Laporan Obat 2018

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
KODE PUSKESMAS :
NAMA PUSKESMAS ; RANGAS
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU
PROPINSI : SULAWESI BARAT

JML STOK
NO NAMA OBAT/BMHP SATUAN STOK AWAL PERSEDIAAN PEMAKAIAN STOK AKHIR
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
1 Abbocath No. 18 Pcs 47 47 2 45 0
2 Abbocath No. 20 Pcs 50 50 2 48 0
3 Abbocath No. 22 Pcs 19 19 - 19 -
4 Abbocath No. 24 Pcs 22 22 3 19 1
5 Acyclovir Cream 3% Tube 42 42 - 42 -
6 Acyclovir tab 200 mg Tablet 245 245 - 245 -
7 Acyclovir tab 400 mg Tablet
8 Albendazol Suspensi 25 mg / 5 ml Btl/10 ml
9 Albendazol tab 400 mg Tablet 20 20 - 20 -
10 Alat Suntik Sekali Pakai 1 ml Pcs 204 204 6 198 1
13 Allopurinol tab 100 mg Tablet 380 200 580 340 240 68
14 Allopurinol tab 300 mg Tablet 320 320 - 320 -
15 Alprazolam Tab 0,25 mg Tablet
16 Ambroxol tab 30 mg Tablet - 1,800 1,800 1,330 470 266
17 Ambroxol Syrup Btl/60 ml 50 60 110 65 45 13
18 Aminophyllin Injeksi 24 mg/ml Ampul
19 Aminophyllin tab 200 mg Tablet
20 Amitriptilyn tab 25 mg Tablet -
21 Amlodipine 10 mg Tablet 400 400 340 60 68
22 Amoxycillin syrup kering 125 mg/ 5 ml Btl/60 ml 37 120 157 63 94 13
23 Amoxycillin capl 250 mg Capsul
24 Amoxycillin capl 500 mg Kaplet 180 3,800 3,980 3,280 700 656
25 Antacida DOEN tab. Kunyah Komb : Tablet 1,380 1,380 630 750 126
26 Antacida DOEN suspensi Btl/60 ml 104 104 24 80 5
27 Antalgin tablet 500 mg Tablet
28 Antalgin Injeksi 250 mg/ml- 2 ml Ampul
29 Antifungi DOEN Kombinasi Tube 38 38 - 38 -
30 Antibakteri DOEN Kombinasi (Bacitracin) Tube 10 10 10 - 2
31 Antimalaria DOEN Kombinasi Tablet 100 100 - 100 -
32 Antimigren : Ergotamin Tartrat + Kofein Tablet 15 15 - 15 -
33 Antihaemorrid Supp Supp - 30 30 10 20 2
34 Antiseptik Hand Rub 500 m Botol 2 2 4 4 - 1
35 Arhtemeter Injeksi 80 mg/ml Ampul
36 Asam Mefenamat tab 500 mg Tablet 1,100 1,500 2,600 2,300 300 460
37 Asam Askorbat tab 50 mg Tablet - 1,000 1,000 1,000 - 200
38 Asam Askorbat tab 250 mg Tablet 1800 1,800 1,600 200 320
39 Asam Folat 1 mg Tablet
40 Asering Infus Btl/500 ml
41 Atropin sulfat Injeksi 0,25 mg/ml Ampul 20 20 - 20 -
42 Attapulgit Tablet 300 300 10 290 2
43 Aqua Pro Injeksi 20 ml Btl/20 ml 6 6 3 3 1
44 Aquagel Sterile Jely 82 gr Tube 5 5 2 3 0
45 Bedak Salisil Pot - 40 40 5 35 1
46 Betametason cream Tube 45 50 95 21 74 4
47 Bisturi buah 41 41 6 35 1
48 Blood Lancet Pcs 300 300 176 124 35
49 Catgut No. 2/0 Pcs
51 Cairan 1/2 DAD Btl/500 ml
52 Carbamazepin tab 200 mg Tablet
53 Captopril tab 25 mg Tablet 180 180 180 - 36
54 Cefadroxil 500 mg Tablet 930 930 330 600 66
55 Cefadroxil Sirup Botol
56 Cetirizine Syr Botol 9 20 29 - 29 -
57 CHKM Btl/15 ml
58 Cimetidine tab 200 mg Tablet
59 Ciprofloxacin tab 500 mg Tablet 520 400 920 270 650 54
60 Dexamethasone Injeksi Ampul 149 149 - 149 -
61 Dexamethasone tab 0,5 mg Tablet 1,100 3,000 4,100 3,880 220 776
62 Dextran 70% Infus Btl/500 ml
63 Dextromethorphan syrup Btl/ 60 ml
64 Dextromethorphan tab 15 mg Tablet
65 Diazepam 2 mg Tablet 55 55 10 45 2
66 Diazepam 5 mg Tablet 90 90 - 90 -
67 Diazepam Injeksi Ampul 10 10 - 10 -
68 Difenhidramin Injeksi 10 mg/ml Ampul 20 20 - 20 -
69 Digoxin tablet 0,25 mg Tablet
70 Diltiazem HCl tablet 30 mg Tablet
71 Domperidon tablet 10 mg Tablet 500 500 30 470 6
72 Etanol 70% 100 ml Botol
73 Etanol 70% 1000 ml Botol 5 3 8 6 2 1
74 Etakridin (Rivanol) 100 ml Botol 2 2 1 1 0
75 Etakridin 0,1% 300 ml Btl/300 6 6 1 5 0
76 Efinefrin HCl Bitartrat Inj Ampul 100 100 - 100 -
77 Erysanbe syrup Btl/ 60 ml
78 Erysanbe Capsul 500 mg Capsul
79 Etylchlorida semprot Btl/100 - 1 1 1 - 0
80 Fenobarbital tab 30 mg Tablet
81 Fenobarbital Inkeksi 50 mg/ml Ampul
82 Fitomenadion (Vit. K1) tab 10 mg Tablet 310 300 610 80 530 16
83 Fitomenadion (Vit. K1) Injeksi Ampul 22 22 - 22 -
84 Fletcher Set
85 Furosemid tablet 40 mg Tablet 310 310 10 300 2
86 Garam Oralit 200 mg Sachet 4,153 4,153 342 3,811 68
87 Gentamicin salep kulit Tube 30 20 50 13 37 3
88 Gentamicin salep mata Tube 22 22 - 22 -
89 Gentamicin sulfat TM 0,3% Btl/ 5 ml
90 Gentian Violet 1% Btl/ 5 ml 7 13 20 - 20 -
91 Glass Ionometer Cemen Set
92 Glibenklamid tab 5 mg Tablet 630 400 1,030 222 808 44
93 Gliceryl Guaicolat tab 100 mg Tablet 1,640 2,000 3,640 2,640 1,000 528
94 Glimepiride Tab 1 mg Tablet 300 300 - 300 -
95 Glimepiride tab 2 mg Tablet 350 350 - 350 -
96 Glukosa 5% Btl/500 ml 16 16 - 16 -
97 Glukosa 10% Btl/500 ml
98 Griseofulvin tab 125 mg Tablet 150 150 105 45 21
99 Haloperidol tab 0,5 mg Tablet 53 53 - 53 -
100 Haloperidol tab 1,5 mg Tablet
101 Hidroklorothiazid (HCT) tab Tablet 590 590 350 240 70
102 Hidrokortison Cream 2,5% Tube 88 88 22 66 4
103 Ibuprofen Syrup Btl/60 ml 280 280 5 275 1
104 Ibuprofen tab 200 mg Tablet 1,600 600 2,200 200 2,000 40
105 Ibuprofen tab 400 mg Tablet 400 400 800 800 - 160
106 Infusion set anak Pcs 5 10 15 - 15 -
107 Infusion set Dewasa Pcs
108 Interhistin tablet Tablet
109 Isosorbid Dinitrat Subli. Tab Tablet 90 90 - 90 -
110 Jarum Jahit bedah No. 9 Pcs - 12 12 8 4 2
111 Jarum Jahit bedah No. 10 Pcs
116 Kaen 3B larutan infus Btl/500 ml
117 Kalium Permanganas Serbuk Pot/ 5 g 35 10 45 44 1 9
118 Kalsium Laktat tab 500 mg Tablet 1,200 600 1,800 350 - 70
119 Kalsium Glukonat Inj i.v 10 % (100mg/ml) Ampul
120 Kapas Pembalut Hidrofil DRC 250 Gram Roll 7 7 1 6 0
121 Kasa Hidrofil DRC 36 m x 80 cm Roll
122 Kasa Pembalut Hidrofil DRC 4m x 15 cm Roll 40 100 140 70 70 14
123 Kasa 5 Cm Roll
124 Karbongliserin Tetes Telinga 10* Botol 12 12 4 8 1
125 Ketokonazol Salep Tube 22 22 22 - 4
126 Ketokenazol Tab Tablet 500 500 100 400 20
127 Kloramfenikol Suspensi Botol/60ml 12 12 - 12 -
128 Kloramfenikol caps 250 mg Tablet 300 300 50 250 10
129 Kloramfenikol Salep Mata 1% Tube 43 43 - 43 -
130 Kloramfenikol Tetes Telinga Botol5 ml 18 12 30 3 27 1
131 Klorfeniramin Maleat (CTM) Tablet 1,100 3,000 4,100 3,200 900 640
132 Klorpromazin tab 25 mg Tablet 60 60 10 50 2
134 Klorpromazin Injeksi Ampul
Kombinasi Tablet salut : Besi II sulfat +
135 Tablet - 2,000 2,000 1,220 780 244
Asam Folat
136 Kotrimoksazol Suspensi Btl/ 60 ml
137 Kotrimoksazol tab 120 mg Tablet 350 350 44 306 9
138 Kotrimoksazol tab 480 mg Tablet 450 400 850 290 560 58
139 Lidocain HCl Injeksi 2% Ampul 121 121 52 69 10
140 Lisol 1 Liter Botol 1 1 - 1 -
141 Loratadine tablet 10 mg Tablet 400 400 - 400 -
142 Loperamide Tablet 130 300 430 130 300 26
143 Magnesium Sulfat injeksi 40 % Ampul
144 Masker Pcs - 500 500 500 - 100
145 Meloksikam tab 7,5 mg Tablet 300 300 100 200 20
146 Meloksikam tab 15 mg Tablet - 700 700 450 250 90
147 Metformin HCl tablet 500 mg Tablet 200 200 - 200 -
148 Metoklorpropamide tab 10 mg Tablet 100 100 - 100 -
149 Metoklorpropamide tab 5 mg Tablet
150 Metoklorpropamide Injeksi (Metolon) Ampul
151 Metronidazol tab 250 mg Tablet 190 300 490 210 280 42
153 Metylergometrin Maleat tab. Tablet 740 740 30 710 6
154 Metylergometrin Maleat Inj Ampul
155 Miconazole Cream Tube 12 12 12 - 2
156 Natrium Diklofenak tablet 25 mg Tablet 90 800 890 440 450 88
157 Natrium Diklofenak tablet 50 mg Tablet -
158 Natrium Klorida Inf 0,9% Btl/ 500 ml 11 20 31 14 17 3
159 Nifedipin Tablet Tablet
160 Nistatin Tab. Vag 100.000 UI Tablet 140 140 - 140 -
161 Nistatin Tab. Vag 500.000 UI Tablet
162 Obat Batuk Hitam (OBH) Btl/ 100 ml 8 24 32 15 17 3
163 Omeprazole Tablet 390 390 90 300 18
164 Oxytocin Inj 10 mg/ml Ampul 80 80 5 75 1
165 Oxytetracyclin HCl Inj Vial 4 4 - 4 -
166 Oxytetracyclin SK. 3% Tube 41 25 66 33 33 7
167 Oxytetracyclin Salep Mata 1% Tube 72 72 5 67 1
168 Papaverin HCl tab 40 mg Tablet 500 1,000 1,500 320 1,180 64
169 Paracetamol tab 500 mg Tablet 1,400 1,600 3,000 2,700 300 540
170 Paracetamol syrup Btl/ 60 ml - 100 100 84 16 17
171 Piracetam Injeksi 3 g/15 ml Ampul
172 Plester/Hipapix (5 cm x 5 m) Roll - 11 11 1 10 0
173 Prednison tab 5 mg Tablet 420 1,000 1,420 1,300 120 260
174 Primakina tablet 15 mg Tablet
175 Propilthiourasil (PTU) tablet Tablet 100 200 300 - 300 -
176 Propranolol tablet 40 mg Tablet 80 80 20 60 4
177 Pyrantel Suspensi 125 mg/5 ml Botol 18 70 88 - 88 -
178 Pyrantel tablet 125 mg Tablet
179 Pyridoxin HCl tablet 10 mg Tablet 600 1,600 2,200 700 1,500 140
180 Pyroxicam tablet 10 mg Tablet
182 Ranitidine Injeksi 25 mg/ml Ampul 15 15 - 15 -
183 Ranitidine tablet 150 mg Tablet 2,650 2,650 2,050 600 410
184 Retinol (Vit. A) 100.000 IU Kapluk Kapluk 45 45 - 45 -
186 Ringer Laktat Infus Btl/ 500 ml - 20 20 7 13 1
Salep 2-4 Kombinasi : As. Salisilat +
187 Pot/ 30 g 12.0 24 36 12 24 2
Belerang
188 Salbutamol tab 2 mg Tablet 218 300 518 228 290 46
189 Salbutamol tab 4 mg Tablet 530 530 - 530 -
190 Salbutamol Syr Botol
191 Sarung Tangan No. 6,5 Steril Pasang
192 Sarung Tangan No. 7 Steril Pasang
194 Scabicid Cream 10 gram Tube
195 Scopamin Tablet 360 360 60 300 12
196 Sianocobalamin (Vit. B12) Injeksi Ampul 65 65 7 58 1
197 Sianocobalamin (Vit. B12) Tab Tablet 500 500 - 500 -
198 Simvastatin tablet 10 mg Tablet
199 Simvastatin tablet 20 mg Tablet 500 500 260 240 52
200 SILK BLACK 3/0 HR 26 MM Peaces 12 12 5 7 1
201 Strip Kolesterol Nesco Strip 60 60 60 - 12
202 Strip Asam Urat Nesco Strip 50 25 75 75 - 15
203 Strip Glukosa Nesco Strip 50 25 75 75 - 15
204 Tetracycline HCl 250 mg Capsul 420 420 290 130 58
205 Tetracycline HCl 500 mg Capsul 110 110 - 110 -
206 Tetrakain Tetes Mata Botol 24 24 3 21 1
207 Thiamin HCl (B1) Inj Ampul
208 Thiamin HCl (B1) Tab 50 mg Tablet 800 1,000 1,800 450 1,350 90
209 Vitamin B Complex tab Tablet 640 3,600 4,240 3,290 950 658
210 Yodium Povidon 10% 300 ml Botol 7 7 3 4 1
212 Zink Tablet Tablet 400 500 900 230 670 46
213 Zink Syr 10 mg Botol 10 10 4 6 1
214 Zink Syr 20 mg Botol 20 20 - 20 -
215 Kantong Mayat Pcs 2 2 - 2 -
216 Tes Kit Malaria Pcs
217 O A T Kategori Anak Paket
218 O A T Kategori 1 Paket 2 4 6 4 2 #REF!
219 O A T Kategori 2 Paket
220 Obat PB Dewasa Strip
221 Obat MB Dewasa Strip
222 Obat PB Anak Strip
223 Obat MB Anak Strip
224 Sangobion Tablet 470 1,750 2,220 70 2,150 14
225 Sarung Tangan M Box 2 3 5 3 2 1
226 Lidokain Spray Botol 2 2 2 - 0
227 Lidokain Gel Tube 4 4 - 4 -
228 Elkana Syr Botol 40 240 280 191 0 38.20
229 Bisakodil 5 mg Tablet 150 150 - 150 -
230 Cetirizine Tab Tablet
231 Kateter buah
232 Dulcolax Suppo 5 mg Suppo 12 12 - 12 -
234 Amlodipine 5 mg Tablet
235 Bonding Tambalan Komposit GC Botol
236 Calcium Hidtoksida Technew Tube
237 Caviton Tube
238 Eugenol Cairan Botol
239 Elite Powder Cemen GC Botol
240 Elite Cemen Liquid GC Botol
241 Sponge Gigi / Hemospon Pcs
242 Tambalan Amalgam Powder SDI Tube
243 Tambalan Komposit GC Hydcal Tube
244 Tambalan Komposit 3M P60 Botol
245 Bisakodil Suppo 10 mg Suppo
246 Tabung Vacum Buah
247 Reagen ZN Paket
248 Mata Klinipet Dos
249 Slide Prostad Pcs
250 Diazepam enema 5 mg/2,5 ml Tube
252 Nistatin Suspensi 100.000 UI/ml Botol
253 Plano Test Pcs
254 Tambalan Komposit Flowable Tube
255 Calsium Hidroside Lightcurring Tube
256 Microbrush Botol
257 Bur Composite Set
258 Bur Intan Set
259 Cotton Roll Pak
260 Celemek Gigi Pcs
261 Celluloid Strip Pak
262 Matrix Band Kompensional Set
263 Hemafort Tablet
264 Mediamer Tablet
265 Metyl Prednisolon 4 mg Tablet
266 ETSA (gigi) Tube
267 Masker N 25 Pcs
JUMLAH KUNJUNGAN RESEP

NO FASILITAS KESEHATAN KET
BPJS NON BPJS
1 Puskesmas
2 Puskesmas Pembantu
3 Poskesdes
JUMLAH
Mengetahui : Menyetujui : Yang Melapor,

Kepala Dinas Kesehatan Kepala Gudang Farmasi Kepala Puskesmas Rangas
Kabupaten Mamuju Dinas Kesehatan Kab. Mamuju
dr. Hj. HAJRAH AS'AD, M.Kes NENENG SALMIAH, S.Farm Nachsan, SKM
NIP. 19640514 200003 2 006 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN : JANUARI
TAHUN : 2018
PEMBERIAN TOTAL
PERMINTAAN KET
PKD DKP/PROGRAM LAIN-LAIN PEMBERIAN
10=(7+9)-8 11 12 13 14 15
(43)
(46)
(19)
(15)
(42)
(245)
-
-
(20)
(191)
100
(108)
400
(320)
-
1,500
50
600
60
3,780
400
(51)
1,000
(38)
50
(100)
100
20%
10
10
2,660
1,200
1,720
500
(20)
(278)
1
5
(29)
(49)
(28)
300
1,200
(204)
(29)
300
(326)
(149)
4,436
(33)
(90)
(10)
(20)
(434)
5
5
(4)
(100)
8
1,000
(434)
(22)
(288)
(3,401)
(21)
(22)
(20)
(542)
3,000
(300)
(350)
(16)
800
(53) 20%
180
(40)
(269)
(1,760)
1,500
(15)
24
300
(90)
12
52
1,000 ED Feb 2018
(5)
14
12
50
(280)
(12)
(190)
(43)
(23)
2,940
(38)
(98)
1,000
20%
100
(253)
(212)
(7)
(1)
(400)
(144)
-
600
(80)
290
(200)
(100)
-
-
200
400
(674)
-
60
600
500
20
200
(140)
-
1
(192)
(69)
(4)
25 20%
(61)
(796)
2,940
85
-
(9)
1,440
-
(300)
100
(88)
-
(660)
500
500
(15)
1,860
400
1,500
20
24
(16)
(530)
50
50
-
12
(228)
100
(500)
500
500
24
120 20%
150
150
218
(110)
(17)
30
(810)
3,200
(0)
10
(394)
(1)
(20)
(2)
-
1
4
-
-
-
-
-
(2,066)
5
8
(4)
100 ED FEB 89
(150)
100
5
(12)
(20)
Mamuju,
r, Yang Menerima,
Rangas Pengelola Obat Puskesmas

Mamuju,
r, Yang Menerima,
MULYANI BADANI S.Si., Apt

NIP. 19790102 200604 2 013
OBAT PROGRAM KIA
BULAN : JANUARI
TAHUN : 2018
NO NAMA OBAT SATUAN STOL AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN STOK AKHIR KET
1 Magnesium Sulfat Injeksi Ampul 471 0 471 0 471
2 Metyl Ergometrin Tablet 0 0 0 0 0
3 Metyl Ergometrin Injeksi Ampul 268 0 268 2 266
4 Kalsium GluI.onat Injeksi I.V 10 % Ampul 471 0 471 0 471
5 Oxytosin Injeksi Ampul 0 0 0 0 0
6 Fitomenadion Inj Ampul 320 0 320 20 300
7 Gentamicin Injeksi Ampul 470 0 470 0 470
8 Mediamer Tablet 0 0 0 0 0
9 Retinol 100.000 IU Kapsul 39 0 39 14 25
11 Tablet tambah darah Tablet 0 0 0 0 0
Mengetahui, Menyetujui, Yang Melapor, Mamuju,

Kepala Dinas Kesehatan Kepala Gudang Farmasi Kepala Puskesmas Rangas Yang Menerima
Kabupaten Mamuju Dinas Kesehatan Kab. Mamuju Pengelola Obat Puskesmas
dr. Hj. Hajrah As'ad, M. Kes Neneng Salmiah S. Farm Nachsan, SKM Mulyani Badani S.Si., Apt
Nip. 19640514 200003 2 006 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
OBAT PROGRAM DIARE
BULAN : JANUARI
TAHUN : 2018
1 Garam oralit Sachet 0 0 0 0 0
2 Zink Tablet 1700 0 1700 0 1700

Nip. 19640514 200003 2 006 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
1 Abbocath No. 18 Pcs 45 45 - 45 -
2 Abbocath No. 20 Pcs 48 48 20 28 4
3 Abbocath No. 22 Pcs 19 19 - 19 -
4 Abbocath No. 24 Pcs 19 19 - 19 -
5 Acyclovir Cream 3% Tube 42 42 9 33 2
7 Acyclovir tab 400 mg Tablet -
8 Albendazol Suspensi 25 mg / 5 ml Btl/10 ml -
9 Albendazol tab 400 mg Tablet 20 20 2 18 0
11 Alat Suntik Sekali Pakai 3 ml Pcs 82 82 82 - 16
12 Alat Suntik Sekali Pakai 5 ml Pcs 120 120 - 120 -
14 Allopurinol tab 300 mg Tablet 320 320 120 200 24
15 Alprazolam Tab 0,25 mg Tablet -
16 Ambroxol tab 30 mg Tablet 470 470 470 - 94
17 Ambroxol Syrup Btl/60 ml 45 45 35 10 7
18 Aminophyllin Injeksi 24 mg/ml Ampul -
19 Aminophyllin tab 200 mg Tablet -
20 Amitriptilyn tab 25 mg Tablet - -
21 Amlodipine 10 mg Tablet 60 60 60 - 12
22 Amoxycillin syrup kering 125 mg/ 5 ml Btl/60 ml 94 94 67 27 13
23 Amoxycillin capl 250 mg Capsul -
24 Amoxycillin capl 500 mg Kaplet 700 3,800 4,500 3,040 1,460 608
25 Antacida DOEN tab. Kunyah Komb : Tablet 750 400 1,150 810 340 162
27 Antalgin tablet 500 mg Tablet -
28 Antalgin Injeksi 250 mg/ml- 2 ml Ampul -
29 Antifungi DOEN Kombinasi Tube 38 38 9 29 2
30 Antibakteri DOEN Kombinasi (Bacitracin) Tube - -
33 Antihaemorrid Supp Supp 20 10 30 - 30 -
34 Antiseptik Hand Rub 500 m Botol - 5 5 5 - 1
35 Arhtemeter Injeksi 80 mg/ml Ampul -
36 Asam Mefenamat tab 500 mg Tablet 300 2,700 3,000 3,000 - 600
38 Asam Askorbat tab 250 mg Tablet 200 1700 1,900 1,570 330 314
39 Asam Folat 1 mg Tablet -
40 Asering Infus Btl/500 ml -
43 Aqua Pro Injeksi 20 ml Btl/20 ml 3 3 - 3 -
44 Aquagel Sterile Jely 82 gr Tube 3 3 3 - 1
45 Bedak Salisil Pot 35 35 3 32 1
46 Betametason cream Tube 74 74 33 41 7
47 Bisturi buah 35 35 17 18 3
48 Blood Lancet Pcs 124 124 124 - 25
49 Catgut No. 2/0 Pcs -
51 Cairan 1/2 DAD Btl/500 ml -
52 Carbamazepin tab 200 mg Tablet -
53 Captopril tab 25 mg Tablet - 500 500 500 - 100
54 Cefadroxil 500 mg Tablet 600 600 - 600 -
55 Cefadroxil Sirup Botol -
56 Cetirizine Syr Botol 29 29 - 29 -
57 CHKM Btl/15 ml -
58 Cimetidine tab 200 mg Tablet -
59 Ciprofloxacin tab 500 mg Tablet 650 650 - 650 -
61 Dexamethasone tab 0,5 mg Tablet 220 4,500 4,720 3,420 1,300 684
62 Dextran 70% Infus Btl/500 ml -
63 Dextromethorphan syrup Btl/ 60 ml -
64 Dextromethorphan tab 15 mg Tablet -
69 Digoxin tablet 0,25 mg Tablet -
70 Diltiazem HCl tablet 30 mg Tablet -
71 Domperidon tablet 10 mg Tablet 470 470 - 470 -
72 Etanol 70% 100 ml Botol -
73 Etanol 70% 1000 ml Botol 2 5 7 6 1 1
74 Etakridin (Rivanol) 100 ml Botol 1 5 6 1 5 0
75 Etakridin 0,1% 300 ml Btl/300 5 5 - 5 -
77 Erysanbe syrup Btl/ 60 ml -
78 Erysanbe Capsul 500 mg Capsul -
79 Etylchlorida semprot Btl/100 - -
80 Fenobarbital tab 30 mg Tablet -
81 Fenobarbital Inkeksi 50 mg/ml Ampul -
82 Fitomenadion (Vit. K1) tab 10 mg Tablet 530 530 310 220 62
83 Fitomenadion (Vit. K1) Injeksi Ampul 22 30 52 3 27 1
84 Fletcher Set -
87 Gentamicin salep kulit Tube 37 37 23 14 5
89 Gentamicin sulfat TM 0,3% Btl/ 5 ml -
90 Gentian Violet 1% Btl/ 5 ml 20 20 2 18 0
91 Glass Ionometer Cemen Set -
92 Glibenklamid tab 5 mg Tablet 808 808 218 590 44
93 Gliceryl Guaicolat tab 100 mg Tablet 1,000 3,000 4,000 380 3,620 76
96 Glukosa 5% Btl/500 ml 16 16 5 11 1
97 Glukosa 10% Btl/500 ml -
98 Griseofulvin tab 125 mg Tablet 45 45 45 - 9
100 Haloperidol tab 1,5 mg Tablet -
101 Hidroklorothiazid (HCT) tab Tablet 240 200 440 240 200 48
104 Ibuprofen tab 200 mg Tablet 2,000 2,000 970 1,030 194
105 Ibuprofen tab 400 mg Tablet - 1,500 1,500 1,100 400 220
106 Infusion set anak Pcs 15 15 1 14 0
107 Infusion set Dewasa Pcs -
108 Interhistin tablet Tablet -
110 Jarum Jahit bedah No. 9 Pcs 4 4 4 - 1
111 Jarum Jahit bedah No. 10 Pcs -
116 Kaen 3B larutan infus Btl/500 ml -
117 Kalium Permanganas Serbuk Pot/ 5 g 1 10 11 - 11 -
118 Kalsium Laktat tab 500 mg Tablet - 3,000 3,000 1,840 1,160 368
119 Kalsium Glukonat Inj i.v 10 % (100mg/ml) Ampul -
120 Kapas Pembalut Hidrofil DRC 250 Gram Roll 6 6 6 - 1
121 Kasa Hidrofil DRC 36 m x 80 cm Roll -
122 Kasa Pembalut Hidrofil DRC 4m x 15 cm Roll 70 70 70 - 14
123 Kasa 5 Cm Roll -
125 Ketokonazol Salep Tube - 24 24 20 4 4
126 Ketokenazol Tab Tablet 400 400 - 400 -
129 Kloramfenikol Salep Mata 1% Tube 43 43 13 30 3
130 Kloramfenikol Tetes Telinga Botol5 ml 27 27 21 6 4
131 Klorfeniramin Maleat (CTM) Tablet 900 500 1,400 1,400 - 280
132 Klorpromazin tab 25 mg Tablet 50 50 - 50 -
134 Klorpromazin Injeksi Ampul -
135 Tablet 780 1,000 1,780 1,780 - 356
Asam Folat
136 Kotrimoksazol Suspensi Btl/ 60 ml - -
139 Lidocain HCl Injeksi 2% Ampul 69 90 159 57 102 11
141 Loratadine tablet 10 mg Tablet 400 400 - 400 -
142 Loperamide Tablet 300 300 300 - 60
143 Magnesium Sulfat injeksi 40 % Ampul -
144 Masker Pcs - 200 200 200 - 40
145 Meloksikam tab 7,5 mg Tablet 200 200 - 200 -
146 Meloksikam tab 15 mg Tablet 250 300 550 200 350 40
147 Metformin HCl tablet 500 mg Tablet 200 200 - 200 -
149 Metoklorpropamide tab 5 mg Tablet -
150 Metoklorpropamide Injeksi (Metolon) Ampul -
154 Metylergometrin Maleat Inj Ampul -
155 Miconazole Cream Tube - -
157 Natrium Diklofenak tablet 50 mg Tablet - -
159 Nifedipin Tablet Tablet -
160 Nistatin Tab. Vag 100.000 UI Tablet 140 140 3 137 1
161 Nistatin Tab. Vag 500.000 UI Tablet -
168 Papaverin HCl tab 40 mg Tablet 1,180 1,180 120 1,060 24
169 Paracetamol tab 500 mg Tablet 300 3,000 3,300 2,430 870 486
170 Paracetamol syrup Btl/ 60 ml 16 16 16 - 3
171 Piracetam Injeksi 3 g/15 ml Ampul -
172 Plester/Hipapix (5 cm x 5 m) Roll 10 10 10 - 2
174 Primakina tablet 15 mg Tablet -
175 Propilthiourasil (PTU) tablet Tablet 300 300 200 100 40
176 Propranolol tablet 40 mg Tablet 60 100 160 60 100 12
177 Pyrantel Suspensi 125 mg/5 ml Botol 88 88 49 39 10
178 Pyrantel tablet 125 mg Tablet -
179 Pyridoxin HCl tablet 10 mg Tablet 1,500 1,500 1,100 400 220
180 Pyroxicam tablet 10 mg Tablet -
183 Ranitidine tablet 150 mg Tablet 600 2,500 3,100 1,100 - 220
184 Retinol (Vit. A) 100.000 IU Kapluk Kapluk 45 400 445 400 45 80
185 Retinol (Vit. A) 200.000 IU Kapluk Kapluk 90 1,500 1,590 1,450 140 290
186 Ringer Laktat Infus Btl/ 500 ml 13.0 20 33 7 26 1
187 Pot/ 30 g 24.0 24 48 16 32 3
Belerang
188 Salbutamol tab 2 mg Tablet 290 290 75 215 15
190 Salbutamol Sirup Botol
191 Sarung Tangan No. 6,5 Steril Pasang 50 50 33 17 7
192 Sarung Tangan No. 7 Steril Pasang 50 50 1 49 0
193 Sarung Tangan No. 7,5 Steril Pasang -
194 Scabicid Cream 10 gram Tube -
195 Scopamin Tablet 300 300 - 300 -
196 Sianocobalamin (Vit. B12) Injeksi Ampul 58 200 258 - 258 -
198 Simvastatin tablet 10 mg Tablet -
199 Simvastatin tablet 20 mg Tablet 240 500 740 430 310 86
202 Strip Asam Urat Nesco Strip - 50 50 50 - 10
203 Strip Glukosa Nesco Strip - 50 50 50 - 10
204 Tetracycline HCl 250 mg Capsul 130 1,000 1,130 340 790 68
205 Tetracycline HCl 500 mg Capsul 110 110 110 - 22
207 Thiamin HCl (B1) Inj Ampul -
208 Thiamin HCl (B1) Tab 50 mg Tablet 1,350 1,350 840 510 168
210 Yodium Povidon 10% 300 ml Botol 4 4 4 - 1
211 Yodium Povidon 10% 30 ml Botol 1 24 25 7 18 1
212 Zink Tablet Tablet 670 670 - 670 -
213 Zink Syr 10 mg Botol 6 6 6 - 1
214 Zink Syr 20 mg Botol 20 20 20 - 4
216 Tes Kit Malaria Pcs -
217 O A T Kategori Anak Paket 1 1 1 -
218 O A T Kategori 1 Paket 2 4 6 6 -
219 O A T Kategori 2 Paket -
220 Obat PB Dewasa Strip -
221 Obat MB Dewasa Strip -
222 Obat PB Anak Strip -
223 Obat MB Anak Strip -
224 Sangobion Tablet 2,150 2,150 370 1,780 74
226 Lidokain Spray Botol - 5 5 1 4 0
228 Elkana Syr Botol 0 100 100 100 0 20.00
230 Cetirizine Tab Tablet -
231 Kateter buah -
233 Dulcolax Suppo 10 mg Suppo 20 20 5 15 1
237 Caviton Tube
247 Reagen ZN Paket
253 Plano Test Pcs
258 Bur Intan Set
259 Cotton Roll Pak
263 Hemafort Tablet
264 Mediamer Tablet
267 Masker N 25 Pcs

BPJS NON BPJS
1 Puskesmas
3 Poskesdes
JUMLAH
Mengetahui : Menyetujui :
Yang Melapor,
Kepala Dinas Kesehatan Kepala Gudang Farmasi
Kepala Puskesmas Rangas
Yang Melapor,
NIP. 19640514 200003 2 006 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN : FEBRUARI
TAHUN : 2018
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
(45)
(4)
(19)
(19)
(22)
(245)
(16)
141
200
(120)
200
(56)
1,000
50
100
500
53
2,188
800
50
500
-
(18)
50
(100)
(15)
20%
(30)
10
-
3,600
2,000
1,554
500
-
(20)
(92)
(3)
7
(28)
(1)
2
149
-
-
-
-
1,000
(600)
-
(29)
1
-
(650)
(149)
2,804
-
-
-
6
(81)
(10)
(20)
- 20%
-
(470)
-
6
(4)
(5)
(100)
-
-
7
1,000
-
152
(23) ED 22
1
(80)
(2,370)
24
(22)
-
(16)
1
(328)
(3,164)
(300)
(350)
20
-
400
(53)
-
88
26
(172)
134
920 20%
(13)
24
200
(90)
12
-
-
-
-
-
-
(11)
1,048
-
7
-
100
-
(6)
20
(400)
(12)
(140)
(14)
24
3,000
(50)
(88)
-
2,136
100
200
500
(34)
(1)
(400) 20%
360
-
300
(200)
(110)
(200)
(100)
-
-
4
(354)
(644)
-
50
1,045
1,000
(4)
200
(133)
-
2
96
(71)
(4)
50
(1)
(916)
2,046
100
-
12
1,774
-
140
(28)
40
-
920 20%
500
700
(15)
2,000 ED 2000
150
250
(18)
(13)
(125)
(134)
23
(48)
-
10
(300)
(258)
(500)
500
306
(0)
50
75
75
(382)
132
(19)
-
498
3,640
5
(10)
(670)
15
30
(2)
-
1
6
-
-
-
-
-
(1,336)
5
(3)
(4) 20%
120
(150)
100
6
(12)
(9)
720
Mamuju,
r, Yang Menerima,

Mamuju,
r, Yang Menerima,

NIP. 19790102 200604 2 013
OBAT PROGRAM KIA
BULAN : FEBRUARI
TAHUN : 2018
1 Magnesium Sulfat Injeksi Ampul 471 0 471 0 0 ED 471
6 Fitomenadion Inj Ampul 300 0 300 0 0 ED 300

Nip. 19640514 200003 2 006 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
OBAT PROGRAM DIARE
BULAN : FEBRUARI
TAHUN : 2018
2 Zink Tablet 1700 0 1700 260 1440

