LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT ( LPLPO )

PUSKESMAS BILUHU

DOKUMEN

Puskesmas : BILUHU Pelaporan Bulan/ Periode : Juni 2022 DINKES KAB. GORONTALO

Kecamatan : BILUHU Permintaan Bulan/Periode : Juli 2022 INSTALASI FARMASI

Kabupaten : Gorontalo PUSKESMAS

Propinsi : Gorontalo

PEMBERIAN
No Nama Obat SATUAN HARGA Stok Awal Penerima Persedia Pemakaia Stok Stok Opt. Perminta
SATUAN an an n Akhir an
DAU DAK

1 Allopurinol 100 mg Tablet 96.00 0 0 0 0

2 Allopurinol 300 mg Tablet 0 0 0 0

3 Alprazolam 0,5 mg Tablet 0 0 0 0

4 Aminofilin Inj 24mg/ml-10ml Ampul 0 0 0 0

5 Aminofilin 200mg Tablet 0 0 0 0

6 Amlodipin 5 Mg Tablet 197.00 0 0 0 0

7 Amlodipin 10 Mg Tablet 352.00 0 0 0 0

8 Amoksisilin 250mg Kapsul 215.00 0 0 0 0

9 Amoksisilin sir. 125/5ml Botol 2,225.00 0 0 0 0

10 Amoksisilin 500mg Kaplet 239.00 0 0 0 0

11 Analog Insulin Inj 100UI Inj 0 0 0 0

12 Antasida sirup botol 2,135.00 0 0 0 0

13 Antasida Doen 500mg Tablet 72.00 0 0 0 0

14 Anti Hemmoroid supp Supp 3,654.00 0 0 0 0

15 Aqua pro inj Vial 2,475.00 0 0 0 0

16 Asam askorbat 50mg Tablet 125.00 0 0 0 0

17 Asam Mafenamat 500 Mg Tablet 117.00 0 0 0 0

18 Asam Traneksamat 250 mg Tablet 0 0 0

19 Asam Traneksamat 500 mg Tablet 0 0 0 0

20 Asam Traneksamat Inj 50 mg/ml Ampul 0 0 0 10

21 Asam Traneksamat Inj 100 mg/ml Ampul 0 0 0 0

22 Asam Valproat 250 mg Tablet 0 0 0 0

23 Asam Valproat 500 mg Tablet 0 0 0 0

24 Asam Valproat Sirup 250 mg/ 5 ml 0 0 0 0

25 Asiklovir 200 mg Tablet 276.00 0 0 0 400

26 Asiklovir 400 mg Tablet 387.00 0 0 0 0

27 Asiklovir 5% Tube 2,860.00 0 0 0 50

28 Attapulgit 600 mg Tablet 199.00 0 0 0 200

29 Bedak Salisil 2% Box 1,080.00 0 0 0 0

30 Betahistin Mesilat 6 mg Tablet 177.00 0 0 0 0

31 Betametason Krim 0,05% Tube 0.00 0 0 0 0

32 Betametason Krim 0,1% Tube 1,444.00 0 0 0 20

33 Benzidamine Orabase Gargle Botol 0 0 0 0

34 Bisakodil 5 mg Tablet 0 0 0 100

35 Bisakodil Supp 5 mg Supp 0 0 0 0

36 Bisakodil Supp 10 mg Supp 5,800.00 0 0 0 0

37 Bisoprolol 5 Mg Tablet 425.00 0 0 0 0

38 Cetirizine Syrup 5 mg/ 5 ml Botol 8,094.00 0 0 0 0

39 Cetirizine 10 mg Tablet 190.00 0 0 0 0

40 Citicoline 125 mg/ml Ampul 0 0 0 0

41 Codein 10 mg Tablet 550.00 0 0 0 0

42 Deksametason inj 5mg/-1ml Ampul 1,830.00 0 0 0 0

43 Deksametason 0,5mg Tablet 52.00 0 0 0 0

