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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
4 Kalxetin 20 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
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN DESEMBER TAHUN 2014

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Coditam Tablet 91 91 0 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 0.5 Jan-17
3 Kalxetin 10 mg Tablet Feb-16
4 Kalxetin 20 mg Tablet Feb-17
5 Phenobarbital 30 mg Tablet
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
10 Prohiper 10 mg Tablet
11 Sandepril Tablet
Stesolid Rectal 5 mg / 2,5 ml Rectal 1 1 0 1 Oct-15
12
Trazep 2 mg/ ml Rectal
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

Mengetahui, Samarinda, 02 Januari 2014


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 19780602 200903 2 003 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN NOVEMBER TAHUN 2014

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Coditam Tablet 91 0 91 0 91 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
3 Kalxetin 10 mg Tablet 0 0 0 0 0 Feb-16
4 Kalxetin 20 mg Tablet 0 0 0 0 0 Feb-17
5 Phenobarbital 30 mg Tablet
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
10 Prohiper 10 mg Tablet
11 Sandepril Tablet
Stesolid Rectal 5 mg / 2,5 ml Rectal 1 0 1 0 1 Oct-15
12
Trazep 2 mg/ ml Rectal
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


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 19780602 200903 2 003 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN OKTOBER TAHUN 2014

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Coditam Tablet 91 91 0 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 0.5 Jan-17
3 Kalxetin 10 mg Tablet 30 30 30 0 Feb-16
4 Kalxetin 20 mg Tablet 0 0 0 0 Feb-17
5 Phenobarbital 30 mg Tablet
6 Olandoz 5 mg Tablet 8 8 7 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 2 2 2 0 Sep-15
10 Prohiper 10 mg Tablet
11 Sandepril Tablet
Stesolid Rectal 5 mg / 2,5 ml Rectal 1 1 0 1 Oct-15
12
Trazep 2 mg/ ml Rectal
13 Seroquel Tablet 75 75 56 19 Feb-15
14 Tofranil 25 mg Tablet 9 9 0 9 Jan-17
PREKURSOR
1 Rhinofed Tablet 45 45 0 45 Aug-16
2 Ericaf Tablet 196.5 196.5 72.0 124.5 Jul-15

Mengetahui, Samarinda, 05 November 2014


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 19780602 200903 2 003 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN SEPTEMBER TAHUN 2014

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Coditam Tablet 91 91 0 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 0.5 Jan-17
3 Kalxetin 10 mg Tablet 0 150 (GF) 16/09/14 150 120 30 Feb-16
4 Kalxetin 20 mg Tablet 0 150 (GF) 16/09/14 150 150 0 Feb-17
5 Phenobarbital 30 mg Tablet
6 Olandoz 5 mg Tablet 8 8 0 8 Jun-15
7 Olandoz 10 mg Tablet 28.5 28.5 28 0.5 Jun-15
8 Zofredal 1 mg Tablet 0.5 0.5 0 0.5 Sep-14
9 Zofredal 2 mg Tablet 2 2 0 2 Sep-15
10 Prohiper 10 mg Tablet
11 Sandepril Tablet
Stesolid Rectal 5 mg / 2,5 ml Rectal 1 1 0 1 Oct-15
12
Trazep 2 mg/ ml Rectal
13 Seroquel Tablet 75 75 0 75 Feb-15
14 Tofranil 25 mg Tablet 9 9 0 9 Jan-17
PREKURSOR
1 Rhinofed Tablet 75 75 30 45 Aug-16
2 Ericaf Tablet 69 210 (GF) 16/09/14 279 82.5 196.5 Jul-15

Mengetahui, Samarinda, 01 September 2014


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 19780602 200903 2 003 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN AGUSTUS TAHUN 2014

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Coditam Tablet 91 91 0 91 Sep-15
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
2 Clorilex 100 mg Tablet 0.5 0.5 0 0.5 Jan-17
3 Kalxetin 10 mg Tablet 4 4 4 0 Feb-16
4 Kalxetin 20 mg Tablet 0 0 0 0 Feb-17
5 Phenobarbital 30 mg Tablet 0 0 0 0 Dec-15
6 Olandoz 5 mg Tablet 8 8 0 8 Jun-15
7 Olandoz 10 mg Tablet 28.5 28.5 0 28.5 Jun-15
8 Zofredal 1 mg Tablet 0.5 0.5 0 0.5 Sep-14
9 Zofredal 2 mg Tablet 2 2 0 2 Sep-15
10 Prohiper 10 mg Tablet 30 30 30 0 Dec-16
11 Sandepril Tablet 0 0 0 0 Jun-14
Stesolid Rectal 5 mg / 2,5 ml Rectal 1 1 0 1 Oct-15
12
Trazep 2 mg/ ml Rectal 0 0 0 0 Jan-15
13 Seroquel Tablet 75 75 0 75 Feb-15
14 Tofranil 25 mg Tablet 9 9 0 9 Jan-17
PREKURSOR
1 Rhinofed Tablet 85 85 10 75 Aug-16
2 Ericaf Tablet 57 90 (GF) 26/08/14 147 78 69 Jul-15

Mengetahui, Samarinda, 29 Agustus 2014


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 19780602 200903 2 003 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JULI TAHUN 2014

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Coditam Tablet 91 91 0 91 Sep-15
2 MST 10 mg Tablet 0 0 0 0 Oct-16
PSIKOTROPIKA
1 Zypraz 0,5 mg Tablet 3.5 3.5 0 3.5 Apr-16
2 Clorilex 100 mg Tablet 0.5 0.5 0 0.5 Jan-17
3 Kalxetin 10 mg Tablet 34 34 30 4 Feb-16
4 Kalxetin 20 mg Tablet 105 105 105 0 Feb-17
5 Phenobarbital 30 mg Tablet 0 0 0 0 Dec-15
6 Olandoz 5 mg Tablet 14 14 6 8 Jun-15
7 Olandoz 10 mg Tablet 28.5 28.5 0 28.5 Jun-15
8 Zofredal 1 mg Tablet 0.5 0.5 0 0.5 Sep-14
9 Zofredal 2 mg Tablet 2 2 0 2 Sep-15
10 Prohiper 10 mg Tablet 75 75 45 30 Dec-16
11 Sandepril Tablet 0 0 0 0 Jun-14
Stesolid Rectal 5 mg / 2,5 ml Rectal 1 1 0 1 Oct-15
12
Trazep 2 mg/ ml Rectal 1 1 1 0 Jan-15
13 Seroquel Tablet 75 75 0 75 Feb-15
14 Tofranil 25 mg Tablet 14 14 5 9 Jan-17
PREKURSOR
1 Rhinofed Tablet 85 85 0 85 Aug-16
2 Ericaf Tablet 105 105 48 57 Jul-15

Mengetahui, Samarinda, 31 Juli 2014


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 19780602 200903 2 003 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JUNI TAHUN 2014

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Coditam Tablet 91 91 0 91 Sep-15
2 MST 10 mg Tablet 0 0 0 0 Oct-16
PSIKOTROPIKA
1 Zypraz 0,5 mg Tablet 3.5 3.5 0 3.5 Apr-16
2 Clorilex 100 mg Tablet 0.5 0.5 0 0.5 Jan-17
3 Kalxetin 10 mg Tablet 95 60 (GF) 23/06/14 155 121 34 Feb-16
4 Kalxetin 20 mg Tablet 30 120 (GF) 23/06/14 150 45 105 Feb-17
5 Phenobarbital 30 mg Tablet 0 0 0 0 Dec-15
6 Olandoz 5 mg Tablet 20 20 6 14 Jun-15
7 Olandoz 10 mg Tablet 28.5 28.5 0 28.5 Jun-15
8 Zofredal 1 mg Tablet 0.5 0.5 0 0.5 Sep-14
9 Zofredal 2 mg Tablet 2 2 0 2 Sep-15
10 Prohiper 10 mg Tablet 105 105 30 75 Dec-16
11 Sandepril Tablet 15 15 15 0 Jun-14
Stesolid Rectal 5 mg / 2,5 ml Rectal 1 1 0 1 Oct-15
12
Trazep 2 mg/ ml Rectal 1 1 0 1 Jan-15
13 Seroquel Tablet 75 75 0 75 Feb-15
14 Tofranil 25 mg Tablet 24 24 10 14 Jan-17
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


Koordinator Depo Obat Rawat Jalan Penyusun Laporan
Yuniastuti, S.Si.,M.Si, Apt Rusmilawati
NIP. 19780602 200903 2 003 NIP. 19651027 199203 2 005
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN MEI TAHUN 2014

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Coditam Tablet 91 91 0 91 Sep-15
2 MST 10 mg Tablet 5 5 5 0 Oct-16
PSIKOTROPIKA
1 Zypraz 0,5 mg Tablet 3.5 3.5 0 3.5 Apr-16
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
4 Kalxetin 20 mg Tablet 0 60 (GF) 20/05/14 60 30 30 Dec-16
5 Phenobarbital 30 mg Tablet 150 150 150 0 Dec-15
6 Olandoz 5 mg Tablet 42 42 22 20 Jun-15
7 Olandoz 10 mg Tablet 28.5 28.5 0 28.5 Jun-15
8 Zofredal 1 mg Tablet 22.5 22.5 22 0.5 Sep-14
9 Zofredal 2 mg Tablet 2 2 0 2 Sep-15
10 Prohiper 10 mg Tablet 30 90 (GF) 120 15 105 Dec-16
11 Sandepril Tablet 15 15 0 15 Jun-14
Stesolid Rectal 5 mg / 2,5 ml Rectal 1 1 0 1 Oct-15
12
Trazep 2 mg/ ml Rectal 1 1 0 1 Jan-15
13 Seroquel Tablet 75 75 0 75 Feb-15
14 Tofranil 25 mg Tablet 24 24 0 24 Jan-17
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


Koordinator Depo Obat Rawat Jalan Penyusun Laporan
Yuniastuti, S.Si.,M.Si, Apt Rusmilawati
NIP. 19780602 200903 2 003 NIP. 19651027 199203 2 005
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN APRIL TAHUN 2014

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet
2 Codein 15 mg Tablet
3 Coditam Tablet 91 91 0 91 Sep-15
4 Durogesic 12,5 Patch
5 Durogesic 25 Patch
6 MST 10 mg Tablet 5 5 0 5 Oct-16
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
11 Kalxetin 20 mg Tablet 40 40 40 0 Dec-16
12 Phenobarbital 30 mg Tablet 700 (GF) 23/04/14 700 550 150 Dec-15
13 Ludiomil 50 mg Tablet
14 Olandoz 5 mg Tablet 42 42 0 42 Jun-15
15 Olandoz 10 mg Tablet 28.5 28.5 0 28.5 Jun-15
Persidal 1 mg Tablet
16
Zofredal 1 mg Tablet 32.5 32.5 10 22.5 Sep-14
Persidal 2 mg Tablet
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
19 Sandepril Tablet 15 15 0 15 Jun-14
Stesolid Rectal 5 mg / 2,5 ml Rectal 1 1 0 1 Oct-15
20
Trazep 2 mg/ ml Rectal 1 1 0 1 Jan-15
21 Stesolid Rectal 10 mg / 2,5 ml Rectal
22 Seroquel Tablet 75 75 0 75 Feb-15
23 Tofranil 25 mg Tablet 24 24 0 24 Jan-17
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


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 19780602 200903 2 003 NIP. 19651027 199203 2 005
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN MARET TAHUN 2014

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet
2 Codein 15 mg Tablet
3 Coditam Tablet 91 91 0.00 91 Sep-15
4 Durogesic 12,5 Patch
5 Durogesic 25 Patch
6 MST 10 mg Tablet 5 5 0.00 5 Oct-16
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet
Atarax 0,5 mg Tablet
2
Zypraz 0,5 mg Tablet 3.5 3.5 0.00 3.5 Apr-16
3 Anxibloc 10 mg Tablet
4 Clorilex 100 mg Tablet 33.25 33.25 0.00 33.25 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 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
11 Kalxetin 20 mg Tablet 30 150 (GF) 10/03/14 180 140.00 40 Dec-16
12 Phenobarbital 30 mg Tablet
13 Ludiomil 50 mg Tablet
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
Persidal 1 mg Tablet
16
Zofredal 1 mg Tablet 32.5 32.5 0.00 32.5 Sep-14
Persidal 2 mg Tablet
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


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 19780602 200903 2 003 NIP. 19651027 199203 2 005
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN FEBRUARI TAHUN 2014

