Laporan Okt Askes

REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE

BULAN JANUARI TAHUN 2015
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Coditam Tablet 91 - 91 - 91 Sep-15
2 MST 10 mg Tablet
PSIKOTROPIKA
1 Zypraz 0,5 mg Tablet
2 Clorilex 100 mg Tablet 0.5 - 0,5 - 0.5 Jan-17
3 Kalxetin 10 mg Tablet
5 Phenobarbital 30 mg Tablet
6 Olandoz 5 mg Tablet 1 - 1 - 1 Jun-15
7 Olandoz 10 mg Tablet 0.5 - 0.5 - 0.5 Jun-15
8 Zofredal 1 mg Tablet 0.5 - 0.5 - 0.5 Sep-14
9 Zofredal 2 mg Tablet - 60 (22/01/2015) 60 30 30 Sep-15
10 Prohiper 10 mg Tablet
11 Sandepril Tablet
Stesolid Rectal 5 mg / 2,5 ml Rectal 1 - 1 - 1 Oct-15
12
Trazep 2 mg/ ml Rectal
13 Seroquel Tablet 50 - 50 50 -
14 Tofranil 25 mg Tablet - 50 (22/01/2015) 50 - 50 Jan-17
PREKURSOR
1 Rhinofed Tablet - - 5 - 5 Aug-16
2 Ericaf Tablet 28.5 - 28.5 28 0.5 Jul-15
Mengetahui, Samarinda, 30 Januari 2015

Koordinator Depo Obat Rawat Jalan Penyusun Laporan
Yuniastuti, S.Si.,M.Si, Apt Rusmilawati

NIP. 19780602 200903 2 003 NIP. 19651027 199203 2 005
BULAN DESEMBER TAHUN 2014
STOK STOK
BULAN BULAN
NARKOTIKA
1 Coditam Tablet 91 91 0 91 Sep-15
2 MST 10 mg Tablet
PSIKOTROPIKA
2 Clorilex 100 mg Tablet 0.5 0.5 0 0.5 Jan-17
3 Kalxetin 10 mg Tablet Feb-16
4 Kalxetin 20 mg Tablet Feb-17
6 Olandoz 5 mg Tablet 1 1 0 1 Jun-15
7 Olandoz 10 mg Tablet 0.5 0.5 0 0.5 Jun-15
8 Zofredal 1 mg Tablet 0.5 0.5 0 0.5 Sep-14
9 Zofredal 2 mg Tablet Sep-15
11 Sandepril Tablet
Stesolid Rectal 5 mg / 2,5 ml Rectal 1 1 0 1 Oct-15
12
13 Seroquel Tablet 60 (GF) 12/12/2014 60 10 50 Feb-16
14 Tofranil 25 mg Tablet 9 9 9 0 Jan-17
PREKURSOR
1 Rhinofed Tablet 42.5 42.5 37.5 5 Aug-16
2 Ericaf Tablet 92.5 92.5 64 28.5 Jul-15

Yuniastuti, S.Si.,M.Si, Apt Nanda Rimbun Sari, A.Md., Far

NIP. 19780602 200903 2 003 NIP. 19870314 201001 2 017
BULAN NOVEMBER TAHUN 2014
STOK STOK
BULAN BULAN
NARKOTIKA
1 Coditam Tablet 91 0 91 0 91 Sep-15
2 MST 10 mg Tablet
PSIKOTROPIKA
2 Clorilex 100 mg Tablet 0.5 0 0.5 0 0.5 Jan-17
3 Kalxetin 10 mg Tablet 0 0 0 0 0 Feb-16
4 Kalxetin 20 mg Tablet 0 0 0 0 0 Feb-17
6 Olandoz 5 mg Tablet 1 0 1 0 1 Jun-15
7 Olandoz 10 mg Tablet 0.5 0 0.5 0 0.5 Jun-15
8 Zofredal 1 mg Tablet 0.5 0 0.5 0 0.5 Sep-14
9 Zofredal 2 mg Tablet Sep-15
11 Sandepril Tablet
Stesolid Rectal 5 mg / 2,5 ml Rectal 1 0 1 0 1 Oct-15
12
13 Seroquel Tablet 19 0 19 19 0 Feb-15
14 Tofranil 25 mg Tablet 9 0 9 0 9 Jan-17
PREKURSOR
1 Rhinofed Tablet 45 0 45 2.5 42.5 Aug-16
2 Ericaf Tablet 124.5 0 124.5 32.0 92.5 Jul-15
Mengetahui, Samarinda, 05 November 2014


NIP. 19780602 200903 2 003 NIP. 19870314 201001 2 017
BULAN OKTOBER TAHUN 2014
STOK STOK
BULAN BULAN
NARKOTIKA
2 MST 10 mg Tablet
PSIKOTROPIKA
3 Kalxetin 10 mg Tablet 30 30 30 0 Feb-16
9 Zofredal 2 mg Tablet 2 2 2 0 Sep-15
11 Sandepril Tablet
12
13 Seroquel Tablet 75 75 56 19 Feb-15
PREKURSOR
1 Rhinofed Tablet 45 45 0 45 Aug-16
2 Ericaf Tablet 196.5 196.5 72.0 124.5 Jul-15


NIP. 19780602 200903 2 003 NIP. 19870314 201001 2 017
BULAN SEPTEMBER TAHUN 2014
STOK STOK
BULAN BULAN
NARKOTIKA
2 MST 10 mg Tablet
PSIKOTROPIKA
3 Kalxetin 10 mg Tablet 0 150 (GF) 16/09/14 150 120 30 Feb-16
11 Sandepril Tablet
12
PREKURSOR
2 Ericaf Tablet 69 210 (GF) 16/09/14 279 82.5 196.5 Jul-15
Mengetahui, Samarinda, 01 September 2014


NIP. 19780602 200903 2 003 NIP. 19870314 201001 2 017
BULAN AGUSTUS TAHUN 2014
STOK STOK
BULAN BULAN
NARKOTIKA
2 MST 10 mg Tablet 0 0 0 0 Oct-16
PSIKOTROPIKA
1 Zypraz 0,5 mg Tablet 3.5 3.5 3.5 0 Apr-16
5 Phenobarbital 30 mg Tablet 0 0 0 0 Dec-15
10 Prohiper 10 mg Tablet 30 30 30 0 Dec-16
11 Sandepril Tablet 0 0 0 0 Jun-14
12
Trazep 2 mg/ ml Rectal 0 0 0 0 Jan-15
PREKURSOR
2 Ericaf Tablet 57 90 (GF) 26/08/14 147 78 69 Jul-15
Mengetahui, Samarinda, 29 Agustus 2014


NIP. 19780602 200903 2 003 NIP. 19870314 201001 2 017
BULAN JULI TAHUN 2014
STOK STOK
BULAN BULAN
NARKOTIKA
PSIKOTROPIKA
1 Zypraz 0,5 mg Tablet 3.5 3.5 0 3.5 Apr-16
12
PREKURSOR
2 Ericaf Tablet 105 105 48 57 Jul-15
Mengetahui, Samarinda, 31 Juli 2014


NIP. 19780602 200903 2 003 NIP. 19870314 201001 2 017
BULAN JUNI TAHUN 2014
STOK STOK
BULAN BULAN
NARKOTIKA
PSIKOTROPIKA
12
PREKURSOR
1 Rhinofed Tablet 0 100 (GF) 23/06/14 100 15 85 Aug-16
2 Ericaf Tablet 171 171 66 105 Jul-15
Mengetahui, Samarinda, 30 Juni 2014

NIP. 19780602 200903 2 003 NIP. 19651027 199203 2 005
BULAN MEI TAHUN 2014
STOK STOK
BULAN BULAN
NARKOTIKA
PSIKOTROPIKA
2 Clorilex 100 mg Tablet 0.5 50 (GF) 14/05/14 50.5 50 0.5 Jan-17
3 Kalxetin 10 mg Tablet 285 60 (GF) 20/05/14 345 250 95 Dec-15
10 Prohiper 10 mg Tablet 30 90 (GF) 120 15 105 Dec-16
12
PREKURSOR
1 Rhinofed Tablet 25 25 25 0 Mar-16
2 Ericaf Tablet 418.75 418.75 247.75 171 Jul-15
Mengetahui, Samarinda, 30 Mei 2014

NIP. 19780602 200903 2 003 NIP. 19651027 199203 2 005
BULAN APRIL TAHUN 2014
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet
4 Durogesic 12,5 Patch
5 Durogesic 25 Patch
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet
Atarax 0,5 mg Tablet
2
Zypraz 0,5 mg Tablet 3.5 3.5 0 3.5 Apr-16
3 Anxibloc 10 mg Tablet
4 Clorilex 100 mg Tablet 33.25 33.25 32.75 0.5 Jan-17
5 Chlorpromazin 100 mg Tablet
Diazepam 5 mg Tablet
6
Valdimex 5 mg Tablet
7 Haloperidol 0,5 mg Tablet
8 Haloperidol 1,5 mg Tablet 0
9 Haloperidol 5 mg Tablet 0
10 Kalxetin 10 mg Tablet 405 405 120 285 Dec-15
12 Phenobarbital 30 mg Tablet 700 (GF) 23/04/14 700 550 150 Dec-15
13 Ludiomil 50 mg Tablet
Persidal 1 mg Tablet
16
Zofredal 1 mg Tablet 32.5 32.5 10 22.5 Sep-14
17
Zofredal 2 mg Tablet 2 2 0 2 Sep-15
18 Prohiper 10 mg Tablet 29 30 (GF) 23/04/14 59 29 30 Dec-16
20
21 Stesolid Rectal 10 mg / 2,5 ml Rectal
Trihexyphenidil 2 mg Tablet 0
24
Hexymer 2 mg Tablet
25 Zypraz 1 mg Tablet
PREKURSOR
1 Ephedrin 25 mg Tablet
2 Rhinofed Tablet 50 50 25 25 Mar-16
3 Ericaf Tablet 282 900 (GF) 23/04/14 1182 763.25 418.75 Jul-15
Mengetahui, Samarinda, 30 April 2014


NIP. 19780602 200903 2 003 NIP. 19651027 199203 2 005
BULAN MARET TAHUN 2014
STOK STOK
BULAN BULAN
NARKOTIKA
3 Coditam Tablet 91 91 0.00 91 Sep-15
6 MST 10 mg Tablet 5 5 0.00 5 Oct-16
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet
2
Zypraz 0,5 mg Tablet 3.5 3.5 0.00 3.5 Apr-16
3 Anxibloc 10 mg Tablet
Diazepam 5 mg Tablet
6
Valdimex 5 mg Tablet
7 Haloperidol 0,5 mg Tablet
8 Haloperidol 1,5 mg Tablet 76 76 76.00 0 Mar-16
9 Haloperidol 5 mg Tablet 24 24 24.00 0 Sep-16
10 Kalxetin 10 mg Tablet 240 300 (GF) 10/03/14 540 135.00 405 Dec-15
14 Olandoz 5 mg Tablet 42 42 0.00 42 Jun-15
15 Olandoz 10 mg Tablet 28.5 28.5 0.00 28.5 Jun-15
16
Zofredal 1 mg Tablet 32.5 32.5 0.00 32.5 Sep-14
17
Zofredal 2 mg Tablet 2 2 0.00 2 Sep-15
18 Prohiper 10 mg Tablet 37 37 8.00 29 Dec-16
19 Sandepril Tablet 15 15 0.00 15 Jun-14
Stesolid Rectal 5 mg / 2,5 ml Rectal 1 1 0.00 1 Oct-15
20
Trazep 2 mg/ ml Rectal 1 1 0.00 1 Jan-15
21 Stesolid Rectal 10 mg / 2,5 ml Rectal
22 Seroquel Tablet 75 75 0.00 75 Feb-15
23 Tofranil 25 mg Tablet 34 34 10.00 24 Jan-17
Trihexyphenidil 2 mg Tablet 13.75 13.75 13.75 0 Apr-18
24
Hexymer 2 mg Tablet
25 Zypraz 1 mg Tablet
PREKURSOR
1 Ephedrin 25 mg Tablet
2 Rhinofed Tablet 50 50 0.00 50 Mar-16
90 (GF) 20/03/14
3 Ericaf Tablet 60 660 378.00 282 Jul-15
510 (GF) 25/03/14
Mengetahui, Samarinda, 31 Maret 2014


NIP. 19780602 200903 2 003 NIP. 19651027 199203 2 005
BULAN FEBRUARI TAHUN 2014
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 1183 1183 1183.00 0 May-17
2 Codein 15 mg Tablet 14.5 14.5 14.50 0 May-17
6 MST 10 mg Tablet 5 5 0.00 5 Oct-16
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 327.25 327.25 327.25 0 Sep-17
2
3 Anxibloc 10 mg Tablet 3.75 3.75 3.75 0 Jun-17
Diazepam 5 mg Tablet 0 0 0.00 0 Dec-17
6
Valdimex 5 mg Tablet 0 0 0.00 0
12 Phenobarbital 30 mg Tablet 0 0 0.00 0 Dec-15
14 Olandoz 5 mg Tablet 61.5 61.5 19.50 42 Jun-15
16
17
18 Prohiper 10 mg Tablet 0 60 (GF) 25/02/14 60 23.00 37 Dec-16
20
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 1 1 1.00 0 Jul-15
Trihexyphenidil 2 mg Tablet 416.25 416.25 402.50 13.75 Apr-18
24
Hexymer 2 mg Tablet
25 Zypraz 1 mg Tablet 0 0 0.00 0
PREKURSOR
1 Ephedrin 25 mg Tablet 3.75 3.75 3.75 0 May-17
2 Rhinofed Tablet 50 (GF) 11/02/14 50 0.00 50 Mar-16
Mengetahui, Samarinda, 28 Februari 2014


NIP. 19780602 200903 2 003 NIP. 19651027 199203 2 005
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 186 1500 (GF) 23/01/14 1686 503.00 1183 May-17
2 Codein 15 mg Tablet 174.5 174.5 160.00 14.5 May-17
6 MST 10 mg Tablet 20 20 15.00 5 Oct-16
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 568.75 900 (GF) 16/01/14 1468.75 1141.50 327.25 Sep-17
2
3 Anxibloc 10 mg Tablet 369.25 369.25 365.50 3.75 Jun-17
Diazepam 5 mg Tablet 900.5 900.5 900.50 0 Dec-17
6
Valdimex 5 mg Tablet 0 0 0.00 0
8 Haloperidol 1,5 mg Tablet 1 100 (GF) 16/01/14 101 0.00 101 Mar-16
30 (GF) 10/01/14
180 (GF) 20/01/14
10 Kalxetin 10 mg Tablet 0 420 270.00 150 Oct-15
90 (GF) 24/01/14
120 (GF) 28/01/14
11 Kalxetin 20 mg Tablet 60 60 (GF) 24/01/14 120 56.00 64 Nov-16
12 Phenobarbital 30 mg Tablet 150 150 150.00 0 Dec-15
16
17
18 Prohiper 10 mg Tablet 17 17 17.00 0 Dec-16
20
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 2 2 1.00 1 Jul-15
Trihexyphenidil 2 mg Tablet 367.5 1100 (GF) 16/01/14 1467.5 1051.25 416.25 Apr-18
24
Hexymer 2 mg Tablet
25 Zypraz 1 mg Tablet 0 0 0
PREKURSOR
1 Ephedrin 25 mg Tablet 313.25 313.25 309.50 3.75 May-17
2 Rhinofed Tablet 0


NIP. 19780602 200903 2 003 NIP. 19651027 199203 2 005
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 128.75 1000 (GF) 10/12/13 1128.75 942.75 186 May-17
2 Codein 15 mg Tablet 250.75 250 (GF) 10/12/13 500.75 326.25 174.5 May-17
3 Coditam Tablet 1 100 (GF) 17/12/13 101 10 91 Sep-15
6 MST 10 mg Tablet 30 60 (GF) 13/12/13 90 70 20 Oct-16
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 1027.75 1000 (GF) 10/12/13 2027.75 1459 568.75 Sep-17
2
3 Anxibloc 10 mg Tablet 494.5 500 (GF) 10/12/13 994.5 625 369.25 Jun-17
Diazepam 5 mg Tablet 1000 (GF) 23/12/13 1000 99.5 900.5 Dec-17
6
Valdimex 5 mg Tablet 1410.5 200 (GF) 10/12/13 1610.5 1610.5 0 Oct-17
300 (GF) 10/12/13
7 Haloperidol 0,5 mg Tablet 286.5 686.5 545.5 141 Mar-17
100 (GF) 19/12/13
8 Haloperidol 1,5 mg Tablet 11 11 10 1 Mar-16
9 Haloperidol 5 mg Tablet 52 52 18 34 Sep-16
10 Kalxetin 10 mg Tablet 180 180 180 0 Jul-15
11 Kalxetin 20 mg Tablet 50 60 (GF) 19/12/13 110 50 60 May-16
12 Phenobarbital 30 mg Tablet 60 200 (GF) 10/12/13 260 110 150 Dec-15
14 Olandoz 5 mg Tablet 61.5 61.5 0 61.5 Jan-15
15 Olandoz 10 mg Tablet 89 89 7.5 81.5 Jun-15
16
Zofredal 1 mg Tablet 82.5 82.5 0 82.5 Sep-14
17
Zofredal 2 mg Tablet 32 240 (GF) 10/12/13 272 135 137 Sep-15
Stesolid Rectal 5 mg / 2,5 ml Rectal 0 5 (GF) 23/12/13 5 0 5 Oct-15
20
20
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 4 4 2 2 May-14
24
Hexymer 2 mg Tablet
PREKURSOR
1 Ephedrin 25 mg Tablet 605.25 605.25 292 313.25 May-17
Mengetahui, Samarinda, 31 Desember 2013

Yuniastuti, S.Si.,M.Si, Apt Yuliani, A.md Far.