44 Diazepam inj 5mg/ml Ampul 2,603.33 0 0 0 0

45 Diazepam rectal 10mg/2,5 ml 12,751.00 0 0 0 10

46 Diazepam 2mg Tablet 47.00 0 0 0 50

47 Difenhiramin inj 10mg/ml Ampul 1,415.00 0 0 0 20

48 Digoksin 0,25mg Tablet 10.00 0 0 0 0

49 Diltiazem 30 mg Tablet 103.00 0 0 0 0

50 Dimenhidrinat 50 mg Tablet 109.00 0 0 0 100

51 Domperidon 10 Mg Tablet 138.00 0 0 0 0

52 Domperidon sirup 5 mg/5ml Botol 3,300.00 0 0 0 0

53 Epinefrin (adrenalin) inj 0,1% Ampul 2,354.00 0 0 0 0

54 Etanol 70% 100 ml Botol 2,625.00 0 0 0 0 0

55 Etil Klorida semprot 100 ml Botol 176,000.00 0 0 0 0

56 Fenitoin Inj 50 mg/mL Ampul 0 0 0 0

57 Fenitoin 100 mg Kapsul 0 0 0 0

58 Fenobarbital 30mg Tablet 149.00 0 0 0 0

59 Fitomenadion inj 10mg/ml-1ml Ampul 4,260.00 0 0 0 20

60 Fitomendaion (Vit K1) 10mg Tablet 835.00 0 0 0 0

61 Furosemid 40mg Tablet 102.00 0 0 0 0

62 Furosemid injeksi 10 mg/ml Ampul 0 0 0 0

63 Garam Oralit 200ml air Bungkus 317.00 0 0 0 0

64 Gemfibrozil 300 mg Kapsul 318.00 0 0 0 0

65 Gentamisin Salep Kulit 0,1 % Tube 2,420.00 0 0 0 0

66 Glibenklamid Tablet 5 mg Tablet 61.00 0 0 0 0

67 Glimepirid 2 mg Tablet 311.00 0 0 0 200

68 Gliquidon 30 mg Tablet 1,150.00 0 0 0 0

69 Gliseril guaiakolat 100mg Tablet 69.00 0 0 0 500

70 Kombinasi : Gliseril Guaiakolat , Deks Tablet 0 0 0 0

71 Kombinasi : Gliseril Guaiakolat , Deks Botol 0 0 0 0

72 Glukosa [Link]. 5% steril Botol 6,900.00 0 0 0 0

73 Glukosa lar. Inf. 10% steril Botol 0 0 0 0

74 Glukosa lar. Inf. 40% steril Botol 0 0 0 0

75 Griseofulvin 125mg Tablet 330.00 0 0 0 0

76 Griseofulvin 250mg Tablet 0 0 0 0

77 Griseofulvin 500mg Tablet 0 0 0 0

78 Haloperidol 0.5mg Tablet 66.00 0 0 0 0

79 Haloperidol 1.5mg Tablet 78.00 0 0 0 0

80 Haloperidol 5mg Tablet 103.00 0 0 0 0

81 Haloperidol Injeksi 50 mg/ ml Ampul 5,605.00 0 0 0 0

82 Hidrogen Peroksida 3% Botol 0 0 0 0

83 Hidroklorotiazida 25mg Tablet 0 0 0 0

84 Hidrokortison Krim 2,5% Tube 2,848.00 0 0 0 0

85 Hyoscine Butylbromide 10 mg Tablet 0 0 0 0

86 Hyoscine Butylbromide Inj 20 mg/ml 0 0 0 0

87 Ibuprofen 200mg Tablet 121.00 0 0 0 1000

88 Ibu profen 400mg Tablet 139.00 0 0 0 0

89 Ibuprofen suspensi 200 mg/5 ml Botol 5,709.00 0 0 0 0

90 Imunoglobulin Anti Tetanus Vial 0 0 0 0

91 Isosorbid Dinitrat 5 mg Tablet 0 0 0 200

92 Kalsium Glukonat Injeksi 10 % Vial 0 0 0 10

93 Kalsium Laktat 500mg Tablet 72.00 0 0 0 0

