Lplpo Ulupulu.xlsx

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PUSKESMAS : NANGARORO KABUPATEN : NAGEKEO POSKESDES : TONGGO

NO.

NAMA JENIS OBAT

SATUAN

STOK AWAL

1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

2

3

4

Abocath No 18 Abocath No 20 Abocath No 22 Abocath No 24 Abocath No 26 Aciclovir salep kulit Aciclovir tablet 400 mg Alat suntik sekali pakai 1 ml Alat suntik sekali pakai 10 ml Alat suntik sekali pakai 2,5 ml Alat suntik sekali pakai 20 ml Alat suntik sekali pakai 3 ml Alat suntik sekali pakai 5 ml Alat suntik sekali pakai 50 ml Albendazole tablet 400 mg Alopurinol tablet 100 mg Aluminium foil Amalgam serbuk 65-75 % Ambroxol sirup 15 mg/ml Ambroxol tablet 30 mg Aminofilin injeksi Aminofilin tablet 200 mg Amitriptilin tablet 25 mg Amlodipin 5 mg Amlodipin 10 mg Amoksisilin kapsul 250 mg Amoksisilin kaplet 500 mg Amoksisilin sirup kering 125 mg/5 ml Ampisilin kaplet 250 mg Ampisilin kaplet 500 mg Ampisilin serbuk injeksi 1.000 mg

buah buah buah buah

2 2 2

buah tube tablet buah buah buah buah buah buah

10 12

buah tablet tablet

60

gulungan botol botol tablet ampul tablet

85

tablet tablet tablet kapsul kaplet botol kaplet kaplet vial

55 4

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

Ampisilin sirup kering 60 ml Antagin injeksi 250 mg / ml Antalgin tablet 500 mg Antasida DOEN II suspensi Antasida DOEN tablet Anti hemoroid suppositoria Anti migrain DOEN tablet Anti parkinson DOEN tablet Antibakteri DOEN komb.Salep(Basitrasin + Polimiksin) Antifungi DOEN salep ( 3 - 6 ) Aqua pro injeksi steril 25 ml Aquadest steril 500 ml Arsuamon tablet Artemether injeksi 1 ml : 80 mg Arterakin tablet Artesunate injeksi Artesunate tablet Asam Asetilsalisilat tablet 100 mg (Asetosal) Asam Asetilsalisilat tablet 500 mg (Asetosal) Asam askorbat tablet 50 mg Asam askorbat tablet 250 mg Asam folat Asam mefenamat tablet 250 mg Asam mefenamat tablet 500 mg Asam traneksamat 500 mg Asam traneksamat injeksi Atenolol tablet 50 mg Atropin sulfat injeksi 0,25 mg/ml Atropin sulfat tablet 0,5 mg Atropin sulfat tetes mata Autoklik Bekarbon (arang aktif) Benzatin benzil penisilin injeksi Besi II tablet salut kombinasi Betahistin Betametason krem 0,1 % Bisoprolol 5 mg Bisturi No. 11 Blood lancet Bromheksin tablet 8 mg Burnazin salep

botol ampul tablet botol tablet

3 30

suposs tablet tablet Pot Pot vial botol tablet ampul tablet vial tablet tablet tablet tablet

70

tablet tablet tablet tablet

100

tablet ampul tablet ampul tablet botol buah tablet vial tablet tablet tube tablet buah buah tablet tube

160

73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113

Calsium glukonat 10 mg/ml Captopril 12,5 mg Captopril 25 mg Cat Gram Catgut Chromic No 2/0 Catgut Chromic No 3/0 Catgut Plain No 2/0 Catgut Plain No 3/0 Cetirizine Cimetidine tablet 200 mg Combur test Cover glass Cyprofloxacin tablet 500 mg Dapson tablet Darplex Deksametason injeksi 5 mg/ml Deksametason tablet 0,5 mg Dekstrometorfan syrup Dekstrometrophan tablet 15 mg Dengue blood Devitalisasi pastae non arsen Diasepam injeksi 5 mg/ml Diasepam tablet 2 mg Diasepam tablet 5 mg Dietilkarbamazin tablet Difenhidramin injeksi 10 mg Digoksin tablet Dimenhidrinat tab 50 mg Doksisiklin kapsul 100 mg Domperidon sirup Domperidon tablet 10 mg Efedrin HCl tablet 25 mg Ekstrak Belladona tablet 10mg Epinefrin/adrenalin injeksi 0,1 % Erytromicyn kapsul 250 mg Erytromicyn kapsul 500 mg Erytromicyn suspensi 125 mg/ 5 ml Etakridina larutan 0,1% Etanol 70 % 100 ml Etanol 70% 300 ml Etanol 70 % 1000 ml

ampul tablet tablet paket buah

1

buah buah

1

buah tablet tablet kit buah tablet tablet tablet ampul tablet

90

botol tablet kit botol ampul tablet tablet tablet ampul tablet tablet kapsul botol tablet tablet tablet ampul kapsul kapsul botol botol botol botol botol

3

114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154

Etanol 96 % 1000 ml Ethil klorida semprot Eugenol cairan F l u o r tablet 0, mg Fenitoin natrium injeksi 50 mg/ml Fenitoin natrium kapsul 30 mg Fenitoin natrium kapsul 100 mg Fenobarbital injeksi 50 mg/ml Fenobarbital tablet 30 mg Fenobarbital tablet 100 mg Fenoksimetil penisilin tablet 250 mg Fenoksimetil penisilin tablet 500 mg Fenolgliserol tetes telinga Fitomenadion (Vit K) injeksi 10 mg/ml Fitomenadion (Vit K1) injeksi 10 mg/ml Fitomenadion (Vit.K1) tablet salut 10 mg Folley cath.10 F Folley cath.14 F Folley cath.16 F Folley cath.18 F Forinokresol (pengganti TKF) Formalin cair Formalin tablet 1 gr Furosemida injeksi Furosemida tablet 40 mg Gameksan lotion 1 % Garam oralit 200 ml air Gentamisin injeksi 40 mg/ml Gentamisin salep kulit 0,1 % Gentian violet larutan Glass Ionomer Cement ART Glibenklamid tablet 5 mg Gliserilguayakolat tablet Gliserin Glukosa injeksi 40 % Glukosa larutan infus 5 % Glukosa larutan infus 10 % Griseofulvin tablet 125 mg Haemocytometer Haemometer Haloperidol tablet 0,5 mg

botol botol botol tablet amp @ 2ml kapsul kapsul ampul tablet tablet tablet tablet botol ampul ampul tablet buah buah buah buah botol botol I ltr tablet ampul tablet botol saset

19

ampul tube botol

1

set/botol tablet tablet botol vial botol botol tablet buah buah tablet

145

155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195

HBSaG HCG Strip Hidrogen peroksida Hidroklorotiasida tablet 25 mg Hidrokortison krem 2,5 % Ibuprofen 100 mg/5 ml suspensi Ibuprofen 200 mg/5 ml suspensi Ibuprofen tablet 200 mg Ibuprofen tablet 400 mg Imersion oil Infus set anak Infus set dewasa Iodin test Iodol kapsul lunak Isosorbid dinitrat tablet 5 mg Jarum dispossible No. 22 ¼ G Jarum dispossible No. 23 ¼ G Jarum jahit/ bedah Kulit No. 9 Jarum jahit/ bedah Kulit No. 10 Jarum jahit/ bedah Kulit No. 11 Jarum jahit/ bedah Kulit No. 12 Jarum jahit/ bedah Kulit No. 13 Jarum jahit/ bedah Kulit No. 14 Jarum jahit/ bedah Otot No. 9 Jarum jahit/ bedah Otot No. 10 Jarum jahit/ bedah Otot No. 11 Jarum jahit/ bedah Otot No. 12 Jarum jahit/ bedah Otot No. 13 Jarum jahit/ bedah Otot No. 14 Jeli USG Kaca slide Kalium permanganat serbuk Kalsium hidroksida pastae Kalsium laktat tablet 500 mg Kapas pembalut absorben 100 gr Kapas pembalut absorben 250 gr Karbamasepin tablet 200 mg Kartu stok Kasa kompres steril 40/40 Kasa pembalut 10 cm Kasa pembalut 4 m x 3 cm

strip strip botol tablet tube botol botol tablet tablet botol set set

2 1

botol kapsul tablet buah buah pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces jerigen buah tube tube buah roll roll tablet lembar roll roll roll

50

196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235

Kasa pembalut 4 m x 5 cm Kasa pembalut 4 m x 6 cm Kasa pembalut 40 m x 80 cm Kasa pembalut hidrofil 2 m x 80 cm Kasa pembalut hidrofil 4 m x 10 cm Kasa pembalut hidrofil 4 m x 15 cm Kasa pembalut hidrifil 16 cm x 16 cm Kertas Pulvis Kertas Resep Kertas saring Ketokonazole cream 2% Ketokonazole tablet 200 mg Ketorolac injeksi 10mg/ml Kinina dihidroklorida injeksi 25 % Kinina sulfat tablet 200 mg Kloramfenikol kapsul 250 mg Kloramfenikol sm 1 % Kloramfenikol suspensi Kloramfenikol tetes mata 0,5 % Kloramfenikol tetes telinga 3 % Klorfeniramin maleat tablet 4 mg Klorfenol kamfer menthol (CHKM) Klorokuin injeksi Klorokuin tablet 250 mg Klorpromazin HCl injeksi 25 mg/ml Klorpromazin tablet 25 mg Klorpromazin tablet 100 mg Klorpropamide tablet 100 mg Kodein tablet 10 mg Komb. Pirimet-sulfadoksin tablet Kotrimoksasol suspensi Kotrimoksasol tablet 120 mg Kotrimoksasol tablet 480 mg Larutan Anisol Larutan Asam asetat Larutan Asam sulfosalisilat Larutan Benedicts Larutan EDTA Larutan Eosin 2 % Larutan Giemsa

236

Larutan Hayem

roll roll roll roll

1

roll roll

4

roll blok blok lembar tube tablet ampul ampul tablet kapsul tube

2

botol botol botol

1

tablet botol ampul tablet ampul tablet tablet tablet tablet tablet botol tablet tablet botol botol botol botol botol botol botol botol

50

237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277

Larutan HCl 0,1 N Larutan Lugol Larutan Natrium sitrat Larutan Rees Ecker Larutan Turk Larutan Ziehl Nelsen Levetran salep Levothyroxin Lidokain injeksi 2 % Lidokain injeksi 2 % (HCl) + Epinefrin 1 : 80.000 - 2 ml Lisol cairan Loratadin tablet Magnesium sulfat injeksi 20 % Magnesium sulfat injeksi 40 % Magnesium sulfat serbuk 30 gram Masker Mebendazol tablet 100 mg Meloksicam 7,5 mg Metformin tablet 500 mg Metilergometrin injeksi 0,200 mg Metilergometrin tablet 0,125 mg Metoklopramide tablet 5 mg Metoklopramide tablet 10 mg Metoklopramide injeksi 5 mg/ml Metoklopramide sirup 5 mg/ml Metronidasol infus Metronidasol tablet 250 mg Metronidasol tablet 500 mg Metylprednisolon Mikonazol salf Mineral mix Monoklorkamfermenthol cairan Morphin Injeksi Mucus section Mummifying pastae Natrium bicarbonat tablet 500 mg Natrium diklofenak tab 25 mg Natrium klorida larutan infus 0,9 % Natrium tiosulfat inj 25% NGT No. 3 NGT No. 3,5

botol botol botol botol botol paket pot tablet ampul

4

ampul botol tablet ampul ampul saset lembar

5

tablet tablet tablet ampul tablet tablet tablet ampul botol botol tablet

50

tablet tablet tube saset botol ampul buah Tube tablet tablet botol ampul pieces pieces

2

278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318

NGT No. 4 NGT NO. 5 NGT NO. 10 NGT NO. 16 NGT NO. 18 Nifedipin tablet 10 mg Nistatin tablet salut 500.000 IU/g Nistatin vaginal tablet 100.000 IU/g Nurse Cup Obat Anti TBC Kategori 2 (sisipan) Obat Anti TBC Kategori Anak Obat Anti TBC Kategori Anak Lanjutan Obat Anti TBC Kategori II FDC Obat batuk hitam Oksitetrasiklin injeksi Oksitetrasiklin s m 1 % Oksitetrasiklin salep kulit 3 % Oksitocyn injeksi 10 IU/ml Omeprasole 20 mg Papaverin injeksi 40 mg/ml Papaverin tablet Parasetamol drops Parasetamol sirup 125 mg/5 ml Parasetamol tablet 100 mg Parasetamol tablet 500 mg Pembalut Gibbs Pethidin injeksi 50 mg/ml Pil KB Kombinasi Pilokarpin HCl tetes mata Piracetam 400 mg Piracetam 800 mg Piracetam injeksi 200 mg/ml Pirantel pamoat tablet 125 mg Piridoksin HCl tablet 10 mg Piroksikam kapsul 20 mg Plastik Obat 8 x 5 cm Plastik Obat 10 x 7 cm Plester 5 yards x 2 inchi Povidon Iodida 10 % 30 ml Povidon Iodida 10 % 60 ml Povidon Iodida 10 % 300 ml

pieces pieces pieces pieces pieces tablet tablet tablet buah paket paket paket paket botol vial Tube Tube ampul

2

Kapsul ampul tablet botol botol tablet tablet

4 90 13

buah ampul tablet botol tablet tablet ampul tablet tablet

30

Kapsul bungkus bungkus roll botol botol botol

1

319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349

Prednison tablet 5 mg Primaquin tablet 15 mg Prokainbenzil penisilin 3 jt IU/vial Propanolol HCl tablet 40 mg Propiltiourasil tablet 100 mg Ranitidin injeksi 50 mg/ml Ranitidin tablet 150 mg Rapid test HIV/AIDS SD Rapid test HIV/AIDS Intec Rapid test HIV/AIDS Oncoprobe Reagen sipilis Reserpina tablet 0,1 mg Retinol 100.000 IU kapsul lunak Retinol 200.000 IU kapsul lunak Ringer laktat larutan infus Salbutamol tablet 2 mg Salbutamol tablet 4 mg Salep 2 - 4 % Salisil bedak 2 % Salisil spiritus 10 % Sarung tangan Ginekologi Sarung tangan No. 6 1/2 Sarung tangan No. 7 Sarung tangan No. 7 1/2 Sarung tangan non steril Save Gloves No. S Save Gloves No. M Save Gloves No. L Selang Karet Anus No. 20 Semen seng serbuk dan cairan Serum Anti Bisa Ular Polivalen Injeksi 50 ml (ABU I)

350 351 352 353 354 355 356 357 358 359

Serum Anti Tetanus Injeksi 1500 IU/amp (ATS)

ampul

Serum Anti Tetanus Injeksi 20.000 IU/amp (ATS) Serum Test Golongan Darah Sianokobalamin 50 mcg Sianokobalamin injeksi Silk/benang bedah sutera No. 2/0 Silk/benang bedah sutera No. 3/0 Silver amalgam serbuk 65 - 75 % Simvastatin tablet 10 mg Simvastatin tablet 20 mg

ampul

tablet

150

tablet vial tablet tablet ampul tablet

30

strip strip strip strip tablet kapsul kapsul botol tablet tablet pot dos botol psg psg psg psg buah psg psg psg buah botol vial

botol tablet ampul buah buah botol tablet tablet

2

360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392

Sintetic filling material Slide box Spiritus Spironolacton tablet 25 mg Spon gelatin cubicles 1 x 1 x 1 cm Sputum pot Stop TB kategori I Stop TB kategori I & 3 Streptomicyn sulfat injeksi 1500 mg/vial Sulfadimidin tablet 500 mg Sulfazetamid tetes mata Temporary stopping fletcher (fletcher) serbuk dan cairan Tetrakain tetes mata Tetrasiklin kapsul 250 mg Tetrasiklin kapsul 500 mg Thiamin HCl injeksi 100 mg/ml Thiamin HCl tablet 50 mg Tissue lensa Torniquet Tramadol injeksi Tramadol kapsul Transfusi set Triheksifenidil HCl tablet 2 mg Umbilical Cord Klem Under Pad Urine bag Ventolin Vitamin B Kompleks tablet Widal Test Wing Needle No. 23 G Zink Rapid test Malaria VAR

JUMLAH KUNJUNGAN RESEP

buah box botol tablet buah buah paket paket vial tablet botol botol botol kapsul kapsul ampul

20 5

tablet bungkus buah ampul kapsul buah tablet buah pieces pieces ampul tablet

34

botol buah tablet buah

15 43

ampul

UMUM BAYAR TIDAK BAYAR

MENGETAHUI/MENYETUJUI: KEPALA DINAS KESEHATAN KAB. NAGEKEO,

(…………………………………………………………………..) NIP.

(LPLPO) TAHUN: 2016 PELAPORAN BULAN : JANUARI 2016 PERMINTAAN BULAN : FEBRUARI 2016 PENERIMAAN

PERSEDIAAN

5

6

1

3

5

200 3

PEMAKAIAN SISA STOK STOK OPT PERMINTAAN 7

0 3 2 2 0 3 0 0 0 0 0 15 12 0 0 60 0 0 0 0 0 85 0 0 0 0 255 7 0 0 0

2

40

206 6

8 0 3 2 2 0 3 0 0 0 0 0 15 10 0 0 20 0 0 0 0 0 85 0 0 0 0 49 1 0 0 0

9

10

50

50

50

330

0 0 0 3 80 0 0 0 0 0 0 0 0 0 0 0 0 0 0 120 0 0 0 150 0 0 0 0 0 0 0 0 0 490 0 0 0 0 0 0 0

1 60

100

140

490

0 0 0 2 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2

5 50

0 0 0 0 3 0 1 0 0 0 0 0 0 0 0 5 140 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0

1 1

50

2

0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 5 90 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0

20

100

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 39 0 0 1 0 0 245 0 0 0 0 0 0 0 0

39

123

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 122 0 0 0 0 0 0 0 0

1

50

0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0 0 0 0 0 0 0

80

0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 0

2 2

200

5 100

0 0 0 3 0 6 0 0 0 0 0 0 0 0 0 0 2 0 0 1 200 0 0 0 0 0 0 0 0 0 5 0 150 0 0 0 0 0 0 0 0

1 2

1

1 100

5 70

0 0 0 2 0 4 0 0 0 0 0 0 0 0 0 0 1 0 0 0 100 0 0 0 0 0 0 0 0 0 0 0 80 0 0 0 0 0 0 0 0

2

3

0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 2 0 0 0

2

5

0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 2 0 0 0

5 200

10 50

1 1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 9 90 213 0 0 0 0 0 0 0 10 80 0 0 1 1 0 0 1

8 60 210

70

1 1

1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 1 30 3 0 0 0 0 0 0 0 10 10 0 0 0 0 0 0 0

50

4

200 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

50

4

150 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

30 100

100

50

ASKES

0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 5 100 0 0 0 0 0 0 0 0 0 0 134 0 0 65 43 0

40 100

100

65 3

0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 5 0 0 0 0 0 0 0 0 0 0 0 34 0 0 0 40 0

YANG MENYERAHKAN: PETUGAS INSTALASI FARMASI,

(……………………………………………………………..) NIP.

YANG MEMINTA/ MELA

(

MAGUS HILARIUS NIP.19631231 200012

BULAN: JANUARI 2016

APBD IIBUFFER PROGRAM DEPKES ASKES JUMLAH KET LAIN 11

12

13

14

15

16

17

………………………………., 2014

YANG MEMINTA/ MELAPORKAN: YANG MENERIMA: KEPALA PUSKESMAS, PETUGAS PUSKESMAS,

(

MAGUS HILARIUS ) NIP.19631231 200012 1 029

( FATMAWATI ) NIP.19820424 200904 2 014

PUSKESMAS : NANGARORO KABUPATEN : NAGEKEO POSKESDES : ULUPULU

NO.

NAMA JENIS OBAT

SATUAN

STOK AWAL

1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

2

3

4 0 3 2 2 0 3 0 0 0 0 0 15 10 0 0 20 0 0 0 0 0 85 0 0 0 0 49 1 0 0 0

Abocath No 18 Abocath No 20 Abocath No 22 Abocath No 24 Abocath No 26 Aciclovir salep kulit Aciclovir tablet 400 mg Alat suntik sekali pakai 1 ml Alat suntik sekali pakai 10 ml Alat suntik sekali pakai 2,5 ml Alat suntik sekali pakai 20 ml Alat suntik sekali pakai 3 ml Alat suntik sekali pakai 5 ml Alat suntik sekali pakai 50 ml Albendazole tablet 400 mg Alopurinol tablet 100 mg Aluminium foil Amalgam serbuk 65-75 % Ambroxol sirup 15 mg/ml Ambroxol tablet 30 mg Aminofilin injeksi Aminofilin tablet 200 mg Amitriptilin tablet 25 mg Amlodipin 5 mg Amlodipin 10 mg Amoksisilin kapsul 250 mg Amoksisilin kaplet 500 mg Amoksisilin sirup kering 125 mg/5 ml Ampisilin kaplet 250 mg Ampisilin kaplet 500 mg Ampisilin serbuk injeksi 1.000 mg

buah buah buah buah buah tube tablet buah buah buah buah buah buah buah tablet tablet gulungan botol botol tablet ampul tablet tablet tablet tablet kapsul kaplet botol kaplet kaplet vial

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

Ampisilin sirup kering 60 ml Antagin injeksi 250 mg / ml Antalgin tablet 500 mg Antasida DOEN II suspensi Antasida DOEN tablet Anti hemoroid suppositoria Anti migrain DOEN tablet Anti parkinson DOEN tablet Antibakteri DOEN komb.Salep(Basitrasin + Polimiksin) Antifungi DOEN salep ( 3 - 6 ) Aqua pro injeksi steril 25 ml Aquadest steril 500 ml Arsuamon tablet Artemether injeksi 1 ml : 80 mg Arterakin tablet Artesunate injeksi Artesunate tablet Asam Asetilsalisilat tablet 100 mg (Asetosal) Asam Asetilsalisilat tablet 500 mg (Asetosal) Asam askorbat tablet 50 mg Asam askorbat tablet 250 mg Asam folat Asam mefenamat tablet 250 mg Asam mefenamat tablet 500 mg Asam traneksamat 500 mg Asam traneksamat injeksi Atenolol tablet 50 mg Atropin sulfat injeksi 0,25 mg/ml Atropin sulfat tablet 0,5 mg Atropin sulfat tetes mata Autoklik Bekarbon (arang aktif) Benzatin benzil penisilin injeksi Besi II tablet salut kombinasi Betahistin Betametason krem 0,1 % Bisoprolol 5 mg Bisturi No. 11 Blood lancet Bromheksin tablet 8 mg Burnazin salep

botol ampul tablet botol tablet suposs tablet tablet Pot Pot vial botol tablet ampul tablet vial tablet tablet tablet tablet tablet tablet tablet tablet tablet ampul tablet ampul tablet botol buah tablet vial tablet tablet tube tablet buah buah tablet tube

0 0 0 2 20 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113

Calsium glukonat 10 mg/ml Captopril 12,5 mg Captopril 25 mg Cat Gram Catgut Chromic No 2/0 Catgut Chromic No 3/0 Catgut Plain No 2/0 Catgut Plain No 3/0 Cetirizine Cimetidine tablet 200 mg Combur test Cover glass Cyprofloxacin tablet 500 mg Dapson tablet Darplex Deksametason injeksi 5 mg/ml Deksametason tablet 0,5 mg Dekstrometorfan syrup Dekstrometrophan tablet 15 mg Dengue blood Devitalisasi pastae non arsen Diasepam injeksi 5 mg/ml Diasepam tablet 2 mg Diasepam tablet 5 mg Dietilkarbamazin tablet Difenhidramin injeksi 10 mg Digoksin tablet Dimenhidrinat tab 50 mg Doksisiklin kapsul 100 mg Domperidon sirup Domperidon tablet 10 mg Efedrin HCl tablet 25 mg Ekstrak Belladona tablet 10mg Epinefrin/adrenalin injeksi 0,1 % Erytromicyn kapsul 250 mg Erytromicyn kapsul 500 mg Erytromicyn suspensi 125 mg/ 5 ml Etakridina larutan 0,1% Etanol 70 % 100 ml Etanol 70% 300 ml Etanol 70 % 1000 ml

ampul tablet tablet paket buah buah buah buah tablet tablet kit buah tablet tablet tablet ampul tablet botol tablet kit botol ampul tablet tablet tablet ampul tablet tablet kapsul botol tablet tablet tablet ampul kapsul kapsul botol botol botol botol botol

0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 5 90 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0

114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154

Etanol 96 % 1000 ml Ethil klorida semprot Eugenol cairan F l u o r tablet 0, mg Fenitoin natrium injeksi 50 mg/ml Fenitoin natrium kapsul 30 mg Fenitoin natrium kapsul 100 mg Fenobarbital injeksi 50 mg/ml Fenobarbital tablet 30 mg Fenobarbital tablet 100 mg Fenoksimetil penisilin tablet 250 mg Fenoksimetil penisilin tablet 500 mg Fenolgliserol tetes telinga Fitomenadion (Vit K) injeksi 10 mg/ml Fitomenadion (Vit K1) injeksi 10 mg/ml Fitomenadion (Vit.K1) tablet salut 10 mg Folley cath.10 F Folley cath.14 F Folley cath.16 F Folley cath.18 F Forinokresol (pengganti TKF) Formalin cair Formalin tablet 1 gr Furosemida injeksi Furosemida tablet 40 mg Gameksan lotion 1 % Garam oralit 200 ml air Gentamisin injeksi 40 mg/ml Gentamisin salep kulit 0,1 % Gentian violet larutan Glass Ionomer Cement ART Glibenklamid tablet 5 mg Gliserilguayakolat tablet Gliserin Glukosa injeksi 40 % Glukosa larutan infus 5 % Glukosa larutan infus 10 % Griseofulvin tablet 125 mg Haemocytometer Haemometer Haloperidol tablet 0,5 mg

botol botol botol tablet amp @ 2ml kapsul kapsul ampul tablet tablet tablet tablet botol ampul ampul tablet buah buah buah buah botol botol I ltr tablet ampul tablet botol saset ampul tube botol set/botol tablet tablet botol vial botol botol tablet buah buah tablet

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 122 0 0 0 0 0 0 0 0

155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195

HBSaG HCG Strip Hidrogen peroksida Hidroklorotiasida tablet 25 mg Hidrokortison krem 2,5 % Ibuprofen 100 mg/5 ml suspensi Ibuprofen 200 mg/5 ml suspensi Ibuprofen tablet 200 mg Ibuprofen tablet 400 mg Imersion oil Infus set anak Infus set dewasa Iodin test Iodol kapsul lunak Isosorbid dinitrat tablet 5 mg Jarum dispossible No. 22 ¼ G Jarum dispossible No. 23 ¼ G Jarum jahit/ bedah Kulit No. 9 Jarum jahit/ bedah Kulit No. 10 Jarum jahit/ bedah Kulit No. 11 Jarum jahit/ bedah Kulit No. 12 Jarum jahit/ bedah Kulit No. 13 Jarum jahit/ bedah Kulit No. 14 Jarum jahit/ bedah Otot No. 9 Jarum jahit/ bedah Otot No. 10 Jarum jahit/ bedah Otot No. 11 Jarum jahit/ bedah Otot No. 12 Jarum jahit/ bedah Otot No. 13 Jarum jahit/ bedah Otot No. 14 Jeli USG Kaca slide Kalium permanganat serbuk Kalsium hidroksida pastae Kalsium laktat tablet 500 mg Kapas pembalut absorben 100 gr Kapas pembalut absorben 250 gr Karbamasepin tablet 200 mg Kartu stok Kasa kompres steril 40/40 Kasa pembalut 10 cm Kasa pembalut 4 m x 3 cm

strip strip botol tablet tube botol botol tablet tablet botol set set botol kapsul tablet buah buah pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces jerigen buah tube tube buah roll roll tablet lembar roll roll roll

0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 0

196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235

Kasa pembalut 4 m x 5 cm Kasa pembalut 4 m x 6 cm Kasa pembalut 40 m x 80 cm Kasa pembalut hidrofil 2 m x 80 cm Kasa pembalut hidrofil 4 m x 10 cm Kasa pembalut hidrofil 4 m x 15 cm Kasa pembalut hidrifil 16 cm x 16 cm Kertas Pulvis Kertas Resep Kertas saring Ketokonazole cream 2% Ketokonazole tablet 200 mg Ketorolac injeksi 10mg/ml Kinina dihidroklorida injeksi 25 % Kinina sulfat tablet 200 mg Kloramfenikol kapsul 250 mg Kloramfenikol sm 1 % Kloramfenikol suspensi Kloramfenikol tetes mata 0,5 % Kloramfenikol tetes telinga 3 % Klorfeniramin maleat tablet 4 mg Klorfenol kamfer menthol (CHKM) Klorokuin injeksi Klorokuin tablet 250 mg Klorpromazin HCl injeksi 25 mg/ml Klorpromazin tablet 25 mg Klorpromazin tablet 100 mg Klorpropamide tablet 100 mg Kodein tablet 10 mg Komb. Pirimet-sulfadoksin tablet Kotrimoksasol suspensi Kotrimoksasol tablet 120 mg Kotrimoksasol tablet 480 mg Larutan Anisol Larutan Asam asetat Larutan Asam sulfosalisilat Larutan Benedicts Larutan EDTA Larutan Eosin 2 % Larutan Giemsa

236

Larutan Hayem

roll

botol

0 0 0 2 0 4 0 0 0 0 0 0 0 0 0 0 1 0 0 0 100 0 0 0 0 0 0 0 0 0 0 0 80 0 0 0 0 0 0 0

botol

0

roll roll roll roll roll roll blok blok lembar tube tablet ampul ampul tablet kapsul tube botol botol botol tablet botol ampul tablet ampul tablet tablet tablet tablet tablet botol tablet tablet botol botol botol botol botol botol

237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277

Larutan HCl 0,1 N Larutan Lugol Larutan Natrium sitrat Larutan Rees Ecker Larutan Turk Larutan Ziehl Nelsen Levetran salep Levothyroxin Lidokain injeksi 2 % Lidokain injeksi 2 % (HCl) + Epinefrin 1 : 80.000 - 2 ml Lisol cairan Loratadin tablet Magnesium sulfat injeksi 20 % Magnesium sulfat injeksi 40 % Magnesium sulfat serbuk 30 gram Masker Mebendazol tablet 100 mg Meloksicam 7,5 mg Metformin tablet 500 mg Metilergometrin injeksi 0,200 mg Metilergometrin tablet 0,125 mg Metoklopramide tablet 5 mg Metoklopramide tablet 10 mg Metoklopramide injeksi 5 mg/ml Metoklopramide sirup 5 mg/ml Metronidasol infus Metronidasol tablet 250 mg Metronidasol tablet 500 mg Metylprednisolon Mikonazol salf Mineral mix Monoklorkamfermenthol cairan Morphin Injeksi Mucus section Mummifying pastae Natrium bicarbonat tablet 500 mg Natrium diklofenak tab 25 mg Natrium klorida larutan infus 0,9 % Natrium tiosulfat inj 25% NGT No. 3 NGT No. 3,5

botol botol botol botol botol paket pot tablet ampul ampul botol tablet ampul ampul saset lembar tablet tablet tablet ampul tablet tablet tablet ampul botol botol tablet tablet tablet tube saset botol ampul buah Tube tablet tablet botol ampul pieces pieces

0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 2 0 0 0

278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318

NGT No. 4 NGT NO. 5 NGT NO. 10 NGT NO. 16 NGT NO. 18 Nifedipin tablet 10 mg Nistatin tablet salut 500.000 IU/g Nistatin vaginal tablet 100.000 IU/g Nurse Cup Obat Anti TBC Kategori 2 (sisipan) Obat Anti TBC Kategori Anak Obat Anti TBC Kategori Anak Lanjutan Obat Anti TBC Kategori II FDC Obat batuk hitam Oksitetrasiklin injeksi Oksitetrasiklin s m 1 % Oksitetrasiklin salep kulit 3 % Oksitocyn injeksi 10 IU/ml Omeprasole 20 mg Papaverin injeksi 40 mg/ml Papaverin tablet Parasetamol drops Parasetamol sirup 125 mg/5 ml Parasetamol tablet 100 mg Parasetamol tablet 500 mg Pembalut Gibbs Pethidin injeksi 50 mg/ml Pil KB Kombinasi Pilokarpin HCl tetes mata Piracetam 400 mg Piracetam 800 mg Piracetam injeksi 200 mg/ml Pirantel pamoat tablet 125 mg Piridoksin HCl tablet 10 mg Piroksikam kapsul 20 mg Plastik Obat 8 x 5 cm Plastik Obat 10 x 7 cm Plester 5 yards x 2 inchi Povidon Iodida 10 % 30 ml Povidon Iodida 10 % 60 ml Povidon Iodida 10 % 300 ml

pieces pieces pieces pieces pieces tablet tablet tablet buah paket paket paket paket botol vial Tube Tube ampul Kapsul ampul tablet botol botol tablet tablet buah ampul tablet botol tablet tablet ampul tablet tablet Kapsul bungkus bungkus roll botol botol botol

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 1 30 3 0 0 0 0 0 0 0 10 10 0 0 0 0 0 0 0

319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349

Prednison tablet 5 mg Primaquin tablet 15 mg Prokainbenzil penisilin 3 jt IU/vial Propanolol HCl tablet 40 mg Propiltiourasil tablet 100 mg Ranitidin injeksi 50 mg/ml Ranitidin tablet 150 mg Rapid test HIV/AIDS SD Rapid test HIV/AIDS Intec Rapid test HIV/AIDS Oncoprobe Reagen sipilis Reserpina tablet 0,1 mg Retinol 100.000 IU kapsul lunak Retinol 200.000 IU kapsul lunak Ringer laktat larutan infus Salbutamol tablet 2 mg Salbutamol tablet 4 mg Salep 2 - 4 % Salisil bedak 2 % Salisil spiritus 10 % Sarung tangan Ginekologi Sarung tangan No. 6 1/2 Sarung tangan No. 7 Sarung tangan No. 7 1/2 Sarung tangan non steril Save Gloves No. S Save Gloves No. M Save Gloves No. L Selang Karet Anus No. 20 Semen seng serbuk dan cairan Serum Anti Bisa Ular Polivalen Injeksi 50 ml (ABU I)

350 351 352 353 354 355 356 357 358 359

Serum Anti Tetanus Injeksi 1500 IU/amp (ATS)

ampul

Serum Anti Tetanus Injeksi 20.000 IU/amp (ATS) Serum Test Golongan Darah Sianokobalamin 50 mcg Sianokobalamin injeksi Silk/benang bedah sutera No. 2/0 Silk/benang bedah sutera No. 3/0 Silver amalgam serbuk 65 - 75 % Simvastatin tablet 10 mg Simvastatin tablet 20 mg

ampul

tablet tablet vial tablet tablet ampul tablet strip strip strip strip tablet kapsul kapsul botol tablet tablet pot dos botol psg psg psg psg buah psg psg psg buah botol vial

botol tablet ampul buah buah botol tablet tablet

150 0 0 0 0 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392

Sintetic filling material Slide box Spiritus Spironolacton tablet 25 mg Spon gelatin cubicles 1 x 1 x 1 cm Sputum pot Stop TB kategori I Stop TB kategori I & 3 Streptomicyn sulfat injeksi 1500 mg/vial Sulfadimidin tablet 500 mg Sulfazetamid tetes mata Temporary stopping fletcher (fletcher) serbuk dan cairan Tetrakain tetes mata Tetrasiklin kapsul 250 mg Tetrasiklin kapsul 500 mg Thiamin HCl injeksi 100 mg/ml Thiamin HCl tablet 50 mg Tissue lensa Torniquet Tramadol injeksi Tramadol kapsul Transfusi set Triheksifenidil HCl tablet 2 mg Umbilical Cord Klem Under Pad Urine bag Ventolin Vitamin B Kompleks tablet Widal Test Wing Needle No. 23 G Zink Rapid test Malaria VAR

JUMLAH KUNJUNGAN RESEP

buah box botol tablet buah buah paket paket vial tablet botol botol botol kapsul kapsul ampul tablet bungkus buah ampul kapsul buah tablet buah pieces pieces ampul tablet botol buah tablet buah ampul

0 0 0 0 0 0 0 0 0 0 0 0 0 0 10 5 0 0 0 0 0 0 0 0 0 0 0 34 0 0 0 40 0

UMUM BAYAR TIDAK BAYAR

MENGETAHUI/MENYETUJUI: KEPALA DINAS KESEHATAN KAB. NAGEKEO,

(…………………………………………………………………..) NIP.

(LPLPO) TAHUN: 2016 PELAPORAN BULAN : FEBRUARI 2016 PERMINTAAN BULAN : MARET 2016 PENERIMAAN

PERSEDIAAN

5

6

6 6 6

5

50

300 10

PEMAKAIAN SISA STOK STOK OPT PERMINTAAN 7

0 9 8 8 0 3 0 0 0 0 0 20 10 0 0 70 0 0 0 0 0 85 0 0 0 0 349 11 0 0 0

1 1

40

349 9

8 0 8 7 8 0 3 0 0 0 0 0 20 10 0 0 30 0 0 0 0 0 85 0 0 0 0 0 2 0 0 0

9

10

100

200

200

5

900

0 0 0 2 120 0 0 0 0 0 0 0 0 0 0 0 0 0 0 220 0 0 0 210 0 0 0 0 0 5 0 0 0 900 0 0 0 0 0 0 0

30

200

210

1

120

0 0 0 2 90 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 0 0 0 4 0 0 0 780 0 0 0 0 0 0 0

4 4

100

2

0 0 0 0 6 0 4 0 0 0 0 0 0 0 0 5 190 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0

100

1

0 0 0 0 6 0 4 0 0 0 0 0 0 0 0 5 90 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0

100

300

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0 0 1 0 0 422 0 0 0 0 0 0 0 0

23

1

197

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 77 0 0 0 0 0 225 0 0 0 0 0 0 0 0

15

1 2

100

0 15 0 0 0 0 0 0 0 0 3 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 120 0 0 0 0 0 0 0

1 1

10

0 15 0 0 0 0 0 0 0 0 2 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 110 0 0 0 0 0 0 0

3

200

10 300

0 0 0 2 0 7 0 0 0 0 0 0 0 0 0 0 1 0 0 0 300 0 0 0 0 0 0 0 0 0 10 0 380 0 0 0 0 0 0 0 0

1

212

10 70

0 0 0 2 0 6 0 0 0 0 0 0 0 0 0 0 1 0 0 0 88 0 0 0 0 0 0 0 0 0 0 0 310 0 0 0 0 0 0 0 0

4

5

0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 2 0 0 0

3

0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 2 0 0 0

10 100 200

100

1 1

1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 11 130 203 0 0 0 0 0 0 0 10 110 0 0 1 1 0 0 1

10 130 200

70

1

1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 1 0 3 0 0 0 0 0 0 0 10 40 0 0 0 1 0 0 0

200

11 100 6

6

350 0 0 0 0 0 30 0 0 0 0 0 11 100 6 0 0 0 0 0 0 6 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

50

11 100 2

3

300 0 0 0 0 0 30 0 0 0 0 0 0 0 4 0 0 0 0 0 0 3 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

50 100

200

200

ASKES

0 0 0 0 0 0 0 0 0 0 0 0 0 0 60 5 100 0 0 0 0 0 0 0 0 0 0 234 0 0 200 40 0

20 100

130

34 40

0 0 0 0 0 0 0 0 0 0 0 0 0 0 40 5 0 0 0 0 0 0 0 0 0 0 0 104 0 0 166 0 0

YANG MENYERAHKAN: PETUGAS INSTALASI FARMASI,

(……………………………………………………………..) NIP.

YANG MEMINTA/ MELA

(

MAGUS HILARIUS NIP.19631231 200012

BULAN: JANUARI 2016

APBD IIBUFFER PROGRAM DEPKES ASKES JUMLAH KET LAIN 11

12

13

14

15

16

17

………………………………., 2014

YANG MEMINTA/ MELAPORKAN: YANG MENERIMA: KEPALA PUSKESMAS, PETUGAS PUSKESMAS,

(

MAGUS HILARIUS ) NIP.19631231 200012 1 029

( FATMAWATI ) NIP.19820424 200904 2 014

PUSKESMAS : NANGARORO KABUPATEN : NAGEKEO POSKESDES : ULUPULU

NO.

