April Lplpo Sumbersari 2022

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DINAS KESEHATAN KABUPATEN BANDUNG

PUSKESMAS SUMBER SARI


KP. LEMBANGHAUR RT 01 RW 05 DS. SUMBERSARI, KEC. CIPARA

LAPORAN PEMAKAIAN DAN LEMBAR PERMINTAAN OBAT (LPLPO


Periode Laporan: April 2022
Kode Puskesmas : P3204130203
Nama Puskesmas : SUMBER SARI
Pelaporan Bulan : April
Permintaan Bulan : Mei

Stok
No. Kode Nama Barang Satuan Penerimaan
Awal
OBAT-OBATAN
1 GFK0001 Acetylcystein Tablet 200 mg Tablet 0 0
2 GFK0327 Albendazol susp 200mg/5mL BOTTLE 0 0
3 GFK0002 Albendazole Tablet 400 mg Tablet 0 0
4 GFK0003 Allopurinol Tablet 100 mg Tablet 500 0
5 GFK0004 Allopurinol Tablet 400 mg Tablet 0 0
6 GFK0005 Ambroxol Sirup 15 mg / 5 ml Botol 0 0
7 GFK0006 Ambroxol Tablet 30 mg Tablet 0 0
8 GFK0008 Aminofilin Injeksi 24 mg / ml Ampul 0 0
9 GFK0007 Aminofilin Tablet 200 mg Tablet 0 0
10 GFK0009 Amitripillin Tablet Salut 25 mg Tablet 0 0
11 GFK0010 Amlodipine Tablet 10 mg Tablet 14650 0
12 GFK0011 Amlodipine Tablet 5 mg Tablet 5200 0
13 GFK0012 Amoxicilin Injeksi 1000 mg/ml Ampul 0 0
14 GFK0013 Amoxicilin Kaplet 250 mg Tablet 0 0
15 GFK0014 Amoxicilin Kaplet 500 mg Tablet 4000 0
16 GFK0015 Amoxicilin Sirup Kering 125 mg/5 ml Botol 70 0
17 GFK0016 Amoxicilin Sirup Kering 250 mg/5 ml Botol 0 0
18 GFK0017 Antalgin (Metampiron) Injeksi 250 mg/ml Ampul 0 0
19 GFK0018 Antalgin (Metampiron) Tablet 500 mg Tablet 0 0
20 GFK0019 Antasida DOEN Suspensi Botol 50 0
21 GFK0020 Antasida DOEN Tablet Tablet 0 0
Antifungi DOEN Salep (Kombinasi : Asam
22 GFK0021 Benzoat 6% + Asam Salisilat 3%) Pot 0 0
23 GFK0022 Antihemoroid DOEN Suppositoria Tablet 30 0
Antimigren DOEN Tablet (Kombinasi :
24 GFK0023 Ergotamin Tartat 1 mg + Caffein 50 mg) Tablet 0 0

