PERSEDIAAN SISA STOK STOK

NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 OPTIMUM

2 3 4 5 6 7 8 9 10 11 12

Kombipak paket
0 0 -20.00%

UMUM BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP

Mengetahui / menyetujui : Yang Menyerahkan : Kepala Puskesmas Yang Menerima

Kepala Dinas Kesehatan an. Kepala PPF & PK Petugas Puskesmas
Kabupaten Melawi Dinas Kesehatan
c/q Kabid Pelayanan dan Kabupaten Melawi
Sumber Daya Kesehatan

dr. Tanjung Harapan Heru Priyono Dedi, A.Md.Kep

NIP 19740804 200502 1 002 Nip. 19670202 198803 1 011 Nip. 19791125 200904 1 001
 LAPORAN PEMAKAIAN

PUSKESMAS : Manding
KECAMATAN : Pinoh Utara
KABUPATEN / KOTA : Melawi
PROVINSI : Kalimantan Barat

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

### 2 3 4 5

###
Acyclovir 200mg tab

###
Acyclovir 400mg tab 100 500

###
Alopurinol tablet 100 mg tab 2170

###
Albendazole tab 400mg tab
0

###
Aminofilin tablet 200 mg tab

###
Amitriptilin HCl tablet salut 25 mg tab
400

###
Ambroxol 30mg tab tab

###
Amlodipin tab 10mg tab
30 300

###
Amoksisilin kapsul 250 mg kaps
0

###
Amoksisilin kaplet 500 mg kapl
3000 3000

###
Ampisilin 500 mg tab
700

###
Antalgin (Metampiron) tablet 500 mg tab
100 0

###
Antasida DOEN I tablet kunyah tab
0 4000

###
Antimigren: Ergotamin + Kofein tab
0

###
Antiparkinson:Karbidopa + Levodopa tab
###
Asam Askorbat (Vit C) tablet 50 mg tab

###
Asetosal tablet 100 mg tab
0

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

### 2 3 4 5

###
Asetosal tablet 500 mg tab
0

###
Atropin Sulfat tablet 0,5 mg tab

###
Atenolol tab 50mg tab

###
Asam Mefenamat 500 mg kapl
3000 1500

###
Azitromicyn 500mg tab
50

###
Anaflu tab
0

###
Betahistin tab 6 mg tab
1510 0

###
Bisoprolol tab 5 mg tab
500 0

###
Bromheksin tab tab
0 0

###
Calcium Laktat (Kalk) Tab 500mg tab
2010 1500

###
Captopril 12,5 mg Tab tab

###
Captopril 25 mg tab tab
2155 2000

###
Captpril 50 mg tab tab

###
Carbamazepin Tab 200 mg tab

###
Cimetidin Tab tab

###
Ciprofloxacin 500 mg kapl
2630 1000

###
Clindamisin kaps 300mg kaps
4050 0
###
Clindamisin kaps 150 mg Kaps

###
Chloramfenikol Kapsul 250 mg kaps

###
Chlorfeniramin Maleat (CTM) tab 4 mg tab
2145 1000

###
Chlorpromazin HCL Injeksi 5 mg/ml-2ml amp

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

### 2 3 4 5

###
Chlorpromazin HCL Injeksi 25 mg/ml amp

###
Chlorpromazin HCL Tablet Salut 100 mg tab
160

###
Chlorpromazin HCL Tablet Salut 25 mg tab

###
Cotrimoksazol dewasa 480mg tab
3900 500

###
Cotrimoksazol forte dewasa 960mg tab
120

###
Deksametason tablet 0,5 mg tab
0 3000

###
Dekstrometorfan sirup 10 mg/5 ml botol

###
Dekstrometorfan tablet 15 mg tab

###
Diazepam injeksi 5 mg/ml - 2 ml amp
29

###
Diazepam tablet 2 mg tab

###
Diazepam tablet 5 mg tab
260 500

###
Digoksin tablet 0,25 mg tab

###
Domperidon tab tab
0 2000

###
Erytromisin Kapsul 500 mg kaps
1100 1000

###
Erytromisin Kapsul 250 mg kaps
0
###
Extract Belladona tab 10mg tab

###
Ethambutol HCl tab 500 mg tab

###
Famotidine tab 20mg tab

###
Furosemid tablet 40 mg tab
600 1000

###
Fenobarbital injeksi 50 mg/ml - 1 ml amp

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

### 2 3 4 5

###
Fenobarbital tablet 100 mg tab

###
Fenobarbital tablet 30 mg tab
90 0

###
Folid Acid 1 mg tab
0

###
Garam Oralit untuk 200 ml air sach
100 100

###
Gemfibrozil 300 mg kaps kaps
180 0

###
Glibenklamid tablet 5 mg tab

###
Glimepiride 1 mg tab
500

###
Glimepiride 2 mg tab

###
guaifenisin tab
0 3000

###
Griseofulvin tablet 125 mg, micronized tab
0 500

###
Hidroklorotiazid (HCT) tablet 25 mg tab
0 1000

###
Haloperidol tablet 0,5 mg tab

###
Haloperidol tablet 1,5 mg tab

###
Haloperidol tablet 5 mg tab
630 0
###
Ibuprofen tablet 200 mg tab

###
Ibuprofen tablet 400 mg tab
300 3000

###
Isoniazid tab 300 mg tab

###
Isosorbid Dinitrat tablet sublingual 5 mg tab

###
Kombinasi Pirimetamin 25 mg + Sulfadoxin tab

###
Kuinin (Kina) tablet 200 mg tab

###
Ketokonazol 200 mg tab
100 900

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

### 2 3 4 5

###
Lansoprazole 30mg Kaps
4840 0

###
Levofloxacin kapl 500mg kapl
200 1000

###
Linkomisin kaps 500mg kaps

###
Loratadin Tablet 10 mg tab
360

###
Loperamid tab 2mg tab
100

###
Malarex tab

###
Metronidazol tablet 250 mg tab

###
Metronidazol tablet 500 mg tab
500 1000

###
Mebendazole Tab 500mg tab

###
Meloxicam 7,5 mg tab tab

###
Meloxicam 15 mg tab tab

###
Metformin HCL tab 500mg tab
0
###
Metilergometrin Maleat tablet salut 0,125 tab

###
Metilprednisolon 4 mg tab
100 3000

###
Metoclorpamid 10 mg tab tab
1200 0

###
Natrium Diklofenak 25 mg tab

###
Natrium Diklofenak 50 mg tab

###
Neo Diagon tab
200 500

###
Nistatin tablet salut 500.000 IU tab
400 0

###
Nistatin tablet vaginal 100.000 IU/g tab
90 0

###
Nifedipin tab 10mg tab

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

### 2 3 4 5

###
Ofloksasin 400mg tab
100

###
Omeprazole Kaps 20 mg Kaps
0 1500

###
Parasetamol tablet 100 mg tab
700 0

###
Parasetamol tablet 500 mg tab
2500 4000

###
Ondansetron tab
648

###
Phenoksimetil Penisilina tablet 500 mg tab

###
Phitomenadion (Vit.K1) tablet salut gula 10 tab
1600

###
Piridoksin HCl (Vit.B6) tablet 10 mg tab
200 0

###
Pirazinamid tab tab
1000

###
Piroxicam kaps 10 mg kaps
100 3000
###
Piroxicam kaps 20 mg kaps
0

###
Prednison tablet 5 mg tab
0 2000

###
Primakuin tablet 15 mg tab
3000 0

###
Propiltiourasil tablet 100 mg tab

###
Pirantel tablet 125 mg tab
800

###
Propranolol HCl tablet 40 mg tab
900

###
Ranitidin tab 150 mg tab
700

###
Rifampicin 450 mg kaplet kapl

###
Risperidon 1 mg tab

###
Risperidon 2 mg tab
1000

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

### 2 3 4 5

###
Salbutamol tab 2 mg tab

###
Salbutamol tab 4 mg tab
3500 0

###
Sefadroksil kaps 500mg kaps
0 2500

###
Sefiksim kaps 100mg kaps
0 4000

###
Setrizin kaps 10mg Kaps
1300 1500

###
Syanocobalamin tab 10 mg tab

###
Spironolacton 25mg tablet tab
2500

###
Simvastatin 10mg tab tab
3420

###
Simvastatin 20mg tab tab
###
Tablet Tambah Darah kombinasi / Besi Ferro tab

###
thyrozol kaps
990

###
Tetrasiklin HCl kapsul 500 mg kaps

###
Tiamin HCl / Mononitrat (Vit.B1) tablet 50 tab
100 3000

###
Urinter kaps
100 1000

###
Tramadol kapsul kaps
10 500

###
Triheksifenidil Hidroklorida tablet 2 mg tab
500

###
Vitamin B Kompleks tablet tab
1000 3000

###
Retinol ( Vitamin A ) 100.000 IU Kapsul luna Kaps

###
Retinol ( Vitamin A ) 200.000 IU Kapsul Luna Kaps

###
Zink tab dispersible 20 mg tab
900 1000

INJEKSI

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

### 2 3 4 5

###
Aminofilina Injeksi 24 mg/ml -10 ml amp

###
Ampisillin Inj vial

###
Antalgin Injeksi 250 mg/ml - 2 ml amp

###
Aqua Pro injeksi Steril 25 ml vial
20

###
Aqua Pro injeksi Steril 50 ml

###
Asam Traneksamat injeksi 50mg/ml amp

###
Atropin Sulfat Injeksi 0,25 mg/ml -1 ml amp
###
Cefotaxime serbuk injeksi 500mg vial

###
Dexamethasone injeksi 5 mg/ml-1ml amp

###
Difenhidramin HCL Inj 10mg/ml-1ml amp

###
Epineprine HCL 0,1% -1ml amp

###
Fitomenadion (Vit K1) Injeksi 10mg/ml-1ml amp
21

###
Gentamisin Injeksi amp

###
Haloperidol Inj 50mg/ml 1 ml amp

###
Kuinin Dihidroklorida Injeksi 25% - 2 ml amp

###
Lidokain inj 2%(HCL) + Epineprin 1:80.000 -2 amp
12 30

###
Metilergometrin Maleat Injeksi amp
63

###
Metoklorpamide Inj amp

###
Magnesium Sulfat inj (IV) 20% - 25 ml vial

###
Magnesium Sulfat inj (IV) 40% - 25 ml vial

###
Oksitetrasiklin HCL Injeksi i.m 50mg/ml-10m vial

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

### 2 3 4 5

###
Oksitosin Injeksi 10 IU/ml-1ml amp
32

###
Sianokobalamin (Vit.B12) injeksi 500 mcg-m amp
15 100

###
Streptomycin Sulfat Serbuk inj 1000 mg / via vial

###
Thiamin HCL Injeksi 100mg/ml-1ml amp

###
Tramadol injeksi 50mg/ml amp
###
Ranitidin Injeksi amp

SYRUP

###
Amoksisilin sirup kering 125 mg/5ml botol
0

###
Amoksisilin sirup kering 250 mg/5ml botol
0 50

###
Ampisillin syrup kering botol

###
Antasida Syrup botol
0 50

###
Ambroxol Syr botol

###
Domperidon suspensi 5mg/5ml botol
0 50

###
Erithromicyn Syr botol

###
Ibuprofen suspensi 100mg/5ml botol
50

###
Kloramphenokol Suspensi 125mg/5ml botol

###
Kotrimoksazol Suspensi Komb botol

###
Obat Batuk Hitam (OBH) cairan botol
60 120

###
Paracetamol Syrup 120mg/5ml botol
100 100

###
Paracetamol drop 100mg btl@15ml botol
144 0

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

### 2 3 4 5

###
Pirantel Suspensi 125mg/5ml botol 60 ml
0

###
Pirantel Suspensi 125mg/5ml botol 10 ml

###
Salbutamol sirup 2mg/5ml botol

###
Sefadroksil sirup kering 125mg/5ml botol
0 60
###
Setrizin sirup 5mg/5ml botol
0 60

###
Zink Sirup 10mg/ml botol
0

###
Interzinc syr botol
0 24

###
Gralisin syr botol

###
Metoklorpamide syr botol

###
Sulcralfat syr botol
0 25

###
Thiampenicol syr botol

OBAT LUAR / SALEP

###
Acyclovir Cream tube
15 0

###
Anti Bakteri DOEN salep,Basitrasin Cr tube
27 25

###
Anti Hemoroid DOEN Kombinasi supp

###
Antifungi DOEN :As. Benzoat + As. Salisilat pot
7

###
Betametason krim 0.1% tube
0 50

###
Chloramfenikol Tetes telinga 3% botol

###
Chloramfenikol Salep Mata 1 % tube

###
Fenol Gliserin tetes telinga 10% botol
0 24

###
Gentian Violet larutan 1 % pot
8 24

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

### 2 3 4 5

###
Gentamisin Salep 0,3 salep Mata tube
0 48

###
Gentamisin Sulfat tetes Mata botol
0 48
###
Hidrokortison krim 2,5 % tube
3 48

###
Isotik tetes Mata botol
0 24

###
Ketokonazol Cream tube
25 50

###
Gentamisin Salep 0,1 salap kulit tube
0 30

###
Oksitetrasiklin HCl salep mata 1 % tube

###
Salep 2-4 pot
15

###
Mikonazol krim 2 % tube
5 24

###
Zolacord kream tube

###
Salisil Bedak 2 % pcs
13 20

###
Berlison N tube

INFUS

###
Dekstran 70 - larutan infus 6% steril botol

###
Glukosa larutan infus 10 % steril (Produk lok botol

###
Glukosa larutan infus 40 % steril (Produk lok botol

###
Glukosa larutan infus 5 % steril (Produk lokal botol

###
Natrium Klorida infus 0,9 % steril (Produk lok botol
11 20

###
Ringer Laktat larutan infus steril (Produk loka botol
68 0

OBAT GIGI

###
Ethyl Chlorid Spray botol
1

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

### 2 3 4 5
###
Eugenol cairan botol

###
Glass - Ionomer cement ( gc ix ) set

###
Sement seng fosfat serbuk & cairan set

###
Monoklorkamfer/Klorfenol kamfer Menthol set

###
Mummifying Pasta set

###
Temporary Stopping Fletcher serbuk dan cai set

###
Kalium Hidroksida Pasta box

###
Devitalisasi pasta /non arsen btl 2gr

###
Lidocain spray botol

BAHAN HABIS PAKAI

###
Alat suntik sekali pakai 0.05 ml pcs
75

###
Alat suntik sekali pakai 0.5ml pcs
1600

###
Alat suntik sekali pakai 1 ml pcs
87

###
Alat suntik sekali pakai 2,5 ml pcs

###
Alat suntik sekali pakai 3 ml pcs
0 200

###
Alat suntik sekali pakai 5 ml pcs
123

###
TP Disposable Syringe 1ml pcs

###
Aqua Gel sachet
0 300

###
Aximed 10x10cm non Woioven pcs
5

###
Aximed 5x10cm non Woioven rol
5 20

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

### 2 3 4 5

###
Catgut No. 2/0 dgn jarum bedah pcs
0

###
Catgut No. 3/0 dgn jarum bedah pcs

###
Catgut Chromic W/O Needle 2/0 pcs
10

###
Catgut Chromic W/O Needle 3/0 pcs
23

###
Etakridin ( Rivanol ) larutan 0,1% 300ml botol

###
Etanol 70% 100 ml botol
9 12

###
Etanol 70% 1000 ml botol

###
Foley Catheter No. 16 pcs
7 0

###
Foley Catheter No. 18 pcs
6 0

###
Handscoon 7.5 pcs
160

###
Handscoon 7 pcs
200

###
Handscoon uk S pcs
0 1000

###
Handscoon uk M pcs
100 1000

###
Infusion set anak pcs
23

###
Infusion set dewasa pcs
4

###
Infus set type-Y pcs

###
IV Catheter No.20 G pcs
6 0

###
IV Catheter No. 22 G pcs
38 50

###
IV Catheter No. 24 G pcs
6 50

###
Jelco 20G pcs

###
Jelco 22G pcs
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

### 2 3 4 5

###
Jelco 24G pcs

###
IV. Chateter trovensity Safety Plus 20G pcs

###
IV. Chateter trovensity Safety Plus 22G pcs

###
IV. Chateter trovensity Safety Plus 24G pcs

###
Kapas Berlemak 500 gram rol

###
Kapas Pembalut / Absorben 250 gram rol

###
Kasa Pembalut 4 x 10 elastis buah

###
Kasa Pembalut Hidrofil 4 m x 3 cm non elasti buah

###
Kasa Pembalut Hidrofil 4 m x 5 cm non elasti buah

###
Kasa Pembalut Hidrofil 4 m x 10 cm non elas buah
40

###
Kasa Pembalut Hidrofil 4 m x 15 cm non elas buah
15

###
kasa steril 16x16 buah
48

###
Kasa Pembalut 18mx22cm pcs

###
Kasa Kompres steril 40 x 40 cm buah
100 100

###
Lysol botol

###
Masker buah
4800

###
Micropore 2 inch/5cmx9,1m buah
18

###
Polifix 10cm x 5m roll
5

###
Polifix 5cm x 1m roll
###
Povidon Iodida larutan 10 % botol 30 ml
20

###
Povidon Iodida larutan 10 % botol 60 ml

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

### 2 3 4 5

###
Povidon Iodida larutan 10 % btl 300 ml

###
Plester 5 yards x 2 inch Zinc oxide roll

###
Pembalut Elastis Policrepe 7,5 cm x 4,55 roll

###
Safety box roll

###
Silk ( Benag Bedah Sutera ) No 3 / 30 pcs
55

###
Soft Cloth on 10 cm x 10 m kotak

###
Urin Bag pcs
12

###
Masflu tab tab

###
Pularex tab tab

###
Samcobion tab tab

VITAMIN

###
Hemafort tab

###
Pehavral tab

###
Betafort syr botol

###
Becefort syr botol

###
Geriavita tab tab

OBAT PROGRAM TB
###
Kategori Anak paket

###
Kategori I paket

###
Kategori II paket

###
Kategori Sisipan paket

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN

### 2 3 4 5

###
Kombipak paket

UMUM
JUMLAH KUNJUNGAN RESEP

Mengetahui / menyetujui : Yang Menyerahkan :

Kepala Dinas Kesehatan an. Kepala PPF & PK
Kabupaten Melawi Dinas Kesehatan
c/q Kabid Pelayanan dan Kabupaten Melawi
Sumber Daya Kesehatan

dr. Tanjung Harapan

NIP 19740804 200502 1 002
RAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

PERSEDIAAN SISA STOK STOK OPTIMUM

PEMAKAIAN PERMINTAAN
4+5 6-7 7 + 10-20%
6 7 8 9 10

0 Err:522 Err:522 Err:522

500
600 100 59980.00% 500

2170 270 1900 26980.00%

0 Err:522 Err:522 Err:522

0 Err:522 Err:522 Err:522

400 Err:522 Err:522 Err:522

0 Err:522 Err:522 Err:522 2000

330 30 300 2980.00%

0 Err:522 Err:522 Err:522

6000 4700 1300 469980.00% 0

700 700 0 69980.00%

100 30 70 302980.00% 3000

4000 0 4000 399980.00% 4000

0 Err:522 Err:522 Err:522 500

0 Err:522 Err:522 Err:522

 0 Err:522 Err:522 Err:522

0 Err:522 Err:522 Err:522

PERSEDIAAN SISA STOK STOK

PEMAKAIAN PERMINTAAN
4+5 6-7 OPTIMUM

6 7 8 9 10

0 0

0 0

0 0

4500 3000 1500 4499.8 1500

50 10 40 9.8

0 0 1999.8 2000

1510 110 1400 109.8

500 350 150 349.8

0 0 0 2999.8 3000

3510 1510 2000 3009.8 1500

0 0 -0.2

4155 2255 1900 4254.8 2000

0 0 -0.2

0 0 -0.2

0 0 -0.2

3630 130 3500 1129.8 1000

4050 0 4050 -0.2

 0 0 -0.2

0 0 -0.2

3145 -55 3200 944.8 1000

PERSEDIAAN SISA STOK STOK

PEMAKAIAN PERMINTAAN
4+5 6-7 OPTIMUM

6 7 8 9 10

0 0

160 0 160 -20.00%

0 0

4400 455 3945 115480.00% 700

120 0 120 -20.00%

3000 0 3000 199980.00% 2000

0 0

0 0

29 0 29

0 0

760 0 760 -20.00%

0 0

2000 0 2000 99980.00% 1000

2100 965 1135 146480.00% 500

0 0
 0 0

0 0

0 0

1600 0 1600 49980.00% 500

0 0

PERSEDIAAN SISA STOK STOK

PEMAKAIAN PERMINTAAN
4+5 6-7 OPTIMUM

6 7 8 9 10

0 0

90 0 90 -20.00%

0 0 -20.00%

200 0 200 -20.00%

180 0 180 -20.00%

0 0

500 0 500

0 0

3000 0 3000 199980.00% 2000

500 0 500 49980.00% 500

1000 0 1000 -20.00%

0 0 -20.00%

0 0 -20.00%

630 30 600 2980.00%

 0 0

3300 300 3000 179980.00% 1500

0 -20.00%

0 0 49980.00% 500

0 0 -20.00%

0 0 -20.00%

1000 50 950 94980.00% 900

PERSEDIAAN SISA STOK STOK

PEMAKAIAN PERMINTAAN
4+5 6-7 OPTIMUM

6 7 8 9 10

4840 190 4650 218980.00% 2000

1200 50 1150 4980.00%

0 0 -20.00%

360 280 80 27980.00%

100 0 100 49980.00% 500

0 0 -20.00%

0 0 -20.00%

1500 0 1500 49980.00% 500

0 0 -20.00%

0 0 99980.00% 1000

0 0 299980.00% 3000

0 0 -20.00%
 0 0 -20.00%

3100 17 3083 1680.00%

1200 0 1200 -20.00%

0 0 399980.00% 4000

0 0 199980.00% 2000

700 0 700 -20.00%

400 0 400 -20.00%

90 0 90 -20.00%

0 0

PERSEDIAAN SISA STOK STOK

PEMAKAIAN PERMINTAAN
4+5 6-7 OPTIMUM

6 7 8 9 10

100 0 100 -20.00%

1500 0 1500 149980.00% 1500

700 0 700

6500 377 6123 337680.00% 3000

648 0 648

0 0

1600 0 1600

200 200 0 219980.00% 2000

1000 0 1000 -20.00%

3100 50 3050 204980.00% 2000

 0 0 99980.00% 1000

2000 0 2000 49980.00% 500

3000 0 3000 -20.00%

0 0 -20.00%

800 200 600 19980.00%

900 0 900 -20.00%

700 0 700 -20.00%

0 0 -20.00%

0 0 -20.00%

1000 0 1000 -20.00%

PERSEDIAAN SISA STOK STOK

PEMAKAIAN PERMINTAAN
4+5 6-7 OPTIMUM

6 7 8 9 10

0 0 -20.00%

3500 152 3348 65180.00% 500

2500 0 2500 69980.00% 700

4000 0 4000 99980.00% 1000

2800 756 2044 155580.00% 800

0 0

2500 0 2500 99980.00% 1000

3420 0 3420 -20.00%

0 0 -20.00%
 0 0 -20.00%

990 0 990 -20.00%

0 0 -20.00%

3100 100 3000 9980.00%

1100 100 1000 9980.00%

510 10 500 980.00%

500 0 500 -20.00%

4000 1000 3000 299980.00% 2000

0 0 -20.00%

0 0 -20.00%

1900 150 1750 14980.00%

0 0

PERSEDIAAN SISA STOK STOK

PEMAKAIAN PERMINTAAN
4+5 6-7 OPTIMUM

6 7 8 9 10

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

20 20 1980.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%
 0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

21 0 21 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

42 0 42 2980.00% 30

63 1 62 80.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

PERSEDIAAN SISA STOK STOK

PEMAKAIAN PERMINTAAN
4+5 6-7 OPTIMUM

6 7 8 9 10

32 0 32 -20.00%

115 15 100 1480.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%
 0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

50 0 50 4980.00% 50

0 0 -20.00%

50 0 50 -20.00%

0 0 -20.00%

50 0 50 -20.00%

0 0 4980.00% 50

50 0 50 4980.00% 50

0 0 -20.00%

0 0 -20.00%

180 57 123 11680.00% 60

200 67 133 16680.00% 100

144 0 144 -20.00%

PERSEDIAAN SISA STOK STOK

PEMAKAIAN PERMINTAAN
4+5 6-7 OPTIMUM

6 7 8 9 10

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

60 0 60 -20.00%
 60 0 60 -20.00%

0 0 -20.00%

24 0 24 -20.00%

0 0 -20.00%

0 0 -20.00%

25 0 25 5980.00% 60

0 0 -20.00%

0 0

15 0 15 4980.00% 50

52 19 33 4380.00% 25

0 0 -20.00%

7 0 7 -20.00%

50 0 50 -20.00%

0 0 4980.00% 50

0 0 -20.00%

24 0 24 -20.00%

32 4 28 380.00%

PERSEDIAAN SISA STOK STOK

PEMAKAIAN PERMINTAAN
4+5 6-7 OPTIMUM

6 7 8 9 10

48 0 48 -20.00%

48 0 48 -20.00%
 51 3 48 280.00%

24 0 24 -20.00%

75 25 50 7480.00% 50

30 0 30 -20.00%

0 0 -20.00%

15 0 15 -20.00%

29 5 24 5480.00% 50

0 0 -20.00%

33 13 20 1280.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

31 1 30 80.00%

68 8 60 780.00%

0 0

1 0 1 80.00% 1

PERSEDIAAN SISA STOK STOK

PEMAKAIAN PERMINTAAN
4+5 6-7 OPTIMUM

6 7 8 9 10
 0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

75 0 75 9980.00% 100

1600 0 1600 -20.00%

87 0 87 -20.00%

0 0 9980.00% 100

200 0 200 9980.00% 100

123 0 123 -20.00%

0 0 -20.00%

300 0 300 -20.00%

5 0 5 -20.00%

25 0 25 -20.00%

PERSEDIAAN SISA STOK STOK

PEMAKAIAN PERMINTAAN
4+5 6-7 OPTIMUM
6 7 8 9 10

0 0 1180.00% 12

0 0 -20.00%

10 4 6 2780.00% 24

23 0 23 2380.00% 24

0 0 -20.00%

21 9 12 880.00%

0 0 -20.00%

7 0 7 980.00% 10

6 0 6 980.00% 10

160 8 152 780.00%

200 0 200 4980.00% 50

1000 0 1000 -20.00%

1100 100 1000 9980.00%

23 0 23 -20.00%

4 0 4 -20.00%

0 0 -20.00%

6 3 3 5280.00% 50

88 0 88 4980.00% 50

56 1 55 80.00%

0 0 -20.00%

0 0 -20.00%
PERSEDIAAN SISA STOK STOK
PEMAKAIAN PERMINTAAN
4+5 6-7 OPTIMUM

6 7 8 9 10

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 4980.00% 50

40 0 40 -20.00%

15 0 15 4980.00% 50

48 0 48 -20.00%

0 0 -20.00%

200 100 100 9980.00%

0 0 -20.00%

4800 0 4800 9980.00% 100

18 6 12 580.00%

5 2 3 2180.00% 20

0 0 -20.00%
 20 0 20 1980.00% 20

0 0 -20.00%

PERSEDIAAN SISA STOK STOK

PEMAKAIAN PERMINTAAN
4+5 6-7 OPTIMUM

6 7 8 9 10

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

55 5 50 480.00%

0 0 -20.00%

12 7 5 680.00%

0 0 199980.00% 2000

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0
 0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

0 0 -20.00%

PERSEDIAAN SISA STOK STOK

PEMAKAIAN PERMINTAAN
4+5 6-7 OPTIMUM

6 7 8 9 10

0 0 -20.00%

BPJS JUMLAH

ang Menyerahkan : Kepala Puskesmas

an. Kepala PPF & PK
Dinas Kesehatan
Kabupaten Melawi

Heru Priyono
Nip. 19670202 198803 1 011
NO DOKUMEN :01
BULAN :31 Maret 2018
HALAMAN :1

PEMBERIAN KETERANGAN

11 12
PEMBERIAN KETERANGAN

11 12
PEMBERIAN KETERANGAN

11 12
PEMBERIAN KETERANGAN

11 12
PEMBERIAN KETERANGAN

11 12
PEMBERIAN KETERANGAN

11 12
PEMBERIAN KETERANGAN

11 12
PEMBERIAN KETERANGAN

11 12
PEMBERIAN KETERANGAN

11 12
PEMBERIAN KETERANGAN

11 12
PEMBERIAN KETERANGAN

11 12
PEMBERIAN KETERANGAN

11 12
PEMBERIAN KETERANGAN
11 12
PEMBERIAN KETERANGAN

11 12
PEMBERIAN KETERANGAN

11 12
PEMBERIAN KETERANGAN

11 12

Yang Menerima
Petugas Puskesmas

Dedi, A.Md.Kep
Nip. 19791125 200904 1 001
 PERSEDIAAN SISA STOK STOK
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 OPTIMUM

1 2 3 4 5 6 7 8 9 10 11 12

299 Kombipak paket

0 0 -20.00%

UMUM BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP

Mengetahui / menyetujui : Yang Menyerahkan : Kepala Puskesmas Yang Menerima

Kepala Dinas Kesehatan an. Kepala PPF & PK Petugas Puskesmas
Kabupaten Melawi Dinas Kesehatan
c/q Kabid Pelayanan dan Kabupaten Melawi
Sumber Daya Kesehatan

dr. Tanjung Harapan Heru Priyono Dedi, A.Md.Kep

NIP 19740804 200502 1 002 Nip. 19670202 198803 1 011 Nip. 19791125 200904 1 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

PUSKESMAS : Manding NO DOKUMEN : 01

KECAMATAN : Pinoh Utara BULAN : 30 april 2018
KABUPATEN / KOTA : Melawi HALAMAN :1
PROVINSI : Kalimantan Barat

PERSEDIAAN SISA STOK STOK OPTIMUM

N
O NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KET
4+5 6-7 7 + 10-20%

### 2 3 4 5 6 7 8 9 10 11 12

###
Acyclovir 200mg tab
500 500 0 500 -20.00%

###
Acyclovir 400mg tab 500 500
500 0 -20.00%

###
Alopurinol tablet 100 mg tab 1900
1000 2900 2200 700 219980.00%

###
Albendazole tab 400mg tab
0 0 Err:522 Err:522 Err:522

###
Aminofilin tablet 200 mg tab
0 Err:522 Err:522 Err:522

###
Amitriptilin HCl tablet salut 25 mg tab
400 400 Err:522 Err:522 Err:522

###
Ambroxol 30mg tab tab
2000 2000 0 2000 -20.00%

###
Amlodipin tab 10mg tab
2790 300 3090 300 2790 29980.00%

###
Amoksisilin kapsul 250 mg kaps
500 500 200 300 19980.00%

###
Amoksisilin kaplet 500 mg kapl
1300 4000 5300 1200 4100 119980.00% 0

###
Ampisilin 500 mg tab
700 700 700 0 69980.00%

###
Antalgin (Metampiron) tablet 500 mg tab
100 0 100 30 70 302980.00% 3000

###
Antasida DOEN I tablet kunyah tab
0 4000 4000 1000 3000 499980.00% 4000

###
Antimigren: Ergotamin + Kofein tab
0 0 Err:522 Err:522 Err:522 500

###
Antiparkinson:Karbidopa + Levodopa tab
0 Err:522 Err:522 Err:522

###
Asam Askorbat (Vit C) tablet 50 mg tab
0 Err:522 Err:522 Err:522
###
Asetosal tablet 100 mg tab
0 0 Err:522 Err:522 Err:522
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

PUSKESMAS : Manding NO DOKUMEN :01

KECAMATAN : Pinoh Utara BULAN :31 Mei 2018
KABUPATEN / KOTA : Melawi HALAMAN :1
PROVINSI : Kalimantan Barat

PERSEDIAAN SISA STOK STOK OPTIMUM

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KET
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

1 Acyclovir 200mg tab

500 0 500 100 400 9980.00%

2 Acyclovir 400mg tab 500 500

500 0 -20.00%

3 Alopurinol tablet 100 mg tab 700

0 700 200 500 19980.00%

4 Albendazole tab 400mg tab

0 0 Err:522 Err:522 Err:522

5 Aminofilin tablet 200 mg tab

0 Err:522 Err:522 Err:522

6 Amitriptilin HCl tablet salut 25 mg tab

400 400 Err:522 Err:522 Err:522

7 Ambroxol 30mg tab tab

2000 0 2000 800 1200 279980.00% 2000

8 Amlodipin tab 10mg tab

2790 2790 790 2000 78980.00%

9 Amoksisilin kapsul 250 mg kaps

300 300 100 200 9980.00%

10 Amoksisilin kaplet 500 mg kapl

4000 0 4000 2700 1300 569980.00% 3000

11 Ampisilin 500 mg tab

700 700 700 0 69980.00%

12 Antalgin (Metampiron) tablet 500 mg tab

100 0 100 30 70 302980.00% 3000

13 Antasida DOEN I tablet kunyah tab

3000 0 3000 1100 1900 209980.00% 1000

14 Antimigren: Ergotamin + Kofein tab

0 0 Err:522 Err:522 Err:522 500

15 Antiparkinson:Karbidopa + Levodopa tab

0 Err:522 Err:522 Err:522

16 Asam Askorbat (Vit C) tablet 50 mg tab

0 Err:522 Err:522 Err:522

17 Asetosal tablet 100 mg tab

0 0 Err:522 Err:522 Err:522
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KET
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