NIP. 19780602 200903 2 003
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 139.75 1000 (GF) 04/11/13 1139.75 1011 128.75 May-17
2 Codein 15 mg Tablet 90.75 250 (GF) 20/11/13 340.75 90 250.75 May-17
3 Coditam Tablet 1 1 0 1 Jan-15
6 MST 10 mg Tablet 0 60 (GF) 20/11/13 60 30 30 Aug-16
PSIKOTROPIKA
2000 (GF) 12/11/13 1072.25
1 Amitriptilin 25 mg Tablet 0.25 3000 1027.75 Sep-17
1000 (GF) 22/11/13 900 (BAYAR RUTIN)
2
3 Anxibloc 10 mg Tablet 541.25 500 (GF) 04/11/13 1041.3 546.75 494.5 Jun-17
4 Clorilex 100 mg Tablet 60 60 7.5 52.5 Jan-17
Diazepam 5 mg Tablet 0
6 700 (GF) 04/11/13
Valdimex 5 mg Tablet 656.5 3156.5 1746 1410.5
1800 (GF) 18/11/13 Oct-17
7 Haloperidol 0,5 mg Tablet 766.5 766.5 480 286.5 Mar-17
30 (GF) 04/11/13
150 (GF) 12/11/13
12 Phenobarbital 30 mg Tablet 110 100 (GF) 04/11/13 210 150 60
16
60 (GF) 12/11/13
Zofredal 1 mg Tablet 30 120 37.5 82.5 Sep-14
30 (GF) 22/11/13
60 (GF) 04/11/13
17
Zofredal 2 mg Tablet 26 150 (GF) 12/11/13 266 234 32 Jul-15
17
Zofredal 2 mg Tablet 26 266 234 32 Jul-15
30 (GF) 22/11/13
Stesolid Rectal 5 mg / 2,5 ml Rectal 4 4 0 4 Apr-14
20
Trazep 2 mg/ ml Rectal 10 (GF) 18/11/13 10 9 1 Jan-15
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 1 5 (GF) 04/11/13 6 2 4 May-14
1000 (GF) 04/11/13
24 800 (GF) 22/11/13
Hexymer 2 mg Tablet
PREKURSOR
1 Ephedrin 25 mg Tablet 950.25 950.25 345 605.25 May-17


NIP. 19780602 200903 2 003
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 124 1250 (GF) 02/10/13 1374 1234.25 139.75 Jul-17
2 Codein 15 mg Tablet 175.75 175.75 85 90.75 Sep-16
6 MST 10 mg Tablet 0 0 0 0
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 900 (PINJAM RUTIN) 900 899.75 0.25
Atarax 0,5 mg Tablet 0
2
3 Anxibloc 10 mg Tablet 1028.5 1028.5 487.25 541.25 Jun-17
4 Clorilex 100 mg Tablet 67.5 67.5 7.5 60 Jan-17
Diazepam 5 mg Tablet 410.5 1000 (GF) 02/10/13 1410.5 1410.5 0
6
Valdimex 5 mg Tablet 0 1000 (GF) 22/10/13 1000 343.5 656.5 Feb-17
7 Haloperidol 0,5 mg Tablet 646.5 400 (GF) 25/10/13 1046.5 280 766.5 Mar-17
60 (GF) 02/10/13
120 (GF) 16/10/13
11 Kalxetin 20 mg Tablet 95 95 75 20 May-16
15 Olandoz 10 mg Tablet 29 60 (GF) 16/09/13 89 0 89 Jun-15
16
30 (GF) 02/10/13
Zofredal 1 mg Tablet 48 108 78 30 May-14
30 (GF) 16/10/13
17 120 (GF) 02/10/13
90 (GF) 16/10/13
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 4 4 0 4 Apr-14
800 (GF) 02/10/13
24 800 (GF) 25/10/13
Hexymer 2 mg Tablet
25 Zypraz 1 mg Tablet 2 2 2 0
PREKURSOR
1 Ephedrin 25 mg Tablet 210 1000 (GF) 08/10/13 1210 259.75 950.25 May-17
Mengetahui, Samarinda, 31 Oktober 2013


NIP. 19780602 200903 2 003
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 827.5 500 (GF) 02/09/13 1327.5 1203.5 124 May-17
6 MST 10 mg Tablet 5 60 (GF) 02/09/13 65 65 0 Feb-16
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 0 0 0
Atarax 0,5 mg Tablet 0 0 0
2
3 Anxibloc 10 mg Tablet 1089.75 500 (GF) 05/09/13 1589.75 561.25 1028.5 Jun-17
Diazepam 5 mg Tablet 73 500 (GF) 05/09/13 573 162.5 410.5 Dec-17
6
Valdimex 5 mg Tablet 1000 1000 1000 0
7 Haloperidol 0,5 mg Tablet 941.5 941.5 295 646.5 Mar-17
90 (GF) 05/09/13
90 (GF) 16/09/13
14 Olandoz 5 mg Tablet 11.5 90 (GF) 16/09/13 101.5 40 61.5 Jan-15
15 Olandoz 10 mg Tablet 63 63 34 29 Jan-15
16
Zofredal 1 mg Tablet 20 60 (GF) 05/09/13 80 32 48 May-14
17 60 (GF) 05/09/13
90 (GF) 16/09/13
Trihexyphenidil 2 mg Tablet 1325.75 1325.75 950 375.75 Apr-18
24
Hexymer 2 mg Tablet
25 Zypraz 1 mg Tablet 2 2 0 2 Jan-14
PREKURSOR
1 Ephedrin 25 mg Tablet 477 477 267 210 May-17


NIP. 19780602 200903 2 003
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 86.75 1500 (GF) 15/08/13 1586.75 759.25 827.5 May-17
2 Codein 15 mg Tablet 0.75 250 (GF) 14/08/13 250.75 55 195.75 Sep-16
6 MST 10 mg Tablet 50 50 45 5 Feb-16
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 76 500 (GF) 12/08/13 576 0 576 Jun-16
Atarax 0,5 mg Tablet 5.5 5.5 5.5 0
2
Zypraz 0,5 mg Tablet 200 200 29.5 170.5 Apr-16
500 (GF) 12/08/13
3 Anxibloc 10 mg Tablet 259.75 1759.75 670 1089.75 Apr-17
1000 (GF) 23/08/13
4 Clorilex 100 mg Tablet 79 79 0 79 Jan-17
Diazepam 5 mg Tablet 1046 1046 973 73 Dec-17
6
Valdimex 5 mg Tablet 1000 (GF) 29/08/13 1000 0 1000 Dec-16
7 Haloperidol 0,5 mg Tablet 21.5 1000 (GF) 23/08/13 1021.5 80 941.5 Mar-17
10 Kalxetin 10 mg Tablet 25 30 (GF) 12/08/13 55 55 0
11 Kalxetin 20 mg Tablet 60 60 (GF) 12/08/13 120 85 35 Apr-16
14 Olandoz 5 mg Tablet 79 79 67.5 11.5 Jun-15
16
Zofredal 1 mg Tablet 80 80 60 20 Feb-15
17
Zofredal 2 mg Tablet 75 60 (GF) 12/08/13 135 75 60 Jan-15
24
Hexymer 2 mg Tablet Jun-16
PREKURSOR
1 Ephedrin 25 mg Tablet 172.5 500 (GF) 23/08/13 672.5 195.5 477 May-17

Yuniastuti,M.Si,Apt. Nanda Rimbun Sari, A.md Far.

NIP. 19780602 200903 2 003 NIP. 19870314 201001 2 017
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 283.75 750 (GF) 04/07/13 1033.75 947 86.75 Apr-17
6 MST 10 mg Tablet 50 50 0 50 Feb-16
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 553.5 1000 (GF) 08/07/13 1553.5 1477.5 76 Jun-16
Atarax 0,5 mg Tablet 12.5 100 (GF) 12/07/13 112.5 107 5.5 Aug-16
2
Zypraz 0,5 mg Tablet 0 200 (GF) 29/07/13 200 0 200 Apr-16
500 (GF) 03/07/13
3 Anxibloc 10 mg Tablet 660.5 1660.5 1400.75 259.75 Apr-17
500 (GF) 12/07/13
4 Clorilex 100 mg Tablet 83 83 4 79 Jan-17
Diazepam 5 mg Tablet 285 2000 (GF) 03/07/13 2285 1239 1046 Dec-17
6
Valdimex 5 mg Tablet 0 0 0
7 Haloperidol 0,5 mg Tablet 217 300 (GF) 03/07/13 517 495.5 21.5 Mar-17
9 Haloperidol 5 mg Tablet 86.5 86.5 18.5 68 Sep-16
60 (GF) 03/07/13
11 Kalxetin 20 mg Tablet 60 210 150 60 Apr-16
90 (GF) 31/07/13
14 Olandoz 5 mg Tablet 116.5 116.5 37.5 79 Jun-15
16
17
Zofredal 2 mg Tablet 90 90 (GF) 03/07/13 180 105 75 Jan-15
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 0 5 (GF) 12/07/13 5 1 4 Apr-14
Trihexyphenidil 2 mg Tablet 1593.25 1500 (GF) 03/07/13 3093.25 1660 1433.25 Apr-18
24
Hexymer 2 mg Tablet 0 0 0 Jun-16
PREKURSOR
1 Ephedrin 25 mg Tablet 582.5 582.5 410 172.5 Jul-17
Mengetahui, Samarinda, 31 JuLi 2013

Rahmatiah, Apt. Nanda Rimbun Sari, A.md Far.

NIP. 198508142010012030 NIP. 19870314 201001 2 017
STOK STOK
BULAN BULAN
NARKOTIKA
6 MST 10 mg Tablet 50 50 0 50 Feb-16
PSIKOTROPIKA
500 (GF) 03/06/13
1 Amitriptilin 25 mg Tablet 430 500 (GF) 14/06/13 1830 1276.5 553.5 Jun-16
400 (GF) 27/06/13
2 Atarax 0,5 mg Tablet 212.5 212.5 200 12.5 Apr-16
500 (GF) 03/06/13
3 Anxibloc 10 mg Tablet 314.5 1314.5 654 660.5 Nov-16
500 (GF) 19/06/13
4 Clorilex 100 mg Tablet 40.5 50 (GF) 03/06/13 90.5 7.5 83 Jan-17
1000 (GF) 03/06/13
Diazepam 5 mg Tablet 0 1500 1215 285 Dec-17
6 500 (GF) 19/06/13
Valdimex 5 mg Tablet 177 177 177 0
10 (retur pasien)
7 Haloperidol 0,5 mg Tablet 312.5 522.5 305.5 217 Dec-17
200 (GF) 27/06/13
9 Haloperidol 5 mg Tablet 92.5 92.5 6 86.5 Sep-16
10 Kalxetin 10 mg Tablet 45 90 (GF) 03/06/13 135 30 105 Oct-14
14 Olandoz 5 mg Tablet 11.5 150 (GF) 03/06/13 161.5 45 116.5 Jun-15
16 30 (GF) 03/06/13
60 (GF) 14/06/13
17 30 (GF) 03/06/13
Zofredal 2 mg Tablet 0 180 90 90 Mar-15
17
150 (GF) 14/06/13
23 Tofranil 25 mg Tablet 12 50 (GF) 03/06/13 62 0 62 Jan-17
Trihexyphenidil 2 mg Tablet 0 2000 (GF) 03/06/13 2000 406.75 1593.25 Apr-18
24
Hexymer 2 mg Tablet 850.75 850.75 850.75 0 Jun-16
PREKURSOR

Rahmatiah, Apt. Uswatun Hasanah

NIP. 198508142010012030
STOK STOK
BULAN BULAN
NARKOTIKA
6 MST 10 mg Tablet 0 60 (GF) 24/05/13 60 10 50 Feb-16
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 421.5 1000 (GF) 11/05/13 1421.5 991.5 430 Jun-16
2 Bellaphen Tablet
3 Atarax 0,5 mg Tablet 287.5 300 (GF) 27/05/13 587.5 375 212.5 Apr-16
4 Anxibloc 10 mg Tablet 169 1000 (GF) 11/05/13 1169 854.5 314.5 Nov-16
5 Clozaril 25 mg Tablet 2 2 2 0
7 Cliad Tablet
Diazepam 5 mg Tablet 271 271 271 0
9
Valdimex 5 mg Tablet 1000 (GF) 10/05/13 1000 823 177 Jul-16
10 Haloperidol 0,5 mg Tablet 117.5 500 (GF) 11/05/13 617.5 305 312.5 Dec-16
12 Haloperidol 5 mg Tablet 20 100 (GF) 11/05/13 120 27.5 92.5 Sep-16
30 (GF) 06/05/13
90 (GF) 11/05/13
19
Persidal 2 mg Tablet 5.5 5.5 5.5 0
20
Zofredal 2 mg Tablet 0 180 (GF) 06/05/13 180 180 0
21 Prohiper 10 mg Tablet 25 25 0 25 Aug-16
Trihexyphenidil 2 mg Tablet 480 900 (GF) 06/05/13 1380 1380 0
27
Hexymer 2 mg Tablet 1250 (GF) 27/05/13 1250 399.25 850.75 Jun-16
28 Trifluoperazine 5 mg Tablet
PREKURSOR
1 Ephedrin 25 mg Tablet 286.75 1000 (GF) 10/05/13 1286.75 474.25 812.5 Jul-17