25 GFK0024 Aqua Pro Injeksi Steril Bebas Pirogen 20 ml Ampul 10 0


Asam Asetil Salisilat (Asetosal) Tablet 80
26 GFK0025 mg Tablet 80 0
27 GFK0381 Asam Askorbat (Vit. C) 500 mg tablet TABLET 1400 0
28 GFK0026 Asam Askorbat (Vit. C) Tablet 50 mg Tablet 254 0
29 GFK0362 Asam askorbat (vitamin C) tab 250 mg TABLET 1500 0
30 GFK0027 Asam Folat Tablet 1 mg Tablet 0 0
31 GFK0028 Asam Mefenamat Tablet 500 mg Tablet 100 0
32 GFK0029 Asiklovir Krim 5% Tube 0 0
33 GFK0296 Asiklovir Tablet 200 mg Tablet 0 0
34 GFK0030 Asiklovir Tablet 400 mg Tablet 0 0
35 GFK0031 Atropin Sulfat Injeksi 0,25 mg/ml - 1 ml Ampul 0 0
36 GFK0032 Bedak Salisil 2% - 50 gram Sachet 0 0
37 GFK0033 Betametason Krim 0,1% Tube 125 0
38 GFK0034 Cefadroxil Sirup Kering 125 mg/5 ml Botol 50 0
39 GFK0349 CHLORQUINE PHOSPHATE Tablet TABLET 0 0
40 GFK0035 Deksametason Injeksi 5 mg/ml Ampul 0 0
41 GFK0036 Deksametason Tablet 0,5 mg Tablet 0 0
42 GFK0342 Desinfektan 5 Liter GALLON 0 0
43 GFK0037 Diazepam Injeksi 5 mg/ml Ampul 0 0
44 GFK0038 Diazepam Rectal 10 mg Suppositoria 0 0
45 GFK0039 Diazepam Rectal 5 mg Suppositoria 5 0
46 GFK0040 Diazepam Tablet 2 mg Tablet 127 0
47 GFK0041 Difenhidramin Hcl Injeksi 10 mg/ml Ampul 0 0
48 GFK0042 Digoxin Tablet 0,25 mg Tablet 0 0
Dimenhidrinat Tablet 50 mg Dimenhidrinat
49 GFK0307 Tablet 50 mg TABLET 0 0
50 GFK0326 Diphteria Antitoxin Serum VIAL 0 0
51 GFK0382 Doksisiklin kaps 100mg TABLET 100 0
52 GFK0305 Domperidon sir 5mg/5mL BOTTLE 50 0
53 GFK0043 Domperidon Tablet 10 mg Tablet 0 2000
54 GFK0044 Epinefrin HCl injeksi 0,1% - 1 ml Ampul 0 0
55 GFK0046 Eritromisin Kapsul 250 mg 0 0
56 GFK0045 Eritromisin Kapsul 500 mg Tablet 0 0
57 GFK0047 Eritromisin Sirup 200 mg/5 ml Botol 0 0
58 GFK0048 Etakridin (Rivanol) 0,1% Botol 0 0
59 GFK0049 Etanol 70% - 1000 ml Botol 2 0
60 GFK0050 Etanol 70% - 300 ml Botol 0 0
61 GFK0324 Etil Klorida spray 100 mL BOTTLE 0 0
62 GFK0051 Eugenol 10 ml Botol 0 0
63 GFK0052 Fenobarbital Injeksi 50 mg/ ml Ampul 0 0
64 GFK0053 Fenobarbital Tablet 30 mg Tablet 100 0
65 GFK0055 Fenoksimetil Fenisilin Tablet 250 mg Tablet 0 0
66 GFK0054 Fenoksimetil Fenisilin Tablet 500 mg Tablet 0 0
67 GFK0056 Fenol Griseol Tetes Telinga 10% Botol 0 0
68 GFK0057 Fitomenadion (Vit. K) Injeksi 10 mg/ml Ampul 0 0
69 GFK0058 Fitomenadion (Vit. K) Injeksi 2 mg/ml Ampul 129 0
70 GFK0059 Fitomenadion (Vit. K) Tablet Salut 10 mg Tablet 0 0
71 GFK0478 Flufenazin inj 25mg/mL (i.m.) AMPULE 0 0
72 GFK0061 Furosemida Injeksi IV/IM 10 mg/ml-2ml Ampul 0 0
73 GFK0060 Furosemida Tablet 40 mg Tablet 400 0
74 GFK0062 Gentamisin Injeksi 80 mg/2,5 ml Ampul 0 0
75 GFK0063 Gentamisin Salep Kulit 0,1% Tube 0 0
76 GFK0064 Gentamisin Salep Mata Tube 0 0
77 GFK0065 Gentamisin Tetes Mata Botol 0 0
78 GFK0066 Glibenclamide Tablet 5 mg Tablet 0 0
79 GFK0067 Glimepirid Tablet 1 mg Tablet 0 0
80 GFK0068 Glimepirid Tablet 2 mg Tablet 7000 0
81 GFK0069 Gliserin Cairan 100 ml Botol 0 0
82 GFK0070 Gluconas calcicus 10% - 10 ml Ampul 0 0
83 GFK0071 Glukosa Lar. Steril Cairan Infus 10% Botol 0 0
84 GFK0072 Glukosa Lar. Steril Cairan Infus 5% Botol 0 0
85 GFK0073 Griseofulvin Tablet 125 mg Tablet 800 0
86 GFK0074 Griseril Guaiakolat Tablet 100 mg Tablet 0 0
87 GFK0477 Haloperidol inj 50mg/mL AMPULE 0 0
88 GFK0075 Haloperidol Tablet 0,5 mg Tablet 0 0
89 GFK0076 Haloperidol Tablet 1,5 mg Tablet 0 0
90 GFK0077 Haloperidol Tablet 2 mg Tablet 0 0
91 GFK0078 Haloperidol Tablet 5 mg Tablet 0 0
92 GFK0079 Hidroklortiazid (HCT) Tablet 25 mg Tablet 100 0
93 GFK0080 Hidrokortison Krim 2,5% Tube 72 0
94 GFK0081 Ibuprofen Suspensi 100 mg/ 5 ml 60 ml Botol 0 0
95 GFK0082 Ibuprofen Suspensi 200 mg/ 5 ml 60 ml Botol 0 0
96 GFK0533 Ibuprofen tab 200mg TABLET 0 0
97 GFK0083 Ibuprofen Tablet 400 mg Tablet 0 0
98 GFK0538 Imunodilator Sirup BOTOL 0 0
99 GFK0458 Imunodulator Kapsul KAPSUL 0 0
100 GFK0084 Isoniazide (INH) 100 mg Tablet 0 0
101 GFK0085 Isoniazide (INH) 300 mg Tablet 0 0
Isosorbid Dinitrat (ISDN) Tablet Sublingual
102 GFK0086 5 mg Tablet 0 0
103 GFK0087 Kalsium Laktat (Kalk) Tablet 500 mg Tablet 1700 0
104 GFK0088 Kaptopril Tablet 12,5 mg Tablet 9600 0
105 GFK0089 Kaptopril Tablet 25 mg Tablet 300 0
106 GFK0090 Karbamazepin Tablet 200 mg Tablet 470 0
107 GFK0091 Ketoconazole Tablet 200 mg Tablet 200 0
108 GFK0360 Ketokonazol krim 2% TUBE 0 0
109 GFK0092 Klindamisin Kapsul 150 mg Kapsul 0 0
110 GFK0093 Klindamisin Kapsul 300 mg Kapsul 0 0
111 GFK0094 Kloramfenikol Kapsul 250 mg Kapsul 0 0
112 GFK0095 Kloramfenikol Salep Kulit (Bufacetine) 2% Tube 0 0
113 GFK0096 Kloramfenikol Salep Mata 1% Tube 0 0
Kloramfenikol Suspensi 125 mg/5 ml - 60
114 GFK0097 ml Botol 0 0
115 GFK0098 Kloramfenikol Tetes Mata 0,5% Botol 0 0
116 GFK0099 Kloramfenikol Tetes Telinga 3% Botol 0 0
117 GFK0100 Klorfeniramin Maleat (CTM) Tablet 4 mg Tablet 178 0
118 GFK0102 Klorpromazin HCL Tablet Salut 100 mg Tablet 0 0
119 GFK0101 Klorpromazin HCL Tablet Salut 25 mg Tablet 0 0
120 GFK0321 Kolekalsiferol (Vit. D3) 400 unit tablet TABLET 0 0
121 GFK0322 Kolekalsiferol (Vit. D3) 400 unit/5 ml syr BOTTLE 0 0
Kotrimoksazol (dewasa) tab 960mg
kombinasi: sulfametoksazol
122 GFK0435 800mg+trimetoprim 160mg TABLET 0 0
Kotrimoksazol Suspensi 60 ml (Kombinasi :
Sulfametaksazol 200 mg/5 ml +
123 GFK0103 Trimetropim 40 mg/5 ml) Botol 300 0
Kotrimoksazol Tablet 480 mg (Kombinasi :
Sulfametaksazol 400 mg + Trimetropim 80
124 GFK0104 mg) Tablet 600 0
125 GFK0105 Lidokain Injeksi Ampul 0 0

Lidokain Injeksi Komb. (Kombinasi :