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
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
3 Coditam Tablet 91 91 0.00 91 Sep-15
4 Durogesic 12,5 Patch
5 Durogesic 25 Patch
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
Atarax 0,5 mg Tablet
2
Zypraz 0,5 mg Tablet 3.5 3.5 0.00 3.5 Apr-16
3 Anxibloc 10 mg Tablet 3.75 3.75 3.75 0 Jun-17
4 Clorilex 100 mg Tablet 40.75 40.75 7.50 33.25 Jan-17
5 Chlorpromazin 100 mg Tablet
Diazepam 5 mg Tablet 0 0 0.00 0 Dec-17
6
Valdimex 5 mg Tablet 0 0 0.00 0
7 Haloperidol 0,5 mg Tablet 0 0 0.00 0 Mar-17
8 Haloperidol 1,5 mg Tablet 101 101 25.00 76 Mar-16
9 Haloperidol 5 mg Tablet 33 33 9.00 24 Sep-16
10 Kalxetin 10 mg Tablet 150 270 (GF) 25/02/14 420 180.00 240 Dec-15
11 Kalxetin 20 mg Tablet 64 60 (GF) 25/02/14 124 94.00 30 Dec-16
12 Phenobarbital 30 mg Tablet 0 0 0.00 0 Dec-15
13 Ludiomil 50 mg Tablet
14 Olandoz 5 mg Tablet 61.5 61.5 19.50 42 Jun-15
15 Olandoz 10 mg Tablet 35.5 35.5 7.00 28.5 Jun-15
Persidal 1 mg Tablet
16
Zofredal 1 mg Tablet 62.5 62.5 30.00 32.5 Sep-14
Persidal 2 mg Tablet
17
Zofredal 2 mg Tablet 17 17 15.00 2 Sep-15
18 Prohiper 10 mg Tablet 0 60 (GF) 25/02/14 60 23.00 37 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 1 1 1.00 0 Jul-15
22 Seroquel Tablet 75 75 0.00 75 Feb-15
23 Tofranil 25 mg Tablet 34 34 0.00 34 Jan-17
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


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 19780602 200903 2 003 NIP. 19651027 199203 2 005
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JANUARI TAHUN 2014

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
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
3 Coditam Tablet 91 91 0.00 91 Sep-15
4 Durogesic 12,5 Patch
5 Durogesic 25 Patch
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
Atarax 0,5 mg Tablet
2
Zypraz 0,5 mg Tablet 45.5 45.5 42.00 3.5 Apr-16
3 Anxibloc 10 mg Tablet 369.25 369.25 365.50 3.75 Jun-17
4 Clorilex 100 mg Tablet 52.5 52.5 11.75 40.75 Jan-17
5 Chlorpromazin 100 mg Tablet
Diazepam 5 mg Tablet 900.5 900.5 900.50 0 Dec-17
6
Valdimex 5 mg Tablet 0 0 0.00 0
7 Haloperidol 0,5 mg Tablet 141 141 141.00 0 Mar-17
8 Haloperidol 1,5 mg Tablet 1 100 (GF) 16/01/14 101 0.00 101 Mar-16
9 Haloperidol 5 mg Tablet 34 34 1.00 33 Sep-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
13 Ludiomil 50 mg Tablet
14 Olandoz 5 mg Tablet 61.5 61.5 0.00 61.5 Jun-15
15 Olandoz 10 mg Tablet 81.5 81.5 46.00 35.5 Jun-15
Persidal 1 mg Tablet
16
Zofredal 1 mg Tablet 82.5 82.5 20.00 62.5 Sep-14
Persidal 2 mg Tablet
17
Zofredal 2 mg Tablet 137 137 120.00 17 Sep-15
18 Prohiper 10 mg Tablet 17 17 17.00 0 Dec-16
19 Sandepril Tablet 15 15 0.00 15 Jun-14
Stesolid Rectal 5 mg / 2,5 ml Rectal 5 5 4.00 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 2 2 1.00 1 Jul-15
22 Seroquel Tablet 75 75 0.00 75 Feb-15
23 Tofranil 25 mg Tablet 34 34 0.00 34 Jan-17
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

Mengetahui, Samarinda, 30 Januari 2014


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 19780602 200903 2 003 NIP. 19651027 199203 2 005
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN DESEMBER TAHUN 2013

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
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
4 Durogesic 12,5 Patch
5 Durogesic 25 Patch
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
Atarax 0,5 mg Tablet
2
Zypraz 0,5 mg Tablet 45.5 45.5 0 45.5 Apr-16
3 Anxibloc 10 mg Tablet 494.5 500 (GF) 10/12/13 994.5 625 369.25 Jun-17
4 Clorilex 100 mg Tablet 52.5 52.5 0 52.5 Jan-17
5 Chlorpromazin 100 mg Tablet
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
13 Ludiomil 50 mg Tablet
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
Persidal 1 mg Tablet
16
Zofredal 1 mg Tablet 82.5 82.5 0 82.5 Sep-14
Persidal 2 mg Tablet
17
Zofredal 2 mg Tablet 32 240 (GF) 10/12/13 272 135 137 Sep-15
18 Prohiper 10 mg Tablet 2 30 (GF) 19/12/13 32 15 17 Dec-16
19 Sandepril Tablet 15 15 0 15 Jun-14
Stesolid Rectal 5 mg / 2,5 ml Rectal 0 5 (GF) 23/12/13 5 0 5 Oct-15
20
20
Trazep 2 mg/ ml Rectal 1 1 0 1 Jan-15
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 4 4 2 2 May-14
22 Seroquel Tablet 75 75 0 75 Feb-15
23 Tofranil 25 mg Tablet 62 62 28 34 Jan-17
Trihexyphenidil 2 mg Tablet 802.75 1000 (GF) 10/12/13 1802.75 1435.25 367.5 Apr-18
24
Hexymer 2 mg Tablet
25 Zypraz 1 mg Tablet 0 0 0
PREKURSOR
1 Ephedrin 25 mg Tablet 605.25 605.25 292 313.25 May-17

Mengetahui, Samarinda, 31 Desember 2013


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 19780602 200903 2 003
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN NOVEMBER TAHUN 2013

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
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
4 Durogesic 12,5 Patch
5 Durogesic 25 Patch
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)
Atarax 0,5 mg Tablet
2
Zypraz 0,5 mg Tablet 75.5 75.5 30 45.5 Apr-16
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
5 Chlorpromazin 100 mg Tablet
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
8 Haloperidol 1,5 mg Tablet 43 43 32 11 Mar-16
9 Haloperidol 5 mg Tablet 61 61 9 52 Sep-16
30 (GF) 04/11/13
10 Kalxetin 10 mg Tablet 30 210 30 180 Jul-15
150 (GF) 12/11/13
11 Kalxetin 20 mg Tablet 20 60 (GF) 04/11/13 80 30 50 May-16
12 Phenobarbital 30 mg Tablet 110 100 (GF) 04/11/13 210 150 60
13 Ludiomil 50 mg Tablet
14 Olandoz 5 mg Tablet 61.5 61.5 0 61.5 Jan-15
15 Olandoz 10 mg Tablet 89 89 0 89 Jun-15
Persidal 1 mg Tablet
16
60 (GF) 12/11/13
Zofredal 1 mg Tablet 30 120 37.5 82.5 Sep-14
30 (GF) 22/11/13
Persidal 2 mg Tablet
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
18 Prohiper 10 mg Tablet 30 30 28 2 Dec-16
19 Sandepril Tablet 15 15 0 15 Jun-14
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
22 Seroquel Tablet 75 75 0 75 Feb-15
23 Tofranil 25 mg Tablet 62 62 0 62 Jan-17
1000 (GF) 04/11/13
Trihexyphenidil 2 mg Tablet 593.25 2393.25 1590.5 802.75 Apr-18
24 800 (GF) 22/11/13
Hexymer 2 mg Tablet
25 Zypraz 1 mg Tablet 0 0 0
PREKURSOR
1 Ephedrin 25 mg Tablet 950.25 950.25 345 605.25 May-17

Mengetahui, Samarinda, 29 November 2013


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 19780602 200903 2 003
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN OKTOBER TAHUN 2013

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
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
3 Coditam Tablet 1 1 0 1 Jan-15
4 Durogesic 12,5 Patch
5 Durogesic 25 Patch
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
Zypraz 0,5 mg Tablet 110.5 110.5 35 75.5 Apr-16
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
5 Chlorpromazin 100 mg Tablet
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
8 Haloperidol 1,5 mg Tablet 53 53 10 43 Mar-16
9 Haloperidol 5 mg Tablet 63 63 2 61 Sep-16
60 (GF) 02/10/13
10 Kalxetin 10 mg Tablet 0 180 150 30 Jul-15
120 (GF) 16/10/13
11 Kalxetin 20 mg Tablet 95 95 75 20 May-16
12 Phenobarbital 30 mg Tablet 210 210 100 110 Dec-15
13 Ludiomil 50 mg Tablet
14 Olandoz 5 mg Tablet 61.5 61.5 0 61.5 Jan-15
15 Olandoz 10 mg Tablet 29 60 (GF) 16/09/13 89 0 89 Jun-15
Persidal 1 mg Tablet
16
30 (GF) 02/10/13
Zofredal 1 mg Tablet 48 108 78 30 May-14
30 (GF) 16/10/13
Persidal 2 mg Tablet
17 120 (GF) 02/10/13
Zofredal 2 mg Tablet 11 221 195 26 May-15
90 (GF) 16/10/13
18 Prohiper 10 mg Tablet 17 30 (GF) 25/10/13 47 17 30 Dec-16
19 Sandepril Tablet 15 15 0 15 Jun-14
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 4 4 0 4 Apr-14
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 4 4 3 1 May-14
22 Seroquel Tablet 75 75 0 75 Feb-15
23 Tofranil 25 mg Tablet 62 62 0 62 Jan-17
800 (GF) 02/10/13
Trihexyphenidil 2 mg Tablet 375.75 1975.75 1382.5 593.25 Apr-18
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


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 19780602 200903 2 003
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN SEPTEMBER TAHUN 2013

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 827.5 500 (GF) 02/09/13 1327.5 1203.5 124 May-17
2 Codein 15 mg Tablet 195.75 195.75 20 175.75 Sep-16
3 Coditam Tablet 1 1 0 1 Jan-15
4 Durogesic 12,5 Patch
5 Durogesic 25 Patch
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
Zypraz 0,5 mg Tablet 170.5 170.5 60 110.5 Apr-16
3 Anxibloc 10 mg Tablet 1089.75 500 (GF) 05/09/13 1589.75 561.25 1028.5 Jun-17
4 Clorilex 100 mg Tablet 79 79 11.5 67.5 Jan-17
5 Chlorpromazin 100 mg Tablet
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
8 Haloperidol 1,5 mg Tablet 53 53 0 53 Mar-16
9 Haloperidol 5 mg Tablet 63 63 0 63 Sep-16
90 (GF) 05/09/13
10 Kalxetin 10 mg Tablet 0 180 180 0 Jul-15
90 (GF) 16/09/13
11 Kalxetin 20 mg Tablet 35 120 (GF) 05/09/13 155 60 95 May-16
12 Phenobarbital 30 mg Tablet 260 260 50 210 Dec-15
13 Ludiomil 50 mg Tablet
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
Persidal 1 mg Tablet
16
Zofredal 1 mg Tablet 20 60 (GF) 05/09/13 80 32 48 May-14
Persidal 2 mg Tablet
17 60 (GF) 05/09/13
Zofredal 2 mg Tablet 60 210 199 11 May-15
90 (GF) 16/09/13
18 Prohiper 10 mg Tablet 25 25 8 17 Dec-16
19 Sandepril Tablet 15 15 0 15 Jun-14
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 4 4 0 4 Apr-14
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 6 6 2 4 May-14
22 Seroquel Tablet 75 75 0 75 Feb-15
23 Tofranil 25 mg Tablet 62 62 0 62 Jan-17
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

Mengetahui, Samarinda, 30 September 2013


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 19780602 200903 2 003
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN AGUSTUS TAHUN 2013

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
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
3 Coditam Tablet 1 1 0 1 Jan-15
4 Durogesic 12,5 Patch
5 Durogesic 25 Patch
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
5 Chlorpromazin 100 mg Tablet
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
8 Haloperidol 1,5 mg Tablet 63 63 10 53 Mar-16
9 Haloperidol 5 mg Tablet 68 68 5 63 Sep-16
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
12 Phenobarbital 30 mg Tablet 360 360 100 260 Dec-15
13 Ludiomil 50 mg Tablet
14 Olandoz 5 mg Tablet 79 79 67.5 11.5 Jun-15
15 Olandoz 10 mg Tablet 63 63 0 63 Jun-15
Persidal 1 mg Tablet
16
Zofredal 1 mg Tablet 80 80 60 20 Feb-15
Persidal 2 mg Tablet
17
Zofredal 2 mg Tablet 75 60 (GF) 12/08/13 135 75 60 Jan-15
18 Prohiper 10 mg Tablet 40 40 15 25 Dec-16
19 Sandepril Tablet 15 15 0 15 Jun-14
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 4 4 0 4 Apr-14
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 0 10 (GF) 12/08/13 10 4 6 May-14
22 Seroquel Tablet 75 75 0 75 Feb-15
23 Tofranil 25 mg Tablet 62 62 0 62 Jan-17
Trihexyphenidil 2 mg Tablet 1433.25 1000 (GF) 12/08/13 2433.25 1107.5 1325.75 Apr-18
24
Hexymer 2 mg Tablet Jun-16
25 Zypraz 1 mg Tablet 2 2 0 2 Jan-14
PREKURSOR
1 Ephedrin 25 mg Tablet 172.5 500 (GF) 23/08/13 672.5 195.5 477 May-17

Mengetahui, Samarinda, 31 Agustus 2013


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 19780602 200903 2 003 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JULI TAHUN 2013

