Laporan Obat Baru

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBA
(LPLPO) DAU
Kode Puskesmas :
Nama Puskesmas : TOILI 2
Kecamatan : TOILI
Puskesmas pembantu Yag Ada : Yang Lapor :
Kabupaten : Banggai
Propinsi : Sulawesi Tengah
NO NAMA OBAT/BHP Satuan Stok Awal penerimaan Persediaan Pengeluaran
a b c d e f g
A Dana Alokasi Khusus (DAK)

1 Ambroxol Tab #REF! #REF!
2 Acyclovir Tab 200 mg Tab #REF! #REF!
3 Acyclovir Tab 400 mg Tab -
4 Alupurinol Tab 100 mg Tab #REF! #REF!
5 Alprazolam tab 0,5 mg Tab #REF! #REF!
6 Aminophyllin Tab 200 mg Tab -
7 Amoxicillin Caps 500 mg / Pehamoxyl 500 Tab -
8 Ampicillin Caplet 500 mg Tab #REF! #REF!
9 Amlodipine 5 Mg Tab #REF! #REF!
10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab -
11 Antalgin Tab 500 mg Tab #REF! #REF!
12 Antasida Doen Tab Kombinasi Tab #REF! #REF!
13 Attapulgit 600 mg tablet (5 x 10 tab) Tab -
14 Asam Ascorbat (Vit C) Tab 50 mg Tab -
15 Asam Mefenamat Tab 500 mg Tab -
16 Betahistin Tb Tab -
17 Calsium Laktat (Calk) Tab 500 mg Tab #REF! #REF!
18 Captopril Tab 25 mg Tab -
19 CarbamazeineTab Tab #REF! #REF!
20 Cefadroxil Capsul 500 mg Tab -
21 Cetirizine Tb Tab -
22 Chloramphenicol Caps 250 mg Tab #REF! #REF!
23 Chlorpheniramin Maleat (CTM) Tab 4 mg Tab -
24 Chlorpromazin HCl Tab Salut 25 mg Tab #REF! #REF!
25 Chlorpromazin HCl Tab Salut 100 mg Tab -
26 Ciprofloxacin Capl 500 mg Tab -
27 Cimetidine Tab 200 mg Tab #REF! #REF!
28 Clonidine Tab #REF! #REF!
29 Cotrimoksazol Ped Tablet 120 mg Tab #REF! #REF!
30 Cotrimoksazol Dewasa Tab 480 mg/ Tab #REF! #REF!
31 Cyanocobalamin (Vit B12) Tab Tab -
32 Dexametason Tab 0,5 mg Tab -
33 Diazepam Tab 2 mg ( @ 100 = @ 100 ) Tab -
34 Diazepam Tab 5 mg ( @ 100 = @ 250 ) Tab #REF! #REF!
35 Domperidome ( @100 = @50 ) Tab -
36 Ephedrin HCl Tab 25 mg Tab #REF! #REF!
37 Erytromysin 500 mg Tab Tab -
38 Fitomenadion (Vit K) Tab Salut 10 mg Tab -

39 Furosemid Tablet 40 mg Tab -
40 Glibenklamid Tab 5 mg Tab -
41 Gliseril Guaiyacolat Tab 100 mg Tab #REF! #REF!
42 Griseofulvin Tab 125 mg micronized Tab #REF! #REF!
43 Haloperidol Tab 1,5 mg Tab -
44 Haloperidol Tab 5 mg Tab #REF! #REF!
45 Hidroklorothiazid (HCT) Tab 25 mg Tab -
46 Ibuprofen Tab 200 mg Tab -
47 Ibuprofen Tab 400 mg Tab #REF! #REF!
48 Isosorbid Dinitrat Tab 5 mg Tab -
49 Komb. Pirimetamin 25 mg + Sulfadoxin 500 mg Tab #REF! #REF!
50 Ketoconzol Tab Tab #REF! #REF!
51 LansoprasolenTb Tab #REF! #REF!
52 Levofloxacin Tab 500 mg Tab #REF! #REF!
53 Loperamide Tab Tab #REF! #REF!
54 Loratadin tab 10 mg Tab -
55 Meloksikam 15 Mg Tab #REF! #REF!
56 Metform Tb Tab -
57 Methyl Prednisolon Tb Tab -
58 Metronidazole Tab 250 mg Tab #REF! #REF!
59 Metronidasole 500 Tab #REF! #REF!
60 Metoclopramide Tab 10 mg Tab -
61 Natrium Diklofenak Tab 50 mg Tab #REF! #REF!
62 Nifedipin Tab 10 mg Tab #REF! #REF!
63 Ofloxacin Tab 400 mg Tab #REF! #REF!
64 Omeprasole Tab -
65 Papaverin Tab 40 mg Tab #REF! #REF!
66 Paracetamol Tab 500 mg Tab -
67 Phenobarbital Tab 30 mg Tab #REF! #REF!
68 Piridoxyn HCl Tab 10 mg Tab -
69 Prednison Tab 5 mg Tab -
70 Piroxicam Caps 20 mg Tab #REF! #REF!
71 PropilTioUrasil (PTU) Tab 100 mg Tab -
72 Propanolol HCl Tab 40 mg Tab #REF! #REF!
73 Pyrantel HCl Tab 125 mg Tab -
74 Ranitidine Tab 150 mg Tab -
75 Retinol 100.000 Iu (Biru) Tab #REF! #REF!
76 Retinol 200.000 Iu (Merah) Tab #REF! #REF!
77 Salbutamol Tab 4 mg Tab -
78 Selviplex Tab #REF! #REF!
79 Simvastatin Tab #REF! #REF!
80 Tablet Tambah Darah Tab -
81 Tetracyclin HCl Caps 250 mg Tab #REF! #REF!
83 Thiamin HCl Monotartrat (Vit B1) Tab 50 mg Tab -
84 Trihexylfenidil Tab -
85 Vitamin B Compleks Tab Tab -
86 Zink Tab -
87 Ambroxol Sy Btl #REF! #REF!

88 Amoxicillin Syrup Kering 125 mg / 5 ml Btl #REF! #REF!
89 Ampicillin Syrup Kering 125 mg / 5 ml Btl #REF! #REF!
90 Antasida Doen Susp Kombinasi Btl #REF! #REF!
91 Antidiare syr Btl -
92 Antiinfluensa Syr (Erlaflu) Btl #REF! #REF!
93 Cotrimoksazol Susp Btl -
94 Cefadroxil Syr Btl #REF! #REF!
95 Cetirizine Syr Btl -
96 Domperidome Sy Btl -
97 erytromysin Syrup Kering Btl -
98 Garam Oralit 200 ml Air Btl -
99 Ibuprofen Syr Btl -
100 Metocloperamide Syr Btl #REF! #REF!
101 Multivit Syr Btl #REF! #REF!
102 Obat Batuk Hitam (OBH) Cairan Btl #REF! #REF!
103 Paracetamol Syrup 100 mg / 5 ml Btl #REF! #REF!
104 Paracetamol Drops 10 ml Btl #REF! #REF!
105 Pyrantel Syr Btl -
106 Zinc Syr Btl #REF! #REF!
107 Ampicillin 1 gram Inj Amp #REF! #REF!
108 Aminopyllin Inj Amp #REF! #REF!
109 Aqua Pro Injeksi Steril Bebas Pirogen Amp -
110 Asering - Asetat Ringer Amp #REF! #REF!
111 Atropin inj 0,25 mg/mL (i.v./i.m./s.k.) Amp -
112 Cefotaxim 1 g Inj Amp -
113 Clorpromazine inj Amp #REF! #REF!
114 Cyanocobalamin (Vit B12) Inj 500 mg / ml Amp -
115 Dexametason Inj 5 mg / ml - 1 ml Amp -
116 Diazepam Inj Amp -
117 Diphenhydramin HCl Inj 10 mg / ml - 1 ml Amp -
118 Ephinefrin HCl/Bitartrat (Adrenalin) Inj 0,1% - 1 ml Amp -
119 Fitomenadion (Vit K) Inj 10 mg - 1 ml Amp -
120 Furocemide Inj Amp -
121 Glukosa Lar Infus 5% Steril Amp -
122 KA EN 3B Amp #REF! #REF!
123 Ketorolac Inj ( @ 12 = @ 6 ) Amp -
124 Lidocain Comp. Inj/Pehacain Inj. Amp -
125 Magnesium Sulfat Inj (i.v.) 20% - 25 ml Amp -
126 Metil Ergometrin Maleat Inj 0,200 mg - 1 ml Amp -
127 Metocloperamide Inj Amp #REF! #REF!
128 Natrium Klorida 0,9% Larutan Infus Steril Amp -
129 Ondansetron Inj Amp -
130 Oxytetracyklin HCl Inj (i.m.) 50 mg / ml - 10 ml Amp #REF! #REF!
131 Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Ampl ) Amp -
132 Phenobarbital Inj Amp #REF! #REF!
133 Ranitidine inj ( @ 25 = @ 10 ) Amp -
134 Ringer Laktat Lar Infus Steril Amp -

135 Thiamin HCl (Vit B1) Inj 100 mg / ml - 1 ml Amp -
136 Vit B1, B6, B12 Inj Amp #REF! #REF!
137 Aciclovir cream (25 Tube) Tub -

138 AntiHemoroid Doen Kombinasi Tub -
139 Antifungi SK Tub -
140 Betametason Cream 0,1% (25 Tube) Tub -
141 Chloramphenicol Salep Kulit 1% (24 tube) Tub -
142 Chloramphenicol Salep Mata 1% (24 tube) Tub -
143 Chloramphenicol Tetes mata (25 Btl) Tub #REF! #REF!
144 Chloramphenicol Tetes Telinga (24 Btl) Tub #REF! #REF!
145 Diasepam Rectal ( Stesolid ) Tub -
146 Etakridina laktat (Rivanol) Tub -
147 Ethyl Klorida Semprot Tub #REF! #REF!
148 Gentian Violet Lar 1% Tub -
149 Hidrokortison Cream 2,5% Tub -
150 Ketoconazol SK Btl #REF! #REF!
151 Mikonazole Sk Btl #REF! #REF!
152 Mycorine Powder Btl -
153 Oxytetracyclin HCl Salep Kulit 3% Btl #REF! #REF!
154 Oxytetracyklin HCl Salep Mata (@25) Tub -
155 Povidon Iodium Lar 60 ml Tub -
157 Povidon Iodium Lar 1000 ml Tub #REF! #REF!
158 Salep 2-4 Kombinasi Tub -
159 Salisil Talk/Bedak 2% Tub -
160 Scabimite Tub -
BMHP
161 Alat Suntik Sekali Pakai 1 ml Pcs -
162 Alat Suntik Sekali Pakai 2.5 ml / 3 ml Pcs -
165 Catgut/Benang Bedah no 2/0-3/0 (chromic) Pcs -
166 Canula Adult & Childr Pcs -
168 E-Care Alcohol Swab Pcs -
169 Etanol 70 % Pcs -
170 FM Crepe 7,5 cm x 4,55 m Pcs #REF! #REF!
171 FM Crepe 10 cm x 4,55 m Pcs -
172 Folly Cath 18 Pcs -
174 Handscoon Pcs -
Handscoon L -
Handscoon M -
175 Infusion Set Anak Pcs -
176 Infusion Set Dewasa Pcs -
177 i.v. Cathether 18 G Rol #REF! #REF!
178 i.v. Cathether 20 G Rol -
181 Kapas Pembalut/Adsorben 100 g Rol -

183 Kasa Kompres 40/40 Steril Pcs #REF! #REF!
184 Kasa Pembalut 2 m x 80 cm Rol -
185 Kasa Pembalut hidrofil 4 m x 15 cm Rol -
187 Kasa Hidrofil 16 x 16 Pcs -
188 Kasa 40 x 80 Btl -
189 LISOL Rol -
190 Masker Rol -
Masker #REF! #REF!
191 Poligyp 5 cm x 2,7 m Pcs -
192 Polifix 5 cm x 1 m Pcs -
193 Poliband Btl #REF! #REF!
194 Policlean Handrub 500 ml Pcs -
195 Plester 7,5 yard x 2 inch (Besar) Rol -
196 Plester 5 yard x 2 inch (2,25 x 5 ) Pcs -
197 Silk (Benang Bedah Sutra) no 3 / 0 Pcs -
198 NGT Pcs #REF! #REF!
199 Urine bag Pcs -
200 Aqua Gell -
201 Catejeel #REF! #REF!
202 Scalvien -
203 Do Care Wash Gloves Antiseptic -
204 Feding Tube #REF! #REF!
Feding Tube #REF! #REF!
205 IV Cath 18 #REF! #REF!
#REF! #REF!
Tambahan : #REF! #REF!
#REF! #REF!
206 Bisacodyl Supp 5 mg -
207 Salbutamol Syr #REF! #REF!
208 Phenol Glycerol -
209 Anti Influenza (Noza) -
210 Miniaspi -
211 multivitamin (LVB) -
212 Analgetik Inj (antrain ) -
213 Phenitoin Inj -
214 Griseofulvin 500 mg Tab -
215 Oxymetazoline Spray 0,05 % -
216 Oxymetazoline Drop 0,025 % -
217 Asam tranexamat Inj -
218 Ipratropium Inh -
219 Amoxicillin 250 #REF! #REF!
Ket Kolom a Nomor Urut
Kolom b Nma Obat atau Sediaan
Kolom c Satuan diisi satuan terkecil
Kolom d Jumlah Volume sdiaan pd awal bulan berjalan
Kolom e Jumlah volume sediaan yg di terima dari Instalasi farmasi
Kolom f Jumlah Stok awal + Penerimaan
Kolom g Jumlah pengeluaran selama 1 (satu) bulan berjalan
Kolom h Jumlah Sisa Persedian setelah dikurangi Pengeluaran
Kolom i Jumlah Pengeluaran selama 1 (satu) bulan dibagi hari kerja (25 hr)
Kolom j Hari Kekosongan obat (dihitung sejak sediaan kosong sampai saat membuat laporan LPLPO )
Kolom k Jumlah volume sediaan yg kosong ( Jumlah hri kekosongan dikali denagn stok kebutuhan )
Kolom l Hari Waktu Tunggu (Jumlah hari menunggu penerimaan obat, ketikal LPLPO terkirim s/d terima distribusi obat)
Kolom m Jumlah volume Tunggu ( Jumlah hri kekosongan yang ditunggu dikali denagn stok kebutuhan )
Kolom n Jumlah volume penggunaan selama 1 (satu) bulan dikali 10 %
Kolom o Jumlah ( Pengeluaran+ Stok Kekosongan + Stok Tunggu ) x 10 % - Sisa Stok
Kolom p Jelas
B Anggaran Pendapatan dan Belanja Daerah (APBD I)
1 Acyclovir Tab 400 mg Tab #REF! - #REF! -