NIP. 198508142010012030
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 0.75 0.75 0 0.75 Jan-17
6 MST 10 mg Tablet 10 10 (GF) 18/04/13 20 20 0
PSIKOTROPIKA
300 (GF) 02/04/13
1 Amitriptilin 25 mg Tablet 239.25 500 (GF) 09/04/13 1539.25 1118 421.5 Jun-16
500 (GF) 17/04/13
2 Bellaphen Tablet
3 Atarax 0,5 mg Tablet 592.5 592.5 305 287.5 Apr-16
200 (GF) 02/04/13
4 Anxibloc 10 mg Tablet 298.5 400 (GF) 11/04/13 998.5 829.5 169 Nov-16
100 (GF) 24/04/13
5 Clozaril 25 mg Tablet 2 2 0 2 Aug-13
6 Clorilex 100 mg Tablet 100 (GF) 27/04/13 100 0 100 Jan-17
7 Cliad Tablet
500 (GF) 11/04/13
9 Diazepam 5 mg Tablet 880 1630 1359 271
250 (GF) 24/04/13 Dec-17
11 Haloperidol 1,5 mg Tablet 180.5 180.5 42.5 138 Mar-16
12 Haloperidol 5 mg Tablet 11 100 (GF) 09/04/13 111 91 20 Sep-16
13 Kalxetin 10 mg Tablet 205 205 135 70 Oct-14
60 (GF) 09/04/13
60 (GF) 24/04/13
17 Olandoz 5 mg Tablet 15.5 120 (GF) 02/04/13 135.5 135 0.5 Jun-15
19
19
Persidal 2 mg Tablet 0.5 80 (GF) 02/04/13 80.5 75 5.5 Nov-16
20
Zofredal 2 mg Tablet 90 (GF) 17/04/13 90 90 0
23 Stesolid Rectal 5 mg / 2,5 ml Rectal 1 5 (GF) 02/04/13 6 0 6 Nov-13
27 Trihexyphenidil 2 mg Tablet 0 2000 (GF) 09/04/13 2000 1520 480 Dec-17
28 Trifluoperazine 5 mg Tablet 40 40 40 0 May-13
29 Valdimex 5 mg Tablet
PREKURSOR


NIP. 198508142010012030
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 89.75 500 (GF) 01/03/13 589.75 589 0.75 Jan-17
2 Codein 15 mg Tablet 270 270 184.25 85.75 Sep-16
4 Durogesic 12,5 Patch 0 0
5 Durogesic 25 Patch 0 0
6 MST 10 mg Tablet 10 10 0 10 Mar-15
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 464.25 600 (GF) 01/03/13 1064.25 825 239.25 Jun-16
2 Bellaphen Tablet
Zypraz 0,5 mg Tablet
3
Atarax 0,5 mg Tablet 772.5 772.5 180 592.5 Jan-16
100 (GF) 01/03/13
Anxibloc 10 mg Tablet 529.5 929.5 631 298.5 Jul-16
4 300 (GF) 11/03/13
Frisium 10 mg Tablet
5 Clozaril 25 mg Tablet 2 2 0 2 Dec-14
6 Cliad Tablet
8 Diazepam 5 mg Tablet 1500 (GF) 11/03/13 1500 620 880
100 (GF) 01/03/13
9 Haloperidol 0,5 mg Tablet 0.5 500.5 170 330.5 Jun-16
400 (GF) 11/03/13
10 Haloperidol 1,5 mg Tablet 26.5 200 (GF) 11/03/13 226.5 46 180.5 Jan-16
90 (GF) 01/03/13
12 Kalxetin 10 mg Tablet 0 210 5 205 Sep-14
120 (GF) 11/03/13
60 (GF) 01/03/13
90 (GF) 01/03/13
14 Phenobarbital 30 mg Tablet 1000 (GF) 11/03/13 1000 190 810 Dec-15
16 Olandoz 5 mg Tablet 135.5 135.5 120 15.5 May-14
17 Olandoz 10 mg Tablet 48 30 (GF) 01/03/13 78 0 78 Jan-15
18
19 Persidal 2 mg Tablet 90 80 (GF) 01/03/13 170 169.5 0.5 Aug-16
22 Stesolid Rectal 5 mg / 2,5 ml Rectal 2 2 1 1 Nov-13
Trihexyphenidil 2 mg Tablet 455.5 1000 (GF) 01/03/13 1455.5 1455.5 0 Jun-17
26
Hexymer 2 mg Tablet
27 Trifluoperazine 5 mg Tablet 70 (GF) 26/03/13 70 30 40 May-13
28 Valdimex 5 mg Tablet 364 364 364 0 Jul-16
PREKURSOR


NIP. 198508142010012030 NIP. 19870314 201001 2 017
STOK STOK
BULAN BULAN
NARKOTIKA
2 Codein 15 mg Tablet 30 250 (GF) 05/02/13 280 10 270 Sep-16
4 Durogesic 12,5 Patch 11 11 11 0 Jul-13
5 Durogesic 25 Patch 7 7 7 0 Nov-13
6 MST 10 mg Tablet 10 10 0 10 Mar-15
PSIKOTROPIKA
300 (GF) 05/02/13
1 Amitriptilin 25 mg Tablet 573.5 1173.5 709.25 464.25 Jun-16
300 (GF) 11/02/13
2 Bellaphen Tablet
3
Anxibloc 10 mg Tablet 790.5 300 (GF) 05/02/13 1090.5 561 529.5 Jul-16
4
6 Cliad Tablet
9 Haloperidol 1,5 mg Tablet 111.5 111.5 85 26.5 Jan-16
11 Kalxetin 10 mg Tablet 30 90 (GF) 05/02/13 120 120 0 Sep-14
15 Olandoz 5 mg Tablet 0.5 150 (GF) 22/02/13 150.5 15 135.5 May-14
30 (GF) 05/02/13
90 (GF) 22/02/13
17
18 Persidal 2 mg Tablet 5 200 (GF) 11/02/13 205 115 90 Aug-16
19 Prohiper 10 mg Tablet 30 60 (GF) 22/02/13 90 35 55 Aug-16
Trihexyphenidil 2 mg Tablet 731.5 1000 (GF) 05/02/13 1731.5 1276 455.5 Jun-17
25
Hexymer 2 mg Tablet
27 Valdimex 5 mg Tablet 309 1000 (GF) 05/02/13 1309 945 364 Jul-16
PREKURSOR
1 Ephedrin 25 mg Tablet 418.75 1000 (GF) 05/02/13 1418.75 355 1063.75 Jul-17


NIP. 198508142010012030 NIP. 19870314 201001 2 017
STOK STOK
BULAN BULAN
NARKOTIKA
2 Codein 15 mg Tablet 180 180 150 30 Sep-16
6 MST 10 mg Tablet 10 10 0 10 Mar-15
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 303 1000 (GF) 16/01/13 1303 729.5 573.5 Jun-16
2 Bellaphen Tablet
3
Anxibloc 10 mg Tablet 167.25 1200 (GF) 16/01/13 1367.3 576.75 790.5 Jul-16
4
6 Cliad Tablet
8 Haloperidol 0,5 mg Tablet 345 100 (GF) 16/01/13 445 197.5 247.5 Jun-16
9 Haloperidol 1,5 mg Tablet 51.5 100 (GF) 16/01/13 151.5 40 111.5 Jan-16
10 Haloperidol 5 mg Tablet 25 100 (GF) 16/01/13 125 20 105 Sep-16
16 Olandoz 10 mg Tablet 79 30 (GF) 16/01/13 109 53 56 Jan-15
17
18 Persidal 2 mg Tablet 110 60 (GF) 16/01/13 170 165 5 Aug-16
22 Stesolid Rectal 10 mg / 2,5 ml Rectal 10 10 10 0 Jun-14
Trihexyphenidil 2 mg Tablet 921.5 1000 (GF) 16/01/13 1921.5 1190 731.5 Sep-17
25
25
Hexymer 2 mg Tablet
27 Valdimex 5 mg Tablet 998.5 500 (GF) 16/01/13 1498.5 1189.5 309 Jun-16
PREKURSOR


NIP. 198508142010012030 NIP. 19870314 201001 2 017
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 298.25 1000 (GF) 03/12/2012 1298.25 1082.5 215.75 Oct-16
6 MST 10 mg Tablet 70 70 60 10 Mar-15
PSIKOTROPIKA
400 (GF) 03/12/2012
1 Amitriptilin 25 mg Tablet 526 1126 823 303 Dec-15
200 (GF) 10/12/2012
2 Bellaphen Tablet
3
Atarax 0,5 mg Tablet 624.5 1500 (GF) 13/12/2012 2124.5 1062 1062.5 Jan-16
Anxibloc 10 mg Tablet 741.5 300 (GF) 13/12/2012 1041.5 874.25 167.25 Aug-15
4
5 Clozaril 25 mg Tablet 7 100 (GF) 10/12/2012 107 75 32 Dec-14
6 Cliad Tablet
8 Haloperidol 0,5 mg Tablet 360 200 (GF) 03/12/2012 560 215 345 Dec-15
9 Haloperidol 1,5 mg Tablet 111.5 111.5 60 51.5 Dec-15
12 Kalxetin 20 mg Tablet 120 90 (GF) 03/12/2012 210 105 105 Aug-15
17 30 (GF) 03/12/2012
60 (GF) 10/12/2012
40 (GF) 03/12/2012
18 Persidal 2 mg Tablet 77.5 177.5 67.5 110 Aug-16
60 (GF) 10/12/2012
22 Stesolid Rectal 10 mg / 2,5 ml Rectal 5 5 (GF) 03/12/2012 10 0 10 Jun-14
23 Seroquel Tablet 45 60 (GF) 10/12/2012 105 30 75 Feb-15
Trihexyphenidil 2 mg Tablet 1149 1000 (GF) 03/12/2012 2149 1227.5 921.5 Jun-17
25
Hexymer 2 mg Tablet
26 Trifluoperazine 5 mg Tablet 470 470 470 0
500 (GF) 03/12/2012
27 Valdimex 5 mg Tablet 451.5 1951.5 953 998.5 Jun-16
1000 (GF) 13/12/2012
PREKURSOR
1 Ephedrin 25 mg Tablet 283.5 1000 (GF) 03/12/2012 1283.5 408.75 874.75 Jul-17


NIP. 198508142010012030
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 879.5 500 (GF) 05/11/12 1379.5 1081.25 298.25 Oct-16
2 Codein 15 mg Tablet 3.5 3.5 3.5 0
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 799 500 (GF) 05/11/12 1299 773 526 Dec-15
2 Bellaphen Tablet
3 1300 (GF) 05/11/12
500 (GF) 28/11/12
Anxibloc 10 mg Tablet 667.5 500 (GF) 20/11/12 1167.5 426 741.5 Aug-15
4
6 Cliad Tablet
200 (GF) 05/11/12
8 Haloperidol 0,5 mg Tablet 290 790 430 360 Jun-16
300 (GF) 20/11/12
9 Haloperidol 1,5 mg Tablet 141.5 141.5 30 111.5 Dec-15
10 Haloperidol 5 mg Tablet 21 100 (GF) 20/11/12 121 30 91 Mar-16
90 (GF) 09/11/12
30 (GF) 20/11/12
60 (GF) 05/11/12
90 (GF) 20/11/12
60 (GF) 05/11/12
60 (GF) 20/11/12
17
17
Zofredal 1 mg Tablet 60 30 (GF) 20/11/12 90 55 35 Mar-14
60 (GF) 05/11/12
18 Persidal 2 mg Tablet 115 215 137.5 77.5 Aug-16
40 (GF) 28/11/12
19 Prohiper 10 mg Tablet 60 (GF) 09/11/12 60 15 45 Aug-16
5 (GF) 09/11/12
22 Stesolid Rectal 10 mg / 2,5 ml Rectal 2 12 7 5 Mar-14
5 (GF) 20/11/12
1500 (GF) 05/11/12
Trihexyphenidil 2 mg Tablet 922 2922 1773 1149 Jun-17
25 500 (GF) 28/11/12
Hexymer 2 mg Tablet
26 Trifluoperazine 5 mg Tablet 470 470 0 470 Mar-13
27 Valdimex 5 mg Tablet 769 1000 (GF) 05/11/12 1769 1317.5 451.5 Dec-15
PREKURSOR
1 Ephedrin 25 mg Tablet 858 858 574.5 283.5 Jul-17


NIP. 198508142010012030
STOK STOK
BULAN BULAN
NARKOTIKA
500 (GF) 02/10/12
1 Codein 10 mg Tablet 721 1971 1091.5 879.5 Jul-16
750 (GF) 15/10/12
3 Coditam Tablet 38 100 (GF) 02/10/12 138 35 103 Jan-15
PSIKOTROPIKA
400 (GF) 02/10/12
1 Amitriptilin 25 mg Tablet 402 500 (GF) 06/10/12 1402 603 799 Dec-15
500 (GF) 18/10/12
2 Bellaphen Tablet
3
Atarax 0,5 mg Tablet 504.5 1000 (GF) 02/10/12 1504.5 1280 224.5 Oct-15
Anxibloc 10 mg Tablet 769 500 (GF) 16/10/12 1269 601.5 667.5 Aug-15
4
50 (GF) 02/10/12
50 (GF) 25/10/12
6 Cliad Tablet
100 (GF) 02/10/12
8 Haloperidol 0,5 mg Tablet 122 622 332 290 Dec-15
400 (GF) 16/10/12
10 Haloperidol 5 mg Tablet 81 81 60 21 Mar-16
60 (GF) 02/10/12
60 (GF) 25/10/12
30 (GF) 02/10/12
12 Kalxetin 20 mg Tablet 65 90 (GF) 06/10/12 275 245 30 Aug-15
90 (GF) 25/10/12
30 (GF) 02/10/12
30 (GF) 18/10/12
30 (GF) 02/10/12
16 Olandoz 10 mg Tablet 41 131 105 26 Feb-14
60 (GF) 18/10/12
17
120 (GF) 02/10/12
18 Persidal 2 mg Tablet 50 250 135 115 Aug-16
80 (GF) 16/10/12
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 2 2 0 2 Mar-14
22 Seroquel Tablet 75 60 (GF) 06/10/12 135 60 75 May-14
1500 (GF) 02/10/12
Trihexyphenidil 2 mg Tablet 2000 1078 922 Jun-17
24 500 (GF) 25/10/12
Hexymer 2 mg Tablet 639 639 639 0
25 Trifluoperazine 5 mg Tablet 470 470 0 470 Mar-13
1000 (GF) 02/10/12
26 Valdimex 5 mg Tablet 384 1884 1115 769 Dec-15
500 (GF) 16/10/12


NIP. 198508142010012030
STOK STOK
BULAN BULAN
NARKOTIKA
750 (GF) 03/09/12
1 Codein 10 mg Tablet 678 1928 1207 721 Jul-16
500 (GF) 19/09/12
4 Durogesic 12,5 Patch 3 10 (GF) 03/09/12 13 2 11 Jul-13
6 MST 10 mg Tablet 80 80 70 10 Oct-14
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 744.5 500 (GF) 03/09/12 1244.5 842.5 402 Dec-15
2 Bellaphen Tablet
3
Atarax 0,5 mg Tablet 419.5 1300 (GF) 03/09/12 1719.5 1215 504.5 Oct-15
Anxibloc 10 mg Tablet 991.5 500 (GF) 19/09/12 1491.5 722.5 769 Aug-15
4
50 (GF) 03/09/12
5 Clozaril 25 mg Tablet 31 131 79 52 Jul-14
50 (GF) 19/09/12
6 Cliad Tablet
9 Haloperidol 1,5 mg Tablet 78 100 (GF) 03/09/12 178 76.5 101.5 Dec-15
60 (GF) 03/09/12
12 Kalxetin 20 mg Tablet 95 215 150 65 Jun-15
60 (GF) 25/09/12
15 Olandoz 5 mg Tablet 68.5 60 (GF) 11/09/12 128.5 105 23.5 Nov-13
30 (GF) 03/09/12
30 (GF) 25/09/12
Persidal 1 mg
17 Tablet
Zofredal 1 mg 60 60 (GF) 03/09/12 120 0 120 Mar-14
100 (GF) 03/09/12
18 Persidal 2 mg Tablet 100 220 170 50 Nov-15
18 Persidal 2 mg Tablet 100 220 170 50 Nov-15
20 (GF) 25/09/12
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 1 10 (GF) 03/09/12 11 9 2 Mar-14
23 Tofranil 25 mg Tablet 0 50 (GF) 03/09/12 50 10 40 Jan-17
Trihexyphenidil 2 mg Tablet
24
1000 (GF) 03/09/12
Hexymer 2 mg Tablet 800 2550 1911 639 Jun-16
750 (GF) 19/09/12
26 Valdimex 5 mg Tablet 937.5 1000 (GF) 03/09/12 1937.5 1553.5 384 Dec-15