94 Kaolin Pektin Sirup Botol 0 0 0 0

95 Kaptopril 12,5 mg Tablet 0 0 0 0

96 Kaptopril 25 mg Tablet 97.00 0 0 0 0

97 Karbamazepin 200mg Tablet 315.00 0 0 0 0

98 Ketokonazole 200 mg Tablet 385.00 0 0 0 0

99 Ketokonazole Salep Kulit 2 % Tube 2,697.00 0 0 0 0

100 Ketorolac 10 mg Tablet 0 0 0 0

101 Ketorolac Supp 100 mg Supp 0 0 0 0

102 Ketorolac Inj 30 mg/ ml Ampul 0 0 0 0

103 Klindamisin 300 mg Kapsul 693.00 0 0 0 0

104 Kloramphenikol 250mg Kapsul 484.00 0 0 0 200

105 Kloramfenikol Salep Kulit 2% Tube 0 0 0 0

106 Kloramphenikol SALEP MATA 1% Botol 0 0 0 20

107 Kloramphenikol Tetes Telinga 3% Botol 0 0 0 10

108 Klorpheniramin maleat (CTM) 4 mg Tablet 46.00 0 0 0 0

109 Klorpromazin hcl 25mg Tablet 0 0 0 0

110 Klorpromazina hcl 100mg Tablet 181.00 0 0 0 0

111 Klorpromazina hcl inj 5mg/ml Ampul 0 0 0 0

112 Klorpromazina hcl inj 25mg/ml Ampul 0 0 0 0

113 Kolkhisin 0,5 mg Tablet 0 0 0 0

114 Kotrimoksazol suspensi 240 mg/5 ml Botol 2,250.00 0 0 0 0

115 Kotrimoksazol 480mg Tablet 158.00 0 0 0 0

116 Lanzoprazole 30 mg Kapsul 521.00 0 0 0 0

117 Levofloksasin 500 mg Tablet 0 0 0 0

118 Lidokain 2% inj Ampul 2,215.00 0 0 0 0

119 Kombinasi Lidokain - Epinefrin inj Ampul 0 0 0 0

120 Lisinopril 10 mg Tablet 0 0 0 0

121 Loperamid 2 mg Tablet 97.00 0 0 0 0

122 Loratadine 10 mg Tablet 159.00 0 0 0 0

123 Magnesium Sulfat 20 % Vial 0 0 0 0

124 Magnesium Sulfat 40 % Vial 3,650.00 0 0 0 0

125 Metformin Hcl 500 mg Tablet 127.00 0 0 0 0

126 Metildopa 250 mg Tablet 1,045.00 0 0 0 200

127 Metilergeometrin Maleat inj 0,2 mg/m Ampul 2,750.00 0 0 0 0

128 Metilergeometrin 0.125mg Tablet 169.00 0 0 0 100

129 Metilprednisolon 4 mg Tablet 214.00 0 0 0 0

130 metoklopramid 10 mg Tablet 110.00 0 0 0 0

131 Metoklopramid inj 5 mg/ml Ampul 4,800.00 0 0 0 0

132 Metronidazol 250mg Tablet 103.00 0 0 0 0

133 Metronidazol 500mg Tablet 143.00 0 0 0 0

134 Metronidazole Dripps 500mg/100 ml Botol 0 0 0 0

135 Miconazole Salep Kulit 2% Tube 3,900.00 0 0 0 0

136 Misoprostol 200 mcg Tablet 0 0 0 0

137 Multivitamin Anak Sirup Botol 0 0 0 20

138 Multivitamin Ibu Hamil Tablet 0 0 0 0

139 Natrium Diklofenak 25 mg Tablet 0 0 0

140 Natrium Diklofenak 50 mg Tablet 0 0 0 0

141 Natrium Dokusat Tetes Telinga 5mg/m Botol 0 0 0 0

142 Nacl inf.0,9% Botol 5,410.00 0 0 0 0

