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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

(LPLPO)

INSTANSI : PUSKESMAS BUKO NOMOR DOKUMEN :


KECAMATAN : PINOGALUMAN BULAN PEMAKAIAN Juni
KABUPATEN : BOLAANG MONGONDOW UTARA BULAN PERMINTAAN : Juli
PROPINSI : SULAWESI UTARA TAHUN : 2019

STOK PEMBERIAAN
SATUAN STOK PENERI PERSE PEMA SISA
KODE NAMA OBAT RUSAK/ EXP OPTIMU PERMIN
TERKECIL AWAL MAAN DIAAN KAIAN STOK TAAN FORNAS
M DAK APBD I DAU LAIN (TK)
1 2 3 4 5 6=4+5 7 8 9=6-7-8 10 11 12 13 14 15 16

OBAT CAIR

1 Alkohol 70% 100 ml botol - - - - - - 0 1,2,3

2 Alkohol 70% 1000 ml botol 46 46 1 - 45 0 1,2,3

3 Ambroxol sirup botol - 50 50 10 - 40 50

4 Aminophylline inj ampul 48 48 - - 48 0 1,2,3

Ampisilin 500mg + Sulbaktam 250 mg Serb ampul 36 - 36 - 36


inj (Bactesyn)
0

5 Amoxicillin drops botol - - - - - - 50 1,2,3

6 Amoxicillin sirup botol - - - - 50 1,2,3

7 Analog insulin Apidra inj pen - - - - - - 0 1,2,3

8 Analog insulin Lantus inj pen - - - - - - 0 1,2,3

Analog long insulin (Ezelin) 100 UI Pen 40 - 40 - 40


0

9 Antalgin inj ampul - - - - - - 30

10 Antasida sirup botol 370 100 470 45 - 425 0 1,2,3


11 Aqua pro inj flacon 108 108 6 - 102 0 1,2,3

12 Asering infus botol - - - - - 0 1,2,3

Asam Traneksamat inj 100 mg/ml ampul 30 30 10 - 20

13 Atropin sulfate inj ampul - - - - - 0 1,2,3

14 Carbol fuchsin 0,3% botol - - - - - - 0

15 Cefepime inj vial - - - - - - 0 2.3

16 Cefixime sirup botol - - - - - - 30 2.3

17 Cefotaxime inj vial - - - - - - 20 2.3

18 ceftriaxone inj vial - - - - - - 20

19 Cefadroxil sirup botol - - - - - 50

20 Cetirizine sirup botol 144 144 40 - 104 0 1,2,3

21 Cotrimoksazol sirup botol 327 327 5 322 - 50

22 Combivent Vial - - - - - 50

23 Chloramphenicol sirup botol 90 90 5 - 85 0 1,2,3

24 Chloramphenicol tetes telinga botol - - - - - - 30 1,2,3

25 Citicholine inj ampul - - - - - - 0

26 Curbion sirup multivitamin botol - - - - - - 50

27 Dexamethasone inj ampul - - - - - - 100 1,2,3

Dextrosa larutan 10% botol - - - - - - 0

28 Diazepam Inj ampul 30 30 - - 30 0 1,2,3

29 Diphenhydramine inj ampul 60 60 - - 60 0 1,2,3

30 Domperidone sirup botol - - - - - 50 1,2,3

31 Epinephrine inj ampul 100 100 100 - - 20 1,2,3

Efedrin Inj 50mg/ml ampul 20 - 20 - 20 0

32 Erythromycin sirup botol 50 - 50 10 - 40 50 1,2,3

33 Eugenol cairan botol 10 10 - - 10 0 1,2,3

34 Formalin cairan liter - - - - - - 0

35 Furosemide inj ampul - - - - 10 1,2,3


36 Gastrucid Supensi botol - - - - 50

37 Gentamicin inj ampul 10 10 - 10 0 2.3

38 Gentamisin Tetes mata botol - - - - - - 30 2.3

39 Gentian violet botol - - - - - - 30

40 Glukosa 10% infus botol - - - - 20 1,2,3

41 Glukosa 40% inj flacon - - - - - - 0 1,2,3

42 Glukosa 5% infus botol 520 520 - 520 0 1,2,3

HCL 0,1 N 100 Ml botol 5 5 - - 5 0

43 H2O2 3% botol - - - - - - 0 1,2,3

44 Hyoscine butylbromide inj ampul - - - - - - 0 2.3

45 Haloperidol inj 5mg/ml (Lodomer) ampul 24 - 24 - - 24 0

46 Ibuprofen sirup botol 180 180 180 - 50 1,2,3

Karbogliserin Tetes Telinga 10% botol - - - - - - 0

47 KAEN 3A infus botol 20 - 20 - - 20 0 1,2,3

48 KAEN 3B infus botol 20 20 - - 20 0 1,2,3

49 Ketamine inj vial - - - - 0 1,2,3

50 Ketorolac inj ampul 456 120 576 24 - 552 100 2.3

51 Kalsium Glukonat ampul 23 - 23 - - 23 0


KCL 7.4% Kalium Klorida OTSU 25ml flacon - - - - 0

52 Kloramfenikol tetes mata botol - - - - - - 30 1,2,3

53 Lidocaine inj ampul 2,400 2,400 - 2,400 0 1,2,3

54 Lysol cairan botol 15 15 - 15 0


Levofloxacin infus 5mg/ml botol 10 - 10 - - 10 0

55 Magnesium Sulfat 20% inj flacon - - - 10 1,2,3

Manitol Lar. Inf 20% botol 20 - 20 - - 20 0


56 Magnesium Sulfat 40% inj flacon - - - - 10 1,2,3

Meropenem Serb inj 500mg vial 8 - 8 - - 8 0


Metamizole / Antalgin inj 1000 mg/2ml ampul 100 100 200 - - 200
57 Metacetin sirup botol - - - - - - 50

