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LAPORAN PEMAKAIAN DAN LEMBAR

PUSKESMAS : PUSTU JELATENG


KAB / KOTA : LOMBOK BARAT
LAPORAN PERIODE / BULAN : juni
PERMINTAAN PERIODE / BULAN : juli

N0 NAMA OBAT SATUAN STOK AWAL


24 25

ALAT KESEHATAN

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


2 Alat Suntik Sekali Pakai - 2.5 cc x 23G x 1 1/4" Set
3 Alat Suntik Sekali Pakai - 5 cc x 22G x 1 1/4" Set
4 Alat Suntik Sekali Pakai - 10 cc x 21G x 1 1/2" Set
5 Benang Operasi - Catgut Plain 2/0 + jarum 1/2 GT 35 mm Set
6 Benang Operasi - Catgut Chromic 2/0 + jarum 1/2 GT 35 mm Set
7 Benang Operasi - Catgut Plain 3/0 + jarum 1/2 GT 35 mm Set
8 Benang Operasi - Catgut Chromic 3/0 + jarum 1/2 GT 35 mm Set
9 Benang Operasi - Silk 2/0 + jarum 1/2 GT 35 mm Set
10 Benang Operasi - Silk 3/0 + jarum 1/2 GT 35 mm Set
11 HAND SCOUND STERIL NO 7 Pasang
12 HAND SCOUND STERIL NO 7,5 Pasang
13 HAND SCOUND NON STERIL UK L Lembar
14 HAND SCOUND NON STERIL UK M Lembar
15 HYPAFIX 10 x 5 CM Pasang
16 Infus Set, IV, Wing needle - Infusion Set Pediatric (60 drops/ml) set
17 Infus Set, IV, Wing needle - Infusion Set Dewasa (20 drops/ml) set
18 Infus Set, IV, Wing needle - I.V Catheter No. 18 G x 32 mm buah
19 Infus Set, IV, Wing needle - I.V Catheter No. 20 G x 1 1/4 " buah
20 Infus Set, IV, Wing needle - I.V Catheter No. 22 G x 1 " buah
21 Infus Set, IV, Wing needle - I.V Catheter No. 24 G x 3/4 " buah
22 Infus Set, IV, Wing needle - I.V Catheter No. 26 G x 1/2 " buah
23 Infus Set, IV, Wing needle - Wing Needle 21G set
24 Infus Set, IV, Wing needle - Wing Needle 23G set
25 Infus Set, IV, Wing needle - Wing Needle 25G set
26 Infus Set, IV, Wing needle - Wing Needle 27G set
27 Jarum Jahit Bedah pcs
28 Kasa, Verband, Kapas - Kasa Pembalut / absorben 250 gr Roll
29 Kasa, Verband, Kapas - Kasa Hydrophil 40 x 80 cm Roll
30 Kasa, Verband, Kapas - Kasa Hydrophil Steril 16 x 16 cm lembar
31 Kasa, Verband, Kapas - Kasa Hydrophil Steril 18 x 22 cm Lembar
32 Kasa, Verband, Kapas - Kasa Pembalut Hydrophil 4 x 3 cm Roll
33 Kasa, Verband, Kapas - Kasa Pembalut Hydrophil 4 x 10 cm Roll
34 Kasa, Verband, Kapas - Kasa Pembalut Hydrophil 4 x 15 cm Roll
35 Kasa, Verband, Kapas - Kasa Pembalut 2 x 80 cm Roll
36 MESS 11 pcs
37 MESS 21 pcs
38 MESS 22 pcs
39 PEMBALUT GIPS 3 INCI buah
40 PLESTER 5 YARDS X 2 INCHI Roll
41 Surgical Mask - 3 ply Tie on (tali) pcs
42 Surgical Mask - 3 ply Earloop (karet) pcs
43 Urologi - Folley Catheter 2 way No. 16 pcs
44 Urologi - Folley Catheter 2 way No. 18 pcs
45 Urologi - Urine Bag Standard Steril 2 Lt (T Valve) pcs