143 Nifedipin 10 mg Tablet 127.00 0 0 0 100

144 Nistatin Drops 100.000 iu Botol 0 0 0 0

145 Nistatin 500.000 iu/g Tablet 704.00 0 0 0 100

146 Nistatin 100.000 iu/g provaginal Tablet 528.00 0 0 0 0

147 OBH sirup Botol 2,190.00 0 0 0 0

148 Oksigen Inhalasi Botol 0 0 0 0

149 Oksitetrasiklin Salep Kulit 3% Tube 1,980.00 0 0 0 0

150 Oksitosin inj 10 iu/ml Ampul 1,900.00 0 0 0 0

151 Omeprazole 10 mg Kapsul 0 0 0 0

152 Omeprazole 20 mg Kapsul 0 0 0 0

153 Omeprazole Serbuk Inj 40 mg Vial 0 0 0 0

154 Ondansetron inj 2 mg/ml Ampul 0 0 0 0

155 Parasetamol 500mg Tablet 60.00 0 0 0 0

156 Parasetamol sir. 120mg/5ml Botol 1,338.00 0 0 0 0

157 Parasetamol Drops 100 mg/ ml Botol 0 0 0 0

158 Parasetamol Infus 10 g/ ml Botol 0 0 0 0

159 Parasetamol Supp 125 mg Supp 0 0 0 10

160 Parasetamol Supp 250 mg Supp 0 0 0 10

161 Permethrin salep kulit 5% Tube 0 0 0 0

162 Piracetam 1200 mg Tablet 0 0 0 0

163 Piracetam inj 1g Vial 0 0 0 0

164 Piracetam inj 3 g Vial 0 0 0 0

165 Pirantel Pamoat 125mg Tablet 330.00 0 0 0 0

166 Pirantel Pamoat Sirup 250 mg/ml Botol 14,370.00 0 0 0 0

167 Piridoksin 10 mg (vitamin B6) Tablet 142.00 0 0 0 0

168 Povidon Iodin 10 % 60 ml Botol 7,040.00 0 0 0 0

169 Povidon Iodin 10 % 300 ml 21,600.00 0 0 0 0

170 Povidon Iodin 10% 30 ml Botol 2,344.00 0 0 0 0

171 Prednison 5mg Tablet 121.00 0 0 0 0

172 Propiltiourasil 50 mg tablet 0 0 0

173 Propiltiourasil 100mg Tablet 0 0 0 0

174 Propranolol hcl 10mg Tablet 80.00 0 0 0 0

175 Kombinasi Pseudoefedrin - Triprolidin Tablet 0 0 0 0

176 Kombinasi Pseudoefedrin - Triprolidin Sirup 0 0 0 0

177 Ranitidin Inj 25 mg/ml Ampul 2,336.00 0 0 0 20

178 Ranitidin Tab 150 mg Tablet 119.00 0 0 0 0

179 Renalite Cairan elektrolit Botol 0 0 0 0

180 Retinol Kaps. 100.000 iu (vitamin A) Kapsul 341.00 0 0 0 0

181 Retinol Kaps. 200.000 iu (vitamin A) Tablet 505.00 0 0 0 0

182 Ringer Laktat lar. Infus Botol 7,150.00 0 0 0 0

183 Risperidone 2 mg Tablet 550.00 0 0 0 0

184 Salbutamol 2mg Tablet 69.00 0 0 0 0

185 Salbutamol 4 mg Tablet 0 0 0 0

186 Kombinasi Salbutamol Ipratropium Br Botol 0 0 0 0

187 Salep 2-4 : Asam Salisilat 2%, Beleran Pot 2,200.00 0 0 0 0

188 Sefadroxil 500 mg Tablet 557.00 0 0 0 0

189 Sefadroxil Sirup Kering 125 mg/ml Botol 0 0 0 0

190 Sefixime 100 mg Tablet 700.00 0 0 0 500

191 Sefixime Sirup 100 mg/ 5 ml Botol 0 0 0 0

