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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

PUSKESMAS : ULUGALUNG
KECAMATAN : EREMERASA PELAPORAN BULAN : JUNI 2019
KABUPATEN : BANTAENG PERMINTAAN BULAN : JULI 2019

STOK PEMBERIAN
NO NAMA BARANG SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
AWAL APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
A. TABLET/KAPLET/KAPSUL
1 Albendazole 400mg Tablet 161 161 5 156
2 Allopurinol 100mg Tablet 600 600 91 509
3 Alprazolam 0,25mg Tablet
4 Alprazolam 0,5mg Tablet
5 Aminofilin 200mg Tablet
6 Amlodipin 5mg Tablet
7 Amlodipin 10mg Tablet
8 Amoxicillin 250mg Kapsul 200 200 40 160 500
9 Amoxicillin 500mg Tablet 6620 6620 740 5880
10 Antasida Doen Tablet 5000
11 Asam Folat 0,4 mcg Tablet 1280 1280 1240 40
12 Asam Folat 1mg Tablet 580 500 1080 340 740
13 Asam Mefenamat 500mg Tablet 5000
14 Acetylcystein 200mg Tablet
15 Acyclovir 200mg Tablet 180 180 180
16 Acyclovir 400mg Tablet 200 200 216
17 Azithromycin 500mg Tablet 500 500
18 Betahistine 6mg Tablet 90 90 60 30 500 480
19 Captopril 12,5mg Tablet
20 Captopril 25mg Tablet
21 Captopril 50mg Tablet
22 Carbamazepin 200mg Tablet
23 Cefadroxil 500mg Kapsul
24 Cefixime 100mg Tablet
25 Cetirizine 10mg Tablet
26 Chlorfeniramine Maleat (CTM) 4mg Tablet
STOK PEMBERIAN
NO NAMA BARANG SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
AWAL APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
27 Chlorpromazine 25mg Tablet
28 Chlorpromazine 100mg Tablet
29 Ciprofloxacin 500mg Tablet
30 Cotrimoxazole 120mg Tablet
31 Cotrimoxazole 480mg Tablet
32 Cotrimoxazole Forte 960mg Tablet
33 Dexamethason 0,5mg Tablet
34 Diltiazem 30mg Tablet
35 Doxicycline 100mg Kapsul
36 Domperidone 10mg Tablet
37 Ergotamine caffein Tablet
38 Erythromicyn 250mg Paket
39 Erythromicyn 500mg Tablet
40 FDC KAT Anak Paket
41 FDC KAT I Paket
42 FDC KAT II Paket
43 Fervital Sachet
44 Fithomenadion (Vit.K1) 10mg Tablet
45 Furosemide 40mg Tablet
46 Garam Oralit Sachet
47 Glibenclamide 5mg Tablet
48 Griseofulvin 125mg Tablet
49 Haloperidol 1,5mg Tablet
50 Ibuprofen 200mg Tablet
51 Ibuprofen 400mg Tablet
52 Isoniasid (INH) 100mg Tablet
53 Isoniasid (INH) 300mg Tablet
54 Isosorbide Dinitrate 5mg Tablet
55 Calcium Lactate (Kalk) 500mg Tablet
56 Ketoconazole 200mg Kapsul
57 Klindamisin 300mg Kapsul
58 Lansoprazole 30mg Kapsul
59 Loperamide 2mg Tablet
60 Loratadine 10mg Tablet
STOK PEMBERIAN
NO NAMA BARANG SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
AWAL APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
61 Metformin 500mg Tablet
62 Metilprednisolone 4mg Tablet
63 Metilprednisolone 8mg Tablet
64 Metoclopramide 5mg Tablet
65 Metoclopramide 10mg Tablet
66 Metronidazole 500mg Tablet
67 Mineral MIX, Kombinasi Sachet
68 Multivitamin
69 Natrium Diklofenak 50mg Tablet
70 Nifedipine 10mg Tablet
71 Nystatin 500.000IU Tablet
72 Nystatin tablet vagina 100.000IU Tablet
73 Omeprazole 20mg Kapsul
74 Ondansetron 4mg Tablet
75 Ondansetron 8mg Tablet
76 Paracetamol 500mg Tablet
77 Pil KB oral kombinasi Tablet
78 Prednison 5mg Tablet
79 Prophylthiuracyl (PTU) 100mg Tablet
80 Pyrantel 125mg Tablet
81 Ranitidine 150mg Tablet
82 Rifampicin 300mg Kapsul
83 Salbutamol 2mg Tablet
84 Salbutamol 4mg Tablet
85 Simvastatin 10mg Tablet
86 Simvastatin 20mg Tablet
87 Spironolactone 100mg Tablet
88 Tablet Tambah Darah Tablet
89 Tetracycline 250mg Kapsul
90 Tetracycline 500mg Kapsul
91 Tramadol 50mg Tablet
92 Vitamin A (Retinol) 100.000IU Kapsul
93 Vitamin B Complex Tablet