58 Methylen blue 0,3% botol - - - - - - 0

59 Methylergometrin maleate inj ampul 100 100 - - 100 0 1,2,3

60 Metoklopramide sirup botol 55 55 10 - 45 0 1,2,3

61 Metronidazole infus botol 19 19 - 19 20 1,2,3

62 Natrium klorida 0,9% infus botol 260 260 20 - 240 0 1,2,3

63 Nelydex tetes mata botol - - - - - - 0

64 OBH sirup botol - - - - - - 0

65 Oil emersi botol - - - - - - 0

66 Omegdiar sirup botol 90 90 5 - 85 0

67 Omeprazole inj vial - - - - - - 10 1,2,3

68 Ondansetron inj ampul - 100 100 20 - 80 50 2.3

One Clean 1 L botol 20 20 20 0


Onescrub 2% 100ml botol 20 20 20 0

69 Otopain tetes telinga botol - - - - - - 30

70 Oxytocin inj ampul - - - 0 1,2,3

71 Pacdin cough sirup botol - 48 48 26 - 22 96

72 Paracetamol drops botol - - - - - - 0 1,2,3

73 Paracetamol infus botol - 50 50 10 - 40 30 3

74 Paracetamol sirup botol - - - - 50 1,2,3

75 Phenobarbital inj ampul 30 - 30 - - 30 0 2.3

76 Piracetam inj ampul - - - - - - 50

77 Pirantel Sirup botol 90 90 39 51 0 1,2,3

78 Povidone 300 ml botol 22 22 - 22 0 1,2,3

79 Povidone 60 ml botol - - - - - - 0 1,2,3

80 Ranitidine inj ampul 100 200 300 - 300 200 2.3

81 Renalyte electrolytes botol - - - - 60 1,2,3

82 Ringer Laktat infus botol 20 100 120 60 60 100 1,2,3


83 Rivanol 300 ml botol 21 21 2 - 19 0 1,2,3

84 Salbutamol sirup botol - - - - - 30 2.3

85 Sodium Bicarbonate inj flacon - - - - - - 0 2.3

86 Sucralfate sirup botol - - - - - - 50 2.3

87 Tetagam inj human tetanus vial 10 - 10 - - 10 0 1,2,3

88 Tramadol inj ampul 12 - 12 - 12 0 2.3

89 Tranexamic Acid inj ampul - - - - - - 0 2.3

Valproat Syr 250 Mg/5ml botol - - - - 30

90 Vit amin B12 inj ampul 200 200 - 200 100 1,2,3

91 Vitamin B1 inj ampul - - - - - 0

92 Vitamin K inj 10 mg ampul - - - - - - 0 1,2,3

93 Vitamin K inj 2 mg ampul 180 180 - 180 0 1,2,3

94 Voluven HES 6% botol - - - - - 0 1,2,3

Water One 1 L botol 20 20 - 20 0

95 Zinc pro drops botol 110 110 - - 110 0 1,2,3

Zinc Sir 20 mg/5ml botol 37 37 10 - 27 50


- - - - 0
OBAT PADAT - - - - 0

96 Acetosal 100 mg tablet - - - - - 0 2.3

97 Acetylcysteine 200 mg tablet - - - - 0 1,2,3

98 Acetysalicylic acid 80 mg tablet 1,000 - 1,000 - 1,000 0 1,2,3

99 ACT (artesunate + amodiaquin) tablet - - - - - - 0

100 Acyclovir 400 mg tablet 1,300 500 1,800 - 1,800 500 1,2,3

