LAPORAN PEMAKAIAN DAN

PUSKESMAS : GUNUNGSARI

KAB/KOTA : LOMBOK BARAT

PELAPORAN BULAN / PERIODE: LAPORAN TAHUNAN

PERMINTAAN BULAN / PERIOD:

NO NAMA OBAT SATUAN

0 1 2
ALAT KESEHATAN
1 ALAT SUNTIK SEKALI PAKAI 1 ML SET
2 ALAT SUNTIK SEKALI PAKAI 2,5 ML / 3 ML SET
3 ALAT SUNTIK SEKALI PAKAI 5 ML SET
4 SPUIT 10 CC SET
5 CATGUT NO. 2/0 SET
6 CATGUT NO. 3/0 SET
7 FOLLY CATHETHER SET
8 HANDSCOUND SET
9 INFUSION SET ANAK SET
10 INFUSION SET DEWASA SET
11 IV CATHETER (ABBOCATH) NO. 18 G SET
12 IV CATHETER (ABBOCATH) NO. 20 G SET
13 IV CATHETER (ABBOCATH) NO. 22 G SET
14 IV CATHETER (ABBOCATH) NO. 24 G SET
15 JARUM JAHID BEDAH SET
16 KAPAS PEMBALUT 250 GRAM SET
17 KASA GULUNG 40 X 80 GULUNG
18 kasa hidrofil 18 x 22 cm pcs
19 KASA KOMPRES 4 x 10 cm GULUNG
20 MASKER SET
21 KASA PEMBALUT HIDROFIL 4 M X 3 CM SET
21 PEMBALUT GIPS 3 inci GULUNG
22 PLESTER 5 yard x 2 inchi GULUNG
23 SILK BENANG BEDAH SET
24 urine bag SET
25 WING NEEDLE NO. 21 G SET
26 WING NEEDLE NO. 23 G SET
27 WING NEEDLE NO. 25 G SET
28 WING NEEDLE NO. 27 G LEMBAR

