LAPORAN PEMAKAIAN DAN LEMBAR PERM

(LPLPO)

KODE PUSKESMAS:
PUSKESMAS: PADANG GUCI HILIR
KECAMATAN: PADANG GUCI HILIR
KABUPATEN: KAUR
PROVINSI: BENGKULU

NO NO.KODE NAMA OBAT/BMHP KELAS TERAPI SATUAN STOK AWAL PENERIMAAN

1 2 3 4 5 6 7
1 Abbocath 18G BMHP Pcs 0
2 Abbocath 20 G BMHP Pcs 63
3 Abbocath 22G BMHP Pcs 38
4 Abbocath 24G BMHP Pcs 50
5 Acyclovir 200 mg Antiviral Tab 900
6 Acyclovir 400 mg Antiviral Tab 180
7 Acyclovir SK Antiviral Tube 0
8 Albendazole Anthelmintics Tab 120
9 Allopurinol 100 mg Antigout Tab 700
10 Allopurinol 300 mg Antigout Tab 1000
11 Alkohol 70% 60 mL Antiseptic Btl 18
12 Alkohol 70% 1L Antiseptic Btl 0
13 Ambroksol 30 mg Mucolitic Tab 700 500
14 Ambroksol Syrup Mucolitic fls 65 50
15 Aminophillin Bronkodilator cap 0
16 Aminophillin Injeksi Bronkodilator amp 0
17 Amitriptilin Antidepressants Tab 0
18 Amlodipine 5 mg Antihipertensi Tab 0
19 Amlodipine 10 mg Antihipertensi Tab 0
20 Amoxicillin Syrup 125mg/5mL Antibiotik fls 0
21 Amoxicillin Syrup Forte Antibiotik fls 82 50
22 Amoxicillin 250 mg Antibiotik Cap 300 700
23 Amoxicillin 500 mg Antibiotik Kap 650 800
24 Ampicillin 500 mg Antibiotik Kap 370
25 Ampicillin Injeksi 1000 mg Antibiotik amp 0
26 Antalgin 500 mg NSAID Tab 770
27 Antalgin Injeksi NSAID Tab 0
28 Antasida DOEN Antacids Tab 0
29 Antasida DOEN Suspensi Antacids fls 3
30 Antibakteri SK (Bacitracin) Antibakteri Tube 45 25
31 Antifungi SK Antifungi pot 80
32 Antihaemoroid Supp Antihaemoroid pcs 40
33 Antimalaria (Suldox) Antimalaria Tab 600
34 Asam Folat Vitamin Tab 0
35 Asam Fusidat Antibakteri Tab 0
36 Asam Mefenamat NSAID Tab 0
37 Asam Traneksamat Antifibrinolitic Tab 0
38 Asam Traneksamat Injeksi Antifibrinolitic amp 20
39 Aseptan Antiseptic Btl 0
40 Atropin Sulfat Antikolinergik Tab 0
41 Atropin Sulfat Injeksi Antikolinergik amp 0
42 Attapulgit Antidiare Tab 0
43 Aqua Dest Pelarut Vial 0
44 Betahistin Antivertigo Tab 30
45 Betamethasone SK SAID Tube 100
46 Bisturi BMHP pcs 88
47 Burnazin Antibakteri Tube 16
48 Captopril 12,5 mg Antihipertensi Tab 1200
49 Captopril 25 mg Antihipertensi Tab 1000
50 Calsium Lactate Vitamin Tab 1450
51 Catgut 2/0 BMHP pcs 33
52 Catgut 3/0 BMHP pcs 48
53 Cefadroxil Antibiotik Cap 400 500
54 Cefadroxil Syrup Antibiotik fls 25
55 Ceterizine 5 mg Antihistamine Tab 3000
56 Ceterizine Syrup Antihistamine fls 92
57 Cendo Tropin SM Antikolinergik pcs 0
58 Chlorpeniramine Maleat 4 mg Antihistamine Tab 1100 300
59 Ciprofloxacin Antibiotik Tab 1830
60 Clobazam Anticonvulsants Tab 140
61 Clonidine Antihipertensi Tab 300
62 Cotrimoksazole Pediatric Antibiotik Tab 0
63 Cotrimoksazole Forte Antibiotik Tab 0
64 Cotrimoksazole Syrup Antibiotik fls 67
65 Depakote SR 250 mg Antiepilepsi Tab 0
66 Depakote Syrup Antiepilepsi fls 0
67 Deksamethasone 5 mg SAID Tab 600 500