101 Albendazole 400 mg tablet 870 - 870 - 870 0 1,2,3

102 Allopurinol 100 mg tablet 1,900 1,900 400 - 1,500 0 1,2,3


Alprazolam tab 0,5 mg tablet 189 189 189 0

103 Ambroksol 30 mg tablet - 2,000 2,000 1,700 - 300 5000

104 Aminophillin 150 mg tablet - - - - - - 0 1,2,3


105 Amlodipine 10 mg tablet 240 240 240 - - 500 1,2,3

106 Amlodipine (Omesivask) 5 mg tablet 4,110 4,110 570 - 3,540 0 1,2,3

Amiodaron (KENDARON) tab 200mg tablet 510 510 - 510 0

107 Amoxicillin 500 mg tablet 3,600 10,000 13,600 2,400 - 11,200 2000 1,2,3

108 Antalgin 500 mg tablet - - - - - - 2000

109 Antasida doen tablet 20,200 20,200 2,300 - 17,900 0 1,2,3

110 Anti Hemoroid supo supositoria 150 150 - 150 0 1,2,3

111 Asam Folat 5 mg tablet 3,900 3,900 1,000 - 2,900 0 1,2,3

112 Asam mefenamat 500 mg tablet 1,800 9,600 11,400 2,200 - 9,200 1,2,3

113 Asam traneksamat 500 mg tablet - - - - - - 500 2.3

114 Asiklovir 200 mg tablet - - - - - - 500 1,2,3

115 Attapulgite tablet 400 - 400 - - 400 0 1,2,3

Atenolol (Betablok) Tab 50mg tablet 960 - 960 - - 960 0

116 Betahistin tab tablet 4,600 4,600 300 - 4,300 0 2.3

117 Bisacodyl supo supositoria - - - - - - 10 1,2,3

118 Bisacodil Suppo 10 mg supositoria - - - - - - 10

119 Bisacodil tab 5 mg tablet - - - - - - 500 2.3

120 Biscodyl Supo 5 mg supositoria - - - - - - 10

121 Bisoprolol 5 mg tablet - - - - - - 0

122 Bromhexine 8 mg tablet - - - - 1000

123 Calsium lactate 500 mg tablet 2,500 2,500 1,100 - 1,400 0 1,2,3

124 Captopril 12,5 mg tablet 2,900 2,900 300 - 2,600 0 1,2,3

125 Captopril 25 mg tablet - - - - - - 500 1,2,3

126 Captopril 50 mg tablet - - - - - - 500 1,2,3

127 Cefadroxil 500 mg tablet - - - - - - 1000 2.3

128 Cefixime 100 mg tablet - - - - - - 1000 2.3

129 Cetirizine 10 mg tablet 2,200 1,500 3,700 1,200 - 2,500 1000 2.3

130 Chloramphenicol 500 mg tablet - - - - 1000 2.3


131 Chlorpheniramine Maleat 4mg tab tablet - - - - 2000 1,2,3

132 Ciprofloxacin 500 mg tablet - - - - - - 1000 1,2,3

133 Citicoline 500 mg tablet - - - - - - 0

134 Clindamycin 150 mg tablet - - - - 500 1,2,3

135 Clobazam tab 10 mg tablet - - - - - - 0 2.3

136 Colchicine 0,5 mg tablet - - - - - - 0 1,2,3


Cotrimoksazol (dewasa) Komb.
Sulfametoksazol 400 + Trimetoprin 80 mg) tablet 1,800 1,800 1,800
tab 480 mg 1000

