 400 400 0 400
56 Metronidazol 250 mg tablet 200 200 0 200
57 Multivitamin (Wishen) kaplet 0 0 0 0
58 New Diatabs tablet 0 0 0 0
59 Nifedipin 10 mg tablet 500 500 0 500
60 Nystatin 500.000 IU tablet 90 90 0 90
61 Oralit 200 ml sachet 2600 2600 300 2300
62 Papaverin 40 mg tablet 0 0 0 0
63 Parasetamol 100 mg tablet 0 0 0 0
64 Parasetamol 500 mg tablet 11000 11000 2000 9000
65 Parasetamol tab tablet 0 0 0 0
66 Phenitoin 30 mg tablet 250 250 0 250
67 Phenylbutazone 200 mg tablet 0 0 0 0
68 Pirantel Pamoat 125 mg tablet 0 0 0 0
69 Piroksikam 10 mg tablet 1000 1000 360 640
70 Piroksikam 20 mg tablet 600 600 0 600
71 Prednison 5 mg tablet 7000 7000 0 7000
72 Propanolol 10 mg tablet 0 0 0 0
73 Propanolol 40 mg tablet 100 100 0 100
74 PTU 100 mg tablet 100 100 0 100
75 Ranitidine 150 mg tablet 1200 1200 200 1000
76 Reserpin 0,10 mg tablet 750 750 250 500
77 Reserpin 0,25 mg tablet 200 200 -1800 2000
78 Salbutamol 2 mg tablet 500 500 0 500
79 Salbutamol 4 mg tablet 0 0 0 0
80 Sulfadimidin 500 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
81 Tetrasiklin 250 mg kapsul 1000 1000 0 1000
82 Tetrasiklin 500 mg tablet 0 0 0 0
83 Thiamphenicol 500 mg tablet 0 0 0 0
84 Vitamin B Kompleks tablet 6000 6000 3000 3000
85 Vitamin B6 10 mg tablet 11000 11000 1000 10000
86 Vitamin B1 50 mg tablet 14000 14000 1000 13000
87 Vitamin B12 tablet 5000 5000 0 5000
88 Vitamin C 50 mg tablet 12000 12000 2000 10000
89 Vitamin K 10 mg tablet 500 500 0 500
OBAT JENIS SIRUP
90 Ambroksol sirup btl 75 75 10 65
91 Amoxicillin SK 125 mg/ 5 ml btl @ 60 ml 98 98 44 54
92 Amoxicillin SK 250 mg/ 5 ml btl @ 60 ml 46 46 8 38
93 Ampisilin Sirup Kering btl 0 0 0 0
94 Antasida suspensi btl 47 47 5 42
95 Besi Sulfat Syrup btl 0 0 0 0
96 Cefadroxil Syrup Kering btl 0 0 0 0
97 Chloramphenicol Syrup btl 0 0 0 0
98 Dekstrometorfan sirup btl 60 ml 77 77 2 75
99 Ibuprofen Syrup Botol 14 14 10 4
100 Kotrimoksazol suspensi btl 60 ml 435 435 27 408
101 Multivitamin Syrup (Pediagrow) btl 0 0 0 0
102 OBH Sirup btl 71 71 26 45
103 Parasetamol Sirup btl 60 ml 116 116 61 55
OBAT NAPZA
104 Diazepam 2 mg tablet 2290 2290 2290 0 ED
105 Diazepam 5 mg tablet 0 0 0 0
106 Diazepam Inj amp 0 0 0 0
107 Fenobarbital 30 mg tablet 468.5 468.5 0 468.5
108 Fenobarbital Injeksi amp 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
109 Fenitoin inj amp 0 0 0 0
110 Haloperidol 5 mg tablet 0 0 0 0
111 Klorpromazin 100 mg tablet 0 0 0 0
112 Klorpromazin 25 mg tablet 900 900 0 900
113 Kodein 10 mg tablet 0 0 0 0
OBAT TB PARU
114 Ethambutol 250 mg tablet 0 0 0 0
115 I N H 100 mg tablet 0 0 0 0
116 I N H 300 mg tablet 1000 1000 0 1000
117 Pirazinamid 500 mg tablet 60 60 0 60
118 Rifampisin 450 mg tablet 0 0 0 0
OBAT LUAR
119 Aqudes Steril 500 ml btl 0 0 0 0
120 Alkohol 70 % 1000 ml Btl 4 4 1 3
121 Acyclovir Cream Tube 45 45 5 40
122 Anti Hemoroid Supp 46 46 11 35
123 Bacitracin-Polymyxin B Tube 200 200 0 200
124 Betametasone Krim Tube 100 100 50 50
125 Borax Gliserin sol Btl 0 0 0 0
126 Etil Klorida Spray Btl 100 ml 2 2 0 2
127 Fenol Gliserol Tts Telinga Btl 0 0 0 0
128 Formalin tab 1 Gram tablet 2 2 0 2
129 Gentamycin Salep Kulit Tube 100 100 0 100
130 Gentamycin Tetes Mata Steril 0,3 % botol 15 15 15 0
131 Gentian Violet Sol Btl 7 7 7 0
132 Gliserin Btl @ 10 ml 0 0 0 0
133 Hydrocortisone Cream 2,5% tube 96 96 48 48
134 Ichtyol Salep 10 gr Pot 0 0 0 0
135 Kalium Permanganat Pot 0 0 0 0
136 Kloramfenikol Salep Kulit (Farsycol) Tube @ 10 gr 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
137 Kloramfenikol Salep Mata 1 % Tube 0 0 0 0
138 Kloramfenikol tetes Mata btl 0 0 0 0
139 Kloramfenikol Tetes Telinga Btl 24 24 0 24
140 Lisol 1000 ml Btl 4 4 1 3
141 Mikonazole Krim Tube 0 0 0 0
142 Oksitetrasiklin Salep Kulit 3 % Tube 175 175 25 150
143 Oksitetrasiklin Salep Mata 1 % Tube 60 60 0 60
144 Rivanol 1 % 300 ml Btl 8 8 0 8
145 Salisil Bedak kotak 40 40 10 30
146 Salisilat Belerang Salep pot 41 41 0 41
147 Yodium Povidone Sol 1000 ml Btl 0 0 0 0
148 Yodium Povidone Sol 300 ml Btl 2 2 1 1
149 Yodium Povidon Sol 10 ml Btl 0 0 0 0
OBAT SUNTIK
150 Adidryl Injeksi vial 4 4 0 4
151 Adimidon Injeksi vial 12 12 0 12
152 Aqua Pro Inj amp 4 10 14 12 2
153 Aminofilin inj amp 30 30 0 30
154 Antalgin inj amp 0 0 0 0
155 Buscopan Injeksi amp 0 0 0 0
156 Cefotaxim inj amp 0 0 0 0
157 Cortison inj amp 0 0 0 0
158 Deksametasone Inj amp 85 85 20 65
159 Dextrose 5 % - Nacl 0,45 % kolf 0 0 0 0
160 Dextrose 5 % - Nacl 1/4 kolf 0 0 0 0
161 Dextrose 5 % kolf 41 41 0 41
162 Dextrose 10 % kolf 4 4 0 4
163 Difenhidramin Inj amp 15 15 0 15
164 Ephinephrin Injeksi amp 0 0 0 0
165 Ketorolac Injeksi amp 10 10 10 0 ED
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
166 Lidokain Inj amp 0 0 0 0
167 Lidokain comp amp 100 100 40 60
168 Metil ergometrin inj amp 5 5 0 5
169 Natrium Klorida Infus kolf 107 107 5 102
170 Natrium Tiosulfat Injeksi amp 0 0 0 0
171 Neurobion Injeksi amp 5 5 0 5
172 Oxytetracyclin Injeksi vial 0 0 0 0
173 Oxytocin Injeksi amp 0 0 0 0
174 Papaverin inj amp 19 19 19 0 ED
175 Ranitidine Injeksi amp 35 35 0 35
176 Ringer Laktat Infus kolf 138 138 6 132
177 Sabu 5 ml Injeksi vial 0 0 0 0
178 Streptomycin Injeksi vial 0 0 0 0
179 Vitamin B1 inj amp 0 0 0 0
180 Vitamin B 12 inj amp 123 123 110 13 ED
181 Vitamin K Injeksi Amp 29 29 0 29
182 Vitamin C Inj Amp 0 0 0 0
ALKES HABIS PAKAI
183 Abbocath No.18 Pcs 42 42 3 39
184 Abbocath No. 20 Pcs 190 190 0 190
185 Abbocath No. 22 Pcs 133 133 0 133
186 Abbocath No.24 Pcs 148 148 0 148
187 Alat Suntik 1 ml Pcs 152 152 0 152
188 Alat Suntik 2,5 ml Pcs 0 0 0 0
189 Alat Suntik 3 ml Pcs 702 702 120 582
190 Alat Suntik 5 ml Pcs 575 575 0 575
191 Alat Suntik 10 ml Pcs 0 0 0 0
192 Alat Suntik 20 ml Pcs 0 0 0 0
193 Blood Set Set 0 0 0 0
194 Cat/Gut 2/0 150 cm Pcs 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
195 Catgut Chromic No. 3/0 70 cm Pcs 120 120 0 120
196 Catgut Chromic No. 3/0 75 cm Pcs 14 14 0 14
197 Catgut Chromic No. 4/0 150 cm Pcs 0 0 0 0
198 Hand Schoen No 7 Pasang 20 20 5 15
199 Hand Schoen No 7,5 Pasang 100 100 100 0
200 Hand Schoen No 8 Pasang 0 0 0 0
201 Hypafix 5 cm Roll 0 0 0 0
202 Infus Set Anak Pcs 58 58 0 58
203 Infus Set Dewasa Pcs 86 86 0 86
204 Jarum Bedah Pcs 0 0 0 0
205 Kapas Pembalut 250 gram Bks 14 14 0 14
206 Kasa 2 y x 80 cm Roll 64 64 6 58
207 Kasa 5 cm x 80 cm Roll 0 0 0 0
208 Kasa Kompres 40 x40 Roll 110 110 0 110
209 Kasa Pemb 40 x 80 cm Roll 0 0 0 0
210 Kasa Steril 16 x 16 ktk/100 lbr 0 0 0 0
211 Kasa Hidrofil 4 x 15 cm Roll 150 150 0 150
212 Kasa Pembalut 4 x 3 cm Roll 0 0 0 0
213 Masker Box/50 Pcs 0 0 0 0
214 Nald Hecting Otot (Jarum Kulit) Set/12 pcs 0 0 0 0
215 Nald Hecting No. 9 pcs 12 12 0 12
216 Nald Hecting No 13 Pcs 0 0 0 0
217 Nald Hecting No 15 Pcs 0 0 0 0
218 NGT No. 3,5 (Feeding Tube) Set 0 0 0 0
219 NGT No. 16 (Feeding Tube) Set 0 0 0 0
220 Nald No. 23 Pcs 200 200 0 200
221 Nald No. 24 Pcs 1000 1000 220 780
222 Scalvein No. 23 Pcs 0 0 0 0
223 Silk No. 3/0 150 cm Pcs 0 0 0 0
224 Silk Black No. 3/0 75 cm (35 mm) Pcs 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
225 Silk Black No. 3/0 75 cm (26 mm) Pcs 12 12 0 12
226 Plester 5 Yard x 2 Inch Roll 12 12 2 10
TAMBAHAN
227 Alkohol Swab ktk/100 paket 3 3 -297 300
228 Pharmafix 2,5 cm x 5 mtr Roll 3 3 0 3
229 Pharmafix 5 cm x 5 mtr Roll 8 8 2 6
230 Pharmafix 10 cm x 5 mtr Roll 6 6 0 6
231 Indo Obat Flu tablet 0 0 0 0
232 Indo Obat Cacing (Mebendazole) tablet 0 0 0 0
233 Indo Obat Penurun Panas tablet 0 0 0 0
234 Ampicillin Injeksi (Vicillin) vial 110 110 0 110 dari KIA
235 Gentamycin Injeksi amp 140 140 0 140 dari KIA
236 Urine Bag Set 8 8 2 6
237 Elastic Verban 7,5 cm x 4,5 M Roll 3 3 0 3
238 Foley Catheter No.16 pcs 9 9 2 7
239 Foley Catheter No.18 pcs 8 8 2 6
240 Kanamycin 1 gr Injeksi vial 3 3 0 3
241 handscoen No.6 1/2 Pasang 50 50 100 67 33

Umum
ASKES Jumlah
Jumlah Kunjungan Resep Bayar Tidak Bayar

384 547 116 1047

Yang Meminta Mengetahui/Menyetujui Yang Menyerahkan Yang Menerima

Pimpinan Puskesmas Kepala Dinkes II / GFK Petugas GFK Petugas Puskesmas

Dr. Herlina Barends (…………………………………………) (………………………………….) Hj. Badariah

 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
NIP. 19670726 199903 2 003 NIP. NIP. NIP. 19580612 197712 2 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : SEDADAP PELAPORAN BULAN : Maret 2011 NO./[Link]:

KECAMATAN : NUNUKAN SELATAN PERMINTAAN BULAN/PERIODE : GFK
KABUPATEN : NUNUKAN PUSK
DINKES

PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA PEMBERIAN KETERANG

NO NAMA OBAT SATUAN STOK AWAL
AN AAN AN STOK OPT AN
JUMLAH
AN
INPRES ASKES APBD I APBD II LAIN2
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet 0 0 0 ED
2 Ambeven tablet 0 0 0 0
3 Albendazole tablet 90 90 0 90
4 Allopurinol 100 mg tablet 600 500 100 400
5 Ambroksol 30 mg tablet 0 0 0 0
6 Amoxicillin 250 mg tablet 1440 1200 520 680
7 Amoxicillin 500 mg tablet 17600 15100 2800 12300
8 Ampisilin 500 mg tablet 1400 1400 200 1200
9 Antalgin 500 mg tablet 3000 3000 1000 2000
10 Antasida DOEN tablet 1600 900 900 0
11 Asam Folat tablet 0 0 0 0
12 Asam Mefenamat 500 mg tablet 8600 6700 2300 4400
13 Atropin Sulfat 0,5 mg tablet 500 500 0 500
14 Acyclovir 200 mg tablet 100 100 0 100
15 Acyclovir 400 mg tablet 400 400 0 400
16 Besi sulfat tablet 4800 4200 1800 2400
17 Bisacodyl (Laxana) tablet 0 0 0 0
18 Buscopan tablet 0 0 0 0
19 Captopril 25 mg tablet 2200 1800 400 1400
20 Captopril 12,5 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
21 Cefadroxil 500 mg tablet 0 0 0 0
22 Chloramphenicol 250 mg tablet 1000 0 0 0 ED
23 Chloroquin 250 mg tablet 0 0 0 0
24 Cimetidine 200 mg tablet 0 0 0 0
25 Ciprofloxacin 500 mg tablet 1800 1650 100 1550
26 CTM 4 mg tablet 14000 12000 11400 600
27 Deksametasone 0,5 mg tablet 7000 4000 4000 0
28 Dekstrometorfan 15 mg tablet 4000 4000 0 4000
29 Digoksin 0,25 mg tablet 0 0 0 0
30 Dimenhidrinat 50 mg tablet 600 600 0 600
31 Domperidone 10 mg tablet 1400 1200 300 900
32 Efedrin 25 mg tablet 4000 4000 2000 2000
33 Ergotamine Kafein tablet 100 0 0 0 ED
34 Erythromycin 250 mg tablet 1080 840 260 580
35 Erythromycin 500 mg tablet 0 0 0 0
36 Famotidine 20 mg tablet 1300 1250 0 1250
37 Furosemide 40 mg tablet 200 200 0 200
38 Glibenklamide 5 mg tablet 1400 1300 100 1200
39 Gliseril Guayakolat 100 mg tablet 6000 5000 2000 3000
40 Griseofulvin 125 mg tablet 1200 1100 0 1100
41 H C T 25 mg tablet 1000 1000 0 1000
42 Ibuprofen 200 mg tablet 200 100 100 0
43 Ibuprofen 400 mg tablet 900 800 500 300
44 Isosorbit Dinitrat 5 mg tablet 500 0 -500 500
45 Kalnex 500 mg tablet 0 0 0 0
46 Kalsium Laktat 500 mg tablet 11000 10000 1000 9000
47 Ketokonazole 200 mg tablet 500 500 0 500
48 Komp Pirimetamin Sulfadoksin tablet 88 88 0 88
49 Kotrimoksazol 120 mg tablet 1100 1100 0 1100
50 Kotrimoksazol 480 mg tablet 4300 5000 3800 600 3200
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
51 Loperamid HCL 2 mg (Novadium) tablet 200 100 0 100
52 Mebendazol tablet 0 0 0 0
53 Methylergometrin 0,125 mg tablet 400 400 0 400
54 Metoklopramide 10 mg tablet 0 0 0 0
55 Metronidazol 500 mg tablet 400 400 0 400
56 Metronidazol 250 mg tablet 200 200 0 200
57 Multivitamin (Wishen) kaplet 0 0 0 0
58 New Diatabs tablet 0 0 0 0
59 Nifedipin 10 mg tablet 500 500 0 500
60 Nystatin 500.000 IU tablet 90 90 10 80
61 Oralit 200 ml sachet 2600 2300 0 2300
62 Papaverin 40 mg tablet 0 0 0 0
63 Parasetamol 100 mg tablet 0 0 0 0
64 Parasetamol 500 mg tablet 11000 9000 4000 5000
65 Parasetamol tab tablet 0 0 0 0
66 Phenitoin 30 mg tablet 250 250 0 250
67 Phenylbutazone 200 mg tablet 0 0 0 0
68 Pirantel Pamoat 125 mg tablet 0 0 0 0
69 Piroksikam 10 mg tablet 1000 640 240 400
70 Piroksikam 20 mg tablet 600 600 0 600
71 Prednison 5 mg tablet 7000 7000 1000 6000
72 Propanolol 10 mg tablet 0 0 0 0
73 Propanolol 40 mg tablet 100 100 0 100
74 PTU 100 mg tablet 100 100 0 100
75 Ranitidine 150 mg tablet 1200 1000 400 600
76 Reserpin 0,10 mg tablet 750 500 250 250
77 Reserpin 0,25 mg tablet 200 2000 0 2000
78 Salbutamol 2 mg tablet 500 500 100 400
79 Salbutamol 4 mg tablet 0 0 0 0
80 Sulfadimidin 500 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
81 Tetrasiklin 250 mg kapsul 1000 1000 0 1000
82 Tetrasiklin 500 mg tablet 0 0 0 0
83 Thiamphenicol 500 mg tablet 0 0 0 0
84 Vitamin B Kompleks tablet 6000 3000 2000 1000
85 Vitamin B6 10 mg tablet 11000 10000 2000 8000
86 Vitamin B1 50 mg tablet 14000 13000 2000 11000
87 Vitamin B12 tablet 5000 5000 1000 4000
88 Vitamin C 50 mg tablet 12000 10000 3000 7000
89 Vitamin K 10 mg tablet 500 500 0 500
OBAT JENIS SIRUP
90 Ambroksol sirup btl 75 65 17 48
91 Amoxicillin SK 125 mg/ 5 ml btl @ 60 ml 98 54 50 4
92 Amoxicillin SK 250 mg/ 5 ml btl @ 60 ml 46 38 15 23
93 Ampisilin Sirup Kering btl 0 0 0 0
94 Antasida suspensi btl 47 42 23 19
95 Besi Sulfat Syrup btl 0 0 0 0
96 Cefadroxil Syrup Kering btl 0 0 0 0
97 Chloramphenicol Syrup btl 0 0 0 0
98 Dekstrometorfan sirup btl 60 ml 77 75 0 75
99 Ibuprofen Syrup Botol 14 4 0 4
100 Kotrimoksazol suspensi btl 60 ml 435 408 32 376
101 Multivitamin Syrup (Pediagrow) btl 0 0 0 0
102 OBH Sirup btl 71 45 10 35
103 Parasetamol Sirup btl 60 ml 116 55 55 0
OBAT NAPZA
104 Diazepam 2 mg tablet 2290 0 0 0 ED
105 Diazepam 5 mg tablet 0 0 0 0
106 Diazepam Inj amp 0 0 0 0
107 Fenobarbital 30 mg tablet 468.5 468.5 0 468.5
108 Fenobarbital Injeksi amp 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
109 Fenitoin inj amp 0 0 0 0
110 Haloperidol 5 mg tablet 0 0 0 0
111 Klorpromazin 100 mg tablet 0 0 0 0
112 Klorpromazin 25 mg tablet 900 900 0 900
113 Kodein 10 mg tablet 0 0 0 0
OBAT TB PARU
114 Ethambutol 250 mg tablet 0 0 0 0
115 I N H 100 mg tablet 0 0 0 0
116 I N H 300 mg tablet 1000 1000 0 1000
117 Pirazinamid 500 mg tablet 60 60 0 60
118 Rifampisin 450 mg tablet 0 0 0 0
OBAT LUAR
119 Aqudes Steril 500 ml btl 0 0 0 0
120 Alkohol 70 % 1000 ml Btl 4 3 2 1
121 Acyclovir Cream Tube 45 40 5 35
122 Anti Hemoroid Supp 46 35 5 30
123 Bacitracin-Polymyxin B Tube 200 200 0 200
124 Betametasone Krim Tube 100 50 50 0
125 Borax Gliserin sol Btl 0 0 0 0
126 Etil Klorida Spray Btl 100 ml 2 2 1 1
127 Fenol Gliserol Tts Telinga Btl 0 0 0 0
128 Formalin tab 1 Gram tablet 2 2 0 2
129 Gentamycin Salep Kulit Tube 100 100 25 75
130 Gentamycin Tetes Mata Steril 0,3 % botol 15 0 0 0
131 Gentian Violet Sol Btl 7 0 0 0
132 Gliserin Btl @ 10 ml 0 0 0 0
133 Hydrocortisone Cream 2,5% tube 96 48 48 0
134 Ichtyol Salep 10 gr Pot 0 0 0 0
135 Kalium Permanganat Pot 0 0 0 0
136 Kloramfenikol Salep Kulit (Farsycol) Tube @ 10 gr 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
137 Kloramfenikol Salep Mata 1 % Tube 0 0 0 0
138 Kloramfenikol tetes Mata btl 0 0 0 0
139 Kloramfenikol Tetes Telinga Btl 24 24 11 13
140 Lisol 1000 ml Btl 4 3 0 3
141 Mikonazole Krim Tube 0 0 0 0
142 Oksitetrasiklin Salep Kulit 3 % Tube 175 150 50 100
143 Oksitetrasiklin Salep Mata 1 % Tube 60 60 5 55
144 Rivanol 1 % 300 ml Btl 8 8 1 7
145 Salisil Bedak kotak 40 30 10 20
146 Salisilat Belerang Salep pot 41 41 10 31
147 Yodium Povidone Sol 1000 ml Btl 0 0 0 0
148 Yodium Povidone Sol 300 ml Btl 2 1 1 0
149 Yodium Povidon Sol 10 ml Btl 0 0 0 0
OBAT SUNTIK
150 Adidryl Injeksi vial 4 4 0 4
151 Adimidon Injeksi vial 12 12 0 12
152 Aqua Pro Inj amp 4 10 2 1 1
153 Aminofilin inj amp 30 30 0 30
154 Antalgin inj amp 0 0 0 0
155 Buscopan Injeksi amp 0 0 0 0
156 Cefotaxim inj amp 0 0 0 0
157 Cortison inj amp 0 0 0 0
158 Deksametasone Inj amp 85 65 50 50
159 Dextrose 5 % - Nacl 0,45 % kolf 0 0 0 0
160 Dextrose 5 % - Nacl 1/4 kolf 0 0 0 0
161 Dextrose 5 % kolf 41 41 3 38
162 Dextrose 10 % kolf 4 4 1 3
163 Difenhidramin Inj amp 15 15 0 15
164 Ephinephrin Injeksi amp 0 0 0 0
165 Ketorolac Injeksi amp 10 0 0 0 ED
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
166 Lidokain Inj amp 0 0 0 0
167 Lidokain comp amp 100 60 60 0
168 Metil ergometrin inj amp 5 5 0 5
169 Natrium Klorida Infus kolf 107 102 6 96
170 Natrium Tiosulfat Injeksi amp 0 0 0 0
171 Neurobion Injeksi amp 5 5 0 5
172 Oxytetracyclin Injeksi vial 0 0 0 0
173 Oxytocin Injeksi amp 0 0 0 0
174 Papaverin inj amp 19 0 0 0 ED
175 Ranitidine Injeksi amp 35 35 0 35
176 Ringer Laktat Infus kolf 138 132 6 126
177 Sabu 5 ml Injeksi vial 0 0 0 0
178 Streptomycin Injeksi vial 0 0 0 0
179 Vitamin B1 inj amp 0 0 0 0
180 Vitamin B 12 inj amp 123 13 13 0 ED
181 Vitamin K Injeksi Amp 29 29 5 24
182 Vitamin C Inj Amp 0 0 0 0
ALKES HABIS PAKAI
183 Abbocath No.18 Pcs 42 39 0 39
184 Abbocath No. 20 Pcs 190 190 10 180
185 Abbocath No. 22 Pcs 133 133 5 128
186 Abbocath No.24 Pcs 148 148 0 148
187 Alat Suntik 1 ml Pcs 152 1529 120 1409
188 Alat Suntik 2,5 ml Pcs 0 0 0 0
189 Alat Suntik 3 ml Pcs 702 582 500 82
190 Alat Suntik 5 ml Pcs 575 575 0 575
191 Alat Suntik 10 ml Pcs 0 0 0 0
192 Alat Suntik 20 ml Pcs 0 0 0 0
193 Blood Set Set 0 0 0 0
194 Cat/Gut 2/0 150 cm Pcs 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
195 Catgut Chromic No. 3/0 70 cm Pcs 120 120 0 120
196 Catgut Chromic No. 3/0 75 cm Pcs 14 14 0 14
197 Catgut Chromic No. 4/0 150 cm Pcs 0 0 0 0
198 Hand Schoen No 7 Pasang 20 15 0 15
199 Hand Schoen No 7,5 Pasang 100 0 0 0
200 Hand Schoen No 8 Pasang 0 0 0 0
201 Hypafix 5 cm Roll 0 0 0 0
202 Infus Set Anak Pcs 58 58 0 58
203 Infus Set Dewasa Pcs 86 86 10 76
204 Jarum Bedah Pcs 0 0 0 0
205 Kapas Pembalut 250 gram Bks 14 14 1 13
206 Kasa 2 y x 80 cm Roll 64 58 22 36
207 Kasa 5 cm x 80 cm Roll 0 0 0 0
208 Kasa Kompres 40 x40 Roll 110 110 5 105
209 Kasa Pemb 40 x 80 cm Roll 0 0 0 0
210 Kasa Steril 16 x 16 ktk/100 lbr 0 0 0 0
211 Kasa Hidrofil 4 x 15 cm Roll 150 150 0 150
212 Kasa Pembalut 4 x 3 cm Roll 0 0 0 0
213 Masker Box/50 Pcs 0 0 0 0
214 Nald Hecting Otot (Jarum Kulit) Set/12 pcs 0 0 0 0
215 Nald Hecting No. 9 pcs 12 12 0 12
216 Nald Hecting No 13 Pcs 0 0 0 0
217 Nald Hecting No 15 Pcs 0 0 0 0
218 NGT No. 3,5 (Feeding Tube) Set 0 0 0 0
219 NGT No. 16 (Feeding Tube) Set 0 0 0 0
220 Nald No. 23 Pcs 200 200 100 100
221 Nald No. 24 Pcs 1000 780 100 680
222 Scalvein No. 23 Pcs 0 0 0 0
223 Silk No. 3/0 150 cm Pcs 0 0 0 0
224 Silk Black No. 3/0 75 cm (35 mm) Pcs 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
225 Silk Black No. 3/0 75 cm (26 mm) Pcs 12 12 12 0
226 Plester 5 Yard x 2 Inch Roll 12 10 0 10
TAMBAHAN
227 Alkohol Swab ktk/100 paket 3 300 0 300
228 Pharmafix 2,5 cm x 5 mtr Roll 3 3 0 3
229 Pharmafix 5 cm x 5 mtr Roll 8 6 0 6
230 Pharmafix 10 cm x 5 mtr Roll 6 6 0 6
231 Indo Obat Flu tablet 0 0 0 0
232 Indo Obat Cacing (Mebendazole) tablet 0 0 0 0
233 Indo Obat Penurun Panas tablet 0 0 0 0
234 Ampicillin Injeksi (Vicillin) vial 110 110 0 110 dari KIA
235 Gentamycin Injeksi amp 140 140 0 140 dari KIA
236 Urine Bag Set 8 6 0 6
237 Elastic Verban 7,5 cm x 4,5 M Roll 3 3 1 2
238 Foley Catheter No.16 pcs 9 7 0 7
239 Foley Catheter No.18 pcs 8 6 0 6
240 Kanamycin 1 gr Injeksi vial 3 3 0 3
241 handscoen No.6 1/2 Pasang 50 50 33 5 28

