Lansia Alda 2019

Rekapitulasi Stok Obat, Reagen dan Perbekkes Instalasi Gudang Farmasi 29 Desember 2017
No Nama Satuan SD Sia Slg
1 Abochat 18 Pcs - 160 153

2 Abochat 20 Pcs - 153 345
3 Abochat 22 Pcs - 74 377
4 Abochat 24 Pcs - 87 139
5 Alat pemantau suhu pcs - 1 -
6 Alat perekam suhu pcs - - -
7 Alat suntik 10 ml pcs - - 100
8 Alat suntik 20 ml pcs - - -
9 Alat suntik sekali pakai 1 ml Pcs - 215 545
10 Alat suntik sekali pakai 2,5 ml / 3 ml Pcs - 233 1,804
11 Alat suntik sekali pakai 5 ml Pcs - 119 371
12 Albendazol syr 200mg/5 ml Botol - - -
13 Albendazol tablet 400 mg tablet 95 88 73
14 Alkohol Swab sachet - 200 -
15 Allopurinol 100 mg tablet 610 1,075 3,970
16 Alprazolam 1 mg tablet 725 - -
17 Ambroxol 30 mg tablet tablet - 340 989
18 Aminofilin inj 24mg/ml-10 ml ampul - 25 59
19 Aminofilin tablet 200 mg tablet 40 - -
20 Amitriptilin HCl tablet salut 25 mg tablet 533 - 490
21 Amlodipin 10 mg tablet 160 269 -
22 Amlodipin 5 mg tablet 755 155 565
23 Amoksisilin 250 mg tablet - 2,340 1,225
24 Amoksisilin 500 mg tablet 1,771 3,835 4,479
25 Amoksisilin sirup kering 125 mg/5 ml Botol 135 172 211
26 Amoniak btl/1000 ml - - -
27 Amoxicillin syr forte 250mg/ml botol 12 - -
28 Antalgin injeksi 250 mg/ml-2ml ampul - - 92
29 Antasida DOEN tablet tablet 850 1,216 3,665
30 Antasida sirup Botol 113 39 355
31 Anti Bakteri DOEN salep Kombinasi (bacitrasin) Tube 27 67 168
32 Anti Fungi DOEN Kombinasi Pot - - -
33 Anti Haemoroid DOEN kombinasi Suppos 30 70 55
34 Anti Migren (ergotamin caffein) tablet - - -
35 Anti Tuberkulosis Kategori I paket 1 - 2
36 Anti Tuberkulosis Kategori II paket - - 1
37 Aprazolam 0,5 mg tablet - 85 -
38 Aqua pro injeksi steril bebas pirogen vial - 26 23
39 Aquadest steril liter - - -
40 Ari Sound Timer pcs -
41 Asam askorbat (Vit C) tablet 50 mg tablet 1,587 2,758 5,732
42 Asam Folat 0,4 mg /profolat tablet 135 420
43 Asam folat 1 mg tablet 520 165
44 Asam mefenamat 500 mg tablet 1,578 1,909 3,605
45 Asam tranexamat inj 100 mg/ml ampul - - -
46 Asam tranexamat inj 50mg/ml ampul - - -
47 Asam Tranexamat tablet 500 mg tablet 300 - -
48 Asam Valproat 500mg / Depakote 500 mg tablet - - -
49 Asam Valproat tab SR 250 Mg / Depakote 250 mg tablet - - -
50 Asetosal 80 mg / Miniaspi tablet -
51 Asetosal tablet 100 mg tablet - - -
52 Asiklovir Krim 5 % 5 gr Tube - 66 92
53 Asiklovir tablet 200 mg tablet 456 - 1,563
54 Asiklovir tablet 400 mg tablet 240 520 1,694
55 Atropin sulfat injeksi 0,25 mg/ml - 1 ml ampul - 100 -
56 Attapulgit (Pularex) tablet 500 - -
57 Azitromisin tab 500 mg tablet 20 - -
58 Bahan tambalan gigi sementara (mix) Botol - - -
59 BCG Vial - 10 7
60 Benecheck Cholesterol strip Botol - 11 20
61 Benecheck Glucose strip Botol - 7 9
62 Benecheck uric strip Botol - 9 12
63 Berotec 0,1 mg(Fenoterol HBr aerosol 100mcg/dosis) Btl 11 5 13
64 Betahistin mesilat tablet 320 234 300
65 Betametason krim 0,1% Tube 40 84 249
66 Bioplacenton tube - 10 20
67 Bisacodil (dulcolax) supp suppos 45 - 35
68 Bisacodil (dulcolax) tab tablet 10 169 248
69 Bisacodil supp infant 5 mg /Dulcolax Suppos 18
70 Bisoprolol 5 mg tablet 450 - 500
71 Blood lancet pcs - - 1,000
72 Blue tip box
73 Box Slide bok - - -
74 Bubuk Abate bks - - -
75 Ca Glukonas ampul - - -
76 Calcidor / Kalsium hidroksida pasta kotak - - -
77 CAMPAK Vial - 9 9
78 Captopril 12,5mg tablet 531 1,488 3,157
79 Captopril 25 mg tablet 628 1,045 1,520
80 Cartridge Gen Expert Pcs
81 Catgut/benang bedah Chromic 2/0 set - 90 -
82 Catgut/benang bedah Chromic 3/0 set - - 110
83 Catgut/benang bedah Plain 2/0 set - - -
84 Catgut/benang bedah Plain 3/0 set - 67 -
85 Cefadroxil tablet 940 1 3,230
86 Cefadroxil syr forte 250mg/ml botol 2 - -
87 Cefadroxyl syr 125 mg/ml Botol 24 3 -
88 Cefiksim syr kering 100mg/5ml btl 30ml 47 10 47
89 Cefixime 100mg tablet 881 380 555
90 Cefotaxim 1,0 G inj Vial - - -
91 Cendo Lyteers Kombinasi tts mata 2,5 mg/ml; NaCl 8,664 botol - 9 -
92 Centrifuse Paket
93 Cetirizin 10 mg tablet 679 2,063 757
94 Cetirizin syr 5mg/5ml btl 60ml 38 10 34
95 Cimetidin tablet - - 188
96 Ciprofloxacin tablet 500 mg tablet 645 1,859 1,880
97 Clindamisin 300 mg tablet 505 - 250
98 Control CBC ST Plus-Normal-Diatron Vial/ 2,5 ml - - -
99 Cuticell Classic pcs -
100 Daryantulle sachet - - 9
101 Deksametason injeksi 5 mg/ml-1 ml ampul - 32 261
102 Deksametason tablet 0,5 mg tablet 1,356 2,435 4,994
103 DFI Cybow Box -
104 DHP-Frimal tablet - - -
105 Diazepam injeksi 5 mg/ml-2 ml ampul - 2 5
106 Diazepam rektal 10 mg Suppos 3 - 18
107 Diazepam rektal 5 mg Suppos 3 10 30
108 Diazepam tablet 2 mg tablet - 258 200
109 Diazepam tablet 5 mg tablet 147 - 742
110 Dietil karbamazin sitrat tablet 100 mg tablet - - -
111 Difenhidramin HCl inj 10 mg/ml-1 ml ampul - 30 -
112 Digoksin tablet 0,25 mg tablet - - -
113 Diltiazem tablet tablet - - -
114 Dimenhidrinat 50 mg tablet - - -
115 Dirui BF 6500 SLS Kit/500 ml
116 Dirui BF Deterjen Kit/10 ml
117 Dirui BF Diluent 20 liter
118 Dirui BF FDO LYSE Kit/5 L
119 Dirui BF FDT LYSE Kit/500 ml
120 Doksisilin kapsul tablet 245 - -
121 Domperidon 10 mg tablet 575 514 -
122 Domperidon syr Botol 64 39 136
123 D-Pieces smokerlyzer Box
124 DT Vial - 2 -
125 EDTA 10 % Botol - - -
126 Efedrin HCl tablet 25 mg tablet 89 100 313
127 Ekstrak Belladona tab 10 mg tablet - - -
128 Epinefrin HCl /adrenalin inj.0,1%-1ml ampul - 1 33
129 Eritromisin 250 mg tablet 542 100 -
130 Eritromisin 500 mg tablet - 100 -
131 Eritromisin sirup kering Botol 18 9 53
132 Etakridin (rivanol) larutan 0,1% Botol - 8 8
133 Etanol 70% Botol - 23 42
134 Etanol 96% botol - - -
135 Etil klorida spray Botol - - 1
136 Eugenol cairan Botol - - 1
137 Fe. Fumarat 300 mg Tablet - - 1,410
138 Fenitoin natrium kapsul 30 mg tablet - - -
139 Fenobarbital inj 50 mg/ml - 2 ml ampul - - -
140 Fenobarbital tablet 30 mg tablet 286 415 1,222
141 Fenolgliserol tetes telinga 10% Botol 45 55 84
142 Fitomenadion (Vit K1) inj 10 mg/ml-1 ml ampul - 18 30
143 Fitomenadion (Vit K1) tablet 10 mg tablet 161 374 969
144 Fitomenadion inj 2 mg/ml ampul - 55 -
145 Fluoksetin / Prestine tablet - - -
146 Food Test - Borak Test Paket - - -
147 Food Test - Formalin Test Paket - - -
148 Food Test - Rhodamin Test Paket - - -
149 Fouchet Botol - - -
150 Furosemid injeksi ampul - - 25
151 Furosemid tablet 40 mg tablet 330 447 490
152 Gabapentin/Alpentin 100 mg kapsul
153 Garam Oralit untuk 200 ml bungkus 72 550 1,441
154 Gentamicin Salp Kulit Tube - - -
155 Gentamisin inj ampul - - 55
156 Gentamisin tts mata botol - - 18
157 Gentian violet larutan 1% Botol - 22 -
158 Glassionomer Cement (GC IX) / GC. Fuji Botol - - -
159 Glibenklamid tablet 5 mg tablet 915 550 1,420
160 Glimepirid 1 mg tablet 915 - 950
161 Glimepirid 2 mg tablet 719 - -
162 Gliseril Guaiakolat tablet 100 mg tablet - - 573
163 Glukosa larutan Infus 10% steril fls - 38 26
164 Glukosa Larutan Infus 5% steril fls - 36 150
165 Griseofulvin tablet 125 mg tablet - - -
166 Griseofulvin tablet 500 mg tablet 200 505 2,658
167 Haloperidol 5 mg tablet - 740 -
168 Haloperidol inj 50mg/ml ampul 12 5 5
169 Haloperidol tablet 0,5 mg tablet 170 315 -
170 Haloperidol tablet 1,5 mg tablet 808 890 840
171 Handscoen Steril psg - 414 704
172 Handscoend Obgyn psg - - -
173 handscoon psg - 1,279 1,047
174 HBSAG Strip pcs - - -
175 HB-UNIJECT Vial - 20 15
176 HCG Strip Pcs - - 100
177 Hidrochlorotiazid (HCT) tablet 25 mg tablet - 876 -
178 Hidrogen Peroksida (H2O2) 3% Botol - - -
179 Hidrokortison krim 2,5% Tube 25 81 225
180 Hiosin HBr Inj (Buscopan) 20 mg ampul - - 51
181 Hiosin N Butil bromida tablet 1,391 - 1,190
182 HIV test (R1) SD Pcs
183 Ibuprofen suspensi 100 mg/5 ml botol 126 - 205
184 Ibuprofen tablet 200 mg tablet - - -
185 Ibuprofen tablet 400 mg tablet 1,282 1,210 4,344
186 ichtiol salep pot 6 21 13
187 Infusion set anak set - 38 79
188 Infusion set dewasa set - 103 298
189 Intec (One Step Anti-HIV 1&2) Box - - -
190 IPV Vial - 8 6
191 Isoniazid 100 mg/PPINH 100 mg tablet
192 Isoniazid tablet 300 mg tablet 50 - -
193 Isosorbid dinitrat tablet sublingual 5 mg tablet 110 - 490
194 Jarum jahit / bedah no. 9 s/d 14 Pcs - 12 84
195 Jelly Dopler btl - - -
196 Jelly USG btl - - -
197 Kaca Slide pcs - 348 144
198 Kaca Tutup pcs - - -
199 Kalsium laktat (Klak) tablet 500 mg tablet 920 2,155 4,070
200 Kapas pembalut / absorben 250 g roll - 9 10
201 Karbamazepin tablet 200 mg tablet 400 - -
202 Kasa kompres 40/40 steril lbr - 9 3
203 Kasa pembalut 2 m x 80 cm roll - 7 12
204 Kasa pembalut elastis 3 inchi roll - - -
205 Kasa pembalut elastis 4 inchi roll - - -
206 Kasa Pembalut hidrofil 4 m x 10 cm elastis roll - 14 -
207 Kasa Pembalut hidrofil 4 m x 5 cm elastis roll - 84 228
208 Kasa steril 16/16 kotak - 77 129
209 Kassa gulung Besar 80cm x 40 m roll - 3 19
210 Kertas lakmus biru pack - - -
211 Kertas Lakmus merah pack - - -
212 Kertas pH Universal Kotak - - -
213 Ketokonazol cream Tube 32 50 105
214 Ketokonazol tab tablet 515 535 1,890
215 Ketoprofen 100mg tablet - - -
216 Ketoprofen Supp suppos - - 47
217 kit gol. Darah A, B, AB set - - 1
218 Kit gol. Darah Anti-D Kit - - -
219 Klindamisin 150 mg tablet - - 140
220 Klopidogrel 75 mg Tablet
221 Kloramfenikol kapsul 250 mg tablet - - 730
222 Kloramfenikol salep Kulit Tube 29 14 35
223 Kloramfenikol salep mata 1 % Tube 43 46 48
224 Kloramfenikol suspensi 125 mg/5 ml Botol - 15 -
225 Kloramfenikol tetes telinga 3 % Botol - 3 54
226 Kloramphenicol tts mata Botol - - 4
227 Klorfeniramin maleat (CTM) tablet 4 mg tablet 1,854 2,110 7,982
228 Klorfenol kamfer menthol (CHKM) Botol - - -
229 Klorpromazin HCl inj 5 mg/ml - 1 ml ampul 14 7 -
230 Klorpromazin HCl tablet salut 100 mg tablet - - -
231 Kodein HCl tablet 10 mg tablet 220 - -
232 Kolkisin 500 mcg tablet - 600
233 Kotrimoksazol suspensi kombinasi Botol 28 104 168
234 Kotrimoksazol tablet dewasa kombinasi tablet 400 456 1,230
235 Labstrip (urinalis) tube
236 Lansoprazole tablet - - -
237 Lar. HCl 0,1 N Botol - - -
238 Lar. Natrium Hipoklorid Botol/ 500ml - - -
239 Lar. Ress Ecker Botol/ 100 ml - - -
240 Lar.Na citrat Botol - - -
241 Lar.Ph 7,2 Botol - - -
242 Larutan Asam Asetat 6 % Botol - - 1
243 Larutan barium klorida Botol - - -
244 Larutan benedict Botol - - -
245 Larutan buffer Ph 6,1 Botol - - -
246 Larutan eosin 2% Botol - - -
247 Larutan giemsa stain Botol - - -
248 Larutan H2O2 3% Botol 1 L
249 Larutan Hayem Botol - - -
250 Larutan karbolfuksin Botol - 1 -
251 Larutan metilen biru Botol - 1 -
252 Larutan turk Botol - - -
253 Larutan Wright Botol - - -
254 Levofloksasin tetes mata 0,5% botol 20 46
255 Lidocain komp.inj ampul - 158 192
256 Lidocain.inj ampul - - -
257 Lisol Botol - - 7
258 Loperamid Hcl tablet 298 288 1,488
259 Loratadin 10mg tablet 937 770 2,524
260 Magnesium sulfat inj (IV) 20%-25 ml vial - - 5
261 Magnesium sulfat inj (IV) 40%-25 ml vial - - 20
262 Malaria test ktk - - -
263 Masker pcs - 1,291 228
264 Masker 3M N95 medikal respirator pcs - - -
265 MDT MD Dewasa Paket
266 Meloksikam 15 mg tablet 1,035 1,010 2,000
267 Mess pcs - 219 191
268 Metanol 100 ml Botol - - -
269 Metanol 1000 ml botol - - -
270 Metformin tablet 1,235 630 3,430
271 Methyl Prednisolon 8mg tablet - - 3,427
272 Metil ergometrin maleat tablet salut 0,125 mg tablet 50 100 128
273 Metil ergometrin maleat inj 0,200mg-1ml ampul - 112 65
274 Metil prednisolon 4 mg tablet 800 - -
275 Metildopa 250mg tablet 55 - -
276 Metoclopramid 10 gr tablet - - 2,484
277 Metoclopramid injeksi ampul - 10 178
278 Metronidazol 500 mg tablet 1,345 315 3,868
279 Metronidazol supositoria 500 mg suppos - - -
280 Metronidazole ovula 500mg ovula - - -
281 Microlit tips for micropipettes MT-up to 1 ml pack - - -
282 Mikonazol krim Tube - 23 26
283 Mineral Mix sachet - - -
284 Minyak Imersi Botol - - -
285 Mouth Pieces smokerlyzer Box
286 Multivitamin syr Botol 117 137 100
287 Multivitamin tab tablet 960 - -
288 Napza Kit 5 Parameter ktk/10
289 N-asetil sistein tablet 2,330 1,125 5,053
290 Natrium bicarbonat tablet 500 mg tablet 925 300 2,522
291 natrium Diklofenak 50 mg tablet 1,155 1,534 3,470
292 Natrium klorida larutan infus 0,9% fls - 20 38
293 Nifedipin 10 mg tablet 302 100 1,879
294 Nistatin suspensi botol
295 Nistatin tablet salut 500.000 IU tablet 129 285 360
296 Nistatin tablet vaginal 100.000 IU/g tablet 28 350 -
297 OAT (Kombipak) anak paket 3 3 -
298 Obat anti malaria tablet - - -
299 Obat batuk hitam (OBH) cairan Botol - - -
300 Oksitetrasiklin HCl salep kulit 3% Tube - - 6
301 Oksitetrasiklin HCl salep mata 1% Tube - - 2
302 Oksitosin inj 10 IU / ml - 1 ml ampul - 128 152
303 Omeprazole 20mg tablet 770 3,205 3,840
304 One ject 0,05 ml pcs - 171 345
305 One ject 0,5 ml pcs - 1,562 729
306 One ject 5 ml pcs - - 100
307 Pantocain tts mata btl - - -
308 Papaverin tablet 40 mg tablet 818 129 2,310
309 Parasetamol Drop Botol 70 240 565
310 Parasetamol rektal 125 mg (dumin) suppos 4 - 1
311 Parasetamol rektal 250 mg (dumin) suppos 3 - 6
312 Parasetamol sirup 120mg/ml Botol 117 351 278
313 Parasetamol tablet 100 mg tablet - - 45
314 Parasetamol tablet 500 mg tablet 2,650 3,548 11,252
315 Pembalut gips 3 inch Roll - - -
318 PENTABIO Vial - 6 5
319 Permetrin krim 5% (Scabimite) tube 2 29 41
320 Petidin inj 50mg/ml ampul - - -
321 Piracetam inj 3g/15ml ampul - - -
322 Pirantel tablet 125 mg tablet - 177 606
323 Pirasetam 800mg tablet - - -
324 Piroxicam 10 mg tablet - - 770
325 Piroxicam 20 mg tablet - - -
326 planotest pcs - 178 86
327 Plester 5 yard x 2 inch roll - 10 22
328 Plester bulat non woven box - 50 100
329 Poli Kateter pcs - - 10
330 POLIO Vial - 11 9
331 Pot Sputum Pcs - 87 200
332 Povidon iodida 10% 30 ml Botol - - -
333 Povidon iodida 10% 300 ml Botol - 28 -
334 Povidon iodida 10% 60 ml Botol - 10 41
335 Povidon Iodine 1 L Botol - - 16
336 Prednison tablet 5 mg tablet - 430 3,598
337 Primakuin tablet 15 mg tablet - - -
338 Prokain benzil penisilin vial - - -
339 Propanolol HCl tablet 10 mg tablet - - -
340 Propanolol HCl tablet 40 mg tablet - - -
341 Propiltiourasil tablet 100 mg tablet - 466 -
342 Pyridoksin HCL ( Vit B6 ) tab 10 mg tablet 2,943 2,048 4,727
343 Ramipril tablet 500
344 Ranitidin inj. 25mg/ml ampul - 14 400
345 Ranitidin tablet 150 mg tablet 1,030 1,664 6,590
346 Rapid Test (HIV 1 & 2 Anti Body) Box - 1 -
347 Rapid Test (HIV 1 & 2 Anti Body) oncoprobe test - -
348 Reagen (Bio-rad) Level 2 (Urine Kontrol) kit/ 12x12 ml - - -
349 Reagen dan Bahan alat lab.Malaria paket - - -
350 Reagen Fotometer Kimia Klinik Randox Albumin kit 1
351 Reagen Fotometer Kimia Klinik Randox Glukosa kit 1
352 Reagen Fotometer Kimia Klinik Randox HDL kit 1
353 Reagen Fotometer Kimia Klinik Randox Kolesterol darah kit 1
354 Reagen Fotometer Kimia Klinik Randox Kreatinin kit 1
355 Reagen Fotometer Kimia Klinik Randox LDL kit 1
356 Reagen Fotometer Kimia Klinik Randox Protein total kit 1
357 Reagen Fotometer Kimia Klinik Randox SGOT kit 1
358 Reagen Fotometer Kimia Klinik Randox SGPT kit 1
359 Reagen Fotometer Kimia Klinik Randox total bilirubin kit 1
360 Reagen Fotometer Kimia Klinik Randox triglyserida kit 1
361 Reagen Fotometer Kimia Klinik Randox ureum kit 1
362 Reagen Fotometer Kimia Klinik Randox Uric asid kit 1
363 Reagen hematology analyzer Cointender 20 SFRI Clair 31 btl 60ml
364 Reagen hematology analyzer Cointender 20 SFRI clean EZbtl 60ml
365 Reagen hematology analyzer Cointender 20 SFRI cliner 31btl 5 L
366 Reagen hematology analyzer Cointender 20 SFRI diluent btl 20 L
367 Reagen hematology analyzer Cointender 20 SFRI Lyse 31 botol 500ml
368 Reagen Human Bilirubin Total Direct kit/ 12x12 ml - - -
369 Reagen Human Cholesterol Kit/ 4x30 ml - - -
370 Reagen Human Combina 11,S Kit/150 s - - -
371 Reagen Human Creatinin Kit/ 200 ml - - -
372 Reagen Human GOT kit/ 10x10 ml - - -
373 Reagen Human GPT kit/ 10x10 ml - - -
374 Reagen Human HDL Cholesterol kit/ 4 x 80 ml - - -
375 Reagen Human Humatrol N (Serum kontrol) Kit/ 6x5 ml - - -
376 Reagen Human Test Ca/ Kalsium kit/ 200 ml - - -
377 Reagen Human Test Glukosa darah kit/ 4x100 ml - - -
378 Reagen Human Total Protein kit/ 4 x 100 m - - -
379 Reagen Human Triglycerides kit/ 9x15 ml - - -
380 Reagen Human Urea Liquicolor kit/ 2x100 ml - - -
381 Reagen Human Uric Acid Kit - - -
382 Reagen kimia klinik potometer 5010 albumin - Rajawali 1000ml
383 Reagen kimia klinik potometer 5010 alkali phospatase - Rkit 10x10ml
384 Reagen kimia klinik potometer 5010 asam urat - Rajawali kit 4x30ml
385 Reagen kimia klinik potometer 5010 bilirubin T/D - Rajawakit 2x100ml
386 Reagen kimia klinik potometer 5010 CK NAC Activated - Rkit 20x3ml
387 Reagen kimia klinik potometer 5010 CK-MB - Rajawali kit 20x3ml
388 Reagen kimia klinik potometer 5010 gamma GT - Rajawalikit 10x10ml
389 Reagen kimia klinik potometer 5010 glukosa - Rajawali kit 4x100ml
390 Reagen kimia klinik potometer 5010 haemoglobin - Rajawkit 10x500ml
391 Reagen kimia klinik potometer 5010 kalsium - Rajawali kit 2x100ml
392 Reagen kimia klinik potometer 5010 kolesterol HDL - Rajakit
393 Reagen kimia klinik potometer 5010 kolesterol LDL - Raja kit 80ml
394 Reagen kimia klinik potometer 5010 kolesterol total - Raj kit 4x100ml
395 Reagen kimia klinik potometer 5010 kreatinin - Rajawali btl 200ml
396 Reagen kimia klinik potometer 5010 LDH - Rajawali kit 20X5ml
397 Reagen kimia klinik potometer 5010 SGOT - Rajawali kit 20X5ml
398 Reagen kimia klinik potometer 5010 SGPT - Rajawali kit 20X5ml
399 Reagen kimia klinik potometer 5010 total protein - Rajawabtl 1000ml
400 Reagen kimia klinik potometer 5010 trigliserida - Rajawalikit 4x100ml
401 Reagen kimia klinik potometer 5010 UREUM - Rajawali kit 2x100ml
402 Reagen TB kit - 1 -
403 Reagen widal H Vial - - -
404 Reagen widal O Vial - - -
405 Risperidon 1 mg tablet - - -
406 Risperidon 2 mg tablet 225 760 260
407 RL larutan infus fls - 26 279
408 Safety box pcs - - 14
409 Salbutamol inhalasi 100 mcq/dosis botol 4 7 11
410 Salbutamol nebulizer Kotak - - 1
411 Salbutamol tablet 2 mg tablet 587 296 605
412 Salbutamol tablet 4 mg tablet 7 106 994
413 Salep 2-4 kombinasi pot 1 38 -
414 Salep luka bakar (Levertran) Tube 3 7 27
415 Salisil bedak 2% bungkus 21 7 10
416 Seftriakson Injeksi vial - - -
417 Seretide Diskus ih 100 mcg/puff botol 2
418 Seretide Diskus ih 250 mcg/puff botol 2
419 Seretide inhaler Kombinasi: salmeterol 25 mcg;flutikason botol 8 7 20
420 Serum Anti Bisa Ular polivalen inj 5 ml vial - 2 11
421 Serum Anti Tetanus inj 1500 IU/ampul ampul - 6 13
422 Sianokobalamin (Vit B12) inj 500mcg-ml ampul - 3 -
423 Sianokobalamin tab 50 mcg tablet - 33 5,305
424 Silk no.3/0 dengan jarum bedah set - 59 228
425 Simvastatin 10 mg tablet 265 200 290
426 spironolacton 25 mg tablet 170 300 -
427 Spongestan Hemospon ktk
428 Spritus Botol - - 2
429 Stomach tube FR 12 pcs - - -
432 Strip asam urat (UA SURE) Botol - - -
433 Sukralfat / Ulsidex tablet 165
434 Tablet Tambah darah tablet 1,885 13,860 20,320
435 Td Vial - 10 17
436 Temporary stopping fletcher Set - - -
437 Tetagam ampul - - 4
438 Tetrasiklin HCL kapsul 500 mg tablet 95 - -
439 Thiamfenikol 500 mg tab tablet 20 - -
440 Thiamin HCl (Vit B1) tablet 50 mg tablet 2,023 2,177 4,140
441 TKF botol - - -
442 Tramadol inj ampul 10 - 83
443 Trifluoperazin 5mg tablet - - -
444 Triheksiphenidil HCl tablet 2 mg tablet 1,042 430 618
445 Trombophop gel tube - - 1
446 TT Vial - - -
447 Tube EDTA Box - - -
448 Urin Bag pcs - - 50
449 Vacum cup gel lot activator Bok
450 Vacum Tube EDTA 0,5 ml Bok
451 Vaksin carrier pcs - 1 -
452 Vaksin Rabies Vero kuur - - -
453 Valsartan 160mg tablet - - -
454 Vitamin A 100.000 IU tablet - - -
455 Vitamin A 200.000 IU tablet - - 50
456 Vitamin B komplek tablet tablet 2,291 2,533 4,587
457 White Tip Bks
458 wing needle 21 G pcs - - -
462 Xylol Botol - - -
463 Yellow Tip bks - - -
464 Yodiol Test Botol - - -
465 Zinc syr botol 61 63 119
466 Zinc tab 20 mg tablet 277 1,585 2,888
467 Sukralfat / Ulsidex Sirup botol
468
TOTAL
Sit I GM Tmp BS PLW Tiu Sit II KB Kobes SR
127 - 187 45 91 65 105 260 141 470

