LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT

(LPLPO)

Unit Penerima
Kecamatan
Kabupaten
Provinsi

NO NAMA OBAT DAGANG

1 ABBOCATH (IV CATHETER) NO. 18,20
2 ACYCLOVIR CREAM
3 ACYCLOVIR TABLET 400 MG
4 ALBENDAZOLE TABLET 400 MG
5 ALLOPURINOL TABLET 100 MG
6 ALPRAZOLAM TABLET 1 MG

7 ALUDONNA-D TABLET (20 STRIP @ 8 TABLET)

AMBROKSOL SIRUP 15MG/ML (HOLICOS SIRUP 15

8 MG/ 5 ML)
9 AMBROXOL 30Mg (HOLICOS Tab)
10 AMINOPHYLLINE CAIRAN INJEKSI 24 MG/ML
11 AMINOPHYLLINE TABLET 200 MG
12 AMLODIPINE TABLET 10 MG

13 HOLIDRYL EXPECTORANT SIRUP (BOTOL 100 ML)

OBH JERUK NIPIS sirup 100 Ml(OBH JERUK NIPIS

14 100 ML)

15 AMOXYCILLIN SIRUP 125 MG/5 ML

16 AMOXYCILLIN SIRUP 250 MG/5 ML
17 AMOXYCILLIN TABLET 500 MG
18 ANTACIDA SIRUP 400 MG/5 ML
19 ANTACIDA TABLET
20 SERUM ANTI BISA ULAR POLIVALEN INJEKSI
21 AQUA PRO INJEKSI INJEKSI
22 ASAM MEFENAMAT TABLET 500 MG
23 ASAM ASCORBAT (VITAMIN C) TABLET 50 MG

RINGER LAKTAK, ASERING 500ml (CAIRAN

24 INFUSE)

ASAM ACETIL SALISILAT (MINIASPI TABLET SALUT

25 ENTERIK 80 MG)
ATAPULGIT TABLET (NEW ANTIDES TABLET 600
26 MG)
27 BETAMETASON CREAM 1 MG
28 BEVALEX CREAM (TUBE @ 5 GRAM)
29 ONEMED AUTOCLICK LANCING DEVICE
30 ERGOTAMINE TABLET
31 KALSIUM LAKTAT TABLET 500 MG
32 CAPTOPRIL TABLET 25 MG
33 CARBAMAZEPINE TABLET 200 MG
34 ONEMED CAT GUT CHROMIC
35 ONEMED CAT GUT PLAIN
36 CEFADROXIL CAPSUL 500 MG
37 CETIRIZINE SIRUP 5 MG/5 ML
38 CETIRIZINE CAPSUL 10 MG
39 CHLORAMPHENICOL SUSPENSI 125 MG/5 ML
40 CHLORAMPHENICOL CAPSULE 500 MG
41 KLORFESON CREAM (DUS,TUBE @ 10 GRAM)
42 (CTM) CHLORPENIRAMINE MALEAT 4 MG

43 PROTEXINAL SIRUP (DUS, BOTOL @ 60 ML)

CHLORPROMAZINE TABLET SALUT SELAPUT 25

44 MG

45 TOTAL CHOLESTEROL TEST STRIP (BENECHECK)

46 CIPROFLOXACIN TABLET SALUT SELAPUT 500 MG

47 CLONIDINE TABLET 0.15 MG

48 COTRIMOXAZOLE SIRUP 240 MG/5 ML
49 COTRIMOXAZOLE TABLET 480 MG
50 B12 (CYANOCOBALAMIN) CAIRAN INJEKSI
51 DEXAMETHASONE CAIRAN INJEKSI 5 MG
52 DEXAMETHASONE TABLET 0.5 MG

53 (ANTI ALERGI) SONAMIN CAPTABS

(OBAT FLU DAN BATUK) DEXTRAL SIRUP

54 (DUS,BOTOL 60 ML)
55 DIAZEPAM TABLET 2 MG
ANALGETIK GEL (VOLTADEX GEL (NATRIUM
56 DIKLOFENAK SALEP))
57 NATRIUM DIKLOFENAK TABLET 25MG
58 DIGOXIN TABLET 0.25 MG
OBAT GANGGUAN SISTEM PENCERNAAN
59 (LEXACROL SUSPENSI)
DIOS Fillm Coated Tablet (ANTIHEMOROID &
60 UDEMA)
61 DIPHENHYDRAMINE INJEKSI
OBAT BATUK DAN FLU (HUSTAB TABLET 30STRIP
62 @10TABLET)
63 DOMPERIDONE SIRUP 5 MG/5 ML
64 DOMPERIDONE TABLET 10 MG

65 STERILIZAZION DRY(STERINTECH Sterilization Roll)

66 MULTIVITAMIN SIRUP (PROCURMA SIRUP 60 ML)

67 ERYTHROMYCIN SIRUP KERING 200 MG/5 ML

68 ERYTHROMYCIN CAPSUL 500 MG
OBAT GANGGUAN SALURAN PENCERNAAN
69 INJEKSI (ESOMEPRAZOLE)
70 ALKOHOL 70% 1L
71 TABLET TAMBAH DARAH
72 FOLEY CATHETER NO 18
73 FUROSEMID TABLET
74 GARAM ORALIT
75 GEMFIBROZIL TABLET 300MG
76 GENTAMICINE TETES MATA (GENOIN TM)
77 GENTAMICIN INJEKSI
78 GENTAMICINE SALEP MATA (GENOIN SM)
79 GENTIAN VIOLET
80 GLIMEPIRIDE TABLET 2MG
81 GLISERIL GUAIAKOLAT TABLET 100 MG
82 GLUKOSA 5% CAIRAN INFUS
83 GLUCOSE TEST STRIP (BENECHECK)
GUAIFENESIN TABLET (OBAT BATUK
84 EKSPEKTORAN)
85 HALOPERIDOL TABLET 5 MG
86 PLASTER (LEUKOPLAST 2.5X4.5)
87 HIDROKORTISONE SALEP
88 IBUPROFEN SIRUP 100 MG/5 ML
89 IBUPROFEN TABLET 400 MG
90 COSMOMED Infusion Set(DEWASA)
91 COSMOMED Infusion Set(ANAK)
92 POVIDON 1000ML
MULTIVITAMIN TABLET TAMBAH DARAH
93 (HEMAFORT TABLET SALUT GULA )
94 IV CATHETER NO 18
95 IV CATHETER NO 22
96 IV Cannula With Injection (20G)
97 IV Cannula With Injection (24G)
KALIUM DIKLOFENAK(MEZAC TABLET SALUT
98 ENTERIK 50 MG)
99 KAPAS PEMBALUT 250 G
100 KASA 2 X 80 (COSMOMED )
101 KASA PEMBALUT HYDROFIL 4 X 15
102 KASA PEMBALUT HYDROFIL 4 X 3 (ONEMED)
103 KASA KOMPRES STERIL 40 X 40 (ONEMED)
104 KASA HIDROPHILE 4X 5 (ONEMED)
105 KASA HIDROPHILE 16X16 (ONEMED)
106 KENOKONAZOLE SALEP
107 KETOROLAC INJEKSI 30 MG/ML
108 LANSOPRAZOLE INJEKSI (PROSOGAN SERBUK
INJEKSI 30 MG)
109 LANSOPRAZOLE TABLET 30MG