Umum
ASKES Jumlah
Jumlah Kunjungan Resep Bayar Tidak Bayar

Yang Meminta Mengetahui/Menyetujui Yang Menyerahkan Yang Menerima

Pimpinan Puskesmas Kepala Dinkes II / GFK Petugas GFK Petugas Puskesmas

Dr. Herlina Barends (…………………………………………) (………………………………….) Hj. Badariah

 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
NIP. 19670726 199903 2 003 NIP. NIP. NIP. 19580612 197712 2 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : SEDADAP PELAPORAN BULAN : April 2011 NO./[Link]:

KECAMATAN : NUNUKAN SELATAN PERMINTAAN BULAN/PERIODE : GFK
KABUPATEN : NUNUKAN PUSK
DINKES

PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA PEMBERIAN KETERANG

NO NAMA OBAT SATUAN STOK AWAL
AN AAN AN STOK OPT AN
JUMLAH
AN
INPRES ASKES APBD I APBD II LAIN2
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet 0 0 0 ED
2 Ambeven tablet 0 0 0 0
3 Albendazole tablet 90 90 60 30
4 Allopurinol 100 mg tablet 600 2000 400 300 2100
5 Ambroksol 30 mg tablet 0 1300 0 0 1300
6 Amoxicillin 250 mg tablet 1440 3000 680 840 2840
7 Amoxicillin 500 mg tablet 17600 3100 12300 2300 41800
8 Ampisilin 500 mg tablet 1400 1200 0 1200
9 Antalgin 500 mg tablet 3000 6000 2000 0 8000
10 Antasida DOEN tablet 1600 0 0 0
11 Asam Folat tablet 0 0 0 0
12 Asam Mefenamat 500 mg tablet 8600 22000 4400 2200 24000
13 Atropin Sulfat 0,5 mg tablet 500 500 0 500
14 Acyclovir 200 mg tablet 100 1000 100 0 1100
15 Acyclovir 400 mg tablet 400 400 0 400
16 Besi sulfat tablet 4800 3600 2400 1800 6000
17 Bisacodyl (Laxana) tablet 0 0 0 0
18 Buscopan tablet 0 0 0 0
19 Captopril 25 mg tablet 2200 1400 400 1000
20 Captopril 12,5 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
21 Cefadroxil 500 mg tablet 0 0 0 0
22 Chloramphenicol 250 mg tablet 1000 0 0 0 ED
23 Chloroquin 250 mg tablet 0 0 0 0
24 Cimetidine 200 mg tablet 0 0 0 0
25 Ciprofloxacin 500 mg tablet 1800 1000 1550 150 2400
26 CTM 4 mg tablet 14000 20000 600 4000 22000
27 Deksametasone 0,5 mg tablet 7000 24000 0 10000 19000
28 Dekstrometorfan 15 mg tablet 4000 3000 4000 1000 5000
29 Digoksin 0,25 mg tablet 0 0 0 0
30 Dimenhidrinat 50 mg tablet 600 600 0 600
31 Domperidone 10 mg tablet 1400 900 100 800
32 Efedrin 25 mg tablet 4000 10000 2000 0 12000
33 Ergotamine Kafein tablet 100 0 0 0 ED
34 Erythromycin 250 mg tablet 1080 580 120 460
35 Erythromycin 500 mg tablet 0 2000 0 0 2000
36 Famotidine 20 mg tablet 1300 1250 450 800
37 Furosemide 40 mg tablet 200 1000 200 0 1200
38 Glibenklamide 5 mg tablet 1400 1200 100 1100
39 Gliseril Guayakolat 100 mg tablet 6000 20000 3000 1000 22000
40 Griseofulvin 125 mg tablet 1200 1100 100 1000
41 H C T 25 mg tablet 1000 3000 1000 1000 3000
42 Ibuprofen 200 mg tablet 200 2000 0 100 1900
43 Ibuprofen 400 mg tablet 900 4000 300 500 3800
44 Isosorbit Dinitrat 5 mg tablet 500 500 0 500
45 Kalnex 500 mg tablet 0 0 0 0
46 Kalsium Laktat 500 mg tablet 11000 11000 9000 1000 19000
47 Ketokonazole 200 mg tablet 500 1000 500 50 1450
48 Komp Pirimetamin Sulfadoksin tablet 88 88 8 80
49 Kotrimoksazol 120 mg tablet 1100 1000 1100 0 2100
50 Kotrimoksazol 480 mg tablet 4300 2000 3200 700 3600
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
51 Loperamid HCL 2 mg (Novadium) tablet 200 3000 100 200 200
52 Mebendazol tablet 0 0 0 0
53 Methylergometrin 0,125 mg tablet 400 400 0 400
54 Metoklopramide 10 mg tablet 0 0 0 0
55 Metronidazol 500 mg tablet 400 400 100 300
56 Metronidazol 250 mg tablet 200 1000 200 100 1100
57 Multivitamin (Wishen) kaplet 0 1000 0 0 0
58 New Diatabs tablet 0 0 0 0
59 Nifedipin 10 mg tablet 500 500 500 0 1000
60 Nystatin 500.000 IU tablet 90 80 10 70
61 Oralit 200 ml sachet 2600 1000 2300 250 3050
62 Papaverin 40 mg tablet 0 0 0 0
63 Parasetamol 100 mg tablet 0 0 0 0
64 Parasetamol 500 mg tablet 11000 30000 5000 1000 34000
65 Parasetamol tab tablet 0 0 0 0
66 Phenitoin 30 mg tablet 250 250 0 250
67 Phenylbutazone 200 mg tablet 0 0 0 0
68 Pirantel Pamoat 125 mg tablet 0 0 0 0
69 Piroksikam 10 mg tablet 1000 1444 400 240 1600
70 Piroksikam 20 mg tablet 600 1400 600 100 1900
71 Prednison 5 mg tablet 7000 10000 6000 0 16000
72 Propanolol 10 mg tablet 0 0 0 0
73 Propanolol 40 mg tablet 100 100 0 100
74 PTU 100 mg tablet 100 100 0 100
75 Ranitidine 150 mg tablet 1200 600 600 0
76 Reserpin 0,10 mg tablet 750 2500 250 250 2750
77 Reserpin 0,25 mg tablet 200 6000 2000 0 8000
78 Salbutamol 2 mg tablet 500 400 100 300
79 Salbutamol 4 mg tablet 0 0 0 0
80 Sulfadimidin 500 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
81 Tetrasiklin 250 mg kapsul 1000 3000 1000 0 4000
82 Tetrasiklin 500 mg tablet 0 0 0 0
83 Thiamphenicol 500 mg tablet 0 0 0 0
84 Vitamin B Kompleks tablet 6000 10000 1000 1000 10000
85 Vitamin B6 10 mg tablet 11000 17000 8000 1000 24000
86 Vitamin B1 50 mg tablet 14000 20000 11000 1000 30000
87 Vitamin B12 tablet 5000 6000 4000 0 10000
88 Vitamin C 50 mg tablet 12000 10000 7000 2000 15000
89 Vitamin K 10 mg tablet 500 500 100 400
OBAT JENIS SIRUP 0
90 Ambroksol sirup btl 75 48 23 25
91 Amoxicillin SK 125 mg/ 5 ml btl @ 60 ml 98 4 4 0
92 Amoxicillin SK 250 mg/ 5 ml btl @ 60 ml 46 23 23 0
93 Ampisilin Sirup Kering btl 0 0 0 0
94 Antasida suspensi btl 47 19 19 0
95 Besi Sulfat Syrup btl 0 0 0 0
96 Cefadroxil Syrup Kering btl 0 0 0 0
97 Chloramphenicol Syrup btl 0 0 0 0
98 Dekstrometorfan sirup btl 60 ml 77 75 5 70
99 Ibuprofen Syrup Botol 14 4 4 0
100 Kotrimoksazol suspensi btl 60 ml 435 376 46 330
101 Multivitamin Syrup (Pediagrow) btl 0 0 0 0
102 OBH Sirup btl 71 35 10 25
103 Parasetamol Sirup btl 60 ml 116 0 0 0
OBAT NAPZA
104 Diazepam 2 mg tablet 2290 1000 0 18 982 ED
105 Diazepam 5 mg tablet 0 0 0 0
106 Diazepam Inj amp 0 0 0 0
107 Fenobarbital 30 mg tablet 468.5 468.5 468.5 0
108 Fenobarbital Injeksi amp 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
109 Fenitoin inj amp 0 0 0 0
110 Haloperidol 5 mg tablet 0 0 0 0
111 Klorpromazin 100 mg tablet 0 0 0 0
112 Klorpromazin 25 mg tablet 900 900 900 0
113 Kodein 10 mg tablet 0 0 0 0
OBAT TB PARU
114 Ethambutol 250 mg tablet 0 0 0 0
115 I N H 100 mg tablet 0 0 0 0
116 I N H 300 mg tablet 1000 1000 1000 0 2000
117 Pirazinamid 500 mg tablet 60 100 60 0 160
118 Rifampisin 450 mg tablet 0 0 0 0
OBAT LUAR
119 Aqudes Steril 500 ml btl 0 0 0 0
120 Alkohol 70 % 1000 ml Btl 4 10 1 1 10
121 Acyclovir Cream Tube 45 35 0 35
122 Anti Hemoroid Supp 46 30 11 19
123 Bacitracin-Polymyxin B Tube 200 200 25 175
124 Betametasone Krim Tube 100 0 0 0
125 Borax Gliserin sol Btl 0 0 0 0
126 Etil Klorida Spray Btl 100 ml 2 5 1 2 4
127 Fenol Gliserol Tts Telinga Btl 0 0 0 0
128 Formalin tab 1 Gram tablet 2 1000 2 2 1000
129 Gentamycin Salep Kulit Tube 100 100 75 25 50
130 Gentamycin Tetes Mata Steril 0,3 % botol 15 200 0 10 190
131 Gentian Violet Sol Btl 7 0 0 0
132 Gliserin Btl @ 10 ml 0 0 0 0
133 Hydrocortisone Cream 2,5% tube 96 168 0 72 144
134 Ichtyol Salep 10 gr Pot 0 0 0 0
135 Kalium Permanganat Pot 0 0 0 0
136 Kloramfenikol Salep Kulit (Farsycol) Tube @ 10 gr 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
137 Kloramfenikol Salep Mata 1 % Tube 0 0 0 0
138 Kloramfenikol tetes Mata btl 0 0 0 0
139 Kloramfenikol Tetes Telinga Btl 24 50 13 2 61
140 Lisol 1000 ml Btl 4 3 0 3
141 Mikonazole Krim Tube 0 0 0 0
142 Oksitetrasiklin Salep Kulit 3 % Tube 175 100 100 75 125
143 Oksitetrasiklin Salep Mata 1 % Tube 60 100 55 30 125
144 Rivanol 1 % 300 ml Btl 8 7 1 6
145 Salisil Bedak kotak 40 20 20 0
146 Salisilat Belerang Salep pot 41 31 31 0
147 Yodium Povidone Sol 1000 ml Btl 0 0 0 0
148 Yodium Povidone Sol 300 ml Btl 2 0 0 0
149 Yodium Povidon Sol 10 ml Btl 0 0 0 0
OBAT SUNTIK
150 Adidryl Injeksi vial 4 4 0 4
151 Adimidon Injeksi vial 12 12 0 12
152 Aqua Pro Inj amp 4 10 1 1 0
153 Aminofilin inj amp 30 30 0 30
154 Antalgin inj amp 0 0 0 0
155 Buscopan Injeksi amp 0 10 0 0 0
156 Cefotaxim inj amp 0 0 0 0
157 Cortison inj amp 0 0 0 0
158 Deksametasone Inj amp 85 200 50 20 230
159 Dextrose 5 % - Nacl 0,45 % kolf 0 0 0 0
160 Dextrose 5 % - Nacl 1/4 kolf 0 0 0 0
161 Dextrose 5 % kolf 41 38 2 36
162 Dextrose 10 % kolf 4 3 0 3
163 Difenhidramin Inj amp 15 15 3 12
164 Ephinephrin Injeksi amp 0 0 0 0
165 Ketorolac Injeksi amp 10 0 0 0 ED
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
166 Lidokain Inj amp 0 200 0 20 180
167 Lidokain comp amp 100 0 0 0
168 Metil ergometrin inj amp 5 5 5 0
169 Natrium Klorida Infus kolf 107 96 4 92
170 Natrium Tiosulfat Injeksi amp 0 0 0 0
171 Neurobion Injeksi amp 5 5 0 5
172 Oxytetracyclin Injeksi vial 0 0 0 0
173 Oxytocin Injeksi amp 0 0 0 0
174 Papaverin inj amp 19 0 0 0 ED
175 Ranitidine Injeksi amp 35 35 10 25
176 Ringer Laktat Infus kolf 138 126 14 112
177 Sabu 5 ml Injeksi vial 0 10 0 0 0
178 Streptomycin Injeksi vial 0 0 0 0
179 Vitamin B1 inj amp 0 0 0 0
180 Vitamin B 12 inj amp 123 0 0 8 ED
181 Vitamin K Injeksi Amp 29 24 1 23
182 Vitamin C Inj Amp 0 0 0 0
ALKES HABIS PAKAI
183 Abbocath No.18 Pcs 42 39 4 35
184 Abbocath No. 20 Pcs 190 180 10 170
185 Abbocath No. 22 Pcs 133 128 0 128
186 Abbocath No.24 Pcs 148 148 0 148
187 Alat Suntik 1 ml Pcs 152 1409 20 1389
188 Alat Suntik 2,5 ml Pcs 0 0 0 0
189 Alat Suntik 3 ml Pcs 702 1000 82 82 0
190 Alat Suntik 5 ml Pcs 575 575 118 457
191 Alat Suntik 10 ml Pcs 0 0 60 1022
192 Alat Suntik 20 ml Pcs 0 0 0 0
193 Blood Set Set 0 0 0 0
194 Cat/Gut 2/0 150 cm Pcs 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
195 Catgut Chromic No. 3/0 70 cm Pcs 120 120 0 120
196 Catgut Chromic No. 3/0 75 cm Pcs 14 14 0 14
197 Catgut Chromic No. 4/0 150 cm Pcs 0 0 0 0
198 Hand Schoen No 7 Pasang 20 15 15 0
199 Hand Schoen No 7,5 Pasang 100 0 0 0
200 Hand Schoen No 8 Pasang 0 0 0 0
201 Hypafix 5 cm Roll 0 0 0 0
202 Infus Set Anak Pcs 58 58 0 58
203 Infus Set Dewasa Pcs 86 76 10 66
204 Jarum Bedah Pcs 0 0 0 0
205 Kapas Pembalut 250 gram Bks 14 13 1 12
206 Kasa 2 y x 80 cm Roll 64 36 32 4
207 Kasa 5 cm x 80 cm Roll 0 0 0 0
208 Kasa Kompres 40 x40 Roll 110 105 0 105
209 Kasa Pemb 40 x 80 cm Roll 0 0 0 0
210 Kasa Steril 16 x 16 ktk/100 lbr 0 0 0 0
211 Kasa Hidrofil 4 x 15 cm Roll 150 150 0 150
212 Kasa Pembalut 4 x 3 cm Roll 0 0 0 0
213 Masker Box/50 Pcs 0 0 0 0
214 Nald Hecting Otot (Jarum Kulit) Set/12 pcs 0 0 0 0
215 Nald Hecting No. 9 pcs 12 12 0 12
216 Nald Hecting No 13 Pcs 0 0 0 0
217 Nald Hecting No 15 Pcs 0 0 0 0
218 NGT No. 3,5 (Feeding Tube) Set 0 0 0 0
219 NGT No. 16 (Feeding Tube) Set 0 0 0 0
220 Nald No. 23 Pcs 200 100 0 100
221 Nald No. 24 Pcs 1000 680 100 580
222 Scalvein No. 23 Pcs 0 0 0 0
223 Silk No. 3/0 150 cm Pcs 0 0 0 0
224 Silk Black No. 3/0 75 cm (35 mm) Pcs 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
225 Silk Black No. 3/0 75 cm (26 mm) Pcs 12 0 5 7
226 Plester 5 Yard x 2 Inch Roll 12 10 2 8
TAMBAHAN
227 Alkohol Swab ktk/100 paket 3 300 0 300
228 Pharmafix 2,5 cm x 5 mtr Roll 3 3 0 3
229 Pharmafix 5 cm x 5 mtr Roll 8 6 0 6
230 Pharmafix 10 cm x 5 mtr Roll 6 6 2 4
231 Indo Obat Flu tablet 0 0 0 0
232 Indo Obat Cacing (Mebendazole) tablet 0 0 0 0
233 Indo Obat Penurun Panas tablet 0 0 0 0
234 Ampicillin Injeksi (Vicillin) vial 110 110 0 110 dari KIA
235 Gentamycin Injeksi amp 140 140 0 140 dari KIA
236 Urine Bag Set 8 6 0 6
237 Elastic Verban 7,5 cm x 4,5 M Roll 3 2 0 2
238 Foley Catheter No.16 pcs 9 7 0 7
239 Foley Catheter No.18 pcs 8 6 0 6
240 Kanamycin 1 gr Injeksi vial 3 3 0 3
241 handscoen No.6 1/2 Pasang 50 50 28 28 0

Umum
ASKES Jumlah
Jumlah Kunjungan Resep Bayar Tidak Bayar

Yang Meminta Mengetahui/Menyetujui Yang Menyerahkan Yang Menerima

Pimpinan Puskesmas Kepala Dinkes II / GFK Petugas GFK Petugas Puskesmas

Dr. Herlina Barends (…………………………………………) (………………………………….) Hj. Badariah

 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
NIP. 19670726 199903 2 003 NIP. NIP. NIP. 19580612 197712 2 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : SEDADAP PELAPORAN BULAN : Mei 2011 NO./[Link]:

KECAMATAN : NUNUKAN SELATAN PERMINTAAN BULAN/PERIODE : GFK
KABUPATEN : NUNUKAN PUSK
DINKES

PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA PEMBERIAN KETERANG

NO NAMA OBAT SATUAN STOK AWAL
AN AAN AN STOK OPT AN
JUMLAH
AN
INPRES ASKES APBD I APBD II LAIN2
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet 0 0 0 ED
2 Ambeven tablet 0 0 0 0
3 Albendazole tablet 90 30 0 30
4 Allopurinol 100 mg tablet 600 2100 200 1900
5 Ambroksol 30 mg tablet 0 1300 300 1000
6 Amoxicillin 250 mg tablet 1440 2840 600 2240
7 Amoxicillin 500 mg tablet 17600 41800 3600 38200
8 Ampisilin 500 mg tablet 1400 1200 700 500
9 Antalgin 500 mg tablet 3000 8000 2000 6000
10 Antasida DOEN tablet 1600 0 0 0
11 Asam Folat tablet 0 0 0 0
12 Asam Mefenamat 500 mg tablet 8600 24100 2500 21600
13 Atropin Sulfat 0,5 mg tablet 500 500 0 500
14 Acyclovir 200 mg tablet 100 1100 0 1100
15 Acyclovir 400 mg tablet 400 400 0 400
16 Besi sulfat tablet 4800 6000 1800 4200
17 Bisacodyl (Laxana) tablet 0 0 0 0
18 Buscopan tablet 0 0 0 0
19 Captopril 25 mg tablet 2200 1000 500 500
20 Captopril 12,5 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
21 Cefadroxil 500 mg tablet 0 0 0 0
22 Chloramphenicol 250 mg tablet 1000 500 0 500 ED
23 Chloroquin 250 mg tablet 0 0 0
24 Cimetidine 200 mg tablet 0 0 0 0
25 Ciprofloxacin 500 mg tablet 1800 2400 50 2350
26 CTM 4 mg tablet 14000 22000 4000 18000
27 Deksametasone 0,5 mg tablet 7000 19000 6000 13000
28 Dekstrometorfan 15 mg tablet 4000 5000 0 5000
29 Digoksin 0,25 mg tablet 0 0 0 0
30 Dimenhidrinat 50 mg tablet 600 600 0 600
31 Domperidone 10 mg tablet 1400 800 200 600
32 Efedrin 25 mg tablet 4000 12000 1000 11000
33 Ergotamine Kafein tablet 100 0 0 0 ED
34 Erythromycin 250 mg tablet 1080 460 120 340
35 Erythromycin 500 mg tablet 0 2000 300 1700
36 Famotidine 20 mg tablet 1300 800 700 100
37 Furosemide 40 mg tablet 200 1200 0 1200
38 Glibenklamide 5 mg tablet 1400 1100 100 1000
39 Gliseril Guayakolat 100 mg tablet 6000 22000 1000 21000
40 Griseofulvin 125 mg tablet 1200 1000 0 1000
41 H C T 25 mg tablet 1000 3000 0 3000
42 Ibuprofen 200 mg tablet 200 1900 600 1300
43 Ibuprofen 400 mg tablet 900 3800 300 3500
44 Isosorbit Dinitrat 5 mg tablet 500 500 0 500
45 Kalnex 500 mg tablet 0 0 0 0
46 Kalsium Laktat 500 mg tablet 11000 19000 19000 0
47 Ketokonazole 200 mg tablet 500 1450 1450 0
48 Komp Pirimetamin Sulfadoksin tablet 88 80 0 80
49 Kotrimoksazol 120 mg tablet 1100 2100 100 2000
50 Kotrimoksazol 480 mg tablet 4300 3600 800 2800
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
51 Loperamid HCL 2 mg (Novadium) tablet 200 500 700 300 400
52 Mebendazol tablet 0 0 0 0
53 Methylergometrin 0,125 mg tablet 400 400 0 400
54 Metoklopramide 10 mg tablet 0 0 0 0
55 Metronidazol 500 mg tablet 400 300 0 300
56 Metronidazol 250 mg tablet 200 1100 200 900
57 Multivitamin (Wishen) kaplet 0 0 0 0
58 New Diatabs tablet 0 0 0 0
59 Nifedipin 10 mg tablet 500 1000 0 1000
60 Nystatin 500.000 IU tablet 90 70 0 70
61 Oralit 200 ml sachet 2600 3050 0 3050
62 Papaverin 40 mg tablet 0 0 0 0
63 Parasetamol 100 mg tablet 0 0
64 Parasetamol 500 mg tablet 11000 34000 3000 31000
65 Parasetamol tab tablet 0 0 0 0
66 Phenitoin 30 mg tablet 250 250 0 250
67 Phenylbutazone 200 mg tablet 0 0 0 0
68 Pirantel Pamoat 125 mg tablet 0 0 0 0
69 Piroksikam 10 mg tablet 1000 1600 120 1480
70 Piroksikam 20 mg tablet 600 1900 120 1780
71 Prednison 5 mg tablet 7000 16000 3000 13000
72 Propanolol 10 mg tablet 0 0 0 0
73 Propanolol 40 mg tablet 100 100 0 100
74 PTU 100 mg tablet 100 100 0 100
75 Ranitidine 150 mg tablet 1200 2000 2000 200 1800
76 Reserpin 0,10 mg tablet 750 2750 250 2500
77 Reserpin 0,25 mg tablet 200 8000 0 8000
78 Salbutamol 2 mg tablet 500 300 0 300
79 Salbutamol 4 mg tablet 0 0 0 0
80 Sulfadimidin 500 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
81 Tetrasiklin 250 mg kapsul 1000 4000 1000 3000
82 Tetrasiklin 500 mg tablet 0 0 0 0
83 Thiamphenicol 500 mg tablet 0 0 0 0
84 Vitamin B Kompleks tablet 6000 10000 3000 7000
85 Vitamin B6 10 mg tablet 11000 24000 1000 23000
86 Vitamin B1 50 mg tablet 14000 30000 3000 27000
87 Vitamin B12 tablet 5000 10000 1000 9000
88 Vitamin C 50 mg tablet 12000 15000 3000 12000
89 Vitamin K 10 mg tablet 500 400 0 400
OBAT JENIS SIRUP 0
90 Ambroksol sirup btl 75 25 25 0
91 Amoxicillin SK 125 mg/ 5 ml btl @ 60 ml 98 0 0 0
92 Amoxicillin SK 250 mg/ 5 ml btl @ 60 ml 46 0 0 0
93 Ampisilin Sirup Kering btl 0 0 0 0
94 Antasida suspensi btl 47 0 0 0
95 Besi Sulfat Syrup btl 0 0 0 0
96 Cefadroxil Syrup Kering btl 0 0 0 0
97 Chloramphenicol Syrup btl 0 0 0 0
98 Dekstrometorfan sirup btl 60 ml 77 70 3 67
99 Ibuprofen Syrup Botol 14 0 0 0
100 Kotrimoksazol suspensi btl 60 ml 435 330 35 295
101 Multivitamin Syrup (Pediagrow) btl 0 0 0 0
102 OBH Sirup btl 71 25 25 0
103 Parasetamol Sirup btl 60 ml 116 0 0 0
OBAT NAPZA
104 Diazepam 2 mg tablet 2290 982 160 822 ED
105 Diazepam 5 mg tablet 0 0 0 0
106 Diazepam Inj amp 0 0 0 0
107 Fenobarbital 30 mg tablet 468.5 0 0 0
108 Fenobarbital Injeksi amp 0 462,5 4 458,5
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
109 Fenitoin inj amp 0 0 0 0
110 Haloperidol 5 mg tablet 0 0 0 0
111 Klorpromazin 100 mg tablet 0 0 0 0
112 Klorpromazin 25 mg tablet 900 0 0 0
113 Kodein 10 mg tablet 0 0 0 0
OBAT TB PARU
114 Ethambutol 250 mg tablet 0 0 0 0
115 I N H 100 mg tablet 0 0 0 0
116 I N H 300 mg tablet 1000 2000 0 2000
117 Pirazinamid 500 mg tablet 60 160 0 160
118 Rifampisin 450 mg tablet 0 0 0 0
OBAT LUAR
119 Aqudes Steril 500 ml btl 0 0 0 0
120 Alkohol 70 % 1000 ml Btl 4 10 1 7
121 Acyclovir Cream Tube 45 35 10 25
122 Anti Hemoroid Supp 46 19 10 59
123 Bacitracin-Polymyxin B Tube 200 175 0 175
124 Betametasone Krim Tube 100 0 0 0
125 Borax Gliserin sol Btl 0 0 0 0
126 Etil Klorida Spray Btl 100 ml 2 4 2 3
127 Fenol Gliserol Tts Telinga Btl 0 0 0 0
128 Formalin tab 1 Gram tablet 2 1000 2 1000
129 Gentamycin Salep Kulit Tube 100 50 50 100
130 Gentamycin Tetes Mata Steril 0,3 % botol 15 190 10 180
131 Gentian Violet Sol Btl 7 0 0 0
132 Gliserin Btl @ 10 ml 0 0 0 0
133 Hydrocortisone Cream 2,5% tube 96 144 72 24
134 Ichtyol Salep 10 gr Pot 0 0 0 0
135 Kalium Permanganat Pot 0 0 0 0
136 Kloramfenikol Salep Kulit (Farsycol) Tube @ 10 gr 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
137 Kloramfenikol Salep Mata 1 % Tube 0 0 0 0
138 Kloramfenikol tetes Mata btl 0 0 0 0
139 Kloramfenikol Tetes Telinga Btl 24 61 2 61
140 Lisol 1000 ml Btl 4 3 0 3
141 Mikonazole Krim Tube 0 0 0 0
142 Oksitetrasiklin Salep Kulit 3 % Tube 175 125 75 100
143 Oksitetrasiklin Salep Mata 1 % Tube 60 125 30 0
144 Rivanol 1 % 300 ml Btl 8 6 0 6
145 Salisil Bedak kotak 40 0 0 0
146 Salisilat Belerang Salep pot 41 0 0 0
147 Yodium Povidone Sol 1000 ml Btl 0 0 0 0
148 Yodium Povidone Sol 300 ml Btl 2 0 0 0
149 Yodium Povidon Sol 10 ml Btl 0 0 0 0
OBAT SUNTIK
150 Adidryl Injeksi vial 4 4 0 4
151 Adimidon Injeksi vial 12 12 0 12
152 Aqua Pro Inj amp 4 0 0 0
153 Aminofilin inj amp 30 30 0 30
154 Antalgin inj amp 0 0 0 0
155 Buscopan Injeksi amp 0 0 0 0
156 Cefotaxim inj amp 0 0 0 0
157 Cortison inj amp 0 0 0 0
158 Deksametasone Inj amp 85 230 30 200
159 Dextrose 5 % - Nacl 0,45 % kolf 0 0 0 0
160 Dextrose 5 % - Nacl 1/4 kolf 0 0 0 0
161 Dextrose 5 % kolf 41 36 0 36
162 Dextrose 10 % kolf 4 3 0 3
163 Difenhidramin Inj amp 15 12 0 12
164 Ephinephrin Injeksi amp 0 0 0 0
165 Ketorolac Injeksi amp 10 0 0 0 ED
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
166 Lidokain Inj amp 0 180 40 140
167 Lidokain comp amp 100 0 0 0
168 Metil ergometrin inj amp 5 0 0 0
169 Natrium Klorida Infus kolf 107 92 6 86
170 Natrium Tiosulfat Injeksi amp 0 0 0 0
171 Neurobion Injeksi amp 5 5 5 0
172 Oxytetracyclin Injeksi vial 0 0 0 0
173 Oxytocin Injeksi amp 0 0 0 0
174 Papaverin inj amp 19 0 0 0 ED
175 Ranitidine Injeksi amp 35 25 0 25
176 Ringer Laktat Infus kolf 138 112 18 94
177 Sabu 5 ml Injeksi vial 0 0 0 0
178 Streptomycin Injeksi vial 0 0 0 0
179 Vitamin B1 inj amp 0 0 0 0
180 Vitamin B 12 inj amp 123 8 0 0 ED
181 Vitamin K Injeksi Amp 29 23 15 8
182 Vitamin C Inj Amp 0 0 0 0
ALKES HABIS PAKAI
183 Abbocath No.18 Pcs 42 35 0 35
184 Abbocath No. 20 Pcs 190 170 15 155
185 Abbocath No. 22 Pcs 133 128 5 123
186 Abbocath No.24 Pcs 148 148 5 143
187 Alat Suntik 1 ml Pcs 152 1389 0 1389
188 Alat Suntik 2,5 ml Pcs 0 0 0 0
189 Alat Suntik 3 ml Pcs 702 0 322 700
190 Alat Suntik 5 ml Pcs 575 457 57 400
191 Alat Suntik 10 ml Pcs 0 1022 60 0
192 Alat Suntik 20 ml Pcs 0 0 0 0
193 Blood Set Set 0 0 0 0
194 Cat/Gut 2/0 150 cm Pcs 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
195 Catgut Chromic No. 3/0 70 cm Pcs 120 120 0 120
196 Catgut Chromic No. 3/0 75 cm Pcs 14 14 0 14
197 Catgut Chromic No. 4/0 150 cm Pcs 0 0 0 0
198 Hand Schoen No 7 Pasang 20 0 0 0
199 Hand Schoen No 7,5 Pasang 100 0 0 0
200 Hand Schoen No 8 Pasang 0 0 0 0
201 Hypafix 5 cm Roll 0 0 0 0
202 Infus Set Anak Pcs 58 58 2 56
203 Infus Set Dewasa Pcs 86 66 10 56
204 Jarum Bedah Pcs 0 0 0 0
205 Kapas Pembalut 250 gram Bks 14 12 1 11
206 Kasa 2 y x 80 cm Roll 64 4 0 4
207 Kasa 5 cm x 80 cm Roll 0 0 0 0
208 Kasa Kompres 40 x40 Roll 110 105 0 105
209 Kasa Pemb 40 x 80 cm Roll 0 0 0 0
210 Kasa Steril 16 x 16 ktk/100 lbr 0 0 0 0
211 Kasa Hidrofil 4 x 15 cm Roll 150 150 33 117
212 Kasa Pembalut 4 x 3 cm Roll 0 0 0 0
213 Masker Box/50 Pcs 0 0 0 0
214 Nald Hecting Otot (Jarum Kulit) Set/12 pcs 0 0 0 0
215 Nald Hecting No. 9 pcs 12 12 0 12
216 Nald Hecting No 13 Pcs 0 0 0 0
217 Nald Hecting No 15 Pcs 0 0 0 0
218 NGT No. 3,5 (Feeding Tube) Set 0 0 0 0
219 NGT No. 16 (Feeding Tube) Set 0 0 0 0
220 Nald No. 23 Pcs 200 100 100 0
221 Nald No. 24 Pcs 1000 580 180 400
222 Scalvein No. 23 Pcs 0 0 0 0
223 Silk No. 3/0 150 cm Pcs 0 0 0 0
224 Silk Black No. 3/0 75 cm (35 mm) Pcs 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
225 Silk Black No. 3/0 75 cm (26 mm) Pcs 12 7 5 2
226 Plester 5 Yard x 2 Inch Roll 12 8 0 8
TAMBAHAN
227 Alkohol Swab ktk/100 paket 3 300 0 300
228 Pharmafix 2,5 cm x 5 mtr Roll 3 3 0 3
229 Pharmafix 5 cm x 5 mtr Roll 8 6 0 6
230 Pharmafix 10 cm x 5 mtr Roll 6 4 1 3
231 Indo Obat Flu tablet 0 0 0 0
232 Indo Obat Cacing (Mebendazole) tablet 0 0 0 0
233 Indo Obat Penurun Panas tablet 0 0 0 0
234 Ampicillin Injeksi (Vicillin) vial 110 110 0 110 dari KIA
235 Gentamycin Injeksi amp 140 140 0 140 dari KIA
236 Urine Bag Set 8 6 0 6
237 Elastic Verban 7,5 cm x 4,5 M Roll 3 2 0 2
238 Foley Catheter No.16 pcs 9 7 0 7
239 Foley Catheter No.18 pcs 8 6 0 6
240 Kanamycin 1 gr Injeksi vial 3 3 3 0
241 handscoen No.6 1/2 Pasang 50 0 0 0

Umum
ASKES Jumlah
Jumlah Kunjungan Resep Bayar Tidak Bayar

0 0 0 0

Yang Meminta Mengetahui/Menyetujui Yang Menyerahkan Yang Menerima

Pimpinan Puskesmas Kepala Dinkes II / GFK Petugas GFK Petugas Puskesmas

Dr. Herlina Barends (…………………………………………) (………………………………….) Hj. Badariah

 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
NIP. 19670726 199903 2 003 NIP. NIP. NIP. 19580612 197712 2 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : SEDADAP PELAPORAN BULAN : Juni 2011 NO./[Link]:

KECAMATAN : NUNUKAN SELATAN PERMINTAAN BULAN/PERIODE : GFK
KABUPATEN : NUNUKAN PUSK
DINKES

PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA PEMBERIAN KETERANG

NO NAMA OBAT SATUAN STOK AWAL
AN AAN AN STOK OPT AN
JUMLAH
AN
INPRES ASKES APBD I APBD II LAIN2
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet 0 0 0 0
2 Ambeven tablet 0 0 0 0
3 Albendazole tablet 30 30 30 0
4 Allopurinol 100 mg tablet 1900 1900 100 1800
5 Ambroksol 30 mg tablet 1000 1000 700 300
6 Amoxicillin 250 mg tablet 2240 2240 720 1520
7 Amoxicillin 500 mg tablet 38200 38200 3400 34800
8 Ampisilin 500 mg tablet 500 500 200 300
9 Antalgin 500 mg tablet 6000 6000 0 6000
10 Antasida DOEN tablet 0 0 0 0
11 Asam Folat tablet 0 0 0 0
12 Asam Mefenamat 500 mg tablet 21600 21600 3400 18200
13 Atropin Sulfat 0,5 mg tablet 500 500 0 500
14 Acyclovir 200 mg tablet 1100 1100 0 1100
15 Acyclovir 400 mg tablet 400 400 100 300
16 Besi sulfat tablet 4200 4200 1200 3000
17 Bisacodyl (Laxana) tablet 0 0 0 0
18 Buscopan tablet 0 0 0 0
19 Captopril 25 mg tablet 500 500 200 300
20 Captopril 12,5 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
21 Cefadroxil 500 mg tablet 0 100 100 0 100
22 Chloramphenicol 250 mg tablet 500 500 250 250
23 Chloroquin 250 mg tablet 0 0 0 0
24 Cimetidine 200 mg tablet 0 0 0 0
25 Ciprofloxacin 500 mg tablet 2350 2350 50 2300
26 CTM 4 mg tablet 18000 18000 4000 14000
27 Deksametasone 0,5 mg tablet 13000 13000 4000 9000
28 Dekstrometorfan 15 mg tablet 5000 1000 6000 0 6000
29 Digoksin 0,25 mg tablet 0 0 0 0
30 Dimenhidrinat 50 mg tablet 600 600 0 600
31 Domperidone 10 mg tablet 600 600 200 400
32 Efedrin 25 mg tablet 11000 11000 0 11000
33 Ergotamine Kafein tablet 0 0 0 0
34 Erythromycin 250 mg tablet 340 340 0 340
35 Erythromycin 500 mg tablet 1700 1700 200 1500
36 Famotidine 20 mg tablet 100 100 100 0
37 Furosemide 40 mg tablet 1200 1200 0 1200
38 Glibenklamide 5 mg tablet 1000 1000 100 900
39 Gliseril Guayakolat 100 mg tablet 21000 21000 3000 18000
40 Griseofulvin 125 mg tablet 1000 1000 0 1000
41 H C T 25 mg tablet 3000 3000 0 3000
42 Ibuprofen 200 mg tablet 1300 1300 300 1000
43 Ibuprofen 400 mg tablet 3500 3500 0 3500
44 Isosorbit Dinitrat 5 mg tablet 500 100 600 0 600
45 Kalnex 500 mg tablet 0 0 0 0
46 Kalsium Laktat 500 mg tablet 0 20000 20000 2000 18000
47 Ketokonazole 200 mg tablet 0 1500 1500 100 1400
48 Komp Pirimetamin Sulfadoksin tablet 80 80 0 80
49 Kotrimoksazol 120 mg tablet 2000 2000 0 2000
50 Kotrimoksazol 480 mg tablet 2800 100 2900 1000 1900
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
51 Loperamid HCL 2 mg (Novadium) tablet 400 400 200 200
52 Mebendazol tablet 0 0 0 0
53 Methylergometrin 0,125 mg tablet 400 400 0 400
54 Metoklopramide 10 mg tablet 0 100 100 0 100
55 Metronidazol 500 mg tablet 300 300 100 200
56 Metronidazol 250 mg tablet 900 900 0 900
57 Multivitamin (Wishen) kaplet 0 0 0 0
58 Natrium diklofenak 50 mg tablet 0 500 500 500 0
59 Nifedipin 10 mg tablet 1000 1000 0 1000
60 Nystatin 500.000 IU tablet 70 70 0 70
61 Oralit 200 ml sachet 3050 3050 150 2900
62 Papaverin 40 mg tablet 0 0 0 0
63 Parasetamol 100 mg tablet 0 0 0 0
64 Parasetamol 500 mg tablet 31000 31000 1000 30000
65 Parasetamol tab tablet 0 0 0 0
66 Phenitoin 30 mg tablet 250 250 0 250
67 Phenylbutazone 200 mg tablet 0 0 0 0
68 Pirantel Pamoat 125 mg tablet 0 0 0 0
69 Piroksikam 10 mg tablet 1480 1480 120 1360
70 Piroksikam 20 mg tablet 1780 1780 0 1780
71 Prednison 5 mg tablet 13000 13000 1000 12000
72 Propanolol 10 mg tablet 0 0 0 0
73 Propanolol 40 mg tablet 100 100 100 0
74 PTU 100 mg tablet 100 100 100 0
75 Ranitidine 150 mg tablet 1800 1800 1000 800
76 Reserpin 0,10 mg tablet 2500 2500 250 2250
77 Reserpin 0,25 mg tablet 8000 1000 9000 0 9000
78 Salbutamol 2 mg tablet 300 300 0 300
79 Salbutamol 4 mg tablet 0 0 0 0
80 Sulfadimidin 500 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
81 Tetrasiklin 250 mg kapsul 3000 3000 0 3000
82 Tetrasiklin 500 mg tablet 0 0 0 0
83 Zinc 20 Mg tablet 0 100 100 0 100
84 Vitamin B Kompleks tablet 7000 7000 3000 4000
85 Vitamin B6 10 mg tablet 23000 23000 1000 22000
86 Vitamin B1 50 mg tablet 27000 27000 1000 26000
87 Vitamin B12 tablet 9000 9000 1000 8000
88 Vitamin C 50 mg tablet 12000 12000 3000 9000
89 Vitamin K 10 mg tablet 400 400 100 300
OBAT JENIS SIRUP
90 Ambroksol sirup btl 0 0 0 0
91 Amoxicillin SK 125 mg/ 5 ml btl @ 60 ml 0 0 0 0
92 Amoxicillin SK 250 mg/ 5 ml btl @ 60 ml 0 0 0 0
93 Ampisilin Sirup Kering btl 0 0 0 0
94 Antasida suspensi btl 0 0 0 0
95 Besi Sulfat Syrup btl 0 0 0 0
96 Cefadroxil Syrup Kering btl 0 0 0 0
97 Chloramphenicol Syrup btl 0 0 0 0
98 Dekstrometorfan sirup btl 60 ml 67 67 5 62
99 Ibuprofen Syrup Botol 0 0 0 0
100 Kotrimoksazol suspensi btl 60 ml 295 295 25 270
101 Multivitamin Syrup (Pediagrow) btl 0 0 0 0
102 OBH Sirup btl 0 0 0 0
103 Parasetamol Sirup btl 60 ml 0 0 0 0
OBAT NAPZA
104 Diazepam 2 mg tablet 822 822 25 797
105 Diazepam 5 mg tablet 0 0 0 0
106 Diazepam Inj amp 0 0 0 0
107 Fenobarbital 30 mg tablet 0 500 500 49.5 450.5
108 Fenobarbital Injeksi amp 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
109 Fenitoin inj amp 0 0 0 0
110 Haloperidol 5 mg tablet 0 0 0 0
111 Klorpromazin 100 mg tablet 0 0 0 0
112 Klorpromazin 25 mg tablet 0 0 0 0
113 Kodein 10 mg tablet 0 0 0 0
OBAT TB PARU
114 Ethambutol 250 mg tablet 0 0 0 0
115 I N H 100 mg tablet 0 0 0 0
116 I N H 300 mg tablet 2000 2000 2000 0
117 Pirazinamid 500 mg tablet 160 160 0 160
118 Rifampisin 450 mg tablet 0 0 0 0
OBAT LUAR
119 Aqudes Steril 500 ml btl 0 0 0 0
120 Alkohol 70 % 1000 ml Btl 7 1 8 0 8
121 Acyclovir Cream Tube 25 25 0 25
122 Anti Hemoroid Supp 59 59 3 56
123 Bacitracin-Polymyxin B Tube 175 175 50 125
124 Betametasone Krim Tube 0 0 0 0
125 Borax Gliserin sol Btl 0 0 0 0
126 Etil Klorida Spray Btl 100 ml 3 3 0 3
127 Fenol Gliserol Tts Telinga Btl 0 0 0 0
128 Formalin tab 1 Gram tablet 1000 1000 0 1000
129 Gentamycin Salep Kulit Tube 100 100 100 0
130 Gentamycin Tetes Mata Steril 0,3 % botol 180 180 10 170
131 Gentian Violet Sol Btl 0 0 0 0
132 Gliserin Btl @ 10 ml 0 0 0 0
133 Hydrocortisone Cream 2,5% tube 24 24 24 0
134 Ichtyol Salep 10 gr Pot 0 0 0 0
135 Kalium Permanganat Pot 0 0 0 0
136 Kloramfenikol Salep Kulit (Farsycol) Tube @ 10 gr 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
137 Kloramfenikol Salep Mata 1 % Tube 0 0 0 0
138 Kloramfenikol tetes Mata btl 0 0 0 0
139 Kloramfenikol Tetes Telinga Btl 61 61 27 34
140 Lisol 1000 ml Btl 3 3 0 3
141 Mikonazole Krim Tube 0 0 0 0
142 Oksitetrasiklin Salep Kulit 3 % Tube 100 100 100 0
143 Oksitetrasiklin Salep Mata 1 % Tube 0 125 125 25 100
144 Rivanol 1 % 300 ml Btl 6 6 2 4
145 Salisil Bedak kotak 0 0 0 0
146 Salisilat Belerang Salep pot 0 0 0 0
147 Yodium Povidone Sol 1000 ml Btl 0 0 0 0
148 Yodium Povidone Sol 300 ml Btl 0 0 0 0
149 Yodium Povidon Sol 10 ml Btl 0 0 0 0
OBAT SUNTIK
150 Adidryl Injeksi vial 4 4 1 3
151 Adimidon Injeksi vial 12 12 1 11
152 Aqua Pro Inj amp 0 0 0 0
153 Aminofilin inj amp 30 4 34 0 34
154 Antalgin inj amp 0 0 0 0
155 Buscopan Injeksi amp 0 10 10 5 5
156 Cefotaxim inj amp 0 0 0 0
157 Cortison inj amp 0 0 0 0
158 Deksametasone Inj amp 200 10 210 15 195
159 Dextrose 5 % - Nacl 0,45 % kolf 0 0 0 0
160 Dextrose 5 % - Nacl 1/4 kolf 0 0 0 0
161 Dextrose 5 % kolf 36 10 46 3 43
162 Dextrose 10 % kolf 3 3 0 3
163 Difenhidramin Inj amp 12 12 0 12
164 Ephinephrin Injeksi amp 0 0 0 0
165 Ketorolac Injeksi amp 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
166 Lidokain Inj amp 0 0 0 0
167 Lidokain comp amp 140 140 60 80
168 Metil ergometrin inj amp 0 0 0 0
169 Natrium Klorida Infus kolf 86 10 96 0 96
170 Natrium Tiosulfat Injeksi amp 0 0 0 0
171 Neurobion Injeksi amp 0 0 0 0
172 Oxytetracyclin Injeksi vial 0 0 0 0
173 Oxytocin Injeksi amp 0 0 0 0
174 Papaverin inj amp 0 0 0 0
175 Ranitidine Injeksi amp 25 1 26 5 21
176 Ringer Laktat Infus kolf 94 94 5 89
177 Sabu 5 ml Injeksi vial 0 0 0 0
178 yodium povidon 30 ml vial 0 2 2 0 2
179 Vitamin B1 inj amp 0 0 0 0
180 Vitamin B 12 inj amp 0 0 0 0
181 Vitamin K Injeksi Amp 8 8 0 8
182 Vitamin C Inj Amp 0 0 0 0
ALKES HABIS PAKAI
183 Abbocath No.18 Pcs 35 35 0 35
184 Abbocath No. 20 Pcs 155 155 0 155
185 Abbocath No. 22 Pcs 123 123 123 0
186 Abbocath No.24 Pcs 143 143 0 143
187 Alat Suntik 1 ml Pcs 1389 1389 0 1389
188 Alat Suntik 2,5 ml Pcs 0 0 0 0
189 Alat Suntik 3 ml Pcs 700 700 70 630
190 Alat Suntik 5 ml Pcs 400 400 0 400
191 Alat Suntik 10 ml Pcs 0 0 0 0
192 Alat Suntik 20 ml Pcs 0 0 0 0
193 Blood Set Set 0 0 0 0
194 catgut plain 3/0 70 cm Pcs 0 4 4 4 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
195 Catgut Chromic No. 3/0 70 cm Pcs 120 120 0 120
196 Catgut Chromic No. 3/0 75 cm Pcs 14 14 2 12
197 Catgut Chromic No. 4/0 150 cm Pcs 0 0 0 0
198 Hand Schoen No 7 Pasang 0 0 0 0
199 Hand Schoen No 7,5 Pasang 0 0 0 0
200 Hand Schoen No 8 Pasang 0 0 0 0
201 Hypafix 5 cm Roll 0 0 0 0
202 Infus Set Anak Pcs 56 56 5 51
203 Infus Set Dewasa Pcs 56 56 5 51
204 Jarum Bedah Pcs 0 0 0 0
205 Kapas Pembalut 250 gram Bks 11 1 12 0 12
206 Kasa 2 y x 80 cm Roll 4 4 1 3
207 Kasa 5 cm x 80 cm Roll 0 0 0 0
208 Kasa Kompres 40 x40 Roll 105 105 0 105
209 Kasa Pemb 40 x 80 cm Roll 0 0 0 0
210 Kasa Steril 16 x 16 ktk/100 lbr 0 0 0 0
211 Kasa Hidrofil 4 x 15 cm Roll 117 117 5 112
212 Kasa Pembalut 4 x 3 cm Roll 0 10 10 2 8
213 Masker Box/50 Pcs 0 0 0 0
214 Nald Hecting Otot (Jarum Kulit) Set/12 pcs 0 0 0 0
215 Nald Hecting No. 9 pcs 12 12 0 12
216 Nald Hecting No 13 Pcs 0 0 0 0
217 Nald Hecting No 11 Pcs 0 48 48 12 36
218 Nald hacting no 7 Set 0 12 12 0 12
219 NGT No. 16 (Feeding Tube) Set 0 0 0 0
220 Nald No. 23 Pcs 0 50 50 0 50
221 Nald No. 24 Pcs 400 400 400 0
222 Scalvein No. 23 Pcs 0 0 0 0
223 Silk No. 3/0 150 cm Pcs 0 0 0 0
224 Silk Black No. 3/0 75 cm (35 mm) Pcs 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
225 Silk Black No. 3/0 75 cm (26 mm) Pcs 2 2 2 0
226 Plester 5 Yard x 2 Inch Roll 8 8 0 8
TAMBAHAN
227 Alkohol Swab ktk/100 paket 300 300 300 0 ED
228 Pharmafix 2,5 cm x 5 mtr Roll 3 3 0 3
229 Pharmafix 5 cm x 5 mtr Roll 6 6 0 6
230 Pharmafix 10 cm x 5 mtr Roll 3 3 0 3
231 Indo Obat Flu tablet 0 0 0 0
232 Indo Obat Cacing (Mebendazole) tablet 0 0 0 0
233 Indo Obat Penurun Panas tablet 0 0 0 0
234 Ampicillin Injeksi (Vicillin) vial 110 110 0 110 dari KIA
235 Gentamycin Injeksi amp 140 140 0 140 dari KIA
236 Urine Bag Set 6 6 0 6
237 Elastic Verban 7,5 cm x 4,5 M Roll 2 2 0 2
238 Foley Catheter No.16 pcs 7 7 0 7
239 Foley Catheter No.18 pcs 6 6 0 6
240 Kanamycin 1 gr Injeksi vial 0 0 0 0
241 handscoen No.6 1/2 Pasang 0 0 0 0

