Lplpo 2024 - Yg Sedang Di Kerjain

D AN
N
N
N
L
PT
A
A
IA
A
C
N
SE A
TA
IA
W
O
O
A
A
R M
NO JENIS OBAT
ST
A
TU
IN
K
K
PE ERI
C
A
K
M
SA
SA
O
M
O
R
ST
ST
PE
SI
PE
PE
1 2 3 4 5 6 7 8 9 10
OBAT
1 Acyclovir 400 mg tab 600 200 800 0 800
2 Albendazol syirup tab 0 0 0 0 0
3 Albendazol 400 mg tab 2508 0 2508 0 2508
4 Alprazolam 0.5 mg tab 0 0 0 0 0
5 Amitriptylin 25 mg tab 290 0 290 0 290 500
6 Amlodipin 10 mg tab 0 0 0 0 0
7 Amlodipin 5 mg tab 1350 0 1350 550 800 2000
8 Amoxycilin kaplet 500 mg kap 6600 2600 9200 3600 5600 5000
9 Amoxycilin sirup kering 125 mg/5 ml botol 0 0 0 0 0
10 Amoxycilin sirup kering 100 mg/ml (drop) botol 41 0 41 0 41
11 Antasida DOEN tablet 5600 2000 7600 2600 5000 5000
12 Antasida DOEN sirup botol 0 0 0 0 0
13 Azytromicyin 500 mg tab 20 0 20 0 20
14 Asam Folat 1 mg tab 600 0 600 0 600
15 Asam mefenamat kaplet 500 mg kap 2000 2000 4000 1300 2700 1000
16 Besi (II) sulfat (Tablet Tambah Darah) tab 2610 7200 9810 2060 7750
17 Betametason krim 0,1% tube 0 0 0 0 0 100
18 Captopril 12,5 mg tab 0 0 0 0 0
19 Captopril 25 mg tab 350 0 350 0 350 1000
20 Carbamazepine 200 mg tab 0 0 0 0 0
21 Cotrimoksazol sirup botol 125 0 125 20 105
22 Cefadroxil sirup kering 125 mg/5 ml botol 0 0 0 0
23 Cefadroxil 250 mg tab 900 900 300 600 3000
24 Cetirizin tablet 10 mg tab 0 0 0 0 0 5000
25 Cotrimoxazol Tab 800 mg/160 mg tab 0 0 0 0 0 3000
26 Chlorfeniramin maleat (CTM) 4 mg tablet 2700 0 2700 2700 0 5000
27 Ciprofloxacin 500 mg tab 1700 0 1700 1200 500 5000
28 Codein 10 mg tab 300 0 300 9 291
29 Deksametason 0,5 mg tab 0 0 0 0 0
30 Deksametason 5 mg/ml injeksi 98 0 98 0 98
31 Diazepam 2 mg tablet 328 0 328 234 94
32 Diazepam injeksi ampul 0 0 0 0 0 10
34 Domperidon tab 10 mg tab 2300 0 2300 0 2300
35 Domperidon sirup botol 0 0 0 0 0 10
36 Furosemide 40 mg tab 1100 0 1100 0 1100
37 Garam Oralit sachet 150 0 150 0 150
38 Glibenclimde 5 mg tab 1800 1000 2800 100 2700 1000
39 Griseofulvin (micronized) 125 mg tab 0 0 0 0 0 2000
40 Griseofulvin 500 mg tab 0 0 0 0 0 1000
41 Haloperidol 0,5 mg tab 757 0 757 170 587
43 Haloperidol 5 mg tab 0 500 500 0 500 1000
44 Herbapain Premeditol 200 mg tab 300 0 300 120 180
45 Herbakof Sirup botol 0 0 0 0 0 100
46 Herbacold silfamin 150 mg tab 0 1800 1800 180 1620
47 Hidrocortison cream 2,5% tube 0 72 72 72 0
48 Ibuprofen 400 mg tab 0 5000 5000 300 4700 1000
49 Ibuprofen suspensi 200 mg/5 ml botol 116 0 116 0 116
50 Ketoconazol 200 mg tab 800 0 800 800 0 3000
51 Lansoprazole 30 mg tab 600 2000 2600 1800 800 1500
52 Lidokain injeksi 2 ml ampul 280 0 280 2 278
53 Loratadine 10 mg tab 0 0 0 0 0 5000
54 Meconazole salep tube 0 0 0 0 0 100
55 Metformin Tab 1400 0 1400 0 1400
56 Metocloperamid Hcl 10 mg tab 2000 0 2000 0 2000
58 Metil prednisolon tab 0 0 0 0 0 5000
59 Mineral mix bks 400 0 400 0 400
60 Metrodinazole sirup botol 30 0 30 0 30
61 Natrium Diklofenak 25 mg tab 0 0 0 0 0 3000
62 Natrium Diklofenak 50 mg botol 0 2800 2800 300 2500
63 Natrium Klorida larutan infus 0,9% botol 36 40 76 34 42
64 Ondan sentron hcl dehytrate 4 mg tube 50 0 50 0 50
65 Obat Anti Tuberculosis FDC Kategori I Paket 1 0 1 1 0 6
66 Oksitosin Injeksi ampul 8 0 8 3 5 50
67 Parasetamol sirup 120 mg/5 ml 60 ml botol 100 200 300 151 149 100
68 Parasetamol tablet 500 mg tab 4200 4600 8800 4500 4300 3000
69 Phenobarbital tablet tab 0 0 0 0 0 100
70 Ranitidin injeksi ampul 0 0 0 0 0 30
71 Riboquin 150 mg tab 90 0 90 0 90
72 Ringer Laktak larutan infus 500 ml botol 25 40 65 11 54 40
73 Risperidon 2 mg tab 500 0 500 0 500 500
74 Salbutamol 4 mg tab 0 0 0 0 0 3000
75 Simvastatin 10 mg tab 4500 0 4500 100 4400
76 Trihexyphenidil 2 mg tab 424 0 424 162 262 500
77 Valsartan 160 mg tab 0 0 0 0 0 2000
78 Vitamin A (Retinol) 100.000 iu kaps 200 0 200 0 200
80 Vitamin B Kompleks tablet tab 3600 3000 6600 1500 5100 5000
81 Vitamin B1 (Thiamin) tab 0 0 0 0 0
82 Vitamin B12 (Sianokobalamin) 50 mcg tab 0 0 0 0 0 3000
83 Vitamin B12 (Sianokobalamin) injeksi ampul 109 100 209 9 200
84 Vitamin C 50 mg tab 0 3000 3000 1300 1700 3000
85 Vitamin K (Fitomenadion) tab 400 0 400 0 400
86 Zinc SIRUP botol 77 0 77 4 73
87 Zinc tab dispersible 20 mg tab 500 0 500 0 500
N
A
TA
N
A
PEMBERIAN
G
IN
N
A
M
ER
R
PE
ET
K
APBN APBD DAK LAIN2 JLH
11 12 13 14 15 16
500
2000
5000
1000
1000
3000
3000
10
10
1000
100
1000
1500
1400
100
3000
40
500
500
1800
5000
2000
2000
D AN
N
N
N
L
PT
A
A
IA
A
C
N
SE A
TA
IA
W
O
O
A
A
R M
NO JENIS OBAT
ST
A
TU
IN
K
K
PE ERI
C
A
K
M
SA
SA
O
M
O
R
ST
ST
PE
SI
PE
PE
1 2 3 4 5 6 7 8 9 10
OBAT
1 Acyclovir 400 mg tab 800 0 800 200 600 350
3 Albendazol 400 mg tab 2508 0 2508 0 2508 1500
5 Amitriptylin 25 mg tab 290 500 790 0 790
7 Amlodipin 5 mg tab 800 2000 2800 700 2100 2000
14 Asam Folat 1 mg tab 600 0 600 100 500
19 Captopril 25 mg tab 350 1000 1350 700 650
21 Cotrimoksazol sirup (ED) botol 105 0 105 0 105 100
23 Cefadroxil 250 mg tab 600 3000 3600 700 2900 1000
25 Cotrimoxazol Tab 800 mg/160 mg tab 0 3000 3000 600 2400
28 Codein 10 mg tab 291 0 291 0 291
33 Diazepam injeksi ampul 0 10 10 0 10
35 Domperidon sirup botol 0 0 0 0 0
43 Haloperidol 5 mg tab 500 1000 1500 10 1490
44 Herbapain Premeditol 200 mg tab 180 0 180 180 0 900
47 Hidrocortison cream 2,5% tube 0 72 72 72 0 72
48 Ibuprofen 400 mg tab 4700 1000 5700 1600 4100
51 Lansoprazole 30 mg tab 800 1500 2300 950 1350
55 Metformin Tab 1400 0 1400 0 1400 400
59 Mineral mix bks 400 0 400 0 400
66 Oksitosin Injeksi ampul 5 0 5 1 4
71 Riboquin 150 mg tab 90 0 90 0 90
73 Risperidon 2 mg tab 500 500 1000 40 960
76 Trihexyphenidil 2 mg tab 262 500 762 210 552
77 Valsartan 160 mg tab 0 1800 1800 210 1590
78 Vitamin A (Retinol) 100.000 iu kaps 200 0 200 0 200 1000
80 Vitamin B Kompleks tablet tab 5100 5000 10100 2300 7800
82 Vitamin B12 (Sianokobalamin) 50 mcg tab 0 2000 2000 200 1800
83 Vitamin B12 (Sianokobalamin) injeksi ampul 200 0 200 35 165 100
84 Vitamin C 50 mg tab 1700 2000 3700 1200 2500 5000
N
A
TA
N
A
PEMBERIAN
G
IN
N
A
M
ER
R
PE
ET
K
11 12 13 14 15 16
350
1500
2000
200
5000
100
1000
900
100
2400
400
500
2800
100
5000
100
100
950
100
5000
D AN
N
N
N
L
PT
A
A
IA
A
C
N
SE A
TA
IA
W
O
O
A
A
R M
NO JENIS OBAT
ST
A
TU
IN
K
K
PE ERI
C
A
K
M
SA
SA
O
M
O
R
ST
ST
PE
SI
PE
PE
1 2 3 4 5 6 7 8 9 10
OBAT
1 Acyclovir 400 mg tab 600 350 950 500 450
7 Amlodipin 5 mg tab 2100 2000 4100 700 3400 1000
9 Amoxycilin sirup kering 125 mg/5 ml botol 0 0 0 0 0 100
10 Amoxycilin sirup kering 100 mg/ml (drop) botol 26 0 26 10 16 100
12 Antasida DOEN sirup botol 0 0 0 0 0 100
14 Asam Folat 1 mg tab 500 0 500 100 400
15 Asam mefenamat kaplet 500 mg kap 2000 0 2000 500 1500
16 Besi (II) sulfat (Tablet Tambah Darah) tab 5600 0 5600 1500 4100 2000
19 Captopril 25 mg tab 650 0 650 50 600 500
22 Cefadroxil sirup kering 125 mg/5 ml botol 0 0 0 0 50
28 Codein 10 mg tab 291 0 291 40 251 200
29 Deksametason 0,5 mg tab 0 0 0 0 0 5000
30 Deksametason 5 mg/ml injeksi 22 0 22 2 20 200
31 Diazepam 2 mg tablet 420 0 420 267 153 500
48 Ibuprofen 400 mg tab 4100 0 4100 1200 2900
55 Metformin Tab 1400 400 1800 1800 0 400
59 Mineral mix bks 400 0 400 0 400
61 Natrium Diklofenak 25 mg tab 950 2800 3750 600 3150
62 Natrium Diklofenak 50 mg botol 1250 0 1250 500 750 1000
Prednisolone tablet tab 500 0 500 300 200 100
71 Riboquin 150 mg tab 90 0 90 0 90
77 Valsartan 160 mg tab 1590 0 1590 480 1110
84 Vitamin C 50 mg tab 2500 5000 7500 700 6800 5000
N
A
TA
N
A
PEMBERIAN
G
IN
N
A
M
ER
R
PE
ET
K
11 12 13 14 15 16
1000
2000
1000
500
100
800
100
5000
100
100
300
1000
100
4000
D AN
N
N
N
L
PT
A
A
IA
A
C
N
SE A
TA
IA
W
O
O
A
A
R M
NO JENIS OBAT
ST
A
TU
IN
K
K
PE ERI
C
A
K
M
SA
SA
O
M
O
R
ST
ST
PE
SI
PE
PE
1 2 3 4 5 6 7 8 9 10
OBAT
1 Acyclovir 400 mg tab 450 0 450 50 400
7 Amlodipin 5 mg tab 3400 1000 4400 0 4400 1000
14 Asam Folat 1 mg tab 400 0 400 100 300
19 Captopril 25 mg tab 600 0 600 100 500 500
21 Cotrimoksazol sirup botol 80 0 80 30 50 100
28 Codein 10 mg tab 251 0 251 60 191 200
48 Ibuprofen 400 mg tab 2900 0 2900 900 2000 2000
55 Metformin Tab 0 0 0 0 0 400
59 Mineral mix bks 400 0 400 0 400
69 Phenobarbital tablet tab 0 100 100 0 100