68 Deksamethasone 5 mg Injeksi SAID Tab 173
69 Diphenhidramine Injeksi Antihistamine amp 0 30
70 Digoksin Antiarimtia Tab 0
71 Doxicycline Antibiotik Tab 0
72 Domperidone Antiemesis Tab 1000
73 Domperidone Syr Antiemesis fls 60
74 Dopamin Inotropic agent Tab 0
75 Ephedrine Dekongestan Tab 0
76 Epinefrine Inj Adrenergik Agonis amp 0 50
77 Erytromicin 250 mg Antibiotik Cap 180
78 Erytromicin 500 mg Antibiotik Cap 0
 79 Erytromicin Syr Antibiotik fls 20
80 Fenitoin Anticonvulsants Cap 0
81 fenol Glycerol TT Antiseptik Topical pcs 24
82 Furosemide Diuretik Tab 300
83 Foley Chateter No 16 BMHP pcs 0
84 Foley Chateter no 18 BMHP pcs 10
85 Gavistal Drop Gastrointestinal agfls 0
86 Gentamicin Inj Antibiotik amp 70
87 Gentamicin TM Antibiotik pcs 25
88 Glibenckamide Antidiabetes Tab 390
89 Glyceryl Guaiacolate Ekspektoran Tab 900 200
90 Glimepiride Antidiabetes Tab 450
91 Gluconas Calcii Kalsium Tab 0
92 Glukosa 5% Elektrolit fls 18
93 Glukosa 10% Elektrolit fls 32
94 Griseofulvin 125 mg Antifungi Tab 0
95 Griseofulvin 500 mg Antifungi Tab 0
96 Halloperidol Antipsikotik Tab 0
97 HCT Diuretik Tab 1000
98 Hydrocortison SK SAID Tube 94
99 Ibuprofen 200 mg NSAID Tab 1100
100 Ibuprofen 400 mg NSAID Tab 950
101 Ibuprofen Syr NSAID fls 62
102 Infuset Makro BMHP pcs 10
103 Infuset Micro BMHP pcs 7
104 ISDN Antiangina Tab 0
105 Kapas 500 mg BMHP pcs 9
106 Kapas 250 mg BMHP pcs 0
107 Kapas Berlemak 500 mg BMHP pcs 2
108 Kapas Berlemak 250 mg BMHP pcs 0
109 Karbamazepin Anticonvulsants Tab 0
110 kassa Steril 16 x 16 BMHP pcs 26
111 Kassa Absorben BMHP pcs 0
112 Kassa 40x80 BMHP pcs 4
113 Kassa 4x5 BMHP pcs 10
114 Ketorolac Injeksi NSAID amp 47
115 Ketoconazole Antifungi Tab 290
116 Ketoconazole SK Antifungi Tube 37
117 Klindamicin Antibiotik Tab 550
118 Klopidogrel Antiplatelet Tab 0
119 Kloramphenicol 250 mg Antibiotik Cap 0
120 Kloramphenicol Syr Antibiotik fls 0
121 Kloramphenicol SM Antibiotik Tube 58
122 Kodeine Antitusif (N) Tab 0
123 Klorpromazin Antipsikotik Tab 160
124 Klorpromazin Inj Antipsikotik amp 0
125 Kuinin Antimalaria Tab 240
126 Lansoprazole PPI Cap 260
127 Laxadine Suspensi Pencahar fls 0
128 Lidocaine Anastetic amp 0
129 Lidocaine Comp Anastetic amp 102
130 Loperamide Antidiare Tab 900
131 Loratadine Antihistamine Tab 1700 500
132 Lysol 1L Antiseptik Btl 0
133 MgSO4 20% / 40% Antidisritmik pcs 0
134 Meloxicam 7,5 mg NSAID Tab 90
135 Methilergometrin Ergotderivate Tab 0
136 Methilergometrin Inj Ergotderivate amp 68
137 Metronidazole 250 mg Antibiotik Tab 1200
138 Metronidazole 500 mg Antibiotik Tab 0
139 Mikonazole SK Antifungi Tube 50
140 NaCl Elektrolit fls 48
141 Natrium Diclofenac 25 mg NSAID Tab 700
142 Natrium Diclofenac 50 mg NSAID Tab 400
143 Nifedipine Antihipertensi Tab 640
144 Nystatin Antifungi Tab 200