Nip. 19640514 200003 2 006 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
1 Abbocath No. 18 Pcs 45 45 - 45 -
2 Abbocath No. 20 Pcs 28 28 23 5 5
3 Abbocath No. 22 Pcs 19 19 2 17 0
4 Abbocath No. 24 Pcs 19 19 3 16 1
6 Acyclovir tab 200 mg Tablet 245 245 30 215 6
7 Acyclovir tab 400 mg Tablet - -
8 Albendazol Suspensi 25 mg / 5 ml Btl/10 ml - -
10 Alat Suntik Sekali Pakai 1 ml Pcs 44 200 244 93 151 19
11 Alat Suntik Sekali Pakai 3 ml Pcs - 200 200 176 24 35
13 Allopurinol tab 100 mg Tablet 360 200 560 560 - 112
15 Alprazolam Tab 0,25 mg Tablet - -
16 Ambroxol tab 30 mg Tablet - 1,000 1,000 1,000 - 200
18 Aminophyllin Injeksi 24 mg/ml Ampul - -
19 Aminophyllin tab 200 mg Tablet - -
20 Amitriptilyn tab 25 mg Tablet - - -
21 Amlodipine 10 mg Tablet - - -
23 Amoxycillin capl 250 mg Capsul - -
24 Amoxycillin capl 500 mg Kaplet 1,460 2,200 3,660 2,620 1,040 524
25 Antacida DOEN tab. Kunyah Komb : Tablet 340 340 340 - 68
26 Antacida DOEN suspensi Btl/60 ml 27 27 27 - 5
27 Antalgin tablet 500 mg Tablet - -
28 Antalgin Injeksi 250 mg/ml- 2 ml Ampul - -
30 Antibakteri DOEN Kombinasi (Bacitracin) Tube - - -
33 Antihaemorrid Supp Supp 30 30 16 14 3
35 Arhtemeter Injeksi 80 mg/ml Ampul - -
36 Asam Mefenamat tab 500 mg Tablet - - -
38 Asam Askorbat tab 250 mg Tablet 330 1500 1,830 300 1,530 60
39 Asam Folat 1 mg Tablet - -
40 Asering Infus Btl/500 ml - -
44 Aquagel Sterile Jely 82 gr Tube - 5 5 1 4 0
45 Bedak Salisil Pot 32 32 32 - 6
47 Bisturi buah 18 100 118 21 97 4
48 Blood Lancet Pcs - 200 200 200 - 40
53 Captopril tab 25 mg Tablet - 1,000 1,000 1,000 - 200
56 Cetirizine Syr Botol 29 10 39 - 39 -
57 CHKM Btl/15 ml - -
58 Cimetidine tab 200 mg Tablet - -
59 Ciprofloxacin tab 500 mg Tablet 650 650 120 530 24
60 Dexamethasone Injeksi Ampul 149 149 19 130 4
62 Dextran 70% Infus Btl/500 ml - -
63 Dextromethorphan syrup Btl/ 60 ml - -
64 Dextromethorphan tab 15 mg Tablet - -
65 Diazepam 2 mg Tablet 22 100 122 10 112 2
69 Digoxin tablet 0,25 mg Tablet - -
70 Diltiazem HCl tablet 30 mg Tablet - -
72 Etanol 70% 100 ml Botol - -
73 Etanol 70% 1000 ml Botol 1 6 7 1 6 0
74 Etakridin (Rivanol) 100 ml Botol 5 5 5 - 1
75 Etakridin 0,1% 300 ml Btl/300 5 5 2 3 0
77 Erysanbe syrup Btl/ 60 ml - -
78 Erysanbe Capsul 500 mg Capsul - -
79 Etylchlorida semprot Btl/100 - - -
80 Fenobarbital tab 30 mg Tablet - -
81 Fenobarbital Inkeksi 50 mg/ml Ampul - -
82 Fitomenadion (Vit. K1) tab 10 mg Tablet 220 200 420 380 40 76
83 Fitomenadion (Vit. K1) Injeksi Ampul 27 27 6 21 1
84 Fletcher Set - -
89 Gentamicin sulfat TM 0,3% Btl/ 5 ml - -
91 Glass Ionometer Cemen Set 1 1 - 1 -
93 Gliceryl Guaicolat tab 100 mg Tablet 3,620 3,620 680 2,940 136
95 Glimepiride tab 2 mg Tablet 350 350 100 250 20
96 Glukosa 5% Btl/500 ml 11 20 31 6 25 1
97 Glukosa 10% Btl/500 ml - -
98 Griseofulvin tab 125 mg Tablet - 700 700 470 230 94
100 Haloperidol tab 1,5 mg Tablet - -
102 Hidrokortison Cream 2,5% Tube 24 26 50 35 15 7
104 Ibuprofen tab 200 mg Tablet 1,030 200 1,230 1,140 90 228
105 Ibuprofen tab 400 mg Tablet 400 900 1,300 1,300 - 260
107 Infusion set Dewasa Pcs - -
108 Interhistin tablet Tablet - -
110 Jarum Jahit bedah No. 9 Pcs - - -
111 Jarum Jahit bedah No. 10 Pcs - -
116 Kaen 3B larutan infus Btl/500 ml - -
117 Kalium Permanganas Serbuk Pot/ 5 g 11 11 4 7 1
118 Kalsium Laktat tab 500 mg Tablet 1,160 2,000 3,160 1,160 2,000 232
119 Kalsium Glukonat Inj i.v 10 % (100mg/ml) Ampul - -
120 Kapas Pembalut Hidrofil DRC 250 Gram Roll - 7 7 3 4 1
121 Kasa Hidrofil DRC 36 m x 80 cm Roll - -
122 Kasa Pembalut Hidrofil DRC 4m x 15 cm Roll - 30 30 30 - 6
123 Kasa 5 Cm Roll - -
125 Ketokonazol Salep Tube 4 25 29 21 8 4
128 Kloramfenikol caps 250 mg Tablet 200 200 - 200 -
131 Klorfeniramin Maleat (CTM) Tablet - 500 500 500 - 100
134 Klorpromazin Injeksi Ampul - -
135 Tablet - 3,000 3,000 1,800 1,200 360
Asam Folat
136 Kotrimoksazol Suspensi Btl/ 60 ml - -
141 Loratadine tablet 10 mg Tablet 400 400 100 300 20
142 Loperamide Tablet - 200 200 20 180 4
143 Magnesium Sulfat injeksi 40 % Ampul - -
144 Masker Pcs - 200 200 200 - 40
145 Meloksikam tab 7,5 mg Tablet 200 200 200 - 40
146 Meloksikam tab 15 mg Tablet 350 350 350 - 70
147 Metformin HCl tablet 500 mg Tablet 200 200 30 170 6
149 Metoklorpropamide tab 5 mg Tablet - -
150 Metoklorpropamide Injeksi (Metolon) Ampul - -
152 Metronidazol tab 500 mg Tablet 570 570 210 360 42
154 Metylergometrin Maleat Inj Ampul - -
155 Miconazole Cream Tube - - -
157 Natrium Diklofenak tablet 50 mg Tablet - - -
158 Natrium Klorida Inf 0,9% Btl/ 500 ml 22 22 10 12 2
159 Nifedipin Tablet Tablet - -
161 Nistatin Tab. Vag 500.000 UI Tablet - -
163 Omeprazole Tablet 120 90 210 210 - 42
168 Papaverin HCl tab 40 mg Tablet 1,060 1,060 90 970 18
170 Paracetamol syrup Btl/ 60 ml - - -
171 Piracetam Injeksi 3 g/15 ml Ampul - -
173 Prednison tab 5 mg Tablet 350 2,000 2,350 870 1,480 174
174 Primakina tablet 15 mg Tablet - -
175 Propilthiourasil (PTU) tablet Tablet 100 200 300 100 200 20
176 Propranolol tablet 40 mg Tablet 100 100 10 90 2
177 Pyrantel Suspensi 125 mg/5 ml Botol 39 100 139 66 73 13
178 Pyrantel tablet 125 mg Tablet - -
179 Pyridoxin HCl tablet 10 mg Tablet 400 1,000 1,400 1,080 320 216
180 Pyroxicam tablet 10 mg Tablet - -
183 Ranitidine tablet 150 mg Tablet - 2,000 2,000 2,000 - 400
186 Ringer Laktat Infus Btl/ 500 ml 26.0 26 18 8 4
187 Pot/ 30 g 32.0 32 32 - 6
Belerang
190 Salbutamol Sirup Botol - -
191 Sarung Tangan No. 6,5 Steril Pasang 17 50 67 67 - 13
192 Sarung Tangan No. 7 Steril Pasang 49 49 49 - 10
193 Sarung Tangan No. 7,5 Steril Pasang - -
194 Scabicid Cream 10 gram Tube - -
195 Scopamin Tablet 300 300 100 200 20
198 Simvastatin tablet 10 mg Tablet - -
200 SILK BLACK 3/0 HR 26 MM Peaces 4 4 4 - 1
205 Tetracycline HCl 500 mg Capsul - - -
207 Thiamin HCl (B1) Inj Ampul - -
208 Thiamin HCl (B1) Tab 50 mg Tablet 510 2,000 2,510 2,190 320 438
210 Yodium Povidon 10% 300 ml Botol - 10 10 2 8 0
213 Zink Syr 10 mg Botol - 15 15 13 2 3
214 Zink Syr 20 mg Botol - 10 10 10 - 2
216 Tes Kit Malaria Pcs - -
217 O A T Kategori Anak Paket 1 1 - 1 -
218 O A T Kategori 1 Paket - 6 6 - 6 -
219 O A T Kategori 2 Paket - -
220 Obat PB Dewasa Strip - -
221 Obat MB Dewasa Strip - -
222 Obat PB Anak Strip - -
223 Obat MB Anak Strip - -
224 Sangobion Tablet 1,780 1,780 1,300 480 260
227 Lidokain Gel Tube 4 4 2 2 0
228 Elkana Syr Botol 0 120 120 103 17 21
230 Cetirizine Tab Tablet - -
231 Kateter buah - -
236 Bonding Tambalan Komposit GC Botol 1 1 0 1 -
237 Calcium Hidtoksida Technew Tube 1 1 0 1 -
238 Caviton Tube 1 1 0 1 -
239 Eugenol Cairan Botol 1 1 0 1 -
240 Elite Powder Cemen GC Botol 1 1 0 1 -
241 Elite Cemen Liquid GC Botol 1 1 0 1 -
242 Sponge Gigi / Hemospon Pcs 50 50 11 39 2
243 Tambalan Amalgam Powder SDI Tube 1 1 0 1 -
244 Tambalan Komposit GC Hydcal Tube 1 1 0 1 -
245 Tambalan Komposit 3M P60 Botol 1 1 0 1 -
247 Reagen ZN Paket
253 Plano Test Pcs
258 Bur Intan Set
259 Cotton Roll Pak
263 Hemafort Tablet
264 Mediamer Tablet
267 Masker N 25 Pcs

BPJS NON BPJS
1 Puskesmas
3 Poskesdes
JUMLAH
Yang Melapor,
NIP. 19640514 200003 2 006 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN : MARET
TAHUN : 2018
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
(45)
23
(15)
(12)
(7)
(179)
-
-
(18)
(39)
187
(120)
672
(24)
-
1,200
60
-
-
-
600
46
-
2,104
1,000
60
500
-
(11)
50
(100)
(15)
12
10
-
3,000
2,400
(1,170)
600
-
(20)
86
1
(3)
38
43
(72)
240
-
-
-
-
1,200
(600)
-
(39)
-
-
(386)
(107)
4,556
-
-
-
(100)
(86)
(10)
(20)
-
-
(404)
-
(5)
6
(1)
(100)
-
-
8
1,000
-
416
(14)
-
(90)
(1,770)
13
(22)
-
(7)
(1)
198
(2,124)
(300)
(130)
(18)
-
334
(53)
-
96
35
76
1,278
1,560
(5)
50
-
(90)
24
-
-
-
-
-
-
(2)
(608)
-
(0)
-
50
-
(3)
17
106
(12)
(200)
10
(12)
3,000
(28)
(100)
-
960
100
200
566
89
(1)
(180)
(156)
-
240
240
420
(134)
(100)
-
-
(228)
(108)
(504)
-
50
432
500
20
200
(137)
-
7
252
(62)
(4)
44
3
(862)
3,278
100
-
8
(436)
-
(80)
(78)
6
-
976
600
800
(15)
2,400
76
248
14
50
(72)
156
12
80
59
-
12
(80)
(247)
(500)
600
446
50
30
60
60
(174)
300
(16)
-
2,308
4,424
(6)
(35)
(670)
24
24
(2)
-
(1)
(6)
-
-
-
-
-
1,080
3
10
0
107
(150)
-
12
(1)
9
500
(1)
(1)
(1)
(1)
(1)
(1)
(26)
(1)
(1)
(1)
Mamuju,
r, Yang Menerima,

NIP. 19790102 200604 2 013
OBAT PROGRAM KIA
BULAN : MARET
TAHUN : 2018

Nip. 19640514 200003 2 006 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
OBAT PROGRAM DIARE
BULAN : MARET
TAHUN : 2018
2 Zink Tablet 1440 0 1440 340 1100

Nip. 19640514 200003 2 006 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
1 Abbocath No. 18 Pcs 45 45 17 28 3
2 Abbocath No. 20 Pcs 5 23 28 - 28 -
3 Abbocath No. 22 Pcs 17 17 8 9 2
4 Abbocath No. 24 Pcs 16 16 - 16 -
5 Acyclovir Cream 3% Tube 21 21 21 - 4
13 Allopurinol tab 100 mg Tablet - 700 700 550 150 110
20 Amitriptilyn tab 25 mg Tablet
23 Amoxycillin capl 250 mg Capsul -
24 Amoxycillin capl 500 mg Kaplet 1,040 2,200 3,240 2,440 800 488
25 Antacida DOEN tab. Kunyah Komb : Tablet - 500 500 500 - 100
26 Antacida DOEN suspensi Btl/60 ml -
29 Antifungi DOEN Kombinasi Tube 21 21 21 - 4
30 Antibakteri DOEN Kombinasi (Bacitracin) Tube -
33 Antihaemorrid Supp Supp 14 20 34 29 5 6
35 Arhtemeter Injeksi 80 mg/ml Ampul -
36 Asam Mefenamat tab 500 mg Tablet - 3,000 3,000 2,310 690 462
37 Asam Askorbat tab 50 mg Tablet - 2,400 2,400 1,500 900 300
38 Asam Askorbat tab 250 mg Tablet 1530 1,530 430 1,100 86
39 Asam Folat 1 mg Tablet -
40 Asering Infus Btl/500 ml -
43 Aqua Pro Injeksi 20 ml Btl/20 ml 1 1 2 - 2 -
45 Bedak Salisil Pot - 10 10 10 - 2
47 Bisturi buah 97 97 33 64 7
48 Blood Lancet Pcs - 300 300 300 - 60
53 Captopril tab 25 mg Tablet - 1,200 1,200 610 590 122
56 Cetirizine Syr Botol 39 39 2 37 0
57 CHKM Btl/15 ml -
58 Cimetidine tab 200 mg Tablet -
62 Dextran 70% Infus Btl/500 ml -
63 Dextromethorphan syrup Btl/ 60 ml -
64 Dextromethorphan tab 15 mg Tablet -
69 Digoxin tablet 0,25 mg Tablet -
70 Diltiazem HCl tablet 30 mg Tablet -
73 Etanol 70% 1000 ml Botol 6 6 2 4 0
74 Etakridin (Rivanol) 100 ml Botol -
75 Etakridin 0,1% 300 ml Btl/300 3 3 6 2 4 0
77 Erysanbe syrup Btl/ 60 ml -
78 Erysanbe Capsul 500 mg Capsul -
79 Etylchlorida semprot Btl/100 -
80 Fenobarbital tab 30 mg Tablet -
81 Fenobarbital Inkeksi 50 mg/ml Ampul -
82 Fitomenadion (Vit. K1) tab 10 mg Tablet 40 500 540 - 540 -
83 Fitomenadion (Vit. K1) Injeksi Ampul 21 21 21 - 4
84 Fletcher Set -
85 Furosemid tablet 40 mg Tablet 150 150 150 - 30
87 Gentamicin salep kulit Tube 15 13 28 28 - 6
89 Gentamicin sulfat TM 0,3% Btl/ 5 ml -
91 Glass Ionometer Cemen Set 1 1 - 1 -
92 Glibenklamid tab 5 mg Tablet 232 200 432 302 130 60
93 Gliceryl Guaicolat tab 100 mg Tablet 2,940 2,940 530 2,410 106
95 Glimepiride tab 2 mg Tablet 250 250 250 - 50
96 Glukosa 5% Btl/500 ml 25 25 - 25 -
97 Glukosa 10% Btl/500 ml -
98 Griseofulvin tab 125 mg Tablet 230 900 1,130 650 480 130
99 Haloperidol tab 0,5 mg Tablet 53 53 43 10 9
100 Haloperidol tab 1,5 mg Tablet -
103 Ibuprofen Syrup Btl/60 ml 90 200 290 46 - 9
104 Ibuprofen tab 200 mg Tablet 90 200 290 - 290 -
105 Ibuprofen tab 400 mg Tablet - 1,600 1,600 1,600 - 320
107 Infusion set Dewasa Pcs 50 50 15 35 3
108 Interhistin tablet Tablet -
116 Kaen 3B larutan infus Btl/500 ml -
117 Kalium Permanganas Serbuk Pot/ 5 g 7 7 7 - 1
118 Kalsium Laktat tab 500 mg Tablet 2,000 2,000 840 1,160 168
119 Kalsium Glukonat Inj i.v 10 % (100mg/ml) Ampul -
121 Kasa Hidrofil DRC 36 m x 80 cm Roll -
123 Kasa 5 Cm Roll -
127 Kloramfenikol Suspensi Botol/60ml 12 12 3 9 1
129 Kloramfenikol Salep Mata 1% Tube 12 10 22 - 22 -
131 Klorfeniramin Maleat (CTM) Tablet -
134 Klorpromazin Injeksi Ampul -
135 Tablet 1,200 1,000 2,200 1,550 650 310
Asam Folat
136 Kotrimoksazol Suspensi Btl/ 60 ml -
139 Lidocain HCl Injeksi 2% Ampul 15 15 15 - 3
140 Lisol 1 Liter Botol 1 1 1 - 0
142 Loperamide Tablet 180 180 - 180 -
143 Magnesium Sulfat injeksi 40 % Ampul -
144 Masker Pcs - 250 250 250 - 50
145 Meloksikam tab 7,5 mg Tablet -
146 Meloksikam tab 15 mg Tablet - 450 450 450 - 90
147 Metformin HCl tablet 500 mg Tablet 170 170 170 - 34
148 Metoklorpropamide tab 10 mg Tablet 100 100 - - -
150 Metoklorpropamide Injeksi (Metolon) Ampul -
152 Metronidazol tab 500 mg Tablet 360 360 360 - 72
154 Metylergometrin Maleat Inj Ampul -
155 Miconazole Cream Tube - 48 48 38 10 8
156 Natrium Diklofenak tablet 25 mg Tablet 100 100 100 - 20
157 Natrium Diklofenak tablet 50 mg Tablet - 500 500 500 - 100
159 Nifedipin Tablet Tablet 200 200 100 100 20
161 Nistatin Tab. Vag 500.000 UI Tablet -
163 Omeprazole Tablet - 300 300 300 - 60
167 Oxytetracyclin Salep Mata 1% Tube 19 3 22 - 22 -
168 Papaverin HCl tab 40 mg Tablet 970 970 30 940 6
169 Paracetamol tab 500 mg Tablet 130 3,300 3,430 2,310 1,120 462
170 Paracetamol syrup Btl/ 60 ml -
171 Piracetam Injeksi 3 g/15 ml Ampul -
172 Plester/Hipapix (5 cm x 5 m) Roll 3 8 11 7 4 1
173 Prednison tab 5 mg Tablet 1,480 1,480 230 1,250 46
174 Primakina tablet 15 mg Tablet -
175 Propilthiourasil (PTU) tablet Tablet 200 200 - 200 -
176 Propranolol tablet 40 mg Tablet 90 90 - 90 -
177 Pyrantel Suspensi 125 mg/5 ml Botol 73 100 173 8 165 2
178 Pyrantel tablet 125 mg Tablet -
182 Ranitidine Injeksi 25 mg/ml Ampul 15 15 2 13 0
183 Ranitidine tablet 150 mg Tablet - 2,500 2,500 1,550 - 310
184 Retinol (Vit. A) 100.000 IU Kapluk Kapluk 72 72 10 62 2
187 Pot/ 30 g - 48 48 39 9 8
Belerang
190 Salbutamol Sirup Botol 12 12 - 12 -
191 Sarung Tangan No. 6,5 Steril Pasang - 100 100 50 50 10
192 Sarung Tangan No. 7 Steril Pasang - 100 100 50 50 10
193 Sarung Tangan No. 7,5 Steril Pasang -
194 Scabicid Cream 10 gram Tube -
200 SILK BLACK 3/0 HR 26 MM Peaces - 48 48 5 43 1
205 Tetracycline HCl 500 mg Capsul -
207 Thiamin HCl (B1) Inj Ampul -
208 Thiamin HCl (B1) Tab 50 mg Tablet 320 4,000 4,320 140 4,180 28
212 Zink Tablet Tablet 670 670 100 570 20
213 Zink Syr 10 mg Botol 2 24 26 15 11 3
214 Zink Syr 20 mg Botol -
218 O A T Kategori 1 Paket 6 6 5 1 1
221 Obat MB Dewasa Strip -
222 Obat PB Anak Strip -
224 Sangobion Tablet 480 480 315 165 63
226 Lidokain Spray Botol - 3 3 3 - 1
227 Lidokain Gel Tube 2 2 2 - 0
228 Elkana Syr Botol 17 107 124 124 - 25
229 Bisakodil 5 mg Tablet 150 150 150 0 30
231 Kateter buah -
235 Bonding Tambalan Komposit GC Botol 1 1 - 1 -
236 Calcium Hidtoksida Technew Tube 1 1 - 1 -
237 Caviton Tube 1 1 - 1 -
238 Eugenol Cairan Botol 1 1 - 1 -
239 Elite Powder Cemen GC Botol 1 1 - 1 -
240 Elite Cemen Liquid GC Botol 1 1 - 1 -
241 Sponge Gigi / Hemospon Pcs 39 39 20 19 4
242 Tambalan Amalgam Powder SDI Tube 1 1 - 1 -
243 Tambalan Komposit GC Hydcal Tube 1 1 - 1 -
244 Tambalan Komposit 3M P60 Botol 1 1 - 1 -
245 Bisakodil Suppo 10 mg Suppo 10 10 - 10 -
247 Reagen Hematologi Analizer Kit
249 Slide Prostat Dos
253 Plano Test Pcs
256 Aplicator Botol
258 Bur Intan Set
259 Cotton Roll Pak
263 Hemafort Tablet
264 Mediamer Tablet
267 Masker N 25 Pcs

BPJS NON BPJS
1 Puskesmas
3 Poskesdes
JUMLAH
Yang Melapor,
Yang Melapor,
NIP. 19640514 200003 2 006 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN : APRIL
TAHUN : 2018
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
(8)
(28)
1
(16)
50
(204)
-
-
(18)
(122)
132
(120)
510
(76)
-
2,000
30
-
100
-
600
(26)
-
2,128
2,000
100
500
-
25
25
(100)
(15)
30
15
-
2,082
900
(584)
500
-
(20)
300
(2)
(2)
50
50
(24)
360
-
-
-
-
500
(380)
12
(35)
-
500
300
(130)
3,140
-
-
-
100
(86)
(10)
(20)
-
-
(220)
-
(2)
-
(2)
(100)
-
-
8
-
-
(540)
50
-
300
(1,955)
50
(22)
-
(11)
(1)
300
(1,774)
(300)
500
(25)
-
300
42
-
(176)
20
100 ED 244
(290)
1,920
(1)
(17)
300
(90)
24
-
-
-
-
-
-
24
(152)
-
5
10
100
-
12
12
(126)
(5)
(200)
(22)
(9)
3,000
(40)
(82)
-
2,000
100
(42)
560
200
2
300
(180)
10
400
500
800
400
- ED 100
-
-
(190)
600
(358)
-
50
500
600
(23)
20
(137)
-
12
1,000
(57)
(4)
(27)
(22)
(904)
1,852
100
-
7
(974)
-
(200)
(90)
(155)
-
946
500
500
(11)
3,000 ED 950
(50)
(156)
(19)
50
222
(120)
(12)
10
10
-
-
(200)
(81)
(500)
400
400
(37)
50
100
100
(268)
(9)
-
(4,012)
3,976
(1)
(33)
(450)
20
20
(2)
-
(1)
5
-
-
-
-
-
400
5
4
2
149
180
200
10
(5)
(4)
800
(1)
(1)
(1)
(1)
(1)
(1)
50
(1)
(1)
(1)
(10)
200
1
2
2
Mamuju,
r, Yang Menerima,

r, Yang Menerima,

NIP. 19790102 200604 2 013
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
1 Abbocath No. 18 Pcs 28 28 9 19 2
2 Abbocath No. 20 Pcs 28 28 7 21 1
3 Abbocath No. 22 Pcs 9 1 10 3 7 1
4 Abbocath No. 24 Pcs 16 16 - 16 -
5 Acyclovir Cream 3% Tube - - - -
7 Acyclovir tab 400 mg Tablet - - -
8 Albendazol Suspensi 25 mg / 5 ml Btl/10 ml - - -
15 Alprazolam Tab 0,25 mg Tablet - - -
16 Ambroxol tab 30 mg Tablet - - - -
18 Aminophyllin Injeksi 24 mg/ml Ampul - - -
19 Aminophyllin tab 200 mg Tablet - - -
23 Amoxycillin capl 250 mg Capsul - - -
25 Antacida DOEN tab. Kunyah Komb : Tablet - 2,000 2,000 830 1,170 166
27 Antalgin tablet 500 mg Tablet - - -
28 Antalgin Injeksi 250 mg/ml- 2 ml Ampul - - -
29 Antifungi DOEN Kombinasi Tube - 24 24 6 18 1
35 Arhtemeter Injeksi 80 mg/ml Ampul - - -
36 Asam Mefenamat tab 500 mg Tablet 690 2,100 2,790 2,010 780 402
37 Asam Askorbat tab 50 mg Tablet 900 900 1,800 110 1,690 22
38 Asam Askorbat tab 250 mg Tablet 1100 1,100 - 1,100 -
39 Asam Folat 1 mg Tablet 200 200 200 - 40
40 Asering Infus Btl/500 ml - - -
41 Atropin sulfat Injeksi 0,25 mg/ml Ampul 20 20 - - -
42 Attapulgit Tablet 0 - - -
47 Bisturi buah 64 64 8 56 2
48 Blood Lancet Pcs - 200 200 - 200 -
49 Catgut No. 2/0 Pcs - - -
51 Cairan 1/2 DAD Btl/500 ml - - -
52 Carbamazepin tab 200 mg Tablet - - -
53 Captopril tab 25 mg Tablet 590 500 1,090 780 310 156
55 Cefadroxil Sirup Botol - - -
56 Cetirizine Syr Botol 37 37 1 36 0
57 CHKM Btl/15 ml - - -
58 Cimetidine tab 200 mg Tablet 500 500 - 500 -
61 Dexamethasone tab 0,5 mg Tablet 1,340 3,200 4,540 2,780 1,760 556
62 Dextran 70% Infus Btl/500 ml - - -
63 Dextromethorphan syrup Btl/ 60 ml - - -
64 Dextromethorphan tab 15 mg Tablet - - -
69 Digoxin tablet 0,25 mg Tablet - - -
70 Diltiazem HCl tablet 30 mg Tablet - - -
72 Etanol 70% 100 ml Botol - - -
73 Etanol 70% 1000 ml Botol 4 4 4 - 1
74 Etakridin (Rivanol) 100 ml Botol - - -
75 Etakridin 0,1% 300 ml Btl/300 4 4 3 1 1
77 Erysanbe syrup Btl/ 60 ml - - -
78 Erysanbe Capsul 500 mg Capsul - - -
80 Fenobarbital tab 30 mg Tablet - - -
81 Fenobarbital Inkeksi 50 mg/ml Ampul - - -
82 Fitomenadion (Vit. K1) tab 10 mg Tablet 540 540 - 540 -
83 Fitomenadion (Vit. K1) Injeksi Ampul - 30 30 - 30 -
84 Fletcher Set - - -
85 Furosemid tablet 40 mg Tablet - 300 300 100 200 20
87 Gentamicin salep kulit Tube - 30 30 30 - 6
89 Gentamicin sulfat TM 0,3% Btl/ 5 ml - - -
90 Gentian Violet 1% Btl/ 5 ml 12 12 12 - 2
91 Glass Ionometer Cemen Set 1 1 1 - 0
93 Gliceryl Guaicolat tab 100 mg Tablet 2,410 2,410 1,120 1,290 224
94 Glimepiride Tab 1 mg Tablet 300 300 30 270 6
95 Glimepiride tab 2 mg Tablet - 300 300 50 250 10
96 Glukosa 5% Btl/500 ml 25 25 - 25 -
97 Glukosa 10% Btl/500 ml - - -
98 Griseofulvin tab 125 mg Tablet 480 300 780 410 370 82
99 Haloperidol tab 0,5 mg Tablet 10 100 110 - 110 -
100 Haloperidol tab 1,5 mg Tablet - - -
101 Hidroklorothiazid (HCT) tab Tablet 200 200 - 200 -
103 Ibuprofen Syrup Btl/60 ml - 200 200 58 - 12
104 Ibuprofen tab 200 mg Tablet 290 290 200 90 40
105 Ibuprofen tab 400 mg Tablet - 1,000 1,000 610 390 122
107 Infusion set Dewasa Pcs 35 35 - 35 -
108 Interhistin tablet Tablet - - -
116 Kaen 3B larutan infus Btl/500 ml - - -
117 Kalium Permanganas Serbuk Pot/ 5 g - 5 5 5 - 1
118 Kalsium Laktat tab 500 mg Tablet 1,160 1,160 1,160 - 232
119 Kalsium Glukonat Inj i.v 10 % (100mg/ml) Ampul - - -
120 Kapas Pembalut Hidrofil DRC 250 Gram Roll 2 5 7 2 5 0
121 Kasa Hidrofil DRC 36 m x 80 cm Roll 5 5 5 - 1
123 Kasa 5 Cm Roll - - -
124 Karbongliserin Tetes Telinga 10* Botol 2 2 #VALUE! #VALUE!
131 Klorfeniramin Maleat (CTM) Tablet 2,000 2,000 1,660 340 332
134 Klorpromazin Injeksi Ampul - - -
135 Tablet 650 2,000 2,650 1,980 670 396
Asam Folat
136 Kotrimoksazol Suspensi Btl/ 60 ml - - -
139 Lidocain HCl Injeksi 2% Ampul - 200 200 146 54 29
140 Lisol 1 Liter Botol - 2 2 - 2 -
141 Loratadine tablet 10 mg Tablet 80 300 380 80 300 16
143 Magnesium Sulfat injeksi 40 % Ampul 10 10 - 10 -
144 Masker Pcs - 400 400 400 - 80
145 Meloksikam tab 7,5 mg Tablet - - -
147 Metformin HCl tablet 500 mg Tablet - - - -
148 Metoklorpropamide tab 10 mg Tablet - - - -
149 Metoklorpropamide tab 5 mg Tablet - - -
150 Metoklorpropamide Injeksi (Metolon) Ampul - - -
152 Metronidazol tab 500 mg Tablet - - - -
154 Metylergometrin Maleat Inj Ampul - - -
155 Miconazole Cream Tube 10 48 58 11 47 2
159 Nifedipin Tablet Tablet 100 100 200 - 200 -
161 Nistatin Tab. Vag 500.000 UI Tablet - - -
162 Obat Batuk Hitam (OBH) Btl/ 100 ml 5 12 17 17 - 3
164 Oxytocin Inj 10 mg/ml Ampul 63 63 - 63 -
166 Oxytetracyclin SK. 3% Tube 43 43 43 - 9
171 Piracetam Injeksi 3 g/15 ml Ampul - - -
174 Primakina tablet 15 mg Tablet - - -
177 Pyrantel Suspensi 125 mg/5 ml Botol 165 165 15 - 3
178 Pyrantel tablet 125 mg Tablet - - -
179 Pyridoxin HCl tablet 10 mg Tablet 290 100 390 390 - 78
180 Pyroxicam tablet 10 mg Tablet - - -
183 Ranitidine tablet 150 mg Tablet - 3,000 3,000 1,830 1,170 366
187 Pot/ 30 g 9.0 48 57 30 27 6
Belerang
189 Salbutamol tab 4 mg Tablet 120 120 120 - 24
190 Salbutamol Sirup Botol 12 12 5 7 1
191 Sarung Tangan No. 6,5 Steril Pasang 50 50 100 50 50 10
192 Sarung Tangan No. 7 Steril Pasang 50 50 100 50 50 10
193 Sarung Tangan No. 7,5 Steril Pasang - - -
194 Scabicid Cream 10 gram Tube - - -
198 Simvastatin tablet 10 mg Tablet - - -
201 Strip Kolesterol Nesco Strip 300 300 40 260 8
202 Strip Asam Urat Nesco Strip - 100 100 75 25 15
203 Strip Glukosa Nesco Strip - 100 100 25 75 5
206 Tetrakain Tetes Mata Botol 14 14 - 14 -
207 Thiamin HCl (B1) Inj Ampul - - -
208 Thiamin HCl (B1) Tab 50 mg Tablet 4,180 4,180 280 - 56
213 Zink Syr 10 mg Botol 11 6 17 14 3 3
214 Zink Syr 20 mg Botol - - -
216 Tes Kit Malaria Pcs - - -
218 O A T Kategori 1 Paket 1 5 6 3 3 1
219 O A T Kategori 2 Paket - - -
220 Obat PB Dewasa Strip - - -
221 Obat MB Dewasa Strip - - -
222 Obat PB Anak Strip - - -
223 Obat MB Anak Strip - - -
224 Sangobion Tablet 165 165 165 - 33
226 Lidokain Spray Botol - 4 4 - 4 -
227 Lidokain Gel Tube - 12 12 - 12 -
228 Elkana Syr Botol 0 149 149 84 65 17
229 Bisakodil 5 mg Tablet 0 180 180 - 180 -
230 Cetirizine Tab Tablet - - -
231 Kateter buah - - -
235 Bonding Tambalan Komposit GC Botol 1 1 1 0 0
240 Elite Cemen Liquid GC Botol 1 1 1 0 0
241 Sponge Gigi Pcs 19 10 29 29 - 6
243 Tambalan Komposit GC Tube 1 1 1 0 0
244 Tambalan Komposit 3M P60 Botol 1 1 1 0 0
245 Bisakodil Suppo 10 mg Suppo 10 10 - 10 -
246 Tabung Vacum Buah - - -
247 Reagen ZN Paket 1 1 - 1 -
248 Mata Klinipet Dos - - -
249 Slide Prostad Pcs 2 2 2 0 0
250 Diazepam enema 5 mg/2,5 ml Tube 10 10 - 10 -
252 Nistatin Suspensi 100.000 UI/ml Botol 10 10 1 9 0
253 Plano Test Pcs
256 Aplicator Botol
258 Bur Intan Set
259 Cotton Roll Pak
263 Hemafort Tablet
264 Mediamer Tablet
267 Masker N 25 Pcs

BPJS NON BPJS
1 Puskesmas
3 Poskesdes
JUMLAH
Yang Melapor,
Yang Melapor,
NIP. 19640514 200003 2 006 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN : MEI
TAHUN : 2018
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
(8) 20%
(13) 20%
(3) 20%
(16) 20%
- 20%
(210) 20%
- 20%
- 20%
(18) 20%
93 20%
(154) 20%
(118) 20%
(354) 20%
10 20%
- 20%
1,000 20%
(38) 20%
- 20%
100 20%
- 20%
800 20%
22 20%
- 20%
2,928 20%
(174) 20%
43 20%
- 20%
- 20%
(11) 20%
50 20%
(100) 20%
(15)
20%
(13) 20%
15 20%
- 20%
2,200 20%
(1,558) 20%
(1,100) 20%
400 20%
- 20%
- ED 20 20%
200 20%
(2) 20%
6 20%
50 20%
(23) 20%
(46) 20%
(200) 20%
- 20%
- 20%
- 20%
- 20%
626 20%
(236) 20%
- 20%
(35) 20%
- 20%
(500) 20%
(100) 20%
(130) 20%
2,100 20%
- 20%
- 20%
- 20%
(100) 20%
(86) 20%
(10) 20%
(20) 20%
- 20%
- 20%
(340) 20%
- 20%
5 20%
- 20%
6 20%
(100) 20%
- 20%
- 20%
- 20%
1,000 20%
- 20%
(540) 20%
(30) 20%
- 20%
(80) 20%
(2,000) 20%
50 20%
(22) 20%
- 20%
24 20%
1 20%
(56) 20%
2,000 20%
(234) 20%
(190) 20%
(25) 20%
- 20%
300 20%
(110) 20%
- 20%
(200) 20%
(27) 20%
100 ED 142 20%
150 20%
500 20%
15 20%
(35) 20%
300 20%
(90) 20%
24 20%
- 20%
- 20%
- 20%
- 20%
- 20%
- 20%
24 20%
1,500 20%
- 20%
(3) 20%
6 20%
60 20%
- 20%
24 20%
12 20%
(150) 20%
(9) 20%
(200) 20%
(4) 20%
(14) 20%
3,000 20%
(40) 20%
(85) 20%
- 20%
1,870
20%
100 20%
(34) 20%
460 20%
121 20%
(2) 20%
(204) 20%
(180) 20%
(10) 20%
480 20%
500 20%
600 20%
600 20%
- 20%
- 20%
- 20%
448 20%
500 20%
(424) 20%
- 20%
(34) 20%
500 20%
500 20%
7 20%
(200) 20%
(137) 20%
- 20%
24 20%
360 20%
(63) 20%
(4) 20%
52 20%
12 20%
(610) 20%
1,768 20%
100 20%
- 20%
(7) 20%
(986) 20%
- 20%
(200) 20%
(90) 20%
50 ED 150 20%
- 20%
1,000 20%
500 20%
500 20%
(6) 20%
1,026 20%
(62) 20%
(180) 20%
0 20%
9
20%
200 20%
300 20%
(1) 20%
10 20%
10 20%
- 20%
12 20%
(200) 20%
(80) 20%
(500) 20%
500 20%
300 20%
(30) 20%
(212) 20%
65 20%
(45) 20%
(92) 20%
100 20%
(14) 20%
- 20%
2,000 ED 3900 20%
4,286 20%
2 20%
(20) 20%
(570) 20%
30 20%
20 20%
(2) 20%
- 20%
(1) 20%
- 20%
- 20%
- 20%
- 20%
- 20%
- 20%
198 20%
5 20%
(4) 20%
(12) 20%
36 20%
(180) 20%
300 20%
5 20%
(6) 20%
(4) 20%
800 20%
1 20%
(1) 20%
(1) 20%
(1) 20%
(1) 20%
1 20%
35 20%
(1) 20%
1 20%
1 20%
(10) 20%
100 20%
(1) 20%
5 20%
2 20%
(10) 20%
(10) 20%
(8) 20%
300
2
2
2
3
1
2
10
2
2
Mamuju,
r, Yang Menerima,