18 Asetosal tablet 500 mg tab

500 0 500 0 500

19 Atropin Sulfat tablet 0,5 mg tab

0 0

20 Atenolol tab 50mg tab

0 0

21 Asam Mefenamat 500 mg kapl

1200 0 1200 1200 0 5199.8 4000

22 Azitromicyn 500mg tab

440 0 440 0 440 -0.2

23 Anaflu tab
0 0 0 1999.8 2000

24 Betahistin tab 6 mg tab

1300 0 1300 100 1200 99.8

25 Bisoprolol tab 5 mg tab

150 0 150 0 150 -0.2

26 Bromheksin tab tab

0 0 0 0 0 2999.8 3000

27 Calcium Laktat (Kalk) Tab 500mg tab

4000 0 4000 500 3500 1999.8 1500

28 Captopril 12,5 mg Tab tab

0 0 -0.2

29 Captopril 25 mg tab tab

1900 0 1900 1100 800 3099.8 2000

30 Captpril 50 mg tab tab

0 0 -0.2

31 Carbamazepin Tab 200 mg tab

0 0 -0.2

32 Cimetidin Tab tab

0 0 999.8 1000

33 Ciprofloxacin 500 mg kapl

4400 0 4400 100 4300 99.8

34 Clindamisin kaps 300mg kaps

4050 0 4050 0 4050 -0.2

35 Clindamisin kaps 150 mg Kaps

0 0 -0.2

36 Chloramfenikol Kapsul 250 mg kaps

0 0 999.8 1000

37 Chlorfeniramin Maleat (CTM) tab 4 mg tab

4800 0 4800 2200 2600 3199.8 1000

38 Chlorpromazin HCL Injeksi 5 mg/ml-2ml amp

39 Chlorpromazin HCL Injeksi 25 mg/ml amp

0 0
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KET
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

40 Chlorpromazin HCL Tablet Salut 100 mg tab

160 160 0 160 -20.00%

41 Chlorpromazin HCL Tablet Salut 25 mg tab

0 0

42 Cotrimoksazol dewasa 480mg tab

4400 0 4400 1300 3100 129980.00%

42 Cotrimoksazol forte dewasa 960mg tab

120 120 0 120 -20.00%

43 Deksametason tablet 0,5 mg tab

4300 0 4300 1700 2600 169980.00%

44 Dekstrometorfan sirup 10 mg/5 ml botol

0 0

45 Dekstrometorfan tablet 15 mg tab

0 0

46 Diazepam injeksi 5 mg/ml - 2 ml amp

0

47 Diazepam tablet 2 mg tab

0 0

48 Diazepam tablet 5 mg tab

760 0 760 160 600 15980.00%

49 Digoksin tablet 0,25 mg tab

0 0

50 Domperidon tab tab

2600 0 2600 600 2000 109980.00% 500

51 Erytromisin Kapsul 500 mg kaps

1500 500 2000 600 1400 59980.00%

52 Erytromisin Kapsul 250 mg kaps

0 0 0

53 Extract Belladona tab 10mg tab

0 0

54 Ethambutol HCl tab 500 mg tab

0 0

55 Famotidine tab 20mg tab

0 0

56 Furosemid tablet 40 mg tab

1600 0 1600 0 1600 49980.00% 500

57 Fenobarbital injeksi 50 mg/ml - 1 ml amp

0 0

58 Fenobarbital tablet 100 mg tab

0 0

59 Fenobarbital tablet 30 mg tab

90 0 90 0 90 -20.00%

60 Folid Acid 1 mg tab

0 0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KET
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

61 Garam Oralit untuk 200 ml air sach

200 200 200 0 69980.00% 500

62 Gemfibrozil 300 mg kaps kaps

180 0 180 0 180 -20.00%

63 Glibenklamid tablet 5 mg tab

0 0

64 Glimepiride 1 mg tab
500 500 0 500

65 Glimepiride 2 mg tab
0 0

66 guaifenisin tab
3600 0 3600 1200 2400 219980.00% 1000

67 Griseofulvin tablet 125 mg, micronized tab

500 0 500 0 500 49980.00% 500

68 Hidroklorotiazid (HCT) tablet 25 mg tab

1000 0 1000 0 1000 -20.00%

69 Haloperidol tablet 0,5 mg tab

0 0 -20.00%

70 Haloperidol tablet 1,5 mg tab

0 0 -20.00%

71 Haloperidol tablet 5 mg tab

600 0 600 100 500 9980.00%

72 Ibuprofen tablet 200 mg tab

0 0

73 Ibuprofen tablet 400 mg tab

1500 0 1500 1500 0 549980.00% 4000

74 Isoniazid tab 300 mg tab

0 -20.00%

75 Isosorbid Dinitrat tablet sublingual 5 mg tab

1000 0 1000 0 1000 49980.00% 500

76 Kombinasi Pirimetamin 25 mg + Sulfadoxin tab

0 0 -20.00%

77 Kuinin (Kina) tablet 200 mg tab

0 0 -20.00%

78 Ketokonazol 200 mg tab

1650 0 1650 750 900 164980.00% 900

79 Lansoprazole 30mg Kaps

1900 0 1900 1900 0 389980.00% 2000

80 Levofloxacin kapl 500mg kapl

500 500 0 500 -20.00%

81 Linkomisin kaps 500mg kaps

0 0 -20.00%

82 Loratadin Tablet 10 mg tab

360 360 0 360 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KET
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

83 Loperamid tab 2mg tab

400 0 400 0 400 49980.00% 500

84 Malarex tab
0 0 -20.00%

85 Metronidazol tablet 250 mg tab

0 0 -20.00%

86 Metronidazol tablet 500 mg tab

6400 0 6400 100 6300 9980.00%

87 Mebendazole Tab 500mg tab

0 0 -20.00%

88 Meloxicam 7,5 mg tab tab

600 0 600 600 0 159980.00% 1000

89 Meloxicam 15 mg tab tab

0 0 299980.00% 3000

90 Mersibion 5000 tab

500 0 100 400 9980.00%

91 Metformin HCL tab 500mg tab

0 0 0 -20.00%

92 Metilergometrin Maleat tablet salut 0,125 tab

0 0 -20.00%

93 Metilprednisolon 4 mg tab
3083 0 3083 1283 1800 228280.00% 1000

94 Metoclorpamid 10 mg tab tab

1200 0 1200 0 1200 -20.00%

95 Natrium Diklofenak 25 mg tab

0 0 399980.00% 4000

96 Natrium Diklofenak 50 mg tab

0 0 199980.00% 2000

97 Neo Diagon tab

225 225 0 225 -20.00%

98 Nistatin tablet salut 500.000 IU tab

400 0 400 0 400 99980.00% 1000

99 Nistatin tablet vaginal 100.000 IU/g tab

90 0 90 0 90 99980.00% 1000

100 Nifedipin tab 10mg tab

0 0 99980.00% 1000

101 Ofloksasin 400mg tab

100 100 0 100 -20.00%

102 Omeprazole Kaps 20 mg Kaps

1050 1050 510 540 200980.00% 1500

103 Parasetamol tablet 100 mg tab

700 0 700 0 700

104 Parasetamol tablet 500 mg tab

2600 2600 2100 500 609980.00% 4000
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KET
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

105 Ondansetron tab

276 276 0 276 -20.00%

106 Phenoksimetil Penisilina tablet 500 mg tab

0 0

107 Phitomenadion (Vit.K1) tablet salut gula 10 tab

1170 1170 70 1100 6980.00%

108 Piridoksin HCl (Vit.B6) tablet 10 mg tab

2200 0 2200 600 1600 259980.00% 2000

109 Pirazinamid tab tab

1000 1000 0 1000 -20.00%

110 Piroxicam kaps 10 mg kaps

2000 0 2000 1100 900 309980.00% 2000

111 Piroxicam kaps 20 mg kaps

0 0 0 99980.00% 1000

112 Prednison tablet 5 mg tab

2000 0 2000 1200 800 219980.00% 1000

113 Primakuin tablet 15 mg tab

3000 0 3000 0 3000 -20.00%

114 Propiltiourasil tablet 100 mg tab

0 0 -20.00%

115 Pirantel tablet 125 mg tab

600 600 0 600 -20.00%

116 Propranolol HCl tablet 40 mg tab

900 900 0 900 -20.00%

117 Ranitidin tab 150 mg tab

2000 0 2000 700 1300 69980.00%

118 Rifampicin 450 mg kaplet kapl

0 0 -20.00%

119 Risperidon 1 mg tab

0 0 -20.00%

120 Risperidon 2 mg tab

1000 1000 0 1000 -20.00%

121 Salbutamol tab 2 mg tab

0 0 -20.00%

122 Salbutamol tab 4 mg tab

3348 3348 848 2500 134780.00% 500

123 Sefadroksil kaps 500mg kaps

1800 0 1800 600 1200 159980.00% 1000

124 Sefiksim kaps 100mg kaps

1800 1800 0 1800 99980.00% 1000

125 Setrizin kaps 10mg Kaps

1300 0 1300 400 900 139980.00% 1000

126 Syanocobalamin tab 10 mg tab

0 0
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KET
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

127 Spironolacton 25mg tablet tab

2500 2500 0 2500 99980.00% 1000

128 Simvastatin 10mg tab tab

3420 3420 0 3420 -20.00%

129 Simvastatin 20mg tab tab

0 0 -20.00%

130 Tablet Tambah Darah kombinasi / Besi Ferro tab

0 0 -20.00%

131 thyrozol kaps

700 700 0 700 -20.00%

132 Tetrasiklin HCl kapsul 500 mg kaps

0 0 -20.00%

133 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 tab

3600 0 3600 800 2800 79980.00%

134 Urinter kaps

1000 0 1000 400 600 39980.00%

135 Tramadol kapsul kaps

500 0 500 0 500 -20.00%

136 Triheksifenidil Hidroklorida tablet 2 mg tab

500 500 0 500 -20.00%

137 Vitamin B Kompleks tablet tab

3000 0 3000 400 2600 239980.00% 2000

138 Retinol ( Vitamin A ) 100.000 IU Kapsul luna Kaps

0 0 -20.00%

139 Retinol ( Vitamin A ) 200.000 IU Kapsul Luna Kaps

0 0 -20.00%

140 Zink tab dispersible 20 mg tab

1750 0 1750 150 1600 14980.00%

INJEKSI
0 0

141 Aminofilina Injeksi 24 mg/ml -10 ml amp

0 0 -20.00%

142 Ampisillin Inj vial

0 0 -20.00%

143 Antalgin Injeksi 250 mg/ml - 2 ml amp

0 0 -20.00%

144 Aqua Pro injeksi Steril 25 ml vial

20 20 20 0 4980.00% 30

144 Aqua Pro injeksi Steril 50 ml

0 0 -20.00%

145 Asam Traneksamat injeksi 50mg/ml amp

0 0 -20.00%

146 Atropin Sulfat Injeksi 0,25 mg/ml -1 ml amp

0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KET
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

147 Cefotaxime serbuk injeksi 500mg vial

0 0 -20.00%

148 Dexamethasone injeksi 5 mg/ml-1ml amp

0 0 -20.00%

149 Difenhidramin HCL Inj 10mg/ml-1ml amp

0 0 -20.00%

150 Epineprine HCL 0,1% -1ml amp

0 0 1980.00% 20

151 Fitomenadion (Vit K1) Injeksi 10mg/ml-1ml amp

21 21 0 21 -20.00%

152 Gentamisin Injeksi amp

0 0 -20.00%

153 Haloperidol Inj 50mg/ml 1 ml amp

0 0 -20.00%

154 Kuinin Dihidroklorida Injeksi 25% - 2 ml amp

0 0 -20.00%

155 Lidokain inj 2%(HCL) + Epineprin 1:80.000 -2 amp

42 0 42 12 30 4180.00% 30

156 Metilergometrin Maleat Injeksi amp

63 63 1 62 80.00%

157 Metoklorpamide Inj amp

0 0 -20.00%

158 Magnesium Sulfat inj (IV) 20% - 25 ml vial

0 0 -20.00%

159 Magnesium Sulfat inj (IV) 40% - 25 ml vial

0 0 -20.00%

160 Oksitetrasiklin HCL Injeksi i.m 50mg/ml-10m vial

0 0 -20.00%

161 Oksitosin Injeksi 10 IU/ml-1ml amp

32 32 0 32 -20.00%

162 Sianokobalamin (Vit.B12) injeksi 500 mcg-ml amp

100 0 100 70 30 6980.00%

163 Streptomycin Sulfat Serbuk inj 1000 mg / via vial

0 0 -20.00%

164 Thiamin HCL Injeksi 100mg/ml-1ml amp

0 0 -20.00%

165 Tramadol injeksi 50mg/ml amp

0 0 -20.00%

166 Ranitidin Injeksi amp

0 0 -20.00%

SYRUP
0 0 -20.00%

167 Amoksisilin sirup kering 125 mg/5ml botol

0 0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KET
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

168 Amoksisilin sirup kering 250 mg/5ml botol

50 0 50 0 50 4980.00% 50

169 Ampisillin syrup kering botol

0 0 -20.00%

170 Antasida Syrup botol

50 0 50 10 40 980.00%

171 Ambroxol Syr botol

0 0 4980.00% 50

172 Domperidon suspensi 5mg/5ml botol

100 0 100 0 100 -20.00%

173 Erithromicyn Syr botol

0 0 4980.00% 50

174 Ibuprofen suspensi 100mg/5ml botol

50 0 50 0 50 4980.00% 50

175 Kloramphenokol Suspensi 125mg/5ml botol

0 0 -20.00%

176 Kotrimoksazol Suspensi Komb botol

0 0 -20.00%

177 Obat Batuk Hitam (OBH) cairan botol

60 0 60 60 0 11980.00% 60

178 Paracetamol Syrup 120mg/5ml botol

100 0 100 50 50 14980.00% 100

179 Paracetamol drop 100mg btl@15ml botol

144 0 144 144 0 24380.00% 100

180 Pirantel Suspensi 125mg/5ml botol 60 ml

0 0 0 -20.00%

181 Pirantel Suspensi 125mg/5ml botol 10 ml

0 0 -20.00%

182 Salbutamol sirup 2mg/5ml botol

0 0 -20.00%

183 Sefadroksil sirup kering 125mg/5ml botol

195 0 195 15 180 1480.00%

184 Setrizin sirup 5mg/5ml botol

208 0 208 0 208 -20.00%

185 Zink Sirup 10mg/ml botol

0 0 0 -20.00%

186 Interzinc syr botol

144 0 144 0 144 -20.00%

187 Gralisin syr botol

0 0 -20.00%

188 Metoklorpamide syr botol

0 0 -20.00%

189 Sulcralfat syr botol

100 100 0 100 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KET
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

190 Thiampenicol syr botol

0 0 -20.00%

OBAT LUAR / SALEP

0 0

191 Acyclovir Cream tube

25 0 25 25 0 7480.00% 50

192 Anti Bakteri DOEN salep,Basitrasin Cr tube

25 0 25 0 25 2480.00% 25

193 Anti Hemoroid DOEN Kombinasi supp

0 0 -20.00%

194 Antifungi DOEN :As. Benzoat + As. Salisilat pot

7 12 19 2 17 180.00%

195 Betametason krim 0.1% tube

60 0 60 35 25 8480.00% 50

196 Chloramfenikol Tetes telinga 3% botol

0 0 4980.00% 50

197 Chloramfenikol Salep Mata 1 % tube

288 0 288 0 288 -20.00%

198 Fenol Gliserin tetes telinga 10% botol

24 0 24 0 24 -20.00%

199 Gentian Violet larutan 1 % pot

2 0 2 2 0 4980.00% 48

200 Gentamisin Salep 0,3 salep Mata tube

57 0 57 27 30 7680.00% 50

201 Gentamisin Sulfat tetes Mata botol

60 0 60 0 60 -20.00%

202 Hidrokortison krim 2,5 % tube

63 0 63 20 43 4480.00% 25

203 Isotik tetes Mata botol

18 0 18 5 13 480.00%

204 Ketokonazol Cream tube

51 0 51 21 30 7080.00% 50

205 Gentamisin Salep 0,1 salap kulit tube

1 0 1 1 0 3080.00% 30

206 Oksitetrasiklin HCl salep mata 1 % tube

0 0 -20.00%

207 Salep 2-4 pot

20 0 20 7 13 3080.00% 24

208 Mikonazol krim 2 % tube

24 0 24 13 11 6280.00% 50

209 Zolacord kream tube

0 0 -20.00%

210 Salisil Bedak 2 % pcs

26 0 26 8 18 780.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KET
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

211 Berlison N tube

0 0 -20.00%

INFUS
0 0 -20.00%

212 Dekstran 70 - larutan infus 6% steril botol

0 0 -20.00%

213 Glukosa larutan infus 10 % steril (Produk lok botol

0 0 -20.00%

214 Glukosa larutan infus 40 % steril (Produk lok botol

0 0 -20.00%

215 Glukosa larutan infus 5 % steril (Produk lokal botol

0 0 -20.00%

216 Natrium Klorida infus 0,9 % steril (Produk lok botol

8 0 8 2 6 180.00%

217 Ringer Laktat larutan infus steril (Produk loka botol

13 0 13 3 10 2280.00% 20

OBAT GIGI
0 0

218 Ethyl Chlorid Spray botol

1 1 0 1 80.00% 1

219 Eugenol cairan botol

0 0 -20.00%

220 Glass - Ionomer cement ( gc ix ) set

0 0 -20.00%

221 Sement seng fosfat serbuk & cairan set

0 0 -20.00%

222 Monoklorkamfer/Klorfenol kamfer Menthol set

0 0 -20.00%

223 Mummifying Pasta set

0 0 -20.00%

224 Temporary Stopping Fletcher serbuk dan cai set

0 0 -20.00%

225 Kalium Hidroksida Pasta box

0 0 -20.00%

226 Devitalisasi pasta /non arsen btl 2gr

0 0 -20.00%

227 Lidocain spray botol

0 0 -20.00%

BAHAN HABIS PAKAI

0 0 -20.00%

228 Alat suntik sekali pakai 0.05 ml pcs

75 75 75 0 27480.00% 200

229 Alat suntik sekali pakai 0.5ml pcs

1000 0 1000 200 800 319980.00% 3000
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KET
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

230 Alat suntik sekali pakai 1 ml pcs

100 0 100 0 100 19980.00% 200

231 Alat suntik sekali pakai 2,5 ml pcs

5 0 5 5 0 20480.00% 200

232 Alat suntik sekali pakai 3 ml pcs

100 0 100 100 0 29980.00% 200

233 Alat suntik sekali pakai 5 ml pcs

100 0 100 0 100 9980.00% 100

234 TP Disposable Syringe 1ml pcs

0 0 -20.00%

235 Aqua Gel sachet

200 200 0 200 -20.00%

236 Aximed 10x10cm non Woioven pcs

5 5 2 3 180.00%

237 Aximed 5x10cm non Woioven rol

25 0 25 10 15 980.00%

238 Catgut No. 2/0 dgn jarum bedah pcs

0 0 0 1180.00% 12

239 Catgut No. 3/0 dgn jarum bedah pcs

0 0 -20.00%

240 Catgut Chromic W/O Needle 2/0 pcs

24 0 24 12 12 3580.00% 24

241 Catgut Chromic W/O Needle 3/0 pcs

46 0 46 16 30 3980.00% 24

242 Etakridin ( Rivanol ) larutan 0,1% 300ml botol

0 0 -20.00%

243 Etanol 70% 100 ml botol

2 0 2 2 0 2580.00% 24

244 Etanol 70% 1000 ml botol

0 0 -20.00%

245 Foley Catheter No. 16 pcs

4 0 4 2 2 1180.00% 10

246 Foley Catheter No. 18 pcs

6 0 6 0 6 980.00% 10

247 Handscoon 7.5 pcs

152 152 152 0 25180.00% 100

248 Handscoon 7 pcs

110 110 0 110 -20.00%

249 Handscoon uk S pcs

400 0 400 300 100 79980.00% 500

250 Handscoon uk M pcs

600 600 100 500 29980.00% 200

251 Infusion set anak pcs

23 23 23 0 4280.00% 20
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KET
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

252 Infusion set dewasa pcs

4 4 4 0 2380.00% 20

253 Infus set type-Y pcs

0 0 -20.00%

254 IV Catheter No.20 G pcs

75 0 75 0 75 -20.00%

255 IV Catheter No. 22 G pcs

100 0 100 0 100 -20.00%

256 IV Catheter No. 24 G pcs

45 0 45 0 45 -20.00%

257 Jelco 20G pcs

0 0 -20.00%

258 Jelco 22G pcs

0 0 -20.00%

259 Jelco 24G pcs

0 0 -20.00%

260 IV. Chateter trovensity Safety Plus 20G pcs

0 0 -20.00%

261 IV. Chateter trovensity Safety Plus 22G pcs

0 0 -20.00%

262 IV. Chateter trovensity Safety Plus 24G pcs

0 0 -20.00%

263 Kapas Berlemak 500 gram rol

0 0 1980.00% 20

264 Kapas Pembalut / Absorben 250 gram rol

0 0 1980.00% 20

265 Kasa Pembalut 4 x 10 elastis buah

0 0 -20.00%

266 Kasa Pembalut Hidrofil 4 m x 3 cm non elasti buah

0 0 -20.00%

267 Kasa Pembalut Hidrofil 4 m x 5 cm non elasti buah

74 0 74 0 74 4980.00% 50

268 Kasa Pembalut Hidrofil 4 m x 10 cm non elas buah

18 100 118 38 80 8780.00% 50

269 Kasa Pembalut Hidrofil 4 m x 15 cm non elas buah

0 100 100 41 59 9080.00% 50

270 kasa steril 16x16 buah

48 48 48 0 9780.00% 50

271 Kasa Pembalut 18mx22cm pcs

0 0 -20.00%

272 Kasa Kompres steril 40 x 40 cm buah

200 0 200 200 0 24980.00% 50

273 Lysol botol

0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KET
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

274 Masker buah

4800 4800 0 4800 -20.00%

275 Micropore 2 inch/5cmx9,1m buah

11 11 0 11 1180.00% 12

276 Polifix 10cm x 5m roll

3 3 0 3 1980.00% 20

277 Polifix 5cm x 1m roll

0 0 -20.00%

278 Povidon Iodida larutan 10 % botol 30 ml

60 0 60 0 60 -20.00%

279 Povidon Iodida larutan 10 % botol 60 ml

0 0 0 0 -20.00%

280 Povidon Iodida larutan 10 % btl 500ml

24 24 0 24 -20.00%

281 Plester 5 yards x 2 inch Zinc oxide roll

0 0 -20.00%

282 Pembalut Elastis Policrepe 7,5 cm x 4,55 roll

0 0 -20.00%

283 Safety box roll

0 0 -20.00%

284 Silk ( Benag Bedah Sutera ) No 3 / 30 pcs

60 0 60 10 50 3380.00% 24

285 Soft Cloth on 10 cm x 10 m kotak

0 0 -20.00%

286 Urin Bag pcs

5 0 5 0 5 -20.00%

287 Masflu tab tab

0 0 199980.00% 2000

288 Pularex tab tab

0 0 -20.00%

289 Samcobion tab tab

0 0 -20.00%

VITAMIN
0 0 -20.00%

290 Hemafort tab

0 0 -20.00%

291 Pehavral tab

0 0 -20.00%

292 Betafort syr botol

0 0 -20.00%

293 Becefort syr botol

0 0 -20.00%

294 Geriavita tab tab

0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KET
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

OBAT PROGRAM TB
0 0

295 Kategori Anak paket

0 0 -20.00%

296 Kategori I paket

0 0 -20.00%

297 Kategori II paket

0 0 -20.00%

298 Kategori Sisipan paket

0 0 -20.00%

299 Kombipak paket

0 0 -20.00%

UMUM BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP

Mengetahui / menyetujui : Yang Menyerahkan : Kepala Puskesmas Yang Menerima

Kepala Dinas Kesehatan an. Kepala PPF & PK Petugas Puskesmas
Kabupaten Melawi Dinas Kesehatan
c/q Kabid Pelayanan dan Kabupaten Melawi
Sumber Daya Kesehatan

dr. Tanjung Harapan Heru Priyono Dedi, A.Md.Kep

NIP 19740804 200502 1 002 Nip. 19670202 198803 1 011 Nip. 19791125 200904 1 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

PUSKESMAS : Manding NO DOKUMEN :01

KECAMATAN : Pinoh Utara BULAN :30 juni 2018
KABUPATEN / KOTA : Melawi HALAMAN :1
PROVINSI : Kalimantan Barat

PERSEDIAAN SISA STOK STOK OPTIMUM

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

1 Acyclovir 200mg tab

400 0 400 100 300 9980.00%
2 Acyclovir 400mg tab 500 400
0 500 100 9980.00%
3 Alopurinol tablet 100 mg tab 500
0 500 0 500 -20.00%
4 Albendazole tab 400mg tab
0 0 Err:522 Err:522 Err:522
5 Aminofilin tablet 200 mg tab
0 Err:522 Err:522 Err:522
6 Amitriptilin HCl tablet salut 25 mg tab
400 400 Err:522 Err:522 Err:522
7 Ambroxol 30mg tab tab
1200 0 1200 800 400 279980.00% 2000
8 Amlodipin tab 10mg tab
2000 2000 100 1900 9980.00%
9 Amoksisilin kapsul 250 mg kaps
100 100 0 100 -20.00%
10 Amoksisilin kaplet 500 mg kapl
1300 0 1300 900 400 389980.00% 3000
11 Ampisilin 500 mg tab
0 0 0 0 0 -20.00%
12 Antalgin (Metampiron) tablet 500 mg tab
70 0 70 70 0 306980.00% 3000
13 Antasida DOEN I tablet kunyah tab
1900 0 1900 1200 700 219980.00% 1000
14 Antimigren: Ergotamin + Kofein tab
0 0 Err:522 Err:522 Err:522 500
15 Antiparkinson:Karbidopa + Levodopa tab
0 Err:522 Err:522 Err:522
16 Asam Askorbat (Vit C) tablet 50 mg tab
0 Err:522 Err:522 Err:522
17 Asetosal tablet 100 mg tab
0 0 Err:522 Err:522 Err:522
18 Asetosal tablet 500 mg tab
500 0 500 0 500
19 Atropin Sulfat tablet 0,5 mg tab
0 0
20 Atenolol tab 50mg tab
0 0
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

21 Asam Mefenamat 500 mg kapl

0 0 0 0 0 3999.8 4000
22 Azitromicyn 500mg tab
440 0 440 0 440 -0.2
23 Anaflu tab
0 0 0 1999.8 2000
24 Betahistin tab 6 mg tab
1200 0 1200 100 1100 99.8
25 Bisoprolol tab 5 mg tab
150 0 150 0 150 -0.2
26 Bromheksin tab tab
0 0 0 0 0 2999.8 3000
27 Calcium Laktat (Kalk) Tab 500mg tab
2500 0 2500 200 2300 699.8 500
28 Captopril 12,5 mg Tab tab
0 0 -0.2
29 Captopril 25 mg tab tab
800 0 800 100 700 2099.8 2000
30 Captpril 50 mg tab tab
0 0 -0.2
31 Carbamazepin Tab 200 mg tab
0 0 -0.2
32 Cimetidin Tab tab
0 0 999.8 1000
33 Ciprofloxacin 500 mg kapl
3600 0 3600 100 3500 99.8
34 Clindamisin kaps 300mg kaps
4050 0 4050 0 4050 -0.2
35 Clindamisin kaps 150 mg Kaps
0 0 -0.2
36 Chloramfenikol Kapsul 250 mg kaps
0 0 999.8 1000
37 Chlorfeniramin Maleat (CTM) tab 4 mg tab
2600 0 2600 900 1700 1899.8 1000
38 Chlorpromazin HCL Injeksi 5 mg/ml-2ml amp

39 Chlorpromazin HCL Injeksi 25 mg/ml amp

0 0
40 Chlorpromazin HCL Tablet Salut 100 mg tab
160 160 0 160 -20.00%
41 Chlorpromazin HCL Tablet Salut 25 mg tab
0 0
42 Cotrimoksazol dewasa 480mg tab
3100 0 3100 100 3000 9980.00%
42 Cotrimoksazol forte dewasa 960mg tab
120 120 0 120 -20.00%
43 Deksametason tablet 0,5 mg tab
2600 0 2600 600 2000 59980.00%
44 Dekstrometorfan sirup 10 mg/5 ml botol
0 0
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

45 Dekstrometorfan tablet 15 mg tab

0 0
46 Diazepam injeksi 5 mg/ml - 2 ml amp
0
47 Diazepam tablet 2 mg tab
0 0
48 Diazepam tablet 5 mg tab
600 0 600 0 600 -20.00%
49 Digoksin tablet 0,25 mg tab
0 0
50 Domperidon tab tab
2000 0 2000 600 1400 109980.00% 500
51 Erytromisin Kapsul 500 mg kaps
1400 0 1400 0 1400 -20.00%
52 Erytromisin Kapsul 250 mg kaps
0 0 0
53 Extract Belladona tab 10mg tab
0 0
54 Ethambutol HCl tab 500 mg tab
0 0
55 Famotidine tab 20mg tab
0 0
56 Furosemid tablet 40 mg tab
1600 0 1600 0 1600 49980.00% 500
57 Fenobarbital injeksi 50 mg/ml - 1 ml amp
0 0
58 Fenobarbital tablet 100 mg tab
0 0
59 Fenobarbital tablet 30 mg tab
90 0 90 0 90 -20.00%
60 Folid Acid 1 mg tab
0 0 0 -20.00%
61 Garam Oralit untuk 200 ml air sach
0 0 0 0 49980.00% 500
62 Gemfibrozil 300 mg kaps kaps
180 0 180 0 180 -20.00%
63 Glibenklamid tablet 5 mg tab
0 0
64 Glimepiride 1 mg tab
500 500 0 500
65 Glimepiride 2 mg tab
0 0
66 guaifenisin tab
2400 0 2400 1500 900 249980.00% 1000
67 Griseofulvin tablet 125 mg, micronized tab
400 0 400 100 300 59980.00% 500
68 Hidroklorotiazid (HCT) tablet 25 mg tab
1000 0 1000 0 1000 -20.00%
69 Haloperidol tablet 0,5 mg tab
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

70 Haloperidol tablet 1,5 mg tab

0 0 -20.00%
71 Haloperidol tablet 5 mg tab
500 0 500 0 500 -20.00%
72 Ibuprofen tablet 200 mg tab
0 0
73 Ibuprofen tablet 400 mg tab
0 0 0 0 0 399980.00% 4000
74 Isoniazid tab 300 mg tab
0 -20.00%
75 Isosorbid Dinitrat tablet sublingual 5 mg tab
1000 0 1000 0 1000 49980.00% 500
76 Kombinasi Pirimetamin 25 mg + Sulfadoxin 5 tab
0 0 -20.00%
77 Kuinin (Kina) tablet 200 mg tab
0 0 -20.00%
78 Ketokonazol 200 mg tab
900 0 900 100 800 99980.00% 900
79 Lansoprazole 30mg Kaps
0 0 0 0 0 199980.00% 2000
80 Levofloxacin kapl 500mg kapl
500 500 0 500 -20.00%
81 Linkomisin kaps 500mg kaps
0 0 -20.00%
82 Loratadin Tablet 10 mg tab
360 360 0 360 -20.00%
83 Loperamid tab 2mg tab
400 0 400 0 400 49980.00% 500
84 Malarex tab
0 0 -20.00%
85 Metronidazol tablet 250 mg tab
0 0 -20.00%
86 Metronidazol tablet 500 mg tab
5700 0 5700 0 5700 -20.00%
87 Mebendazole Tab 500mg tab
0 0 -20.00%
88 Meloxicam 7,5 mg tab tab
0 0 0 0 0 99980.00% 1000
89 Meloxicam 15 mg tab tab
0 0 299980.00% 3000
90 Mersibion 5000 tab
400 0 100 400 9980.00%
91 Metformin HCL tab 500mg tab
0 0 0 -20.00%
92 Metilergometrin Maleat tablet salut 0,125 mg tab
0 0 -20.00%
93 Metilprednisolon 4 mg tab
1800 0 1800 1800 0 279980.00% 1000
94 Metoclorpamid 10 mg tab tab
1200 0 1200 0 1200 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

95 Natrium Diklofenak 25 mg tab

0 0 399980.00% 4000
96 Natrium Diklofenak 50 mg tab
0 0 199980.00% 2000
97 Neo Diagon tab
225 225 0 225 -20.00%
98 Nistatin tablet salut 500.000 IU tab
400 0 400 0 400 99980.00% 1000
99 Nistatin tablet vaginal 100.000 IU/g tab
90 0 90 0 90 99980.00% 1000
100 Nifedipin tab 10mg tab
0 0 99980.00% 1000
101 Ofloksasin 400mg tab
100 100 0 100 -20.00%
102 Omeprazole Kaps 20 mg Kaps
540 540 540 0 203980.00% 1500
103 Parasetamol tablet 100 mg tab
700 0 700 0 69980.00%
104 Parasetamol tablet 500 mg tab
500 500 500 0 449980.00% 4000
105 Ondansetron tab
276 276 0 276 -20.00%
106 Phenoksimetil Penisilina tablet 500 mg tab
0 0
107 Phitomenadion (Vit.K1) tablet salut gula 10 m tab
1100 1100 0 1100 -20.00%
108 Piridoksin HCl (Vit.B6) tablet 10 mg tab
1600 0 1600 100 1500 209980.00% 2000
109 Pirazinamid tab tab
1000 1000 0 1000 -20.00%
110 Piroxicam kaps 10 mg kaps
900 0 900 0 900 199980.00% 2000
111 Piroxicam kaps 20 mg kaps
0 0 0 99980.00% 1000
112 Prednison tablet 5 mg tab
800 0 800 800 0 179980.00% 1000
113 Primakuin tablet 15 mg tab
3000 0 3000 0 3000 -20.00%
114 Propiltiourasil tablet 100 mg tab
0 0 -20.00%
115 Pirantel tablet 125 mg tab
600 600 0 600 -20.00%
116 Propranolol HCl tablet 40 mg tab
900 900 0 900 -20.00%
117 Ranitidin tab 150 mg tab
1300 0 1300 1000 300 199980.00% 1000
118 Rifampicin 450 mg kaplet kapl
0 0 -20.00%
119 Risperidon 1 mg tab
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

