2019.xlsx

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO) NO: NAMA PUSKESMAS: MANGKUNG KECAMATAN: PRAYA BARAT KABUPATEN: LOMBOK TENGAH PROPINSI: NUSA TENGGARA BARAT

No.

Nama Obat

TANGGAL:

Satuan

PELAPORAN BULAN: DESEMBER PENERIMAAN BULAN: JANUARI 2019

STOK AWAL

PENERIM PERSEDIA PEMAKAI AAN AN AN

Obat PKD dan penunjang 1 ACT injeksi 2 ACT tablet/ OBAT ANTI MALARIA 3 Acyclovir 200 mg tablet 4 Acyclovir krim 5% 5 Albendazol tablet 400 mg 6 Alopurinol tablet 100 mg 7 Alprazolam 0,5 mg tablet 8 Ambroxol tablet 9 Ambroxol sirup 15mg/ml 10 Aminofilina injeksi 24 mg / ml-10ml 11 Aminofilina tablet 200 mg 12 Amitriptilina tablet 25 mg 13 Amlodipin 5 mg 14 Amlodipin 10 mg 15 Amoksisilina kapsul 500 mg 16 Amoksisilina sirup kering 125 mg/ 5ml 17 Amoksisilina sirup kering 250 mg/ 5ml 18 Ampisilina injeksi 19 Antasida DOEN tablet 20 Antasida DOEN suspensi 21 Antibakteri DOEN salep kombinasi 22 Antifungi DOEN kombinasi 23 Antihemaroid DOEN kombinasi 24 Aqua Pro injeksi steril bebas pirogen 25 Aquadest steril 26 Asam Mefenamat tablet 500 mg 27 Asam Askorbat (Vit. C) tablet 50 mg 28 Asam Tranexamat 500mg/5 ml injeksi 29 Asam Tranexamat 500mg

vial 24 tablet 100 tablet tube 5 gram 30 tablet 100 tablet 100 tablet 100 tablet botol 60 ml 30 ampul 100 tablet 100 tablet 30 tablet 30 tablet 100 tablet botol 60 ml botol 60 ml 10 vial 100 tablet btl 60 ml 25 tube@5 gr 24 pot@30 gr 10 supp 10 vial @ 20 ml 500 ml 100 tablet 1000 tablet 10 ampul 100 tablet

200

100

4,000 145

30

1,400 2,400 8

5,000 300

200 100 9,000 445 30 1,400 2,400 8 -

30 31 32 33 34 35 36 37 38 39 40 41 42 43 44

Asering cairan infus Asetosal tablet 100 mg Asetosal tablet 500 mg Attalpulgite 600mg - New Antides Atropin Sulfat injeksi 0,25 mg / ml-1 ml Benzatin Benzil Penisillin 2,4 juta IU Betametason krim 0,1 % Calsium Glukonas Injeksi Captopril tablet 25 mg Cefadroxil 500 mg Cyproploxasin tablet Deksametason inj. 5 mg /ml-1 ml Deksametason tablet 0,5 mg Diazepam injeksi 5 mg/ ml- 2 ml Diazepam rectal tube (stesolid rectal)

botol 500 ml 100 tablet 100 tablet 100 tablet 30 ampul 10 vial 25 tube@5 gr 24 ampul 100 tablet 100 kapsul 100 tablet 100 ampul 100 tablet 30 ampul 5 tube

45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74

Diazepam tablet 2 mg Diazepam tablet 5 mg Difenhidramina injeksi 10 mg/ ml- 1 ml Digoksin tablet 0,25 mg Domperidon tablet 10 mg Doxycyklin tablet 100 mg Dulcolax 5mg supp Efedrina HCl. tablet 25 mg Ekstrak Belladona tablet 10 mg Epinefrin injeksi 0,1 % - 1 ml Eritromisin kapsul 500 mg Etakridina (Rivanol) larutan 0,1 % Etanol 70 % Fenobarbital injeksi 50 mg / ml-2 ml Fenobarbital injeksi 50 mg / ml-1 ml Fenobarbital tablet 30 mg Fenoksimetil Penisilina tablet 250 mg Fenoksimetil Penisilina tablet 500 mg Fenolgliserol tetes telinga 10 % Fitomenadion (Vit. K) injeksi 10 mg / ml-1 ml Fitomenadion (Vit. K) tablet salut 10 mg Furosemida tablet 40 mg Garam Oralit untuk 200 ml air Garam oralit new ORS FORMULA Gentamycin injeksi Gentian Violet larutan 1 % Glibenklamida tablet 5 mg Glimepiride tablet 1 mg Gliseril Guayakolat tablet 100 mg Glukosa infus 5 %