Mamuju,
r, Yang Menerima,

NIP. 19790102 200604 2 013
OBAT PROGRAM KIA
BULAN : APRIL
TAHUN : 2018

Nip. 19640514 200003 2 006 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
OBAT PROGRAM DIARE
BULAN : APRIL
TAHUN : 2018
2 Zink Tablet 1100 0 1100 480 620

Nip. 19640514 200003 2 006 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
OBAT PROGRAM KIA
BULAN : MEI
TAHUN : 2018

Nip. 19640514 200003 2 006 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
OBAT PROGRAM DIARE
BULAN : MEI
TAHUN : 2018
2 Zink Tablet 620 0 620 110 510

Nip. 19640514 200003 2 006 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
1 Abbocath No. 18 Pcs 19 19 3 16 1
2 Abbocath No. 20 Pcs 21 21 3 18 1
3 Abbocath No. 22 Pcs 7 7 3 4 1
4 Abbocath No. 24 Pcs 16 16 - 16 -
9 Albendazol tab 400 mg Tablet 18 18 18 - 4
19 Aminophyllin tab 200 mg Tablet 100 100 - 100 -
25 Antacida DOEN tab. Kunyah Komb : Tablet 1,170 1,170 670 500 134
26 Antacida DOEN suspensi Btl/60 ml 35 50 85 45 40 9
33 Antihaemorrid Supp Supp 25 25 - 25 -
34 Antiseptik Hand Rub 500 m Botol - - - -
37 Asam Askorbat tab 50 mg Tablet 1,690 1,690 170 1,520 34
38 Asam Askorbat tab 250 mg Tablet 1100 1,100 - 1,100 -
41 Atropin sulfat Injeksi 0,25 mg/ml Ampul - - - -
44 Aquagel Sterile Jely 82 gr Tube - 6 6 - 6 -
47 Bisturi buah 56 56 - 56 -
48 Blood Lancet Pcs 200 200 - 200 -
56 Cetirizine Syr Botol 36 36 - 36 -
57 CHKM Btl/15 ml - - -
58 Cimetidine tab 200 mg Tablet 500 500 50 450 10
72 Etanol 70% 100 ml Botol 50 50 8 42 2
73 Etanol 70% 1000 ml Botol - - - -
74 Etakridin (Rivanol) 100 ml Botol 6 6 3 3 1
75 Etakridin 0,1% 300 ml Btl/300 1 1 - 1 -
80 Fenobarbital tab 30 mg Tablet 300 300 - 300 -
86 Garam Oralit 200 mg Sachet 2,115 2,115 158 - 32
87 Gentamicin salep kulit Tube - 50 50 40 10 8
90 Gentian Violet 1% Btl/ 5 ml - - - -
91 Glass Ionometer Cemen Set - 1 1 1 - 0
93 Gliceryl Guaicolat tab 100 mg Tablet 1,290 1,290 1,290 - 258
96 Glukosa 5% Btl/500 ml 25 25 2 23 0
97 Glukosa 10% Btl/500 ml - - -
103 Ibuprofen Syrup Btl/60 ml - 100 100 65 35 13
104 Ibuprofen tab 200 mg Tablet 90 90 90 - 18
105 Ibuprofen tab 400 mg Tablet 390 500 890 890 - 178
106 Infusion set anak Pcs 2 2 - 2 -
110 Jarum Jahit bedah No. 9 Pcs 24 24 - 24 -
118 Kalsium Laktat tab 500 mg Tablet - - - -
121 Kasa Hidrofil DRC 36 m x 80 cm Roll 6 6 2 4 0
122 Kasa Pembalut Hidrofil DRC 4m x 15 cm Roll - 60 60 30 30 6
124 Karbongliserin Tetes Telinga 10* Botol - - - -
125 Ketokonazol Salep Tube 10 10 2 8 0
131 Klorfeniramin Maleat (CTM) Tablet 340 3,000 3,340 2,440 900 488
135 Tablet 670 1,900 2,570 1,670 900 334
Asam Folat
136 Kotrimoksazol Suspensi Btl/ 60 ml - - -
144 Masker Pcs - 450 450 450 - 90
146 Meloksikam tab 15 mg Tablet - - - -
155 Miconazole Cream Tube 47 47 26 21 5
156 Natrium Diklofenak tablet 25 mg Tablet - 500 500 180 320 36
159 Nifedipin Tablet Tablet 200 200 - - -
162 Obat Batuk Hitam (OBH) Btl/ 100 ml - 24 24 6 18 1
163 Omeprazole Tablet - 360 360 210 150 42
166 Oxytetracyclin SK. 3% Tube - 52 52 9 43 2
167 Oxytetracyclin Salep Mata 1% Tube 15 25 40 2 38 0
172 Plester/Hipapix (5 cm x 5 m) Roll 9 9 5 4 1
173 Prednison tab 5 mg Tablet 1,130 1,130 930 200 186
177 Pyrantel Suspensi 125 mg/5 ml Botol - - - -
178 Pyrantel tablet 125 mg Tablet - - -
179 Pyridoxin HCl tablet 10 mg Tablet - 1,000 1,000 1,000 - 200
183 Ranitidine tablet 150 mg Tablet 1,170 1,100 2,270 1,870 400 374
187 Pot/ 30 g 27.0 9 36 36 - 7
Belerang
189 Salbutamol tab 4 mg Tablet - 300 300 100 200 20
191 Sarung Tangan No. 6,5 Steril Pasang 50 50 100 - 100 -
202 Strip Asam Urat Nesco Strip 25 75 100 50 50 10
203 Strip Glukosa Nesco Strip 75 75 50 25 10
208 Thiamin HCl (B1) Tab 50 mg Tablet - 2,000 2,000 1,100 900 220
209 Vitamin B Complex tab Tablet 670 4,300 4,970 3,670 1,300 734
211 Yodium Povidon 10% 30 ml Botol 30 30 - 30 -
213 Zink Syr 10 mg Botol 3 6 9 9 - 2
218 O A T Kategori 1 Paket 3 3 3 - 1
223 Obat MB Anak Strip - - - -
224 Sangobion Tablet - - - -
226 Lidokain Spray Botol 4 4 - 4 -
227 Lidokain Gel Tube 12 10 22 3 19 1
228 Elkana Syr Botol 65 36 101 59 42 12
235 Bonding Tambalan Komposit GC Botol 0 - - -
236 Calcium Hidtoksida Technew Tube 1 2 3 1 2 0
240 Elite Cemen Liquid GC Botol 0 1 1 - 1 -
241 Sponge Gigi / Hemospon Pcs 0 1 1 1 - 0
243 Tambalan Komposit GC Hydcal Tube 0 1 1 1 0 0
244 Tambalan Komposit 3M P60 Botol 0 - - -
245 Bisakodil Suppo 10 mg Suppo 10 10 4 6 1
249 Slide Prostad Pcs 2 2 - 2 -
253 Plano Test Pcs 100 100 100 0 20
254 Tambalan Komposit Flowable Tube - - -
255 Calsium Hidroside Lightcurring Tube - - -
256 Aplicator Botol - - -
257 Bur Composite Set - - -
258 Bur Intan Set - - -
259 Cotton Roll Pak - - -
260 Celemek Gigi Pcs - - -
261 Celluloid Strip Pak - - -
262 Matrix Band Kompensional Set - - -
263 Hemafort Tablet 200 200 80 120 16
264 Mediamer Tablet
267 Masker N 25 Pcs

BPJS NON BPJS
1 Puskesmas
3 Poskesdes
JUMLAH

Dinas Kesehatan Kab. Mamuju
Yang Melapor,
NIP. 19640514 200003 2 006 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN : JUNI
TAHUN : 2018
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
(12) 20%
(14) 20%
(0) 20%
(16) 20%
- 20%
200 20%
100 20%
- 20%
- ED 18 20%
200 20%
200 20%
(71) 20%
377 20%
(40) 20%
- 20%
1,000 20%
49 20%
- 20%
(100) 20%
- 20%
500 20%
(72) 20%
- 20%
2,772 20%
304 20%
14 20%
- 20%
- 20%
(18) 20%
48 20%
(100) 20%
(15)
20%
(25) 20%
10 20%
- 20%
1,709 20%
(1,316) 20%
(1,100) 20%
500 20%
- 20%
- 20%
100 20%
(2) 20%
(6) 20%
25 20%
48 20%
(56) 20%
(200) 20%
- 20%
- 20%
- 20%
- 20%
772 20%
(380) 20%
- 20%
(36) 20%
- 20%
(390) 20%
400 20%
(55) 20%
1,859 20%
- 20%
- 20%
- 20%
(54) 20%
(86) 20%
(10) 20%
(20) 20%
- 20%
- 20%
(208) 20%
(32) 20%
- 20%
1 20%
(1) 20%
(100) 20%
- 20%
- 20%
10 20%
(300) 20%
- 20%
(342) 20%
(30) 20%
- 20%
20 20%
300 ED 1957 20%
38 20%
(22) 20%
- 20%
15 20%
1 20%
300 20%
3,000 20%
(226) 20%
400 20%
(21) 20%
- 20%
(472) 20%
(110) 20%
- 20%
(200) 20%
24 20%
60 20%
500 20%
1,068 20%
(2) 20%
(6) 20%
100 20%
(90) 20%
(24) 20%
- 20%
- 20%
- 20%
- 20%
- 20%
- 20%
6 20%
1,000 20%
- 20%
2 20%
(2) 20%
6 20%
- 20%
12 20%
(6) 20%
(150) 20%
(9) 20%
(200) 20%
10 20%
(8) 20%
3,000 20%
(40) 20%
(89) 20%
- 20%
1,900
20%
50 20%
200 20%
(202) 20%
(41) 20%
(2) 20%
200 20%
(180) 20%
(10) 20%
540 20%
400 20%
500 20%
700 20%
- 20%
- 20%
- 20%
400 20%
500 20%
400 20%
- 20%
48 20%
300 20%
600 20%
(12) 20%
100 ED 200 20%
(115) 20%
- 20%
(11) 20%
200 20%
(43) 20%
(4) 20%
(32) 20%
(36) 20%
(526) 20%
3,116 20%
60 20%
- 20%
2 20%
916 20%
- 20%
(200) 20%
(90) 20%
60 20%
50 20%
1,200 20%
500 20%
500 20%
(10) 20%
1,844 20%
(62) 20%
(180) 20%
22 20%
43
20%
30 20%
(80) 20%
(7) 20%
(100) 20%
(71) 20%
- 20%
15 20%
(200) 20%
(68) 20%
(500) 20%
500 20%
500 20%
(8) 20%
(150) 20%
10 20%
35 20%
(128) 20%
- 20%
(14) 20%
- 20%
700 20%
3,104 20%
3 20%
(30) 20%
(196) 20%
50 20%
50 20%
(2) 20%
- 20%
(1) 20%
8 20%
- 20%
- 20%
- 20%
- 20%
- 20%
1,000 20%
(4) 20%
(4) 20%
(15) 20%
40 20%
(180) 20%
100 20%
5 20%
(6) 20%
(4) 20%
600 20%
- 20%
(1) 20%
(1) 20%
(1) 20%
(1) 20%
(1) 20%
1 20%
(1) 20%
1 20%
- 20%
(1) 20%
- 20%
(1) 20%
- 20%
(2) 20%
(10) 20%
(10) 20%
(7) 20%
120 20%
- 20%
- 20%
- 20%
- 20%
- 20%
- 20%
- 20%
- 20%
- 20%
(24) 20%
Mamuju,
Yang Menerima,
Pengelola Obat Puskesmas

Mamuju,
r, Yang Menerima,

NIP. 19790102 200604 2 013
OBAT PROGRAM KIA
BULAN : JUNI
TAHUN : 2018

Nip. 19640514 200003 2 006 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
OBAT PROGRAM DIARE
BULAN : JUNI
TAHUN : 2018
2 Zink Tablet 510 0 510 190 320

Nip. 19640514 200003 2 006 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
1 Abbocath No. 18 Pcs 92 - 92 29 63 6
2 Abbocath No. 20 Pcs 54 23 77 10 67 2
3 Abbocath No. 22 Pcs 33 1 34 14 20 3
4 Abbocath No. 24 Pcs 48 - 48 - 48 -
5 Acyclovir Cream 3% Tube 21 - 21 21 - 4
6 Acyclovir tab 200 mg Tablet 635 - 635 65 570 13
7 Acyclovir tab 400 mg Tablet - - - - - -
8 Albendazol Suspensi 25 mg / 5 ml Btl/10 ml - - - - - -
9 Albendazol tab 400 mg Tablet 54 - 54 18 36 4
10 Alat Suntik Sekali Pakai 1 ml Pcs 322 - 322 151 171 30
13 Allopurinol tab 100 mg Tablet 720 1,300 2,020 1,120 900 224
15 Alprazolam Tab 0,25 mg Tablet - - - - - -
18 Aminophyllin Injeksi 24 mg/ml Ampul - - - - - -
19 Aminophyllin tab 200 mg Tablet - 100 100 - 100 -
20 Amitriptilyn tab 25 mg Tablet - - - - - -
21 Amlodipine 10 mg Tablet - - - - - -
23 Amoxycillin capl 250 mg Capsul - - - - - -
24 Amoxycillin capl 500 mg Kaplet 2,200 7,500 9,700 7,740 1,960 1,548
25 Antacida DOEN tab. Kunyah Komb : Tablet 1,170 2,500 3,670 2,000 1,670 400
27 Antalgin tablet 500 mg Tablet - - - - - -
28 Antalgin Injeksi 250 mg/ml- 2 ml Ampul - - - - - -
29 Antifungi DOEN Kombinasi Tube 39 24 63 27 36 5
30 Antibakteri DOEN Kombinasi (Bacitracin) Tube - - - - - -
31 Antimalaria DOEN Kombinasi Tablet 300 - 300 - 300 -
32 Antimigren : Ergotamin Tartrat + Kofein Tablet 45 - 45 - 45 -
35 Arhtemeter Injeksi 80 mg/ml Ampul - - - - - -
36 Asam Mefenamat tab 500 mg Tablet 1,470 7,300 8,770 6,360 2,410 1,272
37 Asam Askorbat tab 50 mg Tablet 2,590 3,300 5,890 1,780 4,110 356
38 Asam Askorbat tab 250 mg Tablet 3,730 - 3,730 430 3,300 86
39 Asam Folat 1 mg Tablet - 400 400 400 - 80
40 Asering Infus Btl/500 ml - - - - - -
41 Atropin sulfat Injeksi 0,25 mg/ml Ampul 40 - 40 - 40 -
42 Attapulgit Tablet 70 - 70 70 - 14
43 Aqua Pro Injeksi 20 ml Btl/20 ml 5 1 6 - 6 -
44 Aquagel Sterile Jely 82 gr Tube 7 6 13 4 9 1
47 Bisturi buah 217 - 217 41 176 8
48 Blood Lancet Pcs 200 500 700 300 400 60
49 Catgut No. 2/0 Pcs - - - - - -
50 Catgut No. 3/0 Pcs - - - - - -
51 Cairan 1/2 DAD Btl/500 ml - - - - - -
52 Carbamazepin tab 200 mg Tablet - - - - - -
53 Captopril tab 25 mg Tablet 900 2,400 3,300 2,200 1,100 440
54 Cefadroxil 500 mg Tablet 1,480 - 1,480 220 1,260 44
55 Cefadroxil Sirup Botol - - - - - -
56 Cetirizine Syr Botol 112 - 112 3 109 1
57 CHKM Btl/15 ml - - - - - -
58 Cimetidine tab 200 mg Tablet 500 500 1,000 50 950 10
59 Ciprofloxacin tab 500 mg Tablet 1,110 300 1,410 760 650 152
60 Dexamethasone Injeksi Ampul 390 - 390 34 356 7
61 Dexamethasone tab 0,5 mg Tablet 3,320 9,800 13,120 8,620 4,500 1,724
62 Dextran 70% Infus Btl/500 ml - - - - - -
63 Dextromethorphan syrup Btl/ 60 ml - - - - - -
64 Dextromethorphan tab 15 mg Tablet - - - - - -
66 Diazepam 5 mg Tablet 258 - 258 - 258 -
67 Diazepam Injeksi Ampul 30 - 30 - 30 -
68 Difenhidramin Injeksi 10 mg/ml Ampul 60 - 60 - 60 -
69 Digoxin tablet 0,25 mg Tablet - - - - - -
70 Diltiazem HCl tablet 30 mg Tablet - - - - - -
71 Domperidon tablet 10 mg Tablet 1,120 - 1,120 160 960 32
72 Etanol 70% 100 ml Botol - 50 50 8 42 2
73 Etanol 70% 1000 ml Botol 10 - 10 6 4 1
74 Etakridin (Rivanol) 100 ml Botol - 6 6 3 3 1
75 Etakridin 0,1% 300 ml Btl/300 8 3 11 5 6 1
76 Efinefrin HCl Bitartrat Inj Ampul 300 - 300 - 300 -
77 Erysanbe syrup Btl/ 60 ml - - - - - -
78 Erysanbe Capsul 500 mg Capsul - - - - - -
79 Etylchlorida semprot Btl/100 - - - - - -
80 Fenobarbital tab 30 mg Tablet - 300 300 - 300 -
81 Fenobarbital Inkeksi 50 mg/ml Ampul - - - - - -
82 Fitomenadion (Vit. K1) tab 10 mg Tablet 1,120 500 1,620 90 1,530 18
84 Fletcher Set - - - - - -
85 Furosemid tablet 40 mg Tablet 350 300 650 350 300 70
86 Garam Oralit 200 mg Sachet 6,852 - 6,852 467 6,385 93
88 Gentamicin salep mata Tube 66 - 66 - 66 -
89 Gentamicin sulfat TM 0,3% Btl/ 5 ml - - - - - -
90 Gentian Violet 1% Btl/ 5 ml 25 - 25 13 12 3
91 Glass Ionometer Cemen Set 2 1 3 2 1 0
92 Glibenklamid tab 5 mg Tablet 622 500 1,122 632 490 126
93 Gliceryl Guaicolat tab 100 mg Tablet 6,640 - 6,640 2,940 3,700 588
94 Glimepiride Tab 1 mg Tablet 870 - 870 50 820 10
95 Glimepiride tab 2 mg Tablet 500 300 800 450 350 90
96 Glukosa 5% Btl/500 ml 75 - 75 2 73 0
97 Glukosa 10% Btl/500 ml - - - - - -
98 Griseofulvin tab 125 mg Tablet 1,080 1,500 2,580 1,150 1,430 230
99 Haloperidol tab 0,5 mg Tablet 173 100 273 43 230 9
100 Haloperidol tab 1,5 mg Tablet - - - - - -
103 Ibuprofen Syrup Btl/60 ml 90 500 590 169 421 34
104 Ibuprofen tab 200 mg Tablet 470 200 670 290 380 58
105 Ibuprofen tab 400 mg Tablet 390 3,100 3,490 3,100 390 620
106 Infusion set anak Pcs 18 - 18 8 10 2
107 Infusion set Dewasa Pcs 70 50 120 28 92 6
108 Interhistin tablet Tablet - - - - - -
109 Isosorbid Dinitrat Subli. Tab Tablet 270 - 270 - 270 -
110 Jarum Jahit bedah No. 9 Pcs - 24 24 - 24 -
111 Jarum Jahit bedah No. 10 Pcs - - - - - -
116 Kaen 3B larutan infus Btl/500 ml - - - - - -
117 Kalium Permanganas Serbuk Pot/ 5 g 7 10 17 17 - 3
118 Kalsium Laktat tab 500 mg Tablet 3,160 - 3,160 2,000 1,160 400
119 Kalsium Glukonat Inj i.v 10 % (100mg/ml) Ampul - - - - - -
121 Kasa Hidrofil DRC 36 m x 80 cm Roll - 11 11 7 4 1
123 Kasa 5 Cm Roll - - - - - -
124 Karbongliserin Tetes Telinga 10* Botol 7 - 7 #VALUE! #VALUE! -
125 Ketokonazol Salep Tube 26 29 55 29 26 -
126 Ketokenazol Tab Tablet 470 - 470 20 450 -
127 Kloramfenikol Suspensi Botol/60ml 30 - 30 3 27 -
128 Kloramfenikol caps 250 mg Tablet 600 - 600 - 600 -
129 Kloramfenikol Salep Mata 1% Tube 48 10 58 15 43 -
130 Kloramfenikol Tetes Telinga Botol5 ml 53 - 53 10 43 -
131 Klorfeniramin Maleat (CTM) Tablet 340 5,000 5,340 4,100 1,240 -
132 Klorpromazin tab 25 mg Tablet 120 - 120 - 120 -
133 Klorpromazin tab 100 mg Tablet 281 - 281 11 270 -
134 Klorpromazin Injeksi Ampul - - - - - -
135 Tablet 2,520 4,900 7,420 5,200 2,220 -
Asam Folat
136 Kotrimoksazol Suspensi Btl/ 60 ml - - - - - -
137 Kotrimoksazol tab 120 mg Tablet 490 200 690 300 390 -
138 Kotrimoksazol tab 480 mg Tablet 890 1,700 2,590 1,400 1,190 -
139 Lidocain HCl Injeksi 2% Ampul 69 200 269 167 102 -
140 Lisol 1 Liter Botol 3 2 5 1 4 -
141 Loratadine tablet 10 mg Tablet 680 300 980 500 480 -
142 Loperamide Tablet 540 - 540 - 540 -
143 Magnesium Sulfat injeksi 40 % Ampul 10 10 20 - 20 -
144 Masker Pcs - 1,100 1,100 1,100 - -
145 Meloksikam tab 7,5 mg Tablet - - - - - -
146 Meloksikam tab 15 mg Tablet - 750 750 750 - -
147 Metformin HCl tablet 500 mg Tablet 170 - 170 170 - -
148 Metoklorpropamide tab 10 mg Tablet 100 - 100 - 100 -
149 Metoklorpropamide tab 5 mg Tablet - - - - - -
150 Metoklorpropamide Injeksi (Metolon) Ampul - - - - - -
151 Metronidazol tab 250 mg Tablet 810 1,100 1,910 1,100 810 -
152 Metronidazol tab 500 mg Tablet 360 - 360 360 - -
153 Metylergometrin Maleat tab. Tablet 1,550 - 1,550 420 1,130 -
154 Metylergometrin Maleat Inj Ampul - - - - - -
155 Miconazole Cream Tube 57 96 153 75 78 -
156 Natrium Diklofenak tablet 25 mg Tablet 100 800 900 580 320 -
157 Natrium Diklofenak tablet 50 mg Tablet - 1,300 1,300 1,300 - -
158 Natrium Klorida Inf 0,9% Btl/ 500 ml 52 40 92 29 63 -
159 Nifedipin Tablet Tablet 300 300 600 100 500 -
160 Nistatin Tab. Vag 100.000 UI Tablet 411 - 411 10 401 -
161 Nistatin Tab. Vag 500.000 UI Tablet - - - - - -
162 Obat Batuk Hitam (OBH) Btl/ 100 ml 8 43 51 28 23 -
163 Omeprazole Tablet - 960 960 810 150 -
164 Oxytocin Inj 10 mg/ml Ampul 194 - 194 14 180 -
165 Oxytetracyclin HCl Inj Vial 12 - 12 - 12 -
166 Oxytetracyclin SK. 3% Tube 55 96 151 65 86 -
167 Oxytetracyclin Salep Mata 1% Tube 56 28 84 9 75 -
168 Papaverin HCl tab 40 mg Tablet 2,700 - 2,700 300 2,400 -
169 Paracetamol tab 500 mg Tablet 2,230 7,000 9,230 7,030 2,200 -
170 Paracetamol syrup Btl/ 60 ml - - - - - -
171 Piracetam Injeksi 3 g/15 ml Ampul - - - - - -
172 Plester/Hipapix (5 cm x 5 m) Roll 16 15 31 14 17 -
173 Prednison tab 5 mg Tablet 3,860 - 3,860 1,280 2,580 -
174 Primakina tablet 15 mg Tablet - - - - - -
175 Propilthiourasil (PTU) tablet Tablet 600 - 600 - 600 -
176 Propranolol tablet 40 mg Tablet 270 - 270 - 270 -
177 Pyrantel Suspensi 125 mg/5 ml Botol 238 100 338 23 315 -
178 Pyrantel tablet 125 mg Tablet - - - - - -
179 Pyridoxin HCl tablet 10 mg Tablet 610 2,100 2,710 2,420 290 -
180 Pyroxicam tablet 10 mg Tablet - - - - - -
182 Ranitidine Injeksi 25 mg/ml Ampul 38 - 38 5 33 -
183 Ranitidine tablet 150 mg Tablet 1,170 6,600 7,770 5,250 2,520 -
184 Retinol (Vit. A) 100.000 IU Kapluk Kapluk 196 - 196 10 186 -
185 Retinol (Vit. A) 200.000 IU Kapluk Kapluk 460 100 560 20 540 -
186 Ringer Laktat Infus Btl/ 500 ml 45 40 85 40 45 -
187 Pot/ 30 g 36 105 141 105 36 -
Belerang
188 Salbutamol tab 2 mg Tablet 450 700 1,150 640 510 -
189 Salbutamol tab 4 mg Tablet 240 300 540 220 320 -
190 Salbutamol Sirup Botol 19 12 31 5 26 -
191 Sarung Tangan No. 6,5 Steril Pasang 100 200 300 100 200 -
192 Sarung Tangan No. 7 Steril Pasang 100 200 300 113 187 -
193 Sarung Tangan No. 7,5 Steril Pasang - - - - - -
194 Scabicid Cream 10 gram Tube - - - - - -
195 Scopamin Tablet 600 - 600 - 600 -
196 Sianocobalamin (Vit. B12) Injeksi Ampul 560 - 560 150 410 -
197 Sianocobalamin (Vit. B12) Tab Tablet 1,500 - 1,500 - 1,500 -
198 Simvastatin tablet 10 mg Tablet - - - - - -
199 Simvastatin tablet 20 mg Tablet 650 1,150 1,800 1,070 730 -
200 SILK BLACK 3/0 HR 26 MM Peaces 80 48 128 24 104 -
201 Strip Kolesterol Nesco Strip 260 320 580 110 470 -
202 Strip Asam Urat Nesco Strip 25 225 250 175 75 -
203 Strip Glukosa Nesco Strip 75 150 225 125 100 -
204 Tetracycline HCl 250 mg Capsul 1,170 - 1,170 310 860 -
205 Tetracycline HCl 500 mg Capsul - - - - - -
206 Tetrakain Tetes Mata Botol 46 - 46 4 42 -
207 Thiamin HCl (B1) Inj Ampul - - - - - -
208 Thiamin HCl (B1) Tab 50 mg Tablet 4,500 6,000 10,500 1,520 8,980 -
209 Vitamin B Complex tab Tablet 1,750 12,800 14,550 11,780 2,770 -
210 Yodium Povidon 10% 300 ml Botol 15 2 17 9 8 -
211 Yodium Povidon 10% 30 ml Botol 110 - 110 12 98 -
212 Zink Tablet Tablet 1,810 - 1,810 270 1,540 -
213 Zink Syr 10 mg Botol 16 36 52 38 14 -
214 Zink Syr 20 mg Botol - - - - - -
215 Kantong Mayat Pcs 6 - 6 - 6 -
216 Tes Kit Malaria Pcs - - - - - -
217 O A T Kategori Anak Paket 3 - 3 - 3 -
218 O A T Kategori 1 Paket 10 5 15 11 4 -
219 O A T Kategori 2 Paket - - - - - -
220 Obat PB Dewasa Strip - - - - - -
221 Obat MB Dewasa Strip - - - - - -
222 Obat PB Anak Strip - - - - - -
223 Obat MB Anak Strip - - - - - -
224 Sangobion Tablet 645 - 645 480 165 -
225 Sarung Tangan M Box 5 13 18 11 7 -
226 Lidokain Spray Botol 4 7 11 3 8 -
227 Lidokain Gel Tube 14 22 36 5 31 -
228 Elkana Syr Botol 82 292 374 267 107 -
229 Bisakodil 5 mg Tablet 330 180 510 150 360 -
230 Cetirizine Tab Tablet - - - - - -
231 Kateter buah - - - - - -
232 Dulcolax Suppo 5 mg Suppo 19 - 19 1 18 -
233 Dulcolax Suppo 10 mg Suppo 12 - 12 - 12 -
234 Amlodipine 5 mg Tablet - 870 870 870 - -
236 Bonding Tambalan Komposit GC Botol 2 - 2 1 1 -
237 Calcium Hidtoksida Technew Tube 3 2 5 1 4 -
238 Caviton Tube 3 - 3 - 3 -
239 Eugenol Cairan Botol 3 - 3 - 3 -
240 Elite Powder Cemen GC Botol 3 - 3 - 3 -
241 Elite Cemen Liquid GC Botol 2 1 3 1 2 -
242 Sponge Gigi / Hemospon Pcs 58 11 69 50 19 -
243 Tambalan Amalgam Powder SDI Tube 3 - 3 - 3 -
244 Tambalan Komposit GC Hydcal Tube 2 1 3 2 1 -
245 Tambalan Komposit 3M P60 Botol 2 - 2 1 1 -
246 Bisakodil Suppo 10 mg Suppo 20 10 30 4 26 -
247 Tabung Vacum Buah - - - - - -
248 Reagen ZN Paket 1 1 2 - 2 -
249 Mata Klinipet Dos - - - - - -
250 Slide Prostad Pcs - 4 4 2 2 -
251 Diazepam enema 5 mg/2,5 ml Tube 10 10 20 - 20 -
252 Diazepam enema 10 mg/2,5 ml Tube 10 10 20 - 20 -
253 Nistatin Suspensi 100.000 UI/ml Botol 9 10 19 2 17 -
254 Plano Test Pcs - 100 100 100 - -
255 Tambalan Komposit Flowable Tube - - - - - -
256 Calsium Hidroside Lightcurring Tube - - - - - -
257 Aplicator Botol - - - - - -
258 Bur Composite Set - - - - - -
259 Bur Intan Set - - - - - -
260 Cotton Roll Pak - - - - - -
261 Celemek Gigi Pcs - - - - - -
262 Celluloid Strip Pak - - - - - -
263 Matrix Band Kompensional Set - - - - - -
264 Hemafort Tablet - 200 200 80 120 -

BPJS NON BPJS
1 Puskesmas 2357 934
3 Poskesdes 814 794
JUMLAH 3171 1728 4899
Yang Melapor,
drg. H. FIRMON, MPH NENENG SALMIAH, S.Farm Nachsan, SKM

NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN : TRIWULAN II
TAHUN : 2018
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
(28)
(55)
(3)
(48)
25
(492)
-
-
(14) ED 18
10
93
(308)
444
(106)
-
1,440
19
-
(100)
-
-
(76)
-
7,328
730
57
-
-
(4)
-
(300)
(45)
(8)
17
-
5,222
(1,974)
(2,784)
480
-
(40)
84
(6)
(4)
36
21
(127)
(40)
-
-
-
-
1,540
(996)
-
(105)
-
(890)
262
(315)
5,844
-
-
-
(145)
(258)
(30)
(60)
-
-
(768)
(32)
3
1
-
(300)
-
-
-
(300)
-
(1,422)
(35)
-
120
(5,825) ED 1957
108
(66)
-
4
1
268
(172)
(760)
190
(71)
-
(50)
(178)
-
(576)
(13)
(218)
(32)
3,330
(0)
(58)
-
(270)
(24)
-
-
-
-
-
-
20
1,240
-
(1)
4
74
-
#VALUE!
3
(430)
(24)
(600)
(28)
(33)
2,860
(120)
(259)
-
2,980
-
(90)
210
65
(3)
20
(540)
(20)
1,100
-
750
170
(100)
-
-
290
360
(710)
-
(3)
260
1,300
(34)
(400) ED 200
(391)
-
5
660
(166)
(12)
(21)
(66)
(2,100)
4,830
-
-
(3)
(1,300)
-
(600)
(270)
(292)
-
2,130
-
-
(28)
2,730
(176)
(520)
(5)
69
130
(100)
(21)
(100)
(74)
-
-
(600)
(260)
(1,500)
-
340
(80)
(360)
100
25
(550)
-
(38)
-
(7,460)
9,010
1
(86)
(1,270)
24
-
(6)
-
(3)
7
-
-
-
-
-
315
4
(5)
(26)
160
(210)
-
-
(17)
(12)
870
-
(3)
(3)
(3)
(3)
(1)
31
(3)
1
-
(22)
-
(2)
-
-
(20)
(20)
(15)
100
-
-
-
-
-
-
-
-
-
(40)
Mamuju,
r, Yang Menerima,

NIP. 19790102 200604 2 013
NIP. 19790102 200604 2 013
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
1 Abbocath No. 18 Pcs 16 16 5 11 1
2 Abbocath No. 20 Pcs 18 18 18 - 4
3 Abbocath No. 22 Pcs 4 4 4 - 1
4 Abbocath No. 24 Pcs 16 16 4 12 1
9 Albendazol tab 400 mg Tablet - - - -
13 Allopurinol tab 100 mg Tablet 180 400 580 580 - 116
17 Ambroxol Syrup Btl/60 ml 9 9 9 - 2
25 Antacida DOEN tab. Kunyah Komb : Tablet 500 400 900 800 100 160
36 Asam Mefenamat tab 500 mg Tablet 940 940 940 - 188
37 Asam Askorbat tab 50 mg Tablet 1,520 1,520 720 800 144
38 Asam Askorbat tab 250 mg Tablet 1100 1,100 700 400 140
47 Bisturi buah 56 56 24 32 5
48 Blood Lancet Pcs 200 200 200 - 40
56 Cetirizine Syr Botol 36 36 - - -
57 CHKM Btl/15 ml - - -
72 Etanol 70% 100 ml Botol 42 42 7 35 1
73 Etanol 70% 1000 ml Botol - - - -
75 Etakridin 0,1% 300 ml Btl/300 1 1 - 1 -
76 Efinefrin HCl Bitartrat Inj Ampul 100 100 13 87 3
83 Fitomenadion (Vit. K1) Injeksi Ampul 30 30 - - -
86 Garam Oralit 200 mg Sachet - 300 300 300 - 60
91 Glass Ionometer Cemen Set - 1 1 - 1 -
93 Gliceryl Guaicolat tab 100 mg Tablet - - - -
96 Glukosa 5% Btl/500 ml 23 23 4 19 1
97 Glukosa 10% Btl/500 ml - - -
104 Ibuprofen tab 200 mg Tablet - - - -
106 Infusion set anak Pcs 2 2 2 - 0
107 Infusion set Dewasa Pcs 22 22 22 - 4
110 Jarum Jahit bedah No. 9 Pcs 24 24 9 15 2
117 Kalium Permanganas Serbuk Pot/ 5 g - - - -
122 Kasa Pembalut Hidrofil DRC 4m x 15 cm Roll 30 6 36 36 - 7
125 Ketokonazol Salep Tube 8 8 8 - 2
127 Kloramfenikol Suspensi Botol/60ml 9 9 2 7 0
129 Kloramfenikol Salep Mata 1% Tube 7 10 17 17 - 3
131 Klorfeniramin Maleat (CTM) Tablet 900 3,000 3,900 2,600 1,300 520
135 Tablet 900 1,900 2,800 2,400 400 480
Asam Folat
136 Kotrimoksazol Suspensi Btl/ 60 ml 50 50 15 35 3
142 Loperamide Tablet 180 180 100 80 20
143 Magnesium Sulfat injeksi 40 % Ampul 10 10 3 7 1
144 Masker Pcs - 500 500 500 - 100
153 Metylergometrin Maleat tab. Tablet 180 400 580 310 270 62
159 Nifedipin Tablet Tablet - - - -
162 Obat Batuk Hitam (OBH) Btl/ 100 ml 18 18 8 10 2
163 Omeprazole Tablet 150 180 330 220 110 44
166 Oxytetracyclin SK. 3% Tube 43 43 22 21 4
169 Paracetamol tab 500 mg Tablet 100 3,200 3,300 3,300 - 660
173 Prednison tab 5 mg Tablet 200 1,000 1,200 450 750 90
178 Pyrantel tablet 125 mg Tablet 100 100 55 45 11
179 Pyridoxin HCl tablet 10 mg Tablet - 1,200 1,200 900 300 180
183 Ranitidine tablet 150 mg Tablet 400 1,900 2,300 2,000 300 400
187 Pot/ 30 g - 43 43 33 10 7
Belerang
202 Strip Asam Urat Nesco Strip 50 25 75 75 - 15
203 Strip Glukosa Nesco Strip 25 50 75 75 - 15
208 Thiamin HCl (B1) Tab 50 mg Tablet 900 700 1,600 1,100 500 220
209 Vitamin B Complex tab Tablet 1,300 3,200 4,500 3,000 1,500 600
212 Zink Tablet Tablet 400 400 400 - 80
213 Zink Syr 10 mg Botol - 5 5 5 - 1
218 O A T Kategori 1 Paket - 8 8 4 4 1
225 Sarung Tangan M Box 5 5 5 - 1
228 Elkana Syr Botol 42 40 82 82 - 16
235 Bonding Tambalan Komposit GC Botol 0 1 1 - 1 -
236 Calcium Hidtoksida Technew Tube 2 2 1 1 0
241 Sponge Gigi / Hemospon Pcs 0 - - -
243 Tambalan Komposit GC Hydcal Tube 0 - - -
245 Bisakodil Suppo 10 mg Suppo 0 - - 0 -
252 Nistatin Suspensi 100.000 UI/ml Botol 8 8 - 8 -
253 Plano Test Pcs 120 120 120 0 24
263 Hemafort Tablet 120 120 120 0 24
264 Mediamer Tablet
267 Masker N 25 Pcs

