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JENIS OBAT TABLET

NO NAMA OBAT SATUAN 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13

1
Asam Asetilsalisilat (asetosal) tablet 100 mg Tablet
2
Asam Asetilsalisilat (asetosal) tablet 500 mg Tablet
3
Albendazol tablet/kapsul/kaplet 400 mg Tablet
4
Alopurinol tablet/kapsul/kaplet 100 mg Tablet
5
ALPRAZOLAM TABLET 1 MG Tablet
6
AMBROXOL 30 MG TAB Tablet
7
Aminofilin tablet scored 200 mg Tablet
8
Amitriptilin tablet salut 25 mg (HCl) Tablet
9
Amlodipin tablet 5 mg Tablet
10
Amoksisilin kapsul/kaplet/tablet scored 500 mg Kaplet
11 Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida
200 mg Magnesium Hidroksida 200 mg Tablet
12
Antimigren: Ergotamin Tartrat 1 mg + Kofein 50 mg Tablet
13
Asam Askorbat (Vitamin C) tablet 250 mg Tablet
14
Asam Askorbat (Vitamin C) tablet 50 mg Tablet
15
Asam Folat tablet/kapsul/kaplet 1 mg Tablet
16
ASAM MEFENAMAT 500 MG TAB Kaplet
17
ASAM TRANEXAMAT TABLET 500 MG Tablet
18
ASAM VALPROAT 250 MG Tablet
19
Asiklovir tablet/kapsul/kaplet 400 mg Tablet
20
ATTAPULGIT TABLET 600 MG Tablet
21
BETAHISTIN MESILAT TABLET 6 MG Tablet
NO NAMA OBAT SATUAN 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13

22
Bisakodil 5 mg (dulkolax) Tablet
23
D H P TAB Tablet
24
Deksametason tablet 0,5 mg Tablet
25
DIAZEPAM 2 MG TAB Tablet
26
DIAZEPAM 5 MG TAB Tablet
27
Digoksin tablet 0,25 mg Paket
28
Dimenhidrinat tablet 50 mg Tablet
29
Domperidon tablet 10 mg Tablet
30
Doksisiklin tablet/kapsul/kaplet 100 mg Tablet
31
EFEDRIN HCL 25 MG TAB Tablet
32
ERYTHROMYCIN 500 MG Tablet
33
Fenitoin kapsul/kaplet 100 mg Tablet
34
FENITOIN NATRIUM 30 MG KAPSUL Kapsul
35
Fenobarbital tablet/kapsul/kaplet 100 mg Kapsul
36
Fenobarbital tablet/kapsul/kaplet 30 mg Kapsul
37 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tablet
38 Furosemid tablet 40 mg Tablet
Garam Oralit I serbuk, kombinasi : Natrium klorida 0,52 g kalium
39 klorida 0,30 g Trinatrium sitrat dihidrat 0,58 g Glukosa Anhidrat
2,70 g
Sachet
40 Glibenklamid tablet 5 mg Tablet
41 Glimepiride tablet 1 mg Tablet
42 Glimepiride tablet 2 mg Tablet
43 GLISERYL GUAIAKOLAT 100 MG TAB Tablet
NO NAMA OBAT SATUAN 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13

44 Griseofulvin tablet 125 mg Tablet


45 Haloperidol tablet 0,5 mg Tablet
46 Haloperidol tablet 1,5 mg Tablet
47 Haloperidol tablet 5 mg Tablet
48 HYOCINA N BUTILBROMID 10 MG TAB Tablet
49 Ibuprofen tablet 400 mg Tablet
50 ISOSORBID DINITRAT SUB LINGUAL 5 MG Tablet
51 KALSIUM LAKTAT 500 MG Tablet
52 Kaptopril tablet scored 12,5 mg Tablet
53 Kaptopril tablet scored 25 mg Tablet
54 Karbamazepin tablet 200 mg Tablet
55 KETOKONZOL TABLET 200 MG Tablet
56 Kloramfenikol tablet/kapsul/kaplet 250 mg Tablet
57 KLORFENIRAMINI MALEAT TAB 4 MG( CTM ) Tablet
58 KLORPROMAZIN 100 MG TAB (HCL) Tablet
59 KODEINA 10 MG TAB Tablet

60
Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg Asam folat
0,25 mg (TTD) Tablet

61
Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400
mg Trimetoprim 80 mg Tablet
62 KUININE TAB SALUT SELAPUT 222 MG Tablet
63 LOPERAMID TAB 2 MG Tablet
64 LORATADIN TABLET 10 MG Tablet
65 METFORMIN HCL TABLET 500 MG Tablet
NO NAMA OBAT SATUAN 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13

66 Metilergometrin Maleat (Metilergometrin) tablet salut 0,125 mg Tablet


67 Metoklopramide tablet 5 mg Tablet
68 Metoklopramide tablet 10 mg Tablet
69 METRONIDAZOLE 250 MG TAB Tablet
70 METRONIDAZOLE 500 MG TAB Tablet
71 MINERAL MIX SERBUK Tablet
72 MULTI MICRO NUTRIEN Sachet
73 NATRIUM DIKLOFENAK 50 MG TAB Tablet
74 Nifedipin tablet/kapsul 10 mg Tablet
75 Nistatin tablet salut 500.000 IU/ g Tablet
76 OAT KAT ANAK FDC Paket
77 OAT KAT ANAK KOMB Paket
78 OAT KAT I KOMB Paket
79 OAT KAT I.3 FDC Paket
80 OAT KAT II FDC Paket
81 OAT KAT SISIPAN FDC Paket
82 Omeprazol kapsul/kaplet 20 mg kaplet
83 Parasetamol tablet 500 mg Tablet
84 PERFENAZIN TAB 4 MG Tablet
85 Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg (HCl) Tablet
86 PIROKSIKAM 10 MG TAB Tablet
87 PIROKSIKAM 20 MG TAB Tablet
88 Prednison tablet/kapsul/kaplet 5 mg Tablet
NO NAMA OBAT SATUAN 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13

89 PRIMAKUIN TABLET 15 MG Tablet


90 PROPANOLOL 40 MG TAB (HCL) Tablet
91 PROPILTIOURASIL 100 MG TAB Tablet
92 PYRANTEL SCORE (BASE) 125 MG TAB Tablet
93 Ranitidin tablet 150 mg Tablet
94 RETINOL 100 000 IU KAPSUL (VIT A BIRU) Kapsul Lunak
95 RETINOL 200 000 IU CAP (VIT A MERAH) Kapsul Lunak
96 SALBUTAMOL 4 MG TAB Tablet
97 Simvastatin tablet 10 mg Tablet
98 Simvastatin tablet 20 mg Tablet
99 SETERIZIN 10 MG Tablet
100 Siprofloxsasin Tablet
101 TETRASIKLIN 500 KAPSUL Kapsul
102 THIAMPENICOL KAPSUL 250 MG Kapsul
103 THIAMPENICOL KAPSUL 500 MG Kapsul
104 THIAMIN HCL 50 MG TAB ( VIT B1 ) Tablet
105 TRIHEKSIFENIDIL HCL 2 MG TAB Tablet
106 VIT B KOMPLEK TAB Tablet
107 ZINC TAB 20 MG Tablet
14 15 16 17 18 19 20 21 22 23 Total

0
14 15 16 17 18 19 20 21 22 23 Total

0
14 15 16 17 18 19 20 21 22 23 Total

0
14 15 16 17 18 19 20 21 22 23 Total

0
14 15 16 17 18 19 20 21 22 23 Total

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
JENIS OBAT SYRUP

NO NAMA OBAT SATUAN 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

1 AMBROXOL SYR 15 mg/ml


Botol
2 Amoksisilin sirup kering 125 mg/ 5 ml
Botol
3 Amoksisilin sirup kering forte 250 mg/5 ml
Botol

Antasida DOEN II suspensi, kombinasi : Aluminium


4 Hidroksida 200 mg/5 ml Magnesium Hidroksida 200
mg/5 ml
Botol
5 DOMPERIDON SYRUP
Botol
6 Kloramfenikol suspensi 125 mg/ 5 ml
Botol

Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg +


7 Trimetoprim 40 mg / 5 ml
Botol
8 Metoklopramide sirup 5 mg/ 5 ml
Botol
9 METRONIDAZOL SUSPENSI
Botol
10 MULTIVITAMIN SYR
Botol
11 NISTATIN SUSPESI
Botol
12 O B H SYR
Botol