145 Nystatin Drop Antifungi pcs 0
146 Oksitetrasiklin SM Antibiotik Tube 84
147 Oksitosin Oxytocic agents amp 0
148 Omeprazole PPI Cap 450 600
149 Omeprazole Inj PPI amp 0
150 Ondancentron Antiemesis Tab 0
151 Ondancentron Inj Antiemesis amp 15
152 Oralit Elektrolit sct 149 100
153 Paracetamol 100 mg Antipiretik Tab 0
154 Paracetamol 500 mg Antipiretik Tab 6500
155 Paracetamol Drop Antipiretik fls 0
156 Paracetamol Syr Antipiretik fls 45
157 Pembalut Elastis BMHP pcs 0
158 Phenobarbital Anticonvulsants Tab 160
159 Phenobarbital Inj Anticonvulsants amp 0
160 Piroxicam 10 mg NSAID Tab 700
161 Piroxicam 20 mg NSAID Tab 1600
162 Polifix BMHP pcs 2
163 Povidon Iodine 60 mL Topical antimicrobiBtl 4 5
164 povidon Iodine 300 mL Topical antimicrobiBtl 0
165 Prednison SAID Tab 1100
166 Primaquin Antimalaria Tab 500
167 Propranolol 10 mg Antidisritmik Tab 0
168 Propanolol 40 mg Antidisritmik Tab 300
169 Propyltiouracyl Antitiroid Tab 600
170 Pyrantel Pamoat Antelmintics Tab 168
171 Pyrantel Pamoat Syr Antelmintics fls 26
172 Ranitidine H2 Antagonist Tab 500 200
173 Ranitidine Inj H2 Antagonist amp 0
174 Reserpin Antihipertensi Tab 0
175 Risperidone Antipsikotik Tab 0
176 RL Elektrolit fls 21
177 Rivanol Topical antimicrobiBtl 7
178 Salbutamol 2 mg Bronkodilator Tab 600
179 Salbutamol 4 mg Bronkodilator Tab 600
180 Salbutamol Inhaler Bronkodilator Tab 0
181 Salicyl Talk Antiseptik Topical Pcs 64
182 Scabimite SK Scabicidal agent Tube 0
183 Safe Glove 7,5 BMHP pcs 95
184 Safe Glove 8 BMHP pcs 95
185 Silk 3/0 BMHP pcs 39
186 Simvastatin AntihyperlipidemiaTab 500
187 Soft U Derm Tube 0
188 Spironolactone Diuretik Tab 0
189 Spuit 1 cc BMHP pcs 295
190 Spuit 2,5 cc BMHP pcs 460
191 Spuit 3 cc BMHP pcs 455
192 Spuit 5 cc BMHP pcs 482
193 Spuit 10 cc BMHP pcs 0
194 Stolax pcs 0
195 Surgical Masker BMHP pcs 80 50
196 Tetracyclin 250 mg Antibiotik Cap 300
197 Tetracyclin 500 mg Antibiotik Cap 380 300
198 Tramadol Analgetik Opiad Tab 84
199 Tramadol Inj Analgetik Opiad amp 30
200 Trihexiphenidil Antiparkinson Tab 80
201 Udofa 0
202 Ulsafate Gastrointestinal agTab 660
203 Ulsafate Susp (Sucralfate) Gastrointestinal agfls 65
204 Umbilical Klem BMHP pcs 0
205 Urine Bag BMHP pcs 37
206 Vagizol Ovula pcs 0
207 Vitamin B1 Vitamin Tab 1800
208 Vitamin B1 Inj Vitamin amp 90
209 Vitamin B12 Vitamin Tab 0
210 Vitamin B12 Inj Vitamin amp 0 100
211 Vitamin B Complex Vitamin Tab 600 500
212 Vitamin C Vitamin Tab 1100
213 Vitamin K Vitamin Tab 0
214 Vitamin K Inj Vitamin amp 0 30
215 Xilocain Jelly 2% pcs 0
216 Zink Vitamin Tab 390
217 Zink Syr Vitamin fls 40
218 OBH Syrup Ekspektoran fls 115
219 New Antides (Attapulgite) Antidiare Tab 770
220 Salep 2-4 Antibakteri Topicalpot 57
221 Safe Glove 8,5 BMHP pcs 100
222 Plester BMHP pcs 3 5
223
224
225