126 GFK0106 Lidokain HCl 2% + Epinefrin 1: 80.000) 2 ml Ampul 40 0
127 GFK0107 Loratadin Tablet 10 mg Tablet 0 0
128 GFK0108 Magnesium Sulfat Injeksi 20% - 25 ml Vial 6 0
129 GFK0109 Magnesium Sulfat Injeksi 40% - 25 ml Vial 6 0
130 GFK0110 Mebendazole Sirup 100 mg/5 ml Botol 0 0
131 GFK0111 Mebendazole Tablet 100 mg Tablet 0 0
132 GFK0112 Meloxicam Tablet 15 mg Tablet 0 0
133 GFK0113 Metformin Tablet 500 mg Tablet 7000 0
134 GFK0114 Metildopa (Dopamet) Tablet 250 mg Tablet 0 0
Metilergometrin Maleat (Metergin) Injeksi
135 GFK0115 0,2 mg/ml Ampul 0 0
Metilergometrin Maleat (Metergin) Tablet
136 GFK0116 Salut 0,125 mg Tablet 0 0
137 GFK0117 Metilprednisolon Tablet 4 mg Tablet 0 0
138 GFK0118 Metoklorpramid Injeksi 5 mg/ml Ampul 0 0
139 GFK0119 Metoklorpramid Tablet 10 mg Tablet 470 0
140 GFK0120 Metronidazole Syrup Botol 0 0
141 GFK0121 Metronidazole Tablet 250 mg Tablet 0 0
142 GFK0122 Metronidazole Tablet 500 mg Tablet 600 0
143 GFK0123 Mikonazole Krim 2% Tube 30 0
144 GFK0124 Multivitamin + Mineral Tablet Tablet 0 0
145 GFK0125 Multivitamin Sirup Botol 0 0
146 GFK0126 Multivitamin Tablet Tablet 300 0
147 GFK0127 Natrium Bikarbonat Tablet 500 mg Tablet 0 0
148 GFK0128 Natrium Diklofenak Tablet 50 mg Tablet 0 0
149 GFK0494 Natrium Klorida Cairan Infus 0,9% - 10 ml BOTTLE 50 0

