LEMBAR PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

LPLPO
KODE PUSKESMAS ::
PUSBAN/POLINDES KEDANG MURUNG DOKUMEN PELAPORAN & PERMINTAAN PUSKESMAS DOKUMEN GFK [ PENYERAHAN OBAT ]
KECAMATAN : KOTA BANGUN NOMOR B- /DINKES/PUSK-KB/065.25/ 42024 NOMOR BULAN
April
KABUPATEN : KUTAI KARTANEGARA TANGGAL 25 April 2024 TANGGAL TAHUN : 2024

STOK PENERI- PERSE- PEMA- SISA STOK PERMIN- PEMBERIAN

NO NAMA SEDIAAN OBAT/ BMHP MEDIS SATUAN KET
AWAL MAAN DIAAN KAIAN STOK OPT TAAN APBN APBD I APBD II PROG. LAIN2 JML
1 2 3 4 5 6 (4+5) 7 (6-8) 8 9 10 11 12 13 14 15 16 17
OBAT GENERIK BERLOGO
1 Albendazol tablet 400 mg Tablet 0 0 0
2 Alopurinol tablet 100 mg Tablet 60 20 80 80
3 Ambroxol sirup 15 mg/ml Botol 0 0 0
4 Ambroxol tablet 30 mg Tablet 50 50 50
5 Amlodipin tablet 5 mg Tablet 170 170 170
6 Amlodipin tablet 10 mg Tablet 90 90 90
7 Amoksisilin kaplet 500 mg Kaplet 0 0 0
8 Amoksisilin sirup kering 125 mg/5 ml Botol 0 0 0
9 Amoksisilin sirup kering 250 mg/5 ml Botol 0 0 0
10 Ambroxol sirup 30 mg/ml Botol 0 0 0
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg dan Magnesium Hidroksida 200
11 Tablet 90 90 90
mg
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 ml dan Magnesium Hidroksida 200
12 Botol 9 9 9
mg/5 ml
13 Anti bakteri DOEN salep kombinsai : Basitrasin 500 IU/gr + Polimiksin 10.000IU/g Tube 0 0 0
14 Antifungi DOEN kombinasi : Asam Benzoat 6 % + Asam Salisilat 3 % Pot 0 0 0
15 Antihemoroid DOEN kombinasi : Bismut Subgalat 150 mg + Heksaklorofen 2.5 mg Supp 10 10 10
16 Antiparkinson DOEN tablet kombinasi : Karbidopa 25 mg + Levodopa 250 mg Tablet 0 0 0
17 Asam Askorbat (Vitamin C ) tablet 50mg Tablet 240 240 240
18 Asam Asetilsalisilat 80 mg (MINIASPI'80) Tablet 0 0 0
Asam Mefenamat kaplet 500 mg
19 Tablet 120 120 120
20 Asiklovir krim 5% Tube 8 8 8
21 Asiklovir tablet 400 mg Tablet 80 80 80
22 Asiklovir tablet 200 mg Tablet 100 100 100
23 Betahistin Mesilat tablet 6 mg Tablet 60 60 60
24 Betametason krim 0.1% (sebagai valerat) Tube 1 1 1
25 Calsium Gluconas 100 mg/ml Injeksi Ampul 2 2 2
26 Cetirizine tablet 10 mg Tablet 70 70 70
27 Cetirizine syrup Botol 5 5 5
28 Deksametason injeksi i.v. 5 mg/ml Ampul 0 0 0
29 Deksametason tablet 0.5 mg Tablet 0 0 0
30 Desoximetasone 0,25 % Crem Tube 0 0 0
31 Digoksin tablet 0.25 mg Tablet 0 0 0
32 Dimenhidrinat tablet 50 mg Tablet 0 0 0
33 Domperidon tablet 10 mg Tablet 100 100 100
34 Eritromisin kapsul 500 mg Kapsul 0 0 0
35 Eritromisin sirup 200 mg/5 ml Botol 0 0 0
36 Etakridin larutan 0.1% Botol 0 0 0
37 Fenol Gliserol tetes telinga 10% Botol 5 5 5
38 Fitomenadion (Vit.K) injeksi 2 mg/1ml Ampul 0 0 0
39 Fitomenadion (Vitamin K) tablet salut gula 10 mg Tablet 0 0 0
40 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul 0 0 0
41 Furosemid tablet 40 mg Tablet 0 0 0
Garam Oralit I serbuk, kombinasi : Natrium 0.70 gr, Kalium Klorida 0.30 gr, Trinatrium Sitrat Dihidrat 0.58
42 Sachet 82 82 82
gr, Glukosa Anhidrat 4 gr
43 Gentamycin Sulfat Injeksi Ampul 0 0 0
44 Gentamisin injeksi 40 mg/ml Ampul 0 0 0
45 Gentamisin salep kulit 0.1% Tube 5 5 5
46 Gentamisin salep Mata 0,3% Tube 0 0 0
47 Gentian Violet larutan 1 % Botol 0 0 0
48 Glibenklamida tablet 5 mg Tablet 0 0 0
49 Glimepiride tablet 1 mg Tablet 150 150 150
50 Glimepiride tablet 2 mg Tablet 50 50 50
51 Gliseril Gualakolat tablet 100 mg Tablet 140 140 140
52 Glukosa larutan infus 5 % steril D5 Botol 0 0 0
53 Griseofulvin Micronized tablet 125 mg Tablet 0 0 0
54 Hidroklorotiazida tablet 25 mg (HCT) Tablet 0 0 0
55 Hidrokortison krim 2.5% Tube 5 5 5
56 Ibuprofen suspensi 100 mg/5 ml Botol 5 5 5
57 Ibuprofen suspensi 200 mg/5 ml Botol 0 0 0
 58 Ibuprofen tablet 200 mg Tablet 80 80 80
59 Ibuprofen tablet 400 mg Tablet 0 0 0
60 Isosorbid Dinitrat tablet Sublingual 5 mg Tablet 0 0 0
61 Kalsium Laktat (Kalk) tablet 500 mg Tablet 280 280 280
62 Kaptopril tablet 12.5 mg Tablet 0 0 0
63 Kaptopril tablet 25 mg Tablet 0 0 0
64 Kaptopril tablet 50 mg Tablet 0 0 0
65 Kandesartan tablet 8 mg Tablet 0 0 0
66 Ketokonazol krim 2% Tube 2 2 2
67 Ketokonazol tablet 200 mg Tablet 0 0 0
68 Klindamisin kapsul 150 mg Kapsul 0 0 0
69 Kloramfenikol kapsul 250 mg Kapsul 0 0 0
70 Kloramfenikol salep mata 1% Tube 0 0 0
71 Kloramfenikol salep kulit 1% Tube 0 0 0
72 Kloramfenikol suspensi 125 mg/ 5ml Botol 0 0 0
73 Kloramfenikol tetes telinga 3% Botol 1 1 1
74 Klorfeniramina Maleat (CTM) tablet 4 mg Tablet 100 100 100
75 Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg + Trimetoprin 80 mg Tablet 0 0 0
76 Kotrimoksazol suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprin 40 mg/5 ml Botol 0 0 0
77 Lanzoprazol kapsul 30 mg Kapsul 0 0 0
78 Loratadine 10 mg/tablet Tablet 0 0 0
79 Lidokain injeksi 2% Ampul 4 4 4
80 Magnesium Sulfat injeksi (IV) 20% - 25 ml Vial 0 0 0
81 Magnesium Sulfat injeksi (IV) 40% - 25 ml Vial 0 0 0
82 Meloksikam tablet 15 mg Tablet 80 80 80
83 Menadion Natrium Bisulfit (Vit.K3) injeksi 10 mg/ml Ampul 0 0 0
84 Metformin Hci tablet 500 mg Tablet 200 200 200
85 Metildopa tablet 250 mg Dopamet 250 mg Tablet 30 30 30
86 Metilprednisolon tablet 4 mg Tablet 70 70 70
87 Metoklopramide tablet 10 mg Tablet 0 0 0
88 Metronidazol tablet 250 mg Tablet 0 0 0
89 Metronidazol tablet 500 mg Tablet 50 50 50
90 Mikonazol krim/salep 2% (Nitrat) Tablet 5 5 5
91 Natrium Diklofenak tablet 50 mg Tablet 70 70 70
92 Natrium Klorida larutan infus 0.9 % Botol 0 0 0
93 Nifedipin tablet 10 mg Tablet 100 100 100
94 Nystatin Vaginal tab 100.000 IU/g Tablet 20 20 20
95 N- Acetylcysteine 200 mg Tablet 90 90 90
96 Obat Batuk Hitam (O.B.H) @ 100 ml Botol 0 0 0
97 Oksitetrasiklin salep kulit 3% Tube 5 5 5
98 Oksitetrasiklin HCl Salep Mata 1% Tube 0 0 0
99 Oksitosin injeksi 10 IU/ml - 1 ml ( Pitogin Inj) Ampul 0 0 0
100 Omeprazol kapsul 20 mg Kapsul 0 0 0
101 Ondansentron tablet 4 mg Tablet 0 0 0
102 Ondansentron Injeksi 4mg/2ml Ampul 0 0 0
103 Papaverin tablet 40 mg Tablet 0 0 0
104 Parasetamol sirup 120 mg/5 ml Botol 15 15 15
105 Parasetamol tablet 500 mg Tablet 390 390 390
106 Pirantel tablet score (Base) 125 mg Tablet 0 0 0
107 Piridoksin (Vitamin B6) tablet 10 mg (HCI) Tablet 100 100 100
108 Piroksikam tablet 20 mg Tablet 70 70 70
109 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0 0 0
110 Ranitidin injeksi 25 mg/2 ml Ampul 5 5 5
111 Ranitidin tablet 150 mg Tablet 70 70 70
112 Retinol (Vitamin A) 100.000 IU kapsul lunak Kapsul 0 0 0
113 Retinol (Vitamin A) 200.000 IU kapsul lunak Kapsul 0 0 0
114 Ringer Laktat larutan infus RL Botol 1 1 1
115 Salbutamol tablet 2 mg (sebagai Sulfat) Tablet 40 40 40
116 Salbutamol tablet 4 mg (sebagai Sulfat) Tablet 0 0 0
117 Salbutamol sirup 2 mg/5 ml Botol 0 0 0
118 SALEP WHITFIELD CREM Pot 0 0 0
119 Salep 2-4, kombinasi : Asam Salisilat 2% + Belerang Endap 4% Pot 0 0 0
120 Salisil Bedak 2% Kotak 3 3 3
121 Sefadroksil sirup kering 125 mg/5 ml Botol 0 0 0
122 Sefadroksil sirup kering 250 mg/5 ml Botol 0 0 0
123 Sefadroksil kapsul 500 mg Kapsul 0 0 0
124 Sianokobalamin (Vit. B12) tablet 50 mg Tablet 0 0 0
125 Simetidin tablet 200 mg Tablet 0 0 0
126 Simvastatin tablet 10 mg Tablet 0 0 0
127 Simvastatin tablet 20 mg Tablet 80 80 80
128 Siprofloksasin tablet 500 mg (sebagai HCI) Tablet 0 0 0
129 Tablet tambah darah kombinasi Tablet 140 140 140
130 Tiamin (Vitamin B1) tablet 50 mg (HCI/Nitrat) Tablet 60 60 60
131 Vitamin B Kompleks tablet Tablet 0 0 0
132 Sivit-Zinc Tablet 0 0 0
133 Stimuno Sachet 0 0 0
134 Zinc tablet 20 mg Tablet 50 50 50
OBAT GENERIK BERMEREK 0 0 0
135 Analgesik, Antipiretik ( Kand. Parasetamol 125 mg/supp rect) Supp 0 0 0
136 Anestetika lokal injeksi (Lidocain 20 mg, Adrenalin 0,0125 mg) LIDOCAIN COMPRESITUM Ampul 0 0 0
137 Anti platelet/trombus ( Kand.Asam Asetilsalisilat 80 mg) ASPIMEC Tablet 0 0 0
138 Anti Spasmodik injeksi (Kand. Hyoscine-N-Butilbromide 20 mg/ml) Ampul 0 0 0
139 Anti Spasmodik tab (Kand. Hyoscine-N-Butilbromide 10 mg) SCOPMA PLUS Tablet 0 0 0
140 Antihipermotilitas (Kand.LOPERAMID 2 mg) Tablet 40 40 40
141 Antiscabisit 5 % crem (Permethrin 5 %) SCABIMID CREM Tube 2 2 2
142 Antivomit injeksi ( Kand. Metoklopramide 5 mg/2 ml Inj ) Ampul 0 0 0
143 Antivomit sirup (Kand. Domperidon 5 mg/5 ml syr) Botol 2 2 2
144 Kombinasi : Attapulgite dan Pectin tablet/ Pularex (NEW ANTIDES) Tablet 20 20 20
145 Kombinasi : kaolin dan pectin (sirup antidiare untuk bayi dan anak) KAOTIN Syr Botol 8 8 8
146 Ipratropium bromide 0,5 mg, Salbutamol Sulphate 3,01 Unit Dose Vials (COMBIVENT) Blister 0 0 0
147 SULFADIAZINE SILVER 10 mg (Salep Luka Bakar) Tube 0 0 0
148 Syrup pelengkap untuk pengobatan diare pada anak-anak (kand. Zink)/ ZINK KID syr 20 mg/5ml Botol 2 2 2
149 Sucralfate Suspensi 500mg/5ml Syr Botol 8 8 8
150 Herbalkof syrup obat batuk herbal Botol 0 0 0
VAKSIN (BMHP Medis) 0 0 0
151 ADS 0,05 ML Piece 0 0 0
152 ADS 0,5 ML Piece 0 0 0
153 ADS 5 ML Piece 0 0 0
154 ADS 2 ML Piece 0 0 0
155 SAFETY BOX 5 ML Piece 1 1 1
156 SAFETY BOX 2,5 ML Piece 1 1 1
BAHAN HABIS PAKAI 0 0 0
158 Alat suntik sekali pakai 1 ml Piece 15 15 15
159 Alat suntik sekali pakai 2,5 ml Piece 0 0 0
160 Alat suntik sekali pakai 3 ml Piece 45 45 45
161 Alat suntik sekali pakai 5 ml Piece 8 8 8
162 Alat suntik sekali pakai 10 ml Piece 15 15 15
163 Alkohol Swab Piece 0 0 0
164 Aquadest steril (Aqua Pro Injection) Vial 2 2 2
165 Blood lancet Box 0 0 0
166 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (cromic) Piece 1 1 1
167 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (Plain) Piece 1 1 1
168 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (cromic) Piece 0 0 0
169 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (plain) Piece 0 0 0
170 Folley Catheter 16 G Piece 2 2 2
171 FRAMYCETIN SULFATE 10 cm-10 cm (DARRYANTUL) Piece 0 0 0
172 Handscoen Gynecology ( Powdered Letex Steril L) Pasang 0 0 0
173 Handscoon No. 6 S Pasang 35 35 35
174 Handscoon No. 7 M Pasang 20 20 20
175 Handscoon No. 7,5 L Pasang 0 0 0
176 Handscoon Steril 6 Pasang 0 0 0
177 Handscoon Steril 6,5 Pasang 0 0 0
178 Handscoon Steril 7 Pasang 0 0 0
179 Hidrogen Peroksida 3 / H2O2 Botol 0 0 0
180 Hypavix atau Polyvix 10 cm x 5 m Roll 0 0 0
181 Infusion Set Anak Piece 0 0 0
182 Infusion Set Dewasa Piece 0 0 0
183 IV Catheter No. 20 G Piece 3 3 3
184 IV Catheter No. 22 G Piece 5 5 5
185 IV Catheter No. 24 G Piece 0 0 0
186 IV Catheter No. 26 G Piece 0 0 0
187 Kaca Slide Kotak 0 0 0
188 Kapas 500 Bungkus 1 1 1
189 Kapas 250 gram Bungkus 0 0 0
190 Kasa Pembalut Hydrofil 4m x 15cm Roll 10 10 10
191 Kasa Steril 16 x 16 cm Kotak 10 10 10
192 Etanol 70 % 1 Liter Botol 0 0 0
193 Masker plus 2 Ply TALI (Biasa) Box 0 0 0
194 Masker plus 3 Ply (Hijab) Piece -4 -4 -4
195 Masker Sungkup Oksigen Anak Piece 0 0 0
196 Masker Sungkup Oksigen Dewasa Piece 0 0 0
197 Oxygen Nasal Cannula (Oxyflow Bayi) Piece 0 0 0
198 Oxygen Nasal Cannula (Oxyflow Anak) Piece 2 2 2
199 Oxygen Nasal Cannula (Oxyflow Dewasa) Piece 0 0 0
200 Perban Elastis Roll 0 0 0
201 Plesterin (Bulat Soft) Kotak 0 0 0
202 SOFTA-MAN @ B-BRAUN 500 ml Botol 0 0 0
203 Underped Piece 1 1 1
204 Urine bag Piece 0 0 0
205 Wing Needle 27 G x 3/4 Piece 0 0 0
206 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0 0 0
207 Aseptik Gel Botol 0 0 0