137 Cotrimoxazole 960 mg tablet - - - - - 0 1,2,3

138 Daryant Tulle Framisetin Sulfat 1% pcs 10 - 10 10 - - 20

139 Dexamethasone 0,5 mg tablet - - - - - - 5000 1,2,3

140 Diazepam 2 mg tablet 6 - 6 3 - 3 10 1,2,3

141 Diazepam stesolid 10mg supositoria - - - - - - 5 1,2,3

142 Diazepam stesolid 5mg supositoria - - - - - - 5 1,2,3

143 Diklofenac sodium 50 mg tablet - - - - - - 3000 1,2,3

144 Digoxin tablet - - - - - - 0

145 Diltiazem tab 30 mg tablet - - - - - - 0 1,2,3

146 Domperidone 10 mg tablet 1,600 1,600 200 - 1,400 500 1,2,3

147 Doxycycline 100 mg tablet 400 400 - 400 0 1,2,3

148 Dumin rectal 125 mg supositoria - - - - - 10

149 Dumin rectal 250 mg supositoria - - - - - - 0

150 Ergotamine caffeine tablet - - - - - - 0 1,2,3

151 Erythromycin 500 mg tablet - - - - 500 1,2,3

152 Fenitoin tablet - - - - - 0 1,2,3

153 Fenobarbital 30 mg tablet - - - - - - 0 1,2,3

154 Furosemide 40 mg tablet 1,000 - 1,000 - - 1,000 0 1,2,3

155 Glibenclamide 5 mg tablet 700 700 - 700 500 1,2,3

156 Glimepiride 4 mg tablet - 700 700 400 - 300 1000 1,2,3


157 Glyceryl guaiacolate 100 mg tablet - 2,000 2,000 1,700 - 300 5000

158 Glyceryl trinitrate 500 mcg tablet - - - - - - 5000 1,2,3

159 Griseofulvin 125 mg tablet 2,000 2,000 500 - 1,500 0 1,2,3

160 Haloperidol 0,5 mg tablet - - - - - - 0 2.3

161 Hydrochlorothiazide 25 mg tablet - - - - - 0 1,2,3

162 Hyoscine butylbromide 10 mg tablet - - - - - - 500 1,2,3

163 Ibuprofen 400 mg tablet - 1,000 1,000 400 - 600 3000 1,2,3

164 Isosorbid Dinitrat 5 mg tablet 300 - 300 - - 300 0 1,2,3


Kalsium Karbonat (CALPOROSIS) kap kaplet 420 420 - 420
500mg 0

165 Kalipar Potasium aspartate tablet 450 - 450 - 450 0 2.3

Karvedilol (V-Bloc) tab 6.25 mg tablet 300 - 300 - 300 0


Klonidin tab tab 0.15 mg tablet 900 - 900 - - 900 0

166 Ketoconazole 200 mg tablet 650 - 650 100 - 550 500 1,2,3

167 Ketoprofen supo supositoria - - - - - - 10 2.3

168 Karbamazepim tablet 1,000 1,000 - - 1,000 0 1,2,3

169 Klorpromazin 100 mg tablet - - - - - - 0 1,2,3

170 Kuinin sulfat 222 mg tablet 420 - 420 - - 420 0 1,2,3

171 Lanzoprasol 30 mg tablet 850 700 1,550 - 1,550 500 2.3

Levonogestrel 150 mcg + etinilestradiol 30 tablet - - - - -


mcg
0

172 Levofloxacin 500 mg tablet - - - - - - 0 2.3

LEVORAP Antiparkonson Doen Tab. Komb. tablet 300 - 300 - 300


Bensezid 25 mg + Levodopa 100 mg
0
Lisonopril ta 10 mg tablet - - - - - - 0

173 Lincomycin 500 mg tablet - - - - - - 500

174 Loperamide 2 mg tablet 600 500 1,100 - 1,100 500 2.3

175 Loratadine 10 mg tablet - - - - - - 1000 1,2,3


176 Meloxicam tab 7,5 mg tablet 1,800 1,800 - 1,800 1000

177 Metformin 500 mg tablet 700 700 300 400 - 1000 1,2,3

178 Methisoprinol 500 mg tablet - - - - - 0

179 Methyldopa 250 mg tablet - - - - - - 500 2.3

180 Metilergometrin maleat tab tablet 1,500 - 1,500 - - 1,500 0 1,2,3

181 Metilprednisolon tab tablet 2,500 2,000 4,500 400 - 4,100 0 1,2,3

182 Metoclopramide 10 mg tablet 1,300 1,300 - 1,300 0 1,2,3

183 Metoclopramide 5 mg tablet - - - - - - 0 1,2,3

184 Metronidazol 500 mg tablet - - - - - - 1000 1,2,3

185 Metronidazole supo supositoria - - - - - - 0 2.3

186 Microlax rectal tube - - - - - - 20


Natrium Diklofenat tab tablet 300 300 - 300 3000

187 Nifedipine 10 mg tablet 1,000 1,000 2,000 - 2,000 1000 1,2,3

188 Norit botol - - - - - - 0 1,2,3

189 Nystatin 500.000 IU tablet - - - - - - 0 1,2,3

190 OAT kategori Sisipan - KDT kotak - - - - - 0 1,2,3

191 Omegavit multivitamin tablet - - - - - - 1000