227 83 238 49 36 82 117 405 176 281
269 110 295 43 49 72 148 505 128 316
460 105 61 50 47 - 138 289 140 158
1 - - - - - - - - -
- - - - - - - - - -
310 - - - 3 200 - - - -
100 - - - - - - 79 - -
1,109 571 971 177 68 508 213 1,098 243 1,429
1,586 328 1,100 451 419 898 272 2,684 45 781
682 474 637 136 411 502 320 1,427 538 450
10 - - - - - - 55 5 28
100 315 200 604 73 515 90 75 76 50
100 - 100 - 328 - - 400 - 422
1,820 3,340 980 1,490 2,310 5,810 3,521 2,060 1,259 3,440
1,549 - 585 200 - - - 400 100 100
559 1,938 510 - 1,583 2,480 210 305 673 230
77 30 4 - 21 27 28 33 25 19
275 - 430 400 400 210 50 866 175 -
315 100 - - 200 140 290 990 256 -
2,241 2,322 3,030 550 2,490 390 3,165 860 3,635 190
277 - 1,495 1,110 1,160 1,265 117 3,465 2,820 3,090
3,534 2,846 1,050 290 1,355 3,755 46 1,209 1,766 964
2,595 13,477 8,483 2,660 3,140 6,700 5,277 5,514 5,765 5,050
314 233 158 240 100 272 273 212 322 28
- 1 - - - - - - - -
6 - 29 9 6 9 - 17 - 17
- - 30 - 51 21 - - - -
8,905 9,101 2,610 2,700 2,470 6,660 8,465 9,595 4,283 4,990
272 215 257 180 167 293 246 369 211 377
88 219 - 50 34 89 89 134 199 -
24 - - 48 19 21 - 24 23 -
57 12 - 28 - 18 - 48 47 14
- - - - - - - - - -
8 5 3 1 7 3 2 7 3 14
1 2 - - - - - - 1 -
207 285 - - - 30 - 290 600 100
53 44 38 11 - 9 - 121 24 32
20 - - - 68 - - 24 - -
6,064 7,915 3,967 3,076 540 6,950 4,198 11,197 5,517 4,900
2,770 1,990 900 500 770
410 360 250 - 110 - 313 510 -
2,230 3,900 2,670 1,760 1,830 3,440 4,030 7,110 3,288 3,665
20 - 10 - - 5 - 5 10 -
- 10 20 - 19 10 5 - 10 -
490 - 470 - - 100 - 500 500 -
- - - - 100 100 - 200 - -
305 270 200 - - - - - - -
- - - - 90 - - - - -
76 22 105 68 40 36 47 105 87 -
310 - 510 960 264 - 1,234 820 2,977 -
391 1,911 420 1,170 1,935 345 1,463 912 1,618 1,930
- - 12 - - 5 20 37 27 130
20 550 560 - - 670 974 1,000 1,000 -
130 - - - 30 - - 60 40 140
- - - 1 - - - - - -
10 - - 13 20 - 13 27 2 13
10 2 20 2 7 4 - 12 10 29
14 5 5 4 - 6 - 14 9 18
11 5 20 2 - - - 14 4 29
- - 16 4 9 - 5 4 10 -
380 730 275 570 70 170 690 320 640 210
137 276 307 126 59 118 118 115 183 23
25 8 - 24 7 17 - 15 8 -
49 - - 10 25 47 - 100 - -
50 70 - 30 18 117 148 60 237 -
18 6
565 - 60 - - 300 - - - -
800 500 400 500 400 400 - 1,700 1,500 600
- - - - - - - - - -
34 - - - - - - - - -
22 22 66 24 48 24 - 77 24 -
- - - - - - - - - -
4 - - 12 28 - 13 23 12 13
3,050 4,099 2,310 3,030 2,735 2,910 7,359 6,610 4,215 4,980
1,473 3,638 2,205 1,970 2,010 3,140 6,247 3,710 4,256 4,937
- - 48 60 27 24 3 75 - -
175 122 59 15 27 99 85 209 156 60
- - - - - - 5 36 - -
- - - - 66 89 71 - 47 36
1,364 1,044 1,640 1,440 1,180 536 1,811 2,898 634 -
35 - 29 - - - - - - 6
88 146 71 - 38 83 67 107 84 74
71 29 - 16 29 9 23 24 29 47
1,790 544 500 230 1,070 725 516 768 70 1,550
44 - 28 - 20 - 2 19 - -
34 - 12 - - - - - - -
2,840 4,573 522 1,890 2,160 4,550 4,444 4,582 2,910 3,957
120 10 - 21 - - 29 64 29 -
70 263 - - 190 - 670 - - -
3,477 2,761 1,590 1,500 2,945 2,710 2,340 6,044 1,668 2,310
430 100 400 440 240 350 125 320 350 450
- - - - - - - - - -
19 15 5 13 5
- - - - 14 - - - - -
154 - 54 150 86 65 118 143 54 198
1,871 4,800 7,565 2,613 1,890 5,730 4,096 5,824 6,532 5,500
4 3 3
- - - - - - - - - -
3 4 6 - 10 1 2 6 - -
12 - - 5 12 - 7 48 10 1
32 24 20 4 14 2 3 41 9 1
1,145 170 254 100 110 100 114 934 1,540 584
240 250 296 100 130 200 - - - -
- - - - - - - 5 - -
30 30 30 30 41 36 24 66 23 60
- - 210 200 13 125 200 200 230 800
500 490 170 100 - 100 200 - - -
530 - - - - - - - 650 -
- 200 100 - 230 100 - - - -