94 Vitamin B1 (Thiamin) Tablet
STOK PEMBERIAN
NO NAMA BARANG SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
AWAL APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
95 Vitamin B12 (Cyanocobalamin) Tablet
96 Vitamin B6 (piridoksin) Tablet
97 Vitamin C 50mg Tablet
98 Vitamin C 250mg Tablet
99 Zinc 20mg Tablet
B. SIRUP
100 Albendazole Sirup 200mg Botol
101 Amoxicillin sirup kering 125mg/5ml Botol
102 Antasida suspensi Botol
103 Cefadroxil sirup kering 125mg/5ml Botol
104 Cefadroxil sirup kering 250mg/5ml Botol
105 Cetirizine sirup Botol
106 Chloramfenicol suspensi 125mg/5ml Botol
107 Cotrimoxazole sirup 60ml Botol
108 Domperidone suspensi/sirup 5mg/ml Botol
109 Erythromicyn sirup Botol
110 Ibuprofen suspensi 200mg/5ml Botol
111 Paracetamol drop Botol
112 Paracetamol sirup 120mg/5ml Botol
113 Pyrantel sirup Botol
114 Sefiksim sirup kering 100mg/5ml Botol
115 Zink sirup Botol
C. INJEKSI & INFUS
116 Aminofilin Injeksi Ampul
117 Amoxicillin serbuk injeksi 1000mg Vial
118 Ampicillin 1g inj Vial
119 Antalgin inj Ampul
120 Aqua Pro Injeksi Vial
121 Asam Traneksamat Ampul
122 Asering infus botol
123 Atropine sulfate 0,25mg Ampul
124 Calcii gluconas inj Ampul
125 Dexamethasone inj Ampul
126 Diazepam injeksi 5mg/ml Ampul
STOK PEMBERIAN
NO NAMA BARANG SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
AWAL APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
127 Difenhidramine inj. 10mg/ml (HCl) Ampul
128 Epinefrin inj Ampul
129 Fenobarbital inj Ampul
130 Fitomenadion injeksi 10mg/ml Ampul
131 Furosemide inj Ampul
132 Gentamicin inj Ampul
133 Glukosa 5% infus Botol 500ml
134 Glukosa 10% Infus Botol 500ml
135 Glukosa 40% Botol
136 Hyoscine N-buthylbromide inj Ampul
137 KA-EN 3B Botol
138 Lidocaine inj 2% Ampul
139 Lidocain inj 2% (HCl) Comp. Ampul
140 Metil Ergometrin inj Ampul
141 Metilprednisolon inj 125mg/ml Vial
142 Metoklopramide inj 5mg/ml Ampul
143 MgSO4 20% Ampul
144 MgSO4 40% Ampul
145 NaCl 0,9% Infus Botol 500ml
146 Oxitocin inj. 10 ui/ml Ampul
147 Ondansetron injeksi Ampul
148 Piracetam 1g inj Ampul
149 Prokain Benzil Penisilin G injeksi Ampul
150 Ranitidine HCl inj Ampul
151 Ringer Laktat (RL) Infus Botol 500ml
152 Tramadol injeksi Ampul
153 Vitamin B1 (tiamin) inj Ampul
154 Vitamin B12 (Cyanocobalamin) Inj Ampul
155 Vitamin B6 (piridoksin) inj Ampul
D. OBAT LUAR
156 Anti Hemoroid Supp
157 As. Salycil + Bel. Endap (2-4 salep) Pot
158 Antifungi DOEN salep Pot
159 Asiklovir Cr Tube
STOK PEMBERIAN
NO NAMA BARANG SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
AWAL APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
160 Betametason krim 0,1% Tube
161 Etakridine Larutan 0,1% Botol
162 Fenol Gliserol TT Botol
163 Gentian Violet Botol
164 Gentamicin 0,1 % salep mata Tube
165 Gentamicin 0,3% salep kulit Tube
166 Gentamisin tetes mata Botol
167 Hydrocortisone krim 2,5% Tube
168 Ketoconazole Cr 2% Tube
169 Kloramfenikol salep mata 1% Tube
170 Kloramfenikol tetes telinga 3% Botol
171 Miconazole Cream Tube
172 Oksitetrasiklin salep kulit Tube
173 Oksitetrasiklin salep mata Tube
174 Povidone Iodida Larutan 10% 30ml Botol
175 Povidone Iodida Larutan 60ml Botol
176 Povidone Iodida Larutan 300ml Botol
177 Povidone Iodida Larutan 1000ml Botol
178 Policresulen 36% Botol
179 Salisil Bedak 2% Kotak
E. BAHAN MEDIS HABIS PAKAI
180 Alkohol 70% 1 Liter Botol
181 Alkohol 70% 100ml Botol
182 Alkohol swab Kotak
183 ARM Sling M Pcs
184 ARM Sling L Pcs
185 Aseptan 500cc + pump Botol
186 Blood Lancet Kotak
187 Blood Transfusion Set Pcs