13 Parasetamol drop 100 mg/ml btl @15ml (60mg/0,6ml)


Botol
14 Parasetamol sirup 120 mg / 5 ml
Botol
21 22 23 Total

0
0
JENIS OBAT INJEKSI

NO NAMA OBAT SATUAN 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13

1
Aminofilin injeksi 24 mg/ml Ampul

2
Ampisilin serbuk injeksi i.v. 1000 mg/vial Vial

3
ASAM TRANEXAMAT INJEKSI 50 MG / ML Ampul

4
AQUA PRO INJ STERIL Vial

5 CEFTRIAXON 1 GR INJ
Vial

6
Deksametason injeksi i.v./i.m. 5 mg/ml Ampul

7
Diazepam injeksi i.v./i.m 5 mg/ml Ampul

8
Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) Ampul

9
Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml Ampul

10
Fenitoin injeksi 50 mg/ml Ampul

11
Fenobarbital injeksi i.m./i.v. 50 mg/ml Ampul

12 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml


Ampul

13 FUROSEMID INJ IV/IM 10 MG/ML


Ampul

14 Gentamisin injeksi 40 mg/ ml


Ampul
NO NAMA OBAT SATUAN 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13

15
HYOCINA N BUTILBROMID INJ 20 MG Ampul

16
KALSIUM GLUKONAS INJ 100 MG/ML Ampul

17
Kloramfenikol serb inj 1000 mg/mL Vial

18
Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml Ampul

19
Lidokain injeksi 2% (HCL) Ampul

20
MAGNESIUM SULFAT 20 % INJ 25 ML Vial

21
MAGNESIUM SULFAT 40 % INJ 25 ML Vial

22
Metoklopramide INJ 5 MG/ML Ampul

23
Metilergometrin Maleat injeksi 0,200 mg-1 ml Ampul

24
Oksitosin injeksi 10 IU/ml Ampul

25
OXYTETRACIKLIN HCL INJ IM 50 MG/ML 10 ML Vial

26
RANITIDIN INJ 25 MG/2 ML Ampul

27
Sianokobalamin (vitamin B12) injeksi 500 mcg Ampul

28
THIAMIN INJ ( VIT BI ) 100 MG/ML Ampul
NO NAMA OBAT SATUAN 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13
14 15 16 17 18 19 20 21 22 23 Total

0
14 15 16 17 18 19 20 21 22 23 Total

0
14 15 16 17 18 19 20 21 22 23 Total

0
NO NAMA OBAT LUAR SATUAN 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13

1 Anti Bakteri DOEN salep kombinasi: Basitrasin 500 IU/g Polimiksin 10.000 IU/g Tube

2 ANTI FUNGI DOEN KOMB Pot

3 ASIKLOVIR CREAM 5% Tube

4 BETAMETASON CREAM 0,1 % Tube

5 FENOL GLISEROL TT 10% TUBE

6 GENTAMICIN SK 0,1% Botol

7 GENTAMICIN SALEP MATA 0,3% Tube

8 GENTAMISIN SULFAT TETES MATA Tube

9 GENTIAN VIOLET LART 1% Botol

10 HEXACHLOROCYLOHEXANE 0,5% (Peditox) Botol

11 HIDROGEN PEROKSIDA LARUTAN 3% Botol

12 HIDROKORTISON CREAM 2,5 % Tube

13 ICHTIOL SALEP HITAM Pot

14 KALIUM PERMANGANAT SERBUK Pot

15 KETOKONAZOL KRIM 2% Tube

16 Kloramfenikol salep mata 1 % Tube

17 Kloramfenikol teter telinnga 3 % Botol

18 MICONAZOLE CREAM 2% Tube

19 OKSITETRASIKLIN SK 3% Tube

20 OKSITETRASIKLIN SM 1% Tube
21 Povidon Iodida larutan 10% 30 ml Botol

22 Povidon Iodida larutan 10% 300 ml Botol

23 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% Botol

24 SALEP LUKA BAKAR (bioplacenton) Pot

25 Bedak salisil serbuk 2% Tube

26 SULFASETAMID NATRIUM TM 15 % Botol


14 15 16 17 18 19 20 21 22 23 Total

0
0

0
NO NAMA ALAT KESEHATAN SATUAN 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12

1 Alat Suntik Sekali Pakai - 1 cc Tuberculin 27G x 1/2" Set

2 Alat Suntik Sekali Pakai - 2.5 cc x 23G x 1 1/4" Set

3 Alat Suntik Sekali Pakai - 5 cc x 22G x 1 1/4" Set

4 Alat Suntik Sekali Pakai - 10 cc x 21G x 1 1/2" Set

5 Benang Operasi - Catgut Plain 2/0 + jarum 1/2 GT 35 mm Set

6 Benang Operasi - Catgut Chromic 2/0 + jarum 1/2 GT 35 mm Set

7 Benang Operasi - Catgut Plain 3/0 + jarum 1/2 GT 35 mm Set

8 Benang Operasi - Catgut Chromic 3/0 + jarum 1/2 GT 35 mm Set

9 Benang Operasi - Silk 2/0 + jarum 1/2 GT 35 mm Set

10 Benang Operasi - Silk 3/0 + jarum 1/2 GT 35 mm Set

11 HAND SCOUND STERIL NO 7 Pasang

12 HAND SCOUND STERIL NO 7,5 Pasang

13 HAND SCOUND NON STERIL UK L Lembar

14 HAND SCOUND NON STERIL UK M Lembar

15 HYPAFIX
Infus Set,10
IV,xWing
5 CMneedle - Infusion Set Pediatric (60 Pasang

16 drops/ml) set

17 Infus Set, IV, Wing needle - Infusion Set Dewasa (20 drops/ml) set

18 Infus Set, IV, Wing needle - I.V Catheter No. 18 G x 32 mm buah

19 Infus Set, IV, Wing needle - I.V Catheter No. 20 G x 1 1/4 " buah

20 Infus Set, IV, Wing needle - I.V Catheter No. 22 G x 1 " buah

21 Infus Set, IV, Wing needle - I.V Catheter No. 24 G x 3/4 " buah

22 Infus Set, IV, Wing needle - I.V Catheter No. 26 G x 1/2 " buah

23 Infus Set, IV, Wing needle - Wing Needle 21G set

24 Infus Set, IV, Wing needle - Wing Needle 23G set


NO NAMA ALAT KESEHATAN SATUAN 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12

25 Infus Set, IV, Wing needle - Wing Needle 25G set

26 Infus Set, IV, Wing needle - Wing Needle 27G set

27 Jarum Jahit Bedah pcs

28 Kasa, Verband, Kapas - Kasa Pembalut / absorben 250 gr Roll

29 Kasa, Verband, Kapas - Kasa Hydrophil 40 x 80 cm Roll

30 Kasa, Verband, Kapas - Kasa Hydrophil Steril 16 x 16 cm lembar

31 Kasa, Verband, Kapas - Kasa Hydrophil Steril 18 x 22 cm Lembar

32 Kasa, Verband, Kapas - Kasa Pembalut Hydrophil 4 x 3 cm Roll

33 Kasa, Verband, Kapas - Kasa Pembalut Hydrophil 4 x 10 cm Roll

34 Kasa, Verband, Kapas - Kasa Pembalut Hydrophil 4 x 15 cm Roll

35 Kasa, Verband, Kapas - Kasa Pembalut 2 x 80 cm Roll

36 MESS 11 pcs

37 MESS 21 pcs

38 MESS 22 pcs

39 PEMBALUT GIPS 3 INCI buah

40 PLESTER 5 YARDS X 2 INCHI Roll

41 Surgical Mask - 3 ply Tie on (tali) pcs

42 Surgical Mask - 3 ply Earloop (karet) pcs

43 Urologi - Folley Catheter 2 way No. 16 pcs


44 Urologi - Folley Catheter 2 way No. 18 pcs
45 Urologi - Urine Bag Standard Steril 2 Lt (T Valve) pcs
46
47
48
NO NAMA ALAT KESEHATAN SATUAN 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12
13 14 15 16 17 18 19 20 21 22 23 Total

