LAPORAN PEMAKAIAN DAN LEMB

NAMA PUSKESMAS :
BULAN :

Stock BULAN
NO NAMA OBAT SEDIAAN Awal Penerimaan

1 2 3 4 5

OBAT GENERIK PKD

1 Albendazol tablet 400 mg Tablet
2 Allopurinol 300 mg Tablet
3 Alopurinol tablet 100 mg Tablet
4 Ambroxol 30 mg tablet Tablet
5 Ambroxol syr Syrup
6 Aminofilin injeksi 24 mg/ml - 10 ml ampul
7 Aminofilin tablet 200 mg Tablet
8 Amitriptilin hcl tablet salut 25 mg Tablet
9 Amlodipin 5 mg Tablet
10 Amoksisilin Kaplet 500 mg Tablet
11 Amoksisilin kapsul 250 mg capsul
12 Amoksisilin syrup kering 125 mg/ 5 Syrup
13 Amoksisilin+As.Klavulanat 625 mg tablet
14 Antalgin( metampiron) tab 500 mg Tablet
15 Antalgin injeksi 250 mg/ ml - 2 ml ampul
16 Antasida Doen II Suspensi Kombinas syrup
17 Antasida doen tablet kombinasi tablet
18 Antibakteri doen salap kombinasi/ba tube
19 Antifungi doen kombinasi tube
20 Antihaemaroid doen kombinasi tablet
21 Antimigrain doen kombinasi tablet
22 Aqua proinjeksi steril , bebas pirog botol
23 Aquadest steril botol
24 As.Traneksamat 100 mg inj ampul
25 As.Traneksamat 50 mg inj ampul
26 As.Traneksamat tab 500 mg /Tran tablet
27 Asam folat/Anemolat 1mg tablet
28 Asam askorbat ( vit c ) tablet 250 tablet
29 Asam askorbat ( vit c ) tablet 50 m tablet
30 Asam Mefenamat 250 mg(Stanalin) capsul
31 Asam Mefenamat 500 mg tablet
32 Asam Mefenamat 50mg/5mlSuspen Botol
33 Asetosal tablet 100 mg tablet
34 Asetosal tablet 500 mg tab
35 Asetil sistein 200mg tab
36 Asifit Kapsul
37 Asiklovir cream 5 % tube
38 Asiklovir tablet 200 mg tablet
39 Asiklovir tablet 400 mg tablet
40 Atropin sulfat injeksi 0,25 mg/ml - ampul
41 Atropin sulfat tab 0,5 mg tablet
42 Attapulgite 300 mg/Pularex tab tablet
43 Attapulgite 600 mg tablet
44 Atorvastatin 10mg/ Atovar tablet
45 Benzatin benzil penisilin in 2,4 juta ampul
46 Besi II Sulfat 250mg+As Folat 0,25 tablet
47 Betahistin Mesilat Tablet 6mg tablet
48 Betametason krim 0,1 % tube
49 Bisoprolol tab 5mg tablet
50 Bisakodil 5mg supp/ Dulcokax/Stola suppositoria
51 Bisakodil 10 mg supp/ Dulcokax/Sto suppositoria
52 Bisakodil tablet/ Dulcokax/Stolax tablet
53 Burnazin crem tube
54 Bromheksin HCl tab/ Mucohexin tablet
55 Ceterizine 10 mg tablet
56 Cetirizin syr 5 mg/5 ml Syrup
57 Clobazam 10 mg tablet
58 Deksametason inj. 5 mg/ml - 1 ml ampul
59 Deksametason tablet 0,5 mg tablet
60 Deksametason + desklorphenirami tablet
61 Desoximethason crem/Denomix cr tube
62 Diazepam inj 5 mg/ml ampul
63 Diazepam tablet 2 mg tablet
64 Diazepam tablet 5 mg tablet
65 Diazepam rektal tube
66 Dietilkarbamazin sitrat tablet 100 tablet
67 Difenhidramin hcl inj. 10 mg / ml -1 ampul