Prednisolone tablet tab 200 0 200 200 0
71 Riboquin 150 mg tab 90 0 90 0 90
77 Valsartan 160 mg tab 1110 0 1110 300 810
84 Vitamin C 50 mg tab 6800 4000 10800 1600 9200 5000
85 Vitamin K (Fitomenadion) tab 300 0 300 0 300 500
N
A
TA
N
A
PEMBERIAN
G
IN
N
A
M
ER
R
PE
ET
K
11 12 13 14 15 16
100
100
2000
800
1000
ED
3000
]\\[
1000
500
D AN
N
N
N
L
PT
A
A
IA
A
C
N
SE A
TA
IA
W
O
O
A
A
R M
NO JENIS OBAT
ST
A
TU
IN
K
K
PE ERI
C
A
K
M
SA
SA
O
M
O
R
ST
ST
PE
SI
PE
PE
1 2 3 4 5 6 7 8 9 10
OBAT
1 Acyclovir 400 mg tab 400 0 400 0 400
6 Ampicillin inj ampul 0 0 0 0 0 20
7 Amlodipin 5 mg tab 4400 0 4400 500 3900 1000
14 Asam Folat 1 mg tab 300 0 300 300 0 1000
18 Captopril 12,5 mg tab 0 0 0 0 0 1000
19 Captopril 25 mg (ED mei) tab 500 0 500 500 0 500
28 Codein 10 mg tab 191 0 191 0 191 200
36 Furosemide 40 mg (ED april) tab 800 0 800 0 800
44 Herbavomitz botol 0 0 0 0 0 48
48 Ibuprofen 400 mg tab 2000 2000 4000 1000 3000 2000
58 Metil Ergometrin 0,125 mg tab 0 0 0 0 0 200
59 Mineral mix bks 400 0 400 0 400
71 Riboquin 150 mg tab 90 0 90 0 90
77 Valsartan 160 mg tab 810 0 810 90 720
84 Vitamin C 50 mg tab 9200 0 9200 1600 7600 5000
N
A
TA
N
A
PEMBERIAN
G
IN
N
A
M
ER
R
PE
ET
K
11 12 13 14 15 16
20
1000
16800
1000
1000
1000
ED
5000
ED
48
48
24
200
300
500
5
D AN
N
N
N
L
PT
A
A
IA
A
C
N
SE A
TA
IA
W
O
O
A
A
R M
NO JENIS OBAT
ST
A
TU
IN
K
K
PE ERI
C
A
K
M
SA
SA
O
M
O
R
ST
ST
PE
SI
PE
PE
1 2 3 4 5 6 7 8 9 10
OBAT
1 Acyclovir 400 mg tab 400 0 400 0 400
6 Ampicillin inj vial 0 20 0 0 20
7 Amlodipin 5 mg tab 3900 0 3900 200 3700
14 Asam Folat 1 mg tab 0 1000 1000 0 1000 1000
16 Aqua proinjeksi vial 0 10 10 0 10
19 Captopril 12,5 mg tab 0 1000 1000 0 1000 1000
20 Captopril 25 mg tab 0 0 0 0 0 500
29 Codein 10 mg tab 191 0 191 10 181 200
30 Dektrose infus 5% botol 0 0 0 0 0 5
38 Garam Oralit sachet 88 0 88 20 68 100
49 Ibuprofen 400 mg tab 3000 0 3000 1100 1900 2000
50 Ibuprofen suspensi 200 mg/5 ml botol 59 0 59 5 54 50
55 Meconazole salep tube 0 24 24 0 24
58 Metocloperamid Hcl 5 mg tab 0 0 0 0 0 1000
59 Metil Ergometrin 0,125 mg tab 0 200 200 0 200
60 Mineral mix bks 400 0 400 0 400
Metronidazole tablet tab 0 0 0 0 0 1000
64 Natrium Klorida larutan infus 0,9% botol 5 0 5 1 4 60
72 Riboquin 150 mg tab 90 0 90 0 90
78 Valsartan 160 mg tab 720 0 720 0 720
85 Vitamin C 50 mg tab 7600 0 7600 700 6900
N
A
TA
N
A
PEMBERIAN
G
IN
N
A
M
ER
R
PE
ET
K
11 12 13 14 15 16
2000
3000
2000
300
100
48
1000
50
500
1000
1000
60
200
2000
80
2000
D AN
N
N
N
L
PT
A
A
IA
A
C
N
SE A
TA
IA
W
O
O
A
A
R M
NO JENIS OBAT
ST
A
TU
IN
K
K
PE ERI
C
A
K
M
SA
SA
O
M
O
R
ST
ST
PE
SI
PE
PE
1 2 3 4 5 6 7 8 9 10
OBAT
1 Acyclovir 400 mg tab 400 0 400 0 400
7 Amlodipin 5 mg tab 3700 0 3700 400 3300
11 Antasida DOEN tablet 14400 0 14400 3300 11100
13 Azytromicyin 500 mg tab 0 0 0 0 0 500
14 Asam Folat 1 mg tab 1000 0 1000 100 900
19 Captopril 12,5 mg tab 1000 0 1000 0 1000
20 Captopril 25 mg tab 0 0 0 0 0 500
29 Codein 10 mg tab 181 0 181 30 151
30 Dektrose infus 5% botol 0 4 4 0 4
36 Dextrose monohidrat infus 5 % Infus botol 0 4 4 0 4
37 Furosemide 40 mg tab 0 0 0 0 0 300
49 Ibuprofen 400 mg tab 1900 1000 2900 1300 1600 2000
56 Meloxicam tablet Tab 0 0 0 0 0 2000
61 Mineral mix bks 400 0 400 0 400
62 Metronidazole tablet tab 0 1000 1000 500 500 1000
68 Obat Anti Tuberculosis FDC Kategori I Paket 5 0 5 0 5
71 Parasetamol tablet 500 mg tab 3800 2000 5800 2600 3200
74 Riboquin 150 mg tab 90 0 90 0 90
75 Ringer Laktak larutan infus 500 ml botol 119 80 199 55 144
77 Salbutamol 2 mg tab 0 1000 1000 200 800
80 Valsartan 160 mg tab 720 0 720 120 600
87 Vitamin C 50 mg tab 6900 0 6900 1200 5700
89 Zinc SIRUP botol 10 0 10 10 0 20
N
A
TA
N
A
PEMBERIAN
G
IN
N
A
M
ER
R
PE
ET
K
11 12 13 14 15 16
2000
1000
500
100
500
3000
2000
60
2000
1000
600
1000
100
LAPORAN PEMAKAIAN DAN LEMBARAN PERMINTAAN OB
(LPLPO)
Kode Puskesmas : P1104052201
Nama Puskesmas : JAMBUR LAK-LAK
Kecamatan : KETAMBE
Puskesmas Pembantu yang ada :4 Yang Lapor : ......................
Kabupaten : Aceh Tenggara
D AN
N
N
L
IA
A
N
SE A
IA
W
A
A
R M
NO JENIS OBAT
A
TU
K
PE ERI
S
A
K
SA
SA
M
O
N
ST
PE
SI
PE
1 2 3 4 5 6 7
OBAT
1 Acyclovir 400 mg tab 400 0 400 50
2 Albendazol syirup tab 0 0 0 0
3 Albendazol 400 mg tab 690 0 690 0
4 Alprazolam 0.5 mg tab 0 0 0 0
5 Amitriptylin 25 mg tab 567 0 567 0
6 Ampicillin inj vial 20 0 0 0
7 Amlodipin 5 mg tab 3300 0 3300 300
8 Amoxycilin kaplet 500 mg kap 100 2000 2100 2100
9 Amoxycilin sirup kering 125 mg/5 ml botol 0 0 0 0
10 Amoxycilin sirup kering 100 mg/ml (drop) botol 0 0 0 0
11 Antasida DOEN tablet 11100 0 11100 4200
12 Antasida DOEN sirup botol 0 0 0 0
13 Azytromicyin 500 mg tab 0 0 0 0
14 Asam Folat 1 mg tab 900 0 900 0
15 Asam mefenamat kaplet 500 mg kap 100 1000 1100 900
16 Aqua proinjeksi vial 10 0 10 0
17 Besi (II) sulfat (Tablet Tambah Darah) tab 1900 0 1900 1000
18 Betametason krim 0,1% tube 0 50 50 8
19 Captopril 12,5 mg tab 1000 0 1000 0
20 Captopril 25 mg tab 0 500 500 0
21 Salep 2-4 tube 0 0 0 0
22 Cotrimoksazol sirup botol 10 100 110 30
24 Cefadroxil 500 mg tab 0 2000 2000 600
25 Cetirizin tablet 10 mg tab 0 0 0 0
26 Cotrimoxazol Tab 800 mg/160 mg tab 200 500 700 200
27 Chlorfeniramin maleat (CTM) 4 mg tablet 600 3000 3600 3500
28 Ciprofloxacin 500 mg tab 0 0 0 0
29 Codein 10 mg tab 151 0 151 61
30 Dexametason tablet tablet 0 2000 2000 1600
31 Deksametason 5 mg/ml injeksi 8 0 8 0
32 Diazepam 2 mg tablet 152 0 152 110
33 Diazepam 5 mg tablet 300 0 300 10
34 Diazepam injeksi ampul 7 0 7 0
35 Domperidon tab 10 mg tab 700 0 700 300
36 Dextrose monohidrat infus 5 % Infus botol 4 0 4 0
37 Diphenhidramin inj ampul 0 0 0 0
38 Garam Oralit sachet 148 0 148 110
39 Glibenclimde 5 mg tab 1800 0 1800 200
40 Griseofulvin (micronized) 125 mg tab 0 0 0 0
41 Griseofulvin 500 mg tab 0 0 0 0
42 Haloperidol 0,5 mg tab 42 0 42 42
43 Haloperidol 1,5 mg tab 0 0 0 0
44 Haloperidol 5 mg tab 0 0 0 0
45 Herbavomitz botol 47 0 47 0
46 Ibuprofen 200 mg tab 0 0 0 0
47 Herbacold silfamin 150 mg tab 810 0 810 810
48 Hidrocortison cream 2,5% tube 0 0 0 0
49 Ibuprofen 400 mg tab 1600 2000 3600 1500
50 Ibuprofen suspensi 200 mg/5 ml botol 89 60 149 15
51 Ketoconazol 200 mg tab 200 2000 2200 1350
52 Lansoprazole 30 mg tab 1200 0 1200 700
53 Lidokain injeksi 2 ml ampul 162 0 162 12
54 Loratadine 10 mg tab 0 1000 1000 700
55 Meconazole salep tube 15 24 39 14
56 Meloxicam 15 mg tablet Tab 0 600 600 210
57 Metformin Tab 0 0 0 0
58 Metocloperamid Hcl 10 mg tab 700 0 700 200
59 Metocloperamid Hcl 5 mg tab 1000 0 1000 200
60 Metil Ergometrin 0,125 mg tab 200 0 200 0
61 Metylprednisolon 4 mg tab 0 1000 1000 900
62 Mineral mix bks 400 0 400 0
63 Metronidazole tablet tab 500 1000 1500 500
64 Metrodinazole sirup botol 10 0 10 0
65 Natrium Diklofenak 25 mg tab 900 0 900 900
66 Natrium Diklofenak 50 mg botol 0 0 0 0
67 Natrium Klorida larutan infus 0,9% botol 60 0 60 9
68 Ondan sentron hcl dehytrate 4 mg tube 0 0 0 0
69 Obat Anti Tuberculosis FDC Kategori I Paket 5 0 5 1
70 Oksitosin Injeksi ampul 0 0 0 0
71 Omeprazole tablet 0 1000 1000 500
72 Parasetamol sirup 120 mg/5 ml 60 ml botol 140 100 240 81
73 Parasetamol tablet 500 mg tab 3200 0 3200 2600
74 Phenobarbital tablet tab 400 0 400 0
75 Ranitidin injeksi ampul 25 0 25 25
76 Riboquin 150 mg tab 90 0 90 0
77 Ringer Laktak larutan infus 500 ml botol 144 0 144 27
78 Risperidon 2 mg tab 790 0 790 70
79 Salbutamol 2 mg tab 800 0 800 100
80 Simvastatin 10 mg tab 2000 0 2000 0
81 Trihexyphenidil 2 mg tab 280 0 280 60
82 Valsartan 160 mg tab 600 0 600 30
83 Vitamin A (Retinol) 100.000 iu kaps 140 800 940 0
84 Vitamin A (Retinol) 200.000 iu kaps 1095 850 1945 1945
85 Vitamin B Kompleks tablet tab 4000 0 4000 1900
86 Vitamin B1 (Thiamin) tab 0 0 0 0
87 Vitamin B12 (Sianokobalamin) 50 mcg tab 1200 0 1200 400
88 Vitamin B12 (Sianokobalamin) injeksi ampul 247 0 247 23
89 Vitamin C 50 mg tab 5700 0 5700 2300
90 Vitamin K (Fitomenadion) tab 1000 0 1000 100
91 Zinc SIRUP botol 0 0 0 0
92 Zinc tab dispersible 20 mg tab 300 0 300 300
BAHAN MEDIS HABIS PAKAI (BMHP