NAMA JENIS OBAT

SATUAN

STOK AWAL

1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

2

3

4 0 8 7 8 0 3 0 0 0 0 0 20 10 0 0 30 0 0 0 0 0 85 0 0 0 0 0 2 0 0 0

Abocath No 18 Abocath No 20 Abocath No 22 Abocath No 24 Abocath No 26 Aciclovir salep kulit Aciclovir tablet 400 mg Alat suntik sekali pakai 1 ml Alat suntik sekali pakai 10 ml Alat suntik sekali pakai 2,5 ml Alat suntik sekali pakai 20 ml Alat suntik sekali pakai 3 ml Alat suntik sekali pakai 5 ml Alat suntik sekali pakai 50 ml Albendazole tablet 400 mg Alopurinol tablet 100 mg Aluminium foil Amalgam serbuk 65-75 % Ambroxol sirup 15 mg/ml Ambroxol tablet 30 mg Aminofilin injeksi Aminofilin tablet 200 mg Amitriptilin tablet 25 mg Amlodipin 5 mg Amlodipin 10 mg Amoksisilin kapsul 250 mg Amoksisilin kaplet 500 mg Amoksisilin sirup kering 125 mg/5 ml Ampisilin kaplet 250 mg Ampisilin kaplet 500 mg Ampisilin serbuk injeksi 1.000 mg

buah buah buah buah buah tube tablet buah buah buah buah buah buah buah tablet tablet gulungan botol botol tablet ampul tablet tablet tablet tablet kapsul kaplet botol kaplet kaplet vial

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

Ampisilin sirup kering 60 ml Antagin injeksi 250 mg / ml Antalgin tablet 500 mg Antasida DOEN II suspensi Antasida DOEN tablet Anti hemoroid suppositoria Anti migrain DOEN tablet Anti parkinson DOEN tablet Antibakteri DOEN komb.Salep(Basitrasin + Polimiksin) Antifungi DOEN salep ( 3 - 6 ) Aqua pro injeksi steril 25 ml Aquadest steril 500 ml Arsuamon tablet Artemether injeksi 1 ml : 80 mg Arterakin tablet Artesunate injeksi Artesunate tablet Asam Asetilsalisilat tablet 100 mg (Asetosal) Asam Asetilsalisilat tablet 500 mg (Asetosal) Asam askorbat tablet 50 mg Asam askorbat tablet 250 mg Asam folat Asam mefenamat tablet 250 mg Asam mefenamat tablet 500 mg Asam traneksamat 500 mg Asam traneksamat injeksi Atenolol tablet 50 mg Atropin sulfat injeksi 0,25 mg/ml Atropin sulfat tablet 0,5 mg Atropin sulfat tetes mata Autoklik Bekarbon (arang aktif) Benzatin benzil penisilin injeksi Besi II tablet salut kombinasi Betahistin Betametason krem 0,1 % Bisoprolol 5 mg Bisturi No. 11 Blood lancet Bromheksin tablet 8 mg Burnazin salep

botol ampul tablet botol tablet suposs tablet tablet Pot Pot vial botol tablet ampul tablet vial tablet tablet tablet tablet tablet tablet tablet tablet tablet ampul tablet ampul tablet botol buah tablet vial tablet tablet tube tablet buah buah tablet tube

0 0 0 2 90 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 0 0 0 4 0 0 0 780 0 0 0 0 0 0 0

73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113

Calsium glukonat 10 mg/ml Captopril 12,5 mg Captopril 25 mg Cat Gram Catgut Chromic No 2/0 Catgut Chromic No 3/0 Catgut Plain No 2/0 Catgut Plain No 3/0 Cetirizine Cimetidine tablet 200 mg Combur test Cover glass Cyprofloxacin tablet 500 mg Dapson tablet Darplex Deksametason injeksi 5 mg/ml Deksametason tablet 0,5 mg Dekstrometorfan syrup Dekstrometrophan tablet 15 mg Dengue blood Devitalisasi pastae non arsen Diasepam injeksi 5 mg/ml Diasepam tablet 2 mg Diasepam tablet 5 mg Dietilkarbamazin tablet Difenhidramin injeksi 10 mg Digoksin tablet Dimenhidrinat tab 50 mg Doksisiklin kapsul 100 mg Domperidon sirup Domperidon tablet 10 mg Efedrin HCl tablet 25 mg Ekstrak Belladona tablet 10mg Epinefrin/adrenalin injeksi 0,1 % Erytromicyn kapsul 250 mg Erytromicyn kapsul 500 mg Erytromicyn suspensi 125 mg/ 5 ml Etakridina larutan 0,1% Etanol 70 % 100 ml Etanol 70% 300 ml Etanol 70 % 1000 ml

ampul tablet tablet paket buah buah buah buah tablet tablet kit buah tablet tablet tablet ampul tablet botol tablet kit botol ampul tablet tablet tablet ampul tablet tablet kapsul botol tablet tablet tablet ampul kapsul kapsul botol botol botol botol botol

0 0 0 0 6 0 4 0 0 0 0 0 0 0 0 5 90 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0

114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154

Etanol 96 % 1000 ml Ethil klorida semprot Eugenol cairan F l u o r tablet 0, mg Fenitoin natrium injeksi 50 mg/ml Fenitoin natrium kapsul 30 mg Fenitoin natrium kapsul 100 mg Fenobarbital injeksi 50 mg/ml Fenobarbital tablet 30 mg Fenobarbital tablet 100 mg Fenoksimetil penisilin tablet 250 mg Fenoksimetil penisilin tablet 500 mg Fenolgliserol tetes telinga Fitomenadion (Vit K) injeksi 10 mg/ml Fitomenadion (Vit K1) injeksi 10 mg/ml Fitomenadion (Vit.K1) tablet salut 10 mg Folley cath.10 F Folley cath.14 F Folley cath.16 F Folley cath.18 F Forinokresol (pengganti TKF) Formalin cair Formalin tablet 1 gr Furosemida injeksi Furosemida tablet 40 mg Gameksan lotion 1 % Garam oralit 200 ml air Gentamisin injeksi 40 mg/ml Gentamisin salep kulit 0,1 % Gentian violet larutan Glass Ionomer Cement ART Glibenklamid tablet 5 mg Gliserilguayakolat tablet Gliserin Glukosa injeksi 40 % Glukosa larutan infus 5 % Glukosa larutan infus 10 % Griseofulvin tablet 125 mg Haemocytometer Haemometer Haloperidol tablet 0,5 mg

botol botol botol tablet amp @ 2ml kapsul kapsul ampul tablet tablet tablet tablet botol ampul ampul tablet buah buah buah buah botol botol I ltr tablet ampul tablet botol saset ampul tube botol set/botol tablet tablet botol vial botol botol tablet buah buah tablet

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 77 0 0 0 0 0 225 0 0 0 0 0 0 0 0

155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195

HBSaG HCG Strip Hidrogen peroksida Hidroklorotiasida tablet 25 mg Hidrokortison krem 2,5 % Ibuprofen 100 mg/5 ml suspensi Ibuprofen 200 mg/5 ml suspensi Ibuprofen tablet 200 mg Ibuprofen tablet 400 mg Imersion oil Infus set anak Infus set dewasa Iodin test Iodol kapsul lunak Isosorbid dinitrat tablet 5 mg Jarum dispossible No. 22 ¼ G Jarum dispossible No. 23 ¼ G Jarum jahit/ bedah Kulit No. 9 Jarum jahit/ bedah Kulit No. 10 Jarum jahit/ bedah Kulit No. 11 Jarum jahit/ bedah Kulit No. 12 Jarum jahit/ bedah Kulit No. 13 Jarum jahit/ bedah Kulit No. 14 Jarum jahit/ bedah Otot No. 9 Jarum jahit/ bedah Otot No. 10 Jarum jahit/ bedah Otot No. 11 Jarum jahit/ bedah Otot No. 12 Jarum jahit/ bedah Otot No. 13 Jarum jahit/ bedah Otot No. 14 Jeli USG Kaca slide Kalium permanganat serbuk Kalsium hidroksida pastae Kalsium laktat tablet 500 mg Kapas pembalut absorben 100 gr Kapas pembalut absorben 250 gr Karbamasepin tablet 200 mg Kartu stok Kasa kompres steril 40/40 Kasa pembalut 10 cm Kasa pembalut 4 m x 3 cm

strip strip botol tablet tube botol botol tablet tablet botol set set botol kapsul tablet buah buah pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces jerigen buah tube tube buah roll roll tablet lembar roll roll roll

0 15 0 0 0 0 0 0 0 0 2 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 110 0 0 0 0 0 0 0

196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235

Kasa pembalut 4 m x 5 cm Kasa pembalut 4 m x 6 cm Kasa pembalut 40 m x 80 cm Kasa pembalut hidrofil 2 m x 80 cm Kasa pembalut hidrofil 4 m x 10 cm Kasa pembalut hidrofil 4 m x 15 cm Kasa pembalut hidrifil 16 cm x 16 cm Kertas Pulvis Kertas Resep Kertas saring Ketokonazole cream 2% Ketokonazole tablet 200 mg Ketorolac injeksi 10mg/ml Kinina dihidroklorida injeksi 25 % Kinina sulfat tablet 200 mg Kloramfenikol kapsul 250 mg Kloramfenikol sm 1 % Kloramfenikol suspensi Kloramfenikol tetes mata 0,5 % Kloramfenikol tetes telinga 3 % Klorfeniramin maleat tablet 4 mg Klorfenol kamfer menthol (CHKM) Klorokuin injeksi Klorokuin tablet 250 mg Klorpromazin HCl injeksi 25 mg/ml Klorpromazin tablet 25 mg Klorpromazin tablet 100 mg Klorpropamide tablet 100 mg Kodein tablet 10 mg Komb. Pirimet-sulfadoksin tablet Kotrimoksasol suspensi Kotrimoksasol tablet 120 mg Kotrimoksasol tablet 480 mg Larutan Anisol Larutan Asam asetat Larutan Asam sulfosalisilat Larutan Benedicts Larutan EDTA Larutan Eosin 2 % Larutan Giemsa

236

Larutan Hayem

roll

botol

0 0 0 2 0 6 0 0 0 0 0 0 0 0 0 0 1 0 0 0 88 0 0 0 0 0 0 0 0 0 0 0 310 0 0 0 0 0 0 0

botol

0

roll roll roll roll roll roll blok blok lembar tube tablet ampul ampul tablet kapsul tube botol botol botol tablet botol ampul tablet ampul tablet tablet tablet tablet tablet botol tablet tablet botol botol botol botol botol botol

237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277

Larutan HCl 0,1 N Larutan Lugol Larutan Natrium sitrat Larutan Rees Ecker Larutan Turk Larutan Ziehl Nelsen Levetran salep Levothyroxin Lidokain injeksi 2 % Lidokain injeksi 2 % (HCl) + Epinefrin 1 : 80.000 - 2 ml Lisol cairan Loratadin tablet Magnesium sulfat injeksi 20 % Magnesium sulfat injeksi 40 % Magnesium sulfat serbuk 30 gram Masker Mebendazol tablet 100 mg Meloksicam 7,5 mg Metformin tablet 500 mg Metilergometrin injeksi 0,200 mg Metilergometrin tablet 0,125 mg Metoklopramide tablet 5 mg Metoklopramide tablet 10 mg Metoklopramide injeksi 5 mg/ml Metoklopramide sirup 5 mg/ml Metronidasol infus Metronidasol tablet 250 mg Metronidasol tablet 500 mg Metylprednisolon Mikonazol salf Mineral mix Monoklorkamfermenthol cairan Morphin Injeksi Mucus section Mummifying pastae Natrium bicarbonat tablet 500 mg Natrium diklofenak tab 25 mg Natrium klorida larutan infus 0,9 % Natrium tiosulfat inj 25% NGT No. 3 NGT No. 3,5

botol botol botol botol botol paket pot tablet ampul ampul botol tablet ampul ampul saset lembar tablet tablet tablet ampul tablet tablet tablet ampul botol botol tablet tablet tablet tube saset botol ampul buah Tube tablet tablet botol ampul pieces pieces

0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 2 0 0 0

278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318

NGT No. 4 NGT NO. 5 NGT NO. 10 NGT NO. 16 NGT NO. 18 Nifedipin tablet 10 mg Nistatin tablet salut 500.000 IU/g Nistatin vaginal tablet 100.000 IU/g Nurse Cup Obat Anti TBC Kategori 2 (sisipan) Obat Anti TBC Kategori Anak Obat Anti TBC Kategori Anak Lanjutan Obat Anti TBC Kategori II FDC Obat batuk hitam Oksitetrasiklin injeksi Oksitetrasiklin s m 1 % Oksitetrasiklin salep kulit 3 % Oksitocyn injeksi 10 IU/ml Omeprasole 20 mg Papaverin injeksi 40 mg/ml Papaverin tablet Parasetamol drops Parasetamol sirup 125 mg/5 ml Parasetamol tablet 100 mg Parasetamol tablet 500 mg Pembalut Gibbs Pethidin injeksi 50 mg/ml Pil KB Kombinasi Pilokarpin HCl tetes mata Piracetam 400 mg Piracetam 800 mg Piracetam injeksi 200 mg/ml Pirantel pamoat tablet 125 mg Piridoksin HCl tablet 10 mg Piroksikam kapsul 20 mg Plastik Obat 8 x 5 cm Plastik Obat 10 x 7 cm Plester 5 yards x 2 inchi Povidon Iodida 10 % 30 ml Povidon Iodida 10 % 60 ml Povidon Iodida 10 % 300 ml

pieces pieces pieces pieces pieces tablet tablet tablet buah paket paket paket paket botol vial Tube Tube ampul Kapsul ampul tablet botol botol tablet tablet buah ampul tablet botol tablet tablet ampul tablet tablet Kapsul bungkus bungkus roll botol botol botol

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 1 0 3 0 0 0 0 0 0 0 10 40 0 0 0 1 0 0 0

319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349

Prednison tablet 5 mg Primaquin tablet 15 mg Prokainbenzil penisilin 3 jt IU/vial Propanolol HCl tablet 40 mg Propiltiourasil tablet 100 mg Ranitidin injeksi 50 mg/ml Ranitidin tablet 150 mg Rapid test HIV/AIDS SD Rapid test HIV/AIDS Intec Rapid test HIV/AIDS Oncoprobe Reagen sipilis Reserpina tablet 0,1 mg Retinol 100.000 IU kapsul lunak Retinol 200.000 IU kapsul lunak Ringer laktat larutan infus Salbutamol tablet 2 mg Salbutamol tablet 4 mg Salep 2 - 4 % Salisil bedak 2 % Salisil spiritus 10 % Sarung tangan Ginekologi Sarung tangan No. 6 1/2 Sarung tangan No. 7 Sarung tangan No. 7 1/2 Sarung tangan non steril Save Gloves No. S Save Gloves No. M Save Gloves No. L Selang Karet Anus No. 20 Semen seng serbuk dan cairan Serum Anti Bisa Ular Polivalen Injeksi 50 ml (ABU I)

350 351 352 353 354 355 356 357 358 359

Serum Anti Tetanus Injeksi 1500 IU/amp (ATS)

ampul

Serum Anti Tetanus Injeksi 20.000 IU/amp (ATS) Serum Test Golongan Darah Sianokobalamin 50 mcg Sianokobalamin injeksi Silk/benang bedah sutera No. 2/0 Silk/benang bedah sutera No. 3/0 Silver amalgam serbuk 65 - 75 % Simvastatin tablet 10 mg Simvastatin tablet 20 mg

ampul

tablet tablet vial tablet tablet ampul tablet strip strip strip strip tablet kapsul kapsul botol tablet tablet pot dos botol psg psg psg psg buah psg psg psg buah botol vial

botol tablet ampul buah buah botol tablet tablet

300 0 0 0 0 0 30 0 0 0 0 0 0 0 4 0 0 0 0 0 0 3 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392

Sintetic filling material Slide box Spiritus Spironolacton tablet 25 mg Spon gelatin cubicles 1 x 1 x 1 cm Sputum pot Stop TB kategori I Stop TB kategori I & 3 Streptomicyn sulfat injeksi 1500 mg/vial Sulfadimidin tablet 500 mg Sulfazetamid tetes mata Temporary stopping fletcher (fletcher) serbuk dan cairan Tetrakain tetes mata Tetrasiklin kapsul 250 mg Tetrasiklin kapsul 500 mg Thiamin HCl injeksi 100 mg/ml Thiamin HCl tablet 50 mg Tissue lensa Torniquet Tramadol injeksi Tramadol kapsul Transfusi set Triheksifenidil HCl tablet 2 mg Umbilical Cord Klem Under Pad Urine bag Ventolin Vitamin B Kompleks tablet Widal Test Wing Needle No. 23 G Zink Rapid test Malaria VAR

JUMLAH KUNJUNGAN RESEP

buah box botol tablet buah buah paket paket vial tablet botol botol botol kapsul kapsul ampul tablet bungkus buah ampul kapsul buah tablet buah pieces pieces ampul tablet botol buah tablet buah ampul

0 0 0 0 0 0 0 0 0 0 0 0 0 0 40 5 0 0 0 0 0 0 0 0 0 0 0 104 0 0 166 0 0

UMUM BAYAR TIDAK BAYAR

MENGETAHUI/MENYETUJUI: KEPALA DINAS KESEHATAN KAB. NAGEKEO,

(…………………………………………………………………..) NIP.

(LPLPO) TAHUN: 2016 PELAPORAN BULAN : MARET 2016 PERMINTAAN BULAN : APRIL 2016 PENERIMAAN

PERSEDIAAN

5

6

3

50

300 10

PEMAKAIAN SISA STOK STOK OPT PERMINTAAN 7

0 8 7 8 0 6 0 0 0 0 0 20 10 0 0 80 0 0 0 0 0 85 0 0 0 0 300 12 0 0 0

1 2 1

5 2

240 6

8 0 7 5 7 0 6 0 0 0 0 0 15 8 0 0 80 0 0 0 0 0 85 0 0 0 0 60 6 0 0 0

9

10

50

200

200

2

120

0 0 0 2 140 0 0 0 0 0 0 0 0 0 0 0 0 0 0 220 0 0 0 200 0 0 0 0 0 6 0 0 0 900 0 0 0 0 0 0 0

1 40

163

100

1

120

0 0 0 1 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 57 0 0 0 100 0 0 0 0 0 5 0 0 0 780 0 0 0 0 0 0 0

100

100

2

0 0 100 0 6 0 4 0 0 0 0 0 0 0 0 5 190 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0

20

40

1

0 0 80 0 6 0 4 0 0 0 0 0 0 0 0 5 150 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0

25

100

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 102 0 0 0 0 0 325 0 0 0 0 0 0 0 0

5

234

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 97 0 0 0 0 0 91 0 0 0 0 0 0 0 0

2 2

0 15 0 0 0 0 0 0 0 0 4 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 110 0 0 0 0 0 0 0

3

2

30

0 12 0 0 0 0 0 0 0 0 4 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 80 0 0 0 0 0 0 0

1 2

2

200

10 100

0 0 0 3 0 8 0 0 0 0 0 0 0 0 0 0 3 0 0 0 288 0 0 0 0 0 0 0 0 0 10 0 410 0 0 0 0 0 0 0 0

1

253

8 100

0 0 0 2 0 8 0 0 0 0 0 0 0 0 0 0 3 0 0 0 35 0 0 0 0 0 0 0 0 0 2 0 310 0 0 0 0 0 0 0 0

5

0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 2 0 0 0

3

0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 7 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 2 0 0 0

5

15 100 300

100

1

1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 0 16 100 303 0 0 0 0 0 0 0 10 140 0 0 1 1 0 0 1

13 280

50

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 0 3 100 23 0 0 0 0 0 0 0 10 90 0 0 1 1 0 0 1

2

4 6

300 0 0 0 0 0 30 0 0 0 0 0 0 0 6 0 0 0 0 0 0 7 0 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

30

4

2 2

270 0 0 0 0 0 30 0 0 0 0 0 0 0 2 0 0 0 0 0 0 5 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

50 100

200

50

ASKES

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 5 100 0 0 0 0 0 0 0 0 0 0 304 0 0 216 0 0

10 2 80

100

0 0 0 0 0 0 0 0 0 0 0 0 0 0 80 3 20 0 0 0 0 0 0 0 0 0 0 204 0 0 216 0 0

YANG MENYERAHKAN: PETUGAS INSTALASI FARMASI,

(……………………………………………………………..) NIP.

YANG MEMINTA/ MELA

(

MAGUS HILARIUS NIP.19631231 200012

BULAN: JANUARI 2016

APBD IIBUFFER PROGRAM DEPKES ASKES JUMLAH KET LAIN 11

12

13

14

15

16

17

………………………………., 2014

YANG MEMINTA/ MELAPORKAN: YANG MENERIMA: KEPALA PUSKESMAS, PETUGAS PUSKESMAS,

(

MAGUS HILARIUS ) NIP.19631231 200012 1 029

( FATMAWATI ) NIP.19820424 200904 2 014

PUSKESMAS : NANGARORO KABUPATEN : NAGEKEO POSKESDES : ULUPULU

NO.

NAMA JENIS OBAT

SATUAN

STOK AWAL

1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

2

3

4 0 7 5 7 0 6 0 0 0 0 0 15 8 0 0 80 0 0 0 0 0 85 0 0 0 0 60 6 0 0 0

Abocath No 18 Abocath No 20 Abocath No 22 Abocath No 24 Abocath No 26 Aciclovir salep kulit Aciclovir tablet 400 mg Alat suntik sekali pakai 1 ml Alat suntik sekali pakai 10 ml Alat suntik sekali pakai 2,5 ml Alat suntik sekali pakai 20 ml Alat suntik sekali pakai 3 ml Alat suntik sekali pakai 5 ml Alat suntik sekali pakai 50 ml Albendazole tablet 400 mg Alopurinol tablet 100 mg Aluminium foil Amalgam serbuk 65-75 % Ambroxol sirup 15 mg/ml Ambroxol tablet 30 mg Aminofilin injeksi Aminofilin tablet 200 mg Amitriptilin tablet 25 mg Amlodipin 5 mg Amlodipin 10 mg Amoksisilin kapsul 250 mg Amoksisilin kaplet 500 mg Amoksisilin sirup kering 125 mg/5 ml Ampisilin kaplet 250 mg Ampisilin kaplet 500 mg Ampisilin serbuk injeksi 1.000 mg

buah buah buah buah buah tube tablet buah buah buah buah buah buah buah tablet tablet gulungan botol botol tablet ampul tablet tablet tablet tablet kapsul kaplet botol kaplet kaplet vial

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

Ampisilin sirup kering 60 ml Antagin injeksi 250 mg / ml Antalgin tablet 500 mg Antasida DOEN II suspensi Antasida DOEN tablet Anti hemoroid suppositoria Anti migrain DOEN tablet Anti parkinson DOEN tablet Antibakteri DOEN komb.Salep(Basitrasin + Polimiksin) Antifungi DOEN salep ( 3 - 6 ) Aqua pro injeksi steril 25 ml Aquadest steril 500 ml Arsuamon tablet Artemether injeksi 1 ml : 80 mg Arterakin tablet Artesunate injeksi Artesunate tablet Asam Asetilsalisilat tablet 100 mg (Asetosal) Asam Asetilsalisilat tablet 500 mg (Asetosal) Asam askorbat tablet 50 mg Asam askorbat tablet 250 mg Asam folat Asam mefenamat tablet 250 mg Asam mefenamat tablet 500 mg Asam traneksamat 500 mg Asam traneksamat injeksi Atenolol tablet 50 mg Atropin sulfat injeksi 0,25 mg/ml Atropin sulfat tablet 0,5 mg Atropin sulfat tetes mata Autoklik Bekarbon (arang aktif) Benzatin benzil penisilin injeksi Besi II tablet salut kombinasi Betahistin Betametason krem 0,1 % Bisoprolol 5 mg Bisturi No. 11 Blood lancet Bromheksin tablet 8 mg Burnazin salep

botol ampul tablet botol tablet suposs tablet tablet Pot Pot vial botol tablet ampul tablet vial tablet tablet tablet tablet tablet tablet tablet tablet tablet ampul tablet ampul tablet botol buah tablet vial tablet tablet tube tablet buah buah tablet tube

0 0 0 1 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 57 0 0 0 100 0 0 0 0 0 5 0 0 0 780 0 0 0 0 0 0 0

73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113

Calsium glukonat 10 mg/ml Captopril 12,5 mg Captopril 25 mg Cat Gram Catgut Chromic No 2/0 Catgut Chromic No 3/0 Catgut Plain No 2/0 Catgut Plain No 3/0 Cetirizine Cimetidine tablet 200 mg Combur test Cover glass Cyprofloxacin tablet 500 mg Dapson tablet Darplex Deksametason injeksi 5 mg/ml Deksametason tablet 0,5 mg Dekstrometorfan syrup Dekstrometrophan tablet 15 mg Dengue blood Devitalisasi pastae non arsen Diasepam injeksi 5 mg/ml Diasepam tablet 2 mg Diasepam tablet 5 mg Dietilkarbamazin tablet Difenhidramin injeksi 10 mg Digoksin tablet Dimenhidrinat tab 50 mg Doksisiklin kapsul 100 mg Domperidon sirup Domperidon tablet 10 mg Efedrin HCl tablet 25 mg Ekstrak Belladona tablet 10mg Epinefrin/adrenalin injeksi 0,1 % Erytromicyn kapsul 250 mg Erytromicyn kapsul 500 mg Erytromicyn suspensi 125 mg/ 5 ml Etakridina larutan 0,1% Etanol 70 % 100 ml Etanol 70% 300 ml Etanol 70 % 1000 ml

ampul tablet tablet paket buah buah buah buah tablet tablet kit buah tablet tablet tablet ampul tablet botol tablet kit botol ampul tablet tablet tablet ampul tablet tablet kapsul botol tablet tablet tablet ampul kapsul kapsul botol botol botol botol botol

0 0 80 0 6 0 4 0 0 0 0 0 0 0 0 5 150 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0

114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154

Etanol 96 % 1000 ml Ethil klorida semprot Eugenol cairan F l u o r tablet 0, mg Fenitoin natrium injeksi 50 mg/ml Fenitoin natrium kapsul 30 mg Fenitoin natrium kapsul 100 mg Fenobarbital injeksi 50 mg/ml Fenobarbital tablet 30 mg Fenobarbital tablet 100 mg Fenoksimetil penisilin tablet 250 mg Fenoksimetil penisilin tablet 500 mg Fenolgliserol tetes telinga Fitomenadion (Vit K) injeksi 10 mg/ml Fitomenadion (Vit K1) injeksi 10 mg/ml Fitomenadion (Vit.K1) tablet salut 10 mg Folley cath.10 F Folley cath.14 F Folley cath.16 F Folley cath.18 F Forinokresol (pengganti TKF) Formalin cair Formalin tablet 1 gr Furosemida injeksi Furosemida tablet 40 mg Gameksan lotion 1 % Garam oralit 200 ml air Gentamisin injeksi 40 mg/ml Gentamisin salep kulit 0,1 % Gentian violet larutan Glass Ionomer Cement ART Glibenklamid tablet 5 mg Gliserilguayakolat tablet Gliserin Glukosa injeksi 40 % Glukosa larutan infus 5 % Glukosa larutan infus 10 % Griseofulvin tablet 125 mg Haemocytometer Haemometer Haloperidol tablet 0,5 mg

botol botol botol tablet amp @ 2ml kapsul kapsul ampul tablet tablet tablet tablet botol ampul ampul tablet buah buah buah buah botol botol I ltr tablet ampul tablet botol saset ampul tube botol set/botol tablet tablet botol vial botol botol tablet buah buah tablet

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 97 0 0 0 0 0 91 0 0 0 0 0 0 0 0

155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195

HBSaG HCG Strip Hidrogen peroksida Hidroklorotiasida tablet 25 mg Hidrokortison krem 2,5 % Ibuprofen 100 mg/5 ml suspensi Ibuprofen 200 mg/5 ml suspensi Ibuprofen tablet 200 mg Ibuprofen tablet 400 mg Imersion oil Infus set anak Infus set dewasa Iodin test Iodol kapsul lunak Isosorbid dinitrat tablet 5 mg Jarum dispossible No. 22 ¼ G Jarum dispossible No. 23 ¼ G Jarum jahit/ bedah Kulit No. 9 Jarum jahit/ bedah Kulit No. 10 Jarum jahit/ bedah Kulit No. 11 Jarum jahit/ bedah Kulit No. 12 Jarum jahit/ bedah Kulit No. 13 Jarum jahit/ bedah Kulit No. 14 Jarum jahit/ bedah Otot No. 9 Jarum jahit/ bedah Otot No. 10 Jarum jahit/ bedah Otot No. 11 Jarum jahit/ bedah Otot No. 12 Jarum jahit/ bedah Otot No. 13 Jarum jahit/ bedah Otot No. 14 Jeli USG Kaca slide Kalium permanganat serbuk Kalsium hidroksida pastae Kalsium laktat tablet 500 mg Kapas pembalut absorben 100 gr Kapas pembalut absorben 250 gr Karbamasepin tablet 200 mg Kartu stok Kasa kompres steril 40/40 Kasa pembalut 10 cm Kasa pembalut 4 m x 3 cm

strip strip botol tablet tube botol botol tablet tablet botol set set botol kapsul tablet buah buah pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces jerigen buah tube tube buah roll roll tablet lembar roll roll roll

0 12 0 0 0 0 0 0 0 0 4 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 80 0 0 0 0 0 0 0

196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235

Kasa pembalut 4 m x 5 cm Kasa pembalut 4 m x 6 cm Kasa pembalut 40 m x 80 cm Kasa pembalut hidrofil 2 m x 80 cm Kasa pembalut hidrofil 4 m x 10 cm Kasa pembalut hidrofil 4 m x 15 cm Kasa pembalut hidrifil 16 cm x 16 cm Kertas Pulvis Kertas Resep Kertas saring Ketokonazole cream 2% Ketokonazole tablet 200 mg Ketorolac injeksi 10mg/ml Kinina dihidroklorida injeksi 25 % Kinina sulfat tablet 200 mg Kloramfenikol kapsul 250 mg Kloramfenikol sm 1 % Kloramfenikol suspensi Kloramfenikol tetes mata 0,5 % Kloramfenikol tetes telinga 3 % Klorfeniramin maleat tablet 4 mg Klorfenol kamfer menthol (CHKM) Klorokuin injeksi Klorokuin tablet 250 mg Klorpromazin HCl injeksi 25 mg/ml Klorpromazin tablet 25 mg Klorpromazin tablet 100 mg Klorpropamide tablet 100 mg Kodein tablet 10 mg Komb. Pirimet-sulfadoksin tablet Kotrimoksasol suspensi Kotrimoksasol tablet 120 mg Kotrimoksasol tablet 480 mg Larutan Anisol Larutan Asam asetat Larutan Asam sulfosalisilat Larutan Benedicts Larutan EDTA Larutan Eosin 2 % Larutan Giemsa

236

Larutan Hayem

roll

botol

0 0 0 2 0 8 0 0 0 0 0 0 0 0 0 0 3 0 0 0 35 0 0 0 0 0 0 0 0 0 2 0 310 0 0 0 0 0 0 0

botol

0

roll roll roll roll roll roll blok blok lembar tube tablet ampul ampul tablet kapsul tube botol botol botol tablet botol ampul tablet ampul tablet tablet tablet tablet tablet botol tablet tablet botol botol botol botol botol botol

237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277

Larutan HCl 0,1 N Larutan Lugol Larutan Natrium sitrat Larutan Rees Ecker Larutan Turk Larutan Ziehl Nelsen Levetran salep Levothyroxin Lidokain injeksi 2 % Lidokain injeksi 2 % (HCl) + Epinefrin 1 : 80.000 - 2 ml Lisol cairan Loratadin tablet Magnesium sulfat injeksi 20 % Magnesium sulfat injeksi 40 % Magnesium sulfat serbuk 30 gram Masker Mebendazol tablet 100 mg Meloksicam 7,5 mg Metformin tablet 500 mg Metilergometrin injeksi 0,200 mg Metilergometrin tablet 0,125 mg Metoklopramide tablet 5 mg Metoklopramide tablet 10 mg Metoklopramide injeksi 5 mg/ml Metoklopramide sirup 5 mg/ml Metronidasol infus Metronidasol tablet 250 mg Metronidasol tablet 500 mg Metylprednisolon Mikonazol salf Mineral mix Monoklorkamfermenthol cairan Morphin Injeksi Mucus section Mummifying pastae Natrium bicarbonat tablet 500 mg Natrium diklofenak tab 25 mg Natrium klorida larutan infus 0,9 % Natrium tiosulfat inj 25% NGT No. 3 NGT No. 3,5

botol botol botol botol botol paket pot tablet ampul ampul botol tablet ampul ampul saset lembar tablet tablet tablet ampul tablet tablet tablet ampul botol botol tablet tablet tablet tube saset botol ampul buah Tube tablet tablet botol ampul pieces pieces

0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 7 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 2 0 0 0

278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318

NGT No. 4 NGT NO. 5 NGT NO. 10 NGT NO. 16 NGT NO. 18 Nifedipin tablet 10 mg Nistatin tablet salut 500.000 IU/g Nistatin vaginal tablet 100.000 IU/g Nurse Cup Obat Anti TBC Kategori 2 (sisipan) Obat Anti TBC Kategori Anak Obat Anti TBC Kategori Anak Lanjutan Obat Anti TBC Kategori II FDC Obat batuk hitam Oksitetrasiklin injeksi Oksitetrasiklin s m 1 % Oksitetrasiklin salep kulit 3 % Oksitocyn injeksi 10 IU/ml Omeprasole 20 mg Papaverin injeksi 40 mg/ml Papaverin tablet Parasetamol drops Parasetamol sirup 125 mg/5 ml Parasetamol tablet 100 mg Parasetamol tablet 500 mg Pembalut Gibbs Pethidin injeksi 50 mg/ml Pil KB Kombinasi Pilokarpin HCl tetes mata Piracetam 400 mg Piracetam 800 mg Piracetam injeksi 200 mg/ml Pirantel pamoat tablet 125 mg Piridoksin HCl tablet 10 mg Piroksikam kapsul 20 mg Plastik Obat 8 x 5 cm Plastik Obat 10 x 7 cm Plester 5 yards x 2 inchi Povidon Iodida 10 % 30 ml Povidon Iodida 10 % 60 ml Povidon Iodida 10 % 300 ml

pieces pieces pieces pieces pieces tablet tablet tablet buah paket paket paket paket botol vial Tube Tube ampul Kapsul ampul tablet botol botol tablet tablet buah ampul tablet botol tablet tablet ampul tablet tablet Kapsul bungkus bungkus roll botol botol botol

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 0 3 100 23 0 0 0 0 0 0 0 10 90 0 0 1 1 0 0 1

319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349

Prednison tablet 5 mg Primaquin tablet 15 mg Prokainbenzil penisilin 3 jt IU/vial Propanolol HCl tablet 40 mg Propiltiourasil tablet 100 mg Ranitidin injeksi 50 mg/ml Ranitidin tablet 150 mg Rapid test HIV/AIDS SD Rapid test HIV/AIDS Intec Rapid test HIV/AIDS Oncoprobe Reagen sipilis Reserpina tablet 0,1 mg Retinol 100.000 IU kapsul lunak Retinol 200.000 IU kapsul lunak Ringer laktat larutan infus Salbutamol tablet 2 mg Salbutamol tablet 4 mg Salep 2 - 4 % Salisil bedak 2 % Salisil spiritus 10 % Sarung tangan Ginekologi Sarung tangan No. 6 1/2 Sarung tangan No. 7 Sarung tangan No. 7 1/2 Sarung tangan non steril Save Gloves No. S Save Gloves No. M Save Gloves No. L Selang Karet Anus No. 20 Semen seng serbuk dan cairan Serum Anti Bisa Ular Polivalen Injeksi 50 ml (ABU I)

350 351 352 353 354 355 356 357 358 359

Serum Anti Tetanus Injeksi 1500 IU/amp (ATS)

ampul

Serum Anti Tetanus Injeksi 20.000 IU/amp (ATS) Serum Test Golongan Darah Sianokobalamin 50 mcg Sianokobalamin injeksi Silk/benang bedah sutera No. 2/0 Silk/benang bedah sutera No. 3/0 Silver amalgam serbuk 65 - 75 % Simvastatin tablet 10 mg Simvastatin tablet 20 mg

ampul

tablet tablet vial tablet tablet ampul tablet strip strip strip strip tablet kapsul kapsul botol tablet tablet pot dos botol psg psg psg psg buah psg psg psg buah botol vial

botol tablet ampul buah buah botol tablet tablet

270 0 0 0 0 0 30 0 0 0 0 0 0 0 2 0 0 0 0 0 0 5 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392

Sintetic filling material Slide box Spiritus Spironolacton tablet 25 mg Spon gelatin cubicles 1 x 1 x 1 cm Sputum pot Stop TB kategori I Stop TB kategori I & 3 Streptomicyn sulfat injeksi 1500 mg/vial Sulfadimidin tablet 500 mg Sulfazetamid tetes mata Temporary stopping fletcher (fletcher) serbuk dan cairan Tetrakain tetes mata Tetrasiklin kapsul 250 mg Tetrasiklin kapsul 500 mg Thiamin HCl injeksi 100 mg/ml Thiamin HCl tablet 50 mg Tissue lensa Torniquet Tramadol injeksi Tramadol kapsul Transfusi set Triheksifenidil HCl tablet 2 mg Umbilical Cord Klem Under Pad Urine bag Ventolin Vitamin B Kompleks tablet Widal Test Wing Needle No. 23 G Zink Rapid test Malaria VAR

JUMLAH KUNJUNGAN RESEP

buah box botol tablet buah buah paket paket vial tablet botol botol botol kapsul kapsul ampul tablet bungkus buah ampul kapsul buah tablet buah pieces pieces ampul tablet botol buah tablet buah ampul

0 0 0 0 0 0 0 0 0 0 0 0 0 0 80 3 20 0 0 0 0 0 0 0 0 0 0 204 0 0 216 0 0

UMUM BAYAR TIDAK BAYAR

MENGETAHUI/MENYETUJUI: KEPALA DINAS KESEHATAN KAB. NAGEKEO,

(…………………………………………………………………..) NIP.

(LPLPO) TAHUN: 2016 PELAPORAN BULAN : APRIL 2016 PERMINTAAN BULAN : MEI 2016 PENERIMAAN

PERSEDIAAN

5

6

2

10 5

400 10

PEMAKAIAN SISA STOK STOK OPT PERMINTAAN 7

0 7 7 7 0 6 0 0 0 0 0 25 13 0 0 80 0 0 0 0 0 85 0 0 0 400 60 16 0 0 0

1 1 1

10 2

80

85

300 60 8

8 0 6 6 6 0 6 0 0 0 0 0 15 11 0 0 0 0 0 0 0 0 0 0 0 0 100 0 8 0 0 0

9

ed 70

ed 85

10

100

100

210 5

0 0 0 1 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 157 0 0 0 200 0 0 0 0 0 5 0 0 0 990 0 5 0 0 0 0 0

1 70

157

200

1

360 1

0 0 0 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 630 0 4 0 0 0 0 0

5 100

2

0 0 80 0 6 0 4 0 0 0 0 0 0 0 0 10 250 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0

10 1 1

40

3

0 0 70 0 5 0 3 0 0 0 0 0 0 0 0 10 210 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0

200

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 97 0 0 0 0 0 291 0 0 0 0 0 0 0 0

10

291

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 87 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1 2

50 1

2

0 12 0 0 0 0 0 0 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 130 0 1 0 0 0 0 2

2

1 2

60

2

0 10 0 0 0 0 0 0 0 0 4 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 70 0 1 0 0 0 0 0

2

200

10

0 0 0 4 0 8 0 0 0 0 0 0 0 0 0 0 3 0 0 0 235 0 0 0 0 0 0 0 0 0 12 0 310 0 0 0 0 0 0 0 0

2 4

235

10 180

0 0 0 2 0 4 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 130 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 7 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 2 0 0 0

4

4

2

0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 100 300

50

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 0 18 200 323 0 0 0 0 0 0 0 10 140 0 0 1 1 0 0 1

15 100 323

2 100

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 0 3 100 0 0 0 0 0 0 0 0 8 40 0 0 1 1 0 0 1

3

2 4

270 0 0 0 0 0 30 0 0 0 0 0 0 0 5 0 0 0 0 0 0 7 4 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

40

4

3 5

230 0 0 0 0 0 30 0 0 0 0 0 0 0 1 0 0 0 0 0 0 4 4 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

5 100

100

ASKES

0 0 0 0 0 0 0 0 0 0 0 0 0 0 80 8 120 0 0 0 0 0 0 0 0 0 0 304 0 0 216 0 0

40 110

200

10

0 0 0 0 0 0 0 0 0 0 0 0 0 0 40 8 10 0 0 0 0 0 0 0 0 0 0 104 0 0 206 0 0

YANG MENYERAHKAN: PETUGAS INSTALASI FARMASI,

(……………………………………………………………..) NIP.

YANG MEMINTA/ MELA

(

MAGUS HILARIUS NIP.19631231 200012

BULAN: APRIL 2016

APBD IIBUFFER PROGRAM DEPKES ASKES JUMLAH KET LAIN 11

12

13

14

15

16

17

………………………………., 2014

YANG MEMINTA/ MELAPORKAN: YANG MENERIMA: KEPALA PUSKESMAS, PETUGAS PUSKESMAS,

(

MAGUS HILARIUS ) NIP.19631231 200012 1 029

( FATMAWATI ) NIP.19820424 200904 2 014

PUSKESMAS : NANGARORO KABUPATEN : NAGEKEO POSKESDES : ULUPULU

NO.