UMUM
ASKES JUMLAH
BAYAR TIDAK BAYAR
29 31 60

Mengetahui/ Menyetujui, Yang Menyerahkan, Yang Melaporkan, Yang Menerima,

Kepala UPT. Dinkes Puskesmas Kota Bangun Staf Gudang UPT. Puskesmas Kota Bangun Kepala Pusban / Polindes Petugas Pusban/polindes

RAJIANSYAH,A.Md.Kep DAYANTI MAULIDYA, A. Md., Farm Ns.Junaidi,S.Kep Ns.Junaidi,S.Kep

NIP. 197402205 200212 1 006 N199408242013012001

 LEMBAR PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

LPLPO
KODE PUSKESMAS ::
PUSBAN/POLINDES KEDANG MURUNG DOKUMEN PELAPORAN & PERMINTAAN PUSKESMAS DOKUMEN GFK [ PENYERAHAN OBAT ]
KECAMATAN : KOTA BANGUN NOMOR B- /DINKES/PUSK-KB/065.25/ 42024 NOMOR BULAN
April
KABUPATEN : KUTAI KARTANEGARA TANGGAL 25 April 2024 TANGGAL TAHUN : 2024

STOK PENERI- PERSE- PEMA- SISA STOK PERMIN- PEMBERIAN

NO NAMA SEDIAAN OBAT/ BMHP MEDIS SATUAN KET
AWAL MAAN DIAAN KAIAN STOK OPT TAAN APBN APBD I APBD II PROG. LAIN2 JML
1 2 3 4 5 6 (4+5) 7 (6-8) 8 9 10 11 12 13 14 15 16 17
OBAT GENERIK BERLOGO
1 Albendazol tablet 400 mg Tablet 0 0 0 0
2 Alopurinol tablet 100 mg Tablet 60 200 260 180 80 300
3 Ambroxol sirup 15 mg/ml Botol 0 0 0 0
4 Ambroxol tablet 30 mg Tablet 50 0 50 50 0 200
5 Amlodipin tablet 5 mg Tablet 170 0 170 150 20 200
6 Amlodipin tablet 10 mg Tablet 90 200 290 250 40 200
7 Amoksisilin kaplet 500 mg Kaplet 0 0 0 0
8 Amoksisilin sirup kering 125 mg/5 ml Botol 0 0 0 0
9 Amoksisilin sirup kering 250 mg/5 ml Botol 0 0 0 0
10 Ambroxol sirup 30 mg/ml Botol 0 0 0 0
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg dan Magnesium Hidroksida 200
11 Tablet 90 200 290 140 150 100
mg
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 ml dan Magnesium Hidroksida 200
12 Botol 9 0 9 2 7
mg/5 ml
13 Anti bakteri DOEN salep kombinsai : Basitrasin 500 IU/gr + Polimiksin 10.000IU/g Tube 0 0 0 0
14 Antifungi DOEN kombinasi : Asam Benzoat 6 % + Asam Salisilat 3 % Pot 0 0 0 0
15 Antihemoroid DOEN kombinasi : Bismut Subgalat 150 mg + Heksaklorofen 2.5 mg Supp 10 0 10 10
16 Antiparkinson DOEN tablet kombinasi : Karbidopa 25 mg + Levodopa 250 mg Tablet 0 0 0 0
17 Asam Askorbat (Vitamin C ) tablet 50mg Tablet 240 200 440 440
18 Asam Asetilsalisilat 80 mg (MINIASPI'80) Tablet 0 0 0 0
Asam Mefenamat kaplet 500 mg
19 Tablet 120 0 120 120 0 200
20 Asiklovir krim 5% Tube 8 0 8 8
21 Asiklovir tablet 400 mg Tablet 80 0 80 80
22 Asiklovir tablet 200 mg Tablet 100 0 100 100
23 Betahistin Mesilat tablet 6 mg Tablet 60 0 60 40 20 200
24 Betametason krim 0.1% (sebagai valerat) Tube 1 5 6 4 2 5
25 Calsium Gluconas 100 mg/ml Injeksi Ampul 2 0 2 2
26 Cetirizine tablet 10 mg Tablet 70 0 70 70
27 Cetirizine syrup Botol 5 0 5 5
28 Deksametason injeksi i.v. 5 mg/ml Ampul 0 0 0 0
29 Deksametason tablet 0.5 mg Tablet 0 0 0 0
30 Desoximetasone 0,25 % Crem Tube 0 0 0 0
31 Digoksin tablet 0.25 mg Tablet 0 0 0 0
32 Dimenhidrinat tablet 50 mg Tablet 0 0 0 0
33 Domperidon tablet 10 mg Tablet 100 0 100 100 0 200
34 Eritromisin kapsul 500 mg Kapsul 0 0 0 0
35 Eritromisin sirup 200 mg/5 ml Botol 0 0 0 0
36 Etakridin larutan 0.1% Botol 0 0 0 0
37 Fenol Gliserol tetes telinga 10% Botol 5 0 5 5
38 Fitomenadion (Vit.K) injeksi 2 mg/1ml Ampul 0 0 0 0
39 Fitomenadion (Vitamin K) tablet salut gula 10 mg Tablet 0 0 0 0
40 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul 0 0 0 0
41 Furosemid tablet 40 mg Tablet 0 0 0 0
Garam Oralit I serbuk, kombinasi : Natrium 0.70 gr, Kalium Klorida 0.30 gr, Trinatrium Sitrat Dihidrat 0.58
42 Sachet 82 0 82 82
gr, Glukosa Anhidrat 4 gr
43 Gentamycin Sulfat Injeksi Ampul 0 0 0 0
44 Gentamisin injeksi 40 mg/ml Ampul 0 0 0 0
45 Gentamisin salep kulit 0.1% Tube 5 5 10 7 3 5
46 Gentamisin salep Mata 0,3% Tube 0 0 0 0
47 Gentian Violet larutan 1 % Botol 0 0 0 0
48 Glibenklamida tablet 5 mg Tablet 0 0 0 0
49 Glimepiride tablet 1 mg Tablet 150 0 150 50 100
50 Glimepiride tablet 2 mg Tablet 50 200 250 100 150
51 Gliseril Gualakolat tablet 100 mg Tablet 140 0 140 140
52 Glukosa larutan infus 5 % steril D5 Botol 0 0 0 0
53 Griseofulvin Micronized tablet 125 mg Tablet 0 0 0 0
54 Hidroklorotiazida tablet 25 mg (HCT) Tablet 0 0 0 0
55 Hidrokortison krim 2.5% Tube 5 0 5 5
56 Ibuprofen suspensi 100 mg/5 ml Botol 5 0 5 5
57 Ibuprofen suspensi 200 mg/5 ml Botol 0 0 0 0
 58 Ibuprofen tablet 200 mg Tablet 80 0 80 80
59 Ibuprofen tablet 400 mg Tablet 0 0 0 0
60 Isosorbid Dinitrat tablet Sublingual 5 mg Tablet 0 0 0 0
61 Kalsium Laktat (Kalk) tablet 500 mg Tablet 280 200 480 180 300
62 Kaptopril tablet 12.5 mg Tablet 0 0 0 0
63 Kaptopril tablet 25 mg Tablet 0 0 0 0
64 Kaptopril tablet 50 mg Tablet 0 0 0 0
65 Kandesartan tablet 8 mg Tablet 0 0 0 0
66 Ketokonazol krim 2% Tube 2 0 2 2
67 Ketokonazol tablet 200 mg Tablet 0 0 0 0
68 Klindamisin kapsul 150 mg Kapsul 0 0 0 0
69 Kloramfenikol kapsul 250 mg Kapsul 0 0 0 0
70 Kloramfenikol salep mata 1% Tube 0 0 0 0
71 Kloramfenikol salep kulit 1% Tube 0 0 0 0
72 Kloramfenikol suspensi 125 mg/ 5ml Botol 0 0 0 0
73 Kloramfenikol tetes telinga 3% Botol 1 5 6 6
74 Klorfeniramina Maleat (CTM) tablet 4 mg Tablet 100 0 100 80 20 100
75 Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg + Trimetoprin 80 mg Tablet 0 0 0 0
76 Kotrimoksazol suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprin 40 mg/5 ml Botol 0 0 0 0
77 Lanzoprazol kapsul 30 mg Kapsul 0 0 0 0
78 Loratadine 10 mg/tablet Tablet 0 0 0 0
79 Lidokain injeksi 2% Ampul 4 0 4 4
80 Magnesium Sulfat injeksi (IV) 20% - 25 ml Vial 0 0 0 0
81 Magnesium Sulfat injeksi (IV) 40% - 25 ml Vial 0 0 0 0
82 Meloksikam tablet 15 mg Tablet 80 0 80 80
83 Menadion Natrium Bisulfit (Vit.K3) injeksi 10 mg/ml Ampul 0 0 0 0
84 Metformin Hci tablet 500 mg Tablet 200 0 200 200 0 200
85 Metildopa tablet 250 mg Dopamet 250 mg Tablet 30 0 30 30
86 Metilprednisolon tablet 4 mg Tablet 70 200 270 80 190
87 Metoklopramide tablet 10 mg Tablet 0 0 0 0
88 Metronidazol tablet 250 mg Tablet 0 0 0 0
89 Metronidazol tablet 500 mg Tablet 50 0 50 50
90 Mikonazol krim/salep 2% (Nitrat) Tablet 5 0 5 5
91 Natrium Diklofenak tablet 50 mg Tablet 70 0 70 70
92 Natrium Klorida larutan infus 0.9 % Botol 0 5 5 5