0
0

0
13 14 15 16 17 18 19 20 21 22 23 Total

0
13 14 15 16 17 18 19 20 21 22 23 Total

0
NO NAMA OBAT SATUAN 24 25 26 27 28 29 30 31

1 DEVITALISASI PASTA ( NON ARSEN ) Pot


2 ETIL KLORIDA SPRAY Botol
3 EUGENOL CAIRAN Botol
4 GLASS IONOMER CEMENT ART Botol
5 KALSIUM HIDROKSIDA PASTA Pot
6 KLORFENOL KAMFER MENTHOL (CHKM) Botol
7 MUMMIFYING PASTA Pot
8 POLIKRESULEN (ALBOTYL) Botol
9 SEMEN SENG FOSFAT SERBUK + CAIRAN Pot
10 SPONGOSTAN Kotak
11 TEMPORARY STOPPING FLETCER SERBUK+CAIRAN
(caviton) Pot
12 TRIKRESOL FORMALIN (TKF) Botol
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
23 Total

0
NO NAMA OBAT SATUAN 24 25 26 27 28 29 30 31 1

1
Antihemoroid, kombinasi: bismut subgalat 150 mg he SUPP
2
BISACODYL SUPP (DULCOLAX) 10 MG / Stolax supp SUPP
3
Diazepam larutan rektal 5 mg/2,5 mL (stesolit rectal) TUBE
4
MICROLAX
5
NISTATIN VAGINAL TAB 100 000 IU/GR TABLET
6
PARASETAMOL SUPP 80 MG SUPP
7 PARASETAMOL SUPP 125 MG
SUPP

8 SABU I 5 ML VIAL

9 SALBUTAMOL (AS SULPHATE) 2,5 MG/2,5 ML NEBULS Ampul

10 SERUM ATS 1 500 IU VIAL

11 Serum ATS 20.000 IU


2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Total

0
NO NAMA OBAT SATUAN 24 25 26 27 28 29 30 31

1 CARIK CELUP / URIN TES 3 GPH Stik


2 CARIK CELUP / URIN TES 11 GPH Stik
3 Antiseptik dan Disinfektan - alkohol 70% 100 ml Botol
4 Antiseptik dan Disinfektan - alkohol 70% 1 liter Botol
5 GLISERIN Botol
6 HB TEST KIT Set
7 KIT GOL DARAH Set
8 LART AS ACETAT Botol
9 LART ASAM KLORIDA 0,1 N Botol
10 LAR ASAM KLORIDA 0,1% Botol
11 LART BARIUM CHLORIDA 10 % Botol
12 LART BENEDICT Botol
13 LART E D T A 10 % Botol
14 LART ETANOL ASAM Botol
15 LART KOH 10 % Botol
16 LART NACL 0,9 % Botol
17 LART NATRIUM CITRAT 0,38 % Botol
18 LART ASAM CITRAT 3,8% Botol
19 LART REES ECKER Botol
20 LART SCHLESINGER Botol
21 LART TURK Botol
22 OIL EMERSI Botol
23 PP TEST Stik
24 RDT TEST MALARIA Stik
25 STIK GULA DARAH Stik
26 STIK ASAM URAT Stik
27 STIK KOLESTEROL Stik
28 STIK HBSAG Stik
29 STIK HBSAG Stik
30 WIDAL TEST Set
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

43

21
Total

43

21

0
NO NAMA OBAT SATUAN 24 25 26 27 28 29 30 31 1 2

1
REAGEN ABX MINIDIL LMG PAKET
2
REAGEN ABC MINILYSE LMG PAKET
3 REAGEN ABX MINICLEAN PAKET
4 REAGEN ABX MINOTROL PAKET
5 KARTU GOLONGAN DARAH LEMBAR
6 BLOD LANCET BIJI

TAMBAHAN
TABLET
1 Khloramphenichol 500 mg TABLET
2 Amlodipin 10 mg TABLET
3 Hyocina N Butilbromid Plus TABLET
4 Allupurinol 300 mg TABLET

SYRUP
1 Thiampenicol syr Botol

INJEKSI
1 Metamizol injeksi (Novaldo) Ampul
ketorolak injeksi

OBAT LUAR
1 Gentamisin TT Botol
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Total

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
NO NAMA OBAT CAIRAN SATUAN 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19

1 GLUKOSA INF 10 % BOTOL

2 GLUKOSA INF 40 % BOTOL

3 GLUKOSA INF 5 % BOTOL

4 NATRIUM KLORIDA INF ( NACL ) 0,9% BOTOL

5 RINGER LAKTAT INF BOTOL


20 21 22 23 Total

0
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

PUSKESMAS : LABUAPI
KABUPATEN : LOMBOK BARAT
PELAPORAN BULAN/PERIODE MARET TAHUN : 2017
PERMINTAAN BULAN/PERIODE APRIL
TANGGAL : 28 MARET 2017

NO KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
OBAT AWAL MAAN DIAAN KAIAN STOK OPT. TAAN APBD BUFER BUFER
PUSAT PROP
0 1 2 3 4 5 6 7 8 9 10 11 12 13

ALAT KESEHATAN

Set
1 Alat Suntik Sekali Pakai - 1 cc Tuberculin 27G x 1/2" 37 30 67 0 67 0
Set
2 Alat Suntik Sekali Pakai - 2.5 cc x 23G x 1 1/4" 30 85 115 0 115 0
Set
3 Alat Suntik Sekali Pakai - 5 cc x 22G x 1 1/4" 19 0 19 0 19 0
Set
4 Alat Suntik Sekali Pakai - 10 cc x 21G x 1 1/2" 0 0 0 0 0 0
Set
5 Benang Operasi - Catgut Plain 2/0 + jarum 1/2 GT 35 mm 0 0 0 0 0 0
Set
6 Benang Operasi - Catgut Chromic 2/0 + jarum 1/2 GT 35 mm 0 0 0 0 0
Set
7 Benang Operasi - Catgut Plain 3/0 + jarum 1/2 GT 35 mm 0 0 0 0 0
Set
8 Benang Operasi - Catgut Chromic 3/0 + jarum 1/2 GT 35 mm 0 0 0 0 0
Set
9 Benang Operasi - Silk 2/0 + jarum 1/2 GT 35 mm 0 0 0 0 0
Set
10 Benang Operasi - Silk 3/0 + jarum 1/2 GT 35 mm 0 0 0 0 0
Pasang
11 HAND SCOUND STERIL NO 7 0 0 0 0 0
NO KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
OBAT AWAL MAAN DIAAN KAIAN STOK OPT. TAAN APBD BUFER BUFER
PUSAT PROP
0 1 2 3 4 5 6 7 8 9 10 11 12 13
Pasang
12 HAND SCOUND STERIL NO 7,5 0 0 0 0 0
Lembar
13 HAND SCOUND NON STERIL UK L 0 0 0 0 0 0
Lembar
14 HAND SCOUND NON STERIL UK M 15 100 115 0 115 0
Pasang
15 HYPAFIX 10 x 5 CM 0 0 0 0 0
set
16 Infus Set, IV, Wing needle - Infusion Set Pediatric (60 drops/ml) 0 4 4 0 4 0
set
17 Infus Set, IV, Wing needle - Infusion Set Dewasa (20 drops/ml) 0 10 10 0 10 0
buah
18 Infus Set, IV, Wing needle - I.V Catheter No. 18 G x 32 mm 0 5 5 0 5 0
buah
19 Infus Set, IV, Wing needle - I.V Catheter No. 20 G x 1 1/4 " 0 10 10 0 10 0
buah
20 Infus Set, IV, Wing needle - I.V Catheter No. 22 G x 1 " 0 0 0 0 0 0
buah
21 Infus Set, IV, Wing needle - I.V Catheter No. 24 G x 3/4 " 0 5 5 0 5 0
buah
22 Infus Set, IV, Wing needle - I.V Catheter No. 26 G x 1/2 " 0 5 5 0 5 0
set
23 Infus Set, IV, Wing needle - Wing Needle 21G 0 0 0 0 0
set
24 Infus Set, IV, Wing needle - Wing Needle 23G 0 0 0 0 0
set
25 Infus Set, IV, Wing needle - Wing Needle 25G 0 0 0 0 0
set
26 Infus Set, IV, Wing needle - Wing Needle 27G 0 0 0 0 0
pcs
27 Jarum Jahit Bedah 0 0 0 0 0
Roll
28 Kasa, Verband, Kapas - Kasa Pembalut / absorben 250 gr 0 2 2 0 2
Roll
29 Kasa, Verband, Kapas - Kasa Hydrophil 40 x 80 cm 0 0 0
lembar
30 Kasa, Verband, Kapas - Kasa Hydrophil Steril 16 x 16 cm 0 0 0 0 0
NO KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
OBAT AWAL MAAN DIAAN KAIAN STOK OPT. TAAN APBD BUFER BUFER
PUSAT PROP
0 1 2 3 4 5 6 7 8 9 10 11 12 13
Lembar
31 Kasa, Verband, Kapas - Kasa Hydrophil Steril 18 x 22 cm 0 1 1 0 1
Roll
32 Kasa, Verband, Kapas - Kasa Pembalut Hydrophil 4 x 3 cm 0 0 0 0 0
Roll
33 Kasa, Verband, Kapas - Kasa Pembalut Hydrophil 4 x 10 cm 0 90 90 0 90
Roll
34 Kasa, Verband, Kapas - Kasa Pembalut Hydrophil 4 x 15 cm 0 0 0 0 0
Kasa, Verband, Kapas - Kasa Pembalut 2 x 80 cm Roll
35 0 5 5 0 5
pcs
36 MESS 11 0 0 0
pcs
37 MESS 21 0 0 0
pcs
38 MESS 22 0 0 0
buah
39 PEMBALUT GIPS 3 INCI 0 0 0 0
Roll
40 PLESTER 5 YARDS X 2 INCHI 3 3 0 3 0
pcs
41 Surgical Mask - 3 ply Tie on (tali) 0 100 100 0 100 0
Surgical Mask - 3 ply Earloop (karet) pcs
42 45 300 345 0 345 0