NAMA JENIS OBAT

SATUAN

STOK AWAL

1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

2

3

4 0 6 6 6 0 6 0 0 0 0 0 15 11 0 0 0 0 0 0 0 0 0 0 0 0 100 0 8 0 0 0

Abocath No 18 Abocath No 20 Abocath No 22 Abocath No 24 Abocath No 26 Aciclovir salep kulit Aciclovir tablet 400 mg Alat suntik sekali pakai 1 ml Alat suntik sekali pakai 10 ml Alat suntik sekali pakai 2,5 ml Alat suntik sekali pakai 20 ml Alat suntik sekali pakai 3 ml Alat suntik sekali pakai 5 ml Alat suntik sekali pakai 50 ml Albendazole tablet 400 mg Alopurinol tablet 100 mg Aluminium foil Amalgam serbuk 65-75 % Ambroxol sirup 15 mg/ml Ambroxol tablet 30 mg Aminofilin injeksi Aminofilin tablet 200 mg Amitriptilin tablet 25 mg Amlodipin 5 mg Amlodipin 10 mg Amoksisilin kapsul 250 mg Amoksisilin kaplet 500 mg Amoksisilin sirup kering 125 mg/5 ml Ampisilin kaplet 250 mg Ampisilin kaplet 500 mg Ampisilin serbuk injeksi 1.000 mg

buah buah buah buah buah tube tablet buah buah buah buah buah buah buah tablet tablet gulungan botol botol tablet ampul tablet tablet tablet tablet kapsul kaplet botol kaplet kaplet vial

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

Ampisilin sirup kering 60 ml Antagin injeksi 250 mg / ml Antalgin tablet 500 mg Antasida DOEN II suspensi Antasida DOEN tablet Anti hemoroid suppositoria Anti migrain DOEN tablet Anti parkinson DOEN tablet Antibakteri DOEN komb.Salep(Basitrasin + Polimiksin) Antifungi DOEN salep ( 3 - 6 ) Aqua pro injeksi steril 25 ml Aquadest steril 500 ml Arsuamon tablet Artemether injeksi 1 ml : 80 mg Arterakin tablet Artesunate injeksi Artesunate tablet Asam Asetilsalisilat tablet 100 mg (Asetosal) Asam Asetilsalisilat tablet 500 mg (Asetosal) Asam askorbat tablet 50 mg Asam askorbat tablet 250 mg Asam folat Asam mefenamat tablet 250 mg Asam mefenamat tablet 500 mg Asam traneksamat 500 mg Asam traneksamat injeksi Atenolol tablet 50 mg Atropin sulfat injeksi 0,25 mg/ml Atropin sulfat tablet 0,5 mg Atropin sulfat tetes mata Autoklik Bekarbon (arang aktif) Benzatin benzil penisilin injeksi Besi II tablet salut kombinasi Betahistin Betametason krem 0,1 % Bisoprolol 5 mg Bisturi No. 11 Blood lancet Bromheksin tablet 8 mg Burnazin salep

botol ampul tablet botol tablet suposs tablet tablet Pot Pot vial botol tablet ampul tablet vial tablet tablet tablet tablet tablet tablet tablet tablet tablet ampul tablet ampul tablet botol buah tablet vial tablet tablet tube tablet buah buah tablet tube

0 0 0 0 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 630 0 4 0 0 0 0 0

73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113

Calsium glukonat 10 mg/ml Captopril 12,5 mg Captopril 25 mg Cat Gram Catgut Chromic No 2/0 Catgut Chromic No 3/0 Catgut Plain No 2/0 Catgut Plain No 3/0 Cetirizine Cimetidine tablet 200 mg Combur test Cover glass Cyprofloxacin tablet 500 mg Dapson tablet Darplex Deksametason injeksi 5 mg/ml Deksametason tablet 0,5 mg Dekstrometorfan syrup Dekstrometrophan tablet 15 mg Dengue blood Devitalisasi pastae non arsen Diasepam injeksi 5 mg/ml Diasepam tablet 2 mg Diasepam tablet 5 mg Dietilkarbamazin tablet Difenhidramin injeksi 10 mg Digoksin tablet Dimenhidrinat tab 50 mg Doksisiklin kapsul 100 mg Domperidon sirup Domperidon tablet 10 mg Efedrin HCl tablet 25 mg Ekstrak Belladona tablet 10mg Epinefrin/adrenalin injeksi 0,1 % Erytromicyn kapsul 250 mg Erytromicyn kapsul 500 mg Erytromicyn suspensi 125 mg/ 5 ml Etakridina larutan 0,1% Etanol 70 % 100 ml Etanol 70% 300 ml Etanol 70 % 1000 ml

ampul tablet tablet paket buah buah buah buah tablet tablet kit buah tablet tablet tablet ampul tablet botol tablet kit botol ampul tablet tablet tablet ampul tablet tablet kapsul botol tablet tablet tablet ampul kapsul kapsul botol botol botol botol botol

0 0 70 0 5 0 3 0 0 0 0 0 0 0 0 10 210 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0

114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154

Etanol 96 % 1000 ml Ethil klorida semprot Eugenol cairan F l u o r tablet 0, mg Fenitoin natrium injeksi 50 mg/ml Fenitoin natrium kapsul 30 mg Fenitoin natrium kapsul 100 mg Fenobarbital injeksi 50 mg/ml Fenobarbital tablet 30 mg Fenobarbital tablet 100 mg Fenoksimetil penisilin tablet 250 mg Fenoksimetil penisilin tablet 500 mg Fenolgliserol tetes telinga Fitomenadion (Vit K) injeksi 10 mg/ml Fitomenadion (Vit K1) injeksi 10 mg/ml Fitomenadion (Vit.K1) tablet salut 10 mg Folley cath.10 F Folley cath.14 F Folley cath.16 F Folley cath.18 F Forinokresol (pengganti TKF) Formalin cair Formalin tablet 1 gr Furosemida injeksi Furosemida tablet 40 mg Gameksan lotion 1 % Garam oralit 200 ml air Gentamisin injeksi 40 mg/ml Gentamisin salep kulit 0,1 % Gentian violet larutan Glass Ionomer Cement ART Glibenklamid tablet 5 mg Gliserilguayakolat tablet Gliserin Glukosa injeksi 40 % Glukosa larutan infus 5 % Glukosa larutan infus 10 % Griseofulvin tablet 125 mg Haemocytometer Haemometer Haloperidol tablet 0,5 mg

botol botol botol tablet amp @ 2ml kapsul kapsul ampul tablet tablet tablet tablet botol ampul ampul tablet buah buah buah buah botol botol I ltr tablet ampul tablet botol saset ampul tube botol set/botol tablet tablet botol vial botol botol tablet buah buah tablet

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 87 0 0 0 0 0 0 0 0 0 0 0 0 0 0

155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195

HBSaG HCG Strip Hidrogen peroksida Hidroklorotiasida tablet 25 mg Hidrokortison krem 2,5 % Ibuprofen 100 mg/5 ml suspensi Ibuprofen 200 mg/5 ml suspensi Ibuprofen tablet 200 mg Ibuprofen tablet 400 mg Imersion oil Infus set anak Infus set dewasa Iodin test Iodol kapsul lunak Isosorbid dinitrat tablet 5 mg Jarum dispossible No. 22 ¼ G Jarum dispossible No. 23 ¼ G Jarum jahit/ bedah Kulit No. 9 Jarum jahit/ bedah Kulit No. 10 Jarum jahit/ bedah Kulit No. 11 Jarum jahit/ bedah Kulit No. 12 Jarum jahit/ bedah Kulit No. 13 Jarum jahit/ bedah Kulit No. 14 Jarum jahit/ bedah Otot No. 9 Jarum jahit/ bedah Otot No. 10 Jarum jahit/ bedah Otot No. 11 Jarum jahit/ bedah Otot No. 12 Jarum jahit/ bedah Otot No. 13 Jarum jahit/ bedah Otot No. 14 Jeli USG Kaca slide Kalium permanganat serbuk Kalsium hidroksida pastae Kalsium laktat tablet 500 mg Kapas pembalut absorben 100 gr Kapas pembalut absorben 250 gr Karbamasepin tablet 200 mg Kartu stok Kasa kompres steril 40/40 Kasa pembalut 10 cm Kasa pembalut 4 m x 3 cm

strip strip botol tablet tube botol botol tablet tablet botol set set botol kapsul tablet buah buah pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces jerigen buah tube tube buah roll roll tablet lembar roll roll roll

0 10 0 0 0 0 0 0 0 0 4 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 70 0 1 0 0 0 0 0

196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235

Kasa pembalut 4 m x 5 cm Kasa pembalut 4 m x 6 cm Kasa pembalut 40 m x 80 cm Kasa pembalut hidrofil 2 m x 80 cm Kasa pembalut hidrofil 4 m x 10 cm Kasa pembalut hidrofil 4 m x 15 cm Kasa pembalut hidrifil 16 cm x 16 cm Kertas Pulvis Kertas Resep Kertas saring Ketokonazole cream 2% Ketokonazole tablet 200 mg Ketorolac injeksi 10mg/ml Kinina dihidroklorida injeksi 25 % Kinina sulfat tablet 200 mg Kloramfenikol kapsul 250 mg Kloramfenikol sm 1 % Kloramfenikol suspensi Kloramfenikol tetes mata 0,5 % Kloramfenikol tetes telinga 3 % Klorfeniramin maleat tablet 4 mg Klorfenol kamfer menthol (CHKM) Klorokuin injeksi Klorokuin tablet 250 mg Klorpromazin HCl injeksi 25 mg/ml Klorpromazin tablet 25 mg Klorpromazin tablet 100 mg Klorpropamide tablet 100 mg Kodein tablet 10 mg Komb. Pirimet-sulfadoksin tablet Kotrimoksasol suspensi Kotrimoksasol tablet 120 mg Kotrimoksasol tablet 480 mg Larutan Anisol Larutan Asam asetat Larutan Asam sulfosalisilat Larutan Benedicts Larutan EDTA Larutan Eosin 2 % Larutan Giemsa

236

Larutan Hayem

roll

botol

0 0 0 2 0 4 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 130 0 0 0 0 0 0 0

botol

0

roll roll roll roll roll roll blok blok lembar tube tablet ampul ampul tablet kapsul tube botol botol botol tablet botol ampul tablet ampul tablet tablet tablet tablet tablet botol tablet tablet botol botol botol botol botol botol

237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277

Larutan HCl 0,1 N Larutan Lugol Larutan Natrium sitrat Larutan Rees Ecker Larutan Turk Larutan Ziehl Nelsen Levetran salep Levothyroxin Lidokain injeksi 2 % Lidokain injeksi 2 % (HCl) + Epinefrin 1 : 80.000 - 2 ml Lisol cairan Loratadin tablet Magnesium sulfat injeksi 20 % Magnesium sulfat injeksi 40 % Magnesium sulfat serbuk 30 gram Masker Mebendazol tablet 100 mg Meloksicam 7,5 mg Metformin tablet 500 mg Metilergometrin injeksi 0,200 mg Metilergometrin tablet 0,125 mg Metoklopramide tablet 5 mg Metoklopramide tablet 10 mg Metoklopramide injeksi 5 mg/ml Metoklopramide sirup 5 mg/ml Metronidasol infus Metronidasol tablet 250 mg Metronidasol tablet 500 mg Metylprednisolon Mikonazol salf Mineral mix Monoklorkamfermenthol cairan Morphin Injeksi Mucus section Mummifying pastae Natrium bicarbonat tablet 500 mg Natrium diklofenak tab 25 mg Natrium klorida larutan infus 0,9 % Natrium tiosulfat inj 25% NGT No. 3 NGT No. 3,5

botol botol botol botol botol paket pot tablet ampul ampul botol tablet ampul ampul saset lembar tablet tablet tablet ampul tablet tablet tablet ampul botol botol tablet tablet tablet tube saset botol ampul buah Tube tablet tablet botol ampul pieces pieces

0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 0 0 0 0

278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318

NGT No. 4 NGT NO. 5 NGT NO. 10 NGT NO. 16 NGT NO. 18 Nifedipin tablet 10 mg Nistatin tablet salut 500.000 IU/g Nistatin vaginal tablet 100.000 IU/g Nurse Cup Obat Anti TBC Kategori 2 (sisipan) Obat Anti TBC Kategori Anak Obat Anti TBC Kategori Anak Lanjutan Obat Anti TBC Kategori II FDC Obat batuk hitam Oksitetrasiklin injeksi Oksitetrasiklin s m 1 % Oksitetrasiklin salep kulit 3 % Oksitocyn injeksi 10 IU/ml Omeprasole 20 mg Papaverin injeksi 40 mg/ml Papaverin tablet Parasetamol drops Parasetamol sirup 125 mg/5 ml Parasetamol tablet 100 mg Parasetamol tablet 500 mg Pembalut Gibbs Pethidin injeksi 50 mg/ml Pil KB Kombinasi Pilokarpin HCl tetes mata Piracetam 400 mg Piracetam 800 mg Piracetam injeksi 200 mg/ml Pirantel pamoat tablet 125 mg Piridoksin HCl tablet 10 mg Piroksikam kapsul 20 mg Plastik Obat 8 x 5 cm Plastik Obat 10 x 7 cm Plester 5 yards x 2 inchi Povidon Iodida 10 % 30 ml Povidon Iodida 10 % 60 ml Povidon Iodida 10 % 300 ml

pieces pieces pieces pieces pieces tablet tablet tablet buah paket paket paket paket botol vial Tube Tube ampul Kapsul ampul tablet botol botol tablet tablet buah ampul tablet botol tablet tablet ampul tablet tablet Kapsul bungkus bungkus roll botol botol botol

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 0 3 100 0 0 0 0 0 0 0 0 8 40 0 0 1 1 0 0 1

319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349

Prednison tablet 5 mg Primaquin tablet 15 mg Prokainbenzil penisilin 3 jt IU/vial Propanolol HCl tablet 40 mg Propiltiourasil tablet 100 mg Ranitidin injeksi 50 mg/ml Ranitidin tablet 150 mg Rapid test HIV/AIDS SD Rapid test HIV/AIDS Intec Rapid test HIV/AIDS Oncoprobe Reagen sipilis Reserpina tablet 0,1 mg Retinol 100.000 IU kapsul lunak Retinol 200.000 IU kapsul lunak Ringer laktat larutan infus Salbutamol tablet 2 mg Salbutamol tablet 4 mg Salep 2 - 4 % Salisil bedak 2 % Salisil spiritus 10 % Sarung tangan Ginekologi Sarung tangan No. 6 1/2 Sarung tangan No. 7 Sarung tangan No. 7 1/2 Sarung tangan non steril Save Gloves No. S Save Gloves No. M Save Gloves No. L Selang Karet Anus No. 20 Semen seng serbuk dan cairan Serum Anti Bisa Ular Polivalen Injeksi 50 ml (ABU I)

350 351 352 353 354 355 356 357 358 359

Serum Anti Tetanus Injeksi 1500 IU/amp (ATS)

ampul

Serum Anti Tetanus Injeksi 20.000 IU/amp (ATS) Serum Test Golongan Darah Sianokobalamin 50 mcg Sianokobalamin injeksi Silk/benang bedah sutera No. 2/0 Silk/benang bedah sutera No. 3/0 Silver amalgam serbuk 65 - 75 % Simvastatin tablet 10 mg Simvastatin tablet 20 mg

ampul

tablet tablet vial tablet tablet ampul tablet strip strip strip strip tablet kapsul kapsul botol tablet tablet pot dos botol psg psg psg psg buah psg psg psg buah botol vial

botol tablet ampul buah buah botol tablet tablet

230 0 0 0 0 0 30 0 0 0 0 0 0 0 1 0 0 0 0 0 0 4 4 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392

Sintetic filling material Slide box Spiritus Spironolacton tablet 25 mg Spon gelatin cubicles 1 x 1 x 1 cm Sputum pot Stop TB kategori I Stop TB kategori I & 3 Streptomicyn sulfat injeksi 1500 mg/vial Sulfadimidin tablet 500 mg Sulfazetamid tetes mata Temporary stopping fletcher (fletcher) serbuk dan cairan Tetrakain tetes mata Tetrasiklin kapsul 250 mg Tetrasiklin kapsul 500 mg Thiamin HCl injeksi 100 mg/ml Thiamin HCl tablet 50 mg Tissue lensa Torniquet Tramadol injeksi Tramadol kapsul Transfusi set Triheksifenidil HCl tablet 2 mg Umbilical Cord Klem Under Pad Urine bag Ventolin Vitamin B Kompleks tablet Widal Test Wing Needle No. 23 G Zink Rapid test Malaria VAR

JUMLAH KUNJUNGAN RESEP

buah box botol tablet buah buah paket paket vial tablet botol botol botol kapsul kapsul ampul tablet bungkus buah ampul kapsul buah tablet buah pieces pieces ampul tablet botol buah tablet buah ampul

0 0 0 0 0 0 0 0 0 0 0 0 0 0 40 8 10 0 0 0 0 0 0 0 0 0 0 104 0 0 206 0 0

UMUM BAYAR TIDAK BAYAR

MENGETAHUI/MENYETUJUI: KEPALA DINAS KESEHATAN KAB. NAGEKEO,

(…………………………………………………………………..) NIP.

(LPLPO) TAHUN: 2016 PELAPORAN BULAN :MEI 2016 PERMINTAAN BULAN : JUNI 2016 PENERIMAAN

PERSEDIAAN

5

6

2 2 2

10 5

200 5

PEMAKAIAN SISA STOK STOK OPT PERMINTAAN 7

0 8 8 8 0 6 0 0 0 0 0 25 16 0 0 0 0 0 0 0 0 0 0 0 0 100 200 13 0 0 0

5 3

30 150 10

8 0 8 8 8 0 6 0 0 0 0 0 20 13 0 0 0 0 0 0 0 0 0 0 0 0 70 50 3 0 0 0

9

10

100

200

300

360 3

0 0 0 0 130 0 0 0 0 0 0 0 0 0 0 0 0 0 0 200 0 0 0 300 0 0 0 0 0 4 0 0 0 990 0 7 0 0 0 0 0

30

100

100

150 2

0 0 0 0 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0 0 0 200 0 0 0 0 0 4 0 0 0 840 0 5 0 0 0 0 0

100

5

0 0 70 0 5 0 3 0 0 0 0 0 0 0 0 10 310 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0

20

1

1 50

2

0 0 50 0 5 0 2 0 0 0 0 0 0 0 0 9 260 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0

300

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 87 0 0 0 0 0 300 0 0 0 0 0 0 0 0

5

280

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 82 0 0 0 0 0 20 0 0 0 0 0 0 0 0

DAU

1 3

0 10 0 0 0 0 0 0 0 0 5 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 70 0 1 0 0 0 0 0

1

20

0 9 0 0 0 0 0 0 0 0 5 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 0 1 0 0 0 0 0

2

300

10 200

0 0 0 4 0 4 0 0 0 0 0 0 0 0 0 0 3 0 0 0 300 0 0 0 0 0 0 0 0 0 12 0 330 0 0 0 0 0 0 0 0

1 1

300

8 120

0 0 0 3 0 3 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 210 0 0 0 0 0 0 0 0

5

5

0 0 0 0 0 0 0 0 9 0 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1

3

0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 100 500

4 100

1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 0 13 200 500 0 0 0 0 0 0 0 12 140 0 0 1 2 0 0 1

13 60 310

2 40

1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 0 0 140 190 0 0 0 0 0 0 0 10 100 0 0 1 1 0 0 1

50

3

6

230 0 0 0 0 0 80 0 0 0 0 0 0 0 4 0 0 0 0 0 0 10 4 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

30

3 3

200 0 0 0 0 0 80 0 0 0 0 0 0 0 4 0 0 0 0 0 0 7 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

50 100

200

ASKES

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 8 110 0 0 0 0 0 0 0 0 0 0 304 0 0 206 0 0

40 1 60

140

20

0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 7 50 0 0 0 0 0 0 0 0 0 0 164 0 0 186 0 0

YANG MENYERAHKAN: PETUGAS INSTALASI FARMASI,

(……………………………………………………………..) NIP.

YANG MEMINTA/ MELA

(

MAGUS HILARIUS NIP.19631231 200012

BULAN: APRIL 2016

APBD IIBUFFER PROGRAM DEPKES ASKES JUMLAH KET LAIN 11

12

13

14

15

16

17

………………………………., 2014

YANG MEMINTA/ MELAPORKAN: YANG MENERIMA: KEPALA PUSKESMAS, PETUGAS PUSKESMAS,

(

MAGUS HILARIUS ) NIP.19631231 200012 1 029

( FATMAWATI ) NIP.19820424 200904 2 014

PUSKESMAS : NANGARORO KABUPATEN : NAGEKEO POSKESDES : ULUPULU

NO.

NAMA JENIS OBAT

SATUAN

STOK AWAL

1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

2

3

4 0 8 8 8 0 6 0 0 0 0 0 20 13 0 0 0 0 0 0 0 0 0 0 0 0 70 50 3 0 0 0

Abocath No 18 Abocath No 20 Abocath No 22 Abocath No 24 Abocath No 26 Aciclovir salep kulit Aciclovir tablet 400 mg Alat suntik sekali pakai 1 ml Alat suntik sekali pakai 10 ml Alat suntik sekali pakai 2,5 ml Alat suntik sekali pakai 20 ml Alat suntik sekali pakai 3 ml Alat suntik sekali pakai 5 ml Alat suntik sekali pakai 50 ml Albendazole tablet 400 mg Alopurinol tablet 100 mg Aluminium foil Amalgam serbuk 65-75 % Ambroxol sirup 15 mg/ml Ambroxol tablet 30 mg Aminofilin injeksi Aminofilin tablet 200 mg Amitriptilin tablet 25 mg Amlodipin 5 mg Amlodipin 10 mg Amoksisilin kapsul 250 mg Amoksisilin kaplet 500 mg Amoksisilin sirup kering 125 mg/5 ml Ampisilin kaplet 250 mg Ampisilin kaplet 500 mg Ampisilin serbuk injeksi 1.000 mg

buah buah buah buah buah tube tablet buah buah buah buah buah buah buah tablet tablet gulungan botol botol tablet ampul tablet tablet tablet tablet kapsul kaplet botol kaplet kaplet vial

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

Ampisilin sirup kering 60 ml Antagin injeksi 250 mg / ml Antalgin tablet 500 mg Antasida DOEN II suspensi Antasida DOEN tablet Anti hemoroid suppositoria Anti migrain DOEN tablet Anti parkinson DOEN tablet Antibakteri DOEN komb.Salep(Basitrasin + Polimiksin) Antifungi DOEN salep ( 3 - 6 ) Aqua pro injeksi steril 25 ml Aquadest steril 500 ml Arsuamon tablet Artemether injeksi 1 ml : 80 mg Arterakin tablet Artesunate injeksi Artesunate tablet Asam Asetilsalisilat tablet 100 mg (Asetosal) Asam Asetilsalisilat tablet 500 mg (Asetosal) Asam askorbat tablet 50 mg Asam askorbat tablet 250 mg Asam folat Asam mefenamat tablet 250 mg Asam mefenamat tablet 500 mg Asam traneksamat 500 mg Asam traneksamat injeksi Atenolol tablet 50 mg Atropin sulfat injeksi 0,25 mg/ml Atropin sulfat tablet 0,5 mg Atropin sulfat tetes mata Autoklik Bekarbon (arang aktif) Benzatin benzil penisilin injeksi Besi II tablet salut kombinasi Betahistin Betametason krem 0,1 % Bisoprolol 5 mg Bisturi No. 11 Blood lancet Bromheksin tablet 8 mg Burnazin salep

botol ampul tablet botol tablet suposs tablet tablet Pot Pot vial botol tablet ampul tablet vial tablet tablet tablet tablet tablet tablet tablet tablet tablet ampul tablet ampul tablet botol buah tablet vial tablet tablet tube tablet buah buah tablet tube

0 0 0 0 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 0 0 0 200 0 0 0 0 0 4 0 0 0 840 0 5 0 0 0 0 0

73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113

Calsium glukonat 10 mg/ml Captopril 12,5 mg Captopril 25 mg Cat Gram Catgut Chromic No 2/0 Catgut Chromic No 3/0 Catgut Plain No 2/0 Catgut Plain No 3/0 Cetirizine Cimetidine tablet 200 mg Combur test Cover glass Cyprofloxacin tablet 500 mg Dapson tablet Darplex Deksametason injeksi 5 mg/ml Deksametason tablet 0,5 mg Dekstrometorfan syrup Dekstrometrophan tablet 15 mg Dengue blood Devitalisasi pastae non arsen Diasepam injeksi 5 mg/ml Diasepam tablet 2 mg Diasepam tablet 5 mg Dietilkarbamazin tablet Difenhidramin injeksi 10 mg Digoksin tablet Dimenhidrinat tab 50 mg Doksisiklin kapsul 100 mg Domperidon sirup Domperidon tablet 10 mg Efedrin HCl tablet 25 mg Ekstrak Belladona tablet 10mg Epinefrin/adrenalin injeksi 0,1 % Erytromicyn kapsul 250 mg Erytromicyn kapsul 500 mg Erytromicyn suspensi 125 mg/ 5 ml Etakridina larutan 0,1% Etanol 70 % 100 ml Etanol 70% 300 ml Etanol 70 % 1000 ml

ampul tablet tablet paket buah buah buah buah tablet tablet kit buah tablet tablet tablet ampul tablet botol tablet kit botol ampul tablet tablet tablet ampul tablet tablet kapsul botol tablet tablet tablet ampul kapsul kapsul botol botol botol botol botol

0 0 50 0 5 0 2 0 0 0 0 0 0 0 0 9 260 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0

114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154

Etanol 96 % 1000 ml Ethil klorida semprot Eugenol cairan F l u o r tablet 0, mg Fenitoin natrium injeksi 50 mg/ml Fenitoin natrium kapsul 30 mg Fenitoin natrium kapsul 100 mg Fenobarbital injeksi 50 mg/ml Fenobarbital tablet 30 mg Fenobarbital tablet 100 mg Fenoksimetil penisilin tablet 250 mg Fenoksimetil penisilin tablet 500 mg Fenolgliserol tetes telinga Fitomenadion (Vit K) injeksi 10 mg/ml Fitomenadion (Vit K1) injeksi 10 mg/ml Fitomenadion (Vit.K1) tablet salut 10 mg Folley cath.10 F Folley cath.14 F Folley cath.16 F Folley cath.18 F Forinokresol (pengganti TKF) Formalin cair Formalin tablet 1 gr Furosemida injeksi Furosemida tablet 40 mg Gameksan lotion 1 % Garam oralit 200 ml air Gentamisin injeksi 40 mg/ml Gentamisin salep kulit 0,1 % Gentian violet larutan Glass Ionomer Cement ART Glibenklamid tablet 5 mg Gliserilguayakolat tablet Gliserin Glukosa injeksi 40 % Glukosa larutan infus 5 % Glukosa larutan infus 10 % Griseofulvin tablet 125 mg Haemocytometer Haemometer Haloperidol tablet 0,5 mg

botol botol botol tablet amp @ 2ml kapsul kapsul ampul tablet tablet tablet tablet botol ampul ampul tablet buah buah buah buah botol botol I ltr tablet ampul tablet botol saset ampul tube botol set/botol tablet tablet botol vial botol botol tablet buah buah tablet

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 82 0 0 0 0 0 20 0 0 0 0 0 0 0 0

155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195

HBSaG HCG Strip Hidrogen peroksida Hidroklorotiasida tablet 25 mg Hidrokortison krem 2,5 % Ibuprofen 100 mg/5 ml suspensi Ibuprofen 200 mg/5 ml suspensi Ibuprofen tablet 200 mg Ibuprofen tablet 400 mg Imersion oil Infus set anak Infus set dewasa Iodin test Iodol kapsul lunak Isosorbid dinitrat tablet 5 mg Jarum dispossible No. 22 ¼ G Jarum dispossible No. 23 ¼ G Jarum jahit/ bedah Kulit No. 9 Jarum jahit/ bedah Kulit No. 10 Jarum jahit/ bedah Kulit No. 11 Jarum jahit/ bedah Kulit No. 12 Jarum jahit/ bedah Kulit No. 13 Jarum jahit/ bedah Kulit No. 14 Jarum jahit/ bedah Otot No. 9 Jarum jahit/ bedah Otot No. 10 Jarum jahit/ bedah Otot No. 11 Jarum jahit/ bedah Otot No. 12 Jarum jahit/ bedah Otot No. 13 Jarum jahit/ bedah Otot No. 14 Jeli USG Kaca slide Kalium permanganat serbuk Kalsium hidroksida pastae Kalsium laktat tablet 500 mg Kapas pembalut absorben 100 gr Kapas pembalut absorben 250 gr Karbamasepin tablet 200 mg Kartu stok Kasa kompres steril 40/40 Kasa pembalut 10 cm Kasa pembalut 4 m x 3 cm

strip strip botol tablet tube botol botol tablet tablet botol set set botol kapsul tablet buah buah pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces jerigen buah tube tube buah roll roll tablet lembar roll roll roll

0 9 0 0 0 0 0 0 0 0 5 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 0 1 0 0 0 0 0

196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235

Kasa pembalut 4 m x 5 cm Kasa pembalut 4 m x 6 cm Kasa pembalut 40 m x 80 cm Kasa pembalut hidrofil 2 m x 80 cm Kasa pembalut hidrofil 4 m x 10 cm Kasa pembalut hidrofil 4 m x 15 cm Kasa pembalut hidrifil 16 cm x 16 cm Kertas Pulvis Kertas Resep Kertas saring Ketokonazole cream 2% Ketokonazole tablet 200 mg Ketorolac injeksi 10mg/ml Kinina dihidroklorida injeksi 25 % Kinina sulfat tablet 200 mg Kloramfenikol kapsul 250 mg Kloramfenikol sm 1 % Kloramfenikol suspensi Kloramfenikol tetes mata 0,5 % Kloramfenikol tetes telinga 3 % Klorfeniramin maleat tablet 4 mg Klorfenol kamfer menthol (CHKM) Klorokuin injeksi Klorokuin tablet 250 mg Klorpromazin HCl injeksi 25 mg/ml Klorpromazin tablet 25 mg Klorpromazin tablet 100 mg Klorpropamide tablet 100 mg Kodein tablet 10 mg Komb. Pirimet-sulfadoksin tablet Kotrimoksasol suspensi Kotrimoksasol tablet 120 mg Kotrimoksasol tablet 480 mg Larutan Anisol Larutan Asam asetat Larutan Asam sulfosalisilat Larutan Benedicts Larutan EDTA Larutan Eosin 2 % Larutan Giemsa

236

Larutan Hayem

roll

botol

0 0 0 3 0 3 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 210 0 0 0 0 0 0 0

botol

0

roll roll roll roll roll roll blok blok lembar tube tablet ampul ampul tablet kapsul tube botol botol botol tablet botol ampul tablet ampul tablet tablet tablet tablet tablet botol tablet tablet botol botol botol botol botol botol

237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277

Larutan HCl 0,1 N Larutan Lugol Larutan Natrium sitrat Larutan Rees Ecker Larutan Turk Larutan Ziehl Nelsen Levetran salep Levothyroxin Lidokain injeksi 2 % Lidokain injeksi 2 % (HCl) + Epinefrin 1 : 80.000 - 2 ml Lisol cairan Loratadin tablet Magnesium sulfat injeksi 20 % Magnesium sulfat injeksi 40 % Magnesium sulfat serbuk 30 gram Masker Mebendazol tablet 100 mg Meloksicam 7,5 mg Metformin tablet 500 mg Metilergometrin injeksi 0,200 mg Metilergometrin tablet 0,125 mg Metoklopramide tablet 5 mg Metoklopramide tablet 10 mg Metoklopramide injeksi 5 mg/ml Metoklopramide sirup 5 mg/ml Metronidasol infus Metronidasol tablet 250 mg Metronidasol tablet 500 mg Metylprednisolon Mikonazol salf Mineral mix Monoklorkamfermenthol cairan Morphin Injeksi Mucus section Mummifying pastae Natrium bicarbonat tablet 500 mg Natrium diklofenak tab 25 mg Natrium klorida larutan infus 0,9 % Natrium tiosulfat inj 25% NGT No. 3 NGT No. 3,5

botol botol botol botol botol paket pot tablet ampul ampul botol tablet ampul ampul saset lembar tablet tablet tablet ampul tablet tablet tablet ampul botol botol tablet tablet tablet tube saset botol ampul buah Tube tablet tablet botol ampul pieces pieces

0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 0 0 0 0

278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318

NGT No. 4 NGT NO. 5 NGT NO. 10 NGT NO. 16 NGT NO. 18 Nifedipin tablet 10 mg Nistatin tablet salut 500.000 IU/g Nistatin vaginal tablet 100.000 IU/g Nurse Cup Obat Anti TBC Kategori 2 (sisipan) Obat Anti TBC Kategori Anak Obat Anti TBC Kategori Anak Lanjutan Obat Anti TBC Kategori II FDC Obat batuk hitam Oksitetrasiklin injeksi Oksitetrasiklin s m 1 % Oksitetrasiklin salep kulit 3 % Oksitocyn injeksi 10 IU/ml Omeprasole 20 mg Papaverin injeksi 40 mg/ml Papaverin tablet Parasetamol drops Parasetamol sirup 125 mg/5 ml Parasetamol tablet 100 mg Parasetamol tablet 500 mg Pembalut Gibbs Pethidin injeksi 50 mg/ml Pil KB Kombinasi Pilokarpin HCl tetes mata Piracetam 400 mg Piracetam 800 mg Piracetam injeksi 200 mg/ml Pirantel pamoat tablet 125 mg Piridoksin HCl tablet 10 mg Piroksikam kapsul 20 mg Plastik Obat 8 x 5 cm Plastik Obat 10 x 7 cm Plester 5 yards x 2 inchi Povidon Iodida 10 % 30 ml Povidon Iodida 10 % 60 ml Povidon Iodida 10 % 300 ml

pieces pieces pieces pieces pieces tablet tablet tablet buah paket paket paket paket botol vial Tube Tube ampul Kapsul ampul tablet botol botol tablet tablet buah ampul tablet botol tablet tablet ampul tablet tablet Kapsul bungkus bungkus roll botol botol botol

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 0 0 140 190 0 0 0 0 0 0 0 10 100 0 0 1 1 0 0 1

319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349

Prednison tablet 5 mg Primaquin tablet 15 mg Prokainbenzil penisilin 3 jt IU/vial Propanolol HCl tablet 40 mg Propiltiourasil tablet 100 mg Ranitidin injeksi 50 mg/ml Ranitidin tablet 150 mg Rapid test HIV/AIDS SD Rapid test HIV/AIDS Intec Rapid test HIV/AIDS Oncoprobe Reagen sipilis Reserpina tablet 0,1 mg Retinol 100.000 IU kapsul lunak Retinol 200.000 IU kapsul lunak Ringer laktat larutan infus Salbutamol tablet 2 mg Salbutamol tablet 4 mg Salep 2 - 4 % Salisil bedak 2 % Salisil spiritus 10 % Sarung tangan Ginekologi Sarung tangan No. 6 1/2 Sarung tangan No. 7 Sarung tangan No. 7 1/2 Sarung tangan non steril Save Gloves No. S Save Gloves No. M Save Gloves No. L Selang Karet Anus No. 20 Semen seng serbuk dan cairan Serum Anti Bisa Ular Polivalen Injeksi 50 ml (ABU I)

350 351 352 353 354 355 356 357 358 359

Serum Anti Tetanus Injeksi 1500 IU/amp (ATS)

ampul

Serum Anti Tetanus Injeksi 20.000 IU/amp (ATS) Serum Test Golongan Darah Sianokobalamin 50 mcg Sianokobalamin injeksi Silk/benang bedah sutera No. 2/0 Silk/benang bedah sutera No. 3/0 Silver amalgam serbuk 65 - 75 % Simvastatin tablet 10 mg Simvastatin tablet 20 mg

ampul

tablet tablet vial tablet tablet ampul tablet strip strip strip strip tablet kapsul kapsul botol tablet tablet pot dos botol psg psg psg psg buah psg psg psg buah botol vial

botol tablet ampul buah buah botol tablet tablet

200 0 0 0 0 0 80 0 0 0 0 0 0 0 4 0 0 0 0 0 0 7 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392

Sintetic filling material Slide box Spiritus Spironolacton tablet 25 mg Spon gelatin cubicles 1 x 1 x 1 cm Sputum pot Stop TB kategori I Stop TB kategori I & 3 Streptomicyn sulfat injeksi 1500 mg/vial Sulfadimidin tablet 500 mg Sulfazetamid tetes mata Temporary stopping fletcher (fletcher) serbuk dan cairan Tetrakain tetes mata Tetrasiklin kapsul 250 mg Tetrasiklin kapsul 500 mg Thiamin HCl injeksi 100 mg/ml Thiamin HCl tablet 50 mg Tissue lensa Torniquet Tramadol injeksi Tramadol kapsul Transfusi set Triheksifenidil HCl tablet 2 mg Umbilical Cord Klem Under Pad Urine bag Ventolin Vitamin B Kompleks tablet Widal Test Wing Needle No. 23 G Zink Rapid test Malaria VAR

JUMLAH KUNJUNGAN RESEP

buah box botol tablet buah buah paket paket vial tablet botol botol botol kapsul kapsul ampul tablet bungkus buah ampul kapsul buah tablet buah pieces pieces ampul tablet botol buah tablet buah ampul

0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 7 50 0 0 0 0 0 0 0 0 0 0 164 0 0 186 0 0

UMUM BAYAR TIDAK BAYAR

MENGETAHUI/MENYETUJUI: KEPALA DINAS KESEHATAN KAB. NAGEKEO,

(…………………………………………………………………..) NIP.

(LPLPO) TAHUN: 2016 PELAPORAN BULAN : JUNI 2016 PERMINTAAN BULAN : JULI 2016 PENERIMAAN

PERSEDIAAN

5

6

10 5

500

PEMAKAIAN SISA STOK STOK OPT PERMINTAAN 7

0 8 8 8 0 6 0 0 0 0 0 30 18 0 0 0 0 0 0 0 0 0 0 0 0 70 550 3 0 0 0

1 1

3 3

30 200 1

8 0 8 7 7 0 6 0 0 0 0 0 27 15 0 0 0 0 0 0 0 0 0 0 0 0 40 350 2 0 0 0

9

10

300

500

90 3

0 0 0 0 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 400 0 0 0 700 0 0 0 0 0 4 0 0 0 930 0 8 0 0 0 0 0

40

160

200

4

360 2

0 0 0 0 60 0 0 0 0 0 0 0 0 0 0 0 0 0 0 240 0 0 0 500 0 0 0 0 0 0 0 0 0 570 0 6 0 0 0 0 0

ed 2

100

3 5

100

3 200

0 100 50 0 5 0 5 5 0 0 0 0 100 0 0 12 460 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0

20

1

12 50

1

0 80 50 0 4 0 5 5 0 0 0 0 100 0 0 0 410 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0

ed 11

4

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 82 0 0 0 0 0 20 0 0 0 0 0 0 0 0

16

20

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 66 0 0 0 0 0 0 0 0 0 0 0 0 0 0

DAU

4

0 9 0 0 0 0 0 0 0 0 5 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 0 1 0 0 0 0 0

1

50 1

0 9 0 0 0 0 0 0 0 0 5 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

2

400

15 300

0 0 0 5 0 3 0 0 0 0 0 0 0 0 0 0 3 0 0 0 400 0 0 0 0 0 0 0 0 0 19 0 510 0 0 0 0 0 0 0 0

1 1

260

7 120

0 0 0 4 0 2 0 0 0 0 0 0 0 0 0 0 3 0 0 0 140 0 0 0 0 0 0 0 0 0 12 0 390 0 0 0 0 0 0 0 0

4

2

0 0 0 0 0 0 0 0 12 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 2 0 0 0

1

3

1

0 0 0 0 0 0 0 0 11 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 1 0 0 0

100

50

1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 0 0 240 190 0 0 0 0 0 0 0 10 150 0 0 1 2 0 0 1

1

106 190

10

1

1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 134 0 0 0 0 0 0 0 0 10 140 0 0 1 1 0 0 0

2

5

200 0 0 0 0 0 80 0 0 0 0 0 0 0 6 0 0 0 0 0 0 7 1 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

60

10

2

1 2

140 0 0 0 0 0 70 0 0 0 0 0 0 0 4 0 0 0 0 0 0 7 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

50

500

20

ASKES

0 0 0 0 0 0 0 0 0 0 0 0 0 0 100 7 50 0 0 0 0 0 0 0 0 0 0 664 0 0 186 20 0

10 1 50

140

32 2

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 6 0 0 0 0 0 0 0 0 0 0 0 524 0 0 154 18 0

YANG MENYERAHKAN: PETUGAS INSTALASI FARMASI,

(……………………………………………………………..) NIP.

YANG MEMINTA/ MELA

(

MAGUS HILARIUS NIP.19631231 200012

BULAN: JUNI 2016

APBD IIBUFFER PROGRAM DEPKES ASKES JUMLAH KET LAIN 11

12

13

14

15

16

17

………………………………., 2014

YANG MEMINTA/ MELAPORKAN: YANG MENERIMA: KEPALA PUSKESMAS, PETUGAS PUSKESMAS,

(

MAGUS HILARIUS ) NIP.19631231 200012 1 029

( FATMAWATI ) NIP.19820424 200904 2 014

PUSKESMAS : NANGARORO KABUPATEN : NAGEKEO POSKESDES : ULUPULU

NO.