68 Digoksin tablet 0,25 mg tablet
69 Diltiazem tablet 30 mg tablet
70 Domperidon 10 mg tablet
71 Domperidon Drops syrup
72 Domperidon Suspensi syrup
73 Doxicyclin 100mg tablet
74 Echinature Kap Kapsul
75 Echinature Kids syr Syrup
76 Efedrin hcl tablet 25 mg tablet
77 Ekstrak belladone tablet 10 mg tablet
78 Epinefrin hcl/bitatrat (adrenalin) in ampul
79 Erithromicyn Syr Syrup
80 Erytromicin 250 mg Kapsul
81 Erytromicin 500 mg tablet
82 Etakridin ( rivanol ) larutan 0,1 % larutan
83 Etakridin ( rivanol ) larutan 0,1 % larutan
84 Etambutol hcl tablet 250 mg tablet
85 Etambutol hcl tablet 500 mg tablet
86 Etanol 70 % 100ml larutan
87 Etanol 70 % 1000ml larutan
88 Famotidin 20 mg tablet
89 Famotidin 40 mg tablet
90 Fenobarbital injeksi 50 mg/ml - 2 m ampul
91 Fenobarbital tablet 100 mg Tablet
92 Fenobarbital tablet 30 mg Tablet
93 Fenoksimetil penisilina tablet 250 Tablet
94 Fenoksimetil penisilina tablet 500 Tablet
95 Fenol gliserol tetes telinga 10 % larutan
96 Fitomenadion (vit k 1) inj 10 mg/ml ampul
97 Fitomenadion (vit k 1) tab salut 10 tablet
98 Fitomenadion inj 2 mg/Infan ampul
99 Fituno Kapsul
100 Flunarizine tab 5 mg tablet
101 Furosemida injeksi ampul
102 Furosemida tablet 40 mg tablet
103 Garam oralit untuk 200 ml air sacc
104 Gentamycin Inj 80mg ampul
105 Gentamycin salp kulit tube
106 Gentamycin Tts Mata 0,3% larutan
107 Gentian violet larutan 1 % larutan
108 Glibenklamid tablet 5 mg tablet
109 Gliseril guayakolat tablet 100 mg tablet
110 Gliserin larutan
111 Glukosa larutan infus 10 % steril larutan
112 Glukosa larutan infus 40 % steril larutan
113 Glukosa larutan infus 5 % steril larutan
114 Griseofulvin tablet 125 mg , micron tablet
115 Haloperidol tablet 0,5 mg tablet
116 Haloperidol tablet 1,5 mg tablet
117 Haloperidol tablet 5 mg tablet
118 Hidroklorotiazid ( hct ) tablet 25 m tablet
119 Hidrokortison krim 2,5 % tube
120 Ibuprofen Suspensi syrup
121 Ibuprofen tab tablet
122 Ibuprofen tablet 200 mg tablet
123 Ibuprofen tablet 400 mg tablet
124 Ichtiol zalf 30 gr pot
125 Isoniazid tablet 100 mg tablet
126 Isoniazid tablet 300 mg tablet
127 Isosorbit dinitrat tablet subligual 5 tablet
128 Itraconazole 100 mg tablet
129 Kalium Diklofenak 50mg tablet
130 Kalium Permanganat serbuk pot
131 Kalsium laktat ( kalk ) tablet 500 m tablet
132 Kaptopril 12,5 mg tablet
133 Kaptopril 25 mg tablet
134 Kaptopril 50 mg tablet
135 Karbamazepin tablet 200 mg tablet
136 Karbogliserin Tetes Telinga 10 % larutan
137 Ketoconazol 200 mg Tab tablet
138 Ketoconazol cream tube
139 Ketopropen tab 100 mg tablet
140 Ketopropen supp/Protofen supp suppositoria