93 Nifedipin tablet 10 mg Tablet 100 0 100 100
94 Nystatin Vaginal tab 100.000 IU/g Tablet 20 0 20 20
95 N- Acetylcysteine 200 mg Tablet 90 0 90 90
96 Obat Batuk Hitam (O.B.H) @ 100 ml Botol 0 0 0 0
97 Oksitetrasiklin salep kulit 3% Tube 5 0 5 5
98 Oksitetrasiklin HCl Salep Mata 1% Tube 0 0 0 0
99 Oksitosin injeksi 10 IU/ml - 1 ml ( Pitogin Inj) Ampul 0 0 0 0
100 Omeprazol kapsul 20 mg Kapsul 0 100 100 80 20 100
101 Ondansentron tablet 4 mg Tablet 0 0 0 0
102 Ondansentron Injeksi 4mg/2ml Ampul 0 0 0 0
103 Papaverin tablet 40 mg Tablet 0 0 0 0
104 Parasetamol sirup 120 mg/5 ml Botol 15 0 15 15
105 Parasetamol tablet 500 mg Tablet 390 200 590 270 320
106 Pirantel tablet score (Base) 125 mg Tablet 0 0 0 0
107 Piridoksin (Vitamin B6) tablet 10 mg (HCI) Tablet 100 0 100 70 30 100
108 Piroksikam tablet 20 mg Tablet 70 0 70 70 0 200
109 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0 0 0 0
110 Ranitidin injeksi 25 mg/2 ml Ampul 5 0 5 5
111 Ranitidin tablet 150 mg Tablet 70 100 170 170
112 Retinol (Vitamin A) 100.000 IU kapsul lunak Kapsul 0 0 0 0
113 Retinol (Vitamin A) 200.000 IU kapsul lunak Kapsul 0 0 0 0
114 Ringer Laktat larutan infus RL Botol 1 5 6 6
115 Salbutamol tablet 2 mg (sebagai Sulfat) Tablet 40 0 40 40
116 Salbutamol tablet 4 mg (sebagai Sulfat) Tablet 0 0 0 0
117 Salbutamol sirup 2 mg/5 ml Botol 0 0 0 0
118 SALEP WHITFIELD CREM Pot 0 0 0 0
119 Salep 2-4, kombinasi : Asam Salisilat 2% + Belerang Endap 4% Pot 0 0 0 0
120 Salisil Bedak 2% Kotak 3 0 3 3
121 Sefadroksil sirup kering 125 mg/5 ml Botol 0 0 0 0
122 Sefadroksil sirup kering 250 mg/5 ml Botol 0 0 0 0
123 Sefadroksil kapsul 500 mg Kapsul 0 0 0 0
124 Sianokobalamin (Vit. B12) tablet 50 mg Tablet 0 0 0 0
125 Simetidin tablet 200 mg Tablet 0 0 0 0
126 Simvastatin tablet 10 mg Tablet 0 0 0 0
127 Simvastatin tablet 20 mg Tablet 80 200 280 280 0 400
128 Siprofloksasin tablet 500 mg (sebagai HCI) Tablet 0 0 0 0
129 Tablet tambah darah kombinasi Tablet 140 800 940 320 620
130 Tiamin (Vitamin B1) tablet 50 mg (HCI/Nitrat) Tablet 60 0 60 60
131 Vitamin B Kompleks tablet Tablet 0 0 0 0
132 Sivit-Zinc Tablet 0 0 0 0
133 Stimuno Sachet 0 0 0 0
134 Zinc tablet 20 mg Tablet 50 0 50 10 40
OBAT GENERIK BERMEREK 0 0 0 0
135 Analgesik, Antipiretik ( Kand. Parasetamol 125 mg/supp rect) Supp 0 0 0 0
136 Anestetika lokal injeksi (Lidocain 20 mg, Adrenalin 0,0125 mg) LIDOCAIN COMPRESITUM Ampul 0 0 0 0
137 Anti platelet/trombus ( Kand.Asam Asetilsalisilat 80 mg) ASPIMEC Tablet 0 0 0 0
138 Anti Spasmodik injeksi (Kand. Hyoscine-N-Butilbromide 20 mg/ml) Ampul 0 0 0 0
139 Anti Spasmodik tab (Kand. Hyoscine-N-Butilbromide 10 mg) SCOPMA PLUS Tablet 0 0 0 0
140 Antihipermotilitas (Kand.LOPERAMID 2 mg) Tablet 40 100 140 20 120
141 Antiscabisit 5 % crem (Permethrin 5 %) SCABIMID CREM Tube 2 0 2 2
142 Antivomit injeksi ( Kand. Metoklopramide 5 mg/2 ml Inj ) Ampul 0 0 0 0
143 Antivomit sirup (Kand. Domperidon 5 mg/5 ml syr) Botol 2 0 2 2
144 Kombinasi : Attapulgite dan Pectin tablet/ Pularex (NEW ANTIDES) Tablet 20 0 20 20
145 Kombinasi : kaolin dan pectin (sirup antidiare untuk bayi dan anak) KAOTIN Syr Botol 8 0 8 8
146 Ipratropium bromide 0,5 mg, Salbutamol Sulphate 3,01 Unit Dose Vials (COMBIVENT) Blister 0 0 0 0
147 SULFADIAZINE SILVER 10 mg (Salep Luka Bakar) Tube 0 0 0 0
148 Syrup pelengkap untuk pengobatan diare pada anak-anak (kand. Zink)/ ZINK KID syr 20 mg/5ml Botol 2 0 2 2
149 Sucralfate Suspensi 500mg/5ml Syr Botol 8 0 8 8
150 Herbalkof syrup obat batuk herbal Botol 0 0 0 0
VAKSIN (BMHP Medis) 0 0 0 0
151 ADS 0,05 ML Piece 0 0 0 0
152 ADS 0,5 ML Piece 0 0 0 0
153 ADS 5 ML Piece 0 0 0 0
154 ADS 2 ML Piece 0 0 0 0
155 SAFETY BOX 5 ML Piece 1 0 1 1
156 SAFETY BOX 2,5 ML Piece 1 0 1 1
BAHAN HABIS PAKAI 0 0 0 0
158 Alat suntik sekali pakai 1 ml Piece 15 0 15 15
159 Alat suntik sekali pakai 2,5 ml Piece 0 0 0 0
160 Alat suntik sekali pakai 3 ml Piece 45 30 75 75
161 Alat suntik sekali pakai 5 ml Piece 8 0 8 8
162 Alat suntik sekali pakai 10 ml Piece 15 0 15 15
163 Alkohol Swab Piece 0 100 100 100 0 100
164 Aquadest steril (Aqua Pro Injection) Vial 2 0 2 2
165 Blood lancet Box 0 0 0 0
166 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (cromic) Piece 1 0 1 1
167 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (Plain) Piece 1 0 1 1
168 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (cromic) Piece 0 0 0 0
169 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (plain) Piece 0 0 0 0
170 Folley Catheter 16 G Piece 2 0 2 2
171 FRAMYCETIN SULFATE 10 cm-10 cm (DARRYANTUL) Piece 0 0 0 0
172 Handscoen Gynecology ( Powdered Letex Steril L) Pasang 0 0 0 0
173 Handscoon No. 6 S Pasang 35 0 35 35
174 Handscoon No. 7 M Pasang 20 0 20 12 8 20
175 Handscoon No. 7,5 L Pasang 0 0 0 0
176 Handscoon Steril 6 Pasang 0 0 0 0
177 Handscoon Steril 6,5 Pasang 0 0 0 0
178 Handscoon Steril 7 Pasang 0 0 0 0
179 Hidrogen Peroksida 3 / H2O2 Botol 0 0 0 0
180 Hypavix atau Polyvix 10 cm x 5 m Roll 0 0 0 0
181 Infusion Set Anak Piece 0 0 0 0 2
182 Infusion Set Dewasa Piece 0 0 0 0 2
183 IV Catheter No. 20 G Piece 3 0 3 3
184 IV Catheter No. 22 G Piece 5 0 5 3 2 5
185 IV Catheter No. 24 G Piece 0 0 0 0 5
186 IV Catheter No. 26 G Piece 0 0 0 0
187 Kaca Slide Kotak 0 0 0 0
188 Kapas 500 Bungkus 1 0 1 1
189 Kapas 250 gram Bungkus 0 0 0 0
190 Kasa Pembalut Hydrofil 4m x 15cm Roll 10 1 11 11
191 Kasa Steril 16 x 16 cm Kotak 10 0 10 10
192 Etanol 70 % 1 Liter Botol 0 0 0 0
193 Masker plus 2 Ply TALI (Biasa) Box 0 0 0 0
194 Masker plus 3 Ply (Hijab) Piece -4 50 46 46
195 Masker Sungkup Oksigen Anak Piece 0 0 0 0
196 Masker Sungkup Oksigen Dewasa Piece 0 0 0 0
197 Oxygen Nasal Cannula (Oxyflow Bayi) Piece 0 0 0 0
198 Oxygen Nasal Cannula (Oxyflow Anak) Piece 2 0 2 2
199 Oxygen Nasal Cannula (Oxyflow Dewasa) Piece 0 0 0 0
200 Perban Elastis Roll 0 0 0 0
201 Plesterin (Bulat Soft) Kotak 0 0 0 0
202 SOFTA-MAN @ B-BRAUN 500 ml Botol 0 0 0 0
203 Underped Piece 1 0 1 1
204 Urine bag Piece 0 0 0 0
205 Wing Needle 27 G x 3/4 Piece 0 0 0 0
206 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0 0 0 0
207 Aseptik Gel Botol 0 0 0 0

