DAFTAR STOCK OBAT - OBATAN

KLINIK PRATAMA POLTEKBANG SURABAYA BULAN FEBRUARI TAHUN 2021

JUMLAH
NO NAMA OBAT KEMASAN SISA OBAT OBAT OBAT SISA OBAT
BULAN LALU MASUK KELUAR BULAN INI
1 2 3 4 5 6 7
I Antibiotik
1 Acyclovir 400mg Tablet 160 0 60 100
2 Amoxicillin (hufanoxil) 500mg Tablet 0 0 0 0
3 Cefadroxil (cefat) 500mg Tablet 160 0 0 160
4 Cefixime 100mg Tablet 120 0 0 120
5 Ciprofloxacin (novaflox) 500mg Tablet 115 0 0 115
6 Clindamycin 300 Tablet 110 0 0 110
7 Cotrimoxsasole Tablet 70 0 0 70
8 Ampicillin (pencil) 500mg Tablet 10 0 0 10
9 Primadex forte Tablet 30 0 0 30
10 Amoxan Tablet 200 0 0 200
11 Prolic 300 Tablet 200 0 0 200

II Anti Nyeri
1 Mefinal Tablet 17 0 17 0
2 Meloxicam 15mg Tablet 200 0 0 200
3 Meloxicam 7,5mg Tablet 140 0 0 140
4 Renadinac Tablet 480 0 40 440
5 Grateos Tablet 0 0 0 0
6 Asam mefenamat Tablet 0 0 0 0
7 Paracetamol Tablet 299 0 0 299
8 Cataflam Tablet 150 0 0 150
9 Ostelox 7.5 mg Tablet 60 0 0 60

III Vitamin & Multivitamin

 1 Grahabion Tablet 230 0 0 230
2 Neuralgin Tablet 250 0 20 230
3 Neurodex Tablet 500 0 0 500
4 Neurophyron V Tablet 370 0 70 300
5 Vitamin C Tablet 0 0 0 0
6 Glucosamine Tablet 100 0 0 100
7 Rhea Health Tone PCS 0 0 0 0
8 Obat Herbal PCS 0 0 0 0
9 Caviplex Tablet 400 0 25 375
10 Becomzet Tablet 300 0 0 300
11 Becom C Multivitamin Tablet 450 0 0 450

IV Obat Batuk & Pilek

1 GG Tablet 393 0 0 393
2 Decolsin Tablet 16 0 4 12
3 Demacolin Tablet 270 0 10 260
4 Salbutamol Tablet 158 0 0 158
5 Tremenza Tablet 0 0 0 0
6 Grantusif Tablet 300 0 10 290
7 Paratusin Tablet 300 0 0 300
8 Calortusin Tablet 290 0 20 270
9 Alphara Tablet 300 0 0 300
10 Hufagrip Tablet 250 0 0 250
11 Dextral Tablet 300 0 0 300

V Obat Alergi & Radang

1 Gabiten Tablet 200 0 0 200
2 Ketoconazole Tablet 4 0 4 0
3 Cetirizine Tablet 40 0 40 0
4 CTM Tablet 210 0 0 210
5 Dexteem plus Tablet 300 0 0 300
6 Gabiten Tablet 200 0 0 200
VI Obat Maag & diare & mual
1 Antasida Tablet 255 0 0 255
2 Buscopan P Tablet 28 0 0 28
3 Domperidone Tablet 580 0 200 380
4 Dulcolax Tablet 10 0 10 0
5 Lansoprasole (Dobrizol) Tablet 320 0 0 320
6 Gradilex Tablet 256 0 0 256
7 New Diatabs Tablet 104 0 0 104
8 Oralit Sachet 261 0 1 260
9 Polycrol f Tablet 176 0 20 156
10 Spasminal Tablet 177 0 0 177
11 Dexanta Tablet 300 0 0 300

VII Obat Wasir dan Obat suppo

1 Ambeven Tablet 280 0 0 280
2 Boraginol oint N Zalf Tube 11 0 0 11
3 Borraginal N Supp supp 20 0 0 20
4 Boraginol Suppo S supp 5 0 0 5
5 Profenid supp 11 0 0 11
6 Kalnex Tablet 80 0 0 80
7 Dulcolax Suppo supp 0 0 0 0

VIII Obat Hipertensi

1 Amlodipine 5mg Tablet 0 0 0 0
2 Nipedipine 10mg Tablet 60 0 0 60
3 Betahistin 12mg (merislon) Tablet 39 0 0 39
4 Furosemide 40mg Tablet 20 0 10 10
5 Isosorbid dinitrat (ISDN) Tablet 70 0 0 70

IX Obat Kolestrol
1 Simvastatin 10mg Tablet 70 0 20 50
 X Obat Asam Urat
1 Allopurinol 100mg Tablet 0 0 0 0

XI Obat Gula Darah

1 Metformin 500mg Tablet 200 0 0 200
2 Glimepiride 2mg Tablet 40 0 0 40
3 Glibenclamide Tablet 100 0 0 100

XII Tts Mata, Tts Telinga, Tts Hidung

1 Erlamycetin (Erla) tts mata Botol 6 0 1 5
2 Cendo Lyteers Botol 10 0 0 10
3 Cendo Polynel Tetes Mata Botol 5 0 0 5
4 Cendo Xitrol Botol 5 0 0 5
5 iliadin spray Botol 1 0 0 1
6 Erlamycetin (Erla) tts telinga Botol 4 0 0 4
7 Otopain Tetes Telingan Botol 10 0 0 10
8 Forumen Tetes Telinga Botol 5 0 0 5
9 Cendo Xitrol Salep Mata Tube 10 0 0 10
10 Cendo Gentamicin Salep Mata Tube 10 0 0 10

XIII Obat Salep Kulit & Spray

1 Salep acyclovir Tube 10 0 0 10
2 Salep betametasone Tube 9 0 1 8
3 Salep bioplancenton Tube 2 0 0 2
4 Salep burnazine Tube 4 0 0 4
5 Salep dexosimetason (dexigen 5gr) Tube 25 0 0 25
6 Spray Ethylchloride Tube 2 0 0 2
7 Ethychloride Spray PCS 5 0 0 5
8 Balsem geliga Tube 0 0 0 0
9 Salep Hydrocortison 2,5% Tube 9 0 0 9
10 Balsem lion head Tube 0 0 0 0
11 Salep nufacort Tube 25 0 0 25
12 Balsem Tjincau Tube 1 0 0 1
13 Minyak Kayu putih 30ml Botol 1 0 0 1
14 Counterpain Cream PCS 2 0 0 2
15 Scabimite Cream PCS 1 0 0 1
16 Ketoconazol Cream PCS 25 0 0 25
17 Betason N Cream PCS 27 0 0 27
18 Erlaneohidrocort Cream PCS 25 0 0 25
19 Inerson Cream PCS 9 0 0 9

XIV Obat Oral Mulut

1 Betadine Kumur Besar (gargle) Botol 4 0 0 4
2 Ensytin Drop Botol 1 0 0 1
3 Kenalog Oral salep Tube 2 0 0 2

XV Stik
1 Stik UA (Asam Urat) Dos 25 0 0 25
2 Stik Chol (Kolestrol) Dos 11 0 0 11
3 Stik GDA (Gula Darah) Dos 26 0 0 26

XVI Obat Ampul

1 Epineprine Ampul 4 0 4 0
2 Lidocaine Ampul 8 0 0 8
3 Pulmicort Ampul 5 0 5 0
4 Ventolin Ampul 5 0 0 5
5 Pehacain Ampul 1 0 0 1
6 Dexamethasone INJ Ampul 0 0 0 0
7 Amiodarone Ampul 0 0 0 0

XVII Obat AlKes

1 Infus NACL 100ml PCS 0 0 0 0
2 Infus NACL 500ml PCS 0 0 0 0
 3 Infus RL 500ml PCS 0 0 0 0
4 Masker neb dwsa PCS 5 0 2 3
5 Oxyflow nasal oxygen dwsa PCS 3 0 2 1
6 Spuit 10cc (disp syringe) PCS 5 0 0 5
7 surflo 18G PCS 5 0 0 5
8 surflo 20G PCS 0 0 0 0
9 Tensocrepe 10cm PCS 5 0 0 5
10 Tensocrepe 7.5cm x 4.5 cm PCS 5 0 0 5
11 Kasa steril Husada box 27 0 0 27
12 Hansaplast Standart (1kotak isi 100) PCS 399 0 0 399
13 Hypafix PCS 4 0 0 4
14 Daryantule PCS 40 0 1 39
15 Alkohol swab (1kotak isi 100) Kotak 1 0 0 1
16 Alkohol swab (buah) PCS 200 0 200 0
17 Infuz PZ PCS 6 0 0 6
18 Water For Injection 25 CC PCS 7 0 0 7
19 H2O2 3% PCS 0 0 0 0
20 Ketomed Shampo PCS 5 0 0 5
21 Salicyl Talc Menthol PCS 20 0 0 20
22 Masker Earloop BOX 0 0 0 0
23 Masker Hijab BOX 0 0 0 0
24 Tas Kresek Hitam PAK 0 0 0 0
25 Tas Kresek Putih PAK 0 0 0 0
26 Handscoon UK.S BOX 0 0 0 0
27 Handscoon UK.M BOX 0 0 0 0
28 Handscoon UK.L BOX 0 0 0 0
29 Sarung Tangan Latex PASANG 0 0 0 0
30 Jas Hujan APD PCS 0 0 0 0
31 Surgical Gown Waterproof PASANG 0 0 0 0
32 Surgical Gown Disposable PASANG 0 0 0 0
33 Bulk Fill Posterior Komposit 3M PCS 0 0 0 0
34 Sendok Plastik Bening PCS 0 0 0 0
 35 Sedotan Plastik Tekuk PCS 0 0 0 0
36 Callusol Sol PCS 5 0 0 5
37 Stik Narkoba 6 parameter PCS 0 0 0 0
38 Lungane Rapid Test Kit for Covid-19 PCS 125 0 125 0

XVIII Alkes Gigi

1 Formocresol PCS 0 0 0 0
2 Edta PCS 0 0 0 0
3 Paramono Clorofenol PCS 0 0 0 0
4 Ampul Carpule Sitoject PCS 0 0 0 0
5 Single Bond Universal RV 3M PCS 0 0 0 0
6 Articulating Paper PCS 0 0 0 0
7 Jarum Dental Anastasi PCS 0 0 0 0
8 Fuji Glas ionomer cement type ix PCS 0 0 0 0
9 Caviton White Gc PCS 0 0 0 0
10 Filtek Z350 XT Universal Komposit 3M PCS 0 0 0 0
11 Mata Bur Poles PCS 0 0 0 0
12 Saliva Ejektor Dochem Blue PCS 0 0 0 0
13 Cotton Roll PCS 5 0 5 0
14 Antiseptik Liquid Teno Dent PCS 0 0 0 0
15 Calcyl Syringe PCS 0 0 0 0
16 Cocoa Butter GC PCS 0 0 0 0
17 Iodontin Paste Syringe With Ca(OH)2 PCS 0 0 0 0
18 Mata Bur Tulang Type SS PCS 0 0 0 0
19 Protaper Dentsply PCS 0 0 0 0
20 Oco Tooth Stain Remover PCS 0 0 0 0
21 Filtek Z350 XT Flowable PCS 0 0 0 0
22 Tooth Mousse Plus GC PCS 0 0 0 0
 Surabaya, 05 Maret 2021
KANIT POLIKLINIK Apoteker penanggung jawab

dr. SAMODERO GUMILAR, M.Kes apt. Aziszia Insanya Lamakluang, S. Farm

PENATA TK.I (III/d)
NIP. 198210072008121003
HUN 2021

Keterangan
KETERANGAN obat retur
TGL. (ED)
8

May-21
Jun-21
May-21
Sep-21
May-24
Jan-22
Sep-22
Okt-21
Jan-21
Jan-23
Feb-22

Des-21
Oct-22
May-23
Apr-22
Mar-22
Sep-22
Sep-23
Feb-23
Mar-22
Mar-22
Jan-22
Jan-22
Aug-22
Sep-21
Jul-25
Jun-22
Jun-22
Jun-23
Sep-22
Jun-23

Jul-23
Sep-21
Sep-24
Jun-22
Jun-22
Jul-24
Jun-22
Jun-22
Sep-22
Jun-22
Apr-22

Nov-20
Jul-21
Sep-21
Mar-22
May-21
Feb-24
May-21
Jun-21
Nov-21
Jan-22
Mar-22
Dec-23
Nov-22
Oct-22
Apr-22
Jul-21
Sep-22

Jan-22
Sep-22
Jan-23
Nov-22
Mar-23
Jan-23

Mar-21
Jan-22
Jul-22
May-22
Mar-23

May-21
Jun-21

May-21
Oct-22
Jul-21

Feb-22
May-23
Aug-22
Aug-22
Jul-21
Dec-22
Mar-21
Dec-22
Jan-23
Feb-23

Okt -23
Ags-21
Nov-21
Jan-23
Des-21
Nov-22
Jan-23
Jul-22
Nov-24
Aug-22
Feb-23
Sep-22
Jun-24
Nov-22
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24

Des-22
Mei-21
Ags-21

Jun-21
Mar-21
Jun-22

Mar-23
Apr-23
Apr-21
Jan-24
Nov-24
Nov-24
Nov-24

May-22
Apr-22
Mar-22
Mar-23
Apr-23
Feb-23
Feb-21
Mar-21
Sep-24
May-22
Feb-22
Feb-23
Jul-24
Feb-23
Mei-24

Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Feb-23
Feb-23
Feb-23
Feb-23
Feb-23
Feb-23
Feb-23
Feb-23
Feb-23
Feb-23
Feb-23
May-22
May-22
May-22
May-22
May-22
May-22

Feb-23
Feb-23
Feb-23
Feb-23
Feb-23
Feb-23
Feb-23
Aug-22
Aug-22
Aug-22
Aug-22
Jan-23
Jan-23
Jan-23
Jan-23
Sep-23
Sep-23
Sep-23
Sep-23
Sep-23
Sep-23
Sep-23
 , 05 Maret 2021
enanggung jawab

ya Lamakluang, S. Farm
 DAFTAR STOCK OBAT - OBATAN
KLINIK PRATAMA POLTEKBANG SURABAYA BULAN DESEMBER TAHUN 2022

JUMLAH
NO NAMA OBAT KEMASAN SISA OBAT OBAT OBAT SISA OBAT
BULAN LALU MASUK KELUAR BULAN INI
1 2 3 4 5 6 7
I Antibiotik
1 Acyclovir 400mg Tablet 173 0 20 153
2 Azythromycin Tablet 0 1140 210 930
3 Cefadroxil 500mg Tablet 0 1392 819 573
4 Cefixime 100mg Tablet 0 600 72 528
5 Ciprofloxacin 500mg Tablet 0 0 0 0
6 Clindamycin 300 Tablet 400 200 88 512
7 Cotrimoxsasole Tablet 0 0 0 0
8 Co-amoxiclav Kapsul 0 1500 494 1006
9 Levofloksasin 500 mg Tablet 21 100 11 110
10 Primadex forte Tablet 94 100 83 111
11 Ketokonazole 200 mg Tablet 210 0 107 103
12 Thiamphenicol 500 mg Tablet 60 0 0 60
13 Tetracyclin 500 mg Tablet 99 0 0 99
14 Coroflox 500mg Tablet 60 0 0 60
15 Indanox 300mg Kapsul 0 0 0 0
16 Leomoxyl 500mg Tablet 684 0 70 614
17 Qcef 500mg Tablet 0 0 0 0
18 Fixatic 100mg Tablet 0 0 0 0
19 Novaflox 500mg Tablet 34 0 34 0
20 Meflosin 500mg Tablet 60 270 60 270
21 Tisacef Tablet 0 450 450 0

II Anti Nyeri
1 Ibuprofen 400 mg Tablet 209 100 36 273
 2 Cataflam Fast Powder 50mg box 0 180 0 180
3 Nichoflam 50 mg Tablet 0 0 0 0
4 Meloxicam 15mg Tablet 0 800 100 700
5 Meloxicam 7,5mg Tablet 0 800 34 766
6 Renadinac 50 mg Tablet 495 508 133 870
7 Ponsamic (asam mefenamat 500 mg) Tablet 276 0 221 55
8 Maganol (Paracetamol 500 mg) Tablet 290 0 290 0
9 Cataflam 50 mg Tablet 0 1400 371 1029
10 Praxion 120 mg/5 ml 60 ml suspensi 0 0 0 0
11 Merislon Tablet 100 200 93 207
12 Eperison 50 mg Tablet 415 600 125 890
13 Piroxicam 20 mg Tablet 0 300 15 285
14 Betahistin 6 mg Tablet 0 400 0 400
15 Exaflam 50mg Tablet 0 0 0 0
16 Kadiflam 50mg Tablet 140 1500 254 1386
17 Voltaren 50mg Tablet 0 1150 100 1050
18 Xepamol 500mg Tablet 0 2000 506 1494
19 Analspec 500mg Tablet 0 1500 0 1500

III Vitamin & Multivitamin

1 Grahabion Tablet 0 0 0 0
2 Neuralgin Rx Tablet 486 0 156 330
3 Neurophyron V Tablet 446 300 201 545
4 Mecobalamin kapsul 110 200 10 300
5 Glucosamine Tablet 0 1000 262 738
6 Caviplex CDEZ Tablet 0 1000 0 1000
7 Caviplex Tablet 0 2000 860 1140
8 Becomzet Tablet 0 0 0 0
9 L-Bio kapsul 92 0 0 92
10 Zink Tablet 150 0 0 150
11 Vitamin B6 Tablet 100 0 0 100
12 Dtrivit 1000 (Vitamin D3 1000 ) Tablet 110 0 0 110
13 Viostin DS Tablet 410 0 0 410
14 Novakal 500 mg (Kalsium) Tablet 0 0 0 0
15 Becom C Multivitamin Tablet 0 0 0 0
16 Goralgin Tablet 0 0 0 0
17 Neurodex Tablet 0 0 0 0
18 Etabion Tablet 20 0 20 0
19 Licokalk Tablet 440 200 14 626
20 Hevit C 1000mg Tablet 110 200 10 300
21 Xepaneuron Tablet 288 800 415 673
22 Gabapentin 300mg Tablet 10 0 0 10
23 Sakatonik D3 1000 Tablet 80 80 80 80
24 Morfit D3 1000 Tablet 90 90 90 90
25 Biometis Tablet 0 500 0 500
26 Vitamin C IPI Tablet 0 450 450 0
27 Xepavit 4500 0 4250 250

IV Obat Batuk & Pilek

1 Ambroxol Tablet 75 700 295 480
2 GG (Guaifenesin) Tablet 0 300 10 290
3 Bronchitin tablet 0 0 0 0
4 Demacolin Tablet 0 2000 1000 1000
5 Salbutamol 2 mg Tablet 203 100 50 253
6 Grantusif Tablet 0 2500 1564 936
7 Calortusin Tablet 0 3000 1270 1730
8 Alphara Tablet 0 750 0 750
9 Hufagrip Tablet 0 1500 355 1145
10 N-acetylcystein Kapsul 0 2800 740 2060
11 Grathazon (Dexamethasone 0,5 mg) Tablet 0 2600 1560 1040
12 OBH Rama Syr 100 ml Botol 0 0 0 0
13 Dextral Tablet 0 0 0 0
16 Flutamol tablet 0 1500 346 1154
17 Flucodin Tablet 0 1800 540 1260
18 Lapisiv-T Tablet 0 1500 206 1294
19 Trifed Tablet 0 750 466 284

V Obat Alergi & Radang

1 Gabiten Tablet 0 0 0 0
2 Cetirizine Tablet 177 500 117 560
3 Cormetisone 4mg Tablet 0 3450 1908 1542
4 Dexteem plus Tablet 0 800 186 614
5 Interhistin Tablet 400 0 0 400
6 Loratadin Tablet 135 700 160 675
7 Methyl Prednisolon 4 mg Tablet 0 0 0 0
8 Dexamethasone 0,5 mg Tablet 0 0 0 0
9 Telfast OD Tablet 50 0 0 50
10 Stenirol 4mg Tablet 0 0 0 0
11 Histapan Tablet 0 300 0 300

VI Sistem pencernaan
1 Antasida Tablet 0 0 0 0
2 Buscopan Tablet 75 0 0 75
3 Buscopan Plus Tablet 186 0 0 186
4 Domperidone Tablet 0 0 0 0
5 Lansoprasole kapsul 243 1400 873 770
6 Gradilex Tablet 75 0 10 65
7 New Diatabs Tablet 0 0 0 0
8 Oralit Sachet 0 1900 859 1041
9 Polycrol Forte Tablet 240 2880 1912 1208
10 Omedrinat Tablet 96 200 57 239
11 Spasminal Tablet 55 100 5 150
12 Inpepsa Syr 100 ml Botol 0 0 0 0
13 Dexanta Tablet 0 0 0 0
14 Ramolit sachet 0 0 0 0
15 Nucral Sirup 100ml Botol 0 0 0 0
16 Omeprazole kapsul 0 0 0 0
17 Omedom Tablet 100 800 140 760
18 Ondansetron 4mg Tablet 200 100 100 200
19 akita Tablet 695 0 65 630
20 Sucralfate Sirup Botol 0 0 0 0
21 Imodium Tablet 0 500 203 297
22 Ulpraz kapsul 0 1200 8 1192

VII Obat Wasir dan Obat suppo

1 Ambeven Tablet 60 0 10 50
2 Boraginol oint N Zalf Tube 6 0 0 6
3 Borraginal N Supp supp 7 30 9 28
4 Boraginol Suppo S supp 0 50 13 37
5 Boraginol S Salep 15 Gram Tube 6 0 0 6
6 Profenid supp 11 0 0 11
7 Kalnex Tablet 108 0 16 92
8 Dulcolax Tablet 0 30 0 30
9 Dulcolax Suppo supp 20 0 2 18
10 Asamnex Tablet 0 30 0 30
11 Paracetamol supp 80mg supp 0 10 0 10

VIII Obat Hipertensi

1 Amlodipine 10 mg Tablet 105 400 10 495
2 candesartan 8 mg Tablet 10 150 0 160
3 Clopidogrel 75 mg Tablet 60 0 60 0
4 Nifedipine 10mg Tablet 60 0 0 60
5 Furosemide 40mg Tablet 70 0 13 57
6 Aspilet 80 mg Tablet 87 0 0 87
7 Isosorbid dinitrat (ISDN) 10mg Tablet 20 100 0 120
8 Amlodipine 5 mg Tablet 35 400 0 435
9 Propanolol 10mg Tablet 0 100 0 100
IX Obat Kolestrol
1 Atorvastatin 10 mg Tablet 70 30 0 100
2 Atorvastatin 20 mg Tablet 20 130 90 60

