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LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN O

(LPLPO) - 2020

PUSKESMAS : Sumber Waras


LAPORAN BULAN : JANUARI 2020
PERMINTAAN BULAN :

Pemakai
an SISA PENERIMA
NO NAMA OBAT SATUAN Rata2 AWAL AN
2017
1 2 3 4 5
1 Albendazol suspensi 200 mg/5ml Botol 0 0
2 Aminofillin tablet 150mg Tablet SS 0 0
3 Amlodipin tablet 5 mg Tablet 0 0
4 Antasida sirup Botol 0 0
5 Antasida tablet kunyah Tablet 0 0
6 Anti bakteri salep kombinasi Tube 0 0
7 Antifungi salep Pot 0 0
8 Antihemoroid komb bismut subgalat heksaklorofen Supp 0 0
9 Antimalaria tablet kombinasi Sulfadoksin 500 mg+pirim Tablet 0 0
10 Asam askorbat tab 50 mg Tablet 0 0
11 Atapulgit tablet 600 mg Tablet 0 0
12 Betahistine Mesilate 6 mg Tablet 0 0
13 Betametason valerate krim 0,1% Tube 0 0
14 Bisakodil kaptab salut 5 mg Kaptab 0 0
15 Combivent UDV Vial 0 0
16 Deksametason injeksi 5 mg/ml Ampul 0 0
17 Deksametason tablet 0,5 mg Tablet 0 0
18 Difenhidramin injeksi 10mg/ml Ampul 0 0
19 Digoksin tablet 0,25 mg Tablet 0 0
20 Diltizem HCl tablet 30 mg Tablet 0 0
21 Domperidon sirup 5 mg/5ml Botol 0 0
22 Domperidon tablet 10 mg Tablet 0 0
23 Eritromisin kapsul 250 mg Kapsul 0 0
24 Eritromisin kaptab 500 mg Kaptab 0 0
25 Fitomenadion (Vit K) tablet 10 mg Tablet 0 0
26 Gentamisin sulfat tetes mata 0,3% Botol 0 0
27 Gibenklamid kaptab 5 mg Kaptab 0 0
28 Glimepiride tablet 2 mg Tablet 0 0
29 Glukosa 5% 500 ml Tablet 0 0
30 Griseofulvin tablet 125 mg Tablet 0 0
31 Haloperidol 2 mg Tablet 0 0
32 Haloperidol 5 mg Tablet 0 0
33 Hidrokortison krim 2,5% Tube 0 0
34 Ibuprofen suspensi 200 mg/5ml Botol 0 0
35 Isosorbid dinitrat tablet 5 mg Tablet 0 0
36 Kalsium laktat tab 500 mg Tablet 0 0
37 Kaptopril 12,5 mg Tablet 0 0
38 Karbogliserin tetes telinga 10% Botol 0 0
39 Ketokonazol tablet 200 mg Tablet 0 0
40 Ketokonazole krim 2% Tube 0 0
41 Klindamisin kapsul 150 mg Kapsul 0 0
42 Kloramfenikol 500 mg kapsul Kapsul 0 0
43 Kloramfenikol kapsul 250 mg Kapsul 0 0
44 Kloramfenikol salep 2% Tube 0 0
45 Kloramfenikol salep mata 1% Tube 0 0
46 Klorfeniramin maleat (ctm) tablet 4 mg Tablet 0 0
47 Metilergometrin maleat 0,125 mg Tablet 0 0
48 Metilprednisolon tablet 4 mg Tablet 0 0
49 Metoklopramid 10 mg Tablet 0 0
50 Metoklopramid drop 2 mg/ml Botol 0 0
51 Mikonazol krim 2% Tube 0 0
52 N Asetil sistein kapsul Kapsul 0 0
53 Natrium klorida 0,9% 500 ml Botol 0 0
54 Nistatin vaginal tablet 100.000IU Tablet 0 0
55 Obat Anti Tubercolosis FDC Anak Paket 0 0
56 Obat Anti Tubercolosis FDC I Paket 0 0
57 Obat Anti Tubercolosis FDC II Paket 0 0
58 Oksitetrasiklin 1% salep mata Tube 0 0
59 Omeprazol kapsul 20 mg Kapsul 0 0
60 Parasetamol 500 mg Tablet 0 0
61 Parasetamol sirup 120 mg/5ml Botol 0 0
62 Perak Sulfadiazin krim 1% Tube 0 0
63 Pirantel pamoat tablet 125 mg Tablet 0 0
64 Piridoksin (Vit B6) tablet 10 mg Tablet 0 0
65 Prednison tablet 5 mg Tablet 0 0
66 Propanolol HCl tablet 10 mg Tablet 0 0
67 Ranitidin injeksi 25 mg/ml Ampul 0 0
68 Ringer laktat 500 ml Botol 0 0
69 Salbutamol sirup 4 mg Tablet 0 0
70 Salbutamol tablet 2 mg Tablet 0 0
71 Salep 24 Pot 0 0
72 Sefadroksil 500 mg kapsul Kapsul 0 0
73 Sefadroksil sirup kering 125mg/5ml Botol 0 0
74 Setirizin sirup 5mg/5ml Botol 0 0