1 Alat suntik sekali pakai 1 ml set 100 0 100 20
2 Alat Suntik 3 cc zontic set 46 0 46 46
5 Alat suntik sekali pakai 100 ml pcs 19 0 19 0
6 Asguard clear film 5 cm x 10 ml pcs 0 0 0 0
7 Asguard flex non-woven 5 ml x 10 ml pcs 16 0 16 13
21 Aximed face masker (earloop) Box 3 0 3 3
8 Baju APD set 2 0 2 0
9 Hand Scun Aximed M Box 10 0 10 0
10 Hospitech Oxygen Nassal Canula Anak set 5 0 5 0
11 Hospitech Oxygen Nassal Canula Dewasa set 10 0 10 0
12 I.V Chateter 22 G Hospitecch abocath pcs 0 0 0 0
13 I.V Chateter 24G Hospitech abocath pcs 0 0 0 0
14 I.V Chateter 26G Hospitech abocath pcs 0 0 0 0
15 Infusion Set Dewasa set 0 0 0 0
Infusion Set anak set 50 50 100 5
16 Jayamas Onemed Kassa Steril 16 x 16 cm ktk 11 0 11 11
17 Kasa Hidrofil Unicorn Non Steril 4 yard x 10 Roll 10 0 10 1
18 Masker Aero Pro N95 ktk 0 0 0 0
19 Masker Jenis karet hijab (Head Loop) hijab Box 5 0 5 1
20 Masker Forsh Medcal N95 Box 2 0 2 0
22 Nousmed Intravenory Catheter no. 20 pcs 114 0 114 10
23 Nausmed Intravenory Catheter no. 22 pcs 89 0 89 19
Nausmed surgical face mask Earloop box 40 0 40 0
24 Pot Sputum pot 40 0 40 0
Povidon Iodine botol 3 3 6 1
25 Oxiflow Bayi pcs 2 0 2 0
26 Sanitizer/ Hand Scrub 500 ml Botol 2 0 2 1
27 SMI Cat Gut Plain 3/0 DS 19 mm pcs 0 0 0 0
28 SMI Cat Gut Plain 3/0 HR 37 mm pcs 0 0 0 0
29 SMI Silk Black 0 HR 30 mm pcs 0 0 0 0
30 SMI Silk Black 3/0 HR 30 mm pcs 0 0 0 0
31 SMI Silk Black 3/0 DS 30 mm pcs 0 0 0 0
32 SMI Silk Black 2/0 HR 37 mm pcs 0 0 0 0
33 Surgical Glove Steril 7,5 ( Aximed) pcs 0 0 0 0
34 Stomatch tube (NGT) FR.14 pcs 0 0 0 0
35 Stomatch tube (NGT) FR.16 pcs 0 0 0 0
36 TROGE Glove Steril No.7,5 pair 40 0 40 0
37 TROGE Glove Steril No.8 pair 45 0 45 0
38 Three way stop lock pcs 27 0 27 0
39 Umbilical Cord Clamp (Hospitech) pcs 31 0 31 6
40 UTAMA (2019) Kapas Absorben 1000 gr pack 2 0 2 0
41 UTAMA (2019) Kapas Absorben 500 gr pack 4 0 4 1
42 Under Pad pcs 20 0 20 0
43 Glove Non Steril Ukuran L pcs 1000 0 1000 100
44 Glove Non Steril Ukuran M pcs 100 0 100 100
45 Glove Non Steril Ukuran S pcs 0 0 0 0
46 Zinc oxide adhesive plaster roll 24 0 24 1
Mengetahui / menyetujui Yang Menyerahkan, Yang Memint

Kepala Dinas Kesehatan Petugas IFK Pimpinan Puskesm
Drs. Jamanuddin, M.Ap Irma Yulia Puteri, S.Farm Nelly Afni, SKM
NIP. 19660325 199401 1 001 NIP. 19800522 200312
PERMINTAAN OBAT
Laporan Pemakaian, Bulan-Tahun : Juli 2023

Laporan Permintaan, Bulan-Tahun : Agustus 2023
:
N
N
PT
A
IA
TA
N
O
O
A
A
PEMBERIAN
G
ST
IN
K
K
N
C
A
A
M
SA
O
M
ER
R
ST
PE
SI
PE
ET
K
8 9 10 11 12 13 14 15 16
OBAT
350
0
690 exp.date
0
567
20
3000
0 10000
0 100
0 100
6900
0 100
0 500
900
200 3000
10
600
42 100
1000
500 500
0 48
80 100
0 50
1400 2000
0 5000
500 500
100 5000
0 5000
90
400
8 10 exp.date
42
290
7
400
4
0 60
38
1600 0
0 2000
0 1000
0
0
0 ed juni
47 0
0 3000 3000
0
0 144
2100 2000
134 50
850 3000
500 500
120
300 5000
25 24
390 2000
0 400
500 500 exp.date
800 500 exp.date
200
100 5000
400 exp.date
1000 1000
10 exp.date juli
0 5000
0 1000
51
0
4
0 10
500
159 100
600
400
0 50
90
117
720
700
2000
220
570
940
1945
2100
0 1000
800
224
3400
900
0 20 ED
0 1000
S HABIS PAKAI (BMHP)

80
0 500
0 100
169
19
0
13 5
0
2
10
5
10
0
0 50
0 50
0 20
95 50
0 100
9
1
4
2
104
70
40
40
5 5
2
1
0 50
0
0
0 50
0
0
0
0
0 20
40
45
27
25
2
3
20
900
0
0 200
23
Yang Meminta, Yang Menerima,

Pimpinan Puskesmas Petugas Puskesmas
Nelly Afni, SKM apt. Kamilaini, S.Farm
NIP. 19800522 200312 2 006
LAPORAN PEMAKAIAN DAN LEMBARAN PERMINTAAN OBAT
(LPLPO)
Kecamatan : KETAMBE
Puskesmas Pembantu yang ada :4 Yang Lapor : ...................... :
D AN
N
N
L
PT
A
IA
A
C
N
SE A
IA
W
O
O
A
A
R M
NO JENIS OBAT
ST
A
TU
K
K
PE ERI
C
A
K
SA
SA
O
M
O
R
ST
ST
PE
SI
PE
PE
1 2 3 4 5 6 7 8 9
OBAT
1 Acyclovir 400 mg tab 350 300 650 0 650
2 Albendazol suspensi botol 0 10 10 7 3
7 Amlodipin 5 mg tab 3000 0 3000 250 2750
8 Amoxycilin kaplet 500 mg kap 0 5000 5000 2100 2900
14 Asam Folat 1 mg tab 900 0 900 100 800
18 Betametason krim 0,1% tube 42 50 92 42 50
19 Captopril 12,5 mg tab 1000 0 1000 0 1000
20 Captopril 25 mg tab 500 0 500 0 500
25 Cetirizin tablet 10 mg tab 0 0 0 0 0
27 Chlorfeniramin maleat (CTM) 4 mg tablet 100 3000 3100 2900 200
28 Ciprofloxacin 500 mg tab 0 0 0 0 0
29 Codein 10 mg tab 90 0 90 55 35
30 Dexametason tablet tablet 400 3000 3400 1600 1800
37 Diphenhidramin inj ampul 0 60 60 0 60
39 Glibenclimde 5 mg tab 1600 0 1600 500 1100
40 Griseofulvin (micronized) 125 mg tab 0 0 0 0 0
41 Griseofulvin 500 mg tab 0 0 0 0 0
45 Herbavomitz botol 47 0 47 0 47
46 Herbakof Sirup botol 0 0 0 0 0
Ibuprofen 200 mg tab 0 3000 3000 1200 1800
49 Ibuprofen 400 mg tab 2100 0 2100 1200 900
51 Ketoconazol 200 mg tab 850 1000 1850 600 1250
54 Loratadine 10 mg tab 300 3000 3300 1000 2300
56 Meloxicam 15 mg tablet Tab 390 600 990 990 0
57 Metformin Tab 0 0 0 0 0
59 Metocloperamid Hcl 5 mg (ED Agt) tab 800 0 800 800 0
62 Metylprednisolon 4 mg tab 100 3000 3100 1200 1900
63 Mineral mix bks 400 0 400 400 0
64 Metronidazole tablet tab 1000 500 1500 500 1000
72 Omeprazole tablet 500 1000 1500 400 1100
73 Parasetamol sirup 120 mg/5 ml 60 ml botol 159 100 259 204 55
76 Ranitidin 150 mg tab 0 0 0 0 0
77 Ranitidin injeksi ampul 0 0 0 0 0
78 Riboquin 150 mg tab 90 0 90 0 90
81 Salep 2-4 tube 0 48 48 19 29
85 Valsartan 160 mg tab 570 0 570 30 540
92 Vitamin B6 tab 0 1000 1000 200 800
93 Vitamin C 50 mg tab 3400 0 3400 1700 1700
BAHAN MEDIS HABIS PAKAI (BMHP)