2 Alupurinol Tab 100 mg Tab #REF! - #REF! -
3 Amoxicillin Caps 500 mg / Pehamoxyl 500 Tab #REF! - #REF! -
4 Asam Ascorbat (Vit C) Tab 50 mg Tab #REF! - #REF! -
5 Asam Mefenamat Tab 500 mg Tab #REF! - #REF! -
6 Calsium Laktat (Calk) Tab 500 mg Tab #REF! - #REF! -
7 Captopril Tab 25 mg Tab #REF! - #REF! -
8 Chlorpheniramin Maleat (CTM) Tab 4 mg Tab #REF! - #REF! -
9 Chlorpromazin HCl Tab Salut 25 mg Tab #REF! - #REF! -
11 Cotrimoksazol Dewasa Tab 480 mg/ Tab #REF! - #REF! -
12 Diazepam Tab 2 mg ( @ 100 = @ 100 ) Tab #REF! - #REF! -
13 Ephedrin HCl Tab 25 mg Tab #REF! - #REF! -
14 Gliseril Guaiyacolat Tab 100 mg Tab #REF! - #REF! -
15 Griseofulvin Tab 125 mg micronized Tab #REF! - #REF! -
16 Haloperidol Tab 5 mg Tab #REF! - #REF! -
17 Ibuprofen Tab 400 mg Tab #REF! - #REF! -
18 Metform Tb Tab #REF! - #REF! -
19 Piridoxyn HCl Tab 10 mg Tab #REF! - #REF! -
20 Prednison Tab 5 mg Tab #REF! - #REF! -
21 PropilTioUrasil (PTU) Tab 100 mg Tab #REF! - #REF! -
22 Retinol 10.000 IU Caps Tab #REF! - #REF! -
24 Cotrimoksazol Susp Btl #REF! - #REF! -

25 erytromysin Syrup Kering Btl #REF! - #REF! -
26 Obat Batuk Hitam (OBH) Cairan Btl #REF! - #REF! -
27 Paracetamol Syrup 100 mg / 5 ml Btl #REF! - #REF! -
28 Aqua Pro Injeksi Steril Bebas Pirogen Amp #REF! - #REF! -

29 Clorpromazine inj Amp/Flc #REF! - #REF! -
30 Cyanocobalamin (Vit B12) Inj 500 mg / ml Amp/Flc #REF! - #REF! -
31 Diazepam Inj Amp/Flc #REF! - #REF! -
32 Magnesium Sulfat Inj (i.v.) 20% - 25 ml Amp/Flc #REF! - #REF! -
33 Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Ampl ) Amp/Flc #REF! - #REF! -
34 Phenobarbital Inj Amp/Flc #REF! - #REF! -
35 AntiHemoroid Doen Kombinasi Tub #REF! - #REF! -

36 Antifungi SK Tub #REF! - #REF! -
37 Etanol 70 % Tub #REF! - #REF! -
38 Gentian Violet Lar 1% Tub #REF! - #REF! -
39 Hidrokortison Cream 2,5% Tub #REF! - #REF! -
40 Oxytetracyclin HCl Salep Kulit 3% Tub #REF! - #REF! -
41 Povidon Iodium Lar 300 ml Tub #REF! - #REF! -
42 Salisil Talk/Bedak 2% Tub #REF! - #REF! -
43 Nystatin Suppo #REF! - #REF! -
44 Ergotamin Tab #REF! - #REF! -
BMHP
45 Catgut/Benang Bedah no 2/0-3/0 (plain&chromic) pcs #REF! - #REF! -
46 Folly cath 18 pcs #REF! - #REF! -
47 Handscoon pcs #REF! - #REF! -
48 i.v. Cathether 22 G pcs #REF! - #REF! -
50 Kapas Pembalut/Adsorben 250 g pcs #REF! - #REF! -
51 Kasa Pembalut 2 m x 80 cm pcs #REF! - #REF! -
52 Urine bag pcs #REF! - #REF! -
Tambahan
a
b
c
d
e
f
g
C Psikotropika / Precursor
1 Amitriptiline 25 mg Tab #REF! #REF!

2 Alprasolam 0,5 Tab #REF! #REF!
3 Carbamazepine 200 mg Tab Tab #REF! #REF!
6 Chlorpromazin HCl Inj Amp #REF! #REF!
7 Diazepam Tab 2 mg Tab -
8 Diazepam Tab 5 mg Tab #REF! #REF!
9 Diasepam Rectal Tab -
11 Haloperidol Tab 0,5 mg Tab #REF! #REF!
15 Trihexyfenidil Tab -
D Program P2P
Diare
1 Zink Tab #REF! #REF!
2 Oralit Tab #REF! #REF!
Imunisasi
1 BCG Amp #REF! #REF!
2 DPT - HB - Hib Amp #REF! #REF!
3 DT Amp #REF! #REF!
4 HB o Amp #REF! #REF!
5 IPV Amp #REF! #REF!
6 TD Amp #REF! #REF!
7 POLIO Amp #REF! #REF!
8 MR Amp #REF! #REF!
#REF! #REF!
9 ASSP 05 ml Pcs #REF! #REF!
TB paru
4 Kategori I Paket #REF! #REF!
5 Kategori II Paket #REF! #REF!
6 Kategori Anak Paket #REF! #REF!
7 Reagen Paket #REF! #REF!
HIV/ Kusta
9 PB Anak Blister #REF! #REF!
10 MB Anak Blister #REF! #REF!
11 PB Dewasa Blister #REF! #REF!
12 MB Dewasa Blister #REF! #REF!
Kecacingan
14 DEC Tab #REF! #REF!
15 Albendasole Tab #REF! #REF!
16 Paracetamol Tab #REF! #REF!
Rabies
Verorab Inj Amp #REF! #REF!
Malaria
17 Primaquin Tab #REF! #REF!
18 ACT Tab #REF! #REF!
19 Doxyciclin Tab #REF! #REF!
20 Artesunat Inj Amp #REF! #REF!
21 Artemeter Inj Amp #REF! #REF!
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBA
(LPLPO) JKN
Kode Puskesmas :
Kecamatan : TOILI
Puskesmas pembantu Yag Ada

: Yang Lapor :
Kabupaten : Banggai

a b c d e f g
3 Acyclovir Tab 400 mg Tab -
6 Aminophyllin Tab 200 mg Tab -
7 Amoxicillin Caps 500 mg / Pehamoxyl 500 Tab -
10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab -
13 Attapulgit 600 mg tablet (5 x 10 tab) Tab -
14 Asam Ascorbat (Vit C) Tab 50 mg Tab -
15 Asam Mefenamat Tab 500 mg Tab -
16 Betahistin Tb Tab -
18 Captopril Tab 25 mg Tab -
20 Cefadroxil Capsul 500 mg Tab -
21 Cetirizine Tb Tab -
23 Chlorpheniramin Maleat (CTM) Tab 4 mg Tab -
25
Chlorpromazin HCl Tab Salut 100 mg Tab -
26 Ciprofloxacin Capl 500 mg Tab -
31 Cyanocobalamin (Vit B12) Tab Tab -
32 Dexametason Tab 0,5 mg Tab -
33 Diazepam Tab 2 mg ( @ 100 = @ 100 ) Tab -
35 Domperidome ( @100 = @50 ) Tab -
36
Ephedrin HCl Tab 25 mg Tab #REF! #REF!
37
Erytromysin 500 mg Tab Tab -
38 Fitomenadion (Vit K) Tab Salut 10 mg Tab -

39 Furosemid Tablet 40 mg Tab -
40 Glibenklamid Tab 5 mg Tab -
45 Hidroklorothiazid (HCT) Tab 25 mg Tab -
46 Ibuprofen Tab 200 mg Tab -
48 Isosorbid Dinitrat Tab 5 mg Tab -
54 Loratadin tab 10 mg Tab -
56 Metform Tb Tab -
57 Methyl Prednisolon Tb Tab -
60 Metoclopramide Tab 10 mg Tab -
64 Omeprasole Tab -
66 Paracetamol Tab 500 mg Tab -
68 Piridoxyn HCl Tab 10 mg Tab -
69 Prednison Tab 5 mg Tab -
71 PropilTioUrasil (PTU) Tab 100 mg Tab -
73 Pyrantel HCl Tab 125 mg Tab -
74 Ranitidine Tab 150 mg Tab -
77 Salbutamol Tab 4 mg Tab -
80 Tablet Tambah Darah Tab -
83 Thiamin HCl Monotartrat (Vit B1) Tab 50 mg Tab -
84 Trihexylfenidil Tab -
85
Vitamin B Compleks Tab Tab -
86
Zink Tab -

91 Antidiare syr Btl -
93 Cotrimoksazol Susp Btl -
95 Cetirizine Syr Btl -
96 Domperidome Sy Btl -
97 erytromysin Syrup Kering Btl -
98 Garam Oralit 200 ml Air Btl -
99 Ibuprofen Syr Btl -
105 Pyrantel Syr Btl -

109 Aqua Pro Injeksi Steril Bebas Pirogen Amp -
111 Atropin inj 0,25 mg/mL (i.v./i.m./s.k.) Amp -
112 Cefotaxim 1 g Inj Amp -
114 Cyanocobalamin (Vit B12) Inj 500 mg / ml Amp -
115 Dexametason Inj 5 mg / ml - 1 ml Amp -
117 Diphenhydramin HCl Inj 10 mg / ml - 1 ml Amp -
118 Ephinefrin HCl/Bitartrat (Adrenalin) Inj 0,1% - 1 ml Amp -
119 Fitomenadion (Vit K) Inj 10 mg - 1 ml Amp -
120 Furocemide Inj Amp -
121 Glukosa Lar Infus 5% Steril Amp -
123 Ketorolac Inj ( @ 12 = @ 6 ) Amp -
124 Lidocain Comp. Inj/Pehacain Inj. Amp -
125 Magnesium Sulfat Inj (i.v.) 20% - 25 ml Amp -
126 Metil Ergometrin Maleat Inj 0,200 mg - 1 ml Amp -
128 Natrium Klorida 0,9% Larutan Infus Steril Amp -
129 Ondansetron Inj Amp -
131 Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Ampl ) Amp -
133 Ranitidine inj ( @ 25 = @ 10 ) Amp -
134 Ringer Laktat Lar Infus Steril Amp -
135 Thiamin HCl (Vit B1) Inj 100 mg / ml - 1 ml Amp -
137
Aciclovir cream (25 Tube) Tub -
138
AntiHemoroid Doen Kombinasi Tub -
139 Antifungi SK Tub -
140 Betametason Cream 0,1% (25 Tube) Tub -
141 Chloramphenicol Salep Kulit 1% (24 tube) Tub -
142 Chloramphenicol Salep Mata 1% (24 tube) Tub -
145 Diasepam Rectal ( Stesolid ) Tub -
146 Etakridina laktat (Rivanol) Tub -
148 Gentian Violet Lar 1% Tub -
149 Hidrokortison Cream 2,5% Tub -
152 Mycorine Powder Btl -
154 Oxytetracyklin HCl Salep Mata (@25) Tub -
158 Salep 2-4 Kombinasi Tub -
159 Salisil Talk/Bedak 2% Tub -
160 Scabimite Tub -
BMHP
162 Alat Suntik Sekali Pakai 2.5 ml / 3 ml Pcs -
165 Catgut/Benang Bedah no 2/0-3/0 (chromic) Pcs -
168 E-Care Alcohol Swab Pcs -
169 Etanol 70 % Pcs -
171 FM Crepe 10 cm x 4,55 m Pcs -
174 Handscoon Pcs -
Handscoon L -
Handscoon M -
175 Infusion Set Anak Pcs -
176 Infusion Set Dewasa Pcs -
184 Kasa Pembalut 2 m x 80 cm Rol -
187 Kasa Hidrofil 16 x 16 Pcs -
188 Kasa 40 x 80 Btl -
189 LISOL Rol -
190 Masker Rol -
Masker #REF! #REF!
191 Poligyp 5 cm x 2,7 m Pcs -
192 Polifix 5 cm x 1 m Pcs -
194
Policlean Handrub 500 ml Pcs -
195
Plester 7,5 yard x 2 inch (Besar) Rol -
196 Plester 5 yard x 2 inch (2,25 x 5 ) Pcs -
197 Silk (Benang Bedah Sutra) no 3 / 0 Pcs -
199 Urine bag Pcs -
200 Aqua Gell -
202 Scalvien -
203 Do Care Wash Gloves Antiseptic -
#REF! #REF!
#REF! #REF!
206 Bisacodyl Supp 5 mg -
208 Phenol Glycerol -
209
Anti Influenza (Noza) -
210 Miniaspi
-
211 multivitamin (LVB)
-
212 Analgetik Inj (antrain )
-
213 Phenitoin Inj -
214 Griseofulvin 500 mg Tab -
215 Oxymetazoline Spray 0,05 % -
216 Oxymetazoline Drop 0,025 % -
217 Asam tranexamat Inj -
218 Ipratropium Inh -


Kolom p Jelas

1 Acyclovir Tab 400 mg Tab #REF! - #REF! -
4 Asam Ascorbat (Vit C) Tab 50 mg Tab #REF! - #REF! -
5 Asam Mefenamat Tab 500 mg Tab #REF! - #REF! -
6 Calsium Laktat (Calk) Tab 500 mg Tab #REF! - #REF! -
7 Captopril Tab 25 mg Tab #REF! - #REF! -
8 Chlorpheniramin Maleat (CTM) Tab 4 mg Tab #REF! - #REF! -
11 Cotrimoksazol Dewasa Tab 480 mg/ Tab #REF! - #REF! -
12 Diazepam Tab 2 mg ( @ 100 = @ 100 ) Tab #REF! - #REF! -
13 Ephedrin HCl Tab 25 mg Tab #REF! - #REF! -
14 Gliseril Guaiyacolat Tab 100 mg Tab #REF! - #REF! -
15 Griseofulvin Tab 125 mg micronized Tab #REF! - #REF! -
16 Haloperidol Tab 5 mg Tab #REF! - #REF! -
19 Piridoxyn HCl Tab 10 mg Tab #REF! - #REF! -
20 Prednison Tab 5 mg Tab #REF! - #REF! -
21 PropilTioUrasil (PTU) Tab 100 mg Tab #REF! - #REF! -
24 Cotrimoksazol Susp Btl #REF! - #REF! -