BPJS NON BPJS
1 Puskesmas
3 Poskesdes
JUMLAH
Yang Melapor,
Yang Melapor,

NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN : JULI
TAHUN : 2018
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
50
50
50
50
48
180
-
-
50
200
200
79
800
(100)
-
1,000
50
-
(100)
-
1,000
53
-
2,980
860
3
-
-
24
48
(100)
(15)
(14)
10
-
3,500
64
440
800
-
-
200
(2)
(2)
48
(21)
(3)
240
24
24
-
-
1,200
(182)
-
25 ED 36
-
(120)
300
(61)
3,124
-
-
-
(61)
(86)
(10)
(20)
-
-
(104)
(27)
-
4
(1)
(71)
-
-
-
(300)
-
(340)
30 ED 30
-
20
800
65
(22)
-
48
(1)
(70)
4,000
(250)
400
20
-
500
(110)
-
(200)
24
100 ED 38
1,000
1,800
48
48
300
(90)
(4)
-
-
-
-
-
-
48
2,000
-
8
5
43
-
24
10
(40)
(5)
(200)
48
24
2,020
(40)
(89)
-
2,480
(17)
100
500
(4)
(2)
100
200
(3)
700
500
500
600
-
-
-
400
500
300
24
48
414
720
40
100
(105)
-
10
200
(34)
(4)
48
(20)
(296)
3,960
72
-
4
(210)
-
(200)
(90)
100
21
1,000
500
500
(10)
2,100
(62)
(180)
40
48
60
300
(7)
200
200
-
24
(200)
(59)
(500)
(128)
632
11
252
90
90
(200)
-
(14)
-
820
2,100
(66)
(26)
480
48
24
(2)
-
(1)
-
-
-
-
-
-
1,000
6
(4)
(19)
100
(180)
200
-
(6)
(4)
600
(1)
0
(1)
(1)
(1)
(1)
10
(1)
-
-
-
-
(1)
-
(2)
(10)
(10)
(8)
144
-
-
-
-
-
-
-
-
-
144
300
Mamuju,
r, Yang Menerima,

Mamuju,
r, Yang Menerima,

NIP. 19790102 200604 2 013
OBAT PROGRAM KIA
BULAN : JULI
TAHUN : 2018
3 Metyl Ergometrin Injeksi Ampul 249 0 249 0 0 ED 249

drg. H. FIRMON, MPH Neneng Salmiah S. Farm Nachsan, SKM Mulyani Badani S.Si., Apt
Nip. 19610310 198710 1 002 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
OBAT PROGRAM DIARE
BULAN : JULI
TAHUN : 2018
2 Zink Tablet 320 0 320 120 200

Nip. 19610310 198710 1 002 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
1 Abbocath No. 18 Pcs 11 11 3 8 1
2 Abbocath No. 20 Pcs - 25 25 7 18 1
3 Abbocath No. 22 Pcs - 20 20 4 16 1
4 Abbocath No. 24 Pcs 12 20 32 6 26 1
6 Acyclovir tab 200 mg Tablet 30 30 30 - 6
9 Albendazol tab 400 mg Tablet - 200 200 4 196 1
13 Allopurinol tab 100 mg Tablet - 800 800 370 430 74
17 Ambroxol Syrup Btl/60 ml - - - -
21 Amlodipine 10 mg Tablet 300 300 - 300 -
26 Antacida DOEN suspensi Btl/60 ml 28 3 31 31 - 6
30 Antibakteri DOEN Kombinasi (Bacitracin) Tube 48 48 - 48 -
36 Asam Mefenamat tab 500 mg Tablet - 3,500 3,500 3,500 - 700
37 Asam Askorbat tab 50 mg Tablet 800 100 900 900 - 180
38 Asam Askorbat tab 250 mg Tablet 400 400 300 100 60
39 Asam Folat 1 mg Tablet 800 800 200 600 40
47 Bisturi buah 32 32 7 25 1
48 Blood Lancet Pcs - - - -
49 Catgut No. 2/0 Pcs 24 24 4 20 1
50 Catgut No. 3/0 Pcs 24 24 5 19 1
53 Captopril tab 25 mg Tablet 130 1,200 1,330 750 580 150
56 Cetirizine Syr Botol - - - -
57 CHKM Btl/15 ml - - -
61 Dexamethasone tab 0,5 mg Tablet 380 3,200 3,580 3,580 - 716
65 Diazepam 2 mg Tablet 80 80 - - -
71 Domperidon tablet 10 mg Tablet 200 200 200 - 40
72 Etanol 70% 100 ml Botol 35 35 15 20 3
73 Etanol 70% 1000 ml Botol - - - -
74 Etakridin (Rivanol) 100 ml Botol - - - -
75 Etakridin 0,1% 300 ml Btl/300 1 4 5 3 2 1
83 Fitomenadion (Vit. K1) Injeksi Ampul - 30 30 - 30 -
85 Furosemid tablet 40 mg Tablet 100 100 200 - 200 -
86 Garam Oralit 200 mg Sachet - 1,300 1,300 700 600 140
88 Gentamicin salep mata Tube 22 22 2 20 0
92 Glibenklamid tab 5 mg Tablet 250 250 - 250 -
96 Glukosa 5% Btl/500 ml 19 20 39 24 15 5
97 Glukosa 10% Btl/500 ml - - -
103 Ibuprofen Syrup Btl/60 ml - - - -
106 Infusion set anak Pcs - 48 48 3 45 1
107 Infusion set Dewasa Pcs - 48 48 5 43 1
109 Isosorbid Dinitrat Subli. Tab Tablet 90 90 10 80 2
117 Kalium Permanganas Serbuk Pot/ 5 g - - - -
118 Kalsium Laktat tab 500 mg Tablet - 500 500 500 - 100
124 Karbongliserin Tetes Telinga 10* Botol - 24 24 18 6 4
125 Ketokonazol Salep Tube - 5 5 5 - 1
129 Kloramfenikol Salep Mata 1% Tube - 48 48 28 20 6
131 Klorfeniramin Maleat (CTM) Tablet 1,300 2,100 3,400 2,200 1,200 440
135 Tablet 400 400 400 - 80
Asam Folat
137 Kotrimoksazol tab 120 mg Tablet 30 30 - 30 -
139 Lidocain HCl Injeksi 2% Ampul 28 28 28 - 6
140 Lisol 1 Liter Botol 2 10 12 3 9 1
144 Masker Pcs - 300 300 300 - 60
151 Metronidazol tab 250 mg Tablet 200 200 200 - 40
156 Natrium Diklofenak tablet 25 mg Tablet 150 500 650 650 - 130
158 Natrium Klorida Inf 0,9% Btl/ 500 ml 15 40 55 55 - 11
162 Obat Batuk Hitam (OBH) Btl/ 100 ml 10 10 10 - 2
167 Oxytetracyclin Salep Mata 1% Tube 30 30 30 - 6
169 Paracetamol tab 500 mg Tablet - 4,000 4,000 4,000 - 800
172 Plester/Hipapix (5 cm x 5 m) Roll 3 4 7 7 - 1
173 Prednison tab 5 mg Tablet 750 750 440 310 88
178 Pyrantel tablet 125 mg Tablet 45 100 145 24 121 5
183 Ranitidine tablet 150 mg Tablet 300 3,100 3,400 3,160 240 632
184 Retinol (Vit. A) 100.000 IU Kapluk Kapluk 62 1,000 1,062 712 350 142
186 Ringer Laktat Infus Btl/ 500 ml 10.0 40 50 50 - 10
187 Pot/ 30 g 10.0 48 58 43 15 9
Belerang
195 Scopamin Tablet 200 200 100 100 20
199 Simvastatin tablet 20 mg Tablet 100 100 100 - 20
200 SILK BLACK 3/0 HR 26 MM Peaces 8 12 20 5 15 1
201 Strip Kolesterol Nesco Strip - 400 400 180 220 36
208 Thiamin HCl (B1) Tab 50 mg Tablet 500 900 1,400 800 600 160
209 Vitamin B Complex tab Tablet 1,500 2,100 3,600 3,600 - 720
211 Yodium Povidon 10% 30 ml Botol 28 28 - 28 -
212 Zink Tablet Tablet - 1,000 1,000 1,000 - 200
213 Zink Syr 10 mg Botol - 12 12 12 - 2
217 O A T Kategori Anak Paket 1 1 1 - 0
218 O A T Kategori 1 Paket 4 4 4 1
222 Obat PB Anak Strip 6 6 6 - -
225 Sarung Tangan M Box - 6 6 4 2 1
226 Lidokain Spray Botol 4 4 2 2 0
228 Elkana Syr Botol 0 196 196 51 145 10
245 Bisakodil Suppo 10 mg Suppo 0 - - -
253 Plano Test Pcs 150 150 150 0 30
263 Hemafort Tablet 0 200 200 200 0 40
264 Mediamer Tablet 300 300 100 200 20
267 Masker N 25 Pcs

BPJS NON BPJS
1 Puskesmas
3 Poskesdes
JUMLAH
Yang Melapor,
Yang Melapor,

NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN : AGUSTUS
TAHUN : 2018
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
12
(10)
(11)
(19)
50
36
400
-
(191)
(210)
(132)
(80)
500
10
-
1,000
50
-
(100)
-
(300)
55
-
3,000
(340)
50
-
-
0
(48)
(100)
(15)
20
15
-
4,200
3,000
500
(360)
-
-
200
(2)
0
50
(31)
(17)
500
(15)
(13)
-
-
520
(180)
15
15
-
(80)
200
(14)
4,296
-
-
-
100 ED 80
(86)
(10)
(20)
-
-
240
(2)
-
-
2
(87)
-
-
10
(300)
-
400
(30)
-
(200)
400
(32)
(18)
-
24
1
(250)
4,000
(250)
24
14
-
(656)
(110)
-
(24)
25
50
800
2,000
(41)
(37)
200
(68)
12
-
-
-
-
-
-
24
1,000
-
5
(3)
52
-
16
12
(100)
(7)
(200)
14
(9)
2,000
(40)
(89)
-
1,200
(13)
(30)
(210)
100
(5)
188
300
(7)
600
400
500
800
-
-
-
800
500
(196)
-
(72)
780
520
66
100
(117)
-
20
(144)
(21)
(4)
(18)
36
(170)
4,800
146
-
8
218
-
(200)
(90)
75
(92)
1,120
300
400
(10)
3,552
-
-
60
50
92
204
(7)
88
174
-
-
100
(43)
(500)
300
300
(9)
(4)
125
125
(200)
-
(14)
-
360
4,320
(74)
(28)
1,200
25
15
(2)
-
1
5
-
-
-
-
-
1,000
3
0
(15)
(84)
(180)
-
-
(6)
(4)
720
(1)
(1)
(1)
(1)
(1)
(1)
-
(1)
-
-
-
-
(1)
-
(2)
(10)
(10)
(1)
180
-
-
-
-
-
-
-
-
-
240
(80)
Mamuju,
r, Yang Menerima,

r, Yang Menerima,

NIP. 19790102 200604 2 013
OBAT PROGRAM KIA
BULAN : AGUSTUS
TAHUN : 2018

Nip. 19610310 198710 1 002 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
OBAT PROGRAM DIARE
BULAN : AGUSTUS
TAHUN : 2018
2 Zink Tablet 200 0 200 200 0

Nip. 19610310 198710 1 002 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
LAPORAN PEMAKA
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML
NO NAMA OBAT/BMHP SATUAN STOK AWAL
PENERIMAAN
1 2 3 4 5
1 Abbocath No. 18 Pcs 8
5 Acyclovir Cream 3% Tube - 48
6 Acyclovir tab 200 mg Tablet -
8 Albendazol Suspensi 25 mg / 5 ml Btl/10 ml 15
9 Albendazol tab 400 mg Tablet 196
10 Alat Suntik Sekali Pakai 1 ml Pcs 270
13 Allopurinol tab 100 mg Tablet 430 500
16 Ambroxol tab 30 mg Tablet - 1,000
17 Ambroxol Syrup Btl/60 ml - 10
19 Aminophyllin tab 200 mg Tablet 100
21 Amlodipine 10 mg Tablet 300
22 Amoxycillin syrup kering 125 mg/ 5 ml Btl/60 ml 35 60
24 Amoxycillin capl 500 mg Kaplet 800
25 Antacida DOEN tab. Kunyah Komb : Tablet 700
26 Antacida DOEN suspensi Btl/60 ml - 50
29 Antifungi DOEN Kombinasi Tube 14
30 Antibakteri DOEN Kombinasi (Bacitracin) Tube 48
31 Antimalaria DOEN Kombinasi Tablet 100
32 Antimigren : Ergotamin Tartrat + Kofein Tablet 15
33 Antihaemorrid Supp Supp 10 20
34 Antiseptik Hand Rub 500 m Botol - 7
36 Asam Mefenamat tab 500 mg Tablet - 4,200
37 Asam Askorbat tab 50 mg Tablet - 3,000
38 Asam Askorbat tab 250 mg Tablet 100
39 Asam Folat 1 mg Tablet 600
41 Atropin sulfat Injeksi 0,25 mg/ml Ampul -
42 Attapulgit Tablet 0
43 Aqua Pro Injeksi 20 ml Btl/20 ml 2
44 Aquagel Sterile Jely 82 gr Tube 2
45 Bedak Salisil Pot - 5
46 Betametason cream Tube 38
47 Bisturi buah 25
48 Blood Lancet Pcs - 100
49 Catgut No. 2/0 Pcs 20
50 Catgut No. 3/0 Pcs 19
53 Captopril tab 25 mg Tablet 580 600
54 Cefadroxil 500 mg Tablet 240
56 Cetirizine Syr Botol -
57 CHKM Btl/15 ml
58 Cimetidine tab 200 mg Tablet 200 2,000
59 Ciprofloxacin tab 500 mg Tablet 230 200
60 Dexamethasone Injeksi Ampul 50
61 Dexamethasone tab 0,5 mg Tablet - 4,300
65 Diazepam 2 mg Tablet - 100
66 Diazepam 5 mg Tablet 86
67 Diazepam Injeksi Ampul 10
68 Difenhidramin Injeksi 10 mg/ml Ampul 20
71 Domperidon tablet 10 mg Tablet - 1,500
72 Etanol 70% 100 ml Botol 20
74 Etakridin (Rivanol) 100 ml Botol - 2
75 Etakridin 0,1% 300 ml Btl/300 2
76 Efinefrin HCl Bitartrat Inj Ampul 87
79 Etylchlorida semprot Btl/100
80 Fenobarbital tab 30 mg Tablet 300
82 Fitomenadion (Vit. K1) tab 10 mg Tablet 80 400
83 Fitomenadion (Vit. K1) Injeksi Ampul 30
84 Fletcher Set
85 Furosemid tablet 40 mg Tablet 200
86 Garam Oralit 200 mg Sachet 600 400
87 Gentamicin salep kulit Tube 50
88 Gentamicin salep mata Tube 20
90 Gentian Violet 1% Btl/ 5 ml -
91 Glass Ionometer Cemen Set -
92 Glibenklamid tab 5 mg Tablet 250
93 Gliceryl Guaicolat tab 100 mg Tablet -
94 Glimepiride Tab 1 mg Tablet 250
95 Glimepiride tab 2 mg Tablet 300 50
96 Glukosa 5% Btl/500 ml 15 20
98 Griseofulvin tab 125 mg Tablet 680
99 Haloperidol tab 0,5 mg Tablet 110
101 Hidroklorothiazid (HCT) tab Tablet 120
102 Hidrokortison Cream 2,5% Tube 23 24
103 Ibuprofen Syrup Btl/60 ml -
104 Ibuprofen tab 200 mg Tablet -
105 Ibuprofen tab 400 mg Tablet -
106 Infusion set anak Pcs 45
107 Infusion set Dewasa Pcs 43
109 Isosorbid Dinitrat Subli. Tab Tablet 80
110 Jarum Jahit bedah No. 9 Pcs 5 12
117 Kalium Permanganas Serbuk Pot/ 5 g - 10
118 Kalsium Laktat tab 500 mg Tablet -
120 Kapas Pembalut Hidrofil DRC 250 Gram Roll 3 5
121 Kasa Hidrofil DRC 36 m x 80 cm Roll 4
122 Kasa Pembalut Hidrofil DRC 4m x 15 cm Roll -
123 Kasa 5 Cm Roll
124 Karbongliserin Tetes Telinga 10* Botol 6 16
125 Ketokonazol Salep Tube -
126 Ketokenazol Tab Tablet 100
127 Kloramfenikol Suspensi Botol/60ml 7
128 Kloramfenikol caps 250 mg Tablet 200
129 Kloramfenikol Salep Mata 1% Tube 20 14
130 Kloramfenikol Tetes Telinga Botol5 ml 15
131 Klorfeniramin Maleat (CTM) Tablet 1,200 2,000
132 Klorpromazin tab 25 mg Tablet 40
133 Klorpromazin tab 100 mg Tablet 89
135 Tablet - 1,200
Asam Folat
136 Kotrimoksazol Suspensi Btl/ 60 ml 25
137 Kotrimoksazol tab 120 mg Tablet 30
138 Kotrimoksazol tab 480 mg Tablet 450
139 Lidocain HCl Injeksi 2% Ampul - 100
140 Lisol 1 Liter Botol 9
141 Loratadine tablet 10 mg Tablet 100
142 Loperamide Tablet 50 300
143 Magnesium Sulfat injeksi 40 % Ampul 7
144 Masker Pcs - 300
145 Meloksikam tab 7,5 mg Tablet
146 Meloksikam tab 15 mg Tablet -
147 Metformin HCl tablet 500 mg Tablet - 600
151 Metronidazol tab 250 mg Tablet - 800
152 Metronidazol tab 500 mg Tablet -
153 Metylergometrin Maleat tab. Tablet 400
155 Miconazole Cream Tube 79
156 Natrium Diklofenak tablet 25 mg Tablet - 750
157 Natrium Diklofenak tablet 50 mg Tablet 200 600
158 Natrium Klorida Inf 0,9% Btl/ 500 ml - 180
159 Nifedipin Tablet Tablet -
160 Nistatin Tab. Vag 100.000 UI Tablet 117
162 Obat Batuk Hitam (OBH) Btl/ 100 ml - 10
163 Omeprazole Tablet 240
164 Oxytocin Inj 10 mg/ml Ampul 34
165 Oxytetracyclin HCl Inj Vial 4
166 Oxytetracyclin SK. 3% Tube 46
167 Oxytetracyclin Salep Mata 1% Tube - 50
168 Papaverin HCl tab 40 mg Tablet 350
169 Paracetamol tab 500 mg Tablet - 5,800
170 Paracetamol syrup Btl/ 60 ml 250
172 Plester/Hipapix (5 cm x 5 m) Roll - 20
173 Prednison tab 5 mg Tablet 310 1,000
175 Propilthiourasil (PTU) tablet Tablet 200
176 Propranolol tablet 40 mg Tablet 90
177 Pyrantel Suspensi 125 mg/5 ml Botol -
178 Pyrantel tablet 125 mg Tablet 121
179 Pyridoxin HCl tablet 10 mg Tablet 200 1,200
182 Ranitidine Injeksi 25 mg/ml Ampul 10
183 Ranitidine tablet 150 mg Tablet 240
184 Retinol (Vit. A) 100.000 IU Kapluk Kapluk 350
185 Retinol (Vit. A) 200.000 IU Kapluk Kapluk 150
186 Ringer Laktat Infus Btl/ 500 ml - 160
187 Pot/ 30 g 15.0 50
Belerang
188 Salbutamol tab 2 mg Tablet 100 100
190 Salbutamol Sirup Botol 7
191 Sarung Tangan No. 6,5 Steril Pasang 80 100
192 Sarung Tangan No. 7 Steril Pasang 50 150
195 Scopamin Tablet 100
196 Sianocobalamin (Vit. B12) Injeksi Ampul 65
197 Sianocobalamin (Vit. B12) Tab Tablet 500
198 Simvastatin tablet 10 mg Tablet 70 500
200 SILK BLACK 3/0 HR 26 MM Peaces 15
201 Strip Kolesterol Nesco Strip 220
202 Strip Asam Urat Nesco Strip - 125
203 Strip Glukosa Nesco Strip - 125
204 Tetracycline HCl 250 mg Capsul 200
205 Tetracycline HCl 500 mg Capsul
206 Tetrakain Tetes Mata Botol 14
208 Thiamin HCl (B1) Tab 50 mg Tablet 600
209 Vitamin B Complex tab Tablet - 4,300
210 Yodium Povidon 10% 300 ml Botol 80
211 Yodium Povidon 10% 30 ml Botol 28
212 Zink Tablet Tablet -
214 Zink Syr 20 mg Botol
215 Kantong Mayat Pcs 2
217 O A T Kategori Anak Paket - 1
218 O A T Kategori 1 Paket - 5
224 Sangobion Tablet -
225 Sarung Tangan M Box 2 3
226 Lidokain Spray Botol 2
227 Lidokain Gel Tube 17
228 Elkana Syr Botol 145
229 Bisakodil 5 mg Tablet 180
231 Kateter buah
232 Dulcolax Suppo 5 mg Suppo 6
233 Dulcolax Suppo 10 mg Suppo 4
234 Amlodipine 5 mg Tablet 700
235 Bonding Tambalan Komposit GC Botol 1
236 Calcium Hidtoksida Technew Tube 1
237 Caviton Tube 1
238 Eugenol Cairan Botol 1
239 Elite Powder Cemen GC Botol 1
240 Elite Cemen Liquid GC Botol 1
241 Sponge Gigi / Hemospon Pcs 0
242 Tambalan Amalgam Powder SDI Tube 1
243 Tambalan Komposit GC Hydcal Tube 0
244 Tambalan Komposit 3M P60 Botol 0
245 Bisakodil Suppo 10 mg Suppo 0
247 Reagen ZN Paket 1
249 Slide Prostad Pcs 2
250 Diazepam enema 5 mg/2,5 ml Tube 10
251 Diazepam enema 10 mg/2,5 ml Tube 10
252 Nistatin Suspensi 100.000 UI/ml Botol 5
253 Plano Test Pcs 180
258 Bur Intan Set
259 Cotton Roll Pak
263 Hemafort Tablet 0 300
264 Mediamer Tablet 200
265 Metyl Prednisolon Tablet
267 Masker N 25 Pcs

BPJS NON BPJS
1 Puskesmas
3 Poskesdes
JUMLAH

drg. H. FIRMON, MPH NENENG SALMIAH, S.Farm

NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011
PORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
BULAN : SEPTEMBER
TAHUN : 2018
STOK PEMBER
PERSEDIAAN PEMAKAIAN STOK AKHIR PERMINTAAN
PENGAMAN PKD
6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20% 10=(7+9)-8 11
8 4 4 1 1
18 5 13 1 (7)
16 7 9 1 (1)
26 8 18 2 (8)
48 8 40 2 (30)
- - - 400
- - - 200
15 13 2 3 14
196 12 184 2 (170)
270 5 265 1 (259)
218 145 73 29 101
100 - 100 - (100)
930 730 200 146 878
150 50 100 10 (40)
- - - -
1,000 1,000 - 200 3,000
10 10 - 2 50
- - - -
100 - 100 - (100)
- - - -
300 300 - 60 600
95 90 5 18 103
- - - -
800 800 - 160 3,500
700 700 - 140 1,500
50 38 12 8 50
- - - -
- - - -
14 4 10 1 (5)
48 - 48 - (48)
100 - 100 - (100)
15 15 - 3 200
30 - 30 - (30)
7 7 - 1 12
- - - -
4,200 3,100 1,100 620 3,000
3,000 3,000 - 600 3,600
100 100 - 20 300
600 300 300 60 500
- - - -
- - - -
- - - 200
2 - 2 - (2)
2 2 - 0 6
5 5 - 1 24
38 31 7 6 30
25 5 20 1 (14)
100 100 - 20 300
20 - 20 - (20)
19 3 16 1 (12)
- - - -
- - - -
1,180 1,080 100 216 1,196
240 240 - 48 288
- - - 15
- - - 15
- - - -
2,200 2,200 - 440 2,640
430 330 100 66 389
50 23 27 5 100
4,300 4,000 300 800 4,500
- - - -
- - - -
- - - -
100 50 50 10 100
86 41 45 8 4
10 - 10 - (10)
20 - 20 - (20)
- - - -
- - - -
1,500 300 1,200 60 (840)
20 13 7 3 12
- - - 6
2 2 - 0 12
2 2 - 0 6
87 - 87 - (87)
- - - -
- - - -
- - - 6
300 - 300 - (300)
- - - -
480 - 480 - (480)
30 - 30 - (30)
- - - -
200 140 60 28 108
1,000 300 700 60 (340)
50 47 3 9 53
20 - 20 - (20)
- - - -
- - - 12
- - - -
250 - 250 - (250)
- - - 3,000
250 - 250 - (250)
350 50 300 10 (240)
35 - 35 - (35)
- - - -
680 340 340 68 400
110 - 110 - (110)
- - - -
120 10 110 2 (98)
47 37 10 7 50
- - - 50
- - - 2,000
- - - 2,000
45 5 40 1 (34)
43 23 20 5 24
- - - 200
80 - 80 - (80)
17 7 10 1 12
- - - -
- - - -
- - - -
- - - -
- - - -
- - - -
10 10 - 2 24
- - - 2,000
- - - -
8 3 5 1 (1)
4 4 - 1 5
- - - 100
- - - -
22 8 14 2 (4)
- - - 12
100 - 100 - (100)
7 - 7 - (7)
200 70 130 14 200
34 - 34 - (34)
15 7 8 1 12
3,200 3,000 200 600 3,400
40 - 40 - (40)
89 40 49 8 (1)
- - - -
1,200 1,100 100 220 1,500
25 25 - 5 50
30 30 - 6 400
450 350 100 70 500
100 24 76 5 (47)
9 5 4 1 2
100 100 - 20 200
350 150 200 30 (20)
7 - 7 - (7)
300 300 - 60 600
- - - 400
- - - 500
600 300 300 60 400
- - - -
- - - -
- - - -
800 550 250 110 410
- - - 600
400 400 - 80 480
- - - -
79 55 24 11 50
750 600 150 120 570
800 800 - 160 960
180 - 180 - (180)
- - - -
117 - 117 - (117)
- - - -
10 10 - 2 12
240 160 80 32 112
34 - - - 24
4 - 4 - (4)
46 6 40 1 (33)
50 5 45 1 (39)
350 30 320 6 (284)
5,800 4,700 1,100 940 4,540
250 167 83 33 117
- - - -
20 8 12 2 (2)
1,310 1,010 300 202 1,200
- - - -
200 - 200 - (200)
90 - 90 - (90)
- - - 50
121 85 36 17 200
1,400 1,000 400 200 1,000
- - - 500
- - - 600
10 - 10 - (10)
240 240 - 48 2,000
350 30 320 6 (284)
150 - 150 - (150)
160 10 150 2 (138)
65 62 3 12 71
200 170 30 34 174
420 215 205 43 53
7 - 7 - (7)
180 30 150 6 (114)
200 40 160 8 (112)
- - - -
- - - 12
100 - 100 - (100)
65 20 45 4 (21)
500 - 500 - (500)
570 520 50 104 574
- - - 500
15 9 6 2 12
220 170 50 34 200
125 125 - 25 200
125 125 - 25 200
200 200 - 40 -
- - - 100
14 - 14 - (14)
- - - -
600 600 - 120 1,500
4,300 3,800 500 760 4,060
80 12 68 2 (54)
28 8 20 2 (10)
- - - 1,500
- - - 50
- - - 50
2 - 2 - (2)
- - - -
1 - - - -
5 1 4 0 (3)
- - - -
- - - -
- - - -
- - - -
- - - -
- - - 500
5 4 1 1 4
2 - 2 - (2)
17 2 15 0 (13)
145 47 98 9 (42)
180 - 180 - (180)
- - - 200
- - - 5
6 - 6 - (6)
4 - 4 - (4)
700 300 400 60 500
1 - 0 - 2
1 - 1 - (1)
1 - 0 - 1
1 - 1 - 1
1 - 1 - (1)
1 - 1 - (1)
- - - - 100
1 - 1 - (1)
- - - 1
- - - 1
- - - -
- - - -
1 1 0 1
- - - -
2 2 0 2
10 - 10 - (10)
10 - 10 - (10)
5 - 5 - (5)
180 80 100 16 (4)
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
- - - 1
300 300 0 60 360
200 - 200 - (200)
1,000
1
Ma
Yang Melapor,
armasi
Kepala Puskesmas Rangas Peng
. Mamuju
S.Farm Nachsan, SKM

Nip. 19630723 198903 1 009 MULY
03 2 011
NIP. 19
TEMBER
PEMBERIAN TOTAL
KET
DKP/PROGRAM LAIN-LAIN PEMBERIAN
12 13 14 15
ED 15
ED 100
ED 400
ED 34
ED 1
ED 1
Mamuju,
Yang Menerima,

NIP. 19790102 200604 2 013
OBAT PROGRAM KIA
BULAN : SEPTEMBER
TAHUN : 2018

Nip. 19610310 198710 1 002 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
2 Abbocath No. 20 Pcs 18 18 5 13 1
3 Abbocath No. 22 Pcs 16 16 7 9 1
4 Abbocath No. 24 Pcs 26 26 8 18 2
5 Acyclovir Cream 3% Tube - 48 48 8 40 2
6 Acyclovir tab 200 mg Tablet - - - -
8 Albendazol Suspensi 25 mg / 5 ml Btl/10 ml 15 15 13 2 3
17 Ambroxol Syrup Btl/60 ml - 10 10 10 - 2
21 Amlodipine 10 mg Tablet 300 300 300 - 60
24 Amoxycillin capl 500 mg Kaplet 800 800 800 - 160
26 Antacida DOEN suspensi Btl/60 ml - 50 50 38 12 8
32 Antimigren : Ergotamin Tartrat + Kofein Tablet 15 15 15 - 3
33 Antihaemorrid Supp Supp 10 20 30 - 30 -
36 Asam Mefenamat tab 500 mg Tablet - 4,200 4,200 3,100 1,100 620
38 Asam Askorbat tab 250 mg Tablet 100 100 100 - 20
47 Bisturi buah 25 25 5 20 1
48 Blood Lancet Pcs - 100 100 100 - 20
49 Catgut No. 2/0 Pcs 20 20 - 20 -
50 Catgut No. 3/0 Pcs 19 19 3 16 1
53 Captopril tab 25 mg Tablet 580 600 1,180 1,080 100 216
54 Cefadroxil 500 mg Tablet 240 240 240 - 48
57 CHKM Btl/15 ml - - -
58 Cimetidine tab 200 mg Tablet 200 2,000 2,200 2,200 - 440
61 Dexamethasone tab 0,5 mg Tablet - 4,300 4,300 4,000 300 800
65 Diazepam 2 mg Tablet - 100 100 50 50 10
71 Domperidon tablet 10 mg Tablet - 1,500 1,500 300 1,200 60
72 Etanol 70% 100 ml Botol 20 20 13 7 3
73 Etanol 70% 1000 ml Botol - - - -
74 Etakridin (Rivanol) 100 ml Botol - 2 2 2 - 0
75 Etakridin 0,1% 300 ml Btl/300 2 2 2 - 0
82 Fitomenadion (Vit. K1) tab 10 mg Tablet 80 400 480 - 480 -
86 Garam Oralit 200 mg Sachet 600 400 1,000 300 700 60
91 Glass Ionometer Cemen Set - - - -
96 Glukosa 5% Btl/500 ml 15 20 35 - 35 -
97 Glukosa 10% Btl/500 ml - - -
110 Jarum Jahit bedah No. 9 Pcs 5 12 17 7 10 1
122 Kasa Pembalut Hidrofil DRC 4m x 15 cm Roll - - - -
124 Karbongliserin Tetes Telinga 10* Botol 6 16 22 8 14 2
125 Ketokonazol Salep Tube - - - -
129 Kloramfenikol Salep Mata 1% Tube 20 14 34 - 34 -
135 Tablet - 1,200 1,200 1,100 100 220
Asam Folat
136 Kotrimoksazol Suspensi Btl/ 60 ml 25 25 25 - 5
137 Kotrimoksazol tab 120 mg Tablet 30 30 30 - 6
139 Lidocain HCl Injeksi 2% Ampul - 100 100 24 76 5
140 Lisol 1 Liter Botol 9 9 5 4 1
141 Loratadine tablet 10 mg Tablet 100 100 100 - 20
144 Masker Pcs - 300 300 300 - 60
147 Metformin HCl tablet 500 mg Tablet - 1,100 1,100 800 300 160
151 Metronidazol tab 250 mg Tablet - 800 800 550 250 110
153 Metylergometrin Maleat tab. Tablet 400 400 400 - 80
158 Natrium Klorida Inf 0,9% Btl/ 500 ml - 180 180 - 180 -
162 Obat Batuk Hitam (OBH) Btl/ 100 ml - 10 10 10 - 2
164 Oxytocin Inj 10 mg/ml Ampul 34 34 - - -
167 Oxytetracyclin Salep Mata 1% Tube - 50 50 5 45 1
169 Paracetamol tab 500 mg Tablet - 5,800 5,800 4,700 1,100 940
170 Paracetamol syrup Btl/ 60 ml 250 250 167 83 33
183 Ranitidine tablet 150 mg Tablet 240 240 240 - 48
187 Pot/ 30 g 15.0 50 65 62 3 12
Belerang
199 Simvastatin tablet 20 mg Tablet - - - -
204 Tetracycline HCl 250 mg Capsul 200 200 200 - 40
208 Thiamin HCl (B1) Tab 50 mg Tablet 600 600 600 - 120
209 Vitamin B Complex tab Tablet - 4,300 4,300 3,800 500 760
212 Zink Tablet Tablet - - - -
213 Zink Syr 10 mg Botol - - - -
217 O A T Kategori Anak Paket - 1 1 - - -
228 Elkana Syr Botol 145 145 47 98 9
239 Eugenol Cairan Botol 1 1 1 1 0
242 Sponge Gigi / Hemospon Pcs 0 - - - -
248 Reagen ZN Paket 1 1 1 0
250 Slide Prostad Pcs 2 2 2 0
254 Plano Test Pcs 180 180 80 100 16
257 Microbrush Botol - - -
264 Hemafort Tablet 0 300 300 300 0 60
265 Mediamer Tablet 200 200 - 200 -
266 Metyl Prednisolon Tablet