192 Omeprazole 20 mg tablet - - - - - - 1000 1,2,3

193 Ondansetron 4 mg tablet 612 612 120 - 492 0 2.3

194 Ondansetron 8 mg tablet - - - 100 2.3

195 Paket stop TB kategori I kotak - - - - - 0 1,2,3

196 Panviton multivitamin tablet - - - - - - 500

197 Papaverin 40 mg tablet - - - - - - 200

198 Paracetamol 500 mg tablet 19,600 19,600 3,200 - 16,400 0 1,2,3

199 Piracetam 400 mg tablet - - - - - - 1000


200 Piracetam 800 mg tablet - - - - - - 1000

201 Piroxicam 20 mg tablet - - - - - - 2000

202 Prednison 5 mg tablet 15,400 15,400 500 - 14,900 0 1,2,3


203 Prenase multivitamin tablet - - - - - - 500

204 Primaquine 15 mg tablet - - - - - - 0 1,2,3

205 Probenecid 500 mg tablet - - - - - - 0 1,2,3

206 Propanolol 10 mg tablet - - - - 0 1,2,3

207 Propylthiouracil 100 mg tablet 300 - 300 - 300 0 1,2,3

208 Pyrantel tab 125 mg tablet 1,700 1,700 - 1,700 0 1,2,3

209 Ranitidine 150 mg tablet 1,200 1,000 2,200 2,200 - - 5000 1,2,3

210 Salbutamol 2 mg tablet 900 - 900 - 900 0 1,2,3

211 Salbutamol 4 mg tablet 600 600 200 - 400 1000 1,2,3

212 Salbutamol nebules 2,5 mg tablet - - - - - 10

213 Simvastatin 10 mg tablet 1,290 1,680 2,970 450 2,520 1000 1,2,3

214 Spironolactone 100 mg tablet 500 500 - - 500 0 1,2,3

215 Sucralfate 500 mg tablet 600 600 - 600 1000 2.3

Tablet Tambah darah Kombinasi Ferro tablet - - - - -


fumarat 60 mg + Asam Folat 0,4 Mg
0

216 Tetrasiklin 250 mg tablet - - - - - - 0 1,2,3

217 Tetrasiklin 500 mg tablet 500 500 - - 500 0 1,2,3

218 Thiamphenicol 500 mg tablet - - - - - - 1000

219 Tilomix tablet - - - - - - 2000

220 Triheksifenidil 2mg tablet 1,000 1,000 - - 1,000 0 1,2,3

Tyarit Tab tablet 540 - 540 - - 540 0


Ulsidex 500 mg tab tablet 400 2,000 2,400 100 - 2,300 500

221 Valsartan tab 80 mg tablet - - - - - - 0 2.3

222 Vitalamin Vidabion tablet - 1,000 1,000 200 - 800 2000

223 Vitamin A 100.000 IU tablet - 500 500 - 500 500 1,2,3

224 Vitamin A 200.000 IU tablet - 500 500 - 500 500 1,2,3

225 Vitamin B complex tablet 2,700 2,700 1,600 - 1,100 0 1,2,3

226 Vitamin B1 50 mg tablet 900 900 100 - 800 0 1,2,3


227 Vitamin B6 10 mg tablet 5,600 5,600 300 - 5,300 0 1,2,3

228 Vitamin C 50 mg tablet 1,000 1,000 1,000 - - 3000 1,2,3

229 Vitamin K 10 mg tablet 100 100 100 - - 1000 1,2,3

230 Zinc 20 mg tablet 4,500 4,500 - 4,500 0 1,2,3

- - - - 0

231 OBAT GIGI - GAS - - - - 0

232 Alginate 500g zak - - - - - - 0

233 Amalgam ana2000 botol - - - - - - 0


Biomedical obat semprot oral & nose botol - - - - - -
234 Ortoviro 0

235 Bonding stae refill botol - - - - - - 0

236 Calcium hydroxide pasta Hydcal tube - - - - - - 0

237 Calciumpolystyrene Kalikate sachet - - - - - - 0

238 Caviton 30g botol - - - - - - 0

239 Dental gipsum kg 5 5 - - 5 0

240 Devitalising paste pulp botol - - - - - - 0 1,2,3


Elite cement 100 semen seng fosfat set - - - - - -
241 0

242 Etil Clorida spray botol - - - - - - 10 1,2,3

243 ETSA etching gel kit 12gm dispo - - - - - - 0

244 Glass ionomer GC fuji IX set - - - - - - 0 1,2,3

245 Iodoform paste Mumifing pasta botol - - - - - - 0


Lidocain (Xylocaine) Spery 10 % botol 1 1 - - 1 5

246 Komposit a A2, A3, A 3,5 solareX botol - - - - - - 0

247 L Bio sachet - - - - - - 300


Oxymetazoline Nasal Spray Iliadin 0,05% botol - - - - - -
248 0

249 Pulp-X botol - - - - - - 0


Symbicort Budesonid-formoterol Inh can - - - - - -
80/4,5 mcg
0
250 Temporari stoping fletcher serbuk set - - - - - - 0
- - - - 0
OBAT SALEP/SERBUK - - - - 0