TABLET DAN SERBUK ORAL

46 Asam Asetilsalisilat (asetosal) tablet 100 mg Tablet


47 Asam Asetilsalisilat (asetosal) tablet 500 mg Tablet
48 Albendazol tablet/kapsul/kaplet 400 mg Tablet
49 Alopurinol tablet/kapsul/kaplet 100 mg Tablet
50 ALPRAZOLAM TABLET 1 MG Tablet
51 AMBROXOL 30 MG TAB Tablet
52 Aminofilin tablet scored 200 mg Tablet
53 Amitriptilin tablet salut 25 mg (HCl) Tablet
54 Amlodipin tablet 5 mg Tablet
55 Amoksisilin kapsul/kaplet/tablet scored 500 mg Kaplet
56 Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroks Tablet 10 10
57 Antimigren: Ergotamin Tartrat 1 mg + Kofein 50 mg Tablet
58 Asam Askorbat (Vitamin C) tablet 250 mg Tablet
59 Asam Askorbat (Vitamin C) tablet 50 mg Tablet
60 Asam Folat tablet/kapsul/kaplet 1 mg Tablet
61 ASAM MEFENAMAT 500 MG TAB Kaplet
62 ASAM TRANEXAMAT TABLET 500 MG Tablet
63 ASAM VALPROAT 250 MG Tablet
64 Asiklovir tablet/kapsul/kaplet 400 mg Tablet
65 ATTAPULGIT TABLET 600 MG Tablet
66 BETAHISTIN MESILAT TABLET 6 MG Tablet
67 Bisakodil 5 mg (dulkolax) Tablet
68 D H P TAB Tablet
69 Deksametason tablet 0,5 mg Tablet
70 DIAZEPAM 2 MG TAB Tablet
71 DIAZEPAM 5 MG TAB Tablet
72 Digoksin tablet 0,25 mg Paket
73 Dimenhidrinat tablet 50 mg Tablet
74 Domperidon tablet 10 mg Tablet
75 Doksisiklin tablet/kapsul/kaplet 100 mg Tablet
76 EFEDRIN HCL 25 MG TAB Tablet
77 ERYTHROMYCIN 500 MG Tablet
78 Fenitoin kapsul/kaplet 100 mg Tablet
79 FENITOIN NATRIUM 30 MG KAPSUL Kapsul
80 Fenobarbital tablet/kapsul/kaplet 100 mg Kapsul
81 Fenobarbital tablet/kapsul/kaplet 30 mg Kapsul
82 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tablet
83 Furosemid tablet 40 mg Tablet
84 Garam Oralit I serbuk, kombinasi : Natrium klorida 0,52 g kalium k Sachet
85 Glibenklamid tablet 5 mg Tablet
86 Glimepiride tablet 1 mg Tablet
87 Glimepiride tablet 2 mg Tablet
88 Glimepiride tablet 4 mg Tablet
89 GLISERYL GUAIAKOLAT 100 MG TAB Tablet
90 Griseofulvin tablet 125 mg Tablet
91 Haloperidol tablet 0,5 mg Tablet
92 Haloperidol tablet 1,5 mg Tablet
93 Haloperidol tablet 5 mg Tablet
94 HYOCINA N BUTILBROMID 10 MG TAB Tablet
95 Ibuprofen tablet 400 mg Tablet
96 ISOSORBID DINITRAT SUB LINGUAL 5 MG Tablet
97 KALSIUM LAKTAT 500 MG Tablet
98 Kaptopril tablet scored 12,5 mg Tablet
99 Kaptopril tablet scored 25 mg Tablet
100 Karbamazepin tablet 200 mg Tablet
101 KETOKONZOL TABLET 200 MG Tablet
102 Kloramfenikol tablet/kapsul/kaplet 250 mg Tablet
103 Kloramfenikol tablet/kapsul/kaplet 500 mg Tablet
104 KLORFENIRAMINI MALEAT TAB 4 MG( CTM ) Tablet
105 KLORPROMAZIN 100 MG TAB (HCL) Tablet
106 KODEINA 10 MG TAB Tablet
107 Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg Asam folat Tablet
108 Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 40 Tablet
109 KUININE TAB SALUT SELAPUT 222 MG Tablet
110 LOPERAMID TAB 2 MG Tablet
111 LORATADIN TABLET 10 MG Tablet
112 METFORMIN HCL TABLET 500 MG Tablet
113 Metilergometrin Maleat (Metilergometrin) tablet salut 0,125 mg Tablet
114 Metoklopramide tablet 5 mg Tablet
115 Metoklopramide tablet 10 mg Tablet
116 METRONIDAZOLE 250 MG TAB Tablet
117 METRONIDAZOLE 500 MG TAB Sachet
118 MINERAL MIX SERBUK Tablet
119 MULTI MICRO NUTRIEN Tablet
120 MULTIVITAMIN ANAK TABLET HISAP Tablet
121 NATRIUM DIKLOFENAK 50 MG TAB Paket
122 Nifedipin tablet/kapsul 10 mg Paket
123 Nistatin tablet salut 500.000 IU/ g Paket
124 OAT KAT ANAK FDC Paket
125 OAT KAT ANAK KOMB Paket
126 OAT KAT I KOMB Paket
127 OAT KAT I.3 FDC kaplet
128 OAT KAT II FDC Tablet
129 OAT KAT SISIPAN FDC Tablet
130 Omeprazol kapsul/kaplet 20 mg Tablet
131 Parasetamol tablet 100 mg Tablet
132 Parasetamol tablet 500 mg Tablet 10
133 PERFENAZIN TAB 4 MG Tablet
134 Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg (HCl) Tablet
135 PIROKSIKAM 10 MG TAB Tablet 10
136 PIROKSIKAM 20 MG TAB
137 Prednison tablet/kapsul/kaplet 5 mg
138 PRIMAKUIN TABLET 15 MG
139 PROPANOLOL 40 MG TAB (HCL)
140 PROPILTIOURASIL 100 MG TAB Tablet
141 PYRANTEL SCORE (BASE) 125 MG TAB Tablet
142 Ranitidin tablet 150 mg Tablet
143 RETINOL 100 000 IU KAPSUL (VIT A BIRU) Kapsul Lunak
144 RETINOL 200 000 IU CAP (VIT A MERAH) Kapsul Lunak
145 SALBUTAMOL 4 MG TAB Tablet
146 Setirizin tablet 10 mg Tablet
147 Simvastatin tablet 20 mg Tablet
148 Siprofloksasin tablet 500 mg (sebagai HCl) Tablet
149 SPIRONOLAKTON TABLET 25 MG Tablet
150 TETRASIKLIN 500 KAPSUL Kapsul
151 THIAMPENICOL KAPSUL 250 MG Kapsul
152 THIAMPENICOL KAPSUL 500 MG Kapsul
153 THIAMIN HCL 50 MG TAB ( VIT B1 ) Tablet
154 TRIHEKSIFENIDIL HCL 2 MG TAB Tablet
155 VIT B KOMPLEK TAB Tablet
156 ZINC TAB 20 MG Tablet

SYRUP

157 AMBROXOL SYR 15 mg/ml Botol


158 Amoksisilin sirup kering 125 mg/ 5 ml Botol
159 Amoksisilin sirup kering forte 250 mg/5 ml Botol 1
160 Antasida DOEN II suspensi, kombinasi : Aluminium Hidrok Botol
161 DOMPERIDON SYRUP Botol
162 Kloramfenikol suspensi 125 mg/ 5 ml Botol
163 Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg + Trimeto Botol
164 Metoklopramide sirup 5 mg/ 5 ml Botol
165 METRONIDAZOL SUSPENSI Botol
166 MULTIVITAMIN SYR Botol
167 NISTATIN SUSPESI Botol
168 O B H SYR Botol
169 Parasetamol drop 100 mg/ml btl @15ml (60mg/0,6ml) Botol
170 Parasetamol sirup 120 mg / 5 ml Botol
IBUPROFEN SYR Botol
INJEKSI