150 GFK0441 Natrium Klorida Cairan Infus 0,9% - 100 ml BOTTLE 0 0

151 GFK0129 Natrium Klorida Cairan Infus 0,9% - 500 ml Botol 21 0


152 GFK0130 Nifedipine Tablet 10 mg Tablet 0 0
153 GFK0132 Nistatin Tablet 500.000 IU Tablet 0 0
154 GFK0131 Nistatin Tablet Vaginal 100.000 IU Tablet Vaginal 0 0
COVID-19
155 GFK0406 Obat Flu Batuk Sirup BOTTLE 0 0
OBAT-OBATAN
156 GFK0133 Obat Flu Sirup Botol 0 0
157 GFK0134 Obat Flu Tablet Tablet 0 1500
158 GFK0323 Oksigen ih, gas dalam tabung BOTTLE 0 0
159 GFK0135 Oksitetrasiklin HCl Salep Kulit 3% Tube 0 0
160 GFK0136 Oksitetrasiklin HCl Salep Mata 1% Tube 0 0
161 GFK0137 Oksitosin Injeksi 10 IU/ml Ampul 0 0
162 GFK0138 Omeprazol Tablet 20 mg Tablet 0 0
163 GFK0532 Ondansetron 8 mg /2 ml AMPULE 0 0
164 GFK0304 Oseltamivir Kapsul 75 Mg KAPSUL 0 0
165 GFK0139 Parasetamol Drops 100mg/ml Botol 24 0
166 GFK0140 Parasetamol Sirup 120 mg/5 ml Botol 300 0
167 GFK0141 Parasetamol Suppositoria Suppositoria 0 0
168 GFK0142 Parasetamol Tablet 500 mg Tablet 9000 0
169 GFK0348 Pehavral Tablet TABLET 0 0
170 GFK0438 Periokin Spray BOTTLE 0 0
171 GFK0475 Permetrin krim 5% TUBE 0 0
172 GFK0143 Piridoksin (Vit. B6) Tablet 10 mg Tablet 0 0
173 GFK0144 Piridoksin (Vit. B6) Tablet 25 mg Tablet 0 0
174 GFK0145 Piroxicam Kapsul 20 mg Tablet 0 0
175 GFK0146 Povidon Iodida 10% Cairan 30 ml Botol 6 0
176 GFK0147 Povidon Iodida 10% Cairan 300 ml Botol 0 0
177 GFK0332 Povidon Iodida 10% Cairan 60 ml BOTTLE 2 0
178 GFK0148 Prednison Tablet 5 mg Tablet 0 0
179 GFK0149 Propanolol Tablet 10 mg Tablet 0 0
180 GFK0150 Propanolol Tablet 40 mg Tablet 0 0
181 GFK0151 Propiltiourasil Tablet 100 mg Tablet 0 0
182 GFK0152 Ranitidine Injeksi 25 mg/ml Ampul 0 0
183 GFK0153 Ranitidine Tablet 150 mg Tablet 5200 0
184 GFK0366 Remdesivir Inj 100 mg VIAL 0 0
185 GFK0154 Ringer Laktat Cairan Infus 500 ml Botol 0 0
186 GFK0474 Risperidone Tablet 1 mg TABLET 0 0
187 GFK0155 Risperidone Tablet 2 mg Tablet 0 0
188 GFK0464 Sabun Cuci Tangan 500 ml BOTTLE 2 0
189 GFK0156 Salbutamol Nebulizer 1 mg/ml - 2,5 ml Ampul 0 0
190 GFK0157 Salbutamol Tablet 2 mg Tablet 800 0
191 GFK0158 Salbutamol Tablet 4 mg Tablet 900 0
Salep 2-4 (Kombinasi : Asam Salisilat 2% +
192 GFK0159 Belerang Endap 2%) Pot 0 100
193 GFK0160 Scabimite Cream (Premetrin 5% krim) Tube 0 0
Serum anti bisa ular I (khusus ular dari luar
194 GFK0473 papua) inj (i.m./i.v.) VIAL 0 0
195 GFK0161 Serum Anti Tetanus Injeksi 1.500 IU (ATS) Ampul 3 0
Sianokobalamin (Vit. B12) Injeksi 500
196 GFK0162 mcg/ml Ampul 0 0
197 GFK0163 Sianokobalamin (Vit. B12) Tablet 50 mcg Tablet 300 0
198 GFK0164 Simvastatin Tablet 10 mg Tablet 0 0
199 GFK0165 Simvastatin Tablet 20 mg Tablet 0 0
200 GFK0166 Siprofloksasin Tablet 500 mg Tablet 3400 0
201 GFK0440 SULFADIAZINE SILVER CREAM 35 G TUBE 0 0
202 GFK0167 Tetrasiklin Kapsul 250 mg Kapsul 0 0
203 GFK0168 Tetrasiklin Kapsul 500 mg Kapsul 0 0
204 GFK0169 Thiamfenikol Kapsul 500 mg Kapsul 0 0
205 GFK0170 Thiamin HCl (Vit. B1) Injeksi 100 mcg/ml Ampul 0 0
206 GFK0171 Thiamin HCl (Vit. B1) Tablet 50 mg Tablet 0 0
207 GFK0306 Tiamin (vitamin B1) tab 100 mg TABLET 0 0
208 GFK0444 Triheksifenidil tab 2mg TABLET 0 0
209 GFK0172 Trihexifenidil Hidroksida Tablet 2 mg Tablet 0 0
210 GFK0173 Vitamin B Kompleks Tablet Tablet 4000 0
BMHP
211 GFK0341 ALAT SEMPROT BUAH 0 0
212 GFK0186 Alat Suntik Sekali Pakai 0,05 ml Pcs 0 0
213 GFK0187 Alat Suntik Sekali Pakai 1 ml Pcs 0 0
214 GFK0190 Alat Suntik Sekali Pakai 10 ml Pcs 0 0
215 GFK0188 Alat Suntik Sekali Pakai 3 ml Pcs 50 0
216 GFK0189 Alat Suntik Sekali Pakai 5 ml Pcs 0 0
217 GFK0211 Alkohol Swab Pcs 1200 0
218 GFK0526 Apron LEMBAR 0 0
219 GFK0330 BARA COAT/GOWN NAVY BIRU PCS 0 0
220 GFK0520 Blood Glucose On Call Strip Test Acon STRIP 0 0
221 GFK0212 Blood Lancet Pcs 0 0
222 GFK0191 Canula Oksigen Pcs 0 0
Catgut/Benang Bedah No. 2/0 dengan
223 GFK0192 jarum bedah Pcs 0 0
Catgut/Benang Bedah No. 3/0 dengan
224 GFK0193 jarum bedah Pcs 0 0
Catgut/Benang Bedah No. 4/0 dengan
225 GFK0467 jarum bedah PIECES 0 0
226 GFK0334 COVER SHOES PCS 0 0
227 GFK0367 COVERALL DISPO PIECES 1 0
COVERALL PP+PE COATED ZIPPER WITH
228 GFK0329 HOOD L PCS 0 0