120 Risperidon 2 mg tab

1000 1000 0 1000 -20.00%
121 Salbutamol tab 2 mg tab
0 0 -20.00%
122 Salbutamol tab 4 mg tab
2500 2500 100 2400 59980.00% 500
123 Sefadroksil kaps 500mg kaps
1200 0 1200 500 700 149980.00% 1000
124 Sefiksim kaps 100mg kaps
1800 1800 1000 800 199980.00% 1000
125 Setrizin kaps 10mg Kaps
900 0 900 600 300 159980.00% 1000
126 Syanocobalamin tab 10 mg tab
0 0
127 Spironolacton 25mg tablet tab
2500 2500 0 2500 99980.00% 1000
128 Simvastatin 10mg tab tab
3420 3420 0 3420 -20.00%
129 Simvastatin 20mg tab tab
0 0 -20.00%
130 Tablet Tambah Darah kombinasi / Besi Ferro tab
0 0 -20.00%
131 thyrozol kaps
700 700 0 700 -20.00%
132 Tetrasiklin HCl kapsul 500 mg kaps
0 0 -20.00%
133 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg tab
2700 0 2700 0 2700 -20.00%
134 Urinter kaps
600 0 600 100 500 9980.00%
135 Tramadol kapsul kaps
500 0 500 0 500 -20.00%
136 Triheksifenidil Hidroklorida tablet 2 mg tab
500 500 0 500 -20.00%
137 Vitamin B Kompleks tablet tab
2600 0 2600 100 2500 209980.00% 2000
138 Retinol ( Vitamin A ) 100.000 IU Kapsul lunak Kaps
0 0 -20.00%
139 Retinol ( Vitamin A ) 200.000 IU Kapsul Lunak Kaps
0 0 -20.00%
140 Zink tab dispersible 20 mg tab
1750 0 1750 150 1600 14980.00%
INJEKSI
0 0
141 Aminofilina Injeksi 24 mg/ml -10 ml amp
0 0 -20.00%
142 Ampisillin Inj vial
0 0 -20.00%
143 Antalgin Injeksi 250 mg/ml - 2 ml amp
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

144 Aqua Pro injeksi Steril 25 ml vial

0 0 0 0 2980.00% 30
144 Aqua Pro injeksi Steril 50 ml
0 0 980.00% 10
145 Asam Traneksamat injeksi 50mg/ml amp
0 0 -20.00%
146 Atropin Sulfat Injeksi 0,25 mg/ml -1 ml amp
0 0 -20.00%
147 Cefotaxime serbuk injeksi 500mg vial
0 0 -20.00%
148 Dexamethasone injeksi 5 mg/ml-1ml amp
0 0 -20.00%
149 Difenhidramin HCL Inj 10mg/ml-1ml amp
0 0 -20.00%
150 Epineprine HCL 0,1% -1ml amp
0 0 1980.00% 20
151 Fitomenadion (Vit K1) Injeksi 10mg/ml-1ml amp
21 21 0 21 -20.00%
152 Gentamisin Injeksi amp
0 0 -20.00%
153 Haloperidol Inj 50mg/ml 1 ml amp
0 0 -20.00%
154 Kuinin Dihidroklorida Injeksi 25% - 2 ml amp
0 0 -20.00%
155 Lidokain inj 2%(HCL) + Epineprin 1:80.000 -2ml amp
30 0 30 2 28 3180.00% 30
156 Metilergometrin Maleat Injeksi amp
62 62 0 62 -20.00%
157 Metoklorpamide Inj amp
0 0 -20.00%
158 Magnesium Sulfat inj (IV) 20% - 25 ml vial
0 0 -20.00%
159 Magnesium Sulfat inj (IV) 40% - 25 ml vial
0 0 -20.00%
160 Oksitetrasiklin HCL Injeksi i.m 50mg/ml-10ml vial
0 0 -20.00%
161 Oksitosin Injeksi 10 IU/ml-1ml amp
32 32 0 32 -20.00%
162 Sianokobalamin (Vit.B12) injeksi 500 mcg-ml amp
30 0 30 20 10 11980.00% 100
163 Streptomycin Sulfat Serbuk inj 1000 mg / vial vial
0 0 -20.00%
164 Thiamin HCL Injeksi 100mg/ml-1ml amp
0 0 -20.00%
165 Tramadol injeksi 50mg/ml amp
0 0 -20.00%
166 Ranitidin Injeksi amp
0 0 -20.00%
SYRUP
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

167 Amoksisilin sirup kering 125 mg/5ml botol

0 0 0 -20.00%
168 Amoksisilin sirup kering 250 mg/5ml botol
50 0 50 0 50 4980.00% 50
169 Ampisillin syrup kering botol
0 0 -20.00%
170 Antasida Syrup botol
40 0 40 0 40 -20.00%
171 Ambroxol Syr botol
0 0 4980.00% 50
172 Domperidon suspensi 5mg/5ml botol
100 0 100 0 100 -20.00%
173 Erithromicyn Syr botol
0 0 4980.00% 50
174 Ibuprofen suspensi 100mg/5ml botol
50 0 50 0 50 4980.00% 50
175 Kloramphenokol Suspensi 125mg/5ml botol
0 0 -20.00%
176 Kotrimoksazol Suspensi Komb botol
0 0 -20.00%
177 Obat Batuk Hitam (OBH) cairan botol
0 0 0 0 0 5980.00% 60
178 Paracetamol Syrup 120mg/5ml botol
50 0 50 20 30 11980.00% 100
179 Paracetamol drop 100mg btl@15ml botol
0 0 0 0 0 9980.00% 100
180 Pirantel Suspensi 125mg/5ml botol 60 ml
0 0 0 -20.00%
181 Pirantel Suspensi 125mg/5ml botol 10 ml
0 0 -20.00%
182 Salbutamol sirup 2mg/5ml botol
0 0 -20.00%
183 Sefadroksil sirup kering 125mg/5ml botol
180 0 180 80 100 7980.00%
184 Setrizin sirup 5mg/5ml botol
208 0 208 58 150 5780.00%
185 Zink Sirup 10mg/ml botol
0 0 0 -20.00%
186 Interzinc syr botol
114 144 258 114 144 11380.00%
187 Gralisin syr botol
0 0 -20.00%
188 Metoklorpamide syr botol
0 0 -20.00%
189 Sulcralfat syr botol
100 100 0 100 -20.00%
190 Thiampenicol syr botol
0 0 -20.00%
OBAT LUAR / SALEP
0 0
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

191 Acyclovir Cream tube

25 0 25 25 0 7480.00% 50
192 Anti Bakteri DOEN salep,Basitrasin Cr tube
25 0 25 0 25 2480.00% 25
193 Anti Hemoroid DOEN Kombinasi supp
0 0 -20.00%
194 Antifungi DOEN :As. Benzoat + As. Salisilat pot
11 0 11 0 11 -20.00%
195 Betametason krim 0.1% tube
25 0 25 1 24 5080.00% 50
196 Chloramfenikol Tetes telinga 3% botol
0 0 4980.00% 50
197 Chloramfenikol Salep Mata 1 % tube
288 0 288 0 288 -20.00%
198 Fenol Gliserin tetes telinga 10% botol
24 0 24 0 24 -20.00%
199 Gentian Violet larutan 1 % pot
0 0 0 0 0 4780.00% 48
200 Gentamisin Salep 0,3 salep Mata tube
30 0 30 3 27 5280.00% 50
201 Gentamisin Sulfat tetes Mata botol
60 0 60 0 60 -20.00%
202 Hidrokortison krim 2,5 % tube
43 0 43 13 30 3780.00% 25
203 Isotik tetes Mata botol
13 0 13 1 12 80.00%
204 Ketokonazol Cream tube
30 0 30 10 20 5980.00% 50
205 Gentamisin Salep 0,1 salap kulit tube
0 0 0 0 0 2980.00% 30
206 Oksitetrasiklin HCl salep mata 1 % tube
0 0 -20.00%
207 Salep 2-4 pot
13 0 13 1 12 2480.00% 24
208 Mikonazol krim 2 % tube
11 0 11 4 7 5380.00% 50
209 Zolacord kream tube
0 0 -20.00%
210 Salisil Bedak 2 % pcs
18 0 18 0 18 -20.00%
211 Berlison N tube
0 0 -20.00%
INFUS
0 0 -20.00%
212 Dekstran 70 - larutan infus 6% steril botol
0 0 -20.00%
213 Glukosa larutan infus 10 % steril (Produk lokal botol
0 0 -20.00%
214 Glukosa larutan infus 40 % steril (Produk lokal botol
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

215 Glukosa larutan infus 5 % steril (Produk lokal) botol

0 0 -20.00%
216 Natrium Klorida infus 0,9 % steril (Produk loka botol
6 0 6 0 6 980.00% 10
217 Ringer Laktat larutan infus steril (Produk lokal botol
10 0 10 8 2 2780.00% 20
OBAT GIGI
0 0
218 Ethyl Chlorid Spray botol
1 1 1 0 180.00% 1
219 Eugenol cairan botol
0 0 -20.00%
220 Glass - Ionomer cement ( gc ix ) set
0 0 -20.00%
221 Sement seng fosfat serbuk & cairan set
0 0 -20.00%
222 Monoklorkamfer/Klorfenol kamfer Menthol ( set
0 0 -20.00%
223 Mummifying Pasta set
0 0 -20.00%
224 Temporary Stopping Fletcher serbuk dan caira set
0 0 -20.00%
225 Kalium Hidroksida Pasta box
0 0 -20.00%
226 Devitalisasi pasta /non arsen btl 2gr
0 0 -20.00%
227 Lidocain spray botol
0 0 -20.00%
BAHAN HABIS PAKAI
0 0 -20.00%
228 Alat suntik sekali pakai 0.05 ml pcs
0 0 0 0 19980.00% 200
229 Alat suntik sekali pakai 0.5ml pcs
800 0 800 300 500 329980.00% 3000
230 Alat suntik sekali pakai 1 ml pcs
100 0 100 0 100 9980.00% 100
231 Alat suntik sekali pakai 2,5 ml pcs
0 0 0 0 0 19980.00% 200
232 Alat suntik sekali pakai 3 ml pcs
0 0 0 0 0 19980.00% 200
233 Alat suntik sekali pakai 5 ml pcs
100 0 100 0 100 9980.00% 100
234 TP Disposable Syringe 1ml pcs
0 0 -20.00%
235 Aqua Gel sachet
200 200 0 200 -20.00%
236 Aximed 10x10cm non Woioven pcs
5 5 2 3 180.00%
237 Aximed 5x10cm non Woioven rol
15 0 15 0 15 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

238 Catgut No. 2/0 dgn jarum bedah pcs

0 0 0 1180.00% 12
239 Catgut No. 3/0 dgn jarum bedah pcs
0 0 -20.00%
240 Catgut Chromic W/O Needle 2/0 pcs
12 0 12 0 12 2380.00% 24
241 Catgut Chromic W/O Needle 3/0 pcs
30 0 30 0 30 2380.00% 24
242 Etakridin ( Rivanol ) larutan 0,1% 300ml botol
0 0 -20.00%
243 Etanol 70% 100 ml botol
0 0 0 0 0 2380.00% 24
244 Etanol 70% 1000 ml botol
0 0 -20.00%
245 Foley Catheter No. 16 pcs
2 0 2 0 2 980.00% 10
246 Foley Catheter No. 18 pcs
6 0 6 0 6 980.00% 10
247 Handscoon 7.5 pcs
0 0 0 0 9980.00% 100
248 Handscoon 7 pcs
110 110 0 110 -20.00%
249 Handscoon uk S pcs
100 0 100 0 100 49980.00% 500
250 Handscoon uk M pcs
500 500 0 500 19980.00% 200
251 Infusion set anak pcs
23 23 23 0 4280.00% 20
252 Infusion set dewasa pcs
4 4 4 0 2380.00% 20
253 Infus set type-Y pcs
0 0 -20.00%
254 IV Catheter No.20 G pcs
75 0 75 0 75 -20.00%
255 IV Catheter No. 22 G pcs
100 0 100 0 100 -20.00%
256 IV Catheter No. 24 G pcs
45 0 45 0 45 -20.00%
257 Jelco 20G pcs
0 0 -20.00%
258 Jelco 22G pcs
0 0 -20.00%
259 Jelco 24G pcs
0 0 -20.00%
260 IV. Chateter trovensity Safety Plus 20G pcs
0 0 -20.00%
261 IV. Chateter trovensity Safety Plus 22G pcs
0 0 -20.00%
262 IV. Chateter trovensity Safety Plus 24G pcs
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

263 Kapas Berlemak 500 gram rol

0 0 1980.00% 20
264 Kapas Pembalut / Absorben 250 gram rol
0 0 1980.00% 20
265 Kasa Pembalut 4 x 10 elastis buah
0 0 -20.00%
266 Kasa Pembalut Hidrofil 4 m x 3 cm non elastis buah
0 0 -20.00%
267 Kasa Pembalut Hidrofil 4 m x 5 cm non elastis buah
74 0 74 0 74 4980.00% 50
268 Kasa Pembalut Hidrofil 4 m x 10 cm non elasti buah
80 0 80 0 80 4980.00% 50
269 Kasa Pembalut Hidrofil 4 m x 15 cm non elasti buah
59 0 59 29 30 7880.00% 50
270 kasa steril 16x16 buah
0 0 0 0 4980.00% 50
271 Kasa Pembalut 18mx22cm pcs
0 0 -20.00%
272 Kasa Kompres steril 40 x 40 cm buah
0 0 0 0 0 4980.00% 50
273 Lysol botol
0 0 -20.00%
274 Masker buah
4800 4800 0 4800 -20.00%
275 Micropore 2 inch/5cmx9,1m buah
11 11 0 11 1180.00% 12
276 Polifix 10cm x 5m roll
3 3 0 3 1980.00% 20
277 Polifix 5cm x 1m roll
0 0 -20.00%
278 Povidon Iodida larutan 10 % botol 30 ml
60 0 60 0 60 -20.00%
279 Povidon Iodida larutan 10 % botol 60 ml
0 0 0 0 -20.00%
280 Povidon Iodida larutan 10 % btl 500ml
24 24 0 24 -20.00%
281 Plester 5 yards x 2 inch Zinc oxide roll
0 0 -20.00%
282 Pembalut Elastis Policrepe 7,5 cm x 4,55 roll
0 0 -20.00%
283 Safety box roll
0 0 -20.00%
284 Silk ( Benag Bedah Sutera ) No 3 / 30 pcs
50 0 50 0 50 2380.00% 24
285 Soft Cloth on 10 cm x 10 m kotak
0 0 -20.00%
286 Urin Bag pcs
5 0 5 0 5 -20.00%
287 Masflu tab tab
0 0 199980.00% 2000
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

288 Pularex tab tab

0 0 -20.00%
289 Samcobion tab tab
0 0 -20.00%
VITAMIN
0 0 -20.00%
290 Hemafort tab
0 0 -20.00%
291 Pehavral tab
0 0 -20.00%
292 Betafort syr botol
0 0 -20.00%
293 Becefort syr botol
0 0 -20.00%
294 Geriavita tab tab
0 0 -20.00%
OBAT PROGRAM TB
0 0
295 Kategori Anak paket
0 0 -20.00%
296 Kategori I paket
0 0 -20.00%
297 Kategori II paket
0 0 -20.00%
298 Kategori Sisipan paket
0 0 -20.00%
299 Kombipak paket
0 0 -20.00%

UMUM BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP

Mengetahui / menyetujui : Yang Menyerahkan : Kepala Puskesmas Yang Menerima

Kepala Dinas Kesehatan an. Kepala PPF & PK Petugas Puskesmas
Kabupaten Melawi Dinas Kesehatan
c/q Kabid Pelayanan dan Kabupaten Melawi
Sumber Daya Kesehatan
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

dr. Tanjung Harapan Heru Priyono Dedi, A.Md.Kep

NIP 19740804 200502 1 002 Nip. 19670202 198803 1 011 Nip. 19791125 200904 1 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

PUSKESMAS : Manding NO DOKUMEN :01

KECAMATAN : Pinoh Utara BULAN :31 JULI 2018
KABUPATEN / KOTA : Melawi HALAMAN :1
PROVINSI : Kalimantan Barat

PERSEDIAAN SISA STOK STOK OPTIMUM

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

1 Acyclovir 200mg tab

300 0 300 100 200 9980.00%
2 Acyclovir 400mg tab 400 800
400 800 0 -20.00%
3 Alopurinol tablet 100 mg tab 500
0 500 100 400 9980.00%
4 Albendazole tab 400mg tab
0 0 Err:522 Err:522 Err:522
5 Aminofilin tablet 200 mg tab
0 Err:522 Err:522 Err:522
6 Amitriptilin HCl tablet salut 25 mg tab
400 400 Err:522 Err:522 Err:522
7 Ambroxol 30mg tab tab
400 0 400 400 0 239980.00% 2000
8 Amlodipin tab 10mg tab
1900 1900 900 1000 89980.00%
9 Amoksisilin kapsul 250 mg kaps
100 100 0 100 -20.00%
10 Amoksisilin kaplet 500 mg kapl
400 0 400 200 200 319980.00% 3000
11 Ampisilin 500 mg tab
0 0 0 0 0 -20.00%
12 Antalgin (Metampiron) tablet 500 mg tab
0 0 0 0 0 99980.00% 1000
13 Antasida DOEN I tablet kunyah tab
1500 1000 2500 1000 1500 99980.00%
14 Antimigren: Ergotamin + Kofein tab
0 0 Err:522 Err:522 Err:522 500
15 Antiparkinson:Karbidopa + Levodopa tab
0 Err:522 Err:522 Err:522
16 Asam Askorbat (Vit C) tablet 50 mg tab
0 Err:522 Err:522 Err:522
17 Asetosal tablet 100 mg tab
0 0 Err:522 Err:522 Err:522
18 Asetosal tablet 500 mg tab
500 0 500 300 200
19 Atropin Sulfat tablet 0,5 mg tab
0 0
20 Atenolol tab 50mg tab
0 0
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

21 Asam Mefenamat 500 mg kapl

0 0 0 0 0 3999.8 4000
22 Azitromicyn 500mg tab
440 0 440 210 230 209.8
23 Anaflu tab
0 0 0 1999.8 2000
24 Betahistin tab 6 mg tab
1100 500 1600 100 1500 99.8
25 Bisoprolol tab 5 mg tab
150 0 150 0 150 -0.2
26 Bromheksin tab tab
0 0 0 0 0 2999.8 3000
27 Calcium Laktat (Kalk) Tab 500mg tab
2300 0 2300 0 2300 -0.2
28 Captopril 12,5 mg Tab tab
0 0 -0.2
29 Captopril 25 mg tab tab
800 0 800 100 700 2099.8 2000
30 Captpril 50 mg tab tab
0 0 -0.2
31 Carbamazepin Tab 200 mg tab
0 0 -0.2
32 Cimetidin Tab tab
0 0 999.8 1000
33 Ciprofloxacin 500 mg kapl
3600 0 3600 100 3500 99.8
34 Clindamisin kaps 300mg kaps
4050 0 4050 0 4050 -0.2
35 Clindamisin kaps 150 mg Kaps
0 0 -0.2
36 Chloramfenikol Kapsul 250 mg kaps
0 0 999.8 1000
37 Chlorfeniramin Maleat (CTM) tab 4 mg tab
1700 0 1700 0 1700 499.8 500
38 Chlorpromazin HCL Injeksi 5 mg/ml-2ml amp

39 Chlorpromazin HCL Injeksi 25 mg/ml amp

0 0
40 Chlorpromazin HCL Tablet Salut 100 mg tab
160 160 0 160 -20.00%
41 Chlorpromazin HCL Tablet Salut 25 mg tab
300 300 0 300 -20.00%
42 Cotrimoksazol dewasa 480mg tab
3000 0 3000 0 3000 -20.00%
42 Cotrimoksazol forte dewasa 960mg tab
120 120 120 0 11980.00%
43 Deksametason tablet 0,5 mg tab
2000 1000 3000 1000 2000 99980.00%
44 Dekstrometorfan sirup 10 mg/5 ml botol
0 0
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

45 Dekstrometorfan tablet 15 mg tab

0 0
46 Diazepam injeksi 5 mg/ml - 2 ml amp
0
47 Diazepam tablet 2 mg tab
0 0
48 Diazepam tablet 5 mg tab
600 0 600 250 350 24980.00%
49 Digoksin tablet 0,25 mg tab
0 0
50 Domperidon tab tab
1400 1000 2400 0 2400 -20.00%
51 Erytromisin Kapsul 500 mg kaps
1400 0 1400 0 1400 -20.00%
52 Erytromisin Kapsul 250 mg kaps
0 0 0
53 Extract Belladona tab 10mg tab
0 0
54 Ethambutol HCl tab 500 mg tab
0 0
55 Famotidine tab 20mg tab
0 0
56 Furosemid tablet 40 mg tab
1600 0 1600 600 1000 59980.00%
57 Fenobarbital injeksi 50 mg/ml - 1 ml amp
0 0
58 Fenobarbital tablet 100 mg tab
0 0
59 Fenobarbital tablet 30 mg tab
90 0 90 0 90 -20.00%
60 Folid Acid 1 mg tab
0 0 0 -20.00%
61 Garam Oralit untuk 200 ml air sach
0 0 0 0 49980.00% 500
62 Gemfibrozil 300 mg kaps kaps
180 0 180 0 180 -20.00%
63 Glibenklamid tablet 5 mg tab
0 0
64 Glimepiride 1 mg tab
500 500 0 500
65 Glimepiride 2 mg tab
0 0
66 guaifenisin tab
900 1000 1900 500 1400 49980.00% 0
67 Griseofulvin tablet 125 mg, micronized tab
300 0 300 0 300 49980.00% 500
68 Hidroklorotiazid (HCT) tablet 25 mg tab
1000 0 1000 0 1000 -20.00%
69 Haloperidol tablet 0,5 mg tab
400 400 0 400 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

70 Haloperidol tablet 1,5 mg tab

0 0 -20.00%
71 Haloperidol tablet 5 mg tab
500 0 500 80 420 7980.00%
72 Ibuprofen tablet 200 mg tab
0 0
73 Ibuprofen tablet 400 mg tab
0 1000 0 0 900 399980.00% 4000
74 Isoniazid tab 300 mg tab
0 -20.00%
75 Isosorbid Dinitrat tablet sublingual 5 mg tab
1000 0 1000 0 1000 -20.00%
76 Kombinasi Pirimetamin 25 mg + Sulfadoxin 5 tab
0 0 -20.00%
77 Kuinin (Kina) tablet 200 mg tab
0 0 -20.00%
78 Ketokonazol 200 mg tab
900 0 900 100 800 99980.00% 900
79 Lansoprazole 30mg Kaps
0 0 0 0 0 199980.00% 2000
80 Levofloxacin kapl 500mg kapl
500 500 0 500 -20.00%
81 Linkomisin kaps 500mg kaps
0 0 -20.00%
82 Loratadin Tablet 10 mg tab
360 360 0 360 -20.00%
83 Loperamid tab 2mg tab
400 0 400 0 400 49980.00% 500
84 Malarex tab
0 0 -20.00%
85 Metronidazol tablet 250 mg tab
0 0 -20.00%
86 Metronidazol tablet 500 mg tab
5700 0 5700 0 5700 -20.00%
87 Mebendazole Tab 500mg tab
0 0 -20.00%
88 Meloxicam 7,5 mg tab tab
0 0 0 0 0 99980.00% 1000
89 Meloxicam 15 mg tab tab
0 0 299980.00% 3000
90 Mersibion 5000 tab
400 0 400 0 39980.00%
91 Metformin HCL tab 500mg tab
0 0 0 -20.00%
92 Metilergometrin Maleat tablet salut 0,125 mg tab
0 0 -20.00%
93 Metilprednisolon 4 mg tab
0 0 0 0 0 99980.00% 1000
94 Metoclorpamid 10 mg tab tab
1200 0 1200 200 1000 19980.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

95 Natrium Diklofenak 25 mg tab

0 0 399980.00% 4000
96 Natrium Diklofenak 50 mg tab
0 0 199980.00% 2000
97 Neo Diagon tab
225 225 0 225 -20.00%
98 Nistatin tablet salut 500.000 IU tab
400 0 400 0 400 99980.00% 1000
99 Nistatin tablet vaginal 100.000 IU/g tab
90 0 90 0 90 99980.00% 1000
100 Nifedipin tab 10mg tab
0 0 99980.00% 1000
101 Ofloksasin 400mg tab
100 100 0 100 -20.00%
102 Omeprazole Kaps 20 mg Kaps
0 300 300 180 120 167980.00% 1500
103 Parasetamol tablet 100 mg tab
0 0 0 0 -20.00%
104 Parasetamol tablet 500 mg tab
0 2000 2000 0 2000 399980.00% 4000
105 Ondansetron tab
276 276 72 204 7180.00%
106 Phenoksimetil Penisilina tablet 500 mg tab
0 0 -20.00%
107 Phitomenadion (Vit.K1) tablet salut gula 10 m tab
1100 1100 0 1100 -20.00%
108 Piridoksin HCl (Vit.B6) tablet 10 mg tab
1500 0 1500 600 900 59980.00%
109 Pirazinamid tab tab
1000 1000 0 1000 -20.00%
110 Piroxicam kaps 10 mg kaps
0 800 800 0 800 199980.00% 2000
111 Piroxicam kaps 20 mg kaps
0 0 0 99980.00% 1000
112 Prednison tablet 5 mg tab
0 1000 1000 100 900 59980.00% 500
113 Primakuin tablet 15 mg tab
3000 0 3000 0 3000 -20.00%
114 Propiltiourasil tablet 100 mg tab
0 0 -20.00%
115 Pirantel tablet 125 mg tab
600 600 0 600 -20.00%
116 Propranolol HCl tablet 40 mg tab
900 900 100 800 9980.00%
117 Ranitidin tab 150 mg tab
300 0 300 0 300 49980.00% 500
118 Rifampicin 450 mg kaplet kapl
0 0 -20.00%
119 Risperidon 1 mg tab
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

120 Risperidon 2 mg tab

1000 1000 160 840 45980.00% 300
121 Salbutamol tab 2 mg tab
0 0 -20.00%
122 Salbutamol tab 4 mg tab
2500 2500 100 2400 59980.00% 500
123 Sefadroksil kaps 500mg kaps
700 500 1200 500 700 149980.00% 1000
124 Sefiksim kaps 100mg kaps
800 800 300 500 79980.00% 500
125 Setrizin kaps 10mg Kaps
300 1000 1300 400 900 89980.00% 500
126 Syanocobalamin tab 10 mg tab
0 0
127 Spironolacton 25mg tablet tab
2500 2500 0 2500 99980.00% 1000
128 Simvastatin 10mg tab tab
3420 3420 0 3420 -20.00%
129 Simvastatin 20mg tab tab
0 0 -20.00%
130 Tablet Tambah Darah kombinasi / Besi Ferro tab
0 0 -20.00%
131 thyrozol kaps
700 700 0 700 -20.00%
132 Tetrasiklin HCl kapsul 500 mg kaps
0 0 -20.00%
133 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg tab
2700 0 2700 600 2100 59980.00%
134 Urinter kaps
500 0 500 300 200 29980.00%
135 Tramadol kapsul kaps
500 0 500 0 500 49980.00% 500
136 Triheksifenidil Hidroklorida tablet 2 mg tab
500 500 0 500 -20.00%
137 Vitamin B Kompleks tablet tab
2500 0 2500 1900 600 289980.00% 1000
138 Retinol ( Vitamin A ) 100.000 IU Kapsul lunak Kaps
0 0 -20.00%
139 Retinol ( Vitamin A ) 200.000 IU Kapsul Lunak Kaps
0 0 -20.00%
140 Zink tab dispersible 20 mg tab
1600 0 1600 1100 500 109980.00%
INJEKSI
0 0
141 Aminofilina Injeksi 24 mg/ml -10 ml amp
0 0 -20.00%
142 Ampisillin Inj vial
0 0 -20.00%
143 Antalgin Injeksi 250 mg/ml - 2 ml amp
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

144 Aqua Pro injeksi Steril 25 ml vial

0 0 0 0 2980.00% 30
144 Aqua Pro injeksi Steril 50 ml
0 0 980.00% 10
145 Asam Traneksamat injeksi 50mg/ml amp
0 0 -20.00%
146 Atropin Sulfat Injeksi 0,25 mg/ml -1 ml amp
0 0 -20.00%
147 Cefotaxime serbuk injeksi 500mg vial
0 0 -20.00%
148 Dexamethasone injeksi 5 mg/ml-1ml amp
0 0 -20.00%
149 Difenhidramin HCL Inj 10mg/ml-1ml amp
0 0 -20.00%
150 Epineprine HCL 0,1% -1ml amp
0 0 1980.00% 20
151 Fitomenadion (Vit K1) Injeksi 10mg/ml-1ml amp
21 21 0 21 -20.00%
152 Gentamisin Injeksi amp
0 0 -20.00%
153 Haloperidol Inj 50mg/ml 1 ml amp
0 0 -20.00%
154 Kuinin Dihidroklorida Injeksi 25% - 2 ml amp
0 0 -20.00%
155 Lidokain inj 2%(HCL) + Epineprin 1:80.000 -2ml amp
30 0 30 2 28 3180.00% 30
156 Metilergometrin Maleat Injeksi amp
62 62 0 62 -20.00%
157 Metoklorpamide Inj amp
0 0 -20.00%
158 Magnesium Sulfat inj (IV) 20% - 25 ml vial
0 0 -20.00%
159 Magnesium Sulfat inj (IV) 40% - 25 ml vial
0 0 -20.00%
160 Oksitetrasiklin HCL Injeksi i.m 50mg/ml-10ml vial
0 0 -20.00%
161 Oksitosin Injeksi 10 IU/ml-1ml amp
32 32 0 32 -20.00%
162 Sianokobalamin (Vit.B12) injeksi 500 mcg-ml amp
30 0 30 20 10 11980.00% 100
163 Streptomycin Sulfat Serbuk inj 1000 mg / vial vial
0 0 -20.00%
164 Thiamin HCL Injeksi 100mg/ml-1ml amp
0 0 -20.00%
165 Tramadol injeksi 50mg/ml amp
0 0 -20.00%
166 Ranitidin Injeksi amp
0 0 -20.00%
SYRUP
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

167 Amoksisilin sirup kering 125 mg/5ml botol

0 0 0 -20.00%
168 Amoksisilin sirup kering 250 mg/5ml botol
50 0 50 0 50 4980.00% 50
169 Ampisillin syrup kering botol
0 0 -20.00%
170 Antasida Syrup botol
40 0 40 0 40 -20.00%
171 Ambroxol Syr botol
0 0 4980.00% 50
172 Domperidon suspensi 5mg/5ml botol
100 50 150 50 100 4980.00%
173 Erithromicyn Syr botol
0 0 4980.00% 50
174 Ibuprofen suspensi 100mg/5ml botol
50 0 50 0 50 4980.00% 50
175 Kloramphenokol Suspensi 125mg/5ml botol
0 0 -20.00%
176 Kotrimoksazol Suspensi Komb botol
0 0 -20.00%
177 Obat Batuk Hitam (OBH) cairan botol
0 60 0 10 50 6980.00% 60
178 Paracetamol Syrup 120mg/5ml botol
50 0 50 20 30 11980.00% 100
179 Paracetamol drop 100mg btl@15ml botol
0 50 50 0 50 9980.00% 100
180 Pirantel Suspensi 125mg/5ml botol 60 ml
0 0 0 -20.00%
181 Pirantel Suspensi 125mg/5ml botol 10 ml
0 0 -20.00%
182 Salbutamol sirup 2mg/5ml botol
0 0 -20.00%
183 Sefadroksil sirup kering 125mg/5ml botol
100 60 160 40 120 3980.00%
184 Setrizin sirup 5mg/5ml botol
150 0 150 30 120 2980.00%
185 Zink Sirup 10mg/ml botol
0 0 0 -20.00%
186 Interzinc syr botol
144 0 144 0 144 -20.00%
187 Gralisin syr botol
0 0 -20.00%
188 Metoklorpamide syr botol
0 0 -20.00%
189 Sulcralfat syr botol
100 100 75 25 7480.00%
190 Thiampenicol syr botol
0 0 -20.00%
OBAT LUAR / SALEP
0 0
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