192 Seftriaxon Inj 1000 mg Vial 11,000.00 0 0 0 0

193 Sianokobalamin 50 mcg (vitamin B12) Tablet 0 0 0 0

194 Sianokobalamin 100 mcg (Vitamin B12 Tablet 0 0 0 0

195 Sianokobalamin inj 500 mcg/ml Ampul 0 0 0 0

196 Sianokobalamin Inj 1000 mcg/ml Ampul 0 0 0 0

197 Silver Sulfadiazine Krim 10 mg/g Tube 0 0 0 0

198 Simvastatin 10 mg Tablet 136.00 0 0 0 0

199 Siprofloxacin 500 mg Tablet 309.00 0 0 0 0

200 Siprofloksasin Infus 2% Botol 0 0 0 0

201 Spironolakton 25 mg Tablet 350.00 0 0 0 0

202 Sucralfat Sirup 500 mg/5 ml Botol 0 0 0 0

203 Tablet Tambah Darah Kombinasi Tablet 330.06 0 0 0 0

204 Tiamin hcl (Vit. B1) 50mg Tablet 37.00 0 0 0 0

205 Tiamin hcl inj. 100mg/ml Ampul 0 0 0 20

206 Tramadol 50 mg Kapsul 0 0 0 0

207 Triamsolone Asetonida 0,1% salep Tube 0 0 0 0

208 Triheksifenidil 2mg Tablet 0 0 0 0

209 Triheksifenidil 5 mg Tablet 0 0 0 0

210 Vaksin Anti Rabies, untuk manusia Vial 0 0 0 0

211 Vitamin B. Complex Tablet 138.00 0 0 0 0

212 Kombinasi Vitamin B1, B6 dan B12 inje Ampul 0 0 0 0

213 Xylocain Jelly 2% Tube 0 0 0 0

214 Zink dispersible 20 mg Tablet 618.00 0 0 0 0

215 Zink Drops 10 mg/ml Botol 12,100.00 0 0 0 0

216 Zink Sirup 10 mg/ 5 ml Botol 0 0 0 0

217 Reagen Paket 0 0 0 0

218 OAT kategori I Paket 0 0 0 0

219 OAT Kategori II Paket 0 0 0 0

220 OAT Kategori Anak Paket 0 0 0 0

221 MDT MB Dewasa Blister 0 0 0 0

222 MDT MB Anak Blister 0 0 0 0

223 MDT PB Dewasa Blister 0 0 0 0

224 MDT PB Anak Blister 0 0 0 0

225 RDT Pcs 0 0 0 0

226 DHP Tablet 0 0 0 0

227 Primaquin Tablet 0 0 0 0

228 Ambroksol sirup 15 mg/5 ml Botol 3,300.00 0 0 0 0

229 Ambroksol 30 mg Tablet 132.00 0 0 0 200

230 Antalgin 500 mg Tablet 0 0 0 1000

231 Bromheksin 8 mg Tablet 99.00 0 0 0 0

232 Etakridin (Rifanol) 0,1% Botol 3,600.00 0 0 0 5

233 Eugenol Cairan Botol 21,720.00 0 0 0 0

234 Gentian Violet Botol 1,760.00 0 0 0 20

235 Oksitetrasiklin Salep Mata Tube 2,112.00 0 0 0 0

236 Piroksikam 20 mg Tablet 132.00 0 0 0 500

237 Pehacain Ampul 2,830.05 0 0 0 0

238 Ketoprofen supp supp 0 0 0 0

239 sikzonoat injeksi ampul 0 0 0 0

240 antibakteri doen Tube 3,642.00 0 0 0 0

241 [Link] Sistein Tablet 0 0 0 1000

 BAHAN HABIS PAKAI

1 Abocath no. 18 Buah 0 0 0 0

2 Abocath no. 20 Buah 3,470.00 0 0 0 20

3 Abocath no. 22 Buah 0 0 0 0

4 Abocath no. 24 Buah 0 0 0 0