X Obat Asam Urat

1 Allopurinol 100mg Tablet 235 200 35 400
2 Allopurinol 300mg Tablet 340 100 40 400

XI Obat Gula Darah

1 Acarbose 50 mg Tablet 30 0 0 30
2 Acarbose 100 mg Tablet 100 100 15 185
3 Metformin 500mg Tablet 100 100 90 110
4 Glimepiride 2mg Tablet 100 100 23 177

XII Tts Mata, Tts Telinga, Tts Hidung

1 Erlamycetin (Erla) tts mata Botol 3 0 0 3
2 Cendo Lyteers Botol 6 20 4 22
3 Cendo Polynel Tetes Mata Botol 8 5 2 11
4 Cendo Xitrol tetes mata Botol 0 0 0 0
5 iliadin spray Botol 0 3 2 1
6 Erlamycetin (Erla) tts telinga Botol 3 15 0 18
7 Otopain Tetes Telinga Botol 0 4 0 4
8 Forumen Tetes Telinga Botol 1 0 0 1
9 Cendo Xitrol Salep Mata Tube 4 24 20 8
10 Santadex Tube 2 0 0 2
11 Rohto cool tube 3 10 2 11
12 Cendo Gentamicin Salep Mata Tube 0 0 0 0
13 Genoint Tetes Mata Botol 0 5 0 5
14 Cendo Vasacon A strip 3 0 0 3
15 Cendo Xitrol minidose strip 6 15 6 15
16 alletrol tetes mata Botol 0 0 0 0
17 Erlamycetin plus tetes mata Botol 5 15 1 19
18 Genoint Salep Mata Tube 9 0 0 9
19 Cendo Floxa strip 7 0 0 7
20 Erlamycetin salep mata tube 7 13 3 17

XIII Obat Salep Kulit & Spray

1 Salep acyclovir Tube 14 0 1 13
2 Salep betametasone Tube 11 0 1 10
3 Salep bioplancenton Tube 6 3 3 6
4 Salep burnazine Tube 1 0 0 1
5 Salep dexosimetason (dexigen 5gr) Tube 21 3 11 13
6 Miconazole Salep 10 gram Tube 31 0 2 29
7 Aloclaire plus gel 8 ml tube 2 0 0 2
8 Aloclaire Plus Mouthwash 60ml botol 4 0 0 4
9 Ethychloride Spray PCS 0 0 0 0
10 Balsem geliga Tube 0 0 0 0
11 Salep Hydrocortison 2,5% Tube 9 20 0 29
12 Balsem lion head Tube 0 0 0 0
13 Salep nufacort Tube 0 0 0 0
14 Voltadex gel 20g Tube 0 0 0 0
15 Minyak Kayu putih 30ml Botol 21 0 8 13
16 Counterpain Cream 15g tube 0 20 15 5
17 Rogencin cream tube 0 23 9 14
18 Scabimite Cream PCS 3 0 1 2
19 Ketoconazole Cream PCS 12 20 8 24
20 Betason N Cream PCS 6 30 5 31
21 Erlaneohidrocort Cream PCS 0 0 0 0
22 Inerson Cream PCS 0 0 0 0
23 Bedak Salicyl Botol 0 40 0 40
24 Fungares cream tube 0 0 0 0
25 Fungasol cream tube 0 0 0 0
26 Genolon cream tube 0 0 0 0
27 Genalten cream tube 8 0 3 5
28 Hotin DCL 30g tube 0 15 3 12
29 Benoson cream 5g tube 0 25 0 25
30 Flamar gel tube 0 38 17 21
31 Minyak Kayu putih 60ml Botol 0 42 17 25
32 Thrombophop gel 20g tube 0 10 3 7
33 Counterpain cool 15g tube 0 20 0 20
34 Betadine 5ml Botol 0 6 6 0

XIV Obat Oral Mulut

1 Betadine Kumur 100 ml (gargle) Botol 6 15 7 14
2 Kandistatin Drop Botol 4 0 0 4
3 Kenalog Oral salep Tube 0 0 0 0
4 Bufacomp in oralbase Tube 15 3 2 16

XV Stik
1 Stik UA (Asam Urat) Dos 0 0 0 0
2 Stik Chol (Kolestrol) Dos 0 0 0 0
3 Stik GDA (Gula Darah) Dos 0 0 0 0

XVI Obat Ampul

1 Epineprine Ampul 0 30 30 0
2 Lidocaine Ampul 0 0 0 0
3 Diphenhydramine Injeksi Ampul 0 30 30 0
4 Omeprazole injeksi box 0 6 6 0
5 Ventolin Ampul 0 0 0 0
6 Pulmicort 0,5mg/2ml Ampul 0 105 105 0
7 Pehacain Ampul 0 0 0 0
8 Neurobion Injeksi Ampul 0 60 60 0
9 Dexamethasone INJ Ampul 0 100 100 0
10 Atropin sulfat Injeksi Ampul 0 0 0 0
11 Buscopan injeksi Ampul 0 10 10 0
12 Antrain injeksi Ampul 0 25 25 0
13 Ondane injeksi Ampul 0 0 0 0
14 Ondansetron 2mg/ml injeksi Ampul 0 20 20 0
15 Ranitidine Injeksi Ampul 0 10 10 0
16 Paracetamol Infus botol 0 3 3 0

XVII Obat AlKes

1 Infus NACL 100ml PCS 0 0 0 0
2 Infus D5% 500 ml PCS 0 0 0 0
3 Infus D40% 25 ml PCS 0 0 0 0
4 Infus NACL 500ml PCS 0 0 0 0
5 Infus RL 500ml PCS 0 0 0 0
6 Masker neb dwsa PCS 0 0 0 0
7 Oxyflow nasal oxygen dwsa PCS 0 0 0 0
8 Spuit 10cc (disp syringe) PCS 0 0 0 0
9 surflo 18G PCS 0 0 0 0
10 surflo 20G PCS 0 0 0 0
11 Tensocrepe 10cm PCS 0 0 0 0
12 Tensocrepe 7.5cm x 4.5 cm PCS 0 0 0 0
13 Kasa steril Husada box 0 0 0 0
14 Hansaplast Standart (1kotak isi 100) PCS 0 0 0 0
15 Hypafix box 0 0 0 0
16 Daryantule PCS 0 0 0 0
17 Alkohol swab (1kotak isi 100) Kotak 0 0 0 0
18 Ranitidin injeksi 24 mg/ml PCS 0 0 0 0
19 Infuz PZ PCS 0 0 0 0
20 Water For Injection 25 CC PCS 0 0 0 0
21 H2O2 3% PCS 0 0 0 0
22 Ketomed Shampo PCS 0 0 0 0
23 Masker Earloop BOX 0 0 0 0
24 Masker Hijab BOX 0 0 0 0
25 Surflo 22G pcs 0 0 0 0
26 Infuset Dewasa pcs 0 0 0 0
 27 Handscoon UK.S BOX 0 0 0 0
28 Handscoon UK.M BOX 0 0 0 0
29 Handscoon UK.L BOX 0 0 0 0
30 Sarung Tangan Latex PASANG 0 0 0 0
31 Jas Hujan APD PCS 0 0 0 0
32 Surgical Gown Waterproof PASANG 0 0 0 0
33 Surgical Gown Disposable PASANG 0 0 0 0
34 Bulk Fill Posterior Komposit 3M PCS 0 0 0 0
35 Sendok Plastik Bening PCS 0 0 0 0
36 Alkohol 70% 1 Liter botol 0 0 0 0
37 Callusol Sol botol 0 3 3 0
38 Stik Narkoba 6 parameter PCS 0 0 0 0
39 Dextrose 40% 25 ml botol 0 0 0 0
40 Lungane Rapid Test Kit for Covid-19 PCS 0 0 0 0

XVIII Alkes Gigi

1 Formocresol PCS 0 0 0 0
2 Edta PCS 0 0 0 0
3 Paramono Clorofenol PCS 0 0 0 0
4 Ampul Carpule Sitoject PCS 0 0 0 0
5 Single Bond Universal RV 3M PCS 0 0 0 0
6 Articulating Paper PCS 0 0 0 0
7 Jarum Dental Anastasi PCS 0 0 0 0
8 Fuji Glas ionomer cement type ix PCS 0 0 0 0
9 Caviton White Gc PCS 0 0 0 0
10 Filtek Z350 XT Universal Komposit 3M PCS 0 0 0 0
11 Mata Bur Poles PCS 0 0 0 0
12 Saliva Ejektor Dochem Blue PCS 0 0 0 0
13 Cotton Roll PCS 0 0 0 0
14 Antiseptik Liquid Teno Dent PCS 0 0 0 0
15 Calcyl Syringe PCS 0 0 0 0
 16 Cocoa Butter GC PCS 0 0 0 0
17 Iodontin Paste Syringe With Ca(OH)2 PCS 0 0 0 0
18 Mata Bur Tulang Type SS PCS 0 0 0 0
19 Protaper Dentsply PCS 0 0 0 0
20 Oco Tooth Stain Remover PCS 0 0 0 0
21 Filtek Z350 XT Flowable PCS 0 0 0 0
22 Tooth Mousse Plus GC PCS 0 0 0 0

Surabaya, 31 Desember 2022

KANIT POLIKLINIK Apoteker penanggung jawab

dr. SAMODERO GUMILAR, M.Kes apt. Eka Dewi Pratiwi, S. Farm

Pembina (IV/a)
NIP. 198210072008121003

Keterangan
obat retur
TAHUN 2022

KETERANGAN
TGL. (ED)
8

Oct-23
May-24
Jan-25
Sep-23
May-24
May-24
May-24
May-24
May-24
May-24
May-24
Jan-25
May-24
Sep-24
Sep-24
May-24
Jan-25
Sep-24
Sep-24
Sep-24
Sep-24

Feb-25
Feb-24
Jul-23
Feb-24
Feb-24
Aug-23
Sep-23
Sep-23
Feb-24
Feb-24
Jun-23
Jun-23
Sep-24
Oct-23
Sep-24
Sep-24
Sep-24
Sep-24
Sep-24

Feb-24
Jul-23
Feb-24
Jul-23
Jul-25
Aug-23
Feb-24
Sep-22
Jun-23
Feb-24
Aug-23
Jun-25
Feb-24
Jun-25
Jun-23
Jun-23
Feb-24
Feb-24
Jul-25
Jul-25
Sep-23
Sep-23
Jun-23
Jun-23
Jun-23
Jun-25
Jun-25

Jul-23
Jul-23
Sep-23
Sep-24
Feb-24
Jul-24
Jun-23
Feb-24
Feb-24
Feb-24
Feb-25
Aug-23
Jun-23
Aug-23
Jun-23
Jun-23
Jun-23

Feb-24
Sep-25
Sep-25
Feb-24
Jan-25
Jun-24
Mar-24
Feb-24
Feb-24
Feb-24
Mar-24

Jun-23
Feb-24
Feb-24
Feb-24
Feb-24
Dec-23
Feb-24
Feb-24
Oct-24
Jan-26
Jul-24
Aug-23
Feb-25
Feb-25
Feb-25
Sep-23
Sep-23
Feb-23
Dec-23
Dec-23
Feb-25
Sep-23

Feb-24
Feb-24
Feb-24
Feb-24
Jun-24
Feb-24
Feb-24
Jan-23
Jan-23
Jun-23
Feb-24

Feb-24
Feb-24
Feb-24
Oct-24
Oct-24
Jan-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24

Feb-24
Nov-23

Feb-24
Feb-24
Nov-23
Feb-24

Jun-24
Jun-24
Jun-24
Nov-23
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Jan-24
Jan-24

Okt -23
Jun-24
Jun-24
Jun-24
Aug-24
Jul-25
Jun-24
Jun-24
Jun-24
Jun-24
Nov-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-25
Jun-24
Jan-24
Jan-24
Jan-24
Jan-24
Jan-24
Jan-24
Jun-24
Jan-24
Jan-24
Jul-24

Jul-24
Jul-24
Jun-24
Jul-24

Jun-24
Jun-24
Jun-24

Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Nov-24
Jun-24
Nov-24
Jul-23
Jul-23
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24

Feb-24
Jun-24
Jun-24
Feb-24
Aug-23
Jun-24
Apr-23
Jun-24
Nov-24
Nov-24
Sep-24
Aug-24
Jan-24
Jun-24
Jul-24
Jun-24
Mei-24
Sep-23
Nov-24
Nov-24
Nov-24
Nov-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24

Feb-23
Feb-23
Feb-23
Feb-23
Feb-23
Feb-23
Feb-23
Aug-22
Aug-22
Aug-22
Aug-22
Jan-23
Jan-23
Jan-23
Jan-23
 Sep-23
Sep-23
Sep-23
Sep-23
Sep-23
Sep-23
Sep-23

1 Desember 2022
enanggung jawab

wi Pratiwi, S. Farm
 DAFTAR STOCK OBAT - OBATAN
KLINIK PRATAMA POLTEKBANG SURABAYA BULAN JANUARI TAHUN 2023

JUMLAH
NO NAMA OBAT KEMASAN SISA OBAT OBAT OBAT SISA OBAT
BULAN LALU MASUK KELUAR BULAN INI
1 2 3 4 5 6 7
I ANTIBIOTIK
1 Azythromycin 500mg Tablet 930 0 36 894
2 Cefadroxil 500mg Tablet 573 0 168 405
3 Cefixime 100mg Tablet 528 0 218 310
4 Ciprofloxacin 500mg Tablet 0 0 0 0
5 Clindamycin 300mg Tablet 512 0 82 430
6 Cotrimoxsasole Tablet 0 0 0 0
7 Co-amoxiclav Kapsul 1006 0 238 768
8 Levofloksasin 500 mg Tablet 110 0 0 110
9 Primadex forte Tablet 111 0 111 0
10 Thiamphenicol 500 mg Tablet 60 0 0 60
11 Tetracyclin 500 mg Tablet 99 0 0 99
12 Coroflox 500mg Tablet 60 0 0 60
13 Leomoxyl 500mg Tablet 614 0 40 574
14 Meflosin 500mg Tablet 270 0 60 210

II ANTIFUNGI
1 Ketokonazole 200 mg Tablet 103 0 10 93

III ANTIVIRUS
1 Acyclovir 400mg Tablet 153 0 3 150

IV ANALGETIK, ANTIPIRETIK, ANTIINFLAMASI

1 Ibuprofen 400 mg Tablet 273 0 20 253
2 Cataflam Fast Powder 50mg box 180 0 69 111
3 Meloxicam 15mg Tablet 700 0 0 700
4 Meloxicam 7,5mg Tablet 766 0 0 766
5 Renadinac 50mg Tablet 870 0 218 652
6 Ponsamic 500mg Tablet 55 0 55 0
3 Cataflam 50mg Tablet 1029 0 326 703
4 Merislon 12mg Tablet 207 0 37 170
5 Eperison 50 mg Tablet 890 0 56 834
4 Piroxicam 20 mg Tablet 285 0 0 285
5 Betahistin 6 mg Tablet 400 0 56 344
6 Kadiflam 50mg Tablet 1386 0 26 1360
5 Voltaren 50mg Tablet 1050 0 350 700
6 Xepamol 500mg Tablet 1494 0 408 1086
7 Analspec 500mg Tablet 1500 0 190 1310

V VITAMIN
1 Grahabion Tablet 0 0 0 0
2 Neuralgin Rx Tablet 330 0 92 238
3 Neurophyron V Tablet 545 0 112 433
4 Mecobalamin kapsul 300 0 0 300
5 Glucosamine Tablet 738 0 230 508
6 Caviplex CDEZ Tablet 1000 0 120 880
7 Caviplex Tablet 1140 0 300 840
8 Becomzet Tablet 0 0 0 0
9 L-Bio kapsul 92 0 0 92
10 Zink Tablet 150 0 0 150
11 Vitamin B6 Tablet 100 0 0 100
12 Dtrivit 1000 (Vitamin D3 1000 ) Tablet 110 0 0 110
13 Viostin DS Tablet 410 0 0 410
14 Becom C Tablet 0 0 0 0
15 Neurodex Tablet 0 0 0 0
16 Licokalk Tablet 626 0 0 626
17 Hevit C 1000mg Tablet 300 0 15 285
18 Xepaneuron Tablet 673 0 5 668
19 Gabapentin 300mg Tablet 10 0 0 10
20 Sakatonik D3 1000 Tablet 80 0 0 80
21 Morfit D3 1000 Tablet 90 0 0 90
22 Biometis Tablet 500 0 0 500

VI OBAT BATUK DAN FLU

1 Ambroxol Tablet 480 0 13 467
2 GG (Guaifenesin) Tablet 290 0 20 270
3 Bronchitin tablet 0 0 0 0
4 Demacolin Tablet 1000 0 130 870
5 Salbutamol 2 mg Tablet 253 0 10 243
6 Grantusif Tablet 936 0 68 868
7 Calortusin Tablet 1730 0 220 1510
8 Alphara Tablet 750 0 0 750
9 Hufagrip Tablet 1145 0 40 1105
10 N-acetylcystein Kapsul 2060 0 31 2029
11 Grathazon (Dexamethasone 0,5 mg) Tablet 1040 0 0 1040
12 Flutamol tablet 1154 0 4 1150
13 Flucodin Tablet 1260 0 100 1160
14 Lapisiv-T Tablet 1294 0 70 1224
15 Trifed Tablet 284 0 16 268

VII ANTI ALERGI DAN RADANG

1 Cetirizine Tablet 560 0 95 465
2 Cormetisone 4mg Tablet 1542 0 415 1127
3 Dexteem plus Tablet 614 0 49 565
4 Interhistin Tablet 400 0 20 380
5 Loratadin Tablet 675 0 80 595
6 Methyl Prednisolon 4 mg Tablet 0 0 0 0
7 Dexamethasone 0,5 mg Tablet 0 0 0 0
8 Telfast OD Tablet 50 0 0 50
 9 Histapan Tablet 300 0 0 300

VIII OBAT SALURAN CERNA

1 Buscopan Tablet 75 0 0 75
2 Buscopan Plus Tablet 186 0 56 130
3 Lansoprasole kapsul 770 0 133 637
4 Gradilex Tablet 65 0 60 5
5 New Diatabs Tablet 0 0 0 0
6 Oralit Sachet 1041 0 166 875
7 Polycrol Forte Tablet 1208 0 350 858
8 Omedrinat Tablet 239 0 9 230
9 Spasminal Tablet 150 0 0 150
10 Omeprazole kapsul 0 0 0 0
11 Omedom Tablet 760 0 194 566
12 Ondansetron 4mg Tablet 200 0 42 158
13 akita Tablet 630 0 180 450
14 Sucralfate Sirup Botol 0 0 0 0
15 Imodium Tablet 297 0 56 241
16 Ulpraz kapsul 1192 0 410 782

IX WASIR DAN SUPPOSITORIA

1 Ambeven Tablet 50 0 0 50
2 Boraginol N oint Tube 6 0 3 3
3 Borraginal N Supp supp 28 0 5 23
4 Boraginol S Supp supp 37 0 7 30
5 Boraginol S oint Tube 6 0 3 3
6 Profenid supp 11 0 0 11
7 Kalnex Tablet 92 0 15 77
8 Dulcolax Tablet 30 0 0 30
9 Dulcolax Suppo supp 18 0 0 18
10 Asamnex Tablet 30 0 0 30
11 Paracetamol supp 80mg supp 10 0 0 10
 X CARDIOVASKULAR
1 Amlodipine 10 mg Tablet 495 0 0 495
2 candesartan 8 mg Tablet 160 0 30 130
3 Clopidogrel 75 mg Tablet 0 0 0 0
4 Nifedipine 10mg Tablet 60 0 0 60
5 Furosemide 40mg Tablet 57 0 0 57
6 Aspilet 80 mg Tablet 87 0 0 87
7 Isosorbid dinitrat (ISDN) 10mg Tablet 120 0 0 120
8 Amlodipine 5 mg Tablet 435 0 0 435
9 Propanolol 10mg Tablet 100 0 0 100
0
XI ANTILIPIDEMIA 0
1 Atorvastatin 10 mg Tablet 100 0 0 100
2 Atorvastatin 20 mg Tablet 60 0 0 60

XII ANTIPIRAI
1 Allopurinol 100mg Tablet 400 0 0 400
2 Allopurinol 300mg Tablet 400 0 0 400

XIII ANTIDIABETIKA ORAL

1 Acarbose 50 mg Tablet 30 0 0 30
2 Acarbose 100 mg Tablet 185 0 0 185
3 Metformin 500mg Tablet 110 0 20 90
4 Glimepiride 2mg Tablet 177 0 10 167

XIV OBAT MATA DAN TELINGA TOPIKAL

1 Erlamycetin tetes mata Botol 3 0 0 3
2 Cendo Lyteers tetes mata Botol 22 0 2 20
3 Cendo Polynel Tetes Mata Botol 11 0 0 11
4 Cendo Xitrol tetes mata Botol 0 0 0 0
5 iliadin spray Botol 1 0 1 0
 6 Erlamycetin tetes telinga Botol 18 0 0 18
7 Otopain Tetes Telinga Botol 4 0 0 4
8 Forumen Tetes Telinga Botol 1 0 1 0
9 Cendo Xitrol Salep Mata Tube 8 0 2 6
10 Santadex tetes telinga Tube 2 0 0 2
11 Rohto cool tetes mata tube 11 0 3 8
12 Cendo Gentamicin Salep Mata Tube 0 0 0 0
13 Genoint Tetes Mata Botol 5 0 0 5
14 Cendo Vasacon A minidose strip 3 0 0 3
15 Cendo Xitrol minidose strip 15 0 4 11
16 alletrol tetes mata Botol 0 0 0 0
17 Erlamycetin plus tetes mata Botol 19 0 1 18
18 Genoint Salep Mata Tube 9 0 1 8
19 Cendo Floxa minidose strip 7 0 0 7
20 Erlamycetin salep mata tube 17 0 1 16