NIP. 198508142010012030
STOK STOK
BULAN BULAN
NARKOTIKA
1000 (GF) 02/08/12
1 Codein 10 mg Tablet 148 1648 970 678 May-16
500 (GF) 09/08/12
5 Durogesic 25 Patch 17 17 0 17 Mar-13
PSIKOTROPIKA
500 (GF) 13/08/12
1 Amitriptilin 25 mg Tablet 481.5 1381.5 637 744.5 Dec-15
400 (GF) 15/08/12
2 Bellaphen Tablet
3
500 (GF) 02/08/12
Atarax 0,5 mg Tablet 719.5 1719.5 1300 419.5 Oct-15
500 (GF) 16/08/12
Anxibloc 10 mg Tablet 562.5 1000 (GF) 13/08/12 1562.5 571 991.5 Aug-15
4
5 Clozaril 25 mg Tablet 61 61 30 31 Jul-14
6 Cliad Tablet
10 Haloperidol 5 mg Tablet 43 100 (GF) 13/08/12 143 30 113 Mar-16
30 (GF) 02/08/12
90 (GF) 13/08/12
30 (GF) 02/08/12
15 Olandoz 5 mg Tablet 38.5 98.5 30 68.5 Nov-13
30 (GF) 13/08/12
16 Olandoz 10 mg Tablet 41 60 (GF) 02/08/12 101 60 41 Feb-14
Persidal 1 mg
17 Tablet
Zofredal 1 mg 60 60 (GF) 02/08/12 120 60 60 Jul-13
40 (GF) 02/08/12
18 Persidal 2 mg Tablet 110 250 150 100 Jan-15
100 (GF) 15/08/12
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 11 11 10 1 Dec-13
23 Tofranil 25 mg Tablet 50 (GF) 16/08/12 50 50 0 Jan-17
24
1500 (GF) 02/08/12
Hexymer 2 mg Tablet 260 2260 1460 800 Oct-15
500 (GF) 15/08/12
26 Valdimex 5 mg Tablet 441.5 1500 (GF) 02/08/12 1941.5 1004 937.5 Oct-15


NIP. 198508142010012030
STOK STOK
BULAN BULAN
NARKOTIKA
1000 (GF) 04/07/12
1 Codein 10 mg Tablet 237 1487 1339 148 May-16
250 (GF) 21/07/12
4 Durogesic 12,5 Patch 1 15 (GF) 24/07/12 16 10 6 Jul-13
5 Durogesic 25 Patch 12 15 (GF) 27/07/12 27 10 17 Mar-13
6 MST 10 mg Tablet 90 90 20 70 Oct-14
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 942.75 400 (GF) 21/07/12 1342.75 861.25 481.5 Dec-15
2 Bellaphen Tablet
3
Atarax 0,5 mg Tablet 1309 500 (GF) 21/07/12 1809 1089.5 719.5 Oct-15
800 (GF) 04/07/12
Anxibloc 10 mg Tablet 123.5 1423.50 861 562.5 Aug-15
4 500 (GF) 21/07/12
50 (GF) 04/07/12
50 (GF) 21/07/12
6 Cliad Tablet
90 (GF) 04/07/12
60 (GF) 27/07/12
30 (GF) 04/07/12
15 Olandoz 5 mg Tablet 46 106 67.5 38.5 Nov-13
30 (GF) 21/07/12
Persidal 1 mg
17 Tablet 60 (GF) 04/07/12
Zofredal 1 mg 0 150 90 60 Jul-13
17 Tablet
Zofredal 1 mg 0 150 90 60 Jul-13
90 (GF) 10/07/12
60 (GF) 04/07/12
140 (GF) 12/07/12
5 (GF) 04/07/12
5 (GF) 27/07/12
5 (GF) 12/07/12
10 (GF) 27/07/12
23 1750 (GF) 04/07/12
Hexymer 2 mg Tablet 22 2272 2012 260 Oct-15
500 (GF) 30/07/12
1000 (GF) 04/07/12
25 Valdimex 5 mg Tablet 425 1925 1483.5 441.5 Oct-15
500 (GF) 21/07/12


NIP. 198508142010012030
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 172 1000 (GF) 02/06/12 1172 935 237 May-16
4 Durogesic 12,5 Patch 1 1 0 1 Agt-12
PSIKOTROPIKA
500 (GF) 02/06/12
1 Amitriptilin 25 mg Tablet 99.25 1599.25 656.5 942.75 Dec-15
1000 (GF) 11/06/12
2 Bellaphen Tablet
3 1000 (GF) 02/06/12
Atarax 0,5 mg Tablet 140 2640 1331 1309 Oct-15
1500 (GF) 20/06/12
300 (GF) 02/06/12
Anxibloc 10 mg Tablet 368.75 868.75 745.25 123.5 Aug-15
4 200 (GF) 11/06/12
50 (GF) 02/06/12
50 (GF) 13/06/12
6 Cliad Tablet
10 Haloperidol 5 mg Tablet 100 (GF) 02/06/12 100 0 100 Mar-16
15 Olandoz 5 mg Tablet 100 100 54 46 Nov-13
30 (GF) 02/06/12
120 (GF) 11/06/12
Persidal 1 mg
17 Tablet
17 Tablet
100 (GF) 02/06/12
40 (GF) 11/06/12
Trihexyphenidil 2 mg Tablet 417 400 (GF) 02/06/12 817 817 0 Dec-16
23
Hexymer 2 mg Tablet 750 (GF) 11/06/12 750 728 22 Mar-15
25 Valdimex 5 mg Tablet 251.5 1500 (GF) 02/06/12 1751.5 1326.5 425 Oct-15


NIP. 198508142010012030 NIP. 19870314 201001 2 017
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 460 500 (GF) 04/05/12 960 788 172
2 Codein 15 mg Tablet 3.5 3.5 0 3.5
3 Coditam Tablet 99 99 25 74
4 Durogesic 12,5 Patch 3 3 2 1
5 Durogesic 25 Patch 21 21 6 15
6 MST 10 mg Tablet 60 60 30 30
PSIKOTROPIKA
500 (GF) 04/05/12
1 Amitriptilin 25 mg Tablet 81.75 1081.75 982.5 99.25
500 (GF) 22/05/12
2 Bellaphen Tablet
3 600 (GF) 04/05/12
Atarax 0,5 mg Tablet 393 1993 1853 140
1000 (GF) 22/05/12
100 (GF) 04/05/12
Anxibloc 10 mg Tablet 311.5 1011.5 642.75 368.75
4 600 (GF) 11/05/12
5 Clozaril 25 mg Tablet 9 50 (GF) 04/05/12 59 59 0
6 Cliad Tablet
8 Haloperidol 0,5 mg Tablet 215 500 (GF) 04/05/12 715 440 275
9 Haloperidol 1,5 mg Tablet 0 200 (GF) 04/05/12 200 0 200
10 Haloperidol 5 mg Tablet
30 (GF) 04/05/12
11 Kalxetin 10 mg Tablet 30 210 135 75
150 (GF) 11/05/12
12 Kalxetin 20 mg Tablet 131 60 (GF) 04/05/12 191 185 6
15 Olandoz 5 mg Tablet 155 155 55 100
16 Olandoz 10 mg Tablet 22.5 150 (GF) 04/05/12 172.5 127.5 45
Persidal 1 mg
17 Tablet
Zofredal 1 mg 30 30 (GF) 04/05/12 60 60 0
18 Persidal 2 mg Tablet 93 100 (GF) 04/05/12 193 153 40
19 Sandepril Tablet 25 25 0 25
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 8 8 8 0
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 1 5 (GF) 28/05/12 6 3 3
22 Seroquel Tablet 60 120 (GF) 04/05/12 180 90 90
Trihexyphenidil 2 mg Tablet 395 1500 (GF) 04/05/12 1895 1478 417
23
Hexymer 2 mg Tablet
24 Trifluoperazine 5 mg Tablet 560 560 0 560
25 Valdimex 5 mg Tablet 555 1000 (GF) 04/05/12 1555 1303.5 251.5
26 Zypraz 1 mg Tablet 35 35 0 35


NIP. 198508142010012030 NIP. 19870314 201001 2 017
A ASKES
W. SJAHRANIE
ED
Mar-16
Jan-16
Sep-14
Agt-12
Mar-13
Sep-14
Dec-15
Jul-15
Aug-15
Aug-13
Dec-15
Dec-15
Sep-13
Dec-14
Nov-13
Feb-14
Jul-13
Jan-15
Jun-14
Nov-13
Dec-13
May-14
Dec-16
Mar-15
May-13
Oct-15
Jan-14
Samarinda, 31 Mei 2012

Penyusun Laporan
Nanda Rimbun Sari, A.md Far.

NIP. 19870314 201001 2 017
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 0 1000 (GF) 16/04/12 1000 540 460 Mar-16
6 MST 10 mg Tablet 40 60 (GF) 11/04/12 100 40 60 Sep-14
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 402.5 400 (GF) 04/04/12 802.5 720.75 81.75 Dec-15
2 Bellaphen Tablet
3 600 (GF) 04/04/12
Atarax 0,5 mg Tablet 768 1868 1475 393 Jul-15
500 (GF) 24/04/12
Anxibloc 10 mg Tablet 397 600 (GF) 04/04/12 997 685.5 311.5 Aug-15
4
6 Cliad Tablet
100 (GF) 04/04/12
500 (GF) 11/04/12
11 Kalxetin 10 mg Tablet 0 180 (GF) 04/04/12 180 150 30 Jul-13
15 Olandoz 5 mg Tablet 5 150 (GF) 04/04/12 155 0 155 Nov-13
16 Olandoz 10 mg Tablet 97.5 60 (GF) 04/04/12 157.5 135 22.5 Feb-14
Persidal 1 mg
17 Tablet
17 Tablet
18 Persidal 2 mg Tablet 113 100 (GF) 11/04/12 213 120 93 Jan-15
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 2 2 1 1 Jan-13
Trihexyphenidil 2 mg Tablet 1865 1865 1470 395 Dec-16
23
Hexymer 2 mg Tablet Mar-15
25 Valdimex 5 mg Tablet 906 800 (GF) 04/04/12 1706 1151 555 Oct-15


NIP. 198508142010012030 NIP. 19870314 201001 2 017
STOK STOK
BULAN BULAN
NARKOTIKA
2 Codein 15 mg Tablet 166 500 (GF) 06/03/12 666 662.5 3.5 Jan-16
6 MST 10 mg Tablet 50 50 10 40 Jun-14
PSIKOTROPIKA
2 Bellaphen Tablet
3
Atarax 0,5 mg Tablet 244 1700 (GF) 03/03/12 1944 1176 768 May-15
Anxibloc 10 mg Tablet 734 500 (GF) 03/03/12 1234 837 397 Aug-15
4
5 Clozaril 25 mg Tablet 80 50 (GF) 03/03/12 130 72 58 Aug-13
6 Cliad Tablet
100 (GF) 03/03/12
100 (GF) 17/03/12
16 Olandoz 10 mg Tablet 165 30 (GF) 03/03/12 195 97.5 97.5 Feb-14
Persidal 1 mg
17 Tablet
Zofredal 1 mg 120 120 60 60 Jul-13
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 4 4 1 3 Oct-12
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 4 4 2 2 Jan-13
120 (GF) 03/03/12
22 Seroquel Tablet 30 270 150 120 May-14
120 (GF) 20/03/12
23
Hexymer 2 mg Tablet 213 213 213 0 Mar-15


NIP. 198508142010012030 NIP. 19870314 201001 2 017
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 0 5 (Depo R. Inap) 5 5 0
2 Codein 15 mg Tablet 0 500 (GF) 10/02/12 500 334 166 Jan-16
10 (GF) 14/02/12
15 (GF) 25/02/12
5 Durogesic 25 Patch 0 0 0 0 0 Mar-13
6 MST 10 mg Tablet 50 50 0 50 Jun-14
PSIKOTROPIKA
200 (GF) 04/02/12
1 Amitriptilin 25 mg Tablet 177.5 1377.5 831 546.5 Sep-15
1000 (GF) 15/02/12
2 Bellaphen Tablet
Zypraz 0,5 mg Tablet 371 800 (GF) 04/02/12 1171 1171 0 Aug-14
3
Atarax 0,5 mg Tablet 0 1000 (GF) 15/02/12 1000 756 244 May-15
500 (GF) 04/02/12
Anxibloc 10 mg Tablet 572 1372 638 734 Aug-15
4 300 (GF) 15/02/12
Frisium 10 mg Tablet 0
6 Cliad Tablet
9 Haloperidol 1,5 mg Tablet 91 91 75 16 Sep-14
30 (GF) 04/02/12
30 (GF) 10/02/12
60 (GF) 04/02/12
120 (GF) 10/02/12
16 Olandoz 10 mg Tablet 0 300 (GF) 14/02/12 300 135 165 Feb-14
Persidal 1 mg 0
17 Tablet
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 1 5 (GF) 04/02/12 6 2 4 Jan-13
Trihexyphenidil 2 mg Tablet 5.5 5.5 5.5 0 Dec-15
23
Hexymer 2 mg Tablet 0 2000 (GF) 04/02/12 2000 1787 213 Mar-15


NIP. 198508142010012030 NIP. 19870314 201001 2 017
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 32 500 (GF) 04/01/12 532 532 0 Oct-15
4 MST 10 mg Tablet 50 60 (GF) 17/01/12 110 60 50 Jun-14
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 1.5 1000 (GF) 04/01/12 1001.5 824 177.5 Mar-15
2 Bellaphen Tablet
1000 (GF) 17/01/12
Zypraz 0,5 mg Tablet 0 1500 1129 371 Aug-14
3 500 (GF) 26/01/12
Atarax 0,5 mg Tablet 208 208 208 0
Anxibloc 10 mg Tablet 0 1000 (GF) 11/01/12 1000 428 572 Aug-15
4
Frisium 10 mg Tablet 350.25 350.25 350.25 0
6 Cliad Tablet
8 Haloperidol 0,5 mg Tablet 201 500 (GF) 04/01/12 701 556 145 Nov-13
9 Haloperidol 1,5 mg Tablet 71 100 (GF) 21/01/12 171 80 91 Sep-14
10 Haloperidol 5 mg Tablet 0
30 (GF) 04/01/12
60 (GF) 04/01/12
30 (GF) 04/01/12
12 Kalxetin 20 mg Tablet 0 330 187 143 Aug-14
300 (GF) 04/01/12
13 Phenobarbital 30 mg Tablet 0
14 Ludiomil 50 mg Tablet 0
Persidal 1 mg 23 23 23 0
17 Tablet
Trihexyphenidil 2 mg Tablet 39 1000 (GF) 04/01/12 1039 1033.5 5.5 Dec-15
23
Hexymer 2 mg Tablet 0


NIP. 198508142010012030 NIP. 19870314 201001 2 017
STOK STOK
BULAN BULAN
NARKOTIKA
4 MST 10 mg Tablet 60 (GF) 16/12/11 60 10 50 Jun-14
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 798 798 796.5 1.5 Mar-15
2 Bellaphen Tablet
Calmlet 0,5 mg Tablet
3 500 (GF) 14/12/11
Atarax 0,5 mg Tablet 927 1827 1619 208 May-15
400 (GF) 22/12/11
Anxibloc 10 mg Tablet 260 300 (GF) 06/12/11 560 560 0
4
Frisium 10 mg Tablet 600 (GF) 16/12/11 600 249.75 350.25 Mar-16
50 (GF) 06/12/11
50 (GF) 14/12/11
6 Cliad Tablet
8 Haloperidol 0,5 mg Tablet 581 581 380 201 Nov-13
120 (GF) 06/12/11
12 Kalxetin 20 mg Tablet 90 270 270 0 Aug-14
60 (GF) 16/12/11
15 Olandoz 5 mg Tablet 30 90 (GF) 14/12/11 120 120 0
16 Olandoz 10 mg Tablet 56 30 (GF) 14/12/11 86 86 0
17 Persidal 1 mg Tablet 83 83 60 23 Sep-13
100 (GF) 06/12/11
40 (GF) 14/12/11
Trihexyphenidil 2 mg Tablet 684.5 1000 (GF) 06/12/11 1684.5 1645.5 39 Dec-15
23
Hexymer 2 mg Tablet
900 (GF) 06/12/11
300 (GF) 14/12/11