171 Aminofilin injeksi 24 mg/ml Ampul


172 Ampisilin serbuk injeksi i.v. 1000 mg/vial Vial
173 ASAM TRANEXAMAT INJEKSI 50 MG / ML Ampul
174 AQUA PRO INJ STERIL Vial
175 CEFTRIAXON 1 GR INJ Vial
176 Deksametason injeksi i.v./i.m. 5 mg/ml Ampul
177 Diazepam injeksi i.v./i.m 5 mg/ml Ampul
178 Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) Ampul
179 Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml Ampul
180 Fenitoin injeksi 50 mg/ml Ampul
181 Fenobarbital injeksi i.m./i.v. 50 mg/ml Ampul
182 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul
183 FUROSEMID INJ IV/IM 10 MG/ML Ampul
184 Gentamisin injeksi 40 mg/ ml Ampul
185 HYOCINA N BUTILBROMID INJ 20 MG Ampul
186 KALSIUM GLUKONAS INJ 100 MG/ML Ampul
187 Kloramfenikol serb inj 1000 mg/mL Vial
188 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml Ampul
189 Lidokain injeksi 2% (HCL) Ampul
190 MAGNESIUM SULFAT 20 % INJ 25 ML Vial
191 MAGNESIUM SULFAT 40 % INJ 25 ML Vial
192 Metoklopramide INJ 5 MG/ML Ampul
193 Metilergometrin Maleat injeksi 0,200 mg-1 ml Ampul
194 Oksitosin injeksi 10 IU/ml Ampul
195 OXYTETRACIKLIN HCL INJ IM 50 MG/ML 10 ML Vial
196 RANITIDIN INJ 25 MG/2 ML Ampul
197 Sianokobalamin (vitamin B12) injeksi 500 mcg Ampul
198 THIAMIN INJ ( VIT BI ) 100 MG/ML Ampul

OBAT KHUSUS

199 Antihemoroid, kombinasi: bismut subgalat 150 mg heksaklorofen SUPP


200 BISACODYL SUPP (DULCOLAX) 10 MG / Stolax supp SUPP
201 Diazepam larutan rektal 5 mg/2,5 mL (stesolit rectal) TUBE
202 MICROLAX
203 NISTATIN VAGINAL TAB 100 000 IU/GR TABLET
204 PARASETAMOL SUPP 80 MG SUPP
205 PARASETAMOL SUPP 125 MG SUPP
206 SABU I 5 ML VIAL
207 SALBUTAMOL (AS SULPHATE) 2,5 MG/2,5 ML NEBULS Ampul
208 SERUM ATS 1 500 IU VIAL
209 Serum ATS 20.000 IU

CAIRAN

210 Glukosa larutan infus 10 % steril Botol


211 Glukosa larutan infus 40 % steril Botol
212 Glukosa larutan infus 5 % steril Botol
213 Nacl 0,9% Botol
214 Ringer Laktat larutan infus Botol

OBAT LUAR

215 Anti Bakteri DOEN salep kombinasi: Basitrasin 500 IU/g Polimiksi Tube
216 ANTI FUNGI DOEN KOMB Pot
217 ASIKLOVIR CREAM 5% Tube
218 BETAMETASON CREAM 0,1 % Tube
219 FENOL GLISEROL TT 10% TUBE
220 GENTAMICIN SK 0,1% Botol
221 GENTAMICIN SALEP MATA 0,3% Tube
222 GENTAMISIN SULFAT TETES MATA Tube
223 GENTIAN VIOLET LART 1% Botol
224 HEXACHLOROCYLOHEXANE 0,5% (Peditox) Botol
225 HIDROGEN PEROKSIDA LARUTAN 3% Botol
226 HIDROKORTISON CREAM 2,5 % Tube
227 ICHTIOL SALEP HITAM Pot
228 KALIUM PERMANGANAT SERBUK Pot
229 KETOKONAZOL KRIM 2% Tube
230 Kloramfenikol salep mata 1 % Tube
231 Kloramfenikol teter telinnga 3 % Botol
232 MICONAZOLE CREAM 2% Tube
233 OKSITETRASIKLIN SK 3% Tube
234 OKSITETRASIKLIN SM 1% Tube
235 Povidon Iodida larutan 10% 30 ml Botol
236 Povidon Iodida larutan 10% 300 ml Botol
237 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang endap 4% Botol
238 SALEP LUKA BAKAR (bioplacenton) Pot
239 Bedak salisil serbuk 2% Tube
240 SULFASETAMID NATRIUM TM 15 % Kotak

OBAT GIGI

241 DEVITALISASI PASTA ( NON ARSEN ) Pot


242 ETIL KLORIDA SPRAY Botol
243 EUGENOL CAIRAN Botol
244 GLASS IONOMER CEMENT ART Botol
245 KALSIUM HIDROKSIDA PASTA Pot
246 KLORFENOL KAMFER MENTHOL (CHKM) Botol
247 MUMMIFYING PASTA Pot
248 POLIKRESULEN (ALBOTYL) Botol
249 SEMEN SENG FOSFAT SERBUK + CAIRAN Pot
250 SPONGOSTAN Kotak
251 TEMPORARY STOPPING FLETCER SERBUK+CAIRAN (caviton) Pot
252 TRIKRESOL FORMALIN (TKF) Botol

BAHAN LABORATORIUM

253 CARIK CELUP / URIN TES 3 GPH Stik


254 CARIK CELUP / URIN TES 11 GPH Stik
255 Antiseptik dan Disinfektan - alkohol 70% 100 ml Botol
256 Antiseptik dan Disinfektan - alkohol 70% 1 liter Botol
257 GLISERIN Botol
258 HB TEST KIT Set
259 KIT GOL DARAH Set
260 LART AS ACETAT Botol
261 LART ASAM KLORIDA 0,1 N Botol
262 LAR ASAM KLORIDA 0,1% Botol
263 LART BARIUM CHLORIDA 10 % Botol
264 LART BENEDICT Botol
265 LART E D T A 10 % Botol
266 LART ETANOL ASAM Botol
267 LART KOH 10 % Botol
268 LART NACL 0,9 % Botol
269 LART NATRIUM CITRAT 0,38 % Botol
270 LART ASAM CITRAT 3,8% Botol
271 LART REES ECKER Botol
272 LART SCHLESINGER Botol
273 LART TURK Botol
274 OIL EMERSI Botol
275 PP TEST Stik
276 RDT TEST MALARIA Stik
277 STIK GULA DARAH Stik
278 STIK ASAM URAT Stik
279 STIK KOLESTEROL Stik
280 STIK HBSAG Stik
281 STIK HBSAG Stik
282 WIDAL TEST Set