191 Acyclovir Cream tube

25 0 25 25 0 7480.00% 50
192 Anti Bakteri DOEN salep,Basitrasin Cr tube
25 0 25 0 25 2480.00% 25
193 Anti Hemoroid DOEN Kombinasi supp
0 0 -20.00%
194 Antifungi DOEN :As. Benzoat + As. Salisilat pot
11 0 11 0 11 -20.00%
195 Betametason krim 0.1% tube
24 50 74 24 50 7380.00% 50
196 Chloramfenikol Tetes telinga 3% botol
0 0 4980.00% 50
197 Chloramfenikol Salep Mata 1 % tube
288 0 288 0 288 -20.00%
198 Fenol Gliserin tetes telinga 10% botol
24 0 24 0 24 -20.00%
199 Gentian Violet larutan 1 % pot
0 0 0 0 0 4780.00% 48
200 Gentamisin Salep 0,3 salep Mata tube
30 0 30 3 27 5280.00% 50
201 Gentamisin Sulfat tetes Mata botol
60 0 60 0 60 -20.00%
202 Hidrokortison krim 2,5 % tube
30 48 78 30 48 5480.00% 25
203 Isotik tetes Mata botol
12 0 12 9 3 1880.00% 10
204 Ketokonazol Cream tube
30 0 30 10 20 5980.00% 50
205 Gentamisin Salep 0,1 salap kulit tube
0 0 0 0 0 2980.00% 30
206 Oksitetrasiklin HCl salep mata 1 % tube
0 0 -20.00%
207 Salep 2-4 pot
13 0 13 1 12 2480.00% 24
208 Mikonazol krim 2 % tube
11 0 11 4 7 5380.00% 50
209 Zolacord kream tube
0 0 -20.00%
210 Salisil Bedak 2 % pcs
18 0 18 0 18 -20.00%
211 Berlison N tube
0 0 -20.00%
INFUS
0 0 -20.00%
212 Dekstran 70 - larutan infus 6% steril botol
0 0 -20.00%
213 Glukosa larutan infus 10 % steril (Produk lokal botol
0 0 -20.00%
214 Glukosa larutan infus 40 % steril (Produk lokal botol
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

215 Glukosa larutan infus 5 % steril (Produk lokal) botol

0 0 -20.00%
216 Natrium Klorida infus 0,9 % steril (Produk loka botol
6 20 26 0 26 980.00% 10
217 Ringer Laktat larutan infus steril (Produk lokal botol
10 0 10 8 2 2780.00% 20
OBAT GIGI
0 0
218 Ethyl Chlorid Spray botol
1 1 1 0 180.00% 1
219 Eugenol cairan botol
0 0 -20.00%
220 Glass - Ionomer cement ( gc ix ) set
0 0 -20.00%
221 Sement seng fosfat serbuk & cairan set
0 0 -20.00%
222 Monoklorkamfer/Klorfenol kamfer Menthol ( set
0 0 -20.00%
223 Mummifying Pasta set
0 0 -20.00%
224 Temporary Stopping Fletcher serbuk dan caira set
0 0 -20.00%
225 Kalium Hidroksida Pasta box
0 0 -20.00%
226 Devitalisasi pasta /non arsen btl 2gr
0 0 -20.00%
227 Lidocain spray botol
0 0 -20.00%
BAHAN HABIS PAKAI
0 0 -20.00%
228 Alat suntik sekali pakai 0.05 ml pcs
0 0 0 0 19980.00% 200
229 Alat suntik sekali pakai 0.5ml pcs
500 0 500 0 500 299980.00% 3000
230 Alat suntik sekali pakai 1 ml pcs
100 0 100 0 100 9980.00% 100
231 Alat suntik sekali pakai 2,5 ml pcs
0 0 0 0 0 19980.00% 200
232 Alat suntik sekali pakai 3 ml pcs
0 0 0 0 0 19980.00% 200
233 Alat suntik sekali pakai 5 ml pcs
100 0 100 0 100 9980.00% 100
234 TP Disposable Syringe 1ml pcs
0 0 -20.00%
235 Aqua Gel sachet
200 200 0 200 -20.00%
236 Aximed 10x10cm non Woioven pcs
5 5 2 3 180.00%
237 Aximed 5x10cm non Woioven rol
15 0 15 0 15 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

238 Catgut No. 2/0 dgn jarum bedah pcs

0 0 0 1180.00% 12
239 Catgut No. 3/0 dgn jarum bedah pcs
0 0 -20.00%
240 Catgut Chromic W/O Needle 2/0 pcs
12 0 12 0 12 2380.00% 24
241 Catgut Chromic W/O Needle 3/0 pcs
30 0 30 0 30 2380.00% 24
242 Etakridin ( Rivanol ) larutan 0,1% 300ml botol
0 0 -20.00%
243 Etanol 70% 100 ml botol
0 0 0 0 0 2380.00% 24
244 Etanol 70% 1000 ml botol
0 0 -20.00%
245 Foley Catheter No. 16 pcs
2 0 2 0 2 980.00% 10
246 Foley Catheter No. 18 pcs
6 0 6 0 6 980.00% 10
247 Handscoon 7.5 pcs
0 0 0 0 9980.00% 100
248 Handscoon 7 pcs
110 110 2 108 #VALUE! ALKOHOL
249 Handscoon uk S pcs
100 0 100 0 100 49980.00% 500
250 Handscoon uk M pcs
500 500 0 500 19980.00% 200
251 Infusion set anak pcs
23 23 23 0 4280.00% 20
252 Infusion set dewasa pcs
4 4 4 0 2380.00% 20
253 Infus set type-Y pcs
0 0 -20.00%
254 IV Catheter No.20 G pcs
75 0 75 0 75 -20.00%
255 IV Catheter No. 22 G pcs
100 0 100 0 100 -20.00%
256 IV Catheter No. 24 G pcs
45 0 45 0 45 -20.00%
257 Jelco 20G pcs
0 0 -20.00%
258 Jelco 22G pcs
0 0 -20.00%
259 Jelco 24G pcs
0 0 -20.00%
260 IV. Chateter trovensity Safety Plus 20G pcs
0 0 -20.00%
261 IV. Chateter trovensity Safety Plus 22G pcs
0 0 -20.00%
262 IV. Chateter trovensity Safety Plus 24G pcs
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

263 Kapas Berlemak 500 gram rol

0 0 1980.00% 20
264 Kapas Pembalut / Absorben 250 gram rol
0 0 1980.00% 20
265 Kasa Pembalut 4 x 10 elastis buah
0 0 -20.00%
266 Kasa Pembalut Hidrofil 4 m x 3 cm non elastis buah
0 0 -20.00%
267 Kasa Pembalut Hidrofil 4 m x 5 cm non elastis buah
74 0 74 0 74 4980.00% 50
268 Kasa Pembalut Hidrofil 4 m x 10 cm non elasti buah
80 0 80 0 80 4980.00% 50
269 Kasa Pembalut Hidrofil 4 m x 15 cm non elasti buah
59 0 59 29 30 7880.00% 50
270 kasa steril 16x16 buah
0 0 0 0 4980.00% 50
271 Kasa Pembalut 18mx22cm pcs
0 0 -20.00%
272 Kasa Kompres steril 40 x 40 cm buah
0 0 0 0 0 4980.00% 50
273 Lysol botol
0 0 -20.00%
274 Masker buah
4800 4800 0 4800 -20.00%
275 Micropore 2 inch/5cmx9,1m buah
11 11 0 11 1180.00% 12
276 Polifix 10cm x 5m roll
3 3 0 3 1980.00% 20
277 Polifix 5cm x 1m roll
0 0 -20.00%
278 Povidon Iodida larutan 10 % botol 30 ml
60 0 60 0 60 -20.00%
279 Povidon Iodida larutan 10 % botol 60 ml
0 0 0 0 -20.00%
280 Povidon Iodida larutan 10 % btl 500ml
24 24 0 24 -20.00%
281 Plester 5 yards x 2 inch Zinc oxide roll
0 0 -20.00%
282 Pembalut Elastis Policrepe 7,5 cm x 4,55 roll
0 0 -20.00%
283 Safety box roll
0 0 -20.00%
284 Silk ( Benag Bedah Sutera ) No 3 / 30 pcs
50 0 50 0 50 2380.00% 24
285 Soft Cloth on 10 cm x 10 m kotak
0 0 -20.00%
286 Urin Bag pcs
5 0 5 0 5 -20.00%
287 Masflu tab tab
0 0 199980.00% 2000
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

288 Pularex tab tab

0 0 -20.00%
289 Samcobion tab tab
0 0 -20.00%
VITAMIN
0 0 -20.00%
290 Hemafort tab
0 0 -20.00%
291 Pehavral tab
0 0 -20.00%
292 Betafort syr botol
0 0 -20.00%
293 Becefort syr botol
0 0 -20.00%
294 Geriavita tab tab
0 0 -20.00%
OBAT PROGRAM TB
0 0
295 Kategori Anak paket
0 0 -20.00%
296 Kategori I paket
0 0 -20.00%
297 Kategori II paket
0 0 -20.00%
298 Kategori Sisipan paket
0 0 -20.00%
299 Kombipak paket
0 0 -20.00%

UMUM BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP

Mengetahui / menyetujui : Yang Menyerahkan : Kepala Puskesmas Yang Menerima

Kepala Dinas Kesehatan an. Kepala PPF & PK Petugas Puskesmas
Kabupaten Melawi Dinas Kesehatan
c/q Kabid Pelayanan dan Kabupaten Melawi
Sumber Daya Kesehatan

dr. Tanjung Harapan Heru Priyono Dedi, A.Md.Kep

NIP 19740804 200502 1 002 Nip. 19670202 198803 1 011 Nip. 19791125 200904 1 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

PUSKESMAS : Manding NO DOKUMEN :01

KECAMATAN : Pinoh Utara BULAN :31 AGUSTUS 2018
KABUPATEN / KOTA : Melawi HALAMAN :1
PROVINSI : Kalimantan Barat

PERSEDIAAN SISA STOK STOK OPTIMUM

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

1 Acyclovir 200mg tab

200 0 200 0 200 -20.00%
2 Acyclovir 400mg tab 700
800 0 800 100 9980.00%
3 Alopurinol tablet 300 mg tab 2000
0 2000 2000 0 -20.00%
4 Alopurinol tablet 100 mg tab 400
0 400 200 200 19980.00%
5 Albendazole tab 400mg tab
0 0 0 0 -20.00%
6 Aminofilin tablet 200 mg tab
0 0 0 0 -20.00%
7 Amitriptilin HCl tablet salut 25 mg tab
400 400 Err:522 Err:522 Err:522
8 Ambroxol 30mg tab tab
0 0 0 0 0 199980.00% 2000
9 Amlodipin tab 10mg tab
1000 1000 730 270 122980.00% 500
10 Amoksisilin kapsul 250 mg kaps
100 100 0 100 -20.00%
11 Amoksisilin kaplet 500 mg kapl
200 3000 3200 2100 1100 509980.00% 3000
12 Ampisilin 500 mg tab
0 1000 0 0 1000 -20.00%
13 Antalgin (Metampiron) tablet 500 mg tab
0 0 0 0 0 99980.00% 1000
14 Antasida DOEN I tablet kunyah tab
0 0 0 0 0 99980.00% 1000
15 Antimigren: Ergotamin + Kofein tab
0 Err:522 Err:522 Err:522 500
16 Antiparkinson:Karbidopa + Levodopa tab
0 Err:522 Err:522 Err:522
17 Asam Askorbat (Vit C) tablet 50 mg tab
0 3500 0 3500 -20.00%
18 Asetosal tablet 100 mg tab
0 0 Err:522 Err:522 Err:522
19 Asetosal tablet 500 mg tab
200 0 200 100 100 59980.00% 500
20 Atropin Sulfat tablet 0,5 mg tab
0 0
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

21 Atenolol tab 50mg tab

0 0
22 Asam Mefenamat 500 mg kapl
0 4500 0 0 2800 999.8 1000
23 Azitromicyn 500mg tab
230 0 230 0 230 -0.2
24 Anaflu tab
0 0 0 1999.8 2000
25 Betahistin tab 6 mg tab
1500 0 1500 240 1260 239.8 exp. 7-2018
26 Bisoprolol tab 5 mg tab
150 0 150 0 150 -0.2
27 Bromheksin tab tab
0 0 0 0 0 2999.8 3000
28 Calcium Laktat (Kalk) Tab 500mg tab
2300 0 2300 700 1600 699.8
29 Captopril 12,5 mg Tab tab
0 0 -0.2
30 Captopril 25 mg tab tab
700 1000 1700 1500 200 3499.8 2000
31 Captpril 50 mg tab tab
0 0 -0.2
32 Carbamazepin Tab 200 mg tab
0 0 -0.2
33 Cimetidin Tab tab
0 0 999.8 1000
34 Ciprofloxacin 500 mg kapl
3600 0 3600 100 3500 99.8
35 Clindamisin kaps 300mg kaps
4050 0 4050 0 4050 499.8 500 Exp.agt 2018
36 Clindamisin kaps 150 mg Kaps
0 0 -0.2
37 Chloramfenikol Kapsul 250 mg kaps
0 0 999.8 1000
38 Chlorfeniramin Maleat (CTM) tab 4 mg tab
1700 0 1700 1200 500 1699.8 500
39 Chlorpromazin HCL Injeksi 5 mg/ml-2ml amp

40 Chlorpromazin HCL Injeksi 25 mg/ml amp

0 0
41 Chlorpromazin HCL Tablet Salut 100 mg tab
160 100 260 20 240 1980.00%
42 Chlorpromazin HCL Tablet Salut 25 mg tab
300 0 300 0 300 -20.00%
43 Cotrimoksazol dewasa 480mg tab
3000 0 3000 0 3000 -20.00%
44 Cotrimoksazol forte dewasa 960mg tab
0 0 0 0 49980.00% 500
45 Deksametason tablet 0,5 mg tab
2000 0 2000 1000 1000 99980.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

46 Dekstrometorfan sirup 10 mg/5 ml botol

0 0
47 Dekstrometorfan tablet 15 mg tab
0 0
48 Diazepam injeksi 5 mg/ml - 2 ml amp
0
49 Diazepam tablet 2 mg tab
0 0
50 Diazepam tablet 5 mg tab
350 0 350 50 300 4980.00%
51 Digoksin tablet 0,25 mg tab
0 0
52 Domperidon tab tab
2400 1000 3400 1500 1900 149980.00%
53 Erytromisin Kapsul 500 mg kaps
1400 0 1400 600 800 59980.00%
54 Erytromisin Kapsul 250 mg kaps
0 0 0 49980.00% 500
55 Extract Belladona tab 10mg tab
0 0
56 Ethambutol HCl tab 500 mg tab
0 0
57 Famotidine tab 20mg tab
0 0
58 Furosemid tablet 40 mg tab
1000 0 1000 500 500 49980.00%
59 Fenobarbital injeksi 50 mg/ml - 1 ml amp
0 0
60 Fenobarbital tablet 100 mg tab
0 0
61 Fenobarbital tablet 30 mg tab
90 0 90 0 90 -20.00%
62 Folid Acid 1 mg tab
0 0 0 -20.00%
63 Garam Oralit untuk 200 ml air sach
0 0 0 0 49980.00% 500
64 Gemfibrozil 300 mg kaps kaps
180 0 180 0 180 -20.00%
65 Glibenklamid tablet 5 mg tab
0 0
66 Glimepiride 1 mg tab
500 500 0 500
67 Glimepiride 2 mg tab
0 0
68 guaifenisin tab
1400 0 1400 1100 300 209980.00% 1000
69 Griseofulvin tablet 125 mg, micronized tab
300 500 800 0 800 -20.00%
70 Hidroklorotiazid (HCT) tablet 25 mg tab
1000 0 1000 0 1000 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

71 Haloperidol tablet 0,5 mg tab

400 400 200 200 19980.00%
72 Haloperidol tablet 1,5 mg tab
200 200 0 200 -20.00%
73 Haloperidol tablet 5 mg tab
420 0 420 90 330 8980.00%
74 Ibuprofen tablet 200 mg tab
0 0
75 Ibuprofen tablet 400 mg tab
900 4000 0 0 3100 49980.00% 500
76 Isoniazid tab 300 mg tab
0 -20.00%
77 Isosorbid Dinitrat tablet sublingual 5 mg tab
1000 0 1000 0 1000 -20.00%
78 Kombinasi Pirimetamin 25 mg + Sulfadoxin 5 tab
0 0 -20.00%
79 Kuinin (Kina) tablet 200 mg tab
0 0 -20.00%
80 Ketokonazol 200 mg tab
800 800 1600 700 900 69980.00% 0
81 Lansoprazole 30mg Kaps
0 0 0 0 0 199980.00% 2000
82 Levofloxacin kapl 500mg kapl
500 500 0 500 -20.00%
83 Linkomisin kaps 500mg kaps
0 0 -20.00%
84 Loratadin Tablet 10 mg tab
360 360 0 360 -20.00%
85 Loperamid tab 2mg tab
400 0 400 0 400 49980.00% 500
86 Malarex tab
0 0 -20.00%
87 Metronidazol tablet 250 mg tab
0 0 -20.00%
88 Metronidazol tablet 500 mg tab
5700 0 5700 0 5700 -20.00%
89 Mebendazole Tab 500mg tab
0 0 -20.00%
90 Meloxicam 7,5 mg tab tab
0 0 0 0 0 99980.00% 1000
91 Meloxicam 15 mg tab tab
0 0 299980.00% 3000
92 Mersibion 5000 tab
0 0 0 0 49980.00% 500
93 Metformin HCL tab 500mg tab
300 300 0 300 -20.00%
94 Metilergometrin Maleat tablet salut 0,125 mg tab
0 0 -20.00%
95 Metilprednisolon 4 mg tab
0 0 0 0 0 99980.00% 1000
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

96 Metoclorpamid 10 mg tab tab

1000 0 1000 0 1000 -20.00%
97 Natrium Diklofenak 25 mg tab
0 0 399980.00% 4000
98 Natrium Diklofenak 50 mg tab
0 0 199980.00% 2000
99 Neo Diagon tab
225 225 25 200 52480.00% 500
100 Nistatin tablet salut 500.000 IU tab
400 1000 1400 400 1000 39980.00% 0
101 Nistatin tablet vaginal 100.000 IU/g tab
90 1000 1090 290 800 28980.00% 0
102 Nifedipin tab 10mg tab
1000 1000 100 900 9980.00% 0
103 Ofloksasin 400mg tab
100 100 0 100 -20.00%
104 Omeprazole Kaps 20 mg Kaps
120 3000 3120 1590 1530 208980.00% 500
105 Parasetamol tablet 100 mg tab
0 0 0 0 -20.00%
106 Parasetamol tablet 500 mg tab
2000 4200 4200 2600 1600 359980.00% 1000
107 Ondansetron tab
204 204 72 132 7180.00%
108 Phenoksimetil Penisilina tablet 500 mg tab
0 0 -20.00%
109 Phitomenadion (Vit.K1) tablet salut gula 10 m tab
1100 0 1100 0 1100 -20.00%
110 Piridoksin HCl (Vit.B6) tablet 10 mg tab
900 3000 3900 500 3400 49980.00%
111 Pirazinamid tab tab
1000 1000 0 1000 -20.00%
112 Piroxicam kaps 10 mg kaps
800 800 1600 0 0 199980.00% 2000
113 Piroxicam kaps 20 mg kaps
0 0 0 99980.00% 1000
114 Prednison tablet 5 mg tab
900 500 1400 1300 100 229980.00% 1000
115 Primakuin tablet 15 mg tab
3000 0 3000 0 3000 -20.00%
116 Propiltiourasil tablet 100 mg tab
0 0 -20.00%
117 Pirantel tablet 125 mg tab
600 600 600 0 109980.00% 500
118 Propranolol HCl tablet 40 mg tab
900 900 100 800 9980.00% exp. Agt 2018
119 Ranitidin tab 150 mg tab
300 500 800 800 0 129980.00% 500
120 Rifampicin 450 mg kaplet kapl
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

121 Risperidon 1 mg tab

0 0 -20.00%
122 Risperidon 2 mg tab
840 840 0 840 29980.00% 300
123 Salbutamol tab 2 mg tab
0 0 49980.00% 500
124 Salbutamol tab 4 mg tab
2800 500 3300 700 2600 119980.00% 500
125 Sefadroksil kaps 500mg kaps
700 1000 1700 1200 500 169980.00% 500
126 Sefiksim kaps 100mg kaps
800 500 1300 400 900 89980.00% 500
127 Setrizin kaps 10mg Kaps
900 500 1400 800 600 129980.00% 500
128 Syanocobalamin tab 10 mg tab
0 0
129 Spironolacton 25mg tablet tab
2500 2500 0 2500 -20.00% exp. Juni 2018
130 Simvastatin 10mg tab tab
3420 3420 0 3420 49980.00% 500
131 Simvastatin 20mg tab tab
0 0 -20.00%
132 Tablet Tambah Darah kombinasi / Besi Ferro tab
0 0 -20.00%
133 thyrozol kaps
700 700 0 700 -20.00%
134 Tetrasiklin HCl kapsul 500 mg kaps
0 0 -20.00%
135 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg tab
2100 0 2100 0 2100 -20.00%
136 Urinter kaps
200 0 200 0 200 -20.00%
137 Tramadol kapsul kaps
500 0 500 0 500 49980.00% 500
138 Triheksifenidil Hidroklorida tablet 2 mg tab
500 500 0 500 -20.00%
139 Vitamin B Kompleks tablet tab
600 1000 1600 1200 400 219980.00% 1000
140 Retinol ( Vitamin A ) 100.000 IU Kapsul lunak Kaps
0 0 -20.00%
141 Retinol ( Vitamin A ) 200.000 IU Kapsul Lunak Kaps
0 0 -20.00%
142 Zink tab dispersible 20 mg tab
500 0 500 500 0 99980.00% 500
143 INJEKSI
0 0
144 Aminofilina Injeksi 24 mg/ml -10 ml amp
0 0 -20.00%
145 Ampisillin Inj vial
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

146 Antalgin Injeksi 250 mg/ml - 2 ml amp

100 100 0 100 -20.00%
147 Aqua Pro injeksi Steril 25 ml vial
0 0 0 0 2980.00% 30
148 Aqua Pro injeksi Steril 50 ml
0 0 980.00% 10
149 Asam Traneksamat injeksi 50mg/ml amp
0 0 -20.00%
150 Atropin Sulfat Injeksi 0,25 mg/ml -1 ml amp
0 0 -20.00%
151 Cefotaxime serbuk injeksi 500mg vial
0 0 -20.00%
152 Dexamethasone injeksi 5 mg/ml-1ml amp
0 0 -20.00%
153 Difenhidramin HCL Inj 10mg/ml-1ml amp
0 0 -20.00%
154 Epineprine HCL 0,1% -1ml amp
200 200 0 200 -20.00%
155 Fitomenadion (Vit K1) Injeksi 10mg/ml-1ml amp
21 21 0 21 -20.00%
156 Gentamisin Injeksi amp
0 0 -20.00%
157 Haloperidol Inj 50mg/ml 1 ml amp
0 0 -20.00%
158 Kuinin Dihidroklorida Injeksi 25% - 2 ml amp
0 0 -20.00%
159 Lidokain inj 2%(HCL) + Epineprin 1:80.000 -2ml amp
28 30 58 30 28 2980.00%
160 Metilergometrin Maleat Injeksi amp
62 62 0 62 -20.00%
161 Metoklorpamide Inj amp
0 0 -20.00%
162 Magnesium Sulfat inj (IV) 20% - 25 ml vial
0 0 -20.00%
163 Magnesium Sulfat inj (IV) 40% - 25 ml vial
0 0 -20.00%
164 Oksitetrasiklin HCL Injeksi i.m 50mg/ml-10ml vial
0 0 -20.00%
165 Oksitosin Injeksi 10 IU/ml-1ml amp
32 32 0 32 -20.00%
166 Sianokobalamin (Vit.B12) injeksi 500 mcg-ml amp
10 200 210 28 182 2780.00%
167 Streptomycin Sulfat Serbuk inj 1000 mg / vial vial
0 0 -20.00%
168 Thiamin HCL Injeksi 100mg/ml-1ml amp
0 0 -20.00%
169 Tramadol injeksi 50mg/ml amp
0 0 -20.00%
170 Ranitidin Injeksi amp
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

171 SYRUP
0 0 -20.00%
172 Amoksisilin sirup kering 125 mg/5ml botol
0 0 0 4980.00% 50
173 Amoksisilin sirup kering 250 mg/5ml botol
50 50 100 0 100 -20.00%
174 Ampisillin syrup kering botol
0 0 -20.00%
175 Antasida Syrup botol
40 0 40 40 0 8980.00% 50
176 Ambroxol Syr botol
0 0 4980.00% 50
177 Domperidon suspensi 5mg/5ml botol
100 0 100 61 39 6080.00%
178 Erithromicyn Syr botol
120 120 0 120 -20.00%
179 Ibuprofen suspensi 100mg/5ml botol
50 0 50 0 50 4980.00% 50
180 Kloramphenokol Suspensi 125mg/5ml botol
0 0 -20.00%
181 Kotrimoksazol Suspensi Komb botol
0 0 4980.00% 50
182 Obat Batuk Hitam (OBH) cairan botol
0 60 0 10 50 6980.00% 60
183 Paracetamol Syrup 120mg/5ml botol
50 0 50 20 30 11980.00% 100
184 Paracetamol drop 100mg btl@15ml botol
50 100 150 100 50 14980.00% 50
185 Pirantel Suspensi 125mg/5ml botol 60 ml
0 0 0 -20.00%
186 Pirantel Suspensi 125mg/5ml botol 10 ml
0 0 -20.00%
187 Salbutamol sirup 2mg/5ml botol
0 0 4980.00% 50
188 Sefadroksil sirup kering 125mg/5ml botol
120 60 180 0 180 4980.00% 50 exp. Sep 2018
189 Setrizin sirup 5mg/5ml botol
120 0 120 0 120 4980.00% 50
190 Zink Sirup 10mg/ml botol
0 0 0 -20.00%
191 Interzinc syr botol
144 48 192 2 190 180.00%
192 Gralisin syr botol
0 0 -20.00%
193 Metoklorpamide syr botol
0 0 -20.00%
194 Sulcralfat syr botol
25 25 0 25 4980.00% 50
195 Thiampenicol syr botol
0 0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

196 OBAT LUAR / SALEP

0 0 0
197 Acyclovir Cream tube
0 25 0 14 11 6380.00% 50
198 Anti Bakteri DOEN salep,Basitrasin Cr tube
12 0 12 5 7 2980.00% 25
199 Anti Hemoroid DOEN Kombinasi supp
0 0 -20.00%
200 Antifungi DOEN :As. Benzoat + As. Salisilat pot
7 0 7 7 0 3080.00% 24
201 Betametason krim 0.1% tube
50 72 122 22 100 2180.00%
202 Chloramfenikol Tetes telinga 3% botol
0 0 4980.00% 50
203 Chloramfenikol Salep Mata 1 % tube
288 0 288 24 264 2380.00%
204 Fenol Gliserin tetes telinga 10% botol
24 0 24 0 24 -20.00% exp. Agt 2018
205 Gentian Violet larutan 1 % pot
0 0 0 0 0 4780.00% 48
206 Gentamisin Salep 0,3 salep Mata tube
27 0 27 7 20 5680.00% 50
207 Gentamisin Sulfat tetes Mata botol
60 0 60 50 10 4980.00%
208 Hidrokortison krim 2,5 % tube
48 0 48 0 48 2480.00% 25
209 Isotik tetes Mata botol
1 0 1 1 0 2080.00% 20
210 Ketokonazol Cream tube
13 0 13 0 13 4980.00% 50
211 Gentamisin Salep 0,1 salap kulit tube
0 0 0 0 0 2980.00% 30
212 Oksitetrasiklin HCl salep mata 1 % tube
0 0 -20.00%
213 Salep 2-4 pot
24 24 48 24 24 4780.00% 24
214 Mikonazol krim 2 % tube
7 48 55 21 34 7080.00% 50
215 Zolacord kream tube
0 0 -20.00%
216 Salisil Bedak 2 % pcs
18 0 18 5 13 2480.00% 20
217 Berlison N tube
0 0 -20.00%
218 INFUS
0 0 -20.00%
219 Dekstran 70 - larutan infus 6% steril botol
0 0 -20.00%
220 Glukosa larutan infus 10 % steril (Produk lokal botol
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

221 Glukosa larutan infus 40 % steril (Produk lokal botol

-20.00%
222 Glukosa larutan infus 5 % steril (Produk lokal) botol
0 0 -20.00%
223 Natrium Klorida infus 0,9 % steril (Produk loka botol
26 20 46 35 11 4480.00% 10
224 Ringer Laktat larutan infus steril (Produk lokal botol
2 20 22 19 3 3880.00% 20
225 OBAT GIGI
0 0
226 Ethyl Chlorid Spray botol
1 1 1 0 180.00% 1
227 Eugenol cairan botol
0 0 -20.00%
228 Glass - Ionomer cement ( gc ix ) set
0 0 -20.00%
229 Sement seng fosfat serbuk & cairan set
0 0 -20.00%
230 Monoklorkamfer/Klorfenol kamfer Menthol ( set
0 0 -20.00%
231 Mummifying Pasta set
0 0 -20.00%
232 Temporary Stopping Fletcher serbuk dan caira set
0 0 -20.00%
233 Kalium Hidroksida Pasta box
0 0 -20.00%
234 Devitalisasi pasta /non arsen btl 2gr
0 0 -20.00%
235 Lidocain spray botol
0 0 -20.00%
236 BAHAN HABIS PAKAI
0 0 -20.00%
237 Alat suntik sekali pakai 0.05 ml pcs
0 0 0 0 19980.00% 200
238 Alat suntik sekali pakai 0.5ml pcs
500 3200 3700 1600 2100 159980.00%
239 Alat suntik sekali pakai 1 ml pcs
100 100 200 20 180 1980.00%
240 Alat suntik sekali pakai 2,5 ml pcs
0 200 200 50 150 24980.00% 200
241 Alat suntik sekali pakai 3 ml pcs
0 200 200 120 80 31980.00% 200
242 Alat suntik sekali pakai 5 ml pcs
100 100 200 100 100 19980.00% 100
243 TP Disposable Syringe 1ml pcs
0 0 -20.00%
244 Aqua Gel sachet
200 200 0 200 -20.00%
245 Aximed 10x10cm non Woioven pcs
5 5 2 3 180.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

246 Aximed 5x10cm non Woioven rol

15 0 15 0 15 -20.00%
247 Catgut No. 2/0 dgn jarum bedah pcs
0 0 0 1180.00% 12
248 Catgut No. 3/0 dgn jarum bedah pcs
0 0 -20.00%
249 Catgut Chromic W/O Needle 2/0 pcs
0 0 0 0 0 2380.00% 24
250 Catgut Chromic W/O Needle 3/0 pcs
30 60 90 0 90 2380.00% 24
251 Etakridin ( Rivanol ) larutan 0,1% 300ml botol
0 0 -20.00%
252 Etanol 70% 100 ml botol
0 0 0 0 0 2380.00% 24
253 Etanol 70% 1000 ml botol
0 0 -20.00%
254 Foley Catheter No. 16 pcs
2 10 12 2 10 180.00%
255 Foley Catheter No. 18 pcs
6 10 16 6 10 580.00%
256 Handscoon 7.5 pcs
0 100 100 0 100 -20.00%
257 Handscoon 7 pcs
108 108 48 60 4780.00%
258 Handscoon uk S pcs
100 500 600 200 400 69980.00% 500
259 Handscoon uk M pcs
500 200 700 500 200 69980.00% 200
260 Infusion set anak pcs
0 100 100 15 85 1480.00%
261 Infusion set dewasa pcs
0 50 50 20 30 1980.00%
262 Infus set type-Y pcs
0 0 -20.00%
263 IV Catheter No.20 G pcs
75 0 75 7 68 680.00%
264 IV Catheter No. 22 G pcs
100 0 100 0 100 -20.00%
265 IV Catheter No. 24 G pcs
45 0 45 0 45 -20.00%
266 Jelco 20G pcs
0 0 -20.00%
267 Jelco 22G pcs
0 0 0 -20.00%
268 Jelco 24G pcs
0 0 0 -20.00%
269 IV. Chateter trovensity Safety Plus 20G pcs
0 0 0 -20.00%
270 IV. Chateter trovensity Safety Plus 22G pcs
0 0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

271 IV. Chateter trovensity Safety Plus 24G pcs

0 0 0 -20.00%
272 Kapas Berlemak 500 gram rol
20 20 0 20 -20.00%
273 Kapas Pembalut / Absorben 250 gram rol
20 20 10 10 980.00%
274 Kasa Pembalut 4 x 10 elastis buah
0 0 0 -20.00%
275 Kasa Pembalut Hidrofil 4 m x 3 cm non elastis buah
0 0 0 -20.00%
276 Kasa Pembalut Hidrofil 4 m x 5 cm non elastis buah
74 200 274 74 200 7380.00%
277 Kasa Pembalut Hidrofil 4 m x 10 cm non elasti buah
80 50 130 80 50 7980.00%
278 Kasa Pembalut Hidrofil 4 m x 15 cm non elasti buah
30 50 80 30 50 2980.00%
279 kasa steril 16x16 buah
0 0 0 0 4980.00% 50
280 Kasa Pembalut 18mx22cm pcs
0 0 -20.00%
281 Kasa Kompres steril 40 x 40 cm buah
0 0 0 0 0 4980.00% 50
282 Lysol botol
0 0 -20.00%
283 Masker buah
4800 4800 0 4800 -20.00%
284 Micropore 2 inch/5cmx9,1m buah
11 11 0 11 1180.00% 12
285 Polifix 10cm x 5m roll
3 30 33 4 29 2380.00% 20
286 Polifix 5cm x 1m roll
0 0 -20.00%
287 Povidon Iodida larutan 10 % botol 30 ml
60 0 60 0 60 -20.00%
288 Povidon Iodida larutan 10 % botol 60 ml
0 0 0 0 -20.00%
289 Povidon Iodida larutan 10 % btl 500ml
24 24 0 24 -20.00%
290 Plester 5 yards x 2 inch Zinc oxide roll
0 0 -20.00%
291 Pembalut Elastis Policrepe 7,5 cm x 4,55 roll
0 0 -20.00%
292 Safety box roll
0 0 -20.00%
293 Silk ( Benag Bedah Sutera ) No 3 / 30 pcs
50 36 86 26 60 2580.00%
294 Soft Cloth on 10 cm x 10 m kotak
0 0 -20.00%
295 Urin Bag pcs
5 0 5 0 5 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