NAMA JENIS OBAT

SATUAN

STOK AWAL

1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

2

3

4 0 8 7 7 0 6 0 0 0 0 0 27 15 0 0 0 0 0 0 0 0 0 0 0 0 40 350 2 0 0 0

Abocath No 18 Abocath No 20 Abocath No 22 Abocath No 24 Abocath No 26 Aciclovir salep kulit Aciclovir tablet 400 mg Alat suntik sekali pakai 1 ml Alat suntik sekali pakai 10 ml Alat suntik sekali pakai 2,5 ml Alat suntik sekali pakai 20 ml Alat suntik sekali pakai 3 ml Alat suntik sekali pakai 5 ml Alat suntik sekali pakai 50 ml Albendazole tablet 400 mg Alopurinol tablet 100 mg Aluminium foil Amalgam serbuk 65-75 % Ambroxol sirup 15 mg/ml Ambroxol tablet 30 mg Aminofilin injeksi Aminofilin tablet 200 mg Amitriptilin tablet 25 mg Amlodipin 5 mg Amlodipin 10 mg Amoksisilin kapsul 250 mg Amoksisilin kaplet 500 mg Amoksisilin sirup kering 125 mg/5 ml Ampisilin kaplet 250 mg Ampisilin kaplet 500 mg Ampisilin serbuk injeksi 1.000 mg

buah buah buah buah buah tube tablet buah buah buah buah buah buah buah tablet tablet gulungan botol botol tablet ampul tablet tablet tablet tablet kapsul kaplet botol kaplet kaplet vial

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

Ampisilin sirup kering 60 ml Antagin injeksi 250 mg / ml Antalgin tablet 500 mg Antasida DOEN II suspensi Antasida DOEN tablet Anti hemoroid suppositoria Anti migrain DOEN tablet Anti parkinson DOEN tablet Antibakteri DOEN komb.Salep(Basitrasin + Polimiksin) Antifungi DOEN salep ( 3 - 6 ) Aqua pro injeksi steril 25 ml Aquadest steril 500 ml Arsuamon tablet Artemether injeksi 1 ml : 80 mg Arterakin tablet Artesunate injeksi Artesunate tablet Asam Asetilsalisilat tablet 100 mg (Asetosal) Asam Asetilsalisilat tablet 500 mg (Asetosal) Asam askorbat tablet 50 mg Asam askorbat tablet 250 mg Asam folat Asam mefenamat tablet 250 mg Asam mefenamat tablet 500 mg Asam traneksamat 500 mg Asam traneksamat injeksi Atenolol tablet 50 mg Atropin sulfat injeksi 0,25 mg/ml Atropin sulfat tablet 0,5 mg Atropin sulfat tetes mata Autoklik Bekarbon (arang aktif) Benzatin benzil penisilin injeksi Besi II tablet salut kombinasi Betahistin Betametason krem 0,1 % Bisoprolol 5 mg Bisturi No. 11 Blood lancet Bromheksin tablet 8 mg Burnazin salep

botol ampul tablet botol tablet suposs tablet tablet Pot Pot vial botol tablet ampul tablet vial tablet tablet tablet tablet tablet tablet tablet tablet tablet ampul tablet ampul tablet botol buah tablet vial tablet tablet tube tablet buah buah tablet tube

0 0 0 0 60 0 0 0 0 0 0 0 0 0 0 0 0 0 0 240 0 0 0 500 0 0 0 0 0 0 0 0 0 570 0 6 0 0 0 0 0

73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113

Calsium glukonat 10 mg/ml Captopril 12,5 mg Captopril 25 mg Cat Gram Catgut Chromic No 2/0 Catgut Chromic No 3/0 Catgut Plain No 2/0 Catgut Plain No 3/0 Cetirizine Cimetidine tablet 200 mg Combur test Cover glass Cyprofloxacin tablet 500 mg Dapson tablet Darplex Deksametason injeksi 5 mg/ml Deksametason tablet 0,5 mg Dekstrometorfan syrup Dekstrometrophan tablet 15 mg Dengue blood Devitalisasi pastae non arsen Diasepam injeksi 5 mg/ml Diasepam tablet 2 mg Diasepam tablet 5 mg Dietilkarbamazin tablet Difenhidramin injeksi 10 mg Digoksin tablet Dimenhidrinat tab 50 mg Doksisiklin kapsul 100 mg Domperidon sirup Domperidon tablet 10 mg Efedrin HCl tablet 25 mg Ekstrak Belladona tablet 10mg Epinefrin/adrenalin injeksi 0,1 % Erytromicyn kapsul 250 mg Erytromicyn kapsul 500 mg Erytromicyn suspensi 125 mg/ 5 ml Etakridina larutan 0,1% Etanol 70 % 100 ml Etanol 70% 300 ml Etanol 70 % 1000 ml

ampul tablet tablet paket buah buah buah buah tablet tablet kit buah tablet tablet tablet ampul tablet botol tablet kit botol ampul tablet tablet tablet ampul tablet tablet kapsul botol tablet tablet tablet ampul kapsul kapsul botol botol botol botol botol

0 80 50 0 4 0 5 5 0 0 0 0 100 0 0 0 410 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0

114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154

Etanol 96 % 1000 ml Ethil klorida semprot Eugenol cairan F l u o r tablet 0, mg Fenitoin natrium injeksi 50 mg/ml Fenitoin natrium kapsul 30 mg Fenitoin natrium kapsul 100 mg Fenobarbital injeksi 50 mg/ml Fenobarbital tablet 30 mg Fenobarbital tablet 100 mg Fenoksimetil penisilin tablet 250 mg Fenoksimetil penisilin tablet 500 mg Fenolgliserol tetes telinga Fitomenadion (Vit K) injeksi 10 mg/ml Fitomenadion (Vit K1) injeksi 10 mg/ml Fitomenadion (Vit.K1) tablet salut 10 mg Folley cath.10 F Folley cath.14 F Folley cath.16 F Folley cath.18 F Forinokresol (pengganti TKF) Formalin cair Formalin tablet 1 gr Furosemida injeksi Furosemida tablet 40 mg Gameksan lotion 1 % Garam oralit 200 ml air Gentamisin injeksi 40 mg/ml Gentamisin salep kulit 0,1 % Gentian violet larutan Glass Ionomer Cement ART Glibenklamid tablet 5 mg Gliserilguayakolat tablet Gliserin Glukosa injeksi 40 % Glukosa larutan infus 5 % Glukosa larutan infus 10 % Griseofulvin tablet 125 mg Haemocytometer Haemometer Haloperidol tablet 0,5 mg

botol botol botol tablet amp @ 2ml kapsul kapsul ampul tablet tablet tablet tablet botol ampul ampul tablet buah buah buah buah botol botol I ltr tablet ampul tablet botol saset ampul tube botol set/botol tablet tablet botol vial botol botol tablet buah buah tablet

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 66 0 0 0 0 0 0 0 0 0 0 0 0 0 0

155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195

HBSaG HCG Strip Hidrogen peroksida Hidroklorotiasida tablet 25 mg Hidrokortison krem 2,5 % Ibuprofen 100 mg/5 ml suspensi Ibuprofen 200 mg/5 ml suspensi Ibuprofen tablet 200 mg Ibuprofen tablet 400 mg Imersion oil Infus set anak Infus set dewasa Iodin test Iodol kapsul lunak Isosorbid dinitrat tablet 5 mg Jarum dispossible No. 22 ¼ G Jarum dispossible No. 23 ¼ G Jarum jahit/ bedah Kulit No. 9 Jarum jahit/ bedah Kulit No. 10 Jarum jahit/ bedah Kulit No. 11 Jarum jahit/ bedah Kulit No. 12 Jarum jahit/ bedah Kulit No. 13 Jarum jahit/ bedah Kulit No. 14 Jarum jahit/ bedah Otot No. 9 Jarum jahit/ bedah Otot No. 10 Jarum jahit/ bedah Otot No. 11 Jarum jahit/ bedah Otot No. 12 Jarum jahit/ bedah Otot No. 13 Jarum jahit/ bedah Otot No. 14 Jeli USG Kaca slide Kalium permanganat serbuk Kalsium hidroksida pastae Kalsium laktat tablet 500 mg Kapas pembalut absorben 100 gr Kapas pembalut absorben 250 gr Karbamasepin tablet 200 mg Kartu stok Kasa kompres steril 40/40 Kasa pembalut 10 cm Kasa pembalut 4 m x 3 cm

strip strip botol tablet tube botol botol tablet tablet botol set set botol kapsul tablet buah buah pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces jerigen buah tube tube buah roll roll tablet lembar roll roll roll

0 9 0 0 0 0 0 0 0 0 5 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235

Kasa pembalut 4 m x 5 cm Kasa pembalut 4 m x 6 cm Kasa pembalut 40 m x 80 cm Kasa pembalut hidrofil 2 m x 80 cm Kasa pembalut hidrofil 4 m x 10 cm Kasa pembalut hidrofil 4 m x 15 cm Kasa pembalut hidrifil 16 cm x 16 cm Kertas Pulvis Kertas Resep Kertas saring Ketokonazole cream 2% Ketokonazole tablet 200 mg Ketorolac injeksi 10mg/ml Kinina dihidroklorida injeksi 25 % Kinina sulfat tablet 200 mg Kloramfenikol kapsul 250 mg Kloramfenikol sm 1 % Kloramfenikol suspensi Kloramfenikol tetes mata 0,5 % Kloramfenikol tetes telinga 3 % Klorfeniramin maleat tablet 4 mg Klorfenol kamfer menthol (CHKM) Klorokuin injeksi Klorokuin tablet 250 mg Klorpromazin HCl injeksi 25 mg/ml Klorpromazin tablet 25 mg Klorpromazin tablet 100 mg Klorpropamide tablet 100 mg Kodein tablet 10 mg Komb. Pirimet-sulfadoksin tablet Kotrimoksasol suspensi Kotrimoksasol tablet 120 mg Kotrimoksasol tablet 480 mg Larutan Anisol Larutan Asam asetat Larutan Asam sulfosalisilat Larutan Benedicts Larutan EDTA Larutan Eosin 2 % Larutan Giemsa

236

Larutan Hayem

roll

botol

0 0 0 4 0 2 0 0 0 0 0 0 0 0 0 0 3 0 0 0 140 0 0 0 0 0 0 0 0 0 12 0 390 0 0 0 0 0 0 0

botol

0

roll roll roll roll roll roll blok blok lembar tube tablet ampul ampul tablet kapsul tube botol botol botol tablet botol ampul tablet ampul tablet tablet tablet tablet tablet botol tablet tablet botol botol botol botol botol botol

237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277

Larutan HCl 0,1 N Larutan Lugol Larutan Natrium sitrat Larutan Rees Ecker Larutan Turk Larutan Ziehl Nelsen Levetran salep Levothyroxin Lidokain injeksi 2 % Lidokain injeksi 2 % (HCl) + Epinefrin 1 : 80.000 - 2 ml Lisol cairan Loratadin tablet Magnesium sulfat injeksi 20 % Magnesium sulfat injeksi 40 % Magnesium sulfat serbuk 30 gram Masker Mebendazol tablet 100 mg Meloksicam 7,5 mg Metformin tablet 500 mg Metilergometrin injeksi 0,200 mg Metilergometrin tablet 0,125 mg Metoklopramide tablet 5 mg Metoklopramide tablet 10 mg Metoklopramide injeksi 5 mg/ml Metoklopramide sirup 5 mg/ml Metronidasol infus Metronidasol tablet 250 mg Metronidasol tablet 500 mg Metylprednisolon Mikonazol salf Mineral mix Monoklorkamfermenthol cairan Morphin Injeksi Mucus section Mummifying pastae Natrium bicarbonat tablet 500 mg Natrium diklofenak tab 25 mg Natrium klorida larutan infus 0,9 % Natrium tiosulfat inj 25% NGT No. 3 NGT No. 3,5

botol botol botol botol botol paket pot tablet ampul ampul botol tablet ampul ampul saset lembar tablet tablet tablet ampul tablet tablet tablet ampul botol botol tablet tablet tablet tube saset botol ampul buah Tube tablet tablet botol ampul pieces pieces

0 0 0 0 0 0 0 0 11 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 1 0 0 0

278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318

NGT No. 4 NGT NO. 5 NGT NO. 10 NGT NO. 16 NGT NO. 18 Nifedipin tablet 10 mg Nistatin tablet salut 500.000 IU/g Nistatin vaginal tablet 100.000 IU/g Nurse Cup Obat Anti TBC Kategori 2 (sisipan) Obat Anti TBC Kategori Anak Obat Anti TBC Kategori Anak Lanjutan Obat Anti TBC Kategori II FDC Obat batuk hitam Oksitetrasiklin injeksi Oksitetrasiklin s m 1 % Oksitetrasiklin salep kulit 3 % Oksitocyn injeksi 10 IU/ml Omeprasole 20 mg Papaverin injeksi 40 mg/ml Papaverin tablet Parasetamol drops Parasetamol sirup 125 mg/5 ml Parasetamol tablet 100 mg Parasetamol tablet 500 mg Pembalut Gibbs Pethidin injeksi 50 mg/ml Pil KB Kombinasi Pilokarpin HCl tetes mata Piracetam 400 mg Piracetam 800 mg Piracetam injeksi 200 mg/ml Pirantel pamoat tablet 125 mg Piridoksin HCl tablet 10 mg Piroksikam kapsul 20 mg Plastik Obat 8 x 5 cm Plastik Obat 10 x 7 cm Plester 5 yards x 2 inchi Povidon Iodida 10 % 30 ml Povidon Iodida 10 % 60 ml Povidon Iodida 10 % 300 ml

pieces pieces pieces pieces pieces tablet tablet tablet buah paket paket paket paket botol vial Tube Tube ampul Kapsul ampul tablet botol botol tablet tablet buah ampul tablet botol tablet tablet ampul tablet tablet Kapsul bungkus bungkus roll botol botol botol

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 134 0 0 0 0 0 0 0 0 10 140 0 0 1 1 0 0 0

319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349

Prednison tablet 5 mg Primaquin tablet 15 mg Prokainbenzil penisilin 3 jt IU/vial Propanolol HCl tablet 40 mg Propiltiourasil tablet 100 mg Ranitidin injeksi 50 mg/ml Ranitidin tablet 150 mg Rapid test HIV/AIDS SD Rapid test HIV/AIDS Intec Rapid test HIV/AIDS Oncoprobe Reagen sipilis Reserpina tablet 0,1 mg Retinol 100.000 IU kapsul lunak Retinol 200.000 IU kapsul lunak Ringer laktat larutan infus Salbutamol tablet 2 mg Salbutamol tablet 4 mg Salep 2 - 4 % Salisil bedak 2 % Salisil spiritus 10 % Sarung tangan Ginekologi Sarung tangan No. 6 1/2 Sarung tangan No. 7 Sarung tangan No. 7 1/2 Sarung tangan non steril Save Gloves No. S Save Gloves No. M Save Gloves No. L Selang Karet Anus No. 20 Semen seng serbuk dan cairan Serum Anti Bisa Ular Polivalen Injeksi 50 ml (ABU I)

350 351 352 353 354 355 356 357 358 359

Serum Anti Tetanus Injeksi 1500 IU/amp (ATS)

ampul

Serum Anti Tetanus Injeksi 20.000 IU/amp (ATS) Serum Test Golongan Darah Sianokobalamin 50 mcg Sianokobalamin injeksi Silk/benang bedah sutera No. 2/0 Silk/benang bedah sutera No. 3/0 Silver amalgam serbuk 65 - 75 % Simvastatin tablet 10 mg Simvastatin tablet 20 mg

ampul

tablet tablet vial tablet tablet ampul tablet strip strip strip strip tablet kapsul kapsul botol tablet tablet pot dos botol psg psg psg psg buah psg psg psg buah botol vial

botol tablet ampul buah buah botol tablet tablet

140 0 0 0 0 0 70 0 0 0 0 0 0 0 4 0 0 0 0 0 0 7 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392

Sintetic filling material Slide box Spiritus Spironolacton tablet 25 mg Spon gelatin cubicles 1 x 1 x 1 cm Sputum pot Stop TB kategori I Stop TB kategori I & 3 Streptomicyn sulfat injeksi 1500 mg/vial Sulfadimidin tablet 500 mg Sulfazetamid tetes mata Temporary stopping fletcher (fletcher) serbuk dan cairan Tetrakain tetes mata Tetrasiklin kapsul 250 mg Tetrasiklin kapsul 500 mg Thiamin HCl injeksi 100 mg/ml Thiamin HCl tablet 50 mg Tissue lensa Torniquet Tramadol injeksi Tramadol kapsul Transfusi set Triheksifenidil HCl tablet 2 mg Umbilical Cord Klem Under Pad Urine bag Ventolin Vitamin B Kompleks tablet Widal Test Wing Needle No. 23 G Zink Rapid test Malaria VAR

JUMLAH KUNJUNGAN RESEP

buah box botol tablet buah buah paket paket vial tablet botol botol botol kapsul kapsul ampul tablet bungkus buah ampul kapsul buah tablet buah pieces pieces ampul tablet botol buah tablet buah ampul

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 6 0 0 0 0 0 0 0 0 0 0 0 524 0 0 154 18 0

UMUM BAYAR TIDAK BAYAR

MENGETAHUI/MENYETUJUI: KEPALA DINAS KESEHATAN KAB. NAGEKEO,

(…………………………………………………………………..) NIP.

(LPLPO) TAHUN: 2016 PELAPORAN BULAN : JULI 2016 PERMINTAAN BULAN : AGUSTUS 2016 PENERIMAAN

PERSEDIAAN

5

6

10 5

200

PEMAKAIAN SISA STOK STOK OPT PERMINTAAN 7

0 8 7 7 0 6 0 0 0 0 0 37 20 0 0 0 0 0 0 0 0 0 0 0 0 40 550 2 0 0 0

1

20 270

8 0 8 7 7 0 6 0 0 0 0 0 36 20 0 0 0 0 0 0 0 0 0 0 0 0 20 280 2 0 0 0

9

10

100

100

360

0 0 0 0 160 0 0 0 0 0 0 0 0 0 0 0 0 0 0 340 0 0 0 500 0 0 0 0 0 0 0 0 0 930 0 6 0 0 0 0 0

30

100

250

30 1

0 0 0 0 130 0 0 0 0 0 0 0 0 0 0 0 0 0 0 240 0 0 0 250 0 0 0 0 0 0 0 0 0 900 0 5 0 0 0 0 0

0 80 50 0 4 0 5 5 0 0 0 0 100 0 0 0 410 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0

30

0 80 50 0 4 0 5 5 0 0 0 0 100 0 0 0 380 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0

20

200

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 86 0 0 0 0 0 200 0 0 0 0 0 0 0 0

110

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 86 0 0 0 0 0 90 0 0 0 0 0 0 0 0

1

10

0 9 0 0 0 0 0 0 0 0 5 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 10 0 0

0 9 0 0 0 0 0 0 0 0 5 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 10 0 0

5

1

100

5 100

5 0 0 5 0 2 0 0 0 0 0 0 0 0 0 0 3 0 0 0 240 0 0 0 0 0 0 0 0 0 17 0 490 0 0 0 0 0 0 0 0

1

150

10

5 0 0 4 0 2 0 0 0 0 0 0 0 0 0 0 3 0 0 0 90 0 0 0 0 0 0 0 0 0 17 0 480 0 0 0 0 0 0 0 0

5

2

0 0 0 0 0 0 0 0 11 0 0 0 0 0 0 7 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 3 0 0 0

1

0 0 0 0 0 0 0 0 11 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 3 0 0 0

2

50 1

1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 0 134 0 0 0 0 0 0 0 0 10 190 0 1 1 1 0 1 0

20

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 0 134 0 0 0 0 0 0 0 0 10 170 0 1 1 1 0 1 0

46

2

3 3

186 0 0 0 0 0 70 0 0 0 0 0 0 0 6 0 0 0 0 0 0 7 3 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

36

150 0 0 0 0 0 70 0 0 0 0 0 0 0 6 0 0 0 0 0 0 7 3 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

50

50

ASKES

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 6 0 0 0 0 0 0 0 0 0 0 0 574 0 0 204 18 0

110

1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 6 0 0 0 0 0 0 0 0 0 0 0 464 0 0 204 17 0

YANG MENYERAHKAN: PETUGAS INSTALASI FARMASI,

(……………………………………………………………..) NIP.

YANG MEMINTA/ MELA

(

MAGUS HILARIUS NIP.19631231 200012

BULAN: JULI 2016

APBD IIBUFFER PROGRAM DEPKES ASKES JUMLAH KET LAIN 11

12

13

14

15

16

17

………………………………., 2014

YANG MEMINTA/ MELAPORKAN: YANG MENERIMA: KEPALA PUSKESMAS, PETUGAS PUSKESMAS,

(

MAGUS HILARIUS ) NIP.19631231 200012 1 029

( FATMAWATI ) NIP.19820424 200904 2 014

PUSKESMAS : NANGARORO KABUPATEN : NAGEKEO POSKESDES : ULUPULU

NO.

NAMA JENIS OBAT

SATUAN

STOK AWAL

1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

2

3

4 0 8 7 7 0 6 0 0 0 0 0 36 20 0 0 0 0 0 0 0 0 0 0 0 0 20 280 2 0 0 0

Abocath No 18 Abocath No 20 Abocath No 22 Abocath No 24 Abocath No 26 Aciclovir salep kulit Aciclovir tablet 400 mg Alat suntik sekali pakai 1 ml Alat suntik sekali pakai 10 ml Alat suntik sekali pakai 2,5 ml Alat suntik sekali pakai 20 ml Alat suntik sekali pakai 3 ml Alat suntik sekali pakai 5 ml Alat suntik sekali pakai 50 ml Albendazole tablet 400 mg Alopurinol tablet 100 mg Aluminium foil Amalgam serbuk 65-75 % Ambroxol sirup 15 mg/ml Ambroxol tablet 30 mg Aminofilin injeksi Aminofilin tablet 200 mg Amitriptilin tablet 25 mg Amlodipin 5 mg Amlodipin 10 mg Amoksisilin kapsul 250 mg Amoksisilin kaplet 500 mg Amoksisilin sirup kering 125 mg/5 ml Ampisilin kaplet 250 mg Ampisilin kaplet 500 mg Ampisilin serbuk injeksi 1.000 mg

buah buah buah buah buah tube tablet buah buah buah buah buah buah buah tablet tablet gulungan botol botol tablet ampul tablet tablet tablet tablet kapsul kaplet botol kaplet kaplet vial

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

Ampisilin sirup kering 60 ml Antagin injeksi 250 mg / ml Antalgin tablet 500 mg Antasida DOEN II suspensi Antasida DOEN tablet Anti hemoroid suppositoria Anti migrain DOEN tablet Anti parkinson DOEN tablet Antibakteri DOEN komb.Salep(Basitrasin + Polimiksin) Antifungi DOEN salep ( 3 - 6 ) Aqua pro injeksi steril 25 ml Aquadest steril 500 ml Arsuamon tablet Artemether injeksi 1 ml : 80 mg Arterakin tablet Artesunate injeksi Artesunate tablet Asam Asetilsalisilat tablet 100 mg (Asetosal) Asam Asetilsalisilat tablet 500 mg (Asetosal) Asam askorbat tablet 50 mg Asam askorbat tablet 250 mg Asam folat Asam mefenamat tablet 250 mg Asam mefenamat tablet 500 mg Asam traneksamat 500 mg Asam traneksamat injeksi Atenolol tablet 50 mg Atropin sulfat injeksi 0,25 mg/ml Atropin sulfat tablet 0,5 mg Atropin sulfat tetes mata Autoklik Bekarbon (arang aktif) Benzatin benzil penisilin injeksi Besi II tablet salut kombinasi Betahistin Betametason krem 0,1 % Bisoprolol 5 mg Bisturi No. 11 Blood lancet Bromheksin tablet 8 mg Burnazin salep

botol ampul tablet botol tablet suposs tablet tablet Pot Pot vial botol tablet ampul tablet vial tablet tablet tablet tablet tablet tablet tablet tablet tablet ampul tablet ampul tablet botol buah tablet vial tablet tablet tube tablet buah buah tablet tube

0 0 0 0 130 0 0 0 0 0 0 0 0 0 0 0 0 0 0 240 0 0 0 250 0 0 0 0 0 0 0 0 0 900 0 5 0 0 0 0 0

73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113

Calsium glukonat 10 mg/ml Captopril 12,5 mg Captopril 25 mg Cat Gram Catgut Chromic No 2/0 Catgut Chromic No 3/0 Catgut Plain No 2/0 Catgut Plain No 3/0 Cetirizine Cimetidine tablet 200 mg Combur test Cover glass Cyprofloxacin tablet 500 mg Dapson tablet Darplex Deksametason injeksi 5 mg/ml Deksametason tablet 0,5 mg Dekstrometorfan syrup Dekstrometrophan tablet 15 mg Dengue blood Devitalisasi pastae non arsen Diasepam injeksi 5 mg/ml Diasepam tablet 2 mg Diasepam tablet 5 mg Dietilkarbamazin tablet Difenhidramin injeksi 10 mg Digoksin tablet Dimenhidrinat tab 50 mg Doksisiklin kapsul 100 mg Domperidon sirup Domperidon tablet 10 mg Efedrin HCl tablet 25 mg Ekstrak Belladona tablet 10mg Epinefrin/adrenalin injeksi 0,1 % Erytromicyn kapsul 250 mg Erytromicyn kapsul 500 mg Erytromicyn suspensi 125 mg/ 5 ml Etakridina larutan 0,1% Etanol 70 % 100 ml Etanol 70% 300 ml Etanol 70 % 1000 ml

ampul tablet tablet paket buah buah buah buah tablet tablet kit buah tablet tablet tablet ampul tablet botol tablet kit botol ampul tablet tablet tablet ampul tablet tablet kapsul botol tablet tablet tablet ampul kapsul kapsul botol botol botol botol botol

0 80 50 0 4 0 5 5 0 0 0 0 100 0 0 0 380 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0

114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154

Etanol 96 % 1000 ml Ethil klorida semprot Eugenol cairan F l u o r tablet 0, mg Fenitoin natrium injeksi 50 mg/ml Fenitoin natrium kapsul 30 mg Fenitoin natrium kapsul 100 mg Fenobarbital injeksi 50 mg/ml Fenobarbital tablet 30 mg Fenobarbital tablet 100 mg Fenoksimetil penisilin tablet 250 mg Fenoksimetil penisilin tablet 500 mg Fenolgliserol tetes telinga Fitomenadion (Vit K) injeksi 10 mg/ml Fitomenadion (Vit K1) injeksi 10 mg/ml Fitomenadion (Vit.K1) tablet salut 10 mg Folley cath.10 F Folley cath.14 F Folley cath.16 F Folley cath.18 F Forinokresol (pengganti TKF) Formalin cair Formalin tablet 1 gr Furosemida injeksi Furosemida tablet 40 mg Gameksan lotion 1 % Garam oralit 200 ml air Gentamisin injeksi 40 mg/ml Gentamisin salep kulit 0,1 % Gentian violet larutan Glass Ionomer Cement ART Glibenklamid tablet 5 mg Gliserilguayakolat tablet Gliserin Glukosa injeksi 40 % Glukosa larutan infus 5 % Glukosa larutan infus 10 % Griseofulvin tablet 125 mg Haemocytometer Haemometer Haloperidol tablet 0,5 mg

botol botol botol tablet amp @ 2ml kapsul kapsul ampul tablet tablet tablet tablet botol ampul ampul tablet buah buah buah buah botol botol I ltr tablet ampul tablet botol saset ampul tube botol set/botol tablet tablet botol vial botol botol tablet buah buah tablet

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 86 0 0 0 0 0 90 0 0 0 0 0 0 0 0

155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195

HBSaG HCG Strip Hidrogen peroksida Hidroklorotiasida tablet 25 mg Hidrokortison krem 2,5 % Ibuprofen 100 mg/5 ml suspensi Ibuprofen 200 mg/5 ml suspensi Ibuprofen tablet 200 mg Ibuprofen tablet 400 mg Imersion oil Infus set anak Infus set dewasa Iodin test Iodol kapsul lunak Isosorbid dinitrat tablet 5 mg Jarum dispossible No. 22 ¼ G Jarum dispossible No. 23 ¼ G Jarum jahit/ bedah Kulit No. 9 Jarum jahit/ bedah Kulit No. 10 Jarum jahit/ bedah Kulit No. 11 Jarum jahit/ bedah Kulit No. 12 Jarum jahit/ bedah Kulit No. 13 Jarum jahit/ bedah Kulit No. 14 Jarum jahit/ bedah Otot No. 9 Jarum jahit/ bedah Otot No. 10 Jarum jahit/ bedah Otot No. 11 Jarum jahit/ bedah Otot No. 12 Jarum jahit/ bedah Otot No. 13 Jarum jahit/ bedah Otot No. 14 Jeli USG Kaca slide Kalium permanganat serbuk Kalsium hidroksida pastae Kalsium laktat tablet 500 mg Kapas pembalut absorben 100 gr Kapas pembalut absorben 250 gr Karbamasepin tablet 200 mg Kartu stok Kasa kompres steril 40/40 Kasa pembalut 10 cm Kasa pembalut 4 m x 3 cm

strip strip botol tablet tube botol botol tablet tablet botol set set botol kapsul tablet buah buah pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces jerigen buah tube tube buah roll roll tablet lembar roll roll roll

0 9 0 0 0 0 0 0 0 0 5 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 10 0 0

196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235

Kasa pembalut 4 m x 5 cm Kasa pembalut 4 m x 6 cm Kasa pembalut 40 m x 80 cm Kasa pembalut hidrofil 2 m x 80 cm Kasa pembalut hidrofil 4 m x 10 cm Kasa pembalut hidrofil 4 m x 15 cm Kasa pembalut hidrifil 16 cm x 16 cm Kertas Pulvis Kertas Resep Kertas saring Ketokonazole cream 2% Ketokonazole tablet 200 mg Ketorolac injeksi 10mg/ml Kinina dihidroklorida injeksi 25 % Kinina sulfat tablet 200 mg Kloramfenikol kapsul 250 mg Kloramfenikol sm 1 % Kloramfenikol suspensi Kloramfenikol tetes mata 0,5 % Kloramfenikol tetes telinga 3 % Klorfeniramin maleat tablet 4 mg Klorfenol kamfer menthol (CHKM) Klorokuin injeksi Klorokuin tablet 250 mg Klorpromazin HCl injeksi 25 mg/ml Klorpromazin tablet 25 mg Klorpromazin tablet 100 mg Klorpropamide tablet 100 mg Kodein tablet 10 mg Komb. Pirimet-sulfadoksin tablet Kotrimoksasol suspensi Kotrimoksasol tablet 120 mg Kotrimoksasol tablet 480 mg Larutan Anisol Larutan Asam asetat Larutan Asam sulfosalisilat Larutan Benedicts Larutan EDTA Larutan Eosin 2 % Larutan Giemsa

236

Larutan Hayem

roll

botol

5 0 0 4 0 2 0 0 0 0 0 0 0 0 0 0 3 0 0 0 90 0 0 0 0 0 0 0 0 0 17 0 480 0 0 0 0 0 0 0

botol

0

roll roll roll roll roll roll blok blok lembar tube tablet ampul ampul tablet kapsul tube botol botol botol tablet botol ampul tablet ampul tablet tablet tablet tablet tablet botol tablet tablet botol botol botol botol botol botol

237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277

Larutan HCl 0,1 N Larutan Lugol Larutan Natrium sitrat Larutan Rees Ecker Larutan Turk Larutan Ziehl Nelsen Levetran salep Levothyroxin Lidokain injeksi 2 % Lidokain injeksi 2 % (HCl) + Epinefrin 1 : 80.000 - 2 ml Lisol cairan Loratadin tablet Magnesium sulfat injeksi 20 % Magnesium sulfat injeksi 40 % Magnesium sulfat serbuk 30 gram Masker Mebendazol tablet 100 mg Meloksicam 7,5 mg Metformin tablet 500 mg Metilergometrin injeksi 0,200 mg Metilergometrin tablet 0,125 mg Metoklopramide tablet 5 mg Metoklopramide tablet 10 mg Metoklopramide injeksi 5 mg/ml Metoklopramide sirup 5 mg/ml Metronidasol infus Metronidasol tablet 250 mg Metronidasol tablet 500 mg Metylprednisolon Mikonazol salf Mineral mix Monoklorkamfermenthol cairan Morphin Injeksi Mucus section Mummifying pastae Natrium bicarbonat tablet 500 mg Natrium diklofenak tab 25 mg Natrium klorida larutan infus 0,9 % Natrium tiosulfat inj 25% NGT No. 3 NGT No. 3,5

botol botol botol botol botol paket pot tablet ampul ampul botol tablet ampul ampul saset lembar tablet tablet tablet ampul tablet tablet tablet ampul botol botol tablet tablet tablet tube saset botol ampul buah Tube tablet tablet botol ampul pieces pieces

0 0 0 0 0 0 0 0 11 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 3 0 0 0

278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318

NGT No. 4 NGT NO. 5 NGT NO. 10 NGT NO. 16 NGT NO. 18 Nifedipin tablet 10 mg Nistatin tablet salut 500.000 IU/g Nistatin vaginal tablet 100.000 IU/g Nurse Cup Obat Anti TBC Kategori 2 (sisipan) Obat Anti TBC Kategori Anak Obat Anti TBC Kategori Anak Lanjutan Obat Anti TBC Kategori II FDC Obat batuk hitam Oksitetrasiklin injeksi Oksitetrasiklin s m 1 % Oksitetrasiklin salep kulit 3 % Oksitocyn injeksi 10 IU/ml Omeprasole 20 mg Papaverin injeksi 40 mg/ml Papaverin tablet Parasetamol drops Parasetamol sirup 125 mg/5 ml Parasetamol tablet 100 mg Parasetamol tablet 500 mg Pembalut Gibbs Pethidin injeksi 50 mg/ml Pil KB Kombinasi Pilokarpin HCl tetes mata Piracetam 400 mg Piracetam 800 mg Piracetam injeksi 200 mg/ml Pirantel pamoat tablet 125 mg Piridoksin HCl tablet 10 mg Piroksikam kapsul 20 mg Plastik Obat 8 x 5 cm Plastik Obat 10 x 7 cm Plester 5 yards x 2 inchi Povidon Iodida 10 % 30 ml Povidon Iodida 10 % 60 ml Povidon Iodida 10 % 300 ml

pieces pieces pieces pieces pieces tablet tablet tablet buah paket paket paket paket botol vial Tube Tube ampul Kapsul ampul tablet botol botol tablet tablet buah ampul tablet botol tablet tablet ampul tablet tablet Kapsul bungkus bungkus roll botol botol botol

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 0 134 0 0 0 0 0 0 0 0 10 170 0 1 1 1 0 1 0

319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349

Prednison tablet 5 mg Primaquin tablet 15 mg Prokainbenzil penisilin 3 jt IU/vial Propanolol HCl tablet 40 mg Propiltiourasil tablet 100 mg Ranitidin injeksi 50 mg/ml Ranitidin tablet 150 mg Rapid test HIV/AIDS SD Rapid test HIV/AIDS Intec Rapid test HIV/AIDS Oncoprobe Reagen sipilis Reserpina tablet 0,1 mg Retinol 100.000 IU kapsul lunak Retinol 200.000 IU kapsul lunak Ringer laktat larutan infus Salbutamol tablet 2 mg Salbutamol tablet 4 mg Salep 2 - 4 % Salisil bedak 2 % Salisil spiritus 10 % Sarung tangan Ginekologi Sarung tangan No. 6 1/2 Sarung tangan No. 7 Sarung tangan No. 7 1/2 Sarung tangan non steril Save Gloves No. S Save Gloves No. M Save Gloves No. L Selang Karet Anus No. 20 Semen seng serbuk dan cairan Serum Anti Bisa Ular Polivalen Injeksi 50 ml (ABU I)

350 351 352 353 354 355 356 357 358 359

Serum Anti Tetanus Injeksi 1500 IU/amp (ATS)

ampul

Serum Anti Tetanus Injeksi 20.000 IU/amp (ATS) Serum Test Golongan Darah Sianokobalamin 50 mcg Sianokobalamin injeksi Silk/benang bedah sutera No. 2/0 Silk/benang bedah sutera No. 3/0 Silver amalgam serbuk 65 - 75 % Simvastatin tablet 10 mg Simvastatin tablet 20 mg

ampul

tablet tablet vial tablet tablet ampul tablet strip strip strip strip tablet kapsul kapsul botol tablet tablet pot dos botol psg psg psg psg buah psg psg psg buah botol vial

botol tablet ampul buah buah botol tablet tablet

150 0 0 0 0 0 70 0 0 0 0 0 0 0 6 0 0 0 0 0 0 7 3 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392

Sintetic filling material Slide box Spiritus Spironolacton tablet 25 mg Spon gelatin cubicles 1 x 1 x 1 cm Sputum pot Stop TB kategori I Stop TB kategori I & 3 Streptomicyn sulfat injeksi 1500 mg/vial Sulfadimidin tablet 500 mg Sulfazetamid tetes mata Temporary stopping fletcher (fletcher) serbuk dan cairan Tetrakain tetes mata Tetrasiklin kapsul 250 mg Tetrasiklin kapsul 500 mg Thiamin HCl injeksi 100 mg/ml Thiamin HCl tablet 50 mg Tissue lensa Torniquet Tramadol injeksi Tramadol kapsul Transfusi set Triheksifenidil HCl tablet 2 mg Umbilical Cord Klem Under Pad Urine bag Ventolin Vitamin B Kompleks tablet Widal Test Wing Needle No. 23 G Zink Rapid test Malaria VAR

JUMLAH KUNJUNGAN RESEP

buah box botol tablet buah buah paket paket vial tablet botol botol botol kapsul kapsul ampul tablet bungkus buah ampul kapsul buah tablet buah pieces pieces ampul tablet botol buah tablet buah ampul

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 6 0 0 0 0 0 0 0 0 0 0 0 464 0 0 204 17 0

UMUM BAYAR TIDAK BAYAR

MENGETAHUI/MENYETUJUI: KEPALA DINAS KESEHATAN KAB. NAGEKEO,

(…………………………………………………………………..) NIP.

(LPLPO) TAHUN: 2016 PELAPORAN BULAN : AGUSTUS 2016 PERMINTAAN BULAN : SEPTEMBER 2016 PENERIMAAN

PERSEDIAAN

5

6

200

PEMAKAIAN SISA STOK STOK OPT PERMINTAAN 7

0 8 7 7 0 6 0 0 0 0 0 36 20 0 0 0 0 0 0 0 0 0 0 0 0 20 480 2 0 0 0

1

20 230

8 0 8 7 7 0 6 0 0 0 0 0 35 20 0 0 0 0 0 0 0 0 0 0 0 0 0 250 2 0 0 0

9

10

50

50

200

180 3

0 0 0 0 180 0 0 0 0 0 0 0 0 0 0 0 0 0 0 290 0 0 0 450 0 0 0 0 0 0 0 0 0 1080 0 8 0 0 0 0 0

20

96

280

540 3

0 0 0 0 160 0 0 0 0 0 0 0 0 0 0 0 0 0 0 194 0 0 0 170 0 0 0 0 0 0 0 0 0 540 0 5 0 0 0 0 0

0 80 50 0 4 0 5 5 0 0 0 0 100 0 0 0 380 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0

90

0 80 50 0 4 0 5 5 0 0 0 0 100 0 0 0 290 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 86 0 0 0 0 0 90 0 0 0 0 0 0 0 0

5

90

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 81 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 9 0 0 0 0 0 0 0 0 5 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 10 0 0

4

1

1

0 5 0 0 0 0 0 0 0 0 5 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 0 0

200

5 0 0 4 0 2 0 0 0 0 0 0 0 0 0 0 3 0 0 0 290 0 0 0 0 0 0 0 0 0 17 0 480 0 0 0 0 0 0 0 0

5

1

190

8 60

0 0 0 3 0 2 0 0 0 0 0 0 0 0 0 0 3 0 0 0 100 0 0 0 0 0 0 0 0 0 9 0 420 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 11 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 3 0 0 0

1

3

0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 3 0 0 0

10

100 1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 10 134 0 0 0 0 0 0 0 0 10 270 0 2 1 1 0 1 0

8

2 20 2 1 1 1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 2 134 0 0 0 0 0 0 0 0 8 250 0 0 0 0 0 0 0

15 113

2

150 0 0 0 0 0 70 0 0 0 0 0 15 113 6 0 0 0 0 0 0 7 5 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

15 113

7 1 2

150 0 0 0 0 0 70 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 4 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

50

ASKES

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 6 0 0 0 0 0 0 0 0 0 0 0 514 0 0 204 17 0

170

10

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 6 0 0 0 0 0 0 0 0 0 0 0 344 0 0 194 17 0

YANG MENYERAHKAN: PETUGAS INSTALASI FARMASI,

(……………………………………………………………..) NIP.