1 Alat suntik sekali pakai 1 ml set 80 0 80 15 65
2 Alat Suntik 3 cc zontic set 0 500 500 60 440
5 Alat suntik sekali pakai 100 ml pcs 19 0 19 0 19
6 Alat suntik sekali pakai 2,5 ml pcs 0 200 200 0 200
7 Alkohol 1 liter botol 0 5 5 1 4
8 Asguard clear film 5 cm x 10 ml pcs 0 0 0 0 0
9 Asguard flex non-woven 5 ml x 10 ml pcs 13 5 18 1 17
10 Aximed face masker (earloop) Box 0 0 0 0 0
11 Baju APD set 2 0 2 0 2
12 Hand Scun Aximed M Box 10 0 10 1 9
13 Hospitech Oxygen Nassal Canula Anak set 5 0 5 0 5
14 Hospitech Oxygen Nassal Canula Dewasa set 10 0 10 1 9
15 I.V Chateter 22 G Hospitecch abocath pcs 0 0 0 0 0
16 I.V Chateter 24G Nousmed Abocath pcs 0 100 100 12 88
17 Abocath Promakan alfa 26 G pcs 0 100 100 0 100
18 Infusion Set Dewasa set 0 0 0 0 0
19 Infusion Set anak set 95 50 145 11 134
20 Jayamas Onemed Kassa Steril 16 x 16 cm ktk 0 0 0 11 0
21 Kasa Hidrofil Unicorn Non Steril 4 yard x 10 Roll 9 0 9 5 4
22 Kasa Hidrofil Unicorn Non Steril 40 x 80 cm Roll 0 1 1 0 1
23 Masker Aero Pro N95 ktk 1 0 1 0 1
24 Masker Jenis karet hijab (Head Loop) hijab Box 4 0 4 1 3
25 Masker Forsh Medcal N95 Box 2 0 2 0 2
26 Nousmed Intravenory Catheter no. 20 pcs 104 0 104 0 104
27 Nausmed Intravenory Catheter no. 22 pcs 70 100 170 10 160
28 Nausmed surgical face mask Earloop box 40 0 40 0 40
29 Pot Sputum pot 40 0 40 0 40
30 Povidon Iodine botol 5 5 10 2 8
31 Oxiflow Bayi pcs 2 0 2 0 2
32 Rivanol 300 ml botol 0 5 5 1 4
33 Sanitizer/ Hand Scrub 500 ml medika Botol 1 0 1 0 1
34 Sanitizer/ Hand Scrub 500 ml fresko Botol 0 5 5 1 4
35 Sanitizer/ Hand Scrub 500 ml kast@med botol 0 5 5 1 4
36 SMI Cat Gut Plain 3/0 DS 19 mm pcs 0 0 0 0 0
37 SMI Cat Gut Plain 3/0 HR 37 mm pcs 0 0 0 0 0
38 SMI Silk Black 0 HR 30 mm pcs 0 0 0 0 0
39 SMI Silk Black 3/0 HR 30 mm pcs 0 0 0 0 0
40 SMI Silk Black 3/0 DS 30 mm pcs 0 0 0 0 0
42 Surgical Glove Steril 7,5 ( Aximed) pcs 0 0 0 0 0
43 Stomatch tube (NGT) FR.14 pcs 0 0 0 0 0
45 TROGE Glove Steril No.7,5 pair 40 0 40 0 40
46 TROGE Glove Steril No.8 pair 45 0 45 0 45
47 Three way stop lock pcs 27 0 27 0 27
48 Umbilical Cord Clamp (Hospitech) pcs 25 0 25 0 25
49 UTAMA (2019) Kapas Absorben 1000 gr pack 2 0 2 0 2
51 Under Pad pcs 20 0 20 2 18
52 Glove Non Steril Ukuran L pcs 900 0 900 100 800
53 Glove Non Steril Ukuran M pcs 0 0 0 0 0
54 Glove Non Steril Ukuran S pcs 0 0 0 0 0
55 Zinc oxide adhesive plaster roll 23 0 23 0 23
Mengetahui / menyetujui Yang Menyerahkan, Yang Meminta,

Kepala Dinas Kesehatan Petugas IFK Pimpinan Puskesmas
Drs. Jamanuddin, M.Ap Irma Yulia Puteri, S.Farm Nelly Afni, SKM
NIP. 19660325 199401 1 001 NIP. 19800522 200312 2 006
Laporan Pemakaian, Bulan-Tahun : Agustus 2023
Laporan Permintaan, Bulan-Tahun : September 2023
N
PT
A
TA
N
O
A
PEMBERIAN
G
IN
K
N
C
A
M
O
ER
R
ST
PE
ET
K
10 11 12 13 14 15 16
OBAT
500
10000
100
100
2000
100
500
2000
2000
100
500
100
50
2000
5000
500
5000
3000
100
3000
10
300
1000
1000
2000
1000
48
200
1800
200
4000
100
3000
1000
5000
48
2000
1000
ED
700
5000
ED augt
1000
100
2000
1000
10
200
5000
2000
50
20
48
300
1000
20
EDIS HABIS PAKAI (BMHP)
500
100
20
100
50
50
20
400
200
Yang Menerima,
Petugas Puskesmas
apt. Kamilaini, S.Farm

LAPORAN PEMAKAIAN DAN LEMBARAN PERMINTAAN
(LPLPO)
Kecamatan : KETAMBE
Puskesmas Pembantu yang ada :4 Yang Lapor : ......................
Kabupaten 0
D AN
N
N
L
IA
A
N
SE A
IA
W
A
A
R M
NO JENIS OBAT
A
TU
K
PE ERI
A
K
SA
M
O
N
ST
PE
PE
1 2 3 4 5 6
OBAT
1 Acyclovir 400 mg tab 650 200 850
2 Albendazol suspensi botol 3 0 3
3 Albendazol 400 mg tab 0 500 500
4 Alprazolam 0.5 mg tab 0 0 0
5 Allupurinol tab tab 0 1000 1000
6 Amitriptylin 25 mg tab 527 0 527
7 Ampicillin inj vial 20 20 40
8 Amlodipin 5 mg tab 2750 0 2750
9 Amoxycilin kaplet 500 mg kap 2900 12000 14900
10 Amoxycilin sirup kering 125 mg/5 ml botol 0 0 0
11 Amoxycilin sirup kering 100 mg/ml (drop) botol 0 0 0
12 Antasida DOEN tablet 2800 2000 4800
13 Antasida DOEN sirup botol 0 0 0
14 Azytromicyin 500 mg tab 0 0 0
15 Asam Folat 1 mg tab 800 0 800
16 Asam mefenamat kaplet 500 mg kap 2000 2000 4000
17 Aqua proinjeksi vial 10 0 10
18 Besi (II) sulfat (Tablet Tambah Darah) tab 0 2000 2000
19 Betametason krim 0,1% tube 50 100 150
20 Captopril 12,5 mg tab 1000 0 1000
21 Captopril 25 mg tab 500 500 1000
22 Carbamazepine 200 mg tab 0 0 0
23 Cotrimoksazol sirup botol 15 100 115
24 Cefadroxil sirup kering 125 mg/5 ml botol 0 0 0
25 Cefadroxil 500 mg tab 1500 2000 3500
26 Cetirizin tablet 10 mg tab 0 1800 1800
27 Cotrimoxazol Tab 800 mg/160 mg tab 900 500 1400
28 Chlorfeniramin maleat (CTM) 4 mg tablet 200 12000 12200
29 Ciprofloxacin 500 mg tab 0 3000 3000
30 Codein 10 mg tab 35 0 35
31 Dexametason tablet tablet 1800 3000 4800
32 Deksametason 5 mg/ml injeksi 8 0 8
33 Diazepam 2 mg tablet 0 0 0
34 Diazepam 5 mg tablet 235 0 235
35 Diazepam injeksi ampul 5 0 5
36 Domperidon tab 10 mg tab 100 450 550
37 Dextrose monohidrat infus 5 % Infus botol 4 0 4
38 Diphenhidramin inj ampul 60 0 60
39 Garam Oralit sachet 208 0 208
40 Gentamisin injeksi ampul 0 55 55
41 Glibenclimde 5 mg tab 1100 1200 2300
42 Griseofulvin (micronized) 125 mg tab 0 2000 2000
43 Griseofulvin 500 mg tab 0 0 0
44 Haloperidol 0,5 mg tab 0 0 0
45 Haloperidol 1,5 mg tab 0 0 0
46 Haloperidol 5 mg tab 460 0 460
47 Herbavomitz botol 47 0 47
48 Herbakof Sirup botol 0 0 0
49 Herbacold silfamin 150 mg tab 0 0 0
50 Hidrocortison cream 2,5% tube 0 96 96
51 Ibuprofen 200 mg tab 1800 0 1800
52 Ibuprofen 400 mg tab 900 0 900
53 Ibuprofen suspensi 200 mg/5 ml botol 94 120 214
54 Ketoconazol 200 mg tab 1250 500 1750
55 Lansoprazole 30 mg tab 50 0 50
56 Lidokain injeksi 2 ml ampul 160 0 160
57 Loratadine 10 mg tab 2300 5000 7300
58 Meconazole salep tube 29 0 29
59 Meloxicam 15 mg tablet Tab 0 0 0
60 Metformin Tab 0 0 0
61 Metocloperamid Hcl 10 mg tab 0 0 0
62 Metocloperamid Hcl 5 mg tab 100 0 100
63 Metil Ergometrin 0,125 mg tab 200 1000 1200
64 Metylprednisolon 4 mg tab 1900 4200 6100
65 Mineral mix bks 0 0 0
66 Metronidazole tablet tab 1000 0 1000
67 Metrodinazole sirup botol 0 0 0
68 Natrium Diklofenak 25 mg tab 0 0 0
69 Natrium Diklofenak 50 mg botol 0 0 0
70 Natrium Klorida larutan infus 0,9% botol 105 0 105
71 Ondan sentron hcl dehytrate 4 mg tube 0 0 0
72 Obat Anti Tuberculosis FDC Kategori I Paket 3 0 3
73 Oksitosin Injeksi ampul 0 0 0
74 Omeprazole tablet 1100 0 1100
75 Parasetamol sirup 120 mg/5 ml 60 ml botol 55 200 255
76 Parasetamol tablet 500 mg tab 2500 5000 7500
77 Permetrin salep 5% tube 0 4 4
78 Phenobarbital tablet tab 400 0 400
79 Prednisolone 4 mg tab 0 400 400
80 Ranitidin 150 mg tab 0 2000 2000
81 Ranitidin injeksi ampul 0 0 0
82 Riboquin 150 mg tab 90 0 90
83 Ringer Laktak larutan infus 500 ml botol 86 20 106
84 Risperidon 2 mg tab 670 0 670
85 Salep 2-4 tube 29 0 29
86 Salbutamol 2 mg tab 3200 0 3200
87 Simvastatin 10 mg tab 2000 0 2000
88 Trihexyphenidil 2 mg tab 80 300 380
89 Valsartan 160 mg tab 540 0 540
90 Vitamin A (Retinol) 100.000 iu kaps 940 0 940
91 Vitamin A (Retinol) 200.000 iu kaps 1945 0 1945
92 Vitamin B Kompleks tablet tab 500 0 500
93 Vitamin B1 (Thiamin) tab 900 0 900
94 Vitamin B6 tab 800 200 1000
95 Vitamin B12 (Sianokobalamin) 50 mcg tab 600 0 600
96 Vitamin B12 (Sianokobalamin) injeksi ampul 215 0 215
97 Vitamin C 50 mg tab 1700 1000 2700
98 Vitamin K (Fitomenadion) tab 900 0 900
99 Vitamin K (Fitomenadion) injeksi ampul 0 120 120
100 Zinc SIRUP botol 0 0 0
101 Zinc tab dispersible 20 mg tab 2000 0 2000
BAHAN MEDIS HABIS PAKAI (BM

1 Alat suntik sekali pakai 1 ml set 65 0 65
2 Alat Suntik 3 cc Zontik set 440 200 640
5 Alat suntik sekali pakai 100 ml pcs 19 0 19
6 Alat suntik sekali pakai 2,5 ml pcs 200 0 200
7 Alkohol 1 liter botol 4 0 4
8 Asguard clear film 5 cm x 10 ml pcs 0 0 0
9 Asguard flex non-woven 5 ml x 10 ml pcs 17 0 17
10 Aximed face masker (earloop) Box 0 0 0
11 Baju APD set 2 5 7
12 Cletira spray botol 0 1 1
13 Hand Scun Aximed M Box 9 0 9
14 Hospitech Oxygen Nassal Canula Anak set 5 0 5
15 Hospitech Oxygen Nassal Canula Dewasa set 9 0 9
16 I.V Chateter 22 G Hospitecch abocath pcs 0 0 0
17 I.V Chateter 24G Nousmed Abocath pcs 88 0 88
18 Abocath Promakan alfa 26 G pcs 100 0 100
19 Infusion Set Dewasa set 0 0 0
20 Infusion Set anak set 134 0 134
21 Jayamas Onemed Kassa Steril 16 x 16 cm ktk 0 0 0
22 Kasa Hidrofil Unicorn Non Steril 4 yard x 10 Roll 4 0 4
23 Kasa Hidrofil Unicorn Non Steril 40 x 80 cm Roll 1 1 2
24 Masker Aero Pro N95 ktk 1 0 1
25 Masker Jenis karet hijab (Head Loop) hijab Box 3 0 3
26 Masker Forsh Medcal N95 Box 2 0 2
27 Nousmed Intravenory Catheter no. 20 pcs 104 0 104
28 Nausmed Intravenory Catheter no. 22 pcs 160 0 160
29 Nausmed surgical face mask Earloop box 40 0 40
30 Pot Sputum pot 40 0 40
31 Povidon Iodine botol 8 0 8
32 Oxiflow Bayi pcs 2 0 2
33 Rivanol 300 ml botol 4 0 4
34 Sanitizer/ Hand Scrub 500 ml medika Botol 1 0 1
35 Sanitizer/ Hand Scrub 500 ml fresko Botol 4 0 4
36 Sanitizer/ Hand Scrub 500 ml kast@med botol 4 0 4
37 SMI Cat Gut Plain 3/0 DS 19 mm pcs 0 24 24
38 SMI Cat Gut Plain 3/0 HR 37 mm pcs 0 0 0
39 SMI Silk Black 0 HR 30 mm pcs 0 0 0
40 SMI Silk Black 3/0 HR 30 mm pcs 0 24 24
41 SMI Silk Black 3/0 DS 30 mm pcs 0 0 0
42 SMI Silk Black 2/0 HR 37 mm pcs 0 0 0
43 Surgical Glove Steril 7,5 ( Aximed) pcs 0 0 0
44 Stomatch tube (NGT) FR.14 pcs 0 0 0
45 Stomatch tube (NGT) FR.16 pcs 0 0 0
46 TROGE Glove Steril No.7,5 pair 40 0 40
47 TROGE Glove Steril No.8 pair 45 0 45
48 Three way stop lock pcs 27 0 27
49 Umbilical Cord Clamp (Hospitech) pcs 25 0 25
50 UTAMA (2019) Kapas Absorben 1000 gr pack 2 0 2
51 UTAMA (2019) Kapas Absorben 500 gr pack 2 0 2
52 Under Pad pcs 18 0 18
53 Glove Non Steril Ukuran L pcs 800 0 800
54 Glove Non Steril Ukuran M pcs 0 0 0
55 Glove Non Steril Ukuran S pcs 0 0 0
56 Qilan Latex Eximination gloves S pcs 0 200 200
57 Zinc oxide adhesive plaster roll 23 0 23
Mengetahui / menyetujui Yang Menyerahkan,
Kepala Dinas Kesehatan Petugas IFK
Drs. Jamanuddin, M.Ap Irma Yulia Puteri, S.Farm