REAGEN

283 REAGEN ABX MINIDIL LMG PAKET


284 REAGEN ABC MINILYSE LMG PAKET
285 REAGEN ABX MINICLEAN PAKET
286 REAGEN ABX MINOTROL PAKET

TAMBAHAN

287 HALOPERIDOL INJ 5 MG/ML


288 Cover Glass 24 x 24 mm
289 DASABION (MULTIVITAMIN)
Lysol 1 L botol
Blood Lancet pcs
Ondansetron inj ampul
Metamizol inj ampul
Ketorolac inj ampul
Sarung Tangan Steril (OBGYN) Panjang pasang
Sarung Tangan non Steril (OBGYN) Panjang pcs
Oxyflow (Cannul) Anak pcs
Kasa, Verband, Kapas - Kasa Hydrophil 40x40 cm buah
Metil Prednisolon 8 mg tablet
Atropin sulfat INJ IM/IV/SK 0.25 Mg/mL ampul
Klorpromazini 25 mg tablet
scabimide SK tube
bisoprolol 5 mg tablet
IAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

26 27 28 29 30 31 1 2 3 4
10 10

15 15
10

10

5
3

20 10

10

6 3
10 10 10

10

10

1
1
1
PEMAKAIAN
5 6 7 8 9 10 11 12 13 14
10 10 10

10 10
10 10 10 8

10 10 10 6

10 10 10 10 10

5
5 6 10

10 20 30 10 10 10 20

10
10

6 10 10

10
10 10 10 10 10 10

10 10 10

10 10 20

1
1

1 1
1

1
/X/2015

15 16 17 18 19 20 21 22 23 JML

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10 10 30 10 110
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10 60
10 78
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10 10 6 10 82
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10 10 70
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6 6
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10 7 41
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10 30 40 220
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20
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12 6 6 59
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10 10 10 4 134
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10 30
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10 50
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20 10 70
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2
1
1 1 2
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1 2
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KET
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OB
NAMA PUSKESMAS : PUSTU JELATENG
KAB/KOTA : LOMBOK BARAT
LAPORAN PERIODE/BULAN : JULI
PERMINTAAN PERIODE/BULAN : AGUSTUS

STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK


NO NAMA OBAT SATUAN
3 4 5=3+4 6 7=5-6

ALAT KESEHATAN

1 Alat Suntik Sekali Pakai - 1 cc Tuberculin 27G x 1/2" Set 0 0 0 0


2 Alat Suntik Sekali Pakai - 2.5 cc x 23G x 1 1/4" Set 12 10 22 0 15
3 Alat Suntik Sekali Pakai - 5 cc x 22G x 1 1/4" Set 0 0 0 0
4 Alat Suntik Sekali Pakai - 10 cc x 21G x 1 1/2" Set 0 0 0 0
5 Benang Operasi - Catgut Plain 2/0 + jarum 1/2 GT 35 m Set 0 0 0 0
6 Benang Operasi - Catgut Chromic 2/0 + jarum 1/2 GT 3 Set 0 0 0 0
7 Benang Operasi - Catgut Plain 3/0 + jarum 1/2 GT 35 m Set 0 0 0 0
8 Benang Operasi - Catgut Chromic 3/0 + jarum 1/2 GT 3 Set 0 0 0 0
9 Benang Operasi - Silk 2/0 + jarum 1/2 GT 35 mm Set 0 0 0 0
10 Benang Operasi - Silk 3/0 + jarum 1/2 GT 35 mm Set 0 0 0 0
11 HAND SCOUND STERIL NO 7 Pasang 0 0 0 0
12 HAND SCOUND STERIL NO 7,5 Pasang 0 0 0 0
13 HAND SCOUND NON STERIL UK L Lembar 0 0 0 0
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
NO NAMA OBAT SATUAN
3 4 5=3+4 6 7=5-6
14 HAND SCOUND NON STERIL UK M Lembar 0 0 0 0
15 HYPAFIX 10 x 5 CM Pasang 1 1 2 0 1
16 Infus Set, IV, Wing needle - Infusion Set Pediatric (60 dr set 0 0 0 0
17 Infus Set, IV, Wing needle - Infusion Set Dewasa (20 dro set 0 0 0 0
18 Infus Set, IV, Wing needle - I.V Catheter No. 18 G x 32 m buah 0 0 0 0
19 Infus Set, IV, Wing needle - I.V Catheter No. 20 G x 1 1/4 buah 0 0 0 0
20 Infus Set, IV, Wing needle - I.V Catheter No. 22 G x 1 " buah 0 0 0 0
21 Infus Set, IV, Wing needle - I.V Catheter No. 24 G x 3/4 " buah 0 0 0 0
22 Infus Set, IV, Wing needle - I.V Catheter No. 26 G x 1/2 " buah 0 0 0 0
23 Infus Set, IV, Wing needle - Wing Needle 21G set 0 0 0 0
24 Infus Set, IV, Wing needle - Wing Needle 23G set 0 0 0 0
25 Infus Set, IV, Wing needle - Wing Needle 25G set 0 0 0 0
26 Infus Set, IV, Wing needle - Wing Needle 27G set 0 0 0 0
27 Jarum Jahit Bedah pcs 0 0 0 0
28 Kasa, Verband, Kapas - Kasa Pembalut / absorben 250 gr Roll 0 0 0 0
29 Kasa, Verband, Kapas - Kasa Hydrophil 40 x 80 cm Roll 0 0 0 0
30 Kasa, Verband, Kapas - Kasa Hydrophil Steril 16 x 16 cm lembar 0 0 0 0
31 Kasa, Verband, Kapas - Kasa Hydrophil Steril 18 x 22 cm Lembar 0 0 0 0
32 Kasa, Verband, Kapas - Kasa Pembalut Hydrophil 4 x 3 c Roll 0 0 0 0
33 Kasa, Verband, Kapas - Kasa Pembalut Hydrophil 4 x 10 Roll 0 0 0 0
34 Kasa, Verband, Kapas - Kasa Pembalut Hydrophil 4 x 15 Roll 0 0 0 0
35 Kasa, Verband, Kapas - Kasa Pembalut 2 x 80 cm Roll 0 0 0 0
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
NO NAMA OBAT SATUAN
3 4 5=3+4 6 7=5-6
36 MESS 11 pcs 0 0 0 0
37 MESS 21 pcs 0 0 0 0
38 MESS 22 pcs 0 0 0 0
39 PEMBALUT GIPS 3 INCI buah 0 0 0 0
40 PLESTER 5 YARDS X 2 INCHI Roll 0 0 0 0
41 Surgical Mask - 3 ply Tie on (tali) pcs 0 0 0 0
42 Surgical Mask - 3 ply Earloop (karet) pcs 0 0 0 0
43 Urologi - Folley Catheter 2 way No. 16 pcs 0 0 0 0
44 Urologi - Folley Catheter 2 way No. 18 pcs 0 0 0 0
45 Urologi - Urine Bag Standard Steril 2 Lt (T Valve) pcs 0 0 0 0
0 0 0 0
TABLET DAN SERBUK ORAL 0 0 0 0
0 0 0 0
46 Asam Asetilsalisilat (asetosal) tablet 100 mg Tablet 0 0 0 0
47 Asam Asetilsalisilat (asetosal) tablet 500 mg Tablet 0 0 0 0
48 Albendazol tablet/kapsul/kaplet 400 mg Tablet 0 0 0 0
49 Alopurinol tablet/kapsul/kaplet 100 mg Tablet 0 0 0 0
50 ALPRAZOLAM TABLET 1 MG Tablet 0 0 0 0
51 AMBROXOL 30 MG TAB Tablet 120 0 120 110 10
52 Aminofilin tablet scored 200 mg Tablet 0 0 0 0
53 Amitriptilin tablet salut 25 mg (HCl) Tablet 0 0 0 0
54 Amlodipin tablet 5 mg Tablet 0 0 0 0
55 Amoksisilin kapsul/kaplet/tablet scored 500 mg Kaplet 778 0 778 60 718
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
NO NAMA OBAT SATUAN
3 4 5=3+4 6 7=5-6
56 Antasida DOEN I tablet kunyah, kombinasi : Aluminium Tablet 192 0 192 78 114
57 Antimigren: Ergotamin Tartrat 1 mg + Kofein 50 mg Tablet 0 0 0 0
58 Asam Askorbat (Vitamin C) tablet 250 mg Tablet 0 0 0 0
59 Asam Askorbat (Vitamin C) tablet 50 mg Tablet 142 0 142 82 60
60 Asam Folat tablet/kapsul/kaplet 1 mg Tablet 0 0 0 0
61 ASAM MEFENAMAT 500 MG TAB Kaplet 310 0 310 70 240
62 ASAM TRANEXAMAT TABLET 500 MG Tablet 0 0 0 0
63 ASAM VALPROAT 250 MG Tablet 0 0 0 0
64 Asiklovir tablet/kapsul/kaplet 400 mg Tablet 0 0 0 0
65 ATTAPULGIT TABLET 600 MG Tablet 0 0 0 0
66 BETAHISTIN MESILAT TABLET 6 MG Tablet 0 0 0 0