YANG MEMINTA/ MELA

(

MAGUS HILARIUS NIP.19631231 200012

BULAN: JULI 2016

APBD IIBUFFER PROGRAM DEPKES ASKES JUMLAH KET LAIN 11

12

13

14

15

16

17

………………………………., 2014

YANG MEMINTA/ MELAPORKAN: YANG MENERIMA: KEPALA PUSKESMAS, PETUGAS PUSKESMAS,

(

MAGUS HILARIUS ) NIP.19631231 200012 1 029

( FATMAWATI ) NIP.19820424 200904 2 014

PUSKESMAS : NANGARORO KABUPATEN : NAGEKEO POSKESDES : ULUPULU

NO.

NAMA JENIS OBAT

SATUAN

STOK AWAL

1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

2

3

4 0 8 7 7 0 6 0 0 0 0 0 35 20 0 0 0 0 0 0 0 0 0 0 0 0 0 250 2 0 0 0

Abocath No 18 Abocath No 20 Abocath No 22 Abocath No 24 Abocath No 26 Aciclovir salep kulit Aciclovir tablet 400 mg Alat suntik sekali pakai 1 ml Alat suntik sekali pakai 10 ml Alat suntik sekali pakai 2,5 ml Alat suntik sekali pakai 20 ml Alat suntik sekali pakai 3 ml Alat suntik sekali pakai 5 ml Alat suntik sekali pakai 50 ml Albendazole tablet 400 mg Alopurinol tablet 100 mg Aluminium foil Amalgam serbuk 65-75 % Ambroxol sirup 15 mg/ml Ambroxol tablet 30 mg Aminofilin injeksi Aminofilin tablet 200 mg Amitriptilin tablet 25 mg Amlodipin 5 mg Amlodipin 10 mg Amoksisilin kapsul 250 mg Amoksisilin kaplet 500 mg Amoksisilin sirup kering 125 mg/5 ml Ampisilin kaplet 250 mg Ampisilin kaplet 500 mg Ampisilin serbuk injeksi 1.000 mg

buah buah buah buah buah tube tablet buah buah buah buah buah buah buah tablet tablet gulungan botol botol tablet ampul tablet tablet tablet tablet kapsul kaplet botol kaplet kaplet vial

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

Ampisilin sirup kering 60 ml Antagin injeksi 250 mg / ml Antalgin tablet 500 mg Antasida DOEN II suspensi Antasida DOEN tablet Anti hemoroid suppositoria Anti migrain DOEN tablet Anti parkinson DOEN tablet Antibakteri DOEN komb.Salep(Basitrasin + Polimiksin) Antifungi DOEN salep ( 3 - 6 ) Aqua pro injeksi steril 25 ml Aquadest steril 500 ml Arsuamon tablet Artemether injeksi 1 ml : 80 mg Arterakin tablet Artesunate injeksi Artesunate tablet Asam Asetilsalisilat tablet 100 mg (Asetosal) Asam Asetilsalisilat tablet 500 mg (Asetosal) Asam askorbat tablet 50 mg Asam askorbat tablet 250 mg Asam folat Asam mefenamat tablet 250 mg Asam mefenamat tablet 500 mg Asam traneksamat 500 mg Asam traneksamat injeksi Atenolol tablet 50 mg Atropin sulfat injeksi 0,25 mg/ml Atropin sulfat tablet 0,5 mg Atropin sulfat tetes mata Autoklik Bekarbon (arang aktif) Benzatin benzil penisilin injeksi Besi II tablet salut kombinasi Betahistin Betametason krem 0,1 % Bisoprolol 5 mg Bisturi No. 11 Blood lancet Bromheksin tablet 8 mg Burnazin salep

botol ampul tablet botol tablet suposs tablet tablet Pot Pot vial botol tablet ampul tablet vial tablet tablet tablet tablet tablet tablet tablet tablet tablet ampul tablet ampul tablet botol buah tablet vial tablet tablet tube tablet buah buah tablet tube

0 0 0 0 160 0 0 0 0 0 0 0 0 0 0 0 0 0 0 194 0 0 0 170 0 0 0 0 0 0 0 0 0 540 0 5 0 0 0 0 0

73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113

Calsium glukonat 10 mg/ml Captopril 12,5 mg Captopril 25 mg Cat Gram Catgut Chromic No 2/0 Catgut Chromic No 3/0 Catgut Plain No 2/0 Catgut Plain No 3/0 Cetirizine Cimetidine tablet 200 mg Combur test Cover glass Cyprofloxacin tablet 500 mg Dapson tablet Darplex Deksametason injeksi 5 mg/ml Deksametason tablet 0,5 mg Dekstrometorfan syrup Dekstrometrophan tablet 15 mg Dengue blood Devitalisasi pastae non arsen Diasepam injeksi 5 mg/ml Diasepam tablet 2 mg Diasepam tablet 5 mg Dietilkarbamazin tablet Difenhidramin injeksi 10 mg Digoksin tablet Dimenhidrinat tab 50 mg Doksisiklin kapsul 100 mg Domperidon sirup Domperidon tablet 10 mg Efedrin HCl tablet 25 mg Ekstrak Belladona tablet 10mg Epinefrin/adrenalin injeksi 0,1 % Erytromicyn kapsul 250 mg Erytromicyn kapsul 500 mg Erytromicyn suspensi 125 mg/ 5 ml Etakridina larutan 0,1% Etanol 70 % 100 ml Etanol 70% 300 ml Etanol 70 % 1000 ml

ampul tablet tablet paket buah buah buah buah tablet tablet kit buah tablet tablet tablet ampul tablet botol tablet kit botol ampul tablet tablet tablet ampul tablet tablet kapsul botol tablet tablet tablet ampul kapsul kapsul botol botol botol botol botol

0 80 50 0 4 0 5 5 0 0 0 0 100 0 0 0 290 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0

114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154

Etanol 96 % 1000 ml Ethil klorida semprot Eugenol cairan F l u o r tablet 0, mg Fenitoin natrium injeksi 50 mg/ml Fenitoin natrium kapsul 30 mg Fenitoin natrium kapsul 100 mg Fenobarbital injeksi 50 mg/ml Fenobarbital tablet 30 mg Fenobarbital tablet 100 mg Fenoksimetil penisilin tablet 250 mg Fenoksimetil penisilin tablet 500 mg Fenolgliserol tetes telinga Fitomenadion (Vit K) injeksi 10 mg/ml Fitomenadion (Vit K1) injeksi 10 mg/ml Fitomenadion (Vit.K1) tablet salut 10 mg Folley cath.10 F Folley cath.14 F Folley cath.16 F Folley cath.18 F Forinokresol (pengganti TKF) Formalin cair Formalin tablet 1 gr Furosemida injeksi Furosemida tablet 40 mg Gameksan lotion 1 % Garam oralit 200 ml air Gentamisin injeksi 40 mg/ml Gentamisin salep kulit 0,1 % Gentian violet larutan Glass Ionomer Cement ART Glibenklamid tablet 5 mg Gliserilguayakolat tablet Gliserin Glukosa injeksi 40 % Glukosa larutan infus 5 % Glukosa larutan infus 10 % Griseofulvin tablet 125 mg Haemocytometer Haemometer Haloperidol tablet 0,5 mg

botol botol botol tablet amp @ 2ml kapsul kapsul ampul tablet tablet tablet tablet botol ampul ampul tablet buah buah buah buah botol botol I ltr tablet ampul tablet botol saset ampul tube botol set/botol tablet tablet botol vial botol botol tablet buah buah tablet

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 81 0 0 0 0 0 0 0 0 0 0 0 0 0 0

155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195

HBSaG HCG Strip Hidrogen peroksida Hidroklorotiasida tablet 25 mg Hidrokortison krem 2,5 % Ibuprofen 100 mg/5 ml suspensi Ibuprofen 200 mg/5 ml suspensi Ibuprofen tablet 200 mg Ibuprofen tablet 400 mg Imersion oil Infus set anak Infus set dewasa Iodin test Iodol kapsul lunak Isosorbid dinitrat tablet 5 mg Jarum dispossible No. 22 ¼ G Jarum dispossible No. 23 ¼ G Jarum jahit/ bedah Kulit No. 9 Jarum jahit/ bedah Kulit No. 10 Jarum jahit/ bedah Kulit No. 11 Jarum jahit/ bedah Kulit No. 12 Jarum jahit/ bedah Kulit No. 13 Jarum jahit/ bedah Kulit No. 14 Jarum jahit/ bedah Otot No. 9 Jarum jahit/ bedah Otot No. 10 Jarum jahit/ bedah Otot No. 11 Jarum jahit/ bedah Otot No. 12 Jarum jahit/ bedah Otot No. 13 Jarum jahit/ bedah Otot No. 14 Jeli USG Kaca slide Kalium permanganat serbuk Kalsium hidroksida pastae Kalsium laktat tablet 500 mg Kapas pembalut absorben 100 gr Kapas pembalut absorben 250 gr Karbamasepin tablet 200 mg Kartu stok Kasa kompres steril 40/40 Kasa pembalut 10 cm Kasa pembalut 4 m x 3 cm

strip strip botol tablet tube botol botol tablet tablet botol set set botol kapsul tablet buah buah pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces jerigen buah tube tube buah roll roll tablet lembar roll roll roll

0 5 0 0 0 0 0 0 0 0 5 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 0 0

196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235

Kasa pembalut 4 m x 5 cm Kasa pembalut 4 m x 6 cm Kasa pembalut 40 m x 80 cm Kasa pembalut hidrofil 2 m x 80 cm Kasa pembalut hidrofil 4 m x 10 cm Kasa pembalut hidrofil 4 m x 15 cm Kasa pembalut hidrifil 16 cm x 16 cm Kertas Pulvis Kertas Resep Kertas saring Ketokonazole cream 2% Ketokonazole tablet 200 mg Ketorolac injeksi 10mg/ml Kinina dihidroklorida injeksi 25 % Kinina sulfat tablet 200 mg Kloramfenikol kapsul 250 mg Kloramfenikol sm 1 % Kloramfenikol suspensi Kloramfenikol tetes mata 0,5 % Kloramfenikol tetes telinga 3 % Klorfeniramin maleat tablet 4 mg Klorfenol kamfer menthol (CHKM) Klorokuin injeksi Klorokuin tablet 250 mg Klorpromazin HCl injeksi 25 mg/ml Klorpromazin tablet 25 mg Klorpromazin tablet 100 mg Klorpropamide tablet 100 mg Kodein tablet 10 mg Komb. Pirimet-sulfadoksin tablet Kotrimoksasol suspensi Kotrimoksasol tablet 120 mg Kotrimoksasol tablet 480 mg Larutan Anisol Larutan Asam asetat Larutan Asam sulfosalisilat Larutan Benedicts Larutan EDTA Larutan Eosin 2 % Larutan Giemsa

236

Larutan Hayem

roll

botol

0 0 0 3 0 2 0 0 0 0 0 0 0 0 0 0 3 0 0 0 100 0 0 0 0 0 0 0 0 0 9 0 420 0 0 0 0 0 0 0

botol

0

roll roll roll roll roll roll blok blok lembar tube tablet ampul ampul tablet kapsul tube botol botol botol tablet botol ampul tablet ampul tablet tablet tablet tablet tablet botol tablet tablet botol botol botol botol botol botol

237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277

Larutan HCl 0,1 N Larutan Lugol Larutan Natrium sitrat Larutan Rees Ecker Larutan Turk Larutan Ziehl Nelsen Levetran salep Levothyroxin Lidokain injeksi 2 % Lidokain injeksi 2 % (HCl) + Epinefrin 1 : 80.000 - 2 ml Lisol cairan Loratadin tablet Magnesium sulfat injeksi 20 % Magnesium sulfat injeksi 40 % Magnesium sulfat serbuk 30 gram Masker Mebendazol tablet 100 mg Meloksicam 7,5 mg Metformin tablet 500 mg Metilergometrin injeksi 0,200 mg Metilergometrin tablet 0,125 mg Metoklopramide tablet 5 mg Metoklopramide tablet 10 mg Metoklopramide injeksi 5 mg/ml Metoklopramide sirup 5 mg/ml Metronidasol infus Metronidasol tablet 250 mg Metronidasol tablet 500 mg Metylprednisolon Mikonazol salf Mineral mix Monoklorkamfermenthol cairan Morphin Injeksi Mucus section Mummifying pastae Natrium bicarbonat tablet 500 mg Natrium diklofenak tab 25 mg Natrium klorida larutan infus 0,9 % Natrium tiosulfat inj 25% NGT No. 3 NGT No. 3,5

botol botol botol botol botol paket pot tablet ampul ampul botol tablet ampul ampul saset lembar tablet tablet tablet ampul tablet tablet tablet ampul botol botol tablet tablet tablet tube saset botol ampul buah Tube tablet tablet botol ampul pieces pieces

0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 3 0 0 0

278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318

NGT No. 4 NGT NO. 5 NGT NO. 10 NGT NO. 16 NGT NO. 18 Nifedipin tablet 10 mg Nistatin tablet salut 500.000 IU/g Nistatin vaginal tablet 100.000 IU/g Nurse Cup Obat Anti TBC Kategori 2 (sisipan) Obat Anti TBC Kategori Anak Obat Anti TBC Kategori Anak Lanjutan Obat Anti TBC Kategori II FDC Obat batuk hitam Oksitetrasiklin injeksi Oksitetrasiklin s m 1 % Oksitetrasiklin salep kulit 3 % Oksitocyn injeksi 10 IU/ml Omeprasole 20 mg Papaverin injeksi 40 mg/ml Papaverin tablet Parasetamol drops Parasetamol sirup 125 mg/5 ml Parasetamol tablet 100 mg Parasetamol tablet 500 mg Pembalut Gibbs Pethidin injeksi 50 mg/ml Pil KB Kombinasi Pilokarpin HCl tetes mata Piracetam 400 mg Piracetam 800 mg Piracetam injeksi 200 mg/ml Pirantel pamoat tablet 125 mg Piridoksin HCl tablet 10 mg Piroksikam kapsul 20 mg Plastik Obat 8 x 5 cm Plastik Obat 10 x 7 cm Plester 5 yards x 2 inchi Povidon Iodida 10 % 30 ml Povidon Iodida 10 % 60 ml Povidon Iodida 10 % 300 ml

pieces pieces pieces pieces pieces tablet tablet tablet buah paket paket paket paket botol vial Tube Tube ampul Kapsul ampul tablet botol botol tablet tablet buah ampul tablet botol tablet tablet ampul tablet tablet Kapsul bungkus bungkus roll botol botol botol

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 2 134 0 0 0 0 0 0 0 0 8 250 0 0 0 0 0 0 0

319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349

Prednison tablet 5 mg Primaquin tablet 15 mg Prokainbenzil penisilin 3 jt IU/vial Propanolol HCl tablet 40 mg Propiltiourasil tablet 100 mg Ranitidin injeksi 50 mg/ml Ranitidin tablet 150 mg Rapid test HIV/AIDS SD Rapid test HIV/AIDS Intec Rapid test HIV/AIDS Oncoprobe Reagen sipilis Reserpina tablet 0,1 mg Retinol 100.000 IU kapsul lunak Retinol 200.000 IU kapsul lunak Ringer laktat larutan infus Salbutamol tablet 2 mg Salbutamol tablet 4 mg Salep 2 - 4 % Salisil bedak 2 % Salisil spiritus 10 % Sarung tangan Ginekologi Sarung tangan No. 6 1/2 Sarung tangan No. 7 Sarung tangan No. 7 1/2 Sarung tangan non steril Save Gloves No. S Save Gloves No. M Save Gloves No. L Selang Karet Anus No. 20 Semen seng serbuk dan cairan Serum Anti Bisa Ular Polivalen Injeksi 50 ml (ABU I)

350 351 352 353 354 355 356 357 358 359

Serum Anti Tetanus Injeksi 1500 IU/amp (ATS)

ampul

Serum Anti Tetanus Injeksi 20.000 IU/amp (ATS) Serum Test Golongan Darah Sianokobalamin 50 mcg Sianokobalamin injeksi Silk/benang bedah sutera No. 2/0 Silk/benang bedah sutera No. 3/0 Silver amalgam serbuk 65 - 75 % Simvastatin tablet 10 mg Simvastatin tablet 20 mg

ampul

tablet tablet vial tablet tablet ampul tablet strip strip strip strip tablet kapsul kapsul botol tablet tablet pot dos botol psg psg psg psg buah psg psg psg buah botol vial

botol tablet ampul buah buah botol tablet tablet

150 0 0 0 0 0 70 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 4 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392

Sintetic filling material Slide box Spiritus Spironolacton tablet 25 mg Spon gelatin cubicles 1 x 1 x 1 cm Sputum pot Stop TB kategori I Stop TB kategori I & 3 Streptomicyn sulfat injeksi 1500 mg/vial Sulfadimidin tablet 500 mg Sulfazetamid tetes mata Temporary stopping fletcher (fletcher) serbuk dan cairan Tetrakain tetes mata Tetrasiklin kapsul 250 mg Tetrasiklin kapsul 500 mg Thiamin HCl injeksi 100 mg/ml Thiamin HCl tablet 50 mg Tissue lensa Torniquet Tramadol injeksi Tramadol kapsul Transfusi set Triheksifenidil HCl tablet 2 mg Umbilical Cord Klem Under Pad Urine bag Ventolin Vitamin B Kompleks tablet Widal Test Wing Needle No. 23 G Zink Rapid test Malaria VAR

JUMLAH KUNJUNGAN RESEP

buah box botol tablet buah buah paket paket vial tablet botol botol botol kapsul kapsul ampul tablet bungkus buah ampul kapsul buah tablet buah pieces pieces ampul tablet botol buah tablet buah ampul

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 6 0 0 0 0 0 0 0 0 0 0 0 344 0 0 194 17 0

UMUM BAYAR TIDAK BAYAR

MENGETAHUI/MENYETUJUI: KEPALA DINAS KESEHATAN KAB. NAGEKEO,

(…………………………………………………………………..) NIP.

(LPLPO) TAHUN: 2016 PELAPORAN BULAN : SEPTEMBER 2016 PERMINTAAN BULAN : OKTOBER 2016 PENERIMAAN

PERSEDIAAN

5

6

200

PEMAKAIAN SISA STOK STOK OPT PERMINTAAN 7

0 8 7 7 0 6 0 0 0 0 0 35 20 0 0 0 0 0 0 0 0 0 0 0 0 0 450 2 0 0 0

1

120 2

8 0 8 7 6 0 6 0 0 0 0 0 35 20 0 0 0 0 0 0 0 0 0 0 0 0 0 330 0 0 0 0

9

10

100

200

600

0 0 0 0 160 0 0 0 0 0 0 0 0 0 0 0 0 0 0 294 0 0 0 370 0 0 0 0 0 0 0 0 0 1140 0 5 0 0 0 0 0

60

84

200

210 4

0 0 0 0 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 210 0 0 0 170 0 0 0 0 0 0 0 0 0 930 0 1 0 0 0 0 0

0 80 50 0 4 0 5 5 0 0 0 0 100 0 0 0 290 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0

60

0 80 50 0 4 0 5 5 0 0 0 0 100 0 0 0 230 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0

100

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 81 0 0 0 0 0 100 0 0 0 0 0 0 0 0

1

14

62

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 67 0 0 0 0 0 38 0 0 0 0 0 0 0 0

1

0 5 0 0 0 0 0 0 0 0 5 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 9 0 0

1

1

0 5 0 0 0 0 0 0 0 0 5 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 0 0

2

2

200

10

0 0 0 5 0 2 0 0 0 0 0 0 0 0 0 0 5 0 0 0 300 0 0 0 0 0 0 0 0 0 19 0 420 0 0 0 0 0 0 0 0

124

1 50

0 0 0 5 0 2 0 0 0 0 0 0 0 0 0 0 5 0 0 0 176 0 0 0 0 0 0 0 0 0 18 0 370 0 0 0 0 0 0 0 0

5

0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 3 0 0 0

2

0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 3 0 0 0

10

12

1

2 2

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 12 134 0 0 0 0 0 0 0 0 20 250 0 1 0 0 0 2 2

4

85 1

1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 8 134 0 0 0 0 0 0 0 0 20 165 0 0 0 0 0 2 1

4 4

150 0 0 0 0 0 70 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 8 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

20

4

2

130 0 0 0 0 0 70 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 6 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

3

100

ASKES

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 9 0 0 0 0 0 0 0 0 0 0 0 444 0 0 194 17 0

90

24

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 9 0 0 0 0 0 0 0 0 0 0 0 354 0 0 170 17 0

YANG MENYERAHKAN: PETUGAS INSTALASI FARMASI,

(……………………………………………………………..) NIP.

YANG MEMINTA/ MELA

(

MAGUS HILARIUS NIP.19631231 200012

BULAN: JULI 2016

APBD IIBUFFER PROGRAM DEPKES ASKES JUMLAH KET LAIN 11

12

13

14

15

16

17

………………………………., 2014

YANG MEMINTA/ MELAPORKAN: YANG MENERIMA: KEPALA PUSKESMAS, PETUGAS PUSKESMAS,

(

MAGUS HILARIUS ) NIP.19631231 200012 1 029

( FATMAWATI ) NIP.19820424 200904 2 014

PUSKESMAS : NANGARORO KABUPATEN : NAGEKEO POSKESDES : ULUPULU

NO.

NAMA JENIS OBAT

SATUAN

STOK AWAL

1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

2

3

4 0 8 7 6 0 6 0 0 0 0 0 35 20 0 0 0 0 0 0 0 0 0 0 0 0 0 330 0 0 0 0

Abocath No 18 Abocath No 20 Abocath No 22 Abocath No 24 Abocath No 26 Aciclovir salep kulit Aciclovir tablet 400 mg Alat suntik sekali pakai 1 ml Alat suntik sekali pakai 10 ml Alat suntik sekali pakai 2,5 ml Alat suntik sekali pakai 20 ml Alat suntik sekali pakai 3 ml Alat suntik sekali pakai 5 ml Alat suntik sekali pakai 50 ml Albendazole tablet 400 mg Alopurinol tablet 100 mg Aluminium foil Amalgam serbuk 65-75 % Ambroxol sirup 15 mg/ml Ambroxol tablet 30 mg Aminofilin injeksi Aminofilin tablet 200 mg Amitriptilin tablet 25 mg Amlodipin 5 mg Amlodipin 10 mg Amoksisilin kapsul 250 mg Amoksisilin kaplet 500 mg Amoksisilin sirup kering 125 mg/5 ml Ampisilin kaplet 250 mg Ampisilin kaplet 500 mg Ampisilin serbuk injeksi 1.000 mg

buah buah buah buah buah tube tablet buah buah buah buah buah buah buah tablet tablet gulungan botol botol tablet ampul tablet tablet tablet tablet kapsul kaplet botol kaplet kaplet vial

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

Ampisilin sirup kering 60 ml Antagin injeksi 250 mg / ml Antalgin tablet 500 mg Antasida DOEN II suspensi Antasida DOEN tablet Anti hemoroid suppositoria Anti migrain DOEN tablet Anti parkinson DOEN tablet Antibakteri DOEN komb.Salep(Basitrasin + Polimiksin) Antifungi DOEN salep ( 3 - 6 ) Aqua pro injeksi steril 25 ml Aquadest steril 500 ml Arsuamon tablet Artemether injeksi 1 ml : 80 mg Arterakin tablet Artesunate injeksi Artesunate tablet Asam Asetilsalisilat tablet 100 mg (Asetosal) Asam Asetilsalisilat tablet 500 mg (Asetosal) Asam askorbat tablet 50 mg Asam askorbat tablet 250 mg Asam folat Asam mefenamat tablet 250 mg Asam mefenamat tablet 500 mg Asam traneksamat 500 mg Asam traneksamat injeksi Atenolol tablet 50 mg Atropin sulfat injeksi 0,25 mg/ml Atropin sulfat tablet 0,5 mg Atropin sulfat tetes mata Autoklik Bekarbon (arang aktif) Benzatin benzil penisilin injeksi Besi II tablet salut kombinasi Betahistin Betametason krem 0,1 % Bisoprolol 5 mg Bisturi No. 11 Blood lancet Bromheksin tablet 8 mg Burnazin salep

botol ampul tablet botol tablet suposs tablet tablet Pot Pot vial botol tablet ampul tablet vial tablet tablet tablet tablet tablet tablet tablet tablet tablet ampul tablet ampul tablet botol buah tablet vial tablet tablet tube tablet buah buah tablet tube

0 0 0 0 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 210 0 0 0 170 0 0 0 0 0 0 0 0 0 930 0 1 0 0 0 0 0

73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113

Calsium glukonat 10 mg/ml Captopril 12,5 mg Captopril 25 mg Cat Gram Catgut Chromic No 2/0 Catgut Chromic No 3/0 Catgut Plain No 2/0 Catgut Plain No 3/0 Cetirizine Cimetidine tablet 200 mg Combur test Cover glass Cyprofloxacin tablet 500 mg Dapson tablet Darplex Deksametason injeksi 5 mg/ml Deksametason tablet 0,5 mg Dekstrometorfan syrup Dekstrometrophan tablet 15 mg Dengue blood Devitalisasi pastae non arsen Diasepam injeksi 5 mg/ml Diasepam tablet 2 mg Diasepam tablet 5 mg Dietilkarbamazin tablet Difenhidramin injeksi 10 mg Digoksin tablet Dimenhidrinat tab 50 mg Doksisiklin kapsul 100 mg Domperidon sirup Domperidon tablet 10 mg Efedrin HCl tablet 25 mg Ekstrak Belladona tablet 10mg Epinefrin/adrenalin injeksi 0,1 % Erytromicyn kapsul 250 mg Erytromicyn kapsul 500 mg Erytromicyn suspensi 125 mg/ 5 ml Etakridina larutan 0,1% Etanol 70 % 100 ml Etanol 70% 300 ml Etanol 70 % 1000 ml

ampul tablet tablet paket buah buah buah buah tablet tablet kit buah tablet tablet tablet ampul tablet botol tablet kit botol ampul tablet tablet tablet ampul tablet tablet kapsul botol tablet tablet tablet ampul kapsul kapsul botol botol botol botol botol

0 80 50 0 4 0 5 5 0 0 0 0 100 0 0 0 230 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0

114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154

Etanol 96 % 1000 ml Ethil klorida semprot Eugenol cairan F l u o r tablet 0, mg Fenitoin natrium injeksi 50 mg/ml Fenitoin natrium kapsul 30 mg Fenitoin natrium kapsul 100 mg Fenobarbital injeksi 50 mg/ml Fenobarbital tablet 30 mg Fenobarbital tablet 100 mg Fenoksimetil penisilin tablet 250 mg Fenoksimetil penisilin tablet 500 mg Fenolgliserol tetes telinga Fitomenadion (Vit K) injeksi 10 mg/ml Fitomenadion (Vit K1) injeksi 10 mg/ml Fitomenadion (Vit.K1) tablet salut 10 mg Folley cath.10 F Folley cath.14 F Folley cath.16 F Folley cath.18 F Forinokresol (pengganti TKF) Formalin cair Formalin tablet 1 gr Furosemida injeksi Furosemida tablet 40 mg Gameksan lotion 1 % Garam oralit 200 ml air Gentamisin injeksi 40 mg/ml Gentamisin salep kulit 0,1 % Gentian violet larutan Glass Ionomer Cement ART Glibenklamid tablet 5 mg Gliserilguayakolat tablet Gliserin Glukosa injeksi 40 % Glukosa larutan infus 5 % Glukosa larutan infus 10 % Griseofulvin tablet 125 mg Haemocytometer Haemometer Haloperidol tablet 0,5 mg

botol botol botol tablet amp @ 2ml kapsul kapsul ampul tablet tablet tablet tablet botol ampul ampul tablet buah buah buah buah botol botol I ltr tablet ampul tablet botol saset ampul tube botol set/botol tablet tablet botol vial botol botol tablet buah buah tablet

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 67 0 0 0 0 0 38 0 0 0 0 0 0 0 0

155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195

HBSaG HCG Strip Hidrogen peroksida Hidroklorotiasida tablet 25 mg Hidrokortison krem 2,5 % Ibuprofen 100 mg/5 ml suspensi Ibuprofen 200 mg/5 ml suspensi Ibuprofen tablet 200 mg Ibuprofen tablet 400 mg Imersion oil Infus set anak Infus set dewasa Iodin test Iodol kapsul lunak Isosorbid dinitrat tablet 5 mg Jarum dispossible No. 22 ¼ G Jarum dispossible No. 23 ¼ G Jarum jahit/ bedah Kulit No. 9 Jarum jahit/ bedah Kulit No. 10 Jarum jahit/ bedah Kulit No. 11 Jarum jahit/ bedah Kulit No. 12 Jarum jahit/ bedah Kulit No. 13 Jarum jahit/ bedah Kulit No. 14 Jarum jahit/ bedah Otot No. 9 Jarum jahit/ bedah Otot No. 10 Jarum jahit/ bedah Otot No. 11 Jarum jahit/ bedah Otot No. 12 Jarum jahit/ bedah Otot No. 13 Jarum jahit/ bedah Otot No. 14 Jeli USG Kaca slide Kalium permanganat serbuk Kalsium hidroksida pastae Kalsium laktat tablet 500 mg Kapas pembalut absorben 100 gr Kapas pembalut absorben 250 gr Karbamasepin tablet 200 mg Kartu stok Kasa kompres steril 40/40 Kasa pembalut 10 cm Kasa pembalut 4 m x 3 cm

strip strip botol tablet tube botol botol tablet tablet botol set set botol kapsul tablet buah buah pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces jerigen buah tube tube buah roll roll tablet lembar roll roll roll

0 5 0 0 0 0 0 0 0 0 5 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 0 0

196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235

Kasa pembalut 4 m x 5 cm Kasa pembalut 4 m x 6 cm Kasa pembalut 40 m x 80 cm Kasa pembalut hidrofil 2 m x 80 cm Kasa pembalut hidrofil 4 m x 10 cm Kasa pembalut hidrofil 4 m x 15 cm Kasa pembalut hidrifil 16 cm x 16 cm Kertas Pulvis Kertas Resep Kertas saring Ketokonazole cream 2% Ketokonazole tablet 200 mg Ketorolac injeksi 10mg/ml Kinina dihidroklorida injeksi 25 % Kinina sulfat tablet 200 mg Kloramfenikol kapsul 250 mg Kloramfenikol sm 1 % Kloramfenikol suspensi Kloramfenikol tetes mata 0,5 % Kloramfenikol tetes telinga 3 % Klorfeniramin maleat tablet 4 mg Klorfenol kamfer menthol (CHKM) Klorokuin injeksi Klorokuin tablet 250 mg Klorpromazin HCl injeksi 25 mg/ml Klorpromazin tablet 25 mg Klorpromazin tablet 100 mg Klorpropamide tablet 100 mg Kodein tablet 10 mg Komb. Pirimet-sulfadoksin tablet Kotrimoksasol suspensi Kotrimoksasol tablet 120 mg Kotrimoksasol tablet 480 mg Larutan Anisol Larutan Asam asetat Larutan Asam sulfosalisilat Larutan Benedicts Larutan EDTA Larutan Eosin 2 % Larutan Giemsa

236

Larutan Hayem

roll

botol

0 0 0 5 0 2 0 0 0 0 0 0 0 0 0 0 5 0 0 0 176 0 0 0 0 0 0 0 0 0 18 0 370 0 0 0 0 0 0 0

botol

0

roll roll roll roll roll roll blok blok lembar tube tablet ampul ampul tablet kapsul tube botol botol botol tablet botol ampul tablet ampul tablet tablet tablet tablet tablet botol tablet tablet botol botol botol botol botol botol

237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277

Larutan HCl 0,1 N Larutan Lugol Larutan Natrium sitrat Larutan Rees Ecker Larutan Turk Larutan Ziehl Nelsen Levetran salep Levothyroxin Lidokain injeksi 2 % Lidokain injeksi 2 % (HCl) + Epinefrin 1 : 80.000 - 2 ml Lisol cairan Loratadin tablet Magnesium sulfat injeksi 20 % Magnesium sulfat injeksi 40 % Magnesium sulfat serbuk 30 gram Masker Mebendazol tablet 100 mg Meloksicam 7,5 mg Metformin tablet 500 mg Metilergometrin injeksi 0,200 mg Metilergometrin tablet 0,125 mg Metoklopramide tablet 5 mg Metoklopramide tablet 10 mg Metoklopramide injeksi 5 mg/ml Metoklopramide sirup 5 mg/ml Metronidasol infus Metronidasol tablet 250 mg Metronidasol tablet 500 mg Metylprednisolon Mikonazol salf Mineral mix Monoklorkamfermenthol cairan Morphin Injeksi Mucus section Mummifying pastae Natrium bicarbonat tablet 500 mg Natrium diklofenak tab 25 mg Natrium klorida larutan infus 0,9 % Natrium tiosulfat inj 25% NGT No. 3 NGT No. 3,5

botol botol botol botol botol paket pot tablet ampul ampul botol tablet ampul ampul saset lembar tablet tablet tablet ampul tablet tablet tablet ampul botol botol tablet tablet tablet tube saset botol ampul buah Tube tablet tablet botol ampul pieces pieces

0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 3 0 0 0

278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318

NGT No. 4 NGT NO. 5 NGT NO. 10 NGT NO. 16 NGT NO. 18 Nifedipin tablet 10 mg Nistatin tablet salut 500.000 IU/g Nistatin vaginal tablet 100.000 IU/g Nurse Cup Obat Anti TBC Kategori 2 (sisipan) Obat Anti TBC Kategori Anak Obat Anti TBC Kategori Anak Lanjutan Obat Anti TBC Kategori II FDC Obat batuk hitam Oksitetrasiklin injeksi Oksitetrasiklin s m 1 % Oksitetrasiklin salep kulit 3 % Oksitocyn injeksi 10 IU/ml Omeprasole 20 mg Papaverin injeksi 40 mg/ml Papaverin tablet Parasetamol drops Parasetamol sirup 125 mg/5 ml Parasetamol tablet 100 mg Parasetamol tablet 500 mg Pembalut Gibbs Pethidin injeksi 50 mg/ml Pil KB Kombinasi Pilokarpin HCl tetes mata Piracetam 400 mg Piracetam 800 mg Piracetam injeksi 200 mg/ml Pirantel pamoat tablet 125 mg Piridoksin HCl tablet 10 mg Piroksikam kapsul 20 mg Plastik Obat 8 x 5 cm Plastik Obat 10 x 7 cm Plester 5 yards x 2 inchi Povidon Iodida 10 % 30 ml Povidon Iodida 10 % 60 ml Povidon Iodida 10 % 300 ml

pieces pieces pieces pieces pieces tablet tablet tablet buah paket paket paket paket botol vial Tube Tube ampul Kapsul ampul tablet botol botol tablet tablet buah ampul tablet botol tablet tablet ampul tablet tablet Kapsul bungkus bungkus roll botol botol botol

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 8 134 0 0 0 0 0 0 0 0 20 165 0 0 0 0 0 2 1

319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349

Prednison tablet 5 mg Primaquin tablet 15 mg Prokainbenzil penisilin 3 jt IU/vial Propanolol HCl tablet 40 mg Propiltiourasil tablet 100 mg Ranitidin injeksi 50 mg/ml Ranitidin tablet 150 mg Rapid test HIV/AIDS SD Rapid test HIV/AIDS Intec Rapid test HIV/AIDS Oncoprobe Reagen sipilis Reserpina tablet 0,1 mg Retinol 100.000 IU kapsul lunak Retinol 200.000 IU kapsul lunak Ringer laktat larutan infus Salbutamol tablet 2 mg Salbutamol tablet 4 mg Salep 2 - 4 % Salisil bedak 2 % Salisil spiritus 10 % Sarung tangan Ginekologi Sarung tangan No. 6 1/2 Sarung tangan No. 7 Sarung tangan No. 7 1/2 Sarung tangan non steril Save Gloves No. S Save Gloves No. M Save Gloves No. L Selang Karet Anus No. 20 Semen seng serbuk dan cairan Serum Anti Bisa Ular Polivalen Injeksi 50 ml (ABU I)

350 351 352 353 354 355 356 357 358 359

Serum Anti Tetanus Injeksi 1500 IU/amp (ATS)

ampul

Serum Anti Tetanus Injeksi 20.000 IU/amp (ATS) Serum Test Golongan Darah Sianokobalamin 50 mcg Sianokobalamin injeksi Silk/benang bedah sutera No. 2/0 Silk/benang bedah sutera No. 3/0 Silver amalgam serbuk 65 - 75 % Simvastatin tablet 10 mg Simvastatin tablet 20 mg

ampul

tablet tablet vial tablet tablet ampul tablet strip strip strip strip tablet kapsul kapsul botol tablet tablet pot dos botol psg psg psg psg buah psg psg psg buah botol vial

botol tablet ampul buah buah botol tablet tablet

130 0 0 0 0 0 70 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 6 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392

Sintetic filling material Slide box Spiritus Spironolacton tablet 25 mg Spon gelatin cubicles 1 x 1 x 1 cm Sputum pot Stop TB kategori I Stop TB kategori I & 3 Streptomicyn sulfat injeksi 1500 mg/vial Sulfadimidin tablet 500 mg Sulfazetamid tetes mata Temporary stopping fletcher (fletcher) serbuk dan cairan Tetrakain tetes mata Tetrasiklin kapsul 250 mg Tetrasiklin kapsul 500 mg Thiamin HCl injeksi 100 mg/ml Thiamin HCl tablet 50 mg Tissue lensa Torniquet Tramadol injeksi Tramadol kapsul Transfusi set Triheksifenidil HCl tablet 2 mg Umbilical Cord Klem Under Pad Urine bag Ventolin Vitamin B Kompleks tablet Widal Test Wing Needle No. 23 G Zink Rapid test Malaria VAR

JUMLAH KUNJUNGAN RESEP

buah box botol tablet buah buah paket paket vial tablet botol botol botol kapsul kapsul ampul tablet bungkus buah ampul kapsul buah tablet buah pieces pieces ampul tablet botol buah tablet buah ampul

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 9 0 0 0 0 0 0 0 0 0 0 0 354 0 0 170 17 0

UMUM BAYAR TIDAK BAYAR

MENGETAHUI/MENYETUJUI: KEPALA DINAS KESEHATAN KAB. NAGEKEO,

(…………………………………………………………………..) NIP.

(LPLPO) TAHUN: 2016 PELAPORAN BULAN : OKTOBER 2016 PERMINTAAN BULAN : NOVEMBER 2016 PENERIMAAN

PERSEDIAAN

5

6

300

PEMAKAIAN SISA STOK STOK OPT PERMINTAAN 7

0 8 7 6 0 6 0 0 0 0 0 35 20 0 0 0 0 0 0 0 0 0 0 0 0 0 630 0 0 0 0

5 2

376

8 0 8 7 6 0 6 0 0 0 0 0 30 18 0 0 0 0 0 0 0 0 0 0 0 0 0 254 0 0 0 0

9

10

100

100

200

2

0 0 0 0 200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 210 100 0 0 370 0 0 0 0 0 0 0 0 0 930 0 3 0 0 0 0 0

70

210 72

370

330 3

0 0 0 0 130 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 0 0 0 600 0 0 0 0 0 0 0

0 80 50 0 4 0 5 5 0 0 0 0 100 0 0 0 230 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0

20

160

1

0 60 50 0 4 0 5 5 0 0 0 0 100 0 0 0 70 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0

50

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 117 0 0 0 0 0 38 0 0 0 0 0 0 0 0

14

38

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 103 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 5 0 0 0 0 0 0 0 0 5 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 0 0

3

0 5 0 0 0 0 0 0 0 0 5 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0

4

3

100

5 100

4 0 0 5 0 2 0 0 0 0 0 0 0 0 0 0 8 0 0 0 276 0 0 0 0 0 0 0 0 0 23 0 470 0 0 0 0 0 0 0 0

2

2

1

276

4 100

2 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 0 0 0 0 0 0 0 0 0 0 19 0 370 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 3 0 0 0

4

6

1

0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 2 0 0 0

10

1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 18 134 0 0 0 0 0 0 0 0 20 165 0 1 0 0 0 2 1

8 134

165 1

1 1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 10 0 0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 1 0

ED

2

130 0 0 0 0 0 70 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 6 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

40

5 1

90 0 0 0 0 0 70 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 1 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

100

ASKES

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 9 0 0 0 0 0 0 0 0 0 0 0 454 0 0 170 17 0

236

26

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 9 0 0 0 0 0 0 0 0 0 0 0 218 0 0 144 17 0

YANG MENYERAHKAN: PETUGAS INSTALASI FARMASI,

(……………………………………………………………..) NIP.

YANG MEMINTA/ MELA

(

MAGUS HILARIUS NIP.19631231 200012

BULAN: JULI 2016

APBD IIBUFFER PROGRAM DEPKES ASKES JUMLAH KET LAIN 11

12

13

14

15

16

17

………………………………., 2014

YANG MEMINTA/ MELAPORKAN: YANG MENERIMA: KEPALA PUSKESMAS, PETUGAS PUSKESMAS,

(

MAGUS HILARIUS ) NIP.19631231 200012 1 029

( FATMAWATI ) NIP.19820424 200904 2 014

PUSKESMAS : NANGARORO KABUPATEN : NAGEKEO POSKESDES : ULUPULU

NO.

