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REKAPITULASI STOK NARKOTIKA, PSIKOTROPIKA & PREKURSOR RUTIN

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


BULAN MEI TAHUN 2016

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 478.50 1500 (04/05/2016) 1978.5 1351.5 627 Apr-19
2 Codein 15 mg Tablet 78 78 48 30 Aug-17
100 (10/05/2016)
3 Codein 20 mg Tablet 68.75 268.75 170 98.75 Apr-19
100 (25/05/2016)
4 Codipront Kapsul
5 Clopedine Inj 2 ml Ampul
6 MST 10 mg Tablet 128 128 20 108 Oct-18
60 (04/05/2016)
7 MST 15 mg Tablet 30 150 120 30 Feb-19
60 (18/05/2016)
5 (18/05/2016)
8 Durogesic 12,5 mg Patch 4 11 11 0
2 Mutasi(30/05/2016) Feb-17
9 Durogesic 25 mg Patch 3 5 (26/05/2016) 8 5 3 Jul-17
10 Codipront cum exp cap Kapsul 3 Mutasi (13/05/2016) 3 3 0
11 Codipront syr Botol 1 Mutasi (19/05/2016) 1 1 0
PSIKOTROPIKA
100 (04/05/2016)
1 Analsik Tablet 64 264 190 74 Dec-18
100 (25/05/2016)
2 Amitriptilin 25 mg Tablet 398 500 (12/05/2016) 898 682 216 Mei-19, Jun-19
3 Alprazolam 0,5 mg Tablet 58.5 200 (04/05/2016) 258.5 244 14.5 Nov-18
4 Braxidin Tablet 0 14 Mutasi(25/05/2016) 14 14 0
5 Clobazam 10 mg Tablet 461 1000 (12/05/2016) 1461 954 507 Jul-19
Cepezet 206.75 206.75 10 196.75 Feb-18
6 Tablet
Chlorpromazin 25 mg
7 Diazepam 2 mg Tablet
Diazepam 5 mg Tablet
8
Valdimex 5 mg Tablet 777.75 600 (12/05/2016) 1377.75 1116 261.75 Nov-18
9 Esilgan Tabelet 0 30 Mutasi (31/05/2016) 30 30 0
10 Haloperidol 0,5 mg Tablet 144 200 (23/05/2016) 344 320 24 Apr-19
11 Haloperidol 1,5 mg Tablet 75.75 100 (23/05/2016) 175.75 130 45.75 Mar-20
12 Phenobarbital 30 mg Tablet 522 600 (04/05/2016) 1122 1105.25 16.75 Nov-18
13 Phenobarbital 100 mg Tablet
14 Risperidon 2 mg Tablet 203.5 203.5 68 135.5 Jan-19
15 Ritalin 10 mg Tablet
16 Foransi 10 mg Tablet 23 23 23 Feb-17
17 Nopres 20 mg Tablet 103 103 5 98 Feb-18, Apr-18, Jul-19
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
18 Stesolid Rectal 5 mg / 2,5 ml Rectal 10 10 5 5 Jul-17
19 Stesolid Rectal 10 mg / 2,5 ml Rectal 6 10 (04/05/2016) 16 12 4 Feb-17
Trihexyphenidil 2 mg
20 Tablet
Hexymer 2 mg 1017.5 1500 (12/05/2016) 2517.5 2492.5 25 Mar-19
21 Zolmia Tablet
22 Seroquel XR Tablet 50 50 50 Sep-16, Des-16
23 Sibital 50 mg Tablet
PREKURSOR
300 (02/05/2016)
1 Ephedrin 25 mg Tablet 154.5 654.5 425.25 229.25 Jan-17
200 (25/05/2016)
2 Aldisa SR Tablet 3 100 (02/05/2016) 103 100 3 Oct-17
3 Trifed Tablet 59.5 59.5 32 27.5 Sep-17
4 Trifed Syrup Botol 2 2 0 2 Jan-17
15 Mutasi(09/05/2016)
5 Tuzalos Tablet 27 27 0
12 Mutasi(19/05/2016)
6 Ergotamin Tablet 596 596 361.75 234.25 Sep-18
7 Clozapine 100 mg Tablet 0.75 0.75 0.75 Mar-17
8 Alco DM Syrup Botol

Samarinda, 01 Juni 2016


Pembuat laporan,

Irma farida Meilani Winda Aprila Amd. Far


NIP. 19790529 200701 2 009

Mengetahui,
Koord. Depo Farmasi Jalan Ka. Instalasi Farmasi RSUD A W Syahranie

Yuniastuti, S.Si.,M.Si, Apt Dra. Hj.Linawati., Apt


NIP : 19780602 200903 2 003 NIP : 19640412 199203 2 010
REKAPITULASI STOK NARKOTIKA, PSIKOTROPIKA & PREKURSOR RUTIN
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JUNI TAHUN 2016

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 627.00 1500 (13/06/2016) 2167.0 1060.5 1106.5
2 Codein 15 mg Tablet 30 100 (22/06/2016) 130 85 45
3 Codein 20 mg Tablet 98.75 98.75 85 13.75
4 Codipront Kaps Kapsul 10 Mutasi dr dp. sakura (21/06/2016) 10.00 10 0
5 Clopedine Inj 2 ml Ampul
6 MST 10 mg Tablet 108 108 40 68
7 MST 15 mg Tablet 30 120 (06/06/2016) 150 100 50
8 Durogesic 12,5 mg Patch 0 5 (22/06/2016) 5 0 5
9 Durogesic 25 mg Patch 3 5 (13/06/2016) 8 5 3
10 Codipront cum exp cap Kapsul
11 Codipront cum exp syr Botol 1 Mutasi dr Depo Sakura (28/06/2016) 1 1 0

PSIKOTROPIKA
200 (07/06/2016)
1 Analsik Tablet 74 374 364 10
100 (24/06/2016)
2 Amitriptilin 25 mg Tablet 216 800 (13/06/2016) 1016 468.5 547.5
200 (06/06/2016)
3 Alprazolam 0,5 mg Tablet 14.5 314.5 235 79.5
100 (24/06/2016)
4 Clobazam 10 mg Tablet 507 1000 (13/06/2016) 1507 824 683
Cepezet
5 Tablet 196.75 196.75 3.25 193.50
Chlorpromazin 25 mg
6 Diazepam 2 mg Tablet
7 Diazepam 5 mg Tablet
8 Valdimex 5 mg Tablet 261.75 1300 (06/06/2016) 1561.75 997 564.50
9 Esilgan Tabelet 0 3 Mutasi dr Depo Sakura (30/06/2016) 3 3 0
200 (07/06/2016)
10 Haloperidol 0,5 mg Tablet 24 324 235 89
100 (24/06/2016)
11 Haloperidol 1,5 mg Tablet 45.75 100 (07/06/2016) 145.75 140 5.75
600 (06/06/2016)
12 Phenobarbital 30 mg Tablet 16.75 1116.75 659.75 457
500 (27/06/2016)
13 Phenobarbital 100 mg Tablet
14 Risperidon 2 mg Tablet 135.5 135.5 20 115.5
15 Ritalin 10 mg Tablet
16 Foransi 10 mg Tablet 23 23
17 Nopres 20 mg Tablet 98 98 98
18 Stesolid Rectal 5 mg / 2,5 ml Rectal 5 10 (13/06/2016) 15 3 12
19 Stesolid Rectal 10 mg / 2,5 ml Rectal 4 15 (07/06/2016) 19 17 2
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR
BULAN BULAN
Trihexyphenidil 2 mg 2000 (06/06/2016)
20 Tablet 25 2525 2190 335
Hexymer 2 mg 500 (24/06/2016)
21 Zolmia Tablet
22 Seroquel XR Tablet 50 50 50
23 Sibital 50 mg Tablet