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 283.75 750 (GF) 04/07/13 1033.75 947 86.75 Apr-17
2 Codein 15 mg Tablet 0.75 0.75 0 0.75 Sep-16
3 Coditam Tablet 7 7 6 1 Jan-15
4 Durogesic 12,5 Patch
5 Durogesic 25 Patch
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
5 Chlorpromazin 100 mg Tablet
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
8 Haloperidol 1,5 mg Tablet 63 63 0 63 Mar-16
9 Haloperidol 5 mg Tablet 86.5 86.5 18.5 68 Sep-16
10 Kalxetin 10 mg Tablet 105 30 (GF) 12/07/13 135 110 25 May-15
60 (GF) 03/07/13
11 Kalxetin 20 mg Tablet 60 210 150 60 Apr-16
90 (GF) 31/07/13
12 Phenobarbital 30 mg Tablet 510 510 150 360 Dec-15
13 Ludiomil 50 mg Tablet
14 Olandoz 5 mg Tablet 116.5 116.5 37.5 79 Jun-15
15 Olandoz 10 mg Tablet 3 90 (GF) 03/07/13 93 30 63 Jun-15
Persidal 1 mg Tablet
16
Zofredal 1 mg Tablet 80 80 0 80 Feb-15
Persidal 2 mg Tablet
17
Zofredal 2 mg Tablet 90 90 (GF) 03/07/13 180 105 75 Jan-15
18 Prohiper 10 mg Tablet 25 30 (GF) 12/07/13 55 15 40 Dec-16
19 Sandepril Tablet 15 15 0 15 Jun-14
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 0 5 (GF) 12/07/13 5 1 4 Apr-14
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 2 5 (GF) 03/07/13 7 7 0 May-14
22 Seroquel Tablet 75 75 0 75 Feb-15
23 Tofranil 25 mg Tablet 62 62 0 62 Jan-17
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
25 Zypraz 1 mg Tablet 2 2 0 2 Jan-14
PREKURSOR
1 Ephedrin 25 mg Tablet 582.5 582.5 410 172.5 Jul-17

Mengetahui, Samarinda, 31 JuLi 2013


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 198508142010012030 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JUNI TAHUN 2013

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 285.75 1000 (GF) 03/06/13 1285.75 1002 283.75 Apr-17
2 Codein 15 mg Tablet 0.75 0.75 0 0.75 Sep-16
3 Coditam Tablet 7 7 0 7 Jan-15
4 Durogesic 12,5 Patch
5 Durogesic 25 Patch
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
5 Chlorpromazin 100 mg Tablet
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
8 Haloperidol 1,5 mg Tablet 138 138 75 63 Mar-16
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
11 Kalxetin 20 mg Tablet 110 90 (GF) 27/06/13 200 140 60 Apr-16
12 Phenobarbital 30 mg Tablet 610 610 100 510 Dec-15
13 Ludiomil 50 mg Tablet
14 Olandoz 5 mg Tablet 11.5 150 (GF) 03/06/13 161.5 45 116.5 Jun-15
15 Olandoz 10 mg Tablet 48 48 45 3 Jun-15
Persidal 1 mg Tablet
16 30 (GF) 03/06/13
Zofredal 1 mg Tablet 20 110 30 80 Feb-15
60 (GF) 14/06/13
Persidal 2 mg Tablet
17 30 (GF) 03/06/13
Zofredal 2 mg Tablet 0 180 90 90 Mar-15
17
Zofredal 2 mg Tablet 0 180 90 90 Mar-15
150 (GF) 14/06/13
18 Prohiper 10 mg Tablet 25 30 (GF) 03/06/13 55 30 25 Dec-16
19 Sandepril Tablet 15 15 0 15 Jun-14
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 5 5 5 0 Apr-14
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 1 5 (GF) 03/06/13 6 4 2 May-14
22 Seroquel Tablet 75 75 0 75 Feb-15
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
25 Zypraz 1 mg Tablet 2 2 0 2 Jan-14
PREKURSOR
1 Ephedrin 25 mg Tablet 812.5 812.5 230 582.5 Jul-17

Mengetahui, Samarinda, 29 Juni 2013


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Rahmatiah, Apt. Uswatun Hasanah


NIP. 198508142010012030
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN MEI TAHUN 2013

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 0.75 500 (GF) 24/05/13 500.75 215 285.75 Apr-17
2 Codein 15 mg Tablet 0.75 0.75 0 0.75 Sep-16
3 Coditam Tablet 22 22 15 7 Jan-15
4 Durogesic 12,5 Patch
5 Durogesic 25 Patch
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
6 Clorilex 100 mg Tablet 100 100 59.5 40.5 Jan-17
7 Cliad Tablet
8 Chlorpromazin 100 mg 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
11 Haloperidol 1,5 mg Tablet 138 138 0 138 Mar-16
12 Haloperidol 5 mg Tablet 20 100 (GF) 11/05/13 120 27.5 92.5 Sep-16
13 Kalxetin 10 mg Tablet 70 150 (GF) 06/05/13 220 175 45 Oct-14
14 Kalxetin 20 mg Tablet 80 90 (GF) 06/05/13 170 60 110 Oct-15
15 Phenobarbital 30 mg Tablet 710 710 100 610 Dec-15
16 Ludiomil 50 mg Tablet
30 (GF) 06/05/13
17 Olandoz 5 mg Tablet 0.5 120.5 109 11.5 Jun-15
90 (GF) 11/05/13
18 Olandoz 10 mg Tablet 48 30 (GF) 27/05/13 78 30 48 Jun-15
Persidal 1 mg Tablet
19
Zofredal 1 mg Tablet 50 30 (GF) 06/05/13 80 60 20 May-14
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
22 Sandepril Tablet 15 15 0 15 Jun-14
23 Stesolid Rectal 5 mg / 2,5 ml Rectal 6 6 1 5 Apr-14
24 Stesolid Rectal 10 mg / 2,5 ml Rectal 4 4 3 1 May-14
25 Seroquel Tablet 75 75 0 75 Feb-15
26 Tofranil 25 mg Tablet 30 30 18 12 Jan-17
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
29 Zypraz 1 mg Tablet 2 2 0 2 Jan-14
PREKURSOR
1 Ephedrin 25 mg Tablet 286.75 1000 (GF) 10/05/13 1286.75 474.25 812.5 Jul-17

Mengetahui, Samarinda, 31 Mei 2013


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Rahmatiah, Apt. Uswatun Hasanah


NIP. 198508142010012030
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN APRIL TAHUN 2013

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 0.75 0.75 0 0.75 Jan-17
2 Codein 15 mg Tablet 85.75 85.75 85 0.75 Sep-16
3 Coditam Tablet 42 42 20 22 Jan-15
4 Durogesic 12,5 Patch
5 Durogesic 25 Patch
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
8 Chlorpromazin 100 mg Tablet
500 (GF) 11/04/13
9 Diazepam 5 mg Tablet 880 1630 1359 271
250 (GF) 24/04/13 Dec-17
10 Haloperidol 0,5 mg Tablet 330.5 200 (GF) 24/04/13 530.5 413 117.5 Dec-16
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
14 Kalxetin 20 mg Tablet 90 210 130 80 Oct-15
60 (GF) 24/04/13
15 Phenobarbital 30 mg Tablet 810 810 100 710 Dec-15
16 Ludiomil 50 mg Tablet
17 Olandoz 5 mg Tablet 15.5 120 (GF) 02/04/13 135.5 135 0.5 Jun-15
18 Olandoz 10 mg Tablet 78 78 30 48 Jun-15
Persidal 1 mg Tablet
19
19
Zofredal 1 mg Tablet 110 110 60 50 May-14
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
21 Prohiper 10 mg Tablet 55 55 30 25 Aug-16
22 Sandepril Tablet 15 15 0 15 Jun-14
23 Stesolid Rectal 5 mg / 2,5 ml Rectal 1 5 (GF) 02/04/13 6 0 6 Nov-13
24 Stesolid Rectal 10 mg / 2,5 ml Rectal 6 6 2 4 May-14
25 Seroquel Tablet 75 75 0 75 Feb-15
26 Tofranil 25 mg Tablet 30 30 0 30 Jan-17
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
30 Zypraz 1 mg Tablet 2 2 0 2 Jan-14
PREKURSOR
1 Ephedrin 25 mg Tablet 581.75 581.75 295 286.75 Jul-17

Mengetahui, Samarinda, 30 April 2013


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Rahmatiah, Apt. Uswatun Hasanah


NIP. 198508142010012030
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN MARET TAHUN 2013

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
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
3 Coditam Tablet 42 42 0 42 Jan-15
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
7 Chlorpromazin 100 mg 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
11 Haloperidol 5 mg Tablet 105 105 94 11 Sep-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
13 Kalxetin 20 mg Tablet 10 160 70 90 Sep-15
90 (GF) 01/03/13
14 Phenobarbital 30 mg Tablet 1000 (GF) 11/03/13 1000 190 810 Dec-15
15 Ludiomil 50 mg Tablet
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
Persidal 1 mg Tablet
18
Zofredal 1 mg Tablet 110 110 0 110 May-14
19 Persidal 2 mg Tablet 90 80 (GF) 01/03/13 170 169.5 0.5 Aug-16
20 Prohiper 10 mg Tablet 55 55 0 55 Aug-16
21 Sandepril Tablet 15 15 0 15 Jun-14
22 Stesolid Rectal 5 mg / 2,5 ml Rectal 2 2 1 1 Nov-13
23 Stesolid Rectal 10 mg / 2,5 ml Rectal 8 8 2 6 May-14
24 Seroquel Tablet 75 75 0 75 Feb-15
25 Tofranil 25 mg Tablet 30 30 0 30 Jan-17
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
29 Zypraz 1 mg Tablet 2 2 0 2 Jan-14
PREKURSOR
1 Ephedrin 25 mg Tablet 1063.75 1063.75 482 581.75 Jul-17

Mengetahui, Samarinda, 28 Maret 2013


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 198508142010012030 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN FEBRUARI TAHUN 2013

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 775.75 500 (GF) 05/02/13 1275.75 1186 89.75 Jan-17
2 Codein 15 mg Tablet 30 250 (GF) 05/02/13 280 10 270 Sep-16
3 Coditam Tablet 63 63 21 42 Jan-15
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
Zypraz 0,5 mg Tablet
3
Atarax 0,5 mg Tablet 987.5 987.5 215 772.5 Jan-16
Anxibloc 10 mg Tablet 790.5 300 (GF) 05/02/13 1090.5 561 529.5 Jul-16
4
Frisium 10 mg Tablet
5 Clozaril 25 mg Tablet 2 2 0 2 Dec-14
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet
8 Haloperidol 0,5 mg Tablet 247.5 247.5 247 0.5 Jun-16
9 Haloperidol 1,5 mg Tablet 111.5 111.5 85 26.5 Jan-16
10 Haloperidol 5 mg Tablet 105 105 0 105 Sep-16
11 Kalxetin 10 mg Tablet 30 90 (GF) 05/02/13 120 120 0 Sep-14
12 Kalxetin 20 mg Tablet 85 60 (GF) 05/02/13 145 135 10 Sep-15
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
15 Olandoz 5 mg Tablet 0.5 150 (GF) 22/02/13 150.5 15 135.5 May-14
30 (GF) 05/02/13
16 Olandoz 10 mg Tablet 56 176 128 48 Jan-15
90 (GF) 22/02/13
Persidal 1 mg Tablet
17
Zofredal 1 mg Tablet 35 90 (GF) 11/02/13 125 15 110 May-14
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
20 Sandepril Tablet 15 15 0 15 Jun-14
21 Stesolid Rectal 5 mg / 2,5 ml Rectal 9 9 7 2 Nov-13
22 Stesolid Rectal 10 mg / 2,5 ml Rectal 0 10 (GF) 22/02/13 10 2 8 May-14
23 Seroquel Tablet 75 75 0 75 Feb-15
24 Tofranil 25 mg Tablet 30 30 0 30 Jan-17
Trihexyphenidil 2 mg Tablet 731.5 1000 (GF) 05/02/13 1731.5 1276 455.5 Jun-17
25
Hexymer 2 mg Tablet
26 Trifluoperazine 5 mg Tablet
27 Valdimex 5 mg Tablet 309 1000 (GF) 05/02/13 1309 945 364 Jul-16
28 Zypraz 1 mg Tablet 2 2 0 2 Jan-14
PREKURSOR
1 Ephedrin 25 mg Tablet 418.75 1000 (GF) 05/02/13 1418.75 355 1063.75 Jul-17

Mengetahui, Samarinda, 28 Februari 2013


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 198508142010012030 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JANUARI TAHUN 2013