UMUM BPJS
JUMLAH KUNJUNGAN RESEP

53 50

Mengetahui/Menyetujui: Yang Menyerahkan

Kepala Dinas Kesehatan Kab.Kaur Kepala IFK Kab.Kaur

(…………………………………………………….) (……………………………………………)
NIP. NIP.
EMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

BULAN: JULI
TAHUN: 2018

PEMBERIAN
PERSEDIAAN PEMAKAIAN SISA STOCK STOK OPT PERMINTAAN JUMLAH
DAK KAPITASI LAIN
8 9 10 11 12 13 14 15 16
0 0
63 63
38 38
50 50
900 200 700
180 100 80
0 0
120 120
700 700
1000 1000
18 1 17
0 0
1200 100 1100
115 15 100
0 0
0 0
0 0
0 0
0 0
0 0
132 10 122
1000 1000
1450 400 1050
370 370
0 0
770 770
0 0
0 0
3 3 0
70 10 60
80 80
40 40
600 600
 0 0
0 0
0 0
0 0
20 20
0 0
0 0
0 0
0 0
0 0
30 30
100 100
88 88
16 16
1200 1200
1000 1000
1450 100 1350
33 33
48 5 43
900 200 700
25 20 5
3000 100 2900
92 92
0 0
1400 200 1200
1830 100 1730
140 140
300 300
0 0
0 0
67 20 47
0 0
0 0
1100 200 900
173 10 163
30 30
0 0
0 0
1000 1000
60 60
0 0
0 0
50 50
180 180
0 0
 20 20
0 0
24 24
300 300
0 0
10 5 5
0 0
70 70
25 25
390 390
1100 300 800
450 450
0 0
18 18
32 32
0 0
0 0
0 0
1000 1000
94 94
1100 1100
950 300 650
62 10 52
10 3 7
7 7
0 0
9 1 8
0 0
2 2
0 0
0 0
26 1 25
0 0
4 1 3
10 10
47 47
290 40 250
37 37
550 550
0 0
0 0
0 0
58 5 53
0 0
160 160
 0 0
240 240
260 60 200
0 0
0 0
102 102
900 100 800
2200 2200
0 0
0 0
90 90
0 0
68 68
1200 200 1000
0 0
50 50
48 48
700 50 650
400 50 350
640 640
200 100 100
0 0
84 10 74
0 0
1050 90 960
0 0
0 0
15 15
249 49 200
0 0
6500 300 6200
0 0
45 20 25
0 0
160 160
0 0
700 700
1600 1600
2 2
9 1 8
0 0
1100 200 900
500 500
0 0
300 300
 600 600
168 20 148
26 5 21
700 200 500
0 0
0 0
0 0
21 21
7 7
600 600
600 600
0 0
64 64
0 0
95 95
95 95
39 39
500 100 400
0 0
0 0
295 295
460 460
455 100 355
482 482
0 0
0 0
130 50 80
300 300
680 680
84 84
30 30
80 80
0 0
660 200 460
65 20 45
0 0
37 37
0 0
1800 100 1700
90 90
0 0
100 10 90
1100 400 700
1100 200 900
0 0
 30 5 25
0 0
390 390
40 40
115 10 105
770 770
57 57
100 100
8 1 7