PREKURSOR
1 Ephedrin 25 mg Tablet 229.25 500 (06/06/2016) 729.25 483.25 246
2 Aldisa SR Tablet 3 100 (06/06/2016) 103 70 33
50 (06/06/2016)
3 Trifed Tablet 27.5 127.5 79 49
50 (27/06/2016)
4 Trifed Syrup Botol 2 2 2 0
5 Tuzalos Tablet 0 8 Mutasi dr Depo Sakura (01/06/2016) 8 8 0
6 Ergotamin Tablet 234.25 300 (07/06/2016) 534.25 302.25 232
7 Clozapine 100 mg Tablet 0.75 0.75 0.75
8 Alco DM Syrup Botol

Samarinda, 01 Juli 2016


Pembuat laporan,

Irma farida Meilani Eka Susilowati A


NIP. 19790529 200701 2 009

Mengetahui
Koord. Depo Farmasi Rawat Jalan

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


NIP : 19780602 200903 2 003
ED

Apr-19
Apr-19
Apr-19

Oct-18
Feb-19
Sep-17
Jul-17

Feb-19
Mei-19, Jun-19
Nov-18
Nov-19
Feb-18

Nov-18

Mar-20
Apr-19
Nov-18

Jan-19

Feb-17
Feb-18, Apr-18, Jul-19
Nov-17
Jun-17
ED

Mar-18

3 bx Sep-16, 2 bx Des-16

Jan-17
Oct-17
Mar-17

Sep-18
Mar-17

nda, 01 Juli 2016

Susilowati A
REKAPITULASI STOK NARKOTIKA, PSIKOTROPIKA & PREKURSOR RUTIN
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN JULI TAHUN 2016

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1 Codein 10 mg Tablet 1066.5 800 (12/07/2016) 1866.5 1203 663.5 Apr-19
2 Codein 15 mg Tablet 45 45 45 0
200 (12/07/2016)
3 Codein 20 mg Tablet 13.75 313.75 107.5 206.25 Apr-19
100 (26/07/2016)
4 Codipront Kaps Kapsul
5 Clopedine Inj 2 ml Ampul
6 MST 10 mg Tablet 68 0 68 41 27 Oct-18
7 MST 15 mg Tablet 50 60 (12/07/2016) 110 60 50 Feb-19
8 Durogesic 12,5 mg Patch 5 0 5 3 2 Sep-17
9 Durogesic 25 mg Patch 3 0 3 0 3 Jul-17
10 Codipront cum exp cap Kapsul 0 10 ( mutasi 19/07/2016) 10 10 0
11 Codipront cum exp syr Botol

PSIKOTROPIKA
100 (12/07/2016)
100 (26/07/2016)
1 Analsik Tablet 10 230 130 100 Feb-19
10 ( mutasi 21/07/2016)
10 ( mutasi 21/07/2016)
2 Amitriptilin 25 mg Tablet 547.5 400 (12/07/2016) 947.5 727.75 219.75 Jun-19
3 Alprazolam 0,5 mg Tablet 79.5 200 (12/07/2016) 279.5 150 129.5 Nov-18
4 Clobazam 10 mg Tablet 683 700 (12/07/2016) 1383 673 710.25 Feb-20
Cepezet
5 Tablet 193.5 0 193.5 0 193.5 Feb-18
Chlorpromazin 25 mg
6 Diazepam 2 mg Tablet
7 Diazepam 5 mg Tablet
8 Valdimex 5 mg Tablet 564.5 800 (12/07/2016) 1364.5 802 562.5 Nov-18
9 Esilgan Tabelet
10 Haloperidol 0,5 mg Tablet 89 100 (26/07/2016) 189 89 100
11 Haloperidol 1,5 mg Tablet 5.75 100 (12/07/2016) 105.75 40 65.75 Apr-19
500 (12/07/2016)
12 Phenobarbital 30 mg Tablet 457 200 (28/07/2016) 1207 1000 207 Nov-18
50 ( mutasi 11/07/2016)
13 Phenobarbital 100 mg Tablet
14 Risperidon 2 mg Tablet 115.5 0 115.5 75 40.5 Jan-19
15 Ritalin 10 mg Tablet
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
16 Foransi 10 mg Tablet 23 0 23 0 23 Feb-17
17 Nopres 20 mg Tablet 98 0 98 0 98 Feb-18, Apr-18, Jul-19
18 Stesolid Rectal 5 mg / 2,5 ml Rectal 12 0 12 3 9 Nov-17
19 Stesolid Rectal 10 mg / 2,5 ml Rectal 2 14 (12/07/2016) 16 6 10 Mar-18
Trihexyphenidil 2 mg
20 Tablet 335 2335 1687.5 647.5 Mar-19
Hexymer 2 mg 2000 (12/07/2016)
21 Zolmia Tablet
22 Seroquel XR Tablet 50 0 50 0 50 3 bx Sep-16, 2 bx Des-16
23 Sibital 50 mg Tablet

PREKURSOR
1 Ephedrin 25 mg Tablet 246 500 (12/07/2016) 746 186.25 559.75 Jan-17
100 (12/07/2016)
2 Aldisa SR Tablet 33 183 110 73 Dec-17
50 (26/07/2016)
3 Trifed Tablet 49 0 49 26 23 Mar-17
4 Trifed Syrup Botol
5 Tuzalos Tablet
6 Ergotamin Tablet 232 100 (26/07/2016) 332 266.75 65.25 Sep-18
7 Clozapine 100 mg Tablet 0.75 0 0.75 0.0 0.75 Mar-17
8 Alco DM Syrup Botol
9 Tramadol Tablet 293 1100 (12/07/2016) 1393 940.5 452.5 Oct-18

Pembuat laporan, Samarinda, 01 Agustus 2016

Indarti Yuliani A.Md., Far


NIP. 19770705 199703 2 006

Mengetahui
Koord. Depo Farmasi Rawat Jalan Ka. Instalasi Farmasi RSUD A W Syahranie