NIP. 198508142010012030
STOK STOK
BULAN BULAN
NARKOTIKA
1000 (GF) 03/11/11
1 Codein 10 mg Tablet 390.5 1890.5 1156.5 734 Sep-15
500 (GF) 18/11/11
2 Coditam Tablet 110 100 (GF) 23/11/11 210 126 84 Apr-14
4 MST 10 mg Tablet
PSIKOTROPIKA
200 (GF) 03/11/11
1 Amitriptilin 25 mg Tablet 319 1319 521 798 Mar-15
800 (GF) 09/11/11
2 Bellaphen Tablet
Calmlet 0,5 mg Tablet 0
3 700 (GF) 03/11/11
Atarax 0,5 mg Tablet 384 2084 1157 927 Nov-14
1000 (GF) 16/11/11
300 (GF) 03/11/11
Anxibloc 10 mg Tablet 224 1224 964 260 Dec-14
4 700 (GF) 09/11/11
100 (GF) 03/11/11
50 (GF) 09/11/11
6 Cliad Tablet
30 (GF) 03/11/11
120 (GF) 09/11/11
12 Kalxetin 20 mg Tablet 150 150 (GF) 03/11/11 300 210 90 Jan-14
15 Olandoz 5 mg Tablet 120 120 90 30 Nov-13
22 Seroquel Tablet 30 180 (GF) 09/11/11 210 150 60 Feb-14
Trihexyphenidil 2 mg Tablet 840 1000 (GF) 03/11/11 1840 1155.5 684.5 Dec-15
23
Hexymer 2 mg Tablet
300 (GF) 03/11/11
1100 (GF) 16/11/11


NIP. 198508142010012030
STOK STOK
BULAN BULAN
NARKOTIKA
1000 (GF) 07/10/11
500 (GF) 28/10/11
4 MST 10 mg Tablet
PSIKOTROPIKA
500 (GF) 07/10/11
1 Amitriptilin 25 mg Tablet 219.5 300 (GF) 18/10/11 1219.5 900.5 319 42064
200 (GF) 21/10/11
2 Bellaphen Tablet
Calmlet 0,5 mg Tablet 1197 500 (GF) 07/10/11 1697 1697 0
3
Atarax 0,5 mg Tablet 0 500 (GF) 21/10/11 500 116 384 Nov-14
300 (GF) 07/10/11
Anxibloc 10 mg Tablet 388 1388 1164 224 Dec-14
4 700 (GF) 14/10/11
6 Cliad Tablet
8 Haloperidol 0,5 mg Tablet 101 900 (GF) 07/10/11 1001 565 436 Jun-15
11 Kalxetin 10 mg Tablet 90 120 (GF) 14/10/11 210 165 45 Jun-13
12 Kalxetin 20 mg Tablet 37 300 (GF) 07/10/11 337 187 150 Jan-14
19 Sandepril Tablet 5 50 (GF) 07/10/11 55 15 40 Jun-14
120 (GF) 07/10/11
60 (GF) 18/10/11
23
Hexymer 2 mg Tablet
1000 (GF) 07/10/11
25 Valdimex 5 mg Tablet 578 2078 1559 519 May-15
500 (GF) 25/10/11


NIP. 198508142010012030
STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JML PENGELUARAN
BULAN
NARKOTIKA
1000 (GF)8/6/09
1 Codein 10 mg Tablet 512.25 2512.25 1540.5
2 MST 10 mg Tablet 171 1000(GF)24/6/09 171 15

-
PSIKOTROPIKA
400 (GF)6/6/09
1 Amitriptilin 25 mg Tablet 67.5 967.5 498.25
500(GF)23/6/09
2 Bellaphen Tablet 143 - 143 60
3 Camlet 0,5 mg Tablet 1983 800 (GF)23/6/09 2783 1990.5
4 Clobazam 10 mg Tablet 465 - 465 196
5 Clozaril 25 mg Tablet 135 - 135 30
6 Cliad Tablet 131 - 131 -
7 Chlorpromazin 100 mg Tablet 917 - 917 20
8 Haloperidol 0,5 mg Tablet 374 1000(GF)23/6/09 1374 445
9 Haloperidol 1,5 mg Tablet 761.5 - 761.5 77
10 Haloperidol 5 mg Tablet 142 - 142 -
11 Kalxetin 10 mg Tablet 66 - 66 10
12 Kalxetin 20 mg Tablet 265 300(GF)23/6/09 565 235
13 Luminal 30 mg Tablet 3600 - 3600 305
14 Ludiomil 50 mg Tablet 125 - 125 10
15 Persidal 1 mg Tablet 25 200(GF)10/6/09 225 60
16 Persidal 2 mg Tablet 273.5 - 273.5 130
17 Stelazine 5 mg Tablet 1000 - 1000 -
1000 (GF)6/6/09
18 Trihexyphenidil 2 mg Tablet 157.5 2157.5 2035
19 Valdimex 5 mg Tablet 900 1000(GF)15/6/09

1000(GF)27/6/09 1900 1134
Samarinda, 3 Juli 2009
Mengetahui,
Dra. Riani Maida Hutahaean, Apt Lita Ingria Desiana

NIP.19540925 198312 2001

STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN
BULAN
NARKOTIKA
1000 (GF)8/6/09
1 Codein 10 mg Tablet 512.25 2512.25 1540.5
2 MST 10 mg Tablet 171 1000(GF)24/6/09 171 15

-
PSIKOTROPIKA
2 Camlet 0,5 mg Tablet 1983 800 (GF)23/6/09 2783 1990.5
6 Valdimex 5 mg Tablet 900 1000(GF)27/6/09 1900 1134
Mengetahui,

NIP.19540925 198312 2001
ANIE
STOK
AKHIR
BULAN
971.75
156
469.25
83
792.5
259
105
131
897
926
684.5
142
56
330
3295
115
165
143.5
1000
122.5
766
ANIE
STOK
AKHIR
BULAN
971.75
156
83
792.5
259
131
3295
766
STOK STOK
BULAN BULAN
NARKOTIKA
500 (GF)4/9/09
1 Codein 10 mg Tablet 157 1657 884.5 772.5
1000(GF)16/9/09
2 MST 10 mg Tablet 146 - 146 30 116
PSIKOTROPIKA
1 Bellaphen Tablet 8 - 8 8 -
2 Camlet 0,5 Mg Tablet 1400 500 (GF) 4/9/09 1900 1036 864
Atarax 0,5 mg Tablet - - - - -
3 Clobazam 10 mg Tablet 150 - 150 - 150
Anxibloc 10 Mg Tablet 886.5 - 886.5 61.5 825
4 Cliad Tablet 131 - 131 - 131
5 Luminal 30 mg Tablet 2784 - 2784 107.5 2676.5
Stesolid Rectal 5 mg
6 Rectal 6 6 - 6
/ 2,5 ml -
7 Valdimex 5 mg Tablet 210 1000 (GF)4/9/09 1210 800 410
Samarinda, 3 Oktober 2009
Mengetahui,

NIP.19540925 198312 2001
STOK
BULAN
NARKOTIKA
1 Codein 10 mg Tablet 930.5 500 (GF) 4/8/09 1430.5 1273.5
2 MST 10 mg Tablet 156 - 156 10
PSIKOTROPIKA
1 Bellaphen Tablet 28 28 20
1000 (GF)4/8/09
2 Camlet 0,5 Mg Tablet 2500 1100
Atarax 0,5 mg Tablet 403 1500(GF)24/8/09 403 403
3 Clobazam 10 mg Tablet 150 - 150 -
Anxibloc 10 Mg Tablet 1000 - 1000 113.5
Stesolid Rectal 5 mg /
6 Rectal 6 6 -
2,5 ml -
7 Valdimex 5 mg Tablet 1107 - 1107 897
Samarinda, 3 September 2009
Mengetahui,

NIP.19540925 198312 2001
NIE
STOK
AKHIR
BULAN
157
146
8
1400
-
150
886.5
131
2784
6
210
STOK
BULAN
NARKOTIKA
1 Codein 10 mg Tablet 971.75 1000 (GF)29/7/09 1971.75 1041.25
2 MST 10 mg Tablet 156 - 156 -
PSIKOTROPIKA
2 Camlet 0,5 Tablet 792.5 - 792.5 792.5
Atarax 0,5 mg Tablet - 1000 (GF)22/7/09 1000 597
Anxibloc 10 Mg Tablet - 1000 (GF)22/7/09 1000 -
6 Rectal - 10 (GF) 29/7/09 10 4
2,5 ml
7 Valdimex 5 mg Tablet 766 1000 (GF)22/7/09 1766 659
Samarinda, 3 Agustus 2009
Mengetahui,

NIP.19540925 198312 2001
NIE
STOK
AKHIR
BULAN
930.5
156
28
-
403
150
1000
131
2999
1107
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JML PENGELUARAN AKHIR
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 36.5 1000(GF) 5/4/10 1036.5 762.25 274.25
2 Coditam Tablet - 100(GF) 22/4/10 100 - 100
3 MST 10 mg Tablet 113 - 113 20 93
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 25.5 500(GF) 5/4/10 525.5 393.5 132
2 Bellaphen Tablet - - - - -
3 Camlet 0,5 Mg Tablet - 1000(GF) 22/4/10 1000 190 810
Atarax 0,5 Mg Tablet 655 200(GF) 5/4/10 855 855 -
4 Anxibloc 10 Mg Tablet - - - - -
Frisium 10 Mg Tablet 364.75 - 364.75 350 14.75
5 Clozaril 25 mg Tablet - - - - -
6 Cliad Tablet - - - - -
7 Chlorpromazin 100 mg Tablet 632.5 - 632.5 59 573.5
8 Haloperidol 0,5 mg Tablet 67.5 500(GF) 5/4/10 567.5 482 85.5
9 Haloperidol 1,5 mg Tablet 268.5 - 268.5 15 253.5
10 Haloperidol 5 mg Tablet 88 - 88 29 59
11 Kalxetin 10 mg Tablet 184 - 184 20 164
13 Phenobarbital 30 mg Tablet 1568 - 1568 295 1273
14 Ludiomil 50 mg Tablet - - - - -
15 Persidal 1 mg Tablet 140 - 140 120 20
16 Persidal 2 mg Tablet - 100(GF) 5/4/10 100 99 1
17 Trifluoperazine 5 Mg Tablet 715 - 715 - 715
18 Rectal 6 10(GF) 22/4/10 16 6 10
2,5 ml
19 Rectal 5 - 5 1 4
2,5 ml
20 Trihexyphenidil 2 mg Tablet 545.75 1000(GF) 15/4/10 1545.75 1493.5 52.25
21 Valdimex 5 mg Tablet 209 300(GF) 5/4/10 1509 1240.75 268.25
1000(GF) 12/4/10
Mengetahui,

NIP.19540925 198312 2001
ED
Oct-13
Aug-12
Oct-11
Sep-12
-
May-12
Jul-13
-
Dec-13
-
-
Jun-12
Dec-11
Jun-11
Jun-11
Mar-11
Sep-11
Dec-13
-
Jan-13
Sep-13
May-13
Jan-12
Oct-11
Sep-14
Jul-13
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 1099 1099 852.5 246.5 Apr-15
4 MST 10 mg Tablet 0 0 0 0
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 397.5 500 (GF) 14/09/11 897.5 678 219.5 Mar-15
2 Bellaphen Tablet
1500 (GF) 07/09/11
Calmlet 0,5 mg Tablet 868 2868 1671 1197 May-12
3 500 (GF) 23/09/11
500 (GF) 07/09/11
Anxibloc 10 mg Tablet 369.5 1369.5 981.5 388.0 Apr-15
4 500 (GF) 22/09/11
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet 0.75 0.75 0.75 0
30 (GF) 07/09/11
11 Kalxetin 10 mg Tablet 45 165 75 90 May-13
90 (GF) 10/09/11
150 (GF) 07/09/11
12 Kalxetin 20 mg Tablet 0 300 263 37 Jan-14
150 (GF) 22/09/11
60 (GF) 07/09/11
40 (GF) 14/09/11
21 Seroquel Tablet 15 120 (GF) 17/09/11 135 135 0
Trihexyphenidil 2 mg Tablet 1295.5 1900 (GF) 14/09/11 3195.5 1790.5 1405 Dec-15
22
Hexymer 2 mg Tablet
24 Valdimex 5 mg Tablet 901 1000 (GF) 07/09/11 1901 1323 578 May-15


NIP. 198508142010012030
STOK STOK
BULAN BULAN
NARKOTIKA
500 (GF) 03/08/11
1 Codein 10 mg Tablet 313 1813 714 1099 Apr-15
1000 (GF) 09/08/11
2 Coditam Tablet 180 180 70 110 Jul-13
4 MST 10 mg Tablet 51 51 51 0
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 200 (GF) 03/08/11
151 751 353.5 397.5 Dec-14
400 (GF) 09/08/11
2 Bellaphen Tablet
1000 (GF) 06/08/11
Camlet 0,5 Mg Tablet 0 500 (GF) 16/08/11 2000 1132 868 May-12
3
500 (GF) 25/08/11
Atarax 0,5 Mg Tablet 0
Anxibloc 10 Mg Tablet 228.5 1000 (GF) 09/08/11 1228.5 859.0 369.5 Dec-14
4
Frisium 10 Mg Tablet
50 (GF) 03/08/11
150 (GF) 13/08/11
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet 0.75 0.75 0 0.75 Jun-12
9 Haloperidol 1,5 mg Tablet 253 253 38 215 Jun-12
30 (GF) 03/08/11
90 (GF) 09/08/11
15 Olandoz 10 Mg Tablet 6 150 (GF) 09/08/11 156 108 48 Nov-13
1000 (GF) 03/08/11
Trihexyphenidil 2 mg Tablet 523 2523 1227.5 1295.5 Dec-15
22 1000 (GF) 13/08/11
Hexymer 2 mg Tablet
23 Trifluoperazine 5 Mg Tablet 635 635 0 635 May-13
1000 (GF) 13/08/11
24 Valdimex 5 mg Tablet 921.5 2421.5 1520.5 901 May-15
500 (GF) 26/08/11
26 Zypraz 0,5 mg Tablet 66.5 66.5 66.5 0


NIP. 198508142010012030 NIP. 19870314 201001 2 017
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 110.5 1500 (GF) 02/07/11 1610.5 1297.5 313 Apr-15
2 Coditam Tablet 30 200 (GF) 27/07/11 230 50 180 Jul-13
3 Durogesic 25 Patch 0 0 0 0
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 200 (GF) 02/07/11
342 842 691 151 Dec-14
300 (GF) 09/07/11
2 Bellaphen Tablet
3 Camlet 0,5 Mg Tablet
Atarax 0,5 Mg Tablet 0 0 0
500 (GF) 09/07/11
4 Anxibloc 10 Mg Tablet 255.50 1255.5 1027 228.5 Dec-14
500 (GF) 25/07/11
5 Clozaril 25 mg Tablet 50 (GF) 09/07/11
50 150 137 13 Aug-13
50 (GF) 14/07/11
6 Cliad Tablet
9 Haloperidol 1,5 mg Tablet 304.5 304.5 51.5 253 Jun-12
120 (GF) 02/07/11
15 Olandoz 10 Mg Tablet 97 97 91 6 Jul-12
17 Persidal 2 mg Tablet 100 (GF) 02/07/11
5 205 105 100 Jan-15
100 (GF) 09/07/11
21 Seroquel Tablet 45 60 (GF) 20/07/11 105 60 45 Jun-13
22 Trihexyphenidil 2 mg Tablet 1000 (GF) 02/07/11
346 2346 1823 523 Dec-15
1000 (GF) 09/07/11
Hexymer 2 mg Tablet
1000 (GF) 02/07/11
24 Valdimex 5 mg Tablet 270.5 2070.5 1149 921.5 Feb-15
800 (GF) 20/07/11
26 Zypraz 0,5 mg Tablet 700 (GF) 02/07/11
216 1916 1849.5 66.5 May-14
1000 (GF) 14/07/11