Umum
ASKES Jumlah
Jumlah Kunjungan Resep Bayar Tidak Bayar

313 725 153 1191

Yang Meminta Mengetahui/Menyetujui Yang Menyerahkan Yang Menerima

Pimpinan Puskesmas Kepala Dinkes II / GFK Petugas GFK Petugas Puskesmas

Dr. Herlina Barends (…………………………………………) (………………………………….) Hj. Badariah

 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
NIP. 19670726 199903 2 003 NIP. NIP. NIP. 19580612 197712 2 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : SEDADAP PELAPORAN BULAN : Juli 2012 NO./[Link]:

KECAMATAN : NUNUKAN SELATAN PERMINTAAN BULAN/PERIODE : GFK
KABUPATEN : NUNUKAN PUSK
DINKES

PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA PEMBERIAN KETERANG

NO NAMA OBAT SATUAN STOK AWAL
AN AAN AN STOK OPT AN
JUMLAH
AN
INPRES ASKES APBD I APBD II LAIN2
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet 0 0 0 0
2 Amlodipin 5 mg tablet 480 480 120 360
3 Albendazole tablet 570 570 30 540
4 Allopurinol 100 mg tablet 900 900 300 600
5 Ambroksol 30 mg tablet 3300 3300 1300 2000
6 Amoxicillin 250 mg tablet 2400 2400 1320 1080
7 Amoxicillin 500 mg tablet 2900 10000 12900 5600 7300
8 Ampisilin 500 mg tablet 800 800 700 100
9 Antalgin 500 mg tablet 6000 6000 3000 3000
10 Antasida DOEN tablet 5000 5000 4000 1000
11 Asam Folat tablet 0 0 0 0
12 Asam Mefenamat 500 mg tablet 0 4500 4500 2600 1900
13 Atropin Sulfat 0,5 mg tablet 0 0 0 0
14 Acyclovir 200 mg tablet 0 1500 1500 150 1350
15 Acyclovir 400 mg tablet 0 1500 1500 100 1400
16 Besi sulfat tablet 3000 3000 1800 1200
17 Bisacodyl (Laxana) tablet 0 0 0 0
18 Buscopan tablet 0 0 0 0
19 Captopril 25 mg tablet 2600 2600 1000 1600
20 Captopril 12,5 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
21 Cefadroxil 500 mg tablet 2700 2700 650 2050
22 Chloramphenicol 250 mg tablet 750 750 0 750
23 Chloroquin 250 mg tablet 0 0 0 0
24 Cimetidine 200 mg tablet 0 0 0 0
25 Ciprofloxacin 500 mg tablet 0 0 0 0
26 CTM 4 mg tablet 11000 11000 10000 1000
27 Deksametasone 0,5 mg tablet 9600 9600 9200 400
28 Dekstrometorfan 15 mg tablet 2000 2000 0 2000
29 Digoksin 0,25 mg tablet 0 0 0 0
30 Dimenhidrinat 50 mg tablet 400 400 0 400
31 Domperidone 10 mg tablet 0 1500 1500 400 1100
32 Ergotamine Kafein tablet 0 0 0 0
33 Erythromycin 250 mg tablet 0 2400 2400 120 2280
34 Erythromycin 500 mg tablet 0 0 0 0
35 Famotidine 20 mg tablet 0 0 0 0
36 Furosemide 40 mg tablet 1000 1000 0 1000
37 Glibenklamide 5 mg tablet 300 300 300 0
38 Gliseril Guayakolat 100 mg tablet 9000 9000 5000 4000
39 Griseofulvin 125 mg tablet 1000 1000 400 600
40 H C T 25 mg tablet 1000 1000 0 1000
41 Ibuprofen 200 mg tablet 0 0 0 0
42 Ibuprofen 400 mg tablet 400 400 400 0
43 Isosorbit Dinitrat 5 mg tablet 400 400 0 400
44 Kalnex 500 mg tablet 0 0 0 0
45 Kalsium Laktat 500 mg tablet 12000 12000 2000 10000
46 Ketokonazole 200 mg tablet 250 250 100 150
47 Komp Pirimetamin Sulfadoksin tablet 0 0 0 0
48 Kotrimoksazol 120 mg tablet 1200 1200 400 800
49 Kotrimoksazol 480 mg tablet 0 1000 1000 1000 0
50 Loperamid HCL 2 mg (Novadium) tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
51 Mebendazol tablet 0 0 0 0
52 Methylergometrin 0,125 mg tablet 300 300 0 300
53 Metoklopramide 10 mg tablet 0 0 0 0
54 Metronidazol 500 mg tablet 500 500 200 300
55 Metronidazol 250 mg tablet 100 100 100 0
56 Multivitamin (Wishen) kaplet 0 0 0 0
57 Natrium diklofenak 50 mg tablet 1600 1600 550 1050
58 Nifedipin 10 mg tablet 900 900 0 900
59 Nystatin 500.000 IU tablet 200 200 0 200
60 Oralit 200 ml sachet 1350 1350 475 875
61 Papaverin 40 mg tablet 5000 5000 2000 3000
62 Parasetamol 100 mg tablet 1500 1500 0 1500
63 Parasetamol 500 mg tablet 6000 6000 6000 0
64 Phenitoin 30 mg tablet 250 250 0 250
65 Phenylbutazone 200 mg tablet 0 0 0 0
66 Pirantel Pamoat 125 mg tablet 400 400 100 300
67 Piroksikam 10 mg tablet 1200 1200 600 600
68 Piroksikam 20 mg tablet 880 880 360 520
69 Prednison 5 mg tablet 5000 5000 0 5000
70 Propanolol 10 mg tablet 0 0 0 0
71 Propanolol 40 mg tablet 0 0 0 0
72 PTU 100 mg tablet 400 400 200 200
73 Ranitidine 150 mg tablet 5300 5300 1200 4100
74 Reserpin 0,10 mg tablet 750 750 250 500
75 Reserpin 0,25 mg tablet 8000 8000 0 8000
76 Salbutamol 2 mg tablet 1000 1000 500 500
77 Salbutamol 4 mg tablet 0 0 0 0
78 Sulfadimidin 500 mg tablet 0 0 0 0
79 Tetrasiklin 250 mg kapsul 3000 3000 0 3000
80 Tetrasiklin 500 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
81 Zinc 20 Mg tablet 800 800 300 500
82 Vitamin B Kompleks tablet 10000 10000 7000 3000
83 Vitamin B6 10 mg tablet 5000 2000 7000 2000 5000
84 Vitamin B1 50 mg tablet 10000 10000 3000 7000
85 Vitamin B12 tablet 9000 9000 1000 8000
86 Vitamin C 50 mg tablet 12000 12000 7000 5000
87 Vitamin K 10 mg tablet 0 0 0 0
OBAT JENIS SIRUP
88 Ambroksol sirup btl 0 0 0 0
89 Amoxicillin SK 125 mg/ 5 ml btl @ 60 ml 285 285 200 85
90 Amoxicillin SK 250 mg/ 5 ml btl @ 60 ml 9 9 9 0
91 Ampisilin Sirup Kering btl 0 0 0 0
92 Antasida suspensi btl 285 285 175 110
93 Besi Sulfat Syrup btl 0 0 0 0
94 Cefadroxil Syrup Kering btl 0 0 0 0
95 Chloramphenicol Syrup btl 0 0 0 0
96 Dekstrometorfan sirup btl 60 ml 101 101 20 81
97 Ibuprofen Syrup Botol 65 65 31 34
98 Kotrimoksazol suspensi btl 60 ml 109 109 102 7
99 Multivitamin Syrup (Pediagrow) btl 3 3 3 0
100 Gliserin 100 ml 10 10 0 10
101 OBH Sirup btl 139 139 51 88
102 Parasetamol Sirup btl 60 ml 50 50 35 15
OBAT NAPZA
103 Diazepam 2 mg tablet 394 394 394
104 Diazepam 5 mg tablet 0 0 0
105 Diazepam Inj amp 24 24 24
106 Efedrin 25 mg tablet 8200 8200 8200
107 Fenobarbital 30 mg tablet 1009 1009 1009
108 Fenobarbital Injeksi amp 25 25 25
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
109 Fenitoin inj amp 0 0 0
110 Haloperidol 5 mg tablet 70 70 70
111 Klorpromazin 100 mg tablet 0 0 0
112 Klorpromazin 25 mg tablet 863 863 863
113 Kodein 10 mg tablet 230 230 230
OBAT TB PARU
114 Ethambutol 250 mg tablet 0 0 0 0
115 I N H 100 mg tablet 0 0 0 0
116 I N H 300 mg tablet 0 0 0 0
117 Pirazinamid 500 mg tablet 160 160 0 160
118 Rifampisin 450 mg tablet 0 0 0 0
OBAT LUAR
119 Aqudes Steril 500 ml btl 0 0 0 0
120 Alkohol 70 % 1000 ml Btl 4 4 4 0
121 Acyclovir Cream Tube 25 25 25 0
122 Anti Hemoroid Supp 0 0 0 0
123 Bacitracin-Polymyxin B Tube 75 75 50 25
124 Betametasone Krim Tube 0 0 0 0
125 Borax Gliserin sol Btl 0 0 0 0
126 Etil Klorida Spray Btl 100 ml 7 7 3 4
127 Fenol Gliserol Tts Telinga Btl 19 19 2 17
128 Formalin tab 1 Gram tablet 500 500 0 500
129 Gentamycin Salep Kulit Tube 15 100 115 45 70
130 Gentamycin Tetes Mata Steril 0,3 % botol 10 100 110 40 70
131 Gentian Violet Sol Btl 40 40 16 24
132 Gliserin Btl @ 10 ml 0 0 0 0
133 Hydrocortisone Cream 2,5% tube 0 120 120 120 0
134 Ichtyol Salep 10 gr Pot 6 6 6 0
135 Kalium Permanganat Pot 65 65 23 42
136 Kloramfenikol Salep Kulit (Farsycol) Tube @ 10 gr 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
137 Kloramfenikol Salep Mata 1 % Tube 216 216 43 173
138 Kloramfenikol tetes Mata btl 0 0 0 0
139 Kloramfenikol Tetes Telinga Btl 0 168 168 39 129
140 Lisol 1000 ml Btl 9 9 1 8
141 Mikonazole Krim Tube 0 0 0 0
142 Oksitetrasiklin Salep Kulit 3 % Tube 0 100 100 81 19
143 Oksitetrasiklin Salep Mata 1 % Tube 20 100 120 23 97
144 Rivanol 1 % 300 ml Btl 11 11 2 9
145 Salisil Bedak kotak 0 42 42 16 26
146 Salisilat Belerang Salep pot 63 63 37 26
147 Yodium Povidone Sol 1000 ml Btl 0 0 0 0
148 Yodium Povidone Sol 300 ml Btl 1 1 1 0
149 Yodium Povidon Sol 30 ml Btl 9 9 9 0
OBAT SUNTIK
150 Adidryl Injeksi vial 0 0 0 0
151 Adimidon Injeksi vial 25 25 25 0 ED
152 Aqua Pro Inj amp 17 17 2 15
153 Aminofilin inj amp 24 24 0 24
154 Antalgin inj amp 20 90 110 50 60
155 Buscopan Injeksi amp 5 5 0 5
156 Cefotaxim inj amp 0 0 0 0
157 Cortison inj amp 14 14 0 14
158 Deksametasone Inj amp 410 410 120 290
159 Dextrose 5 % - Nacl 0,45 % kolf 0 0 0 0
160 Dextrose 5 % - Nacl 1/4 kolf 0 0 0 0
161 Dextrose 5 % kolf 0 60 60 27 33
162 Dextrose 10 % kolf 0 0 0 0
163 Difenhidramin Inj amp 95 95 10 85
164 Ephinephrin Injeksi amp 0 0 0 0
165 Ketorolac Injeksi amp 23 23 11 12
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
166 Lidokain Inj amp 121 121 121 0
167 Lidokain comp amp 0 0 0 0
168 Metoklorpramide injeksi amp 36 36 12 24
169 Metil ergometrin inj amp 0 0 0 0
170 Natrium Klorida Infus kolf 189 189 19 170
171 Natrium Tiosulfat Injeksi amp 0 0 0 0
172 Neurobion Injeksi amp 0 0 0 0
173 Oxytetracyclin Injeksi vial 1 1 1 0
174 Oxytocin Injeksi amp 0 0 0 0
175 Papaverin inj amp 168 168 7 161
176 Ranitidine Injeksi amp 45 45 15 30
177 Ringer Laktat Infus kolf 219 219 74 145
178 Sabu 5 ml Injeksi vial 0 0 0 0
179 Vitamin B1 inj amp 80 80 0 80
180 Vitamin B 12 inj amp 170 170 25 145
181 Vitamin K Injeksi Amp 0 0 0 0
182 Vitamin C Inj Amp 25 25 1 24
ALKES HABIS PAKAI
183 Abbocath No.18 Pcs 21 21 5 16
184 Abbocath No. 20 Pcs 157 157 54 103
185 Abbocath No. 22 Pcs 65 65 22 43
186 Abbocath No.24 Pcs 46 46 5 41
187 Alat Suntik 1 ml Pcs 495 495 50 445
188 Alat Suntik 2,5 ml Pcs 0 0 0 0
189 Alat Suntik 3 ml Pcs 100 500 600 480 120
190 Alat Suntik 5 ml Pcs 249 249 149 100
191 Alat Suntik 10 ml Pcs 58 58 0 58
192 Alat Suntik 20 ml Pcs 0 0 0 0
193 catgut plain 3/0 70 cm Pcs 0 0 0 0
194 Catgut Chromic No. 3/0 70 cm Pcs 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
195 Catgut Chromic No. 3/0 75 cm Pcs 0 0 0 0
196 Catgut Chromic No. 4/0 150 cm Pcs 0 0 0 0
197 Hand Schoen No 7 Pasang 0 0 0 0
198 Hand Schoen No 7,5 Pasang 0 0 0 0
199 Hand Schoen No 8 Pasang 0 0 0 0
200 Hypafix 5 cm Roll 0 0 0 0
201 Infus Set Anak Pcs 138 138 0 138
202 Infus Set Dewasa Pcs 186 186 30 156
203 Jarum Bedah Pcs 0 0 0 0
204 Kapas Pembalut 250 gram Bks 28 28 6 22
205 Kasa 2 y x 80 cm Roll 1 1 0 1
206 Kasa 5 cm x 80 cm Roll 0 0 0 0
207 Kasa Kompres 40 x40 Roll 55 55 10 45
208 Kasa Pemb 40 x 80 cm Roll 9 9 4 5
209 Kasa Steril 16 x 16 ktk/100 lbr 62 62 27 35
210 Kasa Hidrofil 4 x 15 cm Roll 0 0 0 0
211 Kasa Pembalut 4 x 3 cm Roll 0 0 0 0
212 Masker Box/50 Pcs 100 100 50 50
213 Nald Hecting Otot (Jarum Kulit) Set/12 pcs 0 0 0 0
214 Nald Hecting No. 9 pcs 12 12 0 12
215 Nald Hecting No 13 Pcs 0 0 0 0
216 Nald Hecting No 11 Pcs 24 24 0 24
217 Nald hacting no 7 Set 12 12 0 12
218 NGT No. 16 (Feeding Tube) Set 0 0 0 0
219 Nald No. 23 Pcs 0 0 0 0
220 Nald No. 24 Pcs 0 0 0 0
221 Scalvein No. 23 Pcs 0 0 0 0
222 Silk No. 3/0 150 cm Pcs 0 0 0 0
223 Silk Black No. 3/0 75 cm (35 mm) Pcs 0 0 0 0
224 Silk Black No. 3/0 75 cm (26 mm) Pcs 37 37 37 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
225 Plester 5 Yard x 2 Inch Roll 12 12 8 4
TAMBAHAN
226 Anti fungi DOEN pot 60 60 16 44 ED
227 Pharmafix 2,5 cm x 5 mtr Roll 0 0 0 0
228 Pharmafix 5 cm x 5 mtr Roll 0 0 0 0
229 Pharmafix 10 cm x 5 mtr Roll 0 0 0 0
230 Gemfibrozil 500 mg tablet 340 340 100 240
231 PCT Drop 100mg/ml tablet 0 0 0 0
232 Glokosamine tablet 120 300 420 300 120
233 Ampicillin Injeksi (Vicillin) vial 110 110 0 110 dari KIA
234 Gentamycin Injeksi amp 140 140 0 140 dari KIA
235 Cetirizin syirup botol 29 29 0 29
236 Piracetam 1200 mg tablet 40 40 0 40
237 Urine Bag Set 0 0 0 0
238 Elastic Verban 7,5 cm x 4,5 M Roll 2 2 2 0
239 Foley Catheter No.16 pcs 4 4 0 4
240 Foley Catheter No.18 pcs 2 2 0 2
241 Kanamycin 1 gr Injeksi vial 10 10 10 0
242 Loratadin tablet 250 250 0 250
243 Sacorit tablet 0 0 0 0
244 Metoklopramide injeksi amp 36 36 12 24
245 Cairan infus DBD (Widahes 130) botol 5 5 0 5
246 Asetosal tablet 200 200 0 200
247 Cetirizin 10 mg botol 0 0 0 0
248 Lansoprazole 30 mg tablet 100 100 20 80
249 H2O2 800 ml botol 9 9 0 9
250 Ketoko salep kulit 2% Pasang 0 25 25 8 17

Umum
ASKES Jumlah
Jumlah Kunjungan Resep Bayar Tidak Bayar

313 725 153 1191

 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
Jumlah Kunjungan Resep
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
313 725 153 1191

Yang Meminta Mengetahui/Menyetujui Yang Menyerahkan Yang Menerima

Pimpinan Puskesmas Kepala Dinkes II / GFK Petugas GFK Penanggungjawab Apotik

Dr. Herlina Barends (…………………………………………) (………………………………….) [Link] Syahdiana S,farm.,Apt

NIP. 19670726 199903 2 003 NIP. NIP. NIP. 19811223200902 2 005
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : SEDADAP PELAPORAN BULAN : Juni 2012 NO./[Link]:

KECAMATAN : NUNUKAN SELATAN PERMINTAAN BULAN/PERIODE : GFK
KABUPATEN : NUNUKAN PUSK
DINKES

PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA PEMBERIAN KETERANG

NO NAMA OBAT SATUAN STOK AWAL
AN AAN AN STOK OPT AN
JUMLAH
AN
INPRES ASKES APBD I APBD II LAIN2
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet 0 0 0 0
2 Amlodipin 5 mg tablet 480 480 60 420
3 Albendazole tablet 570 570 30 540
4 Allopurinol 100 mg tablet 900 900 200 700
5 Ambroksol 30 mg tablet 3300 3300 800 2500
6 Amoxicillin 250 mg tablet 2400 2400 960 1440
7 Amoxicillin 500 mg tablet 2900 2000 4900 3100 1800
8 Ampisilin 500 mg tablet 800 800 400 400
9 Antalgin 500 mg tablet 6000 6000 2000 4000
10 Antasida DOEN tablet 5000 5000 2000 3000
11 Asam Folat tablet 0 0 0 0
12 Asam Mefenamat 500 mg tablet 0 0 0 0
13 Atropin Sulfat 0,5 mg tablet 0 0 0 0
14 Acyclovir 200 mg tablet 0 0 0 0
15 Acyclovir 400 mg tablet 0 0 0 0
16 Besi sulfat tablet 3000 3000 600 2400
17 Bisacodyl (Laxana) tablet 0 0 0 0
18 Buscopan tablet 0 0 0 0
19 Captopril 25 mg tablet 2600 2600 200 2400
20 Captopril 12,5 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
21 Cefadroxil 500 mg tablet 2700 2700 350 2350
22 Chloramphenicol 250 mg tablet 750 750 0 750
23 Chloroquin 250 mg tablet 0 0 0 0
24 Cimetidine 200 mg tablet 0 0 0 0
25 Ciprofloxacin 500 mg tablet 0 0 0 0
26 CTM 4 mg tablet 11000 11000 5000 6000
27 Deksametasone 0,5 mg tablet 9600 9600 4800 4800
28 Dekstrometorfan 15 mg tablet 2000 2000 0 2000
29 Digoksin 0,25 mg tablet 0 0 0 0
30 Dimenhidrinat 50 mg tablet 400 400 0 400
31 Domperidone 10 mg tablet 0 0 0 0
32 Ergotamine Kafein tablet 0 0 0 0
33 Erythromycin 250 mg tablet 0 0 0 0
34 Erythromycin 500 mg tablet 0 0 0 0
35 Famotidine 20 mg tablet 0 0 0 0
36 Furosemide 40 mg tablet 1000 1000 0 1000
37 Glibenklamide 5 mg tablet 300 300 200 100
38 Gliseril Guayakolat 100 mg tablet 9000 9000 2000 7000
39 Griseofulvin 125 mg tablet 1000 1000 200 800
40 H C T 25 mg tablet 1000 1000 0 1000
41 Ibuprofen 200 mg tablet 0 0 0 0
42 Ibuprofen 400 mg tablet 400 400 400 0
43 Isosorbit Dinitrat 5 mg tablet 400 400 0 400
44 Kalnex 500 mg tablet 0 0 0 0
45 Kalsium Laktat 500 mg tablet 12000 12000 1000 11000
46 Ketokonazole 200 mg tablet 250 250 50 200
47 Komp Pirimetamin Sulfadoksin tablet 0 0 0 0
48 Kotrimoksazol 120 mg tablet 1200 1200 200 1000
49 Kotrimoksazol 480 mg tablet 0 0 0 0
50 Loperamid HCL 2 mg (Novadium) tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
51 Mebendazol tablet 0 0 0 0
52 Methylergometrin 0,125 mg tablet 300 300 0 300
53 Metoklopramide 10 mg tablet 0 0 0 0
54 Metronidazol 500 mg tablet 500 500 200 300
55 Metronidazol 250 mg tablet 100 100 100 0
56 Multivitamin (Wishen) kaplet 0 0 0 0
57 Natrium diklofenak 50 mg tablet 1600 1600 350 1250
58 Nifedipin 10 mg tablet 900 900 0 900
59 Nystatin 500.000 IU tablet 200 200 0 200
60 Oralit 200 ml sachet 1350 1350 150 1200
61 Papaverin 40 mg tablet 5000 5000 1000 4000
62 Parasetamol 100 mg tablet 1500 1500 0 1500
63 Parasetamol 500 mg tablet 6000 6000 6000 0
64 Phenitoin 30 mg tablet 250 250 0 250
65 Phenylbutazone 200 mg tablet 0 0 0 0
66 Pirantel Pamoat 125 mg tablet 400 400 0 400
67 Piroksikam 10 mg tablet 1200 1200 300 900
68 Piroksikam 20 mg tablet 880 880 240 640
69 Prednison 5 mg tablet 5000 5000 0 5000
70 Propanolol 10 mg tablet 0 0 0 0
71 Propanolol 40 mg tablet 0 0 0 0
72 PTU 100 mg tablet 400 400 100 300
73 Ranitidine 150 mg tablet 5300 5300 500 4800
74 Reserpin 0,10 mg tablet 750 750 250 500
75 Reserpin 0,25 mg tablet 8000 8000 0 8000
76 Salbutamol 2 mg tablet 1000 1000 0 1000
77 Salbutamol 4 mg tablet 0 0 0 0
78 Sulfadimidin 500 mg tablet 0 0 0 0
79 Tetrasiklin 250 mg kapsul 3000 3000 0 3000
80 Tetrasiklin 500 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
81 Zinc 20 Mg tablet 800 800 100 700
82 Vitamin B Kompleks tablet 10000 10000 4000 6000
83 Vitamin B6 10 mg tablet 5000 5000 2000 3000
84 Vitamin B1 50 mg tablet 10000 10000 2000 8000
85 Vitamin B12 tablet 9000 9000 0 9000
86 Vitamin C 50 mg tablet 12000 12000 4000 8000
87 Vitamin K 10 mg tablet 0 0 0 0
OBAT JENIS SIRUP
88 Ambroksol sirup btl 0 0 0 0
89 Amoxicillin SK 125 mg/ 5 ml btl @ 60 ml 285 285 62 223
90 Amoxicillin SK 250 mg/ 5 ml btl @ 60 ml 9 9 9 0
91 Ampisilin Sirup Kering btl 0 0 0 0
92 Antasida suspensi btl 285 285 85 200
93 Besi Sulfat Syrup btl 0 0 0 0
94 Cefadroxil Syrup Kering btl 0 0 0 0
95 Chloramphenicol Syrup btl 0 0 0 0
96 Dekstrometorfan sirup btl 60 ml 101 101 10 91
97 Ibuprofen Syrup Botol 65 65 15 50
98 Kotrimoksazol suspensi btl 60 ml 109 109 37 72
99 Multivitamin Syrup (Pediagrow) btl 3 3 3 0
100 Gliserin 100 ml 10 10 0 10
101 OBH Sirup btl 139 139 16 123
102 Parasetamol Sirup btl 60 ml 50 150 200 50 150
OBAT NAPZA
103 Diazepam 2 mg tablet 394 394 37 357
104 Diazepam 5 mg tablet 0 0 0 0
105 Diazepam Inj amp 24 24 0 24
106 Efedrin 25 mg tablet 7200 7200 350 6850
107 Fenobarbital 30 mg tablet 1009 1009 21 988
108 Fenobarbital Injeksi amp 25 25 0 25
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
109 Fenitoin inj amp 0 0 0 0
110 Haloperidol 5 mg tablet 70 70 30 40
111 Klorpromazin 100 mg tablet 0 0 0 0
112 Klorpromazin 25 mg tablet 863 863 16 847
113 Kodein 10 mg tablet 230 230 10 220
OBAT TB PARU
114 Ethambutol 250 mg tablet 0 0 0 0
115 I N H 100 mg tablet 0 0 0 0
116 I N H 300 mg tablet 0 0 0 0
117 Pirazinamid 500 mg tablet 160 160 0 160
118 Rifampisin 450 mg tablet 0 0 0 0
OBAT LUAR
119 Aqudes Steril 500 ml btl 0 0 0 0
120 Alkohol 70 % 1000 ml Btl 4 4 1 3
121 Acyclovir Cream Tube 25 25 25 0
122 Anti Hemoroid Supp 0 0 0 0
123 Bacitracin-Polymyxin B Tube 75 75 25 50
124 Betametasone Krim Tube 0 0 0 0
125 Borax Gliserin sol Btl 0 0 0 0
126 Etil Klorida Spray Btl 100 ml 7 7 0 7
127 Fenol Gliserol Tts Telinga Btl 19 19 0 19
128 Formalin tab 1 Gram tablet 500 500 0 500
129 Gentamycin Salep Kulit Tube 15 15 15 0
130 Gentamycin Tetes Mata Steril 0,3 % botol 10 10 10 0
131 Gentian Violet Sol Btl 40 40 5 35
132 Gliserin Btl @ 10 ml 0 0 0 0
133 Hydrocortisone Cream 2,5% tube 0 0 0 0
134 Ichtyol Salep 10 gr Pot 6 6 6 0
135 Kalium Permanganat Pot 65 65 15 50
136 Kloramfenikol Salep Kulit (Farsycol) Tube @ 10 gr 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
137 Kloramfenikol Salep Mata 1 % Tube 216 216 36 180
138 Kloramfenikol tetes Mata btl 0 0 0 0
139 Kloramfenikol Tetes Telinga Btl 0 0 0 0
140 Lisol 1000 ml Btl 9 9 0 9
141 Mikonazole Krim Tube 0 0 0 0
142 Oksitetrasiklin Salep Kulit 3 % Tube 0 0 0 0
143 Oksitetrasiklin Salep Mata 1 % Tube 20 20 20
144 Rivanol 1 % 300 ml Btl 11 11 2 9
145 Salisil Bedak kotak 0 0 0 0
146 Salisilat Belerang Salep pot 63 63 24 39
147 Yodium Povidone Sol 1000 ml Btl 0 0 0 0
148 Yodium Povidone Sol 300 ml Btl 1 1 1 0
149 Yodium Povidon Sol 30 ml Btl 9 9 6 3
OBAT SUNTIK
150 Adidryl Injeksi vial 0 0 0 0
151 Adimidon Injeksi vial 25 25 0 25
152 Aqua Pro Inj amp 17 17 0 17
153 Aminofilin inj amp 24 24 0 24
154 Antalgin inj amp 20 20 5 15
155 Buscopan Injeksi amp 5 5 0 5
156 Cefotaxim inj amp 0 0 0 0
157 Cortison inj amp 14 14 0 14
158 Deksametasone Inj amp 410 410 110 300
159 Dextrose 5 % - Nacl 0,45 % kolf 0 0 0 0
160 Dextrose 5 % - Nacl 1/4 kolf 0 0 0 0
161 Dextrose 5 % kolf 0 60 60 20 40
162 Dextrose 10 % kolf 0 0 0 0
163 Difenhidramin Inj amp 95 95 5 90
164 Ephinephrin Injeksi amp 0 0 0 0
165 Ketorolac Injeksi amp 23 23 11 12
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
166 Lidokain Inj amp 121 121 0 121
167 Lidokain comp amp 0 0 0 0
168 Metoklorpramide injeksi amp 36 36 6 30
169 Metil ergometrin inj amp 0 0 0 0
170 Natrium Klorida Infus kolf 189 189 6 183
171 Natrium Tiosulfat Injeksi amp 0 0 0 0
172 Neurobion Injeksi amp 0 0 0 0
173 Oxytetracyclin Injeksi vial 1 1 0 1
174 Oxytocin Injeksi amp 0 0 0 0
175 Papaverin inj amp 168 168 7 161
176 Ranitidine Injeksi amp 45 45 15 30
177 Ringer Laktat Infus kolf 219 219 134 85
178 Sabu 5 ml Injeksi vial 0 0 0 0
179 Vitamin B1 inj amp 80 80 0 80
180 Vitamin B 12 inj amp 170 170 10 160
181 Vitamin K Injeksi Amp 0 0 0 0
182 Vitamin C Inj Amp 25 25 1 24
ALKES HABIS PAKAI
183 Abbocath No.18 Pcs 21 21 5 16
184 Abbocath No. 20 Pcs 157 157 39 118
185 Abbocath No. 22 Pcs 65 65 5 60
186 Abbocath No.24 Pcs 46 46 0 46
187 Alat Suntik 1 ml Pcs 495 495 10 485
188 Alat Suntik 2,5 ml Pcs 0 0 0 0
189 Alat Suntik 3 ml Pcs 100 500 600 100 500
190 Alat Suntik 5 ml Pcs 249 249 149 100
191 Alat Suntik 10 ml Pcs 58 58 0 58
192 Alat Suntik 20 ml Pcs 0 0 0 0
193 catgut plain 3/0 70 cm Pcs 0 0 0 0
194 Catgut Chromic No. 3/0 70 cm Pcs 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
195 Catgut Chromic No. 3/0 75 cm Pcs 0 0 0 0
196 Catgut Chromic No. 4/0 150 cm Pcs 0 0 0 0
197 Hand Schoen No 7 Pasang 0 0 0 0
198 Hand Schoen No 7,5 Pasang 0 0 0 0
199 Hand Schoen No 8 Pasang 0 0 0 0
200 Hypafix 5 cm Roll 0 0 0 0
201 Infus Set Anak Pcs 138 138 0 138
202 Infus Set Dewasa Pcs 186 186 0 186
203 Jarum Bedah Pcs 0 0 0 0
204 Kapas Pembalut 250 gram Bks 28 28 3 25
205 Kasa 2 y x 80 cm Roll 1 1 0 1
206 Kasa 5 cm x 80 cm Roll 0 0 0
207 Kasa Kompres 40 x40 Roll 55 55 10 45
208 Kasa Pemb 40 x 80 cm Roll 9 9 2 7
209 Kasa Steril 16 x 16 ktk/100 lbr 62 62 11 51
210 Kasa Hidrofil 4 x 15 cm Roll 0 0 0 0
211 Kasa Pembalut 4 x 3 cm Roll 0 0 0 0
212 Masker Box/50 Pcs 100 100 0 100
213 Nald Hecting Otot (Jarum Kulit) Set/12 pcs 0 0 0 0
214 Nald Hecting No. 9 pcs 12 12 0 12
215 Nald Hecting No 13 Pcs 0 0 0 0
216 Nald Hecting No 11 Pcs 24 24 0 24
217 Nald hacting no 7 Set 12 12 0 12
218 NGT No. 16 (Feeding Tube) Set 0 0 0 0
219 Nald No. 23 Pcs 0 0 0 0
220 Nald No. 24 Pcs 0 0 0 0
221 Scalvein No. 23 Pcs 0 0 0 0
222 Silk No. 3/0 150 cm Pcs 0 0 0 0
223 Silk Black No. 3/0 75 cm (35 mm) Pcs 0 0 0 0
224 Silk Black No. 3/0 75 cm (26 mm) Pcs 37 37 37 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
225 Plester 5 Yard x 2 Inch Roll 12 12 3 9
TAMBAHAN
226 Anti fungi DOEN pot 60 60 6 54 ED
227 Pharmafix 2,5 cm x 5 mtr Roll 0 0 0 0
228 Pharmafix 5 cm x 5 mtr Roll 0 0 0 0
229 Pharmafix 10 cm x 5 mtr Roll 0 0 0 0
230 Gemfibrozil 500 mg tablet 340 340 100 240
231 PCT Drop 100mg/ml tablet 0 0 0 0
232 Glokosamine tablet 120 300 420 120 300
233 Ampicillin Injeksi (Vicillin) vial 110 110 0 110 dari KIA
234 Gentamycin Injeksi amp 140 140 0 140 dari KIA
235 Cetirizin syirup botol 29 29 0 29
236 Piracetam 1200 mg tablet 40 40 0 40
237 Urine Bag Set 0 0 0 0
238 Elastic Verban 7,5 cm x 4,5 M Roll 2 2 2 0
239 Foley Catheter No.16 pcs 4 4 0 4
240 Foley Catheter No.18 pcs 2 2 0 2
241 Kanamycin 1 gr Injeksi vial 10 10 10 0
242 Loratadin tablet 250 250 0 250
243 Sacorit tablet 0 0 0 0
244 Metoklopramide injeksi amp 36 36 36
245 Cairan infus DBD (Widahes 130) botol 5 5 0 5
246 Asetosal tablet 200 200 0 200
247 Cetirizin 10 mg botol 0 0 0 0
248 Lansoprazole 30 mg tablet 100 100 20 80
249 H2O2 800 ml botol 9 9 0 9
250 handscoen No.6 1/2 Pasang 0 0 0 0

Umum
ASKES Jumlah
Jumlah Kunjungan Resep Bayar Tidak Bayar
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
Jumlah Kunjungan Resep
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17

Yang Meminta Mengetahui/Menyetujui Yang Menyerahkan Yang Menerima

Pimpinan Puskesmas Kepala Dinkes II / GFK Petugas GFK Penanggungjawab Apotik

Dr. Herlina Barends (…………………………………………) (………………………………….) [Link] Syahdiana S,farm.,Apt

NIP. 19670726 199903 2 003 NIP. NIP. NIP. 19811223200902 2 005
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : SEDADAP PELAPORAN BULAN : Juli 2012 NO./[Link]:

KECAMATAN : NUNUKAN SELATAN PERMINTAAN BULAN/PERIODE : GFK
KABUPATEN : NUNUKAN PUSK
DINKES

PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA PEMBERIAN KETERANG

NO NAMA OBAT SATUAN STOK AWAL
AN AAN AN STOK OPT AN
JUMLAH
AN
INPRES ASKES APBD I APBD II LAIN2
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet 0 0 0 0
2 Amlodipin 5 mg tablet 420 420 60 360 200
3 Albendazole tablet 540 540 0 540
4 Allopurinol 100 mg tablet 700 700 100 600 1000
5 Ambroksol 30 mg tablet 2500 2500 500 2000 2000
6 Amoxicillin 250 mg tablet 1440 1440 360 1080 2400
7 Amoxicillin 500 mg tablet 1800 10000 11800 4500 7300 15000
8 Ampisilin 500 mg tablet 400 400 300 100 2000
9 Antalgin 500 mg tablet 4000 4000 1000 3000 5000
10 Antasida DOEN tablet 3000 3000 2000 1000 10000
11 Asam Folat tablet 0 0 0 0
12 Asam Mefenamat 500 mg tablet 0 4500 4500 2600 1900 10000
13 Atropin Sulfat 0,5 mg tablet 0 0 0 0
14 Acyclovir 200 mg tablet 0 1500 1500 150 1350
15 Acyclovir 400 mg tablet 0 1500 1500 100 1400 3000
16 Besi sulfat tablet 2400 2400 1200 1200 3600
17 Bisacodyl (Laxana) tablet 0 0 0 0
18 Buscopan tablet 0 0 0 0
19 Captopril 25 mg tablet 2400 2400 800 1600 2500
20 Captopril 12,5 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
21 Cefadroxil 500 mg tablet 2350 2350 300 2050 1000
22 Chloramphenicol 250 mg tablet 750 750 0 750
23 Chloroquin 250 mg tablet 0 0 0 0
24 Cimetidine 200 mg tablet 0 0 0 0
25 Ciprofloxacin 500 mg tablet 0 0 0 0
26 CTM 4 mg tablet 6000 6000 5000 1000 20000
27 Deksametasone 0,5 mg tablet 4800 4800 4400 400 15000
28 Dekstrometorfan 15 mg tablet 2000 2000 0 2000
29 Digoksin 0,25 mg tablet 0 0 0 0
30 Dimenhidrinat 50 mg tablet 400 400 0 400
31 Domperidone 10 mg tablet 0 1500 1500 400 1100 1500
32 Ergotamine Kafein tablet 0 0 0 0
33 Erythromycin 250 mg tablet 0 2400 2400 120 2280 500
34 Erythromycin 500 mg tablet 0 0 0 0 5000
35 Famotidine 20 mg tablet 0 0 0 0
36 Furosemide 40 mg tablet 1000 1000 0 1000
37 Glibenklamide 5 mg tablet 100 100 100 0 10000
38 Gliseril Guayakolat 100 mg tablet 7000 7000 3000 4000 10000
39 Griseofulvin 125 mg tablet 800 800 200 600 1000
40 H C T 25 mg tablet 1000 1000 0 1000 2000
41 Ibuprofen 200 mg tablet 0 0 0 0
42 Ibuprofen 400 mg tablet 0 0 0 0
43 Isosorbit Dinitrat 5 mg tablet 400 400 0 400
44 Kalnex 500 mg tablet 0 0 0 0
45 Kalsium Laktat 500 mg tablet 11000 11000 1000 10000 5000
46 Ketokonazole 200 mg tablet 200 200 50 150 1000
47 Komp Pirimetamin Sulfadoksin tablet 0 0 0 0
48 Kotrimoksazol 120 mg tablet 1000 1000 200 800
49 Kotrimoksazol 480 mg tablet 0 1000 1000 1000 0 10000
50 Loperamid HCL 2 mg (Novadium) tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
51 Mebendazol tablet 0 0 0 0
52 Methylergometrin 0,125 mg tablet 300 300 0 300
53 Metoklopramide 10 mg tablet 0 0 0 0 5000
54 Metronidazol 500 mg tablet 300 300 0 300 5000
55 Metronidazol 250 mg tablet 0 0 0 0
56 Multivitamin (Wishen) kaplet 0 0 0 0
57 Natrium diklofenak 50 mg tablet 1250 1250 200 1050 1000
58 Nifedipin 10 mg tablet 900 900 0 900
59 Nystatin 500.000 IU tablet 200 200 0 200
60 Oralit 200 ml sachet 1200 1200 325 875 15000
61 Papaverin 40 mg tablet 4000 4000 1000 3000 5000
62 Parasetamol 100 mg tablet 1500 1500 0 1500 1000
63 Parasetamol 500 mg tablet 0 0 0 0 20000
64 Phenitoin 30 mg tablet 250 250 0 250
65 Phenylbutazone 200 mg tablet 0 0 0 0
66 Pirantel Pamoat 125 mg tablet 400 400 100 300
67 Piroksikam 10 mg tablet 900 900 300 600 15000
68 Piroksikam 20 mg tablet 640 640 120 520 1200
69 Prednison 5 mg tablet 5000 5000 0 5000 5000
70 Propanolol 10 mg tablet 0 0 0 0
71 Propanolol 40 mg tablet 0 0 0 0
72 PTU 100 mg tablet 300 300 100 200 1000
73 Ranitidine 150 mg tablet 4800 4800 700 4100 3000
74 Reserpin 0,10 mg tablet 500 500 0 500
75 Reserpin 0,25 mg tablet 8000 8000 0 8000
76 Salbutamol 2 mg tablet 1000 1000 500 500 1000
77 Salbutamol 4 mg tablet 0 0 0 0
78 Sulfadimidin 500 mg tablet 0 0 0 0
79 Tetrasiklin 250 mg kapsul 3000 3000 0 3000
80 Tetrasiklin 500 mg tablet 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
81 Zinc 20 Mg tablet 700 700 200 500 1000
82 Vitamin B Kompleks tablet 6000 6000 3000 3000 15000
83 Vitamin B6 10 mg tablet 3000 2000 5000 0 5000 5000
84 Vitamin B1 50 mg tablet 8000 8000 1000 7000 5000
85 Vitamin B12 tablet 9000 9000 1000 8000 2000
86 Vitamin C 50 mg tablet 8000 8000 3000 5000 15000
87 Vitamin K 10 mg tablet 0 0 0 0 1000
OBAT JENIS SIRUP
88 Ambroksol sirup btl 0 0 0 0 300
89 Amoxicillin SK 125 mg/ 5 ml btl @ 60 ml 223 223 138 85 500
90 Amoxicillin SK 250 mg/ 5 ml btl @ 60 ml 0 0 0 0 200
91 Ampisilin Sirup Kering btl 0 0 0 0
92 Antasida suspensi btl 200 200 90 110 300
93 Besi Sulfat Syrup btl 0 0 0 0
94 Cefadroxil Syrup Kering btl 0 0 0 0
95 Chloramphenicol Syrup btl 0 0 0 0
96 Dekstrometorfan sirup btl 60 ml 91 91 10 81
97 Ibuprofen Syrup Botol 50 50 16 34 100
98 Kotrimoksazol suspensi btl 60 ml 72 72 65 7 300
99 Multivitamin Syrup (Pediagrow) btl 0 0 0 0
100 Gliserin 100 ml 10 10 0 10
101 OBH Sirup btl 123 123 35 88
102 Parasetamol Sirup btl 60 ml 150 150 135 15 500
OBAT NAPZA
103 Diazepam 2 mg tablet 357 357 67 297
104 Diazepam 5 mg tablet 0 0 0 0
105 Diazepam Inj amp 24 24 24 0 ED
106 Efedrin 25 mg tablet 6850 6850 110 6740
107 Fenobarbital 30 mg tablet 988 988 95 893
108 Fenobarbital Injeksi amp 25 25 0 25
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
109 Fenitoin inj amp 0 0 0 0
110 Haloperidol 5 mg tablet 40 40 40 0
111 Klorpromazin 100 mg tablet 0 0 0 0
112 Klorpromazin 25 mg tablet 847 847 0 847
113 Kodein 10 mg tablet 220 220 20 200
OBAT TB PARU
114 Ethambutol 250 mg tablet 0 0 0 0
115 I N H 100 mg tablet 0 0 0 0
116 I N H 300 mg tablet 0 0 0 0
117 Pirazinamid 500 mg tablet 160 160 0 160
118 Rifampisin 450 mg tablet 0 0 0 0
OBAT LUAR
119 Aqudes Steril 500 ml btl 0 0 0 0
120 Alkohol 70 % 1000 ml Btl 3 3 3 0 20
121 Acyclovir Cream Tube 0 0 0 0 100
122 Anti Hemoroid Supp 0 0 0 0 100
123 Bacitracin-Polymyxin B Tube 50 50 25 25 250
124 Betametasone Krim Tube 0 0 0 0 300
125 Borax Gliserin sol Btl 0 0 0 0
126 Etil Klorida Spray Btl 100 ml 7 7 3 4 10
127 Fenol Gliserol Tts Telinga Btl 19 19 2 17
128 Formalin tab 1 Gram tablet 500 500 0 500
129 Gentamycin Salep Kulit Tube 0 100 100 30 70 100
130 Gentamycin Tetes Mata Steril 0,3 % botol 0 100 100 30 70 100
131 Gentian Violet Sol Btl 35 35 11 24 50
132 Gliserin Btl @ 10 ml 0 0 0 0
133 Hydrocortisone Cream 2,5% tube 0 120 120 120 0 300
134 Ichtyol Salep 10 gr Pot 0 0 0 0 100
135 Kalium Permanganat Pot 50 50 8 42 50
136 Kloramfenikol Salep Kulit (Farsycol) Tube @ 10 gr 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
137 Kloramfenikol Salep Mata 1 % Tube 180 180 7 173
138 Kloramfenikol tetes Mata btl 0 0 0 0 100
139 Kloramfenikol Tetes Telinga Btl 0 168 168 39 129 100
140 Lisol 1000 ml Btl 9 9 1 8
141 Mikonazole Krim Tube 0 0 0 0 100
142 Oksitetrasiklin Salep Kulit 3 % Tube 0 100 100 81 19 300
143 Oksitetrasiklin Salep Mata 1 % Tube 100 100 3 97
144 Rivanol 1 % 300 ml Btl 9 9 0 9
145 Salisil Bedak kotak 0 42 42 16 26 50
146 Salisilat Belerang Salep pot 39 39 13 26 50
147 Yodium Povidone Sol 1000 ml Btl 0 0 0 0
148 Yodium Povidone Sol 300 ml Btl 0 0 0 0 20
149 Yodium Povidon Sol 30 ml Btl 3 3 3 0 100
OBAT SUNTIK
150 Adidryl Injeksi vial 0 0 0 0
151 Adimidon Injeksi vial 25 25 25 0
152 Aqua Pro Inj amp 17 17 2 15
153 Aminofilin inj amp 24 24 0 24
154 Antalgin inj amp 15 90 105 45 60
155 Buscopan Injeksi amp 5 5 0 5
156 Cefotaxim inj amp 0 0 0 0
157 Cortison inj amp 14 14 0 14
158 Deksametasone Inj amp 300 300 10 290
159 Dextrose 5 % - Nacl 0,45 % kolf 0 0 0 0
160 Dextrose 5 % - Nacl 1/4 kolf 0 0 0 0
161 Dextrose 5 % kolf 40 60 100 67 33 100
162 Dextrose 10 % kolf 0 0 0 0
163 Difenhidramin Inj amp 90 90 5 85
164 Ephinephrin Injeksi amp 0 0 0 0 500
165 Ketorolac Injeksi amp 12 12 0 12 50
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
166 Lidokain Inj amp 121 121 121 0 1000
167 Lidokain comp amp 0 0 0 0 100
168 Metoklorpramide injeksi amp 30 30 6 24 50
169 Metil ergometrin inj amp 0 0 0 0
170 Natrium Klorida Infus kolf 183 183 13 170
171 Natrium Tiosulfat Injeksi amp 0 0 0 0
172 Neurobion Injeksi amp 0 0 0 0 100
173 Oxytetracyclin Injeksi vial 1 1 1 0
174 Oxytocin Injeksi amp 0 0 0 0 100
175 Papaverin inj amp 161 161 0 161
176 Ranitidine Injeksi amp 30 30 0 30
177 Ringer Laktat Infus kolf 209 209 64 145
178 Sabu 5 ml Injeksi vial 0 0 0 0 10
179 Vitamin B1 inj amp 80 80 0 80 100
180 Vitamin B 12 inj amp 160 160 15 145
181 Vitamin K Injeksi Amp 0 0 0 0
182 Vitamin C Inj Amp 24 24 0 24
ALKES HABIS PAKAI
183 Abbocath No.18 Pcs 16 16 0 16 100
184 Abbocath No. 20 Pcs 118 118 15 103 100
185 Abbocath No. 22 Pcs 60 60 17 43 100
186 Abbocath No.24 Pcs 46 46 5 41 100
187 Alat Suntik 1 ml Pcs 485 485 40 445
188 Alat Suntik 2,5 ml Pcs 0 0 0 0
189 Alat Suntik 3 ml Pcs 500 500 1000 880 120 3000
190 Alat Suntik 5 ml Pcs 100 100 0 100 1000
191 Alat Suntik 10 ml Pcs 58 58 0 58
192 Alat Suntik 20 ml Pcs 0 0 0 0
193 catgut plain 3/0 70 cm Pcs 0 0 0 0
194 Catgut Chromic No. 3/0 70 cm Pcs 0 0 0 0 100
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
195 Catgut Chromic No. 3/0 75 cm Pcs 0 0 0 0 100
196 Catgut Chromic No. 4/0 150 cm Pcs 0 0 0 0
197 Hand Schoen No 7 Pasang 0 0 0 0
198 Hand Schoen No 7,5 Pasang 0 0 0 0
199 Hand Schoen No 8 Pasang 0 0 0 0
200 Hypafix 5 cm Roll 0 0 0 0
201 Infus Set Anak Pcs 138 138 0 138
202 Infus Set Dewasa Pcs 186 186 30 156
203 Jarum Bedah Pcs 0 0 0 0
204 Kapas Pembalut 250 gram Bks 25 25 3 22
205 Kasa 2 y x 80 cm Roll 1 1 0 1
206 Kasa 5 cm x 80 cm Roll 0 0 0
207 Kasa Kompres 40 x40 Roll 45 45 0 45
208 Kasa Pemb 40 x 80 cm Roll 7 7 2 5 10
209 Kasa Steril 16 x 16 ktk/100 lbr 51 51 16 35 100
210 Kasa Hidrofil 4 x 15 cm Roll 0 0 0 0 100
211 Kasa Pembalut 4 x 3 cm Roll 0 0 0 0
212 Masker Box/50 Pcs 100 100 50 50
213 Nald Hecting Otot (Jarum Kulit) Set/12 pcs 0 0 0 0
214 Nald Hecting No. 9 pcs 12 12 0 12
215 Nald Hecting No 13 Pcs 0 0 0 0
216 Nald Hecting No 11 Pcs 24 24 0 24
217 Nald hacting no 7 Set 12 12 0 12
218 NGT No. 16 (Feeding Tube) Set 0 0 0 0
219 Nald No. 23 Pcs 0 0 0 0 500
220 Nald No. 24 Pcs 0 0 0 0 500
221 Scalvein No. 23 Pcs 0 0 0 0
222 Silk No. 3/0 150 cm Pcs 0 0 0 0
223 Silk Black No. 3/0 75 cm (35 mm) Pcs 0 0 0 0
224 Silk Black No. 3/0 75 cm (26 mm) Pcs 0 37 37 0 100
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
225 Plester 5 Yard x 2 Inch Roll 9 9 5 4 20
TAMBAHAN
226 Anti fungi DOEN pot 54 54 10 44 50 ED
227 Pharmafix 2,5 cm x 5 mtr Roll 0 0 0 0
228 Pharmafix 5 cm x 5 mtr Roll 0 0 0 0
229 Pharmafix 10 cm x 5 mtr Roll 0 0 0 0
230 Gemfibrozil 500 mg tablet 240 240 0 240 500
231 PCT Drop 100mg/ml tablet 0 0 0 0 200
232 Glokosamine tablet 300 300 600 480 120 2000
233 Ampicillin Injeksi (Vicillin) vial 110 110 0 110 dari KIA
234 Gentamycin Injeksi amp 140 140 0 140 dari KIA
235 Cetirizin syirup botol 29 29 0 29
236 Piracetam 1200 mg tablet 40 40 0 40
237 Urine Bag Set 0 0 0 0
238 Elastic Verban 7,5 cm x 4,5 M Roll 0 0 0 0 10
239 Foley Catheter No.16 pcs 4 4 0 4
240 Foley Catheter No.18 pcs 2 2 0 2
241 Kanamycin 1 gr Injeksi vial 0 0 0 0 100
242 Loratadin tablet 250 250 0 250
243 Sacorit tablet 0 0 0 0 5000
244 Metoklopramide injeksi amp 30 30 6 24
245 Cairan infus DBD (Widahes 130) botol 5 5 0 5
246 Asetosal tablet 200 200 0 200
247 Cetirizin 10 mg botol 0 0 0 0 2000
248 Lansoprazole 30 mg tablet 80 80 0 80 500
249 H2O2 800 ml botol 9 9 0 9
250 Bisturi Tube 0 0 0 0 0 100
251 Ketokonazol slp kulit 2% Tube 0 25 25 8 17 50
Umum
ASKES Jumlah
Bayar Tidak Bayar
Jumlah Kunjungan Resep
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
Jumlah Kunjungan Resep