Yuniastuti, S.Si.,M.Si, Apt Dra. Hj.Linawati., Apt


NIP : 19780602 200903 2 003 NIP : 19640412 199203 2 010
REKAPITULASI STOK NARKOTIKA, PSIKOTROPIKA & PREKURSOR RUTIN
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN AGUSTUS TAHUN 2016

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
1200 (03/08/2016)
1 Codein 10 mg Tablet 663.5 1963.5 1751.5 212 Apr-19
100 (29/08/2016)
100 (03/08/2016
2 Codein 15 mg Tablet 0 100 (12/08/2016) 300 106.5 193.5 Apr-19
100 (29/08/2016)
3 Codein 20 mg Tablet 206.25 100 (29/08/2016) 306.25 190 116.25 Apr-19
4 Codipront Kaps Kapsul
5 Clopedine Inj 2 ml Ampul
60 (05/08/2016)
6 MST 10 mg Tablet 27 60 (12/08/2016) 207 152 55 Oct-18
60 (15/08/2016)
60 (03/08/2016)
7 MST 15 mg Tablet 50 170 75 95 Feb-19
60 (29/08/2016)
5 (03/08/2016)
8 Durogesic 12,5 mg Patch 2 3 (Mutasi dari Depo SAKURA 01/08/2016) 15 15 0
5 (22/08/2016)
9 Durogesic 25 mg Patch 3 5 (29/08/2016) 8 2 6 Jul-17
10 Codipront cum exp cap Kapsul 0 0
11 Codipront cum exp syr Botol

PSIKOTROPIKA
1 Analsik Tablet 100 100 (02/08/2016) 200 130 70 Feb-19
100 (02/08/2016)
2 Alprazolam 0,5 mg Tablet 129.5 329.5 205 124.5 Nov-18
100 (29/08/2016)
3 Clobazam 10 mg Tablet 710.25 400 (02/08/2016) 1110.25 797.25 313 Feb-20
4 Diazepam 2 mg Tablet
5 Diazepam 5 mg Tablet
900 (02/08/2016)
6 Valdimex 5 mg Tablet 562.5 1762.5 1218.5 544 Nov-18
300 (31/08/2016/0
7 Esilgan Tabelet
800 (02/08/2016)
8 Phenobarbital 30 mg Tablet 207 200 (29/08/2016) 1407 892 515 Nov-18
200 (31/08/2016)
9 Phenobarbital 100 mg Tablet
10 Risperidon 2 mg Tablet 40.5 0 40.5 5 35.5 Jan-19
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
11 Ritalin 10 mg Tablet
12 Foransi 10 mg Tablet 23 0 23 0 23 Feb-17
13 Nopres 20 mg Tablet 98 0 98 40 58 Feb-18, Apr-18, Jul-19
14 Stesolid Rectal 5 mg / 2,5 ml Rectal 9 5 (12/08/2016) 14 10 4 Nov-17
15 (02/08/2016)
15 Stesolid Rectal 10 mg / 2,5 ml Rectal 10 5 (29/08/2016) 35 27 8 Mar-18
5 (31/08/2016)
16 Zolmia Tablet
17 Seroquel XR Tablet 50 0 0 0 50 3 bx Sep-16, 2 bx Des-16
18 Sibital 50 mg Tablet

PREKURSOR
1 Ephedrin 25 mg Tablet 559.75 0 559.75 280.75 279 Jan-17
50 (02/08/2016)
2 Aldisa SR Tablet 73 223 105 118 Dec-17
100 (31/08/2016)
3 Trifed Tablet 23 100 (02/08/2016) 123 90.75 32.25 Mar-17
1 (02/08/2016)
2 (19/08/2016)
4 Trifed Syrup Botol 0 8 8 0
3 (23/08/2016)
2 (25/08/2016)
5 Tuzalos Tablet 0 10 (Mutasi dari Depo SAKURA 11/08/2016) 10 10 0
400 (02/08/2016)
6 Ergotamin Tablet 65.25 665.25 389 276.25 Sep-18
200 (31/08/2016)
7 Clozapine 100 mg Tablet 0.75 0 0.75 0 0.75 Mar-17
8 Alco DM Syrup Botol
OBAT-OBAT TERTENTU
800 (02/08/2016)
1 Amitriptilin 25 mg Tablet 219.75 1119.75 848.25 271.5 Jun-19
100 (29/08/2016)
Cepezet 100 mg 193.5 0 193.5 1.25 192.25 Feb-18
2 Tablet
Chlorpromazin 25 mg
100 (02/08/2016)
3 Haloperidol 0,5 mg Tablet 100 300 191 109 Mar-20
100 (31/08/2016)
4 Haloperidol 1,5 mg Tablet 65.75 100 (02/08/2016) 165.75 70 95.75 Apr-19
Trihexyphenidil 2 mg 0 70 (Mutasi dari Depo IGD 03/08/2016) 70 67.5 2.5 Mar-19
5 Tablet 2000 (02/08/2016)
Hexymer 2 mg 647.5 3647.5 2202.5 1445 Mar-19
1000 (31/08/2016)
800 (02/08/2016)
6 Tramadol Tablet 452.5 200 (16/08/2016) 2052.5 1538 514.5 Oct-18
600 (22/08/2016)
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
Pembuat laporan, Samarinda, 02 September 2016

Indarti Uswatun Hasanah


NIP. 19770705 199703 2 006

Mengetahui
Koord. Depo Farmasi Rawat Jalan Ka. Instalasi Farmasi RSUD A W Syahranie

Yuniastuti, S.Si.,M.Si, Apt Dra. Hj.Linawati., Apt


NIP : 19780602 200903 2 003 NIP : 19640412 199203 2 010
REKAPITULASI STOK NARKOTIKA, PSIKOTROP
DEPO OBAT RAWAT JALAN INSTALASI FARMAS
BULAN AGUSTUS TAHUN

STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN
BULAN
NARKOTIKA
1 Codein 10 mg Tablet 524 1000
2 Codein 15 mg Tablet 186
100
3 Codein 20 mg Tablet 101.25 200
300
4 Codipront Kaps Kapsul
5 Clopedine Inj 2 ml Ampul
6 MST 10 mg Tablet 61
7 MST 15 mg Tablet 40 60
10
8 Durogesic 12,5 mg Patch 2
10
9 Durogesic 25 mg Patch 4