141 Ketorolac inj 30 mg ampul
142 Klindamisin 150 mg tablet
143 Klindamisin 300 mg tablet
144 Kloramfenikol Tetes Mata larutan
145 Kloramfenikol 125 mg/5 ml suspen Botol
146 Kloramfenikol kapsul 250 mg capsul
147 Kloramfenikol salap mata 1 %/colm tube
148 Kloramfenikol tetes telinga 3 %/ co larutan
149 Klorfeniramin maleas ( ctm ) tablet tablet
150 Kloramfenikol +Hidrocortison krim tube
151 Klorokuin fosfat tablet 150 mg tablet
152 Klorokuin fosfat tablet 100 mg tablet
153 Klorpromazin 100 mg tablet tablet
154 Klorpromazin 25mg tablet tablet
155 Klorpromazin inj 25 mg Ampul
156 Kodein tablet 10 mg tablet
157 Kombinasi pirimetamin 25 mg+ sul tablet
158 Kotrimoksazol dewasa tablet tablet
159 Kotrimoksazol pediatrik tablet tablet
160 Kotrimoksazol suspensi syrup
161 Kuinin (Kina) tablet 200 mg tablet
162 Kuinin dihidroklorida inj. 25 % - 2 m tablet
163 Lansoprazole Kapsul 30mg capsul
164 Levofloksasin 500 mg tablet
165 Levofolxacin infus 5 mg/ml larutan
166 Lidokain 1 % ampul
167 Lidokain 2 % + epinefrin 2ml ampul
168 Linkomisin 500mg Kapsul
169 Loperamid 2mg tablet
170 Loratadine 10 mg tablet
171 Lorazepam tablet Tablet
172 Magnesium sulfat inj (iv) 20 % - 25 larutan
173 Magnesium sulfat inj (iv) 40 % - 25 larutan
174 Mebendazole syp syrup
175 Meloxicam 15 mg tablet
176 Meloxicam 7,5 mg tablet
177 Metformin Hcl tablet 500mg tablet
178 Methilprednisolon 4 mg tablet
179 Methilprednisolon 8 mg tablet
180 Metiergometrin maleat inj.0,2 mg - larutan
181 Metilergometrin maleat tab sal 0,1 tablet
182 Metoklopramide tab 10 mg tablet
183 Metronidazol tablet 250 mg tablet
184 Metronidazol tablet 500 mg tablet
185 Metronidazole Infus 500mg/100 ml larutan
186 Mikonazol krim/salep 2 % tube
187 Mikobalamin 500mg/Lanabal tablet
188 Natrium bikarbonat tab 500 mg tablet
189 Natrium diklofenak tab 25 mg tablet
190 Natrium diklofenak tab 50 mg tablet
191 Natrium klorida larutan infus 0,9 % larutan
192 N.Acetyl Systein 200 mg tablet
193 Nifedipin tablet tablet
194 Nistatin tablet vaginal 100.000 IU / tablet
195 Nistatin tablet salut 500.000 IU tablet
196 Obat batuk hitam ( o.b.h ) cairan larutan
197 Ofloksasin tablet 200 mg tablet
198 Oksitetrasiklin hcl inj. I.m 50 mg/ml larutan
199 Oksitetrasiklin hcl salap 3 % tube
200 Oksitetrasiklin hcl salap mata 1 % tube
201 Oksitosin injeksi 10 iu/ ml - 1 ml Ampul
202 Omeprazol injeksi 40 mg Ampul
203 Omeprazol tablet 20 mg capsul
204 Ondansetron tab 4 mg tablet
205 Ondansetron inj Ampul
206 Papaverin 40 mg/Spasminal tablet tablet
207 Parasetamol Drops syrup
208 Parasetamol syrup 120 mg / 5 ml syrup