TABLET DAN SERBUK ORAL

1 ACETOSAL 500 MG TABLET TABLET

2 ALBENDAZOLE TABLET
3 ALLOPURINOL TAB 100 MG TABLET
4 AMBROXOL 30 MG TAB TABLET
5 AMINOPHILLIN 200 MG TAB TABLET
6 AMITRIPTILLIN 25 MG TAB TABLET
7 AMOXICILLIN 500 MG TABLET TABLET
8 ANTASIDA DOEN TAB TABLET
9 ANTIMIGREN TAB TABLET
10 ASAM ASCORBAT 250MG TAB (VIT C) TABLET
11 ASAM ASCORBAT 50MG TAB (VIT C) TABLET
12 ASAM MEFENAMAT 500 MG TAB TABLET
13 ASIKLOVIR 400 MG TABLET
14 ATROPIN SULFAT TAB TABLET
15 BISAKODIL 5 MG TAB ( DULKOLAX ) TABLET
16 CAPTOPRIL 12,5 MG TAB TABLET
17 CAPTOPRIL 25 MG TAB TABLET
18 CETERIZINE TABLET
19 CIPROFLOXACIN 500 MG TAB TABLET
20 DHP (ARTERAKIN ) TABLET
21 DEXAMETASON 0,5 MG TAB TABLET
22 DEXTROMETHORFAN HBR 15 MG TAB TABLET
23 DIAZEPAM 2 MG TAB TABLET
24 DIAZEPAM 5 MG TAB TABLET
25 DIGOXIN 0,25 MG TAB TABLET
26 DOXYCYCLIN 100 MG CAPS KAPSUL
27 EFEDRIN HCL 25 MG TAB TABLET
28 ERYTHROMYCIN 500 MG TAB TABLET
29 EXTRAK BELLADONA 10 MG TAB TABLET
30 FENITOIN 100 MG KAPSUL TABLET
31 FENITOIN NATRIUM 30 MG KAPSUL TABLET
32 FENOBARBITAL 100 MG TAB TABLET
33 FENOBARBITAL 30 MG TAB TABLET
34 FITOMENADION 10 MG TAB ( VIT K ) TABLET
35 FOLIC ACID 1 MG TAB TABLET
36 FUROSEMID 40 MG TAB TABLET
37 GARAM ORALIT 200 ML TABLET
38 GLIBENCLAMID 5 MG TABLET
39 GLISERYL GUAYACOLAT 100 MG TAB TABLET
40 GRISEOFULVIN 125 MG TAB TABLET
41 HALOPERIDOL 0,5 MG TAB TABLET
42 HALOPERIDOL 1,5 MG TAB TABLET
43 HALOPERIDOL 5 MG TAB TABLET
44 HIDROKLORTIAZID 25 MG TAB ( HCT ) TABLET
45 HYOCINA N BUTILBROMID 10 MG TAB TABLET
46 IBUPROFEN 400 MG TAB TABLET
47 ISOSORBID DINITRAT SUBLINGUAL 5 MG TABLET
48 KALSIUM LAKTAT 500 MG TABLET
49 KARBAMAZEPIN 200 MG TAB TABLET
50 KLORAMPHENIKOL 250 MG KAPSUL TABLET
51 KLORFENIRAMINI MALEAT TAB ( CTM ) TABLET
52 KLORPROMAZIN 100 MG TAB TABLET
53 KLORPROMAZIN 25 MG TAB TABLET
54 KODEIN 10 MG TAB TABLET
55 KOTRIMOXAZOLE 480 MG TAB TABLET
56 LoPERAMID TAB 2 MG TABLET
57 MEBENDAZOLE 100 MG TAB TABLET
58 METIL ERGOMETRIN MALEAT 0,125 MG TABLET
59 METOCHKLOPROPAMID 10 MG TAB TABLET
60 MATRONIDAZOLE 250 MG TAB TABLET
61 METRONIDAZOLE 500 MG TAB TABLET
62 NATRIUM DIKLOFENAK 50 MG TAB TABLET
63 NIFEDIPIN 10 MG TAB TABLET
64 NISTATIN 500 000 IU TAB SALUT TABLET
65 OAT KAT ANAK FDC PAKET
66 OAT KAT ANAK KOMB PAKET
67 OAT KAT I KOMB PAKET
68 OAT KAT I.3 FDC PAKET
69 OAT KAT II FDC PAKET
70 OAT KAT SISIPAN FDC TABLET
71 OMEPRAZOLE KAPS 20 MG TABLET
72 PARACETAMOL 100 MG TAB TABLET
73 PARACETAMOL 500 MG TAB TABLET
74 PERFENAZIN TAB 4 MG PAKET
75 PIRIDOXIN HCL 10 MG TAB TABLET
76 PIROXIKAM 20 MG TAB TABLET
77 PREDNISON 5 MG TAB TABLET
78 PROPANOLOL 40 MG TAB TABLET
79 PROPILTIOURASIL 100 MG TAB TABLET
80 PYRANTEL PAMOAT 365 MG TAB TABLET
81 RANITIDIN 150 MG TAB TABLET
82 RESERPIN 0,25 MG TAB TABLET
83 RETINOL 100 000 IU KAPSUL ( VIT A BIRU ) KAPSUL
84 RETINOL 200 000 IU KAPSUL ( VIT A MERAH ) KAPSUL
85 SALBUTAMOL 4 MG TAB TABLET
86 SIMVASTATIN 10 MG TAB TABLET
87 TABLET TAMBAH DARAH KOMB TABLET
88 TETRASIKLIN 500 MG KAPSUL KAPSUL
89 THIAMIN HCL MONO 50 MG TAB (VIT B1) TABLET
90 TRIHEKSIFENIDIL HCL 2 MG TAB TABLET
91 VIT B COMPLEK TAB TABLET
92 ZINC TAB TABLET
93 KETOKENAZOLE TABLET TABLET
SYRUP

1 AMBROXOL SYR BOTOL

2 AMOSISILLIN SK 125MG/5ML BOTOL
3 ANTASIDA DOEN SYR BOTOL
4 DEXTROMETOPHAN SYR BOTOL
5 KLORAMPHENIKOL SYR BOTOL
6 KOTRIMOXAZOLE SYR BOTOL
7 METOCLOPRAMID SYR BOTOL
8 MULTIVITAMIN SYR BOTOL
9 OBH SYR BOTOL
10 PARAETAMOL SYR BOTOL
SENDOK OBAT
INJEKSI