JUMLAH

103

Yang Menerima/Melapor Yang Menerima/melaporkan

Kepala Puskesmas Padang Guci Hilir Petugas Pengelola Obat
Puskesmas Padang Guci Hilir

(………………………………………………………) (…………………………………………………)
KET

17
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O
(LPLPO)

KODE PUSKESMAS:
PUSKESMAS: PADANG GUCI HILIR
KECAMATAN: PADANG GUCI HILIR
KABUPATEN: KAUR
PROVINSI: BENGKULU

NO NO.KODE NAMA OBAT/BMHP KELAS TERAPI SATUAN STOK AWALPENERIMAANPERSEDIAAN

1 2 3 4 5 6 7 8

1 Abbocath 18G BMHP Pcs 0 0

2 Abbocath 20 G BMHP Pcs 63 63
3 Abbocath 22G BMHP Pcs 38 38
4 Abbocath 24G BMHP Pcs 50 50
5 Acyclovir 200 mg Antiviral Tab 700 700
6 Acyclovir 400 mg Antiviral Tab 80 80
7 Acyclovir SK Antiviral Tube 0 0
8 Albendazole Anthelmintics Tab 120 120
9 Allopurinol 100 mg Antigout Tab 700 700
10 Allopurinol 300 mg Antigout Tab 1000 1000
11 Alkohol 70% 60 mL Antiseptic Btl 17 17
12 Alkohol 70% 1L Antiseptic Btl 0 0
13 Ambroksol 30 mg Mucolitic Tab 1100 1100
14 Ambroksol Syrup Mucolitic fls 100 100
15 Aminophillin Bronkodilator cap 0 0
16 Aminophillin Injeksi Bronkodilator amp 0 0
17 Amitriptilin AntidepressantsTab 0 0
18 Amlodipine 5 mg Antihipertensi Tab 0 0
19 Amlodipine 10 mg Antihipertensi Tab 0 0
20 Amoxicillin Syrup 125mg/5mL Antibiotik fls 0 0
21 Amoxicillin Syrup Forte Antibiotik fls 122 122
22 Amoxicillin 250 mg Antibiotik Cap 1000 1000
23 Amoxicillin 500 mg Antibiotik Kap 1050 1050
24 Ampicillin 500 mg Antibiotik Kap 370 370
25 Ampicillin Injeksi 1000 mg Antibiotik amp 0 0
26 Antalgin 500 mg NSAID Tab 770 770
27 Antalgin Injeksi NSAID Tab 0 0
28 Antasida DOEN Antacids Tab 0 0
29 Antasida DOEN Suspensi Antacids fls 0 0
30 Antibakteri SK (Bacitracin) Antibakteri Tube 60 60
31 Antifungi SK Antifungi pot 80 80
32 Antihaemoroid Supp Antihaemoroid pcs 40 40
33 Antimalaria (Suldox) Antimalaria Tab 600 600
34 Asam Folat Vitamin Tab 0 0
35 Asam Fusidat Antibakteri Tab 0 0
36 Asam Mefenamat NSAID Tab 0 0
37 Asam Traneksamat Antifibrinolitic Tab 0 0
38 Asam Traneksamat Injeksi Antifibrinolitic amp 20 20
39 Aseptan Antiseptic Btl 0 0
40 Atropin Sulfat Antikolinergik Tab 0 0
41 Atropin Sulfat Injeksi Antikolinergik amp 0 0
42 Attapulgit Antidiare Tab 0 0
43 Aqua Dest Pelarut Vial 0 0
44 Betahistin Antivertigo Tab 30 30
45 Betamethasone SK SAID Tube 100 100
46 Bisturi BMHP pcs 88 88
47 Burnazin Antibakteri Tube 16 16
48 Captopril 12,5 mg Antihipertensi Tab 1200 1200
49 Captopril 25 mg Antihipertensi Tab 1000 1000
50 Calsium Lactate Vitamin Tab 1350 1350
51 Catgut 2/0 BMHP pcs 33 33
52 Catgut 3/0 BMHP pcs 43 43
53 Cefadroxil Antibiotik Cap 700 700
54 Cefadroxil Syrup Antibiotik fls 5 5
55 Ceterizine 5 mg Antihistamine Tab 2900 2900
56 Ceterizine Syrup Antihistamine fls 92 92
57 Cendo Tropin SM Antikolinergik pcs 0 0
58 Chlorpeniramine Maleat 4 mg Antihistamine Tab 1200 1200
59 Ciprofloxacin Antibiotik Tab 1730 1730
60 Clobazam Anticonvulsants Tab 140 140
61 Clonidine Antihipertensi Tab 300 300
62 Cotrimoksazole Pediatric Antibiotik Tab 0 0
63 Cotrimoksazole Forte Antibiotik Tab 0 0