4,399 620 1,010 1,000 1,120 1,830 1,200 1,000 1,504 3,870
57 150 73 95 74 194 118 80 160 55
12 - - 5 6 - 1 3 28 6
1 - - - - - - - - -
70 566 - - - - 100 - 88 990
- - 685 - - - - - - -
16 - - 19 29 69 20 184 4 28
976 380 270 - 770 115 330 220 - -
46 2,096 300 700 - 360 - - 1,000 860
6 91 - 50 50 17 2 90 - 32
62 21 26 7 8 31 20 13 10 -
34 11 10 24 8 16 7 51 32 40
3 - 1 - - - - - - -
- - - - 3 - - - 1 -
3 2 - 1 - 1 - - - -
85 - - - - - - 300 -
- - - - - - - - - -
17 - 30 - - 3 5 - - 2
1,260 100 265 - 120 100 200 700 610 200
91 91 24 - 92 81 2 101 64 69
10 14 24 26 6 39 25 - - -
455 641 850 750 - 1,590 210 2,523 647 900
30 45 29 30 60 86 28 46 35 49
100 - - - 130 - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
3 - - 2 - 2 - 4 - -
35 - 3 - 16 - - - - -
565 1,038 765 480 520 323 465 615 462 530
1,755 1,628 807 354 324 625 236 1,488 1,602 600
10 7 10 - 10 8 3 - 3 7
5 - 90 - - - - 95 - 105
- - - - 7 21 - - - -
35 83 - 8 14 27 3 28 - 31
- - - 1 - - - 1 - -
1,158 1,742 60 700 260 900 2,335 3,550 1,925 1,845
410 - 400 390 600 450 - 2,280 - -
2,624 575 - 610 1,130 350 1,268 570 710 690
- 30 10 - 510 - - 150 - -
40 - - - 44 56 30 44 17 45
98 49 84 19 75 62 42 31 25 60
- 27 - - 100 - 40 - - -
350 942 260 - 370 260 470 2,020 330 900
1,775 1,940 15 - 620 400 426 1,000 2,015 770
- - - - 10 - - 5 - -
640 1,340 - - 215 - 216 480 500 -
1,085 840 1,060 700 10 - 659 2,700 560 -
1,617 415 50 67 196 287 172 595 616 439
70 10 30 - 23 - - 50 - -
3,429 714 - 475 110 986 90 1,350 200 1,800
- - - - - - - - - 19
22 - 19 35 22 - 15 73 22 48
95 - 100 - 25 - - 150 200 -
1,000 362 - - 90 - - - 510 -
- - - - - 2 - 5 6 -
129 197 253 95 43 82 76 143 136 55
10 - 8 - 15 5 - 100 - -
690 230 - - 590 200 - 1,190 797 380
123 151 201 - 189 93 77 64 223 -

- - - 774 - - - - 480 -
3,684 8,625 2,570 770 1,760 5,890 5,950 5,120 1,715 4,300
7 13 15 14 24 21 16 15 28 -
74 77 145 45 50 45 14 38 108 62
418 115 137 33 135 63 90 472 127 163
- - - - - - - - -
11 - 5 10 27 4 17 12 12
80 596 - - - 100 - 200 500 -

445 - 75 - - 270 809 438 680 200
17 - - - 432 24 - 122 - -
- - 2 - - - - - - -
10 - 3 2 1 - - 4 - 5
1,972 288 360 - 360 266 - 54 120 144
250 - - - - - - - - -
4,185 6,072 1,840 2,060 780 5,740 4,884 5,531 3,317 4,810
35 12 6 - 10 22 11 36 10 32
1,030 300 - - - - - 580 - 100
236 - 100 20 120 - 9 216 - -
70 3 - 5 2 39 11 37 - -
3 - - - - - - - - -
2 - - - - - - - - -
107 - - 15 25 86 56 155 - -
144 - - 50 305 - 130 194 - -
184 67 89 20 91 76 60 100 101 75
8 8 7 2 2 1 10 27 4 12
- - - - - - - - - 1
- - - - 3 2 - 1 - -
- - - - - - - - - -
77 148 239 41 68 81 67 59 126 95
340 1,150 1,290 2,900 1,020 220 - 1,210 1,365 2,069
- - - - 9 100 - 180 - 100
42 - 38 - 36 - 8 - 20 20
2 - - - - - - 3 1 -
- - - - - - - - - -
- - - - - - - - - -
300
- - - - - - 145 210 - -
47 31 12 - 86 81 22 49 55 -
60 - 141 74 45 40 7 64 69 48
- - - - 15 20 19 8 64 -
69 29 80 45 29 45 32 67 71 5
- - - - - - - 5 4 33
3,222 3,969 1,600 1,680 1,475 2,320 770 2,610 1,985 1,900
2 - - - - - - - - -
3 - - - - - - 2 - 5
- 140 - 410 - - - - - -
410 - - 100 70 - - - - -
900 150
63 205 2 139 26 174 171 189 156 149
1,725 4,002 930 540 1,710 1,680 4,839 1,413 6,158 2,300
205 - 150 - - 190 - - - 160

1 - 1 5 10 5 - 3 1 5
6 - - - - - - - - -
- - - - - - - - - -
- - - - - 2 - - - 2
- - - - - - - 4 - -
3 - 1 - 9 2 - 3 5 9
1 - - - - 5 - - - -
- - - - - 1 - - 1 2
- - - - - 4 - 1 1 -
2 - - - - 2 - - - -
1 - - - - 1 - 2 1 2
4 1
- - - - - 2 - - - 2
- - - - - - - - - -
- - - - - - - - - -
1 - - - - - - - - 2
- - - - - - - - - -
40 12 24 10 48 19
460 144 123 41 3 137 155 546 164 214
- - 3 38 40 - - - - -
25 12 9 9 - 5 - 25 - 1
209 710 80 1,180 1,920 1,520 1,034 610 841 350
995 1,942 3,030 1,990 910 2,300 1,796 1,525 1,301 2,588
5 - - - 4 1 9 61 11 18
30 29 10 - 11 21 12 18 13 36
1 - 5 - - - - 9 - -
3,196 300 500 25 277 422 - 1,450 410 350
- - - - - - - - - -
- 273 - 310 1,010 330 165 - 1,320 50

285 50 300 9 60 100 98 643 155 -
1 - - - - - - - - 2
- - - - - - - - - 1
1,200 4,216 960 370 585 946 2,893 7,870 3,862 5,300
1,957 2,125 - 100 2,600 330 3,466 1,476 880 2,300
585 190 80 - 278 1,080 - 320 580 170
117 53 22 27 12 124 78 98 75 157
2,280 - 550 - - 405 - - 1,814 -
- - - - 100 - - - - -
1,008 670 1,150 1,190 2,260 2,830 3,195 1,970 1,367 310
114 - 28 - 59 10 - 372 10 120
1,179 500 1,035 530 1,605 1,389 888 2,710 1,692 1,350
55 - - 9 - 10 - - 10 18
30 - 40 5 18 - 5 - - -
- - - - - - - - - -
27 132 31 75 1 83 - 127 62 32
- - - - - - - - - -
1 - 2 1 - 1 - - - -
284 100 200 183 63 195 86 377 79 65

1,865 980 1,000 1,200 500 1,850 956 1,900 2,000 1,900
2,070 610 2,630 4,061 635 1,300 3,345 3,744 1,660 1,671
4,005 2,345 875 - 400 1,260 1,862 538 865 1,480
1,820 5,459 2,850 2,420 1,090 1,680 3,150 4,900 2,105 2,170
137 14 59 1 35 36 12 49 28 -
240 634 775 100 495 1,100 674 1,229 1,386 1,130
200 374 30 245 397 90 480 435 - 400

96 327 145 136 25 170 59 200 - 275
4 2 1 - - - 2 7 1 -
- - - - 9 - - 2 - -
- - - - - - - - - 2
- - - 2 2 - - 9 - -
- - - - - - - 11 - 5
66 110 68 97 83 88 70 107 82 21
610 3,868 4,835 2,630 4,990 340 2,975 1,427 3,349 3,278
961 - 900 101 96 175 - 900 - -
953 700 1,200 808 592 636 - 1,100 - -
557 - - - 100 280 - 1,082 - -
- - - - 2 - - - - -
43 664 1,320 263 - 124 1,015 827 720 700
9 8 - 124 7 94 - 9 113 2
- 5 11 4 3 5 4 29 6 3
1 2 9 5 11 5 6 29 - 2
493 276 406 297 239 348 - 490 193 118
860 - 1,600 - 510 - - - - 290
17,862 5,952 8,310 2,435 10,936 6,215 5,834 8,428 6,433 2,900
- - - - 1 - - 5 - -
3 - - - - - - 5 - -
- - - - - - - - - -
10 - - 24 28 - - 11 15 19
36 2 20 3 15 15 25 21 120 22
- - - - - - - - - -
3 - - - - - - - - -
26 726 - - 380 1,072 - 348 - -
- - 130 - - - 60 50 - 30
2,685 350 - 50 100 - - 80 - -
- 53 - - - 110 - - - -
- - - - 75 39 - - - -
68 17 27 - 6 16 19 75 53 22
149 50 100 50 100 50 50 197
38 - 4 - - 2 9 17 - 18
15 - - 17 18 - - 18 17 28
195 - 90 - - 106 - - 100 200
95 - 5 - 5 30 10 7 40 -
10 18 4 4 - 28 15 36 - 13
23 8 1 9 56 44 6 58 2 -
- - - 8 10 1 12 - 9 1
159 3,325 970 - 2,050 2,450 1,016 1,390 1,666 2,430
- - - - 280 - - 374 - 200
- - - - - - - - - -
160 - - - - - - - - 100
- - 440 200 90 300 - - - 800
160 - 170 - 300 500 - - 700 1,100
3,173 4,557 650 600 1,720 5,585 864 1,910 1,001 2,250
500
167 9 144 30 50 6 35 138 183 272
4,639 4,576 5,602 280 1,410 2,790 3,390 7,799 3,313 2,100
- - - - - - - - -
- - - - - 200 - -
- - - - - - - - - -
- - 1 - - - - - - -
3
10
1
4
4
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
1 1
1 1
2 4
1 3
1 1
1 1
1 1
2 4
2 4
1 3
2 3
2 4
2 6
1 4
1 3
1 4
1 4
1 1
1 1
1 4
- - 16 - - 3 - 10 - -
- - - - - - - 2 - -
- - - - - - - 2 - -
- - - - - - - 300 - -
1,079 520 720 - 200 150 549 900 395 -
423 74 472 21 102 74 44 526 15 95
43 157 75 - 2 50 50 110 - -
5 - - 5 13 4 3 10 23 -
9 - 7 - 16 1 2 6 - 4
2,160 1,234 956 500 940 90 753 1,060 690 530
1,738 2,176 590 516 608 270 556 1,550 650 950
33 44 25 34 2 59 14 60 - -
11 24 31 - 5 3 - 4 - -
57 46 - - 4 19 13 48 28 -
- - - - - - - - - -
8
10
- 3 10 - - - 5 - - -
6 1 - - 5 2 2 4 3 5
70 11 53 - 15 6 14 62 33 -
- 10 100 - 200 56 56 162 - 59
- - - - 1,000 140 2,665 - 500 1,620
122 109 23 3 20 105 47 81 136 84
247 240 640 280 1,050 290 300 1,760 225 250
845 457 - - 110 290 - 400 480 400
1 - - - - 1 4 - 3 -
- - 10 - - - - 3 - -
- - - - - - - - - -
- - 10 - - - - 3 - -
- - - - 1 - - - - -
500
90,835 21,725 - 18,285 19,490 14,200 11,085 1,170 8,500 3,690
20 - - 2 38 - 6 64 34 44
- - - - - - - - - -
- - 3 - - - - - - -
100 - - - - 150 - - - -
249 - - - - - - - - -
3,293 6,538 800 700 1,020 2,040 2,499 1,040 5,760 1,500
- - - - 1 1 - - - -
50 6 - - 29 2 15 72 4 -
290 - - - - - - 300 80 -
1,624 1,510 890 920 560 500 468 3,530 1,706 406
- - - - - - - - - -
- - - - - - - - - -
- - - - 1 - - 3 - 1
12 - - 3 - 2 5 88 - 35
- - - - - - - - - -
- - 1 - - - - - - -
- - - - - 90 - - - -
100 - - 86 2 - - - - -
100 - 400 179 20 - - - - 30
3,967 4,936 4,319 3,420 760 4,760 5,610 5,372 2,083 7,180
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
- - - - - - - - - -
18 - 7 1 - - 3 7 - 20
148 - 57 74 31 75 - 40 78 37
1,300 2,334 320 680 2,310 1,900 1,013 1,320 1,454 200
SL Total
77 2,737
202 4,338
124 8,410
51 2,695
- 2
- 1
10 694
- 679
500 14,667
- 32,819
300 12,317
- 118
300 3,654
400 3,450
2,460 83,295
360 4,419
290 10,362
45 723
457 9,703
70 12,484
1,060 73,372
1,658 39,397
3,090 44,470
5,830 374,604
219 12,728
- 1
11 141
- 1,774
2,010 401,830 615
180 7,167
46 2,603
- 255
- 3,031
- 5,000
5 698
- 21
484 2,081
30 2,057
- 280
60
4,220 140,516
4,030 41,015
- 2,928
4,250 198,515
- 140
10 124
200 9,960
- 1,800
- 775
4,300
170 260
54 853
- 23,644
650 36,659
22 1,657
1,410 19,084
- 860
- 25
- 519
12 488
10 331
16 235
- 192
60 23,119
128 5,068
19 972
30 1,441
132 3,381
17 119
200 6,975
100 31,800
-
- 41
- 34
27 1,224
- 30
- 505
1,830 78,404
4,315 89,304
-
6 741
24 2,349
33 770
12 1,016
1,170 41,888
1 127
24 2,069
40 661
490 16,869
36 367
8 1,203
2
2,090 208,617
- 1,155
560 1,941
900 48,009
220 15,880
- -
10 387
- 23
72 3,938
4,540 175,575
61
- 270
1 497
4 400
6 639
370 15,479
70 2,475
- 1,505
34 914
100 5,878
- 3,760
- 3,080
-
-
-
-
-
200 6,975
- 21,392
118 2,724
6
- 91
- 24
- 2,416
- 685
15 1,240
160 7,363
500 25,662
2 1,670
24 803
12 984
- 42
1 6
3 25
- 1,795
- 300
2 339
30 33,608
- 1,135
- 372
1,140 26,350
41 4,690
- 1,680
- -
- -
- -
- 28
- 304
381 19,911
1,000
1,327 39,074
- 58
19 1,199
3 49
36 291
- 15
2,420 30,165
100 9,995
380 24,126
- 1,273
15 855
29 2,408
- 167
990 25,245
- 30,501
5 92
- 11,276
449 34,201
128 19,805
26 1,080
950 77,200
- 19
- 844
230 1,768
100 7,338
1 183
84 3,839
28 1,047
3,730 51,888
37
30 1,640
- 8,954
4,379 91,094
2 205
70 2,033
165 8,927
- -
- 416
5,000
100 3,026
290 6,407
12 715
- 2
9 117
- 10,824
- 51,500
2,068 326,022
7 1,121
- 8,810
1 725
- 1,063
- 9
- 15
45 837
- 2,556
53 6,388
19 473
- 1
- 10
- 19
64 2,805
320 22,124
- 5,189
29 290
- 61
- 5
15 155
300
104 1,189
63 5,804
39 784
21 681
20 726
- 46
1,100 300,897
- 3
4 43
- 550
214 7,014
21,450
77 3,568
2,489 51,502
10
- 5,005
3 216
- 15
- 1
- 16
1 9
- 126
- 36
- 25
- 20
- 17
- 24
5
- 13
- 7
- 4
- 18
- 13
38 737
121 8,812
- 481
20 380
342 40,200
1,175 48,623
5 839
5 1,154
- 15
- 66,272
- 280
3
1,110 97,713
- 4,514
- 28
- 7
2,730 476,927
40 55,201
- 8,866
100 6,611
20 7,269
100 755
983 31,417
110 4,016
840 44,346
- 132
8 236
- 4
40 2,055
- 2,400
- 32
12
77 14,738
1,979 147,990
76
3,200 112,694
655 27,132
3,905 103,228
64 2,195
556 16,000
-
65 5,490
84 4,495
- 106
18 56
- 2
- 19
- 18
71 6,386
1,356 337,623
- 12,949
800 56,200
- 18,219
- 2
40 9,348
- 14,258
5 900
5 904
118 15,493
3,700 7,005
6,850 111,006
- 6
1 18
1 5
- 864
7 1,408
- 20
- 3
300 20,535
- 270
- 4,132
- 163
- 7,378
23 1,210
99 3,100
10 411
- 825
- 1,178
4 961
9 1,077
7 575
1 148
1,024 35,508
- 2,554
- 420
315 5,875
- 1,830
235 8,631
1,050 94,718
200 1,500
79 1,528
4,940 121,933
- 1
- 225
- -
- 5
3
3
1
3
2
1
2
2
2
1
2
2
3
3
10
1
4
4
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
- -
2 109
2
6
4
2
2
2
6
6
4
5
6
8
5
4
5
5
2
2
5
- 484
- 5
- 5
- 1,000
- 11,358
195 12,037
- 2,951
16 156
2 114
- 47,431
510 14,121
27 640
- 115
13 893
- 500
41
16
- 338
7 57
14 342
42 988
840 31,403
83 1,836
325 16,262
290 8,142
500
3 90
- 288
- 285
- 287
- 1
220 1,485
16,650 2,052,505
- 408
- 16
- 7
100 4,145
85 454
590 63,270
- 10
- 296
- 2,570
346 55,550
- 1
- -
- 5
8 549
-
-
- 1
- 14
- 450
- 18,588
- 28,329
3,920 68,498
3
- 100
- 100
- 100
- 100
- 14
- 18
- 62
70 2,103
1,425 65,951
3385264857
549660132.851
3934924989.851
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN
(LPLPO)
KODE PUSKESMAS :
PUSKESMAS : Sungai Dareh
KECAMATAN : Pulau Punjung
KAB/KOTA : Dharmasraya
PROPINSI : Sumatera Barat
No. Nama Sediaan Satuan Stok Awal Penerimaan Persediaan
1 2 3 4 5 6
15 Allopurinol 100 mg tablet 290 290
22 Amlodipin 5 mg tablet 740 740
24 Amoksisilin 500 mg tablet 135 135
29 Antasida DOEN tablet tablet 160 300 460
30 Antasida sirup Botol 9 9
Anti Bakteri DOEN salep Kombinasi
31 (bacitrasin) Tube 10 10
41 Asam askorbat (Vit C) tablet 50 mg tablet 350 350
44 Asam mefenamat 500 mg tablet 140 140
47 Asam Tranexamat tablet 500 mg tablet - -
64 Betahistin mesilat tablet 90 90
65 Betametason krim 0,1% Tube 5 5
78 Captopril 12,5mg tablet 110 110
79 Captopril 25 mg tablet 250 250
85 Cefadroxil tablet - -
89 Cefixime 100mg tablet - -
93 Cetirizin 10 mg tablet 200 200
96 Ciprofloxacin tablet 500 mg tablet 90 90
97 Clindamisin 300 mg tablet - -
102 Deksametason tablet 0,5 mg tablet 660 660
121 Domperidon 10 mg tablet - -
143 Fitomenadion (Vit K1) tablet 10 mg tablet 50 50
151 Furosemid tablet 40 mg tablet - -
153 Garam Oralit untuk 200 ml bungkus 23 23
154 Gentamicin Salp Kulit Tube - -
159 Glibenklamid tablet 5 mg tablet 475 475
160 Glimepirid 1 mg tablet - -
161 Glimepirid 2 mg tablet - 100 100
162 Gliseril Guaiakolat tablet 100 mg tablet - 200 200
179 Hidrokortison krim 2,5% Tube 9 9
181 Hiosin N Butil bromida tablet 100 100
185 Ibuprofen tablet 400 mg tablet - -
199 Kalsium laktat (Klak) tablet 500 mg tablet - -
213 Ketokonazol cream Tube 12 12
214 Ketokonazol tab tablet 30 30
219 Klindamisin 150 mg tablet - -
227 Klorfeniramin maleat (CTM) tablet 4 mg tablet 235 235