XV OBAT KULIT TOPIKAL

1 acyclovir Tube 13 0 1 12
2 betametasone Tube 10 0 8 2
3 bioplancenton Tube 6 0 3 3
4 burnazine Tube 1 0 1 0
5 dexosimetason (dexigen 5gr) Tube 13 0 0 13
6 Miconazole Tube 29 0 0 29
7 Ethychloride Spray PCS 0 0 0 0
8 Balsem geliga Tube 0 0 0 0
9 Hydrocortison 2,5% Tube 29 0 7 22
10 Balsem lion head Tube 0 0 0 0
11 nufacort Tube 0 0 0 0
12 Voltadex gel 20g Tube 0 0 0 0
13 Minyak Kayu putih 30ml Botol 13 0 0 13
14 Counterpain Cream 15g tube 5 0 0 5
15 Rogencin tube 14 0 0 14
16 Scabimite PCS 2 0 1 1
17 Ketoconazole PCS 24 0 4 20
18 Betason N PCS 31 0 14 17
19 Inerson Cream PCS 0 0 0 0
20 Bedak Salicyl Botol 40 0 0 40
21 Genalten cream tube 5 0 5 0
22 Hotin DCL 30g tube 12 0 2 10
23 Benoson cream 5g tube 25 0 8 17
24 Flamar gel tube 21 0 7 14
25 Minyak Kayu putih 60ml Botol 25 0 0 25
26 Thrombophop gel 20g tube 7 0 0 7
27 Counterpain cool 15g tube 20 0 0 20
28 Betadine 5ml Botol 0 0 0 0
29 Ketomed Shampo PCS 0 0 0 0
30 Callusol Sol botol 0 0 0 0

XVI OBAT TOPIKAL MULUT

1 Betadine Kumur 100 ml (gargle) Botol 14 0 13 1
2 Kandistatin Drop Botol 4 0 1 3
3 Kenalog Oral salep Tube 0 0 0 0
4 Bufacomp in oralbase Tube 16 0 13 3
5 Aloclaire plus gel 8 ml tube 2 0 0 2
6 Aloclaire Plus Mouthwash 60ml botol 4 0 0 4

XVII SEDIAAN INJEKSI

1 Epineprine injeksi Ampul 0 0 0 0
2 Lidocaine injeksi Ampul 0 0 0 0
3 Diphenhydramine Injeksi Ampul 0 0 0 0
4 Omeprazole injeksi box 0 0 0 0
5 Ventolin Ampul 0 0 0 0
6 Pulmicort Ampul 0 0 0 0
7 Pehacain injeksi Ampul 0 0 0 0
 8 Neurobion Injeksi Ampul 0 0 0 0
9 Dexamethasone injeksi Ampul 0 0 0 0
10 Atropin sulfat Injeksi Ampul 0 0 0 0
11 Buscopan injeksi Ampul 0 0 0 0
12 Antrain injeksi Ampul 0 0 0 0
14 Ondansetron injeksi Ampul 0 0 0 0
15 Ranitidine Injeksi Ampul 0 0 0 0
16 Paracetamol Infus botol 0 0 0 0

Surabaya, 31 Januari 2023

KANIT POLIKLINIK Apoteker penanggung jawab

dr. SAMODERO GUMILAR, M.Kes apt. Eka Dewi Pratiwi, S. Farm

Pembina (IV/a)
NIP. 198210072008121003

Keterangan
obat kadaluarsa
TAHUN 2023

KETERANGAN
TGL. (ED)
8

May-24
Jan-25
Sep-23
May-24
May-24
May-24
May-24
May-24
May-24
Jan-25
May-24
Sep-24
May-24
Sep-24

May-24

Oct-23

Feb-25
Feb-24
Feb-24
Feb-24
Aug-23
Sep-23
Feb-24
Feb-25
Feb-25
Sep-24
Oct-23
Sep-24
Sep-24
Sep-24
Sep-24

Feb-24
Feb-24
Feb-24
Feb-24
Jul-25
Aug-23
Feb-24
Feb-24
Feb-24
Feb-24
Aug-23
Jun-25
Feb-24
Feb-24
Feb-24
Jul-25
Jul-25
Sep-23
Sep-23
Feb-24
Feb-24
Feb-24

Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Jul-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-25
Feb-25
Feb-25
Feb-25
Feb-25

Sep-25
Sep-25
Feb-24
Jan-25
Jun-24
Mar-24
Feb-24
Feb-24
Mar-24

Feb-24
Feb-24
Feb-24
Dec-23
Feb-24
Feb-24
Oct-24
Jan-26
Jul-24
Sep-23
Sep-23
Feb-25
Dec-23
Dec-23
Feb-25
Sep-23

Feb-24
Feb-24
Feb-24
Feb-24
Jun-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Oct-24
Oct-24
Jan-24
Feb-24
Feb-24
Feb-24

Feb-24
Feb-24

Feb-24
Nov-23

Feb-24
Feb-24
Nov-23
Feb-24

Jun-24
Jun-24
Jun-24
Nov-23
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Jan-24
Jan-24

Okt -23
Jun-24
Jun-24
Jan-23
Aug-24
Jul-25
Jun-24
Jun-24
Nov-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-25
Jan-24
Jan-24
Jan-24
Jan-24
Jun-24
Jan-24
Jan-24
Jul-24
Nov-24
Jun-24

Jul-24
Jul-24
Jun-24
Jul-24
Jun-24
Jun-24

Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Nov-24
 Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24

31 Januari 2023
enanggung jawab

wi Pratiwi, S. Farm
 DAFTAR STOCK OBAT - OBATAN
KLINIK PRATAMA POLTEKBANG SURABAYA BULAN FEBRUARI TAHUN 2023

JUMLAH
NO NAMA OBAT KEMASAN SISA OBAT OBAT OBAT SISA OBAT
BULAN LALU MASUK KELUAR BULAN INI
1 2 3 4 5 6 7
I ANTIBIOTIK
1 Azythromycin 500mg Tablet 894 0 10 884
2 Cefadroxil 500mg Tablet 405 0 51 354
3 Cefixime 100mg Tablet 310 0 170 140
4 Ciprofloxacin 500mg Tablet 0 0 0 0
5 Clindamycin 300mg Tablet 430 0 1 429
6 Cotrimoxsasole Tablet 0 0 0 0
7 Co-amoxiclav Kapsul 768 0 68 700
8 Levofloksasin 500 mg Tablet 110 0 0 110
9 Primadex forte Tablet 0 0 0 0
10 Thiamphenicol 500 mg Tablet 60 0 0 60
11 Tetracyclin 500 mg Tablet 99 0 0 99
12 Coroflox 500mg Tablet 60 0 0 60
13 Leomoxyl 500mg Tablet 574 0 135 439
14 Meflosin 500mg Tablet 210 0 20 190

II ANTIFUNGI
1 Ketokonazole 200 mg Tablet 93 0 0 93

III ANTIVIRUS
1 Acyclovir 400mg Tablet 150 0 0 150

IV ANALGETIK, ANTIPIRETIK, ANTIINFLAMASI

1 Ibuprofen 400 mg Tablet 253 0 109 144
2 Cataflam Fast Powder 50mg box 111 0 36 75
3 Meloxicam 15mg Tablet 700 0 0 700
4 Meloxicam 7,5mg Tablet 766 0 55 711
5 Renadinac 50mg Tablet 652 0 92 560
6 Ponsamic 500mg Tablet 0 0 0 0
3 Cataflam 50mg Tablet 703 0 100 603
4 Merislon 12mg Tablet 170 0 20 150
5 Eperison 50 mg Tablet 834 0 35 799
4 Piroxicam 20 mg Tablet 285 0 10 275
5 Betahistin 6 mg Tablet 344 0 0 344
6 Kadiflam 50mg Tablet 1360 0 230 1130
5 Voltaren 50mg Tablet 700 0 50 650
6 Xepamol 500mg Tablet 1086 0 162 924
7 Analspec 500mg Tablet 1310 0 257 1053

V VITAMIN
1 Grahabion Tablet 0 0 0 0
2 Neuralgin Rx Tablet 238 0 78 160
3 Neurophyron V Tablet 433 0 99 334
4 Mecobalamin kapsul 300 0 0 300
5 Glucosamine Tablet 508 0 283 225
6 Caviplex CDEZ Tablet 880 0 0 880
7 Caviplex Tablet 840 0 100 740
8 Becomzet Tablet 0 0 0 0
9 L-Bio kapsul 92 0 0 92
10 Zink Tablet 150 0 16 134
11 Vitamin B6 Tablet 100 0 0 100
12 Dtrivit 1000 (Vitamin D3 1000 ) Tablet 110 0 0 110
13 Viostin DS Tablet 410 0 110 300
14 Becom C Tablet 0 0 0 0
15 Neurodex Tablet 0 0 0 0
16 Licokalk Tablet 626 0 0 626
17 Hevit C 1000mg Tablet 285 0 10 275
18 Xepaneuron Tablet 668 0 188 480
19 Gabapentin 300mg Tablet 10 0 0 10
20 Sakatonik D3 1000 Tablet 80 0 60 20
21 Morfit D3 1000 Tablet 90 0 0 90
22 Biometis Tablet 500 0 20 480

VI OBAT BATUK DAN FLU

1 Ambroxol Tablet 467 0 54 413
2 GG (Guaifenesin) Tablet 270 0 0 270
3 Bronchitin tablet 0 0 0 0
4 Demacolin Tablet 870 0 100 770
5 Salbutamol 2 mg Tablet 243 0 6 237
6 Grantusif Tablet 868 0 170 698
7 Calortusin Tablet 1510 0 721 789
8 Alphara Tablet 750 0 0 750
9 Hufagrip Tablet 1105 0 50 1055
10 N-acetylcystein Kapsul 2029 0 129 1900
11 Grathazon (Dexamethasone 0,5 mg) Tablet 1040 0 645 395
12 Flutamol tablet 1150 0 0 1150
13 Flucodin Tablet 1160 0 115 1045
14 Lapisiv-T Tablet 1224 0 530 694
15 Trifed Tablet 268 0 0 268

VII ANTI ALERGI DAN RADANG

1 Cetirizine Tablet 465 0 169 296
2 Cormetisone 4mg Tablet 1127 0 85 1042
3 Dexteem plus Tablet 565 0 69 496
4 Interhistin Tablet 380 0 0 380
5 Loratadin Tablet 595 0 28 567
6 Methyl Prednisolon 4 mg Tablet 0 0 0 0
7 Dexamethasone 0,5 mg Tablet 0 0 0 0
8 Telfast OD Tablet 50 0 50 0
 9 Histapan Tablet 300 0 20 280

VIII OBAT SALURAN CERNA

1 Buscopan Tablet 75 0 0 75
2 Buscopan Plus Tablet 130 0 130 0
3 Lansoprasole kapsul 637 0 212 425
4 Gradilex Tablet 5 0 5 0
5 New Diatabs Tablet 0 0 0 0
6 Oralit Sachet 875 0 122 753
7 Polycrol Forte Tablet 858 0 416 442
8 Omedrinat Tablet 230 0 0 230
9 Spasminal Tablet 150 0 0 150
10 Omeprazole kapsul 0 0 0 0
11 Omedom Tablet 566 0 367 199
12 Ondansetron 4mg Tablet 158 0 29 129
13 akita Tablet 450 0 280 170
14 Sucralfate Sirup Botol 0 0 0 0
15 Imodium Tablet 241 0 56 185
16 Ulpraz kapsul 782 0 106 676

IX WASIR DAN SUPPOSITORIA

1 Ambeven Tablet 50 0 0 50
2 Boraginol N oint Tube 3 0 0 3
3 Borraginal N Supp supp 23 0 8 15
4 Boraginol S Supp supp 30 0 7 23
5 Boraginol S oint Tube 3 0 0 3
6 Profenid supp 11 0 0 11
7 Kalnex Tablet 77 0 0 77
8 Dulcolax Tablet 30 0 0 30
9 Dulcolax Suppo supp 18 0 0 18
10 Asamnex Tablet 30 0 0 30
11 Paracetamol supp 80mg supp 10 0 0 10
 X CARDIOVASKULAR
1 Amlodipine 10 mg Tablet 495 0 330 165
2 candesartan 8 mg Tablet 130 0 10 120
3 Clopidogrel 75 mg Tablet 0 0 0 0
4 Nifedipine 10mg Tablet 60 0 0 60
5 Furosemide 40mg Tablet 57 0 0 57
6 Aspilet 80 mg Tablet 87 0 0 87
7 Isosorbid dinitrat (ISDN) 10mg Tablet 120 0 20 100
8 Amlodipine 5 mg Tablet 435 0 100 335
9 Propanolol 10mg Tablet 100 0 30 70
0
XI ANTILIPIDEMIA 0
1 Atorvastatin 10 mg Tablet 100 0 0 100
2 Atorvastatin 20 mg Tablet 60 0 0 60

XII ANTIPIRAI
1 Allopurinol 100mg Tablet 400 0 0 400
2 Allopurinol 300mg Tablet 400 0 0 400

XIII ANTIDIABETIKA ORAL

1 Acarbose 50 mg Tablet 30 0 0 30
2 Acarbose 100 mg Tablet 185 0 0 185
3 Metformin 500mg Tablet 90 0 10 80
4 Glimepiride 2mg Tablet 167 0 20 147

XIV OBAT MATA DAN TELINGA TOPIKAL

1 Erlamycetin tetes mata Botol 3 0 0 3
2 Cendo Lyteers tetes mata Botol 20 0 2 18
3 Cendo Polynel Tetes Mata Botol 11 0 2 9
4 Cendo Xitrol tetes mata Botol 0 0 0 0
5 iliadin spray Botol 0 0 0 0
 6 Erlamycetin tetes telinga Botol 18 0 0 18
7 Otopain Tetes Telinga Botol 4 0 0 4
8 Forumen Tetes Telinga Botol 0 0 0 0
9 Cendo Xitrol Salep Mata Tube 6 0 0 6
10 Santadex tetes telinga Tube 2 0 0 2
11 Rohto cool tetes mata tube 8 0 1 7
12 Cendo Gentamicin Salep Mata Tube 0 0 0 0
13 Genoint Tetes Mata Botol 5 0 0 5
14 Cendo Vasacon A minidose strip 3 0 0 3
15 Cendo Xitrol minidose strip 11 0 0 11
16 alletrol tetes mata Botol 0 0 0 0
17 Erlamycetin plus tetes mata Botol 18 0 0 18
18 Genoint Salep Mata Tube 8 0 2 6
19 Cendo Floxa minidose strip 7 0 0 7
20 Erlamycetin salep mata tube 16 0 0 16

XV OBAT KULIT TOPIKAL

1 acyclovir Tube 12 0 1 11
2 betametasone Tube 2 0 0 2
3 bioplancenton Tube 3 0 0 3
4 burnazine Tube 0 0 0 0
5 dexosimetason (dexigen 5gr) Tube 13 0 11 2
6 Miconazole Tube 29 0 0 29
7 Ethychloride Spray PCS 0 0 0 0
8 Balsem geliga Tube 0 0 0 0
9 Hydrocortison 2,5% Tube 22 0 4 18
10 Balsem lion head Tube 0 0 0 0
11 nufacort Tube 0 0 0 0
12 Voltadex gel 20g Tube 0 0 0 0
13 Minyak Kayu putih 30ml Botol 13 0 5 8
14 Counterpain Cream 15g tube 5 0 0 5
15 Rogencin tube 14 0 2 12
16 Scabimite PCS 1 0 1 0
17 Ketoconazole PCS 20 0 2 18
18 Betason N PCS 17 0 9 8
19 Inerson Cream PCS 0 0 0 0
20 Bedak Salicyl Botol 40 0 1 39
21 Genalten cream tube 0 0 0 0
22 Hotin DCL 30g tube 10 0 0 10
23 Benoson cream 5g tube 17 0 0 17
24 Flamar gel tube 14 0 4 10
25 Minyak Kayu putih 60ml Botol 25 0 9 16
26 Thrombophop gel 20g tube 7 0 0 7
27 Counterpain cool 15g tube 20 0 0 20
28 Betadine 5ml Botol 0 0 0 0
29 Ketomed Shampo PCS 0 0 0 0
30 Callusol Sol botol 0 0 0 0

XVI OBAT TOPIKAL MULUT

1 Betadine Kumur 100 ml (gargle) Botol 1 0 1 0
2 Kandistatin Drop Botol 3 0 0 3
3 Kenalog Oral salep Tube 0 0 0 0
4 Bufacomp in oralbase Tube 3 0 3 0
5 Aloclaire plus gel 8 ml tube 2 0 2 0
6 Aloclaire Plus Mouthwash 60ml botol 4 0 3 1

XVII SEDIAAN INJEKSI

1 Epineprine injeksi Ampul 0 0 0 0
2 Lidocaine injeksi Ampul 0 0 0 0
3 Diphenhydramine Injeksi Ampul 0 0 0 0
4 Omeprazole injeksi box 0 0 0 0
5 Ventolin Ampul 0 0 0 0
6 Pulmicort Ampul 0 0 0 0
7 Pehacain injeksi Ampul 0 0 0 0
 8 Neurobion Injeksi Ampul 0 0 0 0
9 Dexamethasone injeksi Ampul 0 0 0 0
10 Atropin sulfat Injeksi Ampul 0 0 0 0
11 Buscopan injeksi Ampul 0 0 0 0
12 Antrain injeksi Ampul 0 0 0 0
14 Ondansetron injeksi Ampul 0 0 0 0
15 Ranitidine Injeksi Ampul 0 0 0 0
16 Paracetamol Infus botol 0 0 0 0

Surabaya, 28 Februari 2023

KANIT POLIKLINIK Apoteker penanggung jawab

dr. SAMODERO GUMILAR, M.Kes apt. Eka Dewi Pratiwi, S. Farm

Pembina (IV/a)
NIP. 198210072008121003

Keterangan
obat kadaluarsa
TAHUN 2023

KETERANGAN
TGL. (ED)
8

May-24
Jan-25
Sep-23
May-24
May-24
May-24
May-24
May-24
May-24
Jan-25
May-24
Sep-24
May-24
Sep-24

May-24

Oct-23

Feb-25
Feb-24
Feb-24
Feb-24
Aug-23
Sep-23
Feb-24
Feb-25
Feb-25
Sep-24
Oct-23
Sep-24
Sep-24
Sep-24
Sep-24

Feb-24
Feb-24
Feb-24
Feb-24
Jul-25
Aug-23
Feb-24
Feb-24
Feb-24
Feb-24
Aug-23
Jun-25
Feb-24
Feb-24
Feb-24
Jul-25
Jul-25
Sep-23
Sep-23
Feb-24
Feb-24
Feb-24

Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Jul-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-25
Feb-25
Feb-25
Feb-25
Feb-25

Sep-25
Sep-25
Feb-24
Jan-25
Jun-24
Mar-24
Feb-24
Feb-24
Mar-24

Feb-24
Feb-24
Feb-24
Dec-23
Feb-24
Feb-24
Oct-24
Jan-26
Jul-24
Sep-23
Sep-23
Feb-25
Dec-23
Dec-23
Feb-25
Sep-23

Feb-24
Feb-24
Feb-24
Feb-24
Jun-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Oct-24
Oct-24
Jan-24
Feb-24
Feb-24
Feb-24

Feb-24
Feb-24

Feb-24
Nov-23

Feb-24
Feb-24
Nov-23
Feb-24

Jun-24
Jun-24
Jun-24
Nov-23
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Jan-24
Jan-24

Okt -23
Jun-24
Jun-24
Jan-23
Aug-24
Jul-25
Jun-24
Jun-24
Nov-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-25
Jan-24
Jan-24
Jan-24
Jan-24
Jun-24
Jan-24
Jan-24
Jul-24
Nov-24
Jun-24

Jul-24
Jul-24
Jun-24
Jul-24
Jun-24
Jun-24

Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Nov-24
 Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24

28 Februari 2023
enanggung jawab

wi Pratiwi, S. Farm
 DAFTAR STOCK OBAT - OBATAN
KLINIK PRATAMA POLTEKBANG SURABAYA BULAN MARET TAHUN 2023

JUMLAH
NO NAMA OBAT KEMASAN SISA OBAT OBAT OBAT SISA OBAT
BULAN LALU MASUK KELUAR BULAN INI
1 2 3 4 5 6 7
I ANTIBIOTIK
1 Azythromycin 500mg Tablet 884 0 32 852
2 Cefadroxil 500mg Tablet 354 0 104 250
3 Cefixime 100mg Tablet 140 0 40 100
4 Ciprofloxacin 500mg Tablet 0 0 0 0
5 Clindamycin 300mg Tablet 429 0 40 389
6 Cotrimoxsasole Tablet 0 0 0 0
7 Co-amoxiclav Kapsul 700 0 133 567
8 Levofloksasin 500 mg Tablet 110 0 34 76
9 Primadex forte Tablet 0 0 0 0
10 Thiamphenicol 500 mg Tablet 60 0 0 60
11 Tetracyclin 500 mg Tablet 99 0 0 99
12 Coroflox 500mg Tablet 60 0 0 60
13 Leomoxyl 500mg Tablet 439 0 0 439
14 Meflosin 500mg Tablet 190 0 70 120

II ANTIFUNGI
1 Ketokonazole 200 mg Tablet 93 0 20 73

III ANTIVIRUS
1 Acyclovir 400mg Tablet 150 0 20 130

IV ANALGETIK, ANTIPIRETIK, ANTIINFLAMASI

1 Ibuprofen 400 mg Tablet 144 0 0 144
2 Cataflam Fast Powder 50mg box 75 0 4 71
3 Meloxicam 15mg Tablet 700 0 0 700
4 Meloxicam 7,5mg Tablet 711 0 0 711
5 Renadinac 50mg Tablet 560 0 20 540
6 Ponsamic 500mg Tablet 0 0 0 0
3 Cataflam 50mg Tablet 603 0 223 380
4 Merislon 12mg Tablet 150 0 0 150
5 Eperison 50 mg Tablet 799 0 66 733
4 Piroxicam 20 mg Tablet 275 0 10 265
5 Betahistin 6 mg Tablet 344 0 16 328
6 Kadiflam 50mg Tablet 1130 0 0 1130
5 Voltaren 50mg Tablet 650 0 0 650
6 Xepamol 500mg Tablet 924 0 193 731
7 Analspec 500mg Tablet 1053 0 203 850

V VITAMIN
1 Grahabion Tablet 0 0 0 0
2 Neuralgin Rx Tablet 160 0 0 160
3 Neurophyron V Tablet 334 0 94 240
4 Mecobalamin kapsul 300 0 0 300
5 Glucosamine Tablet 225 0 45 180
6 Caviplex CDEZ Tablet 880 0 90 790
7 Caviplex Tablet 740 0 308 432
8 Becomzet Tablet 0 0 0 0
9 L-Bio kapsul 92 0 17 75
10 Zink Tablet 134 0 0 134
11 Vitamin B6 Tablet 100 0 0 100
12 Dtrivit 1000 (Vitamin D3 1000 ) Tablet 110 0 0 110
13 Viostin DS Tablet 300 0 5 295
14 Becom C Tablet 0 0 0 0
15 Neurodex Tablet 0 0 0 0
16 Licokalk Tablet 626 0 50 576
17 Hevit C 1000mg Tablet 275 0 0 275
18 Xepaneuron Tablet 480 0 84 396
19 Gabapentin 300mg Tablet 10 0 0 10
20 Sakatonik D3 1000 Tablet 20 0 0 20
21 Morfit D3 1000 Tablet 90 0 0 90
22 Biometis Tablet 480 0 70 410