25 erytromysin Syrup Kering Btl #REF! - #REF! -
26 Obat Batuk Hitam (OBH) Cairan Btl #REF! - #REF! -
27 Paracetamol Syrup 100 mg / 5 ml Btl #REF! - #REF! -

29 Clorpromazine inj Amp/Flc #REF! - #REF! -
30 Cyanocobalamin (Vit B12) Inj 500 mg / ml Amp/Flc #REF! - #REF! -
Diazepam Inj Amp/Flc #REF! - #REF! -
31
32 Magnesium Sulfat Inj (i.v.) 20% - 25 ml Amp/Flc #REF! - #REF! -
33 Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Ampl ) Amp/Flc #REF! - #REF! -

34 Phenobarbital Inj Amp/Flc #REF! - #REF! -
35 AntiHemoroid Doen Kombinasi Tub #REF! - #REF! -

36 Antifungi SK Tub #REF! - #REF! -
37 Etanol 70 % Tub #REF! - #REF! -
38 Gentian Violet Lar 1% Tub #REF! - #REF! -
39 Hidrokortison Cream 2,5% Tub #REF! - #REF! -
40 Oxytetracyclin HCl Salep Kulit 3% Tub #REF! - #REF! -
41 Povidon Iodium Lar 300 ml Tub #REF! - #REF! -
42 Salisil Talk/Bedak 2% Tub #REF! - #REF! -
43 Nystatin Suppo #REF! - #REF! -
44 Ergotamin Tab #REF! - #REF! -
BMHP
45 Catgut/Benang Bedah no 2/0-3/0 (plain&chromic) pcs #REF! - #REF! -
46 Folly cath 18 pcs #REF! - #REF! -
47 Handscoon pcs #REF! - #REF! -
50 Kapas Pembalut/Adsorben 250 g pcs #REF! - #REF! -
51 Kasa Pembalut 2 m x 80 cm pcs #REF! - #REF! -
52 Urine bag pcs #REF! - #REF! -
Tambahan
a
b
c
d
e
f
g
7 Diazepam Tab 2 mg Tab -
9 Diasepam Rectal Tab -
15 Trihexyfenidil Tab -
D Program P2P
Diare
1
Zink Tab #REF! #REF!
Imunisasi
#REF! #REF!
TB paru
HIV/ Kusta
Kecacingan
Rabies
Malaria
LAPORAN BULANAN KEFARMASIAN
A .Pustu / Polindes / Poskesdes
Jenis Pelayanan Resep

No Tanggal Konseling Informasi Obat Ket
Rawat Jalan Rawat Inap
a b c d d e f
1 - - - - -
2 - - - - -
3 - - - - -
4 - - - - -
5
- - - - -
6
- - - - -
7 - - - - -
8 - - - - -
9 - - - - -
10 - - - - -
11 - - - - -
12 - - - - -
13 - - - - -
14 - - - - -
15 - - - - -
16 - - - - -
17 - - - - -
18 - - - - -
19 - - - - -
20 - - - - -
21 - - - - -
22 - - - - -
23 - - - - -
24 - - - - -
25 - - - - -
26
- - - - -
27
- - - - -
28
- - - - -
29
- - - - -
30 - - - - -
31 - - - - -
Jumlah A - - - - -
LAPORAN MONITORING INDIKATOR PERESEPAN
A : ISPA Non Pneumonia
A 1 .Pustu / Polindes / Poskesdes
Jumlah
Nama Penderita Umur
item Obat Antibiotik Ya/Tdk
No Tgl Nama Obat
(N) (A) (B) (A / N)

a b c d e f g
2
3
7
8
8
Jumlah
Nama Penderita Umur
No Tgl Nama Obat
(N) (A) (B) (A / N)
10
11
12
13
14
15
16
17
18
18
Nama Penderita Umur Jumlah
No Tgl Nama Obat
(N) (A) (B) (A / N)
19
20
21
22
23
23
24
25
26
27
28
Jumlah
Nama Penderita Umur
No Tgl Nama Obat
(N) (A) (B) (A / N)
29
30
31
Jumlah Penderita 0 Jumlah Item Obat 0

Jumlah Antibiotik 0
Jumlah Rerata #DIV/0!
Persentase #DIV/0!
B : DIARE NS
B 1 .Pustu / Polindes / Poskesdes
Jumlah
Nama Penderita Umur
No Tgl Nama Obat
(N) (A) (B) (A / N)

a b c d e f g
1
1
4
4
8
8
Jumlah
Nama Penderita Umur
No Tgl Nama Obat
(N) (A) (B) (A / N)
10
11
12
13
14
15
16
17
18
19
19
Jumlah
Nama Penderita Umur
No Tgl Nama Obat
(N) (A) (B) (A / N)
20
21
22
23
23
24
25
26
27
Jumlah
Nama Penderita Umur
No Tgl Nama Obat
(N) (A) (B) (A / N)

28
29
30

Jumlah Antibiotik 0
Persentase #DIV/0!
C : MYALGIA
C 1 .Pustu / Polindes / Poskesdes

item Obat Injeksi Ya/Tdk
No Tgl Nama Obat
(N) (A) (B) (A / N)
a b c d e f g
5
5

No Tgl Nama Obat
(N) (A) (B) (A / N)
10
11
11
12
13
14
15
16
16
17
18
19

No Tgl Nama Obat
(N) (A) (B) (A / N)
20
21
21
22
23
24
25
26
26
27

No Tgl Nama Obat
(N) (A) (B) (A / N)
28
29
30
31

Jumlah Injeksi 0
Persentase #DIV/0!
KET. A1 / A / ,A3 : Data di ambil dri pencatatan kunjungan Pasien urutan pertama untuk kasus tersebut ( Tiap Hari )
a . Nomor Urut
b. Tanggal kunjungan Penderita
c. Nama penderita
d. Umur Penderita
e. Jumlah item Obat dalam 1 (satu) lembar Resep (racikan dihitung 1 item)
f. Antibiotika dan Injeksi ( Ya = 1 / Tidak = 0 )
g. Nama Item Obat yang tertulis Pd lembar Resep
h. Dosis Penggunaan
KET. B1 / B2 / B3 : a . Nomor Urut

b. Nama SarKes
c. Jumlah Penderita dalam 1 (satu ) bulan
d. Jumlah Item Obat dalam lembar Resep (racikan dihitung 1 item)
e. Antibiotika dan Injeksi ( Ya = 1 / Tidak = 0 )
f. Jumlah Item Obat dibagi Jumlah Penderita
g. Jumlah antibiotika dibagi Jumlah Penderita X 100 %
KET .C1 / C 2 / C3 : a. Jelas

b. Nama SarKes
c. Hasil Rerata Puskesmas dan Jaringan Puskesmas
d. Hasil Persentase Puskesmas dan Jaringan Puskesmas
Total = Rerata Puskesmas + Rerata Jaringan Puskesmas
Persentase = Persentase Puskesmas + Persentase Jaringan Puskesmas dibagi 2
LAPORAN PEMANTAUAN RESEP OBAT GENERIK DI PUSKESMAS , PUSTU DAN POLINDES *)

Jenis Pelayanan : JKN/ Umum *)
Nama Pustu/Polindes/Poskesdes :
R/ OBAT
JUMLAH LEMBAR RESEP
TOTAL R/ R/ OBAT GENERIK
NO RUANG /POLI / Pustu / Polindes
Umum JKN Umum JKN Umum
a b c d f g i
1 Umum
2 Anak
3 KIA
4 Gigi
Total 0 0 0 0 0
% Penggunaan Rerata Item /

Antibiotika pada ISPA Non Pneumonia Antibiotika pada Diare Non Spesifik Antibiotika pada Myalgia ISPA
a a b c d
*) Coret yg tdk perlu

Ket : Data Pada Laporan Ini diambil dari data laporan POR ( Jumlah Persentase Puskesmas Induk dan Pustu )
Mengetahui
Kepala Puskesmas.......................
(.................................................................................) (............................................................)
Nip Nip
(.................................................................................) (......................................................................................)
Nip Nip
PERMINTAAN OBAT
Format : 1
Bulan :
Tahun :
SWK SWT
Stok Opt
Sisa Stok SK BS Permintaan Ket
Hr Jml Hr Jml (SO)
h i j k l m n p q r
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
SK SWK SWT
Sisa Stok Opt
BS Permintaan Ket
Stok Hr Jml Hr Jml (SO)
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
SK SWK SWT
Stok Opt
Sisa Stok BS Permintaan Ket
Hr Jml Hr Jml (SO)
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
Format : 2
Sisa Stok
-
#REF!
#REF!
-
-
-
-
-
-
-
-
-
-
-
-
-
#REF!
#REF!
-
-
-
-
-
-
-
-
-
#REF!
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Sisa Stok
-
-
-
-
-
-
-
-
Format : 3
Sisa Stok
#REF!
#REF!
#REF!
#REF!
-
#REF!
-
#REF!
-
-
#REF!
#REF!
-
#REF!
-
#REF!
Format : 4
Sisa Stok
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
PERMINTAAN OBAT
Format : 1
Bulan :
Tahun :
SWK SWT Stok Opt

Hr Jml Hr Jml (SO)
h i j k l m n p q r
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
SWK SWT Stok Opt

(SO)
Hr Jml Hr Jml
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
SWK SWT Stok Opt
(SO)
Hr Jml Hr Jml
0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
Sisa SK SWK SWT Stok Opt
BS Permintaan Ket
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
SK SWK SWT Stok Opt
Hr Jml Hr Jml (SO)
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
Format : 2
Sisa Stok
-
#REF!
#REF!
-
-
-
-
-
-
-
-
-
-
-
-
-
#REF!
#REF!
-
-
-
-
-
-
-
-
-
#REF!
-
-
-
-
-
-
-
-
-
-
-
-
-
Sisa Stok
-
-
-
-
-
-
-
-
Format : 3
Sisa Stok
#REF!
#REF!
#REF!
#REF!
-
#REF!
-
#REF!
-
-
#REF!
#REF!
-
#REF!
-
#REF!
Format : 4
Sisa Stok
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
Bulan :
Tahun :
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
h i j
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Bulan :
Tahun :
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
h i j
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Bulan :
Tahun :
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
h i j
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Bulan :
Tahun : 2019
% R/ GENERIK terhadap Total

NERIK R/
Ket
JKN Umum JKN
j l = I / f x 100% m = j /g x 100 % 0
Form. POR 5d
Rerata Item / Lembar resep

Rata 2
Diare Myalgia
e f g
0
Pengelola Obat Puskesmas……...……
(..................................................................)
Nip
(........................................................................................)
Nip
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O
(LPLPO)
Kode Puskesmas :
Kecamatan :
Kabupaten : Banggai
a b c d e f g

3 Acyclovir Tab 400 mg Tab - -
6 Aminophyllin Tab 200 mg Tab - -
7 Amoxicillin Caps 500 mg / Pehamoxyl 500 Tab - -
10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab - -
13 Attapulgit 600 mg tablet (5 x 10 tab) Tab - -
14 Asam Ascorbat (Vit C) Tab 50 mg Tab - -
15 Asam Mefenamat Tab 500 mg Tab - -
16 Betahistin Tb Tab - -
18 Captopril Tab 25 mg Tab - -
20 Cefadroxil Capsul 500 mg Tab - -
21 Cetirizine Tb Tab - -
23 Chlorpheniramin Maleat (CTM) Tab 4 mg Tab - -
25 Chlorpromazin HCl Tab Salut 100 mg Tab - -
26 Ciprofloxacin Capl 500 mg Tab - -
31 Cyanocobalamin (Vit B12) Tab Tab - -
32 Dexametason Tab 0,5 mg Tab - -
33 Diazepam Tab 2 mg ( @ 100 = @ 100 ) Tab - -
35 Domperidome ( @100 = @50 ) Tab - -
37 Erytromysin 500 mg Tab Tab - -
38 Fitomenadion (Vit K) Tab Salut 10 mg Tab - -

39 Furosemid Tablet 40 mg Tab - -
40 Glibenklamid Tab 5 mg Tab - -
43 Haloperidol Tab 1,5 mg Tab - -
45 Hidroklorothiazid (HCT) Tab 25 mg Tab - -
46 Ibuprofen Tab 200 mg Tab - -
48 Isosorbid Dinitrat Tab 5 mg Tab - -
54 Loratadin tab 10 mg Tab - -
56 Metform Tb Tab - -
57 Methyl Prednisolon Tb Tab - -
60 Metoclopramide Tab 10 mg Tab - -
64 Omeprasole Tab - -
66 Paracetamol Tab 500 mg Tab - -
68 Piridoxyn HCl Tab 10 mg Tab - -
69 Prednison Tab 5 mg Tab - -
71 PropilTioUrasil (PTU) Tab 100 mg Tab - -
73 Pyrantel HCl Tab 125 mg Tab - -
74 Ranitidine Tab 150 mg Tab - -
77 Salbutamol Tab 4 mg Tab - -
80 Tablet Tambah Darah Tab - -
83 Thiamin HCl Monotartrat (Vit B1) Tab 50 mg Tab - -
84 Trihexylfenidil Tab - -
85 Vitamin B Compleks Tab Tab - -
86 Zink Tab - -

