LEMBAR PEMAKAIAN DAN LEMBAR PERMINTA

Kode Puskesmas
Puskesmas : Pustu Sekoban Bulan : juli
Kecamatan : Lamandau Tahun : 2022
Kab/Kota : Lamandau
Propinsi : Kalimantan Tengah

TABLET, KAPSUL, KAPLET, SIRUP, SU

Stok Awal Penerimaan
No. Nama Barang Kemasan
APBD Buffer APBD Buffer
1 Acetosal 100mg tablet
2 Acetylcysteine 200mg kapsul
3 Acyclovir 400mg tablet
4 Albendazol 400mg tablet
5 Allopurinol 100mg tablet
6 Alprazolam 1mg tablet
7 Ambroxol Sirup 15mg/5ml botol
8 Ambroxol 30mg tablet
9 Aminophylin 200mg botol
10 Amitriptilin HCl 25mg tablet
11 Amlodipine 5mg tablet
12 Amlodipine 10mg tablet
13 Amoxicillin Sirup 125mg/60ml botol
14 Amoxicillin Sirup 250mg/60ml botol
15 Amoxicillin 250mg tablet
16 Amoxicillin 500mg tablet
17 Antalgin 500mg tablet
18 Antasida Doen 200mg+200mg tablet
19 Antasida Suspensi 60ml botol
20 Attapulgite 650mg (NEO DIAGON 650) tablet
21 Asam Folat 400mcg (PROFOLAT 400) tablet
22 Asam Mefenamat 500mg tablet
23 Betahistine Mesilate 6mg tablet
24 Calcium Lactate 500mg tablet
25 Captopril 12,5mg tablet
26 Captopril 25mg tablet
27 Captopril 50mg tablet
28 Carbamazepin 200mg tablet
29 Cefadroxil 500mg (CEDROX 500) tablet
30 Cefadroxil Sirup 125mg/60ml botol
31 Cetirizine 10mg tablet
32 Cetirizine Sirup 5mg/5ml botol
33 Chloramphenicol 500mg (CHLORAMEX 500) kapsul
34 Chloramphenicol 125mg/5ml botol
35 CTM (Chlorpeniramin Maleat) 4mg tablet
36 Chlorpromazine HCl 100mg tablet
37 Cimetidin 200mg tablet
38 Ciprofloxacin 500mg tablet
39 Clobazam 10mg tablet
40 Clozapine 25mg tablet
41 Codein HCl 10mg tablet
42 Cotrimoxazole Sirup 240mg/5ml botol
43 Cotrimoxazole 960mg tablet
44 Dexamethason 0,5mg tablet
45 Herbalpain tablet 50
46 Diazepam 5mg tablet
47 Digoxin 0,25mg tablet
48 Dimenhydrinate 50mg tablet 50
49 DHP-FRIMAL tablet
50 Domperidone 10mg tablet
51 Domperidone Sirup 5mg/5ml botol
52 Ephedrin HCl 25mg tablet
53 Ergotamin Caffeine 1mg+100mg tablet
54 Erytromicin 200mg/5ml botol
55 Erytromicin 250mg tablet
56 Ethambutol HCl 250mg tablet
57 Ethambutol HCl 500mg tablet
58 Furosemid 40mg tablet
59 Garam Oralit u/ 200ml Air sach
60 Glibenclamid 5mg tablet
61 Glimepiride 2mg tablet