1 AMINOPHILINA 24 MG / ML - 10 ML AMPUL
2 AMPISILIN INJ. IM/IV 500 MG/VIAL VIAL
3 ANTALGIN INJEKSI 250 MG/ML - 2 ML AMPUL
4 AQUA PRO INJEKSI STERIL AMPUL
5 ARTEMETER INJ AMPUL
6 ARTESUNAT INJ VIAL
7 ATROPIN SULFAT INJ AMPUL
8 CEFTRIAXON 1 GR INJ VIAL
9 DEXAMETHASON INJ AMPUL
10 DIAZEPAM INJ AMPUL
11 DIPHENHIDRAMIN INJ AMPUL
12 EPHINEPRIN INJ AMPUL
13 FENOBARBITAL INJ 50 MG/ML AMPUL
14 FITOMENADION INJ ( VIT K1 ) AMPUL
15 GENTAMICIN 40 MG AMPUL INJ AMPUL
16 HYOCINA N BUTILBROMID INJ AMPUL
17 KALSIUM GLUKONAS INJ VIAL
18 KLORAMPHENIKOL INJ AMPUL
19 LIDOCAIN COMP INJ AMPUL
23 LIDOCAIN 2 % INJ AMPUL
24 MAGNESIUM SULFAT 20 % INJ AMPUL
25 MAGNESIUM SULFAT 40 % INJ AMPUL
26 METHOCLOPRAMID INJ AMPUL
27 METILERGOMETRIN MALEAT INJ AMPUL
28 OXITOSIN INJ AMPUL
29 OXYTETTRACIKLIN HCL INJ VIAL
30 PROCAIN BEN PENICILIN INJ VIAL
31 RANITIDIN INJ AMPUL
32 SIANOCOBALAMIN INJ AMPUL
33 THIAMIN HCL INJ ( VIT B1 ) AMPUL
30 ADRENALIN INJ.

OBAT KHUSUS

1 ANTIHEMOROID DOEN KOMB SUPP

2 BISAKODYL SUPP (DULKOLAX) SUPP
3 DIAZEPAM RECTAL ( STESOLIT RECTAL ) TUBE
4 NISTATIN VAGINAL OVULA 100.000 IU SUPP
5 SABU 5 ML VIAL
6 SALBUTAMOL NEBULS AMPUL
7 SERUM ATS 1.500 IU AMPUL

CAIRAN

1 GLUKOSA INF 10 % BOTOL

2 GLUKOSA INF 40 % BOTOL
3 GLUKOSA INF 5 % BOTOL
4 NATRIUM KLORIDA INF (NACL) BOTOL
5 RINGER LAKTAT INF BOTOL

OBAT LUAR

1 ANTI BAKTERI DOEN SALEP KOMB TUBE

2 ANTI FUNGI DOEN KOMB POT
3 ASIKLOVIR CREAM 5% TUBE
4 BETAMETASON CREAM 0.1% TUBE
5 ETAKRIDIN (RIVANOL) LARUTAN 0,1% BOTOL
6 FENOL GLISEROL TT BOTOL
7 GENTAMICIN SK TUBE
8 GENTAMICIN SULFAT TM 0,3 % TUBE
9 GENTIAN VIOLET LART 1 % BOTOL
10 HIDROKORTISON CREAM 2,5 % TUBE
11 ICHTIOL SALEP HITAM POT
12 KALIUM PERMANGANAT SERBUK POT
13 KLORAMPHENIKOL SM 1 % TUBE
14 KLORAMPHENIKOL TT 3 % BOTOL
15 MICONAZOLE CREAM TUBE
16 OKSITETRASILIN SK 3 % TUBE
17 OKSITETRASILIN SM 1 % TUBE
18 POVIDON IODIUM LARUTAN 10% 30 ML BOTOL
19 POVIDON IODIUM LARUTAN 10% 300 ML BOTOL
20 SALEP 2-4 POT
21 salisil bedak 2 % POT
22 SULFASETAMIDA NATRIUM TM 15% BOTOL
23 SCABISID CRM TUBE
OBAT GIGI