209 Parasetamol tablet 100 mg Tablet
210 Parasetamol tablet 500 mg tablet
211 Paracetamol 120mg Eff/Sanmol Tube 10 tube
212 Paracetamol 125 mg Supp/Pamol suppositoria
213 Pirantel tablet 125 mg tablet
214 Pirantel Suspensi 125 mg syrup
215 Pirazinamid tablet 500 mg tablet
216 Piridoksin hcl tablet 10 mg tablet
217 Piroksikam 10 mg tab tablet
218 Piroksikam 20 mg tab tablet
219 Povidon Iodida lar 10 % - 300 ml larutan
220 Povidon Iodida lar 10 % - 30 ml larutan
221 Povidon Iodida lar 10 % - 60 ml larutan
222 Prednison tablet 5 mg tablet
223 Primakuin tablet 15 mg tablet
224 Propanolol hcl tablet 10 mg tablet
225 Propanolol hcl tablet 40 mg tablet
226 Propiltiourasil tablet 100 mg tablet
227 Ranitidin inj 25 mg Ampul
228 Ranitidin tablet 150 mg tablet
229 Reserpin tab 0,10 mg tablet
230 Reserpin tab 0,25 mg tablet
231 Retinol 100.000 ui capsul
232 Retinol 200.000 ui capsul
233 Rifampisin kapsul 600 mg tablet
234 Rimfampisin kapsul 300 mg tablet
235 Rimfampisin kapsul 450 mg tablet
236 Ringer laktat larutan infus steril larutan
237 Salbutamol tablet 2 mg tablet
238 Salbutamol tablet 4 mg tablet
239 Salbutamol cairan /Ventolin Nebule larutan
240 Salbutamol Serbuk /Ventolin Rotac capsul
241 Salbutamol rotahaler /Ventolin Rota capsul
242 Salbutamol Inhalasi/ Fartolin Inhalas fls
243 Salbutamol syr/Salbron syrup
244 Salep 2-4 komb As.Salisilat 2 % +B pot
245 Salisil bedak 2 % pot
246 Sefadroxyl 500 mg tablet
247 Sefadroxyl sirup kering 125 mg / 5 syrup
248 Sefaleksin 500 mg tablet
249 Sefiksim kapsul 100 mg capsul
250 Sefiksim syr syrup
251 Sefotaksim injeksi 1 gram vial
252 Seftriason inj 1 gr vial
253 Serum Anti Bisa Ular (ABU) Vial 5 ml
254 Serum Anti Tetanus (ATS) 1500 vial 1 ml
255 Sianokobalamin ( vit b 12 ) inj.500 Ampul
256 Simetidin tablet 200 mg tablet
257 Simvastatin 10 mg tablet
258 Simvastatin 20 mg tablet
259 Siprofloxasin infus larutan
260 Siprofloxasin tab 500 mg tablet
261 Streptomisin sulfat serbuk inj. 1000 vial
262 Sukralfat sirup/Ulsidex syrup
263 Sukralfat 500 mg tablet
264 Sulfasetamida Natrium tetes Mata larutan
265 Tetracain Hcl tetes mata larutan
266 Thiampenikol tablet capsul
267 Tiamin hcl ( vit b 1 ) inj. 100 mg/ml Ampul
268 Tiamin hcl mononitrat ( vit b 1 ) ta tablet
269 Tiamin hcl mononitrat ( vit b 1 ) ta tablet
270 Tramadol injeksi Ampul
271 Tramadol tablet 50 mg tablet
272 Triheksifenidil hcl tab 2 mg tablet
273 Urea crem / Soft U Derm 10 % tube
274 Vaksin Rabies Vero vial
275 Vaksin Anti Bisa Ular (ABU) Vial
276 Vitamin b komplek tablet tablet
277 Zink Dispersible 20 mg tablet
 278 Zinkpro Drops syrup
279 Zirkum sirup syrup