43 Urologi - Folley Catheter 2 way No. 16 pcs 0 0 0 0 0 0

44 Urologi - Folley Catheter 2 way No. 18 pcs 0 0 0 0

45 Urologi - Urine Bag Standard Steril 2 Lt (T Valve) pcs 0 0 0 0 0 0

TABLET DAN SERBUK ORAL

1 Asam Asetilsalisilat (asetosal) tablet 100 mg Tablet 0 0 0 0 0

2 Asam Asetilsalisilat (asetosal) tablet 500 mg Tablet 90 0 90 0 90 0

3 Albendazol tablet/kapsul/kaplet 400 mg Tablet 252 2010 2262 0 2262 0


NO KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
OBAT AWAL MAAN DIAAN KAIAN STOK OPT. TAAN APBD BUFER BUFER
PUSAT PROP
0 1 2 3 4 5 6 7 8 9 10 11 12 13

4 Alopurinol tablet/kapsul/kaplet 100 mg Tablet 0 0 0 0 0

5 ALPRAZOLAM TABLET 1 MG Tablet 0 0 0 0 0 0

6 AMBROXOL 30 MG TAB Tablet 917 800 1717 0 1717 0

7 Aminofilin tablet scored 200 mg Tablet 89 0 89 0 89 0

8 Amitriptilin tablet salut 25 mg (HCl) Tablet 100 0 100 0 100 0

9 Amlodipin tablet 5 mg Tablet 0 0 0 0 0 0

10 Amoksisilin kapsul/kaplet/tablet scored 500 mg Kaplet 962 1000 1962 0 1962 0

11 Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg Magnes Tablet 123 200 323 0 323 0

12 Antimigren: Ergotamin Tartrat 1 mg + Kofein 50 mg Tablet 72 0 72 0 72 0

13 Asam Askorbat (Vitamin C) tablet 250 mg Tablet 91 200 291 0 291 0

14 Asam Askorbat (Vitamin C) tablet 50 mg Tablet 4 0 4 0 4 0

15 Asam Folat tablet/kapsul/kaplet 1 mg Tablet 0 0 0 0 0 0

16 ASAM MEFENAMAT 500 MG TAB Kaplet 32 1200 1232 0 1232 0

17 ASAM TRANEXAMAT TABLET 500 MG Tablet 19 0 19 0 19 0

18 ASAM VALPROAT 250 MG Tablet 0 0 0 0 0 0

19 Asiklovir tablet/kapsul/kaplet 400 mg Tablet 56 0 56 0 56 0

20 ATTAPULGIT TABLET 600 MG Tablet 62 200 262 0 262 0

21 BETAHISTIN MESILAT TABLET 6 MG Tablet 31 100 131 0 131 0

22 Bisakodil 5 mg (dulkolax) Tablet 29 0 29 0 29 0


NO KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
OBAT AWAL MAAN DIAAN KAIAN STOK OPT. TAAN APBD BUFER BUFER
PUSAT PROP
0 1 2 3 4 5 6 7 8 9 10 11 12 13

23 D H P TAB Tablet 0 0 0 0 0

24 Deksametason tablet 0,5 mg Tablet 12 100 112 0 112 0

25 DIAZEPAM 2 MG TAB Tablet 40 0 40 0 40 0

26 DIAZEPAM 5 MG TAB Tablet 0 0 0 0 0 0

27 Digoksin tablet 0,25 mg Paket 0 0 0 0 0 0

28 Dimenhidrinat tablet 50 mg Tablet 0 0 0 0 0 0

29 Domperidon tablet 10 mg Tablet 0 0 0 0 0 0

30 Doksisiklin tablet/kapsul/kaplet 100 mg Tablet 40 0 40 0 40 0

31 EFEDRIN HCL 25 MG TAB Tablet 50 0 50 0 50 0

32 ERYTHROMYCIN 500 MG Tablet 0 0 0 0 0 0

33 Fenitoin kapsul/kaplet 100 mg Tablet 38 0 38 0 38 0

34 FENITOIN NATRIUM 30 MG KAPSUL Kapsul 0 0 0 0 0 0

35 Fenobarbital tablet/kapsul/kaplet 100 mg Kapsul 0 0 0 0 0 0

36 Fenobarbital tablet/kapsul/kaplet 30 mg Kapsul 10 0 10 0 10 0

37 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tablet 8 100 108 0 108 0

38 Furosemid tablet 40 mg Tablet 114 0 114 0 114 0

39 Garam Oralit I serbuk, kombinasi : Natrium klorida 0,52 g kalium klorida 0,30 g Trina Sachet 292 100 392 0 392 0

40 Glibenklamid tablet 5 mg Tablet 10 700 710 0 710 0

41 Glimepiride tablet 1 mg Tablet 210 0 210 0 210 0


NO KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
OBAT AWAL MAAN DIAAN KAIAN STOK OPT. TAAN APBD BUFER BUFER
PUSAT PROP
0 1 2 3 4 5 6 7 8 9 10 11 12 13

42 Glimepiride tablet 2 mg Tablet 0 200 200 0 200 0

43 GLISERYL GUAIAKOLAT 100 MG TAB Tablet 0 0 0 0 0 0

44 Griseofulvin tablet 125 mg Tablet 21 100 121 0 121 0

45 Haloperidol tablet 0,5 mg Tablet 0 0 0 0 0 0

46 Haloperidol tablet 1,5 mg Tablet 98 0 98 0 98 0

47 Haloperidol tablet 5 mg Tablet 0 0 0 0 0 0

48 HYOCINA N BUTILBROMID 10 MG TAB Tablet 107 107 0 107 0

49 Ibuprofen tablet 400 mg Tablet 128 500 628 0 628 0

50 ISOSORBID DINITRAT SUB LINGUAL 5 MG Tablet 30 0 30 0 30 0

51 KALSIUM LAKTAT 500 MG Tablet 116 150 266 0 266 0

52 Kaptopril tablet scored 12,5 mg Tablet 0 100 100 0 100 0

53 Kaptopril tablet scored 25 mg Tablet 27 300 327 0 327 0

54 Karbamazepin tablet 200 mg Tablet 164 0 164 0 164 0

55 KETOKONZOL TABLET 200 MG Tablet 100 0 100 0 100 0

56 Kloramfenikol tablet/kapsul/kaplet 250 mg Tablet 460 0 460 0 460 0

57 KLORFENIRAMINI MALEAT TAB 4 MG( CTM ) Tablet 61 1000 1061 0 1061 0

58 KLORPROMAZIN 100 MG TAB (HCL) Tablet 16 0 16 0 16 0

59 KODEINA 10 MG TAB Tablet 0 0 0 0 0 0

60 Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg Asam folat 0,25 mg (TTD) Tablet 30 2100 2130 0 2130 0
NO KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
OBAT AWAL MAAN DIAAN KAIAN STOK OPT. TAAN APBD BUFER BUFER
PUSAT PROP
0 1 2 3 4 5 6 7 8 9 10 11 12 13