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 215.75 1250 (GF) 16/01/13 1465.75 690 775.75 Jan-17
2 Codein 15 mg Tablet 180 180 150 30 Sep-16
3 Coditam Tablet 103 103 40 63 Jan-15
4 Durogesic 12,5 Patch 11 11 0 11 Jul-13
5 Durogesic 25 Patch 7 7 0 7 Nov-13
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
Zypraz 0,5 mg Tablet
3
Atarax 0,5 mg Tablet 1062.5 1062.5 75 987.5 Jan-16
Anxibloc 10 mg Tablet 167.25 1200 (GF) 16/01/13 1367.3 576.75 790.5 Jul-16
4
Frisium 10 mg Tablet
5 Clozaril 25 mg Tablet 32 32 30 2 Dec-14
6 Cliad Tablet
7 Chlorpromazin 100 mg 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
11 Kalxetin 10 mg Tablet 30 120 (GF) 16/01/13 150 120 30 Sep-14
12 Kalxetin 20 mg Tablet 105 90 (GF) 16/01/13 195 110 85 Sep-15
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
15 Olandoz 5 mg Tablet 22.5 60 (GF) 16/01/13 82.5 82 0.5 May-14
16 Olandoz 10 mg Tablet 79 30 (GF) 16/01/13 109 53 56 Jan-15
Persidal 1 mg Tablet
17
Zofredal 1 mg Tablet 65 60 (GF) 16/01/13 125 90 35 May-14
18 Persidal 2 mg Tablet 110 60 (GF) 16/01/13 170 165 5 Aug-16
19 Prohiper 10 mg Tablet 45 45 15 30 Aug-16
20 Sandepril Tablet 25 25 10 15 Jun-14
21 Stesolid Rectal 5 mg / 2,5 ml Rectal 9 9 0 9 Nov-13
22 Stesolid Rectal 10 mg / 2,5 ml Rectal 10 10 10 0 Jun-14
23 Seroquel Tablet 75 75 0 75 Feb-15
24 Tofranil 25 mg Tablet 40 40 10 30 Jan-17
Trihexyphenidil 2 mg Tablet 921.5 1000 (GF) 16/01/13 1921.5 1190 731.5 Sep-17
25
25
Hexymer 2 mg Tablet
26 Trifluoperazine 5 mg Tablet
27 Valdimex 5 mg Tablet 998.5 500 (GF) 16/01/13 1498.5 1189.5 309 Jun-16
28 Zypraz 1 mg Tablet 2 2 0 2 Jan-14
PREKURSOR
1 Ephedrin 25 mg Tablet 874.75 874.75 456 418.75 Jul-17

Mengetahui, Samarinda, 31 Januari 2013


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 198508142010012030 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN DESEMBER TAHUN 2012

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 298.25 1000 (GF) 03/12/2012 1298.25 1082.5 215.75 Oct-16
2 Codein 15 mg Tablet 0 250 (GF) 10/12/2012 250 70 180 Sep-16
3 Coditam Tablet 103 103 0 103 Jan-15
4 Durogesic 12,5 Patch 11 11 0 11 Jul-13
5 Durogesic 25 Patch 7 7 0 7 Nov-13
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
Zypraz 0,5 mg 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
Frisium 10 mg Tablet
5 Clozaril 25 mg Tablet 7 100 (GF) 10/12/2012 107 75 32 Dec-14
6 Cliad Tablet
7 Chlorpromazin 100 mg 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
10 Haloperidol 5 mg Tablet 91 91 66 25 Sep-16
11 Kalxetin 10 mg Tablet 95 60 (GF) 10/12/2012 155 125 30 Sep-14
12 Kalxetin 20 mg Tablet 120 90 (GF) 03/12/2012 210 105 105 Aug-15
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
15 Olandoz 5 mg Tablet 105.5 105.5 83 22.5 May-14
16 Olandoz 10 mg Tablet 79 79 0 79 Jan-15
Persidal 1 mg Tablet
17 30 (GF) 03/12/2012
Zofredal 1 mg Tablet 35 125 60 65 Mar-14
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
19 Prohiper 10 mg Tablet 45 45 0 45 Aug-16
20 Sandepril Tablet 25 25 0 25 Jun-14
21 Stesolid Rectal 5 mg / 2,5 ml Rectal 10 10 1 9 Nov-13
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
24 Tofranil 25 mg Tablet 40 40 0 40 Jan-17
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
28 Zypraz 1 mg Tablet 2 2 0 2 Jan-14
PREKURSOR
1 Ephedrin 25 mg Tablet 283.5 1000 (GF) 03/12/2012 1283.5 408.75 874.75 Jul-17

Mengetahui, Samarinda, 29 Desember 2012


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Rahmatiah, Apt. Uswatun Hasanah


NIP. 198508142010012030
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN NOVEMBER TAHUN 2012

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
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
3 Coditam Tablet 103 103 0 103 Jan-15
4 Durogesic 12,5 Patch 11 11 0 11 Jul-13
5 Durogesic 25 Patch 17 17 10 7 Nov-13
6 MST 10 mg Tablet 30 60 (GF) 05/11/12 90 20 70 Oct-14
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 799 500 (GF) 05/11/12 1299 773 526 Dec-15
2 Bellaphen Tablet
Zypraz 0,5 mg Tablet
3 1300 (GF) 05/11/12
Atarax 0,5 mg Tablet 224.5 2024.5 1400 624.5 Jan-16
500 (GF) 28/11/12
Anxibloc 10 mg Tablet 667.5 500 (GF) 20/11/12 1167.5 426 741.5 Aug-15
4
Frisium 10 mg Tablet
5 Clozaril 25 mg Tablet 77 77 70 7 Dec-14
6 Cliad Tablet
7 Chlorpromazin 100 mg 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
11 Kalxetin 10 mg Tablet 70 190 95 95 Jul-14
30 (GF) 20/11/12
12 Kalxetin 20 mg Tablet 30 240 (GF) 09/11/12 270 150 120 Sep-15
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
60 (GF) 05/11/12
15 Olandoz 5 mg Tablet 0.5 150.5 45 105.5 May-14
90 (GF) 20/11/12
60 (GF) 05/11/12
16 Olandoz 10 mg Tablet 26 146 67 79 Jan-15
60 (GF) 20/11/12
Persidal 1 mg Tablet
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
20 Sandepril Tablet 25 25 0 25 Jun-14
21 Stesolid Rectal 5 mg / 2,5 ml Rectal 10 10 0 10 Nov-13
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
23 Seroquel Tablet 75 75 30 45 Feb-15
24 Tofranil 25 mg Tablet 40 40 0 40 Jan-17
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
28 Zypraz 1 mg Tablet 32 32 30 2 Jan-14
PREKURSOR
1 Ephedrin 25 mg Tablet 858 858 574.5 283.5 Jul-17

Mengetahui, Samarinda, 30 November 2012


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Rahmatiah, Apt. Uswatun Hasanah


NIP. 198508142010012030
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN OKTOBER TAHUN 2012

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
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
2 Codein 15 mg Tablet 3.5 3.5 0 3.5 Jan-16
3 Coditam Tablet 38 100 (GF) 02/10/12 138 35 103 Jan-15
4 Durogesic 12,5 Patch 11 11 0 11 Jul-13
5 Durogesic 25 Patch 17 17 0 17 Nov-13
6 MST 10 mg Tablet 10 60 (GF) 02/10/12 70 40 30 Oct-14
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
Zypraz 0,5 mg 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
Frisium 10 mg Tablet
50 (GF) 02/10/12
5 Clozaril 25 mg Tablet 52 152 75 77 Dec-14
50 (GF) 25/10/12
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet
100 (GF) 02/10/12
8 Haloperidol 0,5 mg Tablet 122 622 332 290 Dec-15
400 (GF) 16/10/12
9 Haloperidol 1,5 mg Tablet 101.5 100 (GF) 16/10/12 201.5 60 141.5 Dec-15
10 Haloperidol 5 mg Tablet 81 81 60 21 Mar-16
60 (GF) 02/10/12
11 Kalxetin 10 mg Tablet 45 60 (GF) 18/10/12 225 155 70 Apr-14
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
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
30 (GF) 02/10/12
15 Olandoz 5 mg Tablet 23.5 60 (GF) 06/10/12 143.5 143 0.5 May-14
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
Persidal 1 mg Tablet
17
Zofredal 1 mg Tablet 120 120 60 60 Mar-14
120 (GF) 02/10/12
18 Persidal 2 mg Tablet 50 250 135 115 Aug-16
80 (GF) 16/10/12
19 Sandepril Tablet 25 25 0 25 Jun-14
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 10 10 0 10 Nov-13
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
23 Tofranil 25 mg Tablet 40 40 0 40 Jan-17
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
27 Zypraz 1 mg Tablet 35 35 3 32 Jan-14

Mengetahui, Samarinda, 31 Oktober 2012


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Rahmatiah, Apt. Uswatun Hasanah


NIP. 198508142010012030
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN SEPTEMBER TAHUN 2012

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
750 (GF) 03/09/12
1 Codein 10 mg Tablet 678 1928 1207 721 Jul-16
500 (GF) 19/09/12
2 Codein 15 mg Tablet 3.5 3.5 0 3.5 Jan-16
3 Coditam Tablet 149 149 111 38 Jan-15
4 Durogesic 12,5 Patch 3 10 (GF) 03/09/12 13 2 11 Jul-13
5 Durogesic 25 Patch 17 17 0 17 Nov-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
Zypraz 0,5 mg 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
Frisium 10 mg Tablet
50 (GF) 03/09/12
5 Clozaril 25 mg Tablet 31 131 79 52 Jul-14
50 (GF) 19/09/12
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet
8 Haloperidol 0,5 mg Tablet 375 200 (GF) 25/09/12 575 453 122 Dec-15
9 Haloperidol 1,5 mg Tablet 78 100 (GF) 03/09/12 178 76.5 101.5 Dec-15
10 Haloperidol 5 mg Tablet 113 113 32 81 Mar-16
11 Kalxetin 10 mg Tablet 100 30 (GF) 11/09/12 130 85 45 Feb-14
60 (GF) 03/09/12
12 Kalxetin 20 mg Tablet 95 215 150 65 Jun-15
60 (GF) 25/09/12
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
15 Olandoz 5 mg Tablet 68.5 60 (GF) 11/09/12 128.5 105 23.5 Nov-13
30 (GF) 03/09/12
16 Olandoz 10 mg Tablet 41 101 60 41 Feb-14
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
19 Sandepril Tablet 25 25 0 25 Jun-14
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 10 10 0 10 Nov-13
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 1 10 (GF) 03/09/12 11 9 2 Mar-14
22 Seroquel Tablet 15 60 (GF) 03/09/12 75 0 75 May-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
25 Trifluoperazine 5 mg Tablet 470 470 0 470 May-13
26 Valdimex 5 mg Tablet 937.5 1000 (GF) 03/09/12 1937.5 1553.5 384 Dec-15
27 Zypraz 1 mg Tablet 35 35 0 35 Jan-14

Mengetahui, Samarinda, 29 September 2012


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Rahmatiah, Apt. Uswatun Hasanah


NIP. 198508142010012030
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN AGUSTUS TAHUN 2012

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1000 (GF) 02/08/12
1 Codein 10 mg Tablet 148 1648 970 678 May-16
500 (GF) 09/08/12
2 Codein 15 mg Tablet 3.5 3.5 0 3.5 Jan-16
3 Coditam Tablet 174 174 25 149 Sep-14
4 Durogesic 12,5 Patch 6 6 3 3 Jul-13
5 Durogesic 25 Patch 17 17 0 17 Mar-13
6 MST 10 mg Tablet 70 60 (GF) 09/08/12 130 50 80 Oct-14
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
Zypraz 0,5 mg 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
Frisium 10 mg Tablet
5 Clozaril 25 mg Tablet 61 61 30 31 Jul-14
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet
8 Haloperidol 0,5 mg Tablet 220 200 (GF) 02/08/12 420 45 375 Dec-15
9 Haloperidol 1,5 mg Tablet 155 155 77 78 Dec-15
10 Haloperidol 5 mg Tablet 43 100 (GF) 13/08/12 143 30 113 Mar-16
11 Kalxetin 10 mg Tablet 110 110 10 100 Feb-14
30 (GF) 02/08/12
12 Kalxetin 20 mg Tablet 85 205 110 95 Feb-15
90 (GF) 13/08/12
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
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
19 Sandepril Tablet 25 25 0 25 Jun-14
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 10 10 0 10 Nov-13
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 11 11 10 1 Dec-13
22 Seroquel Tablet 35 60 (GF) 02/08/12 95 80 15 May-14
23 Tofranil 25 mg Tablet 50 (GF) 16/08/12 50 50 0 Jan-17
Trihexyphenidil 2 mg Tablet
24
1500 (GF) 02/08/12
Hexymer 2 mg Tablet 260 2260 1460 800 Oct-15
500 (GF) 15/08/12
25 Trifluoperazine 5 mg Tablet 500 500 30 470 May-13
26 Valdimex 5 mg Tablet 441.5 1500 (GF) 02/08/12 1941.5 1004 937.5 Oct-15
27 Zypraz 1 mg Tablet 35 35 0 35 Jan-14

Mengetahui, Samarinda, 31 Agustus 2012


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Rahmatiah, Apt. Uswatun Hasanah


NIP. 198508142010012030
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JULI TAHUN 2012