OBAT NON GENERIK

1 Anadex syr syr
2 Alpara syr syrup
3 Asering 500 cc larutan
4 Baby cough syr syrup
5 Becefort Suspensi syrup
6 Becefort Tablet tablet
7 Beneuron tablet
8 Bionemi tab tablet
9 Bioron tab tablet
10 Becom C tablet
11 Betafort Syr syrup
12 Bio ATP tablet
13 Bioplacenton Gel tube
14 Biovitan Syr syrup
15 Bisakodil / Dulcolax 18 tablet/Ktk
16 Bisolvon Extra Syr Botol 60 ml
17 Calsidol syr Larutan 5ml
18 Cendo Xitrol Tetes Mata botol 5ml
19 Cendo Xitrol Tts Mata mini dose Tube
20 Cendo cetamid tts mata botol
21 Colfin Tablet
22 Curcuma tablet tablet
23 Dasabion Tablet tablet
24 Dextrosin tab tablet
25 Dextrofen syr syrup
26 Fg Troches tab hisap tablet
27 Fitbon Plus
28 Flucort N crem tube
29 Fludane Tablet tube
30 Formalin cair larutan
31 Gerac tablet tablet
32 Geriavita tablet
33 Gericare kaplet tablet
34 Good Proliver tablet
35 H2O2 3 % larutan
36 Hemafort kap tablet
37 Hemorogard Kapsul kapsul
 38 Hexacort Crem Tube
39 Hidrex Surgical 500 cc larutan
40 Hustab P Syr syruo
41 Hustab tab tablet
42 Ikaneuron 5000/Nerva 5000 tablet
43 Interhistin tablet tablet
44 Isotic Clearens larutan
45 Isotic Neolyson larutan
46 Lexavit tab tablet
47 Lisol larutan
48 Livron B-Plex tablet tablet
49 Lybex Syr syrup
50 Merlopam 0,5 mg tablet
51 Minyak Telon larutan
52 Neurovit-E Tablet tablet
53 Nodrof Flu Antitussive tablet
54 Noza Tablet tablet
55 Oxfezin syr syrup
56 Obat batuk hitam Indo Plus cairan larutan
57 Pain Kila / Stop Pain tube
58 Pehapral tablet
59 Pharmaton Formula capsul
60 Polykresulen (albothyl) larutab
61 Ponflu Kaplet tablet
62 Ponflu Syr syrup
63 Prolysin Syr syrup
64 Risperidone 2 mg tablet
65 Sagestam cream tube
66 Sanbe Kids syr syrup
67 Scabisid crem tube
68 Topras Tablet tablet
69 Tremenza/*neo protifed tablet
70 Tuzalos tab tablet
71 Vitalex syrup
72 Woods papermint antitusive syrup
73 Xylocaine jelly 2% gel

OBAT GIGI

1 Air Raksa Dental Use larutan

2 Devitalisasi pasta (non arsen) larutan
 3 Dental Merkuri
4 Eter Anaestetik Botol
5 Etil klorida semprot Botol
6 Eugenol cairan larutan
7 Fluor tablet 0,5 mg tablet
8 Glass lonomer cement ( gc ix ) set /botol
9 Iodoform pasta Botol
10 Kalsium hidroksi pasta 2 tube/kotak
11 Monoklorkamfer mentol cairan (CH botol 10 ml
12 Mummifying pasta botol / kotak
13 Semen seng fosfat serbuk dan cairan botol
14 Silver amalgam serbuk 65 - 75 % 1 oz / botol
15 Spon gelatin cubicle cubicles 1x1x 24 buah / kotak
16 Temporari stoping (fletcher) serbuk dan cairan