61 Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg Trimetoprim 8 Tablet 50 200 250 0 250 0

62 KUININE TAB SALUT SELAPUT 222 MG Tablet 0 0 0 0 0 0

63 LOPERAMID TAB 2 MG Tablet 80 100 180 0 180 0

64 LORATADIN TABLET 10 MG Tablet 0 0 0 0 0 0

65 METFORMIN HCL TABLET 500 MG Tablet 150 700 850 0 850 0

66 Metilergometrin Maleat (Metilergometrin) tablet salut 0,125 mg Tablet 90 0 90 0 90 0

67 Metoklopramide tablet 5 mg Tablet 0 0 0 0 0

68 Metoklopramide tablet 10 mg Tablet 202 200 402 0 402 0

69 METRONIDAZOLE 250 MG TAB Tablet 0 0 0 0 0 0

70 METRONIDAZOLE 500 MG TAB Tablet 148 200 348 0 348 0

71 MINERAL MIX SERBUK Tablet 0 0 0 0 0 0

72 MULTI MICRO NUTRIEN Sachet 70 300 370 0 370 0

73 NATRIUM DIKLOFENAK 50 MG TAB Tablet 53 150 203 0 203 0

74 Nifedipin tablet/kapsul 10 mg Tablet 0 100 100 0 100 0

75 Nistatin tablet salut 500.000 IU/ g Tablet 0 0 0 0 0 0

76 OAT KAT ANAK FDC Paket 0 0 0 0 0 0

77 OAT KAT ANAK KOMB Paket 0 0 0 0 0 0

78 OAT KAT I KOMB Paket 0 0 0 0 0 0

79 OAT KAT I.3 FDC Paket 0 0 0 0 0 0


NO KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
OBAT AWAL MAAN DIAAN KAIAN STOK OPT. TAAN APBD BUFER BUFER
PUSAT PROP
0 1 2 3 4 5 6 7 8 9 10 11 12 13

80 OAT KAT II FDC Paket 0 0 0 0 0 0

81 OAT KAT SISIPAN FDC Paket 0 0 0 0 0 0

82 Omeprazol kapsul/kaplet 20 mg kaplet 28 90 118 0 118 0

83 Parasetamol tablet 500 mg Tablet 934 1850 2784 0 2784 0

84 PERFENAZIN TAB 4 MG Tablet 0 0 0 0 0 0

85 Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg (HCl) Tablet 64 200 264 0 264

86 PIROKSIKAM 10 MG TAB Tablet 0 200 200 0 200

87 PIROKSIKAM 20 MG TAB Tablet 110 0 110 0 110


Prednison tablet/kapsul/kaplet 5 mg
88 Tablet 0 300 300 0 300
PRIMAKUIN TABLET 15 MG
89 Tablet 0 0 0 0 0

90 PROPANOLOL 40 MG TAB (HCL) Tablet 0 0 0 0 0

91 PROPILTIOURASIL 100 MG TAB Tablet 6 6 0 6

92 PYRANTEL SCORE (BASE) 125 MG TAB Tablet 27 0 27 0 27

93 Ranitidin tablet 150 mg Tablet 104 400 504 0 504

94 RETINOL 100 000 IU KAPSUL (VIT A BIRU) Kapsul Lunak 41 0 41 0 41

95 RETINOL 200 000 IU CAP (VIT A MERAH) Kapsul Lunak 198 0 198 0 198

96 SALBUTAMOL 4 MG TAB Tablet 13 150 163 0 13

97 Simvastatin tablet 10 mg Tablet 75 150 225 0 225

98 Simvastatin tablet 20 mg Tablet 0 0 0 0 0


NO KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
OBAT AWAL MAAN DIAAN KAIAN STOK OPT. TAAN APBD BUFER BUFER
PUSAT PROP
0 1 2 3 4 5 6 7 8 9 10 11 12 13

99 SETERIZIN 10 MG Tablet 0 200 200 0 200

100 SPIRONOLAKTON TABLET 25 MG Tablet 0 0 0

101 TETRASIKLIN 500 KAPSUL Kapsul 45 100 145 0 145

102 THIAMPENICOL KAPSUL 250 MG Kapsul 0 0 0 0 0

103 THIAMPENICOL KAPSUL 500 MG Kapsul 4 0 4 0 4

104 THIAMIN HCL 50 MG TAB ( VIT B1 ) Tablet 837 300 1137 0 1137

105 TRIHEKSIFENIDIL HCL 2 MG TAB Tablet 148 0 148 0 148

106 VIT B KOMPLEK TAB Tablet 730 700 1430 0 1430

107 ZINC TAB 20 MG Tablet 30 500 530 0 530


SYRUP

1 AMBROXOL SYR 15 mg/ml Botol 0 0 0 0 0 0

2 Amoksisilin sirup kering 125 mg/ 5 ml Botol 9 20 29 0 29 0

3 Amoksisilin sirup kering forte 250 mg/5 ml Botol 8 10 18 0 18 0

4 Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 Botol 7 5 12 0 12 0

5 DOMPERIDON SYRUP Botol 0 0 0 0 0 0

6 Kloramfenikol suspensi 125 mg/ 5 ml Botol 2 10 12 0 12 0


7 Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg + Trimetoprim 40 mg / 5 m Botol 7 0 7 0 7 0
8 Metoklopramide sirup 5 mg/ 5 ml Botol 1 10 11 0 11
9 METRONIDAZOL SUSPENSI Botol 0 0 0 0 0
NO KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
OBAT AWAL MAAN DIAAN KAIAN STOK OPT. TAAN APBD BUFER BUFER
PUSAT PROP
0 1 2 3 4 5 6 7 8 9 10 11 12 13

10 MULTIVITAMIN SYR Botol 6 10 16 0 16


11 NISTATIN SUSPESI Botol 1 0 1 0 1

12 O B H SYR Botol 0 0 0 0 0 0

13 Parasetamol drop 100 mg/ml btl @15ml (60mg/0,6ml) Botol 5 0 5 0 5 0

14 Parasetamol sirup 120 mg / 5 ml Botol 33 100 133 0 133 0


INJEKSI

1 Aminofilin injeksi 24 mg/ml Ampul 0 0 0 0 0 0

2 Ampisilin serbuk injeksi i.v. 1000 mg/vial Vial 0 10 10 0 10 0

3 ASAM TRANEXAMAT INJEKSI 50 MG / ML Ampul 0 0 0 0

4 AQUA PRO INJ STERIL Vial 0 2 2 0 2 0


CEFTRIAXON 1 GR INJ
5 Vial 0 0 0 0 0 0

6 Deksametason injeksi i.v./i.m. 5 mg/ml Ampul 0 0 0 0 0 0

7 Diazepam injeksi i.v./i.m 5 mg/ml Ampul 0 0 0 0 0 0

8 Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) Ampul 8 0 8 0 8 0

9 Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml Ampul 0 0 0 0 0 0

10 Fenitoin injeksi 50 mg/ml Ampul 0 0 0 0

11 Fenobarbital injeksi i.m./i.v. 50 mg/ml Ampul 0 0 0 0 0 0


Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml
12 Ampul 0 0 0 0 0 0
FUROSEMID INJ IV/IM 10 MG/ML
13 Ampul 0 0 0 0
NO KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
OBAT AWAL MAAN DIAAN KAIAN STOK OPT. TAAN APBD BUFER BUFER
PUSAT PROP
0 1 2 3 4 5 6 7 8 9 10 11 12 13
Gentamisin injeksi 40 mg/ ml
14 Ampul 0 0 0 0 0 0