UMUM
ASKES JUMLAH
BAYAR TIDAK BAYAR
33 31 64

Mengetahui/ Menyetujui, Yang Menyerahkan, Yang Melaporkan, Yang Menerima,

Kepala UPT. Dinkes Puskesmas Kota Bangun Staf Gudang UPT. Puskesmas Kota Bangun Kepala Pusban / Polindes Petugas Pusban/polindes

RAJIANSYAH,A.Md.Kep DAYANTI MAULIDYA, A. Md., Farm Ns.Junaidi,S.Kep Ns.Junaidi,S.Kep

NIP. 197402205 200212 1 006 N199408242013012001

 LEMBAR PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

LPLPO
KODE PUSKESMAS ::
PUSBAN/POLINDES KEDANG MURUNG DOKUMEN PELAPORAN & PERMINTAAN PUSKESMAS DOKUMEN GFK [ PENYERAHAN OBAT ]
KECAMATAN : KOTA BANGUN NOMOR B- /DINKES/PUSK-KB/065.25/ 3/2024 NOMOR BULAN
Maret
KABUPATEN : KUTAI KARTANEGARA TANGGAL 25 Maret 2024 TANGGAL TAHUN : 2024

STOK PENERI- PERSE- PEMA- SISA STOK PERMIN- PEMBERIAN

NO NAMA SEDIAAN OBAT/ BMHP MEDIS SATUAN KET
AWAL MAAN DIAAN KAIAN STOK OPT TAAN APBN APBD I APBD II PROG. LAIN2 JML
1 2 3 4 5 6 (4+5) 7 (6-8) 8 9 10 11 12 13 14 15 16 17
OBAT GENERIK BERLOGO
1 Albendazol tablet 400 mg Tablet 0 0 0 0
2 Alopurinol tablet 100 mg Tablet 30 100 130 70 60 200
3 Ambroxol sirup 15 mg/ml Botol 0 0 0 0
4 Ambroxol tablet 30 mg Tablet 50 50 50 0
5 Amlodipin tablet 5 mg Tablet 90 200 290 120 170 0
6 Amlodipin tablet 10 mg Tablet 0 200 200 110 90 200
7 Amoksisilin kaplet 500 mg Kaplet 0 0 0 0
8 Amoksisilin sirup kering 125 mg/5 ml Botol 0 0 0 0
9 Amoksisilin sirup kering 250 mg/5 ml Botol 0 0 0 0
10 Ambroxol sirup 30 mg/ml Botol 0 0 0 0
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg dan Magnesium Hidroksida 200
11 Tablet 40 200 240 150 90 200
mg
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 ml dan Magnesium Hidroksida 200
12 Botol 4 10 14 5 9 0
mg/5 ml
13 Anti bakteri DOEN salep kombinsai : Basitrasin 500 IU/gr + Polimiksin 10.000IU/g Tube 0 0 0 0
14 Antifungi DOEN kombinasi : Asam Benzoat 6 % + Asam Salisilat 3 % Pot 0 0 0 0
15 Antihemoroid DOEN kombinasi : Bismut Subgalat 150 mg + Heksaklorofen 2.5 mg Supp 10 10 10 0
16 Antiparkinson DOEN tablet kombinasi : Karbidopa 25 mg + Levodopa 250 mg Tablet 0 0 0 0
17 Asam Askorbat (Vitamin C ) tablet 50mg Tablet 100 200 300 60 240 200
18 Asam Asetilsalisilat 80 mg (MINIASPI'80) Tablet 0 0 0 0
Asam Mefenamat kaplet 500 mg
19 Tablet 170 170 50 120 0
20 Asiklovir krim 5% Tube 8 8 8 0
21 Asiklovir tablet 400 mg Tablet 80 80 80 0
22 Asiklovir tablet 200 mg Tablet 100 100 100 0
23 Betahistin Mesilat tablet 6 mg Tablet 20 50 70 10 60 0
24 Betametason krim 0.1% (sebagai valerat) Tube 1 1 1 5
25 Calsium Gluconas 100 mg/ml Injeksi Ampul 1 1 2 2 0
26 Cetirizine tablet 10 mg Tablet 120 120 50 70 0
27 Cetirizine syrup Botol 5 5 5 0
28 Deksametason injeksi i.v. 5 mg/ml Ampul 0 0 0 0
29 Deksametason tablet 0.5 mg Tablet 0 0 0 0
30 Desoximetasone 0,25 % Crem Tube 0 0 0 0
31 Digoksin tablet 0.25 mg Tablet 0 0 0 0
32 Dimenhidrinat tablet 50 mg Tablet 0 0 0 0
33 Domperidon tablet 10 mg Tablet 100 100 100 0
34 Eritromisin kapsul 500 mg Kapsul 0 0 0 0
35 Eritromisin sirup 200 mg/5 ml Botol 0 0 0 0
36 Etakridin larutan 0.1% Botol 0 0 0 0
37 Fenol Gliserol tetes telinga 10% Botol 0 5 5 5 0
38 Fitomenadion (Vit.K) injeksi 2 mg/1ml Ampul 0 0 0 0
39 Fitomenadion (Vitamin K) tablet salut gula 10 mg Tablet 0 0 0 0
40 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul 0 0 0 0
41 Furosemid tablet 40 mg Tablet 0 0 0 0
Garam Oralit I serbuk, kombinasi : Natrium 0.70 gr, Kalium Klorida 0.30 gr, Trinatrium Sitrat Dihidrat 0.58
42 Sachet 82 82 82 0
gr, Glukosa Anhidrat 4 gr
43 Gentamycin Sulfat Injeksi Ampul 0 0 0 0
44 Gentamisin injeksi 40 mg/ml Ampul 0 0 0 0
45 Gentamisin salep kulit 0.1% Tube 5 5 5 5
46 Gentamisin salep Mata 0,3% Tube 0 0 0 0
47 Gentian Violet larutan 1 % Botol 0 0 0 0
48 Glibenklamida tablet 5 mg Tablet 0 0 0 0
49 Glimepiride tablet 1 mg Tablet 160 100 260 110 150 0
50 Glimepiride tablet 2 mg Tablet 50 50 50 200
51 Gliseril Gualakolat tablet 100 mg Tablet 60 200 260 120 140 0
52 Glukosa larutan infus 5 % steril D5 Botol 0 0 0 0
53 Griseofulvin Micronized tablet 125 mg Tablet 0 0 0 0
54 Hidroklorotiazida tablet 25 mg (HCT) Tablet 0 0 0 0
55 Hidrokortison krim 2.5% Tube 0 5 5 5 0
56 Ibuprofen suspensi 100 mg/5 ml Botol 5 5 5 0
57 Ibuprofen suspensi 200 mg/5 ml Botol 0 0 0 0
 58 Ibuprofen tablet 200 mg Tablet 80 80 80 0
59 Ibuprofen tablet 400 mg Tablet 0 0 0 0
60 Isosorbid Dinitrat tablet Sublingual 5 mg Tablet 0 0 0 0
61 Kalsium Laktat (Kalk) tablet 500 mg Tablet 100 300 400 120 280 200
62 Kaptopril tablet 12.5 mg Tablet 0 0 0 0
63 Kaptopril tablet 25 mg Tablet 0 0 0 0
64 Kaptopril tablet 50 mg Tablet 0 0 0 0
65 Kandesartan tablet 8 mg Tablet 0 0 0 0
66 Ketokonazol krim 2% Tube 2 2 2 0
67 Ketokonazol tablet 200 mg Tablet 0 0 0 0
68 Klindamisin kapsul 150 mg Kapsul 0 0 0 0
69 Kloramfenikol kapsul 250 mg Kapsul 0 0 0 0
70 Kloramfenikol salep mata 1% Tube 0 0 0 0
71 Kloramfenikol salep kulit 1% Tube 0 0 0 0
72 Kloramfenikol suspensi 125 mg/ 5ml Botol 0 0 0 0
73 Kloramfenikol tetes telinga 3% Botol 1 1 1 5
74 Klorfeniramina Maleat (CTM) tablet 4 mg Tablet 150 150 50 100 0
75 Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg + Trimetoprin 80 mg Tablet 0 0 0 0
76 Kotrimoksazol suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprin 40 mg/5 ml Botol 0 0 0 0
77 Lanzoprazol kapsul 30 mg Kapsul 0 0 0 0
78 Loratadine 10 mg/tablet Tablet 0 0 0 0
79 Lidokain injeksi 2% Ampul 4 4 4 0
80 Magnesium Sulfat injeksi (IV) 20% - 25 ml Vial 0 0 0 0
81 Magnesium Sulfat injeksi (IV) 40% - 25 ml Vial 0 0 0 0
82 Meloksikam tablet 15 mg Tablet 80 80 80 0
83 Menadion Natrium Bisulfit (Vit.K3) injeksi 10 mg/ml Ampul 0 0 0 0
84 Metformin Hci tablet 500 mg Tablet 110 200 310 110 200 0
85 Metildopa tablet 250 mg Dopamet 250 mg Tablet 30 30 30 0
86 Metilprednisolon tablet 4 mg Tablet 110 110 40 70 200
87 Metoklopramide tablet 10 mg Tablet 0 0 0 0
88 Metronidazol tablet 250 mg Tablet 0 0 0 0
89 Metronidazol tablet 500 mg Tablet 50 50 50 0
90 Mikonazol krim/salep 2% (Nitrat) Tablet 5 5 5 0
91 Natrium Diklofenak tablet 50 mg Tablet 30 100 130 60 70 0
92 Natrium Klorida larutan infus 0.9 % Botol 0 0 0 5