PSIKOTROPIKA
1 Analsik Tablet 70 200
2 Alprazolam 0,5 mg Tablet 106.5 100
3 Clobazam 10 mg Tablet 332.25 500
4 Diazepam 2 mg Tablet
5 Diazepam 5 mg Tablet
6 Valdimex 5 mg Tablet 1.5
7 Valisanbe 2 mg 0.0 1700
8 Esilgan Tabelet
9 Phenobarbital 30 mg Tablet 356.5 1100
10 Phenobarbital 100 mg Tablet 0.00
11 Risperidon 2 mg Tablet 163 163
12 Prohiper Tablet 0 90
13 Foransi 10 mg Tablet 23
14 Nopres 20 mg Tablet 38
15 Stesolid Rectal 5 mg / 2,5 ml Rectal 6 10
16 Stesolid Rectal 10 mg / 2,5 ml Rectal 2 20
17 Zolmia Tablet
18 Seroquel XR Tablet 50
19 Sibital 50 mg Tablet

PREKURSOR
1 Ephedrin 25 mg Tablet 257.5 300
100
2 Aldisa SR Tablet 48
150
3 Trifed Tablet 8.75
4 Trifed Syrup Botol 0 2
5 Tuzalos Tablet 0
6 Ergotamin Tablet 153.25 20
7 Clozapine 100 mg Tablet 0.75
8 Alco DM Syrup Botol
OBAT-OBAT TERTENTU
1 Amitriptilin 25 mg Tablet 396 1000
Cepezet 100 mg
2 Tablet 154
Chlorpromazin 25 mg
3 Haloperidol 0,5 mg Tablet 87 200
4 Haloperidol 1,5 mg Tablet 41.25 100
Trihexyphenidil 2 mg
5 Tablet
Hexymer 2 mg 0.5 2000
1000
6 Tramadol Tablet 434.5
1500

Pembuat laporan,

Indarti
NIP. 19770705 199703 2 006

Mengetahui
Koord. Depo Farmasi Rawat Jalan

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


NIP : 19780602 200903 2 003
PITULASI STOK NARKOTIKA, PSIKOTROPIKA & PREKURSOR RUTIN
O OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN AGUSTUS TAHUN 2016

STOK
PENERIMAAN JUMLAH PENGELUARAN AKHIR
BULAN

04 Nov 16 1524 1486 38


186 112.0 74
04 Nov 16
01 Nov 16 701.25 650.5 50.75
22 Nov 16

61 55 6
04 Nov 16 100 65 35
04 Nov 16
22 20 2
11 Nov 16
4 4 0

04 Nov 16 270 116 154


04 Nov 16 206.5 125 81.5
04 Nov 16 832.25 633.25 199

04 Nov 16 1.5 1.0 0.5


04 Nov 16 1700.0 1089.0 611.0

04 Nov 16 1456.5 820 636.5

163 20 143
30 Nov 16 90 0 90
23 0 23
38 0 38
11 Nov 16 16 6 10
08 Nov 16 22 12 10

0 0 50

04 Nov 16 557.5 477.50 80


04 Nov 16
298 170 128
22 Nov 16
8.75 8.00 0.75
04 Nov 16 2 0 2
0
Mutasi dari Sakura Tgl 17 Nov 16 173.25 168.25 5
0.75 0 0.75
22 Nov 16 1396 638.50 757.5
154 3.5 150.5
11 Nov 16 287 122 165
11 Nov 16 141.25 30 111.25

29 Nov 16 2000.5 420.0 1580.5


04 Nov 16
2934.5 2003 931.5
22 Nov 16

Samarinda, 02 Desember 2016

Eka usilowati A

Ka. Instalasi Farmasi RSUD A W Syahranie

Dra. Hj.Linawati., Apt


NIP : 19640412 199203 2 010
ED

Nov-19
Aug-17

Nov-19

Jul-20
Feb-19
Jan-18

May-19
Mar-19
Jun-20

Nov-18
Jul-21

Nov-18

Aug-19
Feb-20
Feb-17
Feb-18, Apr-18, Jul-19
Nov-17
Mar-18

3 bx Sep-16, 2 bx Des-16
Barang Ada Di gudang

Jan-17
Jun-18
Mar-17
Apr-18

Sep-18
Mar-17
Feb-20
Feb-18
Mar-20
Apr-19

Jul-18
Oct-18

ber 2016

A W Syahranie

Apt
3 2 010
REKAPITULASI STOK NARKOTIKA, PSIKOTROPIKA & PREKURSOR RUTIN
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN DESEMBER TAHUN 2016

STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
NARKOTIKA
2000 ( 02/12/16 )
1 Codein 10 mg Tablet 38 3038 2038 1000 Nov-19
1000 ( 29/12/16 )
2 Codein 15 mg Tablet 74 74 74 0 Aug-17
200 ( 02/12/16 )
3 Codein 20 mg Tablet 50.75 450.75 252.5 198.25 Nov-19
200 ( 29/12/16 )
4 Codipront Kaps Kapsul 0 0 0.0 0 0
5 Clopedine Inj 2 ml Ampul 0 0 0 0 0
6 MST 10 mg Tablet 6 120 ( 21/12/16 ) 126 60 66 Nov-18
7 MST 15 mg Tablet 35 15 ( Mutasi 19/12/16 ) 50 50 0
15 ( 02 /12/16 )
8 Durogesic 12,5 mg Patch 2 27 14 13 Jan-18
10 ( 29/12/16 )
9 Durogesic 25 mg Patch 0 5 ( 29/12/16 ) 5 0 5 Jan-18

PSIKOTROPIKA
1 Analsik Tablet 154 100 ( 13/12/16 ) 254 165 89 May-19
2 Alprazolam 0,5 mg Tablet 81.5 300 ( 13/12/16 ) 381.5 70 311.5 Mar-19
3 Clobazam 10 mg Tablet 199 1000 ( 13/12/16 ) 1199 946.75 252.25 Aug-20
4 Diazepam 2 mg Tablet 0 0 0 0 0
5 Diazepam 5 mg Tablet 0 0 0 0 0
6 Valdimex 5 mg Tablet 2.25 0 2.25 0 2.25 Nov-18
7 Valisanbe 5 mg Tablet 607 2000 ( 13/12/16 ) 2607 1483.5 1123.5 Jul-21
8 Esilgan Tabelet 0 0 0 0 0
9 Phenobarbital 30 mg Tablet 636.5 1000 ( 19/12/16 ) 1636.5 1501 135.5 Nov-18
10 Phenobarbital 100 mg Tablet 0 0 0 0 0
11 Risperidon 2 mg Tablet 143 0 143 40.5 102.5 Aug-19
12 Prohiper Tablet 90 0 90 45 45 Feb-20
13 Foransi 10 mg Tablet 23 0 23 5 18 Feb-17
14 Nopres 20 mg Tablet 38 0 38 10 28 Feb-18, Apr-18, Jul-19
15 Stesolid Rectal 5 mg / 2,5 ml Rectal 10 5 ( 13/12/16 ) 15 5 10 Mar-18
10 ( 13/12/16 )
16 Stesolid Rectal 10 mg / 2,5 ml Rectal 10 35 22 13 Mar-18
15 ( 29/12/16 )
17 Zolmia Tablet 0 0 0 0 0
3 bx Sep-16, 2 bx Des-16
18 Seroquel XR Tablet 50 0 50 0 50
Barang Ada Di gudang
19 Sibital 50 mg Tablet 0 0 0 0 0