VI OBAT BATUK DAN FLU

1 Ambroxol Tablet 413 0 0 413
2 GG (Guaifenesin) Tablet 270 0 20 250
3 Bronchitin tablet 0 0 0 0
4 Demacolin Tablet 770 0 540 230
5 Salbutamol 2 mg Tablet 237 0 15 222
6 Grantusif Tablet 698 0 426 272
7 Calortusin Tablet 789 0 369 420
8 Alphara Tablet 750 0 0 750
9 Hufagrip Tablet 1055 0 20 1035
10 N-acetylcystein Kapsul 1900 0 135 1765
11 Grathazon (Dexamethasone 0,5 mg) Tablet 395 0 0 395
12 Flutamol tablet 1150 0 30 1120
13 Flucodin Tablet 1045 0 115 930
14 Lapisiv-T Tablet 694 0 91 603
15 Trifed Tablet 268 0 268 0

VII ANTI ALERGI DAN RADANG

1 Cetirizine Tablet 296 0 0 296
2 Cormetisone 4mg Tablet 1042 0 0 1042
3 Dexteem plus Tablet 496 0 96 400
4 Interhistin Tablet 380 0 0 380
5 Loratadin Tablet 567 0 0 567
6 Methyl Prednisolon 4 mg Tablet 0 0 0 0
7 Dexamethasone 0,5 mg Tablet 0 0 0 0
8 Telfast OD Tablet 0 0 0 0
 9 Histapan Tablet 280 0 0 280

VIII OBAT SALURAN CERNA

1 Buscopan Tablet 75 0 0 75
2 Buscopan Plus Tablet 0 0 0 0
3 Lansoprasole kapsul 425 0 0 425
4 Gradilex Tablet 0 0 0 0
5 New Diatabs Tablet 0 0 0 0
6 Oralit Sachet 753 0 0 753
7 Polycrol Forte Tablet 442 0 442 0
8 Omedrinat Tablet 230 0 10 220
9 Spasminal Tablet 150 0 131 19
10 Omeprazole kapsul 0 0 0 0
11 Omedom Tablet 199 0 199 0
12 Ondansetron 4mg Tablet 129 0 120 9
13 akita Tablet 170 0 0 170
14 Sucralfate Sirup Botol 0 0 0 0
15 Imodium Tablet 185 0 185 0
16 Ulpraz kapsul 676 0 238 438

IX WASIR DAN SUPPOSITORIA

1 Ambeven Tablet 50 0 20 30
2 Boraginol N oint Tube 3 0 1 2
3 Borraginal N Supp supp 15 0 5 10
4 Boraginol S Supp supp 23 0 10 13
5 Boraginol S oint Tube 3 0 0 3
6 Profenid supp 11 0 1 10
7 Kalnex Tablet 77 0 0 77
8 Dulcolax Tablet 30 0 10 20
9 Dulcolax Suppo supp 18 0 0 18
10 Asamnex Tablet 30 0 0 30
11 Paracetamol supp 80mg supp 10 0 0 10
 X CARDIOVASKULAR
1 Amlodipine 10 mg Tablet 165 0 10 155
2 candesartan 8 mg Tablet 120 0 0 120
3 Clopidogrel 75 mg Tablet 0 0 0 0
4 Nifedipine 10mg Tablet 60 0 0 60
5 Furosemide 40mg Tablet 57 0 0 57
6 Aspilet 80 mg Tablet 87 0 0 87
7 Isosorbid dinitrat (ISDN) 10mg Tablet 100 0 0 100
8 Amlodipine 5 mg Tablet 335 0 110 225
9 Propanolol 10mg Tablet 70 0 0 70
0
XI ANTILIPIDEMIA 0
1 Atorvastatin 10 mg Tablet 100 0 0 100
2 Atorvastatin 20 mg Tablet 60 0 0 60

XII ANTIPIRAI
1 Allopurinol 100mg Tablet 400 0 0 400
2 Allopurinol 300mg Tablet 400 0 0 400

XIII ANTIDIABETIKA ORAL

1 Acarbose 50 mg Tablet 30 0 0 30
2 Acarbose 100 mg Tablet 185 0 0 185
3 Metformin 500mg Tablet 80 0 0 80
4 Glimepiride 2mg Tablet 147 0 30 117

XIV OBAT MATA DAN TELINGA TOPIKAL

1 Erlamycetin tetes mata Botol 3 0 1 2
2 Cendo Lyteers tetes mata Botol 18 0 2 16
3 Cendo Polynel Tetes Mata Botol 9 0 0 9
4 Cendo Xitrol tetes mata Botol 0 0 0 0
5 iliadin spray Botol 0 0 0 0
 6 Erlamycetin tetes telinga Botol 18 0 0 18
7 Otopain Tetes Telinga Botol 4 0 1 3
8 Forumen Tetes Telinga Botol 0 0 0 0
9 Cendo Xitrol Salep Mata Tube 6 0 0 6
10 Santadex tetes telinga Tube 2 0 0 2
11 Rohto cool tetes mata tube 7 0 0 7
12 Cendo Gentamicin Salep Mata Tube 0 0 0 0
13 Genoint Tetes Mata Botol 5 0 0 5
14 Cendo Vasacon A minidose strip 3 0 0 3
15 Cendo Xitrol minidose strip 11 0 2 9
16 alletrol tetes mata Botol 0 0 0 0
17 Erlamycetin plus tetes mata Botol 18 0 0 18
18 Genoint Salep Mata Tube 6 0 0 6
19 Cendo Floxa minidose strip 7 0 0 7
20 Erlamycetin salep mata tube 16 0 0 16

XV OBAT KULIT TOPIKAL

1 acyclovir Tube 11 0 2 9
2 betametasone Tube 2 0 0 2
3 bioplancenton Tube 3 0 0 3
4 burnazine Tube 0 0 0 0
5 dexosimetason (dexigen 5gr) Tube 2 0 0 2
6 Miconazole Tube 29 0 0 29
7 Ethychloride Spray PCS 0 0 0 0
8 Balsem geliga Tube 0 0 0 0
9 Hydrocortison 2,5% Tube 18 0 0 18
10 Balsem lion head Tube 0 0 0 0
11 nufacort Tube 0 0 0 0
12 Voltadex gel 20g Tube 0 0 0 0
13 Minyak Kayu putih 30ml Botol 8 0 0 8
14 Counterpain Cream 15g tube 5 0 0 5
15 Rogencin tube 12 0 3 9
16 Scabimite PCS 0 0 0 0
17 Ketoconazole PCS 18 0 3 15
18 Betason N PCS 8 0 4 4
19 Inerson Cream PCS 0 0 0 0
20 Bedak Salicyl Botol 39 0 4 35
21 Genalten cream tube 0 0 0 0
22 Hotin DCL 30g tube 10 0 3 7
23 Benoson cream 5g tube 17 0 0 17
24 Flamar gel tube 10 0 8 2
25 Minyak Kayu putih 60ml Botol 16 0 0 16
26 Thrombophop gel 20g tube 7 0 0 7
27 Counterpain cool 15g tube 20 0 8 12
28 Betadine 5ml Botol 0 0 0 0
29 Ketomed Shampo PCS 0 0 0 0
30 Callusol Sol botol 0 0 0 0

XVI OBAT TOPIKAL MULUT

1 Betadine Kumur 100 ml (gargle) Botol 0 0 0 0
2 Kandistatin Drop Botol 3 0 0 3
3 Kenalog Oral salep Tube 0 0 0 0
4 Bufacomp in oralbase Tube 0 0 0 0
5 Aloclaire plus gel 8 ml tube 0 0 0 0
6 Aloclaire Plus Mouthwash 60ml botol 1 0 0 1

XVII SEDIAAN INJEKSI

1 Epineprine injeksi Ampul 0 0 0 0
2 Lidocaine injeksi Ampul 0 0 0 0
3 Diphenhydramine Injeksi Ampul 0 0 0 0
4 Omeprazole injeksi box 0 0 0 0
5 Ventolin Ampul 0 0 0 0
6 Pulmicort Ampul 0 0 0 0
7 Pehacain injeksi Ampul 0 0 0 0
 8 Neurobion Injeksi Ampul 0 0 0 0
9 Dexamethasone injeksi Ampul 0 0 0 0
10 Atropin sulfat Injeksi Ampul 0 0 0 0
11 Buscopan injeksi Ampul 0 0 0 0
12 Antrain injeksi Ampul 0 0 0 0
14 Ondansetron injeksi Ampul 0 0 0 0
15 Ranitidine Injeksi Ampul 0 0 0 0
16 Paracetamol Infus botol 0 0 0 0

Surabaya, 31 Maret 2023

KANIT POLIKLINIK Apoteker penanggung jawab

dr. SAMODERO GUMILAR, M.Kes apt. Eka Dewi Pratiwi, S. Farm

Pembina (IV/a)
NIP. 198210072008121003

Keterangan
obat kadaluarsa
AHUN 2023

KETERANGAN
TGL. (ED)
8

May-24
Jan-25
Sep-23
May-24
May-24
May-24
May-24
May-24
May-24
Jan-25
May-24
Sep-24
May-24
Sep-24

May-24

Oct-23

Feb-25
Feb-24
Feb-24
Feb-24
Aug-23
Sep-23
Feb-24
Feb-25
Feb-25
Sep-24
Oct-23
Sep-24
Sep-24
Sep-24
Sep-24

Feb-24
Feb-24
Feb-24
Feb-24
Jul-25
Aug-23
Feb-24
Feb-24
Feb-24
Feb-24
Aug-23
Jun-25
Feb-24
Feb-24
Feb-24
Jul-25
Jul-25
Sep-23
Sep-23
Feb-24
Feb-24
Feb-24

Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Jul-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-25
Feb-25
Feb-25
Feb-25
Feb-25

Sep-25
Sep-25
Feb-24
Jan-25
Jun-24
Mar-24
Feb-24
Feb-24
Mar-24

Feb-24
Feb-24
Feb-24
Dec-23
Feb-24
Feb-24
Oct-24
Jan-26
Jul-24
Sep-23
Sep-23
Feb-25
Dec-23
Dec-23
Feb-25
Sep-23

Feb-24
Feb-24
Feb-24
Feb-24
Jun-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Oct-24
Oct-24
Jan-24
Feb-24
Feb-24
Feb-24

Feb-24
Feb-24

Feb-24
Nov-23

Feb-24
Feb-24
Nov-23
Feb-24

Jun-24
Jun-24
Jun-24
Nov-23
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Jan-24
Jan-24

Okt -23
Jun-24
Jun-24
Jan-23
Aug-24
Jul-25
Jun-24
Jun-24
Nov-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-25
Jan-24
Jan-24
Jan-24
Jan-24
Jun-24
Jan-24
Jan-24
Jul-24
Nov-24
Jun-24

Jul-24
Jul-24
Jun-24
Jul-24
Jun-24
Jun-24

Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Nov-24
 Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24

, 31 Maret 2023
enanggung jawab

wi Pratiwi, S. Farm
 DAFTAR STOCK OBAT - OBATAN
KLINIK PRATAMA POLTEKBANG SURABAYA BULAN APRIL TAHUN 2023

JUMLAH
NO NAMA OBAT KEMASAN SISA OBAT OBAT OBAT SISA OBAT
BULAN LALU MASUK KELUAR BULAN INI
1 2 3 4 5 6 7
I ANTIBIOTIK
1 Azythromycin 500mg Tablet 852 0 20 832
2 Cefadroxil 500mg Tablet 250 0 92 158
3 Cefixime 100mg Tablet 100 0 100 0
4 Ciprofloxacin 500mg Tablet 0 0 0 0
5 Clindamycin 300mg Tablet 389 0 40 349
6 Cotrimoxsasole Tablet 0 0 0 0
7 Co-amoxiclav Kapsul 567 0 34 533
8 Levofloksasin 500 mg Tablet 76 0 0 76
9 Primadex forte Tablet 0 0 0 0
10 Thiamphenicol 500 mg Tablet 60 0 10 50
11 Tetracyclin 500 mg Tablet 99 0 0 99
12 Coroflox 500mg Tablet 60 0 0 60
13 Leomoxyl 500mg Tablet 439 0 0 439
14 Meflosin 500mg Tablet 120 0 16 104

II ANTIFUNGI
1 Ketokonazole 200 mg Tablet 73 0 0 73

III ANTIVIRUS
1 Acyclovir 400mg Tablet 130 0 0 130

IV ANALGETIK, ANTIPIRETIK, ANTIINFLAMASI

1 Ibuprofen 400 mg Tablet 144 0 0 144
2 Cataflam Fast Powder 50mg box 71 0 9 62
3 Meloxicam 15mg Tablet 700 0 10 690
4 Meloxicam 7,5mg Tablet 711 0 90 621
5 Renadinac 50mg Tablet 540 0 33 507
6 Ponsamic 500mg Tablet 0 0 0 0
3 Cataflam 50mg Tablet 380 0 50 330
4 Merislon 12mg Tablet 150 0 5 145
5 Eperison 50 mg Tablet 733 0 40 693
4 Piroxicam 20 mg Tablet 265 0 0 265
5 Betahistin 6 mg Tablet 328 0 0 328
6 Kadiflam 50mg Tablet 1130 0 36 1094
5 Voltaren 50mg Tablet 650 0 0 650
6 Xepamol 500mg Tablet 731 0 227 504
7 Analspec 500mg Tablet 850 0 180 670

V VITAMIN
1 Grahabion Tablet 0 0 0 0
2 Neuralgin Rx Tablet 160 0 90 70
3 Neurophyron V Tablet 240 0 70 170
4 Mecobalamin kapsul 300 0 0 300
5 Glucosamine Tablet 180 0 80 100
6 Caviplex CDEZ Tablet 790 0 100 690
7 Caviplex Tablet 432 0 96 336
8 Becomzet Tablet 0 0 0 0
9 L-Bio kapsul 75 0 0 75
10 Zink Tablet 134 0 0 134
11 Vitamin B6 Tablet 100 0 100 0
12 Dtrivit 1000 (Vitamin D3 1000 ) Tablet 110 0 0 110
13 Viostin DS Tablet 295 0 10 285
14 Becom C Tablet 0 0 0 0
15 Neurodex Tablet 0 0 0 0
16 Licokalk Tablet 576 0 0 576
17 Hevit C 1000mg Tablet 275 0 0 275
18 Xepaneuron Tablet 396 0 126 270
19 Gabapentin 300mg Tablet 10 0 10 0
20 Sakatonik D3 1000 Tablet 20 0 0 20
21 Morfit D3 1000 Tablet 90 0 0 90
22 Biometis Tablet 410 0 20 390

VI OBAT BATUK DAN FLU

1 Ambroxol Tablet 413 0 0 413
2 GG (Guaifenesin) Tablet 250 0 0 250
3 Bronchitin tablet 0 0 0 0
4 Demacolin Tablet 230 0 100 130
5 Salbutamol 2 mg Tablet 222 0 10 212
6 Grantusif Tablet 272 0 64 208
7 Calortusin Tablet 420 0 72 348
8 Alphara Tablet 750 0 0 750
9 Hufagrip Tablet 1035 0 60 975
10 N-acetylcystein Kapsul 1765 0 0 1765
11 Grathazon (Dexamethasone 0,5 mg) Tablet 395 0 0 395
12 Flutamol tablet 1120 0 0 1120
13 Flucodin Tablet 930 0 60 870
14 Lapisiv-T Tablet 603 0 67 536
15 Trifed Tablet 0 0 0 0

VII ANTI ALERGI DAN RADANG

1 Cetirizine Tablet 296 0 106 190
2 Cormetisone 4mg Tablet 1042 0 0 1042
3 Dexteem plus Tablet 400 0 110 290
4 Interhistin Tablet 380 0 65 315
5 Loratadin Tablet 567 0 77 490
6 Methyl Prednisolon 4 mg Tablet 0 0 0 0
7 Dexamethasone 0,5 mg Tablet 0 0 0 0
8 Telfast OD Tablet 0 0 0 0
 9 Histapan Tablet 280 0 0 280

VIII OBAT SALURAN CERNA

1 Buscopan Tablet 75 0 0 75
2 Buscopan Plus Tablet 0 0 0 0
3 Lansoprasole kapsul 425 0 425 0
4 Gradilex Tablet 0 0 0 0
5 New Diatabs Tablet 0 0 0 0
6 Oralit Sachet 753 0 0 753
7 Polycrol Forte Tablet 0 0 0 0
8 Omedrinat Tablet 220 0 0 220
9 Spasminal Tablet 19 0 0 19
10 Omeprazole kapsul 0 0 0 0
11 Omedom Tablet 0 0 0 0
12 Ondansetron 4mg Tablet 9 0 0 9
13 akita Tablet 170 0 170 0
14 Sucralfate Sirup Botol 0 0 0 0
15 Imodium Tablet 0 0 0 0
16 Ulpraz kapsul 438 0 60 378

IX WASIR DAN SUPPOSITORIA

1 Ambeven Tablet 30 0 10 20
2 Boraginol N oint Tube 2 0 2 0
3 Borraginal N Supp supp 10 0 0 10
4 Boraginol S Supp supp 13 0 3 10
5 Boraginol S oint Tube 3 0 0 3
6 Profenid supp 10 0 0 10
7 Kalnex Tablet 77 0 16 61
8 Dulcolax Tablet 20 0 0 20
9 Dulcolax Suppo supp 18 0 2 16
10 Asamnex Tablet 30 0 0 30
11 Paracetamol supp 80mg supp 10 0 0 10
 X CARDIOVASKULAR
1 Amlodipine 10 mg Tablet 155 0 10 145
2 candesartan 8 mg Tablet 120 0 10 110
3 Clopidogrel 75 mg Tablet 0 0 0 0
4 Nifedipine 10mg Tablet 60 0 0 60
5 Furosemide 40mg Tablet 57 0 0 57
6 Aspilet 80 mg Tablet 87 0 0 87
7 Isosorbid dinitrat (ISDN) 10mg Tablet 100 0 0 100
8 Amlodipine 5 mg Tablet 225 0 35 190
9 Propanolol 10mg Tablet 70 0 0 70
0
XI ANTILIPIDEMIA 0
1 Atorvastatin 10 mg Tablet 100 0 0 100
2 Atorvastatin 20 mg Tablet 60 0 0 60

XII ANTIPIRAI
1 Allopurinol 100mg Tablet 400 0 0 400
2 Allopurinol 300mg Tablet 400 0 0 400

XIII ANTIDIABETIKA ORAL

1 Acarbose 50 mg Tablet 30 0 0 30
2 Acarbose 100 mg Tablet 185 0 0 185
3 Metformin 500mg Tablet 80 0 0 80
4 Glimepiride 2mg Tablet 117 0 0 117

XIV OBAT MATA DAN TELINGA TOPIKAL

1 Erlamycetin tetes mata Botol 2 0 1 1
2 Cendo Lyteers tetes mata Botol 16 0 3 13
3 Cendo Polynel Tetes Mata Botol 9 0 0 9
4 Cendo Xitrol tetes mata Botol 0 0 0 0
5 iliadin spray Botol 0 0 0 0
 6 Erlamycetin tetes telinga Botol 18 0 1 17
7 Otopain Tetes Telinga Botol 3 0 0 3
8 Forumen Tetes Telinga Botol 0 0 0 0
9 Cendo Xitrol Salep Mata Tube 6 0 0 6
10 Santadex tetes telinga Tube 2 0 0 2
11 Rohto cool tetes mata tube 7 0 4 3
12 Cendo Gentamicin Salep Mata Tube 0 0 0 0
13 Genoint Tetes Mata Botol 5 0 0 5
14 Cendo Vasacon A minidose strip 3 0 0 3
15 Cendo Xitrol minidose strip 9 0 1 8
16 alletrol tetes mata Botol 0 0 0 0
17 Erlamycetin plus tetes mata Botol 18 0 2 16
18 Genoint Salep Mata Tube 6 0 0 6
19 Cendo Floxa minidose strip 7 0 0 7
20 Erlamycetin salep mata tube 16 0 1 15

XV OBAT KULIT TOPIKAL

1 acyclovir Tube 9 0 0 9
2 betametasone Tube 2 0 0 2
3 bioplancenton Tube 3 0 0 3
4 burnazine Tube 0 0 0 0
5 dexosimetason (dexigen 5gr) Tube 2 0 2 0
6 Miconazole Tube 29 0 0 29
7 Ethychloride Spray PCS 0 0 0 0
8 Balsem geliga Tube 0 0 0 0
9 Hydrocortison 2,5% Tube 18 0 1 17
10 Balsem lion head Tube 0 0 0 0
11 nufacort Tube 0 0 0 0
12 Voltadex gel 20g Tube 0 0 0 0
13 Minyak Kayu putih 30ml Botol 8 0 4 4
14 Counterpain Cream 15g tube 5 0 0 5
15 Rogencin tube 9 0 4 5
16 Scabimite PCS 0 0 0 0
17 Ketoconazole PCS 15 0 1 14
18 Betason N PCS 4 0 1 3
19 Inerson Cream PCS 0 0 0 0
20 Bedak Salicyl Botol 35 0 2 33
21 Genalten cream tube 0 0 0 0
22 Hotin DCL 30g tube 7 0 1 6
23 Benoson cream 5g tube 17 0 0 17
24 Flamar gel tube 2 0 1 1
25 Minyak Kayu putih 60ml Botol 16 0 0 16
26 Thrombophop gel 20g tube 7 0 0 7
27 Counterpain cool 15g tube 12 0 3 9
28 Betadine 5ml Botol 0 0 0 0
29 Ketomed Shampo PCS 0 0 0 0
30 Callusol Sol botol 0 0 0 0

XVI OBAT TOPIKAL MULUT

1 Betadine Kumur 100 ml (gargle) Botol 0 0 0 0
2 Kandistatin Drop Botol 3 0 0 3
3 Kenalog Oral salep Tube 0 0 0 0
4 Bufacomp in oralbase Tube 0 0 0 0
5 Aloclaire plus gel 8 ml tube 0 0 0 0
6 Aloclaire Plus Mouthwash 60ml botol 1 0 0 1