296 Masflu tab tab

0 0 199980.00% 2000
297 Pularex tab tab
0 0 -20.00%
298 Samcobion tab tab
0 0 -20.00%
299 VITAMIN
0 0 -20.00%
300 Hemafort tab
0 0 -20.00%
301 Pehavral tab
0 0 -20.00%
302 Betafort syr botol
0 0 -20.00%
303 Becefort syr botol
0 0 -20.00%
304 Geriavita tab tab
0 0 -20.00%
305 OBAT PROGRAM TB
0 0
306 Kategori Anak paket
0 0 -20.00%
307 Kategori I paket
0 0 -20.00%
308 Kategori II paket
0 0 -20.00%
309 Kategori Sisipan paket
0 0 -20.00%
310 Kombipak paket
0 0 -20.00%

UMUM BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP

Mengetahui / menyetujui : Yang Menyerahkan : Kepala Puskesmas Yang Menerima

Kepala Dinas Kesehatan an. Kepala PPF & PK Petugas Puskesmas
Kabupaten Melawi Dinas Kesehatan
c/q Kabid Pelayanan dan Kabupaten Melawi
Sumber Daya Kesehatan
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12
dr. Tanjung Harapan Heru Priyono Dedi, A.Md.Kep
NIP 19740804 200502 1 002 Nip. 19670202 198803 1 011 Nip. 19791125 200904 1 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

PUSKESMAS : Manding NO DOKUMEN :01

KECAMATAN : Pinoh Utara BULAN :30 SEPTEMBER 2018
KABUPATEN / KOTA : Melawi HALAMAN :1
PROVINSI : Kalimantan Barat

PERSEDIAAN SISA STOK STOK OPTIMUM

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

1 Acyclovir 200mg tab

200 0 200 0 200 -20.00%
2 Acyclovir 400mg tab 700
800 0 800 100 209980.00% 2000
3 Alopurinol tablet 300 mg tab 2000
2000 0 2000 0 -20.00%
4 Alopurinol tablet 100 mg tab 200
0 200 0 200 -20.00%
5 Albendazole tab 400mg tab
0 0 0 0 -20.00%
6 Aminofilin tablet 200 mg tab
0 0 0 0 -20.00%
7 Amitriptilin HCl tablet salut 25 mg tab
400 400 Err:522 Err:522 Err:522
8 Ambroxol 30mg tab tab
0 0 0 0 0 199980.00% 2000
9 Amlodipin tab 10mg tab
1000 1000 730 270 122980.00% 500
10 Amoksisilin kapsul 250 mg kaps
100 100 0 100 -20.00%
11 Amoksisilin kaplet 500 mg kapl
1100 3000 4100 1300 2800 429980.00% 3000
12 Ampisilin 500 mg tab
1000 0 0 0 900 -20.00%
13 Antalgin (Metampiron) tablet 500 mg tab
0 0 0 0 0 99980.00% 1000
14 Antasida DOEN I tablet kunyah tab
0 0 0 0 0 299980.00% 3000
15 Antimigren: Ergotamin + Kofein tab
0 Err:522 Err:522 Err:522 500
16 Antiparkinson:Karbidopa + Levodopa tab
0 Err:522 Err:522 Err:522
17 Asam Askorbat (Vit C) tablet 50 mg tab
0 3500 0 3500 -20.00%
18 Asetosal tablet 100 mg tab
0 0 Err:522 Err:522 Err:522
19 Asetosal tablet 500 mg tab
200 0 200 100 100 209980.00% 2000
20 Atropin Sulfat tablet 0,5 mg tab
0 0
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

21 Atenolol tab 50mg tab

0 0
22 Asam Mefenamat 500 mg kapl
2800 1000 0 0 2000 4999.8 5000
23 Azitromicyn 500mg tab
230 0 230 0 230 -0.2
24 Anaflu tab
0 0 0 1999.8 2000
25 Betahistin tab 6 mg tab
1500 0 1500 240 1260 239.8 exp. 7-2018
26 Bisoprolol tab 5 mg tab
150 0 150 0 150 -0.2
27 Bromheksin tab tab
0 3000 3000 0 2600 2999.8 3000
28 Calcium Laktat (Kalk) Tab 500mg tab
1600 0 1600 300 1300 299.8
29 Captopril 12,5 mg Tab tab
0 0 -0.2
30 Captopril 25 mg tab tab
200 2000 2200 200 2000 4199.8 4000
31 Captpril 50 mg tab tab
0 0 -0.2
32 Carbamazepin Tab 200 mg tab
0 0 -0.2
33 Cimetidin Tab tab
0 0 999.8 1000
34 Ciprofloxacin 500 mg kapl
3500 0 3500 600 2900 599.8
35 Clindamisin kaps 300mg kaps
4050 0 4050 0 4050 499.8 500 Exp.agt 2018
36 Clindamisin kaps 150 mg Kaps
0 0 -0.2
37 Chloramfenikol Kapsul 250 mg kaps
0 1000 500 0 1000 -0.2 0
38 Chlorfeniramin Maleat (CTM) tab 4 mg tab
500 500 1000 500 500 3499.8 3000
39 Chlorpromazin HCL Injeksi 5 mg/ml-2ml amp

40 Chlorpromazin HCL Injeksi 25 mg/ml amp

0 0
41 Chlorpromazin HCL Tablet Salut 100 mg tab
160 100 260 20 240 1980.00%
42 Chlorpromazin HCL Tablet Salut 25 mg tab
300 0 300 0 300 -20.00%
43 Cotrimoksazol dewasa 480mg tab
3000 0 3000 200 2800 219980.00% 2000
44 Cotrimoksazol forte dewasa 960mg tab
0 500 500 100 400 209980.00% 2000
45 Deksametason tablet 0,5 mg tab
1000 0 1000 1000 0 399980.00% 3000
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

46 Dekstrometorfan sirup 10 mg/5 ml botol

0 0
47 Dekstrometorfan tablet 15 mg tab
0 0
48 Diazepam injeksi 5 mg/ml - 2 ml amp
0
49 Diazepam tablet 2 mg tab
0 0
50 Diazepam tablet 5 mg tab
350 0 350 50 300 4980.00%
51 Digoksin tablet 0,25 mg tab
0 0
52 Domperidon tab tab
1900 0 1900 500 1400 249980.00% 2000
53 Erytromisin Kapsul 500 mg kaps
1400 0 1400 600 800 59980.00%
54 Erytromisin Kapsul 250 mg kaps
0 500 500 0 500 99980.00% 1000
55 Extract Belladona tab 10mg tab
0 0
56 Ethambutol HCl tab 500 mg tab
0 0
57 Famotidine tab 20mg tab
0 0
58 Furosemid tablet 40 mg tab
500 0 500 100 400 209980.00% 2000
59 Fenobarbital injeksi 50 mg/ml - 1 ml amp
0 0
60 Fenobarbital tablet 100 mg tab
0 0
61 Fenobarbital tablet 30 mg tab
90 0 90 0 90 -20.00%
62 Folid Acid 1 mg tab
0 0 0 -20.00%
63 Garam Oralit untuk 200 ml air sach
0 500 500 0 500 299980.00% 3000
64 Gemfibrozil 300 mg kaps kaps
180 0 180 0 180 -20.00%
65 Glibenklamid tablet 5 mg tab
0 0
66 Glimepiride 1 mg tab
500 500 0 500
67 Glimepiride 2 mg tab
0 0
68 guaifenisin tab
300 1000 1300 500 800 349980.00% 3000
69 Griseofulvin tablet 125 mg, micronized tab
800 0 800 100 700 309980.00% 3000
70 Hidroklorotiazid (HCT) tablet 25 mg tab
1000 0 1000 0 1000 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

71 Haloperidol tablet 0,5 mg tab

400 400 200 200 19980.00%
72 Haloperidol tablet 1,5 mg tab
200 200 0 200 -20.00%
73 Haloperidol tablet 5 mg tab
420 0 420 90 330 8980.00%
74 Ibuprofen tablet 200 mg tab
0 0
75 Ibuprofen tablet 400 mg tab
3100 500 0 0 1800 499980.00% 5000
76 Isoniazid tab 300 mg tab
0 -20.00%
77 Isosorbid Dinitrat tablet sublingual 5 mg tab
1000 0 1000 0 1000 -20.00%
78 Kombinasi Pirimetamin 25 mg + Sulfadoxin 5 tab
0 0 -20.00%
79 Kuinin (Kina) tablet 200 mg tab
0 0 -20.00%
80 Ketokonazol 200 mg tab
900 0 900 400 500 139980.00% 1000
81 Lansoprazole 30mg Kaps
0 0 0 0 0 499980.00% 5000
82 Levofloxacin kapl 500mg kapl
500 500 0 500 -20.00%
83 Linkomisin kaps 500mg kaps
0 0 -20.00%
84 Loratadin Tablet 10 mg tab
360 500 860 60 800 305980.00% 3000
85 Loperamid tab 2mg tab
400 0 400 0 400 99980.00% 1000
86 Malarex tab
0 0 -20.00%
87 Metronidazol tablet 250 mg tab
0 0 -20.00%
88 Metronidazol tablet 500 mg tab
5700 0 5700 200 5500 19980.00%
89 Mebendazole Tab 500mg tab
0 0 -20.00%
90 Meloxicam 7,5 mg tab tab
0 0 0 0 0 99980.00% 1000
91 Meloxicam 15 mg tab tab
4000 4000 400 3600 339980.00% 3000
92 Mersibion 5000 tab
0 500 0 0 299980.00% 3000
93 Metformin HCL tab 500mg tab
300 300 0 300 49980.00% 500
94 Metilergometrin Maleat tablet salut 0,125 mg tab
0 0 -20.00%
95 Metilprednisolon 4 mg tab
0 0 0 0 0 399980.00% 4000
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

96 Metoclorpamid 10 mg tab tab

1000 0 1000 100 900 9980.00%
97 Natrium Diklofenak 25 mg tab
4000 4000 200 3800 419980.00% 4000
98 Natrium Diklofenak 50 mg tab
2000 2000 150 1850 214980.00% 2000
99 Neo Diagon tab
200 500 700 50 650 104980.00% 1000
100 Nistatin tablet salut 500.000 IU tab
1000 0 1000 100 900 9980.00% 0
101 Nistatin tablet vaginal 100.000 IU/g tab
800 0 800 0 800 -20.00% 0
102 Nifedipin tab 10mg tab
900 0 900 0 900 -20.00% 0
103 Ofloksasin 400mg tab
100 100 0 100 49980.00% 500
104 Omeprazole Kaps 20 mg Kaps
1530 3000 4530 4530 0 752980.00% 3000
105 Parasetamol tablet 100 mg tab
0 0 0 0 -20.00%
106 Parasetamol tablet 500 mg tab
1600 4200 4200 2600 1600 759980.00% 5000
107 Ondansetron tab
130 130 -2 132 -220.00%
108 Phenoksimetil Penisilina tablet 500 mg tab
0 0 -20.00%
109 Phitomenadion (Vit.K1) tablet salut gula 10 m tab
1100 0 1100 0 1100 -20.00%
110 Piridoksin HCl (Vit.B6) tablet 10 mg tab
3400 0 3400 400 3000 39980.00%
111 Pirazinamid tab tab
1000 1000 0 1000 -20.00%
112 Piroxicam kaps 10 mg kaps
0 0 0 0 0 299980.00% 3000
113 Piroxicam kaps 20 mg kaps
0 0 0 99980.00% 1000
114 Prednison tablet 5 mg tab
100 0 100 100 0 109980.00% 1000
115 Primakuin tablet 15 mg tab
3000 0 3000 0 3000 -20.00%
116 Propiltiourasil tablet 100 mg tab
0 0 -20.00%
117 Pirantel tablet 125 mg tab
600 600 600 0 109980.00% 500
118 Propranolol HCl tablet 40 mg tab
900 900 100 800 9980.00% exp. Agt 2018
119 Ranitidin tab 150 mg tab
300 500 800 800 0 279980.00% 2000
120 Rifampicin 450 mg kaplet kapl
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

121 Risperidon 1 mg tab

0 0 -20.00%
122 Risperidon 2 mg tab
840 840 0 840 -20.00%
123 Salbutamol tab 2 mg tab
0 0 299980.00% 3000
124 Salbutamol tab 4 mg tab
2800 500 3300 700 2600 119980.00% 500
125 Sefadroksil kaps 500mg kaps
500 500 1000 500 500 249980.00% 2000
126 Sefiksim kaps 100mg kaps
900 500 1400 950 450 294980.00% 2000
127 Setrizin kaps 10mg Kaps
600 500 1100 600 500 259980.00% 2000
128 Syanocobalamin tab 10 mg tab
0 0
129 Spironolacton 25mg tablet tab
2500 2500 0 2500 -20.00% exp. Juni 2018
130 Simvastatin 10mg tab tab
0 500 500 0 500 49980.00% 500
131 Simvastatin 20mg tab tab
0 0 -20.00%
132 Tablet Tambah Darah kombinasi / Besi Ferro tab
0 0 -20.00%
133 thyrozol kaps
700 700 0 700 -20.00%
134 Tetrasiklin HCl kapsul 500 mg kaps
0 0 -20.00%
135 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg tab
2100 0 2100 0 2100 -20.00%
136 Urinter kaps
200 0 200 100 100 59980.00% 500
137 Tramadol kapsul kaps
500 0 500 0 500 49980.00% 500
138 Triheksifenidil Hidroklorida tablet 2 mg tab
500 500 0 500 -20.00%
139 Vitamin B Kompleks tablet tab
400 1000 1400 900 500 389980.00% 3000
140 Retinol ( Vitamin A ) 100.000 IU Kapsul lunak Kaps
0 0 -20.00%
141 Retinol ( Vitamin A ) 200.000 IU Kapsul Lunak Kaps
0 0 -20.00%
142 Zink tab dispersible 20 mg tab
500 500 1000 1000 0 149980.00% 500
143 INJEKSI
0 0
144 Aminofilina Injeksi 24 mg/ml -10 ml amp
0 0 -20.00%
145 Ampisillin Inj vial
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

146 Antalgin Injeksi 250 mg/ml - 2 ml amp

100 100 0 100 -20.00%
147 Aqua Pro injeksi Steril 25 ml vial
0 0 0 0 2980.00% 30
148 Aqua Pro injeksi Steril 50 ml
0 0 980.00% 10
149 Asam Traneksamat injeksi 50mg/ml amp
0 0 -20.00%
150 Atropin Sulfat Injeksi 0,25 mg/ml -1 ml amp
0 0 -20.00%
151 Cefotaxime serbuk injeksi 500mg vial
0 0 -20.00%
152 Dexamethasone injeksi 5 mg/ml-1ml amp
0 0 -20.00%
153 Difenhidramin HCL Inj 10mg/ml-1ml amp
0 0 -20.00%
154 Epineprine HCL 0,1% -1ml amp
200 200 0 200 -20.00%
155 Fitomenadion (Vit K1) Injeksi 10mg/ml-1ml amp
21 21 0 21 -20.00%
156 Gentamisin Injeksi amp
0 0 -20.00%
157 Haloperidol Inj 50mg/ml 1 ml amp
0 0 -20.00%
158 Kuinin Dihidroklorida Injeksi 25% - 2 ml amp
0 0 -20.00%
159 Lidokain inj 2%(HCL) + Epineprin 1:80.000 -2ml amp
28 30 58 30 28 5980.00% 30
160 Metilergometrin Maleat Injeksi amp
62 62 31 31 3080.00%
161 Metoklorpamide Inj amp
0 0 -20.00%
162 Magnesium Sulfat inj (IV) 20% - 25 ml vial
0 0 -20.00%
163 Magnesium Sulfat inj (IV) 40% - 25 ml vial
0 0 -20.00%
164 Oksitetrasiklin HCL Injeksi i.m 50mg/ml-10ml vial
0 0 -20.00%
165 Oksitosin Injeksi 10 IU/ml-1ml amp
32 32 0 32 -20.00%
166 Sianokobalamin (Vit.B12) injeksi 500 mcg-ml amp
10 200 210 75 135 7480.00%
167 Streptomycin Sulfat Serbuk inj 1000 mg / vial vial
0 0 -20.00%
168 Thiamin HCL Injeksi 100mg/ml-1ml amp
0 0 -20.00%
169 Tramadol injeksi 50mg/ml amp
0 0 -20.00%
170 Ranitidin Injeksi amp
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

171 SYRUP
0 0 -20.00%
172 Amoksisilin sirup kering 125 mg/5ml botol
0 60 60 10 50 10980.00% 100
173 Amoksisilin sirup kering 250 mg/5ml botol
100 100 1 99 80.00%
174 Ampisillin syrup kering botol
0 0 -20.00%
175 Antasida Syrup botol
0 0 0 0 9980.00% 100
176 Ambroxol Syr botol
50 50 2 48 10180.00% 100
177 Domperidon suspensi 5mg/5ml botol
100 0 100 61 39 6080.00%
178 Erithromicyn Syr botol
120 120 0 120 -20.00%
179 Ibuprofen suspensi 100mg/5ml botol
50 50 100 0 100 4980.00% 50
180 Kloramphenokol Suspensi 125mg/5ml botol
0 0 -20.00%
181 Kotrimoksazol Suspensi Komb botol
0 0 4980.00% 50
182 Obat Batuk Hitam (OBH) cairan botol
60 0 50 10 16980.00% 120
183 Paracetamol Syrup 120mg/5ml botol
50 100 150 59 91 20880.00% 150
184 Paracetamol drop 100mg btl@15ml botol
0 0 0 0 0 9980.00% 100
185 Pirantel Suspensi 125mg/5ml botol 60 ml
0 0 0 -20.00%
186 Pirantel Suspensi 125mg/5ml botol 10 ml
0 0 -20.00%
187 Salbutamol sirup 2mg/5ml botol
50 50 8 42 5780.00% 50
188 Sefadroksil sirup kering 125mg/5ml botol
0 0 0 0 0 9980.00% 100
189 Setrizin sirup 5mg/5ml botol
0 0 0 0 0 4980.00% 50
190 Zink Sirup 10mg/ml botol
0 0 0 -20.00%
191 Interzinc syr botol
190 0 190 105 85 15480.00% 50
192 Gralisin syr botol
0 0 -20.00%
193 Metoklorpamide syr botol
0 0 -20.00%
194 Sulcralfat syr botol
25 50 75 27 48 12680.00% 100
195 Thiampenicol syr botol
0 0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

196 OBAT LUAR / SALEP

0 0 0
197 Acyclovir Cream tube
11 48 0 28 20 7780.00% 50
198 Anti Bakteri DOEN salep,Basitrasin Cr tube
7 25 32 23 9 4780.00% 25
199 Anti Hemoroid DOEN Kombinasi supp
0 0 -20.00%
200 Antifungi DOEN :As. Benzoat + As. Salisilat pot
0 24 24 0 24 2380.00% 24
201 Betametason krim 0.1% tube
100 0 100 91 9 14080.00% 50
202 Chloramfenikol Tetes telinga 3% botol
0 0 4980.00% 50
203 Chloramfenikol Salep Mata 1 % tube
264 0 264 24 240 2380.00%
204 Fenol Gliserin tetes telinga 10% botol
0 0 0 0 0 -20.00%
205 Gentian Violet larutan 1 % pot
0 0 0 0 0 4780.00% 48
206 Gentamisin Salep 0,3 salep Mata tube
20 48 68 0 68 4980.00% 50
207 Gentamisin Sulfat tetes Mata botol
10 0 10 0 10 -20.00%
208 Hidrokortison krim 2,5 % tube
48 24 72 30 42 5480.00% 25
209 Isotik tetes Mata botol
1 0 1 1 0 2080.00% 20
210 Ketokonazol Cream tube
13 50 63 13 50 6280.00% 50
211 Gentamisin Salep 0,1 salap kulit tube
0 0 0 0 0 2980.00% 30
212 Oksitetrasiklin HCl salep mata 1 % tube
0 0 -20.00%
213 Salep 2-4 pot
24 24 48 24 24 2380.00%
214 Mikonazol krim 2 % tube
34 48 82 58 24 10780.00% 50
215 Zolacord kream tube
0 0 -20.00%
216 Salisil Bedak 2 % pcs
13 0 13 0 13 1980.00% 20
217 Berlison N tube
0 0 -20.00%
218 INFUS
0 0 -20.00%
219 Dekstran 70 - larutan infus 6% steril botol
0 0 -20.00%
220 Glukosa larutan infus 10 % steril (Produk lokal botol
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

221 Glukosa larutan infus 40 % steril (Produk lokal botol

-20.00%
222 Glukosa larutan infus 5 % steril (Produk lokal) botol
0 0 -20.00%
223 Natrium Klorida infus 0,9 % steril (Produk loka botol
11 0 11 0 11 1980.00% 20
224 Ringer Laktat larutan infus steril (Produk lokal botol
3 20 23 20 3 3980.00% 20
225 OBAT GIGI
0 0
226 Ethyl Chlorid Spray botol
0 0 0 0 0 80.00% 1
227 Eugenol cairan botol
0 0 -20.00%
228 Glass - Ionomer cement ( gc ix ) set
0 0 -20.00%
229 Sement seng fosfat serbuk & cairan set
0 0 -20.00%
230 Monoklorkamfer/Klorfenol kamfer Menthol ( set
0 0 -20.00%
231 Mummifying Pasta set
0 0 -20.00%
232 Temporary Stopping Fletcher serbuk dan caira set
0 0 -20.00%
233 Kalium Hidroksida Pasta box
0 0 -20.00%
234 Devitalisasi pasta /non arsen btl 2gr
0 0 -20.00%
235 Lidocain spray botol
0 0 -20.00%
236 BAHAN HABIS PAKAI
0 0 -20.00%
237 Alat suntik sekali pakai 0.05 ml pcs
0 200 200 0 200 -20.00%
238 Alat suntik sekali pakai 0.5ml pcs
2100 0 2100 0 2100 -20.00%
239 Alat suntik sekali pakai 1 ml pcs
180 0 180 0 180 -20.00%
240 Alat suntik sekali pakai 2,5 ml pcs
150 200 350 20 330 11980.00% 100
241 Alat suntik sekali pakai 3 ml pcs
80 200 280 280 0 57980.00% 300
242 Alat suntik sekali pakai 5 ml pcs
100 100 200 20 180 1980.00%
243 TP Disposable Syringe 1ml pcs
0 0 -20.00%
244 Aqua Gel sachet
200 200 0 200 -20.00%
245 Aximed 10x10cm non Woioven pcs
5 5 2 3 180.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

246 Aximed 5x10cm non Woioven rol

15 0 15 0 15 -20.00%
247 Catgut No. 2/0 dgn jarum bedah pcs
0 0 0 1180.00% 12
248 Catgut No. 3/0 dgn jarum bedah pcs
0 0 3580.00% 36
249 Catgut Chromic W/O Needle 2/0 pcs
0 36 36 0 36 -20.00%
250 Catgut Chromic W/O Needle 3/0 pcs
30 30 60 0 60 -20.00%
251 Etakridin ( Rivanol ) larutan 0,1% 300ml botol
0 0 -20.00%
252 Etanol 70% 100 ml botol
0 0 0 0 0 2380.00% 24
253 Etanol 70% 1000 ml botol
0 0 -20.00%
254 Foley Catheter No. 16 pcs
10 10 20 5 15 480.00%
255 Foley Catheter No. 18 pcs
10 0 10 9 1 880.00%
256 Handscoon 7.5 pcs
100 100 5 95 480.00%
257 Handscoon 7 pcs
60 60 42 18 4180.00%
258 Handscoon uk S pcs
400 400 100 300 9980.00%
259 Handscoon uk M pcs
500 200 700 300 400 29980.00%
260 Infusion set anak pcs
85 85 5 80 480.00%
261 Infusion set dewasa pcs
30 30 19 11 4880.00% 30
262 Infus set type-Y pcs
0 0 -20.00%
263 IV Catheter No.20 G pcs
68 0 68 0 68 -20.00%
264 IV Catheter No. 22 G pcs
100 0 100 48 52 4780.00%
265 IV Catheter No. 24 G pcs
45 100 145 0 145 -20.00%
266 Jelco 20G pcs
0 0 -20.00%
267 Jelco 22G pcs
0 0 0 -20.00%
268 Jelco 24G pcs
0 0 0 -20.00%
269 IV. Chateter trovensity Safety Plus 20G pcs
0 0 0 -20.00%
270 IV. Chateter trovensity Safety Plus 22G pcs
0 0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

271 IV. Chateter trovensity Safety Plus 24G pcs

0 0 0 -20.00%
272 Kapas Berlemak 500 gram rol
20 20 0 20 -20.00%
273 Kapas Pembalut / Absorben 250 gram rol
20 20 10 10 980.00%
274 Kasa Pembalut 4 x 10 elastis buah
0 0 0 -20.00%
275 Kasa Pembalut Hidrofil 4 m x 3 cm non elastis buah
0 0 0 -20.00%
276 Kasa Pembalut Hidrofil 4 m x 5 cm non elastis buah
200 200 30 170 2980.00%
277 Kasa Pembalut Hidrofil 4 m x 10 cm non elasti buah
50 50 0 50 -20.00%
278 Kasa Pembalut Hidrofil 4 m x 15 cm non elasti buah
50 50 0 50 -20.00%
279 kasa steril 16x16 buah
0 0 0 0 0 4980.00% 50
280 Kasa Pembalut 18mx22cm pcs
0 60 60 48 12 6780.00% 20
281 Kasa Kompres steril 40 x 40 cm buah
0 0 0 0 0 4980.00% 50
282 Lysol botol
0 0 -20.00%
283 Masker buah
4800 4800 0 4800 -20.00%
284 Micropore 2 inch/5cmx9,1m buah
11 11 0 11 -20.00%
285 Polifix 10cm x 5m roll
29 29 0 29 -20.00%
286 Polifix 5cm x 1m roll
0 0 -20.00%
287 Povidon Iodida larutan 10 % botol 30 ml
60 0 60 60 0 5980.00%
288 Povidon Iodida larutan 10 % botol 60 ml
0 0 0 0 -20.00%
289 Povidon Iodida larutan 10 % btl 500ml
24 24 0 24 -20.00%
290 Plester 5 yards x 2 inch Zinc oxide roll
0 0 -20.00%
291 Pembalut Elastis Policrepe 7,5 cm x 4,55 roll
0 0 -20.00%
292 Safety box roll
0 0 -20.00%
293 Silk ( Benag Bedah Sutera ) No 3 / 30 pcs
60 60 47 13 7080.00% 24
294 Soft Cloth on 10 cm x 10 m kotak
0 0 -20.00%
295 Urin Bag pcs
5 0 5 0 5 1980.00% 20
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

296 Masflu tab tab

0 0 199980.00% 2000
297 Pularex tab tab
0 0 -20.00%
298 Samcobion tab tab
0 0 -20.00%
299 VITAMIN
0 0 -20.00%
300 Hemafort tab
0 0 -20.00%
301 Pehavral tab
0 0 -20.00%
302 Betafort syr botol
0 0 -20.00%
303 Becefort syr botol
0 0 -20.00%
304 Geriavita tab tab
0 0 -20.00%
305 OBAT PROGRAM TB
0 0
306 Kategori Anak paket
0 0 -20.00%
307 Kategori I paket
0 0 -20.00%
308 Kategori II paket
0 0 -20.00%
309 Kategori Sisipan paket
0 0 -20.00%
310 Kombipak paket
0 0 -20.00%

UMUM BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP

Mengetahui / menyetujui : Yang Menyerahkan : Kepala Puskesmas Yang Menerima

Kepala Dinas Kesehatan an. Kepala PPF & PK Petugas Puskesmas
Kabupaten Melawi Dinas Kesehatan
c/q Kabid Pelayanan dan Kabupaten Melawi
Sumber Daya Kesehatan
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12
dr. Tanjung Harapan Heru Priyono Dedi, A.Md.Kep
NIP 19740804 200502 1 002 Nip. 19670202 198803 1 011 Nip. 19791125 200904 1 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

PUSKESMAS : Manding NO DOKUMEN :01

KECAMATAN : Pinoh Utara BULAN : 31 oktober 2018
KABUPATEN / KOTA : Melawi HALAMAN :1
PROVINSI : Kalimantan Barat

PERSEDIAAN SISA STOK STOK OPTIMUM

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

1 Acyclovir 200mg tab

200 0 200 0 200 -20.00%
2 Acyclovir 400mg tab 200
700 0 700 500 249980.00% 2000
3 Alopurinol tablet 300 mg tab 800
2000 0 2000 1200 119980.00%
4 Alopurinol tablet 100 mg tab 200
0 200 0 200 -20.00%
5 Albendazole tab 400mg tab
0 0 0 0 -20.00%
6 Aminofilin tablet 200 mg tab
0 0 0 0 -20.00% 0
7 Amitriptilin HCl tablet salut 25 mg tab
400 400 Err:522 Err:522 Err:522
8 Ambroxol 30mg tab tab
0 0 0 0 0 199980.00% 2000
9 Amlodipin tab 10mg tab
270 270 270 0 76980.00% 500
10 Amoksisilin kapsul 250 mg kaps
100 100 0 100 -20.00%
11 Amoksisilin kaplet 500 mg kapl
2800 2800 1700 1100 469980.00% 3000
12 Ampisilin 500 mg tab
900 0 0 0 400 -20.00%
13 Antalgin (Metampiron) tablet 500 mg tab
0 0 0 0 0 99980.00% 1000
14 Antasida DOEN I tablet kunyah tab
0 0 0 0 0 299980.00% 3000
15 Antimigren: Ergotamin + Kofein tab
0 Err:522 Err:522 Err:522 500
16 Antiparkinson:Karbidopa + Levodopa tab
0 Err:522 Err:522 Err:522
17 Asam Askorbat (Vit C) tablet 50 mg tab
0 0 3500 -20.00%
18 Asetosal tablet 100 mg tab
0 0 Err:522 Err:522 Err:522
19 Asetosal tablet 500 mg tab
100 0 100 0 100 199980.00% 2000
20 Atropin Sulfat tablet 0,5 mg tab
0 0
21 Atenolol tab 50mg tab
0 0
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

22 Asam Mefenamat 500 mg kapl

2000 0 0 1800 4999.8 5000
23 Azitromicyn 500mg tab
230 0 230 0 230 -0.2
24 Anaflu tab
0 0 0 1999.8 2000
25 Betahistin tab 6 mg tab
1260 0 1260 460 800 459.8
26 Bisoprolol tab 5 mg tab
150 0 150 0 150 -0.2
27 Bromheksin tab tab
2600 2600 0 2300 2999.8 3000
28 Calcium Laktat (Kalk) Tab 500mg tab
1300 0 1300 400 900 399.8
29 Captopril 12,5 mg Tab tab
0 0 -0.2
30 Captopril 25 mg tab tab
2000 2000 200 1800 4199.8 4000
31 Captpril 50 mg tab tab
0 0 -0.2
32 Carbamazepin Tab 200 mg tab
0 0 -0.2
33 Cimetidin Tab tab
0 0 999.8 1000
34 Ciprofloxacin 500 mg kapl
2900 0 2900 1400 1500 1399.8
35 Clindamisin kaps 300mg kaps
4050 0 4050 0 4050 499.8 500 Exp.agt 2018
36 Clindamisin kaps 150 mg Kaps
0 0 -0.2
37 Chloramfenikol Kapsul 250 mg kaps
1000 1000 100 900 99.8 0
38 Chlorfeniramin Maleat (CTM) tab 4 mg tab
500 500 300 200 3299.8 3000
39 Chlorpromazin HCL Injeksi 5 mg/ml-2ml amp

40 Chlorpromazin HCL Injeksi 25 mg/ml amp

0 0
41 Chlorpromazin HCL Tablet Salut 100 mg tab
240 240 0 240 -20.00%
42 Chlorpromazin HCL Tablet Salut 25 mg tab
300 0 300 0 300 -20.00%
43 Cotrimoksazol dewasa 480mg tab
2800 0 2800 1100 1700 309980.00% 2000
44 Cotrimoksazol forte dewasa 960mg tab
400 400 200 200 219980.00% 2000
45 Deksametason tablet 0,5 mg tab
0 0 0 0 0 299980.00% 3000
46 Dekstrometorfan sirup 10 mg/5 ml botol
0 0
47 Dekstrometorfan tablet 15 mg tab
0 0
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