BPJS NON BPJS
1 Puskesmas
3 Poskesdes
JUMLAH
Yang Melapor,

NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009

NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN : SEPTEMBER
TAHUN : 2018
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
1
(7)
(1)
(8)
(30)
400
200
14
(170)
(259)
101
(100)
878
(40)
-
3,000
50
-
(100)
-
600
103
-
3,500
1,500
50
-
-
(5)
(48)
(100)
200 ED 15
(30)
12
-
3,000
3,600
300
500
-
-
200
(2)
6
24
30
(14)
300
(20)
(12)
-
-
1,196
288
15
15
-
2,640
389
100
4,500
-
-
-
100
4
(10)
(20)
-
-
(840)
12
6
12
6
(87)
-
-
6
(300)
-
(480)
(30)
-
108
(340)
53
(20)
-
12
-
(250)
3,000
(250)
(240)
(35)
-
400
(110)
-
(98)
50
50
2,000
2,000
(34)
24
200
(80)
12
-
-
-
-
-
-
24
2,000
-
(1)
5
100
-
(4)
12
(100)
(7)
200
(34)
12
3,400
(40)
(1)
-
1,500
50
400
500
(47)
2
200 ED 100
(20)
(7)
600
400
500
400
-
-
-
410
600
480 ED 400
-
50
570
960
(180)
-
(117)
-
12
112
24 ED 34
(4)
(33)
(39)
(284)
4,540
117
-
(2)
1,200
-
(200)
(90)
50
200
1,000
500
600
(10)
2,000
(284)
(150)
(138)
71
174
53
(7)
(114)
(112)
-
12
(100)
(21)
(500)
574
500
12
200
200
200
-
100
(14)
-
1,500
4,060
(54)
(10)
1,500
50
50
(2)
-
-
(3)
-
-
-
-
-
500
4
(2)
(13)
(42)
(180)
200
5
(6)
(4)
500
2 ED 1
(1)
1 ED 1
1
(1)
(1)
100
(1)
1
1
-
-
1
-
2
(10)
(10)
(5)
(4)
1
1
1
1
1
1
1
1
1
360
(200)
1,000
1
Mamuju,
r, Yang Menerima,

NIP. 19790102 200604 2 013

NIP. 19790102 200604 2 013
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
1 Abbocath No. 18 Pcs 4 4 4 - 1
2 Abbocath No. 20 Pcs 13 13 13 - 3
4 Abbocath No. 24 Pcs 18 18 8 10 2
8 Albendazol Suspensi 25 mg / 5 ml Btl/10 ml 2 15 17 - 17 -
13 Allopurinol tab 100 mg Tablet 200 1,000 1,200 500 700 100
14 Allopurinol tab 300 mg Tablet 100 100 100 - 20
16 Ambroxol tab 30 mg Tablet - 1,500 1,500 1,400 100 280
17 Ambroxol Syrup Btl/60 ml - 20 20 15 5 3
21 Amlodipine 10 mg Tablet - 600 600 500 100 100
24 Amoxycillin capl 500 mg Kaplet - 1,500 1,500 1,500 - 300
25 Antacida DOEN tab. Kunyah Komb : Tablet - 1,500 1,500 990 510 198
30 Antibakteri DOEN Kombinasi (Bacitracin) Tube 48 48 36 12 7
32 Antimigren : Ergotamin Tartrat + Kofein Tablet - - - - -
36 Asam Mefenamat tab 500 mg Tablet 1,100 3,000 4,100 2,610 1,490 522
37 Asam Askorbat tab 50 mg Tablet - 3,600 3,600 2,100 1,500 420
38 Asam Askorbat tab 250 mg Tablet 0 - - -
39 Asam Folat 1 mg Tablet 300 300 600 400 200 80
44 Aquagel Sterile Jely 82 gr Tube - 6 6 4 2 1
47 Bisturi buah 20 20 20 - 4
48 Blood Lancet Pcs - 100 100 100 - 20
49 Catgut No. 2/0 Pcs 20 20 12 8 2
50 Catgut No. 3/0 Pcs 16 16 4 12 1
53 Captopril tab 25 mg Tablet 100 1,200 1,300 890 410 178
54 Cefadroxil 500 mg Tablet - - - -
57 CHKM Btl/15 ml - - -
58 Cimetidine tab 200 mg Tablet - 2,000 2,000 2,000 - 400
59 Ciprofloxacin tab 500 mg Tablet 100 1,000 1,100 160 940 32
60 Dexamethasone Injeksi Ampul 27 200 227 27 200 5
61 Dexamethasone tab 0,5 mg Tablet 300 5,000 5,300 4,396 904 879
65 Diazepam 2 mg Tablet 50 100 150 - 150 -
70 Diltiazem HCl tablet 30 mg Tablet 100 100 - 100 -
71 Domperidon tablet 10 mg Tablet 1,200 1,200 140 1,060 28
72 Etanol 70% 100 ml Botol 7 30 37 27 10 5
73 Etanol 70% 1000 ml Botol - 2 2 2 - 0
74 Etakridin (Rivanol) 100 ml Botol - 12 12 5 7 1
75 Etakridin 0,1% 300 ml Btl/300 - 6 6 2 4 0
80 Fenobarbital tab 30 mg Tablet 300 300 20 280 4
86 Garam Oralit 200 mg Sachet 700 700 400 300 80
90 Gentian Violet 1% Btl/ 5 ml - 10 10 10 - 2
93 Gliceryl Guaicolat tab 100 mg Tablet - 2,000 2,000 1,500 500 300
96 Glukosa 5% Btl/500 ml 35 35 3 32 1
97 Glukosa 10% Btl/500 ml - - -
99 Haloperidol tab 0,5 mg Tablet 110 110 - - -
121 Kasa Hidrofil DRC 36 m x 80 cm Roll - - - -
128 Kloramfenikol caps 250 mg Tablet 130 1,000 1,130 30 1,100 6
135 Tablet 100 1,500 1,600 1,600 - 320
Asam Folat
136 Kotrimoksazol Suspensi Btl/ 60 ml - 50 50 42 8 8
137 Kotrimoksazol tab 120 mg Tablet - - - -
138 Kotrimoksazol tab 480 mg Tablet 100 1,500 1,600 340 1,260 68
141 Loratadine tablet 10 mg Tablet - - - -
144 Masker Pcs - 300 300 300 - 60
145 Meloksikam tab 7,5 mg Tablet 400 400 400 - 80
147 Metformin HCl tablet 500 mg Tablet 300 400 700 170 530 34
153 Metylergometrin Maleat tab. Tablet - 1,000 1,000 180 820 36
164 Oxytocin Inj 10 mg/ml Ampul - 200 200 17 183 3
165 Oxytetracyclin HCl Inj Vial 4 4 - - -
169 Paracetamol tab 500 mg Tablet 1,100 4,600 5,700 4,150 1,550 830
170 Paracetamol syrup Btl/ 60 ml 83 117 200 116 84 23
173 Prednison tab 5 mg Tablet 300 2,000 2,300 900 1,400 180
178 Pyrantel tablet 125 mg Tablet 36 500 536 251 285 50
183 Ranitidine tablet 150 mg Tablet - - - -
187 Pot/ 30 g 3.0 96 99 38 61 8
Belerang
198 Simvastatin tablet 10 mg Tablet 50 600 650 650 - 130
201 Strip Kolesterol Nesco Strip 50 200 250 170 80 34
202 Strip Asam Urat Nesco Strip - 200 200 175 25 35
203 Strip Glukosa Nesco Strip - 200 200 150 50 30
204 Tetracycline HCl 250 mg Capsul - - - -
208 Thiamin HCl (B1) Tab 50 mg Tablet - - - -
217 O A T Kategori Anak Paket - - - -
225 Sarung Tangan M Box 1 4 5 5 - 1
228 Elkana Syr Botol 98 98 31 67 6
234 Amlodipine 5 mg Tablet 400 500 900 825 75 165
237 Caviton Tube 0 - - -
244 Tambalan Komposit 3M P60 Botol 0 1 1 - 1 -
249 Slide Prostad Pcs 0 144 144 - 144 -
253 Plano Test Pcs 100 100 20 80 4
263 Hemafort Tablet 0 500 500 400 100 80
264 Mediamer Tablet 200 200 100 100 20
265 Metyl Prednisolon 4 mg Tablet 1000 1,000 400 600 80
267 Masker N 25 Pcs
BPJS NON BPJS
1 Puskesmas
3 Poskesdes
JUMLAH
Yang Melapor,

NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009

NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN : OKTOBER
TAHUN : 2018
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
48
48
48
48
(18)
-
300
(17)
(184)
(188)
377
(100)
(100)
120
-
1,800
25
-
(100)
-
500
50
-
3,000
678
(13)
-
-
12
31
(100)
200
(8)
12
-
2,042
1,020
-
280
-
-
200
(2)
3
25
24
100
120
24
(7)
-
-
758
200
15
15
-
2,500
(748)
(168)
4,371
-
-
-
(150)
(143)
(10)
(20)
-
(100)
(892)
22
2
(1)
(2)
(87)
-
-
6
(256)
-
(480)
(17)
-
(96)
180
24
(2)
-
15
-
(250)
1,500
(250)
(300)
(28)
-
52
100 ED 110
-
(66)
48
50
800
1,000
(40)
(44)
100
(80)
(7)
-
-
-
-
-
-
15
500
-
(1)
8
100
-
10
24
(100)
(7)
(1,064)
(30)
10
3,858
(40)
(38)
-
2,300
42
100
(852)
79
(7)
200
100
(7)
600
500
600
(326)
-
-
-
394
500
(604)
-
41
900
392
(143)
-
(117)
-
(8)
(24)
(163)
- ED 4
35
(12)
(254)
3,430
55
-
(1)
(320)
-
(134)
(90)
50
-
900
500
500
10
2,000
(254)
(128)
(106)
(15)
54
102
(7)
(16)
(4)
-
12
(100)
100
(500)
780
300
(21)
200
200
200
-
-
(14)
-
2,000
4,520
(42)
(0)
1,000
24
24
(2)
-
-
5
1
-
-
-
-
1,000
6
5
(13)
(30)
29
200
5
(6)
(4)
915
(1)
(1)
-
(1)
(1)
(1)
100
(1)
-
(1)
-
50
(1)
-
(144)
(10)
(10)
(5)
(56)
-
-
-
-
-
-
-
-
-
380
20
(120)
Mamuju,
r, Yang Menerima,

NIP. 19790102 200604 2 013

NIP. 19790102 200604 2 013
LAPORAN PEMAKA
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML
NO NAMA OBAT/BMHP SATUAN STOK AWAL
PENERIMAAN
1 2 3 4 5
1 Abbocath No. 18 Pcs 35 -
2 Abbocath No. 20 Pcs 36 25
5 Acyclovir Cream 3% Tube - 48
6 Acyclovir tab 200 mg Tablet 180 -
8 Albendazol Suspensi 25 mg / 5 ml Btl/10 ml - 15
9 Albendazol tab 400 mg Tablet 196 200
10 Alat Suntik Sekali Pakai 1 ml Pcs 390 400
13 Allopurinol tab 100 mg Tablet 610 1,700
16 Ambroxol tab 30 mg Tablet - 1,000
17 Ambroxol Syrup Btl/60 ml 9 10
19 Aminophyllin tab 200 mg Tablet 300 -
21 Amlodipine 10 mg Tablet 300 300
22 Amoxycillin syrup kering 125 mg/ 5 ml Btl/60 ml 221 120
24 Amoxycillin capl 500 mg Kaplet 2,300 5,800
25 Antacida DOEN tab. Kunyah Komb : Tablet 1,300 1,300
26 Antacida DOEN suspensi Btl/60 ml 68 67
29 Antifungi DOEN Kombinasi Tube 34 24
30 Antibakteri DOEN Kombinasi (Bacitracin) Tube 48 48
31 Antimalaria DOEN Kombinasi Tablet 300 -
32 Antimigren : Ergotamin Tartrat + Kofein Tablet 45 -
33 Antihaemorrid Supp Supp 55 20
34 Antiseptik Hand Rub 500 m Botol - 21
36 Asam Mefenamat tab 500 mg Tablet 940 7,700
37 Asam Askorbat tab 50 mg Tablet 2,320 3,100
38 Asam Askorbat tab 250 mg Tablet 1,600 -
39 Asam Folat 1 mg Tablet 600 1,300
41 Atropin sulfat Injeksi 0,25 mg/ml Ampul - -
42 Attapulgit Tablet - -
43 Aqua Pro Injeksi 20 ml Btl/20 ml 6 -
44 Aquagel Sterile Jely 82 gr Tube 12 -
45 Bedak Salisil Pot - 20
46 Betametason cream Tube 97 48
47 Bisturi buah 113 -
48 Blood Lancet Pcs 200 100
49 Catgut No. 2/0 Pcs 20 24
50 Catgut No. 3/0 Pcs 19 24
51 Cairan 1/2 DAD Btl/500 ml - -
52 Carbamazepin tab 200 mg Tablet - -
53 Captopril tab 25 mg Tablet 910 2,600
54 Cefadroxil 500 mg Tablet 910 -
55 Cefadroxil Sirup Botol - -
56 Cetirizine Syr Botol 36 -
58 Cimetidine tab 200 mg Tablet 950 2,000
59 Ciprofloxacin tab 500 mg Tablet 490 900
60 Dexamethasone Injeksi Ampul 226 -
61 Dexamethasone tab 0,5 mg Tablet 1,780 9,400
65 Diazepam 2 mg Tablet 176 100
66 Diazepam 5 mg Tablet 258 -
67 Diazepam Injeksi Ampul 30 -
68 Difenhidramin Injeksi 10 mg/ml Ampul 60 -
70 Diltiazem HCl tablet 30 mg Tablet - -
71 Domperidon tablet 10 mg Tablet 480 1,500
72 Etanol 70% 100 ml Botol 97 -
73 Etanol 70% 1000 ml Botol - -
74 Etakridin (Rivanol) 100 ml Botol 3 2
75 Etakridin 0,1% 300 ml Btl/300 4 4
76 Efinefrin HCl Bitartrat Inj Ampul 274 -
80 Fenobarbital tab 30 mg Tablet 900 -
82 Fitomenadion (Vit. K1) tab 10 mg Tablet 930 400
83 Fitomenadion (Vit. K1) Injeksi Ampul 60 30
84 Fletcher Set - -
85 Furosemid tablet 40 mg Tablet 400 200
86 Garam Oralit 200 mg Sachet 600 2,000
87 Gentamicin salep kulit Tube 60 103
88 Gentamicin salep mata Tube 64 -
89 Gentamicin sulfat TM 0,3% Btl/ 5 ml - -
90 Gentian Violet 1% Btl/ 5 ml - -
91 Glass Ionometer Cemen Set 1 1
92 Glibenklamid tab 5 mg Tablet 600 300
93 Gliceryl Guaicolat tab 100 mg Tablet - -
94 Glimepiride Tab 1 mg Tablet 750 -
95 Glimepiride tab 2 mg Tablet 570 850
96 Glukosa 5% Btl/500 ml 57 40
97 Glukosa 10% Btl/500 ml - -
98 Griseofulvin tab 125 mg Tablet 1,460 500
99 Haloperidol tab 0,5 mg Tablet 330 -
101 Hidroklorothiazid (HCT) tab Tablet 520 -
102 Hidrokortison Cream 2,5% Tube 61 72
103 Ibuprofen Syrup Btl/60 ml 35 100
104 Ibuprofen tab 200 mg Tablet - -
105 Ibuprofen tab 400 mg Tablet - 1,100
106 Infusion set anak Pcs 47 48
107 Infusion set Dewasa Pcs 65 48
109 Isosorbid Dinitrat Subli. Tab Tablet 260 -
110 Jarum Jahit bedah No. 9 Pcs 44 12
117 Kalium Permanganas Serbuk Pot/ 5 g - 10
118 Kalsium Laktat tab 500 mg Tablet - 500
119 Kalsium Glukonat Inj i.v 10 % (100mg/ml) Ampul - -
120 Kapas Pembalut Hidrofil DRC 250 Gram Roll 7 15
121 Kasa Hidrofil DRC 36 m x 80 cm Roll 8 5
122 Kasa Pembalut Hidrofil DRC 4m x 15 cm Roll 30 49
124 Karbongliserin Tetes Telinga 10* Botol 6 40
125 Ketokonazol Salep Tube 8 5
126 Ketokenazol Tab Tablet 350 -
127 Kloramfenikol Suspensi Botol/60ml 23 -
128 Kloramfenikol caps 250 mg Tablet 600 -
129 Kloramfenikol Salep Mata 1% Tube 27 72
130 Kloramfenikol Tetes Telinga Botol5 ml 32 15
131 Klorfeniramin Maleat (CTM) Tablet 3,400 7,100
132 Klorpromazin tab 25 mg Tablet 120 -
133 Klorpromazin tab 100 mg Tablet 267 -
135 Tablet 1,300 3,100
Asam Folat
136 Kotrimoksazol Suspensi Btl/ 60 ml 60 50
137 Kotrimoksazol tab 120 mg Tablet 110 -
138 Kotrimoksazol tab 480 mg Tablet 1,150 500
139 Lidocain HCl Injeksi 2% Ampul 76 100
140 Lisol 1 Liter Botol 13 10
141 Loratadine tablet 10 mg Tablet 340 400
142 Loperamide Tablet 310 500
143 Magnesium Sulfat injeksi 40 % Ampul 24 -
144 Masker Pcs - 1,100
145 Meloksikam tab 7,5 mg Tablet - -
146 Meloksikam tab 15 mg Tablet - -
147 Metformin HCl tablet 500 mg Tablet - 600
150 Metoklorpropamide Injeksi (Metolon) Ampul - -
151 Metronidazol tab 250 mg Tablet 500 1,200
152 Metronidazol tab 500 mg Tablet - -
153 Metylergometrin Maleat tab. Tablet 850 700
154 Metylergometrin Maleat Inj Ampul - -
155 Miconazole Cream Tube 137 96
156 Natrium Diklofenak tablet 25 mg Tablet 470 1,550
157 Natrium Diklofenak tablet 50 mg Tablet 200 2,000
158 Natrium Klorida Inf 0,9% Btl/ 500 ml 38 220
159 Nifedipin Tablet Tablet - -
160 Nistatin Tab. Vag 100.000 UI Tablet 361 -
162 Obat Batuk Hitam (OBH) Btl/ 100 ml 28 10
163 Omeprazole Tablet 500 390
164 Oxytocin Inj 10 mg/ml Ampul 133 -
165 Oxytetracyclin HCl Inj Vial 12 -
166 Oxytetracyclin SK. 3% Tube 110 48
167 Oxytetracyclin Salep Mata 1% Tube 68 50
168 Papaverin HCl tab 40 mg Tablet 1,520 -
169 Paracetamol tab 500 mg Tablet 100 13,000
170 Paracetamol syrup Btl/ 60 ml - 432
172 Plester/Hipapix (5 cm x 5 m) Roll 7 29
173 Prednison tab 5 mg Tablet 1,260 2,000
175 Propilthiourasil (PTU) tablet Tablet 600 -
176 Propranolol tablet 40 mg Tablet 270 -
177 Pyrantel Suspensi 125 mg/5 ml Botol - -
178 Pyrantel tablet 125 mg Tablet 166 200
179 Pyridoxin HCl tablet 10 mg Tablet 500 3,400
182 Ranitidine Injeksi 25 mg/ml Ampul 30 -
183 Ranitidine tablet 150 mg Tablet 940 5,000
184 Retinol (Vit. A) 100.000 IU Kapluk Kapluk 474 1,000
185 Retinol (Vit. A) 200.000 IU Kapluk Kapluk 510 1,500
186 Ringer Laktat Infus Btl/ 500 ml 18 220
187 Pot/ 30 g 25 141
Belerang
190 Salbutamol Sirup Botol 21 -
191 Sarung Tangan No. 6,5 Steril Pasang 200 300
192 Sarung Tangan No. 7 Steril Pasang 174 350
193 Sarung Tangan No. 7,5 Steril Pasang - -
195 Scopamin Tablet 500 -
196 Sianocobalamin (Vit. B12) Injeksi Ampul 251 -
197 Sianocobalamin (Vit. B12) Tab Tablet 1,500 -
200 SILK BLACK 3/0 HR 26 MM Peaces 47 12
201 Strip Kolesterol Nesco Strip 430 400
202 Strip Asam Urat Nesco Strip 50 225
203 Strip Glukosa Nesco Strip 25 250
204 Tetracycline HCl 250 mg Capsul 600 -
205 Tetracycline HCl 500 mg Capsul - -
206 Tetrakain Tetes Mata Botol 42 -
208 Thiamin HCl (B1) Tab 50 mg Tablet 2,000 1,600
209 Vitamin B Complex tab Tablet 2,800 9,600
210 Yodium Povidon 10% 300 ml Botol 166 100
211 Yodium Povidon 10% 30 ml Botol 86 -
212 Zink Tablet Tablet 400 1,000
213 Zink Syr 10 mg Botol - 17
214 Zink Syr 20 mg Botol - -
215 Kantong Mayat Pcs 6 -
217 O A T Kategori Anak Paket 2 1
218 O A T Kategori 1 Paket 4 13
221 Obat MB Dewasa Strip - -
222 Obat PB Anak Strip - 6
223 Obat MB Anak Strip - -
224 Sangobion Tablet - -
225 Sarung Tangan M Box 7 9
226 Lidokain Spray Botol 10 -
227 Lidokain Gel Tube 55 -
228 Elkana Syr Botol 187 236
229 Bisakodil 5 mg Tablet 540 -
232 Dulcolax Suppo 5 mg Suppo 18 -
233 Dulcolax Suppo 10 mg Suppo 12 -
234 Amlodipine 5 mg Tablet - 1,600
236 Bonding Tambalan Komposit GC Botol 2 1
237 Calcium Hidtoksida Technew Tube 4 -
238 Caviton Tube 3 -
239 Eugenol Cairan Botol 3 -
240 Elite Powder Cemen GC Botol 3 -
241 Elite Cemen Liquid GC Botol 3 -
242 Sponge Gigi / Hemospon Pcs - -
243 Tambalan Amalgam Powder SDI Tube 3 -
244 Tambalan Komposit GC Hydcal Tube - -
245 Tambalan Komposit 3M P60 Botol - -
246 Bisakodil Suppo 10 mg Suppo - -
247 Tabung Vacum Buah - -
248 Reagen ZN Paket 3 -
249 Mata Klinipet Dos - -
250 Slide Prostad Pcs 6 -
251 Diazepam enema 5 mg/2,5 ml Tube 30 -
252 Diazepam enema 10 mg/2,5 ml Tube 30 -
253 Nistatin Suspensi 100.000 UI/ml Botol 21 -
254 Plano Test Pcs - 450
255 Tambalan Komposit Flowable Tube - -
256 Calsium Hidroside Lightcurring Tube - -
257 Aplicator Botol - -
258 Bur Composite Set - -
259 Bur Intan Set - -
260 Cotton Roll Pak - -
261 Celemek Gigi Pcs - -
262 Celluloid Strip Pak - -
263 Matrix Band Kompensional Set - -
264 Hemafort Tablet 120 500
265 Mediamer Tablet 200 300

BPJS NON BPJS
1 Puskesmas
3 Poskesdes
JUMLAH

drg. H. FIRMON, MPH NENENG SALMIAH, S.Farm

NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011
PORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
BULAN : TRIWULAN III
TAHUN : 2018
STOK PEMBER
PERSEDIAAN PEMAKAIAN STOK AKHIR PERMINTAAN
PENGAMAN PKD
6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20% 10=(7+9)-8 11
35 12 23 2 (9)
61 30 31 6 5
40 15 25 3 (7)
74 18 56 4 (34)
48 8 40 2 (30)
180 150 30 30 150
- - - - -
15 13 2 3 14
396 16 380 3 (361)
790 135 655 27 (493)
772 391 381 78 88
314 97 217 19 (101)
2,310 1,680 630 336 1,386
350 100 250 20 (130)
- - - - -
1,000 1,000 - 200 1,200
19 19 - 4 23
- - - - -
300 - 300 - (300)
- - - - -
600 300 300 60 60
341 251 90 50 211
- - - - -
8,100 6,600 1,500 1,320 6,420
2,600 1,800 800 360 1,360
135 95 40 19 74
- - - - -
- - - - -
58 32 26 6 12
96 - 96 - (96)
300 - 300 - (300)
45 15 30 3 (12)
75 15 60 3 (42)
21 21 - 4 25
- - - - -
8,640 7,540 1,100 1,508 7,948
5,420 4,620 800 924 4,744
1,600 1,100 500 220 820
1,900 1,000 900 200 300
- - - - -
- - - - -
- - - - -
6 - 6 - (6)
12 6 6 1 1
20 20 - 4 24
145 56 89 11 (22)
113 36 77 7 (34)
300 300 - 60 360
44 4 40 1 (35)
43 8 35 2 (25)
- - - - -
- - - - -
3,510 2,700 810 540 2,430
910 380 530 76 (74)
- - - - -
36 - 36 - (36)
- - - - -
2,950 2,450 500 490 2,440
1,390 870 520 174 524
226 69 157 14 (74)
11,180 10,500 680 2,100 11,920
- - - - -
- - - - -
- - - - -
276 66 210 13 (131)
258 41 217 8 (168)
30 - 30 - (30)
60 - 60 - (60)
- - - - -
- - - - -
1,980 580 1,400 116 (704)
97 35 62 7 (20)
- - - - -
5 5 - 1 6
8 5 3 1 3
274 13 261 3 (245)
- - - - -
- - - - -
- - - - -
900 - 900 - (900)
- - - - -
1,330 370 960 74 (516)
90 - 90 - (90)
- - - - -
600 240 360 48 (72)
2,600 1,300 1,300 260 260
163 110 53 22 79
64 2 62 0 (60)
- - - - -
- - - - -
2 1 1 0 0
900 150 750 30 (570)
- - - - -
750 - 750 - (750)
1,420 650 770 130 10
97 28 69 6 (35)
- - - - -
1,960 740 1,220 148 (332)
330 - 330 - (330)
- - - - -
520 90 430 18 (322)
133 80 53 16 43
135 97 38 19 78
- - - - -
1,100 1,100 - 220 1,320
95 10 85 2 (73)
113 50 63 10 (3)
- - - - -
260 10 250 2 (238)
56 26 30 5 1
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
10 10 - 2 12
500 500 - 100 600
- - - - -
22 12 10 2 4
13 9 4 2 7
79 79 - 16 95
- - - - -
46 26 20 5 11
13 13 - 3 16
350 50 300 10 (240)
23 2 21 0 (19)
600 70 530 14 (446)
99 45 54 9 -
47 19 28 4 (5)
10,500 7,800 2,700 1,560 6,660
120 - 120 - (120)
267 40 227 8 (179)
- - - - -
4,400 3,900 500 780 4,180
110 50 60 10 -
110 50 60 10 -
1,650 950 700 190 440
176 72 104 14 (18)
23 8 15 2 (5)
740 500 240 100 360
810 480 330 96 246
24 3 21 1 (17)
1,100 1,100 - 220 1,320
- - - - -
- - - - -
600 300 300 60 60
- - - - -
- - - - -
- - - - -
1,700 1,250 450 250 1,050
- - - - -
1,550 880 670 176 386
- - - - -
233 93 140 19 (28)
2,020 1,720 300 344 1,764
2,200 2,000 200 400 2,200
258 63 195 13 (119)
- - - - -
361 10 351 2 (339)
- - - - -
38 28 10 6 24
890 460 430 92 122
133 20 113 4 (89)
12 - 12 - (12)
158 51 107 10 (46)
118 43 75 9 (23)
1,520 350 1,170 70 (750)
13,100 12,000 1,100 2,400 13,300
432 349 83 70 336
- - - - -
36 21 15 4 10
3,260 1,900 1,360 380 920
- - - - -
600 - 600 - (600)
270 - 270 - (270)
- - - - -
366 164 202 33 (5)
3,900 3,000 900 600 2,700
- - - - -
- - - - -
30 - 30 - (30)
5,940 5,400 540 1,080 5,940
1,474 742 732 148 158
2,010 1,530 480 306 1,356
238 78 160 16 (66)
166 138 28 28 138
770 480 290 96 286
1,010 595 415 119 299
21 - 21 - (21)
500 250 250 50 50
524 277 247 55 85
- - - - -
- - - - -
500 100 400 20 (280)
251 58 193 12 (123)
1,500 - 1,500 - (1,500)
1,370 930 440 186 676
810 710 100 142 752
59 30 29 6 7
830 560 270 112 402
275 275 - 55 330
275 275 - 55 330
600 200 400 40 (160)
- - - - -
42 - 42 - (42)
- - - - -
3,600 2,500 1,100 500 1,900
12,400 10,400 2,000 2,080 10,480
266 33 233 7 (193)
86 10 76 2 (64)
1,400 1,400 - 280 1,680
17 17 - 3 20
- - - - -
6 - 6 - (6)
- - - - -
3 1 2 0 (1)
17 9 8 2 3
- - - - -
- - - - -
- - - - -
6 6 - 1 7
- - - - -
- - - - -
16 13 3 3 13
10 2 8 0 (6)
55 4 51 1 (46)
423 180 243 36 (27)
540 - 540 - (540)
- - - - -
- - - - -
18 - 18 - (18)
12 - 12 - (12)
1,600 1,200 400 240 1,040
3 - 3 - (3)
4 1 3 0 (2)
3 - 3 - (3)
3 - 3 - (3)
3 - 3 - (3)
3 - 3 - (3)
- - - - -
3 - 3 - (3)
- - - - -
- - - - -
- - - - -
- - - - -
3 1 2 0 (1)
- - - - -
6 2 4 0 (2)
30 - 30 - (30)
30 - 30 - (30)
21 3 18 1 (14)
450 350 100 70 320
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
- - - - -
620 620 - 124 744
500 100 400 20 (280)
Ma
Yang Melapor,
armasi
Kepala Puskesmas Rangas Peng
. Mamuju
S.Farm Nachsan, SKM

Nip. 19630723 198903 1 009 MULY
03 2 011
NIP. 19
WULAN III
PEMBERIAN TOTAL
KET
DKP/PROGRAM LAIN-LAIN PEMBERIAN
12 13 14 15
ED 15
ED 36
ED 80
ED 30
ED 38
ED 100
ED 400
ED 34
ED 1
ED 1
Mamuju,
Yang Menerima,

NIP. 19790102 200604 2 013
OBAT PROGRAM KIA
BULAN : NOVEMBER
TAHUN : 2018

Nip. 19610310 198710 1 002 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
OBAT PROGRAM KIA
BULAN : OKTOBER
TAHUN : 2018

Nip. 19610310 198710 1 002 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
1 Abbocath No. 18 Pcs - - - - -
2 Abbocath No. 20 Pcs - 20 20 10 10 2
3 Abbocath No. 22 Pcs 4 20 24 14 10 3
4 Abbocath No. 24 Pcs 10 20 30 15 15 3
8 Albendazol Suspensi 25 mg / 5 ml Btl/10 ml 17 17 2 15 0
14 Allopurinol tab 300 mg Tablet - 200 200 - 200 -
16 Ambroxol tab 30 mg Tablet 100 1,800 1,900 1,400 500 280
22 Amoxycillin syrup kering 125 mg/ 5 ml Btl/60 ml 54 54 54 - 11
24 Amoxycillin capl 500 mg Kaplet - 3,000 3,000 3,000 - 600
30 Antibakteri DOEN Kombinasi (Bacitracin) Tube 12 31 43 - 43 -
32 Antimigren : Ergotamin Tartrat + Kofein Tablet - 100 100 - 100 -
37 Asam Askorbat tab 50 mg Tablet 1,500 1,100 2,600 2,600 - 520
46 Betametason cream Tube 15 24 39 39 - 8
47 Bisturi buah - 100 100 77 23 15
49 Catgut No. 2/0 Pcs 8 24 32 - 32 -
50 Catgut No. 3/0 Pcs 12 12 2 10 0
53 Captopril tab 25 mg Tablet 410 800 1,210 1,210 - 242
57 CHKM Btl/15 ml - - -
58 Cimetidine tab 200 mg Tablet - 2,500 2,500 2,500 - 500
71 Domperidon tablet 10 mg Tablet 1,060 1,060 260 800 52
72 Etanol 70% 100 ml Botol 10 50 60 26 34 5
73 Etanol 70% 1000 ml Botol - 2 2 2 - 0
75 Etakridin 0,1% 300 ml Btl/300 4 4 2 2 0
86 Garam Oralit 200 mg Sachet 300 200 500 200 300 40
90 Gentian Violet 1% Btl/ 5 ml - 15 15 10 5 2
93 Gliceryl Guaicolat tab 100 mg Tablet 500 1,500 2,000 1,200 800 240
96 Glukosa 5% Btl/500 ml 32 32 17 15 3
97 Glukosa 10% Btl/500 ml - - -
99 Haloperidol tab 0,5 mg Tablet - 100 100 10 90 2
120 Kapas Pembalut Hidrofil DRC 250 Gram Roll 3 3 3 - 1
124 Karbongliserin Tetes Telinga 10* Botol 5 5 5 - 1
128 Kloramfenikol caps 250 mg Tablet 1,100 1,100 - 1,100 -
132 Klorpromazin tab 25 mg Tablet 40 40 - - -
135 Tablet - 2,300 2,300 2,300 - 460
Asam Folat
136 Kotrimoksazol Suspensi Btl/ 60 ml 8 40 48 28 20 6
138 Kotrimoksazol tab 480 mg Tablet 1,260 1,260 460 800 92
142 Loperamide Tablet 100 100 200 200 - 40
144 Masker Pcs - 250 250 250 - 50
145 Meloksikam tab 7,5 mg Tablet 500 500 470 30 94
151 Metronidazol tab 250 mg Tablet 230 400 630 630 - 126
163 Omeprazole Tablet 120 120 120 - 24
165 Oxytetracyclin HCl Inj Vial - - - -
167 Oxytetracyclin Salep Mata 1% Tube 30 30 - 30 -
179 Pyridoxin HCl tablet 10 mg Tablet 900 900 1,800 1,300 500 260
187 Pot/ 30 g 61.0 61 16 45 3
Belerang
196 Sianocobalamin (Vit. B12) Injeksi Ampul 10 100 110 64 46 13
198 Simvastatin tablet 10 mg Tablet - 780 780 745 35 149
203 Strip Glukosa Nesco Strip 50 200 250 125 125 25
208 Thiamin HCl (B1) Tab 50 mg Tablet - 1,000 1,000 1,000 - 200
209 Vitamin B Complex tab Tablet 400 4,600 5,000 3,800 1,200 760
214 Zink Syr 20 mg Botol 5 5 5 - 1
218 O A T Kategori 1 Paket 1 5 6 6 - 1
225 Sarung Tangan M Box - 1 1 1 - 0
228 Elkana Syr Botol 67 67 48 19 10
229 Bisakodil 5 mg Tablet 85 30 115 5 110 1
253 Plano Test Pcs 80 80 50 30 10
263 Hemafort Tablet 100 400 500 350 150 70
264 Mediamer Tablet 100 100 100 0 20
265 Metyl Prednisolon 4 mg Tablet 600 600 200 400 40
267 Masker N 25 Pcs