NIP. 19660325 199401 1 001 NIP. 19800522 200
BARAN PERMINTAAN OBAT
Laporan Pemakaian, Bulan-Tahun : September 2023

Laporan Permintaan, Bulan-Tahun : Oktober 2023
Lapor : ...................... :
N
N
PT
A
A
IA
TA
N
IA
O
O
A
A
PEMBERIAN
ST
G
D
IN
K
K
N
SE
C
A
A
M
SA
O
M
ER
R
R
ST
PE
PE
SI
PE
ET
K
7 8 9 10 11 12 13 14 15
OBAT
200 650
0 3
100 400 1000
0 0 300
200 800 1000
10 517
4 36
1200 1550 3000
4000 10900 50000
0 0 200
0 0 100
3700 1100 5000
0 0 100
0 0 500
0 800
1700 2300 3000
1 9
2000 0 5000
43 107 100
200 800 1000
0 1000 2000
0 0
30 85 100
0 0 50
3000 500 4000
1350 450 2000
200 1200 1000
3000 9200 5000
600 2400 3000
0 35 300
2000 2800 4000
5 3 10
0 0 500
69 166
0 5
100 450 1000
1 3
7 53
10 198
0 55
1100 1200 2000
200 1800 1000
0 0 1000
0 0
0 0
50 410 200
28 19 96
0 0 200
0 0 1800
34 62 200
1800 0 3000
900 0 5000
10 204 100
900 850 3000
50 0 1000
4 156
2000 5300 0
29 0 48
0 0 3000
0 0 1000
0 0
0 100 500
0 1200
1800 4300 5000
0 0
600 400 1000
0 0 100
0 0 3000
0 0 2000
11 94 . 60
0 0
1 2
0 0 10
1100 0 5000
20 235 200
2900 4600 2000
0 4
0 400
0 400
800 1200
0 0 50
0 90
48 58 40
0 670
29 0 48
300 2900
700 1300
100 280 300
0 540
0 940
0 1945
500 0
200 700 500
0 1000 3000
600 0 2000
55 160
1100 1600 2000
0 900 500
0 120
0 0 20
300 1700
HAN MEDIS HABIS PAKAI (BMHP)

4 61
150 490
0 100
18 136
0 19
0 200
0 4 2
0 0
4 13 5
0 0
1 6
0 1
0 9
0 5
0 9
0 0
10 78
5 95
0 0 20
32 102
0 0 100
3 1 20
0 2 1
0 1
1 2
0 2
18 86
37 123
0 40
20 20 40
2 6
0 2 10
2 2 5
0 1 2
3 1 2
1 3 2
0 24 0
0 0
0 0
0 24 24
0 0
0 0
0 0
0 0
0 0 20
0 40
0 45
0 27
4 25
0 2
0 2
0 18
400 400
0 0 400
0 0 200
0 200
3 20
Pimpinan Puskesmas Petugas Puskesmas
Nelly Afni, SKM apt. Kamilaini, S.Farm

NIP. 19800522 200312 2 006
16
K
ET
ER
A
N
G
A
N
ed juni
ED
(LPLPO)
Kecamatan : KETAMBE
Kabupaten 0
D AN
N
N
L
PT
A
IA
A
C
N
SE A
IA
W
O
O
A
A
R M
NO JENIS OBAT
ST
A
TU
K
K
PE ERI
C
A
K
SA
SA
O
M
O
R
ST
ST
PE
SI
PE
PE
1 2 3 4 5 6 7 8 9
OBAT
1 Acyclovir 400 mg (ED 150) tab 650 0 650 150 500
2 Albendazol suspensi botol 3 0 3 0 3
5 Allupurinol tab tab 800 1000 1800 200 1600
8 Amlodipin 5 mg tab 1550 1500 3050 500 2550
14 Artesunat Injeksi vial 0 1 1 0 1
16 Asam Folat 1 mg tab 800 0 800 0 800
21 Captopril 12,5 mg tab 800 1000 1800 100 1700
22 Captopril 25 mg tab 1000 2000 3000 300 2700
31 Codein 10 mg tab 35 0 35 35 0
32 Dexametason tablet tablet 2800 2000 4800 1000 3800
34 DHP-Primal tablet 0 27 27 0 27
40 Diphenhidramin inj ampul 53 0 53 0 53
41 Garam Oralit (ED okt) sachet 198 0 198 198 0
42 Gentamisin injeksi ampul 55 0 55 0 55
49 Herbavomitz botol 19 0 19 19 0
50 Herbakof Sirup botol 0 0 0 0 0
53 Ibuprofen 200 mg tab 0 3000 3000 2000 1000
54 Ibuprofen 400 mg tab 0 0 0 0 0
56 Ketoconazol 200 mg tab 850 0 850 500 350
58 Lidokain injeksi 2 ml (56 ED okt) ampul 156 0 156 66 90
59 Loratadine 10 mg tab 5300 0 5300 1700 3600
61 Meloxicam 15 mg tablet Tab 0 0 0 0 0
62 Metformin Tab 0 0 0 0 0
66 Metylprednisolon 4 mg tab 4300 0 4300 2300 2000
67 Mineral mix bks 0 0 0 0 0
68 Metronidazole tablet tab 400 0 400 0 400
72 Natrium Klorida larutan infus 0,9% botol 94 0 94 10 84 .
79 Permetrin salep 5% tube 4 6 10 0 10
81 Prednisolone 4 mg tab 400 0 400 200 200
82 Primaquin Phospat tab 0 40 40 0 40
83 Ranitidin 150 mg tab 1200 0 1200 0 1200
85 Riboquin 150 mg tab 90 0 90 0 90
88 Salep 2-4 tube 0 0 0 0 0
90 Simvastatin 10 mg (ED Okt) tab 1300 0 1300 1300 0
92 Valsartan 160 mg (Ed Okt) tab 540 0 540 540 0
97 Vitamin B6 tab 1000 3000 4000 500 3500
100 Vitamin C 50 mg tab 1600 2000 3600 1100 2500
102 Vitamin K (Fitomenadion) injeksi ampul 120 0 120 0 120

2 Alat Suntik 3 cc Zontik set 490 0 490 77 413
9 Asguard flex non-woven 5 ml x 10 ml pcs 13 0 13 0 13
10 Aximed face masker (earloop) Box 0 0 0 0 0
12 Cletira spray botol 1 0 1 0 1
21 Jayamas Onemed Kassa Steril 16 x 16 cm ktk 0 0 0 0 0
22 Kasa Hidrofil Unicorn Non Steril 4 yard x 10 Roll 1 0 1 1 0
30 Pot Sputum pot 20 40 60 20 40
31 Povidon Iodine 300 ml botol 6 0 6 2 4
33 Rivanol 300 ml botol 2 0 2 0 2
34 Sanitizer/ Hand Scrub 500 ml medika Botol 1 0 1 1 0
35 Sanitizer/ Hand Scrub 500 ml fresko Botol 1 0 1 0 1
37 SMI Cat Gut Plain 3/0 DS 19 mm pcs 24 0 24 2 22 0
52 Under Pad pcs 18 0 18 0 18
53 Glove Non Steril Ukuran L pcs 400 0 400 100 300
54 Glove Non Steril Ukuran M pcs 0 0 0 0 0
55 Glove Non Steril Ukuran S pcs 0 0 0 0 0
56 Qilan Latex Eximination gloves S pcs 200 200 400 0 400

dr. Heri Al Hilal Irma Yulia Puteri, S.Farm Nelly Afni, SKM
NIP. 19781017 200604 1 003 NIP. 19800522 200312 2 006
Laporan Pemakaian, Bulan-Tahun : Oktober 2023
Laporan Permintaan, Bulan-Tahun : November 2023
N
PT
A
TA
N
O
A
PEMBERIAN
G
IN
K
N
C
A
M
O
ER
R
ST
PE
ET
K
10 11 12 13 14 15 16
OBAT
1000
300
1000
5000
200
100
5000
100
500
3000
5000
200
1000
500
100
50
3000
2000
1000
5000
1000
300
2000
10
500
100
300
200
2000
1000
96
200
1800
200
3000
5000
100
3000
1000
1000
48
3000
1000
500
5000
1000
100
3000
2000
10
3000
200
3000
50
40
48
2000
300
3000
1000
3000
2000
2000
500
20
EDIS HABIS PAKAI (BMHP)
20
100
20
1
40
10
5
2
2
2
24
20
400
200
Yang Menerima,
Petugas Puskesmas

(LPLPO)
Nama Puskesmas : JAMBUR LAK-LAK Laporan Pema
Kecamatan : KETAMBE Laporan Perm
Kabupaten 0
D AN
N
N
L
PT
A
IA
A
C
N
SE A
TA
IA
W
O
O
A
A
R M
NO JENIS OBAT
ST
A
TU
IN
K
K
PE ERI
C
A
K
M
SA
SA
O
M
O
R
ST
ST
PE
SI
PE
PE
1 2 3 4 5 6 7 8 9 10
OBAT
1 Acyclovir 400 mg tab 500 0 500 200 300 4000
2 Albendazol suspensi botol 3 0 3 0 3 200
4 Alprazolam 0.5 mg tab 0 0 0 0 0 300
5 Allupurinol tab tab 1600 1000 2600 200 2400 1000
8 Amlodipin 5 mg tab 2550 0 2550 450 2100 1500
16 Asam Folat 1 mg tab 800 0 800 0 800
21 Captopril 12,5 mg tab 1700 0 1700 0 1700 500
22 Captopril 25 mg tab 2700 0 2700 0 2700
25 Cefadroxil sirup kering 125 mg/5 ml botol 0 0 0 0 0 50
Clorpromazin tablet 0 0 0 0 0 300
31 Codein 10 mg tab 0 0 0 0 0 500
32 Dexametason tablet tablet 3800 0 3800 1370 2430 5000
38 Domperidon tab 10 mg tab 750 0 750 0 750 500
39 Dextrose monohidrat infus 5 % Infus botol 3 0 3 0 3 5
40 Diphenhidramin inj ampul 53 0 53 6 47 50
41 Garam Oralit sachet 0 100 100 0 100 200
47 Haloperidol 1,5 mg tab 0 0 0 0 0 500
51 Herbacold silfamin 150 mg tab 0 0 0 0 0 1800
53 Ibuprofen 200 mg tab 1000 4000 5000 1500 3500 2000
54 Ibuprofen 400 mg tab 0 2500 2500 1200 1300 2000
61 Meloxicam 15 mg tablet Tab 0 0 0 0 0 5000
62 Metformin Tab 0 0 0 0 0 1000
66 Metylprednisolon 4 mg tab 2000 600 2600 1000 1600 5000
69 Metrodinazole sirup botol 0 0 0 0 0 100
72 Natrium Klorida larutan infus 0,9% botol 84 0 84 6 78 . 40
76 Omeprazole tablet 3600 0 3600 510 3090 1000
83 Ranitidin 150 mg tab 1200 3300 4500 410 4090
85 Riboquin 150 mg tab 90 0 90 0 90
88 Salep 2-4 tube 0 0 0 0 0 200
90 Simvastatin 10 mg tab 0 0 0 0 0 2000
91 Simvastatin 20 mg tab 0 2000 2000 500 1500 1000
97 Vitamin B1 (Thiamin) tab 0 2000 2000 500 1500 1000
98 Vitamin B6 tab 3500 0 3500 100 3400 1000
101 Vitamin C 50 mg tab 2500 0 2500 2000 500 7000