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1000 (GF) 04/07/12
1 Codein 10 mg Tablet 237 1487 1339 148 May-16
250 (GF) 21/07/12
2 Codein 15 mg Tablet 3.5 3.5 0 3.5 Jan-16
3 Coditam Tablet 84 100 (GF) 10/07/12 184 10 174 Sep-14
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
Zypraz 0,5 mg 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
Frisium 10 mg Tablet
50 (GF) 04/07/12
5 Clozaril 25 mg Tablet 6 106 45 61 Aug-13
50 (GF) 21/07/12
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet
8 Haloperidol 0,5 mg Tablet 535 535 315 220 Dec-15
9 Haloperidol 1,5 mg Tablet 155 155 0 155 Dec-15
10 Haloperidol 5 mg Tablet 100 100 57 43 Mar-16
11 Kalxetin 10 mg Tablet 140 140 30 110 Feb-14
90 (GF) 04/07/12
12 Kalxetin 20 mg Tablet 0 120 (GF) 10/07/12 270 185 85 Feb-15
60 (GF) 27/07/12
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
30 (GF) 04/07/12
15 Olandoz 5 mg Tablet 46 106 67.5 38.5 Nov-13
30 (GF) 21/07/12
16 Olandoz 10 mg Tablet 135 135 94 41 Feb-14
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
18 Persidal 2 mg Tablet 15 215 105 110 Jan-15
140 (GF) 12/07/12
19 Sandepril Tablet 25 25 0 25 Jun-14
5 (GF) 04/07/12
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 2 12 2 10 Nov-13
5 (GF) 27/07/12
5 (GF) 12/07/12
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 3 18 7 11 Dec-13
10 (GF) 27/07/12
22 Seroquel Tablet 60 60 (GF) 04/07/12 120 85 35 May-14
Trihexyphenidil 2 mg Tablet
23 1750 (GF) 04/07/12
Hexymer 2 mg Tablet 22 2272 2012 260 Oct-15
500 (GF) 30/07/12
24 Trifluoperazine 5 mg Tablet 500 500 0 500 May-13
1000 (GF) 04/07/12
25 Valdimex 5 mg Tablet 425 1925 1483.5 441.5 Oct-15
500 (GF) 21/07/12
26 Zypraz 1 mg Tablet 35 35 0 35 Jan-14

Mengetahui, Samarinda, 31 Juli 2012


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Rahmatiah, Apt. Uswatun Hasanah


NIP. 198508142010012030
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JUNI TAHUN 2012

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 172 1000 (GF) 02/06/12 1172 935 237 May-16
2 Codein 15 mg Tablet 3.5 3.5 0 3.5 Jan-16
3 Coditam Tablet 74 100 (GF) 12/06/12 174 90 84 Sep-14
4 Durogesic 12,5 Patch 1 1 0 1 Agt-12
5 Durogesic 25 Patch 15 15 3 12 Mar-13
6 MST 10 mg Tablet 30 60 (GF) 11/06/12 90 0 90 Oct-14
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
Zypraz 0,5 mg 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
Frisium 10 mg Tablet
50 (GF) 02/06/12
5 Clozaril 25 mg Tablet 0 100 94 6 Aug-13
50 (GF) 13/06/12
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet
8 Haloperidol 0,5 mg Tablet 275 500 (GF) 02/06/12 775 240 535 Dec-15
9 Haloperidol 1,5 mg Tablet 200 200 45 155 Dec-15
10 Haloperidol 5 mg Tablet 100 (GF) 02/06/12 100 0 100 Mar-16
11 Kalxetin 10 mg Tablet 75 180 (GF) 11/06/12 255 115 140 Feb-14
12 Kalxetin 20 mg Tablet 6 180 (GF) 02/06/12 186 0 186 Dec-14
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
15 Olandoz 5 mg Tablet 100 100 54 46 Nov-13
30 (GF) 02/06/12
16 Olandoz 10 mg Tablet 45 195 60 135 Feb-14
120 (GF) 11/06/12
Persidal 1 mg
17 Tablet
17 Tablet
Zofredal 1 mg 0 60 (GF) 02/06/12 60 60 0 Jul-13
100 (GF) 02/06/12
18 Persidal 2 mg Tablet 40 180 165 15 Jan-15
40 (GF) 11/06/12
19 Sandepril Tablet 25 25 0 25 Jun-14
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 0 5 (GF) 02/06/12 5 3 2 Nov-13
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 3 3 0 3 Dec-13
22 Seroquel Tablet 90 60 (GF) 02/06/12 150 90 60 May-14
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
24 Trifluoperazine 5 mg Tablet 560 560 60 500 May-13
25 Valdimex 5 mg Tablet 251.5 1500 (GF) 02/06/12 1751.5 1326.5 425 Oct-15
26 Zypraz 1 mg Tablet 35 35 0 35 Jan-14

Mengetahui, Samarinda, 30 Juni 2012


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 198508142010012030 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN MEI TAHUN 2012

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
Zypraz 0,5 mg 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
Frisium 10 mg Tablet
5 Clozaril 25 mg Tablet 9 50 (GF) 04/05/12 59 59 0
6 Cliad Tablet
7 Chlorpromazin 100 mg 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
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
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

Mengetahui, Samarinda, 31 Mei 2012


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


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
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN APRIL TAHUN 2012

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 0 1000 (GF) 16/04/12 1000 540 460 Mar-16
2 Codein 15 mg Tablet 3.5 3.5 0 3.5 Jan-16
3 Coditam Tablet 174 174 75 99 Sep-14
4 Durogesic 12,5 Patch 3 3 0 3 Agt-12
5 Durogesic 25 Patch 0 25 (GF) 04/04/12 25 4 21 Mar-13
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
Zypraz 0,5 mg 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
Frisium 10 mg Tablet
5 Clozaril 25 mg Tablet 58 58 49 9 Aug-13
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet
100 (GF) 04/04/12
8 Haloperidol 0,5 mg Tablet 60 660 445 215 Dec-15
500 (GF) 11/04/12
9 Haloperidol 1,5 mg Tablet 106 106 106 0 Dec-15
10 Haloperidol 5 mg Tablet
11 Kalxetin 10 mg Tablet 0 180 (GF) 04/04/12 180 150 30 Jul-13
12 Kalxetin 20 mg Tablet 101 150 (GF) 04/04/12 251 120 131 Oct-14
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
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
Zofredal 1 mg 60 30 (GF) 04/04/12 90 60 30 Jul-13
18 Persidal 2 mg Tablet 113 100 (GF) 11/04/12 213 120 93 Jan-15
19 Sandepril Tablet 25 25 0 25 Jun-14
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 3 5 (GF) 04/04/12 8 0 8 Nov-13
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 2 2 1 1 Jan-13
22 Seroquel Tablet 120 60 (GF) 04/04/12 180 120 60 May-14
Trihexyphenidil 2 mg Tablet 1865 1865 1470 395 Dec-16
23
Hexymer 2 mg Tablet Mar-15
24 Trifluoperazine 5 mg Tablet 560 560 0 560 May-13
25 Valdimex 5 mg Tablet 906 800 (GF) 04/04/12 1706 1151 555 Oct-15
26 Zypraz 1 mg Tablet 35 35 0 35 Jan-14

Mengetahui, Samarinda, 30 April 2012


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 198508142010012030 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN MARET TAHUN 2012

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet
2 Codein 15 mg Tablet 166 500 (GF) 06/03/12 666 662.5 3.5 Jan-16
3 Coditam Tablet 84 100 (GF) 09/03/12 184 10 174 Sep-14
4 Durogesic 12,5 Patch 15 15 12 3 Agt-12
5 Durogesic 25 Patch 0 20 (GF) 17/03/12 20 20 0 Mar-13
6 MST 10 mg Tablet 50 50 10 40 Jun-14
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 546.5 500 (GF) 03/03/12 1046.5 644 402.5 Sep-15
2 Bellaphen Tablet
Zypraz 0,5 mg 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
Frisium 10 mg Tablet
5 Clozaril 25 mg Tablet 80 50 (GF) 03/03/12 130 72 58 Aug-13
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet
8 Haloperidol 0,5 mg Tablet 160 400 (GF) 03/03/12 560 500 60 Dec-15
100 (GF) 03/03/12
9 Haloperidol 1,5 mg Tablet 16 216 110 106 Dec-15
100 (GF) 17/03/12
10 Haloperidol 5 mg Tablet
11 Kalxetin 10 mg Tablet 60 90 (GF) 03/03/12 150 150 0 Sep-13
12 Kalxetin 20 mg Tablet 83 180 (GF) 03/03/12 263 162 101 Oct-14
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
15 Olandoz 5 mg Tablet 53 30 (GF) 03/03/12 83 78 5 Nov-13
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
18 Persidal 2 mg Tablet 13 280 (GF) 03/03/12 293 180 113 Jan-15
19 Sandepril Tablet 25 25 0 25 Jun-14
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
Trihexyphenidil 2 mg Tablet 0 2000 (GF) 30/03/12 2000 135 1865 Dec-16
23
Hexymer 2 mg Tablet 213 213 213 0 Mar-15
24 Trifluoperazine 5 mg Tablet 560 560 0 560 May-13
25 Valdimex 5 mg Tablet 640 1500 (GF) 03/03/12 2140 1234 906 Jul-15
26 Zypraz 1 mg Tablet 35 35 0 35 Jan-14

Mengetahui, Samarinda, 31 Maret 2012


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 198508142010012030 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN FEBRUARI TAHUN 2012

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
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
3 Coditam Tablet 84 100 (GF) 04/02/12 184 100 84 Sep-14
10 (GF) 14/02/12
4 Durogesic 12,5 Patch 0 25 10 15 Agt-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
5 Clozaril 25 mg Tablet 108 50 (GF) 15/02/12 158 78 80 Aug-13
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet
8 Haloperidol 0,5 mg Tablet 145 400 (GF) 04/02/12 545 385 160 Dec-15
9 Haloperidol 1,5 mg Tablet 91 91 75 16 Sep-14
10 Haloperidol 5 mg Tablet
30 (GF) 04/02/12
11 Kalxetin 10 mg Tablet 105 165 105 60 Sep-13
30 (GF) 10/02/12
60 (GF) 04/02/12
12 Kalxetin 20 mg Tablet 143 323 240 83 Oct-14
120 (GF) 10/02/12
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
15 Olandoz 5 mg Tablet 0 90 (GF) 14/02/12 90 37 53 Nov-13
16 Olandoz 10 mg Tablet 0 300 (GF) 14/02/12 300 135 165 Feb-14
Persidal 1 mg 0
17 Tablet
Zofredal 1 mg 0 120 (GF) 10/02/12 120 0 120 Jul-13
18 Persidal 2 mg Tablet 140 120 (GF) 10/02/12 260 247 13 Jan-15
19 Sandepril Tablet 25 25 0 25 Jun-14
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 4 4 0 4 Oct-12
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 1 5 (GF) 04/02/12 6 2 4 Jan-13
22 Seroquel Tablet 90 60 (GF) 10/02/12 150 120 30 May-14
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
24 Trifluoperazine 5 mg Tablet 560 560 0 560 May-13
25 Valdimex 5 mg Tablet 0 2000 (GF) 09/02/12 2000 1360 640 Jul-15
26 Zypraz 1 mg Tablet 35 35 0 35 Jan-14

Mengetahui, Samarinda, 29 Februari 2012


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 198508142010012030 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JANUARI TAHUN 2012
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 32 500 (GF) 04/01/12 532 532 0 Oct-15
2 Coditam Tablet 109 100 (GF) 18/01/12 209 125 84 Sep-14
3 Durogesic 25 Patch 3 5 (GF) 04/01/12 8 8 0 Mar-13
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
5 Clozaril 25 mg Tablet 73 150 (GF) 17/01/12 223 115 108 Aug-13
6 Cliad Tablet
7 Chlorpromazin 100 mg 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
11 Kalxetin 10 mg Tablet 75 165 60 105 Jun-13
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
15 Olandoz 5 mg Tablet 0 30 (GF) 16/01/12 30 30 0 Nov-13
16 Olandoz 10 mg Tablet 0 150 (GF) 16/01/12 150 150 0 Nov-13
Persidal 1 mg 23 23 23 0
17 Tablet
Zofredal 1 mg 0 60 (GF) 11/01/12 60 60 0 Jul-13
18 Persidal 2 mg Tablet 12 200 (GF) 30/01/12 212 72 140 Jan-15
19 Sandepril Tablet 25 25 0 25 Jun-14
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 4 4 0 4 Oct-12
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 3 3 2 1 Oct-12
22 Seroquel Tablet 60 120 (GF) 16/01/12 180 90 90 May-14
Trihexyphenidil 2 mg Tablet 39 1000 (GF) 04/01/12 1039 1033.5 5.5 Dec-15
23
Hexymer 2 mg Tablet 0
24 Trifluoperazine 5 mg Tablet 560 560 0 560 May-13
25 Valdimex 5 mg Tablet 425 700 (GF) 04/01/12 1125 1125 0 Jul-15
26 Zypraz 1 mg Tablet 35 35 0 35 Jan-14

Mengetahui, Samarinda, 31 Januari 2012


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 198508142010012030 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN DESEMBER TAHUN 2011
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 734 500 (GF) 06/12/11 1234 1202 32 Sep-15
2 Coditam Tablet 84 100 (GF) 16/12/11 184 75 109 Sep-14
3 Durogesic 25 Patch 14 10 (GF) 22/12/11 24 21 3 Mar-13
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
5 Clozaril 25 mg Tablet 58 158 85 73 Aug-13
50 (GF) 14/12/11
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet
8 Haloperidol 0,5 mg Tablet 581 581 380 201 Nov-13
9 Haloperidol 1,5 mg Tablet 76 76 5 71 Sep-14
10 Haloperidol 5 mg Tablet
11 Kalxetin 10 mg Tablet 165 165 90 75 Jun-13
120 (GF) 06/12/11
12 Kalxetin 20 mg Tablet 90 270 270 0 Aug-14
60 (GF) 16/12/11
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
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
18 Persidal 2 mg Tablet 58 198 186 12 Jan-15
40 (GF) 14/12/11
19 Sandepril Tablet 40 40 15 25 Jun-14
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 6 6 2 4 Oct-12
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 3 3 0 3 Oct-12
22 Seroquel Tablet 60 120 (GF) 14/12/11 180 120 60 May-14
Trihexyphenidil 2 mg Tablet 684.5 1000 (GF) 06/12/11 1684.5 1645.5 39 Dec-15
23
Hexymer 2 mg Tablet
24 Trifluoperazine 5 mg Tablet 590 590 30 560 May-13
900 (GF) 06/12/11
25 Valdimex 5 mg Tablet 549 1749 1324 425 Jul-15
300 (GF) 14/12/11
26 Zypraz 1 mg Tablet 35 35 0 35 Jan-14