93 Nifedipin tablet 10 mg Tablet 100 100 100 0
94 Nystatin Vaginal tab 100.000 IU/g Tablet 20 20 20 0
95 N- Acetylcysteine 200 mg Tablet 90 90 90 0
96 Obat Batuk Hitam (O.B.H) @ 100 ml Botol 0 0 0 0
97 Oksitetrasiklin salep kulit 3% Tube 0 5 5 5 0
98 Oksitetrasiklin HCl Salep Mata 1% Tube 0 0 0 0
99 Oksitosin injeksi 10 IU/ml - 1 ml ( Pitogin Inj) Ampul 0 0 0 0
100 Omeprazol kapsul 20 mg Kapsul 0 0 0 100
101 Ondansentron tablet 4 mg Tablet 0 0 0 0
102 Ondansentron Injeksi 4mg/2ml Ampul 0 0 0 0
103 Papaverin tablet 40 mg Tablet 0 0 0 0
104 Parasetamol sirup 120 mg/5 ml Botol 7 20 27 12 15 0
105 Parasetamol tablet 500 mg Tablet 210 300 510 120 390 200
106 Pirantel tablet score (Base) 125 mg Tablet 0 0 0 0
107 Piridoksin (Vitamin B6) tablet 10 mg (HCI) Tablet 0 100 100 100 0
108 Piroksikam tablet 20 mg Tablet 160 160 90 70 0
109 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0 0 0 0
110 Ranitidin injeksi 25 mg/2 ml Ampul 5 5 5 0
111 Ranitidin tablet 150 mg Tablet 0 100 100 30 70 100
112 Retinol (Vitamin A) 100.000 IU kapsul lunak Kapsul 0 0 0 0
113 Retinol (Vitamin A) 200.000 IU kapsul lunak Kapsul 0 0 0 0
114 Ringer Laktat larutan infus RL Botol 1 1 1 5
115 Salbutamol tablet 2 mg (sebagai Sulfat) Tablet 40 40 40 0
116 Salbutamol tablet 4 mg (sebagai Sulfat) Tablet 0 0 0 0
117 Salbutamol sirup 2 mg/5 ml Botol 0 0 0 0
118 SALEP WHITFIELD CREM Pot 0 0 0 0
119 Salep 2-4, kombinasi : Asam Salisilat 2% + Belerang Endap 4% Pot 0 0 0 0
120 Salisil Bedak 2% Kotak 1 2 3 3 0
121 Sefadroksil sirup kering 125 mg/5 ml Botol 0 0 0 0
122 Sefadroksil sirup kering 250 mg/5 ml Botol 0 0 0 0
123 Sefadroksil kapsul 500 mg Kapsul 0 0 0 0
124 Sianokobalamin (Vit. B12) tablet 50 mg Tablet 0 0 0 0
125 Simetidin tablet 200 mg Tablet 0 0 0 0
126 Simvastatin tablet 10 mg Tablet 0 0 0 0
127 Simvastatin tablet 20 mg Tablet 160 160 80 80 200
128 Siprofloksasin tablet 500 mg (sebagai HCI) Tablet 0 0 0 0
129 Tablet tambah darah kombinasi Tablet 300 300 160 140 800
130 Tiamin (Vitamin B1) tablet 50 mg (HCI/Nitrat) Tablet 130 130 70 60 0
131 Vitamin B Kompleks tablet Tablet 0 0 0 0
132 Sivit-Zinc Tablet 0 0 0 0
133 Stimuno Sachet 0 0 0 0
134 Zinc tablet 20 mg Tablet 50 50 50 0
OBAT GENERIK BERMEREK 0 0 0 0
135 Analgesik, Antipiretik ( Kand. Parasetamol 125 mg/supp rect) Supp 0 0 0 0
136 Anestetika lokal injeksi (Lidocain 20 mg, Adrenalin 0,0125 mg) LIDOCAIN COMPRESITUM Ampul 0 0 0 0
137 Anti platelet/trombus ( Kand.Asam Asetilsalisilat 80 mg) ASPIMEC Tablet 0 0 0 0
138 Anti Spasmodik injeksi (Kand. Hyoscine-N-Butilbromide 20 mg/ml) Ampul 0 0 0 0
139 Anti Spasmodik tab (Kand. Hyoscine-N-Butilbromide 10 mg) SCOPMA PLUS Tablet 0 0 0 0
140 Antihipermotilitas (Kand.LOPERAMID 2 mg) Tablet 40 40 40 100
141 Antiscabisit 5 % crem (Permethrin 5 %) SCABIMID CREM Tube 2 2 2 0
142 Antivomit injeksi ( Kand. Metoklopramide 5 mg/2 ml Inj ) Ampul 0 0 0 0
143 Antivomit sirup (Kand. Domperidon 5 mg/5 ml syr) Botol 2 2 2 0
144 Kombinasi : Attapulgite dan Pectin tablet/ Pularex (NEW ANTIDES) Tablet 20 20 20 0
145 Kombinasi : kaolin dan pectin (sirup antidiare untuk bayi dan anak) KAOTIN Syr Botol 3 5 8 8 0
146 Ipratropium bromide 0,5 mg, Salbutamol Sulphate 3,01 Unit Dose Vials (COMBIVENT) Blister 0 0 0 0
147 SULFADIAZINE SILVER 10 mg (Salep Luka Bakar) Tube 0 0 0 0
148 Syrup pelengkap untuk pengobatan diare pada anak-anak (kand. Zink)/ ZINK KID syr 20 mg/5ml Botol 2 2 2 0
149 Sucralfate Suspensi 500mg/5ml Syr Botol 8 8 8 0
150 Herbalkof syrup obat batuk herbal Botol 0 0 0 0
VAKSIN (BMHP Medis) 0 0 0 0
151 ADS 0,05 ML Piece 0 0 0 0
152 ADS 0,5 ML Piece 0 0 0 0
153 ADS 5 ML Piece 0 0 0 0
154 ADS 2 ML Piece 0 0 0 0
155 SAFETY BOX 5 ML Piece 1 1 1 0
156 SAFETY BOX 2,5 ML Piece 1 1 1 0
BAHAN HABIS PAKAI 0 0 0 0
158 Alat suntik sekali pakai 1 ml Piece 0 20 20 5 15 0
159 Alat suntik sekali pakai 2,5 ml Piece 0 0 0 0
160 Alat suntik sekali pakai 3 ml Piece 0 50 50 5 45 30
161 Alat suntik sekali pakai 5 ml Piece 8 8 8 0
162 Alat suntik sekali pakai 10 ml Piece 15 15 15 0
163 Alkohol Swab Piece 0 0 0 100
164 Aquadest steril (Aqua Pro Injection) Vial 2 2 2 0
165 Blood lancet Box 0 0 0 0
166 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (cromic) Piece 1 1 1 0
167 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (Plain) Piece 1 1 1 0
168 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (cromic) Piece 0 0 0 0
169 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (plain) Piece 0 0 0 0
170 Folley Catheter 16 G Piece 2 2 2 0
171 FRAMYCETIN SULFATE 10 cm-10 cm (DARRYANTUL) Piece 0 0 0 0
172 Handscoen Gynecology ( Powdered Letex Steril L) Pasang 0 0 0 0
173 Handscoon No. 6 S Pasang 35 35 35 0
174 Handscoon No. 7 M Pasang 20 20 20 0
175 Handscoon No. 7,5 L Pasang 0 0 0 0
176 Handscoon Steril 6 Pasang 0 0 0 0
177 Handscoon Steril 6,5 Pasang 0 0 0 0
178 Handscoon Steril 7 Pasang 0 0 0 0
179 Hidrogen Peroksida 3 / H2O2 Botol 0 0 0 0
180 Hypavix atau Polyvix 10 cm x 5 m Roll 0 0 0 0
181 Infusion Set Anak Piece 0 0 0 0
182 Infusion Set Dewasa Piece 0 0 0 0
183 IV Catheter No. 20 G Piece 3 3 3 0
184 IV Catheter No. 22 G Piece 5 5 5 0
185 IV Catheter No. 24 G Piece 0 0 0 0
186 IV Catheter No. 26 G Piece 0 0 0 0
187 Kaca Slide Kotak 0 0 0 0
188 Kapas 500 Bungkus 1 1 1 0
189 Kapas 250 gram Bungkus 0 0 0 0
190 Kasa Pembalut Hydrofil 4m x 15cm Roll 10 10 10 1
191 Kasa Steril 16 x 16 cm Kotak 10 10 10 0
192 Etanol 70 % 1 Liter Botol 0 0 0 0
193 Masker plus 2 Ply TALI (Biasa) Box 0 0 0 0
 50 Masker plus 3 Ply (Hijab) Piece -4 -4 -4 50
195 Masker Sungkup Oksigen Anak Piece 0 0 0 0
196 Masker Sungkup Oksigen Dewasa Piece 0 0 0 0
197 Oxygen Nasal Cannula (Oxyflow Bayi) Piece 0 0 0 0
198 Oxygen Nasal Cannula (Oxyflow Anak) Piece 0 0 0 0
199 Oxygen Nasal Cannula (Oxyflow Dewasa) Piece 2 2 2 0
200 Perban Elastis Roll 0 0 0 0
201 Plesterin (Bulat Soft) Kotak 0 0 0 0
202 SOFTA-MAN @ B-BRAUN 500 ml Botol 0 0 0 0
203 Underped Piece 0 0 0 0
204 Urine bag Piece 1 1 1 0
205 Wing Needle 27 G x 3/4 Piece 0 0 0 0
206 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0 0 0 0
207 Aseptik Gel Botol 0 0 0 0

