LAMPIRAN I : KEPUTUSAN KEPALA PUSKESMAS PAKISAJI

KABUPATEN MALANG
NOMOR : 440/288/421.103.107/2015
TANGGAL : 31 OKTOBER 2015

DAFTAR OBAT DAN BAHAN MEDIS HABIS PAKAI (BMHP)

No. NAMA OBAT SATUAN JUMLAH KET.

1 2 3 4 5
1 Acarbose TABLET 100
7 Aminofilina 200 mg TABLET 100
9 Amoksilin 250 mg KAPSUL 100
10 Amoksilin 500 mg KAPLET 100
11 Antalgin 500 mg TABLET 100
12 Antasida (MgOH 200mg+AlOH 200mg) TABLET 100
15 Asam Askorbat ( Vit C ) 50 mg/ 250 mg TABLET 100
18 Asam mefenamat 500 mg TABLET 100
19 Asam Traneksamat 500 mg TABLET 100
20 Asetosal 100 mg TABLET 100
21 Asiklovir 400mg TABLET 100
24 Cetirizin 10mg TABLET 50
25 Deksametason 0,5 mg TABLET 100
26 Digoksin 0,25 mg TABLET 100
28 Dimenhidrinat tablet 50mg TABLET 100
29 Doksisiklin 100mg KAPSUL 100
30 Domperidon tablet 10 mg TABLET 100
31 Efedrin HCL 25 mg TABLET 1,000
32 Eritromisin 500mg KAPLET 100
33 Fitomenadion (Vit K1) 10mg TABLET 100
34 Furosemid 40 mg TABLET 100
35 Glibenklamid 5 mg TABLET 100
36 Glimepiride tablet 2 mg TABLET 50
37 Gliseril Guaiakolat 100 mg TABLET 1,000
41 Ibuprofen 200 mg TABLET 100
42 Ibuprofen 400 mg TABLET 100
43 Isosorbid Dinitrat sublingual 5 mg TABLET 100
45 Kalsium Laktat (Kalk) 500 mg TABLET 100
46 Kaptopril 12,5 mg TABLET 100
 47 Kaptopril 25 mg TABLET 100
48 Ketokonazol 200mg tablet TABLET 50
49 Klindamisin kapsul 150 mg KAPSUL 50
52 Klorfeniramin Maleat (CTM) 4 mg TABLET 100
56 Kotrimoksazol dewasa kombinasi : Sulfametoksazol400mg+Trimetoprim80mg TABLET 100
59 Loratadin tablet 10 mg TABLET 50
62 Metformin 500mg tablet TABLET 100
63 Metil Prednisolon 4 mg TABLET 100
65 Metoklopramid 5mg TABLET 100
67 Metronidazol 500mg TABLET 100
69 Natrium Diklofenac 50 mg TABLET 50
70 Nifedipin 10 mg tablet TABLET 100
72 Omeprazole 20mg TABLET 30
74 Parasetamol 500 mg TABLET 100
75 Parasetamol drop 100mg/ml btl @ 15ml BOTOL 10
77 Pirasetam 800 mg tablet TABLET 100
78 Piridoksin HCL (Vit B6) tablet 10 mg TABLET 1,000
79 Prednison tablet 5 mg TABLET 100
81 Propanolol HCL tablet 10 mg TABLET 100
83 Ranitidin tablet 150 mg TABLET 100
85 Salbutamol tablet 4 mg TABLET 100
86 Simvastatin 10 mg TABLET 100
87 Siprofloksazin tablet 500 mg TABLET 100
88 Tablet Tambah Darah Kombinasi : Besi sulfat 200mg+Asam folat 0,25mg TABLET 30
89 Tetrasiklin HCL kapsul 250 mg KAPSUL 100
90 Tetrasiklin HCL kapsul 500 mg KAPSUL 100
91 Thiamfenikol 500mg kapsul KAPSUL 100
92 Tiamin HCL (VitB1) 50 mg TABLET 1,000
93 Vitamin B Kompleks TABLET 100
94 Zinc 20 mg TABLET 100
b. Injeksi
1 Aminofilina 24 mg/ml - 10 ml AMPUL 30
4 Antalgin 250 mg/ml - 2 ml AMPUL 30
8 Deksametason injeksi 5 mg/ml-1ml AMPUL 100
9 Difenhidramin HCL Inj 10mg/ml-1 ml AMPUL 30
10 Epinefrin injeksi AMPUL 25
11 Fitomenadion (Vit K1)inj 10mg/ml-1ml AMPUL 30
12 Fitomenadion (Vit K1)inj infant AMPUL 10
13 Furosemid injeksi AMPUL 30
14 Gentamisin injeksi AMPUL 5
15 Hyosin n butilbromid inj 250mg/ml AMPUL 5
16 Kloramfenikol injeksi VIAL 5
17 Lidokain komp injeksi,Kombinasi:Lidokain HCl2%+Epinefrin1:80000-2ml AMPUL 100
 22 Omeprazole 40 mg inj. VIAL 5
23 Oksitetrasiklin HCL inj. i.m 50mg/ml-10ml AMPUL 5
24 Oksitosin injeksi 10 IU/ml - 1 ml AMPUL 100
25 Ondansetron injeksi AMPUL 5
26 Piracetam injeksi 1 gr / 5 ml BOTOL 5
27 Piracetam injeksi 3 gr / 5 ml BOTOL 5
28 Ranitidin injeksi 25mg/2ml AMPUL 10
29 Sefotaksim injeksi 1 gram VIAL 5
30 Sianokobalamin(VitB12)inj.500mcg/ml-1ml AMPUL 100