75 Setirizin tablet 10 mg Tablet 0 0
76 Sianokobalamin inj 500mcg/ml Ampul 0 0
77 Sianokobalamin tablet 50 mcg Tablet 0 0
78 Simvastatin tab salut selaput Tablet 0 0
79 Siprofloksasin tablet 500 mg Tablet SS 0 0
80 Tablet tambah darah Tablet 0 0
81 Tetagam Human Tetanus im 250 UI Syringe 0 0
82 Tetrasiklin kapsul 250 mg Kapsul 0 0
83 Tetrasiklin kapsul 500 mg Kapsul 0 0
84 Tiamin (Vit B1) tablet 50 mg Tablet 0 0
85 Vitamin B Kompleks Tablet 0 0
86 Zinc tablet dispersible 20 mg Tablet 0 0
87 0 0
87 Acyklovir tab 200 mg Tablet 0 0
88 Acyklovir tab 400 mg Tablet 0 0
89 Acyklovir kriem 5% tube 0 0
90 allupurinol tab 100 mg Ktk,10x10 tab 0 0
91 Ambroksol tab 30 mg ktk,10x10 tab 0 0
92 Ambroksol sirup 15mg/5ml btl, 60ml 0 0
93 Amoxicilin kaplet 500 mg kaplet 0 0
94 Amoxicilin sirup kering 125mg/5ml botol 0 0
95 Anti bakteri DOEN salep kulit Basitrasin 500 IU/g+ polimi tube 0 0
96 Asam asetil alisilat 80mg tablet 0 0
97 Asam mefenamat 500 mg kaplet 0 0
98 Atropin inj 0,2 mg/ml ampul 0 0
99 Bedak salisil serbuk 2 % dus 0 0
100 Bufacetin klorampheicol slep kulit tube 0 0
101 Eritromisin sirup kering 200mg/5ml botol 0 0
102 Fitomenadion (Vit K) injeksi ampul 0 0
103 Fuosemide tablet tablet 0 0
104 Garam oralit serbuk sachet 0 0
105 Gentamicin salep mata tube 0 0
106 kotrimoksazol anak suspensi 5ml botol 0 0
107 kotrimiksazol tablet dewasa 480mg tablet 0 0
108 Lansoprazole tab 30 mg tablet 0 0
109 loperamide 2 mg tablet 0 0
110 loratadine tab 10 mg kaplet 0 0
111 Meloksikam 15mg tab ktk, 5x10 tablet 0 0
112 Metilergometri injeksi 0,2mg ampul 0 0
113 Metronidazol sirup botol 0 0
114 NAaCL 0,5% botol 0 0
115 Natrium diklophenac 25mg tablet 0 0
116 Nifedipin tab 10 mg tablet 0 0
117 Nistatin tablet tablet 0 0
118 Oksitosin injeksi 10 IU/ML ampul 0 0
119 Pehacain injeksi box, @20 ampul 0 0
120 Salbutamol sirup botol 0 0
121 Amlodipin tab 10mg tablet 0 0
122 Griselin guayakolat tab 100mg tablet 0 0
123 Kloramfenicol sirup botol 0 0
124 rivanol botol 0 0
125 Metronidazol tab 500 mg tablet 0 0
126 Ranitidin tab tablet 0 0
127 Yodium 30ml botol 0 0
128 Yodium 60ml botol 0 0
129 Prophyltirulasin tab 100 mg tablet 0 0
130 Atropin sulfat tablet tablet 0 0
131 donperidon tetes 5mg/ml botol 0 0
132 Etylkloid sprai botol 0 0
133 kasa kotak kotak 0 0
134 kasa gulung roll 0 0
135 Alat suntik 2,5cc set 0 0
136 Alat suntik 3cc set 0 0
137 Alat suntik 5cc set 0 0
138 kaptopril tab 25mg tablet 0 0
139 Chloram tetes telinga tube 0
140 Ibuprofen tablet 0
141 alkohol 60ml botol 0
142 twist blood lanset box @ 100 piece 0 0
143 benang operasi plain catget with needle 3,0 box @12 piece 0 0
144 benang operasi chromic catgut with needie 3,0 box @ 12 piece 0 0
145 paper tape / 1.25 cm x 9,14 m roll 0 0
146 paper tape / 5.0cm x 9.14 m roll 0 0
147 swab 2-ply dus @ 100 lembar 0 0
148 face mask ear loop dus @ 50 pcs 0 0
149 face mask ties on dus @ 50 pcs 0 0
150 examination gloves, size xs box @ 50 pasang 0 0
151 examination gloves, size s box @ 50 pasang 0 0
152 examination gloves, size m box @ 50 pasang 0 0
153 benang operasi silk braided without needle 3.0 box @ 12 piece 0 0
153 Kapas 500 gr ball 0 0
153 Softa-Man 500 ml botol 0 0
153 Yodium 1 Liter botol 0 0