62 Griseofulvin 125mg tablet
63 Guaifenisin 100mg tablet
64 Haloperidol 0,5mg tablet
65 Haloperidol 5mg tablet
66 Hidrochlortiazid (HCT) 25mg tablet
67 Ibuprofen Sirup 100mg/5ml botol
68 Ibuprofen 200mg tablet
69 Ibuprofen 400mg tablet
70 Isoniazid (INH) 100mg tablet
71 Isosorbidinitrat (ISDN) 5mg tablet
72 Ketoconazole 200mg tablet
73 Laktulosa 3,335g/5ml botol
74 Lansoprazole 50mg kapsul
75 Loperamide 2mg tablet
76 Loratadine 10mg tablet
77 Metformin 500mg tablet
78 Methylergometrin 0,125mg tablet
79 Methylprednisolone 4mg tablet
80 Metoclopramide HCl 5mg tablet
81 Metronidazol 500mg tablet
82 Metronidazol 125mg/5ml botol
83 Mineral Mix sach
84 Multivitamin (SIVIT-ZINC) tablet
85 Natrium Bikarbonat 500mg tablet
86 Natrium Diklofenak 25mg tablet 100
87 Nifedipin 10mg tablet
88 Kaolin Pektin Sirup (NOVADIAR) botol
89 Nystatin 100.000iu Tablet Vagina tablet
90 Nystatin 500.000iu tablet
91 OAT ANAK paket
92 OAT KAT 1. DEWASA paket
93 OAT KAT 2. DEWASA paket
94 Omeprazole 20mg kapsul
95 Ondasentron 8mg tablet
96 Papaverin 40mg tablet
97 Paracetamol 120mg/5ml botol
98 Paracetamol Drop 100mg/ml botol
99 Paracetamol 500mg tablet
100 Pirantel Pamoat 125mg/5ml botol
101 Pirantel Pamoat 125mg tablet
102 Pirantel Pamoat 250mg (PANTRIN 250) tablet
103 Piroxicam 10mg tablet
104 Prednison 5mg tablet 100
105 Prophylthiuracil (PTU) 100mg tablet
106 Quinine 222mg tablet
107 Ranitidine 150mg tablet 100
108 Risperidone 2mg tablet
109 Salbutamol 2mg/5ml botol
110 Salbutamol 2mg tablet
111 Salbutamol 4mg tablet
112 Simvastatin 10mg tablet
113 Simvastatin 20mg tablet
114 Sucralfate 500mg/5ml botol
115 Tablet Tambah Darah tablet
116 Tetracycline HCl 500mg tablet
117 Trihexilphenidil 2mg tablet
118 Ventolin Nebule pcs
119 Vitamin A (Retinol) Merah (200.000iu) kapsul
120 Vitamin A (Retinol) Biru (100.000iu) kapsul
121 Vitamin B Complex tablet
122 Vitamin B1 (Thiamin) 50mg tablet
123 Vitamin B6 (Pyridoxin HCl) 10mg tablet
124 Vitamin B12 (Sianokobalamin) 50mcg tablet
125 Vitamin C (Asam Ascorbat) 50mg tablet
126 Vitamin K (Phytomenadion) 10mg tablet
127 Zinc Suspensi 20mg/5ml botol
128 Zinc 20mg tablet
LEMBAR PERMINTAAN OBAT (LPLPO)