100 tablet 100 tablet 30 ampul 100 tablet 100 tablet 100 tablet 6 supp 250 tablet 1000 tablet 30 ampul 100 kapsul btl 300 ml btl 1000 ml 30 ampul 31 ampul 100 tablet 100 tablet 100 tablet 24 btl @ 5 ml 30 ampul 100 tablet 100 tablet 100 bungkus 25 saset 5 ampul 10 ml 100 tablet 50 tablet 1000 tablet btl 500 ml

100 10 75 24 100 1,000

5 100

100 12

30 10 9

90 160

300 150 100

100 10 75 24 100 1,000 5 100 100 12 30 10 9 90 160 300 150 100

75 Glukosa infus 10 % btl 500 ml 76 Glukosa infus 40 % 10 amp @ 25 ml 77 Griseofulvin tablet 125 mg Mikronized 100 tablet 78 Haloperidol tablet 1,5 mg 100 tablet 79 Haloperidol tablet 5 mg 100 tablet 80 Haloperidol injeksi 5mg/ml (LODOMER 5) kotak@12ampul 81 Hidroklortiazide (HCT) tablet 25 mg 1000 tablet 82 Hidrokortison krim 2,5 % 24 tube @ 5 gr 83 Hyoscine N Butilbromide/ Scopma 100 tablet 84 Ibuprofen tablet 200 mg 100 tablet 85 Ibuprofen tablet 400 mg 100 tablet 86 Isoniazid ( INH ) 100mg 1000 tablet 87 Isosorbid Dinitrat (ISDN) Sub Lingual tablet 5 mg 100 tablet 88 Kalsium Laktat tablet 500 mg btl 1000 tablet 89 Karbamazepin 200 mg 100 tablet 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119

Ketokonazole tablet 200 mg Kloramfenikol injeksi Kloramfenikol kapsul 250 mg Kloramfenikol suspensi 125mg/5 ml Kloramfenikol salep mata 1 % Kloramfenikol tetes mata 0,5 % Kloramfenikol tetes telinga 1 % Kloramfenikol tetes telinga 3 % Klorfeniramin Maleat (CTM) tablet 4 mg Klorpromazina injeksi 25 mg / ml-2 ml Klorpromazina tablet 25 mg Klorpromazina tablet 100 mg Kotrimoksazol dewasa tablet Kotrimoksazol pediatrik tablet Kotrimoksazol suspensi Kuinin ( Kina ) tablet 200 mg Lidokain Kompositum injeksi Lidokain 2% injeksi (tunggal) Magnesium Sulfat injeksiI (IV) 20 %-25 ml Magnesium Sulfat injeksiI (IV) 40 %-25 ml Metformin HCL 500 mg tablet Metilergometrin Maleat tablet 0,125 mg Metilergometrin Maleat injeksi 0,2 mg / ml Metoclopramide 10 mg Metocloperamide inj Metronidazol tablet 250 mg Metronidazol tablet 500 mg Miconazol krim Misoprotol tab 200 mcg Multivitamin ibu hamil

50 tablet vial 100 kapsul botol 60 ml tube 5 gram botol 60 ml 24 botol botol 1000 tablet 30 ampul 1000 tablet 250 tablet 100 tablet 100 tablet btl 60 ml 60 tablet 30 ampul 100 ampul 10 vial 10 vial 100 tablet 100 tablet ktk 30 ampul 100 tablet ampul 100 tablet 100 tablet tube 10 gram 30 tablet 100 tablet