48 Diazepam injeksi 5 mg/ml - 2 ml amp

0
49 Diazepam tablet 2 mg tab
0 0
50 Diazepam tablet 5 mg tab
300 0 300 0 300 -20.00%
51 Digoksin tablet 0,25 mg tab
0 0
52 Domperidon tab tab
1400 0 1400 0 1400 199980.00% 2000
53 Erytromisin Kapsul 500 mg kaps
800 0 800 0 800 -20.00%
54 Erytromisin Kapsul 250 mg kaps
500 500 0 500 99980.00% 1000
55 Extract Belladona tab 10mg tab
0 0
56 Ethambutol HCl tab 500 mg tab
0 0
57 Famotidine tab 20mg tab
0 0
58 Furosemid tablet 40 mg tab
400 0 400 0 400 199980.00% 2000
59 Fenobarbital injeksi 50 mg/ml - 1 ml amp
0 0
60 Fenobarbital tablet 100 mg tab
0 0
61 Fenobarbital tablet 30 mg tab
90 0 90 0 90 -20.00%
62 Folid Acid 1 mg tab
0 0 0 -20.00%
63 Garam Oralit untuk 200 ml air sach
500 500 400 100 39980.00%
64 Gemfibrozil 300 mg kaps kaps
180 0 180 0 180 -20.00%
65 Glibenklamid tablet 5 mg tab
0 0
66 Glimepiride 1 mg tab
500 500 0 500
67 Glimepiride 2 mg tab
0 0
68 guaifenisin tab
800 0 800 700 100 369980.00% 3000
69 Griseofulvin tablet 125 mg, micronized tab
700 0 700 200 500 319980.00% 3000
70 Hidroklorotiazid (HCT) tablet 25 mg tab
1000 0 1000 0 1000 -20.00%
71 Haloperidol tablet 0,5 mg tab
200 200 0 200 -20.00%
72 Haloperidol tablet 1,5 mg tab
200 200 0 200 -20.00%
73 Haloperidol tablet 5 mg tab
330 0 330 0 330 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

74 Ibuprofen tablet 200 mg tab

0 -20.00%
75 Ibuprofen tablet 400 mg tab
1800 0 200 1400 519980.00% 5000
76 Isoniazid tab 300 mg tab
0 -20.00%
77 Isosorbid Dinitrat tablet sublingual 5 mg tab
1000 0 1000 0 1000 -20.00%
78 Kombinasi Pirimetamin 25 mg + Sulfadoxin tab
0 0 -20.00%
79 Kuinin (Kina) tablet 200 mg tab
0 0 -20.00%
80 Ketokonazol 200 mg tab
500 0 500 100 400 109980.00% 1000
81 Lansoprazole 30mg Kaps
0 0 0 0 0 499980.00% 5000
82 Levofloxacin kapl 500mg kapl
500 500 0 500 -20.00%
83 Linkomisin kaps 500mg kaps
0 0 -20.00%
84 Loratadin Tablet 10 mg tab
800 800 200 600 319980.00% 3000
85 Loperamid tab 2mg tab
400 0 400 0 400 99980.00% 1000
86 Malarex tab
0 0 -20.00%
87 Metronidazol tablet 250 mg tab
0 0 -20.00%
88 Metronidazol tablet 500 mg tab
5500 0 5500 300 5200 29980.00%
89 Mebendazole Tab 500mg tab
0 0 -20.00%
90 Meloxicam 7,5 mg tab tab
0 0 0 0 0 99980.00% 1000
91 Meloxicam 15 mg tab tab
3600 3600 1500 2100 449980.00% 3000
92 Mersibion 5000 tab
0 500 0 0 299980.00% 3000
93 Metformin HCL tab 500mg tab
300 300 0 300 49980.00% 500
94 Metilergometrin Maleat tablet salut 0,125 tab
0 0 -20.00%
95 Metilprednisolon 4 mg tab
0 0 0 0 0 399980.00% 4000
96 Metoclorpamid 10 mg tab tab
900 0 900 0 900 -20.00%
97 Natrium Diklofenak 25 mg tab
3800 3800 0 3800 399980.00% 4000
98 Natrium Diklofenak 50 mg tab
1850 1850 1050 800 304980.00% 2000
99 Neo Diagon tab
650 650 150 500 114980.00% 1000
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

100 Nistatin tablet salut 500.000 IU tab

900 0 900 100 800 9980.00% 0
101 Nistatin tablet vaginal 100.000 IU/g tab
800 0 800 0 800 -20.00% 0
102 Nifedipin tab 10mg tab
900 0 900 0 900 -20.00% 0
103 Ofloksasin 400mg tab
100 100 0 100 49980.00% 500
104 Omeprazole Kaps 20 mg Kaps
0 0 0 0 0 299980.00% 3000
105 Parasetamol tablet 100 mg tab
0 0 0 0 -20.00%
106 Parasetamol tablet 500 mg tab
1600 4200 2600 1600 759980.00% 5000
107 Ondansetron tab
132 132 0 132 -20.00%
108 Phenoksimetil Penisilina tablet 500 mg tab
0 0 -20.00%
109 Phitomenadion (Vit.K1) tablet salut gula 10 tab
1100 0 1100 0 1100 -20.00%
110 Piridoksin HCl (Vit.B6) tablet 10 mg tab
3000 0 3000 1000 2000 99980.00%
111 Pirazinamid tab tab
1000 1000 0 1000 -20.00%
112 Piroxicam kaps 10 mg kaps
0 0 0 0 0 299980.00% 3000
113 Piroxicam kaps 20 mg kaps
0 0 0 99980.00% 1000
114 Prednison tablet 5 mg tab
0 0 0 0 0 99980.00% 1000
115 Primakuin tablet 15 mg tab
0 0 0 0 0 -20.00%
116 Propiltiourasil tablet 100 mg tab
0 0 -20.00%
117 Pirantel tablet 125 mg tab
0 0 0 0 49980.00% 500
118 Propranolol HCl tablet 40 mg tab
800 800 0 800 -20.00% exp. Agt 2018
119 Ranitidin tab 150 mg tab
0 0 0 0 199980.00% 2000
120 Rifampicin 450 mg kaplet kapl
0 0 -20.00%
121 Risperidon 1 mg tab
0 0 -20.00%
122 Risperidon 2 mg tab
840 840 0 840 -20.00%
123 Salbutamol tab 2 mg tab
0 0 299980.00% 3000
124 Salbutamol tab 4 mg tab
2600 2600 0 2600 49980.00% 500
125 Sefadroksil kaps 500mg kaps
500 500 0 500 199980.00% 2000
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

126 Sefiksim kaps 100mg kaps

300 300 100 200 209980.00% 2000
127 Setrizin kaps 10mg Kaps
500 0 500 200 300 219980.00% 2000
128 Syanocobalamin tab 10 mg tab
0 0
129 Spironolacton 25mg tablet tab
2500 2500 0 2500 -20.00% exp. Juni 2018
130 Simvastatin 10mg tab tab
500 500 0 500 49980.00% 500
131 Simvastatin 20mg tab tab
0 0 -20.00%
132 Tablet Tambah Darah kombinasi / Besi Ferro tab
0 0 -20.00%
133 thyrozol kaps
700 700 0 700 -20.00%
134 Tetrasiklin HCl kapsul 500 mg kaps
0 0 -20.00%
135 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 tab
2100 0 2100 0 2100 -20.00%
136 Urinter kaps
100 0 100 0 100 49980.00% 500
137 Tramadol kapsul kaps
500 0 500 0 500 49980.00% 500
138 Triheksifenidil Hidroklorida tablet 2 mg tab
500 500 0 500 -20.00%
139 Vitamin B Kompleks tablet tab
500 500 100 400 309980.00% 3000
140 Retinol ( Vitamin A ) 100.000 IU Kapsul luna Kaps
0 0 -20.00%
141 Retinol ( Vitamin A ) 200.000 IU Kapsul Luna Kaps
0 0 -20.00%
142 Zink tab dispersible 20 mg tab
0 0 0 0 49980.00% 500
143 INJEKSI
0 0
144 Aminofilina Injeksi 24 mg/ml -10 ml amp
0 0 -20.00%
145 Ampisillin Inj vial
0 0 -20.00%
146 Antalgin Injeksi 250 mg/ml - 2 ml amp
100 100 0 100 -20.00%
147 Aqua Pro injeksi Steril 25 ml vial
0 0 0 0 2980.00% 30
148 Aqua Pro injeksi Steril 50 ml
0 0 980.00% 10
149 Asam Traneksamat injeksi 50mg/ml amp
0 0 -20.00%
150 Atropin Sulfat Injeksi 0,25 mg/ml -1 ml amp
0 0 -20.00%
151 Cefotaxime serbuk injeksi 500mg vial
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

152 Dexamethasone injeksi 5 mg/ml-1ml amp

0 0 -20.00%
153 Difenhidramin HCL Inj 10mg/ml-1ml amp
0 0 -20.00%
154 Epineprine HCL 0,1% -1ml amp
200 200 0 200 -20.00%
155 Fitomenadion (Vit K1) Injeksi 10mg/ml-1ml amp
21 21 0 21 -20.00%
156 Gentamisin Injeksi amp
0 0 -20.00%
157 Haloperidol Inj 50mg/ml 1 ml amp
0 0 -20.00%
158 Kuinin Dihidroklorida Injeksi 25% - 2 ml amp
0 0 -20.00%
159 Lidokain inj 2%(HCL) + Epineprin 1:80.000 -2 amp
28 0 28 0 28 2980.00% 30
160 Metilergometrin Maleat Injeksi amp
31 31 0 31 -20.00%
161 Metoklorpamide Inj amp
0 0 -20.00%
162 Magnesium Sulfat inj (IV) 20% - 25 ml vial
0 0 -20.00%
163 Magnesium Sulfat inj (IV) 40% - 25 ml vial
0 0 -20.00%
164 Oksitetrasiklin HCL Injeksi i.m 50mg/ml-10m vial
0 0 -20.00%
165 Oksitosin Injeksi 10 IU/ml-1ml amp
32 32 0 32 -20.00%
166 Sianokobalamin (Vit.B12) injeksi 500 mcg-ml amp
135 0 135 15 120 1480.00%
167 Streptomycin Sulfat Serbuk inj 1000 mg / via vial
0 0 -20.00%
168 Thiamin HCL Injeksi 100mg/ml-1ml amp
0 0 -20.00%
169 Tramadol injeksi 50mg/ml amp
0 0 -20.00%
170 Ranitidin Injeksi amp
0 0 -20.00%
171 SYRUP
0 0 -20.00%
172 Amoksisilin sirup kering 125 mg/5ml botol
50 0 50 0 50 9980.00% 100
173 Amoksisilin sirup kering 250 mg/5ml botol
99 99 0 99 -20.00%
174 Ampisillin syrup kering botol
0 0 -20.00%
175 Antasida Syrup botol
0 0 0 0 9980.00% 100
176 Ambroxol Syr botol
50 50 2 48 10180.00% 100
177 Domperidon suspensi 5mg/5ml botol
39 0 39 19 20 1880.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

178 Erithromicyn Syr botol

120 0 120 0 120 -20.00%
179 Ibuprofen suspensi 100mg/5ml botol
100 0 100 20 80 6980.00% 50
180 Kloramphenokol Suspensi 125mg/5ml botol
0 0 -20.00%
181 Kotrimoksazol Suspensi Komb botol
0 0 4980.00% 50
182 Obat Batuk Hitam (OBH) cairan botol
10 0 0 50 5 16980.00% 120
183 Paracetamol Syrup 120mg/5ml botol
91 0 91 41 50 19080.00% 150
184 Paracetamol drop 100mg btl@15ml botol
0 0 0 0 0 9980.00% 100
185 Pirantel Suspensi 125mg/5ml botol 60 ml
0 0 0 -20.00%
186 Pirantel Suspensi 125mg/5ml botol 10 ml
0 0 -20.00%
187 Salbutamol sirup 2mg/5ml botol
42 0 42 12 30 6180.00% 50
188 Sefadroksil sirup kering 125mg/5ml botol
0 0 0 0 0 9980.00% 100
189 Setrizin sirup 5mg/5ml botol
0 0 0 0 0 4980.00% 50
190 Zink Sirup 10mg/ml botol
0 0 0 -20.00%
191 Interzinc syr botol
85 0 85 15 70 6480.00% 50
192 Gralisin syr botol
0 0 -20.00%
193 Metoklorpamide syr botol
0 0 -20.00%
194 Sulcralfat syr botol
48 0 48 28 20 12780.00% 100
195 Thiampenicol syr botol
0 0 0 -20.00%
196 OBAT LUAR / SALEP
0 0 0
197 Acyclovir Cream tube
20 0 0 9 11 5880.00% 50
198 Anti Bakteri DOEN salep,Basitrasin Cr tube
7 25 32 23 9 4780.00% 25
199 Anti Hemoroid DOEN Kombinasi supp
0 0 -20.00%
200 Antifungi DOEN :As. Benzoat + As. Salisilat pot
0 24 24 0 24 2380.00% 24
201 Betametason krim 0.1% tube
100 0 100 91 9 14080.00% 50
202 Chloramfenikol Tetes telinga 3% botol
0 0 4980.00% 50
203 Chloramfenikol Salep Mata 1 % tube
240 0 240 90 150 8980.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

204 Fenol Gliserin tetes telinga 10% botol

0 0 0 0 0 -20.00%
205 Gentian Violet larutan 1 % pot
0 0 0 0 0 4780.00% 48
206 Gentamisin Salep 0,3 salep Mata tube
68 0 68 20 48 6980.00% 50
207 Gentamisin Sulfat tetes Mata botol
10 0 10 0 10 -20.00%
208 Hidrokortison krim 2,5 % tube
42 0 42 18 24 4280.00% 25
209 Isotik tetes Mata botol
0 0 0 0 0 1980.00% 20
210 Ketokonazol Cream tube
50 0 50 20 30 6980.00% 50
211 Gentamisin Salep 0,1 salap kulit tube
0 0 0 0 0 2980.00% 30
212 Oksitetrasiklin HCl salep mata 1 % tube
0 0 -20.00%
213 Salep 2-4 pot
24 0 24 6 18 580.00%
214 Mikonazol krim 2 % tube
24 0 24 0 24 4980.00% 50
215 Zolacord kream tube
0 0 -20.00%
216 Salisil Bedak 2 % pcs
13 0 13 0 13 1980.00% 20
217 Berlison N tube
0 0 -20.00%
218 INFUS
0 0 -20.00%
219 Dekstran 70 - larutan infus 6% steril botol
0 0 -20.00%
220 Glukosa larutan infus 10 % steril (Produk loka botol
0 0 -20.00%
221 Glukosa larutan infus 40 % steril (Produk loka botol
-20.00%
222 Glukosa larutan infus 5 % steril (Produk lokal botol
0 0 -20.00%
223 Natrium Klorida infus 0,9 % steril (Produk lok botol
11 0 11 0 11 1980.00% 20
224 Ringer Laktat larutan infus steril (Produk loka botol
3 0 3 0 3 1980.00% 20
225 OBAT GIGI
0 0
226 Ethyl Chlorid Spray botol
0 0 0 0 0 80.00% 1
227 Eugenol cairan botol
0 0 -20.00%
228 Glass - Ionomer cement ( gc ix ) set
0 0 -20.00%
229 Sement seng fosfat serbuk & cairan set
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

230 Monoklorkamfer/Klorfenol kamfer Menthol set

0 0 -20.00%
231 Mummifying Pasta set
0 0 -20.00%
232 Temporary Stopping Fletcher serbuk dan cai set
0 0 -20.00%
233 Kalium Hidroksida Pasta box
0 0 -20.00%
234 Devitalisasi pasta /non arsen btl 2gr
0 0 -20.00%
235 Lidocain spray botol
0 0 -20.00%
236 BAHAN HABIS PAKAI
0 0 -20.00%
237 Alat suntik sekali pakai 0.05 ml pcs
200 0 200 0 200 19980.00% 200
238 Alat suntik sekali pakai 0.5ml pcs
2100 0 2100 300 1800 29980.00%
239 Alat suntik sekali pakai 1 ml pcs
180 0 180 0 180 -20.00%
240 Alat suntik sekali pakai 2,5 ml pcs
150 330 480 380 100 47980.00% 100
241 Alat suntik sekali pakai 3 ml pcs
0 0 0 0 29980.00% 300
242 Alat suntik sekali pakai 5 ml pcs
180 0 180 10 170 980.00%
243 TP Disposable Syringe 1ml pcs
0 0 -20.00%
244 Aqua Gel sachet
200 200 0 200 -20.00%
245 Aximed 10x10cm non Woioven pcs
3 3 0 3 -20.00%
246 Aximed 5x10cm non Woioven rol
15 0 15 0 15 -20.00%
247 Catgut No. 2/0 dgn jarum bedah pcs
0 0 0 1180.00% 12
248 Catgut No. 3/0 dgn jarum bedah pcs
0 0 3580.00% 36
249 Catgut Chromic W/O Needle 2/0 pcs
36 0 36 2 34 180.00%
250 Catgut Chromic W/O Needle 3/0 pcs
60 0 60 0 60 -20.00%
251 Etakridin ( Rivanol ) larutan 0,1% 300ml botol
0 0 -20.00%
252 Etanol 70% 100 ml botol
0 0 0 0 0 2380.00% 24
253 Etanol 70% 1000 ml botol
0 0 -20.00%
254 Foley Catheter No. 16 pcs
15 0 15 5 10 480.00%
255 Foley Catheter No. 18 pcs
1 0 1 0 1 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

256 Handscoon 7.5 pcs

95 95 11 84 1080.00%
257 Handscoon 7 pcs
18 18 0 18 -20.00%
258 Handscoon uk S pcs
300 300 0 300 -20.00%
259 Handscoon uk M pcs
400 400 0 400 -20.00%
260 Infusion set anak pcs
80 80 0 80 -20.00%
261 Infusion set dewasa pcs
30 30 19 11 4880.00% 30
262 Infus set type-Y pcs
0 0 -20.00%
263 IV Catheter No.20 G pcs
68 0 68 0 68 -20.00%
264 IV Catheter No. 22 G pcs
100 0 100 48 52 4780.00%
265 IV Catheter No. 24 G pcs
145 145 0 145 -20.00%
266 Jelco 20G pcs
0 0 -20.00%
267 Jelco 22G pcs
0 0 0 -20.00%
268 Jelco 24G pcs
0 0 0 -20.00%
269 IV. Chateter trovensity Safety Plus 20G pcs
0 0 0 -20.00%
270 IV. Chateter trovensity Safety Plus 22G pcs
0 0 0 -20.00%
271 IV. Chateter trovensity Safety Plus 24G pcs
0 0 0 -20.00%
272 Kapas Berlemak 500 gram rol
20 0 20 0 20 -20.00%
273 Kapas Pembalut / Absorben 250 gram rol
10 0 10 10 10 980.00%
274 Kasa Pembalut 4 x 10 elastis buah
0 0 0 -20.00%
275 Kasa Pembalut Hidrofil 4 m x 3 cm non elasti buah
0 0 0 -20.00%
276 Kasa Pembalut Hidrofil 4 m x 5 cm non elasti buah
170 170 0 170 -20.00%
277 Kasa Pembalut Hidrofil 4 m x 10 cm non elast buah
50 50 0 50 -20.00%
278 Kasa Pembalut Hidrofil 4 m x 15 cm non elast buah
50 50 0 50 -20.00%
279 kasa steril 16x16 buah
0 0 0 0 0 4980.00% 50
280 Kasa Pembalut 18mx22cm pcs
12 0 12 0 12 1980.00% 20
281 Kasa Kompres steril 40 x 40 cm buah
0 0 0 0 0 4980.00% 50
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

282 Lysol botol

0 0 -20.00%
283 Masker buah
4800 4800 0 4800 -20.00%
284 Micropore 2 inch/5cmx9,1m buah
11 11 0 11 -20.00%
285 Polifix 10cm x 5m roll
29 29 0 29 -20.00%
286 Polifix 5cm x 1m roll
0 0 -20.00%
287 Povidon Iodida larutan 10 % botol 30 ml
0 0 0 0 0 -20.00%
288 Povidon Iodida larutan 10 % botol 60 ml
0 0 0 0 -20.00%
289 Povidon Iodida larutan 10 % btl 500ml
24 24 0 24 -20.00%
290 Plester 5 yards x 2 inch Zinc oxide roll
0 0 -20.00%
291 Pembalut Elastis Policrepe 7,5 cm x 4,55 roll
0 0 -20.00%
292 Safety box roll
0 0 -20.00%
293 Silk ( Benag Bedah Sutera ) No 3 / 30 pcs
13 13 1 12 2480.00% 24
294 Soft Cloth on 10 cm x 10 m kotak
0 0 -20.00%
295 Urin Bag pcs
5 0 5 0 5 1980.00% 20
296 Masflu tab tab
0 0 199980.00% 2000
297 Pularex tab tab
0 0 -20.00%
298 Samcobion tab tab
0 0 -20.00%
299 VITAMIN
0 0 -20.00%
300 Hemafort tab
0 0 -20.00%
301 Pehavral tab
0 0 -20.00%
302 Betafort syr botol
0 0 -20.00%
303 Becefort syr botol
0 0 -20.00%
304 Geriavita tab tab
0 0 -20.00%
305 OBAT PROGRAM TB
0 0
306 Kategori Anak paket
0 0 -20.00%
307 Kategori I paket
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

308 Kategori II paket

0 0 -20.00%
309 Kategori Sisipan paket
0 0 -20.00%
310 Kombipak paket
0 0 -20.00%

UMUM BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP

Mengetahui / menyetujui : Yang Menyerahkan : Kepala Puskesmas Yang Menerima

Kepala Dinas Kesehatan an. Kepala PPF & PK Petugas Puskesmas
Kabupaten Melawi Dinas Kesehatan
c/q Kabid Pelayanan dan Kabupaten Melawi
Sumber Daya Kesehatan

dr. Tanjung Harapan Heru Priyono Dedi, A.Md.Kep

NIP 19740804 200502 1 002 Nip. 19670202 198803 1 011 Nip. 19791125 200904 1 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

PUSKESMAS : Manding NO DOKUMEN

KECAMATAN : Pinoh Utara BULAN
KABUPATEN / KOTA : Melawi HALAMAN
PROVINSI : Kalimantan Barat

PERSEDIAAN SISA STOK STOK OPTIMUM

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11

1 Acyclovir 200mg tab

200 0 200 100 100 59980.00% 500
2 Acyclovir 400mg tab 1900
200 2000 2200 300 29980.00%
3 Alopurinol tablet 300 mg tab 300
800 0 800 500 49980.00%
4 alpazolam 0,5 mg tab 0
0 0 0 0 49980.00% 500
5 Alopurinol tablet 100 mg tab 200
0 200 0 200 -20.00%
6 Albendazole tab 400mg tab
0 0 0 0 -20.00%
7 Aminofilin tablet 200 mg tab
0 0 0 0 -20.00%
8 Amitriptilin HCl tablet salut 25 mg tab
400 400 Err:522 Err:522 500
9 Ambroxol 30mg tab tab
0 0 0 0 0 199980.00% 2000
10 Amlodipin tab 10mg tab
270 600 870 Err:522 300 519980.00% 500
11 Amoksisilin kapsul 250 mg kaps
100 100 0 100 -20.00%
12 Amoksisilin kaplet 500 mg kapl
2800 3000 5800 4700 1100 769980.00% 3000
13 Ampisilin 500 mg tab
400 0 0 0 400 -20.00%
14 Antalgin (Metampiron) tablet 500 mg tab
0 0 0 0 0 99980.00% 1000
15 Antasida DOEN I tablet kunyah tab
0 0 0 0 0 299980.00% 3000
16 Antimigren: Ergotamin + Kofein tab
0 Err:522 Err:522 Err:522 500
17 Antiparkinson:Karbidopa + Levodopa tab
0 Err:522 Err:522 Err:522
18 Asam Askorbat (Vit C) tablet 50 mg tab
0 0 3500 -20.00%
19 Asetosal tablet 100 mg tab
0 0 Err:522 Err:522 Err:522
20 Asetosal tablet 500 mg tab
100 0 100 0 100 199980.00% 2000
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11

21 Atropin Sulfat tablet 0,5 mg tab

0 0
22 Atenolol tab 50mg tab
0 0
23 Asam Mefenamat 500 mg kapl
1800 500 0 0 1800 4999.8 5000
24 Azitromicyn 500mg tab
230 0 230 0 230 -0.2
25 Anaflu tab
0 0 0 1999.8 2000
26 Betahistin tab 6 mg tab
800 0 800 0 800 -0.2
27 Bisoprolol tab 5 mg tab
150 0 150 0 150 -0.2
28 Bromheksin tab tab
2600 2600 0 2300 2999.8 3000
29 Calcium Laktat (Kalk) Tab 500mg tab
1300 0 1300 400 900 399.8
30 Captopril 12,5 mg Tab tab
0 0 -0.2
31 Captopril 25 mg tab tab
2000 4000 6000 2600 3400 6599.8 4000
32 Captpril 50 mg tab tab
0 0 -0.2
33 Carbamazepin Tab 200 mg tab
0 0 -0.2
34 Carbamazepin Tab 200 mg tab
0 0 0 0 0 500
35 Cimetidin Tab tab
0 0 999.8 1000
36 Ciprofloxacin 500 mg kapl
1500 0 1500 0 1500 -0.2
37 Clozapin tab
500
38 Clindamisin kaps 300mg kaps
0 500 500 0 500 499.8 500
39 Clindamisin kaps 150 mg Kaps
0 0 -0.2
40 Chloramfenikol Kapsul 250 mg kaps
900 900 100 900 99.8 0
41 Chlorfeniramin Maleat (CTM) tab 4 mg tab
200 3000 3200 900 2300 899.8
42 Chlorpromazin HCL Injeksi 5 mg/ml-2ml amp

43 Chlorpromazin HCL Injeksi 25 mg/ml amp

0 0
44 Chlorpromazin HCL Tablet Salut 100 mg tab
240 240 0 240 49980.00% 500
45 Chlorpromazin HCL Tablet Salut 25 mg tab
300 0 300 0 300 49980.00% 500
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11

46 Cotrimoksazol dewasa 480mg tab

2800 0 2800 0 2800 199980.00% 2000
47 Cotrimoksazol forte dewasa 960mg tab
400 1000 1400 1200 200 319980.00% 2000
48 Deksametason tablet 0,5 mg tab
0 0 0 0 0 299980.00% 3000
49 Dekstrometorfan sirup 10 mg/5 ml botol
0 0
50 Dekstrometorfan tablet 15 mg tab
0 0
51 Diazepam injeksi 5 mg/ml - 2 ml amp
0
52 Diazepam tablet 2 mg tab
0 0
53 Diazepam tablet 5 mg tab
300 0 300 0 300 49980.00% 500
54 Digoksin tablet 0,25 mg tab
0 0
55 Domperidon tab tab
1400 2000 3400 2000 1400 399980.00% 2000
56 Erytromisin Kapsul 500 mg kaps
800 1000 1800 0 1800 -20.00%
57 Erytromisin Kapsul 250 mg kaps
500 1000 1500 0 1500 99980.00% 1000
58 Extract Belladona tab 10mg tab
0 0
59 Ethambutol HCl tab 500 mg tab
0 0
60 Famotidine tab 20mg tab
0 0
61 Furosemid tablet 40 mg tab
400 2000 2400 0 2400 199980.00% 2000
62 Fenobarbital injeksi 50 mg/ml - 1 ml amp
0 0
63 Fenobarbital tablet 100 mg tab
0 0
64 Fenobarbital tablet 30 mg tab
90 0 90 0 90 -20.00%
65 Folid Acid 1 mg tab
0 0 0 -20.00%
66 Garam Oralit untuk 200 ml air sach
500 3000 3500 0 3500 -20.00%
67 Gemfibrozil 300 mg kaps kaps
180 0 180 0 180 -20.00%
68 Glibenklamid tablet 5 mg tab
0 0
69 Glimepiride 1 mg tab
500 500 0 500
70 Glimepiride 2 mg tab
0 0
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11

71 guaifenisin tab
800 3000 3800 2500 1300 549980.00% 3000
72 Griseofulvin tablet 125 mg, micronized tab
500 0 500 100 400 309980.00% 3000
73 Hidroklorotiazid (HCT) tablet 25 mg tab
1000 0 1000 0 1000 -20.00%
74 Haloperidol tablet 0,5 mg tab
200 200 0 200 -20.00%
75 Haloperidol tablet 1,5 mg tab
200 200 0 200 -20.00%
76 Haloperidol tablet 5 mg tab
330 0 330 0 330 49980.00% 500
77 Ibuprofen tablet 200 mg tab
0 -20.00%
78 Ibuprofen tablet 400 mg tab
1800 5000 0 200 3200 519980.00% 5000
79 Isoniazid tab 300 mg tab
0 -20.00%
80 Isosorbid Dinitrat tablet sublingual 5 mg tab
1000 0 1000 0 1000 -20.00%
81 Kombinasi Pirimetamin 25 mg + Sulfadoxin 5 tab
0 0 -20.00%
82 Kuinin (Kina) tablet 200 mg tab
0 0 -20.00%
83 Ketokonazol 200 mg tab
400 1000 1400 660 740 165980.00% 1000
84 Lansoprazole 30mg Kaps
0 1000 0 100 900 109980.00% 1000
85 Levofloxacin kapl 500mg kapl
500 500 0 500 -20.00%
86 Linkomisin kaps 500mg kaps
0 0 -20.00%
87 Loratadin Tablet 10 mg tab
600 3000 3600 2000 1600 499980.00% 3000
88 Loperamid tab 2mg tab
400 1000 1400 700 700 169980.00% 1000
89 Malarex tab
0 0 -20.00%
90 Metronidazol tablet 250 mg tab
0 0 -20.00%
91 Metronidazol tablet 500 mg tab
5200 0 5200 700 4500 69980.00%
92 Mebendazole Tab 500mg tab
0 0 -20.00%
93 Meloxicam 7,5 mg tab tab
0 0 0 0 0 99980.00% 1000
94 Meloxicam 15 mg tab tab
2100 3000 5100 2250 2850 224980.00%
95 Mersibion 5000 tab
0 2400 200 2200 19980.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11

96 Metformin HCL tab 500mg tab

300 500 800 500 300 99980.00% 500
97 Metilergometrin Maleat tablet salut 0,125 mg tab
0 0 -20.00%
98 Metilprednisolon 4 mg tab
0 4000 4000 1100 2900 109980.00%
99 Metoclorpamid 10 mg tab tab
900 0 900 0 900 -20.00%
100 Natrium Diklofenak 25 mg tab
3800 5000 8800 1800 7000 179980.00%
101 Natrium Diklofenak 50 mg tab
1850 2000 3850 3150 700 314980.00%
102 Neo Diagon tab
650 1000 1650 350 1300 34980.00%
103 Nistatin tablet salut 500.000 IU tab
800 0 800 0 800 -20.00% 0
104 Nistatin tablet vaginal 100.000 IU/g tab
800 0 800 0 800 -20.00% 0
105 Nifedipin tab 10mg tab
900 0 900 0 900 -20.00% 0
106 Ofloksasin 400mg tab
500 500 0 500 49980.00% 500
107 Omeprazole Kaps 20 mg Kaps
0 3000 0 0 3000 -20.00%
108 Parasetamol tablet 100 mg tab
0 0 0 0 -20.00%
109 Parasetamol tablet 500 mg tab
1600 5000 4200 2100 2100 709980.00% 5000
110 Ondansetron tab
132 132 96 36 19580.00% 100
111 Phenoksimetil Penisilina tablet 500 mg tab
0 0 -20.00%
112 Phitomenadion (Vit.K1) tablet salut gula 10 m tab
1100 0 1100 0 1100 -20.00%
113 Piridoksin HCl (Vit.B6) tablet 10 mg tab
2000 0 2000 0 2000 -20.00%
114 Pirazinamid tab tab
1000 1000 0 1000 -20.00%
115 Piroxicam kaps 10 mg kaps
0 0 0 0 0 299980.00% 3000
116 Piroxicam kaps 20 mg kaps
0 0 0 99980.00% 1000
117 Prednison tablet 5 mg tab
0 0 0 0 0 99980.00% 1000
118 Primakuin tablet 15 mg tab
0 0 0 0 0 -20.00%
119 Propiltiourasil tablet 100 mg tab
0 0 -20.00%
120 Pirantel tablet 125 mg tab
0 0 0 0 49980.00% 500
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11

121 Propranolol HCl tablet 40 mg tab

800 800 0 800 -20.00%
122 Ranitidin tab 150 mg tab
0 0 0 0 199980.00% 2000
123 Rifampicin 450 mg kaplet kapl
0 0 -20.00%
124 Risperidon 1 mg tab
0 0 -20.00%
125 Risperidon 2 mg tab
840 840 0 840 49980.00% 500
126 Salbutamol tab 2 mg tab
3000 3000 1200 1800 119980.00%
127 Salbutamol tab 4 mg tab
500 500 0 100 199980.00% 2000
128 Sefadroksil kaps 500mg kaps
500 2000 2500 1100 1400 309980.00% 2000
129 Sefiksim kaps 100mg kaps
300 2000 2300 1100 1200 309980.00% 2000
130 Setrizin kaps 10mg Kaps
500 2000 2500 1300 1200 329980.00% 2000
131 Syanocobalamin tab 10 mg tab
0 0 -20.00%
132 Spironolacton 25mg tablet tab
0 0 0 0 -20.00%
133 Simvastatin 10mg tab tab
500 500 0 500 49980.00% 500
134 Simvastatin 20mg tab tab
0 0 -20.00%
135 Tablet Tambah Darah kombinasi / Besi Ferro tab
0 0 -20.00%
136 thyrozol kaps
700 700 0 700 -20.00%
137 Tetrasiklin HCl kapsul 500 mg kaps
0 0 -20.00%
138 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg tab
2100 0 2100 1000 1100 #VALUE!
139 Urinter kaps
100 0 100 0 100 49980.00% 500
140 Tramadol kapsul kaps
0 0 0 0 0 49980.00% 500
141 Triheksifenidil Hidroklorida tablet 2 mg tab
500 500 0 500 -20.00%
142 Valepsy tab
0 0 0 0 0 49980.00% 500
143 Vitamin B Kompleks tablet tab
500 3000 3500 2200 1300 519980.00% 3000
144 Retinol ( Vitamin A ) 100.000 IU Kapsul lunak Kaps
0 0 -20.00%
145 Retinol ( Vitamin A ) 200.000 IU Kapsul Lunak Kaps
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11