251 Acyclovir cream tube - - - - - - 50

252 Antifungi Doen tube 72 72 - - 72 0

Anti Bakteri Salep Kom : Basitrasin 500 tube - - - - -


Iu/g + polimiksin 10.000 IU/G
0

253 Basirasin Salep tube - - - - - 0


Aseptic alkohol gel antiseptic pembersih botol 75 75 - 75
254 tangan 0

255 Betametason cream tube 151 151 - 151 0 1,2,3

256 Bioplacenton gel tube - - - - - - 50

257 Bricasma terbutaline can - - - - - - 0

258 Burnazin silver sulphadiazine tube - - - - - - 0 1,2,3

259 Caladine lotion botol - - - - - - 10


Calcium Polysystyrene (Kalitake) sachet 20 - 20 - - 20 0

260 Chloramphenicol salep kulit tube - - - - - - 50 1,2,3

261 Chloramphenicol salep mata tube 24 48 72 24 - 48 50 1,2,3

262 Cutimed gel tube - - - - - - 0

263 Desoximetasone cream tube 30 30 - 30 0 2.3

264 Dexocort Salep 0,25% tube - - - - - - 0

265 Diclofenac sodium gel tube - - - - - 20

266 Garam Oralit tube - - - - - - 0

267 Gentamicin salep mata tube - - - - - - 50 2.3

268 Hydrocortisone cream tube 180 180 24 - 156 0 1,2,3

269 Ichtyol salep pot - - - - - - 50

270 Ketoconazole cream tube 42 42 - 42 0 1,2,3

271 Lidocain jelly dispo - - - - - - 0 1,2,3


272 Miconazole cream tube 48 48 96 - 96 50 1,2,3

My Jelly 82 gr Tube 39 - 39 - 39 0

273 Nebacetin salep tube - - - - - - 0

274 Salep 2-4 pot 24 24 - - 24 0 1,2,3

275 Sabun Anti Bakteri botol - - - 24

276 Salisil bedak kotak 240 240 - 240 0 1,2,3

277 Sodium fusidat Fucilex tube 38 38 - 38 0 2.3

278 Thrombophob gel tube - - - - - - 24

279 Ultrasound gel USG botol 90 90 - - 90 0


- - - - 0
OBAT LAINNYA - - - - 0

280 Absorbent paper points 15-40 kotak - - - - - - 0 1,2,3

281 apron Lembar 100 100 - - 100 0

282 Absorbent paper points 45-80 kotak - - - - - - 0 1,2,3

283 Alkohol swab pcs 600 300 900 500 - 400 0

Aesculap Blades / carbon steel scalpel Pcs - - - -


blades #18
0

Aesculap Blades / carbon steel scalpel pcs - - - -


blades #22
0
Autoclick Lancing Device PCs 19 19 1 - 18 0

284 BeneChek Asam Urat Stik - - - - - 0

285 BeneChek Colesterol Stik - - - - - 0

286 BeneChek Glukosa Stik - - - 500


BeneChek Plus Uric Test Strip 25's Stik - - - 500

BeneChek Plus Total Cholesterol Test strip Stik - - - -


10's
0

287 Bisturi no. 11 pcs - - - - - 0

288 Bisturi no. 18 pcs - - - - - - 0


289 Bisturi no. 20 pcs - 100 100 - 100 50

290 Bisturi no. 22 pcs - - - - - - 0


Blood Lancet pcs 400 300 700 400 - 300 300

291 Catgut Chrom 3/0 Rol 100 meter roll 4 - 4 - - 4 0

292 Catgut Chromic 2/0 pcs - - - - - - 0

293 Catgut Chromic 3/0 pcs - - - - - - 0

294 Catgut plain 2/0 + jarum pcs 120 120 - 120 0

295 Catgut plain 3/0 + jarum pcs 96 96 - 96 0

297 Cutimed siltec 10x10cm pcs - - - - - - 0

298 Cutimed sorbact 7x9cm pcs - - - - - - 0

299 Duk steril disposible pcs - - - - - - 0


Endotracheal tube with cuff 6.0mm pcs - - - - - 0
endotracheal tube with cuff 7.0 mm pcs - - - - - 0
Feeding tube 100 cm No. 10 pcs - - - - - 0
fedding tube 100 cm no.6 pcs - - - - - 0
foley catheter 2 way no.6 ESKAMED pcs 100 100 - 100 0
foley catheter 2 way no.8 ESKAMED pcs 100 100 100 0
foley catheter 2 way no.14 ESKAMED pcs 90 90 90 0

300 Foley catheter 2 way no. 16 pcs 10 10 - 10 0

301 Foley catheter 2 way no. 18 pcs 90 90 - 90 0

302 Foley catheter 2 way no. 20 pcs 100 100 - 100 0

303 Foley catheter 2 way no. 6 pcs - - - - - 0

304 Gutta percha points 15-40 pcs - - - - - 0 1,2,3

305 Gutta percha points 45-80 pcs - - - - - 0 1,2,3

Handscone Examination Gloves S pcs 700 700 - 700 0


Handscone Examination Gloves M Pcs 700 1,000 1,700 300 - 1,400 0
Handscone Examination Gloves L pcs 1,300 1,300 - 1,300 0