15 HYOCINA N BUTILBROMID INJ 20 MG Ampul 7 0 7 0 7 0

16 KALSIUM GLUKONAS INJ 100 MG/ML Ampul 0 0 0 0 0 0

17 Kloramfenikol serb inj 1000 mg/mL Vial 0 0 0 0 0 0

18 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml Ampul 3 32 35 17 18 0

19 Lidokain injeksi 2% (HCL) Ampul 0 0 0 0 0 0

20 MAGNESIUM SULFAT 20 % INJ 25 ML Vial 0 0 0 0 0 0

21 MAGNESIUM SULFAT 40 % INJ 25 ML Vial 0 0 0 0 0 0

22 Metoklopramide INJ 5 MG/ML Ampul 4 10 14 0 14 0

23 Metilergometrin Maleat injeksi 0,200 mg-1 ml Ampul 0 0 0 0 0 0

24 Oksitosin injeksi 10 IU/ml Ampul 0 0 0 0 0 0

25 OXYTETRACIKLIN HCL INJ IM 50 MG/ML 10 ML Vial 0 0 0 0 0 0

26 RANITIDIN INJ 25 MG/2 ML Ampul 1 0 1 0 1 0

27 Sianokobalamin (vitamin B12) injeksi 500 mcg Ampul 0 0 0 0

28 THIAMIN INJ ( VIT BI ) 100 MG/ML Ampul 0 0 0 0 0 0


OBAT KHUSUS

1 Antihemoroid, kombinasi: bismut subgalat 150 mg heksaklorofen 2,5 mg lidokain 1 SUPP 0 0 0 0 0 0

2 BISACODYL SUPP (DULCOLAX) 10 MG / Stolax supp SUPP 0 0 0 0 0 0

3 Diazepam larutan rektal 5 mg/2,5 mL (stesolit rectal) TUBE 6 0 6 0 6


NO KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
OBAT AWAL MAAN DIAAN KAIAN STOK OPT. TAAN APBD BUFER BUFER
PUSAT PROP
0 1 2 3 4 5 6 7 8 9 10 11 12 13

4 MICROLAX SUPP 0 0 0 0 0

5 NISTATIN VAGINAL TAB 100 000 IU/GR TABLET 7 3 10 0 10

6 PARASETAMOL SUPP 80 MG SUPP 1 2 3 0 3


PARASETAMOL SUPP 125 MG
7 SUPP 1 1 0 1

8 SABU I 5 ML VIAL 0 0 0 0 0

9 SALBUTAMOL (AS SULPHATE) 2,5 MG/2,5 ML NEBULS Ampul 3 14 17 0 17

10 SERUM ATS 1 500 IU VIAL 0 0 0 0 0

11 Serum ATS 20.000 IU Botol 0 0 0 0 0 0


CAIRAN

1 Glukosa larutan infus 10 % steril Botol 0 0 0 0 0 0

2 Glukosa larutan infus 40 % steril Botol 0 0 0 0 0 0

3 Glukosa larutan infus 5 % steril Botol 0 0 0 0 0 0

4 Nacl 0,9% Botol 0 7 7 0 7 0

5 Ringer Laktat larutan infus Botol 0 20 20 0 20 0

OBAT LUAR

1 Anti Bakteri DOEN salep kombinasi: Basitrasin 500 IU/g Polimiksin 10.000 IU/g Tube 6 0 6 0 6 0

2 ANTI FUNGI DOEN KOMB Pot 0 0 0 0 0 0

3 ASIKLOVIR CREAM 5% Tube 3 0 3 0 3 0


NO KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
OBAT AWAL MAAN DIAAN KAIAN STOK OPT. TAAN APBD BUFER BUFER
PUSAT PROP
0 1 2 3 4 5 6 7 8 9 10 11 12 13

4 BETAMETASON CREAM 0,1 % Tube 0 20 20 0 20 0

5 FENOL GLISEROL TT 10% TUBE 5 4 9 0 9

6 GENTAMICIN SK 0,1% Botol 8 40 48 0 48

7 GENTAMICIN SALEP MATA 0,3% Tube 2 10 12 0 12

8 GENTAMISIN SULFAT TETES MATA Tube 8 8 0 8

9 GENTIAN VIOLET LART 1% Botol 4 4 0 4

10 HEXACHLOROCYLOHEXANE 0,5% (Peditox) Botol 0 0 0 0

11 HIDROGEN PEROKSIDA LARUTAN 3% Botol 0 0 0 0 0

12 HIDROKORTISON CREAM 2,5 % Tube 0 0 0 0 0

13 ICHTIOL SALEP HITAM Pot 0 0 0 0 0

14 KALIUM PERMANGANAT SERBUK Pot 5 5 0 5

15 KETOKONAZOL KRIM 2% Tube 9 9 0 9 0

16 Kloramfenikol salep mata 1 % Tube 0 0 0 0 0 0

17 Kloramfenikol teter telinga 3 % Botol 0 10 10 0 10 0

18 MICONAZOLE CREAM 2% Tube 6 10 16 0 16 0

19 OKSITETRASIKLIN SK 3% Tube 2 0 2 0 2 0

20 OKSITETRASIKLIN SM 1% Tube 15 0 15 0 15 0

21 Povidon Iodida larutan 10% 30 ml Botol 0 0 0 0 0

22 Povidon Iodida larutan 10% 300 ml Botol 0 2 2 0 2 0


NO KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
OBAT AWAL MAAN DIAAN KAIAN STOK OPT. TAAN APBD BUFER BUFER
PUSAT PROP
0 1 2 3 4 5 6 7 8 9 10 11 12 13

23 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% Botol 4 10 14 0 14 0

24 SALEP LUKA BAKAR (bioplacenton) Pot 0 0 0 0 0 0

25 Bedak salisil serbuk 2% Tube 8 10 18 0 18 0

26 SULFASETAMID NATRIUM TM 15 % Botol 0 0 0 0 0 0


OBAT GIGI

1 DEVITALISASI PASTA ( NON ARSEN ) Pot 0 0 0 0 0 0

2 ETIL KLORIDA SPRAY Botol 0 9 9 0 9 0

3 EUGENOL CAIRAN Botol 0 1 1 0 1 0

4 GLASS IONOMER CEMENT ART Botol 0 1 1 0 1 0

5 KALSIUM HIDROKSIDA PASTA Pot 0 0 0 0 0 0

6 KLORFENOL KAMFER MENTHOL (CHKM) Botol 0 0 0 0 0 0

7 MUMMIFYING PASTA Pot 0 0 0 0 0 0

8 POLIKRESULEN (ALBOTYL) Botol 0 0 0 0 0 0

9 SEMEN SENG FOSFAT SERBUK + CAIRAN Pot 0 0 0 0 0 0

10 SPONGOSTAN Kotak 0 0 0 0 0 0

11 TEMPORARY STOPPING FLETCER SERBUK+CAIRAN (caviton) Pot 0 0 0 0 0 0

12 TRIKRESOL FORMALIN (TKF) Botol 0 0 0 0 0 0


BAHAN LABORATORIUM

1 CARIK CELUP / URIN TES 3 GPH Stik 93 93 43 50 0


NO KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
OBAT AWAL MAAN DIAAN KAIAN STOK OPT. TAAN APBD BUFER BUFER
PUSAT PROP
0 1 2 3 4 5 6 7 8 9 10 11 12 13

2 CARIK CELUP / URIN TES 11 GPH Stik 76 76 21 55 0

3 Antiseptik dan Disinfektan - alkohol 70% 100 ml Botol 0 0 0 0 0 0

4 Antiseptik dan Disinfektan - alkohol 70% 1 liter Botol 0 0 0 0 0

5 GLISERIN Botol 0 0 0 0 0 0

6 HB TEST KIT Set 0 0 0 0 0 0

7 KIT GOL DARAH Set 9 0 9 0 9 0

8 LART AS ACETAT Botol 0 0 0 0 0 0

9 LART ASAM KLORIDA 0,1 N Botol 0 0 0 0

10 LAR ASAM KLORIDA 0,1% Botol 0 0 0 0 0 0

11 LART BARIUM CHLORIDA 10 % Botol 0 0 0 0 0 0

12 LART BENEDICT Botol 0 0 0 0 0 0

13 LART E D T A 10 % Botol 0 0 0 0 0 0

14 LART ETANOL ASAM Botol 0 0 0 0 0 0

15 LART KOH 10 % Botol 0 0 0 0 0 0


LART NACL 0,9 %
16 Botol 0 0 0 0 0 0

17 LART NATRIUM CITRAT 0,38 % Botol 0 0 0 0 0 0

18 LART ASAM CITRAT 3,8% Botol 0 0 0 0


LART REES ECKER
19 Botol 0 0 0 0 0 0

20 LART SCHLESINGER Botol 0 0 0 0 0 0


NO KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
OBAT AWAL MAAN DIAAN KAIAN STOK OPT. TAAN APBD BUFER BUFER
PUSAT PROP
0 1 2 3 4 5 6 7 8 9 10 11 12 13