PREKURSOR
100 ( 02/12/16 )
100 ( 13/12/16 )
1 Ephedrin 25 mg Tablet 80 100 ( 19/12/16 ) 566 566 0
100 ( 21/12/16 )
86 ( Mutasi 27/12/16 )
2 Aldisa SR Tablet 128 2 ( Mutasi 29/12/16 ) 130 130 0
3 Trifed Tablet 0.75 0 0.75 0 0.75 Mar-17
4 Trifed Syrup Botol 2 0 2 0 2 Apr-18
5 Tuzalos Tablet 0 0 0 0 0
6 Ergotamin Tablet 5 0 5 0 5 Sep-18
7 Clozapine 100 mg Tablet 0.75 0 0.75 0 0.75 Mar-17
8 Alco DM Syrup Botol 0 0 0 0 0.00
OBAT-OBAT TERTENTU
1 Amitriptilin 25 mg Tablet 757.75 1000 ( 13/12/16 ) 1757.75 955.25 802.5 Feb-20
Cepezet 100 mg 150.5 0 150.5 0 150.5 Feb-18
2 Tablet
Chlorpromazin 25 mg 0 0 0 0 0
200 ( 06/12/16 )
3 Haloperidol 0,5 mg Tablet 165 565 442 123 Mar-20
200 ( 23/12/16 )
4 Haloperidol 1,5 mg Tablet 111.25 200 ( 23/12/16 ) 311.25 111 200.25 Apr-19
Trihexyphenidil 2 mg 2.5 0 2.5 2.5 Sep-18
5 Tablet 2000 ( 13/12/16 )
Hexymer 2 mg 1580.5 5580.5 3723.75 1856.75 Jul-18
2000 ( 23/12/16 )
6 Tramadol Tablet 931.5 1500 ( 13/12/16 ) 2431.5 2082.5 349 Jun-18

Pembuat laporan, Samarinda, 03 Januari 2017

Indarti Nia Patmawati, Amd., Far


NIP. 19770705 199703 2 006

Mengetahui
Koord. Depo Farmasi Rawat Jalan Ka. Instalasi Farmasi RSUD A W Syahranie

Yuniastuti, S.Si.,M.Si, Apt Dra. Hj.Linawati., Apt


NIP : 19780602 200903 2 003 NIP : 19640412 199203 2 010
STOK STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH PENGELUARAN AKHIR ED
BULAN BULAN
15 (05/01/17)
16 Stesolid Rectal 10 mg / 2,5 ml Rectal 13 38 23 15 Mar 18, Apr 18
10 (31/01/17)
17 Zolmia Tablet 0 0 0 0 0
3 Box Sep-16, 2 Box Des-16
18 Seroquel XR Tablet 50 0 50 0 50
Barang Ada Di gudang
19 Sibital 50 mg Tablet 0 0 0 0 0

PREKURSOR
1 Ephedrin 25 mg Tablet 0 0 0 0 0
100 (05/01/2017)
2 Aldisa SR Tablet 0 200 125 75 Jun 18, Agust 18
100 (20/01/2017)
28 (03/01/17) Mutasi Dari Sakura
3 Trifed Tablet 0.75 228.75 131.25 97.5
200 (05/01/17) Jun-18
Trifed Syrup 1 (23/01/17) Mutasi Dari Sakura
4 Botol 2 6 3 3
3 (30/1/17) Mar 18, Juni 2018
5 Tuzalos Tablet 0 0 0 0 0
6 Ergotamin Tablet 5 1000 (05/01/17) 1005 279.75 725.25 Sep-18
7 Clozapine 100 mg Tablet 0.75 0 0.75 0 0.75 Mar-17
8 Alco DM Syrup Botol 0 0 0 0 0.00
OBAT-OBAT TERTENTU
500(05/01/17)
1 Amitriptilin 25 mg Tablet 802.5 2302.5 1053 1249.5 Feb-20
1000 (31/01/17)
Cepezet 100 mg 150.5 0 150.5 1 149.5 Feb-18
2 Tablet
Chlorpromazin 25 mg 0 0 0 0 0
300 (09/01/2017)
3 Haloperidol 0,5 mg Tablet 123 923 365 558 Mar-20
500(31/01/17)
4 Haloperidol 1,5 mg Tablet 200.25 0 200.25 50 150.25 Apr 19, Mei 19
Trihexyphenidil 2 mg 2.5 0 2.5 2.5 0 Sep-18
5 Tablet 1000 (05/1/17)
Hexymer 2 mg 1856.75 3856.75 3121.25 735.5 Jul-18
1000 (30/01/17)
2000 (05/01/17) Jun-18
6 Tramadol Tablet 349 4349 2379 1970
2000 (31/1/17) Sep-19

Pembuat laporan, Samarinda, 03 Februari 2017

Nia Patmawati, Amd., Far Dewi Nurhayati

Mengetahui
Koord. Depo Farmasi Rawat Jalan Ka. Instalasi Farmasi RSUD A W Syahranie

Yuniastuti, S.Si.,M.Si, Apt Dra. Hj.Linawati., Apt


NIP : 19780602 200903 2 003 NIP : 19640412 199203 2 010
13 Foransi 10 mg Tablet 18 0 18 18 0 Feb-17
14 Nopres 20 mg Tablet 23 0 23 0 23 Feb-18
15 Stesolid Rectal 5 mg / 2,5 ml Rectal 19 0 19 11 8 May-18
10 (07/02/2017) (GF) Mar-18, Apr-18
2 (10/02/2017) (Mutasi) Mutasi Dari Sakura
5 (13/02/2017) (Mutasi) Mutasi Dari IGD
3 (14/02/2017) (Mutasi) Mutasi Dari IGD
2 (14/02/2017) (Mutasi) Mutasi Dari Sakura
1 (16/02/2017) (Mutasi) Mutasi Dari Sakura
56 56 0
16 Stesolid Rectal 10 mg / 2,5 ml Rectal 15 4 (20/02/2017) (Mutasi) Mutasi Dari IGD
8 (22/02/2017) (Mutasi) Mutasi Dari IGD
2 (24/02/2017) (Mutasi) Mutasi Dari IGD
2 (27/02/2017) (Mutasi) Mutasi Dari IGD
1 (28/02/2017) (Mutasi) Mutasi Dari IGD
1 (28/02/2017) (Mutasi) Mutasi Dari Sakura
Total = 41
17 Zolmia Tablet 0 0 0 0 0
3 Box Sep-16, 2 Box Des-16
18 Seroquel XR Tablet 50 0 50 0 50
Barang Ada Di gudang
19 Sibital 50 mg Tablet 0 0 0 0 0