67 Bisakodil 5 mg (dulkolax) Tablet 0 0 0 0
68 D H P TAB Tablet 0 0 0 0
69 Deksametason tablet 0,5 mg Tablet 10 0 10 10 0
70 DIAZEPAM 2 MG TAB Tablet 0 0 0 0
71 DIAZEPAM 5 MG TAB Tablet 0 0 0 0
72 Digoksin tablet 0,25 mg Paket 0 0 0 0
73 Dimenhidrinat tablet 50 mg Tablet 0 0 0 0
74 Domperidon tablet 10 mg Tablet 0 0 0 0
75 Doksisiklin tablet/kapsul/kaplet 100 mg Tablet 0 0 0 0
76 EFEDRIN HCL 25 MG TAB Tablet 0 0 0 0
77 ERYTHROMYCIN 500 MG Tablet 0 0 0 0
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
NO NAMA OBAT SATUAN
3 4 5=3+4 6 7=5-6
78 Fenitoin kapsul/kaplet 100 mg Tablet 0 0 0 0
79 FENITOIN NATRIUM 30 MG KAPSUL Kapsul 0 0 0 0
80 Fenobarbital tablet/kapsul/kaplet 100 mg Kapsul 0 0 0 0
81 Fenobarbital tablet/kapsul/kaplet 30 mg Kapsul 0 0 0 0
82 Fitomenadion (Vit.K1) tablet salut gula 10 mg Tablet 0 0 0 0
83 Furosemid tablet 40 mg Tablet 0 0 0 0
84 Garam Oralit I serbuk, kombinasi : Natrium klorida 0,52 g Sachet 124 0 124 6 118
85 Glibenklamid tablet 5 mg Tablet 0 0 0 0
86 Glimepiride tablet 1 mg Tablet 0 0 0 0
87 Glimepiride tablet 2 mg Tablet 0 0 0 0
88 Glimepiride tablet 4 mg Tablet 0 0 0 0
89 GLISERYL GUAIAKOLAT 100 MG TAB Tablet 81 100 181 41 140
90 Griseofulvin tablet 125 mg Tablet 0 0 0 0
91 Haloperidol tablet 0,5 mg Tablet 0 0 0 0
92 Haloperidol tablet 1,5 mg Tablet 0 0 0 0
93 Haloperidol tablet 5 mg Tablet 0 0 0 0
94 HYOCINA N BUTILBROMID 10 MG TAB Tablet 0 0 0 0
95 Ibuprofen tablet 400 mg Tablet 200 500 700 220 480
96 ISOSORBID DINITRAT SUB LINGUAL 5 MG Tablet 0 0 0 0
97 KALSIUM LAKTAT 500 MG Tablet 0 0 0 0
98 Kaptopril tablet scored 12,5 mg Tablet 340 0 340 10 330
99 Kaptopril tablet scored 25 mg Tablet 171 0 171 20 151
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
NO NAMA OBAT SATUAN
3 4 5=3+4 6 7=5-6
100 Karbamazepin tablet 200 mg Tablet 0 0 0 0
101 KETOKONZOL TABLET 200 MG Tablet 0 0 0 0
102 Kloramfenikol tablet/kapsul/kaplet 250 mg Tablet 0 0 0 0
103 Kloramfenikol tablet/kapsul/kaplet 500 mg Tablet 0 0 0 0
104 KLORFENIRAMINI MALEAT TAB 4 MG( CTM ) Tablet 765 0 765 59 706
105 KLORPROMAZIN 100 MG TAB (HCL) Tablet 0 0 0 0
106 KODEINA 10 MG TAB Tablet 0 0 0 0
107 Kombinasi tablet salut : Besi (II) sulfat 7H2O 200 mg Asa Tablet 0 0 0 0
108 Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametok Tablet 100 0 100 10 90
109 KUININE TAB SALUT SELAPUT 222 MG Tablet 0 0 0 0
110 LOPERAMID TAB 2 MG Tablet 0 0 0 0
111 LORATADIN TABLET 10 MG Tablet 0 0 0 0
112 METFORMIN HCL TABLET 500 MG Tablet 0 0 0 0
113 Metilergometrin Maleat (Metilergometrin) tablet salut Tablet 0 0 0 0
114 Metoklopramide tablet 5 mg Tablet 0 0 0 0
115 Metoklopramide tablet 10 mg Tablet 0 0 0 0
116 METRONIDAZOLE 250 MG TAB Tablet 0 0 0 0
117 METRONIDAZOLE 500 MG TAB Sachet 0 0 0 0
118 MINERAL MIX SERBUK Tablet 0 0 0
119 MULTI MICRO NUTRIEN Tablet 0 0 0
120 MULTIVITAMIN ANAK TABLET HISAP Tablet 0 0 0
121 NATRIUM DIKLOFENAK 50 MG TAB Paket 0 0 0
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
NO NAMA OBAT SATUAN
3 4 5=3+4 6 7=5-6
122 Nifedipin tablet/kapsul 10 mg Paket 0 0 0
123 Nistatin tablet salut 500.000 IU/ g Paket 0 0 0
124 OAT KAT ANAK FDC Paket 0 0 0
125 OAT KAT ANAK KOMB Paket 0 0 0
126 OAT KAT I KOMB Paket 0 0 0
127 OAT KAT I.3 FDC kaplet 0 0 0
128 OAT KAT II FDC Tablet 0 0 0
129 OAT KAT SISIPAN FDC Tablet 0 0 0
130 Omeprazol kapsul/kaplet 20 mg Tablet 0 0 0
131 Parasetamol tablet 100 mg Tablet 0 0 0
132 Parasetamol tablet 500 mg Tablet 546 200 746 134 612
133 PERFENAZIN TAB 4 MG Tablet 0 0 0
Piridoksin (Vitamin B6) tablet/kapsul/kaplet 10 mg
134 (HCl) Tablet 0 0 0 0
135 PIROKSIKAM 10 MG TAB Tablet 200 0 200 30 170
136 PIROKSIKAM 20 MG TAB 0 0 0
137 Prednison tablet/kapsul/kaplet 5 mg 0 0 0
138 PRIMAKUIN TABLET 15 MG 0 0 0
139 PROPANOLOL 40 MG TAB (HCL) 0 0 0
140 PROPILTIOURASIL 100 MG TAB Tablet 0 0 0
141 PYRANTEL SCORE (BASE) 125 MG TAB Tablet 0 0 0
142 Ranitidin tablet 150 mg Tablet 0 0 0
143 RETINOL 100 000 IU KAPSUL (VIT A BIRU) Kapsul Lunak 0 0 0 0
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
NO NAMA OBAT SATUAN
3 4 5=3+4 6 7=5-6
144 RETINOL 200 000 IU CAP (VIT A MERAH) Kapsul Lunak 0 0 0 0
145 SALBUTAMOL 4 MG TAB Tablet 180 0 180 50 130
146 Setirizin tablet 10 mg Tablet 0 0 0
147 Simvastatin tablet 20 mg Tablet 0 0 0