91 Antidiare syr Btl - -
93 Cotrimoksazol Susp Btl - -
95 Cetirizine Syr Btl - -
96 Domperidome Sy Btl - -
97 erytromysin Syrup Kering Btl - -
98 Garam Oralit 200 ml Air Btl - -
99 Ibuprofen Syr Btl - -
105 Pyrantel Syr Btl - -
109 Aqua Pro Injeksi Steril Bebas Pirogen Amp - -
111 Atropin inj 0,25 mg/mL (i.v./i.m./s.k.) Amp - -
112 Cefotaxim 1 g Inj Amp - -
114 Cyanocobalamin (Vit B12) Inj 500 mg / ml Amp - -
115 Dexametason Inj 5 mg / ml - 1 ml Amp - -
116 Diazepam Inj Amp - -
117 Diphenhydramin HCl Inj 10 mg / ml - 1 ml Amp - -
118 Ephinefrin HCl/Bitartrat (Adrenalin) Inj 0,1% - 1 ml Amp - -
119 Fitomenadion (Vit K) Inj 10 mg - 1 ml Amp - -
120 Furocemide Inj Amp - -
121 Glukosa Lar Infus 5% Steril Amp - -
123 Ketorolac Inj ( @ 12 = @ 6 ) Amp - -
124 Lidocain Comp. Inj/Pehacain Inj. Amp - -
125 Magnesium Sulfat Inj (i.v.) 20% - 25 ml Amp - -
126 Metil Ergometrin Maleat Inj 0,200 mg - 1 ml Amp - -
128 Natrium Klorida 0,9% Larutan Infus Steril Amp - -
129 Ondansetron Inj Amp - -
131 Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Ampl ) Amp - -
133 Ranitidine inj ( @ 25 = @ 10 ) Amp - -
134 Ringer Laktat Lar Infus Steril Amp - -

135 Thiamin HCl (Vit B1) Inj 100 mg / ml - 1 ml Amp - -
137 Aciclovir cream (25 Tube) Tub - -

138 AntiHemoroid Doen Kombinasi Tub - -
139 Antifungi SK Tub - -
140 Betametason Cream 0,1% (25 Tube) Tub - -
141 Chloramphenicol Salep Kulit 1% (24 tube) Tub - -
142 Chloramphenicol Salep Mata 1% (24 tube) Tub - -
145 Diasepam Rectal ( Stesolid ) Tub - -
146 Etakridina laktat (Rivanol) Tub - -
148 Gentian Violet Lar 1% Tub - -
149 Hidrokortison Cream 2,5% Tub - -
152 Mycorine Powder Btl - -
154 Oxytetracyklin HCl Salep Mata (@25) Tub - -
155 Povidon Iodium Lar 60 ml Tub - -
158 Salep 2-4 Kombinasi Tub - -
159 Salisil Talk/Bedak 2% Tub - -
160 Scabimite Tub - -
BMHP
161 Alat Suntik Sekali Pakai 1 ml Pcs - -
162 Alat Suntik Sekali Pakai 2.5 ml / 3 ml Pcs - -
165 Catgut/Benang Bedah no 2/0-3/0 (chromic) Pcs - -
Err:509 Err:509
166 Canula Adult & Childr Pcs - -
168 E-Care Alcohol Swab Pcs - -
169 Etanol 70 % Pcs - -
171 FM Crepe 10 cm x 4,55 m Pcs - -
172 Folly Cath 18 Pcs - -
174 Handscoon Pcs - -
Handscoon - -
Handscoon - -
175 Infusion Set Anak Pcs - -
176 Infusion Set Dewasa Pcs - -
178 i.v. Cathether 20 G Rol - -
181 Kapas Pembalut/Adsorben 100 g Rol - -

184 Kasa Pembalut 2 m x 80 cm Rol - -
185 Kasa Pembalut hidrofil 4 m x 15 cm Rol - -
187 Kasa Hidrofil 16 x 16 Pcs - -
188 Kasa 40 x 80 Btl - -
189 LISOL Rol - -
190 Masker Rol - -
Masker #REF! #REF!
191 Poligyp 5 cm x 2,7 m Pcs - -
192 Polifix 5 cm x 1 m Pcs - -
194 Policlean Handrub 500 ml Pcs - -
195 Plester 7,5 yard x 2 inch (Besar) Rol - -
196 Plester 5 yard x 2 inch (2,25 x 5 ) Pcs - -
197 Silk (Benang Bedah Sutra) no 3 / 0 Pcs - -
199 Urine bag Pcs - -
200 Aqua Gell - -
202 Scalvien - -
203 Do Care Wash Gloves Antiseptic - -
#REF! #REF!
#REF! #REF!
206 Bisacodyl Supp 5 mg - -
208 Phenol Glycerol - -
209 Anti Influenza (Noza) - -
210 Miniaspi - -
211 multivitamin (LVB) - -
212 Analgetik Inj (antrain ) - -
213 Phenitoin Inj - -
214 Griseofulvin 500 mg Tab - -
215 Oxymetazoline Spray 0,05 % - -
216 Oxymetazoline Drop 0,025 % - -
217 Asam tranexamat Inj - -
218 Ipratropium Inh - -
Kolom p Jelas
1 Acyclovir Tab 400 mg Tab - - - -

4 Asam Ascorbat (Vit C) Tab 50 mg Tab - - - -
5 Asam Mefenamat Tab 500 mg Tab - - - -
6 Calsium Laktat (Calk) Tab 500 mg Tab - - - -
7 Captopril Tab 25 mg Tab - - - -
8 Chlorpheniramin Maleat (CTM) Tab 4 mg Tab - - - -
9 Chlorpromazin HCl Tab Salut 25 mg Tab - - - -
11 Cotrimoksazol Dewasa Tab 480 mg/ Tab - - - -
12 Diazepam Tab 2 mg ( @ 100 = @ 100 ) Tab - - - -
13 Ephedrin HCl Tab 25 mg Tab - - - -
14 Gliseril Guaiyacolat Tab 100 mg Tab - - - -
15 Griseofulvin Tab 125 mg micronized Tab - - - -
16 Haloperidol Tab 5 mg Tab - - - -
19 Piridoxyn HCl Tab 10 mg Tab - - - -
20 Prednison Tab 5 mg Tab - - - -
21 PropilTioUrasil (PTU) Tab 100 mg Tab - - - -
22 Retinol 10.000 IU Caps Tab - - - -
24 Cotrimoksazol Susp Btl - - - -

25 erytromysin Syrup Kering Btl - - - -
26 Obat Batuk Hitam (OBH) Cairan Btl - - - -
27 Paracetamol Syrup 100 mg / 5 ml Btl - - - -

29 Clorpromazine inj Amp/Flc - - - -
30 Cyanocobalamin (Vit B12) Inj 500 mg / ml Amp/Flc - - - -
31 Diazepam Inj Amp/Flc - - - -
32 Magnesium Sulfat Inj (i.v.) 20% - 25 ml Amp/Flc - - - -
33 Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Ampl ) Amp/Flc - - - -
34 Phenobarbital Inj Amp/Flc - - - -
35 AntiHemoroid Doen Kombinasi Tub - - - -

36 Antifungi SK Tub - - - -
37 Etanol 70 % Tub - - - -
38 Gentian Violet Lar 1% Tub - - - -
39 Hidrokortison Cream 2,5% Tub - - - -
40 Oxytetracyclin HCl Salep Kulit 3% Tub - - - -
41 Povidon Iodium Lar 300 ml Tub - - - -
42 Salisil Talk/Bedak 2% Tub - - - -
43 Nystatin Suppo - - - -
44 Ergotamin Tab - - - -
BMHP
45 Catgut/Benang Bedah no 2/0-3/0 (plain&chromic) pcs - - - -
46 Folly cath 18 pcs - - - -
47 Handscoon pcs - - - -
48 i.v. Cathether 22 G pcs - - - -
50 Kapas Pembalut/Adsorben 250 g pcs - - - -
51 Kasa Pembalut 2 m x 80 cm pcs - - - -
52 Urine bag pcs - - - -
Tanbahan
a
b
c
d
e
f
g


7 Diazepam Tab 2 mg Tab - -
9 Diasepam Rectal Tab - -
15 Trihexyfenidil Tab - -
D Program P2P
Diare
Imunisasi
#REF! #REF!
TB paru
HIV/ Kusta
Kecacingan
Rabies
Malaria
A .Puskesmas Induk

a b c d d e f
1 - - - - -
2 - - - - -
3 - - - - -
4 - - - - -
5 - - - - -
6 - - - - -
7 - - - - -
8 - - - - -
9 - - - - -
10 - - - - -
11 - - - - -
12 - - - - -
13 - - - - -
14 - - - - -
15 - - - - -
16 - - - - -
17 - - - - -
18 - - - - -
19 - - - - -
20 - - - - -
21 - - - - -
22 - - - - -
23 - - - - -
24 - - - - -
25 - - - - -
26 - - - - -
27 - - - - -
28 - - - - -
29 - - - - -
30 - - - - -
31 - - - - -
Jumlah A - - - - -
LAPORAN MONITORING INDIKAT
A.1 : Puskesmas Induk
Jumlah
Nama Penderita Umur
No Tgl Nama Obat
(N) (A) (B) (A / N)
a b c d e f g
3
3
7
8
Jumlah
Nama Penderita Umur
No Tgl item Obat Antibiotik Ya/Tdk Nama Obat
(N) (A) (B) (A / N)
10
11
12
13
13
14
15
16
17
18
18
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
19
20
21
22
23
23
24
25
26
27
28
28
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
29
30
31
Jumlah Injeksi 0
Persentase #DIV/0!
B : DIARE NS
B.1 :Puskesmas Induk
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)

a b c d e f g
3
3
8
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
14
15
16
17
18
19
19
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
20
21
22
23
23
24
25
26
27
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
28
29
30
Jumlah Injeksi 0
Persentase #DIV/0!
C : MYALGIA
C.1 : Puskesmas Induk
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)

a b c d e f g
3
3
8
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
14
15
16
17
18
19
19
No Tgl Nama Obat
(N) (A) (B) (A / N)
20
21
22
23
24
24
25
26
27
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
28
29
30
31
Jumlah Injeksi 0
Persentase #DIV/0!
a . Nomor Urut
c. Nama penderita
d. Umur Penderita
h. Dosis Penggunaan

b. Nama SarKes

b. Nama SarKes
% Penggunaan Rerata Ite
a a b c d
Mengetahui
(.................................................................................) (............................................................)
Nip Nip
AR PERMINTAAN OBAT
Format : 1
Bulan :
Tahun :
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
h i j k l m n p q r
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
SK SWK SWT
Sisa Stok Opt
BS Permintaan Ket
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
Err:509
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
Format : 2
Sisa Stok
-
#REF!
#REF!
-
-
-
-
-
-
-
-
-
-
-
-
-
#REF!
#REF!
-
-
-
-
-
-
-
-
-
#REF!
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Sisa Stok
-
-
-
-
-
-
-
-
Format : 3
Sisa Stok
Sisa Stok
#REF!
#REF!
#REF!
#REF!
-
#REF!
-
#REF!
-
-
#REF!
#REF!
-
#REF!
-
#REF!
Format : 4
Sisa Stok
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
N
Format 5
B : Jaringan Puskesmas

Informasi
No Pustu/Polindes Konseling
Rawat Jalan Rawat Inap Obat
a b
1 - - - - 0
2 - - - - 0
3 - - - - 0
4 - - - - 0
5 - - - - 0
6 - - - - 0
7 - - - - 0
8 - - - - 0
9 - - - - 0
10 - - - - 0
11 - - - - 0
12 - - - - 0
13 - - - - 0
14 - - - - 0
15 - - - - 0
16 - - - - 0
17 - - - - 0
18 - - - - 0
19 - - - - 0
20 - - - - 0
Jumlah B - - - 0
Total A + B - - - 0
Ket : Kolom a. jelas

Kolom b. Jelas
Kolom c dan d. Jumlah lembar Rese
Kolom e. Penderita yang minta penjelasan secara det
Kolom f. Penjelasan / informasi yang dilakukan /
Kolom f. Penjelasan / informasi yang dilakukan /diberikan kepada penderita/masyarakat

ITORING INDIKATOR PERESEPAN
Form. POR 5 a
Bulan :
Tahun :
A.2 : Jaringan Puskesmas
Sesuai Jumlah Rerata Item Persentase

Pedoman No Nama Pustu / Polindes Obat Per
Penderita Item Obat Antibiotik Lembar Resep (%)
Dosis Ket
Ya / Tdk a b c d e f = d/c g = ( e/c ) x 100 %
h i j 1 0 #DIV/0! #DIV/0!
2 0 #DIV/0! #DIV/0!
3 0 #DIV/0! #DIV/0!
4 0 #DIV/0! #DIV/0!
5 0 #DIV/0! #DIV/0!
6 0 #DIV/0! #DIV/0!
7 0 #DIV/0! #DIV/0!
8 0 #DIV/0! #DIV/0!
9 0 #DIV/0! #DIV/0!
10 0 #DIV/0! #DIV/0!
11 0 #DIV/0! #DIV/0!
12 0 #DIV/0! #DIV/0!
13 0 #DIV/0! #DIV/0!
14 0 #DIV/0! #DIV/0!
15 0 #DIV/0! #DIV/0!
16 0 #DIV/0! #DIV/0!
17 0 #DIV/0! #DIV/0!
18 0 #DIV/0! #DIV/0!
19
20
21
22
23
24 0 #DIV/0! #DIV/0!
Jumlah 0 0 0 #DIV/0! #DIV/0!
A.3 :Hasil Puskesmas dan Jaringan
Jumlah
No Fasilitas Pelayanan
Rerata Item Obat Persentase ( % )
a b c d
A Puskesmas Induk 0
B
Jaringan Puskesmas 0
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5 B
Bulan :
Tahun :
B.2 : Jaringan Puskesmas
Sesuai Jumlah Persentase

Pedoman Rerata Item
Dosis Ket No Nama Pustu / Polindes Obat Per (%)
Penderita Item Obat Antibiotik Lembar Resep
Ya / Tdk
h i j a b c d e f = d/c g = ( e/c ) x 100 %
1 0 0 0 0 #DIV/0! #DIV/0!
2 0 0 0 0 #DIV/0! #DIV/0!
3 0 0 0 0 #DIV/0! #DIV/0!
4 0 0 0 0 #DIV/0! #DIV/0!
5 0 0 0 0 #DIV/0! #DIV/0!
6 0 0 0 0 #DIV/0! #DIV/0!
7 0 0 0 0 #DIV/0! #DIV/0!
8 0 0 0 0 #DIV/0! #DIV/0!
9 0 0 0 0 #DIV/0! #DIV/0!
10 0 0 0 0 #DIV/0! #DIV/0!
11 0 0 0 0 #DIV/0! #DIV/0!
12 0 0 0 0 #DIV/0! #DIV/0!
13 0 0 0 0 #DIV/0! #DIV/0!
14 0 0 0 0 #DIV/0! #DIV/0!
15 0 0 0 0 #DIV/0! #DIV/0!
16 0 0 0 0 #DIV/0! #DIV/0!
17 0 0 0 0 #DIV/0! #DIV/0!
18 0 0 0 0 #DIV/0! #DIV/0!
19 0 0 0 0 #DIV/0! #DIV/0!
20 0 0 0 0 #DIV/0! #DIV/0!
21 0 0 0 0 #DIV/0! #DIV/0!
22 0 0 0 0 #DIV/0! #DIV/0!
23 0 0 0 0 #DIV/0! #DIV/0!
B.3 :Hasil Puskesmas dan Jaringan
Jumlah
a b c d
A Puskesmas Induk 0
B
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5 C
Bulan :
Tahun :
C.2 : Jaringan Puskesmas