110 LIDOCAIN PLUS EPHINEPRIN (PEHACAIN CAIRAN

INJEKSI)
111 LIDOCAIN COMPOSITUM INJEKSI 2 Ml

112 MULTIVITAMIN MINERAL TABLET (LIVRON B PLEX

TABLET SALUT GULA)

113 MULTIVITAMIN MINERAL TABLET (PEHAVRAL

TABLET)
114 LORATADINE CAPTABS 10 MG
115 MGSO4 INJEKSI 20%
116 MGSO4 INJEKSI 40%

117 OBAT ANALGESIK +DIAZEPAM (METANEURON)

118 ANTALGIN TABLET 500MG

119 METFORMIN TABLET 500 MG

120 METHYLERGOMETRINE TABLET SALUT SELAPUT

0,125 MG
121 METHYLPREDNISOLONE TABLET 4 MG

122 METOCLOPRAMIDE SIRUP(LEXAPRAM SIRUP 5

MG/5 ML)
123 METRONIDAZOLE TABLET 500 MG
124 MICONAZOLE SALEP 2%
125 MULTIVITAMIN SIRUP (LYTACUR SIRUP)
126

127 MULTIVITAMIN (BECEFORT TABLET SALUT GULA)

128 COSMO MED Nasal Oxygen Cannula

129 NIFEDIPINE TABLET 10 MG

130 BENECHECK Plus Multi-Monitoring System (Total

Cholesterol, Blood Glucose, Uric Acid
131 COSMOMED Nebulizer Mask
132 PARACETAMOL SIRUP 120 MG/5 ML
133 PARACETAMOL TABLET 500 MG

134 ANTI INFLUENZA DAN BATUK (ALPARA SIRUP)

135 ANTI INFLUENZA (MOLEXFLU CAPTABS)

136 ANALGETIK & ANTIPIRETIK (ARTHRIFEN PLUS

TABLET)
137 LUBRICATING (MY JELLY)
138 ANTI DIARE (NEO KAOMINAL SUSPENSI)
139 PHYTOMENADIONE (VITAMIN K) INJEKSI

140 PHYTOMENADIONE (VITAMIN K) INJEKSI 2

MG/ML

141 PHYTOMENADIONE (VITAMIN K) TABLET 10 MG

142 PIROXICAM TABLET 10 MG
143 POVIDONE IODINE 30 ML
144 PREDNISONE TABLET 5 MG
145 PROKAIN BENZIL PENISILIN G INJEKSI
146 PYRANTEL TABLET 125 MG
147 PYRIDOXINE TABLET
148 RANITIDINE INJEKSI 25 MG/ML
149 RANITIDINE TABLET 150 MG
150 VITAMIN A 100000 IU
151 VITAMIN A 200000 IU
152 RIVANOL

153 INHALER NEBULIZER (SALBUTAMOL LIQUID 0.1

%)
154 SALBUTAMOL TABLET 4 MG
155 ANALGETIK ANTIPIRETI (HOLIMOL CAPTABS)
156 BEDAK SALYCIL

157 SARUNG TANGAN NON STERIL (AXIMED

Examination Gloves)
158 COSMOMED SARUNG TANGAN (STERIL)
159 ONEMED SILK 3 - 0
160 SIMVASTATIN TABLET 10 MG
161 NATRIUM CLORIDA 0.9% INFUS

162 OBAT BATUK & FLU (NOVADRYL SIRUP)

163 DISPOSIBLE 1ML

164 DISPOSIBLE 10 ML
165 DISPOSIBLE 3 ML
166 DISPOSIBLE 5 ML
167 ONEMED Glucose + Protein Test
168 ANTI TETANUS INJEKSI
169 TETRACYCLINE TABLET 250 MG
170 THIAMINE INJEKSI 100 MG/ML
171 THIAMINE TABLET 50 MG

172 MULTIVITAMIN & ANALGETIC (TRIFANEURON

CAPTABS )

173 MULTIVITAMIN NEUROTROPIK (MOLANEURON

TABLET & BIO-ATP TABLET SALUT SELAPUT)

174 MULTIVITAMIN & ANALGETIC (PRITAGESIC

CAPTABS SALUT SELAPUT )

175 MULTIVITAMIN NEUROTROPIK INJEKSI (BIORON

1000 CAIRAN INJEKSI)
176 AXIMED ALKOHOL SWAB
177 ANTOKSID CAPSUL (DUS, 10 STRIP @ 10 KAPSUL)

178 ONEMED Umbilical Cord Clamp

179 COSMOMED UNDERPAD
180 ONEMED Under Pad Steril(60X90)
181 BeneCheck Uric Acid Test Strip(Strip 25's)
182 COSMOMED URINE BAG WITH HANGER
183 ONEMED KASA HIDROPHILE 4 X 10
184 VITAMIN B COMPLEX
185 ZIRKUM KID Sirop 60 Ml
186 ZINC TABLET 20 MG
TAAN OBAT

: Parungsari
: Wanasalam
: Lebak
: Banten

Nama Obat Sediaan Stok Awal Penerimaan Persediaan

ABBOCATH (IV CATHETER) NO. 18 PIECES 18 20 38
ACYCLOVIR SALEP 5 % SALEP 10 30 40
ACYCLOVIR TABLET 400 MG TABLET 300 400 700
ALBENDAZOLE TABLET 400 MG TABLET 0
ALLOPURINOL TABLET 100 MG TABLET 0
ALPRAZOLAM TABLET 1 MG TABLET 50 50
ALUMINIUM HYDROXIDE|MAGNESIUM HYDROXIDE|
SIMETICONE TABLET TABLET 0