Mengetahui, Samarinda, 31 Desember 2011


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Rahmatiah, Apt. Uswatun Hasanah


NIP. 198508142010012030
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN NOVEMBER TAHUN 2011
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
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
3 Durogesic 25 Patch 6 20 (GF) 18/11/11 26 12 14 Mar-13
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
Frisium 10 mg Tablet
100 (GF) 03/11/11
5 Clozaril 25 mg Tablet 48 198 140 58 Aug-13
50 (GF) 09/11/11
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet
8 Haloperidol 0,5 mg Tablet 436 500 (GF) 03/11/11 936 355 581 Nov-13
9 Haloperidol 1,5 mg Tablet 141 141 65 76 Sep-14
10 Haloperidol 5 mg Tablet
30 (GF) 03/11/11
11 Kalxetin 10 mg Tablet 45 195 30 165 Jun-13
120 (GF) 09/11/11
12 Kalxetin 20 mg Tablet 150 150 (GF) 03/11/11 300 210 90 Jan-14
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
15 Olandoz 5 mg Tablet 120 120 90 30 Nov-13
16 Olandoz 10 mg Tablet 64 60 (GF) 16/11/11 124 68 56 Nov-13
17 Persidal 1 mg Tablet 98 98 15 83 Sep-13
18 Persidal 2 mg Tablet 68 100 (GF) 03/11/11 168 110 58 Jan-15
19 Sandepril Tablet 40 40 0 40 Jun-14
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 6 6 0 6 Oct-12
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 3 3 0 3 Oct-12
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
24 Trifluoperazine 5 mg Tablet 635 635 45 590 May-13
300 (GF) 03/11/11
25 Valdimex 5 mg Tablet 519 1919 1370 549 Jul-15
1100 (GF) 16/11/11
26 Zypraz 1 mg Tablet 35 35 0 35 Jan-14

Mengetahui, Samarinda, 01 Desember 2011


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Rahmatiah, Apt. Uswatun Hasanah


NIP. 198508142010012030
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN OKTOBER TAHUN 2011
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1000 (GF) 07/10/11
1 Codein 10 mg Tablet 246.5 1746.5 1356 390.5 Sep-15
500 (GF) 28/10/11
2 Coditam Tablet 80 100 (GF) 07/10/11 180 70 110 Apr-14
3 Durogesic 25 Patch 6 6 0 6 Mar-13
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
Frisium 10 mg Tablet
5 Clozaril 25 mg Tablet 123 123 75 48 Aug-13
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet
8 Haloperidol 0,5 mg Tablet 101 900 (GF) 07/10/11 1001 565 436 Jun-15
9 Haloperidol 1,5 mg Tablet 191 191 50 141 Sep-14
10 Haloperidol 5 mg Tablet
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
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
15 Olandoz 5 mg Tablet 0 120 (GF) 07/10/11 120 0 120 Nov-13
16 Olandoz 10 mg Tablet 95 60 (GF) 07/10/11 155 91 64 Nov-13
17 Persidal 1 mg Tablet 109 109 11 98 Sep-13
18 Persidal 2 mg Tablet 127 60 (GF) 25/10/11 187 119 68 Jan-15
19 Sandepril Tablet 5 50 (GF) 07/10/11 55 15 40 Jun-14
20 Stesolid Rectal 5 mg / 2,5 ml Rectal 7 7 1 6 Oct-12
21 Stesolid Rectal 10 mg / 2,5 ml Rectal 5 5 2 3 Oct-12
120 (GF) 07/10/11
22 Seroquel Tablet 0 180 150 30 Feb-14
60 (GF) 18/10/11
Trihexyphenidil 2 mg Tablet 1405 1000 (GF) 07/10/11 2405 1565 840 Dec-15
23
Hexymer 2 mg Tablet
24 Trifluoperazine 5 mg Tablet 635 635 0 635 May-13
1000 (GF) 07/10/11
25 Valdimex 5 mg Tablet 578 2078 1559 519 May-15
500 (GF) 25/10/11
26 Zypraz 1 mg Tablet 35 35 0 35 Jan-14

Mengetahui, Samarinda, 01 November 2011


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Rahmatiah, Apt. Uswatun Hasanah


NIP. 198508142010012030
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JUNI TAHUN 2009

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,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Dra. Riani Maida Hutahaean, Apt Lita Ingria Desiana


NIP.19540925 198312 2001

REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES


DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JUNI TAHUN 2009

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
1 Bellaphen Tablet 143 - 143 60
2 Camlet 0,5 mg Tablet 1983 800 (GF)23/6/09 2783 1990.5
3 Clobazam 10 mg Tablet 465 - 465 196
4 Cliad Tablet 131 - 131 -
5 Luminal 30 mg Tablet 3600 - 3600 305
6 Valdimex 5 mg Tablet 900 1000(GF)27/6/09 1900 1134

Samarinda, 3 Juli 2009

Mengetahui,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Dra. Riani Maida Hutahaean, Apt Lita Ingria Desiana


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
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN SEPTEMBER TAHUN 2009

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR
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,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Dra. Riani Maida Hutahaean, Apt Lita Ingria Desiana


NIP.19540925 198312 2001
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN AGUSTUS TAHUN 2009

STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN
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
4 Cliad Tablet 131 - 131 -
5 Luminal 30 mg Tablet 2999 - 2999 215
Stesolid Rectal 5 mg /
6 Rectal 6 6 -
2,5 ml -
7 Valdimex 5 mg Tablet 1107 - 1107 897

Samarinda, 3 September 2009

Mengetahui,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Dra. Riani Maida Hutahaean, Apt Lita Ingria Desiana


NIP.19540925 198312 2001
NIE

STOK
AKHIR
BULAN

157
146

8
1400
-
150
886.5
131
2784
6
210
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JULI TAHUN 2009

STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN
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
1 Bellaphen Tablet 83 - 83 55
2 Camlet 0,5 Tablet 792.5 - 792.5 792.5
Atarax 0,5 mg Tablet - 1000 (GF)22/7/09 1000 597
3 Clobazam 10 mg Tablet 269 - 269 119
Anxibloc 10 Mg Tablet - 1000 (GF)22/7/09 1000 -
4 Cliad Tablet 131 - 131 -
5 Luminal 30 mg Tablet 3295 - 3295 296
Stesolid Rectal 5 mg /
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,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Dra. Riani Maida Hutahaean, Apt Lita Ingria Desiana


NIP.19540925 198312 2001
NIE

STOK
AKHIR
BULAN

930.5
156

28
-
403
150
1000
131
2999

1107
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN APRIL TAHUN 2010

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
12 Kalxetin 20 mg Tablet 185 - 185 115 70
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
Stesolid Rectal 5 mg /
18 Rectal 6 10(GF) 22/4/10 16 6 10
2,5 ml
Stesolid Rectal 10 mg /
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

Samarinda, 1 Mei 2010

Mengetahui,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Dra. Riani Maida Hutahaean, Apt Lita Ingria Desiana


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
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN SEPTEMBER TAHUN 2011
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 1099 1099 852.5 246.5 Apr-15
2 Coditam Tablet 110 100 (GF) 23/09/11 210 130 80 Apr-14
3 Durogesic 25 Patch 6 6 0 6 Mar-13
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
Atarax 0,5 mg Tablet
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
Frisium 10 mg Tablet
5 Clozaril 25 mg Tablet 83 100 (GF) 10/09/11 183 60 123 Aug-13
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet 0.75 0.75 0.75 0
8 Haloperidol 0,5 mg Tablet 397 500 (GF) 17/09/11 897 796 101 Jun-15
9 Haloperidol 1,5 mg Tablet 215 215 24 191 Sep-14
10 Haloperidol 5 mg Tablet
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
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
15 Olandoz 10 mg Tablet 48 150 (GF) 17/09/11 198 103 95 Nov-13
16 Persidal 1 mg Tablet 109 109 0 109 Sep-13
60 (GF) 07/09/11
17 Persidal 2 mg Tablet 62 162 35 127 Jan-15
40 (GF) 14/09/11
18 Sandepril Tablet 20 20 15 5 Jun-14
19 Stesolid Rectal 5 mg / 2,5 ml Rectal 9 9 2 7 Oct-12
20 Stesolid Rectal 10 mg / 2,5 ml Rectal 5 5 0 5 Oct-12
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
23 Trifluoperazine 5 mg Tablet 635 635 0 635 May-13
24 Valdimex 5 mg Tablet 901 1000 (GF) 07/09/11 1901 1323 578 May-15
25 Zypraz 1 mg Tablet 35 35 0 35 Jan-14

Mengetahui, Samarinda, 01 Oktober 2011


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Rahmatiah, Apt. Uswatun Hasanah


NIP. 198508142010012030
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN AGUSTUS TAHUN 2011
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
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
3 Durogesic 25 Patch 0 20 (GF) 03/08/11 20 14 6 Mar-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
5 Clozaril 25 mg Tablet 13 213 130 83 Aug-13
150 (GF) 13/08/11
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet 0.75 0.75 0 0.75 Jun-12
8 Haloperidol 0,5 mg Tablet 0 600 (GF) 06/08/11 600 203 397 Jun-15
9 Haloperidol 1,5 mg Tablet 253 253 38 215 Jun-12
10 Haloperidol 5 mg Tablet
30 (GF) 03/08/11
11 Kalxetin 10 mg Tablet 44 164 119 45 Dec-12
90 (GF) 09/08/11
12 Kalxetin 20 mg Tablet 213 213 213 0 Jan-14
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
15 Olandoz 10 Mg Tablet 6 150 (GF) 09/08/11 156 108 48 Nov-13
16 Persidal 1 mg Tablet 114 114 5 109 Sep-13
17 Persidal 2 mg Tablet 100 60 (GF) 06/08/11 160 98 62 Jan-15
18 Sandepril Tablet 35 35 15 20 Jun-14
19 Stesolid Rectal 5 mg / 2,5 ml Rectal 9 9 0 9 Oct-12
20 Stesolid Rectal 10 mg / 2,5 ml Rectal 7 7 2 5 Oct-12
21 Seroquel Tablet 45 60 (GF) 16/08/11 105 90 15 May-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
25 Zypraz 1 mg Tablet 45 45 10 35 Jan-14
26 Zypraz 0,5 mg Tablet 66.5 66.5 66.5 0

Mengetahui, Samarinda, 01 September 2011


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 198508142010012030 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JULI TAHUN 2011
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
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
4 MST 10 mg Tablet 6 60 (GF) 09/07/11 66 15 51 Oct-11
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
Frisium 10 Mg Tablet
5 Clozaril 25 mg Tablet 50 (GF) 09/07/11
50 150 137 13 Aug-13
50 (GF) 14/07/11
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet 0.75 0.75 0 0.75 Jun-12
8 Haloperidol 0,5 mg Tablet 198 300 (GF) 02/07/11 498 498 0 Nov-13
9 Haloperidol 1,5 mg Tablet 304.5 304.5 51.5 253 Jun-12
10 Haloperidol 5 mg Tablet
11 Kalxetin 10 mg Tablet 103 103 59 44 Dec-11
120 (GF) 02/07/11
12 Kalxetin 20 mg Tablet 225 345 132 213 Jan-14
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
15 Olandoz 10 Mg Tablet 97 97 91 6 Jul-12
16 Persidal 1 mg Tablet 184 184 70 114 Sep-13
17 Persidal 2 mg Tablet 100 (GF) 02/07/11
5 205 105 100 Jan-15
100 (GF) 09/07/11
18 Sandepril Tablet 60 60 25 35 Jun-14
19 Stesolid Rectal 5 mg / 2,5 ml Rectal 9 9 0 9 Oct-12
20 Stesolid Rectal 10 mg / 2,5 ml Rectal 7 7 0 7 Oct-12
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
23 Trifluoperazine 5 Mg Tablet 635 635 0 635 May-13
1000 (GF) 02/07/11
24 Valdimex 5 mg Tablet 270.5 2070.5 1149 921.5 Feb-15
800 (GF) 20/07/11
25 Zypraz 1 mg Tablet 45 45 0 45 Jan-14
26 Zypraz 0,5 mg Tablet 700 (GF) 02/07/11
216 1916 1849.5 66.5 May-14
1000 (GF) 14/07/11