64 Cotrimoksazole Syrup Antibiotik fls 47 47
65 Depakote SR 250 mg Antiepilepsi Tab 0 0
66 Depakote Syrup Antiepilepsi fls 0 0
67 Deksamethasone 5 mg SAID Tab 900 900
68 Deksamethasone 5 mg Injeksi SAID amp 163 163
69 Diphenhidramine Injeksi Antihistamine amp 30 30
70 Digoksin Antiarimtia Tab 0 0
71 Doxicycline Antibiotik Tab 0 0
72 Domperidone Antiemesis Tab 1000 1000
73 Domperidone Syr Antiemesis fls 60 60
74 Dopamin Inotropic agent Tab 0 0
75 Ephedrine Dekongestan Tab 0 0
76 Epinefrine Inj Adrenergik Agonamp 50 50
77 Erytromicin 250 mg Antibiotik Cap 180 180
78 Erytromicin 500 mg Antibiotik Cap 0 0
 79 Erytromicin Syr Antibiotik fls 20 20
80 Fenitoin Anticonvulsants Cap 0 0
81 fenol Glycerol TT Antiseptik Topicapcs 24 24
82 Furosemide Diuretik Tab 300 300
83 Foley Chateter No 16 BMHP pcs 0 0
84 Foley Chateter no 18 BMHP pcs 5 5
85 Gavistal Drop Gastrointestinal fls 0 0
86 Gentamicin Inj Antibiotik amp 70 70
87 Gentamicin TM Antibiotik pcs 25 25
88 Glibenckamide Antidiabetes Tab 390 390
89 Glyceryl Guaiacolate Ekspektoran Tab 800 800
90 Glimepiride Antidiabetes Tab 450 450
91 Gluconas Calcii Kalsium Tab 0 0
92 Glukosa 5% Elektrolit fls 18 18
93 Glukosa 10% Elektrolit fls 32 32
94 Griseofulvin 125 mg Antifungi Tab 0 0
95 Griseofulvin 500 mg Antifungi Tab 0 0
96 Halloperidol Antipsikotik Tab 0 0
97 HCT Diuretik Tab 1000 1000
98 Hydrocortison SK SAID Tube 94 94
99 Ibuprofen 200 mg NSAID Tab 1100 1100
100 Ibuprofen 400 mg NSAID Tab 650 650
101 Ibuprofen Syr NSAID fls 52 52
102 Infuset Makro BMHP pcs 7 7
103 Infuset Micro BMHP pcs 7 7
104 ISDN Antiangina Tab 0 0
105 Kapas 500 mg BMHP pcs 8 8
106 Kapas 250 mg BMHP pcs 0 0
107 Kapas Berlemak 500 mg BMHP pcs 2 2
108 Kapas Berlemak 250 mg BMHP pcs 0 0
109 Karbamazepin Anticonvulsants Tab 0 0
110 kassa Steril 16 x 16 BMHP pcs 25 25
111 Kassa Absorben BMHP pcs 0 0
112 Kassa 40x80 BMHP pcs 3 3
113 Kassa 4x5 BMHP pcs 10 10
114 Ketorolac Injeksi NSAID amp 47 47
115 Ketoconazole Antifungi Tab 250 250
116 Ketoconazole SK Antifungi Tube 37 37
117 Klindamicin Antibiotik Tab 550 550
118 Klopidogrel Antiplatelet Tab 0 0
119 Kloramphenicol 250 mg Antibiotik Cap 0 0
120 Kloramphenicol Syr Antibiotik fls 0 0
121 Kloramphenicol SM Antibiotik Tube 53 53
122 Kodeine Antitusif (N) Tab 0 0
123 Klorpromazin Antipsikotik Tab 160 160
124 Klorpromazin Inj Antipsikotik amp 0 0
125 Kuinin Antimalaria Tab 240 240
126 Lansoprazole PPI Cap 200 200
127 Laxadine Suspensi Pencahar fls 0 0
128 Lidocaine Anastetic amp 0 0
129 Lidocaine Comp Anastetic amp 102 102
130 Loperamide Antidiare Tab 800 800
131 Loratadine Antihistamine Tab 2200 2200
132 Lysol 1L Antiseptik Btl 0 0
133 MgSO4 20% / 40% Antidisritmik pcs 0 0
134 Meloxicam 7,5 mg NSAID Tab 90 90
135 Methilergometrin Ergotderivate Tab 0 0
136 Methilergometrin Inj Ergotderivate amp 68 68
137 Metronidazole 250 mg Antibiotik Tab 1000 1000
138 Metronidazole 500 mg Antibiotik Tab 0 0
139 Mikonazole SK Antifungi Tube 50 50
140 NaCl Elektrolit fls 48 48
141 Natrium Diclofenac 25 mg NSAID Tab 650 650
142 Natrium Diclofenac 50 mg NSAID Tab 350 350