PREKURSOR
1 Ephedrin 25 mg Tablet 0 0 0 0 0
2 Aldisa SR Tablet 75 100 (07/02/2017) (GF) 175 70 105 Aug-18

3 Trifed Tablet 97.5 100(21/02/2017) (GF) 197.5 85.25 112.25 Jun-18 /Jul-18
Trifed Syrup
4 Botol 3 0 3 1 2 Jun-18
5 Tuzalos Tablet 0 0 0 0 0
6 Ergotamin Tablet 725.25 0 725.25 310.75 414.5 Sep-18
7 Clozapine 100 mg Tablet 0.75 0 0.75 0.75 0 Retur Ke Gudang ED
8 Alco Drop Botol 0 1 (06/02/2017) (Mutasi) 1 1 0 Mutasi Dari Sakura
OBAT-OBAT TERTENTU
1 Amitriptilin 25 mg Tablet 1249.5 1000 (21/02/2017) (GF) 2249.5 1433.75 815.75 Feb-20
Cepezet 100 mg 149.5 0 149.5 4.25 145.25 Feb-18
2 Tablet
Chlorpromazin 25 mg 0 0 0 0 0
3 Haloperidol 0,5 mg Tablet 558 0 558 230 328 Mar-20
4 Haloperidol 1,5 mg Tablet 150.25 0 150.25 35 115.25 Apr 19, Mei 19
REKAPITULASI STOK NARKOTIKA, PSIKOTROPIKA & PREKURSOR RUTIN
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJAHRANIE
BULAN MARET TAHUN 2017

STOK AWAL STOK AKHIR


NO NAMA OBAT SATUAN PENERIMAAN JUMLAH PENGELUARAN KETERANGAN
BULAN BULAN
NARKOTIKA
1600 (02/03/2017) (GF)
1 Codein 10 mg Tablet 1089.75 1000 (20/03/2017) (GF) 3689.75 2529 1160.75 ED Des-19
Total = 2600
2 Codein 15 mg Tablet 200 0 200 23 177 ED Apr-19
3 Codein 20 mg Tablet 322.25 100 ( 02/03/2017 ) (GF) 422.25 190 232.25 ED Nop-19
4 Codipront Kaps Kapsul 0 3 (31/03/2017) (Mutasi) 3 3 0 Mutasi Dari Sakura
5 Codipront Cum Expectorant syr Botol 0 0 0 0 0
6 Codipront Cum Expectorant Cap Kapsul 0 5 (09/03/2017) (Mutasi) 5 5 0 Mutasi Dari Sakura
7 Clopedine Inj 2 ml Ampul 0 0 0 0 0
120 (02/03/2017) (GF)
ED Des-18 (46 Tab)
60 (15/03/2017) (GF)
8 MST 10 MG Tablet 36 336 170 166
120 (30/03/2017) (GF)
ED Feb-19 (120 Tab)
Total = 300
60 ( 02/03/2017) (GF)
9 MST 15 mg Tablet 115 60 (15/03/2017) (GF) 235 110 125 ED Des-18
Total = 120
5 (02/03/2017) (GF)
10 Durogesic 12,5 mg Patch 12 5 (15/03/2017) (GF) 22 11 11 ED Jan-18
Total = 10
11 Durogesic 25 mg Patch 6 5 (20/03/2017) (GF) 11 6 5 ED Jan-18

PSIKOTROPIKA
1 Analsik Tablet 149 100 (02/03/2017) (GF) 249 30 219 ED Mei-19
ED Jul-18 (10 Tab)
2 Alprazolam 0,5 mg Tablet 135.5 500 (15/03/2017) (GF) 635.5 175 460.5 ED Agust-18 (439 Tab)
ED Mar-19 (11,5 Tab)
3 Braxidin Tab Tablet 0 6 (08/03/2017) (Mutasi) 6 6 0 Mutasi Dari Sakura
30 (10/03/2017) (Mutasi) Mutasi Dari Sakura
4 Clobazam 10 mg Tablet 303.5 1500 (22/03/2017) (GF) 1833.5 652.5 1181
ED Okt-20
Total = 1530
5 Clonazepam 2 mg Tablet 0 100 (06/03/2017) (GF) 100 71.5 28.5
ED Mei-20
6 Diazepam 2 mg Tablet 0 0 0 0 0
7 Diazepam 5 mg Tablet 0 0 0 0 0
8 Kalxetin 10 mg Kapsul 0 30 (15/03/2017) (GF) 30 0 30 ED Agust-18
2000 (02/03/2017) (GF)
9 Valdimex 5 mg Tablet 0 1000 (20/03/2017) (GF) 3000 1222.5 1777.5 ED 0kt-20
Total = 3000
10 Valisanbe 5 mg Tablet 503 0 503 503 0 ED Agust-21
STOK AWAL STOK AKHIR
NO NAMA OBAT SATUAN PENERIMAAN JUMLAH PENGELUARAN KETERANGAN
BULAN BULAN
11 Esilgan Tabelet 0 0 0 0 0
1600 (02/03/2017) (GF)
1000 (20/03/2017) (GF)
12 Phenobarbital 30 mg Tablet 197 3797 1946.5 1850.5 ED Nop-18
1000 ( 30/03/2017 )(GF)
Total = 3600
13 Phenobarbital 100 mg Tablet 0 0 0 0 0
100 (06/03/2017) (GF) ED Jan-19 (50 Tab)
105
14 Risperidon 2 mg Tablet 55.5 200 (30/03/2017) (GF) 355.5 230.5 ED Agust-19(180,5 Tab)
Total = 300 20 Mutasi Ke IGD
ED Feb-20 (75 Tab)
15 Prohiper Tablet 75 30 ( 15/03/2017) (GF) 105 0 105
ED Apr-20 (30 Tab)
16 Foransi 10 mg Tablet 0 0 0 0 0
30 (02/03/2017 )(GF) ED Feb-18 (30 Tab)
17 Nopres 20 mg Tablet 23 30 (15/03/2017) (GF) 83 30 53 ED Agus-19 (23 Tab)
Total = 60
10 (02/03/2017) (GF)
ED Mei-18 (5 Tube)
18 Stesolid Rectal 5 mg / 2,5 ml Rectal 8 10 (30/03/2017) (GF) 28 13 15
Total = 20 ED Agus-18 (10 Tube)
2 (01/03/2017) (Mutasi) Mutasi dari IGD
2(02/03/2017) (Mutasi) Mutasi Dari IGD
11 (03/03/2017) (Mutasi) Mutasi Dari Rawat Inap
2 (08/03/2017) (Mutasi) Mutasi Dari Rawat Inap
5 (09/03/2017) (Mutasi) Mutasi Dari Rawat Inap
19 Stesolid Rectal 10 mg / 2,5 ml Rectal 0 2 (13/03/2017) (Mutasi) 78 48 30 Mutasi Dari Sakura
2 (13/03/2017) (Mutasi) Mutasi Dari Rawat Inap
2 (13/03/2017) (Mutasi) Mutasi Dari IGD
40 (15/03/2017) (GF)
ED Mei-18 (10 Tube)
10(30/03/2017) (GF)
Total = 78 ED Sep-18 (20 Tube)
20 Zolmia Tablet 0 0 0 0 0
ED 3 Box Sep-16, 2 Box Des-16
21 Seroquel XR Tablet 50 0 50 0 50
Barang Ada Di gudang
22 Sibital 50 mg Tablet 0 0 0 0 0