AMBROXOL SIRUP 15 MG/5 ML SIRUP 0 50 50

AMBROXOL TABLET 30 MG TABLET 0 600 600

AMINOPHYLLINE INJEKSI 25 MG/ML INJEKSI 0
AMINOPHYLLINE TABLET 200 MG TABLET 0
AMLODIPINE TABLET 10 MG TABLET 0
AMMONIUM CHLORIDE|MENTHOL|SODIUM CITRATE| SIRUP 50 0 50
DIPHENHYDRAMINE SIRUP
AMMONIUM CHLORIDE|SUCCUS LIQUIRITIAE
DEGLYCYRRHIZINATUS|ANISATED SPIRIT OF AMMONIA SIRUP 0 100 100
SIRUP
AMOXYCILLIN SIRUP 125 MG/5 ML SIRUP 0 144 144
AMOXYCILLIN SIRUP 250 MG/5 ML SIRUP 0 100 100
AMOXYCILLIN TABLET 500 MG TABLET 1300 3000 4300
ANTACIDA SIRUP 400 MG/5 ML SIRUP 0 100 100
ANTACIDA TABLET TABLET 1000 3000 4000
ANTI-SNAKE VENOM INJEKSI INJEKSI 0
AQUA PRO INJEKSI INJEKSI INJEKSI 0
ASAM MEFENAMAT TABLET 500 MG TABLET 200 0 200
ASCORBIC ACID (VITAMIN C) TABLET 50 MG TABLET 300 0 300
ASETAT, ION" 20.02.02.2.0366,RINGERS,RINGER SOL.
UNICAP/OGB WB,MASIH BEREDAR,"LARUTAN Infus 60 60 120
ELEKTROLIT, NUTRISI DAN LAINLAIN Infus 500 ML

ASPIRIN (ASETOSAL) TABLET 80 MG TABLET 0

ATAPULGIT TABLET 600 MG TABLET 0 1000 1000

BETAMETHASONE SALEP 1 MG/G SALEP 24 0 24

BETAMETHASONE|NEOMYCIN SALEP SALEP 0 36 36
BLOOD SET 0 0
CAFFEINE|ERGOTAMINE TARTRATE TABLET TABLET 300 0 300
CALCIUM LACTATE TABLET 500 MG TABLET 700 1000 1700
CAPTOPRIL TABLET 25 MG TABLET 0 1000 1000
CARBAMAZEPINE TABLET 200 MG TABLET 0
CAT GUT CHROMIC 3 - 0 0 24 0 24
CAT GUT PLAIN 3 - 0 0 38 0 38
CEFADROXIL TABLET 500 MG TABLET 0 500 500
CETIRIZINE SIRUP 5 MG/ML SIRUP 30 60 90
CETIRIZINE TABLET 10 MG TABLET 300 200 500
CHLORAMPHENICOL SIRUP 125 MG/5ML SIRUP 0 50 50
CHLORAMPHENICOL TABLET 500 MG TABLET 0
CHLORAMPHENICOL|PREDNISOLONE SALEP SALEP 0
CHLORPHENIRAMINE TABLET 4 MG TABLET 800 2000 2800
CHLORPHENIRAMINE|PHENYLPROPANOLAMINE| SIRUP 0 100 100
PARACETAMOL SIRUP

CHLORPROMAZINE TABLET 25 MG TABLET 0

Cholesterol (total) test system 0 5 0 5

CIPROFLOXACIN TABLET 500 MG TABLET 400 500 900

CLONIDINE TABLET 0.15 MG TABLET 0

COTRIMOXAZOLE SIRUP 240 MG/5 ML SIRUP 60 100 160
COTRIMOXAZOLE TABLET 480 MG TABLET 700 1500 2200
CYANOCOBALAMIN INJEKSI 500 MCG/ML INJEKSI 0
DEXAMETHASONE INJEKSI 5 MG/ML INJEKSI 0
DEXAMETHASONE TABLET 0.5 MG TABLET 2000 3000 5000

DEXAMETHASONE|DEXCHLORPHENIRAMINE TABLET TABLET 0

DEXTROMETHORPHAN|GUAIFENESIN| SIRUP 0
CHLORPHENAMINE|PHENYLPROPANOLAMINE SIRUP
DIAZEPAM TABLET 2 MG TABLET 250 0 250

DICLOFENAC SODIUM SALEP 1 % SALEP 0

DICLOFENAC SODIUM TABLET 25 MG TABLET 0 300 300

DIGOXIN TABLET 0.25 MG TABLET 0
DIMETICONE, ACTIVATED|ALUMINIUM HYDROXIDE GEL| SIRUP 5 48 53
MAGNESIUM TRISILICATE SIRUP

DIOSMIN TABLET 450 MG TABLET 0

DIPHENHYDRAMINE INJEKSI 10 MG/ML INJEKSI 30 60 90

DIPHENHYDRAMINE|PARACETAMOL|BROMHEXINE TABLET 0
TABLET
DOMPERIDONE SIRUP 5 MG/5 ML SIRUP 0
DOMPERIDONE TABLET 10 MG TABLET 0

Dry-heat sterilizer 0 0
EKSTRAK CURCUMA SIRUP 60 ML SIRUP 0

ERYTHROMYCIN SIRUP SIRUP 0 20 20

ERYTHROMYCIN TABLET 500 MG TABLET 500 500 1000

ESOMEPRAZOLE INJEKSI 40 MG INJEKSI 0

ETHANOL 1000 ML 2 3 5
FERROUS SULPHATE|FOLIC ACID TABLET TABLET 0
FOLEY CATHETER 2 WAY NO 18 0 0
FUROSEMIDE TABLET 40 MG TABLET 0
GARAM ORALIT SERBUK SERBUK 0
GEMFIBROZIL TABLET 300 MG TABLET 0
GENTAMYCIN DROPS 0.3 % DROPS 0
GENTAMYCIN INJEKSI 40 MG/ML INJEKSI 0
GENTAMYCIN SALEP 0.3 % SALEP 0 24 24
GENTIAN VIOLET LIQUID 1 % LIQUID 0
GLIMEPIRIDE TABLET 2 MG TABLET 550 0 550
GLISERIL GUAIAKOLAT TABLET 100 MG TABLET 800 2000 2800
GLUCOSE INFUS 5 % INFUS 0
Glucose test system 0 9 0 9

GUAIFENESIN TABLET TABLET 0

HALOPERIDOL TABLET 5 MG TABLET 0

HANSAPLAST 0 3 0 3
HYDROCORTISONE SALEP 2.5 % SALEP 20 24 44
IBUPROFEN SIRUP 100 MG/5 ML SIRUP 0 50 50
IBUPROFEN TABLET 400 MG TABLET 0 0 0
INFUS SET 0 5 30 35
INFUS SET PEDIATRIC 0 30 0 30
IODIUM POVIDON LIQUID 10 % LIQUID 4 2 6

IRON WITH VITAMINS TABLET TABLET 0

IV CATHETER NO 18 0 0
IV CATHETER NO 22 0 0
IV CATHY NO 20 0 0
IV CATHY NO 24 0 0

KALIUM DICLOFENAC TABLET 50 MG TABLET 0

KAPAS PEMBALUT SET 250 G SET 3 3 6

KASA 2Y X 80 CM 0 0
KASA HYDROFIL 4 M X 15 CM 0 0
KASA HYDROFIL 4 M X 3 CM 0 0
KASA KOMPRES DRC 40cm x 40cm 0
KASA LIPAT 4 X 5 0 0
KASA LIPAT KOTAK 16 X 16 STERIL 0 10 40 50
KETOCONAZOLE SALEP 2% SALEP 0 24 24
KETOROLAC INJEKSI 30 MG/ML INJEKSI 0
LANSOPRAZOLE INJEKSI 30 MG INJEKSI 0