229 GFK0345 Desinfektan 20 Liter GALLON 0 0
COVID-19
230 GFK0431 ETANOL 96% GALLON 0 0
BMHP
231 GFK0314 EXTRADINE 5 LITER GALLON 0 0
232 GFK0194 Fixomull Stretch 5cm x 5m Pcs 0 0
233 GFK0195 Folley Catheter No. 16 Pcs 0 0
234 GFK0196 Folley Catheter No. 18 Pcs 0 0
235 GFK0197 Folley Catheter No. 20 Pcs 0 0
236 GFK0343 Helm + Visor Mask BUAH 0 0
237 GFK0198 Infus Set Adult 20 drops/mL Pcs 0 0
238 GFK0199 Infus Set Pedriatic 60 drops/mL Pcs 0 0
239 GFK0462 Isopore Surgical Tape 1 inch ROLL 0 0
240 GFK0463 Isopore Surgical Tape 1/2 inch ROLL 0 0
241 GFK0524 IV Catheter No. 16 PIECES 0 0
242 GFK0200 IV Catheter No. 18 Pcs 0 0
243 GFK0201 IV Catheter No. 20 Pcs 1 0
244 GFK0202 IV Catheter No. 22 Pcs 1 0
245 GFK0203 IV Catheter No. 24 Pcs 0 0
246 GFK0519 IV Catheter No. 26 PIECES 0 0
247 GFK0340 JAS HUJAN PCS 0 0
248 GFK0339 KACAMATA GOOGLE PIECES 0 0
249 GFK0213 Kantong mayat Pcs 0 0
250 GFK0405 KANTONG PLASTIK KUNING 60 X 100 TABLET 0 0
251 GFK0442 Kapas Pembalut/Absorben 100 gram ROLL 0 0
252 GFK0220 Kapas Pembalut/Absorben 250 gram Rol 0 0
253 GFK0460 Kapas Pembalut/Absorben 500 gram ROLL 0 0
254 GFK0179 Kaporit Serbuk Kg 0 0
255 GFK0180 Kaporit Tablet serbuk Kg 0 0
256 GFK0221 Kasa Gulung Besar 40 x 80 cm Rol 0 0
257 GFK0222 Kasa Pembalut Hidrofil 4 m x 10 cm Rol 0 0
258 GFK0223 Kasa Pembalut Hidrofil 4 m x 5 cm Rol 0 0
259 GFK0182 Kasa Steril 16 x 16 cm Kotak 24 0
260 GFK0308 Klor Fenol Kamfer (CHKM) KOTAK 0 0
261 GFK0468 Klorheksidin Lar. 4% - 5L GALLON 0 0
262 GFK0436 Kondom PIECES 0 0
263 GFK0174 Lisol Botol 0 0
264 GFK0204 Masker 3 Ply Tie One Pcs 0 0
265 GFK0390 Masker KN95 PIECES 0 0
266 GFK0205 Masker N95 Pcs 80 0
267 GFK0514 MASKER NON MEDIS ANAK PIECES 0 0
268 GFK0536 Masker Oksigen Anak PIECES 0 0
269 GFK0537 Masker Oksigen Dewasa PIECES 0 0
270 GFK0333 NURSE CAP PCS 0 0
271 GFK0400 OKSIGEN ISI ULANG UNITS 0 0
272 GFK0181 PAC Kg 0 0
273 GFK0224 Plester 2,5 cm x 4,5 cm (Kecil) Rol 0 0
274 GFK0461 Plester 5 cm x 5 cm ROLL 0 0
275 GFK0225 Plester 7,5 cm x 5 cm (Besar) Rol 0 0
276 GFK0226 Plesterin Bulat Soft Rol 17200 0
277 GFK0480 Plesterin Rol 5 cm x 5 cm ROLL 0 0
Polybag Sampah/Limbah Warna Hitam
278 GFK0183 50x70 cm pack @ 24 lbr 0 0
Polybag Sampah/Limbah Warna Hitam
279 GFK0184 60x100 cm pack @ 24 lbr 1 0
Polybag Sampah/Limbah Warna Kuning
280 GFK0185 60x100 cm pack @ 24 lbr 1 0
281 GFK0469 Sabun Cuci Tangan 5 L GALLON 0 0
282 GFK0206 Safety Box Pcs 50 0
283 GFK0336 SAFETY GLASS PCS 0 0
284 GFK0335 Sarung Tangan Kain PCS 0 0
285 GFK0344 Sarung Tangan Karet PAIR 0 0
286 GFK0490 Sarung Tangan Non Steril PIECES 0 0
287 GFK0328 Sarung Tangan Non Steril Uk. L PCS 500 0
288 GFK0214 Sarung Tangan Non Steril Uk. M Psg 0 0
289 GFK0459 Sarung Tangan Non Steril Uk. M PIECES 0 0
290 GFK0215 Sarung Tangan Non Steril Uk. S Psg 0 0
291 GFK0216 Sarung Tangan Non Steril Uk. XL 0 0
292 GFK0527 Sarung Tangan Non Steril Uk. XS PIECES 0 0
293 GFK0217 Sarung Tangan Obgyn Steril Psg 50 0
294 GFK0218 Sarung Tangan Steril 6,5 G Psg 0 0
295 GFK0219 Sarung Tangan Steril 7 G Psg 50 0
296 GFK0479 Sarung Tangan Steril 7,5 G PAIR 0 0
297 GFK0337 SEPATU BOOT PAIR 0 0
Silk (Benang Bedah Sutera) No. 2/0 dengan
298 GFK0466 jarum bedah PIECES 0 0
Silk (Benang Bedah Sutera) No. 3/0 dengan
299 GFK0207 jarum bedah Pcs 0 0
Silk (Benang Bedah Sutera) No. 4/0 dengan
300 GFK0384 jarum bedah PIECES 0 0
301 GFK0177 Softanol 5 Liter Botol/Galon 0 0
302 GFK0175 Softanol 500 ml Botol 0 0
303 GFK0398 Spalk Telapak Tangan Anak PIECES 0 0
304 GFK0399 Spalk Telapak Tangan Dewasa PIECES 0 0
305 GFK0331 STANDARD SHOE COVER PAIR 0 0
306 GFK0312 STERALD 5 LITER GALLON 0 0
307 GFK0310 STERICIDE 5 LITER GALLON 0 0
308 GFK0313 STERICIDE 500 ML BOTTLE 0 0
309 GFK0309 STERICIDE-3 5 LITER GALLON 0 0
310 GFK0311 STERIZYME 5 LITER GALLON 0 0
311 GFK0347 SURGEON CAP WITH TIE PCS 0 0
312 GFK0385 TISSU ROLL 10 0
313 GFK0208 Umbical Clam Pcs 0 0
314 GFK0209 Underpad (Softpad) 60x90 cm Pcs 0 0
315 GFK0210 Urine Bag Steril 2 L Pcs 0 0
316 GFK0227 Verband Elastis 10 cm Rol 0 0
317 GFK0472 Verband Elastis Besar Uk. 15 cm x 4,55 m ROLL 0 0
318 GFK0470 Verband Elastis Kecil Uk. 7,5 cm x 4,55 m ROLL 0 0