143 Nifedipine Antihipertensi Tab 640 640
144 Nystatin Antifungi Tab 100 100
145 Nystatin Drop Antifungi pcs 0 0
146 Oksitetrasiklin SM Antibiotik Tube 74 74
147 Oksitosin Oxytocic agents amp 0 0
148 Omeprazole PPI Cap 960 960
149 Omeprazole Inj PPI amp 0 0
150 Ondancentron Antiemesis Tab 0 0
151 Ondancentron Inj Antiemesis amp 15 15
152 Oralit Elektrolit sct 200 200
153 Paracetamol 100 mg Antipiretik Tab 0 0
154 Paracetamol 500 mg Antipiretik Tab 6200 6200
155 Paracetamol Drop Antipiretik fls 0 0
156 Paracetamol Syr Antipiretik fls 25 25
157 Pembalut Elastis BMHP pcs 0 0
158 Phenobarbital Anticonvulsants Tab 160 160
159 Phenobarbital Inj Anticonvulsants amp 0 0
160 Piroxicam 10 mg NSAID Tab 700 700
161 Piroxicam 20 mg NSAID Tab 1600 1600
162 Polifix BMHP pcs 2 2
163 Povidon Iodine 60 mL Topical antimicr Btl 8 8
164 povidon Iodine 300 mL Topical antimicr Btl 0 0
165 Prednison SAID Tab 900 900
166 Primaquin Antimalaria Tab 500 500
167 Propranolol 10 mg Antidisritmik Tab 0 0
168 Propanolol 40 mg Antidisritmik Tab 300 300
169 Propyltiouracyl Antitiroid Tab 600 600
170 Pyrantel Pamoat Antelmintics Tab 148 148
171 Pyrantel Pamoat Syr Antelmintics fls 21 21
172 Ranitidine H2 Antagonist Tab 500 500
173 Ranitidine Inj H2 Antagonist amp 0 0
174 Reserpin Antihipertensi Tab 0 0
175 Risperidone Antipsikotik Tab 0 0
176 RL Elektrolit fls 21 21
177 Rivanol Topical antimicr Btl 7 7
178 Salbutamol 2 mg Bronkodilator Tab 600 600
179 Salbutamol 4 mg Bronkodilator Tab 600 600
180 Salbutamol Inhaler Bronkodilator Tab 0 0
181 Salicyl Talk Antiseptik TopicaPcs 64 64
182 Scabimite SK Scabicidal agentTube 0 0
183 Safe Glove 7,5 BMHP pcs 95 95
184 Safe Glove 8 BMHP pcs 95 95
185 Silk 3/0 BMHP pcs 39 39
186 Simvastatin Antihyperlipide Tab 400 400
187 Soft U Derm Tube 0 0
188 Spironolactone Diuretik Tab 0 0
189 Spuit 1 cc BMHP pcs 295 295
190 Spuit 2,5 cc BMHP pcs 460 460
191 Spuit 3 cc BMHP pcs 355 355
192 Spuit 5 cc BMHP pcs 482 482
193 Spuit 10 cc BMHP pcs 0 0
194 Stolax pcs 0 0
195 Surgical Masker BMHP pcs 80 80
196 Tetracyclin 250 mg Antibiotik Cap 300 300
197 Tetracyclin 500 mg Antibiotik Cap 680 680
198 Tramadol Analgetik Opiad Tab 84 84
199 Tramadol Inj Analgetik Opiad amp 30 30
200 Trihexiphenidil Antiparkinson Tab 80 80
201 Udofa 0 0
202 Ulsafate Gastrointestinal Tab 460 460
203 Ulsafate Susp (Sucralfate) Gastrointestinal fls 45 45
204 Umbilical Klem BMHP pcs 0 0
205 Urine Bag BMHP pcs 37 37
206 Vagizol Ovula pcs 0 0
207 Vitamin B1 Vitamin Tab 1700 1700
208 Vitamin B1 Inj Vitamin amp 90 90
209 Vitamin B12 Vitamin Tab 0 0
210 Vitamin B12 Inj Vitamin amp 90 90
211 Vitamin B Complex Vitamin Tab 700 700
212 Vitamin C Vitamin Tab 900 900
213 Vitamin K Vitamin Tab 0 0
214 Vitamin K Inj Vitamin amp 25 25
215 Xilocain Jelly 2% pcs 0 0
216 Zink Vitamin Tab 390 390
217 Zink Syr Vitamin fls 40 40
218 OBH Syrup Ekspektoran fls 105 105
219 New Antides (Attapulgite) Antidiare Tab 770 770
220 Salep 2-4 Antibakteri Topicpot 57 57
221 Safe Glove 8,5 BMHP pcs 100 100
222 Plester BMHP pcs 7 7
223
224
225