306 Handscoen ginekologi psg - - - - - - 0


307 Handscoen non steril Large psg - - - - - - 0

308 Handscoen non steril Medium psg - - - - - - 0


Handscoen steril Obgym pcs 50 50 - 50 0

309 Handscoen steril psg - - - - - - 0

310 Handscoen steril no. 6,5 psg - 100 100 - - 100 100

311 Handscoen steril no. 7 psg 400 400 100 - 300 0

312 Handscoen steril no. 7,5 psg 300 300 50 - 250 0

313 Handscoen steril no. 8 psg - - - - 0

314 HCG test pcs 50 50 50 - - 0


BH sahli Set - - - - - 0

315 Infusion set Anak pcs - - - - - 0

316 Infusion set Dewasa pcs 250 250 - 250 0

317 IV cannula no. 18 pcs 100 100 - 100 100

318 IV cannula no. 20 pcs - 100 100 50 - 50 100

319 IV cannula no. 22 pcs - - - - - 0

320 IV cannula no. 24 pcs - - - - - 0

321 IV cannula no. 26 pcs - - - - 0

322 Jarum jahit No. 10 pcs - - - - - - 0

323 Jarum jahit No. 11 pcs - - - - - 0

324 Jarum jahit No. 12 pcs - - - - - - 0

325 Jarum jahit No. 13 pcs - - - - - - 0

326 Jarum jahit No. 14 pcs - - - - - - 0

327 Jarum jahit No. 15 pcs - - - - - - 0

328 Jarum jahit No. 9 pcs - - - - - - 0

329 Jarum otot besar pcs - - - - - - 0


330 Jarum otot kecil pcs - - - - - - 0
MENGETAHUI YANG MENYERAHKAN YANG MELAPORKAN
331 Jarum untuk insulin pen pcs 39
KEPALA 39
INSTALASI FARMASI & - - 39 0
KEPALA PUSKESMAS BUKO
KEPALA DINAS KESEHATAN
JetBOLAANG
Nebulizer mask Dewasa UTARAPcs PERBEKALAN
- - KESEHATAN
- - -
332KAB. MONGONDOW 0

JUSNAN C. MOKOGINTA, MARS ZULKIFLY MASUARA S.Kep


MENGETAHUI YANG MENYERAHKAN YANG MELAPORKAN
KEPALA DINAS KESEHATAN KEPALA INSTALASI FARMASI & KEPALA PUSKESMAS BUKO
KAB. BOLAANG MONGONDOW UTARA PERBEKALAN KESEHATAN

333 Jet Nebulizer Masker Anak pcs - - - - - - 0

334 Kacamata Anti infeksi pcs - - - - - - 0

335 Kapas
JUSNANBerlemak 500 g
C. MOKOGINTA, MARS bungkus - - - - - - ZULKIFLY
0 MASUARA S.Kep
NIP.putih
19671105 Sri Yulastri Paputungan, S.Si 001 1 200902 19850710
336 Kapas 250 g 200012 1 003 bungkus NIP11. 19851225 201001 211004 - 11 0

337 Kasa hidrofil 40 yard x 80cm roll 9 9 - 9 0

338 Kasa hidrofil 4m x 10cm rol 210 210 - 210 0

339 Kasa hidrofil 4m x 5cm rol - - - - 0

340 Kasa sterile 16x16cm pcs 928 928 320 - 608 0

341 Klem tali pusat pcs 100 100 - - 100 0

342 Masker Oksigen Dewasa pcs - - - - - - 50

343 Masker Oksigen Anak - - - - - - 50

344 Masker 200 200 200 - - 0


Masker Nebulizer Set Anak Besmed Pcs - - - - - 0
Micro brush doche Disposable micro
applicators 1A6542 Fine (1,5mm) warna buckets - - - - - -
345 kuning, biru 0

346 Mucous extractor FR 10 pcs - - - - - 0

347 NGT no.16 pcs - - - - - - 0

348 NGT no.18 pcs - - - - - 0

349 NGT no.3,5 pcs - - - - - - 0

350 NGT no.5 pcs - - - - - - 0

351 NGT no.8 pcs - - - - - - 0

352 Oxygen nasal cannula Anak pcs - - - - - 20

353 Oxygen nasal cannula Dewasa pcs - - - - - 20

354 Pembalut Gibs rol - - - - - - 0

355 Plester coklat yard Leukoplast rol 24 - 24 - 24 0

356 Plester Infus dermafix pcs 50 50 - 50 0

357 Plester luka bakar pcs - - - - - - 0

358 Plester putih Polifix rol 34 34 - 34 0


Plester rawat luka anti air dermafix t
10x25cm pcs 80 80 - 80
359 0

360 Safety box pcs 50 - 50 - - 50 0

361 Silk 2/0 pcs 36 - 36 - 36 0

362 Silk 3/0 pcs 180 - 180 - - 180 0


surgicryl 5/0 HR 17 mm SMI pcs - - - - - 0
surgicryl 4/0 HR 16 mm SMI pcs 24 - 24 - 24 0
surgicryl 5/0 HR 16 mm SMI pcs 24 - 24 - 24 0
surgicryl 3/0 HR 16 mm SMI pcs 24 - 24 - 24 0
surgicryl 2/0 HR 16 mm SMI pcs 24 - 24 - 24 0
surgicryl 3/0 HR 22 mm SMI pcs - - - - - 0
surgicryl 2/0 HR 22 mm SMI pcs - - - - - 0
surgicryl 6/0 DS 12 mm SMI pcs - - - - - 0
surgicryl 5/0 DS 19 mm SMI pcs - - - - - 0
surgicryl 4/0 DS 19 mm SMI pcs - - - - - 0
surgicryl 3/0 DS 19 mm SMI pcs - - - - - 0

363 Suction catheter FR 10 pcs - - - - - 0

364 Suction catheter FR 12 pcs - - - - - - 0

365 Suction catheter FR 14 pcs - - - - - - 0

366 Suction catheter FR 16 pcs - - - - - 0

367 Suction catheter FR 18 pcs - - - - - 0

368 Suction catheter FR 6 pcs - - - - - - 0

369 Suction catheter FR 8 pcs - - - - - - 0

Suction Catheter Steril w/Finger tube pcs - - - - -


Control No.6
0

Suction Catheter Steril w/Finger tube pcs - - - - -


Control No.8
0
Suction Catheter Steril w/Finger tube pcs - - - - -
Control No.12
0
Suction Catheter Steril w/Finger tube pcs - - - - -
Control No.14
0