juli
2022

L, KAPLET, SIRUP, SUSPENSI

Pemakaian Sisa Stok
Exp. Permintaan
APBD Buffer APBD Buffer
0

0
0
0
0
0
0
0
0
0

0 100
20

0
100
0
0

0
0
0
0 100
0
0 100
0

0
0
0
0
0
0
0
0
0

0 100
50 0
 0
0
50 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 50
0
0
0
0
0 50
0
0
0
0
0
0
100 100
0
0
0
0
0
0
0
0
0
0
0 20
0
0 100
0
0
 0
0
100 0
0
0
80 20
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0

0
0
 SALEP, KRIM, SUPPOSITORIA, ANTISEP
Stok Awal Penerimaan
No. Nama Barang Kemasan
APBD Buffer APBD Buffer
1 2 - 4 Salep botol 6
2 Abate sach
3 Acyclovir 5%/5gram botol
4 Aceptic Gel botol
5 Alkohol 70% 1000ml botol
6 Alkohol 70% 300ml botol
7 Alkazyme botol
8 Alkacide 1000ml botol
9 Anti Fungi Doen 30gram botol
10 Anti Haemoroid 2gram suppo
11 Bacitracin Cream 5gram tube
12 Bedak Salicyl buah
13 Betamethasone Cream 0,1%/5gram tube
14 Chloramphenicol Salep Kulit (BUFACETIN) tube
15 Chloramphenicol Salep Mata tube 20
16 Chloramphenicol Tetes Telinga botol
17 Dulcolac Anak suppo
18 Dulcolac Dewasa suppo
19 Gentamicin Salep Mata 0,3%/3,5gram tube 10
20 Gentamicin Tetes Mata botol
21 Gentian Violet 1% botol
22 Hydrocortison Cream tube 20
23 Ketoconazole cream tube
24 Lysol botol 1
25 Miconazole Cream tube
26 Oxytetracycline Salep Mata tube 20
27 Phenol Gliserol Tetes Telinga 10% botol
28 Povidone Iodine 30ml botol
29 Povidone Iodine 300ml botol
30 Rivanol 0,1% botol
31 Soffra-tulle biji
32 Ultrasonic Gel botol
PPOSITORIA, ANTISEPTIK, DLL
Pemakaian Sisa Stok
Exp. Permintaan
APBD Buffer APBD Buffer
6
0
0
0
0
0
0
0
0
0
0
0
0
0
20
0
0
0
3 7
0
0
6 14
0
1
0
5 15
0
0
0
0
0
0
 INJEKSI
Stok Awal Penerimaan
No. Nama Barang Kemasan
APBD Buffer APBD Buffer
1 Antalgin 1000mg/2ml ampul 10
2 Aminophylin 24mg/ml ampul
3 Atropin Sulfat 0,5mg/ml ampul
4 Dexamethasone 5mg/ml ampul
5 Diazepam 5mg/2ml ampul
6 Diphenhydramin 10mg/ml ampul 10
7 Ephinephrine 1mg/ml ampul
8 Kanamycin 1000mg vial
9 Lidocain 20mg/ml ampul 10
10 Lidocain Compositum 2% ampul
11 Methyl Ergomethrine 0,2mg/ml ampul
12 Oxytocin 10IU/ml ampul
13 Papaverin 40mg/ml ampul
14 Ranitidine 25mg/ml ampul
15 Vitamin B1 (Thiamin) Inj ampul
16 Vitamin B12 (Cyanocobalamin) Inj ampul 5
17 Vitamin K (Phitomenadione) 10mg/ml ampul
18 Vitamin K (Phitomenadione) (NEO-K) ampul
INJEKSI
Pemakaian Sisa Stok
Exp. Permintaan
APBD Buffer APBD Buffer
3 7 0
0
0
0
0
10 0
0
0
3 7
0
0
0
0
0
0
5 0 10
0
0
 VAKSIN
Stok Awal Penerimaan
No. Nama Barang Kemasan
APBD Buffer APBD Buffer
1 Vaksin Anti Tetanus Serum ampul
2 Vaksin Anti Rabies vial
3 Vaksin BCG vial
4 Vaksin Bivalent Oral Poliomylitis vial
5 Vaksin Campak vial
6 Vaksin DPT/HB/Hib vial
7 Vaksin COVID-19 (Sinovac) vial
8 Vaksin DT vial
9 Vaksin Hepatitis B Unijeck vial
10 Vaksin IPV vial
11 Vaksin MR vial
12 Vaksin Polio vial
13 Vaksin TD vial
VAKSIN
Pemakaian Sisa Stok
Exp. Permintaan
APBD Buffer APBD Buffer
0
0
0
0
0
0
0
0
0
0
0
0
0
 INFUS
Stok Awal Penerimaan
No. Nama Barang Kemasan
APBD Buffer APBD Buffer
1 KA EN 3A 500ml flakon
2 KA EN 3B 500ml flakon
3 Glucose 5% (D5) 500ml flakon
4 Meylon (Natrium Bikarbonat) flakon
5 MgSO4 20% flakon
6 MgSO4 40% flakon
7 NaCl 0,9% (NS) flakon
8 Ringer Lactate 500ml flakon
9 Water Pro Injection Otsu WI 25ml flakon
INFUS