188 Bracket Handwash Plastik Pcs
189 Canula oksigen L
190 Canula oksigen M
191 Cannula oksigen bayi Pcs
192 Cannula oksigen anak Pcs
STOK PEMBERIAN
NO NAMA BARANG SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
AWAL APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
193 Cannula oksigen dewasa Pcs
194 Catgut Chromic No. 2/0 Pcs
195 Catgut Chromic No. 3/0 Pcs
196 Catgut Chromic No. 4/0 Pcs
197 Catgut Plain No. 2/0 Pcs
198 Catgut Plain No. 3/0 Pcs
199 Dermafix 10 x 15 Pcs
200 Disposable Syringe (Spoit) 1 cc Pcs
201 Disposable Syringe (Spoit) 3 cc Pcs
202 Disposable Syringe (Spoit) 5 cc Pcs
203 Disposable Syringe (Spoit) 10cc Pcs
204 Etil Klorida Spray Botol
205 Farmafix 10 cm
206 Farmafix 5 cm
207 Foley Catheter No.16 Pcs
208 Foley Catheter No.18 Pcs
209 Foley Catheter No.20 Pcs
209 Foley Catheter No.22 Pcs
210 Foley Catheter No.24 Pcs
211 Gynecolog Glove No.6,5 Pasang
212 Gynecolog Glove No.7 Pasang
213 Gynecolog Glove No.7,5 Pasang
214 H2O2 Botol
215 Handrub
216 Handschoen Steril No.6,5 Pasang
217 Handschoen Steril No.7 Pasang
218 Handschoen Steril No.7,5 Pasang
219 Handschoen Steril No.8 Pasang
220 Handschoen Ukuran S Ktk
221 Handschoen Ukuran M Ktk
222 Handschoen Ukuran L Ktk
223 I.V. Catheter No. 18 Pcs
224 I.V. Catheter No. 20 Pcs
225 I.V. Catheter No. 22 Pcs
STOK PEMBERIAN
NO NAMA BARANG SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
AWAL APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
226 I.V. Catheter No. 24 Pcs
227 Infus Set Makro (Dewasa) Pcs
228 Infus Set Mikro (Anak) Pcs
229 Jelly Catheter Tube
230 Jelly USG Botol
231 Kapas 250 g Botol
232 Kapas berlemak 500 g Roll
233 Kapas 1000 g Roll
234 Kasa Hydrofil 40cm x 80cm Roll
235 Kasa Kompress 40 x 40 cm Bungkus
236 Kasa steril 16 x 16 cm Ktk
237 Kasa Pembalut Hydrofil 4 x 10 cm Pcs
238 Kasa Pembalut Hydrofil 4 x 15 cm Pcs
239 Kasa Pembalut Hydrofil 4 x 5 cm Pcs
240 Latex steril sugical gloves no. 7,5
241 Latex steril sugical gloves no. 8
242 Lysol larutan 1 liter Pcs
243 Masker Earloop Pcs
244 Masker Plus 3 Ply Earloop Pcs
245 Masker Tali Pcs
246 Nylon 5/0
247 Optime 4/0 3/8
248 Optime 5/0 3/8
249 Optime 5/0 1/2
250 One scrub 5 liter Botol
251 One scrub 500ml Botol
252 One test hamil Pcs
253 Paper Tape 2,5 cm
254 Paper Tape 5 cm
255 Plesterin 10cm x 5cm Roll
256 Plesterin 5cm x 5cm Roll
257 Pot Sputum Pot
258 Reagen ZN Set
STOK PEMBERIAN
NO NAMA BARANG SATUAN PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK PERMINTAAN KET
AWAL APBD B. STOK PROGRAM LAIN-LAIN
1 2 3 4 5 6=(4+5) 7 8=(6-7) 9 10 11 12 13 14
259 Sharp Container 1 liter Pcs
260 Shoe Cover Pasang
261 Silk no. 2/0 Pcs
262 Silk no. 3/0 Pcs
263 Silk no. 4/0 Pcs
264 Sungkup Oksigen Bayi Pcs
265 Sungkup Oksigen Anak Pcs
266 Sungkup Oksigen Dewasa Pcs
267 Umbilical Cord Klem Steril Nylon Pcs
268 Urine Bag Pcs
269 Water one 1 liter Botol
270 Wing needle 19G Pcs
271 Wing needle 21G Pcs
272 Xylocain Spray
273 Xylocain 2% jelly
F. TAMBAHAN/LAIN-LAIN
274
275
276
277
278

UMUM
BPJS JUMLAH
JUMLAH KUNJUNGAN BAYAR TIDAK BAYAR
RESEP

Bantaeng, 2 Agustus 2019


Mengetahui/Menyetujui, Yang Menyerahkan, Yang Meminta, Yang Meminta,
Kepala Bidang Pelayanan dan Sumber Kasi Farmasi, Alkes dan PKRT Kepala Puskesmas Pengelola Obat
Daya Kesehatan Puskesmas Ulugalung Puskesmas Ulugalung

M I R N A, S.Si, Apt. HABIBI, S.Farm, Apt. Drg. MOH. SHALAHUDDIN, M.Kes IRMAYANTI ILYAS, S.Farm
NIP. 19780426 200502 2 002 NIP. 19840319 201001 1 019 NIP. 19760220 200502 1 003 NIP. 19770311 200312 2 013