1 CHKM b0tol
2 DEVITALISASI PASTA ( NON ARSEN ) b0tol
3 ETIL KLORIDA SPRAY b0tol
4 EUGENOL CAIRAN b0tol
5 GLASS IONOMER CEMENT ART b0tol
6 KALSIUM HIDROKSIDA PASTA b0tol
7 MUMIFYING PASTA (IODOFORM) b0tol
8 POLIKRESULEN ( ALBOTYL ) b0tol
9 SEMEN SENG FOSFAT b0tol
10 SPONGOSTAN pcs
11 TEMPORARY FLETCER ( CAVIT G ) b0tol
12 TRIKRESOL FORMALIN ( TKF) b0tol

BAHAN LABORATORIUM

1 CARIK CELUP / URIN TES botol

2 CAT GRAM kit
3 ETANOL 70% botol
4 GLISERIN botol
5 HB TEST KIT kit
6 KIT GOL DARAH kit
7 LART ANISOL botol
8 LART AS ASETAT botol
9 LAR AS SULFOSALICYLAT botol
10 LART AS CHLORIDA 0,1 % botol
11 LAR BARIUM CHLORIDA 10 % botol
12 LART BENEDICT botol
13 LART EDTA 10 5 botol
14 LART EOSIN 1% botol
15 LART EOSIN 2 % botol
16 LART ETANOL ASAM botol
17 LART FOUCHET botol
18 LART GABBET botol
19 LART HAYEM botol
20 LART KARBOL FUKSIN botol
21 LART KINYOON botol
22 LART KOH 10 % botol
23 LART METANOL botol
24 LART NACL 0,9 % botol
25 LART NATRIUM CITRAT 3,8 % botol
26 LART REES ECKER botol
27 LART SCHLESINGER botol
28 LART TURK botol
29 LART ZIEHL NEELSEN botol
30 OIL EMERSI botol
31 PP TEST ktk
32 WIDAL TEST kit
33 LISOL BTL
LAIN - LAIN

1 cat gut benang bedah 1/0 dg jarum set

2 dekstran 70 lart inf 6 % steril botol
3 iodium test botol
4 kapas berlemak 500 gr bks
5 kasa pembalut hidrofil 4 m x 15 cm rol
6 KASA PEMBALUT HIDROFIL 4 X 3 rol
7 kloroquin 250 mg tab tablet
8 komb pirimetamin + sulfadoksin tab tablet
9 kontrasepsi inj.progesteron kb i amp
10 kontrasepsi pil komb kb i tablet
11 kontrsepsi susuk indoplen kb ii pcs
12 kuinin hidroklorida inj. 25 % 2 ml amp
13 kuinin sulfat 222 mg tab tablet
14 larutan asam klorida 0,1 N sachet
15 metronodazole inf 500 mg/100 ml kapsul
16 mineral mix sachet
17 miulti micro nutrien (MALTIRON) pcs
18 primakuin 15 mg tab tablet
19 procain penicilin inj VIAL
20 TRANFUSION SET SET
21 lycalvit tablet
22 STELAZINE 1 MG tablet
23 STELAZINE 5 MG tablet
24 ABBOCATH 26 G pcs
25 bioplacenton tube
26 larutan H202 BTL
27 MINICLEAN BTL
28 MINIDIL BTL
29