2 Alat Suntik 3 cc Zontik set 413 0 413 108 305 200
6 Alat suntik sekali pakai 2,5 ml pcs 100 0 100 0 100 100
7 Alkohol 1 liter botol 5 5 10 1 9 3
9 Asguard flex non-woven 5 ml x 10 ml pcs 13 0 13 3 10 5
10 Aksamed face mask (earloop) Box 0 40 40 0 40
13 Cotton Swab Box 0 200 200 0 200
16 Hospitech Oxygen Nassal Canula Dewasa set 9 0 9 3 6 10
18 I.V Chateter 24G Nousmed Abocath pcs 75 0 75 5 70 50
20 Infusion Set Dewasa set 0 0 0 0 0 20
22 Jayamas Onemed Kassa Steril 16 x 16 cm ktk 0 0 0 0 0 100
23 Kasa Hidrofil Unicorn Non Steril 4 yard x 10 Roll 0 0 0 0 0 50
24 Kasa Hidrofil Unicorn Non Steril 40 x 80 cm Roll 2 0 2 0 2 1
29 Nausmed Intravenory Catheter no. 22 pcs 103 0 103 17 86 50
31 Pot Sputum pot 40 0 40 0 40 40
32 Povidon Iodine 300 ml botol 4 5 9 0 9 5
33 Oxiflow Bayi pcs 2 0 2 0 2 10
34 Rivanol 300 ml botol 2 0 2 0 2 5
35 Sanitizer/ Hand Scrub 500 ml medika Botol 0 0 0 0 0 2
36 Sanitizer/ Hand Scrub 500 ml fresko Botol 1 0 1 0 1 5
37 Sanitizer/ Hand Scrub 500 ml kast@med botol 5 0 5 2 3 2
38 Sanitizer/ Hand Scrub Lab Care botol 0 5 5 0 5
42 SMI Silk Black 3/0 HR 30 mm pcs 47 0 47 12 35 50
47 Stomatch tube (NGT) FR.16 pcs 0 0 0 0 0 20
54 Ultrasound Gel botol 0 5 5 0 5
55 Under Pad pcs 18 0 18 0 18 20
56 Glove Non Steril Ukuran L pcs 300 0 300 0 300 200
57 Glove Non Steril Ukuran M pcs 0 0 0 0 0 400
58 Glove Non Steril Ukuran S pcs 0 0 0 0 0 200

NIP. 19781017 200604 1 003 NIP. 19800522 200312 2 006
Laporan Pemakaian, Bulan-Tahun : November 2023
Laporan Permintaan, Bulan-Tahun : Desember 2023
N
A
TA
N
A
PEMBERIAN
G
IN
N
A
M
ER
R
PE
ET
K
11 12 13 14 15 16
OBAT
HABIS PAKAI (BMHP)
Yang Menerima,
Petugas Puskesmas

(LPLPO)
Kabupaten 0
D AN
N
N
L
PT
A
IA
A
C
N
SE A
TA
IA
W
O
O
A
A
R M
NO JENIS OBAT
ST
A
TU
IN
K
K
PE ERI
C
A
K
M
SA
SA
O
M
O
R
ST
ST
PE
SI
PE
PE
1 2 3 4 5 6 7 8 9 10
OBAT
1 Acyclovir 400 mg tab 300 0 300 200 100 4000
8 Amlodipin 5 mg tab 2100 1500 3600 1250 2350 500
16 Asam Folat 1 mg tab 800 0 800 0 800
21 Captopril 12,5 mg tab 1700 0 1700 200 1500 500
22 Captopril 25 mg tab 2700 0 2700 0 2700
Cotrimoxazol Tab 400 mg/80 mg tab 0 1000 1000 200 800 1000
Clorpromazin tablet 0 0 0 0 0 300
31 Codein 10 mg tab 0 0 0 0 0 500
39 Dextrose monohidrat infus 5 % Infus (ED) botol 3 0 3 3 0
53 Ibuprofen 200 mg tab 3500 2000 5500 1300 4200 1000
54 Ibuprofen 400 mg tab 1300 0 1300 1000 300 2000
62 Metformin Tab 0 0 0 0 0 1000
83 Ranitidin 150 mg tab 4090 0 4090 290 3800
85 Riboquin 150 mg tab 90 0 90 0 90
88 Salep 2-4 tube 0 0 0 0 0 200
98 Vitamin B6 tab 3400 0 3400 100 3300 1000
101 Vitamin C 50 mg tab 500 6000 6500 1800 4700 7000

2 Alat Suntik 3 cc Zontik set 305 300 605 88 517 200
6 Alat suntik sekali pakai 2,5 ml pcs 100 100 200 2 198 100
7 Alkohol 1 liter botol 9 3 12 0 12 3
13 Cotton Swab Box 200 0 200 0 200
18 I.V Chateter 24G Nousmed Abocath pcs 70 0 70 10 60 50
24 Kasa Hidrofil Unicorn Non Steril 40 x 80 cm Roll 2 0 2 0 2 1
29 Nausmed Intravenory Catheter no. 22 pcs 86 0 86 23 63 50
31 Pot Sputum pot 80 40 120 40 80 40
32 Povidon Iodine 300 ml botol 9 5 14 1 13 5
35 Sanitizer/ Hand Scrub 500 ml medika Botol 0 0 0 0 0 2
37 Sanitizer/ Hand Scrub 500 ml kast@med botol 3 0 3 1 2 2
55 Under Pad pcs 18 10 28 1 27 20
56 Glove Non Steril Ukuran L pcs 300 0 300 200 100 200
57 Qilan Latex Glove Non Steril Ukuran M pcs 0 0 0 0 0 400

NIP. 19781017 200604 1 003 NIP. 19800522 200312 2 006
Laporan Pemakaian, Bulan-Tahun : Desember 2023
Laporan Permintaan, Bulan-Tahun : Januari 2024
N
A
TA
N
A
PEMBERIAN
G
IN
N
A
M
ER
R
PE
ET
K
11 12 13 14 15 16
OBAT
HABIS PAKAI (BMHP)
ED
Yang Menerima,
Petugas Puskesmas

(LPLPO)
Kabupaten 0
D AN
N
N
L
PT
A
IA
A
C
N
SE A
TA
IA
W
O
O
A
A
R M
NO JENIS OBAT
ST
A
TU
IN
K
K
PE ERI
C
A
K
M
SA
SA
O
M
O
R
ST
ST
PE
SI
PE
PE
1 2 3 4 5 6 7 8 9 10
OBAT
1 Acyclovir 400 mg tab 100 0 100 0 100 1000
8 Amlodipin 5 mg tab 2350 250 2600 500 2100 500
16 Asam Folat 1 mg tab 800 0 800 0 800
18 Aqua pro injeksi vial 7 0 7 1 6
21 Captopril 12,5 mg tab 1500 0 1500 0 1500
22 Captopril 25 mg tab 2700 0 2700 130 2570
31 Clorpromazin tablet 0 0 0 0 0 300
33 Codein 10 mg tab 0 0 0 0 0 500
41 Dextrose monohidrat infus 5 % Infus (ED) botol 0 0 0 0
53 Ibuprofen 200 mg tab 4200 1000 5200 2500 2700 1000
54 Ibuprofen 400 mg tab 300 600 900 0 900 2000
62 Metformin Tab 0 0 0 0 0 1000
83 Ranitidin 150 mg tab 3800 0 3800 500 3300
85 Riboquin 150 mg tab 90 0 90 0 90
88 Salep 2-4 tube 0 0 0 0 0 200
98 Vitamin B6 tab 3300 0 3300 200 3100 1000
101 Vitamin C 50 mg tab 4700 6000 10700 2200 8500

Aksamed Axamination glove L Box 0 2 2 0 2
13 Cotton Swab Box 200 0 200 0 200
15 Hospitech Oxygen Nassal Canula Anak set 2 0 2 0 2 5
17 I.V Chateter 22 G Hospitecch abocath pcs 0 0 0 0 0 10
31 Pot Sputum pot 80 40 120 0 120
35 Sanitizer/ Hand Scrub Glorheksidin 500 ml Botol 0 0 1 0 1 2
39 SMI Cat Gut Cromic 3/0 pcs 15 0 15 2 13 50
55 Under Pad pcs 27 20 47 0 47
56 Unicorn Glove Non Steril Ukuran L pcs 100 0 100 100 0
57 Qilan Latex Non Steril Ukuran M pcs 0 400 400 100 300

NIP. 19781017 200604 1 003 NIP. 19800522 200312 2 006
Laporan Pemakaian, Bulan-Tahun : Januari 2024
Laporan Permintaan, Bulan-Tahun : Februari 2024
N
A
TA
N
A
PEMBERIAN
G
IN
N
A
M
ER
R
PE
ET
K
11 12 13 14 15 16
OBAT
ED jan 24
HABIS PAKAI (BMHP)
Yang Menerima,
Petugas Puskesmas

(LPLPO)
Kabupaten 0
D AN
N
N
L
PT
A
IA
A
C
N
SE A
TA
IA
W
O
O
A
A
R M
NO JENIS OBAT
ST
A
TU
IN
K
K
PE ERI
C
A
K
M
SA
SA
O
M
O
R
ST
ST
PE
SI
PE
PE
1 2 3 4 5 6 7 8 9 10
OBAT
1 Acyclovir 400 mg tab 100 0 100 0 100 1000
8 Amlodipin 5 mg tab 2100 500 2600 500 2100 500
16 Asam Folat 1 mg tab 800 0 800 400 400
21 Captopril 12,5 mg tab 1500 0 1500 1500 0
22 Captopril 25 mg tab 2570 0 2570 200 2370
33 Codein 10 mg tab 0 0 0 0 0 500
53 Ibuprofen 200 mg tab 2700 1000 3700 1800 1900 1000
54 Ibuprofen 400 mg tab 900 0 900 100 800 2000
62 Metformin Tab 0 0 0 0 0 1000
83 Ranitidin 150 mg tab 3300 3000 6300 2400 3900
85 Riboquin 150 mg tab 90 0 90 0 90
88 Salep 2-4 tube 0 0 0 0 0 200
98 Vitamin B6 tab 3100 0 3100 0 3100 1000
101 Vitamin C 50 mg tab 8500 0 8500 2100 6400

Aximed Axamination glove L Box 2 0 2 0 2
14 Aximed Axamination glove M Box 12 0 12 1 11
13 Cotton Swab Box 200 0 200 0 200
31 Pot Sputum pot 120 0 120 0 120
55 Under Pad pcs 47 0 47 3 44

NIP. 19781017 200604 1 003 NIP. 19800522 200312 2 006
Laporan Pemakaian, Bulan-Tahun : Februari 2024
Laporan Permintaan, Bulan-Tahun : Maret 2024
N
A
TA
N
A
PEMBERIAN
G
IN
N
A
M
ER
R
PE
ET
K
11 12 13 14 15 16
OBAT
HABIS PAKAI (BMHP)
Yang Menerima,
Petugas Puskesmas