232 Kolkisin 500 mcg tablet 90 90
234 Kotrimoksazol tablet dewasa kombinasi tablet 100 100

258 Loperamid Hcl tablet 90 90
259 Loratadin 10mg tablet 120 120
266 Meloksikam 15 mg tablet 300 300 600
270 Metformin tablet - -
271 Methyl Prednisolon 8mg tablet 90 90
274 Metil prednisolon 4 mg tablet - 200 200
278 Metronidazol 500 mg tablet - -
282 Mikonazol krim Tube 10 10
286 Multivitamin syr Botol - -
287 Multivitamin tab tablet 709 709
289 N-asetil sistein tablet 300 300
291 natrium Diklofenak 50 mg tablet 130 130
303 Omeprazole 20mg tablet 260 300 560
308 Papaverin tablet 40 mg tablet - -
314 Parasetamol tablet 500 mg tablet 600 600
342 Pyridoksin HCL ( Vit B6 ) tab 10 mg tablet 500 500
411 Salbutamol tablet 2 mg tablet 300 300
412 Salbutamol tablet 4 mg tablet - -
415 Salisil bedak 2% bungkus - -
422 Sianokobalamin (Vit B12) inj 500mcg-ml ampul - -

425 Simvastatin 10 mg tablet 210 210
434 Tablet Tambah darah tablet - -
440 Thiamin HCl (Vit B1) tablet 50 mg tablet -
456 Vitamin B komplek tablet tablet 200 200
466 Zinc tab 20 mg tablet -
Tdk. Bayar Bayar BPJS Trans
Mengetahui,
Kepala Unit Layanan Puskesmas.........
............................................................
NIP. .....................................................
DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
Bulan : Januari
Tahun : 2019
Pengeluaran Stok
Sisa Stok Permintaan Ket.
Pemakaian Kadaluarsa Lain-lain Optimum
7 8 9 10 11 12 13
105 185 168 -17
220 520 352 -168
- 135 0 -135
150 310 240 -70
1 8 1.6 -6.4
- 10 0 -10
- 350 0 -350
50 90 80 -10
- 0 0 0
30 60 48 -12
2 3 3.2 0.2
- 110 0 -110
10 240 16 -224
- 0 0 0
- 0 0 0
220 -20 352 372
- 90 0 -90
- 0 0 0
40 620 64 -556
- 0 0 0
- 50 0 -50
- 0 0 0
- 23 0 -23
- 0 0 0
- 475 0 -475
- 0 0 0
40 60 64 4
30 170 48 -122
- 9 0 -9
- 100 0 -100
- 0 0 0
- 0 0 0
- 12 0 -12
10 20 16 -4
- 0 0 0
30 205 48 -157
10 80 16 -64
- 100 0 -100
- 90 0 -90
- 120 0 -120
530 70 848 778
- 0 0 0
90 0 144 144
130 70 208 138
- 0 0 0
5 5 8 3
- 0 0 0
100 609 160 -449
70 230 112 -118
130 0 208 208
435 125 696 571
- 0 0 0
290 310 464 154
- 500 0 -500
20 280 32 -248
- 0 0 0
- 0 0 0
- 0 0 0
200 10 320 310
- 0 0 0
- 0 0 0
150 50 240 190
- 0 0 0
BKKBN Lain2 Jumlah
......................., .................... 2018

Pengelola Obat,
....................................................
NIP. .............................................
(LPLPO)
KODE PUSKESMAS :
15 Allopurinol 100 mg tablet 185 500 685

21 Amlodipin 10 mg tablet - 0
47 Asam Tranexamat tablet 500 mg tablet - 0
93 Cetirizin 10 mg tablet (20) 500 480
160 Glimepirid 1 mg tablet - 0
161 Glimepirid 2 mg tablet 60 100 160
162 Gliseril Guaiakolat tablet 100 mg tablet 170 170


274 Metil prednisolon 4 mg tablet 70 500 570
291 natrium Diklofenak 50 mg tablet - 0
293 Nifedipin 10 mg tablet 100 100
314 Parasetamol tablet 500 mg tablet 310 600 910
412 Salbutamol tablet 4 mg tablet - 0
434 Tablet Tambah darah tablet - 90 90
440 Thiamin HCl (Vit B1) tablet 50 mg tablet - 300 300
456 Vitamin B komplek tablet tablet 50 500 550
466 Zinc tab 20 mg tablet - 0
Mengetahui,
............................................................
NIP. .....................................................
(LPLPO)
Bulan : Februari
Tahun : 2019
Pengeluaran Stok
280 405 448 43
- 0 0 0
130 390 208 -182
30 105 48 -57
170 440 272 -168
- 8 0 -8
- 10 0 -10
- 350 0 -350
20 70 32 -38
- 0 0 0
50 10 80 70
1 2 1.6 -0.4
- 110 0 -110
10 230 16 -214
30 450 48 -402
10 80 16 -64
- 620 0 -620
- 50 0 -50
- 23 0 -23
10 465 16 -449
- 0 0 0
30 130 48 -82
30 140 0 48 48 retur
- 9 0 -9
20 80 32 -48
1 11 1.6 -9.4
10 10 16 6
50 155 80 -75
- 80 0 -80
- 100 0 -100
- 90 0 -90
100 20 160 140
490 180 784 604
250 320 0 400 400 retur
3 2 4.8 2.8
190 150 269 304 35 retur
30 200 0 48 48 retur
- 0 0 0
- 100 0 -100
390 335 624 289
370 540 592 52
10 490 16 -474
10 270 16 -254
- 0 0 0
280 180 448 268
- 90 0 -90
- 300 0 -300
50 500 80 -420
- 0 0 0
BKKBN Lain2 Jumlah
......................., .................... 2018

Pengelola Obat,
....................................................
NIP. .............................................
(LPLPO)
KODE PUSKESMAS :
15 Allopurinol 100 mg tablet 405 650 1055

23 Amoksisilin 250 mg tablet - 0
25 Amoksisilin sirup kering 125 mg/5 ml Botol - 0
26 Amoniak btl/1000 ml - 0
27 Amoxicillin syr forte 250mg/ml botol - 0
28 Antalgin injeksi 250 mg/ml-2ml ampul - 0
29 Antasida DOEN tablet tablet 440 440
64 Betahistin mesilat tablet 10 100 110
65 Betametason krim 0,1% Tube 2 10 12
160 Glimepirid 1 mg tablet - 200 200
161 Glimepirid 2 mg tablet 130 130
214 Ketokonazol tab tablet 10 100 110
227 Klorfeniramin maleat (CTM) tablet 4 mg tablet 155 300 455

282 Mikonazol krim Tube 2 5 7
289 N-asetil sistein tablet - 500 500
345 Ranitidin tablet 150 mg tablet - 0
434 Tablet Tambah darah tablet 90 90
440 Thiamin HCl (Vit B1) tablet 50 mg tablet 300 300 600
466 Zinc tab 20 mg tablet - 200 200
Mengetahui,
............................................................
NIP. .....................................................
(LPLPO)
Bulan : Maret
Tahun : 2019
Pengeluaran Stok
310 745 496 -249
- 0 0 0
410 280 656 376
- 0 0 0
20 85 32 -53
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
140 300 224 -76
- 8 0 -8
- 10 0 -10
- 350 0 -350
50 20 80 60
20 90 32 -58
1 11 1.6 -9.4
30 80 48 -32
20 210 32 -178
250 200 400 200
- 80 0 -80
190 430 304 -126
- 50 0 -50
- 23 0 -23
- 465 0 -465
30 170 48 -122
- 130 0 -130
- 9 0 -9
- 80 0 -80
4 7 6.4 -0.6
20 90 32 -58
80 375 128 -247

- 80 0 -80
- 100 0 -100
- 90 0 -90
- 20 0 -20
550 330 880 550
2 5 3.2 -1.8
240 29 384 355
30 470 48 -422
- 0 0 0
- 100 0 -100
610 325 976 651
690 350 1104 754
- 490 0 -490
- 0 0 0
10 260 16 -244
220 260 352 92
- 90 0 -90
230 370 368 -2
80 420 128 -292
- 200 0 -200
BKKBN Lain2 Jumlah
......................., .................... 2018

Pengelola Obat,
....................................................
NIP. .............................................
(LPLPO)
KODE PUSKESMAS :

25 Amoksisilin sirup kering 125 mg/5 ml Botol - 0
42 Asam Folat 0,4 mg /profolat tablet - 0
43 Asam folat 1 mg tablet - 0
45 Asam tranexamat inj 100 mg/ml ampul - 0
46 Asam tranexamat inj 50mg/ml ampul - 0
48 Asam Valproat 500mg / Depakote 500 mg tablet - 0

Asam Valproat tab SR 250 Mg / Depakote
49 250 mg tablet - 0
50 Asetosal 80 mg / Miniaspi tablet - 0
51 Asetosal tablet 100 mg tablet - 0
52 Asiklovir Krim 5 % 5 gr Tube - 0
53 Asiklovir tablet 200 mg tablet - 0
54 Asiklovir tablet 400 mg tablet - 0
55 Atropin sulfat injeksi 0,25 mg/ml - 1 ml ampul - 0

56 Attapulgit (Pularex) tablet - 0
57 Azitromisin tab 500 mg tablet - 0
58 Bahan tambalan gigi sementara (mix) Botol - 0
59 BCG Vial - 0
60 Benecheck Cholesterol strip Botol - 0
61 Benecheck Glucose strip Botol - 0
62 Benecheck uric strip Botol - 0
Berotec 0,1 mg(Fenoterol HBr aerosol
63 100mcg/dosis) Btl - 0
85 Cefadroxil tablet - 0
89 Cefixime 100mg tablet - 0
97 Clindamisin 300 mg tablet - 0
121 Domperidon 10 mg tablet - 0
151 Furosemid tablet 40 mg tablet - 0
162 Gliseril Guaiakolat tablet 100 mg tablet - 0
163 Glukosa larutan Infus 10% steril fls - 0
164 Glukosa Larutan Infus 5% steril fls - 0
165 Griseofulvin tablet 125 mg tablet - 0
167 Haloperidol 5 mg tablet - 0
168 Haloperidol inj 50mg/ml ampul - 0
169 Haloperidol tablet 0,5 mg tablet - 0
171 Handscoen Steril psg - 0
172 Handscoend Obgyn psg - 0
173 handscoon psg - 0
174 HBSAG Strip pcs - 0
175 HB-UNIJECT Vial - 0
176 HCG Strip Pcs - 0
177 Hidrochlorotiazid (HCT) tablet 25 mg tablet - 0
178 Hidrogen Peroksida (H2O2) 3% Botol - 0
180 Hiosin HBr Inj (Buscopan) 20 mg ampul - 0
182 HIV test (R1) SD Pcs - 0
183 Ibuprofen suspensi 100 mg/5 ml botol - 0
184 Ibuprofen tablet 200 mg tablet - 0
186 ichtiol salep pot - 0
187 Infusion set anak set - 0
188 Infusion set dewasa set - 0
189 Intec (One Step Anti-HIV 1&2) Box - 0
190 IPV Vial - 0
191 Isoniazid 100 mg/PPINH 100 mg tablet - 0
192 Isoniazid tablet 300 mg tablet - 0
193 Isosorbid dinitrat tablet sublingual 5 mg tablet - 0

194 Jarum jahit / bedah no. 9 s/d 14 Pcs - 0
195 Jelly Dopler btl - 0
196 Jelly USG btl - 0
197 Kaca Slide pcs - 0
198 Kaca Tutup pcs - 0
199 Kalsium laktat (Klak) tablet 500 mg tablet - 0

270 Metformin tablet - 0
271 Methyl Prednisolon 8mg tablet - 0
278 Metronidazol 500 mg tablet - 0
286 Multivitamin syr Botol - 0
440 Thiamin HCl (Vit B1) tablet 50 mg tablet 370 370
465 Zinc syr botol - 0
466 Zinc tab 20 mg tablet 200 200
Mengetahui,
............................................................
NIP. .....................................................
(LPLPO)
Bulan : April
Tahun : 2019
Pengeluaran Stok
260 485 416 -69 380
- 0 0 0
320 260 512 252 400
25 60 40 -20 1705
- 0 0 0 37
260 40 416 376 1171
- 8 0 -8 40
- 10 0 -10 8
- 350 0 -350 1553
- 0 0 0 940
- 0 0 0
- 20 0 -20 521
- 0 0 0
- 0 0 0
- 0 0 0 118
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0 4
- 0 0 0 484
- 0 0 0 60
- 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 5
60 30 96 66 520
1 10 1.6 -8.4 48
10 70 16 -54 377
30 180 48 -132 43
- 0 0 0 350
- 0 0 0 275
160 40 256 216 695
- 80 0 -80 605
- 0 0 0 315
130 300 208 -92 430
- 0 0 0 360
- 0 0 0 306
5 18 8 -10 233
20 445 32 -413 1225
- 170 0 -170 775
70 60 112 52 199
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0 195
- 0 0 0 320
- 0 0 0 7
- 0 0 0 110
- 0 0 0 275
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 9 0 -9 5
- 0 0 0
- 80 0 -80 790
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0 1306
- 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 1010
- 7 0 -7 37
10 80 16 -64 230
145 230 232 2 1230

- 80 0 -80 60
- 90 0 -90 625
- 20 0 -20 972
510 320 816 496 340
- 0 0 0
- 0 0 0 0
- 0 0 0 1495
3 2 4.8 2.8
- 0 0 0 6
- 29 0 -29 740
130 340 208 -132 555
- 0 0 0 1065
355 270 568 298 478
580 270 928 658 1530
- 260 0 -260 360
220 40 352 312 100
- 90 0 -90 910
20 350 32 -318 1013
110 310 176 -134 260
- 0 0 0 20
10 190 16 -174 307
BKKBN Lain2 Jumlah
......................., .................... 2018