LANSOPRAZOLE TABLET TABLET 0 0 0

LIDOCAINE INJEKSI 2% INJEKSI 10 0 10

LIDOCAINE|EPINEPHRINE INJEKSI INJEKSI 40 100 140

LISIN, MULTIVITAMIN, MULTIMINERAL TABLET TABLET 0

LISIN, MULTIVITAMIN, MULTIMINERAL TABLET MG TABLET 0 0 0

LORATADINE TABLET 10 MG TABLET 0

MAGNESIUM SULPHATE INJEKSI 20 % INJEKSI 0
MAGNESIUM SULPHATE INJEKSI 40 % INJEKSI 0

METAMIZOLE|DIAZEPAM TABLET TABLET 0

METAMPIRON (ANTALGIN) TABLET 500 MG TABLET 0

METFORMIN TABLET 500 MG TABLET 200 400 600

METHYLERGOMETRINE TABLET 0.125 MG TABLET 0

METHYLPREDNISOLONE TABLET 4 MG TABLET 0

METOCLOPRAMIDE SIRUP 5 MG/ML SIRUP 0

METRONIDAZOLE TABLET 500 MG TABLET 300 300 600

MICONAZOLE SALEP 2% SALEP 0
MULTIVITAMIN SIRUP 60 ML SIRUP 0
MULTIVITAMIN SIRUP 60 ML SIRUP 0

MULTIVITAMIN TABLET MG TABLET 0

Nasal oxygen cannula 0 0

NIFEDIPINE TABLET 10 MG TABLET 0

Occult blood test 0 0

Oxygen mask 0 0
PARACETAMOL SIRUP 120 MG/5 ML SIRUP 20 150 170
PARACETAMOL TABLET 500 MG TABLET 1700 3000 4700
PARACETAMOL|CHLORPHENAMINE|PHENYLEPHRINE| SIRUP 0
DEXTROMETHORPHAN HYDROBROMIDE SIRUP
PARACETAMOL|CHLORPHENAMINE| TABLET 0 300 300
PHENYLPROPANOLAMINE TABLET

PARACETAMOL|IBUPROFEN TABLET TABLET 0

Patient lubricant 0 0
PECTIN|KAOLIN SIRUP SIRUP 0 50 50
PHYTOMENADIONE (VITAMIN K) INJEKSI INJEKSI 0 0 0

PHYTOMENADIONE (VITAMIN K) INJEKSI 2 MG/ML INJEKSI 0

PHYTOMENADIONE (VITAMIN K) TABLET 10 MG TABLET 0

PIROXICAM TABLET 10 MG TABLET 1100 0 1100
POVIDONE IODINE 30 ML ML 10 0 10
PREDNISONE TABLET 5 MG TABLET 600 1000 1600
PROKAIN BENZIL PENISILIN G INJEKSI 15 ML INJEKSI 0
PYRANTEL TABLET 125 MG TABLET 0
PYRIDOXINE TABLET TABLET 0
RANITIDINE INJEKSI 25 MG/ML INJEKSI 0 20 20
RANITIDINE TABLET 150 MG TABLET 0 1000 1000
RETINOL PALMITATE TABLET 100000 IU TABLET 0
RETINOL PALMITATE TABLET 200000 IU TABLET 0
RIVANOL LIQUID LIQUID 0

SALBUTAMOL LIQUID 0.1 % LIQUID 0

SALBUTAMOL TABLET 4 MG TABLET 200 500 700

SALICYLAMIDE|PARACETAMOL|CAFFEINE TABLET TABLET 0
SALICYLIC ACID SERBUK 2% SERBUK 40 100 140

SARUNG TANGAN KARET NON STERIL XS 0 150 0 150

SARUNG TANGAN STERIL 0 30 0 30

SILK 3 - 0 0 0 0 0
SIMVASTATIN TABLET 10 MG TABLET 0
SODIUM CHLORIDE INFUS 0.9 % INFUS 0

SODIUM CITRATE|CHLORPHENAMINE|
DEXTROMETHORPHAN HYDROBROMIDE| SIRUP 0
PHENYLPROPANOLAMINE|AMMONIUM CHLORIDE SIRUP

SPUIT 1 CC INSULIN 0 0
SPUIT 10 CC 0 0
SPUIT 3 CC 0 100 200 300
SPUIT 5 CC 0 0
TEST STRIP FOR GLUCOSE METER 0 0
TETANUS ANTITOXIN TABLET 1.500 IU/ML TABLET 0
TETRACYCLINE TABLET 250 MG TABLET 0
THIAMINE INJEKSI 100 MG/ML INJEKSI 0
THIAMINE TABLET 50 MG TABLET 0 1500 1500
THIAMINE|CYANOCOBALAMIN|METAMIZOLE SODIUM TABLET 200 0 200
MONOHYDRATE|PYRIDOXINE TABLET

THIAMINE|CYANOCOBALAMIN|PYRIDOXINE TABLET TABLET 0

THIAMINE|METAMIZOLE SODIUM MONOHYDRATE| TABLET 0

PYRIDOXINE|CYANOCOBALAMIN TABLET

THIAMINE|PYRIDOXINE|CYANOCOBALAMIN INJEKSI INJEKSI 0

TIP CLEANER 0 0
TOCOPHEROL|ASCORBIC ACID|BETACAROTENE TABLET TABLET 0

UMBILICAL CORD CLAMP 0 0

UNDERPAD 0 94 0 94
UNDERPAD 60 X 90 0 0
Uric acid test system 0 7 0 7
URINE BAG WITH HANGER 0 55 0 55
VERBAND 4 X 10 CM 0 0
VITAMIN B COMPOUND TABLET TABLET 600 1500 2100
ZINC SULPHATE SIRUP 20 MG SIRUP 0 0 0
ZINC SULPHATE TABLET 20 MG/TABLET TABLET 0 300 300
Bulan : Maret
Tahun : 2017

Pemakaian Rusak/Ed Sisa Stok Stok Optimum Permintaan Pemberian Keterangan

15 0 23 15 30
25 0 15 25 50
500 0 200 500 500
0 0 0
0 0 0
10 0 40 10

0 0 0

45 0 5 45 100

500 0 100 500 2000

0 0 0
0 0 0
0 0 0

50 0 0 50 100

75 0 25 75 150

125 0 19 125 200

70 0 30 70 150
3800 0 500 3800 4000
100 0 0 100 200
3600 0 400 3600 4000
0 0 0
0 0 0
200 0 0 200 2000
100 0 200 100 1000