OBAT PROGRAM

1 Alkohol /etanol 70% Botol 500 ml

2 Alkohol Swab Box
3 Antasida doen tablet pcs
4 Azitromisin tablet
5 Besi II Sulfat tablet tablet
6 Blood Administrasi set pcs
7 Blood Glucosa Test Strip botol
8 Blood Lancet pcs
9 Diluent-30 D-Dif botol 20l
10 EZ Cleanser M.30E Botol
11 Fluconazole 150mg kapsul
12 Garam Oralit bungkus
13 Handscoond non steril uk.M kotak 100
14 Immunoassay Malaria Kotak 30 test
15 Isoniazid 300mg tablet
16 IV Chateter no.18 pcs
17 IV Chateter no.24 pcs
18 Kapas 1 kg Bungkus
19 Kertas Whatman kotak
20 Kina Inj, ampul
21 Kolesterol Test Strip botol
22 Kotrimoxazol 480 mg tablet
23 Kotrimoxazol 960 mg tablet
24 Kotrimoxazol suspensi btl
 25 Lancet Divece Kotak
26 Larutan Giemsa 100 ml botol
27 Liquichect Hematology Vial
28 Loratadine 10 mg tablet
29 Lyse M 30D-Dif botol
30 Masker Tie On 3 Ply pcs
31 OAT FDC Kat I kotak
32 OAT FDC Kat II kotak
33 OAT FDC Kat Sisipan kotak
34 OAT Kat Anak kotak
35 OAT Kombipak Kat I kotak
36 Objec Glass kotak
37 Oksitosin injeksi 10iu/ml ampul
38 Parasetamol 500 mg tablet
39 Parasetamol Syr botol
40 Piridoxin (vit B 6) tablet
41 Pot MDR pcs
42 Pot Sputum pcs
43 Pot Urine pcs
44 Probe clenser M-30P Botol
45 Qualitatively Detecs botol
46 RDT Penyakit Menular Seksual Kotak
47 Reagen Ziel Nelsen botol
48 Retinol A 100 000 IU kapsul lunak capsul
49 Retinol A 200 000 IU kapsul lunak capsul
50 Rinse M-30 Galon
51 Slide box kotak
52 Stick Narkoba
53 Syring 10 cc pcs
54 Syring 5 cc pcs
55 Tablet tambah darah tablet
56 Tabung Edta 3 ml botol
57 Test Malaria pcs
58 Tissue gulung Kotak 100
59 Tissue Mikroskope Kotak 100
60 Uric Acid Test Strip botol
61 Vikia HIV 1/2 Pcs
62 Zink tablet

ALKES & BAHAN HABIS PAKAI ( BHP )