Pengelola Obat,
....................................................
NIP. .............................................
105
0
-140
-1645
-37
-1131
-32
2
-1203
-940
0
-501
0
0
-118
0
0
0
-4
-484
-60
0
-500
0
0
0
0
0
0
-5
-490
-38
-307
137
-350
-275
-655
-525
-315
-130
-360
-306
-215
-780
-605
-139
0
0
0
0
-195
-320
-7
-110
-275
0
0
0
0
0
0
0
0
4
0
-710
0
0
0
-1306
0
0
0
0
0
0
0
0
0
0
0
0
0
-1010
-30
-150
-1000
20
-535
-952
-20
0
0
-1495
2
-6
-711
-215
-1065
-208
-1260 dila 100
-100
-60
-820
-663
50
-20
-117
LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)
KODE PUSKESMAS :
PUSKESMAS : Sungai Dareh Bulan : Mei
KECAMATAN : Pulau Punjung Tahun : 2019
Pengeluaran Stok
No. Nama Sediaan Satuan Stok Awal Penerimaan Persediaan Sisa Stok Permintaan Ket.
15 Allopurinol 100 mg tablet 485 300 785 245 540 392 -148
22 Amlodipin 5 mg tablet 260 260 105 155 168 13
24 Amoksisilin 500 mg tablet 60 100 160 30 130 48 -82
29 Antasida DOEN tablet tablet 40 500 540 140 400 224 -176
30 Antasida sirup Botol 8 8 1 7 1.6 -5.4
31 (bacitrasin) Tube 10 10 - 10 0 -10
41 Asam askorbat (Vit C) tablet 50 mg tablet 350 350 30 320 48 -272
42 Asam Folat 0,4 mg /profolat tablet - 0 - 0 0 0
44 Asam mefenamat 500 mg tablet 20 20 10 10 16 6
64 Betahistin mesilat tablet 30 100 130 40 90 64 -26
65 Betametason krim 0,1% Tube 10 10 - 10 0 -10
78 Captopril 12,5mg tablet 70 70 - 70 0 -70
79 Captopril 25 mg tablet 180 180 - 180 0 -180
85 Cefadroxil tablet - 0 - 0 0 0
89 Cefixime 100mg tablet - 0 - 0 0 0
93 Cetirizin 10 mg tablet 40 200 240 80 160 128 -32
94 Cetirizin syr 5mg/5ml btl 60ml - 0 - 0 0 0
96 Ciprofloxacin tablet 500 mg tablet 80 80 - 80 0 -80
97 Clindamisin 300 mg tablet - 0 - 0 0 0
102 Deksametason tablet 0,5 mg tablet 300 300 200 100 320 220
121 Domperidon 10 mg tablet - 0 - 0 0 0
143 Fitomenadion (Vit K1) tablet 10 mg tablet 50 50 - 50 0 -50
151 Furosemid tablet 40 mg tablet - 0 - 0 0 0
153 Garam Oralit untuk 200 ml bungkus 18 18 - 18 0 -18
154 Gentamicin Salp Kulit Tube - 3 3 - 3 0 -3
155 Gentamisin inj ampul - 0 - 0 0 0
156 Gentamisin tts mata botol - 0 - 0 0 0
157 Gentian violet larutan 1% Botol - 0 - 0 0 0
158 Glassionomer Cement (GC IX) / GC. Fuji Botol - 0 - 0 0 0

159 Glibenklamid tablet 5 mg tablet 445 445 - 445 0 -445
160 Glimepirid 1 mg tablet 170 170 15 155 24 -131
161 Glimepirid 2 mg tablet 60 60 50 10 80 70
179 Hidrokortison krim 2,5% Tube 9 9 - 9 0 -9
213 Ketokonazol cream Tube 7 7 - 7 0 -7
214 Ketokonazol tab tablet 80 80 - 80 0 -80
222 Kloramfenikol salep Kulit Tube - 3 3 - 3 0 -3
227 Klorfeniramin maleat (CTM) tablet 4 mg tablet 230 230 60 170 96 -74
232 Kolkisin 500 mcg tablet 80 80 - 80 0 -80
258 Loperamid Hcl tablet 90 90 - 90 0 -90
259 Loratadin 10mg tablet 20 20 - 20 0 -20
266 Meloksikam 15 mg tablet 320 320 270 50 432 382
274 Metil prednisolon 4 mg tablet - 500 500 70 430 112 -318
282 Mikonazol krim Tube 2 2 1 1 1.6 0.6
287 Multivitamin tab tablet 29 29 - 29 0 -29
289 N-asetil sistein tablet 340 340 120 220 192 -28
291 natrium Diklofenak 50 mg tablet - 0 - 0 0 0
293 Nifedipin 10 mg tablet 100 100 - 100 0 -100
303 Omeprazole 20mg tablet 270 600 870 415 455 664 209
314 Parasetamol tablet 500 mg tablet 270 1000 1270 590 680 944 264
342 Pyridoksin HCL ( Vit B6 ) tab 10 mg tablet 490 490 - 490 0 -490
411 Salbutamol tablet 2 mg tablet 260 260 - 260 0 -260
425 Simvastatin 10 mg tablet 40 300 340 100 240 160 -80
434 Tablet Tambah darah tablet 90 90 10 80 16 -64
440 Thiamin HCl (Vit B1) tablet 50 mg tablet 350 350 20 330 32 -298
456 Vitamin B komplek tablet tablet 310 310 120 190 192 2
466 Zinc tab 20 mg tablet 190 190 - 190 0 -190
Tdk. Bayar Bayar BPJS Trans BKKBN Lain2 Jumlah
Mengetahui, ......................., .................... 2018

Kepala Unit Layanan Puskesmas......... Pengelola Obat,
............................................................ ....................................................
NIP. ..................................................... NIP. .............................................
(LPLPO)
KODE PUSKESMAS :

102 Deksametason tablet 0,5 mg tablet 100 300 400
154 Gentamicin Salp Kulit Tube 3 3
161 Glimepirid 2 mg tablet 10 200 210
199 Kalsium laktat (Klak) tablet 500 mg tablet - 200 200
215 Ketoprofen 100mg tablet - 0
216 Ketoprofen Supp suppos - 0
217 kit gol. Darah A, B, AB set - 0
218 Kit gol. Darah Anti-D Kit - 0
219 Klindamisin 150 mg tablet - 0
220 Klopidogrel 75 mg Tablet - 0
221 Kloramfenikol kapsul 250 mg tablet - 0
222 Kloramfenikol salep Kulit Tube 3 3
223 Kloramfenikol salep mata 1 % Tube - 0
224 Kloramfenikol suspensi 125 mg/5 ml Botol - 0
225 Kloramfenikol tetes telinga 3 % Botol - 0
226 Kloramphenicol tts mata Botol - 0

228 Klorfenol kamfer menthol (CHKM) Botol - 0
229 Klorpromazin HCl inj 5 mg/ml - 1 ml ampul - 0
230 Klorpromazin HCl tablet salut 100 mg tablet - 0
231 Kodein HCl tablet 10 mg tablet - 0
233 Kotrimoksazol suspensi kombinasi Botol - 0

266 Meloksikam 15 mg tablet 50 50
274 Metil prednisolon 4 mg tablet 430 430
291 natrium Diklofenak 50 mg tablet - 300 300
303 Omeprazole 20mg tablet 455 455
Mengetahui,
............................................................
NIP. .....................................................
(LPLPO)
Bulan : Juni
Tahun : 2019
Pengeluaran Stok
135 405 216 -189
10 445 16 -429
- 130 0 -130
90 310 144 -166
- 7 0 -7
- 10 0 -10
10 310 16 -294
- 10 0 -10
40 50 64 14
1 9 1.6 -7.4
10 60 16 -44
20 160 32 -128
- 160 0 -160
- 80 0 -80
140 260 224 -36
- 50 0 -50
- 18 0 -18
- 3 0 -3
- 445 0 -445
- 155 0 -155
40 170 64 -106
- 9 0 -9
- 80 0 -80
- 200 0 -200
- 7 0 -7
10 70 16 -54
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 3 0 -3
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
70 300 112 -188

- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 80 0 -80
- 0 0 0
- 100 0 -100
- 90 0 -90
- 20 0 -20
- 50 0 -50
50 380 80 -300
- 1 0 -1
- 0 0 0
- 29 0 -29
50 170 80 -90
190 110 304 194
- 100 0 -100
180 275 288 13
240 440 384 -56
20 470 32 -438
30 230 48 -182
20 220 32 -188
- 80 0 -80
50 280 80 -200
50 140 80 -60
- 190 0 -190
BKKBN Lain2 Jumlah
......................., .................... 2018

Pengelola Obat,
....................................................
NIP. .............................................
(LPLPO)
KODE PUSKESMAS :

85 Cefadroxil tablet - 0
89 Cefixime 100mg tablet - 0
120 Doksisilin kapsul tablet - 0
152 Gabapentin/Alpentin 100 mg kapsul - 0
155 Gentamisin inj ampul - 0
156 Gentamisin tts mata botol - 0
157 Gentian violet larutan 1% Botol - 0
158 Glassionomer Cement (GC IX) / GC. Fuji Botol - 0



271 Methyl Prednisolon 8mg tablet - 0
290 Natrium bicarbonat tablet 500 mg tablet - 0
291 natrium Diklofenak 50 mg tablet 110 300 410
345 Ranitidin tablet 150 mg tablet - 300 300
456 Vitamin B komplek tablet tablet 140 500 640
Mengetahui,
............................................................
NIP. .....................................................
(LPLPO)
Bulan : Juli
Tahun : 2019
Pengeluaran Stok
100 305 160 -145 ???
- 0 0 0
315 130 504 374
10 120 16 -104 ??
100 410 160 -250 ??
2 5 3.2 -1.8
- 10 0 -10
30 280 48 -232
10 0 16 16
- 0 0 0
10 40 16 -24
4 5 6.4 1.4
- 60 0 -60
- 160 0 -160
- 0 0 0
- 0 0 0
- 160 0 -160
- 80 0 -80
- 0 0 0
10 250 16 -234
- 0 0 0
- 0 0 0
- 50 0 -50
- 0 0 0
- 0 0 0
10 8 16 8
- 3 0 -3
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 445 0 -445
10 45 16 -29
10 160 16 -144
- 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
- 0 0 0
2 7 3.2 -3.8
- 80 0 -80
4 3 6.4 3.4
14 56 22.4 -33.6
120 180 192 12 ??

10 70 0 16 16
- 100 0 -100
- 90 0 -90
- 20 0 -20
- 50 0 -50
10 -10 16 26
30 350 48 -302
- 1 0 -1
29 0 46.4 46.4
110 60 176 116
- 0 0 0
260 150 416 266
- 100 0 -100
95 480 152 -328 ?
580 360 928 568
30 440 48 -392
180 120 288 168
10 220 16 -204 ?
- 220 0 -220
10 70 16 -54
60 220 96 -124
140 500 224 -276
10 180 16 -164
BKKBN Lain2 Jumlah
......................., .................... 2018

Pengelola Obat,
....................................................
NIP. .............................................
(LPLPO)
KODE PUSKESMAS :

44 Asam mefenamat 500 mg tablet - 0


271 Methyl Prednisolon 8mg tablet (10) -10
287 Multivitamin tab tablet - 0
308 Papaverin tablet 40 mg tablet - 0
Mengetahui,
............................................................
NIP. .....................................................
(LPLPO)
Bulan : Agustus
Tahun : 2019
Pengeluaran Stok
- 305 0 -305
- 130 0 -130
- 120 0 -120
- 410 0 -410
- 5 0 -5
- 10 0 -10
- 280 0 -280
- 0 0 0
- 40 0 -40
- 5 0 -5
- 60 0 -60
- 160 0 -160
- 160 0 -160
- 80 0 -80
- 0 0 0
- 250 0 -250
- 0 0 0
- 50 0 -50
- 8 0 -8
- 445 0 -445
- 45 0 -45
- 160 0 -160
- 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
- 0 0 0
- 7 0 -7
- 80 0 -80
- 3 0 -3
- 56 0 -56
- 180 0 -180
- 0 0 0
- 100 0 -100
- 90 0 -90
- 20 0 -20
- 50 0 -50
- -10 0 10
- 1 0 -1
- 0 0 0
- 150 0 -150
- 100 0 -100
- 480 0 -480
- 0 0 0
- 360 0 -360
- 220 0 -220
- 220 0 -220
- 70 0 -70
BKKBN Lain2 Jumlah
......................., .................... 2018

Pengelola Obat,
....................................................
NIP. .............................................
(LPLPO)
KODE PUSKESMAS :



267 Mess pcs - 0
268 Metanol 100 ml Botol - 0
269 Metanol 1000 ml botol - 0
283 Mineral Mix sachet - 0
284 Minyak Imersi Botol - 0
285 Mouth Pieces smokerlyzer Box - 0
288 Napza Kit 5 Parameter ktk/10 - 0
290 Natrium bicarbonat tablet 500 mg tablet - 0
292 Natrium klorida larutan infus 0,9% fls - 0
343 Ramipril tablet - 0
344 Ranitidin inj. 25mg/ml ampul - 0
345 Ranitidin tablet 150 mg tablet 120 120
426 spironolacton 25 mg tablet - 0
427 Spongestan Hemospon ktk - 0
428 Spritus Botol - 0
429 Stomach tube FR 12 pcs - 0
432 Strip asam urat (UA SURE) Botol - 0
433 Sukralfat / Ulsidex tablet - 0
435 Td Vial - 0
436 Temporary stopping fletcher Set - 0
437 Tetagam ampul - 0
438 Tetrasiklin HCL kapsul 500 mg tablet - 0
439 Thiamfenikol 500 mg tab tablet - 0
441 TKF botol - 0
442 Tramadol inj ampul - 0
443 Trifluoperazin 5mg tablet - 0
444 Triheksiphenidil HCl tablet 2 mg tablet - 0
445 Trombophop gel tube - 0
446 TT Vial - 0
447 Tube EDTA Box - 0
448 Urin Bag pcs - 0
449 Vacum cup gel lot activator Bok - 0
450 Vacum Tube EDTA 0,5 ml Bok - 0
451 Vaksin carrier pcs - 0
452 Vaksin Rabies Vero kuur - 0
453 Valsartan 160mg tablet - 0
454 Vitamin A 100.000 IU tablet - 0
457 White Tip Bks - 0
458 wing needle 21 G pcs - 0
462 Xylol Botol - 0
463 Yellow Tip bks - 0
464 Yodiol Test Botol - 0

Mengetahui,
............................................................
NIP. .....................................................
(LPLPO)
Bulan : September
Tahun : 2019
Pengeluaran Stok STOK REAL

Pemakaian Kadaluarsa RETUR Optimum
- 305 0 305
- 130 0 100 130
- 120 0 100 120
- 410 0 530
- 5 0 6
- 10 0 10
- 280 0 0 500
- 0 0 100
- 40 0 50
- 5 0 5
- 10 50 0 50
- 160 0 160
- 160 0 0 200
- 80 0 80
- 0 0
- 250 0 250
- 0 0
- 50 0 50
- 8 0 50 8
- 445 0 445
- 45 0 120
- 160 0 190
- 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
- 7 0 7
- 80 0 80
- 3 0 3
- 56 0 66
- 180 0 100 185

- 0 0
- 100 0 0
- 90 0 0
- 20 0 50 50
- 50 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- -10 0
- 350 0 350
- 1 0 1
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 60 0 300 60
- 0 0
- 150 0 50 150
- 0 0
- 100 0 100
- 480 0 480
- 360 0 200 360
- 440 0 440
- 0 0
- 0 0
- 120 0 120
- 220 0 220
- 220 0 220
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 70 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 220 0 220
- 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
- 200 300 0 300
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 0 0
- 180 0 180
BKKBN Lain2 Jumlah

......................., .................... 2018
Pengelola Obat,
....................................................
NIP. .............................................
selisih
0 permi
0
0
-120 cek kartu stok gudang
-1
0
0 retur
0
-10
0
0
0
0
0
0
0
0
0
0
0 cek kartu stok gudang
-75
-30
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
-10
-5
0
0
0
-30
0 cek kartu stok gudang
0
0
0
0
-10
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
0
0
0
0
0
0
0
0
0
0
0
0
0
0
(LPLPO)
KODE PUSKESMAS :

24 Amoksisilin 500 mg tablet 120 100 220
41 Asam askorbat (Vit C) tablet 50 mg tablet - 500 500
44 Asam mefenamat 500 mg tablet - 100 100
93 Cetirizin 10 mg tablet - 200 200
144 Fitomenadion inj 2 mg/ml ampul - 0
145 Fluoksetin / Prestine tablet - 0
146 Food Test - Borak Test Paket - 0
147 Food Test - Formalin Test Paket - 0
148 Food Test - Rhodamin Test Paket - 0
149 Fouchet Botol - 0
150 Furosemid injeksi ampul - 0
152 Gabapentin/Alpentin 100 mg kapsul - 0
153 Garam Oralit untuk 200 ml bungkus 8 25 33
155 Gentamisin inj ampul - 0
156 Gentamisin tts mata botol - 0
157 Gentian violet larutan 1% Botol - 0
158 Glassionomer Cement (GC IX) / GC. Fuji Botol - 0
180 Hiosin HBr Inj (Buscopan) 20 mg ampul - 0
182 HIV test (R1) SD Pcs - 0
183 Ibuprofen suspensi 100 mg/5 ml botol - 0
186 ichtiol salep pot - 0
187 Infusion set anak set - 0
188 Infusion set dewasa set - 0
189 Intec (One Step Anti-HIV 1&2) Box - 0
190 IPV Vial - 0
191 Isoniazid 100 mg/PPINH 100 mg tablet - 0
192 Isoniazid tablet 300 mg tablet - 0
193 Isosorbid dinitrat tablet sublingual 5 mg tablet - 0