40 0 80 40 60

0 0 0

500 0 500 500 1000

23 0 1 23 50
26 0 10 26 50
 0 0 0
100 0 200 100 200
1200 0 500 1200 1000
850 0 150 850 1000
0 0 0
0 0 24 0 0
0 0 38 0 0
400 0 100 400 1000
70 0 20 70 50
400 0 100 400 500
36 0 14 36 50
0 0 0
0 0 0
2100 0 700 2100 3000

90 0 10 90 200

0 0 0

1 0 4 1 0

500 0 400 500 1000

0 0 0
90 0 70 90 150
1600 0 600 1600 1500
0 0 0
0 0 0
3600 0 1400 3600 3000

0 0 0

0 0 0

50 0 200 50 100

0 0 0

300 0 0 300 1000

0 0 0

38 0 15 38 100

0 0 0

30 0 60 30 60

0 0 0

0 0 0
0 0 0

0 0 0
 0 0 0

10 0 10 10 30
500 0 500 500 500

0 0 0

2 0 3 2 3
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
24 0 0 24 50
0 0 0
100 0 450 100 0
2100 0 700 2100 3000
0 0 0
1 0 8 1 0

0 0 0

0 0 0
1 0 2 1 3
44 0 0 44 50
35 0 15 35 30
0 0 0 0 1000
15 0 20 15 30
10 0 20 10 10
4 0 2 4 3

0 0 0

0 0 0
0 0 0
0 0 0
0 0 0

0 0 0

2 0 4 2 2
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
20 0 30 20 50
19 0 5 19 50
0 0 0
 0 0 0

0 0 0 0 200

0 0 10 0 0

40 0 100 40 50

0 0 0

0 0 0 0 2000

0 0 0
0 0 0
0 0 0

0 0 0

0 0 0
300 0 300 300 500

0 0 0

0 0 0

0 0 0

400 0 200 400 500

0 0 0
0 0 0
0 0 0

0 0 0

0 0 0
0 0 0

0 0 0

0 0 0
130 0 40 130 200
4000 0 700 4000 4000

0 0 0

300 0 0 300 1000

0 0 0

0 0 0
39 0 11 39 50
0 0 0 0 300

0 0 0

0 0 0
 900 0 200 900 1000
5 0 5 5 20
1300 0 300 1300 1000
0 0 0
0 0 0
0 0 0
10 0 10 10 10
800 0 200 800 2000
0 0 0
0 0 0
0 0 0

0 0 0

500 0 200 500 500

0 0 0
80 0 60 80 50

50 0 100 50 100

10 0 20 10 100
0 0 0 0 24
0 0 0
0 0 0

0 0 0

0 0 0
0 0 0
100 0 200 100 300
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
1300 0 200 1300 2000

100 0 100 100 2000

0 0 0

0 0 0

0 0 0

0 0 0
 0 0 0

0 0 0
4 0 90 4 0
0 0 0
1 0 6 1 0
5 0 50 5 0
0 0 0
1600 0 500 1600 2000
0 0 0 0 50
200 0 100 200 300
 LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT
(LPLPO)

Unit Penerima : Parungsari Bulan : Maret

Kecamatan : Wanasalam Tahun : 2017
Kabupaten : Lebak
Provinsi : Banten

NO NAMA OBAT KEMASAN Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Stok Optimum Permintaan Pemberian Keterangan
1 ACYCLOVIR CREAM TUBE 10 30 40 25 0 15 25 50 0
2 ACYCLOVIR TABLET 400 MG TABLET 300 400 700 500 0 200 500 500 0
3 ALBENDAZOLE TABLET 400 MG TABLET 0 0 0 0 0 0 0 0 0
4 ALKOHOL 70% 1L BOTOL 2 3 5 2 0 3 2 3 0
5 ALLOPURINOL TABLET 100 MG TABLET 0 0 0 0 0 0 0 0 0
6 ALPRAZOLAM TABLET 1 MG TABLET 50 0 50 10 0 40 10 0 0

7 AMBROKSOL SIRUP 15MG/ML (HOLICOS SIRUP 15 MG/ 5 ML) BOTOL 0 50 50 45 0 5 45 100 0

8 AMBROXOL 30Mg (HOLICOS Tab) TABLET 0 600 600 500 0 100 500 2000 0
9 AMINOPHYLLINE CAIRAN INJEKSI 24 MG/ML AMPUL 0 0 0 0 0 0 0 0 0
10 AMINOPHYLLINE TABLET 200 MG TABLET 0 0 0 0 0 0 0 0 0
11 AMLODIPINE TABLET 10 MG TABLET 0 0 0 0 0 0 0 0 0
12 AMOXYCILLIN SIRUP 125 MG/5 ML BOTOL 0 144 144 125 0 19 125 200 0
13 AMOXYCILLIN SIRUP 250 MG/5 ML BOTOL 0 100 100 70 0 30 70 150 0
14 AMOXYCILLIN TABLET 500 MG TABLET 1300 3000 4300 3800 0 500 3800 4000 0
15 ANTACIDA SIRUP 400 MG/5 ML BOTOL 0 100 100 100 0 0 100 200 0
16 ANTACIDA TABLET TABLET 1000 3000 4000 3600 0 400 3600 4000 0
17 ANTALGIN TABLET 500MG TABLET 0 0 0 0 0 0 0 0 0
18 AQUA PRO INJEKSI INJEKSI AMPUL 0 0 0 0 0 0 0 0 0