PROGRAM DIARE
162 Oralite sach 200mg sachet 800
163 zinc Tablet 700

PROGRAM IMUNISASI
164 Campak vial 0
165 HBO unijek 13
166 BCG vial 13
167 DT vial 17
168 IPV vial 10
169 MR vial 80
170 Pentabio vial 17
171 Pollio vial 23
172 TD vial 12

PROGRAM TB
173 Oat dewasa (fdc) tablet 892
174 Oat anak (fdc) tablet 0

PROGRAM RABIES
175 Vaksin verorab vial 0

PROGRAM GIZI
176 Vitamin tambah darah tablet 6,480
177 Vitamin A 100.000 IU kapsul 200
178 Vitamin A 200.000 IU kaapsul 5,000

PROGRAM KECACINGAN
179 Albendazole Tablet

JUMLAH KUNJUNGAN RESEP

Mengetahui / Menyetujui Yang Menyerahkan Yang Menerima / Melapor


Kepala Dinas Kesehatan Kepala Instalasi Farmasi Pimpinan BLUD Pkm Sumbe

Cikwi. SKM.M.Kes Leni Marlina, S.Farm, Apt Julaeha.S.ST


Nip. 19730729 199703 1 003 Nip. 198106142008032002 Nip.19791201 200604 2 02
AR PERMINTAAN OBAT

No. Reg Keluar


:
No. Reg Kelu :
Tanggal :

PERSEDIA SISA STOK PERMIN PEMBERIAAN EXP


AN
PEMAKAIAN
AKHIR
<6BL ket
OPTIMUM TAAN APBDAPBD
I IILAIN JML N
6 7 8 9 10 11 12 13 14
0 0
0 0 0
0 0 0
0 0 0
0 0 0 500
0 0 0
0 0 0
0 0 0
8633 8633 0
0 0 0 2,000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 100
0 0 0 2,000
0 0 0 100
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 50
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 500
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 50
0 0 0 50
0 0 0 2,000
0 0 0
0 0 0 1,000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 2,000
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 100
0 0 0
0 0 0 200
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 2,000
0 0 0 200
0 0 0
0 0 0
0 0 0
0 0 0 50
0 0 0 500
0 0 0
0 0 0
0 0 0 2,000
0 0 0 180
0 0 0 50
0 0 0
0 0 0 3,000
0 0 0
0 0 0 50
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
120 120 0
0 0 0 2,000
0 0 0
0 0 0
0 0 0
0 0 0 1,000
0 0 0
0 0 0
0 0 0
0 0 0 40
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 1.bal
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 5
0 0 0
0 0 0
0 0 0
0 0 0

800 800
800 700

0 0
13 7
13 5
57 23
10 2
80 70
17 4
23 10
112 47

6268 6,083
0 0

0 0

6480 5,580
200 200
5000 5,000

4000 4,000

BAYAR TIDAK BAYAR ASKES JUMLAH

81 0 576 657

Yang Menerima / Melapor Yang Menerima / Melapor


Pimpinan BLUD Pkm Sumber Waras Koordinator Gudang PKM

Julaeha.S.ST Christina M. Sinurat, AMF


Nip.19791201 200604 2 021 Nip. 19861118 201001 2 023
Albendazol suspensi 200 mg/5ml
Aminofillin tablet 150mg
Amlodipin tablet 5 mg
Antasida sirup
Antasida tablet kunyah