(LPLPO)
Kabupaten 0
D AN
N
N
L
PT
A
IA
A
C
N
SE A
TA
IA
W
O
O
A
A
R M
NO JENIS OBAT
ST
A
TU
IN
K
K
PE ERI
C
A
K
M
SA
SA
O
M
O
R
ST
ST
PE
SI
PE
PE
1 2 3 4 5 6 7 8 9 10
OBAT
1 Acyclovir 400 mg tab 100 0 100 0 100 1000
8 Amlodipin 5 mg tab 2100 500 2600 1000 1600 500
16 Asam Folat 1 mg tab 400 0 400 400 0
22 Captopril 25 mg tab 2370 0 2370 2370 0
32 Ciprofloxacin 500 mg tab 0 0 0 800 -800 3000
33 Codein 10 mg tab 0 0 0 0 0 500
53 Ibuprofen 200 mg tab 1900 500 2400 1200 1200 1000
54 Ibuprofen 400 mg tab 800 0 800 800 0 2000
62 Metformin Tab 0 0 0 0 0 1000
67 Mineral mix bks 0 320 320 0 320
83 Ranitidin 150 mg tab 3900 0 3900 2200 1700
85 Riboquin 150 mg tab 90 0 90 0 90
88 Salep 2-4 tube 0 0 0 0 0 200
98 Vitamin B6 tab 3100 0 3100 200 2900 1000
101 Vitamin C 50 mg tab 6400 0 6400 2400 4000

Aximed Axamination glove L Box 2 0 2 1 1
13 Cotton Swab Box 200 0 200 0 200
27 Masker Forsh Medcal N95 Box 0 0 0 2 -2
31 Pot Sputum pot 120 0 120 0 120
55 Under Pad pcs 44 0 44 0 44

NIP. 19781017 200604 1 003 NIP. 19800522 200312 2 006
Laporan Pemakaian, Bulan-Tahun : Maret 2024
Laporan Permintaan, Bulan-Tahun : April 2024
N
A
TA
N
A
PEMBERIAN
G
IN
N
A
M
ER
R
PE
ET
K
11 12 13 14 15 16
OBAT
ED
ED MAR
ED MAR
HABIS PAKAI (BMHP)
ED
Yang Menerima,
Petugas Puskesmas

(LPLPO)
Nama Puskesmas : JAMBUR LAK-LAK Laporan Pemakaian, Bulan-
Kecamatan : KETAMBE Laporan Permintaan, Bulan-
Kabupaten 0
D AN
N
N
N
L
PT
A
A
IA
A
C
N
SE A
TA
IA
W
O
O
A
A
R M
NO JENIS OBAT
ST
A
TU
IN
K
K
PE ERI
C
A
K
M
SA
SA
O
M
O
R
ST
ST
PE
SI
PE
PE
APBN
1 2 3 4 5 6 7 8 9 10 11
OBAT
1 Acyclovir 400 mg tab 100 0 100 0 100 1000
8 Amlodipin 5 mg tab 1600 1500 3100 650 2450 500
16 Asam Folat 1 mg tab 0 0 0 0 0 500
21 Captopril 12,5 mg tab 0 0 0 0 0 1000
22 Captopril 25 mg tab 0 0 0 0 0 500
23 Carbamazepine 200 mg tab 0 0 0 0 0 500
33 Codein 10 mg tab 0 0 0 0 0 500
48 Haloperidol 5 mg tab 288 0 288 120 168 500
53 Ibuprofen 200 mg tab 1200 2000 3200 1700 1500 3000
54 Ibuprofen 400 mg tab 0 0 0 0 0 2000
55 Ibuprofen suspensi 200 mg/5 ml botol 335 0 335 335 0 ED Aprl
62 Metformin Tab 0 0 0 0 0 1000
67 Mineral mix bks 320 0 320 0 320
76 Omeprazole tablet 300 0 300 300 0 1000
83 Ranitidin 150 mg tab 1700 0 1700 1500 200 2000
85 Riboquin 150 mg tab 90 0 90 0 90
88 Salep 2-4 tube 0 0 0 0 0 200
98 Vitamin B6 tab 2900 0 2900 0 2900 1000
101 Vitamin C 50 mg tab 4000 1000 5000 2200 2800
11 Aximed Axamination glove L Box 1 0 1 0 1
15 Cotton Swab Box 200 0 200 0 200
16 Chlorine desinfektan botol 0 1 1 0 1
25 Kapas 100 gram bks 0 12 12 0 12
26 Kasa Lipat bks 0 30 30 0 30 3
29 Masker Duckbil @ 20 pcs Box 0 50 50 0 50
34 Pot Sputum pot 120 0 120 0 120
54 Umbilical Cord Clamp (Hospitech) pcs 0 0 0 0 0 ED
56 Under Pad pcs 44 0 44 0 44

NIP. 19781017 200604 1 003 NIP. 19800522 200312 2 006
Laporan Pemakaian, Bulan-Tahun : April 2024
Laporan Permintaan, Bulan-Tahun : Mei 2024
N
A
PEMBERIAN
G
N
A
ER
ET
K
APBD DAK LAIN2 JLH
12 13 14 15 16
OBAT
DIS HABIS PAKAI (BMHP)
Yang Menerima,
Petugas Puskesmas

(LPLPO)
Kecamatan : KETAMBE
Puskesmas Pembantu yang ada :4 Yang Lapor
: 2:
N
N
N
L
PT
A
A
A
IA
A
C
N
TA
IA
W
O
O
A
A
IM
NO JENIS OBAT
ST
D
A
TU
IN
K
K
SE
ER
C
A
K
M
SA
SA
O
M
O
R
N
R
ST
ST
PE
PE
SI
PE
PE
1 2 3 4 5 6 7 8 9
OBAT
1 Acyclovir 200 mg tab 0 0 0 0 0
2 Acyclovir 400 mg tab 0 0 0 0 0
3 Acyclovir 400 mg (DAK 2019) tab 800 0 800 0 800
5 Albendazol 400 mg (DAK 2018) tab 0 0 0 0 0
6 Albendazol 400 mg (DAK 2019) set 500 0 500 100 400
7 Alkapharma Alkacide 1L (DAK 2019) botol 0 0 0 0 0
8 Alkapharma Alkazyme sachet 25 mg sachet 0 0 0 0 0
9 Allopurinol 100 mg tab 1200 0 1200 0 1200
11 Ambroxol sirup botol 0 0 0 0 0
12 Aminophylin 200 mg tab 0 0 0 0 0
14 Amlodipin 10 mg (DAK 2019) kap 0 0 0 0 0
16 Amlodipin 5 mg tab 0 150 150 150 0
17 Amoxycilin kaplet 500 mg (DAK 2017) kap 400 1000 1400 1000 400
22 Azytromicyin 500 mg tube 20 0 20 0 20
23 Antiseptic Surgical Handscrub 500 ml (e-Care) botol 4 0 4 0 4
24 Aqua pro injeksi 25 ml (DAK 2019) botol 0 0 0 0 0
25 Artesunate injeksi 60 mg vial 0 0 0 0 0
26 Arthemeter injeksi 1 ml/80 mg (6 ampul/ktk) ampul 0 0 0 0 0
27 Asam Folat 1 mg tab 0 0 0 0 0
28 Asam mefenamat kaplet 500 mg (2019) kap 11250 0 11250 100 11150
29 Bacbutol 500 mg (2014) tab 0 0 0 0 0
30 Bacbutol 500 mg (2015) tab 0 0 0 0 0
31 Besi (II) sulfat (APBA) tab 0 0 0 0 0
33 Besi(II)sulfat (T. Tambah Darah) (DAK 2018) tab 0 0 0 0 0
35 chlorocuin 150 mg tab 0 0 0 0 0
37 Captopril 25 mg tab 1800 0 1800 0 1800
42 Cefotaxime serbuk injeksi 1000 mg vial 0 0 0 0 0
44 Chloramfenicol 250 mg tab 0 0 0 0 0
45 Chloramfenicol salap kulit 2% (Bufacetin) tube 0 0 0 0 0
46 Chloramfenicol salap mata 1% tube 0 0 0 0 0
47 Chloramphenicol suspensi 125 mg/5 mg botol 0 0 0 0 0
48 Chlorfeniramin maleat (CTM) 4 mg (DAK 2018) tablet 7600 3000 10600 3000 7600
50 Chlorpromazin 100 mg tab 0 0 0 0 0
51 Clindamycin 150 mg tab 0 0 0 0 0
52 Codein 10 mg tab 177 0 177 0 177
54 Deksametason 0,5 mg injeksi 13 0 13 3 10
55 DHP-Frimal (Anti Malaria) (9 tab/ktk) tab 0 0 0 0 0
56 Difenhidramin injeksi i.v/i.m 10 mg/ml ampul 0 0 0 0 0
58 Eritromisin 500 mg kaplet 0 0 0 0 0
59 Eritromisin 250 mg kaplet 0 0 0 0 0
60 Eugenol cairan botol 0 0 0 0 0
70 Ibuprofen 200 mg tab 5600 0 5600 100 5500
71 Ibuprofen 400 mg tab 3500 0 3500 0 3500
73 Isoniazid tab 0 0 0 0 0
74 Jayamas Onemed Alkohol 70% 1 Liter botol 5 0 5 0 5
75 Jayamas Onemed Aseptic Gel 500cc botol 0 0 0 0 0
76 Jayamas Onemed Povidone Iodine 30cc botol 0 0 0 0 0
77 Jayamas Onemed Rivanol 300cc botol 0 0 0 0 0
78 Jayamas Onemed USG Gel 250 ml botol 0 0 0 0 0
79 Ketoconazol salep botol 0 0 0 0 0
80 Kuinin Dihidroklorida 25%/2ml, (D-Artepp) ampul 0 0 0 0 0
83 Magnesium Sulfat (MgSO4) 40% (DAK 2019) botol 0 0 0 0 0
84 Magnesium Sulfat (MgSO4) 40% injeksi vial 0 0 0 0 0
85 Metocloperamid Hcl tab 2800 1000 3800 100 3700
87 MDT (Multy Drug Therapy) PB dewasa tab 0 0 0 0 0
88 mineral mix bks 468 0 468 0 468
90 Meconazole tube 0 0 0 0 0
91 ondan sentron hcl dehytrate 8 mg tab 0 0 0 0 0
92 Natrium Diklofenak 25 mg (DAK 2019) tab 2450 0 2450 1500 950
93 Natrium Klorida larutan infus 0,9% (DAK 2019) botol 38 20 58 12 46
94 Nistatin Vaginal 100.000 iu/g tab 0 0 0 0 0
95 Obat Anti Tuberculosis FDC Kategori I (kombi) tab 0 0 0 0 0
96 Obat Anti Tuberculosis FDC Kategori Anak Paket 0 0 0 0 0
98 Obat Anti Tuberculosis FDC Kategori II Paket 0 0 0 0 0
100 Omeprazol 20 mg kaps 0 0 0 0 0
102 Parasetamol tablet 500 mg (APBA) tab 8400 3000 11400 2000 9400
103 Pehacain injeksi amp 0 0 0 0 0
104 Phenobarbital injeksi amp 0 0 0 0 0
106 Pharmaplast S.A.E Egipt Pharmafix 10 x 500 flim roll roll 0 0 0 0 0
107 Pirantel Pamoat 125 mg tab 0 0 0 0 0
108 Povidon Iodine 500 ml (Videne Ecolab 2017) botol 0 0 0 0 0
109 Prednison 5 mg tab 0 300 300 300 0
110 Primakuin 15 mg tab 0 0 0 0 0
111 Primpen (Metoclopramide) sirup 5 mg/5 ml botol 0 0 0 0 0
112 Ranitidin 150 mg tab 0 0 0 0 0
114 Ketoconazol salep tube 0 0 0 0 0
115 Ringer Laktak larutan infus 500 ml (APBA) botol 0 0 0 0 0
116 Ringer Laktak larutan infus 500 ml (DAK 2018) botol 0 0 0 0 0
117 Ringer Laktak larutan infus 500 ml (DAK 2019) botol 49 20 69 14 55
119 Salap 2-4 (APBA) pot 0 0 0 0 0
121 salap whitefild tube 0 0 0 0 0
122 Serum Anti Bisa Ular (A.B.U) cairan inj vial 0 0 0 0 0
124 Sivit Zink kap 30 0 30 0 30
129 Vitamin A (Retinol) 100.000 iu (APBA) kaps 0 0 0 0 0
130 Vitamin A (Retinol) 100.000 iu (DAK 2017) kaps 0 0 0 0 0
131 Vitamin A (Retinol) 200.000 iu (APBA) kaps 100 0 100 0 100
135 Vitamin B12 (Sianokobalamin) injeksi (APBA) ampul 0 0 0 0 0
136 Vitamin B6 (Piridoksin) 10 mg tab 0 0 0 0 0
137 Vitamin C 50mg (DAK 2018) tab 0 0 0 0 0
138 Vitamin C 500mg tab 100 0 100 100 0
139 Clozapin tab 0 0 0 0 0
140 Zink Pro Botol 0 0 0 0 0
141 Vitamin K (Phytomenadion) injeksi ampul 0 0 0 0 0
142 Zinc SIRUP botol 250 0 250 5 245
144 Kalsium Laktas Tab 0 0 0 0 0
145 Metformin Tab 1400 1000 2400 2400 0
147 Pirantel Pamoat 125 mg tablet 0 0 0 0 0
148 oxytetracycline tube 0 0 0 0 0
149 Domperidon syr tablet 0 0 0 0 0
150 Diazepam injeksi tab 0 0 0 0 0
152 diazepam 5 mg tablet 80 0 80 30 50
153 loratadine 10 mg tablet 0 0 0 0 0
154 Riboquin 150 mg tube 100 0 100 0 100
155 chloroquin 150 mg tab 0 0 0 0 0
156 oseltamivir phosphate 75mg tab 10 0 10 0 10
157 Rethaphyl tab 0 0 0 0 0
158 ofloxacin 400 mg tab 600 0 600 0 600
159 Verapamil hcl tab 100 0 100 0 100
160 omeprazol sodium inj ampul 0 0 0 0 0
161 Acetyl sesitein tab 360 120 480 120 360
162 Bionicom tab 900 300 1200 0 1200
163 Herbapain tab 570 120 690 30 660
164 bisacodyl tab 30 0 60 30 30