NAMA JENIS OBAT

SATUAN

STOK AWAL

1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

2

3

4 0 8 7 6 0 6 0 0 0 0 0 30 18 0 0 0 0 0 0 0 0 0 0 0 0 0 254 0 0 0 0

Abocath No 18 Abocath No 20 Abocath No 22 Abocath No 24 Abocath No 26 Aciclovir salep kulit Aciclovir tablet 400 mg Alat suntik sekali pakai 1 ml Alat suntik sekali pakai 10 ml Alat suntik sekali pakai 2,5 ml Alat suntik sekali pakai 20 ml Alat suntik sekali pakai 3 ml Alat suntik sekali pakai 5 ml Alat suntik sekali pakai 50 ml Albendazole tablet 400 mg Alopurinol tablet 100 mg Aluminium foil Amalgam serbuk 65-75 % Ambroxol sirup 15 mg/ml Ambroxol tablet 30 mg Aminofilin injeksi Aminofilin tablet 200 mg Amitriptilin tablet 25 mg Amlodipin 5 mg Amlodipin 10 mg Amoksisilin kapsul 250 mg Amoksisilin kaplet 500 mg Amoksisilin sirup kering 125 mg/5 ml Ampisilin kaplet 250 mg Ampisilin kaplet 500 mg Ampisilin serbuk injeksi 1.000 mg

buah buah buah buah buah tube tablet buah buah buah buah buah buah buah tablet tablet gulungan botol botol tablet ampul tablet tablet tablet tablet kapsul kaplet botol kaplet kaplet vial

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

Ampisilin sirup kering 60 ml Antagin injeksi 250 mg / ml Antalgin tablet 500 mg Antasida DOEN II suspensi Antasida DOEN tablet Anti hemoroid suppositoria Anti migrain DOEN tablet Anti parkinson DOEN tablet Antibakteri DOEN komb.Salep(Basitrasin + Polimiksin) Antifungi DOEN salep ( 3 - 6 ) Aqua pro injeksi steril 25 ml Aquadest steril 500 ml Arsuamon tablet Artemether injeksi 1 ml : 80 mg Arterakin tablet Artesunate injeksi Artesunate tablet Asam Asetilsalisilat tablet 100 mg (Asetosal) Asam Asetilsalisilat tablet 500 mg (Asetosal) Asam askorbat tablet 50 mg Asam askorbat tablet 250 mg Asam folat Asam mefenamat tablet 250 mg Asam mefenamat tablet 500 mg Asam traneksamat 500 mg Asam traneksamat injeksi Atenolol tablet 50 mg Atropin sulfat injeksi 0,25 mg/ml Atropin sulfat tablet 0,5 mg Atropin sulfat tetes mata Autoklik Bekarbon (arang aktif) Benzatin benzil penisilin injeksi Besi II tablet salut kombinasi Betahistin Betametason krem 0,1 % Bisoprolol 5 mg Bisturi No. 11 Blood lancet Bromheksin tablet 8 mg Burnazin salep

botol ampul tablet botol tablet suposs tablet tablet Pot Pot vial botol tablet ampul tablet vial tablet tablet tablet tablet tablet tablet tablet tablet tablet ampul tablet ampul tablet botol buah tablet vial tablet tablet tube tablet buah buah tablet tube

0 0 0 0 130 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28 0 0 0 0 0 0 0 0 0 0 0 0 600 0 0 0 0 0 0 0

73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113

Calsium glukonat 10 mg/ml Captopril 12,5 mg Captopril 25 mg Cat Gram Catgut Chromic No 2/0 Catgut Chromic No 3/0 Catgut Plain No 2/0 Catgut Plain No 3/0 Cetirizine Cimetidine tablet 200 mg Combur test Cover glass Cyprofloxacin tablet 500 mg Dapson tablet Darplex Deksametason injeksi 5 mg/ml Deksametason tablet 0,5 mg Dekstrometorfan syrup Dekstrometrophan tablet 15 mg Dengue blood Devitalisasi pastae non arsen Diasepam injeksi 5 mg/ml Diasepam tablet 2 mg Diasepam tablet 5 mg Dietilkarbamazin tablet Difenhidramin injeksi 10 mg Digoksin tablet Dimenhidrinat tab 50 mg Doksisiklin kapsul 100 mg Domperidon sirup Domperidon tablet 10 mg Efedrin HCl tablet 25 mg Ekstrak Belladona tablet 10mg Epinefrin/adrenalin injeksi 0,1 % Erytromicyn kapsul 250 mg Erytromicyn kapsul 500 mg Erytromicyn suspensi 125 mg/ 5 ml Etakridina larutan 0,1% Etanol 70 % 100 ml Etanol 70% 300 ml Etanol 70 % 1000 ml

ampul tablet tablet paket buah buah buah buah tablet tablet kit buah tablet tablet tablet ampul tablet botol tablet kit botol ampul tablet tablet tablet ampul tablet tablet kapsul botol tablet tablet tablet ampul kapsul kapsul botol botol botol botol botol

0 60 50 0 4 0 5 5 0 0 0 0 100 0 0 0 70 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0

114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154

Etanol 96 % 1000 ml Ethil klorida semprot Eugenol cairan F l u o r tablet 0, mg Fenitoin natrium injeksi 50 mg/ml Fenitoin natrium kapsul 30 mg Fenitoin natrium kapsul 100 mg Fenobarbital injeksi 50 mg/ml Fenobarbital tablet 30 mg Fenobarbital tablet 100 mg Fenoksimetil penisilin tablet 250 mg Fenoksimetil penisilin tablet 500 mg Fenolgliserol tetes telinga Fitomenadion (Vit K) injeksi 10 mg/ml Fitomenadion (Vit K1) injeksi 10 mg/ml Fitomenadion (Vit.K1) tablet salut 10 mg Folley cath.10 F Folley cath.14 F Folley cath.16 F Folley cath.18 F Forinokresol (pengganti TKF) Formalin cair Formalin tablet 1 gr Furosemida injeksi Furosemida tablet 40 mg Gameksan lotion 1 % Garam oralit 200 ml air Gentamisin injeksi 40 mg/ml Gentamisin salep kulit 0,1 % Gentian violet larutan Glass Ionomer Cement ART Glibenklamid tablet 5 mg Gliserilguayakolat tablet Gliserin Glukosa injeksi 40 % Glukosa larutan infus 5 % Glukosa larutan infus 10 % Griseofulvin tablet 125 mg Haemocytometer Haemometer Haloperidol tablet 0,5 mg

botol botol botol tablet amp @ 2ml kapsul kapsul ampul tablet tablet tablet tablet botol ampul ampul tablet buah buah buah buah botol botol I ltr tablet ampul tablet botol saset ampul tube botol set/botol tablet tablet botol vial botol botol tablet buah buah tablet

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 103 0 0 0 0 0 0 0 0 0 0 0 0 0 0

155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195

HBSaG HCG Strip Hidrogen peroksida Hidroklorotiasida tablet 25 mg Hidrokortison krem 2,5 % Ibuprofen 100 mg/5 ml suspensi Ibuprofen 200 mg/5 ml suspensi Ibuprofen tablet 200 mg Ibuprofen tablet 400 mg Imersion oil Infus set anak Infus set dewasa Iodin test Iodol kapsul lunak Isosorbid dinitrat tablet 5 mg Jarum dispossible No. 22 ¼ G Jarum dispossible No. 23 ¼ G Jarum jahit/ bedah Kulit No. 9 Jarum jahit/ bedah Kulit No. 10 Jarum jahit/ bedah Kulit No. 11 Jarum jahit/ bedah Kulit No. 12 Jarum jahit/ bedah Kulit No. 13 Jarum jahit/ bedah Kulit No. 14 Jarum jahit/ bedah Otot No. 9 Jarum jahit/ bedah Otot No. 10 Jarum jahit/ bedah Otot No. 11 Jarum jahit/ bedah Otot No. 12 Jarum jahit/ bedah Otot No. 13 Jarum jahit/ bedah Otot No. 14 Jeli USG Kaca slide Kalium permanganat serbuk Kalsium hidroksida pastae Kalsium laktat tablet 500 mg Kapas pembalut absorben 100 gr Kapas pembalut absorben 250 gr Karbamasepin tablet 200 mg Kartu stok Kasa kompres steril 40/40 Kasa pembalut 10 cm Kasa pembalut 4 m x 3 cm

strip strip botol tablet tube botol botol tablet tablet botol set set botol kapsul tablet buah buah pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces jerigen buah tube tube buah roll roll tablet lembar roll roll roll

0 5 0 0 0 0 0 0 0 0 5 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0

196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235

Kasa pembalut 4 m x 5 cm Kasa pembalut 4 m x 6 cm Kasa pembalut 40 m x 80 cm Kasa pembalut hidrofil 2 m x 80 cm Kasa pembalut hidrofil 4 m x 10 cm Kasa pembalut hidrofil 4 m x 15 cm Kasa pembalut hidrifil 16 cm x 16 cm Kertas Pulvis Kertas Resep Kertas saring Ketokonazole cream 2% Ketokonazole tablet 200 mg Ketorolac injeksi 10mg/ml Kinina dihidroklorida injeksi 25 % Kinina sulfat tablet 200 mg Kloramfenikol kapsul 250 mg Kloramfenikol sm 1 % Kloramfenikol suspensi Kloramfenikol tetes mata 0,5 % Kloramfenikol tetes telinga 3 % Klorfeniramin maleat tablet 4 mg Klorfenol kamfer menthol (CHKM) Klorokuin injeksi Klorokuin tablet 250 mg Klorpromazin HCl injeksi 25 mg/ml Klorpromazin tablet 25 mg Klorpromazin tablet 100 mg Klorpropamide tablet 100 mg Kodein tablet 10 mg Komb. Pirimet-sulfadoksin tablet Kotrimoksasol suspensi Kotrimoksasol tablet 120 mg Kotrimoksasol tablet 480 mg Larutan Anisol Larutan Asam asetat Larutan Asam sulfosalisilat Larutan Benedicts Larutan EDTA Larutan Eosin 2 % Larutan Giemsa

236

Larutan Hayem

roll

botol

2 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 0 0 0 0 0 0 0 0 0 0 19 0 370 0 0 0 0 0 0 0

botol

0

roll roll roll roll roll roll blok blok lembar tube tablet ampul ampul tablet kapsul tube botol botol botol tablet botol ampul tablet ampul tablet tablet tablet tablet tablet botol tablet tablet botol botol botol botol botol botol

237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277

Larutan HCl 0,1 N Larutan Lugol Larutan Natrium sitrat Larutan Rees Ecker Larutan Turk Larutan Ziehl Nelsen Levetran salep Levothyroxin Lidokain injeksi 2 % Lidokain injeksi 2 % (HCl) + Epinefrin 1 : 80.000 - 2 ml Lisol cairan Loratadin tablet Magnesium sulfat injeksi 20 % Magnesium sulfat injeksi 40 % Magnesium sulfat serbuk 30 gram Masker Mebendazol tablet 100 mg Meloksicam 7,5 mg Metformin tablet 500 mg Metilergometrin injeksi 0,200 mg Metilergometrin tablet 0,125 mg Metoklopramide tablet 5 mg Metoklopramide tablet 10 mg Metoklopramide injeksi 5 mg/ml Metoklopramide sirup 5 mg/ml Metronidasol infus Metronidasol tablet 250 mg Metronidasol tablet 500 mg Metylprednisolon Mikonazol salf Mineral mix Monoklorkamfermenthol cairan Morphin Injeksi Mucus section Mummifying pastae Natrium bicarbonat tablet 500 mg Natrium diklofenak tab 25 mg Natrium klorida larutan infus 0,9 % Natrium tiosulfat inj 25% NGT No. 3 NGT No. 3,5

botol botol botol botol botol paket pot tablet ampul ampul botol tablet ampul ampul saset lembar tablet tablet tablet ampul tablet tablet tablet ampul botol botol tablet tablet tablet tube saset botol ampul buah Tube tablet tablet botol ampul pieces pieces

0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 2 0 0 0

278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318

NGT No. 4 NGT NO. 5 NGT NO. 10 NGT NO. 16 NGT NO. 18 Nifedipin tablet 10 mg Nistatin tablet salut 500.000 IU/g Nistatin vaginal tablet 100.000 IU/g Nurse Cup Obat Anti TBC Kategori 2 (sisipan) Obat Anti TBC Kategori Anak Obat Anti TBC Kategori Anak Lanjutan Obat Anti TBC Kategori II FDC Obat batuk hitam Oksitetrasiklin injeksi Oksitetrasiklin s m 1 % Oksitetrasiklin salep kulit 3 % Oksitocyn injeksi 10 IU/ml Omeprasole 20 mg Papaverin injeksi 40 mg/ml Papaverin tablet Parasetamol drops Parasetamol sirup 125 mg/5 ml Parasetamol tablet 100 mg Parasetamol tablet 500 mg Pembalut Gibbs Pethidin injeksi 50 mg/ml Pil KB Kombinasi Pilokarpin HCl tetes mata Piracetam 400 mg Piracetam 800 mg Piracetam injeksi 200 mg/ml Pirantel pamoat tablet 125 mg Piridoksin HCl tablet 10 mg Piroksikam kapsul 20 mg Plastik Obat 8 x 5 cm Plastik Obat 10 x 7 cm Plester 5 yards x 2 inchi Povidon Iodida 10 % 30 ml Povidon Iodida 10 % 60 ml Povidon Iodida 10 % 300 ml

pieces pieces pieces pieces pieces tablet tablet tablet buah paket paket paket paket botol vial Tube Tube ampul Kapsul ampul tablet botol botol tablet tablet buah ampul tablet botol tablet tablet ampul tablet tablet Kapsul bungkus bungkus roll botol botol botol

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 10 0 0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 1 0

319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349

Prednison tablet 5 mg Primaquin tablet 15 mg Prokainbenzil penisilin 3 jt IU/vial Propanolol HCl tablet 40 mg Propiltiourasil tablet 100 mg Ranitidin injeksi 50 mg/ml Ranitidin tablet 150 mg Rapid test HIV/AIDS SD Rapid test HIV/AIDS Intec Rapid test HIV/AIDS Oncoprobe Reagen sipilis Reserpina tablet 0,1 mg Retinol 100.000 IU kapsul lunak Retinol 200.000 IU kapsul lunak Ringer laktat larutan infus Salbutamol tablet 2 mg Salbutamol tablet 4 mg Salep 2 - 4 % Salisil bedak 2 % Salisil spiritus 10 % Sarung tangan Ginekologi Sarung tangan No. 6 1/2 Sarung tangan No. 7 Sarung tangan No. 7 1/2 Sarung tangan non steril Save Gloves No. S Save Gloves No. M Save Gloves No. L Selang Karet Anus No. 20 Semen seng serbuk dan cairan Serum Anti Bisa Ular Polivalen Injeksi 50 ml (ABU I)

350 351 352 353 354 355 356 357 358 359

Serum Anti Tetanus Injeksi 1500 IU/amp (ATS)

ampul

Serum Anti Tetanus Injeksi 20.000 IU/amp (ATS) Serum Test Golongan Darah Sianokobalamin 50 mcg Sianokobalamin injeksi Silk/benang bedah sutera No. 2/0 Silk/benang bedah sutera No. 3/0 Silver amalgam serbuk 65 - 75 % Simvastatin tablet 10 mg Simvastatin tablet 20 mg

ampul

tablet tablet vial tablet tablet ampul tablet strip strip strip strip tablet kapsul kapsul botol tablet tablet pot dos botol psg psg psg psg buah psg psg psg buah botol vial

botol tablet ampul buah buah botol tablet tablet

90 0 0 0 0 0 70 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 1 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392

Sintetic filling material Slide box Spiritus Spironolacton tablet 25 mg Spon gelatin cubicles 1 x 1 x 1 cm Sputum pot Stop TB kategori I Stop TB kategori I & 3 Streptomicyn sulfat injeksi 1500 mg/vial Sulfadimidin tablet 500 mg Sulfazetamid tetes mata Temporary stopping fletcher (fletcher) serbuk dan cairan Tetrakain tetes mata Tetrasiklin kapsul 250 mg Tetrasiklin kapsul 500 mg Thiamin HCl injeksi 100 mg/ml Thiamin HCl tablet 50 mg Tissue lensa Torniquet Tramadol injeksi Tramadol kapsul Transfusi set Triheksifenidil HCl tablet 2 mg Umbilical Cord Klem Under Pad Urine bag Ventolin Vitamin B Kompleks tablet Widal Test Wing Needle No. 23 G Zink Rapid test Malaria VAR

JUMLAH KUNJUNGAN RESEP

buah box botol tablet buah buah paket paket vial tablet botol botol botol kapsul kapsul ampul tablet bungkus buah ampul kapsul buah tablet buah pieces pieces ampul tablet botol buah tablet buah ampul

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 9 0 0 0 0 0 0 0 0 0 0 0 218 0 0 144 17 0

UMUM BAYAR TIDAK BAYAR

MENGETAHUI/MENYETUJUI: KEPALA DINAS KESEHATAN KAB. NAGEKEO,

(…………………………………………………………………..) NIP.

(LPLPO) TAHUN: 2016 PELAPORAN BULAN : NOVEMBER 2016 PERMINTAAN BULAN : DESEMBER 2016 PENERIMAAN

PERSEDIAAN

5

6

100

300

PEMAKAIAN SISA STOK STOK OPT PERMINTAAN 7

0 8 7 6 0 6 0 0 0 0 0 30 18 0 0 100 0 0 0 0 0 0 0 0 0 0 554 0 0 0 0

5 2

250

8 0 8 7 6 0 6 0 0 0 0 0 25 16 0 0 100 0 0 0 0 0 0 0 0 0 0 304 0 0 0 0

9

10

100

200

300

330 5

0 0 0 0 230 0 0 0 0 0 0 0 0 0 0 0 0 0 0 200 28 0 0 300 0 0 0 0 0 0 0 0 0 930 0 5 0 0 0 0 0

50

200

140

90 2

0 0 0 0 180 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28 0 0 160 0 0 0 0 0 0 0 0 0 840 0 3 0 0 0 0 0

100

2

0 60 50 0 4 0 5 5 0 0 0 0 100 0 0 0 170 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0

40 1

1

160

3

0 60 10 0 3 0 5 4 0 0 0 0 100 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0

200

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 103 0 0 0 0 0 200 0 0 0 0 0 0 0 0

20

90

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 83 0 0 0 0 0 110 0 0 0 0 0 0 0 0

10

1

5

0 15 0 0 0 0 0 0 0 0 5 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 11 0 0

2

5

0 13 0 0 0 0 0 0 0 0 5 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 6 0 0

3

3

300

50

5 0 0 8 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 300 0 0 0 0 0 0 0 0 0 19 0 420 0 0 0 0 0 0 0 0

3

2

250

7 60

2 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 50 0 0 0 0 0 0 0 0 0 12 0 360 0 0 0 0 0 0 0 0

2

5

1

0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 3 0 0 0

6

5

1

0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 2 0 0 0

200

100 1 1

1 1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 10 0 200 0 0 0 0 0 0 0 20 100 0 1 1 0 0 2 1

10 140

30 1 1

1 1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 60 0 0 0 0 0 0 0 20 70 0 0 0 0 0 1 0

5

90 0 0 0 0 0 70 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 6 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

60

6 2

30 0 0 0 0 0 70 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

100

ASKES

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 9 0 0 0 0 0 0 0 0 0 0 0 318 0 0 144 17 0

120

35

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 9 0 0 0 0 0 0 0 0 0 0 0 198 0 0 109 17 0

YANG MENYERAHKAN: PETUGAS INSTALASI FARMASI,

(……………………………………………………………..) NIP.

YANG MEMINTA/ MELA

(

MAGUS HILARIUS NIP.19631231 200012

BULAN: NOVEMBER 2016

APBD IIBUFFER PROGRAM DEPKES ASKES JUMLAH KET LAIN 11

12

13

14

15

16

17

………………………………., 2014

YANG MEMINTA/ MELAPORKAN: YANG MENERIMA: KEPALA PUSKESMAS, PETUGAS PUSKESMAS,

(

MAGUS HILARIUS ) NIP.19631231 200012 1 029

( FATMAWATI ) NIP.19820424 200904 2 014

PUSKESMAS : NANGARORO KABUPATEN : NAGEKEO POSKESDES : ULUPULU

NO.

NAMA JENIS OBAT

SATUAN

STOK AWAL

1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

2

3

4 0 8 7 6 0 6 0 0 0 0 0 25 16 0 0 100 0 0 0 0 0 0 0 0 0 0 304 0 0 0 0

Abocath No 18 Abocath No 20 Abocath No 22 Abocath No 24 Abocath No 26 Aciclovir salep kulit Aciclovir tablet 400 mg Alat suntik sekali pakai 1 ml Alat suntik sekali pakai 10 ml Alat suntik sekali pakai 2,5 ml Alat suntik sekali pakai 20 ml Alat suntik sekali pakai 3 ml Alat suntik sekali pakai 5 ml Alat suntik sekali pakai 50 ml Albendazole tablet 400 mg Alopurinol tablet 100 mg Aluminium foil Amalgam serbuk 65-75 % Ambroxol sirup 15 mg/ml Ambroxol tablet 30 mg Aminofilin injeksi Aminofilin tablet 200 mg Amitriptilin tablet 25 mg Amlodipin 5 mg Amlodipin 10 mg Amoksisilin kapsul 250 mg Amoksisilin kaplet 500 mg Amoksisilin sirup kering 125 mg/5 ml Ampisilin kaplet 250 mg Ampisilin kaplet 500 mg Ampisilin serbuk injeksi 1.000 mg

buah buah buah buah buah tube tablet buah buah buah buah buah buah buah tablet tablet gulungan botol botol tablet ampul tablet tablet tablet tablet kapsul kaplet botol kaplet kaplet vial

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

Ampisilin sirup kering 60 ml Antagin injeksi 250 mg / ml Antalgin tablet 500 mg Antasida DOEN II suspensi Antasida DOEN tablet Anti hemoroid suppositoria Anti migrain DOEN tablet Anti parkinson DOEN tablet Antibakteri DOEN komb.Salep(Basitrasin + Polimiksin) Antifungi DOEN salep ( 3 - 6 ) Aqua pro injeksi steril 25 ml Aquadest steril 500 ml Arsuamon tablet Artemether injeksi 1 ml : 80 mg Arterakin tablet Artesunate injeksi Artesunate tablet Asam Asetilsalisilat tablet 100 mg (Asetosal) Asam Asetilsalisilat tablet 500 mg (Asetosal) Asam askorbat tablet 50 mg Asam askorbat tablet 250 mg Asam folat Asam mefenamat tablet 250 mg Asam mefenamat tablet 500 mg Asam traneksamat 500 mg Asam traneksamat injeksi Atenolol tablet 50 mg Atropin sulfat injeksi 0,25 mg/ml Atropin sulfat tablet 0,5 mg Atropin sulfat tetes mata Autoklik Bekarbon (arang aktif) Benzatin benzil penisilin injeksi Besi II tablet salut kombinasi Betahistin Betametason krem 0,1 % Bisoprolol 5 mg Bisturi No. 11 Blood lancet Bromheksin tablet 8 mg Burnazin salep

botol ampul tablet botol tablet suposs tablet tablet Pot Pot vial botol tablet ampul tablet vial tablet tablet tablet tablet tablet tablet tablet tablet tablet ampul tablet ampul tablet botol buah tablet vial tablet tablet tube tablet buah buah tablet tube

0 0 0 0 180 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 28 0 0 160 0 0 0 0 0 0 0 0 0 840 0 3 0 0 0 0 0

73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113

Calsium glukonat 10 mg/ml Captopril 12,5 mg Captopril 25 mg Cat Gram Catgut Chromic No 2/0 Catgut Chromic No 3/0 Catgut Plain No 2/0 Catgut Plain No 3/0 Cetirizine Cimetidine tablet 200 mg Combur test Cover glass Cyprofloxacin tablet 500 mg Dapson tablet Darplex Deksametason injeksi 5 mg/ml Deksametason tablet 0,5 mg Dekstrometorfan syrup Dekstrometrophan tablet 15 mg Dengue blood Devitalisasi pastae non arsen Diasepam injeksi 5 mg/ml Diasepam tablet 2 mg Diasepam tablet 5 mg Dietilkarbamazin tablet Difenhidramin injeksi 10 mg Digoksin tablet Dimenhidrinat tab 50 mg Doksisiklin kapsul 100 mg Domperidon sirup Domperidon tablet 10 mg Efedrin HCl tablet 25 mg Ekstrak Belladona tablet 10mg Epinefrin/adrenalin injeksi 0,1 % Erytromicyn kapsul 250 mg Erytromicyn kapsul 500 mg Erytromicyn suspensi 125 mg/ 5 ml Etakridina larutan 0,1% Etanol 70 % 100 ml Etanol 70% 300 ml Etanol 70 % 1000 ml

ampul tablet tablet paket buah buah buah buah tablet tablet kit buah tablet tablet tablet ampul tablet botol tablet kit botol ampul tablet tablet tablet ampul tablet tablet kapsul botol tablet tablet tablet ampul kapsul kapsul botol botol botol botol botol

0 60 10 0 3 0 5 4 0 0 0 0 100 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0

114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154

Etanol 96 % 1000 ml Ethil klorida semprot Eugenol cairan F l u o r tablet 0, mg Fenitoin natrium injeksi 50 mg/ml Fenitoin natrium kapsul 30 mg Fenitoin natrium kapsul 100 mg Fenobarbital injeksi 50 mg/ml Fenobarbital tablet 30 mg Fenobarbital tablet 100 mg Fenoksimetil penisilin tablet 250 mg Fenoksimetil penisilin tablet 500 mg Fenolgliserol tetes telinga Fitomenadion (Vit K) injeksi 10 mg/ml Fitomenadion (Vit K1) injeksi 10 mg/ml Fitomenadion (Vit.K1) tablet salut 10 mg Folley cath.10 F Folley cath.14 F Folley cath.16 F Folley cath.18 F Forinokresol (pengganti TKF) Formalin cair Formalin tablet 1 gr Furosemida injeksi Furosemida tablet 40 mg Gameksan lotion 1 % Garam oralit 200 ml air Gentamisin injeksi 40 mg/ml Gentamisin salep kulit 0,1 % Gentian violet larutan Glass Ionomer Cement ART Glibenklamid tablet 5 mg Gliserilguayakolat tablet Gliserin Glukosa injeksi 40 % Glukosa larutan infus 5 % Glukosa larutan infus 10 % Griseofulvin tablet 125 mg Haemocytometer Haemometer Haloperidol tablet 0,5 mg

botol botol botol tablet amp @ 2ml kapsul kapsul ampul tablet tablet tablet tablet botol ampul ampul tablet buah buah buah buah botol botol I ltr tablet ampul tablet botol saset ampul tube botol set/botol tablet tablet botol vial botol botol tablet buah buah tablet

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 83 0 0 0 0 0 110 0 0 0 0 0 0 0 0

155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195

HBSaG HCG Strip Hidrogen peroksida Hidroklorotiasida tablet 25 mg Hidrokortison krem 2,5 % Ibuprofen 100 mg/5 ml suspensi Ibuprofen 200 mg/5 ml suspensi Ibuprofen tablet 200 mg Ibuprofen tablet 400 mg Imersion oil Infus set anak Infus set dewasa Iodin test Iodol kapsul lunak Isosorbid dinitrat tablet 5 mg Jarum dispossible No. 22 ¼ G Jarum dispossible No. 23 ¼ G Jarum jahit/ bedah Kulit No. 9 Jarum jahit/ bedah Kulit No. 10 Jarum jahit/ bedah Kulit No. 11 Jarum jahit/ bedah Kulit No. 12 Jarum jahit/ bedah Kulit No. 13 Jarum jahit/ bedah Kulit No. 14 Jarum jahit/ bedah Otot No. 9 Jarum jahit/ bedah Otot No. 10 Jarum jahit/ bedah Otot No. 11 Jarum jahit/ bedah Otot No. 12 Jarum jahit/ bedah Otot No. 13 Jarum jahit/ bedah Otot No. 14 Jeli USG Kaca slide Kalium permanganat serbuk Kalsium hidroksida pastae Kalsium laktat tablet 500 mg Kapas pembalut absorben 100 gr Kapas pembalut absorben 250 gr Karbamasepin tablet 200 mg Kartu stok Kasa kompres steril 40/40 Kasa pembalut 10 cm Kasa pembalut 4 m x 3 cm

strip strip botol tablet tube botol botol tablet tablet botol set set botol kapsul tablet buah buah pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces jerigen buah tube tube buah roll roll tablet lembar roll roll roll

0 13 0 0 0 0 0 0 0 0 5 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 6 0 0

196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235

Kasa pembalut 4 m x 5 cm Kasa pembalut 4 m x 6 cm Kasa pembalut 40 m x 80 cm Kasa pembalut hidrofil 2 m x 80 cm Kasa pembalut hidrofil 4 m x 10 cm Kasa pembalut hidrofil 4 m x 15 cm Kasa pembalut hidrifil 16 cm x 16 cm Kertas Pulvis Kertas Resep Kertas saring Ketokonazole cream 2% Ketokonazole tablet 200 mg Ketorolac injeksi 10mg/ml Kinina dihidroklorida injeksi 25 % Kinina sulfat tablet 200 mg Kloramfenikol kapsul 250 mg Kloramfenikol sm 1 % Kloramfenikol suspensi Kloramfenikol tetes mata 0,5 % Kloramfenikol tetes telinga 3 % Klorfeniramin maleat tablet 4 mg Klorfenol kamfer menthol (CHKM) Klorokuin injeksi Klorokuin tablet 250 mg Klorpromazin HCl injeksi 25 mg/ml Klorpromazin tablet 25 mg Klorpromazin tablet 100 mg Klorpropamide tablet 100 mg Kodein tablet 10 mg Komb. Pirimet-sulfadoksin tablet Kotrimoksasol suspensi Kotrimoksasol tablet 120 mg Kotrimoksasol tablet 480 mg Larutan Anisol Larutan Asam asetat Larutan Asam sulfosalisilat Larutan Benedicts Larutan EDTA Larutan Eosin 2 % Larutan Giemsa

236

Larutan Hayem

roll

botol

2 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 50 0 0 0 0 0 0 0 0 0 12 0 360 0 0 0 0 0 0 0

botol

0

roll roll roll roll roll roll blok blok lembar tube tablet ampul ampul tablet kapsul tube botol botol botol tablet botol ampul tablet ampul tablet tablet tablet tablet tablet botol tablet tablet botol botol botol botol botol botol

237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277

Larutan HCl 0,1 N Larutan Lugol Larutan Natrium sitrat Larutan Rees Ecker Larutan Turk Larutan Ziehl Nelsen Levetran salep Levothyroxin Lidokain injeksi 2 % Lidokain injeksi 2 % (HCl) + Epinefrin 1 : 80.000 - 2 ml Lisol cairan Loratadin tablet Magnesium sulfat injeksi 20 % Magnesium sulfat injeksi 40 % Magnesium sulfat serbuk 30 gram Masker Mebendazol tablet 100 mg Meloksicam 7,5 mg Metformin tablet 500 mg Metilergometrin injeksi 0,200 mg Metilergometrin tablet 0,125 mg Metoklopramide tablet 5 mg Metoklopramide tablet 10 mg Metoklopramide injeksi 5 mg/ml Metoklopramide sirup 5 mg/ml Metronidasol infus Metronidasol tablet 250 mg Metronidasol tablet 500 mg Metylprednisolon Mikonazol salf Mineral mix Monoklorkamfermenthol cairan Morphin Injeksi Mucus section Mummifying pastae Natrium bicarbonat tablet 500 mg Natrium diklofenak tab 25 mg Natrium klorida larutan infus 0,9 % Natrium tiosulfat inj 25% NGT No. 3 NGT No. 3,5

botol botol botol botol botol paket pot tablet ampul ampul botol tablet ampul ampul saset lembar tablet tablet tablet ampul tablet tablet tablet ampul botol botol tablet tablet tablet tube saset botol ampul buah Tube tablet tablet botol ampul pieces pieces

0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 2 0 0 0

278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318

NGT No. 4 NGT NO. 5 NGT NO. 10 NGT NO. 16 NGT NO. 18 Nifedipin tablet 10 mg Nistatin tablet salut 500.000 IU/g Nistatin vaginal tablet 100.000 IU/g Nurse Cup Obat Anti TBC Kategori 2 (sisipan) Obat Anti TBC Kategori Anak Obat Anti TBC Kategori Anak Lanjutan Obat Anti TBC Kategori II FDC Obat batuk hitam Oksitetrasiklin injeksi Oksitetrasiklin s m 1 % Oksitetrasiklin salep kulit 3 % Oksitocyn injeksi 10 IU/ml Omeprasole 20 mg Papaverin injeksi 40 mg/ml Papaverin tablet Parasetamol drops Parasetamol sirup 125 mg/5 ml Parasetamol tablet 100 mg Parasetamol tablet 500 mg Pembalut Gibbs Pethidin injeksi 50 mg/ml Pil KB Kombinasi Pilokarpin HCl tetes mata Piracetam 400 mg Piracetam 800 mg Piracetam injeksi 200 mg/ml Pirantel pamoat tablet 125 mg Piridoksin HCl tablet 10 mg Piroksikam kapsul 20 mg Plastik Obat 8 x 5 cm Plastik Obat 10 x 7 cm Plester 5 yards x 2 inchi Povidon Iodida 10 % 30 ml Povidon Iodida 10 % 60 ml Povidon Iodida 10 % 300 ml

pieces pieces pieces pieces pieces tablet tablet tablet buah paket paket paket paket botol vial Tube Tube ampul Kapsul ampul tablet botol botol tablet tablet buah ampul tablet botol tablet tablet ampul tablet tablet Kapsul bungkus bungkus roll botol botol botol

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 60 0 0 0 0 0 0 0 20 70 0 0 0 0 0 1 0

319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349

Prednison tablet 5 mg Primaquin tablet 15 mg Prokainbenzil penisilin 3 jt IU/vial Propanolol HCl tablet 40 mg Propiltiourasil tablet 100 mg Ranitidin injeksi 50 mg/ml Ranitidin tablet 150 mg Rapid test HIV/AIDS SD Rapid test HIV/AIDS Intec Rapid test HIV/AIDS Oncoprobe Reagen sipilis Reserpina tablet 0,1 mg Retinol 100.000 IU kapsul lunak Retinol 200.000 IU kapsul lunak Ringer laktat larutan infus Salbutamol tablet 2 mg Salbutamol tablet 4 mg Salep 2 - 4 % Salisil bedak 2 % Salisil spiritus 10 % Sarung tangan Ginekologi Sarung tangan No. 6 1/2 Sarung tangan No. 7 Sarung tangan No. 7 1/2 Sarung tangan non steril Save Gloves No. S Save Gloves No. M Save Gloves No. L Selang Karet Anus No. 20 Semen seng serbuk dan cairan Serum Anti Bisa Ular Polivalen Injeksi 50 ml (ABU I)

350 351 352 353 354 355 356 357 358 359

Serum Anti Tetanus Injeksi 1500 IU/amp (ATS)

ampul

Serum Anti Tetanus Injeksi 20.000 IU/amp (ATS) Serum Test Golongan Darah Sianokobalamin 50 mcg Sianokobalamin injeksi Silk/benang bedah sutera No. 2/0 Silk/benang bedah sutera No. 3/0 Silver amalgam serbuk 65 - 75 % Simvastatin tablet 10 mg Simvastatin tablet 20 mg

ampul

tablet tablet vial tablet tablet ampul tablet strip strip strip strip tablet kapsul kapsul botol tablet tablet pot dos botol psg psg psg psg buah psg psg psg buah botol vial

botol tablet ampul buah buah botol tablet tablet

30 0 0 0 0 0 70 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392

Sintetic filling material Slide box Spiritus Spironolacton tablet 25 mg Spon gelatin cubicles 1 x 1 x 1 cm Sputum pot Stop TB kategori I Stop TB kategori I & 3 Streptomicyn sulfat injeksi 1500 mg/vial Sulfadimidin tablet 500 mg Sulfazetamid tetes mata Temporary stopping fletcher (fletcher) serbuk dan cairan Tetrakain tetes mata Tetrasiklin kapsul 250 mg Tetrasiklin kapsul 500 mg Thiamin HCl injeksi 100 mg/ml Thiamin HCl tablet 50 mg Tissue lensa Torniquet Tramadol injeksi Tramadol kapsul Transfusi set Triheksifenidil HCl tablet 2 mg Umbilical Cord Klem Under Pad Urine bag Ventolin Vitamin B Kompleks tablet Widal Test Wing Needle No. 23 G Zink Rapid test Malaria VAR

JUMLAH KUNJUNGAN RESEP

buah box botol tablet buah buah paket paket vial tablet botol botol botol kapsul kapsul ampul tablet bungkus buah ampul kapsul buah tablet buah pieces pieces ampul tablet botol buah tablet buah ampul

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 9 0 0 0 0 0 0 0 0 0 0 0 198 0 0 109 17 0

UMUM BAYAR TIDAK BAYAR

MENGETAHUI/MENYETUJUI: KEPALA DINAS KESEHATAN KAB. NAGEKEO,

(…………………………………………………………………..) NIP.

(LPLPO) TAHUN: 2016 PELAPORAN BULAN : DESEMBER 2016 PERMINTAAN BULAN : JANUARI 2017 PENERIMAAN

PERSEDIAAN

5 3 3

6

10

5

400

PEMAKAIAN SISA STOK STOK OPT PERMINTAAN 7

3 11 7 6 0 6 0 10 0 0 0 30 16 0 0 100 0 0 0 0 0 0 0 0 0 0 704 0 0 0 0

3 2 1

10

8 3

70

411

8 3 8 5 5 0 6 0 0 0 0 0 22 13 0 0 30 0 0 0 0 0 0 0 0 0 0 293 0 0 0 0

9

10

50

10

100

200

300 3

0 0 0 0 230 0 0 0 0 0 10 0 0 0 0 0 0 0 0 100 28 0 0 360 0 0 0 0 0 0 0 0 0 1140 0 6 0 0 0 0 0

80

2

100

350

480 4

0 0 0 0 150 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 28 0 0 10 0 0 0 0 0 0 0 0 0 660 0 2 0 0 0 0 0

100

3

0 60 10 0 3 0 5 4 0 0 0 0 100 0 0 0 110 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0

10

110

2

0 50 10 0 3 0 5 4 0 0 0 0 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0

100

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 83 0 0 0 0 0 210 0 0 0 0 0 0 0 0

18

210

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 65 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1,745

5

5

4

0 18 0 0 0 5 0 0 0 0 5 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 6 0 0

6

3

4

0 12 0 0 0 5 0 0 0 0 5 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 2 0 0

sisa jkn 12

200

5 200

2 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 250 0 0 0 0 0 0 0 0 0 17 0 560 0 0 0 0 0 0 0 0

2

2

2

250

10 100

0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 460 0 0 0 0 0 0 0 0

10

10

2

0 0 0 0 0 0 0 0 12 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 4 0 0 0

6

10

2

0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 2 0 0 0

10 400

1

1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 10 0 460 0 0 0 0 0 0 0 20 70 0 0 1 0 0 2 0

10 460

70

1

1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 1 0

4

7 3

2

30 0 0 0 0 0 70 0 0 0 0 0 0 0 8 0 0 0 0 0 0 0 7 9 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0

7

7 2

1

30 0 0 0 0 0 70 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 7 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0

100

200

ASKES

0 0 0 0 0 0 0 0 0 0 0 0 0 0 90 9 0 0 0 0 0 0 0 0 0 0 0 298 0 0 309 17 0

90 1

210

36

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 88 0 0 273 17 0

YANG MENYERAHKAN: PETUGAS INSTALASI FARMASI,

(……………………………………………………………..) NIP.

YANG MEMINTA/ MELA

(

MAGUS HILARIUS NIP.19631231 200012

BULAN: DESEMBER 2016

APBD IIBUFFER PROGRAM DEPKES ASKES JUMLAH KET LAIN 11

12

13

14

15

16

17

………………………………., 2014

YANG MEMINTA/ MELAPORKAN: YANG MENERIMA: KEPALA PUSKESMAS, PETUGAS PUSKESMAS,

(

MAGUS HILARIUS ) NIP.19631231 200012 1 029

( FATMAWATI ) NIP.19820424 200904 2 014

PUSKESMAS : NANGARORO KABUPATEN : NAGEKEO POSKESDES : ULUPULU

NO.