319 GFK0471 Verband Elastis Sedang Uk. 10 cm x 4,55 m ROLL 0 0


320 GFK0178 Viorex 2% 5 Liter Botol/Galon 0 0
321 GFK0176 Viorex 2% 500 ml Botol 0 0
322 GFK0346 Visor Mask Mika BUAH 0 0
BAHAN LABORATORIUM
323 GFK0515 Alat Suntik Sekali Pakai 0,3 ml PIECES 3840 0
324 GFK0502 ALBUMIN-BCG KIT 0 0
325 GFK0386 Answer HBsag Rapid Test TEST 0 0
326 GFK0387 Asam Sulfosalisilat 20% BOLUS 0 0
327 GFK0228 Benecheck Plus Glucose Test Strip Strip 0 0

328 GFK0229 Benecheck Plus Total Cholesterol Test Strip Strip 800 0
329 GFK0230 Benecheck Plus Uric Test Strip Strip 0 0
330 GFK0231 Benecheck Test System Pcs 0 0
331 GFK0516 BILIRUBIN TOTAL/DIRECT R1 KIT 0 0
Blood Glucose On Call Meter Only
332 GFK0424 Premium UNITS 0 0
333 GFK0501 CHOLESTEROL KIT 0 0
334 GFK0523 Cholesterol On Call Strip Test Acon STRIP 3800 0
335 GFK0500 CREATININE KIT 0 0
336 GFK0389 Etanol 70% - 100 ml BOTTLE 0 0
337 GFK0505 FOKUS FIBRILE ANTIGEN H PARATIPHY KIT 0 0
338 GFK0506 FOKUS FIBRILE ANTIGEN H-A PARATIPHY KIT 0 0
339 GFK0507 FOKUS FIBRILE ANTIGEN H-B PARATIPHY KIT 0 0
340 GFK0508 FOKUS FIBRILE ANTIGEN H-C PARATIPHY KIT 0 0
341 GFK0509 FOKUS FIBRILE ANTIGEN O-A PARATIPHY KIT 0 0
342 GFK0510 FOKUS FIBRILE ANTIGEN O-B PARATIPHY KIT 0 0
343 GFK0511 FOKUS FIBRILE ANTIGEN O-C PARATIPHY KIT 0 0
344 GFK0512 FOKUS FIBRILE ANTIGEN O-D PARATIPHY KIT 0 0
345 GFK0518 G-GT R1 KIT 0 0
346 GFK0499 GLUCOSE- GOD PAP KIT 0 0
347 GFK0388 Golongan Darah Test VIAL 0 0
348 GFK0503 GOT (ASAT) KIT 0 0
349 GFK0495 GPT (ALAT) KIT 0 0
350 GFK0498 HDL-C PRECIPITANT KIT 0 0
351 GFK0491 Hemoglobin Test Meter UNITS 0 0
352 GFK0492 Hemoglobin Test Strip STRIP 0 0
353 GFK0534 HIV Test 2 (Diagnostar DS) PIECES 0 0
354 GFK0535 HIV Test 3 (Standar Q HIV 1/2 AB 3 Line) PIECES 0 0
355 GFK0521 Humasens Plus Glucose Strip STRIP 800 0
356 GFK0522 Humasens Starter Pack UNITS 2 0
357 GFK0530 Kolekalsiferol (Vit. D3) 1.000 tablet TABLET 0 0
358 GFK0232 Media Amies Pcs 0 0
359 GFK0443 Mission Ultra Biosensor Cholesterol UNITS 0 0
Obat antituberkulosa FDC kat. 1 (OAT KDT
360 GFK0513 Dosis Harian) PACKAGE 0 0
361 GFK0486 Primetamine Tablet TABLET 0 0
362 GFK0504 PROTEIN TOTAL MONO KIT 0 0
363 GFK0338 RAPID TEST CORONA TEST 0 0
364 GFK0404 Reagen Control Serum Precicontrol KIT 0 0
365 GFK0402 Reagen Trigliseride KIT 0 0
366 GFK0403 Reagen Urea KILOGRAM 0 0
367 GFK0496 UNITROL I (CONTROL SERUM NORMAL) KIT 0 0
368 GFK0497 UNITROL II (FOC) KIT 0 0
369 GFK0517 URIC ACID KIT 0 0
370 GFK0525 Vaksin Janssen VIAL 0 327
PROGRAM KUSTA
371 GFK0233 MDT MB Anak Tablet Blister 0 0
372 GFK0234 MDT MB Dewasa Tablet Blister 0 0
373 GFK0235 MDT PB Anak Tablet Blister 0 0
374 GFK0236 MDT PB Dewasa Tablet Blister 0 0
PROGRAM IMUNISASI
375 VAC0304 Alat Suntik Sekali Pakai 0,5 ml TABLET 4400 0
376 GFK0529 CONECAVAC 10 DOSIS VIAL 0 10
377 VAC0249 Pelarut BCG Vial 20 0
378 VAC0250 Pelarut Campak Vial 0 0
379 VAC0252 Pelarut MR Vial 0 0
380 VAC0303 Penetes Vaksin Polio (BOPV) Buah 50 0
381 VAC0237 Vaksin Anti Rabies (VAR) Verorab Vial 0 0
382 VAC0238 Vaksin BCG Vial 20 0
383 VAC0239 Vaksin Campak Vial 0 0
VAKSIN CORONAVAC (SARS-CoV-2
384 GFK0487 inactivated) - Duadose VIAL 2160 0
385 GFK0531 VAKSIN COVOVAX (10 dosis) TABLET 0 0
386 VAC0240 Vaksin DTP HB/HIB Vial 0 0
387 VAC0242 Vaksin HBV Vial 0 0
388 VAC0243 Vaksin Hepatitis B Immunoglobulin (HBIg) Vial 1 0
Vaksin Hepatitis B Recombinant Injeksi
389 VAC0251 0,5ml Vial 50 0
VAKSIN HYPERHEP B S/D CAIRAN INJEKSI
390 VAC0306 220 IU/ML VIAL 0 0
391 VAC0241 Vaksin Jerap DT Vial 0 0
392 VAC0247 Vaksin Jerap Td Vial 0 0
393 VAC0256 Vaksin Meningitis (Formening) Vial 0 0
394 VAC0255 Vaksin Meningitis (Menivax) Vial 0 0
395 VAC0244 Vaksin MR Vial 0 0
VAKSIN PCV (PNEUMUCOCCAL
396 GFK0476 CONJUNGATE VACCINE) VIAL 30 0
397 GFK0493 Vaksin Pfizer VIAL 80 20
398 VAC0245 Vaksin Polio (BOPV) Vial 50 0
399 VAC0253 Vaksin Polio (IPV 10 ds) Vial 0 0
400 VAC0254 Vaksin Polio (IPV 20 ds) Vial 0 0
401 VAC0246 Vaksin Polio (IPV 5 ds) Vial 0 0
402 VAC0305 VAKSIN RABIES HYPERRAB S/D 2 ML VIAL 0 0
403 VAC0248 Vaksin Tuberkulin Vial 0 0
PROGRAM TB
404 GFK0489 CARTRIDGE GENEXPERT TEST 0 0
405 GFK0426 CENTRIFUSE UNITS 0 0
406 GFK0257 Kaca Sediaan (Object Glass) Pcs 0 0
407 GFK0258 Obat antituberkulosa FDC Anak Paket 0 0
408 GFK0259 Obat antituberkulosa FDC kat. 1 Paket 0 0
409 GFK0260 Obat antituberkulosa FDC kat. 2 Paket 0 0
410 GFK0320 Obat antituberkulosa kombipak kat. 1 PACKAGE 0 0
411 GFK0261 Pot Dahak Pcs 0 0
412 GFK0262 Reagen Ziehl Neelsen Paket 0 0
413 GFK0365 Xpert MTB/RIF Assay Kit KIT 0 0
PROGRAM GIZI
Besi (Fe) Tablet Tambah Darah + Asam
414 GFK0263 Folat Tablet 54570 0
415 GFK0264 Mineral Mix Sachet 0 0
416 GFK0265 Retinol (Vit. A) Kapsul Lunak 100.000 IU Kapsul Lunak 850 0
417 GFK0266 Retinol (Vit. A) Kapsul Lunak 200.000 IU Kapsul Lunak 5000 0
418 GFK0485 Taburia SACHET 4740 0
PROGRAM HIV AIDS
419 GFK0315 DBS Collection Kit KIT 0 0
420 GFK0267 Duviral (ZDV 300 mg + 3TC 150 mg) Tablet 0 0