1 Abbocath No 16 pcs
2 Abbocath No 18 pcs
3 Abbocath No 20 pcs
4 Abbocath No 22 pcs
5 Abbocath No 24 pcs
6 Alat suntik sekali pakai 1 ml pcs
7 Alat suntik sekali pakai 10 ml pcs
8 Alat suntik sekali pakai 1cc insulin pcs
9 Alat suntik sekali pakai 2.5 ml pcs
10 Alat suntik sekali pakai 20 ml pcs
11 Alat suntik sekali pakai 3 ml pcs
12 Alat suntik sekali pakai 5 ml pcs
13 Antisera Gol.Darah A,B,AB,D set
14 Bisturi no 21 pcs
15 Bisturi no 10 pcs
16 Bisturi no 15 pcs
17 Blood Lancet pcs
18 Catgut/benang bedah no.2/0 chromic pcs
19 Catgut/benang bedah no.2/0 plain pcs
20 Catgut/benang bedah no.3/0 chromic pcs
21 Catgut/benang bedah no.3/0 plain pcs
22 Daryantule / Sofrattule/Bioplacenton Tu pcs
23 Diluent M-30 D Diff Btl 20 l
24 EZ Cleanser M30E Btl
25 Folley Cateter 2 Way 30 cc No. 14 pcs
26 Folley Cateter 2 Way 30 cc No. 16 pcs
27 Folley Cateter 2 Way 30 cc No. 18 pcs
28 Folley Cateter 2 Way 30 cc No. 20 pcs
29 Handscoend Ukuran L Mikro Touch pcs
30 Handscoend Ukuran M Mikro Touch pcs
31 Handscoend Ukuran S Mikro Touch pcs
32 Handscoend No. 6,5 pcs
33 Handscoend No. 7 pcs
34 Handscoend No. 7,5 pcs
35 Handscoend No. 8 pcs
36 Handscoend Non Steril Ukuran L Pcs
37 Handscoend Non Steril Ukuran M Pcs
38 Handscoend Non Steril Ukuran S Pcs
39 Hcl 0,1 N larutan
40 Infusion set anak Pcs
41 Infusion set dewasa Pcs
42 Jarum Jahit Kulit GT 1113 No 10 Pcs
43 Jarum Jahit Kulit GR 1113 No 10 Pcs
44 Jarum Jahit Kulit GT 1113 No 11 Pcs
45 Jarum Jahit Kulit GR 1113 No 11
46 Jarum Jahit Kulit GT 1113 No 12 Pcs
47 Jarum Jahit Kulit GR 1113 No 12
48 Jarum Jahit Kulit GT 1113 No 13 Pcs
49 Jarum Jahit Kulit GR 1113 No 13
50 Jarum Jahit Kulit GT 1113 No 14 Pcs
51 Jarum Jahit Kulit GR 1113 No 14
52 Jarum Jahit Kulit GT 1113 No 9 Pcs
53 Jarum Jahit Kulit GR 1113 No 9 Pcs
54 Kapas berlemak 500 mg bungkus
55 Kapas pembalut / absorben 250 mg bungkus
56 Kasa kompres 40/40 steril bungkus
57 Kasa pembalut 36 m x 80 cm rol
58 Kasa pembalut 2 m x 80 cm rol
59 Kasa pembalut hidrofil 4 m x 10 cm bungkus
60 Kasa pembalut hidrofil 4 m x 15 cm bungkus
61 Kasa pembalut hidrofil 4 m x 3 cm rol
62 Kasa pembalut hidrofil 4 m x 5 cm rol
63 Kasa steril 16 x 16 kotak
64 Liquicheck Hematology Control Normal Vial
65 Lyse M-30 D-Diff Btl 500 ml
66 Masker 25 pcs/ktk
67 Masker N 95 Pcs
68 Nald Inj, box 100 pcs
69 Pastik (Alkohol Swab) box 100 pcs
70 Plester 5 yard x 2 inch rol
71 Plester Leukoplast 4,5 m X 1,25 cm 12 pcs/ktk
72 Plester Micropore Non Dispenserer pcs
73 Plester Micropore WITH Dispenserer pcs
74 Pot Urine 50 cc pcs
75 Probe Cleanser M 30 P pcs
76 Rightsign Multi Drug 3 pcs
77 Rinse M-30 pcs
78 Silk ( benang bedah sutera ) no. 3/0 pcs
79 Stick Glukosa pcs
80 Stick Kolesterol pcs
81 Strip Urine 10 Parameter pcs
82 Terofusion Blood Set Pcs
83 Urin Bag pcs
84 Wing Nedle no 21 G pcs
85 Wing Nedle no 23 G pcs
86 Wing Nedle no 25 G pcs
87 Wing Nedle no 27 G pcs
JUMLAH KUNJUNGAN RESEP UMUM
ASKESKIN TIDAK BAYAR

MENGETAHUI/MENYETUJUI YANG MENYERAHKAN

KEPALA DINAS KESEHATAN KAB. PELALAWAN KEPALA IFK PELALAWAN

(…………………………………………………………..) (…………………………………………………)
RAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO)

BULAN STOCK PEMBERIAN

PERMINTAAN
Persedian Pemakaian Sisa Stock OPTIMUM INPRES ASKES APBD LAIN2

6 7 8 9 10 11 12 13 14

0 0
 ASKES UMUM JUMLAH
BPJS

MENYERAHKAN MENERIMA/MELAPOR YANG MENERIMA

A IFK PELALAWAN KEPALA PUSKESMAS PETUGAS PUSKESMAS

…………………………………) (…………………………………………………………) (………………………………………………………………)

N
JUMLAH KET
JUMLAH

15 16 17
ENERIMA
PUSKESMAS

………………………………)