Mengetahui, Samarinda, 01 Agustus 2011


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 198508142010012030 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JUNI TAHUN 2011
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 1209.5 1209.5 1099 110.5 Apr-15
2 Coditam Tablet 100 100 70 30 Jul-13
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
3 Camlet 0,5 Mg 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
Frisium 10 Mg Tablet
50 (GF) 14/06/11
5 Clozaril 25 mg Tablet 48 148 98 50 Aug-13
50 (GF) 27/06/11
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet 0.75 0.75 0 0.75 Jun-12
8 Haloperidol 0,5 mg Tablet 130 300 (GF) 07/06/11 430 232 198 Nov-13
9 Haloperidol 1,5 mg Tablet 39.5 300 (GF) 27/06/11 339.5 35 304.5 Jun-12
10 Haloperidol 5 mg Tablet
11 Kalxetin 10 mg Tablet 111 60 (GF) 07/06/11 171 68 103 Dec-11
150 (GF) 07/06/11
12 Kalxetin 20 mg Tablet 130 430 205 225 Jan-14
150 (GF) 20/06/11
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
15 Olandoz 10 Mg Tablet 37 90 (GF) 20/06/11 127 30 97 Jul-12
16 Persidal 1 mg Tablet 221 221 37 184 Sep-13
17 Persidal 2 mg Tablet 38 200 (GF) 07/06/11 238 233 5 Jan-15
18 Sandepril Tablet 75 75 15 60 Jun-14
19 Stesolid Rectal 5 mg / 2,5 ml Rectal 9 9 0 9 Oct-12
20 Stesolid Rectal 10 mg / 2,5 ml Rectal 8 8 1 7 Oct-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
23 Trifluoperazine 5 Mg Tablet 635 635 0 635 May-13
400 (GF) 07/06/11
24 Valdimex 5 mg Tablet 205 1605 1334.5 270.5 Feb-15
1000 (GF) 20/06/11
25 Zypraz 1 mg Tablet 50 50 5 45 Jan-14
26 Zypraz 0,5 mg Tablet 0 1000 (GF) 20/06/11 1000 784 216 Mar-14

Mengetahui, Samarinda, 01 Juli 2011


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 198508142010012030 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN MEI TAHUN 2011
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 4.5 1500 (GF) 23/05/11 1504.5 295 1209.5 Apr-15
2 Coditam Tablet 170 170 70 100 Jul-13
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
1 Amitriptilin 25 mg Tablet 401.75 300 (GF) 03/05/11 701.75 432.25 269.5 Sep-14
2 Bellaphen Tablet
3 Camlet 0,5 Mg 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
Frisium 10 Mg Tablet
5 Clozaril 25 mg Tablet 32 50 (GF) 18/05/11 82 34 48 May-13
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet 0.75 0.75 0 0.75 Jun-12
300 (GF) 10/05/11
8 Haloperidol 0,5 mg Tablet 105 445 315 130 Nov-13
40 (Depo IGD) 18/5/11
9 Haloperidol 1,5 mg Tablet 114.5 114.5 75 39.5 Jun-12
10 Haloperidol 5 mg Tablet
11 Kalxetin 10 mg Tablet 117 150 (GF) 11/05/11 267 156 111 Dec-12
150 (GF) 11/05/11
12 Kalxetin 20 mg Tablet 13 313 183 130 Jan-14
150 (GF) 18/05/11
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
15 Olandoz 10 Mg Tablet 59 60 (GF) 24/05/11 119 82 37 Jul-12
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
18 Sandepril Tablet 75 75 0 75 Jun-14
19 Stesolid Rectal 5 mg / 2,5 ml Rectal 9 9 0 9 Oct-12
20 Stesolid Rectal 10 mg / 2,5 ml Rectal 8 8 0 8 Oct-12
60 (GF) 03/05/11
21 Seroquel Tablet 0 120 60 60 Jun-13
21 Seroquel Tablet 0 120 60 60 Jun-13
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
23 Trifluoperazine 5 Mg Tablet 635 635 0 635 May-13
24 Valdimex 5 mg Tablet 701 1000 (GF) 03/05/11 1701 1496 205 Jan-15
25 Zypraz 1 mg Tablet 50 50 0 50 Jan-14

Mengetahui, Samarinda, 01 Juni 2011


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 198508142010012030 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN APRIL TAHUN 2011
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet
699 699 694.5 4.5 Dec-14
2 Coditam Tablet 200 200 30 170 Jul-13
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
1 Amitriptilin 25 mg Tablet 442.25 500 (GF) 04/04/11 942.25 540.5 401.75 Sep-14
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
Frisium 10 Mg Tablet
5 Clozaril 25 mg Tablet 10 50 (GF) 04/04/11 60 28 32 May-13
6 Cliad Tablet
7 Chlorpromazin 100 mg Tablet 0.75 0.75 0 0.75 Jun-12
8 Haloperidol 0,5 mg Tablet 240 240 135 105 Nov-13
9 Haloperidol 1,5 mg Tablet 179.5 179.5 65 114.5 Jun-12
10 Haloperidol 5 mg Tablet
11 Kalxetin 10 mg Tablet 0 150 (GF) 14/04/11 150 33 117 Dec-12
12 Kalxetin 20 mg Tablet 120 (GF) 04/04/11
0 240 227 13 Jan-14
120 (GF) 13/04/11
13 Phenobarbital 30 mg Tablet
14 Ludiomil 50 mg Tablet
15 Olandoz 10 Mg Tablet 52 60 (GF) 13/04/11 112 53 59 Jul-12
16 Persidal 1 mg Tablet 66 66 0 66 Sep-13
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
19 Stesolid Rectal 5 mg / 2,5 ml Rectal 9 9 0 9 Oct-12
20 Stesolid Rectal 10 mg / 2,5 ml Rectal 8 8 0 8 Oct-12
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
23 Trifluoperazine 5 Mg Tablet 635 635 0 635 May-13
24 Valdimex 5 mg Tablet 790 1000 (GF) 04/04/11 1790 1089 701 Jan-15
25 Zypraz 1 mg Tablet 50 50 0 50 Jan-14

Mengetahui, Samarinda, 01 Mei 2011


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 198508142010012030 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN MARET TAHUN 2011
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
1 Amitriptilin 25 mg Tablet 465.25 500 (GF) 12/03/11 965.25 523 442.25 Sep-14
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)
12 Kalxetin 20 mg Tablet 26 150 (GF) 12/03/11 176 176 0 Oct-13
13 Phenobarbital 30 mg Tablet -
14 Ludiomil 50 mg Tablet -
15 Olandoz 10 Mg Tablet 37 90 (GF) 12/03/11 127 75 52 Jul-12
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

Mengetahui, Samarinda, 01 Maret 2011


Koordinator Depo Obat Rawat Jalan Penyusun Laporan

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


NIP. 198508142010012030 NIP. 19870314 201001 2 017
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN FEBRUARI TAHUN 2011
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JML PENGELUARAN AKHIR ED
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 - - - - - -
7 Chlorpromazin 100 mg Tablet 121.75 - 121.75 111 10.75 Jun-12
8 Haloperidol 0,5 mg Tablet 940 - 940 335 605 -
9 Haloperidol 1,5 mg Tablet 324.5 - 324.5 70 254.5 Jun-12
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
16 Persidal 1 mg Tablet 126 - 126 15 111 Sep-13
17 Persidal 2 mg Tablet - 300(GF) 12/2/11 300 180 120 Mar-14
18 Sandepril Tablet 45 - 45 45 - Mar-13
Stesolid Rectal 5 mg /
19 Rectal 7 - 7 7 - Mar-12
2,5 ml
Stesolid Rectal 10 mg /
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,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan
Rahmatiah, Apt. Lita Ingria Desiana
NIP. 198508142010012030
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JANUARI TAHUN 2011
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JML PENGELUARAN AKHIR ED
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
2 Bellaphen Tablet - - - - - -
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
Frisium 10 Mg Tablet - - - - - -
5 Clozaril 25 mg Tablet 29 100(GF) 19/1/11 129 44 85 May-13
6 Cliad Tablet - - - - - -
7 Chlorpromazin 100 mg Tablet 149.75 - 149.75 28 121.75 Jun-12
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
10 Haloperidol 5 mg Tablet - - - - - -
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
13 Phenobarbital 30 mg Tablet - - - - - -
14 Ludiomil 50 mg Tablet - - - - - -
15 Olandoz 5 Mg Tablet - 30(GF) 22/1/11 30 30 - Aug-11
16 Persidal 1 mg Tablet 142 - 142 16 126 Sep-13
17 Persidal 2 mg Tablet 170.25 - 170.25 170.25 - Mar-14
18 Trifluoperazine 5 Mg Tablet 695 - 695 60 635 May-13
19 Sandepril Tablet 75 - 75 30 45 Mar-13
Stesolid Rectal 5 mg /
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,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Rahmatiah, Apt. Lita Ingria Desiana


NIP. 198508142010012030
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN DESEMBER TAHUN 2010
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JML PENGELUARAN AKHIR ED
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
2 Bellaphen Tablet - - - - - -
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
Frisium 10 Mg Tablet - - - - - -
5 Clozaril 25 mg Tablet 4 100(GF) 1/12/10 104 75 29 Oct-12
6 Cliad Tablet - - - - - -
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
10 Haloperidol 5 mg Tablet - - - - - -
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
13 Phenobarbital 30 mg Tablet - - - - - -
14 Ludiomil 50 mg Tablet - - - - - -
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
17 Trifluoperazine 5 Mg Tablet 695 - 695 - 695 May-13
18 Sandepril Tablet 75 - 75 - 75 Mar-13
Stesolid Rectal 5 mg /
19 Rectal 10 - 10 - 10 Mar-12
2,5 ml
Stesolid Rectal 10 mg /
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,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Rahmatiah, Apt. Lita Ingria Desiana


NIP. 198508142010012030
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN NOVEMBER TAHUN 2010
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JML PENGELUARAN AKHIR
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
2 Bellaphen Tablet - - - - -
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
6 Cliad Tablet - - - - -
7 Chlorpromazin 100 mg Tablet 187.25 - 187.25 20 167.25
8 Haloperidol 0,5 mg Tablet - - - - -
9 Haloperidol 1,5 mg Tablet 163 - 163 88 75
10 Haloperidol 5 mg Tablet 34 - 34 34 -
11 Kalxetin 10 mg Tablet 50 - 50 30 20
12 Kalxetin 20 mg Tablet 75 - 75 45 30
13 Phenobarbital 30 mg Tablet - - - - -
14 Ludiomil 50 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
17 Trifluoperazine 5 Mg Tablet 695 - 695 - 695
18 Sandepril Tablet 105 - 105 30 75
Stesolid Rectal 5 mg /
19 Rectal - 10(GF) 2/11/10 10 - 10
2,5 ml
Stesolid Rectal 10 mg /
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,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Rahmatiah, Apt. Lita Ingria Desiana


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
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN OKTOBER TAHUN 2010
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JML PENGELUARAN AKHIR
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 5 1000(GF) 19/10/10 1005 604 401
2 Coditam Tablet - 100(GF) 19/10/10 100 10 90
3 MST 10 mg Tablet 81 - 81 - 81
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 218.5 500(GF) 11/10/10 718.5 663 55.5
2 Bellaphen Tablet - - - - -
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 - - - - -
5 Clozaril 25 mg Tablet - - - - -
6 Cliad Tablet - - - - -
7 Chlorpromazin 100 mg Tablet 244.25 - 244.25 57 187.25
8 Haloperidol 0,5 mg Tablet 2 - 2 2 -
9 Haloperidol 1,5 mg Tablet 316 - 316 153 163
10 Haloperidol 5 mg Tablet 39 - 39 5 34
11 Kalxetin 10 mg Tablet 47 60(GF) 27/10/10 107 57 50
12 Kalxetin 20 mg Tablet 75 - 75 - 75
13 Phenobarbital 30 mg Tablet - - - - -
14 Ludiomil 50 mg Tablet - - - - -
15 Persidal 1 mg Tablet 167 - 167 125 42
16 Persidal 2 mg Tablet 185.25 - 185.25 178.75 6.5
17 Trifluoperazine 5 Mg Tablet 708 - 708 13 695
18 Sandepril Tablet 120 - 120 15 105
Stesolid Rectal 5 mg /
19 Rectal 3 3 3 -
2,5 ml -
Stesolid Rectal 10 mg /
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,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Rahmatiah, Apt. Lita Ingria Desiana


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
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN SEPTEMBER TAHUN 2010
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JML PENGELUARAN AKHIR
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 5 - 5 - 5
2 Coditam Tablet - - - - -
3 MST 10 mg Tablet 81 - 81 - 81
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 352.5 500(GF) 2/9/10 852.5 634 218.5
2 Bellaphen Tablet - - - - -
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
Frisium 10 Mg Tablet - - - - -
5 Clozaril 25 mg Tablet - - - - -
6 Cliad Tablet - - - - -
7 Chlorpromazin 100 mg Tablet 295.75 - 295.75 51.5 244.25
8 Haloperidol 0,5 mg Tablet 15 - 15 13 2
9 Haloperidol 1,5 mg Tablet 368.75 - 368.75 52.75 316
10 Haloperidol 5 mg Tablet 42 - 42 3 39
11 Kalxetin 10 mg Tablet 54 - 54 7 47
12 Kalxetin 20 mg Tablet 75 - 75 - 75
13 Phenobarbital 30 mg Tablet - - - - -
14 Ludiomil 50 mg Tablet - - - - -
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
17 Trifluoperazine 5 Mg Tablet 708 - 708 - 708
18 Sandepril Tablet 50 100(GF) 2/9/10 150 30 120
Stesolid Rectal 5 mg /
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