UMUM
ASKES JUMLAH
BAYAR TIDAK BAYAR
29 31 60

Mengetahui/ Menyetujui, Yang Menyerahkan, Yang Melaporkan, Yang Menerima,

Kepala UPT. Dinkes Puskesmas Kota Bangun Staf Gudang UPT. Puskesmas Kota Bangun Kepala Pusban / Polindes Petugas Pusban/polindes

RAJIANSYAH,A.Md.Kep DAYANTI MAULIDYA, A. Md., Farm Ns.Junaidi,S.Kep Ns.Junaidi,S.Kep

NIP. 197402205 200212 1 006 N199408242013012001

 LEMBAR PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

LPLPO
KODE PUSKESMAS ::
PUSBAN/POLINDES KEDANG MURUNG DOKUMEN PELAPORAN & PERMINTAAN PUSKESMAS DOKUMEN GFK [ PENYERAHAN OBAT ]
KECAMATAN : KOTA BANGUN NOMOR NOMOR BULAN
Februari
KABUPATEN : KUTAI KARTANEGARA TANGGAL TANGGAL TAHUN : 2024

STOK PENERI- PERSE- PEMA- SISA STOK PERMIN- PEMBERIAN

NO NAMA SEDIAAN OBAT/ BMHP MEDIS SATUAN KET
AWAL MAAN DIAAN KAIAN STOK OPT TAAN APBN APBD I APBD II PROG. LAIN2 JML
1 2 3 4 5 6 (4+5) 7 (6-8) 8 9 10 11 12 13 14 15 16 17
OBAT GENERIK BERLOGO
1 Albendazol tablet 400 mg Tablet 0 0 0
2 Alopurinol tablet 100 mg Tablet 70 70 40 30 100
3 Ambroxol sirup 15 mg/ml Botol 0 0 0
4 Ambroxol tablet 30 mg Tablet 70 70 20 50
5 Amlodipin tablet 5 mg Tablet 230 230 140 90 100
6 Amlodipin tablet 10 mg Tablet 0 0 0 100
7 Amoksisilin kaplet 500 mg Kaplet 0 0 0
8 Amoksisilin sirup kering 125 mg/5 ml Botol 0 0 0
9 Amoksisilin sirup kering 250 mg/5 ml Botol 0 0 0
10 Ambroxol sirup 30 mg/ml Botol 0 0 0
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg dan Magnesium Hidroksida 200
11 Tablet 100 100 60 40 200
mg
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 ml dan Magnesium Hidroksida 200
12 Botol 10 10 6 4 10
mg/5 ml
13 Anti bakteri DOEN salep kombinsai : Basitrasin 500 IU/gr + Polimiksin 10.000IU/g Tube 0 0 0
14 Antifungi DOEN kombinasi : Asam Benzoat 6 % + Asam Salisilat 3 % Pot 0 0 0
15 Antihemoroid DOEN kombinasi : Bismut Subgalat 150 mg + Heksaklorofen 2.5 mg Supp 10 10 10
16 Antiparkinson DOEN tablet kombinasi : Karbidopa 25 mg + Levodopa 250 mg Tablet 0 0 0
17 Asam Askorbat (Vitamin C ) tablet 50mg Tablet 160 160 60 100 100
18 Asam Asetilsalisilat 80 mg (MINIASPI'80) Tablet 0 0 0
Asam Mefenamat kaplet 500 mg
19 Tablet 220 220 50 170
20 Asiklovir krim 5% Tube 10 10 2 8
21 Asiklovir tablet 400 mg Tablet 100 100 20 80
22 Asiklovir tablet 200 mg Tablet 100 100 100
23 Betahistin Mesilat tablet 6 mg Tablet 60 60 40 20 100
24 Betametason krim 0.1% (sebagai valerat) Tube 2 2 1 1
25 Calsium Gluconas 100 mg/ml Injeksi Ampul 1 1 1 1
26 Cetirizine tablet 10 mg Tablet 170 170 50 120
27 Cetirizine syrup Botol 5 5 5
28 Deksametason injeksi i.v. 5 mg/ml Ampul 0 0 0
29 Deksametason tablet 0.5 mg Tablet 0 0 0
30 Desoximetasone 0,25 % Crem Tube 0 0 0
31 Digoksin tablet 0.25 mg Tablet 0 0 0
32 Dimenhidrinat tablet 50 mg Tablet 0 0 0
33 Domperidon tablet 10 mg Tablet 120 120 20 100
34 Eritromisin kapsul 500 mg Kapsul 0 0 0
35 Eritromisin sirup 200 mg/5 ml Botol 0 0 0
36 Etakridin larutan 0.1% Botol 0 0 0
37 Fenol Gliserol tetes telinga 10% Botol 3 3 3 0 5
38 Fitomenadion (Vit.K) injeksi 2 mg/1ml Ampul 0 0 0
39 Fitomenadion (Vitamin K) tablet salut gula 10 mg Tablet 0 0 0
40 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul 0 0 0
41 Furosemid tablet 40 mg Tablet 0 0 0
Garam Oralit I serbuk, kombinasi : Natrium 0.70 gr, Kalium Klorida 0.30 gr, Trinatrium Sitrat Dihidrat 0.58
42 Sachet 102 102 20 82
gr, Glukosa Anhidrat 4 gr
43 Gentamycin Sulfat Injeksi Ampul 0 0 0
44 Gentamisin injeksi 40 mg/ml Ampul 0 0 0
45 Gentamisin salep kulit 0.1% Tube 6 6 1 5
46 Gentamisin salep Mata 0,3% Tube 0 0 0
47 Gentian Violet larutan 1 % Botol 0 0 0
48 Glibenklamida tablet 5 mg Tablet 0 0 0
49 Glimepiride tablet 1 mg Tablet 220 220 60 160
50 Glimepiride tablet 2 mg Tablet 130 130 80 50 100
51 Gliseril Gualakolat tablet 100 mg Tablet 120 120 60 60 100
52 Glukosa larutan infus 5 % steril D5 Botol 0 0 0
53 Griseofulvin Micronized tablet 125 mg Tablet 0 0 0
54 Hidroklorotiazida tablet 25 mg (HCT) Tablet 0 0 0
55 Hidrokortison krim 2.5% Tube 1 1 1 0 5
56 Ibuprofen suspensi 100 mg/5 ml Botol 5 5 5
57 Ibuprofen suspensi 200 mg/5 ml Botol 0 0 0
 58 Ibuprofen tablet 200 mg Tablet 100 100 20 80
59 Ibuprofen tablet 400 mg Tablet 0 0 0
60 Isosorbid Dinitrat tablet Sublingual 5 mg Tablet 0 0 0
61 Kalsium Laktat (Kalk) tablet 500 mg Tablet 150 150 50 100 100
62 Kaptopril tablet 12.5 mg Tablet 0 0 0
63 Kaptopril tablet 25 mg Tablet 0 0 0
64 Kaptopril tablet 50 mg Tablet 0 0 0
65 Kandesartan tablet 8 mg Tablet 0 0 0
66 Ketokonazol krim 2% Tube 2 2 2
67 Ketokonazol tablet 200 mg Tablet 0 0 0
68 Klindamisin kapsul 150 mg Kapsul 0 0 0
69 Kloramfenikol kapsul 250 mg Kapsul 0 0 0
70 Kloramfenikol salep mata 1% Tube 0 0 0
71 Kloramfenikol salep kulit 1% Tube 0 0 0
72 Kloramfenikol suspensi 125 mg/ 5ml Botol 0 0 0
73 Kloramfenikol tetes telinga 3% Botol 1 1 1
74 Klorfeniramina Maleat (CTM) tablet 4 mg Tablet 220 220 70 150
75 Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg + Trimetoprin 80 mg Tablet 0 0 0
76 Kotrimoksazol suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprin 40 mg/5 ml Botol 0 0 0
77 Lanzoprazol kapsul 30 mg Kapsul 0 0 0
78 Loratadine 10 mg/tablet Tablet 0 0 0
79 Lidokain injeksi 2% Ampul 4 4 4
80 Magnesium Sulfat injeksi (IV) 20% - 25 ml Vial 0 0 0
81 Magnesium Sulfat injeksi (IV) 40% - 25 ml Vial 0 0 0
82 Meloksikam tablet 15 mg Tablet 100 100 20 80
83 Menadion Natrium Bisulfit (Vit.K3) injeksi 10 mg/ml Ampul 0 0 0
84 Metformin Hci tablet 500 mg Tablet 200 200 90 110 100
85 Metildopa tablet 250 mg Dopamet 250 mg Tablet 30 30 30
86 Metilprednisolon tablet 4 mg Tablet 180 180 70 110
87 Metoklopramide tablet 10 mg Tablet 0 0 0
88 Metronidazol tablet 250 mg Tablet 0 0 0
89 Metronidazol tablet 500 mg Tablet 50 50 50
90 Mikonazol krim/salep 2% (Nitrat) Tablet 5 5 5
91 Natrium Diklofenak tablet 50 mg Tablet 50 50 20 30 100
92 Natrium Klorida larutan infus 0.9 % Botol 0 0 0
93 Nifedipin tablet 10 mg Tablet 100 100 100
94 Nystatin Vaginal tab 100.000 IU/g Tablet 20 20 20
95 N- Acetylcysteine 200 mg Tablet 120 120 30 90
96 Obat Batuk Hitam (O.B.H) @ 100 ml Botol 0 0 0
97 Oksitetrasiklin salep kulit 3% Tube 0 0 0 10
98 Oksitetrasiklin HCl Salep Mata 1% Tube 0 0 0
99 Oksitosin injeksi 10 IU/ml - 1 ml ( Pitogin Inj) Ampul 0 0 0
100 Omeprazol kapsul 20 mg Kapsul 0 0 0
101 Ondansentron tablet 4 mg Tablet 0 0 0
102 Ondansentron Injeksi 4mg/2ml Ampul 0 0 0
103 Papaverin tablet 40 mg Tablet 0 0 0
104 Parasetamol sirup 120 mg/5 ml Botol 13 13 6 7 10
105 Parasetamol tablet 500 mg Tablet 390 390 180 210
106 Pirantel tablet score (Base) 125 mg Tablet 0 0 0
107 Piridoksin (Vitamin B6) tablet 10 mg (HCI) Tablet 20 20 20 0 100
108 Piroksikam tablet 20 mg Tablet 200 200 40 160
109 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0 0 0
110 Ranitidin injeksi 25 mg/2 ml Ampul 5 5 5
111 Ranitidin tablet 150 mg Tablet 0 0 0 0 100
112 Retinol (Vitamin A) 100.000 IU kapsul lunak Kapsul 0 0 0
113 Retinol (Vitamin A) 200.000 IU kapsul lunak Kapsul 0 0 0
114 Ringer Laktat larutan infus RL Botol 5 5 4 1
115 Salbutamol tablet 2 mg (sebagai Sulfat) Tablet 40 40 40
116 Salbutamol tablet 4 mg (sebagai Sulfat) Tablet 0 0 0
117 Salbutamol sirup 2 mg/5 ml Botol 0 0 0
118 SALEP WHITFIELD CREM Pot 0 0 0
119 Salep 2-4, kombinasi : Asam Salisilat 2% + Belerang Endap 4% Pot 0 0 0
120 Salisil Bedak 2% Kotak 4 4 3 1 5
121 Sefadroksil sirup kering 125 mg/5 ml Botol 0 0 0
122 Sefadroksil sirup kering 250 mg/5 ml Botol 0 0 0
123 Sefadroksil kapsul 500 mg Kapsul 0 0 0
124 Sianokobalamin (Vit. B12) tablet 50 mg Tablet 0 0 0
125 Simetidin tablet 200 mg Tablet 0 0 0
126 Simvastatin tablet 10 mg Tablet 0 0 0 0 100
127 Simvastatin tablet 20 mg Tablet 230 230 70 160 100
128 Siprofloksasin tablet 500 mg (sebagai HCI) Tablet 0 0 0
129 Tablet tambah darah kombinasi Tablet 440 440 140 300
130 Tiamin (Vitamin B1) tablet 50 mg (HCI/Nitrat) Tablet 200 200 70 130
131 Vitamin B Kompleks tablet Tablet 0 0 0
132 Sivit-Zinc Tablet 0 0 0 0
133 Stimuno Sachet 0 0 0 50
134 Zinc tablet 20 mg Tablet 50 50 50
OBAT GENERIK BERMEREK 0 0 0
135 Analgesik, Antipiretik ( Kand. Parasetamol 125 mg/supp rect) Supp 0 0 0
136 Anestetika lokal injeksi (Lidocain 20 mg, Adrenalin 0,0125 mg) LIDOCAIN COMPRESITUM Ampul 0 0 0
137 Anti platelet/trombus ( Kand.Asam Asetilsalisilat 80 mg) ASPIMEC Tablet 0 0 0
138 Anti Spasmodik injeksi (Kand. Hyoscine-N-Butilbromide 20 mg/ml) Ampul 0 0 0
139 Anti Spasmodik tab (Kand. Hyoscine-N-Butilbromide 10 mg) SCOPMA PLUS Tablet 0 0 0
140 Antihipermotilitas (Kand.LOPERAMID 2 mg) Tablet 40 40 40
141 Antiscabisit 5 % crem (Permethrin 5 %) SCABIMID CREM Tube 2 2 2
142 Antivomit injeksi ( Kand. Metoklopramide 5 mg/2 ml Inj ) Ampul 0 0 0
143 Antivomit sirup (Kand. Domperidon 5 mg/5 ml syr) Botol 3 3 1 2
144 Kombinasi : Attapulgite dan Pectin tablet/ Pularex (NEW ANTIDES) Tablet 20 20 20
145 Kombinasi : kaolin dan pectin (sirup antidiare untuk bayi dan anak) KAOTIN Syr Botol 5 5 2 3 5
146 Ipratropium bromide 0,5 mg, Salbutamol Sulphate 3,01 Unit Dose Vials (COMBIVENT) Blister 0 0 0
147 SULFADIAZINE SILVER 10 mg (Salep Luka Bakar) Tube 0 0 0
148 Syrup pelengkap untuk pengobatan diare pada anak-anak (kand. Zink)/ ZINK KID syr 20 mg/5ml Botol 2 2 2
149 Sucralfate Suspensi 500mg/5ml Syr Botol 10 10 2 8
150 Herbalkof syrup obat batuk herbal Botol 0 0 0
VAKSIN (BMHP Medis) 0 0 0
151 ADS 0,05 ML Piece 0 0 0
152 ADS 0,5 ML Piece 0 0 0
153 ADS 5 ML Piece 0 0 0
154 ADS 2 ML Piece 0 0 0
155 SAFETY BOX 5 ML Piece 1 1 1
156 SAFETY BOX 2,5 ML Piece 1 1 1
BAHAN HABIS PAKAI 0 0 0
158 Alat suntik sekali pakai 1 ml Piece 0 0 0 10
159 Alat suntik sekali pakai 2,5 ml Piece 0 0 0
160 Alat suntik sekali pakai 3 ml Piece 2 2 2 0 20
161 Alat suntik sekali pakai 5 ml Piece 8 8 8
162 Alat suntik sekali pakai 10 ml Piece 15 15 15
163 Alkohol Swab Piece 0 0 0
164 Aquadest steril (Aqua Pro Injection) Vial 2 2 2
165 Blood lancet Box 0 0 0
166 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (cromic) Piece 1 1 1
167 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (Plain) Piece 1 1 1
168 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (cromic) Piece 0 0 0
169 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (plain) Piece 0 0 0
170 Folley Catheter 16 G Piece 2 2 2
171 FRAMYCETIN SULFATE 10 cm-10 cm (DARRYANTUL) Piece 0 0 0
172 Handscoen Gynecology ( Powdered Letex Steril L) Pasang 0 0 0
173 Handscoon No. 6 S Pasang 45 45 10 35
174 Handscoon No. 7 M Pasang 30 30 10 20
175 Handscoon No. 7,5 L Pasang 0 0 0
176 Handscoon Steril 6 Pasang 0 0 0
177 Handscoon Steril 6,5 Pasang 0 0 0
178 Handscoon Steril 7 Pasang 0 0 0
179 Hidrogen Peroksida 3 / H2O2 Botol 0 0 0
180 Hypavix atau Polyvix 10 cm x 5 m Roll 0 0 0
181 Infusion Set Anak Piece 0 0 0
182 Infusion Set Dewasa Piece 0 0 0
183 IV Catheter No. 20 G Piece 3 3 3
184 IV Catheter No. 22 G Piece 5 5 5
185 IV Catheter No. 24 G Piece 0 0 0
186 IV Catheter No. 26 G Piece 0 0 0
187 Kaca Slide Kotak 0 0 0
188 Kapas 500 Bungkus 1 1 1
189 Kapas 250 gram Bungkus 0 0 0
190 Kasa Pembalut Hydrofil 4m x 15cm Roll 10 10 10
191 Kasa Steril 16 x 16 cm Kotak 10 10 10
192 Etanol 70 % 1 Liter Botol 0 0 0
193 Masker plus 2 Ply TALI (Biasa) Box 0 0 0
194 Masker plus 3 Ply (Hijab) Piece 16 16 20 -4
195 Masker Sungkup Oksigen Anak Piece 0 0 0
196 Masker Sungkup Oksigen Dewasa Piece 0 0 0
197 Oxygen Nasal Cannula (Oxyflow Bayi) Piece 0 0 0
198 Oxygen Nasal Cannula (Oxyflow Anak) Piece 0 0 0
199 Oxygen Nasal Cannula (Oxyflow Dewasa) Piece 2 2 2
200 Perban Elastis Roll 0 0 0
201 Plesterin (Bulat Soft) Kotak 0 0 0
202 SOFTA-MAN @ B-BRAUN 500 ml Botol 0 0 0
203 Underped Piece 0 0 0
204 Urine bag Piece 1 1 1
205 Wing Needle 27 G x 3/4 Piece 0 0 0
206 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0 0 0
207 Aseptik Gel Botol 0 0 0