NIP. 198508142010012030 NIP. 19870314 201001 2 017
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 1209.5 1209.5 1099 110.5 Apr-15
3 Durogesic 25 Patch 0 5 (GF) 07/06/11 5 5 0
4 MST 10 mg Tablet 41 41 35 6 Oct-11
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 269.5 500 (GF) 07/06/11 769.5 427.5 342 Sep-14
2 Bellaphen Tablet
Atarax 0,5 Mg Tablet 665 665 665 0
4 Anxibloc 10 Mg Tablet 97.75 500 (GF) 14/06/11 597.75 342.25 255.50 Dec-14
50 (GF) 14/06/11
50 (GF) 27/06/11
6 Cliad Tablet
9 Haloperidol 1,5 mg Tablet 39.5 300 (GF) 27/06/11 339.5 35 304.5 Jun-12
150 (GF) 07/06/11
150 (GF) 20/06/11
15 Olandoz 10 Mg Tablet 37 90 (GF) 20/06/11 127 30 97 Jul-12
21 Seroquel Tablet 60 60 15 45 Jun-13
22 Trihexyphenidil 2 mg Tablet 805 1000 (GF) 07/06/11 1805 1459 346 Dec-15
Hexymer 2 mg Tablet 0
400 (GF) 07/06/11
24 Valdimex 5 mg Tablet 205 1605 1334.5 270.5 Feb-15
1000 (GF) 20/06/11
26 Zypraz 0,5 mg Tablet 0 1000 (GF) 20/06/11 1000 784 216 Mar-14


NIP. 198508142010012030 NIP. 19870314 201001 2 017
STOK STOK
BULAN BULAN
NARKOTIKA
3 Durogesic 50 Patch 0 0 0
4 Durogesic 25 Patch 0 0 0
5 MST 10 mg Tablet 71 71 30 41 Oct-11
PSIKOTROPIKA
2 Bellaphen Tablet
1000 (GF) 03/05/11
Atarax 0,5 Mg Tablet 535 2035 1370 665 Oct-14
500 (GF) 24/05/11
4 Anxibloc 10 Mg Tablet 234.75 500 (GF) 03/05/11 734.75 637 97.75 Dec-14
5 Clozaril 25 mg Tablet 32 50 (GF) 18/05/11 82 34 48 May-13
6 Cliad Tablet
300 (GF) 10/05/11
40 (Depo IGD) 18/5/11
150 (GF) 11/05/11
150 (GF) 18/05/11
16 Persidal 1 mg Tablet 66 200 (GF) 18/05/11 266 45 221 Sep-13
17 Persidal 2 mg Tablet 85 100 (GF) 18/05/11 185 147 38 Sep-14
60 (GF) 03/05/11
60 (GF) 25/05/11
900 (GF) 03/05/11
22 Trihexyphenidil 2 mg Tablet 502 2402 1597 805 Sep-15
1000 (GF) 11/05/11
Hexymer 2 mg Tablet
24 Valdimex 5 mg Tablet 701 1000 (GF) 03/05/11 1701 1496 205 Jan-15


NIP. 198508142010012030 NIP. 19870314 201001 2 017
STOK STOK
BULAN BULAN
NARKOTIKA
699 699 694.5 4.5 Dec-14
3 Durogesic 50 Patch 5 (GF) 06/04/11 5 5 0
4 Durogesic 25 Patch 5 (GF) 19/04/11
0 10 10 0
5 (GF) 27/04/11
5 MST 10 mg Tablet 71 71 0 71 Oct-11
PSIKOTROPIKA
2 Bellaphen Tablet
3 Camlet 0,5 Mg Tablet 0
Atarax 0,5 Mg Tablet 400 (GF) 04/04/11
843 2043 1508 535 Jun-14
800 (GF) 13/04/11
4 Anxibloc 10 Mg Tablet 320.75 500 (GF) 04/04/11 820.75 586 234.75 Dec-14
5 Clozaril 25 mg Tablet 10 50 (GF) 04/04/11 60 28 32 May-13
6 Cliad Tablet
12 Kalxetin 20 mg Tablet 120 (GF) 04/04/11
0 240 227 13 Jan-14
120 (GF) 13/04/11
17 Persidal 2 mg Tablet 100 (GF) 04/04/11 Aug-14
65 265 180 85
65 265 180 85
100 (GF) 28/04/11
18 Sandepril Tablet 25 50 (GF) 23/04/11 75 75 0 Jun-14
21 Seroquel Tablet 30 30 30 0 Mar-12
22 Trihexyphenidil 2 mg Tablet 376.5 1500 (GF) 04/04/11 1876.5 1374.5 502 Sep-15
Hexymer 2 mg Tablet
24 Valdimex 5 mg Tablet 790 1000 (GF) 04/04/11 1790 1089 701 Jan-15


NIP. 198508142010012030 NIP. 19870314 201001 2 017
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JML PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 172.5 250 (GF) 03/03/11
1672.5 973.5 699 Dec-14
1250 (GF) 03/03/11
2 Coditam Tablet 220 - 220 20 200 Jul-13
3 Durogesic Patch -
4 MST 10 mg Tablet 71 - 71 0 71 Oct-11
PSIKOTROPIKA
2 Bellaphen Tablet -
3 Camlet 0,5 Mg Tablet 807.5 - 807.5 807.5 0
Atarax 0,5 Mg Tablet - 1000 (GF) 03/03/11
2000 1157 843 Jul-14
1000 (GF) 24/03/11
4 Anxibloc 10 Mg Tablet 287.25 500 (GF) 03/03/11 787.25 466.5 320.75 Aug-14
Frisium 10 Mg Tablet -
5 Clozaril 25 mg Tablet 40 - 40 30 10 May-13
6 Cliad Tablet -
7 Chlorpromazin 100 mg Tablet 10.75 - 10.75 10 0.75 Jun-12
8 Haloperidol 0,5 mg Tablet 605 - 605 365 240 Nov-13
9 Haloperidol 1,5 mg Tablet 254.5 - 254.5 75 179.5 Jun-12
10 Haloperidol 5 mg Tablet -
11 Kalxetin 10 mg Tablet - 60 (GF) 22/03/11
90 90 0 Jan-13
30(dari depo r.inap)
13 Phenobarbital 30 mg Tablet -
14 Ludiomil 50 mg Tablet -
16 Persidal 1 mg Tablet 111 - 111 45 66 Sep-13
17 Persidal 2 mg Tablet 120 100 (GF) 03/03/11 220 155 65 Jul-14
18 Sandepril Tablet - 50 (GF) 14/03/11 50 25 25 Jun-14
19 Stesolid Rectal 5 mg / 2,5 ml Rectal - 10 (GF) 12/03/11 10 1 9 Oct-12
20 Stesolid Rectal 10 mg / 2,5 ml Rectal 8 - 8 0 8 Oct-12
21 Seroquel Tablet - 60 (GF) 12/03/11 60 30 30 Mar-12
22 Trihexyphenidil 2 mg Tablet 798.5 1100 (GF) 03/03/11 1898.5 1522 376.5 Sep-15
Hexymer 2 mg Tablet -
23 Trifluoperazine 5 Mg Tablet 635 - 635 0 635 May-13
24 Valdimex 5 mg Tablet 348 2000 (GF) 10/03/11 2348 1558 790 Nov-14
25 Zypraz 1 mg Tablet 0 50 (GF) 31/03/11 50 0 50 Jan-14


NIP. 198508142010012030 NIP. 19870314 201001 2 017
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 415.5 750 (GF) 22/2/11 1165.5 993 172.5 Dec-14
2 Coditam Tablet 200 20 (pasien kembali) 220 - 220 Jul-13
3 Durogesic Patch - 5 (GF) 12/2/11 5 5 - Feb-12
4 MST 10 mg Tablet 81 - 81 10 71 Oct-11
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 213.5 500(GF) 1/2/11 1213.5 748.25 465.25 Sep-14
500(GF) 22/2/11
2 Bellaphen Tablet - - - - - -
3 Camlet 0,5 Mg Tablet 428 500(GF) 1/2/11 1928 1120.5 807.5 May-12
1000(GF) 23/2/11
Atarax 0,5 Mg Tablet - 500(GF) 16/2/11 500 500 - Jun-14
4 Anxibloc 10 Mg Tablet 179 600(GF) 1/2/11 779 491.5 287.5 Aug-14
Frisium 10 Mg Tablet - - - - - -
5 Clozaril 25 mg Tablet 85 - 85 45 40 May-13
6 Cliad Tablet - - - - - -
8 Haloperidol 0,5 mg Tablet 940 - 940 335 605 -
10 Haloperidol 5 mg Tablet - - - - - -
11 Kalxetin 10 mg Tablet 40 - 40 40 - Mar-11
12 Kalxetin 20 mg Tablet 85 60(GF) 12/2/11 205 179 26 Oct-13
60(GF) 26/2/11
13 Phenobarbital 30 mg Tablet - - - - - -
14 Ludiomil 50 mg Tablet - - - - - -
15 Olandoz 5 Mg Tablet - 90(GF) 9/2/11 90 53 37 Aug-11
17 Persidal 2 mg Tablet - 300(GF) 12/2/11 300 180 120 Mar-14
18 Sandepril Tablet 45 - 45 45 - Mar-13
19 Rectal 7 - 7 7 - Mar-12
2,5 ml
20 Rectal 8 - 8 - 8 Oct-12
2,5 ml
21 Seroquel Tablet 60 - 60 60 - Jul-13
22 Trihexyphenidil 2 mg Tablet 775.5 1000(GF) 1/2/11 2775.5 1977 798.5 Sep-15
1000(GF) 22/2/11
Hexymer 2 mg Tablet - - - - - -
23 Trifluoperazine 5 Mg Tablet 635 - 635 - 635 May-13
24 Valdimex 5 mg Tablet 105 1000(GF) 1/2/11 2105 1757 348 Nov-14
1000(GF) 21/2/11
Samarinda, 1 Maret 2011
Mengetahui,
Rahmatiah, Apt. Lita Ingria Desiana
NIP. 198508142010012030
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 124 500(GF) 6/1/11 1624 1208.5 415.5 Sep-14
500(GF)19/1/11 Dec-14
500(GF) 29/1/11
2 Coditam Tablet - 100(GF) 6/1/11 200 - 200 Jul-13
100(GF) 19/1/11
3 Durogesic Patch - 5(GF) 28/1/11 5 5 - Feb-12
4 MST 10 mg Tablet 81 81 - 81 Oct-11
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 444 400(GF) 6/1/11 844 630.5 213,,5 Sep-14
3 Camlet 0,5 Mg Tablet - 1000(GF) 6/1/11 1500 1072 428 May-12
500(GF) 21/1/11
Atarax 0,5 Mg Tablet 218 - 218 218 - May-14
4 Anxibloc 10 Mg Tablet 280.75 500(GF) 6/1/11 780.75 601.75 179 Aug-14
5 Clozaril 25 mg Tablet 29 100(GF) 19/1/11 129 44 85 May-13
8 Haloperidol 0,5 mg Tablet - 1000(GF) 27/1/11 1000 60 940 -
9 Haloperidol 1,5 mg Tablet - 500(GF) 6/1/11 500 175.5 324.5 Jun-12
11 Kalxetin 10 mg Tablet - 90(GF) 6/1/11 90 50 40 Mar-11
12 Kalxetin 20 mg Tablet 75 120(GF) 6/1/11 195 110 85 Sep-13
15 Olandoz 5 Mg Tablet - 30(GF) 22/1/11 30 30 - Aug-11
17 Persidal 2 mg Tablet 170.25 - 170.25 170.25 - Mar-14
19 Sandepril Tablet 75 - 75 30 45 Mar-13
Rectal 10 - 10 3 7 Mar-12
20 2,5 ml
Stesolid Rectal 10 mg / 10(GF) 11/1/11
21 Rectal - 10 2 8 Oct-12
2,5 ml
22 Seroquel Tablet 30 60(GF) 27/1/11 90 30 60 Jul-13
23 Trihexyphenidil 2 mg Tablet 131.5 1000(GF) 11/1/11 2131.5 1356 775.5 Sep-15
1000(GF) 29/1/11
Hexymer 2 mg Tablet - - - - - -
24 Valdimex 5 mg Tablet - 1000(GF) 12/1/11 1500 1395 105 Nov-14
500(GF) 21/1/11
Samarinda, 1 Februari 2011
Mengetahui,

NIP. 198508142010012030
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 582 500(GF) 3/12/10 1082 958 124 Apr-14
2 Coditam Tablet 70 - 70 70 - Jul-13
3 MST 10 mg Tablet 81 - 81 - 81 Oct-11
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 213.5 200(GF) 3/12/10 1013.5 569.5 444 Sep-14
600(GF) 14/12/10
3 Camlet 0,5 Mg Tablet - - - - - -
Atarax 0,5 Mg Tablet 650.5 700(GF) 3/12/10 1350.5 1132.5 218 May-14
4 Anxibloc 10 Mg Tablet 6 500(GF) 1/12/10 806 525.25 280.75 Mar-14

300(GF) 14/12/10
5 Clozaril 25 mg Tablet 4 100(GF) 1/12/10 104 75 29 Oct-12
7 Chlorpromazin 100 mg Tablet 167.25 - 167.25 17.5 149.75 Jun-12
8 Haloperidol 0,5 mg Tablet - - - - - -
9 Haloperidol 1,5 mg Tablet 75 100(GF) 3/12/10 175 175 - Jun-12
11 Kalxetin 10 mg Tablet 20 - 20 20 - Mar-11
12 Kalxetin 20 mg Tablet 30 90(GF) 1/12/10 240 165 75 Mar-13
120(GF) 14/12/10
15 Persidal 1 mg Tablet 142 - 142 - 142 Sep-13
16 Persidal 2 mg Tablet 30.25 280(GF) 3/12/10 310.25 140 170.25 Mar-14
18 Sandepril Tablet 75 - 75 - 75 Mar-13
19 Rectal 10 - 10 - 10 Mar-12
2,5 ml
20 Rectal 6 - 6 6 - Jul-12
2,5 ml
21 Seroquel Tablet - 60(GF) 4/12/10 60 30 30
22 Trihexyphenidil 2 mg Tablet 783.5 1000(GF) 1812/10 1783.5 1652 131.5 Sep-15
Hexymer 2 mg Tablet
23 Valdimex 5 mg Tablet 425.5 1000(GF) 1812/10 1425.5 1425.5 - Jun-14
Samarinda, 3 Januari 2011
Mengetahui,

NIP. 198508142010012030
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 401 1000(GF) 16/11/10 1401 819 582
2 Coditam Tablet 90 - 90 20 70
3 MST 10 mg Tablet 81 - 81 - 81
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 55.5 800(GF) 2/11/10 855.5 642 213.5
3 Camlet 0,5 Mg Tablet - - - - -
Atarax 0,5 Mg Tablet 97.5 900(GF) 2/11/10 1997.5 1347 650.5
1000(GF) 15/11/10
4 Anxibloc 10 Mg Tablet - 500(GF) 15/11/10 500 494 6
Frisium 10 Mg Tablet - 200(GF) 2/11/10 200 200 -
5 Clozaril 25 mg Tablet - 100(GF) 2/11/10 100 96 4
8 Haloperidol 0,5 mg Tablet - - - - -
9 Haloperidol 1,5 mg Tablet 163 - 163 88 75
10 Haloperidol 5 mg Tablet 34 - 34 34 -
13 Phenobarbital 30 mg Tablet - - - - -
15 Persidal 1 mg Tablet 42 100(GF) 2/11/10 142 - 142
16 Persidal 2 mg Tablet 6.5 200(GF) 2/11/10 206.5 176.25 30.25
18 Sandepril Tablet 105 - 105 30 75
19 Rectal - 10(GF) 2/11/10 10 - 10
2,5 ml
20 Rectal - 10(GF) 2/11/10 10 4 6
2,5 ml
21 Trihexyphenidil 2 mg Tablet - 1500(GF) 2/11/10 1500 716.5 783.5
Hexymer 2 mg Tablet
22 Valdimex 5 mg Tablet - 1000(GF) 2/11/10 2000 1574.5 425.5
500(GF) 15/11/10
500(GF) 26/11/10
Samarinda, 1 Desember 2010
Mengetahui,