Pedoman Rerata Item
Ya / Tdk
1 0 0 0 0 #DIV/0! #DIV/0!
2 0 0 0 0 #DIV/0! #DIV/0!
3 0 0 0 0 #DIV/0! #DIV/0!
4 0 0 0 0 #DIV/0! #DIV/0!
5 0 0 0 0 #DIV/0! #DIV/0!
6 0 0 0 0 #DIV/0! #DIV/0!
7 0 0 0 0 #DIV/0! #DIV/0!
8 0 0 0 0 #DIV/0! #DIV/0!
9 0 0 0 0 #DIV/0! #DIV/0!
10 0 0 0 0 #DIV/0! #DIV/0!
11 0 0 0 0 #DIV/0! #DIV/0!
12 0 0 0 0 #DIV/0! #DIV/0!
13 0 0 0 0 #DIV/0! #DIV/0!
14 0 0 0 0 #DIV/0! #DIV/0!
15 0 0 0 0 #DIV/0! #DIV/0!
16 0 0 0 0 #DIV/0! #DIV/0!
17 0 0 0 0 #DIV/0! #DIV/0!
18 0 0 0 #DIV/0! #DIV/0!
19 0 0 0 #DIV/0! #DIV/0!
20 0 0 0 #DIV/0! #DIV/0!
21 0 0 0 #DIV/0! #DIV/0!
22 0 0 0 #DIV/0! #DIV/0!
23 0 0 0 0 #DIV/0! #DIV/0!
C.3 :Hasil Puskesmas dan Jaringan
Jumlah
a b c d
A Puskesmas Induk 0
B
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5d
Rata 2
Diare Myalgia
e f g
(..................................................................)
Nip
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAA
(LPLPO)
Kode Puskesmas :
Kecamatan :
Kabupaten : Banggai
a b c d e f g

10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab - -
35 Domperidome ( @100 = @50 ) Tab - -

86 Zink Tab - -




BMHP
Err:509 Err:509
169 Etanol 70 % Pcs - -
170 FM Crepe 7,5 cm x 4,55 m Pcs #REF!
Handscoon - -
Handscoon - -

188 Kasa 40 x 80 Btl - -
189 LISOL Rol - -
190 Masker Rol - -
Masker #REF! #REF!
200 Aqua Gell - -
202 Scalvien - -
#REF! #REF!
#REF! #REF!
210 Miniaspi - -

Kolom p Jelas




37 Etanol 70 % Tub - - - -
BMHP
Tanbahan
a
b
c
d
e
f
g

D Program P2P
Diare
Imunisasi
#REF! #REF!
TB paru
HIV/ Kusta
Kecacingan
Rabies
Malaria
A .Puskesmas Induk

a b c d d e f
1 - - - - -
2 - - - - -
3 - - - - -
4 - - - - -
5 - - - - -
6 - - - - -
7 - - - - -
8 - - - - -
9 - - - - -
10 - - - - -
11 - - - - -
12 - - - - -
13 - - - - -
14 - - - - -
15 - - - - -
16 - - - - -
17 - - - - -
18 - - - - -
19 - - - - -
20 - - - - -
21 - - - - -
22 - - - - -
23 - - - - -
24 - - - - -
25 - - - - -
26 - - - - -
27 - - - - -
28 - - - - -
29 - - - - -
30 - - - - -
31 - - - - -
Jumlah A - - - - -
LAPORAN MONITORING INDI
Jumlah
Nama Penderita Umur
No Tgl Nama Obat
(N) (A) (B) (A / N)
a b c d e f g
3
3
7
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
13
14
15
16
17
18
18
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
19
20
21
22
23
23
24
25
26
27
28
28
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
29
30
31
Jumlah Injeksi 0
Persentase #DIV/0!
B : DIARE NS
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)

a b c d e f g
3
3
8
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
14
15
16
17
18
19
19
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
20
21
22
23
23
24
25
26
27
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
28
29
30
Jumlah Injeksi 0
Persentase #DIV/0!
C : MYALGIA
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)

a b c d e f g
3
3
8
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
14
15
16
17
18
19
19
No Tgl Nama Obat
(N) (A) (B) (A / N)
20
21
22
23
24
24
25
26
27
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
28
29
30
31
Jumlah Injeksi 0
Persentase #DIV/0!
Nip Nip
a . Nomor Urut
c. Nama penderita
d. Umur Penderita
h. Dosis Penggunaan

b. Nama SarKes

b. Nama SarKes
% Penggunaan Rerata It
a a b c d
Mengetahui
(.................................................................................) (......................................................................................)
Nip Nip
MBAR PERMINTAAN OBAT
O)
Format : 1
Bulan :
Tahun :
SWK SWT
Sisa Stok SK BS Stok Opt (SO) Permintaan Ket
Hr Jml Hr Jml
h i j k l m n o p q
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
SWK SWT
Hr Jml Hr Jml
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
0
SWK SWT
Hr Jml Hr Jml
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
SK SWK SWT
Sisa Stok BS Stok Opt (SO) Permintaan Ket
Hr Jml Hr Jml
- - - 7 - - 0
#REF! - - 7 - - #REF!
0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
Err:509
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
SK SWK SWT
Sisa Stok BS Stok Opt (SO) Permintaan Ket
Hr Jml Hr Jml
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
Format : 2
Sisa Stok
-
#REF!
#REF!
-
-
-
-
-
-
-
-
-
-
-
-
-
#REF!
#REF!
-
-
-
-
-
-
-
-
-
#REF!
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Sisa Stok
-
-
-
-
-
-
-
-
Format : 3
Sisa Stok
#REF!
#REF!
#REF!
#REF!
-
#REF!
-
#REF!
-
-
#REF!
#REF!
-
#REF!
-
#REF!
Format : 4
Sisa Stok
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
IAN
Format 5

No Pustu/Polindes Konseling Informasi Obat
a b
1 - - - - 0
2 - - - - 0
3 - - - - 0
4 - - - - 0
5 - - - - 0
6 - - - - 0
7 - - - - 0
8 - - - - 0
9 - - - - 0
10 - - - - 0
11 - - - - 0
12 - - - - 0
13 - - - - 0
14 - - - - 0
15 - - - - 0
16 - - - - 0
17 - - - - 0
18 - - - - 0
19 - - - - 0
20 - - - - 0
Jumlah B - - - 0
Total A + B - - - 0

Kolom b. Jelas

MONITORING INDIKATOR PERESEPAN
Form. POR 5 a
Bulan :
Tahun :
Sesuai Jumlah Rerata Item

Dosis Ket
Ya / Tdk a b c d e f = d/c
h i j 1 0 #DIV/0!
2 0 #DIV/0!
3 0 #DIV/0!
4 0 #DIV/0!
5 0 #DIV/0!
6 0 #DIV/0!
7 0 #DIV/0!
8 0 #DIV/0!
9 0 #DIV/0!
10 0 #DIV/0!
11 0 #DIV/0!
12 0 #DIV/0!
13 0 #DIV/0!
14 0 #DIV/0!
15 0 #DIV/0!
16 0 #DIV/0!
17 0 #DIV/0!
18 0 #DIV/0!
19
20
21
22
23
24 0 #DIV/0!
Jumlah 0 0 0 #DIV/0!
Jumlah
a b c d
A Puskesmas Induk 0
B
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5 B
Bulan :
Tahun :
Sesuai Jumlah
Pedoman Rerata Item
Dosis Ket No Nama Pustu / Polindes Obat Per
Ya / Tdk
h i j a b c d e f = d/c
1 0 0 0 0 #DIV/0!
2 0 0 0 0 #DIV/0!
3 0 0 0 0 #DIV/0!
4 0 0 0 0 #DIV/0!
5 0 0 0 0 #DIV/0!
6 0 0 0 0 #DIV/0!
7 0 0 0 0 #DIV/0!
8 0 0 0 0 #DIV/0!
9 0 0 0 0 #DIV/0!
10 0 0 0 0 #DIV/0!
11 0 0 0 0 #DIV/0!
12 0 0 0 0 #DIV/0!
13 0 0 0 0 #DIV/0!
14 0 0 0 0 #DIV/0!
15 0 0 0 0 #DIV/0!
16 0 0 0 0 #DIV/0!
17 0 0 0 0 #DIV/0!
18 0 0 0 0 #DIV/0!
19 0 0 0 0 #DIV/0!
20 0 0 0 0 #DIV/0!
21 0 0 0 0 #DIV/0!
22 0 0 0 0 #DIV/0!
23 0 0 0 0 #DIV/0!
Jumlah
a b c d
A Puskesmas Induk 0
B
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5 C
Bulan :
Tahun :
Sesuai Jumlah
Pedoman Rerata Item
Ya / Tdk
1 0 0 0 0 #DIV/0!
2 0 0 0 0 #DIV/0!
3 0 0 0 0 #DIV/0!
4 0 0 0 0 #DIV/0!
5 0 0 0 0 #DIV/0!
6 0 0 0 0 #DIV/0!
7 0 0 0 0 #DIV/0!
8 0 0 0 0 #DIV/0!
9 0 0 0 0 #DIV/0!
10 0 0 0 0 #DIV/0!
11 0 0 0 0 #DIV/0!
12 0 0 0 0 #DIV/0!
13 0 0 0 0 #DIV/0!
14 0 0 0 0 #DIV/0!
15 0 0 0 0 #DIV/0!
16 0 0 0 0 #DIV/0!
17 0 0 0 0 #DIV/0!
18 0 0 0 #DIV/0!
19 0 0 0 #DIV/0!
20 0 0 0 #DIV/0!
21 0 0 0 #DIV/0!
22 0 0 0 #DIV/0!
23 0 0 0 0 #DIV/0!
Jumlah
a b c d
A Puskesmas Induk 0
B
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Nip
Form. POR 5d
Rata 2
Diare Myalgia
e f g
(........................................................................................)
Nip
Form. POR 5 a
Persentase
(%)
g = ( e/c ) x 100 %
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Form. POR 5 B
Persentase
(%)
g = ( e/c ) x 100 %
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Form. POR 5 C
Persentase
(%)
g = ( e/c ) x 100 %
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
(LPLPO)
Kode Puskesmas :
Kecamatan :
Kabupaten : Banggai
a b c d e f g

10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab - -
35 Domperidome ( @100 = @50 ) Tab - -

86 Zink Tab - -



BMHP
Err:509 Err:509
169 Etanol 70 % Pcs - -
170 FM Crepe 7,5 cm x 4,55 m Pcs -
Handscoon - -
Handscoon - -

188 Kasa 40 x 80 Btl - -
189 LISOL Rol - -
190 Masker Rol - -
Masker #REF! #REF!
200 Aqua Gell - -
202 Scalvien - -
#REF! #REF!
#REF! #REF!
210 Miniaspi - -

Kolom p Jelas




37 Etanol 70 % Tub - - - -
BMHP
Tanbahan
a
b
c
d
e
f
g

D Program P2P
Diare
Imunisasi
#REF! #REF!
TB paru
HIV/ Kusta
Kecacingan
Rabies
Malaria
A .Puskesmas Induk

a b c d d e f
1 - - - - -
2 - - - - -
3 - - - - -
4 - - - - -
5 - - - - -
6 - - - - -
7 - - - - -
8 - - - - -
9 - - - - -
10 - - - - -
11 - - - - -
12 - - - - -
13 - - - - -
14 - - - - -
15 - - - - -
16 - - - - -
17 - - - - -
18 - - - - -
19 - - - - -
20 - - - - -
21 - - - - -
22 - - - - -
23 - - - - -
24 - - - - -
25 - - - - -
26 - - - - -
27 - - - - -
28 - - - - -
29 - - - - -
30 - - - - -
31 - - - - -
Jumlah A - - - - -
Jumlah
Nama Penderita Umur
No Tgl Nama Obat
(N) (A) (B) (A / N)
a b c d e f g
3
3
7
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
13
14
15
16
17
18
18
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
19
20
21
22
23
23
24
25
26
27
28
28
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
29
30
31
Jumlah Injeksi 0
Persentase #DIV/0!
B : DIARE NS
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)

a b c d e f g
3
3
8
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
14
15
16
17
18
19
19
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
20
21
22
23
23
24
25
26
27
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
28
29
30
Jumlah Injeksi 0
Persentase #DIV/0!
C : MYALGIA
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)

a b c d e f g
3
3
8
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
14
15
16
17
18
19
19
No Tgl Nama Obat
(N) (A) (B) (A / N)
20
21
22
23
24
24
25
26
27
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
28
29
30
31
Jumlah Injeksi 0
Persentase #DIV/0!
a . Nomor Urut
c. Nama penderita
d. Umur Penderita
f. Antibiotika dan Injeksi ( Ya = 1 / Tidak =
h. Dosis Penggunaan

b. Nama SarKes
e. Antibiotika dan Injeksi ( Ya = 1 / Tidak =

b. Nama SarKes
a a b c d
Mengetahui
(.................................................................................) (......................................................................................)
Nip Nip
AR PERMINTAAN OBAT
Format : 1
Bulan :
Tahun :
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
h i j k l m n p q r
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
SK SWK SWT
Sisa Stok Opt
BS Permintaan Ket
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
Err:509
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
Format : 2
Sisa Stok
-
#REF!
#REF!
-
-
-
-
-
-
-
-
-
-
-
-
-
#REF!
#REF!
-
-
-
-
-
-
-
-
-
#REF!
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Sisa Stok
-
-
-
-
-
-
-
-
Format : 3
Sisa Stok
#REF!
#REF!
#REF!
#REF!
-
#REF!
-
#REF!
-
-
#REF!
#REF!
-
#REF!
-
#REF!
Format : 4
Sisa Stok
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
N
Format 5