194 Jarum jahit / bedah no. 9 s/d 14 Pcs - 0
195 Jelly Dopler btl - 0
196 Jelly USG btl - 0
197 Kaca Slide pcs - 0
198 Kaca Tutup pcs - 0
199 Kalsium laktat (Klak) tablet 500 mg tablet 140 140
200 Kapas pembalut / absorben 250 g roll - 0
201 Karbamazepin tablet 200 mg tablet - 0
202 Kasa kompres 40/40 steril lbr - 0
203 Kasa pembalut 2 m x 80 cm roll - 0
204 Kasa pembalut elastis 3 inchi roll - 0
205 Kasa pembalut elastis 4 inchi roll - 0
206 Kasa Pembalut hidrofil 4 m x 10 cm elastis roll - 0
207 Kasa Pembalut hidrofil 4 m x 5 cm elastis roll - 0

208 Kasa steril 16/16 kotak - 0
209 Kassa gulung Besar 80cm x 40 m roll - 0
210 Kertas lakmus biru pack - 0
211 Kertas Lakmus merah pack - 0
212 Kertas pH Universal Kotak - 0
215 Ketoprofen 100mg tablet - 0
216 Ketoprofen Supp suppos - 0
217 kit gol. Darah A, B, AB set - 0
218 Kit gol. Darah Anti-D Kit - 0
219 Klindamisin 150 mg tablet - 0
220 Klopidogrel 75 mg Tablet - 0
221 Kloramfenikol kapsul 250 mg tablet - 0
223 Kloramfenikol salep mata 1 % Tube - 0
224 Kloramfenikol suspensi 125 mg/5 ml Botol - 0
225 Kloramfenikol tetes telinga 3 % Botol - 0
226 Kloramphenicol tts mata Botol - 0

228 Klorfenol kamfer menthol (CHKM) Botol - 0
229 Klorpromazin HCl inj 5 mg/ml - 1 ml ampul - 0
230 Klorpromazin HCl tablet salut 100 mg tablet - 0
231 Kodein HCl tablet 10 mg tablet - 0
258 Loperamid Hcl tablet - 0
259 Loratadin 10mg tablet 20 50 70
266 Meloksikam 15 mg tablet - 0
267 Mess pcs - 0
268 Metanol 100 ml Botol - 0
269 Metanol 1000 ml botol - 0
Metil ergometrin maleat tablet salut 0,125
272 mg tablet - 0
273 Metil ergometrin maleat inj 0,200mg-1ml ampul - 0
275 Metildopa 250mg tablet - 0
276 Metoclopramid 10 gr tablet - 0
277 Metoclopramid injeksi ampul - 0
278 Metronidazol 500 mg tablet - 0
279 Metronidazol supositoria 500 mg suppos - 0
280 Metronidazole ovula 500mg ovula - 0
Microlit tips for micropipettes MT-up to 1
281 ml pack - 0
289 N-asetil sistein tablet 60 300 360
343 Ramipril tablet - 0
344 Ranitidin inj. 25mg/ml ampul - 0
345 Ranitidin tablet 150 mg tablet 120 120
426 spironolacton 25 mg tablet - 0
427 Spongestan Hemospon ktk - 0
428 Spritus Botol - 0
432 Strip asam urat (UA SURE) Botol - 0
433 Sukralfat / Ulsidex tablet - 0
434 Tablet Tambah darah tablet - 0
435 Td Vial - 0
436 Temporary stopping fletcher Set - 0
437 Tetagam ampul - 0
438 Tetrasiklin HCL kapsul 500 mg tablet - 0
439 Thiamfenikol 500 mg tab tablet - 0
441 TKF botol - 0
442 Tramadol inj ampul - 0
443 Trifluoperazin 5mg tablet - 0
444 Triheksiphenidil HCl tablet 2 mg tablet - 0
445 Trombophop gel tube - 0
446 TT Vial - 0
447 Tube EDTA Box - 0
448 Urin Bag pcs - 0
449 Vacum cup gel lot activator Bok - 0
450 Vacum Tube EDTA 0,5 ml Bok - 0
451 Vaksin carrier pcs - 0
452 Vaksin Rabies Vero kuur - 0
453 Valsartan 160mg tablet - 0
457 White Tip Bks - 0
462 Xylol Botol - 0
463 Yellow Tip bks - 0
464 Yodiol Test Botol - 0
Mengetahui,
............................................................
NIP. .....................................................
(LPLPO)
Bulan : Oktober
Tahun : 2019
Pengeluaran Stok
- 305 0 -305
160 70 256 186
10 210 16 -194
130 280 208 -72
1 4 1.6 -2.4 retur apotik
2 8 3.2 -4.8
20 480 32 -448
100 0 160 160
1 39 1.6 -37.4
- 5 0 -5
- 50 0 -50
- 160 0 -160
- 200 0 -200
- 80 0 -80
- 0 0 0
- 250 0 -250
- 0 0 0
- 50 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
1 32 1.6 -30.4
1 2 1.6 -0.4
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 445 0 -445
- 45 0 -45
- 160 0 -160
- 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
- 0 0 0
- 7 0 -7
- 0 0 0
- 80 0 -80
- 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
- 0 0 0
- 140 0 -140
- 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 2 1.6 -0.4
- 56 0 -56
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
1 2 1.6 -0.4
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
70 210 112 -98

- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 70 0 -70
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- -10 0 10
- 0 0 0
- 0 0 0
20 330 32 -298
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 0 0 0
- 1 0 -1
- 0 0 0
100 260 160 -100
80 120 128 8
- 100 0 -100
120 360 192 -168
- 0 0 0
280 280 448 168 RETUR APOTIK
90 350 144 -206
- 0 0 0
- 0 0 0
- 120 0 -120
- 220 0 -220
- 220 0 -220
- 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
- 220 0 -220
- 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
300 0 480 480
- 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
- 180 0 -180
BKKBN Lain2 Jumlah
......................., .................... 2018

Pengelola Obat,
....................................................
NIP. .............................................
retur apotik
RETUR APOTIK
(LPLPO)
KODE PUSKESMAS :


234 Kotrimoksazol tablet dewasa kombinasi tablet - 0

Mengetahui,
............................................................
NIP. .....................................................
(LPLPO)
Bulan : November
Tahun : 2019
Pengeluaran Stok
- 305 0 -305
- 0 0 0
- 70 0 -70
- 210 0 -210
- 280 0 -280
- 4 0 -4
- 8 0 -8
- 480 0 -480
- 0 0 0
- 39 0 -39
- 5 0 -5
- 50 0 -50
- 160 0 -160
- 200 0 -200
- 80 0 -80
- 0 0 0
- 250 0 -250
- 0 0 0
- 50 0 -50
- 32 0 -32
- 445 0 -445
- 7 0 -7
- 80 0 -80
- 2 0 -2
- 56 0 -56
- 2 0 -2
- 210 0 -210
- 0 0 0
- 0 0 0
- 0 0 0
- 70 0 -70
- 0 0 0
- -10 0 10
- 330 0 -330
- 1 0 -1
- 0 0 0
- 260 0 -260
- 270 0 -270
- 100 0 -100
- 360 0 -360
- 0 0 0
- 280 0 -280
- 350 0 -350
- 220 0 -220
- 220 0 -220
- 0 0 0
- 180 0 -180
BKKBN Lain2 Jumlah
......................., .................... 2018

Pengelola Obat,
....................................................
NIP. .............................................
(LPLPO)
KODE PUSKESMAS :


234 Kotrimoksazol tablet dewasa kombinasi tablet - 0

456 Vitamin B komplek tablet tablet - 0
Mengetahui,
............................................................
NIP. .....................................................
(LPLPO)
Bulan : Desember
Tahun : 2019
Pengeluaran Stok
- 305 0 -305
- 70 0 -70
- 210 0 -210
- 280 0 -280
- 4 0 -4
- 8 0 -8
- 480 0 -480
- 0 0 0
- 39 0 -39
- 5 0 -5
- 50 0 -50
- 160 0 -160
- 200 0 -200
- 80 0 -80
- 250 0 -250
- 50 0 -50
- 32 0 -32
- 445 0 -445
- 7 0 -7
- 80 0 -80
- 2 0 -2
- 56 0 -56
- 210 0 -210
- 0 0 0
- 0 0 0
- 0 0 0
- 70 0 -70
- 0 0 0
- -10 0 10
- 1 0 -1
- 0 0 0
- 260 0 -260
- 270 0 -270
- 100 0 -100
- 360 0 -360
- 100 -100 0 100
- 280 0 -280
- 350 0 -350
- 220 0 -220
- 220 0 -220
- 90 -90 0 90
- 220 0 -220
- 0 0 0
BKKBN Lain2 Jumlah
......................., .................... 2018

Pengelola Obat,
....................................................
NIP. .............................................
REKAPITULASI PEMAKAIAN
KODE PUSKESMAS :
No. Nama Sediaan Satuan
1 2 3 1 2 3 4 5 6 7 8 9 10
15 Allopurinol 100 mg tablet
16 Alprazolam 1 mg tablet
19 Aminofilin tablet 200 mg tablet
20 Amitriptilin HCl tablet salut 25 mg tablet
21 Amlodipin 10 mg tablet
24 Amoksisilin 500 mg tablet
25 Amoksisilin sirup kering 125 mg/5 ml Botol
27 Amoxicillin syr forte 250mg/ml botol
28 Antalgin injeksi 250 mg/ml-2ml ampul
29 Antasida DOEN tablet tablet
30 Antasida sirup Botol
31 (bacitrasin) Tube
33 Anti Haemoroid DOEN kombinasi Suppos
37 Aprazolam 0,5 mg tablet
41 Asam askorbat (Vit C) tablet 50 mg tablet
42 Asam Folat 0,4 mg /profolat tablet
43 Asam folat 1 mg tablet
44 Asam mefenamat 500 mg tablet
47 Asam Tranexamat tablet 500 mg tablet
64 Betahistin mesilat tablet
65 Betametason krim 0,1% Tube
67 Bisacodil (dulcolax) supp suppos
68 Bisacodil (dulcolax) tab tablet
69 Bisacodil supp infant 5 mg /Dulcolax Suppos
70 Bisoprolol 5 mg tablet
78 Captopril 12,5mg tablet
79 Captopril 25 mg tablet
85 Cefadroxil tablet
86 Cefadroxil syr forte 250mg/ml botol
87 Cefadroxyl syr 125 mg/ml Botol
88 Cefiksim syr kering 100mg/5ml btl 30ml
89 Cefixime 100mg tablet
93 Cetirizin 10 mg tablet
94 Cetirizin syr 5mg/5ml btl 60ml
96 Ciprofloxacin tablet 500 mg tablet
97 Clindamisin 300 mg tablet
102 Deksametason tablet 0,5 mg tablet
121 Domperidon 10 mg tablet
143 Fitomenadion (Vit K1) tablet 10 mg tablet
151 Furosemid tablet 40 mg tablet
153 Garam Oralit untuk 200 ml bungkus
159 Glibenklamid tablet 5 mg tablet
160 Glimepirid 1 mg tablet
162 Gliseril Guaiakolat tablet 100 mg tablet
213 Ketokonazol cream Tube
214 Ketokonazol tab tablet
227 Klorfeniramin maleat (CTM) tablet 4 mg tablet

232 Kolkisin 500 mcg tablet
258 Loperamid Hcl tablet
259 Loratadin 10mg tablet
266 Meloksikam 15 mg tablet
271 Methyl Prednisolon 8mg tablet
274 Metil prednisolon 4 mg tablet
278 Metronidazol 500 mg tablet
282 Mikonazol krim Tube
286 Multivitamin syr Botol
287 Multivitamin tab tablet
289 N-asetil sistein tablet
291 natrium Diklofenak 50 mg tablet
303 Omeprazole 20mg tablet
308 Papaverin tablet 40 mg tablet
314 Parasetamol tablet 500 mg tablet
411 Salbutamol tablet 2 mg tablet
415 Salisil bedak 2% bungkus
425 Simvastatin 10 mg tablet
434 Tablet Tambah darah tablet
440 Thiamin HCl (Vit B1) tablet 50 mg tablet
456 Vitamin B komplek tablet tablet
Tdk. Bayar BayarBPJSTrans

BKKBN
Lain2
Jumlah
Mengetahui,
............................................................
NIP. .....................................................
AIAN
Bula: Januari
Tahu: 2019
PEMAKAIAN TANGGAL Jumlah
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
30 10 15 30 20 105
-
-
-
-
20 20 30 50 70 30 220
-
-
-
-
70 40 40 150
1 1
-
-
-
-
-
-
30 10 10 50
-
20 10 30
2 2
-
-
-
-
-
10 10
-
-
-
-
-
30 60 10 20 60 20 20 220
-
-
-
40 40
-
-
-
-
-
-
10 30 40
30 30
-
10 10
20 10 30
10 10
-
-
90 200 160 80 530
10 20 60 90
50 40 40 130
-
3 1 1 5
-
50 30 20 100
20 50 70
60 20 40 10 130
10 5 130 220 10 60 435
-
50 60 80 30 60 10 290
20 20
-
40 20 20 70 30 20 200
-
-
50 40 10 50 150
......................., .................... 2018

Pengelola Obat,
.....................
.....................
..........
NIP. .............
.....................
...........
105
0
0
0
0
220
0
0
0
0
150
1
0
0
0
0
0
0
50
0
30
2
0
0
0
0
0
10
0
0
0
0
0
220
0
0
0
40
0
0
0
0
0
0
40
30
0
10
30
10
0
0
530
90
130
0
5
0
100
70
140
435
0
290
20
0
200
0
0
150
KODE PUSKESMAS :
1 2 3 1 2 3 4 5 6 7 8 9
181 Hiosin N Butil bromida tablet
199 Kalsium laktat (Klak) tablet 500 mg tablet
319 Permetrin krim 5% (Scabimite) tube
342 Pyridoksin HCL ( Vit B6 ) tab 10 mg tablet
345 Ranitidin tablet 150 mg tablet
466 Zinc tab 20 mg tablet
Tdk. Bayar Bayar BPJSTrans

BKKBN
Lain2
Jumlah
Mengetahui,
............................................................
NIP. .....................................................
MAKAIAN
Bula: Februari
Tahu: 2019
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
40 30 180 30 280
-
50 10 60 10 130
10 20 30
60 40 20 10 40 170
-
-
-
20 20
10 20 20 50
1 1
-
10 10
-
-
30 30
10 10
-
-
-
-
-
-
10 10
-
10 10 10 30
30 30
20 20
-
1 1
10 10
30 10 10 50
-
-
20 20 50 10 100
70 90 80 130 70 50 490
40 90 10 70 20 20 250
-
2 1 3
-
30 20 20 100 20 190
20 10 30
-
60 20 90 130 70 20 390
-
10 20 10 60 150 50 70 370
-
10 10
-
10 10
30 60 90 60 40 280
-
-
10 10 30 50
-
......................., .................... 2018

Pengelola Obat,
.....................
.....................
..........
NIP. .............
.....................
...........
KODE PUSKESMAS :
1 2 3 1 2 3 4 5 6 7 8 9 10
22 Amlodipin 5 mg tablet 310
44 Asam mefenamat 500 mg tablet 30
64 Betahistin mesilat tablet 10
65 Betametason krim 0,1% Tube 1
78 Captopril 12,5mg tablet 20
79 Captopril 25 mg tablet 10
122 Domperidon syr Botol
160 Glimepirid 1 mg tablet 10
179 Hidrokortison krim 2,5% Tube
214 Ketokonazol tab tablet 20
227 Klorfeniramin maleat (CTM) tablet 4 mg tablet 40

270 Metformin tablet
282 Mikonazol krim Tube 2
287 Multivitamin tab tablet 240
293 Nifedipin 10 mg tablet
411 Salbutamol tablet 2 mg tablet 10

BKKBN Lain2
Mengetahui,
............................................................
NIP. .....................................................
MAKAIAN
Bula: Maret
Tahu: 2019
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
30 50 40 20 310
-
50 50 410
10 10 20
70 140
-
-
-
10 10 50
10 20
1
10 30
10 20
-
-
10 40 250
-
20 80 190
-
-
-
-
-
20 30
-
-
4
20
10 30 80
-
-
-
10 130 100 550
-
-
-
2
240
20 10 30
-
-
120 110 610
-
100 100 130 20 690
-
-
10
-
40 60 50 30 220
-
110 70 30 230
30 40 10 80
-
Lain2 Jumlah
......................., .................... 2018

Pengelola Obat,
.....................
.....................
..........
NIP. .............
.....................
...........
768
1440
1207
KODE PUSKESMAS :
PUSKESMAS : Sungai Dareh Bula: April
KECAMATAN : Pulau Punjung Tahu: 2019
1 2 3 1 2 3 4 5 6 7 8 9 10
90 Cefotaxim 1,0 G inj Vial
92 Centrifuse Paket
95 Cimetidin tablet
157 Gentian violet larutan 1% Botol
222 Kloramfenikol salep Kulit Tube

268 Metanol 100 ml Botol
269 Metanol 1000 ml botol
272 mg tablet
465 Zinc syr botol

BKKBN
Lain2
Jumlah
Mengetahui,
............................................................
NIP. .....................................................
PEMAKAIAN
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
35 90 30 10 35 45 15 260
-
40 40 80 50 80 30 320
15 10 25
10 30 90 30 60 40 260
-
-
-
-
-
30 20 10 60
1 1
10 10
20 10 30
-
-
-
-
50 30 30 20 10 20 160
-
-
-
-
10 20 30 30 30 10 130
-
-
-
5 5
-
20 20
-
20 30 20 70
-
-
10 10
-
35 40 10 40 20 145
-
-
-
20 180 50 150 60 40 10 510
-
-
-
-
-
-
1 1 1 3
-
-
40 20 20 30 20 130
-
20 160 40 45 30 50 10 355
-
70 10 110 60 70 170 90 580
-
-
10 90 10 50 20 20 20 220
-
20 20
30 10 30 40 110
-
10 10
......................., .................... 2018