100 100

500

100 500

1,000 100

600

100

80

200 10 100

100 600 100 500 1,000 100 600 100 80 200 10 100 -

120 Na diklofenak 25mg 121 Na diklofenak 50mg 122 Natrium Klorida infus 0,9 % Nebules kombinasi : ipatropium br 0.5 mg+ 123 salbutamol 2.5 mg (COMBIVENT) 124 Nebules salbutamol 2,5 mg (VENTOLIN) 125 Nifedipin tablet 126 Nistatin tablet salut 500.000 IU 127 Nistatin tablet vaginal 100.000 IU 128 Obat Batuk Hitam (OBH) cairan 129 Obat Anti Tuberkulosis FDC kategori 1/3 130 Obat Anti Tuberkulosis FDC kategori 2 131 Obat Anti Tuberkulosis FDC kategori anak 132 Obat Anti Tuberkulosis FDC kategori sisipan 133 Obat Anti Tuberkulosis Kombipak kategori 1 134 Obat Anti Tuberkulosis Kombipak kategori anak 135 Oksitetrasiklin HCl. injeksi IM 50 mg / ml- 10 ml 136 Oksitetrasiklin salep kulit 3 % 137 Oksitetrasiklin salep mata 1 % 138 Oksitosin injeksi 10 IU / ml - 1 ml 139 Omeprazole kapsul 140 Papaverin injeksi 141 Papaverin tablet 142 Parasetamol drop 100 mg/ml @ 15 ml 143 Parasetamol sirup 120 mg / 5 ml 144 Parasetamol tablet 100 mg 145 Parasetamol tablet 500 mg 146 Paracetamol suppo 125mg/ Pamol 125 suppo 147 Paracetamol suppo 250 mg/ Pamol 250 suppo 148 Perhidrol ( Lar H2O2 ) 149 Piridoksina HCl. tablet 10 mg 150 Piroksikam kapsul 10 mg 151 Polikresulen 152 Povidon Iodida 10 % , 300 ml 153 Povidon Iodida 10 % , 30 ml 154 Prednison tablet 5 mg 155 Primakuin tablet 15 mg 156 Prokain Penisilin inj 3jt IU 157 Propiltiourasil tablet 100 mg 158 Propanolol 10 mg 159 Propranolol tablet 40 mg 160 Pyrantel Pamoat tablet 125 mg 161 Ranitidin tablet 150 mg 162 Ranitidine injeksi 163 Retinol (Vitamin A) kapsul 100.000 IU

50 tablet 50 tablet botol 500 ml 20 vial 20 vial 100 tablet 100 tablet 100 tablet botol 100 ml paket paket paket paket paket paket 10 vial 25 tube @ 5 gr 25 tube @ 3,5 gr 100 ampul 30 kapsul 100 ampul 1000 tablet botol 15 ml botol 60 ml 100 tablet 100 tablet kotak@12 suppo kotak@12 suppo botol 800 ml 100 tablet 120 tablet 10 ml botol 300 ml botol 30 ml 100 tablet 1000 tablet 30 vial 100 tablet 100 tablet 100 tablet 100 tablet 100 tablet 25 ampul 50 kapsul

45

45 25 300

200

200

10 14 900

70

10

25 300 200 200 10 24 900 70 -

164 165 166 167 168 169 170 171 172 173 174 175 176 177 178

Retinol (Vitamin A) kapsul 200.000 IU 50 kapsul Ringer Laktat larutan infus steril botol 500 ml Risperidon 2 mg tablet 50 tablet Sabu Polivalen 5 ml (ABU I) vial Salbutamol tablet 2 mg 100 tablet Salbutamol tablet 4 mg 100 tablet Salep 2-4 Kombinasi 24 pot @ 30 gr Salisil Bedak 2 % 50 gr Scabicid/Scabimid cream (Permetrin 5%) tube @ 50 ml Serum Anti Tetanus injeksi 1.500 IU / ampul (ATS) ampul 1 ml Sianokobalamin (Vit. B 12) injeksi 500 mcg / ml 100 ampul Simvastatin 10mg 30 tablet Sikzonoate injeksi ampul Sulfasetamida tetes mata 15 % 24 botol @ 5 ml Tablet Tambah Darah kombinasi 100 sase @ 30 tablet

179 180 181 182 183 184 185 186 187

Tetrasiklina HCl. kapsul 250 mg Tetrasiklina HCl. kapsul 500 mg Thiamfenikol tablet 500 mg Tiamine HCl. (Vit. B-1) injeksi 100 mg / ml-1 ml Tiamine HCl. Mononitrat (Vit. B-1) tablet 50 mg Triheksifenidil HCl. tablet 2 mg Vitamin B Komplek tablet Xylamidone injeksi Zinc tablet 20 mg Bahan Medis Habis Pakai