19 ASAM ACETIL SALISILAT (MINIASPI TABLET SALUT ENTERIK 80 TABLET 0 0 0 0 0 0 0 0 0

MG)
20 ASAM ASCORBAT (VITAMIN C) TABLET 50 MG TABLET 300 0 300 100 0 200 100 1000 0
21 ASAM MEFENAMAT TABLET 500 MG TABLET 200 0 200 200 0 0 200 2000 0
22 ATAPULGIT TABLET (NEW ANTIDES TABLET 600 MG) TABLET 0 1000 1000 500 0 500 500 1000 0
23 B12 (CYANOCOBALAMIN) CAIRAN INJEKSI INJEKSI 0 0 0 0 0 0 0 0 0
24 BEDAK SALYCIL KOTAK 40 100 140 80 0 60 80 50 0
BETAMETASON + NEOMICIN SALEP (BEVALEX CREAM TUBE @ 5
25 TUBE 0 36 36 26 0 10 26 50 0
GRAM)
26 BETAMETASON CREAM 1 MG TUBE 24 0 24 23 0 1 23 50 0
27 KALSIUM LAKTAT TABLET 500 MG TABLET 700 1000 1700 1200 0 500 1200 1000 0
28 CAPTOPRIL TABLET 25 MG TABLET 0 1000 1000 850 0 150 850 1000 0
29 CARBAMAZEPINE TABLET 200 MG TABLET 0 0 0 0 0 0 0 0 0
30 CEFADROXIL CAPSUL 500 MG TABLET 0 500 500 400 0 100 400 1000 0
31 CETIRIZINE CAPSUL 10 MG TABLET 300 200 500 400 0 100 400 500 0
32 CETIRIZINE SIRUP 5 MG/5 ML BOTOL 30 60 90 70 0 20 70 50 0
33 CHLORAMPHENICOL CAPSULE 500 MG TABLET 0 0 0 0 0 0 0 0 0
34 CHLORAMPHENICOL SUSPENSI 125 MG/5 ML BOTOL 0 50 50 36 0 14 36 50 0
35 CHLORPENIRAMINE MALEAT 4 MG (CTM) TABLET 800 2000 2800 2100 0 700 2100 3000 0
36 CHLORPROMAZINE TABLET SALUT SELAPUT 25 MG TABLET 0 0 0 0 0 0 0 0 0
37 CIPROFLOXACIN TABLET SALUT SELAPUT 500 MG TABLET 400 500 900 500 0 400 500 1000 0
38 CLONIDINE TABLET 0.15 MG TABLET 0 0 0 0 0 0 0 0 0
39 COTRIMOXAZOLE SIRUP 240 MG/5 ML BOTOL 60 100 160 90 0 70 90 150 0
40 COTRIMOXAZOLE TABLET 480 MG TABLET 700 1500 2200 1600 0 600 1600 1500 0
41 DEXAMETHASONE CAIRAN INJEKSI 5 MG AMPUL 0 0 0 0 0 0 0 0 0
42 DEXAMETHASONE TABLET 0.5 MG TABLET 2000 3000 5000 3600 0 1400 3600 3000 0
43 DIAZEPAM TABLET 2 MG TABLET 250 0 250 50 0 200 50 100 0
44 DIGOXIN TABLET 0.25 MG TABLET 0 0 0 0 0 0 0 0 0
45 DIPHENHYDRAMINE INJEKSI AMPUL 30 60 90 30 0 60 30 60 0
46 DOMPERIDONE SIRUP 5 MG/5 ML BOTOL 0 0 0 0 0 0 0 0 0
47 DOMPERIDONE TABLET 10 MG TABLET 0 0 0 0 0 0 0 0 0
48 ERGOTAMINE TABLET TABLET 300 0 300 100 0 200 100 200 0
49 ERYTHROMYCIN CAPSUL 500 MG TABLET 500 500 1000 500 0 500 500 500 0
50 ERYTHROMYCIN SIRUP KERING 200 MG/5 ML BOTOL 0 20 20 10 0 10 10 30 0
51 FUROSEMID TABLET TABLET 0 0 0 0 0 0 0 0 0
52 GARAM ORALIT SACHET 0 0 0 0 0 0 0 0 0
53 GEMFIBROZIL TABLET 300MG TABLET 0 0 0 0 0 0 0 0 0
54 GENTAMICIN INJEKSI AMPUL 0 0 0 0 0 0 0 0 0
55 GENTAMICINE SALEP MATA (GENOIN SM) TUBE 0 24 24 24 0 0 24 50 0
56 GENTAMICINE TETES MATA (GENOIN TM) BOTOL 0 0 0 0 0 0 0 0 0
57 GENTIAN VIOLET BOTOL 0 0 0 0 0 0 0 0 0
58 GLIMEPIRIDE TABLET 2MG TABLET 550 0 550 100 0 450 100 0 0
59 GLISERIL GUAIAKOLAT TABLET 100 MG TABLET 800 2000 2800 2100 0 700 2100 3000 0
60 GLUKOSA 5% CAIRAN INFUS BOTOL 0 0 0 0 0 0 0 0 0
61 GUAIFENESIN TABLET (OBAT BATUK EKSPEKTORAN) TABLET 0 0 0 0 0 0 0 0 0
62 HALOPERIDOL TABLET 5 MG TABLET 0 0 0 0 0 0 0 0 0
63 HIDROKORTISONE SALEP AMPUL 20 24 44 44 0 0 44 50 0
64 IBUPROFEN SIRUP 100 MG/5 ML BOTOL 0 50 50 35 0 15 35 30 0
65 IBUPROFEN TABLET 400 MG TABLET 0 0 0 0 0 0 0 1000 0