XVII SEDIAAN INJEKSI

1 Epineprine injeksi Ampul 0 0 0 0
2 Lidocaine injeksi Ampul 0 0 0 0
3 Diphenhydramine Injeksi Ampul 0 0 0 0
4 Omeprazole injeksi box 0 0 0 0
5 Ventolin Ampul 0 0 0 0
6 Pulmicort Ampul 0 0 0 0
7 Pehacain injeksi Ampul 0 0 0 0
 8 Neurobion Injeksi Ampul 0 0 0 0
9 Dexamethasone injeksi Ampul 0 0 0 0
10 Atropin sulfat Injeksi Ampul 0 0 0 0
11 Buscopan injeksi Ampul 0 0 0 0
12 Antrain injeksi Ampul 0 0 0 0
14 Ondansetron injeksi Ampul 0 0 0 0
15 Ranitidine Injeksi Ampul 0 0 0 0
16 Paracetamol Infus botol 0 0 0 0

Surabaya, 30 April 2023

KANIT POLIKLINIK Apoteker penanggung jawab

dr. SAMODERO GUMILAR, M.Kes apt. Eka Dewi Pratiwi, S. Farm

Pembina (IV/a)
NIP. 198210072008121003

Keterangan
obat kadaluarsa
AHUN 2023

KETERANGAN
TGL. (ED)
8

May-24
Jan-25
Jan-25
May-24
May-24
May-24
May-24
May-24
May-24
Jan-25
May-24
Sep-24
May-24
Sep-24

May-24

Oct-23

Feb-25
Feb-24
Feb-24
Feb-24
Aug-23
Sep-23
Feb-24
Feb-25
Feb-25
Sep-24
Oct-23
Sep-24
Sep-24
Sep-24
Sep-24

Feb-24
Feb-24
Feb-24
Feb-24
Jul-25
Aug-23
Feb-24
Feb-24
Feb-24
Feb-24
Aug-23
Jun-25
Feb-24
Feb-24
Feb-24
Jul-25
Jul-25
Sep-23
Sep-23
Feb-24
Feb-24
Feb-24

Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Jul-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-25
Feb-25
Feb-25
Feb-25
Feb-25

Sep-25
Sep-25
Feb-24
Jan-25
Jun-24
Mar-24
Feb-24
Feb-24
Mar-24

Feb-24
Feb-24
Feb-24
Dec-23
Feb-24
Feb-24
Oct-24
Jan-26
Jul-24
Sep-23
Sep-23
Feb-25
Dec-23
Dec-23
Feb-25
Sep-23

Feb-24
Feb-24
Feb-24
Feb-24
Jun-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Oct-24
Oct-24
Jan-24
Feb-24
Feb-24
Feb-24

Feb-24
Feb-24

Feb-24
Nov-23

Feb-24
Feb-24
Nov-23
Feb-24

Jun-24
Jun-24
Jun-24
Nov-23
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Jan-24
Jan-24

Okt -23
Jun-24
Jun-24
Jan-23
Aug-24
Jul-25
Jun-24
Jun-24
Nov-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-25
Jan-24
Jan-24
Jan-24
Jan-24
Jun-24
Jan-24
Jan-24
Jul-24
Nov-24
Jun-24

Jul-24
Jul-24
Jun-24
Jul-24
Jun-24
Jun-24

Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Nov-24
 Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24

a, 30 April 2023
enanggung jawab

wi Pratiwi, S. Farm
 DAFTAR STOCK OBAT - OBATAN
KLINIK PRATAMA POLTEKBANG SURABAYA BULAN MEI TAHUN 2023

JUMLAH
NO NAMA OBAT KEMASAN SISA OBAT OBAT OBAT SISA OBAT
BULAN LALU MASUK KELUAR BULAN INI
1 2 3 4 5 6 7
I ANTIBIOTIK
1 Azythromycin 500mg Tablet 832 0 3 829
2 Cefadroxil 500mg Tablet 158 0 158 0
3 Cefixime 100mg Tablet 0 0 0 0
4 Ciprofloxacin 500mg Tablet 0 0 0 0
5 Clindamycin 300mg Tablet 349 0 54 295
6 Cotrimoxsasole Tablet 0 0 0 0
7 Co-amoxiclav Kapsul 533 0 92 441
8 Levofloksasin 500 mg Tablet 76 0 3 73
9 Primadex forte Tablet 0 400 400 0
10 Thiamphenicol 500 mg Tablet 50 0 0 50
11 Tetracyclin 500 mg Tablet 99 0 0 99
12 Coroflox 500mg Tablet 60 0 0 60
13 Leomoxyl 500mg Tablet 439 0 108 331
14 Meflosin 500mg Tablet 104 0 41 63
15 Tisacef Tablet 0 0 0 0

II ANTIFUNGI
1 Ketokonazole 200 mg Tablet 73 0 0 73

III ANTIVIRUS
1 Acyclovir 400mg Tablet 130 0 0 130

IV ANALGETIK, ANTIPIRETIK, ANTIINFLAMASI

1 Ibuprofen 400 mg Tablet 144 0 24 120
2 Cataflam Fast Powder 50mg box 62 0 13 49
3 Meloxicam 15mg Tablet 690 0 100 590
4 Meloxicam 7,5mg Tablet 621 0 20 601
5 Renadinac 50mg Tablet 507 0 52 455
6 Ponsamic 500mg Tablet 0 0 0 0
3 Cataflam 50mg Tablet 330 0 75 255
4 Merislon 12mg Tablet 145 0 10 135
5 Eperison 50 mg Tablet 693 0 53 640
4 Piroxicam 20 mg Tablet 265 0 10 255
5 Betahistin 6 mg Tablet 328 0 5 323
6 Kadiflam 50mg Tablet 1094 0 80 1014
5 Voltaren 50mg Tablet 650 0 40 610
6 Xepamol 500mg Tablet 504 0 401 103
7 Analspec 500mg Tablet 670 0 145 525

V VITAMIN
1 Grahabion Tablet 0 0 0 0
2 Neuralgin Rx Tablet 70 0 70 0
3 Neurophyron V Tablet 170 0 115 55
4 Mecobalamin kapsul 300 0 10 290
5 Glucosamine Tablet 100 0 60 40
6 Caviplex CDEZ Tablet 690 0 115 575
7 Caviplex Tablet 336 0 156 180
8 Becomzet Tablet 0 0 0 0
9 L-Bio kapsul 75 0 75 0
10 Zink Tablet 134 0 134 0
11 Vitamin B6 Tablet 0 0 0 0
12 Dtrivit 1000 (Vitamin D3 1000 ) Tablet 110 0 0 110
13 Viostin DS Tablet 285 0 20 265
14 Becom C Tablet 0 0 0 0
15 Neurodex Tablet 0 0 0 0
16 Licokalk Tablet 576 0 0 576
17 Hevit C 1000mg Tablet 275 0 25 250
18 Xepaneuron Tablet 270 0 175 95
19 Gabapentin 300mg Tablet 0 0 0 0
20 Sakatonik D3 1000 Tablet 20 0 0 20
21 Morfit D3 1000 Tablet 90 0 0 90
22 Biometis Tablet 390 0 35 355
23 Cal-95 Tablet 0 150 18 132

VI OBAT BATUK DAN FLU

1 Ambroxol Tablet 413 0 134 279
2 GG (Guaifenesin) Tablet 250 0 10 240
3 Bronchitin tablet 0 0 0 0
4 Demacolin Tablet 130 0 130 0
5 Salbutamol 2 mg Tablet 212 0 20 192
6 Grantusif Tablet 208 0 80 128
7 Calortusin Tablet 348 0 261 87
8 Alphara Tablet 750 0 0 750
9 Hufagrip Tablet 975 0 30 945
10 N-acetylcystein Kapsul 1765 0 99 1666
11 Grathazon (Dexamethasone 0,5 mg) Tablet 395 0 395 0
12 Flutamol tablet 1120 0 57 1063
13 Flucodin Tablet 870 0 170 700
14 Lapisiv-T Tablet 536 0 100 436
15 Trifed Tablet 0 500 500 0

VII ANTI ALERGI DAN RADANG

1 Cetirizine Tablet 190 0 174 16
2 Cormetisone 4mg Tablet 1042 0 207 835
3 Dexteem plus Tablet 290 0 74 216
4 Interhistin Tablet 315 0 20 295
5 Loratadin Tablet 490 0 0 490
6 Methyl Prednisolon 4 mg Tablet 0 0 0 0
 7 Dexamethasone 0,5 mg Tablet 0 0 0 0
8 Telfast OD Tablet 0 0 0 0
9 Histapan Tablet 280 0 0 280

VIII OBAT SALURAN CERNA

1 Buscopan Tablet 75 0 0 75
2 Buscopan Plus Tablet 0 0 0 0
3 Lansoprasole kapsul 0 800 800 0
4 Gradilex Tablet 0 0 0 0
5 New Diatabs Tablet 0 0 0 0
6 Oralit Sachet 753 0 593 160
7 Polycrol Forte Tablet 0 0 0 0
8 Omedrinat Tablet 220 0 0 220
9 Spasminal Tablet 19 0 19 0
10 Omeprazole kapsul 0 0 0 0
11 Omedom Tablet 0 0 0 0
12 Ondansetron 4mg Tablet 9 0 9 0
13 akita Tablet 0 0 0 0
14 Sucralfate Sirup Botol 0 55 55 0
15 Imodium Tablet 0 0 0 0
16 Ulpraz kapsul 378 0 98 280

IX WASIR DAN SUPPOSITORIA

1 Ambeven Tablet 20 0 0 20
2 Boraginol N oint Tube 0 0 0 0
3 Borraginal N Supp supp 10 0 0 10
4 Boraginol S Supp supp 10 0 0 10
5 Boraginol S oint Tube 3 0 1 2
6 Profenid supp 10 0 0 10
7 Kalnex Tablet 61 0 20 41
8 Dulcolax Tablet 20 0 0 20
9 Dulcolax Suppo supp 16 0 0 16
10 Asamnex Tablet 30 0 0 30
11 Paracetamol supp 80mg supp 10 0 0 10

X CARDIOVASKULAR
1 Amlodipine 10 mg Tablet 145 0 20 125
2 candesartan 8 mg Tablet 110 0 12 98
3 Clopidogrel 75 mg Tablet 0 0 0 0
4 Nifedipine 10mg Tablet 60 0 0 60
5 Furosemide 40mg Tablet 57 0 0 57
6 Aspilet 80 mg Tablet 87 0 0 87
7 Isosorbid dinitrat (ISDN) 10mg Tablet 100 0 0 100
8 Amlodipine 5 mg Tablet 190 0 60 130
9 Propanolol 10mg Tablet 70 0 0 70
0
XI ANTILIPIDEMIA 0
1 Atorvastatin 10 mg Tablet 100 0 0 100
2 Atorvastatin 20 mg Tablet 60 0 0 60

XII ANTIPIRAI
1 Allopurinol 100mg Tablet 400 0 0 400
2 Allopurinol 300mg Tablet 400 0 0 400

XIII ANTIDIABETIKA ORAL

1 Acarbose 50 mg Tablet 30 0 0 30
2 Acarbose 100 mg Tablet 185 0 0 185
3 Metformin 500mg Tablet 80 0 0 80
4 Glimepiride 2mg Tablet 117 0 10 107

XIV OBAT MATA DAN TELINGA TOPIKAL

1 Erlamycetin tetes mata Botol 1 0 0 1
2 Cendo Lyteers tetes mata Botol 13 0 0 13
3 Cendo Polynel Tetes Mata Botol 9 0 0 9
 4 Cendo Xitrol tetes mata Botol 0 0 0 0
5 iliadin spray Botol 0 0 0 0
6 Erlamycetin tetes telinga Botol 17 0 1 16
7 Otopain Tetes Telinga Botol 3 0 0 3
8 Forumen Tetes Telinga Botol 0 0 0 0
9 Cendo Xitrol Salep Mata Tube 6 0 0 6
10 Santadex tetes telinga Tube 2 0 0 2
11 Rohto cool tetes mata tube 3 0 1 2
12 Cendo Gentamicin Salep Mata Tube 0 0 0 0
13 Genoint Tetes Mata Botol 5 0 0 5
14 Cendo Vasacon A minidose strip 3 0 2 1
15 Cendo Xitrol minidose strip 8 0 3 5
16 alletrol tetes mata Botol 0 0 0 0
17 Erlamycetin plus tetes mata Botol 16 0 0 16
18 Genoint Salep Mata Tube 6 0 2 4
19 Cendo Floxa minidose strip 7 0 5 2
20 Erlamycetin salep mata tube 15 0 0 15

XV OBAT KULIT TOPIKAL

1 acyclovir Tube 9 0 1 8
2 betametasone Tube 2 0 0 2
3 bioplancenton Tube 3 0 0 3
4 burnazine Tube 0 0 0 0
5 dexosimetason (dexigen 5gr) Tube 0 0 0 0
6 Miconazole Tube 29 0 0 29
7 Ethychloride Spray PCS 0 0 0 0
8 Balsem geliga Tube 0 0 0 0
9 Hydrocortison 2,5% Tube 17 0 2 15
10 Balsem lion head Tube 0 0 0 0
11 nufacort Tube 0 0 0 0
12 Voltadex gel 20g Tube 0 0 0 0
13 Minyak Kayu putih 30ml Botol 4 0 0 4
14 Counterpain Cream 15g tube 5 0 0 5
15 Rogencin tube 5 0 1 4
16 Scabimite PCS 0 0 0 0
17 Ketoconazole PCS 14 0 0 14
18 Betason N PCS 3 0 2 1
19 Inerson Cream PCS 0 0 0 0
20 Bedak Salicyl Botol 33 0 4 29
21 Genalten cream tube 0 0 0 0
22 Hotin DCL 30g tube 6 0 5 1
23 Benoson cream 5g tube 17 0 1 16
24 Flamar gel tube 1 0 1 0
25 Minyak Kayu putih 60ml Botol 16 0 0 16
26 Thrombophop gel 20g tube 7 0 0 7
27 Counterpain cool 15g tube 9 0 4 5
28 Betadine 5ml Botol 0 0 0 0
29 Ketomed Shampo PCS 0 0 0 0
30 Callusol Sol botol 0 0 0 0

XVI OBAT TOPIKAL MULUT

1 Betadine Kumur 100 ml (gargle) Botol 0 0 0 0
2 Kandistatin Drop Botol 3 0 0 3
3 Kenalog Oral salep Tube 0 0 0 0
4 Bufacomp in oralbase Tube 0 0 0 0
5 Aloclaire plus gel 8 ml tube 0 0 0 0
6 Aloclaire Plus Mouthwash 60ml botol 1 0 0 1

XVII SEDIAAN INJEKSI

1 Epineprine injeksi Ampul 0 0 0 0
2 Lidocaine injeksi Ampul 0 0 0 0
3 Diphenhydramine Injeksi Ampul 0 0 0 0
4 Omeprazole injeksi box 0 30 30 0
5 Ventolin Ampul 0 0 0 0
 6 Pulmicort Ampul 0 0 0 0
7 Pehacain injeksi Ampul 0 0 0 0
8 Neurobion Injeksi Ampul 0 0 0 0
9 Dexamethasone injeksi Ampul 0 0 0 0
10 Atropin sulfat Injeksi Ampul 0 0 0 0
11 Buscopan injeksi Ampul 0 0 0 0
12 Antrain injeksi Ampul 0 0 0 0
14 Ondansetron injeksi Ampul 0 0 0 0
15 Ranitidine Injeksi Ampul 0 0 0 0
16 Paracetamol Infus botol 0 0 0 0

Surabaya, 31 Mei 2023

KANIT POLIKLINIK Apoteker penanggung jawab

dr. SAMODERO GUMILAR, M.Kes apt. Eka Dewi Pratiwi, S. Farm

Pembina (IV/a)
NIP. 198210072008121003

Keterangan
obat kadaluarsa
HUN 2023

KETERANGAN
TGL. (ED)
8

May-24
Jan-25
Jan-25
May-24
May-24
May-24
May-24
May-24
May-24
Jan-25
May-24
Sep-24
May-24
Sep-24
Sep-24

May-24

Oct-23

Feb-25
Feb-24
Feb-24
Feb-24
Aug-23
Sep-23
Feb-24
Feb-25
Feb-25
Sep-24
Oct-23
Sep-24
Sep-24
Sep-24
Sep-24

Feb-24
Feb-24
Feb-24
Feb-24
Jul-25
Aug-23
Feb-24
Feb-24
Feb-24
Feb-24
Aug-23
Jun-25
Feb-24
Feb-24
Feb-24
Jul-25
Jul-25
Sep-23
Sep-23
Feb-24
Feb-24
Feb-24
Feb-24

Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Jul-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-25
Feb-25
Feb-25
Feb-25
Feb-25

Sep-25
Sep-25
Feb-24
Jan-25
Jun-24
Mar-24
Feb-24
Feb-24
Mar-24

Feb-24
Feb-24
Feb-24
Dec-23
Feb-24
Feb-24
Oct-24
Jan-26
Jul-24
Sep-23
Sep-23
Feb-25
Dec-23
Dec-23
Feb-25
Sep-23

Feb-24
Feb-24
Feb-24
Feb-24
Jun-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24

Feb-24
Feb-24
Feb-24
Oct-24
Oct-24
Jan-24
Feb-24
Feb-24
Feb-24

Feb-24
Feb-24

Feb-24
Nov-23

Feb-24
Feb-24
Nov-23
Feb-24

Jun-24
Jun-24
Jun-24
Nov-23
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Jan-24
Jan-24

Okt -23
Jun-24
Jun-24
Jan-23
Aug-24
Jul-25
Jun-24
Jun-24
Nov-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-25
Jan-24
Jan-24
Jan-24
Jan-24
Jun-24
Jan-24
Jan-24
Jul-24
Nov-24
Jun-24

Jul-24
Jul-24
Jun-24
Jul-24
Jun-24
Jun-24

Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
 Jan-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24

a, 31 Mei 2023
enanggung jawab

wi Pratiwi, S. Farm
 DAFTAR STOCK OBAT - OBATAN
KLINIK PRATAMA POLTEKBANG SURABAYA BULAN JUNI TAHUN 2023

JUMLAH
NO NAMA OBAT KEMASAN SISA OBAT OBAT OBAT SISA OBAT
BULAN LALU MASUK KELUAR BULAN INI
1 2 3 4 5 6 7
I ANTIBIOTIK
1 Azythromycin 500mg Tablet 829 0 26 803
2 Cefadroxil 500mg Tablet 0 0 0 0
3 Cefixime 100mg Tablet 0 100 50 50
4 Ciprofloxacin 500mg Tablet 0 0 0 0
5 Clindamycin 300mg Tablet 295 0 70 225
6 Cotrimoxsasole Tablet 0 0 0 0
7 Co-amoxiclav Kapsul 441 0 60 381
8 Levofloksasin 500 mg Tablet 73 0 0 73
9 Primadex forte Tablet 0 200 90 110
10 Thiamphenicol 500 mg Tablet 50 0 30 20
11 Tetracyclin 500 mg Tablet 99 0 0 99
12 Coroflox 500mg Tablet 60 0 0 60
13 Leomoxyl 500mg Tablet 331 0 40 291
14 Meflosin 500mg Tablet 63 0 63 0
15 Tisacef 500mg Tablet 0 300 94 206
16 Clavomet Tablet 0 60 0 60

II ANTIFUNGI
1 Ketokonazole 200 mg Tablet 73 100 15 158

III ANTIVIRUS
1 Acyclovir 400mg Tablet 130 0 0 130

IV ANALGETIK, ANTIPIRETIK, ANTIINFLAMASI

1 Ibuprofen 400 mg Tablet 120 100 0 220
2 Cataflam Fast Powder 50mg box 49 0 12 37
3 Meloxicam 15mg Tablet 590 0 0 590
4 Meloxicam 7,5mg Tablet 601 0 140 461
5 Renadinac 50mg Tablet 455 0 31 424
6 Ponsamic 500mg Tablet 0 0 0 0
3 Cataflam 50mg Tablet 255 0 64 191
4 Merislon 12mg Tablet 135 0 0 135
5 Eperison 50 mg Tablet 640 0 22 618
4 Piroxicam 20 mg Tablet 255 0 0 255
5 Betahistin 6 mg Tablet 323 0 0 323
6 Kadiflam 50mg Tablet 1014 0 109 905
5 Voltaren 50mg Tablet 610 0 42 568
6 Xepamol 500mg Tablet 103 300 135 268
7 Analspec 500mg Tablet 525 0 90 435

V VITAMIN
1 Grahabion Tablet 0 0 0 0
2 Neuralgin Rx Tablet 0 100 32 68
3 Neurophyron V Tablet 55 0 0 55
4 Mecobalamin kapsul 290 100 10 380
5 Glucosamine Tablet 40 0 40 0
6 Caviplex CDEZ Tablet 575 0 105 470
7 Caviplex Tablet 180 0 75 105
8 Becomzet Tablet 0 0 0 0
9 L-Bio kapsul 0 0 0 0
10 Zink Tablet 0 200 65 135
11 Vitamin B6 Tablet 0 0 0 0
12 Dtrivit 1000 (Vitamin D3 1000 ) Tablet 110 0 80 30
13 Viostin DS Tablet 265 0 5 260
14 Becom C Tablet 0 0 0 0
15 Neurodex Tablet 0 0 0 0
16 Licokalk Tablet 576 0 0 576
17 Hevit C 1000mg Tablet 250 0 90 160
18 Xepaneuron Tablet 95 200 55 240
19 Gabapentin 300mg Tablet 0 0 0 0
20 Sakatonik D3 1000 Tablet 20 0 0 20
21 Morfit D3 1000 Tablet 90 0 0 90
22 Biometis Tablet 355 0 60 295
23 Cal-95 Tablet 132 0 12 120
24 Curcuma force Tablet 0 120 0 120

VI OBAT BATUK DAN FLU

1 Ambroxol Tablet 279 100 8 371
2 GG (Guaifenesin) Tablet 240 0 0 240
3 Bronchitin tablet 0 0 0 0
4 Demacolin Tablet 0 0 0 0
5 Salbutamol 2 mg Tablet 192 0 100 92
6 Grantusif Tablet 128 0 108 20
7 Calortusin Tablet 87 0 65 22
8 Alphara Tablet 750 0 30 720
9 Hufagrip Tablet 945 0 60 885
10 N-acetylcystein Kapsul 1666 0 0 1666
11 Trifed Tablet 0 0 0 0
12 Flutamol tablet 1063 0 72 991
13 Flucodin Tablet 700 0 149 551
14 Lapisiv-T Tablet 436 0 29 407
15 Bronex 8mg Tablet 0 100 20 80