NAMA JENIS OBAT

SATUAN

STOK AWAL

1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

2

3

4 3 8 5 5 0 6 0 0 0 0 0 22 13 0 0 30 0 0 0 0 0 0 0 0 0 0 293 0 0 0 0

Abocath No 18 Abocath No 20 Abocath No 22 Abocath No 24 Abocath No 26 Aciclovir salep kulit Aciclovir tablet 400 mg Alat suntik sekali pakai 1 ml Alat suntik sekali pakai 10 ml Alat suntik sekali pakai 2,5 ml Alat suntik sekali pakai 20 ml Alat suntik sekali pakai 3 ml Alat suntik sekali pakai 5 ml Alat suntik sekali pakai 50 ml Albendazole tablet 400 mg Alopurinol tablet 100 mg Aluminium foil Amalgam serbuk 65-75 % Ambroxol sirup 15 mg/ml Ambroxol tablet 30 mg Aminofilin injeksi Aminofilin tablet 200 mg Amitriptilin tablet 25 mg Amlodipin 5 mg Amlodipin 10 mg Amoksisilin kapsul 250 mg Amoksisilin kaplet 500 mg Amoksisilin sirup kering 125 mg/5 ml Ampisilin kaplet 250 mg Ampisilin kaplet 500 mg Ampisilin serbuk injeksi 1.000 mg

buah buah buah buah buah tube tablet buah buah buah buah buah buah buah tablet tablet gulungan botol botol tablet ampul tablet tablet tablet tablet kapsul kaplet botol kaplet kaplet vial

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

Ampisilin sirup kering 60 ml Antagin injeksi 250 mg / ml Antalgin tablet 500 mg Antasida DOEN II suspensi Antasida DOEN tablet Anti hemoroid suppositoria Anti migrain DOEN tablet Anti parkinson DOEN tablet Antibakteri DOEN komb.Salep(Basitrasin + Polimiksin) Antifungi DOEN salep ( 3 - 6 ) Aqua pro injeksi steril 25 ml Aquadest steril 500 ml Arsuamon tablet Artemether injeksi 1 ml : 80 mg Arterakin tablet Artesunate injeksi Artesunate tablet Asam Asetilsalisilat tablet 100 mg (Asetosal) Asam Asetilsalisilat tablet 500 mg (Asetosal) Asam askorbat tablet 50 mg Asam askorbat tablet 250 mg Asam folat Asam mefenamat tablet 250 mg Asam mefenamat tablet 500 mg Asam traneksamat 500 mg Asam traneksamat injeksi Atenolol tablet 50 mg Atropin sulfat injeksi 0,25 mg/ml Atropin sulfat tablet 0,5 mg Atropin sulfat tetes mata Autoklik Bekarbon (arang aktif) Benzatin benzil penisilin injeksi Besi II tablet salut kombinasi Betahistin Betametason krem 0,1 % Bisoprolol 5 mg Bisturi No. 11 Blood lancet Bromheksin tablet 8 mg Burnazin salep

botol ampul tablet botol tablet suposs tablet tablet Pot Pot vial botol tablet ampul tablet vial tablet tablet tablet tablet tablet tablet tablet tablet tablet ampul tablet ampul tablet botol buah tablet vial tablet tablet tube tablet buah buah tablet tube

0 0 0 0 150 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 28 0 0 10 0 0 0 0 0 0 0 0 0 660 0 2 0 0 0 0 0

73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113

Calsium glukonat 10 mg/ml Captopril 12,5 mg Captopril 25 mg Cat Gram Catgut Chromic No 2/0 Catgut Chromic No 3/0 Catgut Plain No 2/0 Catgut Plain No 3/0 Cetirizine Cimetidine tablet 200 mg Combur test Cover glass Cyprofloxacin tablet 500 mg Dapson tablet Darplex Deksametason injeksi 5 mg/ml Deksametason tablet 0,5 mg Dekstrometorfan syrup Dekstrometrophan tablet 15 mg Dengue blood Devitalisasi pastae non arsen Diasepam injeksi 5 mg/ml Diasepam tablet 2 mg Diasepam tablet 5 mg Dietilkarbamazin tablet Difenhidramin injeksi 10 mg Digoksin tablet Dimenhidrinat tab 50 mg Doksisiklin kapsul 100 mg Domperidon sirup Domperidon tablet 10 mg Efedrin HCl tablet 25 mg Ekstrak Belladona tablet 10mg Epinefrin/adrenalin injeksi 0,1 % Erytromicyn kapsul 250 mg Erytromicyn kapsul 500 mg Erytromicyn suspensi 125 mg/ 5 ml Etakridina larutan 0,1% Etanol 70 % 100 ml Etanol 70% 300 ml Etanol 70 % 1000 ml

ampul tablet tablet paket buah buah buah buah tablet tablet kit buah tablet tablet tablet ampul tablet botol tablet kit botol ampul tablet tablet tablet ampul tablet tablet kapsul botol tablet tablet tablet ampul kapsul kapsul botol botol botol botol botol

0 50 10 0 3 0 5 4 0 0 0 0 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0

114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154

Etanol 96 % 1000 ml Ethil klorida semprot Eugenol cairan F l u o r tablet 0, mg Fenitoin natrium injeksi 50 mg/ml Fenitoin natrium kapsul 30 mg Fenitoin natrium kapsul 100 mg Fenobarbital injeksi 50 mg/ml Fenobarbital tablet 30 mg Fenobarbital tablet 100 mg Fenoksimetil penisilin tablet 250 mg Fenoksimetil penisilin tablet 500 mg Fenolgliserol tetes telinga Fitomenadion (Vit K) injeksi 10 mg/ml Fitomenadion (Vit K1) injeksi 10 mg/ml Fitomenadion (Vit.K1) tablet salut 10 mg Folley cath.10 F Folley cath.14 F Folley cath.16 F Folley cath.18 F Forinokresol (pengganti TKF) Formalin cair Formalin tablet 1 gr Furosemida injeksi Furosemida tablet 40 mg Gameksan lotion 1 % Garam oralit 200 ml air Gentamisin injeksi 40 mg/ml Gentamisin salep kulit 0,1 % Gentian violet larutan Glass Ionomer Cement ART Glibenklamid tablet 5 mg Gliserilguayakolat tablet Gliserin Glukosa injeksi 40 % Glukosa larutan infus 5 % Glukosa larutan infus 10 % Griseofulvin tablet 125 mg Haemocytometer Haemometer Haloperidol tablet 0,5 mg

botol botol botol tablet amp @ 2ml kapsul kapsul ampul tablet tablet tablet tablet botol ampul ampul tablet buah buah buah buah botol botol I ltr tablet ampul tablet botol saset ampul tube botol set/botol tablet tablet botol vial botol botol tablet buah buah tablet

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 65 0 0 0 0 0 0 0 0 0 0 0 0 0 0

155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195

HBSaG HCG Strip Hidrogen peroksida Hidroklorotiasida tablet 25 mg Hidrokortison krem 2,5 % Ibuprofen 100 mg/5 ml suspensi Ibuprofen 200 mg/5 ml suspensi Ibuprofen tablet 200 mg Ibuprofen tablet 400 mg Imersion oil Infus set anak Infus set dewasa Iodin test Iodol kapsul lunak Isosorbid dinitrat tablet 5 mg Jarum dispossible No. 22 ¼ G Jarum dispossible No. 23 ¼ G Jarum jahit/ bedah Kulit No. 9 Jarum jahit/ bedah Kulit No. 10 Jarum jahit/ bedah Kulit No. 11 Jarum jahit/ bedah Kulit No. 12 Jarum jahit/ bedah Kulit No. 13 Jarum jahit/ bedah Kulit No. 14 Jarum jahit/ bedah Otot No. 9 Jarum jahit/ bedah Otot No. 10 Jarum jahit/ bedah Otot No. 11 Jarum jahit/ bedah Otot No. 12 Jarum jahit/ bedah Otot No. 13 Jarum jahit/ bedah Otot No. 14 Jeli USG Kaca slide Kalium permanganat serbuk Kalsium hidroksida pastae Kalsium laktat tablet 500 mg Kapas pembalut absorben 100 gr Kapas pembalut absorben 250 gr Karbamasepin tablet 200 mg Kartu stok Kasa kompres steril 40/40 Kasa pembalut 10 cm Kasa pembalut 4 m x 3 cm

strip strip botol tablet tube botol botol tablet tablet botol set set botol kapsul tablet buah buah pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces jerigen buah tube tube buah roll roll tablet lembar roll roll roll

0 12 0 0 0 5 0 0 0 0 5 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 2 0 0

196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235

Kasa pembalut 4 m x 5 cm Kasa pembalut 4 m x 6 cm Kasa pembalut 40 m x 80 cm Kasa pembalut hidrofil 2 m x 80 cm Kasa pembalut hidrofil 4 m x 10 cm Kasa pembalut hidrofil 4 m x 15 cm Kasa pembalut hidrifil 16 cm x 16 cm Kertas Pulvis Kertas Resep Kertas saring Ketokonazole cream 2% Ketokonazole tablet 200 mg Ketorolac injeksi 10mg/ml Kinina dihidroklorida injeksi 25 % Kinina sulfat tablet 200 mg Kloramfenikol kapsul 250 mg Kloramfenikol sm 1 % Kloramfenikol suspensi Kloramfenikol tetes mata 0,5 % Kloramfenikol tetes telinga 3 % Klorfeniramin maleat tablet 4 mg Klorfenol kamfer menthol (CHKM) Klorokuin injeksi Klorokuin tablet 250 mg Klorpromazin HCl injeksi 25 mg/ml Klorpromazin tablet 25 mg Klorpromazin tablet 100 mg Klorpropamide tablet 100 mg Kodein tablet 10 mg Komb. Pirimet-sulfadoksin tablet Kotrimoksasol suspensi Kotrimoksasol tablet 120 mg Kotrimoksasol tablet 480 mg Larutan Anisol Larutan Asam asetat Larutan Asam sulfosalisilat Larutan Benedicts Larutan EDTA Larutan Eosin 2 % Larutan Giemsa

236

Larutan Hayem

roll

botol

0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 460 0 0 0 0 0 0 0

botol

0

roll roll roll roll roll roll blok blok lembar tube tablet ampul ampul tablet kapsul tube botol botol botol tablet botol ampul tablet ampul tablet tablet tablet tablet tablet botol tablet tablet botol botol botol botol botol botol

237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277

Larutan HCl 0,1 N Larutan Lugol Larutan Natrium sitrat Larutan Rees Ecker Larutan Turk Larutan Ziehl Nelsen Levetran salep Levothyroxin Lidokain injeksi 2 % Lidokain injeksi 2 % (HCl) + Epinefrin 1 : 80.000 - 2 ml Lisol cairan Loratadin tablet Magnesium sulfat injeksi 20 % Magnesium sulfat injeksi 40 % Magnesium sulfat serbuk 30 gram Masker Mebendazol tablet 100 mg Meloksicam 7,5 mg Metformin tablet 500 mg Metilergometrin injeksi 0,200 mg Metilergometrin tablet 0,125 mg Metoklopramide tablet 5 mg Metoklopramide tablet 10 mg Metoklopramide injeksi 5 mg/ml Metoklopramide sirup 5 mg/ml Metronidasol infus Metronidasol tablet 250 mg Metronidasol tablet 500 mg Metylprednisolon Mikonazol salf Mineral mix Monoklorkamfermenthol cairan Morphin Injeksi Mucus section Mummifying pastae Natrium bicarbonat tablet 500 mg Natrium diklofenak tab 25 mg Natrium klorida larutan infus 0,9 % Natrium tiosulfat inj 25% NGT No. 3 NGT No. 3,5

botol botol botol botol botol paket pot tablet ampul ampul botol tablet ampul ampul saset lembar tablet tablet tablet ampul tablet tablet tablet ampul botol botol tablet tablet tablet tube saset botol ampul buah Tube tablet tablet botol ampul pieces pieces

0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 2 0 0 0

278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318

NGT No. 4 NGT NO. 5 NGT NO. 10 NGT NO. 16 NGT NO. 18 Nifedipin tablet 10 mg Nistatin tablet salut 500.000 IU/g Nistatin vaginal tablet 100.000 IU/g Nurse Cup Obat Anti TBC Kategori 2 (sisipan) Obat Anti TBC Kategori Anak Obat Anti TBC Kategori Anak Lanjutan Obat Anti TBC Kategori II FDC Obat batuk hitam Oksitetrasiklin injeksi Oksitetrasiklin s m 1 % Oksitetrasiklin salep kulit 3 % Oksitocyn injeksi 10 IU/ml Omeprasole 20 mg Papaverin injeksi 40 mg/ml Papaverin tablet Parasetamol drops Parasetamol sirup 125 mg/5 ml Parasetamol tablet 100 mg Parasetamol tablet 500 mg Pembalut Gibbs Pethidin injeksi 50 mg/ml Pil KB Kombinasi Pilokarpin HCl tetes mata Piracetam 400 mg Piracetam 800 mg Piracetam injeksi 200 mg/ml Pirantel pamoat tablet 125 mg Piridoksin HCl tablet 10 mg Piroksikam kapsul 20 mg Plastik Obat 8 x 5 cm Plastik Obat 10 x 7 cm Plester 5 yards x 2 inchi Povidon Iodida 10 % 30 ml Povidon Iodida 10 % 60 ml Povidon Iodida 10 % 300 ml

pieces pieces pieces pieces pieces tablet tablet tablet buah paket paket paket paket botol vial Tube Tube ampul Kapsul ampul tablet botol botol tablet tablet buah ampul tablet botol tablet tablet ampul tablet tablet Kapsul bungkus bungkus roll botol botol botol

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 1 0

319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349

Prednison tablet 5 mg Primaquin tablet 15 mg Prokainbenzil penisilin 3 jt IU/vial Propanolol HCl tablet 40 mg Propiltiourasil tablet 100 mg Ranitidin injeksi 50 mg/ml Ranitidin tablet 150 mg Rapid test HIV/AIDS SD Rapid test HIV/AIDS Intec Rapid test HIV/AIDS Oncoprobe Reagen sipilis Reserpina tablet 0,1 mg Retinol 100.000 IU kapsul lunak Retinol 200.000 IU kapsul lunak Ringer laktat larutan infus Salbutamol tablet 2 mg Salbutamol tablet 4 mg Salep 2 - 4 % Salisil bedak 2 % Salisil spiritus 10 % Sarung tangan Ginekologi Sarung tangan No. 6 1/2 Sarung tangan No. 7 Sarung tangan No. 7 1/2 Sarung tangan non steril Save Gloves No. S Save Gloves No. M Save Gloves No. L Selang Karet Anus No. 20 Semen seng serbuk dan cairan Serum Anti Bisa Ular Polivalen Injeksi 50 ml (ABU I)

350 351 352 353 354 355 356 357 358 359

Serum Anti Tetanus Injeksi 1500 IU/amp (ATS)

ampul

Serum Anti Tetanus Injeksi 20.000 IU/amp (ATS) Serum Test Golongan Darah Sianokobalamin 50 mcg Sianokobalamin injeksi Silk/benang bedah sutera No. 2/0 Silk/benang bedah sutera No. 3/0 Silver amalgam serbuk 65 - 75 % Simvastatin tablet 10 mg Simvastatin tablet 20 mg

ampul

tablet tablet vial tablet tablet ampul tablet strip strip strip strip tablet kapsul kapsul botol tablet tablet pot dos botol psg psg psg psg buah psg psg psg buah botol vial

botol tablet ampul buah buah botol tablet tablet

30 0 0 0 0 0 70 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 7 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0

360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392

Sintetic filling material Slide box Spiritus Spironolacton tablet 25 mg Spon gelatin cubicles 1 x 1 x 1 cm Sputum pot Stop TB kategori I Stop TB kategori I & 3 Streptomicyn sulfat injeksi 1500 mg/vial Sulfadimidin tablet 500 mg Sulfazetamid tetes mata Temporary stopping fletcher (fletcher) serbuk dan cairan Tetrakain tetes mata Tetrasiklin kapsul 250 mg Tetrasiklin kapsul 500 mg Thiamin HCl injeksi 100 mg/ml Thiamin HCl tablet 50 mg Tissue lensa Torniquet Tramadol injeksi Tramadol kapsul Transfusi set Triheksifenidil HCl tablet 2 mg Umbilical Cord Klem Under Pad Urine bag Ventolin Vitamin B Kompleks tablet Widal Test Wing Needle No. 23 G Zink Rapid test Malaria VAR

JUMLAH KUNJUNGAN RESEP

buah box botol tablet buah buah paket paket vial tablet botol botol botol kapsul kapsul ampul tablet bungkus buah ampul kapsul buah tablet buah pieces pieces ampul tablet botol buah tablet buah ampul

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 88 0 0 273 17 0

UMUM BAYAR TIDAK BAYAR

MENGETAHUI/MENYETUJUI: KEPALA DINAS KESEHATAN KAB. NAGEKEO,

(…………………………………………………………………..) NIP.

(LPLPO) TAHUN: 2017 PELAPORAN BULAN : JANUARI 2017 PERMINTAAN BULAN : FEBRUARI 2017 PENERIMAAN

PERSEDIAAN

5

6

3 2 2

5 5

200

PEMAKAIAN SISA STOK STOK OPT PERMINTAAN 7

3 11 7 7 0 6 0 0 0 0 0 27 18 0 0 30 0 0 0 0 0 0 0 0 0 0 493 0 0 0 0

2 2

10

150

8 3 11 7 7 0 6 0 0 0 0 0 25 16 0 0 20 0 0 0 0 0 0 0 0 0 0 343 0 0 0 0

9

sa jkn 30

10

100

200

300

4

0 0 0 0 250 0 0 0 0 0 8 0 0 0 0 0 0 0 0 200 28 0 0 310 0 0 0 0 0 0 0 0 0 660 0 6 0 0 0 0 0

60

88

60

300 1

0 0 0 0 190 0 0 0 0 0 8 0 0 0 0 0 0 0 0 112 28 0 0 250 0 0 0 0 0 0 0 0 0 360 0 5 0 0 0 0 0

5 200

0 50 10 0 3 0 5 4 0 0 0 0 100 0 0 5 200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0

100

0 50 10 0 3 0 5 4 0 0 0 0 100 0 0 5 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0

sa apbd 10

100

300

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 165 0 0 0 0 0 300 0 0 0 0 0 0 0 0

10

126

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 155 0 0 0 0 0 174 0 0 0 0 0 0 0 0

jkn sisa 174

5

3

20

0 17 0 0 0 5 0 0 0 0 5 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 22 0 0

2

1

0 15 0 0 0 4 0 0 0 0 5 12 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 22 0 0

2

3

300

10 100

0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 300 0 0 0 0 0 0 0 0 0 17 0 560 0 0 0 0 0 0 0 0

1

120

7 60

0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 7 0 0 0 180 0 0 0 0 0 0 0 0 0 10 0 500 0 0 0 0 0 0 0 0

5

10

2

0 0 0 0 0 0 0 0 11 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 4 0 0 0

0 0 0 0 0 0 0 0 11 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 4 0 0 0

15 400

1

1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 15 0 400 0 0 0 0 0 0 0 20 0 0 0 1 0 0 2 0

7 140

1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 8 0 260 0 0 0 0 0 0 0 20 0 0 0 0 0 0 2 0

6 100

5 3

30 0 0 0 0 0 70 0 0 0 0 0 0 0 7 100 0 0 0 0 0 0 5 10 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0

30 0 0 0 0 0 70 0 0 0 0 0 0 0 7 100 0 0 0 0 0 0 5 10 0 0 0 0 0 0 0

1

0 0 0 0 0 0 0 0 0 0

50

100

2 200

ASKES

0 0 0 0 0 0 0 0 0 0 0 0 0 50 0 8 100 0 0 0 0 0 0 0 0 0 2 288 0 0 273 17 0

4 30

80

16 1

0 0 0 0 0 0 0 0 0 0 0 0 0 50 0 4 70 0 0 0 0 0 0 0 0 0 2 208 0 0 257 16 0

sa 8 apbd

YANG MENYERAHKAN: PETUGAS INSTALASI FARMASI,

(……………………………………………………………..) NIP.

YANG MEMINTA/ MELA

(

MAGUS HILARIUS NIP.19631231 200012

BULAN: DESEMBER 2016

APBD IIBUFFER PROGRAM DEPKES ASKES JUMLAH KET LAIN 11

12

13

14

15

16

17

………………………………., 2014

YANG MEMINTA/ MELAPORKAN: YANG MENERIMA: KEPALA PUSKESMAS, PETUGAS PUSKESMAS,

(

MAGUS HILARIUS ) NIP.19631231 200012 1 029

( FATMAWATI ) NIP.19820424 200904 2 014

PUSKESMAS : NANGARORO KABUPATEN : NAGEKEO POSKESDES : ULUPULU

NO.

NAMA JENIS OBAT

SATUAN

STOK AWAL

1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

2

3

4 3 11 7 7 0 6 0 0 0 0 0 25 16 0 0 20 0 0 0 0 0 0 0 0 0 0 343 0 0 0 0 0 0 0

Abocath No 18 Abocath No 20 Abocath No 22 Abocath No 24 Abocath No 26 Aciclovir salep kulit Aciclovir tablet 400 mg Alat suntik sekali pakai 1 ml Alat suntik sekali pakai 10 ml Alat suntik sekali pakai 2,5 ml Alat suntik sekali pakai 20 ml Alat suntik sekali pakai 3 ml Alat suntik sekali pakai 5 ml Alat suntik sekali pakai 50 ml Albendazole tablet 400 mg Alopurinol tablet 100 mg Aluminium foil Amalgam serbuk 65-75 % Ambroxol sirup 15 mg/ml Ambroxol tablet 30 mg Aminofilin injeksi Aminofilin tablet 200 mg Amitriptilin tablet 25 mg Amlodipin 5 mg Amlodipin 10 mg Amoksisilin kapsul 250 mg Amoksisilin kaplet 500 mg Amoksisilin sirup kering 125 mg/5 ml Ampisilin kaplet 250 mg Ampisilin kaplet 500 mg Ampisilin serbuk injeksi 1.000 mg Ampisilin sirup kering 60 ml Antagin injeksi 250 mg / ml Antalgin tablet 500 mg

buah buah buah buah buah tube tablet buah buah buah buah buah buah buah tablet tablet gulungan botol botol tablet ampul tablet tablet tablet tablet kapsul kaplet botol kaplet kaplet vial botol ampul tablet

35 36 37 38 39 40 41 42 43 44 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 75 76 77 78

Antasida DOEN II suspensi Antasida DOEN tablet Anti hemoroid suppositoria Anti migrain DOEN tablet Anti parkinson DOEN tablet Antibakteri DOEN komb.Salep(Basitrasin + Polimiksin) Antifungi DOEN salep ( 3 - 6 ) Aqua pro injeksi steril 25 ml Aquadest steril 500 ml Arsuamon tablet Artemether injeksi 1 ml : 80 mg Arterakin tablet Artesunate injeksi Artesunate tablet Asam Asetilsalisilat tablet 100 mg (Asetosal) Asam Asetilsalisilat tablet 500 mg (Asetosal) Asam askorbat tablet 50 mg Asam askorbat tablet 250 mg Asam folat Asam mefenamat tablet 250 mg Asam mefenamat tablet 500 mg Asam traneksamat 500 mg Asam traneksamat injeksi Atenolol tablet 50 mg Atropin sulfat injeksi 0,25 mg/ml Atropin sulfat tablet 0,5 mg Atropin sulfat tetes mata Autoklik Bekarbon (arang aktif) Benzatin benzil penisilin injeksi Besi II tablet salut kombinasi Betahistin Betametason krem 0,1 % Bisoprolol 5 mg Bisturi No. 11 Blood lancet Bromheksin tablet 8 mg Burnazin salep Calsium glukonat 10 mg/ml Captopril 12,5 mg Captopril 25 mg Cat Gram Catgut Chromic No 2/0 Catgut Chromic No 3/0

botol tablet suposs tablet tablet Pot Pot vial botol tablet ampul tablet vial tablet tablet tablet tablet tablet tablet tablet tablet tablet ampul tablet ampul tablet botol buah tablet vial tablet tablet tube tablet buah buah tablet tube ampul tablet tablet paket buah buah

0 190 0 0 0 0 0 8 0 0 0 0 0 0 0 0 112 28 0 0 250 0 0 0 0 0 0 0 0 0 360 0 5 0 0 0 0 0 0 50 10 0 3 0

79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122

Catgut Plain No 2/0 Catgut Plain No 3/0 Cetirizine Cimetidine tablet 200 mg Combur test Cover glass Cyprofloxacin tablet 500 mg Dapson tablet Darplex Deksametason injeksi 5 mg/ml Deksametason tablet 0,5 mg Dekstrometorfan syrup Dekstrometrophan tablet 15 mg Dengue blood Devitalisasi pastae non arsen Diasepam injeksi 5 mg/ml Diasepam tablet 2 mg Diasepam tablet 5 mg Dietilkarbamazin tablet Difenhidramin injeksi 10 mg Digoksin tablet Dimenhidrinat tab 50 mg Doksisiklin kapsul 100 mg Domperidon sirup Domperidon tablet 10 mg Efedrin HCl tablet 25 mg Ekstrak Belladona tablet 10mg Epinefrin/adrenalin injeksi 0,1 % Erytromicyn kapsul 250 mg Erytromicyn kapsul 500 mg Erytromicyn suspensi 125 mg/ 5 ml Etakridina larutan 0,1% Etanol 70 % 100 ml Etanol 70% 300 ml Etanol 70 % 1000 ml Etanol 96 % 1000 ml Ethil klorida semprot Eugenol cairan F l u o r tablet 0, mg Fenitoin natrium injeksi 50 mg/ml Fenitoin natrium kapsul 30 mg Fenitoin natrium kapsul 100 mg Fenobarbital injeksi 50 mg/ml Fenobarbital tablet 30 mg

buah buah tablet tablet kit buah tablet tablet tablet ampul tablet botol tablet kit botol ampul tablet tablet tablet ampul tablet tablet kapsul botol tablet tablet tablet ampul kapsul kapsul botol botol botol botol botol botol botol botol tablet amp @ 2ml kapsul kapsul ampul tablet

5 4 0 0 0 0 100 0 0 5 100 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0

123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166

Fenobarbital tablet 100 mg Fenoksimetil penisilin tablet 250 mg Fenoksimetil penisilin tablet 500 mg Fenolgliserol tetes telinga Fitomenadion (Vit K) injeksi 10 mg/ml Fitomenadion (Vit K1) injeksi 10 mg/ml Fitomenadion (Vit.K1) tablet salut 10 mg Folley cath.10 F Folley cath.14 F Folley cath.16 F Folley cath.18 F Forinokresol (pengganti TKF) Formalin cair Formalin tablet 1 gr Furosemida injeksi Furosemida tablet 40 mg Gameksan lotion 1 % Garam oralit 200 ml air Gentamisin injeksi 40 mg/ml Gentamisin salep kulit 0,1 % Gentian violet larutan Glass Ionomer Cement ART Glibenklamid tablet 5 mg Gliserilguayakolat tablet Gliserin Glukosa injeksi 40 % Glukosa larutan infus 5 % Glukosa larutan infus 10 % Griseofulvin tablet 125 mg Haemocytometer Haemometer Haloperidol tablet 0,5 mg HBSaG HCG Strip Hidrogen peroksida Hidroklorotiasida tablet 25 mg Hidrokortison krem 2,5 % Ibuprofen 100 mg/5 ml suspensi Ibuprofen 200 mg/5 ml suspensi Ibuprofen tablet 200 mg Ibuprofen tablet 400 mg Imersion oil Infus set anak Infus set dewasa

tablet tablet tablet botol ampul ampul tablet buah buah buah buah botol botol I ltr tablet ampul tablet botol saset ampul tube botol set/botol tablet tablet botol vial botol botol tablet buah buah tablet strip strip botol tablet tube botol botol tablet tablet botol set set

0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 155 0 0 0 0 0 174 0 0 0 0 0 0 0 0 0 15 0 0 0 4 0 0 0 0 5 12

167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 197 198 199 200 201 202 203 204 205 206 207 208 209 210

Iodin test Iodol kapsul lunak Isosorbid dinitrat tablet 5 mg Jarum dispossible No. 22 ¼ G Jarum dispossible No. 23 ¼ G Jarum jahit/ bedah Kulit No. 9 Jarum jahit/ bedah Kulit No. 10 Jarum jahit/ bedah Kulit No. 11 Jarum jahit/ bedah Kulit No. 12 Jarum jahit/ bedah Kulit No. 13 Jarum jahit/ bedah Kulit No. 14 Jarum jahit/ bedah Otot No. 9 Jarum jahit/ bedah Otot No. 10 Jarum jahit/ bedah Otot No. 11 Jarum jahit/ bedah Otot No. 12 Jarum jahit/ bedah Otot No. 13 Jarum jahit/ bedah Otot No. 14 Jeli USG Kaca slide Kalium permanganat serbuk Kalsium hidroksida pastae Kalsium laktat tablet 500 mg Kapas pembalut absorben 100 gr Kapas pembalut absorben 250 gr Karbamasepin tablet 200 mg Kartu stok Kasa kompres steril 40/40 Kasa pembalut 10 cm Kasa pembalut 4 m x 3 cm Kasa pembalut 4 m x 5 cm Kasa pembalut 4 m x 6 cm Kasa pembalut 40 m x 80 cm Kasa pembalut hidrofil 2 m x 80 cm Kasa pembalut hidrofil 4 m x 10 cm Kasa pembalut hidrofil 4 m x 15 cm Kasa pembalut hidrifil 16 cm x 16 cm Kertas Pulvis Kertas Resep Kertas saring Ketokonazole cream 2% Ketokonazole tablet 200 mg Ketorolac injeksi 10mg/ml Kinina dihidroklorida injeksi 25 % Kinina sulfat tablet 200 mg

botol kapsul tablet buah buah pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces jerigen buah tube tube buah roll roll tablet lembar roll roll roll roll roll roll roll roll roll roll blok blok lembar tube tablet ampul ampul tablet

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 22 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0

211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235

Kloramfenikol kapsul 250 mg Kloramfenikol sm 1 % Kloramfenikol suspensi Kloramfenikol tetes mata 0,5 % Kloramfenikol tetes telinga 3 % Klorfeniramin maleat tablet 4 mg Klorfenol kamfer menthol (CHKM) Klorokuin injeksi Klorokuin tablet 250 mg Klorpromazin HCl injeksi 25 mg/ml Klorpromazin tablet 25 mg Klorpromazin tablet 100 mg Klorpropamide tablet 100 mg Kodein tablet 10 mg Komb. Pirimet-sulfadoksin tablet Kotrimoksasol suspensi Kotrimoksasol tablet 120 mg Kotrimoksasol tablet 480 mg Larutan Anisol Larutan Asam asetat Larutan Asam sulfosalisilat Larutan Benedicts Larutan EDTA Larutan Eosin 2 % Larutan Giemsa

236 237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254

Larutan Hayem

botol

Larutan HCl 0,1 N Larutan Lugol Larutan Natrium sitrat Larutan Rees Ecker Larutan Turk Larutan Ziehl Nelsen Levetran salep Levothyroxin Lidokain injeksi 2 % Lidokain injeksi 2 % (HCl) + Epinefrin 1 : 80.000 - 2 ml Lisol cairan Loratadin tablet Magnesium sulfat injeksi 20 % Magnesium sulfat injeksi 40 % Magnesium sulfat serbuk 30 gram Masker Mebendazol tablet 100 mg Meloksicam 7,5 mg

botol

kapsul tube botol botol botol tablet botol ampul tablet ampul tablet tablet tablet tablet tablet botol tablet tablet botol botol botol botol botol botol botol

botol botol botol botol paket pot tablet ampul ampul botol tablet ampul ampul saset lembar tablet tablet

0 7 0 0 0 180 0 0 0 0 0 0 0 0 0 10 0 500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 0 0 0 0 0 0 10 0 0

255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298

Metformin tablet 500 mg Metilergometrin injeksi 0,200 mg Metilergometrin tablet 0,125 mg Metoklopramide tablet 5 mg Metoklopramide tablet 10 mg Metoklopramide injeksi 5 mg/ml Metoklopramide sirup 5 mg/ml Metronidasol infus Metronidasol tablet 250 mg Metronidasol tablet 500 mg Metylprednisolon Mikonazol salf Mineral mix Monoklorkamfermenthol cairan Morphin Injeksi Mucus section Mummifying pastae Natrium bicarbonat tablet 500 mg Natrium diklofenak tab 25 mg Natrium klorida larutan infus 0,9 % Natrium tiosulfat inj 25% NGT No. 3 NGT No. 3,5 NGT No. 4 NGT NO. 5 NGT NO. 10 NGT NO. 16 NGT NO. 18 Nifedipin tablet 10 mg Nistatin tablet salut 500.000 IU/g Nistatin vaginal tablet 100.000 IU/g Nurse Cup Obat Anti TBC Kategori 2 (sisipan) Obat Anti TBC Kategori Anak Obat Anti TBC Kategori Anak Lanjutan Obat Anti TBC Kategori II FDC Obat batuk hitam Oksitetrasiklin injeksi Oksitetrasiklin s m 1 % Oksitetrasiklin salep kulit 3 % Oksitocyn injeksi 10 IU/ml Omeprasole 20 mg Papaverin injeksi 40 mg/ml Papaverin tablet

tablet ampul tablet tablet tablet ampul botol botol tablet tablet tablet tube saset botol ampul buah Tube tablet tablet botol ampul pieces pieces pieces pieces pieces pieces pieces tablet tablet tablet buah paket paket paket paket botol vial Tube Tube ampul Kapsul ampul tablet

0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0

299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342

Parasetamol drops Parasetamol sirup 125 mg/5 ml Parasetamol tablet 100 mg Parasetamol tablet 500 mg Pembalut Gibbs Pethidin injeksi 50 mg/ml Pil KB Kombinasi Pilokarpin HCl tetes mata Piracetam 400 mg Piracetam 800 mg Piracetam injeksi 200 mg/ml Pirantel pamoat tablet 125 mg Piridoksin HCl tablet 10 mg Piroksikam kapsul 20 mg Plastik Obat 8 x 5 cm Plastik Obat 10 x 7 cm Plester 5 yards x 2 inchi Povidon Iodida 10 % 30 ml Povidon Iodida 10 % 60 ml Povidon Iodida 10 % 300 ml Prednison tablet 5 mg Primaquin tablet 15 mg Prokainbenzil penisilin 3 jt IU/vial Propanolol HCl tablet 40 mg Propiltiourasil tablet 100 mg Ranitidin injeksi 50 mg/ml Ranitidin tablet 150 mg Rapid test HIV/AIDS SD Rapid test HIV/AIDS Intec Rapid test HIV/AIDS Oncoprobe Reagen sipilis Reserpina tablet 0,1 mg Retinol 100.000 IU kapsul lunak Retinol 200.000 IU kapsul lunak Ringer laktat larutan infus Salbutamol tablet 2 mg Salbutamol tablet 4 mg Salep 2 - 4 % Salisil bedak 2 % Salisil spiritus 10 % Sarung tangan Ginekologi Sarung tangan No. 6 1/2 Sarung tangan No. 7 Sarung tangan No. 7 1/2

botol botol tablet tablet buah ampul tablet botol tablet tablet ampul tablet tablet Kapsul bungkus bungkus roll botol botol botol tablet tablet vial tablet tablet ampul tablet strip strip strip strip tablet kapsul kapsul botol tablet tablet pot dos botol psg psg psg psg

0 8 0 260 0 0 0 0 0 0 0 20 0 0 0 0 0 0 2 0 30 0 0 0 0 0 70 0 0 0 0 0 0 0 7 100 0 0 0 0 0 0 5 10

343 344 345 346 347 348 349

Sarung tangan non steril Save Gloves No. S Save Gloves No. M Save Gloves No. L Selang Karet Anus No. 20 Semen seng serbuk dan cairan Serum Anti Bisa Ular Polivalen Injeksi 50 ml (ABU I)

buah

350 351 352 353 354 355 356 357 358

Serum Anti Tetanus Injeksi 1500 IU/amp (ATS)

ampul

Serum Anti Tetanus Injeksi 20.000 IU/amp (ATS) Serum Test Golongan Darah Sianokobalamin 50 mcg Sianokobalamin injeksi Silk/benang bedah sutera No. 2/0 Silk/benang bedah sutera No. 3/0 Silver amalgam serbuk 65 - 75 % Simvastatin tablet 10 mg Simvastatin tablet 20 mg Sintetic filling material Slide box Spiritus Spironolacton tablet 25 mg Spon gelatin cubicles 1 x 1 x 1 cm Sputum pot Stop TB kategori I Stop TB kategori I & 3 Streptomicyn sulfat injeksi 1500 mg/vial Sulfadimidin tablet 500 mg Sulfazetamid tetes mata Temporary stopping fletcher (fletcher) serbuk dan cairan Tetrakain tetes mata Tetrasiklin kapsul 250 mg Tetrasiklin kapsul 500 mg Thiamin HCl injeksi 100 mg/ml Thiamin HCl tablet 50 mg Tissue lensa Torniquet Tramadol injeksi Tramadol kapsul Transfusi set Triheksifenidil HCl tablet 2 mg Umbilical Cord Klem Under Pad Urine bag Ventolin

ampul

359 360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386

psg psg psg buah botol vial

botol tablet ampul buah buah botol tablet tablet buah box botol tablet buah buah paket paket vial tablet botol botol botol kapsul kapsul ampul tablet bungkus buah ampul kapsul buah tablet buah pieces pieces ampul

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 0 4 70 0 0 0 0 0 0 0 0 0 2

387 388 389 390 391 392

Vitamin B Kompleks tablet Widal Test Wing Needle No. 23 G Zink Rapid test Malaria VAR

JUMLAH KUNJUNGAN RESEP

tablet botol buah tablet buah ampul

208 0 0 257 16 0

UMUM BAYAR TIDAK BAYAR

MENGETAHUI/MENYETUJUI: KEPALA DINAS KESEHATAN KAB. NAGEKEO,

(…………………………………………………………………..) NIP.

(LPLPO) TAHUN: 2017 PELAPORAN BULAN : FEBRUARI 2017 PERMINTAAN BULAN : MARET 2017 PENERIMAAN

PERSEDIAAN

5

6

5 5

200

PEMAKAIAN SISA STOK STOK OPT 7

3 11 7 7 0 6 0 0 0 0 0 30 21 0 0 20 0 0 0 0 0 0 0 0 0 0 543 0 0 0 0 0 0 0

1 1

7 3

20

450

8 3 11 6 6 0 6 0 0 0 0 0 23 18 0 0 0 0 0 0 0 0 0 0 0 0 0 93 0 0 0 0 0 0 0

9

5 100

100

100

270

100

5 290 0 0 0 0 0 8 0 0 0 0 0 0 0 0 212 28 0 0 350 0 0 0 0 0 0 0 0 0 630 0 5 0 0 0 0 0 0 50 110 0 3 0

30

212 28

350

150 3

20 10 1

5 260 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 480 0 2 0 0 0 0 0 0 30 100 0 2 0

jkn sisa 100

100

5 4 0 0 0 0 100 0 0 5 200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0

2 1

190

3

3 3 0 0 0 0 100 0 0 5 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

200

5

0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 155 0 0 0 0 0 374 0 0 0 0 0 0 0 0 0 20 0 0 0 4 0 0 0 0 5 12

18

314

2

1

0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 137 0 0 0 0 0 60 0 0 0 0 0 0 0 0 0 18 0 0 0 4 0 0 0 0 5 11

sisa apbd 60

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 22 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0

2

1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 20 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 0

200

5 100

0 7 0 0 0 380 0 0 0 0 0 0 0 0 0 15 0 600 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11 0 0 0 0 0 0 10 0 0

4

380

13 300

10

2

0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 300 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 8 0 0

0 0 0 0 0 0 0 0 50 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0

50

2

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0

10 200

10

1

2

0 18 0 460 0 0 0 0 0 0 0 30 0 0 0 1 0 0 2 0 30 0 0 0 0 0 70 0 0 0 0 0 0 0 7 100 0 0 0 0 0 0 5 12

13 360

1

1

2

2 8

0 5 0 100 0 0 0 0 0 0 0 30 0 0 0 0 0 0 1 0 30 0 0 0 0 0 70 0 0 0 0 0 0 0 5 100 0 0 0 0 0 0 3 4

5 50

0 0 0 0 0 0 0

0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 50 0 9 120 0 0 0 0 0 0 0 0 0 2

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 60 0 0 0 0 0 0 0 0 0 2

50 6 60

jkn sisa 3

100

308 0 0 257 16 0

308

40 2

ASKES

YANG MENYERAHKAN: PETUGAS INSTALASI FARMASI,

(……………………………………………………………..) NIP.

0 0 0 217 14 0

BULAN: DESEMBER 2016

PERMINTAANAPBD IIBUFFER PROGRAM DEPKES ASKES JUMLAH KET LAIN 10

11

12

13

14

15

16

17

………………………………., 2014 YANG MEMINTA/ MELAPORKAN: YANG MENERIMA: KEPALA PUSKESMAS, PETUGAS PUSKESMAS,

(

MAGUS HILARIUS ) NIP.19631231 200012 1 029

( FATMAWATI ) NIP.19820424 200904 2 014

PUSKESMAS : NANGARORO KABUPATEN : NAGEKEO POSKESDES : ULUPULU

NO.