UMUM
ASKES JUMLAH
BAYAR TIDAK BAYAR
29 31 60

Mengetahui/ Menyetujui, Yang Menyerahkan, Yang Melaporkan, Yang Menerima,

Kepala UPT. Dinkes Puskesmas Kota Bangun Staf Gudang UPT. Puskesmas Kota Bangun Kepala Pusban / Polindes Petugas Pusban/polindes

RAJIANSYAH,A.Md.Kep DAYANTI MAULIDYA, A. Md., Farm EGIN ZURLAENI,A.Md.Keb EGIN ZURLAENI,A.Md.Keb

NIP. 197402205 200212 1 006 N199408242013012001 N198912032012012001 N198912032012012001

N ZURLAENI,A.Md.Keb

198912032012012001
 LEMBAR PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

LPLPO
KODE PUSKESMAS ::
PUSBAN/POLINDES KEDANG MURUNG DOKUMEN PELAPORAN & PERMINTAAN PUSKESMAS DOKUMEN GFK [ PENYERAHAN OBAT ]
KECAMATAN : KOTA BANGUN NOMOR NOMOR BULAN
Januari
KABUPATEN : KUTAI KARTANEGARA TANGGAL TANGGAL TAHUN : 2024

STOK PENERI- PERSE- PEMA- SISA STOK PERMIN- PEMBERIAN

NO NAMA SEDIAAN OBAT/ BMHP MEDIS SATUAN KET
AWAL MAAN DIAAN KAIAN STOK OPT TAAN APBN APBD I APBD II PROG. LAIN2 JML
1 2 3 4 5 6 (4+5) 7 (6-8) 8 9 10 11 12 13 14 15 16 17
OBAT GENERIK BERLOGO
1 Albendazol tablet 400 mg Tablet 0 0 0
2 Alopurinol tablet 100 mg Tablet 0 100 100 30 70
3 Ambroxol sirup 15 mg/ml Botol 0 0 0
4 Ambroxol tablet 30 mg Tablet 0 100 100 30 70
5 Amlodipin tablet 5 mg Tablet 80 200 280 50 230
6 Amlodipin tablet 10 mg Tablet 0 0 0
7 Amoksisilin kaplet 500 mg Kaplet 0 0 0
8 Amoksisilin sirup kering 125 mg/5 ml Botol 0 0 0
9 Amoksisilin sirup kering 250 mg/5 ml Botol 0 0 0
10 Ambroxol sirup 30 mg/ml Botol 0 0 0
Antasida DOEN I tablet kunyah, kombinasi : Aluminium Hidroksida 200 mg dan Magnesium Hidroksida 200
11 Tablet 40 100 140 40 100
mg
Antasida DOEN II suspensi, kombinasi : Aluminium Hidroksida 200 mg/5 ml dan Magnesium Hidroksida 200
12 Botol 0 10 10 10
mg/5 ml
13 Anti bakteri DOEN salep kombinsai : Basitrasin 500 IU/gr + Polimiksin 10.000IU/g Tube 0 0 0
14 Antifungi DOEN kombinasi : Asam Benzoat 6 % + Asam Salisilat 3 % Pot 0 0 0
15 Antihemoroid DOEN kombinasi : Bismut Subgalat 150 mg + Heksaklorofen 2.5 mg Supp 0 10 10 10
16 Antiparkinson DOEN tablet kombinasi : Karbidopa 25 mg + Levodopa 250 mg Tablet 0 0 0
17 Asam Askorbat (Vitamin C ) tablet 50mg Tablet 80 100 180 20 160
18 Asam Asetilsalisilat 80 mg (MINIASPI'80) Tablet 0 0 0
Asam Mefenamat kaplet 500 mg
19 Tablet 20 200 220 0 220
20 Asiklovir krim 5% Tube 1 10 11 1 10
21 Asiklovir tablet 400 mg Tablet 10 100 110 10 100
22 Asiklovir tablet 200 mg Tablet 0 100 100 100
23 Betahistin Mesilat tablet 6 mg Tablet 0 100 100 40 60
24 Betametason krim 0.1% (sebagai valerat) Tube 3 3 1 2
25 Calsium Gluconas 100 mg/ml Injeksi Ampul 0 1 1 1
26 Cetirizine tablet 10 mg Tablet 0 200 200 30 170
27 Cetirizine syrup Botol 0 5 5 5
28 Deksametason injeksi i.v. 5 mg/ml Ampul 0 0 0
29 Deksametason tablet 0.5 mg Tablet 0 0 0
30 Desoximetasone 0,25 % Crem Tube 0 0 0
31 Digoksin tablet 0.25 mg Tablet 0 0 0
32 Dimenhidrinat tablet 50 mg Tablet 0 0 0
33 Domperidon tablet 10 mg Tablet 40 100 140 20 120
34 Eritromisin kapsul 500 mg Kapsul 0 0 0
35 Eritromisin sirup 200 mg/5 ml Botol 0 0 0
36 Etakridin larutan 0.1% Botol 0 0 0
37 Fenol Gliserol tetes telinga 10% Botol 3 3 3
38 Fitomenadion (Vit.K) injeksi 2 mg/1ml Ampul 0 0 0
39 Fitomenadion (Vitamin K) tablet salut gula 10 mg Tablet 0 0 0
40 Furosemid injeksi i.v./i.m. 10 mg/ml Ampul 0 0 0
41 Furosemid tablet 40 mg Tablet 0 0 0
Garam Oralit I serbuk, kombinasi : Natrium 0.70 gr, Kalium Klorida 0.30 gr, Trinatrium Sitrat Dihidrat 0.58
42 Sachet 2 100 102 102
gr, Glukosa Anhidrat 4 gr
43 Gentamycin Sulfat Injeksi Ampul 0 0 0
44 Gentamisin injeksi 40 mg/ml Ampul 0 0 0
45 Gentamisin salep kulit 0.1% Tube 1 5 6 6
46 Gentamisin salep Mata 0,3% Tube 0 0 0
47 Gentian Violet larutan 1 % Botol 0 0 0
48 Glibenklamida tablet 5 mg Tablet 0 0 0
49 Glimepiride tablet 1 mg Tablet 40 200 240 20 220
50 Glimepiride tablet 2 mg Tablet 50 100 150 20 130
51 Gliseril Gualakolat tablet 100 mg Tablet 20 100 120 0 120
52 Glukosa larutan infus 5 % steril D5 Botol 0 0 0
53 Griseofulvin Micronized tablet 125 mg Tablet 0 0 0
54 Hidroklorotiazida tablet 25 mg (HCT) Tablet 0 0 0
55 Hidrokortison krim 2.5% Tube 2 2 1 1
56 Ibuprofen suspensi 100 mg/5 ml Botol 0 5 5 5
57 Ibuprofen suspensi 200 mg/5 ml Botol 0 0 0
 58 Ibuprofen tablet 200 mg Tablet 0 100 100 100
59 Ibuprofen tablet 400 mg Tablet 0 0 0
60 Isosorbid Dinitrat tablet Sublingual 5 mg Tablet 0 0 0
61 Kalsium Laktat (Kalk) tablet 500 mg Tablet 40 200 240 90 150
62 Kaptopril tablet 12.5 mg Tablet 0 0 0
63 Kaptopril tablet 25 mg Tablet 0 0 0
64 Kaptopril tablet 50 mg Tablet 0 0 0
65 Kandesartan tablet 8 mg Tablet 0 0 0
66 Ketokonazol krim 2% Tube 2 2 2
67 Ketokonazol tablet 200 mg Tablet 0 0 0
68 Klindamisin kapsul 150 mg Kapsul 0 0 0
69 Kloramfenikol kapsul 250 mg Kapsul 0 0 0
70 Kloramfenikol salep mata 1% Tube 0 0 0
71 Kloramfenikol salep kulit 1% Tube 0 0 0
72 Kloramfenikol suspensi 125 mg/ 5ml Botol 0 0 0
73 Kloramfenikol tetes telinga 3% Botol 1 1 1
74 Klorfeniramina Maleat (CTM) tablet 4 mg Tablet 20 200 220 220
75 Kotrimoksazol DOEN I (dewasa) kombinasi : Sulfametoksazol 400 mg + Trimetoprin 80 mg Tablet 0 0 0
76 Kotrimoksazol suspensi kombinasi : Sulfametoksazol 200 mg + Trimetoprin 40 mg/5 ml Botol 0 0 0
77 Lanzoprazol kapsul 30 mg Kapsul 0 0 0
78 Loratadine 10 mg/tablet Tablet 0 0 0
79 Lidokain injeksi 2% Ampul 4 4 4
80 Magnesium Sulfat injeksi (IV) 20% - 25 ml Vial 0 0 0
81 Magnesium Sulfat injeksi (IV) 40% - 25 ml Vial 0 0 0
82 Meloksikam tablet 15 mg Tablet 0 100 100 100
83 Menadion Natrium Bisulfit (Vit.K3) injeksi 10 mg/ml Ampul 0 0 0
84 Metformin Hci tablet 500 mg Tablet 90 200 290 90 200
85 Metildopa tablet 250 mg Dopamet 250 mg Tablet 30 30 30
86 Metilprednisolon tablet 4 mg Tablet 80 100 180 180
87 Metoklopramide tablet 10 mg Tablet 0 0 0
88 Metronidazol tablet 250 mg Tablet 0 0 0
89 Metronidazol tablet 500 mg Tablet 50 50 50
90 Mikonazol krim/salep 2% (Nitrat) Tablet 5 5 5
91 Natrium Diklofenak tablet 50 mg Tablet 0 50 50 50
92 Natrium Klorida larutan infus 0.9 % Botol 0 0 0
93 Nifedipin tablet 10 mg Tablet 0 100 100 100
94 Nystatin Vaginal tab 100.000 IU/g Tablet 0 20 20 20
95 N- Acetylcysteine 200 mg Tablet 0 120 120 120