VII ANTI ALERGI DAN RADANG

1 Cetirizine Tablet 16 100 116 0
2 Cormetisone 4mg Tablet 835 600 355 1080
3 Dexteem plus Tablet 216 0 0 216
4 Interhistin Tablet 295 0 0 295
 5 Loratadin Tablet 490 0 230 260
6 Methyl Prednisolon 4 mg Tablet 0 0 0 0
7 Dexamethasone 0,5 mg Tablet 0 0 0 0
8 Telfast OD Tablet 0 0 0 0
9 Histapan Tablet 280 0 0 280
10 Methyl Prednisolon 8mg Tablet 0 100 0 100
11 Grathazon (Dexamethasone 0,5 mg) Tablet 0 600 74 526

VIII OBAT SALURAN CERNA

1 Buscopan Tablet 75 0 15 60
2 Buscopan Plus Tablet 0 100 93 7
3 Lansoprasole kapsul 0 1600 215 1385
4 Gradilex Tablet 0 0 0 0
5 New Diatabs Tablet 0 0 0 0
6 Oralit Sachet 160 500 24 636
7 Polycrol Forte Tablet 0 1920 760 1160
8 Omedrinat Tablet 220 0 0 220
9 Spasminal Tablet 0 0 0 0
10 Omeprazole kapsul 0 0 0 0
11 Omedom Tablet 0 800 176 624
12 Ondansetron 4mg Tablet 0 150 99 51
13 akita Tablet 0 600 326 274
14 Sucralfate Sirup Botol 0 30 13 17
15 Imodium Tablet 0 0 0 0
16 Ulpraz kapsul 280 0 96 184
17 Lopamid Tablet 0 700 264 436
18 Xepazym Tablet 0 240 30 210

IX WASIR DAN SUPPOSITORIA

1 Ambeven Tablet 20 0 0 20
2 Boraginol N oint Tube 0 0 0 0
3 Borraginal N Supp supp 10 0 0 10
 4 Boraginol S Supp supp 10 0 0 10
5 Boraginol S oint Tube 2 0 1 1
6 Profenid supp 10 10 10 10
7 Kalnex Tablet 41 0 0 41
8 Dulcolax Tablet 20 0 0 20
9 Dulcolax Suppo supp 16 0 0 16
10 Asamnex Tablet 30 0 0 30
11 Paracetamol supp 80mg supp 10 0 0 10

X CARDIOVASKULAR
1 Amlodipine 10 mg Tablet 125 0 10 115
2 candesartan 8 mg Tablet 98 0 18 80
3 Clopidogrel 75 mg Tablet 0 0 0 0
4 Nifedipine 10mg Tablet 60 0 20 40
5 Furosemide 40mg Tablet 57 0 0 57
6 Aspilet 80 mg Tablet 87 0 0 87
7 Isosorbid dinitrat (ISDN) 10mg Tablet 100 0 10 90
8 Amlodipine 5 mg Tablet 130 0 50 80
9 Propanolol 10mg Tablet 70 0 0 70

XI ANTILIPIDEMIA
1 Atorvastatin 10 mg Tablet 100 0 60 40
2 Atorvastatin 20 mg Tablet 60 0 50 10

XII ANTIPIRAI
1 Allopurinol 100mg Tablet 400 0 0 400
2 Allopurinol 300mg Tablet 400 0 0 400

XIII ANTIDIABETIKA ORAL

1 Acarbose 50 mg Tablet 30 0 0 30
2 Acarbose 100 mg Tablet 185 0 0 185
3 Metformin 500mg Tablet 80 200 115 165
4 Glimepiride 2mg Tablet 107 0 67 40

XIV OBAT MATA DAN TELINGA TOPIKAL

1 Erlamycetin tetes mata Botol 1 0 0 1
2 Cendo Lyteers tetes mata Botol 13 0 1 12
3 Cendo Polynel Tetes Mata Botol 9 0 0 9
4 Cendo Xitrol tetes mata Botol 0 0 0 0
5 iliadin spray Botol 0 3 0 3
6 Erlamycetin tetes telinga Botol 16 0 1 15
7 Otopain Tetes Telinga Botol 3 0 0 3
8 Forumen Tetes Telinga Botol 0 0 0 0
9 Cendo Xitrol Salep Mata Tube 6 4 1 9
10 Santadex tetes telinga Tube 2 0 0 2
11 Rohto cool tetes mata tube 2 0 1 1
12 Cendo Gentamicin Salep Mata Tube 0 0 0 0
13 Genoint Tetes Mata Botol 5 0 0 5
14 Cendo Vasacon A minidose strip 1 0 0 1
15 Cendo Xitrol minidose strip 5 2 2 5
16 alletrol tetes mata Botol 0 0 0 0
17 Erlamycetin plus tetes mata Botol 16 0 5 11
18 Genoint Salep Mata Tube 4 0 1 3
19 Cendo Floxa minidose strip 2 0 0 2
20 Erlamycetin salep mata tube 15 0 2 13

XV OBAT KULIT TOPIKAL

1 acyclovir Tube 8 0 1 7
2 betametasone Tube 2 5 6 1
3 bioplancenton Tube 3 2 1 4
4 burnazine Tube 0 1 0 1
5 dexosimetason (dexigen 5gr) Tube 0 7 7 0
6 Miconazole Tube 29 0 0 29
7 Ethychloride Spray PCS 0 0 0 0
 8 Balsem geliga Tube 0 0 0 0
9 Hydrocortison 2,5% Tube 15 0 2 13
10 Balsem lion head Tube 0 0 0 0
11 nufacort krim Tube 0 5 0 5
12 Voltadex gel 20g Tube 0 0 0 0
13 Minyak Kayu putih 30ml Botol 4 0 0 4
14 Counterpain Cream 15g tube 5 5 5 5
15 Rogencin tube 4 0 1 3
16 Scabimite PCS 0 2 2 0
17 Ketoconazole PCS 14 0 1 13
18 Betason N PCS 1 5 6 0
19 Inerson Cream PCS 0 0 0 0
20 Bedak Salicyl Botol 29 0 1 28
21 Genalten cream tube 0 0 0 0
22 Hotin DCL 30g tube 1 0 1 0
23 Benoson cream 5g tube 16 0 0 16
24 Flamar gel tube 0 0 0 0
25 Minyak Kayu putih 60ml Botol 16 0 0 16
26 Thrombophop gel 20g tube 7 0 0 7
27 Counterpain cool 15g tube 5 0 0 5
28 Betadine 5ml Botol 0 0 0 0
29 Ketomed Shampo PCS 0 0 0 0
30 Callusol Sol botol 0 2 2 0
31 Daryantulle lembar 0 20 3 17
32 nebacetin powder botol 0 2 0 2
33 Erlaneohidrocort krim Tube 0 10 5 5
33 Magic Power tissue pcs 0 12 12 0
34 Emla krim 5g tube 0 2 0 2

XVI OBAT TOPIKAL MULUT

1 Betadine Kumur 100 ml (gargle) Botol 0 20 0 20
2 Kandistatin Drop Botol 3 0 0 3
 3 Kenalog Oral salep Tube 0 0 0 0
4 Bufacomp in oralbase Tube 0 0 0 0
5 Aloclaire plus gel 8 ml tube 0 2 1 1
6 Aloclaire Plus Mouthwash 60ml botol 1 2 0 3
7 Ketricin in oralbase Tube 0 15 8 7

XVII SEDIAAN INJEKSI

1 Epineprine injeksi Ampul 0 0 0 0
2 Lidocaine injeksi Ampul 0 0 0 0
3 Diphenhydramine Injeksi Ampul 0 0 0 0
4 Omeprazole injeksi box 0 5 5 0
5 Ventolin Ampul 0 20 10 10
6 Pulmicort Ampul 0 0 0 0
7 Pehacain injeksi Ampul 0 0 0 0
8 Neurobion Injeksi Ampul 0 0 0 0
9 Dexamethasone injeksi Ampul 0 0 0 0
10 Atropin sulfat Injeksi Ampul 0 0 0 0
11 Buscopan injeksi Ampul 0 0 0 0
12 Antrain injeksi Ampul 0 5 5 0
14 Ondansetron injeksi Ampul 0 0 0 0
15 Ranitidine Injeksi Ampul 0 0 0 0
16 Paracetamol Infus botol 0 0 0 0
17 Fitomenadion (vitamin K1) 2mg/ml Ampul 0 5 0 5

Surabaya, 30 Juni 2023

KANIT POLIKLINIK Apoteker penanggung jawab

dr. SAMODERO GUMILAR, M.Kes apt. Eka Dewi Pratiwi, S. Farm

Pembina (IV/a)
 NIP. 198210072008121003

Keterangan
obat kadaluarsa
HUN 2023

KETERANGAN
TGL. (ED)
8

May-24
Jan-25
Jan-25
May-24
May-24
May-24
May-24
May-24
May-24
Jan-25
May-24
Sep-24
May-24
Sep-24
Sep-24
Sep-24

May-24

Oct-23
Feb-25
Feb-24
Feb-24
Feb-24
Aug-23
Sep-23
Feb-24
Feb-25
Feb-25
Sep-24
Oct-23
Sep-24
Sep-24
Sep-24
Sep-24

Feb-24
Feb-24
Feb-24
Feb-24
Jul-25
Aug-23
Feb-24
Feb-24
Feb-24
Feb-24
Aug-23
Jun-25
Feb-24
Feb-24
Feb-24
Jul-25
Jul-25
Sep-23
Sep-23
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24

Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Jul-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-25
Feb-25
Feb-25
Feb-25
Feb-25

Sep-25
Sep-25
Feb-24
Jan-25
Jun-24
Mar-24
Feb-24
Feb-24
Mar-24
Mar-24
Feb-25

Feb-24
Feb-24
Feb-24
Dec-23
Feb-24
Feb-24
Oct-24
Jan-26
Jul-24
Sep-23
Sep-23
Feb-25
Dec-23
Dec-23
Feb-25
Sep-23
Feb-25
Feb-25

Feb-24
Feb-24
Feb-24
Feb-24
Jun-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24

Feb-24
Feb-24
Feb-24
Oct-24
Oct-24
Jan-24
Feb-24
Feb-24
Feb-24

Feb-24
Feb-24

Feb-24
Nov-23

Feb-24
Feb-24
Nov-23
Feb-24

Jun-24
Jun-24
Jun-24
Nov-23
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Jan-24
Jan-24

Okt -23
Jun-24
Jun-24
Jan-23
Aug-24
Jul-25
Jun-24
Jun-24
Nov-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-25
Jan-24
Jan-24
Jan-24
Jan-24
Jun-24
Jan-24
Jan-24
Jul-24
Nov-24
Jun-24
Jun-24
Jun-24
Jun-24
Nov-24
Jan-24

Jul-24
Jul-24
 Jun-24
Jul-24
Jun-24
Jun-24
Jun-24

Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24

a, 30 Juni 2023
enanggung jawab

wi Pratiwi, S. Farm
 DAFTAR STOCK OBAT - OBATAN
KLINIK PRATAMA POLTEKBANG SURABAYA BULAN JULI TAHUN 2023

JUMLAH
NO NAMA OBAT KEMASAN SISA OBAT OBAT OBAT SISA OBAT
BULAN LALU MASUK KELUAR BULAN INI
1 2 3 4 5 6 7
I ANTIBIOTIK
1 Azythromycin 500mg Tablet 803 0 35 768
2 Cefadroxil 500mg Tablet 0 0 0 0
3 Cefixime 100mg Tablet 50 0 50 0
4 Ciprofloxacin 500mg Tablet 0 0 0 0
5 Clindamycin 300mg Tablet 225 0 55 170
6 Cotrimoxsasole Tablet 0 0 0 0
7 Co-amoxiclav Kapsul 381 0 261 120
8 Levofloksasin 500 mg Tablet 73 0 0 73
9 Primadex forte Tablet 110 0 39 71
10 Thiamphenicol 500 mg Tablet 20 0 10 10
11 Tetracyclin 500 mg Tablet 99 0 0 99
12 Coroflox 500mg Tablet 60 0 0 60
13 Leomoxyl 500mg Tablet 291 0 81 210
14 Meflosin 500mg Tablet 0 0 0 0
15 Tisacef 500mg Tablet 206 0 140 66
16 Clavomet Tablet 60 0 0 60

II ANTIFUNGI
1 Ketokonazole 200 mg Tablet 158 0 0 158

III ANTIVIRUS
1 Acyclovir 400mg Tablet 130 0 50 80

IV ANALGETIK, ANTIPIRETIK, ANTIINFLAMASI

1 Ibuprofen 400 mg Tablet 220 0 10 210
2 Cataflam Fast Powder 50mg box 37 0 0 37
3 Meloxicam 15mg Tablet 590 0 10 580
4 Meloxicam 7,5mg Tablet 461 0 36 425
5 Renadinac 50mg Tablet 424 0 80 344
6 Ponsamic 500mg Tablet 0 0 0 0
3 Cataflam 50mg Tablet 191 0 31 160
4 Merislon 12mg Tablet 135 0 51 84
5 Eperison 50 mg Tablet 618 0 55 563
4 Piroxicam 20 mg Tablet 255 0 10 245
5 Betahistin 6 mg Tablet 323 0 0 323
6 Kadiflam 50mg Tablet 905 0 95 810
5 Voltaren 50mg Tablet 568 0 18 550
6 Xepamol 500mg Tablet 268 0 268 0
7 Analspec 500mg Tablet 435 0 435 0

V VITAMIN
1 Grahabion Tablet 0 0 0 0
2 Neuralgin Rx Tablet 68 0 68 0
3 Neurophyron V Tablet 55 0 55 0
4 Mecobalamin kapsul 380 0 10 370
5 Glucosamine Tablet 0 0 0 0
6 Caviplex CDEZ Tablet 470 0 420 50
7 Caviplex Tablet 105 0 105 0
8 Becomzet Tablet 0 0 0 0
9 L-Bio kapsul 0 0 0 0
10 Zink Tablet 135 0 135 0
11 Vitamin B6 Tablet 0 0 0 0
12 Dtrivit 1000 (Vitamin D3 1000 ) Tablet 30 0 30 0
13 Viostin DS Tablet 260 0 20 240
14 Becom C Tablet 0 0 0 0
15 Neurodex Tablet 0 0 0 0
16 Licokalk Tablet 576 0 20 556
17 Hevit C 1000mg Tablet 160 0 160 0
18 Xepaneuron Tablet 240 0 240 0
19 Gabapentin 300mg Tablet 0 0 0 0
20 Sakatonik D3 1000 Tablet 20 0 20 0
21 Morfit D3 1000 Tablet 90 0 0 90
22 Biometis Tablet 295 0 20 275
23 Cal-95 Tablet 120 0 42 78
24 Curcuma force Tablet 120 0 0 120

VI OBAT BATUK DAN FLU

1 Ambroxol Tablet 371 0 10 361
2 GG (Guaifenesin) Tablet 240 0 0 240
3 Bronchitin tablet 0 0 0 0
4 Demacolin Tablet 0 0 0 0
5 Salbutamol 2 mg Tablet 92 0 42 50
6 Grantusif Tablet 20 0 20 0
7 Calortusin Tablet 22 0 22 0
8 Alphara Tablet 720 0 244 476
9 Hufagrip Tablet 885 0 63 822
10 N-acetylcystein Kapsul 1666 0 0 1666
11 Trifed Tablet 0 0 0 0
12 Flutamol tablet 991 0 68 923
13 Flucodin Tablet 551 0 181 370
14 Lapisiv-T Tablet 407 0 0 407
15 Bronex 8mg Tablet 80 0 10 70

VII ANTI ALERGI DAN RADANG

1 Cetirizine Tablet 0 0 0 0
2 Cormetisone 4mg Tablet 1080 0 1060 20
3 Dexteem plus Tablet 216 0 216 0
4 Interhistin Tablet 295 0 84 211
 5 Loratadin Tablet 260 0 45 215
6 Methyl Prednisolon 4 mg Tablet 0 0 0 0
7 Dexamethasone 0,5 mg Tablet 0 0 0 0
8 Telfast OD Tablet 0 0 0 0
9 Histapan Tablet 280 0 0 280
10 Methyl Prednisolon 8mg Tablet 100 0 100 0
11 Grathazon (Dexamethasone 0,5 mg) Tablet 526 0 526 0

VIII OBAT SALURAN CERNA

1 Buscopan Tablet 60 0 0 60
2 Buscopan Plus Tablet 7 0 7 0
3 Lansoprasole kapsul 1385 0 1385 0
4 Gradilex Tablet 0 0 0 0
5 New Diatabs Tablet 0 0 0 0
6 Oralit Sachet 636 0 36 600
7 Polycrol Forte Tablet 1160 0 580 580
8 Omedrinat Tablet 220 0 0 220
9 Spasminal Tablet 0 0 0 0
10 Omeprazole kapsul 0 0 0 0
11 Omedom Tablet 624 0 614 10
12 Ondansetron 4mg Tablet 51 0 51 0
13 akita Tablet 274 0 50 224
14 Sucralfate Sirup Botol 17 0 17 0
15 Imodium Tablet 0 0 0 0
16 Ulpraz kapsul 184 0 70 114
17 Lopamid Tablet 436 0 44 392
18 Xepazym Tablet 210 0 10 200

IX WASIR DAN SUPPOSITORIA

1 Ambeven Tablet 20 0 10 10
2 Boraginol N oint Tube 0 0 0 0
3 Borraginal N Supp supp 10 0 0 10
 4 Boraginol S Supp supp 10 0 0 10
5 Boraginol S oint Tube 1 0 1 0
6 Profenid supp 10 0 0 10
7 Kalnex Tablet 41 0 36 5
8 Dulcolax Tablet 20 0 0 20
9 Dulcolax Suppo supp 16 0 14 2
10 Asamnex Tablet 30 0 0 30
11 Paracetamol supp 80mg supp 10 0 0 10

X CARDIOVASKULAR
1 Amlodipine 10 mg Tablet 115 0 20 95
2 candesartan 8 mg Tablet 80 0 20 60
3 Clopidogrel 75 mg Tablet 0 0 0 0
4 Nifedipine 10mg Tablet 40 0 0 40
5 Furosemide 40mg Tablet 57 0 0 57
6 Aspilet 80 mg Tablet 87 0 0 87
7 Isosorbid dinitrat (ISDN) 10mg Tablet 90 0 0 90
8 Amlodipine 5 mg Tablet 80 0 50 30
9 Propanolol 10mg Tablet 70 0 0 70

XI ANTILIPIDEMIA
1 Atorvastatin 10 mg Tablet 40 0 40 0
2 Atorvastatin 20 mg Tablet 10 0 0 10

XII ANTIPIRAI
1 Allopurinol 100mg Tablet 400 0 0 400
2 Allopurinol 300mg Tablet 400 0 0 400

XIII ANTIDIABETIKA ORAL

1 Acarbose 50 mg Tablet 30 0 0 30
2 Acarbose 100 mg Tablet 185 0 0 185
3 Metformin 500mg Tablet 165 0 50 115
4 Glimepiride 2mg Tablet 40 0 20 20

XIV OBAT MATA DAN TELINGA TOPIKAL

1 Erlamycetin tetes mata Botol 1 0 0 1
2 Cendo Lyteers tetes mata Botol 12 0 0 12
3 Cendo Polynel Tetes Mata Botol 9 0 0 9
4 Cendo Xitrol tetes mata Botol 0 0 0 0
5 iliadin spray Botol 3 0 0 3
6 Erlamycetin tetes telinga Botol 15 0 1 14
7 Otopain Tetes Telinga Botol 3 0 0 3
8 Forumen Tetes Telinga Botol 0 0 0 0
9 Cendo Xitrol Salep Mata Tube 9 0 0 9
10 Santadex tetes telinga Tube 2 0 1 1
11 Rohto cool tetes mata tube 1 0 0 1
12 Cendo Gentamicin Salep Mata Tube 0 0 0 0
13 Genoint Tetes Mata Botol 5 0 0 5
14 Cendo Vasacon A minidose strip 1 0 0 1
15 Cendo Xitrol minidose strip 5 0 0 5
16 alletrol tetes mata Botol 0 0 0 0
17 Erlamycetin plus tetes mata Botol 11 0 3 8
18 Genoint Salep Mata Tube 3 0 1 2
19 Cendo Floxa minidose strip 2 0 2 0
20 Erlamycetin salep mata tube 13 0 3 10

XV OBAT KULIT TOPIKAL

1 acyclovir Tube 7 0 5 2
2 betametasone Tube 1 0 1 0
3 bioplancenton Tube 4 0 0 4
4 burnazine Tube 1 0 0 1
5 dexosimetason (dexigen 5gr) Tube 0 0 0 0
6 Miconazole Tube 29 0 0 29
7 Ethychloride Spray PCS 0 0 0 0
 8 Balsem geliga Tube 0 0 0 0
9 Hydrocortison 2,5% Tube 13 0 1 12
10 Balsem lion head Tube 0 0 0 0
11 nufacort krim Tube 5 0 1 4
12 Voltadex gel 20g Tube 0 0 0 0
13 Minyak Kayu putih 30ml Botol 4 0 4 0
14 Counterpain Cream 15g tube 5 0 5 0
15 Rogencin tube 3 0 3 0
16 Scabimite PCS 0 0 0 0
17 Ketoconazole PCS 13 0 2 11
18 Betason N PCS 0 0 0 0
19 Inerson Cream PCS 0 0 0 0
20 Bedak Salicyl Botol 28 0 5 23
21 Genalten cream tube 0 0 0 0
22 Hotin DCL 30g tube 0 0 0 0
23 Benoson cream 5g tube 16 0 1 15
24 Flamar gel tube 0 0 0 0
25 Minyak Kayu putih 60ml Botol 16 0 0 16
26 Thrombophop gel 20g tube 7 0 0 7
27 Counterpain cool 15g tube 5 0 5 0
28 Betadine 5ml Botol 0 0 0 0
29 Ketomed Shampo PCS 0 0 0 0
30 Callusol Sol botol 0 0 0 0
31 Daryantulle lembar 17 0 17 0
32 nebacetin powder botol 2 0 0 2
33 Erlaneohidrocort krim Tube 5 0 4 1
33 Magic Power tissue pcs 0 0 0 0
34 Emla krim 5g tube 2 0 0 2

XVI OBAT TOPIKAL MULUT

1 Betadine Kumur 100 ml (gargle) Botol 20 0 7 13
2 Kandistatin Drop Botol 3 0 0 3
 3 Kenalog Oral salep Tube 0 0 0 0
4 Bufacomp in oralbase Tube 0 0 0 0
5 Aloclaire plus gel 8 ml tube 1 0 0 1
6 Aloclaire Plus Mouthwash 60ml botol 3 0 1 2
7 Ketricin in oralbase Tube 7 0 7 0