NAMA JENIS OBAT

SATUAN

STOK AWAL

1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

2

3

4 3 11 6 6 0 6 0 0 0 0 0 23 18 0 0 0 0 0 0 0 0 0 0 0 0 0 93 0 0 0 0

Abocath No 18 Abocath No 20 Abocath No 22 Abocath No 24 Abocath No 26 Aciclovir salep kulit Aciclovir tablet 400 mg Alat suntik sekali pakai 1 ml Alat suntik sekali pakai 10 ml Alat suntik sekali pakai 2,5 ml Alat suntik sekali pakai 20 ml Alat suntik sekali pakai 3 ml Alat suntik sekali pakai 5 ml Alat suntik sekali pakai 50 ml Albendazole tablet 400 mg Alopurinol tablet 100 mg Aluminium foil Amalgam serbuk 65-75 % Ambroxol sirup 15 mg/ml Ambroxol tablet 30 mg Aminofilin injeksi Aminofilin tablet 200 mg Amitriptilin tablet 25 mg Amlodipin 5 mg Amlodipin 10 mg Amoksisilin kapsul 250 mg Amoksisilin kaplet 500 mg Amoksisilin sirup kering 125 mg/5 ml Ampisilin kaplet 250 mg Ampisilin kaplet 500 mg Ampisilin serbuk injeksi 1.000 mg

buah buah buah buah buah tube tablet buah buah buah buah buah buah buah tablet tablet gulungan botol botol tablet ampul tablet tablet tablet tablet kapsul kaplet botol kaplet kaplet vial

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

Ampisilin sirup kering 60 ml Antagin injeksi 250 mg / ml Antalgin tablet 500 mg Antasida DOEN II suspensi Antasida DOEN tablet Anti hemoroid suppositoria Anti migrain DOEN tablet Anti parkinson DOEN tablet Antibakteri DOEN komb.Salep(Basitrasin + Polimiksin) Antifungi DOEN salep ( 3 - 6 ) Aqua pro injeksi steril 25 ml Aquadest steril 500 ml Arsuamon tablet Artemether injeksi 1 ml : 80 mg Arterakin tablet Artesunate injeksi Artesunate tablet Asam Asetilsalisilat tablet 100 mg (Asetosal) Asam Asetilsalisilat tablet 500 mg (Asetosal) Asam askorbat tablet 50 mg Asam askorbat tablet 250 mg Asam folat Asam mefenamat tablet 250 mg Asam mefenamat tablet 500 mg Asam traneksamat 500 mg Asam traneksamat injeksi Atenolol tablet 50 mg Atropin sulfat injeksi 0,25 mg/ml Atropin sulfat tablet 0,5 mg Atropin sulfat tetes mata Autoklik Bekarbon (arang aktif) Benzatin benzil penisilin injeksi Besi II tablet salut kombinasi Betahistin Betametason krem 0,1 % Bisoprolol 5 mg Bisturi No. 11 Blood lancet Bromheksin tablet 8 mg Burnazin salep

botol ampul tablet botol tablet suposs tablet tablet Pot Pot vial botol tablet ampul tablet vial tablet tablet tablet tablet tablet tablet tablet tablet tablet ampul tablet ampul tablet botol buah tablet vial tablet tablet tube tablet buah buah tablet tube

0 0 0 5 260 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 480 0 2 0 0 0 0 0

73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113

Calsium glukonat 10 mg/ml Captopril 12,5 mg Captopril 25 mg Cat Gram Catgut Chromic No 2/0 Catgut Chromic No 3/0 Catgut Plain No 2/0 Catgut Plain No 3/0 Cetirizine Cimetidine tablet 200 mg Combur test Cover glass Cyprofloxacin tablet 500 mg Dapson tablet Darplex Deksametason injeksi 5 mg/ml Deksametason tablet 0,5 mg Dekstrometorfan syrup Dekstrometrophan tablet 15 mg Dengue blood Devitalisasi pastae non arsen Diasepam injeksi 5 mg/ml Diasepam tablet 2 mg Diasepam tablet 5 mg Dietilkarbamazin tablet Difenhidramin injeksi 10 mg Digoksin tablet Dimenhidrinat tab 50 mg Doksisiklin kapsul 100 mg Domperidon sirup Domperidon tablet 10 mg Efedrin HCl tablet 25 mg Ekstrak Belladona tablet 10mg Epinefrin/adrenalin injeksi 0,1 % Erytromicyn kapsul 250 mg Erytromicyn kapsul 500 mg Erytromicyn suspensi 125 mg/ 5 ml Etakridina larutan 0,1% Etanol 70 % 100 ml Etanol 70% 300 ml Etanol 70 % 1000 ml

ampul tablet tablet paket buah buah buah buah tablet tablet kit buah tablet tablet tablet ampul tablet botol tablet kit botol ampul tablet tablet tablet ampul tablet tablet kapsul botol tablet tablet tablet ampul kapsul kapsul botol botol botol botol botol

0 30 100 0 2 0 3 3 0 0 0 0 100 0 0 5 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154

Etanol 96 % 1000 ml Ethil klorida semprot Eugenol cairan F l u o r tablet 0, mg Fenitoin natrium injeksi 50 mg/ml Fenitoin natrium kapsul 30 mg Fenitoin natrium kapsul 100 mg Fenobarbital injeksi 50 mg/ml Fenobarbital tablet 30 mg Fenobarbital tablet 100 mg Fenoksimetil penisilin tablet 250 mg Fenoksimetil penisilin tablet 500 mg Fenolgliserol tetes telinga Fitomenadion (Vit K) injeksi 10 mg/ml Fitomenadion (Vit K1) injeksi 10 mg/ml Fitomenadion (Vit.K1) tablet salut 10 mg Folley cath.10 F Folley cath.14 F Folley cath.16 F Folley cath.18 F Forinokresol (pengganti TKF) Formalin cair Formalin tablet 1 gr Furosemida injeksi Furosemida tablet 40 mg Gameksan lotion 1 % Garam oralit 200 ml air Gentamisin injeksi 40 mg/ml Gentamisin salep kulit 0,1 % Gentian violet larutan Glass Ionomer Cement ART Glibenklamid tablet 5 mg Gliserilguayakolat tablet Gliserin Glukosa injeksi 40 % Glukosa larutan infus 5 % Glukosa larutan infus 10 % Griseofulvin tablet 125 mg Haemocytometer Haemometer Haloperidol tablet 0,5 mg

botol botol botol tablet amp @ 2ml kapsul kapsul ampul tablet tablet tablet tablet botol ampul ampul tablet buah buah buah buah botol botol I ltr tablet ampul tablet botol saset ampul tube botol set/botol tablet tablet botol vial botol botol tablet buah buah tablet

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 137 0 0 0 0 0 60 0 0 0 0 0 0 0 0

155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195

HBSaG HCG Strip Hidrogen peroksida Hidroklorotiasida tablet 25 mg Hidrokortison krem 2,5 % Ibuprofen 100 mg/5 ml suspensi Ibuprofen 200 mg/5 ml suspensi Ibuprofen tablet 200 mg Ibuprofen tablet 400 mg Imersion oil Infus set anak Infus set dewasa Iodin test Iodol kapsul lunak Isosorbid dinitrat tablet 5 mg Jarum dispossible No. 22 ¼ G Jarum dispossible No. 23 ¼ G Jarum jahit/ bedah Kulit No. 9 Jarum jahit/ bedah Kulit No. 10 Jarum jahit/ bedah Kulit No. 11 Jarum jahit/ bedah Kulit No. 12 Jarum jahit/ bedah Kulit No. 13 Jarum jahit/ bedah Kulit No. 14 Jarum jahit/ bedah Otot No. 9 Jarum jahit/ bedah Otot No. 10 Jarum jahit/ bedah Otot No. 11 Jarum jahit/ bedah Otot No. 12 Jarum jahit/ bedah Otot No. 13 Jarum jahit/ bedah Otot No. 14 Jeli USG Kaca slide Kalium permanganat serbuk Kalsium hidroksida pastae Kalsium laktat tablet 500 mg Kapas pembalut absorben 100 gr Kapas pembalut absorben 250 gr Karbamasepin tablet 200 mg Kartu stok Kasa kompres steril 40/40 Kasa pembalut 10 cm Kasa pembalut 4 m x 3 cm

strip strip botol tablet tube botol botol tablet tablet botol set set botol kapsul tablet buah buah pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces jerigen buah tube tube buah roll roll tablet lembar roll roll roll

0 18 0 0 0 4 0 0 0 0 5 11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 20 0 0

196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235

Kasa pembalut 4 m x 5 cm Kasa pembalut 4 m x 6 cm Kasa pembalut 40 m x 80 cm Kasa pembalut hidrofil 2 m x 80 cm Kasa pembalut hidrofil 4 m x 10 cm Kasa pembalut hidrofil 4 m x 15 cm Kasa pembalut hidrifil 16 cm x 16 cm Kertas Pulvis Kertas Resep Kertas saring Ketokonazole cream 2% Ketokonazole tablet 200 mg Ketorolac injeksi 10mg/ml Kinina dihidroklorida injeksi 25 % Kinina sulfat tablet 200 mg Kloramfenikol kapsul 250 mg Kloramfenikol sm 1 % Kloramfenikol suspensi Kloramfenikol tetes mata 0,5 % Kloramfenikol tetes telinga 3 % Klorfeniramin maleat tablet 4 mg Klorfenol kamfer menthol (CHKM) Klorokuin injeksi Klorokuin tablet 250 mg Klorpromazin HCl injeksi 25 mg/ml Klorpromazin tablet 25 mg Klorpromazin tablet 100 mg Klorpropamide tablet 100 mg Kodein tablet 10 mg Komb. Pirimet-sulfadoksin tablet Kotrimoksasol suspensi Kotrimoksasol tablet 120 mg Kotrimoksasol tablet 480 mg Larutan Anisol Larutan Asam asetat Larutan Asam sulfosalisilat Larutan Benedicts Larutan EDTA Larutan Eosin 2 % Larutan Giemsa

236

Larutan Hayem

roll

botol

0 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 300 0 0 0 0 0 0 0

botol

0

roll roll roll roll roll roll blok blok lembar tube tablet ampul ampul tablet kapsul tube botol botol botol tablet botol ampul tablet ampul tablet tablet tablet tablet tablet botol tablet tablet botol botol botol botol botol botol

237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277

Larutan HCl 0,1 N Larutan Lugol Larutan Natrium sitrat Larutan Rees Ecker Larutan Turk Larutan Ziehl Nelsen Levetran salep Levothyroxin Lidokain injeksi 2 % Lidokain injeksi 2 % (HCl) + Epinefrin 1 : 80.000 - 2 ml Lisol cairan Loratadin tablet Magnesium sulfat injeksi 20 % Magnesium sulfat injeksi 40 % Magnesium sulfat serbuk 30 gram Masker Mebendazol tablet 100 mg Meloksicam 7,5 mg Metformin tablet 500 mg Metilergometrin injeksi 0,200 mg Metilergometrin tablet 0,125 mg Metoklopramide tablet 5 mg Metoklopramide tablet 10 mg Metoklopramide injeksi 5 mg/ml Metoklopramide sirup 5 mg/ml Metronidasol infus Metronidasol tablet 250 mg Metronidasol tablet 500 mg Metylprednisolon Mikonazol salf Mineral mix Monoklorkamfermenthol cairan Morphin Injeksi Mucus section Mummifying pastae Natrium bicarbonat tablet 500 mg Natrium diklofenak tab 25 mg Natrium klorida larutan infus 0,9 % Natrium tiosulfat inj 25% NGT No. 3 NGT No. 3,5

botol botol botol botol botol paket pot tablet ampul ampul botol tablet ampul ampul saset lembar tablet tablet tablet ampul tablet tablet tablet ampul botol botol tablet tablet tablet tube saset botol ampul buah Tube tablet tablet botol ampul pieces pieces

0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0

278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318

NGT No. 4 NGT NO. 5 NGT NO. 10 NGT NO. 16 NGT NO. 18 Nifedipin tablet 10 mg Nistatin tablet salut 500.000 IU/g Nistatin vaginal tablet 100.000 IU/g Nurse Cup Obat Anti TBC Kategori 2 (sisipan) Obat Anti TBC Kategori Anak Obat Anti TBC Kategori Anak Lanjutan Obat Anti TBC Kategori II FDC Obat batuk hitam Oksitetrasiklin injeksi Oksitetrasiklin s m 1 % Oksitetrasiklin salep kulit 3 % Oksitocyn injeksi 10 IU/ml Omeprasole 20 mg Papaverin injeksi 40 mg/ml Papaverin tablet Parasetamol drops Parasetamol sirup 125 mg/5 ml Parasetamol tablet 100 mg Parasetamol tablet 500 mg Pembalut Gibbs Pethidin injeksi 50 mg/ml Pil KB Kombinasi Pilokarpin HCl tetes mata Piracetam 400 mg Piracetam 800 mg Piracetam injeksi 200 mg/ml Pirantel pamoat tablet 125 mg Piridoksin HCl tablet 10 mg Piroksikam kapsul 20 mg Plastik Obat 8 x 5 cm Plastik Obat 10 x 7 cm Plester 5 yards x 2 inchi Povidon Iodida 10 % 30 ml Povidon Iodida 10 % 60 ml Povidon Iodida 10 % 300 ml

pieces pieces pieces pieces pieces tablet tablet tablet buah paket paket paket paket botol vial Tube Tube ampul Kapsul ampul tablet botol botol tablet tablet buah ampul tablet botol tablet tablet ampul tablet tablet Kapsul bungkus bungkus roll botol botol botol

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 5 0 100 0 0 0 0 0 0 0 30 0 0 0 0 0 0 1 0

319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349

Prednison tablet 5 mg Primaquin tablet 15 mg Prokainbenzil penisilin 3 jt IU/vial Propanolol HCl tablet 40 mg Propiltiourasil tablet 100 mg Ranitidin injeksi 50 mg/ml Ranitidin tablet 150 mg Rapid test HIV/AIDS SD Rapid test HIV/AIDS Intec Rapid test HIV/AIDS Oncoprobe Reagen sipilis Reserpina tablet 0,1 mg Retinol 100.000 IU kapsul lunak Retinol 200.000 IU kapsul lunak Ringer laktat larutan infus Salbutamol tablet 2 mg Salbutamol tablet 4 mg Salep 2 - 4 % Salisil bedak 2 % Salisil spiritus 10 % Sarung tangan Ginekologi Sarung tangan No. 6 1/2 Sarung tangan No. 7 Sarung tangan No. 7 1/2 Sarung tangan non steril Save Gloves No. S Save Gloves No. M Save Gloves No. L Selang Karet Anus No. 20 Semen seng serbuk dan cairan Serum Anti Bisa Ular Polivalen Injeksi 50 ml (ABU I)

350 351 352 353 354 355 356 357 358 359

Serum Anti Tetanus Injeksi 1500 IU/amp (ATS)

ampul

Serum Anti Tetanus Injeksi 20.000 IU/amp (ATS) Serum Test Golongan Darah Sianokobalamin 50 mcg Sianokobalamin injeksi Silk/benang bedah sutera No. 2/0 Silk/benang bedah sutera No. 3/0 Silver amalgam serbuk 65 - 75 % Simvastatin tablet 10 mg Simvastatin tablet 20 mg

ampul

tablet tablet vial tablet tablet ampul tablet strip strip strip strip tablet kapsul kapsul botol tablet tablet pot dos botol psg psg psg psg buah psg psg psg buah botol vial

botol tablet ampul buah buah botol tablet tablet

30 0 0 0 0 0 70 0 0 0 0 0 0 0 5 100 0 0 0 0 0 0 3 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392

Sintetic filling material Slide box Spiritus Spironolacton tablet 25 mg Spon gelatin cubicles 1 x 1 x 1 cm Sputum pot Stop TB kategori I Stop TB kategori I & 3 Streptomicyn sulfat injeksi 1500 mg/vial Sulfadimidin tablet 500 mg Sulfazetamid tetes mata Temporary stopping fletcher (fletcher) serbuk dan cairan Tetrakain tetes mata Tetrasiklin kapsul 250 mg Tetrasiklin kapsul 500 mg Thiamin HCl injeksi 100 mg/ml Thiamin HCl tablet 50 mg Tissue lensa Torniquet Tramadol injeksi Tramadol kapsul Transfusi set Triheksifenidil HCl tablet 2 mg Umbilical Cord Klem Under Pad Urine bag Ventolin Vitamin B Kompleks tablet Widal Test Wing Needle No. 23 G Zink Rapid test Malaria VAR

JUMLAH KUNJUNGAN RESEP

buah box botol tablet buah buah paket paket vial tablet botol botol botol kapsul kapsul ampul tablet bungkus buah ampul kapsul buah tablet buah pieces pieces ampul tablet botol buah tablet buah ampul

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 60 0 0 0 0 0 0 0 0 0 2 0 0 0 217 14 0

UMUM BAYAR TIDAK BAYAR

MENGETAHUI/MENYETUJUI: KEPALA DINAS KESEHATAN KAB. NAGEKEO,

(…………………………………………………………………..) NIP.

(LPLPO) TAHUN: 2017 PELAPORAN BULAN : MARET 2017 PERMINTAAN BULAN : APRIL 2017 PENERIMAAN

PERSEDIAAN

5

6

5

100

300

PEMAKAIAN SISA STOK STOK OPT PERMINTAAN 7

3 11 6 6 0 6 0 0 0 0 0 28 18 0 0 100 0 0 0 0 0 0 0 0 0 0 393 0 0 0 0

2

3 2

190

8 3 11 4 6 0 6 0 0 0 0 0 25 16 0 0 100 0 0 0 0 0 0 0 0 0 0 203 0 0 0 0

9

10

100

100

270 3

0 0 0 5 260 0 0 0 0 0 8 0 0 0 0 0 0 0 0 100 0 0 0 100 0 0 0 0 0 0 0 0 0 750 0 5 0 0 0 0 0

1

100

100

300 2

0 0 0 4 260 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 450 0 3 0 0 0 0 0

2

100

0 30 100 0 4 0 3 3 0 0 0 0 100 0 0 5 110 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 10

110

0 20 90 0 4 0 3 3 0 0 0 0 100 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

jkn sisa 90

200

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 137 0 0 0 0 0 260 0 0 0 0 0 0 0 0

114

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 137 0 0 0 0 0 146 0 0 0 0 0 0 0 0

0 18 0 0 0 4 0 0 0 0 5 11 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 20 0 0

3

3

1

10

0 15 0 0 0 1 0 0 0 0 5 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 10 0 0

sisa jkn 15

2

200

10 100

0 0 0 7 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 200 0 0 0 0 0 0 0 0 0 12 0 400 0 0 0 0 0 0 0 0

3

2

200

7 130

0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 270 0 0 0 0 0 0 0 0

10

5

0 0 0 0 0 0 0 0 11 0 0 0 0 0 0 13 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0

1

3

1

0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0

10

2 2

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 15 0 100 0 0 0 0 0 0 0 30 0 0 0 0 2 0 3 0

6 100

1 1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 9 0 0 0 0 0 0 0 0 0 30 0 0 0 0 1 0 2 0

3 5

10

30 0 0 0 0 0 70 0 0 0 0 0 0 0 5 100 0 0 0 0 0 0 6 9 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0

3 20

2 7

30 0 0 0 0 0 70 0 0 0 0 0 0 0 2 80 0 0 0 0 0 0 4 2 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0

50 2 50

200

ASKES

0 0 0 0 0 0 0 0 0 0 0 0 0 50 0 5 110 0 0 0 0 0 0 0 0 0 2 200 0 0 217 14 0

20 1 60

100

2

0 0 0 0 0 0 0 0 0 0 0 0 0 30 0 4 50 0 0 0 0 0 0 0 0 0 2 100 0 0 217 12 0

jkn sisa 4

YANG MENYERAHKAN: PETUGAS INSTALASI FARMASI,

(……………………………………………………………..) NIP.

YANG MEMINTA/ MELA

(

MAGUS HILARIUS NIP.19631231 200012

BULAN: DESEMBER 2016

APBD IIBUFFER PROGRAM DEPKES ASKES JUMLAH KET LAIN 11

12

13

14

15

16

17

………………………………., 2014

YANG MEMINTA/ MELAPORKAN: YANG MENERIMA: KEPALA PUSKESMAS, PETUGAS PUSKESMAS,

(

MAGUS HILARIUS ) NIP.19631231 200012 1 029

( FATMAWATI ) NIP.19820424 200904 2 014

PUSKESMAS : NANGARORO KABUPATEN : NAGEKEO POSKESDES : ULUPULU

NO.

NAMA JENIS OBAT

SATUAN

STOK AWAL

1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

2

3

4 3 11 4 6 0 6 0 0 0 0 0 25 16 0 0 100 0 0 0 0 0 0 0 0 0 0 203 0 0 0 0

Abocath No 18 Abocath No 20 Abocath No 22 Abocath No 24 Abocath No 26 Aciclovir salep kulit Aciclovir tablet 400 mg Alat suntik sekali pakai 1 ml Alat suntik sekali pakai 10 ml Alat suntik sekali pakai 2,5 ml Alat suntik sekali pakai 20 ml Alat suntik sekali pakai 3 ml Alat suntik sekali pakai 5 ml Alat suntik sekali pakai 50 ml Albendazole tablet 400 mg Alopurinol tablet 100 mg Aluminium foil Amalgam serbuk 65-75 % Ambroxol sirup 15 mg/ml Ambroxol tablet 30 mg Aminofilin injeksi Aminofilin tablet 200 mg Amitriptilin tablet 25 mg Amlodipin 5 mg Amlodipin 10 mg Amoksisilin kapsul 250 mg Amoksisilin kaplet 500 mg Amoksisilin sirup kering 125 mg/5 ml Ampisilin kaplet 250 mg Ampisilin kaplet 500 mg Ampisilin serbuk injeksi 1.000 mg

buah buah buah buah buah tube tablet buah buah buah buah buah buah buah tablet tablet gulungan botol botol tablet ampul tablet tablet tablet tablet kapsul kaplet botol kaplet kaplet vial

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

Ampisilin sirup kering 60 ml Antagin injeksi 250 mg / ml Antalgin tablet 500 mg Antasida DOEN II suspensi Antasida DOEN tablet Anti hemoroid suppositoria Anti migrain DOEN tablet Anti parkinson DOEN tablet Antibakteri DOEN komb.Salep(Basitrasin + Polimiksin) Antifungi DOEN salep ( 3 - 6 ) Aqua pro injeksi steril 25 ml Aquadest steril 500 ml Arsuamon tablet Artemether injeksi 1 ml : 80 mg Arterakin tablet Artesunate injeksi Artesunate tablet Asam Asetilsalisilat tablet 100 mg (Asetosal) Asam Asetilsalisilat tablet 500 mg (Asetosal) Asam askorbat tablet 50 mg Asam askorbat tablet 250 mg Asam folat Asam mefenamat tablet 250 mg Asam mefenamat tablet 500 mg Asam traneksamat 500 mg Asam traneksamat injeksi Atenolol tablet 50 mg Atropin sulfat injeksi 0,25 mg/ml Atropin sulfat tablet 0,5 mg Atropin sulfat tetes mata Autoklik Bekarbon (arang aktif) Benzatin benzil penisilin injeksi Besi II tablet salut kombinasi Betahistin Betametason krem 0,1 % Bisoprolol 5 mg Bisturi No. 11 Blood lancet Bromheksin tablet 8 mg Burnazin salep

botol ampul tablet botol tablet suposs tablet tablet Pot Pot vial botol tablet ampul tablet vial tablet tablet tablet tablet tablet tablet tablet tablet tablet ampul tablet ampul tablet botol buah tablet vial tablet tablet tube tablet buah buah tablet tube

0 0 0 4 260 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 450 0 3 0 0 0 0 0

73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113

Calsium glukonat 10 mg/ml Captopril 12,5 mg Captopril 25 mg Cat Gram Catgut Chromic No 2/0 Catgut Chromic No 3/0 Catgut Plain No 2/0 Catgut Plain No 3/0 Cetirizine Cimetidine tablet 200 mg Combur test Cover glass Cyprofloxacin tablet 500 mg Dapson tablet Darplex Deksametason injeksi 5 mg/ml Deksametason tablet 0,5 mg Dekstrometorfan syrup Dekstrometrophan tablet 15 mg Dengue blood Devitalisasi pastae non arsen Diasepam injeksi 5 mg/ml Diasepam tablet 2 mg Diasepam tablet 5 mg Dietilkarbamazin tablet Difenhidramin injeksi 10 mg Digoksin tablet Dimenhidrinat tab 50 mg Doksisiklin kapsul 100 mg Domperidon sirup Domperidon tablet 10 mg Efedrin HCl tablet 25 mg Ekstrak Belladona tablet 10mg Epinefrin/adrenalin injeksi 0,1 % Erytromicyn kapsul 250 mg Erytromicyn kapsul 500 mg Erytromicyn suspensi 125 mg/ 5 ml Etakridina larutan 0,1% Etanol 70 % 100 ml Etanol 70% 300 ml Etanol 70 % 1000 ml

ampul tablet tablet paket buah buah buah buah tablet tablet kit buah tablet tablet tablet ampul tablet botol tablet kit botol ampul tablet tablet tablet ampul tablet tablet kapsul botol tablet tablet tablet ampul kapsul kapsul botol botol botol botol botol

0 20 90 0 4 0 3 3 0 0 0 0 100 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154

Etanol 96 % 1000 ml Ethil klorida semprot Eugenol cairan F l u o r tablet 0, mg Fenitoin natrium injeksi 50 mg/ml Fenitoin natrium kapsul 30 mg Fenitoin natrium kapsul 100 mg Fenobarbital injeksi 50 mg/ml Fenobarbital tablet 30 mg Fenobarbital tablet 100 mg Fenoksimetil penisilin tablet 250 mg Fenoksimetil penisilin tablet 500 mg Fenolgliserol tetes telinga Fitomenadion (Vit K) injeksi 10 mg/ml Fitomenadion (Vit K1) injeksi 10 mg/ml Fitomenadion (Vit.K1) tablet salut 10 mg Folley cath.10 F Folley cath.14 F Folley cath.16 F Folley cath.18 F Forinokresol (pengganti TKF) Formalin cair Formalin tablet 1 gr Furosemida injeksi Furosemida tablet 40 mg Gameksan lotion 1 % Garam oralit 200 ml air Gentamisin injeksi 40 mg/ml Gentamisin salep kulit 0,1 % Gentian violet larutan Glass Ionomer Cement ART Glibenklamid tablet 5 mg Gliserilguayakolat tablet Gliserin Glukosa injeksi 40 % Glukosa larutan infus 5 % Glukosa larutan infus 10 % Griseofulvin tablet 125 mg Haemocytometer Haemometer Haloperidol tablet 0,5 mg

botol botol botol tablet amp @ 2ml kapsul kapsul ampul tablet tablet tablet tablet botol ampul ampul tablet buah buah buah buah botol botol I ltr tablet ampul tablet botol saset ampul tube botol set/botol tablet tablet botol vial botol botol tablet buah buah tablet

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 137 0 0 0 0 0 146 0 0 0 0 0 0 0 0

155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195

HBSaG HCG Strip Hidrogen peroksida Hidroklorotiasida tablet 25 mg Hidrokortison krem 2,5 % Ibuprofen 100 mg/5 ml suspensi Ibuprofen 200 mg/5 ml suspensi Ibuprofen tablet 200 mg Ibuprofen tablet 400 mg Imersion oil Infus set anak Infus set dewasa Iodin test Iodol kapsul lunak Isosorbid dinitrat tablet 5 mg Jarum dispossible No. 22 ¼ G Jarum dispossible No. 23 ¼ G Jarum jahit/ bedah Kulit No. 9 Jarum jahit/ bedah Kulit No. 10 Jarum jahit/ bedah Kulit No. 11 Jarum jahit/ bedah Kulit No. 12 Jarum jahit/ bedah Kulit No. 13 Jarum jahit/ bedah Kulit No. 14 Jarum jahit/ bedah Otot No. 9 Jarum jahit/ bedah Otot No. 10 Jarum jahit/ bedah Otot No. 11 Jarum jahit/ bedah Otot No. 12 Jarum jahit/ bedah Otot No. 13 Jarum jahit/ bedah Otot No. 14 Jeli USG Kaca slide Kalium permanganat serbuk Kalsium hidroksida pastae Kalsium laktat tablet 500 mg Kapas pembalut absorben 100 gr Kapas pembalut absorben 250 gr Karbamasepin tablet 200 mg Kartu stok Kasa kompres steril 40/40 Kasa pembalut 10 cm Kasa pembalut 4 m x 3 cm

strip strip botol tablet tube botol botol tablet tablet botol set set botol kapsul tablet buah buah pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces pieces jerigen buah tube tube buah roll roll tablet lembar roll roll roll

0 15 0 0 0 1 0 0 0 0 5 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 10 0 0

196 197 198 199 200 201 202 203 204 205 206 207 208 209 210 211 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235

Kasa pembalut 4 m x 5 cm Kasa pembalut 4 m x 6 cm Kasa pembalut 40 m x 80 cm Kasa pembalut hidrofil 2 m x 80 cm Kasa pembalut hidrofil 4 m x 10 cm Kasa pembalut hidrofil 4 m x 15 cm Kasa pembalut hidrifil 16 cm x 16 cm Kertas Pulvis Kertas Resep Kertas saring Ketokonazole cream 2% Ketokonazole tablet 200 mg Ketorolac injeksi 10mg/ml Kinina dihidroklorida injeksi 25 % Kinina sulfat tablet 200 mg Kloramfenikol kapsul 250 mg Kloramfenikol sm 1 % Kloramfenikol suspensi Kloramfenikol tetes mata 0,5 % Kloramfenikol tetes telinga 3 % Klorfeniramin maleat tablet 4 mg Klorfenol kamfer menthol (CHKM) Klorokuin injeksi Klorokuin tablet 250 mg Klorpromazin HCl injeksi 25 mg/ml Klorpromazin tablet 25 mg Klorpromazin tablet 100 mg Klorpropamide tablet 100 mg Kodein tablet 10 mg Komb. Pirimet-sulfadoksin tablet Kotrimoksasol suspensi Kotrimoksasol tablet 120 mg Kotrimoksasol tablet 480 mg Larutan Anisol Larutan Asam asetat Larutan Asam sulfosalisilat Larutan Benedicts Larutan EDTA Larutan Eosin 2 % Larutan Giemsa

236

Larutan Hayem

roll

botol

0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 270 0 0 0 0 0 0 0

botol

0

roll roll roll roll roll roll blok blok lembar tube tablet ampul ampul tablet kapsul tube botol botol botol tablet botol ampul tablet ampul tablet tablet tablet tablet tablet botol tablet tablet botol botol botol botol botol botol

237 238 239 240 241 242 243 244 245 246 247 248 249 250 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 274 275 276 277

Larutan HCl 0,1 N Larutan Lugol Larutan Natrium sitrat Larutan Rees Ecker Larutan Turk Larutan Ziehl Nelsen Levetran salep Levothyroxin Lidokain injeksi 2 % Lidokain injeksi 2 % (HCl) + Epinefrin 1 : 80.000 - 2 ml Lisol cairan Loratadin tablet Magnesium sulfat injeksi 20 % Magnesium sulfat injeksi 40 % Magnesium sulfat serbuk 30 gram Masker Mebendazol tablet 100 mg Meloksicam 7,5 mg Metformin tablet 500 mg Metilergometrin injeksi 0,200 mg Metilergometrin tablet 0,125 mg Metoklopramide tablet 5 mg Metoklopramide tablet 10 mg Metoklopramide injeksi 5 mg/ml Metoklopramide sirup 5 mg/ml Metronidasol infus Metronidasol tablet 250 mg Metronidasol tablet 500 mg Metylprednisolon Mikonazol salf Mineral mix Monoklorkamfermenthol cairan Morphin Injeksi Mucus section Mummifying pastae Natrium bicarbonat tablet 500 mg Natrium diklofenak tab 25 mg Natrium klorida larutan infus 0,9 % Natrium tiosulfat inj 25% NGT No. 3 NGT No. 3,5

botol botol botol botol botol paket pot tablet ampul ampul botol tablet ampul ampul saset lembar tablet tablet tablet ampul tablet tablet tablet ampul botol botol tablet tablet tablet tube saset botol ampul buah Tube tablet tablet botol ampul pieces pieces

0 0 0 0 0 0 0 0 10 0 0 0 0 0 0 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0

278 279 280 281 282 283 284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 300 301 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318

NGT No. 4 NGT NO. 5 NGT NO. 10 NGT NO. 16 NGT NO. 18 Nifedipin tablet 10 mg Nistatin tablet salut 500.000 IU/g Nistatin vaginal tablet 100.000 IU/g Nurse Cup Obat Anti TBC Kategori 2 (sisipan) Obat Anti TBC Kategori Anak Obat Anti TBC Kategori Anak Lanjutan Obat Anti TBC Kategori II FDC Obat batuk hitam Oksitetrasiklin injeksi Oksitetrasiklin s m 1 % Oksitetrasiklin salep kulit 3 % Oksitocyn injeksi 10 IU/ml Omeprasole 20 mg Papaverin injeksi 40 mg/ml Papaverin tablet Parasetamol drops Parasetamol sirup 125 mg/5 ml Parasetamol tablet 100 mg Parasetamol tablet 500 mg Pembalut Gibbs Pethidin injeksi 50 mg/ml Pil KB Kombinasi Pilokarpin HCl tetes mata Piracetam 400 mg Piracetam 800 mg Piracetam injeksi 200 mg/ml Pirantel pamoat tablet 125 mg Piridoksin HCl tablet 10 mg Piroksikam kapsul 20 mg Plastik Obat 8 x 5 cm Plastik Obat 10 x 7 cm Plester 5 yards x 2 inchi Povidon Iodida 10 % 30 ml Povidon Iodida 10 % 60 ml Povidon Iodida 10 % 300 ml

pieces pieces pieces pieces pieces tablet tablet tablet buah paket paket paket paket botol vial Tube Tube ampul Kapsul ampul tablet botol botol tablet tablet buah ampul tablet botol tablet tablet ampul tablet tablet Kapsul bungkus bungkus roll botol botol botol

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 9 0 0 0 0 0 0 0 0 0 30 0 0 0 0 1 0 2 0

319 320 321 322 323 324 325 326 327 328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349

Prednison tablet 5 mg Primaquin tablet 15 mg Prokainbenzil penisilin 3 jt IU/vial Propanolol HCl tablet 40 mg Propiltiourasil tablet 100 mg Ranitidin injeksi 50 mg/ml Ranitidin tablet 150 mg Rapid test HIV/AIDS SD Rapid test HIV/AIDS Intec Rapid test HIV/AIDS Oncoprobe Reagen sipilis Reserpina tablet 0,1 mg Retinol 100.000 IU kapsul lunak Retinol 200.000 IU kapsul lunak Ringer laktat larutan infus Salbutamol tablet 2 mg Salbutamol tablet 4 mg Salep 2 - 4 % Salisil bedak 2 % Salisil spiritus 10 % Sarung tangan Ginekologi Sarung tangan No. 6 1/2 Sarung tangan No. 7 Sarung tangan No. 7 1/2 Sarung tangan non steril Save Gloves No. S Save Gloves No. M Save Gloves No. L Selang Karet Anus No. 20 Semen seng serbuk dan cairan Serum Anti Bisa Ular Polivalen Injeksi 50 ml (ABU I)

350 351 352 353 354 355 356 357 358 359

Serum Anti Tetanus Injeksi 1500 IU/amp (ATS)

ampul

Serum Anti Tetanus Injeksi 20.000 IU/amp (ATS) Serum Test Golongan Darah Sianokobalamin 50 mcg Sianokobalamin injeksi Silk/benang bedah sutera No. 2/0 Silk/benang bedah sutera No. 3/0 Silver amalgam serbuk 65 - 75 % Simvastatin tablet 10 mg Simvastatin tablet 20 mg

ampul

tablet tablet vial tablet tablet ampul tablet strip strip strip strip tablet kapsul kapsul botol tablet tablet pot dos botol psg psg psg psg buah psg psg psg buah botol vial

botol tablet ampul buah buah botol tablet tablet

30 0 0 0 0 0 70 0 0 0 0 0 0 0 2 80 0 0 0 0 0 0 4 2 0 0 0 0 0 0 0 0 0 0 0 10 0 0 0 0 0

360 361 362 363 364 365 366 367 368 369 370 371 372 373 374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392

Sintetic filling material Slide box Spiritus Spironolacton tablet 25 mg Spon gelatin cubicles 1 x 1 x 1 cm Sputum pot Stop TB kategori I Stop TB kategori I & 3 Streptomicyn sulfat injeksi 1500 mg/vial Sulfadimidin tablet 500 mg Sulfazetamid tetes mata Temporary stopping fletcher (fletcher) serbuk dan cairan Tetrakain tetes mata Tetrasiklin kapsul 250 mg Tetrasiklin kapsul 500 mg Thiamin HCl injeksi 100 mg/ml Thiamin HCl tablet 50 mg Tissue lensa Torniquet Tramadol injeksi Tramadol kapsul Transfusi set Triheksifenidil HCl tablet 2 mg Umbilical Cord Klem Under Pad Urine bag Ventolin Vitamin B Kompleks tablet Widal Test Wing Needle No. 23 G Zink Rapid test Malaria VAR

JUMLAH KUNJUNGAN RESEP

buah box botol tablet buah buah paket paket vial tablet botol botol botol kapsul kapsul ampul tablet bungkus buah ampul kapsul buah tablet buah pieces pieces ampul tablet botol buah tablet buah ampul

0 0 0 0 0 0 0 0 0 0 0 0 0 30 0 4 50 0 0 0 0 0 0 0 0 0 2 100 0 0 217 12 0

UMUM BAYAR TIDAK BAYAR

MENGETAHUI/MENYETUJUI: KEPALA DINAS KESEHATAN KAB. NAGEKEO,

(…………………………………………………………………..) NIP.

(LPLPO) TAHUN: 2017 PELAPORAN BULAN : APRIL 2017 PERMINTAAN BULAN : MEI 2017 PENERIMAAN

PERSEDIAAN

5

6

300

PEMAKAIAN SISA STOK STOK OPT PERMINTAAN 7

3 11 4 6 0 6 0 0 0 0 0 25 16 0 0 100 0 0 0 0 0 0 0 0 0 0 503 0 0 0 0

2 2

170

8 3 11 4 6 0 6 0 0 0 0 0 23 14 0 0 100 0 0 0 0 0 0 0 0 0 0 333 0 0 0 0

9

10

200

200

270 2

0 0 0 4 260 0 0 0 0 0 8 0 0 0 0 0 0 0 0 200 0 0 0 200 0 0 0 0 0 0 0 0 0 720 0 5 0 0 0 0 0

40

173

200

330 4

0 0 0 4 220 0 0 0 0 0 8 0 0 0 0 0 0 0 0 27 0 0 0 0 0 0 0 0 0 0 0 0 0 390 0 1 0 0 0 0 0

200

0 20 90 0 4 0 3 3 0 0 0 0 100 0 0 5 200 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

10 1 1 1

160

0 20 80 0 3 0 2 2 0 0 0 0 100 0 0 5 40 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

jkn sisa 80

200

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 137 0 0 0 0 0 346 0 0 0 0 0 0 0 0

5

138

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 0 0 0 132 0 0 0 0 0 208 0 0 0 0 0 0 0 0

3

0 15 0 0 0 4 0 0 0 0 5 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 10 0 0

2

4

0 13 0 0 0 4 0 0 0 0 5 10 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 6 0 0

sisa jkn 13

5

5 100

0 0 0 4 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 10 0 370 0 0 0 0 0 0 0 0

2

5 120

0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 5 0 250 0 0 0 0 0 0 0 0

10

5

2

0 0 0 0 0 0 0 0 20 0 0 0 0 0 0 15 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0

4

6

0 0 0 0 0 0 0 0 16 0 0 0 0 0 0 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0

5

1 1 1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 14 0 0 0 0 0 0 0 0 0 30 0 0 0 1 2 0 3 0

5

1 1 1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 9 0 0 0 0 0 0 0 0 0 30 0 0 0 0 1 0 2 0

3 100

3 6

10

30 0 0 0 0 0 70 0 0 0 0 0 0 0 5 180 0 0 0 0 0 0 7 8 0 0 0 0 0 0 0 0 0 0 0 20 0 0 0 0 0

10

2 3

11

30 0 0 0 0 0 70 0 0 0 0 0 0 0 5 170 0 0 0 0 0 0 5 5 0 0 0 0 0 0 0 0 0 0 0 9 0 0 0 0 0

50

100

ASKES

0 0 0 0 0 0 0 0 0 0 0 0 0 30 0 4 100 0 0 0 0 0 0 0 0 0 2 200 0 0 217 12 0

50

100

10 1

0 0 0 0 0 0 0 0 0 0 0 0 0 30 0 4 50 0 0 0 0 0 0 0 0 0 2 100 0 0 207 11 0

jkn sisa 4

YANG MENYERAHKAN: PETUGAS INSTALASI FARMASI,

(……………………………………………………………..) NIP.

YANG MEMINTA/ MELA

(

MAGUS HILARIUS NIP.19631231 200012

BULAN: APRIL 2017

APBD IIBUFFER PROGRAM DEPKES ASKES JUMLAH KET LAIN 11

12

13

14

15

16

17

………………………………., 2014

YANG MEMINTA/ MELAPORKAN: YANG MENERIMA: KEPALA PUSKESMAS, PETUGAS PUSKESMAS,

(

MAGUS HILARIUS ) NIP.19631231 200012 1 029

( FATMAWATI ) NIP.19820424 200904 2 014

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