421 GFK0268 Efavirenz 200 mg (EFV 1) Tablet 0 0
422 GFK0269 Efavirenz 600 mg (EFV 2) Tablet 0 0
FDC (TDF 300 mg + 3TC 300 mg + EFV 600
423 GFK0270 mg) Tablet 0 0
FDC Anak (ZDV 60 MG + 3TC 30 mg + NVF
424 GFK0271 50 mg) Tablet 0 0
425 GFK0272 HIV Test 1 (SD) tes/ kit 200 0
426 GFK0273 HIV Test 2 (FOKUS) tes/ kit 0 0
427 GFK0274 HIV Test 3 (VIKIA) tes/ kit 0 0
428 GFK0275 Lamivudine 150 mg (3TC) Tablet 0 0
429 GFK0276 Nevirapine 200 mg (NVP) Tablet 0 0
430 GFK0277 Rapid Test Syphillis tes/ kit 300 0
431 GFK0278 RDT Leptospira tes/ kit 0 0
432 GFK0325 REAGEN CD4 Tipe 1 TEST 0 0
433 GFK0279 RPR Syphilis tes/ kit 0 0
434 GFK0280 Tenofovir 300 mg (TDF) Tablet 0 0
435 GFK0281 Zidovudine 100 mg (ZDV) Tablet 0 0
PROGRAM HEPATITIS
436 GFK0282 Reagen Rapid Test HBsAg tes/ kit 0 0
PROGRAM DIARE
437 GFK0383 Atapulgit tablet 650 mg TABLET 0 0
438 GFK0283 Garam Oralit II (200 ml) Serbuk Sachet 1800 0
439 GFK0284 Obat Antidiare Nonspesifik Sirup Botol 0 0
440 GFK0285 Obat Antidiare Nonspesifik Tablet 600 mg Tablet 0 0
441 GFK0286 Zink Sirup 60 ml Botol 108 0
442 GFK0297 Zink Syrup 20mg/5 ml Tablet 0 0
443 GFK0287 Zink Tablet 200 mg Dispersible Tablet 500 0
444 GFK0298 Zink Tablet Dispersible 20 mg Tablet 0 0
PROGRAM FILARIASIS
445 GFK0319 Alat Pelindung Diri (APD) PACKAGE 0 0
446 GFK0317 Bactivec 30 ML BOTTLE 0 0
Dehidroartemisin + Piperaquine Tablet
447 GFK0288 (DHP) Tablet 0 0
448 GFK0289 Dietilkarbamazine (DEC) Tablet 100 mg Tablet 0 0
449 GFK0318 Jumantik Kit PACKAGE 0 0
450 GFK0290 Primakuin Tablet 15 mg Tablet 0 0
451 GFK0316 RDT DBD Combo TEST 0 0
PROGRAM IMS
452 GFK0291 Artesunat Injeksi 60mg/ml Ampul 0 0
453 GFK0292 Azitromisin Tablet 500 mg Tablet 0 0
454 GFK0293 Benzatin Penisilin Injeksi 2,4 mg Ampul 0 0
455 GFK0294 Cefixime + Azitromisin Kombipak Paket 0 0
456 GFK0295 Flukonazol Tablet 150 mg Tablet 0 0
COVID-19
457 GFK0428 ACU CARE PCS 0 0
458 GFK0420 ANTIBACTERIAL FILTER PCS 0 0
459 GFK0421 ASTRAL 150 PCS 0 0
460 GFK0380 BRANKAR UNITS 0 0
461 GFK0453 BUFFER TUBE 0 0
462 GFK0422 BUKU JUKNIS PVC VAKSINISASI COVID-19 PIECES 0 0
463 GFK0528 BUSA KILOGRAM 0 0
464 GFK0412 Cetirizine Sirup 5 mg/ 5 ml GALLON 0 0
465 GFK0394 Cetirizine Tablet TABLET 0 0
466 GFK0457 CRYSTAMIX KIT KIT 0 0
467 GFK0409 Desinfektan Spray BOTTLE 0 0
468 GFK0407 Dry Mist Hydrogen Peroxide Desinfector UNITS 0 0
469 GFK0392 Ermuno Kaplet TABLET 0 0
470 GFK0401 Favipiravir Tablet TABLET 0 0
471 GFK0410 Hand Wash BOTTLE 0 0
472 GFK0413 Hand Wash GALLON 0 0
473 GFK0427 HME PCS 0 0
474 GFK0423 KARTU VAKSINISASI COVID-19 PIECES 0 0
475 GFK0449 KERTAS STIKER LABEL PACKAGE 0 0
476 GFK0379 KURSI RODA UNITS 0 0
477 GFK0439 LARUTAN HAND SANITIZER BOTTLE 10 0
478 GFK0452 LARUTAN HAND SANITIZER 290 ml BOTTLE 0 0
479 GFK0408 Larutan Oxister H2O2 GALLON 0 0
480 GFK0448 Larutan Oxister H2O2 2% - 5L GALLON 0 0
481 GFK0447 Larutan Oxister H2O2 7,5 % - 20L GALLON 0 0
482 GFK0368 Lemari Instrumen 2 Pintu UNITS 0 0
483 GFK0369 Lemari Obat 2 Pintu UNITS 0 0
484 GFK0393 Levofloxacin 500 mg Tablet TABLET 0 0
485 GFK0378 Masker bedah 3fly PIECES 1000 0
486 GFK0415 MASKER NON MEDIS PIECES 0 0
487 GFK0454 MEDICAL SWAB PIECES 0 0
488 GFK0455 MICROTIPS 1O UI PIECES 0 0
489 GFK0456 MICROTIPS 1O0 UI PIECES 0 0
490 GFK0432 MICROTUBE PACKAGE 0 0
491 GFK0414 Minor Set UNITS 0 0
492 GFK0425 NEBULIZER UNITS 0 0
493 GFK0411 Obat Batuk Sirup BOTTLE 96 0
494 GFK0396 Obat Flu Batuk Syrup BOTTLE 0 0
495 GFK0397 Obat Flu Batuk Syrup BOTTLE 0 0
496 GFK0395 Obat Flu Batuk Tablet TABLET 1000 0
497 GFK0370 PARAFILM ROLL 0 0
498 GFK0374 Penlight UNITS 0 0
499 GFK0391 POLYBAG PIECES 0 0
500 GFK0488 PULSE OXIMETRI UNITS 4 0
501 GFK0450 RAK TABUNG PIECES 0 0
502 GFK0417 RAPID TEST ANTIGEN TEST 300 0
503 GFK0433 Reagen PCR Portable PIECES 0 0
504 GFK0377 REGULATOR OKSIGEN UNITS 0 0
505 GFK0419 ROMPI TIM VAKSINISASI COVID-19 PIECES 0 0
506 GFK0371 Sarung Tangan Karet PIECES 0 0
507 GFK0465 Sarung Tangan Non Steril Uk. S PIECES 500 0
508 GFK0373 Stetoskop Dewasa UNITS 0 0
509 GFK0375 TABUNG OKSIGEN UNITS 0 0
510 GFK0430 Tempat Sampah / Limbah Medis 120 L UNITS 0 0
511 GFK0416 Tempat Sampah / Limbah Medis 660 L UNITS 0 0
512 GFK0364 Tempat Sampah / Limbah Medis 87 L UNITS 0 0
513 GFK0372 Tensimeter UNITS 0 0
514 GFK0429 Termometer Gun IR PIECES 0 0
515 GFK0446 TONGUE SPATEL PACKAGE 0 0
516 GFK0376 TROLLEY OKSIGEN UNITS 0 0
VAKSIN CORONAVAC (SARS-CoV-2
517 GFK0418 inactivated) VIAL 122 0
518 GFK0482 VAKSIN COVID-19 (ASTRAZANECA) VIAL 215 0
VAKSIN COVID-19 (GOTONG
519 GFK0483 ROYONG/VGR) VIAL 5 0
VAKSIN COVID-19 (VIRUS SARS-CoV-2
520 GFK0437 Inactive) - BIOFARMA VIAL 750 0
VAKSIN COVID-19 SINOPHARM (GOTONG
521 GFK0484 ROYONG/VGR) VIAL 0 0
522 GFK0481 Vaksin Moderna VIAL 77 5
523 GFK0363 Visor Mask Mika BUAH 0 0
524 GFK0445 VITACEE TABLET KOTAK 0 0
525 GFK0434 Vortex UNITS 0 0
526 GFK0359 VTM TUBE 50 0
527 GFK0451 WARPPING UK. 30 CM x 500 M ROLL 0 0