JUMLAH KUNJUNGAN

bayar
RESEP

20098
Mengetahui Yang menyerahkan
Kepala Dinkesmas Lobar Kepala UPTD IFK Lobar

DRS.H.RACHMAN SAHNAN PUTRA M.KES BQ.ENDANG SUPRIHART

NIP : 19610512 198203 1009 NIP : 19680916 200112 2

keterangan

lembar pertama ( asli ) : ifk

lembar kedua : dinkesmas lobar

lembar ketiga : arsip / puskesmas

stok optimum = stok kerja + waktu kosong obat + stok penyangga + waktu tung

pemberian = stok optimum - sisa stok

AIAN DAN LEMBAR PERMINTAA

NUNGSARI
MBOK BARAT
PORAN TAHUNAN

STOK PENE PERSE PEMA SISA STOK

AWAL RIMAAN DIAAN KAIAN STOK OPT

3 4 5(3+4) 6(5-7 7 8
0
400 2400 2800 2271 529
504 8100 8604 7904 700
252 1000 1252 1199 53
39 90 129 112 17
36 336 372 372 0
0 408 408 308 100
0 0 0 0 0
100 1350 1450 1371 79
100 600 700 620 80
53 1775 1828 1660 168
45 100 145 65 80
78 1100 1178 1145 33
0 850 850 800 50
194 650 844 744 100
105 312 417 411 6
8 117 125 120 5
0 18 18 18 0
350 19920 20270 19518 752
509 1100 1609 1589 20
0 900 900 900 0
0 0 0 0 0
0 0 0 0 0
16 168 184 181 3
108 288 396 324 72
28 0 28 5 23
0 20 20 0 20
0 20 20 0 20
0 20 20 0 20
0 20 20 0 20

0 0 0 0 0
0 3060 3060 950 2110
380 1000 1380 1180 200
3940 20000 23940 20940 3000
670 900 1570 1120 450
280 400 680 380 300
16540 161400 177940 170288 7652
7070 67000 74070 71210 2860
260 900 1160 860 300
390 8000 8390 7040 1350
3000 4000 7000 6000 1000
840 31500 32340 29920 2420
350 1400 1750 1485 265
0 0 0 0 0
48 80 128 54 74
940 13500 14440 12330 2110
1610 15200 16810 15170 1640
60 2910 2970 2540 430
1990 6500 8490 8240 250
73 430 503 99 404
2180 39000 41180 35180 6000
900 2000 2900 1800 1100
1220 0 1220 90 1130
800 2000 2800 2596 204
530 100 630 250 380
210 0 210 120 90
900 4000 4900 3900 1000
300 2000 2300 1860 440
500 2000 2500 1500 1000
0 0 0 0 0
250 0 250 250 0
0 0 0 0 0
0 0 0 0 0
200 3500 3700 3440 260
200 800 1000 730 270
380 200 580 304 276
4435 31000 35435 31191 4244
240 5900 6140 5610 530
6475 77000 83475 77379 6096
780 700 1480 1240 240
0 0 0 0 0
0 0 0 0 0
 173 2200 2373 1903 470
950 0 950 170 780
925 2500 3425 2915 510
1460 12000 13460 11710 1750
100 0 100 0 100
3000 9000 12000 10000 2000
265 0 265 265 0
4030 10200 14230 12230 2000
5722 101000 106722 98615 8107
888 0 888 0 888
0 0 0 0 0
0 0 0 0 0
2450 22500 24950 21650 3300
430 1300 1730 1500 230
0 0 0 0 0
490 1600 2090 1660 430
1600 12100 13700 12350 1350
560 2500 3060 3060 0
0 3100 3100 2400 700
58 1200 1258 1058 200
120 600 720 550 170
190 0 190 90 100
0 0 0 0 0
0 3 3 0 3
0 0 0 0 0
17 122 139 133 6
1 17 18 18 0
0 0 0 0 0
55 1410 1465 1355 110
1050 22000 23050 21400 1650
10941 27000 37941 21631 16310
0 3000 3000 3000 0
1400 17300 18700 16100 2600
400 3600 4000 3480 520
1920 10000 11920 11420 500
100 400 500 400 100
0 300 300 100 200
239 1500 1739 1270 469
1061 12800 13861 11161 2700
0 0 0 0 0
0 3300 3300 2670 630
2900 11650 14550 14200 350
1960 18000 19960 17760 2200
0 300 300 300 0
5785 140610 146395 136865 9530
400 2600 3000 2530 470
3620 38000 41620 37270 4350
120 2400 2520 2280 240
14760 135000 149760 134070 15690
1650 20200 21850 19750 2100
0 100 100 0 100

20 150 170 110 60

447 4400 4847 4353 494
42 600 642 592 50
69 250 319 213 106
74 150 224 144 80
291 2400 2691 2345 346
55 550 605 435 170
17 560 577 539 38
124 1520 1644 1501 143
277 7400 7677 7549 128