146 Zink tab dispersible 20 mg tab

0 500 0 500 49980.00% 500
INJEKSI
0 0
147 Aminofilina Injeksi 24 mg/ml -10 ml amp
0 0 -20.00%
148 Ampisillin Inj vial
0 0 -20.00%
149 Antalgin Injeksi 250 mg/ml - 2 ml amp
100 100 0 100 -20.00%
150 Aqua Pro injeksi Steril 25 ml vial
0 24 0 -24 24 580.00% 30
151 Aqua Pro injeksi Steril 50 ml
0 0 980.00% 10
152 Asam Traneksamat injeksi 50mg/ml amp
0 0 -20.00%
153 Atropin Sulfat Injeksi 0,25 mg/ml -1 ml amp
0 0 -20.00%
154 Cefotaxime serbuk injeksi 500mg vial
0 0 -20.00%
155 Dexamethasone injeksi 5 mg/ml-1ml amp
0 0 -20.00%
156 Difenhidramin HCL Inj 10mg/ml-1ml amp
0 0 -20.00%
157 Epineprine HCL 0,1% -1ml amp
200 200 0 200 -20.00%
158 Fitomenadion (Vit K1) Injeksi 10mg/ml-1ml amp
21 21 0 21 -20.00%
159 Gentamisin Injeksi amp
0 0 -20.00%
160 Haloperidol Inj 50mg/ml 1 ml amp
0 0 -20.00%
161 Kuinin Dihidroklorida Injeksi 25% - 2 ml amp
0 0 -20.00%
162 Lidokain inj 2%(HCL) + Epineprin 1:80.000 -2ml amp
28 20 48 0 48 2980.00% 30
163 Metilergometrin Maleat Injeksi amp
31 31 0 31 -20.00%
164 Metoklorpamide Inj amp
0 0 -20.00%
165 Magnesium Sulfat inj (IV) 20% - 25 ml vial
0 0 -20.00%
166 Magnesium Sulfat inj (IV) 40% - 25 ml vial
0 0 -20.00%
167 Oksitetrasiklin HCL Injeksi i.m 50mg/ml-10ml vial
0 0 -20.00%
168 Oksitosin Injeksi 10 IU/ml-1ml amp
32 32 0 32 -20.00%
169 Sianokobalamin (Vit.B12) injeksi 500 mcg-ml amp
135 0 135 15 120 1480.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11

170 Streptomycin Sulfat Serbuk inj 1000 mg / vial vial

0 0 -20.00%
171 Thiamin HCL Injeksi 100mg/ml-1ml amp
0 0 -20.00%
172 Tramadol injeksi 50mg/ml amp
0 0 -20.00%
173 Ranitidin Injeksi amp
0 0 4980.00% 50
SYRUP
0 0 -20.00%
174 Amoksisilin sirup kering 125 mg/5ml botol
50 100 150 68 82 16780.00% 100
175 Amoksisilin sirup kering 250 mg/5ml botol
99 99 0 99 -20.00%
176 Ampisillin syrup kering botol
0 0 -20.00%
177 Antasida Syrup botol
0 0 0 0 9980.00% 100
178 Ambroxol Syr botol
48 100 148 70 78 16980.00% 100
179 Domperidon suspensi 5mg/5ml botol
20 0 20 20 0 6980.00% 50
180 Erithromicyn Syr botol
120 0 120 0 120 -20.00%
181 Ibuprofen suspensi 100mg/5ml botol
100 50 150 70 80 11980.00% 50
182 Kloramphenokol Suspensi 125mg/5ml botol
0 0 -20.00%
183 Kotrimoksazol Suspensi Komb botol
0 0 4980.00% 50
184 Obat Batuk Hitam (OBH) cairan botol
10 50 0 50 60 16980.00% 120
185 Paracetamol Syrup 120mg/5ml botol
91 0 91 41 50 19080.00% 150
186 Paracetamol drop 100mg btl@15ml botol
0 0 0 0 0 9980.00% 100
187 Pirantel Suspensi 125mg/5ml botol 60 ml
0 0 0 -20.00%
188 Pirantel Suspensi 125mg/5ml botol 10 ml
0 0 -20.00%
189 Salbutamol sirup 2mg/5ml botol
42 50 92 42 50 9180.00% 50
190 Sefadroksil sirup kering 125mg/5ml botol
0 0 0 0 0 9980.00% 100
191 Setrizin sirup 5mg/5ml botol
0 0 0 0 0 4980.00% 50
192 Zink Sirup 10mg/ml botol
0 0 0 -20.00%
193 Interzinc syr botol
85 0 85 15 70 6480.00% 50
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11

194 Gralisin syr botol

0 0 -20.00%
195 Metoklorpamide syr botol
0 0 -20.00%
196 Sulcralfat syr botol
48 50 98 48 50 14780.00% 100
197 Thiampenicol syr botol
0 0 0 -20.00%
OBAT LUAR / SALEP
0 0 0
198 Acyclovir Cream tube
20 0 0 9 11 5880.00% 50
199 Anti Bakteri DOEN salep,Basitrasin Cr tube
7 25 32 7 25 3180.00% 25
200 Anti Hemoroid DOEN Kombinasi supp
0 0 -20.00%
201 Antifungi DOEN :As. Benzoat + As. Salisilat pot
0 24 24 0 24 2380.00% 24
202 Betametason krim 0.1% tube
100 0 100 91 9 14080.00% 50
203 Chloramfenikol Tetes telinga 3% botol
0 0 4980.00% 50
204 Chloramfenikol Salep Mata 1 % tube
240 0 240 90 150 8980.00%
205 Fenol Gliserin tetes telinga 10% botol
0 0 0 0 0 -20.00%
206 Gentian Violet larutan 1 % pot
0 0 0 0 0 4780.00% 48
207 Gentamisin Salep 0,3 salep Mata tube
68 0 68 20 48 6980.00% 50
208 Gentamisin Sulfat tetes Mata botol
10 0 10 0 10 -20.00%
209 Hidrokortison krim 2,5 % tube
42 0 42 18 24 4280.00% 25
210 Isotik tetes Mata botol
0 0 0 0 0 1980.00% 20
211 Ketokonazol Cream tube
50 0 50 20 30 6980.00% 50
212 Gentamisin Salep 0,1 salap kulit tube
0 0 0 0 0 2980.00% 30
213 Oksitetrasiklin HCl salep mata 1 % tube
0 0 -20.00%
214 Salep 2-4 pot
24 0 24 6 18 580.00%
215 Mikonazol krim 2 % tube
24 0 24 0 24 4980.00% 50
216 Zolacord kream tube
0 0 -20.00%
217 Salisil Bedak 2 % pcs
13 0 13 0 13 1980.00% 20
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11

218 Berlison N tube

0 0 -20.00%
INFUS
0 0 -20.00%
219 Dekstran 70 - larutan infus 6% steril botol
0 0 -20.00%
220 Glukosa larutan infus 10 % steril (Produk lokal botol
0 0 -20.00%
221 Glukosa larutan infus 40 % steril (Produk lokal botol
-20.00%
222 Glukosa larutan infus 5 % steril (Produk lokal) botol
0 0 -20.00%
223 Natrium Klorida infus 0,9 % steril (Produk loka botol
11 20 31 1 30 2080.00% 20
224 Ringer Laktat larutan infus steril (Produk lokal botol
3 20 23 17 6 3680.00% 20
OBAT GIGI
0 0
225 Ethyl Chlorid Spray botol
0 0 0 0 0 80.00% 1
226 Eugenol cairan botol
0 0 -20.00%
227 Glass - Ionomer cement ( gc ix ) set
0 0 -20.00%
228 Sement seng fosfat serbuk & cairan set
0 0 -20.00%
229 Monoklorkamfer/Klorfenol kamfer Menthol ( set
0 0 -20.00%
230 Mummifying Pasta set
0 0 -20.00%
231 Temporary Stopping Fletcher serbuk dan caira set
0 0 -20.00%
232 Kalium Hidroksida Pasta box
0 0 -20.00%
233 Devitalisasi pasta /non arsen btl 2gr
0 0 -20.00%
234 Lidocain spray botol
0 0 -20.00%
BAHAN HABIS PAKAI
0 0 -20.00%
235 Alat suntik sekali pakai 0.05 ml pcs
200 0 200 0 200 19980.00% 200
236 Alat suntik sekali pakai 0.5ml pcs
2100 0 2100 300 1800 29980.00%
237 Alat suntik sekali pakai 1 ml pcs
180 0 180 0 180 -20.00%
238 Alat suntik sekali pakai 2,5 ml pcs
150 330 480 380 100 47980.00% 100
239 Alat suntik sekali pakai 3 ml pcs
0 300 300 100 200 39980.00% 300
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11

240 Alat suntik sekali pakai 5 ml pcs

180 0 180 10 170 980.00%
241 TP Disposable Syringe 1ml pcs
0 0 -20.00%
242 Aqua Gel sachet
200 200 0 200 -20.00%
243 Aximed 10x10cm non Woioven pcs
3 3 0 3 -20.00%
244 Aximed 5x10cm non Woioven rol
15 0 15 0 15 -20.00%
245 Catgut No. 2/0 dgn jarum bedah pcs
0 0 0 1180.00% 12
246 Catgut No. 3/0 dgn jarum bedah pcs
0 0 3580.00% 36
247 Catgut Chromic W/O Needle 2/0 pcs
36 48 84 41 43 4080.00%
248 Catgut Chromic W/O Needle 3/0 pcs
60 0 60 0 60 -20.00%
249 Etakridin ( Rivanol ) larutan 0,1% 300ml botol
0 0 -20.00%
250 Etanol 70% 100 ml botol
0 0 0 0 0 2380.00% 24
251 Etanol 70% 1000 ml botol
0 0 -20.00%
252 Foley Catheter No. 16 pcs
15 0 15 5 10 480.00%
253 Foley Catheter No. 18 pcs
1 0 1 0 1 -20.00%
254 Handscoon 7.5 pcs
95 95 11 84 1080.00%
255 Handscoon 7 pcs
18 18 0 18 -20.00%
256 Handscoon uk S pcs
300 300 0 300 -20.00%
257 Handscoon uk M pcs
400 400 0 400 -20.00%
258 Infusion set anak pcs
80 80 0 80 -20.00%
259 Infusion set dewasa pcs
30 30 19 11 4880.00% 30
260 Infus set type-Y pcs
0 0 -20.00%
261 IV Catheter No.20 G pcs
68 0 68 0 68 -20.00%
262 IV Catheter No. 22 G pcs
100 0 100 48 52 4780.00%
263 IV Catheter No. 24 G pcs
145 145 0 145 -20.00%
264 Jelco 20G pcs
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11

265 Jelco 22G pcs

0 0 0 -20.00%
266 Jelco 24G pcs
0 0 0 -20.00%
267 IV. Chateter trovensity Safety Plus 20G pcs
0 0 0 -20.00%
268 IV. Chateter trovensity Safety Plus 22G pcs
0 0 0 -20.00%
269 IV. Chateter trovensity Safety Plus 24G pcs
0 0 0 -20.00%
270 Kapas Berlemak 500 gram rol
20 0 20 0 20 -20.00%
271 Kapas Pembalut / Absorben 250 gram rol
10 0 10 10 10 980.00%
272 Kasa Pembalut 4 x 10 elastis buah
0 0 0 -20.00%
273 Kasa Pembalut Hidrofil 4 m x 3 cm non elastis buah
0 0 0 -20.00%
274 Kasa Pembalut Hidrofil 4 m x 5 cm non elastis buah
170 170 0 170 -20.00%
275 Kasa Pembalut Hidrofil 4 m x 10 cm non elasti buah
50 50 0 50 -20.00%
276 Kasa Pembalut Hidrofil 4 m x 15 cm non elasti buah
50 50 0 50 -20.00%
277 kasa steril 16x16 buah
0 0 0 0 0 4980.00% 50
278 Kasa Pembalut 18mx22cm pcs
12 0 12 0 12 1980.00% 20
279 Kasa Kompres steril 40 x 40 cm buah
0 0 0 0 0 4980.00% 50
280 Lysol botol
0 0 -20.00%
281 Masker buah
4800 4800 0 4800 -20.00%
282 Micropore 2 inch/5cmx9,1m buah
11 11 0 11 -20.00%
283 Polifix 10cm x 5m roll
29 29 0 29 -20.00%
284 Polifix 5cm x 1m roll
0 0 -20.00%
285 Povidon Iodida larutan 10 % botol 30 ml
0 0 0 0 0 -20.00%
286 Povidon Iodida larutan 10 % botol 60 ml
0 0 0 0 -20.00%
287 Povidon Iodida larutan 10 % btl 500ml
24 24 0 24 -20.00%
288 Plester 5 yards x 2 inch Zinc oxide roll
0 0 -20.00%
289 Pembalut Elastis Policrepe 7,5 cm x 4,55 roll
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11

290 Safety box roll

0 0 -20.00%
291 Silk ( Benag Bedah Sutera ) No 3 / 30 pcs
13 13 1 12 2480.00% 24
292 Soft Cloth on 10 cm x 10 m kotak
0 0 -20.00%
293 Urin Bag pcs
5 0 5 0 5 1980.00% 20
294 Masflu tab tab
0 0 199980.00% 2000
295 Pularex tab tab
0 0 -20.00%
296 Samcobion tab tab
0 0 -20.00%
VITAMIN
0 0 -20.00%
297 Hemafort tab
0 0 -20.00%
298 Pehavral tab
0 0 -20.00%
299 Betafort syr botol
0 0 -20.00%
300 Becefort syr botol
0 0 -20.00%
301 Geriavita tab tab
0 0 -20.00%
OBAT PROGRAM TB
0 0
302 Kategori Anak paket
0 0 99980.00% 1000
303 Kategori I paket
0 0 99980.00% 1000
304 Kategori II paket
0 0 99980.00% 1000
305 Kategori Sisipan paket
0 0 99980.00% 1000
306 Kombipak paket
0 0 99980.00% 1000

UMUM BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP

Mengetahui / menyetujui : Yang Menyerahkan : Kepala Puskesmas Yang Menerima

Kepala Dinas Kesehatan an. Kepala PPF & PK Petugas Puskesmas
Kabupaten Melawi Dinas Kesehatan
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11
c/q Kabid Pelayanan dan Kabupaten Melawi
Sumber Daya Kesehatan

dr. Tanjung Harapan Heru Priyono Dedi, A.Md.Kep

NIP 19740804 200502 1 002 Nip. 19670202 198803 1 011 Nip. 19791125 200904 1 001
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

PUSKESMAS : Manding NO DOKUMEN :01

KECAMATAN : Pinoh Utara BULAN :30 NOVEMBER 2018
KABUPATEN / KOTA : Melawi HALAMAN :1
PROVINSI : Kalimantan Barat

PERSEDIAAN SISA STOK STOK OPTIMUM

NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

1 Acyclovir 200mg tab

200 0 200 100 100 59980.00% 500
2 Acyclovir 400mg tab 1900
200 2000 2200 300 29980.00%
3 Alopurinol tablet 300 mg tab 300
800 0 800 500 49980.00%
4 alpazolam 0,5 mg tab 0
0 0 0 0 49980.00% 500
5 Alopurinol tablet 100 mg tab 200
0 200 0 200 -20.00%
6 Albendazole tab 400mg tab
0 0 0 0 -20.00%
7 Aminofilin tablet 200 mg tab
0 0 0 0 -20.00%
8 Amitriptilin HCl tablet salut 25 mg tab
400 400 Err:522 Err:522 500
9 Ambroxol 30mg tab tab
0 0 0 0 0 199980.00% 2000
10 Amlodipin tab 10mg tab
270 600 870 Err:522 300 519980.00% 500
11 Amoksisilin kapsul 250 mg kaps
100 100 0 100 -20.00%
12 Amoksisilin kaplet 500 mg kapl
2800 3000 5800 4700 1100 769980.00% 3000
13 Ampisilin 500 mg tab
400 0 0 0 400 -20.00%
14 Antalgin (Metampiron) tablet 500 mg tab
0 0 0 0 0 99980.00% 1000
15 Antasida DOEN I tablet kunyah tab
0 0 0 0 0 299980.00% 3000
16 Antimigren: Ergotamin + Kofein tab
0 Err:522 Err:522 Err:522 500
17 Antiparkinson:Karbidopa + Levodopa tab
0 Err:522 Err:522 Err:522
18 Asam Askorbat (Vit C) tablet 50 mg tab
0 0 3500 -20.00%
19 Asetosal tablet 100 mg tab
0 0 Err:522 Err:522 Err:522
20 Asetosal tablet 500 mg tab
100 0 100 0 100 199980.00% 2000
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

21 Atropin Sulfat tablet 0,5 mg tab

0 0
22 Atenolol tab 50mg tab
0 0
23 Asam Mefenamat 500 mg kapl
1800 500 0 0 1800 4999.8 5000
24 Azitromicyn 500mg tab
230 0 230 0 230 -0.2
25 Anaflu tab
0 0 0 1999.8 2000
26 Betahistin tab 6 mg tab
800 0 800 0 800 -0.2
27 Bisoprolol tab 5 mg tab
150 0 150 0 150 -0.2
28 Bromheksin tab tab
2600 2600 0 2300 2999.8 3000
29 Calcium Laktat (Kalk) Tab 500mg tab
1300 0 1300 400 900 399.8
30 Captopril 12,5 mg Tab tab
0 0 -0.2
31 Captopril 25 mg tab tab
2000 4000 6000 2600 3400 6599.8 4000
32 Captpril 50 mg tab tab
0 0 -0.2
33 Carbamazepin Tab 200 mg tab
0 0 -0.2
34 Carbamazepin Tab 200 mg tab
0 0 0 0 0 500
35 Cimetidin Tab tab
0 0 999.8 1000
36 Ciprofloxacin 500 mg kapl
1500 0 1500 0 1500 -0.2
37 Clozapin tab
500
38 Clindamisin kaps 300mg kaps
0 500 500 0 500 499.8 500 exp date
39 Clindamisin kaps 150 mg Kaps
0 0 -0.2
40 Chloramfenikol Kapsul 250 mg kaps
900 900 100 900 99.8 0
41 Chlorfeniramin Maleat (CTM) tab 4 mg tab
200 3000 3200 900 2300 899.8
42 Chlorpromazin HCL Injeksi 5 mg/ml-2ml amp

43 Chlorpromazin HCL Injeksi 25 mg/ml amp

0 0
44 Chlorpromazin HCL Tablet Salut 100 mg tab
240 240 0 240 49980.00% 500
45 Chlorpromazin HCL Tablet Salut 25 mg tab
300 0 300 0 300 49980.00% 500
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

46 Cotrimoksazol dewasa 480mg tab

2800 0 2800 0 2800 199980.00% 2000
47 Cotrimoksazol forte dewasa 960mg tab
400 1000 1400 1200 200 319980.00% 2000
48 Deksametason tablet 0,5 mg tab
0 0 0 0 0 299980.00% 3000
49 Dekstrometorfan sirup 10 mg/5 ml botol
0 0
50 Dekstrometorfan tablet 15 mg tab
0 0
51 Diazepam injeksi 5 mg/ml - 2 ml amp
0
52 Diazepam tablet 2 mg tab
0 0
53 Diazepam tablet 5 mg tab
300 0 300 0 300 49980.00% 500
54 Digoksin tablet 0,25 mg tab
0 0
55 Domperidon tab tab
1400 2000 3400 2000 1400 399980.00% 2000
56 Erytromisin Kapsul 500 mg kaps
800 1000 1800 0 1800 -20.00%
57 Erytromisin Kapsul 250 mg kaps
500 1000 1500 0 1500 99980.00% 1000
58 Extract Belladona tab 10mg tab
0 0
59 Ethambutol HCl tab 500 mg tab
0 0
60 Famotidine tab 20mg tab
0 0
61 Furosemid tablet 40 mg tab
400 2000 2400 0 2400 199980.00% 2000
62 Fenobarbital injeksi 50 mg/ml - 1 ml amp
0 0
63 Fenobarbital tablet 100 mg tab
0 0
64 Fenobarbital tablet 30 mg tab
90 0 90 0 90 -20.00%
65 Folid Acid 1 mg tab
0 0 0 -20.00%
66 Garam Oralit untuk 200 ml air sach
500 3000 3500 0 3500 -20.00%
67 Gemfibrozil 300 mg kaps kaps
180 0 180 0 180 -20.00%
68 Glibenklamid tablet 5 mg tab
0 0
69 Glimepiride 1 mg tab
500 500 0 500
70 Glimepiride 2 mg tab
0 0
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

71 guaifenisin tab
800 3000 3800 2500 1300 549980.00% 3000
72 Griseofulvin tablet 125 mg, micronized tab
500 0 500 100 400 309980.00% 3000
73 Hidroklorotiazid (HCT) tablet 25 mg tab
1000 0 1000 0 1000 -20.00%
74 Haloperidol tablet 0,5 mg tab
200 200 0 200 -20.00%
75 Haloperidol tablet 1,5 mg tab
200 200 0 200 -20.00%
76 Haloperidol tablet 5 mg tab
330 0 330 0 330 49980.00% 500
77 Ibuprofen tablet 200 mg tab
0 -20.00%
78 Ibuprofen tablet 400 mg tab
1800 5000 0 200 3200 519980.00% 5000
79 Isoniazid tab 300 mg tab
0 -20.00%
80 Isosorbid Dinitrat tablet sublingual 5 mg tab
1000 0 1000 0 1000 -20.00%
81 Kombinasi Pirimetamin 25 mg + Sulfadoxin 5 tab
0 0 -20.00%
82 Kuinin (Kina) tablet 200 mg tab
0 0 -20.00%
83 Ketokonazol 200 mg tab
400 1000 1400 660 740 165980.00% 1000
84 Lansoprazole 30mg Kaps
0 1000 0 100 900 109980.00% 1000
85 Levofloxacin kapl 500mg kapl
500 500 0 500 -20.00%
86 Linkomisin kaps 500mg kaps
0 0 -20.00%
87 Loratadin Tablet 10 mg tab
600 3000 3600 2000 1600 499980.00% 3000
88 Loperamid tab 2mg tab
400 1000 1400 700 700 169980.00% 1000
89 Malarex tab
0 0 -20.00%
90 Metronidazol tablet 250 mg tab
0 0 -20.00%
91 Metronidazol tablet 500 mg tab
5200 0 5200 700 4500 69980.00%
92 Mebendazole Tab 500mg tab
0 0 -20.00%
93 Meloxicam 7,5 mg tab tab
0 0 0 0 0 99980.00% 1000
94 Meloxicam 15 mg tab tab
2100 3000 5100 2250 2850 224980.00%
95 Mersibion 5000 tab
0 2400 200 2200 19980.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

96 Metformin HCL tab 500mg tab

300 500 800 500 300 99980.00% 500
97 Metilergometrin Maleat tablet salut 0,125 mg tab
0 0 -20.00%
98 Metilprednisolon 4 mg tab
0 4000 4000 1100 2900 109980.00%
99 Metoclorpamid 10 mg tab tab
900 0 900 0 900 -20.00%
100 Natrium Diklofenak 25 mg tab
3800 5000 8800 1800 7000 179980.00%
101 Natrium Diklofenak 50 mg tab
1850 2000 3850 3150 700 314980.00%
102 Neo Diagon tab
650 1000 1650 350 1300 34980.00%
103 Nistatin tablet salut 500.000 IU tab
800 0 800 0 800 -20.00% 0
104 Nistatin tablet vaginal 100.000 IU/g tab
800 0 800 0 800 -20.00% 0
105 Nifedipin tab 10mg tab
900 0 900 0 900 -20.00% 0
106 Ofloksasin 400mg tab
500 500 0 500 49980.00% 500
107 Omeprazole Kaps 20 mg Kaps
0 3000 0 0 3000 -20.00%
108 Parasetamol tablet 100 mg tab
0 0 0 0 -20.00%
109 Parasetamol tablet 500 mg tab
1600 5000 4200 2100 2100 709980.00% 5000
110 Ondansetron tab
132 132 96 36 19580.00% 100
111 Phenoksimetil Penisilina tablet 500 mg tab
0 0 -20.00%
112 Phitomenadion (Vit.K1) tablet salut gula 10 m tab
1100 0 1100 0 1100 -20.00%
113 Piridoksin HCl (Vit.B6) tablet 10 mg tab
2000 0 2000 0 2000 -20.00%
114 Pirazinamid tab tab
1000 1000 0 1000 -20.00%
115 Piroxicam kaps 10 mg kaps
0 0 0 0 0 299980.00% 3000
116 Piroxicam kaps 20 mg kaps
0 0 0 99980.00% 1000
117 Prednison tablet 5 mg tab
0 0 0 0 0 99980.00% 1000
118 Primakuin tablet 15 mg tab
0 0 0 0 0 -20.00%
119 Propiltiourasil tablet 100 mg tab
0 0 -20.00%
120 Pirantel tablet 125 mg tab
0 0 0 0 49980.00% 500
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

121 Propranolol HCl tablet 40 mg tab

800 800 0 800 -20.00% exp. Agt 2018
122 Ranitidin tab 150 mg tab
0 0 0 0 199980.00% 2000
123 Rifampicin 450 mg kaplet kapl
0 0 -20.00%
124 Risperidon 1 mg tab
0 0 -20.00%
125 Risperidon 2 mg tab
840 840 0 840 49980.00% 500
126 Salbutamol tab 2 mg tab
3000 3000 1200 1800 119980.00%
127 Salbutamol tab 4 mg tab
500 500 0 100 199980.00% 2000
128 Sefadroksil kaps 500mg kaps
500 2000 2500 1100 1400 309980.00% 2000
129 Sefiksim kaps 100mg kaps
300 2000 2300 1100 1200 309980.00% 2000
130 Setrizin kaps 10mg Kaps
500 2000 2500 1300 1200 329980.00% 2000
131 Syanocobalamin tab 10 mg tab
0 0 -20.00%
132 Spironolacton 25mg tablet tab
0 0 0 0 -20.00%
133 Simvastatin 10mg tab tab
500 500 0 500 49980.00% 500
134 Simvastatin 20mg tab tab
0 0 -20.00%
135 Tablet Tambah Darah kombinasi / Besi Ferro tab
0 0 -20.00%
136 thyrozol kaps
700 700 0 700 -20.00%
137 Tetrasiklin HCl kapsul 500 mg kaps
0 0 -20.00%
138 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg tab
2100 0 2100 1000 1100 #VALUE!
139 Urinter kaps
100 0 100 0 100 49980.00% 500
140 Tramadol kapsul kaps
0 0 0 0 0 49980.00% 500
141 Triheksifenidil Hidroklorida tablet 2 mg tab
500 500 0 500 -20.00%
142 Valepsy tab
0 0 0 0 0 49980.00% 500
143 Vitamin B Kompleks tablet tab
500 3000 3500 2200 1300 519980.00% 3000
144 Retinol ( Vitamin A ) 100.000 IU Kapsul lunak Kaps
0 0 -20.00%
145 Retinol ( Vitamin A ) 200.000 IU Kapsul Lunak Kaps
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

146 Zink tab dispersible 20 mg tab

0 500 0 500 49980.00% 500
INJEKSI
0 0
147 Aminofilina Injeksi 24 mg/ml -10 ml amp
0 0 -20.00%
148 Ampisillin Inj vial
0 0 -20.00%
149 Antalgin Injeksi 250 mg/ml - 2 ml amp
100 100 0 100 -20.00%
150 Aqua Pro injeksi Steril 25 ml vial
0 24 0 -24 24 580.00% 30
151 Aqua Pro injeksi Steril 50 ml
0 0 980.00% 10
152 Asam Traneksamat injeksi 50mg/ml amp
0 0 -20.00%
153 Atropin Sulfat Injeksi 0,25 mg/ml -1 ml amp
0 0 -20.00%
154 Cefotaxime serbuk injeksi 500mg vial
0 0 -20.00%
155 Dexamethasone injeksi 5 mg/ml-1ml amp
0 0 -20.00%
156 Difenhidramin HCL Inj 10mg/ml-1ml amp
0 0 -20.00%
157 Epineprine HCL 0,1% -1ml amp
200 200 0 200 -20.00%
158 Fitomenadion (Vit K1) Injeksi 10mg/ml-1ml amp
21 21 0 21 -20.00%
159 Gentamisin Injeksi amp
0 0 -20.00%
160 Haloperidol Inj 50mg/ml 1 ml amp
0 0 -20.00%
161 Kuinin Dihidroklorida Injeksi 25% - 2 ml amp
0 0 -20.00%
162 Lidokain inj 2%(HCL) + Epineprin 1:80.000 -2ml amp
28 20 48 0 48 2980.00% 30
163 Metilergometrin Maleat Injeksi amp
31 31 0 31 -20.00%
164 Metoklorpamide Inj amp
0 0 -20.00%
165 Magnesium Sulfat inj (IV) 20% - 25 ml vial
0 0 -20.00%
166 Magnesium Sulfat inj (IV) 40% - 25 ml vial
0 0 -20.00%
167 Oksitetrasiklin HCL Injeksi i.m 50mg/ml-10ml vial
0 0 -20.00%
168 Oksitosin Injeksi 10 IU/ml-1ml amp
32 32 0 32 -20.00%
169 Sianokobalamin (Vit.B12) injeksi 500 mcg-ml amp
135 0 135 15 120 1480.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

170 Streptomycin Sulfat Serbuk inj 1000 mg / vial vial

0 0 -20.00%
171 Thiamin HCL Injeksi 100mg/ml-1ml amp
0 0 -20.00%
172 Tramadol injeksi 50mg/ml amp
0 0 -20.00%
173 Ranitidin Injeksi amp
0 0 4980.00% 50
SYRUP
0 0 -20.00%
174 Amoksisilin sirup kering 125 mg/5ml botol
50 100 150 68 82 16780.00% 100
175 Amoksisilin sirup kering 250 mg/5ml botol
99 99 0 99 -20.00%
176 Ampisillin syrup kering botol
0 0 -20.00%
177 Antasida Syrup botol
0 0 0 0 9980.00% 100
178 Ambroxol Syr botol
48 100 148 70 78 16980.00% 100
179 Domperidon suspensi 5mg/5ml botol
20 0 20 20 0 6980.00% 50
180 Erithromicyn Syr botol
120 0 120 0 120 -20.00%
181 Ibuprofen suspensi 100mg/5ml botol
100 50 150 70 80 11980.00% 50
182 Kloramphenokol Suspensi 125mg/5ml botol
0 0 -20.00%
183 Kotrimoksazol Suspensi Komb botol
0 0 4980.00% 50
184 Obat Batuk Hitam (OBH) cairan botol
10 50 0 50 60 16980.00% 120
185 Paracetamol Syrup 120mg/5ml botol
91 0 91 41 50 19080.00% 150
186 Paracetamol drop 100mg btl@15ml botol
0 0 0 0 0 9980.00% 100
187 Pirantel Suspensi 125mg/5ml botol 60 ml
0 0 0 -20.00%
188 Pirantel Suspensi 125mg/5ml botol 10 ml
0 0 -20.00%
189 Salbutamol sirup 2mg/5ml botol
42 50 92 42 50 9180.00% 50
190 Sefadroksil sirup kering 125mg/5ml botol
0 0 0 0 0 9980.00% 100
191 Setrizin sirup 5mg/5ml botol
0 0 0 0 0 4980.00% 50
192 Zink Sirup 10mg/ml botol
0 0 0 -20.00%
193 Interzinc syr botol
85 0 85 15 70 6480.00% 50
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

194 Gralisin syr botol

0 0 -20.00%
195 Metoklorpamide syr botol
0 0 -20.00%
196 Sulcralfat syr botol
48 50 98 48 50 14780.00% 100
197 Thiampenicol syr botol
0 0 0 -20.00%
OBAT LUAR / SALEP
0 0 0
198 Acyclovir Cream tube
20 0 0 9 11 5880.00% 50
199 Anti Bakteri DOEN salep,Basitrasin Cr tube
7 25 32 7 25 3180.00% 25
200 Anti Hemoroid DOEN Kombinasi supp
0 0 -20.00%
201 Antifungi DOEN :As. Benzoat + As. Salisilat pot
0 24 24 0 24 2380.00% 24
202 Betametason krim 0.1% tube
100 0 100 91 9 14080.00% 50
203 Chloramfenikol Tetes telinga 3% botol
0 0 4980.00% 50
204 Chloramfenikol Salep Mata 1 % tube
240 0 240 90 150 8980.00%
205 Fenol Gliserin tetes telinga 10% botol
0 0 0 0 0 -20.00%
206 Gentian Violet larutan 1 % pot
0 0 0 0 0 4780.00% 48
207 Gentamisin Salep 0,3 salep Mata tube
68 0 68 20 48 6980.00% 50
208 Gentamisin Sulfat tetes Mata botol
10 0 10 0 10 -20.00%
209 Hidrokortison krim 2,5 % tube
42 0 42 18 24 4280.00% 25
210 Isotik tetes Mata botol
0 0 0 0 0 1980.00% 20
211 Ketokonazol Cream tube
50 0 50 20 30 6980.00% 50
212 Gentamisin Salep 0,1 salap kulit tube
0 0 0 0 0 2980.00% 30
213 Oksitetrasiklin HCl salep mata 1 % tube
0 0 -20.00%
214 Salep 2-4 pot
24 0 24 6 18 580.00%
215 Mikonazol krim 2 % tube
24 0 24 0 24 4980.00% 50
216 Zolacord kream tube
0 0 -20.00%
217 Salisil Bedak 2 % pcs
13 0 13 0 13 1980.00% 20
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