148 Siprofloksasin tablet 500 mg (sebagai HCl) Tablet 0 0 0
149 SPIRONOLAKTON TABLET 25 MG Tablet 0 0 0
150 TETRASIKLIN 500 KAPSUL Kapsul 0 0 0
151 THIAMPENICOL KAPSUL 250 MG Kapsul 0 0 0
152 THIAMPENICOL KAPSUL 500 MG Kapsul 0 0 0
153 THIAMIN HCL 50 MG TAB ( VIT B1 ) Tablet 0 0 0
154 TRIHEKSIFENIDIL HCL 2 MG TAB Tablet 0 0 0
155 VIT B KOMPLEK TAB Tablet 80 200 280 70 210
156 ZINC TAB 20 MG Tablet 40 100 140 0 140
0 0 0 0
SYRUP 0 0 0 0
0 0 0 0
157 AMBROXOL SYR 15 mg/ml Botol 0 0 0 0
158 Amoksisilin sirup kering 125 mg/ 5 ml Botol 16 0 16 2 14
159 Amoksisilin sirup kering forte 250 mg/5 ml Botol 4 0 4 1 3
160 Antasida DOEN II suspensi, kombinasi : Aluminium Hid Botol 0 0 2 -2
161 DOMPERIDON SYRUP Botol 0 0 0 0
162 Kloramfenikol suspensi 125 mg/ 5 ml Botol 0 0 0 0
163 Kotrimoksazol Suspensi komb: Sulfametoksazol 200 mg + Botol 15 0 15 0 15
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
NO NAMA OBAT SATUAN
3 4 5=3+4 6 7=5-6
164 Metoklopramide sirup 5 mg/ 5 ml Botol 2 0 2 0 2
165 METRONIDAZOL SUSPENSI Botol 0 0 0 0
166 MULTIVITAMIN SYR Botol 0 0 0 0
167 NISTATIN SUSPESI Botol 0 0 0
168 O B H SYR Botol 7 7 1 6
169 Parasetamol drop 100 mg/ml btl @15ml (60mg/0,6ml) Botol 0 0 0
170 Parasetamol sirup 120 mg / 5 ml Botol 0 0 0 0
IBUPROFEN SIRUP BOTOL 8 0 8 3 5
INJEKSI 0 0 0
0 0
171 Aminofilin injeksi 24 mg/ml Ampul 0 0 0
172 Ampisilin serbuk injeksi i.v. 1000 mg/vial Vial 0 0 0
173 ASAM TRANEXAMAT INJEKSI 50 MG / ML Ampul 0 0 0
174 AQUA PRO INJ STERIL Vial 0 0 0
175 CEFTRIAXON 1 GR INJ Vial 0 0 0
176 Deksametason injeksi i.v./i.m. 5 mg/ml Ampul 0 0 0
177 Diazepam injeksi i.v./i.m 5 mg/ml Ampul 0 0 0
178 Difenhidramin injeksi i.v./i.m. 10 mg/ml (HCl) Ampul 0 0 0
179 Epinefrin (Adrenalin) injeksi i.v/s.k./i.m 1 mg/ml Ampul 0 0 0
180 Fenitoin injeksi 50 mg/ml Ampul 0 0 0
181 Fenobarbital injeksi i.m./i.v. 50 mg/ml Ampul 0 0 0
182 Fitomenadion (Vitamin K1) injeksi i.m. 2 mg/ml Ampul 0 0 0
183 FUROSEMID INJ IV/IM 10 MG/ML Ampul 0 0 0
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
NO NAMA OBAT SATUAN
3 4 5=3+4 6 7=5-6
184 Gentamisin injeksi 40 mg/ ml Ampul 0 0 0
185 HYOCINA N BUTILBROMID INJ 20 MG Ampul 0 0 0
186 KALSIUM GLUKONAS INJ 100 MG/ML Ampul 0 0 0
187 Kloramfenikol serb inj 1000 mg/mL Vial 0 0 0
188 Lidokain injeksi 2% (HCl) + Epinefrin 1 : 80.000 - 2ml Ampul 0 0 0
189 Lidokain injeksi 2% (HCL) Ampul 0 0 0
190 MAGNESIUM SULFAT 20 % INJ 25 ML Vial 0 0 0
191 MAGNESIUM SULFAT 40 % INJ 25 ML Vial 0 0 0
192 Metoklopramide INJ 5 MG/ML Ampul 0 0 0
193 Metilergometrin Maleat injeksi 0,200 mg-1 ml Ampul 0 0 0
194 Oksitosin injeksi 10 IU/ml Ampul 0 0 0
195 OXYTETRACIKLIN HCL INJ IM 50 MG/ML 10 ML Vial 0 0 0
196 RANITIDIN INJ 25 MG/2 ML Ampul 0 0 0
197 Sianokobalamin (vitamin B12) injeksi 500 mcg Ampul 0 0 0
198 THIAMIN INJ ( VIT BI ) 100 MG/ML Ampul 0 0 0
0 0 0
OBAT KHUSUS 0 0 0
0 0 0
199 Antihemoroid, kombinasi: bismut subgalat 150 mg heksa SUPP 0 0 0 0
200 BISACODYL SUPP (DULCOLAX) 10 MG / Stolax supp SUPP 0 0 0
201 Diazepam larutan rektal 5 mg/2,5 mL (stesolit rectal) TUBE 0 0 0
202 MICROLAX 0 0 0
203 NISTATIN VAGINAL TAB 100 000 IU/GR TABLET 0 0 0
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
NO NAMA OBAT SATUAN
3 4 5=3+4 6 7=5-6
204 PARASETAMOL SUPP 80 MG SUPP 0 0 0
205 PARASETAMOL SUPP 125 MG SUPP 0 0 0
206 SABU I 5 ML VIAL 0 0 0
207 SALBUTAMOL (AS SULPHATE) 2,5 MG/2,5 ML NEBULS Ampul 0 0 0
208 SERUM ATS 1 500 IU VIAL 0 0 0
209 Serum ATS 20.000 IU 0 0 0
0 0 0
CAIRAN 0 0 0
0 0 0
210 Glukosa larutan infus 10 % steril Botol 0 0 0
211 Glukosa larutan infus 40 % steril Botol 0 0 0
212 Glukosa larutan infus 5 % steril Botol 0 0 0
213 Nacl 0,9% Botol 5 0 5 0 5
214 Ringer Laktat larutan infus Botol 8 8 0 8
0 0 0
OBAT LUAR 0 0 0
0 0 0
215 Anti Bakteri DOEN salep kombinasi: Basitrasin 500 IU/g P Tube 0 0 0
216 ANTI FUNGI DOEN KOMB Pot 0 0 0
217 ASIKLOVIR CREAM 5% Tube 0 0 0
218 BETAMETASON CREAM 0,1 % Tube 9 9 2 7
219 FENOL GLISEROL TT 10% TUBE 0 0 0
220 GENTAMICIN SK 0,1% Botol 0 0 0
221 GENTAMICIN SALEP MATA 0,3% Tube 0 0 0
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
NO NAMA OBAT SATUAN
3 4 5=3+4 6 7=5-6
222 GENTAMISIN SULFAT TETES MATA Tube 0 0 0
223 GENTIAN VIOLET LART 1% Botol 0 0 0
224 HEXACHLOROCYLOHEXANE 0,5% (Peditox) Botol 0 0 0