29 60 89 59 30
36 630 666 583 83
17 0 17 2 15
23 300 323 297 26
0 0 0 0 0
0 0 0 0 0
23 30 53 18 35
0 42 42 42 0
15 275 290 233 57
0 0 0 0 0
5 210 215 214 1
69 100 169 109 60
25 0 25 0 25
57 510 567 487 80
10 85 95 65 30
45 200 245 232 13
18 0 18 5 13
40 0 40 30 10
105 1600 1705 1679 26
80 100 180 80 100
5 0 5 4 1
6 48 54 37 17
18 80 98 91 7
190 0 190 134 56
170 1000 1170 990 180
0 0 0 0 0
35 0 35 29 6
18 375 393 393 0
0 0 0 0 0
28 0 28 14 14
0 0 0 0 0
0 0 0

45 120 165 140 25

0 45 45 25 20
17 70 87 67 20
70 300 370 270 100
1 1 2 1 1
25 110 135 135 0
0 6 6 5 1
0 0
0 0
0 0
0 0 0 0 0
0 0 0 0 0
150 700 850 700 150
150 600 750 707 43
700 7000 7700 7583 117
0 0
0 0
0 0
55 1100 1155 1115 40
4 183 187 150 37
100 250 350 295 55
65 840 905 666 239
1 5 6 4 2
15 192 207 149 58
89 900 989 916 73
33 50 83 70 13
79 168 247 188 59
90 816 906 856 50
1 108 109 100 9
30 264 294 277 17
49 866 915 795 120
40 542 582 482 100
34 218 252 222 30
42 0 42 42 0
160 500 660 457 203
9 105 114 105 9
1 47 48 46 2
37 144 181 143 38
66 750 816 791 25
54 288 342 325 17
0 24 24 7 17
0 0
0 0
1 2 3 2 1
2 2 4 2 2
5 44 49 49 0
1 34 35 33 2
2 17 19 16 3
3 2 5 4 1
1 0 1 0 1
3 14 17 15 2
2 5 7 5 2
10 20 30 30 0
0 14 14 13 1
2 0 2 1 1
0 0
0 0
0 0
300 350 650 650 0
0 0 0 0 0
6 104 110 104 6
0 4 4 4 0
0 2 2 2 0
2 7 9 8 1
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 16 16 12 4
0 8 8 5 3
0 1 1 0 1
0 7 7 6 1
0 2 2 0 2
0 0 0 0 0
0 100 100 100 0
0 12 12 12 0
0 0 0 0 0
0 0
0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
150 500 650 520 130
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
0 0 0 0 0
268 0 268 118 150
0 12 12 12 0
0 6 6 2 4
0 0 0 0 0
 0 14400 14400 13290 1110
500 2000 2500 430 2070
0 0 0 0 0
0 0 0 0 0
0 14490 14490 2390 12100
0 200 200 100 100
0 200 200 100 100
0 500 500 475 25
0 5 5 3 2
0 1 1 0 1
0 1 1 0 1
0 1 1 0 1

UMUM
tidak bayar
bayar
jps uks lain2

20098 21820 193 1486

 Yang menyerahkan Yang menerima/melapor
Kepala UPTD IFK Lobar plh Kepala Puskesmas

BQ.ENDANG SUPRIHARTINI DRG. HJ FARIDA HIDAYATI

NIP : 19680916 200112 2003 nip : 197661309 199203 2007

smas lobar

/ puskesmas

ok penyangga + waktu tunggu

RMINTAAN OBAT (LPLPO)

NO DOC : /i.ii / ii / 2013

TAHUN : 2013
TANGGAL : 19 FEBRUARI

PERMIN PEMBERIAN KET.

TAAN APBD BUFFER APBN PROG LAIN JML

9 10 10 11 12 13 14 15
 ASKES JUMLAH

lain2
3593 47190
1486
 Yang menerima
melapor Petugas P Yang menerima
Petugas Pengelola Obat Puskesmas

Gst.Ayu W.A.Pisiawati
HIDAYATI NIP : 198 GST.AYU W.ALIT PISIAWATI
199203 2007 NIP : 19830306 200112 2 001