Informasi
a b
1 - - - - 0
2 - - - - 0
3 - - - - 0
4 - - - - 0
5 - - - - 0
6 - - - - 0
7 - - - - 0
8 - - - - 0
9 - - - - 0
10 - - - - 0
11 - - - - 0
12 - - - - 0
13 - - - - 0
14 - - - - 0
15 - - - - 0
16 - - - - 0
17 - - - - 0
18 - - - - 0
19 - - - - 0
20 - - - - 0
Jumlah B - - - 0
Total A + B - - - 0

Kolom b. Jelas

Form. POR 5 a
Bulan :
Tahun :

Dosis Ket
h i j 1 0 0 #DIV/0! #DIV/0!
2 0 0 #DIV/0! #DIV/0!
3 0 0 #DIV/0! #DIV/0!
4 0 0 #DIV/0! #DIV/0!
5 0 0 #DIV/0! #DIV/0!
6 0 0 #DIV/0! #DIV/0!
7 0 0 #DIV/0! #DIV/0!
8 0 0 #DIV/0! #DIV/0!
9 0 0 #DIV/0! #DIV/0!
10 0 0 #DIV/0! #DIV/0!
11 0 0 #DIV/0! #DIV/0!
12 0 0 #DIV/0! #DIV/0!
13 0 0 #DIV/0! #DIV/0!
14 0 0 #DIV/0! #DIV/0!
15 0 0 #DIV/0! #DIV/0!
16 0 0 #DIV/0! #DIV/0!
17 0 0 #DIV/0! #DIV/0!
18 0 0 #DIV/0! #DIV/0!
19 0
20 0
21 0
22 0
23 0
24 0 0 #DIV/0! #DIV/0!
Jumlah
No Nama Fasilitas Pelayanan
A Puskesmas Induk 0
B Jaringan Puskesmas 0
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5 B
Bulan :
Tahun :

Pedoman Rerata Item
Ya / Tdk
1 0 0 0 0 #DIV/0! #DIV/0!
2 0 0 0 0 #DIV/0! #DIV/0!
3 0 0 0 0 #DIV/0! #DIV/0!
4 0 0 0 0 #DIV/0! #DIV/0!
5 0 0 0 0 #DIV/0! #DIV/0!
6 0 0 0 0 #DIV/0! #DIV/0!
7 0 0 0 0 #DIV/0! #DIV/0!
8 0 0 0 0 #DIV/0! #DIV/0!
9 0 0 0 0 #DIV/0! #DIV/0!
10 0 0 0 0 #DIV/0! #DIV/0!
11 0 0 0 0 #DIV/0! #DIV/0!
12 0 0 0 0 #DIV/0! #DIV/0!
13 0 0 0 0 #DIV/0! #DIV/0!
14 0 0 0 0 #DIV/0! #DIV/0!
15 0 0 0 0 #DIV/0! #DIV/0!
16 0 0 0 0 #DIV/0! #DIV/0!
17 0 0 0 0 #DIV/0! #DIV/0!
18 0 0 0 0 #DIV/0! #DIV/0!
19 0 0 0 0 #DIV/0! #DIV/0!
20 0 0 0 0 #DIV/0! #DIV/0!
21 0 0 0 0 #DIV/0! #DIV/0!
22 0 0 0 0 #DIV/0! #DIV/0!
23 0 0 0 0 #DIV/0! #DIV/0!
Jumlah
A Puskesmas Induk 0
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5 C
Bulan :
Tahun :

Pedoman Rerata Item
Ya / Tdk
1 0 0 0 0 #DIV/0! #DIV/0!
2 0 0 0 0 #DIV/0! #DIV/0!
3 0 0 0 0 #DIV/0! #DIV/0!
4 0 0 0 0 #DIV/0! #DIV/0!
5 0 0 0 0 #DIV/0! #DIV/0!
6 0 0 0 0 #DIV/0! #DIV/0!
7 0 0 0 0 #DIV/0! #DIV/0!
8 0 0 0 0 #DIV/0! #DIV/0!
9 0 0 0 0 #DIV/0! #DIV/0!
10 0 0 0 0 #DIV/0! #DIV/0!
11 0 0 0 0 #DIV/0! #DIV/0!
12 0 0 0 0 #DIV/0! #DIV/0!
13 0 0 0 0 #DIV/0! #DIV/0!
14 0 0 0 0 #DIV/0! #DIV/0!
15 0 0 0 0 #DIV/0! #DIV/0!
16 0 0 0 0 #DIV/0! #DIV/0!
17 0 0 0 0 #DIV/0! #DIV/0!
18 0 0 0 #DIV/0! #DIV/0!
19 0 0 0 #DIV/0! #DIV/0!
20 0 0 0 #DIV/0! #DIV/0!
21 0 0 0 #DIV/0! #DIV/0!
22 0 0 0 #DIV/0! #DIV/0!
23 0 0 0 0 #DIV/0! #DIV/0!
Jumlah
A Puskesmas Induk 0
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5d
Rata 2
Diare Myalgia
e f g
(........................................................................................)
Nip
(LPLPO)
Kode Puskesmas :
Kecamatan :
Kabupaten : Banggai
a b c d e f g

10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab - -
35 Domperidome ( @100 = @50 ) Tab - -

86 Zink Tab - -



BMHP
Err:509 Err:509
169 Etanol 70 % Pcs - -
Handscoon Pcs - -
Handscoon Pcs - -
177 i.v. Cathether 18 G Pcs #REF! #REF!
178 i.v. Cathether 20 G Pcs - -

188 Kasa 40 x 80 Btl - -
189 LISOL Rol - -
190 Masker Rol - -
Masker #REF! #REF!
200 Aqua Gell Pcs - -
201 Catejeel Pcs #REF! #REF!
202 Scalvien Pcs - -
203 Do Care Wash Gloves Antiseptic Pcs - -
204 Feding Tube Pcs #REF! #REF!
Feding Tube Pcs #REF! #REF!
205 IV Cath 18 Pcs #REF! #REF!
Pcs #REF! #REF!
Tambahan : Pcs #REF! #REF!
Pcs #REF! #REF!
206 Bisacodyl Supp 5 mg Pcs - -
207 Salbutamol Syr Pcs #REF! #REF!
208 Phenol Glycerol Pcs - -
209 Anti Influenza (Noza) Pcs - -
210 Miniaspi Pcs - -
211 multivitamin (LVB) Pcs - -
212 Analgetik Inj (antrain ) Pcs - -
213 Phenitoin Inj Pcs - -
214 Griseofulvin 500 mg Tab Pcs - -
215 Oxymetazoline Spray 0,05 % Pcs - -
216 Oxymetazoline Drop 0,025 % Pcs - -
217 Asam tranexamat Inj Pcs - -
218 Ipratropium Inh Pcs - -
219 Amoxicillin 250 Pcs #REF! #REF!

Kolom p Jelas




37 Etanol 70 % Tub - - - -
BMHP
Tanbahan
a
b
c
d
e
f
g

D Program P2P
Diare
Imunisasi
#REF! #REF!
TB paru
HIV/ Kusta
Kecacingan
Rabies
Malaria
A .Puskesmas Induk

a b c d d e f
1 - - - - -
2 - - - - -
3 - - - - -
4 - - - - -
5 - - - - -
6 - - - - -
7 - - - - -
8 - - - - -
9 - - - - -
10 - - - - -
11 - - - - -
12 - - - - -
13 - - - - -
14 - - - - -
15 - - - - -
16 - - - - -
17 - - - - -
18 - - - - -
19 - - - - -
20 - - - - -
21 - - - - -
22 - - - - -
23 - - - - -
24 - - - - -
25 - - - - -
26 - - - - -
27 - - - - -
28 - - - - -
29 - - - - -
30 - - - - -
31 - - - - -
Jumlah A - - - - -
Jumlah
Nama Penderita Umur
No Tgl Nama Obat
(N) (A) (B) (A / N)
a b c d e f g
3
3
7
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
14
15
16
17
18
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
19
20
21
22
23
23
24
25
26
27
28
28
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
29
30
31
Jumlah Injeksi 0
Persentase #DIV/0!
B : DIARE NS
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)

a b c d e f g
3
3
8
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
14
15
16
17
18
19
19
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
20
21
22
23
24
25
26
27
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
28
29
30
Jumlah Injeksi 0
Persentase #DIV/0!
C : MYALGIA
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)

a b c d e f g
3
3
8
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
14
15
16
17
18
19
19
No Tgl Nama Obat
(N) (A) (B) (A / N)
20
21
22
23
24
24
25
26
27
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
28
29
30
31
Jumlah Injeksi 0
Persentase #DIV/0!
a . Nomor Urut
c. Nama penderita
d. Umur Penderita
h. Dosis Penggunaan

b. Nama SarKes

b. Nama SarKes
% Penggunaan Rerata Item
a a b c d
Mengetahui
(.................................................................................) (......................................................................................)
Nip Nip
AR PERMINTAAN OBAT
Format : 1
Bulan :
Tahun :
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
h i j k l m n p q r
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
SK SWK SWT
Sisa Stok Opt
BS Permintaan Ket
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
Err:509
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
Format : 2
Sisa Stok
-
#REF!
#REF!
-
-
-
-
-
-
-
-
-
-
-
-
-
#REF!
#REF!
-
-
-
-
-
-
-
-
-
#REF!
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Sisa Stok
-
-
-
-
-
-
-
-
Format : 3
Sisa Stok
#REF!
#REF!
#REF!
#REF!
-
#REF!
-
#REF!
-
-
#REF!
#REF!
-
#REF!
-
#REF!
Format : 4
Sisa Stok
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
Format 5

Informasi
a b
1 - - - - 0
2 - - - - 0
3 - - - - 0
4 - - - - 0
5 - - - - 0
6 - - - - 0
7 - - - - 0
8 - - - - 0
9 - - - - 0
10 - - - - 0
11 - - - - 0
12 - - - - 0
13 - - - - 0
14 - - - - 0
15 - - - - 0
16 - - - - 0
17 - - - - 0
18 - - - - 0
19 - - - - 0
20 - - - - 0
Jumlah B - - - 0
Total A + B - - - 0

Kolom b. Jelas

Form. POR 5 a
Bulan :
Tahun :

Dosis Ket
h i j 1 0 0 #DIV/0! #DIV/0!
2 0 0 #DIV/0! #DIV/0!
3 0 0 #DIV/0! #DIV/0!
4 0 0 #DIV/0! #DIV/0!
5 0 0 #DIV/0! #DIV/0!
6 0 0 #DIV/0! #DIV/0!
7 0 0 #DIV/0! #DIV/0!
8 0 0 #DIV/0! #DIV/0!
9 0 0 #DIV/0! #DIV/0!
10 0 0 #DIV/0! #DIV/0!
11 0 0 #DIV/0! #DIV/0!
12 0 0 #DIV/0! #DIV/0!
13 0 0 #DIV/0! #DIV/0!
14 0 0 #DIV/0! #DIV/0!
15 0 0 #DIV/0! #DIV/0!
16 0 0 #DIV/0! #DIV/0!
17 0 0 #DIV/0! #DIV/0!
18 0 0 #DIV/0! #DIV/0!
19 0
20 0
21 0
22 0
23 0
24 0 0 #DIV/0! #DIV/0!
Jumlah
A Puskesmas Induk 0
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5 B
Bulan :
Tahun :

Pedoman Rerata Item
Ya / Tdk
1 0 0 0 0 #DIV/0! #DIV/0!
2 0 0 0 0 #DIV/0! #DIV/0!
3 0 0 0 0 #DIV/0! #DIV/0!
4 0 0 0 0 #DIV/0! #DIV/0!
5 0 0 0 0 #DIV/0! #DIV/0!
6 0 0 0 0 #DIV/0! #DIV/0!
7 0 0 0 0 #DIV/0! #DIV/0!
8 0 0 0 0 #DIV/0! #DIV/0!
9 0 0 0 0 #DIV/0! #DIV/0!
10 0 0 0 0 #DIV/0! #DIV/0!
11 0 0 0 0 #DIV/0! #DIV/0!
12 0 0 0 0 #DIV/0! #DIV/0!
13 0 0 0 0 #DIV/0! #DIV/0!
14 0 0 0 0 #DIV/0! #DIV/0!
15 0 0 0 0 #DIV/0! #DIV/0!
16 0 0 0 0 #DIV/0! #DIV/0!
17 0 0 0 0 #DIV/0! #DIV/0!
18 0 0 0 0 #DIV/0! #DIV/0!
19 0 0 0 0 #DIV/0! #DIV/0!
20 0 0 0 0 #DIV/0! #DIV/0!
21 0 0 0 0 #DIV/0! #DIV/0!
22 0 0 0 0 #DIV/0! #DIV/0!
23 0 0 0 0 #DIV/0! #DIV/0!
Jumlah
A Puskesmas Induk 0
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5 C
Bulan :
Tahun :

Pedoman Rerata Item
Ya / Tdk
1 0 0 0 0 #DIV/0! #DIV/0!
2 0 0 0 0 #DIV/0! #DIV/0!
3 0 0 0 0 #DIV/0! #DIV/0!
4 0 0 0 0 #DIV/0! #DIV/0!
5 0 0 0 0 #DIV/0! #DIV/0!
6 0 0 0 0 #DIV/0! #DIV/0!
7 0 0 0 0 #DIV/0! #DIV/0!
8 0 0 0 0 #DIV/0! #DIV/0!
9 0 0 0 0 #DIV/0! #DIV/0!
10 0 0 0 0 #DIV/0! #DIV/0!
11 0 0 0 0 #DIV/0! #DIV/0!
12 0 0 0 0 #DIV/0! #DIV/0!
13 0 0 0 0 #DIV/0! #DIV/0!
14 0 0 0 0 #DIV/0! #DIV/0!
15 0 0 0 0 #DIV/0! #DIV/0!
16 0 0 0 0 #DIV/0! #DIV/0!
17 0 0 0 0 #DIV/0! #DIV/0!
18 0 0 0 #DIV/0! #DIV/0!
19 0 0 0 #DIV/0! #DIV/0!
20 0 0 0 #DIV/0! #DIV/0!
21 0 0 0 #DIV/0! #DIV/0!
22 0 0 0 #DIV/0! #DIV/0!
23 0 0 0 0 #DIV/0! #DIV/0!
Jumlah
A Puskesmas Induk 0
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5d
Rata 2
Diare Myalgia
e f g
(........................................................................................)
Nip
(LPLPO)
Kode Puskesmas :
Kecamatan :
Kabupaten : Banggai
a b c d e f g