BPJS NON BPJS
1 Puskesmas
3 Poskesdes
JUMLAH
Yang Melapor,
Yang Melapor,

NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN : NOVEMBER
TAHUN : 2018
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
25
25
25
3
25
200
200
(13)
(184)
276
100
(100)
500
(200)
-
1,400
25
-
(100)
-
860
75
-
4,000
1,000
54
-
-
1
(43)
(100)
(100)
13
12
-
3,230
3,120
-
500
-
-
100
(2)
(3)
50
47
69
200
(32)
(8)
-
-
1,500
200
12
12
-
3,000
28
90
3,977
-
-
-
(150)
(144)
(10)
(20)
-
(100)
(488)
(3)
2
8
0
(87)
-
-
10
(280)
-
(84)
(25)
-
(152)
200
75
12
-
12
-
(140)
1,000
(250)
140
20
-
500
(78)
-
(90)
25
50
1,000
1,500
(29)
(36)
200
(80)
0
-
-
-
-
-
-
10
2,000
-
10
10
100
-
12
24
(12)
(7)
(1,100)
5
(25)
3,122
-
(22)
-
2,760
35
200
(248)
148
(6)
200
240
(7)
700
500
450
(464)
-
-
-
756
600
(50)
-
(82)
640
648
(51)
-
(9)
-
(6)
400
(128)
-
50
(30)
1,000
3,230
123
-
(0)
(960)
-
(126)
(90)
50
126
1,540
500
500
10
3,000
-
-
(64)
(26)
(68)
(56)
(7)
54
107
-
12
(100)
31
(500)
1,000
800
20
200
215
200
-
-
(14)
-
2,000
3,760
(3)
13
1,000
50
50
(2)
-
-
7
-
-
-
1
-
500
5
5
(10)
50
(104)
200
5
(6)
(4)
500
(1)
(1)
-
(1)
(1)
(1)
-
(1)
-
(1)
-
-
(1)
-
(109)
(10)
(10)
(5)
30
-
-
-
-
-
-
-
-
-
400
120
(160)
Mamuju,
r, Yang Menerima,

r, Yang Menerima,

NIP. 19790102 200604 2 013
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
1 Abbocath No. 18 Pcs - - - -
2 Abbocath No. 20 Pcs 10 10 7 3 1
3 Abbocath No. 22 Pcs 10 10 20 13 7 3
4 Abbocath No. 24 Pcs 15 5 20 13 7 3
5 Acyclovir Cream 3% Tube 5 25 30 - 30 -
8 Albendazol Suspensi 25 mg / 5 ml Btl/10 ml 15 15 15 - 3
13 Allopurinol tab 100 mg Tablet 200 1,000 1,200 700 500 140
21 Amlodipine 10 mg Tablet 30 300 330 330 - 66
22 Amoxycillin syrup kering 125 mg/ 5 ml Btl/60 ml - 120 120 100 20 20
24 Amoxycillin capl 500 mg Kaplet - 4,000 4,000 3,500 500 700
25 Antacida DOEN tab. Kunyah Komb : Tablet 300 1,000 1,300 1,140 160 228
29 Antifungi DOEN Kombinasi Tube 6 1 7 7 - 1
32 Antimigren : Ergotamin Tartrat + Kofein Tablet 100 100 20 80 4
37 Asam Askorbat tab 50 mg Tablet - 3,200 3,200 2,000 1,200 400
46 Betametason cream Tube - 47 47 4 43 1
47 Bisturi buah 23 100 123 26 97 5
49 Catgut No. 2/0 Pcs 32 32 4 28 1
50 Catgut No. 3/0 Pcs 10 10 10 - 2
53 Captopril tab 25 mg Tablet - 1,500 1,500 800 700 160
57 CHKM Btl/15 ml - - -
58 Cimetidine tab 200 mg Tablet - 3,000 3,000 2,800 200 560
72 Etanol 70% 100 ml Botol 34 34 22 12 4
73 Etanol 70% 1000 ml Botol - 2 2 2 - 0
74 Etakridin (Rivanol) 100 ml Botol - 8 8 8 - 2
75 Etakridin 0,1% 300 ml Btl/300 2 2 1 1 0
76 Efinefrin HCl Bitartrat Inj Ampul 87 87 5 82 1
88 Gentamicin salep mata Tube 6 6 6 - 1
90 Gentian Violet 1% Btl/ 5 ml 5 12 17 7 10 1
95 Glimepiride tab 2 mg Tablet 100 150 250 250 - 50
96 Glukosa 5% Btl/500 ml 15 20 35 6 29 1
97 Glukosa 10% Btl/500 ml - - -
109 Isosorbid Dinitrat Subli. Tab Tablet 80 80 30 50 6
120 Kapas Pembalut Hidrofil DRC 250 Gram Roll - 10 10 10 - 2
126 Ketokenazol Tab Tablet 60 60 60 - 12
128 Kloramfenikol caps 250 mg Tablet 1,100 1,100 60 1,040 12
129 Kloramfenikol Salep Mata 1% Tube 15 50 65 15 50 3
132 Klorpromazin tab 25 mg Tablet - 100 100 - 100 -
135 Tablet - 2,800 2,800 2,100 700 420
Asam Folat
142 Loperamide Tablet - - - -
144 Masker Pcs - 100 100 100 - 20
145 Meloksikam tab 7,5 mg Tablet 30 500 530 230 300 46
146 Meloksikam tab 15 mg Tablet 60 450 510 510 - 102
151 Metronidazol tab 250 mg Tablet - 800 800 400 400 80
160 Nistatin Tab. Vag 100.000 UI Tablet 68 68 68 - 14
168 Papaverin HCl tab 40 mg Tablet 150 1,000 1,150 170 980 34
172 Plester/Hipapix (5 cm x 5 m) Roll 4 4 4 - 1
173 Prednison tab 5 mg Tablet 1,200 1,200 300 900 60
178 Pyrantel tablet 125 mg Tablet 98 200 298 - 298 -
182 Ranitidine Injeksi 25 mg/ml Ampul 2 2 2 - 0
185 Retinol (Vit. A) 200.000 IU Kapluk Kapluk 35 35 35 - 7
187 Pot/ 30 g 45.0 45 8 37 2
Belerang
191 Sarung Tangan No. 6,5 Steril Pasang 24 24 24 - 5
192 Sarung Tangan No. 7 Steril Pasang - 100 100 100 - 20
198 Simvastatin tablet 10 mg Tablet 35 1,020 1,055 995 60 199
201 Strip Kolesterol Nesco Strip - - - -
208 Thiamin HCl (B1) Tab 50 mg Tablet - 1,000 1,000 700 300 140
211 Yodium Povidon 10% 30 ml Botol - - - -
222 Obat PB Anak Strip 2 2 1 1 0
225 Sarung Tangan M Box - - - -
226 Lidokain Spray Botol - - - -
228 Elkana Syr Botol 19 19 19 - 4
253 Plano Test Pcs 30 30 - 30 -
263 Hemafort Tablet 150 400 550 150 400 30
264 Mediamer Tablet 0 - - -
266 ETSA (gigi) Tube - - -
267 Masker N 25 Pcs 20 20 20 0 4

BPJS NON BPJS
1 Puskesmas
3 Poskesdes
JUMLAH
Yang Melapor,


NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN : JANUARI
TAHUN : 2018
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
20
20
20
9
(30)
200
300
18
(184)
(148)
158
54
500
(200)
-
800
25
-
(100)
-
500
100
-
4,000
1,208
(20)
-
-
8
(43)
(100)
(56)
(3)
14
-
3,380
1,200
-
500
-
-
200
(2)
3
30
(38)
(66)
500
(23)
12
-
-
360
200
10
15
-
3,160
104
(62)
1,200
-
-
-
(150)
(133)
(10)
(20)
-
(100)
(360)
14
2
10
0
(76)
-
-
5
(258)
-
(300)
(10)
-
(174)
(60)
6
7
-
(2)
-
(90)
1,060
(250)
500
(22)
-
(160)
(90)
-
100
(16)
50
1,000
1,500
(24)
(19)
100
(14)
(4)
-
-
-
-
-
-
25
1,000
-
12
10
100
-
25
25
100
(7)
(968)
(32)
(15)
2,816
(100)
(34)
-
2,400
25
100
100
198
(0)
100
200
(7)
600
(24)
812
160
-
-
-
80
500
(118)
-
9
382
1,020
(70)
100
82
-
10
108
(118)
-
(28)
25
(776)
3,200
125
-
10
(540)
-
(150)
(90)
50
(298)
760
500
800
2
1,500
(80)
42
(56)
(27)
(200)
64
(7)
100
200
-
10
(100)
109
(500)
1,134
500
(9)
300
200
200
-
-
(14)
-
1,500
3,000
(17)
-
1,000
25
25
(2)
-
-
(1)
-
-
-
0
500
5
5
(3)
50
(110)
100
5
(6)
(4)
500
(1)
(1)
-
(1)
(1)
(1)
-
(1)
-
(1)
-
-
(1)
-
(99)
(10)
(10)
(5)
(30)
-
-
-
-
-
-
-
-
-
(220)
-
260
-
30
Mamuju,
r, Yang Menerima,


NIP. 19790102 200604 2 013
OBAT PROGRAM KIA
BULAN : DESEMBER
TAHUN : 2018

Nip. 19610310 198710 1 002 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
OBAT PROGRAM KIA
BULAN : Februari
TAHUN : 2019

Nip. 19610310 198710 1 002 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
1 Abbocath No. 18 Pcs 4 - 4 4 - 1
2 Abbocath No. 20 Pcs 23 20 43 30 13 6
3 Abbocath No. 22 Pcs 23 30 53 32 21 6
4 Abbocath No. 24 Pcs 43 25 68 36 32 7
5 Acyclovir Cream 3% Tube 75 25 100 35 65 7
8 Albendazol Suspensi 25 mg / 5 ml Btl/10 ml 34 15 49 17 32 3
9 Albendazol tab 400 mg Tablet 552 - 552 - 552 -
11 Alat Suntik Sekali Pakai 3 ml Pcs 369 1,300 1,669 1,028 641 206
13 Allopurinol tab 100 mg Tablet 1,100 2,000 3,100 1,700 1,400 340
15 Alprazolam Tab 0,25 mg Tablet - - - - - -
16 Ambroxol tab 30 mg Tablet 600 4,700 5,300 3,900 1,400 780
18 Aminophyllin Injeksi 24 mg/ml Ampul - - - - - -
19 Aminophyllin tab 200 mg Tablet 300 - 300 - 300 -
21 Amlodipine 10 mg Tablet 130 1,410 1,540 1,410 130 282
23 Amoxycillin capl 250 mg Capsul - - - - - -
24 Amoxycillin capl 500 mg Kaplet - 8,500 8,500 8,000 500 1,600
25 Antacida DOEN tab. Kunyah Komb : Tablet 810 3,200 4,010 3,040 970 608
27 Antalgin tablet 500 mg Tablet - - - - - -
28 Antalgin Injeksi 250 mg/ml- 2 ml Ampul - - - - - -
30 Antibakteri DOEN Kombinasi (Bacitracin) Tube 103 31 134 36 98 7
32 Antimigren : Ergotamin Tartrat + Kofein Tablet 100 100 200 20 180 4
35 Arhtemeter Injeksi 80 mg/ml Ampul - - - - - -
36 Asam Mefenamat tab 500 mg Tablet 3,390 8,400 11,790 8,800 2,990 1,760
37 Asam Askorbat tab 50 mg Tablet 1,500 7,900 9,400 6,700 2,700 1,340
38 Asam Askorbat tab 250 mg Tablet - - - - - -
39 Asam Folat 1 mg Tablet 600 900 1,500 1,100 400 220
40 Asering Infus Btl/500 ml - - - - - -
41 Atropin sulfat Injeksi 0,25 mg/ml Ampul - - - - - -
42 Attapulgit Tablet - - - - - -
43 Aqua Pro Injeksi 20 ml Btl/20 ml 6 - 6 - 6 -
47 Bisturi buah 43 200 243 123 120 25
48 Blood Lancet Pcs - 100 100 100 - 20
49 Catgut No. 2/0 Pcs 60 24 84 16 68 3
50 Catgut No. 3/0 Pcs 38 - 38 16 22 3
51 Cairan 1/2 DAD Btl/500 ml - - - - - -
52 Carbamazepin tab 200 mg Tablet - - - - - -
53 Captopril tab 25 mg Tablet 510 3,500 4,010 2,900 1,110 580
54 Cefadroxil 500 mg Tablet - - - - - -
55 Cefadroxil Sirup Botol - - - - - -
56 Cetirizine Syr Botol - - - - - -
57 CHKM Btl/15 ml - - - - - -
58 Cimetidine tab 200 mg Tablet - 7,500 7,500 7,300 200 1,460
59 Ciprofloxacin tab 500 mg Tablet 1,540 1,100 2,640 920 1,720 184
62 Dextran 70% Infus Btl/500 ml - - - - - -
63 Dextromethorphan syrup Btl/ 60 ml - - - - - -
64 Dextromethorphan tab 15 mg Tablet - - - - - -
65 Diazepam 2 mg Tablet 350 100 450 - 450 -
69 Digoxin tablet 0,25 mg Tablet - - - - - -
70 Diltiazem HCl tablet 30 mg Tablet 200 100 300 - 300 -
71 Domperidon tablet 10 mg Tablet 3,060 - 3,060 600 2,460 120
72 Etanol 70% 100 ml Botol 51 80 131 75 56 15
73 Etanol 70% 1000 ml Botol - 6 6 6 - 1
74 Etakridin (Rivanol) 100 ml Botol 7 20 27 20 7 4
75 Etakridin 0,1% 300 ml Btl/300 6 6 12 5 7 1
76 Efinefrin HCl Bitartrat Inj Ampul 261 - 261 5 256 1
77 Erysanbe syrup Btl/ 60 ml - - - - - -
78 Erysanbe Capsul 500 mg Capsul - - - - - -
79 Etylchlorida semprot Btl/100 - - - - - -
80 Fenobarbital tab 30 mg Tablet 860 - 860 30 830 6
81 Fenobarbital Inkeksi 50 mg/ml Ampul - - - - - -
82 Fitomenadion (Vit. K1) tab 10 mg Tablet 1,260 - 1,260 180 1,080 36
84 Fletcher Set - - - - - -
86 Garam Oralit 200 mg Sachet 1,300 400 1,700 800 900 160
88 Gentamicin salep mata Tube 38 - 38 20 18 4
89 Gentamicin sulfat TM 0,3% Btl/ 5 ml - - - - - -
91 Glass Ionometer Cemen Set - - - - - -
92 Glibenklamid tab 5 mg Tablet 700 - 700 100 600 20
93 Gliceryl Guaicolat tab 100 mg Tablet 1,300 4,500 5,800 4,000 1,800 800
94 Glimepiride Tab 1 mg Tablet 750 - 750 - 750 -
96 Glukosa 5% Btl/500 ml 82 20 102 26 76 5
97 Glukosa 10% Btl/500 ml - - - - - -
98 Griseofulvin tab 125 mg Tablet 820 1,000 1,820 940 880 188
100 Haloperidol tab 1,5 mg Tablet - - - - - -
101 Hidroklorothiazid (HCT) tab Tablet 290 - 290 80 210 16
103 Ibuprofen Syrup Btl/60 ml - - - - - -
104 Ibuprofen tab 200 mg Tablet - - - - - -
106 Infusion set anak Pcs 115 - 115 10 105 2
108 Interhistin tablet Tablet - - - - - -
109 Isosorbid Dinitrat Subli. Tab Tablet 240 - 240 30 210 6
116 Kaen 3B larutan infus Btl/500 ml - - - - - -
118 Kalsium Laktat tab 500 mg Tablet - - - - - -
119 Kalsium Glukonat Inj i.v 10 % (100mg/ml) Ampul - - - - - -
121 Kasa Hidrofil DRC 36 m x 80 cm Roll - - - - - -
122 Kasa Pembalut Hidrofil DRC 4m x 15 cm Roll - - - - - -
123 Kasa 5 Cm Roll - - - - - -
124 Karbongliserin Tetes Telinga 10* Botol 19 - 19 14 5 3
125 Ketokonazol Salep Tube - - - - - -
126 Ketokenazol Tab Tablet 260 - 260 100 160 20
127 Kloramfenikol Suspensi Botol/60ml 21 - 21 - 21 -
128 Kloramfenikol caps 250 mg Tablet 2,330 1,000 3,330 90 3,240 18
131 Klorfeniramin Maleat (CTM) Tablet 1,390 10,500 11,890 9,700 2,190 1,940
132 Klorpromazin tab 25 mg Tablet 80 100 180 - 140 -
133 Klorpromazin tab 100 mg Tablet 127 - 127 15 112 3
134 Klorpromazin Injeksi Ampul - - - - - -
135 Tablet 100 6,600 6,700 6,000 700 1,200
Asam Folat
137 Kotrimoksazol tab 120 mg Tablet - - - - - -
138 Kotrimoksazol tab 480 mg Tablet 2,160 1,500 3,660 1,170 2,490 234
141 Loratadine tablet 10 mg Tablet - - - - - -
143 Magnesium Sulfat injeksi 40 % Ampul 21 - 21 - 21 -
144 Masker Pcs - 650 650 650 - 130
145 Meloksikam tab 7,5 mg Tablet 30 1,400 1,430 1,100 330 220
146 Meloksikam tab 15 mg Tablet 60 1,150 1,210 1,150 60 230
147 Metformin HCl tablet 500 mg Tablet 1,330 400 1,730 500 1,230 100
150 Metoklorpropamide Injeksi (Metolon) Ampul - - - - - -
151 Metronidazol tab 250 mg Tablet 480 1,700 2,180 1,550 630 310
152 Metronidazol tab 500 mg Tablet - - - - - -
153 Metylergometrin Maleat tab. Tablet 1,290 1,000 2,290 690 1,600 138
154 Metylergometrin Maleat Inj Ampul - - - - - -
156 Natrium Diklofenak tablet 25 mg Tablet 350 2,150 2,500 2,010 490 402
157 Natrium Diklofenak tablet 50 mg Tablet 540 2,000 2,540 2,000 540 400
158 Natrium Klorida Inf 0,9% Btl/ 500 ml 455 - 455 87 368 17
159 Nifedipin Tablet Tablet - - - - - -
160 Nistatin Tab. Vag 100.000 UI Tablet 302 - 302 117 185 23
161 Nistatin Tab. Vag 500.000 UI Tablet - - - - - -
164 Oxytocin Inj 10 mg/ml Ampul 341 200 541 60 481 12
165 Oxytetracyclin HCl Inj Vial 4 - 4 - - -
167 Oxytetracyclin Salep Mata 1% Tube 105 - 105 40 65 8
168 Papaverin HCl tab 40 mg Tablet 760 1,000 1,760 340 1,420 68
169 Paracetamol tab 500 mg Tablet 4,240 11,400 15,640 11,100 4,540 2,220
171 Piracetam Injeksi 3 g/15 ml Ampul - - - - - -
172 Plester/Hipapix (5 cm x 5 m) Roll 23 - 23 12 11 2
173 Prednison tab 5 mg Tablet 2,900 2,000 4,900 1,400 3,500 280
174 Primakina tablet 15 mg Tablet - - - - - -
175 Propilthiourasil (PTU) tablet Tablet 520 - 520 50 470 10
176 Propranolol tablet 40 mg Tablet 270 - 270 - 270 -
177 Pyrantel Suspensi 125 mg/5 ml Botol - - - - - -
178 Pyrantel tablet 125 mg Tablet 419 700 1,119 438 681 88
179 Pyridoxin HCl tablet 10 mg Tablet 1,800 4,500 6,300 4,100 2,200 820
182 Ranitidine Injeksi 25 mg/ml Ampul 16 - 16 10 6 2
183 Ranitidine tablet 150 mg Tablet - - - - - -
184 Retinol (Vit. A) 100.000 IU Kapluk Kapluk 708 - 708 230 478 46
185 Retinol (Vit. A) 200.000 IU Kapluk Kapluk 325 - 325 150 175 30
186 Ringer Laktat Infus Btl/ 500 ml 380 - 380 70 310 14
187 Pot/ 30 g 109 96 205 62 143 12
Belerang
190 Salbutamol Sirup Botol 21 - 21 - 21 -
191 Sarung Tangan No. 6,5 Steril Pasang 263 - 263 150 113 30
193 Sarung Tangan No. 7,5 Steril Pasang - - - - - -
194 Scabicid Cream 10 gram Tube - - - - - -
195 Scopamin Tablet 300 - 300 - 300 -
197 Sianocobalamin (Vit. B12) Tab Tablet 1,500 - 1,500 - 1,500 -
198 Simvastatin tablet 10 mg Tablet 85 2,400 2,485 2,390 95 478
199 Simvastatin tablet 20 mg Tablet - - - - - -
201 Strip Kolesterol Nesco Strip 130 200 330 250 80 50
206 Tetrakain Tetes Mata Botol 42 - 42 - 42 -
207 Thiamin HCl (B1) Inj Ampul - - - - - -
208 Thiamin HCl (B1) Tab 50 mg Tablet - 2,000 2,000 1,700 300 340
209 Vitamin B Complex tab Tablet 2,100 12,400 14,500 11,400 3,100 2,280
210 Yodium Povidon 10% 300 ml Botol 156 - 156 43 113 9
211 Yodium Povidon 10% 30 ml Botol 31 - 31 20 11 4
212 Zink Tablet Tablet - - - - - -
213 Zink Syr 10 mg Botol - - - - - -
214 Zink Syr 20 mg Botol - 5 5 5 - 1
216 Tes Kit Malaria Pcs - - - - - -
217 O A T Kategori Anak Paket - - - - - -
219 O A T Kategori 2 Paket - - - - - -
220 Obat PB Dewasa Strip - - - - - -
221 Obat MB Dewasa Strip - - - - - -
222 Obat PB Anak Strip - 2 2 1 1 0
223 Obat MB Anak Strip - - - - - -
224 Sangobion Tablet - - - - - -
226 Lidokain Spray Botol 2 1 3 3 - 1
227 Lidokain Gel Tube 41 - 41 7 34 1
228 Elkana Syr Botol 184 - 184 98 86 20
230 Cetirizine Tab Tablet - - - - - -
231 Kateter buah - - - - - -
234 Amlodipine 5 mg Tablet 505 800 1,305 1,200 105 240
237 Calcium Hidtoksida Technew Tube 3 - 3 - 3 -
238 Caviton Tube - - - - - -
239 Eugenol Cairan Botol 3 - 3 - 3 -
240 Elite Powder Cemen GC Botol 3 - 3 - 3 -
241 Elite Cemen Liquid GC Botol 3 - 3 - 3 -
242 Sponge Gigi / Hemospon Pcs - - - - - -
243 Tambalan Amalgam Powder SDI Tube 3 - 3 - 3 -
244 Tambalan Komposit GC Hydcal Tube - - - - - -
245 Tambalan Komposit 3M P60 Botol 2 1 3 - 3 -
246 Bisakodil Suppo 10 mg Suppo - - - - - -
247 Tabung Vacum Buah - - - - - -
249 Mata Klinipet Dos - - - - - -
250 Slide Prostad Pcs 272 144 416 29 387 6
251 Diazepam enema 5 mg/2,5 ml Tube 30 - 30 - 30 -
252 Diazepam enema 10 mg/2,5 ml Tube 30 - 30 - 30 -
253 Nistatin Suspensi 100.000 UI/ml Botol 15 - 15 - 15 -
254 Plano Test Pcs 210 - 210 70 140 14
255 Tambalan Komposit Flowable Tube - - - - - -
256 Calsium Hidroside Lightcurring Tube - - - - - -
257 Aplicator Botol - - - - - -
258 Bur Composite Set - - - - - -
259 Bur Intan Set - - - - - -
260 Cotton Roll Pak - - - - - -
261 Celemek Gigi Pcs - - - - - -
262 Celluloid Strip Pak - - - - - -
263 Matrix Band Kompensional Set - - - - - -
264 Hemafort Tablet 250 1,300 1,550 900 650 180
265 Mediamer Tablet 300 - 300 200 100 40

BPJS NON BPJS
1 Puskesmas
3 Poskesdes
JUMLAH
Yang Melapor,

NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009

NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN : TRIWULAN IV
TAHUN : 2018
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
93
93
93
60
(23)
400
800
(12)
(552)
(60)
635
(146)
900
(280)
-
4,000
75
-
(300)
-
1,860
225
-
11,000
2,886
21
-
-
22
(55)
(300)
44
2
38
-
8,652
5,340
-
1,280
-
-
500
(6)
3
105
33
104
820
(31)
(3)
-
-
2,618
600
37
42
-
8,660
(616)
(140)
9,548
-
-
-
(450)
(420)
(30)
(60)
-
(300)
(1,740)
34
7
17
(1)
(250)
-
-
21
(794)
-
(864)
(52)
-
(422)
320
105
17
-
25
-
(480)
3,560
(750)
340
(30)
-
392
(68)
-
(56)
57
150
2,800
4,000
(93)
(99)
400
(174)
(10)
-
-
-
-
-
-
50
3,500
-
21
28
300
-
47
73
(12)
(21)
(3,132)
(56)
(30)
9,796
(140)
(94)
-
7,460
102
400
(1,000)
425
(13)
500
540
(21)
1,900
976
1,862
(630)
-
-
-
1,230
1,600
(772)
-
(32)
1,922
2,060
(264)
100
(45)
-
(3)
484
(409)
-
57
(17)
(30)
9,860
303
-
9
(1,820)
-
(410)
(270)
150
(172)
3,200
1,500
1,800
22
6,500
(334)
(86)
(226)
(69)
(214)
110
(21)
138
303
-
34
(300)
240
(1,500)
2,914
1,600
(10)
700
615
600
-
-
(42)
-
5,500
11,280
(61)
13
3,000
99
99
(6)
-
-
11
1
-
-
1
-
2,000
16
15
(26)
70
(185)
500
15
(18)
(12)
1,915
(3)
(3)
-
(3)
(3)
(3)
100
(3)
-
(3)
-
50
(3)
-
(352)
(30)
(30)
(15)
(56)
-
-
-
-
-
-
-
-
-
560
140
Mamuju,
r, Yang Menerima,

NIP. 19790102 200604 2 013
NIP. 19790102 200604 2 013
LAPORAN TAHUNAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)
TAHUN 2018
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
1 Abbocath No. 18 Pcs 47 - 47 47 - 9
2 Abbocath No. 20 Pcs 50 68 118 115 3 23
3 Abbocath No. 22 Pcs 19 51 70 63 7 13
4 Abbocath No. 24 Pcs 22 45 67 60 7 12
6 Acyclovir tab 200 mg Tablet 245 - 245 245 - 49
8 Albendazol Suspensi 25 mg / 5 ml Btl/10 ml 30 30 30 - 6
9 Albendazol tab 400 mg Tablet 20 200 220 36 184 7
10 Alat Suntik Sekali Pakai 1 ml Pcs 204 1,100 1,304 964 340 193
11 Alat Suntik Sekali Pakai 3 ml Pcs 187 2,300 2,487 2,142 345 428
13 Allopurinol tab 100 mg Tablet 380 5,800 6,180 5,680 500 1,136
15 Alprazolam Tab 0,25 mg Tablet - - - - -
16 Ambroxol tab 30 mg Tablet - 12,200 12,200 11,400 800 2,280
18 Aminophyllin Injeksi 24 mg/ml Ampul - - - - -
21 Amlodipine 10 mg Tablet 400 1,710 2,110 2,110 - 422
23 Amoxycillin capl 250 mg Capsul - - - - -
24 Amoxycillin capl 500 mg Kaplet 180 34,600 34,780 34,280 500 6,856
25 Antacida DOEN tab. Kunyah Komb : Tablet 1,380 7,400 8,780 8,620 160 1,724
27 Antalgin tablet 500 mg Tablet - - - - -
28 Antalgin Injeksi 250 mg/ml- 2 ml Ampul - - - - -
29 Antifungi DOEN Kombinasi Tube 38 61 99 99 - 20
30 Antibakteri DOEN Kombinasi (Bacitracin) Tube 10 79 89 46 43 9
33 Antihaemorrid Supp Supp - 130 130 115 15 23
34 Antiseptik Hand Rub 500 m Botol 2 80 82 82 - 16
35 Arhtemeter Injeksi 80 mg/ml Ampul - - - - -
36 Asam Mefenamat tab 500 mg Tablet 1,100 27,600 28,700 28,000 700 5,600
37 Asam Askorbat tab 50 mg Tablet - 18,500 18,500 17,300 1,200 3,460
38 Asam Askorbat tab 250 mg Tablet 5,000 5,000 5,000 - 1,000
39 Asam Folat 1 mg Tablet 2,600 2,600 2,500 100 500
40 Asering Infus Btl/500 ml - - - - -
41 Atropin sulfat Injeksi 0,25 mg/ml Ampul 20 - 20 - - -
42 Attapulgit Tablet 300 300 300 - 60
43 Aqua Pro Injeksi 20 ml Btl/20 ml 6 1 7 5 2 1
47 Bisturi buah 41 300 341 244 97 49
48 Blood Lancet Pcs 174 6,500 6,674 6,224 450 1,245
49 Catgut No. 2/0 Pcs 48 48 20 28 4
50 Catgut No. 3/0 Pcs 24 24 24 - 5
51 Cairan 1/2 DAD Btl/500 ml - - - - -
52 Carbamazepin tab 200 mg Tablet - - - - -
53 Captopril tab 25 mg Tablet 180 10,000 10,180 9,480 700 1,896
54 Cefadroxil 500 mg Tablet 930 - 930 930 - 186
55 Cefadroxil Sirup Botol - - - - -
56 Cetirizine Syr Botol 9 30 39 3 - 1
57 CHKM Btl/15 ml - - - - -
58 Cimetidine tab 200 mg Tablet 10,000 10,000 9,800 200 1,960
59 Ciprofloxacin tab 500 mg Tablet 520 2,700 3,220 2,940 280 588
62 Dextran 70% Infus Btl/500 ml - - - - -
63 Dextromethorphan syrup Btl/ 60 ml - - - - -
64 Dextromethorphan tab 15 mg Tablet - - - - -
69 Digoxin tablet 0,25 mg Tablet - - - - -
71 Domperidon tablet 10 mg Tablet 500 1,500 2,000 1,400 600 280
72 Etanol 70% 100 ml Botol 130 130 118 12 24
73 Etanol 70% 1000 ml Botol 5 20 25 25 - 5
74 Etakridin (Rivanol) 100 ml Botol 2 33 35 35 - 7
75 Etakridin 0,1% 300 ml Btl/300 6 13 19 18 1 4
76 Efinefrin HCl Bitartrat Inj Ampul 100 - 100 18 82 4
77 Erysanbe syrup Btl/ 60 ml - - - - -
78 Erysanbe Capsul 500 mg Capsul - - - - -
79 Etylchlorida semprot Btl/100 - 1 1 1 - 0
81 Fenobarbital Inkeksi 50 mg/ml Ampul - - - - -
82 Fitomenadion (Vit. K1) tab 10 mg Tablet 310 1,400 1,710 1,410 300 282
84 Fletcher Set - - - - -
85 Furosemid tablet 40 mg Tablet 310 800 1,110 922 188 184
86 Garam Oralit 200 mg Sachet 4,153 2,400 6,553 4,194 300 839
88 Gentamicin salep mata Tube 22 - 22 22 - 4
89 Gentamicin sulfat TM 0,3% Btl/ 5 ml - - - - -
92 Glibenklamid tab 5 mg Tablet 630 1,200 1,830 1,680 150 336
93 Gliceryl Guaicolat tab 100 mg Tablet 1,640 13,500 15,140 14,640 500 2,928
95 Glimepiride tab 2 mg Tablet 350 1,300 1,650 1,650 - 330
96 Glukosa 5% Btl/500 ml 16 80 96 67 29 13
97 Glukosa 10% Btl/500 ml - - - - -
98 Griseofulvin tab 125 mg Tablet 150 3,700 3,850 3,450 400 690
100 Haloperidol tab 1,5 mg Tablet - - - - -
104 Ibuprofen tab 200 mg Tablet 1,600 1,000 2,600 2,600 - 520
105 Ibuprofen tab 400 mg Tablet 400 8,000 8,400 8,400 - 1,680
106 Infusion set anak Pcs 5 58 63 33 30 7
108 Interhistin tablet Tablet - - - - -
109 Isosorbid Dinitrat Subli. Tab Tablet 90 - 90 40 50 8
111 Jarum Jahit bedah No. 10 Pcs - - - - -
116 Kaen 3B larutan infus Btl/500 ml - - - - -
117 Kalium Permanganas Serbuk Pot/ 5 g 35 68 103 103 - 21
118 Kalsium Laktat tab 500 mg Tablet 1,200 10,500 11,700 10,250 - 2,050
119 Kalsium Glukonat Inj i.v 10 % (100mg/ml) Ampul - - - - -
120 Kapas Pembalut Hidrofil DRC 250 Gram Roll 7 37 44 44 - 9
122 Kasa Pembalut Hidrofil DRC 4m x 15 cm Roll 40 296 336 336 - 67
123 Kasa 5 Cm Roll - - - - -
124 Karbongliserin Tetes Telinga 10* Botol 12 40 52 52 - 10
125 Ketokonazol Salep Tube 22 83 105 105 - 21
126 Ketokenazol Tab Tablet 500 500 500 - 100
127 Kloramfenikol Suspensi Botol/60ml 12 - 12 5 7 1
128 Kloramfenikol caps 250 mg Tablet 300 1,000 1,300 260 1,040 52
131 Klorfeniramin Maleat (CTM) Tablet 1,100 34,800 35,900 34,900 1,000 6,980
132 Klorpromazin tab 25 mg Tablet 60 100 160 20 140 4
133 Klorpromazin tab 100 mg Tablet 120 - 120 86 34 17
134 Klorpromazin Injeksi Ampul - - - - -
135 Tablet - 20,600 20,600 19,900 700 3,980
Asam Folat
137 Kotrimoksazol tab 120 mg Tablet 350 400 750 750 - 150
138 Kotrimoksazol tab 480 mg Tablet 450 4,600 5,050 4,620 430 924
141 Loratadine tablet 10 mg Tablet 400 700 1,100 1,100 - 220
142 Loperamide Tablet 130 1,100 1,230 1,230 - 246
143 Magnesium Sulfat injeksi 40 % Ampul 10 10 3 7 1
144 Masker Pcs - 3,750 3,750 3,750 - 750
145 Meloksikam tab 7,5 mg Tablet 300 1,400 1,700 1,400 300 280
146 Meloksikam tab 15 mg Tablet - 2,900 2,900 2,900 - 580
147 Metformin HCl tablet 500 mg Tablet 200 2,100 2,300 2,100 200 420
148 Metoklorpropamide tab 10 mg Tablet 100 - 100 - - -
149 Metoklorpropamide tab 5 mg Tablet - - - - -
150 Metoklorpropamide Injeksi (Metolon) Ampul - - - - -
151 Metronidazol tab 250 mg Tablet 190 4,600 4,790 4,390 400 878
152 Metronidazol tab 500 mg Tablet 330 900 1,230 1,230 - 246
153 Metylergometrin Maleat tab. Tablet 740 1,700 2,440 2,130 310 426
154 Metylergometrin Maleat Inj Ampul 268 - 268 19 - -
156 Natrium Diklofenak tablet 25 mg Tablet 90 6,300 6,390 6,100 290 1,220
157 Natrium Diklofenak tablet 50 mg Tablet - 5,300 5,300 5,300 - 1,060
159 Nifedipin Tablet Tablet 300 300 100 - 20
160 Nistatin Tab. Vag 100.000 UI Tablet 140 - 140 140 - 28
161 Nistatin Tab. Vag 500.000 UI Tablet - - - - -
163 Omeprazole Tablet 2,040 2,040 2,040 - 408
164 Oxytocin Inj 10 mg/ml Ampul 80 200 280 106 140 21
165 Oxytetracyclin HCl Inj Vial 4 - 4 - - -
168 Papaverin HCl tab 40 mg Tablet 500 2,000 2,500 1,520 980 304
169 Paracetamol tab 500 mg Tablet 1,400 38,100 39,500 38,100 1,400 7,620
171 Piracetam Injeksi 3 g/15 ml Ampul - - - - -
172 Plester/Hipapix (5 cm x 5 m) Roll - 67 67 67 - 13
173 Prednison tab 5 mg Tablet 420 9,000 9,420 8,520 900 1,704
174 Primakina tablet 15 mg Tablet - - - - -
175 Propilthiourasil (PTU) tablet Tablet 100 400 500 350 150 70
176 Propranolol tablet 40 mg Tablet 80 100 180 90 90 18
177 Pyrantel Suspensi 125 mg/5 ml Botol 18 270 288 138 - 28
179 Pyridoxin HCl tablet 10 mg Tablet 600 12,600 13,200 12,400 800 2,480
180 Pyroxicam tablet 10 mg Tablet - - - - -
181 Pyroxicam tablet 20 mg Tablet - - - - -
182 Ranitidine Injeksi 25 mg/ml Ampul 15 - 15 15 - 3
183 Ranitidine tablet 150 mg Tablet 2,650 16,100 18,750 15,800 - 3,160
185 Retinol (Vit. A) 200.000 IU Kapluk Kapluk 90 3,350 3,440 3,440 - 688
187 Pot/ 30 g 12.0 390 402 365 37 73
Belerang
188 Salbutamol tab 2 mg Tablet 218 1,800 2,018 1,818 200 364
189 Salbutamol tab 4 mg Tablet 530 1,200 1,730 1,650 80 330
190 Salbutamol Syr Botol 12 12 5 7 1
193 Sarung Tangan No. 7,5 Steril Pasang - - - - -
194 Scabicid Cream 10 gram Tube - - - - -
195 Scopamin Tablet 360 - 360 260 100 52
198 Simvastatin tablet 10 mg Tablet 3,380 3,380 3,320 60 664
199 Simvastatin tablet 20 mg Tablet 2,950 2,950 2,950 - 590
201 Strip Kolesterol Nesco Strip 1,840 1,840 1,810 30 362
202 Strip Asam Urat Nesco Strip 50 2,250 2,300 2,125 175 425
203 Strip Glukosa Nesco Strip 50 2,400 2,450 2,275 175 455
204 Tetracycline HCl 250 mg Capsul 420 1,000 1,420 1,420 - 284
205 Tetracycline HCl 500 mg Capsul 110 - 110 110 - 22
207 Thiamin HCl (B1) Inj Ampul - - - - -
208 Thiamin HCl (B1) Tab 50 mg Tablet 800 12,600 13,400 9,200 300 1,840
209 Vitamin B Complex tab Tablet 640 45,100 45,740 44,240 1,500 8,848
211 Yodium Povidon 10% 30 ml Botol 2 54 56 56 - 11
212 Zink Tablet Tablet 2,100 2,300 4,400 4,400 - 880
213 Zink Syr 10 mg Botol 78 78 78 - 16
214 Zink Syr 20 mg Botol 35 35 35 - 7
216 Tes Kit Malaria Pcs - - - - -
217 O A T Kategori Anak Paket 3 3 2 - 0
219 O A T Kategori 2 Paket - - - - -
220 Obat PB Dewasa Strip - - - - -
221 Obat MB Dewasa Strip - - - - -
222 Obat PB Anak Strip 8 8 7 1 1
223 Obat MB Anak Strip - - - - -
224 Sangobion Tablet 470 1,750 2,220 2,220 - 444
226 Lidokain Spray Botol 2 13 15 15 - 3
227 Lidokain Gel Tube 4 22 26 18 8 4
228 Elkana Syr Botol 40 988 1,028 939 - 188
230 Cetirizine Tab Tablet - - - - -
231 Kateter buah - - - - -
234 Amlodipine 5 mg Tablet 4,170 4,170 4,170 - 834
237 Caviton Tube 1 1 - - -
241 Sponge Gigi / Hemospon Pcs 61 61 61 - 12
243 Tambalan Komposit GC Hydcal Tube 2 2 2 - 0
245 Bisakodil Suppo 10 mg Suppo -
246 Tabung Vacum Buah - - - - -
247 Reagen ZN Paket 2 2 1 1 0
248 Mata Klinipet Dos - - - - -
253 Plano Test Pcs 550 550 520 30 104
254 Tambalan Komposit Flowable Tube - - - - -
255 Calsium Hidroside Lightcurring Tube - - - - -
256 Microbrush Botol - - - - -
257 Bur Composite Set - - - - -
258 Bur Intan Set - - - - -
259 Cotton Roll Pak - - - - -
260 Celemek Gigi Pcs - - - - -
261 Celluloid Strip Pak - - - - -
262 Matrix Band Kompensional Set - - - - -
263 Hemafort Tablet 2,000 2,000 1,600 400 320
264 Mediamer Tablet 300 300 300 - 60
265 Metyl Prednisolon 4 mg Tablet 1,000 1,000 900 100 180
266 ETSA (gigi) Tube - - - - -
267 Masker N 25 Pcs 20 20 20 - 4