Mengetahui/Menyetujui Yang Menyerahkan Yang Menerima

Yang Meminta Kepala Dinkes II / GFK Petugas GFK Penanggungjawab Apotik
Pimpinan Puskesmas

(…………………………………………) (………………………………….) [Link] Syahdiana S,farm.,Apt

Dr. Herlina Barends NIP. NIP. NIP. 19811223200902 2 005
NIP. 19670726 199903 2 003
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT PUSKESMAS

PUSKESMAS : SEDADAP PELAPORAN BULAN : Agustus 2012 NO./[Link]:

KECAMATAN : NUNUKAN SELATAN PERMINTAAN BULAN/PERIODE : GFK
KABUPATEN : NUNUKAN PUSK
DINKES

PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA PEMBERIAN KETERANG

NO NAMA OBAT SATUAN STOK AWAL
AN AAN AN STOK OPT AN
JUMLAH
AN
INPRES ASKES APBD I APBD II LAIN2
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
JENIS TABLET/KAPSUL/KAPLET
1 Aminofilin 200 mg tablet 0 0 0 0 0
2 Amlodipin 5 mg tablet 360 360 90 270 0
3 Albendazole tablet 540 540 0 540 0
4 Allopurinol 100 mg tablet 600 600 200 400 0
5 Ambroksol 30 mg tablet 2000 2000 500 1500 0
6 Amoxicillin 250 mg tablet 1080 360 1440 720 720 480
7 Amoxicillin 500 mg tablet 7300 1000 8300 2700 5600 0
8 Ampisilin 500 mg tablet 100 2000 2100 0 2100 0
9 Antalgin 500 mg tablet 3000 3000 1000 2000 0
10 Antasida DOEN tablet 1000 2000 3000 0 3000 0
11 Asam Folat tablet 0 0 0 0 100
12 Asam Mefenamat 500 mg tablet 1900 1500 3400 2100 1300 2000
13 Atropin Sulfat 0,5 mg tablet 0 0 0 0 0
14 Acyclovir 200 mg tablet 1350 1350 50 1300 0
15 Acyclovir 400 mg tablet 1400 1400 0 1400 0
16 Besi sulfat tablet 1200 3000 4200 600 3600 0
17 Bisacodyl (Laxana) tablet 0 0 0 0 0
18 Buscopan tablet 0 0 0 0 100
19 Captopril 25 mg tablet 1600 800 2400 400 2000 0
20 Captopril 12,5 mg tablet 0 0 0 0 100
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
21 Cefadroxil 500 mg tablet 2050 2050 250 1800 0
22 Chloramphenicol 250 mg tablet 750 750 250 500 0
23 Chloroquin 250 mg tablet 0 0 0 0 0
24 Cimetidine 200 mg tablet 0 0 0 0 0
25 Ciprofloxacin 500 mg tablet 0 1000 1000 100 900 0
26 CTM 4 mg tablet 1000 5000 6000 3000 3000 1500
27 Deksametasone 0,5 mg tablet 400 5000 5400 2700 2700 1400
28 Dekstrometorfan 15 mg tablet 2000 2000 0 2000 0
29 Digoksin 0,25 mg tablet 0 0 0 0 0
30 Dimenhidrinat 50 mg tablet 400 400 0 400 0
31 Domperidone 10 mg tablet 1100 1100 200 900 0
32 Ergotamine Kafein tablet 0 100 100 0 100 0
33 Erythromycin 250 mg tablet 2280 720 3000 120 2880 0
34 Erythromycin 500 mg tablet 0 0 0 0 0
35 Famotidine 20 mg tablet 0 0 0 0 0
36 Furosemide 40 mg tablet 1000 1000 0 1000 0
37 Glibenklamide 5 mg tablet 0 1000 1000 100 900 0
38 Gliseril Guayakolat 100 mg tablet 4000 3000 7000 2000 5000 0
39 Griseofulvin 125 mg tablet 600 600 100 500 0
40 H C T 25 mg tablet 1000 1000 0 1000 0
41 Ibuprofen 200 mg tablet 0 1000 1000 200 800 0
42 Ibuprofen 400 mg tablet 0 1000 1000 0 1000 0
43 Isosorbit Dinitrat 5 mg tablet 400 400 0 400 0
44 Kalnex 500 mg tablet 0 0 0 0 0
45 Kalsium Laktat 500 mg tablet 10000 10000 0 10000 0
46 Ketokonazole 200 mg tablet 150 100 250 50 200 0
47 Komp Pirimetamin Sulfadoksin tablet 0 0 0 0 0
48 Kotrimoksazol 120 mg tablet 800 800 300 500 0
49 Kotrimoksazol 480 mg tablet 0 2000 2000 600 1400 0
50 Loperamid HCL 2 mg (Novadium) tablet 0 400 400 100 300 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
51 Mebendazol tablet 0 0 0 0 0
52 Methylergometrin 0,125 mg tablet 300 300 0 300 0
53 Metoklopramide 10 mg tablet 0 1500 1500 100 1400 0
54 Metronidazol 500 mg tablet 300 500 800 200 600 0
55 Metronidazol 250 mg tablet 0 0 0 0 0
56 Multivitamin (Wishen) kaplet 0 0 0 0 0
57 Natrium diklofenak 50 mg tablet 1050 200 1250 300 950 0
58 Nifedipin 10 mg tablet 900 900 200 700 0
59 Nystatin 500.000 IU tablet 200 200 100 100 100
60 Oralit 200 ml sachet 875 300 1175 225 950 0
61 Papaverin 40 mg tablet 3000 3000 0 3000 0
62 Parasetamol 100 mg tablet 1500 1500 100 1400 0
63 Parasetamol 500 mg tablet 0 10000 10000 2000 8000 0
64 Phenitoin 30 mg tablet 250 250 0 250 0
65 Phenylbutazone 200 mg tablet 0 0 0 0 0
66 Pirantel Pamoat 125 mg tablet 300 300 0 300 0
67 Piroksikam 10 mg tablet 600 300 900 400 500 100
68 Piroksikam 20 mg tablet 520 120 640 0 640 0
69 Prednison 5 mg tablet 5000 5000 1000 4000 0
70 Propanolol 10 mg tablet 0 0 0 0 0
71 Propanolol 40 mg tablet 0 300 300 0 300 0
72 PTU 100 mg tablet 200 200 400 100 300 0
73 Ranitidine 150 mg tablet 4100 4100 500 3600 0
74 Reserpin 0,10 mg tablet 500 500 0 500 0
75 Reserpin 0,25 mg tablet 8000 8000 0 8000 0
76 Salbutamol 2 mg tablet 500 500 1000 200 800 0
77 Salbutamol 4 mg tablet 0 200 200 0 200 0
78 Sulfadimidin 500 mg tablet 0 0 0 0 0
79 Tetrasiklin 250 mg kapsul 3000 3000 0 3000 0
80 Tetrasiklin 500 mg tablet 0 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
81 Zinc 20 Mg tablet 500 200 700 400 300 300
82 Vitamin B Kompleks tablet 3000 5000 8000 3000 5000 0
83 Vitamin B6 10 mg tablet 5000 5000 2000 3000 2000
84 Vitamin B1 50 mg tablet 7000 7000 1000 6000 0
85 Vitamin B12 tablet 8000 8000 1000 7000 0
86 Vitamin C 50 mg tablet 5000 5000 10000 4000 6000 0
87 Vitamin K 10 mg tablet 0 0 0 0 300
OBAT JENIS SIRUP
88 Ambroksol sirup btl 0 300 300 20 280 0
89 Amoxicillin SK 125 mg/ 5 ml btl @ 60 ml 85 150 235 100 135 120
90 Amoxicillin SK 250 mg/ 5 ml btl @ 60 ml 0 0 0 0 120
91 Ampisilin Sirup Kering btl 0 0 0 0 0
92 Antasida suspensi btl 110 60 170 48 122 0
93 Besi Sulfat Syrup btl 0 0 0 0 0
94 Cefadroxil Syrup Kering btl 0 100 100 10 90 0
95 Chloramphenicol Syrup btl 0 0 0 0 10
96 Dekstrometorfan sirup btl 60 ml 81 81 8 73 0
97 Ibuprofen Syrup Botol 34 34 10 24 0
98 Kotrimoksazol suspensi btl 60 ml 7 100 107 37 70 0
99 Multivitamin Syrup (Pediagrow) btl 0 0 0 0 20
100 Gliserin 100 ml 10 10 0 10 0
101 OBH Sirup btl 88 88 10 78 0
102 Parasetamol Sirup btl 60 ml 15 15 15 0 100
OBAT NAPZA
103 Diazepam 2 mg tablet 297 297 67
104 Diazepam 5 mg tablet 0 0 0
105 Diazepam Inj amp 0 0 0 ED
106 Efedrin 25 mg tablet 6740 6740 6740
107 Fenobarbital 30 mg tablet 893 893 893
108 Fenobarbital Injeksi amp 25 25 25
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
109 Fenitoin inj amp 0 0 0
110 Haloperidol 5 mg tablet 0 0 0
111 Klorpromazin 100 mg tablet 0 0 0
112 Klorpromazin 25 mg tablet 847 847 847
113 Kodein 10 mg tablet 200 200 200
OBAT TB PARU
114 Ethambutol 250 mg tablet 0 0 0 0 0
115 I N H 100 mg tablet 0 0 0 0 0
116 I N H 300 mg tablet 0 0 0 0 0
117 Pirazinamid 500 mg tablet 160 160 0 160 0
118 Rifampisin 450 mg tablet 0 0 0 0 0
OBAT LUAR
119 Aqudes Steril 500 ml btl 0 0 0 0 0
120 Alkohol 70 % 1000 ml Btl 0 0 0 0 10
121 Acyclovir Cream Tube 0 100 100 0 100 0
122 Anti Hemoroid Supp 0 0 0 0 50
123 Bacitracin-Polymyxin B Tube 25 25 0 25 75
124 Betametasone Krim Tube 0 100 100 10 90 0
125 Borax Gliserin sol Btl 0 0 0 0 0
126 Etil Klorida Spray Btl 100 ml 4 4 2 2 3
127 Fenol Gliserol Tts Telinga Btl 17 17 4 13 0
128 Formalin tab 1 Gram tablet 500 500 0 500 0
129 Gentamycin Salep Kulit Tube 70 70 10 60 0
130 Gentamycin Tetes Mata Steril 0,3 % botol 70 70 20 50 0
131 Gentian Violet Sol Btl 24 48 72 5 67 0
132 Gliserin Btl @ 10 ml 0 0 0 0 0
133 Hydrocortisone Cream 2,5% tube 0 120 120 48 72 24
134 Ichtyol Salep 10 gr Pot 0 0 0 0
135 Kalium Permanganat Pot 42 42 0 42 0
136 Kloramfenikol Salep Kulit (Farsycol) Tube @ 10 gr 0 0 0 0 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
137 Kloramfenikol Salep Mata 1 % Tube 173 173 0 173 0
138 Kloramfenikol tetes Mata btl 0 0 0 0 0
139 Kloramfenikol Tetes Telinga Btl 129 129 0 129 0
140 Lisol 1000 ml Btl 8 8 1 7 0
141 Mikonazole Krim Tube 0 96 96 5 91 0
142 Oksitetrasiklin Salep Kulit 3 % Tube 19 19 19 0 48
143 Oksitetrasiklin Salep Mata 1 % Tube 97 97 0 97 0
144 Rivanol 1 % 300 ml Btl 9 9 0 9 0
145 Salisil Bedak kotak 26 26 0 26 0
146 Salisilat Belerang Salep pot 26 24 50 10 40 0
147 Yodium Povidone Sol 1000 ml Btl 0 0 0 0 0
148 Yodium Povidone Sol 300 ml Btl 0 10 10 3 7 0
149 Yodium Povidon Sol 30 ml Btl 0 0 0 0 0
OBAT SUNTIK
150 Adidryl Injeksi vial 0 0 0 0 0
151 Adimidon Injeksi vial 0 0 0 0 0
152 Aqua Pro Inj amp 15 15 0 15 0
153 Aminofilin inj amp 24 24 0 24 0
154 Antalgin inj amp 60 60 0 60 0
155 Buscopan Injeksi amp 5 5 5 0 5
156 Cefotaxim inj amp 0 0 0 0 0
157 Cortison inj amp 14 14 0 14 0
158 Deksametasone Inj amp 290 290 0 290 0
159 Dextrose 5 % - Nacl 0,45 % kolf 0 0 0 0 0
160 Dextrose 5 % - Nacl 1/4 kolf 0 0 0 0 0
161 Dextrose 5 % kolf 33 33 26 7 40
162 Dextrose 10 % kolf 0 0 0 0 10
163 Difenhidramin Inj amp 85 85 5 80 0
164 Ephinephrin Injeksi amp 0 0 0 0 0
165 Ketorolac Injeksi amp 12 12 24 0 24 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
166 Lidokain Inj amp 0 1000 1000 15 985 0
167 Lidokain comp amp 0 90 90 0 90 0
168 Metoklorpramide injeksi amp 24 24 6 18 0
169 Metil ergometrin inj amp 0 20 20 0 20 0
170 Natrium Klorida Infus kolf 170 170 0 170 0
171 Natrium Tiosulfat Injeksi amp 0 0 0 0 0
172 Neurobion Injeksi amp 0 0 0 0 0
173 Oxytetracyclin Injeksi vial 0 0 0 0 0
174 Oxytocin Injeksi amp 0 12 12 0 12 0
175 Papaverin inj amp 161 161 0 161 0
176 Ranitidine Injeksi amp 30 30 0 30 0
177 Ringer Laktat Infus kolf 145 145 18 127 0
178 Sabu 5 ml Injeksi vial 0 0 0 0 3
179 Vitamin B1 inj amp 80 80 0 80 0
180 Vitamin B 12 inj amp 145 145 10 135 0
181 Vitamin K Injeksi Amp 0 0 0 0 0
182 Vitamin C Inj Amp 24 24 1 23 0
ALKES HABIS PAKAI
183 Abbocath No.18 Pcs 16 16 0 16 0
184 Abbocath No. 20 Pcs 103 103 0 103 0
185 Abbocath No. 22 Pcs 43 43 0 43 0
186 Abbocath No.24 Pcs 41 41 0 41 0
187 Alat Suntik 1 ml Pcs 445 445 10 435 0
188 Alat Suntik 2,5 ml Pcs 0 0 0 0 300
189 Alat Suntik 3 ml Pcs 120 120 20 100 500
190 Alat Suntik 5 ml Pcs 100 1000 1100 5 1095 0
191 Alat Suntik 10 ml Pcs 58 58 0 58 0
192 Alat Suntik 20 ml Pcs 0 0 0 0 0
193 catgut plain 3/0 70 cm Pcs 0 0 0 0 50
194 Catgut Chromic No. 3/0 70 cm Pcs 0 0 0 0 50
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
195 Catgut Chromic No. 3/0 75 cm Pcs 0 0 0 0 50
196 Catgut Chromic No. 4/0 150 cm Pcs 0 0 0 0 50
197 Hand Schoen No 7 Pasang 0 0 0 0 500
198 Hand Schoen No 7,5 Pasang 0 0 0 0 500
199 Hand Schoen No 8 Pasang 0 0 0 0 0
200 Hypafix 5 cm Roll 0 0 0 0 0
201 Infus Set Anak Pcs 138 138 0 138 0
202 Infus Set Dewasa Pcs 156 156 18 138 0
203 Jarum Bedah Pcs 0 0 0 0 0
204 Kapas Pembalut 250 gram Bks 22 22 3 19 0
205 Kasa 2 y x 80 cm Roll 1 1 1 0 2
206 Kasa 5 cm x 80 cm Roll 0 0 0 0
207 Kasa Kompres 40 x40 Roll 45 45 0 45 0
208 Kasa Pemb 40 x 80 cm Roll 5 5 2 3 5
209 Kasa Steril 16 x 16 ktk/100 lbr 35 15 50 5 45 0
210 Kasa Hidrofil 4 x 15 cm Roll 0 0 0 0 5
211 Kasa Pembalut 4 x 3 cm Roll 0 0 0 0 5
212 Masker Box/50 Pcs 50 50 0 50 0
213 Nald Hecting Otot (Jarum Kulit) Set/12 pcs 0 0 0 12
214 Nald Hecting No. 9 pcs 12 12 0 12 0
215 Nald Hecting No 13 Pcs 0 0 0 0 12
216 Nald Hecting No 11 Pcs 24 24 0 24 0
217 Nald hacting no 7 Set 12 12 0 12 0
218 NGT No. 16 (Feeding Tube) Set 0 0 0 0 2
219 Nald No. 23 Pcs 0 0 0 0 200
220 Nald No. 24 Pcs 0 0 0 0 200
221 Scalvein No. 23 Pcs 0 0 0 0 0
222 Silk No. 3/0 150 cm Pcs 0 0 0 0 0
223 Silk Black No. 3/0 75 cm (35 mm) Pcs 0 0 0 0 0
224 Silk Black No. 3/0 75 cm (26 mm) Pcs 0 108 0 0 108 0
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
225 Plester 5 Yard x 2 Inch Roll 4 6 10 1 9 0
TAMBAHAN
226 Anti fungi DOEN pot 44 44 0 44 0 ED
227 Pharmafix 2,5 cm x 5 mtr Roll 0 0 0 0 0
228 Pharmafix 5 cm x 5 mtr Roll 0 0 0 0 0
229 Pharmafix 10 cm x 5 mtr Roll 0 0 0 0 0
230 Gemfibrozil 500 mg tablet 240 240 0 240 0
231 PCT Drop 100mg/ml tablet 0 0 0 0 50
232 Glokosamine tablet 120 120 120 0 210
233 Ampicillin Injeksi (Vicillin) vial 110 110 0 110 0 dari KIA
234 Gentamycin Injeksi amp 140 140 0 140 0 dari KIA
235 Cetirizin syirup botol 29 29 6 23 0
236 Piracetam 1200 mg tablet 40 40 0 40 0
237 Urine Bag Set 0 0 0 0 0
238 Elastic Verban 7,5 cm x 4,5 M Roll 0 0 0 0 5
239 Foley Catheter No.16 pcs 4 4 0 4 0
240 Foley Catheter No.18 pcs 2 2 0 2 0
241 Kanamycin 1 gr Injeksi vial 0 0 0 0 10
242 Loratadin tablet 250 250 100 150 0
243 Sacorit tablet 0 0 0 0 500
244 Metoklopramide injeksi amp 24 24 6 18 0
245 Cairan infus DBD (Widahes 130) botol 5 5 0 5 0
246 Asetosal tablet 200 200 0 200 0
247 Cetirizin 10 mg botol 0 2000 2000 200 1800 0
248 Lansoprazole 30 mg tablet 80 80 20 60 0
249 H2O2 800 ml botol 9 9 0 9 0
250 Bisturi kotak 0 0 0 50
251 Cetirizine Syrup botol 0 0 0 0 0 0
252 Ketokonazol slp kulit 2% Tube 17 17 7 10 0
Umum
ASKES Jumlah
 PEMBERIAN
NO NAMA OBAT SATUAN STOK AWAL PENERIMA PERSEDI PEMAKAI SISA STOK PERMINTA JUMLAH KETERANG
AN AAN AN STOK OPT AN INPRES ASKES APBD I APBD II LAIN2 AN
1 2 3 4 5 6=(4+5) 7=(6-8) 8 9 10 11 12 13 14 15 16 17
ASKES Jumlah
Bayar Tidak Bayar
Jumlah Kunjungan Resep

Mengetahui/Menyetujui Yang Menyerahkan Yang Menerima

Yang Meminta Kepala Dinkes II / GFK Petugas GFK Penanggungjawab Apotik
Pimpinan Puskesmas