PREKURSOR
1 Ephedrin 25 mg Tablet 0 300 (30/03/2017) (GF) 300 60.5 239.5 ED Feb-19
90 ED Agust-18
2 Aldisa SR Tablet 105 100 (02/03/2017) (GF) 205 105
10 Mutasi Ke Rawat Inap
3 Trifed Tablet 112.25 50 (02/03/2017) (GF) 162.25 117.75 44.5 ED Jul-18
1 (02/03/2017) (GF)
4 Trifed Syrup Botol 2 3 (15/03/2017) (GF) 6 4 2 ED Jun-18
Total = 4
5 Tuzalos Tablet 0 0 0 0 0
6 Ergotamin Tablet 414.5 500 (15/03/2017) (GF) 914.5 451.5 463 ED Sep-18
7 Clozapine 100 mg Tablet 0 0 0 0 0
STOK AWAL STOK AKHIR
NO NAMA OBAT SATUAN PENERIMAAN JUMLAH PENGELUARAN KETERANGAN
BULAN BULAN
8 Alco Drop Botol 0 0 0 0 0
OBAT-OBAT TERTENTU
1000 (02/03/2017) (GF)
ED Feb-20 (1301,75 Tab)
1 Amitriptilin 25 mg Tablet 815.75 1000 (20/03/2017) (GF) 2815.75 914 1901.75
Total = 2000 ED Nov-20 (600 Tab)
Cepezet 100 mg 145.25 0 145.25 2.5 142.75 ED Feb-18
2 Tablet
Chlorpromazin 25 mg 0 0 0 0 0
200 (02/03/2017) (GF)
ED Okt-19 (500 Tab)
100 (15/03/2017) (GF)
3 Haloperidol 0,5 mg Tablet 328 1128 420 708
500 (30/03/2017) (GF)
ED Mar-20 (208 Tab)
Total = 800
4 Haloperidol 1,5 mg Tablet 115.25 100 (02/03/2017) (GF) 215.25 40 175.25 ED Mei-19
Trihexyphenidil 2 mg 0 0 0 0 0
2000 (02/03/2017) (GF)
5 Tablet
Hexymer 2 mg 860.5 3860.5 2425 1435.5 ED Jul-18
1000 (30/03/2017) (GF)
Total = 3000
1300 (02/03/2017) (GF) ED Jun-18 (104,75 Kap)
6 Tramadol Tablet 1596.75 1000 (20/03/2017) (GF) 3896.75 2592 1304.75
ED Sep-18 (1200 Kap)
Total = 2300

Samarinda, 03 April 2017


Pembuat Laporan Penanggung Jawab Stok

Dayang Bella Risky Wanda, Amd., Far Nia Patmawati, Amd., Far
NIP: 19931004 201503 2 002

Mengetahui,
Ka. Instalasi Farmasi RSUD A W Syahranie Penanggung Jawab Farmasi Rawat Jalan

Dra. Hj.Linawati., Apt Yuniastuti., S.Si.,M.Si, Apt


NIP : 19640412 199203 2 010 NIP : 19780602 200903 2 003
STOK AWAL STOK AKHIR
NO NAMA OBAT SATUAN PENERIMAAN JUMLAH PENGELUARAN KETERANGAN
BULAN BULAN
Trihexyphenidil 2 mg 0 0 0 0 0
5 Tablet
Hexymer 2 mg 1435.5 2000 (06/04/2017) (GF) 3435.5 2493.75 941.75 ED Jul-18
2000 (06/04/2017) (GF) ED Jun-18 (1250 Kap)
6 Tramadol Tablet 1304.75 1500 (26/04/2017) (GF) 4804.75 2913.5 1891.25
ED Sep-19 (641,25 Kap)
Total = 3500

Samarinda, 02 Mei 2017


Pembuat Laporan Penanggung Jawab Stok

Uswatun Hasanah Nia Patmawati, Amd., Far

Mengetahui,
Ka. Instalasi Farmasi RSUD A W Syahranie Penanggung Jawab Farmasi Rawat Jalan

Dra. Hj.Linawati., Apt Yuniastuti., S.Si.,M.Si, Apt


NIP : 19640412 199203 2 010 NIP : 19780602 200903 2 003
STOK AWAL STOK AKHIR
NO NAMA OBAT SATUAN PENERIMAAN JUMLAH PENGELUARAN KETERANGAN
BULAN BULAN
Trihexyphenidil 2 mg 0 0 0 0 0
5 Tablet ED Jul-18 (100 Tab)
Hexymer 2 mg 941.75 3000 (08/05/2017) (GF) 3941.75 2786 1155.75
ED Des-18 (1055.75 Tab)
6 Tramadol Tablet 1891.25 2000 (08/05/2017) (GF) 3891.25 3093.25 798 ED Sept-19

Samarinda, 02 Juni 2017


Pembuat Laporan Penanggung Jawab Stok

Febrina Chairiani Nia Patmawati, Amd., Far

Mengetahui,
Ka. Instalasi Farmasi RSUD A W Syahranie Penanggung Jawab Farmasi Rawat Jalan

Dra. Hj.Linawati., Apt Yuniastuti., S.Si.,M.Si, Apt


NIP : 19640412 199203 2 010 NIP : 19780602 200903 2 003
REKAPITULASI STOK NARKOTIKA, PSIKOTROPIKA & PREKURS
DEPO OBAT RAWAT JALAN INSTALASI FARMASI RSUD A.W. SJA
BULAN JUNI TAHUN 2017

STOK
NO NAMA OBAT SATUAN AWAL PENERIMAAN JUMLAH
BULAN
NARKOTIKA
1 Codein 10 mg Tablet 1100.75 2500 (06/06/2017) (GF) 3600.75
2 Codein 15 mg Tablet 82 100 (06/06/2017) (GF) 182
3 Codein 20 mg Tablet 192.25 100 (06/06/2017) (GF) 292.25
4 Codipront Kaps Kapsul 0 0 0
5 Codipront syr Botol 0 0 0
6 Codipront Cum Expectorant syr Botol 0 0 0
10 (05/06/2017) (Mutasi)
10 (09/06/2017) (Mutasi)
7 Codipront Cum Expectorant Cap Kapsul 0 30
10 (21/06/2017) (Mutasi)
Total = 30
8 Clopedine Inj 2 ml Ampul 0 0 0
9 MST 10 MG Tablet 48 240 (07/06/2017) (GF) 288
10 MST 15 mg Tablet 191 240 (15/06/2017) (GF) 431