Pemakaian Sisa Stok
Exp. Permintaan
APBD Buffer APBD Buffer
0
0
0
0
0
0
0
0
0
 ALKES
Stok Awal Penerimaan
No. Nama Barang Kemasan
APBD Buffer APBD Buffer
1 Abbocath T No. 16 biji
2 Abbocath T No. 18 biji
3 Abbocath T No. 20 biji 10
4 Abbocath T No. 22 biji 6
5 Abbocath T No. 24 biji
6 Abbocath T No. 26 biji
7 Alat Suntik Sekali Pakai 0,05cc biji
8 Alat Suntik Sekali Pakai 0,5cc biji
9 Alat Suntik Sekali Pakai 1cc biji
10 Alat Suntik Sekali Pakai 2,5cc biji
11 Alat Suntik Sekali Pakai 3cc biji 105
12 Alat Suntik Sekali Pakai 5cc biji 100
13 Alat Suntik Sekali Pakai 10cc biji
14 Alat Suntik Sekali Pakai 20cc biji
15 Alat Suntik Sekali Pakai 50cc biji
16 Alkohol Swab kotak 100
17 A P D (Baju Hazmat) set
18 A P D IMUNISASI set
19 AUTOCHECK Asam Urat @ 50 strip kotak
20 AUTOCHECK Gula Darah @ 50 strip kotak
21 AUTOCHECK Kolesterol @ 25 strip kotak
22 BLOOD Lancet kotak
23 CATGUT Chromic No. 2/0 biji
24 CATGUT Chromic No. 3/0 biji
25 CATGUT Plain No. 2/0 biji
26 CATGUT Plain No. 3/0 biji 12
27 Folley Catheter No. 10 biji
28 Folley Catheter No. 16 biji
29 Folley Catheter No. 18 biji
30 Folley Catheter No. 20 biji
31 Ethyl Chloride botol
32 Handscoon Steril 7 pcs
33 Handscoon Steril 7,5 pcs
34 Handscoon Steril 8 pcs
35 Handscoon Non Steril M pcs
36 Handscoon Non Steril L pcs
37 Handscoon Non Steril XL pcs
38 HBsAg kotak
39 Infuset Anak biji
40 Infuset Dewasa biji
41 KACA Slides kotak
42 Kapas 500gram kotak
43 Kasa Hidrofil 4 × 10cm roll
44 Kasa Hidrofil 40yd × 80cm roll
45 Kasa Steril kotak
46 Kertas Perkamen pak
47 Magslang FR. 14 pcs
48 Magslang FR. 16 pcs
49 Masker 3ply Medis lembar
50 Masker N95 pcs
51 Masker KN95 pcs
52 Nasal Oksigen Bayi biji
53 Nasal Oksigen Anak biji
54 Nasal Oksigen Dewasa biji
55 Nebulizer Mask Dewasa biji
56 Nebulizer Mask Pediatrik biji
57 Paper Tape roll
58 Papsmear Kit uk. L pcs
59 Papsmear Kit uk. M pcs
60 Pembalut Gips Medigyps 4" biji
61 Penjepit Tali Pusat pcs
62 Plester 5yd × 2" roll
63 Plester Non Woven 5cm × 10m roll
64 Pot Sputum biji
65 Plester Roll Pro-Crepe biji
66 Rapid Test Indec® Covid-19 IgG/IgM kotak
67 RDT Malaria tes
68 RDT Siphyllis AB kotak
69 Sarung Tangan Obsgyn biji
70 Safety Box pcs
71 SD BIOLINE HIV kotak
72 SILK (Benang Bedah Sutra) No. 2/0 biji
73 SILK (Benang Bedah Sutra) No. 3/0 biji
74 Steril Surgical Blade #11F #4HDL pcs
75 Steril Surgical Blade #21F #3HDL pcs
76 Steril Surgical Blade #36F #4HDL pcs
77 Spon Gelatin (1 × 1 × 1)cm biji
78 Stik Pen biji
79 Tes Kehamilan biji
80 Waskom (tempat cuci alat ugd) Curved biji
81 Underpad biji
82 Urine Bag biji
83 URIT 11G botol
84 Wing Needle 21G biji
85 Wing Needle 23G biji
86 Wing Needle 25G botol
87 Wing Needle 27G biji

Mengetahui/Menyetujui,

Kepala Puskesmas Tapin Bini Yang Menyerahkan, Yang Menerim

dr. RUDI ADE MURHARYANTO, A.Md.Far. SAEFUL MUJAB, S.K

NIP. 19770824 200801 1 017 NIP. 19881201 201903 1 014 NIP.
ALKES
Pemakaian Sisa Stok
Exp. Permintaan
APBD Buffer APBD Buffer
0

10
6
0
0
0
0
0
0
10 95
40 60
0

20 80
0
0
0
0
0
0
0
0
0
12
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
0
0
0
0
0
0
0
0
0
0
0
0
0
0

Sekoban, 25 April 2021

Yang Menerima Yang Melapor

SAEFUL MUJAB, S.Kep., Ns. SAEFUL MUJAB, S.Kep., Ns.

NIP. NIP.