NIP. 198508142010012030
ED
Apr-14
Jul-13
Oct-11
Sep-14
-
May-12
May-14
Mar-14
Oct-14
Oct-12
-
Jun-12
Dec-11
Jun-12
Jun-11
Mar-11
Mar-13
-
-
Sep-13
Mar-14
May-13
Mar-13
Mar-12
Jul-12
Sep-15
Jun-14
STOK STOK
BULAN BULAN
NARKOTIKA
2 Coditam Tablet - 100(GF) 19/10/10 100 10 90
3 MST 10 mg Tablet 81 - 81 - 81
PSIKOTROPIKA
3 Camlet 0,5 Mg Tablet 833.5 - 833.5 833.5 -
Atarax 0,5 Mg Tablet - 500(GF) 4/10/10 500 402.5 97.5
4 Anxibloc 10 Mg Tablet 420 - 420 420 -
Frisium 10 Mg Tablet - - - - -
8 Haloperidol 0,5 mg Tablet 2 - 2 2 -
11 Kalxetin 10 mg Tablet 47 60(GF) 27/10/10 107 57 50
12 Kalxetin 20 mg Tablet 75 - 75 - 75
16 Persidal 2 mg Tablet 185.25 - 185.25 178.75 6.5
17 Trifluoperazine 5 Mg Tablet 708 - 708 13 695
19 Rectal 3 3 3 -
2,5 ml -
20 Rectal 6 - 6 6 -
2,5 ml
21 Trihexyphenidil 2 mg Tablet 3 1500(GF) 4/10/10 1503 1503 -
Hexymer 2 mg Tablet
22 Valdimex 5 mg Tablet 393 1000(GF) 4/10/10 1393 1393 -
Samarinda, 1 November 2010
Mengetahui,

NIP. 198508142010012030
ED
Apr-14
Jul-13
Oct-11
Sep-14
-
May-12
Nov-13
Mar-14
-
-
-
Jun-12
Dec-11
Jun-12
Jun-11
Mar-11
Mar-13
-
-
Sep-13
Mar-14
May-13
Mar-13
Jan-12
Oct-11
Jun-15
Jun-14
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 5 - 5 - 5
2 Coditam Tablet - - - - -
3 MST 10 mg Tablet 81 - 81 - 81
PSIKOTROPIKA
3 Camlet 0,5 Mg Tablet 944.5 1000(GF) 22/9/10 1944.5 1111 833.5
Atarax 0,5 Mg Tablet - - - - -
4 Anxibloc 10 Mg Tablet 329 500(GF) 20/9/10 829 409 420
7 Chlorpromazin 100 mg Tablet 295.75 - 295.75 51.5 244.25
9 Haloperidol 1,5 mg Tablet 368.75 - 368.75 52.75 316
15 Persidal 1 mg Tablet 52 200(GF) 15/9/10 252 85 167
16 Persidal 2 mg Tablet 84 280(GF) 15/9/10 364 178.75 185.25
18 Sandepril Tablet 50 100(GF) 2/9/10 150 30 120
19 Rectal 4 5(GF) 17/9/10 9 6 3
2,5 ml
Stesolid Rectal 10
20 Rectal 1 5(GF) 17/9/10 6 - 6
mg / 2,5 ml
21 Trihexyphenidil 2 mg Tablet - 1500(GF) 2/9/10 1500 1497 3
Hexymer 2 mg Tablet
22 Valdimex 5 mg Tablet 526 1000(GF) 2/9/10 1526 1133 393
Mengetahui,

NIP.19540925 198312 2001
IE
ED
Oct-13
Jan-13
Oct-11
Sep-14
-
May-12
Nov-13
Mar-14
-
Apr-12
-
Jun-12
Dec-11
Jun-12
Jun-11
Mar-11
Mar-13
Dec-13
-
Sep-13
Mar-14
May-13
Mar-13
Jan-12
Oct-11
Jun-14
May-14
STOK STOK
BULAN BULAN
NARKOTIKA
2 Coditam Tablet 29 - 29 29 -
3 MST 10 mg Tablet 93 - 93 12 81
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 274 500(GF) 22/8/10 774 421.5 352.5
3 Camlet 0,5 Mg Tablet - 600(GF) 14/8/10 1600 655.5 944.5
1000(GF) 28/8/10
Atarax 0,5 Mg Tablet 307 500(GF) 6/8/10 807 807 -
4 Anxibloc 10 Mg Tablet 273.75 200(GF) 6/8/10 973.75 644.75 329
200(GF) 21/8/10
300(GF) 22/8/10
5 Clozaril 25 mg Tablet 20 50(GF) 14/8/10 70 70 -
7 Chlorpromazin 100 mg Tablet 334.5 - 334.5 38.75 295.75
8 Haloperidol 0,5 mg Tablet 196 300(GF) 6/8/10 496 481 15
13 Phenobarbital 30 mg Tablet 62 50 112 112 -
100(GF) 22/8/10
100(GF) 22/8/10
18 Sandepril Tablet 5 100(GF) 19/8/10 105 55 50
19 Rectal 6 - 6 2 4
2,5 ml
20 Rectal 3 - 3 2 1
2,5 ml
21 Trihexyphenidil 2 mg Tablet 630 1000(GF) 6/8/10 1630 1630 -
Hexymer 2 mg Tablet - - -
500(GF) 28/8/10
Samarinda, 1 September 2010
Mengetahui,

NIP.19540925 198312 2001
ED
Oct-13
Jan-13
Oct-11
Sep-14
-
May-12
Nov-13
Mar-14
-
Apr-12
-
Jun-12
Dec-11
Jun-12
Jun-11
Mar-11
Mar-13
Dec-13
-
Sep-13
Dec-13
May-13
Mar-13
Jan-12
Oct-11
Jun-15
May-14
STOK STOK
BULAN BULAN
NARKOTIKA
3 MST 10 mg Tablet 93 - 93 - 93
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 255 500(GF) 1/7/10 755 481 274
Atarax 0,5 Mg Tablet 209.5 1000(GF) 1/7/10 1709.5 1402.5 307
500(GF) 26/7/10
4 Anxibloc 10 Mg Tablet 504.75 300(GF) 1/7/10 804.75 531 273.75
5 Clozaril 25 mg Tablet 35 - 35 15 20
8 Haloperidol 0,5 mg Tablet 71 500(GF) 1/12/11 871 675 196
300(GF) 26/7/10
9 Haloperidol 1,5 mg Tablet 213.5 - 213.5 119.75 93.75
13 Phenobarbital 30 mg Tablet 727 200(rawat inap) 727 865 62
16 Persidal 2 mg Tablet 10 160(GF) 1/7/10 170 170 -
19 Rectal 6 - 6 - 6
2,5 ml
20 Rectal 3 - 3 - 3
2,5 ml
21 Trihexyphenidil 2 mg Tablet 394 1000(GF) 1/7/10 2394 1764 630
1000(GF) 26/7/10
Hexymer 2 mg Tablet - - - - -
22 Valdimex 5 mg Tablet - 1000(GF) 1/7/10 1500 999 501
500(GF) 26/7/10
Samarinda, 2 Agustus 2010
Mengetahui,

NIP.19540925 198312 2001
ED
Oct-13
Jan-13
Oct-11
Jun-13
-
-
Nov-13
Nov-13
Mar-14
-
Apr-12
-
Jun-12
Dec-11
Dec-11
Jun-11
Jun-11
Mar-11
Sep-11
Dec-13
-
Jan-13
Dec-13
May-13
Mar-13
Jan-12
Oct-11
Jun-15
Jun-15
Sep-13
May-14
May-14
STOK STOK
BULAN BULAN
NARKOTIKA
3 MST 10 mg Tablet 93 - 93 - 93
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 298 500(GF) 22/6/10 798 543 255
Atarax 0,5 Mg Tablet 783 1000(GF) 14/6/10 1783 1573.5 209.5
4 Anxibloc 10 Mg Tablet 666.25 500(GF) 22/6/10 1166.25 661.5 504.75
5 Clozaril 25 mg Tablet - 50(GF) 14/6/10 50 15 35
10 Haloperidol 5 mg Tablet 53 - 53 - 53
13 Phenobarbital 30 mg Tablet 1070.5 - 1070.5 343.5 727
18 Sandepril Tablet - 50(GF) 12/6/10 50 15 35
19 Rectal 9 - 9 3 6
2,5 ml
20 Rectal 3 - 3 - 3
2,5 ml
21 Trihexyphenidil 2 mg Tablet - 1000(GF) 14/6/10 1000 606 394
Hexymer 2 mg Tablet 36.25 - 36.25 36.25 -
22 Valdimex 5 mg Tablet - - - - -
Mengetahui,

NIP.19540925 198312 2001
ED
Oct-13
Jan-13
Oct-11
Sep-12
-
-
Jul-13
Nov-13
-
Apr-12
-
Jun-12
Dec-11
Jun-11
Jun-11
Mar-11
Sep-11
Dec-13
-
Jan-13
Sep-13
May-13
Mar-13
Jan-12
Oct-11
Sep-14
Sep-13
-
STOK STOK
NAMA OBAT
NO
SATUAN AWAL PENERIMAAN JML PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 274.25 1000(GF) 4/5/10 1274.25 1179.25 95 Oct-13
2 Coditam Tablet 100 100(GF) 27/5/10 200 110 90 Jan-13
3 MST 10 mg Tablet 93 - 93 - 93 Oct-11
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 132 500(GF) 4/5/10 632 334 298 Sep-12
3 Camlet 0,5 Mg Tablet 810 500(GF) 4/5/10 1310 1310 - May-12
Atarax 0,5 Mg Tablet - 1000(GF) 25/5/10 1000 217 783 Jul-13
4 Anxibloc 10 Mg Tablet - 1000(GF) 1/5/10 1000 333.75 666.25 Nov-13
Frisium 10 Mg Tablet 14.75 - 14.75 14.75 - Dec-13
5 Clozaril 25 mg Tablet - - - - - -
8 Haloperidol 0,5 mg Tablet 85.5 500(GF) 4/5/10 585.5 159.5 426 Dec-11
10 Haloperidol 5 mg Tablet 59 - 59 6 53 Jun-11
11 Kalxetin 10 mg Tablet 164 - 164 - 164 Mar-11
12 Kalxetin 20 mg Tablet 70 - 70 45 25 Sep-11
13 Phenobarbital 30 mg Tablet 1273 - 1273 202.5 1070.5 Dec-13
15 Persidal 1 mg Tablet 20 100(GF) 4/5/10 120 30 90 Jan-13
16 Persidal 2 mg Tablet 1 100(GF) 4/5/10 301 150 151 Sep-13
200(GF) 25/5/10
18 Rectal 10 - 10 1 9 Jan-12
2,5 ml
19 Rectal 4 - 4 1 3 Oct-11
2,5 ml
20 Trihexyphenidil 2 mg Tablet 52.25 - 52.25 52.25 - Sep-14
Hexymer 2 mg Tablet - 1250(GF) 5/5/10 1500 1463.75 36.25 Sep-13
250(GF) 27/5/10
21 Valdimex 5 mg Tablet 268.25 500(GF) 4/5/10 768.25 768.25 - Jul-13
Samarinda, 1 Juni 2010
Mengetahui,

NIP.19540925 198312 2001
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 1011 - 1011 974.5 36.5
2 MST 10 mg Tablet 113 - 113 - 113
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 347.75 100(bon rutin) 347.75 422.25 25.5
3 Camlet 0,5 Mg Tablet 245 - 245 245 -
Atarax 0,5 Mg Tablet - 1500(GF) 10/3/10 1500 845 655
4 Anxibloc 10 Mg Tablet - - - - -
Frisium 10 Mg Tablet 331.75 500(GF) 20/3/10 831.75 467 364.75
10 Haloperidol 5 mg Tablet 88 - 88 - 88
13 Phenobarbital 30 mg Tablet 1767 - 1767 199 1568
16 Persidal 2 mg Tablet 42 100(GF) 4/3/10 142 142 -
18 Rectal 1 5(GF) 4/3/10 6 - 6
2,5 ml
19 Rectal - 5(GF) 4/3/10 5 - 5
2,5 ml
20 Trihexyphenidil 2 mg Tablet 352.75 1000(GF) 4/3/10 2252.75 1707 545.75
900(GF) 20/3/10
Samarinda, 1 April 2010
Mengetahui,

NIP.19540925 198312 2001
ED
Jun-13
Oct-11
Sep-12
-
Nov-11
Jul-13
-
Dec-13
-
-
Jun-12
Dec-11
Jun-11
Jun-11
Mar-11
Sep-11
Dec-13
-
Jan-13
Mar-13
May-13
Dec-11
Oct-11
Sep-14
Sep-14
Jul-13
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 751.25 1000(GF) 4/2/10 1751.25 740.25 1011 Jun-13
2 MST 10 mg Tablet 113 - 113 - 113 Oct-11
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 226.5 500(GF) 4/2/10 726.5 378.75 347.75 Sep-12
1300(GF)
3 Camlet 0,5 Mg Tablet - 1300 1055 245 Nov-11
11/2/10
Atarax 0,5 Mg 490 490 490 -
Tablet - Jul-13
4 Anxibloc 10 Mg Tablet 82.5 82.5 82.5 - Feb-13
Frisium 10 Mg Tablet - 500(GF) 4/2/10 900 568.25 331.75 Oct-13
400(GF) 24/2/10 Oct-13
5 Clozaril 25 mg Tablet - - - - - -
10 Haloperidol 5 mg Tablet 88 - 88 - 88 Jun-11
11 Kalxetin 10 mg Tablet 270 - 270 17 253 Mar-11
12 Kalxetin 20 mg Tablet 302 - 302 67 235 Sep-11
13 Phenobarbital 30 mg Tablet 1872.5 - 1872.5 105.5 1767 Dec-13
15 Persidal 1 mg Tablet 98.5 - 98.5 98.5 - Feb-12
16 Persidal 2 mg Tablet 147.5 - 147.5 105.5 42 Sep-12
18 Rectal 3 - 3 2 1 Nov-11
2,5 ml
19 Rectal 3 - 3 3 -
2,5 ml Oct-11
20 Trihexyphenidil 2 mg Tablet 751.5 1000(GF) 4/2/10 1751.5 1398.75 352.75 Sep-14
21 Valdimex 5 mg Tablet 837 500(GF) 9/2/10 1337 1108 229 Mar-13
Mengetahui,

NIP.19540925 198312 2001
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 601.75 1000(GF) 25/1/10 1601.75 850.5 751.25
2 MST 10 mg Tablet 116 - 116 3 113
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 644.75 - 644.75 418.25 226.5
3 Camlet 0,5 Mg Tablet - 1000(GF) 5/1/10 1000 1000 -
Atarax 0,5 Mg Tablet 54.5 500(GF) 20/1/10 1054.5 564.5 490
500(GF) 21/1/10
4 Clobazam 10 mg Tablet - - - - -
Anxibloc 10 Mg Tablet 499.25 - 499.25 416.75 82.5
12 Kalxetin 20 mg Tablet 2 300(GF) 6/1/10 302 - 302
13 Phenobarbital 30 mg Tablet 1984 - 1984 111.5 1872.5
14 Ludiomil 50 mg Tablet 5 - 5 5 -
15 Persidal 1 mg Tablet 113.5 - 113.5 15 98.5
16 Persidal 2 mg Tablet 179 - 179 31.5 147.5
Stesolid Rectal 5 mg / 2,5
18 Rectal 2 5(GF)9/1/2010 7 4 3
ml
Stesolid Rectal 10 mg / 2,5
19 Rectal 1 5(GF)9/1/2010 6 3 3
ml
1000(GF) 6/1/10
20 Trihexyphenidil 2 mg Tablet 325.25 2325.25 1573.75 751.5
1000(GF)25/1/10
400(GF)9/1/2010
500(GF) 21/1/10
Samarinda, 1 Februari 2010
Mengetahui,