XVII SEDIAAN INJEKSI

1 Epineprine injeksi Ampul 0 0 0 0
2 Lidocaine injeksi Ampul 0 0 0 0
3 Diphenhydramine Injeksi Ampul 0 0 0 0
4 Omeprazole injeksi box 0 0 0 0
5 Ventolin Ampul 10 0 10 0
6 Pulmicort Ampul 0 0 0 0
7 Pehacain injeksi Ampul 0 0 0 0
8 Neurobion Injeksi Ampul 0 0 0 0
9 Dexamethasone injeksi Ampul 0 0 0 0
10 Atropin sulfat Injeksi Ampul 0 0 0 0
11 Buscopan injeksi Ampul 0 0 0 0
12 Antrain injeksi Ampul 0 0 0 0
14 Ondansetron injeksi Ampul 0 0 0 0
15 Ranitidine Injeksi Ampul 0 0 0 0
16 Paracetamol Infus botol 0 0 0 0
17 Fitomenadion (vitamin K1) 2mg/ml Ampul 5 0 5 0

Surabaya, 31 Juli 2023

KANIT POLIKLINIK Apoteker penanggung jawab

dr. SAMODERO GUMILAR, M.Kes apt. Eka Dewi Pratiwi, S. Farm

Pembina (IV/a)
 NIP. 198210072008121003

Keterangan
obat kadaluarsa
HUN 2023

KETERANGAN
TGL. (ED)
8

May-24
Jan-25
Jan-25
May-24
May-24
May-24
May-24
May-24
May-24
Jan-25
May-24
Sep-24
May-24
Sep-24
Sep-24
Sep-24

May-24

Oct-23
Feb-25
Feb-24
Feb-24
Feb-24
Aug-23
Sep-23
Feb-24
Feb-25
Feb-25
Sep-24
Oct-23
Sep-24
Sep-24
Sep-24
Sep-24

Feb-24
Feb-24
Feb-24
Feb-24
Jul-25
Aug-23
Feb-24
Feb-24
Feb-24
Feb-24
Aug-23
Jun-25
Feb-24
Feb-24
Feb-24
Jul-25
Jul-25
Sep-23
Sep-23
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24

Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Jul-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-25
Feb-25
Feb-25
Feb-25
Feb-25

Sep-25
Sep-25
Feb-24
Jan-25
Jun-24
Mar-24
Feb-24
Feb-24
Mar-24
Mar-24
Feb-25

Feb-24
Feb-24
Feb-24
Dec-23
Feb-24
Feb-24
Oct-24
Jan-26
Jul-24
Sep-23
Sep-23
Feb-25
Dec-23
Dec-23
Feb-25
Sep-23
Feb-25
Feb-25

Feb-24
Feb-24
Feb-24
Feb-24
Jun-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24
Feb-24

Feb-24
Feb-24
Feb-24
Oct-24
Oct-24
Jan-24
Feb-24
Feb-24
Feb-24

Feb-24
Feb-24

Feb-24
Nov-23

Feb-24
Feb-24
Nov-23
Feb-24

Jun-24
Jun-24
Jun-24
Nov-23
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jun-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Jan-24
Jan-24

Okt -23
Jun-24
Jun-24
Jan-23
Aug-24
Jul-25
Jun-24
Jun-24
Nov-24
Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-25
Jan-24
Jan-24
Jan-24
Jan-24
Jun-24
Jan-24
Jan-24
Jul-24
Nov-24
Jun-24
Jun-24
Jun-24
Jun-24
Nov-24
Jan-24

Jul-24
Jul-24
 Jun-24
Jul-24
Jun-24
Jun-24
Jun-24

Jun-24
Jun-24
Jun-24
Jun-24
Jan-24
Jan-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24
Nov-24

a, 31 Juli 2023
enanggung jawab

wi Pratiwi, S. Farm
 LAPORAN STOCK OPNAME OBAT - OBATAN INSTALASI FARMASI
KLINIK PRATAMA POLTEKBANG SURABAYA
BULAN AGUSTUS 2023

JUMLAH
NO NAMA OBAT KEMASAN SISA OBAT OBAT OBAT SISA OBAT
BULAN LALU MASUK KELUAR BULAN INI
1 2 3 4 5 6 7
I ANTIBIOTIK
1 Azythromycin 500mg Tablet 768 0 16 752
2 Cefadroxil 500mg Tablet 0 700 475 225
3 Cefixime 100mg Tablet 0 1000 360 640
4 Ciprofloxacin 500mg Tablet 0 0 0 0
5 Clindamycin 300mg Tablet 170 300 60 410
6 Cotrimoxsasole Tablet 0 0 0 0
7 Co-amoxiclav Kapsul 120 0 120 0
8 Levofloksasin 500 mg Tablet 73 100 73 100
9 Primadex forte Tablet 71 800 50 821
10 Thiamphenicol 500 mg Tablet 10 0 0 10
11 Tetracyclin 500 mg Tablet 99 0 99 0
12 Coroflox 500mg Tablet 60 0 0 60
13 Leomoxyl 500mg Tablet 210 0 210 0
14 Meflosin 500mg Tablet 0 150 17 133
15 Tisacef 500mg Tablet 66 300 346 20
16 Clavomet Tablet 60 300 0 360
17 Cefixime 200mg Tablet 0 300 155 145

II ANTIFUNGI
1 Ketokonazole 200 mg Tablet 158 0 20 138

III ANTIVIRUS
1 Acyclovir 400mg Tablet 80 0 0 80

IV ANALGETIK, ANTIPIRETIK, ANTIINFLAMASI

1 Ibuprofen 400 mg Tablet 210 0 10 200
2 Cataflam Fast Powder 50mg box 37 0 4 33
3 Meloxicam 15mg Tablet 580 0 50 530
4 Meloxicam 7,5mg Tablet 425 0 80 345
5 Renadinac 50mg Tablet 344 0 64 280
6 Ponsamic 500mg Tablet 0 0 0 0
3 Cataflam 50mg Tablet 160 0 120 40
4 Merislon 12mg Tablet 84 200 14 270
5 Eperison 50 mg Tablet 563 0 50 513
4 Piroxicam 20 mg Tablet 245 0 0 245
5 Betahistin 6 mg Tablet 323 0 20 303
6 Kadiflam 50mg Tablet 810 0 166 644
5 Voltaren 50mg Tablet 550 0 106 444
6 Xepamol 500mg Tablet 0 2000 890 1110
7 Analspec 500mg Tablet 0 200 200 0

V VITAMIN
1 Grahabion Tablet 0 0 0 0
2 Neuralgin Rx Tablet 0 500 296 204
3 Neurophyron V Tablet 0 500 210 290
4 Mecobalamin kapsul 370 0 30 340
5 Glucosamine Tablet 0 400 120 280
6 Caviplex CDEZ Tablet 50 0 50 0
7 Caviplex Tablet 0 1500 270 1230
8 Becomzet Tablet 0 0 0 0
9 L-Bio kapsul 0 0 0 0
10 Zink Tablet 0 0 0 0
11 Vitamin B6 Tablet 0 0 0 0
12 Dtrivit 1000 (Vitamin D3 1000 ) Tablet 0 0 0 0
13 Viostin DS Tablet 240 0 45 195
14 Becom C Tablet 0 0 0 0
15 Neurodex Tablet 0 0 0 0
16 Licokalk Tablet 556 0 0 556
17 Hevit C 1000mg Tablet 0 0 0 0
18 Xepaneuron Tablet 0 200 180 20
19 Gabapentin 300mg Tablet 0 0 0 0
20 Sakatonik D3 1000 Tablet 0 0 0 0
21 Morfit D3 1000 Tablet 90 0 0 90
22 Biometis Tablet 275 0 47 228
23 Cal-95 Tablet 78 0 36 42
24 Curcuma force Tablet 120 0 0 120
25 Vitamin C generik Tablet 0 200 20 180

VI OBAT BATUK DAN FLU

1 Ambroxol Tablet 361 0 0 361
2 GG (Guaifenesin) Tablet 240 0 10 230
3 Bronchitin tablet 0 800 730 70
4 Demacolin Tablet 0 1500 270 1230
5 Grantusif Tablet 0 700 330 370
6 Calortusin Tablet 0 300 210 90
7 Alphara Tablet 476 0 150 326
8 Hufagrip Tablet 822 0 80 742
9 N-acetylcystein Kapsul 1666 0 401 1265
10 Trifed Tablet 0 0 0 0
11 Flutamol tablet 923 0 69 854
12 Flucodin Tablet 370 0 170 200
13 Lapisiv-T Tablet 407 0 219 188
14 Bronex 8mg Tablet 70 0 0 70
15 Rhinos SR Kapsul 0 50 16 34

VII ANTI ALERGI, ANTIRADANG, ANTIASMA

 1 Cetirizine Tablet 0 600 291 309
2 Cormetisone 4mg Tablet 20 600 486 134
3 Dexteem plus Tablet 0 500 0 500
4 Interhistin Tablet 211 0 61 150
5 Loratadin Tablet 215 0 0 215
6 Methyl Prednisolon 4 mg Tablet 0 0 0 0
7 Dexamethasone 0,5 mg Tablet 0 0 0 0
8 Telfast OD Tablet 0 0 0 0
9 Histapan Tablet 280 0 0 280
10 Methyl Prednisolon 8mg Tablet 0 0 0 0
11 Grathazon (Dexamethasone 0,5 mg) Tablet 0 1000 470 530
12 Salbutamol 2 mg Tablet 50 0 30 20
13 Ventolin inhaler box 0 1 0 1

VIII OBAT SALURAN CERNA

1 Buscopan Tablet 60 0 5 55
2 Buscopan Plus Tablet 0 0 0 0
3 Lansoprasole kapsul 0 1000 228 772
4 Gradilex Tablet 0 0 0 0
5 New Diatabs Tablet 0 0 0 0
6 Oralit Sachet 600 200 35 765
7 Polycrol Forte Tablet 580 480 630 430
8 Omedrinat Tablet 220 0 16 204
9 Spasminal Tablet 0 400 106 294
10 Omeprazole kapsul 0 100 0 100
11 Omedom Tablet 10 1000 210 800
12 Ondansetron 4mg Tablet 0 500 500 0
13 akita Tablet 224 500 114 610
14 Sucralfate Sirup Botol 0 30 27 3
15 Imodium Tablet 0 1000 53 947
16 Ulpraz kapsul 114 0 56 58
17 Lopamid Tablet 392 0 85 307
18 Xepazym Tablet 200 0 18 182

IX WASIR DAN SUPPOSITORIA

1 Ambeven Tablet 10 0 10 0
2 Boraginol N oint Tube 0 2 2 0
3 Borraginal N Supp supp 10 10 10 10
4 Boraginol S Supp supp 10 20 18 12
5 Boraginol S oint Tube 0 0 0 0
6 Profenid supp 10 0 0 10
7 Kalnex Tablet 5 0 5 0
8 Dulcolax Tablet 20 30 18 32
9 Dulcolax Suppo supp 2 0 0 2
10 Asamnex Tablet 30 0 0 30
11 Paracetamol supp 80mg supp 10 0 0 10

X CARDIOVASKULAR
1 Amlodipine 10 mg Tablet 95 0 45 50
2 candesartan 8 mg Tablet 60 0 60 0
3 Clopidogrel 75 mg Tablet 0 0 0 0
4 Nifedipine 10mg Tablet 40 0 0 40
5 Furosemide 40mg Tablet 57 0 0 57
6 Aspilet 80 mg Tablet 87 0 7 80
7 Isosorbid dinitrat (ISDN) 10mg Tablet 90 0 0 90
8 Amlodipine 5 mg Tablet 30 0 30 0
9 Propanolol 10mg Tablet 70 0 0 70

XI ANTILIPIDEMIA
1 Atorvastatin 10 mg Tablet 0 0 0 0
2 Atorvastatin 20 mg Tablet 10 0 10 0

XII ANTIPIRAI
1 Allopurinol 100mg Tablet 400 0 0 400
 2 Allopurinol 300mg Tablet 400 0 0 400

XIII ANTIDIABETIKA ORAL

1 Acarbose 50 mg Tablet 30 0 30 0
2 Acarbose 100 mg Tablet 185 0 110 75
3 Metformin 500mg Tablet 115 0 40 75
4 Glimepiride 2mg Tablet 20 0 20 0

XIV OBAT MATA DAN TELINGA TOPIKAL

1 Erlamycetin tetes mata Botol 1 0 1 0
2 Cendo Lyteers tetes mata Botol 12 0 4 8
3 Cendo Polynel Tetes Mata Botol 9 0 1 8
4 Cendo Xitrol tetes mata Botol 0 0 0 0
5 iliadin spray Botol 3 1 1 3
6 Erlamycetin tetes telinga Botol 14 0 1 13
7 Otopain Tetes Telinga Botol 3 0 0 3
8 Forumen Tetes Telinga Botol 0 0 0 0
9 Cendo Xitrol Salep Mata Tube 9 0 0 9
10 Santadex tetes telinga Tube 1 5 0 6
11 Rohto cool tetes mata tube 1 0 1 0
12 Cendo Gentamicin Salep Mata Tube 0 0 0 0
13 Genoint Tetes Mata Botol 5 0 0 5
14 Cendo Vasacon A minidose strip 1 1 1 1
15 Cendo Xitrol minidose strip 5 0 1 4
16 alletrol tetes mata Botol 0 0 0 0
17 Erlamycetin plus tetes mata Botol 8 0 4 4
18 Genoint Salep Mata Tube 2 0 1 1
19 Cendo Floxa minidose strip 0 0 0 0
20 Erlamycetin salep mata tube 10 0 1 9

XV OBAT KULIT TOPIKAL

1 acyclovir Tube 2 0 2 0
 2 betametasone Tube 0 0 0 0
3 bioplancenton Tube 4 0 1 3
4 burnazine Tube 1 0 0 1
5 dexosimetason (dexigen 5gr) Tube 0 20 16 4
6 Miconazole Tube 29 0 4 25
7 Ethychloride Spray PCS 0 0 0 0
8 Balsem geliga Tube 0 0 0 0
9 Hydrocortison 2,5% Tube 12 0 0 12
10 Balsem lion head Tube 0 0 0 0
11 nufacort krim Tube 4 10 8 6
12 Voltadex gel 20g Tube 0 20 16 4
13 Minyak Kayu putih 30ml Botol 0 0 0 0
14 Counterpain Cream 15g tube 0 0 0 0
15 Rogencin tube 0 10 10 0
16 Scabimite PCS 0 0 0 0
17 Ketoconazole PCS 11 0 8 3
18 Betason N PCS 0 0 0 0
19 Inerson Cream PCS 0 0 0 0
20 Bedak Salicyl Botol 23 0 5 18
21 Genalten cream tube 0 0 0 0
22 Hotin DCL 30g tube 0 0 0 0
23 Benoson cream 5g tube 15 0 0 15
24 Flamar gel tube 0 0 0 0
25 Minyak Kayu putih 60ml Botol 16 0 10 6
26 Thrombophop gel 20g tube 7 0 1 6
27 Counterpain cool 15g tube 0 0 0 0
28 Betadine 5ml Botol 0 6 6 0
29 Ketomed Shampo PCS 0 0 0 0
30 Callusol Sol botol 0 2 1 1
31 Daryantulle lembar 0 0 0 0
32 nebacetin powder botol 2 2 2 2
33 Erlaneohidrocort krim Tube 1 0 0 1
 33 Magic Power tissue pcs 0 0 0 0
34 Emla krim 5g tube 2 0 0 2
35 Scabicid 5% 5g PCS 0 15 10 5

XVI OBAT TOPIKAL MULUT

1 Betadine Kumur 100 ml (gargle) Botol 13 10 4 19
2 Kandistatin Drop Botol 3 0 0 3
3 Kenalog Oral salep Tube 0 0 0 0
4 Bufacomp in oralbase Tube 0 0 0 0
5 Aloclaire plus gel 8 ml tube 1 0 1 0
6 Aloclaire Plus Mouthwash 60ml botol 2 0 1 1
7 Ketricin in oralbase Tube 0 0 0 0

XVII SEDIAAN INJEKSI

1 Epineprine injeksi Ampul 0 0 0 0
2 Lidocaine injeksi Ampul 0 0 0 0
3 Diphenhydramine Injeksi Ampul 0 0 0 0
4 Omeprazole injeksi box 0 30 30 0
5 Ventolin Ampul 0 0 0 0
6 Pulmicort Ampul 0 0 0 0
7 Pehacain injeksi Ampul 0 0 0 0
8 Neurobion Injeksi Ampul 0 40 40 0
9 Dexamethasone injeksi Ampul 0 0 0 0
10 Atropin sulfat Injeksi Ampul 0 100 100 0
11 Buscopan injeksi Ampul 0 0 0 0
12 Antrain injeksi Ampul 0 20 20 0
14 Ondansetron injeksi Ampul 0 20 20 0
15 Ranitidine Injeksi Ampul 0 0 0 0
16 Paracetamol Infus botol 0 0 0 0
17 Fitomenadion (vitamin K1) 2mg/ml Ampul 0 0 0 0

XVIII INFUS
1 Ringer Laktat 500ml Ampul 0 120 120 0
2 NaCl 0,9% 500ml Ampul 0 40 40 0
3 Water for Injection (WFI) 25ml Ampul 0 10 10 0
4 Dextrose 5% 500ml box 0 2 2 0

Surabaya, 31 Agustus 2023

KANIT POLIKLINIK Apoteker penanggung jawab

dr. SAMODERO GUMILAR, M.Kes apt. Eka Dewi Pratiwi, S. Farm

Pembina (IV/a)
NIP. 198210072008121003
KETERANGAN

8
31 Agustus 2023
enanggung jawab

wi Pratiwi, S. Farm
 LAPORAN STOCK OPNAME OBAT - OBATAN INSTALASI FARMASI
KLINIK PRATAMA POLTEKBANG SURABAYA
BULAN SEPTEMBER 2023

JUMLAH
NO NAMA OBAT KEMASAN SISA OBAT OBAT OBAT SISA OBAT
BULAN LALU MASUK KELUAR BULAN INI
1 2 3 4 5 6 7
I ANTIBIOTIK
1 Azythromycin 500mg Tablet 752 0 6 746
2 Cefadroxil 500mg Tablet 225 0 15 210
3 Cefixime 100mg Tablet 640 0 100 540
4 Ciprofloxacin 500mg Tablet 0 0 0 0
5 Clindamycin 300mg Tablet 410 0 100 310
6 Cotrimoxsasole Tablet 0 0 0 0
7 Co-amoxiclav Kapsul 0 0 0 0
8 Levofloksasin 500 mg Tablet 100 0 50 50
9 Primadex forte Tablet 821 0 100 721
10 Thiamphenicol 500 mg Tablet 10 0 0 10
11 Tetracyclin 500 mg Tablet 0 0 0 0
12 Coroflox 500mg Tablet 60 0 0 60
13 Leomoxyl 500mg Tablet 0 0 0 0
14 Meflosin 500mg Tablet 133 0 60 73
15 Tisacef 500mg Tablet 20 0 20 0
16 Clavomet Tablet 360 0 190 170
17 Cefixime 200mg Tablet 145 0 35 110

II ANTIFUNGI
1 Ketokonazole 200 mg Tablet 138 0 0 138

III ANTIVIRUS
1 Acyclovir 400mg Tablet 80 0 0 80

IV ANALGETIK, ANTIPIRETIK, ANTIINFLAMASI

1 Ibuprofen 400 mg Tablet 200 0 0 200
2 Cataflam Fast Powder 50mg box 33 0 0 33
3 Meloxicam 15mg Tablet 530 0 40 490
4 Meloxicam 7,5mg Tablet 345 0 200 145
5 Renadinac 50mg Tablet 280 0 0 280
6 Ponsamic 500mg Tablet 0 0 0 0
3 Cataflam 50mg Tablet 40 0 40 0
4 Merislon 12mg Tablet 270 0 20 250
5 Eperison 50 mg Tablet 513 0 200 313
4 Piroxicam 20 mg Tablet 245 0 100 145
5 Betahistin 6 mg Tablet 303 0 0 303
6 Kadiflam 50mg Tablet 644 0 160 484
5 Voltaren 50mg Tablet 444 0 0 444
6 Xepamol 500mg Tablet 1110 0 200 910
7 Analspec 500mg Tablet 0 0 0 0

V VITAMIN
1 Grahabion Tablet 0 0 0 0
2 Neuralgin Rx Tablet 204 0 0 204
3 Neurophyron V Tablet 290 0 10 280
4 Mecobalamin kapsul 340 0 0 340
5 Glucosamine Tablet 280 0 0 280
6 Caviplex CDEZ Tablet 0 0 0 0
7 Caviplex Tablet 1230 0 620 610
8 Becomzet Tablet 0 0 0 0
9 L-Bio kapsul 0 0 0 0
10 Zink Tablet 0 0 0 0
11 Vitamin B6 Tablet 0 0 0 0
12 Dtrivit 1000 (Vitamin D3 1000 ) Tablet 0 0 0 0
13 Viostin DS Tablet 195 0 0 195
14 Becom C Tablet 0 0 0 0
15 Neurodex Tablet 0 0 0 0
16 Licokalk Tablet 556 0 0 556
17 Hevit C 1000mg Tablet 0 0 0 0
18 Xepaneuron Tablet 20 0 20 0
19 Gabapentin 300mg Tablet 0 0 0 0
20 Sakatonik D3 1000 Tablet 0 0 0 0
21 Morfit D3 1000 Tablet 90 0 0 90
22 Biometis Tablet 228 0 30 198
23 Cal-95 Tablet 42 0 4 38
24 Curcuma force Tablet 120 0 12 108
25 Vitamin C generik Tablet 180 0 60 120

VI OBAT BATUK DAN FLU

1 Ambroxol Tablet 361 0 80 281
2 GG (Guaifenesin) Tablet 230 0 0 230
3 Bronchitin tablet 70 0 70 0
4 Demacolin Tablet 1230 0 110 1120
5 Grantusif Tablet 370 0 60 310
6 Calortusin Tablet 90 0 0 90
7 Alphara Tablet 326 0 150 176
8 Hufagrip Tablet 742 0 100 642
9 N-acetylcystein Kapsul 1265 0 80 1185
10 Trifed Tablet 0 0 0 0
11 Flutamol tablet 854 0 0 854
12 Flucodin Tablet 200 0 0 200
13 Lapisiv-T Tablet 188 0 20 168
14 Bronex 8mg Tablet 70 0 0 70
15 Rhinos SR Kapsul 34 0 4 30