96 Obat Batuk Hitam (O.B.H) @ 100 ml Botol 0 0 0
97 Oksitetrasiklin salep kulit 3% Tube 0 0 0
98 Oksitetrasiklin HCl Salep Mata 1% Tube 0 0 0
99 Oksitosin injeksi 10 IU/ml - 1 ml ( Pitogin Inj) Ampul 0 0 0
100 Omeprazol kapsul 20 mg Kapsul 0 0 0
101 Ondansentron tablet 4 mg Tablet 0 0 0
102 Ondansentron Injeksi 4mg/2ml Ampul 0 0 0
103 Papaverin tablet 40 mg Tablet 0 0 0
104 Parasetamol sirup 120 mg/5 ml Botol 19 19 6 13
105 Parasetamol tablet 500 mg Tablet 170 300 470 80 390
106 Pirantel tablet score (Base) 125 mg Tablet 0 0 0
107 Piridoksin (Vitamin B6) tablet 10 mg (HCI) Tablet 60 60 40 20
108 Piroksikam tablet 20 mg Tablet 0 200 200 200
109 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0 0 0
110 Ranitidin injeksi 25 mg/2 ml Ampul 5 5 5
111 Ranitidin tablet 150 mg Tablet 0 0 0 0
112 Retinol (Vitamin A) 100.000 IU kapsul lunak Kapsul 0 0 0
113 Retinol (Vitamin A) 200.000 IU kapsul lunak Kapsul 0 0 0
114 Ringer Laktat larutan infus RL Botol 5 5 5
115 Salbutamol tablet 2 mg (sebagai Sulfat) Tablet 40 40 40
116 Salbutamol tablet 4 mg (sebagai Sulfat) Tablet 0 0 0
117 Salbutamol sirup 2 mg/5 ml Botol 0 0 0
118 SALEP WHITFIELD CREM Pot 0 0 0
119 Salep 2-4, kombinasi : Asam Salisilat 2% + Belerang Endap 4% Pot 0 0 0
120 Salisil Bedak 2% Kotak 4 4 4
121 Sefadroksil sirup kering 125 mg/5 ml Botol 0 0 0
122 Sefadroksil sirup kering 250 mg/5 ml Botol 0 0 0
123 Sefadroksil kapsul 500 mg Kapsul 0 0 0
124 Sianokobalamin (Vit. B12) tablet 50 mg Tablet 0 0 0
125 Simetidin tablet 200 mg Tablet 0 0 0
126 Simvastatin tablet 10 mg Tablet 0 0 0 0 0
127 Simvastatin tablet 20 mg Tablet 70 200 270 40 230
128 Siprofloksasin tablet 500 mg (sebagai HCI) Tablet 0 0 0
129 Tablet tambah darah kombinasi Tablet 380 200 580 140 440
130 Tiamin (Vitamin B1) tablet 50 mg (HCI/Nitrat) Tablet 0 200 200 200
131 Vitamin B Kompleks tablet Tablet 0 0 0
132 Sivit-Zinc Tablet 0 0 0 0
133 Stimuno Sachet 0 0 0
134 Zinc tablet 20 mg Tablet 50 50 50
OBAT GENERIK BERMEREK 0 0 0
135 Analgesik, Antipiretik ( Kand. Parasetamol 125 mg/supp rect) Supp 0 0 0
136 Anestetika lokal injeksi (Lidocain 20 mg, Adrenalin 0,0125 mg) LIDOCAIN COMPRESITUM Ampul 0 0 0
137 Anti platelet/trombus ( Kand.Asam Asetilsalisilat 80 mg) ASPIMEC Tablet 0 0 0
138 Anti Spasmodik injeksi (Kand. Hyoscine-N-Butilbromide 20 mg/ml) Ampul 0 0 0
139 Anti Spasmodik tab (Kand. Hyoscine-N-Butilbromide 10 mg) SCOPMA PLUS Tablet 0 0 0
140 Antihipermotilitas (Kand.LOPERAMID 2 mg) Tablet 40 40 40
141 Antiscabisit 5 % crem (Permethrin 5 %) SCABIMID CREM Tube 2 2 2
142 Antivomit injeksi ( Kand. Metoklopramide 5 mg/2 ml Inj ) Ampul 0 0 0
143 Antivomit sirup (Kand. Domperidon 5 mg/5 ml syr) Botol 0 3 3 3
144 Kombinasi : Attapulgite dan Pectin tablet/ Pularex (NEW ANTIDES) Tablet 20 20 20
145 Kombinasi : kaolin dan pectin (sirup antidiare untuk bayi dan anak) KAOTIN Syr Botol 5 5 5
146 Ipratropium bromide 0,5 mg, Salbutamol Sulphate 3,01 Unit Dose Vials (COMBIVENT) Blister 0 0 0
147 SULFADIAZINE SILVER 10 mg (Salep Luka Bakar) Tube 0 0 0
148 Syrup pelengkap untuk pengobatan diare pada anak-anak (kand. Zink)/ ZINK KID syr 20 mg/5ml Botol 2 2 2
149 Sucralfate Suspensi 500mg/5ml Syr Botol 0 10 10 10
150 Herbalkof syrup obat batuk herbal Botol 0 0 0
VAKSIN (BMHP Medis) 0 0 0
151 ADS 0,05 ML Piece 0 0 0
152 ADS 0,5 ML Piece 0 0 0
153 ADS 5 ML Piece 0 0 0
154 ADS 2 ML Piece 0 0 0
155 SAFETY BOX 5 ML Piece 0 1 1 1
156 SAFETY BOX 2,5 ML Piece 0 1 1 1
BAHAN HABIS PAKAI 0 0 0
158 Alat suntik sekali pakai 1 ml Piece 6 6 6 0
159 Alat suntik sekali pakai 2,5 ml Piece 0 0 0
160 Alat suntik sekali pakai 3 ml Piece 8 8 6 2
161 Alat suntik sekali pakai 5 ml Piece 8 8 8
162 Alat suntik sekali pakai 10 ml Piece 15 15 15
163 Alkohol Swab Piece 0 0 0
164 Aquadest steril (Aqua Pro Injection) Vial 2 2 2
165 Blood lancet Box 0 0 0
166 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (cromic) Piece 1 1 1
167 Catgut / Benang Bedah No. 2/0 dengan jarum bedah (Plain) Piece 1 1 1
168 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (cromic) Piece 0 0 0
169 Catgut / Benang Bedah No. 3/0 dengan jarum bedah (plain) Piece 0 0 0
170 Folley Catheter 16 G Piece 2 2 2
171 FRAMYCETIN SULFATE 10 cm-10 cm (DARRYANTUL) Piece 0 0 0
172 Handscoen Gynecology ( Powdered Letex Steril L) Pasang 0 0 0
173 Handscoon No. 6 S Pasang 55 55 10 45
174 Handscoon No. 7 M Pasang 40 40 10 30
175 Handscoon No. 7,5 L Pasang 0 0 0
176 Handscoon Steril 6 Pasang 0 0 0
177 Handscoon Steril 6,5 Pasang 0 0 0
178 Handscoon Steril 7 Pasang 0 0 0
179 Hidrogen Peroksida 3 / H2O2 Botol 0 0 0
180 Hypavix atau Polyvix 10 cm x 5 m Roll 0 0 0
181 Infusion Set Anak Piece 0 0 0
182 Infusion Set Dewasa Piece 0 0 0
183 IV Catheter No. 20 G Piece 3 3 3
184 IV Catheter No. 22 G Piece 5 5 5
185 IV Catheter No. 24 G Piece 0 0 0
186 IV Catheter No. 26 G Piece 0 0 0
187 Kaca Slide Kotak 0 0 0
188 Kapas 500 Bungkus 1 1 1
189 Kapas 250 gram Bungkus 0 0 0
190 Kasa Pembalut Hydrofil 4m x 15cm Roll 10 10 10
191 Kasa Steril 16 x 16 cm Kotak 10 10 10
192 Etanol 70 % 1 Liter Botol 0 0 0
193 Masker plus 2 Ply TALI (Biasa) Box 0 0 0
194 Masker plus 3 Ply (Hijab) Piece 36 36 20 16
195 Masker Sungkup Oksigen Anak Piece 0 0 0
196 Masker Sungkup Oksigen Dewasa Piece 0 0 0
197 Oxygen Nasal Cannula (Oxyflow Bayi) Piece 0 0 0
198 Oxygen Nasal Cannula (Oxyflow Anak) Piece 0 0 0
199 Oxygen Nasal Cannula (Oxyflow Dewasa) Piece 2 2 2
200 Perban Elastis Roll 0 0 0
201 Plesterin (Bulat Soft) Kotak 0 0 0
202 SOFTA-MAN @ B-BRAUN 500 ml Botol 0 0 0
203 Underped Piece 0 0 0
204 Urine bag Piece 1 1 1
205 Wing Needle 27 G x 3/4 Piece 0 0 0
206 Povidon Iodida larutan 10 % 300 ml BETADINE Botol 0 0 0
207 Aseptik Gel Botol 0 0 0

UMUM
ASKES JUMLAH
BAYAR TIDAK BAYAR
19 33 52

Mengetahui/ Menyetujui, Yang Menyerahkan, Yang Melaporkan, Yang Menerima,

Kepala UPT. Dinkes Puskesmas Kota Bangun Staf Gudang UPT. Puskesmas Kota Bangun Kepala Pusban / Polindes Petugas Pusban/polindes

RAJIANSYAH,A.Md.Kep DAYANTI MAULIDYA, A. Md., Farm EGIN ZURLAENI,A.Md.Keb EGIN ZURLAENI,A.Md.Keb

NIP. 197402205 200212 1 006 N199408242013012001 N198912032012012001 N198912032012012001

N ZURLAENI,A.Md.Keb

198912032012012001