UMUM BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP
78 55 133

Mengetahui/Menyetujui: Yang Menyerahkan Yang Menerima/Melapor

Kepala Dinas Kesehatan Kab.Kaur Kepala IFK Kab.Kaur Kepala Puskesmas Padang

(…………………………………………………….) (……………………………………………)(…………………………………………
NIP. NIP.
DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

BULAN: AGUSTUS
TAHUN: 2018

PEMBERIAN
PEMAKAIAN SISA STOCK STOK OPT PERMINTAAN JUMLAH KET
DAK KAPITASI LAIN
9 10 11 12 13 14 15 16 17

0
63
38
50
700
80
0
120
100 600
1000
6 11
0
100 1000
100
0
0
0
0
0
0
10 112
1000
350 700
370
0
770
0
0
0
12 48
80
40
600
 0
0
0
0
20
0
0
0
0
0
30
100
88
16
1200
1000
1350
33
43
100 600
5
2900
92
0
200 1000
130 1600
140
300
0
0
47
0
0
100 800
3 160
30
0
0
1000
60
0
0
3 47
180
0
 20
0
24
300
0
5
0
70
25
390
800
450
0
18
32
0
0
0
1000
94
1100
150 500
52
3 4
1 6
0
8
0
2
0
0
5 20
0
3
10
3 44
250
37
550
0
0
0
53
0
160
 0
240
40 160
0
0
19 83
800
2200
0
0
90
0
68
1000
0
50
3 45
650
350
640
100
0
74
0
60 900
0
0
3 12
200
0
500 5700
0
10 15
0
160
0
100 600
1600
2
6 2
0
900
500
0
300
 600
148
21 0
100 400
0
0
0
2 19
7
600
600
0
64
0
20 75
95
39
400
0
0
4 291
460
4 351
482
0
0
80
300
80 600
84
30
80
0
460
16 29
0
37
0
1700
90
0
6 84
700
900
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 25
0
390
40
105
770
57
100
3 4

Yang Menerima/Melapor Yang Menerima/melaporkan

Kepala Puskesmas Padang Guci Hilir Petugas Pengelola Obat
Puskesmas Padang Guci Hilir

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