BPJS NON BPJS
1 Puskesmas
3 Poskesdes
JUMLAH
Yang Melapor,
NIP. 19640514 200003 2 006 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
AAN OBAT (LPLPO)
PEMBERIAN PEMAKAIAN
PERMINTAAN KET
PKD DKP/PROGRAM LAIN-LAIN RATA-RATA
10=(7+9)-8 11 12 13 14 15
56 4
135 10
69 5
65 5
72 7
294 20
106 19
36 3
(141) 3
817 80
2,225 179
210 17
6,316 473
424 43
- -
12,880 950
351 25
- -
(100) -
- -
2,532 176
1,080 76
- -
40,636 2,857
10,184 718
471 36
- -
- -
119 8
12 4
(100) -
(38) 3
123 10
98 7
- -
32,900 2,333
19,560 1,442
6,000 417
2,900 208
- -
- -
360 25
4 0
28 2
156 11
310 25
196 20
7,019 519
(4) 2
29 2
- -
- -
10,676 790
1,116 78
- -
4 0
- -
11,560 817
3,248 245
275 27
47,200 3,458
- -
- -
- -
120 19
(78) 4
(10) -
(20) -
- -
(100) -
1,080 117
130 10
30 2
42 3
21 2
(60) 2
- -
- -
1 0
(234) 3
- -
1,392 118
73 7
- -
918 77
4,733 350
427 32
26 2
- -
46 4
4 0
1,866 140
17,068 1,220
(190) 4
1,980 138
51 6
- -
3,740 288
(36) 4
- -
1,122 80
349 27
547 38
3,120 217
10,080 700
10 3
101 9
- -
(2) 3
59 5
- -
- -
- -
- -
- -
- -
124 9
12,300 854
- -
53 4
19 1
403 28
- -
62 4
126 9
600 42
(1) 0
(728) 22
100 10
77 7
40,880 2,908
(116) 2
69 7
- -
23,180 1,658
135 10
900 63
5,114 385
1,027 73
13 1
1,320 92
1,476 103
(3) 0
4,500 313
1,380 117
3,480 242
2,320 175
- -
- -
- -
4,868 366
1,476 103
2,246 178
- 2
323 26
7,030 508
6,360 442
169 18
120 8
168 12
- -
113 8
2,448 170
(13) 9
- -
314 25
169 12
844 127
44,320 3,175
946 67
- -
80 6
9,324 710
- -
270 29
18 8
166 12
424 50
14,080 1,033
- -
- -
18 1
18,960 1,317
1,716 125
4,128 287
184 18
401 30
1,982 152
1,900 138
(1) 0
720 50
840 58
- -
- -
212 22
492 36
(500) -
3,924 277
3,540 246
100 8
2,142 151
2,375 177
2,555 190
1,704 118
132 9
(2) 1
- -
10,740 767
51,588 3,687
88 8
67 5
5,280 367
94 7
42 3
(2) -
- -
2 0
51 4
- -
- -
- -
7 1
- -
2,664 185
50 4
18 1
14 2
1,127 78
190 21
- -
- -
1 1
15 1
5,004 348
0 0
1 0
- -
(1) -
(1) -
0 0
73 5
(1) -
2 0
0 0
- -
- -
0 0
- -
(75) 3
(10) -
(10) -
1 0
594 43
- -
- -
- -
- -
- -
- -
- -
- -
- -
1,520 133
360 25
980 75
- -
24 2
Mamuju,
r, Yang Menerima,

NIP. 19790102 200604 2 013
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
2 Abbocath No. 20 Pcs 3 3 3 1
3 Abbocath No. 22 Pcs 7 20 27 11 16 2
4 Abbocath No. 24 Pcs 7 9 16 2 14 0
8 Albendazol Suspensi 25 mg / 5 ml Btl/10 ml - - - -
13 Allopurinol tab 100 mg Tablet 500 3,000 3,500 500 3,000 100
16 Ambroxol tab 30 mg Tablet 800 600 1,400 300 1,100 60
17 Ambroxol Syrup Btl/60 ml 15 25 40 - 40 -
21 Amlodipine 10 mg Tablet - 300 300 300 - 60
25 Antacida DOEN tab. Kunyah Komb : Tablet 160 1,300 1,460 660 800 132
36 Asam Mefenamat tab 500 mg Tablet 700 3,400 4,100 2,600 1,500 520
37 Asam Askorbat tab 50 mg Tablet 1,200 1,200 2,400 1,800 600 360
43 Aqua Pro Injeksi 20 ml Btl/20 ml 2 2 2 - 0
44 Aquagel Sterile Jely 82 gr Tube 1 2 3 3 - 1
45 Bedak Salisil Pot - 20 20 - 20 -
47 Bisturi buah 97 97 63 34 13
49 Catgut No. 2/0 Pcs 28 28 4 24 1
50 Catgut No. 3/0 Pcs - 12 12 - 12 -
57 CHKM Btl/15 ml - - -
58 Cimetidine tab 200 mg Tablet 200 1,000 1,200 400 800 80
72 Etanol 70% 100 ml Botol 12 12 - 12 -
73 Etanol 70% 1000 ml Botol - 2 2 1 1 0
74 Etakridin (Rivanol) 100 ml Botol - - - - -
75 Etakridin 0,1% 300 ml Btl/300 1 10 11 3 8 1
85 Furosemid tablet 40 mg Tablet 188 188 - 188 -
88 Gentamicin salep mata Tube - - - -
90 Gentian Violet 1% Btl/ 5 ml 10 10 10 - 2
95 Glimepiride tab 2 mg Tablet - 300 300 270 30 54
96 Glukosa 5% Btl/500 ml 29 29 10 - 2
97 Glukosa 10% Btl/500 ml - - -
101 Hidroklorothiazid (HCT) tab Tablet 30 100 130 - 130 -
102 Hidrokortison Cream 2,5% Tube 40 40 40 - 8
109 Isosorbid Dinitrat Subli. Tab Tablet 50 50 50 - 10
124 Karbongliserin Tetes Telinga 10* Botol - 24 24 2 22 0
126 Ketokenazol Tab Tablet - - - -
128 Kloramfenikol caps 250 mg Tablet 1,040 1,040 40 1,000 8
129 Kloramfenikol Salep Mata 1% Tube 50 50 - 50 -
130 Kloramfenikol Tetes Telinga Botol5 ml 23 23 - - -
135 Tablet 700 2,400 3,100 2,000 1,100 400
Asam Folat
142 Loperamide Tablet - 200 200 - 200 -
144 Masker Pcs - 100 100 100 - 20
145 Meloksikam tab 7,5 mg Tablet 300 300 600 600 - 120
151 Metronidazol tab 250 mg Tablet 400 1,000 1,400 900 500 180
157 Natrium Diklofenak tablet 50 mg Tablet - 1,000 1,000 1,000 - 200
160 Nistatin Tab. Vag 100.000 UI Tablet - 100 100 15 85 3
167 Oxytetracyclin Salep Mata 1% Tube 5 5 - 5 -
179 Pyridoxin HCl tablet 10 mg Tablet 800 800 1,600 1,400 200 280
182 Ranitidine Injeksi 25 mg/ml Ampul - - - -
185 Retinol (Vit. A) 200.000 IU Kapluk Kapluk - 50 50 5 45 1
187 Pot/ 30 g 37.0 37 22 15 4
Belerang
188 Salbutamol tab 2 mg Tablet 200 200 200 - 40
191 Sarung Tangan No. 6,5 Steril Pasang - - - -
195 Scopamin Tablet 100 100 30 70 6
198 Simvastatin tablet 10 mg Tablet 60 1,140 1,200 100 1,100 20
200 SILK BLACK 3/0 HR 26 MM Peaces 20 20 - 20 -
208 Thiamin HCl (B1) Tab 50 mg Tablet 300 1,000 1,300 1,300 - 260
209 Vitamin B Complex tab Tablet 1,500 3,000 4,500 3,700 800 740
222 Obat PB Anak Strip 1 1 1 - 0
227 Lidokain Gel Tube 8 8 8 - 2
228 Elkana Syr Botol 0 - - -
234 Amlodipine 5 mg Tablet 0 - - -
254 Plano Test Pcs 30 30 30 0 6
264 Hemafort Tablet 400 400 100 300 20
268 Masker N 25 Pcs - - -

BPJS NON BPJS
1 Puskesmas
3 Poskesdes
JUMLAH
Yang Melapor,
Yang Melapor,

NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN PEMAKAIAN OBAT : JANUARI I
BULAN PELAPORAN OBAT : FEBRUARI
TAHUN : 2019
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
25
25
24
(12)
25
200
200
-
(175)
228
583
297
(2,400)
(200)
-
(740)
(40)
-
(100)
-
600
65
-
3,640
(8)
10
-
-
(1)
(43)
(100)
(80)
(15)
12
-
2,000
1,880
-
280
-
-
200
5
6
50
35
42
1,000
(19)
(12)
-
-
400
300
10
10
-
500
356
(120)
3,900
-
-
-
(150)
(139)
(10)
(20)
-
(100)
(600)
(12)
0
12
(4)
(82)
-
-
8
(270)
-
300
30
-
(188)
400
60
12
-
24
-
(84)
1,880
130
350
40 ED 19
-
(378)
(90)
-
(130)
48
15
1,000
1,000
(30)
50
100
60
24
-
-
-
-
-
-
24
1,500
-
6
5
100
-
(20)
24
100
(7)
(952)
(50)
24 ED 23
2,590
(100)
(34)
-
2,000
50
200
(204)
166
(2)
100
(200)
(7)
600
720
600
360
-
-
-
580
400
200
100
50
400
1,200
(86)
100
(67)
-
(2)
300
(131)
-
50
25
(804)
2,700
109
-
(19)
(680)
-
(150)
(90)
50
(104)
1,560
600
600
10
1,000
1,500
750
(73)
24
240
200
6
-
100
50
10
(34)
100
(500)
(980)
-
(20)
200
(200)
(255)
-
-
(14)
-
2,000
3,640
18 ED 10
-
1,000
15
15
(2)
-
-
-
-
-
-
-
-
500
5
6
10
50
(88)
100
5
(6)
(4)
300
1
(1)
-
(1)
(1)
1
25
(1)
-
(1)
-
-
(1)
-
(71)
(10)
(10)
(5)
100
-
-
-
-
-
-
-
-
-
(180)
-
120
1
25
Mamuju,
r, Yang Menerima,

r, Yang Menerima,

NIP. 19790102 200604 2 013
OBAT PROGRAM KIA
OBAT PROGRAM DIARE

1 Garam oralit Sachet 0
2 Zink Tablet 1700 0 1700 1700 0

Nip. 19640514 200003 2 006 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
2 Abbocath No. 20 Pcs - - -
3 Abbocath No. 22 Pcs 16 10 26 7 19 1
4 Abbocath No. 24 Pcs 14 14 - 14 -
12 Alat Suntik Sekali Pakai 5 ml Pcs 45 500 545 - 545 -
13 Allopurinol tab 100 mg Tablet 3,000 3,000 1,100 1,900 220
16 Ambroxol tab 30 mg Tablet 1,100 1,100 900 200 180
26 Antacida DOEN suspensi Btl/60 ml 20 10 30 30 - 6
34 Antiseptik Hand Rub 500 m Botol - 12 12 - 12 -
37 Asam Askorbat tab 50 mg Tablet 600 1,900 2,500 2,500 - 500
42 Attapulgit Tablet - - -
43 Aqua Pro Injeksi 20 ml Btl/20 ml - 5 5 - 5 -
44 Aquagel Sterile Jely 82 gr Tube - - - - -
45 Bedak Salisil Pot 20 10 30 30 - 6
47 Bisturi buah 34 300 334 44 290 9
49 Catgut No. 2/0 Pcs 24 24 24 - 5
50 Catgut No. 3/0 Pcs 12 12 12 - 2
57 CHKM Btl/15 ml - - -
58 Cimetidine tab 200 mg Tablet 800 500 1,300 1,300 - 260
59 Ciprofloxacin tab 500 mg Tablet 100 100 100 - 20
61 Dexamethasone tab 0,5 mg Tablet 300 3,900 4,200 4,200 - 840
72 Etanol 70% 100 ml Botol 12 12 24 4 20 1
73 Etanol 70% 1000 ml Botol 1 1 1 - 0
75 Etakridin 0,1% 300 ml Btl/300 8 8 - 8 -
85 Furosemid tablet 40 mg Tablet 188 188 - 188 -
96 Glukosa 5% Btl/500 ml - - - -
97 Glukosa 10% Btl/500 ml 40 40 13 27 3
99 Haloperidol tab 0,5 mg Tablet 90 90 10 80 2
102 Hidrokortison Cream 2,5% Tube - 48 48 36 12 7
109 Isosorbid Dinitrat Subli. Tab Tablet - - - -
124 Karbongliserin Tetes Telinga 10* Botol 22 22 - 22 -
127 Kloramfenikol Suspensi Botol/60ml 7 7 - - -
130 Kloramfenikol Tetes Telinga Botol5 ml - 24 24 19 5 4
135 Tablet 1,100 2,000 3,100 1,500 1,600 300
Asam Folat
144 Masker Pcs - 50 50 50 - 10
145 Meloksikam tab 7,5 mg Tablet - 700 700 700 - 140
150 Metoklorpropamide Injeksi (Metolon) Ampul 30 30 - 30 -
154 Metylergometrin Maleat Inj Ampul 100 100 10 90 2
157 Natrium Diklofenak tablet 50 mg Tablet - 1,200 1,200 1,100 100 220
158 Natrium Klorida Inf 0,9% Btl/ 500 ml 90 90 - 90 -
160 Nistatin Tab. Vag 100.000 UI Tablet 85 85 - - -
162 Obat Batuk Hitam (OBH) Btl/ 100 ml 8 8 8 - 2
168 Papaverin HCl tab 40 mg Tablet 900 900 340 - 68
178 Pyrantel tablet 125 mg Tablet 210 210 - 210 -
179 Pyridoxin HCl tablet 10 mg Tablet 200 2,000 2,200 700 1,500 140
187 Pot/ 30 g 15.0 24 39 20 19 4
Belerang
188 Salbutamol tab 2 mg Tablet - 300 300 200 100 40
190 Salbutamol Sirup Botol 7 6 13 - - -
195 Scopamin Tablet 70 70 20 50 4
196 Sianocobalamin (Vit. B12) Injeksi Ampul 50 100 150 - 150 -
198 Simvastatin tablet 10 mg Tablet 1,100 1,100 770 330 154
208 Thiamin HCl (B1) Tab 50 mg Tablet - 200 200 200 - 40
212 Zink Tablet Tablet - 1,000 1,000 700 300 140
218 O A T Kategori 1 Paket 7 7 7 - 1
222 Obat PB Anak Strip - - - -
226 Lidokain Spray Botol - 1 1 - 1 -
227 Lidokain Gel Tube -
241 Elite Cemen Liquid GC Botol 0 - - -
244 Tambalan Komposit GC Hydcal Tube 0 2 2 1 1 0
254 Plano Test Pcs 0 - - -
264 Hemafort Tablet 300 300 300 - 60
266 Metyl Prednisolon 4 mg Tablet 0 - - -

BPJS NON BPJS
1 Puskesmas
3 Poskesdes
JUMLAH
Yang Melapor,
Yang Melapor,

NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN : MARET
TAHUN : 2019
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
50
50
(11)
(14)
(22)
200
300
-
(180)
(257)
(722)
(545)
(580)
(200)
-
1,500
(18)
-
(100)
-
1,000
(51)
-
5,120
1,500
60
-
-
48
(43)
(100)
(3)
(15)
(12)
-
2,500
3,000
-
400
-
-
200
(5)
5
36
24
(237)
500
48
48
-
-
900
300
10
10
-
2,000
500
(120)
5,040
-
-
-
(150)
(139)
(10)
(20)
-
(100)
(600)
(15)
10
-
(8)
(82)
-
-
6
(270)
-
100
(29)
-
(188)
(58)
100
-
-
20
-
(76)
2,500
(90)
300
-
(11)
138
(68)
-
(130)
48
50
600
1,000
(30)
(49)
100
100
(6)
-
-
-
-
-
-
24
2,000
-
7
100
100
-
(22)
24
100
- ED 7
(1,000)
25
24
4,000
(100)
(23)
-
200
(28)
300
544
100
(3)
100
130
(7)
200
840
1,000
200
-
-
(30)
500
500
200
(78)
(19)
(282)
1,220
(90)
100
- ED 85
-
10
600
(107)
-
50
(96)
408 ED 560
4,180
50
-
15
(140)
-
(40)
(90)
50
(210)
(660)
500
500
10
2,500
(58)
(12)
(40)
48
140
146
- ED 13
50
150
150
10
(26)
(150)
(500)
794
300
24
300
140
(105)
-
-
(14)
-
2,000
3,460
10 ED 10
24
700
24
24
(2)
-
2
10
-
-
6
-
6
-
1
(1)
-
(100)
100
5
(6)
0
1,000
-
(1)
-
(1)
(1)
-
50
(1)
0
(1)
-
-
(1)
-
(73)
(10)
(10)
(5)
200
-
-
-
-
-
-
-
-
-
360
-
1,000
-
15
Mamuju,
r, Yang Menerima,

r, Yang Menerima,

NIP. 19790102 200604 2 013
OBAT PROGRAM KIA
BULAN : Maret
TAHUN : 2019

Nip. 19610310 198710 1 002 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
OBAT PROGRAM KIA
BULAN : APRIL
TAHUN : 2019

Nip. 19610310 198710 1 002 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
3 Abbocath No. 22 Pcs 19 19 14 5 3
4 Abbocath No. 24 Pcs 14 14 4 10 -
13 Allopurinol tab 100 mg Tablet 1,900 1,900 900 - 180
17 Ambroxol Syrup Btl/60 ml 30 30 30 - 6
25 Antacida DOEN tab. Kunyah Komb : Tablet - 1,500 1,500 1,500 - 300
26 Antacida DOEN suspensi Btl/60 ml - 60 60 60 - 12
29 Antifungi DOEN Kombinasi Tube - 48 48 - 48 -
32 Antimigren : Ergotamin Tartrat + Kofein Tablet 45 45 45 - 9
34 Antiseptik Hand Rub 500 m Botol 12 12 12 - 2
44 Aquagel Sterile Jely 82 gr Tube - - - -
46 Betametason cream Tube 20 24 44 44 - 9
47 Bisturi buah 290 290 101 189 20
49 Catgut No. 2/0 Pcs - 48 48 40 8 8
50 Catgut No. 3/0 Pcs - 48 48 39 9 8
53 Captopril tab 25 mg Tablet 300 900 1,200 1,200 - 240
57 CHKM Btl/15 ml - - -
58 Cimetidine tab 200 mg Tablet - - - -
59 Ciprofloxacin tab 500 mg Tablet - - - -
61 Dexamethasone tab 0,5 mg Tablet - 5,000 5,000 5,000 - 1,000
67 Diazepam Injeksi Ampul 10 10 2 8 0
70 Diltiazem HCl tablet 30 mg Tablet 100 100 - - -
72 Etanol 70% 100 ml Botol 20 20 5 15 1
73 Etanol 70% 1000 ml Botol - 10 10 3 7 1
75 Etakridin 0,1% 300 ml Btl/300 8 8 1 7 0
82 Fitomenadion (Vit. K1) tab 10 mg Tablet 55 55 55 - 11
90 Gentian Violet 1% Btl/ 5 ml 8 20 28 28 - 6
96 Glukosa 5% Btl/500 ml - - - -
97 Glukosa 10% Btl/500 ml 27 27 27 - 5
120 Kapas Pembalut Hidrofil DRC 250 Gram Roll - 7 7 1 6 0
127 Kloramfenikol Suspensi Botol/60ml - - - -
129 Kloramfenikol Salep Mata 1% Tube 16 25 41 1 - 0
131 Klorfeniramin Maleat (CTM) Tablet 200 4,000 4,200 4,200 - 840
135 Tablet 1,600 1,600 1,600 - 320
Asam Folat
138 Kotrimoksazol tab 480 mg Tablet 80 1,500 1,580 680 - 136
142 Loperamide Tablet 50 50 50 - 10
143 Magnesium Sulfat injeksi 40 % Ampul 7 7 - - -
144 Masker Pcs - 50 50 50 - 10
145 Meloksikam tab 7,5 mg Tablet - 800 800 700 100 140
151 Metronidazol tab 250 mg Tablet 100 100 - 100 -
157 Natrium Diklofenak tablet 50 mg Tablet 100 1,000 1,100 1,100 - 220
160 Nistatin Tab. Vag 100.000 UI Tablet - - - -
162 Obat Batuk Hitam (OBH) Btl/ 100 ml - 10 10 10 - 2
163 Omeprazole Tablet - - - -
164 Oxytocin Inj 10 mg/ml Ampul 123 123 - - -
168 Papaverin HCl tab 40 mg Tablet - 1,000 1,000 400 600 80
169 Paracetamol tab 500 mg Tablet 500 4,200 4,700 3,600 1,100 720
170 Paracetamol syrup Btl/ 60 ml 69 50 119 119 - 24
173 Prednison tab 5 mg Tablet 500 500 500 - 100
179 Pyridoxin HCl tablet 10 mg Tablet 1,500 1,500 1,500 - 300
187 Pot/ 30 g 19.0 48 67 47 20 9
Belerang
190 Salbutamol Sirup Botol - - - -
195 Scopamin Tablet 50 50 50 - 10
196 Sianocobalamin (Vit. B12) Injeksi Ampul 150 150 - 150 -
198 Simvastatin tablet 10 mg Tablet 330 780 1,110 700 410 140
200 SILK BLACK 3/0 HR 26 MM Peaces 10 10 10 - 2
203 Strip Glukosa Nesco Strip 525 525 200 325 40
208 Thiamin HCl (B1) Tab 50 mg Tablet - 200 200 200 - 40
209 Vitamin B Complex tab Tablet 500 1,000 1,500 1,500 - 300
212 Zink Tablet Tablet 300 700 1,000 600 400 120
217 O A T Kategori Anak Paket - 2 2 2 - 0
221 Obat MB Dewasa Strip 6 6 1 5 0
222 Obat PB Anak Strip - - - -
223 Obat MB Anak Strip - 6 6 1 5 0
227 Lidokain Gel Tube - - -
241 Elite Cemen Liquid GC Botol 0 - - -
244 Tambalan Komposit GC Hydcal Tube 1 1 - 1 -
254 Plano Test Pcs 0 - - -
264 Hemafort Tablet 0 200 200 200 - 40
266 Metyl Prednisolon 4 mg Tablet 0 - - -

BPJS NON BPJS
1 Puskesmas
3 Puskesmas Keliling
JUMLAH
Yang Melapor,
Yang Melapor,

NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN : APRIL
TAHUN : 2019
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
50
50
24
(6)
(10)
200
200
-
(180)
(50)
(346)
(226)
1,080
(200)
-
500
50
-
(100)
-
500
95
-
1,090
4,000
75
-
-
(48)
(43)
(100)
54
(15)
14
-
2,100
3,600
-
380
-
-
200
(1)
6
30
53
(68)
500
40
38
-
-
1,440
200
25
25
-
1,000
1,000
(120)
6,000
-
-
-
(106)
(139)
(6)
(20)
-
-
(600)
(9)
(3)
-
(6)
(82)
-
-
5
(248)
-
200
10
-
6
(46)
60
25
-
34
-
(100)
1,780
(90)
100
-
32
300
(80)
-
(64)
50
50
500
1,000
(30)
(24)
-
100
19
-
-
-
-
-
-
24
1,500
-
(5)
5
100
-
12
24
-
10
(1,000)
50
20
5,040
(100)
(18)
-
2,880
50
200
816
(191)
(3)
200
500
10
500
740
500
(76)
-
-
(30)
(100)
500
(180)
(75)
56
540
1,320
(79)
200
50
-
12
300
100
-
148
11
(120)
3,220
143
-
(21)
2,000
-
(100)
(90)
50
(210)
2,000
500
500
10
1,000
84
36
(49)
36
(36)
140
-
-
60
60
-
100
(150)
(500)
430
500
24
200
(240)
(85)
-
-
(14)
-
2,000
2,000
5
10
320
20
20
(2)
-
-
5
-
-
(4)
-
(4)
250
1
(1)
-
-
76
100
-
10
10
500
-
(1)
-
(1)
(1)
-
30
(1)
(1)
(1)
-
-
(1)
-
(74)
(10)
(10)
6
100
-
-
-
-
-
-
-
-
-
240
100
300
-
-
Mamuju,
r, Yang Menerima,

r, Yang Menerima,

NIP. 19790102 200604 2 013
1 Abbocath No. 18 Pcs
5 Acyclovir Cream 3% Tube
9 Albendazol tab 400 mg Tablet
10 Alat Suntik Sekali Pakai 1 ml Pcs
13 Allopurinol tab 100 mg Tablet
14 Allopurinol tab 300 mg Tablet
16 Ambroxol tab 30 mg Tablet
17 Ambroxol Syrup Btl/60 ml
22 Amoxycillin syrup kering 125 mg/ 5 ml Btl/60 ml
24 Amoxycillin capl 500 mg Kaplet
25 Antacida DOEN tab. Kunyah Komb : Tablet
26 Antacida DOEN suspensi Btl/60 ml
29 Antifungi DOEN Kombinasi Tube
30 Antibakteri DOEN Kombinasi (Bacitracin) Tube
31 Antimalaria DOEN Kombinasi Tablet
32 Antimigren : Ergotamin Tartrat + Kofein Tablet
33 Antihaemorrid Supp Supp
34 Antiseptik Hand Rub 500 m Botol
36 Asam Mefenamat tab 500 mg Tablet
37 Asam Askorbat tab 50 mg Tablet
38 Asam Askorbat tab 250 mg Tablet
39 Asam Folat 1 mg Tablet
41 Atropin sulfat Injeksi 0,25 mg/ml Ampul
42 Attapulgit Tablet
43 Aqua Pro Injeksi 20 ml Btl/20 ml
44 Aquagel Sterile Jely 82 gr Tube
45 Bedak Salisil Pot
46 Betametason cream Tube
47 Bisturi buah
48 Blood Lancet Pcs
53 Captopril tab 25 mg Tablet
54 Cefadroxil 500 mg Tablet
56 Cetirizine Syr Botol
57 CHKM Btl/15 ml
58 Cimetidine tab 200 mg Tablet
59 Ciprofloxacin tab 500 mg Tablet
60 Dexamethasone Injeksi Ampul
61 Dexamethasone tab 0,5 mg Tablet
65 Diazepam 2 mg Tablet
66 Diazepam 5 mg Tablet
67 Diazepam Injeksi Ampul
68 Difenhidramin Injeksi 10 mg/ml Ampul
71 Domperidon tablet 10 mg Tablet
74 Etakridin (Rivanol) 100 ml Botol
75 Etakridin 0,1% 300 ml Btl/300
76 Efinefrin HCl Bitartrat Inj Ampul
79 Etylchlorida semprot Btl/100
80 Fenobarbital tab 30 mg Tablet
82 Fitomenadion (Vit. K1) tab 10 mg Tablet
83 Fitomenadion (Vit. K1) Injeksi Ampul
84 Fletcher Set
85 Furosemid tablet 40 mg Tablet
86 Garam Oralit 200 mg Sachet
87 Gentamicin salep kulit Tube
88 Gentamicin salep mata Tube
90 Gentian Violet 1% Btl/ 5 ml
91 Glass Ionometer Cemen Set
92 Glibenklamid tab 5 mg Tablet
93 Gliceryl Guaicolat tab 100 mg Tablet
94 Glimepiride Tab 1 mg Tablet
95 Glimepiride tab 2 mg Tablet
98 Griseofulvin tab 125 mg Tablet
101 Hidroklorothiazid (HCT) tab Tablet
102 Hidrokortison Cream 2,5% Tube
103 Ibuprofen Syrup Btl/60 ml
104 Ibuprofen tab 200 mg Tablet
105 Ibuprofen tab 400 mg Tablet
106 Infusion set anak Pcs
107 Infusion set Dewasa Pcs
109 Isosorbid Dinitrat Subli. Tab Tablet
117 Kalium Permanganas Serbuk Pot/ 5 g
118 Kalsium Laktat tab 500 mg Tablet
120 Kapas Pembalut Hidrofil DRC 250 Gram Roll
121 Kasa Hidrofil DRC 36 m x 80 cm Roll
122 Kasa Pembalut Hidrofil DRC 4m x 15 cm Roll
123 Kasa 5 Cm Roll
124 Karbongliserin Tetes Telinga 10* Botol
125 Ketokonazol Salep Tube
126 Ketokenazol Tab Tablet
127 Kloramfenikol Suspensi Botol/60ml
128 Kloramfenikol caps 250 mg Tablet
129 Kloramfenikol Salep Mata 1% Tube
130 Kloramfenikol Tetes Telinga Botol5 ml
131 Klorfeniramin Maleat (CTM) Tablet
132 Klorpromazin tab 25 mg Tablet
133 Klorpromazin tab 100 mg Tablet
135 Tablet
Asam Folat
136 Kotrimoksazol Suspensi Btl/ 60 ml
137 Kotrimoksazol tab 120 mg Tablet
138 Kotrimoksazol tab 480 mg Tablet
139 Lidocain HCl Injeksi 2% Ampul
140 Lisol 1 Liter Botol
141 Loratadine tablet 10 mg Tablet
142 Loperamide Tablet
143 Magnesium Sulfat injeksi 40 % Ampul
144 Masker Pcs
145 Meloksikam tab 7,5 mg Tablet
146 Meloksikam tab 15 mg Tablet
147 Metformin HCl tablet 500 mg Tablet
151 Metronidazol tab 250 mg Tablet
152 Metronidazol tab 500 mg Tablet
153 Metylergometrin Maleat tab. Tablet
155 Miconazole Cream Tube
156 Natrium Diklofenak tablet 25 mg Tablet
157 Natrium Diklofenak tablet 50 mg Tablet
158 Natrium Klorida Inf 0,9% Btl/ 500 ml
159 Nifedipin Tablet Tablet
162 Obat Batuk Hitam (OBH) Btl/ 100 ml
163 Omeprazole Tablet
164 Oxytocin Inj 10 mg/ml Ampul
165 Oxytetracyclin HCl Inj Vial
166 Oxytetracyclin SK. 3% Tube
167 Oxytetracyclin Salep Mata 1% Tube
168 Papaverin HCl tab 40 mg Tablet
169 Paracetamol tab 500 mg Tablet
170 Paracetamol syrup Btl/ 60 ml
172 Plester/Hipapix (5 cm x 5 m) Roll
173 Prednison tab 5 mg Tablet
175 Propilthiourasil (PTU) tablet Tablet
176 Propranolol tablet 40 mg Tablet
177 Pyrantel Suspensi 125 mg/5 ml Botol
178 Pyrantel tablet 125 mg Tablet
179 Pyridoxin HCl tablet 10 mg Tablet
182 Ranitidine Injeksi 25 mg/ml Ampul
183 Ranitidine tablet 150 mg Tablet
184 Retinol (Vit. A) 100.000 IU Kapluk Kapluk
185 Retinol (Vit. A) 200.000 IU Kapluk Kapluk
186 Ringer Laktat Infus Btl/ 500 ml
187 Pot/ 30 g
Belerang
188 Salbutamol tab 2 mg Tablet
189 Salbutamol tab 4 mg Tablet
190 Salbutamol Sirup Botol
192 Sarung Tangan No. 7 Steril Pasang
195 Scopamin Tablet
196 Sianocobalamin (Vit. B12) Injeksi Ampul
197 Sianocobalamin (Vit. B12) Tab Tablet
200 SILK BLACK 3/0 HR 26 MM Peaces
201 Strip Kolesterol Nesco Strip
202 Strip Asam Urat Nesco Strip
203 Strip Glukosa Nesco Strip
206 Tetrakain Tetes Mata Botol
208 Thiamin HCl (B1) Tab 50 mg Tablet
209 Vitamin B Complex tab Tablet
210 Yodium Povidon 10% 300 ml Botol
211 Yodium Povidon 10% 30 ml Botol
212 Zink Tablet Tablet
215 Kantong Mayat Pcs
217 O A T Kategori Anak Paket
223 Obat MB Anak Strip
224 Sangobion Tablet
225 Sarung Tangan M Box
226 Lidokain Spray Botol
227 Lidokain Gel Tube
228 Elkana Syr Botol
229 Bisakodil 5 mg Tablet
231 Kateter buah
232 Dulcolax Suppo 5 mg Suppo
233 Dulcolax Suppo 10 mg Suppo
238 Caviton Tube
248 Reagen ZN Paket
254 Plano Test Pcs
259 Bur Intan Set
260 Cotton Roll Pak
262 Hemafort Tablet
263 Mediamer Tablet
266 Masker N 25 Pcs
267 Ampicillin Injeksi Ampul
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
3 Abbocath No. 22 Pcs 5 5 - 5 -
4 Abbocath No. 24 Pcs 10 10 - 10 -
13 Allopurinol tab 100 mg Tablet - - -
16 Ambroxol tab 30 mg Tablet 700 500 1,200 576 624 115
17 Ambroxol Syrup Btl/60 ml - 50 50 23 27 5
25 Antacida DOEN tab. Kunyah Komb : Tablet - 4,000 4,000 1,690 2,310 338
26 Antacida DOEN suspensi Btl/60 ml - 100 100 31 69 6
32 Antimigren : Ergotamin Tartrat + Kofein Tablet - 100 100 - 100 -
34 Antiseptik Hand Rub 500 m Botol - 8 8 2 6 0
36 Asam Mefenamat tab 500 mg Tablet 1,100 500 1,600 1,336 264 267
37 Asam Askorbat tab 50 mg Tablet - 3,600 3,600 600 3,000 120
38 Asam Askorbat tab 250 mg Tablet 0 - -
41 Atropin sulfat Injeksi 0,25 mg/ml Ampul - - -
44 Aquagel Sterile Jely 82 gr Tube - - -
45 Bedak Salisil Pot - 15 15 - 15 -
46 Betametason cream Tube - 25 25 - 25 -
47 Bisturi buah 189 189 10 179 2
48 Blood Lancet Pcs - 200 200 - 200 -
49 Catgut No. 2/0 Pcs 8 48 56 - 56 -
50 Catgut No. 3/0 Pcs 9 48 57 6 51 1
52 Carbamazepin tab 200 mg Tablet 100 100 - 100 -
53 Captopril tab 25 mg Tablet - 1,500 1,500 300 1,200 60
54 Cefadroxil 500 mg Tablet - - -
56 Cetirizine Syr Botol - - -
58 Cimetidine tab 200 mg Tablet - - -
59 Ciprofloxacin tab 500 mg Tablet - - -
61 Dexamethasone tab 0,5 mg Tablet - 1,000 1,000 1,000 - 200
68 Difenhidramin Injeksi 10 mg/ml Ampul 20 20 - - -
71 Domperidon tablet 10 mg Tablet 600 600 - - -
72 Etanol 70% 100 ml Botol 15 15 12 3 2
73 Etanol 70% 1000 ml Botol 7 7 4 3 1
74 Etakridin (Rivanol) 100 ml Botol - - -
75 Etakridin 0,1% 300 ml Btl/300 7 7 7 - (1)
82 Fitomenadion (Vit. K1) tab 10 mg Tablet - 200 200 - 200 -
84 Fletcher Set - -
88 Gentamicin salep mata Tube - - -
89 Gentamicin sulfat TM 0,3% Btl/ 5 ml 10 10 - 10 -
91 Glass Ionometer Cemen Set - - -
93 Gliceryl Guaicolat tab 100 mg Tablet 500 1,500 2,000 650 1,350 130
95 Glimepiride tab 2 mg Tablet 200 100 300 - 300 -
96 Glukosa 5% Btl/500 ml - - -
97 Glukosa 10% Btl/500 ml - - -
98 Griseofulvin tab 125 mg Tablet 50 50 50 - 10
103 Ibuprofen Syrup Btl/60 ml - - -
104 Ibuprofen tab 200 mg Tablet - - -
109 Isosorbid Dinitrat Subli. Tab Tablet - - -
110 Jarum Jahit bedah No. 9 Pcs - 24 24 - 24 -
117 Kalium Permanganas Serbuk Pot/ 5 g - 24 24 - 24 -
118 Kalsium Laktat tab 500 mg Tablet - - -
119 Kalsium Glukonat Inj i.v 10 % (100mg/ml) Ampul 24 24 - 24 -
121 Kasa Hidrofil DRC 36 m x 80 cm Roll - - -
122 Kasa Pembalut Hidrofil DRC 4m x 15 cm Roll - - -
124 Karbongliserin Tetes Telinga 10* Botol 8 12 20 - 20 -
125 Ketokonazol Salep Tube - - -
126 Ketokenazol Tab Tablet - - -
127 Kloramfenikol Suspensi Botol/60ml - - -
128 Kloramfenikol caps 250 mg Tablet 1,000 1,000 270 730 54
129 Kloramfenikol Salep Mata 1% Tube - - -
130 Kloramfenikol Tetes Telinga Botol5 ml 8 20 28 - 28 -
131 Klorfeniramin Maleat (CTM) Tablet - 6,000 6,000 1,858 4,142 372
133 Klorpromazin tab 100 mg Tablet 24 24 - - -
135 Tablet - 3,000 3,000 2,411 589 482
Asam Folat
137 Kotrimoksazol tab 120 mg Tablet - - -
141 Loratadine tablet 10 mg Tablet - - -
142 Loperamide Tablet - 1,000 1,000 220 780 44
143 Magnesium Sulfat injeksi 40 % Ampul - 10 10 - 10 -
144 Masker Pcs - - -
145 Meloksikam tab 7,5 mg Tablet 100 800 900 450 450 90
151 Metronidazol tab 250 mg Tablet 100 100 - - -
152 Metronidazol tab 500 mg Tablet - - -
155 Miconazole Cream Tube - 48 48 15 33 3
157 Natrium Diklofenak tablet 50 mg Tablet - 1,350 1,350 220 1,130 44
159 Nifedipin Tablet Tablet - - -
163 Omeprazole Tablet - - -
164 Oxytocin Inj 10 mg/ml Ampul - 100 100 24 76 5
165 Oxytetracyclin HCl Inj Vial - - -
173 Prednison tab 5 mg Tablet - 5,000 5,000 1,500 3,500 300
177 Pyrantel Suspensi 125 mg/5 ml Botol - - -
179 Pyridoxin HCl tablet 10 mg Tablet - 3,000 3,000 200 2,800 40
182 Ranitidine Injeksi 25 mg/ml Ampul - - -
183 Ranitidine tablet 150 mg Tablet - 100 100 100 - 20
184 Retinol (Vit. A) 100.000 IU Kapluk Kapluk - 100 100 - 100 -
185 Retinol (Vit. A) 200.000 IU Kapluk Kapluk - 100 100 - 100 -
187 Pot/ 30 g 20.0 36 56 16 40 3
Belerang
190 Salbutamol Sirup Botol - - -
192 Sarung Tangan No. 7 Steril Pasang - 50 50 40 10 8
195 Scopamin Tablet - - -
197 Sianocobalamin (Vit. B12) Tab Tablet 500 500 190 310 38
200 SILK BLACK 3/0 HR 26 MM Peaces - 24 24 13 11 3
201 Strip Kolesterol Nesco Strip - - -
202 Strip Asam Urat Nesco Strip 600 600 - 600 -
203 Strip Glukosa Nesco Strip 325 325 - - -
208 Thiamin HCl (B1) Tab 50 mg Tablet - - -
209 Vitamin B Complex tab Tablet - 2,000 2,000 2,000 - 400
210 Yodium Povidon 10% 300 ml Botol - - -
212 Zink Tablet Tablet 400 400 800 315 485 63
217 O A T Kategori Anak Paket - - -
218 O A T Kategori 1 Paket 2 5 7 3 4 -
223 Obat MB Anak Strip 5 5 1 4 0
224 Sangobion Tablet - - -
225 Sarung Tangan M Box - - -
227 Lidokain Gel Tube - -
228 Elkana Syr Botol 0 - -
229 Bisakodil 5 mg Tablet 20 120 140 - 140 -
232 Dulcolax Suppo 5 mg Suppo 0 - -
233 Dulcolax Suppo 10 mg Suppo 0 - -
234 Amlodipine 5 mg Tablet 0 - -
236 Bonding Tambalan Komposit GC Botol 0 - -
238 Caviton Tube 0 - -
239 Eugenol Cairan Botol 1 1 1 0 0
240 Elite Powder Cemen GC Botol 1 1 1 0 0
241 Elite Cemen Liquid GC Botol 0 - -
242 Sponge Gigi / Hemospon Pcs 0 - -
243 Tambalan Amalgam Powder SDI Tube 1 1 1 0 0
244 Tambalan Komposit GC Hydcal Tube 1 1 1 0 0
246 Bisakodil Suppo 10 mg Suppo 0 - -
248 Reagen ZN Paket 1 1 1 0 0
253 Nistatin Suspensi 100.000 UI/ml Botol 0 - -
254 Plano Test Pcs 0 - -
257 Microbrush Botol - -
264 Hemafort Tablet 0 - -
265 Mediamer Tablet 0 - -
266 Metyl Prednisolon 4 mg Tablet 0 - -
267 ETSA (gigi) Tube - -
268 Masker N 25 Pcs - -
269 Ampicillin Serbuk Inj 1000 mg/ml Vial 10 10 - 10 -
270 Asam Asetilsalisilat 80 mg Tablet 100 100 - 100 -
271 Betahistine Tablet 100 100 - 100 -
272 Dimenhidrinat 50 mg Tablet 100 100 - 100 -
273 Kloramphenicol Salep Kulit 2% Tube 50 50 - 50 -
274 Yodium 1 L Botol 2 2 1 1 0
275 Strip Kolesterol Easy Touch Strip 200 200 20 180 4