Sputum pot pcs 60 - 60 - 60


0

370 Surgical gown baju operasi L pcs - - - - - - 0

371 Surgical gown baju operasi M pcs - - - - - - 0

372 Surgical gown baju operasi XL pcs - - - - - - 0


Swab, 4-PLY pcs - - - - 300

373 Syringe 1 cc pcs 3,100 3,100 - 3,100 0

374 Syringe 10 cc pcs - 1,000 1,000 - - 1,000 50

375 Syringe 20 cc pcs - 60 60 - 60 50

376 Syringe 3 cc pcs 2,300 2,300 200 - 2,100 0

377 Syringe 5 cc pcs - 1,600 1,600 - 1,600 100

378 Syringe 50 cc pcs - - - - - 0


Test Anti HVC Strip test - - - - -

379 Test Anti HIV 1/2 Cassette test - - - - - 0

380 Test HBsAg strip test - - - - - 0


Test Malaria HRP2/pLDH (Pf/PAN) combo test - - - - - -
381 0
Test Malaria PF & Pv Cassette ea - - - - -

382 Topi Operasi pcs - - - - - - 0

383 Underpad pcs 50 - 50 - 50 0

384 Urine Bag pcs 360 360 - 360 0


Uritest Reagen Strips 11G Ea 100 100 - - 100

Venflon pro IV Canula 18 ga 0,9 mm x 25 pcs 100 100 100


mm
0
Venflon pro IV Canula 20 ga 1,1 mm x 32 pcs - - - - -
mm
385 0

Venflon pro IV Canula 22 ga 0,9 mm x 25 pcs - - -


mm
0
Wing Needle 19 g onemed pcs - - - - - 0
Wing Needle 21 g onemed pcs - - - - - 0
wing Needle 25 g onemed pcs - - - - - 0
wing Needle 27 g onemed pcs - - - - - 0
Zienhl Neelson Set, 5 x 100 Ml set 10 10 - - 10 0
- 0
157,598 43,804 201,402 30,431 941 170,030 87,499 -

UMUM ASKES/ BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP TIDAK


BAYAR BAYAR
LAPORAN PENGGUNAAN NARKOTIKA

MASUK KELUAR
NO NAMA OBAT NAMA/ALAMAT JUMLAH SISA STOK KET
TGL DARI TGL/NO RESEP
PASIEN DOKTER
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Mengetahui Petugas
Kepala Puskesmas

ZULKIFLY MASUARA S.Kep ETCE SUMANTY DG MANSYUR S.Farm


NIP :19850710 200902 1 001
LAPORAN PENGGUNAAN PSIKOTROPIKA

NAMA PUSKESMAS : BUKO BULAN : MEI 2019


NO NAMA OBAT STOK AWAL MASUK KELUAR STOK AKHIR KET
1 Alprazolam Tablet 189 0 0 189
2 Diazepam tab 2 mg 6 0 0 6
3 Halloperidol Injeksi 24 0 0 24
4 Tramadol Injeksi 15 0 3 12
5 Trihesilphenidil 1000 0 0 1,000
6 Phenobarbital 30 0 0 30

Mengetahui Petugas
Kepala Puskesmas

ZULKIFLY MASUARA S.Kep NURHAYATI OLII


NIP :19850710 200902 1 001
FORM PEMANTAUAN KETERSEDIAAAN OBAT DAN VAKSIN INDIKATOR
DI PUSKESMAS RAWAT INAP

PERIODE PELAPORAN : Mei 2019


Nama : PKM BUKO
Alamat : DESA TOMBOLANGO TIMUR
Kab/Kota : Bolaang Mongondow Utara
Propinsi : SULAWESI UTARA
Penanggung jawab Farmasi : NURHAYATI OLII
No Nama Obat Bentuk Sediaan Ketersediaan Ada/Tidak Keterangan
1 Albendazol Tablet Ada
2 Amoxicilin 500 mg Tablet Ada
3 Amoxicilin Syrup Tidak
4 Dexamathason Tablet Ada
5 Diazepam Injeksi Ada
6 Epinefrin Injeksi Ada
7 Fitomenadion Injeksi Ada
8 Furosemid Tablet Ada
9 Garam Oralit Sachet Ada
10 Glibenclamid Tablet Ada
11 Captopril Tablet Ada
12 Magnesium Sulfat 20% Injeksi Ada
13 Metilergometin Maleat Injeksi Ada
14 Obat Anti TBC Tablet Ada
15 Oksitosin Injeksi Ada
16 Paracetamol 500 mg Tablet Ada
17 Tablet Tambah Darah Tablet Ada
18 Vaksin BCG Injeksi Ada
19 Vaksin TT Injeksi Ada
20 Vaksin DPT/DPT-HB/DPT-HB-HIB Injeksi Ada