11 Durogesic 12,5 mg Patch 20 10 (06/06/2017) (GF) 30


12 Durogesic 25 mg Patch 5 5 (06/06/2017) (GF) 10

PSIKOTROPIKA
1 Analsik Tablet 124 200 (06/06/2017) (GF) 324
2 Alprazolam 0,5 mg Tablet 388.5 200 (06/06/2017) (GF) 588.5
3 Braxidin Tab Tablet 0 10 (14/06/2017) (GF) 10
1000 (06/06/2017) (GF)
4 Clobazam 10 mg Tablet 1140.25 200 (20/06/2017) (GF) 2340.25
Total = 1200
5 Clonazepam 2 mg Tablet 46.5 0 46.5
6 Diazepam 2 mg Tablet 0 0 0
7 Diazepam 5 mg Tablet 0 0 0
8 Kalxetin 10 mg Kapsul 0 0 0
9 Valdimex 5 mg Tablet 1793.25 2000 (06/06/2017) (GF) 3793.25
10 Valisanbe 5 mg Tablet 0 0 0
11 Esilgan Tabelet 0 0 0
12 Phenobarbital 30 mg Tablet 468 2500 (06/06/2017) (GF) 2968
13 Phenobarbital 100 mg Tablet 0 0 0
14 Risperidon 2 mg Tablet 49.5 200 (06/06/2017) (GF) 249.5

15 Prohiper Tablet 75 0 75
16 Foransi 10 mg Tablet 0 0 0
17 Nopres 20 mg Tablet 16 60 (06/06/2017) (GF) 76
18 Stesolid Rectal 5 mg / 2,5 ml Rectal 17 20 (06/06/2017) (GF) 37
19 Stesolid Rectal 10 mg / 2,5 ml Rectal 21 5 (19/06/2017) (Mutasi) 26
20 Zolmia Tablet 0 0 0
21 Seroquel XR Tablet 50 0 50
22 Sibital 50 mg Tablet 0 0 0

PREKURSOR
1 Ephedrin 25 mg Tablet 1 0 1
2 Aldisa SR Tablet 104 100 (06/06/2017) (GF) 204
3 Trifed Tablet 216 200 (12/06/2017) (GF) 416
4 Trifed Syrup Botol 2 2 (06/06/2017) (GF) 4
5 Tuzalos Tablet 0 0 0
6 Ergotamin + Caffein Tablet 858.5 1000 (06/06/2017) (GF) 1858.5
7 Ericaf Tab Tablet 2.25 0 2.25
8 Clozapine 100 mg Tablet 0 0 0
9 Alco Drop Botol 0 0 0
OBAT-OBAT TERTENTU
1 Amitriptilin 25 mg Tablet 2109.75 1000 (06/06/2017) (GF) 3109.75
Cepezet 100 mg 139.75 0 139.75
2 Tablet
Chlorpromazin 25 mg 0 0 0
100 (06/06/2017) (GF)
3 Haloperidol 0,5 mg Tablet 364 200 (07/06/2017) (GF) 664
Total = 300
4 Haloperidol 1,5 mg Tablet 310.25 0 310.25
Trihexyphenidil 2 mg Tablet 0 0 0
1200 (06/06/2017) (GF)
5
Hexymer 2 mg Tablet 1155.75 600 (20/06/2017) (GF) 2955.75
Total = 1800

6 Tramadol Tablet 798 100 (22/06/2017) (GF) 898

Samarinda, 03 Juli 2017


Pembuat Laporan Pena

Rizki Amalia, Amd., Far Nia P

Mengetahui,

Ka. Instalasi Farmasi RSUD A W Syahranie Penanggung


Dra. Hj.Linawati., Apt Yunia
NIP : 19640412 199203 2 010 NIP : 1
PSIKOTROPIKA & PREKURSOR RUTIN
ASI FARMASI RSUD A.W. SJAHRANIE
I TAHUN 2017

STOK AKHIR
PENGELUARAN KETERANGAN
BULAN

ED: Des 2019 (1411,75 TAB)


2089 1511.75
ED: Jul 2020 (100 TAB)
72.5 109.5 ED: Des 2019
290 2.25 ED: Nop 2019
0 0 -
0 0 -
0 0 -

30 0 Mutasi Dari Depo Sakura

0 0 -
193 95 ED: Feb 2019
ED: Apr 2019
80 351
2 Box Ditarik Sementara KF
ED: Jan 2018 (13 Patch)
2 28
ED: Mei 2019 (15 Patch)
2 8 ED: Jan 2018

51 273 ED: Mei 2019


ED: Agust 2018 (549 Tab)
38 550.5
ED: Mar 2019 (1,5 Tab)
10 0 Mutasi Dari Depo Sakura
ED: Okt 2020 (811,25 Tab)
829 1511.25
ED: Jan 2021 (700 Tab)
46.5 0 ED: Mei 2020
0 0 -
0 0 -
0 0 -
1206.5 2586.75 ED: Agust 2020
0 0 -
0 0 -
1306.75 1661.25 ED: Nop 2018
0 0 -
ED: Jul 2019 (140 Tab)
75 174.5
ED: Agust 2019 (34,5 Tab)
ED: Feb 2020 (15 Tab)
30 45
ED: Apr 2020 (30 Tab)
0 0 -
ED: Feb 2018 (60 Tab)
0 76
ED: Agust 2019 (16 Tab)
13 24 ED: Agust 2018
ED: Des 2018
26 0
Mutasi Dari Depo Sakura
0 0 -
ED: 3 Box Sep-16 & 2 Box Des-16
0 50
Barang Ada di gudang
0 0 -

0 1 ED: Feb 2019


56 148 ED: Des 2018
277.25 138.75 ED: Agust 2018
ED: Jun 2018 (1 Botol)
2 2
ED: Nov 2018 (1 Botol)
0 0 -
284.5 1574 ED: Sept 2018
2.25 0 ED: Agust 2017
0 0 -
0 0 -

646.75 2463 ED: Nov 2020


1.25 138.5 ED: Feb 2018
0 0 -

270 394 ED: Mar 2020

ED: Apr 2019 (160,25 Tab)


45 265.25
ED: Mei 2019 (105 Tab)
0 0 -

2330 625.75 ED: Des 2018

758
ED: Apr 2019
30 (08/06/2017) (Mutasi)
100
10 (09/06/2017) (Mutasi)
Mutasi Ke Depo Rawat Inap
Total = 798

, 03 Juli 2017
Penanggung Jawab Stok

Nia Patmawati, Amd., Far

etahui,

Penanggung Jawab Farmasi Rawat Jalan


Yuniastuti., S.Si.,M.Si, Apt
NIP : 19780602 200903 2 003