188 Alat Suntik sekali pakai 1 ml 189 Alat Suntik sekali pakai 3 ml 190 Alat Suntik sekali pakai 5 ml 191 Alat Suntik sekali pakai 10 ml 192 Alat Suntik sekali pakai 20 ml 193 Alkohol Swab 194 Catgut / Benang Bedah No. 2/0 195 Catgut / Benang Bedah No. 3/0 196 Catgut Chromic Caset 3/0-100 m 197 Foley cathether No. 16 198 Foley cathether No. 18 199 Foley cathether No. 20 200 Feeding Tube 40cm No. 8 201 Hand Rub 500ml 202 Infusion Set anak-anak 203 Infusion Set dewasa 204 IV Cathether No. 18 G 205 IV Cathether No. 20 G 206 IV Cathether No. 22 G 207 IV Cathether No. 24 G

1000 tablet 100 tablet 100 tablet 30 ampul 100 tablet 100 tablet 100 tablet 10 vial 100 tablet 100 set 100 set 100 set 100 set 50 set box 24x70 cm 24x70 cm set set set set set botol set set set set set set

160

200

1 800

1

5,100 21,600

400

360 1 800 1 5,100 21,600 400 -

208 Jarum hecting kombinasi 209 Jelly Dopler 210 Kapas Pembalut / Adsorben 500 gram 211 Kapas Pembalut / Adsorben 250 gram 212 Kasa Pembalut 40 yd x 80 cm 213 Kasa Pembalut 4x10 cm 214 Kasa Pembalut 4x15 cm 215 Kasa hidrofil DRC 35 m x 80 216 Kertas EKG 58mm X 30 mm 217 Kertas EKG 63mm X 30 mm 218 Masker surgical 219 Pembalut gibs 220 Plester 5 yard x 2 inchi 221 Plester Kertas 1" (Surgical tape) 222 Regulator Oksigen

set botol bungkus bungkus rol rol rol rol rol rol set rol rol rol SET

223 Sarung tangan non steril uk.M 224 Sarung tangan non steril uk L 225 Sarung tangan steril NO.6,5 226 Sarung tangan steril NO.7 227 Sarung tangan steril NO.7,5 228 Sarung tangan obgin No. 6,5 229 Sarung tangan obgin No. 7 230 Sarung tangan obgin No. 7,5 231 Sarung tangan obgin No. 8 232 Silk 3/0 + 1/2 GT 35MM 233 Silk 2/0 + 1/2 GT 35MM 234 Surgical mess 11 235 Surgical mess 20 236 Umbilical cord klem 237 Urine bag Bahan Gigi

pasang pasang pasang pasang pasang pasang pasang pasang pasang set set set set set pcs

238 239 240 241 242 243 244 245 246 247 248 249 250 251

Air Raksa dental use Arsen Septodont Rapid Bur set high speed Cavit Cresophene Etil klorida semprot Euginol cairan Glass Ionomer cement (GC IX) Jarum exterpatie Jarum reaming file Kalsium Hidroksida pasta Klorfenol Kamper Menthol ( CHKM ) Mummifying pasta Semen Seng Pospat serbuk dan cairan

100 gram botol kotak botol botol 100 ml dus 12 btl set set set 2 tube 10 ml botol set @ 30 gr

200 200

200 200 -

252 Silver Amalgam 253 Spon Gelatin Cubicles 1 x 1 x 1 cm 254 Temperory Stoping Fletcher serbuk & cair TAMBAHAN 255 Camabion 256 Gentamycin Salep mata 257 Betahistin 258 iliadin dewasa 259 Omeprazol injeksi 260 Setrizin syr 261 Alprazolam 1 mg 262 glimepiride 2 mg

1 oz 24 buah set @ 100 gr 1,000 10 100 40 60

9,000

300

10,000 10 100 40 360 -

Mengetahui/Menyetujui Kepala UPT Farmasi

Yang Menyerahkan

LALU SUDIRMAN NIP. 196912311990031049

Lalu Mustaid

AN OBAT (LPLPO) DANA DAK

ESEMBER ANUARI 2019 TERIMA TANGGAL

SISA STOK

VERIFIKASI TANGGALPENYERAHAN OBAT TANGGAL

PERMINTA STOK AN OPTIMUM BS PROV

PEMBERIAN DAK 15

DAK 16

NON PROGRAM KAPITASI

KET

Yang Menerima Pengelola Obat Puskesmas,

Yang Melaporkan UPT. Puskesmas MANGKUNG

(

MUHAMMAD RUM S.Kep.) NIP : 197112311991031017

)