(…………………………………………) (………………………………….) [Link] Syahdiana S,farm.,Apt

Dr. Herlina Barends NIP. NIP. NIP. 19811223200902 2 005
NIP. 19670726 199903 2 003
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT APOTIK BENING

APOTIK : BENING PELAPORAN BULAN : Sep-12

KABUPATEN : NUNUKAN PERMINTAAN BULAN/PERIODE :

SISA TOTAL STOK OPT TOTAL

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

JENIS TABLET/KAPSUL/KAPLET
1 Albendazole 30 500 15000
2 Acyclovir tablet 0 10 4000 40000 0
3 Acyclovir 400 mg tablet 0 60 950 57000 0
4 Allohex tablet 0 3 14500 43500 0
5 Allopurinol 100 mg tablet 0 240 300 72000 0
6 Allopurinol 300 mg tablet 0 190 300 57000 0
7 Aloclair tablet 0 2 93000 186000 0
8 Aloclair Plus tablet 0 3 105000 315000 0
9 Alodan 300 mg tablet 0 80 500 40000 0
10 Alpara 668 700 467600
11 Ambroksol 30 mg tablet 0 342 250 85500 0
12 Amlodipine 10 mg tablet 0 66 3000 198000 0
13 Amlodipine 5 mg tablet 0 80 2100 168000 0
14 Amoxicillin 250 mg tablet 0 150 500 75000 0
15 Amoxicillin 500 mg tablet 0 1249 600 749400 0
16 Amoxsan 27 4000 108000
17 Andalan tablet 0 301 4000 1204000 0
18 Andalan Laktasi tablet 0 5 14000 70000 0
19 Anflat tablet 0 80 600 48000 0
20 Antasida DOEN tablet 0 5 150 750 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

21 Asam Mefenamat 500 mg tablet 0 102 250 25500 0
22 Becom-C tablet 0 104 1500 156000 0
23 Becom-Zet tablet 0 64 1900 121600 0
24 Betahistine tablet 0 10 1000 10000 0
25 Bronsolvan tablet 0 54 500 27000 0
26 Buscopan Plus tablet 0 90 3650 328500 0
27 Captopril 12.5 mg 76 200 15200
28 Captopril 25 mg tablet 0 270 200 54000 0
29 Cardisan 5 mg tablet 0 30 5600 168000 0
30 Cardivask 10 mg tablet 0 13 11000 143000 0
31 Cefadroxil tablet 0 6 1200 7200 0
32 Cefixime tablet 0 50 2500 125000 0
33 Cetirizine tablet 0 240 500 120000 0
34 Cimetidine 190 200 38000
35 Ciprofloxacin 500 mg tablet 0 76 500 38000 0
36 Cotrimoxazole 400 mg tablet 0 70 500 35000 0
37 Cotrimoxazole Pediatrik tablet 0 100 150 15000 0
38 Curcuma tablet 0 100 750 75000 0
39 Dextamine tablet 0 229 2300 526700 0
40 Divoltar tablet 0 0 700 0 0
41 Domperidone 140 600 84000
42 Doxycycline tablet 0 210 500 105000 0
43 Elkana tablet 0 43 750 32250 0
44 Enzymfort tablet 0 36 650 23400 0
45 Ethambutol 500 mg tablet 0 40 900 36000 0
46 Farmoxyl tablet 0 420 2500 1050000 0
47 Farsorbid 10 mg tablet 0 90 550 49500 0
48 Farsorbid 5 mg tablet 0 0 300 0 0
49 Fexazol tablet 0 0 2300 0 0
50 FG Troches tablet 0 310 1100 341000 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

51 Flucadex tablet 0 0 500 0 0
52 Flunarizine 80 1300 104000
53 Folavit tablet 0 60 900 54000 0
54 Forres kaplet 0 30 4300 129000 0
55 Forten 12,5 mg tablet 0 16 350 5600 0
56 Forten 25 mg tablet 0 9 450 4050 0
57 Furosemide tablet 0 190 200 38000 0
58 Girabloc sachet 0 47 2100 98700 0
59 Glibenclamide tablet 0 110 200 22000 0
60 Glimepiride 1 mg tablet 0 130 1500 195000 0
61 Glimepiride 2 mg tablet 0 230 2300 529000 0
62 Glimepiride 3 mg tablet 0 110 2900 319000 0
63 Griseofulvin 125 mg tablet 0 258 300 77400 0
64 Hepatin tablet 0 18 2600 46800 0
65 Hexavask 10 mg tablet 0 0 3500 0 0
66 Hexavask 5 mg tablet 0 82 2500 205000 0
67 Hexer tablet 0 34 5000 170000 0
68 Hextrofen tablet 0 35 1500 52500 0
69 Histapan tablet 0 230 700 161000 0
70 Histigo tablet 0 2 500 1000 0
71 Ibuprofen tablet 0 200 250 50000 0
72 Imboost tablet 0 48 6000 288000 0
73 Incidal-OD tablet 0 164 3000 492000 0
74 Infantrim tablet 0 68 500 34000 0
75 Isosorbide Dinitrat tablet 0 100 850 85000 0
76 Ketokonazol tablet 0 100 465 46500 0
77 Lansoprazole 30 mg kapsul 0 0 3200 0 0
78 Levofloxacin tablet 0 90 1700 153000 0
79 Lexacrol tablet 0 1155 500 577500 0
80 Librocef tablet 0 73 2800 204400 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

81 Librodan tablet 0 8 4000 32000 0
82 Lodia tablet 0 36 1100 39600 0
83 Loratadin tablet 0 40 500 20000 0
84 Mediamer 50 3000 150000
85 Mefentan tablet 0 3 500 1500 0
86 Mefinal tablet 0 78 1500 117000 0
87 Meloxicam 15 mg tablet 0 28 1900 53200 0
88 Meloxicam 7,5 mg tablet 0 26 1200 31200 0
89 Metformin tablet 0 270 300 81000 0
90 Methylprednisolone tablet 0 174 750 130500 0
91 Metoclopramide tablet 0 72 250 18000 0
92 Metronidazole tablet 0 138 300 41400 0
93 Microgynon tablet 0 40 12000 480000 0
94 Mikrodiol tablet 0 1 9000 9000 0
95 Molacort 0.5 mg tablet 0 613 200 122600 0
96 Molacort 0.75 mg tablet 0 2060 250 515000 0
97 Molexflu tablet 0 390 500 195000 0
98 Mucosolvan tablet 0 56 1300 72800 0
99 Mycoral 200 mg tablet 0 11 5000 55000 0
100 Na Diklofenak 50 mg tablet 0 0 350 0 0
101 Nairet tablet 0 40 800 32000 0
102 Nasaflam tablet 0 37 2500 92500 0
103 Neuralgin tablet 0 410 500 205000 0
104 Neurosanbe tablet 0 115 1100 126500 0
105 Neurosanbe 5000 tablet 0 40 2400 96000 0
106 Nifedipine tablet 0 0 250 0 0
107 Normastin tablet 0 100 500 50000 0
108 Nystatin tablet 0 100 4000 400000 0
109 Ofloxacin tablet 0 10 750 7500 0
110 Phenobiotic tablet 0 97 1000 97000 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

111 Piroxicam 10 mg tablet 0 160 250 40000 0
112 Piroxicam 20 mg tablet 0 90 250 22500 0
113 Plasminex tablet 0 70 2900 203000 0
114 Polysilane tablet 0 8 950 7600 0
115 Poncofen tablet 0 2 1000 2000 0
116 Ponstan 500 mg tablet 0 116 2500 290000 0
117 Primolut tablet 0 2 55000 110000 0
118 Pritacort tablet 0 474 600 284400 0
119 Pritagesic tablet 0 50 450 22500 0
120 Pritamox 500 mg tablet 0 57 1900 108300 0
121 Propanolol tablet 0 90 250 22500 0
122 Pyrazinamide tablet 0 0 350 0 0
123 Ranitidine tablet 0 406 300 121800 0
124 Recolfar tablet 0 30 5000 150000 0
125 Renadinac 25 mg tablet 0 40 600 24000 0
126 Renadinac 50 mg tablet 0 160 800 128000 0
127 Salbron 2 mg tablet 0 0 350 0 0
128 Salbron 4 mg tablet 0 0 400 0 0
129 Salbutamol 4 mg tablet 0 0 200 0 0
130 Sanexon 100 2400 240000
131 Sanmol tablet 0 48 500 24000 0
132 Sanprima tablet 0 182 2300 418600 0
133 Santa E tablet 0 64 4000 256000 0
134 Scopamin tablet 0 0 1000 0 0
135 Simvastatin 10 mg tablet 0 0 800 0 0
136 Simvastatin 20 mg tablet 0 0 1400 0 0
137 Sulfitis tablet 0 30 4900 147000 0
138 Supertetra tablet 0 159 1000 159000 0
139 Tetracycline kapsul 0 84 400 33600 0
140 Titan tablet 0 124 1100 136400 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

141 Topcillin tablet 0 4 1000 4000 0
142 Tramadol tablet 0 45 500 22500 0
143 Transmuco tablet 0 330 600 198000 0
144 Tremenza tablet 0 40 1100 44000 0
145 Trichodazole 100 1900 190000
146 Trogyl tablet 0 0 1000 0 0
147 Vacontil tablet 0 0 1300 0 0
148 Venosmil tablet 0 0 8500 0 0
149 Voltaren 139 6500 903500
150 Vomina tablet 0 0 950 0 0
151 Vosedon 200 2400 480000
OBAT JENIS SIRUP
1 Amoxicillin 8 6000
2 Amoxsan Dry btl 0 8 27500 220000 0
3 Amoxsan Forte btl 0 3 39000 117000 0
4 Amoxsan Paed btl 0 5 27500 137500 0
5 Anflat btl 0 2 17000 34000 0
6 Antasida DOEN btl 0 4 5000 20000 0
7 Cefadroxil btl 0 0 13000 0 0
8 Cefixime btl 0 1 45000 45000 0
9 Cotrimoxazole 8 5000 40000
10 Epexol btl 0 0 20000 0 0
11 Etamox btl 0 3 18000 54000 0
12 Farmadol btl 0 4 70000 280000 0
13 Infantrim btl 0 2 8000 16000 0
14 Inpepsa btl 0 2 63000 126000 0
15 Paracetamol 9 4000 36000
16 Polysilane btl 0 2 22000 44000 0
17 Salbron btl 0 1 21500 21500 0
18 Sanadryl btl 0 3 10000 30000 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

19 Sanadryl DMP btl 0 0 11000 0 0
20 Sanmol btl 0 18 13000 234000 0
21 Sanprima btl 0 3 26000 78000 0
22 Silex 1 40000 40000
23 Staforin 125 btl 0 0 48000 0 0
24 Staforin 250 btl 0 3 85000 255000 0
25 Vomina btl 0 1 13000 13000 0
26 Vosedon btl 0 0 30500 0 0
OBAT NAPZA
1 Analsik tablet 0 0 1200 0 0
2 Braxidin tablet 0 10 900 9000 0
3 Codein tablet 0 147 500 73500 0
4 Efedrin tablet 0 97 0 0 0
5 Opineuron tablet 0 0 1500 0 0
6 Trazep 2 mg tube 0 1 24000 24000 0
7 Valisanbe 2 mg tablet 0 52 700 36400 0
8 Zypraz 60 2500 150000
OBAT LUAR
1 Benoson-G tube 0 1 50000 50000 0
2 Benoson-M tube 0 0 43000 0 0
3 Bersol tube 0 3 18500 55500 0
4 Betamethasone tube 0 36 3000 108000 0
5 Bioplacenton tube 0 4 16000 64000 0
6 Burnazin tube 0 2 52000 104000 0
7 Carmed tube 0 2 36000 72000 0
8 Chloramphenicol TM btl 0 4 2000 8000 0
9 Ethyl btl 0 1 142000 142000 0
10 Formyco tube 0 2 21000 42000 0
11 Forumen btl 0 3 29000 87000 0
12 Fuson tube 0 5 40000 200000 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

13 Gentiderm tube 0 0 5000 0 0
14 Isotic Neolyson btl 0 3 32000 96000 0
15 Lexacorton tube 0 5 6000 30000 0
16 MediKlin tube 0 2 21000 42000 0
17 MediKlin TR tube 0 1 38000 38000 0
18 Melanox tube 0 0 28000 0 0
19 Miconazole tube 0 39 4500 175500 0
20 Mofacort tube 0 6 66000 396000 0
21 Molakrim tube 0 0 11000 0 0
22 Mycoral tube 0 1 12500 12500 0
23 Nymiko btl 0 2 37500 75000 0
24 Oviskin tube 0 8 14000 112000 0
25 Oviskin-N tube 0 11 10000 110000 0
26 Oxytetracycline tube 0 21 2000 42000 0
27 Scabicid tube 0 12 10000 120000 0
28 Scabimite tube 0 3 34000 102000 0
OBAT SUNTIK
1 Andalan (3 bulan) vial 0 525 8000 4200000 0
2 Ceftriaxone vial 0 0 20000 0 0
3 Farbion amp 0 11 6500 71500 0
4 Farpain amp 0 3 37000 111000 0
5 Kalmethasone amp 0 33 8000 264000 0
6 Kanamycin vial 0 9 15000 135000 0
7 Ketorolac amp 0 2 18000 36000 0
8 Neurotam amp 0 7 57000 399000 0
ALKES HABIS PAKAI
1 Abocath 20G pcs 0 1 24000 24000 0
2 Abocath 22G pcs 0 5 24000 120000 0
3 Abocath 24 1 0 0
4 Abocath 26G pcs 0 0 33000 0 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

5 Alkohol 70% 100 ml pcs 0 32 5000 160000 0
6 Alkohol 70% 1000 ml pcs 0 0 43000 0 0
7 Alkohol 70% 300 ml pcs 0 0 12000 0 0
8 Alkohol 95% 100 ml pcs 0 8 6000 48000 0
9 Alkohol 95% 300 ml pcs 0 6 15000 90000 0
10 Blood Lancet GEA pcs 0 2 22000 44000 0
11 Blood Set Otsuka pcs 0 1 30000 30000 0
12 Botol Semprot Spray pcs 0 0 8000 0 0
13 Confidence Size L-1 pcs 0 0 5500 0 0
14 Confidence Size L-10 pcs 0 0 45000 0 0
15 Cotton Buds Besar pcs 0 8 3000 24000 0
16 Daryant-Tulle Sulfate pcs 0 7 18000 126000 0
17 Dermafix-T 10x25 pcs 0 5 19000 95000 0
18 Dermafix-T 5x7 pcs 0 36 3000 108000 0
19 Dispo 1 cc pcs 0 153 1000 153000 0
20 Dispo 3 c pcs 0 155 2000 310000 0
21 Dispo 5 cc pcs 0 49 3000 147000 0
22 Disposable Infusion pcs 0 2 10000 20000 0
23 Elektroda 6 9000 54000
24 Elisabeth Cotton buds pcs 0 1 2000 2000 0
25 Folley Catheter No. 16 pcs 0 1 30000 30000 0
26 Folley Catheter No. 18 pcs 0 1 30000 30000 0
27 Gunting Kuku Mercy pcs 0 4 8000 32000 0
28 Hansaplast Roll pcs 0 58 3000 174000 0
29 Isoplast 1.25 cmx 1 m pcs 0 0 5000 0 0
30 Isoplast 2.5 cmx 4.5 m pcs 0 6 10000 60000 0
31 Kapas Bola pcs 0 1 13000 13000 0
32 Kapas Pembalut 50 g pcs 0 0 6500 0 0
33 Kapas Putih 25 g pcs 0 0 3000 0 0
34 Kapas Wajah Besar pcs 0 0 7000 0 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

35 Kapas Wajah Kecil pcs 0 0 5000 0 0
36 Kasa Husada pcs 0 15 7000 105000 0
37 Kruk Al Import Uk. M pcs 0 0 350000 0 0
38 Kursi Roda pcs 0 0 1450000 0 0
39 LED Penlight pcs 0 3 36000 108000 0
40 Leukoplast 2.5 cmx 4.5 m pcs 0 9 23000 207000 0
41 Lumpang Besar 1 0 0
42 Lumpang Kecil 1 0 0
43 Masker Fancy Jeva pcs 0 7 8000 56000 0
44 Masker Tali Deluxe OM pcs 0 32 1500 48000 0
45 Masker Warna pcs 0 0 2000 0 0
46 Medicreepe 3 1 24000 24000
47 Medicreepe 4.5 4 33000 132000
48 Medicreepe 6 4 38000 152000
49 Mitela 1 13000 13000
50 Needle Terumo 23 pcs 0 600 1000 600000 0
51 Needle Terumo 24 pcs 0 681 1000 681000 0
52 Nesco Lancing Device pcs 0 0 0 0 0
53 Nesco Multicheck Kit pcs 0 1 780000 780000 0
54 New Born pcs 0 0 0 0 0
55 Oxycan pcs 0 3 34000 102000 0
56 Plester Betadine pcs 0 0 500 0 0
57 Rivanol 300 ml pcs 0 12 6000 72000 0
58 S. T. Obgyn pcs 0 3 16000 48000 0
59 Sensi Gloves pcs 0 137 2000 274000 0
60 Sensi Gloves Psg pcs 0 137 2000 274000 0
61 Stethoscope Onemed pcs 0 1 71000 71000 0
62 StickPan Plastik pcs 0 0 0 0 0
63 Sweety Size L-10 pcs 0 26 2000 52000 0
64 Sweety Size S-10 pcs 0 48 2000 96000 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

65 Tempat Bedak pcs 0 2 10000 20000 0
66 Tempat Krim Isi 2 pcs 0 0 8000 0 0
67 Tempat Obat Isi 3 pcs 0 8 10000 80000 0
68 Tensi Clock 200 Onemed pcs 0 0 88000 0 0
69 Tensi Digital Omron pcs 0 0 715000 0 0
70 Thermometer FlexiTemp 5 59000 295000
71 Thermometer Jumbo HP OM pcs 0 4 12000 48000 0
72 Timbangan Dewasa Onemed pcs 0 2 130000 260000 0
73 Tongkat Lipat pcs 0 1 185000 185000 0
74 Tongkat Piramida pcs 0 1 200000 200000 0
75 Tweezer pcs 0 4 20000 80000 0
76 Ukuran Tinggi Badan AMS pcs 0 0 50000 0 0
77 Umbilical Cord Klem pcs 0 50 5000 250000 0
78 Urin Bag pcs 0 0 7000 0 0
79 Urinal Plastik Pria pcs 0 4 15000 60000 0
80 Urinal Wanita 2 15000 30000
81 Verban 10 cm pcs 0 22 2000 44000 0
82 Verban 5 cm pcs 0 32 1000 32000 0
83 Walker Deluxe Onemed pcs 0 0 600000 0 0
84 Winged Infusion Set No. 23 pcs 0 2 14000 28000 0
85 Winged Infusion Set No. 25 pcs 0 2 14000 28000 0
86 Winged Infusion Set No. 27 pcs 0 0 14000 0 0
87 You-You pcs 0 0 15000 0 0
ETALASE 1
1 Air Zam-Zam 1 50000
2 Ambeven 0 28 14000 392000 0
3 Antangin 0 2500
4 Antimo 53 5000
5 Antimo Anak 28 1500
6 Asmasolon 0 21 2000 42000 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

7 Baby Lon Oil 11000
8 Baby Test 53000
9 Balsem Activ
10 Balsem Cap Kaki 3
11 Balsem Geliga
12 Balsem Lang
13 Betadin 60 ml 0 4 0 0
14 Betadin cr 0 0 0
15 Biogesic
16 Bodrex
17 Bodrex Flu & Batuk Berdahak 0 1 0 0
18 Bodrex Flu & Batuk Tidak Berdahak 0 10 13000 130000 0
19 Bodrex Migra
20 Bodrex X-Tra
21 Bodrexin
22 Bodrexin Vaporub
23 Borax
24 Callusol
25 Canesten Cream
26 CDR
27 CDR Fortos
28 Cerebrofort Ginkgo
29 Cerebrofort X-cel
30 Combantrin
31 Combantrin Syr
32 Contrexin
33 Counterpain 100 g
34 Counterpain 15 g
35 Counterpain 30 g
36 Counterpain 5 g
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

37 Counterpain 60 g
38 Counterpain Cool
39 Creobic
40 CTM
41 Daktarin Baby
42 Daktarin Cream
43 Decolgen
44 Decolsin
45 Diapet 0 8 15000 120000 0
46 Diapet NR 0 0 0
47 Diatab 0 7 7500 52500 0
48 Dulcolax 10's
49 Dulcolax 4's
50 EM Kapsul
51 Enervon C
52 Entrostop
53 Entrostop Anak 0 27 10000 270000 0
54 Enzim 40 Plus 50 ml 0 3 4000 12000 0
55 Enzim 40 Plus 100 ml 0 4 4000 16000 0
56 Enzim Mild 0 7 10500 73500 0
57 Enzim Mint 0 21 27000 567000 0
58 Enzyplex
59 Equal
60 Ever e 30's
61 Ever e 4's
62 Ever Green
63 Ever Joy
64 Fasgo
65 Fatigon
66 Fatigon Spirit
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

67 Feminax
68 Fevrin
69 Fitkom Fruit & Vegie
70 Fludane
71 Fresh Care
72 Froz
73 Gentian Violet
74 Gentong Mas
75 Green Oil Herbal
76 Hansaplast Strip 0 0 0
77 Hansaplast Strip Kid 0 76 3000 228000 0
78 Hemaviton Action 30's
79 Hemaviton Action
80 Hemaviton Skin
81 Hemaviton Stamina
82 Hemaviton Stamina Plus 30's 0 5 11000 55000 0
83 Hexos
84 Holisticare
85 Hormoviton
86 Huki Baby M
87 Huki Baby S
88 Inza
89 Inzana
90 Jhonson Gift Pack Small
91 Kalpanax Cair
92 Kalpanax Cream
93 Kana Cream
94 Keji Beling
95 Kina 0 5 8000 40000 0
96 Komix Jahe
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

97 Komix Jeruk Nipis
98 Komix Kid Madu
99 Komix Kid Strawberry
100 Komix OBH 0 0 0
101 Komix Peppermint 0 0 0
102 Kondom Andalan
103 Kondom Fiesta All Night
104 Kondom Fiesta Baggy
105 Kondom Fiesta Banana
106 Kondom Fiesta Classic
107 Kondom Fiesta Dotted
108 Kondom Fiesta Durian
109 Kondom Fiesta Mint
110 Kondom Fiesta Passion
111 Kondom Fiesta Strwaberry
112 Kondom Fiesta Ultra Safe
113 Kondom Fiesta Ultra Thin
114 Kondom Sutra Import
115 Kondom Sutra OK
116 Kondom Sutra RM
117 Konicare Gel
118 Konicare Telon
119 Konicare Telon Plus
120 Konidin
121 Kool Fever Anak 0 94 2000 188000 0
122 Kool Fever Baby
123 Koyo Cabe
124 Kuku Bima Nanas
125 Kuku Bima Orange
126 Kunyit Asam
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

127 Laxing
128 Lelap
129 Madu Asli Barokah
130 Mamy Poko Tisu Basah
131 Mexaquin
132 Mextril BDF
133 Microlax
134 Mikorex 0 0 0
135 Minyak Angin Kapak
136 Minyak Angin Lang 3 ml
137 Minyak Angin Lang 6 ml
138 Minyak Batu Besar
139 Minyak Gandapura
140 Minyak Geliga 30 ml 0 0 0
141 Minyak Geliga 60 ml
142 Minyak GPU
143 Minyak GPU Kecil
144 Minyak Kayu Putih 15 ml 0 4 14000 56000 0
145 Minyak Kayu Putih 120 ml
146 Minyak Kayu Putih 30 ml
147 Minyak Kayu Putih 60 ml
148 Minyak Kayu Putih Kaca 0 1 50000 50000 0
149 Minyak Sereh 30 ml 0 2 14000 28000 0
150 Minyak Sereh 60 ml 0 0 0
151 Minyak Tawon CC 0 0 0
152 Minyak Tawon DD 0 53 5000 265000 0
153 Minyak Tawon EE 0 28 1500 42000 0
154 Minyak Tawon FF 0 50 2000 100000 0
155 Minyak Telon Hasna 0 3 11000 33000 0
156 Minyak Telon Lang 30 ml 0 4 26000 104000 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

157 Minyak Telon Lang 60 ml 0 2 20000 40000 0
158 Mixagrip 0 0 0
159 Mixagrip Flu 0 6 10000 60000 0
160 Mixagrip Pegal Linu 0 2 16000 32000 0
161 My Baby Paket Besar 0 7 10000 70000 0
162 My Baby Paket Kecil 0 0 0
163 My Baby Skin Lotion 0 4 6000 24000 0
164 My Baby Telon 0 0 0
165 Mylanta 150 ml 0 44 2000 88000 0
166 Mylanta 50 ml 0 96 350 33600 0
167 Mylanta tab 0 1 26000 26000 0
168 Napacin 0 54 2000 108000 0
169 Natur e 0 200 0 0
170 Neo Hormoviton Drink 0 0 0
171 Neo Ultracillin 0 1 13000 13000 0
172 Neozep 0 4 4000 16000 0
173 Neurobion 5000 0 3 29000 87000 0
174 Norit 0 4 18500 74000 0
175 Obahama 0 3 30000 90000 0
176 Obat Gosok Dewi Bulan 0 2 35000 70000 0
177 Obat Kurap 19 0 2 16000 32000 0
178 Obat Kurap Kaki 3 Cair 0 10 16000 160000 0
179 Obat Sakit Gigi Cap Kakak Tua 0 19 16000 304000 0
180 Obat Sakit Kepala 19 0 0 0
181 Obat Sariawan Houfeng 0 13 13000 169000 0
182 Oralit 0 0 0
183 Oskadon 0 4 79000 316000 0
184 Pagoda Permen 0 14 38000 532000 0
185 Pagoda Salep 0 3 23000 69000 0
186 Panadol Anak 0 36000 0 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