Kepala Puskesmas Diterima Oleh

(..............................) (..............................)
PATEN BANDUNG
BER SARI
SUMBERSARI, KEC. CIPARAY

PERMINTAAN OBAT (LPLPO)


April 2022

Sisa Stok
Persediaan Pemakaian Permintaan Pemberian Ket.
Akhir Optimum

0 0 0 - 5000 APBD
0 0 0 - 0 APBD
0 0 0 - 100 APBD
500 0 500 800 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
14650 3600 11050 23440 0 APBD
5200 2700 2600 8320 5000 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
4000 1400 2600 6400 10000 APBD
70 0 70 112 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
50 25 25 80 200 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD
30 20 10 48 50 APBD

0 0 0 - 0 APBD

10 2 8 16 0 APBD

80 0 80 128 0 APBD
1400 400 1000 2240 0 APBD
254 0 254 406.4 0 APBD
1500 1500 0 2400 0 APBD
0 0 0 - 0 APBD
100 0 100 160 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
125 75 50 200 50 APBD
50 0 50 80 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 3000 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
5 0 5 8 0 APBD
127 0 127 203.2 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD
0 0 0 - 0 APBD
100 0 100 160 0 APBD
50 15 35 80 0 APBD
2000 300 1700 3200 0 APBD
0 0 0 - 5 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
2 0 2 3.2 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
100 0 100 160 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
129 0 129 206.4 0 APBD
0 0 0 - 100 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
400 400 400 640 1000 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
7000 2400 4600 11200 2000 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
800 0 800 1280 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
100 100 0 160 1000 APBD
72 0 72 115.2 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD
1700 0 1700 2720 0 APBD
9600 200 9400 15360 0 APBD
300 300 0 480 2000 APBD
470 200 270 752 0 APBD
200 100 100 320 0 APBD
0 0 0 - 0 APBD
0 0 0 - 500 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 150 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
178 0 178 284.8 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD

300 0 300 480 0 APBD

600 0 600 960 0 APBD


0 0 0 - 0 APBD

40 0 40 64 0 APBD
0 0 0 - 2000 APBD
6 0 6 9.6 0 APBD
6 0 6 9.6 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
7000 6800 200 11200 7000 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD

0 0 0 - 0 APBD
0 0 0 - 3000 APBD
0 0 0 - 0 APBD
470 0 470 752 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
600 200 400 960 1000 APBD
30 0 30 48 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
300 0 300 480 0 APBD
0 0 0 - 500 APBD
0 0 0 - 5000 APBD
50 0 50 80 0 APBD

0 0 0 - 0 APBD

21 0 21 33.6 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD

0 0 0 - 0 APBD
1500 1500 0 2400 5000 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 1000 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
24 14 10 38.4 50 APBD
300 0 300 480 0 APBD
0 0 0 - 0 APBD
9000 800 8200 14400 10000 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 100 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
6 0 6 9.6 0 APBD
0 0 0 - 0 APBD
2 0 2 3.2 0 APBD
0 0 0 - 0 APBD
0 0 0 - 100 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
5200 2600 2600 8320 5000 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
2 0 2 3.2 0 APBD
0 0 0 - 100 APBD
800 0 800 1280 0 APBD
900 0 900 1440 0 APBD

100 20 80 160 0 APBD


0 0 0 - 0 APBD

0 0 0 - 0 APBD
3 0 3 4.8 0 APBD

0 0 0 - 0 APBD
300 300 300 480 500 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
3400 0 3400 5440 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
4000 4000 0 6400 0 APBD

0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
50 0 50 80 0 APBD
0 0 0 - 0 APBD
1200 0 1200 1920 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD

0 0 0 - 0 APBD

0 0 0 - 0 APBD
0 0 0 - 0 APBD
1 0 1 1.6 0 APBD

0 0 0 - 0 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD

0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
1 0 1 1.6 0 APBD
1 0 1 1.6 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
24 0 24 38.4 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
80 0 80 128 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
17200 0 17200 27520 0 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD

1 0 1 1.6 0 APBD

1 0 1 1.6 0 APBD
0 0 0 - 0 APBD
50 0 50 80 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
500 0 500 800 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
50 0 50 80 0 APBD
0 0 0 - 0 APBD
50 0 50 80 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD

0 0 0 - 0 APBD

0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
10 0 10 16 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

3840 0 3840 6144 0 APBD


0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

800 0 800 1280 0 APBD


0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD
0 0 0 - 0 APBD
3800 0 3800 6080 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
800 0 800 1280 0 APBD
2 0 2 3.2 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
327 0 327 523.2 0 APBD

0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

4400 0 4400 7040 0 APBD


10 0 10 16 0 APBD
20 0 20 32 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
50 0 50 80 0 APBD
0 0 0 - 0 APBD
20 0 20 32 0 APBD
0 0 0 - 0 APBD

2160 0 2160 3456 0 APBD


0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
1 0 1 1.6 0 APBD
50 0 50 80 0 APBD

0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

30 0 30 48 0 APBD
100 0 100 160 0 APBD
50 0 50 80 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

54570 0 54570 87312 0 APBD


0 0 0 - 0 APBD
850 0 850 1360 0 APBD
5000 0 5000 8000 0 APBD
4740 0 4740 7584 0 APBD

0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD

0 0 0 - 0 APBD
200 0 200 320 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
300 0 300 480 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD

0 0 0 - 1000 APBD
1800 200 1600 2880 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
108 36 72 172.8 0 APBD
0 0 0 - 0 APBD
500 500 0 800 1000 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
10 0 10 16 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
1000 0 1000 1600 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
96 0 96 153.6 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
1000 0 1000 1600 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
4 0 4 6.4 0 APBD
0 0 0 - 0 APBD
300 0 300 480 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
500 0 500 800 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD

122 0 122 195.2 0 APBD


215 0 215 344 0 APBD

5 0 5 8 0 APBD

750 0 750 1200 0 APBD

0 0 0 - 0 APBD
82 0 82 131.2 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
0 0 0 - 0 APBD
50 0 50 80 0 APBD
0 0 0 - 0 APBD

Diterima Oleh Diserahkan Oleh

............................) (..............................)

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