Pengelola Obat,
....................................................
NIP. .............................................
KODE PUSKESMAS :
1 2 3 1 2 3 4 5 6 7 8 9 10


BKKBN
Lain2
Jumlah
Mengetahui,
............................................................
NIP. .....................................................
MAKAIAN
Bula: Mei
Tahu: 2019
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
200 15 10 10 10 245
20 30 10 25 20 105
30 30
10 70 10 20 30 140
1 1
-
10 20 30
10 10
10 20 10 40
-
-
-
-
-
10 30 20 10 10 80
-
60 100 10 10 20 200
-
-
-
15 15
40 10 50
-
-
-
20 30 10 60
-
-
-
80 50 20 30 50 40 270
30 10 30 70
-
1 1
50 30 20 20 120
-
100 120 60 10 60 65 415
120 280 60 30 40 60 590
-
-
-
40 10 10 10 30 100
10 10
20 20
30 50 40 120
-
......................., .................... 2018

Pengelola Obat,
.....................
.....................
..........
NIP. .............
.....................
...........
REKAPITULASI PE
KODE PUSKESMAS :
1 2 3 1 2 3 4 5 6 7
166 Griseofulvin tablet 500 mg tablet

267 Mess pcs
301 Oksitetrasiklin HCl salep mata 1% Tube
438 Tetrasiklin HCL kapsul 500 mg tablet
439 Thiamfenikol 500 mg tab tablet
443 Trifluoperazin 5mg tablet
465 Zinc syr botol
Tdk. Bayar Bayar
Mengetahui,
............................................................
NIP. .....................................................
Bulan : Juni
Tahun : 2019
PEMAKAIAN TANGGAL
8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
95
60
10
20
1
10
130
20
10
50
20
30
110
130
160
20
30
10
10
50
BPJS Trans BKKBN Lain2 Jumlah
......................., .................... 2018

Pengelola Obat,
....................................................
NIP. .............................................
Jumlah
24 25 26 27 28 29 30 31
10 30 135
-
10 10
-
10 20 90
-
-
10
-
-
20 40
1
10 10
10 20
-
-
-
10 140
-
-
-
-
-
-
20 40
-
-
-
10
20 70
-
-
-
-
-
-
-
30 50
-
-
-
20 50
20 60 190
-
-
20 30 180
20 60 240
20
-
30
10 20
-
-
-
40 50
-
50
-
-
................... 2018
ola Obat,
...........................
...........................
REKAPITULAS
KODE PUSKESMAS :
1 2 3 1 2 3 4 5 6
183 Ibuprofen suspensi 100 mg/5 ml botol
184 Ibuprofen tablet 200 mg tablet

228 Klorfenol kamfer menthol (CHKM) Botol
229 Klorpromazin HCl inj 5 mg/ml - 1 ml ampul
230 Klorpromazin HCl tablet salut 100 mg tablet
231 Kodein HCl tablet 10 mg tablet
287 multivitamin tab ( vastral ) tablet
422 Sianokobalamin (Vit B12) inj 500mcg-ml ampul

Tdk. Bayar
Mengetahui,
............................................................
NIP. .....................................................
PEMAKAIAN TANGGAL
7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
10 20 40 30
70 60 90 95
10
40 10 20 30
1 1
30
10
10
1 2 1
10
10
10
10
1 1
20 40
1 2 1
14
40 20 30 30
10
10 10 10
29
20 50 40
20 90 20 50 80
20 40 10 25
100 90 50 160 180
30
10 50 100 20
10
10
20 40
40 30 70
10
Bayar BPJS Trans BKKBN Lain2 Jumlah

Bulan : Juli
Tahun : 2019
Jumlah
23 24 25 26 27 28 29 30 31
100
-
315
10
100
2
-
30
10
-
10
4
-
-
-
-
-
-
10
-
-
-
10
-
10
10
2
-
-
-
60
4
14
120
-
-
-
-
10
30
-
-
29
110
260
95
580
30
180
10
-
-
10
60
140
10
Jumlah
......................., .................... 2018

Pengelola Obat,
.................................
...................
NIP. .........................
....................
REKAPITU
KODE PUSKESMAS :
1 2 3 1 2 3 4 5 6
234 Kotrimoksazol tablet dewasa kombinasi tablet

236 Lansoprazole tablet
276 Metoclopramid 10 gr tablet
413 Salep 2-4 kombinasi pot
414 Salep luka bakar (Levertran) Tube
416 Seftriakson Injeksi vial
417 Seretide Diskus ih 100 mcg/puff botol
Seretide inhaler Kombinasi: salmeterol 25

419 mcg;flutikason propionat 50 mcg botol
420 Serum Anti Bisa Ular polivalen inj 5 ml vial
421 Serum Anti Tetanus inj 1500 IU/ampul ampul

423 Sianokobalamin tab 50 mcg tablet
424 Silk no.3/0 dengan jarum bedah set
426 spironolacton 25 mg tablet
428 Spritus Botol
429 Stomach tube FR 12 pcs
432 Strip asam urat (UA SURE) Botol
433 Sukralfat / Ulsidex tablet
435 Td Vial
436 Temporary stopping fletcher Set
437 Tetagam ampul
441 TKF botol
442 Tramadol inj ampul
444 Triheksiphenidil HCl tablet 2 mg tablet
445 Trombophop gel tube
446 TT Vial
447 Tube EDTA Box
448 Urin Bag pcs
451 Vaksin carrier pcs
452 Vaksin Rabies Vero kuur
453 Valsartan 160mg tablet
454 Vitamin A 100.000 IU tablet
457 White Tip Bks
458 wing needle 21 G pcs
462 Xylol Botol
463 Yellow Tip bks
464 Yodiol Test Botol
465 Zinc syr botol
Tdk. Bayar
Mengetahui,
............................................................
NIP. .....................................................
PEMAKAIAN TANGGAL
7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
Bayar BPJS Trans BKKBN Lain2
Bulan : Agustus
Tahun : 2019
Jumlah
23 24 25 26 27 28 29 30 31
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Jumlah
......................., .................... 2018

Pengelola Obat,
.................................
...................
NIP. .........................
....................
REKAPITU
KODE PUSKESMAS :
1 2 3 1 2 3 4 5 6
32 Anti Fungi DOEN Kombinasi Pot
53 Asiklovir tablet 200 mg tablet
95 Cimetidin tablet
150 Furosemid injeksi ampul
154 Gentamicin Salp Kulit Tube

315 Pembalut gips 3 inch Roll
318 PENTABIO Vial
320 Petidin inj 50mg/ml ampul
321 Piracetam inj 3g/15ml ampul
322 Pirantel tablet 125 mg tablet
323 Pirasetam 800mg tablet
324 Piroxicam 10 mg tablet
326 planotest pcs
327 Plester 5 yard x 2 inch roll
328 Plester bulat non woven box
329 Poli Kateter pcs
330 POLIO Vial
331 Pot Sputum Pcs
332 Povidon iodida 10% 30 ml Botol
335 Povidon Iodine 1 L Botol
336 Prednison tablet 5 mg tablet
337 Primakuin tablet 15 mg tablet
338 Prokain benzil penisilin vial
339 Propanolol HCl tablet 10 mg tablet
341 Propiltiourasil tablet 100 mg tablet
343 Ramipril tablet
344 Ranitidin inj. 25mg/ml ampul
346 Rapid Test (HIV 1 & 2 Anti Body) Box
Rapid Test (HIV 1 & 2 Anti Body)
347 oncoprobe test
348 Reagen (Bio-rad) Level 2 (Urine Kontrol) kit/ 12x12 ml

349 Reagen dan Bahan alat lab.Malaria paket
Reagen Fotometer Kimia Klinik Randox
350 Albumin kit
351 Glukosa kit
352 Reagen Fotometer Kimia Klinik Randox HDL kit

353 Kolesterol darah kit
354 Kreatinin kit
355 Reagen Fotometer Kimia Klinik Randox LDL kit

356 Protein total kit
357 SGOT kit
358 SGPT kit
359 total bilirubin kit
360 triglyserida kit
361 ureum kit
Reagen Fotometer Kimia Klinik Randox Uric
362 asid kit
Reagen hematology analyzer Cointender
363 20 SFRI Clair 31 btl 60ml
364 20 SFRI clean EZ 31 btl 60ml
365 20 SFRI cliner 31 btl 5 L
366 20 SFRI diluent 31 btl 20 L
367 20 SFRI Lyse 31 botol 500ml
368 Reagen Human Bilirubin Total Direct kit/ 12x12 ml
369 Reagen Human Cholesterol Kit/ 4x30 ml
370 Reagen Human Combina 11,S Kit/150 s
371 Reagen Human Creatinin Kit/ 200 ml
372 Reagen Human GOT kit/ 10x10 ml
373 Reagen Human GPT kit/ 10x10 ml
374 Reagen Human HDL Cholesterol kit/ 4 x 80 ml
Reagen Human Humatrol N (Serum
375 kontrol) Kit/ 6x5 ml
376 Reagen Human Test Ca/ Kalsium kit/ 200 ml
377 Reagen Human Test Glukosa darah kit/ 4x100 ml
378 Reagen Human Total Protein kit/ 4 x 100 ml
379 Reagen Human Triglycerides kit/ 9x15 ml
380 Reagen Human Urea Liquicolor kit/ 2x100 ml
381 Reagen Human Uric Acid Kit
Reagen kimia klinik potometer 5010
382 albumin - Rajawali 1000ml
Reagen kimia klinik potometer 5010 alkali
383 phospatase - Rajawali kit 10x10ml
Reagen kimia klinik potometer 5010 asam
384 urat - Rajawali kit 4x30ml
385 bilirubin T/D - Rajawali kit 2x100ml
Reagen kimia klinik potometer 5010 CK
386 NAC Activated - Rajawali kit 20x3ml
Reagen kimia klinik potometer 5010 CK-MB
387 - Rajawali kit 20x3ml
388 gamma GT - Rajawali kit 10x10ml
389 glukosa - Rajawali kit 4x100ml
390 haemoglobin - Rajawali kit 10x500ml
391 kalsium - Rajawali kit 2x100ml
392 kolesterol HDL - Rajawali kit
393 kolesterol LDL - Rajawali kit 80ml
394 kolesterol total - Rajawali kit 4x100ml
395 kreatinin - Rajawali btl 200ml
Reagen kimia klinik potometer 5010 LDH -
396 Rajawali kit 20X5ml
Reagen kimia klinik potometer 5010 SGOT
397 - Rajawali kit 20X5ml
Reagen kimia klinik potometer 5010 SGPT -
Reagen kimia klinik potometer 5010 total
399 protein - Rajawali btl 1000ml
400 trigliserida - Rajawali kit 4x100ml
401 UREUM - Rajawali kit 2x100ml
402 Reagen TB kit
403 Reagen widal H Vial
404 Reagen widal O Vial
405 Risperidon 1 mg tablet
407 RL larutan infus fls
408 Safety box pcs
409 Salbutamol inhalasi 100 mcq/dosis botol
410 Salbutamol nebulizer Kotak
Tdk. Bayar
Mengetahui,
............................................................
NIP. .....................................................
PEMAKAIAN TANGGAL
7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
Bulan : September
Tahun : 2019
Jumlah
23 24 25 26 27 28 29 30 31
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Jumlah
......................., .................... 2018

Pengelola Obat,
.................................
...................
NIP. .........................
....................
REKAPITU
KODE PUSKESMAS :
1 2 3 1 2 3 4 5 6
219 Klindamisin 150 mg tablet

Tdk. Bayar
Mengetahui,
............................................................
NIP. .....................................................
PEMAKAIAN TANGGAL
7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
Bulan : Oktober
Tahun : 2019
Jumlah
23 24 25 26 27 28 29 30 31
-
80 80 160
10 10
90 40 130
1 1
1 1 2
-
-
20 20
100 100
-
1 1
-
-
-
-
-
-
-
-
-
-
-
1 1
1 1
-
-
1 1
-
-
1 1
60 10 70
-
-
20 20
-
-
70 30 100
60 20 80
70 50 120
200 80 280
-
40 50 90
-
-
-
-
-
-
-
280 20 300
-
Jumlah
......................., .................... 2018

Pengelola Obat,
.................................
...................
NIP. .........................
....................
REKAPITU
KODE PUSKESMAS :
1 2 3 1 2 3 4 5 6
17 Ambroxol 30 mg tablet tablet
95 Cimetidin tablet
142 Fitomenadion (Vit K1) inj 10 mg/ml-1 ml ampul

223 Kloramfenikol salep mata 1 % Tube

Tdk. Bayar
Mengetahui,
............................................................
NIP. .....................................................
PEMAKAIAN TANGGAL
7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
Bulan : November
Tahun : 2019
Jumlah
23 24 25 26 27 28 29 30 31
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
Jumlah
......................., .................... 2018

Pengelola Obat,
.................................
...................
NIP. .........................
....................
REKAPITU
KODE PUSKESMAS :
1 2 3 1 2 3 4 5 6
1 Abochat 18 Pcs
2 Abochat 20 Pcs
3 Abochat 22 Pcs
4 Abochat 24 Pcs
5 Alat pemantau suhu pcs
6 Alat perekam suhu pcs
7 Alat suntik 10 ml pcs
8 Alat suntik 20 ml pcs
9 Alat suntik sekali pakai 1 ml Pcs
10 Alat suntik sekali pakai 2,5 ml / 3 ml Pcs
11 Alat suntik sekali pakai 5 ml Pcs
12 Albendazol syr 200mg/5 ml Botol
13 Albendazol tablet 400 mg tablet
14 Alkohol Swab sachet
16 Alprazolam 1 mg tablet
17 Ambroxol 30 mg tablet tablet
18 Aminofilin inj 24mg/ml-10 ml ampul
19 Aminofilin tablet 200 mg tablet
20 Amitriptilin HCl tablet salut 25 mg tablet
25 Amoksisilin sirup kering 125 mg/5 ml Botol
26 Amoniak btl/1000 ml
27 Amoxicillin syr forte 250mg/ml botol
28 Antalgin injeksi 250 mg/ml-2ml ampul
34 Anti Migren (ergotamin caffein) tablet
35 Anti Tuberkulosis Kategori I paket
36 Anti Tuberkulosis Kategori II paket
37 Aprazolam 0,5 mg tablet
38 Aqua pro injeksi steril bebas pirogen vial
39 Aquadest steril liter
40 Ari Sound Timer pcs
42 Asam Folat 0,4 mg /profolat tablet
43 Asam folat 1 mg tablet
45 Asam tranexamat inj 100 mg/ml ampul
46 Asam tranexamat inj 50mg/ml ampul
48 Asam Valproat 500mg / Depakote 500 mg tablet

Asam Valproat tab SR 250 Mg / Depakote
49 250 mg tablet
50 Asetosal 80 mg / Miniaspi tablet
51 Asetosal tablet 100 mg tablet
52 Asiklovir Krim 5 % 5 gr Tube
55 Atropin sulfat injeksi 0,25 mg/ml - 1 ml ampul

56 Attapulgit (Pularex) tablet
57 Azitromisin tab 500 mg tablet
58 Bahan tambalan gigi sementara (mix) Botol
59 BCG Vial
60 Benecheck Cholesterol strip Botol
61 Benecheck Glucose strip Botol
62 Benecheck uric strip Botol
Berotec 0,1 mg(Fenoterol HBr aerosol
63 100mcg/dosis) Btl
66 Bioplacenton tube
67 Bisacodil (dulcolax) supp suppos
68 Bisacodil (dulcolax) tab tablet
69 Bisacodil supp infant 5 mg /Dulcolax Suppos
70 Bisoprolol 5 mg tablet
71 Blood lancet pcs
72 Blue tip box
73 Box Slide bok
74 Bubuk Abate bks
75 Ca Glukonas ampul
76 Calcidor / Kalsium hidroksida pasta kotak
77 CAMPAK Vial
80 Cartridge Gen Expert Pcs
81 Catgut/benang bedah Chromic 2/0 set
82 Catgut/benang bedah Chromic 3/0 set
83 Catgut/benang bedah Plain 2/0 set
84 Catgut/benang bedah Plain 3/0 set
86 Cefadroxil syr forte 250mg/ml botol
87 Cefadroxyl syr 125 mg/ml Botol
88 Cefiksim syr kering 100mg/5ml btl 30ml
90 Cefotaxim 1,0 G inj Vial
Cendo Lyteers Kombinasi tts mata 2,5

mg/ml; NaCl 8,664 mg; kalium klorida 1,32
91 mg botol
92 Centrifuse Paket
95 Cimetidin tablet
98 Control CBC ST Plus-Normal-Diatron Vial/ 2,5 ml
99 Cuticell Classic pcs
100 Daryantulle sachet
101 Deksametason injeksi 5 mg/ml-1 ml ampul
103 DFI Cybow Box
104 DHP-Frimal tablet
105 Diazepam injeksi 5 mg/ml-2 ml ampul
106 Diazepam rektal 10 mg Suppos
107 Diazepam rektal 5 mg Suppos
108 Diazepam tablet 2 mg tablet
109 Diazepam tablet 5 mg tablet
110 Dietil karbamazin sitrat tablet 100 mg tablet
111 Difenhidramin HCl inj 10 mg/ml-1 ml ampul
112 Digoksin tablet 0,25 mg tablet
113 Diltiazem tablet tablet
114 Dimenhidrinat 50 mg tablet
115 Dirui BF 6500 SLS Kit/500 ml
116 Dirui BF Deterjen Kit/10 ml
117 Dirui BF Diluent 20 liter
118 Dirui BF FDO LYSE Kit/5 L
119 Dirui BF FDT LYSE Kit/500 ml
120 Doksisilin kapsul tablet
122 Domperidon syr Botol
123 D-Pieces smokerlyzer Box
124 DT Vial
125 EDTA 10 % Botol
126 Efedrin HCl tablet 25 mg tablet
127 Ekstrak Belladona tab 10 mg tablet
128 Epinefrin HCl /adrenalin inj.0,1%-1ml ampul
129 Eritromisin 250 mg tablet
130 Eritromisin 500 mg tablet
131 Eritromisin sirup kering Botol
132 Etakridin (rivanol) larutan 0,1% Botol
133 Etanol 70% Botol
134 Etanol 96% botol
135 Etil klorida spray Botol
136 Eugenol cairan Botol
137 Fe. Fumarat 300 mg Tablet
138 Fenitoin natrium kapsul 30 mg tablet
139 Fenobarbital inj 50 mg/ml - 2 ml ampul
140 Fenobarbital tablet 30 mg tablet
141 Fenolgliserol tetes telinga 10% Botol
142 Fitomenadion (Vit K1) inj 10 mg/ml-1 ml ampul