21 LART TURK Botol 0 0 0 0 0 0

22 OIL EMERSI Botol 0 0 0 0 0 0

23 PP TEST Stik 33 25 58 0 58 0

24 RDT TEST MALARIA Stik 0 0 0 0 0 0

25 STIK GULA DARAH Stik 47 50 97 0 97 0

26 STIK ASAM URAT Stik 89 0 89 0 89 0

27 STIK KOLESTEROL Stik 12 20 32 0 32 0

28 STIK HBSAG Stik 0 50 50 0 50 0

29 STIK HBSAG Stik 0 0 0 0

30 WIDAL TEST Set 0 0 0 0 0 0


REAGEN

0 0 0 0

1 REAGEN ABX MINIDIL LMG PAKET 0 0 0 0

2 REAGEN ABC MINILYSE LMG PAKET 0 0 0 0

3 REAGEN ABX MINICLEAN PAKET 0 0 0 0

4 REAGEN ABX MINOTROL PAKET 0 0 0 0

5 KARTU GOLONGAN DARAH LEMBAR 0 0 0 0 0

6 BLOD LANCET BIJI 100 0 100 0 100 0

0
NO KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
OBAT AWAL MAAN DIAAN KAIAN STOK OPT. TAAN APBD BUFER BUFER
PUSAT PROP
0 1 2 3 4 5 6 7 8 9 10 11 12 13
TAMBAHAN 0
TABLET 0
Khloramphenichol 500 mg TABLET 80 400 480 0 480 0
1
Amlodipin 10 mg TABLET 0 0 0 0 0
2
Hyocina N Butilbromid Plus TABLET 0 0 0 0 0 0
3
Allupurinol 300 mg TABLET 104 200 304 0 304 0
5

0 0

0 0
SYRUP 0 0
Thiampenicol syr Botol 0 0 0 0 0
1

0 0

0 0
INJEKSI 0 0
Metamizol injeksi (Novaldo) Ampul 4 0 4 0 4 0
1
ketorolak injeksi Ampul 5 0 5 0 5 0
2
OBAT LUAR 0 0
Gentamisin TT Botol 0 0
1

0 0

0 0
NO KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
OBAT AWAL MAAN DIAAN KAIAN STOK OPT. TAAN APBD BUFER BUFER
PUSAT PROP
0 1 2 3 4 5 6 7 8 9 10 11 12 13

0 0

0 0

UMUM
TIDAK BAYAR ASKES
UMUM
JUMLAH KUNJUNGAN BPJS UKS LAIN-LAIN
2
382 606 5 1

Yang Menerima / Melapor Yang Menyerahkan

Kepala Puskesmas Labuapi Petugas Gudang Obat


NO KODE NAMA OBAT SATUAN STOK PENERI PERSE PEMA SISA STOK PERMIN PEMBERIAN
OBAT AWAL MAAN DIAAN KAIAN STOK OPT. TAAN APBD BUFER BUFER
PUSAT PROP
0 1 2 3 4 5 6 7 8 9 10 11 12 13

H. SAHRUJI SE,SKM,MM. NI MADE DERATHI

NIP. 19671231 198903 1.130. . NIP. 19761114 199503 2001.


2017

ERIAN
LAIN JUMLAH
LAIN KET.
14 15 16

0
ERIAN
LAIN JUMLAH
LAIN KET.
14 15 16

0
ERIAN
LAIN JUMLAH
LAIN KET.
14 15 16

1 P3K

90 P3K

5 P3K

0 3 P3K

0 100 P3K

0 100 P3K

0
ERIAN
LAIN JUMLAH
LAIN KET.
14 15 16

0
ERIAN
LAIN JUMLAH
LAIN KET.
14 15 16

0 100 P3K

0
ERIAN
LAIN JUMLAH
LAIN KET.
14 15 16

0
ERIAN
LAIN JUMLAH
LAIN KET.
14 15 16

0 100 P3K

0
ERIAN
LAIN JUMLAH
LAIN KET.
14 15 16

200 P3k
ERIAN
LAIN JUMLAH
LAIN KET.
14 15 16

0 5 P3K

0
0
ERIAN
LAIN JUMLAH
LAIN KET.
14 15 16

0
ERIAN
LAIN JUMLAH
LAIN KET.
14 15 16

0
ERIAN
LAIN JUMLAH
LAIN KET.
14 15 16

0
ERIAN
LAIN JUMLAH
LAIN KET.
14 15 16

0 2 P3K
ERIAN
LAIN JUMLAH
LAIN KET.
14 15 16

0
ERIAN
LAIN JUMLAH
LAIN KET.
14 15 16

0
ERIAN
LAIN JUMLAH
LAIN KET.
14 15 16

0
ERIAN
LAIN JUMLAH
LAIN KET.
14 15 16

0
ERIAN
LAIN JUMLAH
LAIN KET.
14 15 16

JUMLAH

2 996

Yang Menerima

Petugas Kamar Obat


ERIAN
LAIN JUMLAH
LAIN KET.
14 15 16

NI MADE DERATHI

NIP. 19761114 199503 2001.