NIP.19540925 198312 2001
E
ED
Jun-13
Oct-11
Sep-12
-
Nov-11
Jul-13
Jul-13
Feb-13
-
-
Jun-12
Jun-11
Jun-11
Jun-11
Mar-11
Sep-11
Dec-13
-
Feb-12
Sep-12
May-13
Nov-11
Oct-11
Jun-13
Mar-13
STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JML PENGELUARAN
BULAN
NARKOTIKA
2 MST 10 mg Tablet 116 - 116 -
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 915.75 - 915.75 271
2 Bellaphen Tablet - - - -
3 Camlet 0,5 Mg Tablet - - - -
Atarax 0,5 Mg Tablet 341.5 800 (GF) 2/12/09 1141.5 1087
4 Clobazam 10 mg Tablet - - - -
Anxibloc 10 Mg Tablet 611.5 - 611.5 112.25
5 Clozaril 25 mg Tablet 24 - 24 24
6 Cliad Tablet - - - -
7 Chlorpromazin 100 mg Tablet 796.5 - 796.5 45
8 Haloperidol 0,5 mg Tablet 408.5 500 (GF) 10/12/09 908.5 240
9 Haloperidol 1,5 mg Tablet 394.5 - 394.5 70
10 Haloperidol 5 mg Tablet 135 - 135 6
11 Kalxetin 10 mg Tablet 326 - 326 -
12 Kalxetin 20 mg Tablet 27 - 27 25
13 Phenobarbital 30 mg Tablet 2025 - 2025 41
14 Ludiomil 50 mg Tablet 20 - 20 15
15 Persidal 1 mg Tablet 174 - 174 60.5
16 Persidal 2 mg Tablet 301.75 - 301.75 122.75
17 Trifluoperazine 5 Mg Tablet 910 - 910 36
Stesolid Rectal 5 mg / -
18 Rectal 4 4 2
2,5 ml
19 Rectal 1 - 1 -
2,5 ml
500 (GF) 2/12/09
20 Trihexyphenidil 2 mg Tablet 369 1869 1543.75
100015/12/09
1000 (GF) (GF)
21 Valdimex 5 mg Tablet 646 15/12/09
500 (GF) 2/12/09 1146 775
Samarinda, 1 Januari 2010
Mengetahui,

NIP.19540925 198312 2001
ANIE
STOK
AKHIR
BULAN
601.75
116
644.75
-
-
54.5
-
499.25
-
-
751.5
668.5
324.5
129
326
2
1984
5
113.5
179
874
325.25
371
STOK STOK
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 773 500 (GF) 4/11/09 1273 660.5 612.5
2 MST 10 mg Tablet 116 - 116 - 116
PSIKOTROPIKA
Atarax 0,5 Mg Tablet 520.5 1000 (GF) 4/11/09 1520.5 1179 341.5
3 Clobazam 10 mg Tablet - - - - -
Anxibloc 10 Mg Tablet 723 - 723 111.5 611.5
4 Cliad Tablet 131 - 131 - 131
5 Luminal 30 mg Tablet 2306 - 2306 281 2025
6 Valdimex 5 mg Tablet 315 1300 (GF) 4/11/09 1615 969 646
Mengetahui,

NIP.19540925 198312 2001
STOK
BULAN
NARKOTIKA
2 MST 10 mg Tablet 116 - 116 -
PSIKOTROPIKA
1 Bellaphen Tablet - - - -
2 Camlet 0,5 Mg Tablet 864 - 864 864
1000 (GF) 5/10/09
Atarax 0,5 Mg 1000 479.5
Tablet
Anxibloc 10 Mg Tablet 825 - 825 102
5 Luminal 30 mg Tablet 2676.5 - 2676.5 370.5
Stesolid Rectal 5 mg / -
6 Rectal 6 6 -
2,5 ml
7 Rectal - 10 (GF) 5/10/09 10 4
2,5 ml
8 Valdimex 5 mg Tablet 410 1000 (GF) 5/10/09 1410 1095
Samarinda, 1 November 2009
Mengetahui,

NIP.19540925 198312 2001
RANIE
STOK
AKHIR
BULAN
773
116
-
-
520.5
-
723
131
2306
6
6
315
STOK STOK
BULAN BULAN
NARKOTIKA
1 Coditam Tablet 91 0 91 0 91
2 MST 10 mg Tablet 0 0 0 0 0
PSIKOTROPIKA
1 Zypraz 0,5 mg Tablet 0 0 0 0 0
2 Clorilex 100 mg Tablet 0.5 0 0.5 0 0.5
3 Kalxetin 10 mg Tablet 0 0 0 0 0
4 Kalxetin 20 mg Tablet 0 0 0 0 0
5 Phenobarbital 30 mg Tablet 0 0 0 0 0
6 Olandoz 5 mg Tablet 1 0 1 0 1
7 Olandoz 10 mg Tablet 0.5 0 0.5 0 0.5
8 Zofredal 1 mg Tablet 0.5 0 0.5 0 0.5
9 Zofredal 2 mg Tablet 30 0 30 0 30
10 Prohiper 10 mg Tablet 0 0 0 0 0
11 Sandepril Tablet 0 0 0 0 0
Stesolid Rectal 5 mg / 2,5 ml Rectal 1 0 1 1 0
12
Trazep 2 mg/ ml Rectal 0 0 0 0 0
13 Seroquel Tablet 0 0 0 0 0
14 Tofranil 25 mg Tablet 50 0 50 42 8
PREKURSOR
1 Rhinofed Tablet 5 0 5 0 5
2 Ericaf Tablet 0.5 0 0.5 0.5 0


NIP. 19780602 200903 2 003 NIP. 19651027 199203 2 005
I STOK NARKOTIKA & PSIKOTROPIKA ASKES
JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
ED
Sep-15
-
-
Jan-17
-
-
-
Jun-15
Jun-15
Sep-14
Sep-15
-
-
Oct-15
-
-
Jan-17
Aug-16
Jul-15

Penyusun Laporan
Rusmilawati
NIP. 19651027 199203 2 005
STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH
BULAN
NARKOTIKA
1 Coditam Tablet 91 0 91
2 MST 10 mg Tablet 0
PSIKOTROPIKA
1 Zypraz 0,5 mg Tablet 0
2 Clorilex 100 mg Tablet 0.5 0 0.5
3 Kalxetin 10 mg Tablet 0
4 Kalxetin 20 mg Tablet 0
5 Phenobarbital 30 mg Tablet 0
6 Olandoz 5 mg Tablet 1 0 1
7 Olandoz 10 mg Tablet 0.5 0 0.5
8 Zofredal 1 mg Tablet 0.5 0 0.5
9 Zofredal 2 mg Tablet 30 0 30
10 Prohiper 10 mg Tablet 0
11 Sandepril Tablet 0
Stesolid Rectal 5 mg / 2,5 ml Rectal 0
12
Trazep 2 mg/ ml Rectal 0
13 Seroquel Tablet 0
14 Tofranil 25 mg Tablet 8 0 8
PREKURSOR
1 Rhinofed Tablet 5 0 5
2 Ericaf Tablet 0
Mengetahui,
Koordinator Depo Obat Rawat Jalan
Yuniastuti, S.Si.,M.Si, Apt

NIP. 19780602 200903 2 003
OTROPIKA ASKES
RSUD A.W. SJAHRANIE
15
STOK
PENGELUARAN AKHIR ED
BULAN
91 Sep-15
-
-
0.5 Jan-17
-
-
-
1 Jun-15
0.5 Jun-15
0.5 Sep-14
30 Sep-15
-
-
Oct-15
-
-
0 Jan-17
5 Aug-16
Jul-15

Penyusun Laporan
Rusmilawati
NIP. 19651027 199203 2 005
STOK STOK
BULAN BULAN
NARKOTIKA
2 MST 10 mg Tablet -
PSIKOTROPIKA
1 Zypraz 0,5 mg Tablet -
2 Clorilex 100 mg Tablet 0.5 Jan-17
3 Kalxetin 10 mg Tablet -
6 Olandoz 5 mg Tablet 1 Jun-15
7 Olandoz 10 mg Tablet 0.5 Jun-15
8 Zofredal 1 mg Tablet 0.5 Sep-14
9 Zofredal 2 mg Tablet 30 Sep-15
10 Prohiper 10 mg Tablet -
11 Sandepril Tablet -
Stesolid Rectal 5 mg / 2,5 ml Rectal Oct-15
12
Trazep 2 mg/ ml Rectal -
13 Seroquel Tablet -
14 Tofranil 25 mg Tablet 0 Jan-17
PREKURSOR
2 Ericaf Tablet Jul-15


NIP. 19780602 200903 2 003 NIP. 19651027 199203 2 005
REKAPITULASI STOK NARKOTIKA, PSIKOTROPIKA & PREKURSOR ASKES
STOK STOK
BULAN BULAN
NARKOTIKA
1 Coditam Tablet 91 0 91 29 62 Sep-15
2 MST 10 mg Tablet -
PSIKOTROPIKA
1 Zypraz 0,5 mg Tablet -
2 Clorilex 100 mg Tablet 0.5 0 0.5 0 0.5 Jan-17
6 Olandoz 5 mg Tablet 1 0 1 0 1 Jun-15
7 Olandoz 10 mg Tablet 0.5 0 0.5 0 0.5 Jun-15
8 Zofredal 1 mg Tablet 0 0 0 0 0 Sep-14
9 Zofredal 2 mg Tablet 0 0 0 0 0 Sep-15
10 Prohiper 10 mg Tablet -
11 Sandepril Tablet -
Stesolid Rectal 5 mg / 2,5 ml Rectal
12
Trazep 2 mg/ ml Rectal -
13 Seroquel Tablet -
14 Tofranil 25 mg Tablet 0 0 Jan-17
PREKURSOR
1 Rhinofed Tablet 5 - 5 5 0 Aug-16
2 Ericaf Tablet Jul-15

Pembuat laporan,
Rusmilawat Winda Aprila Amd. Far

NIP. 19651027 199203 2 005
Mengetahui,
Koord. Depo Farmasi Jalan Ka. Instalasi Farmasi RSUD A W Syahranie
Yuniastuti, S.Si.,M.Si, Apt Dra. Hj.Linawat., Apt

NIP : 19780602 200903 2 003 NIP : 19640412 199203 2 010
REKAPITULASI STOK NARKOTIKA, PSIKOTROPIKA & PREKURSOR ASKES
STOK STOK
BULAN BULAN
NARKOTIKA
1 Coditam Tablet
2 MST 10 mg Tablet
PSIKOTROPIKA
2 Clorilex 100 mg Tablet
6 Olandoz 5 mg Tablet
7 Olandoz 10 mg Tablet
8 Zofredal 1 mg Tablet
9 Zofredal 2 mg Tablet
11 Sandepril Tablet
Stesolid Rectal 5 mg / 2,5 ml Rectal
12
13 Seroquel Tablet
14 Tofranil 25 mg Tablet
PREKURSOR
1 Rhinofed Tablet
2 Ericaf Tablet

Pembuat laporan,
Dayang Bella Risky Wanda Nanda Rimbun Sari A.Md, Far.

NIP. 19931004 201503 2 002 NIP. 19870314 201001 2 017
Mengetahui,
Koord. Depo Farmasi Jalan Ka. Instalasi Farmasi RSUD A W Syahranie
Yuniastut, S.Si.,M.Si, Apt Dra. Hj.Linawat., Apt

NIP : 19780602 200903 2 003 NIP : 19640412 199203 2 010

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REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES

DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE

Mengetahui, Samarinda, 30 Januari 2015

Yuniastuti, S.Si.,M.Si, Apt Rusmilawati

Mengetahui, Samarinda, 02 Januari 2014

Yuniastuti, S.Si.,M.Si, Apt Nanda Rimbun Sari, A.Md., Far

Mengetahui, Samarinda, 05 November 2014

Yuniastuti, S.Si.,M.Si, Apt Nanda Rimbun Sari, A.Md., Far

Mengetahui, Samarinda, 05 November 2014

Yuniastuti, S.Si.,M.Si, Apt Nanda Rimbun Sari, A.Md., Far

Mengetahui, Samarinda, 01 September 2014

Yuniastuti, S.Si.,M.Si, Apt Nanda Rimbun Sari, A.Md., Far

Mengetahui, Samarinda, 29 Agustus 2014

Yuniastuti, S.Si.,M.Si, Apt Nanda Rimbun Sari, A.Md., Far

Mengetahui, Samarinda, 31 Juli 2014

Yuniastuti, S.Si.,M.Si, Apt Nanda Rimbun Sari, A.Md., Far

Mengetahui, Samarinda, 30 Juni 2014

Mengetahui, Samarinda, 30 Mei 2014

Mengetahui, Samarinda, 30 April 2014

Yuniastuti, S.Si.,M.Si, Apt Rusmilawati

Mengetahui, Samarinda, 31 Maret 2014

Yuniastuti, S.Si.,M.Si, Apt Rusmilawati

Mengetahui, Samarinda, 28 Februari 2014

Yuniastuti, S.Si.,M.Si, Apt Rusmilawati

Mengetahui, Samarinda, 30 Januari 2014

Yuniastuti, S.Si.,M.Si, Apt Rusmilawati

Mengetahui, Samarinda, 31 Desember 2013

Yuniastuti, S.Si.,M.Si, Apt Yuliani, A.md Far.

Mengetahui, Samarinda, 29 November 2013

Yuniastuti, S.Si.,M.Si, Apt Yuliani, A.md Far.

Mengetahui, Samarinda, 31 Oktober 2013

Yuniastuti, S.Si.,M.Si, Apt Yuliani, A.md Far.

Mengetahui, Samarinda, 30 September 2013

Yuniastuti, S.Si.,M.Si, Apt Yuliani, A.md Far.

Mengetahui, Samarinda, 31 Agustus 2013

Yuniastuti,M.Si,Apt. Nanda Rimbun Sari, A.md Far.

Mengetahui, Samarinda, 31 JuLi 2013

Rahmatiah, Apt. Nanda Rimbun Sari, A.md Far.

Mengetahui, Samarinda, 29 Juni 2013

Rahmatiah, Apt. Uswatun Hasanah

Mengetahui, Samarinda, 31 Mei 2013

Rahmatiah, Apt. Uswatun Hasanah

Mengetahui, Samarinda, 30 April 2013

Rahmatiah, Apt. Uswatun Hasanah

Mengetahui, Samarinda, 28 Maret 2013

Rahmatiah, Apt. Nanda Rimbun Sari, A.md Far.

Mengetahui, Samarinda, 28 Februari 2013

Rahmatiah, Apt. Nanda Rimbun Sari, A.md Far.

Mengetahui, Samarinda, 31 Januari 2013

Rahmatiah, Apt. Nanda Rimbun Sari, A.md Far.

Mengetahui, Samarinda, 29 Desember 2012

Rahmatiah, Apt. Uswatun Hasanah

Mengetahui, Samarinda, 30 November 2012

Rahmatiah, Apt. Uswatun Hasanah

Mengetahui, Samarinda, 31 Oktober 2012

Rahmatiah, Apt. Uswatun Hasanah

Mengetahui, Samarinda, 29 September 2012

Rahmatiah, Apt. Uswatun Hasanah

Mengetahui, Samarinda, 31 Agustus 2012

Rahmatiah, Apt. Uswatun Hasanah

Mengetahui, Samarinda, 31 Juli 2012

Rahmatiah, Apt. Uswatun Hasanah

Mengetahui, Samarinda, 30 Juni 2012

Rahmatiah, Apt. Nanda Rimbun Sari, A.md Far.