187 Panadol Batuk Berdahak 0 6 14500 87000 0
188 Panadol Batuk Tidak Berdahak 0 4 59500 238000 0
189 Panadol Cold 0 2 23500 47000 0
190 Panadol Original 0 0 0
191 Panadol Soluble 0 19 1000 19000 0
192 Panadol X-Tra 0 10 65000 650000 0
193 Paramex 0 0 0
194 Paratusin 0 27 2000 54000 0
195 Peditox 0 10 2500 25000 0
196 Pembersih Darah KB 0 207 1800 372600 0
197 Pi Kang Shuang 0 0 0
198 Pil Chi Kit Teck Aun 0 7 8500 59500 0
199 Pil Kita 0 0 0
200 Pil Tuntas 0 89 5500 489500 0
201 Polidanmig 0 90 4000 360000 0
202 Polident 0 1 70000 70000 0
203 Povidon Iodine 0 0 0
204 Procold 0 1 24500 24500 0
205 Promagh 0 20 59000 1180000 0
206 Promagh Double Action 0 0 0
207 Pure Baby Hand & Mouth 0 0 0
208 Puyer Kaki Tiga 0 0 0
209 Redoxon 0 0 0
210 Rematon 0 11 12000 132000 0
211 Rheumacyl 0 4 3000 12000 0
212 Rheumacyl Neuro 0 21 7000 147000 0
213 Rheurub Liniment 0 0 0
214 Rivanol 100 ml 0 24 5000 120000 0
215 Sabun Beras 0 0 0
216 Sabun Lemon 0 0 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

217 Sabun Rice Milk 0 2 5000 10000 0
218 Sabun Sandal Wood 0 0 0
219 Sabun SPA Soap Lavender 0 0 0
220 Safe Care 0 27 5000 135000 0
221 Salep 2-4 0 50 2000 100000 0
222 Salep 88 0 12 45000 540000 0
223 Salep Ichtyol 0 0 0
224 Salep Kulit Kaki 3 0 2 35000 70000 0
225 Salep Levertran 0 59 6000 354000 0
226 Salep PK 0 4 5000 20000 0
227 Salonpas Biasa 0 11 6000 66000 0
228 Salonpas Cream 15 g 0 14 2000 28000 0
229 Salonpas Cream 30 g 0 16 37000 592000 0
230 Salonpas Cream Hot 0 8 6000 48000 0
231 Salonpas Gel 0 0 0
232 Salonpas Hot 0 8 0 0
233 Sanaflu 0 0 0
234 Sangobion 0 0 0
235 Sensodyne Cool Gel 0 0 0
236 Sensodyne Fresh Mint 0 2 8000 16000 0
237 Sensodyne Gum Care 0 43 4000 172000 0
238 Sensodyne Original 0 9 7000 63000 0
239 Sensodyne Rapid 0 6 2500 15000 0
240 Siklus 0 0 0
241 Siwak 0 1 0 0
242 Soffel 0 4 16000 64000 0
243 SP Troches Melon 0 14 6000 84000 0
244 SP Troches Strawberry 0 140 1000 140000 0
245 Stop Cold 0 82 1000 82000 0
246 Supertin 0 0 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

247 Telon Lang 60 ml 0 48 1000 48000 0
248 Test Pack Onemed 0 46 1000 46000 0
249 Tisu Fesirih 0 6 3500 21000 0
250 Tisu Nice 0 20 7000 140000 0
251 Tisu Super Magic Man 0 22 7000 154000 0
252 Tolak Angin Anak 0 21 7000 147000 0
253 Tolak Angin Flu 0 24 7000 168000 0
254 Tolak Angin Original 0 20 7000 140000 0
255 Turun Panas Anak 0 21 7000 147000 0
256 Ultraflu 0 22 7000 154000 0
257 Vicks Inhaler 0 20 7000 140000 0
258 Vicks Vaporub 0 17 7000 119000 0
259 Vidoran Smart Orange 0 22 7000 154000 0
260 Vidoran Smart Strawberry 0 21 7000 147000 0
261 Vitalong 30's 0 2 12000 24000 0
262 Vitalong 4's 0 91 5000 455000 0
263 Xon-ce 0 3 5000 15000 0
264 Yellow Lotion 0 1 0 0
265 Yellow Lotion Antiseptic 0 1 41000 41000 0
266 Yoko-Yoko 48 ml 0 2 0 0
267 Yoko-Yoko 82 ml 0 31 2000 62000 0
268 Zalf 19 0 7 6000 42000 0
269 Zevit Grow 0 0 0
ETALASE 2 0 61 500 30500 0
1 Absolute 0 0 0
2 Actifed Hijau 0 2 4000 8000 0
3 Actifed Kuning 0 3 0 0
4 Actifed Merah 0 22 0 0
5 Adem Sari 0 24 0 0
6 Alang Sari 0 0 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

7 Albothyl 0 2 8000 16000 0
8 Arthrifen 0 11 7000 77000 0
9 Asepso 0 7000 0 0
10 Asifit 0 0 0
11 Autan 0 1 38000 38000 0
12 Ayudara 0 7000 0 0
13 Baby Cough 0 220 2000 440000 0
14 Batugin 0 3 250000 750000 0
15 Betadine Feminime 60 ml 0 16 800 12800 0
16 Betadine Mouth Wash 0 0 0
17 Betadine Vaginal 100 ml 0 4 8000 32000 0
18 Betadin Vaginal + Aplikator 0 0 0
19 Bio Activa 0 35 7000 245000 0
20 Biojanna 0 50 3000 150000 0
21 Bisolvon Elixir 0 30 1500 45000 0
22 Bisolvon Extra 0 29 5000 145000 0
23 Bisolvon Flu 0 16 2000 32000 0
24 Bisolvon Kid 0 29 3000 87000 0
25 Bisolvon Larutan 0 0 0
26 Boderx Flu & Batuk Tidak Berdahak 0 84 5000 420000 0
27 Boderxin Demam 0 3 11000 33000 0
28 Bodrex Flu & Batuk Berdahak 0 0 0
29 Bodrexin Flu & Alergi 0 0 0
30 Breathy 0 0 0
31 Caladine Lotion 60 ml 0 0 0
32 Caladine Lotion 95 ml 0 47 7500 352500 0
33 Caladine Powder 0 0 0
34 Cerebrofort 0 1 24000 24000 0
35 Cerebrofort Gold 0 0 0
36 Cerebrofort Gold Strawberry 0 1 18500 18500 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

37 Circus 0 0 0
38 Combi Kid 0 1 45000 45000 0
39 Curcuma Plus 0 0 0
40 Curcuma Plus Pre & DHA 0 1 18500 18500 0
41 Curvit CL 0 41 17000 697000 0
42 Dactylen 0 2 5000 10000 0
43 Dettol 50 ml 0 10 5000 50000 0
44 Dettol 100 ml 0 12 19000 228000 0
45 Dextral 0 9 4000 36000 0
46 Diabetasol Coklat 0 6 5000 30000 0
47 Elkana 0 3 5000 15000 0
48 Enkasari 0 39 5000 195000 0
49 Fancy Plester 0 0 0
50 Ferokid Drop 0 0 0
51 Ferokid Syr 0 0 0
52 Fevrin 0 0 0
53 Fishqua 0 2 10500 21000 0
54 Fitkom Anggur 0 0 0
55 Fitkom Gummy 0 0 0
56 Fitkom Gummy Calcium 0 3 115000 345000 0
57 Fitkom Gummy Fruit & Veggie 0 80 7000 560000 0
58 Fitkom Jeruk 0 15 2000 30000 0
59 Fitkom Strawberry 0 19 10000 190000 0
60 Fruit Blend 0 2 24000 48000 0
61 Garglin 0 1 20000 20000 0
62 Ginasih 0 3 20000 60000 0
63 Habbasyifa 0 2 20000 40000 0
64 Habbats Kid Honey 0 0 0
65 Helmigs 0 0 0
66 Herbalax 0 1 9500 9500 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

67 Herocyn Baby 0 2 3000 6000 0
68 Herocyn Powder (Kecil) 0 1 13000 13000 0
69 Herocyn Talk (B) 0 14 3000 42000 0
70 Hufagrip BP 0 5 0 0
71 Hufagrip Flu 0 42 2000 84000 0
72 Hufagrip Pilek 0 0 0
73 Hufagrip TMP 0 0 0
74 Imboost Force 0 5 2500 12500 0
75 Inhaler Lang 0 10 12000 120000 0
76 Insto 0 0 0
77 Jahe Merah 0 28 1000 28000 0
78 Jamu Selapan 0 0 0
79 Jess Cool 0 6 2500 15000 0
80 Kencing Manis 0 1 0 0
81 Komix DT 0 2 364000 728000 0
82 Konimag 0 13 7000 91000 0
83 Kopi Jahe 0 0 0
84 Kotak P3K 0 0 0
85 Lactacyd 150 ml 0 0 0
86 Lactacyd 60 ml 0 0 0
87 Lactacyd Liquid 60 ml 0 133 1500 199500 0
88 Laserin Madu 60 ml 0 0 0
89 Laserin Madu 110 ml 0 19 4000 76000 0
90 Laserin Ori 4's 0 2 20000 40000 0
91 Laserin Ori 60 ml 0 3 247000 741000 0
92 Laserin Ori 110 ml 0 0 0
93 Laxadine 0 0 0
94 Le Riche 0 0 0
95 Listerine Cool Mint 0 0 0
96 Listerine Fresh Burst 0 2 63000 126000 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

97 Listerine Fresh Citrus 0 1 66000 66000 0
98 Listerine Gum 0 0 0
99 Listerine Original 0 0 0
100 Listerine Vanila Mint 0 3 78000 234000 0
101 L-Mulvit 0 0 0
102 Lokol Tea 0 42 4000 168000 0
103 Madu Dazat 0 15 12000 180000 0
104 Madu Kembang
105 Maximus 0 0 0
106 Melia Biyang 0 10 17000 170000 0
107 Mimi Lan Mintuno 0 0 0
108 Minyak Zaitun Kaleng 0 0 0
109 Mouth Wash Cengkeh 0 0 0
110 Mouth Wash Daun Sirih 0 0 0
111 Nellco Special 0 32 1500 48000 0
112 Neo Ultracyn Powder 0 9 10000 90000 0
113 Nourish Skin 15's 0 3 33000 99000 0
114 Nourish Skin 30's 0 4 15000 60000 0
115 Nourish Skin 60's 0 0 0
116 Nourish Skin Ultimate 15's 0 9 15000 135000 0
117 Nourish Skin Ultimate 30's 0 1 0 0
118 Nutrafor 0 3 118000 354000 0
119 Obat Batuk Ibu dan Anak 0 0 0
120 Obat Batuk Kelapa Laut 0 3 27000 81000 0
121 OBH Combi Anak 0 0 0
122 Omepros 0 0 0
123 Opilax 0 1 11000 11000 0
124 Panadol Drop 0 5 7500 37500 0
125 Panadol Syr 0 0 0
126 Paratusin 0 2 49000 98000 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

127 Pharmaton 0 2 100000 200000 0
128 Pompa Asi Biasa 0 4 19000 76000 0
129 Pompa Asi Elektrik 0 10 50000 500000 0
130 Pompa Asi Selang 0 5 18000 90000 0
131 Prenagen Emesis Plain 0 8 90000 720000 0
132 Prenagen Lactamom Coklat 0 3 28000 84000 0
133 Prenagen Lactamom Vanila 0 1 28500 28500 0
134 Prenagen Mommy Choco 0 0 0
135 Prenagen Mommy Vanila 0 0 0
136 Propolis 0 5 7500 37500 0
137 Proris Forte 0 7 14000 98000 0
138 Purbasari Sabun Sirih 0 4 8000 32000 0
139 Pure Baby Rush Cr 0 2 5000 10000 0
140 Putri Langsing 0 2 7000 14000 0
141 Rohto Cool 0 2 22000 44000 0
142 Rohto Tears 0 0 0
143 Sakatonik Anggur 0 4 17000 68000 0
144 Sakatonik Jeruk 0 3 9000 27000 0
145 Sakatonik Liver 0 4 8000 32000 0
146 Sakatonik Strawberry 0 2 35000 70000 0
147 Salicyl Bedak 0 2 19000 38000 0
148 San-B-Plex 0 11 0 0
149 Sanmol Drop 0 2 12000 24000 0
150 Sarang Semut 0 0 0
151 Sari Kurma Sahara 0 1 57000 57000 0
152 Siladex Antitussive 30 ml 0 6 16000 96000 0
153 Siladex Antitussive 60 ml 0 2 6000 12000 0
154 Siladex Cough 30 ml 0 2 8000 16000 0
155 Siladex Cough 60 ml 0 8 107000 856000 0
156 Siladex Mucolytic 30 ml 0 4 24000 96000 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

157 Siladex Mucolytic 60 ml 0 0 0
158 Slimming Gel 0 49 2000 98000 0
159 Slimming Tea 0 9 12000 108000 0
160 Stimuno 0 0 0
161 Susu Diabetasol Vanila 0 1 80000 80000 0
162 Susu Kuda Liar 0 2 13000 26000 0
163 Susu NL 33 0 0 0
164 Susut Perut 0 4 22000 88000 0
165 Syamil Family 0 3 13000 39000 0
166 Syamil Kids 0 1 13000 13000 0
167 Talk Salicyl 0 0 0
168 Talk Salicyl Menthol 0 2 28000 56000 0
169 Tantum Verde 0 0 0
170 Tempra Drop 0 11 32000 352000 0
171 Tempra Syr 0 1 67000 67000 0
172 Termorex 0 30 0 0
173 Thermolyte 0 0 0
174 Timbangan Badan 0 6 3000 18000 0
175 Tox Tea 0 0 0
176 Triaminic Batuk 0 2 9000 18000 0
177 U-Pad 0 4 7500 30000 0
178 Ultrasonic Gel 0 0 0
179 Vege Blend 0 3 12000 36000 0
180 Vegeta 0 2 12000 24000 0
181 Vegeta Herbal 0 0 0
182 Vicks 44 DT 0 3 13000 39000 0
183 Vicks Anak 27 ml 0 41 11000 451000 0
184 Vicks Anak 54 ml 0 11000 0 0
185 Vicks Dewasa 54 ml 0 0 0
186 Vicks Inhaler 0 37 10000 370000 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

187 Vidoran Smart 120 ml 0 5 2500 12500 0
188 Viostin 0 14 2000 28000 0
189 Visine 0 2 50000 100000 0
190 Vit A IPI 0 10 1000 10000 0
191 Vit B Comp IPI 0 7 1500 10500 0
192 Vit B1 IPI 0 0 0
193 Vit B12 IPI 0 0 0
194 Vit C IPI 0 0 0
195 Woods Antitussive 0 1 25500 25500 0
196 Woods Cherry 0 13 9000 117000 0
197 Woods Expectorant 0 0 0
198 Woods Extra Strong 0 3 8500 25500 0
KOSMETIK 0 0 0
1 Acnes FC Gel 18 g 0 0 0
2 Acnes FC Gel 9 g 0 10 8000 80000 0
3 Acnes Foaming Wash 0 4 9000 36000 0
4 Acnes Powder Lotion 0 4 43000 172000 0
5 Acnes Washing Bar 0 2 39500 79000 0
6 Asthin Force Gel 0 1 9000 9000 0
7 Goat Milk Lotion Cospro 0 2 130000 260000 0
8 Handbody Thailand Day 0 2 38000 76000 0
9 Handbody Thailand Night 0 0 0
10 Jade Pure White 0 8 2000 16000 0
11 Lulur Susu Domba Thailand 0 10 2000 20000 0
12 Magic Pearl Milk Scrub 0 0 0
13 Marcks Bedak 0 2 7000 14000 0
14 Marcks Venus Compact Powder 1 0 4 0 0
15 Marcks Venus Compact Powder 2 0 0 0
16 Marcks Venus Loose Powder 1 0 1 0 0
17 Marcks Venus Loose Powder 2 0 3 17000 51000 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

18 Marcks Venus Loose Powder 3 0 39 33000 1287000 0
19 Marcks Venus Refill 1 0 65 10000 650000 0
20 Marcks Venus Refill 2 0 1 4000 4000 0
21 Marcks Venus Refill 3 0 0 0
22 Marcks Venus Two Way Cake 3 0 1 4000 4000 0
23 Maskara Volum Ex Magnum 0 12 4000 48000 0
24 Maskara Volum Waterproof 0 18 4000 72000 0
25 Maybeline Angel Fit Blush On 0 3 15000 45000 0
26 Maybeline Aqua GEL Foundation 0 37 3000 111000 0
27 Maybeline Clear Smooth Extra Cake Found 05 0 0 0
28 Maybeline Clear Smooth Extra Shine Free Powder Found 02 0 0 0
29 Maybeline Clear Smooth Extra Shine Free Powder Found 03 0 0 0
30 Maybeline Clear Smooth Shine Pressed Powder 01 0 0 0
31 Maybeline Clear Smooth Shine Pressed Powder 04 0 4 0 0
32 Maybeline Make Up Remover 0 6 15000 90000 0
33 Maybeline ME 936 0 18 3000 54000 0
34 Maybeline ME C31
35 Maybeline ME CB41 0 4 32000 128000 0
36 Maybeline ME M31 0 3 20000 60000 0
37 Maybeline ME RM41 0 0 0
38 Maybeline Minerals Liquid Foundation 0 0 0
39 Maybeline Powder Foundation 0 3 19000 57000 0
40 Mustika Ratu Air Sari Mawar 0 0 0
41 Mustika Ratu Cream Zaitun 0 0 0
42 Mustika Ratu Ginasih 0 0 0
43 Mustika Ratu Kopi Body Soap 0 0 0
44 Mustika Ratu Pepaya Body But 0 1 0 0
45 Mustika Ratu Pepaya Body Soap 0 0 0
46 Mustika Ratu Sari Jeruk Nipis 0 0 0
47 Pigeon Face Powder 0 0 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

48 Pigeon UV Protection Gold 0 0 0
49 Pigeon UV Protection Ivory 0 0 0
50 Revlon Dry Shadow 0 1 25000 25000 0
51 Revlon Dry Shadow Ombre 0 1 25000 25000 0
52 Revlon Liquid Eyeliner 0 0 0
53 Rista Acne Cream 0 0 0
54 Rista Acne Lotion 70 ml 0 0 0
55 Seba Med Cleansing Bar 0 0 0
56 Silkygirl Lipgloss 0 0 0
57 SPA Milk Salt 0 2 75000 150000 0
58 Sunblock SPF 30 0 0 0
59 Sunblock SPF 50 0 2 0 0
60 Verile Acne Gel 0 3 0 0
61 Wardah Acne Cleansing Gel 0 2 45000 90000 0
62 Wardah Acne Gentle Scrub 0 2 45000 90000 0
63 Wardah Acne Perfecting Moisturizer 0 45000 0 0
64 Wardah Blush On B 0 45000 0 0
65 Wardah Blush On C 0 0 0
66 Wardah Cleanser 0 2 45000 90000 0
67 Wardah Compact Powder No. 01 0 0 0
68 Wardah Compact Powder No. 2 0 1 0 0
69 Wardah Creamy Foundation Beige 0 2 0 0
70 Wardah Creamy Foundation Light Beige 0 0 0
71 Wardah Creamy Foundation Natural 0 3 0 0
72 Wardah Creamy Foundation Sheer Pink 0 8 36000 288000 0
73 Wardah Day Cream Step 1 0 0 0
74 Wardah Day Cream Step 2 0 2 0 0
75 Wardah Double Function Kit 0 2 0 0
76 Wardah Energizing Floral Body 0 1 0 0
77 Wardah Exclusive Lipstick No. 21 0 4 0 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

78 Wardah Exclusive Lipstick No. 23 0 8 0 0
79 Wardah Exclusive Lipstick No. 28 0 0 0
80 Wardah Exclusive Lipstick No. 29 0 8 0 0
81 Wardah Exclusive Lipstick No. 30 0 0 0
82 Wardah Exclusive Lipstick No. 31 0 1 0 0
83 Wardah Exclusive Lipstick No. 33 0 0 0
84 Wardah Exclusive Lipstick No. 35 0 0 0
85 Wardah Exclusive Lipstick No. 36 0 0 0
86 Wardah Exclusive Lipstick No. 37 0 0 0
87 Wardah Exclusive Lipstick No. 40 0 11 33000 363000 0
88 Wardah Exclusive Lipstick No. 42 0 6 28000 168000 0
89 Wardah Exclusive Lipstick No. 43 0 1 151500 151500 0
90 Wardah Exclusive Lipstick No. 47 0 4 50000 200000 0
91 Wardah Exclusive Lipstick No. 48 0 6 0 0
92 Wardah Exclusive Lipstick No. 49 0 0 0
93 Wardah Exclusive Lipstick No. 50 0 1 0 0
94 Wardah Eye Shadow A 0 3 0 0
95 Wardah Eye Shadow C 0 6 20000 120000 0
96 Wardah Eye Shadow E 0 1 28000 28000 0
97 Wardah Eye Shadow F 0 0 0
98 Wardah Eye Shadow G 0 1 86000 86000 0
99 Wardah Eye Shadow H 0 1 86000 86000 0
100 Wardah Eye Shadow K 0 0 0
101 Wardah Eye Shadow L 0 1 31000 31000 0
102 Wardah Eye Shadow M 0 1 0 0
103 Wardah Eyebrow Black 0 1 56000 56000 0
104 Wardah Eyebrow Brown 0 0 0
105 Wardah Eyeliner Black Brown 0 0 0
106 Wardah Eyeliner White 0 0 0
107 Wardah Facial Mask 0 0 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

108 Wardah Hydrating Toner 0 31 16000 496000 0
109 Wardah Hydrogloss 02 0 11 70000 770000 0
110 Wardah Hydrogloss 03 0 0 0
111 Wardah Hydrogloss 04 0 11 100000 1100000 0
112 Wardah Intensive Night Cream 0 0 0
113 Wardah Light Body Lotion 0 0 0
114 Wardah Light Cleanser Milk 0 0 0
115 Wardah Light Face Mask 0 2 37000 74000 0
116 Wardah Light Face Toner 0 1 38000 38000 0
117 Wardah Light Gentle Wash 0 0 0
118 Wardah Light Two Way Cake 1 0 2 40000 80000 0
119 Wardah Light Two Way Cake 2 0 1 32000 32000 0
120 Wardah Light Two Way Cake 3 0 0 0
121 Wardah Light Two Way Cake 4 0 0 0
122 Wardah Light Two Way Cake Refill 2 0 0 0
123 Wardah Light Two Way Cake Refill 3 0 1 52000 52000 0
124 Wardah Light Two Way Cake Refill 4 0 0 0
125 Wardah Long Lasting Lipstick No. 5 0 0 0
126 Wardah Luminous Face Powder 1 0 0 0
127 Wardah Luminous Face Powder 2 0 1 39000 39000 0
128 Wardah Luminous Face Powder 3 0 2 44000 88000 0
129 Wardah Luminous Liquid Foundation 0 1 0 0
130 Wardah Luminous Two Way Cake 2 0 0 0
131 Wardah Luminous Two Way Cake 3 0 0 0
132 Wardah Luminous Two Way Cake 4 0 2 39000 78000 0
133 Wardah Maskara 0 33 35000 1155000 0
134 Wardah Moisturizer Cream 0 0 0
135 Wardah Night Cream Step 1 0 0 0
136 Wardah Night Cream Step 2 0 3 36000 108000 0
137 Wardah Olive Oil 150 ml 0 7 0 0
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

138 Wardah Olive Soft Scrub 240 ml 0 0 0
139 Wardah Paket Umrah 0 4 45000 180000 0
140 Wardah Parfum EDT 0 5 15000 75000 0
141 Wardah Pure Olive Oil 50 ml 0 0 0
142 Wardah Roll On For Her 0 0 0
143 Wardah Roll On For Him 0 2 0 0
144 Wardah Romantic Rose Handbody 0 0 0
145 Wardah Sunscreen Gel 0 5 17000 85000 0
146 Wardah Woundershine Lipgloss 0 0 0
147 Yesta Body Lotion 100 ml 0 0 0
148 Yesta Day Cream 0 5 50000 250000 0
149 Yesta Facial Foam 0 0 0 0
150 Yesta Foundation Brown 0 5 50000 250000 0
151 Yesta Night Cream 0 1 50000 50000 0
152 Yunasda Body Scrub Instant 0 1 50000 50000 0
TAMBAHAN
1 0 0 0 0
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
 SISA TOTAL TOTAL
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN
STOK
HARGA
HARGA
STOK OPT HARGA
HARGA
PERMINTAAN KETERANGAN

1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10=(8*9) 11 12 13=(11*12) 14 15

19
20
21
22
23
24
25