225 HIDROGEN PEROKSIDA LARUTAN 3% Botol 0 0 0
226 HIDROKORTISON CREAM 2,5 % Tube 0 0 0
227 ICHTIOL SALEP HITAM Pot 0 0 0
228 KALIUM PERMANGANAT SERBUK Pot 0 0 0
229 KETOKONAZOL KRIM 2% Tube 5 5 1 4
230 Kloramfenikol salep mata 1 % Tube 0 0 0 0
231 Kloramfenikol tetes telinnga 3 % Botol 0 0 0
232 MICONAZOLE CREAM 2% Tube 0 0 0
233 OKSITETRASIKLIN SK 3% Tube 0 0 0
234 OKSITETRASIKLIN SM 1% Tube 0 0 0
235 Povidon Iodida larutan 10% 30 ml Botol 0 0 0
236 Povidon Iodida larutan 10% 300 ml Botol 0 0 0
237 Salep 2-4 , Kombinasi : Asam Salisilat 2% + Belerang en Botol 1 1 1 0
238 SALEP LUKA BAKAR (bioplacenton) Pot 0 0 0
239 Bedak salisil serbuk 2% Tube 0 0 0
240 SULFASETAMID NATRIUM TM 15 % Kotak 0 0 0
0 0 0
OBAT GIGI 0 0 0
0 0 0
241 DEVITALISASI PASTA ( NON ARSEN ) Pot 0 0 0 0
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
NO NAMA OBAT SATUAN
3 4 5=3+4 6 7=5-6
242 ETIL KLORIDA SPRAY Botol 0 0 0
243 EUGENOL CAIRAN Botol 0 0 0
244 GLASS IONOMER CEMENT ART Botol 0 0 0
245 KALSIUM HIDROKSIDA PASTA Pot 0 0 0
246 KLORFENOL KAMFER MENTHOL (CHKM) Botol 0 0 0
247 MUMMIFYING PASTA Pot 0 0 0
248 POLIKRESULEN (ALBOTYL) Botol 0 0 0
249 SEMEN SENG FOSFAT SERBUK + CAIRAN Pot 0 0 0
250 SPONGOSTAN Kotak 0 0 0
TEMPORARY STOPPING FLETCER SERBUK+CAIRAN
251 (caviton) Pot 0 0 0
252 TRIKRESOL FORMALIN (TKF) Botol 0 0 0
0 0 0
BAHAN LABORATORIUM 0 0 0
0 0 0
253 CARIK CELUP / URIN TES 3 GPH Stik 0 0 0
254 CARIK CELUP / URIN TES 11 GPH Stik 0 0 0
255 Antiseptik dan Disinfektan - alkohol 70% 100 ml Botol 0 0 0
256 Antiseptik dan Disinfektan - alkohol 70% 1 liter Botol 0 0 0
257 GLISERIN Botol 0 0 0
258 HB TEST KIT Set 0 0 0
259 KIT GOL DARAH Set 0 0 0
260 LART AS ACETAT Botol 0 0 0
261 LART ASAM KLORIDA 0,1 N Botol 0 0 0
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
NO NAMA OBAT SATUAN
3 4 5=3+4 6 7=5-6
262 LAR ASAM KLORIDA 0,1% Botol 0 0 0
263 LART BARIUM CHLORIDA 10 % Botol 0 0 0
264 LART BENEDICT Botol 0 0 0
265 LART E D T A 10 % Botol 0 0 0
266 LART ETANOL ASAM Botol 0 0 0
267 LART KOH 10 % Botol 0 0 0
268 LART NACL 0,9 % Botol 0 0 0
269 LART NATRIUM CITRAT 0,38 % Botol 0 0 0
270 LART ASAM CITRAT 3,8% Botol 0 0 0
271 LART REES ECKER Botol 0 0 0
272 LART SCHLESINGER Botol 0 0 0
273 LART TURK Botol 0 0 0
274 OIL EMERSI Botol 0 0 0
275 PP TEST Stik 0 0 0
276 RDT TEST MALARIA Stik 0 0 0
277 STIK GULA DARAH Stik 0 0 0
278 STIK ASAM URAT Stik 0 0 0
279 STIK KOLESTEROL Stik 0 0 0
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
NO NAMA OBAT SATUAN
3 4 5=3+4 6 7=5-6
280 STIK HBSAG Stik 0 0 0
281 STIK HBSAG Stik 0 0 0
282 WIDAL TEST Set 0 0 0
0 0 0
REAGEN 0 0 0
0 0 0
283 REAGEN ABX MINIDIL LMG PAKET 0 0 0
284 REAGEN ABC MINILYSE LMG PAKET 0 0 0
285 REAGEN ABX MINICLEAN PAKET 0 0 0
286 REAGEN ABX MINOTROL PAKET 0 0 0
0 0 0
TAMBAHAN 0 0 0
0 0 0
287 HALOPERIDOL INJ 5 MG/ML 0 0 0
288 Cover Glass 24 x 24 mm 0 0 0
289 DASABION (MULTIVITAMIN) 0 0 0
Lysol 1 L botol 0 0 0
Blood Lancet pcs 0 0 0
Ondansetron inj ampul 0 0 0
Metamizol inj ampul 0 0 0
Ketorolac inj ampul 0 0 0
Sarung Tangan Steril (OBGYN) Panjang pasang 0 0 0
Sarung Tangan non Steril (OBGYN) Panjang pcs 0 0 0
Oxyflow (Cannul) Anak pcs 0 0 0
Kasa, Verband, Kapas - Kasa Hydrophil 40x40 cm buah 0 0 0
Metil Prednisolon 8 mg tablet 0 0 0
Atropin sulfat INJ IM/IV/SK 0.25 Mg/mL ampul 0 0 0
STOK AWAL PENERIMAAN PERSEDIAAN PEMAKAIAN SISA STOK
NO NAMA OBAT SATUAN
3 4 5=3+4 6 7=5-6
Klorpromazini 25 mg tablet 0 0 0
scabimide SK tube 0 0 0
bisoprolol 5 mg tablet 0 0 0

UMUM
TIDAK BAYAR
JUMLAH KUNJUNGAN RESEP BAYAR
GAKIN UKS
8 42 0

Mengetahui Yang Menyerahkan Yang Menerima/ M


Kepala Dinas Kesehatan Kab. Lobar Kepala UPTD IFK Lobar Pemimpin UPT BLUD P

Drs. H Rachman Sahnan Putra M. Kes Hj. Bq. Endang Suprihartini, Msi.,Apt. NS.Akhmad jua
NIP :19610512 198203 1 009 NIP. 19680916200112 2 003 NIP :19721231 19

KETERANGAN :
LEMBAR PERTAMA (ASLI) : IFK
LEMBAR KEDUA : DIKES LOBAR
LEMBAR KETIGA : ARSIP / PUSKESMAS
NTAAN OBAT ( L P L P O )
NO DOC :
TAHUN : 2018
TANGGAL :25 JULI 2018

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IDAK BAYAR ASKES JUMLAH


UKS LAIN
0 1 0 51

Yang Menerima/ Melapor Yang Menerima


Pemimpin UPT BLUD Puskesmas Pengelola Obat Puskesmas

NS.Akhmad juaini S.kep fitri sri wahyuni


NIP :19721231 199203 1 026