Anti
bakteri
salep
kombinasi
Antifungi salep
Antihemoroid komb bismut subgalat heksaklorofen
Antimalaria tablet kombinasi Sulfadoksin 500 mg+pirimetamin 25 mg
Asam askorbat tab 50 mg
Atapulgit tablet 600 mg
Betahistine Mesilate 6 mg
Betametason valerate krim 0,1%
Bisakodil kaptab salut 5 mg
Combivent UDV
Deksametason injeksi 5 mg/ml
Deksametason tablet 0,5 mg
Difenhidramin injeksi 10mg/ml
Digoksin tablet 0,25 mg
Diltizem HCl tablet 30 mg
Domperidon sirup 5 mg/5ml
Domperidon tablet 10 mg
Eritromisin kapsul 250 mg
Eritromisin kaptab 500 mg
Fitomenadion (Vit K) tablet 10 mg
Gentamisin sulfat tetes mata 0,3%
Gibenklamid kaptab 5 mg
Glimepiride tablet 2 mg
Glukosa 5% 500 ml
Griseofulvin tablet 125 mg
Haloperidol 2 mg
Haloperidol 5 mg
Hidrokortison krim 2,5%
Ibuprofen suspensi 200 mg/5ml
Isosorbid dinitrat tablet 5 mg
Kalsium laktat tab 500 mg
Kaptopril 12,5 mg
Karbogliserin tetes telinga 10%
Ketokonazol tablet 200 mg
Ketokonazole krim 2%
Klindamisin kapsul 150 mg
Kloramfenikol 500 mg kapsul
Kloramfenikol kapsul 250 mg
Kloramfenikol salep 2%
Kloramfenikol salep mata 1%
Klorfeniramin maleat (ctm) tablet 4 mg
Metilergometrin maleat 0,125 mg
Metilprednisolon tablet 4 mg
Metoklopramid 10 mg
Metoklopramid drop 2 mg/ml
Mikonazol krim 2%
N Asetil sistein kapsul

Natrium
klorida
0,9% 500
ml
Nistatin vaginal tablet 100.000IU
Obat Anti Tubercolosis FDC Anak
Obat Anti Tubercolosis FDC I
Obat Anti Tubercolosis FDC II
Oksitetrasiklin 1% salep mata
Omeprazol kapsul 20 mg
Parasetamol 500 mg
Parasetamol sirup 120 mg/5ml
Perak Sulfadiazin krim 1%
Pirantel pamoat tablet 125 mg
Piridoksin (Vit B6) tablet 10 mg
Prednison tablet 5 mg
Propanolol HCl tablet 10 mg
Ranitidin injeksi 25 mg/ml
Ringer laktat 500 ml
Salbutamol sirup 4 mg
Salbutamol tablet 2 mg
Salep 24
Sefadroksil 500 mg kapsul
Sefadroksil sirup kering 125mg/5ml
Setirizin sirup 5mg/5ml
Setirizin tablet 10 mg
Sianokobalamin inj 500mcg/ml
Sianokobalamin tablet 50 mcg
Simvastatin tab salut selaput
Siprofloksasin tablet 500 mg
Tablet tambah darah
Tetagam Human Tetanus im 250 UI
Tetrasiklin kapsul 250 mg
Tetrasiklin kapsul 500 mg
Tiamin (Vit B1) tablet 50 mg
Vitamin B Kompleks
Zinc tablet dispersible 20 mg

Acyklovir tab 200 mg


Acyklovir tab 400 mg
Acyklovir kriem 5%
allupurinol tab 100 mg
Ambroksol tab 30 mg
Ambroksol sirup 15mg/5ml
Amoxicilin kaplet 500 mg
Amoxicilin sirup kering 125mg/5ml
Anti bakteri DOEN salep kulit Basitrasin 500 IU/g+ polimiks
Asam asetil alisilat 80mg
Asam mefenamat 500 mg
Atropin inj 0,2 mg/ml
Bedak salisil serbuk 2 %
Bufacetin klorampheicol slep kulit
Eritromisin sirup kering 200mg/5ml
Fitomenadion (Vit K) injeksi
Fuosemide tablet
Garam oralit serbuk
Gentamicin salep mata
kotrimoksazol anak suspensi 5ml
kotrimiksazol tablet dewasa 480mg
Lansoprazole tab 30 mg
loperamide 2 mg
loratadine tab 10 mg
Meloksikam 15mg tab
Metilergometri injeksi 0,2mg
Metronidazol sirup
NAaCL 0,5%
Natrium diklophenac 25mg
Nifedipin tab 10 mg
Nistatin tablet
Oksitosin injeksi 10 IU/ML
Pehacain injeksi
Salbutamol sirup
Amlodipin tab 10mg
Griselin guayakolat tab 100mg
Kloramfenicol sirup
rivanol
Metronidazol tab 500 mg
Ranitidin tab
Yodium 30ml
Yodium 60ml
Prophyltirulasin tab 100 mg
Atropin sulfat tablet
donperidon tetes 5mg/ml
Etylkloid sprai
kasa kotak
kasa gulung
Alat suntik 2,5cc
Alat suntik 3cc
Alat suntik 5cc
kaptopril tab 25mg
Chloram tetes telinga
Ibuprofen
alkohol 60ml
twist blood lanset
benang operasi plain catget with needle 3,0
benang operasi chromic catgut with needie 3,0
paper tape / 1.25 cm x 9,14 m
paper tape / 5.0cm x 9.14 m
swab 2-ply
face mask ear loop
face mask ties on
examination gloves, size xs
examination gloves, size s
examination gloves, size m
benang operasi silk braided without needle 3.0
Kapas 500 gr
Softa-Man 500 ml
Yodium 1 Liter