10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab - -
35 Domperidome ( @100 = @50 ) Tab - -
NO NAMA OBAT/BHP Satuan Sisa Stok penerimaan Persediaan Pengeluaran

86 Zink Tab - -



BMHP
Err:509 Err:509
169 Etanol 70 % Pcs - -
Handscoon Pcs - -
Handscoon Pcs - -

188 Kasa 40 x 80 Btl - -
189 LISOL Rol - -
190 Masker Rol - -
Masker #REF! #REF!
Pcs #REF! #REF!
Pcs #REF! #REF!

Kolom p Jelas




37 Etanol 70 % Tub - - - -
BMHP
Tanbahan
a
b
c
d
e
f
g


D Program P2P
Diare
Imunisasi
#REF! #REF!
TB paru
HIV/ Kusta
Kecacingan
Rabies
Malaria
A .Puskesmas Induk

a b c d d e f
1 - - - - -
2 - - - - -
3 - - - - -
4 - - - - -
5 - - - - -
6 - - - - -
7 - - - - -
8 - - - - -
9 - - - - -
10 - - - - -
11 - - - - -
12 - - - - -
13 - - - - -
14 - - - - -
15 - - - - -
16 - - - - -
17 - - - - -
18 - - - - -
19 - - - - -
20 - - - - -
21 - - - - -
22 - - - - -
23 - - - - -
24 - - - - -
25 - - - - -
26 - - - - -
27 - - - - -
28 - - - - -
29 - - - - -
30 - - - - -
31 - - - - -
Jumlah A - - - - -
Jumlah
Nama Penderita Umur
No Tgl Nama Obat
(N) (A) (B) (A / N)
a b c d e f g
3
3
7
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
13
14
15
16
17
18
18
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
19
20
21
22
23
23
24
25
26
27
28
28
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
29
30
31
Jumlah Injeksi 0
Persentase #DIV/0!
B : DIARE NS
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)

a b c d e f g
3
3
8
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
14
15
16
17
18
19
19
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
20
21
22
23
23
24
25
26
27
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
28
29
30
Jumlah Injeksi 0
Persentase #DIV/0!
C : MYALGIA
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)

a b c d e f g
3
3
8
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
14
15
16
17
18
19
19
No Tgl Nama Obat
(N) (A) (B) (A / N)
20
21
22
23
24
24
25
26
27
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
28
29
30
31
Jumlah Injeksi 0
Persentase #DIV/0!
a . Nomor Urut
c. Nama penderita
d. Umur Penderita
h. Dosis Penggunaan

b. Nama SarKes

b. Nama SarKes
a a b c d
Mengetahui
(.................................................................................) (......................................................................................)
Nip Nip
AR PERMINTAAN OBAT
Format : 1
Bulan :
Tahun :
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
h i j k l m n p q r
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
SK SWK SWT
Sisa Stok Opt
BS Permintaan Ket
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
Err:509
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
Format : 2
Sisa Stok
-
#REF!
#REF!
-
-
-
-
-
-
-
-
-
-
-
-
-
#REF!
#REF!
-
-
-
-
-
-
-
-
-
#REF!
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Sisa Stok
-
-
-
-
-
-
-
-
Format : 3
Sisa Stok
Sisa Stok
#REF!
#REF!
#REF!
#REF!
-
#REF!
-
#REF!
-
-
#REF!
#REF!
-
#REF!
-
#REF!
Format : 4
Sisa Stok
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
Format 5

Informasi
a b
1 - - - - 0
2 - - - - 0
3 - - - - 0
4 - - - - 0
5 - - - - 0
6 - - - - 0
7 - - - - 0
8 - - - - 0
9 - - - - 0
10 - - - - 0
11 - - - - 0
12 - - - - 0
13 - - - - 0
14 - - - - 0
15 - - - - 0
16 - - - - 0
17 - - - - 0
18 - - - - 0
19 - - - - 0
20 - - - - 0
Jumlah B - - - 0
Total A + B - - - 0

Kolom b. Jelas

Form. POR 5 a
Bulan :
Tahun :

Dosis Ket
h i j 1 0 0 #DIV/0! #DIV/0!
2 0 0 #DIV/0! #DIV/0!
3 0 0 #DIV/0! #DIV/0!
4 0 0 #DIV/0! #DIV/0!
5 0 0 #DIV/0! #DIV/0!
6 0 0 #DIV/0! #DIV/0!
7 0 0 #DIV/0! #DIV/0!
8 0 0 #DIV/0! #DIV/0!
9 0 0 #DIV/0! #DIV/0!
10 0 0 #DIV/0! #DIV/0!
11 0 0 #DIV/0! #DIV/0!
12 0 0 #DIV/0! #DIV/0!
13 0 0 #DIV/0! #DIV/0!
14 0 0 #DIV/0! #DIV/0!
15 0 0 #DIV/0! #DIV/0!
16 0 0 #DIV/0! #DIV/0!
17 0 0 #DIV/0! #DIV/0!
18 0 0 #DIV/0! #DIV/0!
19 0
20 0
21 0
22 0
23 0
24 0 0 #DIV/0! #DIV/0!
Jumlah
A Puskesmas Induk 0
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5 B
Bulan :
Tahun :

Pedoman Rerata Item
Ya / Tdk
1 0 0 0 0 #DIV/0! #DIV/0!
2 0 0 0 0 #DIV/0! #DIV/0!
3 0 0 0 0 #DIV/0! #DIV/0!
4 0 0 0 0 #DIV/0! #DIV/0!
5 0 0 0 0 #DIV/0! #DIV/0!
6 0 0 0 0 #DIV/0! #DIV/0!
7 0 0 0 0 #DIV/0! #DIV/0!
8 0 0 0 0 #DIV/0! #DIV/0!
9 0 0 0 0 #DIV/0! #DIV/0!
10 0 0 0 0 #DIV/0! #DIV/0!
11 0 0 0 0 #DIV/0! #DIV/0!
12 0 0 0 0 #DIV/0! #DIV/0!
13 0 0 0 0 #DIV/0! #DIV/0!
14 0 0 0 0 #DIV/0! #DIV/0!
15 0 0 0 0 #DIV/0! #DIV/0!
16 0 0 0 0 #DIV/0! #DIV/0!
17 0 0 0 0 #DIV/0! #DIV/0!
18 0 0 0 0 #DIV/0! #DIV/0!
19 0 0 0 0 #DIV/0! #DIV/0!
20 0 0 0 0 #DIV/0! #DIV/0!
21 0 0 0 0 #DIV/0! #DIV/0!
22 0 0 0 0 #DIV/0! #DIV/0!
23 0 0 0 0 #DIV/0! #DIV/0!
Jumlah
A Puskesmas Induk 0
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5 C
Bulan :
Tahun :

Pedoman Rerata Item
Ya / Tdk
1 0 0 0 0 #DIV/0! #DIV/0!
2 0 0 0 0 #DIV/0! #DIV/0!
3 0 0 0 0 #DIV/0! #DIV/0!
4 0 0 0 0 #DIV/0! #DIV/0!
5 0 0 0 0 #DIV/0! #DIV/0!
6 0 0 0 0 #DIV/0! #DIV/0!
7 0 0 0 0 #DIV/0! #DIV/0!
8 0 0 0 0 #DIV/0! #DIV/0!
9 0 0 0 0 #DIV/0! #DIV/0!
10 0 0 0 0 #DIV/0! #DIV/0!
11 0 0 0 0 #DIV/0! #DIV/0!
12 0 0 0 0 #DIV/0! #DIV/0!
13 0 0 0 0 #DIV/0! #DIV/0!
14 0 0 0 0 #DIV/0! #DIV/0!
15 0 0 0 0 #DIV/0! #DIV/0!
16 0 0 0 0 #DIV/0! #DIV/0!
17 0 0 0 0 #DIV/0! #DIV/0!
18 0 0 0 #DIV/0! #DIV/0!
19 0 0 0 #DIV/0! #DIV/0!
20 0 0 0 #DIV/0! #DIV/0!
21 0 0 0 #DIV/0! #DIV/0!
22 0 0 0 #DIV/0! #DIV/0!
23 0 0 0 0 #DIV/0! #DIV/0!
Jumlah
A Puskesmas Induk 0
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5d
Rata 2
Diare Myalgia
e f g
(........................................................................................)
Nip
(LPLPO)
Kode Puskesmas :
Kecamatan :
Kabupaten : Banggai
a b c d e f g

10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab - -
35 Domperidome ( @100 = @50 ) Tab - -

86 Zink Tab - -



BMHP
Err:509 Err:509
169 Etanol 70 % Pcs - -
Handscoon Pcs - -
Handscoon Pcs - -

188 Kasa 40 x 80 Btl - -
189 LISOL Rol - -
190 Masker Rol - -
Masker #REF! #REF!
Pcs #REF! #REF!
Pcs #REF! #REF!

Kolom p Jelas




37 Etanol 70 % Tub - - - -
BMHP
Tanbahan
a
b
c
d
e
f
g

D Program P2P
Diare
Imunisasi
#REF! #REF!
TB paru
HIV/ Kusta
Kecacingan
Rabies
Malaria
A .Puskesmas Induk

a b c d d e f
1 - - - - -
2 - - - - -
3 - - - - -
4 - - - - -
5 - - - - -
6 - - - - -
7 - - - - -
8 - - - - -
9 - - - - -
10 - - - - -
11 - - - - -
12 - - - - -
13 - - - - -
14 - - - - -
15 - - - - -
16 - - - - -
17 - - - - -
18 - - - - -
19 - - - - -
20 - - - - -
21 - - - - -
22 - - - - -
23 - - - - -
24 - - - - -
25 - - - - -
26 - - - - -
27 - - - - -
28 - - - - -
29 - - - - -
30 - - - - -
31 - - - - -
Jumlah A - - - - -
Jumlah
Nama Penderita Umur
No Tgl Nama Obat
(N) (A) (B) (A / N)
a b c d e f g
3
3
7
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
13
14
15
16
17
18
18
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
19
20
21
22
23
23
24
25
26
27
28
28
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
29
30
31
Jumlah Injeksi 0
Persentase #DIV/0!
B : DIARE NS
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)

a b c d e f g
3
3
8
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
14
15
16
17
18
19
19
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
20
21
22
23
23
24
25
26
27
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
28
29
30
Jumlah Injeksi 0
Persentase #DIV/0!
C : MYALGIA
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)

a b c d e f g
3
3
8
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
14
15
16
17
18
19
19
No Tgl Nama Obat
(N) (A) (B) (A / N)
20
21
22
23
24
24
25
26
27
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
28
29
30
31
Jumlah Injeksi 0
Persentase #DIV/0!
a . Nomor Urut
c. Nama penderita
d. Umur Penderita
h. Dosis Penggunaan

b. Nama SarKes

b. Nama SarKes
a a b c d
Mengetahui
(.................................................................................) (..................................................................................)
Nip Nip
AR PERMINTAAN OBAT
Format : 1
Bulan :
Tahun :
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
h i j k l m n p q r
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
SK SWK SWT
Sisa Stok Opt
BS Permintaan Ket
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
Err:509
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
Format : 2
Sisa Stok
-
#REF!
#REF!
-
-
-
-
-
-
-
-
-
-
-
-
-
#REF!
#REF!
-
-
-
-
-
-
-
-
-
#REF!
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Sisa Stok
-
-
-
-
-
-
-
-
Format : 3
Sisa Stok
#REF!
#REF!
#REF!
#REF!
-
#REF!
-
#REF!
-
-
#REF!
#REF!
-
#REF!
-
#REF!
Format : 4
Sisa Stok
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
N
Format 5

Informasi
a b
1 - - - - 0
2 - - - - 0
3 - - - - 0
4 - - - - 0
5 - - - - 0
6 - - - - 0
7 - - - - 0
8 - - - - 0
9 - - - - 0
10 - - - - 0
11 - - - - 0
12 - - - - 0
13 - - - - 0
14 - - - - 0
15 - - - - 0
16 - - - - 0
17 - - - - 0
18 - - - - 0
19 - - - - 0
20 - - - - 0
Jumlah B - - - 0
Total A + B - - - 0

Kolom b. Jelas

Form. POR 5 a
Bulan :
Tahun :

Dosis Ket
h i j 1 0 0 #DIV/0! #DIV/0!
2 0 0 #DIV/0! #DIV/0!
3 0 0 #DIV/0! #DIV/0!
4 0 0 #DIV/0! #DIV/0!
5 0 0 #DIV/0! #DIV/0!
6 0 0 #DIV/0! #DIV/0!
7 0 0 #DIV/0! #DIV/0!
8 0 0 #DIV/0! #DIV/0!
9 0 0 #DIV/0! #DIV/0!
10 0 0 #DIV/0! #DIV/0!
11 0 0 #DIV/0! #DIV/0!
12 0 0 #DIV/0! #DIV/0!
13 0 0 #DIV/0! #DIV/0!
14 0 0 #DIV/0! #DIV/0!
15 0 0 #DIV/0! #DIV/0!
16 0 0 #DIV/0! #DIV/0!
17 0 0 #DIV/0! #DIV/0!
18 0 0 #DIV/0! #DIV/0!
19 0
20 0
21 0
22 0
23 0
24 0 0 #DIV/0! #DIV/0!
Jumlah
A Puskesmas Induk 0
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5 B
Bulan :
Tahun :

Pedoman Rerata Item
Ya / Tdk
1 0 0 0 0 #DIV/0! #DIV/0!
2 0 0 0 0 #DIV/0! #DIV/0!
3 0 0 0 0 #DIV/0! #DIV/0!
4 0 0 0 0 #DIV/0! #DIV/0!
5 0 0 0 0 #DIV/0! #DIV/0!
6 0 0 0 0 #DIV/0! #DIV/0!
7 0 0 0 0 #DIV/0! #DIV/0!
8 0 0 0 0 #DIV/0! #DIV/0!
9 0 0 0 0 #DIV/0! #DIV/0!
10 0 0 0 0 #DIV/0! #DIV/0!
11 0 0 0 0 #DIV/0! #DIV/0!
12 0 0 0 0 #DIV/0! #DIV/0!
13 0 0 0 0 #DIV/0! #DIV/0!
14 0 0 0 0 #DIV/0! #DIV/0!
15 0 0 0 0 #DIV/0! #DIV/0!
16 0 0 0 0 #DIV/0! #DIV/0!
17 0 0 0 0 #DIV/0! #DIV/0!
18 0 0 0 0 #DIV/0! #DIV/0!
19 0 0 0 0 #DIV/0! #DIV/0!
20 0 0 0 0 #DIV/0! #DIV/0!
21 0 0 0 0 #DIV/0! #DIV/0!
22 0 0 0 0 #DIV/0! #DIV/0!
23 0 0 0 0 #DIV/0! #DIV/0!
Jumlah
A Puskesmas Induk 0
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5 C
Bulan :
Tahun :