BPJS NON BPJS
1 Puskesmas
JUMLAH
Yang Melapor,

NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN PEMAKAIAN 0BAT: APRIL
BULAN PELAPORAN : MEI
TAHUN : 2019
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
-
50
50
(10)
24
200
-
-
(180)
(180)
(415)
(400)
800
(465)
-
1,000
24
-
(100)
-
600
25
-
1,500
1,000
(32)
-
-
(11)
(43)
(100)
(100)
(11)
(4)
-
2,500
(2,280)
-
380
-
-
200
(3)
6
(15)
(25)
(167)
(200)
(56)
(44)
-
(100)
(840)
200
-
10
-
1,500
500
(120)
3,500
-
-
-
(112)
(139)
(8)
10
-
-
300
11
2
10
6
(82)
-
-
6
(238)
-
(200)
24
-
(380)
300
(28)
24
(10)
(33)
-
(100)
1,500
(68)
(300)
24
-
500
(80)
-
(100)
24
24
1,000
1,000
(19)
(16)
100
-
(24)
(12)
(12)
(12)
-
-
-
(24)
2,000
(24)
(2)
3
200
200
(20)
-
-
10
(406)
48
(28)
(1,912)
(100)
100
-
4,000
24
200
600
(334)
(1)
100
(516)
(10)
100
800
800
500
-
-
(30)
800
600
(80)
(57)
48
500
(866)
(72)
100
24
-
(3)
600
(47)
12
(101)
(31)
258
1,000
(40)
-
(8)
(1,700)
-
(100)
(90)
24
(210)
(2,560)
600
600
-
2,000
(100)
(100)
20
(21)
(180)
(102)
-
100
100
100
-
-
(20)
(82)
440
500
5
200
-
200
-
-
-
-
3,000
3,500
6
10
(107)
15
15
(2)
-
-
(1)
-
-
6
-
(3)
250
5
-
-
50
(140)
200
-
10
10
1,000
-
1
-
1
1
-
-
1
1
1
-
-
1
-
(80)
(10)
(10)
12
100
-
-
-
-
-
-
-
-
-
200
-
500
-
-
(10)
(100)
(100)
(100)
(50)
0
(156)
Mamuju,
r, Yang Menerima,

NIP. 19790102 200604 2 013
OBAT PROGRAM KIA
BULAN PEMAKAIAN : APRIL
BULAN PELAPORAN : MEI
TAHUN : 2019

Nip. 19610310 198710 1 002 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
1 Abbocath No. 18 Pcs -
2 Abbocath No. 20 Pcs 50 50 17 33 3
3 Abbocath No. 22 Pcs 5 50 55 19 36 4
4 Abbocath No. 24 Pcs 10 - 10 - 10 -
5 Acyclovir Cream 3% Tube 9 - 9 - 9 -
16 Ambroxol tab 30 mg Tablet 624 1,000 1,624 864 760 173
20 Amitriptilyn tab 25 mg Tablet -
21 Amlodipine 10 mg Tablet -
25 Antacida DOEN tab. Kunyah Komb : Tablet 2,310 1,000 3,310 1,500 1,810 300
30 Antibakteri DOEN Kombinasi (Bacitracin) Tube 43 43 16 27 3
34 Antiseptik Hand Rub 500 m Botol 6 6 2 4 0
37 Asam Askorbat tab 50 mg Tablet 3,000 3,500 6,500 1,200 5,300 240
38 Asam Askorbat tab 250 mg Tablet - -
45 Bedak Salisil Pot 15 15 6 9 1
47 Bisturi buah 179 179 9 170 2
48 Blood Lancet Pcs 200 200 - 200 -
49 Catgut No. 2/0 Pcs 56 56 - 56 -
50 Catgut No. 3/0 Pcs 51 51 3 48 1
53 Captopril tab 25 mg Tablet 1,200 1,200 553 647 111
59 Ciprofloxacin tab 500 mg Tablet - 500 500 171 329 34
61 Dexamethasone tab 0,5 mg Tablet - 3,000 3,000 2,600 400 520
68 Difenhidramin Injeksi 10 mg/ml Ampul - - -
71 Domperidon tablet 10 mg Tablet - 300 300 55 245 11
72 Etanol 70% 100 ml Botol 3 3 2 1 0
73 Etanol 70% 1000 ml Botol 3 4 7 3 4 1
74 Etakridin (Rivanol) 100 ml Botol - 24 24 - 24 -
75 Etakridin 0,1% 300 ml Btl/300 - 6 6 2 4 0
84 Fletcher Set - -
87 Gentamicin salep kulit Tube 40 40 40 - 8
92 Glibenklamid tab 5 mg Tablet 100 100 100 - 20
93 Gliceryl Guaicolat tab 100 mg Tablet 1,350 1,000 2,350 1,590 760 318
96 Glukosa 5% Btl/500 ml - 5 5 - 5 -
97 Glukosa 10% Btl/500 ml - - -
98 Griseofulvin tab 125 mg Tablet - 500 500 310 190 62
118 Kalsium Laktat tab 500 mg Tablet - - -
123 Kasa 5 Cm Roll 100 100 50 50 10
131 Klorfeniramin Maleat (CTM) Tablet 4,142 4,142 3,272 870 654
133 Klorpromazin tab 100 mg Tablet - - -
135 Tablet 589 4,020 4,609 2,569 2,040 514
Asam Folat
141 Loratadine tablet 10 mg Tablet - 100 100 20 80 4
144 Masker Pcs - 100 100 100 - 20
145 Meloksikam tab 7,5 mg Tablet 450 800 1,250 790 460 158
146 Meloksikam tab 15 mg Tablet 270 270 270 - 54
157 Natrium Diklofenak tablet 50 mg Tablet 1,130 1,130 640 490 128
173 Prednison tab 5 mg Tablet 3,500 3,500 2,300 1,200 460
179 Pyridoxin HCl tablet 10 mg Tablet 2,800 2,800 1,080 1,720 216
183 Ranitidine tablet 150 mg Tablet - 1,000 1,000 735 265 147
185 Retinol (Vit. A) 200.000 IU Kapluk Kapluk 100 100 - - -
187 Pot/ 30 g 40.0 40 18 22 4
Belerang
199 Simvastatin tablet 20 mg Tablet - 100 100 - 100 -
202 Strip Asam Urat Nesco Strip 600 600 - - -
203 Strip Glukosa Nesco Strip - - -
206 Tetrakain Tetes Mata Botol 6 50 56 - 56 -
208 Thiamin HCl (B1) Tab 50 mg Tablet - 2,000 2,000 880 1,120 176
209 Vitamin B Complex tab Tablet - 7,000 7,000 2,710 4,290 542
212 Zink Tablet Tablet 485 600 1,085 310 775 62
217 O A T Kategori Anak Paket -
221 Obat MB Dewasa Strip 4 6 10 4 6 1
224 Sangobion Tablet -
225 Sarung Tangan M Box -
226 Lidokain Spray Botol -
227 Lidokain Gel Tube -
228 Elkana Syr Botol -
231 Kateter buah -
232 Dulcolax Suppo 5 mg Suppo -
233 Dulcolax Suppo 10 mg Suppo -
234 Amlodipine 5 mg Tablet -
236 Bonding Tambalan Komposit GC Botol -
237 Calcium Hidtoksida Technew Tube -
238 Caviton Tube -
239 Eugenol Cairan Botol -
240 Elite Powder Cemen GC Botol -
241 Elite Cemen Liquid GC Botol -
242 Sponge Gigi / Hemospon Pcs -
243 Tambalan Amalgam Powder SDI Tube -
244 Tambalan Komposit GC Hydcal Tube -
245 Tambalan Komposit 3M P60 Botol -
246 Bisakodil Suppo 10 mg Suppo -
247 Tabung Vacum Buah -
248 Reagen ZN Paket -
249 Mata Klinipet Dos -
253 Nistatin Suspensi 100.000 UI/ml Botol -
254 Plano Test Pcs -
255 Tambalan Komposit Flowable Tube -
256 Calsium Hidroside Lightcurring Tube -
257 Microbrush Botol -
258 Bur Composite Set -
259 Bur Intan Set -
260 Cotton Roll Pak -
261 Celemek Gigi Pcs -
262 Celluloid Strip Pak -
263 Matrix Band Kompensional Set -
264 Hemafort Tablet -
265 Mediamer Tablet -
266 Metyl Prednisolon 4 mg Tablet -
267 ETSA (gigi) Tube -
268 Masker N 25 Pcs -
271 Betahistine Tablet 100 300 400 30 370 6
273 Kloramphenicol Salep Kulit 2% Tube 50 50 1 49 0
274 Yodium 1 L Botol 1 1 1 - 0
275 Strip Kolesterol Easy Touch Strip 180 180 40 - 8
276 Sarung Tangan L Box 1 1 1 0 0

BPJS NON BPJS
1 Puskesmas
JUMLAH
Yang Melapor,

NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN PEMAKAIAN 0BAT: MEI
BULAN PELAPORAN : JUNI
TAHUN : 2019
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
50
(13)
(13)
(10)
(9)
-
(189)
-
(180)
142
507
(400)
500
(189)
-
500
30
-
(100)
-
1,000
130
-
(980)
(10)
4
-
-
(5)
(8)
(100)
(100)
20
(2)
-
1,500
(3,860)
-
500
-
-
100
(3)
5
12
25
(159)
(200)
(56)
(44)
-
(100)
17
200
-
10
-
-
(124)
(109)
2,720
-
-
-
(89)
(139)
(8)
-
-
-
(179)
5
(0)
(24)
(2)
(82)
-
-
-
(228)
-
(35)
(24)
-
(214)
(133)
48
-
(10)
(17)
-
120
1,500
(80)
(124)
(5)
-
182
(80)
-
(34)
25
25
500
500
(16)
(22)
100
100
(24)
(12)
(12)
(12)
-
-
-
(15)
2,000
(24)
3
3
(17)
50
(20)
10
200
-
(664)
25
(19)
3,056
(100)
-
-
1,043
7
-
-
(136)
(2)
(56)
(516)
(10)
120
488
600
(5)
-
-
(30)
-
500
86
(58)
14
180
500
(64)
-
-
-
(1)
300
(21)
-
58
(29)
164
1,286
(29)
-
2
1,560
-
(34)
(90)
-
(188)
(424)
500
500
10
1,000
(100)
- ED
10
(0)
300
(100)
-
(19)
(103)
50
-
-
(47)
(310)
300
(100)
(19)
200
300
300
-
-
(56)
-
(64)
(1,038)
5
5
(403)
15
15
(2)
-
-
7
-
-
(1)
6
6
-
3
-
-
-
(114)
-
-
10
10
1,000
-
-
-
-
-
-
-
-
-
-
-
-
-
-
(80)
(10)
(10)
-
100
-
-
-
-
-
-
-
-
-
200
100
300
-
-
(10)
(100)
(334)
(100)
(48)
1
48
3
Mamuju,
r, Yang Menerima,

NIP. 19790102 200604 2 013
OBAT PROGRAM KIA
BULAN PEMAKAIAN : MEI
BULAN PELAPORAN : JUNI
TAHUN : 2019

Nip. 19610310 198710 1 002 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
1 Abbocath No. 18 Pcs - 20 20 - 20 -
2 Abbocath No. 20 Pcs 33 33 8 25 2
3 Abbocath No. 22 Pcs 36 36 - 36 -
4 Abbocath No. 24 Pcs 10 10 - 10 -
5 Acyclovir Cream 3% Tube 9 9 - 9 -
13 Allopurinol tab 100 mg Tablet - - - -
16 Ambroxol tab 30 mg Tablet 760 500 1,260 830 430 166
24 Amoxycillin capl 500 mg Kaplet 4,330 4,330 2,345 1,985 469
25 Antacida DOEN tab. Kunyah Komb : Tablet 1,810 1,810 1,233 577 247
34 Antiseptik Hand Rub 500 m Botol 4 4 2 2 0
36 Asam Mefenamat tab 500 mg Tablet 1,030 1,800 2,830 1,700 1,130 340
37 Asam Askorbat tab 50 mg Tablet 5,300 5,300 1,459 3,841 292
38 Asam Askorbat tab 250 mg Tablet - - -
43 Aqua Pro Injeksi 20 ml Btl/20 ml 3 3 3 - 1
44 Aquagel Sterile Jely 82 gr Tube - - - -
45 Bedak Salisil Pot 9 12 21 9 12 2
47 Bisturi buah 170 170 - 170 -
48 Blood Lancet Pcs 200 200 100 100 20
49 Catgut No. 2/0 Pcs 56 56 - 56 -
50 Catgut No. 3/0 Pcs 48 48 14 34 3
53 Captopril tab 25 mg Tablet 647 100 747 635 112 127
57 CHKM Btl/15 ml - - -
58 Cimetidine tab 200 mg Tablet - - - -
68 Difenhidramin Injeksi 10 mg/ml Ampul - - - -
70 Diltiazem HCl tablet 30 mg Tablet - - - -
72 Etanol 70% 100 ml Botol 1 1 1 - 0
73 Etanol 70% 1000 ml Botol 4 4 1 3 0
74 Etakridin (Rivanol) 100 ml Botol 24 24 - 24 -
75 Etakridin 0,1% 300 ml Btl/300 4 4 1 3 0
92 Glibenklamid tab 5 mg Tablet - 200 200 100 100 20
96 Glukosa 5% Btl/500 ml 5 5 - 5 -
97 Glukosa 10% Btl/500 ml - - - -
121 Kasa Hidrofil DRC 36 m x 80 cm Roll 1 3 4 1 3 0
122 Kasa Pembalut Hidrofil DRC 4m x 15 cm Roll 35 35 - 35 -
123 Kasa 5 Cm Roll 50 50 100 100 - 20
127 Kloramfenikol Suspensi Botol/60ml - - - -
129 Kloramfenikol Salep Mata 1% Tube - - - -
133 Klorpromazin tab 100 mg Tablet - - - -
135 Tablet 2,040 1,110 3,150 1,940 1,210 388
Asam Folat
139 Lidocain HCl Injeksi 2% Ampul 280 280 - 280 -
144 Masker Pcs - 100 100 100 - 20
145 Meloksikam tab 7,5 mg Tablet 460 1,000 1,460 820 640 164
154 Metylergometrin Maleat Inj Ampul 65 65 - 65 -
160 Nistatin Tab. Vag 100.000 UI Tablet - - - -
163 Omeprazole Tablet - - - -
168 Papaverin HCl tab 40 mg Tablet 40 40 - 40 -
173 Prednison tab 5 mg Tablet 1,200 2,000 3,200 1,200 2,000 240
179 Pyridoxin HCl tablet 10 mg Tablet 1,720 1,720 470 1,250 94
183 Ranitidine tablet 150 mg Tablet 265 1,000 1,265 885 380 177
185 Retinol (Vit. A) 200.000 IU Kapluk Kapluk - - - -
187 Pot/ 30 g 22.0 22 12 10 2
Belerang
188 Salbutamol tab 2 mg Tablet 90 90 - - -
190 Salbutamol Sirup Botol - - - -
195 Scopamin Tablet - - - -
197 Sianocobalamin (Vit. B12) Tab Tablet 310 310 20 290 4
199 Simvastatin tablet 20 mg Tablet 100 100 - 100 -
202 Strip Asam Urat Nesco Strip - - - -
203 Strip Glukosa Nesco Strip - - - -
208 Thiamin HCl (B1) Tab 50 mg Tablet 1,120 1,120 175 945 35
209 Vitamin B Complex tab Tablet 4,290 4,290 2,230 2,060 446
217 O A T Kategori Anak Paket - - -
224 Sangobion Tablet - - -
225 Sarung Tangan M Box - - -
226 Lidokain Spray Botol - - -
227 Lidokain Gel Tube - - -
228 Elkana Syr Botol - - -
232 Dulcolax Suppo 5 mg Suppo - - -
233 Dulcolax Suppo 10 mg Suppo - - -
236 Bonding Tambalan Komposit GC Botol - - -
237 Calcium Hidtoksida Technew Tube - - -
238 Caviton Tube - - -
239 Eugenol Cairan Botol - - -
240 Elite Powder Cemen GC Botol - - -
241 Elite Cemen Liquid GC Botol - - -
242 Sponge Gigi / Hemospon Pcs - - -
243 Tambalan Amalgam Powder SDI Tube - - -
244 Tambalan Komposit GC Hydcal Tube - - -
245 Tambalan Komposit 3M P60 Botol - - -
246 Bisakodil Suppo 10 mg Suppo - - -
248 Reagen ZN Paket - - -
253 Nistatin Suspensi 100.000 UI/ml Botol - - -
254 Plano Test Pcs - - -
264 Hemafort Tablet - - -
265 Mediamer Tablet - - -
266 Metyl Prednisolon 4 mg Tablet - - -
271 Betahistine Tablet 370 370 30 340 6
274 Yodium 1 L Botol 0 1 1 1 - 0
275 Strip Kolesterol Easy Touch Strip 0 - - -
276 Sarung Tangan L Box 3 3 2 1 0
277 Strip Asam Urat Easy Touch Box 50 50 50 0 10
278 Strip Glukosa Easy Touch Box 50 50 50 0 10

BPJS NON BPJS
1 Puskesmas
JUMLAH


NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN PEMAKAIAN 0BAT: JUNI
BULAN PELAPORAN : JULI
TAHUN : 2019
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
(20)
(15)
(36)
(10)
(9)
-
(173)
-
(180)
100
(129)
(400)
500
(185)
-
800
25
-
(100)
-
500
50
-
1,500
1,200
50
-
-
(19)
(27)
(100)
(358)
20
5
-
1,500
(2,090)
-
500
-
-
200
4
-
12
30
(170)
300
(56)
(17)
-
(100)
650
200
-
10
-
1,000
(175)
(104)
1,500
-
-
-
(83)
(132)
(8)
-
-
-
(245)
10
(2)
(24)
(2)
(82)
-
-
-
(240)
-
(125)
(19)
-
(330)
300
(8)
30
(10)
(4)
-
20
1,200
(80)
100
20
-
300
(80)
-
(70)
48
-
500
500
(17)
50
-
100
(24)
(12)
(12)
(12)
-
-
-
(13)
2,000
(24)
(2)
(2)
(35)
120
(20)
12
100
-
(700)
25
24
1,500
(100)
-
-
1,500
(7)
300
500
(280)
(2)
(58)
(374)
(10)
500
500
700
300
-
-
(30)
-
500
200
(65)
50
500
(143)
(72)
100
20
-
10
200
(27)
-
(43)
48
300
1,000
(51)
-
(1)
(560)
-
200
(90)
50
(147)
500
500
500
-
1,000
(100)
50
3
25
300 ED
200
-
100
50
(30)
-
-
(27)
(266)
470
(100)
(10)
100
100
100
-
-
(54)
-
(735)
600
5
-
(368)
10
10
(2)
-
-
5
-
-
(2)
-
2
250
4
-
-
-
(128)
-
-
10
10
500
-
-
-
-
-
-
-
-
-
-
-
-
-
-
(62)
(10)
(10)
-
100
-
-
-
-
-
-
-
-
-
-
-
-
-
-
(10)
(100)
(304)
(100)
(49)
3
100
3
100
100
Mamuju,
r, Yang Menerima,

NIP. 19790102 200604 2 013
OBAT PROGRAM KIA
BULAN PEMAKAIAN : JUNI
BULAN PELAPORAN : JULI
TAHUN : 2019

Nip. 19610310 198710 1 002 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013
KODE PUSKESMAS :
KECAMATAN : SIMBORO
KABUPATEN : MAMUJU

JML STOK
PENERIMAAN PENGAMAN
1 2 3 4 5 6 = (4 + 5) 7 8 = (6 - 7) 9 = 7 x 20%
1 Abbocath No. 18 Pcs 20 20 7 13 1
2 Abbocath No. 20 Pcs 25 25 7 18 1
3 Abbocath No. 22 Pcs 36 36 6 30 1
4 Abbocath No. 24 Pcs 10 10 2 8 0
21 Amlodipine 10 mg Tablet - -
22 Amoxycillin syrup kering 125 mg/ 5 ml Btl/60 ml 105 60 165 82 - 16
25 Antacida DOEN tab. Kunyah Komb : Tablet 577 1,700 2,277 1,071 1,206 214
34 Antiseptik Hand Rub 500 m Botol 2 5 7 4 3 1
36 Asam Mefenamat tab 500 mg Tablet 1,130 400 1,530 1,530 - 306
37 Asam Askorbat tab 50 mg Tablet 3,841 3,841 1,138 2,703 228
38 Asam Askorbat tab 250 mg Tablet - -
39 Asam Folat 1 mg Tablet - - -
43 Aqua Pro Injeksi 20 ml Btl/20 ml - 10 10 - 10 -
45 Bedak Salisil Pot 12 6 18 5 13 1
47 Bisturi buah 170 170 5 165 1
48 Blood Lancet Pcs 100 300 400 200 200 40
49 Catgut No. 2/0 Pcs 56 56 12 44 2
50 Catgut No. 3/0 Pcs 34 34 - 34 -
53 Captopril tab 25 mg Tablet 112 700 812 285 527 57
60 Dexamethasone Injeksi Ampul 110 110 - - -
68 Difenhidramin Injeksi 10 mg/ml Ampul - - -
72 Etanol 70% 100 ml Botol - - -
73 Etanol 70% 1000 ml Botol 3 2 5 2 3 0
74 Etakridin (Rivanol) 100 ml Botol 24 24 - 24 -
75 Etakridin 0,1% 300 ml Btl/300 3 3 - 3 -
84 Fletcher Set - -
93 Gliceryl Guaicolat tab 100 mg Tablet 530 100 630 630 - 126
94 Glimepiride Tab 1 mg Tablet 80 80 80 - 16
96 Glukosa 5% Btl/500 ml 5 5 - 5 -
97 Glukosa 10% Btl/500 ml - 10 10 - 10 -
118 Kalsium Laktat tab 500 mg Tablet - 2,000 2,000 900 1,100 180
121 Kasa Hidrofil DRC 36 m x 80 cm Roll 3 3 2 1 0
122 Kasa Pembalut Hidrofil DRC 4m x 15 cm Roll 35 35 5 30 1
123 Kasa 5 Cm Roll - 120 120 15 105 3
124 Karbongliserin Tetes Telinga 10* Botol 20 20 - - -
133 Klorpromazin tab 100 mg Tablet - - -
135 Tablet 1,210 1,210 1,210 - 242
Asam Folat
138 Kotrimoksazol tab 480 mg Tablet - 500 500 150 350 30
139 Lidocain HCl Injeksi 2% Ampul 280 280 - 280 -
144 Masker Pcs - 500 500 500 - 100
145 Meloksikam tab 7,5 mg Tablet 640 500 1,140 1,130 10 226
146 Meloksikam tab 15 mg Tablet - - -
154 Metylergometrin Maleat Inj Ampul 65 65 - 65 -
168 Papaverin HCl tab 40 mg Tablet 40 40 - 40 -
169 Paracetamol tab 500 mg Tablet 2,014 1,000 3,014 3,014 - 603
170 Paracetamol syrup Btl/ 60 ml 143 143 134 9 27
175 Propilthiourasil (PTU) tablet Tablet 20 200 220 - 220 -
179 Pyridoxin HCl tablet 10 mg Tablet 1,250 1,250 680 570 136
183 Ranitidine tablet 150 mg Tablet 380 800 1,180 884 296 177
185 Retinol (Vit. A) 200.000 IU Kapluk Kapluk - - -
187 Pot/ 30 g 10.0 24 34 23 11 5
Belerang
188 Salbutamol tab 2 mg Tablet - - -
197 Sianocobalamin (Vit. B12) Tab Tablet 290 290 290 -
199 Simvastatin tablet 20 mg Tablet 100 100 100 - 20
202 Strip Asam Urat Nesco Strip - - -
203 Strip Glukosa Nesco Strip - - -
208 Thiamin HCl (B1) Tab 50 mg Tablet 945 945 670 275 134
217 O A T Kategori Anak Paket - -
223 Obat MB Anak Strip 1 1 1 0
224 Sangobion Tablet - -
225 Sarung Tangan M Box - -
226 Lidokain Spray Botol - -
227 Lidokain Gel Tube - -
228 Elkana Syr Botol - -
232 Dulcolax Suppo 5 mg Suppo - -
233 Dulcolax Suppo 10 mg Suppo - -
234 Amlodipine 5 mg Tablet - -
236 Bonding Tambalan Komposit GC Botol - -
237 Calcium Hidtoksida Technew Tube - -
238 Caviton Tube - -
239 Eugenol Cairan Botol - -
240 Elite Powder Cemen GC Botol - -
241 Elite Cemen Liquid GC Botol - -
242 Sponge Gigi / Hemospon Pcs - -
243 Tambalan Amalgam Powder SDI Tube - -
244 Tambalan Komposit GC Hydcal Tube - -
245 Tambalan Komposit 3M P60 Botol - -
246 Bisakodil Suppo 10 mg Suppo - -
248 Reagen ZN Paket - -
253 Nistatin Suspensi 100.000 UI/ml Botol - -
254 Plano Test Pcs - -
257 Microbrush Botol - -
264 Hemafort Tablet - -
265 Mediamer Tablet - -
266 Metyl Prednisolon 4 mg Tablet - -
267 ETSA (gigi) Tube - -
268 Masker N 25 Pcs - -
271 Betahistine Tablet 340 340 35 305 7
274 Yodium 1 L Botol 0 - -
275 Strip Kolesterol Easy Touch Strip 0 - -
276 Sarung Tangan L Box 1 2 3 3 0 1
277 Strip Asam Urat Easy Touch Box 200 200 125 75 25
278 Strip Glukosa Easy Touch Box 200 200 125 75 25
279 Acetylcysteine 200 mg Tablet 300 300 - 300 -

BPJS NON BPJS
1 Puskesmas
JUMLAH
Yang Melapor,

NIP. 19610310 198710 1 002 NIP. 19740720 199803 2 011 Nip. 19630723 198903 1 009
OBAT (LPLPO)
BULAN PEMAKAIAN 0BAT: JULI
BULAN PELAPORAN : AGUSTUS
TAHUN : 2019
PEMBERIAN TOTAL
PERMINTAAN KET
10=(7+9)-8 11 12 13 14 15
25
25
(23)
(6)
25
-
500
-
(180)
(40)
(185)
(378)
500
(236)
-
1,500
30
-
(100)
-
800
100 ED 83
-
2,700
500
(24)
-
-
25
(27)
(100)
(433)
(24)
5
-
2,500
(1,337)
-
500
-
-
200
(10)
5
12
50
(159)
200
(30)
(34)
-
(100)
(185)
300
15
15
-
1,000
(171)
100 ED 110
4,000
-
-
-
(61)
(136)
(8)
-
-
-
(208)
-
(1)
(24)
(3)
(82)
-
-
3
(240)
-
(125)
(23)
-
(323)
200
50
50
(10)
24
-
(380)
1,000
200
(118)
(5)
(10)
(111)
(80)
-
(70)
50
50
600
800
(4)
(43)
-
100
(24)
(13)
(12)
(12)
-
-
-
(13)
(20)
(24)
5
3
(24)
(87)
15 ED 20
15
200
-
(700)
24
20
4,000
(78)
100
-
3,546
24
200
(170)
(280)
(2)
(48)
(244)
(10)
600
1,500
1,500
200
-
-
(30)
500
500
(256)
(65)
50
2,000
2,000
(72)
200
30
-
12
500
(20)
-
(44)
(7)
(40)
3,617
100
-
6
(1,978)
-
(220)
(90)
24
(59)
246
500
500
20
2,000
(100)
-
(4)
50
300
(229)
-
(78)
100
50
-
-
(38)
(290)
300
200
20
-
-
-
-
-
(55)
-
800
2,200
6
-
300
12
12
(2)
-
-
1
1
-
0
-
4
500
5
-
-
-
(128)
200
-
-
-
1,000
-
-
-
-
-
-
-
-
-
-
-
-
-
-
(72)
(10)
(10)
-
200
-
-
-
-
-
-
-
-
-
400
200
500
-
-
(10)
(100)
(263)
(100)
(49)
-
-
5
150
150
(300)
Mamuju,
r, Yang Menerima,

NIP. 19790102 200604 2 013
OBAT PROGRAM KIA
BULAN PEMAKAIAN : JULI
BULAN PELAPORAN : AGUSTUS
TAHUN : 2019

Nip. 19610310 198710 1 002 Nip. 19740720 199803 2 011 Nip. 19630723 198903 1 009 Nip. 19790102 200604 2 013
a Obat Puskesmas
Badani S.Si., Apt

90102 200604 2 013

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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

NAMA PUSKESMAS ; RANGAS

PROPINSI : SULAWESI BARAT

JUMLAH KUNJUNGAN RESEP

Mengetahui : Menyetujui : Yang Melapor,

Rangas Pengelola Obat Puskesmas

Rangas Pengelola Obat Puskesmas

MULYANI BADANI S.Si., Apt

Mengetahui, Menyetujui, Yang Melapor, Mamuju,

Mengetahui, Menyetujui, Yang Melapor, Mamuju,

Badani S.Si., Apt

Badani S.Si., Apt

NAMA PUSKESMAS ; RANGAS

PROPINSI : SULAWESI BARAT

JUMLAH KUNJUNGAN RESEP

Rangas Pengelola Obat Puskesmas

Rangas Pengelola Obat Puskesmas

MULYANI BADANI S.Si., Apt

Mengetahui, Menyetujui, Yang Melapor, Mamuju,

Mengetahui, Menyetujui, Yang Melapor, Mamuju,

Badani S.Si., Apt

Badani S.Si., Apt

NAMA PUSKESMAS ; RANGAS

PROPINSI : SULAWESI BARAT

JUMLAH KUNJUNGAN RESEP

Rangas Pengelola Obat Puskesmas

MULYANI BADANI S.Si., Apt

Mengetahui, Menyetujui, Yang Melapor, Mamuju,

Mengetahui, Menyetujui, Yang Melapor, Mamuju,

Badani S.Si., Apt

Badani S.Si., Apt

NAMA PUSKESMAS ; RANGAS

PROPINSI : SULAWESI BARAT

JUMLAH KUNJUNGAN RESEP

Rangas Pengelola Obat Puskesmas

Rangas Pengelola Obat Puskesmas

MULYANI BADANI S.Si., Apt

NAMA PUSKESMAS ; RANGAS

PROPINSI : SULAWESI BARAT

JUMLAH KUNJUNGAN RESEP

Rangas Pengelola Obat Puskesmas

Rangas Pengelola Obat Puskesmas

MULYANI BADANI S.Si., Apt

Mengetahui, Menyetujui, Yang Melapor, Mamuju,

Mengetahui, Menyetujui, Yang Melapor, Mamuju,

Badani S.Si., Apt

Badani S.Si., Apt

Mengetahui, Menyetujui, Yang Melapor, Mamuju,

Mengetahui, Menyetujui, Yang Melapor, Mamuju,

Badani S.Si., Apt

Badani S.Si., Apt

NAMA PUSKESMAS ; RANGAS

PROPINSI : SULAWESI BARAT

JUMLAH KUNJUNGAN RESEP

Kepala Dinas Kesehatan Kepala Gudang Farmasi

Pengelola Obat Puskesmas

Rangas Pengelola Obat Puskesmas

MULYANI BADANI S.Si., Apt

Mengetahui, Menyetujui, Yang Melapor, Mamuju,

Mengetahui, Menyetujui, Yang Melapor, Mamuju,

Badani S.Si., Apt

Badani S.Si., Apt

NAMA PUSKESMAS ; RANGAS

PROPINSI : SULAWESI BARAT