144 Fitomenadion inj 2 mg/ml ampul
145 Fluoksetin / Prestine tablet
146 Food Test - Borak Test Paket
147 Food Test - Formalin Test Paket
148 Food Test - Rhodamin Test Paket
149 Fouchet Botol
150 Furosemid injeksi ampul
152 Gabapentin/Alpentin 100 mg kapsul
155 Gentamisin inj ampul
156 Gentamisin tts mata botol
157 Gentian violet larutan 1% Botol
158 Glassionomer Cement (GC IX) / GC. Fuji Botol

163 Glukosa larutan Infus 10% steril fls
164 Glukosa Larutan Infus 5% steril fls
167 Haloperidol 5 mg tablet
168 Haloperidol inj 50mg/ml ampul
169 Haloperidol tablet 0,5 mg tablet
170 Haloperidol tablet 1,5 mg tablet
171 Handscoen Steril psg
172 Handscoend Obgyn psg
173 handscoon psg
174 HBSAG Strip pcs
175 HB-UNIJECT Vial
176 HCG Strip Pcs
177 Hidrochlorotiazid (HCT) tablet 25 mg tablet
178 Hidrogen Peroksida (H2O2) 3% Botol
180 Hiosin HBr Inj (Buscopan) 20 mg ampul
182 HIV test (R1) SD Pcs
183 Ibuprofen suspensi 100 mg/5 ml botol
186 ichtiol salep pot
187 Infusion set anak set
188 Infusion set dewasa set
189 Intec (One Step Anti-HIV 1&2) Box
190 IPV Vial
191 Isoniazid 100 mg/PPINH 100 mg tablet
192 Isoniazid tablet 300 mg tablet
193 Isosorbid dinitrat tablet sublingual 5 mg tablet

194 Jarum jahit / bedah no. 9 s/d 14 Pcs
195 Jelly Dopler btl
196 Jelly USG btl
197 Kaca Slide pcs
198 Kaca Tutup pcs
200 Kapas pembalut / absorben 250 g roll
201 Karbamazepin tablet 200 mg tablet
202 Kasa kompres 40/40 steril lbr
203 Kasa pembalut 2 m x 80 cm roll
204 Kasa pembalut elastis 3 inchi roll
205 Kasa pembalut elastis 4 inchi roll
206 Kasa Pembalut hidrofil 4 m x 10 cm elastis roll
207 Kasa Pembalut hidrofil 4 m x 5 cm elastis roll

208 Kasa steril 16/16 kotak
209 Kassa gulung Besar 80cm x 40 m roll
210 Kertas lakmus biru pack
211 Kertas Lakmus merah pack
212 Kertas pH Universal Kotak
215 Ketoprofen 100mg tablet
216 Ketoprofen Supp suppos
217 kit gol. Darah A, B, AB set
218 Kit gol. Darah Anti-D Kit
220 Klopidogrel 75 mg Tablet
221 Kloramfenikol kapsul 250 mg tablet
223 Kloramfenikol salep mata 1 % Tube
224 Kloramfenikol suspensi 125 mg/5 ml Botol
225 Kloramfenikol tetes telinga 3 % Botol
226 Kloramphenicol tts mata Botol

228 Klorfenol kamfer menthol (CHKM) Botol
229 Klorpromazin HCl inj 5 mg/ml - 1 ml ampul
230 Klorpromazin HCl tablet salut 100 mg tablet
231 Kodein HCl tablet 10 mg tablet
233 Kotrimoksazol suspensi kombinasi Botol
234 Kotrimoksazol tablet dewasa kombinasi tablet

235 Labstrip (urinalis) tube
236 Lansoprazole tablet
237 Lar. HCl 0,1 N Botol
238 Lar. Natrium Hipoklorid Botol/ 500ml
239 Lar. Ress Ecker Botol/ 100 ml
240 Lar.Na citrat Botol
241 Lar.Ph 7,2 Botol
242 Larutan Asam Asetat 6 % Botol
243 Larutan barium klorida Botol
244 Larutan benedict Botol
245 Larutan buffer Ph 6,1 Botol
246 Larutan eosin 2% Botol
247 Larutan giemsa stain Botol
248 Larutan H2O2 3% Botol 1 L
249 Larutan Hayem Botol
250 Larutan karbolfuksin Botol
251 Larutan metilen biru Botol
252 Larutan turk Botol
253 Larutan Wright Botol
254 Levofloksasin tetes mata 0,5% botol
255 Lidocain komp.inj ampul
256 Lidocain.inj ampul
257 Lisol Botol
260 Magnesium sulfat inj (IV) 20%-25 ml vial
261 Magnesium sulfat inj (IV) 40%-25 ml vial
262 Malaria test ktk
263 Masker pcs
264 Masker 3M N95 medikal respirator pcs
265 MDT MD Dewasa Paket
267 Mess pcs
272 mg tablet
273 Metil ergometrin maleat inj 0,200mg-1ml ampul

275 Metildopa 250mg tablet
277 Metoclopramid injeksi ampul
279 Metronidazol supositoria 500 mg suppos
280 Metronidazole ovula 500mg ovula
Microlit tips for micropipettes MT-up to 1
281 ml pack
283 Mineral Mix sachet
284 Minyak Imersi Botol
285 Mouth Pieces smokerlyzer Box
288 Napza Kit 5 Parameter ktk/10
290 Natrium bicarbonat tablet 500 mg tablet
292 Natrium klorida larutan infus 0,9% fls
294 Nistatin suspensi botol
295 Nistatin tablet salut 500.000 IU tablet
296 Nistatin tablet vaginal 100.000 IU/g tablet
297 OAT (Kombipak) anak paket
298 Obat anti malaria tablet
299 Obat batuk hitam (OBH) cairan Botol
300 Oksitetrasiklin HCl salep kulit 3% Tube
301 Oksitetrasiklin HCl salep mata 1% Tube
302 Oksitosin inj 10 IU / ml - 1 ml ampul
304 One ject 0,05 ml pcs
305 One ject 0,5 ml pcs
306 One ject 5 ml pcs
307 Pantocain tts mata btl
309 Parasetamol Drop Botol
310 Parasetamol rektal 125 mg (dumin) suppos
311 Parasetamol rektal 250 mg (dumin) suppos
312 Parasetamol sirup 120mg/ml Botol
318 PENTABIO Vial
320 Petidin inj 50mg/ml ampul
321 Piracetam inj 3g/15ml ampul
322 Pirantel tablet 125 mg tablet
323 Pirasetam 800mg tablet
326 planotest pcs
327 Plester 5 yard x 2 inch roll
328 Plester bulat non woven box
329 Poli Kateter pcs
330 POLIO Vial
331 Pot Sputum Pcs
335 Povidon Iodine 1 L Botol
336 Prednison tablet 5 mg tablet
337 Primakuin tablet 15 mg tablet
338 Prokain benzil penisilin vial
341 Propiltiourasil tablet 100 mg tablet
343 Ramipril tablet
344 Ranitidin inj. 25mg/ml ampul
346 Rapid Test (HIV 1 & 2 Anti Body) Box
Rapid Test (HIV 1 & 2 Anti Body)
347 oncoprobe test
348 Reagen (Bio-rad) Level 2 (Urine Kontrol) kit/ 12x12 ml

349 Reagen dan Bahan alat lab.Malaria paket
350 Albumin kit
351 Glukosa kit
352 Reagen Fotometer Kimia Klinik Randox HDL kit

353 Kolesterol darah kit
354 Kreatinin kit
355 Reagen Fotometer Kimia Klinik Randox LDL kit

356 Protein total kit
357 SGOT kit
358 SGPT kit
359 total bilirubin kit
360 triglyserida kit
361 ureum kit
Reagen Fotometer Kimia Klinik Randox Uric
362 asid kit
363 20 SFRI Clair 31 btl 60ml
364 20 SFRI clean EZ 31 btl 60ml
365 20 SFRI cliner 31 btl 5 L
366 20 SFRI diluent 31 btl 20 L
367 20 SFRI Lyse 31 botol 500ml
368 Reagen Human Bilirubin Total Direct kit/ 12x12 ml
369 Reagen Human Cholesterol Kit/ 4x30 ml
370 Reagen Human Combina 11,S Kit/150 s
371 Reagen Human Creatinin Kit/ 200 ml
372 Reagen Human GOT kit/ 10x10 ml
373 Reagen Human GPT kit/ 10x10 ml
374 Reagen Human HDL Cholesterol kit/ 4 x 80 ml
Reagen Human Humatrol N (Serum
375 kontrol) Kit/ 6x5 ml
376 Reagen Human Test Ca/ Kalsium kit/ 200 ml
377 Reagen Human Test Glukosa darah kit/ 4x100 ml
378 Reagen Human Total Protein kit/ 4 x 100 ml
379 Reagen Human Triglycerides kit/ 9x15 ml
380 Reagen Human Urea Liquicolor kit/ 2x100 ml
381 Reagen Human Uric Acid Kit
382 albumin - Rajawali 1000ml
Reagen kimia klinik potometer 5010 alkali
383 phospatase - Rajawali kit 10x10ml
Reagen kimia klinik potometer 5010 asam
384 urat - Rajawali kit 4x30ml
385 bilirubin T/D - Rajawali kit 2x100ml
Reagen kimia klinik potometer 5010 CK
386 NAC Activated - Rajawali kit 20x3ml
Reagen kimia klinik potometer 5010 CK-MB
387 - Rajawali kit 20x3ml
388 gamma GT - Rajawali kit 10x10ml
389 glukosa - Rajawali kit 4x100ml
390 haemoglobin - Rajawali kit 10x500ml
391 kalsium - Rajawali kit 2x100ml
392 kolesterol HDL - Rajawali kit
393 kolesterol LDL - Rajawali kit 80ml
394 kolesterol total - Rajawali kit 4x100ml
395 kreatinin - Rajawali btl 200ml
Reagen kimia klinik potometer 5010 LDH -
Reagen kimia klinik potometer 5010 SGOT
397 - Rajawali kit 20X5ml
Reagen kimia klinik potometer 5010 SGPT -
Reagen kimia klinik potometer 5010 total
399 protein - Rajawali btl 1000ml
400 trigliserida - Rajawali kit 4x100ml
401 UREUM - Rajawali kit 2x100ml
402 Reagen TB kit
403 Reagen widal H Vial
404 Reagen widal O Vial
407 RL larutan infus fls
408 Safety box pcs
409 Salbutamol inhalasi 100 mcq/dosis botol
410 Salbutamol nebulizer Kotak
413 Salep 2-4 kombinasi pot
414 Salep luka bakar (Levertran) Tube
416 Seftriakson Injeksi vial
Seretide inhaler Kombinasi: salmeterol 25

419 mcg;flutikason propionat 50 mcg botol
420 Serum Anti Bisa Ular polivalen inj 5 ml vial
421 Serum Anti Tetanus inj 1500 IU/ampul ampul
423 Sianokobalamin tab 50 mcg tablet
424 Silk no.3/0 dengan jarum bedah set
426 spironolacton 25 mg tablet
428 Spritus Botol
432 Strip asam urat (UA SURE) Botol
433 Sukralfat / Ulsidex tablet
435 Td Vial
436 Temporary stopping fletcher Set
437 Tetagam ampul
441 TKF botol
442 Tramadol inj ampul
444 Triheksiphenidil HCl tablet 2 mg tablet
445 Trombophop gel tube
446 TT Vial
447 Tube EDTA Box
448 Urin Bag pcs
451 Vaksin carrier pcs
452 Vaksin Rabies Vero kuur
453 Valsartan 160mg tablet
457 White Tip Bks
462 Xylol Botol
463 Yellow Tip bks
464 Yodiol Test Botol
465 Zinc syr botol
Tdk. Bayar
Mengetahui,
............................................................
NIP. .....................................................
PEMAKAIAN TANGGAL
7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
Bulan : Desember
Tahun : 2019
Jumlah
23 24 25 26 27 28 29 30 31
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Jumlah
......................., .................... 2018

Pengelola Obat,
.................................
...................
NIP. .........................
....................

Lansia Alda 2019

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Rekapitulasi Stok Obat, Reagen dan Perbekkes Instalasi Gudang Farmasi 29 Desember 2017

No Nama Satuan SD Sia Slg

1 Abochat 18 Pcs - 160 153

127 - 187 45 91 65 105 260 141 470

- 200 100 - 230 100 - - - -

123 151 201 - 189 93 77 64 223 -

80 596 - - - 100 - 200 500 -

205 - 150 - - 190 - - - 160

- 273 - 310 1,010 330 165 - 1,320 50

284 100 200 183 63 195 86 377 79 65

200 374 30 245 397 90 480 435 - 400

No. Nama Sediaan Satuan Stok Awal Penerimaan Persediaan

227 Klorfeniramin maleat (CTM) tablet 4 mg tablet 235 235

234 Kotrimoksazol tablet dewasa kombinasi tablet 100 100

422 Sianokobalamin (Vit B12) inj 500mcg-ml ampul - -

Tdk. Bayar Bayar BPJS Trans

BKKBN Lain2 Jumlah

......................., .................... 2018

No. Nama Sediaan Satuan Stok Awal Penerimaan Persediaan

15 Allopurinol 100 mg tablet 185 500 685

227 Klorfeniramin maleat (CTM) tablet 4 mg tablet 205 205

234 Kotrimoksazol tablet dewasa kombinasi tablet 100 100

Tdk. Bayar Bayar BPJS Trans

BKKBN Lain2 Jumlah

......................., .................... 2018

No. Nama Sediaan Satuan Stok Awal Penerimaan Persediaan

15 Allopurinol 100 mg tablet 405 650 1055

227 Klorfeniramin maleat (CTM) tablet 4 mg tablet 155 300 455

Tdk. Bayar Bayar BPJS Trans

80 375 128 -247

BKKBN Lain2 Jumlah

......................., .................... 2018

No. Nama Sediaan Satuan Stok Awal Penerimaan Persediaan

15 Allopurinol 100 mg tablet 745 745

48 Asam Valproat 500mg / Depakote 500 mg tablet - 0

55 Atropin sulfat injeksi 0,25 mg/ml - 1 ml ampul - 0

193 Isosorbid dinitrat tablet sublingual 5 mg tablet - 0

227 Klorfeniramin maleat (CTM) tablet 4 mg tablet 375 375

Tdk. Bayar Bayar BPJS Trans

145 230 232 2 1230

BKKBN Lain2 Jumlah

......................., .................... 2018

158 Glassionomer Cement (GC IX) / GC. Fuji Botol - 0 - 0 0 0

Tdk. Bayar Bayar BPJS Trans BKKBN Lain2 Jumlah

Mengetahui, ......................., .................... 2018

No. Nama Sediaan Satuan Stok Awal Penerimaan Persediaan

15 Allopurinol 100 mg tablet 540 540

227 Klorfeniramin maleat (CTM) tablet 4 mg tablet 170 200 370

234 Kotrimoksazol tablet dewasa kombinasi tablet 100 100

Tdk. Bayar Bayar BPJS Trans

70 300 112 -188

BKKBN Lain2 Jumlah

......................., .................... 2018

No. Nama Sediaan Satuan Stok Awal Penerimaan Persediaan

15 Allopurinol 100 mg tablet 405 405

158 Glassionomer Cement (GC IX) / GC. Fuji Botol - 0

227 Klorfeniramin maleat (CTM) tablet 4 mg tablet 300 300

234 Kotrimoksazol tablet dewasa kombinasi tablet 100 100

Tdk. Bayar Bayar BPJS Trans