Pedoman Rerata Item
Ya / Tdk
1 0 0 0 0 #DIV/0! #DIV/0!
2 0 0 0 0 #DIV/0! #DIV/0!
3 0 0 0 0 #DIV/0! #DIV/0!
4 0 0 0 0 #DIV/0! #DIV/0!
5 0 0 0 0 #DIV/0! #DIV/0!
6 0 0 0 0 #DIV/0! #DIV/0!
7 0 0 0 0 #DIV/0! #DIV/0!
8 0 0 0 0 #DIV/0! #DIV/0!
9 0 0 0 0 #DIV/0! #DIV/0!
10 0 0 0 0 #DIV/0! #DIV/0!
11 0 0 0 0 #DIV/0! #DIV/0!
12 0 0 0 0 #DIV/0! #DIV/0!
13 0 0 0 0 #DIV/0! #DIV/0!
14 0 0 0 0 #DIV/0! #DIV/0!
15 0 0 0 0 #DIV/0! #DIV/0!
16 0 0 0 0 #DIV/0! #DIV/0!
17 0 0 0 0 #DIV/0! #DIV/0!
18 0 0 0 #DIV/0! #DIV/0!
19 0 0 0 #DIV/0! #DIV/0!
20 0 0 0 #DIV/0! #DIV/0!
21 0 0 0 #DIV/0! #DIV/0!
22 0 0 0 #DIV/0! #DIV/0!
23 0 0 0 0 #DIV/0! #DIV/0!
Jumlah
A Puskesmas Induk 0
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5d
Rata 2
Diare Myalgia
e f g
(.......................................................................................)
Nip
(LPLPO)
Kode Puskesmas :
Kecamatan :
Kabupaten : Banggai
a b c d e f g

10 Amlodipne 10 mg ( @ 30 = @ 30 ) Tab - -
35 Domperidome ( @100 = @50 ) Tab - -

86 Zink Tab - -



BMHP
Err:509 Err:509
169 Etanol 70 % Pcs - -
Handscoon Pcs - -
Handscoon Pcs - -

188 Kasa 40 x 80 Btl - -
189 LISOL Rol - -
190 Masker Rol - -
Masker #REF! #REF!
Pcs #REF! #REF!
Pcs #REF! #REF!
Kolom p Jelas




37 Etanol 70 % Tub - - - -
BMHP
Tanbahan
a
b
c
d
e
f
g

D Program P2P
Diare
Imunisasi
#REF! #REF!
TB paru
HIV/ Kusta
Kecacingan
Rabies
Malaria
A .Puskesmas Induk

a b c d d e f
1 - - - - -
2 - - - - -
3 - - - - -
4 - - - - -
5 - - - - -
6 - - - - -
7 - - - - -
8 - - - - -
9 - - - - -
10 - - - - -
11 - - - - -
12 - - - - -
13 - - - - -
14 - - - - -
15 - - - - -
16 - - - - -
17 - - - - -
18 - - - - -
19 - - - - -
20 - - - - -
21 - - - - -
22 - - - - -
23 - - - - -
24 - - - - -
25 - - - - -
26 - - - - -
27 - - - - -
28 - - - - -
29 - - - - -
30 - - - - -
31 - - - - -
Jumlah A - - - - -
Jumlah
Nama Penderita Umur
No Tgl Nama Obat
(N) (A) (B) (A / N)
a b c d e f g
3
3
7
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
13
14
15
16
17
18
18
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
19
20
21
22
23
23
24
25
26
27
28
28
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
29
30
31
Jumlah Injeksi 0
Persentase #DIV/0!
B : DIARE NS
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)

a b c d e f g
3
3
8
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
14
15
16
17
18
19
19
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
20
21
22
23
23
24
25
26
27
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
28
29
30
Jumlah Injeksi 0
Persentase #DIV/0!
C : MYALGIA
Jumlah
Nama Penderita Umur
No Tgl item Obat Injeksi Ya/Tdk Nama Obat
(N) (A) (B) (A / N)

a b c d e f g
3
3
8
8
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
10
11
12
13
14
15
16
17
18
19
19
No Tgl Nama Obat
(N) (A) (B) (A / N)
20
21
22
23
24
24
25
26
27
Jumlah
Nama Penderita Umur
(N) (A) (B) (A / N)
28
29
30
31
Jumlah Injeksi 0
Persentase #DIV/0!
a . Nomor Urut
c. Nama penderita
d. Umur Penderita
h. Dosis Penggunaan

b. Nama SarKes

b. Nama SarKes
a a b c d
Mengetahui
(.................................................................................) (..................................................................................)
Nip Nip
SUSUNAN FORMAT
JANGAN DIRUBAH
SUSUNAN FORMAT
JANGAN DIRUBAH
AR PERMINTAAN OBAT
Format : 1
Bulan :
Tahun :
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
h i j k l m n p q r
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
SK SWK SWT
Sisa Stok Opt
BS Permintaan Ket
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
Err:509
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
SK SWK SWT
Stok Opt
Hr Jml Hr Jml (SO)
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
#REF! - - 7 - - #REF!
- - - 7 - - 0
#REF! - - 7 - - #REF!
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
- - - 7 - - 0
#REF! - - 7 - - #REF!
Format : 2
Sisa Stok
-
#REF!
#REF!
-
-
-
-
-
-
-
-
-
-
-
-
-
#REF!
#REF!
-
-
-
-
-
-
-
-
-
#REF!
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Sisa Stok
-
-
-
-
-
-
-
-
Format : 3
Sisa Stok
#REF!
#REF!
#REF!
#REF!
-
#REF!
-
#REF!
-
-
#REF!
#REF!
-
#REF!
-
#REF!
Format : 4
Sisa Stok
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
#REF!
Format 5

Informasi
a b
1 - - - - 0
2 - - - - 0
3 - - - - 0
4 - - - - 0
5 - - - - 0
6 - - - - 0
7 - - - - 0
8 - - - - 0
9 - - - - 0
10 - - - - 0
11 - - - - 0
12 - - - - 0
13 - - - - 0
14 - - - - 0
15 - - - - 0
16 - - - - 0
17 - - - - 0
18 - - - - 0
19 - - - - 0
20 - - - - 0
Jumlah B - - - 0
Total A + B - - - 0

Kolom b. Jelas

Form. POR 5 a
Bulan :
Tahun :
Sesuai Jumlah Rerata Item

Dosis Ket
Ya / Tdk a b c d e f = d/c
h i j 1 0 0 #DIV/0!
2 0 0 #DIV/0!
3 0 0 #DIV/0!
4 0 0 #DIV/0!
5 0 0 #DIV/0!
6 0 0 #DIV/0!
7 0 0 #DIV/0!
8 0 0 #DIV/0!
9 0 0 #DIV/0!
10 0 0 #DIV/0!
11 0 0 #DIV/0!
12 0 0 #DIV/0!
13 0 0 #DIV/0!
14 0 0 #DIV/0!
15 0 0 #DIV/0!
16 0 0 #DIV/0!
17 0 0 #DIV/0!
18 0 0 #DIV/0!
19 0
20 0
21 0
22 0
23 0
24 0 0 #DIV/0!
Jumlah
a b c d
A Puskesmas Induk 0
B
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5 B
Bulan :
Tahun :
Sesuai Jumlah
Pedoman Rerata Item
Ya / Tdk
1 0 0 0 0 #DIV/0!
2 0 0 0 0 #DIV/0!
3 0 0 0 0 #DIV/0!
4 0 0 0 0 #DIV/0!
5 0 0 0 0 #DIV/0!
6 0 0 0 0 #DIV/0!
7 0 0 0 0 #DIV/0!
8 0 0 0 0 #DIV/0!
9 0 0 0 0 #DIV/0!
10 0 0 0 0 #DIV/0!
11 0 0 0 0 #DIV/0!
12 0 0 0 0 #DIV/0!
13 0 0 0 0 #DIV/0!
14 0 0 0 0 #DIV/0!
15 0 0 0 0 #DIV/0!
16 0 0 0 0 #DIV/0!
17 0 0 0 0 #DIV/0!
18 0 0 0 0 #DIV/0!
19 0 0 0 0 #DIV/0!
20 0 0 0 0 #DIV/0!
21 0 0 0 0 #DIV/0!
22 0 0 0 0 #DIV/0!
23 0 0 0 0 #DIV/0!
Jumlah
a b c d
A Puskesmas Induk 0
B
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5 C
Bulan :
Tahun :
Sesuai Jumlah
Pedoman Rerata Item
Ya / Tdk
1 0 0 0 0 #DIV/0!
2 0 0 0 0 #DIV/0!
3 0 0 0 0 #DIV/0!
4 0 0 0 0 #DIV/0!
5 0 0 0 0 #DIV/0!
6 0 0 0 0 #DIV/0!
7 0 0 0 0 #DIV/0!
8 0 0 0 0 #DIV/0!
9 0 0 0 0 #DIV/0!
10 0 0 0 0 #DIV/0!
11 0 0 0 0 #DIV/0!
12 0 0 0 0 #DIV/0!
13 0 0 0 0 #DIV/0!
14 0 0 0 0 #DIV/0!
15 0 0 0 0 #DIV/0!
16 0 0 0 0 #DIV/0!
17 0 0 0 0 #DIV/0!
18 0 0 0 #DIV/0!
19 0 0 0 #DIV/0!
20 0 0 0 #DIV/0!
21 0 0 0 #DIV/0!
22 0 0 0 #DIV/0!
23 0 0 0 0 #DIV/0!
Jumlah
a b c d
A Puskesmas Induk 0
B
Total 0 0%
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Sesuai
Pedoman
Dosis Ket
Ya / Tdk
Form. POR 5d
Rata 2
Diare Myalgia
e f
(.......................................................................................)
Nip
Form. POR 5 a
Persentase
(%)
g = ( e/c ) x 100 %
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Form. POR 5 B
Persentase
(%)
g = ( e/c ) x 100 %
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Form. POR 5 C
Persentase
(%)
g = ( e/c ) x 100 %
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBA

NO NAMA OBAT/BHP Satuan Stok Awal penerimaan Persediaan Pengeluaran

A Dana Alokasi Khusus (DAK)

38 Fitomenadion (Vit K) Tab Salut 10 mg Tab -

87 Ambroxol Sy Btl #REF! #REF!

134 Ringer Laktat Lar Infus Steril Amp -

137 Aciclovir cream (25 Tube) Tub -

181 Kapas Pembalut/Adsorben 100 g Rol -

NO NAMA OBAT/BHP Satuan Stok Awal penerimaan Persediaan Pengeluaran

1 Acyclovir Tab 400 mg Tab #REF! - #REF! -

24 Cotrimoksazol Susp Btl #REF! - #REF! -

28 Aqua Pro Injeksi Steril Bebas Pirogen Amp #REF! - #REF! -

35 AntiHemoroid Doen Kombinasi Tub #REF! - #REF! -

NO NAMA OBAT/BHP Satuan Stok Awal penerimaan Persediaan Pengeluaran

1 Amitriptiline 25 mg Tab #REF! #REF!

NO NAMA OBAT/BHP Satuan Stok Awal penerimaan Persediaan Pengeluaran

Puskesmas pembantu Yag Ada

NO NAMA OBAT/BHP Satuan Stok Awal penerimaan Persediaan Pengeluaran

NO NAMA OBAT/BHP Satuan Stok Awal penerimaan Persediaan Pengeluaran

38 Fitomenadion (Vit K) Tab Salut 10 mg Tab -

NO NAMA OBAT/BHP Satuan Stok Awal penerimaan Persediaan Pengeluaran

87 Ambroxol Sy Btl #REF! #REF!

107 Ampicillin 1 gram Inj Amp #REF! #REF!

Ket Kolom a Nomor Urut

Kolom c Satuan diisi satuan terkecil

Kolom d Jumlah Volume sdiaan pd awal bulan berjalan

Kolom e Jumlah volume sediaan yg di terima dari Instalasi farmasi

B Anggaran Pendapatan dan Belanja Daerah (APBD I)

24 Cotrimoksazol Susp Btl #REF! - #REF! -

28 Aqua Pro Injeksi Steril Bebas Pirogen Amp #REF! - #REF! -

32 Magnesium Sulfat Inj (i.v.) 20% - 25 ml Amp/Flc #REF! - #REF! -

33 Oxytosin Inj 10 iu / ml - 1 ml ( @ 30 = perr Ampl ) Amp/Flc #REF! - #REF! -

35 AntiHemoroid Doen Kombinasi Tub #REF! - #REF! -

NO NAMA OBAT/BHP Satuan Stok Awal penerimaan Persediaan Pengeluaran

LAPORAN BULANAN KEFARMASIAN

A .Pustu / Polindes / Poskesdes

Jenis Pelayanan Resep

LAPORAN MONITORING INDIKATOR PERESEPAN

A : ISPA Non Pneumonia

A 1 .Pustu / Polindes / Poskesdes

(N) (A) (B) (A / N)

(N) (A) (B) (A / N)

(N) (A) (B) (A / N)

Jumlah Penderita 0 Jumlah Item Obat 0

B 1 .Pustu / Polindes / Poskesdes

(N) (A) (B) (A / N)

(N) (A) (B) (A / N)

(N) (A) (B) (A / N)

(N) (A) (B) (A / N)

Jumlah Penderita 0 Jumlah Item Obat 0

C 1 .Pustu / Polindes / Poskesdes

Nama Penderita Umur Jumlah

Nama Penderita Umur Jumlah

Nama Penderita Umur Jumlah

Jumlah Penderita 0 Jumlah Item Obat 0

KET. B1 / B2 / B3 : a . Nomor Urut

KET .C1 / C 2 / C3 : a. Jelas

LAPORAN PEMANTAUAN RESEP OBAT GENERIK DI PUSKESMAS , PUSTU DAN POLINDES *)

% Penggunaan Rerata Item /

*) Coret yg tdk perlu

SWK SWT Stok Opt

SWK SWT Stok Opt

% R/ GENERIK terhadap Total