31 Streptomisin serbuk injeksi iv 1000mg/ml VIAL 5
32 Tiamin HCl (Vit.B1) injeksi 100 mg/ml-1 ml AMPUL 30
33 Tranexamat Acid Inj. 250 mg/5 ml AMPUL 5
c. Salep
1 Antifungi (As. Benzoat6%+As. salisilat 3%) POT 24
2 Asiklovir krim 5% TUBE 25
3 Betametason krim 0,1 % TUBE 24
4 Gameksan emulsi 1 % 30ml TUBE 5
5 Gentamisin salep kulit 0.1%-5gr TUBE 10
6 Gentamisin salep mata 0,3% TUBE 5
7 Hidrokortison krim 2,5 % TUBE 24
8 Kloramfenikol salep kulit 2 % TUBE 24
9 Kloramfenikol salep mata 1 % TUBE 24
10 Miconazol cream 2 % TUBE 24
d. Serbuk
1 Garam oralit untuk 200 ml air SACHET 100
2 Salisil Bedak 2 % POT 100
e. Sirup
1 Amoksilin 125mg/5ml VIAL 5
2 Antasida syr (MgOH 200mg/5ml+AlOH 200mg/5ml) BOTOL 5
3 Cetirizin syr BOTOL 5
4 Dekstrometorfan 10 mg / 5 ml BOTOL 5
5 Eritromisin sirup BOTOL 5
6 Ibuprofen suspensi 100mg/5ml BOTOL 5
7 Kloramfenikol suspensi 125mg/5ml BOTOL 5
Kotrimoksazol Suspensi komb: Sulfametoksazol
8 BOTOL
200mg+Trimetoprim40mg/5ml 5
d. Tetes
1 Fenol Gliserol tetes telinga 10 % BOTOL 24
2 Gentamisin tetes mata 0.3% BOTOL 10
3 Gentian violet larutan 1 % BOTOL 50
ALKES DAN CAIRAN LUAR
1 Alat suntik sekali pakai 1 ml SET 100
 2 Alat suntik sekali pakai 3 ml SET 100
3 Alat suntik sekali pakai 5 ml SET 100
4 Alat suntik sekali pakai 10 ml SET 100
5 Antiseptic Cairan/ Poli Clean BOTOL 5
6 Aqua pro injeksi, bebas pirogen BOTOL 5
7 Aquadest steril BOTOL 5
8 Blood Tranfusion set PCS 5
9 Catgut chromic/benang bedah No. 2/0-3/0 SACHET 24
13 Etanol 70 % 1000 ml BOTOL 5
14 Foley Catheter no.16 PCS 10
15 Foley Catheter no.18 PCS 10
16 Hanschoen "50 KOTAK 50
17 Hanschoen steril no 6.5 PCS 50
18 Hanschoen steril no 7 PCS 50
19 I.V. Catheter No 18 PCS 50
20 I.V. Catheter No 20 PCS 50
21 I.V. Catheter No 22 PCS 50
22 I.V. Catheter No 24 PCS 50
23 Infusion set anak PCS 50
24 Infusion set dewasa PCS 50
25 Kapas Pembalut / Absorben 250 gr ROL 5
26 Kasa Pembalut 2 m x 80 cm ROL 5
27 Kasa Pembalut elastic 3 inchi ROL 5
28 Kasa Pembalut Hidrofil 4 m x 15 cm ROL 5
29 Kasa Pembalut Hidrofil 4 m x 3 cm ROL 5
30 Kasa Steril PAK 5
31 Lisol, mengandung Kresol tersabun 50% BOTOL 5
32 Masker PCS 50
33 Masker breathing (+ selang) PCS 5
34 Masker non breathing PCS 5
35 Nasal kanul PCS 5
36 NGT 7 x 75/80 PCS 5
37 One Med H₂- O₂ 3 % BOTOL 5
38 One Med Surgical Blade/ Mess PCS 5
39 Plester 5 yards x 2 inch ROL 5
40 Plester infus PCS 5
41 Rivanol larutan 0,1 % 300ml BOTOL 5
42 Silk ( Benang Bedah Sutera ) No. 3/0 SACHET 36
43 Tensocrepe PAK 5
44 Urine Bag PCS 10
45 Underpad PCS 5
 46 Yodium Povidon larutan 10 % 30 ml BOTOL 10
INFUS
1 Asering Larutan infus BOTOL 20
4 Glukosa larutan infus 5 % steril BOTOL 20
5 KAEN 3B BOTOL 20
6 KAEN 4B BOTOL 20
7 Metronidazol infus BOTOL 5
8 Natrium Klorida larutan infus 0,9 % steril BOTOL 20
9 Ringer Lactate infus steril BOTOL 20
21 Pehacain injeksi AMPUL 20
22 Permetrin/Scabicid krim 5% TUBE 24
23 Puralex TABLET 50
27 Ventolin nebuliser BOTOL 20
b. Diare
1 Garam oralit untuk 200 ml air SACHET 100
2 Zinc 20mg TABLET 100
c. Filariasis
4 Klorfeniramin Maleat (CTM) 4 mg TABLET 100
5 Miconazol cream 2 % TUBE 24
6 Pirantel 125 mg TABLET 100
7 Vitamin B Kompleks TABLET 100
e. Gigi
2 Etil Klorida semprot BOTOL 1
g. Jiwa
5 Haldol decanoat 50mg/ml inj AMPUL 1
k. Psikotropik & Narkotik
2 Diazepam 2 mg TABLET 100
5 Fenobarbital 30 mg TABLET 1,000

MENGETAHUI
KEPALA UPTD PUSKESMAS

dr. BAMBANG BUDI PRASTYA