VII ANTI ALERGI, ANTIRADANG, ANTIASMA

 1 Cetirizine Tablet 309 0 41 268
2 Cormetisone 4mg Tablet 134 0 134 0
3 Dexteem plus Tablet 500 0 91 409
4 Interhistin Tablet 150 0 150 0
5 Loratadin Tablet 215 0 55 160
6 Methyl Prednisolon 4 mg Tablet 0 0 0 0
7 Dexamethasone 0,5 mg Tablet 0 0 0 0
8 Telfast OD Tablet 0 0 0 0
9 Histapan Tablet 280 0 0 280
10 Methyl Prednisolon 8mg Tablet 0 0 0 0
11 Grathazon (Dexamethasone 0,5 mg) Tablet 530 0 40 490
12 Salbutamol 2 mg Tablet 20 0 0 20
13 Ventolin inhaler box 1 0 0 1

VIII OBAT SALURAN CERNA

1 Buscopan Tablet 55 0 20 35
2 Buscopan Plus Tablet 0 0 0 0
3 Lansoprasole kapsul 772 0 400 372
4 Gradilex Tablet 0 0 0 0
5 New Diatabs Tablet 0 0 0 0
6 Oralit Sachet 765 0 100 665
7 Polycrol Forte Tablet 430 0 120 310
8 Omedrinat Tablet 204 0 0 204
9 Spasminal Tablet 294 0 0 294
10 Omeprazole kapsul 100 0 27 73
11 Omedom Tablet 800 0 90 710
12 Ondansetron 4mg Tablet 0 0 0 0
13 akita Tablet 610 0 50 560
14 Sucralfate Sirup Botol 3 0 3 0
15 Imodium Tablet 947 0 0 947
16 Ulpraz kapsul 58 0 58 0
17 Lopamid Tablet 307 0 110 197
18 Xepazym Tablet 182 0 0 182

IX WASIR DAN SUPPOSITORIA

1 Ambeven Tablet 0 0 0 0
2 Boraginol N oint Tube 0 0 0 0
3 Borraginal N Supp supp 10 0 0 10
4 Boraginol S Supp supp 12 0 6 6
5 Boraginol S oint Tube 0 0 0 0
6 Profenid supp 10 0 0 10
7 Kalnex Tablet 0 0 0 0
8 Dulcolax Tablet 32 0 0 32
9 Dulcolax Suppo supp 2 0 0 2
10 Asamnex Tablet 30 0 9 21
11 Paracetamol supp 80mg supp 10 0 0 10

X CARDIOVASKULAR
1 Amlodipine 10 mg Tablet 50 0 50 0
2 candesartan 8 mg Tablet 0 0 0 0
3 Clopidogrel 75 mg Tablet 0 0 0 0
4 Nifedipine 10mg Tablet 40 0 0 40
5 Furosemide 40mg Tablet 57 0 0 57
6 Aspilet 80 mg Tablet 80 0 10 70
7 Isosorbid dinitrat (ISDN) 10mg Tablet 90 0 20 70
8 Amlodipine 5 mg Tablet 0 0 0 0
9 Propanolol 10mg Tablet 70 0 20 50

XI ANTILIPIDEMIA
1 Atorvastatin 10 mg Tablet 0 0 0 0
2 Atorvastatin 20 mg Tablet 0 0 0 0

XII ANTIPIRAI
1 Allopurinol 100mg Tablet 400 0 0 400
 2 Allopurinol 300mg Tablet 400 0 0 400

XIII ANTIDIABETIKA ORAL

1 Acarbose 50 mg Tablet 0 0 0 0
2 Acarbose 100 mg Tablet 75 0 0 75
3 Metformin 500mg Tablet 75 0 0 75
4 Glimepiride 2mg Tablet 0 0 0 0

XIV OBAT MATA DAN TELINGA TOPIKAL

1 Erlamycetin tetes mata Botol 0 0 0 0
2 Cendo Lyteers tetes mata Botol 8 0 1 7
3 Cendo Polynel Tetes Mata Botol 8 0 0 8
4 Cendo Xitrol tetes mata Botol 0 0 0 0
5 iliadin spray Botol 3 0 1 2
6 Erlamycetin tetes telinga Botol 13 0 1 12
7 Otopain Tetes Telinga Botol 3 0 0 3
8 Forumen Tetes Telinga Botol 0 0 0 0
9 Cendo Xitrol Salep Mata Tube 9 0 0 9
10 Santadex tetes telinga Tube 6 5 5 6
11 Rohto cool tetes mata tube 0 0 0 0
12 Cendo Gentamicin Salep Mata Tube 0 0 0 0
13 Genoint Tetes Mata Botol 5 0 0 5
14 Cendo Vasacon A minidose strip 1 0 0 1
15 Cendo Xitrol minidose strip 4 0 0 4
16 alletrol tetes mata Botol 0 0 0 0
17 Erlamycetin plus tetes mata Botol 4 0 3 1
18 Genoint Salep Mata Tube 1 0 0 1
19 Cendo Floxa minidose strip 0 0 0 0
20 Erlamycetin salep mata tube 9 0 2 7

XV OBAT KULIT TOPIKAL

1 acyclovir Tube 0 0 0 0
 2 betametasone Tube 0 0 0 0
3 bioplancenton Tube 3 0 0 3
4 burnazine Tube 1 0 0 1
5 dexosimetason (dexigen 5gr) Tube 4 0 4 0
6 Miconazole Tube 25 0 3 22
7 Ethychloride Spray PCS 0 0 0 0
8 Balsem geliga Tube 0 0 0 0
9 Hydrocortison 2,5% Tube 12 0 1 11
10 Balsem lion head Tube 0 0 0 0
11 nufacort krim Tube 6 0 1 5
12 Voltadex gel 20g Tube 4 0 4 0
13 Minyak Kayu putih 30ml Botol 0 0 0 0
14 Counterpain Cream 15g tube 0 0 0 0
15 Rogencin tube 0 0 0 0
16 Scabimite PCS 0 0 0 0
17 Ketoconazole PCS 3 0 3 0
18 Betason N PCS 0 0 0 0
19 Inerson Cream PCS 0 0 0 0
20 Bedak Salicyl Botol 18 0 0 18
21 Genalten cream tube 0 0 0 0
22 Hotin DCL 30g tube 0 0 0 0
23 Benoson cream 5g tube 15 0 1 14
24 Flamar gel tube 0 0 0 0
25 Minyak Kayu putih 60ml Botol 6 0 6 0
26 Thrombophop gel 20g tube 6 0 0 6
27 Counterpain cool 15g tube 0 0 0 0
28 Betadine 5ml Botol 0 0 0 0
29 Ketomed Shampo PCS 0 0 0 0
30 Callusol Sol botol 1 0 0 1
31 Daryantulle lembar 0 0 0 0
32 nebacetin powder botol 2 0 0 2
33 Erlaneohidrocort krim Tube 1 0 1 0
 33 Magic Power tissue pcs 0 0 0 0
34 Emla krim 5g tube 2 0 0 2
35 Scabicid 5% 5g PCS 5 0 2 3

XVI OBAT TOPIKAL MULUT

1 Betadine Kumur 100 ml (gargle) Botol 19 0 2 17
2 Kandistatin Drop Botol 3 0 0 3
3 Kenalog Oral salep Tube 0 0 0 0
4 Bufacomp in oralbase Tube 0 0 0 0
5 Aloclaire plus gel 8 ml tube 0 0 0 0
6 Aloclaire Plus Mouthwash 60ml botol 1 0 0 1
7 Ketricin in oralbase Tube 0 0 0 0

XVII SEDIAAN INJEKSI

1 Epineprine injeksi Ampul 0 0 0 0
2 Lidocaine injeksi Ampul 0 0 0 0
3 Diphenhydramine Injeksi Ampul 0 0 0 0
4 Omeprazole injeksi box 0 0 0 0
5 Ventolin Ampul 0 0 0 0
6 Pulmicort Ampul 0 0 0 0
7 Pehacain injeksi Ampul 0 0 0 0
8 Neurobion Injeksi Ampul 0 0 0 0
9 Dexamethasone injeksi Ampul 0 0 0 0
10 Atropin sulfat Injeksi Ampul 0 0 0 0
11 Buscopan injeksi Ampul 0 0 0 0
12 Antrain injeksi Ampul 0 0 0 0
14 Ondansetron injeksi Ampul 0 0 0 0
15 Ranitidine Injeksi Ampul 0 0 0 0
16 Paracetamol Infus botol 0 0 0 0
17 Fitomenadion (vitamin K1) 2mg/ml Ampul 0 0 0 0

XVIII INFUS
1 Ringer Laktat 500ml Ampul 0 0 0 0
2 NaCl 0,9% 500ml Ampul 0 0 0 0
3 Water for Injection (WFI) 25ml Ampul 0 0 0 0
4 Dextrose 5% 500ml box 0 0 0 0

Surabaya, 30 September 2023

KANIT POLIKLINIK Apoteker penanggung jawab

dr. SAMODERO GUMILAR, M.Kes apt. Eka Dewi Pratiwi, S. Farm

Pembina (IV/a)
NIP. 198210072008121003
KETERANGAN

8
0 September 2023
enanggung jawab

wi Pratiwi, S. Farm
 LAPORAN STOCK OPNAME OBAT - OBATAN INSTALASI FARMASI
KLINIK PRATAMA POLTEKBANG SURABAYA
BULAN OKTOBER 2023

JUMLAH
NO NAMA OBAT KEMASAN SISA OBAT OBAT OBAT SISA OBAT
BULAN LALU MASUK KELUAR BULAN INI
1 2 3 4 5 6 7
I ANTIBIOTIK
1 Azythromycin 500mg Tablet 746 0 44 702
2 Cefadroxil 500mg Tablet 210 0 110 100
3 Cefixime 100mg Tablet 540 0 164 376
4 Ciprofloxacin 500mg Tablet 0 0 0 0
5 Clindamycin 300mg Tablet 310 0 20 290
6 Cotrimoxsasole Tablet 0 0 0 0
7 Co-amoxiclav Kapsul 0 0 0 0
8 Levofloksasin 500 mg Tablet 50 0 0 50
9 Primadex forte Tablet 721 0 0 721
10 Thiamphenicol 500 mg Tablet 10 0 0 10
11 Tetracyclin 500 mg Tablet 0 0 0 0
12 Coroflox 500mg Tablet 60 0 0 60
13 Leomoxyl 500mg Tablet 0 0 0 0
14 Meflosin 500mg Tablet 73 0 0 73
15 Tisacef 500mg Tablet 0 0 0 0
16 Clavomet Tablet 170 0 152 18
17 Cefixime 200mg Tablet 110 0 110 0

II ANTIFUNGI
1 Ketokonazole 200 mg Tablet 138 0 10 128

III ANTIVIRUS
1 Acyclovir 400mg Tablet 80 0 30 50

IV ANALGETIK, ANTIPIRETIK, ANTIINFLAMASI

1 Ibuprofen 400 mg Tablet 200 0 0 200
2 Cataflam Fast Powder 50mg box 33 0 2 31
3 Meloxicam 15mg Tablet 490 0 0 490
4 Meloxicam 7,5mg Tablet 145 0 0 145
5 Renadinac 50mg Tablet 280 0 212 68
6 Ponsamic 500mg Tablet 0 0 0 0
3 Cataflam 50mg Tablet 0 0 0 0
4 Merislon 12mg Tablet 250 0 0 250
5 Eperison 50 mg Tablet 313 0 0 313
4 Piroxicam 20 mg Tablet 145 0 0 145
5 Betahistin 6 mg Tablet 303 0 63 240
6 Kadiflam 50mg Tablet 484 0 84 400
5 Voltaren 50mg Tablet 444 0 70 374
6 Xepamol 500mg Tablet 910 0 410 500
7 Analspec 500mg Tablet 0 0 0 0

V VITAMIN
1 Grahabion Tablet 0 0 0 0
2 Neuralgin Rx Tablet 204 0 204 0
3 Neurophyron V Tablet 280 0 181 99
4 Mecobalamin kapsul 340 0 70 270
5 Glucosamine Tablet 280 0 0 280
6 Caviplex CDEZ Tablet 0 0 0 0
7 Caviplex Tablet 610 0 585 25
8 Becomzet Tablet 0 0 0 0
9 L-Bio kapsul 0 0 0 0
10 Zink Tablet 0 0 0 0
11 Vitamin B6 Tablet 0 0 0 0
12 Dtrivit 1000 (Vitamin D3 1000 ) Tablet 0 0 0 0
13 Viostin DS Tablet 195 0 0 195
14 Becom C Tablet 0 0 0 0
15 Neurodex Tablet 0 0 0 0
16 Licokalk Tablet 556 0 0 556
17 Hevit C 1000mg Tablet 0 0 0 0
18 Xepaneuron Tablet 0 0 0 0
19 Gabapentin 300mg Tablet 0 0 0 0
20 Sakatonik D3 1000 Tablet 0 0 0 0
21 Morfit D3 1000 Tablet 90 0 0 90
22 Biometis Tablet 198 0 15 183
23 Cal-95 Tablet 38 0 0 38
24 Curcuma force Tablet 108 0 12 96
25 Vitamin C generik Tablet 120 0 120 0

VI OBAT BATUK DAN FLU

1 Ambroxol Tablet 281 0 20 261
2 GG (Guaifenesin) Tablet 230 0 20 210
3 Bronchitin tablet 0 0 0 0
4 Demacolin Tablet 1120 0 212 908
5 Grantusif Tablet 310 0 252 58
6 Calortusin Tablet 90 0 0 90
7 Alphara Tablet 176 0 176 0
8 Hufagrip Tablet 642 0 130 512
9 N-acetylcystein Kapsul 1185 0 65 1120
10 Trifed Tablet 0 0 0 0
11 Flutamol tablet 854 0 34 820
12 Flucodin Tablet 200 0 70 130
13 Lapisiv-T Tablet 168 0 0 168
14 Bronex 8mg Tablet 70 0 0 70
15 Rhinos SR Kapsul 30 0 10 20

VII ANTI ALERGI, ANTIRADANG, ANTIASMA

 1 Cetirizine Tablet 268 0 268 0
2 Cormetisone 4mg Tablet 0 0 0 0
3 Dexteem plus Tablet 409 0 143 266
4 Interhistin Tablet 0 0 0 0
5 Loratadin Tablet 160 0 16 144
6 Methyl Prednisolon 4 mg Tablet 0 0 0 0
7 Dexamethasone 0,5 mg Tablet 0 0 0 0
8 Telfast OD Tablet 0 0 0 0
9 Histapan Tablet 280 0 0 280
10 Methyl Prednisolon 8mg Tablet 0 0 0 0
11 Grathazon (Dexamethasone 0,5 mg) Tablet 490 0 139 351
12 Salbutamol 2 mg Tablet 20 0 20 0
13 Ventolin inhaler box 1 0 0 1

VIII OBAT SALURAN CERNA

1 Buscopan Tablet 35 0 0 35
2 Buscopan Plus Tablet 0 0 0 0
3 Lansoprasole kapsul 372 0 267 105
4 Gradilex Tablet 0 0 0 0
5 New Diatabs Tablet 0 0 0 0
6 Oralit Sachet 665 0 455 210
7 Polycrol Forte Tablet 310 0 310 0
8 Omedrinat Tablet 204 0 39 165
9 Spasminal Tablet 294 0 60 234
10 Omeprazole kapsul 73 0 73 0
11 Omedom Tablet 710 0 89 621
12 Ondansetron 4mg Tablet 0 0 0 0
13 akita Tablet 560 0 80 480
14 Sucralfate Sirup Botol 0 0 0 0
15 Imodium Tablet 947 0 32 915
16 Ulpraz kapsul 0 0 0 0
17 Lopamid Tablet 197 0 0 197
18 Xepazym Tablet 182 0 10 172

IX WASIR DAN SUPPOSITORIA

1 Ambeven Tablet 0 0 0 0
2 Boraginol N oint Tube 0 0 0 0
3 Borraginal N Supp supp 10 0 2 8
4 Boraginol S Supp supp 6 0 6 0
5 Boraginol S oint Tube 0 0 0 0
6 Profenid supp 10 0 0 10
7 Kalnex Tablet 0 0 0 0
8 Dulcolax Tablet 32 0 15 17
9 Dulcolax Suppo supp 2 0 0 2
10 Asamnex Tablet 21 0 11 10
11 Paracetamol supp 80mg supp 10 0 0 10

X CARDIOVASKULAR
1 Amlodipine 10 mg Tablet 0 0 0 0
2 candesartan 8 mg Tablet 0 0 0 0
3 Clopidogrel 75 mg Tablet 0 0 0 0
4 Nifedipine 10mg Tablet 40 0 10 30
5 Furosemide 40mg Tablet 57 0 0 57
6 Aspilet 80 mg Tablet 70 0 13 57
7 Isosorbid dinitrat (ISDN) 10mg Tablet 70 0 0 70
8 Amlodipine 5 mg Tablet 0 0 0 0
9 Propanolol 10mg Tablet 50 0 0 50

XI ANTILIPIDEMIA
1 Atorvastatin 10 mg Tablet 0 0 0 0
2 Atorvastatin 20 mg Tablet 0 0 0 0

XII ANTIPIRAI
1 Allopurinol 100mg Tablet 400 0 70 330
 2 Allopurinol 300mg Tablet 400 0 10 390

XIII ANTIDIABETIKA ORAL

1 Acarbose 50 mg Tablet 0 0 0 0
2 Acarbose 100 mg Tablet 75 0 0 75
3 Metformin 500mg Tablet 75 0 0 75
4 Glimepiride 2mg Tablet 0 0 0 0

XIV OBAT MATA DAN TELINGA TOPIKAL

1 Erlamycetin tetes mata Botol 0 0 0 0
2 Cendo Lyteers tetes mata Botol 7 0 0 7
3 Cendo Polynel Tetes Mata Botol 8 0 0 8
4 Cendo Xitrol tetes mata Botol 0 0 0 0
5 iliadin spray Botol 2 0 1 1
6 Erlamycetin tetes telinga Botol 12 0 3 9
7 Otopain Tetes Telinga Botol 3 0 0 3
8 Forumen Tetes Telinga Botol 0 0 0 0
9 Cendo Xitrol Salep Mata Tube 9 0 1 8
10 Santadex tetes telinga Tube 6 0 0 6
11 Rohto cool tetes mata tube 0 0 0 0
12 Cendo Gentamicin Salep Mata Tube 0 0 0 0
13 Genoint Tetes Mata Botol 5 0 0 5
14 Cendo Vasacon A minidose strip 1 0 0 1
15 Cendo Xitrol minidose strip 4 0 2 2
16 alletrol tetes mata Botol 0 0 0 0
17 Erlamycetin plus tetes mata Botol 1 0 1 0
18 Genoint Salep Mata Tube 1 0 1 0
19 Cendo Floxa minidose strip 0 0 0 0
20 Erlamycetin salep mata tube 7 0 2 5

XV OBAT KULIT TOPIKAL

1 acyclovir Tube 0 0 0 0
 2 betametasone Tube 0 0 0 0
3 bioplancenton Tube 3 0 0 3
4 burnazine Tube 1 0 0 1
5 dexosimetason (dexigen 5gr) Tube 0 0 0 0
6 Miconazole Tube 22 0 0 22
7 Ethychloride Spray PCS 0 0 0 0
8 Balsem geliga Tube 0 0 0 0
9 Hydrocortison 2,5% Tube 11 0 3 8
10 Balsem lion head Tube 0 0 0 0
11 nufacort krim Tube 5 0 3 2
12 Voltadex gel 20g Tube 0 0 0 0
13 Minyak Kayu putih 30ml Botol 0 0 0 0
14 Counterpain Cream 15g tube 0 0 0 0
15 Rogencin tube 0 0 0 0
16 Scabimite PCS 0 0 0 0
17 Ketoconazole PCS 0 0 0 0
18 Betason N PCS 0 0 0 0
19 Inerson Cream PCS 0 0 0 0
20 Bedak Salicyl Botol 18 0 0 18
21 Genalten cream tube 0 0 0 0
22 Hotin DCL 30g tube 0 0 0 0
23 Benoson cream 5g tube 14 0 0 14
24 Flamar gel tube 0 0 0 0
25 Minyak Kayu putih 60ml Botol 0 0 0 0
26 Thrombophop gel 20g tube 6 0 1 5
27 Counterpain cool 15g tube 0 0 0 0
28 Betadine 5ml Botol 0 0 0 0
29 Ketomed Shampo PCS 0 0 0 0
30 Callusol Sol botol 1 0 0 1
31 Daryantulle lembar 0 0 0 0
32 nebacetin powder botol 2 0 0 2
33 Erlaneohidrocort krim Tube 0 0 0 0
 33 Magic Power tissue pcs 0 0 0 0
34 Emla krim 5g tube 2 0 0 2
35 Scabicid 5% 5g PCS 3 0 0 3

XVI OBAT TOPIKAL MULUT

1 Betadine Kumur 100 ml (gargle) Botol 17 0 0 17
2 Kandistatin Drop Botol 3 0 0 3
3 Kenalog Oral salep Tube 0 0 0 0
4 Bufacomp in oralbase Tube 0 0 0 0
5 Aloclaire plus gel 8 ml tube 0 0 0 0
6 Aloclaire Plus Mouthwash 60ml botol 1 0 1 0
7 Ketricin in oralbase Tube 0 0 0 0

XVII SEDIAAN INJEKSI

1 Epineprine injeksi Ampul 0 0 0 0
2 Lidocaine injeksi Ampul 0 0 0 0
3 Diphenhydramine Injeksi Ampul 0 0 0 0
4 Omeprazole injeksi box 0 0 0 0
5 Ventolin Ampul 0 0 0 0
6 Pulmicort Ampul 0 0 0 0
7 Pehacain injeksi Ampul 0 0 0 0
8 Neurobion Injeksi Ampul 0 0 0 0
9 Dexamethasone injeksi Ampul 0 0 0 0
10 Atropin sulfat Injeksi Ampul 0 0 0 0
11 Buscopan injeksi Ampul 0 0 0 0
12 Antrain injeksi Ampul 0 0 0 0
14 Ondansetron injeksi Ampul 0 0 0 0
15 Ranitidine Injeksi Ampul 0 0 0 0
16 Paracetamol Infus botol 0 0 0 0
17 Fitomenadion (vitamin K1) 2mg/ml Ampul 0 0 0 0

XVIII INFUS
1 Ringer Laktat 500ml Ampul 0 0 0 0
2 NaCl 0,9% 500ml Ampul 0 0 0 0
3 Water for Injection (WFI) 25ml Ampul 0 0 0 0
4 Dextrose 5% 500ml box 0 0 0 0

Surabaya, 31 Oktober 2023

KANIT POLIKLINIK Apoteker penanggung jawab

dr. SAMODERO GUMILAR, M.Kes apt. Eka Dewi Pratiwi, S. Farm

NIP. 198210072008121003
KETERANGAN

8
31 Oktober 2023
enanggung jawab

wi Pratiwi, S. Farm