1 Alat suntik sekali pakai 1 ml (Cosmomed 2016) set 174 0 174 0 174
2 Alat Suntik 2,5 cc (DAK 2018) set 60 0 60 60 0
3 Alat Suntik 3 cc (Kimsmed, APBA) set 200 100 300 100 200
4 Alat Suntik 3 cc (DAK 2018) set 100 0 100 12 88
5 Alat suntik sekali pakai 10 ml (2016) set 89 0 89 0 89
6 Alat suntik sekali pakai 5 ml (Cosmomed 2016) set 81 100 181 0 181
7 Alat suntik sekali pakai 50 ml (Stera 2014) set 0 0 0 0 0
pcs 0
9 CatGut/Benang Bedah 3/0 dng jarum bedah (2014) 0 0 0 0
10 Cosmomed Folley Chateter no.20 pcs 0 0 0 0 0
11 Cosmomed Suction Chateter no. 8 pcs 0 0 0 0 0
12 ETT with cuf size 3,0 (Aximed) pcs 0 0 0 0 0
17 I.V Chateter 18G (Smiths Medical Jelco 2017) pcs 0 0 0 0 0
18 I.V Chateter 20G (Smiths Medical Jelco 2017) pcs 0 0 0 0 0
20 I.V Chateter 24G Hospitech abocath pcs 44 0 44 5 39
21 I.V Chateter 26G Hospitech abocath pcs 19 0 19 0 19
22 Idealcare Folley Chateter no. 18 pcs 0 0 0 0 0
26 Infusion Set Anak set 0 0 0 0 0
Intravenous Adminset with Airvent & Y connection
with protective shield 21 G x 3,75 mm (Idealcare pcs 0
28 2017) 0 0 0 0
29 handscone protos lembar 0 0 0 0 0
30 Jayamas Onemed Infus Set Anak set 0 0 0 0 0
31 Jayamas Onemed Kapas pembalut 1000 gram roll 2 0 2 0 2
32 Jayamas Onemed Kassa Hydrophil 3 yard x 15cm roll 0 0 0 0 0
33 Jayamas Onemed Kassa Hydrophil 4m x 5cm roll 0 0 0 0 0
34 Jayamas Onemed Kassa Steril 16 x 16cm ktk 41 0 41 21 20
35 kasa kompres DRC 40 X 40 roll 230 0 230 0 230
36 Jayamas Onemed Plesterin 15cm x 5m roll 0 0 0 0 0
37 Jayamas Surgical Mask 3-ply earloop lembar 0 0 0 0 0
38 Jayamas Surgical Mask tie on lembar 0 0 0 0 0
39 Masker Jenis Karet (APBA) Box 0 0 0 0 0
40 masker jenis tali BNPB Box 0 0 0 0 0
41 aximed face masker (earloop) lbr 1500 2000 3500 800 2700
42 Nousmed face masker lbr 0 0 0 0 0
43 Mediaplus Win Flon Abocat 18G pcs 0 0 0 0 0
Onemed Cat Gut Chromic 2/0 + Jarum 1/2 GT pcs 0 0 0
47 (2016) 0 0
pcs 0
48 Onemed Cat Gut Chromic 2/0 + Jarum Bedah (2015) 0 0 0 0
pcs 0
49 Onemed Cat Gut Chromic 3/0 + Jarum 1/2 GT (2016) 0 0 0 0
pcs 0
50 Onemed Cat Gut Chromic 3/0 + Jarum Bedah (2015) 0 0 0 0
51 Onemed Foley Catheter no. 20 (2015) pcs 0 0 0 0 0
54 Plaster leukoplas roll 0 0 0 0 0
55 Pot Sputum pot 0 20 20 0 20
56 Serenity Cat Gut 3/0 (APBA) set 0 0 0 0 0
57 Serenity Infus Set Anak (APBA) set 0 0 0 0 0
58 Silk 2/0 + Jarum 1/2 GT 35 mm (DAK 2014) pcs 0 0 0 0 0
59 Silk no. 2/0 + 1/2 GT 35 ml pcs 0 0 0 0 0
60 Slide (Kaca Lab) pcs 0 0 0 0 0
61 SMI Cat Gut Chromic 0 100 mm pcs 0 0 0 0 0
62 SMI Cat Gut Chromic 2/0 DS 19 mm pcs 0 0 0 0 0
63 SMI Cat Gut Chromic 2/0 HR 40 mm pcs 0 0 0 0 0
66 SMI Cat Gut Plain 2-0 100 mm pcs 0 0 0 0 0
71 SMI Silk 1 100 mm pcs 0 0 0 0 0
72 SMI Silk Black 0 DS 24 mm pcs 0 0 0 0 0
77 Surgical Glove Steril 6,5(Cosmomed 2017) pair 0 0 0 0 0
78 Surgical Glove Steril 6 (Cosmomed 2017) pair 0 0 0 0 0
79 Surgical Glove Steril 7,5 ( 2017 Aximed) pcs 0 0 0 0 0
80 Zink oxide adhesive plaster (1,25 cmx4,5cm) pair 0 0 0 0 0
81 TROGE Abocat 18G (DAK 2019) pcs 0 0 0 0 0
85 Troveno handscone no. 6 pcs 0 0 0 0 0
86 TROGE Glove Steril No.7,5 (DAK 2019) pair 0 0 0 0 0
87 TROGE Glove Steril No.8 (DAK 2019) pair 0 0 0 0 0
88 TROGE Urin Bag (DAK 2019) set 0 0 0 0 0
90 Umbilical Cord Clamp Steril Nylon (Jayamas) pcs 0 0 0 0 0
93 UTAMA (2019) Kapas Berlemak 500 gr pack 0 0 0 0 0
94 UTAMA (2019) Kassa Hydrophil 40yd x 80cm roll 0 0 0 0 0
95 UTAMA (2019) Kassa Hydrophil 4m x 10cm roll 0 0 0 0 0
96 UTAMA (2019) Kassa Hydrophil 4m x 5cm roll 0 0 0 0 0
97 UTAMA (2019) Kassa Steril 16 x 16cm kotak 26 0 26 0 26
98 Win Glove Non Steril Ukuran L pcs 0 0 0 0 0
99 Win Glove Non Steril Ukuran M pcs 0 0 0 0 0
100 Win Glove Non Steril Ukuran S pcs 0 0 0 0 0
101 CHLORTULLE LBR 0 0 0 0 0
102 H2O2 Botol 2 0 2 0 2
104 3 way stop lock pcs 42 0 42 0 42
105 Oxiflow Anak pcs 0 0 0 0 0
106 Under pad pcs 4 0 4 0 4
107 stomatch tube (NGT) FR.14 pcs 4 0 4 0 4
108 stomatch tube (NGT) FR.16 pcs 4 0 4 0 4
109 Zink oxide adhesive plaster (1,25 cmx4,5cm) pcs 0 0 0 0 0
110 asguard clear film 5 cm x 10 ml roll 1 0 1 0 1
111 asguard flex non-woven 5 ml x 10 ml roll 9 0 9 1 8
112

( H. Zainuddin, SKM, M.Kes) (Irma Yulia Puteri, S.Farm) Nelly Afni, SKM
NIP. 19640304 198703 1 008 NIP. 19800522 200312 2 006
AN OBAT
Laporan Pemakaian, Bulan-Tahun : April 2022

Laporan Permintaan, Bulan-Tahun : Mei 2022
N
PT
A
TA
N
O
A
PEMBERIAN
G
IN
K
N
C
A
M
O
ER
R
ST
PE
ET
K
10 11 12 13 14 15 16
0
0
0
0
0
0
0
0
0
300
0
0
0
0
0
0
0
100
0
0
200
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
100
60
0
0
0
0
0
0
0
0
0
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
0
0
0
0
3
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
0
0
0
20
0
0
0
0
20
0
0
0
0
0
5000
0
0
0
0
0
2000
0
0
0
0
2000
0
2000
0
0
0
0
0
500 exp.date
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
BMHP)
0
100
200
0
0
100
0
0
0
0
0
0
0
0
0
0
0
50
50
50
50
0
0
0
0
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
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

mpinan Puskesmas Petugas Puskesmas
RAMADIANI, Amd. Far

19800522 200312 2 006 NIP. 199005250325 2014 03 2 001

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D AN

BAHAN MEDIS HABIS PAKAI (BMHP

Mengetahui / menyetujui Yang Menyerahkan, Yang Memint

Laporan Pemakaian, Bulan-Tahun : Juli 2023

S HABIS PAKAI (BMHP)

Yang Meminta, Yang Menerima,

BAHAN MEDIS HABIS PAKAI (BMHP)

Mengetahui / menyetujui Yang Menyerahkan, Yang Meminta,

EDIS HABIS PAKAI (BMHP)

apt. Kamilaini, S.Farm

BAHAN MEDIS HABIS PAKAI (BM

Drs. Jamanuddin, M.Ap Irma Yulia Puteri, S.Farm

Laporan Pemakaian, Bulan-Tahun : September 2023

HAN MEDIS HABIS PAKAI (BMHP)

Nelly Afni, SKM apt. Kamilaini, S.Farm

BAHAN MEDIS HABIS PAKAI (BMHP)

Mengetahui / menyetujui Yang Menyerahkan, Yang Meminta,

EDIS HABIS PAKAI (BMHP)

apt. Kamilaini, S.Farm

BAHAN MEDIS HABIS PAKAI (BMHP)

Mengetahui / menyetujui Yang Menyerahkan, Yang Meminta,

apt. Kamilaini, S.Farm

BAHAN MEDIS HABIS PAKAI (BMHP)

Mengetahui / menyetujui Yang Menyerahkan, Yang Meminta,

apt. Kamilaini, S.Farm

BAHAN MEDIS HABIS PAKAI (BMHP)

Mengetahui / menyetujui Yang Menyerahkan, Yang Meminta,

apt. Kamilaini, S.Farm

BAHAN MEDIS HABIS PAKAI (BMHP)

Mengetahui / menyetujui Yang Menyerahkan, Yang Meminta,

apt. Kamilaini, S.Farm

BAHAN MEDIS HABIS PAKAI (BMHP)

Mengetahui / menyetujui Yang Menyerahkan, Yang Meminta,

HABIS PAKAI (BMHP)

apt. Kamilaini, S.Farm

Mengetahui / menyetujui Yang Menyerahkan, Yang Meminta,

apt. Kamilaini, S.Farm

BAHAN MEDIS HABIS PAKAI (BMHP)

Mengetahui / menyetujui Yang Menyerahkan, Yang Meminta,

Laporan Pemakaian, Bulan-Tahun : April 2022

Yang Meminta, Yang Menerima,

RAMADIANI, Amd. Far

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