U KODE NAMA OBAT SATUAN PEMAKAIAN UNIT LAYANAN
OBAT PUSTU PUSTU POSKESDESPOSKESDESPOSKESDESPOSKESDES
BENGKEL T.WARU BP.T BP.B BENGKEL MEREMBU
0 1 2 3 4 5 6 7 8 9
ALAT KESEHATAN
1 ALAT SUNTISET 0 0 0 0 0 0
2 ALAT SUNTISET
3 ALAT SUNTISET
4 ALAT SUNTISET
5 CAT GUT 2SET
6 CAT GUT 3SET
7 FOLEY CATPCS
8 HAND SCOSET
9 INFUS SET SET
10 INFUS SET SET
11 IV CATHETESET
12 IV CATHETESET
13 IV CATHETESET
14 IV CATHETESET
15 JARUM JAHSET
16 KAPAS PEMBKS
17 KASA GULUROL
18 KASA HIDRKTK/12's
19 KASA PEMBROL
20 MASKER SET
21 PEMBALUTROL
22 PLESTER 5 ROL
23 SILK BENA SET
24 URINE BAGPCS
25 WING NEED SET
26 WING NEED SET
27 WING NEED SET
28 WING NEED SET
29 KASA GULUROL
TABLET DAN SERBUK
ORAL
ACETOSA
L 500 MG TABLET
1 TAB 0
2 ALBENDAZOTABLET
3 ALOPURINOTABLET
4 AMBROXOLTABLET
5 AMINOPHILTABLET
6 AMITRIPTITABLET
7 AMOXICILLKAPLET
8 ANTASIDA TABLET
9 ANTI MIGRTABLET
10 ASAM ASCO TABLET
11 ASAM ASCO TABLET
12 ASAM MEFKAPLET
13 ASIKLOVIRTABLET
14 ATROPIN STABLET
15 BISACODYLTABLET
16 CAPTOPRILTABLET
17 CAPTOPRILTABLET
18 CETIRIZIN TABLET
19 CIPROFLOXTABLET
20 D H P TAB PAKET
21 DEXAMETAS TABLET
22 DEXTROMETABLET
23 DIAZEPAMTABLET
24 DIAZEPAMTABLET
25 DIGOXIN 0TABLET
26 DOXYCYCLIKAPSUL
27 EFEDRIN HTABLET
28 ERYTHROMY KAPSUL
29 EXTRAK BETABLET
30 FENITOIN KAPSUL
31 FENITOIN KAPSUL
32 FENOBARBITABLET
33 FENOBARBITABLET
34 FITOMENAD TABLET
35 FOLIC ACI TABLET
36 FUROSEMID TABLET
37 GARAM ORA SACHET
38 GLIBENCLATABLET
39 GLISERYL TABLET
40 GRISEOFULTABLET
41 HALOPERIDTABLET
42 HALOPERIDTABLET
43 HALOPERIDTABLET
44 HIDROKLOR TABLET
45 HYOCINA NTABLET
46 IBUPROFENTABLET
47 ISOSORBIDTABLET
48 KALSIUM LTABLET
49 KARBAMAZE TABLET
50 KLORAMPHKAPSUL
51 KLORFENIRTABLET
52 KLORPROMA TABLET
53 KLORPROMA TABLET
54 KODEINA 1TABLET
55 KOTRIMOXA TABLET
56 LOPERAMID TABLET
57 MEBENDAZTABLET
58 METIL ERGTABLET
59 METOCHLOTABLET
60 METRONIDTABLET
61 METRONIDTABLET
62 NATRIUM DTABLET
63 NIFEDIPIN TABLET
64 NISTATIN 5TABLET
65 OAT KAT A PAKET
66 OAT KAT A PAKET
67 OAT KAT I PAKET
68 OAT KAT I. PAKET
69 OAT KAT II PAKET
70 OAT KAT SIPAKET
71 OMEPRAZOKAPSUL
72 PARACETA TABLET
73 PARACETA TABLET
74 PERFENAZITABLET
75 PIRIDOXINTABLET
76 PIROKSIKATABLET
77 PREDNISON TABLET
78 PROPANOLO TABLET
79 PROPILTIOTABLET
80 PYRANTEL TABLET
81 RANITIDINTABLET
82 RESERPIN TABLET
83 RETINOL 10KAPSUL
84 RETINOL 20KAPSUL
85 SALBUTAMTABLET
86 SIMVASTATTABLET
87 TABLET T TABLET
88 TETRASIKLKAPSUL
89 THIAMIN HC TABLET
90 TRIHEKSIF TABLET
91 VIT B KOMTABLET
92 ZINC TAB TABLET
SYRUP
1 AMBROXOLBOTOL
2 AMOXICILLBOTOL
3 ANTASIDA BOTOL
4 DEXTROMET BOTOL
5 KLORAMPHE BOTOL
6 KOTRIMOXBOTOL
7 METOCLOPBOTOL
8 MULTIVITABOTOL
9 O B H SYR BOTOL
10 PARACETAM BOTOL
INJEKSI
1 AMINOPHIL AMPUL
2 AMPISILLI VIAL
3 ANTALGIN AMPUL
4 AQUA PROAMPUL
5 ARTEMETER AMPUL
6 ARTESUNAT VIAL
7 ATROPIN SAMPUL
8 CEFTRIAXONVIAL
9 DEXAMETHA AMPUL
10 DIAZEPHAM AMPUL
11 DIPHENHIDAMPUL
12 EPHINEPRIAMPUL
13 FENOBARBIAMPUL
14 FITOMANAD AMPUL
15 GENTAMICIAMPUL
16 HYOCINA NAMPUL
17 KALSIUM GVIAL
18 KHLORAMPH AMPUL
19 LIDOKAIN AMPUL
20 LIDOKAIN HAMPUL
21 MAGNESIUM AMPUL
22 MAGNESIUM AMPUL
23 METHOCLOAMPUL
24 AMPUL
METILERGOME
25 OXITOSIN IAMPUL
26 OXYTETRACVIAL
PROCAIN
BEN
PENICILLI VIAL
N G INJ 3
JT
IU/VIAL
27
28 RANITIDINAMPUL
29 SIANOKOBAAMPUL
30 THIAMIN IN
AMPUL
OBAT KHUSUS
1 ANTI HAE SUPP
2 BISACODYLSUPP
3 DIAZEPAMTUBE
R
4 NISTATIN VSUPP
5 SABU I 5 MVIAL
6 SALBUTAMOLAMPUL
7 SERUM ATSAMPUL
CAIRAN
1 GLUKOSA IBOTOL
2 GLUKOSA IBOTOL
3 GLUKOSA IBOTOL
4 NATRIUM KLBOTOL
5 RINGER LABOTOL
OBAT LUAR
1 ANTI BAKTTUBE
2 ANTI FUNGPOT
3 ASIKLOVIRTUBE
4 BETAMETAS TUBE
5 ETAKRIDINBOTOL
6 FENOL GLIBOTOL
7 GENTAMICITUBE
8 GENTAMICIBOTOL
9 GENTIAN VBOTOL
10 HIDROKORT TUBE
11 ICHTIOL S POT
12 KALIUM P POT
13 KHLORAMPTUBE
14 KHLORAMPH BOTOL
15 MICONAZOTUBE
16 OKSITETRATUBE
17 OKSITETRATUBE
18 POVIDON IBOTOL
19 POVIDON IBOTOL
20 SALEP 2 - POT
21 SALISIL BE KOTAK
22 SULFASETABOTOL
OBAT GIGI
1 DEVITALISAPOT
2 ETIL KLORIBOTOL
3 EUGENOL BOTOL
4 GLASS IO SET
5 KALSIUM HTUBE
6 KLORFENOBOTOL
7 MUMMIFYIBOTOL
8 POLIKRESUBOTOL
9 SEMEN SENSET
10 SPONGOSTBIJI
11 TEMPORARY SET
12 TRIKRESOL BOTOL
BAHAN LABORATORIUM
1 CARIK CELUBIJI
CAT SET
2 GRAM
3 ETANOL 70BOTOL
4 GLISERIN BOTOL
5 HB TEST KISET
6 KIT GOL D SET
7 LART ANIS BOTOL
LART AS BOTOL
8 ACETAT
LART AS
SULFOSAL BOTOL
9 ICYLAT
10 LART ASAMBOTOL
11 LART BARI BOTOL
12 LART BENEBOTOL
13 LART E D TBOTOL
LART
EOSIN 1 BOTOL
14 %

LART
EOSIN 2 BOTOL
15 %
16 LART ETANBOTOL
LART
17 FOUCHET BOTOL
LART BOTOL
18 GABBET
LART BOTOL
19 HAYEM
LART
KARBOL BOTOL
20 FUKSIN

LART
KINYOON BOTOL
21
22 LART KOH BOTOL
23 LART MET BOTOL
LART
NACL 0,9 BOTOL
24 %
25 LART NATRBOTOL
26 LART REESBOTOL
LART
SCHLESIN BOTOL
27 GER
28 LART TURKBOTOL
29 LART ZIEH SET
30 OIL EMERSBOTOL
31 PP TEST KOTAK
32 WIDAL TESSET
LAIN - LAIN
ABOCET SET
1 NO 26 G
GLIMEPIR TABLET
2 ID
3 DIMENHIDTABLET
KAPAS
BERLEMA BKS
4 K 500 GR

KASA
PEMBALU
T
HIDROFIL ROL
4 M X 15
CM
5
KASA
PEMBALU
T
HIDROFIL ROL
4MX3
CM
6
7 THIAMPHEKAPSUL
8 KOMB PIRITABLET

KONTRAS
EPSI INJ SET
PROGEST
ERON KB I
9
KONTRAS
EPSI PIL SET
KOMB KB
I
10
KONTRAS
EPSI
SUSUK SET
INDOPLE
N KB II
11
12 KUININ DI AMPUL
13 KUININ SUTABLET
14 LART ASAMBOTOL

METRONI
DAZOL
INF 500 BOTOL
MG/100
ML
15
MINERAL
MIX SACHET
16 KOMB

MULTI
MICRO TAB
17 NUTRIEN
18 PRIMAKUINTABLET
PROCAIN
PENICILLI VIAL
19 N INJ
TRANFUSI SET
20 ON SET
21 PERHIDROBOTOL
22 KASA KOMP
BKS
23 KLORPROMA
AMPUL
24 SPUIT 0,05SET
25 SOLOSHOTSET
26 LISOL BOTOL
27 PARAFORMTABLET
28 PRENATIN TABLET
29 BIOPLACTUBE
30 KASA 2X80BKS
31 PARACETAMSUPPO
32 PARACETA TUBE
33 MICROLAXTUBE
34 KETOKONATABLET
35 KETOKONATUBE
36 AMLODIPITABLET
37 ETANOL 7BOTOL
38 ANTAPULGITABLET
39 LORATADITABLET
40 PARACETA BOTOL
NAN
POSKESDES
UGD PUSKEL TOTAL
T.WARU
10 11 12 13

0 0 0 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
0
0
0
0

0
0
0
0
0

0
0

0
0

0
0
0

0
0
0

0
0
0
0
0
0
0

0
0

0
0
0
0

0
0
0
0

0
0

0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

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