5 Abocath no. 26 Buah 0 0 0 0

6 Benang Roll roll 0 0 0 0

7 Blood Lancet Buah 0 0 0 0

8 Canula Oksigen Dewasa buah 0 0 0 0

9 Canula Oksigen Bayi buah 0 0 0 0

10 Catgut/benang bedah 2/0-3/0 Buah 6,420.83 0 0 0 34

11 Disposible 1ml Buah 830.00 0 0 0 0

12 Disposible 3 ml Buah 747.50 0 0 149 179

13 Disposible 5 ml Buah 761.25 0 0 0 0

14 Disposible 10 ml Buah 0 0 0 0

15 Folley cateter Buah 9,200.00 0 0 0 10

16 Formalin Botol 0 0 0 0

17 Framycetin Sulfat Plester Patch 0 0 0 0

18 Gel USG Botol 0 0 0 2

19 Hand Scoen No. 7 Buah 4,807.00 0 0 0 0

20 Hand Scoen No. 7,5 Buah 4,807.00 0 0 0 0

21 Hand Scoen No. 8 Buah 7,600.00 0 0 0 0

22 Handscoen Gynaecology Pair 22,264.00 0 0 0 0

23 Hypafix Plester Roll 0 0 0 5

24 Infusion set anak Buah 5,100.00 0 0 0 0

25 Infusion set dewasa Buah 3,680.00 0 0 0 0

26 Kapas Pembalut 250mg Rol 14,375.00 0 0 0 0

27 Kasa pembalut 4mX10 cm Rol 1,725.00 0 0 0 0

28 Kasa Hidrofil Steril 16 x 16 cm Kotak 9,200.00 0 0 0 0

29 Kasa 40 x 80 cm Rol 120,750.00 0 0 0 0

30 Lisol Botol 0 0 0 0

31 Masker Buah 396.00 0 0 0 0

32 Masker Oksigen dewasa Buah 0 0 0 0

33 Masker Oksigen anak Buah 0 0 0 0

34 Nald Buah 0 0 0 0

35 NGT Buah 0 0 0 0

36 Perban Elastis 0 0 0 0

37 Plester 5 yart X 2 inch Rol 13,371.00 0 0 0 10

38 Save Gloves M Pair 819.26 0 0 0 0

39 Save Gloves L Pair 819.26 0 0 0 0

40 Silk Benang Buah 0 0 0 0

41 Stick Cholesterol Botol 0 0 0 0

42 Stick Glukosa Botol 0 0 0 0

43 Stick Asam Urat Botol 0 0 0 0

44 Stick Hb Botol 0 0 0 0

45 Urina Bag Buah 6,679.20 0 0 0 0

46 Penjepit tali Pusat Buah 1,495.00 0 0 0 50

47 Masker ear loop Buah 379.50 0 0 0 0

48 Handsanitizer 500 ml Botol 0 5

UMUM
ASKES JAMKESTA JUMLAH
JUMLAH UMUM JKN
KUNJUNGAN
RESEP

53 546 599
 Mengetahui Yang Menyerahkan Yang Menerima
Yang Meminta
plt. Kepala Dinas Kesehatan Kepala Instalasi Farmasi Kepala Puskesmas Petugas Puskesmas
Kabupaten Gorontalo Kabupaten Gorontalo

SYUKRI DAWALI, [Link]. Markus, Ssi. Apt Mailan Balango, [Link]. Milawati, [Link].
NIP.19640720 198711 1 002 NIP. 19650302 199703 1 002 NIP. 19870503 201001 2 002 NIP.19861223 201704 2 001
EMBAR PERMINTAAN OBAT ( LPLPO )

SMAS BILUHU

DOKUMEN NOMOR Tanggal

DINKES KAB. GORONTALO

PEMBERIAN
Ket.
DIKES PROV PROGRAM
ED 200

ED 400
ED 5
 Yang Menerima

Petugas Puskesmas

Milawati, [Link].
NIP.19861223 201704 2 001