Samarinda, 1 Oktober 2010

Mengetahui,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Dra. Riani Maida Hutahaean, Apt Lita Ingria Desiana


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
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN AGUSTUS TAHUN 2010
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JML PENGELUARAN AKHIR
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 5 - 5 - 5
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
2 Bellaphen Tablet - - - - -
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
Frisium 10 Mg Tablet - - - - -
5 Clozaril 25 mg Tablet 20 50(GF) 14/8/10 70 70 -
6 Cliad Tablet - - - - -
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
9 Haloperidol 1,5 mg Tablet 93.75 300(GF) 6/8/10 393.75 25 368.75
10 Haloperidol 5 mg Tablet 45 - 45 3 42
11 Kalxetin 10 mg Tablet 54 - 54 - 54
12 Kalxetin 20 mg Tablet 80 60(GF) 22/8/10 140 65 75
13 Phenobarbital 30 mg Tablet 62 50 112 112 -
14 Ludiomil 50 mg Tablet - - - - -
15 Persidal 1 mg Tablet 112 160(GF) 6/8/10 372 320 52
100(GF) 22/8/10
16 Persidal 2 mg Tablet - 160(GF) 6/8/10 260 176 84
100(GF) 22/8/10
17 Trifluoperazine 5 Mg Tablet 715 - 715 7 708
18 Sandepril Tablet 5 100(GF) 19/8/10 105 55 50
Stesolid Rectal 5 mg /
19 Rectal 6 - 6 2 4
2,5 ml
Stesolid Rectal 10 mg /
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 - - -
22 Valdimex 5 mg Tablet 501 500(GF) 6/8/10 1501 975 526
500(GF) 28/8/10

Samarinda, 1 September 2010

Mengetahui,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Dra. Riani Maida Hutahaean, Apt Lita Ingria Desiana


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
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JULI TAHUN 2010
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JML PENGELUARAN AKHIR
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 5 - 5 - 5
2 Coditam Tablet 39 - 39 10 29
3 MST 10 mg Tablet 93 - 93 - 93
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 255 500(GF) 1/7/10 755 481 274
2 Bellaphen Tablet - - - - -
3 Camlet 0,5 Mg Tablet - - - - -
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
Frisium 10 Mg Tablet - - - - -
5 Clozaril 25 mg Tablet 35 - 35 15 20
6 Cliad Tablet - - - - -
7 Chlorpromazin 100 mg Tablet 486.5 - 486.5 152 334.5
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
10 Haloperidol 5 mg Tablet 53 - 53 8 45
11 Kalxetin 10 mg Tablet 84 - 84 30 54
12 Kalxetin 20 mg Tablet 143 - 143 63 80
13 Phenobarbital 30 mg Tablet 727 200(rawat inap) 727 865 62
14 Ludiomil 50 mg Tablet - - - - -
15 Persidal 1 mg Tablet 30 140(GF) 1/7/10 170 58 112
16 Persidal 2 mg Tablet 10 160(GF) 1/7/10 170 170 -
17 Trifluoperazine 5 Mg Tablet 715 - 715 - 715
18 Sandepril Tablet 35 - 35 30 5
Stesolid Rectal 5 mg /
19 Rectal 6 - 6 - 6
2,5 ml
Stesolid Rectal 10 mg /
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,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Dra. Riani Maida Hutahaean, Apt Lita Ingria Desiana


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
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JUNI TAHUN 2010
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JML PENGELUARAN AKHIR
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 95 1000(GF) 2/6/10 1095 1090 5
2 Coditam Tablet 90 - 90 51 39
3 MST 10 mg Tablet 93 - 93 - 93
PSIKOTROPIKA
1 Amitriptilin 25 mg Tablet 298 500(GF) 22/6/10 798 543 255
2 Bellaphen Tablet - - - - -
3 Camlet 0,5 Mg Tablet - - - - -
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
Frisium 10 Mg Tablet - - - - -
5 Clozaril 25 mg Tablet - 50(GF) 14/6/10 50 15 35
6 Cliad Tablet - - - - -
7 Chlorpromazin 100 mg Tablet 540.5 - 540.5 54 486.5
8 Haloperidol 0,5 mg Tablet 426 - 426 355 71
9 Haloperidol 1,5 mg Tablet 238.5 - 238.5 25 213.5
10 Haloperidol 5 mg Tablet 53 - 53 - 53
11 Kalxetin 10 mg Tablet 164 - 164 80 84
12 Kalxetin 20 mg Tablet 25 150(GF) 14/6/10 175 32 143
13 Phenobarbital 30 mg Tablet 1070.5 - 1070.5 343.5 727
14 Ludiomil 50 mg Tablet - - - - -
15 Persidal 1 mg Tablet 90 - 90 60 30
16 Persidal 2 mg Tablet 151 - 151 141 10
17 Trifluoperazine 5 Mg Tablet 715 - 715 - 715
18 Sandepril Tablet - 50(GF) 12/6/10 50 15 35
Stesolid Rectal 5 mg /
19 Rectal 9 - 9 3 6
2,5 ml
Stesolid Rectal 10 mg /
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 - - - - -

Samarinda, 1 Juli 2010

Mengetahui,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Dra. Riani Maida Hutahaean, Apt Lita Ingria Desiana


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
-
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN MEI TAHUN 2010
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
2 Bellaphen Tablet - - - - - -
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 - - - - - -
6 Cliad Tablet - - - - - -
7 Chlorpromazin 100 mg Tablet 573.5 - 573.5 33 540.5 Jun-12
8 Haloperidol 0,5 mg Tablet 85.5 500(GF) 4/5/10 585.5 159.5 426 Dec-11
9 Haloperidol 1,5 mg Tablet 253.5 - 253.5 15 238.5 Jun-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
14 Ludiomil 50 mg Tablet - - - - - -
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
17 Trifluoperazine 5 Mg Tablet 715 - 715 - 715 May-13
Stesolid Rectal 5 mg /
18 Rectal 10 - 10 1 9 Jan-12
2,5 ml
Stesolid Rectal 10 mg /
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,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Dra. Riani Maida Hutahaean, Apt Lita Ingria Desiana


NIP.19540925 198312 2001
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN MARET TAHUN 2010

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JML PENGELUARAN AKHIR
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
2 Bellaphen Tablet - - - - -
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
5 Clozaril 25 mg Tablet - - - - -
6 Cliad Tablet - - - - -
7 Chlorpromazin 100 mg Tablet 662.5 - 662.5 30 632.5
8 Haloperidol 0,5 mg Tablet 212.5 200(GF) 4/3/10 412.5 345 67.5
9 Haloperidol 1,5 mg Tablet 283.5 - 283.5 15 268.5
10 Haloperidol 5 mg Tablet 88 - 88 - 88
11 Kalxetin 10 mg Tablet 253 - 253 69 184
12 Kalxetin 20 mg Tablet 235 - 235 50 185
13 Phenobarbital 30 mg Tablet 1767 - 1767 199 1568
14 Ludiomil 50 mg Tablet - - - - -
15 Persidal 1 mg Tablet - 200(GF) 4/3/10 200 60 140
16 Persidal 2 mg Tablet 42 100(GF) 4/3/10 142 142 -
17 Trifluoperazine 5 Mg Tablet 775 - 775 60 715
Stesolid Rectal 5 mg /
18 Rectal 1 5(GF) 4/3/10 6 - 6
2,5 ml
Stesolid Rectal 10 mg /
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
21 Valdimex 5 mg Tablet 229 1000(GF) 4/3/10 1229 1020 209

Samarinda, 1 April 2010

Mengetahui,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Dra. Riani Maida Hutahaean, Apt Lita Ingria Desiana


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
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN FEBRUARI TAHUN 2010

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JML PENGELUARAN AKHIR ED
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
2 Bellaphen Tablet - - - - -
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 - - - - - -
6 Cliad Tablet - - - - - -
7 Chlorpromazin 100 mg Tablet 709.5 - 709.5 47 662.5 Jun-12
8 Haloperidol 0,5 mg Tablet 518.5 - 518.5 306 212.5 Jun-11
9 Haloperidol 1,5 mg Tablet 314.5 - 314.5 31 283.5 Jun-11
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
14 Ludiomil 50 mg Tablet - - - - - -
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
17 Trifluoperazine 5 Mg Tablet 805 - 805 30 775 May-13
Stesolid Rectal 5 mg /
18 Rectal 3 - 3 2 1 Nov-11
2,5 ml
Stesolid Rectal 10 mg /
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

Samarinda, 1 Maret 2010

Mengetahui,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Dra. Riani Maida Hutahaean, Apt Lita Ingria Desiana


NIP.19540925 198312 2001
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JANUARI TAHUN 2010

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JML PENGELUARAN AKHIR
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
2 Bellaphen Tablet - - - - -
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
5 Clozaril 25 mg Tablet - - - - -
6 Cliad Tablet - - - - -
7 Chlorpromazin 100 mg Tablet 751.5 - 751.5 42 709.5
8 Haloperidol 0,5 mg Tablet 668.5 - 668.5 150 518.5
9 Haloperidol 1,5 mg Tablet 324.5 - 324.5 10 314.5
10 Haloperidol 5 mg Tablet 129 - 129 41 88
11 Kalxetin 10 mg Tablet 326 - 326 56 270
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
17 Trifluoperazine 5 Mg Tablet 874 - 874 69 805
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
21 Valdimex 5 mg Tablet 371 500(GF) 20/1/10 1771 934 837
500(GF) 21/1/10

Samarinda, 1 Februari 2010

Mengetahui,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Dra. Riani Maida Hutahaean, Apt Lita Ingria Desiana


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
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN DESEMBER TAHUN 2009

STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JML PENGELUARAN
BULAN
NARKOTIKA
1 Codein 10 mg Tablet 612.5 1000 (GF) 2/12/09 1612.5 1010.75
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
Stesolid Rectal 10 mg /
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,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Dra. Riani Maida Hutahaean, Apt Lita Ingria Desiana


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
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN NOVEMBER TAHUN 2009

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR
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
1 Bellaphen Tablet - - - - -
2 Camlet 0,5 Mg Tablet - - - - -
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

Samarinda, 1 Oktober 2009

Mengetahui,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Dra. Riani Maida Hutahaean, Apt Lita Ingria Desiana


NIP.19540925 198312 2001
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN OKTOBER TAHUN 2009

STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN
BULAN
NARKOTIKA
1 Codein 10 mg Tablet 772.5 1000 (GF) 5/10/09 1772.5 999.5
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
3 Clobazam 10 mg Tablet 150 - 150 150
Anxibloc 10 Mg Tablet 825 - 825 102
4 Cliad Tablet 131 - 131 -
5 Luminal 30 mg Tablet 2676.5 - 2676.5 370.5
Stesolid Rectal 5 mg / -
6 Rectal 6 6 -
2,5 ml
Stesolid Rectal 10 mg /
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,
Koordinator Depo Obat Rawat Jalan Penyusun Laporan

Dra. Riani Maida Hutahaean, Apt Lita Ingria Desiana


NIP.19540925 198312 2001
RANIE

STOK
AKHIR
BULAN

773
116

-
-
520.5
-
723
131
2306
6

6
315
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN FEBRUARI TAHUN 2015

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR
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

Mengetahui, Samarinda, 02 Maret 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
I STOK NARKOTIKA & PSIKOTROPIKA ASKES
JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN FEBRUARI TAHUN 2015

ED

Sep-15
-

-
Jan-17
-
-
-
Jun-15
Jun-15
Sep-14
Sep-15
-
-
Oct-15
-
-
Jan-17

Aug-16
Jul-15

Samarinda, 02 Maret 2015


Penyusun Laporan

Rusmilawati
NIP. 19651027 199203 2 005
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN MARET TAHUN 2015

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

Samarinda, 02 Maret 2015


Penyusun Laporan

Rusmilawati
NIP. 19651027 199203 2 005
REKAPITULASI STOK NARKOTIKA & PSIKOTROPIKA ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN APRIL TAHUN 2015

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Coditam Tablet 91 0 0 91 Sep-15
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 -
4 Kalxetin 20 mg Tablet -
5 Phenobarbital 30 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
1 Rhinofed Tablet 5 0 5 0 Aug-16
2 Ericaf Tablet Jul-15

Mengetahui, Samarinda, 05 Mei 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
REKAPITULASI STOK NARKOTIKA, PSIKOTROPIKA & PREKURSOR ASKES
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JUNI TAHUN 2015

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
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
3 Kalxetin 10 mg Tablet -
4 Kalxetin 20 mg Tablet -
5 Phenobarbital 30 mg Tablet -
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

Samarinda, 02 Juli 2015


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
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN APRIL TAHUN 2016

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Coditam Tablet
2 MST 10 mg Tablet
PSIKOTROPIKA
1 Zypraz 0,5 mg Tablet
2 Clorilex 100 mg Tablet
3 Kalxetin 10 mg Tablet
4 Kalxetin 20 mg Tablet
5 Phenobarbital 30 mg Tablet
6 Olandoz 5 mg Tablet
7 Olandoz 10 mg Tablet
8 Zofredal 1 mg Tablet
9 Zofredal 2 mg Tablet
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
PREKURSOR
1 Rhinofed Tablet
2 Ericaf Tablet

Samarinda, 01 Mei 2016


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