218 Berlison N tube

0 0 -20.00%
INFUS
0 0 -20.00%
219 Dekstran 70 - larutan infus 6% steril botol
0 0 -20.00%
220 Glukosa larutan infus 10 % steril (Produk lokal botol
0 0 -20.00%
221 Glukosa larutan infus 40 % steril (Produk lokal botol
-20.00%
222 Glukosa larutan infus 5 % steril (Produk lokal) botol
0 0 -20.00%
223 Natrium Klorida infus 0,9 % steril (Produk loka botol
11 20 31 1 30 2080.00% 20
224 Ringer Laktat larutan infus steril (Produk lokal botol
3 20 23 17 6 3680.00% 20
OBAT GIGI
0 0
225 Ethyl Chlorid Spray botol
0 0 0 0 0 80.00% 1
226 Eugenol cairan botol
0 0 -20.00%
227 Glass - Ionomer cement ( gc ix ) set
0 0 -20.00%
228 Sement seng fosfat serbuk & cairan set
0 0 -20.00%
229 Monoklorkamfer/Klorfenol kamfer Menthol ( set
0 0 -20.00%
230 Mummifying Pasta set
0 0 -20.00%
231 Temporary Stopping Fletcher serbuk dan caira set
0 0 -20.00%
232 Kalium Hidroksida Pasta box
0 0 -20.00%
233 Devitalisasi pasta /non arsen btl 2gr
0 0 -20.00%
234 Lidocain spray botol
0 0 -20.00%
BAHAN HABIS PAKAI
0 0 -20.00%
235 Alat suntik sekali pakai 0.05 ml pcs
200 0 200 0 200 19980.00% 200
236 Alat suntik sekali pakai 0.5ml pcs
2100 0 2100 300 1800 29980.00%
237 Alat suntik sekali pakai 1 ml pcs
180 0 180 0 180 -20.00%
238 Alat suntik sekali pakai 2,5 ml pcs
150 330 480 380 100 47980.00% 100
239 Alat suntik sekali pakai 3 ml pcs
0 300 300 100 200 39980.00% 300
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

240 Alat suntik sekali pakai 5 ml pcs

180 0 180 10 170 980.00%
241 TP Disposable Syringe 1ml pcs
0 0 -20.00%
242 Aqua Gel sachet
200 200 0 200 -20.00%
243 Aximed 10x10cm non Woioven pcs
3 3 0 3 -20.00%
244 Aximed 5x10cm non Woioven rol
15 0 15 0 15 -20.00%
245 Catgut No. 2/0 dgn jarum bedah pcs
0 0 0 1180.00% 12
246 Catgut No. 3/0 dgn jarum bedah pcs
0 0 3580.00% 36
247 Catgut Chromic W/O Needle 2/0 pcs
36 48 84 41 43 4080.00%
248 Catgut Chromic W/O Needle 3/0 pcs
60 0 60 0 60 -20.00%
249 Etakridin ( Rivanol ) larutan 0,1% 300ml botol
0 0 -20.00%
250 Etanol 70% 100 ml botol
0 0 0 0 0 2380.00% 24
251 Etanol 70% 1000 ml botol
0 0 -20.00%
252 Foley Catheter No. 16 pcs
15 0 15 5 10 480.00%
253 Foley Catheter No. 18 pcs
1 0 1 0 1 -20.00%
254 Handscoon 7.5 pcs
95 95 11 84 1080.00%
255 Handscoon 7 pcs
18 18 0 18 -20.00%
256 Handscoon uk S pcs
300 300 0 300 -20.00%
257 Handscoon uk M pcs
400 400 0 400 -20.00%
258 Infusion set anak pcs
80 80 0 80 -20.00%
259 Infusion set dewasa pcs
30 30 19 11 4880.00% 30
260 Infus set type-Y pcs
0 0 -20.00%
261 IV Catheter No.20 G pcs
68 0 68 0 68 -20.00%
262 IV Catheter No. 22 G pcs
100 0 100 48 52 4780.00%
263 IV Catheter No. 24 G pcs
145 145 0 145 -20.00%
264 Jelco 20G pcs
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

265 Jelco 22G pcs

0 0 0 -20.00%
266 Jelco 24G pcs
0 0 0 -20.00%
267 IV. Chateter trovensity Safety Plus 20G pcs
0 0 0 -20.00%
268 IV. Chateter trovensity Safety Plus 22G pcs
0 0 0 -20.00%
269 IV. Chateter trovensity Safety Plus 24G pcs
0 0 0 -20.00%
270 Kapas Berlemak 500 gram rol
20 0 20 0 20 -20.00%
271 Kapas Pembalut / Absorben 250 gram rol
10 0 10 10 10 980.00%
272 Kasa Pembalut 4 x 10 elastis buah
0 0 0 -20.00%
273 Kasa Pembalut Hidrofil 4 m x 3 cm non elastis buah
0 0 0 -20.00%
274 Kasa Pembalut Hidrofil 4 m x 5 cm non elastis buah
170 170 0 170 -20.00%
275 Kasa Pembalut Hidrofil 4 m x 10 cm non elasti buah
50 50 0 50 -20.00%
276 Kasa Pembalut Hidrofil 4 m x 15 cm non elasti buah
50 50 0 50 -20.00%
277 kasa steril 16x16 buah
0 0 0 0 0 4980.00% 50
278 Kasa Pembalut 18mx22cm pcs
12 0 12 0 12 1980.00% 20
279 Kasa Kompres steril 40 x 40 cm buah
0 0 0 0 0 4980.00% 50
280 Lysol botol
0 0 -20.00%
281 Masker buah
4800 4800 0 4800 -20.00%
282 Micropore 2 inch/5cmx9,1m buah
11 11 0 11 -20.00%
283 Polifix 10cm x 5m roll
29 29 0 29 -20.00%
284 Polifix 5cm x 1m roll
0 0 -20.00%
285 Povidon Iodida larutan 10 % botol 30 ml
0 0 0 0 0 -20.00%
286 Povidon Iodida larutan 10 % botol 60 ml
0 0 0 0 -20.00%
287 Povidon Iodida larutan 10 % btl 500ml
24 24 0 24 -20.00%
288 Plester 5 yards x 2 inch Zinc oxide roll
0 0 -20.00%
289 Pembalut Elastis Policrepe 7,5 cm x 4,55 roll
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12

290 Safety box roll

0 0 -20.00%
291 Silk ( Benag Bedah Sutera ) No 3 / 30 pcs
13 13 1 12 2480.00% 24
292 Soft Cloth on 10 cm x 10 m kotak
0 0 -20.00%
293 Urin Bag pcs
5 0 5 0 5 1980.00% 20
294 Masflu tab tab
0 0 199980.00% 2000
295 Pularex tab tab
0 0 -20.00%
296 Samcobion tab tab
0 0 -20.00%
VITAMIN
0 0 -20.00%
297 Hemafort tab
0 0 -20.00%
298 Pehavral tab
0 0 -20.00%
299 Betafort syr botol
0 0 -20.00%
300 Becefort syr botol
0 0 -20.00%
301 Geriavita tab tab
0 0 -20.00%
OBAT PROGRAM TB
0 0
302 Kategori Anak paket
0 0 99980.00% 1000
303 Kategori I paket
0 0 99980.00% 1000
304 Kategori II paket
0 0 99980.00% 1000
305 Kategori Sisipan paket
0 0 99980.00% 1000
306 Kombipak paket
0 0 99980.00% 1000

UMUM BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP

Mengetahui / menyetujui : Yang Menyerahkan : Kepala Puskesmas Yang Menerima

Kepala Dinas Kesehatan an. Kepala PPF & PK Petugas Puskesmas
Kabupaten Melawi Dinas Kesehatan
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%
1 2 3 4 5 6 7 8 9 10 11 12
c/q Kabid Pelayanan dan Kabupaten Melawi
Sumber Daya Kesehatan

dr. Tanjung Harapan Heru Priyono Dedi, A.Md.Kep

NIP 19740804 200502 1 002 Nip. 19670202 198803 1 011 Nip. 19791125 200904 1 001
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

22 Atenolol tab 50mg tab

0 0
23 Asam Mefenamat 500 mg kapl
1800 0 0 1300 4999.8 5000
24 Azitromicyn 500mg tab
230 0 230 0 230 -0.2
25 Anaflu tab
0 0 0 1999.8 2000
26 Betahistin tab 6 mg tab
800 0 800 380 420 379.8
27 Bisoprolol tab 5 mg tab
150 0 150 0 150 -0.2
28 Bromheksin tab tab
2300 2300 0 1300 2999.8 3000
29 Calcium Laktat (Kalk) Tab 500mg tab
900 0 900 900 0 899.8
30 Captopril 12,5 mg Tab tab
0 0 -0.2
31 Captopril 25 mg tab tab
3400 3400 1300 2100 5299.8 4000
32 Captpril 50 mg tab tab
0 0 -0.2
33 Carbamazepin Tab 200 mg tab
0 0 -0.2
34 Carbamazepin Tab 200 mg tab
0 0 0 0 0 500
35 Cimetidin Tab tab
0 0 999.8 1000
36 Ciprofloxacin 500 mg kapl
1500 0 1500 0 1500 -0.2
37 Clozapin tab
500
38 Clindamisin kaps 300mg kaps
500 500 50 450 49.8 exp date
39 Clindamisin kaps 150 mg Kaps
0 0 -0.2
40 Chloramfenikol Kapsul 250 mg kaps
900 900 100 700 99.8 0
41 Chlorfeniramin Maleat (CTM) tab 4 mg tab
2300 2300 1600 700 3599.8 2000
42 Chlorpromazin HCL Injeksi 5 mg/ml-2ml amp

43 Chlorpromazin HCL Injeksi 25 mg/ml amp

0 0
44 Chlorpromazin HCL Tablet Salut 100 mg tab
240 240 0 240 49980.00% 500
45 Chlorpromazin HCL Tablet Salut 25 mg tab
300 0 300 0 300 49980.00% 500
46 Cotrimoksazol dewasa 480mg tab
3800 0 3800 0 3800 199980.00% 2000
47 Cotrimoksazol forte dewasa 960mg tab
1400 1400 0 1400 199980.00% 2000
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

48 Deksametason tablet 0,5 mg tab

0 0 0 0 0 299980.00% 3000
49 Dekstrometorfan sirup 10 mg/5 ml botol
0 0
50 Dekstrometorfan tablet 15 mg tab
0 0
51 Diazepam injeksi 5 mg/ml - 2 ml amp
0
52 Diazepam tablet 2 mg tab
0 0
53 Diazepam tablet 5 mg tab
300 0 300 200 100 69980.00% 500
54 Digoksin tablet 0,25 mg tab
0 0
55 Domperidon tab tab
1400 1400 100 1300 9980.00%
56 Erytromisin Kapsul 500 mg kaps
1800 0 1800 0 1800 -20.00%
57 Erytromisin Kapsul 250 mg kaps
1500 1500 0 1500 -20.00%
58 Extract Belladona tab 10mg tab
0 0
59 Ethambutol HCl tab 500 mg tab
0 0
60 Famotidine tab 20mg tab
0 0
61 Furosemid tablet 40 mg tab
2400 2400 800 1600 279980.00% 2000
62 Fenobarbital injeksi 50 mg/ml - 1 ml amp
0 0
63 Fenobarbital tablet 100 mg tab
0 0
64 Fenobarbital tablet 30 mg tab
90 0 90 0 90 -20.00%
65 Folid Acid 1 mg tab
0 0 0 -20.00%
66 Garam Oralit untuk 200 ml air sach
3500 3500 200 3300 19980.00%
67 Gemfibrozil 300 mg kaps kaps
180 0 180 0 180 -20.00%
68 Glibenklamid tablet 5 mg tab
0 0
69 Glimepiride 1 mg tab
500 500 0 500
70 Glimepiride 2 mg tab
0 0
71 guaifenisin tab
1300 1300 0 1300 299980.00% 3000
72 Griseofulvin tablet 125 mg, micronized tab
500 0 500 200 300 69980.00% 500
73 Hidroklorotiazid (HCT) tablet 25 mg tab
1000 0 1000 0 1000 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

74 Haloperidol tablet 0,5 mg tab

200 200 0 200 -20.00%
75 Haloperidol tablet 1,5 mg tab
200 200 0 200 -20.00%
76 Haloperidol tablet 5 mg tab
330 0 330 0 330 49980.00% 500
77 Ibuprofen tablet 200 mg tab
0 -20.00%
78 Ibuprofen tablet 400 mg tab
3200 0 200 2000 219980.00% 2000
79 Isoniazid tab 300 mg tab
0 -20.00%
80 Isosorbid Dinitrat tablet sublingual 5 mg tab
1000 0 1000 0 1000 -20.00%
81 Kombinasi Pirimetamin 25 mg + Sulfadoxin 50 tab
0 0 -20.00%
82 Kuinin (Kina) tablet 200 mg tab
0 0 -20.00%
83 Ketokonazol 200 mg tab
740 740 390 350 88980.00% 500
84 Lansoprazole 30mg Kaps
900 0 100 0 109980.00% 1000
85 Levofloxacin kapl 500mg kapl
500 500 0 500 -20.00%
86 Linkomisin kaps 500mg kaps
0 0 -20.00%
87 Loratadin Tablet 10 mg tab
1600 1600 40 1560 3980.00%
88 Loperamid tab 2mg tab
700 700 300 400 79980.00% 500
89 Malarex tab
0 0 -20.00%
90 Metronidazol tablet 250 mg tab
0 0 -20.00%
91 Metronidazol tablet 500 mg tab
4500 0 4500 400 4100 39980.00%
92 Mebendazole Tab 500mg tab
0 0 -20.00%
93 Meloxicam 7,5 mg tab tab
0 0 0 0 0 -20.00%
94 Meloxicam 15 mg tab tab
2850 2850 0 2850 -20.00%
95 Mersibion 5000 tab
2200 200 2200 19980.00%
96 Metformin HCL tab 500mg tab
300 300 0 300 49980.00% 500
97 Metilergometrin Maleat tablet salut 0,125 mg tab
0 0 -20.00%
98 Metilprednisolon 4 mg tab
2900 2900 1300 1600 129980.00%
99 Metoclorpamid 10 mg tab tab
900 0 900 0 900 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

100 Natrium Diklofenak 25 mg tab

7000 7000 1100 5900 109980.00%
101 Natrium Diklofenak 50 mg tab
700 700 550 150 54980.00%
102 Neo Diagon tab
1300 1300 100 1200 9980.00%
103 Nistatin tablet salut 500.000 IU tab
800 0 800 0 800 -20.00% 0
104 Nistatin tablet vaginal 100.000 IU/g tab
800 0 800 200 600 19980.00% 0
105 Nifedipin tab 10mg tab
900 0 900 0 900 -20.00% 0
106 Ofloksasin 400mg tab
500 500 0 500 49980.00% 500
107 Omeprazole Kaps 20 mg Kaps
3000 0 0 0 1500 -20.00%
108 Parasetamol tablet 100 mg tab
0 0 0 0 -20.00%
109 Parasetamol tablet 500 mg tab
2100 4200 3500 700 849980.00% 5000
110 Ondansetron tab
36 36 24 12 12380.00% 100
111 Phenoksimetil Penisilina tablet 500 mg tab
0 0 -20.00%
112 Phitomenadion (Vit.K1) tablet salut gula 10 m tab
1100 0 1100 0 1100 -20.00%
113 Piridoksin HCl (Vit.B6) tablet 10 mg tab
2000 0 2000 0 2000 -20.00%
114 Pirazinamid tab tab
1000 1000 0 1000 -20.00%
115 Piroxicam kaps 10 mg kaps
0 0 0 0 0 299980.00% 3000
116 Piroxicam kaps 20 mg kaps
0 0 0 99980.00% 1000
117 Prednison tablet 5 mg tab
0 0 0 0 0 99980.00% 1000
118 Primakuin tablet 15 mg tab
0 0 0 0 0 -20.00%
119 Propiltiourasil tablet 100 mg tab
0 0 -20.00%
120 Pirantel tablet 125 mg tab
0 0 0 0 49980.00% 500
121 Propranolol HCl tablet 40 mg tab
800 800 0 800 -20.00% exp. Agt 2018
122 Ranitidin tab 150 mg tab
0 0 0 0 199980.00% 2000
123 Rifampicin 450 mg kaplet kapl
0 0 -20.00%
124 Risperidon 1 mg tab
0 0 -20.00%
125 Risperidon 2 mg tab
840 840 0 840 49980.00% 500 exp.
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

126 Salbutamol tab 2 mg tab

1800 1800 0 1800 -20.00%
127 Salbutamol tab 4 mg tab
100 100 0 199980.00% 2000
128 Sefadroksil kaps 500mg kaps
1400 1400 600 800 259980.00% 2000
129 Sefiksim kaps 100mg kaps
1200 1200 0 1200 199980.00% 2000
130 Setrizin kaps 10mg Kaps
1200 1200 700 500 269980.00% 2000
131 Syanocobalamin tab 10 mg tab
0 0 -20.00%
132 Spironolacton 25mg tablet tab
0 0 0 0 -20.00%
133 Simvastatin 10mg tab tab
500 500 0 500 49980.00% 500
134 Simvastatin 20mg tab tab
0 0 -20.00%
135 Tablet Tambah Darah kombinasi / Besi Ferro tab
0 0 -20.00%
136 thyrozol kaps
700 700 0 700 -20.00%
137 Tetrasiklin HCl kapsul 500 mg kaps
0 0 -20.00%
138 Tiamin HCl / Mononitrat (Vit.B1) tablet 50 mg tab
1100 0 1100 200 900 #VALUE!
139 Urinter kaps
100 0 100 0 100 49980.00% 500
140 Tramadol kapsul kaps
0 0 0 0 0 49980.00% 500
141 Triheksifenidil Hidroklorida tablet 2 mg tab
500 500 0 500 -20.00%
142 Valepsy tab
0 0 0 0 0 49980.00% 500
143 Vitamin B Kompleks tablet tab
1300 1300 900 400 389980.00% 3000
144 Retinol ( Vitamin A ) 100.000 IU Kapsul lunak Kaps
0 0 -20.00%
145 Retinol ( Vitamin A ) 200.000 IU Kapsul Lunak Kaps
0 0 -20.00%
146 Zink tab dispersible 20 mg tab
500 0 500 49980.00% 500
INJEKSI
0 0
147 Aminofilina Injeksi 24 mg/ml -10 ml amp
0 0 -20.00%
148 Ampisillin Inj vial
0 0 -20.00%
149 Antalgin Injeksi 250 mg/ml - 2 ml amp
100 100 0 100 -20.00%
150 Aqua Pro injeksi Steril 25 ml vial
24 0 24 2980.00% 30
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

151 Aqua Pro injeksi Steril 50 ml

0 0 980.00% 10
152 Asam Traneksamat injeksi 50mg/ml amp
0 0 -20.00%
153 Atropin Sulfat Injeksi 0,25 mg/ml -1 ml amp
0 0 -20.00%
154 Cefotaxime serbuk injeksi 500mg vial
0 0 -20.00%
155 Dexamethasone injeksi 5 mg/ml-1ml amp
0 0 -20.00%
156 Difenhidramin HCL Inj 10mg/ml-1ml amp
0 0 -20.00%
157 Epineprine HCL 0,1% -1ml amp
200 200 0 200 -20.00%
158 Fitomenadion (Vit K1) Injeksi 10mg/ml-1ml amp
21 21 0 21 -20.00%
159 Gentamisin Injeksi amp
0 0 -20.00%
160 Haloperidol Inj 50mg/ml 1 ml amp
0 0 -20.00%
161 Kuinin Dihidroklorida Injeksi 25% - 2 ml amp
0 0 -20.00%
162 Lidokain inj 2%(HCL) + Epineprin 1:80.000 -2ml amp
48 48 17 31 4680.00% 30
163 Metilergometrin Maleat Injeksi amp
31 31 9 22 880.00%
164 Metoklorpamide Inj amp
0 0 -20.00%
165 Magnesium Sulfat inj (IV) 20% - 25 ml vial
0 0 -20.00%
166 Magnesium Sulfat inj (IV) 40% - 25 ml vial
0 0 -20.00%
167 Oksitetrasiklin HCL Injeksi i.m 50mg/ml-10ml vial
0 0 -20.00%
168 Oksitosin Injeksi 10 IU/ml-1ml amp
32 32 4 28 380.00%
169 Sianokobalamin (Vit.B12) injeksi 500 mcg-ml amp
120 0 120 64 56 6380.00%
170 Streptomycin Sulfat Serbuk inj 1000 mg / vial vial
0 0 -20.00%
171 Thiamin HCL Injeksi 100mg/ml-1ml amp
0 0 -20.00%
172 Tramadol injeksi 50mg/ml amp
0 0 -20.00%
173 Ranitidin Injeksi amp
0 0 4980.00% 50
SYRUP
0 0 -20.00%
174 Amoksisilin sirup kering 125 mg/5ml botol
82 82 32 50 13180.00% 100
175 Amoksisilin sirup kering 250 mg/5ml botol
99 99 0 99 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

176 Ampisillin syrup kering botol

0 0 -20.00%
177 Antasida Syrup botol
0 0 0 0 9980.00% 100
178 Ambroxol Syr botol
78 78 12 66 11180.00% 100
179 Domperidon suspensi 5mg/5ml botol
0 0 0 0 0 4980.00% 50
180 Erithromicyn Syr botol
120 0 120 0 120 -20.00%
181 Ibuprofen suspensi 100mg/5ml botol
80 80 30 50 7980.00% 50
182 Kloramphenokol Suspensi 125mg/5ml botol
0 0 -20.00%
183 Kotrimoksazol Suspensi Komb botol
50 50 0 50 4980.00% 50
184 Obat Batuk Hitam (OBH) cairan botol
60 0 50 50 50 16980.00% 120
185 Paracetamol Syrup 120mg/5ml botol
50 0 50 0 50 14980.00% 150
186 Paracetamol drop 100mg btl@15ml botol
0 0 0 0 0 9980.00% 100
187 Pirantel Suspensi 125mg/5ml botol 60 ml
0 0 0 -20.00%
188 Pirantel Suspensi 125mg/5ml botol 10 ml
0 0 -20.00%
189 Salbutamol sirup 2mg/5ml botol
50 50 15 35 6480.00% 50
190 Sefadroksil sirup kering 125mg/5ml botol
0 0 0 0 0 9980.00% 100
191 Setrizin sirup 5mg/5ml botol
0 0 0 0 0 4980.00% 50
192 Zink Sirup 10mg/ml botol
0 0 0 -20.00%
193 Interzinc syr botol
70 0 70 28 42 7780.00% 50
194 Gralisin syr botol
0 0 -20.00%
195 Metoklorpamide syr botol
0 0 -20.00%
196 Sulcralfat syr botol
50 50 5 45 10480.00% 100
197 Thiampenicol syr botol
0 0 0 -20.00%
OBAT LUAR / SALEP
0 0 0
198 Acyclovir Cream tube
11 0 0 9 11 5880.00% 50
199 Anti Bakteri DOEN salep,Basitrasin Cr tube
25 25 1 24 2580.00% 25
200 Anti Hemoroid DOEN Kombinasi supp
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

201 Antifungi DOEN :As. Benzoat + As. Salisilat pot

0 24 24 0 24 2380.00% 24
202 Betametason krim 0.1% tube
9 0 9 7 2 5680.00% 50
203 Chloramfenikol Tetes telinga 3% botol
66 66 0 66 -20.00%
204 Chloramfenikol Salep Mata 1 % tube
150 0 150 0 150 -20.00%
205 Fenol Gliserin tetes telinga 10% botol
0 0 0 0 0 -20.00%
206 Gentian Violet larutan 1 % pot
30 0 30 0 30 4780.00% 48
207 Gentamisin Salep 0,3 salep Mata tube
68 0 68 20 48 6980.00% 50
208 Gentamisin Sulfat tetes Mata botol
10 0 10 0 10 -20.00%
209 Hidrokortison krim 2,5 % tube
24 0 24 0 24 -20.00%
210 Isotik tetes Mata botol
0 0 0 0 0 1980.00% 20
211 Ketokonazol Cream tube
30 0 30 22 8 7180.00% 50
212 Gentamisin Salep 0,1 salap kulit tube
10 0 10 0 10 2980.00% 30
213 Oksitetrasiklin HCl salep mata 1 % tube
0 0 -20.00%
214 Salep 2-4 pot
18 0 18 0 18 -20.00%
215 Mikonazol krim 2 % tube
24 0 24 0 24 4980.00% 50
216 Zolacord kream tube
0 0 -20.00%
217 Salisil Bedak 2 % pcs
13 0 13 0 13 1980.00% 20
218 Berlison N tube
0 0 -20.00%
INFUS
0 0 -20.00%
219 Dekstran 70 - larutan infus 6% steril botol
0 0 -20.00%
220 Glukosa larutan infus 10 % steril (Produk lokal) botol
0 0 -20.00%
221 Glukosa larutan infus 40 % steril (Produk lokal) botol
-20.00%
222 Glukosa larutan infus 5 % steril (Produk lokal) botol
0 0 -20.00%
223 Natrium Klorida infus 0,9 % steril (Produk lokal botol
30 0 30 0 30 -20.00%
224 Ringer Laktat larutan infus steril (Produk lokal) botol
6 6 6 0 2580.00% 20
OBAT GIGI
0 0
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

225 Ethyl Chlorid Spray botol

0 0 0 0 0 80.00% 1
226 Eugenol cairan botol
0 0 -20.00%
227 Glass - Ionomer cement ( gc ix ) set
0 0 -20.00%
228 Sement seng fosfat serbuk & cairan set
0 0 -20.00%
229 Monoklorkamfer/Klorfenol kamfer Menthol ( set
0 0 -20.00%
230 Mummifying Pasta set
0 0 -20.00%
231 Temporary Stopping Fletcher serbuk dan caira set
0 0 -20.00%
232 Kalium Hidroksida Pasta box
0 0 -20.00%
233 Devitalisasi pasta /non arsen btl 2gr
0 0 -20.00%
234 Lidocain spray botol
0 0 -20.00%
BAHAN HABIS PAKAI
0 0 -20.00%
235 Alat suntik sekali pakai 0.05 ml pcs
200 0 200 0 200 19980.00% 200
236 Alat suntik sekali pakai 0.5ml pcs
2100 0 2100 300 1800 29980.00%
237 Alat suntik sekali pakai 1 ml pcs
180 0 180 0 180 -20.00%
238 Alat suntik sekali pakai 2,5 ml pcs
150 150 50 100 14980.00% 100
239 Alat suntik sekali pakai 3 ml pcs
200 200 200 49980.00% 300
240 Alat suntik sekali pakai 5 ml pcs
200 0 200 0 200 -20.00%
241 TP Disposable Syringe 1ml pcs
0 0 -20.00%
242 Aqua Gel sachet
200 200 0 200 -20.00%
243 Aximed 10x10cm non Woioven pcs
3 3 0 3 -20.00%
244 Aximed 5x10cm non Woioven rol
15 0 15 0 15 -20.00%
245 Catgut No. 2/0 dgn jarum bedah pcs
12 12 0 12 1180.00% 12
246 Catgut No. 3/0 dgn jarum bedah pcs
13 13 0 13 3580.00% 36
247 Catgut Chromic W/O Needle 2/0 pcs
43 43 0 43 -20.00%
248 Catgut Chromic W/O Needle 3/0 pcs
60 0 60 0 60 -20.00%
249 Etakridin ( Rivanol ) larutan 0,1% 300ml botol
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

250 Etanol 70% 100 ml botol

0 0 0 0 0 2380.00% 24
251 Etanol 70% 1000 ml botol
0 0 -20.00%
252 Foley Catheter No. 16 pcs
15 0 15 5 10 480.00%
253 Foley Catheter No. 18 pcs
1 0 1 0 1 -20.00%
254 Handscoon 7.5 pcs
95 95 11 84 1080.00%
255 Handscoon 7 pcs
18 18 0 18 -20.00%
256 Handscoon uk S pcs
300 300 0 300 -20.00%
257 Handscoon uk M pcs
400 400 0 400 -20.00%
258 Infusion set anak pcs
80 80 0 80 -20.00%
259 Infusion set dewasa pcs
30 30 19 11 4880.00% 30
260 Infus set type-Y pcs
0 0 -20.00%
261 IV Catheter No.20 G pcs
68 0 68 0 68 -20.00%
262 IV Catheter No. 22 G pcs
100 0 100 48 52 4780.00%
263 IV Catheter No. 24 G pcs
145 145 0 145 -20.00%
264 Jelco 20G pcs
0 0 -20.00%
265 Jelco 22G pcs
0 0 0 -20.00%
266 Jelco 24G pcs
0 0 0 -20.00%
267 IV. Chateter trovensity Safety Plus 20G pcs
0 0 0 -20.00%
268 IV. Chateter trovensity Safety Plus 22G pcs
0 0 0 -20.00%
269 IV. Chateter trovensity Safety Plus 24G pcs
0 0 0 -20.00%
270 Kapas Berlemak 500 gram rol
20 0 20 0 20 -20.00%
271 Kapas Pembalut / Absorben 250 gram rol
10 0 10 10 10 980.00%
272 Kasa Pembalut 4 x 10 elastis buah
0 0 0 -20.00%
273 Kasa Pembalut Hidrofil 4 m x 3 cm non elastis buah
0 0 0 -20.00%
274 Kasa Pembalut Hidrofil 4 m x 5 cm non elastis buah
170 170 0 170 -20.00%
275 Kasa Pembalut Hidrofil 4 m x 10 cm non elasti buah
50 50 0 50 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

276 Kasa Pembalut Hidrofil 4 m x 15 cm non elasti buah

50 50 0 50 -20.00%
277 kasa steril 16x16 buah
0 0 0 0 0 4980.00% 50
278 Kasa Pembalut 18mx22cm pcs
12 0 12 0 12 1980.00% 20
279 Kasa Kompres steril 40 x 40 cm buah
0 0 0 0 0 4980.00% 50
280 Lysol botol
0 0 -20.00%
281 Masker buah
4800 4800 0 4800 -20.00%
282 Micropore 2 inch/5cmx9,1m buah
11 11 0 11 -20.00%
283 Polifix 10cm x 5m roll
29 29 0 29 -20.00%
284 Polifix 5cm x 1m roll
0 0 -20.00%
285 Povidon Iodida larutan 10 % botol 30 ml
0 0 0 0 0 -20.00%
286 Povidon Iodida larutan 10 % botol 60 ml
0 0 0 0 -20.00%
287 Povidon Iodida larutan 10 % btl 500ml
24 24 0 24 -20.00%
288 Plester 5 yards x 2 inch Zinc oxide roll
0 0 -20.00%
289 Pembalut Elastis Policrepe 7,5 cm x 4,55 roll
0 0 -20.00%
290 Safety box roll
0 0 -20.00%
291 Silk ( Benag Bedah Sutera ) No 3 / 30 pcs
13 13 1 12 2480.00% 24
292 Soft Cloth on 10 cm x 10 m kotak
0 0 -20.00%
293 Urin Bag pcs
5 0 5 0 5 1980.00% 20
294 Masflu tab tab
0 0 199980.00% 2000
295 Pularex tab tab
0 0 -20.00%
296 Samcobion tab tab
0 0 -20.00%
VITAMIN
0 0 -20.00%
297 Hemafort tab
0 0 -20.00%
298 Pehavral tab
0 0 -20.00%
299 Betafort syr botol
0 0 -20.00%
300 Becefort syr botol
0 0 -20.00%
 PERSEDIAAN SISA STOK STOK OPTIMUM
NO NAMA OBAT SATUAN STOK AWAL PENERIMAAN PEMAKAIAN PERMINTAAN PEMBERIAN KETERANGAN
4+5 6-7 7 + 10-20%

1 2 3 4 5 6 7 8 9 10 11 12

301 Geriavita tab tab

0 0 -20.00%
OBAT PROGRAM TB
0 0
302 Kategori Anak paket
0 0 99980.00% 1000
303 Kategori I paket
0 0 99980.00% 1000
304 Kategori II paket
0 0 99980.00% 1000
305 Kategori Sisipan paket
0 0 99980.00% 1000
306 Kombipak paket
0 0 99980.00% 1000

UMUM BPJS JUMLAH

JUMLAH KUNJUNGAN RESEP

Mengetahui / menyetujui : Yang Menyerahkan : Kepala Puskesmas Yang Menerima

Kepala Dinas Kesehatan an. Kepala PPF & PK Petugas Puskesmas
Kabupaten Melawi Dinas Kesehatan
c/q Kabid Pelayanan dan Kabupaten Melawi
Sumber Daya Kesehatan

dr. Tanjung Harapan Heru Priyono Dedi, A.Md.Kep

NIP 19740804 200502 1 002 Nip. 19670202 198803 1 011 Nip. 19791125 200904 1 001