66 KALIUM DIKLOFENAK(MEZAC TABLET SALUT ENTERIK 50 MG) TABLET 0 0 0 0 0 0 0 0 0

67 KETOKONAZOLE SALEP TUBE 0 24 24 19 0 5 19 50 0

68 KETOROLAC INJEKSI 30 MG/ML AMPUL 0 0 0 0 0 0 0 0 0

69 KLORAMPHENICOL+PREDNISOLONE SALEP (KLORFESON CREAM TUBE 0 0 0 0 0 0 0 0 0

TUBE @ 10 GRAM)
70 LANSOPRAZOLE INJEKSI (PROSOGAN SERBUK INJEKSI 30 MG) AMPUL 0 0 0 0 0 0 0 0 0

71 LANSOPRAZOLE TABLET 30MG TABLET 0 0 0 0 0 0 0 200 0

72 LIDOCAIN COMPOSITUM INJEKSI 2 Ml AMPUL 40 100 140 40 0 100 40 50 0
73 LIDOCAIN PLUS EPHINEPRIN (PEHACAIN CAIRAN INJEKSI) AMPUL 10 0 10 0 0 10 0 0 0
74 LORATADINE CAPTABS 10 MG TABLET 0 0 0 0 0 0 0 0 0
75 METFORMIN TABLET 500 MG TABLET 200 400 600 300 0 300 300 500 0
76 METHYLERGOMETRINE TABLET SALUT SELAPUT 0,125 MG TABLET 0 0 0 0 0 0 0 0 0
77 METHYLPREDNISOLONE TABLET 4 MG TABLET 0 0 0 0 0 0 0 0 0
78 METOCLOPRAMIDE SIRUP(LEXAPRAM SIRUP 5 MG/5 ML) BOTOL 0 0 0 0 0 0 0 0 0
79 METRONIDAZOLE TABLET 500 MG TABLET 300 300 600 400 0 200 400 500 0
80 MGSO4 INJEKSI 20% AMPUL 0 0 0 0 0 0 0 0 0
81 MGSO4 INJEKSI 40% AMPUL 0 0 0 0 0 0 0 0 0
82 MICONAZOLE SALEP 2% TUBE 0 0 0 0 0 0 0 0 0
83 NATRIUM CLORIDA 0.9% INFUS BOTOL 0 0 0 0 0 0 0 0 0
84 NATRIUM DIKLOFENAK TABLET 25MG TABLET 0 300 300 300 0 0 300 1000 0
85 NIFEDIPINE TABLET 10 MG TABLET 0 0 0 0 0 0 0 0 0
86 OBH JERUK NIPIS sirup 100 Ml(OBH JERUK NIPIS 100 ML) BOTOL 0 100 100 75 0 25 75 150 0
87 PARACETAMOL SIRUP 120 MG/5 ML BOTOL 20 150 170 130 0 40 130 200 0
88 PARACETAMOL TABLET 500 MG TABLET 1700 3000 4700 4000 0 700 4000 4000 0
89 PHYTOMENADIONE (VITAMIN K) INJEKSI AMPUL 0 0 0 0 0 0 0 300 0
90 PHYTOMENADIONE (VITAMIN K) INJEKSI 2 MG/ML AMPUL 0 0 0 0 0 0 0 0 0
91 PHYTOMENADIONE (VITAMIN K) TABLET 10 MG TABLET 0 0 0 0 0 0 0 0 0
92 PIROXICAM TABLET 10 MG TABLET 1100 0 1100 900 0 200 900 1000 0
93 POVIDON 1000ML BOTOL 4 2 6 4 0 2 4 3 0
94 POVIDONE IODINE 30 ML BOTOL 10 0 10 5 0 5 5 20 0
95 PREDNISONE TABLET 5 MG TABLET 600 1000 1600 1300 0 300 1300 1000 0
96 PROKAIN BENZIL PENISILIN G INJEKSI AMPUL 0 0 0 0 0 0 0 0 0
97 PYRANTEL TABLET 125 MG TABLET 0 0 0 0 0 0 0 0 0
98 PYRIDOXINE TABLET TABLET 0 0 0 0 0 0 0 0 0
99 RANITIDINE INJEKSI 25 MG/ML AMPUL 0 20 20 10 0 10 10 10 0
100 RANITIDINE TABLET 150 MG TABLET 0 1000 1000 800 0 200 800 2000 0
101 RINGER LAKTAT, ASERING 500ml (CAIRAN INFUS) BOTOL 60 60 120 40 0 80 40 60 0
102 RIVANOL BOTOL 0 0 0 0 0 0 0 0 0
103 SALBUTAMOL LIQUID 0.1 % (INHALER NEBULIZER) AMPUL 0 0 0 0 0 0 0 0 0
104 SALBUTAMOL TABLET 4 MG TABLET 200 500 700 500 0 200 500 500 0
105 SIMVASTATIN TABLET 10 MG TABLET 0 0 0 0 0 0 0 0 0
106 TABLET TAMBAH DARAH TABLET 0 0 0 0 0 0 0 0 0
107 TETRACYCLINE TABLET 250 MG TABLET 0 0 0 0 0 0 0 0 0
108 THIAMINE INJEKSI 100 MG/ML AMPUL 0 0 0 0 0 0 0 0 0
109 THIAMINE TABLET 50 MG TABLET 0 1500 1500 1300 0 200 1300 2000 0
110 VITAMIN A 100000 IU TABLET 0 0 0 0 0 0 0 0 0
111 VITAMIN A 200000 IU TABLET 0 0 0 0 0 0 0 0 0
112 VITAMIN B COMPLEX TABLET 600 1500 2100 1600 0 500 1600 2000 0
113 ZINC SIRUP (ZIRKUM KID Sirop 60 Ml) BOTOL 0 0 0 0 0 0 0 50 0
114 ZINC TABLET 20 MG TABLET 0 300 300 200 0 100 200 300 0
115 BOTOL

OBAT GENERIK BERLOGO

NO NAMA OBAT Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Stok Optimum Permintaan Pemberian Keterangan
1 ANALGETIK & ANTIPIRETIK (ARTHRIFEN PLUS TABLET) TABLET 0 0 0 0 0 0 0 0 0
2 ANALGETIK ANTIPIRETI (HOLIMOL CAPTABS) TABLET 0 0 0 0 0 0 0 0 0

3 ANALGETIK GEL (VOLTADEX GEL (NATRIUM DIKLOFENAK SALEP)) TUBE 0 0 0 0 0 0 0 0 0

4 ANTI ALERGI (SONAMIN TABLET) TABLET 0 0 0 0 0 0 0 0 0

5 ANTI DIARE (NEO KAOMINAL SUSPENSI) BOTOL 0 50 50 39 0 11 39 50 0
6 ANTI INFLUENZA (MOLEXFLU CAPTABS) TABLET 0 300 300 300 0 0 300 1000 0
7 ANTI INFLUENZA DAN BATUK (ALPARA SIRUP) BOTOL 0 0 0 0 0 0 0 0 0
8 ANTIHEMOROID & UDEMA (DIOS Fillm Coated Tablet) TABLET 0 0 0 0 0 0 0 0 0

9 MULTIVITAMIN & ANALGETIC (PRITAGESIC CAPTABS SALUT TABLET 0 0 0 0 0 0 0 0 0

SELAPUT )
10 MULTIVITAMIN & ANALGETIC (TRIFANEURON CAPTABS ) TABLET 200 0 200 100 0 100 100 2000 0
11 MULTIVITAMIN (BECEFORT TABLET SALUT GULA) TABLET 0 0 0 0 0 0 0 0 0

12 MULTIVITAMIN ANTIOKSIDAN (ANTOKSID CAPSUL 10 STRIP @ TABLET 0 0 0 0 0 0 0 0 0

10 KAPSUL)

13 MULTIVITAMIN MINERAL TABLET (LIVRON B PLEX TABLET SALUT TABLET 0 0 0 0 0 0 0 0 0

GULA)
14 MULTIVITAMIN MINERAL TABLET (PEHAVRAL TABLET) TABLET 0 0 0 0 0 0 0 2000 0

15 MULTIVITAMIN NEUROTROPIK (MOLANEURON TABLET & BIO- TABLET 0 0 0 0 0 0 0 0 0

ATP TABLET SALUT SELAPUT)

16 MULTIVITAMIN NEUROTROPIK INJEKSI (BIORON 1000 CAIRAN AMPUL 0 0 0 0 0 0 0 0 0

INJEKSI)
17 MULTIVITAMIN SIRUP (LYTACUR SIRUP) BOTOL 0 0 0 0 0 0 0 0 0
18 MULTIVITAMIN SIRUP (PROCURMA SIRUP 60 ML) BOTOL 0 0 0 0 0 0 0 0 0

19 MULTIVITAMIN TABLET TAMBAH DARAH (HEMAFORT TABLET TABLET 0 0 0 0 0 0 0 0 0

SALUT GULA )
20 OBAT ANALGESIK +DIAZEPAM (METANEURON) TABLET 0 0 0 0 0 0 0 0 0
21 OBAT BATUK & FLU (NOVADRYL SIRUP) BOTOL 0 0 0 0 0 0 0 0 0

22 OBAT BATUK DAN FLU (HUSTAB TABLET 30STRIP @10TABLET) TABLET 0 0 0 0 0 0 0 0 0

23 OBAT BATUK EXPECTORAN (HOLIDRYLSIRUP BOTOL 100 ML) BOTOL 50 0 50 50 0 0 50 100 0

24 OBAT FLU DAN BATUK (DEXTRAL SIRUP BOTOL 60 ML) BOTOL 0 0 0 0 0 0 0 0 0

25 OBAT FLU DAN BATUK (PROTEXINAL SIRUP BOTOL @ 60 ML) BOTOL 0 100 100 90 0 10 90 200 0
 OBAT GANGGUAN SALURAN PENCERNAAN INJEKSI
26 AMPUL 0 0 0 0 0 0 0 0 0
(ESOMEPRAZOLE)
OBAT GANGGUAN SISTEM PENCERNAAN (ALUDONNA-D TABLET
27 TABLET 0 0 0 0 0 0 0 0 0
20 STRIP @ 8 TABLET)

28 OBAT GANGGUAN SISTEM PENCERNAAN (LEXACROL SUSPENSI) BOTOL 5 48 53 38 0 15 38 100 0

BAHAN MEDIS HABIS PAKAI

NO NAMA BMHP Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Stok Optimum Permintaan Pemberian Keterangan
1 ABBOCATH (IV CATHETER) NO. 18,20 PIECES 18 20 38 15 0 23 15 30 0
2 ALKOHOL SWAB (AXIMED) SACHET 0 0 0 0 0 0 0 0 0
3 AUTOCLICK LANCING DEVICE (ONEMED) STRIP 0 0 0 0 0 0 0 0 0
4 BeneCheck Uric Acid Test Strip(Strip 25's) PIECES 7 0 7 1 0 6 1 0 0
5 CAT GUT CHROMIC (ONEMED) PIECES 24 0 24 0 0 24 0 0 0
6 CAT GUT PLAIN (ONEMED) PIECES 38 0 38 0 0 38 0 0 0
7 DISPOSIBLE 10 ML PIECES 0 0 0 0 0 0 0 0 0
8 DISPOSIBLE 1ML PIECES 0 0 0 0 0 0 0 0 0
9 DISPOSIBLE 3 ML PIECES 100 200 300 100 0 200 100 300 0
10 DISPOSIBLE 5 ML PIECES 0 0 0 0 0 0 0 0 0
11 FOLEY CATHETER NO 18 PIECES 0 0 0 0 0 0 0 0 0
12 Glucose + Protein Test (ONEMED) STRIP 0 0 0 0 0 0 0 0 0
13 GLUCOSE TEST STRIP (BENECHECK) STRIP 9 0 9 1 0 8 1 0 0
14 Infusion Set ANAK (COSMOMED) PIECES 30 0 30 10 0 20 10 10 0
15 Infusion Set DEWASA (COSMOMED) PIECES 5 30 35 15 0 20 15 30 0
16 IV Cannula With Injection (20G) PIECES 0 0 0 0 0 0 0 0 0
17 IV Cannula With Injection (24G) PIECES 0 0 0 0 0 0 0 0 0
18 IV CATHETER NO 18 PIECES 0 0 0 0 0 0 0 0 0
19 IV CATHETER NO 22 PIECES 0 0 0 0 0 0 0 0 0
20 KAPAS PEMBALUT 250 G ROLL 3 3 6 2 0 4 2 2 0
21 KASA 2 X 80 (COSMOMED ) ROLL 0 0 0 0 0 0 0 0 0
22 KASA 16X16 (ONEMED) ROLL 10 40 50 20 0 30 20 50 0
23 KASA 4 X 10 (ONEMED) ROLL 0 0 0 0 0 0 0 0 0
24 KASA 4X 5 (ONEMED) ROLL 0 0 0 0 0 0 0 0 0
25 KASA 40 X 40 (ONEMED) ROLL 0 0 0 0 0 0 0 0 0
26 KASA 4 X 3 (ONEMED) ROLL 0 0 0 0 0 0 0 0 0
27 KASA 4 X 15 ROLL 0 0 0 0 0 0 0 0 0
28 LUBRICATING (MY JELLY) TUBE 0 0 0 0 0 0 0 0 0

29 Multi-Monitoring System (Total Cholesterol, Blood Glucose, Uric UNIT 0 0 0 0 0 0 0 0 0

Acid (BENECHECK Plus )
30 Nasal Oxygen Cannula (COSMO MED) PIECES 0 0 0 0 0 0 0 0 0
31 Nebulizer Mask (COSMOMED) PIECES 0 0 0 0 0 0 0 0 0
32 PLASTER (LEUKOPLAST 2.5X4.5) ROLL 3 0 3 1 0 2 1 3 0
 33 SARUNG TANGAN NON STERIL (AXIMED Examination Gloves) PIECES 150 0 150 50 0 100 50 100 0

34 SARUNG TANGAN STERIL (COSMOMED) PAIRS 30 0 30 10 0 20 10 100 0

35 SILK 3 - 0 (ONEMED) PIECES 0 0 0 0 0 0 0 24 0
36 STERILIZAZION DRY(STERINTECH Sterilization Roll) ROLL 0 0 0 0 0 0 0 0 0
37 TOTAL CHOLESTEROL TEST STRIP (BENECHECK) STRIP 5 0 5 1 0 4 1 0 0
38 Umbilical Cord Clamp (ONEMED) PIECES 0 0 0 0 0 0 0 0 0
39 Under Pad Steril 60X90 (ONEMED) PIECES 0 0 0 0 0 0 0 0 0
40 UNDERPAD (COSMOMED ) PIECES 94 0 94 4 0 90 4 0 0
41 URINE BAG WITH HANGER (COSMOMED) PIECES 55 0 55 5 0 50 5 0 0

SERUM
NO NAMA OBAT Sediaan Stok Awal Penerimaan Persediaan Pemakaian Rusak/Ed Sisa Stok Stok Optimum Permintaan Pemberian Keterangan
1 SERUM ANTI TETANUS INJEKSI AMPUL 0 0 0 0 0 0 0 0 0
2 SERUM ANTI BISA ULAR POLIVALEN INJEKSI AMPUL 0 0 0 0 0 0 0 0 0

PUSLING/ MANLING/
PUSKESMAS RASIO PEMAKAIAN
JUMLAH PUSTU JUMLAH TOTAL
JUMLAH KUNJUNGAN
UMUM BPJS UMUM BPJS TABLET INJEKSI SIRUP

Mengetahui/Menyetujui Yang Menyerahkan Yang Meminta Yang Menerima

Kepala Dinas Kesehatan Kepala Seksi Farmasi dan POM Kepala Puskesmas Pengelola Obat Puskesmas
Kabupaten Lebak

H.M Sukirman, S.Sos, M.Si Edi Purnomo, SKM, M.Kes

Nip. 19591108 198103 1 006 Nip. 19700603 199203 1 006 Nip. Nip.